Southern Medical and Surgical Journal, 1853

SOUTHERN

'*

MEDICAL AND SURGICAL JOURNAL.

EDITED BY

L. A. DUGAS, M. D.,

PROFESSOR OF SURGERY IN THE MEDICAL COLLEGE OF GEORGIA.

Medical College of Georgia.

Jc prends Ic bien ou jc k trouve."

VOL. IX. 1853. NEW SERIES.

AUGUSTA. GA.

JAMES McCAPFERTY, PRINTER AND PUBLISHER.
1853.

SOUTHERN '

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. JANUARY, 1851.- [No. 1.

PART FIRST.

(Original Communications.

ARTICLE I.

On Anaesthetic Agents. By Charles T. Jacksox, M. D.,
Chevalier de la Legion d'Honneur, late Geologist and Chem-
ist to the States of Maine, New Hampshire, Rhode Island,
and the United States; Assayer to the State of Massachu-
setts, &c, &c.

BOSTON, October 23d, 1852.
Prof. L. A. Dugas :

My Dear Sir I comply most cheerfully with your request,
that I should prepare a short account of the use of Anaesthetic
Agents in Surgery and Midwifery for publication in your
valuable medical journal. I have for some time had it in con-
templation to prepare for the press a volume, containing all the
information that I possess on the subject, with a digest of the
numerous works that have been published upon it by distin-
guished scientific and medical gentlemen of Europe, but my
professional and official duties have occupied my time so com-
pletely as to have prevented my accomplishing this task; and
I should desire to visit Europe, in order to collect all the best
observations, before publishing a work of so important a char-
acter. I have decided, however, to begin here, and to work up
such materials as are in my hands ; after which, I hope to have
the pleasure of consulting with my generous friends in Europe,
and to collect all the scattered information of a practical char-

v. s. VOL. ix. no. i. 1

6 Jackson, on Ancesthetic Agents. [January,

acter that may b.e needed to complete a work worthy of the
subject, and sufficient to meet the wants of the medical world.
This, the public may expect from my hands.

I have now before me a number of books and pamphlets, on
the use of anaesthetic agents, which have emanated from the
presses of Europe twenty-one of them are in the German
language, one in Latin, three in French, and one in Italian,
while only two or three pamphlets have been published in
England, on Chloroform, and only one regular work on the use
of Ether and Chloroform in Child-birth, and a pamphlet on
Ether, have, thus far, appeared in America. Unfortunately,
the public mind has been more occupied with the disputes
which have taken place here as to the origin of the discovery,
than with the rational investigation of the principles and prac-
tice of Etherization. This, I trust, will cease to agitate us
much longer ; for the question of discovery has been passed
upon by the highest of scientific tribunals the Institute of
France and it is no longer open for discussion, excepting so
far as concerns the appropriation of some reward for the dis-
covery by the Congress of the United States, and even that
I have not sought, prefering that the act should emanate spon-
taneously from the councils of the nation. France and Sweden
have already shewn, by liberal acts, their approbation of this
discovery, and it is to be hoped that our'own country will not
long delay that justice which is expected from her hands.

Leaving this question, permit me now to enter upon the sub-
ject of the practical administration of anaesthetic agents; and
let us enquire, first, what are the means that have been pro-
posed and employed for the production of anaesthesia?

Mesmeric influence, whatever may be its nature, has cer-
tainly acted as a sedative to nervous sensibility, and to such an
extent as to prevent the perception of pain during severe surgi-
cal operations. Of this fact, we have ample evidence on record
in this country, in Europe, and in Asia ; and though I have
not myself seen any successful case in the practice of Boston
surgeons, and am not aware of any having occurred in our
hospital, I am satisfied, from the evidence of those whose state-
ments may be fully relied upon, that anaesthesia has been really

1853.] Jackson, on Ancesthetic Agents.

superinduced in surgical patients by operations of a mes-
meric character. I may be allowed to allude to the striking
and well attested cases, published in this journal, by Dr. L. A.
Dugasjin 1845, pp. 122 and 508, and in 1846, p. 72.

The objection which surgeons make to any reliance on this
mysterious nervous agency is, that there are very few persons
who are capable of being put into a mesmeric state, even when
not alarmed by the terror of a severe surgical operation, and
that even facile subjects may be so agitated as to prevent any
effectual influence being exerted upon them therefore, this
power, whatever it may be, is not generally available.

If we look back, to learn what other means have been proposed
to render persons insensible to pain, we find that Humphry
Davy, in the year 1800, published a work entitled, " Researches,
Chemical and Philosophical, chiefly concerning Nitrous Oxide,
or Dephlogistigated Nitrous Air and its Respiration. By Hum-
phry Davy, superintendant of the Medical Pneumatic Institu-
tion. London/' In this work, Davy gives an account of his
experiments on the effects of inhalation of protoxide of nitrogen,
and in one of his experiments, he says, while suffering from the
pain attendant upon the cutting of a wisdom tooth, " on the day
when the inflammation was most troublesome, I breathed three
large doses of nitrous oxide. The pain always diminished after
the first four or five inspirations ; the thrilling came on, as usual,
and uneasiness wras for a few moments swallowed up in pleas-
ure. As the former state of the mind returned, the state of the
organ returned with it ; and I once imagined that the pain was
more severe after the experiment than before." (Page 465.)

Again, on page 464, he says, after breathing the nitrous oxide,
" I imagined that 1 had increased sensibility of touch : my fin-
gers were pained by anything rough, and the tooth ci]^e pro-
duced from slighter causes than usual. I was certainly mure
irritable, and felt more acutely from trifling circumstances."

This increased irritability produced by inhalation of protox-
ide of nitrogen, is confirmed by the statement of Dr. Beddoes,
the employer of Davy, on page 543, of the same work, who
says, "SevjeraJ times I have found that a cut which had ceased
to be painful has smarted afresh, and on taking two doses in
succession, the smarting ceased in the interval, and returned
during the second respiration."

Jackson, on Ancesthetic Agents. [January,

Thus, it appears from the researches of the discoverer of
exhilerating gas himself, and from the experience of his medi-
cal instructer and employer, Dr. Beddoes, that protoxide of
nitrogen has no anaesthetic properties, and the above quoted
experiments were obviously made with an express view to the
discovery of some pain-subduing properties in this gas. Davy
has the credit of having made early attempts to the discovery
of anaesthesia but he did not find it. Horace Wells, a dentist,
verified Davy's failure before the public in Boston, in 1844, and
in 1847, he again failed in the same way in the hospitals of
New York, thus giving as good evidence as was needed that
protoxide of nitrogen is not an anaesthetic agent, in spite of
all the depositions which he has published to prove that it was
equal or superior to ether.

We shall not consume the time of our readers by recounting
the various absurd proposals which were made by a Dr. Hick-
man, of England such as the administration of carbonic acid
gas by inhalation, so as to produce asphyxia, and of compress-
ing the trachea so as to strangle the patient, and then to operate
upon him while in that half dead state ; or the method proposed
by Morgagni, of compressing the jugular veins until a sort of
apoplexy was brought on; for these methods were at once
rejected by the French Academy of Medicine, as too absurd
for trial and wholly unjustifiable. And we cannot but marvel,
that any one should claim for Doctor Hickman the discovery
of anaesthesia on account of these barbarous proposals, which,
thanks to the humanity of the Academy, were never inflicted
upon any surgical patient. Nor will it be necessary for me to
look over ancient Persian, Hindoo, Chinese, Greek, or Roman
books, to learn that means were sought for and proposed, for
preventing pain in surgical operations.* It is enough for us to
know that they never discovered any such means, and it is no
novelty to us that mankind have always wished for such a dis-
covery. It is well known, that the use of ether vapor for the
production of insensibility to pain in surgical operations was
made by me, and that the Institute of France so decided, after

* Those who feel curious to learn the opinions of the ancients on this subject,
are referred to the work of M. Louis Figuier. Exposition et Histoire Univer-
seles des decouvertes Scientifiques et Modernes. Paris, 1852.

1853.]

Jackson, on Anesthetic Agents.

a full examination of the claims of numerous contestants for the
honor of this discovery.

The method of operating with Ether Vapour and with Chlo-
roform I shall now proceed to detail, premising the necessary-
precautions in judging of the purity of thf> ether to be employed,
and shewing how it may be purified from alcohol and acids
which are frequently contained in the ether of commerce.
Pure sulphuric ether is represented by the formula C4 H5 O.
Its specific gravity from 0-724 at 54 F., or 0715 at 68 F.
It is a light, highly volatile fluid, transparent, highly limpid and
colourless. Its odour is fragrant and peculiar. It boils at from
96 to 98 F., and evaporates with great rapidity when exposed
to the air, leaving nothing behind if it is pure. Owing to its
rapid volatilization it abstracts heat from bodies with great
rapidity. It burns with a white flame, and produces carbonic
acid gas and water.

Ether unites with alcohol readily, and is completely dissolved
by it, but may be separated from it by agitation with water,
for water combines rapidly with the alcohol and abstracts it
from the ether, which is but slightly soluble in water, and being
lighter it floats upon its surface. Owing to this property, we
can readily wash out those impurities in ether which are solu-
ble in water, and for that purpose I employ a very simple
apparatus, called a washing bottle, which is represented in the
wood cut below.

a glass jar.
a b air tube,
j c tube for drawing off the ether.

d division line between the ether
and the water.

A stop cork may be affixed to the
tube c, which may be made of metal,
if desirable. These tubes are insert-
ed through a cork.

Take the ether, and evaporate a portion of it to dryness on
a cloth, and if there is much odour remaining on the cloth the

10 Jackson, on Anaesthetic Agents. [January,

ether is impure. Smell of it as it evaporates to ascertain if
any sulphurous acid is present. Test it also with a slip of blue
litmus paper to discover if it is acid ; for if it is, it will turn the
blue paper red.

To test it for alcohol. After washing the ether, distill the
alcohol from the water, by means of a retort and Leibig's con-
denser, and the alcohol will be obtained, and may be rectified,
as usual, by re-distillation from dry carbonate of potash, or
from dry chloride of calcium.

For practical purposes, if the ether has no smell of sulphur-
ous acid, we need only to wash it with about twice its bulk of
water. For this, we use the washing bottle above figured.
Set the bottle upright, and fill it one-third full of ether, and then
nearly fill it with water, and shake it up for a few minutes, and
then invert the bottle, stopping the tube c before inverting it.
Hold it in this position for a short time, until the line of separa-
tion between the ether and the water is well defined; then open
the tube c, and let the water gently flow out, as it will do, on
account of the ready passage of air up the tube b, to the top of
the liquor. As soon as the ether reaches the tube c, stop it,
and bringing it over the bottle in which you intend to preserve
the ether, open the tube c again, and allow the ether to flow
into it.

This ether, without any re-distillation, is suitable for inhala-
tion; but if it is to be rendered perfectly dry, add a quantity of
dried chloride of calcium, and after agitation for some time,
distill off the ether, condensing the fluid by means of Leibig's
condenser and ice water.

I sometimes have rendered ether less offensive to the smell
by agitating it with lime-water, or still better, with bleaching
powder, hyperchlorite of lime, which destroys the aroma of
some of the volatile oils which it may accidentally contain.
This ether is to be again washed with water, and it is then fit
for use.

Many of the accidents which have happened in the early use
of ether as an anaesthetic agent, (though none of them have
proved fatal,) arose from the use of impure alcoholic ether of
commerce, and ether containing sulphurous acid ; this acid
being not. unfrequently present in the ether of commerce,

1853.] Jackson, on Ancesthetic Agents. 11

which is not always prepared with sufficient care, organic
matter, such as straw, cork, or other things that decompose
sulphuric acid, and generate sulphurous acid being present.

The utmost care is required in the manufacture of ether for
inhalation, and none but colourless oil of vitriol and purified
alcohol should be employed in its preparation.

Mode of administration of Ether Vapour for the production
of Anaesthesia. No other apparatus is required than a large
sponge, or a porous towel. A good sponge is the most con-
venient, and should not be smaller than the two fists of a man
viz., from four to six inches in diamater. The form of the
sponge is of no consequence, provided it is large enough.

Let the patient recline in an easy chair, or if on the opera-
ting couch, let his head and shoulders be elevated, if he reclines
upon his back ; but if he lies upon his side, he may remain pro-
cumbent. Soften the sponge in water, so as to open its texture,
and squeeze it as dry as convenient pour it full of the ether,
and squeeze out enough to prevent its dropping bring the
sponge close to the open mouth of the patient, and let him
breathe fully and boldly. The first impression of the ether
upon the respiratory organs produces coughing at first, but
is soon borne without trouble, and the patient inhales the ether
with great eagerness. Let him inhale it as freely as possible,
for the best effects are those which are soonest brought about,
as no excitement arises if the vapour is given freely, while it
is likely to take place if given too gradually. The patient in a
few minutes is etherized his eyes close, and he falls back, as
if asleep. If you open his eyelids you will find the eye rolled
up, as in sound sleep. The pupil is at first contracted, but soon
dilates under a full dose. The pulse, at first quickened, is, un-
der full etherization rendered slower than natural, and gener-
ally may be diminished about ten beats a minute less than the
natural pulse. Under chloroform, it is not unfrequently re-
duced from 72 to 30 beats per minute, and it gradually rises as
the patient recovers from the effects of the anaesthetic agent.

There is no need of rendering all patients unconscious ; for
loss of all feeling takes place before the unconscious state com-
mences, and there is no difficulty in keeping the patient for

12 Jackson, on Ancesthetic Agents. [January,

hours just on the borders of unconsciousness, without passing
into that state. The surgeon should charge an assistant with
the duty of administering the ether, in order that he should be
able to devote his undivided attention to the operation, and the
etherizer should devote his attention to his particular duty.

In case the patient has become deeply unconscious, and it is
desirable to awaken him, we have only to sponge his face
and head quickly with ice water, when he will generally be
aroused at least this method hastens the recovery in a re-
markable manner.

It is very important for the surgeon to know that the patient
should not be etherized while his stomach is full of food, for he
will be made to vomit in most cases, and he is much more re-
fractory towards the etherization. Make it a rule, then, that
the patient is to be kept fasting for some hours before he is to
be operated upon by ether ; also, that he drinks no ardent spir-
its, wine, or beer, which oppose the anaesthetic effects of ether.
Men who are habitually temperate always are the best subjects
for etherization, and habitual intemperance often prevents per-
sons from being affected favorably by anaesthetic agents. It is
a great mistake to suppose, that etherization is equivalent to
drunkenness from alcohol, or from exhilerating gas : it is di-
rectly opposed to that state. Alcohol excites to violence, and
so does the protoxide of nitrogen while ether vapour, pro-
perly administered, acts very quickly as a sedative, and there is
no disposition shewn to violent actions.

It is wholly unnecessary to detail cases, for the world has
been flooded with them, and three or four well-observed ones
are as good as a thousand. I have made direct experiments
upon habitual inebriates, and upon men who never drank any
intoxicating liquors in their lives, and I know, from these trials,
that ardent spirits act directly against the true and proper
influence of ether.

In Parturition, there is rarely any need of rendering the
female unconscious. She can, by a little instruction, be taught
how to prevent the sensation of pain in each muscular contrac-
tion of the uterus, by anticipating it with the ether, a bottle of
which she may have in one hand, while she holds her sponge,
handkerchief, or towel in the other, and applies the ether over

1853.] Jackson, on Ancesthelic Agents. 13

her mouth as she needs it. Since the introduction of pure
chloroform, I have been in the habit of making a mixture of it
with ether, and thus avoid the peculiar dangers of chloroform.
One measure of pure chloroform, made as I shall presently
describe, and four measures of pure washed sulphuric ether,
mixed, forms the most convenient anaesthetic agent for the
practitioner, since a four ounce phial will contain enough for
any case of labour, and twice as much as is required for any
surgical operation. This mixture, which should be freshly
made for each case, I ha-ve found to be perfectly safe, and I
have used it for more than five years, in my family, and on
numerous patients who have required my surgical aid, without
having witnessed a single unfavorable symptom. I have kept
an American Indian four hours in an insensible and unconscious
state with it, and have administered it to many furious maniacs,
in McLean Asylum, with great advantage ; the patients gaining
rest and sleep for some time, were found to be much relieved,
and one furious maniac was cured, for the time at least.

In Midwifery this mixture of ether with pure chloroform
operates admirably, and the accoucheur may, after instructing
his patient in the mode of inhaling it, allow her to take the
phial into her own hands, and to shake a little of the mixture
upon her handkerchief, just as cologne spirits is used, and then
to inhale it from the handkerchief as she feels a pain coming
on. If unconsciousness is desirable, as well as insensibility to
pain, another person must be charged with the administration
of the anaesthetic agent, under the directions of the accoucheur.
This is always required when instruments are employed for
the delivery of the child. I have used this mixture in my own
family in cases of parturition, and, without producing uncon-
sciousness, except for three minutes in one instance, have always
prevented all sensation of pain, without a single unfavorable
symptom accompanying or following its administration. I have
also used it in every case when my children required their teeth
to be extracted, and with the most agreeable effects.

Pure chloroform is too powerful an agent to be used gener-
ally, and since it is never required to be used alone and we
have other and safer agents, its farther employment in its con-
centrated state should be abandoned. Its vapour is so heavy

14 Jackson, on Ancesthetic Agents. [January,

as to nearly drown the patient, if he happens to draw into his
lungs the pure vapour, and one inhalation too much may prove
an over-dose and put the patient into a state of stupor beyond
the wishes of the operator, and to the no small alarm of the
friends of the patient.

There are also poisonous kinds of chloroform in the market,
which produce immediate death if breathed in a concentrated'
form, and the physician and surgeon may be so unfortunate as
to procure a bad variety.

The fousel oil, or oil of whiskey, is not unfrequently present
in the alcohol used for the manufacture of chloroform, and as
I have ascertained by direct experiment, a poisonous chloride
of amyle is present in most of the chloroform of commerce,
Mr. At wood and myself having separated it from such chlo-
roform. I have also made the poisonous product directly
from a mixture of fousel oil, hyperchlorite of lime and water,
and have proved that it destroys life.

It is not. however, certainly ascertained, that this compound
of amyle alone produces those sudden deaths, which under the
hands of skilful practitioners have so quickly taken place, on
the inhalation of impure chloroform, though the fluidity of the
blood in these fatal cases seems to indicate that some such
body as I have described must have been present, for I found
that such results were produced by the amyle compound, when
inhaled by animals; but, in my experiments, the death of the
animals, a rat and a turtle (testudo picta), took place too slowly
to resemble the known effects of the poisonous chloroform. I
have not yet, however, tried this compound mixed of chloro-
form, which may cause its more rapid action.

I know that there is a kind of chloroform sold in this market
that quickly decomposes and produces some remarkable and
very disagreeable products and free chlorine; and I am in-
formed by an eminent chemical manufacturer, Mr. Luther
Atwood, that such chloroform, in his experiments, usually results
from following the rules printed in the U. S. Dispensatory, 9th
edition, page 841 1851 ; while, by following another method,
similar to that which has been published by Prof. Simpson,
good chloroform results, but it must be made from very pure
alcohol, properly diluted with water. The chloroform which

1853.] Jackson, on AncBsthetic Agents. 15

I use, was manufactured by Mr. Atvvood, for Messrs. Philbrick,
Carpenter & Co., of Boston, and it was made from alcohol
purified by a process peculiar to his own works. This alcohol
has no trace of fousel oil in it, and has not the odour of any
of the materials from which it is extracted. The most highly
rectified and pure alcohol alone is fit for the manufacture of
chloroform. The process for making chloroform, as published
by Simpson, is as follows :

* ty Bleaching powder, Hyperchlorite of Lime, lbs. iv.

Water, lbs. xii.

Alcohol, oz. xii.

Mix in a capacious retort or still, and distill so long as a dense
liquid, which sinks in the water with which it comes over, is
produced."

This chloroform must be washed in the washing bottle, be-
fore described, with a sufficiency of water, to remove any
alcohol or acids it may contain. The chloroform settles to
the bottom and may be drawn ofTby the tube c, of that appar-
atus. There is no need of a re-distillation of this chloroform
from sulphuric acid or from chloride of calcicum a thorough
washing with water is all that is required. This chloroform is
to be used with ether, as before described.

There is a mixture of chloroform and alcohol sold under the
improper name of Chloric Ether, which, when ^dmirtistered
on a wet sponge, is decomposed, the alcohol all leaving the
chloroform and uniting with the water, so that nothing but
chloroform is really administered not a particle of the alcohol
rising in the vapor inhaled by the patient. The only advan-
tage which can possibly arise from the use of this preparation,
is the division of the chloroform into fine globules in the wet
sponge ; but it is an uncertain mixture, and is as objectionable
as pure chloroform the use of it in a case at the Marine
Hospital in Chelsea having produced death in a short space of
time, in the same manner and with the same morbid appear-
ances resulting, as are known to characterize the fatal admin-
istration of bad chloroform.

I have seen cases of violent and very dangerous convulsions
continuing for three days, from the administration of chloroform,
for the prevention of pain in the extraction of a tooth. These

16 Jackson, on Ancesthetic Agents. [January,

convulsions were found to be best controlled by the adminis-
tration of proper doses of morphine, and the patient recovered
in the course of a week.

The first chloroform ever manufactured in the United States,
for anaesthetic use, was made by me in my private laboratory,
and was, after being tried upon myself, administered to my
pupils. I then furnished physicians and surgeons with a suffi-
cient quantity to prove its efficacy, and made an exhibition of
it at a scientific club, where I administered it to our celebrated
surgeon, Dr. John C. Warren, and to Mr. Joseph M. Wight-
man. I subsequently administered it to physicians and to
others in public lectures, and have employed it to some extent
in various petty surgical cases which fell into my hands
while I was engaged in public geological surveys. I have
therefore had some experience in the use of this agent, as well
as of ether, and although I have met with no accidents in
practice with it, I must confess that I prefer my original anaes-
thetic agent, pure ether, or its admixture with pure chloroform.

Dr. Simpson, who substituted chloroform for ether, at the
suggestion of Mr. Waldie, the chemist, still adheres to the
administration of chloroform, but he is extremely careful to
procure the purest kind, and will not employ that which is sold
in the market unless he knows who made it, and that it is pure.
I am ftot aware of any fatal case having happened under the
management of Simpson, and this must be owing to his great
care in selecting pure chloroform. If ether has not caused
death in a single instance, and I am not aware of one having
yet taken place in consequence of its use, why should we not
adhere to its employment in all cases ? It is objected that its
odour is not so agreeable as that of chloroform, and that it is
more bulky and must therefore encumber the practitioner.
These objections are in a great measure removed, by the sub-
stitution of the mixture of ether and chloroform, as employed
by me, and with due care little danger is to be apprehended
from the use of this mixture.

For philosophical experiments, we may wish to employ
other substitutes for ether, and therefore I shall give a list of
those which possess anaesthetic properties, with some remarks
upon their peculiar effects upon man and animals.

1853.] Jackson, on Anccsthetic Agents. 17

They arc, as given in M. Bouisson's work on Anaesthesia

1st. Hydrochloric Ether, (first employed with Sulphuric
Ether, by M. Flourens, of Paris, in 1847.)

2d. Acetic Ether. (M. Figuier.) See Comptes Rendus of
the French Academy of Science, 1848, and M. Bouisson's
TraitS, 1850. Paris.

3d. Nitrous Ether. (M. Flourens.)

4th. Nitric Ether. (Dr. Simpson, on animals.)

5th. Aldehyde. (M. Poggiale.)

6th. Chloride of Hydrocarbon. (Dr. Nunnelly.)

7th. Formomethykc. (M. Bouisson.)

8th. Benzine. (Drs. Simpson and Snow.)

9th. Bi-sulphide of Carbon. (Name of experimenter not
known.) Norway Journal.

Of these, I have tried Nos. 1, 5, 6, and 9, upon my own per-
son, and No. 9, I have administered to my pupils, with rather
alarming results, and have also tried it upon mjself. It is too
powerful, and is dangerous. I have tried, too, chloride of
methyle. and found it to act precisely like chloroform, or the
ter-chloride of formyle. I have tried formic ether, and
cenanthic ether, with unpleasant effects, and without anaesthe-
sia being produced by them. Benzole has been breathed by
me, but its effects were not satisfactory, and it produced con-
siderable irritation in the fauces and larynx. I do not regard
these agents as susceptible of being substituted advantageously
for pure sulphuric ether.

I will give here the results stated inM. Bouisson's admirable
Traite de la Method Anesthesique, (Paris, 1850,) respecting
those agents that have not been tried by me, remarking that
M. Bouisson himself is decidedly in favor of adhering to the
use of ether vapour, as originally proposed and employed by me.

Chloride of ethyle, or hydrochloric ether, is made by satura-
ting alcohol with chlohydric acid gas, and by distilling the
liquid in a water bath, and condensing the ether in a flask of
water surrounded with ice and salt. Hydrochloric ether boils
at 11 centigrade or 42 P. M. Flourens first employed this
ether in the place of sulphuric ether, and for comparison with
it, and found that it produced the same effects. It is so volatile
that it is difficult to keep, and can only be used in cold weather;

18 Jackson, on Anesthetic Agents. [January,

hence, is not employed to any extent in actual practice, for it
would be necessary to keep it constantly surrounded by ice,
to prevent its escape by evaporation, as it boils at 42 F.

Acetic ether, or acetate of the oxide of ethyle, is a colour-
less liquid, having an aromatic odour, somewhat between ether
and acetic acid. Its density is 0*86, and boiling point 74 cent,
or 95 F. This ether being less volatile than oxide of ethyle,
is not so readily administered by inhalation, but, according to
Figuier, it produces effects analogous to those of sulphuric
ether. Tried on a puppy of 2| months, by M. Figuier, it pro-
duced insensibility in five minutes, so that no pain was occasion-
ed by amputation and cauterization of his tail, but it took ten
minutes to render an adult dog insensible to pain. M. Bouis-
son has tried acetic ether in surgical operations on man, but
did not obtain such prompt results as with sulphuric ether. It
required twenty minutes to produce insensibility in a patient
from whose cheek a small cancerous tumour was excised by
that surgeon. He thinks that this ether is suitable for persons
who are easily affected by anaesthetic agents, and that it pro-
duces less coughing than the sulphuric ether. M. Chambert
agrees with M. Bouisson in this opinion.

Nitrous ether, (nitrite of oxide of ethyle,) density 0-95, boils
at 16 cent, or 51 F. This ether is a deadly poison, and its
use must be carefully avoided. M. Flourens has verified its
poisonous properties by experiments on animals, and a servant
maid of a druggist was killed by sleeping in a room where a
carboy of it was broken under her bed. (Ed. Med. and Surg.
Journal, t. xxxv., p. 452.) This etherial fluid, of course, is to
be thrown out of the list of anaesthetic agents.

Nitric ether (nitrate of ethyle) has been used in experiments
on man and animals, by Dr. Simpson, who declares that it pro-
duces anaesthetic effects on man when fifty or sixty drops of it
are inhaled from a handkerchief. He regards it as free from
danger. But this is not a reliable opinion, for severe headache
and vertigo follow its inhalation, as I know, and from my ex-
perience I would not recommend its trial. In case it were
breathed too freely, I have no doubt it would produce fatal
results. I therefore reject it.

Aldehyde (hydrate of the oxide of acetyle) was proposed by

1853.] Jackson, on Anesthetic Agents. 19

M. Poggiale, Professor of Chemistry in the Yal-de-Grace in
1848, as a substitute for ether and chloroform. He had tried
it on animals, with what he regarded as successful results ; but
experiments made by others, on men, proved that it was a very
disagreeable, if not a dangerous substance. Dr. Simpson found
that it produced a severe cough, and great dyspncca and head-
ache. The same results were obtained by me, in experiments
on my own person, in 1847, and I at once denounced aldelyde,
as not being a safe or proper anaesthetic agent.

Chloride of hydrocarbon (or the Dutch oil) was proposed by
Dr. Nunnelly, of Leeds, as an anaesthetic agent ; but experience
has proved that it produces a severe irritation of the throat,
and is not so good an anaesthetic agent as chloroform.

Formomethylae is mentioned, by M. Bouisson, as an anaesthe-
tic agent somewhat between ether and chloroform. It is
obtained by distilling wood naphtha (esprit de bois) with a
mixture of diluted sulphurous acid, and per-oxide of manga-
nese. It is an agreeable aromatic liquid, boils at 42 cent, or
107 F. It has been tried upon dogs with success, but never
upon man. Its value cannot be superior to that of sulphuric
ether, though regarded by M. Bouisson as between ether and
chloroform ; furthermore, it is a rare and costly substance, and
is not known in commerce.

Benzine, produced by the distillation of benzoic acid with lime,
has been proposed as a substitute for ether and chloroform, but
it has proved unsuccessful in the hands of Drs. Simpson and
Snow, who first proposed to employ it, and it should not be
used in operations on man.

Bi-sulphuret of carbon is obtained by passing the vapour of
sulphur over red hot charcoal, and collecting the volatile pro-
duct in pounded ice, and then re-distilling it, and condensing
it again in ice and water. This very disagreeable smelling
liquid was proposed by some one in Christiania. in Norway,
as a substitute for ether. I do not know the name of the writer,
but the article was published in a Norwegian newspaper, called
the Morgenbladjn 1848. I immediately undertook a series of
experiments on this volatile liquid, and found that it did possess
anaesthetic properties of greater power than chloroform, but
that its use was not only disagreeable but also quite dari

20 Norwood, on Veratrum Viride. [January,

owing to the remarkable effects of the bi-sulphuret of carbon
vapour on the circulation, and on the respiratory organs. Its
effect is very sudden, and a person under its influence is as
pale as ashes, and his lips are of a blue colour hence there is
partial asphyxia. After trying it upon my own person, and
repeating the trial on one of my pupils, I concluded that it
would be dangerous to allow the introduction of such a pow-
erful agent into general practice. Its use cannot be safe in
any but the most skillful hands, and even then I should fear
that fatal results would occasionally take place. It is not re-
commended by those who have tried it in France.

From the foregoing resume of all that is known of the pro-
posed substitutes for ether, I think the reader will come to the
conclusion which we have long since arrived at in Boston,
that none of the substitutes that have thus far been proposed,
have on trial been found to be equal in value, so far as efficien-
cy and safety are considered, to the preparation originally
employed by me in my first experiments, viz., the oxide of
ethyle, or pure sulphuric ether vapor mingled with air.

We are in no way opposed to improvements upon my
method ; but the improvements must be proved to be such,
before we can admit them ; and we are convinced that there
is little reason to believe that any substitute will be found that
will, in all the essential requisites, surpass that for which I have
expressed my preference.

ARTICLE II.

Veratrum Viride, or American Hellebore. By W. C. Nor-
wood, M. D., of Cokesbury, South Carolina. (Continued
from p. 653 of Vol. VIII., N. S.)

We gave in the No. of this Journal for November last, an
account of what was known in reference to the effects of
veratrum viride previous to 1850, of the manner in which
we used it and of the cases treated with it. This paper might
be said to contain the experimental process adopted to deter-
mine its powers in controlling arterial action, and the effects
witnessed during these inquiries. But, to proceed : We soon

1853.] Norwood, or Veratrufk Viride. 21

discovered, to our surprise, that in almost every instance, so
soon as nausea or vomiting was excited the pulse became slow,
lull and distinct, the skin cool and often soft and moist, and in
s bathed in a most profuse perspiration, with entire
relief of pain in a number of cases and materially mitigated in
others. The cases in which there was no abatement of pain
were very few. The mouth and tongue grew moist, breathing
and expectoration more free and easy, and by continuing the
remedy, in doses short of the nauseating point, from one to
three days longer, there would be no return of the symptoms
in a large majority of the cases in which the disease was sub-
jected to early treatment. In a small number of cases, if not
continued longer, the symptoms would return on a suspension
of the remedy. In very few cases we have had to continue
the tincture from five to twelve days. These cases are exceed-
ingly rare, and were often treated with other remedies or
suffered to run some time without any treatment. We had,
by a continued if experiments and observations, arrived

at the fact that, in nearly every case, we could reduce the pulse
to any point we wished ; that by putting the patient under its
influence, we could predict with certainty that the pulse would
range between 50 and 85 beats per minute.

Before going any further, we beg leave to present the fol-
lowing two cases of pneumonia the one on account of the
interest of the occasion, and the other because of the peculiar-
ity of the effect :

In 1S40, we were called to see Mr. E., in consultation with
Dr. J. A. Stewart. Mr. E. had been laboring under a severe
attack of pneumonia for several days. The remedies pre-
scribed were entirely approved of and continued for a time,
but failed to relieve. The threatening aspect of the case was
such, that it was thought prudent to inform his parents, at a
distance, of his perilous condition. At this critical juncture,
we observed to Dr. S. that we had been using an article in a
number of cases of pneumonia, with a success and peculiarity
of effect we had never been able to obtain from any other
remedy, and proposed to use it in the present case. We im-
mediately put Mr. E. on the use of the veratrum viride, to be
y three hours the quantity to be increased one drop

X. 3. VOL. IX. NO. I. 2

22 Norwood, on Veratrum Viride. [January,

at each dose until nausea or vomiting occurred. At 8 o'clock,
A. M., commenced with seven drops. The third portion ex-
cited severe nausea and free vomiting, with great paleness,
coolness and moisture of the surface. During the occurrence
of these interesting and striking effects, we were notified that
Mr. E. was vomiting freely, was much worse and was thought
to be dying. We found, however, that what had caused so
much alarm to the patient and his friends, was to us a source
of gratification ; for, after the effort at vomiting was over and
nausea relieved, the pulse was reduced to 63 beats and the pain
relieved.

In this case, a pulse of from 120 to 130 beats, was reduced
in twelve hours, to 63, and all the febrile and inflammatory
symptoms were relieved. This was to us an occasion of thril-
ling and exciting interest. Dr. S. was the first physician to
whom we had stated our belief in its powers, and he now
stood before us witnessing the most commanding demonstra-
tion of the powers of the agent over a disease of acknowledged
fatality and under the most unpromising circumstances. Who
would charge us with wanton enthusiasm? or who would fail
to be enthusiastic on such an occasion ? The portion was re-
duced to one half and continued several days without any return
of the symptoms, and the patient rapidly convalesced.

We were at one time impressed with the belief that nausea
or vomiting, one or both, was essential to the control of the
heart. Called, in February, 1847, to see a son of Mrs. T., la-
bouring under a violent attack of pneumonia, we put him on
the use of veratrum viride every three hours. Although 12
years of age, his general slender health and deformed chest,
having been severely afflicted with asthma, induced us to com-
mence with a very small dose, that we might avoid any drastic
effect of the remedy. The first portion given was two drops,
to be increased one drop every portion until the slightest nau-
sea was experienced, then to lessen or discontinue the remedy,
as the case might require. On taking the third or fourth por-
tion, Mrs. T. discovered that he was getting very pale, that the
skin was cool and moist, and the pain scarcely felt only on taking
a full inspiration. The slowness of the pulse, and the palor
and coolness of the surface alarmed her, and she sent for us.

1853.] Norwood, on Veratrum Viride. 23

We found him pale, cool, moist, and with a pulse beating 35,
full and distinct. When put on the tincture, in the morning,
Ins pulse was 120 to 125, skin hot and dry, frequent and labor-
ed breathing, pain severe, great thirst. In the short space
of twelve or fifteen hours the symptoms were subdued, and by
continuing the tincture in doses of from two to three and four
drops, there was no renewal of the symptoms.

Since the above, we have been able, in a number of cases,
to succeed in reducing the action of the heart and arteries,
without exciting the least nausea or vomiting, by commencing
with a very small dose. Nausea and vomiting are therefore
not absolutely necessary. We might enumerate many other
cases of like success, but deem it unnecessary to detail any
more at present.

In 1850, we determined to announce to the world the fact,
that the reat desideratum had been discovered : an agent by
which we could emphatically say to the heart and arteries, thus
fast shalt thou beat, and no faster. Aware of the fate of ma-
ny remedial agents urged upon the attention of the profession,
and which have proved valueless, we withheld our notice until
we had, by the utmost care and observation, acquired the con-
viction of its being as much a specific in pneumonia typhodes,
as quinine is in intermittent fevers. We leave it to an enlight-
ened profession to judge whether or not the agent has failed
to answer or equal the representations made.

We now began to reflect upon the fact, that in a very large
majority, if not in every disease of violence, a frequent pulse is
manifest, and that we judge, in a great measure, of their inten-
sity, by its frequency and the condition of the vascular system.
We asked ourselves the question: if veratrum viride will control
arterial excitement, break up and arrest pneumonia tvphodes,
why should it not succeed in arresting other fevers and inflam-
mations? Believing, as we did, that the altered and vitiated
condition of the secretions were the consequence of increased
and perverted circulation, and that the degree of their morbid
condition might be measured by that of the vascular system,
we concluded that the veratrum viride would cure other febrile
and inflammatory affections by its specific action on the heart.
We were therefore led to test the veratrum viride in a number

24 Norwood, on Veratrum Viride. [January,

of diseases, and the result of a limited portion of our experience
was given in the January numbers of this Journal, for 1851
and 1852.

In nearly all, if not in every acute disease, especially of a
febrile and inflammatory character, we find the frequency of
the pulse and the derangement of the vascular system in pro-
portion to the force and severity of the case. There is scarcely
an exception to the rule. Why this is so we do not know.
The fact cannot be denied ; and in order to restore health, we
must, of necessity, control the circulation, directly or indirect-
ly. Now, veratrum viride will almost invariably effect this,
whatever may have been the disturbing cause. The how and
the why, we do not understand. We look upon the universali-
ty of its application to be exactly defined by the universality of
the occurrence of increased cardiac action. In testing its
powers, we did not confine our experiments to febrile and
inflammatory diseases of an idiopathic character, but extended
them to traumatic lesions in which fever and inflammation had
supervened, and our labors were crowned with a success that
we little dreamed of realizing. Its power of controlling arteri-
al action, in febrile and inflammatory diseases and in traumatic
lesions, we consider established beyond doubt. We gave the
statement of a case of convulsions, treated with the veratrum
viride, in the January No. (1851) of this Journal ; since which
time we have treated a number of others, with great success.
We have not used it in epileptic convulsions sufficiently to
enable us to speak with confidence and certainty in that dis-
ease. In the case of a Mr. S., whom we commenced treating in
January last, and still have under treatment, there has been no
return of the paroxysms since then, which is a much longer
interval than he has enjoyed for years, and his general health is
much improved. It stands unrivalled in palpitations of the
heart, for promptness and certainty of relief. It is a specific in
the painful affection of the testicle consequent upon the mumps.
We have not failed, in a single case, to obtain relief from the
pain and fever in twelve hours, and prevented a return of the
symptoms, by perfect rest and a continuance of the tincture
for three or four days. How far it will succeed in orchitis, from
other causes, we are not prepared to say. It affords us no ordin-

1853.] Norwood, on Ycratrum Vivid*. 25

ary pleasure, to record its value in the treatment of the inflamed
mamma of lying-in females. If taken in time, in these cases, it
may be relied on to control the fever, pain and inflammation of
the gland, so as to prevent suppuration in almost every instance.
It is valuable in inflammation of the brain. In hooping-cough,
accompanied with high febrile excitement, it has no equal. In
convulsions generally, it is highly valuable. In asthma and
rheumatism its effects are peculiarly striking, especially in the
acute forms. In chronic rheumatism we have not used it. In
puerperal fever our experience is limited, but the few cases
in which it was used stamps it a reliable agent in that dis-
ease. We have found it of great value in the treatment of
typhoid dysentery, and would feel unable to combat that dis-
ease without it or some other remedy of equal power. Its
eifects on the system are in perfect antagonism to those of
scarlet fever. Combined with the diuretic treatment, we do
not believe it can be equalled by any other plan of treatment
that has ever been adopted in scarlet fever. We know it to
be valuable of itself, but its powers are greatly increased by
the above combination.

When we reflect upon the power of veratrum viride to allay
pain, irritability and irritation, and more especially irritative
mobility, in connection with its influence over the heart's ac-
tion and deranged secretions, it is truly difficult properly to
appreciate its value. We know of no untried agent that we
would venture to rely on with more certainty in the treatment
of yellow fever, and we look with interest for the results of its
trial in this disease. From its direct influence over the vascu-
lar system, we believe it will prove valuable in the treatment
of small-pox, and by keeping the excitement down and the
surface cool and pale, it will perhaps prevent the unsightly
pitting which often takes place in that disease. Our remarks
will be concluded in the next, which will embrace the treat-
ment of typhoid fever.

Abbeville C. H., S. C, Xovember, 1852.
Our last contained a statement of the valuable results ob-
tained in the treatment of Pneumonitis, and a brief notice of
the tact that the reduction and control of the heart and arter-

26 Norwood, on Veratrum Viride. [January,

ies were not the consequence or result of the nausea and vom-
iting, but were independent of either of these ; also a notice
of a number of diseases in which we had tested its value. We
must confess, that notwithstanding the time and space already
occupied, that we have scarcely entered the threshold, much
less exhausted the subject. It would take a volume to unfold
the powers and effects of veratrum viride, and the almost in-
numerable cases to which it is peculiarly applicable. The
powers and properties of veratrum viride, when fully known
and understood, will open new fields for thought and investi-
gation, and give greater scope for practical research in all that
relates to the pathology and treatment of disease, than any
agent that has ever enlisted the attention of the medical world;
and we are persuaded that it will completely change many of
the existing views of pathology, and simplify the treatment of
disease to an extent unparalleled in the history of medicine.
Then, as a matter of course, my feeble pen is not equal to the
task of embodying in a few short essays, written at numerous
and interrupted periods, snatched from professional exactions,
all that might be necessary to. a full knowledge and understand-
ing of its powers. The articles will therefore be clogged with
numerous repetitions and unavoidable tautology.

We now enter on the most important and interesting part
of our subject, viz its value in the treatment and cure of
Typhoid Fever a disease whose fatality renders big with in-
terest any thing proposed for its cure. The treatment of
typhoid fever is a matter in which every individual is deeply
interested. Might we not ask with emphasis, what country,
what community, has not felt and heard of the destructive
mortality following in its wake? and has not the cry been
echoed back by every tongue and breeze a remedy to stay
the fell destroyer's progress ! When we have presented as
much of facts and evidence as we deem sufficient on the occa-
sion, you will be able to judge and others can determine whe-
ther a cure has been discovered and the destroyer stayed or
merely checked ; when the value of veratrum viride in pneu-
monia typhoides and other malignant and fatal diseases, is
embraced in the subject, it becomes doubly interesting and
important. In 1850 we first entered on a trial of the tincture

1853.] Norwood, on Veratrum Viride, 27

of veratrum viride in the treatment of typhoid fever. It was
due to our patients and to justice that we should proceed with
caution. We accordingly, at first, gave it in mild and moder-
ately severe cases, avoiding its use at first in all cases of unusual
severity and malignancy. We first used it in the case of a
negro boy of Mrs. W., which was uncomplicated and yielded
readily. When called, on the third day of the disease, the
bowels had been moved sufficiently by a cathartic of calomel,
followed by repeated portions of camphorated Dovers powder,
without abatement of the symptoms. The skin was hot and
dry, great thirst, severe pain in the forehead ; the eyes dull,
heavy and ecchymosed ; tongue covered in the centre with a
dark, thin fur, tip and edges very red and dry ; pulse 127, small,
soft and with a quickness in the stroke, that indicated greater
frequency than really existed. The patient was ordered a six
drop dose, to be increased till nausea or vomiting occurred.
By mistake, the dose was not increased. After continuing the
treatment twelve hours, there being no abatement in the symp-
toms, we were notified of the fact and wrote to increase until
an impression was made and that we would see the patient in
twelve hours. During the absence of the messenger, Mrs. W.
discovered that the dose was to be increased, and did so, and
when this reached eight drops there was free vomiting, with a
subsidence of all febrile symptoms, the severe pain in the head
excepted. At the expiration of twelve hours, we found the
boy with a skin cool and most, thirst materially abated, and the
pulse reduced to fifty-six beats. A blister was applied to re-
lieve the unmitigated pain in the head, and the veratrum viride
was continued four days without any return of the symptoms.

Other mild cases were treated with the same rapidly favora-
ble and successful results. We were thus emboldened and
warranted in extending it to the treatment of cases much more
severe and malignant, as were those of Mr. II., the son of Mr.
Wr., the two at Dr. Q.'s, and that at Dr. T.'s all of which,
except the first, were published at length in the January No. of
this Journal in 1851.

While on a visit to Georgia, in July. 1851, we were asked
by Dr. M. to look at a negro woman of Mr. T.'s. She had
been sick a number of days, with no abatement of the symp-

28 Norwood, on Veratrum Viride. [January,

toms. Pulse 116, skin hot and dry, tongue red and dry, great
thirst, more or less delirium, and a peculiar nervous motion, or
more properly, a tremor and inability to hold the head still or
to take a drink of any thing out of a cup or tumbler with her
own hand. The owner was exceedingly uneasy about the
condition of his negro, as a great many had fallen victims to
that disease. We might have noticed the gurgling noise, sick-
ness at the stomach, and spinal tenderness, which had resisted
the use of blisters to the stomach and spine, as well as cupping
of the same, together with an alterative treatment of calomel.
On being asked our opinion, we observed to Dr. M., we
thought the fever could be cooled and the pulse reduced. By
request, we remained five hours, put her on the use of the
tincture of veratrum viride gave her seven drops at 12, eight
at 2, P. M., and nine at 4, P. M. In half an hour after the
the third portion nausea and vomiting were excited moderate-
ly. The pulse was reduced to 80 beats per minute, the skin
became cool and moist, and the nervous tremor or motion very
much relieved. The Doctor observed, that the pulse was re-
duced as low as he wished it ; the dose was consequently re-
duced to four drops, to be given every three hours. A son of
Mr. T. was also sick of typhoid fever. His case was mild,
the pulse at the highest numbering but a very few beats over
one hundred. When the effects on the negro woman were
known, he was quite anxious to take it also. Accordingly, he
was ordered it every three hours, beginning with seven drops ;
to be increased one drop. The third dose excited severe
nausea and free emesis, producing cool and moist skin, and re-
ducing the pulse to 58 beats per minute. The portion was
then reduced to four drops, at intervals of three hours. The
next morning, at 9 o'clock, found the negro's pulse 80 ; delirium
entirely gone, and full relief of all nervous tremor; skin cool
and moist ; tongue moist, and little or no thirst. The son's
pulse was from 58 to 60, other symptoms in unison.

The above was an occasion of interest and solicitude to us,
for the time, and our feelings can be much better imagined
than expressed. Dr. M. dismissed the cases within thirty hours
after we first saw them, the medicine to be kept up for a few
days, and he to be notified in case of change for the worse.

1853.] Norwood, on Veratrum Viride. 29

Dr. W. saw them, and Dr. S., then a student, was also present.
Dr. W. has since used the veratrum viride extensively, and
with great success. This circumstance led to its introduction
into that region, Coweta, Troup and Heard, as Dr. M. practiced
in the three counties. The letters of Dr. M., Dr. Ridley,
and Dr. Renwick, are testimonials of their opinions of its value
and beneficial effects in the treatment of typhoid fever, &c.

We were called, with Dr. P., to see a negro girl of Judge
B.'s, on whom he was attending. The girl was severely sick
with typhoid fever, which had been unusually fatal in that re-
gion. The pulse was from 120 to 130, when at the highest;
tongue dry, and red on edges and tip, dark brown or black in
the centre ; great tenderness of the abdomen ; gurgling or
rumbling and tympanitic abdomen; decubitus on the back;
feet drawn up ; knees separated ; muttering and delirious while
inclining to sleep, especially during the night ; tendency to
diarrhoea ; tip of the nose peculiarly sharp cr pointed had
been treated with calomel, turpentine, and camphorated Do-
ver's powder. It was on the eighth day we saw her, and, with
desire of Dr. P., commenced giving the tincture every three
hours. The patient being ten or eleven years of age, we com-
menced with two drops, and increased each dose one drop.
In thirty hours the pulse was reduced from 120 to 90 beats per
minute, surface became cool, and mouth and tongue moist. In
fifty hours the pulse was reduced to 70, at which time she was
nauseated and vomited -it was kept at between 75 and 85, till
she was fully convalescent, and did not exceed that point, un-
less suspended, or given at too great intervals.

The Judge observed, after we had been in attendance for a
few days "you say she is better, and will get well. I have
had two to die in my family already, and she will die also."
We are pleased to say that we were correct in our prognosis,
and that when we left, the patient was sitting up and able to
walk about, had a good appetite and regular bowels. This was
a case of no ordinary interest, as in that immediate section
many had denied the elficacy and the powers of the veratrum
viride, but had witnessed the mortality of the disease under
every other mode of treatment. This closes the history of
three cases we assisted in treating in Georgia. We will again

30 Norwood, on Veratrum Viride. [January,

turn to our own, and an adjoining district, and give the cases
of most interest.

On the 14th July, 1852, we saw, in consultation with Dr. C,
Mr. C. It was the sixth day of his relapse. Pulse 120, small,
soft and weak ; gurgling on pressure, and tenderness in the
right iliac region ; bowels flatulent and slightly tympanitic ;
burning in the palm of the right hand ; edges and tip of tongue
dry and red slight white fur on the tongue, which we attribu-
ted to calomel ; preternatural wakefulness. Had been treated
with alterative doses of calomel and Dover's powder had ta-
ken an emetic. Gums slightly distended from calomel, fetid or
mercurial breath, and a number of small ulcers on the cheeks
and tongue; skin dry ; bowels inclining to diarrhoea, but readi-
ly controlled. By consent, was put on the tinct. of veratrum
viride every three hours, to be increased slowly, and to avoid
emesis, as he was opposed to taking it till it produced this effect.
This is a great error ; for those who take it till free emesis is
excited, and the liver properly aroused, convalesce much fast-
er. Commenced with three drops, and increased one drop
every portion given, till six were taken, and slight nausea pro-
duced. It was then reduced to three drops, or more, accord-
ing to effect. On reaching six drops, the pulse was reduced to
80, and kept from 80 to 85. By continuing this treatment for
a number of days, the pulse was reduced as low as 70 in the
morning, with the skin rather cooler than ordinary, and to-
wards sun-set it would get up to 80 or 85, and the skin would
be rather warm, and accompanied with more or less restlessness
till midnight, and then pass off. It was suggested to try a few
portions of quinine. The morning on which he took the
quinine, the pulse was 70, skin cool, mouth and tongue moist.
A portion of quinine was given at 9 and 11. Before 1, his
pulse was from 130 to 135, the skin hot and dry, and a general
aggravation of all the febrile symptoms. The veratrum viride
was resumed in full portions for a few doses, which soon sub-
dued the excitement, and was continued. Convalescence was
slow but perfect. It is an error, not to reduce the pulse as low
as sixty in many cases. There is as much febrile excitement
in some, with a pulse of 80, as there is in others with a pulse of
90 or 100 ; consequently, when this is the case, the convales-

1853.] Norwood, on Veratrum Viride. 31

cence will be extremely slow. In such cases, the veratrum
viride should be given till free emesis is excited, and the pulse
should be kept at 60 or under.

On the 19th July, 1852, we were called into an adjoining
district, to see a negro woman of Mrs. G.'s, in consultation
with Drs. T. and McD. We saw her at 8, A. M., on the 20th,
the twelfth day of the disease. She had been treated with all
the remedies usually resorted to, without relief. She was
slightly mercurialized ; supposed to be three months advanced
in pregnancy ; pulse 130, extremely quick and weak, so much
so that it was difficult to count ; tongue dry and red on the tip
and edges, with a thick dark fur in the centre. The papillae
were not covered with fur, were elevated, enlarged and flatten-
ed at top ; thirst extreme ; great heat in the region of the sto-
mach, and complaining of internal heat and burning ; extremities
cold, with general coolness of the surface, except over the re-
gion of the stomach ; answered questions in a quick and hurried
manner would invariably change some part of the body before
giving an answer. Discharges from the bowels dark and
muddy, mixed with slime ; more or less tenderness and gurgling
on pressure in the right iliac region ; tendency to diarrhosa
slight. On the ninth day from the attack, there was a sudden
and decided change for the worse, and brandy and quinine
were freely given to sustain the action of the heart and arte-
ries, and the surface was thoroughly rubbed to keep up external
warmth.

We have given such a description of the treatment and con-
dition of the patient, at the time of our first visit, as will be fully
endorsed by the physicians in attendance. Two cases had
just terminated fatally in the same family, and two others in a
family not more than six hundred yards distant. We could
not complain of the reputation that had preceded us ; but the
standing of the medicine was anything but favorable in that
region of country. The previous and threatening mortality,
the severity of the case, the new remedy, the unfavorable prog-
nosis of the physicians in attendance, naturally excited the
deepest interest, and curiosity was wrought up to the highest
point as to what course would be pursued. By consent, every
remedy was discontinued, both internal and external, and the

32 Norwood, on Veratrum Viride. [January,

tincture of veratrum viride ordered every three hours, to be
increased pro re nata, which we superintended in person from
9, A. M. till 5 P. M. Three drops were given at 9, which
nauseated and vomited pretty freely before 12. The first mat-
ter thrown up was a large quantity of mucus and slime, follow-
ed by a quantity of dark, thick bile, or bitterish fluid, on the
ejection of which she expressed considerable relief from the
unusual burning or heat in the region of the stomach. Four
drops were given at 12, which excited free emesis in from
thirty to fifty minutes, bringing up an abundance of thick, yel-
low bile. After this paroxysm of vomiting had subsided, the
extremities and surface generally became warm, or, in other
words, there was a general diffusion and equal distribution of
heat She expressed perfect relief from internal heat or burn-
ing, followed by a general feeling of agreeable coolness ; but
three drops were given at 3 o'clock, which excited slight
nausea, and perhaps a slight but single paroxysm of vomiting.
What we had achieved when we left (at 5, P. M.) was the re-
lief from unusual heat in the stomach, severe thirst, general
restlessness, an equable diffusion of heat, and greater fulness
and distinctness of the pulse. Instructions were left to continue
the veratrum viride in three or four drop doses, as she might
be able to bear it, avoiding too much nausea and vomiting, if
possible. After leaving, we sent a message back to give twenty
or thirty drops of laudanum, one hour before the next portion,
to prevent nausea or vomiting, if possible.

That night, as matter of course, was passed by us with more
or less anxiety and interest. On reaching the patient the next
morning, the viride was exciting very little nausea, the pulse
was reduced to 120, more full and distinct, and all the other
symptoms were slightly improved. We were not satisfied
with the small quantity of the veratrum viride we were using ;
wTe therefore ordered an enema of four ounces of cold water
and six drops of the tinct. of veratrum viride every six hours,
and the three drop doses, every three hours, to be continued,
thus making, in all, forty-eight drops in the twenty-four hours.
The enemata were ordered to be given between the portions
by mouth. The nausea and vomiting were kept up for a time
after each enema, but not to an extent that required them to be

1853.] Norwood, on Veratrum Viride. 33

suspended, and which subsided after a few repetitions of the
enema.

The morning following, which was the fourteenth day of the
disease, the pulse was down to 100, and with a like improve-
ment in all the symptoms. The morning following, the pulse
was reduced to 85, and all the other symptoms were greatly
mitigated, so much so that we were not to see her for the next
forty-eight hours. On Sunday morning, at 9, A. M., (the
seventeenth day of the disease,) we were at our post, with our
pleasing anticipations disappointed, blasted, and, for the time,
scattered to the winds, >but to fight the battle at far greater
hazard. Found her flooding ; pains severe and frequent. Re-
quested Dr. T. to examine the condition of the uterus; found
the os tineas soft and dilated, so that he could discover a sub-
stance or body presenting; gave her a portion of ergot; the
fetus was thrown oft' within a half hour, and flooding ceased.
By this time the pulse had reached 135 beats per minute, was
peculiarly quick and feeble ; number of respirations 63 per
minute ; skin hot and dry, the heat of that peculiar acrid kind
called " calor mordax ;" thirst greatly aggravated. The vera-
trum viride was increased to five drops every three hours ;
spirits of turpentine to be given every six hours, in fifteen drop
doses, in a little warm sweet milk to cover the taste, which
excels any vehicle we ever tried. The enema of cold water
to be continued every six hours, and the viride increased to
eight drops. When we left, at 4 in the afternoon, there was
slight moisture of the surface ; the pulse was 130, more full and
distinct ; breathing a little less frequent and hurried. On the
day following it was reduced to 95 beats per minute; on the
following day it was reduced as low as 85, with alike improve-
ment of all the symptoms. The remedies were continued, and
she rapidly and perfectly convalesced. It did appear that
Frovidence brought us safely through the most critical of all
the cases we have met. It also appeared, that so soon as the
foetus was thrown off", she was much less susceptible to the im-
pression of the veratrum viride.

There are many points of interest in the above case, which
are well worthy of particular notice. In the first place, it had
been treated by two skillful physicians, with all the ordinary

34 Norwood, on Veratrum Viride. [January,

remedies. On the ninth day, the stage of collapse or exhaus-
tion set in so rapidly and to such an extent, as to render brandy,
quinine and rubefacient frictions necessary, to keep up the ac-
tions of the heart and arteries as well as the external warmth.
After the free use of the above, from Saturday till Tuesday,
we find there was no relief, but rather a continuance and ag-
gravation of the symptoms. On Tuesday there was a with-
drawal of all remedial agents in use was put on a few drops
of the tincture of veratrum viride, at no time for the first 24
hours exceeding four drops. This was attended with relief
from internal heat and burning, a general distribution of heat
on the surface, and the pulse rendered slower, fuller, and more
distinct, &c. The only change made which seemed to add to
the good effects, were enemata of cold water, containing six
drops of the tinct. of veratrum viride. In the meantime she
aborts with a renewal and aggravation of all the symptoms ;
to meet which, there is added to the treatment 15 drops of spts.
turpentine ; the dose of veratrum viride increased, by mouth,
to five drops, and by enemata to 8 drops. Again, the lessened
susceptibility after the abortion, whereas, under ordinary cir-
cumstances, bleeding increases this susceptibility : true, the
loss of blood was comparatively small, yet, taking into account
the length of time she had been sick, it might be said to have
been relatively large. These are facts and circumstances for
reflection and investigation.

We had intended to report three severe and interesting cases
treated in the same family, but the continual appearance of
articles from other and abler pens, induces us to lay aside much
that we intended for the press. We will simply state that, with
the prompt and efficient assistance of the two physicians in
attendance, we were able to bring all the cases to a happy ter-
mination. We will add, for the sake of brevity, that all the
cases were treated previous to January, 1852, except a very
few. Since the first of June, 1852, w have been called to see
seven cases of typhoid fever, in consultation, all of which were
cured. We had noted down eleven consecutive cases of this
fever, eight of which we saw in consultation, one had been
seen by another physician and two were seen by no other phy-
sician. We notice these on account of their great severity,

1853.] Norwood, on Veratrum Viride. 35

and more especially from the fact of a large majority of them
being patients under treatment by other physicians. We are
in possession of a large number of cases of typhoid and other
diseases, which have been treated with unvarying success with
the veratrum viride. Dr. B. treated 23 cases, without the loss
of a single one all in the same family.

Veratrum viride, green hellebore, American hellebore, is not
our common Poke-root or Phytolacca Decandra, but is the
poke weed, veratrum viride, and is entirely different in its ap-
pearance and properties. Again it is called white hellebore,
by the shakers, and those ordering the veratrum viride often
get the white hellebore proper, or European, for it, by not
being specific in the correction of the error in name. The
properties and powers of veratrum viride are the following :
1st, acrid This property is very limited and confined to the
fauces. 2d. Tt is adanagic, deobstruent or alterative : this pro-
perty it possesses in a marked and very high degree ; not
equalled by calomel or iodine in this particular, which will
adapt it to the relief and cure of many diseases hitherto beyond
the reach of any remedy. Of this class of diseases, those
which we think will be much benefitted by it, are, cancer and
consumption. 3d. It is actively and decidedly expectorant, so
much so that we rarely add any other article. 4th. It is one
of the most certain diaphoretics belonging to the materia med-
ica: it often excites great coolness or coldness of the surface ;
in some cases the skin is rendered merely soft and moist; in
other instances, the perspiration is free, and at other times it is
most abundant ; but, notwithstanding its profuseness, it does
not reduce or exhaust the system, as many diaphoretics do
when in excess, and therefore need not excite alarm nor be
suspended on that account. 5th. It is nervine, not narcotic,
under any circumstances ; as since our first article, we have
taken it more than twenty times to test its varied powers, and
we have taken it in all quantities, from the production of free
emesis down to the minimum dose. This property renders it of
great value in the treatment of painful diseases and such as are
accompanied with convulsions, morbid irritability and irritative
mobility. For example pneumonia, rheumatism, puerperal
fever, convulsions generally, and palpitation of the heart, &c.

36 Norwood, on Verairum Viride. [January,

6th. It is one of the most certain and efficient emetics known, and
is peculiarly adapted to meet that indication in hooping cough,
asthma^ croup, scarlet fever, and in all cases where there is
much febrile and inflammatory action. It often excites severe
nausea and frequent vomiting, which, taken in connection with
great paleness* often alarms the patient and by-standers ; but
these effects, when in excess, are readily relieved by one or two
full portions of morphine and tinct. of ginger, or of laudanum
and brandy. One grand and leading feature is, that the ex-
haustion which follows it, is not excessive and permanent, but
confined merely to the effort. Again, the matter, first ejected,
is a large quantity of thick, slimy mucus, and soon after, the
liver is called on to pour forth its own fluid in abundance. 7th.
The seventh property is its most valuable and interesting, and
for which it stands unparalleled and unequaled as a therapeutic
agent. So much has already been written on what we call the
sedative arterial sedative properties of the agent, or the
power it possesses of controlling and regulating arterial action,
that we shall not again run over the amount of evidence on this
part of the subject. By virtue of this and other powers, the
treatment of disease has been much simplified, and when the
effects, recorded in the case of Mr. G.'s negro woman, shall
have been fully considered, we may bid adieu to much of the
supposed necessity for stimulants in the treatment of atonic or
-asthenic cases. We challenge the medical world to produce
its equal, as a therapeutic agent, for certainty of effect, for ex-
tent of effect, or for peculiarity of effect, and the ease and
safety with which it may be administered to small and great.
In small portions, we have found nothing to equal it in exciting
and promoting appetite.

The formula we use is the following :

#. Root of veratrum viride, dried, . . oz. 8
Alcohol, of the shops, undiluted, ... i: 16
Let it stand from ten days to two weeks. Medium dose for an
adult male, eight drops, to be increased one or two drops every
portion, until nausea or vomiting, or a reduction in the frequen-
cy of the pulse takes place; then reduce one-half in all cases.
Females, and persons from 14 to 18 years of age, should com-
mence with six drops, and increase as above. Children, from

1853.] Norwood, on Veratrum Viride. 37

one to two years of age, to commence with one chop ; from two
to five years of age, two drops, and increase one drop. The
usual interval with us is three hours between the portions. In
ordinary cases of pneumonia, we usually continue it three days
after the symptons are subsided. In typhoid fever, and many
other diseases, it requires to be continued much longer. For
the satisfaction and information of the profession, we would
state that it may be continued indefinitely, or any length of time,
in moderate doses, or short of nausea, without the least incon-
venience. The only objection that could be urged, is the
increase of appetite, or desire for food. It is not cathartic
it is like all other remedial agents, subject to the same rules
and regulations, making it out of the question for a person to
lay down any but general directions for regulating the dose.
We are better pleased with the method adopted for getting its
first impression by Dr. Welburn, of Farmville, Alabama, than
with our own. We allude to the short interval between the
first three portions he administers: He gives "six drops, in ten
minutes seven drops, in ten minutes more eight or ten drops ;
and then suspends the dose till vomiting occurs," which will
be sure to take place in a large majority of cases. In the out-
set of many cases, we would recommend Dr. Welburn's man-
ner of using it. In a male, twenty-five drops is the largest
quantity we have known to be required to excite emesis, and
sixteen drops in the female when given in the manner and at
the intervals we have directed. There need be no danger ap-
prehended of its exciting inflammation of the stomach we
have given special attention to that particular. It is peculiar
and at the same time interesting in its effects. The fact of its
acting as a sedative on almost every other portion of the sys-
tem, diminishing the vascular and muscular action and motion
of every other part, and increasing that of the stomach. We
have seen it produce emesis in very susceptible persons, and the
contractions of the stomach were so rapid as to be almost con-
tinuous and uninterrupted : but a strong alcoholic tincture of
ginger and morphine would afford more prompt and immediate
relief than any other articles that we have ever used. We
have never scon a case that failed to be relieved by the above
remedies in thirty minutes. The great advantage of the rem-
x. a. VOL. IX. no. i. 3

Norwood, on Veratrum Viride. [January,

edy is that it does not exhaust longer than the effort to vomit
is concerned. A great many remedies leave the patient in an
exhausted and enfeebled condition, aside from the effort or im-
mediate action not so with the veratrum viride. Again, tartar
emetic should never be given with it, in any form or manner.
The only cases in which we have seen the tincture of veratrum
viride purge, were when given in combination with tartar emet-
ic, or with Coxe's hive syrup. In most of these cases it excited
a violent cholera-morbus. We would not think of giving the
tincture of veratrum viride where tartar emetic had been used,
without preceding it with a full dose of morphine or laudanum
at least one hour. We have known many fall out with the
veratrum viride when it was not at fault. Again, venesection,
when a large quantity of blood is drawn, increases materially
its effects, whereas opium and morphine lessens or diminishes
them. If a patient had been bled freely, preceded or followed
by a liberal use of tartar emetic, and then followed up with
medium portions of the tincture of veratrum viride, we should
anticipate and prepare for drastic, if not hazardous effects.

The length of our article warns us of the necessity of con-
cluding. We will, for the benefit of many who have written
us, state the diseases in which we have used it with success,
and leave the matter with the profession for further experiment
and application from analogy. We do not hazard any thing of
opinion or reputation, when we assert that it is a specific in
pneumonia, in the qualified terms we have stated ; we say the
same of convulsions accompanied with high febrile excitement,
also of palpitation of the heart. In typhoid fever it has more
than answered our most sanguine anticipations ; we assert the
same in puerperal fever, scarlet fever, rheumatism and asthma.
In the spring of 1851, we were called in consultation with Dr.
Stewart, to Dr. G.'s child, who was well nigh run down with
hooping cough, fever and diarrhoea. We advised the tincture
of veratrum viride, which acted like a charm ; since which
time, Dr. S. has written us a letter highly extolling it as unpar-
alleled in the treatment of hooping cough. We have seen no
ease of metastasis to the testicle in mumps, that was not reliev-
ed of pain and fever in twelve hours. It may be styled the
remedy in croup, when there is great vascular derangement.

1853.] Xorwood, on Veratrum Viride. 39

We have used it with great success in inflammation of the
brain, also in typhoid dysentery. It is a valuable emmena-
gogue. In the inflamed breast, we give it with a confidence
bordering on a certainty of success. In epileptic convulsions
we have confidence of obtaining great relief from it. We look
with confidence to being able to cure consumption, by a timely
and judicious use of it. We trust even cancer will be robbed
of its terrors. We are anxious to test its powers in yellow
fever and in phlegmasia dolens, &c. In conclusion, we will
state to the profession at large, that we have endeavored to
give a faithful and unexaggerated account of a portion of the
cases in which we have used it, with a statement of its powers
and properties. We know that we have like passions with
other men, and that we are liable to be mistaken, that we are
liable to be carried beyond the bounds of truth and soberness,
as well as others, in our great desire to advance and consumate
as far as we may, the honor and perfection of our science.
But we feel confident, that when all is cool and calm when
every property and power is put to the test of fair and proper
trial that every effect and power claimed by us as belonging
to and possessed by veratrum viride, will be emphatically con-
firmed and established by the profession. We have not made
any effort to distinguish between its primary or direct and its
secondary or indirect effects. If we have succeeded in getting
the profession awakened to its properties and enlisted in the
investigation of its application and adaptation to the treatment
of disease, we congratulate ourselves that we have achieved
much with our feeble efforts, and that ere long we shall see
embodied, by much abler pens, all the inestimable and unpar-
alleled powers belonging to veratrum viride.

Columbus, Ga., March 23, 1852.
Dr. W. C. Norwood :

Dear Sir I left home, for Macon, a few days after you. On my
return, found Dr. BosweU in full blast with the veratrum viride :
visited his cases with him have used it in a fe\v*cascs myself, and
in every case it was sure to reduce the pulse. I am as well pleased
with it as I anticipated, and as much so as any one remedy I ever used.
I have no idea that you claim for it as much credit as it is entitled to.
Four out of the six ounces have been used, and we will soon need
more. I design extending its use in every case where there is too

40 Norwood, on Veratrum Viride. [^anuary?

much arterial action, until I have fully tested whether there be a dif-
ference in its effects in different diseases.

S. A. BILLING, M.D.

[We regret, that we mislaid a letter of later date from Dr,
B., which was much more full and specific than the above,
which was written in haste and in answer to other inquiries.]

Flat Shoals, Ga., Feb. 10th, 1852.
Dr. Norwood :

Sir I avail myself of this opportunity for communicating to you
the result of my experience in the use of the preparation of veratrum
viride. * * * But I assure you that the v. viride, as a curative,
far exceeds any thing with which I am acquainted. I have given it
in only two cases, and if it proves as successful in the future, I pro-
nounce it a specific in the fullest acceptation of the term.

Case 1st. I was called to visit Mr. A. on 5th inst. Found him
laboring under a deep-seated attack of pneumonia typhodes : he had
great difficulty in breathing, intense headache, irritable stomach,
skin hot and dry, pulse 165 to the minute. Commenced giving him
the v. viride in five drop doses, until he had taken four portions ; then
increased it to ten drops. By the next day, at noon, his pulse was
reduced to 85 per minute, skin moist and pleasant, cerebral disturb-
ance removed. His recovery from this time forward was rapidly
attained.

Case 2d. I was called to Mrs. J., whom I found laboring under
palpitation of the heart; pulse 130; great anxiety manifested by the
countenance, and, using her own language, a "sense of suffocation"
experienced. Ordered the v. viride given in ten drop doses, every
three hours. The second dose produced free emesis, and with it an
entire abatement of all distressing symptoms.

These two cases were treated with nothing else, save the v. viride,
in order to test its powers in controlling the circulation. I would not
take $20 for the remnant left, (one ounce,) placing the medicine out
of my reach. I think, sir, you may safely stake your reputation, as a
medical man, upon the virtues of your bantling. It is, indeed, the
" philosopher's stone," and the "blessing of him that is ready to per-
ish," will be bestowed upon you for the discovery.

Trusting that you may live long, to seethe success of your medi-
cine placed beyond the reach of envy or malice, I am, my dear sir,
your ob't ser'vt, J. J. C. BLACKBURN, M. D.

Milledgeville, Ga., Jan. 12, 1852.
Dr. Norwood:

Dear Sir, * * * I feel perfect freedom in assuring you, that
I do not know of any article of medicine which manifests itself as a
reliable remedial agent in any kind of specific action, on particular
parts of the human system, with half the certainty as your preparation

1853.] Norwood, on Veratrum Viride. 41

of veratrum does, in controlling inordinate action of the heart, under
the varied forma of febrile excitement. Calomel does not act with
half the certainty, in emulging the liver nor does aloes, in irritating
the lower part of the rectum nor does ergot of rye, in increasing
parturient effort in labor, and, indeed, 1 might say, nor is tartrite of
antimony more certain to produce emesis, nor is castor oil, nor croton
oil, nor any other purgative, more certain to produce catharsis.

How fur your preparation acts, as a remedial agent, beyond its un-
paralleled and uncqualed control of the sanguiferous system, in the
management of fevers of diflcrent types and at different stages or
what is its modus operandi in producing such effects as are distinctly
evident to any observer of common sense, (physician or otherwise,)
and in seeming to produce very beneficial collateral effects from its
use in very dangerous cases, at critical times, / am not prepared to
say. My testimony, as a medical man of some experience, may,
however, be briefly stated to be decidedly favorable to the use of said
article, believing, as I do, that no physician can use it without regard-
ing it as a very efficient article, and such a one as in its specific con-
trol of the action of the heart, in feverish excitements, fully meets our
heretofore earnest desideratum. Digitalis succeeds in one case out
of twenty perhaps this preparation, in nineteen cases out of twenty,
more certainly.

So much, at present, in reference to my appreciation of the use of
your preparation of veratrum viride. I know that I am sincere, and
do not think that I am enthusiastic beyond a reliable matter of fact. *
* * * JOHN F. MORLAND, M. D-

[The Doctor resides at Corinth, Ga. He was acting mem-
ber of the legislature when the above was written. w. c. n.]

Oglethorpe, Ga., 19th Feb., 1852.

My Dear Sir Please pardon me for not giving you, earlier, the
results of my experience in the use of the veratrum viride. So soon
as I received the package you sent me, I made the saturated tincture of
alcohol, and have used it with more certainty of success, in controlling
arterial action, than any other known remedy. I can truly say, that
I have never found any remedy that produced its specific effects so
certainly in my hands it has never failed. I have used it in scarlet
fever, pneumonia, typhoid pneumonia, typhoid fever, inflammatory
rheumatism, and in all cases where I wanted to lessen the frequency
of the heart's action, and in no instance has it failed. In your pub-
lished articles you have claimed much for it, but not more, nor as
much as it really merits ; for if there is any thing in nature entitled to
confidence, to such a degree as to amount to a certainty, it is most
undoubtedly the article. I hope the profession will ui adopt

its use. and thereby secure tor the l triumph

its, in saving thousands from an untimely grave ; and for you, 1 am
certain the prayers of thousands will arise to a throne of grace, that
you may be abundantly blessed in your labors.

Most respectfully, yours, WILLIAM ELLIS, M. D.

42 Dugas, on Extirpation of a Cervical Tumor. [January,

New York, Sept. 22d, 1851.

At the request of Dr. Norwood, of S. Carolina, in order to test the
effects of the internal administration of the veratrum viride upon the
circulation, 1 selected four cases in my wards, and ordered the tincture
of the root to be prescribed as follows :

Case 1st. Adult female : extensive fissure of the anus and rectum,
spasmodic contraction of the sphincter ani, with excessive pain ;
pulse 130. Dose, five drops every three hours. Pulse reduced to 68
in fifteen hours.

Case 2d. Adult male : morbus coxarius; pulse 99. Dose, from
five to eight drops every three hours. Pulse reduced in twelve hours
to 50 beats.

Case 3d. Adult male: articular rheumatism; pulse 120. Dose,
from five to eight drops every three hours. Pulse reduced to 80 in
fifteen hours.

Case 4th. Adult male : the effects of the operation by excision for
large sarcolated hydroceles of the tunica vaginalis on both sides ;
pulse 102. Dose, five drops every three hours. Reduction in ten
hours to 60 beats.

I should have much confidence in the salutary action of the vera-
trum viride in cases of acceleration of the pulse in traumatic lesion of
any of the vital organs, in patients of a robust constitution, or with
sthenic diathesis. J. M. CARNOCHAN, M. D.,

Surgeon of the New York Emigrant's Hospital ;
Prof, of Surgery in the N. York Med. College.

ARTICLE III.

Extirpation of a Cervical Tumor. By L. A. Dugas, M.D., &c.

Elick, a negro (blacksmith), about 40 years of age, belonging
to Mr. James McDow'el, of Talbot county, Ga., was sent to me
in November last, when I obtained the following history of his
case : About thirteen years ago he perceived a small tumor
upon the right side of his neck, a little above the clavicle, which,
although somewhat tender to the touch, remained without giv-
ing him any trouble until nine years ago, when he began to
feel some uneasiness in the right arm, which would be increased
upon pressing or handling the tumor, then apparently not larger
than the end of his thumb. The pain of the limb gradually
became more troublesome until four years ago, since when he
has been more or less incapacitated for the duties of his trade,
his sufferings being very much aggravated by working at the
anvil. For the last six or eight months his entire limb has

1853.] Dugas, on Extirpation of a Cervical Tumor. 43

been the seat of incessantly excruciating pain, depriving him
of sleep, and utterly unfitting him for any kind of work. Sev-
eral years ago his right hand and arm became very tremulous,
and this state of things extended to the left arm, and subse-
quently to the whole muscular system. Several physicians
were consulted, and pronounced the tumor to be aneurismal.

Upon examining the case I found it to be as follows : A
tumor exists in the triangular space above the clavicle, and
between the sterno-cleido-mastoideus and trapezius of the right
side. It appears to be beneath the platysma myoides, presents
a surface about the size of a half-dollar coin, but evidently ex-
tends down to the brachial plexus, the subclavian artery and the
clavicle. It is extremely sensitive to the touch, or rather, when
touched, intense pain is induced in the brachial plexus and
down the arm to the fingers. It is very slightly moveable,
yields a sense of obscure fluctuation, and pulsates visibly as
well as to the touch, synchronously with the arteries. The
pulsation is arrested by compressing the subclavian artery
nearer the heart, but the size of the tumor remains unchanged
nor can this be diminished by direct pressure upon the tumor.
Auscultation reveals no aneurismal sound. General health
pretty good, with the exception of the muscular tremor, which
was much increased by the examination. He carries the limb
in a sling, or holds it up wTith the other hand, when walking or
standing ; but when seated, draws the affected arm around the
back of the chair or bed-post with the left hand, so as to effect
as much pressure as possible and to keep it steady, by which
means he says he is partially relieved of the dreadful pain.
Can use his hand, but cannot elevate the arm probably from
protracted disuse added to the nervous affection. He is so
nervous that he perhaps exaggerates his sufferings.

Being satisfied that the case was one of diseased lymphatic
gland, which derived its pulsations from contact with the sub-
clavian artery, and which irritated, by pressure, the subjacent
brachial plexus, I proceeded to extirpate the tumor on the 27th
November, in presence of the Medical Class and others.

This was effected in the usual manner. The tumor was
found to be about the size of a large hen's egg, in contact with
the subclavian artery, and resting upon the brachial plexus, to

44 Dugas, on Extirpation of a Cervical Tumor. [January,

which it was connected by strong areolar tissue. It proved to
be a lymphatic gland, whose investing membrane was thick
and resisting, and whose structure, broken up by chronic dis-
ease, presented a mass of shreds and small cavities filled with a
caseous and grumous matter.* Subjected to microscopical
examination by Dr. Juriah Harriss, no carcinomatous cells
were detected.

The great impairment of the patient's nervous functions, his
extraordinary timidity and reluctance to submit to what he
thought would in all probability kill him, and the necessity of
inducing, for such an operation, the most complete or coma-
tose anaesthesia for a greater length of time than might be
safe under the circumstances, induced me to omit the use of
chloroform or ether. He bore the knife very badly, was ex-
tremely unruly, and thus protracted the completion of the
operation much beyond what was necessary. A slight suppu-
ration ensued, but the wound was perfectly healed on the 12th
December, and he returned home on the 16th.

The patient felt no more pain in the right arm after the day
of the operation, but said there was still some numbness and
weakness in the limb. When he left here he had so far recov-
ered the use of his arm as to be able to cut wood with an axe,
or with a saw, the left hand, however, being much the stronger
of the two. He could not yet elevate the whole limb but will
doubtless regain its full powers by use.

The rare occurrence of such serious effects from so small a
tumor in the cervical region, together with the interest attach-
ed to the case in consequence of a difference of opinion with
regard to the diagnosis, have induced the writer to put it on
record.

Augusta, Dec. 1852.

An account of diseased Cervical Glands was published by the writer in this
Journal, in 1846, vol. 2, new series, p. 513.

1853.] On Amputation. 45

-i

PART II.
Cclcctic Department.

What is the best time to amputate?

[We extract from one of Mr. Guthrie's lectures, published
in the London Lancet, the following aphorisms in reference to
the time at which amputations should be performed after
wounds. The eminent abilities and extensive experience of
Mr. G. entitle his conclusions to great respect. Editor.]

40. When the wound of an extremity is of so serious a na-
ture as to preclude all hope of saving it by scientific treatment,
that limb should be amputated as soon as possible.

41. An amputation of the upper extremity may almost al-
wavs be done from the shoulder-joint downwards, without much
risk to life, and when necessary, the sooner it is done the better.

42. An amputation of any part of the lower extremity be-
low the knee downwards may be done forthwith, with nearly
an equal chance of freedom from any immediate danger, as of
the upper extremity at or near the shoulder-joint.

43. It is otherwise with amputations above the middle of the
thigh, and up to the hip-joint. They are always attended by
considerable danger.

44. There can be no doubt that if the knife of the surgeon
could in all cases follow the ball of the enemy, or the wheel of
a railway carriage, and make a clean good stump instead of
leaving a contused and ragged wound, it would be greatly to
the advantage of the sufferer ; but as this cannot be, and an
approach to it even can rarely take place, the question naturally
recurs, At what distance of time after the receipt of the in-
jury or aecident can the operation be performed most advan-
tageously for the patient ?

45. In order to answer this question distinctly, it should be
considered with reference to two distinct states of injurv:

1st. When injuries require amputation of the arm below the
shoulder-joint, or of the leg below the knee, these operations
may be done at any time from the moment of infliction until
the expiration of twelve or twenty-four hours, without any
detriment being sustained by the sufferer with regard to his
recovery ; although every one, under such circumstances, must
be desirous to have the operation over. The surgeon having
several equally serious cases of injury of the head or trunk
brought to him at the same time as two requiring amputation,
may defer them more safely perhaps than the assistance he is

46 On Amputation. [January,

also called upon to give to the other cases, the postponement
of which may be attended with greater danger.

2nd. This state embraces those great injuries, in which the
shoulder is carried away with some injury to the trunk, or the
thigh is torn off at or above its middle, rendering an amputation
of the upper third or at the hip-joint necessary ; and it is this
or nearly this state which alone implies a doubt as to the pro-
priety of immediate amputation, and demands further investi-
gation. It is the state to which your attention is earnestly
drawn for future observation.

46. It has been implied, if not actually maintained, that a
man could have his thigh carried away by a cannon-shot with-
out being fully aware of it, or, if aware of it, that it did not
cause much alarm in fact, that it did not materially signify
as to his apprehension, whether the ball took off his limb or the
tail of his coat, or only grazed his breeches. An instance of
this kind has not fallen under my observation.

47. A surgeon on a field of battle can rarely have a patient
brought to him, requiring amputation, under less time than
from a quarter to half an hour ; a surgeon in a ship may see
his patient in less than five minutes after the receipt of the in-
jury ; and to the surgeons of the navy we must hereafter defer
for their testimony as to the absence or presence of any con-
stitutional alarm and shock ; and if they occur, to what degree
do they follow immediately after the receipt of such injury.
The question must not be encumbered and mystified by a re-
ference to all sorts of amputations after all sorts of injuries,
but to the one especial injury viz., that of the upper half of
the thigh.

48. My experience, which may be erroneous, like every thing
human, has taught me, that when a thigh is torn or nearly torn
off, by a cannon-shot, there is always more or less loss of blood,
suddenly discharged, and which soon ceases in death, or in a
state approaching to syncope. When the great artery is torn,
this fainting saves life, for an artery of the magnitude of the
common femoral does not close its canal by retracting and con-
tracting, as a smaller vessel does ; it can only diminish it ; and
the formation of an external coagulum is necessary to preserve
life, which the shock, alarm, and fainting, by taking off the
force of the circulation, aid in forming ; and without which the
patient would bleed to death. An amputation, in this state of
extreme depression, might destroy life.

49. If the cannon-shot, or other instrument capable of crush-
ing the upper part of a thigh, should not divide the principal
artery, and the sufferer should not bleed, it is possible he may
be in the state alluded to, in which the patient, for he may not,

1853.] On Amputation. 47

be called sufferer, is said to be just as composed as if he had
only lost a portion of his breeches. Nevertheless few have
seen a man lose even a piece of his breeches by a cannon-shot
without perceiving that he was indisputably frightened.

50. Whilst some persons, under the loss of a limb high up,
are reduced to a state of syncope, or nearly approaching to it,
which renders them almost, or even entirely speechless ; others
suffer extreme pain, and earnestly entreat assistance, under
which circumstances, amputation should be performed forth-
with. In the former, the administration of stimulants may
render the operation less immediately dangerous.

51. Chloroform, or other similar remedies, may produce an
effect in such cases yet unknown. Its careful administration
may not destroy the ebbing powers of life, and may render an
amputation practicable, which could not otherwise be perform-
ed without the greatest danger. It may be otherwise ; the
point, however, is to be ascertained, although in all cases of
great suffering its use should be unhesitatingly adopted.

52. When the sufferer is brought to the surgeon at the end
of half an hour, having lost a limb below the thigh or shoulder,
by a cannon-shot, he will often be found in a state of such great
depression as to be likely to be destroyed by the infliction of a
serious and painful operation like amputation. This has oc-
curred to me so often as to induce me to recommend delay for
five, six, or even eight hours, if the unfortunate person did not
sutler much, and appeared likely to be revived by the proper
use of stimulants.

53. This recommendation originated from the fact, that as
one seriously wounded man has as much claim as another to
the attention of the surgeon, all could not be attended to at the
same time ; and the success following the deferred cases of
amputation was as great, if not greater, than in those on which
the operation was more immediately. performed.

54. The advantageous results of primary amputations, or
those done within the first twenty-four, or at most forty-eight
hours, over secondary amputations, or thdse done at the end of
several days, or three or four weeks, has been so firmly and
fully established as to admit no longer of dispute.

55. When an amputation is deferred to the secondary period,
a joint is often lost. A leg which might have been cut off be-
low the knee in the first instance, is frequently obliged to be
removed above the knee when done in the second.

56. In the secondary period after reat injuries, the areolar
and muscular textures near the part injured are often unhealthy,
the bones are in many instances inflamed internally, and their
periosteal membranes deposit on the surrounding parts so much

48 Preparations of Arsenic. [January,

new ossific matter as frequently to envelope in a few days the
ligatures on the vessels, and render them immovable, necrosis
of the extremity of the bone following as a necessary conse-
quence, protracting the cure for months.

57. Sloughing of the stump, accompanied by inflammation
of the vein or veins leading to the cava, frequently take place.
This state of stump is often followed by purulent deposits in
and upon the different viscera, and principally in the cavities of
the chest. Where febrile diseases are endemic, they often pre-
vail ; the constitutional irritation is great ; the stumps do not
unite, or open out is apparently united and slough, and fre-
quently after a few days implicate the veins. [London Lancet.

Preparations of Arsenic.

Arsenic, the therapeutic use of which appears to have been
from the earliest ages diffused generally throughout India and
China, has been, since the sixteenth century, much employed
by the physicians of Germany, England, France and Italy.

The therapeutic history of this heroic remedy is one of the
most interesting on record. Thousands of facts had long at-
tested the efficacy of arsenical preparations in the treatment of
intermittent fevers, when experience proved that they might
be also advantageously employed in diseases of the skin ; it was,
moreover, known that arsenic had been extolled in India as a
remedy in the most serious affections, and particularly in ele-
phantiasis.

In 1817, Biett, repeating at the Hospital St. Louis the ex-
periments he had just witnessed in the London Hospitals,
introduced into France the employment of arsenic in the treat-
ment of cutaneous affections, and from the first laid down rules
for its use, which it has not since been found necessary to
modify.

The preparations of arsenic, notwithstanding their incontesti-
ble value in the treatment of many diseases of the skin, are not
applicable to all. They are principally useful in the essential-
ly chronic affections ; in the dry forms, such as psoriasis and
lepra ; and in eruptions of another class, which, after having
resisted rational treatment, and having become, as it were,
established, show an obstinacy which seems dependent on local,
idiopathic conditions of the skin, as in chronic-lichen, and espe-
cially in certain forms of eczema.

They afford us the most effectual remedies in the treatment
of the elephantiasis of the Greeks.

Good effects have also been obtained from the employment

1853.] Preparations of Arsenic. 49

of arsenical preparations in the treatment of venereal diseases,
and especially in the tuberculous and scaly forms of syphilitic
eruptions.

I have already mentioned that the efficacy of certain decoc-
tions (de Felz. d' Arnault, &c.) in the composition of which
more or less antimony is employed, is generally attributed to
the presence of arsenic.

Iodide of Arsenic Thompson's Pills. Iodide of arsenic,
three-fourths of a grain ; extract of hemlock, one scruple: make
into ten pills one to be taken every eight hours. This very
active formula has been principally employed in lepra.

Mr. Donovan has recommended the double iodide of arsenic
and mercury, a compound of equal parts of iodide of arsenic
and bin-iodide of mercury, in the treatment of lepra, psoriasis,
lupus, and of syphilitic affections. Solution of double iodide of
arsenic and mercury modified by Soubeiron. Iodide of arsenic,
iodide of mercury, of each, one part ; distilled water, ninety-
eight parts. This solution contains an hundredth part of each
iodide.

Arsenious Acid. Liquid Arsenious Acid. A solution of
three-quarters of a grain of arsenious acid in eight ounces of
distilled water is employed under this name in the German hos-
pitals. The dose is one table-spoonful, gradually increased to
six, and is to be taken in the morning on an empty stomach
(Foy.) Dr. Gilbert! }s formula : Arsenious acid, three-quarters
of a grain; distilled water, sixteen ounces; dissolve by the aid
of heat ; divide into five phials, the contents of each of which
are to be taken in the morning of either one or two days, accord-
ing to circumstances. This formula is generally preferred by
M. Gilbert in the treatment of diseases of the skin, and especial-
ly of psoriasis. Asiatic Pills. Arsenious acid, three-quarters
of a grain ; black pepper, ten grains ; gum Arabic, one-sixth of
a grain ; water, as much as sufficient to make twelve pills one
to be taken daily. This preparation is very active; it is the
one I usually prefer, varying the dose from one to two, but
more frequently diminishing it in the following manner:
Take the mass of Asiatic pills, eight grains ; extract of taraxi-
cum, twenty-three grains ; mix and divide into twenty-three
pills, of which one or two are to be given daily.

Arsenite. But one arsenite is employed in therapeutics,
namely, the arsenite of potash, forming the basis of Fowler's
solution, which is a very energetic medicine, and requires to
be used with caution. Biett, who frequently prescribed it, re-
commends that the daily dose should at first be only two or
three drops, and never exceed twelve, administered in two
equal portions.

50 Intussusception of the Bowels. [January,

Arsenical Solution. Arseniate of
soda, three-quarters of a grain ; distilled water, one fluid ounce;
dissolve and Alter (Cordex.) Dose: a scruple, gradually in-
creased to half a drachm. This preparation is milder and more
manageable than Fowler's. I prefer it with women and chil-
dren, in cutaneous diseases. Biett s Arsenical Liquor. Ar-
seniate of Ammonia, three grains ; distilled water, four fluid
ounces. The uses and dose of this are the same as those of
the preceding preparation. Pills of Arseniate of Soda. Ar-
seniate of soda, three-quarters of a grain ; extract of taraxicum,
half a drachm ; divide into thirty pills one or two to be taken
for a dose. Use, the same as of the preceding preparation. I
often employ thisformule with advantage. Pills of Arseniate
of Iron (Biett.) Arseniate of iron, two and a half grains; ex-
tract of hops, one drachm; syrup orange flower, a sufficient
quantity ; make into forty-eight pills. Biett employed these
pills particularly in scaly affections and in lupus the dose is
one daily. [Dublin Quarterly Journal.

Remedy for Intussusception of the Bowels. By A. S. Baldwin,

of Jacksonville, Florida. (Extract from a letter to the Edi-
tor.)

Having recently seen in the medical periodicals, several re-
ports of post-mortem examinations, in cases of intussusception
of the bowels, I am induced to send you an account of a rather
simple, but what appeared to me a very effectual remedy for
this complaint, in a case which came under my care about four
years ago, when I had despaired of affording relief by the ordin-
ary remedies. If it shall seem to you to have sufficient merit,
it may, perhaps, by giving it publicity in your journal, induce
other members of the profession to give it a trial. During the
last fifteen years, several cases of this complaint have come
under my observation, most of which terminated fatally. The
various remedies recommended were applied ; among them the
long elastic tube, for the purpose of throwing fluids high up
into the bowels, with the hope of distending them so that the
vaginated folds of the intestine might be drawn out. In some
instances, at least, its use appeared to be productive of mischief,
from passing through the constricted part of the intestines, so
that the fluid injected was lodged in the pouch or sack existing
above the point of obstruction ; to ineffectually increase the
distension already existing there ; for, when the tube was with-
drawn, no fluid was returned, and the distension was increased
without having the effect to remove the difficulty. Injections
administered by the common syringe were returned immedi-

1853.] Intussusception of the Bowels.

ately, even while giving them, ana" had no effect to distend the
lower bowel, so as to aid in overcoming the obstruction, and
the conclusion arrived at was, that adhesions existed between
the folds of" the invaginated parts of the bowel, and the obstruc-
tion was irremediable.

Circumstances which have occurred to me, dispose me to
think that these adhesions do not take place so early, or so fre-
quently, as many are disposed to believe. About three years
ago, a case of this kind occurred in my practice, and for several
days all the appliances which had been recommended had been
used to overcome the obstruction, but without avail. There
was a circumscribed spot, to the left of the umbiiicus, and a
little below it, which was painful ; there was considerable dis-
tension of the abdomen, with a sensation of soreness across, but
which did not amount to pain (being what is called in this
country "misery"). Twice in this case the long tube was
used, and injections thrown high up into the bowels, which,
however, did not return upon the withdrawal of the tube, but
added to the swelling previously existing above the point of
obstruction. I was apprehensive that adhesion had by this
time taken place, and as I despaired of relief by the ordinary
methods, and the patient had arranged his temporal affairs
and given himself up to die, I determined to distend the lower
bowels, to their utmost capacity, by the injection of warm water.

An ivory tube, having a shield around it, was introduced and
passed up until the shield was pressed up against the sphincter
ani, a cloth was wrapped around this and pressed up firmly ;
the tube was now connected by an elastic tube with the pump,
which was placed in a wash-basin of warm water, which was
slowly injected into the bowels, pressure being kept up to pre-
vent its return. Another basin of water was brought, half of
which was thrown up. The abdomen was, of course, much
distended by this quantity of fluid, and considerable rumbling
and commotion of the bowels were produced, the pain at the
point of obstruction was, for a moment, acute, causing the pa-
tient to cry out. The pressure and tube were removed, and
we found he had the power to retain the injection until he
could be helped to the chair, when about five quarts of the in-
jection was passed ; becoming faint, he was laid upon the bed,
and brandy and water administered ; he soon rallied, and pass-
ed as much more, colored by fecal matter ; soon after, a copious
and regular, but very offensive stool was had, in which the oil,
taken several days before, could be distinguished. After this,
he had no farther difficulty, except debility, and a sensation of
soreness at the point of obstruction, which lasted for a few-
days, when he returned to his work, that of a carriage-maker,

52 External use of the Nitrate of Lead. [January,

and up to the present time Has had no return of the complaint.
Since that time I have not had so severe a case of this com-
plaint, but in every case which shows a disposition to be obsti-
nate, I resort to this mode of injection, with uniform and im-
mediate success. Perhaps some of these would have been as
obstinate as the one above detailed, if the former mode of
treatment had been pursued; but I am fully impressed with
the belief that, had this remedy been used with those cases
which had proved fatal, some of them, at least, might have
been saved. The case in which I first tried it was an unprom-
ising one, on account of the long time which had elapsed since
the attack before the remedy was used, sufficient for adhesive
inflammation to have agglutinated together the folds of intes-
tine involved in the intussusception. [Am. Journ. Med. Sc.

External use of the Nitrate of Lead.

Dr. Ogier Ward was induced to make use of this prepara-
tion in cases accompanied by feted discharges, observing its
advantages as a disinfectant under other circumstances.

The first case in which he used it with this intention was
that of a lady, whose lochia were so offensive as to scent the
whole house, and nauseate even the nurse. It was used as an
injection ; and the third application effected the complete re-
moval of the fetor.

He has also used it with success as a lotion for sore legs
when in a sloughy and indolent condition, and finds that it soon
restores them to a healthy state, inducing a proper secretion
of pus, with firm granulations on the surface of the ulcer.

He has not used the nitrate in acute gonorrhoea, but states
that it acts admirably as an astringent in gleety discharges, as
well as in those of cancer uteri, whether sanious or purulent.
In short, as a lotion it is as extensively useful as the diacetate
of lead, while it is superior to that preparation by its disinfect-
ing property.

In chronic cutaneous diseases he has seen the most remarka-
ble instance of its efficacy in a case of eruption, of a kind of
rupia or impetigo of five years' standing. The complaint broke
out on the vertex of a woman, set. 50, and, leaving its original
site, it has gradually crept down over the forehead, nose and
cheeks, to the level of the mouth. The primary form of the
eruption consisted of inflamed, flattened pustules, slightly ele-
vated above the surrounding skin, which, discharging their
contents, formed thick, rough, yellowish crusts, or scabs, fis-
sured in all directions, like those of crusta lactea, which, firmly
adhering and growing from their base, like rupia, for a longer

1853.] Manganese as an Adjuvant to Iron. 53

or shorter time, fell off at last, leaving cicatrices of various
shapes, exactly like the seams and pits of smallpox. The pa-
tient came under Dr. Ward's care some months ago, when he
tried many remedies, both internal and external, in vain, quinine
being the only one that produced any good effect, and this not
permanently. As the skin around the sores and where they
had healed seemed in a state of hypertrophy, the papillae pro-
jecting in many places as in elephantiasis, it occurred to him
that the best way to check the progress of the disease would
be to apply some penetrating astringent to the surface; and
with this view he ordered a lotion of the nitrate of lead, with
quinine, internally. In the course of a few days, the eruption
ceased to make any progress, the crusts began to IjlII off, and
the skin to lose its redness and swelling ; and in a fortnight
every sore was healed, though the face and forehead remained
still seamed with scars. There has been no fresh breaking out
for some weeks, though, as the nose is still red and swelled, he
has ordered the continuance of the lotion.

The formula he generally uses is the following : ty. Plumbi
carb. scr. j ; Acid. nitr. dil. q..s. ad solvendum ; Aquae dist. fej.
M. Fiat lotio bis terve indies assidue utenda. [Prov. Med.
and Surg. Journal.

On the use of Manganese as an adjuvant to Iron. By M.
Petrequin.

M. Petrequin quotes various authors to prove that manga-
nese is a normal constituent of the animal and vegetable tissues;
and believes that wherever iron is present in appreciable quan-
tity, manganese co-exists with it. Hence iron alone will not
always succeed in blood-diseases. M. Petrequin has observed
many cases of chlorosis, which have resisted iron as obstinately
as anaemia connected with cancer or organic degeneration.
Other cases again, after deriving a certain amount of benefit
from iron, remain stationary. Others again appear cured by
iron, but the cure is not permanent. The remedy required in
this case, M. Petrequin finds to be manganese. He does not
give it or iron alone, but combines them.

It is especially in diseases of the blood that ferro-manganic
medicines are useful. They have a special action on the vas-
cular apparatus, on the formation of the blood, and on the circu-
lating fluid itself. They do not act as tonics or astringents,
but as regenerators of the blood. They have succeeded ad-
mirably in anaemia following haemorrhage, operations, polypi,
metrorrhagia, etc. ; also, in chlorosis attending puberty, which

x. s. VOL. IX. no. i. 4

54 Manganese as an Adjuvant to Iron. [January,

is a more common disease than is generally supposed, and oc-
curs even in males. M. Petrequin has also frequently found
the combinations of iron of benefit in the diseases of women at
the critical period. He has often seen in these subjects, metror-
rhagia, accompanied with an aspect of the surface which
would lead to the suspicion of organic uterine disease: the
haemorrhage, however, was but a complication, and the pa-
tients, apparently in a hopeless state, have recovered under the
use of ferro-manganic preparations, conjoined with tonics and
ergotine.

In amenorrhea and dysmenorrhea, the patients often ima-
gine that they require to be bled ; but care must generally be
taken not Jo comply with this request. M. Petrequin has more
than once seen cases of amenorrhcea with severe chlorosis, in
which it has not been desirable to hasten the appearance of the
catamenia the consequent loss of blood aggravating the dis-
ease. The general state of health must here be attended to.
(Edema of the lower limbs sometimes occurs in these cases; but
it is a less severe complication than when it attends metrorrha-
gia. It often disappears, as the.patient recovers, under the use
of iron and manganese.

These medicines are no less efficacious in the treatment of
ancemia resulting from prolonged intermittent fevers, prolong-
ed suppuration, strumous, syphilitic, or cancerous affections,
phthisis, etc. Pills and the syrup of the iodide of manganese
and iron are preferable in these cases.

In all these cases, the ferro-manganic preparations do not
merely act on the stomach and nervous system, but they are
absorbed, and assist in the formation of haematosine and new
blood-globules, so as to restore the blood to its normal condi-
tion. Their effect in this way is greater than that of iron alone.

In the functional affections of the heart connected with chlo-
rosis and anaemia, and which must not be mistaken for organic
disease, a combination of iron and manganese with digitalis
and other moderators of the heart's action is advantageous.
The same remark applies to the functional disorders of the
lungs, attending the same constitutional states.

Disordered states of the nervous system are intimately con-
nected with those of the blood. He, as well asM. Gubian,has
observed that iron is here better tolerated when combined with
manganese. He has also seen benefit from the use of iron with
manganese in many cases of dyspepsia, gastralgia, and gastro-
enteralgia. Nervous affections of the digestive organs are
often the result of chlorosis ; and, where stomachics and cin-
chona have failed, iron has often been found (especially the
carbonate, by some English physicians) to be of service. Gas-

18.r>3.] Manganese as an Adjuvant to Iron. 55

trodynia complicating chlorosis has often yielded to the use of
ferro-manganiferoua water, and to pills of carbonate of iron and
mangane

In nervous affections connected with exhaustion from venere-
al excesses, onanism, rapid growth, &c, as well as in leucor-
rhcea, diabetis, &c, M. Petrequin has a high opinion of these
medicines. He is continuing his researches on their action in
certain cases of sterility from asthenia, and in some hyposthe-
nic affections of the scalp, such' as early baldness, alopecia, &c.

M. Petrequin has confined his observations to a limited num-
ber of the fm-o-manganic preparations; and has made many
observations before publishing the formula? which he finds most
useful. Having found, even at an early period, that the medi-
cines were liable to adulteration, he has availed himself of the
assistance of competent pharmaceutists. Since the publication
of his first memoir, in 1849, these medicines have been exten-
sively used in the South of France and in foreign countries.

The formulas are few, and correspond to the prepa'rations of
generally used in France. They are: 1. Pills of carbon-
ate of iron and manganese, or iodide ; 2. Lozenges of lactate of
iron and manganese; 3. Syrups of lactate or of iodide of iron
and manganese; 4. Ferro-manganic chocolate ; 5. Effervescing
solution of iron and manganese.

Jt has been said that manganese not only preserves water,
but purifies that which has undergone a change (Martin Lau-
zer). Ferro-manganic waters (of which there are many in
France and other parts of the continent) can be preserved and
carried to a distance; which cannot generally be done with
simple ferruginous waters.

M. Petrequin commences by giving the powder of iron and
manganese, with some vinous drink; he then administers two
pills daily, one before breakfast and one before dinner, replacing
them soon by lozenges. The syrups and chocolate complete
the treatment. He gives the medicines at meal-time. The
syrup he gives before breakfast, in doses of a tea-spoonful ; and
he finds it useful to administer directly after it some infusion of
centaury, or of camomile flowers and orange.

Large doses are unnecessary and useless; for they are liable
to produce irritation of the stomach and exhaustion of the ner-
vous system ; and the reparation of the blood is slow and pro-
gressive, and cannot, even were it desirable, be effected rapidly.
Besides, the iron and manganese are not absorbed in any
greater quantity, if large doses are given.

Preparations of Manganese and Iron. M. Burin-Dubuisson,
ot Lyons, who prepared most of the ferro-manganic combina-

56 Manganese as an Adjuvant to Iron. [January,

tions used by M. Petrequin, has published an interesting
brochure, in which he gives the necessary details relating to
the subject. The following formulas are extracted from it.

Powder for Effervescing Solution of Manganese andiron.
Take of coarsely powdered bicarbonate of soda, 20 parts ; tar-
taric acid, 25 parts ; powdered sugar, 53 parts ; finely pow-
dered sulphate of iron, 1 parts: finely powdered sulphate of
manganese, f parts: mix carefully and keep in well stopped
bottles. A tea-spoonful is mixed with each glass of wine and
water drunk during meal-time.

Pills of Carbonate of Iron and Manganese. Take of pure
crystallized sulphate of iron, 75 parts; pure crystallized sulph-
ate of manganese, 25 parts ; crystallized carbonate of soda, 120
parts; honey, 60 parts; water, a sufficient quantity. Pills of
20 centigrammes (3 grains) are made ; they keep easily, with-
out becoming oxidized, in well-closed vessels. From two to
four are given daily.

Ferro-manganic Chocolate. One part of carbonate of iron
and manganese is first mixed with four of sugar, antf divided
into large lozenges; of these, 100 parts (grammes) are mixed
with 500 of chocolate paste, in the preparation of which 100
parts of sugar have been left out. This will make 800 lozen-
ges, each of which contains about three centigrammes (nearly
half a grain) of carbonate of iron and manganese. The choco-
late decomposes the hydrated carbonate of manganese and iron
of the saccharate into hydrated sesquioxide of iron and manga-
nese ; there is no metallic taste.

Syrup of Lactate of Iron and Manganese. Take of lactate
of iron and manganese, 4 parts ; powdered sugar, 16 parts ; rub
together, and add of distilled water, 200 parts ; dissolve rapidly,
and pour into a mattrass over a water bath, containing 384
parts of broken sugar: filter the solution. This syrup con-
tains about 15 parts of lactate of iron and 5 of lactate of man-
ganese in 3,000 parts. One or two spoonfuls are taken daily.

Lozenges of Lactate of Iron and Manganese are made by
adding 20 parts of the lactate to 400 of fine sugar, with a suffi-
cient quantity of water. The mass will make 840 lozenges ;
of which six or eight are taken daily.

Syrup of Iodide of Iron and Manganese. M. Burin Du-
buisson forms a solution of iodide of iron and manganese, in
the proportion of one part by weight to two of water : the pro-
portion of the salts is about three of iodide of iron to one of the
iodide of manganese. Six parts of these are mixed with 294 of
simple syrup ; of this, M. Petrequin gives one or two tea-
spoonfuls daily.

Pills of Iodide of Iron and Manganese. Take of the

1853.] Chloroform in Delirium Tremens. 57

officinal solution prepared by M. Barin Dubuisson, 15 parts
(grammes); hone}', 5 parts; some absorbent powder, 9{ parts.
Divide into 100 pills. The honey and the solution are first
mixed, and evaporated at first rapidly, then more slowly, to ten
parts. Then add the powder, and divide the mass into four
parts, which must be rolled in powder of iron reduced by hy-
drogen; each of these must then be divided on an iron plate
into 25 pills, and again rolled in the iron powder. Finally, they
are covered with a layer of tolu, according to M. Blanchard's
process.

All these preparations must be made very carefully. M.
Burin Dubuisson has ascertained that the commercial salts of
manganese frequently contain copper, and even arsenic ; he
hence insists on the necessity of calcining the sulphate of man-
ganese, twice, or more frequently, at a dark red heat, and of
carefully testing the solution. [London Journ. of Med.

On the internal administration of Chloroform in Delirium
Tremens. By George E. Fexwick, M. D., Lecturer on
Materia Medica, St. Lawrence School of Medicine, Physi-
cian to the Montreal Dispensary.

J. S., aged about 40, labouring under an attack of Delirium
Tremens, brought on by suddenly stopping all stimulants after
having led an irregular life for months, came under my care
on the 16th September, 1852. Present symptoms. Great
anxiety expressed in the countenance, fear of impending danger
frequent sighing, general tremor, delirium when left alone,
which w7as of the quiet muttering kind, as if holding conversa-
tion with some imaginary person, pulse 110, weak, tongue
covered with a whitish fur, bowels had been opened slightly
that morning, appetite capricious, had not slept since the Satur-
day previous. It was 0 o'clock at night when I first saw my
patient ; I ordered a full opiate, and as he bad formerly been
in the habit of chewing opium, I prescribed it in six grain doses,
to be repeated every second hour until he slept ; two doses only
were administered, the effect of which was to deprive him of
consciousness, but he did not sleep, he raved and walked about
his room the whole night.

The following day, Friday, he was worse, tremor increased,
constant muttering, though when spoken to he conversed ration-
ally on whatever subject was stated. He stated there were
too little devils playing the dium on his head, and that they
kept up such a noise he could not sleep. The eye exhibited
greater wildness and less fear than last night, the pulse was
the same 110, but fuller and more bounding, bowels not open.

58 Chloroform in Delirium Tremens. [January,

I prescribed two blue pills rolled in Croton oil, to be taken
immediately and at night the following draught :
$. Spt. iEth. Sulph. 3ii.
Chloroform, 3 i. M.

This draught to be repeated every second hour until sleep
was induced. Owing to a mistake the patient did not take the
pills till 8 o'clock, P. M., and half an hour afterwards the
draught was administered ; the pills operated rather briskly,
both up and down, an hour after they were taken, and the
draught was not repeated.

Saturday, 18th. Found my patient somewhat better, although
he had had but one draught of the chloroform, still, through the
night he had dozed once or twice for a few minutes at a time.
The symptoms not being urgent, I ordered porter to be taken
during the day and nourishment. Visited my patient at 9
o'clock, P. M., determining to administer chloroform myself
and watch its effects.

Igave three teaspoonsful of a mixture composed of chloroform
and spirits of sulphuric ether, in the same proportions as above ;
in a few minutes he complained of drowsiness; he closed his
eyes and became perfectly tranquil, the respirations became
deeper and slower, the pulse fell from 96 to 62 ; to keep up the
action I held the bottle to his nose for a few minutes ; I watched
him for half an hour, during which time he appeared to be in
a natural sleep. This state lasted for about three hours. At
leaving, I directed the draught to be repeated in two hours if
necessary, but my instructions were not attended to.

The day following, Sunday, he appeared much refreshed,
less tremor, pulse 72, had eaten a hearty breakfast. I did not
repeat the chloroform through the day ; that afternoon he slept
for an hour and a-half ; at night I again visited my patient, and
again administered the chloroform and ether as before ; a single
dose threw him into a profound sleep, from which he did not
awake till six o'clock the following morning. From this time
he gradually recovered, slept naturally and well without the use
of chloroform ; the only unpleasant symptom noticed was head-
ache, which came on for two or three mornings afterwards,
and lasted for some hours ; this appeared to be relieved by
porter.

The second case which fell under my observation was one
of quite a different character :

Mr. S., labouring under an attack of delirium tremens,
brought on by a debauch, came under my care 2nd October,
1852. When I saw him there was considerable anxiety, great
tremor, the eye wild and staring, features bloated and swollen,
pulse 120, full and bounding, tongue furred, bowels constipated

5853.] Chloroform in Delirium Tremens. 59

liad not slept for two nights ; I administered 2 drops of Croton
oil immediately, and prescribed the following mixture :
$. Tr. Opii 3 ii.

Ant. Tut. Tart. gr. iv.
Aquas 5 iv. M.

Dose, a tablespoonfull to be taken every three hours. The
Croton oil operated five or six times, and alter the first dose the
antimony was borne by the stomach.

This treatment was continued up to the evening of the 4th
when, as there was bo improvement nor tendency to sleep, I
determined to employ chloroform, and accordingly prescribed
the following :

R. Spt. iEth. Sulph.

Chloroform, aa 5 } M.

Dose, a desert spoonful to be taken every two hours until
sleep is induced. After the second dose my patient fell into a
quiet slumber which lasted six hours. The following day, the
5th, he was much better, countenance improved, eye less start-
ing, much less tremor, pulse 88, bowels had been moved that
morning. I ordered the chloroform to be repeated at night.
After the first dose he slept, and did not awaken till the follow-
ing morning, when he felt much refreshed, and quite himself;
he got up, dressed and took a short walk ; being fatigued, on
his return he laid down again and fell into a sound sleep which
lasted three hours. I ordered the chloroform to be repeated if
necessary at night ; however he slept all night without it ; from
this date he recovered rapidly.

Chloroform has frequently been enployed in the form of
inhalation, with advantage, by Dr. Todd and others. In the
American Journal of Medical Science for January, 185*2, Dr.
Pratt of Baltimore, published two cases of delirium tremens, in
which the internal administration of Chloroform was attended
with most marked success. Since preparing this paper I have
read another case of delirium tremens published by Mr. Butcher
in the Dublin Medical Press, in which the internal use of chloro-
form was attended with like success. Mr. Butcher draws
attention to the lowering of the pulse when the perfect effect of
the medicine was produced. This was most marked in the first
of the above cases, the pulse fell from 96 to 62, it never rose
above 76 while the patient was under treatment. In the second
case, I had not an opportunity of observing the immediate effect
of the medicine on the heart's action, but the pulse fell from
112, which was the number of pulsations previous to the exhi-
bition of the chloroform to 88, which was its standard the follow-
ing morning.

The foregoing cases, though by no means severe or alarming

60 Quinine in Typhoid Fever. [January,

in their character, yet serve as further evidence of the success-
ful employment of chloroform internally in the above class of
diseases. In the first case opium had a decidedly injurious
effect ; all the symptoms were aggravated ; at first I felt at a loss
how to act : having read Dr. Pratt's cases, I determined to adopt
the same line of treatment. Another point I would draw atten-
tion to : in the one case, the disease was brought on by want
of an accustomed stimulus in the other, the attack followed
excess of the stimulus in both the symptoms were peculiar,
and in both the result of the treatment satisfactory.

[Canada Med. Journal.

[The use of quinine in Typhoid fever has many advocates
in the United States, but there are also many who regard it as
not only inefficient but positively injurious. Hence the sug-
gestion has been made, that when it has proved beneficial the
cases were not genuine typhoid fever. We therefore lay be-
fore our readers the following article, as the cases referred to
occurred in a country in which malarial fevers are as rare as
those termed typhoid are common.]

Remarks on the Treatment of Typhoid Fever by Disulphate of
Quina. By J. W. Hayward, Esq., Liverpool.

In a practice, private and parochial, of which I have had
charge for some time, at the south end of this town, I made
particular observations on eighty successive cases of fever of
the typhoid type ; and I found the first symptom, in twenty of
them, was diarrhoea; in twelve, diarrhoea and vomiting; in se-
ven, vomiting alone ; the rest began with pain in the head. All
had pain in the head afterwards ; sixty-six describing it as
" lightness," fourteen as " heaviness." All had tenderness of
abdomen nine to a great extent. Seventy-one complained
of soreness of the flesh over the whole body some to such
an extent that their impression was that they had rheumatism.
Seventeen had considerable inflammation of the sub-maxillary
glands. Seventy-three had delirium, twenty-one of which
were very severe. In all, the tongue became very dry, brown,
hard, and cracked; the first crack was generally a deep, longi-
tudinal one down the centre of the tongue, (even whilst it was
clammy and velvety in appearance, and of a milk-and-water
colour,) extending from the base to nearly the apex ; then ma-
ny transverse and oblique ones. In twenty-four, the skin be-
came rough and brown, with petechia? observable. In all, the
thirst was intense ; and the other symptoms of fever were not

1853.] Quinine in Ti/]> It oid Fever. fll

less evident; therefore suffice it to say they were well-marked
cases of fever of the typhoid character.

In twenty-seven the treatment was commenced in the "first
stage ;" in fifty-three in the "second stage." Three were fatal.
All the rest recovered more or less quickly.

The principal treatment in all except one was the use of di-
sulphate of quina, so much recommended by Dr. Dundas, of
this town, of course modified according to the predominating
symptoms. Thus, if I found the pulse quick, weak and thready;
the tongue cracked, brown, and dry, (rough or smooth ;) great
thirst and delirium ; no appetite ; tenderness of abdomen ; sore-
ness of flesh, &c, I put the patient upon disulphate of quina,
in solution, at once ; four or five grains every two hours. If
great restlessness, and no sleep, I added three or four minims
of tincture of opium to each dose. If* general sinking of vital
powers, some wine or brandy, with beef-tea. If the solution
of quina were vomited, it was given in an equal quantity of
wine, or wine-and-water. If the patient continued sinking,
I increased the quantity of quina, but never had occasion to
extend beyond seven grains per dose. When ringing in the
ears occurred, the quantity was decreased, but still kept up till
there was a good appetite. If the delirium was intense, the
pain in the head described as heavy, (which were always
strong subjects, whose bowels were confined,) with strong
pulse, a dose of chloride of mercury, and sometimes a blister to
the nape of the neck. If tenderness of abdomen was great, a
few leeches or sinapism. If vomiting, a sinapism over the-
stomach. If diarrhoea, a little calomel and opium, or diacetate
of lead and opium ; though this symptom sometimes required
nothing more than the tincture of opium given with the quinine.

In seventy-nine cases, marked improvement was observable
in the course of twelve hours : the pulse was the first to improve,
then the delirium to give way, then the pain in the head, the
thirst, the soreness of flesh, tenderness of abdomen, dryness of
tongue, and the appetite to improve. A pulse of 120, small and
thready, would become 90, softer and fuller ; and in the majority
of the cases the pain in the head and delirium ceased entirely
in the same period, and a rapid improvement followed ; with
the small exception of two cases of children ten and eleven
months old, neither of whom had the medicine regularly, and
both were complicated with bronchitis. The eightieth case
was that of a woman, in which quina was not used. These
three died, evidently from typhus. If the typhoid symptoms
were allowed to become well marked, and the patient to sink
much, his recovery was slow7, and he required wine or brandy.
I feel confident, from personal observation, that were the disul-

62 Loose Bodies in Knee-joint. [January,

phate of quina to be used promptly, and to cinchonism, the
mortality even of typhus itself would be very small.

P. S. The practice alluded to is that of Dr. Whittle, who
wishes me to make this communication to you. Lond. Lancet.

Method of fixing Loose Bodies in the Knee- Joint. By Dr. E.
Bartlett.

All surgical writers agree upon the necessity and difficulty
of properly securing loose bodies in the knee-joint, for the pur-
pose of removing them. The following method is proposed,
as one on which we can rely : Having placed the loose body
at the upper part of the synovial cavity, to the right or left of
the tendons of the rectus and vasti muscles, let an assistant
firmly grasp the lower end of the femur with both hands,
having one thumb on the right and the other on the left side of
the foreign body, with their extremities in contact below it :
thus confining it in a triangular space, two sides of which are
formed by the thumbs, the other and upper one being bounded
by the capsular ligament. This arrangement, with due pres-
sure, secures it effectually, and without difficulty, gives the
operator the use of both his hands, allows the incision to be
made in the direction of the limb, and prevents the escape of
synovia, and the admission of air or blood to the joint.

[Boston Med. and Sur. Journal.

am t s 1 1 1 1 a n .

Our Journal. In issuing the first number of another volume of the
Southern Medical and Surgical Journal, we take oocasion to return
our thanks to the numerous contributors who have made it the medium
of their communications to the profession, and who have thus added
to its usefulness as well as reputation. Thirty-two writers, residing
in nine different States, viz., Alabama, Florida, Georgia, Louisiana,
Massachusetts, Mississippi, South Carolina, Tennessee and Virginia,
have furnished us fifty-two original articles for the last volume, which
will, we think, compare favorably with the original department of any
of our contemporaries. The great majority of these papers are essen-
tially practical, very few of them being theoretical disquisitions. This
we regard as an important feature in this publication, and have
always borne it in mind in making up the Eclectic department.
Among our selections, we count sixty-six original American articles,
derived from our respected exchanges, thus making no less than one

1853.] Miscellany. 01

hundred and eighteen contributions to medical knowledge by our own
countrymen, in the volume for 1852 ! We are not of those who will
transfer to their columns every idle lucubration or hasty suggestion
found in foreign prints, while they pass without notice the writings,
however valuable, of their fellow-citizens. Thifl indifference, mani-
fested by some of our contemporaries, to the dissemination of Ameri-
can contributions, has been long felt and complained of by the profes-
sion and while we know that we have not republished as many of
them as we would have wished, we have the satisfaction to reflect
that we have done as much as our limits would permit. There are
Abstracts, Retrospects, and Periscopes published in Europe, repub-
lished in the United States, and bought extensively by our professional
brethren, and which yet scarcely contain an allusion to anything done
or written in this country. Why so? Can it be that nothing is done
or written by the American medical profession worthy of a place in
such compilations ?

Dr. Norwood, and others, have now for two years been publishing
from time to time, in this Journal, the discovery and usefulness of an
agent capable of controlling with almost mathematical certainty the
action of the heart in disease. There are upwards of thirty medical
periodicals published in the United States, with all of which, save one,
we exchange. Of these, we doubt whether more than five or six
have ever noticed the discovery directly or indirectly. How difFerent
would the case have been if the newly ascertained property of Vera-
trum Viride had been first announced in England, in France, or even
in the depths of Germany! We might cite similar instances of disre-
gard of valuable contributions published in the Journals of almost
every section of our country. They are therefore not peculiar to
this nor to any other of our native periodicals.

The rapidly increasing patronage extended to this Journal, gives us
the gratifying assurance that our course meets the approbation of the
profession, and no efforts will be spared to retain this.

We take pleasure in calling the attention of our readers to the
valuable articles in this number, from the pen of Drs. Jackson and
Norwood both upon subjeefs of great interest, and by writers exten-
sively known. We regard it quite an honor to be favored with the
contributions of the great discoverers of the anesthetic property of
Sulphuric Ether, and of the heart-subduing influence of Veratrum
Viride.

64 Miscellany. [January,

Case of Abstinence for three months, no Food, during that period,
being taken into the Stomach. By J. L. Pierce, M. D., of Fallsington,
Bucks county, Pennsylvania. On the 13th of January, 1836, my
friend, Dr. May, was about leaving Philadelphia for the East, and
requested me to take charge of a number of cases of considerable inter-
est, which he then had under his care. Among these was a lady,
who had for many months been severely affected with disease of the
stomach. As the exact character of the disease may admit of dispute,
and as it is not this to which I wish to draw attention, but a peculiari-
ty in the mode of treating it, I have headed the article in the manner
it stands.

I called, with Dr. May, to see this patient on the 13th of January,
1836. She was about 26 years of age, sallow complexion, emacia-
ted, pulse 120, feeble, but regular. A spot over the left epigastric
region, of an inch and a half in diameter, was very tender on pres-
sure, and considerable tenderness existed for some distance around it.
Her appetite, though not craving, was sufficiently good to enable her
to eat almost any food, though she had been restricted to a very sim-
ple diet. Her bowels were open every two or three days, passages
natural. She was in the habit of vomiting several times a day, and
her food was generally rejected within a few minutes after it was ta-
ken. She had been sick about three months, and had been confined
to the bed a large portion of this time.

I was informed that her case had been considered as carcinoma of
the stomach. Her treatment had consisted of such articles as were
calculated to allay the irritabilty of the stomach and the vomiting, and
to quiet the severe pains of the epigastric region. A constant sore
had been kept up over the affected spot by means of blisters, which
were dressed with anodyne ointments, and occasionally leeches were
applied to the spot.

On taking charge of the case, I watched it for some days very close-
ly. I found that neither food nor medicine appeared to remain upon
the stomach, but that as often as either was administered, vomiting
ensued ; and with the food ejected, there was from a tea-spoonful to a
table-spoonful of matter, such as is usually discharged from an ab-
scess. Should nothing be taken into the stomach for some hours,
emesis would take place of this kind of substance by itself. During
the first week, I pursued the same mode of treatment as had been
made use of formerly, but I soon became satisfied that it was alto-
gether useless, and that the patient must sink unless some more
.effectual plan were adopted. The simplest medicine taken into the
stomach was rejected as soon as the severer kind, and even gum
Arabic water or barley water was as irritating as oysters or roa6t beef
could have been.

Towards the close of January, I asked her if she was willing to
submit for one month to an entire abstinence of all kinds of food by
the mouth, and be nourished solely by enemata. The idea was a
novel one to myself, but my view was that the stomach must rest, and
Jet the character of the disease be what it might, it would thereby

1853.] Miscellany. 65

stand a much better chance of healing. That there was a suppur-
ating sore in the stomach appeared evident, and rest was absolutely
essential. She was now exceedingly emaciated, and so feeble that
she was entirely confined to the recumbent posture.

On the 1st day of February we entered upon our new mode of
treatment 1 directed lamb or mutton broth of good quality to be kept
constantly on hand, and a half a pint to be used as an enema every
three hours. During the first week, 1 allowed her to take notexce
inga tea-spoonful at a time of gum Arabic water or pun ev-

eral times a day, with the request that she would lessen the frequency
of it towards the latter part of the week, so as to be able to refrain
from it entirely on the commencement of the second week. She very
readily acceded to my wishes in every respect, and I have not the
least doubt ot her acting with perfect honesty towards me. I kept up
a running sore over the epigastric region, which I dressed with simple
cerate or basilicon ointment, sprinkled with morphia.

During the first week my patient vomited from three to six times
daily, discharging pus, and a considerable quantity of matter resemb-
ling tubercles. Her sensation of hunger was at times great, but she
bore it with remarkable fortitude. At the expiration of the week she
was evidently more comfortable, and became increasingly so during
each succeeding week of the month, at the close of which her condi-
tion was as follows : Vomiting occurs on an average about twice a
day : substance discharged the same as before, tinged with a little
blood ; tongue clean ; pulse fuller than formerly, and less frequent ;
countenance more healthy. I now asked her if she were willing to
continue the same treatment for another month. She did not hesitate
in giving a prompt response ; and, during this month, not a drop or
morsel of any thing passed her lips.

April 1. Condition in every way improved. The vomiting occurs
once in two or three days ; quantity less ; appearance of discharge
white, with but very few of those particles resembling tubercles;
bowels regular ; pulse 90 ; very little pain ; strength improving.

I now requested her to continue the treatment one month longer.
She consented to do so, and it was astonishing how rapidly the im-
provement progressed. By the middle of the month I consider the
cure to have been nearly completed, but thought it best not to depart
from the course we had been pursuing, lest irritation of the stomach
should renew the vomiting, and other unpleasant symptoms. About
the 24th of the month, 1 allowed her a tea-spoonful of gum Arabic
water three or four times a day, with directions to increase it in fre-
quency each successive day. so that the stomach might be gradually
prepared for its usual nourishment. By the close of the month I felt
satisfied that the disease of the stomach had cealed, that the sore had
healed, and that my patient, by a forbearance and perseverance
seldom equalled, had been rescued from an untimely irrave. She w
now able to sit up a considerable portion of the day, a part of the
time attended to some needle work or knitting ; could walk some dis-
tance without assistance ; complexion good ; pulse 80; bowels regular
and much fleshier than when 1 commenced my attendance upon her.

66 Miscellany. [January,

I continued calling on the patient occasionally until the 18th of
May, when I took my leave of her, with many blessings showered
upon my head.

In consequence of her removal to Southwark, I lost sight of this
patient for nearly two years, when I accidentally met her in the street.
Her appearance had so much improved that I searcely recognized her,
and she assured me that she was in the enjoyment of uninterrupted
health. [Am. Journ. Med. Science.

Binocular Microscope. (From the Transactions of the Phys. Med.
Society of New Orleans.) At a meeting of the Physico-Medical So-
ciety, on Saturday evening, 2d October, Prof. J. L. Riddell called the
attention of the Society to an instrument of his own invention and
manufacture, which promises to be of incalculable advantage in
microscopic researches, especially in the prosecution of microscopic
anatomy and physiology.

He remarked, that he last year contrived, and had lately construct-
ed and used, a combination of glass prisms, to render both eyes ser-
viceable in microscopic observation. The plan is essentially as
follows :

Behind the objective, and as near thereto as practicable, the light
is equally divided, and bent at right angles and made to travel in op-
posite directions, by means of two rectangular prisms, which are in
contact by their edges, that are somewhat ground away. The
reflected rays are received at a proper distance for binocular vision
upon two other rectangular prisms, and again bent at right angles,
being thus either completely inverted, for an inverted microscope, or
restored to their original direction. These outer prisms may be
cemented to the inner, by means of Canada balsam ; or left free to
admit of adjustment to suit different observers. Prisms of other form,
with due arrangement, may be substituted.

This method proves, according to Prof. RiddelPs testimony, equally
applicable to every grade of good lenses, from Spencer's best sixteenth
to a common three inch magnifier, with or without oculars or erecting
eye-pieces, and with great enhancement of penetrating and defining
power. It gives the observer perfectly correct views in length,
breadth, and depth, whatever power he may employ ; objects are seen
holding their true relative positions, and wearing their real shapes.
In looking at solid bodies, however, depressions sometimes appear as
elevations, and vice versa, forming a curious illusion ; for instance, a
metal spherule may appear like a glass ball silvered on the under side,
and the margin of a wafer may seem to ascend from the wafer into
the air.

With this instrument the microscopic dissecting knife can be
exactly guided. The watch-maker and artist can work under the
binocular eyeglass with certainty and satisfaction. In looking at
microscopic animal tissues, the single eye may perhaps behold a con-
fused amorphous, or nebulous mass, which the pair of eyes instantly
shape into delicate superimposed membranes, with intervening spaces,

1853.] Miscellany. (J7

the thickness of which can be correctly estimated. Blood corpuscli s,
usually Been as flat disks, loom out as oblate spheroids. Prof. R.
asserted, in short, that the whole microscopic world could thus be ex-
hibited in a new light, acquiring a ten-fold greater interest, displaying
in every phase a perfection of beauty and symmetry indescribable.
[New Orleans Med. and Surg. Journal.

Experimental investigations on the antidotal and revivifying proper-
ties of Nitrous Oxide. Under this caption the Boston Medical and
Surgical Journal contains the interesting researches of Dr. George
J. Ziegler, who deduces from them the following conclusions :

Firstly, That nitrous oxide or protoxide of nitrogen is a powerful
and direct arterial, nervous and cerebral stimulant.

Secondly, That it exerts a direct chemical influence on the blood,
by supplying the essential elements for thearterialization of that fluid,
and to a certain extent by inducing that process, thus producing in it
similar changes to those effected by the atmospheric air, as proved
by the effect on, and character of the reestablished respiration.

Thirdly, That it is in these various modes antidotal to the effects
of certain narcotizing agents.

Fourthly, That where vital excitability is not completely destroyed,
this remedy has the power of sustaining and increasing it rapidly,
and sufficiently to preserve life in numerous instances in which it
would otherwise be destroyed.

Fifthly, That it will reestablish life action even after all the usual
evidences of its existence have failed, such as innervation, respiration
and circulation ; provided, firstly, that the muscular contractility, or
vis insita of the heart and other tissues is not lost ; secondly, that the
blood has not coagulated or deteriorated to such an extent as to be in-
susceptible of arterialization and revivification ; thirdly, that there is
no organic lesion of any vital part sufficient of itself to prevent recove-
ry ; and fourthly, that innervation is still susceptible of reexcitation.

In conclusion, T will state that in my last paper on the therapeutic
applications of this agent in the form of surcharged liquid more es-
pecially, I inadvertently omitted to mention a peculiarity in its phy-
siological action, which, however, might be anticipated from its influ-
ence over the contiguous renal apparatus, viz., its stimulant effect on
the generative organs, thus operating as an aphrodisiac. This effect,
like its diuretic, is not, however, constant or universal ; yet, never-
theless, its application may prove useful in atonic states of this appa-
ratus. With respect to its favorable therapeutic influences and ap-
plications, therein detailed, I have no reason to change my views,
further experience and reflection only confirming still more strongly
all former observations and impressions.

Preservation of Camphor. The difficulty of preserving camphor
in a state of powder is well known , and is especially experienced by
those practicing in the country, who carry their own medicines with

68 Miscellany.

them. Dr. Dubois, of New Utrecht, informs us that it can be kept
without change in this condition, by rubbing together in the state of
powder two parts of camphor, one part of rhubarb, and one part of
ginger, the articles thus combined' with the camphor not in the least
interfering with its therapeutic effects. [New York Med, Times.

Prize Essays of the American Medical Association. At a meeting
of the Association, held at Richmond, Va., May, 1852, the under-
signed were appointed a committee, to receive voluntary communi-
cations on medical subjects, and to award two prizes, of 8100 each,
to the authors of the best two essays.

Each communication must be accompanied by a sealed packet, con-
taining 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 the 1st of June, 1853.

Communications must be addressed (post paid) to the Chairman of
the Committee, Dr. Joseph M. Smith, 56 Bleeker-street, New York,
on or before the 27th of March, 1853.

Joseph M. Smith, M. D.
John A. Swett, M. D.
W. Parker, M. D.
Gurdon Buck, M. D.
New York, Sept. 14th, 1852. Alfred C. Post, M. D.

Epidemics of South Carolina, Florida, Georgia, and Alabama.
The undersigned, Chairman of the Committee of the American Medi-
cal Association on the epidemics of South Carolina, Florida, Georgia,
and Alabama, vice Dr. W. M. Boling, resigned, respectfully solicits
from the physicians of those States accounts of epidemics of all dis-
eases that have been observed by them during the year 1852.

In the description of each epidemic, attention is earnestly directed
to the following points:

1st. The origin and progress, together with its phases, if they pre-
sent any peculiarities.

2d. The cause, either certain or probable.

3d. Its contagious character, or otherwise, with proofs thereof.

4th. The prognosis.

5th. The treatment.

6th. Collateral circumstances, such as meteorological and other
phenomena, having a direct or indirect bearing upon it.

The physicians of Georgia who may be disposed to furnish the
committee with accounts of epidemics, will be pleased to address their
communications to Dr. S. N. Harris, of Savannah, one of the com-
mittee. From those of South Carolina, Florida and Alabama, the
undersigned will gladly receive contributions.

Charleston, Nov. 1st, 1852. D. J. CAIN, Chairman.

Correction. On page 726, in our last No., in the caption of Dr.
Wellborn's article, read Newnan, Coweta County, Ga., instead
of "Newton County, Ga."

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. FEBRUARY, 1851, [No. 2.

PART FIRST.

(D r i g i n a I Communications.

ARTICLE IV.

On Spinal Irritation. By P. C. Winn, M. D., of Eufaula, Ala.

The obscurity under which the physiological endowments
and actions of the spi?wl system have been veiled, has natural-
ly resulted in much error as to its pathological conditions,
symptoms and effects ; for, unless the healthy functions of an
organ are understood, it is impossible to reach a correct con-
clusion respecting its pathological state.

The spinal system constitutes the great nervous highway of
the animal organism, and yet but little, we believe, was written
upon, and less known, of spinal disease, until within the last half
centurv : and although the researches and investigations of Sir
Charles Bell, Dr. Marshall Hall, Magendie, and others, have
thrown great light upon the anatomical structure and distri-
bution of this system of nerves and upon its pathological
conditions, causing it to be more thoroughly studied and con-
sequently better understood than formerly ; yet much, indeed,
remains to be learned a vast field is here open, inviting the
earnest inquirer after tiuth to * seek that he may find."

There exists such a reciprocity of action, especially in dis-
ease, between the spinal cord, its nerves, and the parts to which
they are distributed, that the practitioner often finds himself
lost, or led widely into error, in forming a diagnosis, when the
spinal marrow and its nerves are the seat of disease.

The influence of this system of nerves is so universal and so

x. s. VOL. IX. no. it. '-3

70 Winn, on Spinal Irritation. [February,

diversified, and that principle called sympathy, which is nothing
more than the extension of a disease, or of the symptoms of
disease, is here so extensive, and so little understood, that the
physician encounters great difficulty in making a satisfactory
diagnosis, and especially is there great difficulty in assigning
to disease its true location when there exists no other evidence
of inflammatory action except that of pain ; for we frequently
meet with disease of some of the viscera, and of other textures
of the body, while the pain or disease is referred to the back,
the spinal marrow, the head, while the converse of this is also
true.

But we design speaking of Spinal Irritation as a special dis-
easea disease sui generis. It is not easy to define clearly what
the disease consists in whether it be an inflammation, increas-
ed excitability, an atony of the nerve, etc. And perhaps it will
be as difficult to determine, with positive certainty, whether
the disease is located in the substance of the spinal cord, the
nerve leading from it, or in the investing membrane.

The term Spinal Irritation is one of such extensive applica^
tion, and, too often, so vaguely used, that we must evidently
encounter some difficulty in restricting it to its proper limits,
and in applying it to that condition of the spinal cord which
we intend to designate as Spinal Irritation. And in adopting
the opinion which we do, we are conscious that it will conflict
with the doctrine of some whose opinions are entitled to the
highest regard. We hope, however, that this article will not
be thought to savor of vanity, for the writer makes no preten-
sions to originality.

We are of opinion that the term strictly applies to an inflam-
matory condition of the spinal cord or the nerve given off from
it, just at its exit from the vertebral canal, which is nothing
more nor less than a myelitis or neuritis, and which may exist
in any of its stages, from simple congestion up to acute inflam-
mation or ramollissement. We do not propose considering it
in its acute form, where the symptoms are clearly and distinct-
ly developed, but in the latent form, where the symptoms are
obscured and masked.

We are of opinion that the disease most generally consists of
simple congestion ; or, when of long standing, of chronic in-

1853.] Winn, on Spinal Irritation. 71

flammation of the cord, the nerves leading from it, or of their
immediate investing membrane. We come to this conclusion
namely, that it is a congestion or inflammation of the cord or
its nerves from a consideration of the physiological functions
of these organs, together with the symptoms developed in the
disease and the remedies most efficient in arresting and curing
it. Now we are all aware that muscular action is dependent
upon the spinal cord and its nerves, and also that the sense of
feeling depends upon those in connection with the brain in
other words, that to produce the sense of feeling in the ex-
tremities, it requires, for instance, that the nerves, spinal cord
and brain be intact, which state of things must also exist to
msure voluntary motion. In the disease under consideration
these functions are usually altered, increased, diminished, or
perverted. For instance, if pressure be made over an irritated
or irritable portion of the spinal cord, it may produce spasm of
one or more muscles, cough, difficulty of breathing, nausea,
pain, frequently very acute, in some remote part of the body,
but always in a part supplied with nerves coming from that
portion of the cord manifesting disease. And in this opinion
we must beg leave to differ with some writers, among whom is
Dr. Wood, of this country. He remarks, in treating of this
disease, vol. ii., p. 738, that "the most rational view of the
affection seems to be, that it is seated essentially in the liga-
ments of the vertebrae, and is generally of a rheumatic or gouty
character." But it appears to us that this view of the subject
would not give a satisfactory reason for many of the anomalous
symptoms attending the disease on the contrary, we have
little doubt but that many of the pains thought to be gouty and
rheumatic, and treated as such, are nothing more than symp-
toms of spinal disease.

Among the many articles written upon, or having relation to,
Spinal Irritation, we notice one by Prof. Ford, (vol. i.? p. 166,
Southern Med. and Surg. Journal 1837,) on Remittent fever,
which throws great light upon the subject now under consid-
eration, and which bears the marks of earnest, ardent toil after
truth, and which, too, has already accomplished much in
making intelligent and modifying the treatment of remittent
and intermittent fever the great disease of the South.

72 Winn, on Spinal Irritation. [February,

In the article referred to, we find the opinions which we
candidly adept. In it may be found ample proof that the pain
felt under pressure is not referable to the skin, the bone itself, or
the ligaments, as some contend, but to the cord, its nerves and
their membrane. From the remarks of J. B. Todd, on this sub-
ject, we infer that he, though less explicit than Prof. Ford, is
of the same opinion. He says, " When not only pressure from
without, but even the slightest motion, aggravates the pain, we
are then forced to admit that the origin of the evil is in the
vicinity of the spinal cord." And we conclude from these mani-
festations under pressure and percussion, such as pain, cough,
dyspnoea, &c, that the disease is wholly dependent upon some
morbid condition of the cord itself, or of the nerves given off
by it, and not in the meninges or neurilemma. For, we cannot
conceive how those remote symptoms could be developed
were the membranes alone the seat of disease, though there
might be pain and tenderness at some point in the vertebras;
nevertheless, we would not deny but that the membranes may
be diseased at the same time with the cord or the nerves, and,
in fact, we think it highly probable, from the vascularity of
these membranes, that the disease may be primarily developed
in them ; yet, certainly, the thousand remote and anomalous
symptoms cannot show themselves until the nervous tissue is
itself involved. We must, however, confess that pathological
anatomy has done but little to sustain the doctrine here assum-
ed ; and yet there need be no surprise at this, when we take
into consideration the anatomical structure of the vascular sys-
tem of this part that is, the great number of veins and venous
radicles, their free and numerous anastomoses with the superfi-
cial and muscular veins, as well as the absence of valves in
them.

The author last quoted infers from the above facts, that a
congestion sufficient to produce the symptoms may easily oc-
cur, and that congestion be easily dissipated. He contends
that " the very sections which are made to reach the supposed
seat of the disease are sufficient to dissipate the venous conges-
tion." This much we have stated to show that anatomy affords
some support to the doctrine of Spinal Irritation.

To give i*7i extenso all the symptoms of this disease, in a

1853.] Winn, on Spinal Irritation. 73

dissertation of this character, would lead us too far; for,
in performing such a task we should have to enumerate the
entire catalogue of diseases to which humanity is liable, as
there is scarcely a disease which may not be simulated or mask-
ed by the one subjudice. The most prominent and, we might
perhaps say, pathognomonic symptom, is that of pain or tender-
ness under pressure, percussion, or the application of a sponge
filled with hot water. This pain is excited by motion, lifting
or carrying heavy burdens, such as throw much exertion upon
the spinal column. Frequently the patient is not conscious of
any irritation or disease of the spinal marrow until detected by
the physician: he may complain of some uneasiness, aching or
vague sense of pain along the spine, but often the symptoms
show themselves in some remote organ or structure. The
symptoms may be those of pain, formication, numbness, spasm,
paralysis, dyspnoea, dysphagia, palpitation of the heart, pyro-
sis, colic, many symptoms referred to the uterus, &c, nearly
or quite all of which may be increased by pressure, or percus-
sion over the affected region of the spine. The dreased point
of the spinal marrow and the complaining organ will be found
exactly to correspond that is, the part to which the disease
is referred being supplied with nerves directly from the affected
point of the spine. Usually the tongue is clean, but may some-
times be coated with a whitish fur ; appetite variable, usually
however there is slight anorexia ; pulse natural, or a little accel-
erated and weak, seldom or never increased in volume or
frequency, unless there be inflammatory action elsewhere ;
irritable temper and melancholy are frequent attendants upon
this disease.

The diagnosis is difficult, and requires no small amount of
cautious and close investigation ; for there are many diseases
closely connected with, if not actually depending upon spinal
irritation for their existence; and hence spinal disease is often
mistaken for inflammatory or other affections of various organs.
Hysteria, and all the host of diseases termed nervous, are
usually primarily or secondarily connected with spina1 disorder;
nor should the practitioner neglect, in any such case, a close
and thorough examination of the spine, or fail to apply the
remedies suitable to the treatment of spinal disease; for it

74 Winn, on Spinal Irritation. [February,

may save him the regret of mistaking this disease (as often
happens) for dyspepsia, colic, hepatitis, disease of the heart,
kidneys, uterus, &c. And no doubt many an unfortunate pa-
tient has been made to undergo the tortures of a treatment for,
first one and then another of these diseases, until he has pain-
fully passed the ordeal of treatment for each, in succession,
when, perhaps, a few cups or a blister to the spine would have
at once relieved the sufferer.

Our young friend, Dr. W. C. Brandon, of Floyd county, Ga.,
recently gave us the history of a case in point, which happened
in the person of a lady who had been the subject of disease for
ten years, during which time she had been under the care of
several doctors, who, in their turn, subjected her to treatment
for a whole catalogue of diseases, with which they alternately
supposed her to be affected, ptyalizing her two or three times,
and passing her through an ordeal of treatment for "dyspepsia,"
liver "complaint," gravel, &c. When called in, he found her
confined to the parturient bed, suffering with ovaritis, and
complaining of pain in the region of the liver, kidneys, of
dyspeptic symptoms, and of a "hurting" between the shoul-
ders ; but discovering (save in the ovary) no sign of inflamma-
mation, except pain, he examined the spine, and on finding the
four upper dorsal and lower cervical vertebras very tender, and
some slight sensitiveness in the lumbar region, he had the upper
portion blistered and sinapisms applied to the lower, which
relieved those anomalous pains and the sense of "hurting" and
" soreness" in the back and neck which had continued so long
to annoy her, and (the ovaritis being in the meantime subdued)
she, using occasionally vegetable tonics, soon found herself in a
greatly improved state of health.

But, with care, there need be but little danger of mistaking
the disease, where there is supposed rheumatism, dyspepsia,
hepatitis, nephritis, gastro-enteritis, &c, and no symptom pre-
sent, except pain, of the existence of a phlegmasia, the physi-
cian may at once be suspicious that he has a case of Spinal
Irritation. Where spinal disease exists for a length of time,
these and other affections may supervene from the irritation
kept up in the part directly supplied by the diseased nerve, or
nerve leading from the diseased portion of the spinal cord, or,

1853.] Winn, on Spinal Irritation. 75

more remotely, from the ganglionic nerves becoming involved
ow account of their intimate connection with the spinal system,
and, consequently, producing afunctional, if not structural, dis-
ease.

We Blight enlarge upon the diagnostic symptoms between
this and other diseases for which it might be mistaken ; but in
most instances such as hepatitis, pleuritis, dyspepsia, nephri-
te there are always evidences of the disease sufficient to
prevent the mistakes to which we have alluded. The difficul-
ty with young practitioners is too often a want of discrimination.
If their patient complain of pain in a particular organ, the first
impression on their mind is the existence there of inflammation,
and having probably erred in the outset, a treatment is institu-
ted accordingly. In all these cases of doubtful character the
spine should be closely and thoroughly examined ; for in cases
where the spine is not primarily affected, it may become so
secondarily, on account of that reciprocity of action (before
mentioned) which exists between it and the parts which it sup-
plies with nerves.

The prognosis of Spinal Irritation, perse, is not unfavorable.
Where it is of long standing, we think it may probably bring
on hydrorachitis, ramollissement, or possibly induration, which
may produce death.

In giving expression to this opinion of the probable results
of this disease, we are not aware of having any written facts
to sustain the supposition. We think it probable that a distant
organ, kept irritated by a diseased nerve, or a nerve leading
from a diseased portion of the cord, may eventually produce
such a morbid action in the part as to result in death.

Remarks upon the treatment of this disease need occupv but
a small space, as it is simple and usually efficient. There are,
perhaps, few or no diseases that give evidence of the therapeu-
tic action of remedies earlier than the one under consideration.
If the case is one of recent origin, and attended by any inflam-
matory excitement, perhaps the detraction of blood by cups to
the affected part of the spine will be the most suitable course.
But if of chronic character, and the tenderness not excessive,
simple vesication will accomplish the desired end. In case
a protracted counter-irritation is desirable, pustulation with

76 Wilson, on Empirical Remedies. [February,

ungent. tart, antim. et potass, is advisable. etons would
accomplish the same result, though inadvisable if milder means
will answer the end. Where the irritation is slight, or occurs
in other diseases, as in intermittent and remittent fever, the
application of sinapisms will frequently relieve the patient in
an exceedingly short time. It may often be necessary to use
some constitutional remedies in connection with the local
treatment, as, for instance, when connected with dyspeptic
symptoms, it may be necessary to use some mild cathartic and
antacid. If general debility exist, tonics, vegetable or mineral,
as the practitioner may think best, should be administered the
ferruginous preparations should never be omitted, if the patient
is anemic or chlorotic.

We might extend remarks upon the treatment of this dis-
ease, and especially upon the treatment of those diseases con-
nected with or dependent upon it such as hysteria, chorea,
perhaps some cases of dysmenorrhcea, &c, but we have
already overleaped the bounds assigned to ourselves in this
dissertation.

article v.

Remarks on the Use of Empirical Remedies ; with some sug-
gestions as to the best means of abating the evil. By John
S. Wilson, M. D., of Air-Mount, Alabama.

Dr. Robert Campbell, in an able essay,* recently published,
has very appropriately compared the relationship of Empiricism
to Medical Science, to the antagonism existing between virtue
and vice ; for every one will be struck with the appositeness
of the comparison, when he contemplates legitimate Medicine,
with her noble aims, her "divinity of purpose," and her self-
sacrificing devotion to the cause of suffering humanity and
then turns his attention to Charlatanry, with all its base tricks
" for coining guilty gain,'*' with its numberless artifices to pros-
titute Science to its unhallowed service, and its ceaseless efforts
to impair the confidence of the community in those who are

* An Essay on Empirical Remedies ; read before the Medical Society of the
State of Georgia, April, 1852. By Robert Campbell, M. D., Chairman.

1853.] Wilson, on Empirical Remedies. Tt

the legitimate conservators of the public health, and the true
expounders and guardians of medical science. To say, then,
that empiricism and medical science are as much at variance
as virtue and vice, or light and darkness to say that physi-
cians, by virtue of their position and education, are in duty
bound to expose the tricks and fallacies of charlatanry and to
warn a credulous and uninformed community against its impo-
sitions, is but to utter a truism. Yet, while this is admitted by
our profession, it is a lamentable truth that we have been re-
creant to the responsible trust committed to us : the most of us
"are prone to regard quackery, in its wide spread and rapid-
ly increasing operation, with a bearing of complaisant regret
and supine resignation, as a necessary and inevitable event."*
Some among us "testimonialize for quacks" some are en-
gaged in the sale of their nostrums while many prescribe
them " without ascertaining their composition." And, alas !
there are some who have sacrificed honor, a pure conscience,
professional respectability, every thing that adorns the man of
virtue and of science, to lucre, and enlisted in the "legion of
([iiackery /" I do not intend to review the influences which
combine to sustain the "nostrum trade:" this has been ably
done in the essay referred to ; and I do hope that its circula-
tion will be co-extensive with its merits, and that it will receive
the attention demanded by the importance of the subject dis-
cussed.

As the principal design of this article is to make some sug-
gestions, as to the best means of counteracting the monstrous
impositions of quackery, I have alluded to the humiliating dere-
lictions, and the supineness of physicians, not only because I
consider these to be the most potent auxiliaries of empiricism,
but also because I think if the evil under consideration is ever
successfully combatted, it must be done by our profession. It
is true, that the influence of our noble profession has been much
diminished by the protection afforded to quackery by legislative
enactments, together with the low standard of education and
morals among us: but I believe if this latter difficulty can be
removed we can accomplish much, in spite of hostile legisla-
tion : and I even cherish the sanguine hope that we will finally
Dr. Campbell"* Essay.

78 Wilson, on Empirical Remedies. [February,

be able to reform our legislators, and induce them to abolish the
Patent Medicine Law, together with several State laws which
are equally inimical to the public welfare, and the dignity and
usefulness of the profession.

As a proper appreciation of the causes of an evil is a desira-
ble, if not an essential, pre-requisite in devising a judicious plan
for its removal, no apology is needed for briefly alluding to the
causes, which, in my estimation, have conspired to degrade
Medicine, by transforming some of her legitimate descendants
into quack-procurers and nostrum venders. The most influ-
ential of those causes is, doubtless, the imperfect system of
medical education among us, whereby many receive the
honors of our colleges who are morally and intellectually
incapacitated for a proper discharge of the responsible duties
devolving upon them as physicians and men of science : and
this defective svstem of education, I think, owes its existence
to two principal causes viz: 1st, the multiplicity of medical
colleges, and the consequent rivalry ; and 2d, the disregard of
the interests and respectability of the medical profession, mani-
fested by our State legislatures, in the passage of laws which
place every ignorant and unprincipled medicaster and half-
educated licentiate on a footing of perfect equality with those
who have been crowned with the highest collegiate honors,
after years of laborious and expensive study. For in this
utilitarian age, it can hardly be expected that our medical
institutions will be very stringent in requiring high moral and
intellectual attainments, when they know that these advanta-
ges will bring to their alumni no legal protection or immunities ;
while the majority of students, influenced by similar considera-
tions, will flock to those colleges where they can "pass" with
the greatest facility and expedition. These are serious obsta-
cles to medical "reform;" but still I am fully persuaded that
they can be obviated, by the combined action of the profession,
through the medium of County and State organizations, and,
above all, by co-operating with our National Association in its
efforts to consummate the noble work for which it was insti-
tuted.

I shall, therefore, leave these rjemote influences in the able
hands to which they have been committed, and proceed to

1853.] Wilson, on Empirical Remedies. 79

make some suggestions as to the more direct means of eleva-
ting the moral tone of the profession, with regard to quack
nostrums; and of thus depriving quackery of the encourage-
ment given it by physicians. To promote this desirable object,

until a more radical reform can be effected, I would suggest,
1st. That the Faculties of our Medical Colleges make it a
special duty to impress upon their classes their moral and pro-
fessional obligations as physicians, and that they be warned,
seriously and earnestly against compromising the dignity of the
profession and the interests of the community, by giving quack
certificates by prescribing secret and unknown compounds,
or by engaging in their sale. No one, who has read the histo-
ry of medicine, or noted the tenacity with which students cling
to the errors, even, of their instructors, will, for a moment, doubt
the potency of their influence, when this is fortified by truth,
by honor, and by professional interest and respectability. So
fully am I convinced of the powers of our professors in the
premises, that I can attribute the extent of the evil under con-
sideration, only to a dereliction of duty, on their part, origin-
ating either in indifference or want of a correct appreciation
of their own influence: I would therefore invoke their atten-
tion to these humble suggestions, and entreat them to avail
themselves of their commanding position, by warning their
pupils continually against any alliance with empiricism.

I would suggest, 2nd. That all within the pale of the profes-
sion, who, in any manner, encourage the use of patent or secret
remedies, be u read out," and that they be declared unworthy
of "the rights, privileges and honors of physicians'' such as,
1st, the privilege of a seat in any medical society or associa-
tion; 2d, the honor of consultation; and 3rd, the right (con-
ventional) of gratuitous medical attention in sickness.

I will conclude these brief suggestions, by submitting the
'plan'' of the committee before referred to; and 1 would re-
commend its adoption by the profession generally, as the best
means of acting on the people after the profession has been
expurgated from empiricism.

Plan. '"1st. The establishment of an efficient standing
committee in this body, whose duty it shall be, with the assist-
ance of the general society, to collect and publish, as far as

80 Wilson, on Empirical Remedies. [February,

practicable, through the popular channels of intelligence, all
the instances of the pernicious effects, resulting from the em-
ployment of empirical remedies, which may come under the
observation of the society -for the advisement of the people."

In the above extract, I have taken the liberty of italicising
the words " through the popular channels," &c, because I
think that this mode of attack has not been properly appreci-
ated by the profession: much has been written in exposition
of the injurious effects of empiricism, and almost every medi-
cal journal contains something of this kind ; but these disclo-
sures never reach the people, and so far as their influence on
them is concerned, they had as well be published in Hebrew,
as in a medical journal. The popular channels of intelligence ,#
must be used then, to disclose the monstrous evils of quackery
and the antidote thus made to accompany the bane.

The 2d recommendation of the committee is, in general
terms, as follows : That the committee report the facts thus
collected to the American Medical Association ; soliciting their
recommendation of such a plan to the several State Medical
Societies and Associations of the Union "for the purpose of
accumulating evidence sufficient for the arraignment of this
injurious system, as a national grievance." And also for this
committee to solicit the interference of the National Associa-
tion, in memorializing the National Congress for the abolition
of the patent medicine law, &c. the evidence of the joint
report of the several State committees being adduced as the
reasonable apology for such application.

Addendum. Since writing the above, my attention has been
arrested by the following requirement of the St. Louis Uni-
versity. I transcribe it from the October No. of this Journal,
for the purpose of giving it my hearty endorsement, and to re-
commend its adoption by all our colleges, not only pro forma,
but bona fide.

" The Doctorate at the St. Louis University. 5th. And that

* Besides the papers of the day, I would suggest that each State Society avail
itself of that happy device of Gluackery 'a Medical Almanac' and that the
facts collected, together with some of the principles of Medical Science, be
published in this, for gratuitous distribution.

1853.] Moragne, on Snake-bite. 81

he publicly assent to the following promise, prior to the confer-
ring 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 respectability of the profession; that you will demean
yourself honorably in the practice thereof; that you will not
put forth any nostrum, or secret method of cure, nor engage in
any other species of quackery; and that you will not publish
any matter or thing laudatory of yourself, or derogatory to the
profession; and in the conferring of this degree, it is done with
the express understanding that the Faculty reserve to them-
selves the right and privilege to revoke said degree whene
the promise here made shall be violated."

ARTICLE VI.

Bite of a Copperhead " Trigonocephalies Contortix" treated
with Whiskey, By N. Harris Moragne. M. D., of Abbe-
ville, South Carolina.

On the 21st of June last, I was called to see a negro man

belonging to Capt. P , of Abbeville district. Found him

partially delirious ; skin hot and dry ; pulse very much excited,
ranging from 100 to 120 ; left leg and ankle swollen to a great
degree. Upon making enquiry into the history of this case, I
learned that the patient had been bitten about twelve hours
previously by a " trigonocephalus," or. as it is frequently styled
in this part of the country, copperhead or highland mockesom
This very poisonous reptile was concealed beneath the step of
a meat-house, and inflicted a wound upon the inside of the foot,,
near the ankle-joint. I immediately applied a ligature above
the seat of affection prescribed poultices over the wound;
and olive oil, ammonia, &c, internally.

22d. The patient is in statu quo no abatement of the swel-
ling, delirious: ordered whiskey, ad libitum.

\t:id. Xo decided improvement still anxious, restless, and
uneasy ; skin hot and dry. Continued the whiskey, combined
with capsicum : it was administered until the patient was fully
under its influence, without regard to quantity. Left opiun?
to be given if necessary.

82 Dugas, on Lithotomy. [February,

24th. Had passed the "crisis." A profuse perspiration was
out over his entire s)Tstem ; the tumefaction was subsiding ; the
delirium had ceased ; he spoke rationally, and speedily conva-
lesced.

Gibson says " Of the numerous American serpents, two
species only are known to be poisonous the crotalus or rattle-
snake and copperhead." If he includes under the common
name of copperhead, both the highland and the water-mocke-
son,then we concur with him in the assertion. The two latter
are of the same family, but not of the same species, which is
abundantly manifest by their mode of living.

The same writer says : " These reptiles are more lively, and
their venom more active, during very warm weather. Upon
the approach of the cold season, they become languid, and then
strike reluctantly, and frequently without any ill consequence."

The interesting case which I witnessed whilst a student in
the University of New York, furnishes a striking proof of the
speedy operation of the poison, even in the dead of winter.

Dr. W., of that city, was bitten on the hand, by a rattle-
snake, sent to him by a friend from the State of Alabama. The
hand soon began to swell, and in a few hours the whole arm
was very much tumefied, presenting a mottled appearance, even
to the shoulder and axilla. He had the best medical advice
the city afforded, yet, after intense suffering for two or three
days, he died.

I have no doubt, that if the alcoholic treatment had been in-
stituted in this case, with the application of the ligature above
the seat of affection, (which last was timely suggested by some
of the Southern students present,) Dr. W. would have recov-
ered.

ARTICLE VII.

'Cases of Lithotomy. By L. A. Dugas, M. D., &c.

However unimportant the report of individual cases in med-
ical or surgical practice may sometimes appear, unless they
offer new facts for consideration, they are not without value
in a statistical point of view and in the collation of facts from
Hvhich practical inferences are to be deduced. Were practition-

1

1853.] Dugas, 07i Lithotomy. S3

ers less backward in laying their experience before the pro-
fession, whether successful or otherwise, a vast amount of useful
information would be accumulated, to which systematic wri-
ters could often refer with advantage. The three cases about
to be placed upon record, are all of the kind operated upon by
the writer during the past year, and will serve to show that
surgical operations performed under the most favorable auspi-
ces will sometimes terminate fatally, wheieas others may prove
successful under the most unfavorable combination of circum-
stances. There are therefore in surgery as well as in medi-
cine, elements of controlling influence yet to be studied yet to
be appreciated.

Case I. Mr. John M. W., of Heard county, Ga., about 24
years of age, had been suffering a number of years with stone
in the bladder, when I visited him on the 10th day of March,
1852. I found him confined to his bed, as he had been for
some months, and suffering excrutiating paroxysms of pain
about every hour when attempting to urinate. He appeared
to be a man of robust constitution, although considerably de-
bilitated and emaciated in consequence of his local affection.
The general condition of his system seemed to be quite favor-
able to the operation, so that, the calculus having been readily
detected, we determined to remove it the next morning.

The usual preparations having been made, I proceeded on
the 11th, at 9, A. M., to the administration of chloroform, un-
der the direction of Dr. J. Harriss. The patient was very
soon brought under its full influence and the calculus removed
by the bi-lateral section and the double lithotome, according tc
Dupuytren's method. The whole time consumed was unuiually
short, and the patient returned to consciousness in a few min<*
utes, without having sutfered any pain. He expressed himself
much gratified, was cleansed and put to bed, feeling as com-
fortable as any one I ever saw under similar circumstances,
and conversing with his friends. He continued so until after
dinner, when, having other engagements, I left him in charger
of his judicious neighbors, Doctors Redwine and Hunt.

I subsequently received the painful intelligence that he died
28 hours after the operation. Dr. Redwine, who furnished me
the facts, states that a short time after my departure, the patM

"84 Dugas, on Lithotomy. [February,

became sick at the stomach, then restless, taking but short
naps, and frequently calling for water; that he complained
during the night of pain in the stomach and bowels; that the
wound having become closed with coagula, bloody urine was
passed per urethram, but resumed its course through the wound
upon this being washed with tepid Water and a syringe ; that
the loss of blood was very slight ; but that he went on gradu-
ally sinking, without any evident cause, until 1 o'clock on the
12th, when he died.

Some might be disposed to attribute the fatal result to the
Chloroform ; yet, when we reflect that the patient required
very little of it to induce anesthesia that he regained his con-
sciousness and clearness of intellect in a few minutes, and that
he remained so several hours before showing any unpleasant
symptoms, such an inference would seem scarcely justifiable.

Two calculi were removed, consisting of oxalate of lime*
The larger of the two weighed 32 grains, was of irregular shape,
being of an inch long, | an inch wide, and \ of an inch thick.
The smaller one weighed 10 grains, was cylindrical, and meas-
ured f inch in length and f of an inch in thickness.

Case II. The subject of this case was Mr. Zac. S., of Lincoln
county, Ga., aged 21 years, and upon whom I performed the
Bi-lateral operation of Lithotomy on the 23d of June last, in
the presence of Drs. M'Cord, Wilkes, Bently and Dunn. I am
indebted to Dr. McCord for the following account of the pa-
tient's history.

"The first symptoms of stone were manifested in his early
infancy, but did not assume a positive character until he was
two years of age, when he was annoyed with straining, difficult
and painfnl micturition, the flow of urine being sometimes sud-
denly arrested. He continued in this state, being sometimes
better and sometimes worse, until 14 years of age, when there
appeared to be an almost complete subsidence of suffering, un-
less he rode on horse-back. This kind of exercise would be
followed by painful urination and the discharge of mucus.
This deceptive abatement of the disease continued but a short
time, after which all the previous symptoms returned. The
least exercise would aggravate them, and he would pass large

.

1853.] Dugas, on Lithotomy. 85

quantities of blood and mucus with his urine. I first saw him
in January last. lie had then frequent, urgent and ir resist able
desires to pass urine, attended with straining, burning, and
shooting pains along the urethra. The mucus would some-
times remain mixed with the urine, and sometimes separate
from it and form a deposit in the bottom of the urinal of a vis-
cid tenacious matter, which would adhere to the vessel when
inverted. The flow of urine appeared sometimes to be im-
peded by it. There was great tenderness and pain over the
region of the bladder, in the perineum and extending to the
sacrum."

I visited Mr. S. on the 22d of June, and found him in bed,
to which he had been uninterruptedly confined for upwards of
six months. Emaciated in the extreme, without appetite, but
great thirst, he experienced about every fifteen minutes (both
night and day) the most excrutiating paroxysms of painful ef-
forts to urinate. Worn down by long suffering, loss of sleep,
impaired digestion, &c., he seemed to be on the verge of the
grave. The sound revealed the presence of a calculus of some
size, but it was very doubtful that he could, in his reduced
condition, bear the operation required for its removal. There
however, no time to lose, and, after frankly stating the
unpromising prospect to the parties concerned, it was deter-
mined to operate the next morning. Dupuytren's bi-lateral
section was made, under the influence of chloroform, and
an ammoniaco-magnesian calculus removed, which weighed
two ounces and two scruples, was globular, its greatest diameter
being 1 \ inches, and its least i\ inches. During the operation
he fainted and appeared to be lifeless, but gradually recovered
and was put to bed. A few hours after the operation, it was
observed that the oozing of blood from the wound was greater
than usual, and that in his debilitated condition it might be fatal,
is checked. The usual means were adopted to lessen this
hemorrhage, but it continued until midnight, rendering the free
use of brandy and broth necessary to sustain life. The 1
blood was not such as to have been serious to a patient less
exhausted, but in this instance it was exce< dingly alarming. It
was probably i ted by the great vascularity of the blad-

der and prostate consequent upon such long standing irritation.

n. ^. von. ix. no. II. 6

86 Dugas, on Lithotomy. [February,

I left the patient, twenty- four hours after the operation, in
charge of Drs. McCord and Bently. In three days he was
fully convalescent, and gradually got entirely well.

Case III. Stephen M., of Jasper county, 5 years of age?
had suffered from stone in the bladder three years, when he
was brought to this city by his mother in October last. His
general health was but slightly impaired. Being put under the
full influence of chloroform on the 21st. the bi-lateral section
was performed as in the above cases, aud a calculus of uric acid
removed. It was a flattened oval of an inch long, | inch
wide, and } inch thick, weighing 35 grains. The child rapidly
recovered his health without any unpleasant symptoms.

Remarks. The first case terminated fatally, although the
condition of the patient was as favorable as we usually find it
in calculous persons, and no appreciable accident or complica-
tion occurred to account for the result. Death took place too
soon to have been induced by infiltration of urine or any in-
flammatory process. There was no amount of hemorrhage
sufficient to induce sinking. He recovered very soon from the
influence of the chloroform upon the brain, and although the
pain in the stomach (epigastrium) annoyed him some time,
nothing is more common than lo find this effect of chloroform
without serious consequences. This death must be put down
to the account of what is called, for want of a better term,
nervous exhaustion.

The second case resulted in restoration to health under cir-
cumstances of the most unpromising character. Whether the
syncope was occasioned by the chloroform or not, is difficult
to determine. He had inhaled very little of it. It is probable
that had he breathed any more of it, the syncope would have
been fatal. The oozing of blood still added to the danger ; yet
he recovered, under the judicious management of his physicians
and the good nursing of kind parents.

The third case was successful, as they generally are in chil-
dren when the operation is not too long deferred.

,

1 853.] Clinical Illustrations of Sub-acute Ovaritis. 87

PART II.

(Eclectic Department.

Clinical Illustrations of Sub-acute Ovaritis. By E. J. Tilt*
M. D., Senior Physician to the Farringdon General Dispen-
sarv and Lying in Charity, and to the Paddington Free Dis-
pensary for women and children.

The light oi' modern physiology thrown on many facts de-
rived from the highest sources, enabled me, some years since,
to apply to these facts the rules of reasoning adopted in gen-
eral pathology, and I then endeavoured to give a wider and
safer basis to our knowledge of the diseases to which the ovaria
are liable, and by so doing, to lend my humble efforts to op-
i tendency to consider the womb as principally affected
in all diseases of women. Others have subsequently added to
our information on these points; but I am not aware that my
views have sustained any serious, attack. In the papers pub-
lished in The Lancet, as well as in a work on "Diseases of
3 1 mat ion and on Ovarian Inflammation,'' I avoided one
chance of error by principally making use of facts registered
by others, without any preconceived views of their import-
I now propose to publish some of the cases I have met
with, leaving others to decide how far they support the views
I have put forth.

Case 1. Emma W . twenty-two years of age, of mid-
dling stature, and with red hair and grey eyes, was admitted
to the Paddington Free Dispensary, July 1 I, 1851. She men-
struated at twelve, and has ever since been regular every
month, even during pregnancy and the ten months she suckled
her child. For several months previous to, and since, wean-
ing the child, she has suffered much from pain in both ovarian
regions, which pain was always increased by menstruation, by
walking, by pressure, by ascending the stairs, or by any sudden
jar. Lately, the left ovarian region has become the most pain-
ful, and the left breast has been likewise sore and swollen.
For the last few weeks the legs swell at night; there is slight
leucorrhcea, little \'c\'l-\\ and she complains of feeling "heavy
for sleep," and would sleep on all day if she could.

On making a digital examination, there was no sign of uter-
ine disease, but pressure directed towards the left ovary was
intensely painful. 1 ordered the following compound camphor
mixture : Solution of potash and tincture of cardamons, tour
drachms each : tincture ofhyoscyamus, six drachms ; camphor
mixture, six ounces: a tablespoonful to be taken three times a
md a small quantity of the following powder to be taken

88 Clinical Illustrations of Sub-acute Ovaritis. [February,

in a little milk at night : Sulphur, two ounces ; biborate of so-
da, one ounce ; while three or four drachms of the following
ointment were to be applied, not rubbed, over the lower por-
tion of the abdomen : Strong mercurial ointment, one ounce ;
extract of belladonna, two drachms. I then directed a thin
linseed poultice to be applied over the anointed surface, and
over that a piece of oiled silk, with the understanding that this
application was to be removed and re-applied as soon as pos-
sible in the morning, at two or three in the afternoon, and be-
fore disposing the patient for her night's rest. (I thus enter
into minutiae, as their observance alone leads to success.)

July 17th. The patient is better: the pains are only vio-
lent at times; there is no leucorrhcea, and the bowels are com-
fortably moved.

2 1 st. Ovarian pains all gone ; the mercurial ointment is
therefore discontinued.

28th. I learnt that on the 22nd, after an attack of diarrhoea,
menstruation returned ten days before it was due, but unac-
companied by ovarian pains. I prescribed the following pills,
to be taken at night : Sulphate of quinine, one scruple; ex-
tract of opium, Ave grains; extract of liquorice, a sufficient
quantity to make ten pills. But upon leaving me, and before
this treatment could be begun, menstruation again appeared,
and there was a throbbing and swelling of both breasts, and
pain referred to the pubis. On making an examination, I found
the neck of the womb hot and swollen ; I ordered injections
with a solution of acetate of lead, and I returned to the appli-
cation of the compound mercurial ointment. I saw the patient
after the subsequent menstrual period, which was normal as to
time, quantity, and pain ; the womb was ascertained to be
healthy, and the patient was quite recovered.

This case was first one of sub-acute ovaritis, lasting for
months, until the increased uterine activity, swelling of the
womb, and irregular and prolonged menstruation, necessitated
the employment of local measures to remove uterine conges-
tion. The mercurial applications, however, should not have
been discontinued on the subsidence of the ovarian pains ; for
as the womb was in a healthy state on the 14th inst., if they
had been continued, the slight attack of uterine disease would
have probably been avoided.

If I had not positively ascertained, on the 14th, that the
womb was in a healthy state, I should, on finding it slightly
diseased, on the 28th, have concluded that the previous pains
were to be attributed to the beginning of undiscovered uterine
affection, and not to ovaritis, which I believe to have been the
primary affection, determining the uterine inflammation in the

1853.] Clinical Illustrations of Suh-acute Ovaritis. 89

same way that the physiological congestion of the ovary de-
termined the physiological congestion of the womb in menstru-
ation.

Cast. 2. Sarah II , thirty-two years of age, with black

hair, grey eyes, and a Roman cast of countenance, was admit-
ted to the Paddington Free Dispensary on the 2nd of June,
1851. She first menstruated at fifteen, and has always been
regular; but at each period she had suffered from pain in the
right leg and (high. She married at twenty-one. Conception
never took place. The last menstrual period came on eighl
days before it was due, and was attended by a great increase
of the pain habitually felt in the leg and thigh, The catame-
nial flow lasted its usual time, but the pains did not abate on its
disappearance, and in addition the patient suffered from con-
stant pain in the right ovarian region, augmented by exertion,
by walking, or by pressure. The water was freely passed ;
the bowels, which were much relaxed during the last epoch,
were now confined ; there was no leucorrhcea; and a digital
examination indicated that the womb was healthy ; slight fe-
ver : and pressure directed towards the right ovarian region
increased the patient's pain. I ordered an antimonial mixture,
and the compound mercurial ointment, directing it to be used
as in the preceding case ; likewise the compound sulphur pow-
der, as in the previous case.

June 4th. Better in every way : the fever is reduced, the
pain less intense, and pressure on the ovarian region determ-
ines less pain. The ointment was ordered to be continued,
and the compound camphor mixture as prescribed in the first
case. A small quantity of carbonate of soda was ordered to
be taken in a little cold water after meals, and two compound
colocynth pills every night.

Oth. The patient came limping into the room with tears in
her eyes. The pain in the right thigh had left her, but that in
the right ovarian region had returned with more intensity than
before. There was difficulty in passing water. On making a
digital examination, I found that the womb was lower down
than on the 2nd June, and that its neck was swollen and pain-
ful in its posterior half: no leucorrhcea. The patient was or-
dered to continue the former treatment, and, in addition, to
have, twice a day. as an enema, a cupful of clear starch, in each
o\' which enemata were to be exhibited forty drops of laudanum.

12th. Four enemata had been administered to the patient,
and the pains had disappeared. I subsequently ascertained
that at the nex; j eriod she menstruated after her usual manner.

The painful detected on the i)th of June,

was certainly secondary to that of the ovary, since, on the
2nd, the womb was found healthy.

90 Clinical Illustrations of Sub -acute Ovaritis. [February,

Case 3. Sarah W , a lymphatic girl, aged twenty-one,

with light hair and blue eyes, tall and slender ; has been living
in London, as a servant, for the last four years. Menstruation
appeared at seventeen, after suffering for a month from head-
ache and great drowsiness. From the third month of its first
appearance menstruation came on regularly. It assumed the
monthly type, lasting four or five days, and being in small
quantity.

Eight days before the last epoch, she was seized with intense
pain in that portion of the left hypogastric region which cor-
responds to the ovary. Notwithstanding the pain, she did her
accustomed work, and menstruation came on at the regular
time, and as abundantly as usual. Unfortunately she was at
that time obliged to go up and down stairs much more than
usual ; and far from being relieved by the catamenia, there re-
mained an intense pain, which she compared to labour pains.
She became hot, thirsty, and feverish at night, and she was
admitted as a patient at the Paddington Free Dispensary on
January 9th. I found the abdomen sore, particularly in the
left ovarian region, where was also a sensation of fulness felt
by the patient herself, and a slight swelling, which could not
be detected on the right side. Walking or moving on the left
leg. and pressure on the painful spot, increased the pain. There
was no leucorrhoea, nor pain above the pubis.

I ordered eight leecl.es to the seat of pain, and poultices to
be afterwards applied over the leech-bites; but as the tongue
was foul, and there was a tendency to sickness and constipa-
tion, I also ordered an emetic, and compound colocvnth pills.

The leech-bites bled freely; the vomiting seemed to relieve
the intense pain, which was, on the contrary, exasperated by
the purgative action of the pills ; and when I saw her on the
13th, she was better in every respect, and the intense pain was
circumscribed in the left ovarian region. There was no pain
above the pubis, no leucorrhoea, no external irritation.

This intense pain produced by menstruation, so w7ell limited
to an organ we know to be highly congested at that time, un-
connected with uterine disturbance, with peritonitis, what is it ?
Those who attribute to the womb all acute disease of the gen-
ital apparatus, will say that the pain in the left ovary was the
result of the uterine congestion determined by menstruation ;
and as, in the absence of marked uterine symptoms, I did not
feel myself justified in making a speculum or even a digital ex-
amination, I could not object to the position, if, in similar cases
(Nos. 1, 4, 6,9, & 10,) an examination had not been made,
without any uterine disease being detected. Considering,
therefore, the case to be one of sub-acute ovaritis, I followed

1853.] Clinical Illustrations of Sub-acute Ovaritis. 91

up the previous treatment by the use of mercurial ointment,
as in the former cas

10th. The patient was comparatively free from pain.

27th. The ointment, pills, and mixture, were continued
until menstruation came on at the usual time, ami in the usual
manner. After it was over, the pain in the left side had com-
pletely disappeared : hut on considerable exertion, or pressure
on the right ovarian region, the patient experienced the same
kind of pain, only less intense. She was directed to continue
the use o( the ointment and poultice at night only ; and on the
10th of February she was discharged cured.

Case 4. Mary C , aged twenty-two, looked like a Flem-
ish girl, very stout, with a ruddy complexion, auburn hair and
blue eyes. She was admitted at the Paddington Free Dispen-
sary, May 15, 1851. Menstruation had been easily established
at sixteen, but had always been accompanied by a great deal of
lumbo-abdominal neuralgia, appearing every month, or some-
times missing for two. six. or nine months without any consid-
erable inconvenience. She had been very lately married. On
interrogating the patient, I heard that when menstruating, three
weeks ago, the flow, after lasting two days, had stopped for
three, and then returned for one day. Its subsidence was fol-
lowed by a violent pain in both ovarian regions whenever she
moved about. It hurt her to pass water. There is consider-
able pain in the right breast, slight leucorrhoea, and considera-
ble fever. Any sudden movement of the lower limbs brings
on the pains, so does ascending the stairs, and pressure on the
ovarian regions, particularly on the right, which I found swollen
and tense; a state of things the patient expressed by saying
" she was all on one side." A digital examination convinced
me that the womb was normal ; the finger directed towards the
ovaries greatly increased the pain, particularly on the right side,
where a solid lump could be distinctly felt, while on the left
side nothing similar could be distinguished, although pain was
determined by pressure with the finger. The bowels were
quite regular. I prescribed an antimonial mixture, and ten
grains i^\ Dover's powder at night, the compound mercurial
ointment to be spread on the ovarian regions, and the applica-
tion of linseed-meal poultices.

22nd. The !ever had abated, the pains in the back had dis-
appeared, and tlmse in the ovarian region were less intense.
The same treatment was continued.

Menstruation returned at the third instead of at the fourth
.. and had lasted its usual lime, when, from standing for
three hours, it returned as a flooding, and continued for several
days.

92 Clinical Illustrations of Sub-acute Ovaritis. [February,

June 4th. She was much better ; pressure on the right side
still, however, brings on pain and a sensation of numbness in
the right limbs. In July the patient had menstruated regularly,
and was free from pain.

If this was not a case of sub-acute ovaritis, developed under
the influence of matrimony in an excitable girl of a sanguine
habit, what is the disease to be called? The very abundant
uterine discharge may have been considered critical in this in-
stance, as it was followed by decided improvement.

Case 5. Elizabeth W , twenty years of age, a brunette,

dark hair, hazel eyes, of slender make and middling stature, is
a needle- woman, single, and in good circumstances. After
slight pains in the back, she menstruated at twelve ; was regu-
lar from the first; the catamenia occurred every four weeks
for three or four days, very abundantly. They had stopped
for a year without any known cause, and they had returned
without physic, being regular for the last three months, but
much less in quantity, and paler in appearance than usual. She
was admitted to the Farringdon Dispensary, January 8, 1850,
complaining of violent pains in both ovarian regions, which
pains had originated during the last insufficient menstrual flow,
and had remained after its cessation. She also complained of
a good deal of pain at the pit of the stomach, the intensity of
which was said to be proportional to that experienced in the
ovarian regions, increasing and diminishing as the latter in-
creased and diminished ; but the pain at the prsecordial region
was relieved by pressure ; while this measure increased that
in the ovarian regions. There was great lowness of spirits,
involuntary tears, invincible drowsiness, and a sensation of stu-
pidity on waking. No uterine symptoms, no leucorrhoea, no
fever or thirst..

I considered the case one of sub-acute ovaritis, and I ordered
five leeches to each ovarian region, to be followed by the con-
stant application of thin linseed poultices, and the compound
camphorated mixture to be taken.

22nd .The patient had been much relieved by the treat-
ment ; the pains, instead of being continued, had become inter-
mittent, occulting two or three times a day : she still continued
drowsy. I ordered the mercurial ointment to be made use of
as in the preceding case, an opium plaster at the pit of the
stomach, and myrrh and aloes pills to be taken a day or two
previous to her epoch.

27th. After taking the pills, which procured three motions,
the patient menstruated more freely than the last time, and
with more than usual forcing pains. Two more -pills taken
two days after the first, produced the same effect, and since
menstruation is over, there is much less pain.

1853.] Clinical Illustrations of Sub-acute Ovaritis. 93

Feb. 3rd. I gave her lulphate-of-iron pills, and a Tew weeks
after, aa menstruation had become norma), and the patient's
health had bo much improved, she was discharged from the dis-
pensary. In this, as in several of the preceding cases, the pa-
tient complained much of feeling unusually heavy, dull and
stupid, with a great tendency to sleep : a state of the nervous
system which frequently expresses the physiological or morbid
action of the ovario-uterine apparatus on the brain. As it is
convenient to express this in one word, I call it pseudo-narcot-
ism ; and it is right to remark that I have noticed this state in
connexion with sub-acute ovaritis, in women who did not ha-
bitually experience this pseudo-narcotism at the menstrual
periods.

Case 0. Jane A , twenty years of age, of a sanguine

complexion, reddish-brown hair, and blue eyes, tall and stout,
is a washerwoman. After two years of great suffering, she
menstruated at eighteen, the flow appearing regularly from
the first every three weeks, lasting three or four days ; was
of a trifling amount, and never missed until marriage, which
took place at nineteen. Two months ago she miscarried, lost
a great deal of blood, and since then has not menstruated.
Admitted Jan. 13th, 1850, at the Paddington Free Dispensary.
The patient complained of great forcing pain in both ovarian
regions. She said the pain was increased by walking, by pres-
sure, and by going up and down stairs. She also complained
of severe forcing pain at the nipples, which was increased by
the ovarian pains, as well as by anything hot she might take.
There was no appearance of disease in the breasts, no leucor-
rhoeal discharge, nor, on a digital examination, any evidence of
uterine disease. I ordered the treatment prescribed in the
former cases. The patient got gradually better, and at the
next period she menstruated regularly.

C \sr. 7. Emily B , admitted to the Farringdon General

Dispensary, October 27th, 1851. She was twenty-three years
of age, of a sanguine temperament, with reddish hair and grey
eyes, and unmarried. Menstruation first appeared at seventeen
and continued regularly every month; but for the last few
months the excretion was very pale and scanty, and the last
catamenial flow only lasted one day. and was attended by a
good deal of pseudo-narcotism, leaving, without any known
cause, a severe and constant pain in the right ovarian region,
but during the day only: for when quiet in bed, the pain left
her. The exertion of going up stairs increases the pain, like-
wise slight pressure on the right side, while great pressure on
the left ovarian region gives no pain. Slight leucorrhoea ; no
fever; but the mouth looked as if painted with yellow dust;

L

94 Clinical Illustrations of Sub-acute Ovaritis. [February,

the tongue was furred, and the patient said she had been bilious
for the last few days ; the bowels were regular. I ordered an
emetic at night, the compound camphorated mixture before
mentioned, and carbonate of soda after meals ; and the com-
pound mercurial ointment to be applied in the usual way to the
side affected.

Nov. 1st. All pain and uneasiness had left the patient.

loth. She returned on account of a cough, and I learnt that
she had just menstruated, and that for many years the dis-
charge had not been so abundaut, of so good a colour, and at-
tended with so little suffering.

In this amenorrhoeal form of sub-acute ovaritis there was
no chlorosis.

Case 8. Anne B , aged nineteen, with very dark hair,

and eyes dark and lustrous, swarthy skin, and sanguine com-
plexion, of average stature and size, and menstruated for the
first time, without prodromata, at seventeen. Three months
after its first appearance, the discharge re-appeared painfully,
but with regularity, every fortnight, lasting three or four days,
and was very abundant. Recently, after four months of amen-
orrhea, menstruation returned of its own accord, much more
abundantly, and with more pain, during which time, being ex-
posed to wet, she caught cold, and was seized with violent pain
in the right ovarian region, accompanied by considerable thirst,
heat and fever. Another gentleman had attended her at her
own house, and ordered twelve leeches to the seat of pain,
poultices, and some medicine; and after being confined to her
bed for a fortnight, menstruation returned at the usual fort-
nightly period, with more clots and greater pain, and lasted
seven days, instead of three or four.

On the 20th of February, 1850, she was admitted to the Pad-
dington Free Dispensary. The pain in the right ovarian region,
although much abated, was still considerable, and was exasper-
ated by stooping, walking, or by pressure. No leucorrhoeal
discharge. I ordered the usual compound camphor mixture,
the ointment, poultices, and two grains of sulphate of quinine,
with two of extract of hyoscyamus, in a pill, every night ; but
before the treatment was begun, the patient again menstruated,
and the function lasted with -great pain for three days; and on
its disappearance, a light leucorrhoeal discharge ensued. The
treatment was then put in force, the local pains gradually dis-
appeared, and on the 4th of April I heard that menstruation had
re-appeared at monthly periods.*

Aug. 11. She applied again, for an attack of jaundice; and
I learnt that she had not again suffered from pains similar to
those which brought her before to the dispensary.

:

1853.] Clinical Illustrations of Sub-acute Ovaritis. 95

Dec. 1851. Anne B again called, and stated that, during

a severe cold, menstruation came on at the usual time, lasted
eleven days, ceased by degrees ; and that upon its cessation,
the ovarian pains, bearable before, became intolerable, causing
her to walk doubled, particularly when going up stairs. She
could not wear her stays, pressure determining a darting pain.

It is interesting to observe how. in this patient, the menstrual
function, which by the use of sulphate of quinine, I had brought
to the tour-weekly type, soon relapsed from the normal to the
three-weekly, and then again from the three-weekly to the fort-
nightly, which it now adopts; and how, in close correspond-
ence with these irregularities of physiological action, there is
also a tendency to relapse into the morbid condition, which I
think deserves to be called sub acute inflammation.

Case 9. Dr. Yinen, of Bayswater, requested me to see a

patient of his, in September, 1849. Mrs. L was then

twenty-eight years of age, with a pale complexion, middling
stature, dark hair, and hazel eyes. She had first menstruated
at twenty, but was always irregular both as*totime and quan-
tity, it being sometimes scanty, at others very profuse. Since
marriage the function had become more regular, but was still
variable in amount

In the previous January she complained of acute pain in the
right ovarian region. Two months after, consulting Dr. Yinen,
he discovered a distinct swelling in that region, and, some
weeks after, the same appeared on the left side, accompanied
by great tenderness at all times, but particularly at the men-
strual epoch. The catamenia then became more scanty, dark-
er, and more painful than usual. There was dorsal pain and
slight leucorrhoea. Twelve leeches had been applied, with but
little benefit, but blisters had been more efficacious. When I
saw the patient she was exhausted by continued suffering, and
was at times affected with hysteria. Menstruation had not
appeared for the last two months. Digital examination was
painful both to the vagina and to the womb, which was some-
what swollen : there was acute pain on pressing in the direc-
tion of the ovaries, the right one being still swollen ; both
breasts were very painful. I ordered the treatment previously
described.

On the 1st of August the patient was better: examination
was no longer painful; pressure in the ovarian regions was
less so ; the womb was neither swollen nor painful, neither did
it present any lesion when examined through the speculum.
In addition to the previous treatment, I ordered cold-water
injections to be made twice a day, per rectum, and twice a day
a vaginal injection of two drachms of tincture of hyoscyamus
in half a pint of tepid water.

9G Clinical Illustrations of Sub-acute Ovaritis. [February,

The patient rapidly improved, lost all pains, and became
stronger. She has had no relapse, bat, although married sev-
eral years, has never been pregnant.

Case 10. Charlotte K called upon me October 18, 1849.

She was about twenty-six years of age ; her constitution being
lymphatic, but her hair and ey^s dark. In childhood she had
several abscesses in one of her legs and groin. Menstruation
appeared at fourteen, but at sixteen was suspended, from her
catching cold : and when it did return it was three-weekly
instead of monthly as before. It was either profuse or scanty,
and preceded for a week by great pain in the ovarian regions.
Pressure, walking, or stooping, aggravated this pain. This
state lasting for several years, had brought dyspepsia, palpita-
tion, hysterical symptoms, and there was often leucorrhoea.

Mr. Pughe, of Aberdovey, in North Wales, considering the
case to be one of chronic ovaritis, sent her to me. Digital ex-
amination was so painful, that I contented myself with having
ascertained that the vagina and neck of the womb were swol-
len, hot, and inflamed. Pressure on the ovarian regions was
also very painful. Leeches had been appied to them a fort-
night previously, and with great benefit ; I therefore ordered
twelve more to be applied, prescribing the usual treatment,
with the addition of aloes pills, and cold-water injections per
rectum.

Oct. 28th. I was able to make a speculum examination, and
ascertained that there was no ulceration of the womb, which I
was led to expect from the persistence of many symptoms
which usually indicate it. When the finger in the vagina was
directed towards either of the ovaries, a sickening pain was
determined ; and when the left hand pressed moderately on the
ovarian region, so as to press the mass of intervening tissues
between both hands, the pain became intolerable.

This patient was fox several months under my care. After
each menstrual epoch, six leeches were applied to each ovarian
region ; when the leech-bites had healed, a blister was applied
to the same part ; and when these were healed, the same sur-
face was anointed with mercurial ointment until the time when
menstruation made its appearance.

Feb. 13th, 1850. She was without pain or discharge, and
menstruation had assumed its normal type, completely losing
the prolonged pains by which it had been accompanied. In
fact, she returned to Wales quite well.

As the preceding cases are fair samples of many others
which I have met with, it may be well to see to what deduc-
tions they lead.

1st. With regard to the predisposing causes of sub-acute

1853.] Clinical Illustrations of Sub-acute Ovaritis, 07

ovaritis, Irregularity of the menstrual process is one of the most
frequently observed ; for eight times out often it occurred in
connexion with menstruation. The earlier part of womanhood
also would seem most liable to this disease, as seven out often
patients were under twenty-three, and the eldest was only
thirty-two. Those too are most liable to it who are endowed
with a sanguine constitution, dark eyes, and red, auburn, or
black hair, constitutional peculiarities generally supposed to be
allied to an ardent temperament. In this, my experience is
supported by thai of Dr. Pistocchi, of Bologna, who has lately
published some interesting cases of ovaritis, and says that all
the patients were women gifted with strong passions. Six out
of the ten patients were single.

2nd. The determining causes were over-exertion during
menstruation, the sudden impression of cold, marriage. In five
cases, however, none could be discovered.

3rd. The symptoms : pain in one or in both ovarian regions.
The pain being fixed, but sometimes subject to irregular ex-
acerbations, being increased by pressure, by going up and
down stairs, by a false step, or by anything that could jar the
corresponding limb. It is well to notice that pressure on the
ovarian regions did not generally determine pain in the course
of the lumbo-abdominal nerves. In two cases the pain was
accompanied by an amount of abdominal swelling discernible
to the eye, obscuiely felt on pressure on the abdomen, better
appreciated by a vaginal examination, and which would have
been made certain if a rectal examination had been deemed
requisite. In five cases there was considerable pain and swel-
ling of the breast corresponding to the side afiected, and of both
when both sides were diseased. This symptom was most
marked in Case (>, which did not occur at a menstrual epoch.
Dr. Pistocchi has noticed it in two cases; but I think Dr.
Lightfoot has gone too far in considering it as pathognomonic
of ovarian inflammation. Thus, the mammary glands, the
uterus, and the ovaries, form a chain of organs as strongly
linked together in the morbid as in the physiological state. In
1 there was numbness and pain in the corresponding limb,
a symptom noticed by Dr. Simpson. In four cases there was
fever, but of do great intensity.

4th. The terminations or morbid conditions induced by sub-
acute ovaritis were, a painful congestion of the womb in four
out often instances : in three, remittent menstruation ; a defi-
ciency of the menstrual excretion in three more; and in two,
bilious plethora. Dr. Rigby has dwelt on the sickening nature
of the pain determined by ovaritis: and Dr. Wool ley, of
Brompton, tells me he has often seen cases similar to those

98 Clinical IHustralions of Sub-acute Ovaritis. [February,

above described by me, and frequently noticed sickness as one
of the symptoms. Dr. Laycock alluded to it some time back
as a symptom frequent in this, as in all ovarian states, both
physiological and morbid.

5th. Treatment. The same local measures previously de-
scribed were always adopted, with the addition of leeches and
the internal exhibition of antimonials when there was fever.
In the cases coinciding with marked biliary derangement, I
prefaced all treatment by an emetic, the temporary increase of
pain thus mechanically determined being amply compensated
by the relief speedily afforded to the patient. Sulphate of
quinine was very useful in bringing back menstruation to its
normal type ; and I cannot too strongly recommend its exhibi-
tion alone, or combined with steel or opium, according to the
case..

6th. Duration of the disease : Generally about twenty-one
days; but in one case, of probable long standing, it was four
months, and in another there was a relapse.

With this summary of my cases I might conclude, if they did
not afford me an opportunity of offering some remarks on the
diagnosis of sub-acute ovarian affections remarks, the length
of which will perhaps be indulgently received, on account of
the recognised difficulty of arriving at a correct diagnosis.

Cases similar to the preceding have doubtless been of fre-
quent occurrence, but they have been differently interpreted.

I. Formerly when they were met with, and sometimes even
now, particularly when they do not occur at the monthly peri-
ods, they were confounded with diseases of the womb, and
called inflammation of the bowels a name wThich will doubt-
less be considered erroneous, as far as the localization of the
disease is concerned, but which, being correct in the indications
of its nature, fortunately often leads to proper treatment.

II. When cases similar to those I have reported took place
at, and in connexion with, the menstrual periods, they were,
and are even now, confounded with many other morbid states,
under the name of dysmenorrhoea. They are considered to
be merely an increase of that pain by which menstruation is
usually attended, and generally left without treatment. This
I believe to be often detrimental to the patient's after health.

III. Some would be inclined to explain my cases by incipient
uterine disease, and might be impelled by theory to resort to
measures, excellent in uterine, but unnecessary, if not danger-
ous, in ovarian disease. Being in doubt as to four out of the
ten cases, a digital examination convinced me that there was
no uterine disease; and in the history of the other cases there
was nothing to make me suspect its existence, nor to warrant
a vaginal examination.

1853.] Clinical Illustrations of Sub-acute Ovaritis. 90

Admitting that mine were neither cases of inflammation of
the bowels, of dysmenorrhea, nor of uterine disease, I must re-
mark that they can only he explained by supposing them to
depend on a nervous affection of the ovary itself, or of the
lum bo-abdominal nerves, which supply alike the womb and the
ovaries and their protecting cavity, unless I am right in con-
sidering them to exemplify a subdued type of ovarian inflam-
mation. It would be impossible for me to show that they did
not depend on ovaralgia or lumbo-abdominal neuralgia, unless
I be permitted to clear the ground by a lew remarks on these
affections.

Ovaralgia has been admitted by systematic writers, vaguely
described by German pathologists, and lately brought promi-
nently forth under the name of ovarian irritation, by Dr. Fleet-
wood Churchill. But while admitting that the ovaries, like the
uterus, may express their own disorder by pain transmitted to
the same system of nerves, we must also bear in mind that those
nerves may take upon themselves a morbid action, quite inde-
pendent of diseased ovaries or womb that lumbo-abdominal
neuralgia may exist.

Certain forms of lumbo-abdominal neuralgia were well de-
scribed by Chaussier ; but it is only since the modern inves-
tigation of the nervous system, that it has been permitted
satisfactorily to explain, by lumbo-abdominal neuralgia, certain
morbid states formerly ascribed to the abdominal viscera.
Without pretending to say that ovaralgia does not exist, I must
own that I have never as yet been able to detect it, and am
inclined to think that cases described as such are to be referred
to lumbo-abdominal neuralgia. I make this assertion with some
hesitation, because by so doing I find my opinion opposed to
that of an obstetric authority of so great a value, that by differ-
ing from it 1 incur the risk of being wrong; but, if wrong, my
dissent will furnish Dr. F. Churchill the opportunity of more
forcibly vindicating his own opinions.

On perusing Dr. F. Churchill's interesting communication on
Ovarian Irritation, in the impression of the Dublin Medical
to for July, 1851, and comparing it with what Drs. Beau,
Valleix, and #ome other French authors, have written on
lumbo-abdominal neuralgia, it will, I think, be evident that they
have all described the same disease. Neither would it be diffi-
cult to explain the mistake ; for it is well known that it is in the
nature ot the affections of nerves to be attended by pain more
concentrated in certain points, whence at times pain radiates,
and pressure to which increases pain. The lumbo-abdominal
neuralgia is often indicated by one or more of the following
foci of pain: 1, the lumbar; 2, the iliac: 3, the hypogastric ;
4, the inguinal ; 5, the uterine.

100 Clinical Illustrations of Sub-acute Ovaritis. [February,

I think that Dr. F. Churchill, being particularly struck by the
inguinal or ovarian point of pain, has described, under the name
of ovarian irritation, a complaint which has been justly referred
to a morbid sensibility of the lumbo-abdominal nerves by Drs.
Valleix, Oxenfield, Beau, and others. He has followed in this
the example of Gooch, who described as irritable uterus those
cases of lumbo-abdominal neuralgia in which the neck of the
womb is the principal centre of pain; an example already set
by neuro-pathologists, who have described as spinal irritation
an ill-defined group of symptoms.

I refer the reader to Dr. F. Churchill's paper, and to the
French authorities I have quoted, in proof of the great simi-
larity, if not identity, of the morbid state described as ovarian
irritation or lumbo-abdominal neuralgia. But, under all cir-
cumstances, I object to the term ovarian irritation, because it
has already been employed to express the physiological action
of the ovaries, and imports another vague and indeterminate
term into ovarian pathology, already sufficiently obscure. If
it be only pain, let it be called ovaralgia, or lumbo-abdominal
neuralgia.

Supposing it to be conceded, until further researches, that
ovaralgia is but another name for lumbo-abdominal neuralgia,
then it only remains to me to establish the diagnosis between it
and sub-acute ovaritis, which is often rendered difficult by the
similarity of the seat of pain in both complaints. Those of a
nervous temperament are most liable to lumbo-abdominal neu-
ralgia, not brunettes of a sanguine constitution, as in most of
the cases given in the previous papers. Pain exists in all, but
while in sub-acute ovaritis it is more fixed, continues with the
same intensity without regular exacerbation, and is exasperated
by every kind of pressure, in lumbo-abdominal neuralgia it is
quite the contrary; for although there may be at all times a
dull, aching sensation, it is frequently not so, and the pain re-
curs by repeated attacks, and is relieved by wide or even by
continued pressure with the united tips of the fingers. Dr. F.
Churchill rightly says, that what he terms ovarian irritation is
characterized by a kind of nervous tenderness which shrinks
from the weight of the finger as much as from ^vere pressure,
and not by the positive pain, as in my cases.

There is no swelling, no heat, no pain of the ovaries, when
these organs are subjected to a rectal examination, as correctly
stated by Dr. F. Churchill, whereas there is heat, swelling and
pain, in sub-acute ovaritis.

The pain is unaccompanied by any sympathetic pain of the
breasts, or fever, in lumbo-abdominal neuralgia; not so in sub-
acute ovaritis. Lumbo-abdominal neuralgia is so frequent an

1853.] Clinical Illustrations of Subacute Ovaritis. 101

accompaniment of uterine disease', that Dr. Beau and others
expect to find it when the former < xists, and Dr. Ben n el looks
upon its o\ arian tonus as almost pathogt omonic of uterine dis-
ease, while sub-acute ovaritis is not so frequent I) induced by
uterine disease. Lastly, with regard to the treatment. Re-
peated blisters and opium are of most w<a iu lumbo-ahdominal
neuralgia, but such remedies, valuable in the later stages of the
disease, require to be employed after leeches, emollients, &c,
in sub acute ovaritis.

Il my argumentation is not at fault, then my ten cases were
examples of sub-acute ovaritis ; and. moreover, the complaint
can be diagnosed with a degree of precision quite sufficient for
all practical purposes, without having recourse to any internal
examination. It was so in six out of the ten cases, while digi-
tal examination was necessary to establish the diagnosis in
four, but a rectal examination in none.

Taught by former experience, wherein the coincidence of
sterility or uterine disease rendered imperative a more accurate
examination, I concluded from the symptoms narrated that the
s were sub acutely inflamed, although my finger did not
Bel them swollen, although I did not see the patienl wince
[mderthe moderate pressure of the finger mediately applied to
ins; but I maintain that win-never the case is com-
plicated or great pressure is required, it is necessary to make a
initiation. From not having done so in the following
case. I (\',A not understand the whole of its bearings, and some
irsmay think lint I was completely wrong.

Cask II. Sarah X , twenty-three years of age, is tall,

of slender make, with light brown hair and grey eyes : she is a
washerwoman in good circumstances. Alter painful prodro-
six months, menstruation first appeared at thirteen,
and at once assumed the monthly type, lasting five days, and
being very abundant, bright and clotty. She was married at
. and iias had two children, and during both lactations,
ged to the thirteenth and twentieth mouths, menstrua-
tion occurred every fourteen days with unusual abundance.
Three months previous to her applying to me for relief, she
who judiciously told her to wean the
child. On doing so, menstruation returned to the monthly
abundant ; but while still debilitated by
thee' labitually profuse menstruation, and about the

time when it should ha i _r t wet through, caught

attended by d instead of the cufamenia

appearing, the patient was seized with . pains in both

ovariai ed by her as bearing down and pinch-

pains, and augmented by standing long or by pressure.

N. S. VOL. IX. NO. II.

102 Clinical Illustrations of Sub-acute Ovaritis. [February,

There was no leucorrhcea and no pain about the pubis when,
January 13th, 1850, she applied for relief at the Paddington
Free Dispensary. I ordered five leeches to each ovarian re-
gion, and the usual treatment ; but not hearing anything more
of the patient, T sought out her abode, and learnt that she had
derived benefit from the treatment, but that having been
obliged to exert herself more than usual, on account of her mo-
ther's illness, she had miscarried of a three-months foetus three
weeks after coming to the dispensary.

Dr. Rigby admits that ovaritis is one of the most frequent
causes of abortion, and possibly my diagnosis was correct, and
a relapse may have brought on the miscarriage. This view
seems to be confirmed by the great, tendency to exaggerated
ovarian action ever since the patient first menstruated, while
the sudden invasion of acute pain in the ovarian region, in con-
sequence of menstruation being interrupted by a feverish cold,
would certainly again cause me to give a similar diagnosis ;
but I abandon the case, as it admits of more than one interpre-
tation, and. merely bring it forward to show that I acquired but
a very imperfect knowledge of it, because I neglected a vaginal
and rectal examination. If the patient had been thus examin-
ed, early pregnancy would have been detected, and she would
have been warned against the excess of fatigue which caused
the death of the embryo, and the prolonged illness of the pa-
tient. This case is well worth the attention of those medical
men who object to a rectal examination on the ground of its
being an unclean practice; as if a medical man can be stopped
by such a consideration when health is at stake !

We cannot conclude without observing that sub-acute in-
flammation of the ovaria does more than cause temporary
ill-health : it may determine or be accompanied by ovarian
peritonitis, and even set up inflammation in the surrounding
portion of the peritonaeum. Many obstetric writers, as well
as Burns, Sir C. M.Clarke, and Dr. R. Lee, have noticed the
great frequency of lesions of the ovaria, and of false mem-
branes in their vicinity, even in unmarried women lesions
not to be accounted for by any previous severe uterine dis-
ease, from which it could be ascertained that the patients had
suffered.

With regard to peritonitis, I will merely cite the practice of
one London hospital, St. George's, where the post-mortem ap-
pearances are noted with a praiseworthy care. In 1850 the
medical practice afforded four instances of idiopathic peritoni-
tis; three occurred in young women of twenty, twenty-one,
and twenty-four years of age; with two the menstrual func-
tion was deranged, and the patients anaemic ; the third, though

1853.] Clinical Illustrations of Sub-acute Ovaritis. 103

man ten months, had had no children, and, after

rag pus in her stools, she recovered.

.. it seems tome that the cases I have previously related
are explanatory of those of peritonitis. Again, there is a form
of peritonitis to which women are more subject than men. in
which bridtes of lymph are so attached as to hind the intestine,
and produce fatal incarceration Why should such bridles be
frequent in the vicinity of the ovaria? I will nnswer
tfiis question, as I found it in one of the last imp: :' the

London Medical Gazette. An eminent pathologist, I >r. Renaud,
of Manchester, relates the death of a girl, twenty-one years of
age, from two bridles of lymph, which produced an impenetra-
ble stricture of the ileum, and nddsthe following reflections:

- My own experience in pathological anatomy, and a perusal
of the cases recorded by others, justifies the conclusion that
peritonitis in femal in many instances out of a chronic

form of congestive irritation, to which the generative appara-
t bin the abdomen is liable. That this long-continued
irritation, as manifested directly by pain and throbbing in the
region of the ovaries and uterus, and indirectly by lumbar irri-
i, dysmenorrhea, crural pains, &c, does frequently ad-
vance to local inflammatory action, is sufficiently evident from
3 of lymph that are so frequently seen matting the
ovaries, broad ligaments, and oviducts together. If therefore,
folds of bowel or portions of omentum are in contiguous rela-
tionship wit!) parts influenced by these morbid actions, it is not
contrary to rational pathology to infer that they will partake
in a limited decree of the same actions; and a bond of union
being thus morbidly constituted, it only requires time and the
peristaltic action of the bowels to elongate the lymph into a
hai d, which, under accidental circumstances, may prove an
incarcerating medium."

Rokitansky is likewise of opinion that internal constrictions
of the intestines, are much more frequent in females than in
males : a result which indeed might have been anticipated, on
account of the great changes in function, structure, and posi-
tion, to which the abdominal viscera are subject, by menstrua-
tion, | v, and from uterine and ovarian tumours ; and
,ied author also reports that

"'In two instances with which I am familiar, the pressure of
the prolapsed ovarium, loaded with purulent fluid, produced in
each i d form l ileus. In one of these the tumour filled

the rectum: neither bougie nor inj-etion could be com
beyond it, and such was its apparent solidity, that I did not \\>[-
a momenl contemplate puncturing. But the deception was
fatal to the patient. The second case, very similar in all re-

104 Ricord's Letters on Syphilis. [February,

spects to the first, occurred in the practice of a surgeon in the
country, who sent me its history, and the morbid parts for ex-
amination."

The pith of the present communication can be summed up
in a few words:

I. It seems urgent on us carefully to bear in mind the fre-
quency of inflammatory products in or about the ovaries, the
frequency of intense suffering in the ovarian regions at the
menstrual periods, and the great probability of both facts stand-
ing one to the other in the relation of cause to effect.

II. It seems incumbent on us to bear in mind the greater
liability of young women to idiopathic peritonitis, and incar-
ceration from bridles of inflammatory lymph, at the very age
when 1 have shown that even the sub-acute inflammation of the
ovaries is most frequent, and therefore the imperative necessity
of watching over the first stages of a complaint, which, being
too of* en left to nature, is as frequently productive of serious
mischief.

III. Lastly, that sub-acute ovaritis can be distinguished from
uterine affections as well as from lumbo-abdominal neuralgia,
but that at all events no harm can ensue from the treatment
recommended. [London Lancet.

Letters upon Syphilis. Addressed to the Editor of L'Union
Medicale, bv P. Ricord. Translated from the French, by
D. D. Slade, M. D.

[Continued froin Page 682, vol. 8.]

FIFTH LETTER.

My dear Friend, I promised to commence to-day the great
questions to which the study of blennorrhagia gives rise. I shall
endeavor to do honor to this serious engagement ; serious in
fact, for. as I hope to be qualified to show, the point that I un-'
dertake to discuss at this moment may be considered as the
key stone to the syphilographic edifice.

All that I have thus far said upon blennorrhagia, relates to
simple blennorrhagia, which may be considered or not as the
product of a special virus, but a virus completely foreign to
that which syphilis, properly called, produces. However, this
blennorrhagia, according to a great number of authors, can pro-
duce consecutive accidents perfectly identical to those which
chancre produces. It is incontestable that a great number of
patients, affected with constitutional syphilis, do not accuse
for antecedents anything but blennorrhagia. These patients
are sometimes right. I do not deny the fact ; but after having

.

1853.] RicorcPs Letters on Sj/jihilis. 105

verified it. I do not confine myselfto leaving it in a crude state,

and to crying out with emphasis, it is a fact, and then oppose it
with intolerance.

The entire question enn be reduced to these term . when a
blennorrhagia has been the point of departure ofa constitution-
al syphilis, has there not been something else than that which
we have before studied in blennorrhagia properly so called ?
Experimentation has proved, and pathological anatomy has
come to its aid. that the urethra, and the deep and cone
points of the other genital mucous surfaces, can be the seat of
chancre, the necessary souice of syphilitic accidents. It is for
not having recognized the concealed chancre, thai the doctrine
of Balfour, of Tode. of Bell, and that great scaffold built upon
the experiments of Hernandez, have very nearly given way.

With the doctrine of the existence of urethral or concealed
chancre, the virulent blennorrhagia cannot be doubted ; it is
identical with chancre, it is the chancre itself.

This idea is not new in science, and I am astonished that the
detractors from priority have brought nothing against me in
this respect. However, it is a lon<j time since the ulcerations
of the urethra were recognized. Mayerne, in the seventeenth
century, attributed at that period the urethral blennorrhagia
to pus produced by ulcers within the urethra, and nave to it
the name of pyrroia. Many others still; whom I do not wish
to recall, have verified the presence of ulcerations in the ureth-
ra; but do you not consider it strange to see Swediaur, who
sustains the identity of blennorrhagia and of chancre, say pre-
cisely that which cannot be denied, viz, that blennorrhagia is
virulent when ulcerations exist in the urethra!

If in three autopsies of persons hung, who were affected
with blennorrhagia, Hunter did not prove the presence of ulcer-
ations in the urethra; it in an autopsy of which M. Phillippe
Boyer has given an account ; if in some others still nothing
has been found, it is because they had to do with simple blen-
norrhagia. I have shown to the Academy of Medicine two
specimens of pathological anatomy, the designs of winch and
the accompanying observations may he found in the cltmque
iconogrdphique of the Venereal Hospital, and upon which
MM. Culierier and Lagneau have made a report. These spe-
cimens presented some chancres of the urethra at different
depths, which previous to death had been recognized by inoc-
ulation.

Thus, inoculation Brit, and pathological anatomy afterwards,
have pr >ved, in an

cres of the urethra. To tell the truth, i - it, even

those who wish to ascribe to simple blennorrhagia the conse-

106 RicorcTs Letters on Syphilis. [February,

quences of syphilis. The chancre concealed in the urethra is
not, then, an hypothesis, but a fact proved as certainly as any
other medical fact. And vet, singular phenomenon! those
even who have best studied the chancre of the urethra who,
like M. Baumes, have been able to recognize it at the depth, of
an inch in the canal when it comes to establish the logical de-
ductions of its existence, love better to launch into the field of
hypothesis, thcin to admit that which observation and good
sense point out to them. Observe, in fact, M. Baumes and
others, establish, with a rare sagacity, the differences which
exist between chancre and blennorrhagia, in tracing with clear-
ness the differential characteristics, and arriving, at the end of
his comparison, to conclude upon the identity of these two ac-
cidents.

It is always, dear friend, the same contest between the logic
of facts and the pieconceived ideas of which I have noticed
the results even in the great mind of Hunter. Very recently
I have again perceived these singular manifestations, in a
pamphlet, otherwise interesting, of M. Lafont Gouzy fils.

But here some serious objections present themselves. '" The
existence of chancre in the urethra cannot explain all the cases
of constitutional syphilis, which appear to have blennorrhagia
as a point of departure.'' "The number of urethral chancres
is too small relatively* to that of the constitutional veroles with
blennorrhagia as antecedent. In fine, there are some cases of
blennorrhagia in which it has been impossible to verify the
urethral chancre, and which have been followed by constitu^
tional accidents."

Here I am going to astonish greatly my antagonists by ma-
king the concession that all this is true. But you will see, dear
friend, that this concession is but apparent ; for I hasten to add,
that which ceases to be true are the explanations which have
been given of these facts.

It is very certain that relatively to the immense number of
blennorrhagias which exist, the symptomatic blennorrhagia of
concealed chancre in the urethra constitutes the exception. In
fact, they say to me, with an appearance of reason, but how
is it, then, that the number of cases of syphilis coming on after
the pretended chancre of the urethra, should be almost in pro-
portion with the veroles coming on after the external chancre ?
Here, my dear friend, I ask all your attention, not because I
wish to be subtile or captious, but because the form of reason-
ing which I am forced to employ to answer this objection, itself
very subtile and captious, has need of being followed in all its
Conditions.

Yes, the chancre concealed in the urethra is rare.

1853.] RicoroVs Letters on Syphilis. 107

No, the number of veroles, the consequence of chancre con-
cealed in the urethral does not appear rare.

You are about to cry out, sophistry ; bul hear me.

That chancre in the urethra is rare, is incontestable ? my
experiments, those of my honorable colleague and friend, M.
Puche, and those of many other observers, have proved it

without reply. \)o you wish 'ha! I establish a proportion? I
much desire to do so. Let us admit I in 1.000, which is, I am
convinced, far greater than the reality. Let there be, then, on
one hand, 1 chancre of the urethra, in 1000 cases of bJennor-
rbagia. Do you recollect on the other hand, how frequent and
extended is blennorrhagia ? Do you recollect that Lislranc,
with perhaps a little exaggeration, said that out of 1,000 adults,
he counted 800 who had had. who had then, or would have blen-
norrhagia ? However this may be. my dear friend, out of 1,000
of blennorrhagia, there are 91)9 of which you never hear
mention, which will have had no unhappy consequences,
against a solitary one, which will have determined the consti-
tutional infection.

It is a small number, without doubt, but make your calcula-
tions upon the hundreds of thousands, upon entire populations,
upon the population of Paris, for example, which numbers
three to four hundred thousand adult men ; compute the num-
ber of blennorrheas contracted in this great city ; only cal-
culate for the concealed chancre but the small number of 1 out
of 1.000, and you will stdl arrive at a sufficiently large number
of blennorrhagias which would consecutiveJy determine the
verole.

Well, what happens in practice ? That you do not see in
the hospitals nor at the consultations of physicians, but those
patients in whom the syphilitic infection has been preceded by
a blennorrhagia with a concealed chancre. A physician of a
hospital devoted to these diseases, could meet, in the course of
his practice, with ten, twenty, thirty examples; but what is
that in comparison to the number of simple cases without anv
unhappy consequences ? But those patients who have no oilier
antecedent than the blennorrhagia for I heir constitutional infec-
tion, strike the mind of observers ; the remembrance o\ them
remains deeply engraved ; their number, relatively small, in-
i their imagination, and they do not fail to pre
rmidable objection to the non-identity of blennorrha-
gia and syphilis.

You see to what this objection is reduced ; I hope that I have
destroyed it. 1 am accused of founding an \i] - with

the concealed chancre, of estal lishing a system. However, 1
have proved the fact of its existence by pathological anatomy.

108 Ricord's Letters on Syphilis. [February,

I have deduced it also from my experiments with inoculation.
Is it not true that blennorrhagia in the immense majority of
cases is exempt from every consequence of syphilis? To what,
then, can we attiibule the infection when it comes on after
blennorrhagia ? J myself attribute it to concealed chancre ! and
my adversaries to what do they attribute it? To a pretend-
ed identity, which the observation of every day, and great
abundance of facts, incessantly contradict. And it is I whom
they accuse of being systematic, I who elevate a doctrine upon
the basis of observation, of experimentation and of pathological
anatomy. What, then, are mv adversaries, who, for the sole
support of their doctrine, invoke but a rude fact, the interpre-
tation of which does not repose upon any of the elements ne-
cessary at the present day tor the demands of science!

Believe, then, dear friend, that it is my adversaries who
launch themselves into the way of hypothesis, whilst I, on the
contrary, strive to bring them back into the path of reality.
You see now that it is easy to conciliate these two terms of my
proposition.

Yes, the chancre concealed in the urethra is rare; but the
number of veroles, the consequence of chancre concealed in
the urethra, does not appear small. It does not appear small,
because we see again only those patients who have been suffer-
ing from this concealed chancre; but if a strict proportion
could be established between the cases of blennorrhagia not fol-
lowed by syphilitic accidents, and those which have given
place to them, we should see that the last are proportionally
very rare, and that this appearance of frequency is entirely
iliusory.

But in other respects, in all the cases in which the constitu-
tional verole has been referred to blennorrhagia, have all possi-
ble precautions been taken in order not to be led into error ? I
do not believe it, when I see that some are contented with a
diagnosis offered by the patient, and w7ith his own history. We
could truly say that the physician has in some way declined
his jurisdiction. You will see some striking examples of this
confidence of the physician in the story of his patient, in the
works of MM. Martins, Cazenave, and in the thesis, in other
respects so w?eli written, of M. Legendre.

How many causes of error there are in the stories of pa-
tients! Blennorrhagia is ordinarily a very painful and annoying
accident, and one which leaves behind some smarting recollec-
tions to those who have had it. When you interrogate patients
upon their previous history, it is always of their blennorrhagia
that thev first speak; they do not suspect the importance that
the chancre can have, which, while it infects, is ordinarily

1853.] RicoriPs Letters on SyphiHs. 109

indolent, suppurates but little, has little tendency to extend,
and often cicatrizes of Its own accord : it is rare that they make
mention of this accident, and if by a pressing inquiry you cause
them to bring the circumstance to mind, they will tell you that
it was a superficial chancre, a sim iation. I am allow-

ed to call to mind, that it is only since my works, that the
manner of considering blennorrhagia as regards the accidents
of constitutional syphilis, has been a little more strict. In fol-
lowing the course which 1 have marked out, we are forcibly
brought to confi ss that the great number of urethral blennorrha-
- which do not furnish inoculable pus, were not followed by
constitutional accidents.

Among other statistics advanced, 1 shall cite the most recent,

those made last year by M. Lafont Gouzy, who. out of 380

< o\ urethritis inoculated, found hut two cases in which the

inoculation gave any results. One of the two presented, four

months later, symptoms of constitutional syphilis.

In this work of M. Lafont Gouzy, he has mentioned two
cases in which the inoculation gave no result, and which were,
however, followed by syphilitic accidents. We shall have oc-
n later to explain these exceptional ca
M. Baumes cites five examples of individuals affected by
simple blennorrhagias, in which the constitutional infection is
nevertheless seen to appear at a later period. From these
facts our honorable colleague draws an argument in conclusion,
that the blennorrhagia non-symptomatic of chancre, can, like
the chancre, produce the syphilitic infection.*

But, first, are all the veroles which have been attributed to
blennorrhagia really the consequence of it? If we did not
take care of the manner in which statistics were made, we
should find, as M. Cazenave and others have, that blennorrha-
gia is the most frequent antecedent of the constitutional verole,
because it is really rare to find individuals who have not had
one or more attacks of blennorrhagia. But, when knowing
the value of the chancre as a necessary antecedent, we seek
what its frequence is, even among the authors where its valua-
tion leaves so much to desire, we find, in the statistics of M.
'nave, for example, that out of 12 observations, blennorrha-
existed, alone or with buboes, but 18 times, while chancre
occurs 38 times. From which M, Cazenave concludes, very
logically, as you see, that blennorrhagia is the most frequent
antecedent of syphilis. The same results from the sumn
up of the observations of M. Legendre, and the same logical
conclusion folio/

* One of the five patients of M. Baumes had a chancre previously ; it is, then.
to this chancre that the verole of this patient must be referred.

110 Ricord's Letters on Syphilis, [February,

It remains established for science, and in my opinion, that
from the statistics of my antagonists even, the chancre visible
and avowed by the patient, is still the most frequent antece-
dent of syphilis. My wards of the Hospital du Midi enclose at
this moment 01 cases of well-marked constitutional syphilis;
all, without exception, have had chancre as precedent.

Now, in cases where we cannot go back to the pre-existence
of a chancre, neither by the recollections of the patient nor by
interrogation, what reason is there to deny absolutely the pre-
existence of an urethral chancre ? You see, then, what we
should think of the opinion of M. Cazenave, expressed in these
terms, " Far from blennorrhagia never giving place to seconda-
ry symptoms, it would appear, on the contrary, to determine
them more frequently than the chancre.'"'

You know, dear friend, for it is in your own Journal, that this
opinion of M. Cazenave has been warmly approved. M. Yidal
(de Cassis) has expressed his sentiments for M. Cazenave in
the following manner, which he says is not an academic au-
thority, but which has the advantage of being an authority
quite special.

'We know what the position of M. Cazenave is, the vast
theatre upon which he makes his observations, his taste for sta-
tistics, for all thejneans, in fact, which, according to my adver-
saries, conduct to certainty. Well, M. Cazenave has succeed-
ed in establishing that the symptom of which the virulence is
rarely affirmed before experimentation, is exactly the symptom
most virulent, the most infectious, according to observation."

It is true that to prevent M. Cazenave from being too much
in a hurry to felicitate himself upon this warm approbation, M.
Yidal hastens to add, on the following page :

"However, I do not dare to go as far as M. Cazenave, who,
according to my ideas, puts too many syphilitic eruptions to the
account of blennorrhagia. Blennorrhagia, in my opinion, is an
affection much more contagious than infectious.''

That is just my idea, Monsieur Yidal, as you are well aware;
only permit me to express my astonishment that it is yours,
you who believe that M. Cazenave has succeeded in establish-
ing the contrary. I do not wish to insist longer upon this
flagrant contradiction, which is, after all, perhaps, but a criti-
cism of conciliation.

As to the cases of blennorrhagia of which the inoculated
muco-pus has not given any results, and which have been fol-
lowed by a general infection, the observations which have been
reported of them leave much to he desired, and are, I ask par-
don of my learned brother of Lyons, to be received with excep-
tions. The astonishing credulity, the truly blind confidence of

.

1853.] RiconPs Letters on St/philis. Ill

some physicians, although rendering their works very respect-
able, are far from carrying conviction into all minds. In
particular cases I do not wish to spare the symptomatolo-
gy of constitutional accidents, which is incomplete, relatively

to some important points, upon which I shall desire to return;
I wish, also, that in these cases, constitutional syphilis should
really be the subject of inquiry.

I admit that the appearance of these syphilitic accidents
agrees; as regards the period, with the time in which blennor-
rhagia is developed ; but are we very sure from this fact alone
that the patients have had nothing but blennorrhagia that
syphilis could not have penetrated by another way? My bro-
ther physician at Lyons has somewhere said that J denied the
possibility of a constitutional syphilitic infection from a simple
blennorrhagia, because I had never seen an example of it. It
is, on the contrary, because I have seen many patients in whom
physicians, who do not think as I do, have recognized but a
simple blennorrhagia, where I have found another door for the
entrance of syphilis, that my convictions have become more
and more profound. When those who maintain that a simple
blennorrhagia should give place to the verole, have told you
that the patienl presented no ulcerations, either upon the geni-
tal organs or upon the lingers, they think they have nothing
more to exact. They forget the instances without number that
the surface of the body presents secret, concealed doors, which
close as soon as they are opened, so that the patients are igno-
rant, or it is for their interest to conceal their knowledge. How
many students have come to me from the other hospitals of
Paris, in whom nothing but a blennorrhagia has been proved,
and in whom I have found chancres in unusual places. While
upon this subject, here is a story, analogous to many in my
practice.

A lady came to consult me for a disease of the rectum, the
symptoms of which, she complained, were those of a fissure.
Upon examination I found absolutely nothing about the anus.
But the finger introduced into the intestine, discovered, at the
height of the superior sphincter, a fissure situated upon the
anterior portion and reposing upon a callous suiface. I pro-
posed an operation; the patient refused, and 1 ordered her en-
emas of rhatania. This treatment had scarcely lasted fifteen
days, when in another visit I perceived an exanthematic erup-
tion, having all the characteristics of a confluent syphilitic
la. Upon farther examination I recognized the swelling
of the posterior cervical ganglions. The ; atienl suffered from
nocturnal cephalalgia, and already scabs commenced to devel-
ope themselves upon the scalp. To me there could be no

112 Contraction of the Knee. [February,

farther doubt upon the nature of the accidents. I then exam-
ided the genital organs ; but I could only perceive a slight
uterine catarrh. Interrogated upon the conditions in which
this lady could have been placed as regards the contagion of
syphilis, she confessed that her husband was diseased, that he
had ulcerations on the penis, and that in the fear of communi-
cating them to her, he had had relations with her a prep outer &
venere. Thus the nature of the fissure was unveiled to me.

Jn this case is it not true, that without the painful accidents
brought on by the fissure, this ulceration would have passed
unperceived ? It would have then happened that we should
have had for the sole antecedent of syphilis, a simple uterine
catarrh. But there exists still other causes of error which I
wish to point out to you. This will be the subject of my next
letter. Yours, &c. Ricord.

[ To be continued.]

On Contraction of the Knee-joint. By John Watson, M. D.,
of New York.

Dear Sir, The object of the present communication is to
direct your attention to the extension pulleys as a means for
overcoming contraction and anchylosis of the knee, and to
suggest the propriety of the same apparatus in the treatment
of permanent contraction and rigidity at the hip-joint, as well,
perhaps, as for breaking up the temporary callus in badly uni-
ted fractures.

Among the mechanical contrivances now in use for this
purpose, as applied to the knee, are first, the screw clamp,
which is secured to the limb in the neighborhood of the affect-
ed joint, in such a way as to straighten it, by what has been
aptly called the crushing process. Secondly, splints and rol-
lers, also applied in the neighborhood of the joint, with the
view of straightening it gradually: and again, in cases of long
standing and perfect consolidation of the joint, the excision of
a prismoid section of bone, either from the opposing portions
of the tibia and femur, or from the shaft of the latter just above
the joint. It remains to be proved how far the extension and
counter-extension apparatus, adjusted to the ankle and perine-
um, may be advantageously introduced as a substitute for less
certain or more hazardous mode of treatment.

The application of the clamp, though recommended and oc-
casionally employed in Europe, has not met with much favor
here. The force being employed directly over the joint by this
apparatus, to be effectual in many cases of long standing, must
be such as to inflict severe injury on the soft parts : and the

1853.] Contraction of the K 113

lurgeon, not having the entire menus of regulating the d<
of pressure requisite', may carry this to such an extent as to
crush the cancellated structure of the condyles, or injure the
s and blood vessels in the vicinity of the joint. Splints
and rollers, to be of any service, must be of long cootinui
and when at last they appear to be iu - ree bucc<

the limb is drawn down bymak nd crook in the upper

pari <>f the shaft of the tibia, rather than by any yielding at the
joint itself. The consequence of this is, that the limb loses
considerably in length by making this double curve; and even
when straightened, the leg is thrown at some distance behind
the proper axis of the lemur. The excision of a prismoi I
tion of bone from the front of the joint, is an operation applica-
ble only to the severest cases of confirmed bony consolidation ;
and though occasionally attended with admirable results, is one
of great severity and much hazard, and, as already proved by
experience, liable to fatal consequences.

1 have taken no pains to inquire upon what authority the
extending and counter-extending straps and pulleys may have
heretofore been suggested or recommended in such cases, nor
am I aware that they have for ihis purpose been ever before
employed. But in the following case, this mode of drawing
down the contracted limb was entirely succesful; and I am
disposed to think that it should hereafter always he borne in
mind, as one of the expedients to which the surgeon should re-
sort, before attempting more painful or dangerous proceedings.

Peter Fred, a German seaman, aged 23, was admitted into
the New York Hospital, on the 16th of June, 1852, with his
left knee (lexed nearly at a right angle, and so rigid as not to
yield in the hast to any force I could apply to it by my own
unaided muscular strength. The contracted joint was free
from pain, and of the same temperature as the rest of the limb.
The patella was firmly glued to the side of the inner condyle
union. The rigidity and contraction had exited
sixteen months, and had followed a sub-acute attack of rheu-
matism, or synovitis, the result of exposure to wet weather in
California. The patient, inoth cts a healthy man, had

been under treatment at an hospital in San Francisco for sev-
eral months, and subjected to repeated blistering, cuppii g, and
other me ocal and general, without advantage.

( >o the 19th of June, with the patient on his back and ui
the lull anaesthetic influence of sulphuric ether, with a counter-
extending strap to make traction from the perineum, and with
the extending bai e the anl

had the force of the pulleys applied to the limb, as in luxations
of the hip-joint, keeping my hands around the joint, tojud.

114 Contraction of the Knee, [February,

feeling of the amount of yielding, and to thus regulate the force
of extension necessary for straightening the limb.

As the extending cords became tense, I could feel, and even
hear, the adventitious adhesions gradually giving way, until, at
length, the patella sprang loose from its attachment to the con-
dyle, and the diseased limb was drawn out as straight as the
other. On loosening the apparatus, I now found I could flex
and extend the joint as freely as if it had never been the seat of
diseased action.

After the operation the limb was adjusted in the straight
apparatus, as usually employed for fractures of the thigh ; a full
anodyne was administered, and an evaporating lotion applied
to the knee, to guard against the occurrence of excessive in-
flammation. For the first twenty-four hours after the straight-
ening of the limb, the patient suffered considerable pain in the
joint; but the ensuing inflammation was slight; and on the 2d
of July it had so far subsided as to admit of passive motion.
The patient soon afterwards began to move about the ward,
with a stiff splint secured behind the knee, to prevent any re-
newed tendency to contraction. On the 29th of July, he was
walking about the yard with the aid of a staff; the joint, how-
ever, still tender. He remained under observation, using daily
embrocations to the joint, and wearing his splint behind the
popliteal space, until the 6th of September, at which date he
was discharged, with his limb in a position which enabled him
to walk with a slight halt, but with some remaining rigidity
and tenderness, though with no further apparent tendency to
contraction.

A point of much importance in all cases similai to the fore-
going, is to determine the time at which the sudden straighten-
ing may be attempted with most advantage. While the disease
is still acute, and the contraction merely muscular, the limb
may be managed by ordinary splints for favoring the straight
or, at most, a very slightly flexed position; and, in the sub-
acute or chronic state, so long as inflammation persists, any
effort at sudden straightening is likely to be followed with a
renewal of acute inflammation, and the recurrence of the con-
traction to as great an extent as ever. The rule, then, shonld
be to wait until the inflammation has wholly subsided, a fact
readily determined by the subsidence of pain, but more conclu-
sively by finding the integuments in the neighborhood of the
affected joint of no greater temperature than the surface of the
skin in other parts of the limb.

An instance somewhat analagous to the foregoing, in which
both knees were affected, but in which the rigidity was still
confined to the fibrous and other softer tissues around the joints,

1853.] Contraction of the Ki 11

occurred to me a few years since, and forcibly illustrates the
truth of the remark just made, in reference to the proper time
for resorting to forcible extension. The patient was a young

man of 'J'-i or 23 years of age. The contraction, in this
also, was the result of a sub-acute attack of rheumatism. The
limbs were SO drawn np, (hat the heels were almost made to
strike against the nates. The rheumatism in the right knee had
entirely disappeared, hut in the left there were still some slight
remains of the inflammatory process. The contraction and
rigidity of the joints had existed six or eighl weeks. Finding
the right knee not absolutely anchylosed, I at once resolved
upon straightening it suddenly: and this 1 effected in an hour
or so. after exj ending the whole of my muscular force upon it.
The limb, once brought down, was secured in the straight po-
sition for a week or ten days, after which the disposition to
contraction disappeared, and the joint was restored to its heal-
thy functions. Having thus succeeded with the right,] resort-
ed to the same procedure for the left knee : and after still more
protracted efforts, I also succeeded in bringing this limb into the
straight position. Hut the o| eration was an exceedingly pain-
ful one. The inflammation returned with greater violence
than at first ; the patient afterwards entered the medical wards
of the hospital, where, notwithstanding every effort to keep the
joint straight, it ultimately contracted so a- to be of little use
to him in walking, and afterwards continued so.

It is remarkable how slight a degree of inflammation in and
about the joints may now and then give rise to the most obsti-
nate tendency to contraction. Many instances, if necessary,.
I could enumerate in proof of this remark. One of the severest
of these was that of a young man, who, after an attack of
rheumatism, lost the use of almost every joint in his body,
large and small, even to those of his fingers and toes, so that
lie lay for years bed-ridden, and drawn up into a sort of ball.
Another instance was that of an elderly lady, who, in conse-
quence of rheumatism, had both elbows permanently fl
and anchylosed. I hive at present under observation a
tleman suffering from anchylosis of his right elbow, resulting
from the same cause : and a young lady of 17 years of age, in
whose case, without any real deformity of the spine, most of
the dorsal vertebrae have become consolidated; the patient, in
the meanwhile, free from pain, an ! not conscious of ever hav-
ing at any time suffered from active inflammation in any por-
tion of the spinal column. Blows and punctures often lead to
similar contractions; and where these occur in early life, de-
priving the limb of its freedom of motion, they lead to arn
development. One instance of this sort, in which the right

116 Contraction of the Knee. [February,

arm has ceased to grow in keeping with the left, I have re-
cently witnessed in a young man, who, many years since, fell
upon his elbow, and has ever since been troubled with a rigid
and contracted joint, now firmly consolidated by bony deposits.

The well-known case of anchylosis of the hip, upon which
the late Dr. J. K. Rodgers operated for producing an artificial
joint, came on without any sensible injury of the part, and
without any evidences of inflammation, while the patient was
confined to bed in the New York Hospital, and under treat-
ment for a fracture of the opposite limb. Now, in this case,
even as soon as the anchylosis was first detected, mere manipu-
lations with the hand were unable to overcome it. But had
the extension pulleys been applied, there is reason to believe
that the limb might have been restored to usefulness. The
operation of exsection of bone, which was resorted to as the
only efficient means of treatment then devised, might thus
have been wholly obviated. The patient, though in the utmost
jeopardy for many days after the operation, ultimately recov-
ered, gaining little, however, by the operation ; for the artificial
joint soon afterwards consolidated. But in a more recent case,
in which the same operation was employed, the result was dis-
astrous. It is not probable, however, that in this latter case,
where the anchylosis was of many years' duration, the exten-
sion pulleys would have proved available. The use of these
for anchylosis at the hip, would, apriori, appear to be safe only
while callus is yet nascent, and before the consolidation has
become so firm as to jeopardize the bony structure of the
acetabulum in attempting to overcome it.

The pulleys may also be substituted, with advantage, for the
more common mode of breaking up the recent callus in badly
united fractures. It has been shown by Dupuytren, that the
formation of the permanent callus after fractures, is completed
only after an interval of many months ; and yet after an inter-
val of three weeks, I have known the temporary callus in a
badly united fracture of the thigh, so very firm as to resist the
best directed efforts to break it up by mere lateral force. I
remember to have once assisted my friend and former colleague,
Dr. Hoffman, in overcoming a similar deformity after fracture
of the leg. In this instance, after etherizing the patient, the
rigidity was overcome by the union of direct pressure over the
seat of accident with extension at the heel. The pulleys, how-
ever, would probably have been an easier and more expeditious
mode of management.

Surgery, as well as medicine, has its fashions ; and while we
are ready to apply the extension pulleys to new uses, we are
learning to dispense with them in some of the very accidents

1853.] Bright' s Disease. 117

for the cure of which they were originally introduced. Our
celebrated countryman, Nathan Smith, about the commence-
ment of the present century, as I learn from one of his early
pupils, Dr. Bat chelder, of this city, as well as from the memoin
of him prepared by his son. Dr. N. R. Smith was in the habit
of pointing out to his students a method of reducing luxations
of the femur on the dorsum of the ilium by merely flexing, ad-
ducting or abducting, and rotating, the thigh upon the pelvis.
Others, both in this country and Europe, have since the time
of Nathan Smith, been accidentally successful in a few similar
cases. In Germany, since 1823, the subject has been more
carefully studied and systematized by Colombat, Wattmann,
Kluge and Rust ; and in our own State, within the pasi year,
by Dr. W. W. Reid, of Rochester, whose process, as described
in the last volume of the Transactions of the New York State
Medical Society, is nearly identical with that of the latter
writer. I am happy to say that the attention which Dr. Reid
has anew attracted to this subject, is likely to make the flexing,
adducting, abducting and rotating process, the general mode
of treatment in all recent luxations of the head of the femur
backwards; and that, at the New York Hospital, two, if not
three cases have already been reduced, without the aid of pul-
leys, by this method. \_j\ew York Medical Times.

On Brighfs Disease, and its Connection with Puerperal Con-
vulsions. By Dr. Litzmann, (Deutsche Klinik.)

Prof. Litzmann, of Kiel, has published an elaborate memoir
on renal disorder in pregnant and puei peral females. He com-
mences by describing twelve cases in which albuminuria and
oedema were present ; some of the women had convulsions.
Three of the patients were pregnant with twins; and nine
(including the twin cases) were pri mi parse.

In several of the cases, especially where convulsions were
present, or were threatened, or where there were symptoms of
mia, as amaurosis, etc., cai Donate of ammonia was discov-
ered in the blood and in the air expired from the lungs, and in
the blood of the children who were bom dead. This was in
accordance with the view of Dr. Frerichs, that urea, when ac-
cumulated in the blood, becomes converted into carbonate of
ammonia, and then produces toxemic symptoms.

Including the twelve cases described, Dr. Litzmann has ex-
amined the urine of 131 persons; 79 during pregnancv, 80
during labor, and 80 after parturition. In these he has found
albumen present in 37, and absent in 95. The examinations

n. s. VOL. IX. NO. II. 8

118 Bright 's Disease. [February,

began, with few exceptions, in the last three months of preg-
nancy ; in almost all cases they were repeated several times,
and in several daily ; yet it is possible that small quantities of
albumen may have escaped notice. In order to avoid the ad-
mixture of foreign matters from the vagina, the catheter was
used always with parturient women and those who had been
delivered, and frequently in pregnant females. In the latter,
as well as in those who had been confined, the urine passed in
the morning was employed. Heat, and acetic, or nitric acid,
were the tests used.

Of the 95 females, whose urine contained no albumen, 53
primiparae and 42 multiparas. Of the 37, who had albuminu-
ria, 26 were primiparae and 11 multiparas; among the latter
was one who had albuminuria in her first pregnancy, and two
who were pregnant with twins.

Among the 37 females, the urine of 16 was discovered to be
albuminous during pregnancy. In ten of these the albuminuria
continued during labor, and for some days afterwards ; in four,
where it was less intense, it disappeared before confinement ;
and in two cases, circumstances prevented the examination
from being continued.

In four women who had been confined, and whose urine
contained albumen, no examination had been made during
pregnancy. There can be no doubt, however, from the quan-
tity of albumen found, and the other symptoms, that it had
been present.

In four females, in whose urine no albumen had been found
during pregnancy, albuminuria appeared during labor in two
evidently for the first time.

In ten persons, in whose urine no albumen had been present
during pregnancy, there was considerable albuminuria after
delivery. In eight of these, the urine, examined during labor,
was found to contain no albumen.

In three females who had been confined, and in whose urine
albumen was found, no previous examination had been made.

There is a form of albuminuria unconnected with renal dis-
ease, but arising from catarrhal irritation or blennorrhea of
the bladder. Dr. Litzmann has observed it twice during preg-
nancy, several times during labor, but most frequently after
delivery. It generally appears on the second or third day, and
goes on increasing till the sixth or seventh. The quantity of
albumen is not great, and is connected with the presence of
purulent mucus. At first, the urine after delivery is high-color-
ed, of acid reaction, -and contains a large quantity of urates
and uric acid, with epithelium and a number of pus or mucous
globules. It afterwards becomes lighter and yellow in color,

1853.*| Brian's Disease. 119

slightly turbid, contains less urates, and is less acid ; on long
standing, it deposits a sediment of pus corpuscles with more
or less epithelium. Fibrinous casts of the urinif'erous tubes are
never present. In only two cases was the quantity of pus in
the urine sufficient to be detected by the naked eye: these
were more chronic than most of the others, recovery not being
effected till the eighth week.

In both these cases, which Dr. Litzmaim relates, there had
been, during labor, longoontinued pressure on the urethra and
neck of the bladder; and this may have acted as the proxim-
ate cause of the disease. Vet cases very often occur, in which
me causes do not produce such effects. In most of the
women affected with vesical catarrh after delivery, the disi ase
could not be attributed to the above cause, the labors having
been regular, and even easy. Dr. Litzmann is inclined to be-
Neve that slight vesical catarrh, which may not cause albumen
to be present in the urine, but which may furnish a sufficient
quantity of pus or mucous corpuscles to be detected with the
microscope, is of not un frequent occurrence after deliver v.
During and before labor the disorder is much more rare.
When it occurred during labor, this had almost always been
tedious, without, however, in general producing retention of
urine. One of the pregnant females who were affected had
^. and was at the same time seized with rheumatic swell-
ing of the hands. In another, the vesical catarrh was brought
on in the fourth month of pregnancy, by retroversion of the
uterus. The local symptoms were generally very slight; on
being questioned, the patients would acknowledge a little un-
easiness or sense of heat in the bladder: but the state of the
urine was generally the only diagnostic symptom. Of the 37
cases of albuminuria which Dr. Litzmann observed, he believes
that half were referrible to catarrh of the bladder: this \,
certained in nine of the cases, by microscopic examination.

Simple albuminuria, and B right's disease, (albuminuria ac-
companied by fibrinous exudation into t tie uriniferous tubes),
gradually into each other in pregnant females. In most
ot the cases in which albuminuria had reached a high degree,
fibrinous east- were found towards the end of pregnancy, or
during labor and the early part of the subsequent period." Of
the 3*3 f albuminuria. Dr. Litzmann found 13 to be con.

nected with Bright 'a disease: in 7, fibrinous casta were found:
in one. the urine could only be examined once, and, though not
then found, they were probably present: and in five, there
could be little doubt from the quantity of albumen and the con-
comitant symptom- i in three cas.< that thev were
present, although the urine was not examined microscopically.

120 BrigMs Disease. [February,

There can be no doubt that, as has already been pointed out
by Rayer, the albuminuria of pregnant females arises from a
mechanical obstruction to the renal circulation. From the ex-
periments of Frerichs, it appears that the retardation of the
venous circulation on the kidneys easily produces exudation of
albumen and fibrin, and finally, even of blood. On the other
hand, increased arterial impulse, as from ligature of the aorta
below the renal arteries, only rarely gives rise to slight albumi-
nuria; and it is when one kidney is extirpated at the same
time with the ligature of the aorta, that any notable quantity
of albumen appears in the urine. In favor of the mechanical
view of the explanation of albuminuria in pregnant women,
may be adduced its predominance in primiparae a fact recog-
nized by all observers. The tight and unyielding abdominal
wall must naturally cause the uterus to press more strongly on
the organs lying behind and above it. It is moreover probable
that when albuminuria has occurred in multiparae, it has been
but a repetition of the same affection which they had as prim-
iparae.

In many of the cases, there were also other causes which
tended to increase the pressure. Five of Dr. Litzmann's pa-
tients, who had albuminuria, were pregnant with twins ; in
others, there was a large quantity of liquor amnii, or a large
child, or both ; in one case, there were periodical contractions
of the muscles, especially of the recti, pressing the uterus against
the spinal column ; in four cases, the pelvis was narrow. Three
of the patients had chronic pulmonary catarrh. It cannot,
however, be denied, that cases are often met with, in which all
these circumstances are present without producing albuminu-
ria; and, on the other hand, that albuminuria sometimes oc-
curs, even in a high degree, without more than ordinary pres-
sure being apparently exerted. An additional ground for
assuming the dependence of albuminuria in pregnant women
on mechanical impediment to the circulation, is found in the
rapidity with which it disappears as soon as, by emptying
the uterus, the free circulation of the blood has been re-estab-
lished.

Besides the mechanical cause, we must take into account the
state of the blood in pregnant women (increase of water and
fibrin, decrease of albumen, diminution of the red, and increase
of the colorless particles). Most of the pregnant women with
albuminuria, observed by Dr. Litzmann, had a more or less
chlorotic appearance ; while others appeared fresh and healthy.
The state of the blood did not appear sufficient to cause albu-
minuria, without an impediment to the circulation of the kid-
neys. In common with Lever, Devilliers and Regnault, etc.,

1853.] Intussusception of the Bowels. 121

Dr. Litzmann has not been able to recognize cold or tbe abuse
of spirituous liquors, etc., as the cause of albuminuria in preg-
nant females [London Jour. Med.

Intussusception of the Bowels. By Daniel Barber, M. D.,
of New Richmond, Ohio.

Gentlemen- Believing that the following plan of treating
intussusception of the bowels is not familiar to the minds of
many of the profession, I submit to you a case in which it was
successfully applied.

The subject was a young man aged twenty years. lie had
two attacks of colic within ten days. Consiipation followed
immediately upon the last. He was treated for four days with
purgatives warm water injections bleeding, &c, without
any effect. At the end of this time (Nov. 13) I was called in
consultation with Dr. Bennett, of Withamsville, the attending
physician. I found the case as follows: Pulse 120, abdomen
tympanitic, and tender to the touch, extremely severe parox-
ysmal pain of the bowels, frequent vomiting of highly offensive
matter, obstinate constipation.

To subdue the tendency to peritoneal inflammation, we re-
peated the bleeding and administered the sulphate of morphine,
in half grain doses every two hours until he was brought fully
under its influence. When I returned on the evening of the
14th, the pulse had fallen to 96 the tenderness and pain of the
bowels were materially diminished the vomiting less frequent
and distressing constipation continued. Frequent and large
quantities of warm water has been continued to be injected.
At my suggestion the following plan of treatment was now
adopted.

We procured a small quantity of brewer's yeast, from which
was prepared in the usual way a quantity sufficient for our
purposes. At about midnight, we gave a tumbler half full, and
ordered the same quantity to be repeated once or twice every
hour.

On the afternoon of the 15th, when it was obvious from the
quantity taken and retained, that the intestines above the ob-
struction, were distended with carbonic acid gas, the colon
was likewise inflated with atmosphere by means of a pair of fire
belh>\v-.

By these means combined, the intestinal earn! throughout its
whole course \\ is inflated, and the obstruction reduced.

At nine rening, a copious evacuation of the

bowels ensued, followed by several others during the night.
At the same time the explosions of gas were so violent as to be

122 Syrup of Assafetida. [February,

heard at some distance from the house it was literally keeping
up a regular fire. The patient was at once relieved, and speed-
ily recovered his former health. Besides the distending force
of the gas, it is very probable that it exercises a beneficial
influence by its sedative and antiseptic properties.

I believe this practice originated with the French, but to
what extent it has been applied I know not. Dr. Johnston and
Rogers, of this place, have given yeast in two or three cases of
this disease during the course of their practice here, with suc-
cess. In one case relief was afforded on the fourteenth day of
the attack, after every other means had been tried and failed.

From the above facts I should feel disposed to give this plan
a trial in every case, where the ordinary means fail. Should
relief not be obtained in a reasonable length of time, and the
case be protracted, and as it w7ere hopeless, a moderate exhibi-
tion of the yeast, by its antiseptic properties and by gently
exciting the peristaltic action, would afford perhaps the best
prospects of success. [Western Lancet.

On Syrup of Assafetida. By Richard Peltz. (From an In-
augural Essay.)

Assafetida has long held a high rank as an antispasmodic and
expectorant, but has not been used as extensively as its virtues
seem to demand, both on account of its very unpleasant odor
and acrid bitter taste. It consists chiefly of resin, gum and
volatile oil.

The Pharmacopoeia of the United States recognises as offi-
cinal two fluid preparations of assafetida the tincture and the
mixture. These, although very good preparations, are both
objectionable on account of their unpleasant taste. This, I
think, could be remedied in part by making a syrup: with
which purpose I have undertaken a number of experiments, to
ascertain if a preparation could not be made which would con-
tain in a more agreeable form all the medicinal properties of
assafetida soluble in water.

Having tried a number of methods I concluded that the follow-
ing formula would make the most perfect preparation ; Take of
assafetida, an ounce ; boiling water, a pint; sugar, two pounds.
Triturate the assafetida in a mortar with a portion of the boil-
ing water until a uniform paste is formed, then gradually add
the remainder of the water, strain and add the sugar, applying
a gentle heat to dissolve it.

Much heat should be avoided in forming the syrup, as the
volatile oil. which is present in considerable proportion in good
assafetida, (nearly 6 per cent.,) a portion of wThich is dissolved
or held in suspension by the water, would be dissipated.

1853.] Glycerin Ointment 123

There is an advantage in using boiling water, as it takes up
more of the gum-resin, which is permanently dissolved or held
in suspension by the sugar.

This syrup, when first made, is nearly white, but upon expo-
sure to light gradually assumes a pinkish tinge. It is of the
same strength as Mixture of Assafetida of the Pharmacopoeia,
and owing to its being more pleasant to the taste, might with
advantage be given as a substitute for that preparation, espe-
cially in cases of children, as the sugar conceals much of the
unpleasant acrid taste of the assafetida.

This syrup is much more permanent than the mixture, hav-
ing kept some for several months without any apparent change,
except in color, owing to the action of the light on the resin;
while the mixture kept in the same situation became very un-
pleasant in a short time. It also has an advantage over the
tincture in being entirely free from alcohol, which sometimes
is objectionable. [Am. Journ. of Pharmacy.

On Glycerin Ointment. By John H. Ecky, M.D., Philadelphia.

Dear Sir I send you a formula for an ointment which I
have found very useful for chapped hands, lips, excoriations of
the skin, &c, &c. I have called it Glycerin Ointment.
^ Spermaceti, 5ss.

White wax, 3j.

Oil of almonds, I ij. (f.)

Glycerin, 5j (f.)

Melt the wax and spermaceti with the oil of almonds at a
moderate heat ; put these into a wedgewood mortar, add the
glycerin, and rub until well mixed and cold. I have used this
ointment in my own family, and distributed much of it among
my friends, and can testify to its value.

I am not aware that an ointment of which glycerin forms a
part has been proposed, and yet few physicians are ignorant
of its property of protecting and soothing inflamed surfaces of
the skin and mucous membrane. To such, however, as are
unacquainted with its valuable properties, I would refer them
to the article on glycerin, in the last edition of Wood & Bache's
Dispensatory. [Ibid.

Solution of Gum Shellac in Alcohol.

Since Professor Dugas's notice of gum shellac in alcoholic

solution as a valuable external application to arthritic joints. I

ested it to a patient who has long been a sufferer with

chronic rheumatism, and learned that at least four years ago

124 Sulphuric Acid in Diarrhoea. [February,

he applied it on the recommendation of a physician, and with
great relief for the moment. Finding it to fail after a while,
he tried what he termed '* abetter coating" for the joints, which
was a fresh egg beaten up with salt and spirits turpentine.
This he found more impermeable than the former, but like it
was temporary in the relief it afforded. \_New Orleans Month-
ly Medical Register.

Sulphuric Acid in Diarrhoea. By John L. Vandervoort, M.D.

Diarrhoea, as met with in young children, especially during
the heat of summer, not unfrequently proves a troublesome
and intractable disease, resisting the antacid and astringent
treatment so commonly resorted to. During the past summer
it was unusually prevalent throughout the city, the stools being
frequent, and of a mucous or watery character, accompanied
by little pain, except when the intestines were distended with
flatus. Failing with the remedies usually employed, I resorted
to the use of sulphuric acid, as suggested by several London
and provincial physicians. It was first given in an obstinate
case at Yorkville; the child was teething, and was naturally
robust and healthy. For several weeks he had had more or
less looseness of the bowels, with occasionally slight vomiting,
and discharges of mucus, tinged with blood. Strict regimen
and minute doses of blue mass and opium failing to exercise
more than temporary effect upon the disease, and observing
that his gums had become spongy and disposed to bleed upon
the slightest touch, I changed his treatment, and gave him four
drops of the acid in a wineglassfull of sweetened water several
times a day. Seeing him again in a couple of days, I found
him much improved ; his discharges were less frequent; there
had been no more vomiting or bleeding from the gums. The
same treatment was continued for a week, when the child's
health was quite restored. In several other cases of similar
character, the acid was given, and with like happy results ; and
within a few days an infant, which had been troubled with ex-
cessive looseness of the bowels for nearly a week, was cured by
a few doses.

One very great advantage which this remedy has over those
in general use, is its agreeable taste, resembling in this respect
lemonade ; hence it is well adapted to children whose aversion
to medicine cannot readily be overcome.

In a late number of the Provincial Medical and Surgical
Journal, is a paper on this subject, by Mr. Sheppard, in which
he alludes to upwards of fifty cases of diarrhoea, many of them
very severe, in which he had used the sulphuric acid; in only

J

1853.] Iodide of Arsenic in Psoriasis PaJmaris. 125

one instance did it fail, and in that case the chalk arid astringent
treatment was also unsuccessful. Mis experience led him to-
the following conclusions:

1st. It is more efficacious than alkalies, opiates, and astrin-
gents, in a proportion greatly exceeding' ten to one.

2nd. It is more rapid in its action (especially in children,)
in a proportion greatly exceeding twenty to one.

3rd. It seems to act in a more rational and (if I may so ex-
press myself) scientific manner, by increasing the tone of the
mucous membrane of the alimentary canal, rather than by
simply ast ringing its pores.

4th. The worse the case, the more rapid and marvelous
seems to be the cure ; a most striking feature, as compared with
the treatment by chalk and opium. [iV. Y. Medical Times.

Psoriasis Palmaris cured by Iodide of Arsenic. By J. F.
Saxford, M. D., Professor of Surgery in the Iowa State
University.

Mr. J. Reed, of this city, merchant, aged 38 years, of san-
guine temperament and vigorous constitution, applied to me,
some time during the past July, on account of a disagreeable
and troublesome affection of the hands and feet, with which he
had suffered for the previous five years. Upon examination we
found the palmar surface of both hands, wrists, and the heels of
both feet covered with thick dense epidermal scales, very dry
and hard, with deep fissures or cracks extending in the direc-
tion of the natural furrows of the palm and fingers. The hands
and feet were extremely stiff and painful, and any attempt to
use them suddenly, was attended with an increase of pain and
bleeding from the cracked portion of the diseased surfaces.
There was also a very troublesome pricking or tingiing sensa-
tion in the parts and a burning or itching that much annoyed
the patient. The eruption in question made its appearance by
one or more inflamed and painful spots, of a dull red color,
which extended in various directions, frequently coalescing.
After a short time these patches became covered with scales,
which increased in number and thickness until the epidermis
seemed thick and hard as leather, and cracked as above men-
tioned. Occasionally when these inflamed spots occurred in
exposed situations, they would suppurate and thus augment the
suffering and discomfort of the patient. The discharge tmm
these little abscesses was thin and sanioos, and alter its escape
the spots seemed disposed to heal without those further cha
described as occurring when suppuration did not take place.

Inquiries were made relative to the influence of season upon

J 26 Iodide of Arsenic in Psoriasis Palmaris. [February,

the development of the disease, but it did not appear that it
underwent any great change at any particular time. The
eruption had been constantly present, to some extent, for five
years, and although partially disappearing occasionally, these
periods of partial exemption had no connection, as far as the
patient was aware, with the season or with his habits of life.

He had applied to numerous physicians, from whom he had
doubtless taken the usual remedies, and had also used various
popular medicines, but without relief.

The cause of the disease, in this case, was obscure. There
was no constitutional indisposition, nor any thing in the patient's
occupation or habits, that could act as a local irritant in its pro-
duction. His general health was remarkably good ; he had not
suffered a functional disturbance for months, and presented,
when I saw him, otherwise than in the respect mentioned, a
perfect physiological condition.

I commenced the treatment by ordering him to drink freely
of cream tartar, until the bowels were moved, and to apply at
night a bread and milk poultice to the diseased parts. The
poultices, which he had frequently applied, always relieved the
heat and pricking of the parts, and softened the thickened epi-
dermis, so that he could scrape away considerable portions after
its removal. During the day he kept a cloth to the feet, wet in
a strong solution of the Bicarb, of Soda, and frequently washed
the hands in the same.

I was led to the employment of Iodide of Arsenic, by acci-
cent. I had intended, after a brief preparatory treatment, to
place the patient on a more energetic course, and had thought
of the Liquor Hydriodatis Arsenici et Hydrargyri, as the medi-
cine to be used, as recommended by Dr. Graves, of Dublin.
Finding myself unable to procure this at our drug stores, and
having much confidence in the combination of Iodine and Ar-
senic in the treatment of various cutaneous diseases, I resorted
to the Iodide of Arsenic.

Eight grains of this medicine were dissolved in four ounces
of distilled water. Of this solution, twenty drops were given
three times a day, in a few drams of sweetened water. At the
same time, fifteen grains of the same medicine was thoroughly
incorporated with one ounce of simple cerate, a small portion
of which was well applied to the diseased surfaces every morn-
ing after the removal of the poultice. The parts were thus in
a soft state, admitting, without pain, the removal of the thicken-
ed cuticle, after which they were in good condition to receive
the ointment.

This treatment was followed by the most decided and happy
results. In two weeks the patient was very much improved,

1853.] Treatment of Chilblains. 127

and in six weeks from the time it was commenced, no vestige
of the disease remained. Two months have elapsed since the
cure appeared complete, and there is no return of the disease.
This being the 6rst thorough disappearance of the eruption in,
five years, together with its exemption from the modifying
influences of the season encourage me lo believe that the cure
is permanent.

The prompt and decided effects of the Iodide of Arsenic in a
case calculated to test its curative powers, justifies the infer-
ence that it is a remedy of peculiar efficacy in the treatment of
the various forms of Psoriasis. No disagreeable local or con-
stitutional effects followed its use.

I am at this time employing the same remedy in a protract-
ed case of Pityriasis, with the prospect of a similar happy result.
[ Western Medico-Chirurg. Journal.

On the Treatment of Chilblains. By M. Trousseau.

M. Trousseau washes all parts affected with chilblains, three
times a-day. with the following lotion : Borax, 50 parts; wa-
ter, 500. Four table-spoonfuls are added to a quart of water.
He also prescribes, both for the prevention and removal of
chilblains, the following lotion, to be used night and morn-
ins:: Sal ammoniac, 20 parts; water, 40; proof spirit, 10.
When ulceration has occurred, he prescribes one of the follow-
ing formulae : Tannin, 10 parts ; water, 500. Or, ext. rhatany,
10 parts; quince mucilage, q. s. This is mixed up as a soft
electuary, with which the parts are smeared; and the applica-
tion is also an excellent one for the cracked lips which occur in
the winter. [Z/ Union Med. Med. Chir. Rev.

ill i s c c 1 1 a n ti .

Aromatic Schiedcun Schnapps. The sale of Holland gin, neatly
put up in medicinal bottles and labelled as above, accompanied with
the highest encomiums of its wonderful efficacv in innumerable dis-
is one of the most cunning and nefarious devices we know of
for leading the unwary into the vice of intemperance. We have
lately noticed it repeatedly upon mantel pieces, alon^ with " other vials
of physio," and apprehend that it will become one of the most popular
nostrum* of the day. It is said that one of its greatest recommenda-
tions is that "it is not bad to take."

128 Miscellany. [February,

Dr. Drake's work on the Diseases of the Interior Valley of North
America. We are happy to learn that Dr. Drake had prepared a
considerable portion of the second volume of this great work, and
that it is the desire and intention of his children that the portion so
prepared should not be lost to the Profession. It is to be revised by
a competent person and printed as soon as possible.

Ligatures of large Arteries, by Prof. Roux. M. Roux, the Nestor
of French Surgery, occasionally furnishes the statistics of his exten-
sive experience. In a paper communicated to the Chirurgical Society
we find that he has ligated the popliteal artery once, the femoral 46
times, the brachial 20 times, the carotid 6 times, the axilary 4
times, the sub-clavian 3 times, and the external iliac twice making
82 operations.

Ink for the Million. To the Editor of the American Journal of
Pharmacy : The following formula for making a very superior ink is
not generally known. The facility of its preparation, and its almost
incredible cheapness, (about two cents a gallon,) render it worthy a
place in your Journal.

ft. 12 oz. avoird. Ext. Logwood,
^ oz. " Bichromate Potash.
5 gallons water;
Dissolve the ingredients separately in water and mix them together,
and in a short time the ink will be fit for use.

An analysis of the above would be very desirable.

As an instance of the very great coloring property of hsematoxylon,
I have found that l-100th of a grain dissolved in 4,000,000 times that
quantity of water, will be tinged a fine pink color by the addition of a
little aqua ammonia. Yours truly,

Philadelphia, Sept. 13, 1852. W. H. Pile.

Electricity. Professor Faraday has instituted a series of experi-
ments, with a view to determine the quantity of electricity connected
with the atoms or particles of matter. He says, it is wonderful to
observe how small a quantity of a compound body is capable of be-
ing decomposed by a certain quantity of electricity. " One grain of
water will require for decomposition, an electric current equal to a
very powerful flash of lightning." The chemical action of a grain
of water upon four grains of zinc, can evolve electricity equal in
quantity to that of a powerful thunderstorm ; and he states, that from
his experiments it would appear, that 800,000 such charges of the
Leyden battery would be necessary to supply electricity sufficient to
decompose a single grain of water. The Leyden battery of which
he speaks consists of fifteen jars, containing 3510 square inches, or

1853.] Miscellany. 129

about twenty-four and a half square feet of coated glass, charged by
thirty turns of a plate electrical machine, the plate being fifty inches
in diameter, and of immense power, giving ten or twelve sparks an
inch long for each revolution. The author of a paper on this subject
in the Philosophical Magazine, remarks, that "the estimate that
800,000 discharges of the battery of fifteen jars, equal to a powerful
flash of lightning, would be necessary to resolve a single grain of
water into its elements, is certainly astounding, when it is recollected
that, according to Professor Faraday, the quantity of electricity that
decomposes a body, is the equivalent quantity of electricity that had
previously held the elements of that body in combination ; for he,
with Davy and others, conceives that electricity and chemical affinity
are identical powers. Hence in one grain, that is, one drop of water,
there must be naturally existing, and constituting the affinity between
its oxygen and hydrogen, no less a quantity of electricity, than
800,000 charges of a battery containing :3.*)10 square inches of coated
glass, or the equivalent of a very powerful flash of lightning. If
this quantity of electricity were converted into one spark, it would
be 4166 miles in length, taking Professor Faraday's mean estimate of
one charge of his battery as the basis of calculation. [Annals of
American Pharmacy.

Muscular jiower of the Insane, by M. Morel. A general popular
error prevails, that the insane are endowed with inordinate muscular
p >wer, and this explains, why so many persons are brought to the
Mareville Asylum tied and corded. When M. Morel was first ap-
pointed to this, he found numerous patients bound up, reputed dan-
gerous, and especially so, because of their vociferations. He set
them at liberty without any ill effect, and attributes much of the vio-
lence that had previously occurred to the ill conduct of the attendants.
He agrees with Jacobi, that as a general rule, the insane exhibit no
inordinate muscular power, and some of the patients of almost
collossal stature are easily managed by one person. Indeed, the
insane when engaged in manual labor, soon tire and require frequent
repose. If some of them by exception, work with a feverish activity,
and display great strength, the majority are dejected and languid.
The persons in whom he has met with the greatest developement of
muscular power, belong to the following categories. 1. Persons of
small stature, delicate complexions, and nervous temperament, and
especially females who appear exhausted by their cries and agitations.
Among snch miserable looking beings, a power of resistance is de-
veloped under certain circumstances, which defies the united ener-
gies of several attendants. 2. Insane epileptics. 3. Monomaniacs
who are not yet exhausted by the disease, or irrational treatment.
"W ben their passion is opposed, these persons sometimes manifest a
resistance only to be overcome by several attendants. [British and
Foreign Mcdico-Chirurgical Review, from Annates Medico-Psycholo-
giques.

130 Miscellany. [February,

BIBLIOGRAPHICAL.

Principles of Human Physiology, with their chief applications to
Psychology, Pathology, Therapeutics, Hygiene and Forensic Medi-
cines. By William B. Carpenter, M. D., F. R. S., F. G. S., &c.
Fifth American, from the fourth London edition. Philadelphia :
Blanchard & Lea. 1853.

The previous editions of this work have exhibited progressive
improvement. Each has been better than its predecessor, more ac-
curate and more elaborate. The rapid sale of it is but one of the
evidences of the high estimate placed upon it by the profession.

In order to justify this-' favorable opinion, to keep pace with the
advance of the science and fully to present his more matured views
of it, the author has remodelled his former work, entirely re-writing
many of the most important chapters and adding several others upon
topics not embraced, or imperfectly discussed in former editions.

The changes are too numerous to admit of an extended notice in
this place. At every point where the recent diligent labors of or-
ganic chemists and micrographers have furnished interesting and
valuable facts, they have been appropriated, and no pains have been
spared in so incorporating and arranging them, that the work may
constitute one harmonious system. These alterations, although they
have greatly enhanced the value of the book, have unavoidably added
to its bulk, until it is no longer well suited to the purposes of the student.
Its appropriate place is the library of the physician. The present
work, and the " Principles of General and Comparative Physiology,"
by the same author, form incomparably, the best treatise on Physiolo-
gical Science in the English language. M....r.

The Druggists General Receipt Book ; comprising a copious Vet-
erinary Formulary and table of Veterinary Materia Medica ;
numerous Recipes in Patent and Proprietary Medicines, Druggist's
Nostrums, etc.; Perfumery and Cosmetics; trade, chemicals, &c,
with an appendix of useful tables. By Henry Beasley. Second
American, from the last London edition, corrected and enlarged.
Philadelphia : Lindsay & Blakiston, 1853, 12 mo., pp. 472.

This work is not intended for the Physician, and how far it will
meet the wants of veterinarians and druggists, we are unable to say.
It contains a vast number of receipts, which may be found useful on
some occasions. The pages devoted to patent and proprietary medi-
cines is of some interest to the physician, as it affords him a know-
ledge of the composition of many of the nostrums which are in fre-
quent use in domestic practice. G.

1853.] Miscellany. 131

Materia Medica or Pharmacology and Therapeutics. By William
Tillv, M. I). Vol. 1, No. 1., November, 18.52. Springfield:
George VV. Wilson's Power Press. 1852. 8vo. pp. (i 1.

This work is to be published in monthly numbers, until it is corn-
pleted. Us author bafl been long known to tbe profession, as a gen-
tleman of considerable ability who has devoted much ;itt ntlOfl to the
subject of which he treats. The work is to be "original, having
none of the characteristics of a compilation." A proper estimate
of the work cannot be formed from an examination of a single num-
ber ; but if Dr. Tully's opinions upon other questions are as erroneous
as those he advances on the subject of tbe absorption of medicinal
substances, it is not probable that the profession generally will concur
with a friend of Dr. Tully, who predicts that this work "will be the
most original philosophical and practically useful book for the physi-
cian which has appeared since the writings of Sydenham."

It is supposed that about twenty numbers will complete the work.
The price is twenty-five cents for each number. G.

The Physicians Pocket Dose and Symptom Book ; containing the
doses anl uses of all the principal articles of the Materia Medica,
and chief officinal preparations, etc., etc. By Joseph H. Wythes,
M L)., author of the " Microscopist," etc. Philadelphia: Lindsay
& Blakiston. 1853. 1 vol. 12 mo., pp. 246.

The title of this little work very clearly indicates its character.
The author supposes that " it might prove of service in the treat-
ment of disease," and that it will prove acceptable to the "country
practitioner." We are sick of the frequent disparaging references
to country practitioners. Surely as high a degree of intellect and
professional knowledge is required for country as for any other prac-
tice ; and we are fully persuaded that .our country practitioners gen-
erally, have as little use for " vade mecums" and "pocket remem-
brancers," as any other class of practitioners. If such a work as
this is at all useful, it will be to those students of medicine who are
"cramming" for an examination for which they do not feel exactly
prepared. G.

Hand-Books of Natural Philosophy and Astronomy. By Dvomsius
Lardner, D. C. L., &c. &c S cond course. Heat Magnetism
Common Electricity Voltaic Electricity. Illustrated by upwards
of 200 engravings on wood. Philad. : Blanchard vSc Lea. 1853.

This is one of those admirable works, for the construction of which
Dr. Lardner has such peculiar talent. It presents a condensed, yet
lucid embodiment, of the present advanced state of knowledge, upon

132 Miscellany.

subjects that must ever be interesting to the admirer of nature's won-
derful manifestations of the greatness and wisdom of the Creator.

Braithwaite's Retrospect of Practical Medicine and, Surgery. Part
26. 1853.

This number sustains the well-established reputation of the work ;
but, like its predecessors and its rival, Ranking's Abstract, it is almost
bare of American intelligence.

New Medical Journals. We have received the first issue of "The
Southern Journal of the Medical and Physical Sciences," edited by
Drs. Jno. W. King, Wm. P. Jones, R. O. Curry and B. Wood, and
published bi-monthly at Nashville, Tennessee. It is full of interest-
ing matter and handsomely printed.

We have also received the Medical Recorder, published bi-monthly
by the Memphis Medical College, edited by Professors Merrill and
Quintard. It contains only 16 pages, but verifies the axiom, that
"good things are put up in small packages.

We wish our confreres a full tide of success and have added
them to our list of exchanges.

o

In addition to the above works, we are indebted to the authors and
publishers for the following pamphlets : Professional Reminiscences
of Foreign Travel, by W. Channing,M. D., of Boston. The Inaug-
ural Address of Worthington Hooker, M. D., &c, &c, upon "the
present mental attitude and tendencies of the Medical profession."
History of the Medical Department of the University of Louisville :
an introductory Lecture, delivered by Prof. L. P. Yandell. A popu-
lar Address, by Dr. W. F. Barr, before the Medical Society of East
Tennessee. Proceedings of the National Pharmaceutical Conven-
tion, held at Philadelphia, in Oct., 1852. Congressional Report of
Hon. E. Stanley, of North Carolina, and Hon. Alex. Evans, of Ma-
ryland, on the Ether discovery. Congressional Report of Hon. W.
H. Bissell, of Illinois, Chairman, upon the Memorial of Dr. W. T.
G. Morton asking remuneration for the discovery of the anaesthetic
properties of Sulphuric Ether. Discovery of the late Dr. H. Wells,
of the applicability of the Nitrous Oxyd Gas, Sulphuric Ether and
other vapours, in surgical operations, &c. And a number of useful
catalogues from the large publishers of medical and scientific works.

Erratum. On p. 17 of last No., line 18 from top, read ter-cliloride,
instead of " too, chloride".

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. 31ARC1I, hi!. [No. 3.

PART FIRST.

Original (I o m m it n i c a 1 1 o n s .

ARTICLE vm.

Remarks mi an Operation for the Radical Cure of Hernia.
By W. II. Robert, M. D., of Orion, Pike Co., Alabama.

A.I the subject of Hernia is at present attracting a great deal
of attention from the learned and skilful of the day, perhaps a
relation of my experience in the treatment of this disease may
not be amiss.

In J 846, a Dr. Woozencraft (probably the same now in Cali-
fornia as Indian agent) passed through Georgia, offering to sell
an Instrument, and the right to operate with it, for the cure of
Scrotal Hernia. The instrument was a very small silver syr-
w hose canula was about an inch long, and terminated in
a trocar-shaped steel point. Two small orifices existed in the
side of the canula near the steel point, from which the fluid
contained in the syringe made its exit. This instrument would
probably have held from 30 to 50 drops of fluid. Dr. Woozen-
craft's manner of operating, was to purge the patient freely
a day previous, and give* a large anodyne in the morning to
quiet the bowels; a good truss was then put around the body
to be ready for application ; the intestines were returned by
and the instrument (previously filled with the oil of
clves, or tinet. cantharides) was passed in the canal just at its
junction with the scrotum. To ascertain if any tissue was

n. s. VOL. IX. no. in. 9

134 Robert, on Hernia. [March,

intervening, and to be sure that the instrument was at least at
or near the canal, the point was made to move about in various
directions ; one finger of the unoccupied hand was pressed
upon the point of the instrument to ascertain if all was right ;
the fluid was then forced up to the canal, and the instrument
withdrawn. The truss was immediately applied to prevent,
by its pressure, the descent of the intestines. In about twenty-
four hours there would commence a deposition of plastic lymph,
which, Dr. Woozencraft argued, would cause an agglutination
of the parietes, or an impaction of the inguinal canal.

As the price demanded by Dr. Woozencraft, for an instru-
ment and the right of a county, was so exorbitant, I did not
bite at that time, but waited a better opportunity. A few
months after, I purchased an instrument from a man who had
them for sale, probably as agent. My instrument differs some
little from the one used by Dr. Woozencraft in having a lancet
point.

Having taken notes at the bed-side of the first patient upon
whom I operated, it is the only one I shall give in detail.

Case 1. Burrell, a negro man, aged about 74 years, in fine
health ; he has been ruptured twelve or fifteen years. April 15,
1840, I operated on him by injecting at the external ring about
20 drops of the oil of cloves, in the presence of Drs. Ogilby,
Jones, Wingfield, Howard, and Anderson, and Messrs. Wright
and Man, students of medicine. He complained very little of
the operation; after which, I applied one of Chase's trusses, to
prevent the descent of the intestines.

16th, 10 o'clock, A. M. Patient had vomited some, which
caused the descent of the intestines. I returned them very easi-
ly. Until now, he had not complained in the least of pain. 12
o'clock, M. Complains very much of pain in the parts, which
are swelled, tense and very painful to the touch. So far, the
swelling is in the bottom of the scrotum. 7 o'clock, P. M. In-
flammation gradually progressing towards the external ring;
he has not vomited since morning. I have allowed him small
quantities of whiskey to-day, as he has been accustomed to the
daily use of it. Pulse natural.

17th, 8 o'clock, A. M. Patient complains very much of the
inflamed parts they appear to be assuming the condition I

1853.] Robert, on Hernia. 185

should think necessary to the radical cure of hernia, that is,
the deposition of a large quantity of plastic lymph ; he lias not
vomited since yesterday, and then only once ; appetite good,
and pulse natural. 6 o'clock, P. M. Scrotum has been very
much distended to-day, but is more flaccid at this hour, still
very tender to the touch, especially about the ramus of ihe
pubis, lie has had an operation from his bowels. His pulse
has been a little excited to-day, but very little.

18th, 8 o'clock, A. M. Burrell passed a good nighl : tumor
not so painful as yesterday not so large ; thai pari of it which
is near the external ring has a very firm feel. He had an evacu-
ation from the bowels of firm consistance, and very painful.
Pulse natural, and spirits good. Ordered, a dose of casioroil.

19th, A.M. Tumefaction about the same as at last report,
deposite so great as to occupy the whole of that side of the
scrotum; says he has very little pain. The; I i he a

perfect filling up of all, from the external ring to the bottom of
the scrotum of the same side.

20th. Report differs in no way from yesterday. From this
date the effusion Was gradually absorbed, and al the end of a
month, notwithstanding the use of a good truss, his hernia was
as bad as ever.

Case -J. In Glennville, Ala., July 24th, 1847, I operated on
a middle-aged negro, ruptured on the right side. lie was tem-
porarily relieved, but the hernia returned in about a month. It
is pro: .\ ever, that he was put to hard work (cutting

saw-logs) as soon as he was relieved from the immediate effects
of the operation.

Case 3. In September following, I operated on a negro
man, s. This negro was ruptured on the right

side, and was also laboring un ler ascites, with a fluid distention
of the scrotum. When last heard from lie remained well of
the hernia.

C kSE I. At the same time as the above, I operated on Mr.
C. J., a young gentleman aged 21 years, ruptured on the right
side. lion produced no effect whatever. In two

rain, without even temporary bei
5 and 6. In October following, I operated un two
blacks, without any permanent effect.

136 Robert, on Hernia. [March,

All the negroes operated on were put to hard work as soon
as they were seni home, so that, even if the operation promised
anything, the chances of success were thus very much dimin-
ished, if not entirely destroyed.

So far as the danger of the operation is concerned, I have
yet to learn that any existed. / have even seen the intestines
come down the day after the operation, and returned without
any bad consequences. I have seen the oil of cloves thrown
into the canal, when a portion of the omentum was yet unre-
turned. This being returned, no more was thought of it.

Since the latter part of 1847, I have not operated at all ; and
if I were called upon again to make an attempt to relieve a case
of hernia, I would rather trust to the application of a small
seton at the external ring than to an operation of this kind. It
is a well established fact, that when irritating injections fail to
relieve hydrocele, a small seton through the sack is almost sure
to cure it, by the deposition of a large quantity of coagulable
lymph. The seton is much more likely to produce constitu-
tional disturbances, and is consequently rather more dangerous ;
but I feel certain that it is much more likely to block up the
external ring than any injection.

Case 7. In May last, I operated on Mr. C. for strangulated
hernia. A fold of the intestine, about six inches long, and a
portion of the omentum had descenced, and at the time of
operating they were very badly strangulated. I returned the
intestine, but being fearful that the omentum was too far gone,
I determined to let it remain where it was to relieve itself of
suppuration ; and, moreover, to see what effect a long-continu-
ed suppuration would have in curing the hernia permanently.
Suppuration continued about a month all the strangulated
omentum sloughed away, and the external ring appeared to be
blocked up.

I saw Mr. C. again in December last. There never had
been any descent of any of the viscera since the operation.
The intestines would pass down the canal to the external ring,
and there seem to be arrested by its occlusion. He had never
worn a truss. Further time is necessary to determine as to
the permanency of the cure.

Case 8. On the 21st of November last, I operated on a gen-

1853.] Robert, on Hernia. 137

tleman fifty years of age, fur the relief of strangulated hernia.
He had heen ruptured for twelve or fifteen years, and lately
had been very much troubled with a descent of another portion
of the viscera, lie bad generally been relieved by purgation,
This course, however, had failed to relieve him of his present
attack. I should think that from the moment of the descent
the strangulation became perfect ; for in less than an hour after,
he had vomiting and hiccough, which continued, with very lit-
tle intermission, until the completion of the operation.

I operated twenty-four hours after the accident. There
was a very great depression of the vital energies. His skin
was very cool, extremities so cold as to require artificial heat
to them, constant shivering, pulse 130 to the minute and very
weak. On cutting down, 1 found the old hernia to consist of a
portion of the omentum, which had become so closely adherent
to the scrotum as almost to constitute a portion of it. The
recent hernia consisted of a fold of the small intestines about
four inches long, and so tightly constricted as to make it very
difficult and dangerous to pass up the probe pointed bistoury
to divide it. As careful as I had to be, I cut my tinker in pro-
tecting the intestines. After so long a time, I succeeded in
passing the knife and removing the difficulty. Three hours
after the operation, when reaction had become fully establish-
ed, I found that a small artery, which had been divided in the
first cut through the skin, was now bleeding freely. The whole
scrotum was filled up to the external ring with coagula. I se-
cured the ends of the artery with ligatures, and removed as
much of the coagulum as possible; yet a great deal remained.
I anain united the edges with sutures and adhesive strips. Very
little suppuration afterwards took place; the remaining coagu-
la were probably absorbed. He recovered rapidly, and was
uj> in ten days. Up to this day he has had no return of the
hernia.

So far, Mr. Editor, as my experience will warrant the opin-
ion, I think that many cases of strangulated hernia are ren-
dered fatal by the severe and long-continued taxis which is
frequently i to. Let u

case of strangulated hernia. The patient has been ruptured
for a long series of years ; this portion of the viscera (be it

138 Hamilton's Case of Mortification. [March,

omentum or intestine) has never been returned, we must rea-
sonably presume adhesion to have taken place : another portion
of the viscera comes down and becomes strangulated can
any one for a moment suppose that taxis will relieve such a
case? An how can any one discriminate these portions the
one strangulated and the other not without cutting down to
them ?

Again, I have seen cases rendered fatal by delay, from a
false opinion entertained by some surgeons of the great danger
attending these operations. I am satisfied that the patient suf-
fers as much pain before as during an operation to relieve the
strangulation. The operation of itself does not seem to me to
be necessarily hazardous. The large proportion of successful
cases are those who received early the benefits of an operation.

I have been insensibly drawn from common reducible hernia,
to cases of strangulated hernia. In the illustration of my
views, my cases of strangulated hernia presented points which
I was desirous of bringing forward, and hence the blending of
one kind with the other. The above article contains my own
views upon this all-important disease. However much they
may differ from those of others, I honestly entertain them, and
therefore do not hesitate to submit them to the profession.

ARTICLE IX.

Extraordinary Case of Mortification, occasioned by Pregnan-
cy. By Samuel L. Hamilton, M. D., of Chattooga county,
Georgia.

Mrs. S., aged twenty years, duiing the sixth month of her
second pregnancy, was attacked June 5th, 1848, with remittent
fever, which readily yielded to ordinary treatment. After this
she did well for twelve or fifteen days, during which time
nothing of importance occurred, but she was perhaps unusual-
ly hearty, which I attributed to her condition.

On the morning of the 20th of June I was again called to see
her, and found her with extreme pain in the toes of her right
limb, which was so cold half way to the knee as to yield to the

1853.] Hamilton's Case of Mortification. 139

hand when applied the same sensation as that of a dead hod}'.
There was little or no excitement of the pulse; nor was there
any evidence of disease in the general system. The pain in
the foot increased from day to day, until the cries and shrieks
of the unfortunate sufferer were almost too intolerable to be
borne by her surrounding friends. It cannot be said that she
was entirely easy until her delivery, except while under the
influence of large doses of morphine, from the effects of which
she would frequently awake in violent pain. Her sleep was
evidently not profound, under as large doses of the above medi-
cine as it is thought prudent to administer under any circum-
stances. It was attempted, but in vain, to restore the lost
temperature of the extremity every thing was used that would
promise this result, without vesicating the skin, which was
avoided, notwithstanding the repeated solicitation of friends for
the application of a fly-blister. There finally appeared large
yellow blisters upon the diseased surface, which, on being rup-
tured, discharged a serous fluid. It was evident, after this, that
there was not sufficient vitality in the skin to warrant recove-
ry. The skin and all the soft tissues now began to slough,
until the ligaments of the metatarsal articulations were destroy-
ed at this point they were separated, which gave the patient
some slight relief. The temperature of the limb was partially
restored from above, down to within a short distance of the
ankle-joint; the pain, however, continued unabated 'till labor
came on, when it then entirely ceased. The lady was then
delivered of a large child, after which there was not the slight-
est return of pain. The labor was in all respects natural the
stump of the extremity, which had been suppurating, now readi-
ly healed the woman recovered, and has since given birth to
two children, without the slightest return of the affection.

I was constrained to the opinion that this extraordinary case
wa^ the result of p.essure of the gravid uterus upon the
arteries and nerves passing through the pelvis viz., the ext.
iliac artery and the great sciatic nerve, whose extremities sup-
ply nutrition and innervation to the disorganized part. From
the history of her previous pregnancy, it appeared thai there
had been running ulcers from about the sixth month until de-
livery; the cicatrices were still perceptible, and occupied the

140 Harper's Case of Retained Placenta. [March,

regions covering the posterior and anterior tibial arteries. I
think it a reasonable inference, that the pressure was exerted
upon the nerves, as well as the arteries, from the intense and
continuous pain which nothing could relieve until the removal
of the cause, when the suffering simultaneously disappeared.

As to the treatment of the case, opium may have given some
temporary relief. Position was tried without the least success.
Supporters were also tried with the same result. We would
feel inclined, however, were we called to treat another case,
to try more thoroughly, both supporters and position. We
might particularize as to local applications, &c, but they were
such as common sense would dictate, and failed to afford any
relief we therefore omit their tedious detail.

article x.

A Case of Retained Placenta. By P. W. Harper, M. D., of
of Laneville, Hancock Co., Georgia.

On the 12th of last October, I was requested by my young
friend, Dr. George W. Darden, of the Shoals of Ogeechee, to
visit Miss C, of Warren county, thirty-one years of age. Be-
fore proceeding in detail with her case, it may not be amiss to
say, that her feet are very much affected with the deformity
familiarly called club-foot. She measures, from the sole of her
foot to the knee-joint, 13^ inches; from her knee-joint to her
hip-bone; 11 inches; from her hip-joint to the crown of her
head, 23| inches making her exactly four feet high, of strong
and healthy constitution, with no deformity about the pelvis
that we could discover.

On my arrival, I ascertained she had been in labor about
thirty hours. The membranes had been ruptured several hours
before I saw her. On examination, I found the case natural,
and of the fourth presentation. There was considerable rigid-
ity of the parts, particularly the os uteri, which impeded the
further descent of the occiput from the left acelnhulum. We
took sixteen ounces of blood from the arm, and then made
another examination, and found the same contraction as before,
without any progress of the child's head. The bowels having

1853.] Harper's Case of Retained Placenta. 141

been freely opened by a purgative, we gave her a dose of mor-
phine, and left her to rest during the night. On examination
the next morning, the parts were relaxed, and the OS uteri so
dilated as to admit the whole of the occiput into the left aceta-
bulum with the anterior fontanel resting a little above the left
symphysis pubis. The pains became very regular, and as we
supposed would now expell the child ; but in this we were dis-
appointed. The head became so impacted in the pelvis, from
its large size, that no efforts we could prudently use changed
the relative position of the head : we could neither make it ad-
vance nor recede. In this situation she remained until the next
day (14th), when, as the last resort, we had to lessen the size
of the head, by perforating it at the posterior fontanel, and
emptying it of its contents. Several hours yet elapsed before
we could effect the delivery of the head, around the neck of
which the funis was wrapped ; this, placed immediately under
the symphysis pubis, with the size of the child, weighing ten
pounds, added greatly to the delay of the expulsion of the
shoulders. After the delivery of the shoulders, she seemed
much prostrated, and all pain ceased. For two or three hours,
we gave the wine of ergot, in table-spoonful doses, every twen-
ty minutes, without any effect whatever. We then had to use
force by extension and counter-extension, which soon effected
the delivery, at 12 o'clock, P. M., on the 14th, after having been
in labour from the 11th, say four days. We then proceeded
to extract the placenta, but here we met with insuperable dif-
ficulties by the contraction of the uterus, though not the hour-
glass contraction. All efforts having failed, we had to desist.
We gave her a dose of castor oil, and left her, with directions
to take morphine after the bowels were opened, to be seen the
next morning.

15th. On our visit, we found the uterus relaxed ; but, on ac*
count of the parts becoming so very sore and sensitive, we
could not extract the placenta, which was attached at or near
the fundus Kim. The only alternative which seemed to be left
us now was to use emolient and soothing injections up the
vagina and into the uterus, and to meet whatever contingencies
might happen, and to trust the case to the efforts of nature
until the next day.

142 Dugas's Case of Club-foot. [March,

16th. Rested pretty well during the night ; with some fever,
though the pulse soft and compressible; seems revived; com-
plains of great soreness to the touch, and the parts much swol-
len. No portion of the placenta could we extract. Directed
equal parts of milk and warm water injected three times a-day ;
dose of castor oil and morphine at night.

17th. The bowels were moved, and she rested tolerably well
during the night ; pulse 130, weak, and much fetor in the room.
Efforts made to extract the placenta, but failed. Same injec-
tion continued, and morphine to be given at such intervals as
to compose.

18th. Did not rest well the preceding night ; pulse about the
same as the day before; great thirst, and some portions of the
placenta have come away, putrid and very offensive. Emoli-
ent injections with weak soap-suds and morphine directed.

19th. Much worse, with an enlargement of the abdomen and
great soreness about the uterus, as well as the other soft parts ;
pulse 120, and weak; small portions of the placenta continue
to be discharged. Directed the bowels to be moved with cas-
tor oil, and the same injections and morphine.

20th. Considerable distension of the whole abdominal region ;
pulse quick and weak ; about two table-spoonfuls of the placen-
ta have been discharged of the color and consistence of mo-
lasses, and so very offensive as scarcely to suffer any one to
remain in the room. Being insensible to all passing events, we
left her, with the expectation of her dying during the day or
night. She died about 4 o'clock, P. M.

ARTICLE XT.

IS on-congenital Talipes Equinus. By L. A. Dugas, M.D., &c.

Cases of accidental or non-congenital Club-foot, are so rare
that no apology is necessary for reporting the following. It is
the second only that the writer remembers to have seen.

The subject of this case was James H., of this city, about
nine years of age. When three years old, his limbs being
perfect, he took scarlet fever and was very ill with it. After
the eruptive period, he suffered a great deal with the pains

1853.] Dugas's Case of Club-foot 143

which sometimes attend this disease; and during the three
suceeedin<_: years there seemed to be occasionally an impedi-
ment in his walking, which was attributed to weakness or to

something of a rheumatic nature. When six years of age,
however, there was still no deformity whatever about the foot
nor leg. Indeed, at that time, none but his parents could per-
ceive any thing peculiar in his Lrait. But his lameness became
gradually more and more evident, although he suffered no pain;
his left heel was perceived to be a little elevated in walking, so
as to throw the weight of the body upon the anterior part of
the foot ; and this peculiarity went on increasing for a couple
of years, until he walked upon the extremity alone of the met-
atarsal bones, being utterly unable to reach the floor with the
heel or to Ilex the loot in the least.

I saw him for the first time on the 6th of April, 1852, and
was then furnished with the above history. I found his left
foot presenting all the features of talipes equinus in the extreme;
the muscles of the left leg were very much atrophied, and,
although there was no ankylosis, the tension of the tendo
achillis was such as to prevent any motion of flexion ; the ex-
tension of the foot seemed to be carried to the utmost possible
degree, the instep being drawn back beyond the axis of the
tibia, and the toes turned up towards the instep. On carefully
measuring the two limbs, the left ankle was found to be about
one inch above that of the right limb. In other words, the
left limb was an inch shorter than the right one.

It is probable that in this case, the immediate cause of the
talipes is to be found in the gradually increasing disproportion
in the length of the limbs, the child instinctively elevating the
heel to compensate for the difference. Why the left limb did
not grow as fast as the right is another question, which need
not occupy us at present.

A sub-cutaneous section of the tendo achillis was made, and
four days afterwards an apparatus applied for the purpose of
rectifying the deviation of the foot. This consisted of the
sheet-iron splint and curved bar proposed some years ago by
Dr. Chase. It ansv. i ed admirably in this case, as it has re-
peatedly done in the several varieties of talipes in which I
have used it. After wearing this about three weeks, my little

144 McKinnon's Case of Monstrosity. [March,

patient left it off, was able to walk, and his heel gradually came
down to the ground so that he was well in two months, and
has remained so to this time.
Augusta, Feb., 1853.

ARTICLE XII.

Monstrosity. [We are indebted to Dr. D. McKinnon, of
Pike Co., Alabama, for a letter, from which we make the fol-
lowing extract :]

"Mrs. M., on the 3rd of November, 1852, after a tedi-
ous labour, was delivered of a male child, weighing about seven
pounds, and presenting the following appearances: The head
and limbs well developed, the stomach, duodenum, jejunum,
ilium, coecum, colon, rectum, liver and spleen, were all on the
outside of the abdomen, without any covering. The viscera
protruded from an opening extending from the pubis to the
umbilicus; the cardiac extremity of the stomach and the rec-
tum were closely attached to the abdominal walls at said
opening, the scrotum forming a part of the attachment of the
rectum. There was no penis nor anus. The infant lived four
hours."

PART II.
(EcUctu Depart ment.

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 112.]
sixth letter.

My dear Friend, Let us continue this review of facts and
arguments which have been opposed to my doctrines.

There is an observer upon whose works my antagonists
place great value, and they are in fact worthy of much esteem.
I have cited them honorably in my preceding letter, and you
see me disposed to accord to them the value which they merit.
This observer, whose results have been opposed to me without
cessation, is M. C. Martins. Well, what do the results of M.
Martins prove in the elucidation of the great question of the

1853.] Ricord's Letters on Syphilis, 1 16

consequences of blennorrhagia as cause of syphilis ? Remark
that it is i ely on accounl fthe accuracy of the observa-
tion, of the scientific method employed by this observer, and
in fine of his statistics, that they have made so much noise

about his figures and his conclusions. What. then. do his figures
say ' I find them very favorable to my doctrines. Js it by-
complaisance 1 Judge of it ?

M. Martins gives a statement of 60 observations of syphilitic
eruptions. Now how many times has the chancre been noted
as antecedent? 46 times, my dear friend. In 14 cases only,
M. Martins assures us that he has found no other antecedent
than simple blennorrhagia, two of which were accompanied
with bubo, and two with orchitis. But M. Martins adds that
he had not the opportunity to make the diagnosis of these cases
of blennorrhagia. and that he trusted to the testimony of the
patients. You know what I think upon this point. There are
some testimonies, without doubt, that we ought to believe; but
I shall always maintain that when there is a question of diag-
nosis as difficult as that of chancre in the urethra, the testimony
of people entirely strangers to the profession, often ignorant
and narrow-minded, and who understand neither the sense nor
the bearing of the question, is of very little value. Without
doubt we accept testimony in some questions much more grave,
in those of life and death ; but it does not follow that the testi-
monies are always true, and the judgments always equitable.

Permit me to offer you a general remark, which finds its
place here. In many of the observations of M. Martins, as in
several of those of M. Cazenave, and as in almost all those of
a great number of authors, you find in their summary these
words many primary accidents. These primary accidents
which have necessarilv produced the constitutional verole, are
the chancre and the blennorrhagia. If my antagonists, by some
reasonable motives, attached the consecutive infection rather
to blennorrhagia than to chancre, we should have to examine
this doctrine. But no, you know and you have read it, and you
ought not to be much astonished, that it is together that they
group these primitive accidents: that it is without considering
the distance which separates their appearance one from the
other, and that it is in giving to them all the same value, the
same consequences and the same results. In truth, is this E
science, is it strict observation? What should you think of a
physician who should tell you, here is a man suffering from
hydrophobia; he has been bitten ten times: it is three years
since, two years, one year, six months, and very recently. But
his disease is evidently owing to the successive inoculations
which he has undergone. Or, here is a varioloid patient, who

146

RicorcPs Letters on Syphilis.

[March,

has gone through five or six epidemics of variola at the last
one the disease manifested itself; it is but the consequence of
contagious and successive infections.

I confess that it is not thus that I understand science. I am
astonished that a mind as strict as that of M. Martins, who
agrees with me that blennorrhagia is due to causes entirely for-
eign to syphilis; who logically is forced to admit that the blen-
norrhagic antecedents as causes of syphilis are extremely rare,
and that the chancre consequently is the most frequent antece-
dent of the verole lam astonished, I say, that in order to
arrive at the conclusion that a simple blennorrhagia can pro-
duce syphilis, he is content with his sixty observations, of which
he chooses three, and particularly one, which I ought to bring
forward here.

"An apothecary, aged 23 years, contracts a blennorrhagia,
but it troubles him so little that he continues at his occupa-
tions. He goes hunting, and even has sexual intercourse.
Then follows an orchitis, which forces him to take care of him-
self. The blennorrhagia is cured, after having lasted six
months. Seven years afterwards, an ulceration appeal's at the
opening of the left nostril, another one at the internal surface of
the lower lip. These ulcerations extend ; the two lips are at-
tacked upon the entire left side, then they are partially cured,
and ulcerations follow at other points. The ulcerations have
rounded bord&rs, and are cut perpendicularly : the cicatrices
are delicate, rosy and pliable. The patient, admitted into the
wards of M. Biett, is cured in a month by the use of the proto-
iodide of mercury. Shall we say that this patient, half physi-
cian, who examined himself carefully, as we have seen him do
at the hospital, had chancres without perceiving them ?"'

Yes, certainly, I will say that that patient had very well-
marked chancres, from the description which M. Martins gives,
and that the patient had not recognized them, on account of
the unusual seat which they occupied. As to the manner of
the contagion, M. Martins will not ask me, and I shall not take
it upon myself to point it out. He knows, however, as well as
I, how these accidents can follow, and without seeking malice
therein, in the exercise of the duties even of this good apothe-
cary.

You are aware, my dear friend, that the chancres, unusual
in their situation, and difficult to discover, are less rare than is
thought to be the case. I cited to you an example in my last
letter. Here are others.

Some years ago.. M. Lustermann, professor at Yal-de-Grace,
brought to my house a lawyer, having a tumor upon the lower
eyelid, at the inner angle of the eye, hard, resistant, elastic,

1853.] Ricorfs Letters on Syphilis. 1 17

with a red granulating surface, and in process of cicatrization.
This tumor had been alreadj Been by many physicians, and,
if my memory Bervea me, some occulists had been consulted,

but its nature had hern until now unknown. I was asked if it
was connected with some venereal antecedent more or less dis-
tant. Pushing my examination further than my brethren, I
found the glands about the ear, those of the parotide an region,
and the sub-maxillary, enlarged, indolent and elastic. The
posterior cervical glands were already tumefied. The surface
of the body wa^ covered with exanthematoiis spots proceeding
from the best characterized syphilitic roseola ; lenticular spots
of a dull red, leaving in some places, under the pressure of the
finger, a tawny yellowish color; absence of fever and of pru-
ritus.

To the great astonishment of M. Lustermann, this was my
diagnosis : Indurated chancre at the inner angle of the eye (suc-
cessive engorgement of the glands about the ear, also of the
parotidean and sub-maxillary) ; secondary affection ofthecer-
mcal glands ; syphilitic roseola; precocious secondary acci-
dents.

To the great astonishment of the patient, I said to him It
is two or three months, sir, more or les*, that you conveyed to
your eye the contagious matter, which inoculated you with
syphilis. Recovered from his surprise, the patient said to me,
"In truth I remember having slept with a woman, and after
certain contacts, I was seized with much itching about the eye,
where I carried my hand, and rubbed it during a considerable
time. It is from that mement that my eyelid has become dis-
eased."

Is it not true, that if this gentleman had been attacked with
a blennorrhagia, either antecedent or accompanying, it would
have be<n to that, that the chancre of the eve and the seconda-
ry accidents would have been attributed ;" Very well, I must
say that the nose of M. Martin's apothecary found itself proba-
bly in the same condition as the eye ofour lawyer.

M. Cazenave ought to recollect the history (no longer ago
than 1847) of a very intelligent student in medicine, in whom
he diagnosed a constitutional syphilis (TembUe, characterized
by a roseola without antecedents. This young man presented
himself at the Hospital du Midi, and there we were able to
show the existence, before all the students, which had passed
entirely unperceived, of an indurated chancre extremely well
mark- d upon the left cheek, and concealed under a

thick tuft of whiskers. The sub-maxillary glands unobjec-
tionable witnesses were engorged and indolent, with that
character of resistance peculiar^ to these glandular enlarge-

148 Ricord's Letters on Syphilis. [March,

merits, symptomatic of indurated chancre. This ulceration, to
which the patient had attached no importance, being revealed
to him, he was able to state with precision the origin and the
date of it, which agreed perfectly with the appearance of the
secondary symptoms.

At this same time in the wards of the Hospital was a patient
having a chancre (primary accident) upon the sinciput. I
showed, at my clinical lecture, a woman who had an indurated
chancre upon the left eyebrow, with a symptomatic enlarge-
ment of the glands about the ear, which had two months pre-
ceded a nocturnal cephalalgia, enlargement of the posterior
cervical glands, and a roseola.

I should never finish, if I attempted to indicate those cases
only which have passed under my eyes, of chancre seated in
unaccustomed places, and which would be confounded with
secondary accidents attributed to a blennorrhagia of shorter or
longer standing, by observers little accustomed to accuracy.
I have at this moment even, in the first ward of my hospital, a
patient, affected at the same time with a simple blennorrhagia
of the urethra (inoculation negative), and with indurated chan-
cre of the upper lip, accompanied with an indolent enlargement
of the submaxillary glands, concomitant affections, but inde-
pendent one of the other.

Here is sufficient, it appears to me, to prove to you how
frequent and insidious are the causes of error under similar
circumstances, and to legalize my scepticism as regards certain
observations.

But I ought not to forget that my learned brother of Lvons
is waiting for me with five observations which he opposes to
my doctrines. I ought the more to return to them, as these
five observations have sufficed to convince the strict and re-
served mind of M. Legendre.

First, as I have already told you, one of these observations is
done away with, for the patient who is the subject of them had
had previous chancres. Four cases of simple blennorrhagia
followed by syphilis remain. But of these four cases I shall
permit myself to do away with two, for M. Baumes did not
practise inoculation. These cases ought, then, to enter into
the numerous category of those blennorrhagias for which there
has not been a strict diagnosis. One remarkable fact, which
you will permit me to notice in passing, is, that M. Baumes,
who is certain of having inoculated the greater portion of the
patients who have presented themselves to him, has fallen pre-
cisely upon two cases of syphilitic blennorrhagia, in the diag-
nosis of which he deprived himself of the precious aid of in-
oculation. We are then reduced to two other cases, where

1853.]

RicoroVs Letters on Syphilis.

149

inoculation has been practised with a negative result, and
which have been followed, nevertheless, by constitutional ac-
cidents !

Jn one of these Cases there h question, also, of a nose, which
again appears to me excessively suspicious. Here is the his-
tory, reported by M. Baumes :

Of the two patients inoculated, one remained at Antigu-
aille two months. His blennorrhagia was difficult to cine . he
had still a white discharge when he left the Hospital. He en-
tered it again three mouths after with a syphilitic eruption, in
red patches, copper colored, partly furfuraceous, partly scaly,
and a rounded ulcer with a greyish ground, with perpendicular
borders, and with an erysipelatous circumference situated in
the left nostril. At this period the discharge did not exist.
Th's patient had had no coitus since hid leav ng the Hospital."

You will find here, again, a very complete description of the
primary ulcer; and how does it happen that in presence of a
fact so important, in the point of view of a question so litigious,
M. Baumes did not try the inoculation of this chancre? 1 re-
gret it sincerely, but in the absence of all strict diagnosis. I
ought to place this nose in the same category with the nose of
the apothecary.

Here I am, then, face to face with one observation only of M.
Baumes, and that the last one. My learned colleague well
says that he inoculated from the seventh to the tenth day of
the appearance of the discharge ; but how much time had pass-
ed since the infecting coitus? M. Baumes knows perfectly
well that a knowledge of this is not unimportant. He knows,
also, as well as I, that the chancre which is ordinarily followed
by secondary accidents, generally extends itself but little: that
it is perfectly indolent : that its suppuration is so little, that it
can pass unperceived. Upon all this. M. Baumes is as well
edifi -d as myself, I am very sure. These ulcerations (to not in
any way pit-vent a blennorrhagia from being produced, a short
or a long time after, and it is not astonishing that the one in
question did not furnish inoculahle pus, the chancre having ar-
rived at the period of reparation, or having completely disap-
peared. It is moreover necessary to suppose, that before his
first entrance into the Hospital, or after his departure up to the
time of his return to it. the patient had not undergone another
contagion, and by a way which escaped the sagacity of our
collea.

All the- ns apply equally to the observation of M.

Lafont G'>nzy, in which secondary accidents came on after a
blenno; rl --en inoculated without result. He

does not say any thing of the time which separated the coitus

n. s. VOL. IX. no. in. 10

150 RicortPs Letters on Syphilis. [March,

from the manifestation of the symptoms, a period sufficiently
long for the cicatrization or reparation of a chancre.

It appears to me, after all this, that my colleague of Lyons,
who maintains that the simple blennorrhagia can give rise to
the same accidents as the chancre, can permit me to send back
what he addressed to me, viz., " that he establishes as principle
that which is in question, and advances an hypothesis devoid
of strict foundations."

Thus fall to the ground, one by one, the objections so grave
in appearance made against my doctrine. Thus, I continue to
believe

With Girtanner, "that syphilis recognizes most generally
for cause, chancres and buboes, and that it very rarely follows
a blennorrhea."

With Swediaur, "that the symptoms of syphilis are rarely
manifested after blennorrhagia."

With M. Rayer, "that the secondary cutaneous eruptions
with blennorrhagia are rare ; that we observe them in a much
smaller proportion, than after superficial and deep venereal
ulcers."

These opinions, as you see, agree very well with the relative
scarcity of the chancres of the urethra with symptoms of blen-
norrhagia."

I could still cite many other authorities. But I have not fin-
ished with the objections. In my next letter I shall examine
some of another nature.

SEVENTH LETTER.

My dear Friend, From this fact alone, viz., that chancres
have been submitted to a treatment called methodical, it has
been thought that the consecutive accidents of a constitutional
infection, which ought to be the result of chancres, could be
attributed to a blennorrhagia which came on afterwards. M.
Baumes pretends to prove it in one of his five observations.
But what is a methodical treatment? What is the treatment
upon which we can absolutely depend for neutralizing effectu-
ally the syphilitic diathesis? For myself, I do not know of an
infallible one. I well know that a great number of very dis-
tinguished practitioners think that with a certain dose of mer-
curv, administered during a given time, we ought to consider
the patients as radically cured. And in order not to go beyond
the limits of my hospital, I shall cite my very honorable col-
league. M. Vidal, who has recently given out, that with one
hundred and ten of Dupuytren's pills, neither more nor less,
we ought to put an end to syphilis.

1853]

Ricord's Letters on Syphilis.

151

As Is, I am the mosl I man in the world.

Nobody more than myself respects the religion of others; but
I have the right, it appears to me. to participation in all

their convictions, when I see every day the proof of the E
errors into which a blind faith may conduct one.

M. Vidal ought to have seen many patients return : and if
this has not happened to him, let him permit me to say, that I
a great number of those, \\ ho have not only
taken the one hundred and ten sacramental pills, but even 120,
150 and more, all of which has not prevented the symptoms
from reappearing.

1 shall no longer insist upon this point, fori shall have occa-
sion to return to it later. What I want to establish hei
that thos - are often deceived who have thought

that they ought to ascribe accidents of constitutional syphilis
to a blennprrhagia which has come on after a chancre, from
the simple fact that the chancre which ha i preceded, had been
submitted to a mercurial treatment.

Here is a point more astonishing, something which will sur-
prise your reason and baffle your logic.

My opposers have estab ies of veroles,

according to their origin and their source.

Thus they admit, ami in this they are perfectly right, that
constitutional syphilis can he transmitted by way of inheritance.

Tin- I they have pretended proofs for this as

tion that constitution*] syphilis can he taken (fembl .

Th I they publish facts for the support of this

times no kind ofantecedent to constitutional
syplnlis can be found, although they do not dare to ascribe it to
the syphilis d'eml*

They pretend that an individual under the influence of a
syphilitic diathesis, without present manifestations, without
apparent symptoms, can, however, under certain circumstances,
transmit syphilis.

They maintain that the duration of the incubation ofsyj hilis
should be unlimited, that the man - of the c

should appear as well after a tew day- as after a tew

. thirty and moi

All the- distinctions, you will fit d es-

tablished particularly in the writings ol W : hut upon

what is what I in vain ask myself. I inquire

by what | ywhal means of come, in

ted by a const;! te this

ise tp one of these circumstance than to another.

Has he e ' ,\ v hilis, after early infancy and we -hall
hereafter see that its effects can be prolonged a special svmp-

152

Ricor(Ts Letters on Syphilis.

[March,

tomatology ? Can constitutional syphilis. cPemblce, be distin-
guished from the other kinds by any pathognomonic sign ? Do
the cases of verole in which the antecedents have not been
made out, ^ive rise to disorders different from those in other
cases? What is a verole without antecedents, unless it is a
verole d'emblee 1 Do we find that those cases of syphilis which
have succeeded to simple blennorrhaon*a, assume forms less
grave, or have less extended seats, as M. Baumes pretended to
find in writing his hook, but which he has not been able to meet
with in his practice?

I answer boldly, no, to all these questions. Constitutional
syphilis presents a symptomatology alike in all cases; and it is
not I who prove it, it is my opposers themselves. Read again
their writings, and see if you can find in the descriptions given
by MM. Cazenave, Baumes, &c., one single characteristic trait
which justifies these arbitrary distinctions.

Again, one thing in my opponents astonishes me. How does
it happen that in these cases of constitutional syphilis, whether
(Vembhe or without antecedents, when it has been impossible
for them to be assured of the conditions of the contagion to
state precisely the when and the how if it is well proved that
the patient has presented no primitive accident, they having
found no door of entrance to the verole; when they are well
convinced that the patient is not mistaken, and that he has no
motive in deceiving ; when, in fine, they have the certainty of
not being themselves deceived; I am astonished, I say, that
they do not admit what Cullerier admitted to explain the inex-
plicable cases, viz., spontaneous syphilis in man.

M. Richard des Brus has made this great step. Among
other facts which brought him to this conviction, he cites one
which is very curious. A young man and a young woman
yield themselves to the pleasures of love. Jn his ardor the
younuj man scratches himself with a hair of his mistress. He
does not stop for such a trifle, and he does so well, that he
communicates his ecorchure to his mistress. The amorous
couple are soon simultaneously affected with constitutional
verole. M. des Brus, who had examined neither of them, did
not the less admit a previous good state of health ; but not be-
ing able to explain the appearance of the verole, he declares it
spontaneous.

I am not as far advanced as this learned colleague, and the
so frequent opportunities that I have of seeing constitutional
affection succeed to a well-determined primitive accident,
causes me to rank the exceptional cases, where the patient does
not know or does not wish to enlighten me, and those in which
I arrive too late to find the entrance of the syphilis, in the cate-

1853.] Ri cord's Letter* on Syphilis. 153

gory of observations which M. Cazenave entitles unknown
antecedent^ and which I call overlooked. Alas! is it not more
satisfactory for the mind, more conformable to our manner of
reasoning in medicine, to admit in those cases where syphilis

has really succeeded to a biennorrhagia not symptomatic of
chancre, that the antecedent has not been recognized, rather
than to lose one's self in that ciowd of subtile distinctions, of
arbitrary categories, and of sterile explanations? How, other-
wise, will my contradictors undertake to prove to me what
they say, and to convince me of error? It is not my habit to
challenge any one ; this sort ol argument ought to be banished
from scientific discussions; but I much wish that they would
_e to prove to me once only, yea, once, that, in those cases
where all my researches having been vain I have said antece-
dent* overlooked that they would prove to me, that something
more affirmative could be substituted for this formula.

From this long discussion, my dear friend, it will appear to
you without doubt legitimate to conclude that if in tins im-
mense majority of cases, biennorrhagia is simple and benign,
there exists also a virulent biennorrhagia; and that the bien-
norrhagia is virulent when there exists a concealed chancre in
the urethra.

N w does the means of making the diagnosis of concealed
chancre exist ?

Is it possible to distinguish a simple biennorrhagia from a
biennorrhagia with concealed chancre ?

Here is the grand question. 1 commence the discussion of it.

Some persons have made light of the diagnosis of blennor-
rhagia. Hecker, and some others who have followed htm,
have not thought that the diagnosis was necessary. Very re-
cently 1 read in your valuable Journal that the diagnosis had
no relative importance. A certain number of physicians have
retained ideas which have been in vogue, and which ougfit
much to astonish the public.

Have you caught biennorrhagia from a wife who was not
yours? Virulent biennorrhagia. The biennorrhagia is viru-
lent for the lover, tor the husband it is benign. You have con-
tracted a biennorrhagia, and you ought to remain bachelor.
Simple treatment. But you wish to marry. Antisyphilitic
treatment. The position of bachelor, or ot future husband, has
the privilege of causing the biennorrhagia to pass from the be-
nign state into a virulent state.

In a question as seiious and as important ns tin's, I do not
wish to insist upon the ridiculousness of these contradictions.
All have understood the necessity of a more Strict diagnosis.
The latest of my opponents, M. Vidal himself, with whom my

154 Quinine in Tetanus. [March,

proceedings in diognosis have not found favor, has made some
attempts in this matter. In the first edition of his Treatise upon
External Pathology, he gave out the hope that it would be pos-
sible to distinguish a virulent discharge from a benign one, by
the odor. This appears, and it is to be regretted that his hopes
were not realized, for this passage disappears in the second
edition.

I hold rather more to my ideas than M. Vidal appears to hold
to his. Will you, then, permit me to give out once more, both
my ideas and my experience upon the diagnosis of blennorrha-
gia, and to examine the objections which have been made to
them.

But I cannot treat of this subject in the short space which
remains for me, not wishing to abuse to-day the generous hos-
pitality which you afford my letters. This point will be the
subject of my next epistle. [Boston Med. and Su?*g. Journal.

On the use of Quinine in Tetanies. By E. A. Pye, M. D., of

Louisiana.

In the spring of 1850, Dr. N , a retired physician of

Catahoula parish a gentleman of intelligence and information
called on me to know "if I had seen any thing, in the course
of my late reading, worthy of a trial in Tetanus." He had a
negro boy, about 14 years old, laboring under the most violent
attack of Traumatic Tetanus that he ever witnessed. The
boy had fallen from a horse some weeks before, receiving a
wound in the face. The wound was apparently slight ; little
attention was paid to it, and it healed in the usual time. Symp-
toms of Tetanus, however, soon made their appearance, and
had gone on constantly from bad to worse, in spite of the treat-
ment. He had been purged, blistered, had taken opium, whis-
key, spirits turpentine, calomel, the hot and cold bath, but with
no relief. "In short," said the Doctor, I have gone through
the routine. I have tried the old practice; unless something
else can be done the boy must die.'' I recollected that in the
New Orleans Medical and Surgical Journal for 1849 I had no-
ticed a case, reported by Dr. Brickell, of the Charity Hospital,
in which chloroform and quinine had been given, and in which
the cure was attributed to quinine, in 30 grain doses. It seem-
ed to me, at least, worthy of a trial the quinine.* The sug-

Note. [A case of Tetanus treated successfully in 1848, with quinine and
morphine, was reported by us in the 6th vol., p. 340, of the Southern Med. &
Surg. Jour. [Edt.

1853.] Quinine in Tetanus. IJMj

gestion was at once adopted. We decided to begin with 30
or 40 grains, and increase the dose until some effects were

produced. The Doctor was rather doubtful of finding his

patient alive on his return; but promised, it' hi; was still living,
to give the quinine a fair chance. On his return he found all
the symptoms increased in intensity. The intervals between
the paroxysms had dwindled to but a few moments of partial
ease; with these transient*exceptions, he was in a state of con-
stant and most violent opisthotonos: and it was evident that
unless relief could be procured, death must soon close the ter-
rible scene. Taking advantage of the first opportunity, the
Doctor got down his throat 30 grains of quinine examining
his watch at the same time. In one hour he again visited him
he could perceive no change; repeated the dose. In the
course of the next two hours the Doctor thought or fancied he
perceived slight the slightest possible diminution in the in-
tensity of the paroxysms; at any rate the hoy thought himself
relieved, and begged for the medicine. He got 30 or 40 grs.
The improvement in the next two hours was evident. The
paroxysms were not only less severe, but the interval was also
decidedly longer and freer from pain. The boy's sensation of
relief was yet more decided, and he clutched at his quinine
and swallowed it with an evident "gusto." He threw his
arms heavily about, saying that he felt '' drunk " and " happv !"
The case went on regularly improving; the only other medi-
cine given being an occasional dose of oil, to keep the bowels
open.

At the end of two weeks I met the Doctor. The boy had
taken two ounces of quinine ; was entirely free from all symp-
toms of Tetanus ; had experienced no bad effects from this
enormous quantity of quinine ; no tinnitus aurium deafness
fulness of the head. The muscles had become relaxed, the
skin was acting finely, the bowels were free. The only pecu-
liar effect of the quinine beinfj the one mentioned above, which
he frequently expressed the feeling as if he were about half
drunk or "happy." Here a prudential regard for the "man
with the poker/' or some other analogous event, from the sud-
den withdrawal of an agent, whatever its modus operandi,
which had kept our patient "happy*' for two weeks, despite
of Tetanus, induced us to taper off': which we accordingly did,
giving him about halt' an ounce of quinine, in gradually dimin-
ished d. >><. in the course of the following two weeks.

I saw him at the end of this time. well, fat and hearty. The

r promised to give me ihe notes ol tin- case, which would

have rendered it more satisfactory. Circumstances having

prevented my getting them, I have thought it might not be

156 Substitute for Ergot. [March,

altogether without interest as it is. In this age of heroic doses
of quinine, the writer records his wholesale administration of
the drug with much diffidence. He not only disclaims the un-
hallowed ambition of ''out Hemding Herod," in this regard,
but deprecates truly, on the contrary, the "spirit of enormous
dosing" so rife through the land. One may, however, some-
times rind himself so situated that the maxim "occasio praeceps"
must stand in the place to him of all precedent. In the pre-
sent instance, the result of treatment, the circumstances of the
ca<e, the character of the gentleman by whom the medicine
was administered all combine to assure the writer that the
practice, I hough seemingly ultra, was in reality only so much
so as the occasion demanded.

Watson says there is no cure for Telanus. Perhaps he is
right ; but Dr. Brickell records a case in which unequivocal
symptoms of the disease yielded to quinine. I give you my
facts for what they are worth. Let others contribute. "Ex
multis Veritas." \_N. O. Med. Journ.

A Valuable Substitute for Ergot. By B. H. Washington,
of Wood burn, Kentucky.

I lately attended a midwifery case, and deem it advisable to
report the treatment for further investigation. The pains com-
menced at 4 A. ML, and continued at intervals of J 5 to 20
minutes, until 6 P.M.; were slight, and produced but little
effect. Upon examination, found os uteri dilated ; head pre-
senting, but high up; scarcely any effect perceptible during
the pain. Not willing to leave the management of the case
any longer. to nature, I concluded to dry-cup her; applied a
cup as low down on the sacrum as possible so as to cover the
origin' of the nerves to the os uteri and produce relaxation. Pre-
vious experiments had shown me the uterus would not contract
unless applied higher up. My design was to produce relaxa-
tion of the os uteri, and then dry-cup higher up, so as to cause
the uterus to contract. The result was most satisfactory to all
interested, for complete relaxation ensued ; at the next pain
the head descended to the outlet, and at the second pain she was
safelv delivered, and that too in less than, ten minutes from the
application of the cup. No hemorrhage resulted ; the placenta
came away with scarcely any inconvenience in about three-
quarters of an hour, and every thing went on well.

This is the second case in which the above plan has been
tried: in the first, the patient was safely delivered in about 15
minutes, and with three pains. She had been suffering upwards

1853.] Substitute for Er 157

of twelve hours, without effect ; was induced to try the plan
from two facia first, the partial paralysis of the arms while the
cup was over the origin of the brachial nerves, and the suc-
cessful application of dry-cupping in a case of dislocated
shoulder joint, as mentioned in my first article on dry-cupping ;
secondly, the cups had been sppliecj on a patient after delivery,
to relieve the disagreeable feelings resulting therefrom, and the
patient told me she could feel the uterus contracting very
Btrongly. Putting these tacts together, it occurred to me that
>n traction was the legitimate function of the uterus, while
expansion was the legitimate function of the os uteri, by the
application of the cups over the origin of the nerves to t he de-
fective parts, the appropriate results would follow. The plan
ha- been followed with the most complete success, as manifest-
ed by the cases above mentioned. I would therefore recom-
mend atrial of it in all tedious cases. Apply, first, a cup as
low down on the sacrum as possible, and if in the course of
ten or fifteen minutes the patient was not delivered I would
recommend the application of another cup higher up, so as to
cause the uterus to contract ; the lower one should always be on
when the upper one is applied, so as to insure relaxation ot the
os uteri when the pains come on.

Jn cases of retained placenta, I would recommend a contrary
course: apply the cups higher up, so as to cause the uterus to
contract at once ; the placenta can always follow the child.

The great advantage of this method of causing the os uteri
to relax and the uterus to contract, over the plan of giving
ergot, needs no other recommendation, I presume, than a simple
statement of facts : When ergot is administered, the woman
is delivered by main force and in opposition to the usual pro-
ceeding of nature, without any relaxation except that produced
by the most fearful and agonizing pains by dry cupping such
a complete relaxation is produced, that two or three pains are
sufficient and the amount of suffering is not more than ordina-
ry. Indeed, the amount of suffering is so much lessened, one
would feel tempted to try it in ordinary cases, where every
thing was going on well, merely to shorten the period of suffer-
ing. Another advantage is, that as soon as the delivery is
the pams are over too; the placenta comes away with scarce-
ly any inconvenience. Whether it would be justifiable to
apply it in an early staire of labor, merely to lessen the dura-
tion of suffering. I leave to be decided by future experience. I
certainly should not recommend it at th without further

trial. In my first article on dry-cupping, 1 omitted two im-
portant items first, that it breaks up the chain ofnerv-ais
sympathy during pregnancy, and, regularly applied, h

158 Treatment of Still-born Children. [March,

broken ; the patient suffers very little, and that little more from
imprudence than from nervous sympathy. Let the patient be
dry-cupped every third or fourth night, (her husband can easily
do it with a tumbler,) and sponge herself two or three times a
week with water, cold or warm, according to fancy, and my
word for it she will suffer as little as the heartiest Indian fe-
male, unless broken down by some organic disease. The other
item is, that if there is a scant secretion of milk, or none at all,
apply three or four cups to the spine, especially over the origin
of the mammary nerves, and there will soon be a plentiful
supply. These items are not theoretical assumptions, but the
result of actual practice, and I sometimes censure myself for
not making them public sooner, as an immense amount of sym-
pathetic suffering can be easily prevented. As mentioned in
my first article, when it is desirable to produce an effect on a
given part, the cups should be more strongly applied over the
origin of the nerves distributed to that part; and they should
be larger than those in common use ; a common tumbler with
a thick rim will answer very well, except in female cases; in
those I use the pump to produce a vacuum, as they can be ap-
plied under the covering without offending the most fastidi-
ous. [Nashville Journ. of Med. and Surg.

New Method of Treating Still-born Children. By T. Wood,

M. D.. of Cincinnati, Ohio.

Mrs. C was brought to bed in her first confinement,

and had a very protracted and tedious labor, from a rigid and
unyielding vulva. The child on delivery was in a state of syn-
cope, so profound as to leave but little hopes for restoration to
life. Full five minutes had been lost in fruitless efforts to excite
breathing, and the only sign of life in the child was a slight con-
vulsive effort while its lower limbs were yet in the vagina, after
which it lay flaccid, ex-sanguineous, and in appearance dead.
Cold air, cold water, and brandy had been thrown on its chest
without producing the slightest effect, and I was about to inflate
its lungs, when I noticed that the vessels of the cord were much
distended with blood, and a very feeble pulsation in its arteries.
Finding this condition of the cord, suggested the idea that,
perhaps, if the blood it contained could be forced into the circu-
lation of the child, it might afford the required stimulation.
Instantly acting on the suggestion, I took the cord between my
thumb and fingers, and drew its whole length between them,
so as to force the blood into the child, when it immediately
cried lustily, and animation was completely restored. It had
no more difficulty in beginning life, and is now doing well.

1853.] Tapping in Hydrocephalus, 159

I report this case under the impression that this mode of
treatment is original.

Since having ihe above case, I tried the Bame treatment in a
child that was delivered by a long labor, embarrassed by con-
vulsions. Animation was at once restored on forcing the
blood from the cord into t he circulation of the child, but there
was not, previous to resorting to this means, such complete
prostration of the child as in the first case, and though effectual,
the result was not bo striking.

My friend, Dr A. M. Slocum, informs me that since I rela-
ted my case to him. he has tried it in a similar prostration of
the child, with the same happy result. [Western Lancet.

Tapping in Hydrocephalus.

The intractable nature of chronic Hydrocephalus is such as
to warrant, in some cases, a resort to tapping; for, although
this operation has usually proved ultimately unsuccessful, it has
repeatedly prolonged life, and may yet be so regulated as to give
permanent relief. In 183G we tapped a child's head seven differ-
ent times, drawing off sixty-three ounces of fluid without the
slightest unpleasant effect yet the child died, apparently from
inattention on the part of the mother to directions. This case
was reported in the first volume of this Journal, (old series.)
1836, p. 440.

The following is an extract from a case reported in the
Transylvania Medical Journal, by M. Howard, M/D., of Lou-
isville.[Ed. S.M.&S.J1.

"The head went on enlarging until it attained an extraor-
dinary size measuring 23 inches in circumference and 14
inches in a vertical direction, from one auricular orifice to the
other. The pressure of the accumulated serum at length pro-
duced total blindness, and a partial paralysis of the mus
The face became contorted, and the extremities hung flaccid
and motionless.

m It now became apparent that the little sufferer was reduced
to great extremity. I abandoned all hope of relieving it with
the aid of mere pharmaceutical agents, and intimated to its
parents that I was willing to give up the
one. On being urged to further effort, 1 pr the opera-

tion of puncturing the membra . dernier resort, at the

same time warning the family that I had but little faith in its
efficacy. The pressure of the enormous accumulation of se-

160 Tapping in Hydrocephalus. [March,

rosity on the extended memhranes and the brain, induced an
intolerable amount of suffering, which was indicated by the
constant moaning and restlessness of the child, even in sleep.
This painful pressure I could alleviate by decanting off a por-
tion of the fluid, but it was at the risk of accelerating the final
issue death. I frankly stated this fact, and warned the fami-
ly that the operation, though simple, was hazardous; that death
might possibly ensue at once, and that the possibility of its ef-
fecting a radical cure was too remote to afford much ground
for hope the only certain recommendation in its favor being
that it would effect a temporary remission of the suffering, if
the patient survived it. Notwithstanding these representa-
tions, the child's father urged the performance of the operation.
The mother, however, had conscientious scruples ; he was,
therefore, induced to defer submitting his child to the risk, un-
til the sanction of a clergyman (the relative of the child before
alluded to) could be obtained.

"In the mean time I had prepared a close-fitting cap of gum
elastic, which I purposed to use, to maintain an equal pressure
during the evacuation of the serum. I also obtained a minute
trocar and canula, the blade of the trocar not being longer than
the ordinary couching needle.

"Experience has taught us, that the principal danger to be
apprehended in puncturing the head for cerebral dropsy, is the
production of fatal syncope, from the sudden removal of pres-
sure from the brain and its appendages. I therefore had stimu-
lants at hand, and determined to decant the water slowly,
watching narrowly, in the mean time, its effect on the pulse.

" The trocar was introduced carefully, a little to the right of
the inferior angle of the fontanelle, in a perpendicular direction,
to avoid the longitudinal sinus. The depth to which the in-
strument penetrated before the fluid was reached, seemed to
favor the belief that the convolutions of the brain had been
unfolded by the pressure of the fluid, and lay in a thin layer
immediately in contact with the membranes.

" Some high European authorities have denounced this opera-
tion as cruel and worse than useless. But the result in (his
case does not sustain this \iew. The patient suffered very
little from the introduction of the instrument, and apparently
none at all afterwards. Upon the withdrawal of the trocar,
the water was forced for a moment in a violent little stream
for several feet, owing to the pressure of the tense membranes.
I allowed it to flow freely fov several minutes, no symptoms of
exhaustion supervening until about twelve ounces had been
withdrawn. Immediately after the operation the patient sunk
into a profound and tranquil slumber, from which she awoke
in about five hours, apparently much refreshed.

1853.] Wry Neck cured without Cutting. 16]

"The most important result of the first tapping was tl.
moral of the paralysis. The countenance regain* d its natural
expression, and the muscles of the limbs appeared to have be-
come more subject to volition.

' To aid the effect of the tapping, I renewed the eonnter irri-
tation, and the exhibition of alterative m days
after the first tapping, I drew off about eight ounces of v.
After the second operation, long slips of adhesive plaster were
1 around the head in various dii ipport the
s, and to assist the action of the elastic bandage. The
little patient now appeared to be progressing finefy. The head
was diminished considerably in size, her appetiteand command
of muscle appeared to increase, and, better than all, the retina
appeared to be regaining its sensibility. Previous to the first
operation she was totally blind, and the muscles of the eyes ap-
peared to work without concert. Strabismus divergens, and
convergens, had occurred at irregular intervals: but now the
movement of the eye-balls obeyed the will, and the nerves ap-
peared to have become sensible of external impressions, though
the sight was far from being perfect. These happy results en-
couraged me to attempt too much on the third operation. I
decanted the serum a little too rapidly, and the patient sunk
into profound syncope, from which she was restored with
difficulty. No untoward consequence ensued, but the mother
of the child became so terribiy alarmed at the effects of the
last tapping, that she refused to allow its repetition. In her
opinion, the object in view would not have justified the result,
if her child had died from the effects of the operation.

" I had the satisfaction of finding, however, that no further
effusion took place. The head was much reduced in size, and
did not subsequently enlarge. She gradually gained a pel
control of the voluntary muscles, and her sufferings from the
serous accumulation appeared to be entirely removed, so that
she became even playful. Several months after I had removed
from the county. I learned from Dr. William Dunham that the
child had died from an attack of typhoid fever, (typhoid pneu-
monia, I think.) Up to the time of her last illness no change
for the worse had taken place in her condition."

Wry Neck Cured without Cutting. By to T. D.,

, to New York Hospital.

The success obtained in the t itortion of

the Head, commonly known as Wry Neck, induces the wri-
ter to make them known to the profession, in order that the
treatment employed, which it is believed haa not hitherto been

162 Wry Neck cured without Cutting. [March,

applied in such caser; may be fully subjected to the test of ex-
perience :

Case I. Hester Higgins. a native of Ireland, aged 25 years,
unmarried, was admitted into the New York Hospital on the
6th Nov. 1848, at which time she had suffered from rheuma-
tism already about seven months ; all the larger joints of the
body having been sufficiently affected. About four months
prior to her admission, she suffered a relapse, after having nearly
recovered, and since then she has experienced but little allevi-
ation of her ailments. Her neck as well as most of her larger
joints are painful, though not much swollen. Her tongue is
slightly furred, her pulse is 85 and soft ; her skin moist, and
bowels regular.

On the 19th of January following, she had nearly recovered
from her rheumatism, under treatment, except rigidity and con-
traction of the muscles of the right side of the neck, by which
the head was drawn downwards and towards the right shoulder.
To relieve this distortion, frictions with stimulating and oleagi-
nous liniments were diligently employed, and, subsequently,
sulphuric ether was applied to the neck. Some slight improve-
ment resulted from the use of these means. On the 18th of
April, however, the condition of the neck had for some time
been stationary, and all hope of further benefit was abandoned.
The motions of the head were very much restricted, and any
attempt to overcome the resistance of the rigid muscles by
stretching them occasioned severe pain. The rigidity did not
appear to reside in the sterno-mastoid muscle, inasmuch as this
muscle did not grow hard and stiff when efforts were made to
elevate the head ; the resistance was evidently seated in the
deeper muscular and tendinous parts.

At the request of my colleague, Dr. Swett, of the Medical
Division, I saw this patient and proposed to make cautious
attempts to overcome the resistance by force, the patient being
first subjected to the influence of sulphuric ether. Considering
the resistance to depend on contracted muscular and tendinous
fibres, my object was either to stretch or rupture them, and in
doing this, no danger was apprehended to the important nerves
and blood-vessels of the neck ; since the forced movement ne-
cessary to accomplish this object would fall far short of the
extensive motions in every direction to which these parts are
accustomed naturally to accommodate themselves.

Dr. Swett assenting to my proposal, the patient was laid
upon her back in bed, with her head resting high up on a pil-
low, so as to be easily got at from the head of the bed. Taking
the head between my two hands placed one on either side, I
cautiously stretched it with a very moderate degree of force in

1853.] Wry Neck cured without Cutting. 103

the direction opposite to that in which it waa distorted, tl
upwards and to the lefl side. Almost immediately every one
standing round the bed (of whom there were at least eight or
ten pupils and medical men), was startled by a loud snapping

sound ofsome thing rupturing, and at the same time I perceiv-
ed that the head yielded, and could he brought almost to its
natural position. It was thought prudenl to proceed no further
at this operation. The patient on recovering her consciou
was not sensible of any new soreness in the parts, and could
bear the head to be moved much easier than before the oper-
ation. She was directed to lie as much as possible on her left
side. On the following day there was considerable soreness
on the right side of the neck. On the 25th of April, one week
after the first operation, the soreness of the neck having very-
much diminished, the operation was repeated a second time.

The proceedings were thesame as in the first operation, only
the stretching was carried to a much greater extent, and with
a much less timid hand. Several times resisting fibres were
felt to yield with a rupturing sensation, till, at length, no further
nice was encountered, and the head could be carried to
the full extent in every direction. After the effects of the ether
had passed of]', the head was bandaged down towards the left
shoulder. On the first of May, the bandage being dispensed
with, the head showed no disposition to resume its distorted
attitude. On the 10th of May (1S49), the head could maintain
unaided its erect natural position, though rotation and flexion
were still limited in extent, and performed awkwardly; the
patient, however, was sensible of the progressive improvement
in these respects. She took her discharge from the hospital
for the purpose of returning to her friends in Ireland. About
one year afterwards she was heard from as continuing well,
and free from any distortion or rigidity of the neck

Gasp, II. In January, 1852, Maria P , of Guilford, Con-
necticut, aged 12 years, and of a healthv constitution, came
under my care, with the head very much distorted from being
drawn down towards the chest, with the face turned to the left
side. The motions of the head were also very much restricted.
In the month of July preceding, she had been attacked with
sore throat and still' neck, that left her ever since in the condi-
tion just described. Slit' had never suffered from rheumatism
in any other part of her body, and had generally enjoyed good
health. I at once decided to employ the treatment which had
been so successful in the preceding and on the 15th of
January, having first etherized my patient, I performed the first
operation. In order to carry the extension of the head to the
requisite degree, it became necessary to have her supported in

164 Wry Neck cured without Cutting. [March,

the sitting posture in a chair, and to place myself in front of
her. Grasping the head between my hands, I acted on it in the
various directions in which resistance was encountered, but
felt no sensation of rupturing fibres, in this or in any of the
subsequent operations. The resisting parts, however, yielded
in some measure, and allowed the head to be brought more
nearly into its natural position. No pain was experienced
from the operation on recovering her consciousness.

On the 19th, no effect was observable from the first opera-
tion ; it was therefore repeated a second time, with the aid of
ether. On the 24th, 26th and 30th of January, and on the
4th and 7th of February, it was also repeated, each time with
the aid of ether. Though a gradual improvement was percep-
tible from these repeated operations,- it became evident that a
complete cure could only be achieved by a patient and perse-
vering repetition of them for a long time; it was therefore
judged most prudent to continue the operations without the
aid of ether. The patient's courage and endurance, though
put to a severe test, proved adequate to the trial. Once every
day she submitted with the most admirable fortitude to the
stretching process, for about ten minutes each time. This was
continued up to the 1st of March, after which it was repeated
twice every day. The manner of manipulating was as follows:
The patient was seated in a chair, and her body steadied by an
assistant standing behind her and holding her shoulders firmly
with both hands. Placing myself in front of her, I grasped her
head with my hands in such a way as to perform most efficiently
the different movements 1 wished to execute. These move-
ments were varied in every direction in which resistance was
encountered, my object being to stretch to the utmost the con-
tracted muscles, and to maintain them on a stretch for a certain
length of time. The process was painful only during its actual
performance, and ceased to be so the moment it was discontin-
ued. On the 24th of March, the operations were suspended,
while the patient made a visit to her family, and were resumed
again on the 8th of April. During this interval no relapse took
place. The same course of treatment was continued till the
10th of May, when she returned to her home, highly gratified
at being able to maintain her head by her own efforts in its
natural erect position, and to turn it in different directions al-
most as well as ever she could. She was advised to continue
for a teng time the daily practice of performing the various
motions of the head as extensively as possible. On the 13th
of January, 1853, J conversed with an aunt of my patient, who
had recently visited her, and who reports that she holds her
head in a very natural manner, and can move it at pleasure

1853.] New Operation, $c. 165

freely in every direction. In ;i word, isiders herself

quite well again, and without any disposition to rela;

[New York Medical Times.

Mr. Bowman's New Operation for the Division and Removal
of False Membrane or Opaque Capsule from the cutis of
Vision.

A new and very simple method of effecting the above object
has been recently introduced by Mr. Bowman, and been attend-
ed with complete success. It is well known how tou<;h and
resisting these bands and portions of membrane often prove, so
that a cutting needle fails to divide or tear them, thopgh it may
drag them from one side of the pupil to the other, the structure
yielding to a certain extent, and then returning to its place on
the withdrawal of the instrument. The iris and ciliary body
to which these membranes are usually attached, are liable to be
stretched and injured under such handling, and we have even
seen the iris detached from its ciliary connexions; serious in-
ilammation is also prone to follow the operation.

The peculiarity of Mr. Bowman's method consists in the use
of two ordinary cataract needles simultaneously. They are
introduced through different points in the cornea down to the
band of membrane, and their points having entered it at the
same or neighboring situations, as convenient, are then separa-
ted, tearing it across, and carrying it in two fragments to oppo-
site sides of the pupil. Thus there is no drag put upon the
vascular parts, and the only tissues touched are the cornea and
the opaque membrane itself. One needle may be made to fur-
nish a fixed point of resistance from which the other can act
with advantage. During the last ten days this method of oper-
ating has been successfullv adopted in seven instances, three of
them were cases in which, after the removal of the lens by dril-
ling, the pupil still continued closed by false membrane ; and in
the other four the sight was more or less interfered with by
bands of lymph or tough opaque capsule passing across the
axisof vision behind the iris. [Western Lancet.

Escalier'b Proceeding in Asphyxia from the Inhalation of
Chloroform.

Professor Rigaud relates in the Ahrillc Medicate of Xov. 3d,
1851, the following case :

months ago I was going to operate upon a woman for a
tumor in her breast, and caused her to take chloroform. After
a few inspirations the pulsation ceased suddenly, and the pa-

n. s. VOL. IX. NO. III. 11

166 Effects of the Vapor of Oil of Turpentine. [March,

tient gave no sign of life. The chloroform was immediately
removed, cold water thrown into the face of the woman, and
frictions made over various parts of her body. After two min-
utes, which seemed so many long hours, these manoeuvres pro-
duced a few feeble contractions of the heart, which soon ceased
again, and were not accompanied by a single appearance of
respiration. In this fatal condition it occurred to me to resort
to the treatment of Dr. Escalier. I introduced my right index
finger into the mouth of the asphyxied patient, made it pass
along the base of the tongue, and lift the epiglotis. Then I
pulled the tongue out of her mouth. This rapid motion caused
an inspiration, which I made use of to let her inhale Ammonia.
But as soon as I let go the tongue it slipped back, and the res-
piration ceased again. I repeated the same manoeuvre, and
produced arrain respiration. But this time I retained the tongue
outside of the mouth, and respiration continued to go on ; after
which, the woman recovered very soon, and all functions re-
sumed their normal actions. Then I made the intended opera-
tion, without chloroform, and every thing went perfectly well.
I have no doubt, that in this case, the life was saved by the
treatment recommended by Dr. Escalier. [Ibid.

The Effects of the Oil of Turpentine on Persons exposed to its
Vapor. By Elisha Harris, M. D., Physician to the N. Y.
City Dispensary.

During the past few years there have come under my obser-
vation and care, several interesting cases of strangury, hema-
turia, &c, resulting from continued exposure to the vapor of
the oil of turpentine. Some points of interest connected with
the history of these cases, may justify the following brief ac-
count of them.

Case. A laborer employed in unlading a cargo of turpen-
tine, began to suffer from vesical irritation and dysuria, at the
c'iose of his second day's labor in the ship; and at the end of
the third day, when he applied to me for relief, he presented all
the symptoms of acute inflammation of the bladder. The
urinary organs were in a state of excessive irritation; there
were almost constant efforts of micturition, with the passage of
but a few drops of bloody urine or more frequently, of blood
onlv. The patient complained of severe pain in his back and
loins, and he suffered from nausea, vertigo, and impaired vision.

The poor fellow had no idea of the true cause of his suffer-
ings, but was confident that he had been maliciously poisoned.
Upon inquiring, I learned the nature of my patient's employ-
ment, and advised him to desist from his labors in the ship. I

1853.] Effects of the Vapor of Oil of Turpentine. 107

prescribed copious draughts of nd demulcent

drink, a tepid batn, Air. In th of forty-eight hours he

had fully recovered. Immediately after (his, there occurred
io the Bame ship three similar cases.

By inquiry, I have since learned that the occurrence of such
on board of vessels freighted with turpentine, and also
among laborers employed in unlading such cargoes, is no un-
frequeqt event in warm weather. The late Dr. F. P. Colton
reported an interesting case that came under Ins care in the
N. Y. Hospital. (Vide Cotton's X. Y. Hospital Cases. N.
York Jour. Med., Vol. V.. No. 3.)

ently I have had occasion to treat several cases of stran-
gury, hematuria, eczema, ovaritis, &c, occurring fn an
whose lobors expose them to the vapor of turpentine. They
I in an extensive manufactory of India Ruhher
s, where camphene is used as the solvent of ihe gum
caoutchouc. Two of these patients were young females, and
in them turpentine seemed to have induced very grave consti-
tutional irritation. Long continued insomnia and malaise had
induced a state of nervous and mental irritability borderii
mania, and almost characteristic of the difficulty. During the
lirst three months that these girls W re employed in the facto-
ry, they suffered from dysmenorrhea and menorrhagia ; and
quently, at the time they came under my care, they suf-
fered !rom ovaritis and kucorrhcea, all oi which had und
ediy been caused by the terebinthine vapor which they were
obliged to respire, while in thedischarge of their duties. The
bodies of both these patients were extensively covered withan
eczematous eruption, which soon disappeared, with all the
other unpleasant effects of the turpentine, on their leaving the
i*act<ry.

One of the young men employed in this factory, suffered a
higher deizree of irritation of the urinary organs than 1 ever
before wil After repeated attempts t<> continue at his

labors in the factory, he was obliged, ultimately, to leave t lie
establishu

The interest excited by those cases has led me to make in-
quiries, in reference to the prevalence <>\ the irritating and
ious etlects of turpentine among artisans who are exposed
to its v;i

The intelligent conductor of an extensive manufactory of
India Rubber goods in this city, informs me that about two
thirds "t ;i!l his employees suffer considerable vesical irritation,
jury, vertigo, mm- . & . during the first few months of
their employment in the factory, and that after a time they
nearly all become bo that the terebinthine air no

168 Effects of the Vapor of Oil of Turpentine. [March,

longer affecls them. In this establishment it#is the practice of
those who suffer from the effects of the turpentine, to take large
and frequent doses of olive oil.

In the India Rubber factories of New Jersey, where cam-
phene is used as the solvent of the caoutchouc, the same facts
are observed as in this city.

In an extensive manufactory in New England, in which
camphene is no longer used, I learn that when the terebinthine
preparations were used, the workmen suffered very much. In
this establishment the workmen were in the habit of antici-
pating the effects of the terebinthine vapor, by subjecting them-
selves to a process of "seasoning." by taking repeated doses of
camphene. In this and other manufactories, I find that females
do not seem to have suffered as much as males from the pecu-
liar local effects of the turpentine, but they have suffered much
more from its effects upon the nervous system and the skin.

In connection with this subject, I would record a case in
which a large quantity of camphene was swallowed by a child,
with almost fatal consequences.

D. H., a boy aged three years, stealthily seized a small can
which he supposed to contain molasses, and drank nearly or
quite six ounces of camphene.

I saw the boy within an hour and a half after the accident.
He was then in a state of profound coma, the eyes were suf-
fused, the pupils largely dilated, conjunctiva injected, the pulse
130, the skin hot and dry, the mouth and fauces red and parch-
ed, the features were somewhat corrugated and anxious, res-
piration hurried; the abdominal muscles were very tensely
contracted, and he lay curved, with his arms closely folded and
pressed on his abdomen Urine that had been voided a short
time previous to my arrival had the odor of violets. I adminis-
tered a large quantity of olive oil. and followed it with an emetic
of ipecac, and warm water. The matters ejected had the odor
of turpentine, as did also the dejections from the bowels.

The child could not be kept awake, even whde vomiting.
There were frequent and ineffectual attempts at micturition,
and there was constant priapism.

I directed a tepid bath, and prescribed demulcent drinks,
with ipecac, gr. j, every fifteen minutes. This treatment was
continued for about eighteen hours, when the little fellow awoke
to consciousness for the first time in nearly twenty hours. Less
than four ounces of urine had been secreted during this coma-
tose period ; and what was voided was tinged with blood. For
several days the patient continued to be excessively nervous
and irritable; but at the end of a week he had to all appearan-
ces fully recovered.

1853.] New Facts relating to Percussion. 1G9

The facts in this case might be of some importance in a
medico-legal point of view, as there are but few such cases on
record. One very similar but less Bevere case, is mentioned
by Ml. Taylor in his treatise on Poisons. (Vide " Taylor on
Poisons" by Griffith, p. 426.)

The history of my case, as well as that of Dr. Evans, quoted
by Mr. Taylor, exhibits striking proof of the energy with which
the oil of turpentine acts upon the nervous system of persons
exposed to its action. [New York Jour, of Medicine.

New Facts relating to Percussion in Pneumonia, Emphysema,
etc. By H. Roger.

1. The pulmonary parenchyma, even containing less air
than in the healthy state, gives, on percussion, a more or less
evident tympanic sound: a portion of lung infiltrated with
serum, or blood, or tubercular matter, and not entirely deprived
of air, furnishes a tympanic sound more or less hollow or
dull, in proportion to the quantity of air. In percussing the
thorax, tympanic resonance will there be obtained in some
cases of pneumonia, of tubercular infiltration, and of pulmonary
Oedema and apoplexy.

2. The natural pulmonic sound is not tympanic. The lung,
distended more than its healthy state (vesicular emphysema),
furnishes a sound sometimes tympanic and sometimes non-
tympanic. Partial emphysema surrounding an engorged and
non-aerated parenchyma (which may happen in pneumonia),
gives rise to a resonance which is usually tympanic; while
this rarely occurs in general emphysema, and is never present
in interlobular emphysema. When, in emphysema, the pulmo-
nary tissue is excessively distended by the air contained in the
air-cells, and at the same time the thoracic walls are very tense,
the thoracic resonance, instead of being exaggerated, as might
a priori be expected, is diminished ; thus is explained (and not
b) the presence of false membranes covering the lung) the
small amount of sound which is sometimes found on percussing
the chests of patients, who are nevertheless highly emphyse-
matous.

3. In pneumothorax, the pectoral resonance is tympanic
when the chest on the affected side is moderately distended,
but scarcely ever when the tension is extreme.

1. When the abdomen ia percussed, the varying tension of

dminal wall may cause the resonance to vary : the more

the wall is, the more obscure is ; i The same

occurs with regard to the resonance in cases of pneumatosis,

[Archives Gen. de Med. London Jour, of Med.

170 Rheumatic and Non-Rheumatic Pericarditis. [March,

Researches on the Pathology of Rheumatic and non-Rheumatic
Pericarditis. By Dr. Ojrmerod.

Recently before the Royal Medical and Chirurgical Society
of London, Dr. Ormerod read a very interesting paper on these
affections. He commenced by a reference to the researches of
the late Dr. Taylor, who had satisfactorily shown that acute
rheumatism was not. exclusively the cause of pericarditis, and
who had also called attention to the importance of granular
disease of the kidney in reference to this morbid condition.
The author desired to limit the use of the word pericarditis to
present inflammation of the pericardium ; and this analysis re-
ferred exclusively to cases of this nature. The means of investi-
gation comprehended complete records of 1410 cases observed
under nearly similar circumstances ; that is, in the wards of
different hospitals. Of these, 1249=88.59 percent, were not
cases of rheumatism; 161=11.41 per cent, were admitted on
account of rheumatism, or suffered from it w[iile under obser-
vation. Of the whole number, 85=6 per cent, had recent
pericarditis, observed during life, or discovered after death, and
were thus distributed:

24 = 1.92 per cent, occurred among 1249 non-rheumatic cases.
61 = 37.88 per cent. 161 rheumatic cases.

85 =6 per cent. 1410

The mean age of 61 subjects of rheumatic pericarditis was
about 21 ; the mean age of 24 subjects of non-rheumatic peri-
carditis was 42 ; the extremes being 7 and 63 years. As to the
different causes of the pericarditis

Rheumatic 61 cases coincided with acute rheumatism.

at r, RuVY1ip .f ( 7 ensued on inflammation of lungs or pleura.

iNon-Kneumauc oi \ g en^d on maligrnant disease ot tne pericardium,

local origin, j { ensued on o]d cardiac disease.

Non-Rheumatic of fcoi

constitutional
origin,

coincided with ha?mo:rhage or exhaustion.
2 coincided with scarlatina or irresipelas respectivel)'.
2 were inexplicable.

S5

The date of the accession of pericarditis was determined in
33 of the rheumatic cases. The mean of these observations
gave the 10. 5th day of rheumatic attack as that on which the
pericardial complication most commonly supervened. The
question, whether a first or second attack of rheumatism was
more likely to be accompanied by pericarditis, was beyond the
reach of hospital statistics. Tins source of information was
silent also on the question, whether pericarditis be more likely
to occur in severe or in the slighter cases of rheumatic fever.

1853.] Rheumatic and Non-Rheumatic Pericarditis. 171

It might, however, be safely inferred, that the severity of the
articular and pericardial affections bore no very close relation-
ship to each other. It was certain that the most severe, even
fatal pericarditis, might occur where there was hut faint evi-
of articular affection, and this latter condition might
exist in the most aggravated and intense form without involv-
ing the addition of pericarditis to the other sources ofdis!
The author then entered upon the consideration of the subject
of non-rheumatic pericarditis of local origin ; and a question
of importance here presented itself What was the influence of
preexiatent cardiac or pulmonary affections in inducing in-
flammation of the pericardium ? The question was of equal
importance in relation to acute rheumatism. The relation of
pulmonary inflammation to pericarditis was thus illustrated :
In the 1110 cases, the basis of this inquiry, some form of pul-
monary inflammation that is, pneumonia, pleuritis, or pleuro-
pneumonia was ascertained to exist, either by auscultation or
dissection, in "265 cases. Of these

117 had pneumonia, of which 10 had recent pericarditis.

86 had pleurisy, " 6 "

G'2 had pleuro-pneuraonia " 8 "

965 33 = 12.4 percent.

In the rheumatic class, pericardial inflammation commonly
preceded, yet sometimes, though rarely, followed, pulmonary
inflammation. The non-rheumatic class told quite a dill-
story ; here pulmonary inflammation had apparently a distinct
influence in inducing pericarditis, and this influence was most
evident in cases of pleurisy ; and clinical observation bore out
the conclusion, that the pericarditis was subsequent to, and pro-
bably contingent on. the pulmonary inflammation. The author
then referred to the comparative fatality of non-rheumatic
compared with rheumatic pericarditis, and also to the desira-
bleness of instituting an exact comparison between Bright's
disease of the kidney and acute rheumatism, in respect to their
tendencies to induce inflammation of the pericardium. In con-
clusion, the author desired to ascertain how far the results ob-
tained by his present analysis agreed with those of the published
of Dr. Taylor, who had made the subject of non-rheumatic
pericarditis so peculiarly his own. The deductions seemed
identical, and one an the perusal of those elaborate

clinical reports with aconviction that non-rheumatic pericardi-
- more within the province of the anatomist than of the
physician. It w,i< a disease with few or no symptoms, its
physical - more often by a chance discovery

than on the suggestions of the disease, and its morbid changes

172 Total Removal of both Radius and Ulna. [March,

small in amount and apparently inactive ; and where opportu-
nity had occurred of watching the disease some time previous
to death, it had been apparently without effect on the general
symptoms, its presence or absence being determined by the ear
alone ; and still, in these, its connection with the fatal termina-
tion had appeared to be that of a coincidence rather than of a
cause.

Dr. Copland felt obliged to the author for the very practical
and literary way in which he had brought his paper before the
Fellows of the Society. The association of disease, as exem-
plified in Dr. Ormer</d's communication, showed us that, in
practice, we must not look at cases of disease as always simple,
but frequently as complicated as those under discussion. All
these were connected with the morbid condition of the blood,
and to this we must look as the cause of the articular rheuma-
tism, the pericarditis, pleuritis, &c. All these were evidences
of the blood being in an abnormal condition, from whatever
cause it originated. Several organs became affected, and when
an -important disease existed, it masked the minor one. We
saw the same train of phenomena in Bright's disease, in which
inflammation of the serous membranes was liable to occur from
the non-elimination of morbid matter from the blood, and its
consequent circulation through the system. These combina-
tions of disease should be viewed in our routine of practice as
the result of the morbid action in the system. [Dublin Medi-
cal Press.

Case of Total Removal of both Radius and Ulna. By Dr.
Compton. (Reported by A. Thibaut.)

Thomas Harris, get. 15, admitted during the month of Febru-
ary, for a lacerated wound of scalp and ear; fracture of inferior
maxillary and humerus: compound comminuted fracture of
radius and ulna.

These injuries were received on board the English ship
Manchester. It appears that the boy was sleeping on the an-
chor chain ; and that the anchor was suddenly let down ; in its
progress, the chain caught the arm and produced the injuries
above mentioned. When the boy was admitted, the wounds
had been dressed for several days, and from want of proper
attendance and care, were in a very filthy condition. The
arm, especially, was in a sloughing state, and both radius and
ulna were actually shattered to pieces, and protruding several
inches out of the mass of muscles.

By the 18th of April, the boy being well of all the other inju-

1853.] Dislocation of the Eye. 173

ries, Dr. Compton determined to remove both the radius and
ulna, lie made a straight incision the whole length of the
inner side of the radius, and a counter-opening opposite the
olecranon process. Having dissected out both bon< b carefully,
and disarticulated them at the elbow, he removed them entire
with the exception of a portion of the lower end of the radius.
A great portion of the periosteum was detached from the hones,
and left in the wound. The usual treatment for such opera-
tions was then followed and the patient improved rapidly, and
the wound had nearly healed, when several abscesses formed on
the fore-arm. These abscesses were, according to Dr. C.'s
opinion, produced by pieces of bones which had been left in the
arm. His opinion was well grounded, for several spicula of
bone came out of the wound, and the arm immediately assumed
a healthy condition, and is now well. The arm is about two
or three inches shorter than the other and is perfectly firm. It
remains at a right angle to the humerus, and can be flexed and
extended so that the hand moves through eight or ten degrees
ofanarcof a circle. He has entire use of the hand he can
both open and shut it, and he grasps objects quite firmly. The
pulse in that arm can be felt as well as in the other. [Neiu Or-
leans Med. Register.

Case of Dislocation of the Eye. By William Jameson, M.D.,
F.R.C.S., Surgeon to Mercer's Hospital. (From the Pro-
ceedings of the Surgical Society of Ireland.)

Dr. Jameson said he would detain the Society but for a very
short time in detailing a case of dislocation of the eye. which
had lately come under his observation in Mercer's Hospital :
Peter Nowlan, setat. 30, a powerfully able and muscular man,
a corn porter, was admitted into Mercer's Hospital on the 3d
of November, at half-past 12 at night. His wife informed me
that he came home that evening at ten o'clock in a most intox-
icated condition, and while staggering about his room, struck
his right eye against a small iron hook or nail that was in a
dresser, which entered at the outer angle of the upper evelid of
that side, and when she went to his assistance discovered his
eye protruded from its socket. She was most anxious to re-
move him at once to hospital, but could not succeed in prevail-
ing on him to go until half-past twelve at night, when in a few
minutes after this I saw him.

He was very boisterous and unruly, had a large cheek apron
held close up to his eye. which he kepi constantly rubbing
pressing against it. On its being removed, he presented a
most peculiar, and I might add, frightful appearance. There

174 Dislocation of the Eye. [March,

was the right eye protruded out of the orbit, firmly fixed and
immoveable, staring, elastic to the touch, and devoid of all
power of vision. The cornea was dry, cloudy, and rather
opaque, pupil moderately contracted, and uninfluenced by the
light of a candle. There was no extravasation of blood, nor
was there any vascularity of the conjunctiva, although its re-
flection from the upper lid on the globe of the eye was partially
torn through. The inferior margin of the upper lid was not
visible, as it was placed behind the globe and spasmodically
closed.

With difficulty I could get him restrained, as he was such a
powerful man, but having accomplished it, I then, with two
fingers of my left hand, elevated the upper lid, at the same
time, with the finger and thumb of my right, pressed the ball
of the eye, and immediately it wras drawn back with a distinct
snap, and the lids closed over its anterior surface. I now, for
the first time, observed the small wound before alluded to at
the outer angle of the upper lid, but could not ascertain or form
any conjecture at the time what amount of injury he might
otherwise have sustained. I therefore had him conveyed to
bed, and ordered cold to be assiduously applied to the part for
the remainder of the night.

4th. The following morning, at visiting hour, we found him
sober, but recollected little of what had occurred. His eyelids
were a little swollen ; there was some slight vascularity of the
conjunctiva; the cornea was clear, shining, and moist, and the
tears ran down the cheek; he could distinguish the daylight;
complained of pain in the head, and a deep pain in the globe
of the eye, with full pulse. He was ordered to have !xvi. of
blood taken from his arm, bowels to be freely opened, and the
cold to be continued to the part.

5th. Lids less tumid; pain and vascularity of conjunctiva
almost gone; complains of the sensation as if gravel were be-
tween the lids; vision improved, but sees objects imperfectly,
as through a thick haze. Ordered the tart. ant. mist., low diet,
and the cold application to be continued.

6th. All pain gone ; conjunctival vascularity less ; sensation
as if gravel were beneath the lids gone ; vision nearly restored;
has complete power over all the motions of the eye. Contin-
ue all.

7th. Convalescent ; no suffusion ; no pain ; vision complete.

9th. Discharged cured.

The foregoing case I consider to be one of great interest,
when we reflect on the novelty and nature of the accident,
and the mode of its being inflicted. In the first instance, the
great escape the orbital plate of the frontal bone had of being

Prevention of Puerpei al Mania. 175

pierced, and consequent injur)' to the anterior lobe of the brain.
Again, the length of time the cornea was lefl uncovered by the
palpebrse, being two hours and a half, and all that time coarsely

rubbed by the apron. The great state of tension the optic
nerve must have been kept in without permanenl losa of\ ision.

The escape the muscular attachments had of being torn from

their origins, which evidently must have been the case from
the subsequent perfect control retained over all the motions
of the eye, as soon as the very slight amount of inflammation

produced by the accident was removed. The powerful con-
traction of the orbicularis muscle behind the globe, with the
complete restoration of vision. And finally, the trifling amount
of constitutional disturbance and local inflammation that fol-
lowed what appeared to be at first sight so very grave an
accident to so very delicate an organ. These, I say, are points
which add considerably to the interest of the case.

Dr. Jacob said the Society were greatly indebted to Dr.
Jameson for the very interesting case he had just brought un-
der their notice. As far as he could recollect, one of exactly
the same kind was scarcely to be found on record. He thought
it was a case which ought not to be dismissed from their con-
sideration, without some suggestion to account for the occur-
rence of such an accident. He would solve the matter in this
manner: Some persons were born with very large eyes and
shallow orbits, and often, while examining the eyes of such
persons, he found that by pressing the lids above and below,
he could with ease get a view of the back of the eye. It was
not that he merely saw one-half of the eye, but by a little ma-
nipulation of the eyelids, in persons with a shallow orbit and a
large eyeball, he could obtain a view of the posterior part of
the ball. Now, if by means of violence, the lids were tucked
in above and below, "they would grip the back of the eye and
produce a downright protrusion of the organ from the orbit.
He could not conceive any other way in which the accident
could happen, because, as they might recollect, neither the
muscles nor the optic nerve were torn in the case described
by Dr. Jameson.

Dr. Jameson The circumstance of the eye being drawn
back with a distinct snap, shows that the muscles were at least
on the stretch.

Dr. Jacob Yes, that is quite evident. [Dublin Med Pr IS.

On th r niion ofPuer / Prof. Sim

Recently, before the Edinburgh Obstetrical Society, Dr.
Simpson gave an account of the use of chloroform in patients

176 Transformation of the Encysted Entozoa. [March,

predisposed to puerperal mania. He stated the particulars of
three cases in which chloroform was used in patients, who in
former confinements had been the subjects of puerperal mania.
In none of these cases did the disease return. One of them had
borne several children previously ; and after each labor, had
ben attacked with puerperal mania, but had entirely escaped
from any recurrence whatever of the disease after the last labor,
in which he had employed chloroform. [Monthly Journal of
Medical Sciences.

On the Transformation of the Encysted Entozoa into Tape-
Worms. By J no C. D alton, Jr., M. D.

The following report of some experiments by Prof. C. Th.
von Siebold, will be found of considerable importance, not only
from their general zoological interest, but more particularly
from their bearing on the question of spontaneous generation.
Notwithstanding that the idea of spontaneous or equivocal gen-
eration is repudiated by the great majority of physiologists at
the present day, it seems to be still entertained in some quar-
ters, even by men of considerable scientific attainments. The
defences of this theory, however, have one after another given
way before the advance of zoological science. It was demon-
strated long ago by Redi and Valisnieri, that the worms, which
appear in putrefying flesh, were not produced, as previously sup-
posed, from the decomposing animal matter itself, but were the
larvae of winged insects, which had been led, by a curious in-
stinct, to deposit their eggs in such places as would afford the
necessary food to the young and imperfect progeny during the
earliest stages of its existence. The Italian observers thus ex-
plained, in the most natural manner, what seemed to be a very
puzzling circumstance, viz., that these worms, which always
showed themselves in great numbers in decomposing animal
substances, were not to be found in any other situations. The
species seemed to be confined to putrefying substances ; and as
they often appeared under circumstances which precluded the
idea of their having been transferred from other collections of
decomposing matter, it was not easy to understand how they
could have originated by the ordinary mode of generation.
Redi and Valisnieri, however, demonstrated that they were the
progeny of perfect insects ; and that the species was not in
reality confined to decomposing substances, but existed else-
where, though in a different form.

The existence of the infusorial animalcula, again, seemed for
a time explicable only on the supposition that they were pro-
duced spontaneously in the animal or vegetable infusions which

1853.] Transformation of the Encysted Entozoa. Ill

Ihey inhabited. But this supposition lias been sel entirely at
rest since the experiments of Schultze,al Berlin, in 1837, proved
that though the production of infusoria was almost invariable

when the infusion was kept -at. the proper temperature and ex-
posed to the access of atmospheric air, yet that the animal-
cules were not generated if sufficient care were taken to pre-
clude all possibility of living germs being introduced into the
infusion from without. We take it, therefore, Dot even the
most determined advocate of the theory of equivocal genera-
tion will place much reliance on the celebrated experiment of
the production of the acarus Crossii from the continued action
ofgalvano electricity on a crystalizable saline solution ; par-
ticularly as the acari so produced possessed generative organs,
and the females, soon after their appearance, provided for a
continuance of the species by an abundant production of ova.
The chances of the accidental introduction of living germs
into the machine during the course of so long-continued an ex-
periment are too great to allow any one to remain satisfied
without a personal inspection of the apparatus.

The only remaining defence of the spontaneous generation
theory, is the existence of entozoa; and it is behind this last,
and apparently most impregnable barrier, that its partizans
have finally entrenched themselves. rl ne entozoa, like the in-
fusoria, are confined to certain situations. They are never de-
tected out of the living body. Particular species of animals
are even infested by particular species of parasites, and by no
others. The Taenia solium inhabits the intestines of the hu-
man subject, the T. serrata those of the dog, the T. crassicollis
those of the cat. In the same individual, even, different organs
are occupied by different entozoa. We must look tor the Tri-
chocephalus dispar in the ccccum, for the Strongylus gigas in
the kidney, and for the Distoma hepaticum in the liver. " These
facts," it has been said,* "seem to show that some extremely
local concurrence of circumstances is essential to the produc-
tion of the several entozoa." But it is very easy I i see that
these strictly local conditions may be not at all necessary for
the production, but only for the development of the entozoa. It
is certainly no more surprising that one species of Ascaris
should inhabit the large, and another the small intestine, than
that the Lobelia inflata should grow only in dry pastures and
the Lobelia cardinal is by the margin of meadow-brooks.
The Lichens flourish on the exposed surfaces of rocks and
stone walls : while the Fungi vegetate in darkness and moisture
on the decaying trunks of dead trees. Yet no one imagines'

Stilles Pathology, Philadelphia, 1848, p. 473.

178 Transformation of the Encysted Entozoa. [March,

these vegetables to be spontaneously generated from the soil
which they inhabit. The fact is simply this : that if the ani-
mal or vegetable germ be deposited in a locality which affords
the conditions necessary for its development, it becomes de-
veloped ; otherwise not. The grains of wheat which had
remained for centuries, WTapped up in the cerements of Egypt-
ian mummies germinated freely when exposed, in an appropriate
soil, to the influences of light, air, warmth and moisture. The
circumstance, therefore, that particular parasites are confined
to particular localities presents no greater difficulty as to their
mode of reproduction, than the same fact regarding other ani-
mal and vegetable organisms.

Every articulation of the Taenia solium contains, when in a
state of maturity, many thousands of ova ; all of which are
necessarily expelled from the body when the articulation drops
off. Now though the chances are enormous against any par-
ticular one of these ova being accidentally transported into the
intestinal canal of another individual, it is easy to see that there
are many causes in operation by which some of them might be
so transported. By far the greater number undoubtedly perish,
from not meeting with the conditions necessary to their devel-
opment. One in a thousand, or, perhaps, one in a million, is
accidentally introduced into the body of another individual,
and consequently becomes developed into a perfect animal.

The greatest difficulty, however, was presented by the
encysted entozoa, which are not only confined to particular
organs, like other parasites, but which are also destitute of any
generative apparatus. Now, a species which is destitute of
generative organs evidently cannot reproduce itself; and the
encysted entozoa have therefore been regarded as presenting
at least one undoubted instance of equivocal generation, i. e., a
progeny without parents. The fact that no similar animals
were found external to the body might have been got over ;
but that those existing as parasites in the parenchyma of living
organs were themselves destitute of any generative apparatus,
seemed to exclude the idea that they had been produced by the
ordinary modes of propagation.

It is strange that those who advocated so strenuously the
doctrine of equivocal generation could not see that this cir-
circumstance might be explained in the same way with the pro-
duction of maggots in putrefying meat ; a point which had been
settled so long ago by Redi and Valisnieri. These maggots
differ in structure from their parents because they are as yet
incomplete. They may be considered, to some extent, as still
in a fetal condition. For the same reason the generative or-
gans are not yet developed. The larva is incapable of repro-

.

1853.] Transformation of the Encysted Entozoa. 179

ducing itself as a larva. But after it has passed through the
natural transformations, and its organization is completed, a
sexual apparatus appears, and the species, though not every
individual belonging to it, is found to be perfect. Now. by
watching the growth of any one individual, from the egg to the
state of a complete insect, we get a history of its transforma-
tions, and comprehend that the animal may be destitute of sex-
ual organs at one period of its existence, and provided with
them at .another. .But if the conditions necessary to the later
stages of development are wanting, the larva will not he trans-
formed into an insect, but will remain a larva; and, of course,
so long as these conditions are wanting, so long will the sexual
organs remain absent. And this is precisely the case with the
encysted entozoa. They bear very much the same relation
to the Taenia as the undeveloped larva to the perfect insect. It
is, perhaps, unnecessary to remind our readers that the Taenia
is not now considered as a single animal, but as a colony of
animals; every articulation being a distinct individual. These
articulations are multiplied by a process of budding, which
takes place just behind the "head," or most anterior individual
of the colony. As new ones appear, those which were previ-
ously produced are pushed farther and farther from the "head ;"
so that the oldest articulations are those situated at the posteri-
or extremity of the chain. The young and imperfect individu-
als compose the "neck" of the Taenia. They are, as vet,
without sexual organs ; but as they increase in size, and are
gradually removed farther from the head, they become provided
with a sexual apparatus, each articulation containing both male
and female organs; so that the posterior portion of the chain
is composed of completely developed hermaphrodite individu-
als. As these individuals arrive successively at maturity, they
become detached from the chain, and pass out of the intestine
with the faeces, after which the ova are probably set free by
the death and decomposition of the parts which enclose them.
A portion, then, of every '-tape-worm" is destitute of repro-
ductive organs, and yet it has itself undoubtedly been produced
from ova, and will hereafter, if circumstances are favorable,
produce ova in its turn.

Now the following experiments, by Prof. Von Siebold. dem-
onstrate the very important point that those parasites which
have been regarded as incapable of reproduction ccies,

are really incapable of it only as individuals, because they have
been prevented from arriving at their mature condition: and
that the sexless encysted entozoa arc in reality only undevel-
oped or diseased Taenia. We have ascertained by personal
inquiry, what might have been anticipated from the previous

180 Transformation of the Encysted Entozoa. [March,

reputation of the observer, that both the experiments, and the
results derived from them, are regarded by scientific men in
Germany, as entitled to complete confidence. The following
account of the experiments is translated from a report, in the
" Silesian Times,'' of the Transactions of the " Silesian Associ-
ation for National Instruction, Scientific Department, Session
of July 7th, 1852:"

REPORT.

Professor Von Siebold made a report on the experiments
which were undertaken some months previously, in the Physi-
ological Institute, under his direction, for the purpose of show-
ing the possibility of a transformation of the cystic parasites
into tape-worms. He had already, in the year 1844, in the
second volume of the Encyclopoedia of Physiology, expressed
the opinion that the parasitic cysticercus (C. fasciolaris,) found
in the liver of rats and mice, was nothing else than an abnor-
mal, dropsical tape-worm ; and that it was, in reality, identical
with the tape-worm of the cat (Taenia crassicollis.) He main-
tained further that the Cysticercus fasciolaris, like all cystic
worms, was invariably destitute of sexual organs, and could
not multiply its species by generation, unless it were transferred
to a favorable locality, where it might lose its dropsical condi-
tion and develope its sexual organs. These changes actually
take place when a rat or a mouse, with a Cysticercus fasciolaris
in its liver, is devoured by a cat. The parenchyma of the
liver, according to Siebold, is digested in the stomach of the
cat : but not so the entozoon. The parasitic animal loses only
its dropsical appendage, and passes, with the digested food,
from the stomach of the cat into the small intestine. It then
finds itself in a favorable locality, and becomes developed into
a perfect tape-worm, with articulations and sexual organs
(Taenia crassicollis.) This idea had been first suggested to
Prof Siebold by the perfect resemblance between the cephalic
extremity of the Cysticercus fasciolaris and that of the Taenia
crassicollis; and by the fact that there are often found, in the
intestine of the cat, several specimens of the T. crassicollis, in
different stages of development. His opinion was adopted by
many naturalists, but its correctness had also been called in
question by others. Some years ago Dr. Kuchenmeister, of
Zittau, had made use of the Cysticercus pisiformis, a species
of encysted parasite very common in the peritoneum of hares
and rabbits, for a series of experiments in which he caused these
parasites to be swallowed by dogs and cats ; in the expectation
that they would become developed into tape-worms in the in-
testine of these animals. The trial succeeded perfectly with

1853.] Transformation of the Encysted Entozoa. 181

dogs ; and the same thing that Prof. Siebold had previously
inferred from a comparison of the Cysticercus fasciolaris of
rats and mice with the Taenia crassicollis of the cat, would
seem to have been definitely established by these experiments
of Kuchenmeister. But Kuchenmeister's experiments, and the
conclusions he drew from them, did not prove satisfactory either
to naturalists or medical men. He had committed the error of
publishing his investigations before they could properly be con-
sidered as terminated. He was consequently obliged, in the
various communications which he published on the subject, one
after another, in the medical journals of northern and southern
Germany, to correct many of his former statements, and even
to retract some of them; and he entangled himself, finally, in
so many contradictions that it is to be feared the doctrine of a
close relation between cysticerci and tape-worms was rather
retarded than advanced by his activity ; particularly as he him-
self several times acknowledged that he was not sufficiently
familiar with the study of intestinal worms to distinguish them
with certainty. Such a confession certainly was not calcula-
ted to increase the confidence of naturalists in his experiments.
He also exhibited his incapacity to distinguish the entozoa by
giving, in succession, several different names to the newly pro-
duced tape-worm, which he described at first as the " Taenia
crassiceps" of the fox, afterwards as the " Taenia serrata" of
the dog. and finally as an entirely new species, under the name
of the "Taenia pisiformis." Prof. Siebold then determined to
undertake himself similar experiments. They were tried prin-
cipally on young dogs, not only with the Cysticercus pisiformis,
but also with the C. cellulosa, C. tenuicollis, Casnurus cerebra-
lis, and Echinococcus veterinorum.

The following results were obtained from the experiments
with the Cysticercus pisiformis. These entozoa, which are
usually about the size of a pea, were given to young dogs, mix-
ed with milk, still enclosed in their peritoneal cysts, and in
quantities varying from thirty to sixty. The dogs were after-
wards killed with chloroform, at various intervals of time, and
the contents of the stomach and intestine being carefully exam-
ined, the entozoa were rapidly discovered in various stages of
development. Two hours after being swallowed, they were
almost all found still in the cavity of the stomach. The
however, which had enclosed them, were gradually digested
and destroyed, and at the same time, the greater number were
not only freed from their envelope, but had also lost the vesi-
cular portion of their posterior extremity. This vesicle was
either entirely digested or else hung in shreds attached to the
end of the body. All the entozoa, which were found in the

N. 9. vol. ix. xo. in. 13

182 Transformation of the Encysted Entozoa. [March,

stomach, whether they had lost the vesicular appendage or not,
invariably had the head and neck drawn back into the body.

When the dogs were killed after an interval of three hours,
no entozoa were found remaining in the stomach. They had
all passed, together with the digested food, into the small intes-
tine. Their cysts and vesicular appendages had all been
destroyed by the digestive processes in the stomach ; but the
head and neck were again, without exception, protruded, and
the body, which had been before contracted, was stretched out
longitudinally. In all of them were to be seen marks of injury
at the posterior extremity of the body, where the vesicular ap-
pendage had been attached. When the dogs were suffered to
live several days after the commencement of the experiment, .
the entozoa were found to have considerably increased in size.
The largest had attained the length of three inches, the small-
est that of one inch. The body, which had previously shown
only transverse wrinkles, now exhibited very plainly articula-
tions in its central portion. The posterior portion was still
wrinkled transversely, and the lacerated spot at its extremity
had assumed the appearance of a cicatrix.

After twenty or twenty-five days, the entozoa were already
several inches long, and perfectly articulated quite to their pos-
terior extremity, where the cicatrix was still evident ; and on
the posterior articulations were to be discovered traces of a
sexual apparatus.

After eight weeks the cysticerci in the intestine of one of
the dogs had attained a length of many inches. The largest
were thirty-six to thirty-nine inches in length, and their poste-
rior articulations were provided with a perfectly developed
sexual apparatus, and contained many mature ova. Several
of those a yard long had already thrown off their posterior
articulations, with their mature sexual products. Von Siebold
was now able to recognize, in this tape-worm, developed out of
the Cysticercus pisiformis, the Taenia serrata of the dog. The
cephalic extremity, the form of the articulations, the structure of
the generative organs, and particularly the mature ova of this
tape-worm, corresponded, in the most perfect manner, with the
same parts in the Taenia serrata. There was no longer any doubt
that the Cysticercus pisiformis of the hare and rabbit bore the
same relation to the Taenia serrata of the dog, as the Cysticercus
fasciolaris of rats and mice to the Taenia crassicollis of the cat.
Furthermore, the T. serrata is rarely met with in the intestines
of parlor and house dogs, but is, on the contrary, very abundant
in hunting dogs ; no doubt because the latter are often allowed
to devour the entrails of hares killed in the chase, swallow at
the same time the Cysticercus, and so become infested with the

1853.] Transformation of the Encysted Entozoa. 183

Taenia ; a circumstance which would naturally be less frequent
with parlor and house i\"^<.

Although Siebold's experiments with the other species of
encysted entozoa, mentioned above, were not entirely finished,
he had yet carried them so far with the " Ceenurus cerehralis "
as to convince himself that this worm, also, which is so much
dreaded by sheep-breeders, becomes developed, in the aliment-
ary canal of the dog, into a tape- worm. The tape-worm pro-
duced from this parasite had not yet, in Siebold's experiments,
become developed to the stage of sexual maturity ; so that he
was si ill unable to determine with certainty its species. He
hoped, however, by means of continued trial, to produce from
the Coenurus cerehralis perfectly mature Taenia ; so that he
might be able, after distinguishing their species, to determine
what animal it is in whose intestine the sexless Ccenurus cere-
hralis becomes developed into a tape-wotm with mature sexual
apparatus. He will then, probably, have it in his power to give
agriculturalists some hints how to prevent the development of
this parasite in the brain of the sheep. For he is convinced
that the encysted entozoa do not originate by spontaneous
eration, but are produced from the microscopic ova of the tape-
worms of certain carnivorous animals, which are introduced
by accident into the bodies of rodentia and ruminantia. Here
they are not developed into tape-worms ; but degenerate into
encysted worms, which exert a more or less injurious influence
on the life of the animal, according to the importance of the
organ in which they have taken up their residence at the ex-
pense of which they live.

The experiments which have been commenced with the
Echinococus veterinorum have already shown that this parasite
is also to be considered as a tape-worm. The progeny of this
destructive entozoon are produced, as is well known, in great
numbers, by a process of budding from its inner surface.
These were given in spoonfuls to young dogs, and in a few
days afterward thousands of exceedingly small tape-worms
were discovered, fastened by their four suckers to the mucous
membrane of the small intestine. The bodies of these tape-
worms consisted of only three divisions, viz., a head and neck
for the first division, then a small articulation, and finally a
longer one at the extremity. In both of these articula!inns"the
sexual organs had already begun to show themselves. They
were not yet, however, so far developed that the worms could
be considered as in a state of maturity, or their species accu-
rately determined. It is Prof. Siebold's intention to continue
these tents : and he hopes, at some future time, to com-

municate their results to the Association. [Buffalo Med. Jour.

184 Quina in Typhus Fever. [March,

On the Treatment of Typhus Fever by Sulphate of Quina. By
Dr. F. M'Evers, Physician to the Cork Fever Hospital, &c.

[In one of our preceding volumes (Part XXV., p. 17), the
reader will find an interesting paper on the treatment of typhus
by quinine, from the pen of Dr. Dundas, of Liverpool. There
is great merit due to this gentleman in introducing this medi-
cine as a remedy for typhus by seeking to identify the poison
of this fever with the remittents and intermittents of the trop-
ics. Dr. Skete, so far back as 1786, broached a similar opinion.
This author says,]

" If the remittents of warm climates are but the continued
fevers of this country, in a more violent degree, and if the
effects of the bark are admitted in such remittents, does it not
necessarily follow that bark would be endowed with similar
powers, even in the fevers which every day occur to our no-
tice, I mean those of the typhus kind, which are frequent in all
large towns, especially London and Edinburgh."

[As we have before stated in the preceding volumes, Dr.
Dundas' plan is to administer the quina in ten grain doses, until
dizziness of the head, or tinnitus aurium, is produced ; or until
a general amelioration of the symptoms takes place. When
tinnitus aurium or dizziness of the head are very urgent Dr. D.
resorts to an emetic ; and he says, if emetics are had recourse
to at an earlv period, the quina is likely to be more success-
ful.]

This treatment is resorted to in all stages of the disease, and
frequently in the advanced periods, under circumstances which
would be considered by the experienced physician as indicative
of the worst form of typhus fever; and this mode of adminis-
tering quina is almost invariably attended with the happiest
results.

Immediately after having become acquainted with Dr. Dun-
das' views on this subject, several persons labouring under bad
maculated typhus were admitted into our hospital, which gave
me opportunities of testing the value of his opinions ; and I
must confess that I pursued the inquiry with much doubt, as I
looked on some of the cures related by him to be of too mar-
vellous a kind to justify my adoption of this treatment without
further confirmation of its value : however, I have now tested
the remedy in nine cases, and, with the exception of one, it has
been signally successful. The first of these cases was the fol-
lowing, the notes of which I take from the daily reports of the
hospital.

Pat Ryan, aged 28, a labourer, was admitted into the hospi-
tal on the 1st January, 1852, from Hop Island. His urgent

1853.] Quina in Typhus Fever. 185

symptom is heacache ; pulse 100; tongue foul ; skin hot; had
taken purgatives at home, and was treated since admission in
the usual way with salines, ablutions, &c, until the thirteenth
day of his illness, when the usual symptoms of bad typhus be-
came apparent. On the previous day his skin was mottled, and
now the entire surface has assumed a dusky hue. Pulse 112,
feeble ; tongue parched, with sordes on the teeth and lips ;
no sleep ; bowels free ; some general fulness of the abdomen,
with epigastric tenderness ; kidneys acting ; headache increas-
ed, and raves a good deal. He was ordered to take ten grains
of sulphate of quina every second hour, and to have broth and
four ounces of port wine.

The changed condition of this patient at my next visit was
most remarkable ; the pulse was considerably reduced ; the
tongue was moist and cleaning, in fact it had lost the dark colour
and parched appearance it presented the day before. The man
slept ; there was less abdominal fulness and tenderness ; the
kidneys acted well, and the bowels were free. He took sixty
grains of quina, without its having produced dizziness or tinni-
tus aurium. The medicine was given in the form of mixture
with a little sulphuric acid, the two or three last doses sick-
ening him a little. I then ordered it in the same dose in the
form of pills, repeating it every three hours, which he bore
without sickness. On this day he took forty grains, and on the
following day he was convalescent. It is remarkable that the
father of this patient, who was admitted a few days before,
passed through the same type of fever, treated in the ordinary
way, and died on the fifteenth or sixteenth day of his illness.

The second case was that of a young man, aged 19, admitted
on the 14th Jan., for some days under my care, whose urgent
symptom was headache, with great prostration of strength.
On the eighth day his breathing became very much hurried,
unattended, howTever, with cough, nor did the stethoscope elicit
any abnormal sound : the man being remarkably pallid, except
during two short exacerbations which occurred in the twenty-
four hours. I ordered him aromatic spirit of ammonia mixture,
with a small quantity of wine, and a sinapism to his chest. The
following [Doming, on examining the chest, I discovered a pur-
ple patch occupying the part to which the mustard had been
applied. His respiration was improved, but he complained of
intense headache. Pulse 10S. and feeble ; no sleep. The pur-
ple patch induced me to make a careful examination of his
body, and on turning him in the bed I observed the lower por-
tion ii the hick ami the nates covered with purple maculae.
The case I looked on then as well adapted for the administra-
tion of quina, and, accordingly, 1 ordered ten grains every two

186 Quina in Typhus Fever. [March,

hours, together with broth, and two ounces of port wine. The
third dose produced violent headache, with tinnitus aurium,
when the medicine was discontinued. At my next visit, on
the following morning, all his symptoms were improved ; the
tinnitus aurium left him in a short time after the medicine was
laid aside, and the headache was greatly mitigated ; he slept,
and expressed himself much better. I placed him again on the
quina, when the third dose produced the same results as yes-
terday, but there was so great an amelioration of all his symp-
toms that I considered him proceeding to convalescence, and
gave him only two grains of quina three times a day, after
which he rapidly recovered.

The next two cases were females, both of whom presented
unfavourable symptoms, and in whom the remedy was equally
successful.

The fifth case was one of great interest, exhibiting other
symptoms of an unfavourable nature, in addition to those enu-
merated in the preceding.

John Eames, aged 55, a smith, was admitted on the 23d of
January, with bad typhus, having been discharged from hospi-
tal on the 3rd inst., cured of ordinary fever with bronchial
complication. On the ninth day of his second attack he be-
came mottled and talked incoherently ; on the tenth day he
was not improved ; he had no sleep; the tongue was parched
and dark, and protruded with difficulty; stools involuntary ;
pulse 120, and feeble. He was ordered to take ten grains of
sulphate of quina every second hour, and to have broth and
two ounces of port wine.

Half-past 9, p.m. The quina wras commenced at 1 o'clock ;
he has taken fifty grains, and appears improved in every re-
spect ; he is more collected, and speaks with less difficulty; he
has had two large voluntary evacuations from the bowels ; the
medicine was directed to be continued.

On the 11th day, I found that he had taken sixty grains since
my last visit, and although he did not sleep much, and had some
singultus in the night, he was much improved in other respects.
The pulse had come down to 100 ; the tongue was still parch-
ed and brown, but he was perfectly conscious ; he was very
deaf and the maculae were improved in colour. On this day
he took only four doses of quina, it having been omitted on
account of the " buzzing," as he expressed it, which the remedy
produced.

12th day. Pulse 96 ; tongue moist and cleaning ; bowels
open, and he passes water freely ; to take five grains of sulphate
of quina every fourth hour.

13th day. Pulse 84 ; tongue clean ; skin cleaning and scaly;
convalescent.

1853.] Quina in Typhus Fever. 187

I will not occupy time with the details of all the cases in
which I have tried this remedy, but will content myself with
the recital of one more case, which occurred within the last
few days, and which I consider in every way worthy of obser-
vation.

Mary Delany, aged 22, admitted from Ballincollig on the 10th
March ; nine days ill : headache ; petechia? ; pulse 120, and very
feeble; tongue parched; got the usual aperient of the hospital.

10th day. One stool ; pulse 130, feeble ; tongue parched and
split ; great thirst ; respiration hurried ; had no sleep ; she is
often flushed, and in the intervals deadly pale ; countenance
anxious, with the appearance of suffering; great fulness of ab-
domen, with tenderness on pressure, especially at the epigastri-
um : macula? of a dark brown. She was ordered ten grains
of sulphate of quina every second hour, and to have broth and
two ounces of red wine.

11th day. Bowels not open ; tongue moist and cleaning;
pulse 100 ; kidneys acting.

12th day. At eight p. m. last evening this girl became very
stupid ; ' did not know what to do with her head," as she ex-
pressed herself: she also became deaf, and had tinnitus aurium ;
this state continued until midnight, with occasional sleep, when
she became "lighter," and afterwards slept well ; the kidneys
have acted, but there is no discharge from the bowels ; she now
presents a totally different appearance from that of yesterday ;
she is free from headache ; her respiration is natural, the ten-
sion and fulness of belly have disappeared; but there is still
some slight epigastric tenderness ; some of the maculae have
disappeared, and the remainder are of a lighter colour. The
sulphate of quina to be continued every fourth hour.

13th day. No stool; tongue clean and moist; pulse 84;
belly natural, slight epigastric tenderness. The quina to be
omitted ; broth and wine to be continued : to have a domestic
enema.

14th day. Convalescent.

Since the first introduction into Europe of the Jesuits' bark
in 1649, the most celebrated writers extolled its efficacy in the
treatment of various diseases, but especially in fevers; owing,
however, to some cause or other, it fell into disuse ; and it is
probable that this was occasioned by the many failures which
attended its administration ; failures which I now feel assured
owing principally to two causes : first, the bark not
having been given in sufficiently large doses; and secondlv,
the bark not having been always of the Lr<'nuine kind. Its use
was revived by the celebrated Sydenham, and after the time
of that eminent man, its excellent qualities were fully establish-

188 Nocturnal Incontinence of Urine. [March,

ed by Hoffman, De Haen, Pringle, Cleghorn, and other practi-
tioners of eminence. And it is worthy of remark that those
who were most enthusiastic in praise of this remedy gave it in
very large doses. Dr. Clark, a celebrated physician who wrote
on fever in the year 1770, was in the habit of prescribing bark
in two drachm doses every two hours, and at the same time of
exhibiting it by the rectum in the form of enema; he relates
that on one occasion in mixing a dose of bark for a patient, he
discovered that the apothecary had by mistake put half an
ounce of bark into each paper instead of two drachms, which
he had ordered ; the patient had been taking this large dose
for a considerable time, and got cured of a bad typhus in con-
sequence. Now, when it is estimated that two pounds of good
bark will yield about two hundred grains of sulphate of quina,
it must be admitted that Dr. Clark's treatment of typhus was
not far short of the heroic method of the present day introduced
by Dr. Dundas. It is unnecessary to advert to the fact that
Dr. Clark's patients were taking a different preparation, possess-
ing, howTever, the same active base.

One great objection to its general use in this country, which
may be advanced, is the high price of the salt ; but should the
remedy be found as efficacious in the practice of others as by
Dr. Dundas and myself, I feel assured that its use, when appli-
cable, would eventually constitute the true economy, of our
fever hospitals. [Dublin Quar. Journ. Braithwaite.

Nocturnal Incontinence of Urine. By M. Trousseau.

We doubt the necessity or propriety of resorting to the apparatuses
suggested by Mr. T. We have often relieved cases of this kind with
Tr. of Iron, and other tonic medication. [Ed. S. M. & S. J.

M. Trousseau observes that the nocturnal enuresis of chil-
dren and young persons takes place after they have been asleep
one or two hours, and that they retain the urine during the
rest of the night. As a possible explanation of this, he refers
to the fact that there is erethism of the genital organs during
the commencement of sleep; and asks then, whether there may
not be a tenesmus of the bladder ? ' But, he further asks, why
should not the sphincter then tend to retain the urine ?

M. Trousseau speaks highly of the treatment by belladonna,
as recommended by MM. Brettonneau and Morand. In al-
most every case in which he has used it, he has found it suc-
cessful.

The organs must be caused to lose their bad habits; and
this may be done by awakening the children after they have

1853.] Nocturnal Incontinence nf Urine. 189

slept an hour, in order that they may urinate. On the next
night they are awaked a few minutes later, and the time of
awakening is made later every night, until at last it is desisted
from. This has sometimes effected a cure.

At the same time, pills containing a centigramme of extract
of belladonna are given ; a week after the quantity is raised to
two, and then to three, rarely to five centigrammes. The child
is now roused only on alternate nights, and if it has not wet its
bed on those nights when it has been left asleep, it is not
awakened ; if it continues free from enuresis for a fortnight,
the dose of belladonna is diminished. If the case goes on fa-
vourably, the treatment is alternately resumed and intermitted
for some weeks, until it is finally left off. This is necessary,
as the disorder may return after some months, in the manner
of marsh fever.

In cases of incontinence of urine, eczema of the vulva or
prepuce may be produced by irritation of the urine : it may
then extend to the meatus urinarius, and cause tenesmus of the
bladder.

If belladonna fails, the syrup of sulphate of strychnine is
sometimes found useful. If these fail, flagellation and stinging
with nettles may be useful, as instruments of intimidation, or
perhaps they may have some reflex power.

M. Trousseau finally describes an oval compressor, which
he has devised for the treatment of nocturnal enuresis.

An elastic band is fixed round the body, and supports at the
back a spring which reaches to the anus. To this is fitted a
metallic plate, on which is fixed a truncated cone of caoutchouc,
two or three centimetres (about two-thirds to an inch) in diam-
eter at the base, according to the age of the patient, and the
amount of compression required. The pressure may be in-
creased or diminished by introducing the cone more or less
deeply ; and the size is varied by adding perforated shields of
caoutchouc, in greater or less number, so as to diminish the
length of the cone. Straps are passed under the thighs; and
thus we have a light bandage, in no way inconvenient, which
in boys acts in some way as a sphincter, by compressing the
neck of the bladder and preventing the urine from escaping,
and imparts to the bladder the habit of remaining full during
the night as well as during the day.

But as this method could only be applied in girls. \
nam, and then with great difficulty, M. Trousseau employs a
modification of the instrument contrived by M. Gariel for ar-
sting uterine hemorrhage. It consists of a caoutchouc bag,
which is introduced beyond the hymen : by means of a tube
it is inflated with air, and a stopcock attached to it is closed.

190 Remedy for Indigestion. [March,

The back presses on the lower part and neck" of the bladder ;
and in the morning the instrument, having been emptied of air,
is taken out and cleaned. [London Jour, of Medicine.

Remedy for Indigestion. By John Spukgin, Esq.

Mr. Spurgin having from numerous trials upon his own case,
which was one of most obstinate indigestion, and those of nu-
merous patients and friends, found the following recipe of emi-
nent service in their relief, he was determined, if possible, to
give it a public recommendation, hoping that it might prove an
instrument in our hands for the expulsion of quackery from
some of the domains of our art. He says :

This latter consideration weighed strongly to induce me to
give the article a proper trial ; and I allowed the late Mr.
South, of Hunter street, who was a general practitioner, to
prepare and sell it, after having satisfied myself in my person,
and with several of my dyspeptic patients, of its efficacy and
undeniable utility. The widow of this gentleman has contin-
ued to prepare and vend it, under the title of the " liquid condi-
ment," for her own benefit, according to this formula:

^. Liq. potassas ; sodii chloridi, aa 3 i. ; sodas phospha-
tis, 3 iss ; aq. purae, I iii.

As much of the solution may be taken at a time as will not
affect the taste of the beverage disagreeably.

In a great many instances the article has proved most useful;
many families have it on their tables for daily consumption;
and even make their tea by first putting two or three teaspoon-
fuls into the tea-pot with the tea.

It is not intended to be resorted to as an occasional remedy
for various forms of indigestion, but constantly, in like manner
as common salt. [Med. Times and Gazette. Braithwaite.

Treatment of Jaundice.

Dr. Budd recommends the following treatment in cases of
jaundice arising from suppressed secretion :

From 3 ss. to 3 j. of sulphate of magnesia, in conjunction
with gr. xv. of carb. of magnesia, and 3 ss. of aromatic spts.
of ammonia three times a day, the sulphate of magnesia to
keep up free action of the bowels ; the carbonate of magnesia
to neutralize any excess of acid in the stomach or bowels ;
and the aromatic spirits of ammonia to support the nervous
system, and to keep up the action of the skin. [Med. Chir.
Rev. Ibid.

1853.] Sal Ammoniac in Enlarged Prostate. 191

On the Administration of Sal Ammoniac in Enlarged Prostate.
By M. Vanoye.

M. Fischer, of Dresden, has long been in the habit of admin-
istering this medicine, in large doses, in chronic enlargement
of the prostate : and since lie published an account of his suc-
cess with it in 1831, various other German practitioners have
supplied corroborative testimony. Seeing that surgical treat-
ment is so inefficient, this means would seem to supply a valu-
able resource, and this especially as it may be employed in
conjunction with other remedies. In the present paper, M.
Vanoye relates two cases in addition, in which the success
obtained seems quite to justify former encomiums. In both,
the gland became progressively and greatly diminished in size.
Large doses are, however, required. We may commence
with fifteen grains every two hours, and go on to double or
treble this quantity, so that nearly half an ounce is taken per
diem. When the dose given is too great, we are admonished
by disorder of the digestive organs, a miliary eruption, profuse
sweats, and especially by scorbutic symptoms. These ill effects
may be prevented or diminished by the employment of mucil-
aginous vehicles, bitter extracts or aromatics, and a good animal
diet. Persons suffering from hemorrhagic disposition, or affec-
tions due to poverty of blood, should not be subjected to this
treatment. [Bulletin de Therap. Med. Chir. Rev. Ibid.

Jtttsttllang.

Quinine and Veratrum Yiride in Typhoid Fever. The gradual
extension during the last few years of Typhoid fever from its former
northern and mountainous habitations, to the warmer and lower re-
gions of the Southern States, and even into Louisiana and Florida, is
a remarkable fact in the history of this disease, for which it may be
difficult to assign any satisfactory reason. Be this as it may, it is an
interesting fact to the practitioners of these sections of country, many
of the oldest of whom were never before called upon to treat this
formidable atfection. The discovery of the jugulating effects of qui-
nine in the management of our fevers, whether designated as inter-
mittent, remittent, congestive, country or malarial, had robbed this
most extensive class of Southern diseases of all its terrors. The
physician rode triumphantly with quinine in his saddle-bags over the
most pestilential districts, administering relief and cutting short with
great certainty the most threatening attacks of the malady. The
planter had learnt to do the same, so that by applying the antidote

192 Miscellany. [March,

upon the first indication of the effects of the morbific agent, this was
at once neutralized, if we may use the expression, and our old-fash-
ioned bilious fever (so called) had disappeared and become obsolete.
Protected against the fatal effects of malarial fevers unharmed by
the scourges of colder climes, consumption and typhoid fever the
sunny South might well have boasted of its delightful and salubrious
atmosphere. Such was the state of things when a new form of fever,
gradually coming down from the mountains of North Carolina, South
Carolina and Georgia, and reaching the terminus of the primitive
geological formations, spread itself over the diluvial plains, inva-
ding with more or less malignancy, cities, villages, plantations, pine
barrens, prairies, valleys, and finally reached the sea-board of the
Atlantic and Gulf of Mexico.

Accustomed to the controlling influence of quinine in the manage-
ment of the former types of fever, the physician and the non-professional
citizen naturally resorted to this potent agent with great confidence,
and did not abandon its use until they became convinced that the new
form of fever would not be jugulated, but would run its course, despite
of quinine and of every thing else. Yet, now that the expect-
ant method of treating typhoid affections is generally adopted in this
region of country, almost every medical journal bears to us intelli-
gence from various points of the Union, as well as from Europe, that
a great discovery has been made in the treatment of Typhoid fever,
and that to quinine must be assigned the additional glory of arresting
this as well as malarial fevers.

We feel that our readers must be gorged to satiety with disquisi-
tions upon Typhoid fever ; for very few of our numbers have been
issued during the last two or three years without something on the
subject, in the original or in the eclectic departments. But, when
any one tells us that he can arrest the progress of Typhoid fever,
whether by quinine, by veratrum viride, or by any other agent, we
feel bound to listen to the facts and to place them before an enlight-
ened profession, who may test them, and whose experience we would
be pleased to learn, whether for or against the new remedies, when-
ever sufficiently extensive and systematic to be of real value. Drs.
Dundas, McEvers, Hayward, and others of Great Britain, have pub-
lished their advocacy of the quinine treatment of Typhoid fevers in
strong terms. In our country a number of practitioners have done
the same, among whom we may name Prof. Th'os. D. Mitchell and
Dr. Fenner. Dr. Norwood and others are equally decided in favor
of veratrum viride. Itjs a question to be decided at the bed-side, and

1853.] Miscellany. 193

without reference to preconceived notions or theories. It matters not
whether Typhoid and malarial fevers be regarded as identical or dis-
similar in origin, cause or nature ; what ire need is a remedy B con-
trolling agent. Let us then weigh the question calmly and without
prejudice try fairly the plana proposed and the truth will soon be
determined. As conductor of this Journal, wo will side with neither
party, but endeavor to keep our readers posted up as to facts.

Reiaardfor the Discovery of Antithetic Agents. From the docu*
ments we are continually receiving, it is evident that the contest for
Congressional remuneration for the discovery of the anaesthetic i I
of Sulphuric Ether is actively carried on by the respective friends of
Drs. Jackson, Morton, and Wells. We have taken some pains to
look into the relative merits of the claimants, and would unhesitating.
ly, were it in our power to do so, confer the reward upon Dr. Charles
T. Jackson, as the first who really discovered and proved by direct
experiment that insensibility could be induced by the inhalation of
Sulphuric Ether. That Dr. Morton was very active in promulgating
the knowledge he derived from Dr. Jackson, seems to be well estab-
lished but we feel equally well assured that if Dr. Jackson had nev-
er made the discovery, Dr. Morton would never have been heard of
in connection with it.

Transactions of the Am. Med. Association.
The Fifth Volume of the Transactions of the American Medical
Association contains upwards of nine hundred pages of matter, about
four hundred of which are allotted to Reports upon the epidemics of
various sections of the Union. These are valuable contributions to
the history of disease, but they will not interest the great mass of
readers. These reports are preceded, however, by papers of intrin-
sic merit and practical value, which all will read with pleasure and
advantage. The first is the " Prize Essay," by Prof. Austin Flint, of
BufFalo, on the " Variations of Pitch in Percussion and Respiratory-
sounds, and their application to Physical Diagnosis." This, like the
other writings of the distinguished author, evinces a discerning and
logical mind of high order. The second is from the gifted pen of
Prof. S. H. Dickson, of Charleston, " On the Blending and Conver-
sion of Types in Fever'' an exceedingly interesting document The
third is uOn the Action of Water on Lead Pipes, and the diseases
proceeding from it," by II. Adams. M. D., of Waltham, Mass., and
ought to be carefully read by all who reside in communities which

1S4 Miscellany. [March,

use water from lead pipes. The fourth paper is by Dr. George Hay-
ward, of Boston, and treats of the "Permanent Cure of Reducible
Hernia," but unfortunately teaches us nothing new upon this import-
ant subject. Prof. Pope, of St. Louis, is the author of the Report
upon " Water ; its Tropical uses in Surgery," which will be found
full of practical utility.

We regret that our limits will not permit us at present to notice
these Transactions more at length. The price of this volume is $5.
Complete sets of the Transactions can be obtained by remitting $25
to Messrs. Blanchard & Lea, Philadelphia.

Privileges of the Graduates of the Medical College of Georgia.
The Faculty of the Medical College of Georgia, having been informed
that a doubt was entertained by some persons as to the exemption of
the Alumni of this institution from the necessity of obtaining a State
License to practice medicine, deemed it important to procure and
to publish the opinion of an eminent jurist on the subject. The
following communication from the Hon. A. J. Miller will, it is hoped,
settle the question.' We add the section of the Statute now in force,
setting forth the penalties incurred by those who may practice medi-
cine without either the Diploma of the Medical College of Georgia or
a State "License."

"Sec. 11. If any person shall hereafter presume without such li-
cense to practice physic, surgery, or in any manner prescribe for the
cure of diseases for fee or reward, he or they shall be liable to be
indicted, and on conviction shall be fined not exceeding the sum of
$500 for the first offence, and for the second, be imprisoned not ex-
ceeding the term of two months, one half of the fine to enure to him
who shall inform, and the other half to the use of the State." Cobb's
Digest, p. 886.

Augusta, February 15th, 1853.

I have been requested to give my opinion upon the question, whether
the Graduates of the Medical College of Georgia are required to un-
dergo an examination before and to receive license to practise from the
Board of Physicians.

This inquiry, I think, is plainly and satisfactorily answered by the
ninth section of the Act of 1828 (Dawson's Compilation, 196) incor-
porating the Medical Academy (now the Medical College) of Georgia.
That section declares that

"The Graduates of the Medical Academy shall be allowed to prac-
tise Medicine and Surgery in this State, in the same manner as they
would have been, had they been examined and licensed by the Board

1853.] Miscellany. 195

of Physicians of the State of Georgia; any law, custom or usage to
the contrary notwithstanding."

Considering the act of incorporation a contract between the State
and Institution, and the section in question as giving a privilege con-
ducive to the prosperity of the latter, I do not believe it to be in the
power of the Legislature, by any subsequent act, to impair any part
of the franchise conferred. The Legislature has not so intended ;
for while, by the acts of 1829 and 1833, the name of the corporation
has been twice changed, and by the last an outfit provided, the powers
and privileges conferred by the original charter upon the College and
its graduates have not been interfered with.

It is true, that the Act of 1825, (Cobb's New Digest, 886,) prohibit-
ing physicians from practising without a license from the Board of
Physicians, has been revived by the Acts of 1839 and 1847 yet, as
the Charter of the College relieved it from the provisions of that Act,
afterwards repealed, the revival of it cannot aflect the exemption
previously granted.

ANDREW J. MILLER,

Attorney- at Lair.

State Medical Society. The Medical Society of the State of Geor-
gia will hold its Fourth Annual Meeting in Savannah, on Wednesday,
the 13th April next. Juriah Harriss, M. D., of Augusta, will deliver
the annual address. It is hoped that a large meeting will assemble,
as the transactions are expected to be of a very interesting character.

D. C. O'Keeffe, Rec. Sec.

Greensboro', Ga., Feb. 1853.

Committees appointed by the President of the Medical Society of the
State of Georgia.

"Resolved, That a committee of three be appointed by the Presi-
dent, for the purpose of proposing subjects for Essays to be pre-
at the next annual meeting.

M Retohedi also, That the President appoint eommittees of one for
each of the Essays ab >ve referred to, whenever he shall have
furnished with the subjects selected."

In accordance with the above Resolutions the following subjects
were presented to til'1 President, who appointed as Reporters tin
tlemen whose names arc annexed to the questions. If the committee-
respond to the call thus made upon them, as we trust all will, the
next meeting of the Society will be exceedingly interesting.

196 Miscellany.

1. On the relative liability of the White and African races to particu-
lar diseases especially to Hemorrhoids, Fistula in ano, Tetanus,
Phthisis pulmonalis, Scrofula, Intermittent fever, Cataract, and
death in case of traumatic injury of the brain. By Dr. R. D.
Arnold, of Savannah.

2. On the existing Laws of Georgia, relating to the Practice of Medi-
cine, and the sale of Drugs, with suggestions for additional legisla-
tion. By Dr. R. Q. Dickinson, of Albany, Baker Co.

3. On the Topography and prevalent diseases, during the past year,
of each Congressional District of Georgia. Dr. P. M . Kollock, of
Savannah, for the 1st District ; Dr. Theophilus Stewart, of Colum-
bus, for the 2d District ; Dr. G. F. Cooper, of Perry, Houston Co.,
for the 3d District ; Dr. W. N. King, ofRoswell, Cobb Co., for the
4th District ; Dr. Robert C. Word, of Cassville, for the 5th District;
Dr. Henry Hull, of Athens, for the 6th District ; Dr. C. J. Paine,
of Milledgeville, for the 7th District; Dr. Marshall Andrews, of
Washington, Wilkes Co., for the 8th District.

4. Dr. J. Le Conte, of Athens On the Medical Botany of Georgia.

5. Dr. I. P. Garvin, of Augusta Bibliographical Sketches of Drs.
Antony, Abbott, and Lyman Hall ; Dr. C. W. West, of Savannah
Bibliographical Sketches of Drs. Waring and Richardsone ; Dr.
C. B. Nottingham, of Macon Bibliographical Sketch of Dr. Baber.

6. Dr. H. Rossignol. of Augusta On the Vital Statistics of the City
of Augusta; Dr. W. G. Bullock, of Savannah On the Vital Sta-
tistics of the City of Savannah ; Dr. John Bacon, of Columbus
On the Vital Statistics of the City of Columbus ; Dr. J. M. Green,
of Macon On the Vital Statistics of the City of Macon ; Dr. J. F.
Alexander, of Atlanta On the Vital Statistics of the City of At-
lanta.

7. Dr. L. D. Ford, of Augusta On Pneumonia, and Pleuropneumo-
nia, as they have prevailed in Georgia of late years : their amalga-
mation with Remittent fever ; and in what respects they differ from
those diseases, as described by European and Northern writers.

3. Dr. H. R. Casey, of Appling, Columbia Co. On the Remittent
peculiarity assumed by Typhoid fever in Georgia.

9. Dr. L. A.* Dugas, of Augusta On the best plan of treating Frac-
tures in country practice.

10. Dr. D. C. O'Keeffe, of Greensboro' On the Epidemic Jaundice
which prevailed during the past year in certain sections of Georgia.

11. Dr. H. F. Campbell, of Augusta On the administration of Re-
medial agents per rectum.

12. Dr. Tomlinson Fort, of Milledgeville The names of regular
physicians, and the number of irregular practitioners in each
county.

13. Dr. J. A. Eve, of Augusta On the use of Anaesthetic agents in
Obstetrical practice.

14. Dr. W. E. Dearing, of Augusta On the Virus of Serpents.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. APRIL, 1861. [\u. 4.

PART FIRST.
r t g i n a I < o m m u n i c a t i o n 0 .

ARTICLE XIII.

Observations on the Value of the Microscope as a means
for the Diagnosis of Disease. By W. J. Burnett, M. D.,
of Boston.

It would indeed be as much out of taste as it would be
uncalled for, to offer an apology for an instrument by the use
of which organic science has already made such signal advan-
ces. Its claims being admitted, my object is to refer to some
of the leading features of its value for the accurate diagnosis of
disease both in and out of the body.

But, in the discussion of this subject, the query at once
arises, does disease always have a tangible material expression,
and that too of a corresponding and invariable character? A
negative answer to this opening question would be regarded
by many as quite unphysical, not to say unscientific ; but, in
the present state of our knowledge, I must consider it as the
one by far the most correct. It is true, that it may be urged
that in virtue of the great fact constantly before us, that vitali-
ty has its expression only in organization which is tangible and
capable of analysis, so must it be inferred that there is always
a tangible expression of any perversion of that vitality. This
view may be very scienti!:: in one sense: but in the present
state of pathology it is not the one practically correct ; for
there are many transitory morbid changes of the vital phe-

\. 8. VOL. IX. NO. iv. 13

198 Burnett, on the Value of the Microscope [April,

nomena, many abnormal conditions of the economy known as
functional, which leave no traces behind in the material parts
or organs in which they occur at least as far as we can now
detect, after the most thorough examination. The probable
existence, however, of corresponding changes, in such instances,
is not denied ; but, in a practical point of view, we stand the
same as though they were even disproved to exist at all.

Too high an estimate, therefore, must not be placed upon
the value of intimate microscopical studies for the elucidation
of pathological conditions and phenomena. It should also be
borne in mind that, even had we in every disease a definite
product on which we could lay our hands, yet, after all, we
cannot thereby go beyond the physical peculiarities of the pro-
duct in question, and these may be wholly inadequate to the
morbid phenomena manifested ; for it is the same in Pathology
as it is in Physiology, that the structure of an organ or a mate-
rial part furnishes us no certain key to its ulterior vital condi-
tions or relations.

The practical value of the microscope then, in pathology,
does not consist in hunting up the traces of obscure phenomena,
but in accurately determining the differential character of well
marked products.

The question then arises, have the elements of these material
products of disease, characteristics sufficiently constant and
unvarying to make them objects of scientific study. That the
correct answer to this query is an affirmative one, I shall now
attempt to show by a reference to the histological relations of
diseased products.

The relations of Physiology to Pathology are such, that the
latter seems but an erring condition of the former. On this
account the elements of morbid products appear under the
same laws as those regulating the production of healthy tissues.
Morphologically speaking, therefore, pathological formations
have no elements differing in kind from those of health. But
the difference lies in their complete want of functional rela-
tions : they subserve no adaptive economical purpose in the
system, but are in one sense parasitic. These products, also,
as superventions in and upon healthy parts, are necessarily
infra formations they are below the standard of those of

1S53.] as a means for the Diagnosis of Disease.

health of which they may, or may not, take on some of the
characteristics. These elements are cells, colloid and granular
forms, all of which wear the semblance of physiological ]
As forthe cells, I may make here the general statement, founded
on a pree >n, that, both as to their genesis

eneral aspect as siny hich belong to the

abnormal cannot be distinguished from those belonging to the
normal products of the economy : that is, they are cells, and in
both cases have all the requisite parts of these organs. Where,
then, are the distinguishing features between these two classes
of objects? I answer, not so much in the characteristics of
their isolated as of the . jated forms, and in their local

and functional relations to the parts in which they occur, or to
the whole system gene or an exemplification of these

points we will take up the three classes of heteromorphous
pathological products, viz., Cancer, Tubercle, and Pus and
pyoid forms: Of these, cancer is the highest, and has most of
the general peculiarities of healthy

In ear! ranee in a distinct and unmistakable form

\v cells, as I have often observed. We can trace
it no farther back, but all analogy is in our favor for supposing,
as is the case with tubercle, that these cells are formed in an
unhealthy plasma effused from the blood. Moreover, on the
inner surface of the testicular tubes, as I have sometimes observ-
ed them just appearing, they seemed to replace the normal
epithelial cells there situated, and to be formed like them.
This cell, the first, is also the last or highest expression of this
product, it being t. nal and not the transitional form.

It is nucleated, and not unfrequently has several distinct nuclei;
but, as t<> id other external characteristics, it has

.nothi: and peculiar; and in my present

opinion, no features by which it, taken alone, may always be dis-
m other purely cell structures.* Formerly mv

aide on the a of the microscope to

.at the

, in a uiven case,

specimen. I once took this

o not thii ..able. He all ad ) to the

brilliant :. u .1 characteristic. But these

ppeared to . J I have met with them

norbid ce..^ in those c: | igenese*.

200 Burnett, on the Value of the Microscope [April,

opinion was, iike that of most of the microscopical pathologists
then and now, that the cancer-cell, as such, has physical pecu-
liarities by which it can always be distinguished from all other
cells, healthy and diseased. But from a late and somewhat
careful review of the subject, based, not only on observations
of the cells as physical objects, but upon a consideration of
them as constituting an expression of pathological action, I am
free to confess that I do not now regard my former opinions
as tenable.

All, or nearly all the microscopical relations of the cancer,
cell which have any claim of being peculiar to it alone, may, I
think, be stated in the following brief manner : When fully
developed it is simply a nucleated cell ; it may, however, have
several nuclei, or even none at all ; it is often of an irregular
shape, fusiform, caudate, &c, &c, and its size is frequently
equally variable ; but the evidence of its being not only of a
pathological, but of what is called a cancerous nature, cannot,
and does not, lie with any one of these points alone, but rather
with a combination of them all, and that, too, united with the
fact of its occurring in the tissues, and under circumstances
where it cannot be regarded as a healthy product. Its dif-
ferential diagnosis, which I think can be made out in nearly
every case, depends upon these considerations which, when
fully examined, will, I believe, be found amply sufficient.

Suppose, for an illustration, a small bit of a cancerous tissue
has been forwarded for microscopical analysis. I know no-
thing of its history, locality, or other relations ; but I decide in
the first place that it is not a normal product, from the fact that
its cell constituents have no type peculiarities. As an hetero-
morphous product, then, the diagnosis lies between its being
tubercle, a pyoid form, or cancer. But as the two former are
only celloid, and not true cell structures, the decision rests
with its being cancer. Put upon these grounds, its diagnosis
would always be attended with no difficulty. But the matter
is not thus easily disposed of: the question arises, may it not
be a homceomorphous non- malignant product of an epitheloid
character ? In other words, can simple epitheloid formations
be always discriminated from cancerous products occurring in
the same locality ? This question has both an histological and

1853.] as a means for the Diagnosis of Disease. 201

a practical importance, and in gjving to it an affirmative an-
swer, I know that I am expressing more than many pathological
microscopists would allow. But my own experience sustains the
correctness of this view. The distinction consists in the absence
of all individual cell-type in the one (cancer), and the presence of
it in the other (epitheloid epigenesis). The cells of cancer taken
separately are simply cells they present no invariable spe-
cial or specific characteristics, as before remarked ; while those
of epithelial tumors have the almost exact resemblance of those
of normal epitheloid tissues. Meckel has, indeed, laid down the
law, that morbid tissues assume the morphological characteris-
tics of the normal parts with which they lie in contact ; and
it might be argued, that, this law being true, cancer occurring
in an epithelial tissue would be so epitheloid as not to be dis-
tinguishable from a simple epithelial product. But, in my
opinion, this law of Meckel holds true only of homacomorphous
products, and cancer is distinguishable by its recklessness of
these very governing laws. From these data, I think the expe-
rienced eye can always, or nearly always, make out the differ-
ential diagnosis in difficult cases of this kind. But here I may
make the remark that, in the successful study of these forms, as
is true of the study of Genera and Species in Natural History,
the appreciation of differences is something not always easily
described in detail, seeming to consist in a faculty of judging
from the tout ensemble of appearances, and which is acquired
only from a somewhat extended study and observation. But
we will carry out the application of these remarks somewhat
further.

There not unfrequently occur cases where it is all important
to know positively, whether a certain disease is of a malignant
nature or not, as bearing on the expediency of an operation, or
on the prognosis of the case. The question is, does the micro-
scope afford any positive and new data for the solution of such
points ? In a majority of cases where a portion of the diseased
tissue is accessible, I think it does ; and even where its data
furnished are not sufficient of themselves, they maybe very
great aids combined with others of a general and clinical char-
acter. Thus, cancer of the uterus may be diagnosed accurate-
ly from the escaped exudations which pass off through the

202 Burnett, on the Value of the Microscope [April,

vagina. This is true likewise of its occurrence in other organs
where there is an escape of its elements externally. But in
cases where the disease has no external communication, but
lies concealed beneath healthy tissues, as is true with many
tumors of the surface of the body, and must be reached by an
exploring needle, the results thus obtained are less reliable and
trustworthy. In the first place, one cannot be positive that the
minute portion thus brought away is the real primitive disease ;
and in the second, the quantity is so small that you cannot make
that comparative examination necessary to afford a positive
result, at least such a one as would allowT you, in any given case,
to assert an opinion as to the nature of the disease, at variance
with that founded on its locality and general history. But such
examinations will furnish at least highly auxiliary data, and in
many cases may serve as the turning point in this or that diag-
nosis. The practical bearings of such examinations are some-
times strikingly prominent as I have myself observed and
wrought out in three or four cases ; but, unfortunately, they are
generally less so than those of a scientific character. Usually
the line of action of the practical surgeon is clear and distinct,
based upon a resume of the general conditions of the case com-
pared with past experience. He is, moreover, generally called
upon in the advanced stages of the disease and when all other
resources have failed, and then his decision to use the knife or
not, is based more upon the constitutional condition of the pa-
tient and the amount of disease, than upon an exact knowledge
of its histological nature.

But the chief value of microscopical studies of cancer, is after
the diseased product has been removed. It is true, that such
examinations have few or no practical bearings for the pa-
tients from whom the disease is taken, but they are of eminent
scientific importance for our most comprehensive knowledge of
this morbid product. If, with a full history of its general and
special relations, is united, in every case, an exact account of
its histological nature, the whole has a scientific completeness,
exactly as when a chemist with any mineral, gives, besides its
locality. &c, its qualitative analysis. And when the annals of
science shall have been made rich with such records, the prac-
tical surgeon will proceed with an inductive certainty in his

1853.] asameans for the Diagnosis of Disease. 203

movements, quite unknown at the present time. The necessi-
ty of such a line of strict inquiry will perhaps be the better
appreciated if we bear in mind that the splendid labors of the
older surgeons want a strict scientific value in this respect,
from the absence of such histological analyses. Recent micro-
scopical studies have shown that the general or gross charac-
iCs of a disease form no invariable and certain index of its
histological and real nature. Then again, depending entirely
on gross appearances, why should the opinion of the most dis-
tinguished surgeon be preferred to that of the most humble, as
to whether a tumor is hard, soft, or grey, white or brown ?
And surely, when Sir Astley Cooper or Velpeau have unhesi-
tatingly and authoritatively pronounced this or that tumor to
be a cancer, their opinion must, in reality, have been founded
upon such arbitrary data as these.

Many of these same considerations just made are applicable
to the second morbid product in question Tubercle. This is,
however, a much inferior formation, being celloid rather than
cellular. Moreover, it is connected with a much lower consti-
tutional dyscrasia, and its local appearance, however small, is
usually attended with general conditions of an unmistakable
character. On this account, therefore, microscopical examina-
tions are not very frequently required for the accurate deter-
mination of this product in the living body. There are cases,
however, when careful histological analyses are necessary to de-
cide between it and the products of so-called chronic inflamma-
tion. But here, as is the case with cancer, these analyses have
now more of a scientific than a practical value ; for in all such
cases, whatever maybe the scientific, yet the therapeutic diasmo-
^uld be the same. This, the best of clinical experience has
shown to be true. But the question occurs, has tubercle a
characteristic element by which, with the aid of the micro-
scope, it can be distinguished from other morbid products. To
lery, I return an affirmative answer, in the same way and
with the same qualifications as I have with cancer ; but at the
same time, a diagnosis of this kind, with the same data, would
have much more assurance than is true of the last mentioned
product. This is so because its elements are colloid, and the
product of a low inflammatory action, so that there are few
others with which it can be well confounded.

204 Burnett, on the Value of the Microscope [April,

The distinguishing characteristics of the tubercle corpuscle
belong to a low vital condition. When first formed, as I have
observed in several instances in the lungs, it consists of a celloid
body of about one two-thousandths of an inch in diameter, non-
nucleated, but containing numerous granules : it is then perfect-
ly spherical and has a very uniform aspect. But at this early
period, and before they have formed a distinct visible product,
these corpuscles are rarely seen. Most observations upon them
are as found in distinct tuberculous matter taken in masses
of various sizes from different organs. They then have a differ-
ent, though not less uniform aspect ; they are smaller, their
contour less regular, and on the whole they have a withered,
shrivelled appearance. This change is due, I think, to a par-
tial exosmosis of their previously contained liquid contents.
Treated with acetic acid, the membrane or involucrum be-
comes more transparent, thus rendering more distinct the
granular contents of the corpuscle. Thus characterized they
lie in the midst of broken parts of their like, together with a
crowd of granules, all of which combined, form the solid con-
stituents of the tuberculous mass.

I think I do not estimate too highly these points, when I affirm,
that with such data the experienced microscopist can pretty
positively decide whether or not a product in question is tuber-
cle. But even were he in any given case, unable to return a
positive decision, this would have very little practical import-
ance, for the products at all likely to be confounded with it, are
those of also a low inflammatory nature, and referible to the
same line of pathological action.

There are cases, however, though confessedly few, where,
during the life of the patient, the microscope may be of much
service in fixing positively the diagnosis of tubercular disease.
Such are cases where this disease has some internal seat, but
communicates externally by a fistulous or other opening. The
best instances of this kind are cases of tuberculosis of the bones,
and several times I have had the satisfaction of accurately de-
termining this disease thus concealed, simply from its exuded
puriform portions escaping externally through long fistulous
canals.

But in truth, as has just been said of cancer, microscopical

1853.] as a means for the Diagnosis of Disease. 205

studies of tubercle have, at present, more of a scientific than a
practical value. Occasions are constantly occurring during
post-mortem examinations, where it is both interesting and im-
portant to accurately determine the nature of larger or smaller
diseased products accidentally or otherwise met with in the
various internal organs. Such decisions are often of much
scientific value, as bearing upon the doctrines of the concomi-
tancy or antagonism of certain diseases. Such examinations
are all the more worthy of attention, from the fact, that on the
surfaces, or in the parenchyma of internal organs, there are
constantly formed from various accidental inflammations,
lymph-like and other products so closely simulating in gross
aspects tubercle, as to be easily taken for it. But I need not
pursue this line of consideration farther, for the various import-
ant bearings of such analyses will be readily suggested to those
at all familiar with these studies. I will add only, that the con-
fidence and satisfaction which the necrotomist has under such
circumstances, constitute one of the pleasantest relations in this
department of microscopy. Like the chemist in his laboratory
with minerals before him, he need not dwell with uncertainty
upon the doubtful aspects of a product at his hand.

In regard to pus and pyoid corpuscles, they need not claim
much of our attention with the relations under discussion, they
are the products of inflammation alone, and, in my opinion,
inflammation never occurs without their being formed to a
greater or less extent. Their microscopical appearances are
too well known to be here described. The highest form, the
pus corpuscle, however, is very uniform in its size and general
appearance, full as much so as that of tubercle. It is the high-
est or ultimate product of common inflammation, and is ob-
served in its most perfect form in the so-called "laudable" pug
which is richest in plastic material. In the majority of in-
stances its gross characteristics are sufficiently indicative of its
exact character. But there not unfrequently occur cases n
which the microscope serves as a happy and positive aid. Such
are instances where it is concealed in some other product, as the
urine, the feces, and effused liquids into any of the cavities of
the body. I need not here enter into detail to show exactly
how this aid is rendered, but instance after instance might be

206 Burnett, on the Value of the Microscope. [April,

quoted illustrating how, by such examinations, an internal
latent inflammation has been positively diagnosed when wholly
inaccessible by any or all of the common symptoms, if perchance
they were present.

As to the so-called " pyoid forms," their practical microsco-
pical relations are still more prominent: They consist of
rudely-made granular corpuscles of variable size, though in other
respects of a pretty uniform aspect ; they are easily distin-
guished from the well-formed pus-corpuscle by this ill-con-
ditioned structure. I regard them as the transitory forms
between the tubercle and pus-corpuscles, if the present state of
our knowledge of these products and their relations will allow
the admission of any such transition. Indeed, the study of the
tout ensemble of their appearances in comparison with tuber-
cle, has had no small weight in the formation of my opinion
that this last is truly an inflammatoid product. Wherever oc-
curring they are the results of an inflammatory process alone,
and that too where the effused blastema is of a very low order.
On these accounts great value may be attached to their pre-
sence which, by the way, generally occurs under circumstances
otherwise obscure ; and then the question of inflammation on
other premises cannot be raised. They are met with in dropsi-
cal fluids of any source, as those of hydrocele, cystic disease
of the ovary, ascites, &c, also in organs laboring under a
chronic inflammatory process, at least where the inflammation
is of an indolent instead of a suppurative character. A well-
marked instance of this last, and where too the microscope is
of signal aid, is that low form of nephritis known as Bright's
disease : for, according to my own observation, their successive
presence in the urine is almost invariably diagnostic of this
disease.

A consideration of the practical value of the microscopical
study of the homoeomorphous products of disease, as well also
as that of the morbid changes of the solid constituents of the
blood, must here be omitted for another time.

1853.] Foote, 07i Fracture of the os Fronds. ^0?

artici.i: xiv.

Fracture of the os Frontis loss of cerebral matter Recovery,
By K. T. Foote, M. D., of Society Hill, Ala.

On the ISth of August, 1851, 4 o'clock, A. M., I was called
in haste to the plantation of Mr. M. J. C, of Macon county,
Alabama. On arriving, I found a negro woman in the follow-
ing condition : Total unconsciousness, not being able to arouse
her by the loudest calls; stertorous breathing ; general paral-
ysis evidencing no sign of sensibility even when severely
pinched; coldness of skin; pulse slow and feeble; pupils
dilated, insensible to the strongest light, etc. ; bloody water
oozing out of ears.

One and a half inches above the left orbitar plate there was
an external wound of two inches in extent ; superiorly to this,
one inch below the coronal suture, another, about one and one-
fourth of an inch long each extending in a line parallel with
the above mentioned suture, that is, transversely across the
cranium. A considerable portion of cerebral matter was lying
in immediate contact with her head. Beneath these wounds
the frontal bone was severely fractured and much depressed.
By way of explanation, I will add, that this injury was inflicted
by a negro man giving her two heavy blows with the pole of
an axe: the woman was asleep at the time.

This being a very serious case, I requested a consultation.
Doctor W. was accordingly called in. The treatment, of
course, was to remove the compression as soon as possible ;
we therefore commenced removing the detached pieces of
bone, and soon took away seven pieces. Two of these were
very large, the others small putting them together they will
measure at least three inches square. We ligated but one
small artery, a branch of the external temporal, the loss of
blood not exceeding *^0 oz. After removing all detached spic-
ula? of bone and cleansing the parts of blood, we found the
dura and pia membranes punctured in several places; in fact,
the whole appeared to be reduced to a pulpy mass. Thi

.' wound was then closed by the uninterrupted suture.
Immediately after removing the largest pieces of bones, the
patient's sensibility began to return, evidence of which she

208 Foote, on Fracture of the os Fronds. (.April,

gave by her deep groans and movements. We ordered cold
cloths to be kept constantly applied to her head, renewing
them every fifteen minutes ; perfect quietude, &c.

The following is merely a transcript of notes recorded at
each visit :

August 18, 6 o'clock, p. m. Appears to be a little conscious,
making some attempt to answer questions when interrogated ;
passed urine ; pulse 85 ; restlessness; continual moving of ex-
tremities. Same treatment continued.

19th, 8 o'clock, a. m. Nurse reports she slept six hours
during the night ; drank water and some water-gruel. Pulse
80, no fever perceptible ; left eye blood-shot. Her infant child
being presented to her, she took and nourished it. 6 o'clock,
p. m., sensorial functions remain the same, pulse varying from
70 to 75. Treatment continued.

20th, 8 o'clock, a. m. No special alteration from the 19th,
only in the pulse, which is now 60. Same treatment, with the
addition of a bolus of calomel and jalap aa 10 grains.

21st, 9 o'clock. Pulse 62; voice more distinct; appears to
be conscious of her condition and the cause of it ; complains
of great pain in occipital region.

22d, 10 o'clock, a. m. Pulse 70 ; sensorial functions the
same. Having noticed a free flow of saliva and difficult deglu-
tition for several days, I examined her particularly, and found
upon pressing on the left side of the inferior maxillary bone, it
gave her great pain ; breath quite offensive; tongue and cavity
of the mouth covered with yellow pimples. Ordered her to
have sulphate magnesia, to keep her bowels open, etc. .

23d, 9 o'clock, a. m. General restlessness ; pulse 75 ; occa-
sional pain in sinciput region; contraction of features ; water
running from left eye ; face much swollen.

24th, 8 o'clock, a. m. A fair night's rest ; very calm and
quiet ; countenance more natural. 6 o'clock, p. m. Slight fe-
ver this evening, supposed to be caused from excitement of
company. Again gave orders to keep her perfectly quiet, with
the same general treatment, viz. cold to the head, saline purga-
tives, water-gruel, &c.

25th, 6 o'clock, p. m. The offensiveness of the breath in-
creased ; great difficulty in swallowing ; pulse 80, rather full.
Same treatment, with an astringent mouth-wash.

1853.] Dugas's Cases. 209

26th, G o'clock, p. m. Pulse 75, full and soft ; complains of
great pain in the space between the helix of the left ear, and
articulation of the inferior maxillary bone ; pus mixed with
sputa, noise disturbs her much.

27th. Much better to-day. Unfavorable symptoms of yes-
terday moderated.

28th. Still improving ; pulse nearly natural ; no symptoms
of inflammation.

20th. Conversation rational and tolerably distinct ; recol-
lection good ; complains of but slight pain. Requests stronger
diet. Healthy suppuration from external wound, with the ex-
ception of two small places, from which issued sanious fluid.
A few granulations of fungous growth shooting up. These
destroyed by burnt alum, cicatrized in a few days.

I continued to visit this patient for several weeks. Nothing
further occurred worthy of notice. I will only add, she con-
tinued to improve rapidly, and is now in quite good health.

The space from which the bones were removed has now for
its covering the common integuments of the scalp. By placing
your hand in immediate contact with that portion of the head,
you feel a strong pulsation synchronous with that of the heart.
The edges of the bone can be sufficiently felt to trace out the
extent of the fracture.

This woman suffers no inconvenience from the injury, when
cool and quiet ; but when over-heated or much excited, a
determination of blood to the head takes place, producing
blindness, giddiness, etc.

ARTICLE xv.

Two Singular Cases Reported by L. A. Dug as, M. D., &c.

The following cases are related merely as accidents of a
singular character :

ACCIDEXTAL CASTRATION".

A negro boy about 14 years of age, belonging to Mr. L. P.
D., was riding a mule, harnessed as usual upon our plantations
for ploughing, when the animal took fright, started off at great
speed and dismounted his rider. In endeavouring to maintain

210 Dugas's Cases. [April,

his position, the boy clung closely to the neck of the mule, but
finally slided off on one side. It so happened that the trace was
suspended to the back band by means of a stout iron hook,
which, as the boy glided over it, caught him by the scrotum
and completely tore out his left testicle, which was found upon
the hook when the mule was captured.

The boy was sent to the city, a distance of eleven miles, and
placed under my charge. The injured side of the scrotum
looked as though it had been laid open longitudinally with a
dull cutting instrument ; the cord was retracted and yielded no
hemorrhage ; the boy stated that it bled freely at first, but
soon ceased to do so. The edges of the wound were carefully
brought together and secured with adhesive strips. No un-
pleasant symptoms ensued ; union was effected by first inten-
tion ; and in a few days the patient returned home perfectly
well.

A negro woman owned by Mr. B. P., was in the street
near the market-house in this city, when a cow, in endeavor-
ing to escape from dogs who furiously pursued her, encountered
the unfortunate woman, thrust a horn into her mouth and tore
open the cheek of her left side, from the angle of the mouth up
to the masseter muscle.

The edges of the wound were brought together by means
of interrupted sutures and adhesive plaster, and union by the
first intention was obtained without farther difficulty. The
face now shows a merely linear cicatrix and is not disfigured.

A friend, on hearing of this case, informed us that one of his
servants was standing before an ox and endeavoring to adjust
the yoke, when the animal suddenly throwing up his head,
caught one of his horns into the man's nostril and hoisted him
into the air, very much to the merriment of the by-standers,
for he was not much injured. Sancho Panza was assuredly
never in a more ludicrous predicament.

1855.] Ricord's Letters on Syphilis. 211

PART II.

(Eclectic Department.

Letters upon Syphilis. Addressed to the Editor of L'Union
.Modi call', by P. Rioobd. Translated from the French, by
D. D. SlAdb, M. D.

[Continued irom Page 151.]

EIGHTH LF.TTER.

My Dear Friend, It is my purpose to-day, as I promised
you, to see if it is possible to distinguish a simple blennorrhagia
from one with a chancre concealed in the urethra. You see
that I lay down the problem as boldly as my opponents.

In the study of this diagnosis, it is important to establish two
conditions; the one a diagnosis absolute, unequivocal and un-
deniable ; the other a rational diagnosis.

An absolute diagnosis cannot be obtained but by artificial
inoculation. Every time that muco-pus furnished by a mucous
surface will give the characteristic pustule, which we will soon
have to examine in studying chancre, we can affirm, whatever
has been the duration of the disease, that this muco-pus is viru-
lent, that there is a chancre somewhere ; the chancre alone
being able to give rise to the positive results of inoculation.
is the incontestable fact established by my researches, and
the absolute and unequivocal diagnosis in all its strictness.

When by the inoculation of muco-pus from the urethra you
obtain the characteristic pustule pronounce boldly, and with-
out the possibility of error, it is a virulent blennorrhagia. But
only ask of inoculation, as of all the other means of investiga-
tion, what we have the right to expect from it. We must have
variolic or vaccinal virus to produce the effects of variola or
vaccine. If at the side of a variolic or vaccinal pustule an
abscess is developed, and you should take the pus from this
abscess to inoculate, you would not obtain the specific effects
of the vaccine nor of the variola. Take some muco-pus in the
neighborhood of a variolic pustule developed upon the Schnei-
denan membrane, and this muco-pus will not give the effects of
the variolic pus.

If you have, then, a patient actually affected with an urethral
chancre, and at the same time with a simple blennorrhagia (a
frequent complication), and in the place of taking the pus from
the chancre, we take it from the blennorrhagia, the result will
be necessarily negative. It does not require much mind to
understand so simple a thing, and I am astonished that M. Vidal,
who has much esprit, should make of this an objection against

212 RicoriTs Letters on Syphilis. [April,

inoculation. I have too high an esteem for his understanding
to admit that he could believe that pus furnished by chancre
of the urethra, when a blennorrhagia coexists, ought necessa-
rily to be mixed with all the blennorrhagic pus ; or that a drop
of pus from a chancre, acting after the manner of leaven, ren-
ders the other necessarily virulent. Without doubt, the com-
plication of morbid elements, as regards the diagnosis, often
renders the analysis difficult, but an exact knowledge of each
of these elements permits us, under any circumstances, to dis-
tinguish between them.

The chancre of the urethra, which can never have a very
great extent or large surface, can furnish but a very small
quantity of virulent pus. Even in the indurated chancre the
secretion is sometimes almost nothing, generally insufficient to
stain the linen of the patient. A very fine example of this can
be seen at this moment in No. 15 of the first ward of the Hos-
pital duMidi.

Every time, then, that we have to deal with a very abundant
discharge, we have the right to suppose that there is something
else besides the product of chancre. We must guard against
concluding upon the absence of chancre in the urethra, from
the negative results of inoculation. But if the inoculation is
repeated several times if, moreover, care has been taken to
press out the secretion of the urethra in order to obtain the
more immediate product of the ulcerated surfaces and the
results have always proved negative, there is a very great pro-
bability that it is a simple blennorrhagia and without the com-
plication of chancre. Without doubt the diagnosis here is
neither absolute nor complete ; but does it not present at least
something more than the diagnosis which is generally made?

In order to draw a conclusion from the negative results of
inoculation, the epoch at which the experiment is made must
be kept strictly in view. We shall see later, in studying the
chancre, that the virulent secretion has a term, and that there
is a moment when the ulcer passing into the state of simple
ulceration ceases to furnish specific pus. If, then, experimenta-
tion is made too late, less can be concluded from the negative
results, than if the inoculation had been made during the first
or second week following the infecting coitus.

In examining inoculation under this point of view, does it not
offer all that strict reasoning can demand ? If the results are
positive, this gives you the most absolute sign that diagnosis
can give. If they are negative, the results conduct then to a
rational diagnosis of which they may be the most valuable ele-
ments. Let a more sure or a more fruitful sign in human pa-
thology be found. What ! would not that be a sign of great

1853.] RicorcVs Letters on Syphilis. 213

importance, which, when it exists, permits US to affirm, in a
necessary inevitable manner, the existence of a lesion with
grave consequences, and which, when not existing, can conduct
us with a sort of certainty to a rational diagnosis!

And because this sign has also its uncertainties, shall we not
pay attention to those circumstances in which it presents a
value and a mathematical precision? Are we, then, so rich in
absolute diagnosis, that we ought to show ourselves indifferent,
sceptical, or scorners with regard to a sign the existence of
which smooths over so many difficulties?

What other means but inoculation, in a case of legal medi-
cine, will permit us to state strictly that a blennorrhagia is or is
not symptomatic of chancre?

But is it asked of me if inoculation is always applicable? Do
we always arrrive in time? Can we and ought we always
to count upon it ? Must we always have recourse to it ? Cer-
tainly not; I have written this and repeated it a hundred times
in my lectures, and it is incredible that objections should be
again silted over that I have myself so many times made. In-
oculation, since it is again necessary to repeat it, is an excellent
means of diagnosis, but of which we are often deprived. Is this
a reason for renouncing the research into the distinctness be-
tween simple and virulent blennorrhagia ? Without doubt, no ;
and fortunately, a well-directed minute study of all the ele-
ments of the disease, gives, in the great majority of cases,
whatever my opponents say, a diagnosis sufficient to enable us
to conclude upon the prognosis, and to furnish the indications
of a treatment truly methodical.

It is not sufficient, as we shall see later, merely to have a
primitive ulcer in order to fear the constitutional verole, and to
necessitate a mercurial treatment ; other conditions are ordina-
rily sufficiently well marked to enable us to recognize them.

Permit me then, to pass over again very briefly in review,
the ordinary elements of the diagnosis of blennorrhagia, of
which there has already been a little question, on account of
the etiology.

You recollect what I said of women considered as a focus of

infection, and the value which we can attribute to the source,

gards concluding upon the virulence or the simplicity of

orrhagia. The patients have a singular naive t^ upon

this point, and entertain a strange idea of morality. How

many times have I Been young people enter my office an..!

to me the blennorrhagia winch 1 ha be other-

than benign, lor I contracted it from a married woman,

the w i-. and I am very sure that it cannot

be anything more than an * cm ; feme at. At this I am accus-

x. 3. VOL. IX. NO. iv. 14

214 RicoroVs Letters on Syphilis. [April,

tomed to answer Sir, if your wife had a lover, would you consi-
der her as a very honest woman? This question troubles almost
all of them, and they see very quickly that in order to settle
upon my diagnosis, I have recourse to means rather more cer-
tain than the morality of the source. A woman perfectly
healthy, I have already said, may be a source of infection.

Among the curious and singular facts which have passed
under my eyes, permit me to relate to you the following, which
has also its morality, as you will see. A young and small
household had invited to breakfast a friend of the husband.
The repast was almost terminated, and the appetite was not
satisfied. It was decided that a morsel of cheese should be
added to the feast. The husband leaves the table, descends
four pair of stairs, and runs to the neighboring grocery to seek
the complement of the friendly repast. Alas ! he does not re-
turn sufficiently quick. During his short absence, and between
the pear and the cheese, his unfaithful better half committed
adultery with his perfidious friend. The husband returns, the
repast is finished, coffee and its accompaniments are taken, the
friend retires, and the husband in his turn consummates the
conjugal act. Three days after, the husband comes to me
with a chancre of the urethra, with symptoms of blennorrha-
gia. He was accompanied by his wife, and he assured me that
he had had relations with no other woman. The most careful
examination of the genital organs of that woman did not per-
mit me to discover any thing suspicious. My prescription
made, these individuals went away, leaving me without expla-
nation of this virulent blennorrhagia of the husband. But the
next day the wife returned, to ask me if I was very sure that
she was not diseased. I examined her anew, and again I af-
firmed to her that she was perfectly well. Then she related to
me the history which I have just told you, and she added that
the delinquent was there, and begged me to examine him. I
found upon him a magnificent chancre on the corona glandis,
in the specific period.

This fact confirms the curious experiments made at the
Lourcine by my young and learned colleague M. Cullerier. He
placed some virulent pus in the vagina, let it rest there during
some time, took it again upon his lancet, and inoculated with
positive results, and the vagina, submitted to the treatment of
injections only, was not infected.

You will conclude with me, my dear friend, that the source
from which the cause of the blennorrhagia has been taken, can-
not give a great value to the diagnosis.

I shall not return to what I have said of incubation as a means
of diagnosis. The chancre of the urethra is sometimes devel-

1853.] RicorcCs Letters on Syphilis. 215

very quickly, and can furnish pus at an early period. So
that, far from considering the blennorrhagia as virulent which
has taken more time to appear, it is the contrary that we must
very often admit.

The violence of the blennorrhagia has been made a synonyme
of the virulence. In truth it is just the contrary. As a gener-
al rule, it is those cases of blennorrhagia which are the least
violent, the least painful, which ought to give us the most fear
of the existence of a chancre in the urethra. The duration of
the discharge is a sign not to be neglected. It is not the dis-
charges the most tenacious which make us fear the existence of
a chancre in the urethra. The nature of the secretion has
great value when we know how to appreciate it. The secre-
tion which is the result of an ulceration of the urethra, is much
more purulent than mucous ; it is ordinarily sanious, rust-color-
ed, and charged with blood ; the least pressure, moreover, upon
the urethra, renders these characteristics very sensible. But
to give to this symptom (the presence of blood) all its value,
we must be certain that the patient has not previously used a
caustic injection, that foreign bodies have not been introduced
into the urethra,or that he has not had a rupture of the canal
during chordee; and that, moreover, sanguinolent matter is
not expelled with the last drop of urine, in which case it would
be the sign of cystitis with vesical tenesmus.

I do not speak to you of the speculum for the urethra as a
means of diagnosis of the ulcerations of this canal. It is an
ingenious method, which has not given what it promised. It
is sufficient sometimes to distinguish chancre, situated even at
a considerable depth in the urethra, to cause the meatus to gape
by stretching open the lips. Wedkind had thought that he
found in the enlargement of the follicles in the neighborhood
of the urethra, near the fraenum, a symptom of virulence; but
these enlargements are generally only phlegmonous, and inde-
pendent of every other complication*

The most important symptom consists in the engorgement of
the canal, especially in the region of the gland, the most fre-
quent seat of chancre in the urethra.

I have already said, that it is not so important to be able to
state the presence of an ulceration, either by the aspect and the
nature of the secretion, or by inoculation, as it is to know if
one is concerned with an ulceration capable of determining the
syphilitic infection. It is this that all authors have had in view,
when they have spoken of virulent blennorrhania.

Well I as we shall soon see, it is the indurated chancre which
is the fatal antecedent of the constitutional verole. ZVow no-
thing is generally more easy to prove than the presence of an

216 Ricord's Letters on Syphilis. [April,

indurated chancre of the urethra with symptoms of blennor-
rhagia. If a blennorrhagic complication does not exist, the
patients scarcely suffer in micturition ; the jet of urine is gen-
erally twisted and troubled by reason of the diminution of the
calibre of the urethra ; the erections are not painful, when the
chancre is seated in the region of the gland.

In order to well ascertain the presence of these ulcerations,
it is necessary to explore the urethra by the aid of pressure
which is exercised from above downwards, from the dorsal face
to the inferior, as when we wish to make the meatus gape. In
exercising this manoeuvre, wre perceive a cord, more or less ex-
tended, that some writers on syphilis have designated under the
name oicorde balanique. It is easy to ascertain, in the great-
est number of cases, the side of the canal upon which the
ulceration is seated. Independently of the indurations plainly
limited upon one side, we see that side form a convexity, whilst
the healthy side separates in forming a crescent. When the
pressure is exercised from right to left, nothing is felt, the indu-
ration ceases to be appreciable.

Doubtless the swelling in the region of the gland or of the
follicles may be only the result of a simple inflammation with-
out virulence ; but to complete the diagnosis we must have
recourse to the accessory symptoms. Thus the affections of
the glands are very rare in the blennorrhagia non-symptomatic
of chancre. When they take place, as I have already pointed
out, they are acute, terminate easily by resolution, or when they
suppurate, it is simple pus that they furnish.

With the urethral chancre, dorsal lymphangitis of the penis
and the affections of the glands are much more frequent. If
the chancre is non-indurated, the glands suppurate almost inevi-
tably, and when the seat of the pus is opened, the suppuration
furnishes incontestable marks of virulence. In the indurated
chancre of the urethra, which is .the most important to recog-
nize, the affections of the glands are inevitable and necessary ;
several glands are affected at once, and they remain indolent
and do not suppurate upon all which conditions, I shall have
occasion to return hereafter.

Finally, if all these conditions have not been appreciated if
these signs have not been seized upon, either because we have
arrived too late or because they have been overlooked, we can
have the certitude, that if the patient has been attacked with
blennorrhagia symptomatic of chancre, six months will not pass
without the appearance of the accidents, if the constitutional
affection has taken place.

We shall have next to examine whether, as a last resource,
it is not better to wait this length of time to give a diagnosis,

1853.] RicorcVs Letters on Syphilis. 217

than to cause the patient to undergo, during the same period,
a mercurial treatment which, alter all, does nut allbrd mure
certainty.

NINTH LETTBB.

My Dear Friend, If I could think that your readers had
remarked the interruption of my correspondence, and espe-
cially if they had complained of it, I should ask of you the
permission to have me excused, on account of other imperious
duties which have taken up the few and short instants which
I could devote to you. I could easily contract the pleasant
and charming habit of these periodical conversations with the
numerous public, that your talent and that of your fellow la-
borers have known how to invite around your Journal. But
you are so rich and so varied in this respect, that my absence
could not cause any loss. I shall, however, do all in my power,
in order that the good will of your readers may hereafter ac-
company me at least as regularly as possible.

I wish to terminate to-day what concerns blennorrhagia, by
some words upon its treatment. You understand that in these
letters, details would be idle and useless. I confine myself to
generalization of all these questions, the developments
making the subject of a special and extended treatise, which I
soon hope to be able to offer to the judgment of my friends.
Here, I touch upon all the doctrines of the Hospital du Midi,
and I ought to conclude that which treats upon blennorrhagia
by some considerations upon the treatment of this disease.

When we see the obstinacy of certain writers on syphilis, in
retaining the old ideas concerning blennorrhagia, recognizing
and admitting only virulent blennorrhagia, it would seem that
these writers ought not to establish the existence of any dis-
charge without applying as soon as possible a mercurial treat-
ment. But, it is not so. The greatest number of them content
themselves with a rational treatment, and among them you
will range M. Vidal, who does nothing but what I do. and
perhaps less, fur in what he has written upon blennorrhagia,
although establishing nowhere, an absolute differential diagnosis
between virulent and benign blennorrhagia, he does not speak
at all of the antisyphilitic treatment properly so called. Look
at the Treatise on External Pathology by M. Vidal, and you
will be astonished like myself, that with his ideas upon the
virulence of blennorrhagia in general, the treatment of my
Colleague sh<uild be so benign.

I have already said a word upon the astonishing and ridicu-
lous custom of those who give copaiba and cubebs for the

218 Ricord's Letters on Syphilis. [April,

blennorrhagia of bachelors, and who reserve mercury for who-
ever wishes to marry. This mode of therapeutics with two
aims recalls to me the history of one of my old colleagues of
the Hospital du Midi. He had in his youth, like many others,
contracted blennorrhagia. At a later period he was to marry
the daughter of an old writer upon syphilis, who was imbued
with the doctrines of the treatment of precaution ; he did not
obtain the hand of his intended except upon the condition of a
long-continued treatment with the liquor of Van Swieten.
The treatment finished, the marriage is accomplished all those
who lived in intimacy with this colleague, and even those per-
sons who were present at his clinical lectures, might have heard
his frequent and bitter recriminations against this treatment of
betrothal. As to the rest, this treatment has been very useless
in the case of our colleague, for he had preserved an habitual
discharge from the urethra, a last and peremptory argument,
which he was in the habit of presenting to the individuals
whom he did not succeed in curing of a similar inconvenience.

Others, more logical in appearance, in admitting the virulent
blennorrhagia, and confessing nevertheless that they cannot
distinguish it from the benign blennorrhagia, give at all hazards
and notwithstanding, a mercurial treatment. Hunter is of this
number, and his manner of reasoning upon the treatment of
blennorrhagia is very curious. If Hunter had no other title to
the thanks and the admiration of the wise, his writings would
not have come down to us, and M. Richelot, your learned and
modest collaborator and friend, would not have gifted France
with his beautiful translation of the works of the great English
physiologist. Let us hear Hunter. The following passage is
not foreign to the question:

" Whatever may be the method adopted for the treatment
of gonorrhoea, whether locally or internally, we must not lose
sight of the fact that a certain quantity of the matter of the
discharge can be absorbed, and show itself afterwards under
the form of constitutional syphilis. To guard against this effect,
I think that small doses of mercury ought to be given internally.
It is not easy to determine at what epoch this mercurial treat-
ment ought to commence ; but if it is true, as I have before
explained, that the syphilitic diathesis once formed cannot be
cured by mercury, while this therapeutical agent has the power
to prevent a similar diathesis from being established, it is im-
portant that it should be commenced early, and should be con-
tinued until the end of the disease, not only until the secretion
of pus has ceased, but also some time after. Mercurial frictions
can be employed, when the stomach and intestines cannot
support the medicine.

1853.] RicoriVs Letters on Syppffi*. 219

"This practice is much more necessary, if the discharge has
existed for a long time, especially when the treatment is com-
posed of simple evacuants only. In fact, when the discharge
IS of long duration, the absorption has mure time to exercise
: and when recourse has been had to evacuants only,
there is more reason to fear that this has taken place, inasmuch
as this treatment has no faculty to expel the virus from the
economy.

" To prevent the establishment of a constitutional virus, the
consequence of the absorption of the venereal pus, it suffices
to prescribe a grain of mercury every evening, or morning
and evening : but it is necessary to continue the employment
of it in proportion to the duration of the disease.

"The success of this practice can never be verified in any
particular case, because it is impossible to say if the pus has
been absorbed, excepting in those cases where it forms buboes ;
and every time that we remain uncertain as to the reality of
the virulent absorption, it is impossible to affirm that a consti-
tutional syphilis will be manifested, if mercury has not been
given : for among those patients who have not taken mercury,
we see few who are attacked with constitutional symptoms,
consecutive upon a gonorrhoea. However it may be, it is pru-
dent to prescribe a mercurial treatment ; for it can be admitted
with reason, that we shall often thus prevent the establishment
of a constitutional syphilis, as takes place when we administer
it to patients affected with chancres or buboes, which under
this treatment would certainly determine a general infection,
sperience has taught us." (Complete TVorks.)

1 ask pardon for this long citation ; you know that it is not
my custom ; but it appeared to me so much more necessary,
as this doctrine serves still as the basis for the reasonings and
the practice of a great number of writers upon syphilis.

Must I first insist upon the manner in which Hunter admits
the constitutional infection from blennorrhagia? It is not the
part actually diseased that infects, it is the pus secreted ! Evi-
dently Hunter has never reflected upon this singular mode of
infection, and those who have followed him do not appear to
have reflected any more.

It is true that this doctrine has been singularlv revised and
augmented. Thus, you will find in a modern writer upon
syphilis, that in blennorrhagia. the infection does not take place
by means of that portion of the mucous sur: ch is dis-

eased, but through the portion of the mucous surface of th*
rt which has remained healthy, this alone having
the power to absorb the virulent muco-pus : from whence it is
necessary, my friend, to draw this absurd conclusion, that if

220 Ricord's Letters on Syphilis. L April,

the entire length of the urethra was diseased, the consecutive
infection would never be feared.

The coques muqueuses of Hufeland are also an emanation
from the Hunterian doctrine. You know that he pretends that
if the blennorrhagia does not oftener infect, it is because the
pus is enveloped in some small mucous follicles {coques), from
which it has not always the power to escape.

Let us return to Hunter, and be painfully surprised to see
this great mind wishing to prevent infection by mercurial
treatment, assuring us that the longer the disease has lasted,
the more chances there will be of infection, and the more it
will be necessary to give mercury : and not perceiving that if
the mercury only acts by preventing the infection, its admin-
istration would be useless after a long continuance of the blen-
norrhagia, inasmuch as the infection would be already established
and the mercury would have no power upon it. Be astonished
that in spite of his uncertainty upon the action of mercury
against the infection, he affirms in a manner so absolute its
efficacy in doses so rigorously and mathematically determined!
Be confounded, at not meeting in the passage cited but a tissue
of wrong constructions and of contradictions. The mercurial
treatment the most ordinarily excites blennorrhagic discharges,
and Hunter wishes that it should be continued until the com-
plete cessation of all secretion! How many patients, whose
discharge does not stop, would be thus condemned to mercury
forever ! My colleague, of whom I lately spoke to you, would
have been literally choked with mercury. What wrould have
become, under the weight of a treatment so prolonged, of an
old soldier whom I attended, who contracted blennorrhagia at
the peace of Amiens, and who had it still in 1845 that is to
say, for more than forty years ?

This entire doctrine of Hunter is lamentable from its discrep-
ancies. Shall I afford myself the pleasure of demonstrating
this singular confession " The success of this practice can
never be verified" ; and that one, more singular still "We
see few patients who are attacked with constitutional symp-
toms consecutive upon a gonorrhoea." Is not every question,
dear friend, even from the confession of Hunter, reduced to this
that the mercury is useful only in the small number of those
patients, whose blennorrhagia is due to a urethral chancre !

Thus everything, even error, comes to confirm the exactitude
and the truth of the doctrine of the Hospital du Midi.

Lastly, the treatment of blennorrhagia brings us again into
the presence of the theory of the half-way treatment of M.
Lagneau, who regards blennorrhagia as a light form' of syphilis,
and advises against it a demi-treatment. We see peep out

1853.] RicorcTs Letters on Syphilis, 221

here the demi- virus, and the demi-\ itulence, of our brother at
Lyons, M. Baumes.

Demi-treatment I Light form of syphilis I Alas! there is
unfortunately nothing light as regards the verole, unless it be
the certain opinions of very grave men. Syphilis exists, or it
does not exist. \( there is syphilis, a treatment as complete as
possible is necessary ; we must make use of all the guarantees
that a serious and methodical treatment can give. Ii the verole
dues not exist good heaven, for what good is an anti-syphilitic
treatment 1 How must we treat simple benign blennorrhagia ?
I repeat again, that I confine myself to the generalities of the
question. First, one word upon the abortive treatment. You
know all that has been said upon repercussion, upon the theory
of the wolf shut up in the sheep-fold ; you are aware of all the
apprehensions which have been manifested in regard to the
metastasis and the wandering about of the virus in the econo-
my, occasioned by the abortive treatment of blennorrhagia.
This doctrine has always astonisned me in presence of the
facts which present themselves in crowds, and that, too, every
day in practice.

First, it is incontestable that the greater part of the accidents
to which blennorrhagia can irive rise, never manifest them-
selves before the end of the first week ; and it is from the se-
cond week, and most generally later, that we see these accidents
take place.

On the other hand (and those who frequent the Hospital du
Midi well know it), the greatest nun\ber of these accidents
manifest themselves only in those cases of blennorrhagia where
no treatment or an insignificant one has been made. Do you
wish me to give you a singular proof of this? Here let me
inform you incidentally that I profess a great deference for
medical statistics, that preci(Jus instrument, which managed as
it has been by the skilful hands of M. Louis, has rendered such
incontestable services to our science. But M. Louis is the first
to recognize and to proclaim that nothing is more difficult and
more delicate than medical statistics; nothing which by its
faults, or by its vicious application, could conduct to greater
deceptions or to more deplorable errors. This profession of
faith being made, I hope that no one can consider as an attack
against statistics, or as a mockery of that precious instrument
of research, what I am going to say relative to the causes of the
accidents produced by blennorrhagia.

I said that the abortive treatment of blennorrhagia was very
innocent of the accidents which may be manifested in the
course of this disease. Do you know, in truth, what the statis-
tics absurdly interpreted would teach in this respect ? Why

222 Ricord's Letters on Syphilis. [April,

that the most frequent antecedent of epididymitis is flax-seed
tea. I possess upon this point enormous statistics, and the stu-
dents of my clinique wait every day with an hilarious impa-
tience, this final question, which I never fail to address to the
patient affected with an epididymitis have you taken flax-seed
tea ? The answer is inevitably affirmative.

What shall we conclude from these statistics and facts ?
Evidently that epididymitis, like the other accidents of blen-
norrhagia, is neither a repercussion nor a metastasis, nor any of
those chimera by which some have desired to oppose the time-
ly and abortive treatment of blennorrhagia.

I am profoundly convinced by my observation and by my
long experience, that a blennorrhagia arrested the first days of
its appearance, far from being followed by those accidents
which are feared, will prevent, on the contrary, the manifesta-
tion of them. The abortive treatment of blennorrhagia is at
the same time the prophylactic treatment of the consecutive
accidents. Thus, in my practice, I have adopted the abortive
treatment applied at the first moments of the appearance of the
blennorrhagia. This is a point of doctrine upon which I
cannot too much insist the commencement of the disease is
known, its end and its consequences are always uncertain. It
is, then, of great importance for the patient to disembarrass
himself of his discharge as soon as possible. In spite of an old
prejudice of which the practice of Bell could be the pretext, I
profess, that the injections which constitute one of the most
important parts of the abortive treatment, far from producing
strictures of the- urethra, as has been said and still repeated,
form the best abortive treatment for these strictures. We can
be assured that the quicker a discharge shall be arrested., the
less shall we have to fear the organized alterations of the ure-
thra; these latter are, as for alF other mucous surfaces, the
consequence of the duration of the inflammation. I well know
that here, again, statistics have been invoked, and that cases
sufficiently numerous have been brought forward, in which
strictures have manifested themselves after injections. But
this is a little like the flax-seed tea in the cases of epididymitis.
From this fact only, that injections are found among the ante-
cedents of stricture, we must not infer a relation of cause to
effect.

Analyze well these observations and you will see that it is a
question of long-standing cases of blennorrhagia which have
resisted every thing even injections ; it is precisely because
these injections have not cured the inflammation, that the stric-
ture has followed which fact does not necessarily imply their
unskilful or untimely employment.

1855.] Scrofulous and Rheumatic Inflammation. 891

I do not wish to terminate this letter, my clear friend, without
saying a word upon the prize which my honorable colleague
ami friend, ML Diday, of Lyons, has just established. S ou
knw that he offers the sum of 300 francs to whoever shall
bring to him (en observations upon simple blennorrhagia which
shall have produced constitutional syphilis. This idea is good,
but do you think it sufficiently generous? Thirty francs for
each observation so ditficult to find frankly, is it enough ? I
consider as beyond price one single fact of syphilis coming on
without syphilitic cause ; thus I shall not establish any price
upon this point. Let my wise and spiritual friend permit me
to say to him, that he would neither compromise his present nor
his future fortune, in increasing a hundred fold the value of the
observations which he demands. [Boston Medical and Sur-
gical Journal.

On Scrofulous and Rheumatic Inflammation of Joints. By
Edward Stanley, Esq., F. R. S., Surgeon to St. Bartholo-
mew's Hospital.

[Mr. Stanley remarks upon the difference in the frequency
with which certain joints are attacked by disease, and how
exempt others seem to be from the like affections. An exam-
ple of the former fact may be taken in the hip and knee-joints,
and of the latter in the lower jaw, the sterno-clavicular articu-
lation, or the heads of the ribs with the vertebrae. Some
explain this by their greater or less exposure to external influ-
ences ; but this cannot be the case, else why should the hip be
more frequently attacked than the ankle-joint ? Others say
that joints are more susceptible from the activity of their
functions; but few joints are more exercised than the lower
jaw, and vet few are more free from disease. After a few ob-
servations on some cases of anchylosis of the lower jaw he
proceeds :]

I now come to the consideration of strumous inflammation of
joints, and before proceeding to investigate its phenomena, the
following questions demand attention : 1st. What are the cir-
cumstances which would lead us to regard the disease as
strumous, when brought to the bedside of a patient? 2nd. In
what condition should we expect to find the structures, viz.,
the bones, cartilages, and synovial membranes of a joint, pro-
vided the be strumous? With reference to the first
Question, 1 am unacquainted with any local symptom, any
precise condition in the affected joint itself, which would ena-
ble us at once to decide on its strumous nature. We must look

224 Scrofulous and Rheumatic Inflammation. [April,

elsewhere. The age and aspect of the patient, the past or
present existence of scrofulous disease in other parts, such
as enlargement and suppuration of the cervical absorbent
glands, strumous ophthalmia, tubercle in the lungs and otfcer
organs, any of these, especially if actually co-existent, would
justify us in regarding the disease as scrofulous. Often, indeed,
these cases are obscure, and sometimes we are led to a wrong
conclusion. The aspect of the patient is delusive, and should
not be too much relied upon. Many instances occur in which
the patient's appearance seems indicative of the existence of
scrofula, whose subsequent progress and favourable recovery
prove that such evidence is fallacious.

We have now to answer the second question. What is the
state of a joint invaded by strumous disease? The morbid
specimen I now exhibit shows the condition of the articular
extremity of a bone in an extreme attack of this nature. The
end of the bone is softened from absorption of its earthy matter,
and its cancelli are filled with tuberculous deposit. It is, how-
ever, according to my experience, rare to meet with so com-
plete an example of strumous disease as this specimen furnishes.
In the majority of cases, I believe that no tubercular matter is
found deposited, and when found, it is only in the last stages of
the affection. Such a condition of bone, when it does exist, is,
in my opinion, irreparable ; and, when the surgeon is summon-
ed to a case exemplifying the disease in this its latest stage, he
can do nothing to restore the bone to its natural state, nothing
to accomplish a cure. There is, however, an earlier stage in
these affections, which you will often have to treat in private,
although it is seldom seen in hospital practice a stage amena-
ble to treatment, a stage in which, generally speaking, the mor-
bid impairment of the bone may be arrested, and its integrity
restored. It is characterized by increased heat, and enlarge-
ment of the bone, immediately above the joint. There is, indeed,
increased vascularity, and low inflammation of the bone, which
is quickly followed by expansion of the cancellous texture, and
absorption of earthy matter. Ultimately in bone thus degener-
ated, tubercle is sometimes deposited. Such, then, is the state
of the bone in a joint affected with struma. The other struc-
tures, the cartilages, synovial membrane, &c, are in a state
of low inflammation, inflammation which has commenced either
in the bone or the synovial membrane itself, and which, if suf-
fered to advance, is followed by its usual consequences,
exudation, thickening of tissues, and sometimes suppuration.
Now the appropriate treatment for an attack of this sort is, per-
fect rest for the limb, and removal of all weight and pressure
from the inflamed joint, so as to insure, as far as possible, its

1853.] Scrofulous and Rheumatic Inflammation. 225

complete tranquillity. If Inflammation exists in any activity.

the judicious application of leeches will be beneficial; but it
should be borne in mind that leeches must not be lavishly em-
ployed, as strumous patients cannot stand depletion. The
remainder of the treatment is constitutional, and should be
directed to the restoration of the general health, if that has fail-
ed ; to its maintenance if it has not. To this end country air,
or, where it is practicable, a resort to the sea side should be
recommended ; a light, nutritious diet enjoined, and the state of
the stomach and bowels be carefully attended to. The follow-
ing particulars of a case which occurred to me some years ago,
illustrates forcibly the truth of my observation, that the articu-
lar ends of bones rarely become the seats of tubercular deposi-
tion, even in well-marked examples of strumous disease.

A boy, ten years old, was under my care for scrofulous
enlargement and suppuration of the cervical glands. While in
the hospital, hip disease supervened, evidently of strumous char-
acter, which ultimately wore out the patient. Examination of
the body showed that the joint was disorganized ; the soft tis-
sues around were infiltrated with tubercular deposit; the cap-
sule and articular cartilages partially destroyed by ulceration;
the bone was dislocated on the dorsum ilii ; the acetabulum
widened, and containing tubercular matter. The mesenteric
and other absorbent glands were infiltrated with tubercle.
Tubercular ulceration was present in the intestinal canal. How-
ever, when a longitudinal section of the head of the femur had
been made, no tubercular deposit was found in the interior of
the bone. Absorption of earthy matter, and widening of the
cancelli, had taken place, but no interstitial tubercle existed.

Not infrequently disease in the soft tissues around a joint,
inflammation, and abscess, are mistaken for disease inside the
joint : and. in some instances, eminent surgeons have amputa-
ted limbs under the impression that an irremediable articular
affection existed, while, in reality, the exterior tissues alone
were involved, the joint itself being sound.

Joints are liable to another form of inflammation, differing
from that we have just reviewed, "rheumatic inflammation.''
Examples of this disease occur generally in combination with
rheumatic fever, and are. therefore, more prevalent in the medi-
cal than in the surgical wards of the hospital. The diagnosis
of articular rheumatism is not usually difficult. When rheu-
matic fever is present, it is, of course, obvious; but when it is
not. the implication of other joints, the cnuse and symptoms of
the attack, and the history of prior rheumatism, will generally
guide us to a right decision : the implication of other joints,
because it is extremely rare to find rheumatism affecting one

226 Scrofulous and Rheumatic Inflammation. [April,

joint only; it attacks two or three simultaneously, or flies about
from one to another : the cause and symptoms of the attack,
because we shall almost invariably find that the patient has
been exposed to cold, or dampness, and because muscular pains
are generally precursory to the articular inflammation. Rheu-
matic disease thus induced, is commonly marked by pain in
one particular spot; the patient does not complain of general
pain in the joint, but points to one especial locality, and de-
scribes it as the seat of all his suffering.

Articular rheumatism is, moreover, intractable, leaving one
joint and assailing another, or departing and recurring in the
same joint. Joints are attacked by rheumatic inflammation in
two ways; either their fibrous structures, their ligaments, suf-
fer, or their sinovial membranes. Now the consequences of
rheumatic inflammation of the ligaments may be serious, such,
indeed, as may terminate in dislocation of the bones of a joint.
For, under its influence, the ligaments become soft and elonga-
ted, so as to permit the bone to slip out of the cavity in which
it is naturally fixed. In this way the head of the femur may be
displaced upwards on the dorsum i 11 i without rupture or ulcer-
ation of either the capsula or the ligamentum terres. An ex-
ample of such an occurrence happened some years ago in the
practice of Mr. Lloyd.

A painter, in the enjoyment of good average health, was in
the habit each morning of taking a warm bath. After having
done so on one occasion, he experienced a pain in the hip-joint;
one of the joints of the fingers also became swollen and infla-
med. He consulted a medical man, who gave him hopes of
speedy recovery. Nevertheless, he remained in bed five
weeks, after which, the pain having subsided, he was told to
get up : this he found himself totally unable to do, and, on ex-
amination, the limb was found to be shortened and inverted,
the head of the bone having been dislocated on the dorsum illi.

A case has also been related to me by Dr. Latham, in which
articular rheumatism of long continuance produced dislocation.
Some years ago, a young woman was in the hospital, under the
care of Mr. Lawrence, suffering from rheumatism in the hip
and wrist joints. She was confined for some time to her bed,
and when permitted at length to get up found that she was
lame, and that the lameness grew gradually worse. After a
while she experienced a sensation as if the bone slipped from
the socket when she walked. On examination, the limb was
found of natural length, and its movements complete ; rotation,
however, was remarkably free ; and when the thigh had been
flexed on the pelvis, and was then rotated, the head of the bone
could be evidently felt to pass over the brim of the acetabulum,

1853.] Scrofulous and Rheumatic Inflammation. 227

Cases like these illustrate the unusual results of a very com-
mon affection, which, although often obstinate and tenacious of

existence, generally terminates well, leaving an unimpaired
joint behind.

Rheumatic synovitis commonly ends in effusion. Ulceration
of the articular cartilages may, however, supervene ; and I have
witnessed a case in which this condition was set up within nine
weeks from the commencement of the attack, so that it was
found necessary to amputate the limb. More usually, however,
rheumatic synovitis gives rise to anchylosis, such anchylosis as
may result from the adhesion of opposite synovial surfaces by
effusion of fibrin, and which, as I have explained in an early
part of the lecture, is called spurious, in contradistinction to
true or osseous anchylosis.

Gonorrheal rheumatism is a form of the disease occurring
in conjunction with gonorrhoea, brought on by exposure to the
vicissitudes of weather, and to the development of which, a
certain unhealthy constitutional state appears necessary. Un-
like ordinary rheumatism, it confines itself to one or two joints,
and unshiftincr, clings to them with remarkable tenacitv. It is,
in truth, an affection that has long bafiled the powers of medi-
cal surgery. In many instances the patients appear to recover,
but the complaint returns on the slightest exposure, and no per-
manent cure is effected. There is now under my care, in
Lazarus, a Pole suffering from gonorrhceal rheumatism of the
wrist joint. In him the disease has yielded for the present to
three grain doses of the iodide of potassium, given three times
daily; and I am informed that the gonorrhceal discharge, which
had become scanty, has reappeared since the mitigation of the
articular disease. The best possible termination in these cases,
a termination which has ensued in the instance I have men-
tioned, is serous effusion into the joint ; for when the fluid is
absorbed, it is not unlikely a useful joint may remain. Some-
time back, a young man, aged twenty-one, was my patient in
the hospital, in consequence of a most acute attack of rheuma-
tism in the shoulder-joint, following gonorrhoea. Though he
was in a reduced state, I ordered him to be bled from the arm ;
mercury was administered ; in fact, very active treatment
adopted. Serous effusion in the joint resulted, and with-
in five weeks I had the gratification of seeing him leave the
ital with the functions of the joint in a great measure re-
stored.

We occasionally meet with examples of rheumatic synovitis
occurring after parturition, which may originate anchylosis.
The affection differs in no shape from ordinary rheumatic syno-
vitis ; but it requires gentle treatment, as the patients attacked

228 Pressure in Chronic Enlargement of Bones. [April,

by it are generally much debilitated, and frequently suffering
from some uterine complication. [Medical Times and Gazette,
Braithwaite^s Retrospect.

Simple mode of applying Pressure in Chronic Enlargement
of certain Bones, 6fC. [Dr. Inman, of Liverpool, records
the following case :

M. C, a delicate girl, three years of age, had a swelling of the
left knee-joint, which was three-quarters of an inch larger than
the right, due to an enlargement of the head of the tibia and
condyles of the femur.]

Considering this to be a case more likely to be benefited by
steady pressure than by more severe remedies, I had recourse,
at first, to strapping ; but finding this of no use I directed the
mother to procure a piece of thin vulcanized India-rubber cloth,
which she was to shape to the knee, allowing an interval in
front of about three-quarters of an inch. The edges were to
be bound by a piece of thin leather, and a piece of wash leather
was to be placed as a tongue between the laced portion and
the knee. Holes were to be made in the cloth behind the bind-
ing, and the whole was to be laced like ladies' stays. The
elastic was to be worn during the day and night. Exercise
was not prohibited, and no medicine was ordered. I saw her
again in ten days. The bandage had been worn for fourteen
hours daily, and taken off at night. The knee was reduced a
quarter of an inch in circumference.

In ten days she called again, complaing of pain and oedema
of the leg, in the. evening, from pressure. On removing the
elastic, whose edges now overlapped, I found the knee restored
to its normal size and shape. The child could run about with-
out pain or inconvenience. I directed the disuse of the band-
age, unless the swelling should return; and told the mother,
that, though I could not promise that there would be no return
of the complaint, I considered the child as cured.

It is unnecessary to make any long comments upon this case.
The fact of a morbid deposit in bone being absorbed, or, I might
almost say, a threatened white-swelling, cured in three weeks,
without blisters, issues, or caustics, without confinement, or
even complete rest, is sufficient to speak for itself. Of course,
such a plan can only be adopted when there is no reason to
believe that active inflammation or purulent deposits are pre-
sent, and where there is no severe pain.

The only novelty in the idea is, probably, the kind of elastic
adopted, which is superior to the elastic web, both on account
of its cheapness and its smoothness. [Ibid,

!

1853.] Dislocations of the Hip-join! .

A \ \i , , Dislocations of the Hin-joi

Pulleys or other mechanical means. By W. W. Reio, MA).,
of Rochester, N. 5f.

On the 13th mber, 1849, Dr. Moore, having a subject

in process of dissection by bis students, proposed to me, that we

t up the muscles of the hip-joints, leaving them in situ :
dislocate the bones and then operate on them by traction in the
usual way, and also by flexion, alter my method, in order that
we might observe the condition and action of the muscles, be-
fore and during both modes of operation.

We found it impossible to force the head of the bone through
the capsular ligament, till we had made a slight incision into it.
The bead then shot through it, tearing it sufficiently to permit
its passage, but the ligament seemed to fit close around the neck
of the bone. As the head passed out, backwards and upwards,
it caught the tendon of the pyrifbrmis, tearing it off as it passed
underneath and above it, which it' it had remained entire, v
have brought its tendon like a cord across the neck, below and
close to the head, lashing it closely down to the dorsum of the
ilium. We were at the time inclined to attribute its rupture
rather to the decayed state of the subject than to excessive dis-
tention by the dislocation. But precisely the same thing oc-
curred in di>! the other hip, although we endeavored
to avoid it by pushing the bone in a different direction, but
as the insertion of this muscle is at the root of the trochan-
ter, it is evident it must obey its movements, and therefore
preserve nearly the same relation to it and the head of the
bone ; whatever direction it takes in being dislocated back-
wards, that is, whether a little more obliquely downwards or
upwards.

When dislocated, the head of the femur rested on the gluteus
minimum muscle ! The gluteus medius and maximus, psoas
.us. illiacus interims, adductor, triceps and pectineus, were
shortened and relaxed. Posteriorly, the obturator internus,
gemelii and quadratus were greatly strained, and it was appa-
rent that the piriformis, if it had not been torn off, would have
been more stretched than they. Anteriorly, the obsturator
externus was stretched, seemingly to its utm- ; fully

adducting the bone, and thus preventing abduction and rota-
tion.

Alter carefully noting the relative position of the bone and

muscles, we made traction on the femur downward and inward

the sound limb, as we are directed by most authors; but

the moment the attempt was made the muscles already named

as being in a state of tension, became more tense, and bound

N. S. VOL. IX. XO. IV. 15

230 Dislocations of the Hip-joint. L April,

the head of the bone more firmly down on the dorsum; although
all the muscles about the joint were separated from each other,
were loose, without vitality, and almost in a state of decompo-
sition; yet it was with great difficulty that we could bring
down the head into its socket ; and when we did so, we carried
away a part of the capsular ligament ; and if the pyriformis
had not been torn off already, it seemed impossible that it
should escape rupture now. But when we abducted, flexed,
and carried the limb over the pelvis, as has been described, the
reduction was effected with great ease. We repeated and va-
ried our experiments on both joints, as often as the subject
would admit, and always with the same results. I was here
enabled to correct one error which I had committed in opera-
ting. If we carried the knee above the umbillicus and pressed
the thigh close to the body, on a line with the side, the pointing
towards the axilla, as I have always done, we brought the
great tendon of the gluteus maximus into strong tension, which
would compress the trochanter so hard that it prevented
the head from mounting over the edge of the acetabulum.
The reduction was effected much easier by carrying the
knee as high as the umbilicus, then abducting and rotating
the thigh.

From the foregoing facts and observations, I think we may
justly deduce the following propositions :

1st. The chief impediment in the reduction of recent dislo-
cations, is the indirect action of muscles that are put upon the
stretch by the mal-position of the dislocated bone, and not by
the contraction of the muscles that are shortened.

2nd. That muscles are capable of so little extension beyond
their normal length, without hazard of rupture, that no attempt
should be made to stretch them any farther, in order to reduce
a dislocation, if that can possibly be avoided.

3rd. The general rule for reducing dislocations should be,
that the limb or bone should be removed, flexed, or drawn in
that direction which will relax the distended muscles, and not
by extension and counter-extension, for the simple purpose of
overcoming the supposed contraction of muscles.

4th. Dislocation of the femur on the dorsum iili, an accident
heretofore esteemed so serious to the patient, and so formida-
ble to all surgeons, is reduced with the greatest ease in a few
seconds or minutes, without much pain, without an assistant,
without pulleys, without Jarvis's adjuster, or any other me-
chanical means, simply by flexing the leg on the thigh, car-
rying the thigh over the sound one upward over the pelvis,
as high as the umbilicus, and then by abducting and rota-
ting it. [Transylvania Medical Journal

1853.] Observations on Diseases of the Ear. 231

Practical Obs s on Diseases of the Ear, with records

of Cases. By W. R. Wildb, sq.

Condyloma of the external meatus. M. D. L., a female, 25,
a seamstress, Buffering from deafness, tinnitus, occasional pain,
fetid and sometimes bloody discharge from left ear for eight
months; is otherwise healthy: attributes her affection to cold.
The external meatus is completely closed by several condylo-
mata which grow around its margin1, but particularly from its
lower edge. They are rather sensitive to the touch, lobulated
on their surface, project a considerable distance beyond the
margin of the aperture, and are a little more florid in colour
than the natural skin. When the tragus is pressed backwards
with the finger, a muco-purulent and offensive discharge ex-
udes between these growths. It is not possible to insert even
a small-sized speculum into the meatus without causing great
pain and irritation. She could only hear the watch on touch-
ing. The right ear was normal. They were touched with the
solid nitrate of silver, after which a poultice was applied. The
subsequent treatment consisted in washing over the morbid
growths with a strong solution of nitrate of silver every second
or third day, and in the intermediate time, keeping a dossil of
fine lint, wet with diluted liquor plumbi, applied to the concha,
besides the internal administration of Plummers pill and sarsa-
parilla. By persisting in this treatment for upwards of two
months, the condylomata disappeared, leaving the meatus na-
tural, when the membrana tympani was found unimpaired, and
the hearii restored.

I have seen a case of cutaneous cancerous ulceration, extend-

om beneath the zygoma, which had quite eaten away the
tragus, completely occluding the external meatus; but the most
common causes of the diseases are eczematous and herpetic
eruptions, and chronic erysipelas, as detailed in the two subse-
quent cases.

Eczema Aurium, thickening and closure of meatus audilorius
externus. M. Q., female, 00, has been deaf, "off and on/' for
several years past, accompanied by noise and wandering pains
in the head, with extreme itchiness in the auditory passages.
The skin covering the auricle, and the scalp adjacent thereto,

I fiery red colour, speckled with patches of yellow, form-
ed by the exudation which has collected in thin branny scales
all over it. The parts are hot, and in some places sticky, from
a thin ichorous matter which exudes from the surface. The
auricle has lost its natural shape, its folds and sinuosities being

illy obliterated, and it has become hard, thickened and
lumpy. The external auditory aperture has, owing to the dis-

232 Observations on Diseases of the Ear. [April,

ease extending into it, been lessened to a third of its natural
size, and it is filled with a branny scurf. Upon removing the
latter impediment, we can obtain but a very partial view of the
membrana tympani, which appears to be thickened and opaque.
Hearing distance, touching. The state of the parts is nearly
the same on both sides.

In examining diseases of the external meatus and auditory
tube, I find a small silver instrument, shaped like a blunt gorget,
very useful.

Cases of this description, and, like this, of long standing, are
very hard to manage, because there generally co-exists some
constitutional taint, as shown in the cutaneous eruptions often
manifest in other portions of the skin, and because the parts
now under consideration have become so much altered in form
and texture that it requires a long course of treatment to re-
store them to their natural condition, and thereby re-establish
their usual functions. The disease principally occurs in fe-
males in middle and advanced life ; but it also happens to chil-
dren from six to twelve years of age. In the latter, however,
it is of a much more active nature, at the same time that it is
much more amenable to treatment. In young persons the
eruption often co-exists with scald head, and in both young and
old, if the disease is allowed to exist for any length of time, it
extends into the meatus, and even over the surface of the tym-
panal membrane, which it thickens and renders opaque. In
old persons a collection of branny scales accumulates in the
external tube. In young persons a thick creamy discharge
will generally be seen coating over the lining of the tube and
the external layer of the membrana tympani.

Cleanliness and attention are indispensable to the eradication
of these affections. In the first instance, continual poulticing
with any emollient substance which keeps up heat and moist-
ure is necessary. Linseed meal, boiled bread and milk, or
well-mashed turnips will be found useful applications. After-
wards when the extreme heat, swelling, vesication, and redness
have subsided, a solution of the liquor plumbi, in the proportion
of a drachm to the ounce, applied with several bits of fine lint,
so as completely to envelope the auricle, and the evaporation
prevented by covering over the whole with a piece of oiled
skin or thin gutta percha, rarely fails to lessen the irritation
and reduce the parts to a healthy condition. But while we
employ these local measures, we must not neglect constitution-
al means. Strict attention to diet should be enforced ; salt
meats, savoury dishes, and pastry ought to be avoided, and a
sufficient quantity of fresh vegetables should be consumed at
dinner. After the patient has been well purged, a course of

1853.] Observations on Diseases of the Ear. 233

Plummer's pill may be prescribed with advantage at least five
grains daily for an adult : and, in a little time, some of the pre-
parations ofsarsapariUa administered in lime water will hasten
the cure, and assist to eradicate the disease from the system.
This affection is very apt to relapse, and we should therefore
continue both our local and constitutional remedies long after
the inflammatory symptoms have subsided. Old ladies think
they never can have a suflicient amount of warmth about their
head, and it is very difficult to induce them to leave oft' even
one flannel nightcap ; but we should at least make the attempt,
as the head and ear ought to be kept as cool as possible. As
the swelling and inflammatory symptoms subside, we should
again turn our attention to the state of the auditory tube. If
any discharge exists, the meatus should be syringed gently with
tepid water daily ; and both it, the concha, and the tympanal
membrane, washed over every second or third day with a so-
lution of nitrate of silver of the strength of at least twelve
grains to the. ounce. Still more advanced in the progress of
this treatment when the exudation has completely ceased and
the thickened cuticle has been quite removed, much benefit will
be derived from smearing over the tube and membrana tym-
pani with brown citrine ointment every third or fourth day.
This latter remedy, of which I have great faith in all diseases
similar to that which we are now considering, should be made
with either rape or cod-liver oil instead of the lard or butter
usually directed in the Pharmacopoeias. It is then of a much
darker colour, and never becomes hard or crumbly. It should
be applied in a melted state with a camel's-hair pencil, and dilu-
ted by about one-third of almond oil.

Chronic erysipelas of auricle. T. M., female, 52, has had
frequent attacks of erysipelas of the head and face during the
last five or six years. The effects of the disease are, however,
now manifest only in the external ears, but more particularly
the right. The auricle is not much enlarged, but has become
hard, inflexible, and resembles a piece of wet thick sole leather ;
its fossae being apparently filled up by subcutaneous deposit.
It is also somewhat shortened in its antero-posterior diameter.
The skin is of a dusky brown colour without any exudation,
eruptions, or crusts upon it, but to the feel it is lumpy and
nodulated, like what we find in certain forms of elephantiasis.
The lobe in particular presents this thickened appearance.
The cfiseai [tended some way in front of the site of th?

tragus, which is also thickened and lumpy. The meatus is
nearly closed. The treatment of this disease is very similar to
that of the forego

Dr. Kramer relates cases of scirrhous degeneration of the

234 Observations on Diseases of the Ear. [April,

auricle, but it would appear that he has applied the term to
cases similar to that now under consideration.

Enlargement of the sebaceous follicles in the concha fre-
quently present in pale, cachectic persons labouring under aural
diseases. They are easily recognized by their dark heads, and
can be pressed out with a pair of forceps. Besides these ecze-
matous eruptions which I described in one case, many other
cutaneous diseases affect the auricle, particularly in children.
You are all aware of the excoriations which take place in in-
fants behind the ears during dentition, and of the popular belief
that they are salutary. Cleanliness is their chief cure when it
is advisable to heal them up. We have a disease in Ireland so
prevalent in some countries, that it would appear to be one of
our national maladies pemphigus gangrenosis, first described
by the late Dr. Whitley Stokes, and of which I have given a
description in the medical memoir attached to the Census of
1841. So fatal is this disease among children that no less than
17,799 deaths have been attributed to it in ten years ; and as it
is a disease very well known to the lower orders, I am inclined
to think that the amount has not been exaggerated. It goes
under different local names, but the most common are " morti-
fying hive," "burnt hole," and " black ear ;" the latter from its
so frequently appearing behind the ears and upon the auricles.
In the Irish it is styled ithcheadh, or the eating disorder, from
its phagedaenic character. The vesicles, or bulla? peculiar to
this affection, generally leave an indelible irregular lace-like
depression, similar to that of vaccination.

Anomalous tumour in the external meatus. M. N., female,
aged 47, has been deaf of the right ear for many years, and is
much annoyed by itching and a stuffed feeling in the meatus.
Upon inspection we find a tumour in shape, size and colour, re-
sembling a half-ripe mulberry, occupying the anterior and
lower edge of the meatus, and extending some way into the
auditory tube, which it almost completely blocks up. It is not
unlike that disease known here as button scurvy, and to which
the late Dr. Wallace, of this city, gave the name of morula.
It is attached by its broad base throughout its whole extent,
and has neither enlarged nor extended for the last three years,
during which time I have been in the habit of examining it
occasionally. The patient never had otorrhcea, and there is no
discharge now present, but occasionally the tumour becomes
painful and irritable, and its colour deepens from a florid red to
a purple. It is now of a firm consistence, corrugated on its
surface, and has a firm unyielding feel, quite unlike a naevus,
for which at first sight it might be mistaken. I will not meddle
with this tumour at present, as I once saw an affection very

1853.] Glycerine in certain forms of DeafneM. 285

similar ill appearance in a lady about this woman's timeoflife
end in frightful cancer, apparently from an endeavour to re-
move it by escharotics.

We meet with various other growths in the externa] meatus
and auditory tube, independent of polypus or Other morbid pro-
duets, resulting from inflammation or its consequences. One
of the most frequent of these is exostosis, of which I have seen
very many examples. The projection generally grows from
the posterior edge of the osseous portion of the tube, and slow-
ly, but gradually projects forwards, so as to leave but a slight
crescent-shaped fissure between it and the anterior wall of the
meatus. The integuments covering such growths are general-
ly very smooth, white, and polished. I have never seen this
disease affect both ears, but I have often remarked it in con-
nexion with inflammatory ailections both of the external tube
and the membrana tympani. Autenrieth has given an account
of one of these growths, and lately Mr. Toynbee communica-
ted a valuable paper on the subject to the ' Provincial Medical
and Surgical Journal.' We had lately at the hospital a young
woman in whom the external meatus was closed by a dense
membrane, through which, when an incision was made, a probe
introduced into the wound came in contact with the bone. As
the patient had never heard on that side, and had never suffer-
ed from any aural disease in infancy, as well as from the cir-
cumstance of there being no bony meatus, we must consider
that case as one of congenital defect, of which there are several
similar examples on record. I have on two occasions, in pri-
vate practice, seen a structure of the auditory tube at the junc-
tion of the membrano-cartilaginous and osseous portions, in one
instance so small as only to admit the round extremity of an
ordinary dressing probe. Hardened cerumen having accumu-
lated behind it, it was with great difficulty removed. [Medical
Times and Gazette.

The Use of Glycerine in err lain forms of Deafness. By
David Steel, M. D., of Petersburg, Va.

Having read with some interest in the London Lancet an
account of the use of glycerine in some of the most common
forms of deafness. I feel it my duty, for the benefit of those who
do not get the Lancet, to lay before them the result of my ex-
perience with this agent in some few cases that have come
under my treatment.

July 17th, 1852. M 55, of scrofulous hibit, com-

plains of deafness, with a constant rumbling noise in both ears.
He stated that he has been in this situation for the last two

236 Glycerine in certain forms of Deafness. [April,

years ; thinks it proceeded from a severe cold taken about that
time. Present condition: natural secretion wanting; aural
canal dry and shining; membrana tympani slightly ulcerated
in one. Ordered them to be well cleansed with warm water,
which brought away some small lumps of hardened cerumen.
Afterwards applied, by means of a fine camel-hair pencil, a
sol. of argt. nit. grs. x, aq. distill j, to the ulcer, and at the
same time counter-irritation behind both ears by means of the
ungt. cantharidin. After healing the ulcers, I directed the
patient to take a small piece of cotton or wool, well saturated
with glycerine, twisted into a small roll, and inserted into both
ears as far as the membrana tympani. This to be continued
night and morning, cleansing them well previous to its applica-
tion. Patient being of a scrofulous habit, directed the follow-
ing: fy. Hydrg. bi-chlor. gr. j ; antim. et potass tart. grs. ij ;
ext. sarsaparilla 3ss. M. Ft. Pil. mass dividend xx. One
sum. ter die.

July 27th. Patjent discharged, well.

July 29th. R , aged 0 : his mother stated that he could

not hear her, unless spoken to in a very loud tone of voice, and
that there was a continual watery discharge from both ears,
which, to use her own expression, "soils his clothes so much
that I cannot keep him clean." In this case the membrana
tympani in both ears were slightly ulcerated. All these symp-
toms supervened upon an attack of measles six months previ-
ous. Ordered, as in first case, ears to be well cleansed with
warm water, and applied a solution of argt. nit. grs. v ; aq.
distill 3 j. After the ulcer healed, directed glycerine, as in the
preceding case.

Aug. 25th. Patient discharged, well.

Aug. 11th. T , aged 23, stated that about four months

previous he had an attack of erysipelas in his head, which, by
suitable treatment, was soon conquered, but left him in his pre-
sent condition, viz., deafness in both ears, a constant, loud,
rumbling noise, and a thin watery discharge from each, which,
he says, "is very disagreeable." No ulceration of the mem-
brana tympani ; directed ears to be cleansed with warm water,
and the glycerine applied as in the preceding cases.

Sept. 1st. Patient discharged, well.

Aug. 19th. D , aged 29, a native of New York, stated

that when in that city he had an attack of acute inflammation
of the internal and external ear, which, by appropriate remedies,
w7as soon relieved of the heat, pain, swelling, &c, but left him
with deafness and a disagreeable crackling noise in one ear.
Directed same treatment as in case No. 3.

Sept. 15th. Patient discharged, well.

1853.] Stricture of (Esophagus. 237

Remarks. From an examination of the preceding cases, it
will be seen that glycerine was the principal remedial agent
used. Its use in these cases was determined on from reading
a paper of Mr. Wakly, surgeon to the Royal Free Hospital,
editor of the London Lancet, &c, and I can fully appreciate
the high wrought eulogy bestowed upon it by that eminent
surgeon. I have copied the above cases from my note-book to
show the pathological conditions in which it is applicable, be-
cause it is not applicable in all cases ; for in complete deafness,
caused by paralysis of the auditory nerve, by displacement of
the small bones of the ear or any other structural lesion, or
where other senses are deficient besides those of audition, this
agent offers but little hope of success ; but in all cases where
the natural secretion is wanting, the auditory canal dry, shining
and inelastic where sonorous undulations have been obstruct-
ed by hardened secretion or where there is reason to believe
a chronic inflammation of the mucous passages of the internal
structure existed this agent may in a majority of cases be
used with success.

The preceding cases are not picked, but detailed as they pre-
sented themselves. Many more could be brought, (and many
more are under treatment, the result of which I am unable to
say,) to show the high value of this agent in the treatment of
most of the common forms of deafness ; but I trust I have ad-
duced a sufficient number to bring the attention of the profes-
sion to a closer examination of this article, which, when done,
I shall have accomplished the object for which this paper is
intended. [Stethoscope.

Case of Stricture of (Esophagus. By William Johnson, M.D.

I was consulted, the 23d of last July, by M C , aged

about 22 years, on account of stricture of the oesophagus. Her
attention was called to it, about two years since. She was
eating a piece af pickled cucumber, and was choked, and still
more so very shortly afterwards, in eating a pear. Since then,
the disease has been gradually increasing. Early in her dis-
ease, she could swallow nothing but liquid articles, or solid
food very thoroughly masticated, and swallowed in very mi-
nute portions at a time. In fact, for some considerable time
back, she has avoided taking any solid food ; particularly ani-
mal, it chokes her even when well masticated, and swallowed
in minute portions liquid food sometimes does the same. She
became very much alarmed, in consequence of the arrest of a
very small cherry stone in her oesophagus, about the 30th of

238 Stricture of (Esophagus. [April,

June last. She was eating a cherry, and the stone accident-
ally slipped into the oesophagus, and produced the greatest
distress by being arrested there. She resides about two miles
from me. In my absence, my son speedily saw her. He di-
rected a solution of tartarized antimony to be held in her mouth ;
it produced great nausea, and in an effort to vomit the stone
was ejected. This patient is anaemic, probably from insufficient
nutrition. Her appetite for food is good, but she is unable to
take sufficient nourishment. The catamenia are regular. Oc-
cular inspection of the fauces elicited nothing abnormal.

As tentative measures, I put her for a short time on tinct.
ferri. chlor., iodid. pctas., and applied an epispastic to the throat.
The difficulty of deglutition was not in any degree relieved by
these means. I now resorted to the bougie. My bougies were
prepared, by saturating strips of muslin in melted bees wax,
and when cold, cutting those pieces in such shape, as when
rolled up tight they would be gently tapering. They were
made of various sizes, from f of an inch to 1J of an inch in
circumference. I commenced, by introducing the smaller
sized, and found difficulty in passing these, but the difficulty
rapidly gave way, and in a few weeks I passed the larger
sized with ease. The size that I used for the greatest length
of time, was If inches in circumference. I finally passed very
readily If of an inch in circumference.

The stricture, I found to be situated some inches below the
termination of the pharynx. I passed the bougie some inches
below the stricture, which did not appear to occupy a very
large extent of surface. A sense of resistance at the stricture
in passing the instrument through it, was experienced. After
passing it a few times, most decided relief was obtained by the
patient. She visited my office, nearly every alternate day, for
three months, and the bougie was introduced at every visit,
either by myself, or my son.

The sense of suffocation, produced by the presence of the
bougie in the oesophagus, was very distressing to the patient,
and she could bear it but a short time at each introduction. I
generally passed it twice or three times every visit which she
paid me, which was much facilitated by covering it well with
glycerine.

In using the instrument, I departed from the directions given
by Velpeau. He advises depressing the tongue with a spoon-
handle or other instrument. This I did not find necessary, and
he says nothing about throwing the patient's head far back,
which I found very important. My method of introducing the
instrument was, to have the patient supported by an assistant
standing behind her. The assistant was directed to bring the

1853.] Veratrum Viride. 239

patient's head far back, so as to render the passage from the
mouth into the throat as straight as possible, the instrument
would then, by a very slight curve in it, readily pass down into
the oesophagus. Its introduction was rendered easier by the
patient protruding her tongue (which she could do with ease)
from her mouth. The patient experienced no pain from the
operation ; nothing but the strangulation above spoken of.

The improvement in this case, was decided, from almost the
first introduction of the bougie, until I pronounced her cured.
I suggested, however, at parting with her, that it would be ad-
visable to have the instrument passed occasionally into the oeso-
phagus, but she found herself so completely relieved that she
did not return, and I learn that she remains well, and has mar-
ried since. Her mother stated, but two or three days since,
that she swallows her food with perfect ease; the bougie has
not been introduced since October last nearly four months.
Remarks. The chief point of interest in this case is, the
rapidity with which it yielded to treatment. The case I would
contrast with one related by Dr. Jameson, of Baltimore, in the
29th No. vol. viii., of the Medical Recorder, Jan. 1825; edited
by Samuel Calhoun, M. D., of Philadelphia. The Doctor's
case is a very interesting one, and will pay well for the perusal.
Dr. Jameson passed ivory balls of different sizes, attached to a
stem, upon which they were secured, nearly every day for ten
months, before he considered his patient cured. My patient
was cured by the bougie passed every alternate day for three
months. Whether this result was owing to the different kinds
of instruments employed, or in my case being a less serious
one, I do not pretend to decide. Dr. Jameson's patient, too,
was a female, but more advanced in life than mine ; his being
about 40 years of age, and his case, too, was of two years
standing. For more than a fortnight he did not succeed in
obtaining any advantages : but by indomitable perseverance,
obtained complete success. His patient was one year under
treatment. These two cases, in addition to others, give ground
for encouragement in persevering attempts to dilate strictures,
and it may yet be found, that well directed manipulation may
obviate the necessity for resorting to the caustic, in the man-
agement of these cases. [New Jersey Medical Reporter.

Veratrum Viride.

Dr. B. T. Kneeland, an intelligent physician of Livingston
county writes us in regard to the use of veratrum viride ''I am
in the habit of using veratrum to quiet the action of the heart,
in diseases attended with great arterial excitement, where it is

240 Circulatory Displacement. [April,

more fashionable to employ digitalis, and with far more cer-
tainty of effect than I could ever obtain with the latter remedy.
I have thus used veratrum in rheumatism, pneumonia, the early
stages of fever, &c. I first tried it in a severe case of pneumo-
nia, the patient having already passed into a comatose state
from what I considered defective arterialization of the blood,
and with applications of cold to the head, and warmth to the
feet, had the satisfaction of seeing a return of consciousness
within twelve hours, and his recovery under the continuance
of the same treatment. In a case of acute rheumatism, after
employing the wine of colchicum, and various other remedies,
without any apparent benefit, the pulse still continuing at 120,
full and hard, I gave three grains of the powdered root of vera-
trum viride, which acted powerfully upon the circulation,
causing temporary blindness, and reducing the frequency of the
pulse to 85 per minute. He was now put upon lemon juice,
and had a rapid and most satisfactory convalescence.

"I recollect to have read in one of the last numbers of the
N. Y. Journal, a plan of treating continued fever, by giving
tartar emetic until free vomiting is induced, and then relying
upon large doses of quinine. Now I have ventured a step be-
yond this, and commenced the treatment of those cases which
began with the usual symptoms of fever, with veratrum and
have obtained the most gratifying results. It has seemed to
procure periodicity r, and thus prepare the case for the success-
ful administration of quinine. With this treatment I have had
no case last over five days, contrary to my former belief, that
typhus fever must run until the morbid poison is eliminated.
When the usual treatment is pursued the majority of cases
prove fatal in this vicinity, and those which recover have a
long and tedious course." [New York Journ. of Med.

Circulatory Displacement. By H. B. Orr, of Nashville, Tenn.

The process for extracting the active principle of medical
drugs by circulatory displacement has until recently been re-
garded more as a speculation or theory than as a practical fact.
Several years since it was spoken of by Mr. Alsop, of London,
as convenient in making infusions; subsequently Dr. Benton
suggested the idea of applying it in tincturing, and more recent-
ly Professor Procter has written in its commendation. But
yet the intrinsic merits of the method have not received from
pharmaceutists that measure of regard which they seem to de-
serve.

My attention was drawn to this method of maceration by an
article recently communicated to the American Journal of

1853.] Circulatory Displacement. 241

Pharmacy by Mr. Laidly, of Richmond. Virginia. I was
pleased with the suggestions induced by the perusal of Mr.
L.'s paper, and was constrained to try the method in a variety
of cases, and thus confirm, what indeed seemed to be at once
obvious, its practicability: my expectations were entirely re-
alized, and it is this that prompts me to commend its investiga-
tion to pharmaceutists.

This mode of tincturation is"very simple and convenient in
its construction. The best form of apparatus is a cylindrical
vessel with a movable diaphragm and a closely fitting top. The
liquid having been put into the vessel, the diaphragm with the
substance on it is then introduced so that a thin stratum of the
menstruum supernates above it. The whole adjustment is then
made and no further attention is required.

This kind of apparatus is very well substituted by a bottle
with a large mouth, the size of the bottle depending upon the
bulk of the ingredients, observing to keep always as much depth
of liquid beneath the drug as practicable, and then a bag as
great in diameter and as shallow as possible completes the
structure.

It will be observed that this form of maceration is in all the
important points different and directly opposed to the old me-
thod ; they are opposite in principle also. In the old mode the
drug is put at the bottom of the vessel in the new it is kept at
the top of the menstruum; in the former you arrive at an ap-
proximate saturation by shaking the mixture in the latter
saturation is obtained by the natural precipitation which goes
on constantly : the one demands attention throughout, the other
needs no w7atching; the old process is retarded by gravity, the
new is facilitated by this principle, for gravity is the promoting
cause of the circulation it is really the sine qua non of the
process. Immediately upon the adjustment of the apparatus,
this principle is seen in active operation, by the colored solu-
tion descending in the vessel, (in consequence of the condensa-
tion in the union of the soluble substance with the menstruum,)
affording ocular evidence that the solution is progressing. It
is then a physical certainty that this mode is applicable, and we
are forced to conclude that it is the only scientific mode of tinc-
turation.

There is another feature in the process which will prove an
additional convenience and abridgment in many cases, and
which, so far as I am informed, has as yet been unnoticed. It
is that of enveloping the substance in filtering paper before
introducing it into the bag. By this arrangement the time and
trouble of subsequent filtration is dispensed with. And this
obviates an evil of some importance in itself; for with men-

242 Chloride of Zinc Paste in Fistula in Ano. [April,

strua of a volatile nature, the time requisite fur their filtration
affords opportunity for considerable evaporation, and in pro-
portion to this evaporation the bulk of the solution is diminish-
ed, giving to it an uncalled for density, this being a condition
without any provision and of evil tendency. But by effecting
the filtration during the process of solution, it not only aids the
pharmaceutist, but is of advantage with respect to the quality
of his product.

The circulatory method is thought to be more rapid in its
operation, generally, than the usual mode ; in many cases it
certainly is decidedly so, as an instance of which guaiacum may
be adduced, as in the preparation of ammoniated tincture of
guaiacum. Here at the commencement of the process the
colored saturated liquid may be seen to emerge from out of the
bag and then to commence its meandering descent, with a
waving motion, mirroring a variety of colors, giving to the
operation a most beautiful appearance. This descent of the
solution and the corresponding ascent of the less dense or un-
saturated particles of the menstruum, have conferred the ap-
pelation of "circulatory " upon the process. The solution of
gums, resins and sugar also affords instances of the facility of
this method.

In point of strength, the result must show favorably for it,
for at each moment the most active portion of the menstruum
is in contact with the substance, so that the depletion must be
thorough as well as the action rapid. And I cannot but reit-
erate the expression of Mr. Laidley ; I hope pharmaceutists
will more generally avail themselves of so simple and easy
mode of extracting the active principle of medical drugs.

[Southern Journ. Med. and Ph. Sciences.

Chloride of Zinc Paste in Fistula in Ano. By E. Lacy, Esq.
Poole.

[Mr. Lacy recommends the application of chloride of zinc
paste in fistula, on account of the perfect success resulting from
it in three cases. It is applied as follows :]

The ordinary paste (chloride of zinc, water, and flour), being
entangled in a grooved probe, is passed up to the opening in the
rectum. The point of a second probe or instrument is then
placed in the grove, and passed just sufficiently high up, that,
by its being retained in that position while the armed probe is
withdrawn, the groove may be cleansed of the paste. This
may be repeated every second or third day. [Medical Times
and Gazette. Braithwaites Ret.

1853.] Cause of Decay of the Teeth in Cki Id r en. 243

On the cause of Decay in the Teeth of Children.

"What is the nature of that diathesis or constitutional predisposition or dis-
order (if any) which so often occasion decay in the teeth of our children V
Dr. Drake to the Miss. Vol. Association, D. S.

[We meet the following remarks upon this interesting subject
in a small pamphlet entitled "A letter to Daniel Drake, M.D.,
on the cause of premature decay in the deciduous teeth, in
which is embodied a review of the discussion of the Mississippi
Valley Association of Dental Surgeons upon the same subject."
Having examined, individually and collectively, the conclu-
sions arrived at by this society, the writer says :]

"I now come to the second object of this letter, that of at-
tempting an answer to your first question, which, according to
my understanding of the subject, the ' Mississippi Valley Asso-
ciation of Dental Surgeons' have utterly failed to give. In
making this effort I shall be very brief. I shall content myself
by simply stating facts, without entering into any minute de-
tails.

The strict interpretation of your question embraces an en-
quiry into all kinds of decay to which the deciduous teeth are
liable. Now as there are two prominent causes of this kind of
decay in the temporary teeth causes which differ from each
other both in their nature and the time of life at which they
commence it is important, therefore, that they should be here
referred to. The one is almost identical with the prevailing
cause of caries in the permanent teeth, and usually commences
its ravages in the molars, and that about the fifth or sixth year
of the child's age. The other may be said to be sui-generis.
It shows itself most frequently in the incisors, and is liable to
commence at any period, from the time the teeth first show
themselves through the gums, up to that when dentition is fully
completed. Believing that your inquiries were intended only
to embrace the last mentioned cause of disease in the decidu-
ous teeth, I shall therefore confine my answer solely to a de-
scription of this cause ; deferring all further notice of the other
until I come to reply to your second question respecting the
premature decay of the permanent teeth.

The 'diathesis, or constitutional predisposition, or disorder,
which so often occasions decay in the teeth of our children,' is
remotely constitutional in its nature, and appears to partake
both of a scrofulous and of an acquired vice: of a scrofulous
vice, because it is most prone to attack the teeth of scrofulous
subjects: of an acquired vice, because the general system must
be likewise much impaired for a shorter or longer period be-
fore the immediate cause of the caries of the teeth is induced*

244 Cause of Decay of the Teeth in Children. [April,

The immediate cause of the decay is a malignant ulcer, most
generally peculiar to the gums, but occasionally attacking the
cheek.

The ulcer is most liable to occur at three particular epochs
of a child's life, and appears to increase in malignancy with
the child's increase of years.

The first period, and most common and mildest form of the
disease, occurs during the cutting of the incisor teeth. It some-
times commences with the first appearance of these teeth
sometimes not until they have all acquired their full length
through the gums.

The ulcer is generally confined to the extreme edge of the
gums, revealing only a small, light, ash-colored, sigzag line, so
small that it is rarely detected by either physician or nurse.
Upon a close examination, the edge of the gum will be found
separated from the teeth, and the body of the ulcer plainly seen
betwreen the edge of the gum and the necks of the teeth.

The gum reveals but little signs of inflammation, is not very
sensitive, and may remain in the condition just described seve-
ral weeks without any material increase or diminution of the
ulcer.

The teeth become slightly loose, rough and dark colored, and
are finally more or less destroyed, depending on the virulency
and duration of the ulcer. It is this form of the disease that
occasions so many children to have dark colored, decayed, and
broken off incisors, from the age of one year and upwards,
while the molars may be sometimes entirely sound. This
form of the disease has never, before, so far as I know, been
described.

The second period that the disease occurs, but much less
rarely than the first, is about the time of cutting the molar teeth,
and is sometimes very malignant. The ulcer usually appears
on the gum at a point where a tooth is about to penetrate, and
proceeds to a greater or less extent, often around the entire
dental arch. The disease may appear in its mildest form, and
run only along the extreme edge of the gums, or it may involve
the greater portion of both the ^um and alveolar process, loosen-
ing the teeth, turning them dark and softening them, as though
they had been exposed to the strongest acids. This form of
the disease has been occasionally observed and described.

The third form of the disease is fortunately still more rare,
but fearfully fatal. It usually appears during the shedding of
the temporary teeth, and although always commencing on the
gum, it rapidly extends to the cheek, often destroying both jaw
and cheek, as well as the life of the patient. This form of the
disease has been described by medical writers under the name
of cancrum oris.

1853.] Hospital Sulphate of Quinine. 245

All three of the forms of the ulcer just described are liable,
and have often been mistaken, for the effects of mercury. But
the sharp, ragged, yet well defined edge of the ulcer the ex-
coriating and corroding effects of the discharge the slight
tumefaction of the gums, and the terrible fetor of the breath,
even in its mildest form a fetor having nothing of the odor of
that arising from mercurial salivation are characteristics suf-
ficiently marked to say nothing of the roughness and discolora-
tion of the teeth, to prevent any mistake of that kind, if closely
observed." [South. Journ. Med. and Phys. Sciences.

Hospital Sulphate of Quinine.

Mr. Edward Herring has introduced a preparation under
this name, consisting of disulphate of quinine only partially
purified. In its medicinal properties it is said to differ but little
from the ordinary disulphate. It has a brownish color, and is,
of course not admissible as a substitute for disulphate of quinine
in general dispensing, but it has been tried in hospitals and dis-
pensaries, and by some medical men who dispense their own
medicines. The preparation is recommended on account of
its economy. The final purification and decolorization of the
salt being attended with some expense, the manufacturer is en-
abled to offer it in a partially purified state at a considerable
reduction from the price at which it can be sold when purified
in the usual way. The amount of impurity must be ascertain-
ed before its real value can be estimated. It may be a question
whether the recognition of a preparation so imperfectly purifi-
ed might not open the door to some abuse. [London Pharm,
Journal.

On Disguising the Taste of Quinine. By M. Piorry.

A piece of chocolate should be half masticated, and retained
between the cheeks and the teeth. The quinine draught is to
be rapidly swallowed; and then the masticatiou of the choco-
late is to be completed, so that it may be swallowed also. The
taste of the quinine is thus hardly perceived. [Bull, de V Acade-
mic Med. Chir. Rev.

Vesicating Oil. By E. Dupuy.

The solubility of cantharadin in chloroform, as shown by the
experiments of Professor W. Procter, suggested to me the idea of
using that vehicle in combination with a fixed oil to obtain a vesi-
cating agent, freed from the disagreeable concomitants of the ordina-

N. 3. VOL. IX. NO. IV. 16

246 New Remedy for Intermittent Fever. [April,

ry fly blister, and retaining the cantharadin in a soluble state. I
proceed thus :

Powdered cantharides, one part.

Castor O'l ' ( ^eacn (by weight) one and a half parts.

To the powder was added the mixture of chloroform and oil in a
close vessel; the ingredients were transferred, after some hours, to a
glass apparatus, and the liquid displaced in the usual way. It amount-
ed to about two-thirds of the original bulk of the liquid employed. A
few drops of the vesicating oil applied to the arm of an adult produced
a perfect blister in eight hours. Its easy application on any given
surface may be of value as a vesicatory or epispastic. I wrould sug-
gest the use of oiled silk over the application of it to the skin ; by re-
taining the moisture of the skin it will favor the action of the oil.

[Amer. Journal of Pharmacy.

A New Remedy for Intermittent Fever.
Dr. Wm. M. Holton, of New York, in a note to the editor of the
N. Y. Medical Gazette, proposes the "Prairie Dock" or ^'Partheni-
um Integrifolium" as a remedy for Intermittent fever.

" A decoction made by pouring hot water upon two ounces of the
dried tops of the plant, has proved equal to twenty grains of quinine.

I have entire confidence in it, not having met a single failure in
over thirty cases, some of which were severe.

I do not claim that it is superior to quinine, except that so far, no
unpleasant nervous effects have been observed.

I claim to be the first to call the attention of the profession to this
remedy, and trust that farther trial and chemical analysis will confirm
my belief in its efficacy, and enable me to give to the profession proof
of the value of an article, the active principle of which, I have no
doubt, will equal quinine, while the supply is abundant, and obtained
in our own country."

Epilepsy.
The readers of this Journal are acquainted with the views of
Dr. Marshall Hall in regard to the pathology of Epilepsy, and its
connection with what he denominates either Trachelismus or Laryn-
gismus, according to the violence of the symptoms. They are also
aware that he proposes Tracheotomy as a remedy for this formi-
dable affection, and that this operation has actually been performed
with temporary advantage. It seems questionable, however, whether
the remedy is not as bad as the disease. Dr. Horace Green reports
in the New- York Medical Gazette an interesting trial made of a less

1853.] Epilepsy. 247

objectionable method for modifying the innervation of the larynx in
such cases. We subjoin an extract from Dr. G.'s report.

u In reflecting on this patient's case, in connection with the theory
advanced by Marshall Hall, I recollected the fact, that spasm of the
glottis occurring in my practice, in laryngeal disease, had, in many
instances, yielded to the topical applications of nitrate of silver to the
larynx ; and at this interview, I proposed to Mr. B. to try the effects
of cauterization of the larynx, before having recourse to tracheotomy.
He consented, and with a sponge-probang I immediately applied a
strong solution of the nitrate of silver to the interior of the larynx.
At this first application of the remedy to the larynx, I remarked the
unusual insensibility of the parts to the local irritant ; for, although
the ordinary caution, that of cauterizing the pharynx and opening of
the glottis before passing the probang into the larynx, was not adopted,
yet not the slightest cough, or apparent irritation was induced, not-
withstanding the sponge, charged with a strong solution of the salt,
(45 grs. to the oz. of water.) was carried deep into the larynx. On
the following day the patient returned, and the application was re-
peated, and this was done daily for five or six consecutive days. It
should be remembered that when this local treatment was commenced
the patient was having some six or eight attacks of epileptic fits daily ;
and that with the occasional exceptions, of which I have spoken,
these attacks had occurred daily, during a period of four years. After
the first application of the nitrate of silver to the larynx, the spasms
ceased, and Mr. B. passed over a period often days without having a
single epileptic attack. The change that took place in this period in
his mental powers was as marked as that which occurred in the dis-
eased nervous functions. His mind, before obscured, became clear,
his memory improved, and he exhibited a spirit buoyant and happy
when freed from the evil spirit that had so long possessed him.

This intermission continued until the tenth day, when, after having
been exposed to considerable excitement, in the transaction of some
business, he had a slight epileptic attack. On the two or three fol-
lowing days he had several attacks on each of these days. The treat-
ment was again renewed, and after a few cauterizations of the larynx
the spasms again ceased and the patient escaped through another
period of ten days when the attacks came on as before. It was now
apparent that the disease partook of that intermittent character which
has been observed by Dr. Babbington and other writers on Epilepsy*.

The attacks had occurred so constantly, through so long a period
of years, that I could not learn that any thing like periodicity had
been before observed as a characteristic of the disease in this case.
This feature, however, was so apparent now, that I determined to try
the effect of quinine, in order, if possible to break it up.

Again were the applications of the nitrate renewed, and in order to
produce as much effect as possible on the larynx, the strength of the
solution was increased to eighty grains to the ounce of water, and
sponge-probang, nearly straight, being used, ^the applications were

248 Epilepsy. [April,

carried through the larynx and trachea to the bronchial bifurca-
tion.*

As in each instance before, the spasms ceased after continuing the
application a few days, and passing the critical period; but as the
patient approached the termination of this second decade, he was di-
rected to take ten grains of quinine daily, for several days. This
was done, the applications were continued, and the patient passed over
the critical period and on the nineteenth day, without experiencing the
slightest attack.

In this period of immunity from the disease a longer period than
had occurred in many years, Mr. B.'s spirits and general health
improved constantly, and he occupied himself in his business (that of
collector) almost daily, during this interval. But near the close of
the nineteenth day, or about the commencement of the twentieth, his
disease again returned, and the fits occurred as before for several
successive days. There was no difficulty, however, in arresting the
spasms by the topical treatment, as soon as this period was passed;
and this has been the case up to the present time. That is, no diffi-
culty occurs in arresting entirely the attacks of epilepsy, for a period
of from ten to twenty days, during which interval the patient appears
in excellent health, in good spirits, and in the possession of his ordina-
ry mental powers.

In three instances, since the commencement of this treatment has
the patient been carried over the first decade, but in no instance, as
yet, have we been able to get over the twentieth day, without a return
of the disease. At this present time, January 27th, he is on one of
his intermission periods, and he appears as exempt from all disease,
and declares that he feels as well as he has felt at any time of his
life.

As the patient has in only one instance, as yet, employed freely the
anti-periodic remedy, it has been determined to enter again on its use,
with the hope that by its full administration the intermittent character
of the disease may be controlled, and the patient restored to permanent
health.

Without endorsing all the views advanced by Marshall Hall, on the
nature and treatment of some of the diseases of the nervous system, I
am prepared to admit that the practical results in this case have alrea-
dy been such as to warrant the conclusion that in epilepsy not origin-
ating in organic lesion, a morbid condition of the larynx may consti-
tute the essential connecting link between the primary exciting cause
of the disease and the subsequent convulsions; and to warrant the
hope that in recent cases of inorganic epilepsy, we have it in our
power, by an entirely safe and facile mode of treatment, to break up
this connection, and arrest the disease."

* At the present day, Mr. Editor, I trust this assertion can be made without
having one's veracity called in question, or endangering one's status in any me-
dical society to which he may belong !

1853.] Miscellany. 249

ill 1 0 c 1 1 1 a n g .

The Pinto Indians. We have often heard marvellous accounts
of a singular race of spotted Indians called Pintos seen by our troops
during the late war with Mexico. The following very interesting
statement corroborates the opinion we had advanced with regard to
the nature of the spots, in our unwillingness to admit the Pintos as a
distinct race of men.

Account of a peculiar class of Aboriginal Inhabitants of certain parts

of Mexico, known under the name of the Pinto Indians. By Col.

A. C. Ramsey, formerly of the United States Army. Communica-
ted by Edward Ludlow, M. D., of this city.

Interspersed among the native population of certain parts of Mexico,
are to be found a class of Indians, in greater or less numbers, pre-
senting characteristics so marked as at once to arrest the attention of
the observer. To this peculiar appearance they owe the name by
which they are familiarly known, that of " Pintos," or painted people,
the word being an abbreviation of the Spanish word pintado, painted.
It is impossible to convey by writing a correct idea of their appear-
ance ; no two of them are alike either in color or in marks on their
persons. You will see a pretty formed girl with one hand white and
the other black ; her face spotted of a gray, blue, black, or white co-
lor. Sometimes a man will have one half of his face lead color, and
the other half of a copper complexion.

Here you will see an arm partly white and partly black, as though
you had " barked" it, and taken orTone portion of the outer skin.

A foot or leg will be spotted black, blue, white, dec, while the other
parts will be all of one color.

Many appear with dark skin on the face, with a large black spot
covering the nose and cheeks.

I have often seen these people with the face all as blue as lead ;
again all black or red ; while their bodies would be entirely of the
natural Indian color.

Nothing on this earth more visibly depicts despair, and extinguishes
all emotion of human sympathy within you, than the sight of some of
these miserable beings. Some created a feeling of horror ; but the
larger portion of them are not revolting in their appearance, but only
repulsive from their looks. They live for the most part in villages by
themselves, speaking only the Aztec language, ignorant, poor, super-
stitious, and without any hope or ambition.

So little intercourse exists between the Pintos and the white people,
that it is almost impossible to get any account of their origin, malady,
or condition. I have heard various histories of them, some absurd
enough, and some contradicted by well-authenticated facts ; but have
never seen nor heard of any description of them in print. Some say
that they are a race of outcasts, who, from some far-off country, were
ejected from the parent stock, and spread themselves along the Pacific

250 Miscellany. [April,

from Sonora to Guatemala ; that their disease is not only hereditary
but contagious, being of a syphilitic or venereal nature. Therefore,
personal contact with a Pinto, to Cat with the same spoon, drink out
of the same cup, sleep on the same bed, or even breathe the same air,
has been said to produce the disease.

Sanitary laws have prohibited their passing beyond their own ter-
ritory.

None are permitted to enter Mexico, nor are they seen even in Cu-
amavaca.

In the valley of Puebla they are not found before reaching Cuetzala.
In the late war with the United States, the regiments raised from
among them were not allowed to defend the capital, or even to en-
camp with the other soldiers. The dread entertained by the people of
the cities, among all classes, for these unfortunate Pintosis laughable.
It is rarely that a gentleman from the capital can be induced to
make a journey to this part of the country. He lives in constant appre-
hension of infection, and would die of fright if among them. Hence
one of the reasons why this magnificent valley is so little known.

It is said that white persons have sometimes been diseased by the
Pintos ; and they will tell you instances in Mexico, how these unfor-
tunate persons have been infected by the most trivial intercourse,
while studiously avoiding all contact. Of course their statements
are to be taken with the same grains of allowance that are given by
medical men to the most astonishing revelations of gentlemen who
sometimes consult them when peculiarly afflicted.

It is not considered proper to speak to a Pinto on the subject of his
disease or the cause of it. It is always good policy not to use the
word in their presence, as it is a stigma of reproach.

To ascertain, therefore, something of their history, I have made
many inquiries of intelligent officials who are stationed in their villa-
ges. But from the most part of these I could glean no information ;
they knew nothing about them, and they did not seem to desire to
know anything. From others I was more fortunate ; and although I
may still be misinformed, yet there seems reason to believe that this
strange affection originated in the last century in the following manner.
The volcano of Inrullo was formed on the night of the 29th of Sept.,
in the year 1759. This eruption, in which the mountain rose from
the plain, and by which a large extent of ground totally changed its
character, is admitted by all to have been one of the most astonishing
physical changes known in the history of the world.

A large space of level country, in which sugar cane and indigo
were cultivated, extended between the small streams of Cuitamba and
San Pedro. This tract of land was known as the hacienda of San
Pedro de Jorullo, and as one of the richest in Mexico.

In the month of June, 1759, a subterraneous noise was heard:
hollow and rumb'injr sounds, accompanied with many earthquakes,
followed in succession for two months, to the great terror of the inhab-
itants ; and on the 29th of September, the mountain rose from the
plain to the height of 224 feet. The panic stricken natives fled to the

1853,] Miscellany. 251

mountains of Aguascara, to escape a terrestrial convulsion which ex-
tended beyond six miles square.

From this place of safety the flames were seen to burst forth on all
sides for more than three square miles. Fragments of burning rocks
were thrown up to a prodigious height. Clouds of ashes hung over,
which were illuminated by the volcanic lire. The heated earth be-
came liquid, and undulated like a tempest-tossed sea.

The streams of Cuitamba and San Pedro flowed into the burning
abyss, which seemed only to add to the brilliancy of the flames. For
many months this volcano was in perpetual convulsion, but finally
subsided.

The natives fled forever from a spot which they believed to be
cursed. But the exhalation of sulphur had affected them.

A strange eruption appeared upon their skins, accompanied with an
itching and smell, which were both painful and offensive. The whole
appearance of the people thus diseased underwent a complete trans-
formation. The skin changed color ; spots of every size, and on all
parts of the body, began to assume a permanent hue. It was then
discovered that the disease was infectious, and whole villages be-
came contaminated.

Whenever one of these people went abroad, his person presented
such strange colored marks that others could not believe them natural,
but supposed them produced by paint, and hence their appellation of
pinto, or painted.

The disease is only cutaneous, and is accompanied with eruption
on the skin, and is easily cured by cleanliness and mercurial ointment.
But as these people are too poor or too indifferent to resort to the well
known remedy, or do not all use it in a village at the same time, the
pest is not permanently eradicated, but returns to plague the whole
population.

That the Pinto malady is not hereditary has been well tested by
many facts. Although a man or woman limpid, that is, free from the
taint, marries a Pinto, and in the course of time becomes Pinio, and
also becomes so from continuous personal contact, still the offspring
exhibits no marks or symptoms of the disease till more than two years
old. If a child born of a Pinto mother be nursed from its birth by a
person limpia, instead of by its Pinto parent, it never is affected, unless
from accidental causes, afterwards. On the contrary, a child born of
parents Umpia, if nursed by persons Pinto, will, after the second year,
show the usual appearances of infection.

I have found persons of intelligence, gente de rason, living all their
lives with their families among the Pinto people, and never dreadino-
the affection for themselves or children.

It is true their little ones are not permitted to sport with Pinto pla}r-
mates, and in that respect they do not differ from careful mothers in
other countries, who will not suffer their children to associate with
dirty, and possibly diseased boys or girls.

For my own part, I have been much among the Pintos. I have
lodged in their houses ; I have slept on their thalme or cane beds ; I

252 Miscellany. [April,

have eaten of their cooking ; taken water from the tinaja, or family
jar ; have drank the milk which their cows have given, and often
using the same xicara, or calabash cup ; and, when I could not help
it, I have swallowed tortillas, or corn cakes, which they have patted
smooth and ;hin between their hands. In wading rivers I have clung
with my arms around a Pinto, and have worn clothes washed and
dried for me by Pinto women. By the margin of rivers or other
streams, the Pinto marks are somewhat less perceptible and peculiar
than in places more remote from water. The balseros, or men who
are engaged in floating the calabash and cane rafts, and who are con-
sequently everyday swimming, exhibit but few indications of this
affection upon their persons. But as they grow older, and quit that
occupation, they assume one of the thousand varieties of the disease.
No doubt that strict personal cleanliness would do much to relieve
these people ; and if the village priests would borrow7 a stray leaf
from the Koran under this head, I think the church would wink at the
interpolation.

The Pintos may be said to inhabit a mountainous country, as they
are rarely found on the plains or in rich settlements. Thus we only
discovered them at Cuetzala, where the mountain district properly
commences; and further down the river, when the mountains are
passed, they diappeared. I have observed, on former excursions,
that Pintos are not found near the rich cities and open country round
Tepeacuacuilco and Iguala, only 14 leagues distant from this place.*
Hence I would infer that it is only their poverty that keeps them in
the Pinto state.

It is to be hoped that further intercourse with these unfortunate
beings will remove the dread and disgust entertained for them by the
better classes of the Mexican republic. They are simple, kind, honest,
hospitable, and industrious where there is any occasion to work. They
are only troublesome when excited by liquor, insult, or wrongs. Their
disease is a species of itch nothing more. My advice to any one
thrown among them would be to keep clean, and keep the ten com-
mandments ; with a white shirt, cotton clothing, and a clear con-
science, there need be no fear of contamination. [IV. York Medical
Times.

The best means to preserve Leeches healthy. By Gustavus Schul-
ler. The apothecaries in Moldavia are, according to the sanitary
laws, compelled to keep constantly a stock of at least 300 healthy and
serviceable leeches. But, particularly as the hot summer months are
the most prejudicial season for these animals, it often happens that in
the time of the greatest need no leeches are to be obtained.

Amongst the various means which have been recommended to keep

* This account was written at Totalzintla, a village or pueblo on the left bank
of the river Mescala. One of the roads leading from Mexico to Acapulco,
crosses the river at this Pinto village. At the lime it was written (last August),
Col. R. was exploiing and surveying the river Mescala, which takes its rise
above the city of Puebla, and empties into the Pacific ocean at Zucatula, some
three hundred miles west of Acapulco. [En.

1853.] Miscellany. 253

leeches healthy, and to restore the sick ones, good well-burnt wood
charcoal has proved, according to my experience, to be the best, as
shown by the following experiment. I washed the charcoal well three
or four times with fresh spring water, to separate the adhering ashes,
and then laid it, while wet, and without breaking it smaller, in a large
glass cylinder ; put the sick leeches, recently washed, into this cylin-
der, but did not give them any more water, as enough was to be found
in the washed charcoal. The glass was tied over with a piece of
linen and placed in a cellar, where, for five days, the leeches were
resigned to their fate.

After this period I found the leeches, to my satisfaction, perfectly
well. They were quite in a condition to be used, which was not the
case in their sick condition.

For two years I have treated my leeches in this way, and always
retained them healthy and serviceable. The number of deaths a-
mongst them has been very small. The only precaution I observe is
to place all my leeches for eight days in summer on recently washed
charcoal, and for two weeks in winter. The method is a cheap one.
and one easy of execution. [Buckner's Rejpertorium, from Annals of
Parm. Am. Journ. Pharm.

Note on the Preparation of Liquid Glue. By M. S. Dumoulin.
All chemists are aware, that when a solution of glue (gelatine) is
heated and cooled several times in contact with the air, it loses the
property of forming a jelly. M. Gmelin observed, that a solution of
isinglass, enclosed in a sealed glass tube and kept in a state of ebulli-
tion on the water-bath for several days, presented the same phenome-
non, that is to say, the glue remained fluid, and did not form a jelly.

The change thus produced is one of the problems most difficult of
solution in organic chemistry. It may be supposed, however, that in
the alteration which the glue undergoes, the oxygen of the air or of
the water plays a principle part ; what leads me to think this is the
effect produced upon glue by a small quantity of nitric acid. It is
well known, that by treating gelatine with an excess of this acid, it is
converted by heat into malic and oxalic acids, fatty matter, tannin,
&c. But it is not thus when this glue is treated with its weight of
water and with a small quantity of nitric acid ; by this means a glue
is obtained which preserves nearly all its primitive qualities, but
which has no longer the power of forming a jelly. Upon this process,
which I communicated, is founded the Parisian manufacture of the
glue which is sold in France under the title of " colle liquide et inal-
terable."

This glue being very convenient for cabinet-makers, joiners, paste-
board workers, toy makers, and others, as it is applied cold, I think it
my duty, in order to increase its manufacture, to publish the process.

It consists in taking 1 kilogrm. [2 and l-5th lbs.] of glue, and dis-
solving it in 1 litre [2 and l-9th pts.] of water in a glazed pot over a
gentle fire, or what is better, in the water-bath, stirring it from time
to time. When all the glue is melted, 200 grms. [7 oz. Av.] of nitric

254 Miscellany. [April,

acid (spec. grav. 1'32) are to be poured in, in small quantities at a
time. This addition produces an effervescence, owing to the disen-
gagement of hyponitrousacid. When all the acid is added, the vessel
is to be taken from the fire, and left to cool.

I have kept the glue, thus prepared, in an open vessel during more
than two years, without its undergoing any change. It is very con-
venient in chemical operations ; I use it with advantage in my labora-
tory for the preservation of various gases, by covering strips of linen
with it. [Chemical Gazette, from Comples Rendus. Ibid.

Sulphite Soda for Preserving Dead Bodies. A prize of 2000 francs
was awarded to M. Sucquet for his improved method of preserving
bodies by the injection of an antiseptic liquid through the carotid
arteries. This preservative liquid is prepared as follows : A current
of sulphurous acid gas is passed through a solution of carbonate of
soda of the strength of from 20 to 22 Baume (sp. gr. 1-160 to M80),
until the whole ef the carbonic acid is displaced, and the solution
contains a slight excess of sulphurous acid. The fluid should then
have a specific gravity of 1*200. It is next placed in a vessel con-
taining clippings of zinc, and allowed to remain in contact with the
metal until it has become sensibly neutral, the blade of a'knife dipped
into it not turning brown on exposure to the air. From four to six
litres of this preparation are employed to inject a subject. After
twenty. four hours, dissection may be proceeded with, and continued,
without any inconvenience, for twenty, thirty, or even forty days.
One of the great advantages arising from the employment of the
sulphite of soda, consists in the beneficial influence it exerts in cases of
the accidents to which the operator is subject in the dissecting room.

During the five years in which this preservative liquid has been
employed, no fatal case has occurred. [N. O. Med. Register.

Discovery of Anaesthesia. We have received a commnnication
from Dr. C. W. Long, of Athens, (formerly of Jackson county,) who
takes exception to the remarks under the Editorial head of our last
number, and reminds us of the priority of his discovery of anaesthesia,
as published in this Journal in December, 1849. The reader will
perceive, on referring to the editorial remarks in question, that they
applied to "the relative merits of the three claimants" before Con-
gress (Drs. Jackson, Morton and Wells), and that they were directly
elicited by the Congressional documents on the subject just received
by us. The circumstance that the claim for compensation has been
urged with great zeal and pertinacity (and consequent publicity) be-
fore Congress, by these gentlemen, for the last two or three sessions,
without meeting with any opposition or counter claim at the hands of
Dr. Long, was well calculated to lead one to infer that he had yielded
the point, or relinquished his own rights. Moreover, as we were not

1853.]

Miscellany.

255

the conductor of this Journal at the time Dr. L. published in it his
article, the full force of that communication had escaped our memory.
We regret the omission to allude, in our remarks, to Dr. L.'s publica-
tion, for, on a reperusal of it now, we are free to acknowledge that
the Doctor has very clearly established the fact that he did, in 1842,
perform several painless surgical operations under the influence of
the inhalation of sulphuric Ether, and that he was thus early and
subsequently seriously engaged in experimenting with this agent as
an anaesthetic. We really think that Dr. Long has done himself
great injustice in neglecting to bring his claims before Congress in
competition with those of others. The Doctor's modesty and disin-
terestedness have concurred to make him rest satisfied with his own
consciousness of merit. We trust, however, that he will not longer
remain thus quiet, but use every exertion to throw the weight of his
claims into the scales by which Congressional compensation is to be
awarded and nothing would give us more real satisfaction than to
see the honor of that great discovery fixed upon the brow of a citizen
of our own native State.

Medical College of Georgia. The twenty-first Annual Commence,
mentof this institution took place on the 1st day of March. The
exercises were conducted at the Masonic Hall, in presence of a large
concourse of citizens. The Dean reported to the Board of Trustees
that there were in attendance upon the Course of Lectures just con-
cluded, one hundred and seventy-one gentlemen of whom 115 were
from Georgia, 29 from Alabama, 21 from South Carolina, 2 from
North Carolina, 1 from Tennessee, 1 from Mississippi, 1 from New
York, and 1 from Canada.

The Degree of Doctor of Medicine was then conferred upon the
following fifty approved candidates:

FROM GEORGIA

David Adams,

- Thesis on

Gastritis,

W. J. Arrington, -

n

II

Meningitis,

A. F. Attaway,

u

K

Spinal Irritation,

James C. Carroll,

u

(I

Dyspepsia,

John S. Clements,

u

M

Veratrum Viride,

R. J. Cochran,

u

tt

Pleurisy,

A. G. Couch,

ti

(i

Typhoid Fever,

L. S. Cunningham,

tt

U

Gastritis,

L. W. Davis,

m m it

a

Puerperal Fever,

W. H. Dean,

m m M

u

Uterine Hemorrhage

L. C. Fambro,

M

u

Veratrum Viride,

W. T. Goldsmith,

"

u

Dysentery.

256

Miscellany.

[April,

FROM GEORGIA.

Thesis on Cynanche Trachealis.

" " Mortification,

" H Scarlatina,

" u Typhoid Fever,

" " Gonorrhoea,

" " Dysentery,

" " Lobelia,

u " Dyspepsia,

u u Dysentery,

" " Measles,

u Fever,

" " Infantile Remittents.

u " Injuries of the Head.

" " Fetal Circulation,

" " Intermittent Fever,

" " Typhoid Fever,

" " Conception.

" " Intermittent Fever.

" " Abortion,

it i( Pregnancy,

" " Spinal Irritation.

" u Abortion.

" " Typhoid Fever,

" " Retroversio Uteri.

Amenorrhcea,

Pneumonia,

Alcoholics,

Fracture of Cranium.

Dysentery,

The Vascular System,

Leucorrhcea,

Bronchitis,

FROM SOUTH CAROLINA.

Thesis on Bronchitis,

" " Rheumatism,

" M Pleurisy,

" " Digestion,

" " Dyspepsia,

FROM NORTH CAROLINA.

- Thesis on Empiricism.

The Honorary Degree of Doctor of Medicine was also conferred
upon Wra, J. Rusk, of Habersham County, and Joshua King, M.D.,
a graduate of Castleton Medical College, was admitted ad eundum
gradum.

The Address to the Graduates was delivered by Dr. W. C. Ware,

V. T. Hart,
J. L. Hamilton,
Joseph Hatton,
Henry Hicks,

E. C. Hughes, -
John R. Humphries,
Loyd Knight,
Johnson Matthews,
L. S. Means,
John P. K. McWhorter
L. W. Mobley, -

R. F. Neely,

D. S. Perkins, -

F. W. B. Perkins,
Ormond Pinkerton,
W. L. Rees,
Aristides Reynolds, .
L. J. Robert,

John Scogin,
B. D. Smith,
J. T. Slaughter,
J. W. Stephens,
F. J. West,
John S. Wilson,

James C. Billingslea,
John E. Crews,
B. C. Flake,
R. T. Foote,
W. A. Johnson,
Wilson M. Liggen,
James Penn,
S. E. Thompson,

S. C. Brunson,
W. W. Graham,
J. A. K. Holman,
G. W. A. McRea,
J. W. West, -

N. H. Wiggins,

FROM

ALABAMA.

Thesis on

,

1853.] Miscellany. 257

of Abbeville District, S. C, one of tbe alumni of this college, and
the Valedictory by W. J. Arrington, of the graduating class both of
which admirably chaste and appropriate productions have been re-
quested by the Trustees for publication.

BIBLIOGRAPHICAL.

A System of Practical Surgery. By Wm. Fergusson, F. R. S.;
Prof, of Surgery in King's College, London, &c, &c. 4th Amer-
ican, from the 3d and enlarged London edition with 393 illustra-
tions. Philadelphia : Blanchard & Lea. 1853.

Among the numerous works upon Surgery published of late years,
we know of none we value more highly than the one before us. It
is perhaps the very best we have for a text-book and for ordinary
reference, being concise and eminently practical.

Manual of Physiology. By W. S. Kirkes, M. D., &c, &c, assist,
ed by Jas. Paget, F. R. S., &c, &c. 2d American, from the 2d
London edition with 165 illustrations. Philadelphia : Blanchard
& Lea. 1853.

The general favor with which the 1st edition of this work was re-
ceived, and its adoption as a favorite text-book by many of our colleges
will ensure a large circulation to this improved edition. It will fully
meet the wants of the student.

What to observe at the bed-side and after death in medical cases.
Published under the authority of the London Medical Society of
observation. Philadelphia: Blanchard & Lea. 1853.

This little work, if carefully read by even old practitioners, cannot
fail to be productive of much good. As a guide to the younger mem-
bers of the profession in directing their attention specially to the best
mode of investigating cases so as to arrive at correct diagnosis, it will
prove exceedingly valuable. The great difficulty with beginners
who have not been under the immediate training of an experienced
physician, is continually found to be in the appreciation of the true
condition of the organs and tissues. Let such provide themselves
with this work and study it thoroughly and they will find much of
the difficulty removed.

Ranking 's Half-yearly Abstract of the Medical Sciences. No. 16.
A very good number of an excellent work would be better if not
so exclusively European.

258 Miscellany. LAPr^>

A Clinical Phrase-look, in English and German. Containing the
usual questions and answers employed in examining and prescrib-
ing for patients, &c, &c. By Montgomery Johns, M. D. Phil-
adelphia : Lindsay & Blakiston. 1853.

This is a little book designed for the use of physicians who practice
in districts and hospitals in which the number of newly arrived Ger-
mans may render it necessary to be somewhat acquainted with their
language.

Maclise's Surgical Anatomy ; with additions from Bourgery, fyc. Ed-
ited by R. W. Piper, M.D. Boston : Jno. J. Jewett & Co. Part 1.

This work will be completed in 8 or 10 parts, of quarto size, at
75 cents each the first of which is before us. We like to see books
made as cheap as possible, but unless the engravings appended to
them for illustration be good, they serve rather to confuse than to en-
lighten the student. In the present instance the plates are very poor.

The American Journal of Science and Arts ; conducted by Professors
B. Silliman, B. Silliman, Jr., and James B. Dana ; aided by
Dr. Wolcott Gibbs, of New-York, in Physicks and Chemistry,
and Prof. Asa Gray, of Cambridge, in Botany. Published at New
Haven, Conn., every 2d month, at $5 per year.

This is a peiiodical of which every American should be proud, and
which ought to be taken by every lover of the natural sciences in our
country for it is as ably conducted as any similar work in the world,
and it is the only repository of the contributions of our fellow citizens
to the study of Nature and the Arts. The March No. contains 13
original communications, among which are the admirable papers of
Jas. D. Dana on "Changes of Level in the Pacific Ocean" of A.
Bigelow on the "Mounds of the Tensaw River" of M. A. DeQua-
trefages " on the Phosphorescence of some Marine Invertebrata of
J. D. Dana " on the question whether Temperature determines the
Distribution of Marine species of Animals in Depth" of J. L. Smith
on the "Re-examination of American Minerals" of W. Hopkins
on " The causes which may have produced changes in the Earth's
superficial Temperature," &c. In addition to the original articles,
each No. contains a resume of scientific intelligence.

We are also indebted to publishers and authors for the following
works, which our space will not permit us to notice more fully at pre-
sent : The Transactions of the College of Physicians of Philadel-
phia, Vol. 1, No. 9 Report of the Pennsylvania Hospital for the In-
sane, for 1852 The Prize Essay of Prof. Flint, on Variations of Pitch

1853.] Miscellany. 259

in Percussion and Respiratory sound and their application to physical
Diagnosis Elephantiasis Arabum successfully treated by ligature of
the femoral Artery, by Prof. Carnochan Remarks on Osteo-aneurism
by the same New Views of Provisional callus, by F. H. Hamil-
ton, M. D. A Treatise on the causes, constitutional effects and treat-
mentof Uterine Displacements, by W. E. Coale, M. D. Smithson-
ian Report on Recent Improvements in the Chemical Arts, by Prof.
J. C. Booth and C. Morfit Sixth Annual Report of the Regents of
the Smithsonian Institute First Report of the Surgeons of the New
York Ophthalmic Hospital Syllabus of a course of Lectures on Dis-
eases of the Eye at the New York Ophthalmic Hospital, by M. Ste-
phenson, M. D. A Discourse on the life, character and services of
Daniel Drake, M. D., by Prof. Gross Introductory Addresses, by
'Prof. Lawson of Cincinnati, Prof. Bowling of Nashville, Prof.
Hughes of Iowa University and sundry Reports and Documents on
the subject of the Discovery of Anaesthetics.

We cheerfully place the "Dublin Medical Press" upon our ex-
change list, and hope that its accomplished Editor may be as well
pleased with our efforts as we are with the specimen he has sent us.
Dublin is now the seat of as much Professional ability as any city in
the British Isles.

Whitlow. Somebody proposes as an abortive treatment of whitlow
the application, very early, of mercurial ointment to the finger. We
doubt its efficacy, but if any one will try it, we would like to know
the result.

A handsome present. Messrs. Philip Schieffelin, Haines & Co.,
Druggists, of New York, have presented to the Medical College of
Georgia a complete series of specimens of the Materia Medica, put
up in large glass-stoppered bottles for exhibition to the Class. It is
altogether one of the finest collections of the kind we have ever seen,
and the specimens, being hermetically sealed, will long remain to
attest the taste and liberality of the respected donors.

Dr. Marshall Hall is on a visit to the United States. We hope that
he may visit this section of the country.

The American Medical Association will meet at New York on the
3rd of May next.

260 Miscellany.

Greensboro,' March 10th, 1853.

At a called meeting of the " Physicians' Society for Medical Ob-
servation of Greene and adjoining Counties," the following resolutions
were unanimously adoped :

Whereas it has pleased an all-wise and mysterious Providence to
remove by death from our Society, our worthy and highly esteemed
brother, R. S. Callaway, M. D., of Greene county, and whereas we
deeply deplore his sudden and premature separation from our fel-
lowship

Be it therefore, Resolved, That our Society has lost one of its most
zealous and devoted members, and our profession a member of unsul-
lied character and strict professional integrity.

Resolved, That we, as a Society, most sensibly feel the void occa-
sioned by the demise of our brother, and that we will ever cherish
his memory as a forcible illustration of the true and faithful physician.

Resolved, That we sincerely condole with the family and friends
of the deceased, and that we hereby tender them our heartfelt sym-
pathy.

Resolved, That we wear the usual badge of mourning for the
space of thirty days.

Resolved, That a copy of these resolutions be forwarded to his be-
reaved family, and that the Southern Medical and Surgical Journal,
Temperance Banner, Christian Index, and Chronicle and Sentinel be
requested to publish them.

JAS. Y. FOSTER, M. D., President.

D. C. O'Keeffe, M. D., Sec'ry.

Death of Professor Horner. It is with profound regret that we
announce the demise of Prof. Wm. E. Horner, which took place on
the 12th instant. He was long distinguished as the ablest American
anatomist, and universally respected for his private virtues.

The British press announces the death of Dr. George Gregory, the
author of the once popular treatise on the Practice of Medicine also,
that of Dr. Jonathan Pereira, the author of the very learned work upon
Materia Medica.

Medical Society of the State of Georgia. We would remind our
readers that this Society will meet at Savannah on the 13th of April.
We hope that there may be a full attendance.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. MAY, 18SS. [No. 5.

PART FIRST.

rtgtnal dommunuattotts.

ARTICLE XVI.

On Spinal Irritation. By John T. Slaughter, M. D., of
Villa Rica, Ga.

The great diversity of opinion relative to the pathology and
treatment of disease, demands an investigation of all the symp-
toms which may supervene in the many affections which may
come within the limits of our observation. Among them all,
there is none that is so common, or so often escapes the physi-
cian's notice, as Spinal Irritation; for the reason that there
is no complaint made by the patient to call his attention to the
fact that it exists.

The cause of all the phenomena in intermittent and remit-
tent fevers, is attributed (by a number of physicians of the
present day) to lesions of the spinal cord ; and Professor Ford
has tried to instil into our minds that it is not only always pre-
sent in these, but may supervene in numerous other diseases
which doctrine has so far been corroborated by my own
investigations.

The first case to which I shall call attention, is one of Inter-
mittent fever, which, though it may not be one of much practi-
cal importance, may serve to throw some light on its obscure
pathology.

n. s. VOL. IX. no. v. 17

262 Slaughter, on Spinal Irritation. [May,

Case I. Miss M., aged about 10 years, was taken with
intermittent fever. Two weeks had elapsed from the com-
mencement of the attack when the paroxysms were entirely
replaced by neuralgia of the inferior extremities, of the most
excruciating character. Portions of the spinal column were
tender on pressure.. Topical applications relieved her, and the
administration of quinine prevented a recurrence.

Case II. Mrs. C, was seized (on the third day of her con-
finement in childbed) with a chill, followed by fever with
nausea, pain in the head, hurried respiration, tenderness on
pressure over the uterus, tongue furred in the centre with red
borders, bowels torpid, and the lochial discharge suspended.
She had been in this situation two days, when I was called to
see her. On examination, I found a portion of the vertebral
column morbidly tender. Ordered, sinapisms to the vertebras,
warm cloths to the vulva, and a dose of the sulphate of mag-
nesia. By the next morning she was so far relieved as to
require no farther treatment.

Case III. Mr. B. was attacked several years ago with
remittent fever, which terminated in an intermittent. After
its cessation there was left remaining in the right hypochon-
drium a sensation of chilliness, which was superseded by erratic
pains along the course of the ascending colon : this eventually
located itself in the right iliac region. Bowels costive ; opera-
tions scybalous and mucous, streaked with blood afterwards
constipation alternating with diarrhoea; noise in the abdomen
resembling the croaking of a frog worse in the recumbent
posture ; a sound resembling the dashing of a liquid against
the parietes of the abdomen, and skin of a dark swarthy hue.
In the latter stage, troubled with hectic and pain in the left
side resembling pleuritis.

This was his state for several years, during which time he
was reduced to a mere skeleton. He had been subjected to
treatment for dyspepsia, chronic hepatitis, and phthisis pulmo-
nalis exhausted most of the articles of the materia medica
and patent nostrums of the day without experiencing any re-
lief. On subjecting him to an examination, I found the third
and fourth dorsal vertebras very tender to the touch. Con-
tinued counter-irritants to the spine relieved him, without the

1853.] D'Alvigny's Case of Frost-bite. 263

aid of any medicine internally. He still has occasionally a
slight return of his old symptoms, but the application of a few
dry cups dispels all unpleasant feelings.

Here was a disease, with all the symptoms of dyspepsia,
which must have had its seat in the spinal marrow. But it is
not only in this disease, but in many others which had with-
stood ordinary treatment for years, that I have found this the
most prominent symptom. Beside topical remedies, 1 have
also found the cold shower-bath to be of great benefit ; and
from observations which I have made, I am of the opinion that
it is in such cases as these that Hydropathy wins her laurels.
This I know, that the sufferings of many might be alleviated
by the bestowal of the proper attention to this subject.

ARTICLE XVII.

A Frost-bitten Scrotum Gangrene Recovery. Reported by
N. D'Alvigny, M. D., of Atlanta, Ga.

Mr. J. W., a farmer, about 30 years of age, in travelling on
horseback on the 3rd of January, 1852, had his scrotum frost-
bitten, and exposed himself to the heat of a large fire, which
caused itching all over the scrotum, and pain in the back and
thighs. His condition becoming alarming, medical advice was
procured on the 5th of the month.

Drs. S. Malone and W. McKown, of Fairburn, found the
patient completely prostrated, and in the most excruciating
agony. The scrotum was of a deep purple, and so much swol-
len that its bursting was apprehended at every moment ; the
slightest pressure on it increased the pain dreadfully. The
pulse was one hundred to the minute.

6th. Aggravation of symptoms, the scrotum turning black.

7th. The scrotum bursting at its lower portion gave issue to
a large quantity of whitish liquid.

8th. Mortification is complete, and the black color extending
all over the scrotum.

9th, 10th and 11th. Mortification progressed to a fearful ex-
tent.

12th. I was called, in consultation. Found the patient very

264 Dugas, 07i Pharyngeal Tumours. [May,

feeble, and emaciated ; the scrotum entirely destroyed on the
left side on the right side about one inch and a half re-
mained, not yet mortified, the right testicle being adherent to
it, and bathed in a mass of putrefaction. Anteriorly the root of
the penis was the line of demarcation. Posteriorly the perine-
um was already interested in the disorder, showing a portion
of the urethra naked. The left testicle was hanging by the
cord ; both glands perfectly sound.

I advised to continue the treatment usual in cases of slough-
ing, viz., the use of chloride of soda, and the administration of
generous diet, wine and tonics.

I refused to perform an operation, which, under the existing
circumstances, could not relieve the patient's sufferings, and
would probably induce a fatal termination ; but proposed to
wait until the mortification should be arrested, and then, if no
appearance of sound and abundant granulation took place, to
perform castration.

15th. The mortification ceased, and granulations at every
point of the sloughing surface formed with astonishing rapidity.

On the 29th, medical attendance was discontinued, the testi-
cles being entirely covered with an artificial scrotum. In two
weeks after the patient was able to go about, and he has since
experienced no pains nor inconvenience of any importance.
He is in a good state of health.

This accident has not deprived those delicate organs of the
important functions assigned to them by nature.

ARTICLE XVIII.

Extirpation of Pharyngeal Tumours. By L. A. Dugas, M. D.,
&c.

There are no surgical affections more frequently encounter-
ed than tumours, and yet there are none in which the surgeon's
skill is so often painfully tested both as to diagnosis and treat-
ment. If, as has been oft-times repeated, no surgeon however
experienced should ever advance a positive opinion as to the
true nature of a tumour before seeing its internal structure, the
difficulty is, in many instances, not diminished when he is call-
ed upon to determine upon the propriety of extirpation. And,

1853.] Dugas, 07i Pharyngeal Tumours. 265

even after having advised a resort to the knife, he often finds
himself surrounded by dangers to the life of the patient, and to
his own reputation, sufficient to deter any one not firmly con-
vinced of the propriety of the course to be adopted and of his
ability to do justice to the patient.

Why these difficulties ? Do they necessarily attach to the
diseases in question or, in other words, has the profession
given to them the careful attention to which they are entitled ?
It is true, that we have some good monographs upon the subject
of tumours, but they are far from being perfect far from fur-
nishing to the practitioner all the data he may need on entering
upon the duties of his profession. The history of tumours to
be found in the systematic works upon Surgery, is usually so
meagre as to be worth comparatively but little, except in cases
of the most ordinary simplicity. It becomes us therefore to
accumulate and to report facts as they present themselves, in
order that materials may be at hand for the construction of a
work consisting not merely of generalities, but also of such
details as may furnish specimens of whatever may be subse-
quently observed in practice. A volume that would contain
nothing more than the history and treatment of individual tu-
mours, so that we might find in it a parallel for any that we may
meet, would be invaluable.

Tumours in the pharynx are comparatively rare, according to
written authorities as well as our own observation. It may
therefore serve the purpose to which wTe have just alluded to
publish the following history of a formidable case recently
treated.

Branch, a negro man about 35 years of age, the property of
Mr. J. A. Smith, of Henry county, Ga., was placed under my
charge early in February last. He first noticed about three
years before, a small tumour behind the soft palate, which he
represented as being very hard and painless. From that time
it gradually increased in size, and was never painful, but ra-
ther inconvenient. I found the tumour filling the pharynx,
extending upwards to the posterior nares, downwards as far
as the larynx, and laterally from one tonsil to the other,
forcing down the right one. The soft palate was carried for-
wards and downwards, so as to constitute a prominence the

266 Dugas, on Pharyngeal Tumours. |_IMay,

size of a large egg, to the posterior surface of which the
tumour was attached. Deglutition was so difficult that he
could take no solid food his articulation was very indistinct,
and respiration considerably impeded when he would walk
briskly, causing him then to breathe loudly and like a horse
affected with the " bellows."

Believing the tumour to be fibrous, I proceeded on the 10th
of February to its removal, as follows:

Provided with actual cauteries, a syringe, sulphate of zinc,
&c, to control the hemorrhage from the general surface and
smaller vessels, I passed a ligature beneath the right carotid
artery, and left it there, ready to be tied should this become
necessary. The patient was then seated in a chair, and an
incision made from the right angle of the mouth to the masseter
muscle which necessitated the ligature of the facial artery.
In the third stage of the operation, a longitudinal incision was
made from the side of the uvula to the roof of the mouth,
through the soft palate, which was then detached from the tu-
mour in the form of flaps. The tumour now presented a white
glistening aspect, and was adherent, posteriorly and laterally,
to the adjacent parts by strong cellular tissue. Having free
access to the parts, the cutting instruments were laid aside, and
the mass was seized with strong tumour forceps and drawn
forwards, whilst my fingers were passed behind and tore asun-
der the attachments of the lower portion of the tumour. The
fingers were then carried successively behind the left, the
upper, and a part of the right portions of the mass, which was
now7 removed. The entire mass thus extirpated constituted
one distinct tumour ; but there was still another left in the right
side, apparently in intimate connection with and pressing down
the tonsil with great force. It did not, like the former, present
a white glistening surface to the eve, but was covered by a
thin stratum of muscular fibres, derived from the pharyngeal
muscles. Upon dividing this stratum with the knife, and
pressing it aside, the tumour was found to be of the same char-
acter as the former and it was likewise removed by the fingers
and forceps, not however without much difficulty. It was
found to be attached to the ramus of the lower jaw, near the
sigmoid notch, to the pterygoid process of the spenoid bone

1853.] Dugas, on Pharyngeal Tumours. 267

and to the posterior aperture of the right nostril, and was
brought away in separate fragments. Both tumours, when
placed together, formed a mass about the size of a turkey's

The patient bore this protracted and painful operation with
wonderful fortitude. The amount of hemorrhage was smaller
than could have been anticipated, but had to be checked occa-
sionally by cold water thrown into the pharynx with a syringe.
After allowing the patient to rest a little, the cheek was stitch-
ed and well brought together with adhesive strips. He was
then put to bed with the wound of the neck partially closed,
and the ligature was permitted to remain beneath the carotid
until the following morning as a precautionary measure.

The patient's recovery was unattended with any circum-
stance worthy of note. He did remarkably well, and would
have been sent home in about a fortnight, had he not taken
cold which affected his bowels and induced considerable fever
for eight or ten days more.

Will this disease return ? Microscopic examination by Dr.
Harriss showed the tumours to be purely fibrous nothing
indicative of malignancy could be detected in it. Time alone
will decide the question.

The structure of these tumours was very similar to that of
fibrous polypi, but differed from them in not being pediculated.
They were, on the contrary, closely attached to all the tissues
with which they came in contact. From the history given by
the patient, it appears that there was at first only one tumour,
and that it was situated behind the velum palati. That in con-
tact with the right tonsil was of subsequent growth. Would
the early removal of the first have prevented the develop-
ment of the second? Some years ago (in 1847) Dr. B., of
an adjoining county, sent us a case upon which we operated,
and which has thus far not been reproduced.

The subject was a negro woman about 25 years of age, who
presented a tumour about the size of a small hen's egg attached
to the posterior surface of the velum palati by a broad base,
about the size of a half-dollar coin. In this instance, instead of
slitting up the soft palate, we plunged a hook into the centre of
the protuberance and circumscribed it with a circular incision

268 Bignon's Case of Dropsy. [May,

carried through the soft palate, thus leaving entire the lateral
half arches and the uvula. The tumour was then readily
drawn through the aperture thus made, for it had no posterior
attachments. The wound cicatrized completely in a short
time, leaving no deformity.
Augusta, March, 1853.

ARTICLE XIX.

Case of Dropsy, cured by External Diuretics. By H. A.
Bignon, M. D., of Augusta, Ga.

Having noticed in the June No. of your Journal a report of
cases of Dropsy, treated by external diuretics, I was induced
to give them a trial. The mixture used consisted of equal
parts of tr. of digitalis, tr. of squills, and soap, of which one
drachm was well rubbed over the abdomen three times a day.

The patient was a negro girl, belonging to Col. M. B :

she was about twelve years of age, and had been laboring un-
der general dropsy for some months before coming under my
care. The chest, abdomen and extremities were very much
distended, and her respiration very much impeded, so much
so that I was compelled to tap her, and succeeded in getting
about three gallons of fluid ; but as soon as the puncture closed
the abdomen commenced distending again, and she became
very nearly in the same condition as when I first saw her.
I then began the use of the diuretic mixture, and in about two
weeks my patient was well, and has continued so up to this
time five months.

1853.] RicoroVs Letters on Syphilis. 269

PART II.

(Eclectic department.

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 223.]

TENTH LETTER.

My Dear Friend To-day I shall speak to you upon syphilis.
As you can have remarked, I have not lost sight for an instant
of my point of departure.

What was it ? To seek out the specific causes of those dis-
eases considered venereal ; to study in a more rigorous manner
their mode of action, in order to arrive at last at a more exact
knowledge of their consequences and of their treatment.

In the preceding letters, I have endeavored to show that if
blennorrhagia can have a special cause, it was not alwavs easy
or even possible to distinguish this special cause from the com-
mon causes of the inflammation of mucous surfaces. I have
endeavored to establish that this cause was not that which
produces syphilis properly so-called ; that its consequences
were entirely different, and that its treatment, unless empirical,
cannot be that which we ought to oppose to syphilis.

I should have been very happy to have merited in all re-
spects the criticism of M. Vidal, who asserts that my efforts
have tended only to prove " that two and two make four." If
I should apply this to all that still passes in syphilopathy, this
proof would not for every one be equally easy to arrive at.

The cause of syphilis not existing in blennorrhagia, where
must it be sought for?

Do not require that I should precipitate myselfinto the depths
of history. I have often descended there, and I declare to you,
dear friend, that I think it impossible to discover the truth there.
The farther one descends, the less light penetrates, and he ar-
rives at a point where the obscurity is complete. So that,
arrived at this point, authors only proceed by groping ; they
wander about without cessation, and lead us astray with them.

Where did syphilis commence ? By whom did it commence?
I much fear that these questions are forever insoluble. What
we can affirm, is that syphilis, such as we know it at the present
day, is not developed spontaneously in man ; it appears to be
always transmitted. And yet, as we have already remarked,
we do not meet with it in any other class of animals. I well
know that very recently your Journal announced that syphilis

270 RicoroVs Letters on Syphilis. [May,

had just been found in Italy in the horse. In order to believe
this news, I await some more complete descriptions of the
symptoms. It would, nevertheless, be rather singular, that
syphilis, which they accuse of having been propagated for the
first time in Italy upon the human race, should appear also for
the first time in Italy upon the horse.

What strikes every man who studies history without precon-
ceived ideas, is, to find in the ancient authors, and especially
in those who were anterior to the epidemic of the fifteenth cen-
tury, perfect descriptions ofall that we know to-day, and which
we range among the primary accidents. Could we trace out
at the present day a description more exact and more true than
that ofCelsus? Galen goes even so far as to find some rela-
tion between the accidents of the genital organs and those of
the throat. William of Sallicet knew that the primary ulcera-
tions of the penis had been contracted from relations commit-
ted with filthy women ; he established perfectly the relations
which exist between ulcerations of the genital organs and bu-
boes, &c.

What has been wanting to observers and historians of the
verole, from the earliest times, is the more exact knowledge of
the filiation of the symptoms, of the connections and origin of
the primary and constitutional accidents. But what was the
leprosy of that epoch? Was the leprosy of the Greeks or of
the Arabs, which we know to-day, similar to the leprosy of
those times ? In no respect ; for the leprosy was then often
contagious, ' and it was frequently communicated by sexual
intercourse. Evidently it was not our present leprosy. The
Bible, in spite ofall the efforts of commentators, enlightens us
but little upon this point. Probably the divine inspirer of the
sacred books might have had serious motives in leaving some
obscurity upon this point. I have no pretension to retrospec-
tive science ; the works of Astruc have frightened me too much,
and I confess that I am little tempted to undertake so great a
work for so small a result. But whoever studies syphilis, how-
ever little he may have his mind tormented by the anxiety to
know, will ask of himself, what I have done a hundred times,
what was this terrible epidemic of the fifteenth century, and
where did it come from.

Some cotemporaries have made it come from the stars. I
do not know that they retrospectively searched out what pass-
ed astronomically at that period, and I am myself unable to do
it. But it is certain that syphilis always reigns although Jupi-
ter is to-day much more temperate, and Saturn and Venus no
longer deliver themselves up to conjunctions which had such
unhappy consequences for the human race. We are, then,

1853.] RicoroVs Letters on Syphilis. 271

forced to seek our explanation upon the earth, and to take our
subject from a less elevated point of view.

This terrible epidemic, this veritable 'S3 of the verole (1493),
which no cotemporary at first thought of making come from
the new world, found this origin in the writings and in the ac-
tive propagandist) of Oviedo, from motives into which it is
useless to enter, and of which we shall find the application in
the religious, political and Jesuitical history of the time. We
know that it is this fable which has become the theme of the
great romance edited by Astruc. Heaven preserve me from
discussing this ; it is a work that has already been well done
by Sanchez. I will allow myself only a slight observation in a
pathological point of view.

In order to have brought about an epidemic upon such a
grand scale, it must have been necessary that all or nearly all
the sailors of Christopher Columbus should have been infected
with syphilis. It was necessary that during a very long voyage,
which was then not made by steamers, the primary accidents
should have remained at the period of progress or of specific
statu quo, susceptible of furnishing the contagious pus that we
shall soon study.

One thing is very remarkable, that the sailors of the fleet,
having arrived at Lisbon and at Bayonne, did not first infect the
women of those ports: and yet is it probable, that contrary to
the habits of sailors of all times, these should have, after along
voyage, exercised continence after arriving in harkor ? Well,
it is not to the women of Lisbon and Bayonne, that they com-
municate their disease ; they leave for Italy where they go to
meet the army of Gonzalve de Cordova in May, 1495, and it is
there that they communicate the verole to whom ? We
know nothing excepting that it was in Italy in the midst of
three armies Spanish, Italian and French that a disease, then
known since 1493 or 1494, raged with fury, each of the bellig-
erent parties repelling the disgrace of communicating it to the
others.

I do not wish to insist longer upon this historical question so
confused and obscure, and which I have not the pretension to
wish to clear up. I only ask myself if this epidemic of the
fifteenth century resembles our venereal diseases of the present
day ; and I find certainly not. The accidents that we observe
to-day resemble infinitely more those that the ancients have
described, than the epidemic of the fifteenth century.

Here, my friend, permit me to communicate to you, with the
reserve and the discretion which similar things exact, an idea
which I believe to be a fruitful one. I submit it as a simple
indication to some young and industrious colleague, who shall

272 RicoroVs Letters on Syphilis. [May,

have the good fortune of finding himself in that happy period
when consistent researches are possible. In studying with
care the descriptions of the epidemic of the fifteenth century,
I am struck with a fact, which appears to me to be of marked
interest. The mode of the transmission of the accidents, their
gravity, the predominance of the constitutional infection over
the local phenomena, which are wanting, or which passed un-
perceived, all this appears to me to resemble much more what
we recognize to-day as the acute glanders, and the farcy, than
the verole. Van Helmont has published an analogous idea,
which has not failed to have been considered perfectly ridicu-
lous. He makes the verole come from the farcy, as the conse-
quence of I do not know what ignoble beastly relations. Apart
undoubtedly from the shameful source from which he drew his
opinion, Van Helmont was perhaps not far from the truth.

Remark, my friend, that a knowledge of the glanders and of
the farcy in man is very recent, and yet the liability of man to
contract this disease, which has existed from all time in the
horse, ought not to be a recent fact. How many men suffer-
ing from the glanders and from the farcy have been liable to be,
and have been, taken for syphilitical patients !

The manner of the transmission of the epidemic of the
fifteenth century ought to strike us. The disease was often
communicated by the breath in churches, in confessionals, to
such an extent that Cardinal Wolsey, accused of having the
syphilis, was brought to judgment for having spoken in the ear
of Henry WIL This mode of propagation is entirely inexpli-
cable for syphilis, which requires an immediate contact. I well
know that all the authors of the time do not admit this mode
of transmission by the sole contact of the breath. Fallopius
ridicules very pleasantly Victor Benoit, who had seen some
holy daughters of a convent catch the verole through the thick
grates of the parloir. Fallopius believes that there was mixed
with this, a little holy ivater. But in all cases could not the
epidemic, which certain authors already, and Paracelsus among
others, considered as a mixture of the ancient venereal diseases
and of the leprosy, be more probably considered as a mixture
of the ancient venereal diseases with the glanders and farcy
the glanders, so spontaneous and easily produced upon horses,
and especially in time of war, and with the incumbrances which
follow in its trail.

Study the symptoms, and you will first see manifested, and
as if oVembUe, the gravest accidents ; which does not happen
with respect to the syphilis of the present day. You will see
that inoculable pus was produced in all parts of the body, which
you do not see in the syphilis now known to us. J do not

1853.] Ricord's Letters on Syphilis. 273

know if I am mistaken, but it appears to me that there is in
this, a truly remarkable subject for research. I seem to see
the first dawning of a truth which has escaped us, even to this
hour. We shall owe this truth to the beautiful works of M.
Rayer, and of his school, and of M. Renaud (of Al fort) upon this
terrible disease with which man is found so sadly endowed ;
and in which I find such striking resemblances with the epi-
demic of the fifteenth century. What glorious things there are
to be done in this matter!

Are we aware of what the glanders, transmitted from man
to man, and removed from the horse, can produce ? Do we
know what its hereditary influence is ? For individuals suffer-
ing from the glanders or from farcy can procreate, and we are
completely ignorant of what would become of the product of
these procreations.

I should be happy to awaken the zeal of some laborer in our
science. There is here, it seems to me, an ample harvest of
glory to reap. But I confess it, all these ideas are still agitated
in my mind, in the vague domain of hypothesis. Your readers
I can understand must be desirous to see me enter into the field
of reality. I arrive there : adopting the conclusion of Voltaire,
I say that syphilis is like the fine arts, of which no one knows
the origin nor the inventor. But what I know is, that it is found
to-day at a source, alas, too certain, and it is from this source
that I shall draw it in my next letter.

ELEVENTH LETTER.

My Dear Friend, We must now determine the source,
where the specific cause, the morbid poison which produces
syphilis, is to be found. This poison, we can at the presant
day call by its name, the syphilitic virus.

Well ! this virus I must needs recall the circumstance, in-
asmuch as endeavors have been made to cause it to be forgot-
ten was formally contested and denied, when I undertook my
first researches in syphilopathy. This was the time when nu-
merous physicians did not dare to give it this name without fear
of compromising themselves. It was the time when the learned
Jourdan, in an access of singular anger, cried out " : call it as
you will, but do not give it the name of virus."

The source of this virus, I have obtained at the point of the
lancet, upon which, however, I have not had the pretension of
placing all science, as my honorable colleague, M. Cazenave,
wittily accuses me.

It is in studying comparatively all the accidents reputed sy-
philitic, that I have succeeded in demonstrating that one alone

274 RicoroVs Letters on Syphilis. [.May,

of these accidents would furnish regularly the purulent matter ;
capable, in placing it under conditions which we shall deter-
mine, of producing, in virtue of a special irritation, an ulcera-
ting inflammation identical to that which has been the source
of it, and of reproducing in its turn the same special secretion,
the same morbid poison, and this without limit.

The syphilitic lesion, source and origin of the secretion,
placed in favorable conditions, produces fatally the phenomena
which we have just indicated, and which is the primitive acci-
dent to which has been given, and which has preserved the name
of chancre.

Every time, as I have already had occasion to remark, that
we were able to see the surfaces from which we took the morbid
secretion, which should serve for experimentation, it is only
when there existed a chancre, that positive results could be ob-
tained, and that we were able to reproduce the chancre.

Must I again say that my excellent colleagues, M.M. Puche
and Cullerier, at Paris; M. Baumes and Diday at Lyons; M.
Renault at Toulon, Serre at Montpelier, M. Thiery at Brussels,
M. Lafont Gouzy at Toulouse, &c, have arrived in their very
numerous experiments, absolutely at the same results as myself.

Every time that the chancre could be produced with a secre-
tion which had not been taken immediately from a primary
ulcer, the secretion was furnished by surfaces which could not
be inspected. The small number of cases, exceptional in
appearance, in which the chancre could be reproduced with a
purulent matter taken from a non-ulcerated surface, find their
rational and absolute explanation in facts analogous to those of
which I have recounted the history. How can it be concluded
that the surfaces which cannot be inspected are not the seat of
chancre, inasmuch as they furnish absolutely the same secretion
as the chancre ? Ah ! if it was proved that the primary ulcer,
fatal source of the syphilitic virus, could not be seated, excep-
ting upon external surfaces which are always visible ; that the
depths ofthe urethra, and the cavity of the neck of the uterus,
could not be the seat of these concealed ulcerations if this was
proved, all would be said ; but does there exist one sole writer
upon syphilis who denies the existence ofthe primitive ulcer
upon all these regions, who does not know and who does not
believe that all syphilitic ulcerations are not always visible ?
How, then, can we deny the possibility of the existence of deep
and concealed chancre, when it in itself furnishes the most un-
deniable proof, that is the secretion?

It has been said that inoculation cannot serve any purpose in
proving the existence ofthe specific cause of syphilis; that it
was preferable to confine ourselves to the ordinary results of

1853.] RicoroVs Letters on Syphilis. 275

contagion to arrive at this proof; for with any pus whatever
we can produce what I pretended to produce only with the
pus of the chancre, while by the mysterious ways of common
contagion phenomena are observed, which inoculation does not
produce.

It is at least strange that these same arguments are equally
employed, both by the maintainers of the syphilitic .virus, and
by those who deny its existence. In fact what do these physio-*
logists say ? That with any pus whatever, that with a cause
no matter what, the same result was arrived at that is to say,
the production of every variety of venereal disease. And upon
what do they rely to sustain this doctrine? Upon motives
which could then appear reasonable ; upon all the uncertainties
which ordinarily exist under the circumstances in which the
venereal diseases are contracted ; for the want of examination
of women ; upon the great number of the accidents determined
by the same woman upon several men while this same woman
could leave other men entirely indemnified from evil consequen-
ces ; finally, upon all the fables that we have already signalized
and combated, and upon which one is truly astonished, after
what the speculum has discovered, to see men of merit as incon-
testable as M. Cazenave wish still to ground superannuated
doctrines.

But I am profoundly astonished that the partizans of the
syphilitic virus, those who recognize in syphilis a specific cause
and in its virus a specificity of action, sustain, that with any
pus whatever effects can be produced analogous to those of the
inoculation virulent par excellence. Do the partizans of these
doctrines think that we could produce vaccinia or the variola by
any kind of pus ? If it was given to them to experiment upon
purulent matters the source and origin of wThich they were
ignorant, what would be their criterion for determining the
nature of them, if it was not the effects produced ? Is it not in
this way that I arrived at distinguishing the syphilitic pus ?

But to this objection of any pus whatever as proof of the inu-
tility of inoculation, I have another thing to answer.

I have inoculated the same patient, and that a hundred times,
with the pus of chancre, of balano-posthitis, with the muco pus
of urethral blennorrhagia, with the muco-pus of blennorrhagic
ophthalmia, with the pus furnished by the phlegmonous inflam-
mations of other regions; and while that of the chancre inev-
itably reproduced the chancre, the other kinds of pus remained
without action. What do they want more than this proof,
and what can they answer to it ?

Another objection, however, has been made. They have
said, the inoculation does not prove anything as to the nature

276 RicoroVs Letters on Syphilis. [May,

of the cause, from the effects that it can produce upon an indi-
vidual already submitted to the infection; in other words, in
inoculating the patient with the secretion that he himself fur-
nishes, no conclusion can be arrived at, inasmuch as that if in-
fected every wound can and ought to become syphilitic.

Herein is a strange error, the consequences of which might
be very grave ; a dangerous prejudice, which I am astonished
.to see again brought forward in our day with the sanction of
observers who make pretentions to exactitude and precision.
The facts which I have just recalled peremptorily destroy this
objection. I well know that facts relating to leech-bites, for
example, have been cited, which have taken on later the char-
acter of venereal ulcers. But be assured, my friend, these bites
like every wound in a syphilitic patient, do not become viru-
lent ulcers, unless they are finally infected by contagion. Ap-
ply leeches where there has been no contact with inoculable
pus, bleed the syphilitic patients as much as you wish, practise
any other operation whatsoever, and never, unless there has
been virulent contact, will a virulent transformation be possi-
ble. Among the numerous observations, which I have collect-
ed in proof of the truth of this assertion, I will recall the follow-
ing fact of the Hospital du Midi.

At the period when I had women in my wards, a patient af-
fected with a phagedenic chancre of the vulva, with abundant
suppuration, was seized with a pain in the tibio-tarsal articula-
tion. Leeches were applied upon the painful spot. Some days
after the patient complaining at the seat of the bites, it was easy
to recognize that some had undergone a veritable transforma-
tion, and that they had become^veritable chancres. One could
believe for a moment in the influence of the general condition
of the patient, and some of the students Relieved in it. As to
myself, I had not the least doubt upon the mechanism of this
transformation. In the first place, all the bites were not ulcer-
ated first proof. Secondly, the patient was seized with similar
pains in the articulation upon the opposite side ; a new applica-
tion of leeches was made, but this time, in guarding the bites
from every infecting contact, none of them underwent the
least syphilitic transformation.

I have made an experiment more conclusive still. It has
often happened that I had to experiment with the pus of a chan-
cre upon a patient even then under the influence of a constitu-
tional syphilis determined by a preceding contagion. Some
comparative inoculations were made, and then again the mat-
ter of the chancre alone gave place to positive results. Thus,
whatever may be said, it is impossible to compare a syphilitic
patient to a bottle full of virus, which it would allow to escape

1853.] RicoroVs Letters on Syphilis. 277

through the smallest opening. The image is poetical, but it is
not just.

But in order that these results should be inevitably obtained,
reason tells us, in the first place, that the virulent matter ought
to be taken from a chancre at a certain period that is to say,
at the period of progress, or of specific statu quo. It is very
easy to conceive this, and I am sure of not fatiguing you in try-
ing to make you understand that if you take the pus for inocu-
lation from the surface of an ulcer which is in process of repar-
ation and of cicatrization, you will have a simple and inoffen-
sive pus, which will give you negative results, and that the
same accident interrogated at two different epochs will say to
you, yes and no. You will conclude, then, with all observers
of good faith, that there is here no contradiction in the results of
experimentation, nor uncertainty, and that it is no evasion, no
subtility of doctrine, to explain facts opposed to the principles
which I sustain, and similar to those of Bru. When Bru did
not succeed in inoculating the pus of chancre, one of two things
happened ; either he made a false diagnosis and directed his
attention to other ulcerations, or he took the pus from chan-
cres at the period of reparation. There is no way of escaping
from this dilemma ; for I repeat it, and I am ready to prove it
to the incredulous, if there are any still, the pus of the chancre is
inevitably inoculable.

You will perhaps find, my friend, that I suffer myself to go
too far in the pleasure of writing to you ; but it is your fault,
you never stop me. Profiting, then, by your good will, I will
say that if the virulent matter composed of a special morbid
poison and of a vehicle, is ordinarily formed of a thin, ichorous,
sero-sanious pus charged with organic detritus, it does not
always present itself with the same characters ; it can offer all
the known varieties of pus or of muco-pus. It can be acid or
alkaline, contain animalcules or not. These different conditions
which appear contradictory, and have also served as an argu-
ment to those who deny the existence of a virus, belong only to
its vehicle, and change nothing of its nature, which remains
always the same. There is but one circumstance important
to signalize, and which experiments upon inoculation have
verified viz. that the putrid pus is not virulent, that gangrene
destroys the virus it kills it.

In order to act, whatever may be the seat of the chancre from
which it has been taken, the virulent matter has no need of
being recently secreted and warm. Preserved as vaccine is, it
acts equally well. Artificial inoculation proved this, contrary
to the opinion of Cullerier, which hitherto was in vogue in
science.

n. s. VOL. IX. no. v. 18

278 Ricord's Letters oh Syphilis. [May,

Inoculation has proved the truth of the different modes of
contagion, more or less contested, so far as necessity of the phy-
siological action and of the orgasm of the part which furnished
the contagion was believed in, and as it was thought that this
ought to be yet warm at the time of infecting. The observa-
tions of Fallopius and Hunter of chancres contracted in touch-
ing the seats of public privies; those of Fabricus of Hilden of
accidents taken in sleeping in sheets in which infected persons
had already slept, and of so many others, in fine, have thus
become incontestable.

You will still permit me to say a word upon the conditions in
which the part which one inoculates ought to be. Whatever
it may be, skin or mucous surface, no matter what region, it
suffices to have a simple solution of continuity without the aid of
any physiological act, in order that the effect should be inevita-
bly produced: there is nothing here, as in the case of the variola
and vaccine, which resists the primitive accident ; there is no
privilege of idiosyncrasy ; the most perfect equality exists in the
presence of a point of a lancet charged with virulent matter.

Thus, then, dear friend, the inoculation made with the pus
coming from a primary accident, with the pus of a chancre, in
the condition which I have just recalled, has always produced
identical results, whether experimentation has had for subject
the patient who furnisned the pus, or whether the pus has been
inoculated from an infected to a healthy individual, as some ex-
perimenters have done.

It has however, again been said it is imprudent, rash and
impossible to conclude anything from artificial inoculation;
you impose upon nature conditions other than those in which she
is placed during the contagion which we can call natural by con-
tradistinction. And condemning this artificial inoculation, they
thought they could say of it what is said of physiological exper-
imentation " Torture demands and pain responds/

Our celebrated physiologist M. Magendie, to whom you ad-
dressed your first, and so remarkable medical letter, will tell you
what he thinks of this indignation of the poets. As for myself,
who do not wish to speak with the same authority, I shall say
that I do not contest the mysteries of nature, that I know she
does many things by processes which she conceals from us. But
I maintain, also, that it would be an unworthy weakness to seek
to render her still more mysterious, and to thicken the veils
which cover her; that it would be shameful to shut our 'eyes
when she wishes to unveil herself.

Let us see, then, if there exists any real difference between the
natural and the artificial contagion. I shall tell you what I think
of this in my next letter. [Boston Med. and Su?*g. Journal.

1853.] Treatment of Syphilis. 279

On the Treatment of Syphilis. By Prof. Bennett, Edinburgh.

[The following remarks are taken from No. 8, of Dr. Ben-
nett's very valuable Clinical Lectures :]

The treatment of syphilis may be said to be of two kinds,
namely, the simple and the mercurial. The profession are rap-
idly deciding in favour of the first, although some of its mem-
bers still give mercury in inveterate cases. Many of those we
meet with, therefore, have taken the drug, and we have to erad-
icate the effects of the mineral poison as wTell as that of the
original disease.

The Simple Treatment is divided into internal or medical,
and external or surgical. The first consists in the observation
of certain hygienic rules, and the employment of general thera-
peutic means. The diet must be light and mild, meat and all
stimulating viands retarding the cure; even with the lightest
diet the hunger should never be quite appeased. The regimen
must be the more diminished and rigid in proportion to the
youth and vigour of the patient. Diluent beverages, decoc-
tions of barley, liquorice, and linseed, alone or mixed with milk,
should be taken freely, to the amount, indeed, of several pints
a day. Perfect repose must be secured by confinement to bed.
Constipation must be obviated by the use of emollient clysters
or mild laxatives. The air should be maintained at the same
temperature ; this is an indispensable precaution in chronic, con-
secutive, and mercurial affections. Exercise is only useful in
the convalscent stage. In chronic syphilis, however, it may
often be carried to fatigue with advantage. Tepid baths, repea-
ted three or four times a day, are always attended with advan-
tage. General blood-letting is often required where the prima-
ry disease is intense, or the system excited and the patient ple-
thoric, but should not be used indiscriminately.

In the external or surgical treatment, strict attention to
cleanliness and the position of the diseased parts should never
be lost sight of. Emollient decoctions or fomentations, or dres-
sings of simple cerate, are the best applications, and the dres-
sings should not be too frequently renewed. Leeches are gen-
erally necessary. The greatest benefit is derived from the
external use of a concentrated solution of opium (in the propor-
tion of about two drachms to one ounce of water ;) it soothes
excessive instability in all cases. When the suppuration is
moderated and the surface of the ulcer clensed, stimulating dres-
sings, consisting of solutions of the sulphates of alum and cop-
per, the nitrate of silver, and subacetate of lead, favour cicatri-
zation.

In inveterate cases, more especially those labouring under

280 Treatment of Syphilis. [May,

tertiary symptoms, the iodide of potassium was introduced by
Dr. Wallace, of Dublin, and used by him with considerable suc-
cess. I have myself given it in numerous cases with benefit,
in doses of five grains, three times a day, conjoined with emolli-
ent applications to the affected parts.

The Mercurial Treatment consists in keeping up slight sali-
vation, by means of the internal administration of blue pills or
some form of mercury, sometimes conjoined with mercurial
frictions or fumigations, at least for the space ofa month This
physiological action of the drug may be produced by adminis-
tering any of its preparations continuously in small doses. If
combined with opium, they act less on the bowels and more on
the system generally.

It is necessary during its action, that the patient do not expose
himself to cold. A certain irritability is produced, and the con-
stant soreness of the gums, the metalic taste in the mouth, not
to speak of the inconveniences of profuse salivation which oc-
casionally occur, render this species of treatment anything but
agreeable to the patient.

Both kinds of treatment have now been extensively tested.
In the year 1822, the Royal Council of Health, in Sweden7
having been charged by the king to conduct a series of experi-
ments upon the different modes of treating venereal diseases,,
reports from all the civil and military hospitals were ordered to-
be drawn up anually. These reports establish the inconveni-
ences of the mercurial system, and the superior advantages of
simple treatment. In the various hospitals of Sweden, 40,000
cases have been done under treatment, one half by the simple
method, the remaining half by mercury; the proportion of re-
lapses have been in the first instance, seven and a half, in the
second, thirteen and two-thirds, in one hundred. Dr. FrickeTs
experiments in the Hamburgh general hospital were first made
public in 1828. In four years, out of 1649 patients of both sexes
582 were treated by a mild mercurial course, and 1067 without
mercury, the mean duration of the latter method has been fifty-
one days, and that by mercury eighty-five. He found that re-
lapses were more frequent, and secondary syphilis more severe
when mercury had been given. When the non-mercurial
treatment was followed, they rarely occurred, and were more
simple and mild when met with. He tells us that he has treated
more than 5000 patients without mercury, and has still to seek
cases in which that remedy may be advantageously employed.
He has never observed caries, loss of the hair, or pains in the
bones, follow his treatment, and in all such cases which have
come under his care, much mercury has been given.

In 1833, the French Council of Health published the reports

1853.] Treatment of Syphilis, 281

sent in by the physicians and surgeons attached to regiments
and military hospitals in various parts of France. Some of the
reports are in favour of a mild mercurial course, others in favor
of simple treatment. They all agree by stating the cure by
mercury to be one-third longer than by the other treatment.
At Strasburg, mercury was only given to very obstinate cases.
Between 1831 and 1834, 5271 patients had been thus treated,
and the number of relapses and secondary affections calling for
the employmeet of mercury had been very small. No case
of caries, and only one or two instances of exostosis, had been
observed. Full reliance may be placed on these facts, as
regiments remain in garrison at Strasburg for five or six
years.

In the various reports now published, more than 80,000 cases
have been submitted to experiment, by means of which it has
been perfectly established that syphilis is cured in a shorter
time, and with less probability of inducing secondary syphilis,
by the simple treatment.

These facts are now very generally admitted, and malignant
syphilis is gradually disappearing. Twenty years ago, the most
frightful secondary and tertiary cases were met with, and the
usual treatment was profuse salivation. At present, such cases
are rare. Abroad, owing to the wise police regulations, the
disease is infinitely more innocent even than it is at present in
Scotland ; and under the salutary influence of a mild and simple
treatment, its virulence is daily abating.

In appreciating the value of this important revolution in
practice, we should not forget to eulogize those who had first
the boldness to introduce it. The credit of this is mainly due,
in England, to Mr. Fergusson, and other British army surgeons,
who practised it during the Peninsular campaign ('Medico-Chir.
Trans.,' vol. iv.,) and to Mr. Rose, of the Coldstream Guards
(Ibid. vol. viii.) In Scotland, the writings and lectures of the
late Professor John Thompson, of this university, were mainly
instrumental in convincing Scotch practitioners of the evils of
mercury in venereal diseases. In England, the Hunterian theo-
ry and practice have been deeply rooted, and in Ireland have
been supported by the writings of Carmichael and Colles. Mer-
cury in consequence is still very generally employed in those
parts of the kingdom. The gigantic experiments made abroad
however, ought to convince the most sceptical ; if not, let them
compare what syphilis is in Scotland with what it was, and
especially observe that we never see an instance of the disease
such as that now in the ward (Case 1,) unless the patient's sys-
tem has been contaminated with mercury. [Lancet.

282 Change of Color in an Adult Negro. [May,

Change of Color in an Adult Negro. By A. Hammer, M. D.,
of St. Louis.

We are very much indebted to Messrs. Br and D ,

JVC. D., in this State, for their kindness in giving us an opportu-
nity of seeing and examining a very interesting case. It is a
negro, named Joseph Daniel, born in Woodford county, Ken-
tucky, residing now in Saline county. Missouri, who is a slave,
of Richard Robertson. He is five feet seven inches high, forty-
three years of age, stout, and appears healthy, has never been
ill, save transient rheumatic pains in various parts, and is at
present suffering from slight pains in the right knee. He is,
from the testimony of the highest authorities, born from black
parents. His present condition, differing from that of his
infancy and boyhood, is the following:

The whole frame, and especially the formation of the skull
and features, present all the characteristics of a full-blooded
negro. The color of the skin of the whole body is white, like
the Caucasian race, that is. entirely dissimilar to that of the
Albinos, but as natural as it can be in a white man, with the
exception of the face ; and a few spots varying from the size
of the head of a pin to that of a five cent piece, on both wrists
and the sternum, which spots are quite as black as in the ne-
gro form and color of the nails being as natural as in the white
man. The face is partly white and partly black, or rather
darkish-brown. The lower portion of the face, from the nose
downwards and bounded on either side by the anterior border
of the masseter muscle, is entirely white, with the exception of
a narrow stripe of black on the inferior lip, extending trans-
versely across it on a line with the mouth. On the upper lip
there is a similar stripe of black, broader than that just men-
tioned, extending upwards on the right side to the ala nasi.
Both ala nasi are black. At the union of the nasal bones with
the nasal cartilages a black stripe, from three to four lines wide
traverses like a saddle the bridge of the nose, communicating
on both sides with black surfaces on the cheeks; all the rest
of the nose being white. Both cheeks, including the orbital
regions, form a continual blackish-brown surface, each one
being a triangle, more or less rectangular, and connected with
each other by the above-mentioned saddle. The triangular
blackish-brown surfaces spoken of occupy a large space on
both sides of the face, and may be described in the following
manner : The superior side of each triangle corresponds with
a line drawn from the internal angle of the supra-orbital arch,
running backwards over the arch and somewhat downwards to
the zigomatic process ; the inferior side commencing from the

1853.] Change of Color in an Adult Negro. 283

point of termination at the zigoma, passing downwards and
forwards to the anterior edge of the masseter muscle at its at-
tachment to the inferior maxilla; the anterior side is described
by a line uniting the last point with the point at which it start-
ed viz., the internal angle of the supra-orbital arch. It must
not be understood, that these lines are strictly mathematical.
They are irregular and somewhat denticulated. The forehead,
with the exception of a few irregular spots of various sizes
scattered over its surface, is entirely white. Strange to say,
there is a white circle of about an inch in width, encircling the
whole face, bordering superiorly the hair of the head, and run-
ning downwards on either side of the face over the masseter
muscles and passing over the inferior part of the face. The
ears are covered with minute spots of a blackish-brown color,
giving to them a freckled appearance. The whole scalp is
white. The hair is short, and as in the genuine negro, curly,
being partly black and partly grey the grey hairs most nu-
merous at the temples the eyes are those of the negro. The
formation of the eyeball and its appendages is normal. All
membranes and visible organs healthy, the cornea excepted,
upon which in both eyes a complete arcus senilis, broad and
corresponding to the whole circumference of the cornea, is
visible. The conjunctiva is of a dirty-yellow tint, the pig-
ment unimpaired, the iris of a beautiful brown color, sight per-
fect.

The hair on the mons veneris are fine, slightly curled, and
yellowish white, but not colorless as in the albinos ; of the
same quality are the hair surrounding the anus and on the ex-
tremities. Those parts of the skin, which are white but ex-
posed to the influence of the sun, as the throat, neck, anterior
part of the chest, and hands, present a sunburnt appearance,
and the epidermis upon them is very much wrinkled. His
mental faculties are of a low order.

I have in my possession a Daguerreotype of this man, and
have caused another to be taken at the Daguerreotype Gallery
of Messrs. Dobyns & Spaulding, corner of Fourth and Olive
streets, where any one having the curiosity to inspect it may
have an opportunity of doing so.

History of the Case. We have the most reliable testimony
that this negro is descended of entirely black parents. He was
black at birth, remained so up to his sixteenth year, when he
was bitten in the scalp by a healthy dog, being unaware at the
time of the dog's approach. The wounds received were not
serious. About two weeks afterwards, however, his hair,
which was before black, commenced turning grey. At the
same time, the deep black of the general surface of the body

284 Change of Color in an Adult Negro. [May,

became uniformly lighter, some places becoming entirely white,
while the surrounding parts remained of a light brown color.
The white places mentioned, gradually increased in size, until
the whole body was as white as we have above described.
This change of color went on, from his 16th to his 25th year.
From this time, up to the present, a period of eighteen years,
his condition, as regards color, remains unchanged, with the ex-
ception, however, that the black patches on the face were eigh-
teen years ago somewhat lighter than they are now. We are
told, that they neither increase nor diminish in size, but in color,
their intensity is influenced by the seasons. At twenty-five
years of age, when the change in the color of his general
surface was perfected, he married a full-blooded negress of a
genuine black color. He has a son now seventeen years of
age, well formed and vigorous, and as black as his mother, and
not a single indication of approaching change like that of his
father up to this time exists.

Remarks. This case of a change in the color of the skin of
the negro stands not alone. Several cases are cited, by Blu-
menbach, Bates, Gualtier, Le Cat, Rayer, Fisher, Rush, [vide
Cyclopededia of Anatomy and Physiology, by Robert B. Todd,
Part 1st, second Edition, London, page 86, in a note :] by Byrd,
Jefferson and Morgan, [vide Lectures on Physiology, Zoology,
A. S. O. : by W. Lawrence, Salem, page 265, in a note ]

No one of these cases, quoted by the authors mentioned cor-
responds entirely with our own, some being instances of com-
plete albinism in the negro, other's instances of a change in
color, by no means so extensive, or involving such an amount of
surface as this case. Among the cases of partial change, men-
tioned by Le Cat, one was, in his opinion, the consequence of
a severe burn or scald.

The question now arises, how has this change been brought
about, or in what does it consist? It is a question which' na-
turally occurs to the mind of every one, but is by no means
susceptible of a satisfactory solution.

We will, nevertheless, venture upon a few remarks, leading
the attention of our readers to some of the more prominent
features of the case, which seem to throw, at least, some light
on this dark question. The case differs, as we have before
said, from that of the negro-albino. Albinism is generally at-
tributed to a decay and an arrest of development of the pig-
mentary cells to a qualitative change of the blood.

With this explanation, we are usually content, though it is
very unsatisfactory, in as much, as it does not explain the cause
of this change.

The usual explanation of albinism is not at all applicable to

1853.] Change of Color in an Adult Negro. 285

#our case, for the pigmentum nigrum is seen on some parts of
the surface. The blood cannot, consequently, be changed.
There is merely an irregular distribution of the pigmentum, or
rather the absorption of its elements from the capillary vessels
is limited to a few select points.

We presume nobody will be so senseless as to assert, that
the blood-vessels of any particular region of the body have a
predilection for the elements of the pigmentum nigrum, and
that they are not equally distributed throughout the whole cur-
rent of the circulation. The irregular distribution of the pig-
ment is good evidence to the exclusive humoral-pathologist of
the part, which the tissues, or so-called solids, play in nutrition
and the metamorphosis is of tissue. It is needless to add, that
both, fluids and solids, are equally active, and that an error in
either can give rise to a pathological state. Our suggestion is,
then, that the entire act of metamorphosis, of tissue in the cutis,
\rete Malpighi,~] is changed in this case in such a way, that the
tissues (solids) have lost the power of attracting from the capil-
laries the elements of the pigment, and that this power of at-
traction is preserved, unimpaired, only in a few places. If we
draw too definite a line between fluids and solids, as the ex-
clusive humoralists and exclusive solidarists usually do: we by
no means attach to this distinction an antithesis, for we recog-
nize, in the human organism, no separation of fluid from solid,
but view them as the unity of organization, each having its
special attributes, and between them a mutual dependence.
We have been forced to make this remark, because of the dif-
ference existing between the schools.

Now, if an abnormal physiological act takes place, or a
pathological condition occurs, and the blood (fluid) is evidently
unchanged, we necessarily look to the solids, for the cause of
the change.

Though we know very little of the part which the so-called
solids, viz., bone, cartilage, fibrous tissue, &c, play in the pro-
cesses of life there is one tissue, viz., the nervous, of which a
great deal is known, and much established. Our attention, then,
in speaking of the solids, must be principally directed to this
tissue as it may be considered the representative of the solids.
We would say, in one word, that we attribute a pathological
condition, under such circumstances, to a, perversion of inner-
vation.

We must now recall to our readers, the fact, that this negro
was bitten by a dog; that he is of a low order of mind, and
that his change of color commenced immediately after this
accident. Farther, we must note the fact, that, in one of Mr.
Le Cat's cases, the change of color was immediately preceded

286 Fracture of the Processus Dentatus. [May,

by a burn or scald, and that Le Cat considers the accident the.
cause of the change. We must farther remark, that in the
Annals of Medicine, cases are related, in which the hair
changed from black to white, in a single night, from excessive
passions.

We allude to these instances, not in the hope of building up
an infallible theory, but as matters worthy of some considera-
tion. Would it appear unreasonable or absurd, to suppose,
that a continued perversion of innervation is the result of ex-
cessive mental emotions? We are inclined to think not.
Similar perversions of innervation, only lower in degree and
less continuous, as far as the result is concerned, are of every
day's occurrence, and nobody seems to be much astonished at
them, while frequently occurring. This idea, which we have
advanced, is but an hypothesis, and we do not contend that it
explains the whole process. It remains for us to show the na-
ture of the supposed perversion of innervation ; but the present
state of medical science does not enable us to do so. [St. Louis
Med. and Surg. Journal.

Fracture of the Processus Dentatus fatal only 5 months after.

[Professor Parker relates, in the New York Journal of Medi-
cine, the following very interesting case of Fracture of the
Processus Dentatus, in which the patient continued to follow
an active occupation for five months, and then suddenly died.]

"On the 12th of August, 1852, while driving a 'fast horse'
at the top of his speed on the plank road near Bushwick, L. I.,
he was thrown violently from his carriage by the wheel striking
against the toll-gate. He alighted upon his head and face,
about fifteen feet from the carriage. Upon rising to his feet
he declared himself uninjured, but soon after complained of
feeling faint: after drinking a glass of brandy, he felt better,
got into his carriage with a friend, and drove home to Riving-
ton-street, in this city, a distance of more than two miles.
There was so little apparent danger in his case that no physi-
cian was called that night. Early on the morning of the fol-
lowing day, Dr. B. was called to visit him. He found his pa-
tient reclining in his chair, in a restless state, and learned that
he had suffered considerable pain in the back part of his head
and neck during the night. He was entirely incapacitated to
rotate the head, which led to the suspicion of some injury to
the articulations of the upper cervical vertebrae ; but so great
a degree of swelling existed about the neck, as to prevent an

1853.] Fracture of the Processus Dentatas. 287

efficient examination. There was no paralysis of any portion
of the body, his pulse was about 90, and his general system
but little disturbed. Warm fomentations were applied to the
neck, and a mild cathartic administered. On the following
day there was no particular change in his symptoms, but as
there existed considerable nervous irritability, tinct. hyoscyami
was prescribed as an anodyne, and fomentations of hops appli-
ed locally. On the third day leeches were applied to the neck,
and after this the swelling so much subsided, that on the fifth
day an irregularity was discovered to exist in the region of the
axis and atlas, which had many of the features of a partial lux-
ation of these vertebras.

" At this time he began to walk about the room, having pre-
viously remained quiet on account of the pain he suffered on
moving. He persisted in helping himself, and almost con-
stantly supported his head with one hand applied to the occiput.
He often remarked, if he could be relieved of the pain in his
head and neck he should feel well. He began to relish his food,
and the swelling nearly disappeared, at the end of a week,
leaving a protuberance just below the base of the occiput, to
the left of the central line of the spinal column, with a corres-
ponding indentation. Notwithstanding strict orders to remain
quietly at home, on the ninth day after the accident he rode out
and in a day or two after returned as actively as ever to his
former occupation of distributing milk throughout the city to
his old customers. During the following four months no mate-
rial change took place in his symptoms, although he constantly
complained of pain in his head. For this period he did not
omit a single day his round of duties as a milkman, which cccu-
pied him constantly and actively from five o'clock in the mor-
ning to nearly noon. On the 1st of November Prof. Watts
examined him, and inclined to the opinion that there was a lux-
ation of the upper cervical vertebrae.

"About the 1st of January, 1853, the pains, from which he
had been almost constantly a sufferer, became more severe, and
he was heard to complain that he could not live in his present
condition : he remarked also that he had heard a snapping in
his neck. After going his daily round on the 11th of January,
he complained of feeling cold, and afterwards of a numbness in
his limbs. In the evening he had a chill and complained of pain
in his bowels. He passed a restless night and arose on the
following morning about six o'clock ; he was obliged to have
assistance in dressing himself, and experienced a numbness of
his left, and afterwards of his right side. He attempted to walk
but could not without help, and it was observed that he drag-
ged his feet. He sat down in a chair and almost instantly ex-

288 Backward Dislocation of the Astragalus. [May,

pired at eight o'clock a. m. on the 12th of January, precisely
five months from the receipt of the injury.

" The autopsy was made thirty hours after death, by Dr. C.
E. Isaacs, in presence of several medical gentlemen.

" Muscular development uncommonly fine ; an unusual
prominence observed in the region of the axis and atlas. On
making an incision from the occiput along the spines of the cer-
vical vertebrae, the parts were found to be very vascular. These
vertebrae were removed en masse, and a careful examination
instituted. The transverse, the odontoid (ligamenta modera-
toria,) as also all the ligaments of this region, excepting the oc-
cipito-axoideum, were in a state of perfect integrity ; this latter
was partially destroyed. A considerable amount of coagulated
blood was found effused between the fractured surfaces, some
of it apparently recent, but much of it was thought to have oc-
curred at the time of the accident, and afterwards to have pre-
vented the union of the bones. The spinal cord exhibited no
appearances of any lesion. The odontoid process was found
completely fractured off, and its lower extremity inclining back-
wards toward the cord. Death finally took place, doubtless,
from the displacement of the process, during some unfortunate
movement of the head, by which pressure was made upon the
cord. The destruction of the occipitoaxoid ligament, which
would otherwise have protected the contents of the spinal cavity
must have favored this result."

Backward Dislocation of the Astragalus.

[Prof. Alden March, of Albany, relates the following very
interesting case, in " The Western Lancet." We give it a
place in our Journal because of its exceedingly rare occur-
rence :]

"Isaac Quackenbush, of Herkimer, N. Y., aged about forty
years, on the 24th of January 1853, while engaged in removing
snow from the roof of his house, and elevated upon a ladder
about ten feet whose base rested on the head of a hogshead,
was suddenly precipitated to the ground ; and in his descent
it was supposed his left foot struck with great force on the edge
of the stoop, or step about eighteen inches from the ground.

"The first impression after the fall that Mr. Q. experienced,
was that he had broken his leg.

" The fore part of the leg pointed a little downwards, having
an unnatural fullness of the space below the internal malleolar

1853.] Backward Dislocation of the Astragalus. 289

process, and not only a fullness, but even a projection between
the tendo achilles and the back part of the tibia, so much so, as
to cause the tendon to be prominent and tense. The knee
joint was sub-flexed, and the patient experienced more or less
of a numb pain in the affected part, and running up the limb;
and at times he complained of a burning heat in the bottom of
the foot, and at other times as though it were in a freezing mix-
ture ; and for most of two days it gave him great pain to extend
the limb. The great toe was partially flexed, though suscep-
tible of being extented by the hand without giving much pain.

"This symptom, and that of the limb being more free from
pain and more comfortable, when partially flexed, can be ex-
plained, when we consider that the tendon of the flexor longus
policis pedis, was carried out of its natural course upon the
backward projecting astragalus, like a fiddle string elevated
upon the bridge ; and that the displaced bone acted in some-
what the same manner on the tendo achilles, when the limb
was extended at the knee joint.

"Dr. Doolittle, of Herkimer, N. Y., a very intelligent physi-
cian, and of a great deal of experience, being the son of an
aged physician of extensive practice, saw the patient twenty
or thirty minutes after the occurence of the accident, when the
character of it was readily detected, and an attempt made to
reduce it. But he soon discovered, by its position, andunyiel-
ded character, that all his efforts, and with all the means within
his reach, would be unavailing.

" The patient, accompanied by a young physician, was placed
in a railroad car, and brought to Albany, on the evening of the
accident with a view to procure my aid in reducing the disloca-
tion. I left town the early part of the same evening, before the
arrival of the patient, to be absent for a few days.

;; The services of my colleagues, Doctors James H. Armsby
and James McNaughton, gentlemen in every respect compe-
tent by their anatomical knowledge and their experience and
skill in the practice of surgery, were solicited; and with all the
exertion in their power, both manual and mechanical, and con-
tinued for a long time, failed to effect a reduction.

" The patient returned to Herkimer where he was again
placed under the care of Doctor Doolittle, who leeched the
limb and put him on a thorough antiphlogistic course of treat-
ment, which very much reduced the tumefaction and inflama-
tion in the course of eight or ten days.

"The State Medical Society commenced its annual session
in this city on Tuesday the first inst., at which were assembled
something like thirty five or forty of the most respeciable Phy-
sicians and Surgeons of the State.

290 Liquor Anunonice Acetatus. |_May,

" It was deemed quite advisable that the patient should have
the, benefit of the skill and wisdom of such an assemblage of
medical men. Accordingly he was requested to visit Albany
again, and although he did not arrive until after the adjourn-
ment of the Society, consequently the case was not examined
by its members, yet I had an opportunity to examine it most
thoroughly on the evening of Thursday, ten days after the ac-
cident.

" At this time, as I have already remarked, the inflammation
and tumefaction had nearly subsided ; and on examination I
found the foot admitted of a moderate degree of flexion and ex-
tension, which was evidently between the os calcis and the as-
tragalus, instead of between the tibia and astragalus.

" The limb did not appear to be much deformed ; and my
deliberate conviction was, that it would not be worth while to
make any further attempt to reduce the displaced bone and my
prognosis, that the limb ultimately would become quite useful."

Contributions calculated to enlighten us in relation to the
action of remedial agents and to the best method of adminis-
tering them are always acceptable. We therefore cheerfully
give place to the following communication of Dr. John T.
Plummer, contained in the " Western Lancet," on
Liquor Ammonice Acetatis.

" The following remarks may be of service, as items in the
general stock of experience. They have been induced by the
diversity of results, reported by different authors. Introduced
more than a hundred years ago, its medicinal properties do not
yet appear to be definitely settled, especially with regard to its
action on the uterine functions ; and the doses to be adminis-
tered. Cloquet of Paris, Mazuyer of Strasburg, and Pat-in of
France, report favorably of its use in dysmenorrhea. The last
named physician appears to have given 40 to 70 drops three or
four times a day ; and by these doses giddiness was produced.
Christison (Dispensatory) says 'the dose should be half an
ounce for an adult every two or three hours ;' and makes no re-
ference to its pathogenetic effects ; but adds, ' many physicians
err in prescribing it in small doses.' Patin advises against the
incautious use of it, as it diminishes the quantity of the menstru-
al discharge. 'In large doses/ says Christison, 'it probably
possesses the narcotic-irritant properties of other neutral am-
moniacal salts. ' In cases of profuse catamenia and uterine
hemorrhages, Patin obtained the most remarkable results.

" For twenty years, I have employed this remedy with fre-

1853.] Liquor Ammonice Acetatus. 291

quent success in amenorrhea, instead of ' profuse catamenia ;'
and in dvsmenorrhcea. I have prepared it extemporaneously,
with strongest cider vinegar ; and with acetic acid of sp. gr.
1011. The first I have generally used in amenorrhea, in half
ounce doses every two hours, at the commencement of the men-
strual efforts, indicated by headache, pains in the loins, &c;
and in dvsmenorrhcea, in like manner. The preparation with
acetic acid, I have used in the same affections, at intervals of 2
to 4 hours. From the use of the vinegar combination, I have
never witnessed the slightest ill effects, except, perhaps, some-
times that degree of nausea which most medicines are apt to
occasion. From the acetic acid preparation, I have observed
variable effects in the doses named.

"A married female, about 30 years old, suffered from a mul-
titude of nervous symptoms, in consequence of a prolapsed
uterus, occasioned by too early rising after confinement with
her first, and as yet only child. To restore menstruation, she
had taken, from various physicians, hellebore, savin, and nu-
merous other articles, with but little effect. (The prolapsus
appears not to have been suspected by her medical attendants.)
After replacing the uterus, I found the catamenial period pain-
ful, but without flow. I gave ]>ss doses of the aqueous acetate
of ammonia, of the strength above named, and the menses ap-
peared without any pathogenetic action from the medicine.
At the next period, the same means were used, after the patient
had been allowed to pass several days beyond the expected
time ; and a more copious catamenia followed, than she had
ever witnessed.

" To another patient about 20, married, but sterile, yet pos-
sessing general good health, I gavo 1 ss of the acetate, with the
effect of vomiting, severe headache, and delirium. In a few
hours the headache and delirium had ceased. Next day 3ij.
of the acetate were given with the like result, but in less degree.

"This article appears to have been proposed as a means of
'dispelling intoxication.' In the last named case, it evidently
induced symptoms, closely imitating intoxication, if it was not
intoxication itself.

" My experience fully accords with that of others, in respect
to the febrifuge properties of this remedial agent. I have
never been able to discover that it, in the slightest degree, ex-
cites the sanguiferous system. So far from it, it has in my
hands, appeared to be a cooling sedative. I have found it to
be especially serviceable, in the early and eruptive stages of
measels, sometimes combined with camphorated water, but
mostly alone.

" I do not wonder, however, that it has by some, been con-

292 Quinine in Typhoid Fever. [May,

sidered as a stimulant of the arterial function. Even as origi-
nally prepared by Minderer, it appears to have differed from our
modern solution, in being more disagreeable in consequence of
the accidental formation of an ammoniacal soap. But as I have
seen it formed extemporaneously by some, claiming to be phy-
sicians and apothecaries, it would serve well, in case of emer-
gency, to fill a smelling bottle.

" I was called in consultation, in the case of a child laboring
under dysenteric fever; and prescribed, in part, the solution of
acet. of ammonia. In a few hours afterward, I w7as called, in
the absence of the family physician, on account of the occur-
rence of vomiting and increase of fever. Suspecting the cause,
I examined the preparation, and found it so strongly ammonia-
cal, that, to satisfy my curiosity, I took it home and added to
one part of the original preparation, six parts of acid. acet.
dilut., before the alkali became neutralized. At another house,
in a case of infantile pneumonitis, I discovered a like prepara-
tion to be the all-sufficient cause of a violent exacerbation of
all the symptoms. I need not multiply examples ; the cases
given, will serve to show, not only an inexcusable recklessness
in the preparation of the medicine; but also, the premises from
which some are willing to draw their conclusions of the proper-
ties of remedial agents. To assure me that it was a neutral
compound that he had been administering, the physician stated
that he added the carbonate of ammonia until effervescence
ceased. He may possibly have heard of litmus and termeric ;
but according to his own avowal, the cessation of effervescence
was enough for him, without the aid of these vegetable tell-tales.

11 Of late years, I prepared this solution exclusively with di-
lute acetic acid and the alkali. On account of the unsightly,
turbid, brown liquid produced by the combination of ordinary
vinegar with the ammonia; and the great variation in the
strength of vinegar; dilute acetic acid of officinal specific grav-
ity should always be used. When properly prepared, it re-
quires much patience in attaining the point of neutralization,
even with the aid of test papers. It may be readily kept for
months, in a cool place, in well stopped vessels."

On the Exhibition of large doses of Quinine as an abortive
remedy in Typhoid Continued Fever. By Otis F. Manson,
M. D., of North Carolina.

" Principiis obsta ; sero medicina paratur
Cum mala per longas convaluere moras."

For the past nine years the writer of this paper has pursued
a system of treatment unmentioned or condemned by the stand-
ard authorities in practical medicine, and, until very recently,

1853.] Quinine in Typhoid Fever. 293

unknown on this continent, save in the extreme Southern
States of our Union.

At the risk of being unread, or of being attacked by over-
whelming numbers the great calamities of authorship we
pen this article : we do so, we fervently believe, not from any
cacoethes scribenda, or desire for ephemeral notoriety, but from
a conscientious desire to contribute to the cause of medical
truth and medical progress. When we first came to this state,
(1841), a fever, belonging to the periodical class, and exhibiting
novel and peculiar phenomena, was then making its advent in
the vicinity of our location. The usual treatment of the most
skillful resident physicians most signally failed in arresting its
progress, that treatment consisting in the employment of the
usual role laid down in the books, viz: bleeding, general and
topical, the mercurial impression, diaphoretics, opium, cathar-
tics, and the various external revulsive and derivative irritants.
General bleeding was soon abandoned by all, as it was quickly
discovered to be hazardous in the extreme. Local bleeding
only to a moderate extent was safely borne, the mercurial im-
pression in the large majority of grave cases could not be timely
effected ; and as in these cases intermissions or decided remis-
sions very rarely occurred, guided as we then were by the
precepts of the schools, quinine was but rarely given, and then
only in small doses and with a trembling hand. This fever
presented symptoms of abnormal sanguineous determination to
the cephalic, thoracic and abdominal organs, either separately
or combined, with the periodical occurrence of cold stages, in
which the symptoms of organic engorgement and diminished
circulation in the extreme parts were made more manifest: in
a few words, the disease was a remittent fever, with marked
hyperemia of some or all of the organs essential to life.

In an essay published in 1846, we gave the symptoms and a
brief outline of our treatment in this fever, the main feature of
which consisted in the liberal employment of quinine without
any hindrance to its use from the presence of local congestion,
fever or inflammation. Not only was this treatment adopted
in this but in every form of idiopathic fever, whether remittent
or continued, which came under our care early in the attack,
with the most satisfactory results. Since the year 1843, our
general rule has been to endeavor to arrest these fevers during
the first twenty-four hours the patient is seen this rule sub-
ject to restrictions hereinafter noticed.

When we entered upon this practice we were opposed by
nearly every member of our professional acquaintance, and by
a host of others. Pictures of consequent insanity, apoplexy,
phrenitis, paralysis and loss of the senses were held up to the

n. s. VOL. IX. no. v. 19

294 Quinine in Typhoid Fever. [May,

people to warn them against the innovation. In the midst of
this clamor we visited Richmond for the purpose of publishing
our views. We there met our ancient tutors and confreres :
from all wTe received a kind and patient hearing, but with en-
couragement from none. Some heard us in silence: many
attempted to dissuade us from persisting in what they consid-
ered " most hazardous practice." These obstacles only stimu-
lated our ardor ; and we may have been intemperate in our
zeal, but not, we hope, to such a degree as to justify the opin-
ion of our friends, who hinted that we possessed the necessary
qualifications to entitle us to an abode in those desirable asy-
lums of Williamsburg and Staunton. But now (we hope we
may be forgiven the taunt, the provocation was severe) they
talk very learnedly of the abortive and sedative action of quin-
ine, and have forgotten the name of him from the lips of whom
they first heard it proclaimed. They have "stolen our thun-
der," and we shall not forget them.

Nothing daunted, however, by all these obstacles, we pursued
our way. Every case of idiopathic fever (chiefly remittent
and typhoid) in which the patient was seen near the accession
of the disease, was immediately subjected to this treatment
with the most signal success. The people, to whom the appeal
was made competent to judge of results, if not of means
pronounced in our favor beyond our most sanguine expecta-
tions. In their train many of our opponents followed; but a
few we are glad, for the honor of the profession, they were
but few stoutly maintained " that the practice was nothing
new to them they had been pursuing it all along" and one
oblivious old fogy, not to be outdone, dated his employment of
the alkaloid at a period before its discovery.

We mention these facts, in order that the date of our first
employment of quinine in continued fever may be proven : the
practice is original with us, so far as we have any knowledge.
Others may have pursued it before; and if so, we will cheer-
fully yield the merit of priority to those who can establish their
claims thereto.

Now we desire to be so plainly understood that misconcep-
tion must be willful, viz: that we lay not a shadow of claim to
the introduction of the use of quinine as a sedative febrifuge.
It was used in this mode before we commenced our professional
career. But to this we do lay claim : that we were the first
to promulgate its applicability to the endemic fevers of Virginia
and North Carolina, and the first anywhere, as far as our in-
formation extends, who successfully employed it as an abortive
remedy in continued fever concerning which we now proceed
more particularly to speak.

1853.] Quinine in Typhoid Fever. 295

For many years past, the usual varieties of periodical fever
have been gradually yielding place to that mysterious, subtle,
hitherto intractable, and often fatal form of continued fever,
now almost universally termed typhoid. There is no need
here of a description of the physiognomy or pathology of this
malady. The distinguished Louis, the able and indefatigable
Chomel, together with a host of others, have nothing left in
these respects for the pen or scalpel to delineate, but we here
lay our humble contribution before the Master Mind of him
who is yet to indite the Unwritten Chapter of its Treatment.

The practice pursued by us in this disease is in the highest
degree rational, founded as it is upon the nature of the disease,
so far as it is known, and on the effects of remedies proven by
repeated and numberless experiments.

Called to a patient in the first stage of the disease, our efforts
are first direcled to combat the symptoms of morbid action,
which, for convenience, we will term the palliative treatment;
and secondly, to arrest, by specific means, the farther progress
of the malady, the abortive or curative treatment.

First : Palliative Treatment. As, in other forms of fever, the
symptoms presented will differ accordingly as different vital
organs are implicated, the general rules of treatment will ne-
cessarily be adopted. Our favorite plan, however, is to com-
mence with the administration of an emetic of ipecacuanha,
from which we have seen great benefit derived, not only from
the removal of the contents of the stomach, for we have seen
headach, lumbar pains, and, in a few cases, delirium, disappear
under its influence. If the headache be intense or annoying,
cups are applied to the mastoidal regions, whence blood flows
profusely from clean scarifications; if delirium is present and
the pulse will bear it, blood is taken from the arm to the extent
of from 10 to 16 ounces, and ice freely applied. At 8 or 9
o'clock at night a cathartic of calomel and rhubarb, in quanti-
ties of 8 or 10 grains of each, is administered. If diarrhoea is
present, a full dose of opium, of 1 or 2 grs., is combined with
the cathartic. Should there, however, be any fear of the rhu-
barb not being tolerated, the calomel alone is given, in a dose
of 15 to 20 grs.

In the interval between the administration of the purgative
and 2 o'clock next morning every means are used to relieve
the threatened organs. Cups are continued to the occiput or
epigastrium, as may be indicated; cold applications to the
head assiduously applied, and all proper means used to prepare
the patient for the

Curative or Abortive Treatment. At 2 o'clock in the morn-
ing from 20 to 30 grs. of sulphate of quinine in pills, or diffused

296 Quinine in Typhoid Fever. [May,

in an ounce of cold water, are given at once to the patient, the
dose being: regulated according to the intensity of the fever,
the quantity being increased pari passu with the degree of vas-
cular excitement. Four hours are now suffered to elapse ; the
patient is allowed to drink moderately of diluents, of which, at
this moment, we prefer sweetened milk and water pleasantly
warm, or the effervescing draught. The condition of the
patient at the end of four hours, viz: at 6 o'clock, in a vast
majority of cases, will be sensibly improved ; his head symptoms
will be partially or entirely removed ; his pulse will be dimin-
ished in frequency and force, and have acquired a more natural
degree of fullness and softness; his skin will have become re-
laxed and perspirable, and in many instances a copious sweat
breaks out, and, as the patient has often expressed himself to
us, " He feels like a new man ; his head is easy for the first
time since he has been sick!" At 6 o'clock, (unless there be
marked symptoms of quininism deafness, roaring, buzzing,
hissing, ringing of the ears present,) if the pulse has not de-
clined very nearly to the normal standard, it is our rule to repeat
the quinine in doses of 10 to 20 grs. During the night the cold
applications and local bleeding are continued, if indicated, but
it is very rarely we have to repeat the cupping after the quin-
ine is given. Ice in most cases will suffice.

The quinine is now suspended, if fever still continues. Calo-
mel is administered in 1 or 2 gr. doses every one or two hours,
until the bowels are sufficiently moved. If diarrhoea is present,
the hyd. cum creta and Dover's powders are preferable. If
fever still continues, at 2 o'clock next morning the quinine is
again given, the dose to be lessened accordingly as the fever
has declined, and the alterative continued. Attention is now
directed to the symptoms present for which no specific rules
can be given, for here the general principles of treatment are
brought into requisition the patient is carefully conducted
towards convalescence, and the wants of nature supplied. As
the fever disappears the diet must be increased, and wine and
tonics, of which we prefer gentian, will be useful, and often
indispensable.

If, however, the fever persists, as it sometimes will, but always
in a mild and modified form, the oil of turpentine, a remedy
long used, but more particularly called to the attention of the
profession by Prof. Wood, now comes admirably into use.
From 20 to 30 drops in a wineglassful of sweet milk, or in
emulsion, may be given every four or five hours. This, how-
ever, will sometimes give rise to unpleasant and even dan-
gerous symptoms, viz: a peculiar intoxication, gastrodynia,
haematuria and dysuria, when of course it will be discontinued.

1853.] Quinine in Typhoid Fever, 297

After this treatment is pursued, it is but seldom that we give
any aperient medicine: officious meddling in this respect, we
have no doubt, has had a principal share in the mortality of
typhoid fever. Mucillaginous enemata are daily used, and a
simple remedy, that will often succeed when repeated enemata
fail, is a suppository of stewed molasses.

Observations on the foregoing Treatment.

The practitioner must not be deterred from the use of the
mercurial cathartic in the first instance, though diarrhoea be
present ; for if the opium does not control its action, the quin-
ine, often administered, certainly will, and in such cases we
have never seen hypercatharsis induced quinine possessing

THE PROPERTY OF PREVENTING AND REMOVING LOCAL DETERMINA-
TION, WHETHER INDUCED BY THE ACTION OF MEDICINAL AGENTS,
OR OCCURRING AS A PHENOMENON OF DISEASE ! !

Neither should nausea or vomiting be considered as indica-
tions adverse to the employment of this remedy : on the con-
trary, if the stomach will bear its mechanical presence for a
short time, it will allay these troublesome symptoms when all
other means fail. It produces these effects by its property

OF ALLAYING IRRITABILITY AND SPASMODIC ACTION.

Nor should delirium be considered a contra-indication. Af-
ter using the means before directed, with all the activity and
energy the case demands and the patient will safely bear, the
delirium will still continue in some instances. In such cases
we have repeatedly seen every symptom of cerebral implica-
tion removed as if by magic, under the influence of this incom-
parable sedative. It is our rule to try the usual means^r^;
we believe them to be necessary and efficient adjuvants to the
salutary influence of the abortive: they prepare the way and
assist the remedy in producing its complete and peculiar influ-
ence : the exhibition of quinine does not interfere in any degree
with the demands of the rational indications, but it is given for
the purpose of assisting their action, and rendering their effects
complete and permanent.

The usual treatment of the best authors of the present day
is merely expectant and palliative ; their whole endeavor is to
ameliorate the condition of vital organs, and to remove the
secondary phenomena: on the other hand, quinine strikes tri-
umphantly at the roots of the malady and removes the cause.

But the reason may be demanded of us, "Why we do not
use this remedy in the latter as well as the primary stage?''
We reply Because our experience is against its use. Believ-
ing, as we do, that the symptoms of the prodromic and invasive
stages are altogether referable to an altered and perverted ac-

298 Collodion in the Treatment of Buboes. [May,

tion of the nervous system, and knowing that quinine possesses
the property of counteracting the morbid action then present
we unhesitatingly and boldly prescribe it ; but soon another
class of symptoms present themselves symptoms referable to
and indicative of organic change those lesions so minutely
and accurately portrayed by the most celebrated pathologists
of the age, and which we believe that quinine has no power to
remove but may often aggravate. These cases must be treated
according to the rational indications. Active interference, our
experience has proven, is no longer admissible ; with watchful
eye and careful hand we must discern and assist the operations
of nature, endeavoring to mitigate and remove the symptoms
of distress, discomfort and danger, and guarding closely the
approaches through which the destroyer may enter at any
moment. [Stethoscope.

Collodion in the Treatment of Buboes. By Jno. Herbert
Claiborne, M. D., of Petersburg, Va.

The obstinacy that buboes sometimes assume, pertinaciously
refusing either to suppurate or to be discussed, often proves
exceedingly annoying to the patient, if it does not indeed occa-
sionally bring reproach upon the efficacy of medical treatment.
Few physicians, I imagine, who have had the treatment of
many of these troublesome affections, have not seen the patience
of their patients grow weary under their unavailing efforts to
scatter a chronic bubo in the groin ; and fortunate may they
consider themselves if they have not been compelled to listen
to imprecations upon their art for its worthlessness and ineffi-
cacy, Since I have begun the use of collodion in such cases,
I am glad to remember that I have been almost entirely exempt
from listening to tirades from the subjects of this malady at
least.

I use the collodion solely for the purpose of discussing or
scattering the bubo, and in my hands it has proved incompara-
bly superior to any other discutient. It operates by pressure,
I believe, thereby lessening the capillary congestion of the
parts, and stimulating the absorbents to remove whatever pro-
ducts may have been thrown out by inflammation about or in
the affected glands.

I have used it in the treatment of buboes of the groin only.
When a patient with a bubo presents himself, if there be not
much acute local inflammation, no matter formed, and no con-
stitutional reaction, I immediately shave off the capilli from
and around the tumor, and with a camel's hair pencil apply

1853.] Collodion in the Treatment of Buboes. 299

the collodion upon the place, allowing one layer to dry before
the application of another, until I form a scab or membrane of
such thickness as I think will exert the proper compression.
Sometimes the application has to be renewed in the course of
twenty-four or forty eight hours. If put on too thickly, it will
give a great deal of pain ; and I have seen it contract so tight-
ly upon the tumor, that the epidermis would be split in fissures
around the borders of the application. This will serve to give
some idea of the force cf the compression which it will exert.
After the application of the collodion, it is better that the pa-
tient remain quiet for a day or two, take an aperient, and re-
strict his diet, though I have succeeded in discussing a chronic
bubo when not an hour has been lost from his usual avocations.

If there be much inflammation about the tumor, I usually
endeavor to subdue this by general and local depletion, satur-
nine applications, rest, &c, before applying the collodion; and
if the bubo be of venereal origin, institute, of course, the specific
treatment for the existing disease.

I have succeeded several times in discussing the bubo in this
manner, even when fluctuation discovered the presence of
matter. If it be of syphilitic origin, however, I doubt very
much the propriety of this. The dissipation of the tumor, in
this instance,. can only occur by a reabsorption of the virus of
the pox into the blood, whereas the sole object of the treatment
of syphilis is to eliminate this poison. In such cases, therefore,
I prefer puncturing the bubo at the earliest indication of mat-
ter, and encouraging suppuration by poultices.

I have several cases in my note-book which strikingly ex-
emplify the efficacy of collodion in the discussion of buboes. I
suppose it might be usefully employed in chronic enlargements
of glands in other portions of the body. I do not know that I
can lay claim to the honor of originating this application of
collodion, if there be honor in it; but I do not remember to
have seen it spoken of by any medical author. If any one shall
rise up and claim it, I am ready to yield unto him "the things
which are his." The principle of scattering buboes by the ap-
plication of pressure was first remarked by me in following
one of the surgical officers in the wards of the Pennsylvania
hospital some few years ago. In that institution they were in
the habit of making pressure by fastening on plates of sheet
lead. In the inconvenience of applying these, and in some ex-
tremely obstinate and annoying cases, which greatly perplexed
me, I thought of substituting the collodion. The success which
attended it exceeded my expectations.

Perhaps some of my professional brethren have used it I
would like to know with what success. [Ibid.

300 The Alum Springs of Virginia. [May,

The Alum Springs of Virginia.

Having for some lime heard of and entertained a favorable
opinion of the Alum Springs of Virginia in the treatment of
certain affections, we are happy to have it in our power to lay
before our readers some account of them. We derive the fol-
lowing facts from an article by Dr. Thomas Pollard, published
in the " Stethoscope. "

The Rockbridge Alum Springs are situated seventeen miles
from Lexington. The water of Spring No. 2, was analyzed
by Dr. Hays, of Boston, one gallon of which was found to
contain

Sulphate of potash,

1.765

" lime, -

3.263

" " magnesia, -

1.763

Protoxide iron,

4.863

Alumina,

- 17.905

Crenate of ammonia,

0.700

Chloride sodium, -

1.008

Silicic acid,

2.840

Free sulphuric acid,

- 15.224

Free carbonic acid,

7.536

56.867

Pure water

58315.133

58372.000
" In a conversation with the late proprietors* of this property,
they informed me that they did not consider the analysis as
made from a fair sample of the water ; that the water was pro-
bably weak at the time, and No. 2, in their estimation, not so
good as the other springs, and that they believed them to con-
tain iodine. Dr. P. H. Christian, one of the proprietors at the
time referred to, informed me that Prof. Rogers had made an
analysis of the water, which had never been published, and that
he understood that Prof. R. found it to contain iodine.

" Therapeutic Application. The diseases in which this wa-
ter has most reputation, are dyspepsia, scrofula, chronic diar-
rhoea and skin diseases. The time has gone by for skepticism
in relation to the medicinal virtues of mineral waters. I can
only give a general outline of the cases to which I shall allude,
as some of them did not come directly under my observation

* It had at this time been purchased by Mr. John W. Frazier of the Bath
Alum, though he had not obtained possession.

1853.] The Alum Springs of Virginia. 301

nnd others I have no permission to make a formal report of.
That some undoubted cases of scrofula have been relieved by
the water of which we are speaking, does not admit of a doubt.
Several such cases I have seen, and of others heard from relia-
ble authority. Dr. Christian, who has had considerable oppor-
tunity of observing its effects, remarked to me that he believed
every case of scrofula, where the constitution was not utterly
broken down, might, if the water were long enough continued,
be cured. We can scarcely hope it, however, to be a specific
in this disease. Two cases which at the springs came under
my notice, where after two months' use in one case and one
month in the other, no perceptible benefit had been perceived
except most decided improvement in the general health. Pro-
bably the foundation of cure was thus laid, and another summer
at the springs, with use of the water in the intermediate time,
may effect the desired object. I allude to these cases as being
the only unfavorable ones I saw or heard of among those suf-
fering from scrofula. One case of most marked improvement
I may allude to as being no doubt familiar to some of the facul-
ty of this city : Mrs. S., of Rocketts, suffering from a large
scrofulous sore on the side of the neck. She had used the wa-
ter four or five weeks, and from her representation the amend-
ment had been rapid. While I saw her, which was during the
space of two weeks, the sore was every day diminishing in
size and assuming a more healthy appearance, and there seem-
ed every prospect of perfect cure. Closely allied to the disease
of which we are speaking, were two cases reported to me as
having been cured by the persons who were the subjects of
them, and as far as an opinion may be formed from two cases,
of course imperfectly described, the use of this water in incipi-
ent phthisis would seem very encouraging. One case, a ser-
vant who waited on the hotel, had been sent by his master to
use the water for haemoptysis, of which he had had several
attacks, and from which his general health had suffered much.
The haemoptysis was attended with pain in the side, and the
lung of that side had been pronounced diseased by his attend-
ing physician. When I saw him his general health was good,
and as far as I could judge, he seemed a well man. The other,
a white man, resident in the neighborhood, told me he had had
several attacks of haemoptysis, with constant pain in the side,
while residing in Georgia. Superadded to this was a running
scrofulous sore about the neck. The sore had healed ; no
haemoptysis had occurred for many months, and to all appear-
ances he was well.

"In dyspepsia this water seems to act with excellent effect.
Almost every case of this disease which has come under my

302 The Alum Springs of Virginia. [May

observation, in which the water has been used both at the
springs and after transportation, has been much benefitted. In
chronic diarrhoea, and in cases of dyspepsia attended with irri-
tability of the bowels, its action is usually very advantageous.
In such cases the quantity used, however, should not be large,
and when it excites any irritation, as it sometimes does, should,
for a day or two, be suspended.

"In skin diseases its virtues are said to be very valuable. I
had no opportunity of judging of its effects in this class of dis-
eases, except in one case of chronic erysipelas of the leg, which
was rapidly improving.

" In one case of chronic sore throat, which came under my
notice, the effect of the water was most salutary. The subject
of it, a gentleman from Philadelphia, had suffered from ulcera-
tion about the fauces and tonsils for several months. Caustics
of various kinds had been used by a medical gentleman of emi-
nence, and no doubt with skill and judgment. He had visited
the White Sulphur Springs without benefit, and came to the
Rockbridge Alum still suffering a good deal, particularly in
swallowing. After spending five days here, at which time I
saw him, the improvement had been most marked difficulty
and pain in deglutition had ceased ; the ulcers, of which there
had been several, were healing, and in two weeks his throat, to
use his expression, 'felt well.' At this time the ulcers had all
healed, with the exception of a long fissured one, which was
cicatrizing.

" Modus operandi. From the existence of sulph. alumina in
this water, we might expect that constipation would be pro-
duced by its use. Such, however, is not the fact. The bowels
seem regulated. If constipation exists, it is removed. If chronic
diarrhoea, it is generally cured. This may appear contradic-
tory, but is not incompatible with the known action of other
remedies. In some cases, wl.en long continued, the water
seems to irritate the bowels the effect probably of the iron.
The presence of the sulph. alumina furnishes a valuable adju-
vant in preventing, in general, this irritant effect of the iron,
of which we have frequently to complain in the use of our
medicinal preparations of this metal.

" The quantity to be used. This, of course, will depend upon
the strength, which, as I have mentioned, varies considerably.
When the water is at its strongest, a tumblerful will frequently
produce emesis, owing, 1 suppose, to the existence of the iron
and alumina. As a general rule, six glassesful during the day
is enough for most individuals: tin's should not be taken when
the stomach is full. Too much of this water is frequently drunk,
overloading and oppressing the stomach, and this remark we
believe will apply generally to the use of mineral waters."

1853.] The Alum Springs of Virginia.

The Bath Alum Springs are seventeen miles from the Rock-
spring and, on Analysis by the same chemist, yield from one
gallon :

' Free sulphuric acid,

7.877

Carbonic acid,

3.846

Sulphate of potash,

.258

Magnesia,

1.282

Lime.

2.539

Protoxide of iron,

21.776

Alumina,

12.293

Crenate of ammonia, -

1.776

Silicate of soda,

3.150

54.798

Pure water,

- 58317.202

58372.000
"Some of the springs are stronger in iron than No. 3, and no
doubt constitute the strongest chalybeate waters in the State.
The water of No. 3 is most generally used. The iron and
alumina are no doubt in the form of the sulphates, both in this
water and in that of the Rockbridge Alum springs. It is so given
by Prof. Rogers, as reported in Dr. Burke's book, p. 295.

" Therapeutic application. The diseases in which this water
is used are very similar to those in which the Rockbridge Alum
springs are applied. Containing more iron, they are more
strongly tonic, and are more adapted to some forms of dyspep-
sia, chlorosis and affections generally requiring an active tonic
impression. Dr. Burke, in his work on the Virginia Springs,
quotes a letter from Dr. Strother of the Warm springs, speak-
ing highly of their virtues, and recommending them as valuable
in chronic diarrhoea, chronic thrush, dyspepsia, nervous debili-
ty and some forms of neuralgia, uterine disorders, particularly
mennorrhagia and fluor albus. The water of these springs has
not had a fair trial, a prejudice existing against it from the fact
that the public are apprised, from their strong metallic taste,
that they contain copperas, which, not knowing that it is one
of our best tonics, (sulph. iron,) they mistakenly believe to be
poisonous.

" This water being very strong, a tumblerful (a quantity
which many persons ignorantly use) produces emesis. This
confirms the impression of the 'poisonous copperas,' and they
cannot be persuaded to make further trial of it. The conse-
quence is, the water has been used to a limited extent. My
own impression of its value is, that when these springs become

304 On Reflex Phenomena. [.May,

better known, and the water more properly used, it will rank
as one of the most valuable of our mineral waters. Though
these springs have been in use only three or four years, I have
been informed, through reliable sources, of the cure of three
cases of scrofula. Two cases of chronic diarrhoea which came
under my notice, were much benefited. Another case improv-
ed but slightly, but I thought it was because the gentleman used
the water in too large quantities.

" Quantity to be used. Four tumblersful are generally
enough to be taken during the day. In some cases, and parti-
cularly in chronic diarrhoea, one wineglassful. repeated five or
six times a day, is as much as should be used."

On Reflex Phenomena. By M. CI. Bernard.

Reflex Phenomena are of two kinds: the one having for ob-
ject the accomplishment of the functions of organic life, the
other those of animal life. M. Bernard has by his experiments
endeavored to show that both of these phenomena are original-
ly identical, and that the great sympathetic nerve plays a prom-
inent part in their production. He first examined the reflex
phenomena of organic life.

Two kinds of nerves are requisite for the production of these
phenomena: the first transmiis the impression to the nervous
centres, the second to the viscera. With one order of these
nervous filaments is always connected a ganglion of the great
sympathetic ; exemple : the lingual nerve transmits the impres-
sion of taste to the nervous centres, a special nerve then con-
veys a corresponding excitation to the submaxilary gland ; on
one of these nerves is situated a ganglion of the sympathetic, the
submaxilary ganglion. Another example : the optic nerve and
the motores oculorum, the first transmitting the impression,
the second the reflex excitation, are separated by the opthalmic
ganglion. The pneumogastric nerve may be considered in the
same light in its relations with the liver, lungs, and spinal mar-
row ; the last is here a conductor of reflex excitation, and the
ganglia of the solar and cardiac plexuses play the same part as
that which has been assigned in the preceding examples to
those of the submaxilary and opthalmic regions.

Excite the lingual nerve, and the secretion of salva will be
increased ; cut the submaxilarly ganglion, the nerve which con-
nects it with the nervous centre, and the excitation of the lin-
gual nerve will no longer produce this phenomenon. The ex-
periments of Herbert Mayo prove that in the movements of
the pupil, the results are identical as regards the optic nerve and
the motores oculorum.

1853.] On Reflex Phenomena. 305

The pneumograstric nerve is the seat of analogous phenome-
na ; as example : this nerve transmits to the nervous centre the
impression made upon the lungs by atmospheric air, their
habitual excitant; this impression, b\ means of the spinal mar-
row and sympathetic, immediately causes the production of
sugar in the liver, which secretion, the result of reflex action,
corresponds to the excitation of which the lungs are the seat,
just as the secretion of saliva is the result of an irritation of the
lingual nerve. Excite the lingual nerve and the secretion of
saliva will be exaggerated; excite the lungs by means of chlo-
roform or chlorine and the secretion of sugar in the liver will
be increased. From these considerations, M. Bernard is led
to attribute the exaggerated production of sugar in the liver,
caused by irritation of the pneumogastric nerve, to the reflex
phenomena of organic life.

After having called the attention of the society to the impor-
tant function which is performed by the great sympathetic
in the production of visceral reflex phenomena, M. Bernard
asks if the reflex phenomena of the limbs have not, even in
this last point of view, a great analogy with the preceding ; it
seems at the first glance that such is not the case, for in the ex-
periments of Marshal Hall, the ganglia do not appear to have
any relation writh the production of reflex movements. The
following experiment, however, imagined by M. Bernard,
seems to show that the intervertebral ganglia cannot be wound-
ed without a corresponding cessation of reflex movement in
the limbs. By a singular disposition the roots of the nerves of
the anterior members in the frog, are seen, on dividing succes-
sively the muscles of the shoulder, to the outside of the medula-
ry canal ; the posterior provided with their proper glanglia. If
these be examined attentively it will be observed that all the
nervous filaments of the posterior root, do not traverse the gang-
lia, and that a certain number of them may be easily isolated by
the point of a needle. From this anatomical arrangement it
results that the ganglia may be destroyed and still a portion of
the posterior root remain intact. Now if the section of the gan-
glia in the living frog be completed, reflex action ceases in the
corresponding member ; the animal no longer withdraws its
foot on its being irritated ; that sensibility, however, remains
perfect, is proven by the fact that the animal manifests signs of
pain by movements of the whole body. This experiment shows
then, that the intervertebral ganglia are necessary to the pro-
duction of reflex movements in the limbs. Lead by analogy,
M. Bernard concludes, in assimilating the intervertebral gan-
glia with those of the great sympathetic, that they are both ne-
cessary in the production of the two order of reflex phenomena
admitted by him. [Gazette Medicale. N. O. Med. Register.

306 On Hemorrhage. [May,

On Hemorrhage. On a new Styptic. By M. Pagliari.

This styptic forms a subject of a long communication to the
Academie des Sciences by C. Sedillot. Its composition is as
follows : eight ounces of balsam of benzoin, one pound of sul-
phate of alumina and potass, and ten pounds of common water
are boiled for six hours in a glazed earthen vessel, care being
taken to add fresh quantities of boiling water, so as to supply the
loss in evaporation, and to stir continually. At the end of this
time the supernatant liquid is separated from the undissolved
benzoin, which has lost its odor and inflammability, and filtered
and preserved in glass bottle's. The liquid thus obtained is
limpid, and of the color of champagne ; its taste slightly stypic,
and its odor pleasant and aromatic, and when evaporated it
leaves a transparent deposit on the sides of the vessel.

The styptic properties of this preparation seem very remark-
able. A single drop immediately coagulates a cupping-glass
ful of blood, and a larger quantity (equal proportions) converts
the blood into a firm and resisting solid. Applied to a wound
the hemorrhage ceases almost immediately, in consequence, as
it would seem, of the formation of such clots upon all the orifices
of the bleeding vessels. The application also produces no irri-
tation and inconvenience, nor does it interfere in any way with
the process of cicatrisation.

The cases given are well authenticated, and the results such
as to leave no doubt as to the valuable styptic properties of the
preparation. There are cases of obstinate primary and secon-
dary hemorrhages, after supgical operations ; one from a severe
cut in the finger; some from the extraction of a tooth. In
these cases a piece of lint was soaked in the styptic and bound
upon the wound. [lb.

The Laws regulating the Bodily Temperature and the Frequen-
cy of the Pulse. By R. Lichtenfels andR. Frohlich.

The authors have made a most careful series of experiments
on themselves. Each experimenter is twenty -two years of age ;
the pulse of one of them is normally 71 per minute, that of the
other 88 ; the normal temperature of each is 98.434. During
the course of the experiments, they rose shortly before 7 A. M.,
took coffee between 7 and 8, had dinner at 2, and evening-cof-
fee between 7 and 8.

1. Daily rate of pulse and temperature. The influence of
the period of the day, per se*, was very trifling, but both pulse
and temperature were greatly affected by food. Before the
morning-coffee, the pulse was lowest ; by the end of the first

1853.] Laws regulating Bodily Temperature, fyc. 307

hour after coffee it rose, on an average of many observations,
nearly 8 beats per minute ; it was slightly less rapid at the end
of the next hour; at the end of the third hour it was only 3.3
beats ; and at the end of the fourth, 2.77 beats over the original
number. The pulse did not sink to the number noted before
coffee, till six hours had elapsed. The mid-day meal raised the
pulse again, and this occurred apparently sooner after protein
than after starchy food, but to a less extent. After the evening-
coffee, the pulse, which had fallen, again rose, but to a less ex-
tent, and its declension occurred more rapidly.

The temperature of the body was affected in a similar way
by food, but the augmentation occurred later than the rising of
the pulse; so that the temperature was often at its maximum
when the pulse had fallen considerably towards the point from
which it had risen. The average amount of increase is about
I of Fah. The greatest average range of the thermometer in
the course of the day (between 7 A. Si. and 10 P. M.) was ra-
ther less than a degree of Fah.

2. Influence of customarxj liquid. The experiments were
performed in the afternoon ; each lasted 100 minutes, and the
greatest tranquility of body was preserved. After beer, the
pulse sank 6 or 7 beats in from 10 to 15 minutes; in 30 minutes
it regained its former frequency ; much before this time, the
subjective feelings of slight incipient intoxication were felt.
In about two hours, the pulse was heightened nearly double
as much as it had been depressed. The temperature, after the
use of beer, fell about one-third of a degree of Fah. After wine,
the pulse at first fell in the same way, and then rose greatly ;
the temperature fell about half a degree of Fah. The same
occurred with alcohol, but afterwards the temperature rose
about a quarter or half a degrea of Fah. Cold water lessened,
at first, the number of the pulse, and lowered the temperature.
In 15 minutes both returned to their former amount. Coffee,
as already said, raised the pulse, but more in the morning than
in the evening.

3. Influence of fasting. Fasting for from 20 to 21 hours
lowered both pulse and temperature. At the end, the pulse
was from 12 to 16 per minute; the temperature as much as
1.8 Fah., under the normal. The curious observation (made
also by Davy and Gierse) was noted, that at the period of cus-
tomary meal-times both pulse and temperature slightly rose.

4. Influence of muscular movements. Various experiments
were tried with different kinds of movements. 1. A ten pound
weight was allowed to hang from the arm for five minutes, the
body being tranquil ; the pulse first fell in frequency, then rose;
its greatest frequency was after the termination of the experi-

308 Ash-tree leaves in Gout and Rheumatism. [May,

ment. When the weight was on the left arm, the rise was
nearly double that which occurred when it was on the right
arm. 2. A weight of one pound was held out horizontally ;
the pulse rose and fell remarkably several times. 3. A weight
of two pounds was rapidly swung round and round with one
one arm, while the other was placed on a table, that the pulse
might be counted. This exercise produced the greatest effect
on the pulse, raising it sometimes from 30 to 50 beats. 4.
Long-continued moderate exercise, carried on to fatigue, raised
the pulse greatly for some considerable time, but never pro-
duced the enormous rise noted in the previous kind (3) of mus-
cular exertion.

5. Influence of narcotic poisons. Belladonna and atropine
at first diminished the frequency of the pulse (16 to 20 beats),
but after a variable time (50 to 117 minutes) the pulse again
rose (12 to 30 beats). The smaller doses produced greater
primary sinking than the large, but required much longer time
to do so; on the contrary, the larger doses produced much
greater secondary rising; that is to say, the maximum sinking
point is inversely, and the maximum rising point is directly,
proportioned to the amount of the drug. It might be said that
small doses depress, larger excite, the pulse. The temperature
was diminished in all cases. Opium, especially in small doses,
caused rising of the pulse, but afterwards there was great sink-
ing, and the temperature diminished. The Cannabis Indica
produced many periods of rising and falling; the temperature
rose for about four hours, and to as great a degree as .7 or 1
Fah. Chloroform and ether, if not pushed to too deep a nar-
cotism, raised both temperature and pulse. [British and For.
Medico- Chirurgical Review.

Infusion of the leaves of the Ash-tree (Fraxinus polygamic)
in the treatment of Gout and Rheumatism. By Drs. Pouget
and Peyraud.

The most useful acquisitions in materia medica are due gen-
erally to chance, or, rather, to a protective Providence over
human health; e. g., the antiperiodic properties of cinchona.

In 1842, Dr. Peyraud experienced his first attack of gout,
for which he employed the usual remedies. The attack lasted
twenty-five days. During the three following years the diseae
increased both in frequency and violence, and the patient went
through the several forms of treatment without finding relief.
He heard, by accident, that the infusion of the ash-leaves had
long been considered a specific in the department of Dordogne,
and that the peasantry of the district used it to "chase away

1853.] Adulteration of Sulphate of Quinine. 309

their pains." Dr. Peyraud found it upon trial so useful that he
had but one attack of the gout from 1845 to J849.

M. B., a merchant of Bordeaux, was seized with an attack of
gout, for the first time, in the right foot. He was ordered
infusion of ash-leaves ; upon the second day he was able to
come down stairs and to leave his house. Ever since, he has
had recourse to the same remedy with good effect upon expe-
riencing premonitory symptoms, such as headache, loss of ap-
petite, etc. The same success followed its administration in
cases of acute articular rheumatism. A house-painter, aged
23, had, upon several occasions, suffered from acute articular
rheumatism, accompanied by endocarditis, which prevented
his following his occupation for four months or more. Decem-
ber 25, 1849, he had pain in the articulations of the feet, knees,
and wrists, with swelling, accompanied by difficulty of respi-
ration and inability to lie down. December 30, he was so
weak that it was thought better, before bleeding him, to try
the infusion of ash-leaves. In about twelve hours, and after
the third dose, the patient was able to breathe easier, and there
were fewer periodical pains. On the fourth day, the articular
pains had diminished in intensity, the respiration was freer, and
the appetite had returned. Jauuary 22d. He was able to re-
sume work. The authors now administer it in the form of a
fine powder in preference to the infusion. Other cases are
related in the Essay. [London Med. Times.

On Adulteration of Sulphate of Quinine. By Dr. Moll.

The excessive price of the true cinchona, the calisava of
Bolivia, has led to the substitution of many inferior kinds,
chiefly remarkable for their containing large proportions of
quinidine. In consequence of their lower price they have ob-
tained admission to the quinine manufactories in large quanti-
ties, and much of the sulphate now produced is depreciated by
the addition of quinidine. This substance differs from the
sulphate of quinine by its greater specific gravity and less floc-
culent crystallization, and it is much more soluble than it is in
water and alcohol. The addition of both cinchonine and quini-
dine may be detected by means of ether ; for while cinchonine
is almost insoluble in this substance, quinidine is so in a far less
degree than is quinine, inasmuch as sixty drops of ether and
twenty of ammonia will dissolve ten grains of quinine and only
one prrain of quinidine. On the addition of these quantities of
sulphuric ether and liq. ammonia, to ten grains of quinine, with
ten drops of dilute sulphuric acid, and fifteen of water, all will

n. s. vol. ix. no. v. 20

310 Reproduction of Nervous Substance, fyc. [May,

remain dissolved, unless cinchonine, or more than ten per cent,
ofquinidine be present, the mechanical impurities only appear-
ing at the surface. If 10 per cent, ofquinidine be present in
the ethereal solution, it will soon crystallize on the surface of
the ether. Traces Of this substance can be yet more certainly
discovered if ether saturated with quinidine be employed, when
all that exists in the suspected salt will remain insoluble. If
the powder contain cinchonine, or more than 10 per cent,
quinidine, it will remain undissolved at the line of demarkation
of the two fluids. If it be quinidine, it is soluble in additional
ether, which cinchonine is not.

To establish the purity of quinine, we must also assure our-
selves of the absence of inorganic substances, by calcination
in platina, or by a solution of the salt in alcohol. Sulphate
and carbonate of lime, magnesia, &c, remain undissolved,
while boracic acid, though soluble, betrays itself by its blue
flame on conflagration. The absence of organic substances,
as salicine, sugar, starch, stearic acid, is known by the color-
less solution which takes place in concentrated sulphuric acid.
The presence of ammoniacal salts is revealed by the odor which
ensues on the addition of caustic alkali. [Brit, and For. Med.
Chir. Rev.,foom Rev. Medic o-Chirurg .

On the Reproduction of Nervous Substance, and on the Struc-
ture and Functions of the Spinal Ganglia. By Dr. A,
Wallcr.

Dr. Waller, after having made many experiments on differ-
ent animals, principally warm blooded ones, of an early age,
and frogs, considers himself entitled to the conclusion: ''That
the old fibres of a divided nerve never gain anew their original
structure and function, and that the reproduction of nervous
substance does not take place merely in the cicatrixjtself, but
also downwards into the terminating ramifications. The old
fibres gradually waste, and after a month or later, new fibres
are formed, which are pale and transparent, possess no double
contour, present a very unequal diameter, being on the one
place very thin, on the other, varicose, like the fibres of the
spinal marrow. In the peripheral part of the glossopharyn-
geal nerve of a frog, three months after the section, their size
was only about one-sixth to one-third of the original fibres;
they resembled, therefore, much more the ramifications of the
nerve in very young frogs. In the central part of the cut
nerve the fibres remain unaltered. Concentrated acetic acid
dissolves the membrane of the newly-formed fibres, leaving
fusiform nuclei : the membranes of the original fibres are com-

1853.] Influence of the Sympathetic Nerve, c. 311

pletely dissolved, no nuclei being left. The reproduction of
fibres, and the return of function, proceed in the same propor-
tion. Of great importance are Dr. Waller's experiments for
the understanding of the structure and function of the ganglia.
While, as he has previously shown, all motor nerves, separated
from their cerebrospinal centre, become entirely changed in
their microscopic appearance, the peripheral part of the sensi-
tive spinal nerves, the root of which is cut through between the
spinal cord and the spinal ganglion, remains unaltered as long
as the connexion with the ganglion is maintained. Ten or
twelve days after having divided one or both of the roots of the
second cervical nerve, he was enabled to make the following
observations: 1. That part of the sensitive nerve which is
situated between the place of division and the ganglion, is
disorganized in the same manner as any dissected nerve in its
peripheral end. 2. Tracing the disorganized fibres into the
interior of the ganglion, they are seen mixed with normal
fibres; the disorganized ones appear to pass into ganglionic
globules, which are likewise altered, seeming to be deprived of
their contents, and to consist merely of a thin, indistinct mem-
brane. 3. The normal fibres appear to end by very thin fila-
ments passing into the normal ganglionic globules. 4. Ail the
fibres originating within the ganglion are in their normal state.
5. The motor fibres are completely disorganized in the whole
of the peripheral part of the nerve [no motion is produced by
galvanism, or any other stimulus]. 6. After having divided
only the posterior root, all the fibres below, or on the other side,
of the ganglion were normal. 7. After having divided the
nerve below the ganglion, or after having cut out the ganglion,
all the fibres in the peripheral part were disorganized. It is
evident, from fhis, that the spinal ganglion acts as a nervous
centre for the sensitive fibres, but not for the motor ones. Dr.
W. promises to give soon more detailed observations, as well
on the same subject as on the function of the nervus vagus and
svmpatheticus. [Mulleins Archives. Brit, and For. Medico-
Chir. Rev.

On the Influence of the Sympathetic Nerve on the Animal Tem-
perature. By Dr. T. Budge.

To the communication of Bernard's observation, that by
dividing the sympathetic nerve between the first and second
ganglion cervicale, the temperaxure of the corresponding side
of the head soon rises several degrees, and remains increased
for some days ['Compt. Rendus,' Mars, 1852], Dr. Budge adds
the remark, that he had observed the same fact already in De-

812 Treatment of Spasmodic Diseases. [May,

cember, 1S51. In another experiment, Dr. Budge destroyed
the lumbar part of the spinal marrow, after which he observed
a considerable decrease of temperature in the whole of the pos-
terior part of the body. [Froriep's Tagesber. Ibid.

Treatment of Spasmodic Diseases.

Dr. Alexander Wood, in an interesting paper {Monthly
Journal of Medical Science, February. 1853,) points out the
irrational and contradictory treatment usually pursued in spas-
modic diseases. In the severer convulsive diseases, as tetanus
and hydrophobia, he remarks, wine, brandy, and opium stim-
ulants are conjoined with the cold affusion or cold bath
sedatives. Opium in small doses, which as a stimulant and
soothing remedy might prove useful, is counteracted by tobacco
a sedative, or by irritating and depressing purgatives. We
are told to administer the most violent purgatives in these
diseases, and are encouraged to persevere in their employment
to an enormous extent, by the hope of eventually obtaining
from the bowels an assortment of strange and heterogeneous
matters.

"In these diseases," he adds, "where the violent muscular
effort demands a large supply of blood, and where the wants of
that supply increases the irritability of the system, we are
taught to bleed, beginning with from thirty to forty ounces, and
repeating it if need be. What end can bloodletting possibly
subserve, unless in those exceptional cases, to be afterwards
specially considered, where urea exists in the fluid ? There is
no morbid matter in the circulating fluid which bleeding can
remove ! There is no inflammation which it can subdue ! On
the contrary, that terrible muscular action, like a consuming
fire, is draining away the nutriment of the system even faster
than your relentless lancet, and when the supply is exhausted
the flickering taper will expire.

" In the case of an unhappy infant, ill-thriven, ill-fed, who lias
imbibed irritability of constitution with the milk of a gay, luxu-
rious, self-indulgent, and nervous mother, and who has had
that irritability confirmed by a long course of ill-regulated man-
agement ; why will you, when the irritation of a tooth has
proved the cause of convulsions, not rest satisfied with removing
the immediate pressure, and then set about improving the
general system, in which the real danger lies, but apply cold
to a head where no symptoms of congestion or inflammation is
to be found, harrow the gums with daily scarifications, and ad-
minister a powerful purgative, glorying in the expulsion of
depraved secretions, which oDly indicate the impaired stale of

1853.] Treatment of Spasmodic Diseases. 313

nutrition, and the necessity for a very opposite kind of treat-
ment ?"

Dr. Wood very earnestly solicits attention to the following
therapeutical considerations, based on the physiology and
pathology of spasmodic affections :

1. The importance of great attention to a proper supply of
nutriment and of air in all circumstances where either heredi-
tary tendency or other circumstances are likely to develop
convulsive diseases. Trismus nascentium is epidemic in the
West Indies, from the absurd way in which infants are there
treated. The same disease was banished from the Dublin
Lying-in Hospital by proper attention to ventilation and clean-
liness.

Laryngismus stridulus is never so satisfactorily treated as by
change of air. The mortality of tetanus in our naval stations
in the West Indies has been very much reduced, mainly ac-
cording to Dr. Dickson, by improved hygiene. (Med. Chir.
Trans, vol. vii. p. 765.)

2. Let us divest our minds of the idea that it is necessary to
treat the fit in any of these diseases. It is only a part of a train
of morbid phenomena, and though the part most striking to the
bystander, ought not to make the same impression on the intel-
ligent physician. No one now thinks of treating the fit either
in epilepsy or in chorea, and why should we think it necessary
in tetanus or hydrophobia?

3. Is it not worthy of consideration whether the obstinate
constipation in tetanus and lead poisoning may not be a spasm
of the muscular coat of the intestines^analogous to that of the
voluntary muscles, and like it, not to be overcome by brute force
(i. e., purgatives?) Certain it is, that in lead colic the finger,
introduced into the rectum, is held by the sphincter as by a
vice, and pressed tightly by the gut, and that this pressure re-
turns at each paroxysm.* Certain it is also, that the retrac-
tion and hardness of the abdomen, associated by Meratf with
that internal construction, is found also to exist in tetanus,
though I am not aware that any one has ever explored the inter-
nal state of the bowel in that disease. It may be necessary to
remove the morbid secretions in the bowels, though every intel-
ligent physician will have to balance the amount of irritation
produced by their presence with that caused by the drastic pur-
gatives necessary for their removal. The spasm which retains
them is the effect of the disease. It is to treat symptoms, to
attack it alone; and when we succeed in overcoming the disease,
the bowels will spontaneously relieve themselves. TrallesJ

* Tranquerel Traite des Maladies de Plomb. etc, p. 210.
t Traite de la Colique Metalique.
: Opii. Usus et Abuses, sect. 2. p. 260.

314 Treatment of Spasmodic Diseases. L^ay,

found opium succeed in a case of ileus where purgatives had
failed. J have seen the same. Lentilius* has confirmed this ;
and in a severe form of colic, Bonnf became convinced by ex-
perience that it was the most powerful remedy.

4. The most efficient and the most frequent agents in the
production of these diseases are sedatives. Bloodletting is a
most powerful sedative, and if carried to an extent in a healthy
person produces convulsions. Is bloodletting, then, a suitable
remedy in these affections? In chorea, it was formerly
practised, and is now abandoned, from the injurious effects
which it produced. In delirium tremens and hysteria, its use
has been also given up. In epilepsy, it is rarely used by intelli-
gent physicians, except to meet the requirements of secondary
affections; and if we still retain its employment in the more
severe convulsive diseases, it is probably only because their
rapid course and frequently fatal issue makes it very difficult
for us to ascertain the effect of any treatment.

5. In one class of convulsive diseases bloodletting seems, in
the present state of our knowledge, to be indispensable. Where
urea exists in the blood and produces convulsions, it must either
be expelled or counteracted. We scarcely know how to
accomplish the latter indication, and therefore are driven back
on the former ; but even while seeking by bloodletting to get
rid of the urea which is mixed with that fluid, we must never
forget that it "both acts on the nervous system as a narcotic
poison and impoverishes the blood, inducing degeneration of
the tissues ;"J and that therefore, while we take blood to re-
move the poison, we rrnpst do our utmost to replace the nutri-
ment which we are unavoidably compelled to abstract along
with it.

6. Our views on this subject would become more definite and
precise, could we avoid imagining that spasm implies augment-
ed strength. It is not easy for us, when seeing the violent
agitation of the system which prevails, to divest our minds of
the idea of great power being developed, but the same remarks
apply to mania, in which disease, thanks to the exeriions of Dr.
W. A. F. Browne, || general depletion, tartar emetic, brisk
cathartics, and ice to the shaved scalp, are no longer in such
vogue as they once were.

If such are the objections to the routine practice, what course
ought to be pursued? It is easier to point out error than to
demonstrate truth. But I venture to suggest

*Eph. Mat. Cur. dec. 3, ann. 1, p. 131.
t De Officio Medici.

I William's Principles of Medicine, p. 150.

II Monthly Journal, 1841, p. 75.

1853.] Treatment of Spasmodic Diseases. 315

7. That sedatives should be cautiously used. Chloroform
and cold affusion have each proved fatal in delirium tremens.

8. That every effort should be made to put into the system
as much nourishment as it is capable of beneficially employing.

9. But, if there is any faith to be placed in antipathic treat-
ment, it is to stimulants we must most trust.

10. It is worth observing, that most of those chemical agents
which produce convulsions, acting, as has been already said, in
large doses as sedatives, do in small doses act as stimulants.

11. We find also, that where the minor spasms, as cramp,
have been excited by irritation of the peripheral distribution of
one class of nerves, as those of the mucous lining of the bowels,
they are often relieved by irritation of the peripheral distribu-
tion of another class of nerves, as by friction on the skin.

12. The cerebral functions, more especially volition and sen-
sation, being much in abeyance, any stimuli, whether mental,
or phisical, by which they can be excited, should be freely given.
It was on this principle that Boerhaave prevented the recur-
rence of epileptic attacks, by directing a red-hot iron to be
applied to any who might be seized.*

13. The extreme sensitiveness to all irritations which exists
whenever the spinal predominates over the cerebral system,
suggests the propriety of enforcing the most absolute quiet, and
preventing the access of all bodily and mental stimuli. In teta-
nus and hydrophobia, the creaking ofa shoe, the slamming of a
door, the sight or even the thought of water, or the gentlest
zephyr playing on the surface of the body, excites a fit. Hence
Armstrong tells us, that in tetanus those patients recover best
who get little active treatment, but are nursed, as it were
through the fit.f

14. And if sources of irritation ought to be prevented, those
actually existing ought to be removed, but never by irritants
which are more powerful than themselves. This surely gives
sufficient latitude to the most devoted admirers of the gum
lancet, the bolus, or the bag and pipe, while it suggests to him a
little caution in these somewhat coarse though most popular
remedies.

15. And lastly, if I have not succeeded in pointing out any
one remed) which stimulates the cerebral without exciting the
spinal system, it is because few, if any such are known. It is a
subject of investigation well worth attention. And if no par-
ticular plan of treatment has been announced, which can be
unhesitatingly recommended, I am perfectly satisfied if I have
created any doubt as to the course which at present is too

* Falconer on the Influence of the Passions, p. 100.
t Lectures, edited byT. G. Thomson, p. 572.

316 Pathology of Rheumatism and Gout. L^-ay>

unhesitatingly followed. I think, at least, something has been
done to show how much more constitutional these affections aie
than is usually supposed, .and thus to open up new plans tor
prevention, if not for cure. And if in acute mania, in puerperal
insanity, in delirium tremens, in chorea, in laryngismus, and
may I add in epilepsy also, empiricism or the influence of
authority has induced us to abandon antiphlogistic treatment,
and to adopt stimulant and soothing remedies, I do not despair
of a sounder pathology soon prevailing in regard to this whole
class of afflictions, and of the discovery yet being made, that
they are much more amenable to treatment that has hitherto
been supposed. [American Journal of Med. Sciences.

Pathology of Rheumatism and Gout. By Prof. J. H. Bennett.

The present theory with regard to these affections is, that
they are both connected with an increase of hthic acid in the
blood. In rheumatism, this is dependent on excess of the
secondary, and in gout, on excess of the primary, digestion. In
rheumatism, however, there is considerable excretion of lactic
acid by the skin (Todd,) whilst in gout there is an excess of
soda, which, uniting with the lithic acid, produces a compound
of lithate of soda, that may be detected as such in the blood
(Garrod,) while sometimes it exudes into the cellular tissue of
the skin, constituting tophaceous deposits. In both diseases,
there is an undue balance between the excess of lithic acid and
the power of excretion in rheumatism by the skin, and in gout
by the kidney. This pathology serves to explain the similitudes
and differences existing between the two affections. In both
there is a certain constitutional state dependent on deranged
digestion, during which exciting causes occasion local effects.
These exciting causes in rheumatism are bad diet, hard work,
exposure to cold and wet, and its subjects generally are the poor
and labouring population. In gout, the causes are good diet,
indolence, repletion, or indigestion, and its subjects are for the
most part the rich and sedentary. The local manifestations in
both are acute wandering pains, with pain and swelling in
rheumatism of the large, and in gout of the small joints, constitu-
ting the acute attack in the one, and the so-called regular attack
in the other. These are combined with a tendency to various
complications of the internal viscera, which are more or less
dangerous to life.

The general indications of treatment are, in both diseases (1.)
so to regulate the nutritive functions as to insure a due balance
between the amount of matters entering the blood as the result

1853.] Treatment of Acute Rheumatism. 317

of digestion, primary or secondary, and the amount of matters
discharged from the economy by the excretory organs. (2)
To conduct the acute attack to a favorable termination, care-
fully watching the internal viscera, and being prepared to act
with vigour should these become affected. Hence the treat-
ment of these diseases resolves itself into what may be called
curative and preventive the first having reference to the acute
attack, the second to the means most likely to hinder its return ;
the one must be carried out by remedies which act upon the
blood and excretory organs, the other by the management of
diet and exercise. [Monthly Jour. Med. Science.

Treatment of Acute Rheumatism by Nitrate of Potash. By
Prof. J. H. Bennett.

Although the general pathology above mentioned [see pre-
ceding article,] which considers rheumatism as a blood-disease
may be considered on the whole as correct, we are not yet
enabled to explain by it the symptoms of an acute attack of the
disease, where, in addition to the constitutional disorder, we
have local pain, occasional heat, redness and swelling, with
febrile symptoms. Most practical men have attributed these
phenomena to a superinduced inflammation, although it has not
been shown that exudation occurs, or that it is followed by the
usual results of that condition. Besides, its erratic character
is opposed to what we know of the process of true inflamma-
tion, and calling it an unhealthy inflammation in noway clears
up the mystery. The real pathology of acute rheumatism,
therefore, has yet to be determined, and as a preliminary step,
a careful histological examination of the affected tissues is ab-
solutely necessary. So far as I am aware, this has never yet
been attempted, if we except some observations by Hasse on
the Structure of the bones in rheumatism (see the Monthly
Journal for June, 1847.)

Our treatment of this disease, therefore, is purely empirical
sometimes directed against the pain, at others against the sup-
posed inflammation ; now attempting to combat the pathologi-
cal condition of the blood, then striving to remedy its effects by
acting on the excretions ; and not unfrequently giving specifics,
in the hope that any change in the constitution, however pro-
duced, may be beneficial. In no disorder, probably, has such
a crowd of opposite remedies and plans of treatment been
extolled, and yet none of them can be depended on, so that it
has been imagined that six weeks' rest is the most useful pre-
scription (Warren.) The latest author on rheumatism endeav-
ours to explain this by observing, that this need not be won-

318 Treatment of Acute Rheumatism. [May,

dered at by " those who consider the true nature of the disorder
and the variety of circumstances under which the physician
may be called upon to minister to his patient's relief. The
bleeding, which in the young, plethoric, and robust, may be
necessary to allay excessive vascular action and cause free
secretion, may in the weakly induce irritability of the heart,
and a consequent attack of cardiac inflammation. The opium,
which in one person may prove of the greatest service in pro-
moting fvee perspiration, and in allaying the general irritability
of the system, may in another check the biliary and other secre-
tions, and thus prevent the elimination of the rheumatic poison.
The continued use of calomel, and the constant purging, which
may be beneficial to one patient by removing large quantities
of unhealthy secretions, may unnecessarily exhaust the strength
of another, and tend very greatly to impede recovery. And
so in regard to every remedy which has been proposed. What
is useful at one time proves useless, or positively injurious, at
another; and the conclusion is forced upon us, that what is
wanted * is far less the discovery of untried methods of treating
disease, than of discriminative canons for the proper use of
those we possess :' far less the discovery of any new medicines
than the adaptation of our present remedies to the exigencies
of each case." (Fuller on Rheumatism, p. 73.) These judi-
cious observations may serve to explain the cause of our failure;
but until we obtain more exact information regarding the
special pathology of rheumatism, it is in vain to hope for a
rational treatment.

For my own part, I generally treat rheumatism on what is
called "general principles;" these are, to alleviate severe pain
by anodynes, diminished excessive vascular action by moderate
bleeding and saline antiphlogistics,and encourage every attempt
at critical discharges by diaphoretics, diuretics, purgatives, etc.
Occasionally I have tried the effects of special remedies in this
disease, and watched a series of cases, all of which were treated
in the same manner. Thus I have tried aconite, and believe
that alone it is of little service; colchicum, also, I have given
frequently, and am of opinion that in pure rheumatism it is of
no advantage, although in gout it is invaluable. This session
(1851-2) you have witnessed another trial of this kind with the
nitrate of potash, a remedy formerly recommended by Dr.
Brocklesby, and which has been given with good effect by M.
Gendrin, in the wards of La Pitie in Paris, as recorded by Dr.
Henry Bennett (Lancet 1844, vol. i. p. 374.) It has more lately
been pressed on our attention by Dr. Basham (Medico- Chir.
Trans, vol. xxxii.,) who tells us that from one to three ounces
oi the salt, if freely diluted in water, may be taken by the

1853.] Miscellany. 319

patient in the course of twenty-four hours, without any injurious
results, but with the effect of relieving in a marked manner the
swelling, heat, and pain in the joints. [76.

ill 1 0 c 1 1 1 a n g .

We have received from a much esteemed correspondent a commu-
nication having for its object the criticism of an article to be found in
the original department of one of our late numbers. The writer takes
exception to the treatment of the case, and gives his reasons for thus
differing from the reporter. While we can perceive some advantages
to be derived from such criticisms, we also feel assured that the evils
w'ould very far counterbalance them. There are few, very few, men
who can discuss a question, even purely scientific, without forgetting
the proprieties without which any controversy may degenerate into
personalities. It is therefore that we have invariably refused to admit
into our columns any thing having the least tendency to such a result.

It may be well, on the present occasion, to reiterate, that in pub-
lishing original communications, with the name of the author, we
cannot hold ourselves responsible for any theories, opinions, or modes
of practice they may advocate. We have frequently published
articles containing views, theoretical and practical, utterly at variance
with what we would deem correct yet the name of the writer being
given, he can alone be responsible for the impression made upon the
reader. If we were to publish none but such as we could endorse in
every particular, we apprehend that we would soon incur the odium
of being unnecessarily fastidious.

The true policy is to let every writer stand upon his own merits.
If he publishes nonsense, he will soon cease to be read and to do mis-
chief: if, on the contrary, his contributions are found to indicate
thought, judgment, and a well stored mind, he will be duly apprecia-
ted and read with advantage. An Editor, it is true, has the privilege
of rejecting such communications as may be deemed unworthy and
we do not hesitate to exercise the right whenever necessary yet we
always, feel inclined to make periodicals as democratic as possible by
lending their pages to whoever wishes to be heard provided he
knows how to write.

Books Received. We have before us the "Proceedings of the
Medical Association of the State of Alabama, at its sixth annual meet-
ing held in the city of Selma in December, 1852." This is a neat

320 Miscellany. [May,

volume of about 170 pages, filled with interesting matter, and highly-
creditable to the profession in our sister State. We hope to be able
to refer to it more at length in our next.

We have also received the "Tenth Annual Report of the Mana-
gers of the State Lunatic Asylum of the State of New York." The
" Report of the Eastern Lunatic Asylum in the city of Williamsburg,
Virginia, for 1852-3." "The Philosophy of Medical Science, con-
sidered with especial reference to Dr. Elisha Bartletl's Essay on the
Philosophy of Medical Science. A Boylstown Prize Essay, 1849.
By E. Leigh, M. D. Boston, 1853. Addresses to the Graduates of
their respective Schools, by Prof. J. W. Richardson, of Nashville;
by Prof. N. S. Davis, of Chicago ; by Prof. M. M. Pallen, of St.
Louis ; and by Prof. H. V. Wooten, of Memphis all of which evince
a high order of talent.

More Medical Journals. We have received " The Virginia Medi-
cal and Surgical Journal," edited by George A. Otis, M. D. and
Howel L. Thomas, M. D., published monthly at Richmond price 85.
Also, " The American Psychological Journal, devoted chiefly to the
elucidation of Mental Pathology, and the Medical Jurisprudence of
Insanity," edited by Edward Mead, M. D., and published at Cincin.
nati 32 pages Bi-monthly at $1. We cheerfully add them to our
list of exchanges, and wish them a successful career. Our Virginia
friends manifest a degree of industry and good taste, as well as of
ability, which must secure to them an extensive patronage.

Dr. Frank A. Ramsay has, it appears, abandoned the East Ten-
nessee Record of Medicine and Surgery, and joined the editorial corps
of the "Southern Journal of the Medical and Physical Sciences,"
published at Nashville.

The Country Doctor. Some of our contemporaries pride ihem-
selves upon never quoting anything from "the secular press ;" but
we have always preferred to adopt the wiser course suggested by the
motto of the Southern Medical Journal "je prends le bien ou je Ie
trouve" and in so doing do not feel that any one's professional digni-
ty has been injured, or any one's professional robe sullied by. contact
with the common herd. Acting on these principles, we give below an
article from the Knickerbocker, entitled " The Country Doctor, a
faithful autobiography : by Glauber Saultz, M. D." Perhaps all our
readers can narrate facts which surpass these ; we are sure almost
all can equal them ; but then it is easier to laugh at another's misfor-
tunes than our own, and "Doctor Saultz V feelings will not be hurt
if every one laughs as hard as it will answer for a dignified m. d. ;

1853.] Miscellany. 321

neither will he make a charge for his visit. [New Hampshire Jour-
nal of Medicine.

I had stumped about the country for a dozen years or so, in the
same equipage, having wonderful success in curing "cases," but half
the time cheated out of the credit of it by catnip tea. I took a notion
to cast up my books to see how rich I was, and what could be made
of outstanding accounts. It cost a great many evenings of hard work
to arrive at the knowledge that, all debts being paid, 1 was not worth
a " brass farthing " not a red cent. Notwithstanding all the lucra-
tive cases of typhus which I had managed, I remained poor. I be-
lieve that people in the city pay their fees with alacrity, because the
charges are exorbitant. When a bill for a hnndred dollars, for look-
ing two or three times at a sick child, is presented to one who lives
in a well furnished house in the upper part of the town, the very
largeness of the demand is a delicate compliment upon his ability to
pay. The man of the house sits down at a handsome secretary, and
draws out a clean check for the full amount, saying " Doctor, you
are very moderate : now that Jacky is out of the woods, come in, in
a sociable way."

As soon as the messenger is gone, the paterfamilias exclaims,
"What an outrageous bill! It is an expensive luxury to be sick."
However, it has its advantages to be attended by a fashionable doctor,
as it has to worship in a fashionable church. On one occasion I was
called in midsummer to attend a sick man on the sea-shore. After
several days, his family physician, the renowned Doctor Jallaps, ar-
rived from the city, and the patient was soon after on his legs, no
thanks to me, and ready for the surf.

" How much are you going to charge him ?" said Doctor Jallaps.

"Twenty-five dollars," said I.

" Poh !" said he, " make it a hundred. He expects it."

"If he expects it," said I, "it would give me great pain to disap-
point his expectations ;" whereupon I acted advisedly, and received
an honored check for a round C. on the Phoenix Bank.

On another occasion, when attending one of my own patients in the
same vicinity, while crossing the " big bridge " when the tide was up,
I came near being drowned. My sulky was soon afloat, but the horse,
being a good swimmer, reached the opposite bank. Now, besides
risking my own life, I fiirly dragged the patient from the very gates
of death. I got him out of a bilious remittent, drove tbe jaundice out
of his skin, and when I came to ask him for ten dollars, he black-
guarded me like a chicken-stealer, and would never employ me again.
The fact is, that people in the country abhor taxes, and a doctor Ts the
worst of publicans. To be sick they think is a dead loss, which they
unchristianly grumble at ; but to have to pay for being cured irritates
them beyond measure. Oh ! how meek they are when they lie
prostrate in a burning fever when their teeth chatter, and the whole
house jars with their shaking ague ! Oh ! how welcome the latch is
lifted up to admit you when life seems to hang upon a hair ! But get

322 Miscellany. [May,

them on their legs, and the first thing which they forget will be that
they were ever on their backs. If many of them do pay you, it is
under protest, procrastinating the settlement to a time when the ac-
count might be outlawed, clipping down the fair proportions of a just
bill, and giving you the most ragged representative of money.

I say that when I came to overhaul my accounts, I was not worth
anything, and therefore arrived at the conclusion that it was high
time to marry a wife who would take care of my money. I did so,
and found my condition better, but for some years had a hard time of
it. My children were extremely pettish and peevish, and what with
nocturnal calls, I had not a night's rest for five years. If anything
ailed them, they were sure to cry the night long ; but if they were
well, they woke up long before the crowing of the cock, climbing
over me at the very moment when I had composed my head for a
short morning nap. But paternal philosophy can well be reconciled
to the sweet music of "cn'ing babes," some thousands of which have
been imported into New York during the present year. But the
number of people taken sick in the day time, who send for the doctor
at night, produced a compound fracture of my time, which seldom gave
me a comatose state. It is the sweetest of all consolations to lay a
weary head upon the pillow, with the thought that rest awaits you
until the dawning light. Whatever carking cares have vexed you,
that is a long season of immunity which stretches through the dark
hours of the night. Then do the strained muscles lapse into the most
easy attitudes in the yielding couch, and the taxed intellect is still, and
you bolt the door upon ingratitude and strife.

But to lie down without security from disturbance is enough to
frighten away sleep. Such is the lot of a country doctor. I could
relate innumerable instances of the utter disregard with which he is
routed from his bed, without occasion, at all hours. Here is one in
point.

I arrived late one winter evening at my own door, after a hard day's
toil. With what a feeling of relaxation did I divest my feet of heavy
boots, set them smoking at the fire, and then regale them in easy slip-
pers! Then, wrapping about me a soft padded gown, with what
luxury did I fall back in my arm-chair, peruse the daily paper, and
sip a cup of tea! "Now," said I, "the labors of the day are over.
A storm is brewing out of doors. I hope that no body will come here
to-nighl. If they do, I won't go. Let them go after Bogardus. I
won't immolate myself for anybody. It is unreasonable." With
that I pulled down my ledger and made a note of the day's visits, one
half of which were to poor houses, negro huts, and Irish shanties. As
to this class, they loved me like a brother, and their confidence in me
was unbounded. They sent for me if their bones ached, or if their
corns hurt them, and I went with all speed, though I sometimes had
occasion to scold them. Before retiring for the night, I opened the
outer door, as was my custom, to see the state of the weather. It was
a tremendous night. The moon shone palety, but the wind blew a
hurricane. It rained, it hailed, it snowed, it Slowed. I thought again

1853.] Miscellany. 323

of the poor mariners on the coast, and with a silent prayer for them,
and all houseless, unprotected ones, I closed the door, and went to bed.
I had just recovered from the shivering sensation of cold sheets, and
become conscious of grateful warmth, while that delightful drowsiness
which borders upon sound sleep stole over me, when there came a
knocking, impatiently repeated, enough to wake the dead. "Bless
me !" I groaned out, crawling out of bed, and lifting the sash, * what
do you want ?"

11 Doctor, want you to come right straight away off to Bank's. His
child's dead."

" Then why do you come ?"

"He's p'isoned. They gin him laud'num for paregoricky."

" How much have they given him V

" Dono. A good deal. Think he won't get over it."

" When did they give it to him ?"

"This arternoon."

" Why didn't you come sooner ? How do you think I am to go two
miles on such a night ? Have you brought a wagon?"

" No."

" Then I won't go. Tell them to ;" and having prescribed

hastily out of the window, I closed the sash, and went back to bed.
But the howling wind and rattling sleet against the panes had not that
soothing effect which they have to one who lies snug and warm and
irresponsible in his couch. " What," said I, " if that child should die
through my neglect ! Will it absolve me from criminality because the
parents are poor ? I will go : I must." With that I leaped out again,
kindled a match, and went down into my office. Not choosing to
wake my man Flummery, or to disturb my old horse, who was
craunching his oats, and housed for the night, I took my slick, and
set out to walk. The snow water went through my shoes like a
sieve ; my neck and bosom were instantly covered with sleet. Nev-
ertheless, I had some humorous thoughts while breasting the storm,
and composed a Latin distich by the way. I had just got the last foot
of the pentameter correct, when my own foot struck against some-
thing which looked like a black log. On scrutiny, by the light of
the moon, I found it to be my old patient, Timmy Timmons, apparent-
ly sound asleep, with his beloved rum-jug by his side. In vain I shook
him, to make him aware of his situation, and see if the spirit had left
his body. I shook the rum-jug, but there was no spirit there, not a
drop. "Timmy," said I, " wake up." No answer. I then kicked
him, but he bore it as if he had been used to kicks. "He is dead,"
said I, and passed on to the next house. There, while opening the
gate, I was fiercely attacked by a stout bull dog; and while keeping
him off, and fighting my way up to the house, the master came out in
his shirt-tail with a loaded gun. " Don't you know me ?" said I, as
he examined the priming ; " it is the doctor."

"Souls alive !" responded he ; "I thought it was a thief! I'm
glad you spoke when you did. In a minute more I should have popped
you over, Doc'. Sorry to do that. My son John's got the fever- aig.
Here, Bull, Bull, Bull, Bull ! g'home, sir!"

324 Miscellany.

"Timmy Timmons," said I, " is lying out in the lane, drunk or
dead, I don't know which; dead drunk, at any rate. He must be
looked after."

"Wait till I put on my breeches. What a wonderful night!
Won't you come in and git warm V'

" No : get on your breeches, and make haste."

" Guy ! when I first heered you, I thought it was Lawrence comin'
to break house. He's a desput fellow. So I gets up and looks out o'
the window, and then I went into the corner to find my gun, and if I
didn't "

" Come, come ; do you want "

" To get the rheumatiz ? No, I don't. Hold on, Doctor ; be down
in one minute."

We returned to the congealed Timmons. My coadjutor took up
the jug, shook it, and said, "Not a drop." He then smelt it.

"It is rum," said ., "the cause of all this misery."

"No, Doctor, not all rum ; there's been a little molasses into the
jug. by the smell of it."

"Lift him up," said [. He did so, and carried his burthen home,
where I brought Timmy to life.

"I now trudged on upon my original errand, hoping to save ano-
ther life more valuable than that of Timmons. Arrived at the house,
I perceived it shut up as if hermetrically sealed. Not a light was to
be seen. I knocked furiously, and at last a nightcap appeared from
the chamber window, and a woman's voice squeaked out, " Who's
there V

" The doctor, to be sure," said I ; " you sent for him. What trie
dogs is the matter ?"

"Oh, its no matter, Doctor. Ephraim's belter. We got a little
sheered, kind of. Gin him laud'num, and he slept kind o' sound, but
he's woke up now."

" How much laudanum did he swallow?"

" Only two drops," said she. "T asn't hurt him none. Wunner-
ful bad storm to night !"

I buttoned my coat up to my throat, turned upon my heel, and
tried to whistle.

"Doctor, Doctor!"

"What do you want?"

"You won't charge nothin' for this visit, will you?"

Now, as I travelled back on foot, the moon became obscured, the
driving sleet blinded the eyes, I heard the Atlantic breakers booming
and beating upon the coast; and with head down, like a bulrush, I
arrived at my own door, wet and disconsolate, saying to myself
" That little plant called Patience does not grow in every
garden!"

Orfila, the great Toxicologi&t, is no mare.. The Parisian papers are full of the
honors paid to his memory. His funeral was attended by upwards of fifty
thousand persons, and eulogies were pronounced at his grave by seven distin-
guished representatives of the Scientific bodies of which he had been a member.

SOUTHERN

MEDICAL AND SURGICAL
JOUEML.

Vol. 9.] NEW SERIES JUKE, 1851. [No. 6.

PART FIRST.

riginal (!Iommunuattrjtt0.

ARTICLE XX.

Cases of Malignant Spotted Fever; with Remarks. By
Arthur W. Preston, M. D., of Americus, Ga.

The following cases of malignant spotted fever are sent for
publication, it may not be amiss to state that, in their delinea-
tion and treatment, the utmost frankness is observed :

During the past twelve months, all the endemic diseases
have increased in number and intensity. The first months pre-
senting serous diarrhoeas, cholera infantum and cholera morbus,
with occasional cases of angina pharyngitis. From June to the
middle of September, intermittents and remittents, together
with melanosis and carbuncle. From the middle of September
until November, malignant double tertians, some few algid,
others combined with semi reaction in which inflammations
of the asthenic type prevailed which if not promptly treated
passed within a few hours into profound and irremediable con-
jestion. Carbuncles have not diminished from their first ap-
pearance up to the present time. From November to the
present, the following diseases have been in existence: Inter-
mittents, chronic and relapsing; measles, very abundant ; con-
gestive pneumonia ; congestive bronchitis; typhoid pneumonia
and spotted fever the latter disease is the one which I shall now
speak of.

In Copland's Medical Dictionary, page 1176, will be found

n. s. VOL. IX. NO. vi. 21

326 "Preston, on Malignant Spotted Fever. [June

an article upon Spotted Fever of New England, which bears
a strict analogy to the cases we have recently met in which
the primary lesion must have been upon the ganglionic nerves,
and the second upon the vascular system. So great was the
rapidity of the attack in four cases, although sent for immedi-
ately, we had not time to reach them before they were dead or
dying. As these diseases sprung upon us without premonition.
we were entirely unprepared to determine what would be the
general outlines, should more present themselves. It is an easy
matter to point out defects when too late to remedy the evil.
That no more shall follow, I beg permission to review the nature
and treatment before I submit to your criticism, after which,
any light you may deem proper to throw upon them will be
thankfully received.

Case I. March 28th, 1853. Russel Jenkins, aged 22
sanguine nervous temperament, five feet seven inches high,
weight 130 lbs., occupation a farmer, habits perfectly tem-
perate and industrious, circumstances good on the 27th,
in the afternoon, complained of general indisposition: took a
dose of salts, which operated five times ; after which, continu-
ed to grow worse to the time I saw him on the following
morning at 8 A. M., at which time the countenance was altered
from a florid to an exsanguious appearance ; the eyes were
peculiarly brilliant and jactitating; lips pale; tongue broad,
flat, thin, and very pale, but firm in fibre; teeth cold, dry and
dead ; very restless, tossing from one side of his bed to the
other; acute lancinating pain in the head; soreness of the
muscles and joints ; stiffness and soreness on the back of the
neck; some sore throat ; pulse 80, full and compressible ; great
anxiety and constant thirst; occasional delirium; hysterical
symptoms. Had been vaccinated four weeks, previous to
which his health had been very good ; but since, had been
from time to time troubled with pains in his joints, and thought
he had rheumatism. Two days previous to confinement he
helped to ditch, and was above his ankles in water the greater
part of that time, during which he thought he had fevers.

Diagnosis. I was slow in forming an opinion as to the pre-
cise character of his disease. The more I looked at it, the

1853.] Preston, on Malignant Spotted Fever. 327

more I was puzzled, and shall not fear censure when I confess
the following : At one time, I thought it a retrocession of
rheumatism upon his brain at another, of the secondary vac-
cine fever. Again, that some malignant exanthema had con-
centrated all its powers upon the cerebro-spinal axis. The
progress of the case determined the justness of the latter con-
clusion.

With appearances so malignant, and uncertainty as to the
correctness of my diagnosis, I trusted to general principles for
my guide. I therefore summed the following symptoms:
1st, the general exsanguiousness ; 2d, the cold, dry and dead
teeth ; 3d, restlessness, &c., and resolved to support the vital
powTers as I best could, until further indications. Instead of
his being benefited by the free purgation on the previous day,
he rapidly grew worse a weighty argument against venesec-
tion. He was ten miles from town ; I therefore did not ask
for consultation, but gave the following: Hyd. sub. m. gr. 3,
ipecac, gr. 2, morph. sulph. gr. J, every eight, and sp. aeth. nit.
every four hours. A blanket was divided into three parts,
immersed in hot water, and well sprinkled with turpentine
then applied over the thorax, abdomen, feet, legs and knees.
The first dose of nitre was immediately rejected, together with
a pint of green fluid, mixed with mucus. 10 A. M. More
quiet ; blood returning to the surface ; headache not so severe.
12 M. Headache better; tongue red.

29th, 8, A.M. Had slept but little during the night. Fami-
ly thought he would die before morning. Is now watchful,
restless, and constantly occupied about his farm ; motions auto-
matic, and passes rapidly from one idea to another. 4 P. M.
Was visited by Drs. Barlow and Vagt, in company with my-
self. The conjunctiva was beautifully injected, and the eyes
peculiarly brilliant ; there is much more calmness, and answers
our questions rationally ; headache is greatly diminished the
pills have procured three bilious operations. Treatment, as
before. After our leaving him, continued to grow worse, and
passed a very restless night, slept none, and was constantly
fighting his brothers, one of whom he bit on the arm. Durino-
the night, he got out of his bed and climbed the logs up to the
joists before they could control him.

328

Preston, on Malignant Spotted Fever. [June,

30th, 10 A. M. All the symptoms had now become greatly
aggravated; const mt jactitation; tries to get out of bed so
that he may work. Typhomania. On t he arms and body
there are several ecchymoses, from the 12th to the \ of an inch
in diameter, their edges jagged and somewhat raised with a
few vesicles. On close examination, a few rose-colored spots
about the size of a duck-shot, smooth and circular, and others
twice or three times as large, resembling a blood-blister. They
were filled with a sen>sanguineous fluid. Blisters to extremi-
ties, cupping on the nape of the neck to one half-pint, anodynes
and diaphoretics, with wine, constituted the remainder of the
treatment. He grew rapidly worse until he died, on the even-
ing of the 31st.

Remarks. During the last two days of his illness, his deliri-
um and restlessness constantly increased, until he completely
exhausted his strength ; and when be no longer possessed
strength to articulate, he muttered incessantly and gradually
passed into a moan, which continued to his last moments. The
blotches, after death, were conspicuous, and in all might have
numbered two hundred or more.

Case II. Marion Young, age 23, five feet six, weight 120
lbs., temperament sanguine, circumstances good, lived five
miles from Case 1st; previous health bad, was a dyspeptic and
invalid; occupation a farmer the brother in-law of case lstr
and waited on him two nights before his death.

April 1st, 10 P.M. Complained of headache, and vomited
bilious matter ; general soreness of muscles and limbs. Did
not think it necessary to obtain medical aid until early the fol-
lowing morning.

April 2d. Died at 11 A. M., without treatment.

No post-mortem allowed. Deceased was covered with pur-
ple blotches and ecchymoses over the whole body, and scarcely
was there a square inch free from them their general diameter
was the } of an inch, some as large as a ten cent piece. From
each nostril a large amount of bloody froth issued there must
have been a pint or more.

Case III. Marion Jenkins, age 32, a farmer, and brother of

1853.] Preston, on Malignant Spotted Fever, 329

case 1st, and wes bitten on the left arm by case 1st, lived four
miles from case 1st.

April 2d. Was slightly indisposed the preceding night, and
greatly alarmed thought his brother might have been poison-
ed, and looked to betaken ill himself; but when so taken, was
not desirous to obtain medical aid. At 3 P. M. the following
symptoms were noticed: Headache; soreness of the limbs and
muscles; body moist wiih sweat, and the hair around the
temples perfectly wet with it; is disposed to sleep, but when
awake his expression indicates alarm, and a close examination
with a view to the reading our thoughts as to the nature of his
disease; at times tries to throw around him an air of careless-
ness, and says, Pshaw! he knows he is not like the others,
and is not going to be very sick. Drs. Barlow, Fish and my-
self, agree upon the following for the night : Infus. senna, I iv\,
Mpjnes. sulph. 3ss., to be taken immediately. Liberal doses
of morphine after the operation of the above, to quiet his fever
and support his strength. 5 P. M. Sweating profuse, over the
head, face and chest large colliquative drops; begins to talk
at random about his wagons and cart wheels, immediately
after the operation of the senna and salts, which took place
within five minutes after they were given, which were bilious
and watery. Every appearance of rapid congestion was set-
ting in with great force Tr. opii. xxx. gtt., and in ten minutes
xxx. more. The fever, which was before violent, and pulse
120 to 130, full, but compressible, sunk to 90. Sweating
diminished, together with the delirium, as it were by a charm,
and prospects brighten. I should have stated that we discov-
ered rose-colored spots upon his chest, arms and thighs, in
number twenty, and one line in diameter: they were well
marked, smooth and circular. On the left elbow there was
one sero-sanguineous blotch larger than a pea, and its surface
distinctly elevated. 9 P. M. Symptoms good, skin a little
moist, and pulse 80 to 90. Tr. opii. gtt. xxx., with a draught
as follows: Infus. senna, 5j. ; senega, 3ss. ; magnes. sulph.,
3j ; zingib. 3ij. to be repeated every four hours.

April 3d, 1 A. M. Continues better; says he feels well,
and wants to sleep. As there was from the first a disposition
to profound sleep, I ordered him to be awaked when he slept

330 Preston, on Malignant Spotted Fever. [June,

too hard. 5 A. M. No change. 9 A. M. Has discovered the
blotches upon himself, and says he knew he had the same dis-
ease, but did not mind, as he knew he should get well. The
blotches were now numerous in all, perhaps, two hundred,
or more. From a fine rose color they had passed to a muddy
brown, and some of them looked as though he had been severe-
ly pinched were much darker, and towards the depending
margin about \ was sero-sanguinous, with a cuticle resembling
a blister: in fact, there were rose-colored, purple and dark,
promiscuously over the whole body at the same time. One
particular circumstance deserves mention : A large consolida-
ted plug of mucus, mixed with blood, was blown from his right
nostril it was 2 inches long, \ wide, and nearly the same in
thickness. 1 P. M. Camphor 5 grains, and tr. opii. gtt. xv.
every four hours. There has been from the beginning great
soreness of muscles and'stiffness of joints ; on the right forearm
there is acute tenderness the moment it is touched, be it never
so tenderly, he cries out ; from the metacarpus to the phalanges
of the fore-finger there is a deep inflamed blush ; the left thigh,
leg and ankle are similarly affected. There is, moreover,
swelling of the glands in his groins.

April 4th, 10 A. M. There has been a febrile exacerbation
the preceding nights, which abated after a mild sweat. There
is now considerable soreness of the whole body, with deep red
blushes on the affected limbs. The blotches have ceased to
increase they are all dark brown or purplish. Pulv. ipecac.
3 gr., camphora. gr. 4, with infusion of senega every six
hours; at night, 2 grs. hyd. sub. m. were added to each of the
above powders.

5th, 7 A. M. The calomel has produced three dark con-
sistent operations, lie now becomes dejected, and is very
solicitous about his recovery. His wife has importuned to give
my opinion, and though several times I have declared almost
positively he will recover, still she is frantic with the loss of
hope. M. J. sees her distress and becomes more cast down.
I endeavor to calm him, whilst he says, " I am worse, and shall
die." " No, your prospects are bright, and you ought not to
suffer yourself thus to be cast down, when your present weak-
ness is produced by the operations, from which you will soon

1853.] Preston, on Malignant Spotted Fever. 331

rally." No, I shall die, and that before night ; you will see it,
and I know I shall." To be taken immediately tr. opii. gtt.
xv. ; sp. am. aromat. gtt. xx. It was rejected in a few minutes.
Again we gave am. aromat. gtt. xx., which produced a burn-
ing sensation, and was therefore discontinued, and instead
thereof a wine-glassful of poor port wine (the best we had).
9 A. M. Is much calmer, and feels better. As he has not been
left alone, without the presence of a medical man, since his
illness, is afraid to be left, as he apprehends some sudden diffi-
culty which may sweep him off: is, therefore, urgent in
entreaties for Dr. Fishand myself to remain until Drs. Barlow
and Vagt return. 4 P. M. Called with Drs. Barlow, sen., and
junior. Is very much improved, and no longer retains the
morning's presentiment. Dover's powders grs. v. with infu-
sion of senega every eight hours.

6th, 10 A. M. The blotches are disappearing, and contin-
ues to improve. Pulv. camphorae, ipecac et opii. every twelve
hours.

7th, 12 M. Has had fever the preceding night; blotches
have nearly disappeared. Took ol. ricini. 1 ss. in the morn-
ing it griped severely. Ordered tr. opii. gtt. xv. et infusion
senega every twelve hours. The inflamed places are nearly
gone, and he lies with more comfort. Soreness up to this time
has been too troublesome to admit his lying long in one posi-
tion.

9th. Blotches gone ; speaks of going home next morning,
which was allowed, owing to peculiar circumstances.

Remarks. In case 1st, the urine was very abundant until
the last two days: it was slightly albuminous towards the lat-
ter part almost entirely suppressed, it did not exceed one
tablespoonful, and was highly colored.

In case 3d, the urine was abundant and slightly albuminous:
on the fifth morning was scanty, and when boiled was brown-
ish and muddy. Calomel was administered at two different
times first by Dr. Barlow, and next by myself. Although it
mifjlit have done good, I believe it interfered with the critical
sweats, and, therefore, prolonged the febrile exacerbations.

Case IV. William Gaskins, age 30, five feet ten ; of a san-

332 Preston, on Malignant Spotted Fever. [June,

guine nervous temperament ; possessed a feeble constitution ;
was crippled by extensive diffuse cellular inflammation, pro-
duced by a wound in the knee.

April 2d. Had nursed case 1st, and stayed up all night with
case 3d was extremely devoted in attention to (he latter.
At 9 A. M. the following day, I was told Wm. Gaskins was
afraid he had been sitting up with a case of malignant small-
pox, and if so, he was certain he should take it and die. He
soon after presented himself to Dr. B. and myself, upon which
the following dialogue ensued : " William, you are not afraid,
are you?" "Yes, to tell the truth, I am ;" at the time tremb-
ling and very pale. "What are you afraid of?" "The small-
pox they say it is the small-pox which killed R. J. and M. S.,
and I believe it is." Finding whatever we said to the contrary
unavailing, we persisted no longer, but gave him tr. opii. gtt.
xv., and a dose of senna, senega and salts.

April 3d. Was visited by Dr. Barlow and myself. 6 P.M.
Eyes very red and muddy ; face deeply flushed ; but one
rose-colored spot upon the gastric region ; pulse 120, full and
compressible; complains of severe pain in the head; gentle
moisture over the body. A pint of bilious matter is vomited,
and no relief follows. Thirst urgent and unassuageable. Or-
dered senna, salts and ginger, every two hours, until free pur-
gation ensued, and thereafter morph. sulph. gr. i, with sp. aeth.
nit. every six hours.

4th, 12 M. Was found by Dr. Barlow almost pulseless;
features deeply altered, and extremities icy cold. There
were deep purple blotches over the whole, with intervening
spaces about half an inch in diameter. Wine and other
stimulants were freely given, until Dr. Fish and myself saw
him at IIP. M. He was then pulseless, rational, and the
extremities flexed ; the ringers drawn in permanently upon the
palms ot the hands; conjunctiva dry and puckered. Ordered
sp. am. aromat. gtt. xl. in warm wine every fifteen minutes;
sinapisms to spine, &c.

Case V. April 3d. A stout negro man, belonging to Rev.
Jasper Hayne, age 22, possessing previously fine health, lived
five miles from the above cases ; had visited M. J. and staid

5853.] Preston, on Malignant Spotted Fever. 333

about the premises an hour after which, went home, and
was seen walking about the yard on Sunday morning. The
same night, on Mrs. Hayne's return, was found lying upon his
back groaning, but speechless and insensible. At 8 P. M. he
died without treatment of any kind.

Autopsy, eighteen hours after death. Owing to very press-
ing circumstances we only examined the thorax and abdomen.
Upon lifting the sternum, the pleura was more than ordinarily
dry; the pericardium was filled with serum ; the right ventri-
cle was filled with dark clotted blood ; the left contained a fluid
but dark blood. On the anterior outer wall of the heart there ,
were a few ecchymoses about the size of a duck-shot. The
lungs were infiltrated with a sero-sanguineous fluid, and upon
squeezing them a bloody froth exuded. The surface was mot-
tled and very much ecchymosed. The cavity contained a pint
and a half, or more, of serum.

Abdomen. The abdominal viscera presented a dry, muddy
and brittle aspect ; the omentum was shrivelled, and the mesen-
tery as if it had been parched. Upon the arch of the colon
there was an ecchymosis the size of a ten cent piece its color
was mahogany. The viscera were otherwise healthy.

Case VI. Mrs. Jenkins, age 62, the mother of case 1 and 3,
had waited on both. The two died, and the third was taken
ill at the house. Her health was previously good.

April 9th, 9 A. M. Vomiting ; pain in the head, and general
soreness of the whole body. 12 M. Was seen, and declared
she should die: therefore, wanted nothing further than to make
her die easy. At 6 P. M. she was a corpse. There were no
blotches upon her body; countenance natural after death.

Case VII. Olivia, an orphan girl, age 14; previous health
good ; lived at E. G. Brown's, three-quarters of a mile from
Mrs. Jenkins; had no communication with the above cases,
save Wm. Gaskins, on whom she waited during his illness.

April 9th, 10 A.M. Was taken with vomiting of bilious
matter, and severe pain in her head. Saw her in the following
condition at 7 P.M. Eyes very red and muddy; lips had a
fuliginous coating; was tormented with thirst, which no amount

334 Preston, on Malignant Spotted Fever. [June,

of water could assuage; pulse 130, and rather compressible;
rose-colored spots upon the arms, chest and thighs also
ecchymoses as large as a five and ten cent piece ; at times
delirious. This symptom appeared in all immediately after
vomiting or purging. Cold water to head, and waited two
hours to determine the propriety of bleeding. I had been ad-
vised to bleed, and contrary to my prepossession did so to the
extent of 14 ounces after which she soon complained of cold
feet. J gave her brandy directly after the blood was drawn.
There was no syncope, nor a tendency thereto. To avoid evil
results, I adopted all the necessary precautions, and gave, in
addition to the above, tr. opii. camphorata, 3iij. : applied
sinapisms along the whole spine, and warm bricks to feet.
Within one hour and twenty minutes of venesection she was
a corpse.

Autop ay fifteen hours after death. We were permitted, or
rather implored, to examine but the brain. The pia mater and
arachnoid wrere deeply injected over the whole surface; the.
veins were filled with black blood, and so numerous were
the anastomoses of the arteries of the pia mater and arachnoid
that the surface of the brain appeared of a rusty mahogany
color; the membranes were shrivelled and dry; the ventricles
contained no fluid whatever; the substance of the brain was
very soft, and putrefaction far advanced. The integuments
on the whole posterior surface of the body were of a thick, dark
brown color.

Case VIII. James Brown, son of E. G. Brown, age 15 ; pre-
vious health good : had visited the sick, and was taken ill in
the morning of the 9th, at the same time as Olivia. 11 A. M.
Complained of soreness of muscles and joints, headache and
vomiting. 7 P. M. Pulse 100, full and compressible ; rose-
colored spots over the whole body. Gave the following every
three hours: Sp. am. aromat. gtt. xv. ; ext. belladonna gr. -*-;
pulv. camphorae gr. iii. Sinapisms along the spine. There
being a muddy redness of the eyes, and some thirst, ordered
abstinence from drink, for reasons hereafter to be stated.

11th, 10 A.M. Very much improved ; blotches more abun-
dant and dark colored ; there is great soreness of limbs. Pulv.

1853.] Preston,o7i Malignant Spotted Fever. 335

ipecac, co. gr. v. ; sp. am. aromat. gtt. xv. et ext. belladonna,
every eight hours.

12th, 11 A. M. Still improving, with less fever. Gave
pulv. camphorae gr. iii. every eight hours; mucilage with
ol. ricini. 3j. ; and sp. tereb. gtt. xv. Within a few minutes
two large serous operations. He then complained of headache,
and asked what should be done for it. Ordered, cold cloths to
forehead, and sinapisms to abdomen, with tr. opii. c. 3ss. to
be repeated until the operations ceased. On the next day I
visited him in company with Dr. Bruce, and found him pro-
foundly comatose: deglutition abolished; face swollen and
suffused with a dark red; had had several spasms during the
day, and the left side was drawn towards the right: the body
is covered with dark brown blotches from the size of a small
shot to a five cent piece. He died at 9 A.M. on the 15th.
Throughout his illness, the soreness increased, together with
redness and swelling of the joints.

*
Case IX. Melissa Brown, (sister of the above,) age 5 years,
was taken on the 9th of April, at midnight, and within one half
hour from apparent health, her pulse was vacillating and com-
pressible ; no headache. There were rose-colored blotches
over her arms and thighs. Aromatic sp. of ammonia, together
with camphor and belladonna, were given. The blotches
continued to increase in number, and grew darker, until scarce-
ly an intervening space was left. Quin. sulph. and wine
were given, and a decoction of red oak bark applied over her
body. Beneath the integuments of the neck and armpits there
was a dark suffusion of blood ; the countenance was cadaver-
ous and shrunken ; the pulse fluttering, and the slightest pres-
sure would stop it it required a nice touch to distinguish
the systole from the diastole. All these symptoms continued
to increase up to the morning of the 13th. I then with confi-
dence addressed myself with a determination to rely on tr. opii.
alone, and that in as large quantities as she could bear, be-
lieving that had the others been treated with lull and free doses
more would have been saved. Ordered, tr. opii. gtt. viij., and
in four hours, tr. opii. gtt. x. Immediately after the first dose
all the unpleasant symptoms disappeared, and she continued to

336 Preston, on Malignant Spotted Fever. [June,

steadily improve, with the addition of quin. sulph. gr. ii., and
wine I ss. ter die.

Case X. Mrs Brown, age 36, complained of being chilly
on the evening of the 13th. There were small petechia? upon
her arms they were very dark. She firmly believed she had
the disease, and would die. Gave her morph. sulph.gr. Jj
wine and quin. sulph. the next morning. Chilly and very much
alarmed. There were several dark colored spots upon her
legs those upon her arms had not increased ; some headache.
This lady had lost a mother, brother, brother-in-law, an orphan
girl, and a son, by the same disease. She verily believed she
should follow them. Grief despondency were the circumstan-
ces against her, together with two weeks watching and constant
nursing. A lady of remarkable kindness, and whose solicitude
knew no bounds. I therefore knew that I had an exhausted
nervous system to contend with. Consequently, gave tr. opii.
gtt. Ix. every twelve hours; quin. sulph. gr. iii. and wine every
three hours. There ensued no further difficulty.

Case XI. and XII. Were treated by stimulants and quin.
some days before rose-colored spots appeared. They were
not confined to their beds. I, myself, had undoubtedly rose-
colored spots over my arms, abdomen and thighs. As a pro-
phylactic I trusted to opium, stimulants and quinine, and have
been able to attend to my professional duties without the
slightest inconvenience.

The character of this disease was so new to us, that we were
entirely unprepared to anticipate its rapid progress its mode
of attack varying in almost every case. We were likewise
ignorant of what the next twelve or twenty-four hours would
unfold. Trusting to general principles was at best but a slim
guide. We could not determine a priori; therefore some ex-
tenuation will be allowed a inferiori. We can look through
the past, and see our errors. I can now see that bleeding would
have been pernicious it must have been so. Even cupping,
when the patients would not bear the slightest purgative with-
out a manifest tendency downwards. Stimulants, alone, could

1853.] Preston, on Malignant Spotted Fever. 337

not be relied on ; sinapisms down the spine were beneficial :
and, above all, opium in full and free doses Wherefore?
Whatever may be the poison which operated with so much
power and certainty, its primary effects must have been through
the medium of the blood, directly upon the organic nervous
system. The three great nervous divisions the Motory, Sen-
sory and Respiratory were the last to experience its effects;
but those concerned in (he office of reproduction and depura-
tion were the first to fail. The tissues and capillaries lost their
normal rythm. The desire for fluids was intolerable, and the
more it was indulged, the greater was the thirst. Vomiting
occurred in all the fatal cases, resulting, no doubt, from cere-
bral disturbance. The period of reaction, instead of being
followed by a benign sweat, was terminated by congestion.
The congestion was evidently of two kinds one sanguineous,
and the other serous. I know not whether this distinction has
befcn made by writers: I shall, however, venture upon its
adoption, and account for it accordingly. When the organic
nervous system has lost its tone partially, semi reaction fol-
lows. The capillary system being already weakened, is unable
to bear the tension required for the increased volume of blood r
it is nevertheless injected, and during its passage the tissues
transmit the smaller globules of serum through their walls. A
removal still farther, and the organic nerves cease to supply
elasticity, and we have, together with serum, the red globules
or coloring matter of the blood ; from whence issue infiltration,
especially in the lungs a mechanism of exquisite capillary
formation. The inflammation was asthenic, and that in pro-
portion to the gravity of the disease. Whenever a septic
influence operates upon an individual, the phenomena will be
proportionate to its power and susceptibility.

Permit me, whilst with timidity I call your attention to a
class of diseases, little understood, which sweeps off, annually,,
thousands of our citizens. I do this with a view to elicit from
the profession that information which every Southern practi-
tioner ought to have, and no doubt desires.

For many years, during my first practice, I heard of Bilious
Pneumonia and Typhoid Pneumonia committing great havoc
in certain districts of this State. I must confess I was at a loss

338 Preston, on Malignant Spotted Fever. [June,

to understand how these diseases could kill in the short space
of one or two days. These terms, I find, are used for any vio-
lent disease, either of the brain or lungs. All means generally
proved abortive ; and physicians, skilful in the treatment of
other diseases, were, and are (the majority) totally unprepared
to form a platform on which they might rely for a guide. It is
the prevailing opinion, that each season has its simple type of
disease, and that these types generally follow in regular order,
is granted to some extent. There is a constitutional cycle,
continually changing our atmosphere, producing thereby a
dysentery, amenable to purgatives one year, to tonics another,
and to astringents, alteratives, &c. This is the pregnant source
of Doctors disagreeing. Medicine is a science a pure sci-
ence ; but vastly more complex than all others. When we
look through the lists of our venerable fathers' times, ought we
to throw all their learning aside, and lay their experience upon
the shelf. Through their records we learn the ever-varying
faith in remedies. For a season, one drug has proved unvary-
ing in its remedial qualities it has borne the title of specific*
and bothered to gainsay. Anon, it falls into other hands, and
times, and is found useless aye, inert.

We are startled by the conviction that coincidences have
had so much to do in the matter. In the science of Quantity,
men do not vary so widely from the truth. From one to a
thousand start in the demonstration of a mathematical problem,
and arrive at the same conclusion. But place these same men
upon the demonstration of a problem in Quality their conclu-
sions are not alike. Wherefore ? The bases are all different :
Climate the physical qualities of soil moral and hygienic
influences are equally opposite. In the annual and periodic
evolutions of atmospheric and aqueous conditions, no two sea-
sons are precisely alike. At one time we have an easy road
to travel, when referring to authors for our guide in the treat-
ment of disease we are chained by the lucid and exact detail.
But again we are foiled when trusting to the same source.
To illustrate: The exanthemas, especially those commonly
known by the name of measles, scarlatina, &c, have had their
specifics; and well might they, when yielding, from the simpli-
city of their type, to almost any remedy, right or wrong. The

1853.] Preston, on Malignant Spotted Fever. 339

very simplest of all combinations were then prevailing hence
the benign inflammatory action.

We are told in the books, that inflammation is manifested by
certain signs and terminations ; that an incised wound heals
by the first intention, &c. True, so far as they go. But there
is one department which has not been properly investigated
viz., the constitutional combinations, which may convert this
simple inflammation into the more complex varieties. A cause
sufficient to produce inflammation of the viscera in London,
Stockholm, &c., may give rise to the phenomena recognised
in those places ; but when superadded to this, we have an indi-
vidual exposed to the above, with a powerful concentration of
malaria, in a malarious district, and his system saturated with
the latter, it would be marvellous did we recognize the same
symptoms as in the former.

To add force to my deductions, I will here call your mind
to the fact of erysipelas prevailing as an epidemic in the wards
of hospitals. Let us now take an individual who has suffered
the simplest wound in a pure atmosphere, and there allow the
healing process to be partially completed carry him from
thence to the infected ward, and the same wound is converted
into one of a much more serious character: it is erysipelatous.
Again, under analogous circumstances, let us carry a case of
pneumonia into wards where malignant typhus prevails, will
it not become typhoid pneumonia. By a parity of reasoning,
I will now refer you to those seasons when bilious and typhoid
pneumonia, together with asthenic inflammations, prevail. We
are too apt to consider that, upon the general disappearance
of intermittents and remittents, after frost, the malaria which
produced these diseases is also abolished therewith. A know-
ledge of facts will convince us to the contrary, especially when
we are credibly informed by the Swedish physicians that inter-
mittents prevail so high as the latitude of 62 North. Now
it must be evident that our thermometer will stand as highT
and higher, in manv of our winter days, as in the Northern
parts of Sweden. In our locality, a physician of ordinary skill,
and the plainest routine, succeeds in curing every case of pneu-
monia. All that he has to do is to give his patients a little
soup and antimony, and the lucky dogs get well. Step a few

340 Preston, on Malignant Spotted Fever. [June,

miles farther, and your learned Doctor your theorist, is mor-
tified by his signal failures. Can it be possible that, as a gen-
eral rule, antimony, given under precisely similar circumstances
in the same disease, should fail in the hands of the learned in
twenty cases whereas it certainly succeeds in the hands of
the ignorant practitioner in a like number ? Certainly it would
be the greatest absurdity to deem it true. I will, in my mind,
offer you a more rational ground for the discrepancies which
are so constantly witnessed. When the variations in tempera-
ture alternate with great changes from low to high, and that
in a country where intermittents, &c, are endemic, we shall
witness corresponding changes in the type of disease. When
an individual whose system is saturated with a malaria capable
of producing a benign quotidian, tertian, or quartian, or a ma-
lignant quotidian, &c, and he is moreover laboring under the
exciting causes of pneumonia, phrenitis, &c, we shall not wit-
ness phenomena such as result from the above named diseases
separately ; instead thereof, will be found the types blended
together to wit: a congestion, or cerebro-spinal meningitis,
coupled with pneumonia in its simple form. Again, there may
be pneumonia associated with gastritis, or gastro-enteritis,
together with hepatic derangement, giving rise to the common
phraseology complicated pneumonia, congestive pneumonia,
congestive bronchitis. As a proof of this fact, we have only
to treat any of the above forms for simple pneumonia, or the
like, and we very soon find we have to change our course or
give up the ship. Let us now remove the complication, by
setting aside the one which most readily yields to wit : the
intermittent, with quinine, opium, &c, and if thereafter is
found a pneumonia, it will yield to the ordinary remedies when
judiciously administered ; or if you please to let it alone, it will
in many instances get well of itself; but this is trusting too
much to nature, and giving the chance to the umpire of matter.
Again, whenever the malarial influence is so strong as to pros-
trate the organic nervous system, and associated therewith
inflammation of any organ, there will be asthenic inflammation
instead of the sthenic.

Let us now, in another season, have diseases of a typhoid
type associated with a malarial influence they will be respec-
tively still more complex and vastly more rapid.

1853.] Preston, on Malignant Spotted Fever. 341

Shall it be Dysentery, thus characterized, prevailing as an
endemic, or epidemic? How sorely puzzling will be its
forms! how devastating its influence ! !

Have we not seen the Algid typhus in the negro, with his
cold icy body ; and when asked how he is, have we not heard,
and despaired, from the laconic answer "better!" But out-
wardly we behold marasmus, sure and steady as clock work.
Thirst, there is none ; appetite none ; instincts are almost abol-
ished, together with the moral and physical impulses. Pros-
trate he lies upon his back, more careless than incapable of
motion intellect torpid, but when roused, clear. There is
profound apathy, with alternate transitions to the quotidian,
tertian or quartan types. Thus do we see the crises of the 7th,
14th, 21 st and 28th days; and by marking the periods (odd or
even days) when the patients are better or worse, we may
with more certainty base our prognosis.

It has been our lot, within the last three months, to be visited
by that peculiar form of inflammation which has swept off
thirty or more of our citizens, within the space of from three to
forty-eight hours, and that within a radius of seven miles. By
some, the disease was called Typhoid Pneumonia by others,
Bilious Pneumonia. But, in fact, it has been in some an asthe-
nic inflammation of the bronchi and in others, of the lun^s,
brain and pharynx. The sanguine, robust, and plethoric, who
were susceptible of malarial influences, were mainly its vic-
tims. When the disease was of a concentrated form, or fully
developed, purgatives, if not inoperative, were sure to aggra-
vate. Again, a class of apparently the same disease yielded
immediately to the influence of senna, manna and salts. It was
astonishing to see how rapidly the integuments, beneath the
eye and upon one side of the face, would become suffused with
dark coagulated blood. One case I shall briefly notice.

Rogers, a boy, 9 years of age, previously healthy, possess-
ing a fine sanguine temperament was taken in February, at
midnight, with slight indisposition. In the morning, 8 o'clock,
there was still but little ailment was disposed to be drowsy j
face flushed, not much; pulse 90, compressible. Gave senna,
manna and ginger tea, together with quin. sulph. and hyd. sub.
m. When seen next morning all the unpleasant symptoms had

N. S. VOL. IX. NO. VI. 22

342 Preston, on Malignant Spotted Fever. [June,

vanished ; beneath the right eye there was a bruised appear-
ance the size of a dollar- The conjunctiva at first was injected,
but had disappeared.

During the last two or three years there has been typhoid
fever associated with intermittens, and for the last five months
the mortality in our section has vastly increased. Carbuncles
and melanosis have been no strangers.

Now, whatever has been the influence which has produced
so many malignant features, of this one effect we are certain ;
that we have, in many instances, to deal with an intense asthe-
nic inflammation, which speedily terminates in effusion or in
sanguineous infiltration. During the last two months of the
last fall, almost ail of our intermittent^ were double tertians,
and the greater proportion of these were malignants instead
of postponed,, they were anticipated double tertian. In some,
there was a marked semi-reaction, very difficult to determine
in others,, a combination of typhoid and congestive symptoms.
Again, the pure algid and congestive varieties. Now, we
have had nearly all of the above forms in the present spotted
fever.

It would afford me pleasure to continue this subject. Least
I weary your patience, I will briefly allude to the character of
inflammation. ,

There is no doubt that we have been altogether remiss in
our investigations with regard to this disturbing force. Dis-
:urbing, I call it for on the one part, nature may be too ener-
getic in restoring an equilibrium; on the other, she maybe
altogether deficient. In the former, we have the simple benign
plastic qualities of an over excited sanguiferous system, in which
the potent lancet is truly, and beyond all doubt, the omnis omne.
But, in the latter the vis vitse no longer yields the plastic-
lymph* Let us now marshal our forces, as in the above, and
what do we behold: an account soon settled a patient ia
articulo mortis*

1853.]

Rossignol's Statistics of Mortality.

343

ARTICLE XXI.

Statistics of Mortality in Augusta, Georgia, during the years
1848, '49, '50, '51 and 52. Arranged by H. Rossignol, M.D.,
of Augusta.

The following Tables have been made from the books of the
City Sexton, and may be relied upon as to numbers ; but as
relates to ages and the immediate causes of death, I will not
vouch for their correctness, as I noticed some errors in these
respects in looking over the books.

Similar tables having been published in this Journal in the
1st volume (old series), p. 650 the 3d vol. (old series), p. 048,
and the 4th vol. (new series), p. G58, it will be seen that these,
when added to them, will complete the vital Statistics of the
City of Augusta for a period of thirty-five years, and that they
contain valuable information, notwithstanding the inaccuracies
alluded to.

Table No. 1.
Census of Augusta, taken by order of the City Council, October, 1852.

Whites.

Males

2779

Females.

2177

Whites.

Males I Females
between between
Hand lfi 6 and 15

m

,66

Free
Negroes.

Slaves.

Males.

Females.

Total.

243 2330 2388 11,753

Transient or temporary residents white 400

Free Negroes and Slaves, not returned .. 400

Business and Suburb population . .*..,, 1,510

Q

14,072

Table No. 2. Deaths in each year.

In preparing this table, the still-born are included, as it was
deemed unnecessary to make a separate table for thetn.

Year.

Whiter.

Blacks

Total.

1848

i04

120

224

1849

105

109

214

1850

168

147

315

1851

184

133

322

1852

230

1 147.

377

344

Rossignol's Statistics of Mortality.

[June,

Table No. 3.
Deaths in each month the Still-born included.

A

j

^3

<

<

Year.

Month.

DO

CO

o

O

Year.

Month.

Vj

TZ

o

-3 *

H

U

H

H

03

of

m

8

-

S

<

P5

S

<

1848.

Jan.

lojis

j lb51.

fan.

10

13

23

Feb.

4

9!13

Feb.

8

9

17

March,

7

7 14

March,

16

11

27

April,

9

10

19

April,

9

8

17

May,

9

6

15

May,

19

10

29

June,

13

9

22

June,

15

13

28

July,

11

7

18

July,

28

16

39

August,

5

19

24

A ugust,

27

14

11

Sept.

3

6

9

Sept.

19

9

28

October,

14

16

30

October,
Nov.

10

13

23

Nov.

9

13

22

14

12

,'6

Dec.

12

8

20

224

Dec.

14

10

24

322

1849.

Jan.

8

9

17

1852.

Jan.

11

5

16

Feb.

3

9

12

Feb.

10

16

26

March,

6

5

11

March,

lfi

12

28

April,

8

11

19

April,

17

10

27

May,

7

15

22

May,

28

17

45

June,

10

16 26

June,

24

19

43

July,

17

11

28

July,

28

19

17

August,

10

10

20

August,

20

12

32

Sept.

12

7

19

Sept.

10

5

15

October,

10

3

L3

October,

24

9

33

Xov.

8

9

17

Nov.

23

15

38

Dec.

6

4

10

214

Dec.

19

8

27

377

1850.

Jan.

Feb.

March,

April,

May,

June,

July,

August,

Sept.

October,

Nov.

ia

12
10
14
15

19
17
10
6
20
15

7
13
12
13
12
JO

9
10
15
14
12

19
25
22
27
27
39
26
20
21

u

27

Dec.

18

10

88

315

1853.]

Rossignol's Statistics of Mortality.

345

Table No. 4.
Number of deaths in each month, during a period of five
years, with averages deduced from the column of whites, from
that of blacks, and from the total.

Whites.

Blacks.

Total.

White
average.

Black
average.

Total
average.

January,

49

44

93

9.80

8.80

18.60

February,

37

56

93

7.40

6.9S

18.60

March,

55

47

102

11.00

8.14

20.40

April,

57

52

109

11.40

10.40

21.80

May,

78

60

J 33

14.16

12.00

26.16

June,

81

77

153

16.20

15.40

31-60

July,

96

62

158

19.20

12.40

31.60

August,

72

65

137

14.40

13.00

26.14

September,

50

42

92

1000

8.40

18 04

October,

78

55

133

14.16

11.00

30 00

November,

69

61

130

13 80

12 20

26.00

December,

69

40

109

13 80

8.00

21.80

Table No. 5.
Average number of deaths per annum, during five year
among the whites and blacks, at different ages.

Whites.

Blacks.

Still-born,

10.75

Still-born,

50.50

Under 5 years,

66.04

Under

5 years,

55.08

From 5 to 10 years,

81.02

From

5 to 10 years,

50.60

" 10 to 20 "

10.60

u

10 to 20 "

80.40

" 20 to 30 "

18.08

u

20 to 30 "

11.06

" 30 to 40 "

13.02

a

30 to 40 "

61.00

" 40 to 50 "

13.06

a

40 to 50 '

80.20

" 50 to 60 "

60.12

tt

50 to 60 "

40.80

" 60 to 70 "

41.02

a

60 to 70 "

10.20

" 70 to 80 "

30.40

a

70 to 80 "

10.00

Over 80 years,

1.00

Over

80 years,

60.20

It will be observed, in the above table, that a much larger
number of blacks are put down as living beyond SO years, than
whiles. This can easily be accounted for by the well known
fact, that negroes, generaliy, are ignorant of their age, and are
particularly fond of living to a "good old age," which they
affect by adding on as many years as suits their taste.

346

Rossignol's Statistics of Mortality,

[June,

1

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H m H N M

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Gi o Oi rf* rf*.

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tO t-1 CO OD

tO CO JD

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p*

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rffc

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cr

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to 00 t

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1

1853.]

Rossignol's Statistics of Mortality.

347

Table No. 7.
Causes of Death, as recorded by the City Sexton.

Very little, if any reliance, can be placed on this table, as the
Sexton rarely derived his information from those who were
capable of giving it. In making this table it was thought best
to give the names of the diseases as found recorded, without
any attempt at classification, as that would have been an end-
less undertaking.

Whites.

Blacks.

GO

05

o

*

c<*

GO

os

o

o*

^-

^

o

*a

to

"<*

"tf

tO

tO

tO

GC

QD

QD

GO

GO

Gt

oo

CO

GO

GO

Sundries,

2

7

4

14

2

9

7

9

5

8

Casualties,

4

5

4

5

5

3

3

8

6

2

Mortification,

1

1

1

1

Old Age,

3

2

1

1

6

3

6

8

9

Rheumatism,

3

1

1

1

1

2

Diarrhoea,

7'

3

2

3

2

1

2

Brain Fever,

1

1

2

4

1

1

1

Croup,

3

1

3

2

1

2

Dysentery,

5

26

46

1

1

22

25

Cholera Infantum,

4

21

14

5

5

6

14

9

4

Affections of Lungs,

1

1

1

1

1

2

Fever,

4

4

4

2

4

5

2

1

Still-born,

6

4

15

14

8

3

4

4

Small-pox,

1

6

3

Pneumonia,

4

16

15

14

22

11

17

18

15

14

Affections of Liver,

3

1

1

1

Tetanus,

1

1

8

Intemperance,

1

1

o

1

3

2

1

Fits, Spasms & Cramps,

9

3

20

9

14

9

12

17

17

13

Pertussis,

3

1

Inflamed Bowels,

7

3

9

4

-9

3

1

2

2

7

Erysipelas,

1

1

2

2

Cholic,

1

1

2

2

3

2

1

Palsy,

1

1

2

1

1

Worms,

3

1

2

1

2

3

6

2

Dropsy,

4

2

3

3

3

5

11

6

6

9

Measles,

6

2

13

1

2

Typhoid Fever,

3

6

2

15

9

1

6

1

6

6

Child-bed,

1

2

2

4

5

1

1

[Continued on next page.]

348

Rossignol's Statistics of Mortality.

[June,

Table No. 7

, (conclu

ded.

)

Whites.

Blacks.

00

05

c

ci

00

os

o

i-h

e?

TT

rf

iO

iO

iC

TJ

-<*

o

lO

to

00

2

00
1

00

2

6

CO

00

OD

2

00

2

or
1

CD

Apoplexy,

Dropsy of Brain,

2

1

1

Inflammation of Brain,

1

2

3

5

2

5

2

I

Scarlet Fever,

1

34

8

6

10

3

Consumption,

C

8

H

13

15

12

5

3

5

8

Ulcerated Sore Throat,

8

1

13

1

Jaundice,

1

1

Congestive Fever,

5

8

3

3

Congestion of Brain,

7

3

1

2

3

Dropsy of Chest,

1

2

2

1

Hemorrhage,

2

1

2

Cancer,

2

2

1

4

1

2

1

Syphilis,

1

Debility,

2

2

1

3

1

2

2

3

Hernia,

1

Paralysis,

1

1

1

1

2

1

Metritis,

]

3

Disease of Heart,

2

6

2

4

4

Dyspepsia,

1

1

1

Suicide,

2

1

Invag'tion of Bowels,

1

Stricture,

1

Diseases unknown,

5

3

4

10

15

10

3

3

7

8

Disease^ stated,

99

102

104

171

215

110

106

144

131

139

1 Whole No. of Deaths,

104

105

16b

|184

1-230

|120

109

147

|138

147

Table No. 8.
Relative proportion of the Sexes of those who died.

In

1848,

died

(Whites)

Males,

59

cc

1849,

it

a

a

56

II

1850,

i<

ii

it

94

ii

1851,

ii

ii

ii

103

u

1852,

<(

cc

ii

119

In

1848,

died

(Blacks)

Males,

54

(<

1849,

if

a

cc

58

it

1850,

a

(<

cc

78

Ci

1851,

ll

a

cc

74

u

1852,

li

<t

(1

69

nales,

45

ii

49

it

74

cc

81

CI

111

nales,

66

cc

51

II

G9

II

64

II

78

1853.] Ricord's Letters on Syphilis. 349

(Eclectic Department.

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 278.]

TWELFTH LETTER.

My Dear Friend Does there exist any real difference
between the natural and the artificial contagion ? This is the
subject of our conference.

The observation and rigorous analysis of facts demonstrate
to those who do not suffer themselves to be led away either by
prejudice, or by preconceived ideas, that the contagion of
syphilis, under whatever circumstance it may operate, is re-
duced in the final analysis to a process of inoculation more or
less analogous to the process by the lancet. The lancet, in fact,
inoculates the accident (the chancre) which by the confession
of all is the most fatally contagious. It is by this accident, by
the chancre, according to observations well made and collected
in the proper time, that syphilis commences.

Laying aside artificial inoculation, the chancre is seen to
develope itself everywhere upon the surface of the body without
choice of seat, and upon all the external or internal integument,
which is accessible, and by consequence, without there being
need either for the parts which are infected, or for those which
furnish the infecting matter, of special functions or of any par-
ticular physiological condition. Other conditions are neces-
sary for contagion.

Examine with care all the parts which are affected, you will
find that it is those which present the most favorable condi-
tions for mechanical lesions, for scratches, for lacerations, and
for solutions of continuity of every kind ; you will find, also, that
it is there where voluminous and numerous follicles exist into
which the virulent matter can introduce itself, that the accident
is by preference developed.

Is it not true that in the male it is more particularly the
border of the prepuce, especially when there is a phymosis
more or less pronounced, the neighborhood of the frasnum, the
adherent points of the semi-mucous surface of the gland and of
the prepuce, points which not Laving the suppleness of other
regions are more easily torn, that by preference become infec-
ted by the contagion ; in the female the fourchette, the points of
insertion of the nymphae, the carunculae myrtiformes, are the
parts which most easily take on the contagion. In the other re-
gions, is it not true that it is when excoriations exist that the

350 Ricord's Letters on Syphilis. [June,

contagion is established? Thus, an excoriation upon the finger
is often the door where syphilis can enter. But the presence
of an excoriation is absolutely indispensable. If it was other-
wise, should I ever go out of the hospital without having a
chancre at the end of each of mv ten fingers? The chancre
often appears upon the lips, but the lips are almost always
cracked ; pleasure excites the smiles, and smiling extends and
dilates the lips. The nipples of nurses are often the seat of
chancre, but these parts are ordinarily cracked and torn. The
chancre seats itself everywhere w7here there has been a cica-
trice, but there also there is a loss of suppleness, and conse-
quently cracks and lacerations are easy.

In all this, my friend, you see nothing which is, as they say,
physiogical, which exacts special vital conditions, a particular
state of organism and the exercise of any function whatsoever.
All this, for you, as for myself, is reduced to a traumatic and
and mechanical phenomenon.

Practice, that criterion of all doctrines, justifies, alas, too often
my doctrine. Nothing is more common than to see the physi-
ological act of generation rest indemnified from every unhappy
consequence, while other acts which have nothing in them
physiological, draw after them painful results. The genital
organs, the seat so special of syphilitic affections, do not always
take the infection from genital organs. It is not always the
genital act properly called, which becomes the infecting cause.
Coitus does not become an infecting act unless certain material
circumstances come into play. Among the innumerable ex-
amples which I could cite for the support of my opinion, 1 ask
permission to cite to you two, which have struck me more, inas-
much as they presented themselves to me suddenly upon the
same day. There is no physician who does not know that
there are some singular days, when curious facts arrive as if in
series.

A gentleman brought me one day his mistress, whom he had
infected, and in a manner which much astonished him. He had
upon the penis a primary ulcer at the period of specific
progress. He had had normal intercourse with his mistress,
and in the same night intercourse more to be blamed, a prepos-
tera venere. The lawful intercourse had been much more fre-
quent than the other. The woman presented absolutely
nothing suspicious upon the genital organs, but she had a
chancre on the anus. What did this mean? That the physi-
ological and natural passages had yielded without laceration,
and had escaped contagion, while the abnormal passages, more
resisting, were torn and became infected.

Here is another couple. Here, again, is a contest between a

1853.] Ricord's Letters on Syphilis. 351

physiological act, and a prelude which does not belong to the
human species, a prelude which is not at least placed among the
genital functions of man. A gentleman surprised at seeing a
suspicious bud pushing forth upon one of his lips (bud without a
flower, as Jean Lemaire would have called it,) without any
disease of the genital organs, comes to ask me to examine the
woman with whom he had had intercourse. I found upon this
woman a chancre at the specific period, situated in the neigh-
borhood of the meatus urinarius. This gentleman had had
rather frequent sexual intercourse with this woman during the
same night, during which he had gone astray so far as to sadly
expose his lips. It is necessary to add that this gentleman
was very subject to chapped lips, and that all this passed in
winter.

These facts, which I could multiply, prove that the physiolo-
gical conditions of the genital act go for nothing in the conta-
gion of syphilis. Thus the doctrine of physiologism finishes
upon this point by falling to the ground. Be well convinced,
that in spite of the most intimate contact, of the most complete
fusion, and of the orgasm the most voluptuous, with an entire
skin and an irreproachable mucous surface, one can escape safe
and sound from the most exposed intercourse. Be assured on
the contrary, that a portion of skin torn, a mucous surface chafed,
will render the slightest intercourse dangerous, and we physi-
cians have a thousand precautions to take in this respect, and
certainly our examinations are strict. We know, however,
that the medical corps has furnished victims to the martyrology
of syphilis, and that it was in the beneficent exercise of our art
that the unfortunate Hourmann, and Delavacherie of Liege,
found a death tediously frightful.

After what I have just toid you, what can you think of the
pretended physiological inoculation of my colleague M. Vidal,
as regards blennorrhagia ? You know when and how this
latter is really inoculated by the lancet. It is then, and only
then, when it proceeds from a chancre, and it is the rarest
case, as M. Vidal agrees with me. But in other conditions in
which blennorrhagia is produced, is there, physiologically and
pathologically speaking, anything which resembles the conta-
gion of chancre ? Do we even always know, as I have said, till
tried, if the blennorrhagia is always due to a veritable conta-
gion ? And yet this condition of contagion has been considered
as a proof of virulence, as a sort of physiological inoculation,
which the lancet cannot produce. Here M. Baumes it would
seem that the successive contagions of blennorrhagia were his
means of diagnosis, without telling us, nevertheless, how many
times blennorrhagia ought to be produced in order to be

352 Ricord's Letters on Syphilis. [June,

virulent. Thusone tnkes a blennorrhagia, he gives it toanother,
where commences the virulence? M. Baumes does not say.
Suppose that a woman is suspected of having contracted a dis-
charge from a suspicious man if we should wish to assure
ourselves upon the nature of the discharge of this woman, it
would be necessary to hold an inquest, to run after the ditferent
sources of the blennorrhagia of the man, and to pursue it, going
back even to the gonorrhceal flux of the Bible. Yes, hut we
should not have made one step in this inquiry, without finding
ourselves in the presence of that most common difficulty, of two
individuals having had commerce with the same woman, the
one will have contracted a blennorrhagia, and the other not.
For one, we should conclude upon the benignity of the blennorr-
hagia, and for the other upon its virulence. All this is not
serious.

Facts and observation, then, do not indicate any difference,
my friend, between the inoculation called physiological and the
artificial. Let us now invoke analogy.

In every malady incontestably contagious we find that the
traumatic conditions dominate, and that under ordinary circum-
stances art can repeat what nature does. Thus the vaccine
inoculated does not differ from ordinary vaccine. The variola
inoculated does not differ from the spontaneous variola. Thus
with the glanders, the farcy, hydrophobia, malignant pustule,
and hospital gangrene. This argument from analogy appears
to me of incontestable value. Why should the syphilitic virus
alone escape from the common rule ?

But the chancre, it has been said, is not the only contagious
syphilitic accident. There are some secondary syphilitic acci-
dents for which the lancet has not yet discovered the contagium.
Science, in fact, contains a great number of observations which
appear conclusive for a very large number of physicians, and
which leave some doubt in the minds of many others. The
numerous tubercles, or condylomata, are considered by a very
large number of writers upon syphilis as contagious, and by
consequence can be transmitted.

When I have studied this accident by means of inoculation,
considering well all the circumstances which could prevent
error, the experiments have always been negative. However,
other observers have obtained contrary results. I can only
answer for this exception by stating the result of my own ex-
perience.

I inoculated with the pus of numerous tubercles coming from
the neighborhood of the vulva of a young girl of Versailles, who
entertained habitual intercourse with the garrison of the place,
and I obtained a positive result. Much astonished, I examined

1853.] Ricord's Letters on Sypkilis. 353

with more care the surfaces from which I had taken the pus,
and it was then easy for me to recognize that among the nu-
merous tubercles, there existed a chancre still at the period of
specific progress. Then, some new inoculations being made
comparatively with the pus taken upon this ulceration, and with
the matter of the mucous tubercles at a distance, the pus of the
chancre gave ihe characteristic pustule, and the muco-purulent
secretion of the mucous tubercles remained without result.
This experiment appeared to me decisive.

In the observations which have been cited of mucous tuber-
cles which have communicated syphilitic accidents the period
which has passed between the time of observing the patient and
the infecting coitus has not been taken into account. It is
always three weeks, a month, two months or even more after
the contagion, that the patients present themselves to the physi-
cian, so that not only the renl form of the commencement is
wanting, but still it is impossible to determine the true nature
of the accident which has been the source of the contagion.
Some individuals forget, and others do not know, that by a suc-
cession of changes easy to observe, where one takes the pains,
the primitive accident (the chancre) passes in situ from the state
of an organ of virulence to the conditions of a secondary acci-
dent, not furnishing any more specific pus. Where are the
observations of persons seen with mucous tubercles, who have
transmitted the disease to another person which could be
observed the second or third day after the infecting coitus, and
in whom the disease has commenced as we see it commence
after the contagion from a chancre ? Does the disease in this
case commence with the chancre, or with the mucous tubercle?
There is not one single incontestable fact which can answer
this question. The facts, however, do not fail as regards
mucous tubercles. As to myself, I possess very numerous ob-
servations of well-characterized mucous tubercles upon men
and women, which prove that the patients thus affected could
indulge in frequent sexual intercourse without communicating
anything. Among all these facts here is one, my friend, which
will remain deeply impressed in the minds of my readers, as it
has in my own.

A gentleman whom I had attended for a chancre two )ears
before, was about to marry.. Before his marriage he came to
see me again, in order to submit himself to a rigorous examina-
tion. I found him in the best state of health ; he could be
married without any scruples. However, this gentleman, a
very strict man, exacted of me another examination the very
evening of his marriage. I still found him perfectly exempt
from every accident, and I delivered to him my bill of health

354 Ricord's Letters on Syphilis. [June,

as clean as possible. One month after, he sent for me. My
dear doctor, he said, my wife has some large pimples upon her
which troubles her very much. See what it can be. Before
passing into the chamber of the wife, I proceeded to a new ex-
amination of the husband. I found him in as healthy a state as
the day of his nuptials-.

But it was not the same with his wife. I found some conflu-
ent and well-developed mucous tubercles, so as to assure me
that the point of departure of the accidents was anterior to the
marriage.

Convinced that the husband had nothing to do with this sad
affair, and that he could not communicate a disease he did not
have, I said to the wife in a firm and decided tone Madam, you
are diseased, and it is not your husband that has rendered you
so. If I become your confidant, I become also your accom-
plice ; in the contrary case, I shall remain the physician of your
husband. I was not long in obtaining a painful confession,
which gave me the key to this unhappy enigma.

I recount to you this fact because it contains this which is
interesting, viz., that since marriage the husband had not passed
two days without having repeated intercourse with his wife,
and notwithstanding, he had absolutely no disease.

I have not finished with the mucous tubercles; permit me to
return to them in my next letter.

THIRTEENTH LETTER,

My Dear Friend, I return to the mucous tubercle. As 5*011
know, this accident, with many writers upon syphilis, is conta-
gious. Among the proofs invoked for the support of this opin-
ion, we must note that which considers as a result of contagion
the successive development of these mucous tubercles upon
those portions of the skin which are contiguous to those where
the accident first developed itself. Thus, patients are seen
who have these mucous tubercles upon the sides of the scrotum.
Do they develope themselves upon the inner portion of the
thighs contagion ! cry out the partisans of this opinion. If
upon one side of the anus these tubercles gain the opposite
side contagion ! they again cry, and so on. Those of my
brethren who profess this doctrine, and there are among them
some very distinguished ones, forget one little circumstance ;
to hold in consideration the cause which has produced the first
tubercles ; that is to say, the state of the constitutional infection
under which the patient labors, a condition which can cause a
second and a third tubercle to put forth, for they do not a?I
appear at the same time. The consideration of the seat of

1853.] Ricord's Letters on Syphilis. 355

preference of these tubercles cannot in any way aid the doc-
trine of contagion; in fact, if there is a contiguity in the parts
of the skin where these tubercles appear, we must also remark
that the acrid secretions are more active : that the skin, in these
places, has a tendency to the mucous transformation, as in the
neighborhood of the genital organs, of the anus, &c. How can
we explain, moreover, by contagion, the development of these
mucous tubercles from one arm-pit to the other?

I shall remain, then, always' convinced, until proof to the
contrary arrives, that when some have thought to have seen
mucous tubercles contagious, while they have admitted that
they could be primary accidents, they have erred in diagnosis.
I do not think*it useless to call to mind that the chancre, at the
period of reparation, often assumes, in granulating, the aspect
of mucous tubercles, that it can undergo sometimes a veritable
metamorphosis, and become in situ a secondary accident, the
physiognomy and the nature of which are those of mucous tu-
bercles. If we have not been witnesses of its commencement,
if we neglect to invoke the testimony of the neighboring glands,
the remains of the margin of the ulcer and the characters of its
base could have been so modified, that the differential diagnosis
would be very difficult to make, especially for inattentive eyes
and for fingers little skilled. Add to this certain particular seats
where the primary accidents are not usually observed, and
where also the transformation of the chancre is more easy, and
more rapid, as upon the lips, upon the tongue, upon the nipples,
and you will see how easy it is to be deceived.

All those veroles, transmitted by kisses more or less lascivious
by the utensils of the table, by pipes, razors, masks, &c. have
no other origin. And how many times have not these circum-
stances been honest pretexts for dissimulating other contracts f
The mask, moreover, has been from all time, and in our day
still a very convenient article for dissimulating a compromising
diagnosis.

Even in certain religious practices, my friend, they have
sought proofs of secondary contagion ; thus they have arranged
in this category the syphilitic accidents transmitted to infants
by the process of the Hebrew circumcision. But these acci-
dents find their natural explanation in the presence of the pri-
mary accidents in the mouth of the circumcisers. Let me
here be permitted to say that I am one of those wrho have most
contributed to cause the ancient and dangerous practice of the
suction to be rejected by the Israelite Consistoire of Paris.

Many physicians will not absolutely take into consideration
the facility with which the chancre passes into the secondary
state ; they occupy themselves only with its seat ; and when

356 Ricord's Letters on Syphilis. [June,

they see a chancre in the mouth, they are induced to consider
it, from this fact alone, as a secondary accident. Herein lies a
grave error of observation ; this gives me occasion to say that
the primary ulcers become much more frequent in the mouth
than in the anus. I meet with these last much less frequently,
both in the hospital and in the city, than formerly. It appears
to me that certain shameful practices diminish in frequency,
and that there is progress in ihis respect in the public morality.
However it may be, from the fact alone that a chancre is seated
in the mouth, don't conclude that it is a secondary ulcer. Do
not forget the famous genito-labial nerve invented by Voltaire,
a spiritual pleasantry which must be sometimes considered as
serious. I know a very distinguished brother physician, who
lias always remained convinced without other proof, that an
ulcer of the cheek had been communicated to him by a seconda-
ry kiss.

If I have told you that I have often seen persons affected
with different varieties of mucous tubercles upon the genital
organs, who transmitted nothing in their sexual intercourse, I
ought to tell you. also, that I have seen an equally large number
with numerous tubercles upon the lips, upon the tongue, and
upon the throat, who lived in family and who practised all the
buccal contracts permitted, without ever transmitting anything.
I know a gentleman of the neighboihood of Paris who had
during six months, numerous tubercles upon the tongue and
upon the lips, who has had with his mistress all possible inter-
course, very negligent about his treatment, and who, convinced
that the accidents which he had could not be contagious, has
continued his intercourse without ever communicating any-
thing.

It is, moreover, as regards the transmissibility of these se-
condary accidents from the nurse to the child, and viceversd,
that this question becomes important. The fact of this trans-
missibility is generally admitted. Hunter has, however, denied
it, and many serious observers partake of the opinion of Hunter.
This question is so important that you should permit me to give
it some development. It concerns public hygiene. It is often
a question of legal medicine; fraud, infidelity, cupidity, can be
brought into action: it is important, then, to guard against all
the causes of error, and not to accept with readiness the stories
of individuals who could have more or less interest in deceiv-
ing us.

If one consults the archives of science, if one searches for
the basis upon which the opinion of the contagion of secondary
accidents of syphilis from the nurse to the child, and recipro-
cally, rests, he is astonished at the little value of facts, and how

1853.] Ricord's Letters on Syphilis. 357

manv grave men there are who are content with liitle. M.
Bouehert, for example, in a memoir reeentl)' published (Gazette
Medicale, 20 Avril, 1850.) has collected all the facts which
have appeared to him the most positive. Well ! read this hook,
interesting in other respects, and you will he convinced, like
myself, that the greater part of these facts are not admissible,
that the observations which appear the most probable are
wanting in essential details, and are so incomplete that M.
Bouehert is himself' forced to confess it, to such a degree that he
finishes by allowing that his conviction upon this point is more
moral than scientific.

Here is what I myself have observed in this matter.

I have seen nurses and infants infected, who have been mu-
tually accused of this infection ; most generally I have succeed-
ed in rinding the point of departure, regular and inevitable,
going back to a primary accident in one or the other. Some-
times I have met with merely simple coincidences. In those
cases where it has not been possible for me to go back to the
primary cause. I arrive too late; the children were not present-
ed to me till five and six months or more after their being put
to nurse. I have had, during several years, a ward of nurses at
the Hospital du Midi. In this ward, I had often women affected
with simple leucorrhcea, to whom I gave to nurse children sent
to me from the Maternite, infected with secondary accidents,
and never under my observation were these women infected.

On the other hand, nurses affected with very manifest secon-
dary accidents have given the breast to infants sent to me as
infected with syphilis, these latter having in reality nothing but
simple eczematous, impeteginous eruptions, or species of porri-
go, and never under my observation were these infants infect-
ed. My learned and industrious friend, Dr. Nonat, charged
during a long time with the care of the nurses dependent upon
the administration of hospitals, has arrived at the same results,
and does not believe in the contagion of secondary accidents
from nurses to children, and vice versa.

In my private practice I have seen a great number of facts
of this kind. Here is one of the most remarkable, which I
observed together with my friend Dr. Chailly-Honore. The
subject of it was an infant born with hereditarv syphilis, and in
whom six weeks alter birth, various accidents made their ap-
pearance, such as mucous tubercles of the ano-genital regions,
humid scaly papulae upon the trunk and upon the limbs, deep
ulcerations upon the lower lip. This infant was given to a
nurse upon the spot at the moment of its birth. We were able,
both M. Chaill v and myself, to observe the child as well as the
nurse, during the eighteen months that the nursing continued.

n. s. VOL. IX. no. vi. 23

358 Ricord's Letters on Syphilis. [June,

The ulceration of the lip persisted during more than three
months. This was scarcely cured, when in spite of a careful
methodical and continued treatment, a new ulceration manifest-
ed itself upon the velum palati, and resisted also during several
months. Well, this nurse remained free from all infection ; she
enjoyed and enjoys still the most perfect health.

Surely, this is a fact well worthy of attention. I have just
observed an analogous one, with my friend M. Bassereau. A
child who, with other symptoms of hereditary syphilis, had
ulcerations upon the lips, was nursed with entire impunity by
its nurse.

You see my friend, how important it is, in the appreciation of
similar facts, to hold in consideration all the conditions in which
the nurse and child could be, if one did not wish to deceive or
to be deceived.

The nurse, at the moment when she takes an infant, might
be under the influence of a syphilitic diathesis which nothing
yet indicates. 1 ought to say that in general when one takes
a nurse, she is not submitted to a complete and absolute exam-
ination. I add that even when this is done, we could still be
deceived, for the diathesis cguld exist when every trace of prim-
itive or secondary accident had disappeared, especially in such
a case as chancre upon the neck of the uterus. I ought still to-
add that the health of the foster-father is not always, alas! a
sufficient guarantee. I have known for a long time how I
should consider the pastoral maxims upon the pure manners of
the country.

The child might be born with hereditary syphilis ; child and
nurse have nothing as yet apparent ; but in some weeks or
months we shall see secondary symptoms manifest themselves.
These might appear in the infant before, during or after a similar
manifestation in the nurse. So- that the first in whom the man-
ifestation shall take place, will accuse the other, if they do not
both accuse each other at the same time, which frequently
occurs. They are both wrong. There is a simultaneousness,
a coincidence, and with attention and patience we shall succeed
in discovering the truth.

It happens sometimes that nurses contract syphilis during
nursing:, and the contagion can have its influence upon them
through different regions. Most frequently it is by the genital
organs. This fact is not uncommon for nurses who come fre-
quently to Paris. Under these conditions the nurses infect their
infants by the aid of their fingers contaminated by the virus.
Thev infect even their husbands, and in these cases the cause
of the evil is always referred to the Parisian child to those
rotten children, as these unchaste nurses are in the habit of

1853.] RicoroVs Letters on Syphilis. 359

saying. It happens very often to M. Cullerier and myself to
make our observations simultaneously in our two hospitals ; he
attends the woman at the Lourcine, and I attend the husband
at the Hospital du Midi. These poor rustic husbands besides
have an extreme candor upon the origin of their verole. The
infant is invariably for them the origin of all the evil.

A mode of contagion quite common with nurses is the inoc-
ulation of the virus which they themselves convey to the nipple.
Affected with a genital chancre, they cany their fingers to the
diseased parts, they soil them, and then, without previous wash-
ing, they draw upon the nipple, more or less irritated, and thus
implant a chancre, which they do not fail to transmit to the
child. The position of these mammary chancres, of which I
have recently seen a very beautiful example in the wards of M.
Cullerier at the Lourcine, is very well explained by the man-
ner in which the women take the breast to give it to the infant.
I have caused another very beautiful example to be designed in
the clinique iconographique (19e Irvraison.)

Here is another means of contagion in nurses. I have met
with one in whom a chancre had been communicated to the
breast by an individual affected with a primitive chancre upon
the lip, and who thought that he should render a good service
to this woman in drawing off the milk by suction. Very recent-
ly there was a young man in my hospital having a primary ulcer
upon the mamma, with numerous and indolent swellings of the
axillary glands, which were followed at the end of six weeks
with an enlargement of the posterior cervical glands, and with
a confluent roseola. This young man had been contaminated
by his mistress, who, with a chancre*upon the lips, had lavished
upon him some eccentric kisses.

Another mechanism. I have seen a nurse come to Paris to
claim indemnity for a syphilis, which she said she had taken
from the infant which she nursed. This woman had an indu-
rated chancre upon the inner side of each mamma ; these chan-
cres were placed opposite to each other. As to the child, rotten,
according to the nurse, it was simply suffering under a porrigo
larvalis of the most common description. The parents, who
were perfectly healthy, little satisfied with the accusation, and
especially with the demand, resisted the pretentions of the
nurse, from whom I obtained a complete avowal. A man irho
wasnot her husband, in the fear of begetting a child and alter-
ing her milk, had given himself up to acts upon her, which the
pen refuses to trace.

An infant can contract chancre at the time of birth, if the
mother is so affected at the period of parturition. This is
without doubt rare, but it is not impossible. These chancres

360 Ricord's Letters on Syphilis. [June,

which are very often apt to be confounded with secondary acci-
dents on account of their varied and unaccustomed seats, con-
stitute, as we can easily conceive, focuses of infection for the
nurses, and are afterwards offered as proofs of the possible con-
tagion of secondary accidents. What again apparently comes
to the aid of this manner of viewing things, is that in endeavor-
ing to go back to the source from which the infant could have
been contaminated, in the case where we arrive too late, we
can find nothing upon the mother, the primary accidents which
she had at the moment of the parturition having had time to
become cicatrised without leaving any traces. Then if the
legal father has in his recollection the remembrance of any
blennorrhagia in his early youth, everything is laid to the
charge of heritage. But what can we say, when we do not
find anything and have no confessions?

Infants at nurse can be infected by strangers, whom we do
not suspect. They might afterwards infect their nurses, and
before these latter could perceive the disease of their infant, and
especially before they could recognize the nature of it, and ac-
count for what they themselves experience, the secondary
accidents so prompt to develope themselves in young infants
could have already appeared, and masked the point of depart-
ure in a manner to render it not easily recognized. I remem-
ber a remarkable case in this respect, for which my learned
brother and friend, M. Richet, Surgeon at the Hospital de
Lourcine, consulted me a few years ago. It was concerning
a little daughter of a lawyer of Paris, still entrusted to the care
of her nurse, and who was affected with syphilitic ulcerations
upon the ano genital regions. The parents being perfectly
healthy, and the nurse absolutely in a healthy state, although she
might have been suspected, the question arose from whence
could come the contagion, when we learned that a clerk in the
house, at that time diseased, had the habit of seating this child
naked upon his hands, often soiled, and which he had not al-
ways taken care to wash. Without this discovery, how would
they have explained the disease of this little child, and who
would they have accused if the nurse had presented any trace
or suspicion of syphilis?

In ali these cases, with habit and perseverance we can suc-
ceed in discovering the source of the accidents. But it is not
always so. The mother of the child is perfectly healthy; the
husband of [he mother is irreproachable ; the nurse is free from
all suspicion; and yet the child becomes diseased with syphilis.
Here, where is the contagion ? Permit me to cite to you a
fact which could serve as an answer to this delicate question.

A young woman, accompanied witn her husband much older

1853.] The Speculwn as a means of Diagnosis. 361

came to consult me for her child which she had just taken from
the nurse, and which was infected with a constitutional syphilis
which she accused the nurse of having communica'ed to it.
The child was almost entirely covered with a moist scaly syph-
ilitic eruption; the region about the anus and the labia was
the seat of ulcerated mucous tubercles. The child was six
months old, and according to the nurse it was at the etui of six
weeks that the first accidents showed themselves. However,
the mother and the husband affirm to me that they never under-
went any contagion, and by a most careful examination, in fact,
I could discover nothing either past or present. The nurse,
examined in her turn, appeared to me perfectly healthy. Her
own child, which she nursed at the same time as the sick infant
was in excellent health. I was much embarrassed in the re-
search for the origin of the syphilis of this child, when I received
the next day the visit of a young cavalry officer, who came to
consult me for a syphilitic plantar and palmar eruption with
which fie was affected. This officer interrogated me with a
touching solicitude upon the disease of the child which had been
presented to me the day before, and he made me a confidant in
the part which concerned him in this question; but as he did
not know the laws of transmission, he was surprised to have
begot a diseased child, inasmuch, said he, as he thought himself
cured, and that he had no symptoms of the disease when he had
connection with the lady, who in fact had not been diseased.

After all that I have told you, my friend, you see how much
reserve, prudence, care and attention are necessary, before ac-
cepting as a demonstrated fact the contagion of secondary
accidents. Do you not think with me, that lor establishing def-
initely this law in syphilography, other facts are necessary than
those at present deposited in the annals of science? [Boston
Med. and Surg. Journal.

The Speculum as a means of Diagnosis.

[We extract the following remarks of Prof. Henry Miller
of Louisville, from his able Report to the Kentucky State
Medical Society. The subject is one of deep interest to the
profession as well as to the community at large :]

"In a paper, on the use of the speculum, read before the
Royal Medical and Chirurgical Society, May 28, 1850 Dr.
Robert Lee makes the assertion, that in the two great classes
of organic diseases of the uterus malignant and non-malig-
nantand in all the displacements of the uterus, he has derived

362 The Speculum as a means of Diagnosis. [June,

little or no aid from the speculum, in their diagnosis and treat-
ment. The writer confesses his unfeigned surprise when this
assertion, by an author of Dr. Lee's standing in the obstetric
department of the profession, first arrested his attention, in
perusing the report of his paper in the London Lancet. In the
discussion which ensued, none of the distinguished gentlemen
present appear to have noticed it or animadverted upon it in
such terms as it deserves. Let us, then, inquire whether the
speculum is indeed superfluous, first, in organic diseases, and
secondly, in displacements of ihe uterus. It will be conceded,
we presume, that inflammation is an organic disease, and that
it is, moreover, the architect of numerous other diseases of the
same class. Now, Dr. Lee virtually affirms that the speculum
is not needed to discover the existence of inflammation of the
cervix uteri, and upon this we join issue with him, being willing
to stake the fortune of the speculum on its trial by a jury of
our peers.

" If the speculum be discarded, we cannot discover inflamma-
tion in this, its favorite lurking-place, except by the symptoms
that accompany it, or by the touch, in the usual mode of exam-
ination. Will the symptoms reveal it? Their uncertainty
and the dimness of the light they shed, are proverbial. There
may be pain or a sense of heat in one of the iliac regions, to-
gether with back-ache and neuralgia of the musculo-cutaneous
nerves of one or both thighs. There may be frequent and
painful micturition or tenesmic irritation of the rectum. The
menstrual function may be deranged, and there may beleucor-
rhoeal discharge. But any or all of these symptoms may be
present, and yet inflammation may not exist, while there may
be inflammation, and few or none of these symptoms be com-
plained of. OF the truth of these remarks no practitioner can
be ignorant, who is much conversant with the diseases of fe-
males, and is familiar with the use of the speculum. The writer
well remembers the case of a lady, the mother of two children,
who miscarried in her third pregnancy, and suffered severely
with her head for more than a year afterwards. She com-
plained of fullness of the head, with more or less pain continu-
al! v, and occasionally with very acute pain. On the part of
the uterine system there was no evidence of any thing amiss,
except that she did not conceive again, and menstruation,
though regular, was scanty, seldom lasting more than a day,
and amounting to a mere show. There was not, at any time,
leucorrhceal discharge, nor did she complain of pelvic pains,
and yet when examined with the speculum, chronic inflamma-
tion, with hypertrophy of the uterine neck, was discovered.
This was cured by the usual treatment : menstruation returned

1853.] The Speculum as a means of Diagnosis. 363

to its healthy type, and the cephalic symptoms gradually aba-
ted.

"Can the touch detect inflammation of the cervix? This
question might be answered by another : could a blind surgeon
detect cutaneous inflammation by the touch? The trnth is
(and every accoucheur well knows it) noneof our senses is more
deceptive than the touch, or more frequently leads to mistakes.
The only discovery which can be made by it, in the matter
under consideration, might be made as well by any other in-
strument as by the finger, viz, the existence of morbid sensi-
bility in the cervix uteri. When the inflamed cervix is pressed
upon the finger, the patient usually winces, and so she would
were it pressed upon by a stick. Morbid sensibility may,
however, exist independently of inflammation, and cannot,
therefore, be regarded as furnishing conclusive evidence in such
an investigation.

"Upon the whole, then, the practitioner who relies on the
symptoms and touch only, for his diagnosis in these cases, can
never know of a surety that inflammation exists : he may sur-
mise it, but cannot possibly have any greater certitude than
could a blind oculist concerning the existence and nature of
inflammation of the eyes.

" Ulceration belongs also to the class of diseases, in which,
according to Dr. Lee's assertion, little or no aid is to he dei ived
from the speculum, howbeit he is incredulous as to the occur-
rence of this morbid state, in the female sexual organs, except
to a very limited extent. He says explicitly that he has never
seen ulceration of the os and cervix uteri, which was not of a
specific character, especially scrofulous and cancerous. To
fortify himself in this position, seems to have been the main
object of his paper; for could it be proved that ulceration is a
rare disease in these parts, the speculum might the more readi-
ly be driven from the field. Dr. Lee's clique, who rallied
around him in the debate, felt equally with himself the neces-
sity of expunging ulceration from the list of female sexual
maladies. To accomplish this, they were forced to maintain
that ulceration necessarily involves a palpable loss of substance.
It is readily admitted that, in this sense, ulceration is a rare
form of disease of the os uteri ; we are not sure, indeed, that
we have ever once met with it, nor have we a right to look for
deeply excavated ulcers in such a situation. The mucous mem-
brane alone is commonly implicated, and this is here of such
exceeding tenuity that it cannot be dissected from the subjacent
tissue. The nearest approximation to a dissection, which can
be made by the most skillful anatomist, is to lift it up, in delicate
patches, upon the point of a sharp lancet. Supposing the mem-

364 The Speculum as a means of Diagnosis. [June,

brane to be destroyed, in its whole thickness, by the ulcerative
process, there would not, therefore, be palpable loss of sub-
stance or any thing like an ordinary ulcer upon the skin, or
even upon the mucous membrane of the intestines. But there
is, nevertheless, what fulfills the definition of ulceration, namely,
a solution of continuity, in a soft part, accompanied by a puru-
lent discharge, for it may be brought to light by the speculum,
and when wiped with a sponge, a raw and often a bleeding sur-
face is exposed. What matters it, if Dr. Lee and his partisans
choose to call it ' abrasion,' ' excoriation,' or by any other name.
Such a surface, produced by morbid action, were only the
epithelium destroyed, is ulceration ; for there is solution of con-
tinuity and there is purulent secretion.

" Ulceration of the os uteri is usually accompanied by inflam-
mation, and the symptoms to which it gives rise are nearly
the same, only there is more constantly purulent leucorrhea.
But this discharge does not always attend it; for the secretion
may be so slight as to be absorbed, and there may be purulent
discharge without ulceration. Ulceration cannot, therefore, be
predicated of any case from the symptoms only. It may be
discovered by the touch, when the roughness of the affected
surface is well marked, but in the very great majority of instan-
ces, nothing can be positively affirmed until the parts are
brought under ocular inspection. Of this, every day's experi-
ence convinces the writer more and more firml>. While
inditing this report, he had occasion to examine a lady,
from a distance, whom one of the most distinguished surgeons
in this country, after examination by the touch alone, pro-
nounced to be laboring under displacement of the womb, the
organ being, as he assuied her, perfectly free from disease: the
writer was soon satisfied, by a specular, as well as tactual ex-
amination, that there was chronic ulceration of the os uteri,
but no displacement of any kind !

"The committee will next attempt to estimate the claims of
the speculum, as a means of diagnosis, in displacement of the
uterus, the oiher class of cases, in which Dr. Lee says it is of
no value. None of these displacements is clearly indicated by
the symptoms alone, except retroversio uteri occurring in the
pregnant state, in which the sudden and total suppression of
urine, together with the severe sufferings of the patient, points
plainly enough to its existence. But in the non-gravid state,
neither retroversion, nor anteversion, nor prolapsus, (the most
common of all the displacements.) is accompanied by such
symptoms as throw any satisfactory light on the subject. To
the touch, at least, an appeal must be made, and through it we
may learn that the organ is displaced, and the manner of its

1853.] The Speculum as a means of Diagnosis. 305

displacement; but we cannot learn its pathological condition, a
capital hiatus in the information we are in quest of; lor the
speculum has taught us the frequent, nay, the almost constant
co-existence of inflammation or ulceration of the cervix uteri.
So true is this, that the writer can conscientiously declare that,
since he has used the speculum freely in his practice, he has
seldom seen an instance of prolapsus or retroversio uteri, un-
complicated with inflammation or ulceration of the cervix ; and
he is becoming more and more skeptical as to the existence of
simple displacement of the uterus. His own view of the pa-
thology of such cases, is that inflammation is the primary and
essential disease, while the displacement is merely a sequence.
Such is the doctrine advocated by Dr. James Henry Bennet,
in his valuable practical work on 'Inflammation of the Uterus,'
who attempts to explain the occurrence of prolapsus on the
principle of the increased gravity of the uterus, acquired by
inflammation. Dr. Meigs rejects the .doctrine, and thinks he
has most triumphantly refuted it by showing, as we think he
has very conclusively, the insufficiency of the explanation.
(Females and their Diseases, p. 137.)

"But it does not seem to have occurred to Dr. Meigs that
the doctrine may be true, while the explanation may be false.
Grant the existence of inflammation of the cervix as the ante-
cedent, and it may be that the irritation, established in the part
and propagated to the neck of the bladder and to the rectum,
will eventually cause prolapsus by the bearing down efforts
which it provokes, and this, we suspect, is the true etiology.

"Be this as it may, and whether inflammation is the antece-
dent or the consequent of the prolapsus, the writer reaffirms,
without the fear of successful contradiction, that inflammation
or ulceration exists in nearly every case of displacement of the
womb, and that it can be detected only by the speculum.

"But Dr. Lee, as we have seen, not only renounces the
speculum in the diagnosis, but also in the treatment of ihe whole
class of diseases we have been considering. It is difficult to
imagine the grounds of this renunciation. Can it be that the
treatment of these diseases, by other means, has been so suc-
cessful in his hands as to preclude the hope of improvement?
If so, we sincerely congratulate him on his good fortune, in a
field where all other practitioners, from time immemorial, have
met with little else than discomfiture. For our own part, we
are not ashamed to confess that, until we called the speculum
to our aid, we were defeated on every hand, or, at best, victory
so seldom perched upon our standard, that we were bound to
regard our success as fortuitous, rather than merited. We
never cured a case of prolapsus by the pessary, or of long-

366 The Speculum as a means of Diagnosis. [June,

standing leucorrhcea, connected with inflammatory or ulcera-
tive disease of the cervix, by constitutional treatment and the
ordinary local appliances.

" Such filibustering may succeed in recent and trivial cases,
but when the disease is more strongly intrenched, it can only
be dislodged by a superior force operating directly and sys-
tematically upon it.

" These uterine affections are essentially local in their nature :
they owe their origin to local causes, and are most successfully
treated by local remedies. But the remedies must be suffi-
ciently potent to make an impression upon the disease. The
sprinkling of an inflamed or ulcerated os uteri, with simple or
medicated water, by means of a syringe (the only local reme-
dies resorted to by the filibusters) cannot be more efficacious
than such piddling ablutions upon other parts of the body.
What would be thought of a surgeon who should attempt to
cure an external chronic inflammation by squirting a little wa-
ter or solution of lead or zinc upon it, two or three times a day ?

"The more potent remedies which are addressed to the af-
fected part through the speculum are, chiefly the local abstrac-
tion of blood by scarrification or leeching, and superficial or
deep cauterization, according to the circumstances of the case.
It is not the design of the writer to enter into details on this
part of the subject; he begs to refer the Society to practical
works, particularly to Dr. Bennet's treatise, already alluded to.
He will, nevertheless, submit a few annotations, suggested by
his own experience in this branch of practice, which has been
pretty extensive.

"First Local depletion may be effected as well by scarifi-
cation as by leeching, when the inflammatory congestion occu-
pies the superfices of the os uteri, and ought to be preferred,
because it may be done more expeditiously, and is far less re-
volting to the patient. When the inflammation is deep-seated,
and there is little or no discoloration upon the surface, leeches
should be employed, and half a dozen are commonly sufficient
to procure as free bleeding as is desirable. Local bloodletting
is a valuable part of the treatment of these cases, and ought
always to be premised, whenever there is any considerable de-
gree of inflammation. It is a good preparation for cauterization,
and may be advantageously repeated, in conjunction with cau-
terization, until the inflammatory congestion is subdued.

"Secondly. With the same view, cold mucilaginous injec-
tions infusion of flaxseed or slippery elm should be thrown
into the vagina, by the patient, three times a day. But these
will accomplish nothing unless a good syringe is provided, and
the patient properly instructed in its use. The injections should

1853.] The Speculum as a means of Diagnosis. 367

be taken in a recumbent posture ; the syringe ought to hold
several ounces and have a pipe, with a bulbous end, long enough
to reach the superior portion of the vagina.

" Thirdly. When the inflammation or ulceration is confined
to the mucous membrane, with only slight enlargement, and
no induration of the cervix, cauterization with the nitrate of
silver in substance, is the only application which will be found
necessary in most cases. This ought not to be repeated too
frequently an error, which the writer has reason to believe,
is committed by some not oftener than once a week. Six or
eight of these hebdominal cauterizations may suffice to cure
the disease; but in some c;ises, a longer perseverance may be
necessary, and in a few. the inflammation may prove altogether
refractory. In such instances, the writer's practice is to cau-
terize once superficially with the potassa cum calce, and after-
ward, with nitrate of silver as at first.

"Fourthly. Should the inflammation have extended to the
proper tissue of the cervix, and resulted in induration, deep
cauterization with the potassa cum calce will be indispensable
to restore the part to its normal state, and heal any ulceration
which may exist. It is quite useless to treat such a condition
with the nitrate of silver ; the ulceration will seldom be cured
by it, and it can make no impression upon the deeper-seated
disease. The writer has practiced deep cauterization, in many
cases ; in several, he has used the actual cautery, and he has
never known any serious accidents to follow. He is always
careful, however, to apply the caustic through a tubular spec-
ulum, and to sponge off the part, so as to guard against any of
the caustic remaining and spreading to the sound parts, alter
the withdrawal of the speculum. With this precaution, he
considers it to be as safe to apply caustic to the cervix uteri as
to the skin. Much obloquy has been cast upon the speculum
on account of alledged abuses of cauterization, and the writer
doubts not that there is some foundation for it; for he can
easily conceive that the careless or inexpert use of such a po-
tent agent, may produce extensive inflammation and sloughing,
followed by unnatural adhesions and contraction of the genital
passage. But such consequences are attributable to the awk-
wardness or ignorance of the operator, and are no more
chargeable to the speculum than is the transfixion of the vein
in phlebotomy to the lancet. The writer can truly say that
no such consequences have ever happened to him or need hap-
pen to any one, fit to be trusted with the speculum.

" Fifthly. Rest in a recumbent posture, more or less strict-
ly guarded, according to the degree of inflammatory action
that exists, is a material adjuvant in the treatment of these

368 The Speculum as a means of Diagnosis. [June,

cases : and where this cannot be enforced, the disease is greatly
prelonged, and may prove altogether ungovernable.

" Exercise, or even the erect or semi-erect position tends in
a direct manner, to increase the uterine congestion and aggra-
vate the sufferings of the patient. The writer cannot doubt,
from what he has seen, that much mischief is often done by
urging the patient to take exercise, under the fallacious idea
that weakness is the sum total of her ailments, and that if she
can only be strengthened by air and erercise, all will be well
with her.

" So strongly is the imagination of some physicians haunted
with the bugbear, weakness, that they will persist in keeping the
patient in motion, notwithstanding that every step is a dagger
to her. When shall more rational views obtain currency in the
profession? How long shall a mere effect engross the atten-
tion, while the cause is overlooked ?

"The writer was recently consulted in the case of a lady,
who suffered greatly from pelvic pains after her second con-
finement, increased by exercise or the erect position. She had
hemorrhagic discharges from the uterus for several weeks
after parturition, with almost daily febrile excitement, intense
thirst, loss of appetite, and general debility. The debility
unfortunately, absorbed the attention of her medical attendant,
and to remedy this, exercise in a carriage was commenced on
the eleventh day after her accouchment, and persisted in daily
in spite of her remonstrances, extorted by the increase of her
suffering, and finally, she was sent away on an excursion in
pursuit of the ignis fatuus, ' strength.' When she returned
home, a specular examination was made, and a high degree of
inflammatory engorgement of the uterine neck and upper por-
tion of the vagina, with ulceration around the os, was discover-
ed, which had existed doubtless since her delivery.

" Sixthly. Although the local treatment is paramount to
every thing else the state of the general system must not be
overlooked or neglected. If constitutional irritation exist, it
must be subdued by appropriate remedies, or if any of the func-
tions are sympathetically deranged, ihey must be restored to
a healthy condition by suitable treatment. In recent cases,
some degree of febrile excitement not unfrequently exists, and
to allay this, it may be proper to put the patient upon an abste-
mious regimen, to purge actively every day or every other day,
and if there be hardness as well as acceleration of the pulse,
genera] bloodletting mav be necessary.

'Dr. Dewees was well aware, though he had not the ocular
proof, of the existence of uterine and vaginal inflammation, in
many instances of leucorrhea, which is only another name for

1853.] Intestinal Fistulce. 369

the disease we have been considering, and the success of his
treatment was doubtless attributable to the bleeding and purg-
ing he prescribed, rather than to cantharides, which he regarded
as a kind of specific. This is fairly to be inferred, from the
fact that none of his cotemporaries or successors have been as
fortunate in the use of cantharides as himself, which can be ac-
counted for only by supposing that they have relied principally
upon the specific, to which the multitude are always prone, to
the neglect of due attention to the state of the system. It is not
intended to be asserted that cantharides is devoid of all reme-
dial virtues in these cases. By its action upon a contiguous
and associated viscus, it may exert some beneficial influence
upon the genital organs; nevertheless we are persuaded that
the antiphlogistics, so vigorously employed by Dr. Dewees,
had a larger share in extinguishing the disease than had the
cantharides pushed ever so often usque ad stranguriam.

" Jn more protracted cases, the general state is characterized
by veritable debility, a languid circulation, coldness of the ex-
tremities, and impaired digestion and assimilation. Under such
circumstances, it will be proper to administer tonics, especially
seme of the preparations of iron, and to regulate the secretions
and excretions by the use of alteratives and purgatives. The
selection of these will be governed by the indications of each
particular case. As to purgatives, it is necessary to observe
that only such of them are admissible as may be required to
procure one full alvine evacuation daily, to effect which a pill
or two of rhubarb and extract of colocynth, or of rhubarb, aloes
and soap, may be taken every night.

"Mercury, iodine, arsenic and antimony, are among the
most powerful alteratives, and the indications for the use of
remedies of this class may be fulfilled by the various prepara-
tions and combinations of these agents.

"As to sarsaparilla, which is so often prescribed, we do not
know that we have ever obtained any good from it, even
when furnished by the regular apothecary ; while sure we are,
that the quack ish preparations of it, which find their way by
the hogshead into the stomachs of our nostrum-loving popula-
tion, are utterly worthless/'

Report of Two Cases of Intestinal Fistulce. By De Laskie
Miller, M. D., Chicago, III.

CaseI. Visited Johnson, aged about 12 years, January

22nd, 1850, found him with considerable febrile movement,
with severe pain in the right iliac region, increased on pressure,
and continuous, bowels constipated. Directed fomentations to

370 Intestinal Fistulce. [June,

the painful part, and ordered a Cathnrtic, to be followed by a
full dose of Dover Powder. 22rd The Cathartic operated
kindly, removing a large quantity of hardened fasces. His
pulse is 120 in the minute tongue dry pain in the right iliac
region, about the same as yesterday. Some tumefaction cor-
responding to the seat of pain. Continue fomentations, and
prescribed the following: ty Hyd. Prot. Chlor. grs. viij. Pulv.
Doveri 9j. M. Div. Chart No. 4. take one every fourth hour.
24th. Patient much the same as yesterday pulse rather
softer and 110 tumefaction increasing, but circumscribed.
Ordered a laxative, to be followed by Dover Powder, sufficient
to quiet the pain. Applied a blister to the whole extent of the
painful part.

The blister drew well, and discharged freely, the tongue be-
came moist the pain gradually subsided, though tenderness to
pressure remained the swelling increases, without extending
its boundary, which is about five inches in diameter. After
several days, detect fluctuation in the part, there seems to be
great exhaustion of the vital forces, the patient complains of
debility, and a sense of depression. He states that two days
before I visited him, he received an injury at the point affected
by falling upon a billet of wood.

Punctured the swelling, which discharged a large quantity
of foetid gas, and a small quantity ofgrumous blood, mixed with
unhealthy pus the tumefaction immediately subsided, and a
distinct ring marking the boundary of the swelling remained.
Ordered a cataplasm to be applied to the part, and prescribed :
Sulph. Morphia, as occasion required to keep the patient
quiet. February 10th. Three days after the abscess was
punctured, the discharge consisted almost entirely of faeces,
with portions of partly digested food ; no natural evacuation
from the bowels during the last three days. Ordered injections.

The anema produced a slight evacuation from the bowels ;
the patient feels but little pain. Advised a nourishing diet,
and porter. March 15th. The patient improving in strength
the Artificial opening assuming the appearance of a fistulous
orifice, and discharges as last noted. The lower portion of the
bowels have been kept open by the use of injections, alternated
with croton oil. April 15th. The patient so much improved,
as to ride 25 miles, to the residence of his father. The discharge
the same in quality as last noted, but less in quantity. The
orifice is evidently smaller. January. One year after the at-
tack, the patient has perfectly recovered ; the orifice continued
to contract, the discharge becoming less, and finally ceased
altogether.

Case 2. Niles had been sick two weeks, and under treat-

1853.] Intestinal Fistulce. 371

ment for inflammation of the bowels, when I was called to see
him, in consultation, found him with pain in the right iliac
region, which was increased on pressure, had taken Calomel
largely, and been catharticised freely. A blister was applied
over the seat of the pain, and anodynes prescribed. About two
weeks subsequent to this time, 1 was requested to visit him
again, and take charge of the case, he was at this time very
much debilitated ; pain end tenderness in the iliac region same
as before, but found an abscess pointing about two inches to
the right side of the spinous process of the second lumbar ver-
tebra: punctured it, when it discharged freely, pus intermin-
gled with flakes of lymph, poultices were applied to the part,
and tonics prescribed. On the second day after the abscess
was opened, faeces were observed to escape from the orifice,
and occasionally portions of undigested food. About three
weeks subsequent to this, another opening was formed about
two inches internal to the anterior superior spinous process of
the ilium, giving exit to a similar discharge. The opening on
the back now began to contract, and finally closed, about six
weeks after it was formed. After the time the first opening was
made, it was difficult to produce an evacuation per anum. In-
jections were used, alternated with croton oil.

This course was followed for near six months, and the patient
sustained by tonics and a nourishing diet, when the fistulous
opening gradually contracted, occasionally closing for a few
days, then opening for a short time, and discharging as before,
till at the end of eighteen months, when it remained closed, and
the patient regained his usual strength and spirits.

Re?narks. There seems but little doubt, that in the case of
Johnson, the inflammatory action, and consequent ulceration
were induced by the injury received by the fall, the billet of
wood forcing the walls of the abdomen, and coats of the intes-
tine, against the accumulation of hardened faeces, contained
within the Colon at the time producing contusion, and possibly
slight laceration of the coats of the intestine. We see exem-
plified in this case the beautiful provision of natnre, which by-
forming adhesions between the various structures, around the-
injury, prevents the fatal consequences that would ensue, from
the escape of foreign substances into the peritoneum. A point
of practical importance is the propriety of the early openings,,
from the great depression of the vital forces; the inference in
this case was, that the contents of the abscess were producing
serious mischief, which was, manifested upon the escape of the
foetid gas, and the relief which followed.

In the case of Niles. is it not probable that some solid foreign
body had found its way, perhaps, into the appendix vermiformis

372 Creasote in Deafness. [June,

whence it could not dislodge itself, causing the inflammation and
ulceration, and leading to the abscess? None such was discov-
ered in the discharges, although the attention of the parents was
directed to it. But it is easy to understand how it might escape
unobserved in ihe great amount of matter that was constantly
discharging. Not ihe least practical point in these cases is the
use of croton oil, this article fulfilled the indicatives admirably,
it produced a uniform peristaltic action throughout the entire
extent of the intestinal canals, without irritating the internal
oiifice of the fistula, by its bulk. In the management of the
above cases, the reader will notice an apparent disregard of the
opinions of the older physicians, " who, in injuries of the abdo-
men, extending to the intestines, never left anything to nature."
\_North- West Med. and Surg. Journal.

On the employment of Creasote in Deafness. By Dr. Harri-
son Curtis.

One of the principal causes of deafness is the absence of the
secretion of cerumen in consequence of a fault in the action of
the ceruminons glands. Often in my clinics, even when the
deafness has continued for a long time, I have observed that it
has no other cause, and on removing t Fiat, I have caused the
infirmity to disappear. It is very true that to obtain this re-
sult, more or less time is necessary, according to the duration
of the infirmity, and in proportion to the gravity of the first
cause of the inaction of the glands. After having cleansed the
auditory meatus, and re-opened, so to speak, the orifice of the
passage, by removing ihe morbid secretion which obstructs it,
the use of a moderate stimulant is indispensable to reestablish
the normal action of the glands. But before all, it is necessary
to cleanse the auditory meatus, as no remedy can have the least
effect, unless this operation has been well performed. In gen-
eral I employ a preparation composed of half an ounce of beef's
gall and a drachm (un gros) of tincture of castor or tincture of
musk. With it I moisten a piece of cotton, which I place in
the auditory meatus at night, to soften the hardened cerumen.
In the morning I syringe the ear with warm water, to which
may be added an ounce of soap liniment and a little cologne. I
have often substituted with advantage, for the preparation of
beef's gall and tincture of castor, the solution of potass of our
Pharmacopoeia London ?) with the oil of sweet almonds, to dis-
solve the cerumen.

I would recommend for this operation, to be particular in the
choice of a syringe. When the ear is well cleansed, and the
glands are in such a state that a stimulant can act upon them,

1853.] Bloodletting in Apoplexy. 373

I would advise, in accordance with results which I have obtain-
ed from my clinical experience, the employment of a solution
of creasote in oil of (sweet) almonds, to induce the ceruminous
glands to resume their normal action. The following is the
formula which I employ

$ Creasote - f. 3j.

Oil of sweet almonds f. 3iv. fit. and with a badger's
hair pencil put a small quantity in the auditory passages night
and morning. I ordinarily commence with a solution of this
strength, and augment the quantity of creasote according to
the effects obtained. Cases, however, present themselves, in
which no good result will be obtained from this application
without applying behind the ear a vesicatory of ointment of
tartarized anitmony, or other derivatives. In otorrhcea, and
always when there is pain or inflammation the creasote is con-
traindicated.

Its application causes no pain or unpleasant sensation, but
only an agreeable feeling of warmth. [Lancet.

Is not Blood-letting sometimes dangerous in Apoplexy? By
M. Aussaguel.

This question assuredly merits the attention of every practi-
tioner. M. Aussaguel has collected in his inaugural thesis,
from which we borrow this extract, a number of facts upon
the subject, which demand grave consideration.

"M. Cruveilhier when he lectures upon the treatment of cer-
ebral haemorrhage, never fails to say 'undoubtedly it is neces-
sary to bleed, but be very circumspect,' * * * nd then he
relates candidly, that having been sent for to visit a patient in
the city, whom he found threatened with an apoplectic attack,
he hastened to open a vein ; the wTound was scarcely closed
when the patient was attacked with hemiplegia: and he adds,
'the relatives of the patient did not hesitate to say that it was
mv lancet that had done the mischief.'

"Since then we have read the thesis of M. Cornil : 'A wo-
man,' says he, ' whom I observed last year in M. Rostan's ward,
was occupied with her household duties, when she experienced,
all at once, a loss of power in her left upper and lower extrem-
ity. She with difficulty walked to the house of her physician,
who bled her immediately. After the venesection, she was
unable to rise: she was completely hemiplegic'

"The following instance came under our own observation.
A friend came to us, stammering in such a manner, that he re-

n. s. VOL. IX. NO. vi. 24

374 Bloodletting in Apoplexy. [June,

quired fifteen minutes to make us understand that, the morning
of the same day, upon awakening he was greatly surprised to
find himself in this condition. There was slight loss of power
in the right arm, and its sensibility was diminished. Dr. Bata-
ilhe having been summoned, practised venesection. The next
day the stammering had increased, and the patient was copi-
ously bled a second time. Syncope ensued, and the patient
revived in fifteen minutes in a state of complete hemiplegia.
It is now two years since he was able to utter a word.

"I ask. then, if facts of this kind were numerous, would they
not have a kind of accusing eloquence against the employment
of blood-letting? and when an impartial witness observes their
development, is he not tempted to say, with the relation of M.
Crnveilhier's patient, ' it is the lancet that has done the mischief/

The author afterwards attempts to account for these excep-
tionable cases, and his explanations are not without a certain
value.

"What occurs after blood-letting in certain cases of pneu-
monia? Does not the weak, small, pulse become full, strong,
and well developed? Do we not observe an increase in the
forces of economy, and is it not generally believed that at that
moment another congestive movement toward the lung occurs?
Therefore rt is to combat the results of blood letting by blood-
letting itself, that M. Bouillaud advises repeated venesection;
in other words, the loss of the same quantity of blood is of
greater efficacy when it is abstracted by several operations
than by one.

"Should we wonder if this were true also for the brain?
Why wonder that this organ, enclosed in its unyielding case,
engorged with blood, resists the tendency to haemorrhage for
a time, and then yields to it after venesection, the circulation
becoming at that moment more active? In other words, are
there not two distinct causes operating in the production of
apoplexy; the circulating mass, and the power which propels
it? and does it not seem impossible to diminish the one without
increasing the other ?

"To diminish the first, without increasing the second, such
should be the aim of the practitioner.

"It is with a view to attain this end that we propose that a
vein should never be opened until the head of the patient is
elevated, and cold applications are made to it, and the blood is
invited to the lower extremities by sinapisms or pediluvia, and
the patient has taken some soothing draught, with a few drops
of digitalis.'' [Rev. Med. Chir. de Malgaigne. Virginia Med,
and Surg. Journal.

1853.] Treatment of Goitre by Electro-puncture. 375

Treatmeat of Goitre by Electro-puncture.

M. Jobert, of the Hofel-Dieu, is in the habit of treating goitre
by electro-puncture. The operation is very simple; each of
the conductors being furnished with a long needle, is plunged
into the tumour, and the apparatus then charged. The opera-
tion is not very painful, and may be repeated every day. The
tumour gradually loses its bulk and hardness. M. Jobert has
been successful in many cases, and in some, where this means
is not effective or speedy enough, he injects iodine, which, after
causing some inflammation, has the effect of causing resolution
in the tumour, and curing it effectually. \Gaz. des Hop. Ibid.

Case of Catalepsy, illustrating some new principles of Treat-
ment in Convulsive and Spasmodic Diseases. By Dr. C. B.

R.ADCLIFFE.

William B , set. 12, residing with his parents at Shep-

herd's-bush Bayswater, was seized on the first of February last
with a painless rigidity of his forearms and hands, which fasted
from tea-time, when it first made its appearance, until bed-time.
Similar symptoms also recurred daily for many days, some-
times beginning early in the morning and lasting throughout
the day, at other times merely showing themselves for a few
minutes, while the patient was preparing for bed ; and so thev
continued to do until the 28th, at which time they extended to
the feet and legs, and in less degree to the upper arms, thighs
and trunk, consciousness being completely suspended, which
was not the case previously. These general symptoms, which
were evidently those of catalepsy, alternated with the more
partial symptoms, occurring several times in a single day, and
recurring throughout the whole of the next week, at the expir-
ation of which period the case was brought to me.

During all these fits, partial or general, the rigid parts were
cold, so cold as to cause some of the bystanders to say they
were dead. Cold, also, had evidently much to do in the matter
as an efficient cause. In the earlier stages of the affection,
playing out of doors (the weather at the time being very severe)
invariably sent the patient info 1 he house crving, with his hands
and forearms immovable ; and the exposure caused bv undress-
ing in a cold bed-room at night gave rise to the same symptoms.
On the morning in which he was brought to me. also, the cold
had acted in the same manner, and it was not until he had been
some time seated in the warm room that the stiffening relaxed.
I had thus an opportunity of satisfying myself that the parts
which had lost their pliability were in reality cold, and that the

376 Catalepsy, [June,

pulse in them was almost extinguished, and the sensibility all
but departed. I had the opportunity of satisfying myself, also,
that this depressed condition exiended more or less to the sys-
tem generally, and that all the mental and bodily functions
were as far as possible removed from anything akin to excite-
ment.

The other facts in connection with this case all denoted the
want of real power. He was any thing but precocious, not
walking for two years*, and not talking for a year later, and
now speaking with hesitation, very slow in apprehension,
feeble in memory, and, though twelve years of age, as irrita-
ble, uncertain, and fretful as an infant. His head is large; his
eyes staring, and the pupils dilated and sluggish ; his complex-
ion sallow and venous; his hand cold and clammy; his pulse
slow (70) and feeble; his body prominent and hard; his skin
unhealthy and covered wirh boils; his appetite voracious.
Both parents appeared to he healthy ; but a cousin of the mo-
ther suffered from fits of a similar character, and lost her life
in one of them, by falling from a foot-bridge into a brook.

Acting upon received views, that increased irritation in the
chief nervous centres had to do with the muscular rigidity.
Mr. Roy, of Brookgreen, had tried the usual course of leeches
behind the ears, blisters to the nape of the neck, low diet, mer-
curials, hot mustard fomentations to the feet, and so on ; but
finding the symptoms becoming more general and confirmed,
he sent the case to me.

The treatment I pursued rested, on the contrary, on the sup-
position that rigidity was dependent on a diminished supply of
nervous and other motive stimulus, a view which I have else-
where endeavored to substantiate in relation to all forms of
muscular contraction, normal and abnormal. I, therefore, re-
commended that the patient should be kept still, and as warm
and comfortable as possible; that animal food and good table-
beer should be given him freely; that he should be undressed
before the fire, and carried to bed wrapped in warm flannels,
having been first for some time immersed in a hot bath ; and
that he should take, every few hours, a small teaspoonful of
spirits of turpentine, with ten drops of aromatic spirits of am-
monia, mixed up with a part of the yolk of an egg, in a little
ginger wine.

A fortnight after this first interview, I saw the patient again,
and found that the draught had occasioned a little irritation in
the bladder, but so little that there was no necessity to discon-
tinue the remedy. On the other hand it had put a stop to a
troublesome and old-established habit of micturating in bed.
As to the rest, there was a material improvement in every re-

J853.] Gutta Per cha in Diseases of the Skin. 377

spect, the countenance being brighter and more energetic, and
there having been no cataleptic rigidity from the day the stim-
ulant and nutritive plan of treatment had been put in practice.
I saw the patient no more ; but learned from the mother,
who called two months subsequently, that the treatment had
been carried out, for a month longer, that the fits had never
returned, and that he was then in better health than he had
been before. \London Lancet.

On the Application of Gutta Percha in the Treatment of Dis-
eases of the Skin. By Robert J. Graves, M.D., F.R.S.

Dr. Graves has been making many successful experiments
with Gutta Percha dissolved in Chloroform, in a great variety
of cutaneous affections. He finds its application more suited
for dry, scalv, tubercular and chronic diseases of the skin than
for acute affections, attended with much oozing of fluid and
comparatively acute inflammation.

Still, its good effects, he says, are by no means limited to
chronic diseases of the skin, or to those of a scaly, dry nature;
for, as will hereafter appear, I have seen it decidedly useful in
the spreading form of impetigo. My experience of this remedy
makes me anxious to witness its application in the first stages
of erysipeles, as analogy leads me to hope for good results in
such cases.

In acme of the face, this application is of essential impor-
tance. The pimples should be covered with the solution, and
the patient enjoined not to rub ofYihe pellicle by washing, etc.

Finally, in several cases of psoriasis I have applied this solu-
tion with great benefit.

When my friend, Dr. Stokes, heard of my success in other
cases, he resolved to try the gutta percha solution in small-pox,
and it gives me great pleasure to say, the result of two t rials
is most encouraging, and leads us to hope that at length a
means of preventing the formation of disfiguring scars on the
face in that disease has been discovered. Dr. Stokes allows
me to publish the two following cases :

The first Ann Kenny, aged 18, was admitted into the Meath
Hospital, May 11, 1852. She was never vaccinated ; her illness
began on the 6th of May, with the usual symptoms. On the 8th
the eruption appeared, and on coming into the hospital it was
wen formed and co. lnent on her face; the fever of a typhoid
character, with considerable prostration of strength ; she was
much annoyed with pain and itching of her face. She was or-
dered wine and carbonate of ammonia mixture, and her face
to be painted with a solution of Gutta Percha in Chloroform.

378 Miscellany. [June,

The solution was applied with a soft brush, the entire face
being well coated with it, and after an interval of five minutes
(just sufficient time to allow the previous coating to dry,) a
second coat of the solution was applied.

This application gave her great relief, and allayed the pain
and itching. On the 13th she was much better, and the solu-
tion was again applied in the same manner.

May 22d. The crusts came off in large pieces, and there was
scarcely any trace of the disease remaining, except a slight
discolouration. During the whole time of her illness, from the
application of the solution her face continued moist, and there
was no ulceration in any place.

The second case presented similar symptoms ; was treated
in the same manner, with the like happy result.

It is of essential importance to observe that ihe gutta percha
solution should not be applied to the face until the pustules are
fully maturated, otherwise injurious consequences may arise.

Lupus supiginosis, psoriasis and other chronic cutaneous
complaints, when unattended with constitutional derangement,
yield readily to repeated applications of the solution of gutta
percha. [Dublin Quarterly Jour, of Med. Science.

SX\ Bttil an 2

" The Aztecs." We have, in common with our fellow citizens, re-
cently had an opportunity to see the two little personages, whose arrival
in this city was heralded in the public prints and announced by pla-
cards upon our street corners as " The Aztecs, a new race of people,
two feet high a complete puzzle to all beholders." The story of
their being the descendants of a dwarfish race of Aztec priests, held
in great veneration in a mysterious and hitherto unknown city, hidden
amidst the mountains of Central America, is too absurd to arrest the
attention of Naturalists, yet remarkably well adapted to the purpose
for which it was invented. Every one who knows anything about
the history of Dwarfs is aware that they do not procreate that they
are impotent. Theso little creatures were at one time much sought
after and petted by the courts of Europe, which seemed to vie with
each other in the possession of the most remarkable specimens of abor-
tive humanity. Attempts were then repeatedly made 'by authority"
t increase the supply by coupling the parties ; but always in vain.

If the " Aztecs " are not dwarfs, as alleged by their keeper and
even by some Professional gentlemen, we would like to know what
they are. Walker defines the word Dwarf, " A man below the com-

1853.] Miscellany. 379

mon size of men"; Webster: "a general name for an animal or
plant which is much below the ordinary size of the species or kind.
A man that never grows beyond two or three feet in height, is a
dwarf." Dunglison : " one who is much below the usual stature."
Now the male of these "Aztecs" is said to be 18 years of age,
33f inches high, and to weigh 20 lbs. ; the female is said to be
10 years of age, 29^- inches high, and 17 lbs. in weight. They
were carefully examined by Dr. J. M. Warren and others in Boston,
in the early part of 1851, who estimated, from inspection of their
dentition, the age of the boy to be from 7 to 8 years, and that of the
girl to be from 4 to 6 years. The boy was 33 inches high and
weighed 20f lbs. The girl was 2|- inches high and weighed 17 lbs.
It appears, therefore, that their stature and weight have undergone
little or no change in two years. Their brain is exceedingly small
and their mental faculties are correspondingly defective. It is true
that they are lively and cheerful, but they have as yet no knowledge
of language, beyond the ability to repeat after their "keeper" a few
words, such as, papa mamma dec, without any apparent conscious-
nesss of their meaning. When addressed, they seem to apprehend ra-
ther the intonation of the voice, as do brutes, than the articulation of
words. Yet we are told that they are neither dwarfs nor idiots. Let us
again refer to our lexicographers : Walker's definition of the word
Idiot, is "a fool, a natural, a changeling," and "Idiocy, a want of
understanding." Webster: "Idiot, a natural fool, or fool from his
birth," and "Idiocy, a defect of understanding; properly a natural
defect." Dunglison: "Idiot foolish', stupid, ignorant. Now used
for one who is fatuous, or who does not possess sufficient, mental facul-
ties for the social condition, and for preserving, himself from danger.
In law, one who has been without understanding from his birth, and
whom the law presumes to be never likely to attain any." The
" Aztecs " are then certainly not only dwarfs, but also idiots.

In thus endeavoring to remove the mystery attempted to be thrown
over the origin and true character of these beings, we do not mean to
detract from their interest philosophically considered, for they present
certain remarkable peculiarities. They appear to be of a mixed
race ; probably an admixture of the Negro and American Indian,
such as may be found in Mexico and most of the South American
States. They differ strikingly from all the dwarfs we have seen, and
from most of those upon record, in the smallness of their head ; for
dwarfs usually have this proportionately more developed than the
other parts of the body, whereas in these, the arrest of evolution has

380 Miscellany. [June,

operated equally upon the brain and the general system. Hence it is
that whilst dwarfs usually speak correctly and are sometimes quite
intelligent, the Aztecs are unable even to ask for the necessaries of
life.

Pulmonary Calcareous Concretions. We are indebted to Dr Jas.
M. Scaife, of Claiboin Parish, Louisiana, for several very handsome
specimens of calcareous concretions expectorated by a patient affected
with consumption. The Doctor states that quite a large number of
them were coughed up with purulent matter.

Such concretions, however, are not confined to phthisical subjects,
but have been observed in the lungs of persons who have died without
any serious lesion of these organs. They usually consist principally
of phosphate of lime and sometimes exist in very'great numbers in
the pulmonary tissue.

A new remedy for Warts. A French writer states, in the " Bulle-
tin de Therapeutique," that he has observed that the use of a tea-
spoonful of Carbonate of {Magnesia, morning and ni-ht, for a few
weeks, was generally attended with the disappearance of warts on
the fingers. Whether this is to be regarded as an effect rather than
a coincidence, seems to us questionable. Warts will often fall off
after having existed a certain length of time ; hence the success of
the incantations and other witcheries resorted to by certain "wart-
curers." One of the most prompt applications wTe have tried is the
Tincture of Iodine. By putting a drop of this upon the wart once a
day, it will generally fall off in a week. Lunar caustic, nitric acid,
potash, &c, will often- succeed very weil, but are apt, if incautiously
applied, to occasion some inflammation and pain.

A new treatment for Pertussis. We find in the " Revue de Ther-
apeutique," &c. that Prof. Hannon, of Brussels, rejects all the es-
tablished methods of treating Hooping Cough, and recommends a
nourishing diet of bread and meat, with a liberal allowance of wine
at least three times a day. His directions are as follows : " In the
morning, roasted meat and toasted bread with Port or Madeira ; at
noon, bread and wine ; at 5 o'clock P. M., broth, roasted meat and
toast; at night, no supper ; at bed time, wine : nothing but cold water
between meals." He adds that, however singular this treatment may
appear, the symptoms will begin to yield in a very few days and the
cure be complete in from one to two weeks. This plan may be worthy

1853.] Miscellany. 381

of trial, but can of course be adapted only to children who have been
weaned.

Yellow Wax for making Ointments. Dr. Henle (An. Medicale)
having observed that unguents prepared with white or bleached wax
became very soon rancid, urges the use of yellow wax as by this
means the unguents will keep fresh four times as long.

"Warrenton, Ga., May 24th, 1853.

" Dr. Dugas : On the 5th inst., several of the Physicians of Warren
County organized themselves into a Medical Society. A Constitution
and By-Laws were adopted the duty of drafting the same having
been put upon some of the members of the Profession at a preceding
preliminary meeting.

" The meetings of the Warrren County Medical Society will be held
bi-monthly, beginning on the 1st Wednesday in July next. The
officers elected to serve ihe ensuing year, are : Jas. S. Jones, M. D.,
President; Robert W. Hubert, M. D., 1st Vice-President ; M. E.
Swinney, M. D., 2d Vice-President ; VVm. H. Pilcher, M. D., Corres-
ponding and Recording Secretary; Sterling Gibson, M D., Treasurer.

(,I will merely state, for the information of those wishing to become
members ef the Warren County Medical Society, that all applications
for membership must be written, and presented to the Society through
its Secretary. WM. H. PILCHER,

" Corresponding and Recording Secretary/'

BIBLIOGRAPHICAL.

Atlas of Pathological Histology. By Dr. Gottlieb Glfge, Profes-
sor &c. in the University of Brussels, &c, &c. Translated from
the German, by Joseph Leidy, M. D., &c, &c, of Philadelphia.
With 320 figures, plain and colored. Philadelphia: Blanchard &
Lea. 1853.

Dr. Leidy certainly deserves the thanks of the profession for having
placed within the reach of those who do not understand German, the
very valuable woik of Prof. Gluge. As normal histology constitutes
the fundamental study of physiology, so does morbid histology be*
come indispensable in the acquisition of correct views of Pathology.
In the present volume, this study is wonderfully facilitated by the
numerous and beautifully executed engravings. The work is divided
into sections, thus : 1st. Development of the elements of tissues;
2d. The elements of tissues combined in perfect or imperfect tissues,
and arranged according to the processes of disease ; 3d. Formation

382

Miscellany.

[June,

of the Blastema; 4th. The histological metamorphosis of the blood;
5th. Pyaemia; 6th. of Gangrene; 7th. Observations on Histology.
We take pleasure in recommending this work, not only as highly
useful, but also as exceedingly creditable to the publishers.

A Treatise on General Pathology. By Dr. J. Henl6, Professor of
Anatomy and Physiology in Heidelberg. Translated from the
German, by Henry C. Preston, A. M., M. D. Philadelphia :
Lindsay & Blakiston. 1853.

This work forms a valuable companion, or rather complement to
that of Prof. Gluge, for the study of the topics upon which it treats
should follow that of pathological histology. Prof. Henle is by com-
mon consent ranked as one of the ablest pathologists of Europe. His
work should therefore be perused attentively by practitioners who do
not wish to remain ignorant of the advances made in this department.

The Action of Medicines in the System ; or the mode in which Ther-
apeutic agents introduced into the stomach produce their peculiar
erlects on the animal economy. Being the Prize Essay to which
the Medical Society of London awarded the Fothergillian Gold
Medal for 1852. By Fk. Wm. Headland, B. A., M. R.C.S., &c.
Philadelphia : Lindsay & Blakiston. 1853.

The title alone of this work indicates the importance of its subject,
and the award of the learned society vouches for the faithfulness of
the execution. We have not yet had an opportunity to examine it
carefully, but as far as we have looked into it, the impression has
been very favorable. The general modes of action of therapeutic
agents introduced into the stomach are treated of in ten propositions.

Prop. I. That the great majority of medicines must obtain entry
into the blood, or internal fluids of the body, before their action can
be manifested.

Prop II. That the great majority of medicines are capable of solu-
tion in the gastric or intestinal secretions, and pass without material
change, by a process of absorption, through the coats of the stomach,
and intestines, to enter the capillaries of the Portal system of veins.

Prop. III. That those medicines which are completely insoluble in
water, and in the gastric and intestinal juices, cannot gain entrance
into the circulation.

Prop. IV. That some few remedial agents act locally on the mu-
cous surface, either before absorption, or without being absorbed at
all. That they are chiefly as follows:

a. Irritant emetics, b. Stomach anaesthetics, c. Irritant cathartics.

Prop. V. That the medicine, when in the blood, must permeate
the mass of the circulation, so far as may be required to reach the
parts on which it tends to act.

That there are two possible exceptions to this rule :

1853.] Miscellany. 383

a. The production of sensation or pain at a distant point, b. The
production of muscular contraction at a distant point.

Prop. VI. That while in the blood the medicine may undergo
changes, which in some cases may, in others may not, afiect its influ-
ence. That these changes may be

a. of Combination, b. of Reconstruction, c. of Decomposition.

Prop. VII. That a first class of medicines, called Haematics, act
while in the blood, which they influence. That their action is per-
manent. 1. That of these some, called Restoratives, act by supply-
ing, or causing to be supplied, a material wanting, and may remain
in the blood. 2. That others, called Catalytics, act so as to counter-
act a morbid material or process; and must pass out of the body.

Prop. VIII. That a second class of medicines, called Neurotics,
act by passing from the b'ood to the nerves or nerve-centres, which
they influence. That they are transitory in aciion. 1. That of
these some, called stimulants, act so as to exalt nervous force, in ge-
neral or in particular. 2. That others called Narcotics, act so as first
to exalt nervous force, and then to depress it ; and have also a spe-
cial influence on the intellectual part of the brain. 3. That others
again, called Sedatives, act so as to depress nervous force, in general
or in particular.

Prop. IX That a third class of medicines, called Astringent', act
by passing from the blood to muscular fibre, which they excite to
contraction.

Prop. X. That a fourth class of Medicines, called Eliminatives,
act by passing out the blood through the glands, which they excite to
the performance of their functions.

Silliman's Journal The May number of this national work is
exceedingly interesting. Among its original papers we note those of
Geo. Mathiot, "On the Electrotyping operations of the United States
coast survey" of Ogden N. Rood, "On a method of exhibiting the
Phenomena of Diffraction with the compound microscope" of J. B.
Upham, M. D., " On the Phenomena and Laws of Sound " of Prof.
Wm. A. Norton, " On Ericson's Hot-air or Caloric engine."

Meeting of the American Medical Association, at New York. The
session was opened on the 3rd of May. Dr. VVelford, of Virginia,
President, in the Chair. The Delegates in attendance numbered
upwards of 500. The following officers were elected for the ensuing
year: President Dr. Jonathan Knight, of Connecticut. Vice-Presi-
dents Dr. Usher Parsons, of Rhode Island; Dr. Lewis Condit, of
New Jersey; Dr. H. R. Frost, of South Carolina, and Dr. R. L.
Howard, of Ohio. Secretaries Drs. E. L. Beadle, of N. York, and
E. L. Lemoine, of Missouri. Treasurer Dr. D. F. Condie, of
Philadelphia.

384 Miscellany. [June,

Medical Society of the State of Georgia.

Savannah, Ga., April 13th, 1853.
The Medical Society of the State of Georgia met at 10 o'clock this
morning in St. Andrew's Hall, and was organized by calling Dr. R. Q.
Dickenson, of Baker county, to the Chair. The roll of members
having been called, the rules were suspended, and eighteen gentle-
tlemen admi'ted to membership in the Sociely. An election for
officers was now held, and the following gentlemen duly elected offi-
cers of the Society for the ensuing year :

President Dr. P. M. Kollock, Savannah, Chatham Co.
1st V. President Dr. R. Q. Dickenson, Albany, Baker Co.
2d " " Dr. G. F. Cooper, Perry, Houston, Co.

Cor. Secretary Dr. Vy. N. King, Savannah, Chatham Co.
Rec. " Dr. D. C. O'Keeffe, Greenesboro', Greene Co.

Treasurer Dr. C. B. Nottingham, Macon, Bibb Co.

Delegates to American Medical Association.

Dr. E. L. Strohecker, of Bibb Co.

" J. C. Gilbert, " Houston,

" H. F. Campbell, " Richmond,

" R. C. Mackall, " Chatham,

" R. McGoldrick, " Bibb,

" L. A. Dugas, <k Richmond,

" Ch. VVest, " Houston,

" T. B. Hoxey, " Muscogee,

Dr. T. R. Lamar, of Bibb Co.
" J. E. Dupree, " Twiggs,
M S W. Burney, " Monroe,
" M.G. Slaughter, " Cobb,
" Th. Stewardson, " "
" J. M. Simmons, " Spalding,
" T. M. Darnell, " DeKalb,
11 Jno. Le Conte, " Clark,

Dr. Long, of Athens, stated that he had published, in the Southern
Medical and Surgical Journal, for 1849, his claims to priority of dis.
covery of the anaesthetic properties of Sulphuric Ether, and he now
presented the subject to the Society to take such action thereon as
may seem to it proper. Whereupon, on motion of Dr. Dickenson, a
committee of three (Drs. Dickenson, Cooper and S. N. Harris) was
appointed to confer with Dr. Long, and investigate his claims to the
discovery in question.

On motion of Dr Nottingham, a committee of one from each Con-
gressional District represented at this meeting was appointed to pre-
pare business for the action of the Society. Drs. Arnold, Hillsman,
Gilbert, Long, O'Keefle and J. Harriss, were appointed that com-
mittee.

A proposition was read from Dr. J. S. Wilson, of Alabama, to
publish a Medical Almanack, detailing the evils of quackery, and
expounding some of the fundamental principles of medicine, to be
edited by him, and published at the expense of the Society.

1853.] Miscellany. 385

On motion of Dr. Dickenson, the Correspending Secretary was
instructed to inform Dr. Wilson that his proposal was duly considered,
but respectfully declined.

The Corresponding Secretary read a letter of resignation from Dr.
H. A. Ramsay, which, on motion of Dr. Cooper, was laid on the table
for the present.

On motion of Dr. Nottingham, a standing committee of three was
appointed, for the current year, to investigate the finances of the So-
ciety, and report thereon during the present session. Drs. Charters,
J. Harriss and McGoldrick, committee.

On motion of Dr. Bulloch :

Resolved, That the gentlemen connected with the Press of the city
be invited to take seats within the Hall, during the sittings of this
Society.

On a call from the Chair for written communications, the follow-
ing Reports were read, and received :

On the existing Laws of Georgia, relating to the Practice of
Medicine, and the Sale of Drugs, with suggestions for additional
legislation by Dr. R. Q. Di< kenson.

On the Topography and prevalent diseases of the First Congress-
ional District by Dr. P. M. Kollock.

On the Topography and prevalent diseases of the Third Congress-
ional District by Dr. G. F. Cooper.

On the remittent peculiarities assumed by Typhoid Fever in Geor-
gia by Dr. H. R. Casey.

On the best plan of treating Fractures in Country Practice by
Dr. L. A.. Dugas.

On the anti-periodic properties of Sulphate of Cinchona by Dr.
Thos. W. Bell.

On the treatment of Strictures of the Urethra, by rapid and free
dilatation, illustrated with cases by Dr. P. F. Eve.

Biographical Sketch of the late Dr. Waring by Dr. C. W. West,

Biographical Sketch of the late Dr. Baber by Dr. C. B. Not-
tingham.

On motion of Dr. Mackall, it was

Resolved, That all the Reports received, and now upon the table,
be referred to a Committee on Printing, who shall have discretionary
power to print, or omit to print, such portions of them as they shall
deem expedient.

Drs. Mackall, Arnold and Posey, were appointed under this reso-
lution ; and on motion, the President, Dr. Kollock, was added to the
committee.

386 Miscellany. [June,

Dr. Dickenson read the report of the committee on Dr. Long's
claims, which was highly favorable, and the following resolution, ap-
pended thereto, unanimously adopted.

Resolved, That it is the opinion of this Society that Dr. C. W.
Long, now of Athens, Georgia, was the first person who used Sulph.
Ether as an anaesthetic agent in surgical operations ; and as an act of
justice to Dr. Long, individually, and to the honor of the Profession of
our State, we recommend him to present his claims to priority in the
use of this most important agent to the consideration of the American
Medical Association at its next meeting.

Dr. S. X. Harris offered the following resolution which was adopt-
ed :

Resolved, That a Committee of five be appointed from this Society,
to address the next Legislature of Georgia, and urge upon their con-
sideration the propriety of enacting a law which shall exempt its
members from Jury duty, and, except in time of actual war, from
military duty, so long as they shall continue in this Society.

Dr. C. W. West moved that all the members of the Society sign
this petition. Carried.

Committee appointed under the above resolution viz : Drs. S. N.
Harris of Chatham Co., I. E. Dupree of Twiggs Co., L. A. Dugas
of Richmond Co., H. V. M. Miller of Floyd Co., Thomas Hoxey of
Muscogee Co.

Dr. Arnold called up Dr. Ramsay's letter of resignation, and offered
the following preamble and resolutions, which were adopted, nem. dis.

Whereas, a communication has been received from Dr. H. A.
Ramsay, tendering his resignation as a member and, whereas, Dr.
Ramsay was admitted into this Society, as will appear from the
minutes of the meeting of 1852, on the express ground that he had
retracted his charges against the Society theretofore published by
him ; and, whereas, since his admission, he has renewed his charges
of a persecution, which exists only in his own brain, and has accom-
panied those charges with scurilous abuse of several members of the
Society thus violating at once, professional and social courtesy,
which charges he has printed and circulated in various forms :

Resolved, That this Society cannot accept the resignation of Dr.
Ramsay, and thus indirectly endorse the propriety ot his conduct while
a member of the Society.

Resolved, That agreeable to the amendment of the Constitution,
adopted at the meeting of 1851, Dr. Ramsay be notified, in writing,
that at the next regular meeting he will be arraigned before the So-
ciety, as having grossly violated the code of Medical Ethics adopted
by it for the government of its members, by various publications made

1853.] Miscellany. 387

by him during the past year, derogatory to the views and purposes of
the Society, and the character of ome of its members.

On motion of Dr. Arnold, a committee of three was appointed to
notify Dr. Ramsay of the passage of these resolutions.

Dr. Arnold moved to amend the Constitution, by striking out from
the 8th Article the words, "of not more than two dollars each."
Carried.

On motion of Dr. Howard, Dr. S. N. Harris, of Savannah, was
appointed Speaker for the next annual meeting of the Society, and the
city of Macon selected as the place of meeting.

On motion of Dr. O'Keeffe, Dr. G. F. Cooper, of Perry, was ap-
pointed Dr. Harris' alternate.

The President announced the following Committee of Arrange-
ments : Drs. E. L. Strohecker, H. K. Green, T. R. Lamar, G.
Harrison and R. B. Xesbit.

On motion of Dr. O'Keeffe, it was

Resolved, That the thanks of this Society are hereby tendered to
the Georgia Medical Society, for their attention and courtesy to its
members during their stay in the city.

On motion of Dr. Nottingham:

Resolved, That, to the professional gentlemen of Savannah, the
members from the interior cannot fail to cherish feelings of the most
kindly regard, in consideration of the cordial reception, affluent hos-
pitality, and high toned spirit of fellowship, wilh which our arrival has
been greeted, and our sojourn rendered pleasant.

Dr. Arnold offered the following resolutions, which were adopted ;

Resolved, That an assessment of 83 00, be made upon each mem-
ber of this Society to defray the current expenses.

Resolved, That the Treasurer notify all absent members of the
above assessment, and request those delinquent for any past assess-
ment to remit their clues to him.

Resolved, That the present Treasurer notify Dr. Alexander, of
Atlanta, and Dr Black, of Augusta, (former Treasurers of this Socie-
ty,) of their delinquency, and request them to forward to him a full
statement of the receipts and expenditures of all monies received by
them, and the balance of funds, if any, in their hands.*

The Chairman of the Committee on business, Dr. Arnold, present-
ed the following Report, which was adopted :

Subjects to be reported on at the next annual meeting.

* It is but justice to Dr. Black, to state that he sent his annual Report by mail
to Savannah, to the address of the Recording Secretary, during ihe recent meet-
ing of the Society, but did not reach its destination in time to ohviate the pas-
sage ot this resolution id relation to himseif; and from the known financial
accuracy of Dr. B. we entertain not the least doubt ot its being correct and sat-
isfactory. (Rec. Scc'y.)

388 Miscellany. [June,

Medical Botany of Georgia. Dr. Joseph Le Conte.

On the relative value of Lithotrity and Lithotomy. Dr. L. A. Dugas.

On the use of Anaesthetic Agents in Obstetrical Practice. Dr. Jos.

A.Eve.
On the mutual relations of Yellow and Bilious Fever. Dr. P. M.

Kollock.
On the Therapeutical value of the Bark of the Cornus Florida (Dog-
wood), as a substitute for Quinine. Dr. C. B. Nottingham.
On the Ve rat rum Viride, as a medicinal agent. Dr. G. F. Cooper.

And that each person, thus appointed, be authorized to chose his
alternate, in case he is not able to perform the duty.

At 8 o'clock of Thursday night, Dr. Juriah Harriss, of Augusta,
delivered, to a highly respectable audience, a chaste, instructive, and
scientific address, on the History of Medicine in the 18th and 19th
centuries.

On motion of Dr. Arnold:

Resolved, That the thanks of the Society be tendered Dr. Harriss,
for his interesting address before them, and that a copy be solicited
for publication.

Hereupon, the Society adjourned, sine die.

D. C. O'KEEFFE, Rec. Sec.

Vermont Medical School. A cotemporavy states that a third Medi-
cal School is about to be organized in Vermont and adds, that " if
the three will unite, they may make one very respectable school.
Rather a hard hit at our Eastern brethren.

Prof. M. Clymer has resigned the Chair of Practice in the Univer-
sity of New York and Dr. John A. Swett has been appointed in his
place.

Dr. Joseph Leidy has been appointed to the Chair vacated by the
death of Prof. Horner. A very good selection.

Dublin has lost- one of her ablest physicians by the death of Prof.
Robert J. Graves.

Dr. Valentine Mott and Dr. John C Warren have been elected
foreign members of the French Academy of Medicine. Why was Dr.
Mott not elected to the Presidency of the American Medical Associa-
tion ? He was certainly entitled to the honor.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. JULY, {80, [No. 7.

PART FIRST,
riginal (ffammttnuattons.

ARTICLE XXII.

A brief Summary of my Experience with the Veratrum
Viride. By John $. Wilson, M. D., of Airmount, Clarke
county, Alabama.

So much has recently been written upon the veratrum by
Dr. Norwood, and others, that some may begin to grow weary
of the subject ; but I feel well assured that such is not the case
with those who have witnessed its wonderful powers, and that
every physician who has enjoyed this privilege will read with
pleasure any additional evidence in its favor, which may tend
to bring it more into notice, and thus extend its use. And if
any of the readers of this Journal should entertain the idea that
an undue proportion of its pages are devoted to this new reme-
dy, they should remember that almost a/Ztbat has been written,
up to this time, upon this g're'at .medicine, has been published
in this Journal alone ; that but few American and no European
journals have as yet^ noticed it; and, consequently, that its
transcendent claims to the attention of the profession are still
comparatively unknown. Instead, then, of offering an apology
for introducing the American hellebore again, I would pay a
merited compliment to Dr. Norwood, by saying that he has
won immortal honor for himself, and conferred an inestimable
favor on mankind, in bringing it first into notice ; and I hesitate

n. s. VOL. IX. NO, vii. 25

390 Wilson, on Veratrum Viride. [July,

not to say that the Journal would be well filled if every page
contained nothing besides an important account of the effects
of veratrum viride.

It is not my design to give a minute and tedious detail of
cases ; I will only mention some of the diseases in which I have
used the medicine under consideration ttie mode of adminis-
tration, and the result, together with such general remarks as
may be suggested tome in common with each case.

At the beginning of the present year, I succeeded in obtain-
ing some of the root of the veratrum viride, after several
ineffectual efforts : from this I made a tincture, according to the
directions of Dr. Norwood, by adding | lb. of the root to li> oz.
of undiluted alcohol. This tincture I have used in the follow-
ing diseases viz : Pneumonia, pleuropneumonia, bronchitis,
broncho-pneumonia, pericarditis, cerebro-spinal meningitis,
epileptiform convulsions, acute rheumatism, general dropsy ;
and in fevers typhoid, remittent and puerperal. Of the tho-
racic diseases, sixteen were pulmonary and one cardiac: of
meningitis, convulsions, acute rheumatism, and dropsy, there
was one case each : of the fevers, three were typhoid, one
puerperal, and several remittent. Of the sixteen pulmonary
cases, all recovered save one, and this was complicated by the
supervention of acute rheumatism. The case of pericarditis
had resulted in effusion, before it was put under treatment, and
terminated fatally : still the veratrum exerted its w'onted con-
trol over the pulse, reducing its frequency from 140 to 60. The
case of cerebro-spinal meningitis was also fatal; but as in the
other case, the remedy exerted a marked control over the
pulse, and for a while there was a flattering amelioration of all
the symptoms.

The subject of the convulsions was an anemic boy of 10 or
12 years of age ; the spasms were very frequent and extreme-
ly severe, every paroxysm apparently putting the life of the
patient in imminent danger: the veratrum, to reduce the fre-
quency of the pulse, and ether inhalations, to quiet the spasms,
were the remedies almost exclusively relied upon ; and these
indications were fulfilled in the happiest possible manner, snatch-
ing the little sufferer from the very jaws of death.

The case of rheumatism occurred in a little boy about 5 years

1853.] Wilson, on Veratrum Viride. 391

of age; it attacked the knee-joint, was very severe, and was
treated principally with colchicum and veratrum; but the for-
mer medicine did not succeed well until the latter was added to
prescription. Under this treatment the disease was subdued
in less than six days, instead of running " six weeks," according
to the dictum of Dr. Warren.

The case of dropsy was fatal, the patient being moribund
when the veratrum was commenced.

We now come to that interesting class of diseases fevers.
Of the three typhoid cases, one terminated favorably in twelve
days ; but the early convalescence in this case was not attribu-
ted to the veratrum, as this was not made a principal remedy,
and as the fever was unusually mild. The other two cases
were severe and protracted, one continuing three and the other
six weeks. Having much confidence in the veratrum, it was
relied upon almost exclusively in the treatment of these two
cases, the prescriptions being complicated as little as possible.
In the case that terminated in convalescence in three weeks,
slight ptyalism supervened, from the use of small doses of calo-
mel in conjunction with the veratrum.

The general plan of treatment which I have adopted in ty-
phoid fever is to give quinine freely for the first few days, or
until the typhoid symptoms are fully developed ; I then resort
to small doses of calomel and the veratrum, experience having
taught me that nothing can be gained by pushing the quinine,
after the disease has become distinctly typhoid. In giving the
veratrum, I generally prescribe 4 gtt. every three hours, for an
adult, to be increased 1 gtt. each dose, until a decided effect is
produced, either upon the pulse or stomach. I have never
been able to carry the dose higher than 14 gtt., and seldom
higher than 8 gtt. ; and I have even known 2 gtt. to produce
a very manifest effect on the pulse of a little girl three years
of age. I have never known it to fail in reducing the frequency
of the pulse when it produced nausea, but I have frequently
succeeded in reducing the pulse, without any nausea, by begin-
ning with very small doses, and increasing gradually.

Having mentioned the diseases in which I have used the
veratrum, and the mode of administration, I conclude with a
few general ssmarks.

392 Wilson, on Veratrum Viride. [July,

It will be seen by reference to the figures given, that my
experience with it has been more extended in pulmonary dis-
eases than in any other class sufficiently so, I think, to speak
with some degree of confidence. As already stated, only one
of those cases proved fatal, and that was complicated. Some
of the cases were severe and alarming, as much so as any I
have ever seen ; and one of the cases of pneumonia was accom-
panied with active pulmonary hemorrhage. With these facts
before me, I can but express a very favorable opinion of the
veratrum in pneumonia and bronchitis. Before the introduc-
tion of this remedy, I treated the diseases mentioned with
antimonials, and generally with success ; but every physician
of experience knows that pneumonia is not unfrequently com-
plicated with a degree of intestinal irritation which forbids the
use of tart, emetic on the Rasorian plan, or, indeed, in any way
capable of subduing the pulmonary inflammation: and even
where this intestinal complication is not an essential feature of
the disease, it is well known that the free use of tart, antimony
will produce it, together with other grave, and even fatal symp-
toms. The veratrum is not obnoxious to those objections ; and
having in addition to the important negative advantage, the
positive one of being more prompt and certain in its effects,
than the antimony, I think it entitled to the preference ; and I
think it possible that time and experience will confirm its
claims, and that it will be recognized as the great desideratum
in the treatment of pulmonary diseases. In this class of dis-
eases I have found it to act promptly, not only as a sedative, but
also as an expectorant and anodvne ; and I would here remark,
that I consider its primary action, that which gives it its great
value, sedative while its secondary effects are expectorant,
emetic, sudorific, and anodyne.

As to its use in fevers, I have but a few more words, as it is
my design to confine myself mostly to facts, and as my expe-
rience with it in this class of diseases has not been extensive.
As before intimated, the veratrum was made the principal
remedy in the treatment of two of the typhoid cases no other
remedies being used except blisters to the abdomen, cold
sponging, spts. mindereri, and in one case small doses of calo-
mel. If I may venture an opinion as to the virtues of vera-

1853.] Wilson, on Veratmm Viride. 393

trum in typhoid fever, from its effects in those two cases, it is
this : Its powers in abbreviating the fever are doubtful ; but its
control over the pulse, the reduction of excessive arterial ac-
tion, and the consequent mitigation of all the more distressing
symptoms, are, comparatively, certain far more so than any
remedy previously in use. But, while I express myself thus
favorably, I do not think the veratrum is applicable to all cases
of typhoid fever; for I would be averse to its use in cases at-
tended with extreme debility and great prostration of the vital
powers: if I were to resort to it at all in cases of this kind, it
would be in doses too small to produce nausea and prostration,
observation having taught me that the patient must have a
considerable degree of recuperative energy to withstand its
depressing effects, unless it is used with great caution.

The case of puerperal fever was one in which the uterus was
the primary seat of inflammation, but the fever wras complica-
ted with diarrhoea and well-marked typhoid symptoms. In
consideration of this complication and the advanced stage of
the disease, I withheld the lancet of course the purgative plan
was wholly inadmissible. Under these circumstances, I pre-
scribed small doses of calomel and opium; veratrum alternate
ly the latter to be increased until it affected the pulse 01
stomach. When this treatment was begun, the pulse ranged
from 120 to 140, quick and thready : after continuing it forty-
eight hours the pulse was reduced nearly to the normal stand-
ard, and kept at this until the metritis was subdued. In this
case it took as many as 14 gtt. to fulfil the indication more
than I have ever given in any other case, except one of pneu-
monia, accompanied with pregnancy the time was much
longer than usual also; but whether the puerperal and pregnant
states modify the action of the remedy, I am unable to say.

As we have a specific in remittents, of course the veratrum
was not the principal remedy in this form of fever : it was only
used during the febrile exacerbation, to moderate the arterial
action, and this design it accomplished very happily ; and al-
though it may possess no specific action in any form of fever,
I consider it an invaluable remedy in controling the action of
the heart and mitigating the intensity of the disease, in every
variety of fever, idiopathic or symptomatic.

394 Long, on the proper use and abuse of Medicines, [July,

I might multiply remarks in connexion with each of the cases
treated, but enough has been said, I think, to convince the
most incredulous that the powers of the veratrum have not
been exaggerated. I will only add, in conclusion, that I have
used it, not only in the twenty-five cases reported in this arti-
cle, but also in others, not embraced in this report ; and I have
never seen it fail in reducing the frequency of the pulse while
there was generally an improvement in its volume: and although
I am naturally more prone to skepticism than credulity, I hesi-
tate not to express the belief that the veratrum viride is one
of the greatest additions made to the materia medica the pre-
sent century, the anaesthetics not excepted : but, while I bestow
this high commendation, I must say, by way of caution, that it
is potent for evil as well as for good like all other active
remedies and should therefore be used with prudence and
circumspection.

ARTICLE XXIII.

On the proper use and abuse of Medicines. By J. A. Long,
M. D., of Long's Cross roads, Tenn.

To what extent remedial agents may be used in the arrest
of disease, without hazarding any thing to the life or constitu-
tion of the patient, is a question of vital import, and one to
which I fear too little attention has been paid. That diseases
are, to a certain extent, under the control of remedial agents,
no one familiar with practical medicine will for a moment doubt ;
but to what extent they are so, is the object of enquiry. That
too much may be done, and no doubt often is, in the persever-
ing use of medicine, is certainly a settled fact more especially
by the junior class of the profession, the reckless and the ig-
norant. Too great a reliance is placed in drugs, and that often
to the exclusion of other invaluable means or adjuvants such
as a well regulated dietetic course, nursing, bathing, &c. No
man thoroughly imbued with the true principles of medicine
and the nature of disease, but knows that there is a strong natu-
ral tendency, in a large proportion of cases, to terminate in
recovery when left alone to nature's own resources. And it is

1853.] Long, on the proper use and abuse of Medicines. 395

one of the popular errors of the day, and probably has been of
all ages, to suppose that all recoveries are cures ; and this is
the great basis upon which quackery rests and the faculty
proper not only suffer the imposition upon the popular mind,
but their silence gives consent: for, in general, we are too
ready to admit that all favorable changes are due to the virtues
of our medicines, and still more ready to encourage and foster
such erroneous opinions, in the minds of others less qualified to
judge.

But few young practitioners enter upon the responsible du-
ties of our profession but what are more or less disappointed
in the curative powers of medicine : for they have been taught,
both by authors and lecturers, that drugs alone could save ;
and, in the language of one writer, " It cannot be doubted that
diseases which if undfsturbed would have spontaneously termi-
nated in health, have often received an unfavorable turn, from
officious interference. If we would studv the dangers as well
as the virtues, of each and every drug we use, and their rela-
tive powers upon the system, in its varied conditions, we would
be better qualified to do good and avoid evil. We should ever
make it a rule, (and strictly adhere to it) 1st, to do no harm ;
2dly, to do all the good possible in our power. We are not
to suppose that drugging is essentially necessary in all cases of
disease, for this will often lead to their abusive employment.
Medicines, taken as a whole, are not harmless agents, but parti-
sans, acting for or against the patient in a large proportion of
cases. How careful, then, ought we to be in their selection,
preparation and administration. I do not believe we are jus-
tifiable in the use of a drug, without we fully comprehend its
theiapeutic action, and there is an indication for such medi-
cine in the case under treatment. More risk is certainly
incurred in the administration of medicine, in whatever stage
of disease, where there is no plain indication, than there possi-
bly can be, in withholding such medicine, until an indication
presents itself, sufficiently clear to the practitioner for him to
take action with some certainty of success. I do not wish to
make an impression upon the reader that I am opposed to the
use of drugs, in the treatment of disease, when judiciously em-
ployed, for no man believes stronger in the controlling power

396 Long, on the proper use and abuse of Medicines. [July,

of remedial agents over disease than the writer, when properly
used and well timed ; but it is to their extravagant and lawless
use I wish to call attention. If the taking of medicines, in case
of disease, were as plainly indicated as that of aliment in health,
then we could not only give the proper quality, but necessary
quantity, to effect a radical cure in all cases. But unfortunate-
ly this is not the case, for after whole years of attentive and
laborious study, and observation, in the boundless plains of our
science, we are still left to grope in the dark: hence it is the
more necessary -to be extremely cautious in the practice of our
profession, to guard us against untimely and needless prescrip-
tions, ignorantly or otherwise. Here we might take up the
long list of the materia ?nedica, and examine each and every
drug separately at least all such as hold any claims to poten-
cy and enquire into their history of use, and abuse, upon the
human system ; but a few examples must suffice, with a pass-
ing reference to others.

Who of us, that have practiced five years, have not seen
patients prostrate under the use of calomel, tartar emetic, opium,
chloroform, &c. There is nothing more common in this sec-
tion, than the hourly administration of calomel, in the treatment
of fevers, and the whole list of phlegmasia, to induce salivation
in doses from 1 to 20 grs., and the use of this drug is persever-
ed in until this object is accomplished, or the patient prostrated.

Case I. (587 of my case book.) I was called to R. N., at-
tacked with bilious fever. This case proved obstinate, and as

I was young and inexperienced, Dr. was requested in

consultation. He decided that my patient was in a dangerous
condition, and of decided bilious temperament ; liver inactive;
and that calomel wTas imperatively called for, to fill two plain
indications that presented in his case : it would bring about ac-
tion in the liver, and disengorge the portal circulation, and lay
a good foundation to induce salivation, if that very desirable
object became necessary, from the obstinacy of the case.
4 grs. calomel, opium \ gr. was ordered every four hours, for
twenty-four hours ; at the end of which time we visited the
patient, and found him somewhat worse. The Doctor attribu-
ted this, of course, to the obstinacy of the disease, and the

1853.] Long, on the proper use and abuse of Medicines. 397

entire inefficiency of the doses given consequently he order-
ed 10 grs. calomel, \ gr. opium, every three hours : at the end
of twelve hours we saw our patient again, and found him in
articulo mortis. The Doctor was still of opinion that the calo-
mel was not given in sufficient doses, or the intervals were too
distant. Up to this time, I had, from my inexperience in
practical medicine, left the prescriptions entirely to his own
judgment ; but being decidedly, by this time, of opinion that
the medicine was sinking him, instead of relieving, I opposed
its further use, which led to the calling in of Dr. P., an old and
experienced physician.

After a very minute examination of the patient, and our
course of treatment, he said, " You cannot force diseases to
yield rather persuade. He ordered some stimulants to be
given first, until the patient should somewhat revive then he
g&vepil. hydrarg. grs. 3, Doveri grs. 5, every four hours, until
three doses were given, using at the same time other adjuvants,
such as, blisters, injections, &c. The patient soon convalesced,
and rapidly recovered his former state of health.

In the case just related, not a shadow of a doubt was left on
my mind, but this patient must inevitably have been lost under
the wholesale calomel treatment. The Doctor just called in,
was a man of some seven or eight years practice, and a gradu-
ate of the Jefferson Medical School, Philadelphia.

Case II. (965 of my case book.) I was called for, in haste,
to see S. R., a little daughter of H. C, who had been given up
by her attending physician. He had treated her for typhoid
fever. Upon examining the little patient, I found she had been
taken with cholera-infantum, and the only symptom present
that possibly could have been taken for typhoid fever was the
diarrhoea. I examined the medicines that had been left, and
which I was told had been administered all the time : they
consisted of small powders, to be taken every three hours, com-
posed of about 2 grs. calomel and 2 grs. aloes, which had been
taken for some seventy-two hours, and the little sufferer (for it
was only about two years old) was perfectly prostrated with
excessive purgation, from the worse than needless use of
medicine. In this case, the attending physician had been at-

398 Long, on the proper use and abuse of Medicines. [July,

tributing the symptoms to the obstinacy of the fever; hence
his perseverance in the use of his remedies. The powders in
this case were discontinued; a check given to the bowels in
the usual way in cases of cholera infantum ; frequent warm
bathing; a flannel bandage was placed around the abdomen,
and the bowels directed to be opened in six hours by a dose of
warm castor oil, with proper directions as to its diet, wras all
that was done ; nor was it necessary for me to visit the patient
a second time it was going about on the third day.

Case III. (1 178 of my case book.) On the 20th February,
1845, I was requested to see a little girl about 5 years old, the
daughter of H. B., under the care and treatment of Dr. B., for
typhoid fever. He had left her, and stated that if the medi-
cines left did not relieve the patient he could do no more. I
found the patient with high fever, dry tongue, severe pain in
the side, and obstinate diarrhoea. A troublesome cough had
attended her from the onset of ihe disease. The medicines left
consisted of calomel 2grs., jajap 3 grs., as near as I could tell,
to be taken every three hours, until the patient was better, or
the whole amount was taken fifteen doses. Eight doses had
been given when I first saw the patient: I found it in an ex-
tremely prostrate condition, and would certainly have sunk
before the remaining powders were consumed. This patient
was suffering under influenza, which was then prevailing in the
country. I ordered a discontinuance of the powders, checked
the bowels with small doses of Doveri, directed fomentations
to the painful side ; bowels to be opened on the following day
by oil or injections. This patient convalesced immediately,
and was about in few days.

My note book abounds with such cases ; but enough has
been given to illustrate my position, and to arouse the interest
and energies of those who wield more able pens than myself.
The history of the treatment of typhoid fever alone, is humili-
ating in the extreme, to the faculty ; for I suppose not a remain-
ing doubt is left upon the mind of any practitioner that the evil
arising from the abuse of medicine, by its extravagant use in
this disease, far outweighs its benefits. The mortality in this

1853.] Carithers : Fetus killed by Ligntning. 399

section of country, in the hands of some practitioners, (more
especially those of northern schools,) has been over one hun-
dred percent., and in some neighborhoods all the patients at-
tacked have died to the no small disgrace of the medical
profession. Such results are doubly afflicting, when we reflect
and consider the strong natural tendency this disease has to
terminate in recovery, if undisturbed and left alone to nature's'
own resources.

ARTICLE XXIV.

Fetus in Utero, killed by Lightning. By James Y. Carithers,
M. D., of Hendricksville, Alabama.

Mrs. F , aged about 40 years, in good health, and eight

months advanced in pregnancy, received on the 10th of June,
1852, a severe shock from a streak of lightning, from which she
recovered in a few hours when she was attacked with labour
pains which caused me to be sent for. On my arrival, I found
her suffering with sharp pains. On examination, per vaginam,
no dilatation of the os uteri had taken place. Bled her freely,
and ordered her an enema of a gill of starch, with a teaspoon-
ful of laudanum, and to take i ofagr. of sulph. morphine every
half hour, until she was relieved from pain. After taking the
fourth dose the pains subsided. Ordered her to take on the
following morning ol. ricini, !i. At 2 P.M., oil acted freely
on the bowels, and at 4 P. M. I found her resting well. Allow-
ed some light nourishment, from that time until she was de-
livered, which took place on the tenth day after she complained
of being very unwell. The child was dead, and from the ap-
'pearance, had been so from the time the mother felt the shock.

400 Ricord's Letters on Syphilis. [July,

(Eclectic Department.

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 361.]
FOURTEENTH LETTER.

My Dear Friend What did I wish to prove to you in my last
letter? That observation had by no means demonstrated the
contagion of syphilis from the nurse to the child, and from the
child to the nurse, without the presence of primary accidents:
that nothing was less established than that pretended contagion
of secondary accidents, and that in all the cases invoked as a
proof of this mode of transmission, either the essential details
were wanting to bring about conviction, or evidently it was a
question of primary accidents.

Mark well, I beg of you, that I do not reject in an absolute
manner this mode of the transmission of syphilis. I only say,
not quitting the field of strict observation and the rigid analysis
of facts, that the existence of this mode of transmission is not
yet proved, and I add that if it is ever proved, it will only be
by inoculation ; inoculation alone being able to furnish the
undeniable demonstration of this, and to put the subject forever
at rest.

But are you going to say to me do you forget, then, that
some persons pretend to have proved by inoculation even, the
contagious properties of secondary accidents? No! certainly
not, I have not forgotten it. I wish that I could. I should not
thus find myself under the painful obligation to cast too legiti-
mate doubts upon the experiments made by men whose works
I honor, but who appear to me to have concluded upon this
subject with a little precipitation.

Wallace has published two observations of secondary inocu-
lation followed by results which appear positive. This writer
upon syphilis well says ( Syphilidologie de Behrend, 1841, page
60 et suiv.) that he has determined in healthy individuals inocu-
lated with pus taken from patients laboring under the influence
of secondary accidents, first, primitive, followed later by con-
firmed secondary accidents. It is very certain that as far as
effects produced and as results, the observations of Wallace
have at first something plausible. But what is not demonstra-
ted at all, is the nature of the accidents reputed secondary in the
patients from whom the inoculated pus has been taken. Here
the most important details are wanting. They are content
with saying that in the first observation the patient had syphili-

1853.] Ricorcfs Letters on Syphilis. 401

tic psydracious pustules of fourteen days' standing. In the
second observation the same pustules are mentioned as dating
from four weeks, and forming little crusts. In the first case the
subject was inoculated upon the shoulders; in the second, upon
the prepuce.

But, first nothing proves that the psydracious pustules from
which Wallace had taken the pus were secondary accidents.
The form, the number, the seat of the pustules, would not suf-
fice to give them this character ; for this, another thing is neces-
sary, which we do not find in the observations of Wallace.

On the other hand, what precautions did he take after having
inoculated ? In a venereal hospital, where we find the virulent
matter everywhere, the subsequent contacts are so easy, if
after artificial inoculation the punctures are not guarded from
every contact, as we are in the habit of doing, by placing them
under a watch-glass, and causing this syphilitic grain to germ-
inate undercover; if the instruments of which we make use
have not been washed with the greatest care ; if, in a word the
most minute precautions have not been taken, it is impossible,
in circumstances so serious and important, to draw strict con-
clusions.

I am much the more exacting in these observations of Wal-
lace, inasmuch as there passed something unusual in the results
of the inoculation.

In the first subject inoculated, the 15th November, it is not
until the 14th December following, that there formed upon the
place of the inoculation a little papule, covered with crusts
below which a small superficial ulcer was discovered. From
this the evolution of the symptoms described by Wallace, and
which might have an entirely different origin.

In the second subject inoculated upon the prepuce the 1st of
June, it is not until the 28th of June that a little crust of a dirty-
yellow color, surrounded by an areola, is found upon the parts
until then abandoned to themselves without any precautions.
The glands in the two groins are swollen, the spot covered
with crusts is scarcely excoriated ; the 24th July, the entire
body is covered with an exanthema, the characters of which
appear to be syphilitic. At a later period, some accidents are
discovered about the anus, the origin of which is not ascertain-
ed ; without doubt from the description, these accidents greatly
resemble the mucous tubercles, and these tubercles exist also
upon the scrotum, upon the back of the tongue and upon the
tonsils ; but the raphe of the patient is red and much tumefied;
the patient says that in walking, a very considerable oozing es-
capes from the anus. Now, the tumefaction of the raphe and
the intra-anal suppuration are often met with in the chancre or

402 Ricord's Letters on Syphilis. [July,

primary ulcer of this region. The primary accident contrac-
ted a \ prep nster a verier -e has for its favorite seat the anterior
portion of the anus where the raphe meets it. There is, then,
in the case of this patient, more probability for the existence of
a primary accident which had commenced in that region, and
about which no previous inquiries had been made, than there
is in placing the commencement of the disease in what had been
observed upon the prepuce, which had not presented any
of the symptoms by which syphilis commences. I add that in
well-made inoculations, the evolution of the symptoms may be
sometimes slow, but it is always constant, and we never see the
interval of a month or twenty-eight days between the inocula-
tion and the appearance of the accidents.

Thus my dear friend, what motives there are for doubt in
these two observations of Wallace! After the analysis that I
have just made of them, I cannot think that they will still serve
as a support to the doctrine of the inoculation of secondary
accidents.

I have just told you of the possibility of an anal chancre in
the case.of the second patient. This supposition appears to me
to be so much the more well founded, as that in England they
seldom search for this seat of chancre the English medical
customs reflect that sort of far-fetched modesty which char-
acterizes this nation. I recollect that in a trip to London,
they showed me at St. Bartholomew's hospital, with a kind of
earnestness, some males and females affected with secondary
accidents which were considered as the immediate result of con-
tagion. My friend Dr. Acton was present at this exhibition.
You are aware that I think infinitely little of constitutional
syphilis d'emblee, by way of contagion ; so that, making use of
my right of search, I put myself upon the way. I laugh still at
the startled air of the house surgeon and his assistants, when
carrying a bold finger and a scrutinizing look into certain
mucous folds, I succeeded in discovering in the perfidious
Albion a back door. I ought to add, that immediately the house
surgeon threw a veil, or, less poetically, let fall the sheet upon
these too visible marks of a contagion very easily explained.

To return to Wallace; it is very singular that he who has
made such a great number of inoculations, has succeeded in
inoculating secondary accidents only in two cases, and that he
has so badly demonstrated these. These cases constitute an
exception, and there cannot be an exception here. The secon-
dary accidents either do or do not inoculate. Please to recall
what I have said upon those cases of blennorrhagia of Bell
reputed exceptional ; there could not be for them any exception,
and experimentation has in fact proved that the exceptional
cases came under the law of inoculable chancre.

1853.] Ricord's Letters on Syphilis. 403

But if the facts which have passed upon the other side of the
channel can, as I think to have proved it, raise up very reason-
able doubts, here is a fact which has taken place very near me,
and which appears to present more value.

It was at the Hospital du Midi that this fact took place. I
should not have the liberty to speak to you of this, had not an
interested party, too interested in fact, given me the right.

It is concerning secondary accidents inoculated from a
patient upon a healthy individual. The inoculation has per-
fectly succeeded. One of our brethren, who without being a
casuist, is not, however, favorable to experimental researches,
has himself practised this inoculation, and has planted upon
each of the fore-arms of .one of the internes of the hospital a
chancre which has indurated, and which has determined the
indolent enlargement of the axillary glands, and wjiich in the
four months which followed has given place to perfectly well-
characterized secondary accidents, nocturnal cephalalgia, fall-
ing out of the hair, scabby eruptions upon the scalp, mucous
tubercles upon the velum palati (psoriasis of the mucous mem-
branes,) &c. ; it is the constitutional verole, the least contesta-
ble possible, and I have no desire to contest it.

But and there is all the question of what nature were the
accidents which furnished the pus inoculated ? The patient
from whom was taken the inoculable matter, according to the
observation which has been given me by the interne inoculated
was affected with an indurated chancre of six weeks' standing
and cicatrized ; he had mucous tuburcles about the anus
ulcerations about the great toes, pustules accumulated upon the
thoracic region; large pustules covered with crusts, below
which, ulcerations progressing and having a tendency even to
spread, were seen ; there existed some of these in the inguinal
regions and upon the side of the chest where the principal group
was seated.

Before the pupil was inoculated, the pus of these pustules had
been inoculated upon the two thighs of the patient himself.
Tin's inoculation had given a positive result, a circumstance
which, without a great passion for experimentation, ought to
have prevented the inoculation upon a healthy individual.

This patient had then very certainly a constitutional syphilis,
which presented characteristic accidents, and of a nature incon-
testable. But were all the accidents in him absolutely of the
same nature? The constitutional verole, as we know, does
not in any way prevent the contraction of new primary acci-
dents, accidents unlimited in their number, and infinitely varied
in their seat. In this particular case, the accidents from which
the pus had been taken : ulcers increasing, covered with crusts,

404

Ricord's Letters on Syphilis.

[July,

very extensive, in an individual only six weeks under the in-
fluence of the syphilitic diathesis, offering in the other regions
the regular evolution of secondary accidents of that period,
permit me to offer a doubt, which for the student who has un-
dergone the inoculation, is to-day a certainty, viz., that the ac-
cidents from which the pus had been taken were not secondary
accidents.

I did not see the patient w7ho furnished the inoculable pus ;
he soon quitted the hospital after this experimentation, and the
pupil interested could not find him again. But the importance
of this fact, however contestable it may be, has induced us, my
honorable colleague M. Puche and myself, to recommence a
series of experiments upon the inoculation of the secondary
accidents. We have already made twenty experiments, all of
which have only afforded us the results formerly obtained, that
is to say, negative results. The inoculations have been made
with the pus of mucous tubercles, of the ecthyma, of rupia, of
ulcerated tubercles, of secondary serpiginous ulcerations; never
have we obtained anything. Here, upon this subject, are two
curious observations which have had as witnesses the numer-
ous students who follow my clinique.

Two patients, lying side by side, ward 1st, Nos. 10 and 17,
had, No. 16 a scabby ulceration upon the axillary region, pro-
gressing and serpiginous ; the other, No. 17, an ulceration upon
the posterior and right side of the neck, of from six to eight
centimetres in diameter, progressing, healing in the centre and
extending itself in circumference ; this patient had still upon
other regions, isolated rupia, ecthyma confluent, and upon the
greatest part of the trunk and of the limbs he had characteristic
cicatrices due to pustulo-crustaceous syphilitic eruptions.

These two patients were inoculated upon the thigh. Upon
No. 1G the inoculation succeeded ; success had been predicted :
upon No. 17, we had announced that the inoculation would be
negative it was negative. Why ? Because that the ulcera-
tion of No. 1 7 was truly secondary ; while in the case of No. 16
the scabby ulcerative eruption of the axillary region, which had
the aspect of pustular crustaceous eruptions belonging to con-
stitutional syphilis, had been the result itself of an inoculation;
and mark how. This patient had at first a scrofulous abscess
in the hollow of the arm-pit ; this abscess had been opened at
the hospital ; the dressing of it was difficult for the patient
himself; one of his neighbors, affected with a phagedenic chan-
cre of the genital organs, rendered him the service of dressing
it, and with his fingers soiled by the virulent pus of his own
chancre, had inoculated him. Without the very precise etiolo-
gy of this case, the patient having had himself formerly symp-

1853.] Ricord's Letters on Syphilis. 405

toms of constitutional syphilis, this accident could have been
attributed to the diathesis, and have been given as an example
of secondary inoculation.

See, then, what care and precautions are necessary in order
to avoid error.

FIFTEENTH LETTER.

My Dear Friend From the numerous observations collect-
ed with care, from the many experiments made by myself, and
from the more numerous ones, still made after my example, I
have the right to conclude, that up to this day, secondary acci-
dents have not been inoculated. I have told you that the new
experiments which 1 have very recently made ; that the experi-
ments again repeated by M. Puche and by M. Cullerier, have
remained confirmatory of the first. But these experiments
having been always practised upon the patient himself, a capi-
tal objection might be made against me. It could be said, the
secondary accidents cannot be inoculated in those who are
already affected ; but they can be perfectly inoculated upon a
healthy individual. This objection could be made even by
those who partake of my doctrines; for I do not think that it
has entered the mind of all that school which is opposed to me,
and which professes that, so far from syphilis preventing a new
contagion, it is sufficient to make a single wound in a syphilitic
patient in order that this wound should take on immediately a
venereal character. I have already elsewhere said, and I shall
ask of you the permission to soon recall what I think of this
opinion. However it may be, the first objection remained;
and if the observations of Wallace had been more probable, and
less contestable, I should have taken the trouble to answer
them, for I was completely destitute of experiments which
proved the contrary. It is under these circumstances that has
been presented the fact of the inoculation from a diseased to a
healthy man, of which I have given you a sketch in my last
letter. I have spoken of this fact upon the special authority of
the person the most interested in it, he who has voluntarily sub-
mitted to the experiment, who undergoes the consequences of
it, and with a legitimacy which we cannot reasonably contest,
raises up pretensions to the scientific right to this fact ; who
believes in having become absolutely the master of it, and
having the right to draw from it all the scientific and practical
consequences which he shall judge proper, leaving to all the
liberty to do as much ; it is, I say, under these circumstances,
that I have thought myself permitted to give my opinion upon
this fact.

n. s. VOL. IX. \o. vn. 26

406 RicoroVs Letters on Syphilis. [July,

I repeat then, that this fact has appeared to me very grave,
very serious, and well worthy of being taken into consideration ;
this is the reason why I have wished to examine it with care.
We do not preocupy ourselves with common facts, and those
without value. This one derives its importance both from the
nature of the experiment which could have great influence in
the elucidation of grave practical questions, and from the indi-
vidual who has submitted himself to the experiment. It is an
interne in pharmacy, a distinguished and intelligent pupil, who
has been occupied with medical studies, and more particularly
with syphilis. I considered the fact merited our attention, on
account of the experimenter, whose science, talents or character,
as you know, dear friend, I have never wished to attack. If
needful, you could attest to this. I have always deeply detested
attacks of this kind, not only because they have often been
unjustly employed against me, but because it is not my custom,
and because my disposition is repugnant to it.

In these letters, rapidly conceived, and more rapidly written,
benevolent expressions might sometimes fail me, but the inten-
tion never. Let this be said once for all, and put to silence
susceptibilities which have no right to exist.

I return to the scientific fact which alone occupies me all
the value and all the importance of this fact is in the diagnosis.
Has the pus of a secondary or of a primary syphilitic accident
been inoculated upon a healthy individual ? I believe, I think,
and I have given my motives, that from this fact alone, viz., that
the patient who furnished the pus has been inoculated positive-
ly himself, that this experiment enters completely into the
domain of those which I myself have made. Thus, if success
has been met with in this case, it is because, according to my
numerous experiments, we have had to do with primary acci-
dents. Unless, which I do not contest, but which remains to be
proved, we have discovered for the inoculation of secondary
accidents, a particular form, a special period, which until now
has escaped us, and which we ought to be able definitely to de-
termine.

For, in fine, this result cannot be an exception, or the effect
of chance. If we could succeed in establishing the circumstan-
ces in which secondary accidents could be inoculated, and
therefore could be contagious, we shall have made a great step
in syphilogeny, and rendered a great service to science. In
all cases, this experiment will confirm this law that an acci-
dent actually contagious is inoculable ; that there is no difference
between artificial and physiological inoculation. It would
prove that this mode of experimentation can well have some
value, and it would be for me a veritable pleasure to see ranged

1853.] RicorcTs Letters on Syphilis. 407

under this opinion those persons who have made the most of
the uncertainties and the difficulties of syphilitic inoculations.

Let me tell you, my friend, that I have no intention, as you
will see, of changing my position. I do not attack, I defend
myself. I do not criticize, I examine. 1 am not ambitious for
the success ofihe polemiste ; I hold to the more modest preten-
tions of the practical observer. Nobody is more ready than
myself to receive light, from whatever source it may come ; or
to recognize the truth* whatever may be the voice that pro-
claims it. I have always uttered what I knew, or thought that
I knew, with loyalty and firmness. My experiments J have
never made secretly ; they have become the property of all, they
have enjoyed the right to see them, to judge of them, and to dis-
cuss them, and certainly in justice they have not found fault
with them ; and without asking me permission, it was a com-
mon right. I have entertained opinions which time and expe-
rience have modified. I shall cite an actual example of this, and
one to the point.

With all the earnest writers on syphilis, past and present, I
have thought that syphilis was not transmissible to animals.
I have made experiments, which like those of Hunter, of Turn-
bull, and especially of M. Cullerier, who has made more numer-
ous ones, have always conducted to negative results. All these
experiments gave me the right to conclude upon the non-trans-
missibility of syphilis to animals, until the contrary is proved.

However, 1 was not too hasty to teach and. to publish these
negative results, as M. Robert de Welz has imagined, since I
had also the essays of Hunter, of Turnbull,of M. Cullerier, and
moreover the numerous unsuccessful experiments, publiclv
stated, of M. Auzias Turenne. M. Auzias has experimented
perhaps more than all of us together, and had also more numer-
ous negative results. But more persevering in his researches,
he has studied the conditions which could prevent the inocula-
tion of animals ; he says that he has recognized them, and that
he has at last succeeded in inoculating the primitive accidents
from man to the monkey, and in return from the monkey upon
man. M. Auzias assures us that one of the principal causes of
the want of success was that the animals licked themselves after
the inoculation. He had thought, originally, that the saliva
neutralized the virus ; but this opinion could not be entertained
in presence of the numerous instances that we see in man of
the primary accidents having for seat the lips, the tongue, and
different points of the buccal cavity. The whole secret was,
that the animals, in licking themselves, must necessarily cleanse
the wound of the inoculation.

But the true reason which must have caused the experiment

408

Ricord's Letters on Syphilis.

[July,

to fail, and upon which M. Auzias Turenne insists the most at
the present time, is the very great plasticity of the blood in
animals, which allows it to interpose itself between the bleeding
part and the virulent matter. It is in taking care to constantly
soak the wound with pus after the inoculation, that it has suc-
ceeded. I have witnessed the experiments, and I can vouch
for the authenticity of them. It is with eagerness that I have
been able to rectify this point in the history of syphilis, in my
clinical lessons.

Until then I had professed, with our predecessors and with
our cotemporaries, that syphilis was the unhappy prerogative
of man, and yet that it was not spontaneous in him. I have
always greatly insisted upon these two facts, which appear
contradictory, specialty of the disease in man, and not sponta-
neousness. I have always thought that syphilis had an origin
somewhere, and that it was necessary to search for it. Is the
problem resolved? The monkeys have not always escaped
from wicked insinuations. Already Overcampand Linder had
accused them of playing an evil trick upon the human race, by
giving it syphilis ; but before M. Auzias, Overcamp and Linder
have been considered as calumniators of monkeys. Were they
right?

What is incontestible is, that since man was acquainted with
monkeys, since he has seen them multiply in the Garden of
Plants in Paris and in other capitals, since he has observed them
either in a state of nature or in captivity, nothing has ever been
seen upon them or among them which resembled primitive
syphilis, and more especially constitutional syphilis.

However, M. Auzias has succeeded in planting upon the ear
of a monkey a primary ulcer. The pus which served for the
inoculation having been taken from a patient in my wards, I
ought to note with care the circumstances in which this pus was
taken. The patient who furnished it was affected with con-
fluent chancres upon the gland, upon the prepuce and upon the
rectum chancres non-indurated, and at the period of specific
progress. These chancres were the result of a recent conta-
gion in an individual under the influence of a constitutional
syphilis, at the secondary period ; and this is very important to
note, for according to the principles that I have given out, this
circumstance explains why the chancres were not indurated in
this patient. Again, these chancres, by their multiplicity, by
the variety of their seat, could have been, in the eyes of inatten-
tive or of superficial observers, confounded with other constitu-
tional accidents, and served as a pretex to conclude upon the
possible inoculation of secondary accidents.

A previous inoculation had been made upon the patient and

1853.] Ricord's Letters on Syphilis. 409

had succeeded. It was with the pus of the pustule of the inoc-
ulation that the monkey was inoculated the first time. A
second inoculation was made upon the monkey with the pus
of his first pustule, and this second inoculation again succeeded.

It was then that one of our young brethren interposed. M.
Robert de Welz, associated professor of a German university,
asked to be inoculated, and was effectually inoculated first
with the pus of the first pustule of the monkey, and then with
that of the second. These inoculations succeeded. But until
then, the patient who first furnished the pus had not had any spe-
cific induration; the monkey whose pustules became a little
thickened, had not presented the certain characters of this indu-
ration; the neighboring glands were not enlarged ; in fine our
German brother, who of his own accord submitted to a perilous
experiment, in whom, moreover, the pustules of inoculation
were not destroyed until at quite a late period, has not experien-
ced the specific induration. The pustules of inoculation pre-
sented at their base, sub-phlegmonous engorgement, very com-
mon, but which might often be confounded with specific indur-
ations by inexperienced observers. The axillary glands (the
inoculations having been made upon the two arms,) were not
enlarged.

For the inoculation at which I assisted, and which was made
upon M. Robert de Welz, a new lancet was used, but the pus
upon the monkey was taken up with a spatula which was not
new. Since then, M. Robert de Welz has made a new inocu-
lation, which succeeded, with new instruments.

Thus far, then, we have only purely primary accidents, essen-
tially local ; but this is not yet the verole. Has the monkey
served only as a soil for the transplantation of the chancre?
This is very possible. We have the right to think so, until we
succeed in producing in him constitutional accidents. This
opinion is so much the more maintainable, inasmuch as many
writers upon syphilis, especially in England, pretend that the
chancre which does not become indurated is not a syphilitic acci-
dent. Will the experiments of M. Auzias come to confirm this
opinion ? I shall inform you at a later period what I think of
this, and what I think upon the induration of chancre.

However it may be, I shall say to you, meanwhile, that if the
primary accidents incontestably inoculable upon man, can be
inoculated upon the monkey, the secondary accidents ought also
to be inoculated, if, perchance, they have very recently become
inoculable.

Is there, then, for each particular disease, as for the epidemics
in general, a versatile character ? Or, rather, is it not the genius
of observers which changes ? [Boston Med. and Surg. Jour.

410 Adulteration of Medicines. [July,

On the Adulteration of Medicines.

Dr. Richard D. Currey has made an excellent Report to the
Tennessee Medical Society, from which we cull the following
notice of some of the articles most frequently adulterated, and
the mode of detecting the imposition :

Aloes. Of the six varieties of this resinous extract, only
three are of sufficient importance to merit notice, the cape,
hepatic, and socotrine, and of these the last is the most valuable.
The usual adulterations are sand, earth, &c. ; but a great fraud
is practiced in palming off the two inferior for the more valua-
ble socotrine. There are characteristic properties belonging
to each, however, which will guard the purchaser, in some de-
gree, against imposition.

Cape aloes possesses a shining, resinous appearance, a deep
brown color, and a glossy, resinous fracture. Its powder is
greenish yellow, and produces a paler colored decoction than
the other kinds. Its odor is strong. Thin laminae present a
yellowish, red color, when held up to the light.

Hepatic aloes is opaque of a liver color, whence its name
of a moderate degree of fragrance, it might be called unpleasant.
Fracture rough and semi-transparent on edges. Powder dull
olive yellow. When held in the hand, it softens and adheres.

Socotrine aloes gives a glossy, smooth and conchoidal frac-
ture is of a garnet red color, and yields a golden yellow pow-
der. Thin laminae are translucent or nearly transparent on
the edges. Its odor is highly fragrant, which is, to a great de-
gree given off, when a portion is heated. I take the liberty of
presenting samples for the inspection of the association.

Alum, which is the sulphate of alumina and potassa, crystal-
lizes in regular octohedrons, but is, in the commercial article,
without regular form. It is adulterated with iron, thus ren-
dering it unfit for the dyer. It should give a colorless solution.
Tincture of nutgalls or prussiate of potash, will detect, in such
solution, the presence of iron. Unslacked lime, added to the
dry powder, will give ofTthe odor of ammonia, if that alkali be
present, and nitrate of silver will detect the existence of chloride
of sodium, or common salt.

Ammonia Aqua. We have, in commerce, five strengths of
this alkali, designated as F., FF., FFF., FFFF., and blistering
ammonia. When adulterated with organic matter, a carbona-
ceous substance will be left after evaporation by heat. The
addition of muriatic acid forms sal ammoniac, which, if resinous
matter be present, will not be pure white or clear, when evap-
orated. Lime water will detect the presence of carbonate of

1853.] Adulteration of Medicines. 411

ammonia, by forming a white, insoluble carb. lime. Nitrate of
silver will detect the presence of muriate of ammonia by form-
ing the white chloride of silver, usually termed horn-silver, and
chloride of barium will throw down an insoluble sulphate, if
sulphate of ammonia be present.

Carbonate of ammonia volatilizes entirely by the application
of heat, and effervesces on the addition of an acid.

Tartrate of antimony and polassa, when in the crystalline
form, is readily recognized, being in white, transparent, rhom-
bic octohedrons, whose lateral planes present a striated appear-
ance. When powdered it readily admits of foreign admixtures,
the most usual of which are the bitartrate of potash. If the
powder has a yellowish tinge, the presence of iron may be sus-
pected, which may be detected by adding to its solution a few
drops of sulphuric acid, and subsequently the prussiate of potash,
[f then the characteristic blue prussiate results, iron is present.
If the bitartrate of potash be present, its solution in 40 parts of
water will be effected by its own volume of 8 parts acetate of
lead in 32 parts water and 15 parts acetic acid.

Arrow root, from the East Indies, does not crepitate between
the fingers, like that from Bermuda or the West Indies. When
pure, full fifteen minutes are required for it to gelatinize and
become adhesive., whereas, potato starch, with which it is adul-
terated, rapidly stiffens and becomes tenacious. The micro-
scope will detect the different varieties of starch granules that
may exist in the arrow root.

Arsenic, being very volatile, a residue will be left if white
sand, chalk, bone dust, or heavy spar, its usual adulterations,
be present.

Sub-nitrate of bismuth effervesces, if chalk or carbonate of
lead be present, on the addition of nitric acid. Diluted sulph-
uric acid will throw down from this nitric acid solution a white
precipitate, if lead be present.

Cantharides often deteriorate by age, and are subject to in-
jury from mites. In the powder or plaster they are adulterated
with euphorbium, which also possesses irritating and vesicating
properties. The presence of this adulteration may be ascer-
tained by heating the substance, when, if a benzoic acid vapor
be given off, its presence is established. The microscope may
also detect its presence. To this may be attributed the frequent
inertness of the cantharides plaster of the shops, as well as to
an insufficient quantity of the Spanish fly.

Castor oil is the only one of the fixed oils soluble in alcohol :
hence this affords a test for lard oil or any other cheaper
admixture. Castor oil capsules, containing but a very small
proportion in each sac, would be insufficient to produce a pur-

412 Adulteration of Medicines, [July,

gative effect, were not this compensated by the addition of a
minute portion of croton oil. Instances have occurred of pain-
ful and even fatal gastritis, resulting from the administration of
these capsules.

Chloroform, when pure, is perfectly transparent, possessing a
sp. gr. 1, 5. It possesses an extensive solvent power. This
property enables us to use it as an analytical agent in sepa-
rating substances from their foreign admixtures, as resin of
guaiac from resin of jalap cinchonia from quinia, and narco-
tina from morphia. Pure chloroform, when allowed to evap-
orate on the hand, leaves no smell. If an unpleasant odor
remains, it is evidence of the presence of some peculiar oil,
which is not volatile, and which has been generated during the
manufacturing process. The presence of these oils is also
supposed to be tested by the discoloration of pure sulphuric
acid, though the experiments of others have not confirmed the
supposition. Instances have frequently occurred of death re-
sulting from the use of chloroform. This is doubtless owing
to the impurity of the article, not because it is of itself thus
fatal. Perfectly pure chloroform has never produced such
results. Can it be otherwise when we may find it varying in
strength from one-twentieth to three-four-ths of what it should
be. Free chlorine and hydrochloric acid have been detected
in it by the litmus paper. If alcohol be present as a diluent,
the bichromate of potash, with a few drops of sulphuric acid,
will cause the production of the green oxide of chromium, float-
ing on the surface. There has also been noticed the formation
of minute crystals, of a pink color, on the sides of the bottle at
the upper surface of the fluid, an impurity resulting from the
oxide of manganese, used in its purification. To be safe in its
use, its sp. gr. should not be less than that indicated, 1, 5;
while it should be fragrant and clear no unpleasant odor on
evaporation should not redden or bleach litmus paper, nor
give a greenish tinge when agitated with sulphuric acid.

Cinchona is estimated by its external as well as chemical
characters. So many different varieties of this truly valuable
bark have been found, that the strictest vigilance is necessary
to prevent fraud in its importation into our ports. Its value is
determined according to the quantity of quinia it yields. Re-
cently, a new principle has been discovered in some barks
brought from Carthagena and Maracaibo, called quinidine,
from its great resemblance, in all its characters, to quinine,
though as an anti-perindic it is valueless. M. Guibourt reck-
ons the value of the different cinchonas thus:

1. Calisaya cinchona, royal yellow.

2. Cin. micrantha, orange yellow.

1853.] Adulteration of Medicines. 413

3. Pitaya,

4. Verrucous true, red.

5. Non-verrucous true, red.

6. Red Lima.

7. Grey Lima.

The calisaya bark is distinguished from all others which are
fraudulently mixed with it, by "the shortness of the fibres of
the entire transverse fracture, and the ease with which they
are broken, instead of bending and remaining adherent."
(Prof. Carson, in Am. Jour. Pharm., April, 1850.) Its color is
uniformly yellow, and possesses no white marbling in its thick-
ness. The nail, when drawn over its internal surface, leaves a
shining mark, and its outer surface is conchoidal. Caliseya has,
also, a more intensely aromatic, bitter taste than the other
barks, this characteristic varying even in its different varieties.
At the recent National Pharmaceutical Association, Dr. Bailey
reported that he had rejected at the port of New York, 300,000
lbs. of spurious bark, especially of that variety that contained
exclusively the newly discovered principle, quinidine. He
was led to reject them from the conviction that they were to
be employed in the adulteration of powdered calisaya, as well
as of quinine. The ostensible object for which they were
imported was for the manufacture of tooth powders. The price
of barks, in good condition and of good quality, at the place of
collection, is said to be not less than from 60 cts. to 81,00 per
lb., for those yielding quinine on the contrary, it is frequently
invoiced to this country at 10 cts. per lb. As it takes 2 oz. to
make one ounce of quinine, it may be readily conjectured why
it is that quinine can be sold sometimes as low as 82,00 per lb.,
and the powdered barks as low as 50 cts. and 81,00 per lb.

Citric acid belongs exclusively to the vegetable kingdom,
being found in lemons, limes, sour oranges, tamarinds and to-
matoes. The juice obtained by expression is readily crystali-
zed in white, inodorous, rhomboidal prisms. They possess a
sharp, sour taste, are soluble partially in water, and insoluble in
alcohol. Its value subjects it to sundry adulterations, as lime,
tartaric acid and sulphuric acid. With chloride of barium,
sulphuric acid, if present, is precipitated as an insoluble sulph-
ate of baryta. Muriate of potash detects the tartaric acid by
the formation of a tartrate of potash, and lime will be left after
incineration. The lemon syrup of commerce is more frequent-
ly made of tartaric acid than of either citric acid or of the pure
juice of lemons. According to Soubeiran, citric acid precipi-
tates baryta, and not lime, from their solutions, whereas tartaric
acid exerts the contrary effect. Moreover, citric acid is de-
liquescent, while tartaric acid is not.

414 Adulteration of Medicines. [July,

Cod liver oil has become so popular in the treatment of dis-
eases of the chest, similating phthisis, that it is subject to vari-
ous adulterations, the most common of which is sperm oil. Pure
cod oil has the odor of sardines, and is free from the lamp oil
odor sp. gr. 9, 7. With nitric acid of sp. gr. 1, 215, a dull
green hue is gradually assumed, which, after several days, chan-
ges to brown, whereas sperm oil, with an acid of same sp. gr.,
produces a pale brown without a shade of green. Besides this
impurity, which is intentionally mixed with it, others are attri-
butable to want of care in assorting the cod from the haddock,
the hake and the pollock, certain species of the finny tribe which
accompany the cod in their haunts, and which are, consequent-
ly, caught at the same time.

Balsam Copaiva M. Guibourt, acting under the authority
of a commission from "Ecole de Pharmacie de Paris," after
examining a variety of samples of this oleo-resinous balsam,
asserts that the four following properties indicate a balsam that
is certainly pure: 1. Entirely soluble in 2 parts of absolute
alcohol. 2. Forming at 60 F. a transparent mixture with two-
fifths of its weight of a strong solution of ammonia. 3. Solidi-
fying with one-sixteenth of its weight of calcined magnesia.
4. Producing a dry and brittle resin after prolonged ebullition
with water.

Its usual impurities are castor oil and turpentine. The pre-
sence of this fixed oil will prevent its solubility, according to
the first property; neither will the resin left after ebullition
harden, but will remain soft. A drop on paper, volatalized by
heat, leaves a translucent spot, if pure, but if impure, this spot
will be surrounded by a fatty areola. Castor oil will also pre-
vent the transparency of the mixture with the solution of am-
monia. Turpentine is detected by its odor.

Creosote. I present for examination, two samples of creosote
the one pure aud colorless, the other impure and reddish, with
an empyreumatic odor. The adulteration in this sample is
owing either to rectified oil of tar, or a peculiar article called
capnomer, wl.ich, in many of its physical and chemical proper-
ties, is similar to creosote. The presence of these impurities
may be detected by acetic acid and caustic potash, which com-
pletely dissolve the creosote, if pure, but if adulterated, will not.

Cubebs, in the powder, is adulterated with ground allspice,
by which the taste will be so altered as to lead to their detec-
tion.

Ergot, in the powder, is rendered inert by the admixture
with plaster and paste.

Ether, sulphuric, has a permanent boiling point at 98 F.
The addition of impurities will have the effect to raise it to a

1853.] Adulteration of Medicines. 415

higher point. Turpentine will also cause a nauseous odor to
remain after moistening a handkerchief with it.

Gum Arabic, when pure, is in round, white lumps, or in mas-
ses presenting a brittle and crackly appearance. Its pure ap-
pearance distinguishes it from the inferior sorts with which it is
sometimes mixed. Gum Senegal is, however, bleached for this
express purpose. The pure gum, however, is perfectly soluble
in water without swelling, from which solution it is precipitated
by alcohol. The salts of the peroxide of iron yield an ochre
precipitate with gum Senegal, while a red coloration will be
afforded with the true gum Arabic. It is in the powdered state
that these tests are of the most value, when it is impossible to de-
tect by the eye, as can be done in the solid state. If starch is
with the powder, it may be tested by iodine the characteristic
blue being produced.

Iodine, that has not been resublimed, is always more or less
impure, hence we have a commercial and a resub limed article.
It has been a mooted question whether the operation of the law
is adverse to the admission of the commercial iodine, on account
of its impurities, into our ports, and so far the action of our in-
spectors, as well as instructions from the Secretary of the
Treasury, have been against its admission. The most common
impurity with which the commercial'^ sophisticated is the large
proportion of water. The standard of purity adopted by the
inspectors, will not allow of more than 2 per cent, of water, yet
it is found of all grades, varying from 2 to 20 per cent. An argu-
ment offered for the admission of such is drawn from its em-
ployment in the manufacture of the iodides, and for daguerrean
purposes, for which it is said to answ7er as well as the resub-
limed. The law, however, is express on this subject, forbid-
ding the importation of any medicine or chemical that is not
pure enough for medicinal purposes, and, as it is conceded by
both parties, that the commercial is not of that purity, it is
very properly excluded. At the recent National Pharmaceuti-
cal Association, Dr. Stewart, to get at the sense of the members
on this subject, introduced a resolution to the effect, that all
articles, good for their kind, should be passed at our ports. As
the importers of this commercial article acknowledge their de-
sign to be for manufacturing purposes, it was urged that it
should be admitted. The whole subject was discussed Prof.
Carson, of the University of Pennsylvania, among others,
taking a part in it, yet the resolution was rejected.

Other impurities found in this chemical are black lead, char-
coal, black oxide of manganese, Galena, sand, clay and chlor-
ides of magnesium and of calcium, and free chlorine. Pure re-
sublimed iodine is in dry crystalline scales. If they adhere to

416 Adulteration of Medicines. [July,

the sides of the vial, it is an evidence of the presence of water.
If entirely vaporizable on application of heat, it is an evidence
ofthe absence of inorganic impurities. The magnet will separ-
ate the black lead, which is truly a carburet of iron, from the
mass, if present ; it is also insoluble in alcohol. Muriatic acid,
mixed with it, will evolve chlorine, affording evidence ofthe
presence of oxide of manganese.

Ipecacuanha root is composed of two parts, the cortex and
woody fibre, in the proportion of 4 to 1. The virtues ofthe
root reside exclusively in the bark, the woody fibre being inert.
Hence it may be seen that when the root is ground up, regardless
of these distinctions, one-fifth of its active properties is de-
stroyed, consequently the choicest powdered ipecac is now la-
belled cortex sine ligno. The root is annulated, rendering its
recognition easy. Hence it is only in its preparations and pow-
der that it admits of adulteration Liquorice root is frequently
ground up to a large extent with it, and again the peculiar pow-
der, called "powder of post," is also added to it. This, of
course, would weaken its emetic properties, to restore which its
adulterators resort to a certain proportion of tartar emetic.
With the microscope we can detect the different starch gran-
ules of these several powders while sulphuretted hydrogen will
produce an orange precipitate, the golden sulphuret of antimo*
ny, if tartar emetic be present. The presence of foreign sub-
stances will also affect its action with certain chemical agents.

Magnesia calcined This substance admits of such ready adul-
teration, that it is rarely found absolutely pure. It is known to
contain carb. lime, carb. magnesia, alumina and silica. With
the carbonates, an effervescence will take place on the ad-
dition of an acid. A complete solution cannot be effected if
silica be present, and the alumina will afford a white precipitate
with ammonia, if present in the muriatic acid solution. If lime
be present, oxalate of ammonia produces a precipitate from the
same acid solution. Carbonate of magnesia is also adulterated
with the same substances, and may be detected by the same
tests.

Blue mass pilula hydrargyria if of the officinal strength,
should contain one-third mercury. While, therefore, it fre-
quently falls far short of this standard, it is also found to contain
a strange medley of impurities, as compensating agents. The
following analysis, made by Prof. Reid, of New York, upon a
sample of imported blue mass, presents these filthy substitu-
tions in a striking manner. In one hundred grains there were
of Mercurv, 7J

Earthy Clay, 27~

Prussian Blue, 1 i

1853.] Adulteration of Medicines. 417

Lard, 2

Soluble saccharine matter, 34
Insoluble organic " 12
Water, 16

Pure blue mass should contain 33J grains mercury in 100.
Here we have only 7-| nearly four-fifths less than there should
be. Sulphate of mercury is also found in it, and when so, it
renders the mass highly injurious. This impurity arises from
the gross error of endeavoring to heighten the color of the con-
serve of roses by means of sulphuric acid. Consequently, on
mixing the ingredients into a mass, a chemical action takes
place the deep blue color of the mass partakes of a golden
tinge, from the formation of the sulphate of mercury. Its pre-
sence may be suspected when this particular tinge is found, but
readily ascertained after washing, by means of the baryta test.
The inorganic earths will be left after incineration of the mass,
and Prussian blue by striking an ink with sulphate of iron.

Mercury ammoniated, white precipitate, so closely resem-
bles dry white lead, calomel, chalk and gypsum, in several of
their physical properties, that it readily admits of adulteration.
Pure white precipitate may be entirely sublimed on the appli-
cation of heat, being resolved into mercury, nitrogen and hy-
drogen. If, therefore, any adulterations exist, there will be a
residue left.

Peroxide of mercury, red precipitate, is also readily suscepti-
ble of adulteration with red lead, brick dust, Armenian bole,
nitric acid and red oxide of iron. A strong heat will also readi-
ly vaporize this substance, if pure; if impure, a residue will be
left. It is also entirely soluble in muriatic acid, and hence its
impurities, if any, will subside.

Protochloride of mercury, pure calomel, acted upon with a
solution of iodide of potassium, changes to a greenish yellow,
and with lime water or the caustic alkalies, it blackens. Treat-
ed with nitric acid, it affords a white precipitate with nitrate
of silver, soluble in an excess of ammonia. The physical pro-
perties of calomel are well known, being insoluble in water,
alcohol, ether, and muriatic or acetic acids, inodorous and taste-
less. Its usual adulterations are chalk, gypsum, phosphate of
lime, carb. lead, sulphate of baryta, sal ammoniac, &c, and
corrosive sublimate through faulty preparations. The test of
its adulterations is easy, for it is entirely vaporizable by heat, if
pure. The presence of corrosive sublimate is manifested by
the yellow, not black color, afforded by lime water, and a scar-
let color with iodide of potassium. Again, corrosive sublimate
is soluble in ether and calomel not. It may thus be separated,
if present, and then, by the evaporation of the ether, the corro-

418 Adulteration of Medicines. [July,

sive sublimate will assume a crystalline character. While
writing this report, I procured three samples of calomel sever-
ally of the manufacture of Mander, Weaver, & Co., Howard &
Farr and not one failed to afford very unequivocal indica-
tions of the presence of corrosive sublimate. That of Mander,
Weaver & Co., was the most impure.

After the application of a strong heat, if a residue is left its
character may be ascertained, for if a carbonate of lime or lead,
it is soluble, with effervescence, in dilute muriatic acid if an
oxide of lead, hydrosulphuret of ammonia will change it blackr
and yellow by iodide of potassium and if a white precipitate
is afforded with oxalic acid and oxalate of ammonia, the residue
is lime.

Bichloride of Mercury. Corrosive sublimate forms a yellow
wash with lime water or caustic alkalies, thus distinguished
from the black wash of calomel. It is also soluble in ether, and
less so in alcohol and water. With iodide of potassium a scar-
let precipitate is produced.

Mercury, red sulphuret. Vermillion is a paint, but the fol-
lowing analysis shows its great impurity. Out of ten samples,

3 of the Triest vermillion were pure.

1 " " contained 15 per ct. carb. magnesia.

1 " " contained 261

1 French " pure

1 " " contained 35 per ct. sulphate of lime.

2 Chinese, " contained 48 and 62 per ct. chromate lead.
1 American," was entirely red lead.

Morphia and its salts are soluble in water and alcohol, and
insoluble in ether. Of the three salts the sulphate is determined
by the baryta test, the muriate by the silver test, and the acetate
by the odor of vinegar. Their impurities are sugar, narcotine,
and perhaps starch. Narcotine is soluble in water, chloroform
and solution of potash and soluble in ether, the action of solv-
ents differing, in a remarkable manner, with the two substances.
The crystalline character affords a good test, pure sulphate of
morphia being in small filiform crystals. The impurities pre-
sent no such regularity. If pure, nitric acid gives the salts of
morphia a blood red color, changing to yellow perchloride of
gold affords a yellow, and the salts of peroxide of iron a blue
precipitate.

Essential and fixed oils are also contra-distinguished as
volatile and fat oils the former being the more valuable, and
adulterated with the latter. The detection of such adulteration
is, however, easily made, for if a transparent, greasy stain is
left, after the application of heat to a drop on paper, it affords
evidence of the presence of such adulteration. All of the fixed

1853.] Adulteration of Medicines. 419

oils, except the single instance of castor oil, are insoluble in
alcohol, while the essential oils are entirely so. Chloroform is
also a solvent for the essential and not for the fixed oils. The
fixed oils afford a saponaceous compound with alkalies the
essential oils do not.

Opium is estimated according to the amount of morphia it
contains. While, therefore, its adulterations may consist of
sand, earths, leaves, vegetable extracts, &c, these are nothing
compared with the fraud sometimes practiced of reducing the
per centage of morphia contained in the mass, by extracting it,
to a certain extent, and then remoulding the cakes and passing
them into the current of trade. Opium has been presented for
admission into our ports, that was so impure as to be actually
alive with worms. This statement is made by one of the ex-
aminers.

Pure Smyrna opium is in irregular, roundish masses, of a
highly bitter, nauseous taste, and brownish, red color, and more
or less soft, according as it is fresh or old. In Mohr's Treatise,
a method is given for ascertaining the proportion of morphia,
and I beg leave to incorporate a succinct account of it in this
report : Half an ounce of opium is to be macerated in an ounce
and a half of cold water, for twenty-four hours, then strain and
strongly express. Repeat the maceration for six, and then
again for three hours. Prepare a thick milk of lime with one
drachm of quick lime, to which add the infusion when boiling
hot. Boil for five minutes, then strain through a cotton cloth,
wash the residue with boiling water, and express. Evapor-
ate the liquor thus obtained to one ounce, filter through pa-
per, and heat to boiling. Then, by the addition of one scruple
of muriate ofammonia, the impure morphia will be precipitated.
Allowing from six to twelve hours for the precipitate to collect,
it is then to be dried and weighed. This will afford the mor-
phia exclusive of narcotine.

Bicarbonate of potassa crystallizes in oblique prisms, thus
distinguished from the carbonate, which exists in a granular
form. It may be remarked here, that the crystalline form of
the various chemical compounds affords ready means for ascer-
taining their character. Every inorganic mineral, whether
compounded in the laboratory of nature or of the chemist,
possesses a certain definite crystalline form, which it will as-
sume at all times, unless the presence of a foreign substance
gives to the crystal-making particles different axes, and there-
by create a new and different form; and such will be the result.
Crystallography, therefore, furnishes invaluable aid in chemical
analysis. This salt of potash is adulterated with the sulphate,
muriate and carbonate. The sulphate is detected by nitrate of

420 Adulteration of Medicines. [July,

barytn, the muriate by the silver test, and carbonate of potash
by the action of corrosive sublimate if even a trace is pre-
sent, a brick red precipitate being produced.

Bitartrate of potash is known in commerce only in the pow-
dered form, and is, therefore, frequently adulterated. Marble,
alum, gypsum, bisulphate of potassa, flour, rice and starch, are
used for this purpose. C. V. Hagner, in the American Journal
of Pharmacy, gives his experience in drug grinding. It was
with this article that he commenced this business. For many
years he had the entire control of such work, until his process
became known, and rival establishments sprang into existence.
One of these establishments failed, and one of the hands sought
employment with him. He could do every thing "powder
this, powder that, and grind 'tother never had any difficulty
except in grinding cream tartar." I expressed, says Mr. Hag-
ner, my astonishment, knowing it to be the easiest thing in the
whole catalogue of drugs to powder, and on asking him what
the difficulty was, he replied, quite innocently, "the alum al-
ways sticks the stones fast."

In testing it for its impurities, marble and gypsum will remain
undissolved in any amount of water alum will be precipitated
in a gelatinous form, by heating the solution to the boiling point,
and then adding ammonia until the liquid acquires an alkaline
character.

Iodide of Potassium. The principal adulterations of this
valuable medicine are carbonate of potassa and chloride of so-
dium. Iodide of potassium is very soluble in water, and in five
times its weight of alcohol is slightly deliquescent and of a
pungent taste. Carbonate of potassa is insoluble in alcohol
is very deliquescent, and consequently its presence wi.l cause
the iodide to assume a pasty, semi-fluid condition. It will also
effervesce with acids, and redden turmeric paper. Either of
the chlorides may be detected by the silver test. The quantity
of iodine present may be ascertained by separating it from the
potassium by heat, condensing the scales and weighing either
of the ingredients separately. In a sample analyzed by Dr.
Christison, he found 74 parts of carbonate of potassa, 16 of wa-
ter, and only 9 of the iodine.

Sulphate of Quinine. The ingenuity of man has been at
work to discover substances with which to adulterate this valu-
able medicine. Whatever would the more closely resemble it
in its physical properties, seemed to have been sought out with
avidity for this base purpose. At one time cinchonine was
made to retain its place with the chemical then salacine was
ascertained to possess somewhat similar properties, and was
mixed with it in large quantities and then again mannite, and

1853.] Adulteration of Medicines. 421

stearine, and starch, were severally used for the purpose. But
a new principle has been recently discovered in a species of
Peruvian bark found in Maracaibo and Carthagena, which,
from its great resemblance to quinine, has been called quini-
dine. There is not the least doubt that our valuable sulphate
is largely adulterated with this inert substance. So fully im-
pressed have our examiners been with this belief, that they have
rejected large quantities of these false barks. Zimmer has
published a severe test for this new principle, and I here present
the association with the appearance presented by two samples
of quinine, tested according to his mode. The one, which was
taken from an ounce jar of Powers & Weightman's manufac-
ture, is almost transparent, there being, however, a thin film
between the separating fluids. The other, taken from a jar
labelled Rosengarten & Denis, is, as you see, a dense mass of
filthy impurities, suspended between two fluids. Zimmer's
test is as follows : To ten grains of the salt add ten drops of
diluted sulphuric acid and fifteen drops of pure water, in a
strong test tube fitted tightly with a cork, and apply a gentle
heat to accelerate the solution. When cooled, add to the solu-
tion fifty drops of officinal sulphuric ether, with twenty drops
of spirits of ammonia, and shake the mixture while the top is
closed by the thumb. The tube is to be then closely stopped
and shaken gently from time to time, so that the bubbles of air
may more readily enter the layer of ether. " If the salt exam-
ined be free from cinchonine andquinidine, or contain the latter
in no greater proportion than ten per cent., it will be complete-
ly dissolved ; while, on the surface, where contact of the two
layers of clear liquid takes place, the mechanical impurities
only will be separated. If more than a tenth of cinchonine or
quinidine be present, an insoluble precipitate will be found
interposed between the two fluids. If it be quinidine, it will be
dissolved on the addition of ether, while cinchonine will remain
unaffected. " Other impurities may be detected as follows:
Gypsum, chalk and magnesia, are left undissolved boracic
acid is soluble in alcohol, and tinges the flame green, if ignited.
Cold sulphuric acid, C. P., will not form a colorless solution if
stearine, sugar, mannite or salacine be present.

Rhubarb may be obtained of two varieties, the Chinese or
India, and Russian or Turkey. The English, though some-
times substituted for the other sorts, is very inferior, and not
at all reliable. This, and also the India, are assorted, and the
better specimens disfigured to resemble the Turkey ; as much
as the fifth of a cargo being found to be these inferior sorts.
To lighten the color, tumeric is rubbed over the root, or mixed
with the powder, to which there is also added a proportional

n. s. VOL. IX. NO. VII. 27

422 Adulteration of Medicines. [July,

quantity of gamboge to increase its cathartic effect. This may
be detected by digesting in ether, and pouring a few drops of
the solution on water : " if gamboge be present, a film of opaque
yellow color will be found floating on the surface, which is dis-
solved by potash, and is changed to an intense red color." It
is stated that within eighty days previous to the passage of the
Drug Law by Congress. 7,000 pounds had been passed through
the Custom House of New York, not one pound of which was
fit for use. Some were worm-eaten, others deteriorated by
age, and the remainder had evidently undergone maceration to
extract the active properties for the preparation of extract of
Rhubarb. And doubtless all of this was subsequently powder-
ed, and so fixed up as to sell for a high price as true Turkey
Rhubarb.

Scammony. One o[ the rarest medicines to be found is Pure
or Mr gin Scammony. It bears a high price, and both physi-
cians and apothecaries seem more content with the cheaper
adulterated article, than to risk the sale, or incur the expense
of the genuine. Of the three varieties, the Smvrna is good for
nothing, the Aleppo contains about 30 per cent, and the Virgin
Scammony 78 per cent. The Lancet for February, gives an
account of theexamination of thirty samples procured in London.
Out of thirteen samples of Scammony in cake, one only was
genuine; the others being adulterated from 8 to 75 per cent.
One sample was entire!}7 factitious, being composed of the re-
sins of guaiacum and jalap, with woody fibre, cellular tissues, &c.

Out of seventeen samples of powdered Scammony, only one
was genuine, the others varying in adulteration from 18 to 65
per cent. The adulterating substances consisted of chalk,
wheat flour, sand and earthy sabstances, gum, woody fibre and
cellular tissue. I take pleasure in presenting samples of this
gum resin, in cake and in powder. Pure Virgin Scammony
should contain 78 per cent, of resin. Chalk will be detected by
effervescence with acids, and flour or starch, by the Iodide test,
and by the microscope.

Nitrate of Silver is offered for sale in the form of pure crys-
tals, or in rolls or sticks, designated as No. 1. and No. 2. The
three varying in purity from the pure to 60 per cent, and 30 per
cent. The adulterations of this last, are so abundant as to ren-
der it unsafe for administration. For internal use none but the
pure should be used. The usual adulterations are nitre, lead,
zinc and copper. Hydrochloric acid will detect nitre, by
separating the silver as an insuluble chloride, and then testing
for the nitre in the solution. Copper will afford a blue color,
with caustic ammonia, and lead will be blackened by sulphur-
etted hydrogen.

1853.] New Splint for Fracture of the Radius. 423

Spirits of Nitric Ether. Nothing is more common than to
dilute this valuable diaphoretic with variable proportions of
water and alcohol. Hence the physician is often disappointed
in the result derived from its employment. Water having the
effect to render it heavier, will raise its specific gravity, and
alcohol will change its odor. The commercial articles general-
ly contains 33 per cent, of water.

Thus much for the analytical view of our subject. There
is another means within our power for exposing these base
frauds. The eye aided by the microscope, can be familiarized
with the appearance of pure and genuine substances, and fails
not to detect when one is mixed with another. The forms of
crystals readily reveal to us their chemical character, it being a
fixed law of the crystalline forces, that a substance will assume
the same crystalline form, if left alone or unmixed, wherever
made ; but it was not until recently, that the microscope was
discovered to subserve such an important purpose in the ex-
amination of powders and other medicines. Crystalline organic
products have been found to possess as great a diversity in
structure and form, as inorganic crystals, and according to Dr.
Pereira and Mr. Queckett, may be used as a criterion of their
purity. They may thus be referred to their respective organs.
These indications are offered, it matters not how minute they
may be, in the form of the cells, the shape of the starch
granules, and the condition of the spiral vessels of the organic
product. Of course, the examiner should be acquainted with
the appearance of undoubtedly pure substances, so as to be
enabled to form a correct conclusion. [Southern Jour, of Med.
and Phys. Sciences.

New Splint for Fracture of the Radius. By Dr. Boxd.

[We give below some of the directions presented by Dr.
Bond to the Philadelphia College of Physicians, for the use of
the splint referred to in this Journal of the 12th inst. It may
be well to mention that Dr. Hays suggests, in the last number
of the American Journal of the Medical Sciences, a substitute
for the splint of Dr." Bond in fractures of the lower end of the
radius. He thus describes the simple manner in which he has
made it. The cover of a cigar box being cut into a proper
shape, a double layer of cotton wadding was laid over it. " A
strip of muslin, six yards long and three inches wide, was rolled
up to within two yards of its end, and then a pin placed at each
edge, not opposite to each other, but one a little nearer to the
end than the other, so that the roll made, with the straight piece,
an angle, the same as that made by the bottom of the splint

424 New Splint for Fracture of the Radius. [July,

with its front edge. The roll was then placed on the end of
the splint, the strip carried over the back, then turned over the
front, over the roll, and again to the back, when the angle gave
to the strip a direction which carried it over the edge and in
front of the roll to the opposite edge. The strip was then
continued over from edge to edge until the whole splint was
covered. The following is Dr. Bond's account of his appa-
ratus.]

1. With a light board, of proper thickness for a splint, take
a profile of the well fore arm and hand of the patient, placing
the hand in its habitual inclination towards the ulnar side of
the arm, and extending the profile from the elbow downwards,
so that it will reach the second joint of the fingers on the in-
side, when these are moderately flexed as much flexed as they
are when the points of the thumb and fingers are brought into
contact. The lower end of the board must be cut off obliquely
(at an angle of fifteen or eighteen degrees) in a direction cor-
responding with that of a body grasped in the hand, when the
hand is inclined to the ulna, as above indicated.

2. Cover the board, thus prepared, with sheeting, or other
strong fabric. This may be done by winding around it, from
end to end, a narrow rolling bandage, covering all of it as near-
ly as may be, with few or no duplications. This is the most
expeditious method. A neater one is to cut a piece of sheeting
of the general form of the board, but extending beyond the
board on every side, and fastening it upon the board either by a
few stitches, drawing towards each other the overlapping edges,
or glueing down those edges upon that side of the board which
is to be towards the arm, and which edges are to be covered
with the pasteboard.

3. Prepare a block of soft, light wood, from seven-eighths to
eleven-eights of an inch thick, and from two to two and a half
inches wide, according to the size of the patient's hand, and of
a length corresponding with the width of the board in the palm
of the hand. This block is to be carved and rounded, so as to
adapt it to the form of the hand, and make it easy for the thumb,
and in the grasp of the hand when it is placed on the board. It
is to be fastened there by screws or nails, so that the remote
edge of it shall correspond exactly with the lower oblique end
of the board.

4. Upon that part of the board not covered by the palm-
block, fasten, by means of small carpet tacks, a piece of book-
binder's pasteboard, extending on each side be\ond the edges of
the board about an inch. If the pasteboard be very thick
and stiff, make a slight incision in it along the edge of the
board, in order to bend more easily the two projecting por-

1853.] New Splint for Fracture of the Radius. 425

tions of it, thereby making a kind of box for the lodgment of
the arm.

It seems to me that this splint, or one constructed on the same
principles, will meet the above mentioned indications in the
following manner : First. The form given to the board retains
the hand in its habitual inclination towards the ulnar edge of
the arm, accomplishing the object aimed at by Dupuytren's
attele cubitale, with as much certainty, with more simplicity,
and more comfort to the patient. Second. The palmer-block
retains the hand in its habitual inclination backwards, and it
gives the fingers that moderate flexion which most relieves the
muscles from tension, and likewise that position which, if stiff-
ness should result, will not only save the hand from a most in-
convenient, ungraceful deformity, but will reserve to it the
power of performing very many of its most frequent and use-
ful functions. In addition to these advantages, this block con-
tributes much to the comfort of the patient. Third. The object
in covering the board with a strong fabric, as above described,
is to retain the bandage with certainty in its place, without ap-
plying it with a dangerous tightness ; for, by fastening the rol-
ler to this covering with pins, the surgeon need never have
his patience tried by finding his dressing deranged, at his next
visit. I can speak with confidence on this point, from having
used it repeatedly in cases where this quality was fully tested.
Fourth. The pastboard is not an essentially necessary part of
the splint, but it will be found to contribute to the comfort of
the patient and the convenience of the surgeon.

The requisites for dressing with this splint are flannel or other
soft fabric, to cover or line the inside of the splint; two com-
presses ; a roller ; sometimes, but not always, a dorsal splint.

The flannel or other fabric with which the splint is lined
should extend a little beyond the edge of the paste-board, and the
same piece may be extended over the palmer block ; but it will
be better to cover this block with a separate piece. For this
purpose take a piece of flannel large enough, when it is doubled
to cover the block. Through the doubled edge, with a proper
needle, carry a small string (such as ligature- twine,) and tie this
around the splint immediately above the block. The covering
of the block thus applied may be conveniently changed, with-
out removing the arm from its bed.

Two compresses will generally be required: the anterior or
palmer, and the posterior or dorsal. The proper construction
and application of the former of these are a most important
point in this dressing, and certainly not less so when long,
straight splints are employed ; and deformity of the radius or
wrist will most frequently result from negligence or want of

426 Treatment of Erysipelas. [July,

skill in its use. If the compress be deficient in thickness, and
the bandage be applied with its usual tightness, there will not
fail to be either a curvature forwards, or a sigmoid flexure,
which are the usual deformities. If the thickness of this com-
press be excessive, there may be a curvature backwards, which
I think seldom occurs; but there will be such undue pressure
by such a compress as to increase the danger of adhesions, and
to aggravate the discomfort of the patient. [Boston Med. and
Surg. Journal.

On the Treatment of Erysipelas by the Muriated Tincture of
Iron. By W. H. Ranking, M. D., Cantab., Physician to the
Norfolk and Norwich Hospital.

Charlotte Andrews, eet. 23, a fat, strumous girl, was admitted
into the Norfolk and Norvvick Hospital, under my care, in April,
for engorged and suppurating cervical glands, which were
treated by generous diet, cod-liver oil, free lancing, and subse-
quent dressing with the iodide of lead ointment, an application
which I may state in passing, appears to me to be more suitable
to scrofulous ulcers than any other with which I am acquainted.
Under this treatment her progress was all that could be desir-
ed, until the 26ih of May, when my attention was called to an
erysipelatous redness over the right breast. This quickly ex-
tended, and in spite of the assiduous endeavor on the part of
our intelligent house-surgeon, to limit its boundaries by the
nitrate of silver, it soon invaded the head and face, inducing
those serious symptoms which are observed in these cases. As
soon as the disease fully declared itself, no time was lost, as is
my invariable custom, in sustaining the powers of the patient
by wine, beef tea and ammonia, the local application being
flour.

On the 28th the disease had continued to extend, and as the
patient was losing strength, the ammonia was replaced by
quinine.

On the 29th, the report is, that the erysipelas had occupied
the entire head and face, and was creeping down the back.
The patient was delirious, with drv tongue and feeble pulse of
130.

On the 30th she was still worse, the tongue was more dry
and dark, and diarrhoea was added to the other unfavorable
symptoms. Wine was given in increasing quantities, so that
she took more than a bottle in the twenty-four hours.

June 1st. She was still more depressed; pulse 140. flut-
tering ; the face livid, and she appeared to be fast sinking.

3j Treatment of Erysipelas.

1853.] lreatment of Erysipelas. 427

At this time, I determined to administer the muriated tincture
ofiron, as recommended by Mr. Bell, of Edingburgh, and did
so, as will be seen, with the best results. The dose was forty
minims in water, every three hours. In the evening, after three
doses, the pulse was still 140, but had more resistance to the
finger, and she was left for the night, with orders to continue the
medicine and wine.

On the 2d, there was a most marvelous change for the better.
The tongue, which the day before was dry and dark, was now
moist and cleaner, the pulse had sunk to 120, and the patient
was able to raise herself in bed. The i'ace was desquamating,
and her only complaint was urgent thirst, which was gratified
with water ad libitum.

3d. I continued the iron in doses of thirty-six drops. The
improvement was still more manifest; the face had become
more natural in appearance, and she was pronounced out of
danger. From this t i rr? e her recovery was uninterrupted.

Knowing how difficult it is to establish a medical fact, I am
prepared to find that some of my hearers may dispute the agen-
cy of the iron in the girl's recovery. On this point I would only
say, that prior to her taking that medicine, she lost ground
hourly, in spite of the freest exhibition of wine, ammonia and
quinine ; and that after three or four doses a perceptible advan-
tage had been gained, which advantage was rendered indispu-
table on the next day, by the improved condition of the pulse
and tongue, and the rapid subsidence of the cutaneous engorge-
ment.

I take no credit to mysely for this mode of treating erysipe-
las, but most willingly record my obligation to Mr. Bell of
Edingburgh, who published a paper on the subject in the
"Monthly Journal of Medical Sciences" for June, 1851. That
gentleman's testimony as to the value of this treatment is most
strong ; he says that in every instance in his practice it has been
successful. His brother, Dr. Charles Bell, is equally impressed
in its favor ; and he states that it not only removes the disease
in a short time, but also renders the patient less susceptible of
returns of the disease. In pursuing the chalybeate treatment
of erysipelas, Mr. Bell regards it as important to bring the sys-
tem rapidly under its influence, and acting on this conviction,
I gave, in the case above related, even larger doses than Mr.
Bell had sanctioned.

Although thecase I have related was an instance of idiopa-
thic erysipelas, ihe treatment is said to be equally beneficial in
the traumatic form, and in infantile erysipelas. Of the latter,
Mr. Bell, details some remarkably interesting cases. [Prov,
Med. and Surg. Journal.

428 Elective Elimination of certain Substances. [July,

Dr. Bernard's Experiments on the Elective Elimination of
certain Substances by the Secretions.

Dr. CI. Bernard has written a very interesting account of
certain experiments made by him "on the elective elimination
of certain substances by the secretions, and in particular by the
salivary secretion." He remarks in limine that this secretion
has not been examined with the same care as the urine, bile,
milk, &c, in regard of the circumstances alluded to; and that
it remains to be explained how the saliva chooses some, while it
rejects other substances equally soluble in it. He performed
two sets of experiments, which were ingeniously contrived
and carefully repeated.

In the first series of experiments he injected into the right
jugular vein a solution of yellow prussiate of potash, of iodide
of potassium, and of grape sugar, and immediately thereafter he
detected the second substance in the saliva, but neither of the
other two ; while in the urine, the prussiate of potash could be
detected, but neither the iodide nor the sugar. Twenty-five
minutes after the injection, abundance of the prussiate of potash
was found in the urine, only a trace of sugar but still no iodide.
The saliva remained as before. The secretions were tested
every half-hour, but no change occurred till the end of two
hours, from the time after injection, when the iodide of potas-
sium at length appeared in the urine. Neither the prussiate
nor the sugar appeared at any time in the saliva, which elimina-
ted only the iodide of potassium ; and it is worthy of remark
that this salt appeared immediately in the saliva, while it was
not detected in the urine for two hours. When, however, the
solution of the iodide was stronger, it appeared sooner in the
urine, though never within the hour.

In the second series of experiments, M. Bernard injected
these three substances in solution, severally into the veins of the
same animal at different times, as well as into the veins of dif-
ferent animals, and he always found that they comported them-
selves in exactly the same manner. Such was the case,
likewise when they were introduced into the stomach. Both
grape and cane sugars, like the prussiate of potash, never ap-
peared in the saliva, while they were eliminated more slowly by
the urine. Thisobservation seemed to contradict the assertions
of some authors, regarding the saliva of diabetic patients, but
on actually testing this secretion in 'laCharite,' M.Bernard
found that there was no trace of sugar in the saliva, while how-
ever, it could be detected in the expectoration from the bron-
chi, of such patients as had phthisis combined with diabetes.
Neither sugar nor prussiate of potash would seem to pass into
the bile, or into the pancreatic juice, in ordinary circumstances,

1853.] Elective Elimination of certain Substances. 429

but when sugar was strong in the blood, it was found in the bile,
but never in the pancreatic juice.

In regard to the elimination of sugar from the economy, M.
Bernard has noted a very curious fact, viz., that though the
mammary secretion naturally contains a kind of sugar, it does
not allow either cane or grape sugar to pass by it. Sugar of
milk is much more difficult of fermentation than the other kinds
of sugar, and may thus be distinguished from them.

When the iodide of potassium was injected into the vein of a
dog, or introduded into its stomach.it could always be detect-
ed in the saliva within forty seconds. It also passed with
rapidity into the tears, and into the pancreatic juice, while it
passed with much greater slowness into the bile, in which it
was often difficult of detection.

M. Bernard also injected lactate of iron into the veins of dogs,
and never found it eliminated by the saliva; in which respect
it agreed with the sugars and prussiate of potash. When
iodide of iron was carefully injected into the vein of a dog, both
iodine and iron were found in the saliva. In another dog, a
solution of the iodide of potash was introduced into the stomach
by a fistulous opening, and afterwards another solution of lac-
tate of iron ; both substances were thereafter detected in the
saliva, showing that the iodine gave to the iron the capability of
being eliminated by the saliva.

M. Bernard at present merely wishes to call attention to
these interesting facts, and does not offer any explanation of
them. But the property which certain substances seem to pos-
sess, of being eliminated by different secretions, is not their only
peculiarity. Their period of sojourn in the economy is also
importantly different. Thus, M. Bernard remarks that the
iodide of potassium and other substances, perfectly soluble, and
really dissolved in the blood, remain for a certain time within
some of the organs of the body ; and he finishes his paper with
the following account of the experiments made by him, in order
to investigate this sojourn of the iodide of potassium in the
animal economy. He introduced into the stomachs of several
dogs, which had permanent salivary and biliary fistulae, a
solution of two grammes of iodide of potassium. The same day
the urine of these dogs exhibited the reaction of the iodide ; next
day it could be detected neither in the bile nor in the urine ; and
on several days following, no trace of it was found in these se-
cretions. It seemed to be completely eliminated from the
system ; but examination of the saliva showed its presence still.
The gastric juice also contained the iodide, both because it
contained saliva, and also because it was furnished directly
with it from the mucous membrane of the stomach. This per-

430 Treatment of Acute Rheumatism. [July

sistence of the iodide in the saliva and gastric juice continued
for three weeks, and possibly it may have continued longer.
Purgatives have a great effect on the sojourn of the iodide in
the economy ; indeed, so much is this the case, that if purga-
tives were employed, soon after the introduction of the salt into
the stomach, a few days sufficed for its total disappearance
from all the secretions.

In concluding M. Bernard observes, that these experiments
show that substances which are soluble, and capable of circu-
lating in the organism without producing mischief, present two
sets of phenomena worthy of remark.

11 1st. Some substances never pass into certain determinate
secretions, e. g. the yellow prussiate of potash, cane and grape
sugars ; others show themselves in all the secretions, only with
greater or less rapidity, e. g. the iodide of potassium.

" 2d. Some of these substances are eliminated completely and
rapidly from the economy, e. g. the yellowT prussiate, sugars,
&c. ; while others are only partially eliminated by the urine,
and may remain in the organism, showing themselves in other
secretions for a longer or shorter time. The iodide of potas-
sium offers a remarkable example of this prolonged sojourn of
soluble substances in the organism, a sojourn which, in the
case of that salt, is prolonged, because the portion not elimina-
ted and re-appearing in the saliva, instead of being expelled
from the system is constantly thrown back into the stomach,
whence it is taken up by the circulation, and returned to the
saliva, and soon.

"The chief conclusion," he continues, 'to be drawn from
this work is, that one cannot yq^qy to any general law, the man-
ner in which these substances act in the organism. The ex-
periments made on one saline substance, can teach nothing
regarding another : no one could have foreseen, for example,
that the iodide of potassium, and the yellow prussiate of potash,
salts equally poluble, should offer, in respect of their passage
into the secretions, and of their elimination from the body, dif-
ferences very striking. Special researches on each particular
substance are necessary in order to establish physiological
history, which ought to be intimately connected with its mode
of action as a therapeutic agent." Archives Generates de Med-
ecine. Med. Examiner.

Treatment of Acute Rheumatism. By Edwin R. Maxson, M.D.,

Adams' Centre, Jefferson Co., New York.

As acute rheumatism is a disease the pathology of which has
been a matter of doubt, and the treatment consequently various,

1853.] Toynbee, on Ear. 431

I here offer a plan of treatment which I have found very satis-
factory.

In a severe case, in which the inflammatory fever runs high,
if the arms are suffering, I draw from two to four ounces of
blood, by cups, from each side of the spine, near the origin of
the brachial nerves, between the shoulders. If the lower limbs
are suffering, I draw the s;ime quantity, by cups, from each
side of the spine, in the lumbar region, near the origin of the
crural nerves. This generally relieves the pain in the limbs
immediately, and checks the progress of the disease. I pro-
cure an evacuation of the bowels by mag. sulph. 5ss., repeated,
if necessary, and then give potassa nit. Bi., dissolved in a tea-
cupful! of warm gruel, every three hours, and continue this till
the fever and inflammatory symptoms subside, which will gen-
erally occur in from four to six days.

At this stage, there is generally left slight swelling and some
stiffness of the joints. I then discontinue the nitrate, and give
potassa iodide, gr. x., with vin. colch., gtt. xx., every six hours.
This should be continued till the slight swelling and stiffness of
the joints subside, which may take place in from four to six days.
The appetite will, in the mean time, generally become good.
The patient then need only be directed to take potassa iodide,
gr. v., three times per day, for a few days more, to prevent a
relapse and render the cure permanent. \_Buffalo Med. Jour.

On a simple Method of ascertaining, without the use of the
Catheter whether the Eustachian Tubes are pervious ; with
some observations on the Treatment of cases of Obstruction
in these Tubes. By Joseph Toynbee, F. R. S.

The author pointed out the objections to the two ordinary
modes of exploring the Eustachian tubes viz. that the use of
the catheter is liable to produce pain and discomfort ; that
without experience, it is not easy to ascertain whether it be
really in the tube; that the plan of attempting to distend the
tympanum by a forcible expiration, while the mouth and nostrils
are kept closed, is not always successful, from the fact that the
young and nervous cannot be taught to perform the act, and
that sometimes, when it is properly done, the guttural orifices
of the tubes seem to be pressed together so as to preclude the
air from entering. In a paper recently read before the Royal
Society, the author endeavored to show that the guttural orifice
of each Eustachian tube is generally closed, and that the air in
the tympanum is not continuous with that in the cavity of the
fauces, except during the momentary act of deglutition. In
proof of this the following experiment was cited : If the mouth

432 Toyjibee, on Ear. [Jul)',

be shut, and the nostrils be held closed by the finger and thumb,
and then the act of swallowing be performed, a sensation of
fulness or pressure is experienced in each ear ; and this sensa-
tion does not disappear upon the removal of the pressure from
the nose, but it vanishes at once when the act of swallowing is
again performed, while the mouth and nostrils are open. During
the first act of swallowing, a small quantity of air was forced
into the tympanitic cavities through the Eustachian tubes, and
it therein remained until the second act of swallowing again
opened the tubes and permitted the air to escape. The muscles
whereby the Eustachian tubes are opened are the tensor and
levator palati, which it is well known take origins from the car-
tilaginous walls of the tubes. As, during the act of swallowing
with closed mouth and nostrils, air is forced through the Eus-
tachian tubes into the tympanitic cavities, it is evident that the
permeability of these tubes can be ascertained by making the
patient swallow some saliva while the mouth and nose are shut.
Nor need the surgeon depend upon the statement of the patient
respecting the sensation of distension felt in the ears; for, by
listening with the otoscope, should the Eustachian tubes be
pervious, the air will be distinctly heard to enter the tympanitic
cavities, and produce a gentle crackling sound. The author
next proceeded to consider the treatment of cases of obstruction
of the Eustachian tubes, especially in reference to the use of
the catheter. It having been ascertained that these tubes are
obstructed, is it desirable to attempt to open them by means of
the catheter? Believing that obstruction in the Eustachian
tubes generally depends upon a thickened state of the mucous
membrane covering the guttural orifice, and that this state is
always associated with a thickened condition of the faucial
mucous membrane and of the mucous membrane of the tympa-
num, the author suggests especially to those inexperienced in
the use of the catheter, not to attempt to pass this instrument
firstly, because, in such cases the mucous membrane of the
Eustachian tube is often so tumefied that no ordinary degree of
pressure will force the air into the tympanum; and, secondly,
because, should the surgeon succeed in transmitting a few air-
bubbles, the relief obtained is only partial and endures for a
very brief period, since the mucous membrane remains as
thick as before, and the ill effects of the obstruction soon recur,
from the air in the tympanum becoming of a different density
from that without. The membrana tympani becomes more or
less fixed. The treatment recommended is such as shall tend
to reduce the thickened mucous membrane of the guttural orifi-
ces of the Eustachian tubes to a healthy size, so that there
.muscles may be able to open them. For this purpose besides

1853.] Cotyledon Umbilicus in Epilepsy. 433

the use of general remedies, the solid nitrate of silver, or a strong
solution of hydrochloric . acid, may be applied to the mucous
membrane of the fauces and to the apertures of the tubes, and
gentle counter-irritation is to be kept up over the region of the
fauces. By these measures, as a general rule, the mucous
membrane can be reduced to its natural state, and the tubes
become again opened by their muscles. Should this not take
place, the Eustachian catheter may now and then be introduced
and air be gently blown through it. A modification in the
shape of the Eustachian catheter is suggested viz. that it
should be oval instead of round, the advantages derived being
that it not only can be passed through the nose with less discom-
fort to the patient, but its presence in the Eustachian tube is
much less disagreeable from the absence of the convex surfaces
which, in the rounded catheter, press against the nearly flat
surfaces of the tube. In conclusion, the author expresses his
coucurrence in the opinion of Harvey and Kramer, that enlar-
ged tonsils are never the cause of obstruction in the Eus-
tachian tubes, and that any benefit that may have followed
their extirpation has arisen from the loss of blood consequent
upon the operation. [Lancet.

Cotyledon Umbilicus in Epilepsy.

This agent has gained some reputation in the treatment of
that obstinate malady, epilepsy. Dr. Abbot submitted the fol-
lowing to the above society :

He had administered in the dose of five grains of the
extract, night and morning, for eight months, with entire
cessation of the fits during that period. The patient was a
gentleman, upwards of fifty years old, who had been subject to
the disorder for five or six years ; the epileptic fits occurring,
at the time the use of the remedy was commenced, as often as
once in two or three weeks, with one or more attacks of epileptic
vertigo daily. The vertigo, under the use of the remedy,
diminished in severity, but not in frequency. At the end of
eight months, the patient began to totter very much in his gait,
with frequent "dropping turns," as if from his legs "giving
way" under him, with only partial loss of consciousness. No
convulsion, but a slight general tremor, wfth some rigidity of
the limbs. A feeble, unexcited pulse, and no flush or heat of
countenance. At this time, the use of the cotyledon umbilicus
was discontinued, and a small quantity of phosphoretted oil was
given, which was followed on the third day by a bad epileptic
fit, and Its use was consequently abandoned. Since that time,
the epileptic attacks have occurred at intervals of three or four

434 Chlorate of Potash in Stomatitis. \i\i\y,

weeks, and the other morbid phenomena are of daily occur-
rence. Under these the powers of life appear to he gradually
failing.

Dr. H. O. Stone referred to two cases in which the cotyle-
don umbilicus had been used with good effect. In one case
there was an interval of one hundred days between the fits,
after using the medicine a short time. [ Western Lancet.

Chlorate of Potash in Ulcerative Stomatitis and Cancrum Oris.

Dr. J. H. Babington states (Dublin Quarterly Journal, Feb.
1853) that, in an epidemic of ulcerative stomatitis which occur-
red in the Coleraine Union Workhouse, in 1849, he used the
chlorate of potash with great success. The treatment adopted
was a mild aperient of rhubarb and magnesia, and the adminis-
tration of chlorate of potash, dissolved in water, sweetened
with syrup, in closes of four grains every fourth hour ; the mouth
was aiso washed with a week lotion of solution of chloride of
soda. They all recovered in about six days. Dr. B. treated
one case with alteratives and tonics, and it was three weeks
before it got quite well ; thereby proving the efficacy of the
chlorate of potash. [ American Jour. Med. Science.

Case of Accidental Poisoning with half an ounce of Tartar
Emetic, successfully treated with Green Tea and Tannin.
By Stephen A. McCreery, M. D., U. S. N. (Communica-
ted bv Thomas Harris, M. D., Chief Bureau Med. and Surg.,
U.S.N.

On the morning of the 28th of September, 1852, Dr.

feeling a little indisposed took twelve grains of blue mass. At
half past two o'clock, P. M., some hours later, he took on an
empty stomach what he believed to be (and what he had
ordered) half an ounce of Rochelle salts with forty grains of
bicarbonate of soda and as much tartaric acid. Immediately
afterwards he dined sparingly on ham, the breast of chicken,
and, tomattoes, and after dinner ate two ripe figs. In about
thirty-five or forty minutes after taking the medicine, he expe-
rienced some nausea, but attributing it to his indiscretion in
having eaten so soon after taking the powder, he resisted the
disposition to vomit which every moment became more urgent.
In the course of four or five minutes, however, he was obliged
to yield to it, and vomited twice very freely, after which he
felt relieved. In two or three minutes the nausea and
vomiting returned, and he then began to suspect that he had
received the wrong medicine. Instant inquiry was made, and

1853.] Poisoning with Tartar Emetic. 435

it was discovered that the person who had put it up had mista-
ken the antimnnii et pntassce iartras for the sodce st poiassce
tartras. Dr. Thomas Williamson, of the Navy, saw t he patient
at twenty-five minutes past 3 P. M., and immediately ordered
for him copious draughts of green tea and large doses of tannin.
Albumen, the infusion of flaxseed, and of the slippery elm, and
iced water were also fieely administered. The vomiting,
which was very distressing, continued writh little intermission
until 9 or 10 o'clock in the evening. There was also very
severe purging with most violent cramps of the legs, and slighter
ones of the wrists. The first evacuation from the bowels was
purely serous; those which followed were of a bilious charac-
ter, but very loose. There were no cramps of the stomach.
When it was thought that the stomach and bowels had been
cleared of the poison, an injection containing tincture of opium
was given and repeated in a few moments. The injections not
being retained, a full dose of the acetate of opium was adminis-
tered by the mouth. Brandy, mint julep was also freely given
as the patient was very much prostrated. A large sinapism
was applied over the epigrastric region, and frictions were used
to the extremities during the paroxysms of cramp. Iced tea
and iced mucilaginous drinks were continued through the night.

September 29. The patient passed a better night than could
have been expected ; wras still nauseated, and complained of
great thirst, and had some headache ; the tongue was moist ;
there was no abdominal pain or soreness, or any burning sensa-
tion about the stomach ; the bowels were twice moved. Iced
tea, and iced milk, and arrowroot diet were directed.

30th. There was no vomiting or purging; no thirst; diet
and drinks were continued as before.

October 1. Rested badly the past night. Had headache and
nausea, and the tongue was coated with white fur, but there
was no febrile excitement. The iced drinks were continued,
and toast, and coffee, chicken broth, and oyster liquor were
allowed the patient.

2d. There was some slight irritation of the mucous mem-
brane of the throat, and pain on pressure in the upper and
right side of the breast ; no fever. A sinapism was applied
over the seat of pain, and the slippery elm bark and gum Arabic
were used to allay the irritation of the throat. The diet and
drinks were continued.

4th. There was still some slight irritation of the throat, and
some cough, but no pain in the chest nor fever. The patient
was allowed full diet. From this date he continued to im-
prove, and on the 13th was able to resume his ordinary occu-
pations. [Ibid.

436 Regeneration of Nerves. [July,

Regeneration of Nerves.

Dr. Augustus Waller has been engaged in a very interesting
series of investigations on the regeneration of nerves.* While
previous observers were contented with examining the nerve-
tubes at the point of section or in the cicatrix, this author has
pursued the investigation to the peripheral ends; and has
arrived at the interesting and unexpected result, that the old
fibres of a divided nerve never recover their original functions,
and that reproduction of a nerve takes place not only in the
cicatrix itself, but throughout the terminal ramifications. The
vagus of a dog having been divided, was examined after twelve
days, when it was found that the inferior segment was com-
pletely disorganized, the fibres being all converted into black
or irregular and opaque parcels, and the membranous tubes
destroyed. At the end of a month the condition was different :
almost all the disorganized substance had been removed ; new
fibres were found in place of the old, possessing all the charac-
ters of young fibres, and being very difficult of recognition,
owing to their grey colour, intimate adherence, and want of
double contour; but on the addition of organic acids concen-
trated acetic especially they were readily recognised as
embryonic fibres. The disorganized nerve presents nothing
similar, there being only an amorphous tissue, which dissolves
readily in acetic acid, without any residue. The areolar tissue
which surrounds the nerves presents nuclei, which, however,
it is easy to distinguish from those of nerve-fibres, they are
shorter, thicker, irregularly scattered on the surface of the
membrane, showing no approach to parallelism, and the tissue
itself does not separate into cylindrical fibres. The gelatinous
fibres of Remak, which present the same structure and reac-
tions as the young nerve-fibres, do not exist in appreciable
quantity in the vagus before its distribution to the oesophagus,
and hence cannot be a source of error in these observations.
The author thinks that the neurilemma plays an important part
in the regeneration of nerve-fibres : it remains intact during
the changes just described. The results of section applied to
the sympathetic fibres show that regeneration takes place in
them in a similar manner. The following remarkable results
were observed with regard to nerves in connexion with gan-
glia : the roots of a spinal nerve were laid bare, and cut above
the ganglion, in such a way as to leave a portion of them in
connexion with it ; the animal was again examined after twelve
days, when it was found that the sensitive part of the root

* Philosophical Transactions, 1850; various papers in the Comptes Rendus
of the Academic des Sciences, 1851, 1852.

*

1853.] Tetanic Symptoms from use of Iodide Potassium, 437

attached to the superior part of the ganglion was altogether
disorganized, in the same manner as when a nerve is cut in its
peripheral portion. The nerve, followed into the ganglion, ex-
hibited its branches disorganized, subdividing in the body, and
mixing with fibres altogether normal, and appearing to termin-
ate in a colleci ion of ganglionic structures equally altered. All
the fibres which passed out of the ganglion preserved their
normal condition, the state of the fibres being found the same,
after a month or more, as at first. The regeneration of the
superior fibres between the ganglion and the spinal marrow
takes place in the ordinary manner. The motor fibres were
completely altered and disorganized to their extremities. These
observations appear to be decidedly opposed to the views of
Valentin, who has advnnced the opinion that the ganglia are
not centres of innervation, but only a mechanical means for
the arrangement of the fibres.

After sections of the chorda tympani, which was effected
by passing a cutting instrument into the tympanal cavity, and
turning it in different directions the inferior portion was
found, at the end of from ten to twenty days, in the cat, dog,
and rabbit, to be completely disorganized. In all these animals
only about twelve or twenty normal tubes were to be found in
the midst of the disorganized textures. These tubes appeared
to the author to come from the lingual nerve, and to follow an
ascending course in the chorda tympani. [British and Foreign
Med. Chir. Rev.

Tetanic Symptoms from the use of Iodide of Potassium. By
D. P. Phillips, M. D.; Passed Assis't Surgeon U.S.N.

A case of some singularity having occurred under my own
observation, and thinking that it might not be devoid of interest
to you, I have concluded briefly to give its history.

Whilst Acting Surgeon of the U. S. ship Massachusetts, a
fireman, named J. White, was admitted upon my sick list with
rheumatism. I ordered the administration of iodide of potassi-
um, grs. viii. ter in die, to be taken before meals in a spoonful of
water. Soon after commencing with the remedy (probably
the second day) he complained of some uneasiness and stiffness
in the jaws; but supposing it to be some trivial affair, I paid
but litile attention to it. On the next day the difficulty had
increased, and I directed frictions with some stimulating lini-
ment; but when I saw him the day after, the jaws were im-
movable. Upon careful inquiry, I ascertained that ever since
he had been using the iodide he had experienced a burning and
uneasy sensation in the oesophagus and stomach. Upon learn-

N. S. VOL. TX. NO. VII. 28

V

438 Miscellany. [July

ing this, I discontinued the medicine, and ordered counter-irri-
tation over the stomach. In a few days the tetanic symptoms
entirely disappeared, and the iodide of potassium was renewed,
but diluted in a tumbler half full of water, and given #er each-
meal. The patient entirely recovered from rheumatism, and
had no return of the trismus. I attributed the unusual symptoms
entireiy to the use of iodide of potassium in too concentrated a
form. [Philad. Med. Examiner.

ill x 0 1 1 1 1 a n 2 .

Chloride of Soda. The efficacy of Chloride of Soda in the treat-
ment of Burns, Wounds, Ulcers, &c, has been so decided in our
hands, that we feel impelled to say a few words on the subject in con-
sequence of having, not unfrequently, found it to fail in the practice of
others ; and having always in such cases ascertained that the solution
used was much stronger than that we are in the habit of prescribing.

The American chloride of soda being very seldom good, we never
use any other than the French. The directions usually accompany-
ing Labarraque's bottles are, however, apt to mislead those who look
to them as a guide in its use. They state, for example, that " a mix-
ture of one part of the chloride with seven or eight of water has been
successfully used in chilblains and burns, and also for bad wounds,
especially for sores in which mortification has commenced." Now,
although so strong a solution may be useful when "mortification has
commenced" it will almost invariably aggravate the condition of burns
and recent wounds. Lisfranc, to whom we are indebted for its use in
burns, always recommended a solution of half an ounce in a quart of
water, insisting that the application must be weak enough to give
no pain, but, on the contrary, to allay this. The sudden relief of the
pain of burns which attends the application of this weak solution by
means of cloths dipped into it, and kept wet, is truly astonishing.
Whether the cuticle be removed or not, the relief is equally prompt,
and the ultimate cure more rapid than by any other medication. One
important effect of the remedy, especially in children, is, that it pre-
vents the excessive suppuration which is itself so often fatal in such
cases.

As an application, or wash, to recent wounds of a lacerated charac-
ter and to chronic ulcers, especially of the legs, we use a mixture of the
sarne strength ; and it is only in cases tending to mortification that we
ever apply it sufficiently strong to produce smarting. In short, if its

1853.] Miscellany. 439

antiphlogistic effect be desired, it must give no pain when applied
whereas, if it be used as a styptitor stimulant it must be made strong,
er. We know of nothing more irritating, and consequently injurious,
to a burn, new wound, or ulcer, than this solution, when made too

Collodionfor Chordee. We read in the " Revue de Therapeutique,
&c." that Dr. Doringer has recently tried the use of Collodion in a
case of Chordee, with good effect. The case was that of a young
man, who, in his third attack of gonorrhoea, was suffering very much
with chordee, which resisted the usual remedies. Dr. D. ordered
cold affusions to the organ until relaxation should occur, and then ap-
plied a thick coat of collodion to- the entire organ. The erections
ceased from that moment; but on the next day, the collodion having
been removed, they returned, and were again arrested with another
application of the coating.

The above appears to us to be an ingenious and useful application
of collodion, but also one not entirely free from danger. If the coating
be not carefully applied over the ei tire organ, including of course the
glans, and if it be not of uniform resistance, strangulation might re-
sult from the unequal compression whenever there occurred a ten-
dency to erection. The coating should be thick enough to prevent its
yielding at any point.

Fly Poison. The danger of using the article commonly called
Cobalt or Fly-Stone, the activity of which depends upon the arsenic
it contains, renders it desirable to get an innocuous substitute for it.
The Swiss, it is said, are in the habit of using, very effectually, a
strong decoction of quassia amara well sweetened with molasses.
The flies being fond of it seek it with avidity and are very promptly
destroyed.

It is said that an infusion or decoction of our poke root or the juice of
its berries, made sweet with molasses, will very effectually destroy
cockroaches. We have tried strewing the floor with cucumber peel-
ings, and found it better than anything we ever used for getting rid of
these filthy insects.

Deaths by Chloroform. The New York Journal of Medicine con.
tains a tabular statement of the thirty-three cases of death from Chlo-
roform recorded in the European and American periodicals up to the
end of 1 852, not including "those imperfectly reported, or those in

440 Miscellany. [July,

which the persons have taken it without the advice and aid of a pro-
fessional person." From these tablGfc, it appears that the anaesthetic
was administered fatally ten times for operations on the toes and fin-
gers, six times for the extraction of teeth, three times for operating on
fistula in ano and hemorrhoids, twice for the application of caustic,
once for opening abscess, and eleven times for other operations. Ten
of the deaths occurred before the operation was performed.

Treatment of Ulcers. We find in the " Revue de Therapeutique,
&c.'5 that Dr. Lasanna, an Italian physician, recommends highly an
ointment made of equal parts of tincture of iodine and Lard in the
treatment of ulcers in general. The application is made twice a day,
and has, according to him, healed in ten days most obstinate ulcers.

Death of Dr. Beaumont Dr. Beaumont, the author of the justly
celebrated researches on the subject of Digestion in a case of fistulous
opening into the stomach, has recently died at St. Louis, aged about
sixty-eight years.

American Medical Association.
We are indebted to the kind attention of Dr. Bulkley, Editor of the
New York Medical Times, for a copy of the proceedings of the Ameri-
can Medical Association, from which we derive the following sum-
mary :

The Association held its sixth annual meeting on Tuesday, May 3d,
in the Presbyterian Church, Bleeker-street, the President, Dr. Bever-
ley Wellford, of Virginia, in the Chair. The morning was occupied
by the Committee of Arrangements, in receiving delegates from the
several States. At 11 A. M., the President declared the meeting
organized, and welcomed the delegates to the city. There were near-
ly five hundred gentlemen present.

On motion, a recess of fifteen minutes was taken to allow the dele-
gates to select one of their number from each State, as a committee to
nominate officers for the ensuing year.

The following gentlemen wTere selected as the Nominating Com-
mittee :

District of Columbia, Thomas Miller; Illinois, N.S Davis; Massachusett
A. L. Pierson; Connecticut, Archibald Welch; Ohio, R. L. Howard; New
Jersey, Lewis Condict; South Carolina, H. R Frost; Pennsylvania, F. West ;
Vermont, E. S. Carr; Tennessee, J. B. Lindsley ; Missouri.C. A.Pope; New
Hampshire, J.Crosby ; Michigan, H. Taylor; Rhode Island, H. Allen ; North
Carolina, J. G. Tull Indiana, Joseph Somes; Delaware, H. F Askew; Ala-
bama, J A.English; Maryland, Joel Hopkins; Iowa, J. C. Hughes; New
York, Joseph M. Smith; Georgia, H. F. Campbell; Kentucky, J. B. Flint;
Maine, Isaac Lincoln ; Virginia, T. P. Atkinson.

Dr. Condie, of Pennsylvania, Chairman of Committee on Publica-

1853.] Miscellany. 441

tions, submitted a Report from the Committee, with resolutions ap-
pended, making the assessment for the present year $5; authorizing
the committee to decide upon the terms at which the volume of Trans-
actions for this year shall be furnished ; and further authorizing thern
to take such measures in relation to the disposal of the copies as they
may deem expedient, and that it should be their duty to inform the
members of the terms agreed upon by a circular. Dr. Condie stated
that a valuable paper would be submitted at this meeting, the mere
illustrations of which would cost 81,000 for printing.

The resolutions were adopted.

The Treasurer's Report showed the total receipts for the past year
to be, $1,905 ; paid out 82,015 ; balance due to Treasurer, $110.

On motion of Dr. Condie, the Committee was authorized to furnish
the Chairman of Committees on Epidemics wilh extra copies of iheir
reports, respectively, at the expense of the Association, the number
of said extra copies not to exceed one hundred

The President then read a long and very able address, reviewing
the origin, progress and benefits achieved by the Association.

Dr. Hays, of Pennsylvania, moved the thanks of the meeting be
presented to the President for his elegant, appropriate and eloquent
address, and requesting a copy for publication in the Transactions of
the Association. Carried.

The Secretary read a resolution passed by the Medical Society of
Virginia, recommending the appointment of a well-qualified chemist
to analyze the most prominent nostrums of the day, and publish the
results monthly in the leading newspapers of each State. Also, a
communication from the President of the American Medical Society
at Paris, appointing Drs. Pittman, Walton and Mcllvaine to attend
this meeting.

On motion of Dr. Atlee, the Committee on Publications were direct-
ed to send a full set of the Transactions of the Association to the So-
ciety in Paris.

A communication was received from Dr. Ramsay, of Georgia,
inclosing documents on personal matter, which, on motion of Dr.
Leving, of South Carolina, were laid on the table.
Dr. Joseph M. Smith, Chairman of the Committee on Nominations,
reported the following officers for the ensuing year :

For President Dr Jonathan Knight, of Connectic.it.

Vice-Presidents Drs. Usher Parsons, of R. I.; Lewis Condict, of N. J. ;
Henry R. Frost, of S. C. ; R. L. Howard, of Ohio.

Secretaries Drs. Edward L. Beadle, of N. Y., and Edwin S. Lemoine, of
Missouri.

Treasurer Dr. Francis Condie, of Penn. who were unanimously elected.

The committee reported St. Louis, Mo., as the place to hold the
next annual meeting.

The report was adopted.

On motion, the Secretary proceeded to call up reports for Special
Committees.

Dr. C. D. Meigs, of Philadelphia, presented a report on "Acute
and Chronic Diseases of the Neck of the Uterus," with a request

442 Miscellany. [July,

that it should be referred to Committee on Publication, without read-
ing.

The report was adopted and referred.

Dr. Condie, of Pennsylvania, Chairman of Committee on Causes of
Tubercular Diseases, stated that in consequence of his duties as
Treasurer and Chairman of Committee on Publication, he had not
been able to complete his report.

The committee had considered the subject very attentively, and the
more they did so the more a new light broke upon them, until they
began to doubt the orthodoxy of many of the received opinions re-
garding tuberculosis, its causes, and the proper course of medical
treatment to be pursued. An abundance of material was furnished
in fact, the report was almost ready ; but he had such onerous duties
to perform during the year, that it was utterly impossible that he
could put it in proper shape.

Dr. Atlee (Pa.) moved that the explanation be accepted, and the
committee continued to the next session of the Association.

On the part of Dr. Porcher, of South Carolina, Dr. Condie stated
that he had sent to him the Report of Committee on " Toxicological
and Medicinal Properties of our Cryptogamic Plants," but with the
request that it should be left, for further additions, to the committee.
The committee was continued.

Dr. G. Emerson, of Pennsylvania, Chairman of Committee on
" Agency of the Refrigeration produced through upward radiation o*
heat, as an exciting cause of Disease," presented his report, which
was referred to Committee on Publication, and read an abstract.
The sanitary lesson designed to be inculcated in this paper is the
importance of guarding against exposure to the refrigerating effects
of nocturnal radiation, especially in sickly places and during epidemic
periods. The means of effecting this are shown to be extremely
simple and always at hand, as any thing will answer the purpose
which may be interposed to cut offthe view of the open sky, and thus
prevent " upward radiation."

Dr. H. F. Campbell, of Georgia, presented a report on Typhoid
Fever, which was referred to Committee on Publication.

Dr. Campbell, said he was not aware, until too late an hour to do
so, of the fact that a written synopsis of each report was required by
the rules of the Association. If permission were granted, he would
make a verbal one, and explain to the convention the views he had
taken regarding this class of fever. The permission was granted.

Dr. Campbell* said I have, Sir, comparatively little experience in the actu-
al treatment of typhoid fever, as it is a disease which rarely prevails in the
district where I am located. I have therelore given in this treatise a condensed
history of the symptoms and pathology of the disease, as now exists in the works
of the best writers. From these data, I have deduced a pathology which I lo-
cate in the ganglionic system of nerves. In corroboration of these views, I
refer to various experiments on these nerves. If you divide some of the superior
branches of this system, near the eye, there occurs an immediate ecchymosis of

* Dr. Campbell's synopsis, as it was reported, contained several errors : he has had an
opportunity to make the necessary corrections in this Journal.

1853.] Miscellany. 443

the conjunctiva, which is very similar to the capillary congestions observable
in typhoid and typhus fevers. I have called attention to the existence and
causes of the maculae, which appear upon the surface, in the one variety (u-phus)
of fever, and extend through the alimentary canal in the other, (typhoid) and
reason that the former are the result of disease in the ganglia along the spinal
column which supply the circulation of the cutaneous surface, while the latter
are the result of disease in the abdominal ganglia, (as the semi lunar, &c.) which
supply the intestines. I have also recorded the morbid appearances in the
larynx, pharynx and oesophagus, and refer them to disease in the pharyngeal
plexus of nerves which supply these parts. I have examined the theory of some
authors who refer the pathology of the two diseases to deficiency of fibrine in
the blood, and have endeavored to show that all the phenomena cannot thus be
accounted lor. Finally, I do not consider typhoid and typhus lever distinct
diseases, but that they* are the same disease affecting different portions of the
ganglionic system of nerves; in typhoid, the visceral ganglia are affected ; in
typhus, the vertebral ganglia.

The synopsis was received with loud applause, and the report re-
ferred to the Committee on Publication.

Dr. Sutton, of Kentucky, presented a report on Epidemics of
Tennessee and Kentucky, with an abstract, which was read by the
Secretary, and the report referred to the Committee on Publication.

Dr. Pitcher, of Michigan, presented a report on the subject of Medi-
cal Education, which he was requested to read at length. The
report was a long and able document, containing many valuable sug-
gestions to prevent the spread of quackery, and on the best means of
training the medicnl student. The committee proposed that all can-
didates for degrees shall have studied at least three years, and recom-
mend the extension of lecture seasons to six months. The committee
repeated their high opinion of the benefits to be derived by students
from bed-side experience, as superior to lectures and flitting hospital
visits, and suggested a supplementary school of practice. They would
not discourage medical schools through the country, but foster them
as useful, and trust to the private instructor and the hospitals as schools
of practice. The committee asked leave to conclude their report by
presenting the following resolutions :

Resolved, That the Association re-affirm its formerly expressed opinions, on
the value and importance of general education to the student and practitioner
ol medicine, and that it would gladly enlarge its rule on this subject, so as to
include the Humanities of the schools, and the Natural Sciences.

Resolved, That in the opinion of this Association, a familiar knowledge of
the elements of Medical Science should precede clinical instruction.

Resolved, That in order to accomplish the latter, the hospitals, when elevated
to the rank of schools of practice, and the intelligent private preceptor, are the
most efficient instrumentalities to be used for that purpose.

On motion of Dr. Atlee, the report and resolutions were adopted.

Dr. Joseph M. Smith, of New York, Chairman of Committee on
Prize Essays, reported that the committee had received fifteen Essays,
which they had critically examined, and that they had awarded the
two prizes of one hundred dollars each to the Essays bearing the
following titles : The first, entitled " The Cell its Physiology, Pa-
thology and Philosophy; by Waldo J. Burnett, M. D., Boston,
Mass. " Natura in minimis maxima est." The second, on the "Sur-
gical Treatment of certain Fibrous Tumours of the Uterus, heretofore

444 Miscellany. [July,

considered beyond the Resourees of Art;" by Washington L. At-
lee, M. D., Philadelphia. " Palmam qui meruit ferat."

The committee also stated that the following named napers are
worthy of being honorably mentioned : 1st, on Erysipelatous Fevpr of
the United States ; 2d, on Chloroform ; 3d, on Subacute Functional
Disorders of the Urinary Bladder of Females; and of three papers
bearing the names of the authors, they asked that the authors of two
of them, viz., Dr. March, of Albany, and Dr. Buck, of New York,
be allowed to submit abstracts to the Association.

Dr. Alden March, of New York, made a verbal abstract of his pa-
per on "Diseases of the Hip Joint," which was favorably reported on
by the committee, and on motion of Dr. A. Smith, he was requested
to read the paper, during the recess to-morrow, in Crosby-street Medi-
cal College.

Dr. March considers hip disease as produced in the head of the
bone by upward and inward pressure, from muscular action, against
the acetabulum.

Prof. Palmer, of Chicago, moved the following :

Resolved, That this Association earnestly recommend tothe local Societies in
different portions of our country, to appointCommittees, whose duties it shall be
to record the prevalence of epidemics or other diseases, and the general state of
health in their respective localities, and to transmit said reports to the Commit-
tees of the Society on Epidemics, through the State Societies where they exist.

Resolved, That the Secretaries be requested to secure a wide publicity to the
above resolutions, by such means as they may deem proper.

The resolutions were adopted.

Dr. G. Buck, of New York, read his paper " on the Surgical treat-
ment of Morbid Growths in the Larynx," upon which the committee
had made a formal report, illustrating a case which had been under
his care by means of the specimen and a wax model.

On motion, the paper was referred to Committee on Publication.

Dr. Mitchell, of Pennsylvania, here proceeded to speak of the vari-
ous difficulties and grievances under which the physicians and sur-
geons in the Navy labored, and recommended the Convention to take
some measures for their relief. He concluded by presenting the fol-
lowing resolution, which was, after considerable discussion, adopted:

Whereas, the claim of naval medical officers to defined rank, assimilated
with the grades of'officers of the line of the navy, has not yet been decided upon
bv Congress; therefore,
"Resolved, That the President of this meeting appoint a committee of three,
which is herebv instructed to communicate to Congress, through the presiding
officer of eacb House, at the commencement of the next session, an expression
of the interest felt by the American Medical Association of the United States
for their professional brethren employed in the Navy, as set forth in the resolu-
tions unanimously adopted at several sessions of this body.

The resolution was put and adopted.

The following resolution was presented by Dr. Charles Hooker, of
Connecticut, and adopted unanimously :

R solved, That the delegates from the several States be requested to appoint
committees, who shall aid the Committee of Publication in procuring subscri-
bers, and in distributing the Annual Transactions of this Association.

1853.] Miscellany. 445

Dr. Mauran, of Rhode Island, presented a report from Dr. Simons,
of South Carolina, chairman of a committee appointed by the Associa-
tion for that purpose, in relation to the necessity of each emigrant ship
being provided with a surgeon, which was read by the Secretary.

The report was accepted, and the committee directed to prepare a
memorial to Congress.

A report was then presented from Dr. Simons, chairman of a com-
mittee of the American Medical Association, to memorialize Congress
in accordance with a resolution of Dr Sutton, of Georgetown, Ken-
tucky, to have the medical statistics of the United States census print-
ed separately, for the use of the medical profession.

This report was also accepted, and the commiltee requested to pre-
pare a memorial to Congress on the subject.

Dr. N. S. Davis, of Illinois, reported at length, and lucidly, on the
Medical Literature of 1853.

Dr. Yandell, of Kentucky, presented a report received from Dr.
S. D. Gross, of Kentucky, on the results of surgical operations for the
relief of malignant diseases, which was referred to a Committee on
Publication. Dr. G. read a brief abstract.

Dr. Gooch called up the subject of the graduating pledge, proposed
by Dr. Peaslee, of New Hampshire, last evening, and laid over, and
proposed the following resolutions :

Resolved, That this Association earnestly recommends to all the respectable
Medical Colleges of the United States to administer to their graduates, previ-
ous to their receiving the diploma, some pledge that they will maintain, to the
best of their abilities, the honor and dignity of the profession ; and that they will
forfeit their degrees, whenever they desert the orthodox system of medicine.

Resolved, That the schools be urged not to graduate any man without requir-
ing him to read the .National Code of Ethics and publicly give his consent to
abide by it, and that they will reserve to themselves the right to withdraw the
diploma, publicly, whenever the graduating pledge has been violated.

There were, said Dr. G., two schools which had already adopted
such rules. Unfortunatelv, as things stood, gentlemen were allowed
to graduate on payment of their fees, without knowing there was such
a thing as a " Code of Ethics" in existence, and permitted to go forth
among medical men as their equals in practice. The consequence
was, systems of quackery, and want of proper esprit du corps among
members of the profession, in many instances.

Dr. Garnett, of Washing! on, spoke to the resolution.

Dr. Atkinson, of Virginia, inquired how the diploma could be with-
drawn ?

Dr. Gooch replied that the diploma could be always withdrawn, if
given under these conditions.

Dr. John H. Phillips of New Jersey, offered the following amend-
ment :

Resolved, That it is the duty of all Boards of Examiners, to whom candidates
may apply for examination or approval, to admit none but those who give sat-
isfactory evidence of a ?ood preliminary education, and that a regular Course
of Medical Practice will afterwards be pursued, and who shall subscribe to the
Code ofEthks adopted by this Association."

Dr. Cox, of Maryland, thought the resolution contemplated an ex-

446 Miscellany. [July,

traordinary act oflegislation, and there would be great difficulty in
applying the principle. The power of revoking a diploma, once giv-
en under the legal sanction of a charter, was a dangerous one to be
intrusted to any set of men.

Dr. Atkinson, of Virginia, thought that, until the millenium, quack-
ery would exist in the profession to some extent, and it was vain to
legislate against it.

On motion of Dr. Sayre, of New York, the Association took a recess
for one hour, without disposing of the resolution.

Dr. Blatchford, of New York, moved to have a resolution, offered
yesterday, on the licensing power, with amendments by Dr. Carnett,
taken up for consideration.

After discussion by Drs. W. Hooker, of Connecticut, Johnson, of
Missouri, and Atlee, of Pennsylvia, on motion of Dr. Atlee, the whole
subject was referred to a committee, to report at the next meeting.

The subject was referred to the following committee : Drs. Wellford,
of Virginia; Samuel Jackson, of Pennsylvania; T. W. Blalchford,
Johnson, of Missouri ; and Peaslee of New Hampshire.

Dr. T. W. Blatchford, of New York, proposed the following reso-
lution:

That a committee of five be appointed, of wrhich Dr. J. O. Edwards,
of Ohio, shall be chairman, whose duty it shall be to report on the best
mode of preventing the domestic adulteration of drugs. The Chair
appointed Dr. Edwards, Drs. Wood and Carson, of Philadelphia,
Dr. C. T. Jackson, of Boston, and Dr. J. H. Griscom, of New York.

Dr. Joseph M. Smith, of New York, read the following:

REPORT OF COMMITTEE ON NOMINATIONS.

The Committee on Nominations, in fulfilling the duty of their appointment,
propose to continue most of the Special Committees appointed by the Associa-
tion, in May, 1851, and May, IH52, and to appoint several new Special Com-
mittees. They, therefore, submit the following list of Chairmen for Special
Committees, with the subjectsto them committed:

1. Dr. D. F. Condie, of Philadelphia, Penn., "On the Causes of Tubercular
Disease."

2. Dr. James Jones, of New Orleans, La., " On the Mutual Relations of
Yellow and Bilious Remittent Fever."

3. Dr. R. S. Holmes, of St. Louis, Mo., "On Epidemic Erysipelas."

4. Dr. George B. Wood, of Philadelphia, Penn.. "On Diseases of Parasitic
Origin."

5. Dr. R. D.Arnold, of Savannah, Ga "On the Physiological Peculiarities
and Diseases of Negroes"

G. Dr. James R. Wood, of New York, "On Statistics of the Operation for
the removal of Stone in the Bladder."

7. Dr. F. Peyre Porcher, of Charleston. So. Ca., "On the Toxicological and
Medicinal Properties of our Cryptogamic Plants."

8 Dr. Goodrich A. Wilson, of Virginia, "On Cholera and its Relation to
Congestive Fever their Analogy or Identity."

9. Dr. Worthinston Hooker, of Connecticut, "On Epidemics of New Eng-
land and New York"

10. Dr. John L. Atlee, of Lancaster, Penn., " On Epidemics of New Jersey,
Pennsylvania, Delaware and Maryland."

11. Dr. D. J. Cain, ol Charleston, S. C, "On Epidemics ot South Carolina,
Florida, Georgia, and Alabama."

12. Dr. W. L. Sutten, of Georgetown, Ky., " On Epidemics of Tennessee
and Kentucky."

1853.] Miscellany 447

13. Dr. Thomas Reyburn, of St. Louis, Mo., "On Epidemics of Missouri,
Illinois, Iowa and Wisconsin."

14. Dr. George Mendenhall, of Cincinnati, Ohio, "On Epidemics of Ohio,
Indiana and Michigan."

15. Dr. E. D. Fenner, of New Orleans, La., "On Epidemics of Mississippi,
Louisiana, Texas and Arkansas."

1G. Dr. Chas. A. Lee, of New York, "On Domestic Hygiene."
17 Dr Daniel Brainard, of Chicago, 111., " On the Constitutional and Local
Treatment of Carcinoma."

18. Dr. N S. Davis, of Chicago, 111., "On the Influence of Local Circum-
stances on the Origin and Prevalence of Typhoid Fever."

19. Dr. Geo. Enselman, of St Louis, Mo., "On the Influence of Geological
Formation on the Character of Disease."

20. Dr Henry M. Bullitt, of Louisville, Ky.. " On the Use and Effect of Ap-
plications of Nitrate of Silver to the Throat, either in local or general disease."

21. Dr. Robert F. Campbell, of Augusta, Ga., "On the Pathogenic Influence
of Feather Beds."

22. Dr. James Bolton, of Richmond, Va , "On the Administration of Anaes-
thetic Agents during Parturition."

23. Dr. Henry Taylor, of Mount Clements, Mich., "On Dysentery."

24. Dr F. Donaldson, of Baltimore, Md., "On the Present and Prospective
Value of the Microscope in Disease."

25. Dr. R L Howard, of Columbus, Ohio, "On the Pathology and Treat-
ment of Scrofula."

Committee on Plans of Organization for State and County Societies. Isaac
Havs, M. D., of Pennsylvania, Chairman; Worihington Hooker, M. D., of
Connecticut; Josiah Andrews, M. D., of Michigan; B. R. Wellford, M D., of
Virginia; A. L. Pierson, M. D., of Massachusetts.

Committee on Medical Literature. T. S. Bell, M. D , of Kentucky, Chairman ;
Samuel H. Pennington, M. D., of New Jersey; Ed. H. Parker, M. D , of New
Hampshire ; William K. Bowling, M. D., of Tennessee ; Zina Pitcher, M. D.,
of Michigan.

Committee on Medical Education. B. R. Wellford, M. D., of Virginia, Chair-
man ; Resign Lowe, M.D., oflowa; Lyndon A. Smith, M. D., of New Jersey;
Jacob Bigelow, M.D., of Massachusetts; L. A. Dugas, M. D., of Georgia.

Committee on Volunteer Communications. Drs. C. A. Pope, Thos. Reyburn,
John S. Moore, J. B. Johnson and A. Litton, of St. Louis, Mo.

Committee of Arrangements. Drs. J. R. Washington, J. S. Moore, S. Pollok,
Thos. Reyburn, J. O'Farrar, W.M. M'Pheeters, C. WT. Hempstead and E. S.
Lemoine, of St. Louis, Mo.

Committee on Publications. Dr. D. F. Condie, Pennsylvania, Chairman;
Dr. E. L. Beadle, of New York; Dr. A. Stille, Pennsylvania; Dr. I. Hays,
Pennsylvania, Dr E. S. Lemoine, of Missouri; Dr. G. Emerson, Pennsylva-
nia; Dr. G. W. Norris, Pennsylvania

On motion of Dr. Watson, of New York, the name of the Commit-
tee on Volunteer Communications was changed to that of Committee
on Prize Essays.

Dr. Wellford resigned his place as Chairman of Committee on
Medical Education, and the President was authorized to fill the va-
cancy.

The vacancy was subsequently filled by the appointment of Dr. J.
L. Cabell, of the University of Virginia.

Dr. Bolton, of Virginia, gave notice that at the next meeting of the
Association, at St. Louis, he would propose the adoption of the amend-
ments to the Constitution, submitted to this Association by the meeting
at Richmond last year, and which have been here indefinitely post-
poned.

Dr. Alfred Stille, Chairman of the Committee to whom was refer-

448 Miscellany. [July,

red sundry memorials touching the course to be pursued by Medical
Colleges and other Boards in the examination of candidates and the
granting of Diplomas, reported, submitting the following resolutions
for adoption :

Resolved, That in order to preserve the purity and honor of the Medical Pro-
fession, and 10 place around young practitioners additional safeguards against
temptations to do wrong, as well as lo draw a more distinct line of separation
between true and false physicians, it be and is hereby recommended, that every
graduate in Medicine be required to subscribe a pledge to submit to the revoca-
tion of his Diploma upon conviction of having knowingly violated the Code of
Ethics of this Association. It is also recommended to the several Medical Col-
leges and such other Boards as are by law authorized lo examine candidates for
admission into the Medical Profession to require from every graduate or licen-
tiate his signature to the Code of fcthics of this Association, and to furnish him
with a copy of the same. It is further recommended that the formal adminis-
tration of a pledge, faithfully to observe, and keep the said Code, form part of
the public exercises of Medical Commencements.

The following form of Promise was among the documents referred
to Committee on Pledge :

I, A. B., of , in the State of , do hereby promise, on the honor of a

gentleman, that I will conform strictly to the Code of Ethics of this my Alma
Mater, in all things pertaining to the practice of my profession; and, when I
shall fail to do so, I hereby grant to the Faculty of said School full power and
authority to withdraw said Diploma, and all the rights and privileges which it
is intended to confer.

Dr. Palmer, of Chicago, and other delegates opposed that part of
the report proposing to clothe Colleges with the power of revoking
diplomas for a breach of the "Code of Ethhs."

Several motions and counter-motions were made. The Chairman
decided on the right of the Committee to withdraw the objectionable
resolution, when the second and third recommendations of the report
were adopted.

Dr. Sayre, of New York, moved that the resolution withdrawn be
taken up, and passed as the sense of the meeting. It was taken up,
and referred to the Committe on the licensing power, of which Dr.
Wellford is Chairman.

Dr. Parker, of Virginia, moved the following, which was adopted:

Resolved, That the Standing Committee, of which Dr. Bolton is Chairman,
be instructed to inquire into all cases of death that may be reported as occur-
ring from the use of anaesthetic agents during the present year in the United
Slates, and report to the next meeting of the Association.

Dr. Campbell, of Georgia, submitted a paper, on a question of pri-
ority in reference to the discovery of the reflex relation subsisting be-
tween the cerebro-spinal and sympathetic system of nerves.

Referred to Committee on Publication.

The President congratulated members on the close of their delibera-
tions, and expressed his wish that they should have a safe return to
their homes, and should all meet at St. Louis next year.

The Association then adjourned sine die.

1853.] Miscellany. 449

Use and abuse of Medicines. The communication of our friend,
Dr. Long, contained in this number, recalls to memory a satire pub-
lished not long since in the Buffalo Medical Journal by the inimitable
"Dr. Smelfungus," and which we hope we may be pardoned for re-
producing. We do not know that a little " spice " should be deemed
altogether out of place in a Journal so strictly practical as ours claims
to be.

Pneumonia. By S3ielfuxgus.

"During the angry controversy between the Nominalists and the Realists,
certain offensive books were ordered to be chained in the libraries. It were well
if, by a similar decree, nineieen-twentieths of the materia medica were locked
up in the cabinets of the curious." Prof. Abner H. Brown.

Smelfungus, standing a few days since on the icy bank by the little
watchhouse beside the railroad bridge at Portageville, upraised his hat
in reverence to the mind that planned it. There stood the bridge, a
structure, firm, sure, and steadfast, yet light, graceful, and symmetri-
cal. Down hundreds of feet in the abysm flowed the dark river, fret-
ting about the solid piers, where,

"Far, far beneath the vast incumbent pile
Slept the broad rock !"

11 Here," he exclaimed, " here at last is the true emblem of medical
science. Every stick in that vast congeries of tressle work is isolated
and capable, in event of decay, of removal and replacement by
another. On no one timber rests any special importance. Any
worthless piece may be cast aside without detriment to the unity of
the whole. And so in medicine. Our temple is not built of impov-
erishable materials, neither does the safety of our art rest upon any
one fact, medicine, or theory. In the progress of discovery our facts
may become worthless, our medicines inert or hurtful, our theories
1 the baseless fabric of a vision,' and still the goodly structure stands ;
for a new and truer fact is substituted ; by a better interpretation of
nature we have some better treatment of disease, and for our withered
theories we gain some surer basis. No mortis or tenon is in the
edifice, and the casting out of an erroneous idea does not involve
the destruction of its neighbor, or endanger the stability of the
whole.

" Therefore, oh watchman ! scan closely all the parts reject fear-
lessly all decayed and broken elements. Go on, ye builders, taking
from and adding to, until the temple of Esculapius stands a perfect
whole of solid and enduring material !"

Having had an easy delivery of these pregnant remarks. Smelfun-
gus retired to the Lauman House to warm his feet and get a cigar.
Once thoroughly warmed and under the influence of a specially good
cigar, he went into a discussion of medical matters things new and
old with all that homely enthusiasm for the good, and peppery indig-
nation for the bad that eharacterize him.

" In medio tutissimus ibis, said the olden poet, and ever since, like

450 Miscellany. ^July,

wine long kept, the pithy adage has grown richer and more truthful.
In all the little eddies and whirlpools of medical inquiry, (with little
great men floating like chips upon the seething waters) we recognize
two mighty currents, deep flowing and rapid in their diverse ways,
uplifting huge contentious waves of difference. The one of these
sweeps on with gathering force against old theories, and already it
threatens the gorgeous though composite pile of our old materia medica
with destruction. And this is the tide, or the gulf-stream, or if you
please the all-enveloping maelstrom of natural medicine."

Here Smelfungus sticks in his allegory, and like Mr. Micawber,
descending abruptly from his lofty periods, he '"docks the tail of sen-
timent."

" In short," (growing red in the face,) " here are two separate
packs of fools annoying sober men with their nonsense. Here is one
class, who tell us that medicine is an invention of the enemy who
call aloud for another Hercules to turn another Alpheus through
those Augean stables the apothecary shops, and sweep from the learned
shelves the latin-labeled drugs as things of no account or value. Oh
ye cold blooded animals who look upon a patient as an interesting
specimen of natural history, and turn a deaf ear to his earnest cry for
pills and potions the world loves medicine ! Man, quoth Cuvier,
(?) is a pill-taking animal, and you who deny this first want of his
nature he will not call upon.

" And yet woe to the poor patient, if in shunning the natural histo-
rian he falls upon the other extreme of unlimited control over dis-
eased action by medicines ! He will surely find himself in extremis !
These men of blood and guts, who remove a pint of disease from a
hole in the brachial vein, and a half a gallon more per anum, are worse
than their do-nothing antagonists. They are no rare birds either. I
have a dozen in my circle of acquaintance whose latest author is good
old Dr. Thomas. Why sir! when my poor friend Dr. T. was com-
ing down with consumption, we met in consultation, a half a dozen
brother chips, when, as the youngest man, I was first called on for an
opinion, I proposed such a mild febrifuge, anodyne, and counter-irri-
tant course as should allay the pressing inflammatory symptoms then
present, and restore the tone of the stomach, old Dr. W's gray hairs
stood up in mingled wonder and disdain. 'Give him an emetic!'
thundered the doughty old Hunker. ' He's got the consumption, that's
the treatment for consumption, and that will do him good !' The good
old gentleman evidently fancied that poor T. was going to puke up a
phthisis pulmonalis ! And every day, with younger men. we see this
same insane notion of a routine of pills, powders, and emetics, for a
disease of assimilation.

" I would to God," (and Smelfungus crushes his cigar in his
righteous indignation,) " that I had the power to make these men read,
learn, and inwardly digest the whole of Martyn Paine's abstrusely
learned volumes!* Alter such a course as that I fancy they would

" Man's inhumanity to man
Makes connt.lp.sc thousand* monrti,"

1853.] Miscellany. 451

turn to our lighter periodical literature with a relish which they do
not manifest at present.

" Quo me vehis ?

' Prone to wander, Lord I feel it !"
sings Smelfungus in answer to a gentle hint as to the subject matter
of conversation, 'and if my text be true 1 have been wandering in
dangerous paths. Now let us get back to this middle ground if we
can find it.

"The revelations constantly making in the natural history of disease
have taught all seekers after truth, that medicines are not the actual
necessities we have deemed them. Yet it does not hence follow that
they are per se, useless or injurious. One great general principle
may be laid down, viz., that when we can with safety omit a medicine,
it is our duty so to do. But this word safety should imply not only
immunity from death, but from unnecessary suffering. I like much,
(always excepting a certain timidity in its tone,) the article on pneu-
monia, in the last ' Braithwaite,' by Dr. R. B. Todd. Dr. Todd pro-
poses to strike out from he list of medicines in this disease, all the
weighty items, such as tartar emetic, calomel, bloodletting, etc. and
to substitute for them in increased doses a medicine long used in pneu-
monia, but considered merely as an adjunct, viz , the acetate of ammo-
nia given in six dram doses. Externally he makes frequent use of
the turpentine stupe. Thus Dr. Todd relieves us from the use of
drugs frequently hurtful and unmanageable. By some process of
reasoning not very lucid, he connects this change of treatment with
the idea of blood poison.

"Smelfungus will help Dr. Todd through in this matter. Perhaps
this blood poison may be an excess of albumen in the fluids. We
have been in the habit of calling the albuminous sputa of pneumonia
the result of inflammation, but the occurrence of critical albuminuria
in this disease would seem to indicate that albumen was in excess
throughout the system, independant of phlogistic action. Dr. Smel-
fungus stands ready to receive the thanks of Dr. Todd for this explan-
ation. But, seriously, the presence of a poison in the blood has some-
thing to do with pneumonia typhoides, and who can tell us the pathol-
ogical differences between that and the acute form.

" The self-limitation of pneumonia is another idea advanced by Dr*
Todd. Now I have had the good fortune to see several cases of this
disease, which, from the stupidity of the friends, had no medical treat-
ment until the occurrence of bloody expectoration in the second stage
alarmed them. In all these cases, the disease had reached its acme,
and was on the decline, having involved only a limited portion of the
lower lobe. Now, my good Sir Hunker! these cases (three or four
in number) are, so far as they go, positive contradictions to your pet
notion, that an inflammation once lighted in the lung, will spread like
wildfire through its whole parenchyma. It may do so, mind you, but
you may safely draw the conclusion that the almost uniform departure
of the inflammation at a certain point in the lung, is not all owing to
your own skill. For if you have such unlimited control over inflam-

452 Miscellany,

mation, why can you not bring it to bear on an erysipelas, or a syno-
vitis? As Allapod says, 4 hence we view,' that you do not in every
case cut short the disease with your routine of bloodletting, calomel,
antimony, and blistering. It cuts itself short, and therein only mani-
fests its natural tendency.

" Shall we, then, abondon bloodletting in pneumonia? Even so;
for it is ijenerally unnecessary. Not so; for cases there be when the
delirous mind grows rational, the swollen countenance natural, and
the choked and labored pulse grows soft and easy, from the lancet.

" Shall we abandon calomel and antimony ? Again, yes ; and again,
no; for cases will occur, when every means that science can prompt
or art direct, are necessary toguide and govern the lava tide of inflam-
mation, to prevent effusion and abscess, and the whole dark array of
sequela.

" \nd blistering :" and Smelfungus speaks tenderly as a lover of
his mistress. ' blisters are always good, and never disappoint us.' If
in all the nauseous scented armamentaria of therapeutics there is one
thing that Smelfungus is willing (metaphorically speaking) to take to
his heart, it is Emplastrum Catharidis ! He loves his blisters as fer-
vently as old Dr. Clysterpipe his syringes, for the old man based his
claim to Christian character on the love he bore his enemies. Pardon
the pun !

"Sir Hunker ! from premises like these we predict the dawning of
a milder day. Pneumonia is still, and ever will be, a disease eminent-
ly requiring the guiding hand of the physician. The old (and we may
still call it the usual and authorized) treatment of pneumonia, is a club
in the hands of Hercules wherewith we may deal mighty blows. But
a pounding less severe will answer in a majority of cases, and we
shall yet learn that a rat-trap is no better than a smaller tool for catch-
ing the ' small deer' that infest our crania.

" Listen, then, to the truthful lesson ! Pneumonia is, in a majority
of cases, a self-limited and little dangerous disease, but it should be
closely watched, lest, as sometimes happens, the diseased action may
not stop at the usual point in the lower lobe, but rage on unchecked
throughout its utmost borders. And mark you, man of the lancet!
He who cures a pneumonia predestined to occupy a whole lung, does
a goodly thing and may congratulate him^lf. Here come in your
whole catalogue of remedies. The God Antiphlogos alone is mighty
to save !"

Neuralgia. Cazenave recommends in facial neuralgia, an oint-
ment composed of chlorform 20 parts, prussiate of potash 10 parts,
and lard 60 parts ; a piece the size of a walnut to be rubbed over the
painful part. An oiled-silk cap is then to be worn for some hours.
[Rev. Med. Chir. Med. Times and Gaz.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. AUGUST, 1851. [No. 8.

PART FIRST.

Original dammttnication*.

ARTICLE XXV.

Foreign Bodies in the Air Passages. By L. A. Dugas, M. D.,
&c. .

The accidental introduction of foreign bodies into the air
passages is sufficiently common and important to merit the
serious attention of the profession in reference to the means to
be employed for their removal ; and every practitioner should
be provided with suitable instruments to meet such contingen-
cies. Foreign bodies may be lodged in the nostrils, the pharynx,
the rima-gloltidis, the larynx, the trachea, or the bronchi, and
the degree of inconvenience they may occasion will vary ac-
cording to their position, size and nature.

The objects most frequently introduced into theV nostrils by
children are peas, beans, berries, grains of cr~~>, buttons, peb-
bles, small coin, &c. In this section of cou ry, the berries of
the Pride of India or China tree, (Melia 4 ..edarach,) a common
shade tree, are very often forced up me nostrils by our chil-
dren, and are sometimes found difficult to remove in conse-
quence of their hardness and polished surface. By dilating the
nostril with a speculum auri, the body may be easily seen, and
generally removed without difficulty with a pair of small dis-
secting forceps. In other cases, a very small tenaculum or a
pair of small dentated forceps may become necessary. The

n. s. VOL. IX. NO. VIII. 29

454 Dugas, on Foreign Bodies. [August,

ear-scoop will sometimes answer the purpose remarkably well.
If the body be engaged so far back as to render its withdrawal
by the interior nares impossible, it may then be forced back
into the pharynx with a small probang or a female catheter.
There is some danger, however, that, in so doing, the body
may pass into the larynx and cause suffocation. This may be
prevented by requiring the patient not to breathe at that mo-
ment, or (if it be a child who cannot be controlled) by forcing
back- the object during expiration. By carrying a wooden
spatula upon the tongue as far as the posterior wall of the
pharynx at the same time that the body is pushed back, the
danger might also be lessened. It would, perhaps, be advan-
tageous to place the patient horizontally upon his back, with
the head lowered, for the operation.

While on this part of our subject, we may be permitted ta
state a singular case which occurred a few years since. A
gentleman was eating a bit of beef-steak, wrhen he suddenly
sneezed and forced the morsel from his mouth up into his nos-
tril. He hastened to a physician for relief, who, finding the
foreign body visible through the anterior nares, endeavored, in
vain, to draw it out with forceps. It was firmly wedged, and
the fragments seized with the forceps would break, without
relief. The manipulations had in the mean time so much irri-
tated the mucous surface that farther efforts were deemed
unadvisable, or would not be tolerated by the patient. Still
very much concerned, however, the patient applied to us.
With a female catheter, the steak was without difficulty forced
back into the pharynx, and spit out. It was found to be as
large as the end of his thumb, and but slightly masticated.

Bodies lodged, in the nostrils should always be removed as
early as possible, for they soon occasion pain, tumefaction, and
subsequently distres. j)g inflammatory symptoms in the nasal
passages, which increase very materially the difficulty of the
operation. Instances are on record in which beans have been
allowed to remain until they have germinated, an given rise to
the most distressing train of symptoms.

Foreign bodies lodged in the pharynx may rest upon the
larynx so as to impede respiration more or less seriously or
they may produce a tumefaction of the mucous membrane,

1853.] Dugas, on Foreign Bodies. 455

which, by extending to the rima-glottidis, will simulate the
peculiar affection termed (Edema Glottidis or they may be so
situated and small as to occasion more inconvenience than real
danger.

When visible, these objects may be easily removed with a
pair of ordinary dressing forceps. They may often be made
to drop out by holding up the patient by the heels, if a child,
or by causing him, if an adult, to incline his chest over the
edge of a bed or table, so as to rest his head upon the floor a
few moments. Sudden succussion of the body whilst in this
position will favor the dislodgment of the object. We have
fresh in memory a case in which an intelligent mother seized
her child by the heels, and with a few strong shakes relieved it
from impending suffocation by the dislodgement of a toy that
had passed into the pharynx.

When such small objects as pins, needles, fish-bones, rye-
beards, &c, get into the pharynx, they are sometimes hidden
behind the pillars of the soft palate or the tonsils, or so deeply
situated that we cannot see them. In such cases, an explora-
tion with the finger will often enable us to feel the object, and
thus to guide the forceps to it. If wTe cannot feel it, we should
resort to the probang in the hope of entangling the object in
the sponge so that it may be withdrawn. This very often
succeeds. If not, we may pass down a pair of curved forceps,
(oesophagus forceps will answer, if we have none shorter,) and
by carefully opening and closing them when in the region indi-
cated by the patient as the seat of pain, we may sometimes
seize and remove the object. Care should be taken, however,
not to wound the epiglottis nor other soft parts. If all our
efforts prove abortive, it may be well to administer an emetic
and to provoke free vomiting by large dvaigfttsj of water.

But by far the most serious casec tire those in which the
foreign body is engaged in the rin s or has passed into

the wind-pipe. These accidents are recognized by u/e imme-
diate difficulty of breathing, which is more or less great, ac-
cording to the size and shape of the object, and which, although
slight at first, may increase to an alarming degree more or less
rapidly, and occasion suffocation, unless the obstructing agent
be removed. The patient coughs violently, and is usually able

456 Dugas, on Foreign Bodies. [August,.

to indicate the cmisfc of his distress. Attempts should be im-
mediately mad I remove it. The patient should be at once
placed with the head in the most depending position, so as to
facilitate the ejection of the foreign body by coughing. If the
object be heavy, the chance of success by this method will be
correspondingly increased. If suffocation be imminent, no time
should be lost in performing laryngotomy, or rather tracheoto-
my, and in endeavoring to remove the object with small curved
dressing forceps if it can be reached. If the opening in the
wind-pipe be made large, as it should be, the foreign body will,
not unfrequently, be forced out through it ; if not, it should be
removed with forceps. When the object is situated within the
rima-glottidis, or between it and the artificial opening, the pa-
tient experiences a sense of relief as soon as this opening is
made, which might lead to the supposition that the obstruction
was removed. In such cases the foreign body must be either
pushed up into the pharynx with a catheter or seized and ex-
tracted with forceps, as may be most convenient.

In Surgery as well as in Medicine, every practitioner will
occasionally encounter anomalous cases cases for the man-
agement of which written authorities have not provided. As
in our judicial tribunals cases are continually met for the adju-
dication of which the Statute books are vainly ransacked, and
even the Common Law found to yield but faint light so will
the physician at the bed-side, not unfrequently find himself
utterly unaided by systematic writers and thrown upon general
principles, perhaps of doubtful value. It is to supply this de-
ficiency that "cases" are reported by the legal profession, and
likewise by practitioners of medicine. We have just epitom-
ized the subject of foreign bodies in the air-passages, as usually
treated, and will now relate the history of an anomalous case
that came under our notice during the last winter.

York, a negro boy, 12 years of age, belonging to Mr. ,

ofColumbia county, was engaged in November last in remov-
ing cockle-burs from the mane of a horse, and put one of them
in his mouth. By a sudden inspiration the bur was carried
down his throat, and he immediately experienced some difficul-
ty in breathing, attended with frequent coughing. Medical
aid was invoked and an emetic administered without relief.

1853.] Dugas, on Foreign Bodies. 457

The boy continued in this state several days, and was then
brought to this city. We found that he breathed and coughed
as though affected with oedema glottidis or with membranous
croup ; his voice was extinct and he spoke in a whisper ; on
walking briskly he suffered for want of breath ; he pointed to
the thyroid cartilage as the seat of soreness ; had some arterial
excitement ; nothing abnormal heard on auscultating the lungs,
but a whiz was perceived on placing the stethoscope upon the
larynx. By the most careful ocular inspection of the pharynx
the bur could not be seen. The finger being, however, carried
down below the epiglottis, would feel the bur rise up against its
extremity whenever the larynx was elevated by an attempt at
deglutition. The cockle-bur was evidently situated vertically,
with one end within the laryngeal aperture, and so securely
fixed by means of its minute hooks into the mucous membrane,
that its position could not be changed by such delicate touches
with the finger as I thought it prudent to make during the mo-
mentary contact alluded to. A pair of oesophageal forceps
being at hand, I made, in vain, repeated attempts to seize the
bur, until the patient became very much exhausted. The
continual movements of the larynx presented an insuperable
difficulty. He was then allowed to rest, and an emetic of
ipecacuanha administered in the evening, in the hope that the
bur might be dislodged during the efforts to vomit. This also
failed, as it had done before.

On the following morning (8th Nov.) I provided myself with
a pair of small curved polypus forceps, and carrying the index
finger of the left hand down below the epiglottis, forcibly drew
this upwards, and at the same time glided the finger still lower,
until its extremity rested in contact with the bur. The forceps
were now, with the right hand, carried along the finger, and
the bur effectually seized and extracted, after but one failure.

In looking over the standard surgical authorities, we find no
allusion whatever to the method adopted in this case to bring
the finger in contact with the larynx, and to stay its move-
ments during the introduction of the necessary instruments.
Some of those who treat at all of the removal of bodies lodged
in the rima-glottidis, recommend in general terms their extrac-
tion with forceps if possible, and, when this cannot be done,

458 Billingslea, on Tetanus. [August,

advise immediate recourse to Tracheotomy. Others make no
mention whatever of the use of forceps, but resort at once to
the knife. We have not had the leisure to examine all the
written authorities at hand, and would therefore simply lay the
subject before the profession, who may judge of its value as
well as its originality. It may be sometimes difficult or impos-
sible, in adults, to introduce the finger sufficiently far below the
epiglottis to draw this forwards effectually and to carry the
finger to the larynx at the same time that its movements are
prevented. But in children this can very rarely be the case.

ARTICLE XXVI.

Tetanus, successfully treated. By J. C. Billingslea, M. D.,
of Tuscaloosa Co., Alabama.

My Dear Sir Below you will find an account of a case of
tetanus which fell under my care recently. If you think it
worthy of a place in \our journal you can publish it.

April 27th, 1853. Was called to see a young negro man,
aged 18 years, the property of Mr. F. I was informed that,
four days previous to this, he had been thrown from a mule,
and after the fall, he complained of "the small of his back and
breast hurting him." I found the boy sitting up at 12 M. He
had considerable fever; pulse 120 per minute, and resisting;
tongue foul ; skin very dry ; not much ability on the part of
the patient to move his lower extremities ; considerable ten-
derness of the spine about the last dorsal and first lumbar ver-
tebras; his chest somewhat tumefied and painful to touch, just
above the epigastrium. He said the mule had trodden on him.
In addition to these, my attention was called to his left foot, the
great toe of which had been frostbitten nearly eighteen months
before, but was thought by his master to be well, until he re-
ceived the fall. The toe was much swollen, and had a cavity
in the end, about a quarter of an inch in diameter, which ex-
tended to the bone and was filled with pus. The whole foot
was very much swollen and tender. He did not know whether
it was hurt in the fall or not, but said it did not commence
swelling till after the fall. He was robust and strong. I bled

1853.] Billingsiea, on Tetanus. 459

him from a large orifice, but took only a small quantity before
a sensible impression was made on his pulse, and he expressed
himself as free of pain, and much better. I then applied cups
over the tender portion of the spine, and afterwards sinapisms
to the same then ordered him the following: $. Calomel,
Dover's powders and sulph. quinine, each 12 grs., divided into
six powders one to be taken every two hours. Tinct. of
iodine to be applied to the foot, followed by a cold poultice.
He had no tetanic symptoms that I discovered at this visit,
although he said the pain in his chest came on by paroxysms.

28th, 11 o'clock, P.M. Was called in haste to him. I
found him with pulse 120 per minute; tongue moist and clean-
ing ; slight diaphoresis ; and whenever touched, or spoken to,
he would be thrown into violent opisthotonos, and during each
spasm would complain of his chest. I think there was not
more than three minutes of repose between the spasms. I was
informed that he had been in this condition all day his medi-
cine had not acted on his bowels ; fortunately, he could open
his mouth about half an inch, and deglutition was not impaired.
I gave him an enema of castor oil and spts. of turpentine, which
I repeated frequently, until I procured a full evacuation of his
bowels then gave him a warm bath, applied cups to the spine,
and afterwards a blister to the same. After the bath, he seem-
ed some better. Between that time and day-light I gave him
about an ounce of paregoric. In the meantime his paroxysms
were not so frequent, and he slept some.

29th. I had the room darkened early and kept quiet. At
6 o'clock, A. M., ordered 4 grs. of quinine every hour, with just
enough paregoric to keep him dozing (which was not much, as
he was very susceptible of its effects). The most nutritious
diet admitted.

30th, 8 o'clock, A.M. I am informed that the paroxysms
were not so frequent or severe yesterday as they were the day
before ; slept well last night, and was not then conscious of
spasms, but now having one every few minutes pulse 110
per minute. Evacuated his bowels by enema ; continued the
quinine as yesterday. At this visit, I discovered a fluctuating
tumour about the size of a hen's egg in the instep of the dis-
eased foot, which was very painful on pressure. The fluid did

460 Billingslea, on Tetanus. [August,

not feel like pus. The swelling was fast leaving the foot on
the application of poultices and tinct. of iodine. I now began
to think that this toe was the cause of all the trouble; and as
the foot was in a very unhealthy condition I did not like to re-
move it (the toe) without first advising with some older sur-
geon.

May 1st. Was met by Dr. Hay ward, of Tuscaloosa, in con-
sultation. After a thorough examination, he also concluded
the toe was the cause of the tetanus, but thought it best not to
remove it in the present condition of the foot. His symptoms
were a little better to-day: pulse 100 per minute; spasms not
quite so frequent. Dr. H. could see no reason for changing a
practice which seemed beneficial, but looked upon his recovery
as very doubtful. We ordered 10 grs. quinine and \ gr. morph.
every two hours ; an enema of castor oil and turpentine.

May 2d, 8 o'clock, A. M. Just as he was yesterday. I or-
dered 15 grs. quinine and \ gr. morphine every two hours.
This was kept up all day and night.

May 3d, 8 o'clock, A. M. Complains of his head roaring ;
pulse 90 per minute: profuse diaphoresis ; skin cool ; a spasm
about every 15 minutes said he was very weak, and appetite
not good. Ordered 10 grs. quinine and \ gr. morphine every
three hours, and food ad libitum.

May 4th. Very deaf; had no spasm last night, but slept all
the time, only when awaked to take his medicine pulse 72,
and weak; skin cool; profuse diaphoresis ; appetite returning ;
has a spasm about every half an hour. I ordered 5 grs. of
quinine, and \ gr. of morphine every two hours. In the after-
noon he became partially blind from the effects of the quinine,
and I omitted it for six hours, when this unpleasant symptom
subsided.

May 5th. No spasm last night, but an occasional one through
the day. Ordered quinine 4 grs. and \ gr. morphine every
three hours.

It is useless to give farther details. Suffice it to say that his
improvement was gradual and continuous, and in two weeks
he had no symptom of tetanus remaining. I gave the quinine
in diminished doses for a week after. The tumour in the in-
step broke, discharging a considerable quantity of thin, unheal-

1855.] Hood: Another White African. 461

thy pus. I dressed this and the toe with quinine, and put the
boy on cod-liver oil and a little brandy three times a day. At
this time he is fatter than I ever saw him, and his foot nearly
well. I think his toe will also get well without an amputation.
I had just read the case reported by Dr. Pye in the New
Orleans Medical Journal, and re-published in your Journal in
March. I thought smaller doses of quinine than those he
recommended would answer the same purpose ; for, the ab-
sorbents acting very suddenly and powerfully might produce
alarming, if not fatal results, after such large quantities had been
administered.

ARTICLE XXVII.

Another White African.

Whiteville, Harris Co., Ga., May 16, 1853.

Dr. Dugas : Dear Sir I noticed in the Eclectic department
of the April No. of your Journal the report of a case of "Change
of Color in an adult negro." I propose, briefly, to present you
with a case of the same kind, equally as remarkable and much
nearer home.

Charlotte, is a woman 34 years old, and living within one
mile of me, whose skin is as fair as that of any lady of Caucas-
ian blood, and who was as black at the age of 1 1 as any African.
She says her health has been uniformly good, with the excep-
tion of one "spell of bowel complaint," which occurred when
she was about 10 years old ; sometime after which a white spot
appeared on her forehead, which gradually though slowly en-
larged. In the mean time other spots appeared on different
parts of the face, which also increased in size, until the whole
face became perfectly white. The change in the color of the
face was completed in about six years, and she says that after
her face " turned white," her whole body changed in one week.
I saw her frequently during the metamorphosis, and noted
its progress, during which time her countenance was so hideous
that she was a fright to all the juveniles of the neighborhood.

She is at present strictly a white woman, except her eyes
and hair, which are those of the negro the latter, however,
being whitish all around the margin. The skin freckles, and is

I

462 Booth: Quinine in Cholera Infantum. [August,

easily blistered by the sun. She is a good servant; has ordin-
ary intelligence ; has had ten healthy children, all of whom are
as black as their father, who is a full-blooded African.

The above are the facts of this "strange freak of nature."
Was the change a pathological or a physiological one ? I am
inclined to the latter opinion, because the subject was in good
health, and the skin seemed to be so, during the change. But
what strange whim possessed the absorbents to remove the
pigmentum nigrum?

These are questions I shall leave to be answered by those
who have more taste and talent for speculation than your hum-
ble servant, E. C. HOOD, M. D.

ARTICLE XXVIII.

[We are happ y to be able to corroborate the testimony of
Dr. Booth in favor of the value of Quinine in the infantile af-
fections of the bowels, usually denominated Cholera Infantum.
We have been using it ever since we saw his first suggestions
in reference to it, and regard it a very important addition to
our resources.]

Quinine in Cholera Infantum. By G. W. Booth, M. D., of
Carrollsville, Miss.

As the season is near at hand when that scourge of infancy,
Cholera Infantum, usually makes its appearance, I will again
invite the attention of the profession to the views I entertain of
its etiology and treatment as published in some of the medical
journals in 1851. In the communication referred to, I stated
it as my opinion that it was of malarial origin. There are many
reasons that I could give to sustain the correctness of this
opinion, but I deem it unnecessary at this time.

My views respecting the origin of the disease influenced me
to use the great and approved antiperiodic, Quinine, in its
treatment. The success I met with in combating the disease
with this article still farther confirmed me in my convictions as
to its predisposing cause. I earnestly solicit the profession to
give Quinine a fair trial in Cholera Infantum : I feel confident
that no one will regret the experiment. I use other articles to

1853.] Extracts from Soc. for Medical Improvement. 463

meet particular indications, such as acetate of lead, and calomel,
in small doses, for controlling the discharge from the bowels,
acting on the liver, &c.

PART II
(Eclectic depart nu n t .

Extracts from the Records of the Boston Society for Medical
Improvement. By Wm. W. Morland, M. D., Sec'y.

September 27, and October 11. Cases of Arrest of Development, Blem-
ishes, etc., in Infants, attributed to Strong Mental Action in the Mother, while
Pregnant; Disagreeable Sights; Sudden Shock, &c ; Discussion upon the
Question whether such Action of the Mind be ever a Cause of such observed
Results.

Case I. Arrest of Development attributed by the Mother to
a Fright during Pregnancy. Dr. Storer reported the case.
Several months since, a female patient of Dr. S.'s expressed
some anxiety respecting her sister, who expected shortly
to be confined, and who could not be persuaded that she
would not have a deformed child. Three or four weeks after
her marriage, she was much affected at seeing a hen injured
by a stone thrown by a boy the stone broke one of its legs,
and removed the lower portion. She was exceedingly troubled
at the time, and as her pregnancy advanced, continually dwelt
upon the subject, insisting that her child when born would be
found to be deformed. Her friends at last began to feel some
concern as to the result, and hence the reason of Dr. S. being
consulted. A few weeks afterwards, Dr. S. heard from his
patient that her sister had been confined, and that one foot was
wanting; that, immediately after her delivery, the mother ask-
ed to see her child ; one foot was shown her as being natural,
and an effort made to divert her attention from the child ; but
she could not be pacified until she saw the other limb, continu-
ally insisting that she knew it was deformed. Dr. S., being
very anxious to see the child, requested that he might know
when it should be brought to this city.

Since the last meeting of the Society, he has had an oppor-
tunity to examine it. The child, perfectly well formed in other
respects, exhibited upon one of the lower extremities, simply a
heel and the rudiments of the five toes, at the extremities of
which were placed microscopic nails. Dr. S. observed that
he was led to refer to this case from the peculiarities of the
patient's conduct previous to her confinement. It was not an
uncommon circumstance for a mother, after the birth of a de-

464 Extracts from Soc.for Medical Improvement. [August,

formed child, to account at once for the defect by something
which had occurred during her pregnancy ; but he believed it
to be very rare for a patient to dwell upon the subject for
months previous to her confinement, and immediately upon her
delivery insist upon seeing her offspring to prove her convic-
tion.

Dr. Bigelow, Sen., remarked that very many of these cases
are referable to afterthought of the mother. Women are often
anxious in regard to the possible deformities of their offspring,
and there are few pregnant women who escape seeing some
peculiar and even disagreeable sight or objects during their
gestation ; any marks observed would, therefore, be coinci-
dental, by the rule of chances : in ninety-nine out of a hundred
pregnant females, no untoward results would be observed. Dr.
B. does not believe it possible that an arrest of development
can arise from the action of the imagination of the mother, or
from the effect of sudden disagreeable impression on her mind.
It is not infrequent that mothers inquire whether their child be
perfect ; at all events, the frequency of deformities after any
shocking sight is the test of the truth of the existence of such
cause for deformity. Dr. B. believes that if one hundred preg-
nant women were to be exposed to the action of such supposed
causes, or should experience any of the strong and peculiar
"longings" of pregnancy, no blemish would be thereby pro-
duced in the children.

Dr. Cabot referred to the fact that, during the siege of An-
twerp, there were very many stillborn, and a large proportion
of deformed children.

J)r. Durkee asked, if this theory of the influence of mental
impressions on the pregnant female does not find support in
certain analogies observed among animals? He referred to
Old Testament narration (Genesis, chap, xxx.), and added that
remarkably similar facts may be observed at the present day
in the breeding of animals.

Dr. Jackson said that very likely there might not be one in a
thousand, exposed as suggested by Dr. Bigelow, in whom un-
fortunate results would follow ; all are not equally susceptible
of such influences some not at all so ; the special cases, how-
ever, are not to be explained or ridiculed away ; there is enough
of plausibility, if nothing more, in the view he sustains of the
matter, to render women cautious of needless exposure to un-
pleasant sights in the early months of pregnancy.

Dr. J. added that, from the cases he had seen, or heard of
upon good authority, he was inclined to believe that a malforma-
tion in the foetus may be induced by an external cause oper-
ating upon the mind 'of the mother during her pregnancy, and,

1853.] Extracts from Soc. for Medical Improvement 465

further, that the malformation may bear to the cause some rela-
tion or resemblance. This last has always been a popular
notion ; but is regarded, on the other hand, by the scientific, as
perfectly absurd ; the presumed cause operating upon the mo-
ther at a period of pregnancy when the fetus must be too far
developed, it is said, for any such malformations as have been
referred to, to be produced. There is, moreover, no nervous
communication between the mother and the fetus. The num-
ber of negative facts is numerous beyond account; of cases,
that is, where a sufficient cause, according to the above hypo-
thesis, existed for malformation, and yet none occurred. No
possible explanation can be offered for the production of a
malformation by the presumed cause ; nor will it be possible,
until we know much more than we do of the obscure subject of
the physiology of the fetus. The resemblance between the
malformation and the cause, it is said, is a mere coincidence ;
but, upon the common doctrine of chances, the coincidence is
too remarkable to be explained away so readily, and, if one
case is suggestive, a second adds very great weight, and a
third is almost or quite conclusive. M. St. Hilaire (Anomalies
de V Organisation) believes that some monstrosities, the anen-
cephalous for instance, owe their being, in some cases, to the
operation of a strong moral cause upon the mother; but he does
not believe in any resemblance in the particular malformation
to the exciting cause, and for the reason above mentioned. It
would have been well had he stated at what period of pregnan-
cy the mothers, in his cases, were subjected to the causes that
led to their monstrous births. Another remark often made, is,
that pregnant women do not predict the malformation, but,.
when it is discovered, look back for some cause to which they
can refer it. This might be questioned; but, allowing that it
is so, and even that they had ceased to think of the assigned
cause, it does not follow that it had not operated efficiently at
the time; the impression was made upon the mind of the mo-
ther, and through it upon the fetus the one was soon effaced,,
the other remained. Much would depend upon the character
of the exciting cause, and much also, as he had before remark-
ed, upon the susceptibility of the individual to the receiving and
the retaining of impressions. Dr. J. then reported the follow-
ing cases :

1. Several years ago, he saw a young lady, about thirteen
years of age, of rather a small and delicate figure, and whose
middle finger upon one hand was fully equal in size to that of a
man's ; the corresponding metacarpal bone being also decidedly
enlarged, and even the forearm somewhat so. The finger was
itself well formed, as in some other cases of similar malforma-

466 Extracts from Sac. for Medical Improvement. [August,

tion that have been observed here. The hand also was other-
wise well formed.

The mother of this young lady, during her pregnancy, was
obliged for a long time to dress a felon or whitlow for an old
uncle, the finger affected corresponding to the one that is mal-
formed in the case of her daughter ; and the operation was
always disagreeable to her, as she was a woman of a particu-
larly nervous temperament.

2. In November, 1846, Dr. J. saw an infant with an exten-
sive blood-mark, as it may be called, upon one of the upper
extremities. The mother, whom he has attended for several
years, and knows to be a woman of very susceptible feelings,
gave the following statement: When two and a half to three
months pregnant, though not at the time aware of her situation,
she had been out of town for the afternoon, when, on her re-
turn, as the cars entered the depot, she saw a man who had
been recently killed. He was lying upon his face, with his
head turned to one side, the sleeve of his coat torn entirely off,
the whole upper extremity exposed and more or less bloody,
and so twisted, as she supposed from dislocation at the shoulder,
that the hand lay upon the upper part of the back. At this
sight she nearly fainted, and probably would have entirely, if
she had not had two of her children with her. For at least a
month afterwards she was decidedly ill ; and during the re-
mainder of her pregnancy she could not banish the thought
from her mind ; she also felt that there would be great danger
in regard to the child in utero, though she never expressed her
anxiety upon this point to any one. The extent and degree of
the discoloration of the skin were not fully recorded by Dr. J.
at the time; but, having recently seen the mother, she informs
him (for the child has since died) that it extended from the back
of the hand and towards the thumb, where it was most marked,
upwards along the extremity to the shoulder, and even some-
whet upon the neck. It was not equally marked throughout,
being in some parts more or less continuous, and in others
simply spotted or dotted. Her other children she has always
dressed in short sleeves ; but this child's arms she covered, on
account of the marked deformity; and, as she says, if it had
lived, it could never have worn a low-necked dress. The child
itself, moreover, was so sensible of the mark that it would occa-
sionally be seen endeavoring to wipe it off. The discolored
arm in the child corresponded, as to the side affected, with the
one that was injured in the man.

3. Dr. Z. B. Adams related to Dr. J., several years ago, the
following case : He attended a woman in labour, and the child
was found to have one of the forearms terminating in a conical

1853.] Extracts from Soc. for Medical Improvement. 467

stump just above the wrist. During her pregnancy she attend-
ed for several weeks upon her brother who had had his hand
torn off by machinery, and the forearm afterwards amputated ;
the injury being upon the same side as the malformation in the
child.

4. Case reported by the late Dr. Doane, of this city. The
mother of several blind children was holding one of them in
her lap, when it put its finger into one of her ear-rings, drew it
down forcibly, and tore it through the flesh. She was preg-
nant at the time ; and when her child was born, it had a fissure
in the ear corresponding to the laceration in its mother's.

At the next meeting, Dr. Storer said he had met with reports
of two cases since the last meeting, which tended to confirm
the opinion at that time advanced, that any remarkable sensa-
tion sustained by the mother during her early pregnancy,
might produce an effect more or less well marked upon the foetus
in utero that this effect need not necessarily partake of the
character of the exciting cause but that, should the mother
be so far influenced as to receive a decided shock upon her
system, it might be followed by some abnormal condition of her
child arrest in development or some peculiar malformation.
The following cases he had observed in the "Proceedings of
the Medical Association of the State of Alabama," for Decem-
ber, 1850.

" Dr. R. Lee Fearn related the following very remarkable
particulars of a case, where the impressions received by a mo-
ther during pregnancy, affected her child in utero. A gentle-
man, whilst shooting, shot through the metacarpal bone of his
index finger. The wound was a bad one, and piece after piece
of the bone came away. A few months after the accident
here mentioned, and in due season, his wife bore him a child
perfectly formed in all respects. When about four months ad-
vanced in her second pregnancy, an operation was deemed
necessary to remove the last remaining portion of bone in her
husband's finger. She witnessed the operation, and was much
shocked and alarmed at the sight. When her child was born,
it was found to be deficient in this very bone, though in all
other particulars it was a well-formed child. The Doctor
thought this was by no means the result of chance, but a very
conclusive instance of cause and effect.

" Dr. Dossey remarked, that the relation of this case called
to his mind a similar instance:

" Dr. G was thrown from his horse and broke his leg,

midway between the ankle and knee. His wife was about five
months advanced in pregnancy. When the child of which she
was pregnant was born, it had on the leg corresponding with

468 E xtr acts f r om Soc. for Medical Improvement. [August,

the injured limb of the father, and at precisely the same spot,
the appearance of a fracture of the limb, and there was also a
decided shattering of the leg."

Dr. Strong thought that the notion so popularly entertained
in reference to this matter is too general not to have some
foundation in truth. It certainly deserves investigation. He
added, that the idea of greater liability to these attributed ef-
fects, from the causes mentioned, in the early part of pregnancy,
seemed to him very well founded ; perhaps the influencing
power, be it the imagination, or what it may, ceases after a
certain period of gestation ; has a limitation. Dr. S. also re-
ferred to the fact that a mare covered by a quagga always
afterwards, when impregnated by a stallion, brought forth
striped colts.

Dr. Cabot mentioned the statement of M. Donne, of Paris,
who declares the above fact, as stated by Dr. Strong, to be
constantly observed under the same conditions ; he even goes
farther, and asserts that one portion of the constitution of one
man is propagated, by another man, from the widow of the first
to children by the second.

Dr. Bigelow, Sen., asked to what cause we must attribute
the imperfections and arrests of development observed in fruits,
flowers, and plants. Have they imagination ? and does it act
with this effect upon them ?

Dr. B. declared his entire disbelief in any such effects from
the attributed causes.

Dr. Hayward, Sen., asked whether this action or influence
(if it be recognized as efficient) is imaginative or purely physi-
cal ? Dr. H. mentioned a mother, who, while pregnant, sud-
denly saw one of her children, ill with pneumonia, covered with
blood by some accident; the child she was carrying, when
born, had a large red stain or spot upon its face. Here,
imagination could hardly be the cause, for the woman had not
thought of, or brooded over, the occurrence, nor had she any
apprehension that her infant would be marked.

Dr. Homans spoke of an acephalous foetus, the mother of
which during pregnancy had not even apprehended any marr-
ing of her child. Dr. H. does not remember, since that case,
any other wherein the mothers had anticipated any monstrosity,
although such did occur. These facts he considered would
militate with the imagination doctrine, or the idea of effect from
strong mental impression or shock on the foetus in utero.

Dr. Strong remarked upon the difference between mental
and physical laws in their action on the system. Some indi-
viduals have, and some have not, the imagination sufficiently
sensitive and impressible for the production of such marked

1853.] Extracts from Soc. for Medical Improvement. 469

action as has been referred to. The final question, however,
is whether such results are ev " r^xluced. If" this be proved
and conceded, it is sufficient to make the fact a fixed one. One
instance thus established is enough, and^s good as ten thousand.
The numerical system is valueless upon this question.

Dr. Bigelow, Sen., would pronounce this principle of differ-
ent impressibility, &c, to be the foundation of all the charla-
tanry of the day. The remarks of Drs. Jackson and Strong
go to prove only the possibility of these occurrences under the
above supposed theory, but do not establish their certainty.
There is not sufficient basis, as he views the subject, for making
a rule or law in regard to it.

Dr. Strong asked if any one had seen so strongly marked
special cases as that, of the slitted ear and the enlarged finger
narrated by Dr. Jackson ?

Dr. Hay ward, Sen., mentioned two cases of slitted ear; the
slit being in the portion in which ear-rings are inserted. One
individual, when seen by Dr. H., was J 6 or 17 years of age.
The mother did not remember any accident or sight possibly
causative of such a result.

Dr. Wm. T. Parker related the following case which occur-
red in his father's practice in Virginia, many years ago: A lady,
three months advanced in pregnancy, saw a pig, driven furious-
ly out of an inclosure by a negro boy, have its bowels torn out
by the stake of a fence. The lady was greatly shocked, and
fainted. Her child, when born, had the entire front of the ab-
domen covered only by a thin film, and the intestines were visi-
ble through it. There was also imperforate anus. The child
died not long after birth.

Dr. Channing related the case of a lady in Edinburgh, of
which he heard while there lately : Her surgeon had been per-
forming the operation for hare-lip, and the lady's attention was
drawn to some blood which chanced to remain upon one of his
fingers; at her request, he described the operation to her. She
was from four to five months gone with child; at birth, the
child was found with hare-lip. The mother stated that she had
been much impressed by the above occurrence and narration.

Dr. C. alluded to the fact that the umbilical cord sometimes
performs amputation of fetal limbs.

Dr. Coale said that the agency of mind upon matter cannot
be denied. Sometimes the cause and the effect of nervous im-
pressions are greatly disproportionate the one to the other.
The action of these impressions on the stomach and bowels
is undoubted. Dr. C mentioned a patient under his care who,
during her pregnancy, saw a deformed man, and was greatly
affected and troubled at the occurrence. Previous to her con-

n. s. VOL. IX. NO. VIII. 30

470 RicorcVs Letters on Syphilis. [August,

finement, however, the vivid impression subsided, to be renew-
ed during the throes of parturition. She became very appre-
hensive of possible deformity of the child about to be born,
which, however, presented none.

Dr. Bigelow, Jr., thought the negative, as well as \he positive
evidence on this subject should all be weighed ; otherwise,
fallacious results are nearly sure. Strong numerical evidence
and many cases seem to him necessary for a decision ; isolated
cases are insufficient.

At the meeting holden Nov. 8, Dr. Storer reported that he
had, during the last week, delivered a woman of an infant with
hare-lip; the mother, the day after confinement, told him that
she had 'been very painfully impressed while visiting, during
her own pregnancy, a friend who was dying from phthisis, and
who, during her visit, had a severe and sudden attackof hae-
moptysis, accompanied by distressing dyspnoea. The pregnant
lady was greatly shocked, so much so as to faint ; and she sub-
sequently thought frequently of the occurrence, fearing its
effects upon the child she carried. This infant was born with
a hare-lip of double fissure.

Dr. Gould mentioned, asa " set-off'' case to the above, the
following: On last Monday, he attended a woman in labour,
who. at the birth of her child, was very anxious that its palate
should be examined, she having, early in her pregnancy, seen a
person with very disagreeable countenance from deformity of
the palate. She had been very unpleasantly affected by the
sight, but, notwithstanding her very strong apprehension, no
effects are visible upon her child.

The discussion of the subject was not resumed. [American
Journ. of Med. Sciences.

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 409.]
SIXTEENTH LETTER.

My Dear Friend, Most decidedly we cannot please every-
body ; and this old adage, so ingeniously presented by La
Fontaine, is particularly applicable when medical science is
concerned. The monkeys have brought me ill luck ; I have
not satisfied the experimenters, who have pretended to have
inoculated them with syphilis, and I have much less satisfied
those who do not believe in this pretended inoculation. How-
ever, see how mistaken I am, since I had the naivete to think

1853.] Ricord's Letters on Syphilis. 471

that from these two parties I merited some praise. You will
see what was my error.

The young Bavarian colleague who has just inoculated his
name with syphilis, has reproached us, myself and others, of
having been hasty in our conclusions upon the non-tr admissi-
bility of syphilis to animals. However, if I count correctly,
more than twenty-four hours have passed by since Hunter, and
the time has been sufficiently long for me to reflect, and that,
too, without too much precipitation.

On the other hand, the colleagues whom I respect, and who
ordinarily entertain the same ideas with me, have reproached
me in almost the same way. They have discovered that I
have been a little hasty with the monkeys; they believe they
tell me that I have yielded to apish tricks. My learned and
able colleague of the Hospital du Midi, M. Puche, is yet in a
state of perfect incredulity relative to the transmissibility of
the syphilis to animals, nor does M. Cullerier, that persevering
experimenter, believe the reality of experiments which make
so much noise.

What I recounted to you in my last letter, I have seen with
my own eyes ; I have also told you the attenuating circumstan-
ces, which it is impossible to put to silence, however satisfied
of the convictions and good faith of M. Auzias Turenne. But
after having told you of this fact of the inoculation of the
virulent pus from man to the monkey, all that I know of the
matter, 1 am astonished at the sudden and premature conclu-
sions which our German colleague draws from the fact ; and to
speak frankly, he who exacts in others so much maturity of
reasoning and reflection, has not himself offered the example.
After all, the promptitude of his conclusions can be excused on
the ground of the very inoculations to which he has courage-
ously submitted himself, and which he would have been very
glad not to have made uselessly.

Our German colleague makes much of this proposition :
" One single positive experiment has more value than an innu-
merable quantity of negative results? Without doubt; but
upon one condition, which is that this experiment should be
positive, that it should be incontestable, and that it should pre-
sent all the guarantees of certainty and exactitude, and, more
than this, that it can be repeated; without all this, it is worth
nothing. The Academy of Science knows the value of this pro-
position constantly brought forward, and by which, periodically,
rash and new experimenters pretend to overthrow the laws of
physics. This argument has served for all human deceptions.
What says the magnetologist who pretends to transport the
sense of sight to the nape of the neck or to the epigastrium ?

472 Ricord's Letters on Syphilis. [August,

Precisely what our German colleague says viz : one single
positive experiment, &c. What says the homoeopathist, who
maintains that an atom otbryonia. diluted in the immensity of
the waters of the ocean can cure pneumonia? Precisely the
same thing as our German colleague.

In the physical and natural sciences, one isolated fact is worth
nothing if it is not susceptible of being repeated. Here is what
all those think who know what the philosophy of science is.
Otherwise this would be the most dangerous and the most per-
fidious stumbling block to progress, if laborious and patient
observation did not come in to prove that it was but a sophism,
an error, and often only a boast. My honorable colleague and
friend, M. Cullerier, ought himself to tell you what he thinks
of the experiments of M. Auzias. As to myself, J have estab-
lished this, that the virulent pus has been transported from man
to the monkey, and from the latter it has been inoculated upon
man ; nothing more, nothing less. Here is the plain fact; af-
terwards comes its interpretation.

I said to you in my last letter, " Might not the monkey have
served herein only as a soil for transplantation V* I believe
so, for here is what happens the puncture of the inoculation
which has been made upon the monkey, scarcely irritated,
scarcely inflamed, and suppurating very little, although soaked
in the virulent pus after it has been made, has a constant ten-
dency to heal up, and this happens with astonishing rapidity.
We do not see in the inoculation made upon the monkey that
ulcerating, continued, increasing progress which is the charac-
ter of the chancre upon man, especially the chancre which does
not become indurated ; we do not find even that period of spe-
cific statu quo, so tenacious, so long, which nature keeps up in
man, and which he has ordinarily so much difficulty to destroy.
There is never in the monkey the least phagedenic tendency ;
nothing which resembles the specific induration in its com-
mencement and in its consequences. A puncture, scarcely
any suppuration, a crust, and a cure! Herein are the effects
of inoculation upon the monkey and all this takes place almost
as quick as one of his gestures. We see that it is for the chan-
cre a refractory and foreign soil; the virulent seed is there
exotic; in vain we take much precaution to sow it well, water
it, to place it in a green-house, or under a bell ; it dies before
having thrown out any roots, and consequently without having
given forth any fruits.

M. Auzias explains all this by the great vitality of their cir-
culation ; it would be more easy to explain it by their nature so
averse to syphilitic virus, upon which I congratulate them. We
can even believe that in the pustule which is produced with so

1855.] RicorcTs Letters on Syphilis. 473

much difficulty, the virulent pus serves there only as an issue-
pea which irritates, causes suppuration, but is not combined
with the tissues; it is mixed with the pus which is produced,
that is all. It would be necessary, in fact, to be able to con-
clude definitely upon any other result, that the pustules produced
upon the monkey were broken, that the ulcerated surfaces
were frequently cleansed, in order that we should not suppose
that there remained some pus of the chancre mixed up, and
that we inoculated afterwards the suppuration furnished by
these surfaces. We know what happens in man. We may in
vain cleanse the surface of the chancres, apply to them even
medicated substances ; still the virulent secretion continues to
be produced. As long as we shall not have carried out this
experimental programme, the sole experiment which has been
made will be insufficient to destroy all which has been estab-
lished by serious men upon numerous and perfectly-established
facts. The sole acquisition made to science, and which I am
perfectly ready to recognize, is, that we can place and preserve
the virulent pus upon the monkey, and afterwards make use of
it to inoculate man, as one transplants a plant from one soil to
another. That is all that I have seen and established, and the
only deduction which I can draw from it.

Until a new order of things, then, our German colleague
would be in the same condition as regards his inoculation, as if
it had been made with virulent pus preserved in tubes or be-
tween two layers of glass.

This induces me to tell you what the pus inoculated upon
man produces, the course which inoculation follows, and what
it teaches as regards the pathology of chancre. But you inform
me that my honorable colleague and friend, M. Cullerier, asks
of you permission to speak. I yield to him with pleasure ; we
shall all gain from it.

SEVENTEENTH LETTER.

My Dear Friend, I think that I have done justice to the
monkeys; for the present, I shall not occupy myself any more
with them. If later, it can be proved to me, that they can con-
tract anything but what I have told you, I shall be found always
ready to acknowledge it. Until then, I do not see any motives
to change my opinion. In waiting, let us return to the poor
human species, to whom, at the present day, no one contests
the claim to the verole as an inalienable right.

However, before going farther, permit me, after all that I
have said to you, and perhaps even by reason of what could be
recently said, to establish the following proposition, which ap-
pears to me to be impossible to overturn :

474 RicorcTs Letters on Syphilis. . [August,

The chancre (primary ulcer) at the period of progress or of
specific statu quo, is the only source of the syphilitic virus
(morbid inoculable poison).

I have already told you in what conditions the virulent pus
ought to be, in order to act ; you know, also, the conditions in
which the parts ought to be, in order to undergo the action of
it. Let us now study the effects of this action ; in other words,
the pathogeny of the chancre. This subject is a serious one,
but a little dry. I depend upon all your good will, to follow
my developments. Please to look for no other interest than
that of the question itself.

If we make a puncture under the epidermis, with a lancet
charged with virulent pus, (his puncture, which ought scarcely
to bleed, soon grows red, becomes prominent, and its summit
is raised up by the serosity, which soon becomes turbid in or-
der to take on afterwards the characters of pus.

Thus, puncture, redness, papule already surrounded with an
areola, vesicle, vesico-pustule, and finally pustule; such is the
series, the constant succession of phenomena produced by inocu-
lation. All this follows without interruption, without any ar-
rest, from one hour to the other, from one day to another; it
is a pathological riband, which is constantly unrolling in order
to arrive at a regular and inevitable term, that is, to the pro-
duction of a pustule of ecthyma, the most perfect, and of the
best possible type.

This pustule is often depressed at its summit, even umbilica-
ted at the point which corresponds to the puncture, and upon
which we perceive most generally a little drop of dried blood.
If the pustule is not broken, the pus which has formed, dries up,
and gives rise to a conical, brown, greenish or blackish crust.
This crust tends to increase at its base; for it covers an ulcer-
ation, the circumference of which tends itself to increase. In
this increase of the ulceration under the crust, the epidermis of
the areola which surrounds it and the border, is successively
raised up by the suppuration; this latter in its turn dries, in
order to form a new disk of crust, while a new areola is formed
at its circumference, and so on.

Tell me, without ceremony, if I am sufficiently clear in this
description; it is of great importance to me to be well under-
stood.

The red circle (the areola) which borders the crust, is or-
dinarily tumefied, and encloses it as the rim of a watch encloses
the glass only, as there is here an increasing ulceration, and
always new pus produced, and as the circumference of the crust
is always less hard than its centre, this crust is not generally
very adherent. Sometimes the crust is formed early ; at other

1853.] RicorcTs Letters on Syphilis. 475

times the pustule remains in the#purulent state during a time
more or less long. This pustule sometimes does not acquire a
very great volume ; often it has at its commencement only the
size of a lentil; at a later period its surface might equal that of
a five-cent piece and even that of a franc ; but it is not rare to
see it acquire dimensions much more considerable.

The pustule offers, then, those transitions which we observe
so often in other forms, and which give to it the aspect of rupia,
either before the formation of the crust or when the crust is
formed. There is only here, as sometimes in rupia, a differ-
ence of volume. If we break the pustule the second or third
day in those cases of quick evolution ; or if we break it at a
later period in the ordinary cases; or if the crust is detached,
we find beneath an ulceration occupying all the thickness of
the skin, perfectly rounded, with the borders cut perpendicu-
larly, as if it had been made with a punch. The borders of this
ulceration, slightly separated from the adjacent parts, tumefied,
serrated, and turned back, lemain surrounded by the red areola
which constitutes the margin of it; they are covered by a
diphtheritic layer, a special adherent pyogenic membrane. The
surface of the ulceration secretes a sanious, sero-sanious pus,
often reddish, and charged with organic detritus; this is the
virulent inoculable pus. When we cleanse this surface, we find

diphtheritic layer more pronounced than that of the borders,
ind which is also constituted by a special pyogenic membrane,
>f a greyish color, of a lardaceous aspect, and which cannot be
letached. Moreover, the bottom of the ulceration reposes upon

base more or less thick, more or less engorged, according to
^he progress which the ulceration is to pursue a progress
especially determined by the character of the soil in which the
syphilitic grain has been sown.

The ulceration which I have just described, and which has
followed an increasing progress, may arrest itself at the extent
rhich I have already indicated, or persist a long time a
lonth, six weeks and more, or continue to increase in order to
:ake on larger dimensions, and to present also important modi-
fications.

In the numerous inoculations which I have made, things have
ilways happened regularly, thus: An incessant evolution
starting from the puncture ; constant production of an ecthyma,,
the ulcerating bottom of which, presents in its turn, above all,
the classical and typical characteristics of the chancre ; ulcera-
tion with a tendency to increase, or remaining a special statu

to.

You already see, my friend, that the artificial inoculation
verthrows all that we have been accustomed to teach and to

476 Ricord's Letters on Syphilis. [August,

repeat to each other for ages p,ast ; you see it break the physi-
ologism of Broussais ; you also see it reduce to its proper value
the doctrine of the pfnjsiologic contagion of a more recent
date. And first, can the theory of incubation sustain itself in
presence of what inoculation produces, and of those results
which you can repeat every day ; for, remark, it is not a unique,
exceptional fact that I relate to you, but there are masses of
identical facts always giving place to the same phenomena, and
of which every body has the proof in their hands.

The electric, expansive mode of Bru ; it is no longer possi-
ble to believe that the syphilitic virus penetrates the economy
like lightning, that it is a shock from the individual infect-
ing, to the individual infected. The chancre, the primitive
ulcer, is no more the result of a shock in return. We can-
not admit, at the present day, unless we are blind, that the
virulent pus traverses our tissues by a solution of continuity
or otherwise, in order to infect first the entire economy, to hide
itself at a distance, in order to return afterwards upon its steps
to hatch in the nest where it had been first placed.

Special grain, the syphilitic virus, grows where it has been
sown ; particular ferment, it is those parts which it immediate-
ly touches that enter first into fermentation. All this lakes
place, as we have already said, more or less quickly, accord-
ing to the disposition of the soil, according to the fermentable
aptitude but all this takes place strictly, absolutely, in a point
at first very circumscribed, which we shall contrive perhaps to
limit bye and bye.

The non-existence of a period of incubation, a fact so evi-
dent, so true and so logical, is not yet, however, accepted ; the
contrary prejudices have been of too long standing not to have
the force of law, or to be easily overthrown. Those who, not-
withstanding, sustain the incubation, and who believe that the
virulence of syphilis is compromised if it does not exist, have
made me a primary objection ; they say to me, if you obtain
instantaneous and uninterrupted effects by artificial inocula-
tion ; if you have observed only a local evolution ; if you have
been struck by an apparent silence of the organism, and if you
have perceived nothing which explains a general participation
in the syphilitic drama, it is because you operate upon an or-
ganism already impregnated, injected ; you inoculate patients,
and those patients are already inoculated.

This objection, you see, enters into the famous theory of
virulent bottles. I have already refuted it ; I have told you
what we ought to think of this opinion as respects wounds, in-
juries and operations made upon syphilitic subjects. I cannot
help returning to it ; permit me to refer you to what I have

1853.] RicorcFs Letters on Syphilis. 411

already stated upon this subject. But I have another answer
to make to this objection, besides the experiments practised
upon the patients themselves. I shall answer this by the ex-
periments made from sick individuals to healthy ones, and I
shall invoke especially the recent inoculations practised upon
man upon the occasion of the inoculation of the monkeys.
Well, in these cases the results of the inoculation have been
identical with those which I have just described to you ; that
is to say, an immediate action, an uninterrupted evolution, and
production of the ecthymatous pustule.

But does artificial inoculation always give rise to this unin-
terrupted series of phenomena ? Are there no circumstances,
in which, between the inoculation and the manifestation of the
symptoms, there will be a period of rest, of sluggishness, as in
the inoculation of the vaccine virus? In the contagion by the
ordinary way, does there not always seem to be a time suffi-
ciently long between the action of the cause and the manifesta-
tion of the effects?

Yes, without doubt, and these are the cases which can justify
and legitimize in some sort the theory of incubation. But when
we take the pains to examine these facts with attention, we see
that they have been badly appreciated. I shall try to reduce
them to their true value, and to bring them back to the laws
before established.

I have already said that these cases have never happened to
me, in my numerous experiments, always publicly made. This
arises evidently from the uniformity of the proceedings which
I have employed. My honorable colleague, M. Puche, who
has experimented as much as myself, and perhaps still more,
has only once or twice seen these accidents manifest them-
selves, at the second or third day after the puncture. All those
who have studied the inoculation of syphilis, know that when
it does not succeed immediately, it is because it is negative.

However, we can understand that a too superficial puncture,
that the virulent pus placed upon surfaces scarcely denuded,
would require a longer time in order to affect the part, and in
order that the effects should be produced. Here is what I
have observed upon M. Robert de Welz. A first puncture
very superficial, which produced no effects the first day, so that
there was something which might resemble incubation. But
the second puncture, which I made myself upon him, followed
the regular course. The partisans of the influence of the gen-
eral state would answer me, what of that? The first puncture
had a slow development, because the organism was not yet
impregnated. The effects of the second puncture have been
rapid, on the contrary, because then the virus had invaded the

478 Ricord's Letters on Syphilis. [August,

entire economy. That is very well, I shall answer, but here is
something which slightly deranges this beautiful theory ; it is
that M. de Welz had a third puncture made, which being too
superficial like the first, has given like that, only tardy results.

Here is the key to incubation, my dear friend. We under-
stand very well, without its help, how in the contagion by the
ordinary methods, virulent pus placed upon surfaces more or
less denuded, and consequently fitted to receive more or less
quickly the virulent action, are affected more or less quickly,
and give place to a morbid action more or less rapid. We
know, and observation teaches us every day, and the experi-
ments of M. Cullerier demonstrate it in an irrefragable manner,
that the virulent pus can remain in contact with healthy sur-
faces without altering them, and without being altered itself;
but we know also that surfaces constantly bathed by the viru-
lent pus, acrid and irritating, excoriating before being specific
we know that these surfaces end by becoming eroded, and by
being placed by this pus itself in the conditions necessary to
the inoculation taking effect.

This sort of vesication might require a time more or less
long to be produced, before the special effects appear, and simu-
late incubation. For example, some virulent pus is collected
in a fold of the vulva, of the vagina, of the prepuce, in the inte-
rior of a follicle; it is not till a longer or shorter period after
the pus shall have been thus placed, that passing through the
successive action that I have just shown, it arrives at the effects
of incubation. There is nothing herein which is plausible ; it
is physical and material; it is what the observation de visit
demonstrates every day to the eyes which know how to see.
How many patients there are who think themselves at first
only affected by a balano-posthitis, and in whom we see chan-
cres produce themselves, in a longer or shorter time. Add to
this the carelessness of patients, the absence of all observation
of what concerns them, a circumstance so common in practice,
and which causes them to take for incubation the time which
has passed between the exposure to the cause, and its apparent
manifestations. Under these circumstances, you will see for
the chancre, as for the bleonorrhagia, the explanation of these
pretended incubations of an elasticity of duration so considera-
ble, that they vary between hours, weeks, and even months.

You see that I enter more and more into the substance of
these important and grave syphilographic questions. In my
next letter I shall treat of the different forms which the chan-
cre can assume.

May your good will, and that of your honored readers, still
accompany me. This is for me the most valuable encourage-
ment. [Boston Med. and Surg. Journal.

1853.] Treatment of Dyspepsia. 479

General Pathology and Treatment of Dyspepsia. By Prof.
J. H. Bennett.

By dyspepsia (from Svtftfsirru, to digest with difficulty,) is
generally understood, all those functional derangements of the
stomach which are primary in their origin, that is, not depen-
dent upon, or symptomatic of, inflammation or other disease in
the economy. Such a disordered condition is exceedingly com-
mon, and often constitutes the despair of the physician, arising,
as it frequently does, from causes which are often obscure, or,
if discovered, are beyond his control. This will become appar-
ent by considering, in the first place, those circumstances
which require to be united to secure a healthy digestion.
These are 1st. A proper quantity and quality of the ingesta.
2d. Sufficient mastication and insalivation. 3d. Active con-
tractility in the muscular coat of the stomach. 4th. Proper
quantity and quality of the gastric, biliary, and pancreatic
fluids. 5th. A consecutive and harmonious action of the in-
testinal canal. Dyspepsia, or indigestion, may be produced by
any cause which occasions derangement of one or more of
these conditions; and hence why so many different circum-
stances may produce somewhat similar symptoms, and why so
many different remedies have been found effectual in various
cases. Notwithstanding that you will frequently meet with
instances which baffle all preconceived rules, there can be no
doubt that a carefulattention to the essential physiological con-
ditions above enumerated will, in the great majority of cases,
conduct you to a successful rational treatment. Thus

1. Of all the causes of dyspepsia, excesses in eating and
drinking are the most common. An over-distended stomach,
or too rich a meal, not unfrequently induces a feeling of weight
or fullness in the epigastrium, nausea and eructation of acid,
bilious or gaseous matters, with a loaded tongue, headache, and
other general symptoms. This is acute dyspepsia, or the em-
barras gastrique of the French. Occasionally, there is more
or less vomiting of bilious matter, when the attack is vulgarly
called a bilious seizure. If called into such a case, immediate-
ly on its occurrence, and before the ingesta have left the
stomach, as determined by the sense of load at the epigastrium,
an emetic should be given; but if vomiting be present, it should
be assisted by warm diluents. As soon as the stomach is
quieted, or, if you have been called in at a late period, when the
ingesta have passed into the intestines, a purgative pill should
be administered, consisting of four grains of calomel, with four
of compound extract of colocynth, followed in a few hours by
a purgative draught of salts and senna. If necessary, an emetic

480 Treatment of Dyspepsia. [August,

may also be given. The purging, with a day or two's con-
finement to farinaceous food, will generally get rid of such an
attack ; but their frequent repetition leads to the chronic form
of dyspepsia, when careful regulation of the diet, with exercise,
must constitute the chief treatment. Hence the advantage of
what is called 'change of air,' and much of the benefit which
is derived from watering-places. Chronic dyspepsia, however,
is far more commonly caused by excess of spirituous and vinous
drinks, than by eating, when abandonment of the evil habit is
a sine qua non in the treatment. Tea-drinkers are very liable
to the disease, and its frequency among female servants is pro-
bably owing to this cause.

2. It may frequently be noticed, that those who have acqui-
red the habit of eating rapidly are more or less dyspeptic. I
knew a journeyman printer who was much tormented with in-
digestion, but who was cured by changing his residence. The
cause of this was for some time a mystery, but on again chang-
ing his house the disease returned, although no apparent cause
could be discovered. I ascertained, however, that it depended
not on the locality per se, but on its distance from the printing-
house. When far off, he eat his dinner with his family rapidly
having only just time enough to walk home and back within the
hour. When he lived near, the time otherwise spent in walking
was occupied in eating, or in cheerful converse with his wife
and family. Since I made this observation, it has often occur-
red to me that the distant residence of artisans from their
place of employment may be the occasional cause of the dys-
peptic symptoms they frequently possess. With regard to the
exact object of the saliva in the process of digestion, whether
it be to convert the farinaceous compounds of the food into
glucose, or, b} its viscidity, to mix up air with the portions
swallowed, is not positively determined ; but its necessity for
the digestion of man is shown by cases where the under lip has
been lost by accident or disease, and where salivary fistulas
have formed, in which dyspepsia is generally present, and in
which the disordered digestion has been cured by operations
that, by restoring the parts to their normal condition, prevent
the escape of saliva. Again, persons habituated to the dirty
habit of spitting, are for the most part dyspeptic ; and it has
been asserted that the pale countenances of the inhabitants of
the United States, and the leanness of their persons, are owing
to this cause. In all cases where dyspepsia can be traced to
this source, the treatment must be obvious.

3. The contractile movements of the stomach, which, by
kneading the ingesta, and keeping them in constant motion,
secures an intimate admixture with the gastric juice, and the

1853.] Treatment of Dyspepsia. 481

rapid transference to the duodenum of such portions of it as-
are transformed into chyme, are evidently of immense import-
ance to a proper performance of digestion. The experiments
of physiologists have shown that digestion in gastric juice out
of the stomach is much slower than in it, and that section of the
pneumogastric nerves, by arresting the contractile movements,
only permit the circumference of the mass in contact with the
secreting surface to be digested. These facts at once explain
the well known influence of mental emotions upon the stomach.
Contentment and hope are as favorable, as dissatisfaction and
despondency are opposed to, good digestion. Nothing is more
common than dyspepsia among literary men who overtask the
mental faculties ; among young persons of very excitable minds ;
and among iudividuals of a melancholy temperament, hypo-
chondriacs, etc., etc. It is in such cases that cheerful society,
active and appropriate occupations, change of scene, removal
from mercantile or literary employments, different trains of
thought, and so on, are beneficial. Hence also many of the
good effects of travel, visiting watering places, etc., etc.

4. Our knowledge with regard to the offices performed by
the gastric, biliary, and pancreatic juices in digestion has of
late years been much advanced. Thus, the gastric juice more
especially operates on the albuminous, and the pancreatic juice
on the fatty compounds of the food. The function of the bile
is perhaps more obscure, all hough it probably acts as a means
of precipitating or separating some of the excretory matters
from chyme, and so facilitates assimilation of the nutritive por-
tions. Digestion may be deranged by all those causes which
too much increase or diminish the secretion of these three fluids
Thus excess of acidity in the stomach is one of the most com-
mon causes of dyspepsia, producing that form of it which
accompanies scrofulous and tubercular diseases. Jt may be in
such excess as to neutralize the alkaline action of the pancrea-
tic juice, and render it difficult or impossible to emulsionize
fatty matters. In such cases, alkalies, with bitter tonics and
the direct introduction of animal oils in excess, are indicated.
On the other hand, the gastric juice may be diminished in quan-
tity, as frequently occurs in persons who suddenly overtask the
powers of the stomach at feasts, or in old persons with feeble
digestion. The sense of load after eating is generally indica-
tive of slow digestion from this cause. In acute cases, a stim-
ulant rouses the stomach to increased action, and hence the
moderate use of drams and generous wines after dinner is occa-
sionally useful. In old persons, the sense of load and feeble-
ness is best removed by giving up tea, and drinking at night a
little weak brandy and water. In chronic cases, acids are indi-

482

Treatment of Dyspepsia.

[August,

cated, especially muriatic acid. The tr. ferri co. of the phar-
macopoeia, is a useful preparation in chlorotic females. We
have no distinct means, as far as I am aware, of rousing the
pancreas into action, and yet many cases are on record in which
fatty matters have passed undigested through the alimentary
canal in consequence of obstruction to the pancreatic duct. In
such cases, and all those in which fatty matters are difficult to
digest, alkalies, especially the liquor potassae, with vegetable
tonics, are indicated. When the bile is deficient, constipation
and dyspepsia are usual results, and are to be relieved by gen-
tle mercurial purgatives, with extract of taraxacum, and by
remedies such as rhubarb, and especially the compound rhubarb
pill, which, by acting on the duodenum, also favour the flow of
bile into the upper part of the alimentary canal. Dr. Clay, of
Manchester, has recommended in such cases the administration
of ox-gall, a remedy, which, although not extensively given, is
evidently rational, and calculated by its purgative action to be
highly serviceable. Excess of bile, on the other hand, ought
to be treated by drastric purgatives, diuretics and diaphoretics,
according to circumstances, to cause excess of excretion. Ex-
ercise should also be insisted on to call the lungs into action,
and thus relieve the liver in its office of separating hydrocarbon.

5. A derangement of the consecutive and harmonious action
of the alimentary canal is another frequent cause of dyspepsia;
for it is as necessary that those portions of the food which are
not assimilable should be removed out of the economy, as that
the nutritive materials should be absorbed. Hence, whatever
impedes the contractility of the intestinal canal, whatever
alters the structure of its mucous membrane, or whatever
mechanically obstructs its caliber, may always be observed to
induce dyspeptic symptoms. The removal of these various
conditions, whether by stimulating the nervous centres, by ap-
propriate diet, or by purgatives and astringents, as they may
be required, need not be more particularly dwelt upon.

. In many cases of dyspepsia, two or more of these classes of
causes may be combined, so as to render the indications for
treatment complex and apparently contradictory. In other
cases, one or more causes may exist, although from the indica-
tions presented they cannot be determined, when our treat-
ment must always be more or less vague and unsatisfactory.
Lastly, there are a few instances where dyspepsia can only be
explained by idnsyncracy, in which we find this or that partic-
ular article of diet to derange the digestive functions, and in
which avoidance of the offending cause is the only plan that is
attended with success.

In addition to the different kinds of dyspepsia to which I

1853.] Treatment of Dyspepsia. 483

have directed your attention, it is practically important to keep
in remembrance the leading symptoms which may be present,
and the remedies by which they may be removed. These are
anorexia, acid eructations, sense of load in the stomach, cardi-
algia, vomiting, flatulence, palpitations of the heart, and cepha-
lalgia. Some persons talk of a stomach cough, which, however,
is more commonly dependent on irritations in the oesophagus
or pharynx, which have hitherto been overlooked. I have al-
ready alluded to the mode of treating most of these symptoms.
Palpitations of the heart often occasion alarm in young dyspep-
tic persons, and in addition to remedies directed towards the
stomach, change of scene, removing attention from the affected
organ, end varied reading should be enjoined. The sense of
load in the stomach is most frequently removed, as we have
previously said, by acids, whilst acid eructations and cardialgia
are best relieved by alkalies and bitter tonics. Vomiting and
flatulence are often very troublesome symptoms, and the varied
remedies which may be employed in a case of chronic vomit-
ing may be gathered from the following history :

Case. Dyspepsia Vomiting of Fermented matter, contain-
ing Sarcina?. Thomas Spence, set. 53, a weaver. Admitted
September G, ] 852. He states that, for fourteen or fifteen years
past, he has been subject to occasional vomiting, which gener-
ally occurred on Sundays, owing, he supposes, to want of exer-
cise at his usual employment. On these days he scarcely ever
took his meals from fear of the almost certain vomiting which
would follow. For two or three years past he has been Jiable
to frequent heart-burn, water-brash, and acid eructations, but
was able to continue at his usual employment till about six
months ago. Since then, he has been gradually losing his ap-
petite, and his strength has become much prostrated. He has
never vomited blood or any dark-colored matter, and has never
passed any such by stool. On admission, tongue clean ; no
difficulty in deglutition; appetite capricious, but always best in
the morning and early part of the day. Shortly after taking
food, he begins to have uneasy sensations in the epigastrium,
sickness, and a sense of weight at the stomach. When these
symptoms appear, the abdomen generally begins to swell, and
in about an hour to an hour and a half, the food is frequently
vomited. The rejected matters consist generally of the half-
digested food, with a thick, dirty, frothy scum on the surface,
resembling yeast. He has also frequent pyrosis, acid eructa-
tions, and flatulence, the latter sometimes so great as to occa-
sion a sensation of choking, especially after vomiting. These
symptoms are worse after some kinds of food than others:
oatmeal, especially in the form of porridge, produces them in

484 Treatment of Dyspepsia. [August,

the severest form ; broths, vegetables, or any kind of slops, do
not agree with him; animal food suits him best, but when even
this is taken for any length of time, the symptoms soon reap-
pear. The abdomen at present is much swollen, very tense,
and tympanitic on percussion, with considerable tenderness over
the epigastrium. The bowels are generally constipated ; the
stools usually of a dark color and hard consistence. IJe ha3
occasionally slight pain and difficulty in voiding his urine; which
is slightly phosphatic. Other functions are normal.

On taking charge of this patient on the 1st of November, I
found him vomiting from time to time large quantities of fluid
mixed with undigested matters, on which there gathered, after
a short time, a thick brownish scum, exactly resembling yeast.
On examining this scum with the microscope, it was ascertain-
ed to contain a large number of sarcinae ventriculi, mingled
with starch corpuscles, more or less broken down, and granu-
lar matter. From the ward-books, I learned that this treatment
had consisted in the successive administration of 1. The local
application of leeches; 2. Of the sulphite of soda, in scruple
doses, with two grains of aromatic powder three times a day ;
3. Of half a grain of protochloride of mercury at night; 4. Of
a scruple of the sulphite of soda every three hours, which was
subsequently increased to half a drachm; 5. Of creosote mix-
ture; 6. Of a naphtha mixture; 7. Of bismuth and aromatic
powders ; and 8. Of pills of calomel and opium. These differ-
ent kinds of treatment, some of which, especially that of the
sulphite of soda, had been continued for several weeks without
intermission, seemed to have produced no good effect.
November 11. During the last four days, he has vomited every
night, four hours after dinner, that is, about* 6 P. M. The ejec-
ted matter presents the same yeast-like character formerly des-
cribed ; but the sarcinae, though still abundant, are not so
numerous. He complains of a great sense of distension, and a
feeling of 'working' or 'bubbling' in the stomach shortly
before vometing. #. Acid, hydrocyan. dil. M. xviii ; Syrup,
aurant. 5j; Aquae l'\\; M., half an oz. three times a day.
November 20. The hydrocyanic acid checked the vomiting
till last night, when it returned with more violence than ever.
November 24. Vomiting still continues regularly every day.
Omittantur mist. acid, hydrocyan. $. Liquor potas. Hss;
Aquae ! vss. Two tablespoonsful to be taken every four hours.
December 2. Alkaline mixture again checked the vomiting,
which, however, returned last night to a slight degree. Appli-
cet vesicat. 4 x. 5 Epigastrio. December 8. Vomiting has
once more returned daily since last report, ty. Tinct. ferri
muriat. 5 j. Sumat 3 ss ter in die ex aqua. December 16. The

1853.] Treatment of Dyspepsia. 485

vomiting has been again check sd, but once more returned in a
slight degree at 1 o'clock this morning. The matter ejected
exhibits very little of the usual frothy scum, but consists of a
brown liquid like coffee, with a few shreds of undigested food.
It is of intensely acid reaction, and contains only a few sarcinae.
The dose of the acid tincture has been reduced to M. xv. The
diet during this period has been principally animal, porridge
and vegetables invariably increasing his complaint. To-day he
left the hospital to visit his friends in the country, expressing
himself as greatly relieved.

Commentary. The kind of chronic vomiting and dyspepsia
which is above described has been long known in Scotland, and
was described by Cullen as a form of pyrosis. It has been
supposed to be associated with the habit of largely consuming
oatmeal as a principal part of the diet, although its real pathol-
ogy was unknown. In 1843, Mr. Goodsir discovered in the
ejected matter from the stomach, in a case of this kind, organi-
zed forms, which from their resembling a woolpack, he denom-
inated sarcina. He considered that they were of a vegetable
nature, and by multiplying fissiparously, communicated to the
contents of the stomach the appearance of yeast, which is also
known to be dependent on the developement and growth of
vegetable structures. This occurrence in the stomach of
course explains their frequent presence in the feces, although,
whether they ever are developed in the intestines is unknown.
On one occasion, however, I have seen them in the urine, which
occurred in the case of a gentleman under the care of Dr. Mac-
kay, of this city. The sarcinae vesicas were in that case
uniformly smaller in size than the sarcinae ventriculi. They
have also been discovered in an abscess of the lung by Virchow.
The exact mode of formation and origin of these structures are
unknown ; but little doubt can exist that their presence is the
real cause of the chronic vomiting and other symptoms of the
individuals affected, and that the cure will depend on such means
as are capable of insuring their destruction and preventing
their return It must be obvious, however, that the same means
which destroy or check vegetable growth on the surface of the
body (see Favus.) are not applicable to the mucous lining of the
stomach. Besides, we are ignorant whether these parasites
grow in an exudation poured out on the mucous membrane, or
are developed only in a fluid. Again, it is very possible that
once introduced from without, the conditions necessary for
their developement may be dependent on some kinds of ingesta,
a view which derives support from the facts observed in the
case before us, namely that they were always increased by far-
inaceous kinds of food. On all these points, however, we are

N. S. VOL. IX. NO. VIII. 31

486 Apparatus for Premature lufants. [August,

as vet ignorant, and our efforts at cure hitherto have not so
much been directed to cutting off the sources of growth, as to
destroying it after it has proceeded to a certain extent. With
this view it has been imagined that the sulphite of soda would
destroy them, by causing, on its union with the gastric juice, the
extrication of sulphurous acid which is so destructive to vege-
table life. This remedy has consequently been given, and, it is
said, with success ; but in the present case it was of no benefit.
Subsequently, a variety of medicines were given, several of
which succeeded in checking the vomiting for a time. Indeed
it was remarked that the mere circumstance of changing the
medicine was sufficient to stop the vomiting for several days,
"when it returned and continued as before. Of all the numer-
ous remedies tried, the tr. ferri muriatis seems to have done
most good. [Clinical Lectures in Monthly Journal of Medical
Science.

Apparatus for Premature Infants.
Dr. Channing, in an account he is publishing of his visits to
various European hospitals, describes an apparatus he saw in
use at the Maternite of St. Petersburgh, the use of which might
be advantageously extended. "It was a species of cradle,
without rockers, into which infants are placed when prema-
turely born, or when imperfectly developed, and for whom a
steadier and higher temperature is required than that of the
atmosphere. It is made of brass, and is everywhere double ; a
space being left between the two plates comprising it, with
openings, into which warm water may be poured, and others
for drawing it off when cool. A soft bed, and a properly ar-
ranged canopy, when needed, complete the apparatus." [Bos-
ton Medical Journal.

Tartarizcd Sulphate of Quinine. By Dr. Galamini.
Dr. Galamini speaks in strong terms of praise of the febrifuge
power of sulphate of quinine when combined with equal parts
of tartaric acid a much smaller quantity of the alkaloid so ad-
ministered sufficing. During an epidemic of ague, it was given
in 43 cases, in 31 of which it speedily effected a cure. In 21
of these, half a scruple sufficed, while in 10 others, it required
more continued use. In most of the cases, there was hyperae-
mia of the brain or bronchial membrane, enlarged spleen, or
gastro-biliary derangement, requiring the preliminary employ-
ment of bleeding or purgatives. Of the 12 other cases, 5 had
relapses; in 3, no effect was produced; and in 4, the above-
named irritative symptoms returned. [Bull, delle Sc. Med.
Brit, and For. Med. Chir. Rev.

1853.] Influence of Posture in Epilepsy. 487

On the Influence of Posture in the Treatment of Epilepsy.
By Dr. Marshall Hall.

We have only to raise one hand and arm high above the
head, and allow the other to hang down, for a minute or two,
and then bring the hands together and compare the syncopal
condition of the former with the apoplectic condition of the
latter, to form an idea of the influence of posture in the treat-
ment of diseases consisting of affections of the circulation, espe-
cially that of the head.

I believe ordinary syncope may pass into fatal sinking if the
raised posture be continued.

I believe that simple apoplexy may become deeper and
deeper, simply from the opposite course of retaining the patient
in the recumbent position.

Sleep, which is a sub-apoplexy, may pass into epilepsy or
apoplexy, solely from the fact of a recumbent position. As a
preventive of epilepsy and apoplexy during sleep, it is of the
utmost moment that the patient should habitually repose with
the head and shoulders much raised. For this purpose both
bed and mattress should be raised by means of a bed chair, or
triangular cushion, and the patient be prevented from gliding
down in the bed by means of a firm bolster, four inches in di-
ameter, placed under the sheet, under the front of the ischia.
The trunk should be raised to an an2leof45 or 50 degrees.

In this manner the encephalon will be less oppressed with
blood, the sleep will be lighter, this position to epilepsy or apo-
plexy will be diminished.

This should be the patient's habit during the rest of life.

There are two other circumstances in which attention to
posture is most important.

The first is the condition of the patient after certain fits of
epilepsy, the respiration being impeded by rattles in the throat.
The posture should be much raised ; but, besides this, it should
not be such that the saliva may full into the fauces. The stu-
por and insensibility prevent the patient from swallowing. The
saliva, therefore, if a just position be not adopted, accumulates
and falls into the fauces, and a throat-rattle and dyspnoea, pain-
ful to witness, and dangerous to life, are the consequence. The
posture of the patient should be such as to allow the saliva to
flow out of the corner of the mouth. In one case such a
change of posture relieved the patient immediately.

The second case requiring extreme attention to the posture
of the patient is that of Syncopal Epilepsy, or that form of
epilepsy in which there is ghastly pallor of the countenance and
other signs of syncopal affection. The patient should be placed

488

Blood-letting in Pneumonia.

[August,

with the head low. If this be not done, the syncope mny be
speedily fatal, an event which actually occurred in an interest-
ing case a few days only ago.

The patient was no other than Ann Ross, on whom Mr. An-
derson had performed the operation of tracheotomy. Her fits
had changed from those of the epilepsia laryngea to the abortive
form. The reader may remember that the patient's age was
thirty-six; that her case wras hereditary, her father having
been epileptic ; and inveterate, her fits having recurred during
twenty-four years; and that she herself was thin and pallid.
She was seized with syncopal epilepsy; was laid on the bed,
and expected to recover as formerly ; was left ; and was at
length found to have expired. A low position and proper at-
tention might have saved the poor creature's life.

I need scarcely observe, that what I have said of epilepsy
applies to many other diseases. It is the principle of position
which I wish to enforce ; a principle, the importance of which
I believe to be still greater and still more extensive in applica-
tion than is generally imagined. [London Lancet.

Of Blood-letting in Pneumonia.

The memoir of Dietl on this subject, published several years
ago, excited much attention at the time, and we think it will
not be unprofitable to transcribe some of the facts and conclu-
sions contained in a recent report by the same author, inserted
in the weekly medical journal of Vienna (Wein. Med. Voschr).

This memoir comprises all the cases of primitive and essen-
tial pneumonia treated at the great hospital of Vienna from
1847 to 1850, without excepting those aggravated by age,
regimen, or analogous circumstances. Cases of secondary
pneumonia supervening upon acute or chronic diseases, such as
typhus, Bright'? disease, etc., are excluded. No patient has
been bled in pneumonia in this hospital since 1844; the practice
is limited to draughts of gum-water, or ptisans containing opi-
um or an expectorant.

In three years, 750 cases of pneumonia were treated on the
expectant plan, viz : 412 men, 338 women. Of these the pneu-
monia was complicated with acute disease in 140 cases, and
with chronic disease in 249. Hyperaemia of the liver and acute
intestinal catarrh were the most frequent complications; men-
ingitis was never observed ; gangrene of the lung only twice,
and pulmonary abscess in a single case. Of 750 patients treat-
ed without bfood-letting, 681 recovered, viz., 384 men, 297
women ; 69 died : 28 men, 41 women 8 died in the stage of
red hepatization ; 56 in that of infiltration ; 5 in that of purulent

1853.] Examination of Human Milk in Legal Medicine. 489

infiltration. No fatal case was exempt from complication.
The mean duration of the disease was 20 or 21 days. In 515
cases the dyspnoea was very great; it is incontestible that the
abstraction oi blood diminishes the oppression, but the relief is
only temporary. The author admits, however, that when the
pneumonia is abandoned to the expectant plan, the embarrass-
ment of the respiration is almost intolerable. This is, he adds,
an inconvenience for which the rapid convalescence more than
compensates. \_Archiues Gen. Virginia Med. and Sur. Jour.

Examination of the Human Milk in Legal Medicine.

Mr. Mercer Adam called the attention of the Society to a
new and important use of the microscope in legal medicine.
He remarked that there were few cases in Medical jurispru-
dence more difficult to decide than whether, after a few weeks
had elapsed, parturition had occurred recently or at a remote
period. In such cases of doubt, where delivery is circumstan-
tially believed to have recently occurred, but where all the
physical signs may, with equal propriety, be reckoned evidences
of this having been at a remote period, he believed that the de-
tection of colostrum corpuscles in the milk would at once de-
cide the question, and, almost with certainty, prove the delivery
to have been recent. In illustration of tin's, he cited the fol-
lowing case, which had recently come under his notice. The
body of a newly-born child* much decomposed, was found
in a morass in the south of Scotland. It was impossible to de-
cide secundum artem whether it had been born alive; but it
appeared to have been dead for four or five weeks. Proceed-
ings were taken to discover the mother, and suspicion fell on a
young woman who was supposed io have been secretly delivered
about four or five weeks previously, that is, about the same
date as the infant was thought to have been exposed. On being
arrested on the charge of concealed pregnancy, she said she
had had a child a year and a half before, which she had nursed
till within three months of her apprehension, and firmly denied
having recently delivered. The two medical men, who were
judicially appointed to examine her, came to different decisions,
so equivocal were all the signs, as to the period which had
elapsed since her delivery. A microscopic examination of her
milk was suggested, and it was found to abound in colostric
globules. This decided the questo vexata, and showed parturi-
tion to have lately occurred. The girl, on being told that
imposture no longer availed, confessed having given birth to a
still-born child, thereby confirming the accuracy of the revela-
tions of the microscope. Mr. Adam considered, that in such

490 Obstinate Ulcer of the Leg, c. [August,

cases, the microscope was likely to be as serviceable to the
medical jurist as it was in the detection of blood globules, sper-
matoza, etc. [Western Lancet.

Obstinate Ulcer of the Leg. New mode of inducing Cicatri-
zation.

It must have occurred to most of our readers to see cases
of old standing ulcers on the leg which it has been easy to
induce to cicatrise up to a certain point, but extremely difficult
to get completely healed. Thus a sore of large dimensions
may, under treatment, contract in the most favorable manner
possible until it is reduced to the size of a shilling or a half-
penny, when it suddenly becomes most obstinately stationary.
In an example of this kind, in which the ulcer had never been
healed for twenty years, Mr. Gay has recently adopted, with
complete success, the somewhat novel procedure which we are
about to describe.

A seaman, named Edward Farrell, aged 3G, was admitted,
on January 10. 1853, with an it regular sore on the front and
inner aspect of his right leg, about the size of the palm of the
hand. He stated, that it was twenty years since the ulcer first
formed ; that he had, in the meantime, been an inmate of nine
different hospitals, and subjected, without success, to a great
variety of treatment ; that he had suffered so much inconveni-
ence from pain, loss of time, etc.? that, regarding the disease as
incurable, he now applied in order to have the leg amputated.
Mr. Gay advised him to defer resort to such a severe mode of
cure, until milder measures had again been tried; and ordered
him to be confined to bed, with a lotion, composed of lot.
plumbi and laudanum, applied to the diseased part. As his
nights were rendered very restless by pain, a pill consisting of
pit. sap. cum opio. gr. v., was exhibited nightly four times in
succession, after which it ceased to be necessary.

Under this treatment, the ulcer rapidly improved, and, by
the middle of February, had become lessened to about the size
of a half crown. Cicatrization had thus far been accomplished,
in part by the dragging in of the surrounding integument, but
chiefly by the foimation of new skin. During the next three
weeks, no progress was made ; the sore remained in precisely
the same state ; it was, however, painless, and the man appear-
ed to be in very good health. He stated, that it was at this
point that the healing process had, on previous occasions, been
arrested. Mr. Gay called attention to the circumstance that
the healthy skin on each side of the cicatrix was in a state of
great tension, and apparently unable further to yield to the

1853.] Iodine as a Preventive of Mammary Abscess. 491

contracting power of the scar. To relieve this condition, he
determined to try the effect of an incision through that part of
the skin where the tension existed in the greatest degree.

On March 10th this was accordingly done. A longitudinal
incision, about three inches long, and deep enough to include
the fascia, was made on the inner side of the leg, two inches
from the border of the cicatrix.

It was noticed, after the lapse of a few days, that, as if to
confirm the propriety of the measure, the new wound gaped
most at the part exactly opposite to the unhealed sore, and that
the latter had already diminished in size.

April 1. (Three weeks after the performance of the incis-
ion.) The original ulcer is now quite closed by a very sound-
looking scar, and of the wound made by the knife there remains
unhealed only a mere line of very healthy granulations, which
will probably be skinned over in the course of a few days. It
is remarkable that the healing of the Jaiter hns been partly by
the formation of new cuticle, and partly by the approximation
of its edges. A stage of contraction will soon no doubt encue
in this cicatrix, but as the traction exercised by it in so doing
will be transferred to the back of the leg, where the skin is
loose, it may be fairly hoped that the scar of the ulcer will es-
cape injury. Mr. Gay observes, that it is only by thus altering
the direction of traction, and transferring it to more healthy
and moveable parts, that any advantage can be expected from
measures similar to the above. If the conditions under which
the artificial sore is placed were precisely similar to those of
the original one, it would then share with the latter in the im-
probability of the accomplishment of cicatrization. But they
are not. The incision is made at some distance from the dis-
eased surface, and in healthy parts, yet unsl retched, and easilv
permitting of considerable yielding. [London Med. Times.

Iodine as a preventive of Mammary Abscess. By H. C. Stew-
art, M. I)., of Salisbury, Somerset Co., Pa.

This communication, I presume, will fall under the notice of
no physician unacquainted with what is usually termed mam-
nary abscess, both as regards the condition of the breast and
the best known means of obviating that distressing condition,
to which the " lying-in woman " is so often subjected.

Perhaps no organ of the body is capable of producing a
greater amount of suffering to the patient, and vexation to the
phvsician, than the female breast. Situated upon a prominent
part of the body delicately constructed influencing and being
influenced at times, by other organs, it is adapted to the per-

492 Iodine as a Preventive of Mammary Abscess. [August,

formance of an important function, the disturbance of which
must necessarily produce a disagreeable and dangerous result,
often requiring the best efforts of the physician to counteract.

Seeing, then, that these things are so, we have been lead to
inquire, is there no remedy ? or must our patients, after having
undergone the agony of parturition, still suffer on, simply be-
cause their breasts have not been properly and sufficiently re-
lieved of milk as fast as secreted ?

If mammary abscess cannot be prevented, it is not because
remedies have not been proposed for it ; for amongst all the ' ills
that flesh is heir to,' there is none, perhaps, for which such a
multitudinous variety of cures has been tried. This is probably
the best evidence of the difficulty of preventing such an occur-
rence.

The first indication that suggests itself to the mind of the
physician, is to remove the tension by withdrawing the milk.
But this cannot always be done : for in how many cases do we
find a complete obstruction of the ducts; others, again, where
there are no nipples, consequently no outlet for the milk. Have
we no remedy here, or must we let the gland inflame, and then
bleed and apply leeches and 'poultices to favor suppuration,'
and when the abscess forms, open it with a lancet, and run the
risk of forming a milk fistula, then apply adhesive strips, and if
all this fail let it alone.

In the early part of my practice, I was called to attend a lady,
the mother of five children, none of whom she had ever suck-
led, owing to inversion of the nipples, and consequent obstruc-
tion of the ducts. So thorough was this obstruction, that the
best efforts of the physicians, on former occasions, had totally
failed to relieve the breasts of a particle of milk ; consequently
the woman had suffered on every occasion from mammary
abscess.

In giving me a history of the treatment at different times, she
said that at one time she came near losing both breasts ; when
the physician, (dead at the time of this conversation,) as a last
remedy, applied something which, from the description given
me, I believed to be iodine. Knowing the efficacy of that ar-
ticle in all glandular affections, I resolved to try it as soon as
the breasts showed any signs of inflammation. On the third
day, finding them large, heavy and intensely painful, I made an
application to the breasts of iodine ointment spread upon linen,
which gave almost immediate relief. After a few applications,
I found the breasts ''perfectly flaccid, completely cool, and
admitting of the freest palpation and handling, without the wo-
man making any complaint." From the favorable result in the
above case, I was induced to try it in two similar cases, with

1853.] Reducing Dislocation of the Thumb. 493

the same success, and so far as I know it has never failed in the
hands of any of my medical friends to whom I have recom-
mended it ; but not a few there are who can bear testimony to
its virtues.

With these few suggestions, I respectfully submit it to the
profession, hoping that it may not disappoint their expectations.

[Medical Examiner.

A new mode of Reducing Dislocation of the Thumb. By John
Doe, M. D., of Cabot, Vermont.

" In this dislocation, the phalangeal end of the metacarpus
projects into the palmar surface of the hand, forcing itself be-
tween and through the flexor muscles of the thumb, which
form a loop around the head of the bone. Extension made up-
on the thumb makes this loop more tense ; and, as the metacar-
pal end of the first phalanx is broad and considerably flattened
on its palmar aspect, it must be apparent at once that the diffi-
culty of reduction is directly as the amount of extension. There
is good reason to believe that extension would never succeed
in these cases without rotation. The principal indication in
treatment here, is to relax the flexors forming the loop, so that
the end of the phalanx can be pushed forward into the loop,
and by carrying the muscles forward with it disengage the
head of the metacarpus. This can be done in the following
manner :

Having previously warmed the hand, if cold, in warm water,
the surgeon should seat himself by the patient, facing in the
same direction, and upon the same side with the injured thumb,
and place the hand upon his knee. Tip back the thumb upon
the dorsum of the metacarpus to more than a right angle, or so
as to form a slightly acute angle with the latter bone ; place
both index fingers against the ball of the thumb, and the ends
of both thumbs against the dorsum of the disarticulated end of
the phalanx ; now by pushing forward forcibly, yet steadily
against the phalangeal bone with both thumbs. Reduction
will generally be effected on the first trial, and almost in-
stantly." {Western Lancet.

Erysipelas.

Collodion appears to be now preferred by many, over every
other local application, but in some cases its contraction causes
a painful degree of pressure upon the inflamed parts. To ob-
viate this, it has been advised to mix two parts castor oil to
thirty of collodion, which gives it the requisite softness and

494 Potash in the Treatment of Scurvy. [August,

elasticity. The local applications used in this disease are nu-
merous, and each different one that has been suggested has its
advocates. Probably the good effects of all, are mainly due to
a common quality that of shielding the surface from the con-
tact of the atmosphere. The collodion answers this purpose
very effectually, but solutions of gutta percha and shellac
scarcely less so. A coating of flour, or powdered starch, as in
the treatment of burns, affords sufficient protection in many
cases, which is increased by first washing the skin with a solu-
tion of glycerine. The white of an egg is scarcely inferior to
any of these. Of the stimulating applications we have found
LugoPs Solution of Iodine the most useful. To prevent the
spreading of the disease, it should be extended for a small space
upon the sound skin. The constitutional treatment of erysipe-
las is not less varied than the local, depending mainly upon the
variable character of the disease in its different stages, and at
different times and places. It is treated both as a sthenic and
an asthenic disease. In this country, and particularly in the
South, the former character is more likely to prevail, requiring
depletion and sedatives; while in Europe, and particularly in
the large cities, the disease is said to assume, in general, the
asthenic character, indicating the use of tonic remedies. The
Bells of Edinburgh recommended the chalybeate treatment,
and they are sustained by Ranking, who succeeded with the
muriated tincture of iron, in doses of 36 drops, after wine, am-
monia, quinine, &c, had failed. He states it as his invariable
practice in this disease, to lose no time in sustaining the pow-
ers of the patient by wine, beef-tea, and ammonia; the local
applications being nitrate of silver and flour. In this region it
is a rare thing, we apprehend, to administer tonics in the early
stage of the disease. [Ibid.

Observations on the use of Potash in the Treatment of Scurvy ;
with Cases. By Willliam A. Hammond, M. D., Assistant
Surg. U. S. Army.

Hitherto, in the treatment of scurvy, little reliance has been
placed by physicians in medicines^ strictly so called. Fresh
vegetables, lime-juice, &c, have been regarded as indispensable
to the cure of this disease ; and in situations where these arti-
cles could not be obtained, the unfortunate patient has generally
lingered out a miserable existence till relieved from his suffer-
ings by death.

The researches of animal chemistry have, at length, howev-
er, thrown some light upon the pathology of scurvy ; and if
future observers confirm the results derived from the following

1855.] Potash in the Treatment of Scurvy. 495

cases, it will not be the least boon which that science has con-
ferred upon the practice of medicine.

New Mexico, where the following cases occurred, presents
to the physician a wide field for the observation of scurvy.
During eight months of the year, it is exceedingly prevalent
among the troops stationed in this territory, and from ihe scant
vegetation of the country, it is impossible to obtain those veg-
etables generally esteemed most beneficial in the treatment of
the disease under consideration. Perhaps, however, I saw less
of scurvy than any medical officer stationed in New Mexi-
co. There did not originate among the troops serving at the
post with me more than four or five cases, out of twelve admit-
ted into the hospital, and those were generally of a mild nature.
This immunity from the disease I ascribe to the fact, thit the
small stream which flows past the post (the water of which
was used by the troops) contains potash in quite an appreciable
quantity. From one of the springs situated among the moun-
tains, which supply the main stream, I obtained very satisfac-
tory evidence of the existence of potash in considerable abund-
ance, a large precipitate of the bi-tartrate being thrown down
by a solution of tartaric acid.

A small portion of some salt of potash (say the bi-tartrate, as
the most agreeable), issued to the troops as a component part
of the ration, would, I am confident, entirely prevent the oc-
currence of this affection among them.

The cases here presented are selected from about a dozen
others, as being those in which the disease was farther advanced
before being placed under treatment.

Case I. William Henry, a private in company "K," 2d
U. S. dragoons, admitted in hospital at Cebolleta, New Mexico,
January 2, 1850, with scorbutus. Has been on detached ser-
vice to Santa Fe, and while there became affected. Counten-
ance sallow and bloated, breath extremely fetid, and gums
exceedingly tender, bleeding profusely upon the slightest touch.
Legs and thighs covered with the characteristic livid spots;
stiffness of the knee and ankle-joints, and slight oedema of the
feet. Ordered, potass, carb. grs. v., ter in die, and sol. alumi-
nis, for mouth.

January 3. Much improved ; continued medicines, 4th, 5th,
6th, and 7th; continued to improve; ordered medicines as
before.

8th. Gums hard and firm ; maculae on legs and thighs en-
tirely gone; complexion clear, and general health restored.
Omit medicine.

9th. Discharged hospital, cured.

490 Potash in the Treatment of Scurvy. [August,

Case II. Augustus Miller, private 2d dragoons. Admitted
into hospital May 26, 1850. Has been affected with scurvy
for three weeks, at Albuquerque, New Mexico, and has been
under treatment for it. Does not know what was given him.
Transferred with his company to this post May 25, 1850. Says
he feels a little better since his arrival here. Has some pain
in right leg, at seat of a fracture which occurred some years
since. Maculae on legs and thighs very abundant, and two or
three large extravasations of blood about the ankle joints of
each leg. Bowels regular. Ordered potass, carb. grs. v, ter
in die.

28th. Spots on lower extremities disappearing; skin over
fracture livid in appearance, and slight motion can be perceived
at the fractured part. Continued medicine as above.

29th. Improving. Pain in leg much less. Motion of frac-
tured parts slightly perceptible. Extravasation fadiug. Gums
firm, and healthy in appearance. Committed some indiscretion
in his diet to-day, in consequence of which he became affected
with dysentery, which required very active treatment, Potass,
carb. was omitted on the 31st, and on June 1st all signs of
scurv) had disappeared. He is much debilitated from the ef-
fect of the dysentery, which still continues.

June 7. Convalescent. Continued to gain strength, and on
the 12th was discharged from hospital, and returned to duty.

Case III. Rafael Garcia, a Mexican, has been affected with
scurvy for a month or more at Berlin, New Mexico, where
he has been on a visit to his friends. First noticed the disease
at that place. Returned to this village June 5, 1850. I first
saw him on the 7th. Gums exceedingly tender and spongy;
teeth very loose, and sore to the touch. Has several large ex-
travasations of blood on his legs, and myriads of the character-
istic spots. On the anteiior surface of the left leg is an ulcer
three inches in diameter, of a pale, indolent appearance ; knees
stiff; flexed on the thigh, and very painful on any attempt to
extend them. Ordered potass, bi-tart. 3j, ter in die. This
medicine was continued for two weeks, at the end of which
time all signs of scurvy had disappeared, with the exception of
the stiffness of the knees. By friction and careful passive mo-
tion for a week, the free use of these joints was completely re-
stored. The ulcer of the leg healed perfectly without the use
of any local application but ung. simp.

These cases are, I conceive, sufficient to prove the benefit to
be derived from the use of the salts of potash in the treatment
of scurvy. Others could be adduced ; but as they are general-

1853.] Potash in the Treatment of Scurvy. 497

]y similar to the above in all essential particulars, I have not
thought it necessary to introduce them here. In regard to the
most eligible combination of potash, I am inclined to think the
bitartrate preferable. It is more generally relished by patients,
and, independently of this advantage, I think its purgative and
diuretic properties beneficial. Both this and the carbonate,
however, becoming exhausted at the post, I administered seve-
ral other salts of the same article, both separately and with
citric acid, without, however, perceiving that the latter article
at ail accelerated the cure.

No vegetables were given to the patients, for the simple rea-
son that they could not be procured. They certainly would
have proved powerful adjuncts to the potash in the treatment
of the disease ; but from the arid nature of the soil of the coun-
try, it is impossible to obtain them, even when in season, in
sufficient quantities for the use of the sick alone.

In situations where the water has not a chemical constitution
resembling that of Cebolleta, I should think it expedient to in-
crease the quantity of potash given at each dose considerably
over that indicated by the above cases. I did not, however,
find it necessary to administer to any over two drachms of the
bicarbonate thrice daily, and this quantity was given but to one
patient.

In all, twelve cases of scurvy were treated with the salts of
potash. Of these, four originated at the post, the remainder in
different parts of the territory. All recovered perfectly, and in
no case did lameness or other deformity remain. The mini-
mum period of treatment was three days, the maximum twenty-
one days, the average nine days and six-tenths.

In regard to the modus operandi of potash in scurvy, I think
the hypothesis of Dr. Garrod, of London (to whom I am in-
debted for the idea of its curative properties), correct. He
regards the disease as depending upon a deficiency of potash
in the blood, and considers it essential to the perfect nutrition
of the muscular fibre.* The urine of each patient whose case
is here related, as also that of all in whom it was examined,
exhibited, before treatment, a total absence of potash, and I
noticed that, as this substance appeared in the urine, amend-
ment commenced.

The action of this remedy must be seen, in order to be pro-
perly appreciated. The return of strength to the body, cheerful-
ness to the mind, and the speedy disappearance of all symptoms-
of the disease which ensue so quickly upon its administration,
liken its influence more to that of a charm than aught else.

* See American Journal of the Medical Sciences, July, 1848, pp. 200-203.

498 Enlarged Spleen. [August,

The importance of the discovery of the curative properties
of potash in the treatment of scurvy cannot be too highly esti-
mated. In our own country, especially, will it prove a most
valuable acquisition. Scurvy has been the scourge of the
numerous parties of overland emigrants to Oregon and Cali-
fornia; more, probably, having been affected among them by
this disease than all others combined, and numbers have, in
consequence, left their bones upon the plains. From the facts
previously mentioned in this article, I am satisfied that not only
as a remedy is potash valuable in scurvy, but that as a prophy-
lactic, also, its qualities entitle it to a high rank among that
class of agents. On the score of economy, a better one could
not be obtained.

The attention of physicians is invited to this subject. It is
only by numerous experiments that the efficacy of this article
can be established on a firm basis, and if these are made, they
will, I think, have as much reason to be satisfied with its action
as myself. [American Jour, of the Med. Sciences.

Enlarged Spleen Suppuration Evacuation of the Pus
through the abdominal walls Recovery. By M.M. Pallen,
M. D.

The following case was read before the St. Louis Medical
Society, on the J 8th of October last.

A girl aged twenty, resided during the month of September,
in a little town on the Illinois river, where she had frequent
attacks of Intermittent Fever. On the 18th of October, 1 saw
her, when she was free from the Intermittent, but had an en-
larged spleen. It extended into the epigastric and umbilical
regions as far as the median line, and inferiorly into the left iliac
region. I ordered for her a combination of laxatives and tonics.
A few days afterwards, she complained of acute pain over the
tumor for this, a blister was prescribed. It failing to give
relief, another was put on the pain remained unabated so
great was it, that she was deprived of sleep at night.

On the Gth November, the integuments over the tumor wen
red and a little cedematous there was also obscure fluctua-
tion. Dr. Pope who saw the case with me, suggested the a]
plication of poultices until fluctuation was more manifest. Or
the Oth, he passed an abscess lancet into the prominent part of
the swelling, and about a pint of sanguineo-purulent matter was
evacuated. It continued to discharge freely for twenty-four
hours, and in the course of a week, the opening healed up. The
circumference of the enlarged spleen was not diminished, but
at the place where the abscess was, there is a deep cup-hke
depression whose diameter is about four inches.

1853.] Matico in Diarrhoea. 499

Suppuration of the spleen is a rare termination, yet, there
h&ve been some examples of it. Such a termination is spoken
of by Cruveilhier and Andral the quantity of pus which is
collected may vary from a few ounces to many pounds. Dr.
Abercrombie cite*s a case, where the spleen contained thirty
pounds of matter. Jn another case, eight pounds of matter
were drawn off by tapping. 'The patient died the next day,
and the spleen was found still to contain seven pounds of mat-
ter, and to form a sore eighteen inches long and twelve inches
in diameter.' In a case which fell under his own observation,
inspection after death, showed that the 'spleen was enlarged,
and in the centre of it, there was an irregular cavity, containing
several ounces of pus.

The matter sometimes makes its way through the diaphragm
and left lung. Dr. Tweedie records a case of spleenic abscess
during fever, in which it had nearly perforated the contiguous
part of the diaphragm. It sometimes finds its way through the
stomach, as in the case reported by M. Coze. The patient
had vomiting of blood, mixed with purulent matter. Post-
mortem examination showed, that the spleen adhered intimate-
ly to the stomach, and formecl a bag full of purulent matter,
and clots of blood. The parietes of it were in general about
six lines in thickness ; and it communicated by a free opening
with the cavity of the stomach, at the place of adhesion. Some-
times the pus is discharged through the colon, as in a case men-
tioned by M. Jacquinelle or, through the abdominal walls, as
reported by Drs. Grotanelli and Raikem, and in the case now
brought before the Society, adhesions in these cases taking
place between the spleen and the parts through which the pus
is discharged. [67. Louis Med. and Surg. Journal.

On Matico in Diarrhoea. By M. Modoni.

M. Modoni states that he has employed this substance in
about 1*20 cases, and usually with good and speedy effect, in
various species of intestinal discharges, and especially in atonic
diarrhoea. It is given at the Bologna Hospital in doses of from
18 grs. to 5j. per diem, no inconvenience, save a little nausea
or diarrhoea, ever being caused, and this being capable of re-
moval, either by diminishing the dose or temporarily suspending
the remedy. In the most favorable cases, an impression is
made upon the disease by three or four doses; and it is quite
relieved in from three to six days. The medicine should, how-
ever, be continued awhile longer in order to prevent relapse.
In those diarrhoeas which owing to the existence of visceral
changes, or in the presence of a general dyscrasis, the return

500

PagliarVs Hemostatic.

[August,

of the diarrhoea is inevitable, the matico is still an invaluable
remedy, owing to the rapidity of its astringent action, which
enables us to suspend the exhausting discharges, and obtain
time for the employment of any other means which the nature
of the case may indicate. [Brit, and For. Med. Chir. Review,
from Bulletino delle Scienze Med.

On Pagliari's Hcemostatic. By M. Sedillot.

M. Pagliari, a pharmacien at Rome, professes to have dis-
covered a styptic liquor of great power ; and several of the of-
ficers of the French army have testified to its efficacy. M. Se-
dillot has also, on several occasions, brought forward cases in
corroboration ; and in the present paper he adduces additional
ones, in some of which considerable vessels, although not those
of the first class, furnished the blood. He says that it has been
objected, that compression is employed by means of bandages
and charpie ; but this is merely to prevent the coagula which
form being removed from the mouths of the vessel ; and it has
only to be continued for twenty-four or forty-eight hours. So
little plastic is human blood, that compression alone, unaided by
styptics, would have to be so prolonged and forcible, that it
would risk the formation of ulcers or gangrene in the parts to
which it was applied.

M. Pagliari has now revealed the composition which is as
follows : Eight ounces of tincture of benzoin, one pound of alum,
and ten pounds of water are boiled together for six hours in a
glazed earthen vessel, the vaporised water being constantly re-
placed by hot water, so as not to interrupt the ebulition. and,
the resinous mass kept stirred round. The fluid is then filter-
ed, and kept in stoppered bottles. It is limped, slightly styptic
in taste, aromatic in odor, and the color of champagne. M.
Hepp, ofStrasburg, has substituted white resin for the benzoin.
Every drop of this fluid poured into a glass containing human
blood, produces an instantaneous magma ; and by increasing
the proportion of the styptic to the quantity of the blood, a
dense, homogeneous, blackish mass results.

Many are the circumstances in which the surgeon may not
be able to have resource to the ligature, as in the case of fria-
ble arteries, secondary haemorrhage from deep-seated, painful
or inflamed wounds, the impossibility of seizing the artery, or
where the haemorrhage results from numerous arterioles, which
are too small or retracted, or from veins and capillary vessels.
In all cases, in fact, where compression is now usually employ-
ed, without much benefit being expected to result from it, and
often, indeed, proving useless or dangerous, this fluid seems in-
dicated. [lb. from Bull, de Ther.

1853.] Irritable Bladder in Children. 501

On Irritable Bladder in Children. By Christopher Flem-
ing, M. D.

Irritable bladder occurs much more frequently in young
children than would at first sight appear, and this, where the
irritability is not the consequence either of inflammation or of
organic disease, although occasionally attributable to some
abnormal defect. The mother or nurse of the child so affected
states, that the child is constantly applying the hand to the or-
gans engaged ; that it appears to suffer pain during micturition ;
that the act is frequent; that it is urgent, but when the urine
has passed off the child appears relieved ; that often, if the urine
falls on the flour or clothes, it rapidly becomes muddy and
whitish, and it is even stated by some, that it is so at the mo-
ment of being passed ; that when the child sits down for such
purpose, it has an inclination to remain longer than is requisite,
and, in some cases, that there is a disposition to prolapsus of
the rectum, from the forcing and straining attendant, and very
frequently a discharge of bloody mucus from the rectum takes
place ; that these symptoms have continued for some time, not-
withstanding the exhibition of medicines to regulate the bowels
and produce other ordinary effects ; that the child is losing
strength and wasting in flesh ; that the appetite is most preca-
rious, and that there is a great desire for drink ; that the quan-
tity of urine passed is very variable, sometimes deficient; that
its quality is equally changeable, at limes being pale, at others
deep in color, and again clear and often muddy, and with copi-
ous sediment.

If accurate inquiry is now instituted, it will be found, that
many such children are born of gouty parents, or of persons
much subject to dyspepsia, and that they are children whose
diet and habits of life are irregular; and in the humble walks
of life that they are, in addition, irregularly clad and irregular-
ly cleansed : such are by no means of unfrequent occurrence.
The quantitative and the qualitative analysis of the urine satis-
factorily explains the symptoms ; and attention to the physical
condition of this secretion, to its chemical constitution, and to
the appearance of the deposits particularly the deposits of
rest assisted by the microscopic characters of the latter, point
out the curative indications which are suitable to each variety
of case. It is beyond all manner of doubt, that, as in adult
age, many practical hints can be taken from attention to the
general constitution of the urine in the surgical diseases of these
organs, and that in the child the normal essential constituents
of this important fluid may be increased or diminished, and that
abnormal ingredients may be superadded. We have here the

n. s. VOL. IX. no. vin. 32

h02 Irritable Bladder in Children. [August,

llthic. the oxalic, and the phosphatic diatheses, and each has its
special influence. In fact, with few exceptions, and the pre-
sence of sugar in the urine of children is one worthy of note,
there is no derangement of the urine found in the adult which
I have not also found in the child, in its most exaggerated
form, both as regards the disproportion between its normal
constituents, and the introduction of abnormal substances. I
feel perfectly satisfied that attention to these details, as sub-
sidiary means, will be found of value in the diagnosis and treat-
ment of many of the diseases of children, and especially in those
cases of cerebral complication which so repeatedly puzzle the
practitioner, and where the quantity of this secretion, on the
one handy is materially diminished, or, on the other, increased.

With a view to the practical study of the morbid condition
of the urine, as auxiliary to the diagnosis and treatment of dis-
eases of the urinary organs in the child, I find it difficult to
condense my remarks so as to avoid the introduction of any
irrelevant matter, and at the same time to escape the charge
of an attempt to undervalue those more minute particulars to
which; justly, much importance is attached. In my lectures
on these subjects, I have been in the habit of directing atten-
tion to the color and smell of the particular specimen under
examination, to its chemical reaction, and to its density ; and I
have always attached very great importance to the deposit
rest, as to shade and outline, and to the transparency or other-
wise of the supernatant fluid. From an analysis of these sev-
eral leading features of urine I have derived the greatest
advantage, and even, in the absence of any microscopic exam-
ination, have been enabled to deckle in very many cases, with
sufficient certainty for practical purposes, on the peculiar na-
ture of the deposit. Of course in some, particularly the " non-
crystalline organic deposit," the assistance of the microscope is
often indispensable; but in children they do not constitute the
majority of the cases met with. As attendant on the "irritable
bladder," I would say that, according to the classification of
urinary deposits by Gohiing Bird, those of uric acid, and \h&
urate of ammonia, and of oxalate of lime, are particularly fre-
quent in occurrence; and that, next in order of frequency are
conjointly or separately with these " the non-crystalline organ-
ised products," such as blood, pus, occasionally mucus, but very
often indeed vibriones. It would be too great an occupation
of space and of time to enumerate the many cases I have wit-
nessed, as illustrative of these statements; they are of almost
daily occurrence. I do not deny that phosphatic deposits are
to be met with, but these deposits do not occur, under ordinary
circumstances, as a substantive deposit in the urine of children.

1853.] Irritable Bladder in Children. 503

The prisms of the neutral triple phosphate are to be seen con-
jointly wilh the crystalline deposits above specified, just as in
adults, but it is very rare indeed to meet with them as solitary
deposits, although so frequent in advanced life; and it is equal-
ly rare to find them combined with that physical and chemical
condition of urine almost necessarily present under such cir-
cumstances. Indeed I find it difficult to bring to my recollec-
tionunless under the most aggravated form of vesical and
renal disease, complicated with phosphatic calculus in the
child that excessive secretion from the mucous membrane of
the bladder which takes so very prominent a part in the forma-
tion of such deposit in advanced life. Amongst the numerous
cases of urinary disease I have witnessed in the child, such is
excessively rare, and it is equally rare as a symptom of calcu-
lus in the child. There was in one case a source of deception,
which was by the merest chance unfolded to me, and which,
perhaps, may be noted as confirmatory of Sir Benjamin Brodie's
opinion as to the special source of those phosphatic salts in the
urine.

In May, 1852, a boy, aged three years, was brought to my
study by his mother, in great alarm from the suffering the child
had endured fer some weeks in passing urine. There was fre-
quency and urgency, and so much forcing and straining as to
produce distressing prolapsus ani. The urine was largely
loaded with lithates, and contained a remarkably tenacious
mucous deposit, deeply colored with blood, and adherent to
the glass. I found in it numerous blood discs and large crys-
tals of the triple phosphate. Symptoms not improving, I felt
justified in sounding the child, which I did with a silver cathe-
ter, and whilst the urine was escaping, a severe paroxysm,
resembling a fit of the stone, occurred, during which a consid-
erable quantity of gelatinous mucus escaped from the rectum.
I collected the urine drawn off through the catheter in one test-
glass, and the discharge from the rectum in the second. The
urine was acid, the latter alkaline; the former was loaded with
lithates interspersed with some crystals of oxalate of lime, the
latter, in addition to mucus, blood globules, and epithelial
scales, was studded with large, distinct, triple, phosphatic
prisms. I merely mention these details incidentally, as inter-
esting and not unimportant phenomena, and particularly in
connection with the statement of Sir Benjamin Brodie already
alluded to. They were to me then novel, and I took the op-
portunity of showing the microscopic appearances and the
specimens to my colleague, Dr. Ilutton. I have since been
enabled to confirm them.

I have said that the lithic acid and lithate of ammonia depos-

504 Irritable Bladder in Children. [August,

its, and also that of the oxalate of lime, are the most frequently
met with in children, and they will be found to be productive
of most decidedly distressing urinary symptoms. I have often
found these deposits present conjointly ; ver.y often the oxalate
of lime and the urate of ammonia, the latter cloaking the for-
mer, unless carefully looked for. I have found the red sand, as
the lithic acid is sometimes termed, in the child, but it is far
more frequent to find the colorless, or nearly colorless, crystals
of lithic acid, and all are met with of every variety of shape and
form, and they are to be seen in the children of the poor as
well as of the rich ; and really it does not appear that diet very
materially influences their presence or their character. I'have
a boy, aged about seven, now in hospital, with suspected cal-
culus in the bladder, and in him numerous crystals of pale lithic
acid exist in combination with oxalate of lime; whilst in ano-
ther ward in the same hospital, there is a boy, somewhat about
the same age, a patient of Dr. Hutton, in whom the red sand
is visible to the naked eye in the test-glass, floating through the
urine, and under the microscope the deep orange crystals are
to be seen distinct, arid in large aggregated masses. It is in
this class of deposits, and in that of the oxalate of lime, that
the surgeon requires to be more circumspect, as the physical
and chemical characters of the urine are often not remarkable.
The color is in such cases often pale; the density very low, so
low as 1007 to 1010 ; the deposit a mere tomentous, semitrans-
parent cloud, but one which will not escape detection by the
practised eye. The suffering experienced in some cases of this
nature is really very great; and if the child happens to have a
long narrow prepuce, or an abnormal opening in the urethra,
he may be put to unnecessary torture from inattention to the
morbid state of the urine. I have known such cases: one, a
fine child, the only son of a fond father, who lived freely, and
thought the child could not do better; the other, a boy aged
three years, with hypospadias, from which the child had not
previously experienced any visible inconvenience. In each the
usual traces of symptoms of irritable bladder existed ; in each,
the ordinary clear condition of urine diverted attention from
the examination of its actual state ; and in each, its normal
restoration caused the subsidence of all annoyance. I do not
dwell on the lithate of ammonia deposit ; its characteristic ap-
pearance is too obvious to require any comment. I shall
merely add, in conclusion, as regards it and the other crystal-
line deposits noted, that when from their continued presence
they produce local or general irritation, they demand the watch-
ful care of the practitioner to put rigidly in force those dietetic
and therapeutic means which are laid down in systematic

1853.] Excision of Inferior Maxillary Bone for Caries. 505

treatises on the subject; and if the symptoms do not yield to
such treatment, he should search for some local cause either in
the bladder or in some portion of the organs implicated; and
he should also bear in mind, that such character of urine is the
most likely to lead to the formation of stone in the bladder, as
proved by its composition in the child, and by the fact of its
being the most common attendant on its presence when found
there; and that hence two practical lessons should not be lost
sight of, namely, to alter, as quickly as can be effected, this
morbid condition of urine, and to suspect the presence of calcu-
lus, should it be obstinate. \_Dublin Quarterly Journal.

Excision of the Inferior Maxillary Bone for Caries. By
W. G. Bulloch, M D., of Savannah, Geo.

Towards the end of July, 1852, John Turner, an Irishman,
entered the Savannah Hospital, and applied to me for relief
under the following circumstances.

The right side of the lower jaw, from the symphysis to the
neighborhood of the articulation, was diseased, and so exten-
sively enlarged from infiltration of the soft parts as to produce
great swelling and deformity of the face, and to impede much
the movements of mastication. It also rendered him an ob-
ject of disgust to himself and others, in consequence of the sani-
ous and excessively fetid discharge which flowed abundantly
from several fistulous orifices opening internally in the mouth,
and externally on the cheek. A probe introduced into these
fistula?, discovered the bone not only denuded, but so perfora-
ted and broken up, that the instrument could readily be passed
into the mouth in various directions.

He was rather obtuse in intellect, and therefore I could not
obtain any very satisfactory information from him of the nature
or history of the disease, except that he stated, to use his own
language, "he got it hurted some year or two ago."

From the nature of the case, it was evident that entire
removal of the diseased portion of bone was the only remedy,
and several of my professional friends who saw the case with
me, were decided in their opinion as to the necessity of such an
operation, other modes of treatment offering no hope or pros-
pect of cure in our opinion.

An operation being determined upon, with the assistance of
Drs. Kollock, Howard, and Warner, after administering a
mixture of chloroform and ether, and bringing the patient
completely under the anaesthetic influence of those agents, I
proceeded to perform the operation in the following manner:

My first incision was made a line or two to the left of the

506 Senile Gangrene. [August,

middle of the lower lip, by transfixing it with the knife directed
obliquely upwards and backwards, then reversing the cutting
edge of the knife, and continuing the incision down to the lower
margin of the jaw. From the termination of that incision I
boldly drew the scalpel along the entire inferior margin of the
bone as well as it could be defined in the swollen state of the
parts, to the angle of the jaw, turning up behind that point, and
extending another incision at right angles or so with that, to a
point nearly opposite the articulation. The formidable flap
made by these incisions was next dissected up, and reflected
upon the upper part of the face, so as to expose fully the dis-
eased portion of bone. The jaw was then sawed through with
the chain saw immediately to the left side of the symphysis.
Seizing the end thus sawed through, the section of bone was
then carefully separated from its internal soft attachments, by
drawing the scalpel along its internal surface with the edge
close upon the bone. Considerable difficulty was experienced
in detaching the soft parts about the angle of the jaw, and the
advantage to be derived in using it as a lever was lost by its
giving way and separating from the ramus and processes above.
These had to be seized singly with a forceps, and separated by
drawing them out and relieving them from their attachments
above with a knife passed carefully under the arch of the malar
bone. After excising portions of the diseased soft paits con-
nected wiih the bone, tying the vessels cut, of which there was
but one of importance, viz., the facial, and suppressing the hem-
orrhage, otherwise inconsiderable in this case, the flap was
brought down, and the edges of the wound were accurately
adjusted by means of a few hair-lip pins and adhesive plaster,
and thus kept in complete apposition. Water dressing was
applied, and such other treatment adopted as circumstances
required to facilitate union and healing of the wound.

He is now, at the time of writing this description, a monih
after the operation, going about, cheerful, and almost eniirelv
well union so completely established as to leave little external
deformity, and exhibiting but slight traces of so extensive an
operation. [American Jour, of the Med. Sciences.

Senile Gangrene.

Not many years ago, one of the most painfully discouraging
subjects of surgical study or practice was that mortification
which is so apt to attack the toes of old people, and has been
called the gongrena senilis. The insidious commencement of
its attack; the agonizing distress which attends its progress;
the inefficiency of measures employed for its remedy, and the

1853,] Coagulation of Blood in Arteries. 507

inevitably fatal result to which it led, rendered this disease in-
deed one of the opprobria of surgery. According to the idea
then entertained, nothing could be done, except keeping up the
patient's strength by an ample allowance of wine and brandy,
dulling his sensibility with opium, and preparing his friends for
the issue. But now the case is very different. The morbid
action being attributed to excessive irritability, dependent upon
weakness proceeding from an imperfect supply of blood, instead
of attempting to supply the deficient vigour by stimulants that
can do no good, and must hurry on the disease, the treatment is
directed with a view to lessening the tendency to over-action
by the use of soothing means. The patient is confined to bed,
debarred from animal food in every form, with the exception
of milk, which, wiih water, constitutes his only drink, supplied
with doses of morphia in proportion to his pain and restlessness,
and has the part affected covered with a linseed poultice. Un-
der this system, the distressing symptoms gradually disappear,
the slough ceases to extend, and after its separation the sore
cicatrizes soundly, no difficulty or bad effects being subsequent-
ly experienced in returning to the ordinary habits of diet and
exercise. The student, therefore, no longer turns over this
page of his principles with a blush for the imperfection of sur-
gery ; and the practitioner, instead of being called upon to
undertake a hopeless task, has frequently the satisfaction of con-
ducting his patient safely through what might formerly have
well been called the valley of the shadow of death. [Monthly
Journal of Med. Science.

Coagulation of Blood in Arteries by means of a Solution of
Per -chloride 'of Iron. Aneurism of the Suborbital Artery
cured by this means.

M. Pravaz, of Lyons, has instituted some experiments with
a \iew to obtaining instantaneous coagulation of blood in arte-
ries. He makes use of perchloride of iron at the maximum of
concentration, a few drops of which are to be injected into the
vessel in which it is desirous to obtain coagulation. This in-
jection is to be made with a very fine trocar, of either gold or
platinum, the diameter of which is scarcely greater than that
of a needle; this is to be introduced very obliquely, through
the parietes of the artery, with a wriggling motion. To this
trocar is adjusted a small syringe, the piston of which works
with a rack and pinion motion, so that the injection proceeds
without impulse, drop by drop, and in such a way the quantity
of liquid injected can be accurately measured. Every turn of
the pinion allows of the escape of two drops of the liquid.

508 Ancesthetic Properties of Lycoperdon Proteus. [August,

Whilst this injection is used, the circulation is momentarily ar-
rested in the vessel by means of pressure above and below. A
few drops suffice (three or four in a sheep, six or eight in the
horse) to form a solid and resisting clot.

Up to this time, the experiments had been only made on
animals, but M. Raonl Deslongchamps has just sent before the
Surgical Society of Paris, a case of aneurism of the suborbital
artery treated with success by injection of perchloride of iron.
It was a tumour situated in the suborbital region, aflording
pretty strong pulsations, isochronous with the heart's action.
This tumour, for the cure of which compression had been used
without effect, disappeared completely by means of the injec-
tion, as recommended by M. Pravaz, after presenting some
inflammatory symptoms, which easily yielded to antiphlogistic
treatment. [Dublin Med. Press, from Gaz. Med. de Toulouse
and Presse Med. Beige.

Ancesthetic Properties of the Lycoperdon Proteus Common
Puff- Ball.

The number of the Medical Times and Gazette, for June 11,
just received, contains an abstract of a paper read before the
Medical Society of London, on the anaesthetic properties of the
Lycoperdon proteus. The author's attention had been direct-
ed to the fact, that the smoke of the common puff-ball was used
in the country for stupefying bees, and the idea struck him,
that it would be worth while to ascertain if the same agent
would produce narcotism in higher classes of animals. Seve-
ral weeks since, he commenced a series of experiments with
the fumes of the fungus, and had continued them to the present
time. He found it possible to produce the most perfect anaes-
thesia with the fumes. His experiments had been made on
dogs, cats, and rabbits, and had been witnessed by Drs. Wills,
Crisp, Cormack, Snow, and several others. He had adminis-
tered the narcotic fumes in the impure state, and in a claiified
state obtained by passing them through a solution of caustic
potass. When an animal was exposed to a laige quantity of
the narcotic vapour, the narcotism came on very speedily, and
the insensibility was most decided, but recovery soon took
place. Dr. Willis and Mr. Richardson had removed a large
tumour from the abdomen of a doer that had been placed under
the influence of the narcotic. No sign of pain was shown
during the operation, and the animal did well afterwards. The
fumes were obtained by burning the fungus. When a moder-
ate quantity was inhaled slowly, the narcotism came on and
passed off slowly, the animal exhibiting all the symptoms of

1855.] Hot Water and Soap in Ptyalism. 509

intoxication, with convulsions, and sometimes vomiting. Sev-
eral animals had been intentionally destroyed by the narcotic.
It destroyed life siowly ; a dog would often inhale the fumes for
twenty minutes or half an hour, after being completely narcot-
ized, previous to expiring. The heart's beat in all cases sur-
vived the respirations. The lungs after death were pale ; there
was no sign of congestion in any organ ; the blood retained its
red colour, but did not coagulate quickly; cadaveric rigidity
set in in two or three houis. During recovery from a pro-
tracted narcotism, an animal would sometimes be quite con-
scious, but insensible to pain. Mr. Richardson had himself
inhaled the clarified fumes of the fungus; they produced in
him symptoms of intoxication and drowsiness, but he did not
breathe them long enough to become completely narcotized.
Mr. Richardson was able to afford but little information as to
the nature of the narcotic agent contained in the fumes. Many
of the fungi possessed narcotic properties, and had been sup-
posed to possess an alkaloid resembling morphia ; but the sub-
ject had never been thoroughly investigated. He should only
say, concerning the narcotic principle contained in the puff-
ball 1st. That it was of a most volatile nature ; 2dly. That it
was not absorbed by alcohol, water, or strong alkaline solution ;
3dly. That if the fungus was burned in oxygen gas, the nar-
cotic principles still remained in the fumes, and produced its
effect, if free oxygen was breathed with it. The fungus had
been given internally to two animals without effect. In Italy,
it was fried and eaten as food. In conclusion, Mr. Richardson
said, that he had been anxious only to show th;it a volatile nar-
cotic principle, capable of causing anaesthesia by inhalation, did
exist in one of the fungi ; it remained to be seen whether other
fungi possessed a similar principle, and whether from a fungus
an anaesthetic could be obtained that might be used in practice,
with as little trouble to the operator and with less danger to
the patient than ether or chloroform.

Dr. Snow corroborated Mr. Richardson's observations, hav-
ing witnessed several of his experiments. There could be no
doubt that the fungus did possess a very volatile narcotic prin-
ciple, capable of causing insensibility to pain. As yet, how-
ever, the narcotic was not so practicable as chloroform. The
subject deserved and required farther research. [Amer. Jour,
of the Med. Sciences.

Hot Water and Soap in Ptyalism.

A great variety of remedies have, from time to time, been
employed in the treatment of ptyalism ; every practitioner

510 Treatment of Sprains by "Firing." [August,

having his own favorite remedy. Tar water, solution of crea-
sote, lead water, sumach root tea, sage tea and honey, alum,
spts. turpentine, &c, have each acquired more or less reputa-
tion in I he hands of different practitioners ; but we have never
been satisfied with any of these remedies, though we have re-
peatedly prescribed them. Very recently, having to treat a
severe case of accidental ptyalism, we prescribed a hot solution
of soap. The patient was suffering with severe pain of the
gums and copious salivary discharge a few drams of spirits
of soap was added to one pint of hot water, and the patient
directed to take it into the mouth, as hot as he could bear, and
retain it until the surplus heat was exhausted, and repeat for an
hour, allowing an interval of half an hour for rest. At the end
of twelve hours, we had the gratification to find the patient
almost entirely relieved of the pain the swelling and redness
of the gums and soft parts about the mouth rapidly diminished,
and in a few days, by the persevering use of the hot water, the
patient was free of all uneasiness about the mouth.

The value of hot water was suggested from having observed
the good effects of hot tar water in a similar case. The pa-
tient, a delicate, nervous female, was directed to use warm tar
water occasionally, but finding that the hotter the water, the
greater relief was afforded, she continued using it as hot as the
mouth could bear it. We had noticed too, the effects of the
prolonged immersion of the Lands of washwomen in warm
soap-suds, corrugating and puckering the skin of the hands and
fingers to such a degree that the blood seemed almost expelled
from the vessels of the part.

The first effect of hot water in mercurial sore mouth, seems
to be relief from the painful distension of the soft parts, and
secondly, an anemic condition of the blood-vessels from con-
traction or collapse of the capillaries. The stronger prepara-
tions of soap are powerfully astringent the kind used in pre-
paring the spts. sapo. was the castile it may be that turpentine
soap is preferable. \_SautkernJour. of Med. and Phys. Sci.

Treatment of Sprains by "Firing? By James Dickinson, Esq.

The advantages of "Firing," in many forms of rheumatic
and neuralgic affections, have been pointed out by Corrigan,
Day, and others (vide "Abstract," vol. iii., p. 199). Its use in
sprains of the back, seems to be one from which the most
striking benefit may be anticipated, as is seen in the following
remarks :

Sprained backs are cases which give the surgeon much trou-
ble and annoyance, appearing in many instances to resibt every

1853.] Miscellany. 511

remedy. Many cases have come under my notice, and finding
thnt blisters, cupping, stimulating liniments, &c, failed, I tried
"Firing," and the results have been most successful ; patients
who for many weeks have evinced the greatest agony, have,
after the first or second application, been perfectly cuied.
The plan to be adopted is as follows: Heat a metal button,
the shank of which is fixed into a wooden handle, to such a
temperature as can be borne with slight pain ; pass it lighily
over the affected part, without inducing vesication, which is
unnecessary. The pain produced is severe, but is transient.
In long-standing cases, two or three applications are required ;
in recent ones, one will be found sufficient.* \_Prov. Med. and
Surg. Jour,

ill 1 0 c c 1 1 a n 2 ,

Medical Jurisprudence. By Alfred Taylor, M.D., F.R.S. Third
American from the fourth London edition. Edited with Notes and
Additions, by Edward Hartsiiorne, M. D., one of the Surgeons*of
Wills' Hospital, etc. Philadelphia: Blanchard & Lea. 1853.
1 vol. 8 vo., pp. 621.

This work of Dr. Taylor has been for some time before the profes-
sion, and the favorable estimate placed upon it is evinced by the
number of editions through which it has passed. We do not hesitate
to express the opinion that this is one of the best works upon the
subject, if not the very best which has yet appeared. This edition
contains many important additions.

"Under Poisoning, the additions include a notice of the new enact-
ments affecting medical evidence, and of the recent decisions regarding
the administration of poison, some new facts and cases illustrative
of the action of arsenic, opium, strychnia, the salts of lead, antimony
and other poisons, as well as improvements in the application of
chemical tests for the detection of poisons : under Wounds, the
changes produced by the new statutes, cases of peculiar and severe
suicidal wounds, struggling and power of exertion in wounds of the
heart, processes for the detection of blood stains, and their distinction
from vegetable dyes, the examination of weapons and projectiles,
additional facts regarding burns on the living and dead bodies: under
Child murder, medical evidence derivable from an examination of
the umbilical cord, with references to many new cases. Additions
have been made under Abortion, on the action of oil of savin :
under Legitimacy, on the duration of pregnancy, proofs from the

* This remedy sometimes affords relief in caphalgia, and other forms of neu-
ralgia. Edt. Buffalo Med. Journal.

512 Miscellany. [August,

development of offspring, plural and twin births: under Rape,
fallacies attending evidence from the examination of females: under
the various forms of death from Asphyxia, additional facts regarding
the examination of the bodies of persons who have died by drowning,
h mging, strangulation, and suffocation, facts and cases illustrating
the means of distinguishing homicidal from suicidal strangulation
under Insanity, some additions on the application of Restraint.
decisions in recent cases, showing the liability of medical practition-
ers, the testimonial capacity of the Insane, with remarks and cases
illustrative of Homicidal Mania and the Plea of Insanity."

Elements of Chemistry. For the use of Colleges, Academies and
Schools. By M. V. Regnault. Illustrated by nearly 700 wood
cuts. Translated from the French, by T. Forest Betton, M.D.,
M. A. N. S., Fellow of the College of Physicians of Philada., etc.,
and edited with notes, by James C. Booth, Melter and Refiner U.
S. Mint, and William L. F^ber, Metallurgist and Mining Engi.
neer. Second edition. In 2 volumes.

This work has been "got up " with great care and labor, and con-
tains a valuable embodiment of chemical knowledge in its present
state of advancement. Its seven hundred wood-cuts are faithful
representations, and admirably executed. Much of the apparatus
employed in the performance of the most important chemical experi-
ments, and in conducting the various processes of metallurgy and
pharmacy, are here strikingly illustrated. The two latter subjects
have occupied much of the attention of the author. The chapter on
crystallography alone is enriched by 122 beautiful diagrams, drawn
conspicuously in white lines upon a black back-ground, and exhibiting
consecutively the principal crystaline forms, classified under six sepa-
rate " Systems of Crystallization," each system based upon the
number and direction of the axes.

An elaborate exposition of the facts and phenomena of Organic
Chemistry, also occupy more than 400 pai;es of the work. The
typography and entire finish of these volumes do credit to the enter-
prizing publishers, and on the whole, although too voluminous for an
ordinary text book, " Regnault's Elements of Chemistry " must be
regarded as quite an acquisition to the library of the Chemist and
Metallurgist, and especially valuable as a work of reference.

A. M****.

Singular nucleus for a Calculus. Dr. VVm. G. Wheeler, of Mas-
sachusetts, reports in the American Journal of Medical Sciences, a
case of Lithotomy performed upon a female, in which "a stone was

1853.] Miscella ny. 513

extracted weighing over two ounces and three quarters, and there was
found passing obliquely through its centre a large wire hair-pin, mea-
suring over three inches and a half in length." .... "Since
the operation, the patient has stated that the pin was introduced through
the urethra about six years ago." . . . "The foreign body caused
some pain and uneasiness soon after its passage within the bladder,
but no severe symptoms were manifested until about two years after
its introduction, since which time they have gradually increased in
severity." The patient has recovered.

Extraordinary case of Saccharine Diabetes. Dr. Fricke, of Bal-
timore, reports, in the Amer. Journal of Medical Sciences, a case of
Saccharine Diabetes, that on one day passed eight hundred and ninety
six ounces of urine, equivalent to fifty six pints, or seven gallons ; and
the amount of sugar contained in this enormous quantity of fluid, was
estimated at four pounds ten ounces. [ Western Lancet.

Saccharated Medicinal Powders. Some of the most useful of our
pharmaceutical preparations are those known as tinctures, which hold
in solution many of the most active principles of vegetable substances.
Yet as alcohol, either pure or more or less diluted with water, consti-
tutes the greater part of their composition, the frequent administration
of this substance is, occasionally, very much open to serious objections,
both on the part of the physician and his patients. For this reason
Dr. Becker recommends the employment of saccharated medicinal
powders as substitutes for tinctures, whenever the latter may be con-
sidered objectionable. He directs equal proportions of the tinctures
of hellebore, cinchona, hyoscyamus, or of other vegetables, as the
case may be, and sugar, to be well mixed together, and then evaporated
so as to drive off the alcohol, and then to administer the residue instead
of the tincture. To this residue he gives the name of helleborus sac-
charatus, hyoscyamus saccharatus, cinchona saccharata, &c, &c,
according to the drug made use of.

This mode of preparation of medical substances has evidently at*
tracted the attention of some of the medical authorities of our own
country, for in reference to this subject the editor of one of the medical
journals makes the following practical observation : ' Supposing the
unimpaired medical properties of the tinctures can be thus fixed in
these powders (which is problematical), this mode of administration
would prove a great boon to physician and patient. Not only is alco-
hol obviously mischievous in many cases wherein the active principles
)f which it is the vehicle, are indicated ; but in others in which such
;ontra indication is not so apparent, it has ofien proved a means of
inducing a habit of dram drinking, which prevails even among respect-
able females to a far greater extent than is usually supposed.

[ Annals of Pharmacy.

614 Miscellany. [August,

Mixtures or other Medicinal Preparations, containing Gum-resins.
The gum-resins, such as myrrh, ammoniacum, assafoetida and others,
may be successfully suspended in mixtures and other preparations by
means of the following easy and simple process. On adding six or
eight drops of pure sweet almond oil to a very small quantity of the
gum-resin employed, it forms into a mass by trituration in a mortar ;
and when the oil and gum resin have become thoroughly incorporated
together, the result is a smooth paste, to which the vehicle, in which
it is intended the gum-resin shall be administered, is to be added very
gradually. By this means an emulsion is prepared in a very speedy
manner. This method of preparing emulsions with the gum resins
admts of the mixture being heated, if necessary, without causing the
least coagulation ; whereas emulsions prepared by means of the yolk
of eug will not allow of the application of heat, without more or less
coagulating; an advantage of which both the pharmaceutist and the
physician will on all occasions gladly avail themselves. [Ibid.

Child poisoned by an over-dose of Laudanum Restored by Gal-
vanism. The iMarch number (1853) of the London Lancet contains
the report by Dr. Kirk, of a case of poisoning by laudanum, in which
galvanism was successfully applied after all other means had failed.
When the child, only one month old, was first seen, it had no pulse,
hands and feet cold, features shrunk and deadly pale; aroused with
difficulty, and soon relapsing into a state of complete stupor; pupils
contracted ; respiration slow and scarcely perceptible ; suspended at
intervals.

The child being unable to swallow, Mr. Kirk applied one of the
conductors of a galvanic battery over the epigastrium, and taking the
other conductor in his right hand, he passed one of the fingers of his
left hand into the mouth of the child, between the teeth and gums, as
far back towards the fauces as it could be conveniently carried (the
battery acting as feebly as possible.) In the meantime the breathing
became regular, the action of the heart was steady and more vigorous,
and all the symptoms of approaching death disappeared. As often
as the galvanic influence was withdrawn, all the unfavorable symp-
toms returned ; but they again disappeared on the renewal of the
agent. At the end of about four hours, Mr. K. succeeded completely
in restoring the child, when a mild emetic was administered, followed
by a dose of oil, and the child rescued from its perilous condition.
New Orleans Journ.

Chlorate of Potash in Croup. The following facts, as given by
Dr. Sankey, corroborate the views laid down by Dr. Budd in his
paper on Croup : A child aged 13 months, with croup and bronchitis,
was treated with blisters, salines, ipecac, etc., without benefit, when
he was put upon the use of chlorate of potash ; and although the child
was much reduced, the circulation languid, the blood not properly
oxygenized, yet in a short time the croup and bronchitis disappeared,
and the child was restored to its usual good health.

1853.] Miscellany. 515

Another child, cet. three years, with croup, had been treated with
leeches, calomel and ipecac, without much benefit; he was put upon
the chlorate of potash, and soon his breathing became easy, and his
countenance lost its anxious and livid hue. It recovered as in the
first cae. The chlorate of potash is supposed to be in part decom-
posed, in these cases, and thus a large portion of its oxygen is given
to the blood, for the absence of which the child perishes in attacks of
croup. [Ibid, from Braithwaite.

A Formula for a Castor Oil Electuary. By Septimus Piesse.
Many persons' stomachs revolt at taking castor oil in an undisguised
form. To overcome this repugnance, it has been the practice to ad-
minister it in the shape of an emulsion, which involves a large in-
crease in the bulk of the dose to be taken, as well as the employment
of a considerable quantity of gum or the yolk of an egg, to form the
emulsion. To disguise the ca>tor oil, to give it in a condensed form,
and to diminish, as much as possible, the quantity of the excipient,
the following formula has been devised :

Take of castor oil, 3 ounces.

White soft soap, - - - 1 drachm.
Simple syrup, .... 1 drachm.

Oil of cinnamon, - - - 6 drops.
Rub the soap with the simple syrup in a mortar, and then add grad-
ually the castor oil, with constant trituration, until it is thoroughly
incorporated with the above ingredients. Finally, mix with the elec-
tuary, thus formed, the oil of cinnamon, or any other essential oil that
may be preferred. By these means, a gelatinous electuary will be
formed, which is rather palatable than otherwise, and nearly equals,
bulk for bulk, castor oil in strength. The quantity of potash present
in a dose of this electuary is only a homoeopathic dose, and conse-
quently, not likely to produce a bad result in any case, even when its
use should be contra-indicated. [Annals of Pharmacy.

Butter as a substitute for Cod Liver Oil. The Union Medicale,
for May 3, quotes the following from the Repertorie de Pharmacie :
Cod-liver oil is an aliment which restores and reconstitutes the tis-
sues ; in a word, it is an analeptic medicine, by the aid of which the
disorganizing action of tubercle is combated. The only inconveni-
ence attending its use is, that it is sometimes difficult of digestion-
In this case, M. Trousseau substitutes with advantage for it, the fol-
lowing compound :

Fresh butter - - - - - - jiv.

Iodide of potassium - - - - - gr. .

Bromide of potassium, .... gr. iij.

Common salt . - - - - - 3ss~

This butter is eaten during the day on very thin slices of bread.
[Association Med. Journ.

516 Miscellany.

Raw Meat in the Diarrhcea of Infants. By M. Trousseau. At
the time of weaning, and for the first year following, children suffer
from diarrhoea which is with difficulty overcome by pharmaceutical
preparations. The evacuations are frequently accompanied with
anaemia which is not relieved by the ferro-manganesian preparations
of our pharmacopoeias. M. Trousseau administers with success, in
these cases, raw meat finely hashed and slightly salted. In the case
of a child three years old, he gave from lour to eight ounces of it
every morning. The raw meat retains in its fibres a certain quantity
of blood ; this organic liquid contains iron and manganese, but in
combinations much more natural and of easier digestion than the
pharmaceutical preparations. Raw meat is preferable to cooked, and
beef blood is much better than raw meat. " We will add," says the
Presse Medicale Beige, that it is a vulgar custom at Brussels and
many other of our cities, in certain affections, to drink the warm
blood of the beef, on an empty stomach, each morning gradually in-
creasing the quantity. We have seen haemoptysic persons, wasted
by frequent hemorrhages, recover from the loss of blood in a short
time, by drinking half a pint of blood each morning at the slaughter
house. No known pharmaceutical article can equal this ferro-man-
ganesian preparation, compounded by nature, and ready to be digested
and assimilated. But it is necessary to drink the blood the moment
the beef is killed, as it loses its properties partially by cooling, from
the time the globules and serum begin to separate. Children take
the blood willingly, though many adults will object to it. Unfortu-
nately, however, it is always difficult to obtain the blood before its
coagulation. [Journal de Chimie Medicale. Virginia Med Jour.

American Medical Society of Paris. We translate the following
from the Gazette des Hopitaux, of March 24th.

" We learn that the American Medical Society continues to receive
a large number of new members. Twenty five or thirty members,
and a number of visitors, are present at the weekly re-unions, which
gives a lively interest to the original dissertations and the debates to
which they ordinarily give rise. Dr. W. E. Johnson (of Ohio) has
recently been elected President oftfie Society. [Western Lancet.

Extraordinary Accident. A man was lately admitted into the
Portsmouth. Portsea, and Gosport Hospital, under the following sin-
gular circumstances : He was trying to extract a cork from a large
stone beer-bottle with his teeth, when it was suddenly driven into his
gullet by the force of the carbonic acid which had been generated in
the bottle. Medical assistance was immediately obtained, but una-
vailingly, and the man was taken to the hospital, where oe-ophagoto-
my was at once practised, and the cork, which measured about three
inches and a half in circumference was extracted. [St. Louis Med.
and Surg. Journal.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. SEPTEMBER, 1853. [No. 9.

PART FIRST.

r t g t n a I & c mm tt n i t a t i o n 5 .

ARTTCLE XXIX.

Uva Ursi, a substitute for Ergot. By E. G. Harris, M. D.,
of Fayette, Alabama.

I wish to call the attention of the medical profession to Uva
Ursi, as a substitute for Ergot, in producing uterine contrac-
tion. Whether it will produce all the effects, or answer all the
indications of that drug, I am not able to say; but I do
know, that it will produce considerable uterine contraction
when given during labor. Since December last, I have given
it in five cases, in all of which it acted more efficiently lhan
ergot. In three of these cases the pains had ceased entirely,
from exhaustion of nervous energy. A strong decoction of
uva ursi was given every ten minutes, and in thirty minutes
the pains had increased considerably, and in from one to one
and a half hours, the delivery was effected and the placenta ex-
pelled, the uterus contracting well, and no untoward symptoms
taking place. In the other two cases the pains had not ceased,
but were fast doing so. I gave them bountifully to two of
my new parturients one of them was delivered in fifty minutes,
the placenta following in less than five; the other in an hour
and twenty minutes, the placenta in ten. In all these cases the
head occupied the superior strat at the time I commenced giv-

N. S. VOL. IX. NO. IX. 33

518 Harris Uva Ursi, a substitute for Ergot. [September,

ing the medicine, in consequence, no doubt, of inefficient uter-
ine contraction. The os uteri was in good condition in all the
cases. Directly after the exhibition of the uva ursi, the pains
would becotfje strong and propulsive, lasting about the ordinary
length of time; then going completely off, leaving the patient
free from pajn, except that produced by pressure upon the soft
parts: the placenta soon followed; the uterus contracted well,
and no hemorrhage more than ordinary. There was little or
no tonic contraction until after the expulsion of the placenta,
when it was complete.

I am aware these five cases are not sufficient to establish its
reputation as a therapeutic agent in labor, yet the result of the
past encourages me to give it a further trial; and should its
use in the future prove as successful m the hands of my pro-
fessional brethren as it has in mine, I shall feel amply rewarded
for any trouble I may have been at in bringing it to their no-
tice. I was first induced to use it by being called to a case
where the pains had ceased ; and having no ergot, and knowing
the effect it had on the kidneys and bladder, I gave it as above
described. I prefer it to ergot, for the following reasons :

1st. Because there fs no danger in it ; you may give it ad
libitum. It is well known that ergot often produces nausea
and vomiting, and sometimes slow weak pulse, cold extremi-
ties, dilatation of the pupils, &c.

2d. Although it inci eases the propulsive efforts of the uterus,
vet it does not produce thnt tonic contraction which is so pain-
ful to the mother, and at times so hazardous to the life of the
child, until after the delivery is affected; this is generally far
otherwise with ergot. More than once hive I seen a young
and healthy mother give birth to a well developed but dead
infant not from the poison being absorbed by the mother, and
through the circulation destroying the child, but alone by the
powerful tonic contraction of the uterus compressing the um-
bilical cord, arresting the circulation, &c. Often have I seen
the placenta retained for hours, and in two cases for a day and
night after it had been entirely detached from the uterus, by the
firm and unyielding grasp of that organ all brought about by
the free administration of ergot

My plan for giving it is as follows :

1853.] Casey's Case of Hepatic Abscess. 519

ty. Uva ursi, a good article, 2 oz.
Boiling water, ... 1 pint.
Pour the water on the leaves in a pitcher or how], stir it till it
becomes cool enough to drink, and give one-fourth as hot as it
can be drank every ten or fifteen minutes, until it has the de-
sired effect. Attention should always be paid to the condition
of the os uteri, dimensions of the pelvis, &c.

ARTICLE XXX.

A Case of Hepatic Abscess Communicated to the Editor, by
H. R. Casey, M. D., of Columbia Co., Ga.

Applixg. Aug. 1st, 1853.

Dear Doctor I have thought a description of a rather un-
usual case, which occurred in my practice about a year since,
would be read by you with interest. If I had taken notes of
the case at the time, I would have given it to you in a form
which would have entitled it to a place in your Journal ; but as
I failed to do so, the account I can now give of it will neces-
sarily be imperfect (from the lapse of time). I will give you the
particulars, as my memory serves me.

I was called to see Mrs. J., aged 24, whom, upon examination,
I found in bed with a face very much flushed and in a profuse
perspiration; high fever; pulse 120, full and bounding. On
enquiry, I learned that she had been nursing a case of typhoid
fever. She seemed much frightened, thinking that she had con-
tracted that much to be dreaded fever. I soon, however, quieted
her fear on that score, telling her that she had no symptom of
typhoid, but a fever of an exactly opposite type. I bled her
freely, gave a mercurial cathartic, and left 15 grains quinine, to
be administered should the fever subside. Visited her the next
day, when the true character of her disease began to shew it-
self. Pulse 125; tongue heavily coated; skin hot and dry, and
slightly tinged with yellow. She now complained of pain in
her right side. On examination, I found considerable swelling,
the intercostal spaces indicating pressure from within. Order-
ed leeches over the region of the liver calomel and Dover's,
powders in small and separate doses, to be followed with Seidlitz
powders ; warm cataplasms to succeed the leeches.

520 Casey's Case of Hepatic Abscess. [September,

Did not see her the next day, from press of business. The
following day was summoned to see her in haste. Found her
complaining of increased pain and soreness the distension
much greater. There was now evidently a change in the
character of her fever : the bright hectic now mantled her
cheek, while the blood which had before coursed rapidly along the
vessels, now took on a slow and measured step. It was now
apparent that the hepatic inflammation had passed into the sup-
purative stage, and that an abscess was there formed. The
liver was very much enlarged, but as yet no pointing. I appli-
ed a large blister over the swelling, put her upon a generous diet,
and gave her the muriated tinct. of iron, and withheld the lan-
cet for further developments.

Some twenty-four hours thereafter I was again called in haste
to see her, when she told me that the pain had left her side, and
had located itself in her hip. On examination, I found a spot
larger than the palm of my hand on the right hip, fiery red.
Not knowing how to account for this, but supposing it to be of
an erysipelatous character, I scarrified it, and ordered it to be
covered with althea poultices. Continue the tr. ferri.

In the course of the next day I again saw her: found her hip
much swelled and fluctuation evident. Continued the warm
application, and on the following morning I plunged my lancet
in the tumor, and gave exit at once to at least a pint of matter.
It was pus, of a creamy appearance and consistence, with not
even a tinge of yellow, and exceedingly offensive. The amount
of matter, and the recent date of the hip affection, determined
its origin in the liver; but why the pointing should have been
down here, instead of opposite the liver, I could not answer.
This being my first case of hepatic abscess, I was not well
"posted up" I judge they are not of frequent occurrence in
this country not remembering an instance where an autopsy
has revealed a cicatrix of the liver as the result of hepatic abscess.
As further confirmatory of the fact that the matter came from
the liver, when the patient sat up, the matter would gravitate
in a bolder stream, and by pressing over the liver and passing
the pressure downwards towards the orifice, the matter would
make its exit freely. In the progress of this, another pointing
was observed opposite the liver, and with my lancet I gave exit
to about a teacupful of matter.

1853.] RicoroVs Letters on Syphilis. 521

Louis states that he has never known of the occurrence of a
cicatrix of the liver the result of a cured hepatic abscess. I
am certain, if ever the body of this "patient becomes a subject
of the dissecting knife, a large cicatrix of the liver will be
among the autopsical appearances.

I called to-day to see the lady, to question her as to the facts
of the case. She states that the matter was discharging three
months or more, and that she thinks as much as three gallons
of it passed off in the time. This, of course, is too large an
estimate. She states that she is in the enjoyment of good
health, but has occasionally pains in her right side, when she
stoops down or bends to the opposite side, doubtless from adhe-
sions of the liver. She thinks her "entrails have grown to her
side/' and states that she was " physicked " some years since
for liver disease.

Your's respectfully,

H. R. Casey.

PART II.

(ErUcttc ^Department.

Letters upon Syphilis. Addressed to the Editor of L'Union
Medicale, by P. Ricord. Translated from the French, by

W. P. L ATT [MORE, M. D.

EIGHTEENTH LETTER.
[Continued from Page 478.]

My Dear Friend, Positive inoculations alwaj's pursue the
course I indicated in my last letter.

When the inoculation fails, the puncture sometimes becomes
sligluly irritated, but it immediately subsides.

Still, without taking away from inoculation any of its cer-
tainty, it is necessary to know that syphilis, like variola, like
vaccinia, has false pustules. Their existence, if the examina-
tion be superficial, may lead to error. My learned colleague,
M. Puche, now acknowledges, with a good faith which does
him honor, that he was thus deceived by ialse pustules when
he made inoculations with the muco-pus furnished by balano-
posthitis. Consequently he does not now accord the same va-
lue as formerly to the facts contained in the Memoir which he
published on this subject ; he has better studied these facts, and

522 Ricoj'd's Letters on Syphilis. [September,

their signification to him has changed. You understand, my
dear friend, that I would not commit the impropriety of speak-
ing thus, had I not the formal authorization of M. Puche tor so
doing. My critics, then, who made much of the inoculations
of the muco pus of non-ulcerous balano-posthitis, who have
used this as a weapon against my doctrines, who would prove
by it that chancre does not alone furnish inoculahle pus, and
that inoculahle blennorrhagia may not be accompanied by ul-
ceration these ciitics, then, I say, can no longer use this argu-
ment without the new verification which its author believes to
be indispensable.

These false pustules are but slightlv developed ; most usually
they are only simple bullae, beneath which we find a superficial
vesication of the skin. Here there is not that complete perfora-
tion of the derma, en emporte-piece, which is observed in the
true inoculation. In some very rare cases, a more profound
inflammation may supervene, and produce something analogous
to furuncle; but the march is always, and even in these cases,
very rapid; the duration ephemeral, from thiee to five or six
days at most ; and the cure supervenes also very quickly, with-
out the intervention of any treatment.

However it may be, I have said, and I still say, that when
the inoculation does succeed, the chancre invariably begins by
a pustule; this is incontestable something which can be re-
produced at will.

However, the syphilographs who have ranked with the
primitive accidents of syphilis so many accidents which do not
belong there, ought, really, to place among them this ecthyma
developed under the conditions already mentioned.

It is true that our learned confrere, M. Cazenave, says that
ecthyma may sometimes be primitive. He even cites in his
Traitedes Syphilides a very fine example of primitive ecthyma
of the lip, the direct and immediate result of contagion. But
what M. Cazenave says of this case, so frequent and common
in my experience, proves to me precisely that neither Biett nor
he knew the true nature, the veriiable essence, of this accident.
Read over this passage from M. Cazenave, and you will he
convinced that, in this particular case, he does not consider the
ecthyma as being simply one period of the chancre. Accord-
ing to him the ecthyma which he calls primitive is always a
syphilide, that is to say, the product of a general constitutional
infection' in a word, what I call a secondary symptom.

But, in order to prove that ecthyma is always the result of a
previous general infection, although it may be the only isolated
accident by which syphilis commences: in order to succeed in
confounding the chancre of the ecthymatous debut, the veritable

1853.] RicoroVs Letters on Syphilis. 523

primitive, contagious, inoculable ecthyma, with the secondary,
constitutional ecthyma, M. Cazenave, after saying so plainly
that this accident might be the first and only result of the con-
tagion which, "aside from the influence of the virus, needs for
its development particular conditions," conditions which, in
short, are those demanded for the inoculation of primitive acci-
dents M. Cazenave, I say, wishing, against his own conv'e-
tion, to biing ecthyma among the sy phi 1 ides, gives as examples
of primitive pustular syphilides, two observations where this
accident was perfectly secondary, and regularly preceded by a
primitive accident on the fingers.

This error is very common with persons who are unacquaint-
ed with all the varieties of chancre. Did not this occur to one
of our unfortunate confreres to whom M. Cazenave alludes?
Was he not thought to have experienced a constitutional infec-
tion (Temblee, and as having offered an example of primitive
pustular eruptions? And yet this poor con fi ere had had a
chancre upon one of the fingers of his right hand ; chancre fol-
lowed by an epifrochlean adenitis, and afterwards, in the regu-
lar order, by secondary accidents. All this was verified, both
by my learned friend M. ]\elaton and by myself. True, a per-
son not much skilled in venereal diseases, although he has
written a great deal about them, was cognizant of the ulcera-
tion of the finger, but pretended that it was only an anatomical
tubercle, which had simply given passage to the virus, without
itself being inoculated. I am very much afraid that this per-
son's brain gave passage to this beautiful story without being
itself inoculated, during the transit, with even a slight resem-
blance to common sense.

I have not yet done with primitive ecthyma. You, who
read everything, sometimes from a sense of duty, often from
taste, and always with profit to those who in turn read you
you must have been surprised at seeing in a manual of syphi-
litic diseases (the learned author of which we both highly
esteem) that this author admitted the possibility of this pro-
duction of a pustule from artificial inoculation, but not other-
wise. In fact, M. Gibert resolutely denies that chancre not
artificially inoculated can commence by a pustule ; he affirms
that this period of chancre has been admitted thiough error in
diagnosis. I think you already perceive on which side lies the
error. -'If you admit," I will say to M. Gibert, "that a pus-
tule may be produced by the point of a lancet, acknowledge
that no great effort of imagination is necessary to find, in the
processes of ordinary contagion, something which may act in
the same manner, a nail, a hair, etc., without taking into ac-
count other circumstances, of which, in your character of

524 Ricoj-d's Letters on Syphilis. [September,

sypliilonath, you must receive the lascivious and disgraceful
confessions."

See, my denr friend, how even the most distinguished ob-
servers are liable to err ! Assuredly, both M. Cazenave and
M. Gibert know as well as I what ecthyma is; and yet how
does it happen that they always obstinately refer it to a general
state, and deny its existence as the product of a chancre?
Why ? Because theory too frequently throws a deceptive veil
between the observer and the matter of observation ; because,
as another observer has just told us, ten years passed in a
veneieal hospital do not suffice to make one comprehend what
passes there; because, alas! there are eyes which are always
looking, but which never see.

I ask your pardon, my dear friend, for dwelling so long upon
the pustular form of chancre. I have done so because I think
it is at length time to get rid of that parrotuge which always
gives the same invariable characters to the primitive 'accident,
as though it were changeless and eternal in form. Than this
doctrine nothing is more false, more contrary to every day's
observation. The primitive accident, on the contrary, pre-
sents numerous varieties, both at its commencement, during its
march, and subsequently. Allow me here to bring forward
what observation and experience have taught me.

Most usually, chancre begins by an ulceration either su-
perficial or profound. The primitive ulcer does not always
destroy the whole thickness of a mucous membrane or of the
skin. Thus, on the semi-mucous membrane of the glans and
prepuce, the ulceration may be so superficial as to give rise to
belief in an ulcerating balano-posthitis, and to justify certain
successful inoculations.

The ulcer (Fzmblee, then, is produced when the virulent
pus is deposited either upon a surface recently denuded, or
upon a bleeding wound, or, which is more difficult, and conse-
quently rarer, upon a suppurating wound. We also see, some-
times and this has been disputed by those who habitually
dispute everything chancre commence under the form of an
abscess. Thus, inoculated leech-bites frequently present, it is
true, an ecthymatous form; but it also happens that the viru-
lent pus inoculates the bottom of the puncture without conta-
gioning the borders ; these may then unite and inclose the virus
which inoculated the bottom ; and this bottom then gives rise
to a little virulent abscess of the subcutaneous cellular tissue,
which, on bursting or on being opened, presents a chancrous
foyer. The infiltration of the virulent pus into the subcutane-
ous or sub-mucous cellular tissue gives rise to the same phe-
nomenon.

1853.] Ricord's Letters on Syphilis. 525

All this is from the every day practice and observation of
my hospital service. I am well aware that, in this so simple
theory of the abscesses as the first period of chancre, some have
sought an argument in support of the existence of the bubo
(Temblee, an existence which I do not admit, and which seems
at variance with my doctrine. But I will hereafter return to
these buboes (Temblee, and in such a way as, I trust, will content
my opponents. However it may be with these different be-
ginnings of the chancre, their varieties have no influence upon
the ulterior form of the ulcerations.

This point has its importance; it bears upon the question of
the unity or the plurality of the syphilitic virus, a question still
obscure enough, or rather obscured by the vagueness and want
of precision of the facts. So far as I am concerned, here is
what I can say in regard to it :

When the inoculation is made on the patient himself, the
debut of the chancre being always the same, the ulceration
following the inoculation takes, finally, the form and offers the
same varieties as the first accident which furnished the inocu-
Iable pus. Thus, if the pus was taken from a phagedenic
ch.mcre, the ulceration will take on the phagedenic character;
if from an induiated chancre, the ulceration will indurate, etc.
This is what my own experience has taught me. But, in the
inoculations made from diseased to healthy individuals, have
matters always happened thus? We cannot tell; for in the
inoculations thus made by other experimenters, no note has
been taken either of the form of the accident from which the
pus was taken, nor of the form of the resulting accident. They
have been contented with saying chancre on one hand, chnn-
cre on the other, without any detailed description ; so ihat, in
fact, these inoculations cannot be of much assistance in eluci-
dating the question.

In common observation, we find that one form in one indi-
vidual may produce a different form in another. But as we
are never rigorously sure of the source of the infection, the
results may be contested by supposing that the individual who
has a different form may have contracted it from another
source than the one he accuses. The results of the last inocu-
lations just made from diseased to healthy individuals, are
balanced, and serve neither pro nor con. In the observation of
M. de Welz, the pus was furnished by a non-indurated chancre,
and his chancres were not indurated, which may depend upon
a want of aptitude in him. In the fact of the inoculation upon
the interne of the Hopitalda Midi, the chancre indurated ; and
yet the pus with which he was inoculated, must have come
horn a non-indurated primitive ulcer, owing to the conditions

526 RicorcTs Letters on Syphilis. [September,

of previous constitutional syphilis under which the patient la-
bored.

You perceive, my dear friend, that this question of plurality
of virus, so clearly laid down by some English physicians, is far
from being resolved. Up to this time we are entitled to be-
lieve only in the existence of a single virus. It appears rational
to admit that chancre, commencing always in the same man-
ner and under conditions which may by determined in advance,
depends upon a single cause, the ulterior effects of which are
determined bv conditions existing in the individual in whom it
is developed.

In fact, the numerous varieties presented by the primitive
ulcer at the period of progress, which manifest themselves more
or less quickly, and which may be summed up thus

Simple chancres; Inflammatory chancres, with a markedly
gangrenous tendency ; Phagedenic chancres ; Indurated chan-
cres seem to find the reason of their existence in causes
secondary and external to the specific cause. I am not now
delivering a course of lectures; I am not writing a book of
special pathology, and consequently cannot enter into too long
details. But, in order to justify my proposition, allow me to
recali some of the coinciding causes which give to the chancre
this or that physiognomy, this or that appearance, this or that
march.

For example, observation demonstrates the results of the
abuse of alcoholic drinks, especially in warm weather. The
simplest chancres, under their influence, rapidly become in-
flammatory, and inflammation in certain regions, as the genital
organs, in a cellular tissue which easily becomes edematous,
very soon reaches gangrene. The action of alcohol in these
cases, with which the English have furnished us such splendid
examples, is so marked that these ulcers might be called aeno-
phagedenic.

]'\>r the other varieties of phagedenic chancres, pultaceous,
diphtheritic, serpiginous, etc., their cause may often be found in
certain hygienic conditions, unhealthy dwellings, bad nourish-
ment, want of cleanliness, in the rash employment and in the
abuse of rancid mercurial ointment for dressings, in certain
diathesic conditions, tubercles, scrofulas, herpetic vice, scurvy,
and often in the different conditions which favor the production
of hospital gangrene. Add to these, as we shall hereafter see,
the influence of an anterior syphilitic diathesis.

However, the most interesting conditions to know, those
which almost of themselves constitute the pox, are those which
preside over the induration of chancre.

But the indurated chancre being one of the important points

1853.] Ricord's Letters on Syphilis. 527

of the doctrine which I uphold, and which these letters are
called upon to defend, you will allow me to make of it the suhject
of my next letter.

NINETEENTH LETTER.

My Dear Friend, If I have been well understood in my
last letter, you have seen that I admitted the unity of the syphil-
itic virus, although the fact has not yet been incontestablv de-
monstrated ; that I did not, like some syphilographists, seek the
explanation of its varied effects in its greater or less activity,
or in its different degrees of acrimony. These effects, on the
contrary, I attributed to certain conditions in the individual
subjected to its action ; so that, in spite of several cases of Bell,
and of analogous cases still occasionally met with in practice,
in which there is only a simple coincidence, we can draw no in-
ference from the form and gravity of the primitive accident of
an individual, as to the form and gravity of the disease of
the person by whom it was communicated. Finally, we can no
longer say, as we formerly said, to a patient : "If your disease
is of a grave form, it is because the person who communicated
it to you was seriously affected ; inasmuch as the contrary is
very often observed.

This law, with respect to the unity of the virus, being laid
down, I will now direct your attention, as I promissed in my
last letter, to the most important variety of chancre namely,
indurated chancre.

The induration of chancre a condition which certain primi-
tive ulcers assume was not unknown to writers of former
times. Some authors even pretend that traces of the doctrine
may be found in Galen a circumstance which does not sur-
prise me the least in ihe world, inasmuch as I believe in the an-
tiquity of the pox. It is certain, that after the great epidemic
of the fifteenth century, some of the first syphilographists of the
time described this remarkable symptom. This fact did not
escape the attention especially of Jean de Vigo, who has other
titles to our esteem than that based on the invention of his fa-
mous plaster.

Nevertheless, you know that to Hunter is awarded the honor
of having first described indurated chancre. This symptom
has even leceived the name of the great physiologist. The
Hunterian chancre, in fact, is nothing else than indurated chan-
cre. And yet Hunter scarcely touches on this subject. You
remember what he says in relation to it : '-Chancre has usually
a thickened base; and although the common inflammation ex-
tends much beyond it, still the specific inflammation is limited to

528 Ricord's Letters on Syphilis. [September,

this base." But, as you see, Hunter does not make this thick-
ened base a constant condition ; and he was right, for the great-
est number of primitive ulcers do not present this peculiarity.
Nor does he make it the condition of the constitutional infec-
tion, an important and inexplicable omission in a man of Hun-
ter's sagacity, instinct and divination.

The syphilographists who came after him, even Bell, with his
illustration of a. split pea, did not appreciate the whole value
of the induration.

Since the time of Bell, most syphilographists have paid no at-
tention to this symptom. M. Lagneau, in his treatise, appears
to attach no importance to it. But I must do M. Lagneauthe
justice, to state that, with Bell and others, he recognized the
fact, that chancre might have a pustular period. But aside from
this circumstance, you will be struck, like myself, with the
confusion which pervades his descriptions of the chancres
which he calls primitive, and those which he calls secondary.
In no respect can he be said to have correct views, relative to
the induration of chancre.

M. Cazenave, " whose work is all alike, and who cannot be
considered in earnest" expressions of courtesy which he has
but recently used in regard to myself, and which I return, so
that I may keep nothing belonging to him, has a method of
appreciating primitive accidents which is truly incredible.
Does he acknowledge any other primitive accident than the
infecting act? According to him, in fact, other accidents
must be either primitive secondary or secondary primitive.
Escape from this dilemma, if you can, notwithstanding all the
wit with which you daily regale us. At all events, the indura-
tion of chancre the capital phenomenon in the disease does
not appear to exist on the other side of the river, as Lisfranc
observed.

And yet, who can now misconceive the importanceof this phe-
nomenon ? In view of all that 1 have done to elucidate this sub-
ject, in view of the judicious observations of the learned Profes-
sor Thiry, of Brussels of those of my pupil and friend, M. Di-
dav, of Lyons of those of M. Marchal (deCalvi) of those of
my learned friend and too kind partisan, M. Venot, of Bordeaux
of those of MM. Acton and Meric, of London of those of
my learned colleagues MM. Puche and Cullerier; and finally,
in view of the observations of my hospital patients themselves,
whose education is such as to leave few chances for inattentive
physicians to commit error, I am justified in concluding, that
they who do not recognize the value of this phenomenon, have
eyes which do not see.

Therefore, as this induration, which may line as well as

1053.] RicortPs Letters on Syphilis. 529

surround chancres, merits the utmost attention of the practi-
tioner, allow me to study it carefully.

All chancres do not become indurated ; at present, only a small
number become so; and if my doctrines are true, this number
will constantly diminish.

But what is the specific condition, ulterior to the insertion of
the virus, which causes the chancre to indurate ?

This is one of the most interesting problems which the study
of syphilis can present, and it is also one exceedingly difficult of
solution. Nevertheless, I believe I have found one of the
unknown quantities.

When we. interrogate the age of the patient, relative to the
cause of the induration, we receive no reply.

The sex, the temperament, the hygienic habits of the patient,
are interrogated with no better result.

Anterior or concomitant diseases, under which the patient
has suffered, do not enlighten us any more than the specific
medication to which he has been subjected.

Thus far, then, we have been forced to content ourselves
with the common explanation, which, you know, refers every-
thing to aptitudes and idiosyncrasies.

Jn fact, it is found that the first chancre developed in certain
individuals does not become indurated, while a second one does;
and that those contracted subsequently do not indurate.

What now is the cause of this mysterious phenomenon ?

One reason for this difference, which has thus far escaped
notice, we shall seek in the general and constnnt laws of virulent,
diseases ; in the striking analogies which exist between variola,
vaccinia, and the pox.

We are now in the true path.

Vaccination, for example, may fail for the first time; this
failure will be due to some want of aptitude of which we are
ignorant ; but, if it succeeds, the unsuccessfulness of subse-
quent vaccinations is explained. The effect of the diathesis
produced by the first vaccination is not yet worn out ; and a
certain period, which modern observation is lending to deter-
mine with accuracy, must elapse before the organism again
acquires aptitude for a vaccinal impregnation.

Very well ! We have thus arrived at a capital fact in syphil-
ogeny, a fact which Ions experience has demonstrated a fact,
which has been also observed by two persons, whom it is
always a pleasure to cite, MM. Puche and Diday. The fact is
this :

As a general rule, a tatiext who has once had an indura-
ted CHANCRE WILL NEVER HAVE ANOTHER.

With respect to vaccinia and variola, it is probable that this

530

Ricord's Letters on Syphilis. [September,

law must present exceptions ; I will add that it is even desira-
ble that these exceptions should exist inasmuch as they show
that the syyhilitic diathesis may be destroyed.

But, one thing is very certain : these exceptions are far more
rare with respect to syphilis ; for MM. Puche, Diday and myself
are still in search of indubitable proofs of their existence.

This circumstance is due, my dear friend, to the fact, that,
when there is indurated chancre, there is of necessity constitu-
tio7talpox.

With the induration, the syphilitic disposition, as Hunter
called it, is acquired ; the syphilitic temperament, as I have else-
wherestated, becomes established ; and finally, a specific diathe-
sis, which gives rise to ulterior manifestations, is developed.

Neither the disposition, the temperament, not the diathesis
can double or triple itself, any more than the analogous disposi-
tion in vaccinia can thus double or triple itself.

The indurated chancre is to the pox what the true variolic
pustule is to the variola; what the true vaccinal pustule is to
the vaccinia.

The nnn-indurated chancre is the pseudo pustule ; it is a
false vaccinia.

Here, my dear friend, you have an admirable law; a law
which brings the pox under the general laws of virulent affec-
tions ; a law which guides us in the study of syphilis, as the var-
iolic and vaccinal inoculations guide us in ihe study of variola ;
a law which satisfies the mind, and gives it a sure resting place
after a painful and tedious vo\ age amid deceptive hypotheses
and contradictory theories; a law, which arithmetic the first
rule of which was so much outraged by one of your former cor-
respondents will serve to establish, if, to obtain the real sum,
similar values be added together.

But I am not charged, at present, with the special education
of your honored correspondent, the provincial student ; with the
duty of teaching him to distinguish the difference which exists
between a diathesis and the manifestations of this diathesis;
between the diathesis, properly so called, and the resulting ca-
chexia; to all of which matters 1 shall undoubtedly have occa-
sion to return, and with respect to which 1 am afraid the mind
of the poor student is in much trouble.

For the present let him be aware he will excuse this magis-
terial style of speaking that the diathesis, acquired by the inlec-
ted patient, prevents the induration of another chancre which
he may contract ; and that this immunity from a new general
infection must also be hereditarily transmitted. By means of
this fact we are able to understand the remark which was made
a little while ago : This transmitted disposition may well have

1853.] Spasmodic Asthma. 531

an influence in the diminution of indurated chancres, and there-
fore in the diminution of constitutional poxes. Variola r.nd
vaccinia also present, in this respect, a curious field for study.
This idea, which originated in my school, hns been carefully
studied in a remarkable thesis, maintained by a distinguished
pupil of Val-de-Grace, whose name I cannot just now call to
mind.

Therefore, the non induraiion of chancres contracted at dif-
ferent periods, subsequent to the developement of an indurated
chancre, is a proof which can easily be verified by statistics, of
the unicite a neologism for the introduction of which lam not
to blame ofthe syphilitic diathesis ; a fact implicitly admitted
by Hunter, when he said that the formation of the syphilitic dis-
position could be prevented, but that this diathesis could not be
destroyed when once established ; a fact which M. Cazenave
did not suspect he had proclaimed in accordance with our views
when he wrote in his Treatise on Syphilis : " We are not aware
that the syphilitic temperament has ever been destroyed." M.
Cazenave would certainly not admit, as a sound principle in
physiology, the assertion that there exists a double sanguine, or
a double bilious temperament, anv more than he would admit
the assumption of the existence of a double glanders, a double
Variola, and a triple hydrophobia, to be a sound principle in
pathology. The non bis in idem is thus, so to speak, a patholo-
gical law. I trust I shall be able thoroughly to elucidate this
question, in all its bearings, while studying the evolution of
constitutional accidents.

These points of doctrine, relative to the etiology ofthe indu-
ration, being thus established, let us now study this phenomenon
with respect to the period of its appearance, and with respect to
its seat, its peculiar symptoms, its nature, and its progress, that
we may finally arrive at a true exposition of its consequences.

This important question will be the subject of my next letter.

[ New York Med. Times.

Spasmodic Asthma.

The first number of the Glasgow Medical Journal, contains
an interesting paper on this subject, by Dr. Eben Watson.

It appears from Dr. Strang's statistics (Report on the Glas-
g' w Mortality Bill for 1851, p. 40,) that in the year 1851, 212
persons died of asthma in Glasgow; and in 1852 (Report on
the Glasgow Mortality Bill for 1852 p. 28,) rather fewer, viz t
202. Now by the same tables, we also find that the total
deaths from all causes, among persons above fifteen years of

532 Spasmodic Asthma. [September,

age, amounted in 1851, to 4543, and, in 1852, to 4853; and
seeing that asthma very rarely attacks persons below fifteen
years of age, it follows that these two numbers afford the
means of ascertaining the ratio between the general amount of
mortality, and that accruing from asthma. Regarding there-
fore, the adult population alone, viz., persons above fifteen years
of age, one denth was caused by asthma, in 1851, for not more
than 20.4 by all other diseases put together; and. in 1852, one
death was caused by asthma for 23 by all other diseases. Or,
to take another view of it, of all deaths happening to persons
above fifteen years cf age, 4.6 per cent., in 1851, and 4.1 per
cent in 1852, arose from asthma.

The name of spasmodic asthma was originally founded on
the meie supposition of a spasm in the air-passages, occurring
so as to cause the sudden paroxysms of dyspnoea, to which the
patient is liable; and now that the structure and functions of
the bronchial tubes have been thoroughly investigated and
made familiar to every one, we do not suppose, but we know,
that such a spasm really occurs ; so that in this instance modern
science has confirmed ancient hypothesis. There are only two
portions of the air-tubes where spasm can at all take place, so
as to cause dyspnoea. These two portions are at the rimaglot-
tidis, and at the extremities of the bronchial tubes, where,
instead of cartilaginous rings, there exist muscular fibres. In
all other parts of the bronchi, the rings of cartilage in their
outer walls prevent anything like complete closure.

Laennec observed that during the asthmatic paroxysm there
was great diminution, or even complete absence, of the respi-
ratory murmur; a fact which is explained by the small tubes
being obliterated by the spasm, so that the air cannot pass into
and distend the air-vesicles. When the spasm begins to relax,
the patient inspires slowly and with difficulty; a vibratory
sound, accompanying the inspiration, is heard by the bystanders
and much more loudly through a stethoscope placed over the
thyroid cartilage. It is caused by the vibration of the glottis,
still partially stretched over the entrance to the windpipe. Suf-
ficient importance has not been attached to the spasm of the
glottis in asthmatic cases ; it is the glottidean contraction which
chiefly hinders the patient from overcoming that of the much
weaker fibres of Reisseissen, in the smaller bronchial tubes. As
soon as the muscles of the glottis relax, and not till then, does,
the respiratory murmur become re-established.

Observation thus teaches us that the superior constriction is
the last to give way ; and Dr. Watson believes that, in early
cases of asthma, it is the first to occur. There are two circum-
stances which prove this satisfactorily to his mind: first, the

1883.] Spasmodic Asthma. 533

fact that many cases of purely laryngeal disease end in spasmo-
dic asthma; and second, that there are cases, though perhaps
not very commom, in which the affection is confined to the
glottis.

In a paper on Chronic Laryngitis, published in the Dublin
Quarterly Journal of Medical Science, in November, 1850, Dr.
Watson stated it as his opinion, that inflammation of the larynx,
especially if ulcers have formed, constitutes a not infrequent
cause of bronchial asthma, and supported that opinion by the
relation of a case, occurring in a lady, who had had acute laryn-
gitis producing ulceration, and passing into the chronic state.
Afterwards, not only the usual symptoms of the laryngeal
disease remained, which were persistent, but a new affection
was excited, viz., spasmodic asthma, in a most severe degree.
The bronchial tubes ultimately became altered by the violence
of the morbid agency that had attacked them. It was not to
be expected that, at this late stage of the disease, any treatment
could produce a perfect recovery: but it is satisfactory to be
able to state that, after the cure of the laryngeal ulcers by the
topical application of solution of caustic, the lady had no such
severe asthmatic paroxysms as those from which she formerly
suffered.

The occurrence of a kind of asthma confined to the glottis
will be sufficiently illustrated by the following case :

Case. A young lady consulted Dr. Watson, about two
years ago, for sudden attacks of breathlessness. She had no
cough of any consequence, and in the intervals of the attacks
she breathed freely enough ; but as she seldom enjoyed a night's
rest, her general health was somewhat disordered. Her pulse
was quiet and natural, and there was no evidence of heart-
disease ; but her complexion was slightly florid, and her lips
were of rather a bluish tinge. When he saw her, there was
none of the bronchitis which generally attends asthma, and her
age forbade the supposition of its being the ordinary kind of
that disease. The respiratory sounds in the larynx were loud
and harsh, and the length of the inspiratory sound was exag-
gerated.

The fits of dyspnoea were worst at ni^ht and in the morning.
When the disease was mild, she could, by keeping very quiet
and still during the evening, avoid the breathlessness for the
early part of the night, and thus she got sleep for a time ; but
soon after midnight she was sure to awake with frightful dysp-
noea, and was obliged either to rise from bed, or, at all events,
to spend in a sitting posture the rest of the time usually allotted
to sleep. Before she came to Dr. Watson, however, she was
always attacked in a similar violent manner in the evening, so

n. s. VOL. IX. NO. ix. 34

534 Spasmodic Asthma. [September,

that it was only after being completely worn out that she
obtained a short repose, from which she was again roused by
extreme breathlessness. There was no approach to hysteria.

No other treatment was used but the regular application of a
solution of caustic (Bi to i) to the affected part, at first every
day, andjafterwards every second day. About six weeks of this
treatment sufficed to remove the symptoms, and the lady
remained quite well until the following winter, when she caught
a slight cold and became affected in a similar way ; but she
applied to Dr. Watson sooner than on the former occasion, and
half the time of the same treatment again produced a cure.
During the autumn, she again had another attack of her disease ;
but this time it was so light, and treated so early, that it did not
resist the topical application above a week. Since then she
has been entirely free of the spasms, notwithstanding the very
changeable and trying weather of the past winter.

Dr. Watson then concludes, 1st, that local causes of irrita-
tion in the larynx may produce spasmodic contractions, not
only of the glottis, but also of the lesser bronchial tubes ; and
2d, that spasmodic affections of the glottis may occur periodi-
cally for a length of time, without involving the small bronchial
tubes in any great or important contraction. These conclu-
sions, if correct, prove that asthma commences in the upper
and not in the lower parts of the air-tubes ; and that in the ra-
tional treatment of that disease, the remedies most likely to
benefit the patient are such as may be applied to the laryngeal
lining and to the glottis itself. But it must be remembered
that, in many of these cases, universal bronchitis exists along
with the spasmodic affection of the upper and lower tubes : this
may arise either from causes capable of exciting both diseases,
or the bronchitis may have existed previously to the occur-
rence of an asthmatic paroxysm. The former is then probably
the exciting cause of the latter; and he admits that it is difficult
nay, perhaps impossible, to ascertain with accuracy in this class
of cases, whether the spasmodic affection was first excited in
the small tubes, or at the top of the larynx. It is enough for
practical purposes, however, to know that the latter region is
always affected in such cases at the same time as the inferior
bronchi, and with even greater intensity; and, moreover, that
it is the spasm of the glottis which chiefly maintains that of the
bronchi, by preventing their expansion during the forcible in-
spirations of the patient.

The ordinary treatment by bleeding, general or local, by
emetics, antispasmodics, opiates, and mercurials internally,
with blisters, and various other counter-irritants externally, has
seldom been followed by even a partial success in these cases.

1853.] Spasmodic Asthma. 535

It is established, both by clinical observation and by Dr. Wil-
liam's experiments,* that bleeding carried to any length cart
never diminish the tendency to spasmodic contraction in the
air-tubes ; but during a bad fit of asthma, such a measure may
be absolutely necessary to relieve congestions, arising seconda-
rily, either in the brain or in the lungs themselves. Again,
though emetics cannot save the patient from a renewal of the
spasm, they may assist in overcoming that which exists, as well
as in clearing away the mucus which clogs up the smaller tubes;
and antispasmodics may assist in prolonging their good effects
for a short time. In some cases, where there is much bronchi-
tis, blisters have a good and more lasting effect, but they do
not exercise much influence over the spasmodic asthma. In
like manner, a slight mercurialization often benefits the bron-
chitis of the more sthenic variety, as indicated by the expecto-
ration containing plastic matter, mixed with mucous globules ;
but it can have no effect on the paroxysmal disease. Opium
only lulls for a time an effect by no means to be lightly
esteemed ; but when the paroxysm becomes severe, it utterly
fails.

There is here, therefore, an evident blank in therapeutics.
There is no agent hitherto proposed which is capable of remov-
ing or greatly diminishing the morbid contractility of the air-
tubes. And Dr. Watson thinks that a solution of caustic ap-
plied to the interior of the larynx supplies this defect. In proof
of its having this exhausting effect on the irritability of the glot-
tis, and ultimately on that of the air-tubes, he refers to the
results of its use in hooping-cough, a disease which is so analo-
gous to spasmodic asthma in its pathology, that it is almost
enough to show the efficacy of a remedy in the treatment of
one of these diseases, to prove its suitableness for the other.
Now, in proof that the topical treatment of hooping-cough is
most efficacious and successful, it is enough to state that, com-
bining the cases treated by him since he first proposed the plan
in 1849, with those treated by M. Joubert, ofCherion, and
published in the Bulletin de Therapeutique, for January, 1852,
we have as follows :

. Cases.

A speedy cure (in ten to fourteen days) resulted in . 78
Shortening of disease (three or four weeks' duration) . 39
No change was effected in ..... 8

Total number treated .... 125

* Report read by Dr. C. J. B. Williams, at the meeting of the British Asso-
ciation in Glasgow. See his work on Diseases of the Chest, p. 320.

536 Spasmodic Asthma. [September,

There was not one death among all the cases treated, and,
taking their percentage, we have

65.4 . . were cured within a fortnight.
31.2 . . were cured in three or four weeks.
6.4 . . resisted the treatment.

100.0

He feels assured that no similar statement could be made re-
garding the results of any other method of treating hooping-
cough.

He cannot, as yet, speak of great numbers of cases of spas-
modic asthma treated in this way; but he has been very suc-
cessful with the topical method in some cases that had previ-
ously been treated without much benefit in the ordinary man-
ner. Of this he gives two instances.

Heart-disease is a frequent concomitant of asthma, and in
such cases it is often supposed that the former is the cause of
the latter disease ; but this is by no means the constant relation
of the two morbid states, for the disturbance to the pulmonary
circulation, occasioned by frequent asthmatic paroxysms, is-
quite as likely to produce the heart-disease as the reverse. It
is however, more important to call attention to the fact of the
great difference between simple spasmodic asthma and that
which coexists with heart disease. The pathology of the for-
mer has already been explained as an affection wholly confined
to the bronchial tubes. But in cardiac asthma, this is Dr. Wat-
son ventures to say, never the case. In that disease, the sub-
stance of the lung is always more or less altered ; generally, the
air-cells have become much distended, their walls atrophied,
and even in some places ruptured ; and it is this vesicular em-
physema, not spasmodic contraction of any part of the bronchi,
which produces the urgent thirst for air so distressingly experi-
enced by these patients. . There could be no good object served
by introducing solution of caustic into the larynx in such cases.

There are, besides the topical application to the larynx, two
other remedial measures which Dr. Watson has for some time
employed in cases of spasmodic asthma, but regarding which
he is not able to speak with precision. The one is electricity,
applied in a gentle current, as much as possible along the course
of the larynx and bronchi. In his experiments on the lower
animals, Dr. C. J. B. Williams found that such a current des-
troyed the contractility of the tubes,* and in several instances
Dr. Watson has thought that it co-operated with other means,
in diminishing the frequency and severity of the asthmatic par-
oxysms. This, however, might be the effect, not only of its

* See Report, formerly referred to.

1853.] Spasmodic Asthma. 537

local, but of its general action as a tonic on the nervous system.
The other agent referred to is strychnia, which he has used in
repeated small doses of one-twentieth or one-sixteenth part of
a grain, and he believes with good effect in some cases. Dr.
Williams found that when animals had been poisoned by this
substance, the air-tubes did not exhibit contractility, and he
thought that they were retained in a tonic spasm by the opera-
tion of the poison. This very probably was the case; but of
course the use of strychnia in medicinal doses produces totally
different effects on the human system, and the benefit accruing
therefrom must have another explanation. Dr. Watson be-
lieves that this medicine, in the doses mentioned above, is a
powerful equalizer of nervous action, and therefore a good
means of diverting that action from concentrating in any parti-
cular organ, such as the bronchi in spasmodic asthma.

In conclusion Dr. Watson recapitulates the chief propositions
sought to be established.

1. Very many cases of bronchial asthma have their origin
in laryngeal disease; that some remain for a variable period as
a spasmodic affection of the glottidean muscles, and that in all
cases of the-disease in question, although the bronchi have long
been affected, the chief contraction still occurs in the larynx.

2. If this contraction at the glottis be in any way overcome,
that of the smaller bronchii either simultaneously or speedily
relaxes.

3. The usual remedies employed in spasmodic asthma are
either directed against the complications of the disease, and not
against its proximate cause, or have been found in practice in-
.capable of accomplishing its removal. The latter are therefore
useless, and the former unfit to fulfil the indications referred to
above.

4. This indication mdij be answered more or less perfectly
indifferent cases, by the application of a solution of caustic of
moderate strength (gr. xv. or 9i to ii) to the glottis, which is
the organ chiefly affected.

5. Cardiac asthma, as it is called, does not usually depend
proximately on simple spasmodic contraction of the bronchial
tubes, but rather on vesicular emphysema. Cases of this kind
are therefore unfit for topical treatment.

6. Electricity passed in general currents, as much as possi-
ble along the bronchial tubes, may be found to diminish their
contractility; and repeated small doses of strychnia may co-
operate with the other means of treatment, probably by with-
drawing the nervous energy to other parts at a distance from
the affected air-tubes. [Assoc. Med. Jour. American Jour.
Med. Science.

538 Inflammatory Gangrene. [September,

Pathology of Inflammatory Gangrene. By J. H. Bennett,
M. D.; Prof., &c.

Occasionally, a very large amount of blood plasma is thrown
out, constituting a violent inflammation ; a greater or less num-
ber of capillaries are also ruptured, and blood-corpuscles are
more or less mixed with the liquor sanguinis exuded. The
exudation thus formed compresses the part so as to obstruct the
bloodvessels, and prevent the continuance of any circulation in
it. Under these circumstances, instead of forming a blastema
for the production of new structures, it undergoes chemical
changes, which induce in it decomposition, and the part is said
to be mortified, or to be affected with moist gangrene. This
change commences first in the blood extravasated, which be-
comes of a purple colour more or less deep ; the corpuscles
break down and become disintegrated ; their hematozine dis-
solves and colours the serum ; and, should the exudation have
coagulated, it forms brown, rust-coloured, purple, or blackish
masses. An acid matter is now formed, which, acting on the
neighboring tissues, produces fetid gases that are abundantly
given off from the affected part. Sulphuretted hydrogen is
evolved, which causes the blackish sloughs usually observed in
such cases, and discolours silver probes and the preparations of
lead. After a time, the elementary tissues surrounding or in-
volved in the exudation become more or less affected. The
transverse striae in the fasciculi of voluntary muscles become
first pale, and are then obliterated. Cellular tissue, fat, and
other soft substances lose their connection, and fall into an un-
defined granular mass. The tendons and fibrous tissue retain
their characteristic structure for a long time after the other soft
parts have been reduced to a softened pulp. The bones resist
the action longest, but at length become rough, soft, and com-
mencing externally, are more and more broken down, and re-
duced to the same pulpy consistence and granular structure as
the surrounding parts.

As the tissues thus become broken down and fluid, they are
discharged from the system in the form of an ichorous matter,
which, examined microscopically, presents numerous granules,
imperfect or broken-down cells, blood-corpuscles, and frag-
ments of filamentous tissue or the other structures involved.
If the morbid action be seated in the subcutaneous tissue, the
skin soon becomes involved, and an opening is formed, which
rapidly increases, and gives vent to the discharge. In a simi-
lar manner, gangrene of internal organs, by destroying the
intermediate parts, at length enables the discharge to reach the
surface, or to find its way into the excretory passages, such as

1353.] Inflammatory Gangrene. 539

the bronchi, the intestinal canal, the meatus auditorius, &c. In
this manner, life may be endangered by the destruction of or-
gans necessary for its continuance, by the exhaustion resulting
from the discharge, and sometimes by the absorption of the
ichorous matter, which, on entering the circulation, acts as a
poison to the economy.

It may be asked, whether inflammation and mortification are
similar processes? whether the latter is only a greater intensi-
ty of the former? or whether, when mortification follows
inflammation, it is dependent on other circumstances, such as
a peculiar state of the atmosphere favouring the decomposition
of the exudation poured out ? In order to answer any of these
questions, we must distinguish between mortification arising
from a variety of circumstances, and an inflammatory gangrene,
properly so called, the which is undoubtedly the rarest of all
the terminations of inflammation. We frequently see mortifi-
cation produced by the application of chemical or mechanical
agents, which directly destroy the tissues. It also arises from
severe and complicated injuries, in which arteries leading to
the portions of structure affected have been divided or crushed.
In old persons, it follows obstruction in the bloodvessels, or is
dependent on circumstances not yet ascertained. In none of
these cases is it caused by inflammation. But when stasis of
the capillaries is produced to a considerable extent, followed by
the exudation of a large quantity of blood-plasma, which instead
of passing into organization, undergoes the changes previously
described, then an inflammatory mortification, properly so
called, is produced. We see this take place after burns, a long
exposure to frost, and in certain cases of erysipelas. Here the
amount of exudation is considerable, the pressure caused by its
extreme, the obstruction to the circulation in the neighboring
parts correspondingly great, and these, as well as the exudation
itself, die. In this sense, therefore, it may be said to depend on
the severity of the inflammation. This, however, is not the
casein the sense of those who consider the adhesive, suppura-
tive, and gangrenous inflammations as different stages of one
process. Suppuration, as we now know, has no connection
with adhesion ; it is opposed to it ; nor is it in any way related
to mortification, which must be considered as a primary alter-
ation of the exudation. The vitality is lost, nnd instead of pas-
sing into organization, it at once becomes subject to the chemi-
cal laws of dead matter, and undergoes putrefaction.

Now, in order that organic substances should enter rapidly
into putrefaction, it is necessary that they find sufficient oxygen
and water for all their carbon to be transformed into carbonic
acid, all their hydrogen into water, and all their azote into am-

540

Inflammatory Gangrene.

[September,

monia. When these conditions are not completely fulfilled,
transition or intermediate substances are formed. When there
is not sufficient oxygen, for instance, an excess of carbon is
produced in the debris, and hence the black colour observed in
mortified parts. There is also often developed a species of con-
tagion, which causes parts undergoing decomposition to excite
it in neighboring ones (eremacausis of Liebig.) This does not
take place in dry gangrene. Thus, a gangrenous stomatitis
(Cancrum oris) destroys, in a short time, a large portion of the
soft parts of the lips and face; noma destroys the genitals of
young female children. This appears to depend upon the quan-
tity of destructive fluid or mixture generated in the process. A
dry gangrenous foot on the other hand, often requires several
weeks before it has produced sufficient decomposition to be de-
tached, and reached all the tissues to the bone.

But there are sometimes external causes which seem to
produce mortification, independent of the amount of exudation,
or the rapidity with which it is thrown out. During the sum-
mer of 1836, I watched with great care the progress of a
sloughing gangrene, prevalent, not only in the infirmary of
Edinburgh, but throughout the city generally. All kinds of
sores and wounds were affected by it, even those of a specific
nature, such as chancres, &c. Neither youth nor age was
exempted from it. It affected not only those who were debili-
tated from disease by intemperance or by diet, but those also in
the most robust health. Thus, a servant- girl, aged 16, who had
never suffered from illness, and of a robust constitution fell down
upon some glass bottles, and slightly cut her left thumb. A
week after, she entered the infirmary with an ulcer the size of a
shilling, filled with a brownish-black slough, discharging a fetid
and sanguinous fluid. In this, as well as other cases which occur
red, it became impossible to attribute the gangrene to the
violence of the injury, the amount of exudation, a state of cach-
exia, or indeed to any circumstances connected with the indi-
vidual. It could not arise from contagion, as it originated sim-
ultaneously in different parts of the city in individuals who had
no communication with each other, was not confined to the in-
firmary, and the system of dressing wounds there precludes the
possibility of this explanation. We, are, therefore, compelled
to ascribe the cause to something without.

Most writers have noticed the connection between a certain
state of the atmosphere and the prevalence of hospital gangrene
and of dysentery. Its more frequent occurrence in summer and
autumn that is, at a period of the year when increased temper-
ature favours the decomposition of animal matter. The good
effects which result from change of air, when every kind of

J

1853.] Analysis of Blood. 541

treatment fails, still farther point out its origin from changes
occurring in the atmosphere. These probably depend upon
some electrical state not yet explained, which powerfully influ-
ences the chemical combinations of the diseased part, and pre-
vents cell growth. At least, such is what we may reasonably
suppose from all the facts with which we are acquainted on
this head. It is similar to blight among vegetables, the potato
disease, and so on. \_Amer. Jour, of Med. Sciences.

Analysis of Blood. A new Method of separating the Blood-
Globules from the Coagulum. By Benjamin S. Shaw, M. D.
of Boston.

Hitherto, a quantitative analysis of the blood has been very
difficult when once this fluid has been coagulated, the principal
difficulty being the perfect separation of the globules. Before
coagulation, this can be pretty easily done by whipping out the
fibrine, or by agitating the blood in a flask in which is suspended
a piece of metal, around which the fibrine collects, and then
filtering the serum which still retains the globules. But it is
not always possible for the chemist to be present at the vene-
section for this purpose. The method I pursue is very simple,
and is not, I think, generally known to chemists.

The blood when drawn, should be immediately poured into
two vessels of the same size. I use two light glass tubes, weigh-
ing, with their ground-glass stoppers, each about an ounce, and
capable of containing each an ounce of blood. The tubes
should be completely filled, the stoppers introduced and allowed
to rest twenty-four hours, so that the coagulation may be com-
plete. One of these portions of the blood is used for the estima-
tion of the globules, fibrine, and albumen, the other for the salts
and the water. The great difficulty then is in separating the
globules from the fibrine without rupturing them, so that they
mav afterwards be retained on a filter. To effect this. I have
tried experiments with different kinds of linen and cotton cloths,
of different degrees of fineness, and find that there is a kind of
linen, rather fine than coarse, and yet the threads of which are
not too closely woven, being about sixty to the inch, through
which, when it has been well washed and soaked, or better still
softened by wear, the globules can be pressed from the clot
without injury, the fibrine being perfectly retained. A satura-
ted solution of sulphate of soda should be prepared in an open
vessel, the linen cut in a circular shape of sufficient size to hold
the clot, and moistened with the solution before its introduction.
The clot inclosed in the linen should then be immersed in the
solution, and gradually pressed with the fingers till all the glo-

542

Analysis of Blood.

[September,

bules are removed, and the fingers and linen then washed with
the solution to remove what few globules may adhere to them.
The fibrine remaining on the cloth should then be washed, dried
and weighed.

The globules/ when examined with the microscope, will be
found unruptured, and of natural appearance. These should
then be filtered by a small filter previously weighed,) the filter
moistened with the sulphate of soda solution, and only a small
quantity of the globules be poured at a time upon the filter.
The globules should then be washed upon the filter with a
fresh solution of sulphate of soda, dried, and the filter spread out
on the surface of a water-bath heated to 212 F. to coagulate
the globules. The heat in the centre of the bath is not suffi-
cient, and the filter should be well spread upon the bottom of
the bath, immediately over the boiling water, as nothing less
than a heat of 212 F. will suffice. When the globules are co-
agulated, the filter should be replaced in the funnel, and the glo-
bules carefully washed with distilled water, so as to remove all
traces of the sulphate of soda, albumen, &c. This can be easi-
ly done without losing a single globule, if the globules have
been fully coagulated. The filter is to be dried and weighed in
a corked tube. The difference between this weight and the
previous weight of the same filter, in the same tube, will give
the exact weight of the globules.

The rest of the analysis is much like the common method.
The solution of the sulphate of soda, after the separation of the
globules, should be coagulated by heat with a few drops of acid,
the coagulum washed with water, alcohol, and ether, dried and
weighed for albumen.

The second portion of the blood, reserved for the estimation
of the water and the salts, should be weighed, dried in a sand-
bath, and again weighed, the loss being water. The residue
should be burned in an open capsule carefully, for large quanti-
ties of carburetted hydrogen are generated, which puff up the
mass, and render it liable to be lost over the sides of the vessel.
When the gas ceases to escape, the calcination should be con-
tinued in a platinum crucible ; but even here the perfect elimi-
nation of the carbon is very difficult.

A physician, furnished with two of these glass-stopped tubes
or even with two common test tubes well corked, can fill them,
and hand them to the chemist, without any necessity for previ-
ously defibrinating the blood. And by this method, also, the
fibrine is perfectly separated, which is not always the case
when the blood is beaten. The other ingredients of the blood,
as the fatty matters, urea, seroline, &c, can also be estimated.
Although this is rarely desired by the physician. [Ibid.

1853.] Strychnia in Impaired Spinal Energy. 543

Case of the Beneficial Effects of Strychnia in impaired Spinal
Energy. By Dr. Marshall Hall, F.R.S., &c.

In remarking upon this case, Dr. Hall says :

Such cases occur from causes of nervous exhaustion, such as
excessive study, muscular effort, sexual indulgence, &c. ; and
in such cases strychnia has appeared to me the appropriate and
useful remedy.

This agent acts distinctly on the spinal marrow. In excess
it induces spasmodic affection. It is therefore contra-indicated
in cases of irritation of this nervous centre and of spasm. Its
appropriate use is in spinal exhaustion. It constitutes one of
our best tonics, improving the general health, and conducing to
the recovery of strength and flesh.

I have given it in minute doses thrice a day, in the midst of
meals, for many months. The following is the formula which
I have adopted: $. Strychniae acetatis, gr. i. ; acidi acetosi,
fllxx. ; alcoholis, 3ij.; aquae distillate, 3vi. M.

Of this, ten drops, containing one-fiftieth part of a grain, may
be given thrice a day ; but I have generally begun with five,
and gone on to fifteen.

In two cases only have I known it to disagree. It seemed to
affect the head. In many the patient has improved in looks,
as in general health and strength, without experiencing any
thing but good from it.

I am giving the strychnia a cautious trial in the epilepsy
attended by pallor, thinness, and nervous exhaustion ; in the
paraplegia the result of sexual excesses, and in which neither
pain nor spasm has occurred ; and in the paralysis agitans.
Lancet, Nov. 27, 1852, from Braithwaite's Retrospect.

In another paper, Dr. Hall says :

I have been recently engaged in some experiments on the
effects of strychnia and their remedies. I can only give a brief
notice of them at the present moment ; on a future occasion I
will give the experiments themselves with their interesting de-
tails.

The effects of the acetate of strychnia show themselves under
two forms or degrees, according to the dose of the poison in
relation to the powers of the animal : these are (1) the milder,
and (2) the severer.

If a dog be placed under the milder form of strychnism, it
passes into a condition of extreme spinal excitability. If, when
in this state, it be continually excited, like the frog under a
similar influence, it certainly dies ; if, on the contrary, it be
placed in a position of absolute quiet, it as certainly recovers

544 Chloroform in Obstruction of the Bowels. [September,

facts which suggest our principle of the treatment of tetanus
and of hydrophobia.

If the animal be placed under the severer form of strychnism,
a different series of phenomena occurs. In the violence of the
paroxysm, extreme laryngismus, extreme efforts at respiration,
apoplexy, asphyxia, death, occur unless one measure be adopt-
ed ; that measure is tracheotomy I

Let alone, the animal would infallibly die of laryngismus ;
tracheotomy being performed, he lives !

But the patient affected with hydrophobia and all hitherto
so affected have died have died of laryngismus. Now of
laryngismus he would not die, if efficient tracheotomy were
performed; would he, then, die?

I must add, in connexion with this last remark, that a dog,
saved from the effects of laryngismus by tracheotomy, did af-
terwards die of exhaustion.

I repeat that all patients afflicted with hydrophobia have died
hitherto; that all have died of laryngismus ; that of laryngis-
mus they need not die, and will not die, if tracheotomy be
performed ! that is, no patient need die from the cause from
which all hydrophobic patients have died hitherto.

If tracheotomy be performed, will the hydrophobic patient
die? This question cannot be answered without an appeal to
experiment. As the animal affected with the severer form of
strychnism was saved from the first effects of the poison, yet
died afterwards of exhaustion, the hydrophobic patient may
die of ulterior effects of the poison. Even then, the terrors of
this most terrific of diseases the fits of strangulation and of
suffocation will be averted.

From the experiments to which I have adverted two practi-
cal inferences are deducible :

1. Let the tetanic patient be preserved from all external ex-
citement absolutely.

2. Let the hydrophobic patient, whilst equally preserved
from excitement, be submitted to efficient tracheotomy. Lan-
cet, Feb. 5, J 853, frm Ibid.

Chloroform in Obstruction of the Bowels from Spasms. By
J. D. Cain, M.D.

Every physician meets, in the course of his practice, with
cases of obstruction of the intestines, which has come gradual-
ly or suddenly, generally from some cause of irritation exist-
ing in them. The obstruction in these cases consists of a
spasmodic contraction of a portion, or of portions of the intes-
tines, generally the small. The plan I formerly pursued was,

1853.] Chloroform in Pneumonia. 545

to cease all attempts at forcing a passage by means of cathar-
tics, if one or two brisk cathartics failed, and to resort to opium
freely, enemata of warm water, melted lard or butter, sweet
oil, etc., the warm bath, fomentations of the abdomen, and
other means of producing relaxation. For more than two years
I have used chloroform, as a more powerful agent than opium,
and its preparations, and as more certain in relaxing the mus-
cular system. The chloroform administered in greater or less
inhalation, soon produces a greater or less degree of resolution,
and taking advantage of the relaxation thus effected, I give
enemata, either stimulating, mucilaginous, or oily, which in a
short time bring away faecal matter. The inhalation may be
repeated as often as in the judgment of the physician the case
demands.

Chloroform possesses the immense advantage over opium, of
relieving effectually and promptly the pain, and in not leaving
the bowels in a constricted state, the sedative effect soon pass-
ing off.

Seven cases have thus been treated by me with highly satis-
factory results. In one case only have I experienced any
difficulty in inducing the requisite degree of relaxation of the
bowels. The subject of this case was very slightly susceptible
to its influence; but the pain was completely relieved by fre-
quent inhalations, and the obstruction gradually overcome.

[Charleston Med. Journal.

Inhalation of Chloroform in Pneumonia.

The late journals of Germany publish more than 200 cases
of pneumonia treated by inhalations of chloroform. Far from
being contra-indicated in pulmonary phlegmasia as had been
thought up to the present time, chloroform on the contrary
would seem, according to these facts, to modify favourably the
inflammatory process of the lung. From among the observa-
tions published, out of 193 cases treated by Drs. Wachner,
Baumgartner, and Schmit, only 9 died. Of 23 cases reported
by Dr. Wawentrapp, of Frankfort, 19 were treated exclusively
by chloroform, and only 1 died. Every two or three hours
the patient is made to inhale the vapour from fifty drops of
chloroform, during ten or fifteen minutes, so as never to let
the effects reach to a loss of consciousness. All the patients
were, of adult age, and the disease upon an average had reached
the fifth day. In every case it was observed that the chloro-
form had a diaphoretic effect, which was sometimes produced
by the first inhalation, and never failed to manifest itself on the
third or fourth day. It gradually diminished the local pain,

546 Composition of the Semen in old men. [September,

and caused it to disappear ; it calmed the thoracic anxiety,
brought back the respiration to its normal type, always appeas-
ed the cough, facilitated the expectoration in rendering it less
abundant ; and, lastly, it reduced the febrile reactions and
induced refreshing sleep three or four days after the inhalations
were commenced. [Gaz. des Hop., from Trans. Med. Jour.

Upon the Composition of the Semen in old men. By Dr. A.
Duplay.

Berard, Burdach, Muller, Longet, state, that spermatozoa are
absent in the seminal secretion of the aged ; Wagner alone as-
serts, that, in men of seventy to eighty years, these bodies are
found in the vesiculae seminales, if not in the testicle. Facts
tend to prove that the fecundating power is retained up to the
age of 100. The author investigated the semen in fifty-one
subjects, after death caused by various diseases. In its physi-
cal properties the semen was sometimes of yellow color, as in
the adult; generally of a paler straw hue, or almost colorless,
milky or creamy. In twelve cases it was thick ; but, in the
greater number, it was serous, though mixed with the usual
mucous secretion from the vesicular seminales. In most cases
the vesiculae seminales were full of fluid ; in one only were
they atrophied. The semen in the vasa deferentia was always
darker-colored than that in the vesiculae.

In thirty-seven cases the author remarked the presence of
spermatozoa ; in fourteen he failed in detecting them. In
twenty-seven cases they were such as were usually seen in the
healthy adult ; in the rest the tail was shorter, and the head
sometimes separated. Once he saw a number of crystals,
whose nature he could not investigate. Considerable variety
existed in their proportion.

In twenty-six cases, spermatozoa were found along the
whole tract of the spermatic passages ; three times only in the
vas deferens ; once only in the fluid of the vesiculae seminales;
seven limes in the vesicula seminalis of the left side only. In
the latter cases there existed mostly degenerations of the testi-
cle, or obliteration of some part of the seminal duct. Secre-
tion of semen continued, however, in cases where there was
considerable atrophy of the testicle ; the highest weight of
which was 11*98 grammes ; the lowest 4*50 grammes. The
tissue of the testicle was always normal; the epididymis con-
tained occasionally cysts. In four cases there was hydrocele.
In the fourteen cases where there were no spermatozoa, the
subjects had passed the age of seventy ; but there were no

1853.] Relationship of Glanders to Acute Inflammation. 547

special changes discoverable in the glands. The secretion of
semen, concludes Dr. Duplay, continues in old men, but in a
less degree; their semen contains spermatozoa even when the
person is beyond the age for fecundation. The cause, there-
fore, of want of power to effect this end cannot be explained
upon the idea of the deficiency of spermatozoa. [Med. Times,
from Archives Gen.

Relationship of Glanders to Acute Diffuse Inflammation.

[The following remarks occur in the report of a case of
glanders by J. T. Banks, M.D., M.R.I.A., King's Professor of
the Practice of Physic, and Physician to the Whitworth and
Hardwicke Hospitals ; and we copy them as well worthy the
attention of those who may be engaged in medico-philosophical
investigations :]

" There are cases presenting all the phenomena of well-mark-
ed glanders, in which we fail, after the most searching investi-
gation, to discover that the individuals so affected have ever
come within the sphere of the poison. In illustration of this I
may refer to the case of a policeman, who died in the Hardwicke
Fever Hospital some time since. Of the many examples of
glanders which I have seen, I never witnessed what appeared
to me a more malignant and rapidly fatal form of the malady,
pustules were scattered over the body, and surrounded by the
white areola, a remarkable phenomenon, the presence of which,
Dr. Hutton, I believe, first pointed out in the eruption of gland-
ers. In this instance I noticed that the white areola became
more distinctly visible after death than it had been before.
The inability to trace the disease to communication with either
horse or man laboring under glanders, led me to practise inocu-
lation with the matter taken from one of the pustules; in a horse
procured for the purpose. The result was the animal's be-
coming affected with acute glanders, and dying on the tenth
lay ; the morbid appearances in each being absolutely identi-
cal, If, in default of evidence, we admit that the disease in the
policeman was not the consequence of the absorption of the
poison of glanders, then we have unequivocal grounds for
stating that a poison generated in the human body is adequate
to the production of a disease in the horse not distinguishable
from glanders.

" My friend, Dr. Frazer, has published in the ' Dublin Medi-
cal Press' a most interesting paper, in which his object is to
prove the identity of glanders and diffuse inflammation, he
reports cases of diffuse inflammation, which he observed
while acting as my clinical clerk in the Whitworth and Hard-

548 Treatment of Rheumatism. [September,

wicke Hospitals, in which there existed the eruption with
the white areola, considered to be pathognomonic of true
glanders. Dr. Frazer, after stating the points of analogy be-
tween the cases of diffuse inflammation adduced by him and
undoubted cases of glanders, asks: 'Are they not identical
diseases?' The question is still an open one. Would the mat-
ter taken from one of these cases have produced glanders?
Perhaps it would. This is an inquiry of much interest, and
one which I shall prosecute when an opportunity presents it-
self." [Dublin Quarterly Journ. Ranking 's Abstract.

Treatment of Rheumatism by Quinia and Veratria.

The treatment of acute Rheumatism by Quinine, commenced
by M. Briquet, and to a certain extent discontinued, on account
of the doubtful character of the termination of one or two cases
in which large quantities were administered, has been very
much revived of late, and the impression respecting it gains
favor daily. I have seen M. B. give it with good effect quite
often. M. Valleix employs and recommends it at La Pitie, and
I hope to be able to send a paper on the subject by a gentleman
who attends his Services and Lectures. One gramme (15 grs.)
is administered once or twice a day, and the patient kept part-
ly quininized. The gravity of the usual symptoms daily de-
creases, and it seems not to be at all hostile to cardiac complica-
tions. M. Trousseau, in commenting upon this and expressing
his favorable impression, alluded also to the expenses attending
the use of this agent, accompanying it at the same time with
the relation of a remarkable instance of recovery from acute
articular Rheumatism, which was then in his wards. It was
true, he added, that it was as yet an isolated case, but the repe-
tition of the means used might give equally favorable results.
It followed the employment of Veratrine after the meihod re-
commended by M. Daniel (?). The patient, a woman under
middle age, suffered intense pain in the articulations, high fever
with endocarditis, exhibiting itself by a derangement of the first
sound at the base of the heart (sigmoid valves of aorta) with
a souffle prolonged into the large vessels, and accompanied with
an alteration in the left ventricle also. In sixty-two hours she
was absolutely cured, leaving not the slightest trace of febrile
excitement, the presence of a slight souffle alone remains. One
half of a milligramme (about 1- 10th of a grain?) was given in
the form of pill, each day increasing the quantity, and, when
the pains were relieved, continuing it in the same dose every
second day. Its influence on the circulation in this case was
prodigious, to use M. Trousseau's expression; the pulse fell to

1853.] Medical Properties of Ox Gall 549

42, and when I heard of the patient two days after, it was still
at this reduced rate. Veratrine, we are aware, is one of the
active principles of colchicum, and it is, therefore, not surpris-
ing that it should possess some power in acute rheumatism,
more particularly in those dependent upon the arthritic diathe-
sis, gout, etc. [Charleston Med. Jour.

Medical Properties of Ox Gall. Read before the Montgomery
County Medical Society.

The broad and catholic grounds which we, as physicians,
occupy, stimulates us to push our researches in every direction,
in order to extend our area of available medical knowledge.
In no way can our efforts be spent to better advantage, than
that of trying to enlarge our list of efficient remedies. We
are bound to use all means, whether moral or physical, which
the indications of science or the test of experience point out as
the most successful in the removal of disease. Of the physical
means, we, as regular physicians, have the privilege of select-
ing any thing which the material world affords. We may use
a substance of any form, whether aeriform, fluid, or solfd, or
from whatever kingdom of nature it may be derived, whether
animal, vegetable, or mineral.

The article that we have selected, and concerning which we
propose to make a few suggestions, is taken from the animal
kingdom, and belongs undoubtedly to that class of substances
termed secretion. Ox bile, which has been brought very
prominently before the profession, by Dr. Charles Clay, of
Manchester, and other eminent British physicians, some few
years since, has not been, as we think, so fully tested in Ameri-
ca, with regard to its medicinal properties, as its merits deserve.
It was brought into use in the first place, from a suggestion
that it might act as a substitute for the human bile, in the case
3f patients who seem to suffer from a deficiency, or perverted
condition of that important secretion. In a country like ours,
where perhaps three-fourths of all the disease with which we
have to contend, is derived either directly or indirectly from a
morbid condition of the liver, it would be well to pay the most
strict attention to every remedial agent which may in the least
promise to be serviceable in these cases. We do not expect
that this article would meet successfully many of the symp-
toms growing out of the retention of the bilious matter in the
zirculation ; but that it will remove that distressing condition
of things caused by its absence from the alimentary canal, will
scarcely admit of a doubt. In order lo accomplish the first
named object, it would necessarily have to eliminate the bilious

n. s. VOL. IX. NO. ix. 35

550

Medical Properties of Ox Gall. [September

er,

matter from the blood, or restore the healthy action of the he-
patic system. This last, however, might be done by its acting
as a healthy stimulus upon the mucous membrane of the duode-
num, thus (according to a well known principle in medicine)
indirectly exciting the liver through the medium of its excreto-
ry duct. For this reason we are of opinion that inspissated ox
bile could be used in jaundice and other like bilious affections
with benefit.

Much might be said concerning the office of the secretion of
the liver in the system of man, but the destined limits of this
paper will not permit. Suffice it to say that its absence from
the alimentary canal is invariably connected with symptoms
which render life a burden. From the character of these
symptoms, if from no other circumstances, we are naturally led
to infer that the bile, in the animal economy, acts more parti-
cularly as an antacid and solvent in the stomach and bowels.
The most common effects of a deficiency in quantity or quali-
ty of the bilious secretion are dyspepsia, acidity of the stomach,
and obstinate constipation. It seems quite evident that these
conditions are owing more to the absence of a sufficient quan-
tity of good bile in the alimentary canal, than to its retention
in the circulation ; and for this reason we infer that this pecu-
liar substance is a secretion, intended for useful purposes, and
not an excretion, merely, as is contended by some.

We then propose to treat those affections arising from defi-
ciency either in quality or quantity of the bilious secretion, by
administering that which will prove, as we think it will in many
instances, a substitute for it. If we may believe the testimony
of several distinguished medical philosophers and practitioners
who have used the ox bile in dyspepsia, and in its almost infin-
ite variety of attendants, we will be fully convinced of its great
utility. It generally corrects the acidity of the stomach and
consequent headache which so often harass dyspeptic persons.
Its alkaline properties seem to counteract the acid, and thus
remove all the symptoms depending upon it. Cases are men-
tioned, upon the highest authority, in which the patient, after
resorting to every article in the list of cathartics, in order to
remove the constipated habit so frequently attending dyspepsia,
have received permanent relief from the use of the inspissated
ox gall. It has been used in cases in which the blue pill was
inadequate to the purpose of producing any but the most tran-
sient effect, and in which all purgatives would leave the bowels
in the same if not a worse condition than that in which they
found them. The patients were compelled to linger on for
three or four years, being almost daily under the painful neces-
sity of taking cathartics, which would produce much griping

^

1853.] Medical Properties of Ox Gall. 551

and general uneasiness after taking them. Under these per-
plexing .circumstances, the article to which we have called at-
tention, has been administered in the form of a pill with the
happiest effect. One of these pills (5 grains) has been given
every three hours, and at these rates they scarcely ever fail to
produce, in less than twenty-four hours, full stools of natural
consistence, and that, too, without any pain whatever attending
their operation. After taking one of these pills twice or thrice
per day, for five or six days, the acidity almost always leaves
the stomach, also the headache subsides, and the bowels re-
sume their natural and healthy condition.

The first instance in which I have used the inspissated ox bile,

was in the case of Mr. R , aged 25 years, an intelligent

young gentleman of my acquaintance, who had been laboring
under dyspepsia, attended with slight hypochondria and the
most obstinate constipation. He was of a delicate nervous
temperament, and much given to sedentary habits. He was
very much troubled with pains in his stomach and bowels, ac-
companied with dizziness in the head. The bowels would
remain without a motion for a w7hole week, unless a purgative
was taken, in which instance an unusually large dose was re-
quired, and the pain attending its operation was represented as
being dreadful. The stool was hard and of a light or brown-
ish color. I might mention, also, that there was a sense of
weight in the right hypochondriac region, sometimes amount-
ing to downright pain. He remained in this condition for sev-
eral years, when he was compelled to give up his avocation,
(school teaching,) and turn his whole attention to the malady
which was preying upon his system. All the cathartics were
tried, that seemed to promise any good in removing the cos-
tiveness, which was the most troublesome symptom in the case.
He would use one article, (for instance, Rhubarb,) until the
system lost its susceptibility of being acted upon by it, and then
he would resort to another with the same result. Thus he
continued up to the summer of 1849, when I commenced treat-
ing him with the inspissated ox bile. On the day that I gnve
him the first dose, he had had no motion of the bowels for four
days. In the afternoon of that day he took two (10 grs.) pills
and repeated in four hours. The last dose was shorilv after-
wards followed by a full, soft and painless stool, to the great
joy an satisfaction of the patient. He continued totnke a pill,
night and morning, until the most complete regularity of the
bowels was established. The pain of the stomach and bowels
entirely subsided, and his general health became much improv-
ed. He is almost of opinion that the tel Bovinum is a specific,
and prepares it himself, to use as occasion may require. This

552

Medical Properties of Ox Gall. [September,

is only one of the many instances of the kind, which could be
mentioned, in which I have used this article with the most sat-
isfactory results.

I shall mention another case which is of a somewhat different
class of patients, who have been signally benefitted by the

remedy under consideration. Mrs. , aged about 22

years, light complexion and medium size was a resident, up
to the summer of last year, of the State of Mississippi. She is
slightly hysterical, and has been for years affected with cos-
tiveness to such an extent as to be under the necessity of taking
physic every few days. Large doses were required, which
after a painful operation, left the bowels in their usual condi-
tion. She was somewhat chlorotic, and frequently suffered
from what she called " fainting spells," which were very un-
pleasant indeed. After I had administered in this (as in the
first mentioned) case, ordinary cathartics with but temporary
effect, I resorted to the inspissated ox bile. I evaporated the
gall to the consistence of thick tar, and then brought it to the
consistence of pill mass by the addition of the precipitated car-
bonate of iron, one 5 gr. pill of which was given three times
per day, with the effect of establishing perfect regularity of the
bowels. I had one pill taken daily for two months, and we
had the satisfaction of seeing the complexion of the patient
assume a more ruddy and healthy appearance, the fainting
fits reduced in frequency, and the strength improved. It would
be well to state that, in this case, after about one month, the
use of the inspissated gall and iron pills were suspended every
other night in order to admit of the administration of a small
dose of taraxicum, for its alterative and tonic effect.

This article is of undoubted utility in cases of children labor-
ing under diarrhoea where the stools are light colored, indicating
a lack of the normal quantity of bilious secretion in the system.
The well known power of bile, whether human or not, of pre-
serving milk from coagulation, has suggested the idea of using
it in cases of infants upon whose stomachs the nurses milk
curdles, producing vomiting and irritability of that organ. This
practice is said to be very satisfactory by those who have am-
ple opportunity of testing it in such cases. From the estab-
lished fact, also, that a solution of gall, when poured even in
very small quantities over hardened faeces which have been
voided from the body, reduces it to a soft, pulpy consistence, it
has led the inductive medical practitioner to use it as an injec-
tion where the rectum is filled with impacted faeces. I have
used it with good effect in a marked case of this kind. We
very plainly see that the mode of operation of this medicine is
the same within as without the alimentary canal Its contents

1853.] Medical Properties of Ox Gall. 553

are softened, thus enabling the natural peristaltic action to
propel them onward. We can in this way account for their
painless operation, while those remedies which act merely by
increasing the peristaltic motion, produce such great pain. It
may be urged that this medicine will prove insufficient from the
fact that constipation is but a symptom of an unhealthy condi-
tion behind it ; but whilst this may be true, it will be well to
recollect that when constipation is once established as a se-
condary effect, it has a baleful reaction upon the system, and
we think that if this symptom be attended to, the first link in the
chain of morbid action will often disappear of itself.

We are living in a period of the history of medicine, which
is distinguished for the application that is made of a philosophi-
cal principle commonly known by the term of "induction."
By it we understand, an inference or general conclusion drawn
from the existence of one or more well established facts or pro-
positions. The advantages which this furnishes to the modern
physician, could not possibly have been appreciated by the old-
er writers on medicine, unless they could have clearly recog-
nized the principle, and seen it exemplified in practical life.
This grand system of philosophy which was introduced by the
immortal Bacon, wras more readily received and more frequent-
ly used by our profession, probably, than any other. The
enlightened medical philosopher is materially aided in his
investigations of the essential character of disease, by the effects
produced upon the system by therapeutical means, and from
other circumstances, in the same manner as the mathematician
and astronomer are aided in determining the size and distance
of remote bodies, from the well known size, distance and posi-
tion of those near them. This mode of investigation has been
productive of more rich and valuable acquisitions to modern
medical science than any which could be named. The various
mechanical contrivances which have from this kind of reason-
ing been applied in surgery, and also the various actions of
substances observable in the chemical laboratory, have furnish-
ed the greatest possible number of good practical hints to the
surgeon and physician. The history of the article under con-
sideration will serve sufficiently to illustrate this position. In
the first place it was brought into use in cases of constipa-
tion growing out of the absence of the normal quantity of bile
in the system, from the fact that its properties, both physical
and vital, are similar to that of the human. In the second
place, its use with beneficial effect, as an injection in cases of
an impacted rectum, was indicated solely by its demonstrated
power of dissolving hardened faeces out of the body ; and, third-
ly, its profitable uses in cases of nursing infants afflicted with

554

Digitaline in Spermatorrhoea. [September,

acidity and coagulation of milk upon the stomach, was natural-
ly enough pointed out by its alkaline property and by its power
of dissolving coagulated milk and preserving it in that state out
of the body.

I vviil close this paper by -merely expressing my ardent wish,
that members of the profession will not forbear making an ex-
amination of the merits of this article, notwithstanding the ap-
parent simplicity, for we should ever remember that the whole
science of medicine is but a grand and systematic aggregate of
great and little things. [Ohio Med. and Surg. Journ.

The Employment of Digitaline in Spermatorrhoea. By M. Lu-
ciex Corvisart. Translated from the French.

M. L. Corvisart, having had the boldness to introduce the
use of digitaline in spermatorrhoea, has already used it three
times, and each time with success. Without pretending to
claim from the observations already made, the conviction of
practitioners, he thinks, and justly, as it seems to us, that this
medicine deserves attention.

We have here the first case in which he thought he perceived
benefit from the use of digitaline in seminal flux.

Case I. P. M., aged 20 years, a stamper, entered the Hotel-
Dieu the 1st of February, 1848, in the ward St. Agnes, under
the care of Professor Chomel : appearance feeble, pale ; ob-
serving during the week strict continence, but every Sunday
for more than a year entering into the lowest debauchery and
repeating coition five or six times, digestion bad, anorexia, pal-
pitation of the heart, face bloated and hot, dizziness, tingling of
the ears, occasional attacks of dyspnoea compelling the patient
to walk his room during the night, disturbed dreams, and
strange noises during partial sleep. The above symptoms had
supervened since November last, at which time, after a debauch,
he experienced a severe pain in the precordial region, charac-
teristic of endo-carditis, for which he was subjected at the
Hotel Dieu to a strictly antiphlogistic treatment, (three bleed-
ings, &c.) The patient, being unable to continue his labors,
has now returned. The volume of the heart is normal ; the
blow of the point against the walls of the chest with a bruit de
souffle, somewhat dry at the first sound of the heart. M. Cho-
mei prescribed first 1, then 2 milligrammes of digitaline.

The sixth day of the treatment, the palpitations having very
much diminished, the patient mentioned that since November
he had almost every night involuntary pollutions, often leaving
no trace in his memory they were known only by the stains

1853.] Digitaline in Spermatorrhoea. 555

on his linen. When awakened by the pollutions, the penis was
found to be in erection, as was also the case each morning.

Pollutions take place almost every day, under the influence
of errotic ideas, or the simple friction of the clothes, with erec-
tion and ejaculation, but without lively pleasure ; they some-
times occur during defecation.

The patient, for three months, has not seen a woman.

He is astonished that the emissions have not occurred for the
last three days, (now the ninth since entering the hospital, and
the third of the treatment of the palpitations by digitaline.)

Feb. 13th, one pollution without any remembrance of it ; the
14th, one on waking : the 15th, one on waking, very slight, (one
or two drops) ; 3 milligrammes were ordered ; no spermator-
rhoea from the 16th to the 19th; then seven days entire with-
out a single pollution, although each day the patient examined
his shirt and drawers with the greatest care ; this was also done
several times by myself.

March 7th. One emission on waking.

March 12th. Discharged, no pollution since the last date.

After thirty-eight days the patient had had but five pollu-
tions, and for twenty-two days but one ; he was still troubled
with erections, although less than formerly. The palpitations
were very much diminished.

Case II. L. H., aged 18 years, sculptor, having never in-
dulged in venereal excesses, was taken when between fifteen
and sixteen years with nocturnal emission without pleasurable
sensations. At first these accidents occurred almost every
night from his sixteenth to his seventeenth year.

The young patient, very much affected, bound the penis with
pack thread, bathed the parts in ice-cold water, avoided every
occasion of provoking erotic ideas, and lived in the most abso-
lute continence.

About the month of December, 1847, he commenced the
practise of masturbation two or three times a week. During
the two months in which he indulged in this habit, the noctur-
nal pollutions disappeared almost entirely ; nevertheless the
symptoms, which had already begun to manifest themselves,
increased. The strength was diminished, the spirits depressed,
the memory short, the patient became very sensible to cold,
digestion slow and painful, the appetite greedy. About the
end of February, 1848, the patient abandoned his practices and
renounced all venereal pleasures. A few days after the noc-
turnal emissions returned as frequently as before. The erec-
tions when the patient was awakened, (which was rarely the
case,) were but slight ; they were not always accompanied by
erotic ideas, but sometimes even the reverse.

55G Treatment of Spermatorrhea. [September,

L. H. remarked that for some weeks, about the close of mic-
turition, the urine was loaded with a white albuminous cloud,
which sunk to the bottom of the vessel, and was more abund-
ant in the morning after fatigue.

The patient experienced pain along the spinal column, shoot-
ing into the epigastric region, and a general, although light,
habitual trembling with stammering.

The patient had used, without success, camphor, internally
and externally ; he thought the erections more numerous, and
the emissions more frequent. M. Huguier had prescribed,
about the end of March, bitter drinks, the syrup of gentian, ex-
ercise, &c, the pollutions diminished during one or two weeks
and then returned.

On the 13th of April the patient came to consult M. Huguier,
who at my request had the goodness to prescribe the digita-
line, 3 milligrammes a day. Each of the three following days
the pollutions persisted, then an interval of six days without
any. The 23d of April he returned to know whether he should
continue the use of the digitaline. M. Huguier admitted him
to his wards in the hospital Beaujon, in order the better to ob-
serve the case. The seventeenth day of the treatment, which
was continued, he had one pollution, that was all. The patient
was discharged the 15th of May, having had in thirty-four days
but five pollutions, of which the two last were separated by an
interval of twenty-two days. There was no seminal discharge
in the urine, that fluid being scarcely troubled and containing
no spermatic animalcula. He had neither trembling nor stam-
mering ; he was free from pain along the spine ; his strength
improving, and his digestion good.

The third case is too lengthy to present entire, but it is not
less conclusive than the others.

How shall the action of digitaline be explained ? The first
patient appears to be an example of spermatorrhoea from atony
of the genital organs ; this was the case also in the third, but
certainly not in the second, who appears to have possessed re-
markable temperance. In two of the cases the erections were
light, not insupportable. It is not by calming these, then, that
the remedy acts. So far, its administration is purely empirical,
but this is not sufficient reason for disregarding it. [North-
Western Med. and Surg. Jour.

Treatment of Spermatorrhea.
With the difficulties connected with the treatment of obsti-
nate cases of this malady, most practitioners are familiar.
Books without number have been written on the subject ; and
almost every system of medicine proposes remedies, many of

1853.] Surg. Operations in Cancerous Diseases. 557

which, on trial, are found of no value whatever. It is hopeless
to undertake to interrupt by medication the repetitions of the
misfortune. There are but two methods, we believe, decidedly
reliable ; one of them is mechanical, the other is left to the inge-
nuity of the render to ascertain. For several years past, some
of the very worst forms in which the disease presents itself,
have been terminated in a short time, and the sufferer restored
to permanent health, by a mechanical contrivance, which origin-
ated, it is believed, in Boston. The way to proceed is this:
Take a piece of firm harness leather one inch wide, and make
a ring, or ferrule, which shall be one eighth of an inch greater
in diameter than the penis. Thrust the points of four pins,
equi-distant from each other, through the walls of the ring, so
that they will project through a little way on the inside, and
then cut off the projecting part of the pins on the outside. On
retiring for the night, slip the ring on the organ, midway, and
insert cotton wool between the two, to keep the pins from
pricking the flesh. An emission seldom occurs without a full
distension of the penis. The theory of a cure, as well as the
facts, are simply these. When an erection takes place, and
even before, the uniform enlargement presses the cotton, which
yields, causing the points of the pins to enter the flesh, and thus
the patient is instantly awakened. This occurs as frequently
as distension comes on, and the semen is therefore retained.
This, we repeat, is superior to any and all other prescriptions
made use of. Last week an instrument was left on sale at Dr.
Cheever's, under the Tremont Temple, in this city, that acts
precisely like the leather ring. It is made of steel, however,
clasping like a dog's collar, according to the size required, and
having on its inner edge a row of sharp points. Within this
steel ring is another, extremely delicate, which opens to receive
the penis, and retains it exactly in the middle. When it begins
to distend, the small ring allows the member to enlarge till it
strikes the sharp points, and then the individual is awake and
safe. After interrupting the emission a few times in this way,
the morbid tendency in many cases is removed, and the sickly,
feeble youth rallies and regains his health. Other cases may
require a more constant use of the remedy, until maturer age
and different circumstance render it no longer necessary.

[Boston Med. and Surg. Journal

Surgical Operations in Cancerous Diseases.

[At the last meeting of the American Medical Association,
Dr. Yandell, of Kentucky, presented a report from Dr. S. D.
Gross, of the same State, on the results of surgical operations

558 Surg. Operations in Cancerous Diseases. [September,

for the relief of malignant diseases. The following is the con-
cluding portion of it.]

From the facts and statements which have now been present-
ed,embracing the opinions of man}- of the most intelligent, expe-
rienced and distinguished practitioners in different ages, and in
different parts of the world, the following conclusions may be
legitimately deduced :

First. That cancerous affections, particularly those of the
mammary gland, have always, with a few rare exceptions, been
regarded by practitioners as incurable by the knife and escharo-
tics. This opinion, commencing with Hippocrates, the father
of medicine, has prevailed from the earliest records of the pro-
fession, to the present moment. Nature never cures a disease
of the kind ; nor can this be effected by any medicine, or inter-
nal remedies, known to the profession.

Secondly. That excision, however early and thoroughly
executed, is nearly always, in genuine cancer, followed by re-
lapse, at a period varying from a few weeks to several months,
from the time of the operation.

Thirdly. That nearly all practitioners, from the time of
Hippocrates to the present day, have been, and are still averse
to any operation for the removal of cancerous tumors, after the
establishment of ulceration, rapid growrth, firm adhesion, organ-
ic change in the skin, lymphatic invasion, the cancerous dyscra-
cy, or serious constitutional derangements ; on the ground that
if had recourse to under these circumstances, the malady
almost inevitably recurs in a very short time, and frequently
destroys the patient more rapidly than when it is permitted to
pursue its own course.

Fourthly. That in all cases of acute carcinoma, or, in other
words, in all cases of this disease, attended with very rapid de-
velopement and great bulk of the tumor, extirpation is improp-
er and unjustifiable, inasmuch as it will only tend to expedite
the fatal result, which, under such circumstances, always takes
place in a very short time.

Fifthly. That all operations performed for the removal of
encephaloid cancer and its different varieties, are more certain-
ly followed by rapid relapse than operations performed upon
scirrhusor hard cancer.

Sixthly. That in nearly all the operations for cancerous
diseases, hitherto reported, the history has been imperfectly
presented, being deficient in the details which are necessary to
a complete and thorough understanding of the subject in each
case. This remark is particularly true in reference to the diag-
nosis of the malady, the minute examination of the morbid struc-
ture, and the history of the case alter the operation, as to the

1853.] Surg. Operations in Cancerous Diseases. 559

period of relapse, the time and nature of the patient's death, and
the result of the post-mortem examination.

Seventhly. That cancerous affections of the lip and skin,
now usually described under the name of cancroid diseases, are
less liable to relapse after extirpation than genuine cancerous
maladies, or those which are characterized by the existence of
the true cancer-cell and cancer-juice. ,

Eighthly. That although practitioners have always been
aware, from the earliest professional records, of the great
liability of cancer to relapse after extirpation, a great majority
of them have always been, and still are, in favor of operation in
the early stage of the disease, especially in scirrhus, before the
tumor has made much progress, or before there is any disease
of the lymphatic ganglions, or evidence of the cancerous cach-
exy.

Ninthly. That many cases of tumors, especially tumors of
the breast and testicle, supposed to be cancerous, are in reality
not cancerous, but of a benign character, and consequently,
readily curable by ablation, whether effected by the knife or by
escharotics. It is to this circumstance that we must ascribe
the astonishing success which is said to have attended the
practice of Hill of Scotland, Nooth of England, and Flajani
ofltaly.

Tenthly. That all operators insist upon the most thorough
excision possible ; removing not merely the diseased mass, but
also a portion of the surrounding and apparently healthy tissues,
as well as all enlarged and indurated ganglions.

Eleventhly. That the practice has always prevailed and
still obtains to save if possible, a sufficient amount of healthy
integument to cover the wound, and to unite, if possible, the
wound by the first intention ; on the ground that these precau-
tions will tend much to retard, if not to prevent, a recurrence
of the disease.

Twelfthly. That much stress is laid by writers upon a pro-
perly regulated diet, and attention to the bowels and secretions
after operation, as means of retarding and preventing relapse.

Thirteenthly. That there is no remedy, medicine or method
of treatment which has the power, so far as we are enabled to
judge of its virtues, of preventing the reproduction of the mor-
bid action after operation, no matter how early or how tho-
roughly it may be performed.

Fourteenth ly. That life has occasionally been prolonged
and even saved by operation after relapse, as in some of the
remarkable cases mentioned in a previous part of this report ;
but that, as a general rule, such a procedure is as incompetent
to effect a permanent cure as a first extirpation. [Ibid.

560 Hemorrhage from the Funis. [September,

Hemorrhage from the Funis. By Walter O'Reilly, M. D.

Having occasion, not long since, to attend a parturient case
on the west side of the City, after detaching the foetus, securing
the cord, bandaging the woman, abstracting the placenta, and,
as is my custom, taking a look at the child before leaving, to
see if all wTas right^ found the under clothes saturated with
blood. On investigation I was surprised to find the blood em-
anating from two small orifices in the funis not larger than pin
holes, within the eighth of an inch of each other, and about
twice that length from the abdominal surface ; the cord having
been previously ligatured for security in two places, I was
obliged to apply a third one below the points of hemorrhage
bordering on the umbilicus, which stopped all further flow, and
the separation took place without any difficulty or trouble,
within the week.

It struck me while dividing the communication between the
mother and child, that it was rather shorter than usual, but did
not think more about it until searching for the cause. I was
inclined to think, perhaps, in removing the child to apply the
ligature, the funis might have been stretched, producing a
break in its coats. I also noticed in extracting the placenta
that it was inclined to give way like a rotten sponge, making
it necessary to abstract it with the palm of the hand to prevent
any being left ; an hour-glass contraction and atony preventing
its delivery without interference.

Had I not discovered the bleeding in time, the child might
have bled to death ; and, of course, would have been charged
to the Doctor's carelessness in tying the string. [New York
Med. Gazette.

Antiperiodic Properties of the Humulus Lupulus. By W. Y.
Gadberry, M. D. of Benton, Miss.

As a substitute for quinine is a great desideratum on ac-
count of its enhanced market value, I have thought a brief
notice of the antiperiodic virtues of the humulus lupulus, or
common hop, might not be unacceptable to the profession. I
am not aware that any author has ascribed to this plant any
such virtue. Having used it for nearly two years I can confi-
dently state that its antiperiodic properties equal, if they do not
exceed, those of any other article of the materia medica with
which we are acquainted, quinine alone excepted ; and, indeed,
in my experience, it has often succeeded in arresting intermit-
tents after that remedy had failed. It is harmless in its effects,
and will often be borne by patients who cannot take quinine.

1853.] Cold Water in Dysentery. 561

Every practitioner is aware of the advantage of combining
an anodyne with antiperiodics; and by reference to the works
on materia medica, the reader will see that hops possess these
properties. When administered alone the infusion is prefera-
ble, and should be made of double the strength prescribed by
the Dispensatory. One ounce infused in a pint of boiling water
maybe taken during the interval, or a larger quantity if neces-
sary. If the secretions are properly regulated, and there exists
no enlargement of the spleen, it will rarely fail to effect a cure
of tertian or quartan ague. It has not succeeded so well in the
cases of quotidian type as in those of more protracted intervals.
The tincture was used alone in three cases successfully. The
following combination is worthy atrial by all who desire a safe
and efficient substitute for quinine :

$ Tinct. hops, tinct. Peruvian bark, aa 1 iv.
Pulv. black pepper, I ss.
To be given in doses of half an ounce every two hours during
the interval.

My limited experience will not justify an opinion upon the
antiperiodic virtue of lupuline, not having used it except in com-
bination with quinine. Patients to whom I have administered
this combination prefer it to quinine alone, on account of its
soothing effect upon the nervous system. The hop is indige-
nous to this country, growing abundantly in almost every gar-
den ; and if I have not over estimated its antiperiodic virtue, it
will prove a blessing to the poor, in whose welfare the physi-
cian should always feel a special interest. [West. Journ. Med.
and Surg.

Cold Water in Dysentery. By F. Blades, M. D.

If it be the accumulated experience of individuals which
gives us our rules in the practice of medicine, every one ought
to contribute his mite, if it be of any value. I am therefore
prompted to send you a slice of my experience.

Last year I had many cases of dysentery to treat. Some of
these " wore the livery" of the ordinary non-malignant variety,
and were amenable to the usual remedial means ; while others,
the majority, were of the epidemic or malignant variety and
with surpassing stubborness " went their ways " heedless of
cure, i. e., by the mostly practised methods.

Now, we, who have not a reputation to live on after a defeat,
cannot well afford if I may use a sinister expression to lose
many patients consecutively, else we fall into disrepute and
strait-away lose our practice.

This motive, which was secondary to the heart-felt interest

562

Cold Water in Dysentery. [September,

L

I had in the recovery of my patients, as also this latter motive,
caused me to depart from the calomel and opium, etc., etc.,
landmarks in treating the more malignant variety of dysentery.
I have now in my mind a case, which conjointly with Dr.
Fowler, then my partner, I was called upon to treat. The
malady "waxed exceedingly sore" from its onset. The gri-
ping was positively excruciating; the straining extremely
ardent and incessant ; the stools exceedingly large, grayish and
bloody, containing membranous-like shreds; the pulse was
quite frequent and not forcible. This is a rudely sketched
outline of the condition of the case as was reported to me to
have existed prior to my attendance. The doctor who was
first called had treated the case with calomel and opium, q. s.,
castor oil and laudanum, as a laxative, once in twenty-four
hours, with other adjuvantiae now passed from memory, for
three or four days, at which time I was called to see this case
with him. The above mentioned symptoms were said to be
unabated. The pulse was now feeble and about 120; the
tongue was covered with a thick brown fur, and dry, the edges
were fiery and the whole tongue was dotted over with elevated
papillae here and there protruding through the fur-coat. The
stomach was so excessively irritable that it would scarcely re-
tain a tea-spoonful of water. I suggested an enema consisting
of a strong solution of nitrate of silver, which was twice or
thrice repeated during the ensuing twenty-four hours. Also
camphor spts. and oil of turpentine, equal parts, to be applied
almost hot, to the abdomen. It was of no use. The disease
increased in severity. We looked upon the mortal issue as
being but a few hours in advance of us. Here was our ex-
tremity, and cold water was the straw caught at. What mi-
raculous buoyancy there was in that dernier resort ! We left
off medicine entirely little use was it when none would be
retained by the stomach and determined to try cold water.
We wrapt the patient in a cold wet sheet and thereupon ha-
ving previously passed a stool every ten or fifteen minutes
he lay one hour and a half, without having desire to go to stool.
At the end of this time the surface almost glowed with warmth,
and there was the moisture of sweat about the face and neck.
The patient was then wiped dry with coarse towels and placed
in a dry bed. This operation was thenceforward repeated
every five or six hours for the next five days, after which time
it was only used once or twice in twenty-four hours for two or
three days longer. Instead of the warm fomentations, which
had been constantly applied, cloths wrung out of cold water
were frequently repeated to the abdomen. As enemas we used
cold water, simply 8 or 10 ounces immediately after every

1853.] Cold Water in Dysentery. 563

evacuation. In every case in the treatment of which we used
cold water injections it was found to be important that it
should be administered immediately subsequent to every stool.
They were borne without distress, and much longer. I ought,
also, to mention that after the first day we used the cold Sitz-
bath of the Hydropathists. From the commencement of this
treatment the irritability of the stomach was entirely appeased;
the stools became less and less in frequency and of a more na-
tural appearance and consistence. As a diet, as well as an
auxiliary to the treatment, we ordered the animal broths well
salted.

Several other cases I have in my mind of a like character
with the above. With the exception of orfe, however, none of
them were so violently attacked. That case being of a more
robust habit the disease did not succumb so readily. I com-
menced treating with calomel, ipecac, and one grain of morph-
ine every three hours at the end of twenty-four hours giving
a castor oil laxative ; warm fomentations to the abdomen ;
enemas of cold water and laudanum. This course was kept
up with more or less modification until the expiration of a
week. I was not flattered by the progress my patient had
made for the better. I then resorted to the water treatment
carrying it out as in the first instance. Upon the first using of
the wet sheet the bowels were quieted two hours, having been
previously moved as often as from 15 to 30 minutes. The pa-
tient kept right on improving steadily, yet, I confess, slowly.
It was gratifying to see the complete relief from the excruci-
ating tormina and tenesmus which followed the " wet-sheet-
packing."

In this case I used, as often as once in four hours, the tur-
pentine emulsion, strongly charged with laudanum. I also,
occasionally, ordered laudanum in the injections.

In many cases, the cold, wet bandage and cold water injec-
tions were used as auxiliaries to other treatment, and with a
highly gratifying effect.

I am so thoroughly convinced of the powerful efficacy of
cold water in the treatment of dysentery that I do not hesitate
to say I regard it as one of the chief remedies for combating
that formidable disease.

Dr. Bennett, of this place, a practitioner of many years
standing, and a correct observer, after being repeatedly disap-
pointed by depending upon the ordinary remedies alone, is,
upon fair trial in many instances, enthusiastic in his confidence
in cold water as a powerful auxiliary in treating dysentery.

It would be absurd to argue a general rule from such limited
experience, yet its effects have been so highly gratifying in the

564

Baths and Cold Water.

[September,

hands of many practitioners, that it is hard to resist the convic-
tion that cold water deserves a more honorable place among the
therapia of dysentery than it has hitherto obtained. [North
Western Med. and Surg. Journal.

Baths and Cold Water.

M. Pinel (nephew) has read a memoir on the treatment of
acute insanity, by prolonged baths, and by pouring cold water
on the head. The following are the results :

We have treated 157 cases, classified as follows: Maniacal
Delirium, 57 ; Lypemania, 38 ; Delirium Aithers Melancholy,
20; Suicidal Delirium, 21; Delirium Tremens, 1G; Entoma-
nia, 5 Total, 157. Males, 91: Females, 66. The moral
causes far exceeded the physical; 122 of the first ; and 39 the
last ; 37 cases were hereditary ; 79 were unmarried, (50 males
and 29 females); 66 were married, 12 were widowers; the
mean age was about 32 years ; one hundred and twenty-
Jive were cured; 4 died; 7 improved; 21 remaining under
treatment. Of those cured, the mean continuance of the dis-
ease had been about two and a half months. There had been
25 relapses ; but half of these had been treated again with suc-
cess. [Jour, de Med. et de Chirurgie. Am. Jour, of Insanity.

Oil of Turpentine as a Dressing for the Umbilical Cord its

prophylactic virtues against Trismus Nascentium. By T. J.

Grafton, M. D., of Miss.

Br. Hester I beg leave, through your journal, to call atten-
tion to the use of the Oil of Turpentine as a dressing to the
umbilicus of new born children, as a prophylactic against Tris-
mus Nascentium, a disease so universally fatal when once
developed, as almost to preclude a hope of cure from any treat-
ment.

So far as my experience enables me to speak, I have never
known the disease to occur, in any child that had been sub-
jected to the turpentine dressing. With whom the practice
originated I have not been able to learn ; my attention was di-
rected to it several years ago by a very intelligent lady, who
had used it upon her negroes, and at whose suggestion it has
been adopted by others in the neighborhood, with the most
flattering results.

This should not surprise us, as turpentine has been long con-
sidered by some as a prophylactic in Traumatic Tetanus. Dr.
Armstrong, in his Lectures upon the Practice of Medicine,
says : " Mr. Stewart, who has seen a great many cases of Teta-
nus, never knew a case arise where turpentine had been applied

1853.] Inquiry into the Action of Anthelmintics. 565

to the local injury;" (page 337, 1st American edition, 2d vol.)
My own experience, so far, is corroborative of the above ex-
tract.

I am led to make this communication with a view of multi-
plying the number of observers, some of whom will doubtless
make known to the profession the results, as the opportunities
of no single individual would be sufficient to establish it as a
fact.

I am well aware, that turpentine has been used as a stimu-
lating application to the umbilicus, as a means of cure after
the disease was developed, yet I do not remember to have seen
it mentioned by any writer as a prophylactic.

In no case of the disease have I been able to detect the dis-
placement of the cranial bones, as suggested by Dr. Sims. My
own belief is that the umbilicus is the source.

The mode of using the turpentine is as follows : At the first
dressing a few drops of the undiluted turpentine is applied im-
mediately to the umbilicus, around the cord, and it is anointed
at every succeeding dressing, the turpentine being diluted one-
half or two-thirds, with olive oil, lard, or fresh butter, which
dressing is continued more or less diluted, according to cir-
cumstances, (or rather according to the irritation produced,)
until healed; though I usually make use of no precaution to
prevent contact with the skin of the abdomen, yet I have never
known distress follow its use ; it would be well enough to pre-
vent too extensive contact. [iY. O. Med. and Surg. Jour.

An Inquiry into the Action of the Anthelmintics. By Dr.

KuCHEXMEISTER, of ZittaU.

Dr. Kiichenmeister has examined the various vermifuges, by
immersing the living intestinal worms of fowls, cats and dogs,
in albumen, at a temperature exceeding 77 Fahr., and adding
the anthelmintics in the form of infusion or of powder. In
some cases, a mixture of warm milk and water wTas substituted
for the albumen. The experiments were not continued for
more lhan from forty to forty-eight hours, if the worm had not
been killed before the expiration of that time. Dr. Kiichen-
meister made use of electricity as the most delicate reagent for
proving the occurrence of the death of the worms. In the
first place, electricity cannot be considered as a vermifuge.
The author subjected a female Hetarakis vesicularis, taken
from a partridge that had been killed, to the action of a rotary
apparatus, which was kept up with longer or shorter intervals
durincr an entire day The animal was not destroyed bv the
experiment. He next tried the remedies employed for the re-

n. s. VOL. IX. no. ix. 36

566 Inquiry into the Action of Anthelmintic*. [September,

moval of taeniae, and first tested kousso in the following man-
ner: A living Taenia crassicolis, procured from a cat, was
placed at four o'clock in a mixture of albumen and doliehos
pruriens. The worm appeared to be perfectly well in this
mixture, and at two o'clock on the following afternoon exhibited
the most vigorous movements. The taenia was now transfer-
red to a vessel containing a mixture of infusion of kousso and
some of the infused as well as some of the fresh powder with
albumen. The temperature of the mixture was 30 R. (1)9.5 F.)
On its introduction, the worm quickly extended itself; after
some time it was found to be dead, its colour having changed
to a dirty reddish yellow. Two Tcenice serratce were placed
at about half-past one in the afternoon in a mixture of albumen
and kousso ; at two o'clock they were dying, and at three com-
pletely dead. Two Teenies serratce from the same dog were
Drought in contact with kousso and milk, at half-past one in
the afternoon, and at two o'clock were dead. Two Tcenice
serratce were placed at half-past one in the afternoon in albu-
men, mixed with decoction of pomegranate root and with some
of the powdered root: they died in three hours. Two others
were placed in milk mixed with the decoction only : thev died
in three and a half hours. A Tcenia crassicolis was put into a
mixture of albumen with ethereal extract of male fern: it died
gradually in three hours and three quarters. A number of
Tcenioe cucumerince were placed in a mixture of albumen and oil
of turpentine : they were dead in an hour and a quarter.

A number of the same were put into a mixture of albumen
and castor oil; they appeared lively at first, but were dead in
seven hours. Similar worms were put into a sallad, composed
of pieces of unwatered herring, boiled potatoes, large pieces of
onion and garlic, albumen, vinegar, and a large quantity of oil.
They died in eight hours. Lastly, the author tested the ver-
mifuge powers of the brown oxide of copper; fifteen grains
were administered in the course of four days to a strong cat.
When the body was opened, the entire intestinal canal was
found to be full of fluid, yellow, flaky faeces; the intestine was
softened, and denuded of epithelium, especially at the termina-
tion of the ileum, where the adjoining Peyer's glands were
much swollen, particularly in two situations, one of which was
an inch and a half long by one-third of an inch broad ; the
other was nearly circular, and its diameter one-third of an
inch. The cat had been purged. The taeniae and ascarides it
contained were lively. It would hence appear that this sub-
stance is both inefficacious as a vermifuge and dangerous to the
system. The following table contains the results of the above
experiments :

1853.] Inquiry into the Action of Anthelmintics. 567

In milk boiled with kousso taeniae died in half an hour.
In a mixture of oil of turpentine and albumen, in 1 to l^hour.
In decoction of kousso with albumen, . . . . l to 3 hours.
In decoction of pomegranate root with milk, . .3 to3^ "
In decoction of pomegranate root with albumen, . 3 M

In ethereal extract of male fern with albumen, . 3 to 4 "
In castor oil with albumen, ....*.. 8 "

In salmagundi with garlic and onions, ... 8 "

Kousso would therefore seem to be the most efficacious remedy
against taenia?. When pomegranate bark and male fern root
fail, their failure may be owing to the habit of administering a
laxative in from four to six hours after the exhibition of the
vermifuge, by which the latter may be carried beyond the
worm. With regard to pomegranate root, it must be observed,
that in large doses it occasions diarrhoea. The same remark
applies to castor oil. The author also alludes to cold water,
strawberries, dolichos pruriens, and filings of tin. When taenia?
are placed in water containing ice, they are instantly benumb-
ed, and ifallowed to remain in it, they will always be found at
the end of ten hours to be quite dead. Strawberries may be
useful as a mild remedy in cases of tape-worm ; if large quan-
tities of them be taken on an empty stomach, entire portions
of the worm will often be passed. Dolichos pruriens, with
which the author tried many experiments, appears to possess
no power of destroying worms. The author has also minutely
studied the medicines recommended for the removal of round
worms. In albumen, these worms behave as the taeniae ; in
water, at about 77 F., they live for some days, but swell, stiff-
en, become longer, thicker, and more sluggish; they lose their
power of suction, and their motions become slow and only par-
tial they resemble leeches which have gorged themselves.
In general, however, the males and young neutrals resist the
effects of water longer than the mature, impregnated, egg-
bearing females, which become quite rigid and inflexible, and
swell considerably. Milk and whey affect the worms like wa-
ter. The following are the medicines, the effects of which
were tested :

1. Camphor. An ascaris lived from eighteen to twenty
hours in albumen into which some camphor had been intro-
duced. 2. A mixture of oil of turpentine and albumen killed
some ascarides which were placed in it from two and a half to
six hours. 3. Ascarides lived forty hours in albumen and
wrormseed, whether the latter was employed in the form of
powder or infusion. 4. Some ascarides were placed in albu-
men mixed with santonine ; they did not die in it, nor did they
die in a watery infusion of santonine. When santonine was

568 Inquiry into the Action of Anthelmintics. [September,

dissolved in oil, especially in castor oil, and mixed with albu-
men and ascarides, the latter died in ten minutes. An injec-
tion of santonine and castor oil was thrown up the rectum of a
cat, and produced numerous motions containing dead worms ;
and on killing the cat, the entire of the lower portion of the
intestinal canal was ascertained to be free from worms, while
four were found near the stomach quite rigid and extended, and
retaining but little life. A Tcenia crassicolis, however, was
found in the intestines, and appeared to be quite uninjured and
very lively. 5. A mixture of albumen and anisseed, with a
strong infusion of the latter, killed the worms in about twenty-
four hours. 6. Parsley, mixed with albumen, killed ascarides
very slowly. 7. Flour of mustard and albumen destroyed
them in about four hours. 8. In rue the worms lived upwards
of twenty-four hours. 9. The same was the case with mille-
foil. In contact with tansy, valerian and camomile, great
numbers of them lived for twenty-four hours. With onions
and garlic they perished in from ten to fifteen hours. A de-
coction of cloves, with or without albumen, killed them in
twelve hours. In an infusion of ginger, with or without albu-
men, they lived about twenty-four hours. Petroleum, mixed
with albumen, killed them in less than six hours, as did also oil
of cajeput and albumen.

A series of vermifuges, taken from the class of balsamics,
was tried in like manner, namely, assafoetida, ammoniacum,
balsam of Peru, extract of juniper, and Venice turpentine. In
all these the worms lived more than twenty-four hours. Of the
class of empyreumatics (brenzlichen stoffe) the following were
tried: Oleum chaberti, [a mixture of four parts of oil of tur-
pentine, and one of the animal oil of Dippel,] oil of amber, cas-
tor oil, tar water, creasote, wood-vinegar, and wood-soot. In
these, for the most part, the worms lived from twenty-four to
forty-eight hours; except the wood-vinegar; in which they
lived rather more than twelve ; and creasote, in which they
died within two hours. Of bitters, the author tried aloes, gam-
boge, ox-gall, worm-wood, myrrh, gentian, quassia, hops, bitter
orange, and acorus calamus ; in all these the ascarides lived
from twenty-four to forty hours. Of astringents, pure tannic
acid, pomegranate root, kousso, extract of walnuts, cinchona
bark and quina, elm bark, willow bark, the flowers and stalks
of meadow sweet, oak bark, dragon's blood, catechu and kino.
In these the worms died in from twenty-four to thirty hours,
with but two exceptions, namely, tincture of galls and pome-
granate root, both of which killed them in the space of eleven
hours. Of saline preparations, sulphate of soda, chloride of
sodium, and the roe of the herring, were tried. In the first the

2853.] Parasites in the Production of Disease. 569

worms died in from fifteen to eighteen hours ; in the second, in
from two to six ; and in the roe of the herring, in four hours.
The following metallic poisons were experimented on : Arse-
nic, calomel, corrosive sublimate, and the salts of tin, of lead,
and of copper. Corrosive sublimate alone destroyed the worms
in so short a time as two hours ; all the other metallic salts re-
quired a much longer period. From these experiments it would
appear that santonine, mixed with oil, is the most powerful
vermifuge, then chloride of sodium, the roe of the herring, gar-
lic, onions, &c. The author advises that santonine should be
given as a vermifuge ; mixed with oil, in the proportion of from
two to five grains to an ounce of castor oil. This solution
should be given in the doses of a teaspoonful until the effect is
produced. As auxiliary treatment, chloride of sodium, herring
brine, mustard, onions and garlic, maybe employed. [Foriep's
Tagsberichte iiber die Fortschritte der Naturund Heilkunde.
Pharmakologie, Band 1, p. 317. Dublin Quarterly Journal.

On the Influence of Parasites in the Production of Disease.
By Joseph Leidy, M. D., Professor of Anatomy in the Uni-
versity of Pennsylvania.

In many animals entozoa and entophyta are almost never
absent, and probably when in their natural habitation, and few
in number, or not of excessive size, are harmless, as observed
by Dujardin in the introduction of his excellent work on Intes-
tinal worms: "Les helminthes se developpent dans un site qui
leur convient, sans nuire plus que les lichens sur l'ecorce d'un
arbre vigoureux. lis ne peuvent devenir nuisibles, generale-
ment, que par suite d'une multiplication excessive, laquelle
semble alors etre une des consequences d'un afFaiblissement
provenant d'une tout autre cause, d'une mauvaise alimentation,
du sejour dans un lieu froid et humide, etc. : sans cela, les hel-
minthes naissent et meurent dans le corps de leurs notes, et
peuvent paraitre et disparaitre alternativement sans incon-
venients.'"*

Many important diseases have been supposed to originate
from parasitic animals and vegetables. The former are not
the true entozoa, for these are too large, and may be detected

* " Worms are developed in localities adapted to their necessities with as
little injury as the moss which grows upon the bark of a vigorous tree. They
can only become injurious, in general, when in excessive numbers, and this
multiplication seems to be owing rather to debility induced by impioper diet
cold and moist habitations, &c, than to their presence. Otherwise worms will
be born and die in the body of their host, and may appear and disappear alter-
nately without inconvenience." Translated by Ed. S. M. ($ S. Journal.

570 Parasites in the Production of Disease. [September,

by the naked eye, but they are considered to be animalculae
so small that they cannot be discovered even with the highest
powers of the microscope. But, independent of the fact that
the existence of such entities is a mere suspicion, none of the
well known animalculae are poisonous. At various times I have
purposely swallowed large draughts of water containing myri-
ads of Monas, Vibrio, Euglenia, Volvox, Leucophyrs, Para-
mecium, Vorticelli) etc., without ever having perceived any
subsequent effect.

The production of certain diseases, however, through the
agency of entophyta, is no longer a subject of doubt ; as in the
case of Muscardine in the Silk-worm, the Mycoderm of Porrigo
favosa in Man, etc. ; but that malarial and epidemic fevers have
their origin in cryptogamic vegetables or spores requires yet a
single proof.* If such were the case minute vegetables and
spores, conveyed through the air, and introduced into the body
in respiration, could be detected. The minutest of all known
living beings is the Vibrio lineola of Miiller, measuring only
the 36.000 of an inch, and the smallest known vegetable spore
is very much larger than this, whilst particles of inorganic
matter can be distinguished the 200,000 of an inch in size.

I have frequently examined the rains and dews of localities
in which intermittents were epidemic upon the Schuylkill and
Susquehanna rivers, but without being able to detect animal-
culae, spores, or even any solid particles whatever. I have
examined the air itself for such bodies, by passing a current
through clear water. This was done by means of a bottle,
with two tubes passing through a cork stopper; one tube dip-
ping into the water, the other reaching not quite to its surface.
By sucking upon the latter tube, a current of air passed through
the former, and was deprived in its course of any solid parti-
cles. Ordinarily, when the atmosphere was still, early in the
morning, or in the evening, neither spores nor animalcules
could be detected. When piles of decaying sticks or dry leaves
were stirred up, or the dust was blown about by the wind, a
host of most incongruous objects could be obtained from the
air ; none, however, which could be supposed capable of pro-
ducing disease.

To assert, under these circumstances, that there are spores
and animalculae capable of giving rise to epidemics, but not dis-
cernible by any means at our command, is absurd ; as it is only
saying in other words that such spores and animalculae are
liquid and dissolved in the air, or in a condition of chemical
solution. That the air may be poisoned by matters incapable

* See an ingenious little work by my distinguished friend Dr. J. K. Mitchell,
** On the Cryptogamous Origin of "Malarious and Epidemic Fevers."

1853.] Miscellany. 571

of detection by the chemist, is proved by the emanations from
such plants as the Rhus vernix, Hippomane mancinella, etc.
[Smithsonian Contributions to Knowledge. Virginia Medical
and Surgical Journal.

ill i 0 c 1 1 1 a n jj .

Spermatorrhcea. There are doubtless but few of our readers who
will not feel interested in the articles contained in this number, on the
subject of Spermatorrhoea, for we know of no cases with which we
are so continually and painfully annoyed as those in which the pa-
tients complain of the real or the imaginary forms of this affection.
Indeed the mind is so uniformly disturbed in such cases that it is
often impossible to determine the true state of things, and therefore
difficult to know whether to administer relief to the brain or to the
generative apparatus. We are so well satisfied, however, that many
of the cases brought to our notice, have been seriously injured by the
injudicious use of Lallemand's favorite remedy cauterization, that
we feel it a duty to raise our voice against such treatment, except as
a last resort. Our objection to the use of the Nitrate of Silver is that
it does not unfrequently occasion strictures and inflammation about
the neck of the bladder either of which may prove to be more seri-
ous than the original affection. Such results would, of course, not
often follow the application if made by a skillful and experienced
operator but in the hands of the rash, it cannot but be extremely
hazardous.

We are free to confess that we have no more confidence in the effi-
cacy of Digitaline than in that of other narcotics, as opium, belladonna,
tobacco, &c , for they are all antaphrodisiacs to a certain degree. The
suggestion of the mechanical means indicated in one of the articles al-
luded to, seems to us a good one ; but care should be taken not to ex-
pose the organ to strangulation, in the event of an erection, without suf.
ficient warning to the patient. The best prescription we know of, is one
which, in our land of plenty, can fortunately be almost always carried
out without inconvenience, and one which we have never known to
fail in esftblishing a radical cure. We mean matrimony. The only
difficulty is to convince the patients that they may form this connex-
ion before they get cured.

We have found much advantage from the cold hipbath nio-ht
and morning, and the injection two or three times a day of a solution

572 Miscellany. [September,

of sulphate of morphia into the urethra. The solution may contain
4 grs. in 8 oz. of water, a small syringe full of which should be
thrown in and retained (by closing the orifice) at least ten minutes,
so that it may run up to or into the bladder, and remain long enough
to produce its sedative effect. The tonic action of the cold bath and
the locally sedative effect of the morphia, will tend to lessen the irri-
tability of the organs upon which depends, in many instances, the
involuntary emissions. If the proportions suggested affect the system
materially, the solution should be made milder.

Death of Drs. Nathaniel Chapman and Charles Caldwell.
It is our painful duty to announce the demise of two of the
most deservedly distinguished physicians of our country. Both
equally versed in the domains of medical and polite literature, their
impressive and brilliant eloquence secured them a degree of popular'
ity rarely attained by teachers of medicine. Nathaniel Chapman,
M. D., died in Philadelphia on the 1st of July, in the 74th year of his
age and Charles Caldwell, M. D., in Louisville, on the 9th of July,
at the advanced age of 90 years. It is affirmed by some that Dr.
Caldwell was only 82 years of age.

Professorial Changes. As usual, at this period of the year, we
have to record quite a number of changes in the organization of our
numerous medical schools.

Prof. Austin Flint, has resigned the Chair of Theory and Practice
of Medicine in the Buffalo Medical College, and his place has been
filled by Dr. Thos. F. Rochester. Prof. Flint is now attached to the
University of Louisville.

Dr. Socrates Maupin, has been elected Professor of Chemistry in
the University of Virginia, in place of Prof. Smith, resigned.

Dr. G. A. Wilson, has been appointed to the chair of Physiology
and Medical Jurisprudence in Hampden, Sidney College, Va.

Dr. E. A. Peaslee, succeeds to the chair of Anatomy, vacated by
the resignation of Prof. J. H. Whittaker, in the New York Medical
College, and Dr. Edward H. Parker of New Hampshire has been
appointed to the chair of Physiology and Pathology in the same insti-
tution.

In Berkshire Medical Institute, Dr. E. K. Sanborn of Lowell, has
been elected Professor of Surgical Pathology and Microscopy.

The Medical College of Ohio, has lost the services of Professors
Bagby and Cobb by resignation.

1853.] Miscellany. 573

The chair of Materia Medica in the Kentucky Medical School, is filled
by Dr. R. J. Breckenridge, in place of Prof. E. D. Force, resigned.

Dr. W. G. Edwards, has resigned the chair of Clinical Medicine
in St. Louis University.

Iowa Medical Journal. We have received the first number of a
new periodical bearing the above title. It is published at Keokuk by
the Faculty of the Medical department of the Iowa University in
Monthly numbers of 32 pages for 82 per annum. Our pioneer broth-
er has our best wishes for his success.

Abortive Treatment of Typhoid Fever. It would doubtless be
agreeable to our readers to know the resnlt of such trials as may have
been made in our section of the country of the abortive and quinine
treatment of Typhoid Fever. We therefore invite communications
on the subject from the Profession. Our attention has again been
drawn to this question by a paper from the pen of Dr. Fenner, of New
Orleans, one of the ablest advocates of this plan of treatment in our
country. The Doctor says (N. O. Med. and Surg. Journal) that
" the propositions I have assumed, are

"1st. That all the continued fevers originating in the Southern
States, are but varieties of endemic malarious fever, and are controlla-
ble by the same remedies, if judiciously applied at their commence-
ment :

" 2d. That all these fevers, most probably, proceed from an aerial
poison, which enters the blood ; first exerting its malign influence
upon this fluid, and thence conveyed through the channels of the cir-
culation to every part of the system :

" 3d. That the primary perturbation of the system generally recog-
nized as an attack of idiopathic fever, consists for the most part in
functional derangement, without any special organic lesion, and is con-
trollable by such a remedy or combination of remedies as is capable
of equalizing the excitement and circulation, restoring the healthy
action of the secretory organs, allaying pain and depurating the blood.
It is believed that such a combination of remedies may be found in
blood-letting, large doses of quinine and opium, and some mercurial,
as calomel or blue mass :

" 4. That the organic lesions found on post-mortem examinations
of fever cases do not fully indicate the disease that had existed ah inni-
tio; but rather, the secondary and ultimate results of disordered action
proceeding from a blood poison ; which morbid action or functional
derangement might probably have been corrected, and the blood-
poison neutralized or eliminated by the judicious application of appro-
priate remedies.

14 The idea of the close relationship subsisting between our endemic
continued and paroxysmal levers was thrown out more as a surges-

574 Miscellany. [September,

tion rendered extremely probable by the facts that had presented
themselves to my observation, and been reported by others, than as a
demonstrated truth ; but I have now to add, that the more I have in-
vestigated it, the more I have become convinced of its truth."

Fracture Tables Dr. Frank H. Hamilton, of Buffalo, some time
ago published tables containing an analysis of 136 cases of fracture of
various bones, together with the result of the treatment. Another
edition has just appeared, for a copy of which we are indebted to the
author, containing in addition to the old tables, a supplement of 325
other cases, taken by Dr. Boardman, of Buffalo, from Dr. Hamilton's
note-book. The whole makes an analysis of 461 cases of various
fractures, with their results, not only as to life or death simply, but as
to deformity, or shortening, or any variance from the condition of the
bone before the fracture. The results arrived at must be of interest,
and though they are not in all respects comforting to the vanity of
surgeons, they are what is far better, instructive.

Of this number of cases, thirty-one resulted in death soon after the
accident, or amputation was immediately required, so that they are ex-
cluded in the general estimate. All these cases are taken from the prac-
tice of Dr. Hamilton, and other well qualified surgeons, leaving out
of consideration all cases treated by ignorant men and quacks, so that
the result obtained must give a fair conclusion as to what may be ex-
pected in the treatment of fractures by the most skillful men.

We call the attention of our readers to the following abstracts from
the summary of all the cases, as showing the proportion of perfect
cures found in the patients of eminent surgeons :

Of nine fractures of the ossa nasi, one was perfect;

Of four fractures of the septum nasi, one was perfect;

Of one fracture of the sup. maxilla, one was perfect ;

Of thirteen fractures of the inf. maxilla, seven were perfect ;

Of forty one fractures of the clavicle, fifteen were perfect;

Of three fractures of the scapula, one was perfect;

Ofthirty-eight fractures of the humerus, seventeen were perfect;

Of twenty-seven fractures of the radius, seventeen were perfect;

Of twenty-three fractures of the ulna, fourteen were perfect ;

Of thirty-four fractures of the radius and ulma, twenty-five were
perfect ;

Of seventy-three fractures of the femur, fourteen were perfect ;

Of seven fractures of the patella, one was perfect ;

Of nineteen fractures of the tibia, fourteen were perfect ;

Of sixteen fractures of the fibula, eight were perfect;

Of seventy-three fractures of the tibia and fibula, twenty-three were
perfect ;

One fracture of the carpal bones was imperfect;

Of three fractures of the metacarpal bones, one was perfect;

One fracture of the phalanges was imperfect ;

Of four fractures of the ribs, two were perfect;

Of two fractures of the pelvis, neither was perfect ;

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL

Vol. 9.] NEW SERIES. OCTOBER, 1853. [Xo. 10.

PART FIRST.

rtgtnal (Hommttnications.

ARTICLE XXXI.

On the External Use of Common Salt in Intermittent or Neu-
ralgic Pains of the Head. By Calvin J. Fall, M. D., of
Stockbridge, Henry Co., Georgia.

The disease in question is an exceedingly painful one, and is
frequently very perplexing to the physician, as I have some
reason to know, having suffered two well-marked and several
slighter attacks of it myself. It is, according to my experience,
much more common in the spring season than at any other
time, as all the cases, ever seen by me, have been previous to
the summer solstice, and none earlier than the vernal equinox.
Its invasion is usually gradual purely periodical, the periods
appearing to be controlled by the diurnal motions of the earth;
the pain, which is pulsating, or rather thrilling, similar to an
electric shock, commencing with the rise of the sun, attaining
its acme when the sun is at the meridian, and again declining
to perfect ease hence the term " sun pain" applied to it by
the people. So far as the throbbing is concerned, by sun-set,
to be again renewed on the following day, accompanied with
the same phenomena, except that each succeeding paroxysm
leaves the integuments more sore to the touch. Its seat is in
the nerve which passes out of the orbit, through the supra-

n. s. VOL. IX. no. x. 37

582 r ' Fall, on the Use of Salt. [October,

orbitar foramen or notch, and ramifies upon the forehead and
temple ;#the general health of the sufferer may be, and is usual-
ly, otherwise, good, but after some days persistence some fever
will be developed, &c. More need not be said on the symp-
toms, as I presume most practitioners are but too familiar with
them.

Its cause is, to me, inscrutable ; it appears to be connected
in some way with the restoration of that proper electro-nervous
equilibrium which, perhaps, has been deranged by the cold and
wet of the preceding winter : this, however, I leave to be set-
tled by those who have more ability and more leisure than I
have. The chemical nature and constitution and physical
properties of a remedial agent may sometimes throw light on
the etiology of disease, where abstract reasoning and post-
mortem examination will avail nothing.

Several years experience has convinced me that we have
no article in the materia medica, which, for simplicity and en-
tire safety in application, or promptitude and certainty of relief,
can be compared writh common salt, (Sodas murias). This
article, so indispensable in domestic economy, may be no less
valuable as a therapeutic agent. I was much pleased with an
article, written by Prof. Dugas, on the Saline Treatment of
Dysentery, and would most cheerfully recommend its adoption
by those of my professional brethren who have not already
done so. The formula I use for convenience is,

White of egg, . . q. v.

Common salt, . . q. s. ad saturandum.

To be spread thick on tow, or cotton, batted, or simply a cloth
folded several thicknesses, and applied to the seat of pain, to be
renewed as often as it becomes hot or dry.

That I may be the better understood, I will append a few
cases treated solely or mainly with salt.

Case I. The writer had a severe attack of " Sun pain," in
the spring of 1833, when at school ; it continued to grow worse,
until he was compelled to abandon his studies and go to his
home, fifteen miles distant. Imagine his surprise and delight
to awake next morning free from all pain. Had no farther

1853.] Fall, on the Use of Salt. 583

attack until the spring of 1838, just after leaving the Medical
College of Georgia. The attack was severe. All the means
recommended by the best authors 1 had an oppportuuity to
consult were faithfully put into requisition, but proved unavail-
ing. I expected to have it to wear out, as on the first attack,
until a gentleman (now professional) told me to try salt. I was
at the time suffering excruciating pain. Had it prepared as
above directed, and applied. Well, the result was as gratify-
ing as unexpected ; the pain gradually, but quickly, disappear-
ed, as dies away the echo on the zephyr. The next day I
re-applied the salt, and took a few doses quinine, which termin-
ated the disease.

Case II. In May, of the same year, saw B. W., a young
man aet. 18 years, a soldier, engaged in the removal of the
Cherokee Indians ; had labored under all the symptoms detail-
ed above for five days before I saw him. His case had been
mistaken for and treated as inflammation of the brain. He
was at the acme of a paroxysm, and was pronounced to be
moribund when I got to him. Having but recently had some
personal acquaintance with the disease, I had no difficulty in
diagnosticating more correctly and cheering his mind with a
brighter prospect. The next morning the salt mixture was
applied, accompanied with a few doses quin. sulph. The cure
was prompt and complete.

I have since had many cases of neuralgia, otalgia, odontal-
gia, &c, &c, in which salt was usually prescribed in some way,
and I have been seldom disappointed.

Case III. Mrs. H., aet. 50, was attacked May, 1853, with
the usual premonitory symptoms of " Sun pain," as I learned
when called, which was only when the case was thought to
have assumed an alarming aspect. The lady's husband, confi-
dent of his own skiil, had been prescribing for her, and kept up
colliquative discharges from the bowels; applied a large vesi-
catory to the cervical spine, and sinapisms freely to the fore-
head, under the impression that it was a case of inflammation
of the brain. She had been bled twice. The reselt was, she
grew weaker daily, and the disease more active ; a pretty high

584 Hammand, on Ovarian Dropsy. [October,

grade of irritative fever, furred tongue, and great mental de-
pression prevailed when I saw her. The salt and egg was
directed instanter, and quin. sulph. advised. This last, how-
ever, was objected to, to which I very readily consented, as I
had a desire to test the powers of salt alone, in a bad case,
especially as I believed it would be altogether sufficient. It
proved so : there was no other paroxysm, and convalescence
speedily followed.

I have already protracted this article much beyond the limits
I had prescribed for myself when I began. I therefore close,
with the wish that it may be found by others to control this
painful affection with as much certainty as it has done in my
hands.

ARTICLE XXXII.

Ovarian Dropsy. By D. W. Hammond, M. D., of C ulloden, Ga.

On the 10th day of April last, I was invited to see Mrs. B.,
a lady about 28 years of age. She informed me, that in the
month of September, 1849, she felt, for the first time, a sharp,
stinging sensation in the right iliac fossa, a little below and to
the left of the anterior superior spinous process of the ilium.
The seizure was transitory, passing off in a few seconds, leaving
a dull, heavy aching in the part. A few days subsequent to
the primal incursion, she discovered a tumor, about the size of
a common orange, projecting from the right flank ; it was hard
and unyielding, and slightly painful to the touch. For several
months it appeared to preserve its quasi organization or devel-
opment. Early in the year 1850, she became enciente ; the
tumor now commenced enlarging rapidly, and continued to
enlarge up to term, when she was delivered of a living off-
spring, the expulsion of the foetus producing but slight, if any,
diminution in the size of the abdomen. The disease now filled
the entire hypogastrium and had ascended to the umbilicus.
Mr. B., becoming alarmed at the condition of his wife, sent for
Dr. Kendal, a distinguished physician of Upson county, who,
upon examination and percussion, discovered fluctuation to be

1853.] Hammond, on Ovarian Dropsy. 585

quite distinct in the cyst, and pronounced it to be a case of
Ovarian Dropsy. The above is, in substance, the history Mrs.
B. gave me of its formative stage. From the birth of her child
up to the time I first saw her she had continued regularly to
enlarge " De die in diemP On examination, I found the abdo-
men enormously distended, and soon satisfied myself, by making
the necessary palpations and explorations over the abdominal
parietes, that it was. correctly diagnosticated by my friend, Dr.
Kendal, it was Ovarian Dropsy.

I advised hydragogue cathartics, and a free use of the hyper-
tartrate potass., stating, at the same time, that if the enlarge-
ment continued to increase in despite the remedies prescribed,
that she should submit to paracentisis abdominis the only
means left which promised any relief to her protracted suffer-
ings. To which she peremptorily objected, stating that

" Dr. " (a steamer) " says there is no water in me, and

people says he is a very knowing doctor."

" Oh yes, madam, he is very knowing in his way; that is, if
knowing how to heat brick-bats, to make red-pepper tea, and
to skin Bayberry bark is knowledge, then he is knowing in-
deed."

" But stop, Doctor, lie told me how I might tell if I had any
water in me, and I've tried it, and I am satisfied there is not one
drop."

" What was his test, madam ?"

" Why, he told me to strip naked, {at night, you know) and
then to set a candle on one side of me, and for my husband to
get down on his knees on the other side, and if as so there was
any water in me, that he could see the light from the candle
shine clear through my belly."

" Pshaw ! pshaw ! nonsense."

" You need'nt make light of it, Doctor, for my husband tried
it, and he could'nt see nothing no, Doctor, there's no water in
me, certain."

I now left her, to enjoy her own opinion, but earnestly re-
quested, before I left, that if she continued to grow larger, and
the distention became so great as to produce alarming symp-
toms, to send for me immediately.

I heard but little from her from the time of my last interview

586 Hammond, on Ovarian Dropsy. [October,

until the 2d day of August inst., when I was summoned in haste
to see her. I found the abdomen of immense size, giving her
great pain and uneasiness. The diaphragm was thrust up into
the chest, impeding greatly the normal action of the heart and
lungs. This hypertrophic and heterologue development gave
rise to distressing palpitations and alarming dyspncea, together
with a constant disposition to syncope. Her strength had fail-
ed very much for the last few months, and she loooked macilent
and care-worn. I at once advised her to submit to the opera-
tion, assuring her that the tumor was filled with liquid. She
replied that I could do as I thought best, stating, that if she was
not speedily relieved she must die very soon. I accordingly
performed paracentesis abdominis, in the usual manner, and
drew off* 83 lbs. of dull white liquid, about the consistence of
syrup. Specific gravity 1*400. The whole was contained in
a large unolocular cyst. On seeing the wTaterflow, the patient
exclaimed, " Well, I always thought he was a fool and now I
know it." Our patient stood the operation well, sitting up the
whole time (two hours) without becoming the least faint. 50
drops of laudanum were now administered, a flannel roller
passed around the body, and the patient put to bed. After the
subsidence of the abdomen, the tumor was found to be thick-
ened and lobated of an oblong shape, and extending from the
right iliac to the hypochondriac region, and was adherent just
below the false ribs. The walls of the sac contained several
deep fissures or sulci, running in a longitudinal direction, con-
centric at the point of adhesion, and divergent at the base ;
which circumstance might be attributable doubtless to the
weight of the sac being suspended from the point of adhesion.
Our patient rested well through the night.

August 3d. Found her with some fever, and slight perito-
neal inflammation. Ordered, sulph. magnesia 5 i., which oper-
ated well during the day. About midnight, I was aroused
from my bed by her husband, who stated his wife was dying.
I found her with spasms of the fingers and facial muscles, and
unable to articulate a word distinctly. Administered a full
dose of laudanum and sulph. ether, which relieved her in 20
minutes.

4th. Much better; sitting up on the side of the bed some

1853.] Weatherly's Case of Glossitis. 587

tenderness over the abdomen. Advised a seidlitz powder, and
camphorated liniment to be applied freely.

5th. Still better ; sitting up some, and able to walk a little
about her chamber. From this time she continued to improve
slowly, and I found her this morning, the 12th, doing moderate-
ly well. She walks about the house occasionally every day;
but complains very much of the weight of the sac pulling her
down from the point of its attachment.

The sac is slowly filling again. I consider the prognosis
unfavorable.

ARTICLE XXXIII.

A Case of Glossitis. Reported by J. S. Weatherly, M. D.,
of Palmetto, Georgia.

Miss. P., aged about fourteen years, rather slender, and of a
nervoso-lymphatic temperament, had been sick three days
when I saw her, on the 8th of April last. The attack occurred
after exposure by going about one afternoon with her shoes
and stockings off. She complained first of sore throat with
occasional chilliness, and the throat grew worse until the 7th,
when she had considerable fever and her tongue began to swell
and be painful. On the morning of the 8th, the fever being
high, headache intense and swallowing difficult, my presence
was requested, and I reached the patient at 8 o'clock, P. M.
I found her with intense cephalalgia, great difficulty of degluti-
tion, even of liquids ; tongue much swollen, protruding between
the teeth, very painful and covered with whitish mucus. She
spoke with great difficulty and only in a whisper; skin tolera-
bly hot ; pulse 145 ; bowels constipated ,' urine very red.

Prescribed comp. cathartic powder a teaspoonful of sp.
aether, nit. \ gr. sulph. morph. and 7 drops tr. ver. viride,
in a wineglassful of water, every three hours ; also, warm ap-
plications to the throat and a hot foot-bath.

April 9th, A. M. Tongue more swollen, and protruding
far between the teeth : she has some cough ; discharges a
tough mucus from the mouth ; head still aching ; pulse 120
has been nauseated bv the ver. viride; bowels have not acted.

588 Hammond Disease of the Bronchial Glands. [October,

Applied a blister to the throat ; attempted to get some salts,
tinct. rhei., and aloes down, but failed, as every attempt at
swallowing strangled her.

Seeing that something had to be done which would give at
least temporary relief, I determined to scarify the tongue.
The blade of a straight bistoury was placed flat upon the dor-
sum of the tongue, and being guided by the left fore-finger, was
pushed as far down as it could be done conveniently ; it was
then turned upon the edge, and brought out, making a deep
incision into the substance of the tongue. Two other incisions
were made in the same manner, which bled freely.

12 o'clock M. Can talk distinctly, and is able to swallow.
She now took the salts, rhei. and aloes the blister was ordered
to be removed and followed by a warm poultice the ver. vir.
and spts. of nitre to be continued cathartic mixture to be re-
peated, if necessary.

April 10th, A. M. Patient nearly well. Bowels had acted
freely ; tongue reduced to nearly its normal size ; pulse 85
complains of nothing except the blister. No unfavorable symp-
toms occurred afterwards. She had a rapid convalescence.

ARTICLE XXXIV.

A Case of fatal disease of the Bronchial Glands. Reported by
J. F. Hammond, M. D., of the U. S. Army.

Barrancas Barracks, Fla., 8th Aug., 1853.
Dear Doctor I have just made an interesting post-mortem
examination. I was called to a negro man, about fifty years
old, a few days ago, whom I found w7ith diarrhoea of three or
four days standing, and difficult respiration ; pulse a little small-
er than natural, and healthy as to frequency ; no pain any
where except in the right hypochondrium, from an old "strain";
head clear ; tongue clean; no thirst; moderate appetite; chest
resonant throughout to percussion ; the bronchial respiration
loud; the vesicular sound nearly natural ; occasionally slight
cough ; sounds of the heart a little obscured ; a little dull pain
on pressure of the right hypochondrium. A blister plaster was
applied over the pain. A bath, and castor oil followed by pills

1853.] Hammond Disease of the Bronchial Glands. 589

of blue mass, ipecac, and plumbi. acet., combined, relieved him
of the diarrhoea in forty-eight hours. I left him at that time as
convalescent. And, as I found him at my last visit breathing
quietly, I concluded he had been shamming as to his respira-
tion.

Twenty-four hours afterwards I was called to him by his
owner. The difficulty of respiration was greatly increased
in every other respect he was apparently well, except that there
was some tenderness on strong pressure over the vertebra?
from the middle of the column downwards. A blister plaster
was applied over the tender part of the spine ; and a Medical
Officer of the Navy was called in consultation. It was deter-
mined that the upper surface of the liver was possibly inflamed,
involving the diaphragm. Calomel and opium, in combination,
were given him every four hours. At the end of seven hours
he was dead,

The autopsy was made an hour and a half after death. The
viscera of the abdomen were perfectly- healthy, except some
injection of the veins of the duodenum. In the thorax, the
heart was healthy; the right lung was suspended by a net of
old adhesions like a cocoon in its mesh ; the left lung was coK
lapsed, but there were old adhesions in many places; both
were covered by a heavy coating of melanotic deposite, which,
in some places, most posteriorly, was spread uniformly under
the surface it seemed to form a part of the tissue as the pig-
mentum nigrum does of the skin; during the intervals of the
deposite the pink hue was a shade deeper than natural ; the
lungs were crepitant and pervious to air throughout ; they
floated perfectly on water; they were rery little congested.
In removing the lungs, several of the bronchial glands were cut
through they were the size of large almonds, black through-
out ; several of them had suppurated, and poured out, when cut,
a deep bluish-black pus. Their pressure upon the bronchial
tubes had, doubtless, caused the death,

590 RicorcTs Letters on Syphilis. [October,

PART II
(Bcitttic depart nunt.

Letters upon Syphilis. Addressed to the Editor of L'Union
Medicale, by P. Ricord. Translated from the French, by
W. P. Lattlmore, M. D.

TWENTIETH LETTER.
[Continued from Page 531.]

My dear Friend: I propose to entertain you with a still
further description of indurated chancre. The subject is some-
what uninteresting, though of much importance ; and I need
all of your kind attention while I attempt to elucidate it.

This important variety of the primitive ulcer is regularly
rounded, in proportion as it is seated upon homogeneous tissues.
Its edges are scarcely ever decolles. They are not always
perpendicular (tallies a pic). A little prominent, they are con-
tinuous with the bottom which is hollowed, as it were, in the
Jorm of a cup. The surface of the ulceration, which is grayish
and lardaceous, is sometimes irised. Its center is of a some-
what deep, brownish color, which has given rise to the desig-
nation of partridge's eye, sometimes applied to it.

But at what period does the induration, which constitutes
the principal character of this variety of chancre commence ?
What time elapses between the act which effects the contagion
and its first manifestation ?

The solution of this question is highly important, inasmuch
as from the moment the induration takes place, the disease
ceases to be merely local. I have sought to determine the
period ; but this is not always an easy matter. Patients seldom
present themselves until a long time after contagion has been
contracted ; and, not aware of the importance of the patholo-
gical state in question, they have failed to notice its commence-
ment.

In the majority of cases, this want of attention on the part
of patients is explained by the fact that indurated chancre is
essentially indolent ; that it is slow in its progress ; that it sup-
purates little ; that it is not perceived until some time has
elapsed ; and that frequently the induration escapes notice.
You are aware that I have already cited examples of this fact.
1 mention it again, in order that you may recall to the minds
of those who are firm believers in the miracle of constitutional
poxes d'emblees.

We are not always sure of the date of the coition or contact
to which the chancre itself is to be referred; consequently, it
is very difficult to ascertain when the induration actually com-

1853.] Ricord's Letters on Syphilis. 591

menced. However, when it is possible to arrive at a true
knowledge of the state of affairs, it is not before the third day
that the induration manifests itself. In all cases, it becomes
manifest in the course of the first or second week. It would
even seem certain unless more precise observations should
prove the contrary that, if a chancre exists for more than
three weeks without becoming indurated, it will not indurate
at all. Induration is a precocious phenomenon. Certain con-
ditions mav so deceive us as to induce belief in subsequent in-
durations. Let us examine these conditions.

The specific induration is not always easily recognized.
After ordinary contagion as well as after artificial inoculation,
the infected part frequently becomes the seat of an inflamma-
tion, that which Hunter called common inflammation, which,
for a given period, incloses and masks the specific induration,
so that it is only in proportion to the degree in which the sim-
ple cedematous, sub-phlegmonous, or frankly inflammatory en-
gorgement is absorbed, that the specific induration is well
described and is found exhumed, as it were, from the inflamma-
tory atmosphere by which it was surrounded. Thus far, the
engorgement, whether cedematous or inflammatory, has been
so prominent an indication that the specific induration is only
thought to commence from the moment it begins to be appre-
ciated ; and persons have thus been led to believe in tardy
indurations, in chancres which have not begun to indurate till
three weeks, a month, and even a longer period, after conta-

sion-

Certain local applications and cauterizations sometimes give
rise to factitious indurations, which may be produced at differ-
ent periods, and thus give rise to misconceptions. These fac-
titious indurations may even be complicated with specific indu-
rations, and render the latter unrecognizable. It is known
that unbelievers in a specific virus formerly stated that corro-
sive sublimate will produce an ulcer similar to the Hunterian
chancre. Similar ! ay, they were right ; but not an identical
ulcer. In fact, with corrosive sublimate; with chromate of
potassa; with liquid acetate of lead, so often employed in
vulgar practice, with hot ashes from a pipe, and sometimes
simply with the nitrate of silver, accidents may be produced
which so closely resemble indurated chancre, as to constantly
deceive physicians who have not an extensive acquaintance
with the disease. Such errors alone have induced the belief
that indurated chancre is not invariably followed by constitu-
tional accidents.

There is another source of error from the influence of which
several syphilographists among others, M. Babington, the

592 RicorcTs Letters on Syphilis. [October,

commentator of Hunter have not escaped. Patients may
preserve an induration which has resulted from a primary con-
tagion, and subsequently contract a new chancre on the same
spot. Without a clear knowledge of the history of the patient,
it might be supposed that the previous induration was the star-
ting point of the latter chancre, and was the first symptom of
the contagion. This is a great error; in all cases, the indu-
ration consecutively follows the ulceration.

Such cases as these in which no account has been taken
of an induration resulting from an anterior contagion have
induced the belief that the new chancre contracted by the
patient, occupying the same spot as the prior induration, be-
comes, in turn, itself indurated ; an error which might occasion
the admission of more exceptions to the law of unicite than
really exist.

You know that several syphilographists assume that all
primitive accidents may be followed by secondary accidents,
and that, if this remark applies to any accident in particular, it
applies to blennorrhagia. Very well ! these syphilographists
admit with stronger reason, that nonindurated, as well as indu-
rated chancres may be followed by constitutional accidents.
It is, therefore, very important to ascertain how far this suppo-
sition is true. You have already seen that common inflamma-
tion can so mask the specific induration as to induce the belief
that another form of chancre exists. It also happens, though
more rarely, that the ulceration, after having been indurated,
becomes phagedenic. Therefore, if one has not seen the com-
mencement of the disease, he may still be deceived, and believe
in the possibility of constitutional accidents succeeding non-
indurated phagedenic chancre.

On the other hand, the induration, without losing its immense
value as a symptom, is not always well formed ; it does not in
all cases, attain the same developement. Sometimes it is su-
perficial. In order to discover it in the thickness of the skin
or mucous membrane, it is necessary to clearly understand its
nature. Sometimes it only imparts to the touch the sensation
derived from feeling a fold of parchment ; at the Hopital du
Midi, I call this form the parchment induration. Indurated
chancres, then, are frequently taken for simple excoriations,
and for simple balano-posthites, when they do not wholly es-
cape attention ; for they are on a level with the healthy parts,
and sometimes even slightly prominent.

The induration ordinarily, invades the whole base of the
ulceration ; but in some rare cases, it only affects the edges, in
which case it is annular. To this form of indurated chancre
we might apply the designation of primitive annular syphilis.

1853.] Ricord's Letters on Syphilis. 593

When no complication exists, the induration is suddenly
circumscribed by the healthy tissues ; it is much more exten-
sive than the ulceration of which it forms the base. It is com-
posed of a hard, somewhat cartilaginous, resisting, elastic, indo-
lent, perfectly rounded nodule, which raises the ulceration
above the surrounding parts, and thus constitutes a variety of
ulcus elevatum.

The induration is sometimes presented under the form of a
more or less prominent crest, when the plastic infiltration
which constitutes it is not formed of homogeneous tissues, and
when it meets resistance at some points, as at the reflection
of the prepuce to the groove at the base of the glans, at which
situation, indeed, the best characterized indurations are found.

If the skin or mucous membrane which covers an induration
be compressed, these tissues become pale, presenting to our
view something analogous to what wTe perceive when, turning
over the eyelid, we compress the conjunctiva upon the tarsal
cartilage.

The induration is usually produced in a slow and gradual
manner. Sometimes it increases by saccades ; in some cases
it remins for a long time, but slightly perceptible, then subse-
quently assumes considerable development. The tissues often
become extensively indurated. I have seen the entire length
of the base of the glans undergo a cartilaginous transformation
which might have given rise to the belief in its cancerous de-
generation. One of the most curious cases of this kind was
sent me by Professor Andral.

The induration, after having diminished, or even disapeared,
is very liable to return. It is not rare, then, to see it acquire
dimensions more considerable than it at first assumed.

The duration of the induration is unlimited. In those cases
in which it is superficial, in which it resembles parchment, I
have seen resolution take place, so completely as to leave no
traces of its existence, within a less period than a month ; at
other times, on the contrary, it persists for months, and even
years. When it is developed on the groove, at the base of the
glands, at wThich point, as I have said, the most marked cases
occur, its duration is greater than at any other spot. It may
quickly disappear from the glans, from the neck of the uterus,
and from the vulvar ring, where it is but slightly marked and
difficult to detect. At the urethra, especially in women, and at
the vagina and anus, its existence is quite ephemeral. Much
attention is required to prevent mistakes. On the tongue, and
particularly on the lips, it remains a tolerably long time. When
the induration begins to disappear, the ulceration has, in all
cases, been healed for some time.

594 Ricord's Letters on Syphilis. [October,

When resolution takes place, the induration undergoes
modifications ; it loses its resistence and elasticity ; it becomes
as it were, gelatiniform, and a wrinkled spot, of a coppery-
brown tint, finally occupies its place.

The indurated chancre, which is less often multiple than the
other varieties, the specific ulcerating period of which is soon
limited sua sponte, or by the aid of art, nevertheless assumes,
at times, considerable dimensions. It extends itself, and exca-
vates the neighboring tissues, so much so, indeed, that we might
expect it to occasion great loss of substance ; but when cica-
trization is complete, frequently no traces of its existence will
remain, for it is the plastic exudation alone which serves as
aliment for the phagedenic influence, thus securing the sur-
rounding tissues from the effects of the ulceration. A know-
ledge of this very common condition of indurated chancre is
important, in view of the etiology of constitutional syphilis, for
it is not the most numerous nor the deepest cicatrices which
prove that the poisoning has taken place.

The specific induration of chancre is absolute proof that the
constitutional infection has occurred. It is the intermediate
state between the primitive and the secondary accident. In
fact, the indurated is that variety of chancre which soonest
loses the distinctive character of the primitive accident, to wit,
the power of furnishing inoculable pus ; but, if the induration
of chancre demonstrates the existence of infection, and if the
degree of its manifestation always bears a definite relation to
the gravity of the accidents which are about to succeed if
this induration can be considered (permit me to use the ex-
pression) as a syphilometer it may also serve as an excellent
guide in treatment ; for this form of accident is the one which
is commonly most amenable to mercurial treatment. Never-
theless, there are cases in which the induration resists treat-
ment; but in this case the induration is generally no longer
specific, but proves to be an organized tissue, that is to say,
an internodular tissue, which has succeeded it. In this way I
was able to account for an induration presented by a patient
who entered the hospital to be treated for caries of the frontal
bone, which came on thirty years after the development of a
chancre at the base of the glans. This induration persisted
under the form of a very marked nodule. In a great number
of cases it is exceedingly diffcult to distinguish between the
internodular tissue and the specific induration. The thickness
of the skin and mucous membranes, the subcutaneous and sub-
mucous cellular tissues, constitute the anatomical seat of the
specific induration ; but it would seem that it usually selects for
its seat the lymphatic capillaries. It is in those regions, in fact

1853.] Ricord's Letters on Syphilis. 595

where the lymphatic network are most prominently exhibited,
and where they are most abundant, that the induration is most
completely formed, and acquires the greatest dimensions. This
opinion receives still farther support from the manner in which
the induration is propagated, that is to say, it is seen to follow
the course of the lymphatic vessels, which are delineated in the
form of cords, in proportion as they become more voluminous.

As to the intimate nature and constitution of the induration,
organic chemistry, which has furnished so many marvelous re-
sults, more, perhaps, than will bear careful investigation, has
taught us nothing; while the microscope, which generally prom-
ises more than it reveals, has thus far shown the specific indu-
ration to be only fibro-plastic tissue, which, proportionably quite
abundant does not differ from that met with in nonspecific
conditions. Such, up to the present time, is the result of the
researches undertaken by one of my highly distinguished dis-
ciples, M. Acton, of England, and of those subsequently prose-
cuted in Paris, by MM. Robin and Marchal (de Calvi.) The
same results have been obtained by our learned and industrious
micrographist, Dr. Lebert, to whom we owe the production of
so many fine works.

Such, my dear friend, are the results of m> researches and
observations on indurated chancre. I present them to you
here, simply as indications ; for, as I have often been obliged
to repeat, I am not now writing a didactic treatise on syphilis :
I am only calling your attention to the principal points of my
doctrine, on account of the objections still made to it, and
which are addressed more or less directly to myself. Ampler
developments form the subject of my oral instruction, and es-
pecially of an extensive work which I am preparing, and of
which these letters, to tell the truth, are merely the summary.
I am here presenting the general principles, the essential points
of doctrine embodied in the latter work, indicating the princi-
pal grounds on which they rest ; and the present letters have
no other merit than that which the character of your readers
may impart to them readers who are no longer students, but
learned and enlightened practitioners, to whom the indications
I have pointed out merely serve the purpose of calling to mind
the careful studies and researches of previous years.

TWENTY-FIRST LETTER.

My dear Friend, How do chancres cicatrize ? Allow me
to say a few words on this important subject.

The period of reparation is indicated by the disappearance
of the areola of the ulcer. Its edges become degorges, sinking
and resting on the bottom ; and the undermining ceases, if it

596 RicorcPs Letters on Syphilis. [October,

existed. The margin becomes of a pale, grayish, pearly tint,
and finally assumes the normal color of the surrounding tissues.
The bottom cleans off; the gray, lardaceous, diphtheritic layer
is at first pierced, as it were, by granulations which, finally
occupying the place of the layer, give to the ulceration agranu-
lar aspect, and a healthy, rosy tint. The pus becomes less
abundant, and of a healthy, creamy character; and it may, in
this case, justly be said to be laudable, for it ceases to be inocu-
lable. In proportion as the parts fill up, the epidermis spreads
from the circumference to the centre, and the cicatrization is
completed in the same way as in any wound which has sup-
purated.

The cicatrix of chancres may remain more prominent than
the surrounding parts, sometimes being on a level with them,
but most frequently depressed, according to the thickness of
the tissues affected. In a great number of cases, it is indelible ;
while in others it completely disappears, as frequently occurs
after indurated chancres, or when the chancre is seated upon a
mucous membrane.

But, as those whose experience has been extensive well know,
the period of reparation is subject to various irregularities. In
serpiginous chancre, one extremity often cicatrizes, while the
other becomes more diseased ; sometimes one side heals, while
the other continues to ulcerate. Finally, the cure often takes
place at one or many points of the centre, while the circum-
ference is constantly augmenting its vicious circle.

You know, in fine, that, in certain individuals, where a pro-
per course of treatment has not been pursued, where the
physician has been ignorant of the means of repressing granu-
lations by cauterizations, or where foolish prejudices have pre-
vented the employment of this remedy, the granulations are
said to become luxuriant and vegetating, and to give to the
ulceration certain aspects which have obtained for it the name
of the budding, fungous, or vegetating chancre. True vegeta-
tions, of varied forms, may then be produced ; but, as these
vegetations may be considered an accidental, epigenic tissue,
they are not of a syphilitic nature, as we shall hereafter see.

At this period, as I have already said, that is to say, when the
chancre has infected the economy, it may itself undergo a
transformation in situ, and finally present the characters of
mucous papules, and thus give some countenance to the opin-
ion of those who, from failure to analyze the subject, are unac-
quainted with these metamorphoses of those who have admit-
ted, besides, that these accidents could be sometimes primitive
and sometimes secondary, and that they were, in all cases,
contagious ; an opinion which I have already controverted.

1853.] Ricord's Letters on Syphilis. 597

But here a point of doctrine arises, on which I insist, and to
which I must again call your attention. It is this : That form
of chancre which may undergo relapses at different times never
returns when it has once cicatrized. If a new inoculable chan-
cre developes itself after cicatrization has become complete, we
can affirm that the chancre is the result of a new infection.

From what 1 have stated, it is very certain that, as far as we
can arrive at a knowledge of the facts from a due acquaintance
with the conditions by which they are surrounded when we
take into consideration the seats which chancres seem to select
for their development, as well as their usually limited number
when we likewise know how to appreciate the variations which
different chancres present with respect to their period of pro-
gress and of specific statu quo, and with respect to their course
and duration, and the different aspects which they may assume
at the period of reparation, and even of subsequent cicatriza-
tion when, finally, we consider the more or less marked influ-
ence of the mercurial treatment in certain cases, we can usual-
ly arrive at a rational diagnosis which is almost absolute.

The physiognomy of the primitive ulcer is ordinarily so ex-
pressive (permit me to use the word), at the specific period,
that we are able, by seeing it, to name it. It is even necessa-
ry to distrust this first impression, inasmuch as it may occasion
indiscretions which can scarcely be repaired. You have al-
lowed me to illustrate my remarks by pathological anecdotes,
and I shall avail myself of your kindness, happy if I can relieve
the aridity of my previous descriptions.

One of our distinguished savans entered my cabinet one day,
and without any preamble showed me a diseased member,
saying, " What is that?" I immediately replied, " It is chan-
cre." "Very well, sir, my wife gave it to me." "Then, sir,
it is not a chancre." " And why not, if you please ? " Be-
cause," I replied, "that which distinguishes simple ulcerations
resembling chancres from true chancres, is the source whence
they have been derived." My patient was not the dupe of an
argument which would have been sufficient for certain physi-
cians whom you know ; and he contented himself with replying,
with much dignity and resignation, "Cure me."

But is the diagnosis always so easy as some of our classical
authorities have assumed it to be ? I appeal to M. Lagneau,
who is so worthy a representative of these authorities at the
present time. Observe now, whether, despite all the care he
exhibits, he succeeds in distinguishing the primitive chancre
from what, with so many others, he still considers the seconda-
ry chancre. Glance again at his synoptical and comparative
table of the ulcers which are liable to be confounded with those

n. s. VOL. IX. no. x. 38

598 RicoraVs Letters on Syphilis. [October,

produced by the syphilitic virus, and tell me whether he is suc-
cessful, and especially whether he enables others to be success-
ful in establishing this difference with certainty.

Mercury, that infallible touchstone in the eyes of believers
a touchstone which, in England, has been the basis of the divi-
sion of syphilis into the true and the false is a deceptive re-
agent. It often cures non-syphilitic accidents, while it aggra-
vates those which are syphilitic, and which sometimes get well
without treatment.

How many chancres exist which are unrecognized by skilful
practitioners ! How many errors are committed with respect
to the different varieties of indurated chancre, the most danger-
ous form of all! Sometimes simple excoriations are mistaken
for the disease; at others, the disease is supposed to be a true
cancerous degeneration. My friend, M. Vitry, of Versailes,
must recollect the case of a patient to whom I was called by a
physician in Paris, not to judge of the nature of his disease, but
to amputate his penis. I recognized the existence of an indu-
rated chancre, with considerable developement of the plastic
exudation, and pills of the protoiodide superseded the knife.

One of our learned professors, belonging to the faculty of
Paris, who excels in diagnosticating syphilis as well as other
diseases, cannot fail to recollect the case of a Russian noble-
man whom we saw together at the house of our honored and
regretted master, M. Marjolin, and in whom he was unwilling
to recognize the existence of a primitive accident, because
nothing was observed but the specific induration, and be-
cause the nobleman could not explain how he had contracted
the accident ; yet, a short time afterwards, as I had predict-
ed, we obtained the most striking proofs of a constitutional
affection.

If you will allow me, I will relate a short anecdote. Cullerier
the nephew, one day sent to me a popular writer in order to
obtain my opinion relative to an ulceration situated upon the
corona of the glands; an ulceration with an indurated base,
and not then presenting those characters at its edges and base
which are authoritatively assumed to constitute chancre.
Nevertheless, I recognized an ulceration with the specific char-
acters of induration already described, and with the gangliona-
ry prolongation which we are shortly to study. Cullerier was
not of my opinion, because he had examined the two women
accused of imparting the contagion, and had found them healthy.
Admitting neither mediate contagion nor spontaneous syphilis,
and placing confidence in the word of the patient, he could not
admit the existence of a primitive ulcer. I, who admit all ra-
tional sources of contagion, and often doubt until I obtain the

1853.] Ricord's Letters on Syphilis. 599

most certain proof, remained convinced either that the patient
had been deceived, that he deceived himself, or that he deceiv-
ed us. In fact, scarcely six weeks had elapsed when very
marked constitutional accidents so marked, indeed, as to be
exceedingly difficult to cure were manifested. But, while
Cullerier was yet pondering the question how and why this
patient had contracted the pox, I was called to the house of a
great lady.

I arrived, knowing nothing of the purport of my visit. This
lady was mysteriously seated in her boudoir ; and, in spite of
the softened light of the room, I could perceive on her face the
evident tokens of a secondary affection. "Doctor," said she,
" I have to speak to you on a very delicate matter." Wishing
to cut short a painful avowal, u I see what it is, Madam," said
I to her ; " for your face tells me plainly enough why I have
the honor to be here." " What do you say ?" replied she, with
astonishment. "That you are diseased, madam, and for that
purpose desire my attentions." "Not the -least in the world;
and I have sent for you in order that you may assist in curing

M. X (the writer sent to me by Cullerier) not only of his

disease, but also of his dangerous liaisons.'" And she then drew
a portrait which was but little flattering of the two women
whom Cullerier had examined and found healthy, and who, ac-
cording to this lady, were the cause of the whole trouble. I
had much difficulty, as you may imagine, in making her under-
stand that the source of our poor author's trouble was much
closer to me, and in obtaining the avowal that the pressing
interest she manifested relative to him was not altogether based
on a purely platonic affection.

It is ever thus, my dear friend, and here is the moral of this
anecdote that people of the world never make you complete
avowTals. By reason of their relations with great ladies, or
others in whom they have confidence, their mind is a thousand
leagues from the truth ; their thoughts are not fixed upon the
true source of their disease, and they seek it where it is not.

You see, then, how difficult, frequently, is the diagnosis of
chancre, and how wrong we should be in denying its existence
when patients will not aid us in tracing it to its source.

I am acquainted with all the difficulties of diagnosis in many
cases, and I have seen persons of the greatest skill commit
frequent errors in relation to it ; and for this reason I have said,
and I still assert, in spite of contrary opinions, that the only
positive, univocal, pathognomonic sign of chancre, at the
period of progress, or of specific statu quo, is the inoculable
character of the pus which it secretes. From this fact I have
drawn the following conclusion :

600 Method of Advancing Rational Medicine. [October,

Inoculation furnishes the most certain sign of the specific
nature of the ulcer.

I stated in the work which I published in 1838, that, if mer-
cury must be given in all cases where a virulent, primitive
accident exists, it is essential to be assured of the fact of viru-
lence by artificial inoculation. But compose yourself, my dear
friend ; this operation, so repugnant to some persons, and even
dangerous, if not properly managed, is unnecessary in prac-
tice; and I have never advised its performance as a general
rule. The prognosis and treatment of the affection depend on
other indications. The induration of chancre, with its accom-
paniments, in relation to which inoculation furnishes us no
assistance, form the conditions whence we deduce the state of
the constitution, and point out to us the specific treatment
which the disease requires. This fact, I trust, I shall be able
to demonstrate. [New York Medical Times.

Our Problems. An Essay to Facilitate United Labours for
Rational Medicine. By F. W. Beneke, late Resident Physi-
cian to the German Hospital, London, &c, &c. Goettin-
gen, 1852.

Manifold are the concussions which medical science has ex-
perienced in the short time of the last half century ; all the errors
created by an imperfect generalization, as depicted in the his-
tory of medicine, have once more appeared before our eyes in
rapid succession. Even now some of them have not yet van-
ished from the scene ; but the conviction more and more is
gaining power, that the only hope for the continual and lasting
progress of medicine lies in the patient and energetic 'pursuit
of the same method to which the so-called exact sciences of
nature owe their flourishing state ; we mean the way of sober,
unprejudiced observation, and strictly logical induction. Not
insignificant is the profit which has already accrued from the
exertions of those who have clearly recognized the correctness
of this view. No one can, however, help feeling that the sub-
ject before us is enormous in comparison with the limited power
of a single being. Many are certainly deterred from entering
upon it by seeing how much is wanted, how little can be done,
when the observer stands alone ; where to begin, and how to
begin, is unclear to not a few, who feel a real desire to work,
and who are also able enough to give aid in the investigation
of many important points.

Great is the progress made in anatomy and physiology, in
physical diagnosis and pathological anatomy ; but with much
reason, Beneke remarks that we have, as yet, gained very little

1853.] Method of Advancing Rational Medicine. G01

through these collateral sciences for the rational treatment of
disease, which always must be the main end of our labour.
The cause of this sad truth he sees in the circumstance, that
our materia medica and our therapeutics are based, to too great
an extent, on rude empiricism, uncontrolled by physiologico-
chemical experiments, or by pathologico-chemical experience.
To remedy this deficiency, Beneke urges the necessity of co-
operation according to a certain plan.

Jf we look at medical and medico-chemical literature, we find
that a great number of men, and of able men, too, have spent
much of their time in pathologico-chemical researches, without
at all promoting the progress of science. The principal cause
of failure in these investigations is, that they have been work-
ing without a guiding idea. In order to avoid this, Beneke, in
the first instance, developes his views on the origin and nature
of disease in general, and on the ways in which the metamor-
phosis of material may become anomalous. Our limited space
prevents us from giving in detail his idea concerning the essen-
tial nature of health and disease; it may be sufficient to state
here, that disease is considered as originating either in disor-
ders of the alimentary material, or in one or other of the
agencies operating upon this (the organs of the body and the
atmospheric air). As the abnormal changes in the constitu-
ents of the food and of the blood (the product of the food) form
the more frequent source of disease, Beneke gives a brief
sketch of the normal metamorphosis of aliments, under their
different heads of azotized, non-azotized, and inorganic. The
normal course of the metamorphosis of these three groups is
indispensable for perfect health; it may depart from the stand-
ard by being either retarded or accelerated ; retarded, when
the single constituents do not run through the complete series
of changes; accelerated, when the metamorphosis takes place
too rapidly. As the series of changes of the azotized compo-
nents is greater than that of the non-azotized, Beneke concludes
that the latter are sooner decomposed than the former, and
proposes, as the first law of dependency (Abhangigkeits-Gesetz)
for the metamorphosis of matter, that, according to the larger
or smaller quantity of the non-azotized constituents (entering
the blood), the metamorphosis of the azotized is more or less
rapid. Although we may admit that this is the case in general,
we cannot agree with Beneke in thinking that it always must
be so ; the circumstance, at least, that the series of changes in
the azotized nutriment is the longer one, cannot be a sufficient
argument to us, as a longer series may be finished, under cer-
tain conditions, more rapidly than a shorter one.

As a second law of dependence, Beneke proposes, " that the

602 Method of Advancing Rational Medicine. [October,

metamorphosis of the azotized and non-azotized alimentary
material is, to a certain extent, dependent on the quality and
quantity of the inorganic material." (p. 12.)

After these preliminary remarks, our author proceeds to the
consideration of the question : ' Of what nature are the abnor-
mal conditions of the food ? What is the nature of the morbid
changes of the blood resulting from them, and which is the
connection between this and the disease of the whole organ-
ism?" (p. 13.)

Although food may deviate from the normal in quantity and
in quality, yet the quantitative disorders are the most frequent-
ly met with, the more so, as those generally considered as quali-
tative are in reality quantitative, consisting in the presence of
a plus or minus of one or several of the normal constituents.
Guided by the idea, that from the disproportion of one group
of the alimentary materials, at first a disorder in the metamor-
phosis of the corresponding group in the blood must ensue, and
later only in the other groups, Beneke divides these disorders
into direct, indirect and complicated ones. If the quantity of
the azotized class exceeds the measures which can be fully
digested and carried through the normal series of changes,
direct disorder in the metamorphosis of the materials of this
class results, which will show itself, in the beginning, in the
abnormity of its ultimate products of decomposition, and later
only in its earlier products. A transitory increase of the inges-
ta will be the cause of a transitory augmentation of urea and
lithic acid in the urine ; if the increase is continued for a long
time, and is considerable, not only urea and lithic acid, but also
oxalic acid, will be excreted in large quantity ; and doubtless,
also, the azotized constituents of the bile, and the proportion of
the albuminates in the blood, will be augmented. In a similar
manner, by the use of too large a quantity of the non-azotized
and inorganic materials, the metamorphosis of these classes
may become disturbed.

Indirect Beneke calls those disorders in the metamorphosis
of one group, which are not effected by disproportion in the
ingestion of material belonging to the same, but of the materi-
als belonging to another group. If, for instance, the quantity
of azotized substance taken w7ithin a certain time be not above
the normal, but the quantity of the non-azotized be increased,
then, according to the first law of dependence, the disorder
would show itself in the series of the azotized material, and the
same form of disease might result as from direct augmentation
in the ingestion of the azotized substances. Beneke considers
these retardations of the azotized constituents of the blood as
essential in the development of scrofulosis, tuberculosis, and

1853.] Method of Advancing Rational Medicine. G03

those conditions which are attended by oxaluria ; in their high-
est degree they may cause the appearance of sugar in the
urine, which, in such cases, probably has its origin in the azot-
ized elements. Another instance of indirect disorder is found
in the fact, that after the habitual use of soda the symptoms of
acidity in the stomach and intestinal canal are increased, as
well as the proportion of mineral acids excreted in the urine;
which phenomena can only be interpreted by a change in the
metamorphosis of the azotized and non-azotized organic mate-
rial of food, effected by the disorder in the ingestion of inorganic
materials. The results which Dr. Parkes has gained from his
researches on the action of liquor potassae illustrate, it may be,
the same order of facts.

By the coincidence of direct and indirect disorders in the
metamorphosis of the single groups, the complicated disorders
result, which are in reality the most frequent.

Although it is frequently difficult to trace the direct, indirect,
and complicated disorders, yet they form in many instances
only the first link of a long chain of consecutive conditions, of
which the one results from the other, and frequently remains
in reciprocal connection with it. As an instance of a more
simple kind, Beneke mentions the connection between the ab-
normal production (or we would rather say, abnormal accumu-
lation and excretion) of oxalic acid and the impaired growth of
cells. His view is, that by the directly or indirectly retarded
metamorphosis of the azotized substances, the quantity of
oxalic acid in the system becomes increased; phosphate of lime
being easily dissolved in a solution of oxalic acid, the presence
of the latter in an augmented proportion tends of course to de-
prive the system of a certain quantity of the phosphate. This
being further essential to the formation of cells, a deficiency of
the latter function must result as a third link in the chain ;
emaciation is the necessary consequence, originating, in this
case, in an abnormal accumulation of the azotized ingredients
of the blood.

Although we do not yet think ourselves entitled to consider
the morbid increase of oxalic acid in the human organism as a
product merely of the azotized substances to the exclusion of
the non-azotized ; and although we cannot admit, in these mor-
bid states, an abnormally increased production, but only the
presence in an increased proportion (probably accumulation in
consequence of retarded metamorphosis); yet we highly value
the manner in which Beneke investigates the origin of disease.
If we look only at the dietetical indications resulting from it,
without entering into the medicinal treatment, we see at once
that the alimentary material must be diminished to such an

604 Method of Advancing Rational Medicine. [October,

extent, that all the ingredients can run through the normal
series of metamorphosis ; we cannot doubt, that by increasing
the quantity of the so-called strengthening food, a practice to
which patient and medical man not rarely resort, the root of
the disease is nourished, and the emaciation must necessarily
increase.

After having thus alluded to the abnormalities in the mixture
of the blood which may arise from the alimentary material, as
the source of the blood, and which he calls therefore primary
disorders, Beneke passes to the consideration of the aggressive
agencies i. e., the agencies causing changes in the blood
namely, the atmospheric air and the organs of the body. The
former of these acts only upon the blood, as the product of the
alimentary material the latter as well on the blood as on the
nutriments.

Without further entering into the contents of this chapter,
we may only say, that here again the disorder may be quanti-
tative or qualitative. By the diminished proportion of oxygen
brought in contact with the blood, the metamorphosis of the
latter must be retarded ; disorders must arise, similar to those
which are effected by too large a quantity of food. On the
other side, by an abnormal introduction (absolutely or relative-
ly) of oxygen, the change of matter must be accelerated.

In considering the action of the living organs, their structure
and function must be always considered simultaneously, Dr.
Beneke, with much reason, particularly dwells on the import-
ance of the influence of the nervous system in the operation of
the organs on the alimentary material and on the blood, and in
the process of metamorphosis in general a circumstance
which we frequently find neglected in physiological chemistry.
The specific agency of the living organ as the effect of the
anatomical structure, modified by the presence of nerves, and
their connection with the nervous centres Beneke calls typi-
cal energy. This is, however, not to be understood as if he
were admitting a so-called vital power independent of the laws
of inorganic nature, but he uses it merely as a term for that
as yet inextricable complexity of various factors. The " typi-
cal energy" of an organ might therefore be shortly interpreted
as the product of all the physico-chemical processes under the
control of the nervous system of that organ. We can never
be permitted to take only into account the mechanical con-
struction of an organ as a merely physical apparatus, but we
must always look at the fact that it is endowed with nerves and
connected with the nervous centres. Whatever excites or
depresses the latter must exercise an exciting or depressing
influence on the metamorphosis of the organic matter. Hence

1853.] Method of Advancing Rational Medicine. 605

the striking influence of joy or grief on the physical state in
general. We have twice had opportunities of observing the
correctness of Dr. Beneke's remark, that under continued de-
pressing mental influences oxalic-acid crystals appeared in the
urine constantly and in very large number, and that at the
same time the quantity of lithic acid became increased, while
no change had taken place in the manner of living. In another
subject we almost daily examined the urine during seven weeks
of great excitement and intense mental activity; the quantity
of twenty-four hours was not changed ; the colour was clearer ;
the specific gravity, in general 102G 1028, had decreased to
1022 1024; not a single crystal of oxalate of lime could be
detected under the microscope, while they were seen almost
always in a small number, as well before as after that period ;
the diet had not been altered ; no change had taken place in
the amount of exercise.

After shortly alluding to another source of disease, in the
disorder of the egesta (through the skin, the kidneys, the liver),
Beneke advances to the proposition and discussion of the sub-
jects for inquiry.

Whatever may be the case we have to deal with, we shall
always have to answer the questions : What is the nature of
the disease? How did it arise, and how may it be removed ?
To these questions, however, we cannot answer, without know-
ing what is the state of health, and what are the means of pre-
serving it. Our knowledge on these points is, as yet, so limited,
that they must be placed among the principal subjects of in-
quiry. If we may say that health exists when the quantity and
quality of the ingesta and egesta are normal, then we see arising
immediately the following points for investigation : '

" 1. To find the standard measure for the quantity and quality of
the ingesta of twenty-four hours.

" 2. To find the standard measure for the egesta of twenty-four
hours; for the ultimate bodies of decomposition of the different series
of metamorphosis.

" 3. To find the standard measure for the atmospheric influences.

u 4. To find the standard measure of the effect of single organs,
and of the -whole living organism on the ingesta and egesta." (p. 46.)

Many points connected with these questions are still in great
obscurity, and an exact solution of the problems is as yet im-
possible ; much advantage, may, however, be gained already
now for scientific as well as practical medicine, by an approxi-
mative investigation of the normal quantity of the ingesta and
egesta, of their dependence on the difference in the atmospheric
conditions, and in the state of the living organism.

G06

Method of Advancing Rational Medicine. [October,

The author, therefore, draws our attention, with reason, to
these points, as being the principal desiderata for pathology and
therapeutics. As the best way to form a correct idea of the
normal measure of the ingesta, Beneke advises to collect as
many accounts as possible of the quantity and quality of food
consumed in twenty-four hours by apparently healthy persons,
in the greatest possible number, in different ages, under differ-
ent atmospheric influences, &c. Much information would be
certainly gained by such observations, but we are inclined to
think, that we should gain more by the accurate investigation
of the process of nutrition and metamorphosis of organic matter
in animals, according to the manner shown to us in the admira-
ble workofDrs. Bidder and Schmidt.* The whole amount of the
ingesta and egesta, in the same animal, must be examined during
one period, when it is allowed to take as much food as it likes ;
during another period, when it takes only a limited quantity
and special quality ; then all the principal excretions (kidneys,
lungs, intestines,) during a third period, that of starvation ; the
gain or loss of weight is carefully to be marked on every day.
Accurate notes are to be taken of the atmospheric influences,
of the activity of the animal, &c, &c. Manifold might be the
variations in these experiments ; food might be withdrawn and
water permitted, according to the desire of the animal ; solid
food without any fluid ; mere vegetable or mere animal food ;
food without large quantities of chloride of sodium, of earthy
phosphates, &c. ; food as much as possible deprived of the inor-
ganic constituents, &c, &c. By this method we should find
at least how much substance is consumed and decomposed in
a starving animal, of a certain species, and of a certain weight,
under certain atmospheric influences; we should further learn,
through the quantity of nitrogen contained in the urine and in
the alvine excretions, through that of the carbonic acid and
water, the proportion of the decomposed albuminous and fatty
substance ; we should perceive how much food of a certain
quality is necessary for keeping the same animal, under certain
circumstances, in the same state ; and what is the effect of an
increase of food, according to the desire of the animal, on the
weight, on the excretions, on quickness of movements, &c.
similar observations, although they would seldom have the
same accuracy, might be made also on ourselves.

After having shown the necessity of enlarging our knowledge
concerning the state of health, Beneke proceeds to the duty of
giving the history of cases of disease, which he divides into
four parts:

* Die Verdauungssaefte und der Stoffwechsel. Milan und Leipzig, 1852.

1853.] Method of Advancing Rational Medicine. 607

" I. The account of the development of the disease given in so
accurate manner, that, by an accumulation of many cases, the (Etiolo-
gy of certain classes of disease, principally of the so-called dyscrasic
states of the blood would become more elucidated.

" II. Description of \\ie present state, in which not only the physical,
but also the physiologico-chemical symptoms must be included.

"III. Plan of treatment, according to rational and empirical prin-
ciples, from which is to arise the science of dietetics and pharmaco-
dynamics, based on physiologico-chemical investigations or on undenia-
ble empirical fa cts .

" IV. Carefully given daily records, not only of the apparent general
course of the disease, but also of all the external conditions, of all the
ingesta and principal egesta, as well in quantity as in quality." (p. 52.)

1. In the history of the development of the disease, Beneke
divides the influences which have acted on the patient into
three classes : (a) the more remote ; (b) the less remote ; (c) the
proximate influences.

(a) The more remote influences concern the parents and grand
parents, their occupation, manner of living, the atmospheric
influences under which they had been, the diseases they have
suffered from, &c, &c. We agree with Beneke, in attributing
much more importance to this part of the history of diseases
than it is generally considered to deserve. Not only in the so-
called hereditary diseases ought we accurately to examine into
the state of health of the parents, but in every single case ; we
must try to find out why in one child of the same parents the
tuberculous, in the other one the gouty, diathesis is developed,
while a third child may enjoy so-called full health what may
be the state of children whose father was suffering at the time
of procreation from syphilitic disease of the bones, while the
mother was of a gouty disposition or affected with osteo-mala-
cia? what was the state of health, the manner of living, the
residence of non-tuberculous parents whose children die of
tuberculous phthisis, &c. ?

(b) The period of the less remote influences commences with
the birth. The infantile management, the food and treatment
at different periods of life, the former and present residence, the
manner of living, as well physical as psychical, the previous
diseases the patient has been suffering from, should be taken
into consideration. We need not dwell on these points; they
are in a similar manner treated of in ' What to Observe at the
Bed-side, and alter Death, in Medical cases.'* We must men-
tion, however, that Dr. Beneke does not forget to allude, under
this head, to the very interesting subject, as yet only little in-
vestigated, in how far we are entitled to judge from the presence

* London, 1353. By the London Medical Society of Observation.

G08 Method of Advancing Rational Medicine. [October,

of a certain group of diseases on a certain state of the blood
and of the whole organism of a certain crasis, as Beneke ex-
presses himself, and from this, on the absence of another crasis.

As a single instance, he mentions that those suffering from
oxalic-acid diathesis are not liable to typhus fever ; that we
may conclude, therefore, from the previous occurrence of ty-
phus, on the absence of the first named diathesis in the same
period. The great importance of the establishment of many
facts of this kind is striking enough ; it would throw light on
the essential nature of the different groups of diseases. It is a
subject we must certainly aim at ; but the history of medicine
has also taught us, how careful we ought to be in forming a
conclusion, lest it may prove fallacious. Although we do not
think ourselves entitled to doubt the correctness of the instance
adduced by Beneke, we are as yet unable to corroborate it, and
we may refer to it to show the difficulty of establishing such a
fact. Three times we have had an opportunity of watching,
during an acute affection (twice of acute rheumatism, and once
of severe angina tonsillaris,) patients whose urine usually ex-
hibited a large number of crystals of oxalate of lime. In all
these three cases, during the whole of the acute attack, and
during the time of convalescence, not a single crystal of oxalate
of lime could be detected ; in two of the cases, they appeared
again after some weeks ; in the third case, no examination was
afterwards made. Whether the disappearance of the oxalic
acid during the acute affection depended on the increased ag-
gression of the atmospheric air and living organs on the blood,
or on the diminished ingestion of material during the time of
pyrexia, or on both causes, is of no importance to the present
question ; but these observations show, that it would be erro-
neous to conclude, from the absence of oxalic acid during the
course of acute diseases, that there is a want of susceptibility
for acute disease in those suffering from the so-called oxalic-
acid diathesis.

(c) The duty of describing the proximate influences or the
exciting cause of the disease is a comparatively easy one after
the investigation of the circumstances creating the disposition.
We must in this manner gradually find the cause, why the
same influence in one case produces pneumonia or bronchitis ;
in another, acute rheumatism ; in a third, diarrhaea ; in a fourth,
ophthalmia; and why a fifth and sixth remain unaffected by it.

II. The general outlines which Beneke gives of the descrip-
tion of the present state, and of the value which he attributes
to each symptom, fully show, that he is equally practised in the
physical and in the physiologico-chemical examinations. Eve-
ry physical symptom must be carefully observed ; this is to be

1853.] Method of Advancing Rational Medicine. 609

done, however, not merely for the diagnosis of a physical
change, but it must also help us in the solution of the principal
question the cognition of the forming material of the organ-
ism, i. e., the blood. The observation of those phenomena,
from which we may judge of the amount of the typical energy
of each organ, and of the whole organism, appears to him of
great importance.

Concerning the physiohgico-chemical examination, Beneke
considers the analysis of the blood of less importance than the
accurate examination of the process of metamorphosis of the
quantity and quality of the ingesta and egesta. Such an ex-
amination of the present state, combined with the previous his-
tory, must lead to a more complete diagnosis than is generally
made and must immediately guide us to a rational plan of treat-
ment. In order to make Beneke's views better understood,
we may be permitted to quote the outlines of a case described
in the shortest manner. The patient is a young man aged 22
years, who has suffered for the last three days from pain and
slight swelling of the joints of the hands and knees. Knowing
this, Beneke inquires first for the more remote, then for the less
remote, and then for the proximate influences. The patient is
the son of a consumptive mother, who died eighteen years ago;
his father is still alive, and is a healthy man. He was suckled
by his mother. After being weaned, he had milk-and-water
with bread for breakfast and supper ; and after the 15th year,
coffee, with bread-and-butter. Has always enjoyed his dinner ;
seldom missed meat, but has been used to eat, also, many pota-
toes and much rye-bread. He generally took much salt with
his food ; drank soft water : and after his 15th year, he had the
allowance of a quart of small beer daily. He had been always
very fond of sugar and sweet things. In his early years, the
patient lived in the country (north of Germany ;) later, he was
employed in a sugar-house in London, where he was frequently
exposed to intense heat, producing profuse perspiration. Has
never been in poor circumstances. When a child, be began
late to walk ; has since suffered much from toothache (princi-
pally from the 10th to the 15th year :) has at present eight de-
cayed teeth. When a child, he had also slight swellings in the
neck. Has not been affected with typhus or ague ; but has had
measles (without epidemic cause) in the 6th year. As a boy,
he always suffered frequently from epistaxis. On one of the last
days before the outbreak of the disease, the patient took very
large meals ; and on the day previous to the appearance of the
affection of the joints, he was exposed to a noxious cause likely
to give origin to cold (working in a cold draught of air, with
the upper part of the body sparingly covered.) The patient is

610 Method of Advancing Rational Medicine. [October,

22 years old, weighs (without clothes) 140 pounds, measures
5ft. 4in. His body is moderately developed ; muscles rather
lax ; bones thin ; colour chlorotic ; hair light ; iris bluish gray ;
conjunctiva pure, slightly-bluish white. Glands of the neck
slightly but not visibly swollen. A few spots of acne and ecth-
yma on the front and on the back of the trunk. Physiognomy
in no respect characteristic ; expression cheerful. During the
consultation, patient appears anxious ; rather hasty in his an-
swers ; the extended arm is slightly trembling. The pulse beats
110 times in the beginning, only 86 times towards the end, of
the visit: is not very elastic, feels soft, and of middle size. The
patient sleeps during seven or eight hours, but is awoke by
every little noise. The physical examination exhibits : forma-
tion and motion (Sibson's chest-measure) of the thorax normal
size and situation of heart normal, slight murmur with the first
sound at the base (anaemic murmur is heard also in a slight de-
gree in the vena jugular dextr.) ; diameter of the liver rather
increased ; sound of percussion perfectly dull. The tongue is
red, with a thin, bluish-white covering on the surface. Appe-
tite not altogether absent ; taste acid after meals. The wrist-
joints are slightly swollen, their temperature is increased, they
are tender and painful. The quantity of carbonic acid expired
is not measured. The perspiration constantly covering the
skin for the last two days has a strongly acid reaction, and a
faint smell of acetic acid; saliva slightly acid. Urine and faeces
at the first visit not seen ; during the following twenty-four
hours, about 8 ounces of faeces, of moderate consistency and
light-brown colour. Quantity of urine, 34 ounces, specific
gravity == 1030; acidity (ascertained by neutralization) = -|-
48 (-|- 15 20 being the standard in health) ; high gold-yellow
colour; on the bottom of the clear fluid, a sediment oflithates
(soluble by warming), and some crystals of uric acid and of
oxalate of lime (microscope) ; the quantity of urea (nitrate of)
does not exceed the average ; but that of lithic acid, sulphuric
acid, and the earthy phosphates, is increased ; no sugar is de-
tected, but by boiling and nitric acid some albumen is precipi-
tated. Patient has taken, during the last twenty-four hours :
water, 48 oz. ; milk, 10 oz. ; gruel and barley-water, 10 oz. ;
bread, 10 oz. ; butter, 3-4 oz. ; mixtur. gummosae, 6 oz. ; with
one drachm of nitrate of potash.

From the previous history, and the examination of the pre-
sent state, Beneke concludes, in this case, on the presence of a
complicated disorder of the blood. The scrofulous dyscrasia
which the patient inherited is connected with an (indirectly)
retarded metamorphosis of the nitrogenized constituents of the
blood, and in the former diet of the patient several things were

1853.] Method of Advancing Rational Medicine. Oil

present to promote this dyscrasia. The circumstance of his
having been late in beginning to walk, the insufficient develop-
ment of the bones, the morbid condition of the teeth, and the
flaccidity of the muscles, all point to an abnormal loss of earthy
phosphates, and therefore, also, according to Beneke's views, to
an abnormal production of oxalic acid. The result of the ex-
amination of the ''status praesens" shows an increased expen-
diture of nitrogenized material ; the presence of albumen in the
urine ; an absolute increase of lithic acid ; no absolute increase
of urea, as only a part of the lithic acid reaches that stage of
decomposition. The ingesta being diminished, we have reason
to conclude that the proportion of the albuminates of the blood
is abnormally augmented. The high colour of the urine, espe-
cially if present for a long period, indicates an impaired func-
tion of the liver, The quantity of sulphuric acid in the urine
being only moderately increased, corresponds to only a slight
degree of pyrexia and increase of change of matter. (Beneke
holds the opinion, that the quantity of sulphuric acid in the
urine, provided no combination of sulphur have been taken
except in the food, is proportional to the intensity of the meta-
morphosis of matter.) The high degree of acidity of the urine
principally depending on the acid phosphates, is frequently
caused by an increase of the azotized components in the blood,
and is, also, often a sign of the presence of a morbid excess
of soda in the blood.

From all this we may conclude, with a high degree of proba-
bility, on an increase of the azotized materials of the blood ; and,
from the diet, we must consider this increase as an indirect one,
occasioned by retarded metamorphosis of the albuminates.
Concerning the inorganic constituents, we may deduce, from
the acidity of the perspiration and of the saliva, and from the
acid taste, an augmented production of organic acid, by which
the presence of an abnormally great quantity of soda in the
blood becomes very probable ; the large proportion of salt pre-
viously taken, and the impaired expenditure of soda through
the liver, make this inference still more plausible. The in-
creased quantity of earthy phosphates points to the pathologi-
cal production of oxalic acid, which is afterwards proved by
the microscope, (p. 71.)

Our space does not permit us to give the whole semeiology
of the case, with the diagnosis and the therapeutical indications
founded on it. We will only add, that Beneke is not content-
ed with the name attributed to such an affection, " articular
rheumatism" as signifying only a single group of the morbid
symptoms ; but his diagnosis would be : chronic disease of the
blood at present augmented, {increase of albuminates and alka-

612 Method of Advancing Rational Medicine. [October,

line basis, diminution of earthy phosphates ;) articular rheuma-
tism ; hyperemia of the liver ; ancemia. (p. 73.)

We must bear in mind, however, that Beneke intends to give
by this only the outlines of a case as it may be taken by men
much occupied; and he wishes merely to show how the pro-
cess of disease is to be observed, and how the physiologico-
chemical examination may help in the diagnosis and treatment.
He has given a more elaborate case in an appendix to this work.
It may be remarked, also, that in calling the adduced case of
rheumatic affection a disease of the blood, Beneke must not be
understood as if he was considering the ultimate cause of the
disease to lie merely in the blood ; in other parts of the same
work he has sufficiently shown that he is always aware of the
intimate connection between the solids and the blood.

There are some expressions in the above case which appear
to state as facts what are, as yet, merely suppositions ; but
this we may attribute to the tendency of a concise style in
writing. For instance, we meet several times with "abnor-
mally increased production of oxalic acid," whereas the in-
creased quantity of oxalic acid in the urine is no proof of its
absolutely increased production, but only of the formation and
excretion of some oxalate which has not been further transfor-
med. "An increased production of organic acid" is another
instance of the expressions we allude to.

Concerning the treatment, the diagnosis formed in the man-
ner above described leads Beneke to the following indications:

11 1. Diminution of the nitrogenized material of the blood (small ven-
esection of about six to eight ounces, and exclusion of nitrogenized
food;) 2. Acceleration of the metamorphosis of the remaining nitro-
genized material (increase of diuresis simply by drinking more water,
and moderate doses of salts of potash, particularly the acetate. ")

He of course carefully avoids repeated or larger venesec-
tions ; he does not continue the low diet too long, nor the salts
with an alkaline basis, especially soda, which already exists in
excess ; he does not resort to frequent purgatives, by which,
according to Schmidt's excellent investigations (Cholera, &c.)
the albuminates of the blood are augmented. After having
subdued the acute attack, Beneke would not permit too much
nitrogenized food, and would warn his patient against taking
those non-nitrogenized substances, by which the metamorpho-
sis of the nitrogenized ones is most retarded (sugar, starch, &c;)
he would combat the increase of soda, and the diminution of red
bloodglobules, by mineral acids, iron, &c.

III. In the determination of the therapeutical indications
in general, Beneke reminds us again to look for the origin of

1853.] Method of Advancing Rational Medicine. 613

disease either in disorder of food and its product the blood, or
in some of the aggressive agencies.

As the organism cannot be retained in the state of health
without a certain supply of alimentary material in the proper
quantity and quality, the establishment of a system of rational
dietetics must be considered as one of the principal subjects for
inquiry. It must comprise :

a. The consideration of all the articles of food ;

b. Of the other influences of life, which all have a direct or
indirect influence on the metamorphosis of the alimentary ma-
terial.

We must therefore form tables showing the exact composi-
tion of all articles of food the quantity of water, the quantity
and quality of nitrogenized and non-nitrogenized, as well as of
the inorganic constituents. Much has been done already, par-
ticularly as regards the organic ingredients ; but much remains
to be fulfilled, and most in regard to the quality of the inorgan-
ic ones, which are of the greatest influence on the nutrition of
the organism. We must furthur learn to fix what is the proper
quantity and quality for each individual case. In doing so it is es-
sential never to omit taking into consideration weight, measure,
age, occupation, residence, with atmospheric influences, and
principally also the typical power of the nervous system. It
is doubtless the case that in a person measuring six feet, and
weighing 170 pounds, more matter is decomposed within twen-
ty-four hours, than in another only five feet high, and weighing
120 pounds, whose other conditions are, however, the same as
those of the former subject. It is ascertained that two persons
of the same hight and weight, of whom the one is low-spirited
and slow, while the other is cheerful, active, and quick in his
motions, require different quantities of food, as the metamorpho-
sis of matter must be slower in the former than it is in the
latter. Every influence, whether psychical or physical, by the
act of respiration is promoted, must increase the metamorpho-
sis of matter, and must not be forgotten in regulating the diet.
Concerning the quality, we must likewise choose it according
to each individual case. We must learn at first, whether there
is an accelration or a retardation in the metamorphosis of a cer-
tain class of alimentary materials in case of retardation,
whether a direct or an indirect one whether there is a plus
or minus of phosphates, a plus or minus of soda, &c, &c; and
according to the result of these investigations we must prescribe
the diet.

As another subject for inquiry, Beneke proposes the investi-
gation of the action of those substances the use of which is not
necessary for the maintenance of health, which may therefore

N. 6. VOL. IX. NO. X. 39

614 Method of Advancing Rational Medicine. [October,

be looked at separately from the nutriments in the proper sense
of the word as coffee, tea, spices, wine, spirits, &c, &c.
These articles of relish (Genus smitieT) certainly exercise an
important influence on the digestion and on the metamorpho-
sis of matter. Researches of some value have been made
already by Dr. Boecker, of Bon,* according to which most of
these so-called excitants do not accelerate, but retard, the
metamorphosis.

For the establishment of rational therapeutic treatment,
besides the knowledge of the nature of the disease or of what
is to be remedied, it is necessary to know the action of the rem-
edies. To achieve this, Beneke seems to put little confidence
in the statistical method as recommended by Louis and Wun-
derlish, but entertains much hope in the physiologico- chemical
experiment performed on the most healthy individnals.
It would lead too far to expose here the preferences and defi-
ciencies of the one method and the other, but we must think
the combination of both of them indispensible for the formation
of the rational pharmacology.

IV. We need scarcely remark on the necessity of not only
elaborate, but frequent records of all the symptoms in each
case, the condition of all the egesta, and the kind of ingesta.

A/ter having thus given the outlines of what is wanted for
the promotion of a rational system of pathology and therapeu-
tics, Beneke briefly, but with much clearness, alludes to the
manner in which the different observations and examinations
are to be conducted. It cannot, of course, be required from a
much-occupied medical man, that he carefully examines and
records all the different points of importance ; but most of us
might have always one or two cases in hand, of which we could
make out the history of the developement of the disease; in
which we could form besides the physical, also the physiologi-
co-chemical diagnosis, in which we could daily note the pro-
gress of the physical symptoms; the quantity and quality of the
ingesta, the atmospheric influences, the quantity of the urine,
its physical quality, its specific gravity, reaction, its degree of
acidity or alkalescence ; the approximative quantity of lithic
acid and urea; of earthly phosphates, of sulphuric acid and of
oxalate of lime ; the presence or absence of sugar ; the quantity
and quality of the alvine evacuations ; that of the perspiration,
and also the reaction of the saliva, if possible, at different times
of the day.

We must not forget to mention that Beneke gives very com-
plete schemes for the examination by which the developement

Beitrage zur Heilkunde,

1853.] Failure of Vaccine. 615

of the disease and the status prcesens may be investigated;
he gives very practical diagrams for taking record of the most
important points in the course of the disease, and another
scheme for the post-mortem examination. He proposes also
the outlines of a useful plan, according to which the chemical
examinations may "be performed. We will, however, at present
not dwell any longer on these points, as we hope to be able to
return to them ere long, when analyzing the plan for the physi-
cal as well as physiologico-chemical examination which is to
be adopted by the Society for Clinical Observation in Germa-

True it is that many of the most important points cannot be
easily observed in private practice, but doubly great is there-
fore the duty which devolves on the medical staff of hospitals.
No hospital ought to be without a laboratory, and without the
instruments necessary for accurate examination.

But the more we enter into the field of scientific examination
for the promotion of rational medicine, the more we must see
how much is to be done, and how little a single individual can
do ; with a full conviction of this fact, our author has urgently
invited his colleagues as well in Germany as abroad to unite
with him, to distribute the labor, and to work according to a
certain plan. And we are happy to say that his exhortation
has been efficient, as at the last Versammlung deutscher Natur-
forscher unci Aerzte, in Wiesbaden, in September, 1852, by the
co-operation of professor Vogel, of Giessen, and Professor H.
Nasse, of Marburg, a Society for Clinical Observation, or ver-
bally translating the rather long German title, "A Society for
United Labors towards the Promotion of Scientific Medicine,"
has been formed, which counts already among its members
many well-known German, and some English names. PIermax
Weber. [Brit, and For. Med. Chir. Review.

Failure of Vaccine. By J. A. Hixgeston, Esq.

The frequent failure of vaccination is now so generally
admitted, that statistical proofs are not requisite in order to
establish its truth. People look upon it- as an equal chance,
whether those who have been vaccinated shall be able to resist
an attack of the small-pox or not, should they be exposed to it;
while some go so far as to surmise, hastily and rashly enough,
that vaccination is all but useless. A few vote for a return to
the old variolous inoculation ; and a few, still more inconsiderate,
boldly declare themselves in favor of the small-pox itself, as the
only and the surest guarantee of their safety. There is, of
course, a great deal of exaggeration and misrepresentation in

616 Failure of Vaccine. [October,

the expressions of this sort, and much more is affirmed against
the non-protective agency of vaccine lymph, than, as is usual,
a dispassionate inquiry into all the circumstances of the case
will justify or imply. The broad and undisputed fact of the
actual diminution of small-pox since vaccination has been in-
troduced and practised, is alone sufficient to contradict these
wild notions, and to refute the vulgar prejudices afloat upon
the subject. For, even during an occasional outbreak, the dis-
ease is nothing now to what it used to be formerly, when the
old inocculation, which is itself not free from risk, was the only
obstacle opposed to its incessant and alarming encroachments.
At that time, it was a real plague of terrible malignity, where-
as it is now a comparatively mild and transient epidemic.
This well-known fact is a satisfactory answer in favor of the
protective influence of vaccination, which, if not universally,
is at least extensively serviceable and effectual. To medical
men, the occasional failure of vaccine lymph presents itself in
a very different light from that in which it is viewed by the
public at large ; and with vaccinators in particular it is a topic
of the deepest interest, which they endeavor to explore to the
best of their abilities, and in every possible direction. The
various points of inquiry offered to their notice, may be re-
duced to the few following items:

I. A chief cause is the capital oversight on the part of the
vaccinator himself, in transferring lymph from an imperfect
pock. There is no doubt that this oversight or carelessness is
a copious source of the quantity of bad lymph in circulation,
as well as of the ultimate failure of vaccination as a protective
agent. For it is a maxim in vaccinating, never to transfer
lymph from a pock in the slightest degree abnormal, nor from
a normal pock in a constitution evidently disordered or unsound ;
because, if it be so transferred, the inevitable result will be ab-
normal pocks and inefficient lymph. It is impossible to restore
contaminated lymph to its primitive purity ; no subsequent care
in its propagation can ever recover its lost or defective virtue.
Having once become devious or degenerate, it continues to
descend, both degenerate and devious, until its power becomes
extinct, and it fails to propagate itself, even in a degenerate
form. This glaring fact is so unquestionable, that it is neces-
sary to bring it forward, and place it first and foremost among
the causes of the failure of the vaccine lymph.

II. Another main cause of failure is, we must candidly own,
carelessness in the act of vaccinating. Not only is the good
quality of the lymph used not strictly inquired into at the out-
set, but, what is more unpardonable, the mode of operating is
not exactly performed. There is a right and a wrong way of

1853.] Failure of Vaccine. 617

vaccinating, just as there is a right and a wrong way of ampu-
tating, bleeding, or tying an artery. Every surgeon knows the
value of performing an operation rightly, and the evil conse-
quences to be apprehended from operating wrongly. It is the
same with vaccination, which, in its vital results, takes rank
among the capital operations of surgery, and requires, for its
proper performance, an intelligence as clear and a hand as dex-
terous as ever fell to the lot of the best of surgeons. By neg-
lecting, or by not being aware of, the precise way of operating,
it happens that so many vaccinations turn out, either eventually
or immediately, inefficient. The puncture is made too wide or
too deep, or irregular ; each of which faults materially affect
the shape and character of the vesicle; or else, if it have been
properly performed, and the lymph effectually inserted, it is not
punctually watched from day to day throughout its progress.
Success demands constant vigilance. In performing the opera-
tion, the cuticle alone must be raised, and the cutis beneath
exposed, but not wounded, or wounded as littte as possible
The cutting, or rather the scratching, of the cuticle, should be
done lightly and delicately, with the least possible irregularity,
and over the smallest extent of surface consistent with the ap-
plication or insertion of the lymph. Its course must be watched
and noted on the third, eighth, and fourteenth days in particu-
lar ; and no case can be pronounced safe, unless every step in
its progress have shown itself to be regular, critical, and com-
plete. It is very necessary to point out these causes of failure ;
first of all, because they are frequent, and seem, in a great
measure, to have lost of late years something of their due wreight
and importance in the estimation of medical men. From the
medical pupil never having been hitherto distinctly educated
on the subject of vaccination, he is naturally liable to fall into
mistakes through inexperience, which can only be overlooked
out of tenderness to his unavoidable ignorance, in consequence
of his never having been taught, ex officio, how to proceed
with scientific precision. But, upon public grounds, inexpert-
ness is inexcusable, and cannot be too severely censured and
condemned.

III. Owing to a want of attention to the proper time for taking
it, the lymph is transferred too soon or too late, and the obvi-
ous consequence is, that unripe or effete lymph is procured and
propagated. Of course such lymph is weak, or altogether in-
efficient. It ought never to be taken away earlier than the
eighth, and sometimes not before the ninth day. At too early
a day it is ichor rather than lymph. Again, it may be taken
away too late ; that is to say, after the ninth day, when it is
becoming purulent, and the vesicle is turning into a pustule.

618 Failure of Vaccine. [October,

The exact time is eight times twenty-four hours, dating from
the hour of the day of vaccinating. The lymph will remain
genuine till the ninth day is over, and sometimes even till the
tenth ; for occasionally the whole course of the pock is stage by
stage a day after its time : thus, the inflamed point of the third
day is delayed till the fourth, and the inflamed halo of the ninth
does not reach its climax till the tenth, and so on. This delay
in the progress of the symptoms is regarded as a favorable
prognosis; and certainly, in cases disposed to reject the specific
action of the virus, the inflammation and vesicle, besides their
being abnormal, rise and disappear much too quickly. Lymph
taken after the tenth day is universally reprobated ; and none
but such as are miserably ignorant or indifferent would ever
think of transferring it at this late epoch.

IV. It is advisable never to transfer lymph that has become
purulent. A prudent vaccinator never does. Not that pus
per se invalidates the lymph any more than blood does: for it
may appear on the ninth day mixed with the genuine lymph :
nor would its accidental presence alone weaken or destroy its
efficiency ; but it indicates more inflammation than is necessa-
ry for the production of the true vesicle, and it moreover signi-
fies the co-existence of an inflammation different in kind from
that which produces the genuine lymph. After the tenth day,
pus is sure to be mixed up with the contents of the vesicle,
which is thenceforth rapidly declining, and ceasing to be pro-
lific. A blow or injury of the vesicle will hurry on the appear-
ance of the tenth day, and consequently render the lymph unfit
for transfer. Sometimes the first stages of the pock are sup-
pressed, and then it breaks forth all of a sudden into its normal
appearance of the eighth day : but such a pock is invalid.

V. Many parents, especially in the upper classes of society,
object to lymph being taken away from their child's arm, lest,
as they fancy, it should weaken its ultimate effect. A preju-
dice of this kind would extinguish vaccination altogether.
Nevertheless, there are not wanting acute observers who con-
sider that, if all the vesicles be exhausted of their lymph, the
prognosis is thereby rendered unfavorable, and, moreover, that
such exhaustion causes local irritation and disturbance. In-
deed, it is affirmed that convulsions and death have ensued from
such a proceeding. Be this as it may, it is certain that every-
one concurs in the propriety of leaving one vesicle intact, for
the express purpose of judging of the normal progress of the
pock from first to last ; and no one would, we should suppose,
be so imprudent as to irritate the exposed surface with the
lancet or an ivory point, merely for the sake of draining it of
every drop of its lymph. Yet it may be well to bear in mind,

1853.] Failure of Vaccine. 619

that one of the causes of the failure of vaccination as a protec-
tive agent, is imputed to thus draining the exposed vesicle an
error which, if it be one, it is easy enough to avoid.

VI. Lymph should never be taken from any but a primary
pock. The pock resulting from a revaccination is not to be
relied on. If there is any reason to doubt the vesicle being a
primary one, it ought to be rejected.

VII. The actual or suspected presence of scrofula, syphilis,
porrigo, etc., is quite sufficient to condemn the subject of it as
a legitimate source of fresh lymph. A vesicle on such a sub-
ject, however perfect, should be allowed to die out by itself.
Indeed, any eruption of the skin is a barrier against vaccina-
tion, except under the imminent risk of catching the small-pox ;
but as to transferring matter from such a constitution, it is out
of the question.

VIII. The sudden accession of constitutional disturbance du-
ring the pock, or the increase and extension of the inflammation
around it, should render the validity of the operation more than
doubtful. A second vaccination should be attempted within
six months from the first, and the sensitive feelings of mothers
opposed to such a proceeding should be steadily overruled.
Many a vaccinator, not satisfied with a first pock, would wish
to repeat it until he felt confident in the normal character of
the last produced. But he is seldom permitted to adopt this
wise precaution : and this may be numbered among the causes
of failure in vaccinating. The forms of society tie our hands,
and force us to comply with its own conventions.

IX. The number of vesicles is said to modify the result of
vaccination. Some maintain that one alone is sufficient, while
others declare that several are requisite, to insure efficiency.
There is no proof to support either the one or the other of these
two assertions. Pathologically speaking, it would seem, apriori,
that the existence of a single good pock manifests the saturation
of the system with the virus as entirely as any multitude of
them would do. But as a matter of fact, there is nothing to
help us in arriving at a decisive conclusion respecting it.

X. The most popular notion concerning the failure of vac-
cine, is that derived from its supposed contamination by passing
through so many successive generations of mankind. This is
the most popular belief, and the one which appeals most readi-
ly to the greater number of minds. Nevertheless, of all the
different reasons alleged for accounting for the acknowledged
fact of deteriorated lymph, this would seem to be the most un-
tenable. It is an hypothesis built up in the face of facts that
directly contravene it. For genuine lymph, dating from the
time of its first introduction, continues to produce a genuine

620 Failure of Vaccine. [October,

vesicle from a genuine vaccination performed on a subject in a
genuine state of health, as exactly now as it at first produced
it under the hands of Jenner himself. Lymph, fresh from the
cow, is certainly more energetic than such as has been long ago
in use ; but the pock that it produces is identical, and its imme-
diate and ultimate effects upon the constitution are the same.
This hypothesis, likewise, fails in explaining the failures that
happened even in persons vaccinated by Jenner. We must
look for the cause of deteriorated lymph in other sources than
this.

XI. Dry lymph is said to be another cause of failure, and the
use of liquid lymph is enjoined. No doubt, liquid lymph, and
vaccination from arm to arm, is always preferable, but it cannot
always be brought about. Besides, there is no solid ground
for supposing that the virus, when dry, upon points, between
glasses, or in a crust, is not equally as active as when it is still
moist and quite new. Every vaccinator is aware of this.
Lymph may be taken to India and brought back again, and
still prove energetic and effective. After all that has been said,
the most apparent cause of failure is that of vaccinating with
lymph taken from an irregularly formed vesicle, or from an
unsound constitution, or at a wrong date of the pock. Inde-
pendent of all other causes, this inadvertence or carelessness
cannot be overlooked. The signs of an obnoxious or doubtful
vesicle ought to be closely studied. They are both constitu-
tional and local. The health may be cachectic, the child
suffering from debility, or some congenital infirmity or malfor-
mation. In these instances the pock is worthless. Regular
vesicles may coexist with an irregular one, which alone is suf-
ficient to invalidate the integrity of all the rest unless its
irregularity can be accounted for by something purely acci-
dental. The following eight points should be impressed on the
memory: 1. Irregularity of form throughout all the stages of
pock. 2. The vesicle not being round. 3. The color of the
inflammation not being fresh and rosy, and that of the vesicle
not of a pearly whiteness. 4. Its fluid contents being straw-
colored, instead of colorless and transparent ; or else being
purulent on the eighth day instead of the tenth. 5. The areola,
or surrounding inflammation, not being defined and circular,
but, on the contrary, irregular, confused, and, as it were, blend-
ed with the vesicle, whereas it ought to be distinct from it.
6. The crust forming prematurely, looking pale or yellowish
brown, and being friable and gritty, instead of dark, round and
compact. 7. The vesicle forming on the fifth day, and rising
up of a conical shape, or festering like a small pustule. 8. The
areola becoming efflorescent, or scurfy, or shooting out into a

1853.] Relations of Vaccination, fyc, to Small-pox. 621

figure like the margins of a map. All such cases should be re-
jected without hesitation, and a second vaccination should be
earnestly advised. It is by vaccinating from vesicles, more or
less imperfect according to this description, that so many fail-
ures are recorded. [Assoc. Med. Jour.

Relations of Vaccination and Inoculation to Small-Pox.

From a very interesting and valuable paper upon this subject,
communicated to the Epidemiological Society of London, by
Dr. Waller Lewis, F. G. S., we take the following extracts.
The author commenced by considering the various questions
in regard to this disease, of which an elucidation is now anx-
iously called for. He then stated numerous cases illustrative
of the protective power of vaccination, and of the superiority
of vaccination to inoculation. He then referred to the proba-
bility of the fact that measles are rendered milder by vaccina-
tion.

" Joler has described an epidemic of measles that took place in
Retzat Circle, in Bavaria, in the district where he himself resided.
He says that the disease was much milder among the vaccinated than
among the unvaccinated ; 15 in 52 died among the non-vaccinated,
while barely 1 in 300 died among the vaccinated, showing that mea-
sles was 86 times more fatal among the former than the latter."

Examples of imperfect vaccination were then dwelt upon,
and the autk)r expressed his opinion clearly and decidedly that
where well-marked cicatrices were not left, the operation should
be accounted a failure, and should be repeated, although he
owned that this was not the opinion held by many German and
English physicians.

Vaccinating from re-vaccinated persons, from those who had
been inoculated, and from such as had previously had small-pox
was strongly denounced, as vaccinia must be extremely modi-
fied in such cases. The author added :

" When we interest ourselves strongly in the propagation of vac-
cination, we must guard ourselves from furnishing arms to its adver-
saries. And is it not furnishing them with arms to employ a virus of
which we are not certain ?"

A most interesting collection of cases was then read, in which
small-pox had attacked the same individual three or four times ;
among others, the following, that had come under the author's
own attention, was narrated :

" Robert D., a tradesman, living in North Audley street, had small-
pox the first time at the time of his birth, his mother suffering from it
at her confinement. He was attacked with the disease a second time

622 Relations of Vaccination, fyc, to Small-pox. [October,

when a boy at school, between nine and ten years of age. When
eighteen years of age, he took it, for the third time, from his sister,
who died of it. All the attacks were severo, but the last the most so.
He lost his hair and his nails, and the skin of his feet ; he was blind
for several days, and his life was despaired of. However, he is still
alive, and not much disfigured. He was never vaccinated nor inocu-
lated. I believe, if again exposed to the disease, he will take it again."

Cases were then adduced to show that several members of
the same family appear sometimes to show great susceptibility
to take the disease. The following curious case of small-pox
in the lower animals was then adduced, the author adding, that
any similar well attested cases would be very valuable addi-
tions to the facts collected by the Society on this subject :

" The following case was related to me by a lady of rank, on whose
veracity I can place the greatest reliance. Some years ago, just
after her confinement, she was seized with small-pox. It became
necessary to have her breasts drawn, and, as no child could be ob-
tained, recourse was had to a puppy, which answered the purpose.
At the usual time the puppy sickened, and had the disease known by
the name of the "distemper." It is said that vaccination, when suc-
cessfully performed on puppies, will almost to a certainty prove a
prophylactic against distemper."

Then followed some interesting cases of individuals who
could be neither vaccinated nor inoculated. The last cases
adduced were of individuals who appeared to have perfect im-
munity from small-pox.

"I have detailed the case of Robert D., who evident^ possesses a
strong innate susceptibility to the action of the small-pox virus, as
shown in his having already taken the disease three several times.
I have now to draw your attention to a case the most directly opposite
to this. Strangely enough, it is that of his own brother, Thomas.
From the elder brother, Robert, as well as a sister, having taken the
small-pox, the parents believed that all their children must take the
disease, and refused to have the subject of this case vaccinated or
inoculated. He was accordingly exposed when a child to the conta-
gion, lying in the same room with his sister, while she was suffering
from the disease, as well as waiting on his brother in his second and
third attacks. Although since that time he has been several times
exposed to the contagion, he has never felt the slightest ill effects

from it Examples of persons possessing a natural

immunity from the disease are rather numerous. Dr. Jackson, of
Philadelphia, saw a man at the small-pox hospital, engaged in laying
out and burying the dead, who had never had an attack of the disease.
He had been frequently inoculated and vaccinated, but always unsuc-
cessfully. Van Swieten speaks of a physician, 70 years of age, who
had practised through numerous epidemics of the disease, but had
never taken it. Diemerbrock states that immunity from small-pox

1853.] Origin of Epidemic Diseasss. 623

was a privilege of his family. It was possessed, he asserts, by his
grandfather, grandmother, his father and himself."

The author drew the following deductions from the cases
adduced :

" 1. That vaccination is a most eminent protection against small-
pox.

" 2. That when perfectly performed it is almost, and, in some
instances, more protective, than inoculation or small-pox itself.

"3. That it appears to render some exanthemata, e.g., measles,
milder than they would have been otherwise.

" 4. That neither vaccination, inoculation, nor small-pox, guaran-
tees the individual, in every instance from small-pox.

" 5. That small-pox attacks some persons three times, or oftener.

"6. That there exists certain individuals who have perfect immu-
nity from vaccination, inoculation, and small-pox.

"7. That great susceptibility to, or perfect immunity from, small-
pox, is sometimes found to be common to several members of the same
family." [Western Journal of Med. and Surg.

On the Influence of Noxious Effluvia on the Origin and Propa-
gation of Epidemic Diseases.

Although some diversity of opinion prevails among medical
men in reference to epidemic disease, especially on the subject
of contagion, all are agreed as to the noxious influence of over-
crowding, defective ventilation, and other similar defects,
prevalent in populous districts. It has occurred to me, that,
without entering into the wide field connected with the nature
and operation of noxious effluvia in general, it might not be
altogether unprofitable if some elucidation of the facts which
have fallen under my observation, both as regards the causa-
tion of, and exemption from epidemic disease, weie laid before
the members of this Society. No one is more ready than my-
self to subscribe to the doctrine so well enunciated by my
friend, Dr. Carpenter, in his valuable paper " On the Predis-
posing Causes of Epidemics," that it is not simply the collection
and tabulation of facts, nor even mere empirical generalization,
that will suffice ; it is the principles and laws springing out of
them which are demanded, if sanitary investigations are to be
raised to the rank of a science. But fully recognizing this as
constituting the great aim and end of all these researches, and
not forgetting the large amount of practical knowledge acquired
of late years, it yet appears to me that there is abundant room
and ample reason for elucidating evidence. Many points of
prime importance to the public health as to matters of fact are
still in much uncertainty. Doubts relating to agents assumed

G24 Origin of Epidemic Diseases. [October,

by sanitary inquirers to be deleterious still linger in the profes-
sion, and by no means only among its least distinguished or
influential members. The exact operation of animal effluvia,
of a cesspool atmosphere, of excessive moisture conditions of-
ten combined in the miserable courts and alleys of our large
towns is by no means fully ascertained. Extended inquiries
of late years have abundantly proved that the same deleterious
agents operate as predisposing causes in regard to the whole
class of zymotic diseases ; that what will develope the exciting
cause of fever will also develope scarlatina, small-pox, diarrhoea,
or cholera. So certain and notorious is this fact to those who
practise among the poor, that before the outbreak of any epi-
demic, knowing where the predisposing causes are rife, they
can foretell the precise localities where it will occur, nay, even
name the alley or point to the exact house that will suffer.
Such considerations have long induced me to conclude, that in
regard to zymotic affections, the predisposing are infinitely more
important than what are called the immediate or exciting
causes. In regard to low fever, for example, it is certain that
its efficient cause, the materies morbi, is never absent from
London and other large towns ; and yet it is rarely, many
would say never, developed, unless there be superadded to it
some predisposing cause. So true is this, that we not only
daily see in the metropolis and elsewhere hundreds and thou-
sands of persons living in the front streets exempt from typhoid
fever, while the inhabitants of the wretched courts behind are
scarcely ever free from it ; but if by chance a given number of
persons are planted in the very centre of an epidemic district,
but freed from the predisposing causes of zymotic affections,
they also, as a rule, will still escape.

" On the Influence of Human Effluvia. According to my observa-
tion, the most injurious of all the causes operating on the diffusion of
epidemic diseases, are the effluvia proceeding from the human body,
particularly from the lungs and skin. The special deleterious agent
consists of the effete, and, as it has been proved experimentally, highly
putrescent organic matter, mingled with the expired air. That it is,
when reintroduced into the living body, highly injurious, might be
inferred from the very fact of the careful provision made by nature
for its incessant elimination from the system. That it is small in
amount is no objection to the intensity of its action ; for, to the physi-
ologist it is well known that a minute quantity of a powerful agent
the putrid matter introduced on the point of a needle in the inspection
of a dead body, a single drop of concentrated prussic acid placed in
the mouth of an animal, is sufficient to destroy life. It is in over-
crowded bedrooms, in unventilated schools, workhouse dormitories,
&c, that this effete matter taints the air, and, entering the blood, poi-

1853.] Origin of Epidemic Diseases. 625

sons the .system. Although there is a great diminution in the amount
of carbonic acid in. the air evolved in the lungs, still the evil, quoad
the development of fever, scarlatina, cholera, and so forth, depends on
the organic, not the chemical products of respiration."

The learned author referred to some experiments proving
the truth of this assertion. He then continued

"It is, however, familiar to all practitioners, that human effluvia
specially exhibit their poisonous influence when either multitudes of
human beings are crowded together, or where a smaller number are
placed in confined and unventilated sleeping places. Many instances
of the influence thus exerted on all kinds of epidemic disease, have
come under my notice, but only a few illustrative examples can here
be adduced. The following case illustrates the effect of overcrowding
in respect to cholera. During the epidemic of 1849, the inmates of
a reformatory establishment for young women suffered intensely from
the pestilence, 40 out of a total of 96 being attacked, and 15, or rather
more than 15 per cent., falling victims to the disease. Now, these
poor sufferers were previously in perfect health ; they were well fed,
well clothed, and carefully attended ; but the dormitories were low
and much crowded ; the windows, for the sake of seclusion, were
partly closed up, thus greatly interfering with the ventilation. After
a careful investigation, I could detect no other cause than this for the
sudden outbreak occurring at a period when there was little cholera
in the neighborhood. As regards the influence of overcrowding in
the development of low fever, I may appeal to the experience of every
medical practitioner whose duties call him much among the poor. It
matters not whether we speak of the closely packed common lodging-
house, of rows of houses built back to back, of the small, unventilated,
and often single sleeping apartments of the mechanic, or of the ill-built
cottages in rural districts, with their one bed-room, overhanging thatch
and small lattice, wherever, either from the presence of numbers or
the absence of ventilation, you have the fetid sickening air generated
by human effluvia, there assuredly you will find fever. Although
observed especially among the poor, fever, as it occurs in this coun-
try, is not especially dependent on poverty and destitution. Want
may, indeed, aggravate the evil, and actual famine, as we unhappily
saw a few years ago in Ireland, may give immense development to
typhus ; but that persons well fed, living in comfort, and strong in
health, may suffer severely from low fever, is shown by a large expe-
rience. One of the best examples, perhaps, is furnished by the sail-
ors belonging to the collier vessels frequenting the Thames. These
men, as a body, are in the prime of life, robust and well fed ; but as I
found by examining many of these vessels, the place where they
sleep the forecastle is excessively small and confined, and with this
serious additional evil, that as the hatchway is usually flush with the
deck, whenever there is much sea, it becomes necessary to close the
hatchway, where the unfortunate sailors must be without any win-
dow, as if shut up in a close box. When, too, the vessels come to

026

Aphonia relieved by Iodine Inhalations. [October,

London, as only one man is required to keep watch at night, all the
sailors are crowded at the same time into their closely-packed berths.
Some years ago the attention of Mr. Busk, the distinguished surgeon
of the seaman's hospital ship, was attracted to the large number of
typhus cases which were admitted. Iu 1841, they amounted to 147 j
in 1842, to 167. It appeared that of all the vessels in the Thames,
the colliers furnished the most fever cases. In investigating this
question I could detect no other cause than the polluted air these men
must have breathed in the confined forecastle. That there is nothing
connected with a sailor's mode of life to expose him to typhus, is
proved by the experience of well-managed vessels, and, as one among
the many proofs which might be adduced, I may mention that Mr.
Clark, who has made ten voyages to India as surgeon in Messrs.
Green's fine vessels had never had a single case of typhus."

The author, after referring to the very great improvement in
the health of those of the working classes who inhabit the model
lodging-houses erected in different parts of the town by the
Society for the improvement of the Dwellings for the Laboring
Poor, and to the highly satisfactory working of the admirable
act carried by the exertions of the Earl of Shaftesbury for con-
trolling common lodging-houses, said that his own experience
of the deplorable conditions of these abodes corroborated the
statements of Capt. Hay; all tended to show that such pesti-
lential places were the habitats of disease, and the cause of
enormous expense to the rate-payers. [London Medical Times
and Gazette.

Aphonia of twenty months standing, relieved by Iodine Inhala-
tion. By Edward B. Stevens, M. D., Lebanon, O.

In a communication to the American Medical Association,
in its Vol. of Transactions for 1850, Prof. Pancoast has given
the record of two cases of loss of voice. The one of six, the
other of seven months standing, both cured by inhalation of a
dilut. colorine vapor.

In connection with these cases, Dr. Pancoast remarks : " The
form of aphonia here alluded to, is that which many practi-
tioners must have met with, following an ordinary cold, without
leaving any perceptible organic lesion in the pulmonary appar-
atus. The voice is reduced to a faint hoarse whisper, distin-
guishable only at the distance of a few feet, and at continued
attempt to talk, though it gives no pain, becomes quickly at-
tended with a feeling of fatigue, as though there was some
obstruction to the passage of the air through the larynx. In
breathing merely, there is little or no difficulty, in these cases,
as the individuals are capable of undergoing considerable ex-

1853.] Aphonia relieved by Iodine Inhalations. 627

ertion without very unusual signs of fatigue. The difficulty
has appeared to me to be in the paralyzed condition of the
muscles of the larynx, whose business it is to dilate the rima
glottidis, during the act of articulation."

The conclusion of Dr. Pancoast is, that such agent as will
excite a healthy and proper degree of stimulation in the affect-
ed structure ought rationally to restore the power of articulation.
He consequently used the dilut. clorine vapor, with entire suc-
cess in the two cases referred to, at the same time suggesting
that iodine, or other similar agents would doubtless produce a
similar effect.

The following case of this kind lately occurred in my prac-
tice, chiefly remarkable from the long duration of absence of
voice, being twenty months, in other respects similar to those
related by Dr. Pancoast.

April 6, 1853. Miss applied for medical advice and
treatment, in a case of loss of voice, of twenty months stand-
ing, supervening upon a slight attack of influenza. Has been
subject to brief attacks of hoarseness, lasting for a few days at
a time, for several years. General health delicate. Since the
present attack, has been subject to a great variety of treatment,
including the application of nit. silv. in strong solution, within
the larynx by means of the sponge probang. Nothing, how-
ever producing any effect upon the voice. I find upon careful
examination, no especial evidence of disease in the fauces;
there is an entire inability to produce sound of any description
with the proper vocal organs ; all attempts at speaking are
made with the lips whispering. But not being able to divest
myself of the idea that a follicular inflammation of the throat
and bronchial tubes was the cause of the mischief in some way,
I commenced the treatment by directing the inhalation of nit.
silv. prepared with the lycopodium, as an inpalpable powder,
and inhaled by means of the apparatus introduced by Dr. Ira
Warren. This treatment was faithfully persevered in for one
month, with no better results than the previously tried reme-
dies.

May 7. Acting upon the idea suggested by Prof. Pancoast
of paralysis of the muscles of the larynx, I now determined to
try the iodine vapor. I accordingly selected an apparatus,
consisting of a metalic vase or urn, with a close fitting cover,
flexible tube, and mouth piece attached, (used some years since
for breathing medicated vapors in the treatment of consump-
tion.) And directed my patient, after filling the vessel half
full with hot water, to drop in 20 drops tinct. iodine, and in-
hale the vapor produced by heated water. Inhalation to be
repeated once to thrice daily, according to the irritation or

628 Per- chloride of Iron Injection in Aneurism. [October,

effects, otherwise, produced. The first inhalation produced
great nausea for a short time, and copious bloody expectoration
but accompanied by an almost immediate, though partial resto-
ration of voice. The dose of iodine was directed to be redu-
ced to 15 drops ; and thereafter no unpleasant effects were pro-
duced. The voice continued to improve steadily under this
treatment, until at the end of a week it had acquired the natur-
al fulness and distinctness of tone.

June 15. More than a month has elapsed since the restora-
tion of voice ; it continues distinct and natural. [Western
Lancet.

Aneurism of the Supra-orbital Artery cured by the Injection of
the concentrated Per-chloride of Iron. By M. Deslong-
champs.

At a meeting of the Surgical Society of Paris, March 30th,
1853, M. Larrey presented the details of a case of aneurism of
the supraorbital artery, communicated by M. Deslongchamps,
a military surgeon.

A patient of the latter presented a tumour upon the supra-
orbital region of the size of a pigeon's egg, in which a regular
pulsation was very manifest. The pulsation was increased by
pressure above the tumour, but disappeared when pressure was
made below or directly upon it.

M. Deslongchamps was convinced that the tumour was of an
aneurismal nature, and as its locality was favorable for that
method, he determined to treat it by compression. A pad
kept in place by a watch-spring, compressed the artery for
twenty-five days, but the tumour did not diminish. M. Des-
longchamps then resolved to employ the plan indicated by the
experiments of M. Pravaz.

An aid obliterated the course of the vessel above and below
the aneurism, and the operator made a minute puncture with a
bistoury in the internal portion of the sac. A syringe was
introduced into the sac, and about ten drops of concentrated
per-chloride of iron was injected. In three minutes the tu-
mour became hard, and no pulsation could be detected. The
syringe was withdrawn, and not a drop of blood escaped.

The following day there was considerable inflammatory swel-
ling, which was combatted by resolvent applications and re-
pose. The second day the tumour had returned to its original
volume ; pulsation could no longer be detected, and after seven
or eight days, during which there was a slight sero-purulent
discharge from the little wound that had been made, the tu-
mour gradually diminished in volume ; about one month after

1853."| Elective Elimination of the Secretions. 629

the operation nothing could be seen of the aneurism except, a
slight ledness and thickening of the skin. \_V Union Medicale*
Virginia Med. and Surg. Journ.

On Elective Elimination by the Salivary and other Secretions.
By M. Cl. Bernard.

In this paper M. Bernard calls attention to the fact, that some
of the secretions rapidly eliminate certain substances, while
other substances, equally soluble, are either eliminated much
more slovviy, or not at all. He relates the results of a series
of experiments, in which iodide of potassium, iodide of iron,
lactate of iron, cane and grape sugar, and yellow prussiate of
potassa, were injected into the veins, and the various secre-
tions then tested for their presence.

Of these, iodide of potassium appeared, at latest, in from 30
to 40 seconds in the saliva, and was also rapidly observed in
the tears and pancreatic juice. It required more than an hour
to become detectable in the urine or the bile; and if injected
in very small quantities, was not found in these at all. Intro-
duced into the stomach, and especially fasting, it was found in
the saliva in 1 J minute. The yellow prussiate of potassa was
not discernible in the saliva, while in 7 minutes it was found in
the urine and abundantly eliminated ; the serum of the blood
also exhibiting a notable quantity in an hour and a half. It was
also found in the bile, while, although it was thus circulating
in t-he blood, no traces of it could be found in the pancreatic
juice. Grape and cane sugar never passed into the saliva or
pancreatic fluid, while it was manifested in the bile and urine,
though less rapidly than the prussiate. As various authors
state they have detected sugar in the saliva in diabetes, the
author examined that of several such patients under M. Raver's
care. In none was sugar detected, although the bronchial
mucus and sputa evidently contained it. The mammary glands
which, in the normal state, contains the sugar of milk in its
secretion, refused passage to grape or cane sugar, even when
these substances existed in large quantities in the blood. A
saturated solution of lactate of iron, thrown into the veins, nev-
er gives rise to iron in the saliva ; but when the iron is injected
as an iodide, it obtains admission into the saliva, both the iron
and the iodine being then detectable.

This expulsion of certain salts by this or that secretion, is
not the only peculiarity the history of elimination presents.
Some substances are eliminated rapidly and completely, while
others remain within the tissues for a more or less long period,
It is well known that certain of these, as mercury, antimony,

n. s. VOL. IX. no. x. 40

630 Arsenic in Chronic Scabies. [October,

and arsenic, become localized in certain organs e. g., the liv-
er and are then gradually eliminated : but it has not been
noted that others, as the iodide of potassium, which are per-
fectly soluble, and remain soluble in the economy, wherein
they circulate without enduring any accident, may remain for
a certain time in the substance of the organs. Two or three
weeks after iodide of potassium had been introduced into the
stomachs of several dogs, and long after its supposed entire
elimination by the urine, in which it had ceased to appear, it
was found in the saliva and gastric juice. If, however, purga-
tives were employed after administering the iodine, it ceased to
be detectable in a few days in any of the secretions. [Archives
Generates, from Med. Chir. Rev.

Arsenic in Chronic Scabies. By Philip H. Williams, M. D.

Case. I was consulted, February, 1852, by H. B., aged 22,
who stated that she had been suffering from an eruption during
nine successive months. The description clearly indicated
scabies ; and the appearance on the arms, wrists, fingers, legs,
ankles, and toes, left no doubt as to the nature of the disease.
There were a few scratched spots on the face, which, although
a comparatively rare seat of scabies, appears in chronic cases
liable to be affected. The itching was, and had been, com-
mensurate with the extent of the malady. Various applications
had been tried without benefit. On the hands and toes several
distinct pustules had recently occurred, which, in the words of
Dr. Bateman, were "moderately inflamed round their bases,
and maturated and broke in two or three days ; then ulcerated,
with increasing pain and inflammation." Hence it would seem
that the decidedly purulent species (scabies purulenta) was su-
pervening on the ordinary development. The pustules subse-
quently appeared on other parts, especially on the arms and
thighs, and remained after the simple eruption had died away.
The constitution, at the commencement of the attack, was
stated to be good ; and at the time the patient came under my
notice, the health was not impaired. The catamenia were
quite regular. 1 prescribed sulphur ointment, giving iodide of
potassium and sarsaparilla in the usual doses, and compound
rhubarb pills at proper intervals. This treatment was con-
tinued for a month, with very little success. I then ordered
three minims of the liquor potassae arsenitis to be taken three
times daily, in camphor mixture. At the end of three weeks
the face became quite free from all traces of the eruption, and
at the end of the fourth week the disease was declining over
the body generally. The mixture was omitted for a few days,

1853.] Aconite in Rheumatism. G31

in consequence of slight headache* niul was ihen resumed in
the same dose, twice daily. In ihree weeks from that dale, the
patient was cured, with the exception of some of 1 he larger
pustules, which were not healed until a fortnight afterwards.
Pouhices oflinseed meal were applied to them.

Up to the present time there has been no return of the
malady.

A younger sister of the patient suffered at the same time
from simple scabies, which yielded at an early period to sul-
phur ointment and tonics. A companion of Harriet B. also
contracted the disease, which became chronic, and required the
same arsenical treatment for its removal. [Assoc. Med. Jour.

On the Treatment of certain cases of Rheumatism with Aconite.
By G. W. Balfour, M. D.

While the employment of aconite in rheumatic fever, where
it is desirable speedily to affect the system, entails an amount
of care and watching, from the powerful nature of the remedy,
which renders it unsuitable for country practice, there are cer-
tain cases of sub-acute rheumatism for which it is most suita-
ble. These are chiefly synovial in character, with a more of
less marked febrile state of the pulse. Where that is wanting,
as in more chronic cases, aconite is rarely useful. Jn less urgent
cases of affection of only one joint, and in many cases of sciati-
ca, regulation of the bowels, and the local employment of the
aconite, are often sufficient.

As aconite, without being cumulative in its action i. e., it is
never prolonged or developed after the immediate action ol the
last dose has ceased, yet has this peculiarity, that one dose paves
the way for another, rendering its action more powerful often
than was to be anticipated, the dose requires to be very cau-
tiously increased, and very often gradually diminished. I have
in one case gradually increased the dose of Dr. Fleming's tinc-
ture to ten minims thrice a day, and as gradually diminished it
to one; still keeping up the same amount of action. The
patient was much benefited, but not cured. Sometimes it
produces symptoms of gastric disturbance, which, when they
threaten, are best prevented by giving the aconite after a meal.

Diaphoresis was believed by Stork to be one of its principal
actions, yet Dr. Fleming never observed it, and I have only
seen it once ; but in that case it was most copious, the whole
bedding being saturated after each dose. The patient was not
benefited by his perspirations, and on account of them the
aconite was stopped. To obtain the curative action of the
aconite, its physiological one requires to be fully developed

632 Physiology of Sea-sickness. [October,

the coincidence of the two is generally well-marked. It is best
given in plain water; and for external use, its tincture may be
mixed in various proportions with plain soap liniment. The
presence of opium, so often combined with it, is unfavorable
to the development either of its physiological or curative ac-
tion. [Monthly Journal.

The Physiology of Sea-sickness. By Marshall Hall, F.R.S.

I have recently made a voyage from Liverpool to the United
States, and I seized upon this occasion to study the physiology
of sea-sickness.

All of the phenomena of this disease induce me to believe
that the spinal cord is the nervous centre, and that the pneumo-
gastric, diaphragmatic, intercostal, and abdominal nerves, are
the eisodic and exodic nerves which, in connexion with this
centre, present the origin and course of the catastaltic and
diastaltic actions, in these circumstances.

It appeared to me that the rolling and pitching of the ship
influenced especially the course of the blood in the spinal cord ;
when the vessel rises, the force of the impulse of the blood upon
this organ is diminished ; when it Hills, the impulse is augment-
ed. There is then constant change in the force of this impulse;
from which results perpetual excitement and irritation of the
cord, of the pneumo-gastric and diaphragmatic nerves, etc.

The movements of a carriage or of a swing, if they are long
continued produce the same effects upon very susceptible per-
sons.

The influence of the position of the body, by which the
movements of elevation or depression are increased or dimin-
ished, is very remarkable. If a horizontal position in the di-
rection of the axis of movement of the vessel is selected and
is preserved, the traveller may escape sea-sickness, and it is
only upon changing this position that he suffers the first symp-
toms.

At first he experiences an indescribable uneasiness, a faint-
ness at the stomach ; presently acidity, eructation, hiccough
supervenes; these symptoms being produced by the influence
of the pneumo-gastric and diaphragmatic nerves upon the
secretions and movements of the stomach, of the diaphragm,,
etc. Almost simultaneously the patient becomes pale, and the
action of the heart becomes feeble and irregular, and sometimes
palpitations occur ; this also is an affection of the pneumo-
gastric nerve. One of my friends suffered for years from irre-
gular action of the heart, after experiencing violent sea-sickness
during a voyage of a few hours. Lastly, nausea occurs, and

1853.] Therapeutical Record. 633

distressing vomiting ; the stomach is first emptied, and after-
wards bile, mucus, etc., is ejected.

The phenomena are repeated by paroxysms; a suffocating
sensation of heat compels the individual to throw off the cloth-
ing, the warmth of which had been previously agreeable; then
vomiting takes place, the pores of the skin are opened and a
cold perspiration occurs, which is followed by a sensation of
chilliness ]t is impossible to convey any idea of the complete
prostration that the patient experiences during an attack of
sea-sickness, both morally and physically. In one case, that
of a young lady, this cruel disease terminated in death.

Before and after the paroxysms, the action of the pneumo-
gastric nerve is defective; its influence as an internal excitor
of the respiration, is imperfect; this state is relieved by the
free exposure of the face, and even of the hands, to the open
air, and especially to the fresh wind, and by strong voluntary
efforts of inspiration.

If the sea becomes calm, one becomes habituated to a slight
movement, but if a storm arises, he is presently sick again. I
had enjoyed six days of physical comfort, when we experienced
the effects of a gale; I suffered from sea-sickness for forty-eight
hours. \_Comptes-rendus de V Academies des Sciences. Virgin-
ia Med. and Surg. Jour.

Therapeutical Record.

Anchylosis. In partial anchylosis of the knee-joint, Mr.
Hancock (Lancet, Jan. 20) has met with great success from
forcible extension, while the patient is under the influence of
chloroform. Only in one of six cases did inflammatory symp-
toms follow.

Ascites Teissier (Gazette des Hop., 1852, p. 120) relates 3
cases of ascites treated by iodine injections, composed of (30 to
70 grains of iodide of potassium, 7 to 10 diachms of tincture of
iodine, in 6 ounces of water. The iodine was rapidly absorbed
and excreted through the kidneys.

M. Ore (Bull de Ther., Sept. 1852) has used iodine injec-
tions in 5 cases: two were cured ; three died, but not from the
injection. The first effects were sinking, pallor of face, lower-
ing of pulse, and severe pain ; in ten minutes these symptoms
went off; subsequently, there was heat, pain, fever, some me-
teorism, colic, and sleeplessness. No important peritonitis,
however, ever appeared to come on. The strength used was
one part of the tincture to three of a vehicle. The remedv is
contra-indicated in ascites, dependent upon liver or heart affec-
tion, or when there is kidney-disease. When the ascites is
from peritonitis, or follows ague, the injection is to be used.

031 Therapeutical Record. [October,

Buboes. M. Bonnafont (LTnion Medicate, 1852, No. 155)
describes a plan of treating Biippumling buboes, by which he
snys much liine is saved, and unsightly scars are avoided.
When the bubo is quite ripe, it is pierced in its most tense part,
and in the direction of the ileo-pubic axis, by a seton needle,
carrying four threads. The two apertures of entrance and
exit of the needle must be formed beyond the perimeter of the
phlegmasia of the skin. The pus is gently but effectually eva-
cuated by pressure, and then compression is applied by means
of pieces of agaric or a dostil, occupying all the space between
the apertures without obstructing them. To these scraped lint
is applied, and the whole is supported by a spica bandage. In
the evening, somewhat forcible compression is again to be ap-
plied, so as to empty the abscess: and the pad is to be again ap-
plied. This is to be repeated twice daily until complete cure.
Care is to be taken not to draw out the threads unless free dis-
charge is secured, and their ends should be tied together. The
medium time a bubo so treated requires for cure is twenty days
although some are cured in ten; and the points made by the
sea: on leave hardly any marks. When the bubo has been
opened before the entire gland had suppurated, the case is
sometimes more tedious, a clear or sanguinolent fluid continu-
ing to ooze. In such cases, vinous injections, combined with
compression, have been found useful.

Cancer. M. Devay (Gaz. Med , 1852. No. 52.) of the Hotel
D.eu Lyon, has long been engaged in investigating the therapeu-
tical propeities of conium in cancer, being of opinion that
Storck's experiments should be resumed with the aid of the
improved chemical knowledge of the present period. He finds
the best preparations to be an extract and balsam, containing
1 per cent, of conicine, made from the seeds of the plant, gath-
ered when at maturity, of full weight, and of an ash-grey
colour. As the result of his researches he states. 1. That an
ointment, applied externally, in chronic enlargements of scrofu-
lous glands, possesses a resolvent power greater than that of any
other substance. 2. In engorgements of the uterus, or inflam-
matory hypertrophy of the organ so frequently complicating
its prolapsus or deviation this medicine, employed internally
and externally, is of great service. 3. In cancerous affections
it exerts remarkable calming effects, and in some cases even
cures seem to have resulted from its employment, especially
in the atrophied form of scirrhus. Its use is less satisfactory
in soft and rapidly increasing tumours, but the progress of some
of these has seemed to be retarded. In other cases.' it has
diminished the size of secondary tumours, rendering the pri-
mary oaes more amenable to surgical operation. As a moans

,

1853.] Therapeutical Record. 635

of assuaging suffering, whether used topically or taken internal-
ly, it is invariably preferred by the patients to opium and all
other narcotics.

M. Manec, surgeon to the Salpelriere has just obtained a
recompense of 2000 francs from the Academie des Sciences
(Gaz. Med., 1853, No. 19,) for the perseverance he has shown
in investigating the action of Frere Gome's Arsenical Paste in
more than 150 cases of cancer, in some of which he obtained
unhoped-for results. His experience leads him to these con-
clusions: 1. That the arsenical paste penetrates the cancer-
ous tissue by a sort of special action which is limited to it.
This action is not simply escharotic, for beneath the superficial
blackish layer, which the caustic has immediately disorganized,
the subjacent morbid tissue seems struck with death, though
it may retain its proper texture, and almost its ordinary ap-
pearance. . Later, the cancerous mass is separated by the elim-
inatory inflammation which is set up around its limits. The
same paste, which extends its action more than six centimetres
deep in a cancer of close texture, when applied to superficial
gnawing ulcers, usually only destroys morbid texture, however
superficial this may be, and respects the sound parts. 2. The
absorption of arsenic is proportionate to the extent of surface
to which it is applied ; and as long as this does not exceed a
two-franc piece in size, there is no danger from this source. A
large surface should only be attacked by successive applica-
tions. 3. Arsenic which is absorbed is chiefly eliminated by
the kidneys, during the space of time of not less than five, and
not more than eight days, as amply demonstrated by Pelouze.
Thus, if we allow nine or ten days to intervene between
successive applications, all danger from absorption may be
avoided.

M. Gozzi, (Bull, delle Sc. Med., xx. p. 231) strongly recom-
mends the following caustic for the destruction of cancerous
growths: Corrosive subl., 9j ; caustic potass, 3ss; arsenic
and cerussa, aa, gr. vj. to be made into a paste with starch
and white of egg. While using this or other caustics, emol-
lient poultices, ointments, &c, should be avoided, as diminish-
ing their effects, unless the irritation produced by their applica-
tion has been excessive. M. Guzzi objects to the usual plan of
destroying the tumour, layer by layer, from the apex to the
base, the latter becoming very indurated after these repeated
applications, and offers great obstacles to the approximation
of surrounding granulations and their cicatrization. He pre-
fers applying the caustic laterally, in the direction where the
tumour seems most inclined to separate.

M. E. Cazenave (L'Uaion Mcdicale, ix.) speaks very highly

630 Therapeutical Record. [October,

of a caustic formed by pouring hydrated sulphuric acid on pow-
dered saffron.

Convulsions puerperal. Mr. Bolton (Lancet, Jan. 29) re-
lates a case in which severe puerperal convulsions, coming on
immediately before labour, and unchecked by depletion, were
completely arrested by the inhalation of chloroform.

Dr. Hoist (Neue Zt. fiir Geburtsk., vol. xxxii. p. 82,) in a bad
case of puerperal convulsions, attended with great rigidity of
the os uteri, threw up warm water against the os uteri for six
minutes, as in Kiwisch's method for biinging on labour. The
os speedily dilated, and labour was completed by the forceps.

Croup. Mr. Smith (Med. Times & Gaz. March 5) relates
four cases of croup in which tracheotomy was performed. All
the patients were in extremis, and in all the result was fatal.

M. Guersant (Bull, de Therap., xlii. 293) details one case, and
refers to another, in which tracheotomy was performed twice
in the same child. M. Guersant has now operated in croup 150
times. The earlier cases were less successful than the latter;
13 of the last 40 private cases, and 13 of the last 31 hospital
cases, recovered, or at the rate of 36-G2 percent. In 3 cases
there was faulty deglutition after the operation, and food es-
caped through the tracheal opening. In such a case the child
must be fed through the oesophageal tube pasced in through the
nares.

Diabetes MelUtus. Dr. Hanekroth, (Schmidt's Jahrb., 1853,
p. 173) recommends a mixture of sulphate of iron 3ss., tinct.
cinch, c, acq. menth. aa. 3vj. ; 20 to 30 drops every two hours.
In two oases there was perfect recovery.

Mr. Sampson (Lancet, Jan. 8) states that the permanganate
of potash (cjrs. ij. v. in solution thrice daily) has a marked
effect in reducing the quantity of urine in cases of obstinate
dvspepsia, and in diabetes mellitus. In a case of the latter
disease, the quantity of urine fell from 10 12 pints to its nor-
mal amount, but still contained sujiar.

Diarrhoea. Mr North, (Med. Times and Gaz., Feb. 12,) in
noticing the employment of dilute sulphuric acid, (in 3ss.
doses every 2 or 3 hours.) states that it is in the serous forms
especially when attended with cramps, that it is most useful.

Dyspepsia. Dr. Bennett (EJ. Monthly Journ., Feb. J 853,)
in a lecture on Dyspepsia, alter insisting on the necessity of
seeing t hat there is no excess in eating and drinking that the
food is properly masticated, and that proper rest is taken after
food, remarks that the sense of load or weight is best relieved
by acids, especially the hydrochloric. Acid eructations and
cardialgia are best relieved by alkalies and bitter tonics. In
cases in ^vhich fatty matters do not appear to be digested, liq.

1853.] Therapeutical Record 637

potassa? is recommended. When the flow of bile appears defi-
cient, mild mercurials and rhubarb is the best treatment.

Epilepsia. Dr. Marshall Hall, in a series of articles (Lancet
Jan. and Feb.) brings forward evidence to show the advantage
ol tracheotomy in preventing the severest attacks of epilepsy,
by rendering impossible the laryngismus, on the occurrence of
which depends the violence of the fits.

Dr. Tyler Smith (Lancet, March 5) has performed trach-
eotomy in a case of " uterine epilepsy." The operation ap-
peared useful but the ultimate issue of the case is not recorded.

Dr. Abbot (Amer. Jour, of Med. Sc. Jan. 1853) gave the
cotyledom umbilicus (grs. v. night and morning) to a man aged
f>0, who had been subject to epilepsy every two or three weeks
for five or six years. The fits entirely ceased, but the patient
began to totter in gait, and had attacks of partial loss of con-
sciousness. The cotyledon was discontinued, and the fits re-
turned.

M. Moreau, physician to the Bicetre, has been induced, by
the recommendation ofM. Herpin, to try the oxide of zinc. His
results do not support M. Herpin's statements.

Erysipilas Dr. Creighton (Edin. Month. Jour. Dec. 1852)
speaks highly of the tinct. ferri sesquichloride, in doses of Til x.
to nix v. every 2 or 4 hours. It appears, however, that ant. pot.
tart. (g;r. i) was also given, so that the inference appears
doubtful.

Fever, Intermittent. Dr. Pepper (Amer. Jour, of Med. Sc.
Jan. 1853) has tried bebeering and cinchonia, in ague. The
former succeeded in 2 cases, failed in 2 ; the latter seemed
more useful.

Fever, Continued. Dr. Barclay (Med. Times & Gaz., Jan.
8) records the effect of large doses (10 grains every 4 hours)
oi' sulphate of quinine, in 18 cases of continued fever, chiefly
typhoid?" In 5 cases there was marked depression ; in two the
pulse became slow, without depression : in 11 no physiological
effect was produced. The average duration of the fever was
not shortened by the treatment, and cinchonism in fever is con-
sidered not to be "more speedy safe and effectual'' than other
meihods.

Dr. Dun das (Med. Times & Gaz., Jan. 20) denies the accu-
racy of Dr. Barclay's inferences, states that "no prostration of
the vital powers" is produced by quinine, and relates a case of
typhoid (?) fever in which the remedy was useful.

' Dr. Douglas (Amer. Jour, of Med'. Sc, Jan. 1853, p. 282)
states that he has never seen the least good follow the use of
large doses of quinine in typhoid/ever.

Fitiula in Aroo. M. Aiquie (Gas. das Hopitaux, No. 48)

638 Therapeutical Record. [October,

states that he has found it a very beneficial practice to cauterize
the lips of the wound by means of nitrate of silver, after the in-
cision of fistula, premature adhesion being prevented without
the necessity of interposing tents., lint, or other material. The
nitrate should be applied, but only to the lips, twenty-four hours
after the operation, and repeated first every, and then every
other morning. He was led to the practice by observing the
condition of wounds when touched by the nitrate. The pelli-
cle or superficial eschar is eliminated in a day or two; the sur-
face so covered being unsuited to contract adhesions. This
covering also enables the wound to tolerate the presence of the
intestinal discharges which pass over it. Most persons com-
plain little of the pain caused by the application; but in some
cases it is severe.

Fractures, Compound. M. Trastour details in a series of
papers (Archieves Generates, vols. xxix. and xxx) numerous
cases of compound fracture he has witnessed in M. Chassaig-
nac's wards illustrative of the favorable results that have fol-
lowed their treatment by "occlusion." As our readers are
aware,* this consists in the immediate application of a cuirass
of adhesive plaster, which is restrained in situ for several days,
all surrounding inflammation being kept down by leeching, if
necessary. M. Trastour's report is highly favorable ; under
this plan the wound far more rapidly heals, pain and traumatic
fever are much diminished, as is the chance of the occurrence
of nervous delirium, tetanus, erysipelas, and purulent infection.
In cases in which it may be doubtful whether amputation will
be required, it enables us to wait with safety for the decision ;
and brings these traumatic cases in nearer relation to the cases
in which amputation is performed for disease, and in which its
results are so much more satisfactory. Since he has adopted
this practice, M. Chassaignac never amputates for traumatic
injuries of the fingers, however violent the injury may have
been. Even when re-union does not take place, very much
longer and better stumps result from leaving the case to nature.

Fractures of the lower end of the Radius. M. Robert (L'
Union Medicale, 1853, Nos. 6 & 7) observes that the various
plans of treating fracture of the lower end of the Radius with
antero-posterior displacement, are either insufficient when the
amount of pressure is slight, or dangerous when it is great, in
consequence of the possible inflammation and gangrene of the
skin of the wrist. Moreover, long-continued pressure gives rise
to slow inflammatory action and adhesion among the synovial
sheaths, leading to stiffness of the wrists and fingers, and an in-

* British and Foreign Medico-Chirugical Review, vol. v. p. 26i

1853.] Therapeutical Record. 639

ability to employ the limb for many months after the accident.
The following is M.Robert's own plan of treatment : The
fracture need not be reduced; but the patient, lying in bed,
stretches out his arm horizontally and parallel to t he trunk, and
puts it on its palmar surface, upon a pad well filled with oat-
chaff. This cushion terminates by a thick lower edge, which
corresponds to three fingers' breadth above the palmar fold
i.e., a little above the fracture, so that the hand hangs pendant
over this border, the fingers being prevented corning in contact
with the bed. When inflammation exists, leeches, fomentations,
&c., are applied to the exposed part. At the end of the eighth
or tenth day, the patient may get up, supporting the arm in a
sling, and still allowing the hand to hang down ; or, indeed, he
may be up from the first, resting his arm on a table. M. Hubert
lias thus treated from fifty to sixty cases, in all of which rapid
consolidation, with absence of deformity, has resulted. The
greatest advantage, however, attendant upon the plan, is the
freedom o( the synovial sheaths from adhesion, so that the pa-
tient can at once resume his occupations.

Furunculus. In the furunculoid epidemic lately prevalent,
various means are proposed by different medical men ; nitro-
hydrochloric acid, alterative-doses of mercury, cholorate of
potash, quinine, and iron are among the chief measures recom-
mended.

Galvanism. Mr. Springfellow exhibited to the Medico-Chi-
urgical Society (Lancet, March 5) a new form of galvanic-bat-
tery, resembling Pulvermacher's, but more portable. For a
full description see report in Lancet.

Heart Disease. M. Beau (Archiv. Gen. Fev. 1853, p. 181,)
in a long paper on heart-affections, in which several original
and disputable views are advocated, recommends digitalis, not
as a sedative, but as a stimulant, and states that it acts by reliev-
ing the imperfect action of the heart, or what he calls the state
of a-systolia, in many cases of hypertrophy. In a case of this
kind the heart beats rapidly, perhaps J 20 times per minute, but
the pulse is feeble and unequal. After the use of digitalis, the
action falls perhaps to GO per minute; but the beats are much
stronger, and are more regular ; at the same time the face ceases
to be injected, and the dyspnoea diminishes. M. Beau believes
that the digitalis augments the contractility ofthe ventricle, and
thus produces these effects. He calls digitalis "the cardiac
cinchona." He gives 20 centigrammes ofthe leaves infused
in a cupful of water, every morning, on an empty stomach.
The diet must be good.

Intestinal Obstructions. Mr. B. Philips (Lancet, Jan. 1.)
advises, in intestinal obstruction, that the drastic purgatives,

640 Therapeutical Record. [October,

such as croton oil, should not be given at an early period ; but
one or two full doses of calomel and opium (8 to 10 grs. of cal-
omel to 2 grs. opium) should he first given, and large emollient
enemata be thrown up every six or eight hours. If these
means fail, Mr. Philips pushes murcuryto salivation, mercurial
inunction as well as administration by the mouth being employ-
ed.

Neuralgia, Cazenave (Rev. Med. Chir. in Med. Times and
Gazette, Feb. 15) recommends in facial neuralgia, an ointment
composed of chlorform 20 parts, prussiate of potash 10 parts,
and lard 60 parts; a piece the size of a walnut to be rubbed
over the painful parts. An oiled-silk cap is then to be worn for
some hours.

Ovarian Cystis. M. Dnplay (Archiv. Gen., Feb. 1853) re-
lates in a case in which an ovarian tumour was tapped, l(j
litres of fluid drawn off and 250 grammes of a fluid (composi-
tion, water 100 parts, alcohol 50. iodide 5, iodide of potassium
5) were thrown into the cyst, and then made to issue out again
through the canula, by pressure; all hut 2 grammes were dis-
charged. Some sharp pain and fever followed ; but in three
days all unfavorable symptoms disappeared, and the patient up
to the date of report (exact time not given) had continued well.

Palate, fissure of. Dr. J. Mason Warren describes (Am.
Jour, of Med. Sc, Jan. 1853) a new forceps to be used in the
operation for cleft palate ; the instrument has a double curve,
one anterior, the other lateral ; and the posterior jaw of the
forceps is longer than the other. The instrument has double
teeth.

Phlegmon. Pofi (Gbz. Tosc. 1, 1852) confirms the state-
ments of Bellini, as to the abortive cure of sub-inflammatory
swellings of the skin and subcutaneous cellular tissue by the
application of a few dropsof liquor of ammonia?. In syphilitic
bubo this method is also useful.

Puerperal Miasmata. Dr. Busch, Director of the Berlin
Midwifery Clinique (Neue Zeitsch. fur Geburtsk., xxxii. p. 313)
after remarking upon the great difficulty there exists in keep-
ing a lying-in hospital free from peurperal fever, relates the
result, of an experiment he tried at Berlin. During February
and March, 1851. after an epidemic of influenza, one of puerpe-
ral i"ever prevailed extensively amidst all classes at Berlin, the
hospital suffering severely during t he latter month. It was
evacuated, thoroughly cleaned and ventilated for six weeks,
and re-opened in May, when, however, every woman admitted
became affected soon after delivery. Reflecting upon the in-
fluence of hot, dry air in destroying contagious fomites, Dr.
Bjicia had alarea iatraiuasd iota the wards) and all the bed-

1853.] Iodine Injections in Dysentery. Git

ding, utensils, &c, were exposed to a temperature of 150 to
170 Fah. during two days. On patients being re-admitted,
no more cases occurred, although the disease still prevailed in
Berlin. In December, 1851, lour women were seized with the
disease in one apartment, one of them dying. A heat of 170
Fah. was resorted to, and no extension of the epidemic occur-
red. To the time of writing, June, 1852, no recurrence had
taken place.

Rheumatism. Dr. Bennett (Edin, Monthly Journal, Dec,

1852) relates six cases of acute rheumatism, in which nit? ate of
potash was used. In all, the medicine was useful ; in two the
benefit was very marked.

Sarcence Ventriculi. Dr. Hassall (Med. Times and Gaz.,
Jan. 29) relates a severe case in which sulphite of soda (as re-
commended by Dr. Jenner) was used with great benefit : infu-
sion of quassia and bicarbonate of potash were also employed,,
and seemed useful.

Dr. Bennett (Edin. Monthly Journal, Feb., 1853, p. 1G8)
refers to a case in which the sulphite of soda was ineffectual.

Scarlatina. Dr. Gillespie (Edin. Monthly Journal, March,

1853) recommends the repeated use of the warm bath, mercu-
rial laxatives on first admission, afterwards small repeated
doses of a diaphoretic, containing antimonial wine, spirit of
ether, nitrate and liquor ammonia? acetatis; and the application
of a strong solution of nitrate of silver to the throat.

Scurvy. Dr. Hammond (Amer. Jour, of Med. Sci., Jan.,
1853) recommends strongly, from experience of twelve cases
in New7 Mexico, the use of the salts of potash, especially the
bitartrnte. The remedy was first employed in consequence of
Garrod's recommendation.

Stomatitis Ulcerosa. Dr. Mackenzie recommends sponging
with the dilute nitric acid of the Pharmacopoeia, and giving
internally carbonate of ammonia, and citrate of iron.

Syphilis. Professor Gamberini (Bull, delle Sci., Med. xxi.,
p. 253) confirms the favourable opinion expressed by Dr. Da-
verts, of the iodide of sodium, and believes, from an experience
of 1 10 cases, that it may be advantageously substituted for the
iodide of potassium. The dose was at first 3j., raised gradu-
ally to 3ij. per diem. [Brit, and For. Med. Cliir. Rev.

Iodine Injections in the Treatment of Dysentery.

M. Delioux has obtained remarkable success in the treatment
of dysentery by injections of iodine. The first effect of these
injections is to increase for a time, the alvine dejections; but
they speedily diminish afterwards and rapidly change in theiy

042 Miscellany. [October,

appearance, and soon cease entirely. They have never been
known to produce any bad effects when used after the following
formula :

$ Tinct. Iodine, 10 to 30 grammes.
Iodide potass. 1 to 2 " Mix.

An emollient enema should be ordered before the iodine in-
jections are given in order to perfectly emply the intestines.
Seldom are the patients enabled to retain the injections beyond
fiiteen or thirty minutes ; yet they have time to make a decided
impression upon the parts affected, and have been found far
preferable to the argentine injections. [Revue Medico-Chir.,
1853. New Orleans Med. andSursr. Journal.

flit 0 c c 1 1 a n ji .

Epidemic Furuncles and Whitlows. This section of country has
been visited during the last few month?, as it was in the summer of
1851, with an epidemic tendency to furuncles and whitlows, which
has in a great many instances proved extremely annoying, not to say
painful. We do not know that it has been as general this year as it
was in 1851, when it prevailed throughout the United States and a
portion of Europe.

We would like to hear from our correspondents on the subject.
Some individuals have had as many as 15 or 20 large furuncles
coming on in succession and in different parts of the body, notwith-
standing strict attention to diet and the use of saline laxatives, as
usually recommended in such cases. We must confess that we nev-
er knew the furunculoid diathesis, if we may use the expression, to be
controlled or benefitted by a resort to this antiphlogistic treatment.
We have sometimes thought that the use of a genuine syrup of sarsa-
parilla was advantageous. Ought not these affections to be regarded,
as well as carbuncles, as evidence of an impaired stamina, rather
than of a phlogistic diathesis? The fact is, that many of the furun-
cles we have seen were of the kind vulgarly called "cat boils" and
which we have been long in the habit of calling carhuncular furuncles.

Satisfied that antiphlogistics do no good, we have generally advised
our patients to take nothing, and to live as usual. If our suspicions
of the state of the system be correct, however, it would be well in
such cases to administer tonics.

These remarks are submitted to the profession in the hope that more
attention may be given to the subject, and that the tonic plan of treat-

1853.] Miscellany. 643

ment may be tried by others, as we intend to do in future, when the
opportunity presents itself.

Savannah Medical College. We have just reeeived the Circular,
announcing that this Institution will go into operation on the first
Monday in November next. The course of lectures will be delivered
by Dr. R. D. Arnold, on the Theory and Practice of Medicine; Dr.
P. M. Kollock, on Obstetrics and the Diseases of Women and Chil-
dren ; Dr. W. G. Bulloch, on the Principles and Practice of Surgery ;
Dr. C. W. West, on Medical Chemistry ; Dr. H. L. Byrd, on Mate-
ria Medica and Therapeutics; Dr. E. H. Martin, on Physiology;
Dr. J. G. Howard, on Anatomy; Dr. J. B. Read, Demonstrator of
Anatomy, on Pathological Anatomy.

We wish our neighbors every success in their laudable enterprise.

It must be gratifying to their Alma Mater to find that two of the
gentlemen appointed to professorshipsjn the Savannah Medical Col-
lege are graduates of the Medical College of Georgia.

Prospectus of the "Georgia Journal of the Medical Sciences."
Dr. George F. Cooper proposes to publish, in Savannah, a Journal
under the above title, to be issued in monthly numbers of 04 pages,
at $3 00 per annum. The first No. will be issued when two hun-
dred subscribers shall have been procured. Dr. Cooper is a talented
physician, and will, we doubt not, discharge the duties of Editor with
credit to himself and usefulness to the profession. We will be happy
to extend to him the hand of fellowship.

New Medical Journals. We cheerfully add to our list of Ex-
changes, "The Peninsular Journal of Medicine and the Collateral
Sciences," edited by E. Andrews, A. M., M. D., Demonstrator of
Anatomy in the University of Michigan, published monthly, at Ann
Arbor and "The People's Medical Gazette," edited by John Davis,
M. D., published monthly at Abbeville C. H., So. Ca. They both
promise to be useful additions to our periodical literature, and the
latter will doubtless exert a favorable influence upon " the people,"
for whom it is specially designed.

Our old friend the " Transylvania Journal" has passed into other
hands and changed its name. It is now the " Kentucky Medical
Recorder," and is edited by H. M. Bullitt, M. D. and R. J. Breck-
enridge, M. D., of Louisville.

G44 Miscellany.

The Praclice of Surgery. By James Milled, F. R. S. E., Professor
of Surgery in the University of Edinburgh, &c , &c. 3d American
from the 2d Edinburgh edition. Edited, with additions, by F. W.
Sargent, M. D., &c. Illustrated with 319 engravings on wood.
Philadelphia: Blanchard & Lea. 1653. vo , pp. 729. [For sale
by T. Richards & Son, of this city. Price $3 25.

No encomium of ours could add to the popularity of Miller's Sur-
gery. Its reputation in this country is unsurpassed by that of any
other work and, when taken in connection with the author's Princi-
ples of Surgery, constitutes a whole, without reference to which no
conscientious surgeon would be willing to practice his art. The ad-
ditions, by Dr. Sargent, have materially enhanced the value of the
work.

Efficacy of the Inversion of the body in cases of Syncope from the In-
halation of Chloroform. Some unfortunate accidents having been
lately reported from the inhalation of chloroform, much attention has
been directed to the discovery of means for their prevention. Among
others, exposure to air, tittillafing the nares or selcs of the feet, intro-
ducing the finger into the fauces and raising the epiglottis, insufflation
of air from mouth to mouth, etc. M. Nelaton has tried all these with-
out success, and thinks them useless. From his experience, he be-
lieves that syncope is the principal cause of death, the subjects of it
being pale, rigid, and corpse-like; and the plan which he has found
most efficacious is the rapid and complete inversion of the body.

The first time, at the Hospital St. Louis, while performing an oper-
ation on the hand, he observed the patient becoming pale, and the
pulse faltering, and immediately had him inverted ; when the face,
before palid, at once became congested, and the interrupted respira-
tion re-established.

At the Hospital de la Faculte a similar case occurred last year ;
and lately M. Denonvilliers, having heard of the plan pointed out by
M. Nelaton, tried it with equal success. In place, then, of the ridicu-
lous proceeding of tittilating the nose or feet in persons who do not
feel the amputation of a limb, the body should be quicklyinverted, as
being the most prompt and easy way of arresting the syncope which
threatens the life of the individual. [Jour, de Med. etde Chirur.
New Orleans Med. and Surg. Journal.

WORKS RECEIVED.

Transactions of the Tennessee State Medical Society at their 24th
annual session Nashville, 1853 contains a number of excellent
papers.

Quarterly Summary of the Transactions of the College of Physi-
cians of Philadelphia from May to July, 1853 contains an able
Biographical Notice of Dr. Drake, by Prof. Meigs, besides other
interesting matter.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 9.] NEW SERIES. NOVEMBER, 185]. [No. 11,

PART FIRST.

(Original Communications.

ARTICLE XXXV.

ON THE VENOMOUS SERPENTS OF GEORGIA.
PART I.
Natural History and Physiology. By John Le Coxte, M. D.,
Professor of Natural Philosophy and Chemistry in the Uni-
versity of Georgia.

No class of animals has enjoyed so large a share of the
marvellous as the snake, which, from the earliest times, excited
the wonder, the respect, or the abhorrence of mankind. In
antiquity, the Serpent played an important part in the systems
of cosmogony and mythology. The facility and rapidity of
its motions, although destitute of any external organs of lo-
comotion; the insidious stealthiness and noiselessness of its
movements, as well as its voiceless character; the remarkable
brilliancy and beauty of some species, as contrasted with the
dingy hideousness of others ; its extreme tenacity of life,
frequently exhibiting signs of vitality after the most serious
mutilations; the extraordinary fecundity of many species;
the very striking phenomenon of a periodical exuviation of the
entire skin, typifying a complete renovation of the animal sys-
tem ; and, above all, the wonderful and truly incomprehensible
lethiferous powers of some kinds, which enabled them to
destroy the largest animals, by means of weapons which seem-

n. s. VOL. IX. NO. xi. 41

646 Le Conte, on Venomous Serpents. [November,

ed to be absolutely insignificant, and with a certainty and
rapidity which appeared to be supernatural as well as super-
human : constitute a combination of qualities and powers,
well calculated to produce a powerful and vivid impression
upon the imagination of primitive races of men. They would
naturally look upon a class of creatures endowed with such
extraordinary powers, as, in many respects, superior to man,
and, consequently, as the appropriate type of some of the attri-
butes of exalted beings.

Hence it is, that Serpent-worship (Ophiolatreia) is found to
be a primitive form of idolatry, either actually or symbolically
celebrated in the religious systems of almost every nation of
the ancient world. From Babylonia, we may trace it East
and West through Persia, Hindostan, China, Mexico and Peru,
Britain and Gaul, Scandinavia, Italy, Illyricum and Thrace,
Greece, Asia Minor and Phoenicia ; and North and South
through Scythia on the one hand, and Africa on the other.
Some venerated it with unbounded horrors : many of their
Gods were accompanied by it as a type of wisdom ; and sev-
eral religions considered it emblematical both of a good and
bad Deity. In the mythology of Egypt, Greece and Italy, the
mystic Serpent consecrated almost every temple, attended
upon almost every Deity ; was imaged in the heavens, was
stamped upon the earth, and characteristically appeared in
every thing belonging to Tartarus. By some nations, as the
Hebrews and Persians, it was the emblem of cunning, deceit,
and wickedness ; by others, such as the Egyptians and Phoene-
cians, it was looked upon in a double point of view, as em-
blematic of the invincible power of royalty, and likewise as
a good genius (Agathodemon), and worshipped as the symbol
of fertility and healing ; while among the Greeks and Romans,
it appeared under a variety of symbolic representations. As
an accompaniment of iEsculapius, the Serpent was the well-
known emblem of the healing art; and at the present time, a
snake with its tail in its mouth is regarded as a symbol of eter-
nity. The Serpent appears also to have held a place in the
Hindoo, Mexican, and Scandinavian mythologies, where it
was considered as the type of an evil Deity; and the tempter
of mankind was represented under the same form. Even m

1853.] LeConte, on Venomous Serpents. 647

the early ages of the Christian church, a sect of the Gnostics
called Ophites, worshipped the Serpent which tempted Eve as
the father of all sciences.

At the present day, throughout the whole Christian as well
as the Mohammedan world, snakes are looked upon with un-
mixed feelings of horror and detestation. The distinction
between the venomous and non-venomous species so well
known to the Egyptians and other nations of antiquity is
almost universally disregarded ; fear and prejudice have com-
bined to throw obliquy upon the whole order of Ophidian
reptiles; and, by the general consent of society, every child is
invested with the powers of indiscriminate destruction, to the
great detriment of many really useful and harmless kinds of
Serpents. It is in the highest degree desirable, that every
intelligent person, and, especially every Physician, should be
able to distinguish the dangerous from the innocuous species,
in order to warn mankind against the real danger, and preserve
them from groundless terrors. Ignorance on the part of the
members of the medical profession in relation to this subject,
is still more lamentable in another point of view: it tends to
foster and perpetuate error in regard to the treatment of snake-
bites. A person receives a slight scratch on the leg from the
bite of a harmless Serpent ; he screams with fright ; his com-
panions pronounce the snake poisonous, and it is destroyed ;
the limb is ligatured, and, of course, swells and becomes edema-
tous ; the physician is called in, administers some reputed
antidote, removes the ligature, and the patient recovers; and,
finally, the case is published, forms an integral part of the
medical experience of the day, and is cited as a valuable con-
tribution to therapeutics. It is to be feared, that such instances
are neither imaginary nor uncommon.

Without going into minuteness of detail, the following are a
few of the most general physiological characteristics of the
Ophidian reptiles. In common with many other members of
the Class Reptilia, the heart consists of two auricles and one
ventricle. The venous blood, collected from all parts of the
body, accumulates in the vena cava, and thence passes into the
right auricle. From the right auricle it passes into the single
ventricle, and by it is impelled through the aorta into all parts

648 Le Conte, on Venomous Serpents. [November,

of the body. A small branch leads to the lung, and the blood,
when purified, is returned to the left auricle, which drives it
into the ventricle. This ventricle thus receives venous blood
from one auricle, arterial from the other, and it is a mixture of
this kind which is distributed through the body. In conse-
quence of this incomplete circulation, the blood is imperfectly
aerated, and the animal is cold-blooded.

The Serpents are especially characterized among Reptilia
by having no sternum nor any vestige of a shoulder-blade, but
whose ribs still surround a great part of the circumference of
the trunk, and are only wanting at the tail. The vertebras are
curiously arranged : the body of one is articulated by a con-
vex surface to a cavity in front of the succeeding vertebra.
This structure of ball-and-socket allows of free lateral motion ;
but the spinous processes of the back prevent motion, up and
down, to any great extent. The third eye-lid and the tympan-
um are deficient ; but the malleus of the ear exists under the
skin, and its handle or shaft passes behind the tympanic bone.
The left lung is generally abortive or rudimentary ; and the
respiratory motion is unassisted by a diaphragm, and is princi-
pally effected by the ribs and abdominal muscles.

The bones of the head, excepting in a few species, possess a
great deal of mobility. The lower jaw, instead of a direct
articulation with the upper, is brought into connection with it,
through the medium of two bones, moveable on each other ;
and, in fact, the whole maxillary apparatus is conformably and
peculiarly modified to permit the requisite distention of the soft
parts surrounding the mouth, and the transmission of the undi-
vided prey to the digestive cavity. But the mechanism by
which this distention is accomplished, and which is, in truth,
a dislocation of the adapted parts, which return to their original
positions after the act of deglutition is performed, requires,
to be well understood, a more particular description. The fol-
lowing is an abstract of the very clear account given hy Prof.
Richard Owen in his great work on " Odontography." " The
two superior maxillary bones have their anterior extremities
joined by an elastic and yielding fibrous tissue with the small
and single intermaxillary bone. The symphysial extremities
of the lower maxillary rami are connected together by a simi-

1853.] LeConte, on Venomous Serpents. 649

lar tissue, allowing of a still wider lateral separation. The
opposite or posterior extremity of each ramus is articulated to
a long and movable vertical pedicle, formed by the tympanic or
quadrate bone, which is itself attached to the extremity of a
horizontal pedicle formed by the mastoid bone, so connected as
also to allow of a certain yielding movement upon the cranium.
The palatine and pterygoid bones have similar loose and mova-
ble articulations, and concur, with the other dentigerous bones
of the mouth, in yielding to the pressure of large bodies with
which the teeth may have grappled."

In Serpents, the male organs of generation are usually con-
cealed within the cloaca : they are bifurcated and armed with
recurved spines. The twTo penises are protruded from the two
lateral commissures of the lips which bound the transverse
opening of the cloaca. In the rattle-snake, the intromittent
organs appear to be double on each side, from the great devel-
opment of the bifurcations of the glans penis. It was this
structure which led Dr. Edward Tyson to announce, that this
snake had four penises. {Phil. Trans., vol. 13, p. 25.)

But the most obvious as well as the most striking character-
istic of Ophidian reptiles, is the total absence of any external
members of locomotion. It is true, that in some genera (Boidse)
the hinder limbs are developed under the skin, formed of sev-
eral bones, and ending in a short exserted spur or hook, placed
one on each side of the vent ; but they are so rudimentary as
to be discoverable only on dissection or very close examina-
tion, and are used as organs of prehension rather than pro-
gression. Not a single species belonging to the Boidse is found
in the United States : our Serpents are, therefore, destitute of
even rudimentary limbs. The popular idea that our common
snakes possess distinct feet, which they may be made to exhibit
under certain circumstances, especially when thrown into the
fire alive, has, doubtless, originated from the fact, that the
bifurcated and thickened penis is protruded from the cloaca in
such cases.

Although destitute of limbs, the usual organs of motion, yet
some Serpents are capable of very rapid progression. This
progression may take place in several ways : thus, the body
may be straightened out entirely in contact with the ground,

650 Le Conte, on Venomous Serpents. [November,

and a slow motion produced by the action of the scales and
ribs, somewhat similar to that of the earthworm with its setae.
This mode of locomotion has been fully established by the
observations of Sir Everard Home. (Phil. Trans, for 1812,
p. 163.) Again, the body may be thrown into several undula-
tions in a horizontal plane, the posterior of which is used as a
fulcrum, or point d'appui, the straightening of the anterior
must result in the advance of the head, which in turn is fixed,
while the rest of the body is again flexed. This is the ordinary
mode of progression. The opinion that, Serpents sometimes
gather up the whole body into one vertical arch or hoop like
a bent spring, the head and tail alone in contact with the
ground and more or less approximated ; and that by a sudden
straightening of the hoop, they can progress with great rapidi-
ty : is probably erroneous. We have already seen, that the
arrangement of the spinous processes of the vertebral column
limits the vertical flexion, and seems to forbid their progression
by vertical undulations, as they are often represented in the
older books of Natural History, and frequently on the stages
of theatres. Snakes frequently spring upon their prey by
throwing themselves into a coil, which is done by contracting
all the muscles on one side of the body, and then, suddenly
calling into violent action all the muscles on the opposite side,
the whole animal is propelled, as if by the release and unwind-
ing of a powerful spring, with an impulse which raises it to
some height from the ground, and projects it to a considerable
distance. But, assuredly, the Kangaroo performances of the
rattle-snake, reported from hear-say testimony by Prof. Ben-
jamin Silliman, which raised itself upon the extremity of its
tail, and in this position, executed a series of extraordinary
leaps, with sufficient rapidity to overtake a man running at full
speed, must lose its credibility in the same proportion as such
a feat is perceived to be mechanically impossible. (Vide. Sil-
liman''s Journal, 1st series, vol. 2, p. 229.)

Before proceeding to an enumeration of the characteristic
marks which distinguish the Venomous from the Non-venom-
ous Serpents, it will be necessary for us to present our readers
with an accurate Catalogue of all the Snakes which are known
to inhabit the State of Georgia. This is rendered more impera-

1853.] Le Conte, on Venomous Serpents. 651

tive from the fact, that the confusion of terms in the popular
names is so inextricable, that, otherwise, I should find it diffi-
cult to designate the several species of Serpents. The presence
or absence of noxious properties, leads to a very natural divis-
ion of this tribe of reptiles into two great groups viz: Venom-
ous and Non- venomous Serpents. In the following Catalogue,
we have appended the popular appellations as far as they are
known.

Catalogue of Serpents inhabiting the State of Georgia.

VENOMOUS SERPENTS.

Crotalus. Linnceus.

1. durissus. Lin. Banded Rattlesnake.

2. adamanteus. P.deBeauvois. Water Rattlesnake. Diamond Rattlesnake.
Crotalophorus. Gray.

3. miliarius. Lin. Ground Rattlesnake.
Trigonocephaly. Oppel.

4. piscivorus. Lacepede. Water Moccasin. Cotton Mouth.

5. contortrix. Lin. Copper-head. Highland Moccasin. Rattle-snake's Pilot.
Elaps. Schneider.

6. fulvius. LinK Bead-snake.

NON- VENOMOUS SERPENTS.
Coluber. Linnceus.

7. constrictor. Lin. Black-snake.

8. guttatus. Lin. Corn-snake. Red Chicken-snake.

9. couperi. Holb. Indigo-snake. Gopher-snake.

10. punctatus. Lin. Ringed-snake.

11. alleghaniensis. Holb. Pilot Black-snake.

12. quadrivittatus. Holb. Chicken-snake.
Coronella. Laurentius.

13. getula. Lin. Chain-snake. Thunder-snake. King-snake.

14. rhombo-maculata. Holb.

15. doliata. Lin. Bead-snake.
Helicops. Wagler.

16. erythrogrammus. Daudin.

17. abacurus. Holb.
Brachyorrhos. Kuhl.

18. amaenus. Say. Red-snake.
Calamaria. Boie.

19. elapsoidea. Holb. Bead-snake.

20. striatula. Lin. Brown-snake.
Rhinostoma. Fitzinger.

21. coccinea. Blum. Scarlet-snake. Bead-snake.
Pituophis. Holbrook.

22. melanoleucus. Daudin. Pine-snake. Bull-snake. Horn-snake.
Psammophis. Boie.

23. flagelliformis. Catesby. Coachwhip-snake.

652 Le Conte, on Venomous Serpents. [November,

Leptophis. Bell.

24. aestivus. Lin. Green-snake. Grass-snake.

25. sauritus. Lin. Ribbon-snake. Garter-snake.
Tropidonotus. Kuhl.

26. fasciatus. Lin. Water-snake. Water-moccasin.

27. erythrogaster. Shaw, Copper-belly. Water-moccasin.

28. taxispilotus. Hold. Water-snake. Water-moccasin.

29. rigidus. Say,

30. sirtalis. Lin Striped-snake. Garter-snake.

31. ordinatus. Lin. Grass-snake. Garter-snake.
Heterodox. Palisot de Beauvois.

32. simus. Lin. Hog-nose-snake.

33. niger. Catesby. Black-viper. Spreading-adder.

34. platyrhinos. Latreille. Hog-nose-viper.

Ophisaurds. Daudin. (Not properly a Serpent.) ventralis. Lin. Glass-
snake.

The foregoing Catalogue shows, that our Fauna is compara-
tively rich in this order of reptiles. Omitting the Ophisaurus,
which can scarcely be considered a Serpent, Prof. J. E. Hol-
brook has described, in his "North American Herpetology,"
47 species of Ophidian reptiles as inhabiting the United States;
and of these, 10 belong to the Venomous group. Dr. J. E.
De Kay found but 16 species inhabiting the State of New
York ; of which, 2 are Venomous. It will be perceived, that
there are 34 species of Serpents inhabiting the State of Geor-
gia; and of these, 6 kinds come under the Venomous division.
It is, therefore, sufficiently obvious, that we enjoy the company
of a large share of the species composing this order of verte-
brata. It is proper to observe, however, that, of the 6 species
classed among the Venomous, two of them, Crotalophorus
miliarius and Elaps fulvius, can scarcely be considered dan-
gerous to man. The former, is greatly dreaded by the common
people, as it gives but a very slight warning with its diminutive
rattle, and is frequently the aggressor. Its bite is very poison-
ous, is generally followed by violent local inflammation, and
even by gangrene and sphacelus; nevertheless, as the snake is
small, the quantity of venom is insufficient to produce death in
large animals. As for the Elaps fulvius, although it is furnish-
ed with an immovable fang on either side of the upper jaw,
yet the poison gland is probably in a rudimentary condition.
It is almost universally considered perfectly harmless, and is
constantly handled with impunity. It seems to have been

1853.]

Le Conte, on Venomous Serpents.

653

placed among the venomous snakes, more from the fact, that
it is the Northern representative of the dreaded Elaps lemnis-
catus of South America, than the possession of any noxious
qualities. According to the best observations, it cannot be
induced to bite under any provocation whatever.

There are, consequently, but 4 species of our Serpents,
which can be considered dangerous to man. Moreover, from
the well-ascertained fact, that the venomous snakes are en-
dowed with powers of fecundity, far inferior to the harmless
ones, they are nothing like so numerous. The rattle-snakes
rarely produce over 9 or 10 at a birth, while 81 living garter-
snakes (Tropidonotus sirtalis) have been taken from a single
individual. From this fact, it is comparatively seldom, that the
poisonous Serpents fall under observation. The universal
dread in which they are held, has enormously exaggerated the
number and abundance of these reptiles. Every one who has
resided many years on the sea-coast of Georgia, has, doubtless,
seen a great number of Rattle-snakes ; but it would be very
erroneous to make this a measure of their comparative abund-
ance. Every specimen which falls a victim to man, is brought
home in triumph, and all the neighbors must see the dreaded
monster. In this manner, I have had numerous opportunities
of seeing them : nevertheless, during many years rambling
at all seasons through the woods on the sea-coast of our State,
I have never met with but one Rattle-snake. Other persons
may have been more fortunate ; but 1 apprehend, that the
number furnished by each man's personal experience, would
be comparatively small.

Again, the relative abundance of our Venomous snakes has
been vastly multiplied, from the fact, that several of our most
common harmless Serpents, have been, almost universally,
confounded with their dangerous congeners. The dread of the
fatal Trigonocephalus piscivorus has brought into suspicion
and disrepute several other snakes that live in the same locali-
ties and possess a greater or less similarity of appearance and
habits, as the Tropidonotus fasciatus, T. erythrogaster, and
T. taxispilotus, (constituting our most abundant water-snakes),
which are not only harmless, but really useful in destroying
vermin. They are all called "Water Moccasins," and are
indiscriminately dreaded and detested.

654 Le Conte, on Venomous Serpents. [November,

Nothing can be more ridiculous than a fear of the common
Water-snakes, chicken-snake, green-snake, black-snake, and
other species. Even should they be forced to bite in self-
defence, the wound can never be more serious than a similar
scratch of a pin or of a point of a knife. The same may.be
said of the blowing or hissing snakes of the genus Heterodon,
usually termed Viper or Adder in the United States, and which
present a formidable appearance from the power they have of
flattening the head and anterior part of the body when irritated.
Some of the species coil themselves when disturbed, assume a
threatening attitude, by flattening the head and neck, which
they lift and wave with an undulating motion, hissing loudly
at the same time, and projecting the head towards the object
of its annoyance ; but they cannot be provoked to bite or even
to open the mouth. These snakes are very generally regarded
as venomous. This unjust obliquy has, doubtless, been, to some
extent, perpetuated, by the fact that some of the species are
vulgarly called Vipers or Adders : thus associating them with
the really venomous European Vipers. The common Black-
snake is generally known to be perfectly harmless : neverthe-
less, it is active, bold, and, sometimes, quite impudent; refusing
to give way to man. Numerous stories are current of their
pursuing individuals. It is quite possible that, under some
circumstances, they may follow after a person who flies in
terror before them ; but such is not the experience of the her-
petologist, with whom the case is exactly reversed : the snake
here being usually the fugitive, and too often escaping by his
superior agility, and thus eluding the just claims of science to
his body.

Distinctive Characteristics of our Venomous Serpents.
It is not my purpose to give detailed scientific descriptions
of the dangerous snakes inhabiting our State. To the natural-
ist and man of science who has access to books on herpetology,
this would be a work of supererogation ; while to persons not
versed in the technicalities of zoology, it would be as useless
as unintelligible. It is my object, to call attention to a few of
those general distinctive characteristics, which are readily re-
cognized by casual observation.

1853.] LeConte, on Venomous Serpents. 655

1. Rattles. The several species ofCrotalus and Crota-
lophorus, are readily and most obviously distinguished from
all other Serpents, whether dangerous or harmless, by the re-
markable rattle at the extremity of the tail. This singular
appendage is made up of many pieces, from one to 30 or more,
which are perfectly similar to each other in their form, and are
articulated together by a very beautiful mechanism. The
piece of rattle immediately connected with the body seems to
be moulded on the last vertebra of the tail, which it encloses,
and from which it is only separated by an interposed layer of
the dermis or true skin, by which it is secreted. Its surface
presents three nearly circular elevations corresponding to three
protuberances : of these, the first, or that nearest to the body
of the animal, is the largest ; the other two rings are encased in
the succeeding piece, which is connected in a similar manner
to the next ring, and so on throughout the series ; the posteri-
or two-thirds of each piece beingembraced by the following, so
that of the three prominent rings that project from each piece,
only the anterior is visible, the two posterior being contained
in the next element of the rattle; excepting the ultimate one,
in which all of the three protuberances are exposed to view.
The last two rings of each piece thus enclosed in the first two
of the succeeding, retain it in its place; but as the diameter of
the former is less than that of the latter, each piece is quite
loose and plays freely about upon that which it envelopes.
None, except the first are connected with the skin of the
animal by any muscle, nerve, or vessel. It is, therefore,
merely an external appendage of the corneous cuticle, moved,
as any foreign body would be, when the end of the tail is agita-
ted. The pieces of the organ are formed successively on the
skin of the tail, receiving from it the materials necessary for
its development, and adhering to it until its growth is com-
plete. A second piece, entirely similar to the first, is formed
under it, and detaches it from the end of the tail. It is pushed
backwards, leaving between its edge and the skin an interval
occupied by the first ring of the new piece. A third piece is
formed under the second, pushing it backwards, but retaining
it, by its posterior rings being included in the cavity of the
second piece. If the vertebrae of the tail continue of uniform

656 Le Conte, on Venomous Serpents. [November,

diameter, all the pieces will be of the same size, and the rattle,
consequently, is of one breadth throughout. On the contrary, if
the vertebras grow while the rattle is in process of formation,
the pieces increase in size, and thus it tapers to its end. It is
very evident, from what has preceded, that the rattle is nothing
more than a modification of the corneous epidermis of the tail,
and that the only reason why it is not thrown off at each pe-
riodical moulting, is, that its mechanical connections prevent
such a result. It is also obvious, that only one piece can be
found at each exuviation of the cuticle. The idea that the
number of rattles mark the age of the snake, is unquestionably
erroneous. Dr. Holbrook has known two rattles added in one
year, and Dr. Bachman has observed four produced in the
same length of time. On the other hand, the rattles are liable
to be lost. Mr. Peale, of the Philadelphia Museum, kept a
living rattlesnake 14 years; it had, when it came into his
possession, eleven rattles ; many were lost, and new ones were
formed, so that at the end of the time, there were still eleven
pieces.

2. Reproduction. All of our poisonous snakes are vivipa-
rous, or rather, ovo-viviparous. Not that their mode of repro-
duction is really different from that of the oviparous serpents,
but that the eggs are developed and hatched in the oviduct be-
fore exclusion from the body, so that the young animals are ex-
pelled alive. It is, therefore, essentially oviparous, and must not
be mistaken for the viviparous placental reproduction of mam-
malia. Among Serpents, as with birds, the development of the
embryo is complicated by the presence of an allantois, and the
amniotic sac with its peculiar liquid. As the period of hatch-
ing approaches, the yolk bag, or vitelline sac, together with its
remaining contents, is gradually taken into the cavity of the ab-
domen, through the umbilical aperture. Should the young
snake be hatched before this sac is completely drawn into the
abdominal cavity, its presence externally, might, very naturally,
lead to the erroneous conclusion, that it possesses a true pla-
centa with an umbilical cord attached.

This ovo-viviparous peculiarity appertains to all venomous
Serpents, and hence, they have been included under the family

1853.] LeConte, on Venomous Serpents. 657

Viperidse. Nevertheless, it is important to bear in mind, that
it is not restricted to them. With us, some of the harmless spe-
cies, as the different kinds of Tropidonoti, are likewise ovo-
viviparous. With some, it appears to depend, in a measure,
upon the latitude, mean temperature, and the greater or less
abundance of food ; so that the same snake may be made ovi-
parous at one time, and ovo-viviparous at another, merely by
altering the circumstances, so as to accelerate or retard the
period of extruding the eggs.

3. Head. The head of our venomous Snakes is dispropor-
tionately large, triangular, rounded or truncated anteriorly,
and flattened above. The enormous breadth of the posterior
part, as contrasted with the remarkably small and contracted
neck, gives a hastate appearance to the head. This peculiar
conformation of the head seems to be connected with the won-
derful distensibility of the several parts composing the cranium,
requisite for swallowing the large animals on which these Ser-
pents prey. To this end, the tympanic bones, which connect
the rami of the lower jaw with the posterior part of the crani-
um, are enormously elongated. This gives great width to
the posterior region of the head ; which is still farther increased,
by the presence of the large poison gland on either side be-
hind the eye. Armed with the power of destroying compara-
tively large animals, nature has invested them with a confor-
mation admirably adapted for transmitting the undivided victim
to the digestive cavity. Nothing is more common than for our
Rattlesnakes to swallow full-grown rabbits.

This distinctive mark, founded upon the peculiar shape of
the head, does not belong to all poisonous Serpents, but is quite
characteristic of those inhabiting our State. The Elaps is the
only exception ; which, as we have seen, is probably innocuous.
Among the harmless snakes, the several species constituting the
genus Heterodon, are the only ones in which, the character of
the head is liable to produce an erroneous impression. Some
of these have the head large, flattened, triangular, and broader
behind: but then, the enormous size of the neck, (as large as
the head,) and the pointed snout turned upwards at the tip, will
readily distinguish them from their dangerous congeners.

658 Le Conte, on Venomous Serpents, [November,

4. Scales on the Head. All of our Venomous snakes,
excepting the Elaps, have a great portion of the superior re-
gion of the head covered with scales instead of plates ; a me-
chanism which appears to be conformable to the extreme dila-
tability of the parts, to which reference has been made. In the
Crotalus, this peculiarity is very conspicuous, inasmuch as the
scales cover the vertex as well as the occiput, extending ante-
riorly as far as the eyes ; the front being the only part covered
with plates. In the Crotalophorus and Trigonocephalus, the
scales do not extend so far forward ; and consequently, this
character becomes less striking. In fact, as a similar arrange-
ment in the anterior extension of the scales of the neck exists,
to some extent, in the innocent Heterodon, it looses more or
less of its value as a distinguishing mark between this genus,
and the Trigonocephalus.

5. Pit between the Eye and the Nostril. In all of our
poisonous Serpents, the Elaps being excepted, there is a deep
pit or fossa, of considerable size, situated on each side between
the eye and the nostril, which penetrates in the direction of the
poison apparatus, at the base of the fang. Dr. Tyson first
pointed out the fact, that these orifices have no connection with
the organs of hearing, and that they led into cup-like cavities
formed by the bones of the skull and those of the upper jaw,
which were not perforated. (Phil. Trans., vol. 13, p. 26.)
Many years later, they were more minutely described by Sir
Everard Home. (Phil. Trans., for 1S04. p. 72.) It seems
that, these pits are found in several different genera of Venom-
ous snakes, and that, they have never been seen in any of the
Non-venomous species. The teleological import of these pits
is not understood. They have no direct communication with
the cavity containing the poison, but are connected with the
lachrymal passages. Dr. Richard Harlan having invariably
found an exceedingly delicate transparent membrane over the
osseous cavity in the bone at the base of the fang, has suggest-
ed ; that, " this membrane, whilst it intercepts any direct com-
munication between the sack and the external canal, might at
the same time permit the action of the atmosphere on the fluid
contained in the sack, and thus change its chemical properties.'"

1853.] LeConte, on Venomous Serpents. G59

{Trans, of Amer. Phil. Society, New Series, vol. 3. p. 311.
1830.) This conjecture appears to receive some support from
the general opinion, that the activity of the poison is increased
by long retention.

6. Undivided Subcaudal Plates. All of our Venomous
snakes, the Elaps being excepted, have broad undivided
plates under the tail posterior to the vent, similar to those under
the abdomen. Sometimes a few of the plates are bifid near the
extremity of the tail. All of our Non-venomous Serpents,
without a single exception, have the subcaudal plates bifid or
divided as far forward as the transverse slit of the vent. This
is not an absolutely g'ercera/ distinctive mark between Venomous
and Non-venomous snakes ; but, with respect to those inhabit-
ing Georgia, it is absolute and highly characteristic.

The six distinctive external characters as above given, are
abundantly sufficient to distinguish the dangerous from the harm-
less Serpents inhabiting our State. But the arrangement of the
teeth and the organization of the mouth, constitute the most
important marks of distinction. The character most common-
ly adduced from the dental system, as distinguishing the Ven-
omous from the Non- venomous snakes, is, that the former have
two, the latter four rows of teeth in the upper jaw ; the two
outer or maxillary rows being wanting in the Venomous species,
and their place being supplied by a single poison fang. Prof.
Owen has shown, that this is not an infallible character: inas-
much as some poisonous snakes, have large immovable fangs
associated with a greater or less number of maxillary teeth.
Among our Serpents, the Elaps is the only one thus organized ;
and we have seen that it is not dangerous. In all of our truly
Venomous snakes, the poison-fangs are associated only with
their successors; constituting all of the teeth attached to the
maxillary bones, which are here shortened to mere tubercles
on the anterior and lateral portion of the head. Consequently,
only the two rows of palatine teeth are seen in the roof of the
mouth ; the arrangement of teeth in the lower jaw, is the same
in all Serpents.

These isolated fangs are usually said to be movable ; but, as
M. Cuvier remarks, it is. properly speaking, the exceedinglv

660 LeConte, on Venomous Serpents. [November,

short maxillary bone that moves. The structure of the venom-
fangs of Serpents, and the machinery by which their deadly
agency is brought to bear against those who are so unfor-
tunate as to be the objects of their attacks, are so interesting,
that, with the assistance of Prof. Owen, we will endeavor to lay
before our readers as clear a description of them as possible.

1. Machinery for Erecting the Fang. The superior
maxillary bone diminishes in length with the decreasing num-
ber of teeth which it supports. The transverse or external
pterygoid bone elongates in the same ratio, so as to retain its
position as an abutment against the shortened maxillary, and
the muscles implanted into this external pterygoid style com-
municate, through it, to the maxillary bone the hinge-like move-
ments backwards and forwards upon the ginglymoid articula-
tions connecting that bone with the anterior frontal and pala-
tine bones. As the fully-developed poison fangs are attached
by the same firm basal anchylosis to shallow maxillary sockets,
which forms the characteristic mode of attachment of the sim-
ple or solid teeth, they necessarily follow all of the movements
of the superior maxillary bone. When the external pterygoid
is retracted, the superior maxillary rotates backwards, and the
poison fang is concealed in the lax mucous gum, with its point
turned backwards. When the muscles draw forward the ex-
ternal pterygoid, the superior maxillary bone is pushed for-
wards, and the recumbent fang withdrawn from its conceal-
ment and erected.

In this power of changing the direction of a large tooth, so
that it may not impede the passage of food through the mouth,
we may perceive an analogy between the typical genera of ven-
omous snakes and the Lophius ; but in the fish, the movement
is confined to the tooth alone and is dependent on the mere
physical property of the elastic medium of attachment ; in the
Serpent, the tooth has no independent motion but rotates with
the jaw, whose movements are governed by muscular actions.
In the fish, the great teeth are erect, except when pressed down
by some extraneous force. In the Serpent, the habitual posi-
tion of the fang is the recumbent one, and its erection takes
place only when the envenomed blow is to be struck.

1853.] LeConte, on Venomous Serpents. 66l

2. Structure of the Fang. That the poison fangs of
venomous snakes are perforated, with the view of injecting the
venom into the wound, was very well known to the ancients :
Galen tells us, that the mountebanks of his day used to stop
these perforations with some kind of paste ; after which, they
would publicly expose themselves to be bitten without danger.
But the peculiar structure of these organs was first described
by Redi and Fontana. A true idea of the structure of a poison-
fang will be formed by supposing a simple conical tooth to be
pressed flat, and its edges to be then bent towards each other,
and soldered together so as to form a hollow cylinder, or rather
cone, open at both ends. The flattening of the fang and its in-
flection around the poison-duct commences immediately above
the base, and the suture of the inflected margins runs along the
anterior and convex side of the recurved fang : the poison-canal
is thus in front of the pulp-cavity. The basal aperture of the
poison-canal is oblique, and its opposite outlet is still more so,
presenting the form of a narrow elliptical longitudinal fissure
terminating at a short distance from the apex of the fang. It is
more strongly curved backwards than the ordinary teeth, but
its acute and slender apex is frequently bent slightly in the con-
trary direction, as in the rattlesnake.

The duct which conveys the poison, although it runs through
the centre of a great part of the tooth, is nevertheless, as we
have seen, really on the outside of the tooth ; the canal in
which it is lodged and protected being formed by a longitudinal
inflection of the parietes of the pulp-cavity or true internal canal
of the tooth. This inflection commences a little beyond the
base of the tooth, where its real nature is readily appreciated,
as the poison-canal there rests in a slight groove or longitudinal
indentation on the convex side of the fang : as it proceeds, it
sinks deeper into the substance of the tooth, and the sides of
the groove meet and coalesce, so that the trace of the inflected
fold ceases, in some species, to be perceptible to the naked
eye ; and the fang appears, as it is commonly described, to be
perforated by the poison-duct.

3. Poison Glands. According to Prof. Muller, the poison
glands occupy the side* of the posterior half of the head ; each
n. s. VOL. IX. NO. xi. 42

662 Le Conte, on Venomous Serpents. [November,

consists of a number of narrow elongated lobes, extending from
the main duct which runs along the lower border of the gland
upwards, and slightly backwards. Each lobe gives off lobules
throughout its extent, thus presenting a pinnatifid structure ; and
each lobule is subdivided into smaller secerning caeca,which con-
stitute the ultimate structure of the gland. The whole gland is
surrounded by a double aponeurotic capsule, of which the outer-
most and strongest layer is in connection with the muscles, by
whose contraction the several caeca and lobes of the gland are
compressed and emptied of their secretion. This is then con-
veyed by the duct to the basal aperture of the poison-canal of
the fang. We may reasonably suppose that the rage which
stimulates the venom-snake to use its deadly wreapon must be
accompanied with an increased secretion and great distention
of the poison glands ; and as the action of the compressing mus-
cles is contemporaneous with the blow by which the Serpent
inflicts its wTound, the poison is, at the same moment, injected
with force into the wound from the apicial outlet of the perfora-
ted fang-

4. Replacement of Fangs. In the typical and most dead-
ly venom-snakes such as the Crotalus and Trigonocephalus,
the poison-fangs acquire their largest size, and are associated
only with their successors, destined to replace them should
these be destroyed by accident. These are clustered in great-
er or less number behind the fully-developed fang, presenting
the same structure, but of a size proportionate to their degree
of development, and further differing in being loosely imbed-
ded in the thick and wide mucous gum, which likewise con-
ceals the fixed and functional fang in its ordinary position of
retraction and repose. It thus appears, that in the posterior
part of the large mucous sheath of the poison fang, the succes-
sors of this tooth are always to be found in different stages of
development. The pulp is at first a simple papilla, and when
it has sunk into the gum the succeeding portion presents a de-
pression along its inferior surface, as it lies horizontally, with
the apex directed backwards : the capsule adheres to this inflec-
ted surface of the pulp. But how the cylindrical cavity of the
dilated fold is occupied in the loose growing poison-fang, and by

1863.] LeConte, on Venomous Serpents. 663

what contrivance it is brought into the same relation with the
severed duct of the poison gland as the displaced fang which it
succeeds, is not yet clearly understood. (On the foregoing
points, vide Owen's "Odontography," Passim, and Todd's
"Cyclopedia of Anatomy and Physiology," Articles, " Reptilia
and Teeth.99)

Habits of our Venomous Serpents. We will conclude
this Paper with a few observations on the habits of each of the
four species of dangerous snakes inhabiting Georgia. On this
point, as well as on many others to be noticed in a future com-
munication, I must express my profound obligations to my
friend W. E. Dearing, M. D., of Augusta, Georgia. For many
years he has studied the habits of our Ophidian reptiles with an
assiduity and discrimination beyond all commendation. En-
dowed by nature with an mtuihve poioer of taming, he has col-
lected and domesticated a great number of our snakes, and has,
thus, been able to investigate their habits, under the most favor-
able circumstances. This has been done in the face of popu-
lar prejudices which were so strong, as to characterize such
studies, so foreign to the spirit of utilitarianism, as little else
than manifestations of mental hallucination,

1. Crotalus durissus. This snake lives on rabbits, squir-
rels, rats, etc., and is a remarkably slow and sluggish animal,
lying quietly in wait for his prey, and permitting any one to pass
within a few feet of him unmolested. When suddenly disturb-
ed, he generally throws himself into a coil, and warns the
aggressor by rapidly vibrating his rattles ; but Dr. DeKay re-
cords a case in which an Indian was struck without the slightest
warning. (Nat. Hist, of New York, " Zoology.") It is a very
commonly received opinion, that the rattlesnake never strikes
unless coiled ; so that if once thrown from this position, he may
be approached without danger. But Dr. Dearing has seen
them strike repeatedly without coiling.

The Hon. Paul Dudley informs us, that these Serpents rattle
most fiercely in clear fair weather. When rainy, they make
no noise ; for which reason, he affirms, the Indians do not like
to travel in the woods in rainy weather. (Phil. Trans, vol. 32

664 LeConte, on Venomous Serpents. [November,

p. 292.) According to the observations of Dr. Dearing, they
will rattle in all kinds of weather ; but the sound is compara-
tively feeble when the atmosphere is moist. He assigns a
physical cause for this fact, which affords a perfectly satisfac-
tory explanation of the phenomenon. Owing to the strongly
hygroscopic properties of the corneous rattle, it becomes quite
soft when the atmosphere is damp, and, consequently, its vibra-
tion produces a comparatively feeble sound.

2. Crotalus adamanteus. This terrible snake is restrict-
ed to the Southern States. It chooses for its abode, damp and
shady places, keeping constantly near the water, from which
circumstance it is sometimes called the "Water-rattle ; ,y
although, as Prof. Holbrook says, there is no evidence of its
taking to the water in search of prey. In other respects, its
habits are similar to the preceding species.

3. Trigonocephaly piscivorus. This snake is found
about damp, swampy places, or in water ; far from which it
is never observed; and hence, called " Water Moccasin." It
lives on fish, frogs, toads, tadpoles, and many of the smaller
reptiles. This Serpent is very vicious, attacking every thing
that comes within his reach and its bite is justly dreaded.
The tail is terminated by a small horny point, about half an
inch in length, which seems to be the homologue of the rattle of
the preceding genus. This excrescence, though perfectly
harmless, has, according to the older writers, given a dreadful
character to its owner, imposing a belief on the credulous, that
he is the terrible Horn Snake, armed with death at both ends,
Lawson informs us, that he ''heard it credibly reported by
those who said they were eye-witnesses, that a small locust tree,
about the thickness of a man's arm, being struck by one of these
snakes at 10 o'clock in the morning, then verdant and flourish-
ing, at four in the afternoon was dead and the leaves red and
withered." (Lawson' s New Voyage to Carolina, p. 130.)
The foregoing story is only surpassed by one recorded by Sir
Hans Sloane: Col. James Taylor of Metapony, told Col. Bev-
erley, that, having found a rattlesnake, they cut off his head
with three inches of his body. A green stick, the bark being

JS53.] LeConte, on Venomous Serpents. 665

peeled off, was put to the head ; it bit it. Small green streaks
were observed to rise up along the stick towards the hand.
The Col. threw the stick down, and, " in a quarter of an hour,
the stick, of its own accord, split into several pieces, and fell
asunder from end to end." (Phil. Trans., vol. 38, p. 321 cited
from Beverley's Hist, of Virginia, 2d Ed., p. 260.) When such
absurd and preposterous notions find a place in grave philoso-
phical transactions, it is not at all astonishing, that "Snake Sto-
ries" should have become typical of everything incredible.

4. Trigonocephaly contortrix. This reptile chooses
dark and shady places for its residence in general, though at
times it is found in meadows of high grass. Dr. Dearing has
frequently observed it about fallen timber and old deserted
houses. Its usual food seems to be field-mice, wood-rats, and
small birds. This snake is equally as vicious as the preceding,
and its bite is considered very dangerous.

It has long been a popular belief, in relation to the Euro-
pean Viper, as well as our Rattlesnakes, that, when the female
is suddenly surprised, she opens her mouth and permits her
young to run down her throat. The English viper-catchers
deny that any such thing ever happens ; and I have been dis-
posed to ascribe the origin of the opinion to the fact, that, these
Serpents being ovo-viviparous, they are sometimes found with
the "young in the oviduct ; which might lead persons to suppose
that they were in the stomach. But the following account
given by the well-known French naturalist and traveller, M.
Palisot De Beauvois, is so direct and positive, that my faith in
the above explanation has been shaken. He asserts, "that he
saw a large Rattlesnake, which he happened to disturb in his
walks, coil itself up, open its jaws, and instantly receive small
ones, which were lying by it, and instinctively rushed into its
mouth. M. De Beauvois retired, and watched the snake, and
in about a quarter of an hour after, saw her discharge them.
He then approached a second time, when the young retired
into its mouth with greater celerity than before: and the snake
immediately moved off in the grass and escaped." (Rees*
"Cyclopaedia." Am. ed., Art. Crotalus, cited from Amer. PhiL
Trans.)

666 LeConte, on Venomous Serpents. [November,

As regards the " Fascinating" or "Charming" power of
snakes, it is now generally considered a fable : a modification,
as Prof. Holbrook suggests, of that of the basilisk of the an-
cients, "a creature whose deadly glance would alone prove
fatal." The curious behavior of birds and some of the smaller
animals, when in the vicinity of these reptiles, is more ration-
ally explained by supposing that they are victims to maternal
solicitude, or, that they are bewildered and paralyzed with
terror, in suddenly finding themselves in the presence of an
enemy of such threatening aspect, rather than to imagine them
to be endowed with a mysterious and indefinable influence over
their weak and defenseless prey. In those cases in which the
animal has been observed to struggle and die, under the gaze
of the snake distant several yards, it is probable, that the vic-
tim had been previously struck, and the serpent was quietly
awaiting the result of the envenomed blow.

Capt. Richard F. Floyd, of Camden county, Georgia, in a
very interesting letter to Rev. James H. Linsley, says, " I
have often drawn near the rattlesnake and looked it steadily
in the eye until the intensity of my gaze became confused and
dim from the most natural cause, without having any strange
effect produced upon me." (vide Silliman's Journal, 1st series,
vol. 46, p. 45, Note. 1844.) Some have imagined that their
victims are overpowered by the horrible stench, which they
are capable of emitting from their bodies. But it seems tb me
very doubtful, whether this effluvium is ever thrown off except
for purposes of defense, as the polecat does ; and even if it
was emitted under other circumstances, it is still more proble-
matical, whether it could, by any possibility, have an intensity
so great as instantly to overpower the animal, and prevent its
escape.

It is a popular opinion, that hogs are particularly destructive
to these reptiles, and that they are quite invulnerable to snake-
bites. There can be no doubt, that these pachyderms are very
seldom killed by the bite of venomous serpents : Dr. Dearing
has known two instances in which they have been bitten, with-
out the slightest injury. Doubtless this arises from no special
immunity from the effects of the poison ; but from the fact,
that the slight vascularity of the skin, and the thick external

,

1853.] Douglass Soothing Liniment. 667

layer of fat, prevent the venom from finding its way into the
circulation. If struck under favorable circumstances, they
would be killed. Dr. De Kay was informed by a respectable
farmer in Dutchess Co., N. Y., that he lost three hogs in one
season by the poison either of the copper-head or rattle-snake.
(Nat. Hist, of New York. "Zoology.")

It is likewise a popular belief, that the poisonous Serpents
are often killed by the common Deer (Cervus virginianus),
which leap on them, with all four feet touching each other, and
off, so quick, that the snake has no power to bite, and this he
repeats until he completely dispatches him. Mr. Linsley says
that, " Mr. George Walter assures me that he witnessed this
fact this season in Missouri, while secreted in the bushes near
the operation." (Vide, Sillimans Journal, 1st series, vol. 46,
p. 44. Note. 1844.) Dr. Dearing informs me, that he has
frequently seen domesticated deer kill various species of the
common snakes by leaping on the body or head ; but has nev-
er seen them perform the operation on the venomous serpents.
A few astute lexicographers have been able to discern in the
Greek word for the stag, " Elaphos," a very early, if not an
intuitive, knowledge of this remarkable habit of the cervine
tribe. For example, the learned Schrevelius derives this word
from "Elein" and "Opheis," " quod serpentes e cavernis tra-
hat" It is true, that to those who are not initiated in the
mysteries of philology, it would seem prima facie probable,
that the progenitors of the Greeks would have given a name
to the stag long before they had observed such a habit in the
animal : but in a science in which vowels have no power and
consonants are interchangeable, what may we not expect a
prolific classical imagination to accomplish ?

Athens, Georgia, Sept. 20th, 1853.

ARTICLE XXXVI.

Soothing Liniment proposed by Dr. T. Douglass, of Alex-
der, Burke Co., Ga.

Prof. Gar vim :

My Dear Sir I beg leave to present you, for examination
and trial, a small specimen of a saponaceous compound which,

668 RicoroVs Letters on Syphilis. [November,

on account of its very prompt and soothing qualities, I have
honored with the name of Lethean Liniment.

It is made by digesting a bar of fresh turpentine soap and
four ounces of gum of camphor in a gallon of good alcohol for
two weeks in the heat of the sun. It is then bottled up while
hot, and one drachm of chloroform added to every four ounces,
set in a cool place, and shaken occasionally while coagulating.

The turpentine affords the best means, in my opinion, of
applying chloroform to the skin, because, by its adhesiveness
it holds that volatile fluid longer and more firmly in contact
with the surface than any other substance could do.

My mode of applying it, is to coat the part well with the
liniment and cover it immediately with a piece of good paper,
which adheres firmly and produces a gentle burning, tingling
sensation, which, in neuralgia, rheumatism, irritability of the
stomach, cramp colic, &c, is perfectly delightful.

Did I think more of money than of honor and humanity I
might possibly make this compound avail me something. But
since I do not wish to become a competitor with all the host
of pain-killers and extractors and eradicators in the country,
you may, if you think it worthy of a trial by our noble pro-
fession, hand it over to Professor Dugas for publication in the
Southern Med. and Surg. Journal.

Very respectfully, Tilman Douglass, M. D.

PART II.
(Eclectic department.

Letters upon Syphilis. Addressed to the Editor of L'Union
Medicale, by P. Ricord. Translated from the French, by
W. P. Lattimore, M. D.

TWENTY-SECOND LETTER.
[Continued from Page 600.]

My Dear Friend It would afford me much pleasure to say
a word relative to the treatment of chancre; but you know
that, according to the plan I have proposed to follow, I can-
not, in this connection, enter into many details.

Perhaps you will permit me to say something here in rela-
tion to prophylaxis. Medical police has advanced much of

1853.] RicorcVs Letters on Syphilis. 669

late years, especially since I and others have made examina-
tions with the speculum, in private hospitals and in public
dispensaries.

It is very certain that, since this mode of investigation has
been generally employed, a great amelioration iu the health of
public women has been observe^. Thus, in 1800, according
to Parent-Duchatelet, one woman in nine was found diseased ;
since 1834, the proportion has been reduced to one in sixty.-
The speculum has had a great share in this amelioration.

But, to be thoroughly successful, I have always insisted that
women should be visited every three days, without distinction
of rank ; whether they be en maison or en carte ; whether they
dwell in Paris or at the barrieres. You remember that inocu-
lable pus may be formed after the second day of an artificial
inoculation. Swediaur admitted that chancre may be devel-
oped within twelve hours. Frequent examinations with the
speculum are therefore indispensable, if we expect the surveil-
lance of public women to furnish a certain guarantee of free-
dom from disease.

I write this word guarantee, with special design ; for there
are some people who, after contracting an accident in their
adventurous loves, think they have the right of claiming indem-
nity from the government. Perhaps you think I am not seri-
ous. I will offer a fact in proof of my assertion. Some years
since, I received a visit from a merchant of Lyons, who was in
a state of great exasperation against the prefect of police. He
came to get a certificate setting forth the fact that he had
contracted a chancre in a house of prostitution, the character
of which he imagined to be guaranteed by the authorities. He
did not know that toleration, like all commissions, receive no
guarantee from the government.

I pass on to state that the ameliorations daily introduced in
the surveillance of prostitution, and the zeal exhibited by the
brethren on whom devolves the painful service of the dispen-
sary of public health, and of the Hospital of Saint Lazarre, will
furnish yet more suspicious results.

Public women are a necessary evil ; this fact is generally
admitted. I do not wish to examine the reasons favorably or
adverse to the proposition, for this is not the place to examine
them. But if the evil is necessary, it does not follow that its
quantity, so to speak, should be extended, as a learned Belgian
brother lately seemed to wish ; but it is essentially necessary
to inspect it well in relation to its quality.

In insisting that public women shall not communicate dis-
ease, it should be so arranged that they shall not be liable to
contract it from those who have commerce with them. How

670 Ricord's Letters on Syphilis. [November,

is this result to be accomplished? Is it necessary to institute
an examination of the persons who visit them, and to prevent
these visits should they prove diseased ? But, apart from the
difficulties of such an institution, the danger which we should
thus seek to prevent would be augmented ; for, instead of fall-
ing into a sewer which the police could cleanse, the unclean
would go elsewhere.

The establishment of lazarets and of quarantines, suggested
by my friend Diday, of Lyons, in a momeut of laudable philan-
thropy, where a clear patent of immunity from the pox, along
with a certificate of vaccination a patent that should be as
indispensable as a passport, a patent without which no one
should be admitted to any public office could be furnished,
cannot be thought of at this day.

Whatever may have been said by the author of this ingen-
ious proposition, the difficulties in the way of such an institu-
tion seem insurmountable.

There was a time, you know, when those affected with pox
were banished from Paris, and condemned to the rope if they
returned ; a time, when at Bicetre, patients were scourged at
their entrance and exit. All this did not diminish the number
of the infected. On the contrary, the scourgers perhaps de-
served, in their turn, to be punished. These barbarous meas-
ures have fallen into disuse.

It is undoubtedly necessary to subject to rigorous surveillance
all persons whom we can reach soldiers, for example and to
sequester every patient over whom we have control ; but a
certain degree of toleration, the pardon of a fault which is suffi-
ciently often involuntary, and excellent hospitals, with such
attendance as may at present be found there, and which time
will still further improve, are the best means of general prophy-
laxis, or those at least which will tend to diminish the gravity
of the disease.

Moreover, all who are acquainted with the conditions to
which women are subjected in the present state of society, with
respect to labor and its remuneration, have for a long time ac-
knowledged the fact that herein lies one of the most fruitful
sources of prostitution, and consequently of the propagation of
syphilis. Therefore, to ameliorate the condition of women with
respect to labor, is to do a kind office as well to humanity as to
morals and public hygiene.

You remember what I said with respect to the manner in
which chancres are produced. It is necessary to remember
this fact, in order to shun the sources of contagion pointed out.
The most important fact which science teaches us relative to
prophylaxis, is the necessity of avoiding exposure. This re-

1853.] Ricord's Letters on Syphilis. G71

mark doubtless appears a little naive ; but let debauchees re-
member it, for it is the very truth. I am now about to touch
upon a delicate subject which is full of shoals. It is still an un-
settled question in morals and medical deontology, whether the
physician ought to give advice, with respect to preservation
from evil to those who voluntarily expose themselves to the
liability of contracting disease from immoral persons. I do not
pretend to be more severe than Parent-Duchatelet, who treated
this subject with a purity of intention of which you are well
aware. Besides, am I not encouraged by the very character
of the journal which gives such liberal hospitality to my letters ?
I address the learned those who are physicians ; and was it
not yourself, my dear friend, who said that science is chaste,
even stark-naked ? Be not alarmed ; for, after all, I shall only
glide over this ticklish subject.

There is no sure and absolute preservative against chancre.
This is my declaration.

If, in spite of a knowledge of this fact, one is still willing to
run his chance, some precautions may be taken. It is especial-
ly necessary to bear in mind the precept of Nicholas Massa,
so energetically rendered by the elder Cullerier: "The con-
nection should not voluntarily be prolonged." At this mo-
ment, indeed, it is necessary to be egotistical, as was remarked
by Hunter, but not egotistical after the manner of Madam de
Stael, who called love the egotism of two.

The most minute attention on the part of suspected persons
ought to be required in houses of prostitution. A fact with
which we have been for a long time familiar, namely, that a
deposit of virulent pus may be held in reserve in the genital
organs of women, demonstrates the necessity of this precaution.
This is a means of always preventing mediate contagion. I
have told you that numerous experiments have proved to me,
that by decomposing the virulent pus we can neutralize it.
Alcohol in water ; water mixed with one-fifth Labarraque's
liquid; all the acids, diluted in water so as not to be caustic;
wine; solutions of sulphate of zinc and acetate of lead, destroy
the inoculable power of virulent pus ; while, if this pus remains
unaltered, excessively minute quantities of it homcepathic
quantities, if you please retain their power to act. M. Puche
informs us that, at the Hbpitaldu Midi, the effects of inocula-
tion have been obtained by him from one drop of pus mixed with
half a glass of water.

Fatty substances are very useful, especially to medical men
who are obliged to practice the touch in dangerous localities.
Astringent lotions, which slightly tan the tissues, have frequent-
ly prevented contagion.

672 Ricord's Letters on Syphilis. [November,

But, if cleanliness is necessary before intercourse, on the part
of the one who may impart the disease, it need be minute only
subsequent to the act in the one who is simply exposed to infec-
tion.

There is another means which the moral sense repudiates,
and in which the debauchee has great confidence : this, un-
doubtedly, often serves as a security against infection ; but, as
was observed by a woman of much esprit, it is a cuirass against
pleasure, and a cobweb against danger. This mediate process
is an article which is often porous, or may already have been
used ; it frequently becomes displaced; it fulfils the. office of a
bad umbrella, which the storm may rend, and which, protecting
badly enough from the tempest, does not prevent the feet from
getting wet. I have seen, in fact, numerous ulcerations of the
root of the penis, of the peno-scrotal angle, of the scrotum, &c.
in those who had taken these useless precautions.

Many patients believe themselves safe from contagion when
they do not terminate the venereal act. A lady who consul-
ted me on her own account, was very much astonished when
she found that she had communicated a disease to her lover ;
because, she said, he did not conclude.

Some syphilographs believe that the urethral infection in
particular is effected after ejaculation, which creates a vacuum,
and because nature abhors a vacuum. But numerous facts
have taught me the reverse of this statement. Ejaculation, on
the contrary, must be considered as a powerful injection from
behind forwards, thus cleaning the urethra; and if urethral af-
fections, already so common, are not more frequent, we must
perhaps attribute the fact to this condition. Thus, an old, ex-
cellent precept recommends a prompt emission of urine after
every suspicious intercourse.

The circumcision of the prepuce, the excision of nymphse
that are too long, also constitute hygenic measures relative to
the genital organs, inasmuch as these appendices greatly favor
contagion.

I ask your pardon for this digression ; but it is the 'duty of
science to destroy the influence of charlatanism with respect to
the dangerous employment of a deceptive prophylaxis.

It would be necessary, were it possible, to indicate all the
measures that prevent contagion and, therefore, the propagation
of syphilis ; not in order to protect or to encourage libertinage,
but to protect the virtue and the chastity which so often become
its victims.

I am yet to speak of cauterization as an abortive remedy
against chancre. But I will make this the subject of my next
letter. [New York Medical Times

1853.] Odontalgia. 673

Odontalgia ; its Pathology and Treatment By J. P. Togg,
M. D.

The simple definition of the technical term odontalgia, is- to
be found in our vernacular word tooth-ache. No theory what-
ever is implied in it. It simply means what it most emphati-
cally is, a pain in a tooth. The character of this pain is Pro-
tean. It may be a slight uneasiness, it may be an intolerable
anguish. It may be dull, heavy, constant like rheumatism,,
acute and lancinating, paroxysmal, darting, boring, throbbing.
Any term of the frightful vocabulary of human suffering may be
applicable to this torture. It may be cumulative, beginning
moderately and increasing to intense severity, or it may at
once attack the sufferer, armed in all its terrors. Yet "tooth-
ache is, after all, only a symptom of some lesion either in the
pulp, the tooth, the jaw, the nerve, the brain, or the system at
large.

The sensibility of the teeth depends entirely upon the ner-
vous filaments distributed through that nervo-vascular mass,
usually known as the pulp. Shut up in a solid box of bone, re-
moved by several lines from the surface of the enamel, this ex-
pansion of nerves is. nevertheless, capable of perceiving very
delicate impressions made upon the outside of its hard, encrust-
ing ivory. The disagreeable sensation produced by even a
few soft fragments of food, intervening between two perfectly
healthy teeth, is a sufficient evidence of the delicacy of its sen-
sibility. This natural and healthy irritability may be easily
exalted to the morbid condition of irritation by impressions act-
ing upon the pulp itself or upon the nervous system generally.
Any cause, therefore, which shall unduly excite these organs
may produce odontalgia. Draughts of ice-cold water, or ex-
tremely hot beverages, mechanical irritation, as blows, or hard
substances forcibly pressed against them, are well known causes
of tooth-ache, owing to the direct impression they make upon
the nervous filaments. Any thing, indeed, which is capable of
exciting pain elsewhere may excite it here. But, besides these,
the teeth are subject to peculiar irritations. No other nerves
are so likely to be exposed by the common accidents of disease.
The regular progress of caries is to advance inwards towards
the cavity, and to lay bare the pulp, by the destruction of its
solid case. This having been accomplished, the sensitive cen-
tre of the organ is brought in direct contact with ail those varied-
irritants we are constantly putting in our mouths. Like any
other exposed nerve, it resents these insults, and warns us to be
more cautious, by the quick, sharp, darting pain which thrills
us. One of the characteristics of this form of tooth-ache is the

674 Odontalgia. [November,

suddenness of its invasion, and the rapidity of its subsidence,
after the irritating substance is removed. To this form we
may give the name, tooth-ache of direct irritation.

Irritation, however, may and often does run on to inflamma-
tion, so that the causes of odontitis or inflammation of the den-
tal pulp will be all those accidents which have already been
enumerated as sources of irritation, mechanical violence, irre-
gularities of temperature, caries, direct contact of irritating
agents, such as alimentary substances, acrid humors or hot or
cold fluids touching the exposed pulp.

The pain, in this form of odontalgia, differs materially from
that which we have already described. It begins ordinarily,
with a dull gnawing uneasiness in the part, accompanied some-
times by a sensation of heat. After a time, this becomes ag-
gravated to a severe throbbing pain, which is ordinarily the pre-
cursor, here as elsewhere, of suppuration. Should the inflam-
mation not extended beyond the pulp cavity the pain is not in-
creased by pressure on the tooth, nor is the tooth started from
its socket. The application of cold to the tooth is also followed
by temporary relief.

The cause of the pain experienced in odontitis will be under-
stood on the most superficial examination of the structure of
a tooth. The pulp is inclosed in a hard, unyielding cavity,
which everywhere adapts its walls to the soft imbedded mass.
In a state of perfect health, there is no room between the pulp
and the walls of its cavity. If now, inflammation sets in, it is
accompanied, of course by distention of the capillaries of the
pulp, but these, meeting on all sides a hard, resisting bone, must
press inwardly upon the soft, sensitive nervous filaments that
are intermingled with them. The continued increase of the
engorgement of the capillaries must, therefore, be accompanied
by a continually increasing aggravation of the pain. Nor is
this latter relieved by the occurrence of suppuration, unless the
fluid gets exit through the fang, or until complete disorganiza-
tion of the pulp has taken place, for the pus which is poured out
only aggravates the difficulty by increasing the already intoler-
able pressure upon the nerves. Any excitation of the heart
and arteries must also be accompanied by a marked increase
in the pain. Like all other inflammations, it has exacerbations
at night. These are partly due to attendant circumstances.
During the day, the erect posture being maintained, the action
of gravitation exerts the same influence over this, as over all
other inflammatory affections. By the simple physical obsta-
cle which it. opposes to circulation it diminishes the infraction
of the vessels. At night, however, the patient being in a re-
cumbent position, the engorgement is greater, because of the

1853.] Odontalgia. 673

removal of this salutary obstacle. The warmth of the head,
also, imbedded in soft pillows, increases the disturbance.
Another point which must be observed in connection with the
symptom of pain, is one which always attracts attention in other
inflammatory diseases. We allude to the temperament of the
patient. Every physician knows that there is great variery of
susceptibility to pain in different individuals. Temperament
and idiosyncrasy are both concerned in this. Nervous and
sanguine persons suffer more from the same morbid change
than the lymphatic and the bilious. What is the most intoler-
able anguish to one, is not much more than uneasiness to anoth-
er. Every surgeon knows that some persons bear operations
much better than others, and that, too, not from superior forti-
tude but actual oligaesthesis ; some patients will suffer little
from the gravest inflammatory disturbance, while others will
be cruelly tortured by comparatively trivial organic disease.

The condition of the tooth, also, must modify the pain. One
already disorganized by caries, or rendered rough by exostosis,
would be more actually painful than an organ entirely healthy.

Inflammation of the pulp maybe either acute or chronic.
The first form extends to every part of the pulp and lining
membrane, and terminates usually in suppuration. It is more
common before than after exposure of the pulp. The second
form usually results from exposure of the pulp and is not so se-
verely painful as the acute ; indeed it may last sometime
without pain, but the susceptibility of the tooth to painful im-
pressions is always increased by it.

This form of odontalgia may be called inflammatory tooth-
ache.

Closely allied to this is periodontitis, or inflammation of the
investing membrane of the tooth. The same causes whicb
produce odontitis may produce this. It is, however, more likely
to be metastatic than the former variety. The tendency of
fibrous membranes to metastatic disease is well known, a ten-
dency which is very much increased by the rheumatic and
gouty diatheses.

The pain, in acute periodontitis, is first dull, then acute and
throbbing. It is distinguished from the disease last described
by soreness and elongation of the tooth, redness and swelling
of the gums and sometimes of the check. The tooth is some-
times so raised as to interfere with mastication. This affection
often ends in alveolar abscess.

In both these forms of odontalgia, we may have all the ac-
companiments ofinflammation, such as constipation, head-achey
dry skin, flushed cheeks, full and rapid pulse, in short, inflama-
tory fever,

676 Odontalgia. [November,.

Odontalgia may also proceed from exostosis, or the growth
of bony vegetations at the base of the fang. These gradually,
yet powerfully and irresistibly, pressing upon the nervous fila-
ments must excite pain. According to Dr. Good, this pain at
first is not quite so acute as in the other varieties of tooth-ache,
for the pulp is not yet in a state of irritation. But by a contin-
uance of the pressure, it is soon brought into this condition,
when the pain will be as severe as on any other occasion, and
far less mitigable. This disease is obscure in its symptoms and
difficult of diagnosis. Often it is not detected till after the re-
moval of the tooth.

Fungus of the nerve, is a cause of tooth-ache, according to
Dr. Hullihen. He says, that it occupies the natural cavity of
the tooth and most probably originates from a remnant of the
dental blood vessels. " It always attacks teeth in which the
nerve has suppurated and is of a deep red color; very soft ;
bleeds freely upon the slightest touch; is sometimes totally
insensible, at others highly sensitive, giving much pain of an
incessant character ; entirely free from any darting or throb-
bing sensation; and, when small and painful, is frequently
mistaken for an exposed nerve. It varies in size, from that of
a pin's head, to a pea and larger. It is sometimes, when small,
deeply situated in a fang ; but more generally protrudes, filling
up a cavity formed by caries."*

So far we have considered those causes of odontalgia, which
directly affect the sensitive expansion in the cavity of the tooth.
We come now to investigate other and more distant causes of
the same affection. Occupying an intermediate place between
the local and general causes, is a condition of the nervous sys-
tem, alluded to by Dr. Harris,! in which the general sensibility
is so exalted that ordinary impressions, which, in a state of
health, are unattended by any uneasiness, may be productive
of severe agony. Analogous affections of other organs are
constantly met with in the practice of medicine. In many
forms of fever, the cutaneous surface becomes so exceedingly
sensitive as to be intolerant of the slightest touch. This is but
a lower degree of the same morbid change which produces,
those severe aching pains in the muscles accompanying fever.

Neuralgic tooth-ache is an affection which may proceed
from a vast variety of morbid conditions. Any disease which
is capable of producing neuralgia elsewhere may bring it about
in the teeth. To enter into the investigation of neuralgic
odontalgia, would lead us into the consideration of all the vari-
ous changes which may induce neuralgia, and would extend

* American Journal of Dental Science, i, 107

t Principles and Practice of Dental Surgery, 5th ed.} p. 337.

1853.] Odontalgia. 677

this little article to a most unwarrantable length. We can,
therefore, glance at but a few of these morbid alterations.

We may have intrinsic or extrinsic affections, capable of
producing neuralgic toolh-ache. Among the first we may-
enumerate neuritis or inflammation of the nerve, either in its
substance or its neurilemma. The morbid change referred to
by Cotunnius and others, namely, a deposit of a gelatinous
character under the neurilemma, is probably a result of inflam-
mation. So, too, the thickening of the neurilemma, observed
by Cirillo and Earle, would seem to be referable to the same
cause.

A more common condition is simple engorgement of the ves-
sels of the nerve, an affection which is often only the first stage
of inflammation. This engorgement has been frequently dis-
covered, especially in cases of sciatica, and may have been
present before death, when no traces of it are found on a post-
mortem examination. The experiments of Broussais and
Goupil are conclusive on this point ; they having found that rab-
bits, in which intense peritonitis existed during life, as seen by
openings in their bellies, exhibited often no traces of this en-
gorgement after death.

Venous congestion is still another cause of this intense pain.
This has often been observed about superficial nerves affected
with neuralgia. The fact that most neuralgic affections are
relieved by heat and aggravated by cold gives additional pro-
bability to this hypothesis of venous congestion acting as a
cause to produce neuralgia. We might further cite the inti-
mate relations between neuralgia and intermittent fever, a
disease marked by intense and frequently recurring paroxysms
of venous congestion.

Any pressure of the nerve along its course may be pro-
ductive of the same affection. An exostosis of the walls of the
infra-orbital or inferior dental canal, an aneurism of one of the
accompanying arteries, a foreign body pressing upon the nerve,
or a tumor affecting it at any part of its course may produce
neuralgic tooth-ache. The teeth may be and often are associ-
ated in the general anguish which involves the whole face,
during an attack of facial neuralgia or tic douloureux. This
may depend upon any of the above enumerated causes. In a
case of this disease, occurring at the Richmond Hospital in
Dublin, the Gasserian ganglion was fibro-cartilaginous and as
large as a nutmeg. Or the disease may be central and depend
upon some disorder of the encephalic mass, affecting the fifth
nerve at its very origin.

It must not be forgotten, however, that this general neural-
gia of the face may be caused by the irritation of a diseased

n. s. VOL. IX. no. xi. 43

678 Odontalgia. [November,

tooth. The phenomena of the transference and radiation of
impressions by nervous centres have not been sufficiently studi-
ed. That they possess these properties is well known. By
radiation of impressions is meant that power of the centres by
which they disperse an impression made at one point, over a
wide circuit in its neighborhood. Thus, to cite a case directly
in point, a diseased tooth, irritating a single ramuscule of the
inferior dental nerve, may arouse sufficient central disturbance
to be reflected over the whole face and head, affecting every
branch of the great trifacial trunk.

Transference of morbid impressions is analogous to radia-
tion, but much more remarkable. In consequence of this pro-
perty of nervous centres, an impression produced at one point
is felt at a remote one. Disease of the hip joint, is a familiar
example. This as all surgeons know, is very often first reveal-
ed by pain in the knee. Mr. Lawrence's case, is a very striking
illustration of this law of nervous centres, for in that, neuralgia
of the thumb was caused by the pressure of a pivot tooth on the
nerve of an old fang.

The teeth may also suffer among other organs, those strange,
wandering pains which accompany and which sometimes con-
stitute as far as symptoms can constitute a disease, the febres
larvatce or masked intermittents, so common in malarious dis-
tricts. These may be easily recognized by the judicious prac-
titioner who is watching for symptoms of this form of disease,
but will be certainly overlooked by the careless observer who
does not think of anything below the surface. As a general
thing, universal malaise accompanies this disturbance, though
but a single nerve may feel the severity of the pain ; and the
watchful physician can assuredly detect the characteristic ele-
ment of periodicity. Sometimes, however, this is very obscure,
and hardly to be recognized by the closest scrutiny, or elimi-
nated by the most careful inquiry. As the disease advances,
the periodical element gradually retires, and the neuralgic be-
comes unduly prominent. An analogous affection is the hepa-
talgia of malarious districts, so generally misunderstood, so
often confounded with chronic hepatitis, so commonly mis-
managed with large doses of calomel. This disease is almost
always more or less regularly intermittent at first, though it
finally becomes constant, or irregularly paroxysmal. In both
affections, at this stage, the history of the case forms our most
valuable diagnostic.

Neuralgic tooth-ache, however occasioned, is characterized
by very much the same train of symptoms. Dr. Wood, in
speaking of it, says : " The pain is usually of the acute char-
acter, sometimes mild in its beginning, gradually increasing in

1853.] Odontalgia. 679

intensity, and as gradually declining ; but usually very irregu-
lar, at one time moderate, at another slow, and occasionally
darting with excruciating violence through the dental arches,
not unfrequently it assumes the regular intermittent form. In-
stead of pain, strictly speaking, the sensation is sometimes of
that kind which is indicated when we say that the teeth are on
edge, and is apt to be excited by certain harsh sounds, such as
that produced in the filing of saw-teeth, by mental inquietude,
and by the contact of acids or other irritant substances. Neu-
ralgic tooth-ache sometimes persists, with intervals of exemp-
tion, for a great length of time. The diagnosis is occasionally
difficult. When, however, it occurs in sound teeth, it is parox-
ysmal in its character, is attended w7ith little or no swelling of
the external parts, occupies a considerable portion of the jaw
and especially when it alternates or is associated with pain of
the same character in other parts of the face, there can be
very little doubt as to its real nature."

Sympathetic tooth-ache cannot by any known means of diag-
nosis in symptomatology, be distinguished from the last variety.
Its history alone can throw any light upon it.

The nervous connections of the teeth are so numerous and
so extensive, that we need not be surprised at the wide range
of their sympathies. The fifth nerve supplying the whole face
and all the organs of the senses brings them in relation with the
entire head. But besides this, they have special connections
with many of the more important organs of the head. Meck-
el's ganglion and its branches, forming a sort of sympathetic
centre for the entire head, is directly connected with the supe-
rior maxillary nerve, just as it is about passing into the infraor-
bital canal for the supply of the upper teeth. With the ear they
are still more intimately connected through the otic ganglion
which rests upon the inferior maxillary nerve, at its exit from
the foramen ovale. This union will explain the extreme fre-
quency of ear-ache in children at the period of second dentition
and the tooth-ache which sometimes attends it. The same
ganglion, by means of the tympanic plexus which is so direct-
ly connected with it, brings them in relation with the glosso
pharyngeal and the pneumo-gastric nerves and so establishes a
sympathy between these organs and the whole upper portion of
the alimentary canal and with the lungs. Through the sym-
pathetic system these connections are indefinitely extended.
With the spinal cord they have not only the union, through the
origin of the fifth nerve, with the spinal bulb, but also through
the numerous filaments of the sympathetic which are connected
with the spinal nerves. Thus we find that, through this intri-
cate web of sensory filaments, the teeth are directly or indirect-
ly united with every organ in the system.

680 Odontalgia. [Aovember,

During certain conditions of the system, therefore, it is not
surprising that these sympathies should be roused to undue ac-
tivity. Many diseases have the power of inordinately exciting
nerves remote from the organ affected. The various disturb-
ances of the alimentary canal are remarkable for their pecu-
liarity. The anatomical connection between the stomach and
bowels and the teeth, already glanced at, sufficiently prepares us
to expect tooth-ache as an occasional accompaniment of disor-
der of the apparatus of alimentation.

Pregnancy is another state which is very liable to excite
sympathetic tooth-ache. This is indeed but a part of those
numerous remote disturbances which are caused by the pecu-
liar condition of the uterus at this interesting period. All the
organs of the abdomen are involved in that intricate net of ner-
vous filaments which are ultimately distributed to the uterus.
The two great cords of the sympathetic which descend from
the solar plexus and semilunar ganglion, on both sides of the
aorta, first unite over that vessel in a plexus which weaves into
itself all the various threads of which these cords and the stray
fibres which surround them are composed. Having thus knit
on the life of the whole abdomen in one intricate interlacement
of fibrillae, the nervous mass then divides into its two hypogas-
tric nerves and their plexuses. These proceed directly to the
ganglia of the uterus, sending off great numbers of nervous
twigs to all the neighboring organs, and wrapping all the pel-
vic viscera in their labyrinthine threads. In this manner is
the great organ of reproduction brought into relation with the
entire frame. During pregnancy, as has been clearly demon-
strated by Dr. Lee, the nervous system undergoes the same
change to which all the other structures of this organ are sub-
jected. They increase in size, and this increase extends even
to the cords which descend from the semilunar ganglia. There
are, therefore, both anatomical and physiological reasons for
the extensive range of sympathies possessed by the pregnant
uterus. The close contact of the semilunar ganglion with the
stomach, and the relations between that organ and the teeth,
explain how these may be involved.

Rheumatism, with its usual wandering character, may attack
the fibrous structures of the teeth. The diagnosis will be made
by a careful study of the diathesis, and a thorough investigation
of the attendant and antecedent circumstances of the case.

Gout, affecting every fibrous tissue in the body, does not
neglect the teeth. Dr. Harris, in a note to the chapter on
tooth-ache, in his Principles and Practice of Dental Surgery,
has an extremely interesting case, which we need not apologise
for quoting :

1853.] Odontalgia. 681

"The subject, Mr. W., a resident of Baltimore, about forty-
years of age, had been subject to attacks of this most excru-
ciatingly painful affection for more than fifteen years. The
paroxysms, for some four or five years previous to the above
mentioned time, had occurred at intervals of from three to six
months, and from ten to twelve days before each attack, during
this period he suffered from pain in the first right superior mo-
lar tooth, which was slightly affected with caries in the centre
of the grinding surface, but it had not yet penetrated to the
pulp cavity. The pain at first was not severe, but it gradually
increased in intensity, and assumed a peculiar boring, and at
times, a grinding and lancinating character. His attacks of
gout were confined to the joint of the big toe of his right foot
and as soon as the pain commenced here it subsided in his
tooth. But when the paroxysm of gout began to pass off, it
again commenced in the tooth, where it continued for about
two weeks. At the request of Mr. W. we removed the dis-
eased portion of the tooth and filled the cavity. The operation
for about three months promised to be successful, but about
ten days previous to the next paroxysm of gout, the tooth be-
gan to ache, the pain subsiding with the occurrence of the
paroxysm, but commencing again, when it passed off, and con-
tinued as it had formerly done for about two weeks. His suf-
fering from the pain in the tooth, during these periods, was so
great, that he determined to have it extracted. What the re-
sult of its removal has been, we have not yet ascertained."

The treatment of tooth-ache must necessarily be as varied as
the disease. To talk of administering one remedy for such
multiform disease is a manifest fallacy.

The tooth-ache of direct irritation has manifestly two indica-
tions first to remove the cause, secondly to allay the pain.
The latter indication is accomplished in various ways. Opiates
and other narcotics and the anaesthetics may be used to deaden
the sensation. Or this may be accomplished in another way,
by so vehemently stimulating the exposed nerve as to exhaust
its sensibility. The essential oils, of cloves, of cinnamon, of
cajeput, are used for this purpose. Intermediate between the
two, is kreasote, which possesses both stimulant and anodyne
powers. Combined with morphia in such proportions as will
form a thin paste, and applied on a small pledget of lint or cot-
ton, it usually acts very agreeably. Dr. Harris prescribes the
following formulae :
ty iEther. sulphuric. 1 j. $ ^Etheris sulphuric. j.

Pulv. camphorse, 3 j. Kreasoti, 3 ss.

Pulv. aluminis, 3 j. Ext. gall. Alep., 3 j.

Morphiae sulphat. 3 j. m. Pulv. G. camph. 3 ss. m.

682 Odontalgia. [November,

These are to be applied on raw cotton, after having first
cleansed and thoroughly dried the offending part, and renewed
as often as may be necessary. Relief is soon obtained, but of
course it is not permanent. A thick solution of gutta percha
in chloroform is another favorite remedy. It has the double
advantage of allaying the pain by its anaesthetic properties, and
of subsequently forming a thin but impervious coating which
sheathes the nerve and protects it for a while from the irritating
substances about it.

Permanent relief, however, can only be afforded by extrac-
tion of the tooth or destruction of the nerve, as there is no
other way of fulfilling the indication of removing the cause.
Of extraction it is not necessary to speak in this place. Des-
truction of the nerve may be accomplished by thrusting a
sharp stilet down through the root of the tooth and by thus
mechanically breaking up the structure of the nerve, or by
escharotics. The most powerful of the latter is the actual
cautery. A favorite mode of domestic application of this
remedy is heating a small knitting needle to high redness and
plunging it down into the pulp till its destruction is effected.
The only caution to be observed is to introduce it so far into
the fang as to destroy the entire nerve. Potassafusa may be
used, made into a paste with absolute alcohol, and applied to
the exposed pulp. Great care should be taken not to allow
this agent to come in contact with the surrounding soft parts,
or much pain and troublesome inflammation and ulceration will
follow. The combination of a small quantity of pure morphia
with this agent will somewhat abate the pain of its operation.
Chloride of zinc is another very powerful escharotic which
must also be used with extreme caution. The most common
of all these potential cauteries, however, is arsenious acid. Dr.
Foster, of New York, uses this in combination with morphias,
sulphas, in the proportion of two parts of the caustic to eight of
the narcotic. It is applied directly over the nerve, on a small
pellet moistened with kreasote, and covered with a cap so as
to avoid pressure. The subsequent treatment for the preser-
vation of the bony shell does not come under our considera-
tion.

In Inflammatory tooth-ache, the dentist has to consider which
of these courses he will take whether he will extract the
tooth, destroy the nerve, or attack the inflammation with anti-
phlogistics. " The propriety or impropriety of extraction will
be determined by the amount of pain, the progress made by
the inflammation, the condition of the parts with which the
tooth is immediately connected, the effect of the local disturb-
ance upon the general system, the situation and importance of

1S33.] Odontalgia. 683

the tooth, and the extent of structural alteration which has ta-
ken place in the crown. If the retention of it on account of
its location, or the loss of several other teeth, is of great im-
portance to the patient, and the circumstances of the case justify
a well grounded belief that it can be preserved and rendered
useful, without acting as a morbid irritant, the operation, if
possible, should be avoided. In this case, supposing the inflam-
mation to have proceeded too far to be arrested, the pulp may
be destroyed and the tooth treated in the manner elsewhere
described, as it would be useless to procrastinate the suffering
of the patient by instituting other treatment in the vain hope
of avoiding an alternative, which, after all, may not enable the
dentist to secure the permanent preservation of the organ.
Indeed, after the lining membrane has become exposed, this is
the only method of procedure, in any stage of the inflammation,
which, with a view to the preservation of the tooth, holds out
any prospect of success."

If the tooth is not eroded, or if the inflammation is not caused
by the direct application of irritants to the exposed pulp, the
antiphlogistic treatment may succeed. It is possible that, in
an intense inflammation accompanied by high sthenic febrile
excitement, venesection might be desirable. As a general
thing, however, the application of leeches to the gum, in the
neighborhood of the diseased tooth, is the only way in which
it is necessary to abstract blood in this painful little affection.
Saline cathartics, and rigid abstinence constitute the rest of
the treatment.

Suppuration having occurred, the treatment must be modi-
fied. This condition may be detected, according to Dr. Hulli-
hen, by the following signs. "At first the tooth is painful only
when hot or cold fluids pass over it, and may continue in this
situation for some time. At length a steady gnawing pain
supervenes, and then the tooth begins to get sore and appear
a little loose and longer than the rest. About this period the
pain assumes a very different character, darting from the tooth
along the courses of the nerve, to the temple, ear, and side of
the head, and to the teeth of both jaws on that side. Within
twenty-four hours the face begins to swell, and the pain changes
to one of a constant throbbing description which indicate that
an alveolar abscess is forming. When a tooth in the manner
described, becomes painful, the nerve is about suppurating ;
when it appears longer than the rest, loose, and is very sore,
the nerve has suppurated and the pus is beginning to ooze out
at the extremity of the fang where the vessels enter, producing
much pressure, hence the sharp darting paroxysm. When the
cheek begins to swell, the matter is effusing between the alveo-

684 Odontalgia. [November,

lus and its lining membrane, and occasions the throbbing pain
which always accompanies the formation of an alveolar ab-
scess. The true abscess of the antrum maxillare, originates in
like manner, from the same cause, when the fangs are very near
or penetrate into that cavity." The treatment recommended
by Dr. Hullihen is the trepanning or drilling of the tooth so as
to evacuate the pus.

Periodontitis is treated very much in the same way as in-
flammation of the pulp. Besides the ordinary antiphlogistic
treatment, counter-irritation to the neighboring cheek may be
of service. Narcotic agents combined with rubefacients have
often been found to be beneficial. A deep incision into the
gum has been recommended. Should alveolar abscess be
threatened, extraction will be necessary. Should it be an inci-
sor or cuspidatus which is involved, it should be removed only
as a last resort. In chronic inflammation the necessity for ex-
traction is more urgent.

Fungus of the nerve must be destroyed by the actual cautery.
The pain may, however, be relieved by making the morbid
growth bleed freely. Dr. Hullihen narrates a singular case of
hemorrhage occurring monthly from fungi in a young lady's
teeth. Destruction of the growth and plugging the teeth did
not relieve. At last it was decided to be a case of vicarious
menstruation, and as soon as the catamenia were regulated by
constitutional treatment, the local disorder vanished.

Neuralgic tooth-ache, originating, as it does, from a great
variety of causes, demands a corresponding variety of treat-
ment. Unfortunately, neuralgia still continues to be one of the
opprobria medicorum, but we have of late been approximating
something like a rational treatment of this obstinate and ago-
nizing distemper.

Thus, if the disease be caused by a general exaltation of
nervous impressibility, the indication is manifestly to subdue
that irritability. If it be purely functional, the narcotics will
accomplish this. If, however, it depends, as it may, upon loss
of balance between the nervous and vascular systems, that
balance must be restored, either by tonics, in one state of the
system, or by sedatives, in another. Arsenic and iron are
favorite remedies of the former class, aconite and the antiphlo-
gistic regimen of the latter. Should the affection proceed
from disturbance of the nervous centres, they must be attend-
ed to.

When neuralgic odontalgia depends upon neuritis of the fifth
pair or its dental branches, local antiphlogistic treatment along
the course of the inflamed nerve, must be adopted. In simple
irritation of a nervous trunk, chloroform applied to the surface

1853.1 Odontalgia. 085

nearest the nerve, and over its course, will often prove emi-
nently successful. If there be any tumor pressing upon the
nerve, it must be removed.

Sometimes the disease continues so obstinate, that even
when purely local it resists all the remedies we apply. In this
case, division of the nerve has been suggested. If the inferior
dental nerve be involved, M. Roux recommends trephining the
lower jaw, so as to reach the nerve, which is easily recognized
by its color and direction. Having exposed it, he then severs
it and passes a stick of potassa fusa up and down the canal so
as to completely destroy it. If the superior maxillary nerve
be affected, an incision is made upon the cheek and the caustic
introduced as deeply as possible along the infra-orbital canal.
This operation is resorted to in those maddening neuralgias of
the face which associate the teeth in their general anguish.
When the teeth thus make part and parcel of a number of suf-
fering organs, the treatment must necessarily be general to the
affected nerve. The main disturbance being quieted, all the
subordinate pains are allayed. As facial neuralgia, however,
may depend upon the irritation of a diseased tooth, it is neces-
sary to examine the case minutely, and to extract immediately,
if necessary. Here, however, caution is to be observed. Pain
may be inflicted unnecessarily ; sound teeth may be drawn
without at all benefiting the patient, and on the other hand a
useless organ may be suffered to remain in the jaw, a perpetual
source of irritation, owing to a timid or procrastinating policy.
When tooth-ache depends upon that general neuralgic condi-
tion which accompanies malarious poisoning, quinine, arsenic
and iron are the proper remedies.

In treating sympathetic tooth-ache, the first point to be de-
termined is the nature and seat of the primary disturbance. If
this can be reached and overcome, it is manifestly our duty to
do it. If not, the determination of the source of irritation will
have at least one good effect; it will prevent the dentist from
unnecessarily wasting his patient's teeth by profitless extrac-
tion. It would occupy us too long to attempt to trace the
various morbid conditions of different parts of the system and
the many modes of treating them, and then we could not suc-
ceed in giving a clear idea of all the circumstances on which
this painful affection may depend. The investigation of the
cause of the disease, and the selection of the appropriate reme-
dies must be left to the judgment of the practitioner and that in
each individual case.

In rheumatic tooth-ache the treatment will be leveled at the
general disease, while the local disturbance must not be neg-
lected. Colchicum, calomel and James' powders, guaiacum,

686 Effects of Sleep. [November,

nitrate of potash and opium at night, followed by a cathartic in
the morning, will answer the first indications, and plasters of
opium and belladonna the second.

In gouty tooth-ache the treatment must also be addressed to
the main disorder.

In tooth-ache from exostosis, the remedy is extraction. In
some cases, however, Dr. Good's mercurial treatment may
succeed, for we may have syphilitic exostosis here as well as
any where else. The existence of the exostosis, however, must
be first established, for pure neuralgia is usually aggravated by
mercury. [Amer. Journal of Dental Science.

Remarks on the Effects of Sleep, in exhausted states of the
system : (read before the Medical Society of Oneida county,
New York.) By John McCall, M. D.,"of Utica, Fellow of
the College of Physicians and Surgeons of the University of
N. York, Member of the Am. Med. Association, etc., etc.

I propose making a few remarks on the present occasion, re-
specting certain views and practices which have obtained to
some extent among physicians, of not allowing such patients
as are regarded as much exhausted, from whatever cause, to
sleep but a few minutes at a time, from an idea, as they express
it, that sleep beyond fifteen or twenty minutes at a time, would
exhaust and prostrate the vital forces. That such opinions
have been entertained by some of our members, I know, and if
nurses and other attendants upon the sick are to be relied on in
all cases, it is to be feared that they are still put in practice by
some of the profession. At least, I have been credibly inform-
ed, that in different parts of our country, some physicians still
give directions to the nurses to wake up patients who are in a
very feeble state, every few minutes, though they may be
sleeping soundly at the time.

Several years since, I was called in consultation in a severe
case of bilious fever, occurring in the fall season. The patient
was a young man in single life, who had been sick some two
weeks, and was in danger of having a typhoid form of the dis-
ease ; he was so reduced in strength at the time as to faint on
being raised from his bed. On my second visit, which was in
the morning, I inquired of the attendant how the patient had
slept during the preceding night ? She replied, " pretty well,"
but remarked that she awoke him every fifteen or twenty min-
utes. With some surprise, I asked by what authority she had
done so; and learned that it was according to the directions
of the attending physician, and upon further inquiry, I found

1853.] Effects of Sleep. 087

that such had been the practice enjoined upon the nurse for
several days. Regarding such advice as not only singular, but
pernicious, I took occasion in the presence of the medical at-
tendant to urge upon the nurse and family the danger of such
practice, and advised that the patient be allowed to sleep as
long as he wished, even three hours at a time if he could, and
that on no occasion should he be again disturbed in like man-
ner. From this time, he was permitted to sleep as long as he
desired, and often from one to three hours without waking.
With careful nursing, strict attention to ventilation and clean-
liness, and a mild supporting course of treatment, our patient
gradually recovered, though his convalescence was slow, and
it was not until the approach of the cold weather of winter that
he fully regained his strength and health.

In another instance, where I was called in consultation, the
same course had been pursued. The patient was a young lad
about eleven years of age, the son of a clergyman, suffering an
attack of inflammation of the bowels. He was naturally feeble
and easily prostrated, had been ill six days when I first saw
him, and by accident I learned that the nurse and watchers, by
direction of the medical attendant, had made it a rule to wake
him every few minutes. He was petulant, "nervous," as it is
called, and easily disturbed by trifling things ; his pulse was
very frequent, varying from 120 to 140 in the minute, small and
feeble, and he was irritated and annoyed by almost everything
said or done to him. He was now told and enjoined to sleep
as long as he wished, and the nurse was forbidden to wake
him, even though he should "sleep hard," to use their own
words. " Tired nature's sweet restorer, balmy sleep," was
now allowed to do her work *' in her dire way," and with the
aid of suitable anodynes and soothing remedies, the young pa-
tient slowly recovered.

In proof that one or more of our profession in distant States
or sections of the country entertain like views, and pursue
similar treatment, if such a term is admissible, I may mention
the case of a merchant from Michigan, who became a patient
of mine while suffering a severe inflammation of the middle
finger of the left hand, occasioned by a slight w7ound received
from the point of a needle near the first joint. This gentleman's
constitution was a good deal impaired, in consequence of a
severe course of fever which he had passed through in the pre-
ceding fall or winter. In the relation of his illness to me, he
stated that by the advice of the physician who attended him,
he was not allowed to sleep but a few minutes at a time. On
my third visit, I learned that his good young wife had made it
a rule to wake him every fifteen or twenty minutes, assuring

G88 Effects of Sleep. [November,

me that his medical attendant in Michigan had advised this
practice. The patient was now told to sleep all night if he
could, and his wife respectfully requested to do the same, and
thus give herself no further solicitude about his "sleeping too
hard." From this time he was allowed and enabled to rest
quite comfortably by taking one or two small Dover's powders
in the evening. He is now fully convinced that sleep, even if
" hard," is nature's best restorer.

How prevalent these opinions may be* I am unable to say,
but I fear there are still a few of the medical profession who
entertain them, and it is very certain that in this region such
notions too generally obtain among nurses and attendants upon
the sick. My object in presenting the subject is to solicit at-
tention thereto, and at the same time to ascertain, if possible,
whether such practice is ever advisable in the class of patients
above mentioned.

Having never seen or heard any good reason given in sup-
port of such opinions and practice, and being unable to recon-
cile either with any experience of my own touching the physi-
ological and pathological view of the case, I trust I shall be
excused in thus briefly discussing the subject. And in order
to find out the truth here as elsewhere, (which, by the by, is
often a difficult matter, and he who asks, ivhat is truth ? and
endeavors to find it by patient thought, and careful examina-
tion, is deserving of something more than the sneers and ridi-
cule of the world,) I shall at once proceed to inquire into the
condition of the human economy in a state of sleep.

And in the first place What is sleep ? Is it a state or con-
dition of rest of the mind and body, or simply of some portion
of the organism? To arrive at the facts in the case, let us
take for example a person sleeping soundly. All the external
senses are more or less locked up in other words, resting.
Neither the sense of vision, hearing, tasting, smelling, nor
speech, attend to their respective functions in sound sleep.
The muscles of locomotion are all quiet and immovable, and
all those parts or portions of the brain and nervous system
concerned in thought and feeling, no longer take note of time
or circumstances, or the objects of earth or heaven. The in-
dividual on awakening can rarely give any account of himself,
or what occurred during his state of sleep. The circulating
system with the secretions and the respiratory movements
all move onward regularly during such a state, and yet, on
awakening, the person is unable to give an account of what
passed during his state of rest. And what is particularly wor-
thy of notice, as bearing on this question, is the fact, that the
sleeper is generally, if not always refreshed and invigorated, so

1853.] Chloroform in Puerperal Convulsions. 689

as to be ready and willing to resume again his labors of body
and mind. How often, too, have we not witnessed the restoration
of the poor patient to health and reason, who only a few hours
before was perhaps all but exhausted from the dreadful effects
of delirium tremens? In this, as in all diseases and affections
of the brain and nervous system which eventuate in some form
of insanity, sleep is the only certain remedy. These statements
require no special proof, as they are facts known to many intel-
ligent persons not of the profession. So long as an individual
sleeps well, there is little or no danger of the supervention of
insanity. 1 suppose that all parts of the brain which are con-
cerned in mental manifestations, require rest or sleep, as well
as the muscles of locomotion. Not only man, but animals,
birds, and all living things require sleep. Plants droop and
suffer, when deprived of that great restorative principle of na-
ture.

The opinion that sleep of two or three hours continuance can
exhaust the powers of the system when in an enfeebled condi-
tion, seems to me unreasonable, and is not founded on any
physiological or pathological principle with which I am ac-
quainted. It is a common idea, that the mind may become
fatigued, sick, or diseased, and that it is never idle or asleep.
I cannot conceive how all this can happen to an immaterial
thing, which the mind is said to be. It seems to me, that phy-
siological and pathological facts relating to the encephalon can
best explain this matter, and one such fact is worth a thousand
metaphysical speculations.

And now let me ask, What is the amount of our knowledge
on this subject 1 What do we know of the use or purposes of
the brain in health, and what do we know of its pathology ?
Certainly if we understood its physiology and pathology, we
could talk intelligibly upon the great subject of mental philoso-
phy. Have we any system on that subject recognized as sound
in all its points, aside from phrenology? And yet who but the
medical philosopher should best understand this matter, as also
the subject of sleep and its effects both in health and disease ?

If these remarks should elicit one useful idea in behalf of our
noble profession, I shall feel satisfied. \_N. Y. Jour, of Med.

On the use of Chloroform in Puerperal Convulsions. By B.
Fordyce Barker, M. D., Professor of Midwifery, &c. in the
New York Medical College.

In the report of the proceedings of the Medical and Surgical
Society in the April number of this journal, I observe that the
use of chloroform in puerperal convulsions was somewhat dis-

690 Chloroform in Puerperal Convulsions. [November,

cussed. Since Dec. 1847, the period when I first commenced
the use of anaesthetics in midwifery,) I have met with fifteen
cases of puerperal convulsions. In four of these cases, no an-
aesthetic agent was used, as the condition of the patient was
such that it was deemed unadvisable. Three of them were
comatose when I first saw them, and could not be roused from
this condition. The fourth occurred subsequent to labor, im-
mediately after the delivery of the placenta. It was retained
some hours ; the physician in attendance was obliged to intro-
duce the hand into the cavity of the uterus in order to extract
it. When the placenta was withdrawn, there was a great loss
of blood, and the patient almost instantly became convulsed. I
saw her in a half hour afterwards, when she had had four con-
vulsions. These were arrested by the use of opium, but the
patient died on the 5th day, from metritis. In two cases, sul-
phuric ether was used as an anaesthetic, one of whom recover-
ed ; the other was seized with convulsions in the seventh month
of pregnancy, on hearing of the death of a sister from the same
cause: when not convulsed, she was furiously maniacal until
the ether was used, which entirely arrested both the convulsions
and mania. Four days after, she was delivered of a dead foetus.
The labor was easy and natural, and unattended by any occur-
rence of either the convulsions or mania; nor had she any un-
pleasant symptoms, as I understood from her physician, until
the day after delivery, when she complained of severe pain in
her breast, then of headache, and within an hour after, she again
became maniacal. The prejudices of her husband and friends
prevented the use of the anaesthetic again, and she died on the
8th day after delivery. This case I saw in consultation, and
administered the ether, but I did not see her after her confine-
ment. In a third case I attempted to use the ether, but the
patient refused to inhale it ; her husband became alarmed, and
I was obliged to desist. She was bled largely, and tart, anti-
monii, calomel, croton oil, &c, were relied upon. She also
became maniacal after delivery, but eventually recovered. In
eight cases of puerperal convulsions I have used the chloroform,
and in all these the effects were most happy, the convulsions
being entirely controlled by its use. Two occurred in my own
practice the other six I saw in consultation. In four the labor
terminated naturally, three of the children being born alive.
Three were delivered by the forceps, and were alive. The
forceps were used in these cases, because the stethoscope indi-
cated danger to the child. One, a shoulder presentation, was
delivered by turning. All of the mothers recovered. No one,
who has not witnessed the total change which the chloroform
induces in an eclamptic patient, can conceive with what satis-

)853.] Chloroform in Puerperal Convulsions.

691

faction its effects are watched by the practitioner and friends.
It is certainly not too much to say that by no other plan of
treatment can such results be gained ; and at this day we may
be warranted in adding that sufficient experience has already
been gained to justify the assertion that the agent is perfectly
safe. At least, no authenticated case of death from the use of
chloroform in obstetrics has yet been reported.

I suppose it will be admitted by all, that a very large major-
ity of cases of puerperal convulsions depends upon sympathetic
or functional derangements, and not on organic changes. In a
large proportion of the cases of death, autopsy reveals no
structural change to explain either the cause of the death, or
the cause of the convulsions. And yet, from a careful exami-
nation of the reports which have been published, I find that 30
per cent, of the cases have proved fatal, which, it must be con-
ceded, is an enormous mortality, fully justifying the horror
which an attack inspires, in the mind of both the physician
and the friends. Hunter said, that he feared only convulsions
and hemorrhage in labor. Mad. Boivin asserts that at the
Maternite, under the most skillful and rational treatment, nearly
one half of the cases of convulsions die. Dubois considers
convulsions more dangerous than hemorrhage.

The following table will show that the danger has not been
greatly magnified :

Mauriceau,

Mad. LaChapelle,*

Desjardin, ,

Velpeau,

Smellie,

T.Clarke,

Lever,

Robert Lee,

Ramsbotham,

Collins,

McClintock & Hardy,

Total

165

29
23

5

i-2
10
17
12
46
22
28
10

214

144

16

51

39

12

* Mad. LaChapelle reports 67 cases of convulsions in 37,895 labors, but only
27 cases (as in the table) are detailed, or the results stated.

692 Chloroform in Puerperal Convulsions. [November,

Authors have differed as to the comparative mortality of
convulsions occurring before and during labor, and those
coming on after delivery. Mauriceau, Velpeau, Duges, Naegle,
Churchill, Murphy, &c, regard those cases which come on
after delivery as much more amenable to treatment than those
which occur before and during labor; while Smellie, Astruc,
Tissot, Ramsbotham, and some others, hold a contrary opinion.
The table I have given above shows that 32 percent, of those
cases occurring before and during labor proved fatal, while
only 22 per cent, died where the convulsions came on after
delivery.

The limits of this paper preclude the possibility of any dis-
cussion of the pathology of this affection. Whatever views
are entertained on this point, it will be admitted by all, that
whether the exciting causes are emotional, or are from irrita-
tion of the uterus, or the stomach, the kidney, or the intestinal
canal ; and whether these be byperaemia, anaemia, or toxaemia,
the development of this affection depends upon some condition
of the nervous system peculiar to the eras of gestation, partu-
rition, and lactation. Furthermore, it may be considered as
settled, that in all cases of convulsions it is the medulla oblonga-
ta which is primarily irritated, either directly by certain condi-
tions of the blood, or indirectly from the terminal branches of
the spinal nerves of the uterus or some other vital organ.
Chloroform overcomes the influence of the cerobro-spinal sys-
tem first, and then of the excito-motor or true spinal system.
Thus it may and undoubtedly does allay the irritation which
induces the convulsions. In certain cases, but these are rare,
the convulsions are at once followed by cerebral congestion,
effusion or hemorrhage ; and here the chloroform will not con-
trol the convulsions, if the pressure is direct upon the medulla
oblongata. But from the cases which have been reported by
Kite, Fearn, Clifton, Wilson, Chailly, Channing, Metcalf, and
others, as well as from my own experience, the conviction is
forced upon my mind that we have in anaesthetics a therapeu-
tic agent which will control this fearful complication of labor
to an extent not before attained. The number of cases report-
ed is yet too few to form a statistical table of value in deter-
mining the relative fatality where chloroform is used, but I
fully believe it will be diminished 75 per cent.

I have met with but one case of convulsions occurring after
delivery, and that was previous to the introduction of anaesthet-
ics. I am inclined to think that in these cases I should still
prefer to rely upon the use of opium rather than upon chloro-
form, for reasons which must be sufficiently obvious. [iV. Y.
Medical Times.

1853.] Morbid Desire to Kill. 693

Upon the Morbid Desire to Kill By Don Raimundo D. Y.
Correa.

[We select the following for several reasons because it is
by a Spaniard, and because it seems to us as bringing promi-
nently forward several points in aid of the settlement (if ever it
shall be settled) of this terrible question. Witness a late case,
where the jury acquitted a seduced female of the crime of mur-
der, on the score of insanity, and the next moment the judge
gave her a free discharge, because he could see no proof of
insanity. The article itself purports to be taken from the Gac.
de Madrid, and may be found in the Medical Times and Ga-
zette of January 29, 1853, and we can hardly gather from it
what portion of it belongs to the author or to the translator.]

The author commences with a eulogy on Esquirol's work on
Homicidal Monomania, 1837, and quotes examples from Pinel,
Marc, Gall and Mende. These show the existence of a partial
delirium, whether in the form of a fixed idea or an excited sen-
sibility, extravagance in the passions, or error in judgment. In
every instance there has been disturbance of the mind, and
hence the words addressed by an advocate to Dr. Marc, upon
the occasion of a trial of simple barbarity. " If monomania be
a disease, its cure is upon the scaffold." The following bit of
legal blood-thirstiness also merits being handed to posterity :
u Your so-called homicidal monomania is an hypothesis, a mod-
ern and convenient invention to shield the guilty, and to with-
draw them from the power of the law."

The author proceeds to say, that from the works of Magen-
die and other physiologists, he can prove that there are certain
powers in man, which drive him in a definite direction, without
his possessing a will sufficiently strong to offer opposition.
These powers which can be reduced to four, reside in the cor-
pora striata, the cerebellum, the crura cerebri and the medulla
oblongata. Injuries to these parts in animals, cause different
involuntary movements, and the author concludes therefrom
that there are in man different impulses stronger than the will.
Governed by these impulses, the homicidal maniac commits his
crime.

A man who commits murder upon a false idea, with pow-
erful impulse, should be considered as suffering from disease in
the same part of the brain. Now we cannot see the applica-
tion of Magendie or Flourens' experiments to the elucication
of psychical disturbance, nor comprehend why, upon division
of the crura cerebri, the injured and dizzy animal rolls over and
over. We have before complained with justice of the gross
ignorance of morbid anatomy displayed by the generality of

n. s. VOL. IX. NO. xi. 44

694

Morbid Desire to Kill.

[November

"mental physicians" in all countries, and we think it hard to
refute statements made upon no foundation whatever. The
examination of the bodies of criminal lunatics does not confirm
in any one point the loose assertions of Dr. Raimundo. Nei-
ther the corpora striata nor the crura cerebri are often found
in an abnormal condition; the cerebellum is for the most partr
natural in structure ; the medulla oblongata unaltered, except
that the membranes covering it become thickened, when other
parts of the encephalic coverings have undergone a similar
change. We have no ground whatever for asserting that these
parts are essentially the seat of morbid actions during life.
The cause of insanity is to be sought for in a source deeper
than that supposed by those philosophers of a somewhat mate-
rialistic school. The author endeavors for judicial purposes to
found a differential diagnosis between the maniac and the re-
sponsible culprit, both of whom have committed murder.

Homicidal Monomania.
The person is one of weak con-
stitution, of nervous excitable tem-
perament, irreproachable charac-
ter, working in business for the
immediate necessaries of life.

The monomaniac is alone.

Criminal Murder.

The criminals are mostly per-
sons of strong constitution, san-
guineous or choleric temperamenty
bad education, given to idle cour-
ses, and occupied in immoral pur-
suits.

The criminal is rarely alone ;
has usually accomplices to share
the booty.

The criminal has a motive, has
some passion to gratify, and se-
lects his object accordingly.

The criminal withdraws from
observation ; tries to mislead the
judge ; to cast suspicion on others,
and to do his best to avoid punish-
ment.

The maniac kills without inter-
est or passion, without motive,
making that man an offering who
may be unfortunate enough to
meet him.

The maniac disdains to fly, and
often gives himself up to justice ;
he often details the particulars of
his act, and seeks punishment
more than pardon.

We doubt if these aphorisms will stand their ground as
unerring tests in this difficult question. The records of the
criminal department of Bethlem Hospital would point to many
an inmate imprisoned for murder, whose constitution was good
and frame powerful and muscular. Many a criminal has had
sufficient nerve to take life alone, unassisted by others ; even
the last who forfeited his life in the Metropolis fell under this
class. Should we be justified in asserting that he was mad?
because he was alone in. his wife's chamber when he cut her
throat T

1853.] Idiotism and Imbecility. 695

Again, the maniac mostly takes life, not by chance or hazard,
but in obedience to a fixed, though erroneous idea, sometimes
in sudden passion. Who can at all times either discover or
appreciate motives? Jealousy, hatred, or revenge, carefully
guarded from public notice, would, but for the Law, impel
many a ruffian to gratify his passion at the cost of another's
life.

The maniac does not always disdain to fly, and can even
argue cleverly in his own defence. But what can be said of
that class of offenders whose lowly-organized and ill-directed
minds are equally under the influence of both fear and evil
passions? Place them under restraint, they behave respectful-
ly and with decency ; give them liberty and passion soon re-
gains the mastery. Can any aphorisms comprehend the
anomalies of this class ? We believe not. Each case must be
determined by circumstances elicited at the trial, and by the
opinions of those in whom the responsibility of the judgment
rests. [American Journal of Insanity.

Predisposing Causes of Idiotism and Imbecility.

Dr. Moreau, of Tours, (see vol. 9, p. 78,) read a Memoir on
the above before the Academy of Medicine at Paris. The
following are extracts from it.

Hereditary causes are the true origin of idiotism. They
originate those vices or imperfections of organization, that are
incompatible with the regular exercise of the intellectual func-
tions. Dr. Moreau's researches extended to 56 cases, and the
relatives of these 56, presented the enormous cipher of 132
pathological conditions, to which the hereditary influence could
be referred. Mania, in the form denominated lypemania is
the most common hereditary source of idiotism. To these,
succeed drunkenness, epilepsy, hysteria. In the collateral
lines, we find, in the order of frequency, convulsions, idiotism,
scrofula, apoplexy.

The hereditary influence extends equally on the father and
mother's side. It is more frequent from grandfather than
grandmother. It is transmitted more commonly by the male
than the female, in the proportion of 53 to 37. Dr. Moreau
presents the following results.

1. Idiotism is produced by hereditary causes, in absolutely
the same manner, as insanity, epilepsy, hysteria, and other ner-
vous diseases are.

2. All our therapeutical efforts should be directed to a modi-
fication of the nervous system, as opposite as possible from the

696 Alum to excite Emesis in Poisoning. [November,

conditions that have originated the affection. Without under-
valuing the value of education, and which he calls a species of
intellectual gymnastics, Dr. Moreau is of opinion, that above
all, we should endeavor to renew {repair) the moral, by modi-
fying its organic state. Thus, changing, by a species of reno-
vation, the vicious tendencies which the hereditary predisposi-
tions have produced. [Bulletin De JWAcademie Nationale de
Paris, Ibid.

Case in which Alum was successfully employed to excite Emesis
in a patient who had taken a large dose of Ovium to destroy
life. By Charles D. Meigs, M. D.

Dr. Meigs was called on Saturday the 20th inst., at 2| o'clock,
P. M., to see a young gentleman, between 26 and 28 years of
age, who, after a drinking frolic, had swallowed two hours pre-
viously, one ounce of powdered opium with the view of destroy-
ing his life. A physician of his acquaintance, who happened to
be present when he swallowed the poison, immediately sent for
30 grs. of sulphate of zinc, and gave it to him, but without its
producing the slightest effort at vomiting. When Dr. Meigs
saw the patient he was in a somnolent condition. One ounce
of powdered alum was immediately procured, and one-half of
it, mixed with a little syrup, was given to the patient, and fol-
lowed in a few minutes by two or three tumblers of warm wa-
ter, when copious vomiting ensued, by which a free discharge
of the contents of the stomach was induced. After the patient
had rested for a short period, the remainder of the alum, follow-
ed by two tumblers of warm water, was given, which caused
renewed and free vomiting, by which Dr. Meigs presumes the
opium was entirely thrown off. The patient continued still
to be very sleepy, but entirely recovered from the effects of
his rash act. Dr. M. considered this case worth relating, as
evincing the verv efficient emetic powers of the alum. [Trans.
Phil. Col. Phys*

Vesicating Oil. By E. Dupoy.
The solubility of cantharidin in chloroform, as shown by the
experiments of Professor W. Procter, suggested to me the idea
of using that vehicle in combination with a fixed oil to obtain
a vesicating agent, freed from the disagreeable concomitants
of the ordinary fly blister, and retaining the cantharidin in a
soluble state. I proceed thus :

Powdered Cantharides, one part.

Chloroform, (by weight) one and a half parts.

Castor Oil, (by weight) one and a half parts.

1853.] Foreign Substances in the Intestinal Canal. 697

To the powder was added the mixture of chloroform and oil
in a close vessel : the ingredients were transferred after some
hours to a glass apparatus, and the liquid displaced in the usual
way. It amounted to about two-thirds of the original bulk of
the liquid employed. A few drops of the vesicating oil applied
to the arm of an adult produced a perfect blister in eight hours.
Its easy application on any given surface may be of value as a
vesicating or epispastic. I would suggest the use of oil silk
over the application of it to the skin ; by retaining the mois-
ture of the skin it will favor the action of the oil. [Transyl-
vania Med. Jour.

Singular Case of Foreign Substances in the Intestinal Canal,
By D. Hays Agnew, M. D., Philadelphia.

The following case I am induced to report from its very
singular character : On examining the body of an individual
who, I believe, labored under some mental alienation during
life, my attention was attracted to an adhesion between the
parietal and visceral layer of peritoneum over the coecum, upon
the separation of which a small opening was perceived through
the walls of the intestine, disclosing a dark-looking substance,
which, upon examination, proved to be a large mass of straw,
little less than an ordinary sized fist, and firmly impacted in all
the space below the ileo-coecal valve. Noticing the transverse
colon very much distended, an incision was made into its cavi-
ty, where were found a pair of suspenders, three rollers, and a
quantity of thread, interwoven with one another. The web-
bing, which evidently was his suspenders, exceeded one and a
quarter inches in breadth, and must be several feet in length,
inasmuch as it extended through the ascending, transverse, and
a portion of the descending colon, and doubled in several pla-
ces upon itself. The rollers were of ordinary muslin, over one
inch in width and the same in diameter, but which must have
been of much greater size when swallowed, as they had, in their
progress along the intestine, become unrolled, leaving long ends
which were encased within layers of faeculent matter. The
peritonitis, which no doubt had been the principal cause of
death, was not, however, produced by the escape of any intes-
tinal matter into the serous cavity, no such discharge having
occurred, the opening into the coecum only presented itself
after the reflected layer of the peritoneum was separated there-
from. Had life been prolonged, it is highly probable that the
ulceration would have extended through the walls of the abdo-
men, and the ccecal contents passed out by this artificial route,

[Medical Examiner.

698 Miscellany. [November,

fHxjsccllanj).

Some Observations on Hip- Joint Disease and its Rational Treatment.
By Louis Bauer, M. D., Physician and Surgeon (Berlin), Member
of the Royal College of Surgeons of England, &c, &c.

Under the above caption, we find in the New York Journal of iMedi-
cine for Sept., 1853, a most excellent paper. The importance of the
subject, and the ability with which it is treated will justify us in pre-
senting our readers the following extracts :

" It is of great importance in the treatment of hip-joint disease, that
its essential origin should be properly understood and appreciated ;
and be it therefore repeated

M 1. Hip-joint disease is primarily seated in the caput femoris.

" 2. Hip-joint disease originates exclusively from tubercular depo-
sitions into the cells of that bone.

" 3. The object which nature purposes to realize by those deposi-
tions, is the elimination of the noxious tubercular substance from
within the organism.

" 4. The -softening of the tubercles begins, either in consequence
of some accidental traumatic or other injury, or spontaneously, by the
gradual juxtaposition and augmentation of the tuberculous matter,
which becomes at last obnoxious to the bone, and sets up reaction and
inflammation.

" 5. As soon as this process takes place, the tuberculous mass soft-
ens, and approaches the surface of the bone, involving more or less
the periosteum, cartilage, and synovial lining of the joint in destruc-
tion.

" 6. If the matter reaches the external surface in the shortest way,
by penetrating the neck of the femur a rare case the destruction
may be trifling, and the cure soon consummated, as far as the joint
itself is concerned. But, if the matter enters the articular cavity, a
more extensive destruction must necessarily be the result. In this
latter case we perceive a thickening and softening of the articular
cartilage, which separates into .fragments, and, sloughing with its
bone, floats about within the articular cavity, adding the new disad-
vantage of a foreign body to the disease. The synovial sac ulcerates
consequently, and the whole joint is more or less transformed into an
osseous ulcer. Small fistula? lead in different directions to the exter-
nal surface, and the environs of the joint are rather infiltrated, and
indurated.

" 7. In this state the disease continues as long as there are still
tuberculous deposits and cartilaginous fragments to be removed, pro-
vided that death does not earlier close the scene.

" 8. Nature effects the restoration in various ways, either by estab-
lishing a true anchylosis, with deposits of bony matter within and
around the acetabulum, with the loss of all mobility of the joint, un-
questionably a very rare case, or the two opposite articular surfaces

]853.] Miscellany. G99

unite by fibrous substance (spurious anchylosis), which is the usual
termination of hip-joint disease. In extremely rare cases, the whole
joint is filled up with fibrous formations, interfering greatly with the
mobility of the hip-joint; but,'in most of the cases, fibrous adhesions
exist only partially, while another part of the articular surface is de-
nuded even of its cartilaginous covering and smooth-like, being polish-
ed. As a modification of the termination of hip-joint disease, we
meet also with luxations of the head of the femur. It is easily un-
derstood that cases of the last description must necessarily be of very
limited number, and that a most extensive carious destruction is to be
premised, both of the femoral head, and the supercilium and labrum
acetabuli. The luxation of the femur is, by no means, of such fre-
quent occurrence as Rust and other German authors have stated; but
of this hereafter."

The author, after dwelling upon some of the important symptoms
of the disease, directs attention to its treatment, and asks the signifi-
cant question : " Does the present state of our knowledge afford us the
means of shortening the process of hip-joint disease V'

" Two medical agencies have been put in requisition to realize this
object ; they are external derivation and the resection of the diseased
portion of the femur. During the last century derivatory appliances,
near the affected joint, have been used to a great extent, from the
simple rubefacient up to the positive destruction of the skin by cauteri-
um actuale and potentiale, and a fair trial has been consequently
given to them to prove their beneficial results. The numerous advo-
cates of derivation assert boldly, that nature was doing the same by
the operation of metastasis, in depositing obnoxious substances in
organs of inferior consequence, thus freeing others of great import-
ance for the maintenance of life, of which, indeed, daily experience
furnishes us with many instances. If metastasis were identical with
derivation, the conclusion would be correct. But I entirely disagree
on this point; for the metastatic deposits of nature are materially of
the same quality, whereas artificial derivation merely excites inflam-
mation, and produces a discharge of ordinary character. Thus we
may artificially transfer an erythematous inflammation of the pleura
upon the skin by a mustard poultice, and put a positive stop to prima-
ry disease ; in fact, we may succeed in subduing diseases by deriva-
tion, in as far as both the disease and the eflect of derivation constitute
the same character ; but it might be an impossibility to influence by
derivation the process of hip-joint disease, where the cause of the af-
fection is a specific substance purposely deposited for elimination,
while inflammation is the mere effect of the undue pressure upon the
osseous texture. And, supposing derivation could even direct the
tuberculous matter from the system to the artificial issue, which is by
no means evident, it would in no way affect the deposits already
formed within the cells ofthe femoral he^d. There the inflammatory
process will and must go on for the final elimination ofthe tubercu-

700 Miscellany. [November,

lous deposits. Any positive counteraction can only tend to protract
the course of hip-joint disease to an unnecessary length, and place
even life in jeopardy. While it is thus exceedingly doubtful, at the
least, whether derivation has any influence upon the tuberculous dis-
ease in general, and while it is positively impossible that derivation
should affect the tuberculous deposits already formed, we know it to
be a fact, that extensive issues particularly cause a new irritation,
enfeeble the system already emaciated, and may even endanger life.

" Thus we must unavoidably come to the conclusion, that deriva-
tion, in cases of hip.joint disease, is not only to be dispensed with, but
even to be severely condemned. But what are the results that ex.
perience gives us in reference to the usefulness of derivation in hip-
joint disease. I need only state, that it has been entirely abandoned
both in England and Germany, where, formerly, scarcely one patient
escaped the application of the ferrumcandens.

" As to the usefulness of resecting the caput femoris in hip-joint
disease, to answer the indication of speedily removing the morbid sub-
stance destined for elimination, I must candidly confess that I have
had but little opportunity of witnessing and watching personally the
effects of that operation. In as far as statistics afford the premises for
correct inferrences, I must decidedly object to it, and John Gay,
Esq., the highly talented surgeon of the Royal Free Hospital in Lon-
don, has, in his elaborate paper on the treatment of the ulcerative
diseases of the joints, read before the Medical Society of London,
stated, with convincing arguments, that very little good is to be ex-
pected from so extensive an operation. According to the statistics of
this operation, which that surgeon placed under the consideration of
that learned and respectable body, the greater number of the patients
subjected to the operation in question died from the immediately suc-
ceeding inflammatory reaction, while another fraction died from tuber-
culosis, and a very insignificant proportion only survived. This is a
decidedly discouraging statement, and its correctness and truthfulness
cannot be questioned.

" In the place of resection, Mr. Gay proposed free incisions into the
diseased joint, and even into those parts of the bones filled with tuber-
culous deposits. This practice he had already followed during a
certain period with the best success, although only in the minor joints.
Avery lively discussion ensued, in which many eminent members of
the profession participated. Experience, reasoning, and sophism
were brought to bear against the new practice, but with the least pos-
sible success. The author in replying at the end of the debate to his
antagonists, remarked that a diseased joint was nothing else than an
ulcer in the bone, or cartilaginous texture ; the joint was partly de-
stroyed, and had thus ceased to exist. The violent reaction which
regularly follows the opening of a joint, referred only to healthy arti-
culations, but in no way to articular ulceration. The free access of
air to the articular cavity was less injurious than the decomposed
matter, tuberculous substance, or the fragments of mortified cartilage.

" To procure in all deep-seated abscesses and ulcerations a speedy

1853.] Miscellany. 701

and free issue, was a fundamental principle in surgery, and especially
in those cases strictly to be adapted, where fragments of mortified
cartilage, identical with foreign bodies, constantly keep up irritation
and suppuration, thus protracting the termination of the disease. All
a priori arguments could not dispute the beneficial results, already
attained by his practice.

"These new principles of Mr. Gay opened at once a new era for
the treatment of the joint diseases, and although old surgeons shook
their heads at the boldness of modern surgery, the younger part of
the profession embraced the new chance for success with eagerness.

"In some of the metropolitan hospitals, as well as in county infirm-
aries, the new measures were frequently put to the test, and as far as
I could learn, the results have been favorable. My own experience
of Mr. Gay's treatment, both in London and Manchester, obliges me
to declare in its favor ; it is in my opinion the only direct remedy for
the abbreviation of hip-joint disease, and it is not, to my knowledge,
followed by any dangerous reaction or fatal consequences. I under-
stand that Dr. John O. Stone, the distinguished surgeon of Bellevue
Hospital, New York, advocates the same practice, and has since 1847
derived great benefit from it.

" The next important question is : Do the modern improvements in
surgery furnish us with the auxiliary means of preventing or curing
those deformities, which are the constant associates of hip-joint disease ?"

With a brief allusion to the progress of modern orthopedic surgery,
the writer adds :

" At about the same time Dr. Buehring, of Berlin, the highly gifted
nephew of the immorral Dieffenbach, Dr. Loriner of Vienna, and Dr.
Bonnet of Lyons, entered into minute researches on the subject in
question, and obtained universally the same result, namely, that the
former theory of hip-joint disease was fictitious and arbitrary; that
the deformities connected with that disease had a dynamical, and by
no means an organical foundation, and thus bringing at once, the
most distressing mutilation within the reach of surgical aid. Some
difficulties, as to the mechanical contrivances, were soon surmounted,
and the new discovery put to a practical test. I am happy to state
that already results have been obtained, which leave no doubt as to
the efficiency of the new systematic treatment, and I myself can con-
firm them by my own experience.
* *"* * * * * * *

" Thus it appears that we possess in permanent extension a sover-
eign remedy for overpowering muscular reflex action, and ultimately
restoring the greatly distorted form.

"The modus operandi of mechanic extension is of course still a
mere problem ; we know at present only the fact. The question, in
reference to the general curability of those deformities, originating
from hip-joint disease, may safely be answered in the affirmative.

" But it remains yet to be decided, whether permanent extension
may effectually be applied to the purpose of preventing those deformi-

702 Miscellany. [November,

ties ; or, whether it be advisable not to interfere while the disease of
the hip-joint is progressing, and to have recourse to it only when that
malady has terminated its phases.

" Some surgeons will have the orthopaedic treatment postponed
until the morbid process within the joint is completely terminated ;
others are in favor of acting immediately. The decision cannot be
difficult. It is far better to prevent a deformity than to cure it, espe-
cially if there are no contra-indications of immediate extension. The
excessive pain has been mentioned as such, and no doubt will set in
with injudicious orthopaedic treatment. But we have it in our power
to avoid it. If in the very beginning of hip-joint disease we place the
hip in a firm position, which secures both the rest and extension of the
afflicted leg, and the comfort of the patient, as we ought to do, there
is no reason why the patient should not be capable of enduring it,
provided the mechanical contrivances answer the purpose. On the
contrary, the patient will be grateful, as such position saves him the
pain, unavoidably caused by accidental movement. In fact, the early
use of mechanical treatment has every thing in its favor.

"1. It meets the first rule of surgery, by giving the affected limb a
quiet position.

" 2. It counteracts the reflex action, and prevents consequently the
deformity.

" 3. It keeps the caput femoris in the anterior and lower part of the
acetabulum, thus preventing any luxation to which circumstances and
the extent of caries might tend.

" 4. It does not cause, but relieves the pain.

"But if the patient is already in an advanced stage of the disease,
it will be necessary to place him under the full influence of chloro-
form before the apparatus is applied. In this state reflex action and
sensation are arrested. We may with impunity and at once stretch
the patient, and give him that position in the instrument which we
deem proper. When the effects of the chloroform have passed by,
and the patient is returned to consciousness, he will only not complain,
but on the contrary will feel greatly relieved, and more comfortable
than before. At least I have obtained these results in all cases un-
der my personal care, and there is no reasonable ground why it
should be otherwise. To keep the patient in the position once assum-
ed, will suffice to prevent or cure the deformity. Should there how-
ever remain a slight deviation, I prefer the repeated use of chloroform
and the total restoration of the form under its influence, to the gradual
increase of the extension, which is extremely painful.

" If, however, the disease of the hip-joint is completely removed,
and we have only to contend with a painless muscular retraction, a
reflex action of some duration, I prefer the gradual extension to the
former, for a sudden extension has not in this case the desired effect,
and might bring on a new irritation in the joint, which Dr. Buehring
experienced. In point of fact, gradual extension is better calculated
to neutralize a long established and powerful reflex action, than the
sudden reduction of the deformity."

1853.] Miscellany. 703

Dr. Bauer finally proposes an apparatus, of which a diagram is
presented, by means of which he secures : " 1st. Stretching of the
knee and hip-joint ; 2d. Abduction of the affected limb ; 3d. Restor-
ing the parallelism of the transversal diameter of the pelvis with the
horizon; and 4th. Comfort and convenience to the patient."

Spermatorrhoea Rings. Quite a revolution has been effected in
New England, in less than a year, by the use of a mechanical inven-
tion, instead of medication, in the treatment of a formidable malady.
Heretofore, tonics, accompanied by a long series of auxiliary assis-
tants, such as jaunts, horseback, sea bathing, a regulated diet, besides
innumerable preparations of drugs, have been prescribed to arrest the
effects of spermatorrhoea, but rarely with any permanent success. It
is a condition resulting, in most instances, from the indulgence of a
pernicious vice. In prisons, self-pollution is nearly universal, and no
ingenuity on the part of wardens or attending physicians has preven-
ted it for any length of time. Some suffer intensely, and even die,
from excessive indulgence in this vice. Schools, too, and colleges,
are often the nurseries of this degrading habit, which carries many
young men to an early grave, often without the true cause being sus-
pected. The weak eyes and continued headaches so common among
students at public institutions might in many instances be traced, if
effort was made in the right direction, to this perpetual violation of a
physiological law. The rings, which this Journal was the first to an-
nounce, are a sure remedy for involuntary forms of the disease. Phy-
sicians are eminently successful with them. In the State Prison at
Charlestown, where Dr. Bemis has given them a thorough trial, we
understand they have performed many cures. In private practice,
also, testimony from the most reliable sources might be cited to
strengthen the medical public's confidence in this simple and only
effectual relief in these cases. Dr. Cheever has shown us another
improvement of the instrument. It is far lighter than the former pat-
terns, and the middle ring is better balanced in the centre of the large
one. The simplicity of the adjustment to any sized organ, makes it
more economical, too, which is a consideration not to be overlooked.
We admire the ingenuity displayed in the manufacture, and predict,
from the great, success that marks their application to severe and long-
protracted cases of individual suffering, that the rings will be very
extensively used in other parts of the world as well as in America.

[Boston Med. and Surg. Journal.

Removal of a Ring from a Young Lady's finger. (Communicated
for the Boston Medical and Surgical Journal.) By A. C. Castle,
M. D., of New York. The following case may not be unaccepta-
ble to the readers of the Journal.

An interesting young lady, about 17 years of age, had presented to
her a gold ring, which she forced over the joints of her middle finger.

704 Miscellany. [November,

After a few minutes the finger commenced swelling, and the ring

could not be remeved. The family physician, Dr. , was sent

for but could do nothing. The family, and the young lady especially,
were now in the greatest consternation. A jeweller was sent for.
After many futile attempts to cut the ring with cutting nippers, and to
saw it apart with a fine saw, and after bruising and lacerating the
flesh, warm fomentations and leeches were applied, but all without

affording the slightest benefit. Dr. requested my presence,

with the compliment that " perhaps my mechanical ingenuity might
suggest something." I at once proceeded to the house of the patient,
and found the young lady in a most deplorable state of mental agony,
the doctor embarrassed, and the family in a high state of excitement.
I procured some prepared chalk, and applied it between the ridges of
swollen flesh, and all round the finger, and succeeded in drying the
oozing and abraded flesh ; then with a narrow piece of soft linen I suc-
ceeded in polishing the ring, by drawing it gently round the ring
between the swollen parts. I then applied quicksilver to the whole
surface of the ring. In less than three minutes the ring was broken
(by pressing it together) in four pieces, to the great relief of all
parties.

In a similar manner (without the chalk) I some time since extracted
a small brass ring from the ear of a child, who, child-like, had inser-
ted it into the cavity of its ear. The operation was more painful and
tedious, but was equally successful.

The modus operandi. The quicksilver at once permeates the metals
if clean (with the exception of iron, steel platina, and one or two
others,) and amalgamates with them. It immediately crystallizes
and renders the metal as hard and as brittle as glass. Hence the ease
with which metals amalgamated w7ith quicksilver can be broken. [lb.

Saccharate of Lime. By M. Trousseau. The virtues of this pre-
paration are due to the fact that sugar in solution is capable of ab-
sorbing a very large quantity of lime. The compound is made by
saturating simple syrup with lime, and then filtering it. A perfectly
transparent mixture is thus obtained, which is not troubled by admix-
ture with water, and is characterized by an extremely alkaline taste.
This syrup combining with water in any proportion, is a convenient
and valuable mode of administering lime. The attention of physi-
cians was first called to the article by Dr. Capitaine, adjunct to the
Faculty of Medicine, and it was first employed by myself at the Neck-
er hospital, in the treatment of the chronic diarrhoeas of children.
The dose for an infant is from a fourth to half a drachm, and for an
adult, from one drachm to two and a half. At the Necker hospital, I
was in the habit of mixing a small portion of this preparation with the
milk allowed each suckling during the day, and it seemed to me to
obviate the tendency of the milk to acidity in the stomach, and to pre-
vent the disposition to diarrhoea so common in children of a certain
age at particular seasons. In comparing the effects of the saccharate
of lime with those of the bicarbonate of soda, I found the former to

1853.] Miscellany. 705

possess marked advantages. [Trousseau, Traite de Therapeutique.
Virginia Med. and Surg. Journal.

Cold as an Anaesthetic Agent. We lately witnessed, says the
editor of the Lancet, the employment of cold as an anaesthetic, in St.
Bartholomew's Hospital, upon a patient suffering from chronic inflam-
mation and enlargement of the knee joint. A bag of pounded ice was
applied for about four minutes, by Mr. Lawrence, over the swollen
parts ; then, with a heated knife, six or more incisions were made by
the side of the patella, extending through the skin and subcutaneous
tissue. The patient suffered no pain whatever. The counter-irritant
effected a marked diminution in the swelling which was of a charac-
ter sufficiently grave to suggest the idea of the possible necessity of
amputation of the limb. [Neio- Orleans Med. and Surg. Journal.

Seidlitz Powders. The necessity for using two papers may be ob-
viated, and a very satisfactory preparation obtained, by mixing two
parts of bitartrate of soda with one part of bicarbonate of soda. The
mixture keeps well even in paper, and effervesces briskly when mixed
with water. [Dublin Med. Press.

Yellow Fever at the South-west. The extension of yellow fever to
almost every port in direct steam-boat communication with New
Orleans, where it made its first appearance in the United States du-
ring the recent summer, should open the eyes of civil authority to the
importance of quarantine regulations calculated to prevent a repeti-
tion of such calamity. So far as we have been able to learn, it is
abundantly established that the pestilential cause of yellow fever can
be carried from place to place by steamers and other ships but more
certainly by steamers, in consequence of the rapidity of their travel,
than in slow moving vessels ; and that this cause, when diffused in
an atmosphere susceptible of propagating it, does become domiciliated,
if we may use the expression, and spreads over an area more or less
extensive, according to circumstances. It appears equally certain
that the cause of the malady cannot be carried about by the human
body so as to induce yellow fever in those who have not been exposed
to the atmosphere of the poisoned district.

With these facts before us, it seems imperative to quarantine vessels,
but not individuals. How far the restriction should operate upon
cargoes or other fomites is a question upon which we are not so well
informed. It ought to be referred to the medical profession of the
ports most interested, for it cannot be expected that persons interested
in commerce and navigation will possess either the requisite know-
ledge or the absence of bias so essential in such an arbitration be-
tween traffic and health.

706 Miscellany. [November,

BIBLIOGRAPHICAL.

Hallucinations : or the rational History of Apparitions, Visions,
Dreams, Ecstacy, Magnetism and Somnambulism. By A. Brierre
de Boismont, &c, &c. 1st American, from the 2nd enlarged
and improved Paris edition. Philadelphia : Lindsay & Blakiston.
1853. 8vo., pp. 553. For sale by T. Richards & Son, price 82.50

The work before us, by one of the most erudite and strong-minded
philosophers of the age, is remarkably interesting as well as instruc-
tive. We know none in which the difficult subject of Hallucinations
is so logically treated, and the attention of the reader so agreeably
entertained. The tedium of the investigation is prevented by the
narrative of upwards of ISO cases in illustration of the subject in all
its phases. As we fully agree with the Translator in his estimate of
the work, we cannot do better than to quote the following paragraphs
contained in his Preface :

" M. Brierre de Boismont treats the important and hitherto neglected
subject of hallucination in various points of view, inasmuch as it bears
important relations to philosophy, medicine, religion, history, morality 7
and jurisprudence. The apparitions of Holy Writ are handled with
the reverence befitting a Christian, whilst much light is thrown on
the probable origin of the hallucinations of many celebrated person-
ages whose characters and actions were so exalted as to place them
apparently above humanity.

" The book will offer attractions to many classes of readers. The
theologian will admire the vein of reverence and morality which per-
vades it ; the philosopher will find much food for study and contem-
plation ; the practical physician will avail himself of the knowledge
and experience detailed in a great variety of cases ; the lawyer will
be deeply impressed by the necessity of vigilance, and a close study
of the case, before be gives in his verdict of insanity ; while the lover
of the marvellous will find ample food for the gratification of his taste,
in the number of strange and picturesque authenticated facts thus
carefully collected."

Practical Observations on Aural Surgery, and the nature and treat-
ment of Diseases of the Ear. With Illustrations. By Wm. R.
Wilde, F. R. C. S., of Ireland ; Surgeon to St. Mark's Ophthalmic
Hospital, &c, &c. Philadelphia: Blanchard <fc Lea. 1853. 8vo.
pp. 475. (For sale by T. Richards & Son.)

This is just such a work as we needed, for we possessed no treatise
on the affections of the ear, in our language, to which we could refer
as a faithful exponent of the present state of knowledge in that depart-
ment. So far as we have had time to look into it, we have every rea-
son to think that it will be found eminently practical and consequently
useful. There are no diseases so often left in the hands of charlatans

1853.] Miscellany. 707

as those of the ear perhaps because of insufficient knowledge on
the part of physicians but mainly in consequence of their intrinsic
difficulty and the unscrupulous promises made by those who pander
to the credulity of patients. Mr. Wilde dwells particularly upon the
importance of a correct diagnosis, by which the enlightened practi-
tioner may discriminate between the cases that may be benefitted by
treatment and those which are incurable, and be able to announce at
once and honestly to the patient what he has to expect.

We take pleasure in recommending this work to our readers.

A Treatise on Operative Ophthalmic Surgery. By H. Haynes Wal-
ton, F. R. C. S., &c, &c. Illustrated by 169 engravings. Edited
by S. Littell, M. D., Surgeon to Wills Hospital, &c, &c. Phil-
adelphia : Lindsay & Blakiston. 1853. 8vo., pp. 598. (For sale
by McKinne & Hall price 83.00.)

We have to add another to the numerous works recently published
upon operative Surgery. The Operative Ophthalmic Surgery of Mr.
Walton is, however, entitled to our unqualified commendation, as a
careful compend of the present state of knowledge in regard to the
operations that may be performed upon one of the most important
organs of the body. We must confess that we can see no good grounds
for separating the principles from the practice of any branch of Sur-
gery, and that a work in which may be found the whole pathology
and treatment of affections of the eye must be more useful to the
general practitioner than one in which he can only find the rules for
operating. The work before us is peculiarly valuable to the special
oculist.

The Maternal management of Children, in health and disease. By
Thomas Bull, M. D., M. R. C. P., author of " Hints to Mothers,57
&c. 2d edition. Philadelphia : Lindsay & Blakiston. 1853..
l2mo., pp. 424 (For sale by McKinne & Hall price $1.)

This is one of those unpretending little works which ought to be
read and studied by every physician as well as mother. By the
physician, because it treats of details too often considered beneath his
notice ; and by the mother, because she will be enlightened at every
page upon subjects which appertain specially to her mission. The
author states that in England and Wales, " one child in jive diesicithin
a year after birth, and one in three before the completion of the fifth
year /" In the large cities of Europe and America the ratio of mor-
tality is probably still greater. There can be but little doubt that
such a frightful state of things is in a great measure attributable to
ignorance of the commonest principles of infantile hvgiene and to

708

Miscellany.

consequent mismanagement. The family physician would add much
to his satisfaction as well as to his success, by urging mothers to pro-
cure and to study this work of Dr. Bull.

A Practical Treatise on the Diseases of Children. By D. Fkancis
Condie, M. D., &c, &c. 4th edition revised and augmented.
Philadelphia: Blanchard & Lea. 1853. 8vo., pp. 732. (For
sale by McKinne & Hall price $2.75.)

American medical literature may justly lay claim to great excel-
lence on the subject of the diseases of children. The works of
Dewees, Eberle, Stewart, Condie and Meigs would do credit to any
country. The fact that Dr. Condie's treatise has now reached its
fourth edition, shows conclusively the high estimate placed upon it
by the profession. The present edition has been carefully improved
by the learned author.

The Micros copist ; or a complete manual on the use of the Microscope,

for Physicians, Students, and all lovers of Natural Science. 2nd

edition, improved and enlarged ; with illustrations. By Joseph H.

Wythes, M. D. Philadelphia : Lindsay & Blakiston. 1853.

12mo., pp. 212. (For sale by McKinne & Hall.)

Every man of science has now (or ought to have) a microscope.
The object of the work before us is to facilitate the acquisition of
those details without the knowledge of which the use of this beautiful
and valuable instrument cannot be satisfactory. It is concise, to the
point, and therefore peculiarly valuable.

Cox's Companion to the Sea Medicine Chest, and Compendium of
Domestic Medicine ; particularly adapted for Captains of Merchant
Vessels, Missionaries and Colonists. With plain rules for taking
the medicines ; to which are added directions for restoring suspend-
ed animation, the method of obviating the effects of poisons, a plain
description of the treatment of Fractures and Dislocations, and a
concise account of Asiatic or Spasmodic Cholera. Revised and
considerably enlarged. By R. Davis, M. R. C. S., &c, &c.
1st American, from the 33d London edition. New York : S. S. &
W. Wood. 1851. 12mo., pp. 216. (For sale by McKinne &
Hall.)

This is certainly the multum in parvo.
thing for us to add.

The title page leaves no-

The Physician's Visiting list, diary, and Book of Engagements, for
1854. Philadelphia : Lindsay & Blakiston. (For sale by McKinne
& Hall.)

This is quite a convenient pocket book for physicians in full practice.

SOUTHERN

MEDICAL AID SURGICAL
JOURNAL

Vol. 9.] NEW SERIES. DECEMBER, 1S53. [No. 12.

PART FIRST.

(Original (Communications.

ARTICLE XXXVII.

Collodion in the Treatment of Various Affections. By Juriah
Harriss, M. D., of Augusta, Ga.

Since 1848, the year of its discovery, Collodion has been
used in the treatment of various affections, particularly in dis-
eases of the skin. No new remedy has been more generally
used or more lauded as a topical application than collodion.
The influence of authority comes to us from all quarters, in
praise of its efficacy in a variety of diseases. Although we
should grant a proper amount of force to the influence of au-
thority, we should not be wedded to it, but only accept its
dicta when sustained by reason and corroborated by experi-
ence. I shall endeavor to give the rational indications which
it would seem to fulfil and the experience of the profession in
Europe and this country. I have been induced to collect this
widely scattered testimony, both for and^against its utility, into
a condensed form, in order that we might see at a glance, the
various affections to which it has been used, the mode of its
application and the success which attended the cases. Another
inducement has been, the great plausibility of its application to
many affections.

I would here state that I have not been able to have access
to all the articles upon the subject, but think that I have con-
densed most of the matter written upon it up to this time. I

n. s. VOL. IX. NO. XII. 45

710 Harriss, on Collodion. [December,

will also add, that the eminently practical Southern Medical
and Surgical Journal contains a great amount of our informa-
tion upon the subject.

The first indication which collodion fulfils is the formation
of an artificial cuticle. In any abrasion of the cutaneous sur-
face, nature makes an effort immediately to throw out in some
form a covering for the delicate tissues, to protect them from
external and injurious influences. Following up this indication
so manifestly shewn us by Nature's teachings, collodion has
been applied, and the result has proved satisfactory. M. La-
tour, believing that atmospheric air was a great stimulus to-
inflammation even in deeply imbedded tissues, says that collo-
dion acts, not only by excluding air directly, but indirectly.
From this belief, he was induced to apply it to rheumatic joints,
and to the abdomen in peritonitis. This excluded the parts
from the injurious effects of cold air and currents. His suc-
cess confirmed him in his opinion.

Collodion must, it would seem, act beneficially in this way
in erysipelas. Who does not know that the latter disease is
frequently caused and yet more often aggravated by currents
of air? If then you secure this affection from such a contin-
gency a great point is certainly gained. If, in addition, you
compress the capillaries, force the blood from them, you em-
ploy a local antiphlogistic, and rid the affected part of all the
characteristics of inflammation, redness, swelling, heat and
pain, and the disease must necessarily yield. The second in-
dication, which collodion fulfils, is then done by its power of
contraction.

The transparency of the article enables us to see the action
of the diseased part beneath the coating, and to note its pro-
gress or retrogression. Its cleanliness is an advantage which
ointments, &c, do not present when applied. The relief which
it affords in obviating distension, pain, itching, &c, are desid-
erata which should not be overlooked.

I have not space, however, to enlarge upon the plausible
advantages of this remedy, and shall therefore proceed to give
the experience of the profession in its use.

Mr. G. P. Maynard, of Boston, in 1848, then a medical stu-
dent, first prepared and used it in surgery, as a substitute for

1853.] Harriss, on Collodion. 711

plasters and sutures in dressing wounds. Dr. Whitney, his
preceptor, also testified to its applicability to wounds, particular-
ly when plasters or sutures are impracticable or inadmissible.
"In most instances,"' he says, "it was applied in conjunction
with straps of cotton and sheep-skin, and with raw cotton,
forming with them strong, unyielding, adhesive straps, banda-
ges and encasements.'"' During the same year it was applied
to the relief of tooth-ache. (Ranking 's Abstract, 1849, from
Am. Jour, of Med. Sciences, 1848.)

In Nov., 1848, Erasmus Wilson employed this agent topi-
cally in the treatment of various affections of the skin : chronic
erythema, chapped nipples and hands, herpes labialis, herpes
preputialis, and herpes zoster, lichen agrius, lupus, acne vulgaris,
and several other affections. He found that in chapped hands
it was not only a protective covering, but promoted the healing
of cracks more rapidly than any other remedy. He certainly
speaks rationally, when he says, "in chapped nipples, it was
even more efficient in its protective and curative action the
gaping cracks were instantly drawn together and almost oblit-
erated by the contracting power of the remedy, and were
effectually shielded from the influence of moisture and the
pressure of the gums of the infant, and all in consequence of
the rapid evaporation of the ether." During this year collo-
dion continued to be used and its application generalized.

In 1849, M. Hairon employed it successfully in ophthalmic
affections. "To be enabled," he remarks, "to protect the
inflamed cornea from contact with the air, to prevent the
movements of the eyelids over its surface, and retain topical
applications long in contact with it, are objects which, if
realized, would much diminish the severity of keratitis and
conjunctivitis." It appears to me that this would prove an
admirable agent to prevent friction, and consequent inflamma-
tion and ulceration of the cornea in granular inflammation of
the eyelids, and to relieve the cornea from the offending cause
when the disease exists. A granular lid will necessarily pro-
duce inflammation of the cornea, if not soon relieved (and it is
an obstinate affection) or some means taken to prevent friction.
M. Barrier, of Lyons, has suggested an improvement in the
application of collodion to the lids. M. Hairon simply closed

712 Harriss, on Collodion [December,

the lids and put a coating of collodion over them. This was
objectionable, because the eye could not be examined without
tearing or cutting loose the coating of collodion. M. Barrier
proposes applying linen dipped in collodion, parallel with the
lashes upon the superior and inferior lids, with threads beneath
them. These threads are to be tied, and when the eye is to
be examined, they are simply untied and the globe of the eye
can be easily reached.

In the Gazette des Hopitaux, for 1849, there is a notice of
the application of collodion to bed-sores, in which the author
states that it proved more serviceable than ordinary remedies;
it adheres closely and is exempt from moisture.

Dr. T. R. Mitchell, of Dublin, recommends the application
of this remedy in ulcerations of the os and cervix uteri : he
thinks it necessary to apply it every forty-eight hours, in con-
sequence of its being detached by the fluid accumulation be-
neath it, and that the results amply repay the physician for the
trouble. The modus curandi is the same as in abrasions of the
skin. (Dublin Med. Press, 1849.)

The use of collodion in erysipelas was, doubtless, first made
by Dr. J. W. Freer, of Illinois, during the latter part of 1849.
It was in an epidemic form of erysipelas that the Doctor first
applied it and found it successful. All will admit that when
epidemic, this disease is more obdurate and intractable than it
is in sporadic cases ; yet in his hands it proved adequate to the
occasion, by relieving pain and expelling the superabundance
of blood from the capillaries. He also found it very successful
in the treatment of burns. I shall refer to the latter application
aaain. (IV. Western Med. and Sur. Jour., Jan. 1850.) Dr. Du-
<?as, in his report to the Georgia State Medical Society, 1852,
upon "Certain New Remedies," mentions a case of erysipelas,
which he treated with collodion. " The collodion was perse-
vered in to the last without appearing to exercise any control-
ling influence whatever." The parts affected were the face
and scalp. The patient recovered, but not through the agency
of the collodion. We shall see that this is not the only unfa-
vorable report of it. It has, however, been extensively used
in erysipelas of the face, in the London hospitals. (London
Lancet, July, 1850.)

1853.] Harriss, on Collodion, 713

Collodion has been used to a considerable extent in mammary
inflammations, by Prof. Evans, of Rush Med. College, who
says, "Disheartened by the general want of success in preven-
ting suppuration by the ordinary means of treatment, and satis-
fied that the most prominent indication of cure, was to over-
come the freedom with which the blood was forced into the
mammas, and by compression cause the absorption of the lymph,
as in some, by the roller-bandage applied on the extremeties,
in various forms of inflammation, I determined to use a com-
plete coating of the collodion to obtain the benefit of its con-
traction." He made the application morning and night and
the results were very satisfactory, as shown by his report of
cases. There was but one in which suppuration took place,
this is certainly a very beautiful result far better that can
be obtained from bandage, tinct. iodine, &c. (N. TV. Med.
and Surg. Journal, Sept. 1850.) Dr. J. H. Murphy, in the
March No. of the same journal says, that he was induced to
try this article in mammary inflammations, from the report of
Prof. Evans : his success was so great that he ventured upon
its use in Small Pox. In the first case he proceeded with
laudable caution and applied it to one of the lower extremities.
Pitting was the sequel of the eruption every where, except
where the collodion had been applied. The extremity to
which the application had been made, presented a "uniform
smooth surface. " In another case, he says, "I brushed the sur-
face of the face, neck and hands of the patient thoroughly, three
or four times a day, for four days. The result was as in the
first case, a perfect prevention of the disfiguring effects of the
disease, although both patients had the affection in a severe
confluent form." The Dr. playfully remarks that the first
patient, "hinted ominously malpractice," because his face had
not been anointed instead of his leg.

I would here state, that in a conversation with Dr. Dugas
upon the use of collodion in mammary inflammations, he said
that in his practice it had acted like a charm ; that it not only
presented suppuration when early applied, but hastened won-
derfully the cure after the abscess had been formed and opened.

In the same No. of the journal, Prof. Evans recommended
highly the use of collodion in chilblains ; it prevents the con-

714

Harriss, on Collodion.

[December,

tact of the oxygen of the air, which but feeds the flame and
produces the intolerable itching and burning sensations char-
acteristic of this affection. He says, the sufferings of the
patient were promptly relieved and the progress of the diseased
action speedily arrested.

M. Aran, gives his testimony in reference to the use of col-
lodion to prevent pitting from small-pox. He had frequently
tried it in varioloid and found it satisfactory; so he determined
to try it in the confluent variety of small-pox. He relates the
case thus : " It occurred in the person of an unvaccinated young
man, and the collodion was applied to all parts of the face but
the lips and ears. Through this transparent covering the pro-
gress of the pustules was observed to become at once arrested
while those uncovered continued enlarging; moreover, a part
of the covering having been detached without being observed
for some hours, the pustules thus exposed began to develop
themselves until again arrested by a reapplication. The ears
too, were now covered and the progress of the pustules stopped
there." [Southern Med. and Surg. Jour., April, 1851.) After
the detachment of the collodion, no cicatrices were observed,
though in other parts they existed in abundance, the eruption
having been very confluent.

The July No. of this Journal, for 1851, contains an ingenious
plan devised by M. Cunier for the treatment of symblepharon
after the adhesions are severed. Every one is doubtless aware
that these adhesions are almost certain to reunite after their dis-
section has been made. M. C. proposes collodion to prevent the
re-union of the lids to the globe of the eve. In adhesions of the
lower eyelids, a narrow strip of linen moistened with collodion
is applied just below the eyelashes and parallel with them, so
as to secure two bits of threads placed transversely beneath
the linen, with their free extremities hanging down. A similar
one, with threads beneath, is fixed over the malar bone ; when
entirely dry, the threads from above are tied to those from the
cheek, sufficiently tight to depress or evert the lid, and main-
tain it so. " In adhesions of the upper lid the second strip should
be placed upon the forehead, for the purpose of drawing up the
eyelid when the threads are tied." The eye should be pro-
tected from dust by a thick veil or shade. U this treatment is

1853.] Harriss, on Collodion. 715

as successful as M. Cunier affirms it to be, it will rid the occu-
list of very frequent and embarrassing accidents.

An extract is contained in the Southern Med. and Surg.
Journal, May, 1851.. (from the Bull. Gen. de Therap.,) on the
treatment of Ingrowing Toe-nail, by M. Meynier. "The flesh
being pressed aside, a little collodion is poured between it and
the nail, which soon dries and keeps the parts asunder until
cicatrization is effected. " M. Larrey succeeded in four cases
out of six.

The same Journal (October, 1851) gives the report of a case,
by M. H. Gassier, of Hemorrhoidal Tumours, treated with
collodion. This was applied after all other remedies had failed,
and before the tumor was reduced; and in twenty minutes the
patient was very considerably relieved. He was soon cured,
and six months had elapsed without a return of the disease.

The Medical Examiner, for March, 1851, gives, in a very
condensed form, the experience of Dr. Li man, of Boston, on
the use of collodion in burns. He states that it allays the
smarting, forms a protective covering which excludes the ac-
tion of the air, and is so exactly adapted to all the parts that
no after dressing is required. The Doctor adds, that in one
case of extensive burn, there were no contractions of the in-
teguments, after it had cicatrized. This is rather an unexpected
result, for we might very readily expect contractions in these
cases, from the peculiar action of the collodion, producing, as it
does, a contraction of itself. During 1852, collodion was ap-
plied with success to Naevi and Entropions.

Collodion has also been employed to subdue the swelling and
relieve pain in Orchitis, by spreading it over the scrotum.
M. Dechange says that it acts by compression and excluding
atmospheric air. This was doubtless employed for the same
purpose as adhesive strips and bandages. If the contractile
power of collodion is sufficient, it will answer the indications
quite as well as the bandage, besides being more convenient to
apply. The bandage I have found far more efficacious than
any other remedy. Dr. Rossignol, of this city, informs me
that he has used it very successfully as a substitute for band-
aging. I have not myself tested the virtue of collodion in this
disease. It doubtless alleviates pain by preventing farther dis-

716 Harriss, on Collodion. [December,

tension, for the pain is dependent upon this, and ceases when
the distension ceases, but its contraction may be sometimes
insufficient to subdue the swelling, which existed before its ap-
plication.

Dr. Claiborne, in the Stethoscope, (March, 1853,) speaking
of the application of collodion to buboes, uses the following
language: "I use the collodion solely for the purpose of dis-
cussing or scattering the bubo, and in my hands it has proved
incomparably superior to any other discutient." In this case it
acts by compression, subduing any inflammation that may ex-
ist. It would seem to be more applicable to indolent, than
acute buboes.

A synopsis of the experience of Dr. Christen, of Prague, with
collodion, in Small-pox and Erysipelas, is presented in the
American Jour, of the Med. Sciences, (April, 1853.) The ex-
perience of the Doctor is diametrically opposed to that of all
others in reference to its preventing pitting in small-pox. In
his hands, it not only did not prevent pitting, but was often
injurious, by confining the pus and giving great pain. It was
frequently necessary to remove it and allow the inflammation
to proceed unchecked. "He says, "the further development
of the variola was neither prevented nor lessened, but only
modified, by the papulas under the layer of collodion forming
even points of pus, which, as the suppurative process advanced,
became confluent, and in severe cases formed a nearly unin-
terrupted layer. The evaporation of the liquid parts was so
impeded that fluid pus was still under the collodion, when the
pustules on other parts of the body had dried and crusted."
Dr. Christen's experience with it in erysipelas is scarcely more
encouraging than in variola. In symptomatic, erysipelas, he
found it of no advantage whatever, but admits its efficacy in
this disease when arising from local causes. These results are
rather surprising, inasmuch as the reports of most others con-
cur in testifying to its efficacy in these affections.

It appears that M. Guersant has employed, with considerable
advantage, collodion and castor oil as an application to erysipe-
las. Formula Collodion, 30 parts ; Castor oil, 2 parts. Mix.
This was applied every day. The idea of mixing these mate-
rials is due to M. Robert Latour. (See Braithwaite's Relros.,
July, 1853.)

1853.] Harriss, on Collodion. 717

Seeing the good effects of the salts of iron in erysipelas,
M. Aran was induced to combine them with collodion, form-
ing a preparation which united the compressive and astringent
effects. This preparation consisted of equal parts of collodion
and ethereal tinct. of the perchloride of iron. He slates that it
forms a somewhat thinner pellicle than ordinary collodion, but
is much more supple and resisting, so that the limb can be
moved in any direction, without cracking. Its adhesion is also
more prolonged. (Bull, de Therap.)

A rather singular application of collodion was made by Dr.
Doringer, but with the desired effect. In an obstinate and
unyielding case of priapism, accompanying gonorrhoea, he
enveloped the whole of the penis of his patient in a coating of
collodion ; from that moment, he says, the patient had no erec-
tion, and suffered only from a slight scalding. It was necessary,
however, to renew the application, as the erection returned
when the collodion was taken off. but not so severely. Two
applications only were made. (Med. Examiner and South.
Med. and Surg. Jour., July, 1S53.)

My own experience with collodion has been very limited.
I have attempted to arrest the development of furuncles with
it, but have entirely failed. Whether my patients carried out
the instructions or not I am unable to say. The true cause of
failure is, doubtless, owing to the late hour at which physicians
are consulted. Patients usually come to us when the boil has
suppurated and is ready to be opened. This is also the case
with whitlows; though in this affection I have but little confi-
dence in the power of collodion to prevent or rather subdue the
inflammation. The disease is usually too deeply seated. The
contraction of the collodion would perhaps only increase the
pain, inasmuch as it is known to be caused by the resistance of
the dense fasciae of the fingers. In cases where boils have been
caused to ulcerate, by friction of clothes, or by pressure, collo-
dion has acted well healing the sore in a short time.

I have applied collodion to but one case of hemorrhoidal
tumors, and in this it proved beneficial. The tumors came
down after each evacuation of the bowels, which occurred once
or twice a day, and the collodion was applied each time, but
after the tumors were cleansed with water. The first applica-

718 Dugas's Case of Femoral Exostosis. [December,

tion gave some pain, but in a few moments great relief was
experienced. No succeeeding application caused pain. The
collodion was persevered in for three days, when relief was
complete. I do not consider this, however, a permanent cure.
The tumors will probably return.

I used collodion in one case of burn of the hand from sulph.
acid. The burn was, however, very superficial, the cuticle
only having been removed. The hand was placed in a weak
solution of chloride of soda for a few moments, which relieved
the pain, and then a coating of collodion was placed upon it,
and the young man resumed his work without discomfort.
Collodion has also relieved, temporarily, tooth-ache, in my
hands ; doubtless by excluding air. When the coating has been
removed, another should be placed upon the tooth. A bit of
cotton dipped in collodion has been recommended, and used
by dentists, as a temporary filling for carious teeth, with ad-
vantage.

ARTICLE XXXVIII.

^i Case of Femoral Exostosis; with Remarks. By L. A.
Dugas, M. D., &c.

Mr. George B . . ., of Newton county, Ga., came to this city
on the 7th of February last, and placed himself under my pro-
fessional care. He was 28 years of age, of slender habit, and,
although rather delicate, did not appear to be in bad health.
He bore, however, an exostosis, the origin of which he attribu-
ted to a fracture or other injury sustained when about one year
of age, and since which time he has been troubled with a tumour
upon the anterior surface of the lower third of the right femur,
and occasional pains in this region. He stated that the tumour
and the pains had increased very much during the last five
years. Any exercise now caused pain and swelling of the soft
parts adjacent, which would subside in a week or ten days, by
repose and emollient applications. For the last twelve months
he had been thus incapacitated for business or enjoyment of
any kind.

Upon examination, I found a considerable tumefaction at the
junction of the lower with the upper two-thirds of the thigh,

1853.] Dugas's Case of Femoral Exostosis. 719

painful when grasped, and evidently occasioned by a considera-
ble exostosis, which bruised the muscles whenever these were
used. The crureus and rectus femoris appeared to have lost
much of their thickness, and the exostosis was consequently
separated from the skin by a very thin stratum. The vasti
seemed larger than those of the other limb, the affected thigh
being on the whole much larger than the sound one.

As the patient had come for the purpose of submitting to
what he thought a comparatively trivial operation, I deemed it
proper to undeceive him, and at once told him that I regarded
the removal of such an exostosis as so serious that nothing but
the most urgent necessity could induce me to attempt it; that
his constitution was evidently not robust and would perhaps
yield sooner than he expected, &c &c. He replied, that his
life was a burden to him under existing circumstances, and that
he would rather take any risk than remain as he was. I then
requested him to remain in bed and to apply emollients, in order
to subdue the acute symptoms induced by travel ; adding that
I would ask some of my professional friends to see him.
Professors Newton and Miller, and Drs. Campbell, Harriss and
Rossignol accordingly visited him ; all of whom concurred with
me as to the seriousness of the case, but thought an operation
proper under the circumstances.

The temporary aggravation having subsided, and the patient
being fully prepared, mentally and physically, the operation
was performed in the presence of the above-named gentlemen
and some others on the 17th February, as follows : The patient
was placed horizontally upon his bed, with the affected limb
extended and the foot resting upon a chair; chloroform was ad-
ministered until insensibility was induced, but not carried so
far as to produce profound coma ; a longitudinal incision about
eight inches in length was made upon the anterior surface of
the thigh and down to the exostosis. This gave issue to a large
quantity of black blood, mixed with grumous matter, apparently
resulting from the contusion of the tissues, which were found to
be quite dark and ragged ; the wound being cleansed, the knife
was carried around the exostosis so as to bring its entire volume
fully into view ; the flaps were now drawn asunder with bent
spatulas and the exostosis sawed off on a level with the shaft of

720 Dugas's Case of Femoral Exostosis. [December,

the femur. The hemorrhage was comparatively slight, and no
vessel required a ligature. The patient regained his conscious-
ness as the operation was completed, and the wound was allowed
to remain open some time to detect any tendency to bleed. A
roll of lint the size of a man's finger was now placed upon the
sawed surface and projected out at the lower end of the incis-
ion, in order to secure a free issue of matter; adhesive strips
brought the flaps in apposition and the patient was put to bed.

Thus far every thing seemed to promise well, and the patient
was highly gratified at having undergone the operation without
pain. But in a few hours he began to complain of a jerking in
the limb: for which an opiate was ordered, and repeated sev-
eral times during the night without much relief.

18th. Passed a bad night; pulse excited; no appetite; still
much annoyed with jerking of the muscles of the affected limb ;
opium and camphor ordered at stated intervals.

19th. Has had another bad night ; pulse more excited than
heretofore ; looks pale and takes no nourishment ; the wound
discharges freely a dark, blackish matter ; thigh considerably
swollen. Adhesive plasters loosened to facilitate the discharge;
wound cleansed with chloride of soda and water ; complains of
nausea, for which ess. peppermint and brandy toddy were oc-
casionally given.

20th. Evidently much worse ; pulse very frequent ; face pale ;
nausea increased to vomiting; refuses all food, but craves cool-
ing beverages ; the matter discharged is very offensive ; tume-
faction increased ; is more disposed to sleep. Adhesive plasters
again raised; no adhesion of flaps; wound cleansed as hereto-
fore and brandy continued, w7ith broth.

21st. Died at 10 A. M. very quietly, having been delirious
through the night whenever awake.

The exostosis was carefully examined after its removal, and
found to consist of an exceedingly compact osseous tissue,
which, however, passed gradually into the cartilaginous state
as the surface was approached. Beneath the periosteum, the
surface was cartilaginous and mammillated, especially about the
summit of the exostosis. Upon a careful inspection of the spe-
cimen, with the aid of the microscope, by Dr. Harriss and my-
self, we found the structure to resemble very accurately that of

1853.] Dugas's Case of Femoral Exostosis. 721

healthy bone, and cartilage undergoing ossification near the
surface The tumour was evidently crowing at the time of its
excision. There was no appearance whatever of cancerous nor
of tubercular matter about it.

Remarks. The above case is both interesting and instruct-
ive ; painfully interesting because of its issue, and eminently
instructive because of the paucity of light thrown upon such
affections and operations by systematic writers. Indeed, it is
truly surprising that so few surgeons speak of femoral exostoses
from actual observation. Those who treat of exostoses at all,
do so in such general terms as to leave the reader without any
valuable information in cases similar to the one under consid-
eration.

That our case was one in which excision was warrantable,
can admit of no doubt : yet we are free to admit that, under
similar circumstances we would now prefer resorting to ampu-
tation than to excision.

In his First lines of the Practice of Surgery, Samuel Cooper
does not treat of Exostosis, but he devotes several pages of his
Surgical Dictionary to the subject. With regard to the treat-
ment of exostosis, in general, he remarks that " our ignorance
of the pathology of exostoses, particularly their causes, accounts
for the imperfection of our treatment of them. With the ex-
ception of the venereal exostoses, or nodes, there is no species of
this affection, for which it can be said that we have any one
medicine of efficacy." After alluding to certain cases in which
they have disappeared, he adds: "When an exostosis is hard,
chronic, and free from pain and alteration of the structure of
the bone, it is a much more common thing for it to cease to
enlarge, and remain stationary during life, without producing
inconvenience, provided it be so situated as not to impede the
functions of any vital organ." (Diet, of Pract. Surg., N. York,
1842, p. 363.) Again (at p. 304) he states that "when exosto-
ses merely occasion a deformity, and no pain nor inconvenience
from the pressure which they produce on the neighbouring parts,
it is certainly most advisable not to undertake any operation for
their removal ;" but adds (p. 365) " when exostoses are produc-
tive of much pain, and injure the health, and their situation

722 Dugas's Case of Femoral Exostosis. [December,

~ . - a

admits of their being safely removed with the aid of suitable
saws, or even with that of a gouge and mallet, the operation
may be undertaken"

Richerand's views are very similar to those of S. Cooper :
"L 'ablation de la tumeur est le seul moyen efficace dans les
exostoses bornees et locales ; mais l'operation est tres doulour-
euse, et le mal est bien preferable a un aussi cruel remede.
Neanmoins si la tumeur cornprimoit quelque organe, ou causoit
une difformitee dont le malade voulut etre gueri a tout prix,
void quel seroit le procede dont on devroit (aire usage." (No-
sog. Chir., Paris, 1815, torn. 3., p. 133.)

According to Chelius, (System of Surgery, by J. M. Chelius,
translated by J. F. South, Philadelphia, 1847,) " The dispersion
of a true exostosis is never to be expected from the various dis-
persing remedies which have been recommended." "When
these remedies have actually dispersed bony swellings, they
were doubtless only inflammatory swellings of the periosteum."
v. 3, p. 411.

''If the exostosis be void of pain, if it do not enlarge, nor in-
convenience the patient, or if situated on any part where me-
chanical treatment is improper, it is advisable to let it alone.
But if the swelling be very inconvenient to the patient, and if
its situation admit of mechanical treatment, the only remedy is
its removal." p. 412.

Velpeau, (Oper. Surg., translated by Townsend & Mott, N.
York, 1847,) in a special chapter devoted to exostoses, says,
" the lower third of the femur is perhaps the region of the osse-
ous system where pediculated exostoses acquire the greatest
volume, and are most frequently met with," and adds, "this is
a kind of exostosis which is scarcely mentioned by authors."
He then states that he had only seen six or seven cases of it, in
neither of which did the patient experience much inconveni-
ence, nor therefore require any operation. After speaking of
the treatment, he adds : " The conclusion, therefore, in my own
mind is, that I would not decide upon the removal of tumors of
this description, unless, notwithstanding my representations,
the patients should find themselves so much incommoded or an-
noyed as to make an urgent demand for relief or unless such
tumors should threaten to acquire too large a volume, or to

1853.] Dugas's Case of Femoral Exostosis. 723

undergo degeneration, or cause, in fine, actual pain, or serious
functional derangement in the part. As for the rest, (in short?)
there is no other treatment for them but extirpation." (p. 141.)

Velpeau advises the use of a tent to give issue to pus, &c.

Miller (Principles of Surgery, Philada., 1852,) observes that
" This kind of exostosis seldom occurs but in the long bones of
the extremities ; and is most frequent in the femur at its lowest
part." (p. 449, with diagram.)

" In the majority of cases, this variety of exostosis may be
left undisturbed. Interference is only warrantable, when bulk
and position are such as to interfere with important functions
as of muscles, vessels, cavities, canals, or internal organs : then
an incision may be made, the neck of the growth severed by a
saw, or bone-pliers, and the exostosis carefully removed. Cases
demanding such treatment, however, are comparatively rare."
Miller urges the importance of leaving the wround open (p. 450)
cites no case of operation by himself nor any one else.

Nelaton (Pathol. Chir., Paris, 1847,) recommends excision,
under circumstances similar to those mentioned by the above
authorities. On looking over the works at hand, I find, as
above remarked, that very few speak from personal observation
of the form of Exostosis under consideration and the number
of reported cases in which excision has been practised is so
small that I feel disposed to append such as I have found to this
narrative.

Sir Astley Cooper relates the two following cases :

"Case. Miss E. O., 11 years of age, was brought to my
house in July, 1817, by Mr. Prior, Surgeon of Clapham, on ac-
count of having an exostosis on the thigh-bone : it was seated
a little above the inner condyle of the os femoris in the line of
the insertion of the triceps muscle. The account she gave me
was, that it was accidentally discovered about eight months be-
fore she applied to me. At first, it did not interfere with her
daily exercises, and it produced no pain on walking ; but from
the month of May last she found some difficulty in bending the
limb. Mr. Mortimer, Surgeon, of Bristol, wrote to me, that he
was requested to examine Miss E. O.'s thigh in the beginning
of the year, and found a small tumor about two inches above
the inner condyle of the femur, directly under the seat of the
garter. This tumor was evidently an osseous enlargement, in-
sensible to pressure, and by no means painful. The skin was

724 Dugas's Case of Femoral Exostosis. [December,

perfectly free from inflammation, and there was no reason to
suppose that the tumor had acquired any addition to its bulk for
years. Its origin was unknown ; it occasioned no pain or in-
convenience whatever, nor did it in any way impede her walk-
ing or dancing, or produce any degree of lameness. Mr. Mor-
timer's view of the case was perfectly correct. In the month
of May last she first found that on going up stairs, she was un-
der the necessity of advancing her right foot on each stair ; and
the same in descending, when she was obliged to proceed side-
ways, being unable without great inconvenience to bend the
limb. Whilst sitting down, and more especially on a low seat,
she felt considerable pain in bending the knee : and after having
sat for some time, she experienced pain and difficulty on rising.
Her lameness, just before her journey to London, had consid-
erably increased, and her leg had become painful down to the
heel. When she attempted to run, she felt a snap upon the
swelling, as if a cord had slipped out of its pulley, which was
owing to the tendon gliding over the projecting part of the bone.

"On Monday, the 21st of July, an operation was performed
for the purpose of removing the swelling, in the presence of Mr.
Prior and Mr. Plowman. An incision was made over the pro-
jecting portion of the bone, and the muscles drawn aside from
its surface : the periosteum, which was much thicker than
usual, was divided by the knife, and turned aside from the ex-
ostosis, which was covered by a bed of cartilage, in which bony
matter had been deposited ; and this was about the thickness of
one-eighth of an inch. The exostosis was next cleared of the
soft parts from the surface of the thigh-bone, upon which it
grew, and a spatula was passed down to confine the muscles
from interfering with the saw. The saw was then attempted
to be used without the forceps, but it could not be well fixed :
the forceps were therefore added to it, and the bone was sawn
through. Some irregularity remained upon the thigh-bone,
which I endeavored to remove by means of a saw recommend-
ed by Mr. Hey, but the muscles interfered with its employment,
in consequence of the depth at which the bone was seated; and
I removed it readily, by means of a pair of bone nippers,

" No vessel of any importance was wounded in this operation,
nor was there any necessity for applying a ligature. The edges
of the wound were approximated, and retained by means of
adhesive plasters ; and an evaporating lotion was applied.

" On the 22d she had some fever, which on the 23d had sub-
sided.

" On the 24th she was carried to the sofa, after which she ex-
perienced no further inconvenience from the operation ; and
before leaving town had entirely lost the painful sensations
which had previously existed." (Surg. Esssays, Philada. 1821.)

1853."! Dugas*s Case of Femoral Exostosis. 725

"Case. James Aris was admitted into Guy's Hospital, Au-
gust 13, 1817, with an exostosis occupying from one to three
inches of the thigh-bone, above its internal condyle, which felt,
through the integuments and muscles, about the size of the finger,
and which was directed rather upwards, not being exactly at
right angles with the thigh-bone. His age was 24 years ; and
14 years ago, while jumping over a post, he first discovered
pain in the part which afterwards formed the seat of the dis-
ease. The pain lasted but a very short time, but it led him to
examine particularly the part, when he perceived a small and
hard swelling. This tumor gradually increased, and at length
began to interfere with the motion of the limb, so as to render
him anxious to have advice respecting it. When walking, he
felt what he described as a snapping in the part, like a cord
slipping from a pulley, which probably arose from the extension
of the sartorius muscle, and its sudden slipping over the swell-
ing. When he placed the limb quite straight, he found a diffi-
culty in bending it; and when bent it was almost equally
difficult to extend it ; each flexion and extension producing a
snapping noise, which could be distinctly heard.

"On considering the inconvenience which the swelling had
produced, and that the disease was obviously on the increase, I
recommended to him the operation which I had performed in
the preceding Case, and advised him to become a patient in the
Hospital, and to submit to one of a similar kind. He procured
admission immediately.

" On the 22d of August I performed the operation. The man
was lying upon a table with his thigh slightly bent, and I made
an incision through the integuments over the swelling, and thus
exposed the sartorius muscle, which appeared to have gained
an increase in its breadth, and to be incapable of being suffi-
ciently drawn aside to completely expose the tumor without
considerable violence; I therefore made an incision through it
in the direction of its fibres, sufficiently large to allow the exos-
tosis to pass through the opening. The periosteum which cov-
ered the swelling, was then exposed, and being cut through, and
turned aside, a surface of cartilage was laid bare, and beneath
it a large process of bone. Mr. Machell, the inventor of the
saw, who was present at the operation, himself applied it, and
with a very few turns of it removed the osseous tumor. The
edges of the wound were brought together, and union attempted
by adhesion.

"In the evening of that day he had some symptoms of consti-
tutional irritation, and some blood was taken from his arm.
On the following day, he took a brisk purging medicine, and
after this time no unpleasant symptoms appeared.

" My dresser, Mr. Humble, informed me that the wound was

n. s. vol. ix. no. xrr. 46

726 Dugas's Case of Femoral Exostosis. [December,

as nearly as possible cicatrized on the 12th of September, and
he was discharged from the Hospital a few days afterwards, and
continues free from the inconveniences which he had experi-
enced prior to the operation." {he. cit., p. 160.)

The late Dr. George McClellan (Prin.andPract. of Surgery,
Philad., 1848, p. 345) thus expresses himself in reference to a
case upon which he operated :

" It is by no means so often necessary to perform the opera-
tion for extirpating an exostosis as is generally supposed. By
far the majority of cases become stationary after they have
attained a moderate size, especially if the patient is kept on an
antiphlogistic regimen, and attention be paid to his regular
secretions and exhalations. Those who have been occasionally
compelled to operate for the removal of exostoses from deep-
seated positions, where they interfere with important motionsy
or functions of any kind, know too well the difficulties and em-
barrassments to resort unnecessarily to a repetition of such
attempts. I have seen patients suffer more from the extirpation
of prominent and troublesome ledges of bone from the linea
aspera than from any other surgical procedure, and afterwards
undergo more local and general irritation as well as fever. I
think 1 never was so much perplexed and worried as in an effort
which I once successfully made to cut away a long and flat
prominence from the inner fork of the linea aspera of the right
thigh in a muscular young man, wThose comfort and business
had been much interfered with by the growth of the tumor. A
large hook of the excrescence extended upwards along the inner
side of the thigh directly over the femoral artery and vein,
where they passed the adductor tendons, and rendered it very
difficult to avoid them. The collateral vessels were also very
greatly enlarged, and bled furiously under every stroke of the
knife. A small narrow saw, however, finally enabled me to
cut away the whole bony mass, and the patient recovered with
severe inflammation and fever."'

Mr. Edward Stanley (Diseases of the Bones, Philad., 1849)
establishes the following rule :

" After the removal of an exostosis, especially when deep-
seated, it is not expedient to approximate the divided edges of
the integuments, in the view of obtaining their adhesion ; since,
in the exposure and removal of the tumor, so much injury is
usuallv done to the surrounding cellular tissue, that suppuration
through it will almost certainly ensue. The wound should be
simply covered with folded damp linen ; and, by this means,
the healing of it will be completed in a shorter time than if

1853.] Dugas's Case of Femoral Exostosis. 727

the adhesion of its sides had been in the first instance attempt-
ed." (p. 137.)

He then relates two cases in which he performed excision.

Case 1. "A man, aged twenty-five, had an exostosis grow-
ing from the lower and front part of the femur, which com-
menced five years previously. The tumor, increasing, had of
late interfered with the knee-joint, occasioning pain in it, and
distension of the synovial membrane by fluid. The tumor was
oblong, the long diameter of its base being in the axis of the
femur, and measuring about four inches, the breadth of its base
about two inches. The increase of the tumor, in such a direc-
tion that it projected into the knee-joint, induced the man to
solicit its removal. Its connexions were carefully examined,
with reference to the question of its being possible to remove it,
without injuring the joint ; and it was decided that the opera-
tion might be safely undertaken.

"An incision was made through the rectus and cruraeus mus-
cles to the base of the tumor, on the side most remote from the
knee-joint. But in doing this, though with all possible caution,
the joint was opened, and it was now discovered that the syno-
vial membrane, in yielding to the accumulation of fluid in the
joint, had extended upwards upon the tumor, and some way be-
yond it upon the front of the femur. With much difficulty, on
account of the deep situation of the tumor, the breadth of its base,
and the hardness of its texture, I effected its removal by means
of a chisel and cutting forceps. The inflammatory fever, im-
mediately consequent on the operation, was not severe ; but as
this subsided, there was no return to health. Constitutional
derangement of another kind ensued ; its prominent features
were rigors, collapse, pain in the head, cramps in the limbs, and
extreme prostration of nervous power: and it soon became
evident, that suppuration had taken place through the subcu-
taneous cellular tissue of the whole limb, from the hip to the
foot. At the end of the third week from the operation, the pa-
tient died." (p. 138, 139.)

Case 2. "Subsequently, in the hospital, I removed an in-
creasing exostosis from the lower and inner part of the femur ;
but here there had been no accumulation of fluid within the
knee-joint, and consequently no extension of the synovial mem-
brane beyond its natural limits." (p. 140.)

M. Roux, the Nestor of French Surgery, remarked, in 1847,
(Medico- Chirurg. Review, July, 1847, p. 263, quoted from
Revue Med. Chirurg.,) that he had seen only seven cases of
pediculated exostosis on the lower third of the femur. The

728 Dugas's Case of Femoral Exostosis. [December,

following are his conclusions with regard to excision of exosto-
ses in general :

"1. With the exception of some whose position renders them
inaccessible, it is almost always possible to remove these tu-
mours. 2. In almost all cases such ablation is indicated, either
for the removal of a great deformity, the relief of continual suf-
fering, or the re-establishment of the deranged functions of
certain organs. 3. In the great majority of cases we can pro-
ceed to the ablation without a preliminary exposure of the
tumour, and without having any great difficulties to overcome.
4. Such an operation may lead to unfortunate results, in con-
sequence of some peculiarity in the seat or relations of the tu-
mour, or from the bad constitution of the patient ; but generally
it is crowned with success." {Revue Medico- Chirurgicale,
Nos. 2 and 3.)

In such operations M. Roux prefers making a lateral incision
upon each side of the tumour, through which he passes the saw
and divides the pedicle of the exostosis. We are disposed to
think that by such a method the danger of purulent infiltration
and the difficulty of the operation must be materially increased.
M. Nelaton observes that "in a case of exostosis of the anterior
and inferior portion of the femur operated upon by M. Roux,
I saw the Professor compelled to unite the two lateral incisions
by a third and transverse one, which extended through the skin,
the rectus cruris and a portion of the triceps, so as to form
two square flaps which he had to dissect up in order to disen-
gage the tumour."*

I have looked over the extensive library of the Medical Col-
lege of Georgia, and have been unable to find any notice of
more than the six cases above cited, in which an exostosis of
the femur has been excised. The disease is admitted to be of
rare occurrence^ and the cases in which an operation may be-

* " Je dois dire eependant qu'apres avoir scie le pedicule, il est quelquefois
tres difficile d'isoler l'osieocele de toutes les parties qui l'entourent; dans un cas
ou M. Roux operait une exostose plaeee a la partie anterieure et inferieure
du femur, j'ai vuce professeur etre oblige de reunir les deux incisions laterales
par une troisieme incision transversale qui dut comprendre la peau, le muscle
crural anierieur et la partie inierieure du triceps crural, de maniere a former
deux lambeaux carres qu'il dut dissequer pour degager la tumeur." (Nelaton,
Pathol. Chir. Paris, 1817. T.2,p.20.)

t In the Museum o( the Medical College of this city, there are two specimens
of exostosis of the lower end of the femur among the collection of diseased bones.
In both, the exostosis is a few inches above the inner condyle and upon the
anterior aspect of the bone. [Ed.

1853.] Dugas's Case of Femoral Exostosis. 729

come necessary must be exceedingly uncommon. Operations
of the kind have doubtless been performed which were never
reported ; and this wrould most probably be the case with such
as terminated unfavorably.

As to the result of the cases reported, we find that the first,
by Sir A. Cooper, was successful ; and we may infer that the
wound healed by first intention, although this is not distinctly
affirmed. In this case, the existence of the tumour had not
been known more than eight months and the patient was only
eleven years of age.

In Sir Astley Cooper's second case the patient was 24 years
of age, and the tumour had existed fourteen years. The wound
was upwards of twenty days in healing; but the result was suc-
cessful.

The third case, alluded to by Prof. McClellan, recovered;
but the details are not given, and we cannot therefore determine
the length of time the wound required to heal.

The fourth case is reported by Mr. Stanley. The patient
was 25 years of age, and the tumour of five years' standing.
Death occurred at the end of the third week, apparently from
purulent infection.

In the fifth case, Mr. Stanley merely adverts to the operation,
but does not furnish us with the result. It was probably favor-
able.

The sixth case is that of M. Roux, referred to by M. Nelaton.
The result is not stated. From the severity of the operation,
as practiced in this instance, we may well doubt that the pa-
tient recovered.

If we add our own case to the list, we have seven in all, of
which three were successful, two fatal, and the two others of
uncertain result. The immediate cause of death in our case,
was evidently infection induced by the rapid decomposition of
the tissues that had been so long exposed to contusion, and
which were found lacerated and filled with black blood and
grumous matter. Notwithstanding the free issue which had
been provided for the offensive matter, its copious discharge, and
ther epeated cleansing to which the wound was subjected,
the poisonous absorption took place rapidly and carried of! the
patient.

730 Hemorrhage in Surgical Operations. [December,

PART II.
(Eclectic Department.

Hemorrhage in Operations Performed with the aid of Chloro-
form. By Kirtley Ryland, M. D., of St. Louis.

In the last number of the St. Louis Medical and Surgical
Journal, there is an article by S. Wolff, M. R. C. S. L., in re-
ply to one published by me, in a previous number of the Jour-
nal. As the article of Mr. Wolff places me in a false light, in
more respects than one, I feel myself called upon to reply to
it.

Mr. Wolff has, in the beginning of his article, taken a wrong
view of the intention of mine. One would infer from his pre-
liminary remarks, that I had commenced a crusade against
the use of chloroform, which he felt it his duty to defeat; be-
cause, as he says, the patients might (some of them at least)
meet with my damnable heresies, and refuse to take chloro-
form when it was desirable they should, and thereby greatly
annoy the surgeon. But as I stated at the time, my only ob-
ject was to call the attention of the profession to the circum-
stance, that chloroform might cause hemorrhage, and ask for
the experience of the older medical men concerning it.

Mr. Wolff thinks I should not attribute the hemorrhage, I
reported to chloroform, " for," says he, "it would be but reason-
able to suppose that hemorrhage would continue if the surgeon
occupied himself with ligating small arteries and overlooked two
or three large ones with their mouths gaping open,'*' and he might
have had manliness enough to have quoted entire, and said,
"with no blood issuing from them." He says, he cannot con-
ceive what arteries they could have been. I firmly believe
he cannot, and I am convinced he would have as much diffi-
culty in conceiving of a standard of comparison or an arterial
anomaly. The facts of this oversight which Mr. Wolffmakes
so much of, are these: I was taking up arteries myself at the
time, and, on the tourniquet being loosened, I observed near
the inner edge of the flap and close to the surface two or three
arteries the size of a young chicken's quill ; I watched them for
a moment, and although their mouths were uncontracted, they
did not bleed, I placed ligatures upon them and went on. This
occurred early in the operation, and yet Mr. Wolff thinks it
sufficient to account for the hemorrhage, and still these stray
arteries did not bleed ; and if they had bled, how that could af-
fect the small arteries and capillaries and make them bleed I
cannot see.

1853.] Hemorrhage in Surgical Operations. 731

Mr. Wolff next lakes hold of the supposition I advanced to
account for the hemorrhage. He says, the iheory will not
stand investigation, but does not prove it, thinking, as he ap-
pears to do throughout his article, that his bare assertion will
be sufficient to convince all. He says, there is a more satisfac-
tory way to account for the hemorrhage than by the theory I
advanced, and proceeding to show what it is, he says, as confi-
dently, as if stating a fact which had come to his own knowl-
edge: "there had been extensive chronic inflammation in the
leg, and where there is chronic inflammation, the hemorrhage
is increased. " Mr. Wolff appears to have forgotten his pre-
vious brilliant and satisfactory solution of the question, or per-
adventure he wished to make assurance doubly sure, and there-
fore brought in this one, which unfortunately enough fails in
one particular the fact upon which it rests is no fact at all.
The injury had been received in the foot, and on account of
the inflammation above the ankle joint, Dr. Wood amputated
the leg just below the knee, in order that there might be no
danger from organic mischief. The rapid and satisfactory
recovery of the patient, proved his judgment to be correct.
And if there had been chronic inflammation, the argument
amounts to nothing; for, like the first, it fails to apply to the
other case. It is a poor and pitiful argument that will not
reach around the subject.

Mr. Wolff next proceeds to give his experience in chloro-
form, which he does in the following remarkable sentence ;

"Sir George Ballingall reports a case of amputation where
twenty ligatures were necessary, occupying some twenty-
five minutes. Fergusson says, that two or three ligatures,
more or less, are not going to interfere with the result ; and for
myself, I can only state that, since I have lived here, now
nearly three years, I had used chloroform very extensively, and
always with good results." Now, what connection has Sir G.
Ballingall's ligatures with Mr. Wolff's experience in chloro-
form ? Perhaps he merely wished to quote some author,
(every one knows how popular foreign quotations are latterly,"
they look learned.) and seeing no other crack at which they
could be introduced, dragged them in where they certainly ap-
pear most wofully out of place. Mr. Wolff appears to think
this experience of his quite enough to settle the affair forever,
but 1 imagine that Dr. Wood's experience upon the same sub-
ject, (mentioned in my former article,) will have quite as much
weight in the part of the State where they both live as Mr.
Wolff's. The concluding paragraph of Mr. Wolff's communi-
cation begins thus: Dr. R. states, that he has never met with
any account of this increased hemorrhage in any author, and

732 Hemorrhage in Surgical Operations. [December,

I am not surprised at it, &c. Now, how Mr. Wolff could
have made such a statement as the above I cannot see ; for I
distinctly mentioned a case, reported by Dr. J. B. Porter, U.
S. A., where ether had been given in an amputation, and the
hemorrhage was violent and almost uncontrollable.

Lastly, in reply to Mr. Wolff's opinion, that if I continue
my investigations, I will soon find reason to change my opinion,
I have only to reply, that I intend to pursue them ; and if he
or any one else convinces me that I am wrong, I shall certainly
acknowledge it and thank him besides. With another case
which has come under my observation, and a few remarks, I
will close.

In March, 1853, Prof. C. A. Pope amputated the middle
finger of Richard Genery, a stout, healthy Irishman, aged
twenty-eight. The patient took chloroform, which I adminis-
tered. A large quantity was necessary. After the operation
Dr. P. left the hospital, directing me to stop the bleeding and
dress the hand. It is found sufficient, ordinarily, to elevate the
hand and apply cold water, which I did, applying pressure to
the artery at the same time ; but after a considerable time it
was found insufficient, and I attempted to stop the bleeding by
other means, and after placing ligatures upcn three small
arteries, twisting or performing torsion upon several others
without yet checking it, I had a common field tourniquet ap-
plied to the artery, and pressure maintained, until the cause of
the bleeding disappeared, which was two hours or more. Dr.
Stone, of Knoxville, Mo., assisted me greatly. A few days
ago, Prof. Pope amputated the finger of a man at the hospital,
which was affected precicely like the one in the foregoing case.
No chloroform was used, and no hemorrhage took place.

In the London Med. Gazette, for Sept., 1850, is an article
from the Boston Med. Journal, giving an account of a case
where ether was used in an operation on the face near the
mouth, and the hemorrhage was so considerable, that the ac-
tual cautery had to be applied, which set fire to the ether vapor.

Since I wrote my first article, I have ascertained some facts
which enable me to account more satisfactorily for these
bleedings than I had done and at the same time, show that
chloroform probably caused them. M. De Chaumont. in a
paper, read before the Edinburgh Physiological Society, says :
u I have found that when blood is agitated with chloroform it
does not coagulate." Secondly: In the London Medical
Gazette, 1850, it is stated that chloroform enters the circulation
in full integrity and without any resolution of its component
parts. The facts taken in connection go to show, that when
a large quantity of chloroform is taken into the circulation and

1853.] Effects of Chloroform on the Blood. 733

the elimination from any cause, retarded hemorrhage would
probably ensue. Moreover, the blood is nearly always found
fluid in patients, poisoned by chloroform, which favors the idea
somewhat.

I propose to repeat the experiments of M. De Chaumont
upon the various ethers, the results of which, together with
others upon the cause of death from anaesthetics, I hope soon
to be able to lay before the profession. [St. Louis Med. and
Surg. Journal.

Effects of Chloroform on the Blood. Mr. De Chaumont read
before the Edinburgh Physiological Society the following
communication :

Much controversy has arisen as to the real nature of the
effect of chloroform on the blood. Amussat, Sedillot, etc,,
have contended that the blood is darkened by it, and that the
effect is quite analagous to asphyxia. Gruby, on the other
hand, contends that not only is the arterial blood not darkened
but that the venous blood is even rendered as bright as the
arterial. I have found that when blood is agitated with chloro-
form it does not coagulate, but becomes quite transparent; and
when the blood is venous the color is rendered as brilliant as
that of arterial blood. Sulphuric ether, on the contrary, does
not effect the color of venous blood. Chloroform seems thus
to have a special effect of brightning colors, not only in this
but in other cases ; as, for instance, when it dissolves iodine,
the solution has not the deep-brown color obtained when water,
alcohol, etc., are used, but has the beautiful violet hue of the
vapor. In some cases chloroform restores the color of old
blood-stains on linen, etc., but the effect is not constant. When
blood, acted upon by that agent, is examined by means of the
microscope, the red globules are found completely dissolved,
the field presenting only a homogeneous colored expanse, in
which the white globules float unaffected. Chloroform acts on
pus very similarly to acetic acid, as it brings into view the
double and tripartite nuclei of the globules, although the effect
is not so speedily accomplished as by acetic acid. When the
blood of leucocythemia is acted upon, the red globules dissolve,
and the white present the reaction not of the ordinary white
globules of the blood but of pus. With the view of observing
the effects of the administration of chloroform on the blood in
the living body, I attempted to anaesthetize a rabbit by the
rectum, so as not to interfere with the respiration. Although
two drachms were injected, no other effect was produced ex-

'34 Effects of Chloroform on the Blood. [December,

cept an intoxicated appearance, which did not give immunity
from pain. This corresponds with what was observed by
Flourens in the early days of etherization. Another rabbit was
anaesthetized by inhalation in the ordinary way, and died sud-
denly during the operation. On opening the body the
lungs were found florid, and without trace of asphyxia ; the
auricles of the heart continued to contract for an hour after
death ; the peristaltic action of the intestines and bladder con-
tinued also with tolerable vigor. Venous blood from this
animal presented the same reactions as before mentioned. The
next experiment was upon mice. Four of these animals were
placed alive in a wide-mouthed bottle, and a few drops of
chloroform poured into the bottom of the vessel. This speedi-
ly caused a great excitement among them, and they soon after
died. The examination of their bodies showed the same signs
as in the rabbit. The brain was also normal. Another rabbit
was anaesthetized by the lungs, and the crural vessels of the
right leg exposed and carefully watched during the whole pro-
cess of inhalation, but without there being any evidence of
change in the color of the venous or the arterial blood. In this
animal also an attempt was afterwards made to induce insen-
sibility by the rectum, but without success. The chloroform
was in this case mixed with water, and the intoxicating effect
produced was greater and continued longer than in the for-
mer. The temperature was also apparently lowered, although
no exact observation by the thermometer was made. Dumeril
and Dumarquay have stated that the temperature is lowered
in anaesthesia, and under the influence of ether and alcohol,
distinguishing the effects of these agents from common narco-
tism, as by laudanum, in which the temperature is raised.
This last rabbit died after a few hours, and the post mortem
appearances showed that death had been occasioned by acute
peritonitis. Here, too, there were no signs of asphyxia, the
lungs being of a bright rose color. In the liver was found a
cyst, containing a white pulty-like mass, which, under the mi-
croscope, showed beautiful oval-shaped cells containing around
nucleus, with several, generally three, oval nucleoli. These,
Dr. Bennett informed me, were entozoa. The action of chlo-
roform on them was curious; the nucleus swelled up so as to
fill the cell, while in another part of the field were seen cells
floating empty, and nucleoli floating about in threes, joined by
filaments. Hence, it seemed as if the nucleus had alone been
dissolved, a curious fact when taken in connection with the
solution of the red gobules of the blood, these being also con-
sidered as nuclei.

The above experiments were all subsequently confirmed by

1853.] Potassium as an Antidote to Mercury. 735

a committee of the Royal Medical Society, by whom it was
also observed that chloroform dropped upon the intestines and
bladder caused violent peristaltic action, and that dropped
upon the heart, while that organ was contracting, it caused a
cessation of the pulsations until it had all evaporated, having a
temporary paralyzing effect on that organ.

From the above experiments I am inclined to think that
chloroform does not act by asphyxia, and that, when this does
occur.it results from the manner of the administration; that
its action is directly upon the nervous centres, first upon that
part connected with the perception of sensation, and lastly on
the spinal cord, or generator of motive force; that although it
arterializes the- color of the venous blood out of the body, I
have not yet been able to observe the same effect in the body ;
and that on the other hand, the arterial blood is in no way af-
fected in color by its inhalation.

Dr. Bennett referred to a report on the action of chloroform
drawn up by himself, and printed in the Transactions of the
Edinburgh Medico-Chirurgical Society about the time when
chloroform was introduced as an anaesthetic. (Monthly Jour-
nal, Jan., 184S.) The results of the experiments there detailed
were similar in some respects to those of Mr. De Chaumont.

Dr. Mathews Duncan remarked, that rabbits were not good
subjects for experiments with chloroform, on account of .the
rapidity with which fatal effects succeeded the anaesthesia.
From recent trials, he was convinced that chloroform introdu-
ced into the stomach could produce anaesthetic effects.

[Monthly Jour, of Med. Science.

Iodide of Potassium as an Antidote to Mercury. By J. W.
Corson, M. D.

In common, doubtless with many others, I have for years
been in the habit, especially in scrofulous constitutions, of al-
ways terminating a mercurial course by the protracted admin-
istration of the iodide of potassium, both as a remedy for the
immediate effects of mercury, and as a prophylactic against its
future injurious consequences. And I have gradually ventured
to be far less apprehensive of the iil effects of the mercurials in
cachectic habits when judiciously managed, than formerly.

These views came as quiet practical teachings from the
bedside. But the peculiar mode of action by which the iodide
of potassium neutralized the slow poison of mercury in thesvs-
tem, was to me, as doubtless to others, a mystery, till the "re-
cent clear and satisfaatory experiments of M. Melsens, of Paris,

736 Potassium as an Antidote to Mercury. [December,

explained the whole matter. The observations of M. Melsens
were first embodied in a remarkably interesting paper, publish-
ed not long since in the Annales de Chimieet de Phisique, and
recently translated by Dr. Budd, of Bristol, and republished in
the British and Foreign Medico- Chirurgical Review for Jan-
uary, 1853. Those who are not already familiar with it we
would refer to the original paper as a master-piece of medical
observation, strengthening the patient deductions from the ex-
perience of the bedside, by the most rigid chemical analysis.

In the hope of directing more attention to these researches
and somewhat confirming them, we have selected the above
cases out of many others that might have been quoted. Some
of them have the advantage of having; been watched for several
years, during which time they have exhibited no wandering
pains, or undue sensitiveness to cold, and no cachectic appear-
ances or other signs of injury from the constitutional effects of
mercury. Four out of five cases had legitimate evidence of
scrofulous or tuberculous taints and were therefore, specially
liable to injury, and better proofs of the efficacy of the antidote.
In the single exception, too, there was a chronic renal affection,
and it is well known that in Bright's disease, and other chronic
difficulties of the kidney, mercury is particularly apt to act at
times with fearful violence. The suffering in this case from
ptyalism, was most severe of all, and the prostration amounted
almost to that of mercurial erethism.

Yet with these constitutional tendencies to hinder us in the
administration, they all belong to that desperate class of cases
in which, from change of structure, or effusion of lymph or se-
rum, life itself was immediately jeopardized, and apparently
could only be saved by the resolvent effects of mercury. The
simple enumeration of the cases would tell the practical physi-
cian that when menacing life, he had, in duty to his patient, no
other choice. They consist it will be recollected, of extensive
dropsy with hepatic congestion, threatening obstructive inflam-
mation of the throat, immense pleuritic effusion, suffocative
laryngitis, and severe puerperal peritonitis. In all these cases
mercury appeared the only remedy capable of meeting the exi-
gency. It succeeded most happily ; and through the singular,
and as we firmly believe efficient counteracting agency of the
iodide of potassium, in a class of subjects most liable to injury,
it left no sting behind. How the iodide of potassium acts in
thus neutralizing the slow poison of mercury, the varied experi-
ments of M. Melsens seems clearly to explain.

He lays it down as an admitted principle, proved by the
well-known fact, that years afterward, persons who have once
freely taken mercury find gold coins discolored by the mercu-

1853.] Potassium as an Antidote to Mercury. 737

rial in the perspiration of their bodies, and that mercury has
been sometimes detected in the body after death ; that mercury
as well as lead combines with the animal tissues, and remains
so to speak, fixed in the system for years. Secondly, that in
the body as well as out of the body, the iodide of potassium acts
as a powerful solvent to the compounds of mercury and lead ;
disengages them readily from the animal tissues, and drains
them off through the kidneys. Many ingenious chemical and
clinical experiments are given to establish these propositions.
M. Melsens first proved that the iodide of potassium passes off
principally in the urine, by taking large quantities himself, and
then analyzing the different secretions of the body. The faeces
contained scarcely a trace, while the urine was loaded with it.
It passes offthrough the kidneys with great rapidity. A per-
son took 77 grains of the iodide of potassium, and in a few min-
utes the urine was charged with it. The compounds of mercu-
ry and lead, with the iodide of potassium, pass off by the kid-
neys in the same way.

An extraordinary cure of a looking-glass maker with severe
mercurial paralysis, is given, in which the patient took the iodide
of potassium in very large doses for several months, and repeat-
edly during this period the iodide of mercury was detected in
the urine by chemical tests.

The great efficacy of the iodide of potassium as an antidote
to the slow poison of lead and mercury, were proved by M.
Melsens, by experiments upon several dogs, which were fed
with the carbonate and sulphate of lead till paralyzed, emacia-
ted, and nearly dead, and then in a short time restored to health
and flesh by the administration of the iodide of potassium.

Three cases of severe lead paralysis among house-painters
and workers in lead, were entirely cured, and a fourth greatly
relieved by the same remedy. In five cases of mercurial par-
alysis and severe suffering among gilders and workers in quick-
silver, the iodide of potassium in a few weeks, accomplished
great relief, or a perfect cure.

It happened in some cases that the poison seemed to be liber-
ated so rapidly by the remedy that it was badly borne. Some-
times profuse resalivation was the consequence. I had under
my own care a gilder, aged G5, a few weeks since, suffering
from mercurial tremors and paralysis, in wThom eight grains of
the iodide of potassium, three times a day, produced distressing
ptyalism, and so added to his sufferings that he refused to con-
tinue the remedy.

Does the iodide of potassium ever salivate, except by libera-
ting mercury ?

We believe not. In the few cases in which salivation oc-

738 Potassium as an Antidote to Mercury. [December,

curs from preparations of iodide, we think it will always be
discovered that mercurials have at some previous time, in the
patient's life, been taken.

From the experiments of M. Melsens, it appears that the
iodide of potassium when taken with mercurials, sometimes
acts as a preventive to injury from the latter. We have for
years been in the habit in strumous, syphilitic cases, of giving
blue pill at night, and the iodide of potassium by day. Or we
have neutralized, as we imagined, the too severe effects of the
prot. iodide of mercury, syphilitic and scrofulous throat affec-
tions, by combining with it the iodide of potassium. We have
very lately witnessed excellent effects from this combination,
in a case of tubercular syphiltic eruption.

Might not the exhibition of the iodide of potassium, in seasons
of special exposure, be a protection to painters and workmen
in lead, against lead colic, and paralysis?

It is curious to notice what immense quantities of the iodide
of potassium may be often safely borne. M. Melsens took
himself for two months, from half a drachm to a drachm and a
half per day, or more than two thousand grains in the whole
period without any inconvenience, except temporary coryza,
and a few pimples, and with a decided increase of appetite.
One of the most severe cases of mercurial paralysis, related as
cured by him, took 2,314 grains of the iodide of potassium, be-
tween the 21st of March and the 23d of June.

Of the cases of our own, one took five grains, three times a
day, for eleven months, with the greatest benefit. M. Melsens
recommends, in cases of mercurial, or lead poisoning, to begin
with fifteen grains in solution, three times a day, and to increase
the dose as the patient will bear it.

Dr. Budd thinks such large doses require two conditions
First, to be given on an empty stomach; and Secondly, in a
state of large dilution.

The cases we have narrated above seem to prove, that in
milder forms, where mercurial paralysis is not induced, and the
system is not highly charged with the noxious mineral ; smaller
doses of the iodide of potassium, if continued sufficiently long,
are highly efficacious.

In conclusion, these researches of M. Melsens explain, we
think, why the iodide of potassium is so serviceable in certain
broken-down syphilitic patients, in whom the quantity of mer-
curials previously taken, finally form an important element in
their disease. We have not sufficiently tested the iodide of
potassium in lead disease, to speak as yet, with confidence from
personal reference. We may, however, as a supplement to
this paper, at a future period, report a few cases of lead paraly-

1853.] C lor of arm. 739

sis, now under treatment, and hope in the mean time, to pro-
mote the principal object of this paper by eliciting from the
profession further observations on this important subject, and
exciting a deeper interest in the original memoir, from which
we have so freely quoted. [New York Jour, of Medicine.

Chloroform.

The introduction of anaesthetic agents to alleviate the suffer-
ings attendant upon surgical operations and child-birth, was
hailed as a discovery which not only robbed the knife of its
terror, but also so far thwarted the operation of the primitive
curse, as to cause certain clerical grandmas to enter their pro-
test against its heaven-defying use. Experience, however, has
proved that the rapture of the surgeon, and the pious fear of his
clerical brother, are alike premature ; that the use of the most
popular as well as powerful of the several anaesthetic agents is
calculated to awaken no little anxiety on the part of the cau-
tious physician, and fear on the part of his patient; and while
our profession must feel that their hopes and expectations are
not vet fully realized, our clerical brethren may rest assured
that their wives will continue to bring forth in sorrow, for
though the pangs attendant may be relieved, the chances of a
sudden exit will serve to keep in force the spirit of the original
penalty of mother Eve's transgression.

By the use of chloroform, we are occasionally reminded that
Death's advent may most emphatically be like a thief in the
night, when least anticipated. The officers of one of the Lon-
don hospitals boasted of having exhibited it in over nine thou-
sand cases, without a single death ; and, as if in mockery the
grim messenger claimed its own in almost their next attempt at
its exhibition.

The mode of death, too, is almost as diverse as the cases are
numerous, hardly any two presenting exactly similar symp-
toms. This observation will be corroborated by consulting
the table contained in the May No. of the New- York Journal
of Medicine and Collateral Sciences for the present year. At
times death is instantaneous, at others, as in Dr. Warren's case,
in the Massachusetts General Hospital, it occurred after a lapse
of three hours. Sometimes the respiratory movements con-
tinue after the heart has ceased to pulsate, and at others, we
observe as one of its earliest manifestations, a paralyzing of
the muscles of respiration. We once gave it to a parturient
woman who strikingly verified this observation. The use of
the agent was suspended, the patient revived, and again upon
its renewal the same symptoms appeared. Several unavailing

740 Chloroform in Pneumonia. [December,

attempts were thus made in this case, and its use finally aban-
doned. In another case, one of amputation of the thigh, its
exhibition was attended with the same result ; here we persist-
ed in our efforts for an hour, without avail till at last, our knife
acting as a stimulus to the respiratory motions, the chloroform
was freely given and its full and happy effect obtained.

The amount too required to produce death varies; some-
times drachms, at others drops only. Twenty-five drops have
proved fatal. (See table above alluded to.) One of our col-
leagues (Professor Denton) was about giving it to a nervous
patient previous to laying open a felon on one of her fingers.
To accustom her to the odor, a very few drops were put upon
a handkerchief and handed her to smell of ; he had hardl-r
turned around, when he looked at her again and saw that her
face was blanched, her eyes set, her muscles rigid, and respira-
tion ceased. This case would undoubtedly have proved fatal,
had not the Dr's admirable coolness prompted the application
of a powerful stimulus. A scalpel, by no means distinguished
for the keenness of its edge, was drawn slowly and firmly over
the inflamed finger, cutting its way down to the bone. Just
as the incision was completed the patient screamed, respiration
was thus restored, and the patient and her friends considered
it a beautiful exhibition of the agent in question; and should
this patient ever have occasion to have a pustule picked, she
will probably insist upon taking chloroform.

We do not indulge in this train of thought from any ill ef-
fects we have ever experienced ; on the contrary, no accident
has ever occurred with us. [Peninsular Jour, of Med.

Inhalation of Chloroform in Pneumonia.

The late journals of Germany publish more than 200 cases
of pneumonia treated by inhalations of chloroform. Far from
being contradicted in pulmonary phlegmasia, as had been
thought up to the present time, chloroform on the contrary
would seem, according to these facts, to modify favorably the
inflammatory process of the lung. From among the observa-
tions published, out of 193 cases treated by Drs. Wachner,
Baumgartner and Schmit, only nine died. Of twenty-three
cases reported by Dr. Wawentrapp. of Frankfort, nineteen
were treated exclusively by chloroform, and only one died.
Every two or three hours the patient is made to inhale the
vapor from fifty drops of chloroform, during ten or fifteen
minutes, so as never to let the effects reach a loss of conscious-
ness. All the patients were of adult age, and the disease upon
an average had reached the fifth day. In every case it was

1853.] Venous and Arterial Blood. 741

observed that the chloroform had a diaphoretic effect, which
was sometimes produced by the first inhalation, and never fail-
ed to manifest itself on the third or fourth day. It gradually
diminished the local pain, and caused it to disappear; it calm-
ed the thoracic anxiety, brought back the respiration to its
normal type, always appeased the cough, facilitated the expec-
toration in rendering it less abundant ; and lastly it reduced the
febrile reaction and induced a refreshing sleep three or four
days after the inhalations were commenced. [Gazette des
Hopitaux. Western Journal of Medicine and Surgery.

Upon the Difference of Temperature between Venous and Arte-
rial Blood. By G. V. Li ebig. (Inaug. Diss. Giessen., 1853.)

Former investigations upon this subject have led to conflict-
ing results. Most of the older observers, such as Haller,
Crawford, Kramer, Seudamore, &c, having declared that the
arterial blood (in the left cavities of the heart) is warmer than
the venous blood of the right cavities by 1 ; while A. Cooper,
Coleman, Mayer, Autenrieth, etc., either pronounce the tem-
perature of both kinds of blood equal, or give to the venous
blood an excess of temperature over the arterial of 05. The
author proceeds, in his attempt to explain these differences, to
inquire, whether the higher temperature be found in the blood
flowing from the lungs, or in that from the capillaries, and he
reverts to some of his former observations upon "muscular
respiration."

The experiments were conducted both upon living and re-
cently killed animals. That death might be caused quickly,
and without loss of blood, the medulla oblongata was severed
in some instances, and narcotin was administered in others.
The thermometer was introduced, either by the jugular vein
or the carotid artery, to the requisite depth to the heart; or it
was inserted into the crural vein, or the vena cava abdomina-
lis. Respiration was prolonged after death, when necessary.
The experiments were performed upon dogs, and with every
possible precaution to avoid errors.

The results were 1. That the temperature of the blood in
the right cavities of the heart exceeds that of the left cavities
by 005 0-16; 2. That the blood flowing into the heart by
the vena cava descendens (probably because the blood which
the former vessel contains comes from parts which present to
the atmosphere a very great extent of surface in which a pro-
cess of cooling takes place).

In the venous system, there go on changes of temperature
corresponding with the respiratory act. In the vena cava su-

n. s. VOL. IX. no. xn. 47

742 Venous and Arterial Blood, [December,

perior it was remarked that at the end of each inspiration the
temperature of the blood rose; between inspiration and expira-
tion it attained it? maximum ; towards the end of expiration it
fell ; and was at its lowest point after expiration. When ani-
mals breathe, or rather expire, shortly and quickly, and then
inspire deeply, the variations of temperature are greater than
usual. When the thermometer is in the right auricle, the high-
est degree corresponds with inspiration, and the lowest with
the beginning of expiration. When the breathing is very short
and hurried, these changes of temperature become diminished,
or even cease altogether. In the vena cava abdominalis the
same phenomena were not observed ; in the vena lliaca they
were reversed, the maximum occurring after expiration, and the
minimum after inspiration.

The author then remarks upon the mechanical influence ex-
erted by the inspiratory movements upon the circulation in
veins. The enlargement of the thoracic, and the diminution
of the abdominal cavities, coincident with inspiration, cause the
blood of the vena cava ascendens to flow into the right auricle,
during and especially at the end of inspiration. The contents
of the vena cava descendens are less than those of the vena
cava ascendens, and they are cleared out at the beginning of
inspiration. During expiration, the abdominal cavity is widen-
ed, and the vena cava abdominalis gains both in space and
contents. Towards the end of inspiration, the auricle will
therefore be filled by the warm blood of the vena cava abdomi-
nalis ; and at this moment is observed the highest degree of
variation in the heart's temperature. In expiration the blood
streams into the auricle chiefly from the vena cava descendens,
and then is remarked the minimum of temperature. As re-
gards differences of temperature in different parts of the same
system, the author found the blood of the vena cava sup. 010,
and that of the auricle 0'^0. Between the auricle, where the
blood from two vessels of different temperature is not com-
pletely mixed, and the ventricle, the difference amounted to
0-i_30-20=.

In the arterial system there are no variations dependent upon
the movements of respiration, or they are very slight, amount-
ing to 0*01 0 00, and connected with the changes in the right
cavities of the heart, and the cooling of the blood in its passage
from the lungs.

In dead animals, the temperature of the blood of the right
ventricle exceeds that of the left by 016. In two experiments,
however, the temperature was found the same in both cavities.
The temperature of the blood of the vena cava abdominalis
v*as once, upon opening the chest, found 0*72 higher than that

3853.] Treatment of Ascites. 743

of the thoracic portion of the carotid during life. The same
observations were repeated in several experiments. The blood
of the vena cava abdominnlis, which comes from the capillaries
of the lower extremities, and of some of the abdominal viscera,
is the warmest blood in the body, even in animals where the
heart has been emptied by bleeding, and to this point the author
attaches great importance.

It would be desirable to know the amount of cooling which
the blood undergoes in its passage through the lungs; but the
subject is fraught with difficulty. The fact, however, if estab-
lished, is most important, inasmuch as the source of animal
heat has been referred by many to the organs of respiration.
Asregardsthe warmth of the blood in the vena cava abdomi-
nal is, it must be remembered, that the vessel lies imbedded in
soft, highly organized parts, where, under all circumstances,
heat is retained for a longer time than in other parts of the
body ; and perhaps this fact will explain the cause of the warmth
of blood rn that vessel as satisfactorily as any theory of changes
going on in the capillary system. [SchmidCs Jalub., 1853.
London Lancet.

On the Treatment of Ascites by Intraperitoneal Injections.
By M. Velpeau.

A question of great importance from its novelty and the lim-
ited number of statistical data which we as yet possess to test
its validity, and cases to which it may be curatively applicable
is the late treatment of ascites by intra-peritoneal injections of
iodine. The use of ioduretted injections, first introduced into
practice by M. Velpeau, in the treatment of hydrocele, has
proved their utility in the removal of serous effusions, and their
superiority over various injections ; and seems on the eve of
becoming generalized as a treatment applicable to all serous
effusions of a chronic character. One would a priori think
that the startling proposition to inject a fluid so irritant as the
tincture of iodine into the cavity lined by so extensive and del-
icate a membrane as the abdominal, would never be tried ; we
would at once anticipate, as the direct and inevitable conse-
quence, a general and fatal peritonitis. Yet since facts are
beginning to multiply on this subject, although they do not
prove the utter harmlessness of the procedure, they demon-
strate the radical cure of cases wherein all other treatment had
failed ; objections, however plausible and urgent thev may
theoretically appear, must give way to experiments and facts.
As a matter of course, this treatment cannot be applicable to all
cases ; as yet, statistical observation has not been sufficiently

744 Treatment of Ascites. [December,

extended to point out accurately those cases to which this
mode of treatment might be specially applicable. Ascites
being but a symptom various are the organic leisions of which
it is the effect; diseases of the heart, especially of its right
chambers, offering impediments to the ingress of venous blood ;
diseases of the liver, particularly those causing atrophy of its
tissue, interfering with venous return, as cirrosis ; diseases of
the spleen, especially those of a miasmatic nature, the sequela
of protracted intermittents, and renal diseases ; where the drop-
sy is a consequence of cardiac and renal disease, it is of a gen-
eral nature. I do not believe that ascites, the consequence of
those organic lesions, can receive any benefit from ioduretted
treatment, inasmuch as the cause is usually irremediable and
permanent, and therefore so must be the effect. Yet there are
unquestionably cases of ascites, which might be designated
simple, as that resulting from general anemia; that the effect
of a peritonitis, acute or subacute, where the inflammatory
peritoneal action having subsided, the serous effusion yet
remains, and that sometimes after all treatment for its relief had
proved nugatory. In the former of these cases, where a well
tried tonic treatment with chalybeates shall have failed associ-
ated with drastic and saline cathartics and diuretics, the injec-
tions of iodine may succeed, as also in ascites, the result of an
acute or subacute peritonitis; here inflammatory aetion may
have been completely subdued, and we have to do with its con-
sequences; its effused products. In these cases, as well as in
ascites, the result of prolonged and invincible anemia, it would
seem in the generality of cases, that the pathological action
which maintains the dropsy is merely the predominance of ex-
hallation over absorption, there being probably no organic alter-
ation persisting otherwise to account for its continuance ; here
I can see from the analogy of its action in hydrocele, that from
ioduretted injections, a new action being originated in the per-
itoneal surface, an impetus is given to absorption, gradually
the effused fluid observed, exhalation by the same rests in
abeyance, and thus an equilibrum being established between
exhalation and absorption a radical cure is effected. The
opinion that the irritant influence of iodine necessarily produ-
ces, when injected into the abdominal cavity, an extensive and
fatal peritonitis appears to be more apparent than real. In
corroboration of the truth of this statement I herewith furnish
you some interesting facts, taken from published cases, treated
in Hotel Dieu, of Lyons, by M. Teissier, one of the attending
physicians.

"I have practiced," says he, "up to the present time, the
mtra-peritoneal injection of iodine upon six female patients af-

1853.] Faults of Medical Writers. 745

fected with ascites. Of this number, two have been cured ;
with the third, the result is yet uncertain, because the injection
is recent ; but there have been no accidents, and the conse-
quences of the injection are to the present moment favorable;
with two others, the operation has been innocent though un-
successful, the ascites having been produced a short time after ;
with the sixth patient, symptoms of peritonitis rapidly followed,
and the patient died in forty-eight hours. In this fatal case I
had to do with a young woman, twenty-two years old, in the
last stage of scrofulous cachexia, and whose case offered no
chance of success by any other method. Thus: two patients
cured, their ascites having resisted all ordinary means purga-
tives, diuretics, vesicatories, mercurial ointment; one patient,
result doubtful; one operation perfectly innocent but unsuc-
cessful ; one operation followed by death. I ought to say, in
this last operation, it was impossible to make the injection run
out after having been thrown in. The injection in these cases
was composed of iodine, iodide of potassium, and water. It
appears, then, evident to me that this operation is destined to
render great service, but it will not always be innocent. MM.
Gromierand Teissier."

The paragraph which conclues these statistical results of
MM. Gromier and Teissier, in my estimation, imports the true
appreciation which should be accorded to the use of these in-
jections in cases of confirmed and invincible ascites. In the
last case of M. Teissier the ascites may have been the conse-
quence of a tubercular peritonitis, as he remarks that the pa-
tient was in the last stage of scrofulous cachexia, though he
makes no mention of this lesion as being the dropsy. These
injections of iodine have been successfully used in certain cases
of ovarian dropsy, as the unilocular form, and have been ad-
vised, as you are aware, in chronic and invincible diseases of
joints, particularly in chronic synovitis. [Dr. E. F. Smith,
European Correspondent of St. Louis Med. and Surg. Jour.

Faults of Medical Writers.

[In the discourse by Dr. Samuel Jackson before the Phila-
delphia County Medical Society at its last annual meeting, we
find the following remarks on a subject which deserves the at-
tention of the profession generally especially those who are
in the habit, as all should be, of writing occasionally for the
press.]

Let the young doctor do his very utmost in acquiring a habit
of writing with perspicuity, propriety and precision. Let him

746 Faults of Medical Writers. [December,

seek no other ornament, for medical language is, like Thomp-
son's loveliness, when " unadorned, adorned the most." No
merit will make amends lor the want of perspicuity. I can
show whole paragraphs in our American books which have
no meaning whatever, being similar in this respect to those
verbose letters that Queen Elizabeth used to write when she
had pre determined to say nothing. Medical diction ought to
use as few words as possible, thus going the shortest way to
the end of a thought. An English writer on morbid poisons,
wishing to describe the daily progress of the variolous pustule,
uses the following verbosity: "You receive from a longdis-
tance, from Dublin or from Edinburgh, a lancet, on the point of
which there is a little dry animal matter. This lancet has
pricked the pustule of a patient suffering with smallpox, and the
contents of the oustule have been suffered to drv on the lancet.
Now with this lancet you make a single puncture in the arm
of a healthy person, not previously defended by vaccination or
otherwise, and what results?"

Now suppose this author, Dr. Simon, had wished to describe
also, the effect of a rattlesnake's bite, he might have begun
thus: You receive from a longdistance, from Utah or Califor-
nia, a rattlesnake, which Li nnae us calls crotalus, it may be the
species horridus or durisus; this dreadful animal has a saccu-
lus of poison at the root of each fang, and when he bites, these
sacculi pour forth their deadly contents along a groove in each
fang. Now you permit this animal to bite a horse, for an ex-
periment, or perhaps it bites one of you, and what results? In
this multiplication of useless verbiage, a great amount of time
is wasted without any compensation.

In a celebrated medical journal, we have this circuitous way
of saying that a certain medicine was probably useful in rheu-
matism ; the disease was cured in eleven days; "and lemon
juice, if it was not the principal remedy, certainly exerted an
important influence toward the production of that end." What
think you, gentlemen, of producing or leading forward an end
or a cure ? O.ie might suppose that the writer was a cobbler,
and that he was talking about the producing or the pulling
forward of his waxed-end. And then he has lemon-juice making
an exertion, and exerting an influence.

Why should a writer say, ''I had recourse to a medicine,"
if he had not previously used it in the same disease? This
word means a running backward. The simple English word to
give, is often supplanted by the Latin word to exhibit ; that is,
to make a show of the medicine. A shopkeeper exhibits his
goods, a physician gin* or orders his medicine. Celsus took
nearly all his ideas from the Greeks, but he did not copy their

1853.] Faults of Medical Writer. 747

words. I believe he never uses the word exhibere, but dare et
idi. Sometimes he says adhibere, but this does not mean to
make a show; moreover, it is pure Latin. His own language
was sufficient for him, except in the mere naming of diseases ;
and hence one reason that his style and manner are universally
approved.

It is of no little importance that our young author should not
practise the coining of words. A new idea may require a
new word, but old ideas will always be most intelligibly intro-
duced by known terms ; hence the great English lexicographer,
whose head might well be fancied as swarming with words,
introduced only four in all his writings. His rule was, "to
admit only such as may supply real deficiences, such as are
readily adopted by the genius of our tongue, and incorporate
easily with our native idiom." If a little license be granted,
how will you define its limits ? How will you definitely
measure the old vulgar phrase too much? A little liberty will
prove like moderate drinking, and lead to intemperance. If
every writer of the present times should coin words at his
pleasure, and the next generation should adopt them and add
to them, what odious gibberish would then fill the air! It is
told of Sir John Mandeville that, when far in northern Asia,
with his retinue, their words were all frozen before they could
be heard, and that, on coming south, they were suddenly
thawed, and filled the air with their liberated voices. I can
hardly credit this fact, as the amiable author does not relate it
himself, and yet something similar may happen to the jargon of
the present generation ; while confined to books it may pass
without much notice, but our successors may find the accumu-
lated vocabulary to become a clattering of unmeaning voices,
the mere echoes of our vanity, and as unintelligible as Sir John's
thawed vocables.

In the Transactions of the American Medical Association
you may find some animating specimens of these important
additions to our deficient language. Nume? ism, socialism,
sensationalism, subjectivity, progressionist, therapeutication,
truths eliminated, annexes of the heart. A writer in vol. iv.,
p. 59, calls impressions " intuitively felt relations" and then
inquires, "Are not all the felt relai ions based on immediacy
and intuition, and not on representational and transmitted im-
pressions." Truly, if men in high places continue to pour forth
such floods of impurity, men in low places may well complain ;
hence I have ventured to notice the subject ; it pertains to self-
education, which is our present topic. [Boston Medical and
Surgical Journal.

'48 Lithotomy. [December,

[Extract of a Letter from Paris, addressed to the Editor of
"The Stethoscope and Virginia Medical Gazette."]

Lithotomy per Rectum.
I witnessed, on the morning of the 25th of July, an interest-
ing operation for stone in the bladder, by Prof. Nelaton of the
Hopital de la Faculte. The subject was a man, about 45
years of age. A calculus of considerable size (as large as a
hen's egg) was extracted, together with several others of small-
er volume, which M. Nelaton supposed to be scales from the
larger stone, which had been cast off spontaneously some time
before the operation. The circumstance of interest connected
with this case is, that lithotomy was performed through the
"dilated rectum." The urethra, into which a grooved direc-
tor or sound had been previously passed, was punctured, and
Depuytren's i; double concealed lithotome" (lithotome cache,)
introduced along the director, to the bladder. It was then
opened and withdrawn, in the track by which it had entered,
dividing the neck of the bladder and the prostate so as to make
an incision continuous with the puncture that had already been
practiced in the urethra, below or in front of the prostate gland.
In this way an opening was created sufficiently large to admit
of the extraction of the stone, the relative size of which I have
given above. This was accordingly accomplished, as in ordi-
nary cases, with the forceps. The smaller calculi, be it ob-
served, M. Nelaton removed with great facility, simply by the
introduction of the fingers, proving thereby the case with
which the bladder is reached " per rectum." No vessel of suf-
ficient diameter to require the ligature was wounded in this
operation. I shall refrain from any lengthy remarks upon this
operation, leaving it to your readers to draw their own con-
clusions relative to its advantages. When we reflect, however,
upon the extreme dilatability of the rectum ; the ease with
which the bladder may be attacked through it ; the tenuity of
the tissues necessarily incised ; the comparatively little danger
of wounding the urethral "bulb" or vessels sufficiently large
to create anxiety in regard to hemorrhage ; lastly, the ease
with which stones of ordinary or even large diameter may be
brought to light we are naturally inclined to look favorably
upon it. A "rectovesical" fistula will of course result ; and
the hope that it will close by primary intention, can scarcely
be entertained, but it may be expected that the "granulating
process" will cause its obliteration as much sooner than the
vesico perineal fistula resulting from the bilateral operation in
the perineum as the extent of surface implicated in the one
case is less than in the other. Particularly may this be antici-

1853.] Orchitis.- Cataract 749

pated, if by proper injections and la vat ions, fcecal irritation be
avoided. The introduction of this operation into practice be-
longs, I believe, to M. Maisonneuve, the bold surgeon of Hopi-
tal Cochin. I say I believe, because I am not aware that it has
been performed in the U. States or elsewhere, though the inci-
sion of the fundus of the bladder, where the stone, making for
itself a vesical pouch, projects into the rectum, has, I am told,
been often practiced. It is difficult to foretell the absolute ter-
mination of any step in operative medicine, especially if regions
be concerned whose inflammatory accidents are to be dreaded.
Yet, when we consider "appearances," (too often and parti-
cularly deceptive in medicine I know) and the anatomical sim-
plicity of the incision requisite in this operation, we are led to
believe it less replete with danger to life than any other method
of lithotomy now employed. This, however, is for " expe-
rience" to prove. Permit me, in conclusion, to add, that the
patient who submitted to this operation has, during the several
subsequent days that have now elapsed, presented none but
favorable symptoms.

Orchitis.
For the radical cure of this affection, M. Velpeau not unfre-
quently punctures the testicle with the lancet. In the several
instances in which I have seen him employ this method, he did
not apparently spare the true substance of the seminal gland,
but passed the lancet freely and in different places through
both the proper tunica-vaginalis and tunica-albuginea. In a
clinical lesson given by him, he spoke of the rapidity with
which cures of this sufficiently troublesome affection are some-
times accomplished by this means, and of the little danger re-
sulting to the testes from wounds of that organ. This last fact
has long been known here and in America, and any one may
be convinced of the fact by giving that method of resolving an
inflamed testes a trial. It undoubtedly acts benignantly, by
discharging whatever serosity may be contained in the tunica
vaginalis propria, and by relieving the tension of the tunica
albuginea. This operation is productive of but little and
momentaneous pain, which is followed by an amelioration of
previously distressing symptoms. M. Velpeau. however, men-
tioned one case, where an aggravation of pain existed for
several days after the punctures. This was, in all probability,
due to a portion of the tubercular matter of the testicle forming
a hernia in the small openings that had been punctured in the
tunica albuginea by the lancet.

Cataract.
I have seen at the Hospital of the Faculty, several operations

750 Cataract. [December,

upon cataractous eyes, involving a principle which, I confess
was a novel one to me, and which I insert here, with the hope
that it may interest those of your readers to whom it may also
be new. These operations consisted neither in extraction, de-
pression nor reclination, but in simply dividing the lenticular
capsule so as to admit the free penetration of the aqueous hu-
mor to the crystalline lens, which is left in situ to undergo the
changes that are impressed upon it by that fluid. These
changes are interesting. At first it increases in volume. Small
mushroom or fungous-like portions of it proceed from the incis-
ions of the capsule. These finally separate and fall into the
anterior chamber of the eye, where they are ultimately dissolv-
ed and disappear. It gees on in this manner until the whole
lens "breaks up," is removed from the field of vision, and sight
is restored. I need not say that some time is required for this
dissolution and absorption of the lens, but it will as surely ar-
rive as that the aqueous humor has the property of dissolving
that body when exposed to its action. There is also but little
danger of inflammation (so much to be dreaded in others) from
this operation, which may be repeated, I might almost say, *'ad
libitum ;" for every surgeon is aware of the comparative harm-
lessness of punctures of the cornea, and the rapidity with which
the aqueous humor is reproduced after having been evacuated.
Indeed, it would not be unwise to "draw ofF" this fluid several
times, at proper intervals, during the process of absorption of
the lens; for it exists in but very small quantity, and becomes
rapidly saturated with the crystalline matter, and then of course
refuses to dissolve a larger portion of it. It is scarcely neces-
sary to add that this process is most applicable to lenticular
cataracts, and that the rapidity of its success must in a great
measure depend upon the greater or less solubility of the
crystalline body. Of course, secondary cataract, and those
which are the result of fibrinous depositions or false mem-
branous exudations upon the capsule, can hardly be supposed
to fall within the pale of the remedial agency of this operative
process.

It would give me pleasure, Mr. Editor, to mention other
subjects connected with the science of our profession ; but,
conscious that brevity is the sauce of communications, unenli-
vened by brilliancy of style, even when questions of interest
are involved in those communications, I am induced to forbear
until another time.

With the heartiest wishes for the continued success of the
"Pioneer Medical Journal" of Old Virginia,

I am yours truly,

Paris, August, 1853. Samuel C. Gholson.

1853.] Wound in the Head. 751

Brief account of a Wound in the Head from the bursting of a
musket, the breech lodging in the cells of the ethmoid and
sphenoid bones, for a period of eight years. (Communicated
by a Military Surgeon.)

An officer, 32 years of age, serving in the island of Ceylon,
in the year 1828, while in the act of firing at an elephant with
a cut-down musket of the old description, was knocked down
by the bursting of the piece. He lay insensible for some time ;
but, being alone, was uncertain how long; and, on the return
of consciousness, found himself wounded in the forehead, the
debris of the musket lying about him. He was, however, able
to get on his feet ; and, on assistance arriving, and search made,
most of the shattered fragments were forthcoming, but the
breech, which was nowhere to be found, until after the lapse of
several days, when it was ascertained to have been the cause
of the wound, and that it actually remained embedded in the
skull. In the course of about three months, the patient had re-
covered sufficiently to resume his duties; the wound in the
forehead remaining open, but being protected by a covering of
black plaster. So matters rested for a few months more, when
the pointed portion of the iron breech made its way through
the palate, together with the head of the screw by which it had
been secured to the stock, and which was still loosely inserted
through its proper hole in the iron, as they had together been
torn from the wood-work. They had continued to descend
gradually lower and lower, so that the point of the iron was in
almost constant contact with the tongue, by which its edge was
worn smooth and polished. As will be naturally concluded, a
profuse secretion of pus was kept up; this was generally most
offensive, requiring the greatest attention to cleanliness, and a
consumption of lint and tow somewhat enormous; despite all
which, the discomfort of the sufferer was occasionally added to
by the engendering of maggots within the wound. It was on
one of these occasions, eight years after the accident, that I
first saw the case, and had from the officer himself a statement
of which the preceding is a summary. The worms were at
this time got rid of by the use of stimulating injections, but not
without great pain. The wround in the forehead was triangu-
lar, with a base about half an inch long, just above the ossa nasi,
and from its centre to the apex was a full inch. Within was
seen, horizontally placed, and level, or neariy so, with the base,
the circular end of the iron ; while, as before mentioned, the
other end. with the head of its connecting screw, had now de-
scended very low through the opening in the roof of the mouth,
the small end of the screw being situated in the right nostril,

752 Wound in the Head. [December,

and easily twirled by the thumb and finger, applied to the op-
posite one in the mouth. There had been great desire to get
away this screw; but, though so loose, there was not space to
admit of its being withdrawn ; to obtain which, an ingenious
attempt had been made, some months previously, by Mr. Elliott,
a young surgeon, to saw ofT about half an inch, thus reducing
its length to an inch and a half; and he had nearly succeeded,
when obliged to desist, from the suffering caused to the patient,
but who expressed his intention to submit to a further trial at
some subsequent date. The attempt, however, was never re-
peated. On the evening of March 25, 1836, after the excite-
ment of a mess dinner, with much conversation, and some
rather loud singing, in which this officer bore a conspicuous
part, while leaning over to one side, his chair slipped from under
him, and he came to the floor in a sitting posture, but did not
at the time appear to have sustained any hurt; though it was
scarcely to be expected that such a succussion, with a large
foreign body in the head and in such close proximity to the
brain, could take place without consequences of a serious and
dangerous tendency. The next day, headache and general
pyrexia came on, and rapidly increased with evident vascular
determination to the brain, delirium ensued, and death closed
the scene on the 2nd April, the seventh day after the fall.
Eight hours after death the head was examined. The brain
and its membranes were in a high state of vascularity, and a
small abscess was found in the anterior lobe of the right hemis-
phere, very thinly separated from the orbitar plate of that side,
and connected with a dense membrane that supplied the defi-
ciency occasioned by the absorption of a triangular portion of
the cribriform plate of the ethmoides, this adventitious mem-
brane being, of course, the only medium of separation between
the brain and the cavity containing the iron, which, on remov-
ing the membrane, was brought into view, but was only fully
exposed by a horizontal section of that part of the os frontis,
below the superciliary ridge and orbitar plate, with the neces-
sary vertical ones to complete the separation. The cavity
formed of the ethmoidal and sphenoid cells, the inner bony
structure of which had been removed by absorption, had a
black appearance, and a fetid sulphurous odour; the iron was
now removed without difficulty by the bullet forceps; had a
black charred appearance, with a strong odour of gunpowder,
and. when cleared of its adherent impurities, weighed (including
the screw) within a drachm and a half of three ounces; its
length 2f inches; and its greatest transverse diameter, lT\
inches. The screw exactly 2 inches in length. [London
Lancet.

1853.] External Stimulus in Cholera. 753

External Stimulus in Cholera.
To the Editor of The Lancet :

Sir, The resources of professional judgment in the treat-
ment of cholera are not so numerous and efficient as to render
a somewhat novel remedy unacceptable to those whose lot it
may be to undertake the charge of many cases. I am indebt-
ed to a lady, of heroic mind and great intelligence, for the hints
which led me to adopt in the collapse of cholera the powerful
external stimulus which I shall presently describe. It appears
that in the most desperate cases, even when life has appeared
extinct, the native Indians are accustomed to apply the actual
cautery freely to the abdomen, not unfrequently with the hap-
py result of restored vitality. The remedy, based on the same
principle, which I have employed in three cases with com-
plete success in the Borough Gaol of Newcastle, is precisely
similar in kind, though somewhat less harsh and formidable in
degree. A piece of linen dipped in brandy is placed over the
epigastrium or abdomen, and ignited ; the brandy burns away
in a minute or so, producing a considerable feeling of pain,
which renders it necessary to secure the hands of the patient.
Slight vesication will probably follow, and, if successful, in a
short time heart and pulse begin to return, and the feelings of
the patient are greatly improved, vomiting will also generally
be put a stop to. It is probable that the application may soon
require repetition, the situation being somewhat varied. In
one case, now convalescent, in which death was apparently
close at hand, the most complete effect was produced by a
third application along the spine in the lumbar region.

Time will not permit me to give details of cases ; but having
now tried the brandy blister in seven or eight cases of total
collapse, I repeat that in three it has been entirely successful,
and in others has had the effect of temporarily rousing the
patients; and if, as experience has since taught me, in some of
these it had been repeated with more energy, greater success
might possibly have resulted. The patients, now convalescent,
say that it is a severe remedy ; but are quite conscious of its
beneficial effects, and attribute to its use, without any hesita-
tion, their restoration from impending death.

I have the honor to remain, Sir, your ob't serv't,

September, 1853. T. M. Greenhow.

P. S. When leisure permits I shall possibly give some de-
tails of the cases which have occurred in the Borough Gaol,
exceeding considerably 100 in number, of whom 8 are dead.
The small number under treatment (less than 20) are all likely
to recover. About a week ago more than 40 patients were ill
at the same time.

754 Nitrate of Silver in Acute Tonsillitis. [December,

On the Application of Nitrate of Silver in Acute Tonsillitis.
By M. Herpin'.

M. Herpin states that he finds the application of nitrate of
silver in substance to be a most excellent mode of abridging the
duration of acute tonsillitis, preventing suppuration in persons
liable to this occurrence. Even in the most intense cases, ac-
companied by great febrile action, he has not had to make more
than three applications. If suppuration has already occurred,
the application is of less avail, and is then, on account of the
closure of the jaws, often impracticable. The application must
be carefully and methodically made opposite a window. If the
velum is inflamed it should be touched in passing from one ton-
sil to another, as also may be the uvula but as a spasm of the
fauces is often then induced, this should be left to the last. If
the application is made within the first twenty-four hours, a
single one often suffices: and this happens in persons who are
liable to relapse of this affection, and have already derived
benefit from the caustic. If seen later, two applications at the
interval of a day, or even three, are required, although the first
at once checks the progress of the disease. More than twenty-
four hours should never be allowed to elapse between the ap-
plications. Since he first recommended this practice, many of
M. Herpin's colleagues at Geneva have adopted it, and with
the best effects, in securing the rapid dispersion of a disagreea-
ble though not a dangerous disease. [L' Union Medicale, and
Med. Chir. Review.

Statistics of Operations for Cancer. By Professor Paget.

In a recent note to The Lancet, Mr. Paget qualifies a remark
which he had made in his lectures at the College of Surgeons,
"that persons operated upon for cancer die upon an average
thirteen months sooner than those upon whom no operation has
been performed," by stating that he referred only to scirrhous
cancer of the breast. He says

In such cases, I believe that the general average duration of
life, after the patient's first observation of the disease, is forty-
nine months ; that the average life of those whose breasts are
removed, and who survive the effects of the operation, is forty-
three months; and that the average life of those in whom the
disease is allowed to run its course is about fifty-five months.

In the second lecture, I said that the general result of opera-
tions for medullary cancers is very different ; and that, although
they are so seldom long survived, that they are generally con-
sidered to be less beneficial than the operations for scirrhous

1853.] A Bean extracted from the Bladder. Idd

cancers of the breast, yet on the whole they are more so. The
general average of life of persons affected with medullary can-
cer of the eye, testicle, breast, bones, or other external organ,
may be reckoned at about twenty-four months from their first
notice of the disease ; but I believe the average for those from
whom the primary disease is removed, and who do not die in
consequence of the operation, is about thirty-four months;
while the average for those in whom the disease is allowed to
run its course is scarcely more thnn a year.

In the third lecture I expressed the belief that, on the whole,
the operation for epithelial cancers is even more effective in
prolonging life than the operation for medullary cancers; but
that the wide diversities in the duration of life amongst those
affected with this form of cancer makes it very difficult, at
present, to deduce such an average as may be relied on. And
I would repeat what I said in one lecture respecting all these
averages namely, that such general results serve only general
considerations in the treatment of particular cases of cancer.
They may justly determine a general rule of action, but it can
be only such a rule as must admit of numerous exceptions. In
many cases of scirrhous cancer there are sufficient reasons for
operating; and, in many cases of medullary and epithelial can-
cers, reasons as sufficient for refraining. The right course
must, in each case, be determined by a just appreciation of all
the conditions each presents. [London Lancet.

A Bean extracted from the Bladder by the Lithotrite.

M. Maisonneuve, Surgeon to the Hopital Cochin, in Paris,
has just removed a large bean from the bladder of a man, 27
years of age, who had wilfully introduced this foreign body into
his urethra. The bean, which, on the introduction of the litho-
trite, was felt floating on the urine, was luckily caught, and
withdrawn without crushing. The urethra must have been
considerably stretched by the passage of the lithotrite partially
open, and holding a foreign body more than half an inch long,
It is, of course, advantageous that the bean should have been
extracted whole; but in supposing that the surgeon had crush-
ed it, the fragments would probably have been passed, as well
as a portion of the bean, which was evacuated the day after
the operation. [Ibid.

Practical Remarks upon Polypi of the Uterus. By Helfft,

The fact that uterine polypi grow rapidly during the period of
gestation, and constitute a very dangerous complication, makes
it advisable to remove even small polypi, when they are dis-

750 Premature Delivery. [December,

covered, although there may have been neither haemorrhage
nor symptoms of pressure. When a polypus is seated at I he
neck of the uterus, and protrudes into the vagina, it can give
rise to haemorrhage during pregnancy ; or it may lead to abor-
tion, or, at a later period, it may interfere with delivery. If it
be in the uterine cavity, dangerous symptoms occur, for the
first time, after the birth, when haemorrhage takes place ; or
the uterus becomes inverted; or the polypus forms a swelling,
which closely resembles, and may even be mistaken for, an
inverted uterus.

A polypus discovered in the early months of pregnancy, of
moderate size, and attached by a narrow peduncle, can be re-
moved by torsion. Usually this operation has but little effect
upon the uterus. When the polypi are larger, and are attach-
ed by a broader base, the ligature is unnecessary ; but, in this
case, inflammation of veins is a possible occurrence, or there
may ensue a direct absorption of the putrid matter caused by
the strangulation of the ligature ; abortion, too, is to be feared.

Polypi within the uterus do not occasion any serious incon-
venience during pregnancy, in spite of the great size which
they sometimes acquire. It is only after the removal of the
placenta that their presence becomes known, by the swelling
which still remains. In lucky cases, the polypus comes down
of itself into the vagina a longer or shorter time after delivery,
either without haemorrhage or any unfavorable symptom, or
attended with severe pain and copious loss of blood. When
the presence of an intra-uterine polypus has been made out, it
is best to leave the organ to itself, should it be disposed to
contract ; in which case there is no fear of haemorrhage.
When, however, severe bleedings come on, the polypus must
be removed, either by torsion, or by the ligature and the
knife. [Ibid.

New Method of Inducing Premature Delivery. By Scanzoni.

The author was induced, by observing the active sympathy
between the breasts and the other parts of the sexual apparatus,
to try to produce premature delivery by irritating trie nerves
of the mammary glands. The first experiment was made upon
a young woman, aged 24, who, two years ago, had been de-
livered by perforation, in consequence of contraction of the
pelvis. In the thirty-second week of utero-gestation, apparatus
constructed of caoutchouc, forming sucking-pumps, were put
upon the nipples. During three days they were used about
seven times, the process going on upon each occasion for two
hours. After the third application, the neck of the uterus be-

1853.] Belladonna in Vomitings in Pregnancy. 757

came shortened; after the sixth, severe labor-pains came on ;
after the seventh, the child was born.

The only danger likely to ensue from this very simple me-
thod of treatment is inflammation of the mammae ; this can be
met with proper treatment.

A second case, of similar kind, occurred to the author. A
young woman, enceinte for the first time, suffered so severely
from dyspnoea, connected with organic disease of the chest,
that premature delivery was necessary for the preservation of
her life. After the third application of the sucking-pumps, an
apparently dead child was born; respiration, however, was
soon re-established. The author remarks, that this case was
not quite conclusive, because premature delivery occurs often
in connection with severe dyspnoea, independent of other influ-
ences. \Verhandl. der Med. Phys. Ges. zu Wiirtzburg, 1853,
and Ibid.

On the Use of Ext. Belladonna in the Treatment of Obstinate
Vomitings in Pregnant Women. By R. L. Scruggs, M. D.,
of Louisiana.

It is not a little surprising that an article capable of promptly
arresting so grave a disease as the obstinate, and even danger-
ous vomitings, which often supervene in the course of preg-
nancy, should have been so entirely neglected or overlooked by
the profession generally ; particularly when it is remembered
that M. Bretonneau, more than eight years ago, announced the
important fact to the profession in Europe, and pointed out the
circumstances under which it ought to be used, the manner of
applying it, &c. In the many recent discussions and papers
read upon the subject of the propriety of inducing premature
labor for this disease, I am surprised to see no allusion made to
this remedy whatever. Even in that excellent and unique
work, published in 1851, by Chas. D. Meigs, "upon woman and
her diseases," no mention is made of it, notwithstanding he
says that the affection is so untractable as to justify the induc-
tion of premature labor. M. Trousseau, in a clinical lecture,
delivered at the Hospital Necker, in January, 1848, thus al-
ludes to M. Bretonneau's theory and practice in these cases.*

"Five years ago," remarked the Professor, "a lady pregnant for
the first time, who, for six weeks, had vomited both liquids and solids,
called in M. Bretonneau. He found the patient in a most alarmino-
state the affection progressed rapidly, and threatened to become
inevitably fatal. This woman, when questioned, complained of sharp

* Yandell's Letters from Paris.

N. S. VOL. IX. NO. XII. 48

758 Belladonna in Vomitings in Pregnancy. [December,

uterine pains. In a primipara, the fibres of the uterus are not broken
in, if you will allow the expression, and not habituated to the process,
and allow themselves to be distended with difficulty; and it is this
which causes the pain. M. Bretonneau thought that the uterine pains
were the cause of the other symptoms, and that if he succeded in mas-
tering them, he would overcome the sympathetic vomitings of the
patient. Acting upon this idea, he covered the hypogastrium repeat-
edly with a mixture of belladonna; the vomitings ceased the same
day, and recovery ensued. Sometime afterwards, he had occasion to
observe another case, where the pains of the uterus did not exist ; but
he thought that even if the brain did not perceive the pains of the
uterus, the ganglia might take note of them, and reaction occur. To
modify these accidents, he believed it to be sufficient to prescribe the
belladonna mixture, and was again gratified with complete success.
The result of these and similar cases justifies him, he thinks, in laying
down the following principle :

" Whenever, in a woman, pregnant for the first time, or many times,
vomitings supervene during the course of gestation, frictions should be
made upon the hypogastrium with a mixture of belladonna, and the
vomitings will cease."

The Professor then asks, " In what manner does the belladonna
act ? I confess it is impossible to determine. Can it be supposed that
the foetus, in being developed, painfully distends the fibres of the
uterus; that the vomitings are sympathetic, like those which super-
vene in cystitis, for example? This is possible. Whether it be this
or something else, it is upon this hypothesis that M. Bretonneau has
employed his remedy. He has promulgated his theory, and has en-
deavored to confirm it by facts. The foetus distends the uterus, the
nervous ganglia take cognizance of it, and sympathetic vomitings are
the consequence. This is the theory, which you may adopt or not,
but which must be admitted to conform, with marvellous exactness, to
the therapeutical results."

I had but just seen these opinions of M. Bretonneau an-
nounced, when I had an opportunity of making a practical
application of them. My first patient, however, presented
other symptoms than those described by him, for the relief of
which he prescribed the belladonna mixture with such confi-
dence and success. The result in this instance was equally
fortunate.

Called in consultation, July 14th: 1848, to Mrs. L. W. D.,
set. 24. This lady had been married about two years, and
had miscarried once during the time, at about the fourth month
of utero-gestation. She had been attended for several days
before I saw her, by an experienced and scientific physician,
who, failing in his efforts to relieve her of a most distressing
cough, solicited my assistance.

Pregnancy,. at the time of my visit, had not been suspected;

1853.] Belladonna in Vomitings in Pregnancy. 759

but upon a more thorough examination of the case, assisted by
the answers elicited from her by questions in reference to this
condition, we satisfied ourselves of the existence of pregnancy.
I immediately suggested to my colleague the theory of M. Bre-
tonneau, and asked, if this theory be correct, might not the
sympathetic irritation produced by the distended and fretted
uterine fibres react as well upon the bronchial mucous mem-
brane thus producing cough as upon the stomach ? He
caught at the idea at once, and we directed equal parts of ext.
belladonna and lard to be rubbed together, and frictions made
with the mixture, every four hours until our return. The next
morning we were much gratified to find that the cough had
entirely disappeared, and the patient feeling, of course, greatly
relieved. She got up in a short time, and continued to enjoy
moderately good health until she removed to Memphis, when
we lost sight of her, but understood she was taken ill some
months afterwards, and after suffering for several davs, was
delivered of a dead foetus, at about the seventh month of utero-
gestation. Having repeatedly seen the vomiting return after
having been arrested by the application of belladonna over the
hypogastrium, and again arrested by the same means, as
promptly as at first, I am inclined to think now, that had the
belladonna been used again in her case she might have gone to
her full term, and possibly borne a living child.

Since the occurrence of this case, I have had repeated oppor-
tunities of testing the virtue of this article in similar cases, and
in no instance has it failed to relieve the patient. Jt may be
proper to remark, however, that any complications that may
be found to co-exist with this condition, such as gastritis, gastro-
enteritis, constipation, &c, ought to be treated with their ap-
propriate remedies; and when the vomiting has continued for
a considerable time, I have usually applied cups, fomentations,
&c, under the impression that the excessive vomiting itself
had excited inflammation of the gastric mucous membrane.
But 1 his has probably been an unnecessary proceeding, since it
would appear from the observations of some of the most distin-
guished physicians of Europe, that no such condition of the
mucous membrane of the stomach has been found to exist in
subjects examined after death from this disease. My own ob-
servations tend also to establish this fact. At least, I have
repeatedly found that the most active means that could be used
for the subduction of the supposed gastric inflammation, proved
altogether unavailing until the belladonna was applied over the
hypogastrium, when the vomiting has invariably ceased. Very
recently I delivered a young married lady of a healthy female
child, who about the middle of December last, was taken with ex-

760 Belladonna in Vomitings in Pregnancy. [December,

cessi ve vomiting, attended with such violent straining, that when
I arrived, I found that the matters ejected from the stomach
were streaked with blood. The stomach being also tender to the
touch, I proposed at once, the application of the cups. But no
persuasion could induce her to allow scarifications, nor even
dry cupping. Failing in this, I ordered a purgative enema, a
stimulating foot bath, a mustard cataplasm over the stomach,
and used a variety of anti-emetic mixtures, but all to no purpose.
I then applied a belladonna plaster over the hvpograstrium, and
very soon she was relieved of her nausea and vomiting, and
had no return of it for eight or ten days, when the plaster wTas
again resorted to, which relieved her as promptly as at first
and she had no return of it afterwards.

I have now under my charge a young married lady, preg-
nant about six months, who suffered for a considerable time
before she applied to me for relief. The belladonna here, as
usual, was prompt and effectual in stopping the vomiting. She
made use of it once or twice afterwards upon feeling slight
nausea, but she is now, and has been for several weeks, per-
fectly healthy and hee from any trouble of that sort.

M. Dubois, while upon the subject of the " induction of abor-
tion in the vomiting of pregnant women," during a recent dis-
cussion in the Academie de Medicine, "stated the results of
his experience m relation to obstinate vomiting in pregnancy.
In proof that this is oftener a more dangerous occurrence than
is usually supposed, he stated that in the course of thirteen years
he had met with twenty cases in which it had proved fatal.
That obstinate vomiting is but the exaggeration of the natural
sympathetic vomiting of pregnane)-, and not due to any spe-
cial lesion, is proved by the facts that at the autopsies nothing
is found, and that when the process of gestation becomes ar-
rested, whether spontaneously or artificially, the vomiting is
ordinarily put an end to, although the woman may not be de-
livered until several days after, of a dead child, and may yet
die of the effects of what she has undergone." (Amer. Jour-
nal of the Medical sciences, Jan. 1853.)

The observations of Dubois,Bretonneau, Ems, Duclos, Trous-
seau, and others, seem to go to establish the fact, that, no matter
how violent or continued the vomitings are in these cases, there
is no real inflammation of the stomach produced by them, and
consequently any anti-phlogistic measures resorted to in view
of this condition of the stomach, would appear to be, to say the
least of it, unnecessary. Notwithstanding my own observa-
tions tend to establish the same fact, yet I cannot recommend
an entire neglect of such adjuvant measures as would naturally
suggest themselves to the intelligent physician. The bowels

1853.] Modes of Arresting Hemorrhage. 761

of course, ought to be attended to, and the cups, fomentations,
poultices, &c, may, 1 think, be justifiably resorted to upon a
mere suspicion of gastric inflammation, for the patient is but
slightly inconvenienced by them, and they will certainly re-
lieve any inflammation that may exist. But I must protest
against the blister. It will do no good at the time, and prove
a source of great annoyance to the patient afterwards.

I have also used the belladonna ointment in cases of painful
menstruation, with apparent benefit, but my experience with it
in the treatment of these latter cases, is too limited to justify
me in recommending it with any great confidence.

I have used it recently in a very violent case of dismenorrhoea,
and it appeared to assist in relieving the pain ; but so many
other measures were resorted to, at the time, for the relief of
this young lady, that it is impossible to determine what part,
if any, the belladonna acted in giving the relief. I think how-
ever it is worthy a still further trial in these cases.

In conclusion, I would suggest that it may be applied much
more conveniently, and with equal efficiency, to the hypogas-
trium, by spreading the extract, undiluted, upon soft leather, in
the manner of using the exp. cantharides, than by the plan
originally suggested, of rubbing it on with the hand. This
plan has the advantage, first, of being more cleanly, and second-
ly, may be re-applied by the patient herself, at any time when
pain or nausea is felt. [Southern Journal of Med. and Physi-
cal Sciences.

Different Modes of arresting Hemorrhage from the Extraction
of Teeth. By Benjamin Wood, M. D.,* Nashville, Tenn.

Dr. A. Saltonstall, of Columbus, Ohio, Miss., reports a case
(American Jour. Dental Science, Oct. 1852) of hemorrhage
from the extraction of a tooth, which, having resisted the usual
means astringents, escharotics and compression was arres-
ted by an artificial fixture acting both as compress and actual
cautery. He ''took a piece of pure silver plate, and cut it in
shape to fit between the teeth and cover the lips of the orfice
about the eighth of an inch on each side. This was bent to fit
the parts, and heated to a white heat, and suddenly applied to
the place, where it remained several days. When it was re-
moved the coagulum came away with it. The orifice was ex-
amined, and a very delicate covering, resembling tissue paper,
had formed over it."

Dr. Levison, of England, in an article published about a year
ago, says, that in cases of excessive hemorrhage, where the
ordinary styptics cannot be depended upon, " we may arrest

762 Modes of Arresting Hemorrhage. [December,

the dangerous hemorrhagic flow with certainty by destroying
the vessels with the bi-chloride of zinc," and gives cases where
this agent, as a last resort, had been successful in his hands.
In alveolar hemorrhage, pieces of cotton dipped into the bi-
chloride were forced down to the alveolar cavities. It was
attended, however, with great pain.

It may be remarked that in some cases where success is as-
cribed to the last remedy employed, the result may have been
owing to a natural stasis of blood from exhaustion of the
patient ; such hemorrhages sometimes continuing for hours,
until after fainting, and then ceasing altogether without any
intervention. An interesting case of the kind was related to
us a few years ago by a reliable lady who was herself the sub-
ject. The bleeding had continued with but occasional and
partial intermissions for three days. On the night of the third
it ceased, and she retired, but. about midnight she was awakened
by a renewed flow of blood. Exhausted by the loss of blood
and sleep, she merely arranged a wash-bowl upon a chair so as
to receive the blood as it flowed from her mouth, and with her
head supported by a pillow, she soon fell asleep. In this
position she was found early the next morning, in a state of
unconsciousness. The bleeding had effectually ceased.

It is fortunate these cases rarely occur. We have had but
few that were troublesome. Besides the use of nitrate of silver
(which as a styptic we have found more reliable than anything
else that we have used,) and the application of pressure, we
have in two or three instances resorted to a partial torsion of
the bloodvessels at the bottom of the aveolar cells. This de-
pends, upon the principle that the mouths of the vessels contract
more readily when lacerated than when divided with a smooth
cut or broken short oft*, as may happen in extracting a tooth,
and that mechanical irritation has a tendency to induce con-
traction. The modus operandi (as we received it while under
pupilage, from our brother, Dr. J. S. Wood) consists in passing
a stylet or an ordinary excavator of the proper shape, to the
bottom of the socket, until a twinge of pain is felt, and then
giving the instrument a sudden turn, so as to twist or lacerate
the artery its situation being indicated by the impression
made upon the nerve which it accompanies.

We know of but one instance in this vicinity, of death having
occurred in consequence of the kind of hemorrhage under
notice. This was in Russellville, Ky., about two years ago.
The patient's tooth was broken in extracting, leaving a portion
of the fang which could not be gotten out. Pressure, as well
as styptics, &c, was tried, but without arresting the hemor-
rage, the man^dying, according to the recollection of our in-

1853.] Poisonous Dropsical Inoculation. 763

formant, in about fifteen hours after the operation. We would
like very much to be favored with a report of the case in full.

In case a tooth is broken and the bleeding proceeds from the
pulp, cavity or nerve canal, the obvious means of arresting it
would be to plug the orifice with a metalic or wood stopping.
A hickory peg or sliver would perhaps be as good as anything.
If the orifice be too small to receive a stopping, it should be
enlarged by means of a drill.

Pressure applied directly to the bleeding vessels and re-
tained in its place is reliable in such cases of hemorrhage ; but
there is sometimes considerable difficulty experienced in its ap-
plication. A ready and effectual means is to roll up pellets of
cotton firmly in the fingers, of a size to suit the alveolar cells,
and introduce them with considerable force, notwithstanding
it be attended with considerable pain, as it always is, we be-
lieve when the hemorrhage has continued for some time.
They may be wet with some styptic solution, or coated with
powdered lunar caustic. After the first pellet has been intro-
duced, we usually fill the remainder of the cavity with one of
a larger size, and if it be a molar tooth with two or three bi-
furcations, cover the whole with a third, sufficiently large for
the purpose but no larger, crowding the edges under the mar-
gins of the gums, which in ordinary conditions, where the blood
possesses its due amount of fibrin, and is of a plastic character,
will be found to adhere to the cotton with sufficient tenacity
to retain it in its place. It will be safest to let this stopping
remain until loosened by the suppurative process. If not
thrown off', however, or removed in the course of a few days,
the pellets thus introduced are apt to prove the source of great
suffering in the sockets, bespeaking the inflammatory action
preparatory to suppuration ; but when this occurs we think they
may be removed at once, regarding it as evidence that active
reparation has commenced.

The " waxed cones'' recommended by Dr. B. B. Brown,
which are made by cutting a piece of linen previously coated
with melted beeswax, into tapering strips and rolling these in a
form to suit the sockets to which they are to be applied, may
be used to great advantage in many cases. [Ibid.

Poisonous Dropsical Inoculation.

An accident of a singular and dangerous nature recently
befel the celebrated surgeon, Prof. Langenbeck, in Berlin.
Having been called in to attend a lady of high rank, in a most
advanced and perilous stage of dropsy, Dr. L. deemed it neces-
sary to proceed without delay, to puncturation, and this with-

'64 Miscellany. [December,

out waiting for other assistance. The operation was, therefore,
instantly and successfully performed, and the patient, previ-
ously at death's door, relieved and saved. During the opera-
tion, however, soma of the acrid discharge fell upon his hand,
and was of course washed off when the work w^as completed;
but, ere long, the hind, arm, throat and neighboring regions
began to swell, and all the febrile and inflammatory symptoms
of animal poison ensued. Vigorous remedies were forthwith
employed, and the danger averted, but the Professor is not yet
so entirely recovered as to enjoy the full use of the side affect-
ed, whilst the venom has shown its lurking agency by causing
eruptions on other parts of the body. [Boston M. and S. Jour.

ill t s c c 1 1 a n 2 .

Our Journal. With this number we close the Ninth Volume of
the New Series of the Southern Medical and Surgical Journal,
and the third year of our Editorial supervision of its pages. The du-
ties of an editor are so onerous that nothing short of enthusiasm in the
cause of Science can make them tolerable for any length of time.
The consciousness, however, that the work, when done, meets with
the approbation of those for whom it is intended, lends to the task the
charm of success, which is always a source of much gratification.
The evidence of this appreciation is to be found in the continued and
increasing patronage of the publication ; and, judging by this stand-
ard, we have every reason not only to be satisfied, but also to continue
at our post with increased diligence. That any periodical can be so
conducted as to please every one, is not to be expected. Some will
become offended because what they may write is nut always deemed
admissible ; others because they are dunned by the printer when they
forget to comply with his terms. Some censure the publisher for the
irregularities of the mails, and others find fault with the editor for the
opinions of contributors to the original department of the work. There
are even some who never forgive a refusal to admit personal contro-
versies into a publication exclusively devoted to Science. We are
happy to say that we have long since ceased to be annoyed by such
small minds, and that the intelligence and respectability of the patrons
of the Souihern Medical and Surgical Journal furnish abundant
testimony in favor of the manner and spirit in which it is conducted.
This is now the oldest Medical Periodical south of the Potomac, and
one of the oldest in the Union : its list of subscribers is probably infe-
rior to very few, if any, in the country: it is and has always been

1853.] Miscellany. 76;

independent of sectional feeling or party bias of any kind, unless the
preference of American to foreign contributions be regarded as savor-
ing of partiality. This preference has been acknowledged on a
former occasion, and the reasons for it then advanced. We can see
no reason why American Journals should be vehicles for the spread
of foreign fame to the almost entire neglect of the just claims of
domestic talent.

In conclusion, we would say to our Patrons : aid us in doubling the
number of our subscribers and contributors, and we will use our best
endeavors to duplicate the value of the Journal.

Vesicaiories. A cotemporary states that " When it becomes ne-
cessary to use blisters to inflamed joints, as in some forms of rheum-
atism, the previous application of a mustard cataplasm will be advisa-
ble, as, after full vesication, when there is a redundance of fibrine, the
vesicle will be filled with it, and the vessels thereby relieved to a
much greater extent than without the previous use of the mustard."

Our experience has taught us, that the previous application of
mustard plaster will retard the action of the ordinary ointment of
cantharides, and sometimes render it almost impossible to produce
vesication.

A Curious Case ihe man who has slept five years. We called
yesterday to see the man who has been asleep for five years, and
whose case was detailed in the Times some weeks since. We found
him in what seemed like a sound sleep. He was lying in bed, his
eyes nearly closed, his respiration rather slower than is usual, his
breathing a little stertorous, pulse some seventy-five strokes in a min-
ute, soft and weak. On attempting to open his eyes, he firmly closed
them, and when, by force, the lids were opened, the eyes were rolled
upward, so that it was impossible to see the pupils. The mouth was
slightly opened ; on attempting to open it wider, the jaws were instantly
locked. There was a constant tremor of the eyelids, and from his
mouth there was some drivelling. His body was extremely emacia-
ted ; his arms were folded upon his breast, and any attempt to remove
them was strongly resisted. The muscles seemed rigid and tense
when the effort was made, and indeed it was impossible, without vio-
lence, to change at all the position of his limbs. Once during our
stay he drew a long breath, like a man who is about to turn in his
sleep. At another time he hitched himself up a little in bed. He
was lifted up bodily and seated on the side of the bed ; his head was
still bent forward on his chest, his legs crooked under him at the same
angle, and his arms folded as when he was lying. There was noth-
ing to indicate that he would not retain the same position for weeks.
We lifted one foot, the other came up with it. There was little or

760 Miscellany. [December,

no bending at the knee, or at the hip ; the feet were raised only as the
upper part of the body was carried backwards. He was placed
standing upon the floor. It required a few moments to balance him
exactly; after that he stood in the same position so long as we re-
mained ; there was nothing to indicate that he would not maintain the
same posture for a month.

This certainly is a most marvellous case. There is not the slight-
est chance for any collusion or deception in the matter. Many of our
best physicians have examined him, none, so far as we can hear,
believe any deception in the case to be possible. From physicians in
the western part of New-York, and from men of the highest standing,
we are assured that the story which is told of him is perfectly true.

Though we have given a history of it before, a brief re-statement
is warranted by the interest created by his presence here. His name
is Cornelius Vroman ; he was born in Schoharie county, but has lived
since he was seventeen years of age in Clarkson, Monroe county, not
far from Rochester. He was a hard-working man, a good worker,
temperate, trusty, and at the time when this strange sleep came on, he
was working on the farm of Mr. Moses Jennings. His mother is
dead; he has a father and two brothers living in Clarkson. On the
19th of June, 1848, he felt unwell enough to call in Dr. John S. Cole,
who found him complaining of some pain in the stomach and in the
head, for which he prescribed. After this, without becoming any
more sick, his sleep each night grew longer, until at last it was found
impossible to wake him. Out of this sleep he has never come, to
remain wakeful for more than sixteen hours at a time; and the ag-
gregate of all his waking hours since the seizure is not over three
days. At first they were oftener, but now the waking intervals recur
about every six weeks. The last time he awoke was while he was in
Rochester, some ten weeks since, which gives us a hope that his
waking-hour now approaches, and that we may see him in his wakeful
condition. When awake he seems totally unconscious of his pecu-
liarity, and has said some things which indicate that he remembers
matters as they were before his change. They say that he straight-
ens himself up then, and walks as limberly as others. Yet, now, to
handle his limbs, we fear that they must be partially anchylosed ; but
on this point we are not satisfactorily informed.

His diet consists principally of milk, sometimes with a little bread
soaked in it. It is with some difficulty that it can be administered.
The jaws must be forced open as in tetanus, and the liquid poured in
between his teeth. Once he went without any food for five days ; but
his friends objected to any farther conduct of the experiment, though
there was no change in his symptoms during that time. When the
seizure occurred he is said to have weighed 160 pounds; now, he
cannot weigh over 90 pounds. His height was six feet two inches.
The secretion of the kidneys is discharged once or twice a day ; it
is very high colored, and not much diminished in quantity. Possibly
it is from habit, possibly from some remains of consciousness, that
in this matter he is subject to the wishes of his attendants. The

1853.] Miscellany. 767

alvine evacuations are \ery scanty, occurring not oftener than at in-
tervals of from six to twenty days.

Once he was left standing for three days ; there was no change in
his position during that time.

We are not informed definitely as to the medical treatment to which
he has been subjected. We are told, however, (and he has scars that
attest it,) that he has been blistered and bled, subjected to issues,
setons, and counter-irritations, of almost every sort ; that tonics and
sudden stimulants have all been applied ; but medicine has exhausted
its resources in vain. Once he was thrown into the water, but it
produced no change.

His personal appearance is any thing but prepossessing. The
beard which covers his face and lips, stands erect, and the hair of his
head also stands on end. We are assured that this is no peculiarity
in the family, and that nothing of this sort, no tendency to epileptic
or kindred diseases, has ever been noticed in the family.

Medical men regard this case with the profoundest interest. It is
entirely without a parallel in medical history. Catalepsy it has been
called, but the rigidity of the muscles is quite uncommon; indeed
the limbs of the cataleptic generally seem to be plastic, maintaining
the position in which they are placed yielding readily, however, to
any counterbalancing power.

We have seen another form of it, in which, though the head, the
neck, or the limbs would take any posture given them, after the lapse
of a few moments they would begin gradually to return to the position
occupied at the time of the seizure. The maintenance of the catalep-
tic state for even a few days is extremely rare. The tetanic spasm
of the. mouth upon attempting to open it, the forcible closing of the
eyelid, and the other slight indications of consciousness, are not com-
mon in catalepsy.

The ecstasy of nosologists recognizes a lack of all consciousness
and recognition, and great muscular rigidity, but more or less mental
excitement is supposed to be indicated by that term. Strange ecsta-
tic seizures connected with hysteria are on record.

Cases are recorded where lethargy or cataphora, as some prefer
to call it and coma have been greatly prolonged ; but in these we
believe the voluntary motions of which we have spoken were entirely
absent. No case, however, of either has been protracted for years as
has this. This curious case seems both to baffle all medical skill, and
to defy the history of medicine to adduce a parallel.

[We copy the foregoing article from the N. Y. Daily Times, one of
whose editors, Dr. F. Tuthill, is the writer, and to whom the readers
of that paper are indebted for frequent medical contributions to its
columns, and which are appreciated by the profession, and cannot fail
to promote its circulation and patronage. We have seen the singular
case alluded to, and can vouch for the accuracy of the description
here given.

We suppose the man to be laboring under that form of Insanity,

708 Miscellany. [December,

denominated Dementia, dependent upon a pathological condition of
the brain and spinal cord, involving the nervous centres, and producing
the remarkable rigidity and fixedness of the muscles of the limbs,
here referred to. It cannot be regarded as Catalepsy, nor is he asleep,
as has been alleged, nor can he be called comatose, at least when we
saw him. The quivering of the eyelids, and resistance to opening
them, the voluntary action of numerous muscles, even those most
rigid, demonstrate that he possesses consciousness, and employs voli-
tion, always however so morbidly developed as to preclude the idea of
feigning or deception. He is certainly an object of deep commiser-
ation, and ought to be placed in the Lunatic Asylum for curative
treatment, for, of even such a case, we have no warrant to despair.
There can be little doubt that the cause of this sad spectacle of human
woe has been masturbation, another warning against this horrible
vice, and which should be heeded by the young.] N. Y. Med. Gaz.

" The Rochester Democrat" of the 24th ult., announces the death of
the "Sleeping Man," Cornelius Vroman, who "died at his brother's
residence, in Clarkson, on Monday, the 17th inst. While on exhibi-
tion in New York, he was taken sick, which seemed to induce a
wakeful state for a short period, and then a stupid condition, with
intervals of wakefulness, until he was brought home on the 14th. He
talked but very little, inquiring after his mother, who had been dead
two years, and his father and brothers, whom he seemed partially to
recognize. He complained of great internal heat, and soreness of his
throat and stomach. On the morning of the day of his death he called
for food, and ate a hearty meal, and from that time he seemed to be in
pain until 2 o'clock P. M., when he died without a struggle. His age
was some 34 years." [Ohio Med. and Surg. Journal.

Duty of Medical Men. Dr. Todd, in his farewell address, on re-
signing his professorship, made the following remarks :

' It appears to me, that when a man proposes to devole himself to
the practice of an honorable profession, he has a twofold duty to per-
form; first, to fit himself to the utmost of his ability for the practical
duties of that profession, and, secondly, having done so, it is incum-
bent on him to divest himself, as far as possible, of every engagement
which may interfere with his bending his thoughts and attention to the
various anxious, difficult, and often perplexing questions which are
continually arising in the course of his professional practice. Every
member of a liberal profession should keep it constantly in view that
he exercises his calling not simply for his own personal benefit, but
for the public good, and for the good of his profession at large. So
every practising physician or surgeon, whether the sphere of his labor
be within wide or narrow limits, should bear in mind that in the suc-
cessful application of his art, by fair, honorable, and truthful means, is
involved the repute and estimation in which his profession is held by
the public at large. Let each of us act under the feeling, that to him-
self specially is committed the keeping of the honorable character

1853.] Miscellany. 760

and the scientific credit of our common profession, and he will have
the strongest motives, not only to eschew everything that savours of
charlatanical pretence, but to seek for and insure the highest means
of moral and intellectual culture." [Med. Gazelle.

Adulterated Cream of Tartar. A very large portion of the cream
of tartar used for domestic purposes, and, what is even worse, much
of that used for medicine, is badly adulterated. A writer in the Bos-
ton Journal says that an examination lately made of six specimens
showed in the purest sixty-two per cent, of foreign matter. The con-
sequences are unwholesome bread and inoperative medicine. An
extensive dealer in the article states that three barrels of alum and
three of flour were lately sent to a mill in Boston, with instructions to
be manufactured into cream of tartar, and to be labelled witli the name
of the manufacturer. The man refused to place his label upon a
spurious article, and the raw material was sent to some more com-
pliant person. Ground cream of tartar is sold in many of the shops
lower than the crystalized can be afforded, and is of course adultera-
ted. Grocers should be very careful in their purchases, and house-
keepers should be quite as careful. The writer in the Boston Journal
says of the specimens analyzed :

" The added ingredients consisted of white sand, ground pumice,
ground rice, and flour. This is a vile compound to offer to a sick
child or an adult invalid. If the purchaser will provide himself with
a small phial of the solution of iodine, and place a drop in connexion
with the suspected article, the presence of flour, or any article con-
taining starch, is instantly shown by the blue tint which follows. Let
him place a few grains in boiling water, and if it is not entirely solu-
ble, let him reject it. An experienced dealer can always judge with
a great degree of accuracy by the appearance of the article. Pure
cream of tartar is intensely white, and has a degree of moisture and
cohesion about it entirely unlike flour, or any of the articles used to
adulterate it."

It is a wonderful evidence of ingenuity to say nothing of the ras-
cality of it the great extent to which adulteration of the most com-
mon articles is carried. Articles so cheap that it would not seem an
object to cheat in their preparation are mixed up with something a
little cheaper, and often very deleterious to health. Stringent laws
should be passed for the inspection of all substances intended for food
or medicine ; the spurious articles should in all cases be destroyed
without mercy, and severe penalties should be visited upon those who
manufacture them or knowingly sell them. [Providence Journal,

Cholera Infantum. The efficacy of sub-nitrate of bismuth in this
affection is incontestable. During the past summer we have had oc-
casion to employ this remedy in a considerable number of cases, and
have had every reason to be satisfied with its effects. The bismuth is
best administered to children in suspension ; the following formula is
convenient: Sub-nitrate of bismuth, 5ij; gum-arabic in powder, 3jj

70 Miscellany. [December,

orange-flower water, and simple syrup, each, gj ; water, ij. A tea-
spoonful every hour. We have found the anti-vomitive powers of
this mineral to be very remarkable. [Virginia Med. and Sur. Jour.

Gleet. -M. Bourgeois has found the following formula of service
in this obstinate affection , Balsam of tolu, 3iij ; liquor of sub-acetate
of lead, 3iij ; linseed oil, giv. Reduce the balsam to a fine powder;
add three drachms each of the lead- water and oil ; then make an
emulsion of the whole by adding gradually the remainder of the oil.

This injection is intended for blennorrhcea ; the amount of balsam
and of sub-acetate of lead being diminished, the remedy may be ad-
vantageously employed in gonorrhoea. [Rev. Medicale. Ibid.

Otalgia. Dr. Delioux announces (Bulletin de Therapeutique) a
simple remedy, which he has found efficacious in relieving a large
number of cases of neuralgia of the ear, and also in curing those cases
of erythism in which the chief symptom consists in distressing hum-
ming and ringing in the ears. This is local etherization. A few
drachms of ether are placed in a bottle, the mouth of which is adapted
to the external meatus. The bottle is grasped in the palm of the
hand, and the animal warmth suffices to volatize the ether. Dr.
Delioux states that the effects of this treatment are rapid and perma-
nent. [Ibid.

Homoeopathy. The following extract is taken from a clever letter
in the Leicester Journal, signed "Chirurgicus."

" Homoeopathy has had its day. Excepting in Vienna, it is now
comparatively little heard of in Germany, and notwithstanding Leipsic
is the head quarters of the doctrine, the homoeopathic hospital of that
city, a small house in the suburbs, contains only eight beds, of which
Mr. Lee, who lately visited it, found only two or three occupied. In
Paris, M. Andral put it to the test of experience in one of the general
hospitals, and the result was a total failure. It was therefore discon-
tinued. He treated 130 to 140 patients in the presence of the
homoeopalhists themselves, adopting every requisite care and precau-
tion, yet in not one instance was he successful. In Russia, a German
homceopathist was invested by the Grand Duke Michael with full
powers to prove, if possible, its advantages over ordinary treatment
on a certain number of patients in the wards of a military hospital.
In two months, however, he was not allowed to proceed further. The
Russian Government tried likewise the comparative treatment in two
hospitals of a number of patients with homoeopathic globules, and a
number of other patients with no drugs of any kind ; and the results
were found \ery similar in both instances. A trial was given at Na-
ples by Royal order. The results of the observations were : 1st.
That the homoeopathic treatment produced no effect ; 2d. That it had
the serious inconvenience, in several of the patients, of preventing the
employment of remedies by which they might be cured. In London,
there are two homoeopathic hospitals, both of which are in a declining

1853.] Miscellany. 771

state, and one I hear is now about closing, if not closed, for want of
funds. A celebrated physician speaks of it thus : ' Everything in
it, and out of it, fully confirms the view, that, as to practice, homoeopa-
thy is truly a nonentity ; it is literally, as your author Hue says,
(see p. 86,) the swallowing of names only.' To swallow the name
of a remedy, or the remedy itself, comes (say the Tartars) to precisely
the same thing. Homceopathists cannot point out a single medical
authority now authorizing homoeopathy. So much for its decline.
The gradual progress of medical science sufficiently shows that we do
not let our patients die, as homoeopaths do. Witness such facts as the
following :

IN LONDON.

Died under 5 years.
From 1730 to 1749, out of every 100 children born 73

" 1750 to 1769, " " 63

" 1770 to 1789, " " 51

" 1790 to 1810, " " 41

" 1810 to 1829, " 31

Regarding the capability of the public to judge the value of medical
remedies in curing disease, I quote Archbishop Whately : Nothing
is more common than to hear a person state confidently, as from his
own experience, that such and such a patient was cured by this or
that remedy ; whereas, all that he knows is, that he took the medicine
and recovered. A termination and a cure are two vastly different
things-" [London Lancet,

BIBLIOGRAPHICAL.

The Obstetric Catechism ; containing 2347 Questions and Answers on
Obstetrics proper. By Joseph Warrington, M. D. 150 illustra-
tions. Philadelphia: E. Barrington & FJasvvell. 1853. 12mo.,
pp. 445. (For sale by T. Richards & Son.)

A Manual of Obstetrics. By Thos. F. Cock, M. D., Physician to
New York Lying-in Asylum, &c, &c. N, York: Samuel S. and
William Wood. 1853. 12mo., pp. 250. (For sale by T. Rich-
ards & Son.

These two works are evidently intended to facilitate the study of
Obstetrics by the omission of all matter deemed by the respective
authors as more or less superfluous. Our opinion of all Manuals on
medical subjects is the same viz., that they may be read with ad-
vantage by beginners, as an introduction to knowledge, but should
then give place to the more elaborate treatises, without which no one
can be qualified to enter upon the duties of so responsible a profession
as that of Medicine.

The works before us, especially the " Catechisjn^ are well adapted
to the purposes of young students.

772 Miscellany.

The Preserver's Pharmacopoeia : containing all the Medicines in the
London Pharmacopeia, arranged in classes according to their action,
with their composition and doses. By a Practising Physician. Re-
vised, with additions, by Thos. F. Cock, M. D. N. York: S. S.
and VVm. Wood. 18mo., pp. 180. (For sale by T, Richards &
Son.

A very convenient remembrancer or suggester. The inexperience
of young practitioners in the details of prescription, or recipe making,
will render this little book quite useful to them.

WORKS RECEIVED.

The Obstetric Catechism. By J. Warrington, M. D.

The Manual of Obstetrics. By Thos. P. Cock, M. D.

The Preserver's Pharmacopoeia. By Thos. F. Cock, M. D.

Transactions of the 4th Annual Meeting of the Medical Society of
the State of Georgia, held in the city of Savannah in April, 1853.

Transactions of the Medical Society of the State of Pennsylvania, at
its annual session held in the city of Philadelphia in May, 1853.

The American Journal of Science and Arts, by Professors Silliman
and Dana.

Proceedings of the American Pharmaceutical Association, at the
annual meeting held in Boston, August, 1853.

Yellow or Malignant Bilious Fever in the vicinity of South-street
wharf, Philadelphia, 1853. By Wilson Jewell, M. D.

On the treatment of Vesico- Vaginal Fistula. By J. Marion Sims,
M. D., of New York.

We are happy to learn that Dr. Sims has been restored to health,
and is devoting his fine abilities to the special treatment of Vesico-
vaginal Fistula and similar accidents of parturition. He has removed
from Montgomery, Ala., to the city of New York, where he will doubt-
less lake a high position among the surgeons of that place.

Fracture 'Fables. By Frank H. Hamilton, M. D., &c, &c, with
a supplement, by John Boardman, A. B., comprising an analysis of 461
cases of Fractures.

Also, a large number of Medical College Circulars, Addresses, &c*

We hope to cull valuable materials from these works as opportunity
will permit.

Obituary. It becomes our painful duty to announce the early and
unexpected death of Dr. Brice T. Gaither, late of Oxford, Ga. He
died on the 21st Sept. last, in the 26th year of his age, of a pulmonary
affection which he contracted during his attendance upon the Lectures
in a Northern institution, and which he attributed to the severity of
the winter climate. He was a man of spotless character and high
promise, whose loss will be lamented by all who knew him. M.

INDEX TO VOL. IX.

Abstinence, case of protracted 64

Abscess, Iodine as a preventive of

mammary 491

Abscess, Hepatic 519

Action of medicines on the system . . 382

Accident extraordinary 516

Aconite in Rheumatism 631

Adulteration of medicines 309, 410

Adulterated cream of Tartar 768

African, another white 461

A handsome present 259

Air-passages, foreign bodies in 453

Alum Springs of Virginia 300

Alum as an Emetic in poisoning

from opium 696

Amputation, what is the best ti me for 45
" of Radius and Ulna. .. 172

Amenorrhcea, manganese in 54

American Medical Association, 68

u J93

259
383
440
577

Ammonia Acetatis liquor 290

Anaesthetic ag'ts, by C.TJackson m.d. 5
do. do. reward for the discovery ol 193

Anaesthesia, discovery of 254

Anaesthetic properties of Lycoperdon

Proteus 508

Anaesthetic agent, cold as an 705

Anaemia, manganese in 54

Antiseptic effects of sulphite of soda 254
Antiperiodical properties of Hops. . . 560
Anthelmintics, inquiry into action of 565
Aneurism cured by injection of per-

chloride of Iron 618

Anchylosis 633

Apoplexy, is not bloodletting some-
times dangerous in 373

Apparatus for premature infants 486

Aphonia relieved by Iodine inhala-
tions 626

Arsenic, preparations of 48

Arsenic in chronic scabies 630

Arrest of development 463

Aromatic Schiedam Schnapps 127

Arteries, ligatures of by M. Roux.. 128

Assafetida syrup 122

Ash-tree leaves in gout & rheumatism 308

Asthma, spasmodic 531

Ascites 633

Ascites treated by intra-peritoneal

injections 743

Aztecs, the 378

Baths and cold water 564

Belladonna in obstinate vomitings of

pregnant women 757

Beaumont, death of Dr 440

Bignon's case of Dropsy cured by ex-
ternal diuretics 268

Billingslea's case of Tetanus 458

Blood, coagulation of in arteries.. . 507

" Analysis of 541

" effect of chloroform on the.. . 733
Blood, difference of temperature of

venous and arterial 741

Bowels, intussusception of 121

" chlorolorm in obstruction of the 544
Bones, pressure in chronic enlarge-
ments of 228

Booth on quinine in cholera infantum 462

Braithewaite's Retrospect 132

Bright's disease in connection with

puerperal convulsions 119

Brierre de Boismont on Hallucina-
tions 706

Bronchial gland, fatal disease of the 588

Buboes treated with collodion 298

Buboes 634

Budd on Diseases of the liver 579

Bull's maternal management of chil-
dren, 707

Burnett, Dr. W. J., on the value of
the Microscope in Diagnosis 197

Camphor, preservation of 67

Callaway, death of Dr. R. S 260

Carpenter's Physiology, 5th edition . . 130
Carithers's case of foetus in utero kill-
ed by lightning 399

Castration, accidental 209

Catalepsy, case illustrating new prin-
ciples 375

Cancrum oris, chlorate of potass in.. 434

Calculus, singular nucleus for a 512

Castor oil electuary, formula for 515

Casey's case of Hepatic abscess 519

Cancerous diseases, surgical opera-
tions in 557

Cancer 634

Cancer, statistics of operations for. . 754

Cataract 749

Chloroform 739

do in delirium tremens 57

do asphyxia relieved by 165

do deaths by 439

do in obstruction of the bowels . . 544

do in Pneumonia 545

do in puerperal convulsions.... 689

774

INDEX.

Chloroform, its effects on the blood . . 733
do hemorrhage in operations with 730
do inhalations in Pneumonia. . . 740
do inversion of the body in syn-
cope from 644

Chlorate of Potash in stomatitis and

cancrum oris 434

Chlorate of Potash in croup 514

Chloride of Soda 438

Change of color in an adult negro. . 282
do do do do do 461

Chilblains, treatment of 127

Children, cause of decay of the teeth 243

do Irritable bladder in 501

do raw meat in the diarrhoea of . . 516
do new treatment of still-born . . . 158

Chordee treated with collodion 439

Cholera infantum 769

do do quinine in 462

Cholera, external stimulus in 753

Chapman and Caldwell, death oi Dis. 572

Circulatory displacement 240

Clymer, Professor 388

Convulsions, chloroform in puerperal 689

do puerperal 636

do connection between Bright's

disease and puerperal J 17

Collodion in the treatment of buboes 298
do do do chordee... 439

do its use in various diseases, by

Dr. Harriss 709

Country Doctor a sketch 320

Concretions, pulmonary calcareous.. 380
Cotyledon Umbilicus in Epilepsy. . . 433
Cod- liver oil, butter a substitute for.. 515

Cold-water in Dysentery 561

Cold as an anaesthetic agent 705

Conception, relation of menstruation

and lactation to 576

Con die's treatise on diseases of chil-
dren 708

Cox's companion to the sea medi-
cine chest 708

Coxalgia 698

Cock's Manual of Obstetrics 771

do Prescriber's Pharmacopoeia.. 772

Creasote in Deafness 372

Croup, chlorate of potash in 514

Croup 636

Cutaneous diseases treated with Ni-
trate of Lead 52

D'Alvigny'scase of frost-bitten scro-
tum 263

Delirium tremens, chloroform in. .. 57
Dead bodies preserved by sulphite of

soda 254

Deafness, creosote in 372

Delivery, new method cf inducing

premature 750

Diarrhoea 636

do sulphuric acid in 124

do matico in 499

do of children, raw meat in. 516

Diagnosis, the speculum in 361

Diabetes 636

Diabetes, extraordiuary case of sac-
charine 513

Digitaline in spermatorrhoea 554

Disinfectant influence of Nit. Plumb. 52
Dislocation of the Hip-joint, by Dr.

Read 229

Dislocation of the Eye 173

Dislocation of the Astragalus 288

Dislocation of the Thumb, new mode

of reducing 493

Douglass, soothing liniment by Dr . . 667
Drake's work on the interior Valley

of North America 128

Dropsy cured by external diuretics. . 268

do Ovarian 584

Dropsical inoculation, poisonous. .. 763

Druggists' general receipt book 130

Dublin Medical Press 259

Dugas, L. A. Extirpation of a cervi-
cal tumour 42

" cases of Lithotomy 82

" Non-congenital talipes equinus 142

" two singular cases 209

" on quinine and veratrum viride 191
" on the discovery of anaesthetics 193
" do do do 254
" case of accidental Castration. . 209
" Extirpation of Pharyngeal Tu-
mours 264

" on the " Aztecs." 378

" on Chloride of Soda 439

" on Foreign bodies in the Air-
passages 453

" on Spermatorrhoea 571

" on Epidemic Furuncles and

Whitlows 642

" on Yellow Fever in the South-
west 705

" case of Femoral Exostosis, with

remarks 718

Dysmenorrhoea, manganese in 54

Dysentery, cold water in 561

do Iodine injections in 641

Dyspepsia 636

do pathology and treatment of 479

Ear, Glycerine in diseases of the 235

Editorial 62, 127, 191, 193, 254, 319

do 379, 438, 571, 642, 705, 764

Electricity 128

Electro-puncture in Goitre 375

Elimination of substances by the se-
cretions 428

Empirical remedies, remarks on, by

Dr. Wilson 76

Entozoa transformed into tape-worms 176

Epilepsia 637

Epilepsy 246

do cotyledon umbilicus in .. 431

do influence </fpotnre in 487

Epidemic diseases, origin and propa-
gation of 623

INDEX.

775

Epidemic furuncles and whitlows.. 642

Ergot, a substitute for 156

Errata 68, 132

Erysipelas 493, 637

Erysipelas, muriated tinct. of iron in 426
Eustachian tubes, diagnosis of dis-
eases of the 431

Excision oi the iadius and ulna 172

Exostosis of the os lemoris 718

Eye, new operation upon the, by Mr.

Bowman 165

Eye, dislocation of the 173

Fall, on common salt in Neuralgia.. 582

Ferguson's Surgery, new edition 257
Fever, quinine and veratrum viride

in typhoid 191

Fever, new remedy for intermittent.. 246

do quinine in typhus 184

do large doses quinine in typhoid 292

do cases of malignant spotted. . . 325

do abortive treatment of typhoid 573

do typhoid 637

do intermittent 637

do yellow, in the south-west 705

Fissure of the palate 640

Fistula-in-ano, chloride of zinc paste

for 242

Fistula-in-ano 637

Fistula, cases of intestinal 369

Fly poison 439

Foote, fracture of the os frontis, by

Dr. R. T 207

Foreign bodies in the air passages.. 453
Foreign substances in the intestinal

canal 697

Foetus in utero killed by lightning.. 399

Fracture of the os frontis 207

do do processus dentatus 286

do do radius, new splint for.. 423

do tables 574

Fractures 638

Frost-bitten scrotum 263

Furunculus 639

Gaither, death of Dr. Brice T 772

Galvanism in poisoning by opium. . 514

Galvanism 639

Gangrena senilis 506

Gangrene, pathology of inflammatory 538
Glanders, relation ot to diffuse in-
flammation 547

Gleet . 759

Glossitis, case of 587

Glue, liquid 253

Glycerine ointment 123

do in deafness 235

Goitre treated by electro-puncture.. . 375

Gout, ash tree leaves in 308

do pathology of 3l6

Graduates of the Medical College of

Georgia, privileges of 194

Graves, death of Professor 388

Gregory, death of Dr 260

Guthrie's aphorisms on amputation . . 45
Gutta-percha in diseases of the skin 377

Elall, Marshall, visit to the U. States 259
Hamilton, mortification caused by

pregnancy, by Dr. S. L 138

Hammond, on ovarian dropsy 584

do diseases of bronchial glands . . *588
Harper's ca*e of retained placenta.. 140
Harris, on uva ursi as a substitute

for ergot 517

Harris, on the use of collodion in va-
rious diseases 709

Head, wound of the 751

Heart, diseases of 639

Hemot rhage, a new styptic for 306

kdo in operations with chloroform 730
do from extraction of teeth, modes

of arresii ng 761

Hemostatic, Pagliari's 500

Hernia, radical cure of 133

do Indian method of reducing

strangulated 577

Hip-joint disease, pathology & treat-
ment of 698

Hood's case of white African 461

Homocopa thy 770

Ho| s, anti-periodical properties of. . 560

Horner, death of Professor 260

Hot water and soap in ptyalism.... 509
Hydrocephalus, tapping in 159

Idiotism and imbecility, causes of. . 695

Incontinence of urine 188

Indigestion, remedy for '.. 190

Indians, Pinto 249

Infants, apparatus for premature 486

Influence of the mother's mind on the

fetus 463

Ink for the million 128

Inoculation and smallpox 621

do poisonous dropsical 763

Insane, muscular power of 129

Intermittent fever, new remedy for.. 246

Intestinal Obstructions 639

do canal, foreign substances in 697

Intussusception, remedy for 50

Iodide of Arsenic in Psoriasis Palm-
ares 125

Iodide of Potassium, tetanic symp-
toms from 437

Iodide of'Poiassium as an antidote to

mercury 735

Iodine in mammary abscess 491

do inhalations in aphonia 626

do injections in dysentery 641

Iowa Medical Journal 573

Ipecac as an external application 576

Iron, Tr. of in erysipelas 426

Iron, perchloride of in Aneurism. . . 628

Jackson, C. T. on Anaesthetic agents 5

J a undice, treatment of 190

John's Clinical phrase book 208

776

INDEX.

Joint?, Scrofulous and Rheumatic. 223
Journal, our 62, 7G4

Kirke's & Paget's Physiology 257

Knee joint, loose bodies in 62

do contractions of 112

Lactation,relation to menstruation, &c 576

Ladies' Physiological Institute 579

Lardner's handbook of N. philosophy 131

Lead, external use of Nitrate of 52

LeConte on Venomous Serpents 645

Leeches, preservation ol 252

Legal medicine, examinat. of milk in 489

Leidy, Dr J 388

Lithotomy, cases by Dr. Dugas 82

do per rectum 748

Lithotrite, bean extracted by the 755

Long, Dr. C. W. discovery of Anes-
thetic by 254

Long, on use and abuse of medicines 391
Lycoperdon Proteus, anesthetic prop-
erties of 508

Maclise's Surgical Anatomy 258

Manganese, adjuvant to iron 53

Manganese and iron, preparations for 55

Mania, prevention of puerperal 175

Matico in diarrhoea 499

Maxillary bone excised 505

McKinnon's case ol monstrosity 144

Medical Journals, new 132, 320, 643

Medical College ol Georgia, privile-
ges of its graduates 194

Medical College of Geo., 2lst Com-
mencement 255

Medical Society of State of Georgia 195

do do " do do 260, 384

do do Warren county .. . 381

do Schools in Vermont 388

do Society in Paris, American.. 516

do writers, faults of 745

do men, duly of 768

Medicines, their action 382

do use and abuse of 394

Medicine, united labors for rational 6U0

Meigs, diseases ol children 579

Menstruation, relation to Jactation, &c 576

Mercury. Iod. Pot. as an antidote to.. 735

Microscope, Binocular (j(j

do value in diagnosis 197

Milk, ex minat'nol in legal medicine 489

Miller's Surgery 644

Monstrosity 144

Mouth, accidental injury of 210

Morbid desire to kill 693

Moragne, whiskey in serpent bites. . 81

Mortification caused by pregnancy.. 138

Mott, honor conferred on Dr 388

Negro, change of color 282 461

Nervous substance reproduced 310, 436
Nerve, influence of sympathetic 311
Neuralgia 452, 640

Nitrous oxide, medicinal properties. . 67

Nitrate of silver in tonsillitis 754

Norwood, W. C, on veratrum viride 20

Odontalgia, pathology and treatment 673

CEsophagos, stricture of 237

CEsophagotomy 5l6

Ointments made with yellow wax... 381
Opium, galvanism in poisoning bv.. 514

do 'alum do "..696

Orfila, funeral honors to 324

Orchitis 749

Otalgia 770

Ovaritis, sub-acute 87

Ovarian cystitis 640

Ox-gall, properties of 549

Palate, fissure of 640

Parasites, in disease 569

Pathology, general 382

Pathological Histology 381

Pericarditis,i heumatic and non-rheu-
matic 170

Pereira, death of Dr. G 260

Pertussis, new treatment 380

Physician's pocket Do^-e-book 131

do Visiting list 708

Pharyngeal tumours 264

Phlegmon 640

Pintu Indians 249

Placenta retained 140

Pneumonia, percussion in 169

do Chloroform in 740

do do do 545

do Bloodletting in 488

Polypi of the Uterus 755

Poisoning by Opium 514

do do 696

do by Tartar Emetic 434

Potash in Scurvy 494

do Nitrate of in rheumatism. 317

Prostate, sal. ammoniac in enlarged 191

Prairie Dock in intermittent fever. . 246

Preston on spotted fever 325

Professorial changes 572

Practitioners of Med. in Virginia. . . 578

Psoriasis palmaris, Iod. arsenic in . . 125

Ptyalism, hot water and soap in 509

Puerperal mania, prevention of .., 175

do miasmata 640

Pulmonary concretions 380

Pulse, temperature and the 306

Quinine in typhoid fever 60, 292

do in tetanus 154

do hospital sulphate of 245

do on disguising the taste of 245

do adulteration of 309

do in cholera infantum 462

do tartarized sulphate of 486

Gluinia and Veratria in rheumatism 448

Banking's Abstract 257

Reflex phenomena 304

INDEX.

777

Regnault's Chemistry 512

Removal of finger ring 703

Rheumatic and non-rheumatic peri-
carditis 170

Rheumatic joints 223

Rheumatism 641

do ash-tree leaves in 308

do pathology of 306

do nitrate potash in 307

do treatment of 430

do quinia and veratria in 548

do aconite in 6**1

Robert, W. H., radical cure of hernia 133
Rossignol's statistics of mortality 343

Saccharate of lime 704

Sal ammoniac in enlarged prostate. . 191

Salt in neuralgia 582

Sarcenae ventriculi 641

Savannah Medical College 643

Scrofulous and rheumatic joints 223

Scurvy 641

Scurvy, potash in 494

Scabies, arsenic in 630

Scarlatina 641

Secretions, experiments on 428, 623

Semen in the aged, composition of.. 546

Sea-sickness, physiology of 632

Serpents of Georgia 615

Seidlitz powders 705

Shellac, alcoholic solution 123

Silliman's Journal 258, 383

Skin, guDa percha for diseases of. . 377

Slaughter, on spinaljrritation 261

Sleep in exhausted system 686

do protracted five years. , 765

Smelfungus, satire by 449

Smallpox, vaccination and inocula-
tion 621

Snake-bite treated with whiskey 81

Soothing Liniment 667

Spinal irritation 261

do do by Dr. Winn 69

do disease, strychnia in 543

Spasmodic diseases, treatment 312

do do illustrated 375

Speculum in diagnosis 361

Spermatorrhoea, digitalinein 554

do treatment of 556

do do 571

do rings 703

Spleen, diseases of 498

Sprains, treatment of 510

Statistics of mortality in Augusta.. 343

Stomatitis 641

do Chloride of Potass in 434

Stricture of esophagus 237

Strychnia in impaired spinal energy 543

Styptic lor hemorrhage 3. 6

Sugar, test for 575

Sulphuric acid in diarrhoea 124

Syphilis 641

do. Ricord's letters on 104,144,211
do. do. do. 269, 349, 400

do. do. do. 470,521,590,668

do. treatment by Bennett 279

Sympathetic nerve, influence of. 311

Syrup of Assafetida 122

Talipes equinus, non-congenital 142

Tape-worms produced from entozoa. 176

Taylors Medical Jurisprudence 511

Teeth, decay of in children 243

Terebinth Oil for dressing umbilicus 564

Tetanus successfully treated 458

do Quinine in 154

Tetanic symptoms from Iod. Pot 437

Tonsillitis Nit. Arg. in acute 754

Tully's Materia Medica 131

Tumour, cervical extirpated 42

Tumours, | haryngeal do 264

Turpentine vapour, effects 166

Ulcer, obstinate 490

do treatment 440

Umbilicns dressed with oh Terebinth 564

Urine, nocturnal incontinence of. 188

Uterus, polypi of. 755

Uva ursi, substitute for ergot 517

Vaccine failure of. 615

Vaccination and small pox 621

Veratrum Viride, by Dr. Norwood... 20
do do by Dr. Kneeland... 239

do do by Dr. Wilson 389

do and Quinia in typhoid fever. 191
do do in rheumatism.... 448

Vesicating Oil 245

Vesicatories 765

Vomiting in Pregnancy, Extract Bel-
ladonna in 757

Warren, honor conferred on Dr 388

Walton's Ophthalmic Surgery 707

Warrington's Obstetric Catechism... 771

Warts, remedy for 380

Weatherly's Case of Glossitis 587

What to observe at the bed-side 257

Whitlow, treatment 259

Winn on Spinal Irritation 69

Wilson, J.S. on empirical remedies.. 76

do on Veratrum Viride 389

Williams's Principles of Medicine. .. 579

Wilde's Aural Surgery. 706

Works received, 132, 258, 319, 580, 644

do do 772

Wound of the Head 751

Wry-neck cured without cutting 161

Wythe's Microscopist.,... ....... ........ 708

7?t<*&<^^

<f-s> 9 /??3 C.