SOUTHERN

MEDICAL AID SURGICAL JOURNAL

EDITED BY

L. A. DFGAS, H. D.,

PROFESSOR OP SURGERY IX THE MEDICAL COLLEGE OP GEORGIA.

Medical College of Georgia.

Je prends le Lien oiije le trouve"

VOL. X. 1854 NEW SERIES.

AUGUSTA, GA.

JAMES UcCAPFERTY, PRINTER AND PUBLISHER.

1854.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES. JANUARY, 1854. [No. I,

ORIGINAL AND ECLECTIC.

ARTICLE I.

Female Medical Education. By Jno. ^taixback Wilson,
M. D., of Airmourit, Clarke county, Alabama.

In appearing as the advocate of Female Medical Education,
we feel conscious that we may subject ourselves to the re-
proaches and animadversions of some worthy members of our
profession. But believing as we do, that the education of
females in certain branches of Medicine, is one of the greatest
wants of our age and country ; and entertaining the idea also
that a measure fraught with such important consequences to
society, has been too little considered or too hastily condemned
by physicians, we are perfectly willing to incur the censures of
the selfish and unreflecting, while we are cheered by the hope
of eliciting the attention and co-operation of those who consid-
er their own private interests as secondary to the advancement
of the noble science of Medicine, and the promotion of the gen-
eral good of mankind. Now, whether we are entitled to the
honor of being considered one of the latter class or not, we can
say in all truth and sincerity that we do most ardently desire
the elevation of our profession, and the general diffusion of its
benefits among all classes. As one of the means for the accom-
plishment of the former end the elevation of the professioi

X. S. VOL. X. NO. I. 1

0 ' ' Wilson, on Female Medical Ediu

we have advocated the excommunication of all nostrum
ers and quack procurers: for the accomplishment of the latter
the general diffusion of its benefits we the edu<

of female physicians, who will thus become the channels tin
which the blessings of scientific medicine may reach I
and best portion of the community: many of whom, in the
present state of things, are not only deprived of these, hut are
subjected to numerous positive evils of the n \ ous char-

acters. But we proceed, without further pre!. invite

attention, to other, and more specific iva>ri^ wnv we adv<
female medical education. We will then consider bow and
where they should obtain it. And lastly, we will briefly indi-
cate some of the obstacles that may interfere.

Why then do we contend for the medical education of fe-
males ?

1st. Because we think that their mental capacities are DO!
only sufficient for the successful practice of certain departments
of the healing art; but that their sexual i<i; would

afford material aid in the diagnosis, and perhaps, in the treat-
ment, of certain sexual disea>es. We do not design enti
into a discussion as to the mental equal i: two se\<

every branch of science, or pursuit in life : we will simply de-
clare our conviction that n< such equality exists ; but. on the
contrary, that the mental, physical and psycotbgical peculiari-
ties of each sex, give to each peculiar adv. n certain'
pursuits, when these are adapted to the eh . illerences
indicated. Now, we assume the position that the practice of
Obstetrics, and perhaps the treatment of soi
disorders, are eminently congenial to the mental, physical and
psycologic peculiarities of the female sex: and we make this
assumption with a full appreciation of the difficulties of this
most important department of our science ; for we have been
painfully convinced of these by sad experience ; still we think
it will be admitted by all, that tact, acumen and promptitude,
combined with manual dexterity, are more needed in the prac-
tice of obstetrics, than the higher reasoning powers which are
generally conceded to our own sex. This being admitted, :
the conclusion is inevitable that this branch of medicine is
ticularly suited to the female mind; for it is a well-estabi;

1854.] Wilson, on Female Medical Education. 7

fact, that the distinguishing mental characteristics of the sex
are quickness of perception, and a mental tact which give to
them a comprehension almost intuitive. The moral or psyco-
logic adaptation of woman needs no proof: all, who have been
so fortunate as to receive the kind ministrations of mother, sister
or wife, in sickness and distress, will respond with a warm heart
to the simple self-evident declaration that woman is peculiarly
qualified by nature for the relief of the afflicted of her own sex,
by touching the tender chords of sympathy in a sister heart
which vibrates responsive to her own. Having now demon-
strated, as we hope, the mental and moral fitness of females for
the practice of certain departments of medicine, we proceed to
notice their physical adaptation ; and under this head we will
endeavor to explain what we mean by the sexual idiosyncracy
as an aid in diagnosis and therapeutics. This phrase may not
express our precise meaning still it is the best we can find ;
and we hope to be able to make it intelligible by the introduc-
tion of a homely illustration. If we mistake not, there is an old
saw which runs thus : ' Seeing is believing, but feeling is know-
ing." Now, while this may not be received as axiomatic in
every case, we think it is not devoid of truth when applied
to the subject under consideration; for who will say that a
woman is not more competent than the opposite sex, to com-
prehend the diagnostic value of certain symptoms and sensa-
tions originating in the sexual constitution, when she has felt
many of those sensations, physiological and pathological, normal
and abnormal, which characterize the protean derangements of
her sex, and render them so difficult of comprehension, espe-
cially by one who only has a theoretical knowledge of them?
This question may serve to indicate, in very general terms,
what we mean by the adaptation of woman, in her "sexual
idiosyncracy." We leave its further illustration, and special
application, to others. But this is only part of the phvsical
adaptation of woman, for the practice of some departments of
medicine, for the smallness of her hand, and the delicacv of her
touch, fit her peculiarly for those manipulations so often required
in parturition, many of which are extremely painful, and even
impracticable, when performed by the clumsy hand of a male.
2nd. We advocate female medical education, not only be-

8 Wilson, on Female Medical Education. [January,

cause woman is mentally, morally and physically worthy of its
reception, but also because her natural qualifications, which
have just been mentioned, give her a natural right to practice
certain departments of medicine, at least. Shall the cry of the
widow and the orphan, then, be unheeded by us ? And shall we
unjustly close the portals of the temple of Medicine against
them, when they have a natural and inalienable right to enter?
Many of this class need employment ; and though this consid-
eration alone may not be deemed sufficient, this, together with
the reasons already given, and others, yet to be adduced, should
entitle them to the privilege oi" engaging in a pursuit so honor-
able, lucrative and useful as the practice of Obstetrics, if not of
other branches of medicine.

3rd. The medical education of females would relieve the
phvsician from the practice of one pf the roost disagreeable and
irksome branches of his profession a branch which is (in a let-
ter to the writer) denounced as "a real drudgery for a man of
science, in most cases" a branch which we believe would
be readily given up, by the better part of <>ur profession, if
they could be convinced that the community would sustain
no injury.

4th. We favor the medical education of females, not only for
the reasons already given, but the greatest and fast reason is
this, viz: Because we are convinced that the safety and Jiajt-
piness, of a large portion, of the most refined and lovely women,
(in the South particularly,) demand it.

Modesty is universally admired as the brightest gem in the
beauteous diadem of female loveliness. And while we deplore
the sad consequences of the morbid sensitiveness of females, in
concealing those sexual secrets, which pertain to their nature,
at the expense of health, and even life itself, we can but admire
while we condemn and deplore ; and we would fain devise some
means which would secure the virtuous of the sex in the pos-
session of those sacred treasures, without the payment of such
a dreadful penalty. This can be accomplished only by qualify-
ing females to administer to the necessities of their own sex, by
bestowing upon them a proper medical education : this plan,
and this only, will secure females from exposure, on the one
hand, and the malpractice of ignorant midwives on the other.

1854.] -on, on Female Medical Education.

It is needless to enlarge upon the evils to which women are ex-
posed, more especially in the South, in the present state of
things ; for every physician who has a practice of any extent,
sees, almost daily, cases which have become incurable, on ac-
count of the reluctance of females to submit to the use of the
speculum ; and every one knows what disadvantages he fre-
quently encounters in the treatment of uterine and other dis-
eases, for the want of a proper examination. And we venture
the assertion, that there is no physician who has practiced
medicine for five years, who has not had cases which brought
reproach upon himself and upon his profession, because he, in
compliance with the natural aversion of females, failed to avail
himself of the speculum and other means involving exposure,
even when convinced of their almost indispensable necessity ;
and of the extreme uncertainty of being able to institute a suc-
cessful plan of treatment without them. Again: we believe
that three -fourths, or more, of the cases of leucorrhoea, dysmen-
orrhea, menorrhagia. lumbago, &c., which linger along under
an inefficient or palliative treatment the opprobria of medicine
and the curse of the whole menstrual life of many females
could be relieved by one or two local applications, were it not
for the almost insuperable objections of the fair sufTerers, to the
inevitable exposure of their sexual secrets, to a male physician.
But we can only hint at some of the most prominent of the
fearful evils to which they are exposed in the absence of female
physicians ; one of these the malpractice of uneducated mid-
wives has already been alluded to, and is of too great magni-
tude to be passed without further consideration. The extent to
which this class is patronized, is one of the strongest evidences
of that horror of exposure, to which we have adverted ; while
the injuries inflicted on children and parturient females, by
their mismanagement and gross ignorance, are the most potent
arguments that could possibly be adduced in favor of educated
female physicians. Who has not seen mothers rendered miser-
able for life, by prolapsus and inversion of the uterus ; rupture
of the perineum; rectal and vaginal fistulae, &c., &c.; all of
which have been occasioned by the ignorance and unskilfulness
of the " old grannies," to whom females are almost compelled
ubmit their lives, in the present state of things ? Who has

10 Wilson, OTi Female Medical Education. [January,

not been shocked by seeing tender infants, not an hour old.
gorged with fat bacon, with the view of purging off the "me-
conemy," to say nothing of the thousand and one other foolish
and destructive errors so rife among this ignorant cla

To recapitulate, then, why we favor female medical educa-
tion. 1st. Because females are mentally, morally and physically
adapted to the practice of certain departments of medicine, and
more especially those pertaining to their own sex. 2d. Be-
cause many females need employment ; and possessing a natural
right, as a consequence of demonstrated natural qualifications,
it is a wrong on our part, for us to refuse them admittance into
the profession. 3d. Because physicians would be relieved, &c.
4th. Because the salvation of females, from exposure on the one
hand, and from irremediable diseases and malpractice on the
other, demands it.

The next thing which will engage our attention, is. '//ow,"
or to what extent females should he educated. It lias already

n seen that we have advocated their education for certain
departments of medicine only. It is hard] ary for us to

say, then, that we are opposed to the Northern plan, lately
introduced, of granting the Doctorate to females. rl nis we

consider a great error, and one well calculated t> retard the
e medical education, for the following reasons:
1st. Because woman is naturally incapacitated for the general
practice of medicine. And 2d. If she is qualified by nature and
education for the practice of one or two departments only, it is
manifestly a falsehood to say that she is worthy of the "Degree,"
" et esse honoratum gradu medicince doGtoris." Now, we would
not have any one to entertain the idea for a moment, that we
really suppose, that the above phrase, taken from a medical
diploma, means all that it implies ; and that all are considered
justly entitled to the honor, who receive a diploma with the
" esse honoratum," "dignus," "probasset," and other flattering
words, which look so pretty in fancy type : still there is some
appearance, of propriety at least, in this, when it is applied to
a male who has given some attention to all the branches ol
medicine, and who may become a proficient in them at some
future time. We believe, then, that females should be educa-
ted, in certain branches onlv ; and therefore that it would be

V^ ilson. on Female Medical Education. 11

absurd to confer on them the comprehensive degree of Doctor
of Medicine. But it may be said; that the human system is so
complete, and all its organs and functions are so intimately as-
sociated., that one branch of medicine cannot be practiced suc-
cessfully, without a knowledge of the whole. While we are
willing to admit the truth of this assertion to some extent, we
still think it should be received with some qualification ; for no
one will pretend to say that a knowledge of Pi . Chem-

istry. Surgery. Materia Medica. Practice, and Medical Jurispru-
dence., is essential to the successful practice of Obstetrics proper;
but. on the contrary, all will admit that a thorough understand-
ing of the anatomy of the parts concerned in parturition. U. ;
ther with a full comprehension of the mechanism of this process,
is all that is really necessary. Still, while we thus restrict the
absolutely indispensable obstetric knowledge to two points, we
would not be understood as underrating the value of more ex-
tensive attainments ; for we can readily imagine cases in which
an acquaintance with Medical Jurisprudence and the diseases
of the puerperal state would be very desirable, if not indispen-
sable. Taking it for granted, then, that females should be
educated for the practice of Midwifery, the important question
arises, as to whether they should be confined strictly to this
branch ; or whether their education should comprehend the
diseases, general or special, pertaining to the sex.

This part of our subject is environed with difficulties not
easily surmounted ; for the peculiar sexual diseases of females
to say nothing of those to which they are subject in common
with males are so obscure, so complicated, and so obstinate,
as to render extensive attainments in the various branche-
the healing art essential to the successful treatment of the for-
mer. This being admitted, then, the question recurs in this
form : Should the education of females be sufficiently compre-
hensive to enable them to treat all the purely sexual diseases of
women? To this, we must answer in the affirmative, for the
following reasons : 1st. Because diversified acquirements would
be desirable, if not indispensable, in the practice of obstetrics
alone; for instance, a knowledge of the symptomatology of
threatened convulsions, phlegmasia dolens. puerperal fever, and
other diseases of child-bed, might be of immense advantage, by

12 Wilson, 071 Female Medical Education. [January,

giving the patient the benefit of timely medical aid. But the
2nd, and great reason, why we think the education of females
should embrace the diseases peculiar to their sex, is this: B
cause, without this, the natural modesty of females would still
leave them exposed to all the evils of incurable disease, or mal-
practice, to which we alluded, while advocating obstetric educa-
tion. And we must be allowed to declare our candid convic-
tion, that the evils to which females are exposed, from neglected
diseases of the genitalia, are far greater than those to which
they are subjected in parturition even in ignoranl hands; for
the latter is a physiological act. and it will terminate favorably,
in the vast majority of cases, if only let alone ; while most of the
female diseases referred to are progr and their end is

irremediable disorganization and a lingering death. Again: it
is a fact, which is generally known to the profession, that fe-
males are less averse to male attention in parturition, than to
the use of the speculum and other diagnostic and therapeutic
measures which are necessary in the treatment of their diseases;
because, in the former case, the mind is wholly occupied by the
anxieties of the present, while this state of mind does no exist in
the latter: we have, then, in this case, not only a negative
state of mind, which is very unfavorable to passive submission,
but conjoined with this, the unavoidable exposure is much
greater than it would be in simple manual assistance.

Having now, in a brief and imperfect manner, indicated the
reasons why we favor the extension of female education while
wre at the same time oppose the granting of the Doctorate it
remains for us to reconcile the apparent inconsistency, by
showing that females can be qualified to treat all the "purely
sexual" diseases, without giving their attention to every de-
partment of medicine. It has already been seen that we con-
sider "extensive attainments" necessary to the successful
management of this class of diseases: the fundmental branches
of female medical education, then the branches which we
deem essential, and at the same time sufficient, for the accom-
plishment of all the objects indicated in this article, should, in
our opinion, be these : 1st. Anatomy (excluding surgical and
pathological anatomy) ; 2d. Human Physiology ; 3d. Medical
Chemistrv ; 4th. Materia Medica ; and 5th. Obstetrics, and the

1854.] Wilson, on Female Medical Education. 13

Diseases peculiar to Females. We would give females five
branches, then, as the basis of a medical education enough, we
think, if well learned, to enable them to treat "purely sexual"
diseases with success : at the same time we would exclude from
their course of study the two most important branches Surge-
ry and the general Practice of Medicine ; and also the minor
ones Medical Jurisprudence and Pathological Anatomy
enough to deprive them of any just or well founded claim to the
degree of " Doctor of Medicine." We admit that this plan is
obnoxious to objections ; some of which will be noticed, in con-
clusion, under the head of ''obstacles that may interfere."

The next thing for consideration in the division made by us,
is where females shall be educated in medicine.

It is our decided opinion, that all of our Medical Colleges
should have professors for the instruction of a class of females,
in obstetrics and its collateral branches, at least, if not in all for
which we have contended. It being once decided, that females
should be educated, the advantages of the plan suggested are so
obvious as to require but little attention ; we will therefore only
mention some of the most prominent of these. In ihe first place,
the great expense of erecting new college buildings and purchas-
ing materials for a museum, library. &c, would be saved ; for
the lectures to the female class could be delivered in the inter-
vals between the lectures to the males : and we would suggest,
en passant, that this arrangement might serve as a salutary
check upon those Colleges which have adoptod the injurious
plan of giving two courses of lectures in the same year, each of
which counts towards a degree ! For it is fair to presume that
those who have the control of such institutions, being influenced
by a desire for gain, might be sustained by the :" consideration'
of a paying female class, although the interest and respectabili^
ty of the outraged profession to which they belong, hajre failed
to influence them. In the second place, we would have the
comfortable assurance that females would thus receive an ortho-
dox education an education untainted by the heteroclitical
errors which are likely to creep into those independent institu-
tions that are too much surrounded by the external forces of
Bloomerism and Woman's Rights. In the third and last place,
the plan suggested would place a medical education in the reach

14 Wilson, on Female Medical Education. [January,

of Southern and Western females, without subjecting them to
the necessity of making a trip to Yankeedom an advantage
which should certainly not be disregarded, especially by the
former class; for to say nothing of the distance, they might find
it very inconvenient, to keep a negro servant, in that " higher-
fl^ liw" land. Before concluding this part of our subject, we
would add that it would be necessary, and highly proper, to sub-
stitute for some of our present professorial corps, one or two
female lecturers.

Having now considered "why" uhown and "where91 fe-
males should be educate. 1. the next and last division is the
"obstacles that may interfere." &C.

The first we meet on the list, is the opposition of the medi-
cal profession. But although this is first in order, we do most
sincerely hope that it is not first in magnitude; and animated
by this hope, therefore, we will boldly meet the objections that
may suggest themselves as likely to originate in this quarter.
It cannot be denied, that female physicians would divide the
practice, and consequently render it less lucrative than it is
now; but admitting that the profits would be diminished, there
would be a corresponding diminution of labor, which would
give the male practitioner more time for study and reflection,
and thus enable him to cultivate more successfully the vast field
of Medicine committed to his special care and guardianship.
But granting that no personal or professional advantage could
arise that would afford an adequate compensation for the pecu-
niary loss referred to, we would still contend that the claims of
suffering humanity, and the good of our race, ought to be suffi-
cient to banish all mercenary influences from the ranks of the
noble and philanthropic profession to which we belong. And
we would add, that the profession would, by taking the initia-
tive in female medical education, regardless of all selfish con-
siderations, re-establish its ancient renown, and win for itself
benedictions, more grateful to every pure and generous heart,
than all the gold of Ophir.

Assuming, then, that a conviction of the necessity of female
medical education is all that is necessary to dispel all opposition,
on pecuniary grounds ; we proceed to notice another adversary
which is likely to emerge from our ranks. This is professional

1854.] Wilson, on Female Medical Education. 15

pride ; and this we regard as a much more formidable enemy
than the other, for being more laudable than avarice, it may be
made a sort of scape-goat for opposition arising from all kinds
of impure and unworthy motives. We consider it more formi-
dable again, because all men have inherited a kind of heredita-
ry sexual pride, which revolts at the idea of being placed on a
level with a woman; while to this, is superadded, among physi-
cians profess ional pride which constitutes the only real bond of
union between them. Therefore it is to be dreaded, because it
is laudable because it is deep-rooted, and because it is univer-
sal. But it is only commendable when it prompts to noble
deeds, and restrains from every thing which is mean, and de-
rogatory to the character of a learned and liberal profession.
Thus far it is legitimate worthy of all praise ; and the greatest
safeguard of which we can boast. But when the noble princi-
ple of which we are speaking, is perverted from noble ends, and
degenerates into that pitiful self-conceit and supercilious scorn
which would refuse a female admission into the temple of Medi-
cine when she is proved to be worthy of the honor, and when
it is demonstrated that the welfare of the race demands it ; it
then becomes a damnable* evil, and a disgrace to the profession.
Ashamed to acknowledge fraternity with a woman, indeed !
Is not this supremely ridiculous, when we recognize as brothers,
grog-shop Thompsonians.f half educated, and wholly uneduca-
ted Licentiates of one-man Medical Boards ; newspaper puff-
ers ; cross-road posters ; patent medicine venders, and certifiers
and prescribers et id omne genus ? For though some of us
may deny the "soft impeachment," and disown our relationship
to this swarm, we are all placed on the same platform by the
laws, and often by public opinion. Let others indulge this false
professional pride, then, if they wish ; but as for us, give us well-
educated, virtuous, honorable and orthodox females, in prefer-
ence to the legion of empirics to whom reference has been
made.

But we must pass on to another objection that may originate
in the medical profession viz : The difficulty of confining fe-
male physicians to their own proper sphere of practice, provided

* No swearing. From " damno," I condemn.
t Vide. Nashville Med. Journal. Nov.

1G Wilson, on Female Medical Education. [January,

the extension is allowed for which we have contended. We
candidly admit that this is a difficulty of some importance ;
still we think that it could be obviated, by specifying in the
license or diploma, all the diseases which they might be author-
ized to treat ; and by reserving the power to revoke the license
or diploma, in case the prescribed limits should be transcended.
As a protection to the community, we would suggest also that
all the disorders embraced within the range of female practice
be distinctly enumerated at the public Commencement, and in
the public prints. The necessity of having the female medical

s attached to our regular colleges, will be readily r
ni/.ed as an important feature in securing the success of the
above plan. Without dwelling more on professional objections,
which we hope, after all. are more imaginary than real, we will
notice, lastly, and very briefly, some of the difficulties that may
originate among females themselves. The most prominent of
these is the natural timidity of the sex, and the fear of incurring
public odium.

v, it is too true, that the proverbial ignorance and want
of refinement, which characterize the midwives "four country,
had a tendency to bring female practitioners into disre-
pute. And we may add, that the natural aversion of the refined
and sensitive females of the South to public display has

ed by the ultra and radical Woman's Rights movements
of some of our Northern states. We would answer these ob-
jections by Baying, that the reproach of ignorance and co
ness would be removed, by the substitution of refined and
educated female physicians, and the only cause of public odium
be thus dispelled. While females confined themselves, then, to
the honorable and useful sphere conceded to them by the medi-
cal profession, and required by the wants of the community,
they would have nothing to fear, either direct or incidental ;
but, on the contrary, they would be animated and encouraged
by the fraternal smiles of physicians, and the applause and pa-
tronage of a grateful people. The last difficulty to be noticed,
and we think the most important, is the social and don.
relations of females. It is generally conceded, that the natural
and conventional circumstances by which woman is surround d,
conspire to render home her most appropriate sphere ; anil it

1854.] Booth's Case of Delirium Tremens. IK

cannot be denied, that there is a direct antagonism between
domestic and public pursuits. This being the case, then, the
practice of medicine, by a married woman, would certainly
interfere often with the darning of stockings, and all the num-
berless duties of good housewifery in general. But this difficul-
ty could be obviated by the employment of a housekeeper an
expense which would hardly be felt by a female in extensive
practice. Again : those who chose to remain free from matri-
monial bonds, would of course avoid the difficulty ; and we
think that they would be amply compensated, for a life of celi-
bacy, by the increased honors and profits that would accrue to
them, in giving their individual attention to the science of
medicine. Other difficulties might be met under this head, but
we fear that we have already protracted this article to an un-
warrantable length : and. besides this, we think it useless for
we believe that all obstacles, whether of a social or domestic
nature, will be readily surmounted by females, if they receive
sufficient encouragement.

In conclusion, we would add that we have submitted our
views on female medical education with some diffidence, and
without dogmatism : if we are wrong, we are willing to be con-
vinced of our error ; and we therefore solicit the opinions of
others on this important subject ; and should any one see fit to
oppose us, we hope it will be done in a spirit of lenity and tol~
eration, and with a sincere desire for truth.

article II.

Chloroform in Delirium Tremens. By E. W. Booth, M. D..
of Carrollville, Miss.

William D., aged about 43, tall and rather spare, a confirmed
drunkard, was taken on the 25th inst. with the usual symptoms
of the above disease, after a debauch of some two weeks dura-
tion. I was called to see him the day after the onset of the
attack, and found him laboring under delirium tremens, and
suffering all the horrors of the " demon damned." I put him on
the use of morphine, in grain doses, and directed that the medi-
cine should be continued till sleep was induced. I was sum-

18 Booth's Case of Delirium Tremens. [January,

moned at 3 o'clock the next morning to see him, as he was said
to be growing worse; I found him raving about imaginary be-
ings who were annoying him greatly. He had taken 10 grains
of morphine, which appeared to exert very little influence on
the disease. I determined to try the internal exhibition of
chloroform, and immediately gave him about half a drachm of
that article, mixed with a little water, and after the expiration
of ten minutes repeated the dose. He, soon after the last dose
was administered, fell into a profound apoplectic stupor : his
breathing was not oftener than once in a minute; his eyes turn-
ed upwards : his pulse about one hundred, full and regular; his
respirntion was loud and stertorous, and at each inspiration he
started as if he had received a powerful shock ; his extremities
were cold, and he could he aroused by powerful shaking for a
few seconds, to relapse again into his former state of deep
insensibility. I sat by his bed. watch in hand, counting his
respirations, and must Bay that my feelings were anything but
pleasant. I had him aroused every three or four minutes for
some time, hoping that this unpleasant state would subside, but
finding no improvement, I then ordered a quantity of water to
be drawn from a well, and poured it on his head, with occasional
intermissions, for several hours. I also gave him an emetic of
mustard and ipecac, which operated well: and had his legs
enveloped in sinapisms. He slept profoundly during the appli-
cation of the water, and seemed to be almost unconscious of the
operation of the emetic.

After treating the case as above related for several hours, he
gradually improved till he became quite conscious, and the
mental hallucinations had left him. Without further treatment,
except camphor and whiskey, he slept soundly the next night,
and in the morning was fairly convalescent. He progressed
favorably, and is now well.

[The above case is quite interesting, as illustrating the influ-
ence of chloroform upon a nervous system affected with mania
a potu and insensible to the action of large doses of morphine.
Cases of mania a potu successfully treated by the internal ad-
ministration of chloroform have been repeatedly reported during
the last year or two, but we do not recollect any in which the

1854.] Carithers' Case of Mammary Abscess. 10

chloroform has so manifestly brought the system under the
influence of the previously taken narcotic. In the present
instance it is evident that the alarming condition of the patient,
after taking the chloroform, was attributable to narcosis induced
bv bringing the system in such a state as to take cognizance,, if
we may use the expression, of the anodyne to which it was be-
fore insensible. It is well known that huge quantities of opium
may be taken with almost impunity by those affected with
delirium tremens but it would seem from the example under
consideration, that it is not altogether safe to follow these large
doses by the use of an agent which so promptly annihilates this
tolerance of narcotics. It is singular that an article which so
effectually blunts the nervous sensibilities as chloroform, should
be at the same time possessed of the property of making the
system amenable to the impressions of opiates which it did not
before seem to feel.

The facts recall to mind a case of tetanus in which the pa-
tient took a grain of morphine every hour during a whole day,
and was at the same time made to inhale chloroform very freely.
He died evidently narcotized. Editor S. M. & S. J.]

ARTICLE III.

Mammary Abscess, treated mith Iodide of Potassium. By
J. Y. Carithers, of Hendricksville, Ala.

Mrs. S., on the fifth day after being delivered of her second
child, complained of pain in her left breast, which suppurated,
in despite of the efforts made to prevent it. The abscess
was opened and a large quantity of pus discharged ; but
this gave relief only for a short time, after which other portions
of the gland became indurated and proceeded to suppuration,
requiring to be punctured. The usual antiphlogistic treatment
was tried with only partial relief, when the following treatment
was adopted : Three grains of iodide of potassium to be taken
in solution morning and night, and to use as a local application
the ung. iodini ; her diet to consist of nothing but rice. In a
few days relief was evident. This treatment was continued for
twenty days, when all signs of soreness disappeared. The lady
is now suckling her child with no inconvenience, four months
having elapsed since the accident.

20 Ricord's Letters upon Syphilis. [January,

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

TWENTY-THIRD LETTER.

[Continued from Vol. Ix, Page 672.]

My dear Friend I promised to call your attention to-day
to the cauterization of chancre.

This remedial measure, which I have so ardently sought to
maintain in therapeutics, has not yet been generally adopted.
Jt has even been expressly condemned by some practitioners;
and I am sorry to add that a very unfavorable opinion of it was
given by the Academy of Medicine, before I had the honor of
being a member of t hat honorable body.

You vvili recollect that one of the members of this learned
society treated cauterization with so little favor as to disdain-
fully return tin to the Corpora?* guard, with whom he
said, it ought ever to have remained. The author of this apos-
tropher, in his character of military surgeon, should, at least,
have informed us as to the efFed of the measure in the corpor-
al's guard : for it is important to be satisfied with respect to its
efficaciousness. It' the met >od, the source whence it
originated is a matter of indifference; and we make this re-
mark without reflecting in any degree whatever on the corpor-
al's guard.

The cauterization of chancre did not originate with me ; but
I am a firm supporter of its value as a remedial measure ; and
in this capacity, you know, my opponents have not failed to
attack me. Jt is, t, . my purpose to defend the principles

which I advocate.

Let us first invoke analogy, in illustration of the question.

We cauterize the bites of the viper and of the mad dog, as
well as anatomical wounds, anthrax, malignant pustule, and
often witli success, when our services are timely invoked.
No one would be inattentive to a puncture made with an in-
strument soiled with the pus of farcy or glanders. The
surgeon who would fail to cauterize in these cases would be
highly culpable. And yet the very men whose hand in all such
cases is armed with iron and with fire, pause when the disease
happens to be chancre ! Why ? Because they either cease
to reason, or cease to reason with effect.

Let us prove our statement.

Does chancre, whatever may be its variety, always produce
accidents at a distance ? Does it always infect the economy ?

With respect to this question, you know there are three par-
ties, with distinct opinions :

One party, which appears to believe in nothing that is not

1854.] RicorcTs Letters upon Syphilis. 21

incredible a party which is still numerous is convinced that
chancre is not a primitive accident, in the strict acceptation of
the term ; but that it simply constitutes the first manifestation
of the general infection, or, as I have already stated, a primitive
secondary, or a secondary primitive accident.

Another party, which already begins to have a glimpse of
the truth and the school of Hunter must be ranged in this
category admit chancre to be at first a local accident ; but
thinks that it must inevitably infect the economy unless specific
medication is employed in time.

Finally, the most rational party that which has observa-
tion, experience and the evidence of facts on its side affirms
that chancre is always, at the commencement, a local affection
which art can arrest, and which even without the intervention
of art, may remain local in certain well-determined circumstan-
ces, whatever may be the extent of the chancre with respect
to its surface or depth. The last observers maintain and this
is one of the consoling points of the doctrines which I profess
that, even when the chancre is about to infect the economy,
this result does not take place instantaneously, but only after
the lapse of an interval sufficiently complete to enable us to
destroy it.

I say nothing with respect to the physiologists whom I have
elsewhere opposed ; and who do not admit a general infection,
either before or during or after exposure to the cause. This
doctrine is now duly interred ; and, what is very singular, some
of its advocates have since become more virulent than myself.
I could cite instances of some who, from unbelievers that they
were in regard to the virulence of the disease, have ended by
believing in everything, even in homoeopathy.

I do not rest here to enter upon the discussion of when and
how buboes are produced: of the time at which the constitu-
tional infection occurs and of its mechanism, we will speak
hereafter. I only wish to recall the reasons which have caused
the rejection of cauterization as an abortive or curative method
of treatment of chancre, together with those which have led
me to adopt it.

What do we wish to accomplish by cauterizing chancres ?

1. To prevent constitutional infection.

2. To hinder the production of buboes.

3. To retard the progress of the primitive accident, which
occasions greater or less deformity, and sometimes the loss of
important organs.

4. Finally, to destroy a focus of contagion.

Those who believe that the constitutional infection always
precedes chancre, not only state that it is useless to cauterize

K. S. VOL. X. NO. I. 2

22 Ricord's Letters upon Syphilis. [January,

the accident, since the disease which we seek to prevent
already exists; but they further add, that it wrould be danger-
ous so to do, inasmuch as the chancre is an emunetory by
which the economy frees itself from the virus. If this opinion
were well founded, it would follow that it is not only imprudent
to destroy the chancre, but that, on the contrary, it is necessary
to preserve and extend it, in order to furnish the virus with
numerous and easy doors of exit. This is a logical sequence.
But you know, my dear friend, that these logicians do not act
in this way ; and we must admit that it is very fortunate for
their patients that their practice is inconsistent with their pro-
fessions.

The difference is not great between this school and that
which, as I have already told you. believes that chancre, at first
local, inevitably produces general infection. The disciples of
this school tell us that the activity of the infection is propor-
tional to the number, the extent, and the duration of the primi-
tive accidents. But, alas! after the statement of these fine
doctrines, there comes a contrary element, which leads to the
direst practical nonsense. In fact, what do they prescribe?
Listen to them, and they tell you: Avoid destroying the chan-
cre; do not seek its rapid cure, for thus you throw back the
virus into the economy, inclose the wolf in the sheepfold, and
finally render the infection more active.

Do you not admire the manner in which all this is deduced
and linked together !

We throw back, we repercuss the virus by drying up the
virulent source! The wolf in the sheepfold is so much the
more dangerous since it is dead ! The infection becomes more
active when we have destroyed the elements which must
increase it !

My intelligence cannot scale the sublime heights of this reas-
oning: are you more fortunate than I, my dear friend ?

This is not all ; the partisans of this doctrine further say to
you : Respect the chancre, for it tells the actual condition of
the patient, and also what will occur later.

They add :

Do not cure the primitive ulcer too soon, for it serves you as
a guide in the general treatment, and forces the patient to
follow this.

What do you now think of these precepts ? What is the
satisfaction, in fact, from knowing each day, beyond a doubt,
that your patient really has a chancre, and from being assured
that it was this which determined the other accidents which
you have subsequently to combat ?

The primitive accident, they say, serves to direct your de-

1854.] RicorcTs Letters upon Syphilis. 23

puratory treatment ; but you, as well as I, know that not one
of those professing these doctrines suspends the general treat-
ment as soon as the chancre is cured, even by their method.
Their treatment is nearly the same in all cases: it is a fixed
dose of mercury administered during a given time, whatever be
the nature of the primitive accident, whatever may have been
its duration. And then what do you say of allowing a chancre
to progress in such a way as to amputate the penis, for the sake
of inducing the patient to follow the treatment ? this is truly
admirable, and one could not be more prudent.

Cauterization has been reproached with being a frequent
cause of bubo ; and in support of this assertion the meagre sta-
tistics of Bell have been cited, statistics wThich a single visit to
the Venereal Hospital of Paris would reduce to naught.

The law, which you can verify when you like, is this: there
are more buboes without a previous cauterization of the chan-
cres than otherwise. Cauterization does not always prevent
the production of buboes ; it never determines specific ones ; it
may often prevent them.

It may often prevent the constitutional infection, it never
favors it.

I am well aware that many observations have been cited in
support of the heresy which I combat ; but they are all of
about the same weight as the observation somewhere to be
found in Van Swieten. In this case the patient had had a
chancre for more than a month, and, after a cauterization, was
affected with secondary ulcerations of the throat, as a conse-
quence of the pretended repercussion! Oh, pox! when wilt
thou be understood ?

M. Lagneau, who is opposed to cauterization, because, among
other inconveniences, it destroys the primitive accident too
quickly, cites against it an instance in which it had a wonder-
ful result. But, lo judge of it the better, let us allow M. Lag-
neau to speak. Here is his observation :

"In 1807, an officer of high rank, called for a short time to
the imperial headquarters at Varsovia, exposed himself to ven-
ereal contagion. Shortly afterwards two chancres appeared
at the base of the glans. Before appropriate treatment was
commenced, the army was unfortunately commanded to march.
The patient was unwilling to leave his regiment at a period
when everything indicated the occurrence of great events in
which he was anxious to participate. Being attached to a
cavalry corps of the advanced guard, his duties were exceed-
ingly arduous on account of the extreme severity of the cold.
I was therefore unable to resort to the usual treatment in such
cases. For many reasons, such as the irregular administra-

24 Chloroform. [January,

tion of the remedies at my disposal, I could not hope to be
able to prevent the developement of accidents, when so many
powerful causes capable of producing them were in operation.
I yielded then, to the reiterated demands of this officer, and touch-
ed his ulcers with the nitrate of silver, forewarning him however,
of what he might expect in the future. The chancres cicatri-
zed very promptly and the patient finished the campaign without
experiencing the slightest inconvenience from them. Shortly
after the battle of Eylau, the army having taken cantonments
upon the Pasargo, he informed me, according to agreement, of
his condition ; and 1 engaged to prevent, by a methodical treat-
ment, the results of a general infection. He followed my ad-
vice, and has not since experienced the slightest venereal symp-
toms/'

After so conclusive an illustration in favor of cauterization,
you will not, I trust, expect me to adduce the thousands of
similar facts which I have been enabled to collect during the
practice of twenty years. This one seems to me sufficient.

In order now to clearly explain to you my views on cauteri-
zation you will allow me, in my next letter, to present to your
notice some important propositions. [N. Y. Med. Times.

Chloroform its External and Internal Uses. By R. L. Madi-
son, M. D., Petersburg, Va.

The use of this powerful anaesthetic has become widely popu-
lar with the medical profession, and richly does it deserve its
popularity. Having passed the ordeal of rigid experiment and
enlarged experience, it now ranks first among those remedies
which science, with lavish hand, has kindly furnished for our
relief, while millions are ready, with willing lips, to testify to
its delightful and lethean influence, and to herald its praises as
a mighty boon to suffering humanity. If to afford immunity
from pain, to impart relief to agonized human nature, be one
among many of the glorious objects of the physician's mission
upon earth, surely the possession of this remedial agent alone
were sufficient to yield the blessings of comparative comfort
to half the "ills that flesh is heir to."

It is not my purpose, in the present article, to speak of the
anaesthetic virtues of chloroform, because they are too well
known and appreciated by the profession to need further com-
mendation or support, but simply, through the medium of your
valuable journal, to invite attention more directly to some other
uses to which it can be, and has been, applied with the same
success, and with equal certainty, as by inhalation.

1854.] Chloroform. 25

I allude to its external application and internal administra-
tion in cases of exalted or perverted nervous action, inducing
spasm whether tonic or clonic, as exemplified in traumatic or
idiopathic tetanus, delirium tremens, spasmodic colic, &c, &c.

Without further preface I will proceed, by way of illustra-
tion, to recite a few cases of recent occurrence, and let them
speak for themselves.

Case I. A little negro about two years of age, belonging to

Mr. R , of Dinwiddie county, was bitten on the heel whilst

asleep, by a rat. This attracted very little attention until the
afternoon of the third or fourth day, when the child was seized
with a violent convulsion, followed, after an interval of an hour,
by another of still greater violence. Being on a visit to the
neighboring house, I was called in before the termination of
the second spasm. He had been immersed in warm water,
and an emetic administered, which relieved his stomach of
some well-digested food. On enquiry whether he had received
any external injury, his mother replied, ''nothing except the
bite of a rat." An examination of the heel revealed a punc-
tured wound, swollen and tender to the touch, the inflammation
extending some distance up the limb. The constitutional dis-
turbance, however, was not sufficiently great to develop much
fever. I expressed my fears to Mr. R , of the tetanic na-
ture of the convulsions, and explained the danger to be appre-
hended from them.

Treatment. Hot bath as often as the spasms should recur.
Ley poultice to the heel, to be changed every hour or two, and
the following liniment: $. Chloroform and ol. olivae, aa 3ij;
spts. ammoniae fort. 5ss. M. To be rubbed well on the whole
length of the spine every half hour until bedtime. Its use to
be resumed during the night, if necessary.

October 4, 10 o'clock A. M. One spasm had occurred, ac-
companied by violent rigidity of the muscles of the forearm
and those of mastication, soon after the rubbing commenced.
There were occasional nervous twitchings during the night,
but otherwise slept composedly. Has no fever ; pain and in-
flammation in the heel diminished. Continued the poultice,
with spinal frictions every two hours during the day, and pre-
scribed : ty. Hyd. chlorid. mit., grs. iv. ; pulv. ipecac, gr. i. INT.

October 5, 10| A. M. Has had no more spasms : medicine
acted once ; appears quite lively. Ordered the liniment to be
continued three times a day. The punctured wound rapidly
healed, and the child has since remained in excellent health.

Case II. J. C, a young man, aet. 28. Sanguine tempera-

Chloroform. [January,

ment and plethoric habit; had been sick with bilious colic for
three or four days, and was convalescing ; was suddenly seized
(Oct. 15, 1 o'clock P. M.) with a severe convulsion of delirium
tremens consequent upon excesses of the previous week and
the antiphlogistic treatment resorted to in his case. The con-
vulsion left him in a partially comatose condition, with some
heat about the head ; pulse 120, small and irritable. Twenty
minutes afterwards he had another spasm. I did not like to
employ the usual remedies in this case, not only on account of
the pre-existing biliary derangement, but also because of the
cephalic symptoms. I therefore determined to use chloroform
externally. With this view a liniment was ordered, compos* d
of equal parts of chloroform and sweet oil. which was directed
to be rubbed well upon the whole length of the spine every
half hour. About 3 o'clock Mr. C. had another spasm of short
duration. After this his pulse gradually diminished in fre-
quency, and increased in volume and softness. From 5 to 6
o'clock had a refreshing nap, and awoke with a clear intellect.
Oct. 16, 9 o'clock A. M. Slept but little ; is now very nerv-
ous and restless; mind inclined to wander ; muscles tremulous.
Ordered an aperient of calomel and-bicarbonate of soda, with
a continuation of the spinal frictions, which by evening entirely
allayed all the abnormal symptoms.

Oct. 17. Dismissed as not requiring further medical aid.
No anodynes were given internally.

These cases are interesting as illustrative of the sedative and
anodyne effects of chloroform where endemically applied, un-
attended with any possible dangerous results, and consequently
obnoxious to no objections. These effects are further proven
by the benefit derivable from the external use of chloroform in
cases of simple neuralgia, muscular rheumatism, cramp, &c,
in many instances relief being immediate.

Case III. J. T., set. 25. Laboring under mania a potu.

Oct. 23. Delirium constant, though of a low and muttering
character; morbidly timid ; pulse feeble and rapid ; great en-
largement of the liver, which is tender on pressure and per-
cussion ; tongue red and dry ; complete anorexia and insomnia ;
extremities cold. He has been intemperate for years

Treatment. Sinapisms to the right hypochondrium and in-
ferior extremities, and the following pill : $. Quinae sulph., g.
camphorae aa., grs. xii ; hydr. chlorid. mit., grs. x; pulv. cpii,
grs. xij. M. Syp. qs. F. in pil. No. xxiv. S. Two every
two hours until bedtime.

Oct. 24, 9 A. M. A little better. Had rise of fever towards
evening, with active delirium nearly all night. Has still con-

1854.1 Chloroform. 27

siderable thirst, and complains much of his liver. Tongue
covered with a dark fur, but moister than yesterday. Pulse 98
and feeble. Directed the pills to be continued once every
three hours until 4 o'clock P. M., when he took the following
draught: R. Quinae sulph., grs. xv. ; aq. camph., B iss. ; acidi
sulph. aromat., gtt. iii ; syp., oSs.; elix. opii, oiss. M.

Oct. 25, 4 A. M. Rested something better ; delirium less
active during the night ; mind clear at intervals ; gums a little
tender ; skin moist ; pulse about 90, and more developed ;
anorexia and jactitation continue.

I ordered an ounce of castor oil ; and at 5 o'clock P. M. he
took R. Chloroform, 3i. ; aq. camph., 5 iss. M.

Oct. 25, 10 A. M. Says he feels a great deal better ; slept
well for the first time in a week; feels hungry; pulse full and
soft ; skin and tongue moist ; the oil has acted twice.

After this he remained calm and rational, but I doubt whe-
ther his health will ever be fully restored, his system being
completely shattered by long continued dissipation.

Case IV. R. H. W., set. about 30. Has had several attacks
of arthritic rheumatism within the last eighteen months. Is
suffering now (Oct. 26) from rheumatism attacking the muscu-
lar coat of the small intestines. Complains of great and inces-
sant pain, constipation, considerable fever, furred tongue, loss
of appetite, &c.

Treatment. Hot emolient cataplasms to the abdomen ; v. s.
oxvi. ; and R. Hyd. chlorid. mit.,grs. x. ; morphiae muriat, gr.
\ ; syp. qs. F. in pi I. No. i.

October 27, 9 A. M. No better; did not sleep at all ; pain
at times intense, aggravated by large collections of wind in the
ascending and transverse colon ; urine very high colored ; pulse
jerking. Ordered a stimulating enema, continued the poulti-
ces to the abdomen, and gave : R. Ammonia? phosphat. 3 iij. ;
aq. font. 1 v. ; syp. aurant., cost. spts. ammonia aromat., aa.
5 ss. M. S. Tablespoonful every three hours in half a glass
of water.

October 28, 10 A. M. Slept very little last night ; pain still
continues ; enema acted well ; no appetite, yet the tongue is
clean and moist, the urine clear, and the pulse nearly natural.
The continued character of the pain and the inability to sleep
induced me to prescribe chloroform internally. Accordingly,
at 7 P. M. he took R. Chloroform, 3jj. ; aq. camph., sij. M.
This draught produced sound and refreshing sleep for four or
five hours, after which he was wakeful but free from pain.
This morning (October 29) says he feels almost entirely well;
convalescence rapid.

28 Yellow Jessamine. [January,

There are very many cases in which it is desirable to ad-
minister an anodyne, and equally desirable not to produce
constipation, or to suspend the peristaltic action of the intes-
tines. In such cases chloroform, in my experience, is an
admirable remedy, not only calming the nervous system and
promptly inducing sleep, but creating no inertia of the diges-
tive organs, and causing no vascular determination to the brain.
There are persons also, in every community, who cannot take
opium, or any of its preparations. These, I should think, might
take chloroform with impunity, although I have had no oppor-
tunity as yet for testing the experiment. [Stethoscope and
Virginia Med. Grax.

Gelseminum Sempervirens, or Yellow Jessamine. Bv II. M.
Nash, M.D., Norfolk, Va.

This plant, no part of which is officinal in the United States
Pharmacopoeia, the Bignonia Sempervirens of Linnaeus, and
the Gelseminum Nitidum of Michaux and Puroh, belongs to
Sex. Syst. Pentandria Digvnia; Nat Ord. Apocynaceae. It
has a smooth twining glabrous stem, with leaves dark green
above, paler beneath, entire lanceolate, perennial and apposite,
and short petioles, bearing flowers in March and April. It
flourishes throughout the Southern states, where its value, in
the treatment of the various fevers incident to the country and
climate, has so recently been discovered, and introduced to the
notice of the medical profession; and nowhere is it produced
more abundantly than in the forests and by the road sides of
our own immediate vicinity, making known its presence in
flowering season, at considerable distances, by its most fra-
grant, but rather narcotic odor.

The tincture of the root is the preparation used in experi-
ments. It has a characteristic odor, and may be given in
doses, for adults, of from ten to fifty drops, in a little water;
and even one to two teaspoonsful have been administered, as it
varies in strength, there being no fixed standard. It will be
found sufficient for all practical purposes, though the whole
plant, doubtless, possesses valuable medicinal virtues.

Jessamine appears to be narcotic, antispasmodic and sedative,
seemingly spending its influence chiefly upon the sensory gan-
glia, spinal cord, and voluntary muscles, leaving unaffected the
intellectual faculties. It reduces the circulation, and promotes
perspiration and the secretions generally, without causing nau-
sea, vomiting or purging, and has been given in every stage of
febrile disorder.

Its physiological effects are dimness of vision, doublesighted-

1854.] Yellow Jessamine. 29

ness, inability to open the eyelids, stiffness of the jaws, general
muscular debility, and complete prostration. These soon pass
off. however, upon withholding its use, leaving the patient com-
fortable and refreshed. I have used the article in every case
of idiopathic fever that has fallen under my treatment within
the last six months, with perfect impunity, and with the most
desirable results, age or sex not effecting its exhibition ; but
not having relied solely upon it in ali cases, especially in those
of higher grade, I am not prepared to pronounce it. as others
farther South have perhaps too rashly done, a specific (a term
rather to be avoided in medicine) in the above diseases.

Accompanied by a gentle purgative, it has been my custom
to give it in appropriate doses, repeated at intervals of one or
two hours, until some of its prominent physiological effects are
produced, as dimness of vision, &c, when it may be suspended,
its equalizing and quieting powers becoming apparent. In
mild cases no other treatment is required, but generally from
one to ten grains of quinine, according to the severity of the
symptoms, should follow each dose of the jessamine, thereby
effectually preventing a relapse, in a short time, from want of
tone, resulting from the relaxing effects of the remedy.

In two instances, I have, by the above course, succeeded in
relieving patients within twenty-four hours, whose cases pre-
sented all the primary symptoms of veritable typhoid fever, and
have seen a full dose of the tincture, with five grains of quinine
added, stop almost immediately a severe chill, no fever super-
vening at all.

In the case of a child two years old, under my charge, com-
plete prostration, with seeming paralysis of the muscles of
deglutition, induced by the carelessness of the nurse in giving
an o\ier dose, was relieved by repeated injections of a strong
solution of quinine, in a very short time. This would prove
effectual in any such case accidentally happening, but with
cautious use no fears may be entertained.

In the course of experiment I have used it in several other
affections, as rheumatism, haemoptysis, &c, with evident ad-
vantage, though not sufficient to predicate its success in such
cases.

The medicinal actions and uses of jessamine deserve fully
to be investigated by all medical men. Of its future extensive
use in the South, where it abounds (a provision not to be look-
ed upon as purely accidental) as a febrifuge, I have little doubt ;
and if its reputation becomes not what 1 would venture to pre-
dict, a coefficient with quinine in treatment of the diseases
indicated, it is that my enthusiasm in its favor obscures my
humble judgment. [Ibid.

30 Composition of Human Milk, $c. [January,

On the Composition of Human Milk in Health and Di
By MM. Veknois and A. Becquerel.

[The results of these investigations are important in the in-
quiry as to how far the milk in different conditions may affect
the chemical structure of the teeth of children and thus modify
their susceptibility to disease. It will be seen that they inval-
idate some of the inferences built upon former analyses, but
although affording more correct data, they at the same time
suggest the uncertainty of chemical analyses in the pn
state of the art, as bases for positive conclusi

"Looking at the contradictory reports of various analyses
of milk. MM. Vernois and A. Becqucrel have entered into an
elaborate investigation of the entire subject. They have i
cially chosen 89 uniform and complete analyses to deduce
certain deductions from. The following is their account of the
composition of this fluid :

In Health. In Acute Disease. In Cliru:

Water, 889,08 . . 884,91 . . . 885,50

Solid parts, .... 110,92 . . 115,09 . . . 114,50

Sugar, 43,64 . . 33,10 ... 1.

uraf and extractive . . 50,40 . . . 31

Butter, . . 29,86 . . . 32,57

Salts (by incineration) 1,38 . . 1,73 . . . 1,50

Density 103v>.(>7 . . 1031,20 . . .1031.17

'* There are more solid parts in the milk of nurses aged from
15 to 20, than in those from 35 to 40. The quantity of butter
is notably increased during the colostral period. Gestation
does not produce alteration in the composition of the milk at
first, but at a later period it increases the proportion of the
parts. Menstruation diminishes the density, the weight of the
water and of the sugar. It increases the weight of the solid
portions, especially the caseum. Insufficient aliment renders
the milk too watery, the effect falling especially on the butter
and caseum. An excess of butter and caseum always accom-
panies an ill state of health of the nursling. There are certain
women wThose milk, independently of any special cause, always
contains an excess of butter or caseum.

" In both acute and chronic disease, the water diminishes
and the solid parts increase; but there the analogy between
these two classes ceases. In acute disease, the sugar consider-
ably diminishes while the three other elements are increased,
the caseum alone nearly repairing what is lost by the sugar.
In chronic disease, the butter and salts are increased, the sugar
remains stationary, and the caseum diminishes. Thus in acute
diseases, we have loss on a respiratory element, and excess in

1854.] Incipient Pulmonary PJtthisis. 31

a nutritive element ; and in the chronic, loss on the nutritive
element, and increase of the respiratory element. In phthisis,
without diarrhoea or emaciation, there is little sensible modifi-
cation ; but these being present, there is considerable diminu-
tion in the weight of butter. In syphilis the density is extra-
ordinarily raised ; the butter diminishes, and the salts dispro-
portionately increase. [Gazette Medicate. Southern Journal
of Med. and Physical Sciences.

On some of the Signs of Incipient Pulmonary Phthisis. By
M. Bourdon.

It is known with what difficulty the presence of pulmonary
tubercles is diagnosticated when the disease is in its incipiency.
and how insufficient the stethoscopic signs are. The latter
may be wanting when the lungs contain a large quantity of
tubercles; they may exist when the lungs contain none; and
they maybe masked by different sounds. The genera] symp-
toms are not a sure means of detecting the disease ; a simple
catarrh may be attended with very grave symptoms, while a
true phthisis may afFect the general system very slightly. It
is at the commencement of the disease that the diagnosis is
most important, because this is the only time that there is a
chance of treating it with any success. M. Bourdon has sought
to elucidate this obscure point. Attracted for a long time by
the frequency of certain symptoms in phthisical patients, he
has studied them with care, in order to establish their value as
signs. These symptoms are arranged under many heads, ac-
cording to the organs in which they show themselves:
1. gastric symptoms: 2. hepatic symptoms; 3. thoracic pain.
The gastric symptoms are not to be confounded with the mor-
bid phenomena observed in almost all diseases. Those which
coincide with the incipiency of phthisis are nauseas, vomit-
ings, epigastric pains, dyspepsia. You must not wait to find
these symptoms in every case ; nevertheless, they are extreme-
ly frequent, since M. Bourdon found them in more than two-
thirds of his subjects. Some phthisical patients suffer from
one of these symptoms; others, on the contrary, have them
all combined. Nausea and vomiting are most common ; and
it is generally after the cough that they exhibit themselves.
It must be observed, however, that their frequency or intensity
are not at all proportioned to the cough ; they occur when the
stomach is empty as well as after a repast. Generally the
vomitings consist of mucous matter, rarely of bile. Still, while
they show themselves with a large number of the tuberculous,
they do so in a positive manner with very few. Another very

32 Incipient Pulmonary Phthisis. [January,

common symptom is the epigastric pain. In the largest num-
ber of cases, it is accompanied with nausea and vomiting; nev-
ertheless it occurs alone sometimes. With the largest number
of patients it is only manifested upon pressure, or is so slight
as not to be noticed by the patient until their attention is at-
tracted to it ; in a smaller number of patients it manifests itself
spontaneously. Although it shows itself both before and after
eating, it is yet most commonly observed after the ingestion of
food. Long continued dyspepsia, without nausea or vomiting,
is frequently observed. Frequently the gastric symptoms pre-
cede the thoracic; but often also they show themselves at the
same time or subsequently. Do they imply a lesion of the
stomach ? is a question which has occupied the author. Some-
times he found the stomach healthy; most frequently it pre-
sented some lesion, which was oftenest a papillated state of the
mucous membrane. The author thinks the pressure of the
tumefied bronchial glands upon the pneumo-gastric might
contribute to the disorders of the stomach.

2. The liver sometimes presents remarkable peculiarities.
In half the patients examined by M. Bourdon there was an
increase of volume, frequently attended with pain. The in-
crease of volume seemed to be particularly observable in the
right lobe; the consistence of the organ seeming to undergo
no change. The changes of sensibility are less frequent than
the changes of volume. Spontaneous pains are rare ; they
only manifest themselves under pressure, or under some sud-
den and straining movement. In some rare cases this change
of sensibility is observed without change of volume. As to
the change the liver undergoes, the autopsies prove that in
more than hall' of the cases it is due to fatty degeneration more
or less advanced. The bile is generally of greater density and
more highly colored.

3. The largest number of phthisical patients suffer from pain
between the shoulders and in the sides of the chest : but, be-
sides these spontaneous pains, there are others to which M.
Bourdon calls the attention of physicians, and which are only
recognized through the medium of percussion. The points
where these pains are discovered are numerous, but they are
most often seated below the clavicles, and only on the side
affected with tubercles. If both sides are affected the pain is
on the side most affected. As to the cause of this pain, M.
Bourdon, like M. Beau, is inclined to ascribe it to intercostal
neuralgia.

The conclusions drawn by M. Bourdon from his researches
are as follows : When prolonged dyspepsia, nauseas, and vom-
itings are observed, without any assignable cause ; when the

1854.] Quinine in Acute Rheumatism. 33

liver is abnormally developed, without there being hepatitis or
disease of the heart; when these phenomena are exhibited
independent of any other affection, or in the course of chlorosis,
or after measles or typhoid fever ; the physician should turn
his attention to tuberculosis, examine the patient with great
care, and even when there is doubt of the reality of the pul-
monary affection, he ought to act as if convinced, or at least
he should take his precautions. [Archives Gen. Virginia
Med. and Surg. Journal.

A Case of Acute Rheumatism treated with full doses of Quinine.
By W. M. Houston, M. D., of Urbanaj Ohio.

On Wednesday afternoon I was called to visit Miss G-

eight miles north-east of this place. On my arrival I obtained
the following history of the case. The patient (sixteen years
of age) was attacked on the previous Saturday with acute
rheumatism of a very severe character. On Sunday, Dr,
Johnson was called in, and for three days applied the usual
remedies for rheumatism, viz: Bleeding, mercurial purgatives,
opium, tartar emetic and colchicum, without any good effect ; in
fact the patient grew worse from day to day, until I first saw her,
when she was unable to move hand or foot ; as the least motion
caused extreme suffering. Her pulse was one hundred, full
and strong ; joints somewhat swollen and slightly red.

What 'course to pursue with a prospect of affording relief,
after the failure of nearly all the anti-rheumatic remedies, was
a question in regard to which physicians might well be excused
for differing in their opinions. Dr. J. was in favor of further
venesection, and, taking the pulse as a guide, this measure
seemed not only warranted but positively indicated. As, how-
ever, she had already been bled twice, I was fearful metastasis
might result from the further loss of blood. I suggested the
following treatment, (which, although seemingly empirical, was
acceded to by Dr. J., as the usual remedies had most signally
failed,) viz : 8 grs. quinine, 2 grs. opium, and 2 grs. ipecac,
every third hour, unless symptoms of narcotism should super-
vene ; chloroform liniment to be applied to the joints ; lemon-
ade to be drank freely. I agreed to see the patient the next
day, but being called in the night to attend an obstetrical case
(eight miles from town, in another direction), which proved
to be a very tedious labor, I did not see her again until
Saturday morning, when I learned that in the course of the
first twelve hours she took 40 grs. quinine, 10 grs. opium, and
10 grs. ipecac ; used 1 oz. of liniment to the joints, but did not
use the lemons. She rested well through the night, and in the

34 Intermitting Diabetes, tyc. [January,

morning felt greatly relieved. During Thursday and Friday
she took about 20 grs. more of quinine, and enough colchicum
to open the bowels. When I saw her on Saturday morning
she was able to walk about the room was entirely free from
pain ; pulse reduced to 70, of moderate force, and with the ex-
ception of a slight stiffness of the joints there was no evidence
that the patient had ever had an attack of rheumatism.

[ Western Lancet.

On Intermitting Diabetes, and on the Diabetes of Old Age,
By H. B. Jones, F.R.S., Physician to St. George's Hospital.

The author's object in this communication was to point out
some phenomena connected with diabetes, which he had not
found mentioned by other writers. Preliminary to the record
of the cases, the author offered some observations on the in-
correct results obtained by calculating the amount of sugar
present in the urine from the specific gravity. If diabetic
urines were solution* of nothing but sugar in distilled water,
the tables by Dr. Henry, and the amount of sugar calculated
from the specific gravity, would give all the information re-
quired ; but a multitude of other substances were present be-
sides sugar, ealih of which was variable, and each of which
might cause the specific gravity to vary, whilst the quantity of
sugar might remain constant. To be accurate, therefore, the
amount of sugar should always be determined by direct exper-
iment, and never calculated from the specific gravity. Results
were given, exhibiting the specific gravity, the amount of sugar
calculated from solid apparatus, and the absolute amount of
sugar obtained by direct analysis. On the subject of intermit-
ting diabetes, the author observed that there could be but little
doubt that our knowledge of the nature of this disorder might
be extended by means of accurate determination of the varie-
ties in the amount of sugar in the urine passed at different
periods of the day, and under different circumstances. His
object in relation to this form of the disease was to record
some cases in which, either from the medical treatment, or the
regimen, or the natural course of the complaint, the variation
in the amount of sugar was not from much to little, but from
highly saccharine urine to total absence of sugar. The state
of the urine a few hours after the sugar had disappeared, and
an hour or two before it reappeared, was most especially
worthy of attention, inasmuch as it might lead to a truer know-
ledge of the state of the system which preceded the com-
mencement of diabetes. In intermitting diabetes the disease
might be seen beginning and ending, and the explanation of

IS54.] Intermitting Diabetes, <-c. 35

the state of the urine which preceded the appearance of the
sugar and followed its disappearance, must be included in the
true theory of diabetes. Moreover, a better knowledge of the
antecedent phenomena might enable us to ward off the disease,
if not to treat it with more success. The records of seven
cases of the intermitting form of the disease were given, and
very minute particulars in several, illustrated the amount of
sugar present in the urine at stated intervals in the twenty-
four hours, as well as the influence of particular forms of diet
on the proportion of sugar excreted. In these cases the state
of the urine just after the sugar had disappeared was worthy
of attention. A remarkable excess of urea was constantly
found before and after the sugar disappeared ; and although
this might be attributed to the animal diet, yet the occurrence
of free uric acid and oxalate of lime in the urine, pointed most
clearly to a state of indigestion which was every day to be
found without any sugar appearing in the urine. The author
offered the following theoretical contrast between ordinary and
saccharine indigestion : Ordinary indigestion showed itself in
a want of action on the sugar and starch taken as food, in con-
sequence of which excessive acidity was produced that is, the
changes in the Don-nitrogenous food were imperfect. Imper-
fect changes also occurred in the nitrogenous food; this was
made evident by an excess of urates and urea in the urine, and
perhaps also by the formation of oxalate of lime. In diabetic
indigestion the effect might be traced also on the two great
classes of food. At first from the non-nitrogenous food sugar
was formed instead of acid. Ultimately, if not simultaneously,
sometimes the arrest of healthy changes extended to the albu-
minous food, and, instead of an excess of urates and urea, other
products were formed, one of which was sugar. It was possi-
ble that some of these products might be found in the urine.
Possibly benzoic acid, which is present in some cases of dia-
betes, in variable quantities, might be one of the new products.
Whether this theory were true or not, it was of practical im-
portance to remark the tendency to acidity in these cases of
intermitting diabetes. In such cases, animal diet alone, or with
alkalies, might stop the formation of sugar. It followed also,
that, when oxalate of lime, uric acid, and excess of urea, wTere
found in the urine, it was probable that the diabetes might be
temporarily, if not permanently, removed. The occurrence
or absence of these substances in the urine mis:ht lead to the
recognition of the stage of the disease, and tlvay might thus
guide us in our prognosis and treatment. The second part of
the communication related to the frequency of diabetes in old
age. Reference is made to a paper, by M. Dechambre, on this

36 Spasmodic Asthma. [January

subject, who concluded, from observations made on the urine
of old people at the Salpetriere, that sugar was habitually pre-
sent in the urine of old people. The author gave the particu-
lars of nine cases of diabetes in elderly people, and thought
that the occurrence of this affection at the latter periods of life
pointed also to the theory of diabetes as an indigestion result-
ing from an arrest of healthy changes in the food. The cases
mentioned in this communication were, in the opinion of the
author opposed to the view of diabetes depending upon an af-
fection of the nerves, or of the liver ; and his daily observation
led him rather to the view taken by Dr. Prout, that diabetes
was an indigestion, and that it first affected the non-nitrogenous,
and afterwards the nitrogenous, constituents of our food. As
regarded treatment, whatever was beneficial for excessive
acidity, was found equally serviceable in diabetes. Alkalies
were used in all the cases with benefit. Small meals, free from
lUgar and acid, and the substances that could glYe rise to sugar
and acids, constituted the best diet. He found, also, that vege-
table acids and alkalies were occasionally useful. In a foot-
note, the author mentioned some experiments he had not yet
published, determining the quantity of sugar in several kinds
of beer and wine. Porter contained from 27 to 57 grains of
sugar in each ounce of liquid; ale from 43 to 50 grains; beer
2."> to 40 grains; port-wine 8.5 to 11 grains ; sherry 2 to 4.7
grains; claret none. The absence of all sugar, and the pre-
sence of a little alcohol, caused claret to taste highly acid, while
the quantity absolutely present was not more, sometimes less,
than in other wines which have no acid taste, as, for example,
most port wine. [Med. Time* and Gazette.

On Spasmodic Asthma. By Professor Eben Watsoiv, M. D.

We find the following conclusions appended to a paper by
Dr. Watson, in the April number of the " Glasgow Medical
Journal:"

" I shall now recapitulate in brief terms the chief propositions
sought to be established in the preceding pages.

" 1st. That 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. That if this contraction at the glottis be in any way
overcome, that of the smaller bronchi either simultaneously or
speedily relaxes.

1854.] Case of Suffocation. 37

" 3d. That the usual remedies employed in cases of spas-
modic asthma are either such as are directed against the com-
plications of the disease, and not against its proximate cause,
or such as have been found in practice incapable of accom-
plishing its removal. The latter are therefore useless, and the
former unfit to fulfil the indication referred to above.

"4th. But this indication may be answered more or less per-
fectly in different cases, by the application of a solution of caus-
tic of moderate strength (gr. xv., or one scruple to one ounce)
to the glottis, which is the organ chiefly affected.

" 5th. 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.

"6th., and lastly, electricity passed in gentle currents, as much
as possible along the bronchial tubes, may be found to diminish
their contractility: and repeated small doses of strychnia may
likewise co-operate with the other means of treatment, probably
by withdrawing the nervous energy to other parts, at a distance
from the affected air tubes.'' [N. Y. Med. Jour.

Case of Suffocation. Reported by G. R. B. Horner, M. D.,
Surgeon U. S. Navy.

Sunday, June 10th. in the morning, Mary Berry, a girl about
seven years eld, residing in the south-eastern part of Philadel-
phia, put the top of a broken glass decanter-stopper into her
mouth. The top was globular, and about two inches around.
From some unknown cause she took along inspiration, and, as
she says, sucked it down her throat. It lodged at the entrance
of the oesophagus, and so obstructed that or the glottis, that she
immediately became strangled. Her mother and others about
her in vain endeavored to relieve her ; an apothecary was sent
for, and could not do so. Luckily, Mr. Isaac Hugg, an ingeni-
ous, long, slender-fingered tailor, living opposite, in Second-
street, heard the alarm, ran to the poor child's relief, and un-
derstanding what had happened, thrust his fingers into her
throat, but at first could not feel the stopper. He tried a second
time : after raising her feet upwards, her head downwards, and
over his knees, and after getting a finger under a projecting
point of the broken surface of the stopper, succeeded in throw-
ing it upon the floor. By this time the child was insensible,
but on the introduction of his fingers, gagged, assisted his ef-
forts, and was resuscitated, though pronounced dead by the
druggist, deceived perhaps by the lividness of her face, and
other fatal signs. Of the above facts I was informed while

x. s. vol. x. no. i. 3

38 Acute Peritonitis in Infants. [January,

passing her residence at the time of the accident, and by subse-
quent enquiry. [Medical Examiner.

Of Acute Peritonitis and its Diagnosis in Infants at the Breast.
By Dr. Isadore Henriett, Physician to to the Foundling
Hospital of Brussels.

The great frequency of affections of the system of serous
membranes in infants at the breast, is a subject worthy of the
deepest consideration of those who devote special attention to
the study and treatment of the diseases of children. The perito-
neum, the pericardium, the pleura, the meninges, far more fre-
quently than is believed, present pathological alterations which
prove the peculiar tendency of these exhalent organs to become
affected in children of early years. With the exception of
meningitis, the symptomatologic manifestations of which are
usually striking, these diseases are diagnosed with difficulty.
We do not mean to say that pleurisy, pericarditis, and inflam-
mation of the peritoneum can only be recognized after death,
but that the functional disturbances which they create are
frequently so slight as to require on the part of the physician
the greatest attention.

We shall attempt to extricate the latter disease from the ob-
scurities which surround it, by coordinating the elements of its
diagnosis which have been furnished by authors, and describing
what we have observed ourselves. We shall establish, finally,
its differential diagnosis from entero-colitis, a frequent disease
of infancy which maybe readily confounded with peritonitis.

In the first place, if we seek for the cause of idiopathic peri-
tonitis in young children we are quickly at a loss. Its sudden
development is not the least strange peculiarity of this affection.
We know that in the adult spontaneous peritonitis is rarely
observed, and that it is ordinarily encountered only in those
peculiar conditions which are produced by the puerperal state,
by traumatic lesions, and by perforations of the digestive tube.
Its etiology, then, is most uncertain. In the two cases which
have occurred in our service, without having recourse to sup-
positions and hypotheses, no cause could be inferred ; it is im-
portant to mention that there was nothing abnormal in the
umbilical cicatrix.

In the adult, the symptoms of peritonitis are well marked ;
it is difficult to mistake them : the symptomatology is so plain,
that without a want of experience that can only be admitted
in young persons upon their entrance upon the profession, it is
impossible to avoid a rigorous diagnosis.

Is it so in Infants ? No. Here we are destitute of the infor-

1854.]

Acute Peritonitis in Infants.

80

mation afforded by the patient ; here the disease is not reflected,
as in the adult, by the contracted face, the small, corded, peri-
toneal pulse. Pain upon pressure exists, indeed, and meteorism ;
but these two morbid manifestations occur also in affections of
the intestinal tube, and yet in a great measure the diagnosis
must be based upon them. It is therefore well to define accu-
rately their conditions, their intensity and progress in peritonitis
of young infants, as distinguished from entero-colitis.

The onset of peritonitis in infants is rapid ; we cannot say
whether it is preceded by shivering as in adults, but we can
assert that it is not announced by any prodromes. The pa-
tients that we have observed, enjoyed a satisfactory state of
health until the very onset of the peritonitis. As far as we
could perceive, until then they presented no unusual symptoms.

Entero-colitis commences less suddenly ; at first the child
refuses the breast, or suckles with indifference for two or three
days before the attack ; then borborygmus occurs, and the
evacuations soon manifest derangement.

In Peritonitis.

The abdominal sensibility is
greater than in any disease of the
abdominal organs : the child cries
upon the slightest pressure.

Meteorism occurs with the
greatest rapidity. At the very
commencement of peritonitis the
abdomen becomes tympanitic al-
most while we are looking at it,
while, at the same time dullness
is established over the inferior or
pubic region.

Vomiting is rare, and usually
occurs only at the outset ; the
matters ejected are unmixed, very
green, and stain a linen cloth.

Constipation was a marked
symptom in the two cases we ob-
served.

The countenance is little chan-
ged ; the eyes are more fixed than
usual, perhaps; the plumpnessof
form is unaltered.

The child is motionless, and
cries when it is moved.

The respiration is entirely tho-
racic, and is greatly accelerated ;
the inspirations are short and in-
complete.

In Entero-colitis.
The abdominal sensibility is
less acute ; slight pressure does
not cause the child to complain.

Meteorism occurs less rapidly,
and always bears a relation to
the intensity of the abdominal le-
sion.

Vomiting is frequent ; the mat-
ters ejected are almost always
mixed, and of a yellowish-green
color.

Diarrhoea is an almost constant
phenomenon.

The countenance is rapidly al-
tered ; the eyes and mouth are
surrounded by bluish rinjjs : ema-
ciation is rapid.

The child frequently flexes its
limbs upon the abdomen.

The same symptoms occur but
much less strikingly. The dia-
phragm does not remain motion-
less and passive as in peritonitis.

40 Acute Peritonitis in Infants. [January,

Such are the most striking symptoms which we have ob-
served. They differ in some respects, particularly in regard
to the appearance of vomited matters and of the countenance,
from those described by Billard, almost the only physician who
has carefully studied peritonitis in children at the breast, or
given a description of it at all complete. This is astonishing,
for since this author wrote, infantile pathology has been very
extensively explored, and several masterly treatises have been
devoted to it. In these, however, this redoubtable affection
receives only a passing notice. Some persons may complain
of our omission of the sigttS of peritonitis furnished by the gen-
eral symptoms and particularly by the pulse. We have not
mentioned them because they are identical with those observed
in other febrile affections.

Case I. Acute Peritonitis ; death. A male child, forty-two
days old, entered the hospital on the 25th of May. 1850. " The
lower limbs were covered by a papulous syphilitic eruption; a
sero-purulent, sometimes sanguinolent, discharge oozed from its
nostrils. In consequence of the obstruction of the nose, respi-
ration was laborious and lactation difficult.

The child was placed upon mercurial preparations, and con-
fided to a healthy nurse, and soon became fat and hearty. To-
wards the end of June the eruptions had disappeared, but the
ozaena was not cured. The nurse baVing conceived a
affection for the child consented to take the hi-chloride of mer-
cury in order to cure it. The results of this treatment were
soon manifested; the child improved most rapidly.

On November 8th, the child became obstinate all at once,
uttered cries, refused to take the breast ; the face was flushed,
the eyes fixed; vomiting of bilious matter occurred. The ab-
domen became enormously distended ; it was hot ; it could not
be touched without causing the child to cry and to shed tears.
Constipation ; hurried thoracic respiration ; high fever. (Two
leeches near the umbilicus, emollient cataplasms ; laxative ene-
ma ; diet)

The child cried all night, lying motionless in its crib.

On the 9th, more vomiting ; one consistent dejection. The
abdomen was very tense and painful. (Protracted warm bath;
four leeches to abdomen ; emollients.)

The child died in the conrse of the day.

Autopsy twenty-four hours after death. Noemaciation. The
peritoneal cavity was filled with a flocculent sero-purulent
liquid : there were various intestinal adhesions. The perito-
neum was highly injected; there was little or no redness of the
intestines, the mucous membrane was healthy ; the liver was

1854.] Acute Peritonitis in Infants. 41

covered by a purulent layer ; the intestines were greatly dis-
tended by gas. Xo other organs presented the slightest al-
teration, except the nasal bones, which were thickened from
periostitis. The umbilical cicatrix was complete, and without
redness.

Case II. Acute Peritonitis : death. A new-born child was
brought to the hospital, Xov. 17th, 1852. It was a female, very
small and feeble. The eyes were invaded by a grave purulent
ophthalmia. It was put under treatment for this affection, and
for a stomatitis (muguet) which supervened shortly after, and,
at the commencement of January, all of its functions were well
performed, it had gained flesh, and would have left the hospital
but for the inclemency of the season.

On the 14th of January, the child became cross, and cried
when it was moved, and showed no inclination to nurse. The
left lower extremity was oedematous, and was covered by
erysipelatous patches. (Hygienic precautions.)

Jan. 16th. The erysipelas disappeared from the left limb, but
invaded the opposite limb.

Jan. 18th. The inflammation abandoned the inferior ex-
tremities, and attacked the left side of the trunk and the
lower part of the arm. In the evening there was bilious vom-
iting.

Jan. 19th. The abdomen became enormously distended ; the
child no longer vomited ; the belly was hot, and excessively
painful. The slightest touch made the little patient cry. There
was dullness at the inferior portion of the abdomen, but fluctua-
tion could not be perceived ; the face was flushed, the eyes
fixed, the inferior extremities motionless, the respiration incom-
plete, thoracic ; one consistent dejection ; fever. The erysipe-
las was still manifest on the arm. (Four leeches to the abdomen ;
emollients ; laxatives ; diet.)

The child died in the afternoon.

Autopsy. Liver enormous, fatty, yellow. Sero-purulent
liquid in peritoneal cavity ; recent false membranes and adhe-
sions of the intestines ; a slight amount of purulent serosity in
the left pleural cavity. The lungs, spleen, and intestines pre-
sented no pathological alteration. The cellular tissue of the
left leg and arm was infiltrated by serum. There was nothing
abnormal in the articulations.

In this case the peritonitis was discovered during life. The
case which preceded it had taught us a useful lesson.

We shall say nothing of the treatment of this disease,
except that it is our intention, having derived so little bene-

42 Acute Peritonitis in Infants. [January,

fit from antiphlogistics and emollients, to combine the mer-
curial preparations with these, when the occasion presents
itself.

We are not, however, very sanguine as to the eventual re-
sult of this combined treatment, for death arrives so promptly
in this disease, that we can hardly believe that constitutional
therapeutical agents can have time to act.

Case III. Acute peritonitis; volvulus; death. Since we
recorded the preceding observations, we have met with a third
case of peritonitis in anew-born child, complicated with volvu-
lus. This is its history :

A female child, born at the Maternity, was brought to the
hospice on the 22d of March, 1853, the seventh day after his
birth. It was a large infant, of good constitution. Its body
was covered by psoriasis guttata. Suspecting a specific cause,
although we could not detect the opaline border which Biett
regards as the pathognomonic sign of the venereal affection,
we confided the child to a nurse who was already taking mer-
curial preparations for the cure of a syphilitic child whom she
was nursing.

Until the sixth day after her admission, we observed nothing
in the little patient ; she nursed well, slept well, her functions
were well performed, the eruption did not progress; but, on
the 28th, we found a radical and menacing change in her situa-
tion.

The abdomen was tense ; there was considerable meteorism,
exquisite sensibility, dullness above the pubes, short and hurri-
ed respiration ; the countenance was anxious; the eyes were
fixed; the limbs were motionless; the child cried when she
was moved ; she had not urinated since the preceding evening;
no vomiting; constipation; feverish pulse; cold extremities;
the eruption had faded.

The catheter was passed, but it did not evacuate a single
drop of urine. The child was placed in a hot bath, with the
hope of bringing back the eruption ; the abdomen was foment-
ed, emollient injections were administered, and a table-spoonful
of the syrup of manna.

In the afternoon of the 28th, the patient vomited yellowish
matters resembling faeces to the eye, but inodorous. The pso-
riasis had completely disappeared. The little patient was ex-
piring.

A catheter introduced into the bladder and also into the
rectum brought away neither urine or faeces. The diagnosis
had been written over the patient's cradle : Acute peritonitis
anal volvulus.

1854.] Acute Peritonitis in Infants. 43

The child died, then, on the day upon which the disease com-
menced.

Autopsy. Several of our colleagues and resident students of
St. John's hospital were present at the post-mortem examina-
tion.

The bladder was contracted, it contained not a drop of urine;
the peritoneum was highly injected, and contained a turbid
flocculent serum ; the intestines were glued together by a grey-
ish, semi-liquid substance: the small bowels were strangulated
by bands of lymph ; the ileum was invaginated ; the rectum
was empty, whilst the portion of intestine above the obstacle
was filled with yellowish liquid. The convex surface of the
liver was covered by false membranes; the spleen was enlarged.
The lungs, kidneys, encephalon, heart, and other organs, were
normal.

This observation (case ?) is interesting in several particulars.
It confirms, in the first place, the description we have already
given of the symptoms and progress of this disease ; and it was
accompanied by a phenomenon which is not mentioned byanv
of the physicians who have written upon the diseases of infancy,
a complete suppression of the urinary secretion. As to the
causes of this symptom, we can only speculate upon them.
There is another important question in connection with this
case. Can it be regarded as an example of spontaneous, idio-
pathic peritonitis. Many physicians deny such a disease alto-
gether, but a careful examination of the above case seems to
demonstrate its existence. In fact, the first symptom which
appeared was the rapid distension of the abdomen, accompani-
ed by the ordinary symptoms of peritonitis in children, with
dullness above the pubes, whilst the psoriasis still preserved all
its distinctiveness, and showed no tendency to disappear. A
metastasis could have been inferred if the abdominal symptoms
had followed the disappearance of the cutaneous eruption, but
this was not the case.

We shall conclude these brief and incomplete remarks by
insisting upon a capital fact, which we noticed in each of our
three patients: the rapidity with which effusion and the organ-
ization of false membranes occurred. As soon as pain and
meteorism were discovered, percussion indicated that effusion
and purulent agglutination had also taken place. We have not
spoken of fluctuation, because we were unwilling to resort to
the manoeuvres necessary to detect it. in consequence of the
extreme pain which they would produce. [Journal de Mede-
cine de Bruxelles. Virginia Med. and Surg. Journ.

44 Cancerous Growths. [January,

Cancerous Growths. Experiments of Dr. II. A. Johnson.
Artificial Tissues. By E. Andrews. M. D.

Cancer growths have long defied the investigations of knife
and microscope, of retort and crucible, to disclose the condi-
tions of their malignancy. Probably bolder sweeps must be
made by the wing of Science before we shall see the unlocking
of this mystery. The scope of investigation, however, at pre-
sent leads us to hope that we may yet succeed in forming
artificial tissues, and learn from them the conditions of their
growth and means of their extermination.

Dr. Johnson, one of the enterprising editors of the N. \V.
Medical Journal, has given this subject ;m examination. He
remarks (vol. 1, p. 1, new series,) that the anatomical cause of
the malignancy of cancer is the continual and irrepressible
growth and reproduction of cells. lie next shows, by chemi-
cal analysis, that there is in these growths a remarkable pre-
dominance of inorganic salts, and also remarks upon the fact
that malignant growths are most frequently found where cell
growths predominate, as in glands and mucous membranes,
but most frequently of all in those glands to which there is a
special determination of these salts, as the testes and the mam-
mae. The experiments of Beneke and others have even shown
that these salts, particularly those of lime, soda and potash,
may actually be made to generate bodies resembling cells, out
of the body. Dr. Johnson repeated and Varied these experi-
ments, with a view to ascertain whether these salts might not
have such a cell-producing power as to account for the inordi-
nate cell growth of cancer. His notes are as follows :

"Exp. No. 1. Albumen, fat and water, intimately mingled
together. Exposed to a uniform temperature of 104 F. Ex-
amined after nine hours contains oil globules, granules, and a
few imperfect celluloid bodies. After twenty-two hours no
perceptible change noticed.

*'Exp. No. 2. Albumen, oil, water and phosphate of lime.
At the expiration of ten hours, contains granules and bodies
resembling the cells found in pus and mucus. After twenty-
two hours, granules previously noticed very abundant bodies
resembling pus or mucus globules, with masses of matter very
similar to those sometimes found in the urine, and composed
of epithelial scales. After seventy hours fewer of the granules
and a large number of the celluloid bodies. Upon the addition
of acetic acid, dark spots are seen having all the appearance
of nuclei ; each globule seems to have a perfect cell wall.

" Exp. Nos. 3, 4, 5 and 6 were variations of Nos. 1 and 2,
by subjecting to pressure during the process, and by adding to

1S54] Cancerous Growths. 45

the preparation a small quantity of super, carb. soda in solu-
tion. The results were similar to those previously noticed.

u Exp. No. 7. Oil. phosphorus and water enclosed in a piece
of bladder, and placed in a cup containing albumen. After
thirty-six hours the albumen in the cup contains granules and
celluloid bodies, as in previous experiments the bladder is
nearly empty with the exception of gas which is distended.
In the drop of fluid remaining there is found an abundance of
the phos. lime, oil globules and the celluloid bodies. Acetic
acid affects them precisely as it does organic ceils. Ether
renders the walls more opaque.

''Exp. No. 8. Repetition of No. 7, with like results.

"Exp. No. 9. Albumen, water, and super carb. soda in a
glass tube, closed by clean fresh membrane, and immersed in
a cup containing oil, water and phos. lime held in solution by
acetic acid. After twenty hours the fluid in the cup contains
granules, celluloid bodies, and triangular prismatic crystals, al-
most exactly like those of the triple phosphate found in the
urine. In the tube are granules and a few celluloid bodies.

"Exp. No. 10. Albumen, water, phosphate of lime, slightly
acidulated with acetic acid, in a tube closed by membrane, and
placed in a cup containing oil, super carb. soda, and water.
After twenty hours the fluid has all passed out of the tube into
the cup, which contains bodies like those already described,
and others of greater size, more irregular outline, and con-
taining large distinct nuclei.

"Exp. No. 13. Oil, phos. lime, and water slightly acidula-
ted, in a tube closed by membrane and placed in a cup con-
taining albumen, water and carb. potass. After twenty-four
hours the cup and tube both contained celluloid bodies of small
size and very regular outline."

From these experiments he concludes that the inorganic salts
favor cell development, and that the presence of these salts in
excess is the cause of that ungovernable growth and reproduc-
tion of cells which is the element of destruction in every cancer.

He derives from these facts two indications of treatment.
First, to prevent the receiving of the salts into the system.
This he would accomplish by making the diet as purely vege-
table as the patient will bear, vegetable food containing less of
the obnoxious substances than animal. The second indication
is to remove from the system as much as may be the salts that
accumulate in it. To this end he would make free use of the
organic acids, particularly the lactic, because these acids readily
dissolve the calcareous and other salts, and these keep them in
a condition to be eliminated by the proper excretory organs.
This subject of the formation of artificial tissues is still under

46 Cancerous Growths. [January,

investigation in Europe. The British and Foreign Medico-
Chirureical Review for April speaks of artificial cells formed
by M. Panutn, from the serum of blood, resembling milk cor-
puscles. He first obtained from the serum a substance resem-
bling the caseine of common cheese ; this substance he dissolv-
ed by adding phosphate of soda, and then added butter and
sugar in the proper proportions for milk. The whole being
shaken up and then allowed to cool, had the white color and
very much the taste of real milk. Under the microscope,
corpuscles like milk corpuscles were observed, and also bo-
dies like nuclei of cells with nucleoli in them. Animals
readily drank and digested this artificial milk, but it differed
from the natural product in not being capable of perfect co-
agulation.

M. Melsens has been experimenting with artificial fibrous
tissue and membrane. He makes a saturated solution of albu-
men and some salt, and then exposes it to a violent shaking.
In consequence of the agitation the clear solution becomes
turbid with fibres, which when allowed to come to rest and
settle in one stratum, form a sort of membrane. These fibres
under the microscope, have a clean outline and look like per-
fectly organized bodies, resembling the yellow fibrous tissue.
These experiments arc interesting, as tending to bring all the
resources of science to settle the question whether art can ori-
ginate organized tissues. The above experiments, plausible as
they seem, are not perfectly satisfactory : for although we can
understand that a globule of oil floating in a saline albuminous
solution, might by chemical action, form a solid covering or
sack around itself, it is not clear that it would be any thing
more than a chemical precipitate on the surface of the oil. It
is not fairly proved yet whether these artificial cells can or
cannot perform the vital functions of secretion, reproduction
and nutrition. A similar remark may be made of the fibres
spoken of. The form resembles that of known organized fibre,
but whether they are possessed of any property of life is not
known. The fibrous form is not decisive as to vitality, because
we can easily conceive that the curling eddies in the agitated
fluid might draw the forming albuminous precipitate into fibres
and shreds without a particle of living tissue being in existence.
Yet it is gratifying to find that investigators are going on in
the attempt to form living tissue, for if they succeed they will
shed a flood of light on obscure diseases, and if they ultimately
fail, it will be almost as valuable as a negative result, as suc-
cess would be for a positive one. It will be a great point
gained when we know whether organic synthesis is or is not
possible to the chemist. [Peninsular Journ. of Med.

1854.] Modus Operandi of Fecundation. 47

On the Modus Operandi of Fecundation. By Waldo I. Bur-
nett, M. D.

With every inquiring mind there is a deep interest connected
with the development of animal life. To watch the origin and
rise of new forms, to trace the successive phases through which
they pass, as the ideas on which they are based become more
and more definitely expressed, until finally the perfect animal is
produced, these have been favorite studies from the earliest
times with some of the most genial minds, and over which they
were accustomed to dwell with increasing delight. But more
interesting still, because more wonderful, is the study of those
necessary preliminaries of all individual development the
mysterious conditions of fecundation. To observe, after nature
has prepared the material, how she puts up a new structure,
and to trace the adaptive idea in the laying of each part, require
but opportunity united with careful diligence and patience.
But to lift the veil beneath which lie hidden the more than
mysterious relations of individuality, this is to tread on the con-
fines which separate the material from the immaterial world.

There is no question in physiology so difficult and at the
same time so interesting as How is a new individuality started
by the conjugation of the sexes; and where so little could be
observed, there has been more scope for speculation.

In modern times, however, with certainly better instruments
if not better opportunities, we have looked for less talk and
more knowledge ; and in this respect, it may be justly said that
we have approached pretty near that boundary, which, as it is
the limitation of that which can be perceived by the senses, is
the real confine between the known and the unknown in physi-
cal science.

As it would be profitless to notice the labors of those numer-
ous men, who, in this department have written upon what they
really knew nothing, yet speculated much, we shall attempt to
show the state of our real knowledge on this ultimatissimum of
phvsiology the modus operandi of fecundation.

Modern histological studies, have, we think, pretty definitely
settled two fundamental and important points: 1st. That the
ovum is, morphologically, only a nucleolated cell ; and 2nd.
That the sperm cell is the true homologue of the ovum.

The ovum (fecundated) produces the embryo ? the sperm-
cell the spermatic particle. The embryo and the spermatic
particle are the correlative representatives of the female and
the male sex. One is the metamorphosed nucleus (vitellus) of
the one ; the other the metamorphosed nucleus (nucleus of the
(laughter cell) of the other. In both, the ovum and the sperm

48 Modus Operandi of Fecundation. [January,

cell, the process of segmentation seems a necessary preliminary
to the evolution of the new being.1

The strict correllation between the essential products of the
sexes is as wonderful as it is beautifully suggestive of the unity
and simplicity of plan by which nature proceeds. This point,
so seductive in all its relations, might be dwelt upon in detail,
but we will continue with main and general facts. The ovum,
as a nucleated or nucleolated cell, continues to grow, and what-
ever size it may attain to by the endogenous formation within
its capsule of new cells, yet, when complete, it is, (even though
belonging to the Ostrich or Epiomis,) morphologically, only
a great compound nucleated or nucleolated cell. All these
conditions of origin, growth, and maturity, can be satisfactorily
studied in the lower animals, and we would especially recom-
mend the compound Ascidiaj lor this purpose. The ovum,
thus complete, is ready lor fecundation.

We have already said that the sperm cell is the analogue, or
more properly homologue, of the ovum ; its origin and develop-
ment, as we have traced them in all their details, are precisely
the same as those of the ovum. The sperm cell increases to a
definite size, its nucleus (vi tell us) then regularly segments, 2, 4,
8, id, &c, and the results of this segmentation, are daughter-
cells. The condition of the sperm-cell at this moment is like
that of the ovum produced by the same process of segmenta-
tion. I mean the mulberry-like condition. But at this point
there is a digression, for with the sperm-cell the nucleus of
each of the daughter-cells is changed into a spermatic particle,
while with the ovum, the whole mass is metamorphosed into
the new being by a process of substitution.

The spermatic particle, then, is only a metamorphosed nu-
cleus of a cell, and, perhaps, were the analogy carried out
completely, each daughter-cell would be the representative of
a miniature ovum.

Physiologically, the phenomena we have thus briefly descri-
bed, obtain equally in the vegetable kingdom; for, as recent
discoveries have shown, even in the simplest cellular plants
there is a conjugation of two kinds of cells, the product of
which terminates in a new generation ; in the other plants, the
superior cryptogamia, and the phanerogamia, there are parts
which in a developmental as well as morphological point of
view, correspond to the essential male and female products of
animals. f

* See Researches on the origin, mode of development, and nature of the sper-
matic particles among the four classes of the Vertebrata. Mem. Amcr. Acad.,
N. S., v, pt., i, 1853.

t We would refer to a profoundly physiological memoir by Robin, titled:
"Ovum, its existence as well in the male as in the female of plants and ani-
mals," &c. Comp. Rend., 1849.

1854.] Modus Operandi of Fecundation. 4#

Throughout the organized world, therefore, the conditions
which wait upon the true generative process are the same the
combination of the repiesentative products of two distinct
sexes and these products, whatever may be said of their form,'
are always physiologically the same; they are cells or cell-
products.

Here we would make a general statement which embodies a
great deal of physiology on this subject: A true generation
must be regarded as resulting only from the conjugation of two
opposite sexes, from a sexual process in which the potential
representatives of two individuals are united for the elimination
of one germ. The germ power thus produced may be extend-
ed by gemmation or by fission, but it can be formed only by
the act of generation, and its play of extension and prolonga-
tion by budding or by division must always be within a certain
cycle, and this cycle is recommenced by the act of the new
conjugation of the sexes.

In this discussion, we have satisfactorily reached this point
that the ovum and the spermatic particle are the potential rep-
resentatives of the sexes to which they respectively belong.
From their union results the condition of fecundation ; the
grand question now is, what is the modus operandi of this fe-
cundating act? BischofFs view, based upon speculative pro-
babilities rather than upon observation, is, that contact alone
of the spermatic particle wTith the ovum being sufficient for
fecundation, impregnation consists in a kind of catalysis which
has its exemplification in chemical conditions as enunciated by
Liebig, (see loc. cit., p. 425.) But if catalysis embodies
conditions in the organic like those of its relations in the inor-
ganic world, it falls very far short of affording the requisitee
xplanation of these phenomena, as we hope soon to show.
This field of probabilities and possibilities we shall enter upon
again.

Newport's contributions upon the physical phenomena of
this subject are far the most complete that we have, and being
the results of a most trustworthy observer, they deserve our
special attention.

Newport's experiments and observations show, in brief, that
contact alone of the spermatic particles with the ovum is requi-
site for fecundation, that each ovum requires several particles ;
and that there must be duration of this contact. Here is a
limit to observation of physical facts, and we regard these im-
portant data worthy of full trust, considering the source from
which they come. This author discusses briefly the question
of the impregnative power, and from the fact that the spermatic
particles are sometimes seen to disappear on the surface of the

50 Modus Operandi of Fecundation. [January,

egg-envelopes, he thinks it may be fair to conclude that the
agency of this body is material in its operation ; on the other
hand, the fact of a mere momentary contact producing changes
in the ovum, suggests in his mind the so-called catalytic power
of certain known bodies. But he thinks that neither this last,-
nor endosmosis, are sufficient to account for the phenomena of
this grand act.

The view of Keber, has at least the merit of being unique if
nothing more. As long ago as 1838, Martin Barry* announ-
ced that he had observed spermatic particles without the ovum.
It should be mentioned however, that long previous to this,
Prevost and Dumasf in their researches found these particles
within the envelopes of the eggs of frogs. But Keber's alleged
discovery is. that the introduction of the spermatic particles
within the ovum, takes place through a special opening, a kind
of micropyle, or an infundibuliform passage. This discovery
was made upon the eggs of muscles (Unio and Anodonta.)

The announcement of the presence of such a structure on
the ovum is indeed wonderful, and more especially so since
other observers, whose attention has been particularly directed
to the embryological study of these animals, have failed to no-
tice it, although one would suppose that an apparatus of this
kind must be very visible. Keber affirms that he has observed
a like structure in the ova of some other animals which he has
examined. But, however well fortified he has sought to make
his observations, they certainly need more than the usual con-
firmation, and we cannot but regard it as far from being a set-
tled fact in embryology, that the ovum has a direct structural,
communication externally for the ingress of spermatic particles
to its interior.

After all this discussion of facts, we revert to the primary
question, what is the nature of the fecundating act? We have
seen that its physical phenomena consist in the contact of ac-
tive vital spermatic particles with the mature ovum ; that this
mature ovum, thus affected, experiences peculiar changes which
terminate finally in the evolution of a new being possessing the
characteristics of the male as well as the female parent. It is
true that, as was observed by Prevost and Dumas, and as has
since been confirmed by Barry, Newport, and others, the sper-
matic particles may force their way through the envelopes of
the egg some distance into its interior, but we regard this as an
unessential condition of the fecundatory act ; adhering by their
heads to the envelopes of the egg, the incessant action of the
tails of these bodies would obviously tend to force them inwards,

* Barry Philos. Transact., 1840, pt. ii, p. 5321843, pt. i. p 33.
1 Prevost and Dumas, Ann. d. Sc. Nat. ii, p. 233.

1854.] Modus Operandi of Fecundation. 51

and especially through such homogeneous, soft tissues as the
egg-envelopes.

By referring to the resultant phenomena of this fecundating
process, we may perhaps gain some insight into the conditional
if not the real nature of its agency. We have already said
that the spermatic particle is the potential representative of
the male: what signification is to be attached to its mere phy-
sical form, that is. whether it is conical, globular, &c., we know-
not; and this seems the more hidden from our perceptions,
from the fact that exactly similar forms and sizes, in fact,
phvsical relations apparently identical belong to spermatic
particles of animals as widely dissimilar as could be. This
fact alone, of the correctness of which we are well assured
from our own observations, should be sufficient to convince us
that we have here to deal with no very simple relations or
properties. But let us pursue the subject a little further. I
scarcely need remark, that the offspring partakes equally of the
phvsical peculiarities of both parents. It will at once be per-
ceived, that in no way can the child receive those of the father
except through the medium of the spermatic particles. And
so, however strange it may appear at first, yet the conclusion
is irresistible that spermatic particles must contain, concealed
within them, in fact must be the vehicles of, not only the gen-
eral peculiarities of the father as an animal, but mental disposi-
tions also, and as is too often true of our own species, morbid
taints superadded to all. It is wholly insufficient to say with
BischofT, that these anomalous conditions belong to the catalytic
action ; or with Newport, that they may be the exemplification
of a force, peculiar and sui generis. For there is something
above and beyond the wakening of latent forces, of one parti-
cle that is positive with another that is negative. The grand
fact is, that the act of fecundation includes whatever may be
said of its also vitalizing the ovum the communication or the
transmission of the individuality of the male parent to the
ovum ; and the material organ of this transmission is. exclu-
sively, the spermatic particle. We cannot see that these phe-
nomena have an adequate explanation in any chemical relations
of matter yet known, and what is more, we cannot conceive
the possibility of this ever being the case, unless, indeed, chem-
istry gets beyond the domain of physics. Xot but that chem-
istry involves points which are equally obscure, such as affinity,
isomorphism, &c., but then the conditions of vitality, and espe-
cially the grand manifestation of it in question, certainly seem
to us to include relations which have no correlation whatever
with those pertaining to inorganic matter. To us the rela-
tions and conditions of cells, which are the primordial forms-

52 Hemorrhage from the Throat. [January,

of organization, demand the teleological view of organic life.*
Individuality is the distinguishing feature of organization, and
we recognize in it something more than a mere collocation of
phvsical conditions ; we regard it as an Idea which exists be-
fore organization, which last is only the language in which the
Idea is expressed. The conditions of this process of fecunda*
tion which we have just reviewed, will accept no other expla-
nation, say what physiologists may about the unphysical char-
acter of such a view ; we must have something beyond mere
co?nhination, which lies with physics; this we have in develop*
ment, which lies with life.

In conclusion, wo may say. that as the domain of science
lies with demonstrable phenomena, bo its legitimate study is
with the sensible and tangible. The conditions of immaterial
agencies, and their relations with material forms, must be ac-
i as pure phenomena incapable of the analysis of ordinary
scientific facts. But after all, how ranch more of an enigma is
the process of fecundation than the essence, the primordial
cause of every thing connected with both the inorganic and
organic world about us. Science should put out her long,
tentacular arms in all directions, laying hold of the tangible
and the sensible, but it should be remembered that the supra-
sensible is beyond her pale, and that "multa esse constant in
corpor> quorum vim rationemque perspicere nemo nisi Qui fecit
/." [Siliiman't Journal.

Hemorrhage from the Throat, produced />>/ Cod- Liver Oil.
By Professor Gamberini.

Many pathologists have accused cod-liver oil of causing
haemoptysis, but as this symptom is so common in those suffer-
ing from pulmonary tubercles, it is difficult to determine whe-
ther it is due to the remedy, or to the ordinary effects of the
disease itself. In order to obtain a positive solution of this
problem, it is necessary to study the phenomenon in question
in individuals using the remedy, who are exempt from any dis-
ease of the respiratory organs. It is upon such data that Dr.
Gamberini has endeavored to discover the truth.

Every physician who prescribes cod-liver oil is accustomed
to hear his patients complain of a sense of heat and burning in
the throat, which varies in duration and intensity, and some-
times makes it necessary to suspend the use of the remedy. If
the fauces are then examined, a deep redness will be observed,
extending over the whole of the superior portion of the pharynx,

* See The Relations of Cells to the Physical and Teleological views of Or-
ganization, in Silliinan's Journal, xv., 87, Jan., 1853.

1854.] Impalement upon a Pitchfork-handle. 53

over the palatine arch, and the tonsils. The capillaries appear
engorged ; sometimes the epithelium is apparently removed.

When this condition occurs, a transudation of blood often
supervenes, to the patient's great alarm, and the no small em-
barrassment of the physician. The blood sometimes scarcely
colors the saliva, and sometimes forms considerable coagula.
The haemorrhage is often preceded by pruritus and cough. If
the remedy is persevered in, notwithstanding these symptoms,
the haemorrhage increases. On the contrary it ceases prompt-
ly when the medicine is suspended.

Auscultation excludes the idea of an alteration of the bron-
chial mucous membrane, or of the pulmonary tissue, a negative
proof, which, when combined with direct inspection, is suffi-
cient to enable us to assign to this haemorrhage its true seat
and cause.

The researches of Dr. Gamberini will doubtless, as a first
result, inform practitioners of the possibility of this accident,
and the change of prescription which it indicates. Pereira
and Cartoni teach that cod-liver oil should be rejected in the
treatment of phthisis, because it favors the recurrence of
haemoptysis. Is it not very probable, if the foregoing explana-
tions are correct, that these authors have been deceived in re-
gard to the phenomenon, and have mistaken a staphylorrhagia
for the haemorrhage caused by the softening of tubercles ? This
question acquires great importance from the fact that cod-liver
oil is probably the best remedy for certain forms of phthisis,
and that, consequently, it would be most unfortunate to attri-
bute to it dangers which it does not possess, and to deprive
ourselves of a precious resource against true haemoptysis, in
consequence of chimerical apprehensions. [Bulletino della
Scienze Mediehe. Gaz. Med. Paris. St. Louis M. fyS. Jour,

By a singular coincidence the following two very remark-
able cases are reported in the same number of the American
Journal of the Medical Sciences, (Oct., 1853.)

Impalement upon a Pitchfork-handle, entering per Yasinam:
Recovery.

Dr. Sargent, of Worcester, reported (to the Boston Society
for Medical Improvement) the case, which had occurred in hfs
practice nearly two years ago. A lady, of abou] 37 years of
age, who had borne several children, the last about three vears
previous to the injury about to be mentioned, and whose last
menstrual period had been about a week before, her bowels
also being in good lax condition, in sliding down from a hayloft,

x. 3. vol. x. no. i. 4

54 Impalement of a Pitchfork-handle, c. [January,

impaled herself upon the handle of a pitchfork, which passed
in at her vagina to the length of twenty-two inches, when her
feet struck the ground. The handle was immediately with-
drawn, the patient carried into the house, and Dr. S. sent for.
He found the patient, half an hour after the injury, lying on her
back, with the thighs flexed, and the skin cool, pale, and moist
(as if from fright), and the pulse not much accelerated. There
was no external injury, and no physical evidence of effusion
into abdomen or thorax, and no urine nor feces on the gar-
ments, nor about the person, nor on the field of the accident,
nor on the handle of the fork. There was some blood flowing
from the vagina. Patient passed water during the visit, and it
was not stained with blood. She complained most of pain in
the left thorax, on a line with the scapula. Dr. S. saw the
handle of the fork, which was rounded, a little larger at the
end than otherwhere, perfectly smooth, two inches in diameter,
and showed distinctly the stain of blood up to an abrupt line,
twentv-two inches from the end.

Dr. S. theorized, in this case, that the instrument must have
perforated the vagina at its upper part to the left, and gone
between the uterus and rectum. [If it had gone to the right,
it would have perforated the caecum.] The form of the instru-
ment would make it much easier for it to pass between than to
perforate organs, and Dr. S. supposed that it passed in front of
the kidney, behind the spleen and between the diaphragm and
false ribs, peeling up the costal pleura till it reached the scaleni
muscles. The subsequent history of the case, which showed \i
fracture of the first rib, while, also, there was at no time any
effusion into the chest, proved this diagnosis correct. Sup-
posing that the greatest safety of the patient was in what might
be called forced rest, Dr. S. gave her one grain of morphia
(by estimate), and bound her chest firmly with a broad bandage
of new flannel, placing a towel, wet in cold water, between this
and the skin. The morphia was repeated in an hour, and one-
third of a grain three hours after. Patient passed water re-
peatedly in first twenty-four hours, without trouble and without
blood, and passed coagula from the vagina. The day follow-
ing, there was emphysema above left clavicle ; and, the day
following, crepitus in left axilla high up, as if from fracture of
bone. There was at no time any evidence of pneumonia or
pleurisy, though there was deficiency of respiratory murmur
in left chest from the pain in its expansion, the percussion re-
maining good.

The pulse stood at 120 for several days, and the opiates were
continued about as long.

The injury was inflicted the 7th of August, 1851, and Dr. S.

1S54.] Extensive Laceration and Contusion. 55

was in daily attendance for nine days; and, occasionally, after-
wards,, for three weeks. The recovery was entirely favorable,
the patient being left only with an ill-united fracture of the first
rib, over which there was some painful swelling for several
weeks, which ultimately subsided, leaving an osseous promi-
nence in the supra-clavicular region, in intimate relations with
the scaleni muscles.

Extensive Laceration and Contusion: Recovery. By G. S-
Bryant. M. D., of Aberdeen. Mi. (Communicated bvProf.
C. D. Meigs.)

Dunns mv residence it) Amherst county, Va., in 1S50, I was
called, on the 25th of April, at about 3 P. M., to see Phoebe, a
slave, aet. 25. black, smooth skin, small stature, and the mother
ofthree healthy children.

On arrival, learned that, at about 2 P. M., patient had leaped
from the height often feet, and alighted upon a tobacco-stick,
which had been driven firmly in the ground and was concealed
by some loose fodder. The stick was four and a half feet lnng,
and one inch square. The vagina was entered without doing
much injury to the vulva ; the stick passed up the canal, and
perforated iis walls on the right side of the os uteri, entered
the cavity of the abdomen, and passed in an oblique direction
upwards, and finally lodged against the twelfth and eleventh
ribs of the fight side.

4 P. M. Hemorrhage quite subsided, but at the time of the
accident it was very profuse from vagina ; pulse 120, and very
small; extremities cold ; countenance anxious ; pain in abdo-
men distressing : nausea and frequent vomiting ; mind clear.

Treatment. R. Tinct. opii. 3j. ; brandy 3 ij. To be given
at once, and repeated every hour or two until reaction, or re-
lief was obtained : warm applications to the extremities, and a
poultice to the entire abdomen, constituted the principal treat-
ment.

26th, 4 P. M. Slept during the latter part of last night, and
has been sleeping occasionally daring the morning, but is not
altogether free from pain. Reaction took place about 12 o'clock
last night ; pulse now 110, quick and hard; abdomen much
swollen, hard, and tender to the touch ; complains a good deal
of the side, about the point where the stick lodged, and the
lower region of the liver. The swelling and contusion exter-
nally are considerable, and she cannot bear the part to be
handled ; vulva very much inflamed ; passes water with much
pain and difficulty.

Dover's powders, grs. x., at bedtime, to be repeated during

56 Extensive Laceration and Contusion. [January,

the night if necessary ; effervescing draught every two hours ;
continue poultices.

27th, 10 A.M. Rested pretty well last night; pulse 112,
hard ; skin dry; abdomen very much distended and painful to
touch ; eyes very red ; has vomited some bilious matter ; pass-
es her water still with difficulty; bowels have not been moved
since accident, fy. Hyd. chlor. mit. grs. vj. ; rhei, grs. x.
Make iv. pills ; to be given at once, and followed by an enema
of soap and water in six or eight hours, if no action is had by
this time; anodynes and poultices continued ; vulva to be fre-
quently cleased with Castile soap and warm water.

28th, 11 A.M. Pulse 100 and softer; has had several bilious
discharges; some discharge of pus from vagina; no other ma-
terial change. $. Blue mass, grs. xvj. : Dover's powder, grs.
xi. Make into viij. pills. One to be given every six hours.
Continue effervescing draught, poultices, &c.

29th, 10 A. M. Abdomen enormously distended, dull on per-
cussion and painful on pressure; bowels have been moved
twice; discharges of bilious character; pulse 118, small and
quick; rested badly last night; skin dry, tongue coated over
with a brown fur. Continue treatment.

30th, 10 A. M. Had, about 2 o'clock last night, a copious
discharge of grumous blood from the bowels, which discharge
continued to occur every hour or two until 9 A. M. this morn-
ing; could not ascertain the exact quantity, nurse supposed it
to be from seven to eight quarts ; this is no doubt a too liberal
estimate. Abdomen has gone down very much; pulse 130,
small and feeble; skin dry and cool ; she seems quite exhaust-
ed ; vaginal discharge continues. Ordered half a grain of sulph.
morphia at once ; infusion of serpentaria B>, to be given at
intervals of two hours. Continue pills and poultices, but dis-
continue draught.

May 2, 9 A. M. Abdomen much flattened ; had two bilious
discharges yesterday, free of blood; pulse 112, small and soft;
vaginal discharge more profuse ; passes her water freely ; skin
dry , has some appetite. Continue treatment.

4th, 10 A. M. Has done well since last visit, until last night.
Nurse thinks she was alarmed by a conversation which took
place in the room upon the subject of death and her probable
recovery. After an hour or two she was better, and again ex-
pressed her belief that she would get well, never before having
any doubt about her recovery. Bowels have been moved once
this morning ; biliary secretions improving: skin continues dry ;
pulse 108; appetite better. Continue treatment; is allowed a
more nutritious diet.

6th, 10 A. M. Pulse 108, soft ; skin moist ; bowels in good

1854.] Diabetes Mellitus. 57

condition ; appetite good ; vaginal discharge diminishing ; com-
plains of little else than soreness in the right side.

Ordered tonics and better diet : mercury discontinued ; no
appearance whatever of its constitutional effects.

8th, 12 ML Convalescing. Continue tonics.

11th, 11 A.M. Convalescing rapidly.

Recovered fully by the middle of June following.

On the Nature and Treatment of Diabetes Mellitus, or Glu-
cosuria. By M. Bouchardat.

[The following abstract upon this subject is taken from the
review of an article in the memoirs of the French Academy,
185-2.]

By the plan which M. Bouchardat now recommends to our
notice, in its full detad, he declares that he can cure the major-
ity of cases of diabetes his test of cures being not only present
removal of the sugar from the urine, but the ability of the
patient to employ feculent aliment, without its reproduction.
He, however, requires the intelligent co-operation of his patient,
and, above all, the frequent testing of the urine, by the patient
himself, as a means of ascertaining progress and guarding
against relapse. The means chiefly to be relied upon are those
of hygienic character ; and at all events the power of these
should be exclusively ascertained at first, before resorting to
any medical agents.

1. Diet As long as the urine exhibit sugar, all feculent and
saccharine aliments must be entirely excluded ; but the patient
need not be confined to what is called an exclusively flesh diet,
although this, when not repugnant to him, is the best. Every
description of meat, dressed with the usual sauces and season-
ings (to the exclusion of flour, however) may be employed ; and
for those who can get over the prejudice against it, the flesh of
carnivorous animals, M. Bouchardat says, is best. By proper
management (and what cannot a French cook do ?) that of
the cat or fox becomes a highly relished viand. Several poor
patients, who otherwise would have been unable to procure
flesh diet, have resorted to this means with advantage. Fish,
in all its numerous varieties, forms a valuable resource for
both rich and poor, and may be eaten with an abundance of
oil and a moderate quantity of vinegar. Eggs, again, so sus-
ceptible of various modes of preparation, are excellent ; and
although milk is forbidden, good fresh cream and all kinds of
cheese are allowed. Except in extreme cases, green vegeta-
bles and salads, although they contain some sugar, starch or
gum, may be taken in moderate quantities ; but abundance of

5S Diabetes MelHtus. [January,

oil, or the yolk of eggs, should be conjoined. For such patients
who cannot well overcome their liking for bread and other
feculents, M. Bouchardat has. during the last len years, had
prepared a bread of flour containing 70 per cent of gluten.

As the prohibited feculent and saccharine bodies belong to
that respiratory group of alimentary substances, we have to
choose others from the same group; and those best calculated
to supply their places are fatty bodies and alcoholic drinks.
Among the latter Bordeaux wine occupies a prominent place,
as much as from one to two litres (from two to four pints.)
being admissable per diem, which, at ten per cent of alcohol,
would supply about 150 grammes (2j oz.) of this substance in
the 24 hours. Fatty bodies must not be given too exclusively
lest they excite disgust, but mingled with other aliments, from
150 to 200 gra mm es being required in addition to the alcohol.
is objectionable from containing dextrine. Coffee drunk
without milk or sugar, and to which a little rum, cream or
brandy may be added, is a good drink. To relieve thirst. Selt-
zer, Spa. Vichy, or soda water may be taken : but acid dritiks,
so keenly desired by the patients, are very objectionable. The
patient should .always eat and drink in moderate quantities,
slowly masticating his food. This practice tends to the relief
of the attendant dyspepsia, and to assisl the distended stomach
to return to its normal dimensions. A flannel bandage applied
around the epigastrium contributes to the same end.

2. Clothing. As chills operate very injuriously on these
patients, warm flannel clothing forma a valuable protective
agent, and beneficially excites the languishing function of the
skin. Indeed some medicinal agents are of no avail unless
aided by complete flannel clothing which maintains diaphore-
sis. General frictions .ire very usefnl, and a moist warmth of
the feet should be maintained.

3. Exercise. To recommend this indiscriminately would
be injudicious, for many patients are too feeble to undertake
it. But when their strength has become somewhat recruited
by regimen, walking, gymnasiics, agricultural labor, dec, much
expedite the cure, and are found, as recovery is approaching,
to enable the feculent aliments to become utilized by the sys-
tem.

4. Pharmaceutical Agents. M. Bouchardat entertains a
high opinion of the utility of carbonate of ammonia (from 5 to
\b grammes 77to230grs. in the 24 hours,) providing flannel
clothing be worn. Other alkalies suffice lor slighter cases,
when the urine contains uric acid as well as glucose. Employ-
ed consentaneously with out-of-door exercise, they seem to
exert great influence in preventing the reappearance of suyar

1S54.] Diabetes Mellitus. 59

in the urine, when feculent aliments are resumed. Opiates, if
given alone, are mere palliatives ; but when conjoined with
other remedies, and in moderate doses, so as to act on the skin
they are very valuable. M. Bouchardat sometimes prescribes
Dover's powder, but prefers the old theriaca before all other
preparations, without defending the absurd complexity of its
composition.

In severe cases of glucosuria, then, diet, exercise, and flannel
clothing constitute the basis of treatment, carbonate of ammo-
nia and opitates best aid their action. Other remedies have
their occasional uses, such as iron, tonics, chloride of sodium,
and antiscorbutic plants. M. Bouchardat often employs
emetics at the commencement, and endeavours to modify the
disturbed functions of the liver by aperients, of which ox-gall
with rhubarb is the best.

Circumstances influencing the effects of Treatment. Fore-
most among the favourable indications in a case is the rapid
return of the urine to a normal state, which may take place in
from 24 to 48 hours after the feculents have been excluded. The
recent date of the affection is another highly favorable circum-
stance ; and because it is so, M. Bouchardat urges testing the
urine whenever the slightest suspicion can be held, and for the
detection of relapses, which are frequent and insidious. Other
favorable circumstances are the retention of considerable em-
bonpoint, the easy circumstances of the patient, and his being
in possession of great perseverance.

The unfavorable circumstances are the reverse of the above ;
but negligence is still worse than poverty, as the poor man has
some resources. The treatment of the case is usually ill man-
aged in hospitals, owing to the vitiated air, the absence of ex-
ercise., the sameness of diet, and the insufficiency of the surveil-
lance. The existence of a great appetite is a common and
not unfavorable circumstance, requiring only moderation in
its gratification, at meals not too far separated. Want of ap-
petite is a far more unfavorable sign, which should be actively
combated. M. Bouchardat has found small doses of rhubarb,
and exercise in the open air, of advantage. Obstinate consti-
pation, resisting the most varied purgatives, is a bad complica-
tion, indicating disease of long duration, which has produced
important modifications in the condition of the alimentary
canal. Fatty substances, combined with matters which leave
residue, as spinach and gluten-bread with bran, are here indica-
ted. Cold and damp air is unfavorable to diabetic patients ;
but M. Bouchardat has had patients from Algeria, and has not
derived advantage from sending others to Italy. M. Bouchard-
at agrees with Dr, Prout in considering the appearance of ah

60 Prolapsus Uteri. [January,

bumen in the urine, which is often met with, as an unfavorable
occurrence. The prognosis of saccharine albuminuria ia
so serious as is that of simple chronic albuminuria. The fre-
quency of the occurrence of phthisis in cases of glucosuria is
familiarly known. In all the autopsies the author has made,
when the patient has not been cut off by an intercurrent affec-
tion, tubercles have been found in the lungs ; and he feels con-
vinced that many cases of phthisis have had their origin in a
glucosuria that has been overlooked, and which might have
been easily removed. In severe and old cases of glucosuria,
vision is always found more or less enfeebled ; but in most
cases, when not of old date, as the condition of the patient has
improved under appropriate regimen, this amaurosis has subsi-
ded. When indeed this is not the case, the prognosis of the
glucosuria is serious; and it will often he found complicated
with albuminuria. Impotence, more or less decided, is another
effect of glucosuria; but in young subjects the generative func-
tions resume their power when the original disease is rationally
treated. Glucosoria may occur at any age, from infancy to
senility; M. Bouchardat having met with most cases between
the age of forty and fifty. He met with none between eighteen
and twenty-five. Old age does not constitute an obstacle to
cure; but so difficult is it to watch over children, that the
author is not aware of a sustained cure prior to fifteen years of
age. lie has met with more male than female patients.

[British and For. Medico- Chin/ mica! R'view.

A New Mode of Treatment for Prolapsus Uteri.

It. Desgranges, Surgeon to the Lyons Hospital, has laid be-
fore the Academy of Medicine of Paris, a new mode of reme-
dying the uterine displacement. It consists in pinching up the
mucous membrane of the vagina, after reduction, with little
forceps, or "serres fines" of Yidal. The forceps produce
ulceration, and fall off from the fifth to the tenth day ; and M.
Desgranges repeats this operation eight or ten times, taking
care always to leave as many of the forceps as possible. At
the commencement he introduces as many as nine ; later, from
six to four; and at last, towards the end, only one of the little
instruments. The treatment lasts in general I wo months and
a half, or three months.

It will be seen that this method rests on the fact that the
narrowing of the passages may prevent any farther descent of
the organ, the loss of substance and cicatrization being instru-
mental in the result. [Lancet.

1S54.] Editorial 61

EDITORIAL AKD fflSCELLMY.

Ulero-abdominal Supporters. Braces, fyc. There are few, if any,
of the modern devices for imposing upon the credulity of the afflicted
which we feel more disposed to condemn than the contrivances vended
under the various names of Ctero-abdominal Supporters, Body Braces,
&c. The fact that they have in many instances received the coun-
tenance of men of standing in the Profession, renders it imperative on
the part of those who believe them injurious, to assign their reasons
for such difference of opinion. It is unfortunately too true, that the
love of notoriety and the prurient desire to see one's name in print, may
account for some of the signatures appended to the certificates heralded
in the newspapers from one extreme to the other of our wide-extended
country, and that some of our brothers have now earned for them-
selves the unenviable, cognomen of '"universal certifyers." But
there are unquestionably many who honestly believe these appliances
useful, and accordingly feel no hesitation in lending the influence of
their name to the patentees.

It matters not under what specific patent the articles are sold they
are all made for the accomplishment of the same mechanical purpose,
and differ very little from each other. Those termed * Utero abdomi-
nal Supporters," are contrived for the avowed purpose of supporting
the abdominal contents, and of thus removing the superincum-
bent weight from the pelvic viscera, and the womb in particular.
Whether the mere weight or pressure of the abdominal viscera ever
operates as the direct cause of prolapsus uteri, or prevents the cure of
this infirmity, is a mooted question which we do not wish to discuss at
present. Our object is simply to determine whether the apparatus
under consideration is adapted to the accomplishment of what is claim-
ed for it viz., to relieve the uterus from the pressure of the superim-
posed masses.

Nature has wisely provided that at the age at which the vaginal
outlet of the pelvis is most apt to lose much of its resistance, to be-
come relaxed, and consequently to favor the descent of the uterus.
the abdominal walls also become more yielding and pendulous, so as
to overhang the brim of the pelvis, and thus to throw the weight of the
abdominal contents anteriorly to the axis of the pelvis, where it can-
not be felt by the uterus. Xow the " abdominal supporters" consist
of a belt, more or less broad, with a strong plate in front, designed to
draw the abdomen upwards at the same time that it is compressed by
the belt ; thus effectually bringing the weight of the viscera back to

62 Editorial. [January,

the position from which nature has deviated it, and therefore over
the axis of the pelvis, into which the viscera are impelled in propor-
tion to the tightness with which the belt is applied. Is it not evident,
that any pressure exerted upon the abdominal contents by means of
corsets or belts of any kind must necessarily tend to force them up-
wards against the diaphragm and downwards into the pelvis? And
is it not equally manifest, that the addition to the belt of a plate or
supporter in front cannot alter this mechanical effect? It would re-
ally, in our humble opinion, be difficult to imagine a better contrivance
for the purpose of inducing prolapsus uteri, if it were desired to do so by
directing and applying the weight of the abdominal contents to this
purpose. How could you more effectually force the viscera into the
pelvis than by elevating the pendulous abdomen and forcibly com-
pressing its contents?

But, since the simplest reference to mechanical principles would
seem to forbid the use of these instruments, let us invoke the aid of
experience, and ask professional men of observation and of candor,
how many females they have ever known who could tolerate such
bandages for any length of time. We are free to testify that we have
never known one of these supporters to be worn without inconvenience
and detriment to the patient's condition. If any one else has been
more fortunate we are not aware of it. A few years ago a peripatetic
lecturer and patentee of the articles honored this city with a visit, and,
it was said, realized some two thousand dollars from the sale of his
44 woman's relief." A number of our fair but frail friends patronized
the stranger, but with no other relief than that of the weight of their
purse.

The only kind of ''supporter" that can be beneficial in pro-
lapsus uteri, is that in which the perineum is forced upwards by
means of a pad attached to a belt. The vaginal outlet is thus com-
pressed and the uterus prevented from descending ; but in such
cases the belt should hang upon the pelvis or hips in such manner as
not to compress the abdomen materially. Otherwise, the downward
and upward pressure would neutralize each other.

With regard to body braces, shoulder braces, &c, destined to
aid or to supersede the action of the muscles, we cannot but look upon
them as ultimately injurious. The sedentary and delicate female
who is easily fatigued by exercise on foot, will doubtless feel relieved
for a while by such mechanical support ; but it is at the expense of a
still greater increase of the existing muscular debility. There is no
principle in physiology better established than lhat the power of the

1854.] Editorial. G3

muscles will grow with use, and diminish by inactivity. Muscular
debility must therefore be overcome by exercise of the muscles, and
not by substituting braces in their stead. If shoulder braces be ap-
plied loosely, and for the mere purpose of apprising the wearer that
he is stooping, so that he may by the action of his muscles correct his
position, they may be thus far useful; but it is out of the question for
them to do good by supplanting the muscles.

BIBLIOGRAPHICAL.
Lectures on Surgical Pathology, delivered at the Royal College of

Surgeons of England. By James Paget, F. R. S., &c, &c.

Philadelphia: Lindsay & Blakiston. 1854. 8vo , pp. 700. (For

sale by McKinne & Hall. Price 83 50.)

These Lectures of the distinguished author treat specially of Hyper-
trophy, Atrophy, Repair, Inflammation, Mortification, Specific Dis-
eases, and Tumors all subjects of deep interest to the general prac-
titioner as well as to the surgeon. Prof. Paget has very judiciously
drawn largely upon the Pathological Museum of the Royal College
for illustrations, and has been thus enabled to embody a most valuable
collection of facts in confirmation of his views. We regard this vol-
ume as a valuable acquisition to Pathological literature.

A Text Book of Anatomy, a guide in Dissections, for the use of Stu-
dents of Medicine and Dental Surgery By Washington R. Han-
dy, M. D., Professor of Anatomy and Physiology in the Baltimore
College of Dental Surgery, &c, &c : with 264 illustrations.
Philadelphia: Lindsay & Blakiston. 1854. 8vo., pp. 810. (For
sale by McKinne & Hall. Price $4 00.)

The object of the author, is to supply the wants of "the Dental as
well as the Medical Student," by the preparation of an anatomical
work "which directs special attention to the Mouth, showing step by
step the important anatomical and physiological relations which it has
with each and all the organs and functions of the general system."

" Dental students are slow to see and feel the necessity of a know-
ledge of any more of Anatomy than so far as the Teeth and their
immediate connections in the mouth are concerned, and to go beyond
this is thought rather a waste of time, and entirely foreign to the prac-
tice of the profession they design to pursue To correct

this false and dangerous sentiment and to demonstrate the necessity
of anatomical knowledge to the scientific, skillful, and successful
Dentist, equally with that of the Physician, forms the second and
chief reason which has induced the author to write the present work."
These quotations from the Preface will serve not only to show the na-

64 Editorial. [January.

ture of the work, but also the clumsy style of the author's diction. The
wood-cuts are poor, but probably as good as could be furnished for
the price. The author's intentions are praiseworthy, and we hope
that this work may be productive of the desired reformation.

Chemistry and Metallurgy as applied to the study and practice of Den-
tal Surgery. By A. Snowden Piggot, M. D., late Professor of
Anatomy and Physiology in the Washington University of Balti-
more. With numerous illustrations. Philadelphia : Lindsay &
Blakiston. 1854. 8vo., pp 516. (For sale by McKinne & Hall.)

This is really quite an interesting work, which cannot fail to meet
with favor and to be eminently useful. It comprises a resume of ani-
mal chemistry, and a full account of the chemical principles involved
in the various organic changes originating in the mouth, together with
their bearing upon the minerals used in operations upon the teeth.
The Book upon the "Chemistry of the Mouth" is especially instruc-
tive. The latter half of the volume is devoted to the Chemistry and
Metallurgy of the metals and earths used by the dentist ; comprehend-
ing the different modes of applying heat ; furnaces ; auxiliary appa-
ratus ; and an account of the materials used in making incorruptible
teeth. The work is got up in fine style, and is highly creditable to
both author and publishers.

A Treatise on the Venereal Disease. By John Hunter, F. R. S.
With copious additions by Dr. Philip Ricokd, Surgeon to the IIo-
pital du Midi, Paris, dec. Edited with Notes by F. J. Bumstead,
M. P., Physician to the N. W. Dispensary, New York. Philadel-
phia: Blaochard & Lea. 1853. 8vo., pp. 520. (For sale by T.
Richards & Son.)

The present edition of John Hunter's great and original work de-
rives additional value by being associated in the present instance with
the no less original views of Ricord and, although these distinguished
authors are found not unfrequently at variance with each other, the
collision always throws additional light upon the question. The study
of syphilitic disorders has been eminently progressive, and we are
here furnished with the opportunity of seeing at a glance the advances
made since the Hunterean era upon many points of this difficult sub-
ject. This work is justly entitled to the patronage of the profession.

The Medical Formulary : being a collection of Prescriptions, derived
from the writings and practice of many of the most eminent physi-
cians of America and Europe ; together with the usual Dietetic
Preparations and Antidotes for Poisons. To which is added an
Appendix, on the Endermic use of Medicines, and on the use of

1854.] Miscellany. 65

Ether and Chloroform. The whole accompanied with a few brief
Pharmaceutical and Medical Observations. By Bdoeakih Ellis.
M. D., late Professor of Materia Medica and Pharmacy in the Phila-
delphia College of Pharmacy. Tenth edition, revised and much
extended. By Robert P. Thomas. M. D.. Professor of Materia
Medica in the Philadelphia College of Pharmacy. Philadelphia :
Blanchard & Lea. 1554. Bto., pp. 296. (For" sale by T. Rich-
ards & Son.)

This Formulary is too well known to need any commendation at
our hands. No work of the kind has ever been more popular
the profession, as the fact of this being the 10th edition abundantly
This edition is u enlarged and revised up to 1554."

In addition to the above works, we have received the following :

An Inquiry into the Nature of Typhoid Fevers : based upon a con-
sideration of their history and pathology. Presented to the American
Medical Association at : . in May. 1553. By Henry F.

Campbell, M. D.. of

Prize Essay : read before the State Medical Society, at its eighth
annual meeting in Dayton, June, 1553. By Samuel G. Armor. M.D.
Hospital Hygiene illustrated; read before the New York Acade-
f Medicine, June. 1553. By John H. Griaoom, If. D.

D Provisional Callus. Bv Frank H. Hamilton, A. M.,
M. D.

An Address to the Public in regard to the affairs of the Medical
department of Hampden Sidney College. By several Physicians of
the city of Richmond.

eral Introductory Addresses. Arc.

We regret that we cannot Dot more at length at present.

Opium. The Opinions thereon of Shrappenkyttzl Smelfu^gus,
M. D.

" I acknowledge no procnutean creed, decapitating nonconformity !~

All is blue in the office of Smelfungus. He is blowing a cloud,
and the room is filled with the aroma of tobacco, about the paternity
of which there can be no doubt it is genuine Connecticut, ^nd no
mistake.

ngevity," he says, cannot be considered a characteristic of
the materia medica. From the earliest days of medicine, empheme-
rae have arisen, fluttered out their existence, and disappeared from the
view. But other articles there are which possess inherent vitality,
which have been for ages the main pillars of therapeutics ; and which
still stand firm in their stately proportions. And stateliest, with
firmest shaft of these, is opium.

44 Opium ! mysterious drug, whose potency is felt not only in the
body, but in the recesses of the mind : where is the link that connects
the sleepy poppy with the grandest powers of our nature ? By what

66 Miscellany. [January,

deephidden agency does it lull the racked nerve to quiet, and
upon the mind with gorgeous dreams, extending time and space be-
yond conception? No man has jet returned from these close pene-
tralia with power to tell their secrets. Used daily and hourly for
many centuries, it is still unknown, misunderstood, abused, and un-
derrated. De Quincy. wrapped in Elysian dreams by its still influ-
ence, quaffing by imperial pints his 'happiness in bottles,' with
powers of utterance never equalled, 'speaking as never man spake,'
has lifted the silver veil, only to reveal behind it the blackness of dark-
ness. He has called from out the depths: but his voice is choked
with sorrow, and we hear sighs only suspira de profundi*. Oh,
mighty agent! instrument by which the soul dips down to Acheron,
and gazes through the portals of Tartarus : no power can interpret
or destroy the

"Now SmelfungUS," I venture to insinuate, "you are on stilts as

long as that euphonious baptismal name of yours, and allow me to

Bt, you are gyrating rather awkwardly. How are you going to

Sum [fungus looked grieved, holds silence for a moment, and then
abruptly changes his style of address.

11 Have you noticed, my friend, how all things work together for
good to them that lore physio I Have you seen how, oui of this ex-
pectant humbug, have come goodly thing- figs from thistles, grapes
from thorns ? Our otherwise Expectant must needs do something.
His lazy theorj was to wait for positive indications; and very natu-
rally, one eternally recurring indication was the relief of pain. So
our friend, Expectant, follows it out. and when you come to examine
his treatment, you find here, there, everywhere, opium, and opium
alone, prescribed in all the ills that flesh is heir to, from AbsO
Unknown. Of eourse, this was nonsense and error. Better and
mora scientific was old Dr.G.'i prescription for a singing in the head,'
viz: a poultice of old music books applied to the coccygeal region,
with the luminous idea of ' drawing the music down V There's re-
vulsive treatment for you ! But after all, good cometh from every
new thing. Some of Expectant's patients get well, and that without
regard to old time depurative theories. And some of these were cases
whereof Dame Nature had not the handling. Dame Nature is a
botch 4 To relieve a pleuirtic inflammation, she fills one side of the
chest with water; a remedy from which the patient might well pray
to be delivered. But Expectant coming to a case of incipient pleuri-
tis, makes a homoeopathic diagnosis, calls it ' pain in the side,' and
gives it three or four grains of opium therefor. Patient gets well in-
stanter. Well, Expectant comes to another patient, finds her with
low typhoid symptoms, and abdominal tenderness, but not much else
to complain of. In the absence of any decided indications, Expectant
prescribes his eternal opium, By-and-by this patient, too, recovers,
and Mr. Observer, standing by, beholds a case of puerperal peritoni-
tis cured by opium.

"From all this, I, sir, sitting in philosophic judgment, derive the

1S54.] Miscellany. 67

great fact that we know nothing about opium. Tell us, old Monument,
who have for forty years dealt out your opinions, what you know
about it ? Did you ever dream that it was a curative you were hand-
ling, and not a palliative merely ? Man of the microscope and tes-
ting tube, read for us this deep, this Sphynx-like riddle ! Are we yet
we staunch old regulars to yield the field in this matter ? Is
opium the curative means, the efficient drug in our mixed prescrip-
tions of calomel et opii.aa.grs.iij. ? For, look you, country practition-
er, dealing SchierTelin's best powdered from the blunt point of your
old jack-knife, you old Clysterpipe, who have not weighed a pre-
scription these half-score years, your small doses of opium weigh three
stout grains !

" Rest / This is the word. Here, in rest and sleep, tired nature's
sweet restorer/ lies the secret. One sensible thing that Dame
Nature does, is to put her patients to bed to so prostrate their lusty
muscles, that the sturdy knees give way, and the recumbent posture
becomes necessary. Here then is the great curative, and opium is a
means thereto. ' Old functional Harmony' used to tell us, with ex-
tremest unction, that ' uterine contraction was the remedy for uterine
haemorrhage.' Nor lead, nor ergot, nor cold water, nor compression,
nor the tampon, but any one or all of these, which could bring on
uterine contraction. So here, in inflammation. Rest is our remedy
not calomel, nor antimony, nor blood-letting, nor opium, but any one
or all, or none of these, so that you secure rest.

M There is a vague idea, derived from some exploded theories, that
calomel has, jure divino, a certain control over inflammation that
the presence of calomel in the stomach, simultaneously with inflam-
mation in the viscera, is incompatible. Now, good Sir Hunker ! you
know that I Smelfun^us have the highest respect fur you of the
conservative school. You know that on every occasion I have rank-
ed myself among you have bowed to the existence of a liver and
scouted at the pretentions of these new comers, who bear that flaun-
ting banner, with the strange device,' Young Physic. But, my dear
sir, we must compromise or surrender. Let us come down a peg or
two and we shall still be men of note. Let us use a little Twiggs's
hair dye and rejuvenate ourselves gray hairs are at discount nowa-
days. Look you ! only a day or two since, a certain divine declared
a decided preference for young physicians over old. He had the har-
dihood to intimate that one good theory, round and well established,
was worth ten years' experience. He was a Scotchman, and I said
to him, that ;it behoveth a Scotchman to be right, for if he be wrong,
he be for ever and eternally wrong.' Between you and I, my aged
friend, it is about time to cave. Now I have a talent for compromises,
and I can propose a satisfactory arrangement which shall govern this
vexed question of Calomel vs. Opium. Let us hereafter say nothing
about being 'bilious.' That's all well enough at the bed-side, but it
is ruled out of professional intercourse. Let us give our calomel, as
we did of old, to all patients of firm fibrinous habits, whose blood has
a tendency to plastic exudation. So much we claim for our side of

68 Miscellany.

the house. Now we may as well, ' needs must when the devil drives/
concede to Young Physic, that calomel should be withheld in cases
where this condition does not obtain, viz., in those manifold diseases
where the blood has a tendency to fluidity. I fear that this will nar-
row down the amount of the drug used, but we must come to it. Don't
you recollect feeding calomel, for a fortnight on a stretch, to that stru-
mous little girl with dysentery last year 1 How fast she did gain,
didn't she ? And how nicely you could trace the curative influence
of the calomel, couldn't you ?" And Smelfungus puts his tongue to
his cheek, and makes a mysterious gesture with his thumb over the
left shoulder. And I can imagine Editor Flint perusing this back-
sliding confession of Smelfungus with a quiet smile and a chuckle,
which means ' I told you so !' But Smelfungus loves freedom of ac-
tion ; he cannot bear to be fastened by the green withes of tradition.
Witness the motto at the head of this article.

But touch him gently, Dr. Flint ! or you may yet see Smelfungus
astride his old bilious llosinante, charging the windmills of natural
medicine with the stern voiced war cry :- " Floret Colomela s ruat
caelum /"

* Salts, sir, in all his steps manna in his ej e
In every gesture, calomel and rhubarb."

Smelfungus loves fun, and from no recent occurrence has he derived
so many good horse-laughs as from the developments at Bellevuc in re
of opium in puerperal peritonitis.

"Dr. Clark would have made no great stir with his interesting ex-
periments in peritonitis, had he not been so severely criticised. Not
but that Dr. Clark's treatment was a goodly instance of a priori rea-
soning applied to therapeutics brilliant in its conception, and tri-
umphant in its success. But the fun of the matter lies in the criticism
of the N. York Medical Gazette. 'This,' he says, 'comes of making
hospital doctors of mere theorists. He tells us that we must look in
the dead-house records for the results of such treatment. Of course
the patients are dead. He stops not to enquire about it they are
dead de necessitate ; and he sheds his tears over them as freely as a
child in the measles. Smelfungus can see him ; leading a lacrymose
group of anxious inquirers beside the green shores and still waters of
the East River. With solemn step and slow, he conducts them down
the gravel walks of Bellevue, 'twixt cabbages and onion beds, and
sadly points to the little dead-house, as filled with the mementoes of
Dr. Clark's recklessness.

" But they look in vain these women are not yet defunct, but still
live to bend as best they may, with abdomen probulgent over their
wash-tubs, the spared monuments of human folly."

" Oh, that mine enemy had written a book !"

If I were to tell you, gentle reader, all that Smelfungus says about
the matter, I should detract from that solemnity which becomes the
pages of a medical journal. A pompous dignity is the main -stay of
our profession, and by a parity of reasoning, a medical monthly should
indulge in no unseemly cachinnations. Vale. [Buffalo Med. Jour.

SOUTHERN

MEDICAL km SURGICAL
JOUEXAL.

Vol. 10.] NEW SERIES FEBRUARY. ISU. [So. J.

OKKtIXAL AMI ECLECTIC.

ARTICLE IV.

The following Report was read at the annual meeting of the
Medical Society of the State of Georgia,, held in Savannah in
April last., and is taken from the M Transactions''* published by
the Society :

On the Best Plan of Treating- Fractures in Country Practice 4
By L. A. Dugas, M.D.. &c.

The tenor of the question upon which it has been made my
duty to report, would seem to presuppose the nee a plan

for treating Fractures in the country., different from that usually
pursued in cities and hospitals. If such necessity exist at all., it
must arise rather from the different circumstances under which
such cases are respectively managed in the country and in cities,
than from any peculiarity in the accidents themselves.

Country practitioners reside at distances more or less consid-
erable from their patients, and can therefore see them compara-
tively seldom. Hence the propriety of adopting methods of
retention that will not be apt to incommode the patient so
much as to require modification, that will not easilv become
displaced, and that may be readjusted by the ordinary attend-
ants, if this should become necessary before the physician can
be present.

N. S. VOL. X. SO. II. 5

70 Dugas, on the Treatment of Fractures. [February,

Again : country practitioners are frequently called upon to
set fractures when they cannot procure the more perfect and
special apparatus usually kept iri well organized hospitals,
by city apothecaries, and by surgeons in extensive practice.
They must therefore use such means as may be at their com-
mand, or such as they may obtain at any plantation or isolated
dwelling.

As the object of this paper is purely practical, I will not stop
to estimate the relative value of the many plans proposed, nor
to quote authorities for or against what I may suggest; but will,
as briefly as possible, present what / conceive to be, in the lan-
guage of the question, " the best plan of treating fractures in
country practice." In doing so, it would savour of presump-
tion were I to expect, for a moment, that all will agree with me
as to the propriety of the procedures I may recommend. I will,
therefore, be quite satisfied if I have the good fortune to secure
the concurrence of a majority of the enlightened members of
this Society.

It cannot be expected that a report of this kind should com-
prehend the treatment, in detail, of each particular fracture.
I will consequently deal in generalities, as far as possible, and
individualize only in such cases as this may seem to be abso-
lutely necessary.

The first bandage usually applied to fractured limbs, especial-
ly in our country, is one to which I must object ; I mean the
roller bandage. I object to its use, not only in country prac-
tice, but also in that of cities ; and as I have elsewhere (South-
ern Med. and Surg. Journal, Feb., 1850, p. 80) expressed my
views upon this part of the subject before us, I beg leave to-
quote the language then used :

What are the ends proposed to be attained by the applica-
tion of the roller or other compressing bandage to a fractured
limb ? They are, I believe, three-fold viz: to aid in retaining
the bones in their proper adaptation; to- prevent the swelling of
the limb, and to reduce this after it has occurred. A serious-
objection to the bandage thus used is, that its application con-
stitutes, by far, the most painful portion of the dressing, especial-
ly if the limb be held for the purpose by an unskilful aid. No
one who has ever witnessed the application of the roller band-

1854.] Dugas, on the Treatment of Fractures. 71

age, from the toes up to the pelvis, in fractures of the os femoris,
when every turn of the roller, however gently carried, imparts
motion and intense pain, can have failed to wish that it might
be dispensed with. Such, at least, is the case with the patient,
if not with the surgeon. This evil is aggravated by the neces-
sity, which very soon occurs, of removing and re-applying the
bandage, as will be hereafter stated. Now, if the proper appo-
sition of the fractured ends can be secured without the roller
bandage, is not the difficulty and painfulness of its application
a sufficient reason to abandon it ? But it is also proposed, by
its use, to prevent the development of swelling. Let us see if
this object is ever attained. Every one knows how difficult it
is to apply the roller bandage to a whole limb in such a way
that the compression will be perfectly uniform, and the circula-
tion not impeded. Even expert surgeons sometimes fail in this,
and the less experienced will of course do so still more frequent-
ly. But, however skilfully applied, the tendency to swelling,
at the seat of fracture, will very soon make the bandage more
tight at this point than below it ; the venous circulation will
become impeded, pain will supervene and increase until the
patient or his friends will be compelled to cut loose the bandage,
in order to release the stricture. The patient will then have
to remain with an imperfect adjustment of dressings until the
physician can see him, which, in the country, may be not only
hours, but days. Cases also unfortunately occur, occasionally,
in which, from the docility or fortitude of the patient, he does
not demand and obtain timely relief from the compression, and
suffers mortification to take place. One of the most distinguish-
ed surgeons of the North stated to the writer a few months
since, that he had been repeatedly called upon to perform am-
putation in consequence of the tightness of the bandage, occa-
sioned by the supervention of swelling at the seat of fracture.
There can be no doubt that such accidents are much more
common than generally supposed, from the fact that few men
are as fond of reporting their unfortunate cases as they are of
heralding their successful achievements.

The third object proposed to be attained by the roller band-
age is the reduction of the swelling or tumefaction usually
occasioned by fractures. For this purpose the bandage is ad-

72 Dugas, 07i the Treatment of Fractures. [February,.

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

If the bones can be maintained in apposition, and the s
fing he subdued without the roller bandage, and if this bandage
cannot, without great danger, be depended upon for the preven-
tion of tumefaction, the necessary inference is that it may he
omitted without impropriety. If. again, it be true that the
manipulations required for the application of the roller bandage
are always painful, that they have almost invariably to be re-
peated once or more as the swelling progresses, that the corn-
ion is generally the principal cause of pain in the treatment
of fractures, and that it occasionally induces mortification, when
least expected, we should conclude, not only that it may he
omitted without impropriety, hut that its use ought to be i
doned in general practice.

The writer wishes not to be understood as alluding here to
the starch bandage, recommended by the distinguished sui
of Brussels. The number of victims to its use, when first sug-
gested, remains yet to be told. Suetin, however, no longer
calls it the ''immovable bandage," but the "movable and im-
movable bandage," and, so great is his apprehension that the
roller bandage, which constitutes a part of it, may be applied
with a view to compression, and therefore, perhaps, too tightly,
that he advises a bit of tape to be placed longitudinally along
the two sides of the limb before the roller bandage, and in such
a manner that the ends will project above and below ; the roller

1854.] Dugas, on the Treatment of Fractures. 73

bandage is then to be applied, with only as much tightness as
may be required to keep it in place ; after which, the ends of
the tape are to be drawn upon, for the purpose of ascertaining,
by their freedom of motion, that the compression is neither too
great nor unequal. If much swelling ensue, it will be manifest-
ed not only by pain, and the appearance of the distal end of the
limb, which is always to be left exposed for inspection, but also
by the difficulty of moving the tapes beneath the bandage ; in
which event, he urges the bandage to be slit open and readjust-
ed more loosely. With these abundant precautions, upon which
Suetin now dwells with great earnestness, the plan is unques-
tionably the best that can be devised, whenever the patient can
have ready access to the surgeon, or to an expert nurse, as soon
as it may become necessary to modify the dressing.

In establishing rules of practice, whether in medicine or in
surgery, authors do not sufficiently discriminate between the
various circumstances in which both practitioners and patients
may be situated. What may be easy and proper under certain
circumstances, may prove difficult and injudicious under a dif-
ferent state of things. A system of practice may be highly
beneficial, and unobjectionable in hospitals or cities, and be en-
tirely unsuited to the camp or country. What may be harmless
in the hands of highly cultivated and experienced physicians,
may cease to be so under the administration of practitioners
less skilful. It is, therefore, important that the principles, as
well as the details of general practice, be plain, intelligible to all,
and of easy execution. The safety of society demands that dan-
gerous expedients be discountenanced by the profession, espe-
cially whenever more harmless procedures can be substituted
for them. The indiscriminate use of the roller bandage, in the
treatment of fractures, has often occasioned the most serious
accidents, and should give way to the simple use of splints and
bandages, applied in such a manner as to admit of being modifi-
ed, according to the progress of tumefaction, by any person of
ordinary intelligence. Let the more complicated and hazard-
ous processes be confined to such cases as may be continually
under the supervision of the surgeon.

Your reporter has not, himself, used the roller bandage in the
treatment of fractures, for the last fifteen years, and has had no

74 Dugas, on the Treatment of Fractures. [February,

cause to regret its abandonment. On the contrary, he is satis-
fied that he has thereby been saved a great deal of trouble in
the management of such cases.

The bones having been, by extension, counter-extension, &c,
placed in proper apposition, it remains to secure their immobili-
ty by such suitable retentive appliances as may be found any-
where. These are common splints, which may be made with
the wood of cigar boxes, shingles, white oak splits, and other
similar materials. In many instances, it may be found conve-
nient and proper to resort to binder's board, or paste board,
which, if not at hand, may be extemporized by cementing toge-
ther, with starch, or flour paste, a number of sheets of paper, or
layers of linen or cotton fabric. The oases in which these
may take the place of wooden splints, will be indicated as we
proceed.

As to the materials to be interposed between the limh and the
splint, they may consist of linen or cotton cloth, cotton wadding,
carded cotton, or ba<_:s half filled with bran or chaff according
to circumstances. A double fold of linen or cotton cloth, is all
that is necessary when the binder's board, or \\< substitutes, are
applied. For the purpose of securing the splints. I would al-
ways prefer the many-tailed bandage, or separate ties, to the
roller bandage, which is, as already intimated, more difficult to
apply, less secure, and not so easily loosened or tightened at
pleasure, as circumstances may require.

The splints used in fractures of the upper extremity should
be as light as possible, for the obvious reason, that any weighty
apparatus would prove a serious inconvenience. Cigar boxes,
and binder's boards, will be found to furnish the best materials.

In fractures of the humerus, the apparatus will necessarily
vary according to the seat of injury. If in the shaft of the bone,
below the insertion of the pectoralis major, four light splints of
wood, sufficiently narrow not to come in contact when applied,
and about three inches shorter than the entire bone, may be
placed upon thin compresses, and secured with a many-tailed
bandage. I have advantageously substituted for these wooden
splints, two bits of binder's board, each wide enough to surround
nearly one half the arm. These will, if applied wet over thin
compresses, mould themselves to the limb, and thus form a very

1354.] Dugas, on the Treatment of Fractures. 75

comfortable casing, which may be easily confined with the
manv-tailed bandage. In fractures of the humerus, the hand
should always be placed in a sling, in such manner that the
weight of the elbow may exercise gentle extension.

Fractures of the fore-arm, whether involving one or both
bones, will require two splints, one of which should extend from
the bend of the arm over the palm of the hand, and to the ex-
tremity of the fingers, in order to give support to the hand, and
to prevent the use of the fingers, especially in children. The
other splint should be applied to the dorsum of the limb, and
extend merely from the elbow to the wrist. The size and shape
of both should be adapted to the limb, but they must be a little
wider than this, in order to prevent the ligatures from approxi-
mating the bones. Bits of cloth, or compresses, of sufficient
thickness to prevent chafing, should be placed beneath each
splint, but the hollow of the hand should contain a thicker pad.
to prevent injurious pressure upon the wrist. The splints, thus
placed, may be secured with a many-tailed bandage, from the
bend of the arm to the wrist, and by another investing the hand
and fingers, leaving out the thumb, or not as deemed most con-
venient. A handkerchief sling, will complete the dressing.

It will be observed, that we have dispensed with, not only
the roller bandage, but also the graduated, or pyramidal com-
press, usuallv recommended for the purpose of pressing asunder
the ulna and radius. However effectually the bones might be
prevented from coming in contact by such a compress, applied
upon a skeleton, or upon the integuments of an extremely ema-
ciated subject, I cannot believe that it will avail anything when
used under ordinary circumstances. Such a degree of tightness
as would be necessary to the full effect of this compress, cannot
.be tolerated by the patient, and must be hazardous. To guard
against union of the radius and ulna, by which rotation of the ,
hand would be impeded ; it will be sufficient to have the splints
a little wider than the limb, for the reason already stated, and to
watch the state of things at the time the callus is about to be
consolidated, so as to impart timely motion if required. Your
reporter has never seen any bad consequences resulting from
the plan here recommended.

There is no fracture for which more complicated appliances

76 Dugas, on the Treatment of Fractures. [February,

have been recommended, than for those of the clavicle, and yet
I know of none so effectually treated by the simplest proa
Instead of the bandage of Dessault, and its modifications. I
have been long in the habit of substituting the following, With
uniform success:

The displacement haying been carefully reduced by move-
ments of the shoulder in various directions, according to the
particular case, and by direct action upon the fragments them-
selves, let an aid maintain the reduction by placing the ends of
the fingers of the affected limb upon the top of the opposite
shoulder, by bringing the elbow against the side, and by pn
big up the elbow, so as to carry the shoulder upwards, outwards
and backwards, as will be done under those cireumstances.
The next step will be to secure the limb in this position. For
this, I procure a square yard of cotton fabric, (unbleached shirt-
ing, tor example, as this is softer than the bleached, which is
usually starched.) and cut it diagonally, so as to obtain a trian-
angular bit, to the acute angles of which should be sewed slips
three inches wide, and three or tour yards long. Apply the
middle of the base, or long side of the triangle, beneath the
elbow, leaving a margin of about tour inches behind, and car-
rying the obtuse angle towards the fingers. One of the acute
angles, with its strip, will now be carried between the arm and
chest, up to the fractured clavicle, around the back of the neck,
over the sound shoulder in front, and beneath the axilla, and
finally around the chest, including the arm just above the elbow.
The other end and strip will be carried in front of the fore-arm,
up to the sound shoulder, behind and beneath the axilla, and
around the chest and arm, so as to meet its fellow and be tied
to it. Finally, the margin left projecting behind the elbow,
should then be elevated, doubled, and so secured with stitches
. as to prevent the elbow from sliding out of the sling in that
direction. The portion of the triangle situated along the fore-
arm, should be also folded around it, and thus secured. Lastly,
the strips encircling the chest and arm should be stitched, to
prevent their upward or downward displacement. If it be ne-
cessary to press down the sternal fragment, this can be effectu-
ally done by interposing a little pad between the bone and the
bandage which passes over it.

1854.] Dugas, on the Treatment of Fractures. 77

The advantages of this bandage are to be found in its perfect
adaptation to the necessities of the case, in its great simplicity,
in the facility with which it may be made secure, and in the
verv slight inconvenience to which it subjects the patient.
Children, as well as adults, bear it without a murmur; and if it
becomes necessary, for the purpose of cleanliness, to remove it,
any intelligent mother, or nurse, may re-apply it. if the physi-
cian be not accessible. Whilst it cannot be denied that, under
any plan of treatment, there will occasionally remain some
unevenness or deformity at the seat of fracture, I must say that
I have very rarely seen anything of the kind in cases treated on
this plan, notwithstanding the fact that I have, not unfrequently.
after applying the bandage once in presence of the mother, left
the subsequent management entirely to herself. (See Southern
Med. and Surg. Journal. July, 1852, p. 75.)

Fractures of the lower extremities require stouter splints,
when used at all. F or fractures below the knee, a trough, con-
sisting of two lateral bits of board, nailed to the edges of the
one upon which the leg is to rest, and bags of bran, or chafY, to
be interposed between the limb and trough, will be found both
comfortable and effectual. The trough should extend from the
bend of the knee to a few inches beyond the foot, in order to
prevent this from the eversion to which it is prone in such cases.
A light splint, placed upon a bag of bran, in front of the tibia.
and secured by means of separate bandages carried around the
trough, will prevent any tilting up of this bone, and give to the
whole apparatus the requisite degree of stability. If the frac-
ture be such as to render continued extension necessary or
desirable, this may be accomplished by having a two pound
weight to hang from the ankle over the foot of the bed. Take
two yards of strong tape, apply the middle of it across the sole
of the foot; and bring the ends up over the ankle and sides of
the leg; then secure the tape in this position by passing a roller
bandage about three inches wide, around it and the leg, just
above the ankle. If the ends of the tape be now turned down,
and the weight fastened to them, the force will be applied both
to the ankle and the sole of the foot, and may, consequently, be
borne a long time without inconvenience. The continued
traction, thus obtained, is useful in overcoming the tendencv to

78 Dugas, on the Treatment of Fractures. [February,

spasmodic action of the muscles in the affected limb, as well as
in preventing the deformity from shortening, which is so apt to
result from fractures not exactly transverse. Separate splints
may be substituted for the trough, if this cannot be conveniently
obtained.

Fractures of the thigh may be most easily managed by ap-
plying four wooden splints, a little shorter than the femur, around
the thigh, and confining them by many-tailed bandages, suitable
compresses having been, of course, interposed between the splints
and the integuments. In addition to these, a splint about four
inches wide, and extending from the side iA the thorax to a
little below the foot, will serve t<> keep the limb straight, and to
maintain the foot in a proper position. This splint should he
secured by separate bandages passed around the abdomen, the
pelvis, the thigh, (over the short splints.) the le<_r. and the foot.
As continued extension, in these cases, if necessary, it may be
effected by .1 weight, as ted for fractures below the knee,

the resistance offered by the weight of the body being sufficient
for counter-extension. It is scarcely necessary to add. that the
patient should lie upon a hard bed. so thai his body may be as
horizontal as possible, and thus prevent any bending at tin
of fracture. We thus avoid the abrasions, or chafing, so com-
monly attending the use of splints that bear upon the perineum,
or axilla ; and the apparatus may he loosened or tightened, with-
out difficulty, to suit the exigencies of the case. If it becomes
desirable, at any time, to place the limb upon a double inclined
plane, this may he done by removing the long splint, and with-
out interfering with the shorter ones.

In fractured ribs, I would advise the interposition, between
the skin and the broad circular bandage in common use, of a bit
of paste board, six or eight inches square, to cover the seat of
fracture, and to prevent the bandage from depressing the frag-
ments, as it is apt to do, especially if there be more than one
rib fractured.

For the treatment of fractures of the inferior maxillary bone,
it will be found most convenient to use paste board, which
should be applied wet, so that it may be moulded to the jaw
laterally and inferiorly. Having thus obtained a good mould,
the jaw will rest comfortably in it, and it may be secured by the
ordinary chin bandage.

1854.] Miller, on Double Monstrosity.

article v.

Account of a Case of Double Monstrosity. By H. V. ML Mil-
ler. M. D.. Professor of Physiology and Pathological Anatomy
in the Medical College of Georgia.

A very interesting specimen of Double Monstrosity was re-
cently exhibited in this city, which demands some notice in this
Journal,, as well from its having originated in a neighboring
State, as from its being a most perfect example of a mode of
union extremely rare.

These children, named Milly and Christian, born in North
Carolina, of African parentage, are females, now about two
years old. They are united posteriorly. The os coccygis of
each seems to be bent backwards and to become continuous
with that of the other. The lower portion, to probably one-third
of its extent, of the sacrum of each., is in like manner joined by
bony union to the corresponding portion of the sacrum of the
other, forming, with the muscles attached to them and the gen-
eral integument, a firm band of two or three inches in diameter,
but so short that the nates of each child are pressed against those
of the other. They are thus united back to back, but not ex-
actly parallel; there is a slight inclination to the right side of
the one and to the left side of the other. In consequence of this
obliquitv they lie more comfortably upon one side than the
other, and from having been from birth constantly laid in this
position, their heads are not symetrical ; the bones of the crani-
um having apparently yielded to the continued pressure in one
direction.

If the children be separated as widely as the uniting band will
permit upon the side towards which the inclination exists, the
hips (one of each child) united as above described, closely re-
semble the buttocks of a normal child, and between them is
situated a common anus. If the legs of either child be separa-
ted, the vulva is brought into view ; the upper part of which is
not unusual, but at the lower portion it unites with the vulva of
the other child, thus forming a common vulva consisting of the
conjoined, upper or pubic halves of two vulvae. Upon sepa-
rating the labia of this conjoined vulva the entrance to the
vagina of each child is shown to be perfectly distinct, separated

80 Miller, on Double Monstrosity. [February,

externally however, but by a thin septum. The urethra? are
also distinct.

If the children be separated upon the side which admits of
freest motion, the common vulva, just described, is disclosed,
looking, when viewed in this direction, like a transverse sulcus,
below which, at the distance of about an inch, is the anus com-
mon to both children.

No means have been employed of determining how fai up
the rectum is the junction of the two alimentary canals, but it
is probably above the internal sphincter, inasmuch as the chil-
dren feel the desire to go to stool and actually discharge their
faeces at the same time. This, however, is the only thing which
they do in common. The urine is discharged, separately and
at different times. In all other respects they are perfectly dis-
tinct; hunger and thirst may he felt by one and not by the
other: one may he sick and the other well: one sutTered severe-
ly from teething, the other but little. One of them is a !
stouter child than the other, but not perceptibly more intell
Their intellectual operations are as distinct as though no union
<\ ; they amuse themselves together as do other children
sometimes become angry and resort to blows, and even at their
early age are very ready, each to accuse the other of faults
committed between them. They are Still too young to deter-
mine what will be for them the easiest mode of progression.
They can stand and walk a few steps either laterally or forward
for one of them, while the other follows by a backward move-
ment. The side step is that which most probably they will
ultimately adopt.

Much curiosity has long existed in regard to the manner of
the birth of duplex monsters, but unfortunately it has not yet
been gratified, nor does this instance offer anything satisfactory
on the subject. No one was present at the birth except the
negro midwife who usually attended the women on the planta-
tion. She could give no other account of it than that one was
born head foremost and the other breech foremost. In examin-
ing their mode of union, one can readily see how they might
have been so placed as to have been born as the midwife states,
and have presented no greater obstacle to delivery than a double
fetal pelvis, which, if the children were not unusually large,

1854.] Miller, on Double Monstrosity. PI

and the mother were well formed, would be by no means insu-
perable. In this case the delivery was accomplished with safety
both to the mother and offspring.

The subject of monsters, under which general term are
included all congenital deformities, whether from excess, dimi-
nution or malformation of parts is very differently regarded
now by men of science from what it was formerly. In the olden
time each monstrosity was considered as the presage of some
public or private misfortune, an example of Divine vengeance.
the effect of witchcraft or the result of diabolical or beastly
intercourse., and to this opinion we owe the name which they
still retain derived from the Latin verb monstrare.

In more enlightened modern times the subject constitutes an
interesting portion of Pathological Anatomy, and demands our
investigation as strongly as the other deviations from the normal
state, which are ordinarily regarded as the legitimate objects of
that science. And though the origin of monstrous births is still
enveloped in great mystery, our enquiries are directed more
rationally in the search for it, to some original malformation in
the germ from which they spring or to some subsequent de-
formation of the embryo by causes operating during its develop-
ment, than when writers sought to account for them by supposing
sexual intercourse with the devil, copulation with beasts or with
menstruating women.

Extended observation has shown that they do not occur by
chance or from the mere caprice of nature, but are under the
influence of certain fixed laws of organization which they never
transcend. Thus, monsters never exhibit a fusion of dissimilar
parts, as nerves with blood-vessels, or either of these with the
intestines. No malformed organ loses its own character or
malformed animal its generic distinction, and though there may
be a wide difference between given specimens, there may be
traced in the entire series, a distinct gradation arising by suc-
cessive steps from the lowest to the highest deviation from the
normal type; and this with such constancy as to admit of group-
ing into genera and species, and the construction out of them
of a new organic kingdom differing only from the others (as has
been remarked by Meckel) by less constancy of form.

The order which prevails even in the production of monsters

82 Miller, on Double Monstrosity. [February,

is strikingly manifested by the definite number in which they
occur, being in Paris about 1 to 3000 births, which would no
doubt be found to be equally true of every species into which
they may be divided, if observations had been sufficiently ex-
tended to ascertain the fact. The frequency with which some
occur, and the comparative rarity of others, are well established.
Some are so common as to be scarcely worthy of note, except
to serve as the basis of calculation ; while others, from their
infrequency, are in themselves in the highest degree inters
Of this latter kind is the one briefly described at the head of
this article.

Complete double monsters, are by no means so frequently
met with as those which are incomplete, or present only the
duplication of certain parts ; but of the former, certain genera
into which they have been divided are much more common
than others. The family distinguished by haying a common
umbilicus, and a bond of union below <r above it permitting
more or less communication between the abdominal or thoracic
cavities, has been often noticed. Individuals of it are to be
found in almost every museum; that of the Medical College of
Georgia contains two. They are capable of living, but the
difficulty of their birth, fortunately, in most instances, puts a
period to their existence. The Siamese Twins are a good ex-
ample of this class in life and are well known.

That class of double monsters known by having distinct or
separate umbilici, and united by the head or sacrum, is more
rare. Of the latter mode of union the annals of science record
but few well authenticated examples, not exceeding six or eight
in all. The most remarkable of these, and the best known,
were the celebrated Hungarian sisters, Helen and Judith, born
in 1701. The mode of union in their case was almost identi-
cally such as is described above connecting the "Carolina
Twins," and the plate which illustrates it would, allowing for
difference of age, well represent also that of Milly and Chris-
tian. The following is the account of these sisters, given in
the third volume of the admirable Histoire des Anomalies, tyc,
of Isidore Geoffroy Saint-Hilaire:

Helen and Judith, placed almost exactly back to back, were
united exteriorly in the sacral region. The external sexual or-

1854.] Miller, on Double Monstrosity. 83

gans presented evident traces of duplicity; but there existed
only a single vulva, situated inferiorly and hidden between the
four thighs: the vagina was at its opening single, but soon divi-
ded into two distinct vagina? ; all the rest of the sexual apparatus
was double. There were two intestines united in a common
canal, (the rectum.) which terminated by a single anus placed
between the right hip of Helen and the left hip of Judith. The
upper part of the sacrum was double, but united about the se-
cond false vertebra and terminated by a single coccyx. The
two aorta? and the two venae cava? inferior, communicated by
their extremities, and thus established two large and direct
communications with the two hearts, and produced a partial
community of life and of functions, the source of physiological
and pathological phenomena of the highest interest.

The two sisters had neither the same character nor tempera-
ment. Helen was larger, handsomer, more active, more docile
and more intelligent. Judith, at the age of six years, experi-
enced an attack of hemiplegia, and remained ever after smaller,
slightly misshapen, a little slow of speech and less intelligent.
They entertained for each other a warm and mutual affection,
and each appeared to regret her misfortune more on her sister's
than upon her own account. During their infancy, however,
they were frequently known to quarrel and strike each other.
Sometimes, to settle a dispute, the stronger or the more irritated
would hoist the other upon her shoulders and carry her off in
spite of her remonstrances.

The menstrual discharge appeared in both about their six-
teenth year, but not at the same time, and there was ever after-
wards a difference, in the period, quantity and duration of this
discharge, notwithstanding the unity of the external orifices of
the sexual apparatus.

They felt simultaneously the desire to go to stool, but sepa-
rately that to discharge their urine. They could walk either
forward or backward, but slowly, and could seat themselves by
twisting their bodies in a very uncomfortable manner.

One often waked while the other slept, or one would be oc-
cupied while the other was idle. They had the measles and
the small-pox simultaneously ; other diseases attacked them
separately. During the illness of one, the other always experi-

84 Miller, on Double Monstrosity. [February,

enced more or less internal distress and a feeling of deep anxiety.
Struck with this deplorable solidarity between the two us
physicians predicted that the death of one of them would be
necessarily and almost immediately followed by that of the
other. In a serious illness which Judith had in her nineteenth
year, it was deemed proper to prepare the unhappy Helen also
for death, and to administer to her, though still in health, the
last sacrament* Judith recovered, however, from this attack,
but died three years afterwards of disease of the brain and lungs,
when the terrible prediction of the physicians was verified.
Helen, who had for several days hid a slight fever, almost im-
mediately after her sister's death, lost all strength, became pros-
trate, and after a short agony, succumbed, a victim not of her
own disease, but of her sister's death. Both expired very near-
ly at the same time. Thus perished these unhappy girls, bound
together by indissoluble ties, and condemned by a frightful and
inevitable fatality, to snfler during all their life and finally to die
the one for the other.

The same author, besides referrin'j to some other cases1, quotes
one more particularly, reported by Tryling, in which the same
union existed. These were born alive just one year before the
Hungarian At the age of lour months a surgeon at-

tempted to separate them, but he employed the cautery instead of
the knife, and from this cause or from the inherent difficulties of
the operation, violent convulsions ensued and the children died.

This form of monstrosity, liki other met with in the

human race, has also been observed in other animals, showing
the universal operation of those laws of organization to which
they owe their origin and in accordance with which they attain
their development.

It is not proposed at present to append to the foregoing ac-
count of this remarkable natural curiosity, further remarks in
reference to its production. But upon viewing the entire group
of singular deviations from normal structure, from the addition
of a supernumerary finger or toe up to the complete duplication
before us, constituting two distinct beings, the question natu-
rally arises, what explanation is science in the present day able
to give of the origin of these phenomena ?

This question will be considered in a future number of this
Journal.

1854.] Weatherly's Case of Eclampsia. 85

ARTICLE VI.

A Fatal Case of Puerperal Eclampsia. By J.S. We.atherly3
M. D,. of Palmetto, Georgia.

I was summoned, in haste, on the morning of the 1st of Sep-
tember, to Mr. W r's. On arriving at the house, I received

the following history of the case, before seeing the patient :

The patient is a negro girl, sixteen or seventeen years old ;
of small stature ; pregnant first time ; supposed to be at full
term ; was well as usual on yesterday evening. She aroused
her husband about midnight, and got out of bed, but fell heavily
to the floor, as the negroes stated, in a fit. Mr. W r was sent
for, and was soon in the cabin: after witnessing the body of the
girl twice writhing with convulsions, he despatched a messen-
ger for me. She had had seven convulsions up to the time of
my arrival, (3 o'clock, A. M.), and I soon saw her have the
eighth one. She is now comatose, with stertorous breathing,
attended with a sighing moan ; bloody froth issuing from the
mouth ; the eyelids are half closed the globes of eyes turned
back; temperature of skin nearly natural ; pulse 115 per min-
ute, moderately full. She has not spoken or moved, voluntarily,
since second fit in fact, she is completely paralyzed. The
convulsions come on every twenty or thirty minutes : as they
approach, the breathing becomes more difficult, the moaning
more distressing, the head is thrown back, the eyes bleared
open, the face and mouth drawn to one side, the arms and
hands move convulsively, then the whole body jerks and
writhes for two or three minutes, requiring several assistants to
confine her in bed, and prevent injury. The abdomen is terri-
bly distended, so much so that I remarked that she must be
pregnant with twins. Vaginal examination reveals the os uteri
soft and dilated to the size of a dime. I could detect no action
about the womb, or any sign of life in fcetus. My prognosis
was of course unfavorable. Her bowels had already been
moved ; and, following the advice of older and wiser heads than
mine, I bled her copiously, letting the blood flow as long as it
would. She had one or two convulsions while the blood was
flowing. After bleeding, we tried to administer quinine, grs.
10 ; ext. belladonna, gr. } ; and one tea-spoonful of McMunn's

v b. vol. x. xo. it. 6

$6 Weatherly's Case of Eclampsia. [February,

elixir opii. ; but she had no power of deglutition. Part of the
mixture ran out of the mouth, while the other gurgled down the
throat, adding to the already evident symptoms of suffocation.
A consultation with Dr. Tatom was requested. In the mean
time enemas were administered, first to obtain full evacuations -r
afterwards with opium and belladonna dissolved in them.
These were badly retained in consequence of relaxed sphincter
ani. A blister was- applied to the nuchae, and the spine rubbed
with hot turpentine ; the index finger was introduced occasion-
ally, and rotated within the mouth of the womb, to produce
dilatation. Nothing seemed to have any effect the convul-
sions coming on every twenty or thirty minutes. We tried to
bleed again, but failed to get much blood. The quinine and
opium were tried again, but none reached the stomach, and very
little got into the mouth, as it had to be prized open. At seven
o'clock, the os uteri is dilated to the size of a twenty-five cents
coin. An infusion of ergot was prepared, and the patient en-
veloped in a sheet wrung out of hot water, then covered with
blankets, after the manner of the hydropaths. She remained
about one hour in the sheet. Dr. Tatom, arriving in the mean-
time, saw her have three or four convulsions whilst in the sheet.
She was placed in bed again, and, after consultation, we deter-
mined to use the ergot enemas. Three ounces of the infusion
were accordingly thrown up every twenty minutes for three
consecutive doses it seemed to produce feeble contractions.
The os, at 11 o'clock, is dilated to the size of a half dollar ; the
head could be felt, but no bag of waters protruded. It wai
now thought that by a patient trial the hand might be intro-
duced, and version effected. I accordingly prepared to make
the experiment ; but before she could be got ready for the
operation she expired. She had, in all, about thirty convul-
sions in eleven hours. As soon as possible, after life was
extinct, an incision was made into the womb, and two male
children of ordinary size extracted. All trace of life was gone
in them.

Remarks. The convulsions, I suppose, were caused from
over-distension of the uterus, irritation, and reflex muscular
contractions. We did not administer chloroform, (although

1854.] Con nell's Case of Gangrene. 87

we had it there for that purpose.) thinking that the symptoms
would not admit of it. Nothing that was done seemed to have

any effect.

If any professional brother has had a similar case, we should
like much to hear from him.

ARTICLE Vir.

A Case of Dry Gangrene in a girl eleven years of age. Re-
ported in a letter to the Editor, by A. Coxxell, M. D., of
Marietta, Ga.

" I send you a morbid specimen, of which the following is a
brief history : Being requested on the 26th November last to
see a negro girl about eleven years of age, belonging to Mr,
Barber, of this county, for the purpose of amputating her leg, I
was informed that about six weeks previous the girl was taken
sick, with pain about the ankle, and had high fever with delirium
for three days. She was treated by the family with ordinarv
domestic remedies. In about two weeks there was formed at
the ankle-joint what they conceived to be an abscess, to which
they applied poultices. &c. In about four weeks the limb showed
marked signs of serious disease. The day before I saw the case,
they were dressing the leg and perceived that it was ' loose/
and concluded that it would have to be taken off.

When I saw the patient the dressing had not been disturbed
for upwards of twenty-four hours, and as I removed this, the
foot came off with it, about four inches above the ankle, the
stump presenting a very rough and uneven surface from which
the tibia and fibula protruded about two inches. The portions
of the tibia and fibula attached to the foot (about four inches)
were mere shells, covered by very soft and offensive flesh, the
skin of which, however, was rather dry and of a dark brown or
blackish color, like that of the foot I send you.

" Assisted by Drs. Hardie and Bass, I amputated the leg about
four inches below the knee. The stump was inclined to sup-
purate for a week or ten days ; but with the ordinary treatment
it has since healed kindly, and the girl Is now well. I deem it
unnecessary to make any remarks on the condition of the foot.

A Case of Inversio Uteri. [February,

as you will see it yourself. It has undergone no change since I
first saw it."

We are much indebted to Dr. Connell for the very interest-
ing specimen referred to above. We find the foot very much
like that of a mummy ; shrivelled, dry, of a dark brown or
blackish hue, and somewhat offensive when brought near the
olfactories. While dry mortification is not a very rare affec-
tion in the aged, we do not recollect to have ever seen a case of
it in a subject so youthful as this. The specimen is deposited
in the museum of the Medical College of Georgia, and will con-
stitute quite a valuable addition to that extensive collection of
pathological anatomy. Emtoi.

Augusta, January, 1854.

A Case of Inversio Uteri. With an analysis of sixty-seven-
cases, collated from various sources. By Sanford B. Hunt,
M. D.

Mrs. Ann W , of Irish birth, aged 25 years, was confin-
ed with her second child, Sept. 7th, 1853. She was attend-
ed by a German midwife, from whom, and from the other
attendants, I obtained the following history : The labor com-
menced yesterday, she having just completed the seventh
month of pregnancy. Pains continued during the night and
day, until a little after 4, P. M., of the 7thT when, after a good
deal of severe pain, the child was expelled. An unusually large
quantity of water came away with the child. She was, at the
moment of delivery, seated nearly erect in her sister's lap, and
the expulsive pain which completed the labor, forced the child
down suddenly, so that it dragged heavily upon the cord by its
entire weight, and the uterus was instantly, and completely, in-
verted, and protruded beyond the vulva, lying as a large glo-
bular mass between her thighs. She was very faint, and they
thought her about to die. The midwife tied the cord and re-
moved the child. She then replaced the uterus within the
vulva, and having placed her patient upon the bed, sent for a
physician. The case then came under my care.

I arrived at the house about 5 o'clock, say three-fourths of
an hour after the accident. She was pale, pulseless, and sigh-
ing apparently moribund. I ordered brandy to be given, and
examined immediately. The placenta the cord being unusu-

1854.] A Case of Inversio Uteri. 89

ally short I found presenting at the vulva. I should estimate
the length of the cord at from eight to ten inches, though it was
not measured. Within the vagina was a large gobular tumor,
as large as the head of a child, but not to be mistaken for it.
Its surface was rough, -moderately firm, and bleeding. This
was the uterus inverted, with the placenta firmly adherent to
it, in a space of about three by four inches. At this time Mrs.
W. lay in a pool of blood, and much blood was constantly es-
caping from her. Without much difficulty I separated the pla-
centa, with the result of a partial check to the hemorrhage. I
then made an effort to reduce the tumor by placing my hand
upon the fundus, and pressing it upward, but there being con-
siderable resistance, and as the hemorrhage, though now not
great, had become (from the amount previously lost) the more
immediate danger, I desisted for the moment from attempts at
reduction, and dispatched a messenger for my colleague, Dr.
Flint. In the mean time I applied a tampon to the bleeding
surface, and cold to the pubes. These means being insufficient,
I compressed the abdominal aorta against the vertebral column.
The hemorrhage then ceased ; and by the continual adminis-
tration of large draughts of brandy, her pulse rallied, and she
was in a more promising situation when Dr. Flint arrived,
which was in about twenty minutes after my own advent the
manipulations described not having occupied over five minutes.

Dr. Fint removed the tampon for the purpose of an exami-
nation. He confirmed my diagnosis, and w7e proceeded im-
mediately to the reduction. The open and fully dilated os
uteri could be felt through the abdominal parietes over the pubis.
Dr. Flint engaging his fingers behind this externally, I intro-
duced my entire hand into the vagina, and gradually carried the
tumor up. The fundus, at first with considerable opposition,
slowly yielded and rolled in upon itself, until the usual promi-
nent tumor over the pubis being felt, Dr. Flint thought the
reduction completed. To convince him to the contrary, I
withdrew my hand, and Dr. F. inserting his own, found the
posterior wall of the uterus still mostly engaged in the os. By
gentle manipulation he soon restored this to its normal position,
and retaining his hand within the uterine cavity until contrac-
tion came on, the reduction was completed, quietly and safely.
On again examining, I found the os uteri in situ, and well con-
tracted. Dr. Flint leaving soon after, I gave brandy pro re
nata. Our patient fell asleep immediately after the reduction.
She was very faint and prostrated for -some time. At 8, P. JVL
I bandaged her, and applied cold to check flowing, which was
then renewed. R Morph. sulph., gr. J, every 4 hours.

September Sth. I found a very smart reaction. She had

90 A Case of Inversio Uteri. [February,

headache, her pulse 120, full and bounding, but soft. Moder-
ate flowing. Urinates with ease, ty Sulph. morph.,gr. \ every
4 hours.

September 10th. Up to this time I have maintained the mor-
phia as above. To-day there is febrile disturbance, and ab-
dominal tenderness. Breasts swollen ; milk profuse. Attrib-
uting this febrile action to the ordinary milk fever, I gave a
saline cathartic. Aside from subsequent difficulty in procuring
sufficient action of the bowels, Mrs. W. went on to convales-
cence with no very peculiar symptoms. She now (Sept. 30th)
sits up most of the time, and is in a favorable condition.

Since the occurrence of this alarming and nearly fatal case,
I have been led from a consideration of the imperfect-state of
information on this branch of obstetric science, from the differ-
ences of opinion as to its proper management, and from the
great importance, both as to the life of the patient, and the re-
putation of the practitioner, of a clear and definite idea of its
real nature, to collate from such sources as were within my
reach all cases of which I could find any record, and to furnish
the results of this labor to the readers of the Journal in a con-
densed form.

Of many of these cases I found the records sufficiently full to
enable me to ascertain their most important phenomena. In
other cases the reports were so meagre, that I could only as-
certain a very few of the symptoms present. I have endeav-
ored to present them in such a form as would give to the
reader a fair and uncolored view of the facts, and in every
case where the occurrence of a symptom was doubtful, I have
omitted to mention it.

I shall first give as brief a summary as possible of the re-
sults of my analysis, and subsequently shall draw from them
such inferences as to treatment as they seem to teach. I trust
that these deductions may possess some value. No one man
is able to speak authoritatively from his own experience on this
subject. So rare is the accident, that the most extensive prac-
titioners frequently pass a lifetime without meeting a single
case, while it has often happened, that upon the man of limited
resources, and narrow obstetrical experience, has fallen the
responsibility of treating this dislocation.

The total number of cases of which I find on record, is sixty
seven : Of these, twenty-one were reduced and recovered ;
thirty-three became chronic ; and thirteen died.

The number of the labor is mentioned in twenty-three cases :
Nine occurred in the first labor ; seven in the second labor ; six
are mentioned as multiparous; and one occurred after abor-
tion, at the fourth month.

1854.] A Case of Inversio Uteri. 91

The degree of inversion is mentioned in forty-one cases :
Thirty-five were cases of complete inversion ; and six were
mentioned as partially inverted.

The time at which the accident occurred is noticed in forty
five cases: Nineteen of these happened immediately on the de-
livery of the child ; eight on attempting to remove the placenta.

The remaining eighteen cases occurred : One, after removing
the placenta by trie hand in the uterus; one, simultaneously
with the first -after pain, seventeen minutes after the expulsion
of the child ; three, half an hour after the delivery of the child ;
one, eighteen hours after labor ; three, three days after parturi-
tion ; owe, on the eighth day ; one, on the twelfth day ; one, on
the fifteenth day ; one, on the tenth day ; four are mentioned
as occurring at unknown periods ; and one, nine days after
abortion at the fourth month. /

The condition of the placenta, is mentioned in thirty-seven
cases : In eighteen of these it is mentioned as adherent ; in nine-
teen it was removed either before the occurrence of inversion,
or without recognizing the difficulty ; in ten cases the placenta
was intentionally detached when adherent.

The records as to hemorrhage are very imperfect.

In only six cases is the degree of hemorrhage before removing
an adherent placenta mentioned : In one of these it was slight
this case was fatal ; in five it was large in amount one of these
was fatal.

The degree of hemorrhage after detaching an adherent pla-
centa, is mentioned in ten cases : In eight of these it is men-
tioned as slight ; in two it was dangerous one of these was
fatal.

Hemorrhage is noticed after removing the placenta as usual,
or before the accident in five cases.

In eight cases it is spoken of in general terms.

Of two cases where the placenta was returned with the
uterus in the operation of reposition : one had fatal hemorrhage;
while in the other it was slight.

In five cases no hemorrhage occurred.

Convulsions occurred in three cases; all of which werefataL

Syncope in twelve cases.

Syncope, without hemorrhage, in one case.

The above closes the record of the more important symp-
toms occurring in the recorded cases. It is to be regretted
that it is not more complete, but a careful revision has not
enabled me to add anything to them. In the consideration of
the phenomena of fatal and irreducible cases, other facts of
importance will be deduced. I shall first, however, attempt a
review of the causes of this accident, and shall, as far as the

92 A Case of lnversio Uteri. [February,

facts in my possession enable me, endeavor to show the more
usual causes of the dislocation.

Ten cases were attended by female midwives.

In ten cases there was undue traction on the funi<. '

In nine cases there was a rapid labor.

In jive cases the patient was delivered in the erect posture.

Infive cases there was a short funis.

In one case it was perhaps attributable to sneezing, produced
by snuff, given to accelerate the delivery of the placenta.

In one case it- occurred on getting out of bed, on the third
day.

In one case on leaving the bed on the fifteenth day.

In one while at stool, on the tenth day ; and in one there was
placenta praevia.

Of the circumstances bearing upon the treatment of the ac-
cident, the record is more full and satisfactory. I have already
enumerated twenty-one cases as recovering alter reposition.

In four other cases death occurred after the reposition of the
organ.

Of the irreducible cases thirty-three became chronic, and/fofl
others died from consecutive circumstances. I defer the de-
tails until I speak of the treatment.

Of the thirteen fatal cases it is recorded that death occurred
immediately and before the reposition of the organ could be
effected, \nfour cases.

In four other cases, death occurred after the reposition of
the uterus, and the remainingy/ut; deaths occurred in chronic
cases.

Remarks. The twenty-three cases in which the number of
the labor is mentioned, would indicate that the tendency to in-
version decreases with the number of children which the
woman has borne.

The proposition of first labors is 1 in 255.

second " is 1 in 3*28.

" " multiparous labors is 1 in 5*83.

Causes. The cause to which the inversion is attributed,
varies very much in different cases. It is noticed that 1 in 6*7
were attended by female accoucheurs. As the proportion of
labors occurring under the supervision of female attendants is
undoubtedly much less than 1 in 6*7, it is probable that a lack
of necessary skill and precaution were influential in producing
the accident. But it is by no means fair to draw the inference

Dr. Wm. Hunter estimated the circumstances under which traction on the
funis may produce inversion very correctly, when he said that, " When a uterus
is flaccid, it is inverted as easily as the finger of a glove; but when it is hard,
globular, and contracted, it is as difficult to invert as a jackboot."

1S54.] A Case of Inter sio Uteri. 93

that a want of skill is always, or even generally the cause. Dr.
Meigs details a case, (the one mentioned as a placenta praevia,)
in which after the delivery, the fundus came down, was easily
replaced, but again came down, and speedily fatal. It will also
be noticed, that nineteen of sixty-seven cases occurred immedi-
ately after the delivery of the child. In these cases it is diffi-
cult to suppose that any cause within the control of the attend-
ant could have operated, except the erect position, which was
mentioned mfive cases. A short funis is another cause which
is probably the most frequent of any, though only mentioned in
five cases. The erect posture, combined with a short funis,
would almost inevitably produce inversion. It is highly pro-
bable that the funis is the more frequent cause, from the fact
that so large a portion of the cases had adherent placenta 1 in
3*53 of the entire number of cases are mentioned as adherent.
As there is nothing in the adhesion itself to bring on inversion,
we may suppose that it furnishes the condition necessary to
make a traction on the cord, either accidental or intentional,
the source of the dislocation. In 1 in 6 7 of the cases undue
traction was made upon the cord. It is now the habit of many
excellent and careful accoucheurs to deliver the placenta
immediately. Without the usual and proper precaution of
placing one hand upon the fundus of the uterus while making
traction with the other, it is plain that the practice alluded
to would be mischievous. With this precaution there can
be no danger in prudent hands. Rapid labor is mentioned
in nine cases. No mention is made in the records, of the quan-
tity of amniotic fluid. In my own case there was an unusually
large discharge of the waters occurring at the moment of deliv-
ery. The other causes enumerated are evidently exceptional.
One inversion occurred on getting out of bed on the third day ;
one from the sase cause on the fifteenth day, and one at stool
on the tenth day.

Degree of Inversion. Only two divisions have been made
in this analysis, partial and complete inversion. Another di-
vision, or rather stage of inversion, has been made by some
writers that of depression. It is supposed that in those cases
of inversion occurring at a length of time after placental deliv-
ery, a slight depression exists in the fundus, from the time of
removing the placenta; that an inverted action of the uterine
fibre being thus produced, it goes on gradually increasing the
depression with each afterpain, until it at last becomes partial
or complete. It is not improbable that this condition may
sometimes obtain. The treatment proper for this stage would
be the introduction of some firm instrument, like a rectum
bougie, into the cavity of the uterus, and restoring the fundu3

94 A Case of Incersio Uteri. [February,

to its natural shape by pressure from within. The operation
would be a simple and easy one, but its necessity could not, as
a general thing, be detected in time to make it useful.

By partial inversion is intended that condition when the fun-
dus protruding through the os tinoae, the inversion is still in-
complete, the os itself forming a ligating band about the sub-
stance of the organ. Of the forty-one cases in which the de-
gree of inversion is noted, only six are mentioned as partial.
It is probable that but few cases remain long partially inverted ;
they going on either to complete inversion, or to spontaneous
reposition. That the latter is not impossible, is proved by a
number of cases to be hereafter enumerated, and the argument
to be drawn therefrom is, that it would not be judicious to do
as recommended and practiced in one instance by a distinguish-
ed American accoucheur, who in a case of partial inversion,
dragged down the fundus, and made it a complete inversion,
in order to prevent ligation by the os.

Complete inversion is mentioned in thirty-jive cases. It is
thus evident either that the complete is by far the more com-
mon form of the accident, or that the partial form is not so often
detected ; a consideration of some probability, and likely to
result unfortunately, for it does not appear that partial inversion
is any more manageable in its chronic stage than is complete ;
and the consequences of the ligation by the os may be much
more serious, producing much and obstinate hemorrhage, and,
not unfrequently, gangrene of the excluded portion. It is proba-
ble that in all cases of complete inversion the uterus is at first
protruded through the vulva. The displaced organ can, how-
ever, without difficulty, be returned within the vagina. In
cases of complete inversion, the peritoneal surface of the dis-
placed organ forms a cavity, in which are contained the ova-
ries and fallopian tubes, and sometimes portions of the intestine.

The internal or mucous surface is turned outward as we
turn a glove. It forms a gobular tumor, of a size proportioned
to its recent character. It has a rough rugose surface, firm to
the touch, and bleeding when handled.

Treatment. In one-half of the cases of inversion, the practi-
tioner will find the placenta attached to the inner, and now
conical, surface of the uterus. Should the placenta have been
already removed or expelled, there is no doubt as to the proper
course to be pursued. But when the placenta still remains ad-
herent, there is room for discussion as to whether to replace
the uterus with the placenta still attached, or to first detach it,
and then reduce. The weight of authority is in favor of the
former method of procedure. The argument adduced in its
favor, is the danger of increased hemorrage attendant on the

1854] A Case of Inuersio Uteri 95

removal of the after-birth. In support of this argument are ar-
rayed many of the most distinguished names in obstetrical
science.

Burns says: " If the placenta still adhere, we should not re-
move it till we have reduced the uterus ; after which we excite
the contraction of the womb to make it throw it off."

Denman, after advising the removal of the placenta when
only partially adherent, adds; ''But if the placenta should
wholly adhere, it would be better to replace the uterus be-
fore we endeavor to separate the placenta. The ground of
this opinion is, that while we are separating the placenta the
cervix of the uterus is contracting, and the difficulty of repla-
cing it is increasing, which is a greater evil by far than a re-
tained placenta.'"'

Dewees (System of Midwifery, p. 456 :) " If the placenta
offers itself before the prolapsed fundus, we may, if detached,
deliver it immediately ; but if it be adherent, and the mouth of
the uterus does not offer too much resistence, it must be car-
ried up with the fundus, and separated as before directed."

Gooch (Midwifery, p. 273:) "First make an attempt to re-
place the uterus without separating the placenta from it ; and if
you succeed so much the better ; then by external pressure and
friction, excite the action of the uterus to separate and expel
the placenta."

Besides the authors above quoted, Clarke, Carus, Newnham,
and Blundell, record a decided protest against removing the
placenta prior to the reduction of the displaced organ. All of
them, however, admit that their method renders reduction
more difficult, and in cases where the bulk of the placenta is
such as to render its return impossible, they permit its removal.
On the other side of the question we find Bandelocque, Bol-
vin, Churchill, and Moreau. As my own opinion coincides
with those last mentioned, I shall briefly state the reasons
which govern my decision, and the facts from my analysis
which bear upon it.

It is hardly probable that the placenta will in any case of
inversion be found attached in its whole surface. The turning
outward of the uterine cavity must necessarily detach it in
some portion of its surface.

In nineteen out of thirty-seven cases in which the condition
of the placenta is recorded, it was detached without recogniz-
ing the difficulty, or expelled spontaneously. It is not to be
supposed that these placentae were adherent.

In the eighteen remaining cases the placenta was adherent.
In only six of these is it recorded that any attempt was made
to return the placenta. Two of these attempts failed ; in the

96 A Case of Invcrsio Uteri. [February,

other four the placenta was carried up with the uterus. In
one of these four cases, there was fatal hemorrhage after the re-
duction. In another, the placenta remained attached for four
hours after reduction. In the third case, the placenta was not
removed till five days after reduction. Of the fourth and last
case, no record is made of subsequent difficulties.

It would seem from these facts, that whatever may be the
danger of immediately detaching the secundines, their return
is also a formidable operation, attended by great difficulty in
performance, and when successful, leaving another and danger-
ous condition still present. Some of the facts in our analysis
will go to showr that the danger of hemorrhage has been greatly
overrated.

In the first place, out of the thirteen deaths, only four died
from hemorrhage.

Of these four, one died after the reduction of the placenta
with the uterus.

One died prior to detaching an adherent placenta.

One died, the placenta being expelled previously to recogni-
zing the accident.

One died from hemorrhage consecutive to removing an at-
tached placenta.

Thus we have only one death in sixty seven cases, which
can be attributed to detaching the placenta. The history of
other fatal cases will incidentally farther illustrate this point
in treatment.

The arguments thus adduced are :

First ; the attempt to return the placenta very much increa-
ses the difficulty of reposition.

Second ; when successful it leaves a formidable difficulty to
be still encountered.

Third; it does not decrease the dangee of hemorrhage.

Bv removing the placenta immediately you avoid these dif-
ficulties without increasing the danger.

The placenta having then been removed, our next step is to
replace the uterus. But here another difficulty, not mentioned
by any author, may intervene. The hemorrhage may have
been so great as to be of more immediate consequence than
the displacement it-self. There may be after-pains present in
the uterus, offering a resistance to manipulation too great to be
overcome. In my own case, both these happened. On re-
moving the placenta I attempted immediate reposition, but the
resistance of the after-pain was such as to render it impossible.
The flooding, too, though much less than before the removal
of the placenta, was still, in her exhausted condition, very for-
midable. I, therefore, during the delay previous to Dr. Flint's

1854.] A Case of Inversio Uteri. 97

arrival, directed my efforts to checking the hemorrhage, and
restoring consciousness. This accomplished, the patient was
in a much more favorable condition for reduction than a few
minutes previously.

The hand is the best instrument for reduction. It is mana-
geable and always present. Some writers have recommended
the head of a walking-stick, a large bougie, or any other blunty
rounded instrument. Such an one would be liable to slip from
the globular surface, and do injury to the parts, and has no
advantage to compensate for this danger. Others have pro-
posed that the hand itself should be shielded by a cloth why,
I do not know. First returning the uterus within the vagina, it
should be carried bodily up until the vagina is " on the stretch.*''
At this point it has been advised by Mr. Xewnham to " return
first that portion of the organ which was last excluded from
the os." How this is to be doDe in complete inversion does not
appear; in partial inversion it is possible, and is, I opine, the
usual method of completing all reductions. When the fundus
is returned within the os, the womb passes in its progress
through all the degrees of partial inversion ; and it is then con-
venient to pass the fingers above the everted lips of the os, and
to press the excluded portion upward with the thumb. In all
cases, the whole hand should be introduced. The pressure
should be firm, and continued for some time, even if the os does
not yield at first. Dr. Dewees has said that he does not be-
lieve it possible to return a complete inversion, though he adds
that he cannot speak from positive knowledge. A complete
inversion may be as readily returned as a partial one, provided
there is not too great contraction of the os. Now complete
inversion does not necessarily suppose such contraction. The
os may be dilated to its fullest extent. The fact of inversion
predicates a lax fibre, and very many cases of unmistakably
complete inversion are recorded as reduced. The uterus hav-
ing been restored to its natural position, the hand should be
maintained within its^ cavity until contraction takes place.
The after treatment does not require consideration here. Only
one fact need be mentioned: I have found no case recorded
where the patient died from subsequent disease, such as metri-
tis, or peritonitis.

I have already enumerated a portion of the fatal cases those
which had any bearing on the question of removal of the pla-
centa.

Death occurred immediately, and before reposition, in four
cases.

One died from hemorrhage before the difficulty was detected.
The placenta had been removed.

A Case of Inversio Uteri. [February,

One from hemorrhage from an attached placenta, which was
not removed.

One from hemorrhage subsequent to the removal of an ad-
herent placenta.

One from " nervous exhaustion with slight hemorrhage."

Four deaths occurred immediately after reduction. One
from hemorrhage, the placenta having been returned with the
uterus ; and three from convulsion. The remaining five of the
thirteen deaths were in chronic cases. We have thus consid-
ered the principal features of the accident. Only one consid-
eration remains that of the period after inversion at which
reposition may be effected. As time passes on, the uterus con-
tracts, its parietes become thicker and firmer, and the OS uteri-
is more closely contracted, and less readily dilated to admit the
return of the excluded portion. Every consideration com-
bines to make an immediate reposition desirable and nee
ry. The delay of even a few moments is to be regretted,
while the passing of on hour may forever forbid replacement.
An hour after the accident is considered a long time, and likely
to make the operation unsuccessful. Dr. Locock speaks of
having succeeded at the end of an hour and a half, in a tone
which indicates a pleasurable disappointment. But lest the
practitioner should be too readily discouraged, many cases of
successful attempts at reduction are recorded at much longer
periods. In recording these cases, I have, in most instances,
preceded the length oi time at which the reduction was effected
by the name of the accoucheur. This I have done, that the
character of the reporter may in some measure settle the cred-
ibility of the report. Dr. Aver, of Boston, thirty-one hours;
Dr. Merryman, " long afterward ;" Dr. McCoy, 2 days ; un-
known reporters, ] 2 hours, 57 hours, 4 weeks. Besides these
are the following cases from Churchill, which are not elsewhere
included in this analysis: Suffler, 6 or 7 hours ; White, 17
hours ; Wynter, 24 hours ; Dickenson, 27 hours ; Cawlev, 3
days; Dr. Radford, 7 days; Chopart and Ane, 8 days; Ingle-
by, 8 days ; Lanverjat, 10 or 12 days ; Hoin, 13 days ; Dr. Bel-
combe, 12 weeks.

Churchill evidently considers these cases authentic. They
are nevertheless exceptional cases, and should not be admitted
in excuse for any delay of immediate reposition.

That the consideration of chronic inversion is not less im-
portant than that of the immediate accident, is evident from the
fact, that of the sixty-seven cases enumerated, thirty-two were
either irreducible or not reduced, and became chronic. The
term chronic, though not strictly applicable, is still sufficiently
descriptive. It means that condition which is expressed in the

1854.] A Case of Inversio Uteri. 99

word irreducible. I have no sufficient data for explaining why
so large a proportion of the cases were not reduced. In many
instances it is evident that the accident was not detected until
so long a time had elapsed that reduction was impossible. In
a very few it is stated by the reporters, that though the acci-
dent was discovered early, the condition of the organ, and es-
pecially of the or uteri, was such as to preclude reposition.
We have already quoted the opinion of Dr. Dewees that a
complete inversion is necessarily irreducible, and though we
think it sufficiently shown that this is not even frequently the
case, yet it is easy to conceive that there might be such a tonic
contraction or rigidity of the os, as to preclude any possibility
of dilating it sufficiently to replace the organ. In such a con-
dition it is evident that no safe amount of force would result
in success. I find reason to believe, from the different reports
I have read, that most cases of the chronic form were insidi-
ous in their oncoming. The pain resulting from a simple de-
pression of the fundus might easily be mistaken for after-pain
of unusual severity ; and this depression may go on through
the various stages of partial, until at last it becomes a complete
inversion. Or. supposing the displacement to be only partial,
the true state of thingswould be very liable to escape detection
until too late for any remedial measures.

Chronic inversion is not necessarily complete it may be
partial. To this latter form of the disorder I shall first direct
my inquiries. A partial inversion would not protrude beyond
the vulva. The physical signs of its presence would be a de-
pression in, or entire want of the usual globular tumor over the
pubis ; while an examination, per vaginam, would reveal there
a gobular mass, protruding from the os uteri, and more or less
ligated by it. Our attention should be directed to the possibili-
ty of inversion, by the presence of unusually severe uterine painr
of hemorrage, of syncope and hemorrage, or of syncope or con-
vulsion, and of retention of urine. The sensations of the
patient would be the same as those attendant on prolapsus
uteri, but in a more aggravated form. If to these sensations
we add the occurrence of syncope without hemorrhage, we
should have sufficient reason to suspect inversion.

It has been remarked that partial inversion was, in some
sense, a more important and dangerous accident than com-
plete. From the greater degree of ligation by the os, there
would be greater danger of hemorrhage, of strangulation, and
of consequent gangrene. The hemorrhage, too, would be
more uncontrolable. Added to this, the accident is less liable to
detection, and is not in all cases more readily reduced than is
the other form.

100 A Case of Inversio Uteri. [February,

Relative to the treatment of partial inversion, there can be
no great difference between it and that proper for the complete
form. The greater liability to gangrene, however, makes a dis-
tinction which should not be overlooked. I find Jive cases in
which gangrene occurred. Singularly enough, all of these
resulted in what may be called a cure ; that is, the cases recov-
ered from this amputation by natural process, and regained a
comfortable general health. I do not find any cases which
were fatal from gangrene. An inference which may be drawn
from this fact would go to prove that the proposition of Dr.
Dewees, (and which in one instance he carried out,) to pull
down upon an irreducible partial inversion, and render it com-
plete, is not justified by the ulterior consequences of gangrene.
It is to avoid gangrene that Dr. Dewees proposes this plan, but
until a greater amount of evidence is furnished of the fatality
of gangrene, the operation can hardly be justified. It should
not be forgotten, however, that very many complete cases en-
joy a comfortable degree of general health. Were it proven
that the probability of regaining such a degree of health under
complete inversion, is greater than the chance of a cure by
gangrene, then the operation would be worthy of consideration.
As yet, no sufficient data exist to decide this point.

But no case of partial inversion should be readily surrender-
ed to either of the uncertain chances. Every attempt at reduc-
tion should be made. Methodical compression of the protruded
portion should be employed, and all such local applications as
would be likely to relax the constricted fibres of the os, and
diminish the size of the vaginal tumor. Among these I would
suggest, as most likely to be beneficial, the application of bella-
donna to the os. The hemorrhage should be controlled by the
local use of astringents, and very firm and long continued pres-
sure should be made.

The propriety of surgical interference will be considered
under the head of complete irreducible inversion ; and all other
remarks as to treatment will apply to either form of the accident.

I find (aside from the five cases of cure by gangrene) that of
the irreducible cases,^ue, or nearly one-sixth, terminated by
spontaneous reposition. For a long time the possibility of this
very fortunate occurrence was denied by authors, but the oc-
currence of two cases in France, and subsequently of three in
this country, have placed the matter beyond a doubt. Few
incidents in the self-instituted processes of nature for the cure
of the disease are more interesting than this. Only the authen-
tic sources by which the cases are furnished could convince us
of the possibility of so great an effort to accomplish a restora-
tion, not of function only, but of natural position, against so

1854.] A Case of Inversio Uteri. 101

many chances of failure. I trust I shall not be tedious if I de-
vote some space to the history of these cases.

The first was that of Madame De La Barr, the wife of a
surgeon of Beuzeville. Six months after the occurrence of in-
version, this lady, in getting out of bed. fell upon the floor. At
that moment she felt an extraordinary motion in her bellv, ac-
companied by very severe uterine pain, which was followed
by syncope. On recovering from this condition, it was ascer-
tained that the uterus had returned to its natural position.

The second case is the famous one of Madame Boncharlatt,
authenticated by Baudelocque. Madam B., after suffering for
seven or eight years with inversion, consulted Baudelocque,
who failed in an attempt to reduce it. On the evening prece-
ding the day on which another attempt was to be made, her
friends insisted upon her walking about the room. She strug-
gled and fell upon the carpet, and immediately felt an unusual
movement and pain in the uterus, followed by momentary un-
consciousness. Baudelocque being called, found that sponta-
neous reposition had taken place This woman, having re-
covered her health, subsequently gave birth to a child.

To come down to more recent times. In the Boston Medi-
cal and Surgical Journal, vol. XL, p. 277. Dr. I. 0. Hatch, of
Kent, Mass., communicates the case of Mrs. H., who had in-
verted uterus, the diagnosis being confirmed by Prof. Beers, of
New Haven, who made an attempt at reposition. At the end
of nine or ten months, Mrs. H. found that the tumor in the
vagina had so changed its place "that she did not know what
had become of it." She afterwards bore a child at full time.

Dr. Meigs also relates two cases of gradual and spontaneous
reposition : one, after three years had elapsed; the other after,
many months. Both these cases subsequently bore children.

We have thus disposed often of the thirty-two irreducible
cases by spontaneous cure -Jive of them by gangrene, and con-
sequent mutillation of the organ, and five by what we can only
consider as a most remarkable accident the spontaneous
reposition of the organ, and its restoration to integrity of func-
tion, as proved in four cases by the occurrence of subsequent
pregnancy. It may not be amiss to mention, in this connection,
another case of remarkable interest, if there is no error in the
diagnosis, or hiatus in the history. This case involves the
possibility of conception taking place in an inverted uterus.
The wife of Julian Rousin gave birth, in October, 1777, to a
healthy child, but the midwife, in extracting the placenta, in-
verted the uterus. The tumor was merely returned into the
vagina. Ten months afterward, she suspected herself preg-
nant. At three months, after a good deal of pain, she expelled

n. s. vol. x. NO. II. 7

102 A Case of Inner sio Uteri. [February,

a considerable mass, which MM Thuilier and Vager recogni-
zed as an inverted uterus. For several days M. Vager tried
to reduce it, but could not, and at last, by advice of MM. Thui-
lier and Paroifreu, he returned it to the vagina. Six days after,
Madame Roussin expelled a fetus five inches in length. The
woman was subsequently examined by M. Chevruel, who
found the uterus still inverted. He supposed it a case of fallo-
pian pregnancy. Probably such a case will never occur again,
and there is much room to doubt the history of this case. No
one but a midwife saw it till after the abortion. By supposing
the original accident to have been prolapsus, the inversion to
have occurred at the moment of abortion, the fetus to have re-
mained in the vagina while the uterus pushed on through the
vulva, and finally, the fetus to have been expelled by some
casual movement after six days, and we have done away with
all the mystery. Such is the explanation of this history
offered by M. Moreau.

Two other terminations of inversion remain to be considered,
first, using such means only as may tend to allay the inconveni-
ences and dangers attendant on the condition ; and second,
the cure by operation.

Upon the measure of health and comfort attainable in the
first mode of management, must depend, in some degree, the
propriety of the operation. In a case related to me by Prof.
James P. White, of this city, to which he was called some
twelve or fourteen days after inversion had occurred, which
was then for the first time detected, and had become irreduci-
ble, he resorted to such a treatment as it seems to me is most
appropriate to such cases. The hemorrhage and discharges
were controlled by astringent injections ; the uterus was repla-
ced as high up as possible, and maintained there by a pessary
made of curled hair, inclosed in oil silk. The recumbent posi-
tion was maintained until the parts could accustom themselves
to this new condition; and finally there was a restoration to
a very comfortable degree of health, so that the patient was
able to attend to her ordinary household duties, and even to
ride, occasionally, a distance of some miles, to this city. That
such may be the result under judicious treatment, is evident
from the whole history of chronic inversion. At the moment
of the accident, the womb is in a condition of hypertrophy.
Its enormous size can scarcely be contained within the vagina,
and accordingly we find it generally extruded from the os ex-
ternum, and lying between the thighs. At this time it is
subject to frequent hemorrhage. The patulous orifice of the
placental vessels are still unclosed, and at the slightest handling,
pour out blood profusely. But after the uterus is returned to

1854.] A Case of Inversio Uteri. 103

the vagina, and is thus shielded from the air, and from irrita-
ting contact with surrounding substances, the ordinary and
normal diminution of the uterus after parturition takes place;
the lochial discharge is instituted, and finally the organ regains
its natural unimpregnated size, and performs its menstrual
function uninterruptedly. Dr. White tells me that he has seen
the menstrual secretion oozing gultatim from the mucous sur-
face. The data of irreducible cases are insufficient to say
what proportion of them may result thus favorably. In a case
read before the New York Medical Association, by Dr. Van
Pelt, the uterus was, (owing to circumstances unnecessary to
be mentioned here,) found on the morning of the fourth day
after inversion, lying externally to the vulva, and so concealed
in dry, hard clots, which had formed it, that Dr. V. P. could not
decide on the nature of the accident until they had been
softened by fomentations, and removed. This uterus was re-
duced. This case is quoted as showing the little danger of
metritis which exists, and the gravity of accident which may
be recovered from. In other cases, (two in number,) the
patients are mentioned as living in comfortable health some
years after inversion.

These facts and inferences have all a bearing upon the ques-
tion of operation for the removal of the uterus. If the patient
enjoys any comfortable degree of health, there should be no
operation. The only circumstances under wThich the knife or
ligature are justifiable, are those involving great danger to the
patient's life. A case of inversion in which the organ had
diminished to nearly its natural size, could present symptoms
no worse than those of ordinary prolapsus. We believe that
the knife has not yet been proposed for this latter displacement.
The circumstances which militate against an operation are
briefly these :

1st. The probability of the system's accustoming itself to
the accident, and regaining a degree of health ; 2d. The pro-
bability of spontaneous reposition ; and 3d. The dangers attend-
ant on an operation.

The data of this analysis which bear on the propriety of
operation are as follows : There were thirty two irreducible
cases. Of these, Jive terminated by spontaneous reposition ;
Jive by strangulation and gangrene, followed by recovery ; four
are recorded as successful cases of ligation ; six are mentioned
as "extirpated" successfully; and four cases of ligation were
fatal.

It will be seen thatjorce in three and a half of the cases opera-
ted upon, died. Of the eight cases remaining, there is no record
except of the two already quoted as in comfortable health years

304 A Case of Inversio Uteri. [February,

after the accident. I shall quote somewhat largely from the
histories of these operations.

Of the four successful cases of ligation, two were tied, sup-
posing them to be polypi. These, of course, are to be consid-
ered merely as fortunate terminations of unfortunate blunders.

The third of these cases is reported by Dr. Usher Parsons,
of Rhode Island, in the Boston Medical and Surgical Journal,
vol. xiv, p. 511. It was a partial inversion of four years' stand-
ing. There had been great suffering from alarming hemor-
rhage, leucorrhcea, nervousness, and uterine pain. The tumor
was lighted just below the point of stricture, at the os tincae.
Four days after, the operation was completed by the knife and
sissors. It resulted in a cure.

Of the fourth and last case of successful ligation, I have no
record beyond the mere fact of the operation.

Of the six successful cases of "extirpation," it is not stated
whether the knife or ligature was used. One of these was ex-
tirpated on the fourteenth day after labor, by an English sur-
geon a most unjustifiable and ignorant proceeding.

Of the four cases of unsuccessful ligation, one was ligated
immediately after delivery, the uterus being mistaken for a
tumor in which the placenta was implanted. On the eighteenth
day after, she was admitted into Boyer's ward at LaCharite.
Seven days after, the ligated portion came away, and she died
a few days later.

Another case was also ligated by mistake, six months after
inversion. She died five days after the operation. The two
remainingcasesdied of peritonitis occurring after the operation.

Thus of fourteen cases in which surgical interference took
place, ten recovered and four died. Of the four who died, the
operation was performed in ignorance of the true condition of
the parts in two cases a fact which would have more weight
were it not that two of the successful operations were also in
the same category of surgical blunders.

No record of amputations of the womb would be complete
without some mention of Mr. Crosse's tables, collated with es-
pecial reference to the success of this operation. It is proba-
ble that some, perhaps most, of the cases I have recorded, are
also included in Mr. Crosse's statistics. A portion of them,
however, are too recent, and too little known to have found
place in his records.

Mr. Crosse has collected thirty-three cases of operations,
from various sources nineteen cases were treated successfully
by ligature ; five were treated unsuccessfully by ligature, of
which three died ; one case was treated successfully by excis-
ion ; two cases of excision were unsuccessful ; and five cases

1854.] A Case of Inversio UterL 105

successfully, and one unsuccessfully, by ligature and excision
combined.

Thus the average of unsuccessful cases according to Mr.
Crosse, is one in four and one-tenth. The average of my an-
alysis is more fatal, being of fatal cases one in three and five-
tenths. Adding the two together, we have twelve deaths in
forty-seven operations. One circumstance should be mention-
ed : In very few of the cases, (I think in only one that of Dr.
Parsons,) is it recorded whether the inversion was partial or
complete. I consider this an important point. In removing a
portion only of the uterus, as in partial inversion, the danger
would be much less than in the complete form. In the former
case, the operation being always performed just below the point
of ligation by the os, the integrity of the peritoneal cavity is
not at ail invaded, except at the point where the peritoneum
forms the lining membrane of the abnormal inverted cavity of
the uterus. The ligation by the os would effectually prevent the
effusion of blood, or check the progress of inflammatory action
into the peritoneal sac. But in complete inversion the con-
verse of these propositions holds true. The peritoneal cavity
is largely invaded, and there is nothing above to check effusion.

I have thus completed the consideration of this subject. It
has been extended to greater length than I had at first anticipa-
ted ; but the reader will readily appreciate how it is that a
subject widens and extends as we investigate. Some sources
of error exist in this analysis. The literature of inversio uteri
is scattered through many books and periodical journals. Many
of the records are unsatisfactory some perhaps are false. I
have admitted nothing as a fact that was not distinctly stated
as such, while I have taken it for granted that all the records
were originally written in a spirit of truth.

There is another source of error. How many cases of in-
version have died unrecognized, and been recorded only as sud-
den and fatal floodings, convulsions, or syncopes, no one can
tell. How many which have been recognized, have been con-
cealed, or not reported, is also unknown. The impulse which
we feel to report a successful case, and our repugnance to im-
mortalize our failures is so natural, that it not unfrequently
detracts from the relative value of our statistical records. But
from these records, such as they are, I have drawn the follow-
ing conclusions as to the causes of inversion, its treatment, and
its terminations :

The liability to inversion decreases, but not to any marked
degree, with the number of children which the woman has borne.

That no one cause can be assigned as universal, but that the
complication of a short funis with a rapid labor, the erect pos-

106 Acute Articular Rheumatism. [February,

ture when delivered, and a large quantity of amniotic fluid, are
the conditions most frequently present as causes.

Inversion may occur without neglect, or undue interference
on the part of the accoucheur.

The placenta is adherent in a large proportion of the cases.

When adherent it should be removed prior to any attempt
to reduce the inversion.

Such removal of the placenta does not increase, but rather
decreases the risk of hemorrhage ; while it facilitates reduc-
tion.

The returning of the placenta in reducing the inversion
complicates the after treatment, and adds to the danger of hem-
orrhage, while it retards and renders difficult the reduction.

Hemorrhage does not occur to any more fatal extent than
does convulsion or syncope.

All cases in which convulsion occurred were fatal.

There is little danger of metritis occurring after reduction.

Reduction increases in difficulty with the length of time
which elapses before it is attempted. Partial inversion is less
easily detected, but more readily reduced than complete.

No operation for extirpation should be resorted to until it is
evident that life is endangered.

A sufficient number of cases occur in which either gradual
diminution in the size of the organ, or spontaneous reposition
occur, to justify and demand a delay of any operation for ex-
tirpation, until it is urgently called for by the imminent danger
of the patient.

The operation by ligature, involves less danger than that
by excision, and is therefore preferable to it.

An operation is more frequently necessary in partial than
complete inversion, and is at the same time less dangerous.

Finally, under judicious local and general treatment, an in-
verted uterus may often exist for many years without great
loss of locomotion or of usefulness, and with a comfortable de-
gree of general health. [Buffalo Med. Journal.

There is no plan so well adapted to improve our knowledge
of diseases, and consequently to enable us to estimate properly
the value of therapeutic means, than that of studying them
without the perturbating influences of medication. As in the
study of natural history we select specimens in their normal
and undisfigured condition, so in endeavoring to determine the
true characteristics of diseases, we should examine them in
their state of nature, and neither deformed nor transformed by

1854.] Acute Articular Rheumatism, 107

the interference of art. The natural history of diseases is what
we need. The French school has done much toward this, and
the Homeopaths, who have honestly carried out their doctrine,
have taught us some valuable lessons on the subject. We
cheerfully give place to the subjoined researches of a Belgian
practitioner. [Editor.

Of the Expectant Method pursued at the Military Hospital
of Antwerp, in the Treatment of Acute Articular Rheuma-
tism* By J. Devtalsche, Adjunct Physician to the Hospital.
(Translaled from the Archives Beiges de Medecine Militaire.)

I propose in this essay to make known the method pursued
by Dr. Gouzee, in the treatment of articular rheumatism, and
the results which he obtains by it. This subject is not without
interest, there being no acute disease in regard to the treat-
ment of which the opinions of physicians are more divergent
than this. Unanimous in their judgment of the gravity, long
duration, and the danger of the complications of rheumatism,
they all teach that it should be opposed energetically ; but dis-
agreement arises as soon as it becomes necessary to select the
therapeutic agents which shall be employed. Some can only
see safety in repeated venesections, others recommend active
medicines, to be given in large doses usually, and each one
boasts of the preeminent advantages of his own plan.

Imbued with these notions before my arrival, in 1847, at the
Military Hospital of Antwerp, it was not without terror that I
saw M. Gouzee employing an expectant treatment in the most
intense cases of febrile articular rheumatism. This dismay
was converted into astonishment, when I observed that his pa-
tients recovered more rapidly than those I had previously seen
subjected to the ordinary methods.

Yet Dr. Gouzee had already made known his plan of treat-
ment. In a report of his clinic for the second quarter of 1843,
that eminent practitioner writes as follows :

" Of late years, there have been recommended the most violent and
disproportionate modes of treating acute articular rheumatism. Tar-
tarized antimony, nitrate of potash, blood-letting, opium, iodide of
potassium, and sulphate of quinia have been employed in frightfully
enormous doses ; and, surely, it cannot be asserted that a lar^e pro-
portion of the patients subjected to these various methods of treatment

* I have been astonished that physicians who have endeavored to appreciate
the value of the different modes of treatment recommended in articular rheuma-
tism, have never examined into the course of this disease uninfluenced by reme-
dies. The memoir of Dr. Dewalsche in part supplies this want, and furnishes
instructive facts bearing upon this capital point. [Xotc by M. Malgaigne.

108 Acute Articular Rheumatism. [February,

have been cured cito, tuto, el jucunde. It is even said that sulphate
ofquinia, administered in Rasorian doses, has occasionally jugulated
the patient instead of the disease.

"I have long employed a simple expectant treatment in this disease,
and a year has never elapsed without my having cause for astonish-
ment at the facility and promptitude with which my patients recover-
ed." (Archives Beiges. Jan. 1844, p. 7.)

Since that time Dr. Gouzee has occasionally recurred to this
topic, and I had believed that his opinions were generally known
and appreciated, until the perusal of recent scientific publica-
tions, and a late discussion in the Academy of Medicine of Paris
convinced me that they had not attracted all the attention they
merited. I believed then that it would not be unprofitable to
report some cases of rheumatism treated on the expectant plan.
If they do not convince practitioners of the incontestable supe-
riority of this method, they may at least, by making known the
natural progress of rheumatism left to itself, serve as points of
comparison, from which the degree of efficacy of the various
means recommended in this disease, may be deduced.

M. Gouzee's treatment is most simple. The gentle, equable
and continued warmth of the bed, in a pure and temperate at-
mosphere; and a mild drink, taken warm or cold, according to
the patient's taste, but always in great abundance. If the arti-
culations of the superior extremities are particularly affected,
the arms are placed in bathing-pans of warm water twice a
day, and are allowed to remain one or two hours, the rest of
the body being carefully covered ; these local baths are some-
times used for the lower extremities, but, in this case, their
employment is attended with many difficulties. The local
baths moderate pain and swelling, procure general relaxation,
favour perspiration ; they do not fatigue the patients, or neces-
sitate painful movements, or permit the surface to be chilled
as it is after general baths, which M. Gouzee never employs.
During the intervals, the affected parts are covered with cata-
plasms or with sheets of cotton-batting. After the pain in the
joints has disappeared, the patient should still remain in bed for
several days, until the disease is completely dissipated. At this
period M. Gouzee no longer insists upon a severe diet ; experi-
ence has taught him that a substantial diet, accompanied by-
some bitter tonic, by a decoction of bark, or solution of quinia,
are generally of great utility towards the termination of rheu-
matism, in procuring a more prompt and complete cure, and in
preventing relapses.

Here is an example of the rapidity with which rheumatism,
of very considerable intensity, may subside under the influence
of the simplest means :

1854.] Acute Articular Rheumatism. 109

Case I. Torfs, (cornet au 3e chasseurs a pied,) 20 years of age,
never having had any sickness, entered the military hospital of An-
twerp, June 27, 1850. For three days he has experienced pain and
stiffness in the joints, with a febrile movement in the evening.

June 2Sth. Swelling, heat, pain, and slight redness of the knees
and ankles. The pain is greatest in the right knee ; the countenance
is animated, the cheeks flushed, the pulse at 100, the skin hot and dry ;
no sleep ; nothing abnormal in the sounds of the heart. (Copious
diluent drinks. Diet.)

June 29th. Abundant sweats all night. The pain has left the lower
limbs, which remain stiff, and has invaded the wrists, which are red
and tumefied ; the slightest movement of the arms is insupportable.
The shoulders are also painful and swollen. (Arm-baths, twice.)

June 30th. The same copious sweating during the night, sleep,
moderated pain, less swelling, pulse at 64. (Same treatment.)

July 1st. There is scarcely any pain, the pulse has fallen to 76, the
nocturnal perspiration continued. (Continued repose in bed. Broth.)

July 2d. The patient can move the articulations of the arm ; he
experiences pain about the scapula. The diaphoresis has become
constant.

July 3d. No pain, pulse at 60, nothing abnormal about the heart.
The patient leaves his bed. (Improved diet. Eggs.)

A slight diarrhoea supervened upon the 5th, but readily yielded to
a sweetened solution ofsalep, with syrup of white poppies.

July 7th. A solution of six grains of sulphate of quinia was pre-
scribed.

July 10th. The temperature fell in consequence of a cold wind.
The patient experiences vague pains in the knees and in the right
shoulder. (Repose in bed.) The pains passed off the following day,
and convalescence was fully established on the 12th. Four grains
of sulphate of quinia was administered, and a more liberal allowance
of food.

The patient left the hospital on August 1st.

This case presents an instance of rheumatism, accompanied
by a febrile movement from the onset, a great number of arti-
culations being involved at the same time, and nevertheless a
cure was obtained with wonderful rapidity, since convalescence
was established on the sixth day of the treatment, and the ninth
day after the invasion of the disease. Surely no one will pre-
tend to procure a more prompt and satisfactory result, from
any mode of treatment.

The following observation is not less remarkable:

Case II. Vandeputte, cannoneer in the 4th artillery. 21 years of
age, robust, of strong constitution, entered the Military Hospital of
Antwerp, January 17th, 1851. Two days before, while on duty, he
had experienced acute pain in the left hip, which became so violent,
that upon the following day he was unable to walk.

110 Acute Articular Rlteumatism. [February,

January 18th. The pain in the hip was gone. I found the ankles
hot and swollen, and very painful. No sleep; pulse full and calm,
temperature of the skin normal. {Repose in bed. Common ptisan.
Two soups.)

Jan. 19th. Same state, except that the right knee is painful, but
without tumefaction.

Jan. 20th. The tibio-tarsal articulations are free ; the pain in the
knee continues. The patient has slept well.

Jan. 21st. The pain in the knee has diminished. (Same treatment.
A little solid food.)

Jan. 22d. The pain has left the knee, and has invaded the right
shoulder; it is intense, and prevents any movement of the arm ; no
slleep ; pulse at 78. (Same prescription.)

Jan. 23d. The pain is transferred to the left wrist and elbow, and
to the joints of the right middle finger ; the latter are red and tumefi-
ed. Pulse 74. (Arm-baths, twice.) Moisture of the surface has
been present since the entrance of the patient into the hospital. There
is no thirst ; the stools are regular; the viscera of the chest are ex-
empt from any complication.

Jan. 24th. The weather, hitherto mild and beautiful, became cold ;
wind from the northwest. The left knee and wrist are red, hot, tu-
mefied, and so painful that the patient has not slept. Intense fever,
thirst, pulse at 100, skin hot but moist. The patient complains of a
pain under the right nipple, and coughs, and expectorates some mu-
cous sputa. Nothing abnormal upon exploring the chest. (Same
local baths. Absolute diet.)

Jan. 25th. The pain, diminished in the knee, entirely gone from
the elbow, has invaded the fingers, which are swollen ; pulse at 84 ;
less cough. {Same treatment. Soups.)

Jan. 26th. The two wrists are still stiff and swollen, but there is no
pain any where. The cough has been troublesome, and has kept the
patient awake ; pulse 88. (Same treatment.)

Jan. 27th. Much less cough, sleep tranquil, no pain, pulse at 66.

Jan. 29th. No more cough ; the swelling and stiffness of the wrists
has gone. The patient walks about the ward. (Sulphate of quinia,
grs. iv. ; water, giv. ; simple syrup, |j. A spoonful every two hours.)

Jan. 30th. The patient was allowed solid fuod. Towards evening
there was a storm ; the mercury descended very low in the barome-
ter ; during the night the pain returned in the left shoulder, elbow and
wrist, and continued on the 31st. (Arm-baths.)

Feb. 1st. There is no longer any pain. The patient has a good
colour and complexion, and but little loss of strength ; the convales-
cence continues, notwithstanding the frequent atmospheric changes.
The diet is gradually increased-

He left the hospital on the 6th of March.

In this case, the patient was young and vigorous, as our can-
noneers usually are : he was suffering from a shifting articular
rheumatism, which had only lasted two days. The circumstan-

1854.] Acute Articular Rheumatism. Ill

ces, in the eyes of a partisan of bloodletting, would have been
so many indications for frequent and copious abstractions of
blood. Nevertheless, we see that the disease pursued its course
without accidents, and terminated in twelve days, with scarce-
ly any treatment, leaving neither feebleness nor anaemia behind
it, and having lasted only two weeks altogether.

The two preceding facts confirm the results of the observa-
tions to which Dr. Gouzee has long devoted himself, in regard
to the great influence which the state of the atmosphere exerts
upon the progress, duration, and intensity of the majority of
diseases, and especially of acute articular rheumatism. This
latter affection is readily exasperated by sudden meteorological
changes, and particularly by east or northeast winds, which,
in our climate, render the atmosphere dry and cold ; under the
influence of the mild and humid weather which accompanies
southern and western winds, patients with this disease usually
amend rapidly. Therefore M. Gouzee deems it important to
carefully note, in giving the history of diseases, the meteorolo-
gical vicissitudes which may have occurred, in order that we
may better understand the effect that remedies have had inde-
pendently of those powerful influences of external agents,
which are usually so little regarded.

Case III. Panhuyzen, a soldier of the carbineer regiment, aged
23, of sanguine temperament, entered the hospital on the 4th of May,
1352, having arrived from the camp at Braschaert. For two days
past he has had acute pains, shifting from one articulation to another.
May 5th. The two feet, but particularly the left, are painful, red,
and swollen. The general suffering is considerable. Sleeplessness,
flushed face, frequent pulse, skin moist. The heart's sounds are nor-
mal. (Free drinks, cataplasms, loco dol.)

May 6th. Same pains, abundant sweats, pulse at 90.
May 7th. Sweats continue abundant, less pain, sleeps well.
May 8th. Feet are free; right wrist attacked, sweats. (Armbaths.)
May 11th. Left wrist involved ; pulse at 80, less perspiration-
May 12th. Suffering much diminished.

May 14th. Convalescence, the patient leaves his bed. (Improved
diet.)

He left the hospital on the 25th.

Case IV. Boston, a soldier in the 1st artillery, 21 years, robust
and sanguine, has never been sick previously. On July 2d, 1852,
having got wet while on duty at Braschaert, he was taken with a chill,
followed by a fever. The next day, pain in the joints of the inferior
extremities. He was transported to the hospital on July 4th.

July 5th. The two knees and the left foot are swollen, red, and
painful. Face animated, pulse frequent, sweat copious, heart's sounds
normal. (Repose, drinks, diet.)

112 Acute Articular Rheumatism. [February,

On the following days the fever gradually diminished, the pain and
swelling continue in the left knee. (Raw cotton.)
On the 10th, convalescence ; exit on the 12th.

I have no remark to make on the two preceding cases. The
following observation is more important, both on account of
the intensity of the disease, and of the existence of a bellows
sound at the heart.

Case V. Jods, soldier in the 3d foot chasseurs, 21 years, lympha-
tic, but with a tolerably good constitution, suffered a year since with
acute articular rheumatism.

On the 3d of June, 1851, after being on duty all night, he had a
violent chill, accompanied by pain in the lumbar region. This WM
treated, at his quarters, by a saturnine lotion, but persisted until the
8th, when the articulations of the extremities became involved. On
the 9th he was brought to the hospital.

June 10th. I found the ankles and the light wrist swollen, red, hot,
and very painful. The patient could not sjeep on account of his suf-
fering ; the pulse, at 104, was incompressible ; the skin was hot and
moist. Auscultation discovered a loud murmur, amounting almost to
a rasping sound, in place of the first sound of the heart. The exist-
ence of this symptom, which was particularly apparent towards the
left side of the heart, was verified by Dr. Gouzee. The patient had
no precordial pain, or oppression, the dullness of that region was not
augmented, and the lungs were healthy. (Repose in bed, arm-baths,
diet.)

June 11th. The right knee is slightly tumefied, and very painful,
the other articulations are in the same condition as yesterday. The
abnormal bruit of the heart continues; the pulse is regular at 88;
an abundant diaphoresis is established. The patient has slept well.
(Same treatment.)

June 12th. The pain in the ankles has disappeared, it is diminished
in the wrist and knee ; the joints of the toes of the right foot are con-
gested and painful. The murmur of the heart is less rude and not so
loud; the sweating continues ; no stool for four days. Altogether,
the patient sutlers less. (Same treatment.)

June 13th. The patient feels so well that he believes himself cured.
All the articulations heretofore affected are free. Slight pain in
right shoulder. Bruit de rape diminished, pulse at 84, sweat, two
natural dejections. (Continue in bed, diet.)

June 14th. No pain anywhere, pulse at 71, heart's sounds are
normal ; M. Gouzee, however, believes that he can delect a slight
trace of the murmur which has masked the first sound. (Repose;
soup ; rice and milk.)

June 15th. Pulse 64. All the functions are well performed.

June 16th. Dr Gouzee considers the heart's sounds normal. The
patient took a solution containing four grains of quinia, which was re-
peated the next day. His diet was gradually improved. This soldier
resumed his duties on the 1st of July.

1854.] Acute Articular Rheumatism. 113

What was the semeiological value of the abnormal cardiac
murmur observed in this patient? Was it the sign of acute
endocarditis? Was it the result of an organic lesion which
occurred durinsr the antecedent attack of rheumatism ? The
question is difficult. I do not know how those physicians who
consider the bellows murmur which occasionally supervenes
during the course of articular rheumatism, a sufficient sign in
itself of the existence of acute endocarditis, can explain it. The
absence of precordial anxiety, oppression, and pain, the regu-
larity of the pulse, and the fact that only a normal degree of
dullness existed, inclined us at first to believe that this murmur
depended upon an old organic lesion. Therefore we expected
that it would continue after the cure of the rheumatism. Nev-
ertheless, it diminished rapidly, and finally ceased almost as soon
as the disease of the joints, without any medication having been
employed against it. This unexpected result induces us to think
that the murmur should be attributed to some other cause.

This fact had already been remarked. M. Gouzee who had
observed it frequently, published some reflections upon it in the
essay we have already cited : "'In one patient, he says, there
was a bellows murmur accompanying the first sound of the
heart, which disappeared during the convalescence. There
are two curious questions, in connection with this murmur,
which will be decided at some future day, when the prejudices
of the day have subsided. These are : whether the endocar-
dial murmur is as frequently the expression of an endocarditis,
as some physicians imagine ; and, secondly, whether certain
modes of treating rheumatism have not great influence in the
production of this sound."' More recently, in 1S51, Dr. Hart,
a regimental surgeon, has made known a similar case, in an
essay published in the Archives de Medecine Militaire. It re-
mains to find an explanation of these curious facts. Does the
endocardial murmur depend upon a change in the composition
of the blood ?

"It has been asked, say the authors of the Compendium de J
cine Pratique, (art. Auscultation.) if the peculiar murmurs which char-
acterize anaemia and chlorosis are not due to a modification in the
composition of the blood. Then, from a generalization of this idea, it
has been suggested that if the blood, when it has become more fluid and
less abundant, produces, in circulating through the vessels, murmurs
that are not observed when it is endowed with its normal qualities,
perhaps, by an inverse modification, when it is more plastic, richer,
more consistent, more abundant, it may occasion analogous murmurs.
This would lead to the following conclusions : 1. The bellows mur-
mur may be the result of a diminution in the quantity of the circulating
fluid ; 2. It may be the result of an increase in the quantity of blood
in circulation ; 3. The bellows murmur may sometimes indicate an

114 Acute Articular Rheumatism. [February,

abnormal fluidity in the blood ; 4. It may also characterize an aug-
mentation in the plasticity of the blood; in a few words, any notable
change in the quantity or quality of the blood contained in the cavities
of the heart, may produce a modification in its sounds. Then it would
be established that, if the bellows murmur frequently occurs as a coin-
cident phenomenon in articular rheumatism, it is proper to attribute this
circumstance to the well known alterations presented by the blood in that
disease."

These propositions are not demonstrated, any more than is
the fact of the existence of endocarditis under the same cir-
cumstances ; but, as the authors just quoted remark, they be-
gin to have supporters.

Let us not forget to remark once more the rapidity of the
cure in this case. Notwithstanding the intensity of the disease,
convalescence was established in less than a fortnight.

Case VI. Warnier, quartermaster in the 1st artillery, 23 years of
age, brown hair, brown skin, face habitually florid, has suffered from
three intense attacks of articular rheumatism since January, 1846.
The first was treated by depletion at Gand, the second at Antwerp on
the expectant plan, and the third at Bruges.

The 1 Oth of June, 1850, being at the polygon of Braschaert, he was
seized with pain in the inferior extremities, and went to bed.

On the 15th, the pains became more intense, and fever came on.
The following day he was carried to the military hospital at Antwerp.

June 17th- Wrists red, very much swollen, very painful upon the
slightest movement ; left knee tumefied and slightly painful ; pain in
the neck, in the shoulders, and in the back and sides ; face very much
flushed ; pulse at 112, regular but not very full ; slight murmur ac-
companying the first sound of the heart, most apparent just beyond the
nipple ; diarrhoea since the 12th. The wind is north, and the weather
cold. (This state of the temperature lasted until the 28th.) Arm'
baths, gum water with syrup of poppies, diet.)

June 18th. The condition of the wrists is improved ; the left knee
and right instep are affected ; the pains about the trunk are ameliora-
ted ; pulse at 90; same murmur at the heart ; abundant sweat ; more
diarrhoea. (Arm-baths, broth, rice and milk.)

June 19th. Slept well, right wrist still swollen, vague pains in the
fingers ; left knee and right foot are free. (Continue in bed, diluent
drinks.)

June 20th. There only remains a slightly painful tumefaction of
the right wrist, and a little uneasiness about the sternum ; the diapho-
resis continues ; pulse at 80, cardiac souffle less loud, countenance
natural ; stools normal.

June 21st. The wrist, knee, and fingers are stiff but not painful ;
pulse at 75 ; the patient walks in the gardens. On the 22d all of the
articulations were free, and all of the functions were well performed.
There was still a slight endocardital mnrmur.

1854.] Strabis?nus. .115

After the 25th, the bellows murmur gradually diminished ; on the
30th. it was no longer perceptible. The patient left the hospital on
the 6th of July.

In this patient there was a marked progressive amelioration,
notwithstanding the most unfavourable atmospherical circum-
stances. As in the preceding case, the murmur which existed
in the cardiac region subsided gradually and spontaneously.
Nothing proves that these patients were the subjects of acute
endocarditis, because, in the first place, the simple occurrence
of a bellows murmur should not be considered pathognomonic
of that affection, and. secondly, because this phenomenon dis-
appeared of itself almost simultaneously with the cure of the
rheumatism, which would not have been the case if it had de-
pended upon a phlegmasia of the internal membrane of the
heart. If admitting the existence of that phlegmasia, we had
instituted an active antiphlogistic treatment, it is probable that
the venesections would not have prevented the cessation of the
murmur. Then, the cure of a redoubtable complication would
have been attributed to energetic medication, whereas the
efforts of nature, seconded by careful nursing, were quite com-
petent to set ever} thing in order.

We could easily multiply cases, but we believe that those
which we have already cited are sufficient to justify the follow-
ing conclusions :

1. Acute articular rheumatism has a natural tendency to
terminate in the course of one or two weeks.

2. Treated on an expectant plan, by simple hygienic and
dietetic precautions, it pursues its march without danger, and
ceases as soon, if not sooner, than when combatted by active
measures.

3. It is not proven that the active treaments recommended
in this disease are useful or even innocent.

4. The cardiac murmurs which are frequently observed du-
ring the course of rheumatism, disappear spontaneouslv in the
great majority of cases, in proportion as the disease ameliorates,
and under the influence of the simplest treatment.

5. It is far from being demonstrated that these sounds are al-
ways the sign of endocarditis. [Virginia Med. and Surg. Jour.

New mode of Operating for Strabismus by a Temporary Liga-
ture. By M. Tavjgxot.

M. Tavignot sent in a memoir, the object of which is to ex-
plain a new method of operating for strabismus. This new
operation is founded on the following idea, that instead of
lengthening a muscle supposed to be too short, you must short-

116 . Strabismus. [February?

en a muscle in reality too long. Instead of leaving the eye to
oscillate with difficulty, and sometimes sluggishly, between two
muscles, one of which is mutilated by a section," and the other
remains always more or less powerless, my method of opera-
ting, says the author, attacks the longest muscle, and not only
shortens it by a sufficient length to equal that of its antago-
nist, but it furthermore acts by increasing its physiological
contraction.

First Operation. The longest muscle that is to say, that
one which is opposed to the deviation being exposed in the
ordinary manner for strabotomy, the operator proceeds in the
following manner : A blunt hook, with an eye at its extremity,
is passed underneath the muscle, so as by lifting it up to detach
it from the globe of the eye. The hook is then carried for-
ward, so that its concavity embraces the muscle at a little dis-
tance from its aponeurotic expansion. A thread of silk is then
passed through the eye of the hook, then the hook itself is
brought towards the operator, leaving the ligature under the
muscle. By a double twist of the ends of the thread on one
another, a simple, yet very resisting, knot is obtained. There
only then remains to finish the operation, to tighten the knot,
and cut away one of the ends of the ligature. The other end
is brought to the corresponding angle of the eye and fixed to a
spot on the circumference of the orbit.

The first effect of this ligature is to render the lateral fibres
of the muscles more central, and thus to bring about a shorten-
ing of this organ. The second effect is to develop an adhesive
inflammation, which not only fixes permanently the abnormal
juxtaposition of the muscular fibres, but also establishes adhe-
sion between the muscle and subjacent sclerotic membrane.

The ligature not being intended to produce division of the
muscle, must consequently be only temporary. Towards the
end of the second, or beginning of the third day. it can be easi-
ly taken off by means of a gentle traction carefully applied to
the end which remains.

This first operation may not in all cases produce the effect
which we have described. Very severe strabismus will no
doubt prove refractory. It is at least with this idea that I
have devised a way of making it more efficacious.

Second Operation. The hook having been passed under the
muscle, as in the preceding case, the ligature is passed, not
directly under the muscle, but under the hook, so as to embrace
the muscular expansion.

Before going further, it must be discovered by a momentary
constriction if the globe is perfectly restored to its normal po-
sition. To prove experimentally that the ligature has effected

1853.] Editorial and Miscellany. 117

the required degree of shortening, we must proceed, during the
operation, in the following manner : The ligature being passed
once under the hook, a different colored thread must be passed
through the loop thus formed, then constriction is made by
means of the first-mentioned ligature, but taking care to make
only one knot, and to make it a single one only. The hook is
then withdrawn, and the eye left to itself. The changes in its
direction can now be judged of accurately. If the globe is not
brought back sufficiently, a larger quantity of muscular tissue
must be embraced by the ligature ; if the globe is too much
brought back, a lesser quantity of muscular tissue must be en-
closed ; but in either case the ligature already put on must be
withdrawn as soon as possible. Owing to the precautions we
have adopted with this view, nothing is more easy; the eye
being fixed, one end of the ligature is drawn with one hand,
while the other hand pulls the thread passed through the loop
of this same ligature. The knot gives way immediately to this
opposed extension. There only then remains to pass the hook
again underneath the muscle (if it has not been already done
before taking away the ligature) and recommence the opera-
tion, keeping in mind the data furnished by the first trial.

[Dublin Med. Press, from Presse Med. Beige.

EDITORIAL AXD MISCELLANY.

Transactions of the fourth Annual Meeting of the Medical Society of
the State of Georgia, held in the City of Savannah, April, 1853.

The "Transactions" of our State Medical Society were received
too late for notice in our last. It is to be regretted that this publica-
tion, comprising only about one hundred pages, should have been so
long delayed, and that its typographical errors are so numerous as
very seriously to impair its value. Typographical errors involving
orthography only are of but little importance ; but when they are
such as to affect the writer's meaning, as is frequently the case in the
work before us, they misinterpret the author and mislead the reader.
In order to show that we are not unnecessarily captious, we will direct
attention to some of the errors noticed in one alone of the articles.
On page 37, we find "the necessary influence''' instead of the neces-
sary inference ; page 38, "In established rules of practice " instead
of In establishing rules of practice; "be discontinued" for be dis-

n. s. vol. x. no. u. . 8

118 Editorial and Miscellany. [February,

countenanced; "process" for processes ; "extensive counter exten-
sion, &c." for extension, counter-extension, &c. ; "material" for
materials. On p. 39, "their compress" for thin compresses ; "from
the end of the arm " for from the bend of the arm. On p. 41, " com-
press " for compresses. Yet, in the errata placed upon the cover,
there is but one of these errors noticed !

We really feel mortified at the justness of the criticisms of the
newspapers upon the artistic imperfections of the work, for, intrinsi-
cally, it is decidedly creditable to the contributors of its matter. It
contains, besides the minutes of proceedings : Report A, by Dr. R.
Q. Dickinson, on the existing Laws of Georgia relating to the Prac-
tice of Medicine ; Report B, by Dr. P. M. Kollock, on the Topogra-
phy and Prevalent diseases of the 1st Congressional District, during
the past year ; Report C, by Dr. G. F. Cooper, on the Topography
and Prevalent Diseases of the 3d Congressional District, during the
past year ; Report D, by Dr. L. A. Dugas, on the best plan of treat-
ing Fractures in country practice; Report E, by Dr. R. C. Word,
on the Topography and Prevalent Diseases of the 5th Congressional
District ; Dr. R. D. Arnold's apology for not presenting a Report upon
the subject assigned him ; a Communication from Dr. T. \V. Bell, on
the use of Sulphate of Cinchonia ; a Biographical Sketch of the late
Dr. Waring, by Dr. C. W. West ; a Biographical Sketch of the late
Dr. Baber, by Dr. C. B. Nottingham ; and the Annual Address, by

Dr. J. Harms,

The excellent Report of Dr. Dickinson will be found very useful to
the profession in Georgia, who are not unfrequently at a loss with
regard to the laws now in force. The following are the author's con-
clusions :

" From the various enactments previously referred to in tin's report,
and the preceding decision of the supreme court, we very confidently
conclude, that no person is authorized to practice medicine or surgery
in Georgia, for 'fee or reward,5 except,

" 1st. The licentiates of the Medical Board.

" 2d. The graduates of the Georgia Medical College.

" 3d. Those engaged in practice, in this state, in 1839,

"The licentiates of the Botanico Medical Board the graduates of
the Botanic Medical College, and those engaged in the practice of
this exploding humbug in 1847, are authorized to continue to practice
this system.*

The Legislature at the session of 1851-'2 passed special Acts authorizing a
round dozen of individuals named, to practice on the Homoeopathic system,
and one (Robt. C. McCullock,) to pursue the " Dutch or Indian practice. "

1854.] Editorial and Miscellany. 119

" All apothecaries and druggists who have been licensed by the
Medical Board to sell drugs and medicines, and all who were engaged
in the business in 1839 (when the act of 1825 was revived under its
enlarged title) are legally authorized to pursue the business. And
* merchants and shopkeepers' are authorized to 'sell medicines al-
ready prepared.'

"By an Act passed in February, 1850, it is enacted, 'That, from
and after the passage of this Act, it shall be lawful for every physician
and surgeon who shall be summoned by the sheriff or coroner of the
county, to make post mortem examinations for the information of Ju-
ries of inquest ; to charge and receive from the treasurer of the coun-
ty the sums, (following) to wit : For each post mortem examination,
where death has resulted from external violence, where no dissection
is required, the sum of ten dollars ; for the same where dissection is
necessary, and where no interment of the body has been made, twen-
ty dollars ; for the same, after one or more days interment, thirty dol-
lars ; for the same, where any chemical analysis is required, the sum
of fifty dollars, and the expense of such analysis : Provided, that the
compensation allowed in this Act, shall not extend to more than one
physician for each post mortem examination.'

" It is also enacted by the penal laws, (Cobb's Dig. p. 816) that
any physician, surgeon or other person, wilfully endeavoring to spread
the small pox, without innoculation, or by innoculation with matter
of the small pox, or using any other innoculation than that called vac-
cination, unless by special commission or authority from the inferior
court of the county where the small pox shall make its appearance,
shall be indicted, and on conviction, fined in a sum not exceeding
$1,000, and be imprisoned in the common jail, at the discretion of
the court."

The following " Suggestions for Additional Legislation " are very-
judicious :

"In view of the very little regard manifested for the laws now in
force, either by the Faculty or the people at large, I doubt the expe-
diency of any additional legislation, until we can give assurance of a
more strict observance of the laws now in force. I doubt if much
over half the physicians now engaged in practice, or half the apoth-
ecaries engaged in selling drugs in Georgia, are legally authorized
to do so. I am persuaded the better course would be for this Society
to direct its efforts to secure a faithful observance of the laws now in
force, before seeking to procure additional legislation. I am aware
that a resolution has been passed by the society, recommending its
members to endeavor to procure an observance of the laws relative to
the licensing of physicians and ihe sale of drugs; and to report such
persons as are thus engaged, in violation of law ; but, as yet, 1 have
not heard of one who has been reported, either to the courts, or grand
juries, or to this society. In this case we have realized the truth of
the old proverb, ' what is every one's business is nobody's business.'
To effect this observance I would respectfully suggest the propriety of

120 Editorial and Miscellany. [February,

this society appointing a committee of one or more persons in every
county, whose duty it shall be first, to use persuasive efforts to in-
duce all the physicians and apothecaries in their respective counties
to comply with the requisitions of existing laws ; and if unsucci
to take legal steps to have the laws enforced ; and require these com-
mittees to report annually to the society the result of their ellorts.
The duty of such a committee would certainly be an unenviable one.
But prompted by a desire to elevate the character of the profession of
medicine, and promote the best interests of the community in which
they live, it is but reasonable to presume, men may he found in ev-
ery county to engage in the enterprise when shielded and sustained
by a special appointment from this society.

"Efforts have been made for several yc.irs past to procure the pas-
sage of a law by our Legislature, requiring the registry of Birthi and
Deaths in each county. Bowever important, in man bs, such

a requisition, uniformly and faithfully observed, might prove, it is
much to be doubted, if such an Act should b , if it would not

remain a dead letter in our statute book. There has I since

the year 15 -J:*, (t. Cobb's Dij .) a law requiring tin1

Clerk of the Court of Ordinary in each county ' to enter and re
in a book to be kept for that purpose, the Dames of all persona who
may report themselves to him, or who may be reported by their pa-
rents or guardians, as well as all who may he hereafter horn within
the said county, and who may be reported aid, upon due

proof being made by affidavit or oath to the said Clerk of the
birth.' And notwithstanding the existence of this law, it is not at
all probable that the birth of one person in five hundred is thus i
tered.

"It is certainly an anomalous state of things that a physician is li-
able, both to a suit for damages and to indictment for mal-practice ;
and yet he is prevented by law, (after burial) and by a state of public
opinion, stronger than law, from making such investigations, both as
to the effect of disease and his remedies, as would enable him t
scribe with skill and certainty in future cases of the same dis<

" What changes should be made in this report, it is difficult t<
termine. To suffer the repose of the dead to be indiscriminately dis-
turbed, and their mortal remains subjected to the gashing knife and
grating saw, are well calculated to shock and to wound all the finer
sympathies and feelings of the human heart. By legal enactments to
make distinctions of cast or grade would be both invidious and unjust.
To suffer the bold and reckless pretender in medicine to wend his
way to an ignominious notoriety over the sufferings and lives of her
citizens with impunity, is what 'the Empire State of the South' could
not, and should not, for one moment, tolerate. How, then, is this
anomalous state of things to be remedied ? The best means I can sug-
gest is the enlightening influence of kind and sympathetic intercourse
between the physician and his patrons. Convince them of the impor-
tance of post mortem examinations, to the advancement of Medical
Science, and the benefit thence resulting to the whole human family,

1854.] Editorial and Miscellany. 121

and to themselves and their families, as parts of the whole : and many
will be induced to suffer them to be made. When the privilege is
granted, the utmost delicacy and neatness should be observed through-
out the whole operation, and the corpse and its dressings restored as
nearly as practicable in the same condition it was received. I am per-
suaded, by such a course, the piivilege of post mortem examination
might be frequently obtained, and every one, properly conducted,
breaks down a barrier to a repetition. It should be clearly explained
to the friends of the deceased, that the desire is not to dissect the body,
but only to examine the organs principally involved in the disease. I
would, most earnestly and affectionately, urge my young brethren of
the profession to avaii themselves, as often as they can, consistently
with a frank and undisguised course of conduct on their part, and a
delicate regard to the feelings of their patrons, of this most useful
means of their own individual improvement, and the advancement of
their profession.

" The Congress of the United States have acted wisely and humane-
ly in their efforts to suppress the introduction of spurious and adulter-
ated drugs and medicines into this country ; but it is very doubtful if
Southern physicians, remote from the sea ports, derive the benefits
anticipated from this law. If our physicians have to use adulterated
medicines, it is a matter of little importance to them and their patients
whether the adulteration is made in Constantinople or Liverpool, or
Boston or New York. Would it not be equally wise and humane in
our State Legislature to appoint inspectors of drugs and medicines, at
the principal commercial inlets of our own State, with stringent regu-
lations and heavy penalties on apothecaries for adulterating their
medicines ?

" But if legislation is needed in Georgia on any subject ' relating
to the practice of medicine and the sale of drugs,' it is in the sup-
pression of the infuriate and wide spread mania of gulling and swind-
ling in the sale and use of quack and secretly prepared medicines.
It is not for the pecuniary profits of the profession I desire to see this
nefarious traffic suppressed. I confidently believe these profits are
increased by the indiscriminate use of such medicines. I am prompt-
ed alone by a desire to preserve the health and prolong the lives of my
fellow-creatures. If our Legislature in its wisdom, has, by wise and
stringent enactments, attempted to prevent the introduction and spread
of the plague and small pox, why not, by similar enactments, pro-
scribe this still greater and wide spread evil ? I verily believe the
injury to the health and lives of the people of Georgia by plague and
small pox, is not to be compared to that resulting from the use of quack
medicines. This is more than the combined influence of sword,
pestilence and famine.' But I have no desire that our Legislature
should prohibit our good citizens from the use ot these health-restoring
and life-prolonging panaceas ; but when they do use them. I grearly
desire they should know in truth and verity what they are using. To
effect this object I suggest that our Legislature be respectfully and
earnestly memorialized to pass a law prohibiting the sale, within this

122 Editorial and Miscellany. [February,

State, of any secretly compounded, or any pretended patent medicine,
unless the composition of such mixture shall be plainly printed on the
bottle or paper containing said medicine or mixture ; with heavy pen-
alties for violation or false representation. This being known, I am
persuaded very many of these favorite panaceas would soon lose all
their charms and virtues. There is great inconsistency in our legisla-
tion relative to the practice of medicine, which wisely prohibits the
graduates of all Medical Colleges (except our own), from practising
their profession in this State without a license ; whilst ignorant pre-
tenders, and reckless and avaricious quacks and patentees are Buffer-
ed to hawk their pretended medicines and nostrums, by the wagon
load, into every nook and corner of the State, and deposit them for
sale in every store and shop, without the slightest restriction against
their sale, or the first legal effort to protect the people against any
injury either to health or life they may produce. It is much to be
regretted, that members of our own profession, prompted more by
the love of filthy lucre than the elevation of the profession, occasion-
ally engage in this low and deceptive traffic What can place an in-
dividual in a more degraded position, in the estimation of all honorable
and intelligent men, than to set himself up as the sole proprietor of
some fulsomely extolled, secretly composed nostrum, and then ailix to
his name M. 1).? 'Oh, shame where is thy blush!1 The real Doc-
tor in Medicine is above all such trick and humbug, [f he makes a
useful discovery or improvement, it is for the honor of his profession,
and the good of the public, and he publishes it 'for the healing of the
nations.' The truckster and pretender works ibr his individual pe-
cuniary interest, and relies upon (he ignorance and credulity of the
people to raise him to ignominious notoriety. It is high time lor the
law to oppose its strong arm against this wide spread and growing
evil."

The Topographical Reports are all interesting, and we only regret
that similar ones were not received from the other congressional dis-
tricts. A complete series of them would have been of great value.
In the 1st District, Dr. Kollock reports the prevalent affections to
have been intermittent, remittent,congestive, yellow and typhoid fevers,
pneumonia, influenza, diarrhoea and dysentery. In November, chol-
era asphyxia made its appearance on the Savannah and Ogeechee
rivers, but only to a limited extent.

From the 3d District, Dr. Cooper reports that, from his own obser-
vation and that of others, there occurred during the previous year the
various forms of malarial fevers, typhoid fever, diarrhoea, dysentery,
cholera morbus, pneumonia, bronchitis, rheumatism, neuralgia, rubeo-
la, dec. The reporter thus expresses himself with regard to the use
of common salt in intermittent fever :

" As is usual in wet seasons, intermittent and remittent fevers pre-

1854.] Editorial and Miscellany. 123

vailed to a great extent, but we had less typhoid fever than the previous
year. Intermittent fever abounded in every portion of the county,
more generally, however, in what is known as the ' Lime Lands," and
so far as observed by us, was less amenable to quinine than in any
former season. In a few cases the chloride of sodium was resorted to,
according to the direction of M. Piorry, and although our facilities for
observing were not peculiarly favorable, yet, so far as noticed, we
were highly pleased with the results. It not only overcame the chill,
but in a few days the pallor gave way, and the cheek began to glow
with health, with an increased cheerfulness and vivacity of the patient.
Three years ago, Dr. Wm. P. Hort and Prof. Riddell, of the Univer-
sity of Louisiana, instituted some beautiful, interesting, and apparentlv
conclusive experiments upon the 'distinct and independent vitality of
the blood,' in which the solution of chloride of sodium was noticed to
give a quickness and activity to the movements of the blood-globules,
not imparted by any other solution, save, perhaps, the chlorate of potass.
These experiments were not confined to freshly drawn blood, but it
was allowed to become dry, and even remain so for two, three, and, I
think, four days, and then remoistened with the various solutions, and
even upon the fourth day movements were visible, which, after repeat-
ed observation, were attributed to independent vitality. In these ex-
periments, it occurs to us, we may have a solution of the rapid and
salutary effects of salt upon the economy in inducing that freshness
of color and vivacity which are observed so soon after its administra-
tion. Entering the circulation, it may act directly upon the globules,
in giving to them a vigorous and impulsive movement, and exerting a
chemical change upon their contents, or a physical change upon the
cell- wall itself. These facts, of the action of salt upon the blood, it
seems, would contribute largely in explaining the rapid diminution of
the size of the spleen in intermittent fever, noticed by M. Piorrv.

"It has been observed that the spleen, when enlarged, diminished
rapidly in size after the administration of salt. Now, this fact, con-
sidered in connexion with what Dr. Bennett terms leucocythemia,
and the part which the spleen probably plays in haematosis, becomes,
at least, of speculative interest. Observe the colorless corpuscles
must be largely in the ascendency in persons who have suffered re-
peated attacks of intermittent fever, certainly the powers engaged in
the completion of blood, in all its integral parts are impaired. If,
therefore, the enlarged spleen be viewed as a precedent to, and in a
great measure, the cause of the redundance of the colorless corpus-
cle, its rapid diminution, the change of the complexion and increased
vivacity referred to above, upon the administration of salt, may have
an easy rationale in the power which salt is seen to exert in the ap-
pearance and movements of the blood."

We find in Dr. Word's report on the 5th District, the expression of
views so judicious that we beg leave to subjoin some of them :

A few years after the early settlement of the country, malarious
diseases were uncommon, inflammatory diseases more frequent than

124 Editorial and Miscellany. [February,

at present, the inflammation of higher grade, and vigorous antiphlo-
gistic treatment better borne, and more successful than more recently.
With the clearing up of the land, exposing a larger surface covered
with a rich vegetable mould, and saturated with the rains of winter
to the action of a summer's sun, there has been a marked increase of
all the affections which ' malaria ' is supposed to produce, and a very
observable modification in the general sanative condition of the pop-
ulation, or in the character of many diseases which it is not pretend-
ed that malaria originates, but over which it appears to extend its
mysterious influence. Many of the inflammatory attacks, occurring
Lil winter in the last few years, have been found to assume the livery
of this subtle morbific agent, evincing a decided tendency to periodici-
ty, and demanding the administration of quinine. Many others, it is
true, offer no such peculiarity, but are truely and frankly phlegmasia!,
requiring, for their successful treatment, the free and bold employ-
ment of the lancet, and all the antiphlogistic expedients so familiar to
the past generation of physicians. This intermingling of symptoms,
* blending of lights and shadows, ' is still more common in autumn and
spring, and more embarrassing, because a just diagnosis is often diffi-
cult, and a mistake highly dangerous. To subject a patient, pre-
viously enfeebled by miasmatic influence, or actually laboring under
an irregular form of miasmatic disease, though simulating, with as-
tonishing accuracy, an acute inflammation, to the debilitating effects
of the antiphlogistic treatment, is not simply unnecessary, but, as has
been too often sadly demonstrated, hazardous or fatal, producing pro-
longed debility, tedious convalescence, or else speedily, or more re-
motely, death. To omit to do so, upon the other hand, when an im-
portant organ is truly the Bent of active inflammation, is to expose him
to immediate peril, or to the doubtful consequences of the pathological
changes, by which that condition is followed. In a more malarious
region, as well as in districts where the influence of malaria is less
marked, the nice discrimination, so often demanded here, is, perhaps,
less important, but the ability to make it, in this section, decides be-
tween success and the want of it. Many conditions, classified as
particular diseases, might be cited as illustrative of this point. Rheu-
matism, dysentery, inflammation of the liver, brain, spleen, lungs, &c.
when uncomplicated by the influence mentioned, unquestionably de-
mand the free and frequent employment of the lancet. It has been
more generally used, and more universally approved and sanctioned,
by the experience of the profession in all ages, than any other means
for combating this class of diseases. The careful analysis of the
blood in inflammatory diseases, and the microscopic examination of
the state of the capillary vessels during their progress, has given,
more recently, rational confirmation to the lessons of successful em-
piricism, by demonstrating the favorable nature of the changes which
bloodletting induces in the blood itself, as well as in the vessels and
tissues of the affected parts. And yet, there have not been wanting,
from time to time, physicians, and even entire schools, who have pro-
tested against its employment, and sustained their position by an appeal

1854.] Editorial and Miscellany. 125

to cases to which it had been judged to be applicable, but in which it
had produced the most unfortunate results. Like difference of opinion
still prevails all over the world. In England and France, the lancet
is regarded as the 'sheet anchor of hope,' in the class of diseases un-
der consideration, and its use recommended with an exclusiveness
and universality proportioned to their estimation of its importance.
In their more southern colonial possessions, in India and Algeria, its
employment is deprecated as inefficient, and positively hurtful in dis-
eases having the same classification, name, and symptoms. In the
northern part of the United States, the opinions of English physicians
are very generally entertained ; while the existence around them of
similar conditions, has prompted southern physicians to adopt the views
of the colonists of India and Algeria, and to join them in their denunci-
ation of what they regard as the abuse of the lancet.

u Every year cases of all the above enumerated diseases are met with,
which, if taken as the types of the whole, would freely sustain either
of the opinions just adverted to. At the first settlement of the country,
almost every case was of highly inflammatory character, and early and
efficient bleeding its most successful treatment. With the increase of
the causes of malaria in the clearing up of the country, a few years
subsequently, instances were observed in which this plan was not
followed up by prompt and complete restoration to health as formerly,
but appeared to induce an adynamic condition, the precursor of death ;
or if recovery took place, it was only after tedious convalescence.
This class of cases, now in larger proportion, is of more frequent oc-
currence in autumn than in winter, but is liable to be met with at any
season of the year; more frequently observed, however, in some lo-
calities than others. The proportion of cases demanding the treat-
ment formerly so successful, though lessening, is still large, and
when they are recognized, the success attending it is in the highest
degree gratifying.

" Promptly to detect these diverse conditions, amidst a bundle of
symptons, perplexingly alike in both, exacts the highest diagnostic
skill a skill not attainable by the study of written rules so much
as by the careful observation of very many examples of each, and the
ability to seize upon the indescribable shades of difference between
them. Many cases are so clearly marked as to leave no room for
doubt. No person would mistake neuralgia of the liver, or spleen,
when marked by diurnal paroxysms, and unaccompanied by tender-
ness or acceleration of the pulse, for inflammation of these viscera.
Few physicians would mistake the thoracic pain, and pulmonary hy-
peraemia recurring regularly every day, which sometimes attends a
marked attack of intermittent fever, for inflammation of the lungs.
But, in other instances, there co-exists with malarious disease some
degree of congestion, or actual inflammation, of a portion or the
whole of an organ ; in these the paroxysmal character of the pain is
less distinct, or is not perceptible, the other characteristics of malari-
ous disease are less evident, and there is every probability that injury
may be done by the injudicious abstraction of blood. By keeping in

126 Editorial and Miscellany, [February,

view, however, the paroxysmal tendency of malarious diseases, their
constant co existence with cerebrospinal irritation, the usual absence
of the other conditions of inflammation in the pains which they occa-
sion, and in pneumonia especially, by resorting to auscultation and
percussion to determine the exact state of the lung, and by regarding,
also, the degrees of previous exposure of the subject, it is possible,
generally, to obtain a solution of the problem.

"If there be no error in the views thus imperfectly i ipresa d, it
is necessary, in malarious districts, not only to recognize a widely
spread depressing agency, complicating, to some extent, even purely
inflammatory attacks, but to suspect, also, and be ready to deled
widely ditFereni which are known by a common appellation,

An alteration of the nomenclature of diseases, would simplify
the labor, and guard, to at, against error ; thus, if tin- so

called pneumonia, which, in southern Georgia and Alabama, (and
of which a few cases occur with us,) proves so fatal under the use of
the lancet, and yi< Ids so promptly to quinine, were designated ac-
cording to its real character, as a marked intermittent or remittent
fever, there would be no difficulty in deciding upon its treatment ; or
if a common variety ofso-called rheumatism had some distinct appel-
lation to show that it depends upon spinal irritation, and has its
in the nerves of the cerebro-spinal system, and is perfectly distinct
from those other forms which attack the fibrous tissue of the body,
and are attended by high vascular action, there would be no prob-
ability of the injudic of colchicum, ami the lancet, or the
unwise abstinence from sinapisms and quinine.*'

add Dr. Word's opinion of Veratrum Viride :

Veratrum 1 nee the appearance of Dr. Norwood's article

upon this subject, in the January number of the Augusta Medical
and Surgical Journal, we have treated a lew eases of typhoid pneumo-
nia with this remedy, and though it did not prove so successful as in
bis hands, we are greatly encouraged with its effects. Its controlling
influence upon arterial action is truly wonderful. It is indeed a great
discovery a triumph for its author a triumph to the Southern pro-
n, and an acquisition to science and to the world of incalculable
benefit !

" Judging from the limited experience we have had in the use of
this remedy, we do not think it capable of cutting short an attack of
typhoid fever, but we believe that it will prove of great service in
moderating the excitement and the severity of the symptoms, and in
many cases may be 6olely relied upon to conduct the patient safely
through the disease. "

We do not recollect to have heard before of the occurrence of milk
sickness in Georgia.

" Milk sickness is mentioned as incident and peculiar to particular
localities in the county of Walker. The poison proved fatal to sev-
eral individuals, and a number of cattle in former years. The

1854.] Editorial and Miscellany. 127

bounds within which the poison originates, can be accurately defined,
but the cause remains yet to be discovered. "

Our apology tor reprinting in this Journal the Report D, will be
found in our remarks upon the typographical errors of the " Trans-
actions.'"'

Inlroductory Address, delivered in the Medical College of Georgia at
the opening of the annual session, Nov. 7. 1853. Bj I. P. Gakyik,
M.D.,&c.

The perusal of Prof. Garvin's Address will prove a treat to those
who may have the good fortune to receive it. The Class have ap-
preciated its merits by having it published at their own expense. We
may be allowed to make a few extracts from it, illustrative of the au-
thor's chaste style.

"But the exercise of the intellect, and the amount of scientific
knowledge which Medicine requires of those who would cultivate it,
before they can be deemed worthy of its honors and emoluments, are
not its only claims to the respect and gratitude of men, but it is worthy
of all honor, for some of the nobler moral qualities which it developes,
strengthens, and enlarges. We are not disposed to arrogate for it
more than is its due, when we assert that it is but another name for
Philanthropy itself. The motto of the practitioner of medicine may
well be ' Homo sum, et humani a me nil alienum puto.' The great
aim of all the intellectual labor which must be undergone to secure
the qualifications necessary for its successful ex- but to ena-

ble it the more successfully to minister to human suffering. Amid
revelry and mirth in the crowded mart in the tumultuous assem-
bly or in the more dignified deliberations of the forum, Medicine has
no place. Its province is the haunts of human suffering its mission
is the bed-side where man struggles for his life. It is there, to inter-
pose between the monster and his prey, and by skilful and timely
efforts, to snatch the trembling victim from the grave, and give him
back to usefulness and enjoyment. Amid such scenes is the appro-
propriate place for the medical practitioner. It matters not whether
they exhibit themselves in the palaces of the rich, or in the hovels of
the poor, their claims for aid and sympathy are equally recognised ;
for Medicine asks not the rank or fortune, of those who crave its assist-
ance. It is no idle boast, that it extends its cares alike to the poor as
to the rich. Indeed, the poor, by common consent, seem to be made
its heritage. Whilst others give vent to their sympathy for human
suffering, in eloquent phrases, or, of their abundance, dole out that
which costs not the slightest sacrifice of personal ease or enjoyment,
the practitioner of medicine is expected to manifest his sympathy, by
deserting the comforts of the domestic fireside, by night and by day
braving the summer's heat, or the winter's cold, and risking health,

128 Editorial and Miscellany. [February,

and even life itself, in the cause of humanity. So universally and
cheerfully are these sacrifices made, that the public never imagine,
for a single moment, that such services are entitled to any recognition
or reward, beyond the respect of the wise and the good, and this meed
has been extended to them in every age.

" But some have urged against the benevolent character of the
profession of medicine, that the frequent sight of human suffering has
a tendency to harden the heart, and render it insensible to the claims
of humanity. It may be so with the idle, or merely curious spec-
tator of human wretchedness, but it is never thus, with those who on-
ly seek such scenes for benevolent purposes. It has been wisely
ordained, that the frequent performance of virtuous deeds, should
strengthen the love of virtue, and this is eminently true of the med-
ical profession. The daily exercise of its kind offices renders their
performance in a great degree necessary to the happiness of the physi-
cian. He may indeed stand by the couch of the dying, with a tear-
less eye, but is he slow to seize every opportunity to relieve the suf-
ferer, and smooth his passage to the grave I Is he not found at the
bedside of the diseased at all hours as well when the world is hush-
ed in sleep, as when it is engaged in the bustle of life } His is not
that sickly sensibility, which expends itself in tears, or unfits its pos-
ter useful exertion, but it is that living, moving, acting sym-
pathy, which employs itself in efforts to re!;

" The benevolence which Medicine developes and cultivates, not
only exhibits itself in incessant, laborious, and often painful effort to
relieve the diseased of every rank and condition of life, but it does so
at the expense of every selfish enjoyment. For the medical man
are but few of the pleasures of social life, lie has but little
time for the society, or converse of firiandt. He has but few hours
for relaxation. The holy Sabbath, the day of rest, ordained lor man
and brute, brings no rest to him. Whilst men engaged in other pur-
suits, may screen themselves from the summer's sun, and the winter's
frost, and lie down at night on downy couches, to pleasant dreams
the phyician must brave the tempest, and need neither cold nor heat,
nor hunger nor fatigue, in his mission of mercy. Even when 'the
pestilence which walketh in darkness, and wasteth at noonday,' scat-
ters far and wide its noiseless shafts, he is expected to stand firm at his
post. The merchant and the mechanic, the lawyer and the man of
letters, nay, the very slave, may all fly before the face of the destroy-
er but he does not. Though thousands fall around him, he must
face the danger, and be ever ready at every personal sacrifice and
hazard, to succour the smitten. The heroism which leads men to the
cannon's mouth, in true grandeur, falls far beneath that moral hero-
ism which is always exhibited by the physician in pestilential visita-
tions. The soldier moves to the conflict, surrounded by all ' the
pride, and pomp, and circumstance of glorious war.' The eyes of
his comrades are upon him their shouts ring in his ears and he is
nerved to action by bright hopes of laurel crowns, and the applause of
an admiring world. His heroic efforts are soon over a few short

1854.] Editorial and Miscellany. 129

minutes, or hours, and glory or the grave is won. Not so with the
physician : no voice cheers him on, but the still, small voice of an ap-
proving conscience no sound of spirit-stirring drum, or ear-piercing
fife, falls upon his ear he hears but the groans of the sick and dying,
and the wailings of the bereaved. No vision of laurel crowns no
hope of the hosannas of the mob sustain his spirit; but he toils on,
through days and weeks, it may be months, with a stout heart and an
unblenching cheek. Full well he knows, that however his services
may be appreciated during these days of desolation, the grave or ob-
livion when they have passed away, are the only rewards in store for
him. When the glorious victories of our troops in Mexico were pro-
claimed throughout our land, each hero's name at once became a
household word, and honors and rewards were profusely showered
upon them ; but the physicians who for months have been battling
with disease and death in their most frightful forms, in the homesteads
of the afflicted cities and towns of the South-west, are unknown ; and
when, ever and anon, some one of this devoted band has yielded up his
life in the cause of humanity, the public eye has not marked his fall,
nor has the public heart felt one throb of sorrow. Thus it has ever
been, and ever will be ; yet medical men will never prove recreant
to their high trust, or hesitate to sacrifice comfort and health, and
even life itself, in the cause of humanitv. "

Prof. Parker's treatment of Hydrocele. Prof. W. Parker, of New
York, advocates (N. Y. Journ. of Medicine,) the use of lunar caustic
in preference to injections, for the radical cure of hydrocele. After
drawing off the fluid with a trocar in the usual manner, he introduces
through the canula a common probe, the end of which is coated with
nitrate of silver for half an inch or more. This extremity thus
charged is carried lightly over the serous surface of the tunica vagi-
nalis, in various directions, and then removed. The patient complains
of some pain during this part of the operation but is directed to
keep quiet and to apply cold lotions should the inflammation be at all

Radical Care of Hernia. Wutzer's plan for the radical cure of
reducible inguinal hernia is gaining favor, and is advocated judicious-
ly by Dr. Weber, in the N. Y. Journ. of Med., Jan. 1854. Wutzer's
method is somewhat similar to that of Gerdy, but the invagination and
adhesion are effected by means of compression of the integuments
and sac between a cylinder introduced up to the internal inguinal
ring and a narrow plate on the outside, both of which are brought
together with screws. The cylinder contains an elastic needle,
which, when the invagination is completed, may be projected so as to

130 Editorial and Miscellany. [February,

transfix the upper and anterior portion of the walls and to pass
through an opening in the external plate. The point is then covered
with a cork and the compression made ; to be continued a week, more
or less, according to the degree of inflammation induced.

Munificence of Physicians. It is not long since that the lamented
Orfila bequeathed large sums for the promotion of medical knowledge.
More recently, Dr. Shattuck, of Boston, has contributed fifteen thou-
sand dollars for the endowment of a Professorship of Pathological
Anatomy in the Medical College of his city. We now read that a
physician of one of the Parisian Hospitals has made a donation to
the " Gazette des Hopilaux" of 10,000 francs on condition that his
name be kept secret ; that 3,000 francs be appropriated to the
encouragement of the authors of useful and practical papers to be
published in that gazette ; and that the remainder be expended in dis-
tributing copies to poor physicians or students.

Death of distinguished Physicians. We announce with regret the
demise of Dr. Hester, the able editor of the New Orleans Medical
and Surgical Journal, and of Dr. Samuel McClellan, one of the best
obstetricians of Philadelphia.

Deaths by Chloroform in England At the coroner's inquest re-
cently held in consequence of the death of a patient under the influ-
ence of chloroform, at St. Bartholomew's Hospital (London) it was
stated that thirty deaths had occurred from the use of that agent in
Great Britain since its introduction. In the case under examination,
the patient was a girl 22 years of age, affected with syphilitic ulcer-
ations of the vagina, for which cauterization was deemed advisable,
and the anaesthetic administered under the direction of Mr. Paget.
It proved fatal, although the patient had inhaled it without injury for
the same purpose about a fortnight before.

Dr. DeWolf, of Chester, Mass., reports in the Buffalo Med. Journal,
the death of a lady in child-bed, from the injudicious inhalation of
chloroform.

Quackery in England. It is stated that,'according to the census
returns of England, there are in that country nearly thirty thousand
persons practising medicine in its various branches without legal
qualifications.

1854.] Editorial and Miscellany. 131

New mode of inducing Vomiting. The Now Hampshire Journal of
Medicine reports a case of poisoning by opium, in which, after the
failure of the usual means for inducing vomiting, the patient was made
to drink two glasses of vinegar and water, immediately followed by
3ij. ofcarb. potassa in water. A powerful effervescence took place,
which instantly produced copious vomiting.

The American Medical Monthly. New York is determined to be
no laggard in the cause of science. We have just received the
American Medical Monthly, issued under the patronage of the New
York Medical College, and edited by Prof. E. H. Parker. We doubt
not that it will prove a valuable addition to our periodical literature
and we very cheerfully add it to our list of exchanges.

The Town Council of Fredericksburg, Virginia, have recently
passed an order, directing that the tax on licences, paid by lawyers,
physicians and dentists, for the year 1852, should be refunded. This
is in accordance with a decision recently made by Judge Lomax, that
such taxes are unconstitutional. [Fredericksburg Herald.

We wish we had such a Judge in Georgia. Edt.

Paste made of Sulphuric Acid and Saffron as a new Caustic in
Malignant Ulceration of the Face. M. E. Cazenave, of Paris, relates,
in L'Union Medicale, for 22d January, two cases of malignant ulcer-
ation of the face, in which he has successfully employed a local ap-
plication, made from sulphuric acid and powdered saffron. The
remedy is formed by pouring the acid on the saffron, and applying it
in the form of a soft paste. Its corrosive action is immediately mani-
fested on the diseased tissues; the paste dries, and falls off in two
or or three days, in the form of black crusts, which carry with them
the eschar. The application is made several times ; the wound as-
sumes a healthy red tint, and cicatrization takes place. In one case
a year has elapsed, and in the other two years, and the disease has
not returned.

The efficacy of this treatment is evidently dependent on the sul-
phuric acid, which we believe would succeed equally well if made
into paste with common flour, or any ligneous powder as with saffron.
A paste of sulphuric acid and flour would be worth trying in obsti-
nate cases of phagedenic ulceration. Association Transylvania Med.
Journal.

Transactions of the Medical Society of the Slate of Georgia. We
are requested to state that a number of the members of the Society
are in arrears for the assessment of 83 and that copies of the

1 32 Editorial and Miscellany.

Transactions are left at this office for distribution to such as may pay
up their dues.

American Medical Association. The seventh annual meeting of
the American Medical Association will be held in the city of St. Louis
on Tuesday, May 2nd, 1854. The Secretaries of all societies and of
all other bodies entitled to representation in the Association, are re-
quested to forward to the undersigned correct lists of their respective
delegations as soon as they may be appointed, and it is earnestly de-
sired by the Committee of Arrangements that the appointments be
made at as early a period as possible.

The following are extracts from Art. 2nd of the Constitution:

" Each local society shall have the privilege of sending to the asso-
ciation one delegate for every ten of its regular resident members, and
one for every additional fraction of more than half of this number.
The faculty of every regularly constituted medical college or char-
school of medicine shall have the privilege of sending two del-
s. The professional stall' of every chartered or municipal
hospital containing a hundred inmates or more, shall have the privilege
of sending two delegates, and every other permanently organized
medical institution of good standing, shall have the privilege of send-
ing one delegate.

" Delegates representing the medical stafTof the United States Army
and Navy, shall be appointed by the chiefs of the army and navy
medical bureaux. The number of delegates appointed shall be four
from the army medical officers, and an equal number from the navy
medical officers."

The latter clause, in relation to delegates from the army and navy,
was adopted as an amendment to Art. 2nd of the Constitution, at the
last meeting of the Association, held in New York, in May, 1853.

E. S. Lemoine,
One of the Secretaries,

St. Louis.
&j~ The Medical Press of the United States is respectfully re-
quested to copy the foregoing.

Anaesthesia in Midwifery and Fatal Effects of Anastnetic Agents.
The undersigned was appointed by the American Medical Associ-
ation to report on the above mentioned subjects at its next session in
St. Louis. He therefore respectfully urges his medical brethren to
make extensive and close observations on anaesthesia in midwifery,
and also to analyze carefully all alleged cases of death from the use of
anaesthetic agents, and to forward the results to him before February
1st, 1854. The latter cases must be those only occurring within the
present year of the Association.

Richmond, Va. James Bolton.

Erratum. In January No., on p. 17, for "E. W. Booth," read G. W. Booth.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES MAECH, 1854. [No. S.

ORIGINAL AND ECLECTIC.

ARTICLE VIII.

Essay upon the Presence of Sugar in the Urine, and its Con-
nection with Respiration. By Alyaro Reyxoso. (Trans-
lated for this Journal, by Wm. J. Holt. M. D., of Georgia,
now in Paris.)

The memoir that I have the honor to present to the Academy,
is no more than the development of three notes that I have
already submitted to their judgment. I have, since the publica-
tion of these notes, repeated a number of times my experiments,
and found some new facts which come to the support of the
theory that I had published.

Life is an assemblage of successive formations and decompo-
sitions : during its existence our organs are continually being
destroyed and reformed, although at certain epochs each one of
its actions can be augmented or diminished separately.* We
have a proof of the decomposition that our organs undergo, in
the continual need of nourishment ; a want which does not de-
pend entirely upon the diminution of the liquids, for the solids
contribute their share. In fact, these parts, especially the mus-
cles, diminish, and their normal composition is ultimately
changed, when nourishment is wanting. An addition of new
materials supposes a corresponding consumption, and as the

* See Burdach, vol. viii., p. 420, and vol. ix., p. 101 and 691.
n. s. vol. x. no. in. 9

134 Reynoso, on Sugar in the Urine. [March,

body remains the same when nutrition undergoes no alteration,
this ought to have as antagonist a resorption, the proportional
quantity of which is too great in atrophy and too feeble in
hypertrophy. And this renewing of materials ought to accom-
pany all the acts of life ; for the increase of activity in a func-
tion induces, as a consequence, either the want of greater
nourishment and repose, or wasting and reduction. It is what
we observe in fevers, after violent exercises, continued wateh-
ings, constant labors of the study, and commotions of the
passions. After that, our body is subjected to a continual
change of its substances, so that at the end of a certain number
of years there remains not an atom of the matter of which it
was formed.

The animal then has need of matters to repair the losses that
the vital energy causes to his organs matters which ought to
present the same composition as the organs themselves.

Besides, we know that life is always accompanied with a
certain discnu'.-i'-i^ment of heat; and whether we consider this
heat (after the manner of the ancients) as the source of life, or
only as the result, it is proved that the disengagement of heat is
in proportion to the energy and activity of life. Again: we see
that respiration exercises an influence upon the production of
heat, and that these two functions are in direct connexion in the
animal series, in the different circumstances and periods of life.
We know, for example, that respiration is the condition of mus-
cular force, and that the development of the respiratory system
in the animal series is in direct connexion with the facility and
velocity of voluntary motion.

The heat disengaged is in proportion to the respiration.

It is equally incontestable that the quantity of heat develop-
ed is generally in proportion to the oxygen inspired and the
carbonic acid expired. Thus, at a high degree of organization,
when life enjoys great activity, and when the development of
heat is considerable the consumption of oxygen is greater.

Substances proper to combine easily with oxygen and to de-
velope the most heat in this combustion, will then be necessary
for an animal. For aliment, then, two kinds of substances are
necessary : one kind destined to identify themselves wfth the
parts of the organism, to repair the losses which accompany the

1854.] Reynoso, on Sugar in the Urine. 135

exercise of life, and to develope our organs ; others destined to
furnish heat by their combination with the oxygen in the act of
respiration. The decompositions which accompany the exer-
cise of life, and the heat which is the cause or effect of it, being
both in direct connexion with vital energy, it is clear that the
quantity of aliment ought to be proportional to vital activity.
Liebig calls the reparatory aliments, plastic aliments ; and under
this denomination he ranks albumine, caseine and fibrin, vege-
table and animal. These substances are, in fact, the only ones
furnished by these two kingdoms which can be capable of giv-
ing origin, in the process of nutrition, to the essential parts of
the blood, which nourishes our organs. We understand, also,
that we should rank among the plastic aliments, the different
mineral salts, which contribute to the formation of the solids
and to the composition of the liquids, of the economy.

Liebig designates under the name of agents of respiration,
the aliments destined to combine themselves with the oxygen,
to develope heat, and ranks in that class all of the non-azotized
matters sugar, starch, fat. Among these several agents of
respiration, the most suitable is fat, inasmuch as it burns more
easily and produces more heat.

As long as harmony exists between the proportions of these
substances, in the mixed nourishment and vital energy, each
one accomplishes its end ; for, in the circulation, the plastic
aliments are preserved from combustion by the presence of non-
azotized substances ; but as soon as they are wanting, there is a
certain proportion of the plastic aliments destroyed, although
they burn with difficulty and produce little heat. It is probable
that these plastic aliments are not burned, until after having
been changed into other substances, into fat for example.*

When, on the contrary, the plastic aliments are wanting, the

* Even during a mixed regimen we see appearing in the urine principles
such as urea, uric acid, &c, azotized substances which cannot proceed but from
burned azotised matters. Their origin is very easy to explain. "VVe have
already admitted that life is an uninterrupted series of decompositions and
formations. The azotised substances of our organs, which have been modified
during the exercise of the latter, and which are no longer proper to contribute
to their structure, are destroyed by the economy, burned by the oxygen, and re-
jected under the form of urea, uric acid. The sulphur and phosphorus contain-
ed in these substances are transformed into sulphuric and phosphoric acids, and
rejected under the form of sulphate a ud phosphates.

136 Reynoso, on Sugar in the Urine. March,

animal wastes away and dies ; for animals have not the faculty
of transforming sugar, starch, and fat, into plastic aliments, a
property which vegetables alone possess.

If the animal 'is subjected to a very abundant, mixed regimen,
he acquires a plumpness, that is to say, the organs grow, on ac-
count of the accumulated plastic substances and the deposited
respiratory agents, as for example, fat.

Let us examine the part that the aliments take in the forma-
tion of fat.

We have already said, that fat is a substance destined to
contribute to the production of heat ; its accumulation in the
organism can not proceed, but from want of respiration, an
excess of nourishment, or both of them together. Fat can either
arise from the aliments, or form itself in the economy; it can
also be deposited in the organism, in these two manners together.
Almost always the economy produces the greater part, espe-
cially when the nourishment is rich in plastic substances.
When an animal is submitted to a regimen, poor in plastic
substances, then the accumulation of fat is sensibly equal to the
ingesta of the animal. When fat predominates in the aliments
and the plastic matters do not suffice for the formation of cells,
the muscles are resorbed and fat deposited ; but a disease fol-
lows and the animal dies. If he is submitted to a mixed regi-
men, rich in plastic principles, then we find that the quantity
of fat accumulated is superior to that which was contained in
the nourishment. Moreover, it is a curious fact that there
ought previously to exist in the food a certain quantity of fat
in order to determine the rapid formation of a greater quantity
of this substance in the economy. Thus, for example, rice,
which we may consider a grain without fatty principle, does
not fatten, while Indian corn, which contains a small quantity
of it, is very proper for that purpose.

What are the aliments which produce fat ? In what organ is it
formed? The first question is resolved the second not as yet.*

* See on the question of the formation of fat Boussingault, Economie
lurale, vol. ii., p. 561 ; Dumas, Chimie Physiologique; Liebig, nouvelles let-
tres sur la Chimie, p. 118; Persoz, Experiences sur l'engrais des oies ; Annales
de Chimie et de Physique, vol. xiv, p. 408; Jacqelin remarques sur les expe-
riences de M. Persoz; Annales de Chimie et de Physique, vol. xxi., p. 490.

1854.] Reynoso, on Sugar in the Urine. 137

Fat can proceed either from azotised or non-azotised ali-
ments. The azotised aliments, according to M. Wurtz, by-
putrefaction, divide into ammonia and fatty acids, (butyric and
valerianic.) so that we understand that fat is drawn off or de-
rived from these azotised matters. If we recollect that sugar
produces butyric acid, when in the presence of caseum in a
state of putrefaction, (Pelouze and Gelis,) and besides that, this
same sugar, in presence of particular ferments, which are found
in potatoes, beets, &c, produces amy lie alcohol, from whence
arises valerianic acid, an acid found by M. Chevreul in the fat
of the cetaceae, we will easily conceive of the formation of fat,
by the means of sugar. If it is so, says M. Boussingault, ani-
mals would share with vegetables, the faculty of creating fatty
bodies, and that, probably by analagous means. We see, in
fact, that starch and the saccharine substance gradually disap-
pears in plants as the fatty substance accumulates in the seeds.

According to Liebig, we would be able to deduce the forma-
tion of fat from starch, by the following division :

C^H^O'^C^H^O-l-COs-l-O7

Starch. Fat.

As we know that starch is never absorbed but in the state of
grape sugar, it would be necessary, in order to explain this for-
mation, to establish the following formula : C 2 H g 4 0 1 4 =
4HO + C11 H10O-|-O7-|-CO2.

The oxygen set free in this reaction, would combine with
other substances, and would be rejected under the same form,
as the oxygen introduced into the system by respiration. It
would necessarily follow that there would be in the organism, a
source for oxygen, independent of that of the air, so that some-
times the quantity of carbonic acid eliminated, would be greater,
proportionally, than the inspired oxygen.

The air, in which animals live who are subjected to the pro-
cess of fattening, has not as yet been analysed, so that we cannot
affirm, whether this hypothesis be true or false. However, I
will recall a fact which I think comes to the support of it.
MM. Regnault and Reiset have often proved, that in chickens
submitted to a regimen of grain, the quantity of carbonic acid
expired, is superior to the oxygen furnished by respiration.*

* Annales de Chimie et de Physique, vol. xxvi., p. 514.

138 Reynoso, on Sugar in the Urine. [March,

If we admit that sugar and starch can be transformed into
fat by the above equation, we will be able to understand its
formation by the proteic matters. According to M. Hunt,*
protein, which is the normal kind of albuminous matters, would
be derived from the cellular tissue, and would be an amide of
this latter substance. He supposes that the small quantities of
sulphur and phosphorus met with, take the place of the oxygen
and normal azote. M. Hunt proposes as the formula of protein
and the explanation of its formation, the following equation :f
Protein

2C12 H10O10-|-3NH3 12HO=C24H,7N308
Gelatine

2C12 H1 O1 -|-4 N II3 12 II 0=C2 4 H2 N4 O8

The reaction observed by M. Gehrardt, gives probability to
the formula of gelatine; when isinglass is boiled with sulphuric
acid diluted with water, a large quantity of sulphate of ammonia
and sugar is formed, which ferments with the leaven of beer
and produces carbonic acid and alcohol.

Thus, then, fat would be derived from protein by a reaction
analagous to that which explains its production by means of
starch ; only the oxygen set free, would be absorbed by the
residues of carbon and azote, to form the uric compounds found
rejected by the urine.

To complete the enunciation of theories on the use of sugar
in the economy, we must recollect that, according to Tiede-
mann and Gmelin, it contributes to the formation of bile. Be-
sides, it would form the lactic acid found in the economy.
According to Berzelius, lactic acid would also be the product
of the spontaneous decomposition of the animal matters in the
interior of the body.

Whatever may be the modifications that sugar undergoes,
before it is destroyed in the economy, it is shown that it always
finishes by being completely burned, producing carbonic acid

* Comptes Rendus de Travaux de Chimie, par MM. Laurent et Gehrardt,
1850, p. 317.

t The formula for protein, of M. Hunt, makes Carbon, 53-93 ; Hydrogen,
6-36; Azote, 15.73; Oxygen, 24 34

MM. Dumas and Cahours have found for albumine Carbon, 53-59; Hydro-
gen, 7-27; Azote, 15-72; Oxygen, 23-52.

1S54.] Reynoso, on Sugar in the Urine. 139

and water. Besides, it is certain that a large part of the sugar
disappears through the lungs in the act of respiration; for the
blood which leaves the liver and continues towards the lungs,
contains sugar, and that which leaves the lun^s is completely
exempt from it, or sensibly so. I say sensibly, for it is probable
that the arterial blood contains sugar in such small quantities
that analysis cannot disclose it, and which is destined to be
burned in the rest of the economy ; for combustion not only
takes place in the lungs, but in all parts of the body.

If respiration is enfeebled if the economy cannot produce
the quantity of heat indispensable for its normal support, then a
part of the sugar which exists in the economy, escapes through
the secretions, not being able to be burned in order to produce
the heat, nor to undergo the other transformations to which it
is subjected in the normal exercise of our functions. For the
formation of fat, for example, although indicating: an excess of
combustible food, a good alimentation and assimilation of azo-
tised principles is imperiously required. Now, a good alimenta-
tion and assimilation of the azotised principles, can not take
place except when the nutrition of our organs demand them,
and when the heat disengaged in respiration second them
conditions which require the complete exercise of our functions.

Thus, whatever may be the form under which the sugar dis-
appears in respiration, it is certain that it is destroyed, either
in being burned directly, or converted into other substances.
Besides, whether this transformation or combustion of sugar is
connected with respiration itself, (and primitively as I think)
or whether the respiration does not contribute to it except after
the vigour of life, by its connexion with other functions, and by
exercising a superior and by its importance a much more
marked influence, in either event, the destruction of sus;ar is in
proportion to the degree of respiration.

To resume, my position is as follows :

It being shown that the sugar is destroyed in respiration, it
remains to prove that this destruction is in direct proportion
to the respiration.

The sugar which is not destroyed in the respiratorv act or
metamorphosed in the economy, passes into the urine and it is
by its presence in this liquid that we judge of its non-destruction

140 Reynoso, on Sugar in the Urine. [March,

or nonmodification ; for in a physiological state, sugar is not
found in the urine.

Let us glance at the theories, that we can produce upon this
phenomena.

Firstly: The respiration remaining normal; the BUgar ap-
pearing in the urine, would be there, because the liver secretes
a greater quantity of it than the economy can consume.

Secondly: My theory is as follows: the quantity of sugar
consumed by the animal in a healthy state, will be diminished
when the function of respiration is no longer exercised, as in the
normal state.

Since the experiments which have led to admit a glucogenic
power in the liver, it lias been imagined, thai whenever sugar
appeari in the urine, its presenoe is due to the fact thai the
liver produces a greater quantity of il than the animal destroys.
Without wishing to note all that this proposition presents as
positive, we will say, without denying either the importance
or exactness of THE woac,4 which has served as the basis of
this theorv, that this function of the liver appears to us insuffi-
cient to explain this phenomenon.

If we admit that sugar is destroyed durin<_r respiration, we
must necessarily admit, either that the sugar increases beyond
the force which destroys it, or that the respiration diminishes
and can no longer destroy the quantity which disappears in the
normal condition. The two circumstances might take place
separately or conjointly. I only believe the second, for it is the
only one that we can prove. It would be necessary to prove
numerically that the quantity of sugar produced by the liver
can surpass greatly the enormous quantities that we destroy
every day. It appears at first sight incredible, that the quanti-
ty of sugar produced in the liver when an animal respires ether,
can be greater than that which he can ingest at one meal,
either of sugar itself, or of aliments susceptible of being trans-
formed into sugar, a quantity which nevertheless is entirely
destroyed.

Without enumerating the numerous cases in which sugar

*I think he probably alludes to a recent memoir, by Mr. Claude Bernard,
upon the nouvelle fonction du foie considere comme organe producteur de
matiere sucree chez l'homme et les animaux. Holt.

1854.] Reynoso, on Sugar in the Urine. 141

appears in the urine when the first proposition is incapable of
explaining its presence, there are circumstances of the passage
of sugar which contradict it entirely ; while on the other hand
all the facts are well explained by the second, as soon as we
admit of a modification in respiration. We will have occasion
to return to this subject.

The first note that I had the honour to present to the Acade-
my wras thus conceived :

" The functions of the medulla oblongata have been studied
by different physiologists, all of whom agree in considering it
as the focus and regulating organ of the respiratory movements.
Besides M. Flourens has found, that there is a part of the bulb,
very circumscribed, which is the veritable seat of respiration.
This point is found in rabbits, immediately above the origin of
the eighth pair of nerves and its inferior limit almost under-
neath that origin. M. Bernard, by pricking rabbits near the
origin of the pneumo-gastric, renders them diabetic ; and he
explains this phenomenon by saying, that under the influence of
the excitement produced, the liver secretes so much sugar that
not being able to be consumed by respiration, it passes into the
urine. I thought to be able to explain the phenomena by ad-
mitting that, under the influence of the lesion caused by the
puncture, paralysis of the respiration ensued, if not complete at
least partial, and that consequently the normal sugar not being
able to be burned, passed into the urine. In order to prove it,
it was necessary to find a means to obstruct respiration by
causing asphyxia ; the experiment has proved to us, that by
means of anesthaetic agents, we succeeded in producing sugar
in the urine.

" Supposing our explanation to be right, we ought to find as
much more sugar, as the animal subjected to the etherisation
had a more active respiration and as his food contained more
sugar ; for there passed off more of unburned sugar. We have
observed, in fact, that in herbivorous animals and those subject-
ed to a mixed regimen, more sugar passes than in carnivorous
animals nourished entirely on animal food : in the case of two
men subjected to etherisation, the more vigorous gives more
sugar.

u In short, it was curious to see whether in other circum-

142 Reynoso, on Sugar in the Urine. [March,

stances of asphyxia, we would find the animals becoming
diabetic. Rabbits strangulated and drowned gave us sugar in
the urine ; but it must be added that we did not obtain it in
every case, probably because the means of asphyxia, induced
numerous disturbing causes in the economy.

" Thus, a living animal which did not breathe, would nor-
mally present sugar in his urine. M. Bernard has, in fact,
proved that in the foetus sugar is always found in the urine.

" We think that it should be looked for also in persons sub-
jected to a hyposthenic treatment.

" A word upon the manner of making the experiments. We
may operate upon animals; or better, upon a vigorous and
healthy man. We first make them urinate; afterwards ether-
ise them. We collect the urine, treat it with the sub acetate of
lead, filter and precipitate th' ofthe*salt of the lead by the

carbonate of soda. It is in the filtered and concentrated liquor,
that the presence of sugar must be looked for, with an alkaline
solution of the tartrate of potaBM and copper, or in placing it in
contact with the leaven of beer, which transforms the sugar into
alcohol and carbonic acid.

"We think that these experiments will render clear the dis
of the diabetics ; for they establish the relation which exists be-
tween the respiration, nervous influence and the sugar of urine."

Effect of Inspirations of Ethbb.

As I said in my first note, whenever an animal breathes ether,
sugar appears in the urine. I explain that fact, by the trouble
that the respiration undergoes, which being diminished, can not
destroy all the sugar that the blood furnishes.

It has been attempted to explain this phenomenon in a differ-
ent manner. It has been pretended that the vapors of ether,
upon arriving at the lungs, produced an irritation, which would
be transmitted by the pneumo-gastric to the encephalon, and
thence reflected upon the great sympathetic, which, irritated in
its turn, would increase the production of sugar in the liver and
to such a point, that the economy being no longer able to des-
troy all, would reject the excess by the urine. Nevertheless, I
have made an experiment which does not accord with this in-
genious explanation.

1854.] Reynoso, on Sugar in the Urine. 143

I take a rabbit and make it urinate. Afterwards, I cut the
two pneumogastrics at the neck, taking away at least two cen-
timetres (about an inch) of the nerve of both sides, and then
make the animal respire ether. I commence at first by placing
it in a complete state of anaesthesia. When he is entirely
aroused, I make it again respire ether during ten minutes, but
without placing it in a complete state of anaesthesia. Then I
examine its urine, which is very clear and contains sugar in as
great quantity as if the pneumogastrics had not been destroyed.

Thus, whenever we make a rabbit breathe ether, whether he
possesses his pneumogastrics, or whether he has been deprived
of them, there is always a passage of sugar in the urine,

When rabbits breathe chloroform, Dutch liquor, hydriodic,
hydrobromic, chloramylic, nitric* and acetic ether, aldehyde,
benzine and acetone, we obtain also the passage of sugar in the
urine. The same result is obtained by slowly putting them in a
state of asphyxia by means of sulphuretted hydrogen and carbo-
nic acid or with the vapors of hydrocyanic acid.

I think, then, I may conclude that :

All substances which induce anaesthesia, gases or irrespirable
vapors, cause sugar to pass into the urine ; and that this pas-
sage is independent of the integrity of the pneumo gastric nerves.

I will cite a fact discovered by M. Bernard, after the publi-
cation of my work, and which enters naturally into this same
class.

According to him, when an animal respires chlorine, a pas-
sage of sugar into the urine takes place. Here, the chlorine
acts, firstly, because it is respired in the place of air and thence
diminishes the quantity of oxygen inspired, afterwards, because
it disorganises the pulmonary vesicles which become unfit for
their exercise.

Almost all of my experiments upon the inspiration of anaes-
thetic agents have been made upon rabbits. The best condi-
tions to obtain a satisfactory result are the following. The
rabbits that are bought in market are generally fatigued and
badly nourished; it is necessary to let them rest twenty-four
hours and feed them abundantly with carrots. At the end of
that time, we commence the experiment and obtain the sugar

* The nitric ether was rather a mixture of nitric and nitrous ether.

144 Reynoso, on Sugar in the Urine. [March,

in a quantity proportional to the length of time that they breathe
the anaesthetic agents. If one has the patience to make them
breathe the ether an hour and a half, a very good result will be
obtained. We commence by putting them in a complete state
of anaesthesia and allowing them to recover, recommencing
again the anaesthesia, and so on for five or six times successive-
ly. With simply one etherisation, a good result may be ob-
tained, but it is better to etherise them five or six times succes-
sively.

Vital Point (noeud vital?) of M. Flourens,

I promised in my first note that the vital point ought to play
an important part in the passage of sugar in the urine, being the
motor point of the respiratory mechanism ; since then, thanks to
the kindness of M. Flourens, who has opened the doors of his
laboratory and lavished his wise counsels upon me, I have
been able to assure myself that I was not mistaken in my
premises.

At the posterior extremity of the fourth ventricle, between
the two posterior pyramids of the medulla, there exists a small
V in the gray substance, inscribed at or in the bifurcation of
these two pyramids. This V, is the continuation of the gray
substance of the medulla, and is also called the calamus scrip-
torius. It is in this V of the gray substance, and between the
two sides of the angle formed by the V, that the vital point of
M. Flourens is found.* According to him, " the superior limit
of the vital point is formed by the foramen ccecum, the inferior
at the point of junction of the posterior pyramids; between
these two limits is found the vital point, the distance between
them being scarcely a line."

M. Flourens was not contented to determine the position and
limits of the vital point ; he went further, and thanks to a vig-
orous and rational analysis, in this point hardly as large as a
line, he has distinguished the demarcations. He exposes the
result of his researches as follows ;

" I often make the experiment, proceeding by transverse sec-
tions.

"If the section passes in front of the foramen ccecum, the res-

* Comptes rendus des seances de l'academie des sciences, vol. xxxiii, p. 438.

1854.] Reynoso, on Sugar in the Urine. 145

piratory movements of the thorax continue, while those of the
face cease.

" If the section passes behind the point of junction of the
pyramids, the respiratory movements of the face (the movement
of the nostrils and gaping) continue, while those of the thorax
cease.

" If the section passes upon the point of the V of the gray sub-
stance inscribed in the V of the pyramids or point of the pen,
(calamus scriptorius ?) the respiratory movements of the face
and thorax cease immediately, and at the same time.

'' I often make the experiment in another manner : I use a
small punch, the opening of which has a diameter of scarcely
half a line ; I plunge this pucheon into the medulla oblongata,
being careful that the opening of the instrument corresponds to
and embraces the V of the gray substance. I thus isolate
suddenly the vital point from the rest of the medulla oblongata
pyramids, restiform bodies, etc., and immediately the respirato-
ry movements of the trunk and face are abolished.

" Thus by experiment, the limits of this point are marked
below, by the persistence of the inspiratory movements of the
head ; and above, by the persistance of those of the trunk.* "

When the vital point of M. Flourens is pricked, there is
always a passage of sugar in the urine ; I have repeated fre-
quently the experiment in the presence of M. Flourens, and I
have constantly obtained the same result.

I took a rabbit and made it urinate. The urine was troubled
as usual and did not contain sugar ; I pricked the vital point,
and as soon as it could urinate again, I obtained a clear urine
and containing sugar in considerable quantity, and easily deter-
mined by every test.

It is an error to think that I meant to say, in my first note,
that the point of the bulb that M. Bernard pricked, in order to
cause a passage of sugar in the urine, was the vital point of M.
Flourens. I by no means meant that, but I thought, and still
think, that the point which M. Bernard pricks is under the de-
pendence of the vital point, which has also been called by M.
Flourens, central, motor point of the respiratory mechanism. It

* Flourens recherches experimentales sur les proprietes et les fonctions do
systeine nerveux, p. 201.

140 Reynoso, on Sugar in the Urine. [March,

is at the same time the centre of action and co-ordinator ; and
by coordinated movement, M. Flourens means: "all (or any?)
movement which results from the concurrence, union or group-
ing, so to say, of several other movements, distinct and separa-
ted one from the other, and which if grouped in another manner
would have given another result total."

The central point of coordination of the different acts of
respiration, is the focus, so to say, from which emanate its
coordinating actions, so that its action is multiple but unique.
It presents unity in its multiplicity, simplicity in its complexity.
I think, then, that although the point that M. Bernard pricks,
be a half an inch above the vital point, the puncture made at
this point intercepts some of the active and co-ordinating rays of
the vital point, and that thus it is under its dependence, for it
obstructs its action t> reach the point where it ought to arrive
in order to keep up the harmony in combining and rendering
active the respiratory moTements.

I forgot to remark that, when the vital point is pricked, not
only the urine becomes limpid, but the quantity is considerably
increased.

In my second note, presented to the Academy, the 10th
of November, 1851. upon the connexion between the respira-
tory phenomena and the presence of sugar in the urine, I thus
expressed myself:

"In a preceding note, we announced that there exists a
connexion between the respiratory phenomena and the presence
of sugar in the urine, in such a manner, that all substances
which enfeeble the respiration in diminishing the haematosis
produced in the lungs, are so many causes which might, in our
opinion, determine the passage of sugar in the urine. We ad-
ded that, according to this principle, sugar ought to be found in
the urine of individuals subjected to hyposthenic treatments; to
enumerate them in short, it will only be necessary to cite the
generalization of M. E. Robin.

" According to him, the substances, which after death, keep
up a slow combustion by means of the humid oxygen, are hy-
posthenics in different degrees during life. For example, the
metallic salts, ethers, the salts of quinine and narcotics in
general.

1854.] Reynoso, on Sugar in the Urine- 147

" Having examined the urine of persons subjected to treat-
ments* of the bichloride, iodide and sulphuret of mercury, salts
of antimony, opium and sulphate of quinine, we found sugar."

The third note presented on the 3d of December, 1851, is as
follows :

" In my preceeding notes, I endeavored to establish the con-
nexion which exists between the presence of sugar in the urine
and the respiration ; in such a manner that all causes occasion-
ing a hindrance in the accomplishment of this function, would
produce a passage of sugar in the urine.

"We spoke of the hyposthenic treatment which obstructs a
part of the blood from the action of the oxygen. I will add to
the examples already given, that in the case of dogs subjected
to a treatment of arsenic, lead, zinc, copper and the sulphate of
iron, and also with patients treated with the corbonate of iron,
I have always determined the presence of sugar in the urine.

" I now approach the second part of my researches. When-
ever the respiration becomes troubled, either by a disease
proper of the lungs, or by the effect of some other affection
causing a disorder in its normal exercise, there will be sugar in
the urine.

u I have determined its presence in the urine of tuberculous
patients, and the quantity of it was proportionally considerable
as the period of the disease was more advanced, and as the in-
flammatory symptoms were less intense.

" In pleurisy and chronic bronchitis there is sugar in the
urine ; the same in asthma.

" It is found also in hysteria and epilepsy after the attacks.

" In cholera there ought to be sugar in the urine, for, ac-
cording to the experiments of M. Rayer, the air undergoes none
or scarcely any change in the lungs. It would be desirable,
that, the physicians engaged in the study of this disease, would
look for the presence of sugar in the urine of the patients."

We also have sugar in the urine after drinking a strong in-
fusion of coffee.

I had an occasion to examine the urine of two drunken men
and found sugar in it. We know, that after the researches of

*I knew, after the publication of this note, that M. Chevallier, had found so-
gar in the urine during a mercurial treatment.

148 Reynoso, on Sugar in the Urine. [March,

Prout, alcohol is a substance which diminishes in the highest
degree the exhalation of carbonic acid and thus the respiration.
Moreover, we know, that according to the experiments of
MM. Bourchardat and Sandras, alcohol prevents the transfor-
mation of venous into arterial blood ; the arterial preserves the
colors proper to venous blood, and thus alcohol may determine
all the accidents of asphyxia. These same observers have
determined the presence of sugar in the venous blood of a
drunken man. We comprehend then the causes which pro-
duce the passage of sugar in the urine of drunken persons, and
I will add that it exists in a considerable quantity.

The Habitual I Sueaa in the Urine of

Old Pjk < us,

I made the following experiments together with M. De-
chambre.

The modifications that respiration undergoes in <>]d age, are
so notable and important, that Reveille Parise does not hesitate
to consider them as the origin. Starting point, and the organic
cause of old age. The senile deterioration of the respiratory
organs, impedes the accomplishment of ha^matosis in a proper
manner, and also the production of a general calorification to
the extent that a complete and normal exercise of our functions
exacts.

The modifications which obstruct the respiration are : lateral
depression of the thorax, anterior projection of the sternum,
stiffness of the costo- vertebral articulations, induration or ossi-
fication of the cartilaginous appendices, rarified parenchyma of
the lunsrs, thin or ruptured cellular walls, obliterated vessels.
Except when, by one cause or another, the blood of old people
does not contain sugar, or only in a small quantity, (which con-
ditions were in my theory,) there can not be a more favorable
condition to the production of glucosuria.* Having in view
the verification of this conjecture, we made the following ex-
periments :

First Experiment. We chose at first, at the hospice of Sal-
petriere. a woman aged eighty-one, in the last stage of decrepi-
tude. We assured ourselves that she was exempt from any

Is the translation correct 1 Holt.

1854.] Reynoso, on Sugar in the Urine. 149

cough or sense of suffocation, and exhibited no physical or
symptomatic sign of pulmonary or cardiac affection, or any
other disease capable o obstructing the respiration; so that if
there was any insufficiency of combustion, it could only be at-
tributed to the state of the lungs engendered by old age. The
urine of this woman, collected in the morning, in quantity about
two ounces, was at first treated by the acetate of lead, in order
to separate the uric acid and other precipitable organic matters,
and then placed in a filter. The filtered liquor was freed of the
salt of lead which it might have retained by means of the car-
bonate of soda, and re-filtered. We poured in the saccharime-
tric liquor of M. Barreswil,* (cuprico-potassic,) and after a
minute boiling obtained a very abundant reddish precipitate,
(protoxide of copper.)

Second Experiment. The same experiment was made upon
the urine of five women, aged from sixty-eight to eighty-one
years, in the surgical wards at Salpetriere, one of them treated
for an abscess of the arm, another for rheumatic pains, the third
for a chronic affection of the skin, the two last for contusions ;
all of them otherwise in good health. The urine of these five
women, also collected in the morning, gave a very characteris-
tic precipitate.

Third Experiment. In order to obtain more easily old
people exempt from affections of the heart or lungs, we author-
ized the urine to be collected without the infirmary ; we chose,
on the same day, eight women who appeared to offer the requis-
ite conditions, aged seventy, and already very decrepit ; two
gave only a slight yellowish shade, but little significative ; six
a veritable reddish precipitate.

Fourth Experiment. Wishing to know whether the gluco-
suria was constant with these women or only momentary, at
the end of a week, we took, a second time, the urine of seven
of them comprising the glucosurics ; with two there was no
trace of a yellowish shade ; with two others the shade was
a little apparent; in the three last cases there was a pre-
cipitate.

The results so far obtained, left still some uncertainty ; fer-

* Tartrate of Potassa and Copper. Holt.
v. s. vol. x. no. in. 10

150 Reynoso, on Sugar in the Urine. [March,

mentation offered us a more decisive means of verification ; we
had recourse to it with success.

Fifth Experiment. The urine of four women, aged from
seventy to ninety-two years, was collected, after having deter-
mined with the specimens that they gave, a reddish precipitate
with the liquor of Barreswill. There was about the third of a
quart of urine. At first treated by the acetate of lead and the
carbonate of soda, as in the preceding experiments, it was re-
duced by evaporation to two or three spoonfuls, then placed in
contact with the yeast of beer in a retort, the neck of which
was adapted to a small receiver. We took no measures to
collect the carbonic acid, the formation of alcohol sufficing to
test the presence of sugar. By distilling at a gentle heat,
about a scruple of colorless liquid was soon produced in the re-
ceiver. The receiver was then removed and slightly heated,
while a burning match was presented to the orifice ; a blue
flame ran along the whole length of the neck, leaving an un-
equivocal odor of alcohol.

Sixth Experiment. The same experiment was made a few
days after, upon the urine of six women, aged also more than
seventy years. The whole quantity was two-thirds of a quart,
it was reduced by evaporation to four or five spoonfuls. This
time, with the first product of distillation, equivalent to about
three scruples, a bluish flame was obtained which did not cease
to crown the neck of the receiver for eight or ten minutes, and
which left a veritable odor of punch.

The alcoholic fermentation having been evident, therefore
the urine experimented upon contained a considerable quantity
of saccharine principle.

It was at first the intention of M. Dechambre and myself to
find, whether there was any proportion between the degree of
glucosuria and the age or decrepitude of the subjects. There
very probably is ; but the only tests which our time, so far, has
allowed us to make, have not given a satisfactory result. In the
third experiment, we took care to employ in each case the same
quantity of urine and the same reacting portion, and classed
them according to the abundance of the precipitates ; doubtless
a process but little rigorous, but, however, susceptible of furnish-
ing some valuable signs. But, this classification was not at all

1854.] Reynoso, 071 Sugar in the Urine. 151

conformable to the advancement in age or degree of decrepitude.
Certain women, very well preserved, notwithstanding their
great age, having the skin still pliant, breasts well developed, and
thorax but little deformed, gave a great deal of sugar while
others, entirely dried up, gave none at all, or in very small
quantity. We understand, moreover, how many difficulties
such a research ought to present, when we reflect that, in the
same subject, the glucosuria may disappear from one day to
another, or vary in intensity, as we have seen above.

Diabetes.

I now arrive at the disease especially characterised by the
presence of sugar in the urine. Certainly, one is not sick be-
cause he has sugar in the urine, but because it is only found
there after a derangement of the vital functions.

We do not pretend to characterise a disease by one of its
symptoms: for it has been known ever since the time of Hippo-
crates, who said, una natura, una conjluxio, consentientia
omnia, that the organism is a whole, an unique assemblage ;
that no system of the isolated parts is subservient to one func-
tion exclusively : that all the functions harmonize with each
other and contribute to the same end so that a derangement
in one function reacts upon the others. However, there are
some functions which are more important than others, and
whose alteration causes more disturbance in the others. In
disease it is to be determined, what is the function primarily
altered and which has caused the other troubles. In diabetes,
we think that the respiration is primarily altered, and that the
other disturbances, which accompany it, are only the effect.
Besides, although for the most part, diabetic patients only die
from pulmonary tubercles, we often see, when they die before
the period of marasmus, that the lungs are perfectly sound.
We consider this tuberculisation as an effect of the profound
alteration of the function, and we believe, that one of the most
frequent causes of diabetes, is a derangement in the functions
of the vital point of M. Flourens, it being the motor, the centre
of action of the respiratory apparatus. We will afterwards
examine the theory, which explains diabetes by a want of al-
kalinity in the blood, and also that which accounts for it by

152 Reynoso, on Sugar in the Urine. [March,

admitting an augmentation of the production of sugar by the
liver ; but before that, we will show that there is really, always
a disturbance in the respiration.

Firstly, the presence of tubercles.

The quantity of carbonic acid expired, diminishes in diabetes,
(Coindet,) also the animal heat becomes less (Bouchard at.)
We know that the quantity of carbonic acid disengaged in
respiration, is less during sleep ; therefore the production of
heat is less during sleep, and it is for that reason that we feel
the want of better covering, and are more exposed to become
cold.

All things equal in other respects, the quantity of sugar in-
creases in the urine during the night, (Coindet,) so that if in
the morning when the patient awakes, his urine is examined,
much more sugar is detected than at any other time of the
day. I said, all things equal in other respects, for it is evident.
that after a meal at which a quantity of feculent or saccharine
substances have been eaten, we find the greatest abundance of
sugar in the urine.

We will now see that the quantity of sugar diminishes as the
respiration increases. A moderate exercise accelerates the
respiratory movements, increases the quantity of carbonic acid
exhaled, and the absorption of oxygen is generally triple the
normal condition (Prout, Scharling, Lassaigne.) Nowr the
quantity of sugar diminishes, according to Bouchanlat, in the
urine after a regular exercise, the labors of the field, in the free
air, circumstances, which as we have seen, augment the com-
bustion during respiration.

We know that the sugar disappears in diabetes, when they
are laboring under an intense fever. This fact, so inexplicable
before, is easily understood, when we recollect that the quanti-
ty of carbonic acid exhaled has been increased, so that the
respiration being increased, the production of heat augmented,
the sugar is destroyed as well as when the patient is subjected
to exercise in the open air, and as much more, as the quantity
of it is less on account of the diet which the patients are obliged
to observe.

As in well characterised inflammations which do not disturb
the respiration, the exhalation of carbonic acid increases, it is

1854.] Reynoso, on Sugar in the Urine. 153

not extraordinary, that when an inflammation takes place with
a diabetic patient, his urine should not contain sugar. I think
that this explanation is more satisfactory than to say, that in
order to be diabetic, it is necessary to enjoy good health.*

Let us examine the two principal theories, that have been
produced upon the cause of diabetes.

lstly. That with diabetics, there would exist a continual
source of sugar in the economy, independently of that taken in
bv means of the food. That this sugar would be formed in the
liver, and its production would be so much increased, that the
economy not being able to employ it, would reject it There
is an important fact against this theory, a fact which proves
that the sugar rejected from the economy in the case of di-
abetics, proceeds from the feculent or saccharine matter ingest-
ed ; for when these two substances are suppressed, the urine no
longer contains sugar. All the physicians, who have had oc-
casion to observe this cruel disease, agree upon that point.
However, we will cite two authorities in support of our asser-
tion :

The proportion of sugar contained in the urine, is in con-
stant conformity to the proportion of feculent or saccharine
food." (Andral. pathologie interne, vol. ii., p. 447.) '; It is a
fact, evident to me, that the urine of almost all of the diabetics,
subjected for several days, either to abstinence, or an exclusively
animal regimen, exhibits no trace of sugar." (Loc cit.)

* We have already admitted, that the elements of our organs, whieh become
unfit for their structure and functions because of their exercise, are burned by
the oxygen and rejected under the form of uric acid, urea, &c. In diabetes,
these substances diminish, to such a point in the urine, that for a long time
their existence has been denied. That proves, that during this disease, the
matters which give rise to (uric acid, &c, I suppose. Holt) them are not
burned in the economy. Here, we can easily suppose two things which are
equally true: lstly, Because of the lessening oi the disengagement of heat, the
quantity of vital energy and also the nutrition of our organs diminish; con-
sequently, the materials, which give rise to the uric compounds, diminish, and
we easily understand, therefore, why they are found in such small quantity in
the urine; 2ndly, The respiraton being diminished, the combustion of the
parts of our organs, unfit for life, can not take place as well as when the respi-
ration is in a normal state. These elements, not being able to be rejected,
remain in the economy, there undergo different transformations and give rise
to the purulent, gangrenous &c., deposits, that we meet with so often in di-
abetic patients.

154 Reynoso, on Sugar in the Urine. March,

" It is a favorable circumstance, and I must say, the most
common one to see the urine return to its normal quantity and
composition, after twenty-four or forty-eight hours of a regimen
from which feculent and saccharine aliments will have been
rigidly excluded." (Bouchardat, du diabete sucre., p. 44.) This
theory produces in its favor but one " exceptional " fact, report-
ed by M. Andral, (Path, int., vol. ii., p. 450.,) in which, v i
a patient, with whom sugar appeared in the urine, although
subjected to an animal regimen. But if it is considered that
this patient was at a hospital where he could not be watched,
and therefore might easily have eaten the bread of his com-
rades, and that moreover he was only seventeen years of age,
which will explain his discarding the regimen; this fact loses a
little of its value. But, even supposing that the patient took
neither feculent nor saccharine substances, should we base a
theory upon one exceptional fact, expose a number of observa-
tions as exceptions? It appears to us more logical to wait un-
til other like facts be acquired by experiment, before giving an
opinion.

We have said elsewhere, and we repeat it here, that the su-
gar being normally destroyed in the economy, when it is not,
we must admit, either that its quantity has increased beyond
the destructive force of the organism, or that this force has di-
minished. If the quantity of sugar has increased, that may be
accounted for in this way, that the economy receives by means
of feculent and saccharine food more of it than it can destroy,
and that the economy itself produces more of it than it can
consume, independently of the feculent or saccharine aliments.

In the first place, there is a kind of instinct which regulates
for us the quantity of respiratory food that we need ; secondly,
we have elsewhere said, that the sugar which is not immediate-
ly destroyed, may be converted into fat and deposited in the
economy. Experiment has proved that, if in a healthy condi-
tion one eats a large proportion of sugar, it passes into the urine,
and also that takes place when glucose is injected into the veins
beyond certain limits. But that is not the case with diabetics.
With them, the quantity of sugar which would be destroyed in
a healthy condition, appears in the urine. We must therefore
admit, that it is the destructive force which has diminished, and

1854.] Reynoso, on Sugar in the Urine. 155

we know, that this destruction is under the dependence of the
respiration,

As to the excessive production of sugar by the liver without
feculents, we have already said why we do not think it suf-
ficient to account for diabetes.

2r.dly. This theory has for its basis, the observations of
M. Chevreul, upon the influence of alkalies upon the transfor-
mation of organic matters in the presence of oxygen. M.
Mialhe has observed that grape or diabetic sugar has no re-
ducing action upon the oxide of copper, either cold or warm,
and that it does not acquire its disoxygenising property until
after having been chemically influenced by an alkaline sub-
stance, free or carbonated ; from that he has deduced, that it is
by the akalies normally contained in the blood and the animal
liquids, that the transformation of the saccharine matter is pro-
duced. T the alkalinity is no longer sufficient, the tranforma-
tion cannot take place ; the sugar being no longer decomposed,
or assimilated, is diffused throughout the economy, becomes a
foreign bodr, and as such is rejected through the renal glands
and all of the secretory apparatus.

" Diabetes then, recognizes as its cause, a defect in the as-
similation of sugar, from a want of a sufficient alkalinity in the
animal econony. In a healthy man, the blood is alkaline, and
ought to reman alkaline, for the accomplishment of the inter-
visceral functions. But the elements of acidity, constantly in-
troduced into .he economy, would tend to predominate, if they
were not counterbalanced and eliminated by the especial secre-
tions, the swest and urine.

" These elements of acidity are :

" Istly. The ingestion of acids themselves.

" 2dly. Exclusively azotised food ; meats, on account of the
albuminoid matters, contain a great deal of sulphur and phos-
phorus ; these bodies, on account of their combustion in our or-
gans, give rise to a great quantity of sulphuric and phosphoric
acids, which are spread through all our humours, there saturate
at first the alkaline bases which are there met with, and end by
predominating.

" 3dly. Defect in the perspiration of the skin, an emunctory
destined to eliminate the acids of the economy."

156 Reynoso, on Sugar in the Urine. [March

M. Mialhe terminates the exposition of his theory by this
phrase : " So long as the presence of glucose in the urine, of
herbivorous animals, normally alkaline, that is to say, the possi-
bility of the existence of glucose in presence of an excess of
alkali is not shown, I will remain unshaken in my convictions."

If we do not entirely share the views of M. Mialhe, we will
at least avow that, this theory has led him to advise a treatment,
the good results of which the physicians can daily determine.

In the following points I do not coincide with M. Mialhe.
In order that the sugar should be destroyed in the economy, it is
evident that the presence of alkalies is necessay, but there are
also other indispensable conditions. If the oxygen is not of
sufficient quantity, either because of the inspiration of irrespira-
ble gases, or the impossibility of its entering into the pulmonary
canals, if the structure of the lungs is modified, etc. ; in short, if
all of the normal conditions of respiration are not fulfilled, the
sugar will not be destroyed, whatever may be the alkalinity of
the blood. As an example : I made a rabbit respire ether ; his
urine contained sugar, and notwithstanding it was dkaline.

Among the elements of acidity, M. Mialhe placed meat, and,
nevertheless, it is this element which, as nourishment, is most
proper for diabetics.

An animal regimen is useful in diabetes, because the feculents
and sugar, being absent in the food, can not remain in the
economy, and thence we succeed in preventing a great many
of the troubles, which are the effect of this abnormal presence
of sugar in the blood. But the use of meat aloie meets with
only a temporary good ; for as soon as feculents or sugar are
again taken, the alarming symptoms of diabetes return. It is
evident, that it is necessary to employ an anima. regimen; but
also it must be endeavored to destroy the cause which hinders
the assimilation of sugar.

In the theory of M. Mialhe, if it is true that he has not ex-
pressed himself, contrary to the opinion that we have just an-
nounced, upon the animal regimen, it is evident, also, according
to this theory, that with an exclusive animal regimen, the pa-
tient ought to grow rather worse than better, for this element
of acidity would hinder the presence of alkalies, free or carbon-
ated, and would thus render more abnormal the composition of

1854.] Reynoso, on Sugar in the Urine. 157

the blood, which would give rise to other troubles than those
which are manifested when saccharine food is taken ; so that,
what we would gain by an abstinence of feculents, we would
lose by animal food.

The cause which determines the defect in the alkalinity of
the blood, is, according to M. Mialhe, the suppression of the
sweat, an emunctory destined to eliminate the acids of the
economy, which, if they are not eliminated, prevent the pre-
sence of the alkalies in the blood, free or carbonated.

Under different climates, and in different periods of life, we
see the sweat and urine always holding such a relation that
they are always in an inverse proportion to each other. We
always see that, when the sweat increases, the urine diminishes,
and vice versa, and by this means the health is preserved, for
always the same function of elimination is exercised, although
by different organs. Besides the relation that is remarked
in the production of these two secretions, we are convinced
that they have a more intimate connexion, if the chemi-
cal composition, as well as the apparatus which served to
separate them from the mass of the blood are examined and
compared. In diabetes, the urinary secretion is to such an
extent augmented, that we do not understand why this increase
in the production of urine should not cause an equilibrium by
the absence of the cutaneous perspiration. I think that this
disappearance of the sweat, has been, for the most part, only the
effect of the augmentation of the urinary secretion.

We can account for this augmentation of the urine, if we
recollect a fact already noticed by Wcehler, that all the salts
which are eliminated by the urine, render active the secretion
of that liquid. The sugar, in diabetes, is a substance which
can not be rendered useful by the economy and which is elimi-
nated by the urine ; it would render active the secretion of that
liquid, as would any other diuretic whatever. The thirst, which
accompanies the disease, would then be only the effect of the
want which the economy feels for disembarrassing itself of this
substance, and besides, it would be inevitable, because, in pro-
portion as liquid is introduced, the liquid would be promptly
eliminated on account of the activity of the urinary secretion.
Moreover, the experiments of M. Bouchardat, prove that the
blood of diabetics is equally alkaline as in the normal state.

158 Reynoso, on Sugar in the Urine. [March,

But, even supposing that this theory should not be absolutely
true, it will at least have served to show, that alkalies, in ren-
dering active and facilitating the destruction of sugar, ought to
be prescribed in diabetes. It is, perhaps, because they facilitate
combustion, and thence the disengagement of heat, that the
alkalies are general excitants.

The alkalinity of the blood, being one of the conditions in the
destruction of sugar in the economy, may become, when it is
altered, a cause of diabetes.

M. Bouchardat, has lately occupied himself a great deal with
diabetes, especially with a view to its treatment. We will not
examine his work ; it is a little aside from our subject, which is
to discover the causes of the disease.

In diabetes, the feculent and saccharine aliments are digested
as in the normal state ; only, in health, they are assimilated and
destroyed during the act of respiration, while, in diabetes, they
are not destroyed, because of a modification in the respiration.
So that diabetes may be caused by anything which produces
profound troubles in the function. But, almost always its origin
is in the troubles of the functions of the nervous centres which
preside over respiration.

We can go further, and we will be able to find other causes
of diabetes, when we will understand better the usages and
means of destruction of sugar in the economy, and then we
will see that anything which interferes with the normal destina-
tion of sugar, may give rise to diabetes. As, in the actual state
of the science, it is to the respiration that we attribute the des-
truction of sugar, and as we can explain, by the troubles in this
function, the cases in which the urine becomes saccharine, we
will therefore admit the alteration of the respiration as the cause
of diabetes.

Action of Curara.
One of the most conclusive proofs of the theory that I have
just exposed, was furnished me by a fact noticed by M. Bernard
after my first experiments. This fact shows, that if the nerv-
ous system plays a part in the passage of sugar in the urine,
we must consider its action as intercedent in the respiration,
and not as exciting the glucogenic force of the liver.

1854.] Reynoso, 071 Sugar in the Urine. 1 59

=-

M. Bernard found, that, when animals are killed with curara,
there is a passage of sugar in the urine.

This fact enters naturally into the category of those that I
have before observed. The curara, in effect, acts, as is proved
by the researches of Munter and Virchow, in destroying, in
abolishing the respiration, so that it kills rather by asphyxia
than any other way. We can prolong life, for a longer or shor-
ter length of time, by practising artificial respiration.

M. M. Pelouze and Bernard have proved on the other hand,
that the curara destroys all the properties of the nervous system.
We can not then say, that it excites them in order to react
afterwards upon the liver. We might object, it is true, that
before destroying, the curara excites to a high degree the nerv-
ous system ; but then it would be necessary, to establish one
hypothesis, to prove another.

The method of testing Sugar in the Urine.
We may employ three means to accomplish this end. The
first, the most important, decisive and that without which we
should never draw a conclusion, is fermentation, and I think it
useless to relate here the procedure.

The second, is founded upon the property of the salts of cop-
per to be decomposed by glucose in the presence of alkalies.
This procedure is mostly employed, but it is also that, which
may most easily lead to error ; for in employing it we may sus-
pect the presence of sugar where it does not exist, or remain
doubtful when it does exist. We must then guard against these
errors. For that, it is necessary to commence by separating
the albuminoid substances ; which also reduce the salts of cop-
per in the presence of alkalies. For this purpose we add to the
urine the tribasic acetate of lead; we pour into the filtered
liquid the carbonate of soda, to separate the excess of the salt
of lead; we filter again and concentrate the liquid. Jt is there
that we should look for sugar, by means of the liquor of Barris-
wil, or the tartrate of copper and potassa. Unfortunately these
precautions are always neglected, because one does not wish to
devote the time necessary to it. Even in operating in the above
manner, it is necessary to have recourse to fermentation, in or-
der to draw a definite conclusion as to the presence of sugar.

160 Reynoso, on Sugar in the Urine. [March,

The third procedure is, polarisation. To obtain good results,
it is also necessary to precipitate the urine by the subacetate
of lead, in order to discolor it and precipitate the albuminoid
principles. But it will be necessary, again to control by fer-
mentation the result thus obtained. The use of polarisa-
tion is somewhat delicate ; but fortunately those, who would
wish to employ it, have at their disposal the memoirs of M.
Biot and the pamphlet of the Abbe Moigno.

I ought to make the general remark that, if sugar is looked
for in urine which only contains a small quantity of it, it is
necessary to operate upon at least three or lour ounces of urine,
which must be concentrated and then treated by the above
procedures.

Note. I thought that I ought to abstain from all indication as
to the treatment of diabetes, and it is with regret that I have
deduced from my experiments a method of treatment contrary
to all scientific results. It has been reasoned in the following
manner: "If diabetes proceeds from a detect of respiration,
from a diminution in the combustion of BUgar, nothing would
be more easy, in order to render active this combustion, than to
employ an air in which the oxygen would be in greater propor-
tion than in the atmospheric air. And to obtain a much more
active combustion it will be necessary to employ inspirations
of oxygen. It is possible that the inspirations of this gas have
produced good results in practice; but I am sure that these
effects cannot be attributed to the fact that the combustion had
been increased ; for MM. Regnault and Reisset have proved
that the respiration of animals, of different classes, in an atmos-
phere containing two or three times more oxygen than the
normal air, presents no difference with that which is perform-
ed in our terrestrial atmosphere. The consumption of oxygen
is the same, the connexion between the oxygen contained in
the carbonic acid, and that consumed, undergoes no sensible
change ; the proportion of azote exhaled is the same ; in short
the animals do not appear to perceive that they are in an at-
mosphere different from the ordinary one. I think that if an
augmentation of the respiration by changing the composition
of the air was desired, it would be necessary to replace a part

1854.] T 'atom's Case of Spinal Meningitis. 161

of the azote by hydrogen and give to the patients to breathe a
mixture of oxygen, azote and hydrogen, for then the consump-
tion of oxygen is greater. But nevertheless I abstain from
taking the responsibility of this indication, and if I have
thought necessary to make it, it is because it is the only way
in which the composition of the air can augment the consump-

tion of oxygen.

ARTICLE IX.

A Case of Spinal Meningitis, treated with large doses Quinine.
By S. Z. Tatom, M.D., of Coweta county, Ga.

Mrs. B., set. 34, was delivered of her sixth child, 10th June,
1853, by a midwife, and did well until the 14th, when she was
attacked with epidemic dysentery. I was called to see her.
Operations every fifteen or twenty minutes ; muco-sanguineous ;
tormina and tenesmus great; pulse 110, quick, small; tongue
coated around the edges and tip ; skin dry and hot ; hypogastri-
um tender ; lochia scanty and offensive ; strength exhausted.

Treatment. ty. Opii., gr. \; Acet. Plumb., grs. 2; Camph-
ora, gr. 2 : to be given every two hours, according to circum-
stances. Enema tinct. opii, acetate plumbi, and starch ; warm
fomentations over abdomen ; vaginal injections, with diluted
milk 98 Fahr. Continued "above treatment, with but little va-
riation, until the 18th; dismissed case.

June 24th. I was called to see patient. Found the flexor
muscles of extremities rigidly contracted, those of face occa-
sionally twitching ; tongue partially paralyzed ; voice indistinct ;
formication, tingling, &c. ; perspiration and deglutition difficult;
drawing sensation in the region of diaphragm ; countenance
anxious; pulse 80, regular, small and soft; skin cool, soft; bow-
els regular ; lochia natural ; abdominal tenderness subsided ;
tongue good ; three inferior cervical and two superior dorsal
vertebrae very tender on pressure.

Treatment. $. Opii., gr. \ ; musk, grs. 2; quinine, grs. 2;
made into pill. One every 2\ hours. Cups over tender part
of spine, followed by blister, and stimulating liniments to spine
and extremities.

June 25th, 8 o'clock, A. M. Found patient as I left her.
Continue same treatment.

162 Landrum's Case of Puerperal Convulsions. [March,

June 26th, 9 o'clock, A.M. Patient is worse; says she will
die. Diarrhoea copious ; paroxysms of dyspnoea, resembling
that of croup; croupal sound ; excruciating pain in the region
of diaphragm ; " feels as if something was drawing her in two;"
deglutition almost impossible; abdominal muscles contracted;
can't straighten herself; sits in half recumbent position ; pants
for breath ; fist firmly clenched ; legs flexed upon thighs ; feet
drawn; toes at almost right angles to feet; pulse 110, small and
weak; tongue red; skin dry and hot. Prescribed, enema:
Tinct. opii., acetat. plumbi. and starch, in cold mucilage, which
arrested diarrhoea. Having exhausted my catalogue of narcot-

O JO

ics and antispasmodics to no avail, I tried galvanism, the warm
bath, and a host of adjuvants ; but patient continued to grow
e until 10 o'clock, A. M., next day ('37th). Another physi-
cian was sent for: but before he arrived, as patient was appa-
rently near her dissolution, I determined on venesection and
large doses of quinine, as a dernier resort (which was concurred
in by the Doctor, on his arrival). She was accordingly bled
from the arm 10 oz. ; pulse began to fail. Prescribed: Quinine,
grs. 15; sulph. morphia. <jr. -J ', in solution, every hour, which
was continued fifteen hours; at the expiration of which time,
every muscle was relaxed ; breathes easy ; says she feels well ;
but thinks she "can't hear good ..will soon get fat on that bit-
ter medicine." Continued the same treatment for two days,
but in modified doses. The patient, however, swallowed an
ounce of quinine in the space of three days, and with proper
treatment directed to the spinal meningitis, (complicated, per-
haps, with myelitis,) was restored to health.

Thus was a daughter, wife and mother, rescued from the iron
grasp of death, by heroic, and, I might add, empiric doses of
quinine.

ARTICLE X.

A Fatal Case of Puerperal Convulsions. By Z P. Landrum,

M. D., of Lexington, Ga.

Was called to Mrs. L., on the first January, 1854, about one
o'clock. Found her in the first stage of labour, suffering very
much from the pains attendant on this stage. Upon inquiry,

1854.] Landrum's Case of Puerperal Convulsions. 163

ascertained that her pains commenced about 8 o'clock, and had
recurred regularly with diminished intervals. An examination
per vaginam revealed the head of a child presenting in the first
position, os uteri dilated to the size of a dollar, and mucous se-
cretion from vagina profuse. Expulsive pains commenced about
7 o'clock, P. M, irregular and ineffectual for two or three hours,
and then subsiding almost entirely. At 10 o'clock, gave her an
opiate, and feeling unwell, retired to bed, leaving instructions
with an old midwife to wake me up if any thing unusual occur-
red. Was aroused about two o'clock, and found my patient
staring vacantly, with pupils much dilated, and slight twitching
in the muscles of her mouth. She went off immediately into a
convulsion, which was relieved by opening a vein in her arm
and permitting it to bleed until she began to recover. Pains
increased in violence and regularity, until she was delivered of a
male child. The womb not having been diminished much in
bulk, I was led to suspect a plurality; which suspicion was
confirmed, by detecting on examination, per vaginam, another
head, presenting in the same position as the first. She was de-
livered of a second fetus, female, about an hour and a quarter
after the birth of the first, and appeared remarkably well, con-
sidering the length of labour and suffering. Expressed sorrow
at the death of her children, both of which were still-born, but
made no complaint of head symptoms nor could I detect any
thing in her appearance forewarning a return of the convulsions.
I had retired but a few minutes, when I was summoned again
to my patient, and found her going off into another convulsion.
The external and internal recti muscles of the eyes were acting
alternately, throwing these organs from one side to the other of
the orbits. During this convulsion, I attempted the delivery of
the placentas, and was constrained to detach the entire con-
necting surface of both, before I could succeed. This convul-
sion was undoubtedly apoplectic, there having been but little
agitation in her muscular system. She soon passed into a co-
matose state, with stertorous breathing, and death closed the
scene in about half an hour.

There was nothing unusual in the appearance of, the second
child, but the features of the first were very much distorted, the
corner of its mouth being completely drawn to one side.

164 Contributions to Pharmacy. [March,

Professor Mettauer is an eminent and successful practition-
er, whose views are entitled to high regard. The following
contributions will therefore be doubtless found useful to many
of our readers. [Editor.

Contributions to Pharmacy. By John P. Mettauer, M. D.,
LL. D., of Virginia, Professor of the Principles and Practice
of Medicine and Surgery, in the Medical Department of
Randolph Macon College.

It will not be denied that the operation of therapeutical
agents is essentially influenced by the mode by which they are
prepared.

This fact, so generally true, is particularly exemplified in
the preparations ofcinchona,cantharides, colchicum, guaiacum,
and several other medicinal substances of which I shall speak
presently.

For more than twenty-five years, my attention has been
particularly directed to this subject, and, during this period, I
have adopted several new methods of preparing some of the
articles of the materia medica, and have satisfied myself, by re-
peated practical trials, that these preparations possessed su-
perior efficacy to those generally employed.

Many years ago I prepared an acetous infusion of canthar-
ides,* for blistering purposes. This infusion was first designed
for vesicating the scalps of infants, without removing the hair ;
and its action was very satisfactory. It was applied simply
by wetting the surface of the head, and the hair nearest its
roots, and then carefully covering the parts with a cabbage
leaf, or oiled silk, to prevent the too sudden evaporation of
the blistering fluid. When other parts of the body were to be
blistered, a thin compress of bibulous paper, or cloth saturated
with the infusion, was applied to them, and carefully covered
with oiled silk. To insure speedy and effective vesication, I
usually re-applied the tincture two or three times, after inter-
vals of half an hour. I found this agent equally as efficient
and certain in its action with adults as with infants. It ren-
dered the removal of the hair unnecessary, as it blistered
every part of the surface, even when a very thick head of
hair existed. This preparation has been used by many of my
medical friends, and with entire satisfaction. Within the last
ten years, I was induced to prepare an aethereous solution of
cantharidesf as a vesicant, and have found it far more prompt

+ Ifc. Canth. contus., giiss.; Acid acet., Oij. Digest for 14 days, and filter,
t^. Cantharid. contus., iij. ; Spirit, oeth. nitric, Oii. Digest for 8 days,
and filter.

1854.] Contributions to Pharmacy. 165

and certain in its operation than the acetous infusion. It may
be applied in the same manner as the latter. Frequently,
merely wetting the skin with the solution, without covering
the part, will blister; especially in infants. When adults are
to be blistered, the preparation should generally be applied
with a thin compress, and carefully covered, as already sug-
gested, moistening the compress from time to time, until the
skin is decidedly reddened. I have found this by far the most
convenient and reliable means of blistering that I have ever
emploved. This cethereal tincture of cantharides is also an
efficient internal remedy. As an emmena^ngue and diuretic
it has greatly exceeded my expectation. The cetherous men-
struum seems not only to promote the operation of the can-
tharidin upon the genitourinary organs ; but at the same time
to guard against strangury. I now use this preparation of
cantharides almost exclusively, both externally and internally,
when the lytta is indicated, and have done so for seven or
eight years.

The remarkable efficacy of the cetherous preparation of the
Spanish Fly induced me, five years ago, to employ spirits of
nitric oether as a menstruum for cubebs, colchichum, guaiacum,
squill, ergot, gossypium, sanguinaria, ipecacuanha, digitalis,
nux vomica, and some other articles of less importance. The
cetherous tincture of cubebs* is a most valuable remedy in all
the sub-acute inflammations of the bladder, of the uretha, of
the uterine cavity, and of the mucous lining of the stomach
and intestines. It should be administered in some mucilagi-
nous vehicle.

The tincture of colchicumf is applicable to the treatment of
all of the cases demanding the use of the colchicum, and is de-
cidedly preferable to the vinous seminal tincture now in use,
by reason of its tendency to act on the urinary system. It is
very well adapted to the treatment of sub-acute rheumatism,
gout, cedema, and neuralgic rheumatism, especially if the
urinary secretion is materially diminished in quantity. In
the bloating occasionally connected with dysmenorrhcea, a
combination of this tincture with the cetherous tincture of
cantharides, sanguinaria and gum guiacum will be found a
most valuable remedy. It should be taken three or four times
daily in an infusion of pine tops, in doses of ten to twenty
drops each. The same combination will also be found valu-
able in the sub-acute stage of gout and rheumatism.

*fy. Pip. cubeb. contus., giv. ; Spirit oeth. nitric, Oij. Digest tor 8 days,
and filter.

+ fy. Sem. colchic. contus., giv.; Spirit, oeth. nitric, Oij. Digest 10 days,
and filter.

K. 8. VOL. x. xo. in. 11

16G Contributions to Pharmacy. [March,

The cetherous tincture of gum goaiacum* is superior to the
preparations of that article now in general u>e in the treat-
ment of rheumatism by reason of its tendency to act on the
urinary system; and the same may be said of it as an emmen-
agogue when there is rheumatic irritation of the uterus as an
associate cause of dysmenorrhea.

The cetherous tincture of squillsf is adapted to all cases in
which squills are indicated, and is an elegant preparation. In
dropsy, cedema of the mucous lining of the larynx, and of the
lungs, in asthma, and as an expectorant and diuretic it will be
found a most convenient and valuable preparation. A combi-
nation of equal parts of this tincture and of the syrup of lo-
belia inflata taken three or four times daily, in doses of 3s>. to
3j. each, is the most efficient remedy I have ever used in
asthma.

The cetherous tincture of ergot J is best suited to cases of in-
action or torpor of the uterus connected with debility or ex-
haustion ; it may be used either as an emmena^ogue or as a
parturient. In uterine haemorrhage, or monorrhagia depend-
ent on debility, or exhaustion of the uterus, it will be found a
valuable remedy. Its action upon the uterus is greatly in-
fluenced by the cetherous menstruum. It is best to ^ive it in
some diuretic vehicle, such as pine tops tea, or flax seed or
elm tea ; and it may be taken in doses of 3ss. to 3ij. once in
four or five hours.

The tincture of gossypium is possessed of properties very
similar to that of ergot and may be employed in like doses
with it, and in similar diseases.

The tincture of sanguinaria|| is voluable when combined
with the tinctures of cantharides, gum guaiacum, colchicurn,
cubebs, and indeed any other emmenagogue, in the treatment
of dysmenorrhcea. It is also a valuable expectorant and di-
aphoretic in pneumonia, bronchitis, and cedema of the mucous
lining of the air passages. It is administered in doses from
3ss. to 3ij., once in three or four hours. This tincture may
also be employed alone as a diaphoretic and expectorant.

The oethereous tinct. of ipecacuanha^! is so closely assimilated

* ft. Guaiac. gum. resin, |iy.; Spirit cethe. nitric, Oij. Digest 8 days, and
decant.

t J$c. Scill. maritim. contus., 3-iv; Spirit ceth. nitric, Oij. Digest 8 days,
and filter.

t fy. Ergot, contus., gij; spirit ceth. nitric, Oj. Digest 10 daps, and filter.

fy. Gossypii. herbac, %iv. ; Spirit, ceth. nitric, Oij. Digest for 10 days, and
filter.

II fy. Sanguinar. canadens. contus. giv; spirit ceth. nitric, Oij. Digest 8 days
and filter.

V fy. Cephael. ipecac, rad. contus., ij. ; spirit, aeth. nitric, Oij. Digest 8
days, and filter.

1854.] Contributions to Pharmacy. 167

to the tincture of the sanguinaria in its therapeutical proper-
ties, as to be applicable to the treatment of the same diseases.
It is an elegant and most convenient preparation. In typhoid
fever it will be found far superior to the ipecac pill as a diapho-
retic, especially when the tongue is dry and the thirst urgent.
It may be used also in typhus fever, or indeed in any febrile
affections during the sub-acute stage. This valuable prepar-
ation acts both as a diaphoretic and diuretic in these cases, as
well as an expectorant.

The cethereous tincture of digitalis* is a far better preparation
than the alcoholic, on account of its greater activity ; and this
it derives chiefly from the cethereous menstruum. In doses
from 3ss. to 3j., in some diuretic infusion, taken three times
daily, it will be found wrell adapted to all such cases as require
the foxglove.

The cethereous tincture of nux vomicaf is especially indi-
cated in the treatment of seminal debility, or to speak more
properly, debility of the generative organs. In this, the
gravest of human ills, after such preliminary treatment as
may be demanded for the correction of constipation, and pros-
tatic tenderness, this tincture will be found a most excellent
means of restoring the erections. It is also valuable in exci-
ting appetite for food, and in the invigoration of the digestive
organs. This preparation is wrell adapted likewise to the treat-
ment of paraplegia, especially when the bladder and rectum
are implicated, as well as such other forms of paralysis as de-
mand the nux vomica or its alkaloid. It may be given in
doses from 3ss. to oiss. three times daily, before or after
meals, in some bitter infusion. The cold infusion of wild
cherry bark I have generally preferred as the vehicle for it.

The cethereous solutions or tinctures are more readily pre-
pared, requiring to be digested for a less time than the alcohol-
ic, and keep without the least deterioration. They are also
adapted to those conditions of the constitution in which alco-
holic menstrua would be objectionable.

Hydrargyrum cum creta. This valuable preparation of
mercury is usually formed by triturating l'\\y mercury with
5 v. of prepared chalk, until the globules are extinguished.
This is a tedious process, and the resulting powder is not of
uniform strength, nor is the mercury completely rubbed down.
Indeed, it is questionable whether the powder, when apparent-

ft. Digital, purp. fol., iss. ; spirit, aeth. nitric. Oij. Digest for 10 days,
and filter.

t fy. Nueis vomicae pulv., 3 i j . ; spirit ceth. nitric, Oij. Digest 10 days, and
filter.

I 6k Contributio?is to Pharmacy. [March,

ly well formed, always contains mercury, as a compound may
be readily formed by uniting other colouring substances with
chalk, to imitate blue mercurial powder; and I think I have
met with such imitations several times. The blue powder that
1 have procured from the shops has generally disappointed me ;
and for a number of years I have prepared it myself according
to the following method :

Take one part of pure starch : eight parts of prepared chalk ;
and sixteen parts of mercury. Reduce the starch to fine pow-
der. The chalk may now be added, and after being well
mixed, the mercury can be united. The powder must next be
moistened with water, but not to the extent of wetting it ; and
the whole rubbed until nearly dry, when the mass should be
again moistened and rubbed dry. In this manner the process
must be repeated from time to time, as may be convenient,
until the powder assumes a uniform bluish appearance. After
the chalk seems to be saturated with the mercury, rub the
mass perfectly dry, and then moisten it sufficiently to make it
adhere to the surface of the mortar by pressing with the pestle.
By carefully passing the pestle over the adhering mass, so as
to render its surface smooth, the superfluous mercury will now
escape from it in small globules and fall to the bottom of the
mortar, and the separation may be facilitated by striking the
bottom of the mortar against the table repeatedly, and by pour-
ing the mercury over the surface of the mass where any glob-
ules appear. The mercury may now be removed from the
mortar ; and as soon as the mass becomes sufficiently dry, the
trituration must be renewed and continued until the mass be-
comes a smooth, dry powder. Prepared according to this
method, I have used blue powder in my practice more thar>
twenty-five years, and have uniformly found it far more certain
in its operation than that obtained from the shops. I prescribe
it in the ordinary doses, or nearly so, and yet I am satisfied it
is stronger than that in general use. I invariably direct it to
be administered nearly dry, united with brown sugar, and to
be mixed in a cup by stirring the powder and sugar together
with a straw or the point of a knife. The dose may then be
aaken into the mouth and swallowed, first with the saliva, and
afterwards with a mouthful of water. This powder should nev-
er be mixed in a silver spoon, or any other utensil possessing
an affinity for mercury, or the powder may be rendered entire-
ly inert ; and such an accident once befell a patient of mine,
who nearly lost her life before the cause of the failure of the
medicine in producing its proper effects was discovered.

[ Virginia Med. and Surg. Journal.

1854.] Philosophy of certain Dislocations, fyc. 169

Philosophy of certain Dislocations of the Hip and Shoulder,
and their reduction. Read before the Detroit Medical So-
ciety. Bv M. Guxv, M. D., Prof, of Surgery in the Uni-
versity of Mich.

The views here advanced I have taught for the past two
years to the gentlemen composing the Medical Class in the
University; and I shall offer no apology for calling the atten-
tion of the Society for a few moments this evening to the sub-
ject of Dislocations of the Hip and Shoulder, and more particu-
larly to that form of the accident, which, from the anatomi-
cal peculiarities of the joint, is one exceedingly difficult to
reduce; and for the reduction of which Dr. Reid has but
recently proposed a novel and efficient mode.

It is not my intention to discuss the question of priority
which has been raised in reference to this subject, for there
can be no doubt that Dr. Reid arrived at his conclusions by a
course of reasoning and experiment; and that those conclu-
sions were most essentially novel to a large majority of the
profession. I propose rather, briefly to consider the prominent
peculiarities of the joint, and the relation of the parts in a state
of dislocation ; the structures which oppose the return of the
head of the femur to the acetabulum; the manner in which
Dr. Reid's manipulations overcome this opposition; and lastly,
the application of the principle involved, to the reduction of
some other dislocations.

The encircling ridge which gives depth to the cotyloid cav-
ity, presents upon its outer slope a plane, the inclination of
which varies in different parts. At its posterior portion this
inclination is very great, and it would seem in dislocation in
this direction impossible to return the head of the bone to the
cavity without lifting it completely over the ridge ; upwards
and backwards it is more gradual, and would seem to afford a
much more easily surmountable obstacle; yet when we exam-
ine the relation of the parts in a dislocation in this direction,
we find that applied to this surface, we have the anterior and
inferior surface of the head and neck of the femur, the rotund-
ity of the head corresponding with the curvature of the slope,
while the edge of the acetabulum corresponds with the curv-
ature described by the anterior and inferior surface of the
neck. Although thus seemingly locked together, comparative-
ly slight extension in the line of dislocation would cause the
head to ride over the edge of the cavity, were it not bound
down in this position by the surrounding tissues. Which par-
ticular tissue constitutes these bands is an important question
to him who seeks to relax them. Dr. Reid, in common with

170 Philosophy of certain Dislocations, fyc. [March,

the profession generally, considers the muscles the agents
which thus oppose our etForts at reduction, and his manipula-
tions are conducted with a view to relax them, while the
femur acting as a lever, the head of the bone is raised clear of
the edge of the cavity. With this same view we have the
directions of the books and public teachers to apply extension
and counter-extension slowly and uniformly in order to tire
out the rebellious muscles. Blood-letting, antimony, and the
hot bath are also called in to aid in this laudable crusade
againgt these wicked organs.

In this view, I would respectfully differ with Dr. Reid, the
teachers, books and profession, and state my honest belief that
the muscles oppose our efforts very little more than they do
the progress of our earih in its orbit. This belief I have re-
peatedly verified by experiments upon the dead subject, and
the members of the medical class of 1851-2 in the University
will remember those conducted before them. A subject was
placed upon the table, the lower border of the gluteus maximus
was raised, and a scalpel carried through the subjacent muscles,
and an opening made in the posterior and superior poition
of the capsular ligament The round ligament was then di-
vided, and the head of the femur luxated upon the dorsum of
the ilium. The usual indications of this dislocation were
present. The subject was placed in the proper position, a
counter-extending band applied to the peri nee urn and fixed ;
the strength of two men exerted now upon the extending
band, while endeavor was made to raise the head of the bone
clear of the acetabulum with a jack towel, was insufficient to
reduce the luxation. Reid's method of manipulation readily
replaced the bone. This experiment was repeated many
times, and uniformly with the same result. As muscular
action could not have opposed our efforts and prevented suc-
cess in this case, the question naturally presents itself, what
structure stood between effort and success? 1 answer, the
untorn portion of the capsular ligament. In support of this
view, let us consider for a moment the position of the limb at
the instant of escape of the head from the socket during the
process of dislocation. To do this we must bear in mind
that force applied to the knee or foot while the limb is in a
state of adduction, constitutes the most frequent cause of this
dislocation. Force thus applied adducts the limb still more
powerfully before dislocation takes place, and at the moment
of the escape of the head of the bone from the socket, the limb
is in a direction which crosses the thigh of the opposite side.
Immediately that the head of the bone has cleared the edge of
the acetabulum, it settles into its position upon the dorsum of

2851.] Philosophy of certain Dislocations, fyc. 171

the ilium, and the limb assumes she position and direction indi-
cative of the accident. During the dislodgement of the bone,
the superior and posterior portion of the capsular ligament is
ruptured., through which the head protrudes ; while from the
position of the limb at the instant of protrusion, the anterior
and inferior portion is very much relaxed, thus allowing the
head to ride easily over the acetabulum. As soon as the head
settles into its position upon the dorsum of the ilium, the direc-
tion of the limb is changed, and the untorn portion of the liga-
ment becomes more tense, and for this reason the head of the
bone cannot be readily returned to its place, till the limb is
again placed in a position to relax it. Dr. Reid's method does
this most effectually, and I conceive that any other plan which
does not accomplish this, as for instance extension and counter-
extension by the pully, or Jarvis's apparatus, in the usual di-
rection, succeeds only by lacerating much more extensively, if
not by actually tearing the ligament completely asunder, before
the head of the bone will ride over the edge of the cavity.

The principle, then, I would seek to establish, is this that
in luxations of the hip and shoulder, the untorn portion of the
capsular ligament, by binding down the head of the dislocated
bone, prevents its ready return over the edge of the cavity to its
place in the socket; and that this return can be easily effected
by putting the limb in such a position as will effectually ap-
proximate the two points of attachment of that portion of the
ligament which remains untorn.

This principle can be successfully applied to the reduction
of the backward luxation of the femur into the ischiatic notch,
and also to the several luxations of the shoulder. It has sev-
eral times been my guide in the reduction of the downward
dislocation of the humerus into the axilla. The patient is
seated upon the floor, an assistant slowly raises the arm to an
angle of forty-five degrees to the plane upon which the patient
is sitting; and now while the assistant makes extension in this
direction, the surgeon makes pressure with the hand upon the
top of the shoulder, the bone readily returns to its place, and
the arm is dropped to the side and secured in a sling.

White's method of reducing this luxation, w7hich is figured
in Druitt, is essentially the same, the only difference being in
the position of the patient. According to his plan the patient
lies upon his back, the scapula is fixed by a counter-extending
band applied to the top of the shoulder, or by the hand of an
assistant, while "the arm is raised from the side, and drawn
straight up by the head, till the bone is thus elevated into the
socket." In either method it will be seen that the upper and
untorn portion of the capsular ligament, by the elevation of the

172 Traumatic Tetanus. [March,

arm is very much relaxed, thus giving a latitude of motion to
the head which greatly facilitates its return, and which could
not be obtained by any manipulation in which this relaxation
was less perfect. Nine-tenths of the force spent in extension
and counter-extension may be spared, in the reduction of all
those dislocations in which, by alteration of the position of the
limb, such relaxation is effected; and in the several luxations
above specified this end is undoubtedly attainable. [Peninsu-
lar Journal of Medicine.

Two Cases of Traumatic Tetanus, successfulh/ treated by Ice.
By B. D. Carpenter, M. D., of Patchogue, Suffolk County.
Long Island.

Case I. Aug. 22d, 1849. E. G., aged 1(5 years, of good
constitution and habits, jumped from a fence on the stump of a
twig some half inch in diameter : which made a wound in the
ball of the right foot three-fourths of an inch deep. Twelve
days after the accident he complained of feeling lame and stiff;
during the night, was awakened by a violent spasm ; the next
day. complained of stiffness and soreness of the muscles of the
neck and throat, and pain at the scrobiculus cordis; the fol-
lowing night, during sleep, was seized again with spasm ; and
the next morning, when I was sent for, I found him complain-
ing of pain in the above region, great rigidity of the whole
muscular system, attended with difficulty in swallowing and
constraint in moving the head and jaws, and in articulating.
During the spasm, the body was curved backwards and thrown
to one side, the dyspnoea was considerable, pulse full and slight-
ly accelerated, skin warm and moist, bowels costive, urine
scanty and high-colored.

Administered a purgative, which was assisted by enemas.
The patient was then put upon the free use of opium in the
shape of Dover's Powder, and the bowels kept open by the use
of cathartics and injections of 1 1 tinct. assafcetida, in half a
pint of soap suds, repeated as often as the preceding one came
away. This treatment was continued for four days, during
which time he gradually grew worse. The tetanic rigidity
and spasm increased until the sixth day ; when, finding he must
die unless something farther could be done to allay the pain
and extreme spasm, and viewing the difficulty as being an ir-
ritation of the spine, perhaps connected with congestion of the
membranes covering the spinal marrow, I determined to apply
ice to the head and the whole length of the spinal column,
since the whole muscular system was affected. I did so, and
in ten minutes had the satisfaction of seeing the pulse come

1854.] Traumatic Tetanus. 173

down from 110 to 75, and all the urgent symptoms relieved;
the rigidity was gone, and he had but one spasm after the ice
was applied ; his bowels were kept open, and assafoetida in-
jections were continued twice a day, to allay the irritability of
the nervous system, manifested by slight twitchings. No medi-
cines were given by the mouth. The wound entirely healed,
and in three days the patient was discharged cured ; and his
health since has been as perfect as before the attack.

Case II. Aug. 1 1th, 1853. A. C, 21 years of age, a robust
farmer, in good health, in assisting to remove some old lumber,
stepped on the point of a rusty nail, which entered the hollow
of the foot to the depth of three-fourths of an inch. The wound
was not very sore, and was dressed with some simples by him-
self; and he remained at work moderately until the 16th, five
days after the accident, when he complained in the afternoon
of twitching in that foot and slight pain in the region of the
wound and leg of that side. Was quiet the rest of the day,
and retired early to bed, but slept none from restlessness, anxie-
ty, and slight pains and twitching of the nervous system. On
the 16th, felt some pain in the head and through from the lower
end of the sternum to the back. I saw him at 6 P. M., and
found him complaining of pain as above mentioned, which had
gradually increased at the sternum, great rigidity of the mus-
cles of the left side of the neck, accompanied with slight
dyspnoea and some difficulty in swallowing. Even at this time
there was present the peculiar expression of countenance found
in tetanus. Pulse 100 and hard; bowels costive; had eaten
nothing ; the wound had not commenced to heal, and was cov-
ered slightly with a thin serous discharge. Made a free incis-
ion into the wound, and dressed it with bread and milk poultice,
to which tinct. opii was added ; ordered ten grs. of calomel
with ten of rhei, to be followed by pil. colocynth. comp. until
the bowels were freely moved, and enemas of tincture of assa-
foetida, 5) every three hours, or as often as the preceding one
should be voided, large doses of Dover's Powder by the mouth,
and to have the neck bathed in camphorated oil and tinct. opii.
18th, 7, A. M., found that the bowels had been freely moved,
and that spasm of the whole muscular system had commenced.
About 3, A. M., pain in the neck and at the sternum increased,
and there was great rigidity of the muscular system generally,
dyspnoea great, much difficulty in swallowing and articulation,
jaws partially closed, entirely so during the spasm, pulse 120 ;
indeed, all the symptoms increased in a marked degree, with
slight delirium. Ordered one-fourth of a grain of morphine
every hour, and to continue the assafoetida injections. 6, P.M.,
all the symptoms greatly aggravated, pulse so small and fre-

174 Aphonia, cured by Electro-Magnetism. [March,

quent that it could not be counted, jaws closed, breathing ex-
tremely difficult, body almost constantly drawn backwards or
forwards and to one side, face pale, skin moistened with clam-
my sweat, and perfect rigidity of muscular system. Had slept
none for 48 hours. Applied ice to the head and whole length
of spinal column; in twenty minutes the pulse came down to
100, the skin was covered with profuse perspiration, the mus-
cular system relaxed ; in short, there was a perfect yielding of
all the urgent symptoms, and the patient slept soundly and
pleasantly for the succeeding two hours, during which time
the breathing was natural, and there was neither tetanic rigid-
ity or spasm. When he awoke there was still some delirium,
the pain in the region of the sternum was very great, and for
half an hour the tetanic rigidity and spasm were considerable.
The ice was again applied, when the symptoms immediately
yielded, and the patient (with the exception of short intervals)
slept quietly the balance of the night.

17th, 6, A. M., the bowels were moved by the assafcetida in-
jections, the delirium had passed off, the tetanic rigidity was
gone. Pulse 80, breathing natural but said there was great
soreness of the chest and all the muscles of the body. Drank
some soup, continued the ice and injections as before. 11, A.
M., there was some slight twitching of the muscles, without
rigidity ; from this time the patient continued to improve
without either tetanic rigidity or spasm until, on the 25th, he
was discharged cured, with the wound nearly healed.

The ice was applied from ten to thirty minutes each time,
with intervals of from two to eight hours. [Ohio Med. and
Surg. Journal.

Aphonia of Four Years1 Standing, cured by Electro- Magnet-
ism. By F. K. Bailkv, M. D., Almont.

Mrs S , aged 79, in the spring of 1849, had a severe

attack of Bronchitis, which was relieved by appropriate treat-
ment.

On regaining her general strength, however, her voice was at
times very hoarse, and at the close of the day it was difficult
to speak loud at all. In the course of six months from the first
attack, there was a complete Aphonia, which continued until
last April.

At that time she was induced to make a trial of Electro-
Magnetism. In a few days after this means was tried, her
voice became more distinct, but very rough at first. In the
course of a week or two, speech was natural, and has con-
tinued until the present time.

1854.] Editorial and Miseellany. 175

The favorable result in th's case may lead to the use of
Electro-Magnetism in other affections produced by want ot
proper innervation. I will add, the apparatus used was one
manufactured by Charles Crosman, Detroit. [Peninsular
Journal of Med.

EDITORIAL AND MISCELLANY.

An Inquiry into the Nature of Typhoidal Fevers ; based upon a con-
sideratimi of their History and Pathology. By Henry F. Camp-
bell, M. D. Presented to the American Medical Association, at
its session of May, 1853.

Typhoid fevers have at all times engaged a large share of atten-
tion, and there is perhaps no disease which has enlisted more talent
and patient investigation than this. Yet its pathology is the subject
of as great discrepancy, and its treatment of as much empiricism, as
any in the nosological catalogue. Whether the essay before us will
furnish the profession a satisfactory solution of the long mooted ques-
tions or not, remains to be determined. The argument is certainly
very plausible, and cannot fail to airest the attention of pathologists.
We regard the appearance of any thing new upon Typhoid fevers as
peculiarly opportune, since they are becoming daily more and more
within the domain of Southern practitioners, who constitute the great
mass of the readers of this Journal. It affords us pleasure, therefore,
to present the following notice of Dr. Campbell's very interesting
work.

The design of the essay is to demonstrate the dependence of
Typhoidal fevers upon an abnormal condition of the ganglionic or
sympathetic system of nerves. In the accomplishment of this purpose,
the writer first presents a critical analysis of the symptoms and pa-
thological lesions observed in these fevers, and then studies the
anatomical and physiological relations of the nervous system of or-
ganic life. From these premises naturally flow the pathological
deductions which are, however, so ingeniously wrought out that, in
order to do full justice to the author, we append them in his own lan-
guage.

"Having thus carefully recounted the more important features
in the anatomy and physiology of the sympathetic system, it remains
but to consider them in connection with the phenomena of ty-
phoidal fevers. Such a review will be attended with the following
results : In the first place, the essential symptoms of typhoid

176 Editorial and Miscellany. [March,

fever are located in organs deriving their innervation principally,
and in many instances entirely, from the ganglionic system. In
the organic or involuntary muscles as for instance the heart's
of which, during life, we rind the frequency increased, the force dimin-
ished, and the regularity impaired all of which effects must be plainly
attributable to the altered innervation of the organ. After death, we
ihave seen it the subject of very material alteration ; its substance is
flabby, pale, and much softened, so that it breaks readily under the
fingers. Instance again, the muscular coat of the intestine ; we have
meteor ism an almost invariable symptom in typhoid fever and
which we may legitimately refer to the loss oHonicity in the muscular
coat of the intestinal canal, from impaired innervation of that coat, by
which condition, together with the altered state of the secretory sur-
faces, the passive accumulation of gas in the intestines is allowed, and
hence the tympanites.

"That this altered condition in the innervation of the organic mus-
cular fibre does exist, is shown most remarkably in the mode of dying
;in some cases, viz., that mode termed asthenia, ' occasioned by causes
acting directly on the circulatory forces, affecting the vis nervosa,
upon which the contractile property of the heart depends.'* and far-
ther, that this depression in the involuntary muscles has no invariable
correspondence in the state of the voluntary muscular system ; as we
shall rind remarkably illustrated in the observations of Dr. Flint.f
'In some of the cases attended with most danger, and some of them
ending fatally, the muscular strength was retained in a surprising
degree. In two fatal cases of the typhoid type, characterized by
active persistent delirium, the muscular efforts were almost constant
and quite strong up to a few hours before death. One of these cases
terminated on the ninth day, and the other on the third day after
coming under observation. The mode of dying in each was by asthe-
nia, or, perhaps, more properly, necrcemia ; the system of involuntary
muscles exhibiting reduction of force to a degree incompatible with life
the voluntary muscles remaining active. This is a curious fact.'

" This relative condition of the voluntary and organic muscular
systems, appears to impress even the observing and philosophic mind
of Dr. Flint as almost inexplicable ; and it is not surprising that it
should, when we consider that his views of the pathology of typhoid
fever have no fixed or definite reference to the organic system of
nerves ; but, on the admission of the ganglionic pathology of the dis-
ease, the full interpretation of these phenomena, besides many other
similar facts (meteorism) before inexplicable, become easy and natural.

"II. Besides the organic muscular system, which we have just
shown to be under the influence of ganglionic nervous aberration, we
find that the other characteristic phenomena of typhoid fever refer to
the functions of nutrition and secretion, both of which important pro-
cesses depend upon the vascular system, which, especially in the vis-
cera, is admitted to be under the sole dominion of the sympathetic
nerve. And, what is more remarkably illustrative of this fact, is, that

* Flint, p. 125. t Reports on Continued Fever, p. 59.

1854.] Editorial and Miscellany. 177

there appears to be a very close relation between the amount of dis-
ease observed in any particular portion of the organism the aliment-
ary canal for instance and the degree to which it is indebted to the
ganglionic system for its innervation ; thus we find but a small amount
of disease, congestion, seldom any ulceration, in the larynx ; ulcera-
tion is somewhat more common in the pharynx, oesophagus, and
stomach, though still not abundant. It disappears in the duodenum,
which receives but few sympathetic filaments, and again appears in
the upper portion of the ileum, increasing, as we descend, in direct
proportion to the amount of ganglionic fibres the part receives, till it
reaches its maximum in the lower portion, where the nervous supply
is very abundant; after which, we rind ulceration occasionally in the
ccecum, still less frequent in the colon, till in the rectum, whose inner-
vation is principally from the cerebro-spinal system, it is never ob-
served. So, likewise, with regard to the other organs; we find the
liver, lungs, and spleen are all subject to congestions, which can be
referred to the same abnormal innervation of these viscera.

"From the relative unfrequency of disease in certain portions of
the abdominal viscera, and elsewhere. Louis, as we have seen, though
admitting their diagnostic importance, is disposed to view them as re-
sults, secondary to the lesion in the ileum ; we cannot, however, agree
with him, but are compelled to regard them as the common primary
results of a common cause which exists in the ganglionic system, and
that the frequency or the gravity of disease in any one of these organs
is determined alone by the amount to which the ganglionic ingredient
mixes with, or enters into its innervation, and that disease in these
localities has no etiological reference whatever to that in the ileum ;
but, when it exists, is as significant of the true pathology as is the-
ileitis for it invariably indicates, both by its location and character,
that its origin is abnormal innervation.

u So far then as regards the localities in which the manifestations of
typhoid fever occur, we have found an exact correspondence with the
distribution of the sympathetic nerve, as likewise between the amount
of disease and the proportion of ihis kind of innervation in any given
parts. Now it will be our object to examine carefully, in order to
ascertain if there is any analogy between the character of these ty-
phoidal phenomena, and those results which have been obtained by
experiment upon this system of nerves. In this interesting depart-
ment of physiological inquiry, there have been many engaged, but a
few will answer very well the purposes of our comparison. As early
as the year 1732, Pomfour du Petit found that the division of the trunk
of the sympathetic, opposite the fourth or fifth cervical vertebra in
dogs, was very rapidly followed by great disturbance in the circula-
tion of the eyeball, producing inflammation, flattening of the cornear
retraction of the eyeball, with protrusion of a fold of the conjunctiva
and ?ijlow of tears, and ultimately ulceration and destruction of the
organ. The experiments of Dupuy upon horses, wherein he extirpa-
ted trie superior cervical ganglion, were followed by the same results
with regard to the local effect in the eye, but also, with the more ap-

178 Editorial and Miscellany. March,

posite and corroborative consequences, that there was an eruption
over the whole cutaneous surface, with emaciation and an oedematous
state of the limbs. Dr. John Reid, has also experimented on the sym-
pathetic nerve in the neck, and found the eye similarly affected with
the above, the conjunctiva becoming red and congested in a few min-
utes, while in other experiments* the eye presented an ecchymosed or
bloodshotten appearance. Each one of these conditions of the eye
must be borne in mind, in order to appreciate the comparison ; inas-
much as, on account of the great difficulty of making such experiments
on oilier portions of the sympathetic system, we can find none on
record which will serve as reference ; for it will readily appear that,
from the remote position of these nerves, it is impossible to make
their section without so materially deranging other important parts of
the organism as to render the results valueless in deduction.

" Now, a reference to some of the pathological phenomena of typhoid
fever, will discover a close analogy, if not identity to the above re-
sults ; in the first place, the conjunctival congestion : its character,
the Attendant suffusion, together with the entire freedom from pain,.
even on exposure to the strongest light ; while, at the same time none
ot the symptoms of true inflammation arc present ; all indicate the
seat of the nervous derangement upon which it depends to be the
ganglionic systemf and not the cerebrospinal, the analogous de*
rangements of which are invariably of a sthenic character, and
attended with acute pain in the region in which they occur Again,
an attentive consideration of the character of these congestions will
show that they do not vary in any respect, except in degree, whether
occurring in the mucous membrane of the eye, that of the stomach,
pharynx, small intestine, large intestine, or bladder, in the typhoid
type, or on the cutaneous surface in the typhus. In all the above
localities, and under all circumstances, we find the capillary conges-
tions wearing the same aspect, assuming invariably a passive charac-
ter, often approaching the condition of true stasis, but never attended
with the florid redness, the pain or the swelling of active inflamma-
tion. Lastly, in the cutaneous petechial eruptions or maculae of the
typhous type of continued fever, we can also detect the same charac-
ter of passive congestion from deficiency of nervous energy carried to
a still greater degree ; in this type, the nervous power of the cutane-
ous capillaries is so far diminished, that it amounts to a state of actual
paralysis, allowing such distension of the capillaries that their rupture
and a subcutaneous effusion is the result.

" We have thus far endeavored to show that typhoidal fevers result
from alterations in the condition of the ganglionic nervous system,
by comparing the typhoid phenomena with the normal action of
the sympathetic system ; and we have found that the analogy is com-

* Arneman's Experiments on Nerves. Gottingen, 1787.

t Dr. A. Billing remarks, in relation to this subject: "Without, therefore, at
present seeking for farther proofs, I deduce from blushing, and from the effects
of electricity, fire, and cantharides, that the capillaries are dependent upon the
nervous system for that tone or energy which preserves them from over-disten-
sion." The First Principles of Medicine, p. 44.

1854.] Editorial and Miscellany. 179

plete, and that typhoid phenomena are but the result of aberrations in
the normal action of these nerves. Their action may be either exag-
gerated or diminished ; for instance, a portion of this system controls
the action of the heart, and in health endows this organ with a fre-
quency of action amounting to 60 beats per minute in the adult ; and
without disturbing causes, this number will continue unvaryingly in
its regularity till the close of life. But we know that this regularity
is liable to many interruptions and disturbances; some of them but
momentary, as from the emotions ; others disturb it for many hours
by increasing its frequency, as in paroxysmal fever ; and lastly, in
typhoid fever, we find this increase of frequency kept up for many-
weeks, but still retaining the remarkable feature of continuousness,
which distinguishes the normal action of the sympathetic system from
that of the cerebro-spiual system, which is intermittent in all its phe-
nomena, whether normal or abnormal. Were we now requested to
explain the difference which marks the increased frequency of pulse
in these three instances ; to answer why is it evanescent in one case ;
of but a few hours' duration in the second; and yet continue many
weeks in the case of typhoid fever ? we think, Ave should do it thus :
The heart, being under the dominion of the ganglionic system, per-
forms its normal action through its influence ; but from the intimate
connection between the sympathetic and cerebro-spinal systems,
especially in this organ, it is very liable to be affected by emotional
causes acting in the brain ; these, of course, will be evanescent; or
it may be affected by causes acting in the spinal marrow, which may
be more durable, as would be the case in a paroxysm of intermittent
fever;* but it will be observed that, in these cases, the organic sys-
tem is only secondarily implicated, and so soon as the mental emotion
subsides, or the spinal irritation is removed or has exhausted itself in
a paroxysm, the excitor being withdrawn, the sympathetic becomes
again normal, and the action of the heart consequently natural. But
in continued fever, the case is quite different ; the irritation is now
located in the ganglionic centre itself, which supplies the heart, and
consequently the increased frequency continues as long as this irrita-
tion remains, which is coeval with the duration of the disease. There
is one feature of continued fever, of which, heretofore, we have seen
no satisfactory explanation, that we think can be accounted for ration-
ally according to the pathology here suggested ; we refer to the par-
oxysms and exacerbations which frequently complicate the course of
continued fever. We would attribute these paroxysms to the exten-
sion of the irritation from the ganglionic to the cerebro-spinal centres,
and we conceive that it is only under such circumstances that we find
these intercurrent paroxysms masking the course of the typhoid affec-
tion. By this means there is effected a true blending of types from a

* We have adopted the pathology of intermittent fever advocated by Maillot,
viz., that it consists in cerebro-spinal intermittent irritations. Prof. J. F. Lob-
stein remarks: "The paroxysms of intermittent fever are tied down to a regular
rythmus, in consequence of being radicated in the nervous system, upon which
nature has impressed a law according to which they must perform their func-
tions periodically." Sympathetic Nerve, p. 121.

180 Editorial and Miscellany. [March,

blending of proximate causes, and the two sets of phenomena exist in
combination; a continued fever characterized by paroxysms of ex-
acerbation. In the same manner, on the other hand, can we conceive
of paroxysmal fever becoming continued under favorable circumstan-
ces, by the transmission of irritation from the cerebro-spinal to the
ganglionic system.

" As the abnormal innervation in the sympathetic system can pro-
duce a continued accelerated action in the heart, in typhus and typhoid
fever, so. likewise, can the diarrhoea of the typhoid type be shown to
be a result probably of a similar condition. The normal action of the
ganglionic system endows the intestinal canal and other viscera with
the function of healthy secretion ; but during the existence of the
typhoid state this proper action is destroyed ; in place of the organs
being the seat of a normal and proper circulation, which is necessary
for the due exercise of their function secretion, the vessels become
the seat of obstructions and congestions, the secretions become more
abundant, but abnormal and vitiated ; we have then diarrlura. As
eongestions become more marked, we find the paralyzed and
over-distended vessels giving why, allowing lubmembraiMMis effusions
of blood, and occasionally considerable hemorrhage all being the
result of the altered condition of the innervation of these organs.
Thus, what in its beginning wai purely dynamical affection, soon
becomes organic ; for without the proper supply of ganglionic nervous
influence, we have seen, from the above-mentioned experiments, that
the circulation ceases, the capillaries become turgescent, especially
in highly vascular secretory organs (as the mucous surfaces, or the
glandular plates of Payer, for instance), efiotioa of lymph takes placeT
and, as above stated, finally, the capillaries are ruptured, and the tis.
suei in certain places rapidly disintegrate by the process of ulcera-
tion which is the actual condition of things in the intestinal di
of typhoid fever.

" From what has already been said in relation to the distinctive
features of the two types of continued fever typhoid and typhus,
their interpretation, according to the pathology herein argued, will
have been, doubtless ere this, naturally suggested. We have seen
that typhoid fever is marked by an accelerated pulse, more or lees
nervous derangement, an altered condition of the blood, frequently a
mild cutaneous eruption, diarrhoea, and meteorism. On post-mortem
examination, we find lesions; viz. congestions and ulcerations of a
peculiar character, that is, simulating those produced by experimental
sections of the nerves in all those parts supplied by the visceral por-
tion of the ganglionic system of nerves. On the other hand, we have
seen that typhus fever is characterized by a somewhat more acceler-
ated pulse, much more marked nervous derangement, the same altered
condition of the blood, well-marked and always serious alterations in
the capillary circulation of the skin, amounting often to actual ecchy-
mosis, while the post-mortem examination shows almost entire exemp-
tion from lesion in the abdominal viscera. Thus, we find that while
both diseases have all their general symptoms so exactly similar that

1854.] Editorial and Miscellany. 181

we are forced to acknowledge their identity, and see in them what is
essentially but one disease, yet typhoid fever has its principal and
most prominent manifestations in the abdominal viscera internally ;
and typhus fever manifests itself in aberrations of the circulation, very
analogous to those of typhoid, but occurring in the capillaries of the
cutaneous surface.

" Now the ganglionic pathology is the only theory by which such
marked incongruities in the two forms of what, to the observation and
scrutiny of every one. must ever appear as one disease, can be per-
fectly and satisfactorily reconciled. We cannot deny that the two
are but types of the same disease ; yet how incongruous and strange
it is that, in certain cases (typhoid), diarrhoea and intestinal lesion
should appear the main the most important features ; while in the
other cases (typhus), undeniably of the same disease, even more grave
and threatening, there should be not a trace of diarrhoea, and on post-
mortem examination no intestinal lesion whatever, but, instead, serious
disease and congestion of the skin, with subcutaneous sanguineous
effusions, similar to the submembranous sanguineous effusions of the
typhoid type. Indeed, from the very smallest degree of attention
must result the conclusion that, in the two cases, the disease is one
and the same, but seated in different portions of the organism ; and
this conclusion will accord exactly with what we have considered the
distinctive pathology of the two forms, viz. that in each type the dis-
ease is located in a different portion of the ganglionic system. There
are certain parts of the system which are affected in both forms of the
disease as the ganglia supplying the heart ; but after this, the two
types have entirely distinct and separate sets of ganglia, the morbid
action in which gives rise to their respective manifestations. In ty-
phoid fever, the internal or visceral isolated ganglia, such as the semi-
lunar, <5cc, are the seat of the morbid action; and these supplying
mainly, we may say entirely, the abdominal viscera, and having but
little connection with the other or external portions of the organism,
these viscera become the seat of nearly all the morbid phenomena;
while that little implication of the cutaneous surface and general ner-
vous system which we often observe, is entirely due to the remote and
very obscure connection which their isolated ganglia may have with
the nervessupplyingthe.se parts.

"Now, in the typhus type, the same disease, or morbific agent (its
exact nature we do not pretend to define), affects an entirely different
set of nervous centres a set of ganglia which, by their anatomical
position, their internal and universal relations with the anterior and
posterior roots of the spinal nerves, are plainly destined to preside
over the capillary circulation of parts more superficial the cutane-
ous surface. We have reference to the vertebral sympathetic ganglia ;
and, in attributing the location of typhus fever to these ganglia, we
have a ready and satisfactory interpretation of all its distinctive char-
acteristics. The skin becomes congested and ecchymosed (petechial)
because its circulation is dependent upon and controlled by innerva-
tion derived from these vertebral ganglia ; which ganglia being the

W. 3. VOL. X. NO. ITT. 12

182 Editorial and Miscellany. [Match,

seat of abnormal action (perhaps paralysis), innervation is deficient,
the cutaneous circulation is retarded ; in certain places there is ob-
struction, with actual rupture and effusion, giving rise to petechias.
The general (cerebro-spinal) system is more seriously involved in
typhus than in typhoid fever, because the connection is more direct
between the vertebral ganglia which are the seat of typhus and
the cerebro spinal system. In a word, then, we would locate typhoid
fever in the visceral portion of the ganglionic system, and typhus in
the vertebral portion.

u We are fully aware that our views of the pathology of typhoMal
fevers would be greatly corroborated, could there be discovered any
appreciable lesion in the ganglionic nervous centres, in subjects who
have died during their progress ; but, like the pathological anatomy of
all the nervous system, this would be an investigation attended with
many difficulties ; for histological changes in the nervous centres are
of such a character that though they may be competed to subvert
the intellect, entirely paralyze or destroy the functions of a large por-
tion of the organism, and ultimately, ii|>on the most positive rational
evidence, seem to be the cause of death, yet on examination the alter-
ations observable in those centres are of the most insignificant and ir-
relevant character, pertaining only to the involucre, while the centres
themselves, which, from the previous symptoms, had been plainly the
true seat of the disease, bav< b en found apparently normal and intact.
These changes, then, are probably molecular and inappreciable with
our present means of investigation, and will require y< are, and far more
perfect appliances, to incorporate them among the positive and demon-
strable things of our science. Still, there are occasionally isolated
facts, even in the pathology of the ganglionic nervous centres, which
we may refer to in corroboration of our opinion that those centn
affected in typhoidal fevers, and that such affection gives rise to its
characteristic symptoms, or to phenomena quite analogous in their
nature. The case reported by Prof Lobsteia is of this nature It
was that of a young girl who had suffered from paralysis of the lower
extremities for some time, but for three months previous to her
labored under the most incurable d/arrluva with tormina, &c. On
making a post-mortem examination, there was found a large abscess
on the left side, extending from the sixth to the tenth dorsal vertebra.
On opening this abscess, it was found that the trunk of the left sympa-
thetic nerve was entirely destroyed from the sixth to the twelfth verte-
bra, and in the lumbar portion the same nerve was in a state of inflam-
mation.*

There are also two cases reported as occurring in the practice of
Dr. Aronsshon, of the Strasburg Hospital : The first, that of a man
forty-seven years old, affected with diarrhoza. He died of a tumour in
the abdomen, and it was found that "the semilunar ganglia were af-
fected with distinct inflammation." The second case was a woman
aged about thirty years, who, in her second pregnancy, was subjected
to vomiting throughout the whole of her gestation. She was also

* Structure, Functions, and Diseases of the Sympathetic Nerve, p. 147.

1854.] Editorial and Miscellany. 183

affected with a furfur 'ace ous eruption upon the breast and arms, with
swelling of the limbs, and with diajrhcea. On a post-mortem examin-
ation, the villous coat of the stomach was found inflamed and thicker
than usual, especially towards the pylorus, 'and the semi-lunar ganglia
were found in a state of genuine inflammation.9

'"In the body of a boy ten years of age,' says Lobstein, * who had
died from the retrocession of a miliary eruption, attended with symp-
toms of great anxiety, oppression of the chest, and distension of the
epigastrium. I found a place in the left trunk of the intercostal (which
is the old name for sympathetic) nerve, highly inflamed between the
eighth and tenth ribs, icith a phlogosis of the ninth and tenth thoracic
ganglia, and their two anastomotic branches with the costal nerves.'

" The following observations are quite pertinent to the state of con-
gestion in which the lungs are almost invariably found, to a more or
less degree, in typhoid and typhus fever. ' On examining into the
condition of the nerves in diseases of the lungs, I discovered another
alteration which is peculiar to these organs ; to wit, in that species of
peripneumony . in which the lungs become red and slightly indurated*
and which, I think, should be called spleenification ; the nervous fil-
aments attending the ramifications of the bronchia were found equally
red, a little more tumid, but much more tender than usual : so as to
he broken by the slightest degree of force.9] And, lastly, the same
author^: quotes a case still more in point, from the writings or Profes-
sor Autenrieth, of Tubingen, wherein it is asserted, though he does
not seem to connect the circumstance with the pathology of the disease
at all, that he has seen the abdominal nerves of the ganglionic system
somewhat changed in subjects who have died of typhoid fever.

" The above cases, though not conclusive, are at least strongly
corroborative of our view of the pathology of typhoid fever ; for
while we must admit that the diarrhoea, the eruption, the pulmonary
congestion, oedema. &c., might have been produced by other causes
than disease of the ganglia found inflamed or divided, still, when
these coincidental circumstances are viewed in connection with the
known result of artificial section of accessible portions of the sympa-
thetic nerve, as those about the neck and eye, and also in view of
the entire dearth of experiments and facts bearing upon this portion of
the ganglionic system, we must regard them as significant and valu-
able, even though they afford what we may term only a legitimate
suspicion of the correctness of our pathological views.

' \\ e have now completed our investigations in relation to this in-
tricate, but, at the same time, most interesting topic of pathological in-
quiry; we have reviewed its history, and collected from every source
within our reach as complete a delineation of its prominent and charac-
teristic phenomena as has been necessary for their full developement.

Exactly what is described by Dr. Flint as thepseudo-pneumotisof continued
fever.

+ Lobstein, p. 139. ;Op. cit. p. 137.

See experiments of Panfour du Petit, Dupuy, John Reid, and others, already
referred to.

184 Editorial and Miscellany. [March,

In so doing, we have been struck with the vast number of reliable and
significant facts our science is in possession of, in regard to this disease.
No disease in the catalogue is more invariable in its characteristic
manifestations; no disease has been more diligently studied, or has
enlisted in its investigation such faithful observers. Our knowledge
in regard to its observed phenomena and facts is clear, well defined,
almost certain ; to complete the science in regard to it, it has but
remained that these cognate, well-ascertained facts and phenomena
be rationally and correctly interpreted, that its true pathology might
be deduced. To this arduous, though not unpleasing task, not with-
out many misgivings, we have earnestly and diligently devoted our-
selves, more with the hope that our labors would prove suggestive to
others of the true mode of arriving at the real pathology, than that we
should be able to supply the want or remedy the deficiency.

" Starting with what we considered the rational assumption that
the pathology of typboidal fevers is in (he ganglionic system ofnerres,
we have compared their characteristic traits and phenomena, with
first, the normal action of this portion of the nervous system, then with
the known and well-established results of experimental irritation and
action of various portions of these nerves, and we have found that the
analogy is sufficiently close to admit the legitimate inference that the
symptoms and pathological lesions of typhoid and typhus fever are
produced by abnormal action in certain portions of this system of
nerves. First, because no typhoid or typhus phenomenon ever oc-
curs, except in r pplied by this system ; secondly, because the
peculiar phenomena of tlie^c diseases occur in a more marked decree,
in those parts most abundantly supplied from this source ; and third-
ly, because the nature of these symptoms is always found more
purely and characteristically typhoid in those portions of the organ-
ism supplied exclusively by this kind of innervation. And farther,
on the other hand, we are forced to admit the truth of these impres-
sions, because we have hitherto had no theory or legitimate and con-
sonant combination of theories, to our own mind, as competent to the
full and rational explanation ofa/Zthe phenomena of the disease as-
the one now offered.

" Practical Deductions. Pathology is only valuable when it
has a tendency to the prevention, amelioration, or cure of disease, and
the results of our most successful labours in this department are but
nugatory unless in them can be found a clue to a more rational and
perfect management of the affections to which they refer.

" If the views embodied in the foregoing treatise be correct, the
following practical inferences must present themselves as legitimate,
if not inevitable : First, that in the management of this class of fevers
the strictest attention should be paid to the improvement of the tone ot
the nervous system ; all depressing measures, or such as are calculated
to exhaust the nervous energies, as depletion by purgation or other-
wise, should be scrupulously avoided ; and secondly, that in their
place means of an opposite character should be invoked. Indeed^

1854.] Editorial and Miscellany. 185

that treatment now most in favour, though hut empirically* applied,
will be found on the admission of the above pathology the most ration-
al, and to offer the best hope of success. We have reference to that
treatment which is addressed almost exclusively to the nervous sys-
tem, and has for its object the sustentation and elevation of its ener-
gies. Some of the means employed have been attended in their
application with the most marked beneficial results. Among these,
we would mention the plan of Dr. Percival, wherein the disease was
treated by frequent profuse cold affusions, especially in the case of
children; which treatment we should rationally expect, from the
known effect of cold water thus applied, to improve the condition of
the depressed nervous centres. The administration of stimulants, as
camphor, quinia, brandy, opium, turpentine, and the ethers, have all
been favourably known to the profession as remarkably efficient in
these fevers.

" In relation to the beneficial results recently obtained from large
doses of quinia, by Dr. Dundas and others, we can readily appre-
ciate what vast benefit may accrue from them, especially in cases
where the cerebro-spinal system of nerves are extensively impli-
cated, and where the disease is marked by regular obstinate
paroxysms, for quinia, though it possesses, in our opinion, but little
influence over the ganglionic system itself, still, would relieve these
periodic exacerbations by its effects upon this system, through the
cerebro-spinal nerves (which in these cases we regard as the
instigator of the paroxysm), upon which most of its power is ex-
pended. That the doses required should be large, we can easily
understand, as any effect produced upon the ganglionic system through
the cerebro-spinal is only accomplished by powerful and long-con-
tinued impressions, on account of the comparative isolation of the two
systems from each other.

" To those who are in the proper field for such experiments, and
possessed of the proper facilities, we would recommend the trial, in
typhoid and typhus fevers, of such agents as are known to possess a
direct power to stimulate the nervous system, even when in a state of
partial paralysis such an agent is strychnia. This we would suggest
as applicable in minute but efficient doses, with the view of waking up
and restoring the diminished energy of innervation, upon which the im-
paired function depends, in the same manner that we would advise it in
other similar cases where the cerebro-spinal system was implicated.

a The above is all we offer in regard to treatment ; there are many
measures of a like nature, which, were we writing a complete
treatise on the management of these diseases, would require a full
and extended consideration, as also the measures and applications
which the emergency of each case will naturally suggest and
demand."

* Of course, this term is not applied in its offensive sense.

186 Editorial and Miscellany. [March,

Transactions of the Fourth Annual Meeting of the Medical Society of
the State of Georgia, held in the city of Savannah, April, 1853.

Not having been able to complete, in our last number, the notice of
the Transactions of the Medical Society of the State of Georgia, we
now resume it.

At page 65 we find a communication from Dr. Thos. W. Bell, of
Houston county, upon the use of the Sulphate of Cinchonia as a sub-
stitute for Quinine. The author states that he has used it in eleven
cases of intermittent fever with success, but has not tried it in remit-
tents.

"Its effects resemble very much those of quinine. When given in
large doses, it produces cerebral disorder, such as fullness of the
head with ringing in the ears. I do not know that in full doses, it
possesses the sedative properties of quinine.

" I first tried it, hoping to find a remedy more efficacious in the
treatment of the quotidian form of intermittent*, which is so prone to
recur time and again, but I find that relapses are about as frequent as
after the use of quinine, or other remedies that I have tried.

" I gave about the same quantity in the intervals of the paroxysms,
that I usually give of quinine ; from 18 to 2 I grs.

"Dr. Pepper gave 1G grs., and 1 have no evidence to prove that
this is not a sufficient quantity, even in this latitude.

" From this limited experience, I am induced to believe its anti-
periodic virtues are not much, if at all inferior to quinine.

11 1 hope other members of the profession, who live where autumnal
periodics are as numerous as with us, will test its virtue. If it
should prove as successful generally, as with Dr. Pepper, and with
myself, we will have a remedy, for the cure of periodics, at a little
over one-third the present cost of the sulph. of quinine. "

From the biographical sketch of the late Dr. Wm. R. Waring, of
Savannah, by Dr. C. W. West, we cull the following characteristics
of the subject of the memoir :

" Like most of our professional men, Dr. Waring was too much
engaged with the labors of an active exercise of his profession to
write much, but the few articles from his pen would alone establish
the traits of his mind. One of them, an excellent description of
disease, clear, minute, and searching ; the others entirely argumen-
tative. His report to the city council on the epidemic, yellow fever,
of 1820, contains much valuable information, though unfortunately,
his mind was too deeply imbued with the pathological views of the
French school to arrive at correct conclusions. Broussais had just
broken the bonds of the humoral pathologists, and finding the origin
of many conlinued and remittent fevers to consist in a diseased state
of the gastro-intestinal mucous membrane, led away into an equally
grave error, many of the medical profession of that day. Hence Dr.

1854.] Editorial and Miscellany. 181

"Waring's error in fixing the pathology of yellow fever upon the
diseased mucous coat of the stomach, and attributing all the fevers of
our climate to the same cause. But when we remember the vague-
ness of the pathology of fever previously held, and the nearer
approach to truth, confirmed by a more successful mode of treatment,
which resulted from the change, we look with leniency upon an ar-
dent reception of a theory, false in fact, and vet productive of so much
good. Under the more enlightened pathology of the present day, no
man would be excusable for holding the doctrines of Broussais,
though at that time it was rather evidence of a mind keeping pace
with the developments of science. Such strong impressions are not
easily dismissed, and Dr. Waring continued to practice upon the
theory of his illustrious teacher even after his dogmas had been
exploded.

" Dr. Waring's mind was strictly philosophical ; trained to reason
closely and logically, he dealt principally with facts and their legiti-
mate deductions. Hence he was deliberate, and even slow, in his
diagnosis, but generally clear and positive, firm and intelligent in
treatment, and very generally successful. If he formed theories, it
was only after study and reflection, and they were the results of
judgment, not of fancy. A mind thus acting must necessarily be
acquisitive he was a constant and unremitting student, not deterred
even by the labor of an extensive practice. The midnight lamp was
not a figure of speed) to him, but a reality, which brought him con-
stantly in close converse with the great minds of the age. Xor until
disease had enfeebled him, did he relax from assiduous study.

M With little imagination or fancy, he was rather taciturn, and
seemed indisposed to communicate, but when in the confidence of
social life, he could be drawn out to unburden the accumulated stores
of his intellect, they were found to be rich treasures, which instructed
and delighted all about him.

'Tubercular phthisis, with its unerring certainty of march, gradu-
ally wasted him away, and he died in this city in the year 1842."

Dr C. B. Nottingham also furnishes us an excellent biographical
sketch of the late Dr. Ambrose Baber, of Macon.

A.S a practitioner of medicine, Dr. Baber was prompt, decisive
and energetic. His practice sharing largely of the anticipating
method of cure : the temporising expedients of the expectant system
of the distinguished French pathologist which led captive in those
days many enlightened intellects in medicine, found little favor in his
views. Clear and perspicuous in diagnosis, he no sooner arrived at
a satisfactory conclusion as to the pathology of a case than he was
prepared to invoke, from his ample store of therapeutic knowledg
such agents as were best calculated to meet the indications of treat-
ment. He was however a prudent and even cautious man. Daring
heroism or reckless boldness could not claim him as a votarv.
Although highly gifted in powers of obse nation and deduction, and
consequently a ready diagnosticator his tact, sagacity and quick

188 Editorial and Miscellany. [March,

perception enabling him to learn more of a case ordinarily by a
hurried glance, slight manipulation, and a few questions apparently
carelessly propounded, than many men could by protracted investiga-
tion ; yet he met with many cases in a large practice, which, in his
judgment, partook of the character of abstruse problems requiring
for their solution, the most systematic investigation and careful reflec-
tion before therapeutic measures were instituted. In cases of such
obscurity he ever made it a matter of scrupulous regard to truth, the
interests of the sufferer and his own reputation, to pursue a course of
calm, deliberate and cautious enquiry bringing to the task scrutini-
sing examination, patient analysis, and a general concentration of
effort, that was sure in the end to result in views of clear and definite
elucidation alike creditable to himself and conducive to the welfare
of his patient. Not unfrequently was it the case that he would visit a
patient, the pathology of whose disease was not clearly manifest a
second, and sometimes even a third time, before declaring his
diagnosis or suggesting a prescription ; permitting neither the
anxiety of the afflicted, the personal labor or the apparent want of
skill, which such a course might suggest to observers, to swerve him
from his conscientious sense of duty and probity an example
worthy of imitation by those who consider themselves able by intu-
ition to solve the hidden mysteries of the dark arcana of disease and
arrogate to themselves the capacity of instituting the best means of
cure without ever evincing any show of hesitation.

" In his intercourse with his patients, Dr. Baber did not indulge
affability. On the contrary, he was usually blunt, stern and some-
times even austere rarely unveiling to any the secret workings
of the mind by which he wrought his diagnosis or determined upon
the plan of treatment, and never tolerating the slightest suggestion
or contradiction in any way affecting his opinions or measures.
Being perfectly satisfied with his elucidation of the case, and having
a definite object in view in making his therapeutic appliances, he
moved with a firm and steady step, uninfluenced alike by the whims
and caprices of the patient or the fears and apprehensions of friends.
Dissatisfaction expressed or plainly implicated was but the signal for
his withdrawal from the case thereby giving the family an opportu-
nity of seeking aid elsewhere. Let it not be inferred, however, that
he was either unacquainted with the politeness and courtesies of the
gentleman, or a stranger to the benignities of the profession. Digni-
fied, urbane and benevolent, he yielded precedence to no one in the
true sympathies of the man or the charities and kindly offices of the
profession ; but pursuing his labors with a due sense of their obliga-
tions, their responsibilities and their true dignity, he considered the
non-professional, even among the more intelligent, incompetent to
appreciate the pathological and therapeutic ratiocination of his
mind, and that his own self respect and cherished reputation was
always more or less involved in a faithful adherence to his well con-
sidered and well matured directions.

" Dr. Baber's bearing among his brethren of the profession, was

1854.] Editorial and Miscellany. 189

equally as dignified and in some respects as reserved as among his
patients having but little intercourse with any, except those whose
intellect and acquirements, in his judgment, reflected honor upon the
profession, and consequently commanded his respect. With such, at
fitting times, he would unbend himself to free and even familiar
intercourse. On such occasions his manners were bland, his con-
versation graceful and his whole bearing that of the educated
physician and cultivated gentleman. With drivellers and pretenders
those who hang as an incubus upon the profession courting pop-
ular favor by dissimulation and trickery, or by calumniating the fair
character of their superiors deriving honor by their connection with
the profession without making any return those drones and igno-
ramuses who look to the profession as a foster-mother giving them
some show of respectability and position, yet who do nothing to add
to or support its dignity, its honor, its usefulness, but on the contrary
whose daily life is one continual slander upon its purifying and eleva-
ting influences with such he never associated, and when opportunity
presented, rarely failed to impress them with a full consciousness of
the ineffable contempt with which he viewed their unmanly and
dishonorable conduct.

"For the junior members of promise, he cherished feelings of the
most kindly and considerate regard. Cheerfully aiding them in the
many ways in which the senior practitioner has it in his power to
advance their views and forward their preferment, he was esteemed
by the rising young men of the profession as the patron of merit.

" In consultation, he was ever a man of mark expressing himself
courteously, yet firmly, deliberately and fully listening respectfully
to the opinions of others, yet insisting boldly and zealously upon the
correctness of his own, he exercised a power and controlling influ-
ence in the consulting room that rarely failed to make itself felt in
the management of the case. Harmony was never so much the end
sought, as the means of securing the welfare of the patient and the
triumph of truth.

11 Important elements in his character, those having much to do
with his success, were energy, industry, decision, and firm determi-
nation of purpose. Viewed in relation to his profession, they made
him diligent, faithful and untiring in whatever he undertook. De-
voting himself with a spirit of self-sacrifice upon the altar of duty, he
was ever ready to respond to the call of suffering, and when in the
chamber of affliction and peril, was scrupulously studious to leave
nothing undone that might conduce to the interests or properly to the
comfort of the sufferers. Neither, considerations of personal comfort
or bodily pain, the fatigue of sleepless nights or incessant toil, were
permitted to intefere with the full discharge of his sacred obligations,
to those who sought reliet at his hands.

" With an elevated ambition of excellence, a refined pride of
character, an honorable, independent and chivalrous deportment, and
an integrity of unspotted purity, was associated in his later years, the
amenities and grates of the christian. Generous to a fault among

1D0 Editorial and Miscellany. [March,

his friends, he was benevolent to the poor and liberal in his offerings
to the various enterprises designed for the moral and social improve-
ment of his race. Pursuing his profession under circumstances of
unrivaled popularity that enabled him to command a full practice
within a circle bounded by the selfish and sordid horizon of pecuniary
emolument, he looked beyond the reward of the hour, and freely
ministered its high charities wherever a claim presented for their
exercises responding, alike, promptly to the call of the widow, the
orphan and the virtuous destitute of the sterner Bex, as to that of those
upon whom fortune smiled in the gifts of ease and affluence.

"Such was Dr. Baber. With a character distinguished by such
ennobling traits, and a life illustrated by such deeds of usefulness,
grace and charity, he could not fail to command the respect, confi-
dence, admiration and patronage of the public who knew him."

The last paper in the work before us is the Address delivered by
Dr. Juriah Ilarriss, of Augusta. It is a chaste and erudite produc-
tion highly creditable to the author. We regret that our limits will
allow us to reproduce only the opening and closing remarks of the
speaker.

"'History is philosophy teaching by example,' and tin-
source of human knowledge. Embodying the past and the present,
she will enable us to avail ourselves of the one as well as the other.

"Analogy is the first and most simple process of inductive reason-
ing, and if properly carried out, leads to positive and invariable results.
If the data are ascertained, and the reasoning correct, the conclusion
must inevitably be true. From history, we are enabled to collect the
data and approve the truths, or demonstrate the errors in the reason-
ings or conclusions of our predecessors. We must of necessity profit
by the experience of others, since life is too short for one individual
to pass from the origin of the sciences to their present perfection
without its aid. Difficult indeed would it be tor us to acquire new
facts, or make new discoveries, if we were unacquainted with the
truths that have been determined by those who have preceded us. It
is the records of these facts which benefit mankind, for otherwise
how comparatively vain and profitless they would prove.

" But aside from facts ; it is from a multiplication of theories, and
theories oftentimes adverse in character, the offspring of individual
minds, that we must generalize and reach primitive causes of natural
phenomena.

" The history of medicine is its veritable flame of truth, and the
most fruitful source of instruction, and he who is unmindful of its
promptings, however intellectual, or however persevering in his labors,
will never add very much to science. His labors may be incessant, but
the field is too extensive to be traversed by him ; he may be gifted
in mind, but the subject is too vast and abstruse to be grasped by his
unaided intellect. But this field must be cultivated, even to its utmost
limit, which can alone be accomplished by toil toil the most un-

1854] Editorial and Miscellany. 191

remitting and when the energies are exhausted, the benevolent
searcher after truth will record the result of his researches^ as land-
marks for those who come after him, and who will be thus enabled
to profit by his experience. It is only by such means that science
secures permanent progress, and mankind real benefits.

" But history has other advantages than that of giving us the ex-
perience of the past. It prevents us from coming to unjust or unfair
conclusions, and its recoids prove that an impartial historian may
find important truths, wrapped in the mysteries of conflicting opinions.
Its study tends to divest us of our self-importance and egotistical pre-
tensions. It inspires us with modesty, and demonstrates that a blind
confidence, or pertinacious adherence to our own opinions indicates
weakness. It disciplines the mind, enlarges the views, and refines
the taste. ' The cold study of the scholastic, and the false philosophy
of Talmud, can offer interest to no one save the true historian, who,
in the midst of the greatest confusion, can unravel the mysteries, and
draw forth a few sparks of light.5 "

The speaker then proceeds in a very happy manner to establish a
comparison between the state of medicine in the 18th and 19th centu-
ries, and concludes thus :

"It is the glory and triumph of medicine, that she has been placed
upon the immutable foundation of truth. For centuries she has been
struggling for that honor, but until the advent of the era in which we
live, she has been ranked as a mere art. Her disciples have nature
and truth for their guide their object, the amelioration of the suffer-
ings of mankind. Up to this century she has had to contend with
ignorance, overcome prejudice, resist contumely and ridicule, and
fight against quackery and pretending artisans.

" It is at length and happily, the proud province of the scientific
physician, to stand upon the high eminence of science, surrounded
by an atmosphere of truth, and crowned with imperishable laurels,
wreathed by the gratitude of the world. The remark of the illustrious
Roman orator, ' homines ad deos nulla re proprius accidunt. quam
saltern hominibus dando,' is appropriate only to physicians of this
century. He does not stalk forth as of yore, the unblushing charlatan,
the unscrupulous and heartless quack, the boasting pretender, but
walks forth conscious of his own skill and rectitude a dispenser of
health."

Singular Atmospheric Phenomenon. The subject of quarantine reg-
ulations is being agitated in Louisiana, and a circular has been address-
ed to members of the Medical Profession in that state for the purpose
of eliciting their views with regard to the origin and propagation of
Yellow Fever. We have just read the reply of Dr. James S. McFar-
lane, who is a strong believer in the local origin of the disease, and in
its non-contagiousness, and who is consequently decidedly opposed to

102 Editorial and Miscellany. March,

^quarantine regulations. We have never believed that yellow fever is
contagious, or, in other words that it can be communicated from man
to man ; but we can see no good reason why an atmospheric disease or
poison may not be carried about in a ship, and discharged upon a
wharf with the cargo, and thus infect the atmosphere to such a degree
that those who breathe it may take the disease. Nor do we think it
unreasonable to admit that the poison may be propagated or increased
in quantity, if thus deposited in a susceptible atmosphere, whereas it
would prove inert if turned out in an atmosphere less congenial to its
vitality, if we may so express ourselves. The history of the late
epidemic would seem to establish almost beyond a doubt that the
yellow fever was carried along the coast of the Mississippi by the
steamers, however successfully it may be demonstrated that it was
not brought to New Orleans from South America or the West Indies.

The following singular atmospheric phenomenon is related by Dr.
McFarlane in his able article :

"Among many local phenomena which occurred, and which could
have no relation to contagion or importation, and which may to a cer-
tain extent, account for the presence of an epidemic, wen' the follow-
ing:

' A piece of fresh meat attached to a kite, and elevated a few hundred
feet, came down in twenty or thirty minutes, completely covered with
living, moving vermiform animalcuhr, ami this circumstance occurred
throughout the whole epidemic, whenever the experiment was made,
which was almost daily.

'The upper stratum of clouds never changed their position from
the commencement to the close of the epidemic: they appeared
"nailed to the sky," and this extraordinary phenomenon was obser-
ved in the interior as well as in the city ; but what is most remarkable
in the premises is the fact that on the very day that they were observed
to move, for the first time in several months, the epidemic began to
decline, and continued to do so until it ceased to exist, without the aid
of cold, frosts or tempests.

" If these phenomena be corroborated by more extended experiments,
in future epidemics, they may serve in part to account for the exist-
ence of a yellow fever epidemic, without any reference to contagion
or importation.

" They demonstrate a horribly polluted condition of our local atmos-
phere, and show that that atmosphere was permanently established
around us throughout the whole epidemic."

New process for coating Pills. M. Calloud, (de Chamber)) in
Journal de Pharmacie, xxiii. 301, treats of the subject of enveloping
medicinal substances in a covering to prevent unpleasant taste. After
having tried gum, starch and sugar without satisfaction, owing to the

1 -54.] Editorial and Miseellany. 193

hygroscopic tendency of the sugar and gum in moist air or with a
moist mass, and their tendency to crack when very dry, he had
recourse to the dried mucilage of flax-seed prepared with sugar, with
success.

The following is his method :

Take of Flaxseed, one part.

White sugar, three parts.

Spring water, a sufficient quantity.

A thick mucilage is obtained by carefully boiling the seeds, the
sugar is added, and the whole of the moisture evaporated by careful-
desiccation.

This mixture is but vei;y slightly hygroscopic, may be reduced to-
fine powder, and employed for covering pills. This operation is
effected extemporaneously with great facility. The pills slightly
moistened, are rolled in the mucilaginous powder, by which they are
coated with a layer of the compound.

If. Calloud has used this chiefly for carbonate of iron pills, but it
may be applied to other kinds.

Garot's process of coating pills with gelatine is most applicable to
disagreeably odorous substances, as assafcetida. castor, valerian, etc.,
which are completely masked by it. When the gelatine is previously
colored with carmine the pills bore the appearance of hawthorn berries.

If. Calloud suggests another process applicable in certain cases,
which is the use of the butter of cacao as a covering for pills, where,
owing to gastric irritation, the unmasked pills will cause disagreeable
symptoms The process is very simple : The prepared pills are
thrown into melted butter of cacao, then removed with a perforated
skimmer, and finally rolled in finely powdered sugar, or what is
better, sugar of milk. [American Journal of Pharmacy.

JS'ew Apparatus for extracting Drugs. If. Schwaerzler, (Gazette
aVAugslourg, Avril 23, 1553,) has stated that if a flask is three
fourths filled with water, and then closed with an air tight cork
through which passes a tube reaching to the bottom of the flask, and
the latter is plunged into boiling water, it is well known that the
dilatation of the enclosed air will force the liquid out through the
tube. If a funnel-shaped vessel is attached to the top of the tube se-
curely by a soft cork, the fluid will be driven up into it, and a portion
of air will escape through the tube. If now the flask is lifted out of
the water bath, the air in it contracts, and the water in the upper
vessel returns to the flask. Taking advantage of this idea, an
anonymous correspondent of the Journal de Pharmacie, (tome xxiv.
p. 134, 3e serie,) has suggested a lixivating apparatus which consists
of a flasK, a tubulated bell-glass inverted, and a suitable tube connect-
ing them in the manner described. A diaphragm of perforated tin is
placed within the bell-glass, and upon this the substance to be extracted
is loosely put. The flask is now placed in a vessel of boiling water ;
the water in the flask soon commences to rise in the bell-glass until it
has covered the ingredients. After contact a sufficient time, by lifting

194 Editorial and Miscellany. [March,

up the apparatus from the water bath, the fluid retreats to the flask,
and carries with it a part of the soluble matter of the substance.- This
is repeated several times until the substance is sufficiently exhausted.
We have tried this experiment with a Florence flask and an invert-
ed bottle with the bottom removed, and find it operates very well.
The writer suggests that it is equally applicable to extraction with
alcohol and ether, avoiding the point of ebullition, providing the upper
vessel with a cover, and, in the case of ether a condensing apparatus,
to avoid loss. In our small experiment, the temperature of the liquid
in the upper vessel, when the air commenced to escape, was about
180 F. [Ibid.

Cause and Treatment of Prolapsus of the Rectum. By M. Duch-
aussay. In a short but interesting memoir, M. Duchaussay reviews
the circumstances attending this troublesome complaint, and fixes
attention in particular upon the loss of power in the sphincter ani
muscle as the chief cause of the descent of the bowel. Moreover, be
endeavours to show that Dupuvtren's operation, by excising the ra-
diating folds of skin around the anus, and the operation by four touches
with the actual cautery, practised by Guersaut, act not by causing
any subsequent retraction of the cellular tissue, skin, and mucous
membrane, but rather by stimulating the sphincter muscle, so that it
regains its contractility, and therefore its retentive character. How
else, asks M. Duchaussay, do we explain the fact, that the prolapsus
is often cured, or does not return after two days, or even after one
day, or not at all, after the operation ? He points out the fact, that in
cases of this disease in infants, three fingers may sometimes be intro-
duced without causing contraction of the sphincter, before the opera-
tion by cautery, whilst afterwards, if one be passed, a powerful
contraction of the sphincter immediately ensues. As proof that this
recovery of contractile power by the sphincter is the cause of cure, a
case is mentioned in which M. Guersant had used the cautery too
superficially, the sphincter failed to contract, and the disease returned.
A second cauterization was followed, on the contrary, by return of the
muscular contractility, and the cure was complete.

According to the author, the cautery acts as a stimulant to the
paralyzed muscle, just as it will to the deltoid in a like condition.
After pointing out the inconveniences and apparent severity of M.
Guersant's method, M. Duchaussay suggests that a slighter cautery,
or some other stimulant to muscular contractility, might act as well,
and he suggests strychnine. This, with M. Guersant's permission,
has been tried in the Hopital des Enfants, in the case of a girl aged
eleven years. The prolapsus here arose from obstinate constipation ;
it had lasted for four years ; the bowel protruded at each evacuation
about ten centimeters (=4 inches). During the first month of her
admission she was treated by laxatives only, with no other result than
that of diminishing the length of the protruded portion of bowel to
about four centimeters (1| inches). Strychnia was then employed
endermically near the region of the sphincter ; the next day there was

1854.] Editorial and Miscellany. 195

no evacuation ; on the following day the bowels acted once, only a
slight bulging of the rectum taking place ; on the third day the pro-
trusion was still less after an ordinary evacuation ; and during the
next thirteen days it did not occur again.

Blisters were made in the cleft between the nates, and on the right
thigh close to that cleft ; one-sixth of a grain of strychnia was applied
the first day, one-third on the second, and one-third on the fourth day.
On the fifth day, about half a grain of sulphate of strychnia was used,
and this was repeated for the last time on the sixth day. In the case
of a boy, it is recommended to be applied between the scrotum and
anus, immediately over the anterior interlacement of the sphincter ani
fibres. The remedy certainly deserves further trial. [Archives Gen.
de Med. Brit, and For. Medico-Chir. Rev.

Infantile Leucorrhcea. In several numbers of the 'Medical Times
and Gazette,' for Sept. 10th to Oct. *29th, will be found the History of
a recent Epidemic of Infantile Leucorrhaia, with an account of Five
Cases of alleged Felonious Assaults. By \V. R. Wilde, F. R. C. S..
&c. " Considerable excitement." Mr. Wilde states. " has prevailed
among all classes in Dublin during the last month, owing to the cir-
cumstance of no less than three cases of felonious assaults upon chil-
dren under ten years of age having been brought forward by the
Crown at the late Commission before the Chief Justice."

A correspondence has been published in the : Freeman's Journal,'
between Dr. Ireland. Physician to the Police, upon whose information
the cases were sent for trial, and .Mr. Wilde, who had one of the
accused persons defended. Most of the leading members of the pro-
fession in Dublin gratuitously tendered their evidence in court, " in
what they considered the cause of truth, science, and humanity."
The occurrence of this form of vaginitis, in an epidemic form, as
shown by Mr. Wilde, is perfectly well known to most practical physi-
cians and surgeons.

Mr. Wilde notices the nelusion, which is extensively prevalent in
Ireland, to the effect that a man can get rid of an obstinate gonorrhoea
by having connexion with a virgin ; and as the easiest and surest
mode of effecting that, a child of tender years is selected; hence the
felonious assaults occasionally attempted, and for which men have
been most justly convicted, and most righteously punished. But in
all such cases it has been proved, that the men, after the commission
of the crime, still laboured under gonorrhoea or venereal, although the
popular opinion among the lower orders is, that the disease is not
only completely, but instantaneously, transmitted from the male to the
female. A similar superstition, it appears, is found to exist among
the Arabs, as stated by Mr. Duchesne, in his recent work on ' Prosti-
tution in Algeria.' It is the knowledge of this wide-spread supersti-
tion, which leads the mother at once, on the appearance of vaginal
discharge, to jump to the conclusion that impure connexion has taken
place, and possibly she may be confirmed in this idea by some medi-
cal men not conversant with the true nature of the affection.

196 Editorial and Miscellany.

Mr. Wilde dwells upon the suggestions, insinuations, and threaten,
ings, which are usually had recourse to in these cases, in order to ex-
tort a confession of connexion, and very justly remarks that it is not
likely that a child, who has neither passion nor love to influence her,
will conceal the fact from her parents or near relatives, when hard
pressed. In Mr. Wilde's contribution it is stated that one mother,
on her own statement before the jury, actually threatened to cut her
child's tongue out if she did not confess to the connexion. Besides
the three cases already referred to as having become the subjects of
trial at the late Dublin Commission, Mr. Wilde cites six other
instances of epidemic leucorrhcea that have been brought under the
notice of the profession, either at public institutions, or through the
medium of the medical journals. For the details of these cases, and
of the trials, we must refer our readers to the 'Medial Times and
Gazette.' [Ibid.

Monomania Book-stealing. An Englishmen in Paris having been
ronvicted of stealing books from a stall, and condemned to two years'
imprisonment, pleaded monomania, or an irresistible impulse, as ground
of mitigation of sentence. From the previous history, however, of the
culprit, it was established that he must be held responsible for \\\< aotl :
the plea was therefore negatived. [Annales Medico- Psychologique,
and Ibid.

A Case Book, to be used at the Bed-side. By G. F. Cooper, M. D.r

of Americus, Ga.

We have been favored with a copy of Dr. Cooper's case-book, and
take pleasure in recommending it to the profession as admirably adapt-
ed to the purpose for which it is intended* With such a help practi-
tioners can without difficulty keep an excellent epitome of their cases
for subsequent reference. We hope that a supply of the work will be
forwarded to our booksellers.

Husband's Isinglass Adhesive Plaster. We acknowledge the re-
ception of a specimen of the above article, which we have tried and find
very excellent. We therefore cheerfully recommend it to the profes-

The State Medical Society. The fifth annual meeting of the
Medical Society of the State of Georgia, will be held in the city of
Macon, on the Second Wednesday (12th) in April next.

D. C. O'KEEFE, Bee. Secretary.

Greenesboro', Ga., March 1st, 1854.

Errata. In January number, page 11, third line from top, for 'complete,"
read complex. Page 13, tenth line from bottom, for "sustained," read retained.
Page 17, twelfth line from top, for " individual," read undivided.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES APRIL, 18*4. [No. 4.

ORIGINAL AND ECLECTIC.

ARTICLE XI.

The Remittent Peculiarity of Typhoid Fever in Georgia.
Read before the Medical Society of the State of Georgia, by
H. R. Casey, M. D., of Columbia county, Ga.

A communication from the President of the Medical Society
of the State of Georgia has been handed me, to which was ap-
pended the above caption, stating that I had been appointed to
write an essay upon that subject, to be read before the Society
at its next annual meeting. I am informed that this appoint-
ment was made from the fact that I was the first to present to
the notice of the profession cases of Typhoid Fever, of a purely
intermittent character. (Vide Southern Med. and Surg. Jour.,
Dec, 1851.)

From the day that Typhoid fever was first distinctlv de-
scribed> to the time to which allusion is made above, it has
been looked upon as a fever of a continued type ; and no fever
could be called either typhus or typhoid which was not of a
continued character.

Louis, who is justly regarded as the first great exponent of
the physiology and pathology of Typhoid fever, speaks of it
only as a continued fever. Petit, Serres, Andral, Chomel, and
the other French authorities, all agree as to the type of the
fever ; and as this is. strictly speaking, the fever of France, and

n. s. vol. x. xo. iv. 13

198 Casey, on Typhoid Fever. [April,

particularly of Paris, its portraiture, as given by those men,
should be considered a true and faithful likeness.

And in this country, so far as my reading and my knowledge
extends, all the writers concur with the French authorities as
to the type of the fever. Gerhard, Jackson, Bartlett, Bell,
Austin Flint and G. B. Wood, all agree on this point. Dr.
Wood says, "that in the formative stage of the fever, in the
first seven or nine days of the disease, before it is yet fully de-
veloped, Typhoid fever may, and does, sometimes assume a
remittent type.'7

Now I am not to be understood as attacking the position as-
sumed by writers on Typhoid fever viz. that it is a fever of a
continued type for my own observation attests the truth of it.
I have seen it prevailing as a continued fever; at another time
as a remittent; and again as an intermittent.

And this is the sole object of my essay : I wish to divert the
minds of the profession from the long established notion that
Typhoid fever is necessarily, essentially ; and under all circum-
stances, a continued fever.

I contend, that true and crenuine Typhoid fever prevails in
Georgia, exhibiting ail the other manifestations of the (fit
(as laid down in the standard works,) except in the type of the
fever proper. We have as true genuine Typhoid fever in
Georgia, of an intermittent character, as ia exhibited to physi-
cians of Paris in their " continued fever"

The road has been blazed out for diagnosis in Typhoid fever;
but who can say he has always, and under all circumstances,
found all these blazes apparent ? Does he not oftentimes find
some of them obscured, or even entirely wanting ? Oftentimes
we have cases of genuine Typhoid fever; but where are the
rose spots ? or the sudamina ? the tympanites ? the diarrhea T
or the follicular disease ? One patient has a full, strong pulse
another a small corded one ; one set of symptoms apparent in
one case, and absent in another.

The singular forms of Typhoid fever which have prevailed of
late years in different sections of the United States, exhibit to
the eye of the medical philosopher the very wide difference of
expression it may assume yea, and I might add, the very sin-
gular contrariety of treatment will also furnish theme for con-
templation.

1854.] Casey, on Typhoid Fever. 199

Now the ulcerations of Peyer's gland, which are considered
characteristic of the disease, and which are held to be the true
test of Typhoid fever even these have been found not to exist
in patients who have died of this fever. It is said that Louis
once treated a case of what he considered genuine Typhoid
fever, judging from all the life symptoms: the patient died ; a
post-mortem was instituted ; the ulcerations did not exist. The
French philosopher changed his opinion, and declared it could,
not have been a case of Typhoid fever. The non-existence of
one symptom, broke up the entire chain of evidence, upon which
he had predicated his diagnosis, and instituted his treatment.

M. Andral has clearly shown, in his Clinique Medicale, that
patients have perished under a fever marked with all the symp-
toms of typhoid ; and there were no exanthemata certainly
no ulcerations nor any apparent alteration in any part of the
digestive tube, which would explain the cause of death. On
the other hand, there are other diseases, such as cholera, scar-
latina and phthisis, in which the intestinal mucous follicles are
altered.

Nor do I think that these ulcerations should be held as diag-
nostic of the disease ; for we cannot be satisfied of their exist-
ence until after death. And here another difficulty may present
itself; an autopsy may be denied us.

I contend that we cannot rely on any one isolated feature to
establish or deny the existence of Typhoid fever in a given
case ; but rather upon its entire physiognomy its tout ensemble
of symptoms.

To say that such a case is not typhoid, because the fever
remits or intermits, is not good philosophy.

It has been shown in evidence that all the other accredited
symptoms of Typhoid fever are subject to modification, and
even to change ; then why not the type of the fever ?

May not those endemic influences which give origin and
peculiarity at certain seasons of the year to our pleurisies and
pneumonias, and stamp upon them the impress of intermittens
cy may they not have some agency in changing the type of
Typhoid fever? I merely throw out this hint for what it is
worth ; it may serve as a nut for the " quinine curer" to crack.

I shall not stop to account for the why and the wherefore .;

200 Casey, on Typhoid Fever, [April,

I leave that for future investigation. Sufficient for the purposes
of this essay, is the promulgation of the fact that Typhoid fever
has an existence in Georgia as an intermittent fever.

A case in point presents itself to ray recollection. Some few
months since my services were demanded. On arriving at the
house, I found the patient, a negress some 10 or 12 yean i
ill of fever. After making the necessary examination, I obtain-
ed from the owner the following history of the case: The pprl
had been sick for a week, with a fever which would rise every
day about noon, and continue on through the night ; that she
would he free of fever most of the morning; was extremely
weak; had no appetite ; had nothing to say. and complained
mostly of pain in the head. She had given her pills and nil,
and, when clear of fever, she ha. I given her freely of quinine.
From this history, together with the symptoms then apparent, I
stated to the owner that the girl had Typhoid fever. If so, this,
she said, was the second case in the family a boy was just
getting well, who had been down in bed four weeks with a fever,
which the Doctor called an " intermittent fever ;" but nothing
he gave him had any effect on the fever it kept on till it seem-
ed to wear out itself after a long time. And such, I stated to
her, would in all probability be the case with the girl. She
would get well after awhile. I told her to give no more pills. n< n
oil, nor quinine bathe her feet nightly in warm water give
her an anodyne afterwards, and to seek rather to control the
bowels than to give medicines to move them ; and if diarrhoea
set in to send for me in haste. Giving such general directions,
in regard to diet, regimen, etc., as the case required, I left the
patient in charge of her owner. The case, I subsequently
learned, went on well: the fever continued some fourteen daya
longer, when the patient convalesced.

Another case in point, not within my practice, yet within my
knowledge : A young lady was under treatment by two re-
spectable physicians, for what they considered a case of inter-
mittent fever. Dose after dose of quinine was administered :
and the obstinacy and unyielding character of the fever was by
them attributed to some local internal irritation or inflamma-
tion. A member of the family, in conversation with me, men-
tioned the case, and I gave it as my opinion that it was Typhoid

1854.] Casey, on Typhoid Fever. 201

fever. A third physician was subsequently called in, and after
a full and fair investigation of the case, he pronounced it Ty-
phoid fever. The attendant physicians yielded their assent :
the quinine was discontinued; the young lady's fears quieted
on the score of internal inflammation ; all medication was with-
held, save those of a soothing character ; she was put upon a
mild but generous diet; the fever kept on its course till it ex-
hausted itself, and the patient convalesced after four weeks
confinement to bed.

Now, here we have two well marked cases of a fever of an
intermittent type, resisting the ordinary method of treatment,
so successfully instituted in the common periodical intermit-
tents of this country.

Is not this one fact of itself sufficient to cause the physician
to pause in his career, and ask himself, why is it that I cannot
control this fever? Why is it that these fevers are not at all
influenced by the great fever controling quinine ? Surely there
must be something in the peculiar nature of this fever itself
which places it out of the category of the ordinary malarial
fevers, over which quinine holds complete dominion. Reason
thus, Doctor, with yourself, and your quinine and Typhoid fever
will come in and settle the question.

In the number of the Southern Medical and Surgical Journal,
for Dec. 1851, will be found my "Contributions to the History
of Typhoid fever." By reference to that article it will be seen
that I have reported thirty cases of genuine Typhoid fever of
an intermittent character, all occurring on the same plantation,
and presenting in their history all that is required to constitute
true French typhoid disease, save the type of the fever. By
reference to those cases, we find them of a purely intermittent
character, there being generally a decided intermission of from
two to six hours. These were the first cases of Typhoid fever
that had ever come under my notice, and I did not hesitate to
pronounce them so on my first inspection. Although the type
of the fever did not tally with my book authorities, yet I was
ready to believe that from climacteric or other influences, the
types of fevers might change. In the face, then, of authority, I
pronounced my opinion, and subsequent observations have con-
firmed me in it.

202 Casey, * on Typhoid Fever. [April,

We should have an eye to our cases after the example of the
great Sydenham, that we may see not only the character of the
fever, as influenced by local causes, but also the nature of the
epidemic at different seasons, in order that we may successfully
apply those principles of treatment which the peculiar type of
the fever requires.

In conclusion, I would add, that the subject of Typhoid fever
is worthy of our serious consideration should attract the atten-
tion and elicit the scrutiny of the Southern physician. Fifteen
or twenty years since, we scarcely ever heard of Typhoid fever.
Bilious fever was then the rank weeds that grew in the pathway
of the physician ; and with his scythe or cutting knife he went
on mowing down the weeds (a nd oftentimes the patients). It
was then that the mercurial 1st, seeing nought but the liver at
fault, and recognizing in calomel the only controlling agent of its
morbid actions and vitiated secretions, went on heavily dosing
his patients to remove the great offending bile.

The unfortunate patient, in these days, to be cured of bilious
fever, was to be subjected to a routine treatment of calomel for
the first eighl or ten days, and when the system was prostrated
by the disease, (or mayhap the treatment,) he was then to be
put upon a tonic and stimulating treatment. The lancet and
mercury first, and late'm the disease wine and barks.

But, happily for the present generation, a light came, (and, if
I mistake not, from the city of Augusta.) which entirely revolu-
tionized the treatment of this great Southern scourge. . . A
remission in the febrile paroxysm was sought after early in the
disease, and obtained by milder and less injurious means, and
when obtained, quinine was given, and the fever broken up.
Since the introduction of the quinine practice, we have but
little bilious fever in this section of the country : the fever is
broken up in its incipiency ere it has time to fasten itself upon
the patient in a regular remittancy. Thus, an enemy which
had annually extended its ravages from the lakes of the North
to the reefs of Florida, leaving desolation in its trail, has given
up the warfare, and crowned the " Queen of Cinchon" the fair
conqueror.

Simple Intermittent fever in common parlance, chill and
fever then became the prevailing type of fever of the South

1854.] Casey, on Typhoid Fever. 203

and the South-west. The discovery of the febrifuge placed in
the hands of the physician a remedy that was positive and
certain in its results. There is no problem in mathematics
of more certain solution than that quinine will dissolve inter-
mittent fever to cany out the idea, it is the true solver of this
fever.

But, within the past few years, a new form of fever, coming
down from the mountains of the Carolinas and Georgia, has
appeared amonsrst us. baffling the skill and setting at nought
the treatment of the oldest and most erudite physicians. This
fever is now becoming very common in the Southern and
South-western States, and, judging from the number of articles
that fill the medical periodicals of the South, the profession is
laudably engaged in giving and seeking counsel.

If this is to be the fever of this country, we should be active
in seeking a knowledge of the disease. Let us study it in all its
varied forms, that we may be able to diagnosticate it under
whatever form it may assume. It is certainly true, that as yet
we know no remedy that has perfect control over this fever.
The time is yet to come, (and it may come,) when we can say
to the fever, "thus far shalt thou go." The prophecy was made
years ago by him who wrote knowingly of Typhoid fever; but
the prophecy has not yet been fulfilled. Louis says, u The little
success obtained hitherto, ought not to discourage the'friends of
science and humanity, and induce them to believe that we shall
never arrive at a treatment more appropriate to the disease we
have been considering. Who could have foreseen the effects
of opium, and of cinchona, and the preservative virtue of vac-
cination? Chance and observation have given rise to these
powerful means of preservation. What chance and observa-
tion have done, they could do again, and doubtless will do so ;
and therapeutics, as well as other parts of our science, must ex-
pect everything from observation." Such is the language of this
profound Frenchman whose anatomical demonstrations gave a
" local habitation" to the disease ; and such is the opinion of
writers of a later date. Dr. Bartlett, in his late work on Typhus
and Typhoid fevers, says. - We may hope that our treatment
of the disease will yet become more successful and uniform
more exact in its application, and more positive in its results.

204 Casey, on Typhoid Fever. [April,

Many 'ministers and interpreters' of nature,' faithful to their
high vocation, and competent to its duties, are zealously and
patiently occupied in endeavoring to accomplish this end.
Guided by a sound philosophy, relying upon the one great means
of ascertaining the properties and relations ol all forms of mat-
ter, inorganic or organic, that of observation, they, or their
successors may yet find, by persevering experiment or for-
tunate discovery, methods of modifying the living organization,
and of correcting its disturbed actions, which shall give us
much greater control over the disease than we are now able to
exert."

Dr. Norwood thinks he has discovered the great desideratum,
and offers to the profession his Veratrum Viride as a controling
agent in Typhoid fever. The Doctor certainly instances cases
where his fondling has been used with great success. I have
never used it myself in this fever, and therefore cannot give an
opinion as to its virtues here. Typhoid fever is certainly one
of the most prostrating of our fevers; every symptom indicates
great nervous prostration; all the vital forces seem at the lowest
ebb; and my experience writh veratrum viride is, that it has
per se the power of producing in the human economy these
same demonstrations. It is certainly one of the most depress-
ing agents of the materia medica and I have been unwilling
to superinduce upon a pre-existing debility, the increased pros-
tration consequent upon the administration of this powerful
remedy. And hence I have thought the veratrum more appli-
cable to the treatment of acute inflammatory diseases, than to
those of low grade.

I would, en passant, give my testimony to its great virtues as
a remedial agent. The thanks of the profession, I think, are
due to Dr. Norwood for his valuable discovery ; and if future
investigations shall establish the fact that veratrum viride is a
controling agent of Typhoid fever, the plaudits of the world
shall greet the name and memory of the man through whose
agency the fact was established.

1851.1 Harriss, on Varicocele. 205

article xn.

Remarks upon Varicocele, and its Treatment. By Juriah
Harris?, M. D., of Augusta, Ga.

It has been the prevailing opinion of the profession, that it is
best not to operate upon Varicocele, save in the most urgent
cases. Palliative treatment has been the rule, and this rule has
been established by the fear of fatal accidents attending the
operation. It is only since 1830, that plans for its radical cure
have been at all favorably received. Even now, operations are
verv far from beinsr generallv advocated. Most English and
American authors are still opposed to operating, whenever it
can be avoided.

The principal objection that has been offered is the fear of
phlebitis. Certainly this risk should be properly contemplated,
and the patient advised of it before operating ; but this, like
many other dangerous operations, becomes, under certain cir-
cumstances, not only advisable, but necessary. Among those
who give cautious advice is B. Cooper. Cirsocele, he says.
can, for the most part, only be palliated, seldom radically cured.
In speaking of tying the veins, he remarks that, the propriety of
performing this operation for the cure of varicocele may be just-
ly questioned, unless in certain cases of so much suffering and
danger as to warrant this hazard.* The pain is sometimes so
unendurable, that many writers, and Gooch among the number,
(though previous to 1830,) recommended castration. This
shows, at least, the necessity of an operation under certain cir-
cumstances, and the improvement of surgery has warranted a
more frequent active interference on the part of the surgeon.
The danger of phlebitis occurring is certainly exaggerated, and
too greatly feared. French authors are far more favorable to
the operation than the English, and their practice proves that
phlebitis is not so much to be dreaded as generally supposed.
The results of the operations of MM. Reynaud, Breschet, Aug.
Berard, Velpeau, all go to show this. M. Vidal (de Cassis)
says: As for myself, I have operated more than 250 times,
(1851,) and in this number there cannot be counted more than
five cases of phlebitis. f He adds, that an accident, which

* Cooper's Surg. Diet. Art. Cirsocele. t Vidal. Pathologie Externe.

206 Harriss, on Varicocele. [April,

merited the name of phlebitis, has never happened to those upon
whom he adopted his process of operating. I will speak of his
method hereafter. M. Malgaigne states that serious accidents
very rarely attend operations for varicocele* Such authority
induced me to look favorably upon the operation, and seeing
that the French were so successful, in spite of many unfavorable
circumstances as bad air, bad food, and bad constitutions I
concluded that the operation would succeed here where we
have none of these circumstances to contend with. These
were the inducements to operate upon the case which will be
presently reported.

Still more authority may be adduced in support of the opera-
tion. The success attending M. Ricord's practice is weighty
in itself. MM. Monod, Michon. and Nelajton, in their report
upon a memoir of Escalier, say, that the surest way to avoid
the accidents, which accompany varicocele, is to operate. Pain,
pruritus of the scrotum, drawing upon the cord, so as to impede
exercise and labour, and fatal inflammation of the enlarged
veins, which, according to authors, sometimes occur spontane-
ously, are all inducements to operate. M. Vidal justly remarks
that, many opponents of this operation frequently perform others
more dangerous for lesions less inconvenient and less serious.
Sometimes the venous mass, by compressing the artery, may
lessen its circulation, and cause atrophy of the testicle, inde-
pendently of any of its direct pressure of the organ. The
vas deferens is sometimes entirely obliterated. Breschet, and
his followers, report but one fatal case, and this they attribute
to the imprudence of the patient.

Causes. They are predisposing and active. The predis-
posing mostly arise from the peculiar position, anatomical
arrangement and physiological uses of the parts. The perpen-
dicular position of the veins when the body is erect, making it
necessary for the current of blood to overcome the force of
gravity, predisposes to varicocele. Their great length is favor-
able to its development, inasmuch as the weight and dilating
force of the column are proportionate to its length. In addition
to this, the walls of these veins are very thin, and consequently
Jess resisting than in others. The spermatic veins are deprived
* Malgaigne. Medicine Operatoire.

1854.] Harriss. on Varicocele. 207

of valves, and hence the whole column of blood presses upon
the walls, and tends constantly to dilate them. The frequent
alterations in the amount of blood the veins contain, according
to the position of the body, and the indulgence of the passions,
are also causes.

The active causes are, abuse of venereal pleasures, mastur-
bation, hence more frequent in the young than the old, horse-
back exercise, walking, standing, hernia, tumors in the iliac
region, foecal matters in the lower portion of the colon and
rectum, which press upon the veins.

Morgagni observed that varicocele was more frequent upon
the left than the right side, which he attributed to the fact that
the left vein, in emptying into the renal vein, formed more of a
right angle to the current of blood than did the right, which
joined the inferior vena cava. An accumulation of foecal mat-
ters in the rectum would press upon the left vein without affect-
ing the right. The left testicle hangs lower than the right, and
hence the additional length and size of this vein render it more
liable to be affected. Most authors state that varicocele may
exist upon one or both sides, separately or simultaneously.
Vidal (de Cassis), however, says, that it always exists upon the
left.* "This is the most inflexible pathological law with which
I am acquainted."' He never saw but one case upon the right.
and in that instance the heart was upon the right side. I pre-
sume M. Vidal intends this as a general rule, not a universal one.

I will say but few words upon the diagnosis, inasmuch as it
can only be confounded with hernia. To distinguish varico-
cele from hernia, it is necessary to place the patient in the
horizontal position, when, if the tumor be either it will disap-
pear. But in cases of hernia, if the patient is made to cough,
the hernia will re-appear, or an impulse will be felt by the finger
applied to the abdominal ring. In varicocele such will not be
the case. While in the recumbent posture, if the finger be
placed upon the abdominal ring, and the patient requested to
stand up, a hernia will not descend, but a varicocele may.
These affections may, however, exi'st together, when the diag-
nosis necessarily becomes more difficult, and requires greater
care on the part of the surgeon.

* Pathologic Externe. Vidal.

208 Harms, on Varicocele. [April,

Treatment. This may be palliative or radical. The expe-
rience of the profession shows that the palliative treatment is
extremely unsatisfactory: even the suspensory bandage but
very partially relieves the inconveniences attending varicocele.
This is particularly the case with the laboring classes. In the
summer season, when perspiration is abundant, the bandage, by
increasing the heat of the parts, produces very annoying and
troublesome pruritus. The secretion from the scrotum during
the existence of this disease is more irritating than in the
healthy state, and the bandage but adds to this evil. Indeed,
even with the application of the bandage, of truss, more or less
blood will accumulate in the enlarged veins, and prove an in-
convenience to the patient. In some instances, the pain is by
no means alleviated by the use of a bandage, and an operation
becomes essentially necessary.

The treatment for a radical cure consists in an operation.
The processes for operating in varicocele are very various, but
the object to be attained in them all is the arrest of the circula-
tion in the varicosed veins. Excision, compression, and liga-
ture, have all been proposed and advocated. The first two
have now but few advocates. Most surgeons seem to prefer
the ligature when an operation is deemed necessary. Although
surgeons are pretty well united in preferring the ligature, they
are very much divided in reference to the process to be adopted.
There are those proposed by Pare, Breschet, Velpeau, Berard,
Ratier, Reymond, Vidal, Ricord, Pancoast, &c. The processes
of Vidal and Ricord are, perhaps, the most simple and approved.
That of Pancoast, is but a slight modification of Ricord's plan.

Case. A free mulatto boy, from Atlanta, came to me on the
23d October, 1853, requesting an examination of his testicles,
and my advice as to what could be done to rid him of the affec-
tion. On inspection, I found his left testicle very pendant and
large ; the tumour was reducible by pressure, unresisting and
compressible, and feeling like so many " earth-worms in a sack."
I stated to him the nature" of the affection ; and upon his in-
forming me that it was very much in his way, and was a very
serious inconvenience to him in his daily labor, which was that
of a mason, although he wore a suspensory bandage and that he

1854.] Harriss, on Varicocele. 209

wished very much to marry, but could not get his consent so long
as he had this uncomely appendage and. finally, as it had evi-
dently affected his morale, I advised an operation. I explained
to him the nature of the operation (for he was very intelligent)
and the risks he had to run. He decided on being operated
upon the following morning, and insisted that it should be done
immediately With the kind and efficient aid of Drs. Rossig-
nol. Mackie and Barry. I operated upon the 24th. The process
I adopted was that of M. Ricord. The bundle of varicosed
veins was separated from the cord, and a needle,- armed with a
double ligature, was passed under the veins a second needfe,
armed in like manner, was passed above the bundle of veins,
through the same cutaneous openings as the first. This was
done by letting the veins slip through the fingers, and making
the second needle enter the opening of exit of the first, and
pass out at the point of entrance made by the first needle.
This left a free extremity of one ligature and a loop of the other
upon each side. The free ends were passed successively
through the loops, and drawn upon. This, of course, formed a
subcutaneous ligature of the veins, without including a particle
of skin. The free ends were then secured upon small pieces of
gum catheter, which completed the operation.

The pain induced by drawing the ligatures around the bundle
of veins, lasted some fifteen or twenty minutes, when it passed
away, and the patient suffered none afterwards, save a little
soreness, which supervened upon the inflammatory action, set
up to obliterate the vein.

Dr. Mackie. who had the kindness to attend him during my
temporary absence from town, informed me that he had little or
no fever during the continuance of the ligature. About six
daws after the operation I saw him, at which time he had no
fever, but the tunica vaginalis of the left side was largely dis-
tended with a serous effusion ; but little tenderness of the part.
We ordered the application of tinct. iodine, which removed the
serum in three or four days. Owing to my absence, the liga-
tures were not removed until the eighteenth day. They could
have been removed on the eleventh or twelfth day. During
the whole of this time he was kept in bed. When I called to
remove the ligature, the patient informed me that he had hadr

210 Dugas's Case of Talipes Varus. [Apri?r

for some days past, venereal desires the first for a long time.
He was much more cheerful than before, and very grateful.
The ligatures were removed without pain, which is one of the
beauties of this operation. There was a large lump at the point
at which the ligatures had been applied, probably the effusion
of coagulable lymph, which blocked up the veins ; below this
point the veins were empty and felt like mere cords. He was
ordered to wear a suspensory bandage for at least a month.

I heard from him a short time since, when he said he felt
better than he ever had, and could labor with much more ease
to himself, than previously to the operation.

ARTICLE XIII.

A Case of Non-congenital Talipes Varus, By L. A. Dugas,

M.D./&C.

Having reported in this Journal (March, 1853, p. 142) a case
of non-congenital Talipes Equinus, I may be permitted now to
publish one of Talipes Varus, also of non-congenital origin.

The subject is a daughter of Wm. S. Campbell, Esq., of
Henry county, Ga., who, when eighteen months of age, had art
acute attack of illness which left her with a partial paralysis of
one of her lower extremities. In attempting to walk tlie affect-
ed foot would turn under the weight of the body, so that after
the complete subsidence of paralysis the foot remained in the
usual position of confirmed and complete talipes varus. She
continued in this state until four years of age, when she was
placed under my charge.

On the 11th of January last, I performed the sub-cutaneous
section of the Tendo Achillis, and placed the foot in Scarpa's
shoe. In a fortnight she was able to place the sole of the foot
flat upon the floor : and from that time she rapidly improved
under the use of a more simple apparatus, consisting of an
ordinary shoe, with steel bands running up alongside of the
leg.

This is the third instance of non-congenital club-foot I have
seen, and it is somewhat remarkable that they were all different.
The first was a case of the kind termed, by Dr. Little, Talipes

1S54.] Peri-uterine Phlegmon. 211

Calcaneus existed in an adult, and was not subject to treat-
ment ; the second was one of Talipes Equinus, reported as
above stated ; and the third, one of Talipes Varus, just described.
Augusta.. March, 1854.

Of Inflammation of the Peri-uterine Cellular Tissue, and of
Retro-uterine Phlegmon in particular. By F L. J. Val-
leix, Physician to the Hospital La Pitie, Paris. [Transla-
ted from I/Union Medicale.]

It may be asserted, in a general way, that our knowledge of
inflammation of the peri-uterine tissues is very vague. Sys-
tematic works on medicine undoubtedly contain cases of these
lesions, but they are almost invariably instances of termination
by suppuration, true pelvic abscesses : so that we are led to
believe that the tendency to suppuration in this disease is
extreme, whereas I shall presently show that a very small
minority of cases end in this way. This single fact proves
that ihis affection has not been properly investigated, since
only the rarest mode of termination is recognized at all.

Such an opinion is still farther confirmed by the fact that
the disease is nowhere described separately. It is only inci-
dentally mentioned in speaking of phlegmonous inflammation
of the iliac fossa, of tumours of the pelvis, of inflammation of
the broad ligaments, wherefore we may infer that the symp-
toms peculiar to it have been completely neglected. If, then,
I show that it has its proper signs and symptoms, and two
principal modes of termination ; if. on the other hand, we can
diagnosticate it with precision, it will not be doubted that this
disease has often been overlooked. I may mention that M.
Satis* and Dr. Bennett,f both of whom have furnished us with
interesting researches upon uterine inflammations, do not allude
to the affection which we are considering. I may add, how-
ever, that several English authors have recently treated of
pelvicellulitis, but their descriptions are inexact, and inapplicable
to the disease which I am about to discuss.

In eighteen months I have observed : 1. 19 cases of retro-
uterine phlegmon; but only 11 of these were recorded with
the necessary care ; 2. 3 cases of ante-uterine inflammation ;
3. 1 case in which the inflammation was seated on one side

* Des inflammations des annexes de Futerus et des ligaments larges. These, Paris.
1847.

t Treatise on Inflammations and other diseases of the Uterus. By Dr. Henrv
Bennett. Third edition. London; Churchill, 1S53.

212 Peri-uterine Phlegmon. [April,

of the neck ; 4. 2 cases in which there was inflammation
anteriorly and posteriorly at the same time; in all 25 cases.
Of this number, only 17 can be entirely relied upon in making
out the history of this affection.

Definition. 1 give the name of peri-uterine inflammation to
that phlegmasia which occupies the vicinity of the point of
junction of the neck and body of the uterus, and only accident-
ally extends to the broad ligaments. We know that there is
a .^pace between the anterior cul-de-sac of the vagina and the
corresponding reflexion of the peritoneum, filled with fine
cellular tissue, described by anatomists and surgeons, especially
by Jobert (de Lamballe,) who has dwelt upon the importance
of this arrangement in the operation for vesico vaginal fistula.
It is at this point and at a corresponding posterior point that
the principal varieties of peri-uterine inflammation have their
seat. In one case only have I found an inflammatory tumour
upon one side of the uterus without any accompanying disease
anteriorly or posteriorly.

The number of cases which I have cited, proves that this
affection is quite frequent. Any one can convince himself of
this, who, with a knowledge of the symptoms, explores the
genital organs in the manner described hereafter.

Causes. It is as yet impossible to indicate with precision
all the causes of peri-uterine inflammation. As facts are ac-
cumulated, this knowledge will be supplied.

The age. of my patients varied from seventeen to forty-two
years. In no instance had the cessation of the menses occurred.
This fact is valuable, for it proves that the inflammations we
are describing are produced during the period in which the
uterus enjoys all its functional activity.

I observed nothing deserving of mention in the constitution
or temperament.

Of the 17 carefully recorded cases, 11 related to women
with dysmenorrhcea, dependant upon congestion.

In 3 of the 25 cases, the patients laboured under uterine dis-
placement, which had been treated by the uterine redressnur.'
1 do not place the use of this instrument among the proximate
causes, because the inflammation did not arise immediately
after the application of the pessary, but many days afterward,
the menses having intervened, and no bad symptom having
occurred in the interval. The inflammation may be thus ex-
plained. On the one hand, we know that the first return of
the catamenia after the use of the stem pessary is character-
ized by increased abundance in the menstrual flow; the san-

* Simpson's stem pessary, modified by Valleix ; commonly called the impaling
uterine machine . Translator.

1854.] Peri-uterine Phlegmon. 213

guineous fluctus, then, is greater than usual. On the other hand
we shall see that it is particularly during the menstrual epoch
that the inflammation we are describing is produced ; because
undoubtedly, the tissues which surround the uterus are the
seat of an hyperemia, which, when excessive, easily passes
into inflammation. We can readily understand, therefore,
how the reduction of the uterus, by favoring this hyperaemia,
likewise favours the production of inflammation. We must
not imagine that the instrument produces this effect by offering
direct violence to the uterus or the tissues surrounding it.
This may happen in some cases, if the pessary is applied care-
lessly, especially if the genital organs are already inflamed ;
but it did not occur in the cases I have cited.

Lastly, 1 have seen two cases in which the peri-uterine tis-
sues were painful and swollen, and presented, in a word, all
the symptoms of sub-acute inflammation, and in both of which
the patients had, at several catamenial periods, acute inflam-
mation of the retro-uterine tissue, of which the pre-existing
inflammation was evidently the predisposing cause. The fol-
lowing is a striking example of this :

Case I. A dress-maker, aged 22, entered la Pitie, Ward S.
Genevieve, No. 25, in 1852.

Her catamenia appeared at 13, and have always recurred regular-
ly ; she became pregnant at 15|, and was safely delivered at term.
The following year she miscarried at two months, without any assig-
nable cause. She continued to enjoy good health until her last preg-
nancy, during which she suffered from prostration and pains in the
abdomen and loins. Three months and a half ago her acouchment
took place. Everything transpired happily, and the patient left her
bed on the sixth day.

Soon after, she suffered pain in walking, with a sense of weight in
the rectum and fatigue in the limbs. She had occasional attacks
of vomiting, and micturition and defecation were painful ; coitus
became excessively painful.

Five weeks before she entered la Pitie, she was treated in a neigh-
bouring hospital. A blister was applied to the epigastrium, which
relieved the vomiting, but the other symptoms were not amended.
She only remained a week under treatment.

At the end of that period the catamenia appeared, but instead of
lasting only four days as usual, they were protracted, and an abund-
ant htemorrhage, alternating with profuse leucorrhcea, lasted for
twelve days. There were expulsive pains in the rectum, and lan-
cinations in the abdomen. Urination and defecation were accompa-
nied by severe suffering. The appetite disappeared. This condi-
tion lasted until the patient entered la Pitie twenty days ago. Her
physiognomy expressed suffering, but was not anxious or contracted.

Upon a vaginal examination, we found the neck of the uterus in-

n. s. vol. x. no. iv. 14

214 Peri-uterine Phlegmon. [April,

clined forwards, its orifice slightly gaping. The body of the uterus
could not be felt by the hand on the abdomen, even when the organ
was lifted by the finger in the vagina.

When the finger was carried to the posterior cul-de-sac, it detected
a globular tumour, of doughy feel, immoveable, and very painful
upon pressure. The tumour filled the concavity of the sacrum, and
reached along the sides of the uterine neck as though it would em-
brace it. The tumour was felt compressing the rectum when the
finger was introduced into that cavity. The abdomen was yielding,
undeformed, painless upon pressure.

The pulse, although feeble and slightly accelerated, was regular.
The first sound of the heart was accompanied by a very faint bellows
murmur.

I did not wish to u&e the catheter immediately, for fear of oc-
casioning too much pain, and I prescribed : 10 cups upon the abdomen ;
cataplasms; emolient vaginal injections containing opium ; an opium
pill ; a laxative enema ; repose in bed, and diet.

Two days subsequently the appetite returned. The pain had so
much diminished that 1 was able to introduce an uterine sound. It
entered without encountering the slightest obstacle, and while it was
in the uterine cavity, the tumour already alluded to was felt distinctly
behind the cervix. (Baths. Rejwse. Laxatives.)

Under this treatment the tumour gradually diminished, and the
other symptoms disappeared. On the tenth day all spontaneous pain
had subsided, but pressure still produced pain. On the fifteenth day
there was no pain on pressure, and the tumor was reduced to half its
volume.

On the twentieth day its existence could hardly be detected ; the
strength had returned, and the patient left the hospital.

Reflections. What was the disease from which this woman
suffered before she entered the hospital ? Was it not an af-
fection altogether similar to that for which she was treated?
There is every reason to believe so, for the symptoms were
the same. Moreover it is not uncommon to meet with cases
of relapse at longer or shorter intervals, so that this case, re-
garded from that point of view, is not at all exceptional.

The disease appeared at the catamenial period, and there
was considerable menorrhagia. There is nothing extraordina-
ry in this, for this affection begins at the menstrual epoch in
the great majority of cases, and there was a sub-acute inflam-
mation of the womb, as was shown by direct exploration ; now,
according to the recent researches of Herard, metrorrhagia is
a common symptom of metritis.

In a single case out of 17, the disease supervened a short
time after delivery. Perhaps this may hereafter be found to
be a more common cause. It is remarkable, however, that it
should apparently have had so little influence in the cases I

1854.] Peri-uterine Phlegmon. 215

have observed, when it is recollected how frequently inflam-
mation attacks the broad ligaments after parturition. We
must not confound with these cases those in which inflamma-
tion existing primarily in the iliac fossa subsequently invades
the cellular tissue around the neck, because, in the latter, there
is a simple extension of inflammation.

Inflammation of the uterus and vagina may nevertheless ex-
tend to the peri-uterine tissue, and produce the disease which
we are considering. I observed an instance of this in a girl of
17, who had contracted a vaginitis. The inflammation attack-
ed the uterus and subsequently the peri-uterine tissue ; the
extension of the inflammation caused acute pain, and produced
a tumour which suppurated.

In one case, the peri-uterine inflammation occurred after ex-
cessive indulgence in coition.

In all the other patients, there was no appreciable proximate
cause. During the catemenial period severe pains occurred ;
fever lighted up, and the disease declared itself.

Symptoms. The symptoms of this affection are very char-
acteristic, and admit of a positive diagnosis. They differ in
some respects according to the seat of the disease, which we
consequently divide into three principal varieties. The first is
retro-uterine phlegmon ; the second is ante-uterine phlegmon ;
and the third is a combination of these two species. In describ-
ing the first species I shall make known the symptoms which
are common to the three : it will be sufficient afterwards to
indicate the peculiarities of the two others.

1. Retro-uterine Phlegmon. Outset. Before experien-
cing the characteristic symptoms of the disease, all of the
patients suffered for some hours from malaise and a sense of
weight and heat in the rectum. Six out of eleven had a mark-
ed chill. In all there was loss of appetite and constipation.

The first symptom of the confirmed disease is pain. Sponta-
neous pain is a constant symptom ; it is always considerable
and sometimes excessive. It comes on with violent exacerba-
tions, which are sometimes unendurable, the patients rolling
on their beds, contorting their bodies, and uttering cries.
They describe the pain differently. Some complain of a sen-
sation of burning, others of a painful throbbing, the majority of
a violent lancinating pain. Pain upon pressure is not less con-
stant ; it is developed by pressure upon the hvpogastrium, by
percussion, by vaginal exploration, and especially by the pas-
sage of faecal matters through the intestine. Defecation causes
acute suffering in the region of the sacrum and anus, and is
usually the signal for one of those violent exacerbations already
desciibed.

216 Peri-uterine Phlegmon. [April,

There is one constant and remarkable symptom which de-
serves especial mention. I refer to the expulsive pains which
are felt in the rectum. The patients experience the sensation
of a foreign body in the gut, which induces ineffectual con-
tractions, and which depends upon two different causes : upon
the pressure of the inflammatory tumour upon the anterior
wall of the rectum, and upon the propagation of the inflamma-
tion to the coats of the intestine, which is manifested by the
expulsion of mucus. These pains, which have been already
remarked in retro-uterine hematocele, are more striking in the
disease of which we are speaking, and amount to something
characteristic.

By the finger in the vagina, a tumour is discovered behind
the neck of the uterus, and separated from it by a deep furrow.
When this tumour is very large, it completely effaces the pos-
terior cul-de-sac, as I observed in a case which I shall mention
farther on, which terminated in suppuration. The size of this
tumour is usually equal to the half of a hen's egg; the angle
formed between it and the cervix almost equals in depth the
posterior vaginal cul-de-sac. The transverse rugae of the va-
gina may be felt upon the surface of the tumour, which is im-
moveable, of soft consistence, but without fluctuation. The
contact of the finger at this point gives great pain. We shall
find, when we come to speak of the diagnosis, that this state of
things so closely simulates retroflexion, as to have often been
mistaken for it.

Exploration by the rectum causes mat pain, and may usually
be dispensed with. It enables the physician to feel a tumour
in front of the gut.

When the tumour is of greater size, its surface is smoother,
but not so much so as in retro-uterine ha?matocle. By one
finger in the vagina and another in the rectum its inferior por-
tion may be pressed, and we may judge of the amount of
thickening in the recto- vaginal partition in which it is develop-
ed. Occasionally, at a certain period of the disease, manifest
fluctuation may be detected in this way.

At the same time, the finger in the vagina finds heat, pain,
and throbbing in the neck of the uterus; in a word, all the
signs of inflammation of that part are manifested. By palpa-
tion, with the hand on the hypogastrium, we find that the other
peri-uterine tissues, the broad ligaments, etc., are yielding and
exempt from inflammation.

A speculum examination is extremely painful and is gener-
ally useless. It may show the visible symptoms of inflamma-
tion of the cervix, which has already been revealed by other
symptoms.

1854.] Peri-uterine Phlegmon. 217

As regards the digestive organs, the symptoms are usually-
limited to loss of appetite, slight thirst and nausea, and obstin-
ate constipation with the expulsive pains I have already men-
tioned ; or, when the inflammation extends to the rectum,
diarrhoea comes on, with tenesmus, and mucous passages simi-
lar to those of dysentery.

In two cases, bilious vomiting, continual nausea and slight
salivation, were conjoined with the preceding symptoms. The
inflammation, in these instances, had evidently spread to the
peritoneum, as was shown by the hypogastric tenderness, etc.

There was no derangement of the urinary organs so long as
the ante-uterine cellular tissue was not involved.

The pulse was moderately accelerated in the majority of
cases ; in the two instances in which the neighbouring periton-
eum became involved, it rose to 108 and 114, and became small
and feeble ; in the other cases it was never beyond 90, and
preserved its ordiuary volume.

The face was always anxious, and, during the exacerbations
expressive of the greatest suffering.

The decubitus was usually dorsal, the head being raised and
the trunk slightly flexed.

I have never observed any cerebral symptoms.

Such are the symptoms of this disease. In cases in which
suppuration is established they are modified, and then rapidly
amend when the abscess opens and liberates the confined pus.
But I shall return to this point in speaking of the terminations
of the disease.

2. Ante-uterine Phlegmon. As I have already mentioned,
I have only observed this inflammation in an isolated form three
times. The symptoms peculiar to it are the following: The
patients experience acute pain in the hypogastrium with ex-
acerbations. The finger in the vagina finds the posterior cul-
de-sac perfectly free and yielding. In the anterior cul-de-sac,
on the contrary, it discovers a tension, an unusual resistance
caused by inflammation, and not a rounded and circumscribed
tumour as in the preceding variety. The condensed nature of
the tissue uniting the vaginal wall to the bladder, explains this
difference. The lateral limits of this tension cannot be per-
ceived distinctly. Pressure upon the tense parts occasions the
most acute pain, and the same result is caused when traction
is exercised upon the part by pushing the cervix uteri back-
wards.

Another constant symptom is the pain caused by the vesical
contractions during micturition. Frequent and irresistible de-
sire to urinate also supervenes.

218 Peri-uterine Phlegmon. [April,

All of the symptoms described under the former variety,
except those which have their seat in the rectum, belong
equally to this. I have remarked, however, that peritoneal
symptoms were more commonly manifested in the ante-uterine
variety ; because, no doubt, inflammation extends upwards
with more facility in the direction in which the tissue is looser.

3. Ante and Retro-uterine Inflammations combined.

This variety does not require a separate description, since a
portrait of the disease may be had by adding the symptoms
peculiar to each of the other varieties to those which are com-
mon to both. It is sufficient, therefore, to mention it. I have
seen but two cases of it ; in these inflammation appeared first
in the parts behind the cervix, and was not developed anteri-
orly for two or three days.

As to the case in which the inflammation was located on one
side of the cervix, inasmuch as the tumour inclined backwards
towards the rectum, the symptoms of the first variety predom-
inated.

Progress, Duration and Termination, The progress of the
disease should be studied with the greatest care, for it furnishei
matter for the most important considerations. It presents, as
I have already repeatedly mentioned, violent exacerbations.
These occur even when the inflammation remains limited to
the parts posterior to the uterus, and can only be explained,
under these circumstances, by the successive invasion of many
closely connected portions of the peri-uterine tissue. When
inflammation extends to more distant parts, as the lateral or
anterior cellular structure, these extensions also occur at inter-
vals, and account for the exacerbations.

These intervals of violent pain and relative calm give this
affection a peculiar physiognomy, with which the physician
must be well acquainted not to be led into error. The first
symptoms are violent, they amend rapidly under treatment, or
even disappear altogether, and the physician may imagine that
the disease will gradually subside ; but it is not so. At the end
of eight, ten, or even twenty-four hours, the symptoms returned
with increased intensity, and so proceed in an irregular inter-
mittent form for six or eight days. In some cases I have even
known this intermittency to resemble periodicity so closely as
to induce the attendants to administer sulphate of quinia.

The duration of the affection, when it terminates in resolu-
tion, is usually eight or ten days. After this period, however, a
painful induration still remains at the part which was inflamed,
and the patients should be very prudent. When the disease

1854.] Peri-uterine Phlegmon. 219

terminates in suppuration, the symptoms are more protracted,
because several days elapse before the purulent collection
forms ; after this, a natural or artificial opening into the tumor
promptly relieves the patient's sufferings.

The disease ordinarily terminates in resolution. In 25 cases,
I have seen suppuration only twice in retro-uterine inflamma-
tion, once in ante-uterine inflammation, and once when inflam-
mation occupied both the anterior and posterior cellular tissue;
in all, 4 cases out of 25. This is a very important point, for
it proves that this disease has been often misunderstood, since
it has only been studied in those cases in which it has produ-
ced an abscess, and yet it is not less strikingly characterized
when it terminates by resolution.

Fluctuation is readily detected only in the retro-uterine varie-
ty and in those cases alone of this form in which the tumor pro-
jects considerably between the rectal and vaginal walls. In all
of the cases which I have observed the pus found its way into
the vagina; we can easily conceive, however, that the abscess
may open into the rectum. When the tumour opens spontane-
ously into the vagina, the genital organs are found bathed in
pus, but it is usually impossible to discover the orifice by which
that liquid escapes, concealed as it is in the folds of the vagina.

In some instances the pus has been evacuated by the bistou-
ry, as was done in the following case :

Case II. Retro-uterme Phlegmon. Termination by suppuration.
Marie Gautrou, aged 30, entered la Pitie, May 3d, 1853, Ward S.
Genevieve, No. 26.

This woman gave birth to her first child on the 21st of February,
1853. Her labor was natural, and only lasted six hours; she was
delivered of a male child, at term. Three days afterwards she was
attacked by high fever and nervous agitation, and was bled ; she got
up in nine days.

A fortnight after her confinement, without having had either chill
or fever, she was seized with violent pain in the hypogastrium, espe-
cially on the right side, with cramps in the limbs ; at the same time
there was a slight oozing of blood from the vagina. She simply ap-
plied cataplasms on the abdomen.

For the last fortnight she has been more sick. She has had pain
in the left iliac fossa during her catamenial period ; defecation has
become difficult and painful, and she suffers from colics and expulsive
pains in the rectum.

May 4th. Upon percussing the hypogastrium, we found dullness
for three fingers breadth above the pubis. Upon palpation, the fun-
dus of the uterus was felt to be large and rounded. By the finger in
the vagina, it was ascertained that both the body and neck of the
uterus were carried slightly forwards. Behind the cervix, which

220 Peri-uterine Phlegmon. [April

was patulous,, we perceived a fluctuating tumour, which seemed to be
a part of the uterus. The posterior cul-de-sac was obliterated. The
tumour had a smooth surface, was soft, and very painful on pressure.
It descended to the commencement of the middle third of the posterior
wall of the vagina. Upon introducing the middle finger into the rec-
tum and the index into the vagina, the tumour could be felt between
the two.

The tumor obtruded upon the rectum, and gave rise to tenesmus.
The pulse was normal, and the heat of skin was not augmented. (15
leeches to the hypogastrium ; emollient encmata with opium ; emollient
injections ; cataplasms )

May 8th. The tumour projects farther into the vagina, and pre-
sents fluctuation. The sense of weight in the rectum and the tenes-
mus continues ; the patient passes only a little liquid matter in her
stools. There is still pain and insistence upon pressure in the hypo,
gastrium. (Emollient injectfons and cataplasms ; an opium pill ; 12
leeches to the hypogastrium.)

i \0lh. There is less prominence in the vagina ; fluctuation
is evident; the pain has diminished. There have been neither chills
nor horripilations, but the pulse is somewhat accelerated and the heat
of surface is increased.

May VSth. The patient has suffered much less since the leeches
were applied. The vaginal wall of the tumour has become very thin.

On the night of the 19th the tumour opened spontaneously, but a
very small quantity of pus escaped. The next day I made a large
opening with the bistoury, and gave issue to the remainder of the
purulent collection.

Four days afterwards the tumor had almost disappeared, and the
pain had git atly diminished.

The 25th of June the patient left the hospital perfectly well, with
the exception of a slight induration of the recto-vaginal wall.

Reflections. In this case we have all the symptoms of retro-
uterine phlegmon, uncomplicated with peritoneal inflammation.
The patient had been delivered two months and a half when
she came under my observation. Should we refer the com-
mencement of the retro-uterine inflammation for which she was
treated to the period at which she experienced pain in the hyp-
ogastrium and cramps in the limbs, two weeks after her con-
finement ? I think not. An inflammation of this sort may
have existed at that period, but it must have subsided sponta-
neously, for the patient was free from pain until the occurrence
of the characteristic symptoms which appeared a fortnight be-
fore her entrance into the hospital. Most probably there was
simple metritis on the first occasion, for, it will be remarked,
there were then none of those symptoms about the rectum
which give the disease we are considering its peculiar physiog-
nomy.

1854.] Peri-uterine Phlegmon. 221

When the inflammation is located in the parts anterior to the
uterus, pus may likewise find its way into the vagina, asl have
seen it to do in one instance. I know of no case, however, in
which such an abscess has been opened by the knife ; for under
these circumstances, the tumour is not prominent, and it is dif-
ficult to detect fluctuation.

In one instance I have known the abscess to open into the
bladder. This accident was announced by frequent desires to
urinate, pain after micturition, and the presence of a quantity
of foetid, greyish, diffluent pus in the urine.

Lastly, the inflammation sometimes extends to the broad lig-
aments, and the disease then assumes other symptoms, with
which every one is acquainted,

Anatomical Lesions. As peri uterine inflammation is not
in itself a cause of death, we should be ignorant of its exact
morbid anatomy had not the extension of the inflammation, or
the rupture of an abscess, occasionally given rise to fatal peri-
tonitis, or some other grave lesion. In such cases there have
been found in the reduplication of the vaginal wall and rectum
or in the cellular tissue uniting the bladder and uterus, absces-
ses containing phlegmonous or sanious pus, and the different
openings into neighboring cavities to which I have already al-
luded. It would be useless to enlarge upon this point.

Diagnosis. The diagnosis of this disease was very difficult
before the introduction of the modes of exploration which we
now possess. The affection was then only recognized by a few
physicians, and by them only in those cases in which an abscess
lormed. I have myself witnessed many very pardonable
errors of diagnosis.

Retro-uterine phlegmon is most likely to be confounded with
retro-flexion. A vaginal exploration gives almost identical
results in the two cases. In both, the cervix is a little for-
ward, there is a tumor at the posterior and superior portion of
the vagina, and a deep sulcus between the cervix and the tumor.
The tumor is harder and less painful in retroflexion, it is true,
but these are insufficient distinctions. Doubt is immediately
removed, however, by the employment of the uterine sound.
In retro-uterine phlegmon this instrument readily enters the
uterine cavity, and penetrates an inch or more, and the tumour
remains immovable. Sometimes the inflammatory swelling is
so great that the womb is deviated to the right or left. If, then,
there is some difficulty in introducing the sound, it is not neces-
sary to employ force, but the beak of the instrument should be
gently inclined to the right and left, and it will presently ad-
vance towards one or the other of the iliac fossae.

I have been consulted three times for supposed retroflections,

222 Peri-uterine Phlegmon. [April,

which were nothing but inflammations of this sort. In two of
them, painful pressure had been employed with a view of redu-
cing the deviation. The mode of exploration which I have des-
cribed proved the error which had been committed, and the
patients recovered under the treatment which I shall presently
detail.

The same method of diagnosis will distinguish retro-uterine
phlegmon from a tumor of the posterior wallofthe uterus, from
an ovarian tumor, etc.

Inflammation of the cellular tissue between the cervix and
bladder may be mistaken for cystitis. The circumscribed pain
and tension in the anterior vaginal cul-de-sac, and the gastric
and peritoneal symptoms will suffice to prove the existence of
the first of these two affections.

Prognosis Notwithstanding the severity of the symptoms,
the prognosis is not grave. It <>nlv becomes so when inflamma-
tion extends to other parts; but then we have another disease.
The most favorable point of opening for the abscess is the
vagina.

Treatment The treatment of these ailections may be sum-
med up in a very few words.

General and local blood-letting should be employed in the
fust instance with considerable energy. I have principally re-
lied upon cups and leeches, and have almost always had to em-
ploy them three or lour times to combat the exacerbations to
which I have alluded. They invariably produce some relief.

The second method consists in the application of very small
blisters, dressed with a salt of morphia, (gr. \ to gr. j.) I direct
them to be renewed as often as they dry up. By calming
the pain, they render the progress of the disease more uniform.
Their good effect was manifest in every case.

As adjuvants, we have cataplasms, hip-baths, emolient and
narcotic injections, nnrcotics internally, ice, Selzer water, and
the portion of Riviere* in case of vomiting.

When constipation is obstinate, as it usually is, a laxative
should always be administered. It may consist of magnesia,
citrate of magnesia, sulphate of soda, etc.

Lastly, diet and the most absolute rest, complete tins simple
treatment by the aid of which the disease almost always termi-
nates by resolution.

When abscess occurs it may be opened with the bistoury ;

*The anti-emetic portion of Riviere consists of : Citric acid, grammes ij.,
(gr. xl); Simple syrup, gram, xxv., (j .) ; Bi-carbonate of potassa, gram, ij.,
(gr. xl.); Water, gram, exx, givss.) The American measurements are only
approximate, but the proportions are observed. (Taken from the Formulairc
des hopilaux de Paris.) Translator.

1854.] Emphysema in Children. 223

but this operation should not be attempted unless the tumour
projects considerably into the vagina, and fluctuation is unmis-
takeable. When the abscess opens spontaneously, the orifice
is sometimes too small to allow of the perfect evacuation of the
pus. Under such circumstances the opening should be en-
larged bv a probe-pointed bistoury, the parts being exposed by
a bi-valve speculum. If the spontaneous opening cannot be
discovered, a simple puncture should be made, after which the
probe-pointed knife may be used as before.

When the pus flows into the vagina, emollient injections
should be frequently employed ; or if it escapes by the rectum
or bladder, it is equally useful to wash out these organs with
some emollient liquid. [Virginia Med. and Surg. Journal.

General Emphysema in Children. By Dr. Roger.

On seven different occasions, I have seen children, who,
without any appreciable external cause, without any apparent
surgical lesion, without having made any violent muscular
effort,* and almost always during the course of some affection
of the chest, presented suddenly the following symptoms: A
tumour appeared at the lower lateral or anterior part of the
neck, without any discolouration of the skin, spreading but not
disappearing under the pressure of the hand, and giving an evi-
dent sensation of crepitation. This tumour, or rather this
prominence, at first less than an inch in diameter, extends
whenever the child cries or makes large respiratory move-
ments ; it gains the face, puffing up the cellular tissue and com-
pletely altering the physiognomy, and descending towards the
arms, thorax and abdomen, it involves the whole surface, unless
its progress is interrupted by death.

The pathognomonic crepitation tells us at once the nature of
the affection. There is evidently emphysema of the areolar
tissue, which, originating in some thoracic lesion, has progressed
by continuity and contiguity in every direction.

While this infiltration of air is going on, grave functional
disorders make their appearance. The respiration, already
accelerated by the primary disease, becomes yet more rapid ?
the pulse becomes extremely frequent and small, and in a few
hours, or one or two days at the utmost, the child succumbs to
asphyxia, complicated, perhaps, with coma and cyanosis, its
body disfigured and monstrously distended.

* M. Velpeau has presented to the Academy of Medicine, in the name of
M. Vitali, a case of general emphysema, supervening in a boy while he was
struggling to disengage himself Irom the arms of a play-fellow. (Arch. Gen.de
Med.~ t. xxi., p. 37-2.)

224 Emphysema in Children. [April,

What was the cause of this genera] emphysema in these
seven cases? Is it possible to admit a spontaneous gasseous
exhalation, a true secretion? or shall we rather suppose that
the air-passages were opened at some point and placed in com-
munication with the peripheral areolar tissue ? Without deny-
ing absolutely the possibility of the development of gas in living
parts,* I believe that the emphysema which occurred in these
cases is much more naturally explained by supposing some
solution of continuity in the air-passages.

This explanation is confirmed by analogy. Emphysema oc-
curs in childhood as well as at other periods of life, from surgi-
cal injuries involving the organs of respiration ; it is not rare in
difficult labours in which the patients strain violently ; it has
been observed in adults, in cases of rupture of sub-pleural pul-
monary emphysema, f or of opening of a tubercular cavity at
the apex of the lung into the cellular tissue of the inferior por-
tion of the neck. Dr. Boddand, of Gand, has reported J the
case of a young girl of 16, who died from general emphysema,
in which was discovered "in the right ventricle of the larynx,
a little below the vocal chord, a small round ulcer, perforated
in its centre," through which the air had entered the cellular
tissue. Dr. Burgraeve has even cited an example of general
emphvsema consequent upon softening of the stomach with
sub-peritoneal rupture of that viscus.

It was in children presenting analogous pathological condi-
tions, that I observed the development of general emphysema.
The reader may judge by the following cases, which 1 will sum
up briefly :

Case I. 15 , a little girl of two years, had laboured under

double pneumonia for several days. One morning I noticed a swell-
ing of the lower part of the cheek with the characteristic crepitus.
The emphysema extended to th$ neck and upper part of the chest, and
death occurred in less than forty-eight hours. The application of dry
cups over the emphysematous parts gave no relief.

* The development of gas during life is not rare, says Voge\,(Encyc. Anatom.,
t ix., Path. Anal., Am. ed., p. 38); it takes place in putrid levers,' in typhus,
and gangrene. It is commonly evolved from the animal fluids, especially from
the blood, when, before undergoing any chemical decomposition, it is arrested
in different parts of the body, and its purification by respiration and secretion is
thus impeded ; or, when certain secretions, as the bile and urine, are checked,
and their constituents remain in the blood. Gaseous products are then developed,
which collect in the parenchyma of organs, and in the cellular tissue, constituting
emphysema. Authors have also spoken of spontaneous gaseous exhalation after
the bite of the rattle-snake; but they do not allude to the infiltration of this gas,
(except, perhaps, in the cases of gangrene observed by M. Sigaud ; see his work
on the Diseases of Brazil.)

t Archives Generates. 1843. T. i., p. 473.

t Gazette Medicate de Paris. T. viii., p. 698.

1854.] Emphysema in Children. *-2*2*>

Case II. A boy of three years, affected with a pneumonia follow-
ing hooping-cough. Emphysema of the neck, thorax, face and abdo-
men. Death two days afterwards

Case III. A girl of five years, at Villette ; symptoms of broncho-
pneumonia. The face and neck were emphysematous when I saw
her ; high fever and dyspnoea. Death was impending.

Case IV. A boy of four years, of robust frame. Bronchitis;
pleurisy of the left side ; paroxysms of hooping-cough without sibilus.
After three or four days, emphysema was discovered one morning.
It occupied the face and neck, subsequently the thorax M. Roux
was called in consultation and proposed punctures, which were not
practiced.

Case V. An infant daughter of Madame L , at Gonesse :

double broncho-pneumonia. Emphysema mistaken for anasarca, had
extended to the abdomen. I was called in consultation, and arrived
when the child was moribund.

Case VI. A little girl of one year, suffering from impetiginous
eczema of the scalp, with profuse sero-purulent discharge. On the
third day a tumefaction appeared altogether analogous to that which
characterizes mumps. High fever came on, and vomiting and a
greenish diarrhoea ; subsequently there were some convulsive move-
ments, and then emphysema appeared upon the neck and extended to
the face and thorax. Death occurred in two days, there having been
no diminution in the sero-purulent discharge.

Case VII. Quite recently I was called in consultation by Dr,
Ozanam to a child of rive years, who had been attacked successively
by measles and broncho pneumonia. Dyspnoea and extreme frequen-
cy of pulse had supervened, and, at the same time, a superficial
emphysema, which was at first circumscribed, but which extended
gradually over the trunk as far as the navel. The pneumonia had
been treated by Kermes mineral, calomel, aconite, and blisters. I
advised numerous punctures, and Dr. Ozanam accordingly inserted a
fine trocar a great number of times. This treatment was fortunately-
successful, and an altogether exceptional cure was obtained. Dr.
Ozanam will soon publish the details of this case, which, we believer
is unique.

To the foregoing cases we would add :

1. Three or four similar observations which M. Guersent
encountered in his long career, but in which no autopsy was
made.

2. A case which is somewhat analagous to those which pre-
cede. It relates to a child on whom M. Guersent (the younger)
practiced tracheotomy to prevent asphyxia from croup. The
air in passing through the opening made in the trachea infiltra-
ted itself into the cellular tissue of the edges of the wound, andr
notwithstanding methodical compression, it gained the face
and thorax and thence occupied the whole body. The child
died in three davs.

226 Emphysejna in Children. [.April,

3. A case published in V Union Medicale (Feb. 8th, 1853),
by M. Sandret, of Besancon. In a child affected with hydro-
phobia, a spontaneous emphysema appeared on the last day of
life, and pervaded the whole surface.

Upon examining the facts which I have briefly recapitulated,
it will be seen that in every case the patients were affected
with some acute disease of the respiratory organs, just as
talis Guillot observed in the cases which he has reported. In
all, the characteristic sub-cutaneous crepitation was first mani-
fested either in the course or in the immediate vicinity of the
organs of respiration.

Should we not conclude from these facts, and from the fore-
going considerations, that in these young subjects some lacera-
tion of the mucous membrane of the trachea, or some rupture
of the pulmonary cells and corresponding pleura occurred
during a fit of crying or coughing, and that the air passing
through this orifice gradually permeated the cellular tissue of
the whole body. Such must have been the mechanism of the
case of general emphysema which I met in my private prac-
tice, although I was not allowed to make an autopsy by which
this assertion might be verified.

M. Guillot, more fortunate than I, has proved this fact in the
most positive manner by his remarkable researches.

The prognosis of general emphysema is extremely grave.
With one exception, every case I have seen has rapidly ter-
minated in death. Dr. Ozanam's case proves, however, that
death is not inevitable, and that the lesion is not altogether
hopeless.

The dilatations of sub-pleural emphysema, when they burst,
which is a most rare occurrence, are perforated by an exceed-
ingly minute orifice, as M. Guillot has demonstrated ; it is not
impossible, therefore, that occlusion may take place almost im-
mediately by means of adhesive inflammation. The perforation
once obliterated, (as happens in pneumo-thorax sometimes,)
the air infiltrated into the cellular tissue may be absorbed.
What we observe in traumatic emphysema of the walls of the
thorax, proves that absorption is not very difficult under such
circumstances.

As to the treatment of general emphysema, I believe that
absorption of the infiltrated air may be promoted by resolvent
applications ; but it is first necessary to combat the immediate
effects of the laceration of the lung, that is to say the progress-
ive permeation of the cellular tissue. Calmatives, opiates,
other narcotics, and digitalis, diminish the frequency of the
respiration, and consequently the chances of generalization of
the emphysema. The little patients will at least be comforted,

1854.] Medical Properties of Nitrate of Soda. 827

and the fatal termination retarded; and it is not impossible that
by gaining this delay adhesive inflammation will have time to
obliterate the perforation.

I believe, however, that it is perfectly justifiable to evacuate
the air by slight incisions, or punctures with a fine trocar, with-
out waiting for an occlusion of which there is only a bare pos-
sibility, or for a re-absorption which is a very tedious process.
It will be seen (case vii.) that this course was adopted in the
only instance in which a cure has been effected. [Rev. Mi d.
Chirurg., from Gaz Med. de Strasbourg, and Ibid.

On the Medical properties of Nitrate of Soda. Bv J. B.
Brown, M. D.

This article which in many works on Materia Medica is not
even mentioned, seems to be possessed of qualities too valuable
to be entirely passed over, or as is done in some books, merely
quoted for the purpose of calling its name. As I have made
use of this drug with much success in my own practice during
the last two years in this country, I deem it a duty to commu-
nicate the results to our profession.

The first notice of the physiological action of this salt I found
in a medical journal for 1843. in which Dr. Zimmerman pub-
lished the results of his experiments ; it is as follows:

- Nitrate of Soda dissolves the protein element of the blood
much less than Nitrate of Potassa, coagulated fibrin being but
very little or rather not at all influenced by it, while at the same
time it contracts the blood corpuscles much more firmly even
to shriveling, and renders the serum redder and richer in
haematin."

Rademacher, a Physician of Vienna, was probably the first
who used this article to any very great extent as a therapeuti-
cal agent. As he attributes to it the most extraordinary prop-
erties in different diseases, claiming it as a universal remedy
and recommending it in the most heterogeneous affections
without stating any particular indications for its use. I was in-
duced two years since to make some experiments myself for
the purpose of ascertaining whether the medicine possessed
the value which its friends had claimed for it. Rademacher
thinks that it is more useful in gastric fevers than Nit Potass,
which as an active solvent of fibrine, causes a more rapid
putrescence, and which in cases where the a priori zymotic
tendency is evidently contra-indicated, whilst the Nit Soda
although it restrains the pseudoplastic process, does not produce
anv excessive evacuations.

228 Medical Properties of Nitrate of Soda. [April,

When given as a gentle laxative this salt is easily borne, but
when given in large quantities it produces fluid passages with
tenesmus. Nevertheless according to my experience with this
remedy in the prevailing diseases of this country such as irri-
tation of the mucous membrane of the intestines and especially
in acute or chronic dysentery, its value can scarcely be surpas-
sed by any other agent of our materia medica. No remedy
has so rapidly succeeded with me in restoring natural passages
and relieving the intense suffering in the worse forms of this
annual complaint, as Nitrate of Soda. Most of my cases, I had
to treat only four or five days, when all the symptoms under
the influence of this specific, if I may use this term, disappear-
ed entirely. Other cases, in which a cure was not so speedily
brought about, were comparatively rare, and I found this fact
greatly owing to a fault of diet or some other unfavorable cir-
cumstance of the patient. Nevertheless I have been so fortu-
nate, as never to treat any case of dysentery longer than at
most for a fortnight, whilst out of 6 cases I generally restored 5
of them to health, within the above mentioned limited space of
a few days. It is not my purpose to enter into a detail of the
treatment of this disease, but I will confine myself here to a
single remark, that of all the remedies in use against it, there is
no one existing, to my knowledge, safer, quicker and more in-
nocent in its agency, than the one under consideration.

The formula I usually employ is this :

fy 01. Amygdal. dulc. 3iv to vj

Gum Mimos. 3ij to iij

Aq. distillat. 5 jv to vj

Fiat lege artis emulsio, cui adde
Sodic Nitratis ) aa

Aquas lauro-Cerasi ) 3ss

Syr. Simp. 3j

M. S. A table-spoonful to be taken every one to two hours,
after having been well shaken.

For children I prescribe the half or only third part of the
quantity, and I found it an excellent means for overcoming in
their different forms, diarrhoea and dysentery, at least for the
purpose of diminishing the irritability of the bowels, after which
other remedies, according to the indications of the case, might
be made use of.

After the evacuations have become normal, the medicine is to
be continued for one or two days, on account of a great liabili-
ty to relapse, which not unfrequently may very disagreeably
surprise both the patient and physician. But this disposition is
owing to the disease itself, as every practitioner will agree, and
not to the specific effect of Nitrate of Soda. In some cases of

1854.] Milk from Spayed Cows. 229

the most severe characters I ordered the addition of a few
grains of the Extract of Opium to the former mixture, in order
to allay more rapidly the extremely painful tenesmus and the
nervous excitement in general. I prefer the extract to the
opium in substance, because it has a milder effect, quieting the
system more and not producing that peculiar venous orgas-
mus, which opium itself does. But I must remark here that
even this milder preparation of opium ought never to be used
for several days in succession for reasons I can not now explain,
being beyond the limits of my present purpose. One of my
patients, who suffered in a dreadful manner, after taking a mix-
ture of brandy with pepper, in order to stop the whole- matter
at once, as he thought, had to take the above described portion
four times one after the other; within 7 days he was perfectly
restored.

I have been now in more than a hundred cases of dysentery
so successful, as to restore my patients within the period of from
4 to 14 days at most, under the principal influence of Nitrate of
Soda, never using a single grain of calomel, which I avoid for
fear of salivation and of its consequence, these being often as
bad a complaint as the former, or even still worse. I would
therefore recommend this salt as a very powerful and innocent
substitute for calomel in all the different forms of dysenteric
or congestive diarrhoea and dysentery.

I would mention, en passant, that tonics or astringents are
to be employed, whenever, after the disappearance of the char-
acteristic mucous discharges, a tendency to a diarrhoea from
atony manifests itself, either spontaneously or in consequence
of an improper diet. [North Western Med. and Surg. Journal.

Milk from Spayed Cows. By J. U. Heckerman, Tiffin Citv,
Ohio.

Except bread alone, there is perhaps no article that enters
so largely into the consumption of man as that of milk. As
food and drink, it is extensively consumed by the adult portion
of our race, it constitutes the exclusive nourishment of nine
tenths of all children under twelve months, and forms the
chief diet of the remaining one tenth.

The chemical and medical properties of milk have long been
made the subject of scientific investigation, and long has the
writer in vain looked for something from the pen of a senior
observer on the point to which he now wishes to direct atten-
tion.

It has ever been a desideratum in the rearing of children who
are denied the breast of a mother or nurse, to procure milk

n. s. vol. x. NO. iv. 15

230 Milk from Spayed Cows. [April,

from an animal in which it approaches nearest to that of the
human female, and which shall uniformly have the same con-
stituent properties.

In looking over the tables which are given of the constitu-
ents of milk, we seldom meet two authors who agree in their
observations; indeed so great are the discrepancies, that they
only serve to confound us in confusion. This circumstance
can be accounted for by the different animals experimented
upon, the season of the year, the character of the food afforded
and the period of pregnancy or non-pregnancy of the animals
at the lime of the experiments. Taking the cow, we find that
exercise and food, among other things, greatly affect the quali-
ty of the milk. The milk of cows kept in the byre contains a
larger amount of butyrine than is afforded by animals running
at large, while the milk of the latter abounds more in caseine.
So great, indeed is the influence of food upon the secretions,
that when cows are fed upon bitter or strong smelling grass
or herbs, the taste and smell of such grass is imparted to the
milk.

Milk, we" have already said, forms the chief diet of that un-
fortunate class of infants, who are reared by dry nursing, and
it is estimated that three fourths of these die ; indeed, it has
been said that, in London, this mortality amounts to seven
eighths of the whole number. Be this as it may, we do know
the mortality to be very great, sufficiently so at least to de-
mand the earnest attention of every physician.

Standard authors direct children who are thus reared, or
who have been early weaned from the breast, to be supported
on milk largely diluted by water, and sugar, without, however,
any reference to the condition of the animal from which the
milk is derived. This we hold to be a serious defect, to be
especiallyso considered, when the remedy is at hand, yet seldom
or never used, for lack of information upon the subject.

Lasaigne found that the milk of cows far advanced in preg-
nancy, contains neither caseine, sugar of milk or lactic acid,
but abounded in albumen and uncombined soda ; while from
the same animal shortly after parturition, the three first named
substances were found, and albumen was entirely absent.

It is now the received opinion, that upon the accession of
pregnancy a woman should no longer furnish nourishment to
a former child, and that such continuance proves detrimental
to the health of both parties. These views are confirmed by
experience, and by the habits of inferior animals.

If the milk of a pregnant woman afford improper nutriment
to a child, surely the same fluid from a cow, in like condition,
cannot be proper. Remembering, then, that cows, on the

1854.] Dr. WehrCs Method of Turning. 2$i

average, are pregnant three fourths of the whole year, the in-
ference must be that the milk ordinarily derived from these
animals is not of a proper character to constitute the diet of
infants.

With a view to remedy this universally-existing evil, I would
suggest to the profession the propriety of having milk cows
spayed, in order to procure milk of a uniform consistency.
The act of spaying is performed with facility, and is unatten-
ded with danger, the only precaution necessary being, that no
food be given for twelve to eighteen hours, and the milk
drawn immediately before the operation ; the animal becomes
kindly disposed, is easily kept, will yield better and a larger
amount of milk in a given time, and is with great ease brought
into a marketable condition.

The steps of the operation upon the cow are the same as
upon the calf or the sow, except that it is important to place her
upon the right side, unless the operator be left handed. The
best time for operating is about four weeks after parturition,
as the future amount of milk will depend upon the quantity
given at the time of the operation. For some weeks after, the
secretion of milk will be small, but will gradually increase un-
til the amount previously given is furnished, which we have
known continue without interruption (of course less in winter
than in summer) for the space of ten years.

It is not expected that every father can be circumstanced to
keep a cow for the accomodation of his child ; but if physicians
were to direct the attention of those who do keep cows, to the
above facts, it would be found advantageous to keep the spaved
instead of the ordinary animal, and the proprietors of milk-fur-
nishing dairies would readily furnish the supply, if the demand
was made. The fact above briefly stated, we think of suffi-
cient importance to claim the attention of every medical prac-
titioner, as furnishing him the means of preventing much suf-
fering on the part of advancing infancy, and saving the domes-
tic idol in the circles of many grateful friends. [West. Lancet.

On Dr. Wehn's Method of Turning. By J. S. Unzicker, M.D.,
of Cincinnati.

Some years as:o I gave a translation of Dr. Wehn's method of
turning, in the Western Lancet. It differs from the old way
of turning.

1st. By placing the patient on her knees and elbows, until
one foot is brought down.

2d. By tieing the umbilical cord before it is compressed by
the head, and deliver afterwards.

232 Dr. WehrCs Method of Turning. [April,

This way of turning is undoubtedly more safe to the child,
less painful to the mother, and easier to the operator than the
old plan. Of this I am now so well satisfied, that I should con-
sider myself guilty of malpractice, were I to turn again ac-
cording to the plan as laid down by the books.

I have turned thirteen cases within the last three years, a few
of which I will here recite:

Case I. Mrs. A., age 35. At my arrival, the midwife informed
me that the patient had been in labor 36 hours, and that about 24
hours ago, the liquor amnii had escaped, and that her pains had been
very severe all this time, but that the child would not come down.
After a careful examination I found the left shoulder presenting, and
prepared for turning by placing the woman on her knees and elbows,
when the pains immediately abated. I had no difficulty in finding
the feet, bul found it very diihcult to turn, on account of the tonic
contraction of the uterus around the child. By careful manipulation,
I at last succeeded in bringing down one foot. I then placed the pa-
tient on her back, when the pains immediately returned, bringing
down the breech. Then reaching up with my left index finger and
gently bringing down the umbilical cord, which waa immediately tied,
and the head was born ten minutes after. The child is now living, a
fine boy two years old.

Case II. Mrs. D., age 23. Found right arm and cord pre
ing. Liquor amnii had escaped a few minutes before my arrival.
Finding the cord yet pulsating, I prepared to turn, but fearing that the
cord might get braced. I ligated it immediately, then bringing down
one toot, and delivered the child alive.

Case III. Mrs. R 19, with narrow pelvis. This person I

had delivered twice before unsuccessfully. The first child was born
dead, after a severe and tedious labor of 36 hours. The second child
I delivered with the forceps, but also dead. When I was called the
third time to deliver this person, I determined to try turning, before
the patient was debilitated by the severe pains which she had always
to suffer before. As soon, therefore, as the os uteri was sufficiently
dilated, I turned without difficulty, tied the cord as soon as I could
reach it, and delivered the head with the forceps. The child is living
and doing well.

Case IV. Mrs. G., age 26, of delicate constitution. Had been
in labor 18 hours. Pains very feeble. Breech presentation. Her
midwife had given two doses ofsecalae cornutum, which had no other
effect than producing nausea. I then prescribed

R. Pulv. Rad. Colchici, . . gr. x. ) xjr . 0 . -p.. .,
> , ^. > M. in 3 part. Divide.

Elaeosacchar. Cinnamon, . gr. xv. $ r

One of these powders was given every fifteen minutes, when the pains

increased, and a living child was born, the umbilical cord having been

tied like in the previous cases.

These facts but too clearly prove, (the old theory notwith-

1S54.] Common Salt in Intermittent Fever. 233

standing.) that the umbilical cord can be successfully tied, before
respiration is established. Dr. Wehn's theory regarding it, I
have not been able to obtain ; but think, myself, that the success
of his method may be explained in this way : As the head
enters the pelvis, the cord is but partially compressed, and the
circulation of venous blood in the umbilical arteries becomes
checked, while the arterial blood through the umbilical vein,
continues to be forced towards the child, the brain therebv be-
coming congested, and the child dies of apoplexy. But if the
circulation is entirely cut off by ligating the cord before the
head presses upon it, the equilibrium of the brain will be re-
tained, and no such consequences follow. [Ibid

Common Salt in Intermittent Fever.
We find in the Xew York Journal of Medicine a report by
Dr. J. C. Huchison of 22 cases of Intermittent fever, treated
with Chloride of Sodium. The following extracts will show
the result :

RECAPITULATION".

Age. 9 were under ten years of age, 6 between twelve and
twenty, 4 between twenty and forty, and 1 at forty.

Sex. 7 were males, 12 females, and 1, sex not known.

Race. 16 were white, and 4 black.

Proportion of Cases cured, benefited, tyc. Of the 22 cases
reported in 12, or 54.5 per cent, viz., Nos. 1, 3, 6, 7, 8, 12, 14,
16, 17, 19, 20, 21, the paroxysms were immediately suspended.
Nos. 12, 20, 21, occurred in the same patient.

In 3 of the cases, or 13.6 percent., viz., 5,9, 18, one parox-
ysm only occurred after the remedy was commenced. It was
completely successful, therefore, in 15 cases, 6S.2 percent. In
cases 2, 11, 22, the paroxysms were postponed or moderated.
No. 11, it will be remembered, vomited after each dose, so that
the salt was not returned in sufficient quantity to have produced
any marked anti-periodic effect. For Nos.2, 4, 13, and 15,
the remedy was not prescribed a second time, the patients ob-
jecting; an increased dose might have arrested the disease.
Case 4 did not take all that was prescribed. In one case only,
(Xo. 10.) after fair trial, was there no obvious good effect from
the remedy.

Permanency of the Cures. In three of the patients onlv, for
reasons which have been elsewhere stated, was I enabled to
ascertain with any degree of accuracy the permanency of the
cures. Cases 12, 20, 21, which occurred in the same* patient,
had longer intervals of immunity from the disease each time

234 Common Salt in Intermittent Fever. [April,

when checked by the salt, than when quinia had effected the
same purpose; and when last heard from, five months had
elapsed without a return of the malady. It was said of No. 3,
that the disorder did not return so soon as it had previously
done when checked by quinia ; and of No. 6, it will be remem-
bered, that the patient had not relapsed twelve months after
the paroxysms had been checked by nine drachms of the salt,
although they had previously returned quite frequently after
the use of quinia. So far as the evidence goes, therefore,
(which, however, is too limited for a general conclusion,) it
indicates the superiority of the chloride of sodium over the
usual remedies in the permanency of the cures effected by it.
And here we should not lose sight of the favorable influence
\h&i ?nay have been exerted by the quinia before the salt was
prescribed.

The difficulty of effecting positive cures of intermittent fever
by any remedy or course of treatment, however rigidly pursu-
ed, is very great, and sometimes impossible, even though pro-
phylactics be continually used, as long as the individual remains
exposed to the cause which developed it. The writer can here
speak emphatically, because he lias, on two different occasions,
been compelled to "fly his country, "! in order to get rid of this
harassing pest. In a number of cases, and among others now
distinctly remembered are No. 0 and 7 detailed above, the par-
oxysms would recur every two or three weeks, notwithstanding
quinia with Yallefs mass and other remedies to relieve the dis-
ordered viscera, including counter-irritation over them, were
diligently plied.

Duration of the disease, and general health of the patients.
In a large proportion of the patients the disease had existed a
very long time. Of most of them it is noted, that they had
been its victims from six to twelve months. By this it is not
to be understood that the disorder then commenced de novo,
but that it had recurred more regularly and with shorter inter-
vals during that period than previously ; for many of them had
been its victims for a much longer time, and indeed a few could
scarcely remember any period of their lives when they were
not from time to time subject to the disease. In four cases
(11, 13, 16, 17), the patients never had the disorder before;
and in most of them (all but the very recent ones), there was
of course more or less impairment of the general health, with
visceral obstructions.

Dose and Mode of Administration. The quantity given
varied from eight to twelve drachms during the apyrexia. At
first, eight drachms were given, but the amount was subse-
quently increased to nine, ten, and even twelve drachms in one

1854.] Common Salt in Intermittent Fever. 235

instance, with obvious benefit. Children required somewhat
larger proportional doses than adults.

Mucilage of elm was selected as the vehicle, on account of
its convenience, and because it sufficiently disguised the reme-
dy, which was deemed a matter of importance ; for it would
have lost much of its efficacy, or have been repudiated alto-
gether, had the patients known they were taking simply com-
mon salt ; as it is well known to physicians that the influence
of the mind upon this disease is very considerable. The fol-
lowing was the formula used :

$. Chloridi sodii, . . !iij.
Ulmi pulv. . . . 3iij.
Aq. bullientis, . . f 3 viii.
Infuse two hours and strain. This forms a saturated solution.
Dose, a table-spoonful every two, three, or four hours, so that
five or six doses may be taken during the a pyrexia. It was
not deemed necessary to precede its employment by evacuants,
because the patients had recently used such remedies during
their former attacks ; and moreover, I preferred to use the salt
alone, because its real value could thus be better determined.
When it is necessary to precede the use of the salt as an anti-
periodic, by emetics or cathartics, perhaps there is nothing
better for the purpose, in ordinary cases, than the same reme-
dy administered in emetic doses, which will usually produce
also moderate catharsis.

Disturbing Effects. In most of the cases the remedy was
well tolerated by the stomach, nausea or vomiting having oc-
curred in but four (3, 11, 14, 15). Four cases also (2,3, 15,
17), had moderate alvine evacuations, unattended with pain.
There was considerable thirst in every case; no other unpleas-
ant effects. When given in the above manner (dissolving it in
as small a quantity of water as possible), it is less likely to dis-
turb the stomach, than the same or even a less amount would in
a larger proportion of the solvent. The taste was objected to
by some, whilst others disliked it much less than quinia.

Conclusions. From our experience of the anti-periodic vir-
tues of chloride of sodium as detailed above, we think the
following conclusions may be legitimately deduced :

I. Although inferior to cinchona and its preparations, it yet
forms a very good substitute for them in intermittent fever,
having failed, as we have elsewhere seen, to produce a speedy
suspension of the paroxysms in 31.8 per cent, of the cases
only: in a majority of cases, therefore, it may be substituted
for quinia.

1L It may be used instead of, and indeed preferably to quinia,
first, in cases not unfrequently met with, where the latter reme-

23G Sore Legs. [April,

dy is forbidden by the very unpleasant nervous and cerebral
symptoms it produces, (delirium, tinnitus aurium, cephalalgia,
faintness, &c.,) an example of which I have recently seen in the
New York hospital, when sulph. copper was substituted. Se-
condly, where quinia, from frequent repetition, has lost its effect
in ague. Thirdly, it is commended on the score of economy,
which is a consideration of importance to the poor especially,
who are now in a measure debarred from the use of quinia by
its high price. And, fourthly, it is always at hand, whilst quinia
sometimes cannot be obtained.

III. It has been found to be more energetic in curing ague
than any of the vegetable or mineral tonics commonly used for
that purpose, excepting bark, and should therefore be preferred
to arsenic, which has been ranked by M. Andral, Prof. Wood,
and indeed most other authorities, next in value to quinia. And,
moreover, 1 think arsenic should never be used until after
quinia and common s<ilt have failed to do good, on account of
its unpleasant and sometimes disastrous consequences to the
general system and stomach, and the increased facilities affords
for using the remedy as a toxicological agent.

Sore Legs.
Dr. H. T. Patterson publishes in the Medical Examiner
(March, 1854), an expose of Spender's method of treating ulcers
of the leg by chalk ointment and bandages. After testifying to
the practical value of the work of Spender, "On Ulcerous Dis-
eases of the Leg," he proceeds thus to describe the author's
principles and treatment:

"Our author cannot say too much in condemnation of the
poultice in these cases. It is astonishing how constantly
patients apply to one even yet with their legs enveloped in
that irritating abomination, a sour bread-and-milk poultice.
By surgeons they are much less used than formerly, but still
far too frequently. To ulcers of the leg they should never be
applied, except to cleanse them when sloughing. The only
poultice I have used for years is the simple paste of ground
flaxseed, or 'cake meal,' and boiling water. To this may be
added a little Liq. Sodae Chlorin., to overcome fcetor, or pow-
dered charcoal, or yeast, as a corrective to the sore. With
regard to the preparation of the edge in very old sores, I do
not think that Mr. S., is sufficiently explicit. Mere compres-
sion will not answer in very many cases. In some cases there
is a mass of unseparated cuticular deposit which, after soften-
inor by a poultice, may be gently separated by the handle of

1854.] Sore Legs. 237

the scalpel. But in others the cutis itself is thickened, callous,
and semi-cartilaginous, often inverted and the ulcer burrowing
beneath. The only remedy is its removal, without which
cicatrization will not commence This may be effected by
the caustic alkali or the knife. Xitrate of silver will not
answer, often making no impression whatever on the indu-
rated mass. The scalpel, however, is always preferable, and
should be used freely so as to secure a new and healthy edge.
This done, the next tiling is to procure incrustation, which
Mr. S. proposes to effect by his chalk ointment, the main
peculiarity of his practice. His object in this ointment is to
have a bland, unirritating, impalpable powder, held together
by the smallest quantity of unctuous matter that will permit
its being spread and otherwise managed. He employs pre-
pared chalk and fresh lard in the proportion of three or even
four parts of the former to one of the latter. The formula
which he prefers, and which I have generally adopted, is
as follows :

Take of Prepared Chalk, 4 lbs.

Fresh Lard, 1 lb.

Olive Oil, 3 oz.

To the lard and oil, melted together, the chalk should be added
gradually, being first rubbed to a fine powder and passed
through a sieve. The mass should then be stirred until near-
ly cold. It may be rendered still smoother by subsequent
rubbing in a marble or wedgewood mortar, but this will
scarcely be required. It is impossible to prepare the ointment
properly by mere trituration without the aid of heat, as I have
seen apothecaries attempt. Under all circumstances there will
be a slight degree of grittiness, due to the chalk, but not enough
to constitute a practical objection. In private practice, how-
ever, I have used an ointment prepared with the precipitated
carbonate of lime, w7hich is perfectly smooth. The comparative
costliness of this substance would be an objection to its adopt-
ion in hospital practice, or where, from the size of the sore or
the frequency of dressing, the quantity used is very great.

" The ointment is spread, about the thickness of a wafer,
upon linen or cotton cloth, and applied over the whole sore,
extending some distance beyond its margin. The next step is
to apply a tight bandage from the toe to the knee. Mr. S.
recommends a roller of calico (muslin) or flannel, two inches
wTide and six or eight yards long. The flannel he employs
only in old and feeble subjects, or where there is much oedema
of the limb. The bandage should be applied firmly and smooth-
ly by the surgeon himself. Xo man can possibly apply a bandage
properly to his own limb, and very few nurses, even in Hospitals,

238 Sure Legs. [April,

will be found competent to this duty. As the success of the
treatment depends very much upon the manner in which the
bandage is applied, the only safe plan is for the surgeon to at-
tend to it himself It should be made to embrace the limb
closely, and may be drawn as tight as possible. Occasional
reverse turns or folds will be necessary, and it should be fast-
ened firmly with two or three circular turns below the knee.
Properly applied it will remain for days and even a week or
more. The longer the sore is left undisturbed the better. It
should not be opened unless there is pain or foetor, or the dis-
charge is sufficient to soil the dressing offensively. At first,
the rapid reduction in the size ot the limb, from the absorption
of serous effusion and even of more solid adventitious deposit,
will cause the bandages to slacken and require their more fre-
quent renewal. In many cases, however, 1 have changed the
dressing only once in a week or ten days, ai d with the best
results. The laced stocking I have used in a lew cases, as a
substitute for the bandage, but it did not answer my purpose.
The patient complained much more of inconvenience, and
there was a want of uniform compression about the ankle,
where it is particularly needed. The elastic stocking of vul-
canized caoutchouc, or has contre fej tutrices, made by Vie, of
l'aris. nnd now on sale here, I have employed in several
instances with the most satisfactory results. It answers ad-
mirably as a preventive of ulcer in varicose limbs, or as a pro-
tection after the sore is healed, but it cannot become a substitute
for the bandage in the treatment of the sore.

"When this dressing is removed the surface will be found
almost universally improved, clean and free from offensive odor.
The discharge would seem in a great measure absorbed, and
its acrimony neutralized by the chalk. At the same time it
will be perceived that a thin layer of chalk has been deposited
on the edges of the sore, and sometimes also in patches in the
middle. This must not he disturbed on any account, as beneath
it is forming the tender new cicatrix. Neither must the limb
be wiped or washed. If wet with discharge, it may be dried
by a soft cloth gently pressed upon it. A new dressing of the
ointment should then be laid upon it, and the bandage reapplied
as quickly as possible. With each removal of the dressing the
crust will be seen to have encroached still farther upon the
surface, until it is finally covered. If found to crack and be-
come irregular, its separation may be assisted gently. The
applications (especially the bandage) should be continued tor
some time after the ulcer is entirely cicatrized.

"This treatment I can from extended experience confidently
recommend to my professional brethren. It is applicable to

1854.] Galvanism as an Obstetric Agent. 239

all ulcers of the leg in which a varicose condition of the super-
ficial veins constitutes the element of difficulty and delay in
the cure, and these will be found (I am satisfied) to be lour-
fifths of all the cases that occur. Mr. Spender entirely dis-
regarded the usual distinction of ulcers into the indolent and
irritable, treating both alike. Some of the very worst, irritable
sores I have ever seen have yielded at once to the chalk oint-
ment and compression."

On Galvanism as an Obstetric Agent. By Thomas Radford,
M. D.5 F.R.C.P. Ed., F.R.C.S., Eng., Consulting Physician
to the Manchester and Salford Lying-in Hospital, etc.. etc.

Having been the first to recommend and practically to em-
ploy galvanism as an obstetric agent in this country, and having
been the first who ever adapted its use to arrest uterine haemor-
rhage, I confess I was highly gratified to read the very excel-
lent remarks of Dr. Robert Barnes in The Lancet,* which so
fully agree with the observations J had formerly made.

1 was first led to its use during and after parturition by the
successful treatment of a case of atony of the urinary bladder,
which occurred after a difficult labour. Vide Provincial Med-
ical and Surgical Journal, 1844, vol. viii. p. 604.

Those who are unacquainted with my opinions on this subject
might conclude from Dr. Barnes's statement which I am sure
he does not mean to be understood that I have only employ-
ed galvanism in cases of "post-partum haemorrhages." This,
however, is not so. In my first case it was employed, during
the first, second, and third stages of the labour. I will now
briefly state the kind of cases in which it has been successfully
employed by me.

1st. In cases of tedious labour arising from uterine inertia.

2nd. In cases of accidental haemorrhage, either before or
after the rupture of the membranes, and especially when ex-
haustion from loss of blood exists.

3d. In cases of " placenta praevia," in which, the practice
of detaching the placenta is adopted, and the vital powers are
greatly depressed.

4th. In cases of internal flooding before or during labour.

5th. In cases of post-partum floodings.

6th. In cases of hour-glass or irregular contraction of the
uterus.

7th. To originate, de novo, uterine action, or in cases in
which it is desired to induce premature labour.

* January number, p. 23 *23.

240 Galvanism as an Obstetric Agent. [April,

8th. Iq cases of abortion, when the indications show the
necessity, or justify the expulsion of the ovum.

9th. In cases of asphyxia in infants.

Galvanism is especially advantageous as a general stimulant
in all those cases in which the vital powers are extremely
depressed from loss of blood. Its beneficial effects are to
be observed in the change of the countenance, restoring an
animated expression ; in its influence on the heart and arteries ;
in changing the character of respiration ; and its warming
influence on the general surface. I have several times observed,
in cases in which other powerful stimulants have failed to pro-
duce any beneficial effects, the most decided advantage accrue
after its application.

I have never observed that the child, in utero, has been in-
jured by its use, which gives it a great advantage over the
administration of secale cornutum, which, in many cases, is
destructive of it. " This drug is liable to great deterioration ;
its operation is not always certain, its failure depending some-
times, perhaps, on its inert qualities, but frequently on a con-
stitutional idiosyncrasy which resists its powers. There are
organic states which forbid its use: when the os uteri is undi-
lated or undilatable, the child being still alive, it ought not to
be administered. If in such a case it induces powerful tonic
contraction of the uterus, it destroys the child. We cannot
control or confine its action, and therefore it is totally unsuitable
to cases in which we want only a limited effect. Again, if
exhaustion is an element in the case, it is wholly inapplicable,
as we ought not to adopt any means which tend further to de-
press the vital powers. The powerful and sanitary influence
of galvanism was most decidedly obtained in the preceding
case" (referring to a case to which these remarks were
appended,) "and the great advantage of this agent is, that its
effects may be carried to any decree, from first only exciting
the uterus so to contract that its diameters are lessened, and
that its tissue comes to be applied to the body of the child.
These, however, may be at pleasure increased, so as to
accomplish the expulsion of the child and and placenta. The
gradual changes produced upon the uterine tissue were
admirably seen in the foregoing case, and also its great power
developed by its continued application to arrest the discharge,
expel the child and the placenta, and leave the organ safe from
the occurrence of post-partum flooding.'' Extracted from a
case detailed in the proceedings of the local branch of the
Provincial Medical and Surgical Association, 1847.

In the above-named case I used the poles externally, and
have before this, and ever since adopted this mode of applica-
tion. [London Lancet.

1854.] Uretroscope. 241

Uretroscope.

We recently described an instrument invented by M. Jobert
for the purpose of exploring the cavity of the cervix of the
uterus. We have now to announce another innovation, which
aims at nothing less than the application of the sense of vision
to the diagnosis of diseases of the urethra ; what with these
two improvements, and Helmholz' speculum for the retina, and
other instruments which are no doubt in store for us, few of
the internal organs will long remain exempt from our imperti-
nent inspection.

M. Desormeaux's uretroscope was presented to the French
Academy on the 29th of November last. In his description of
his apparatus, the inventor modestly alludes to the attempts of
Ratier and Segalas to solve the problem which he believes that
he has mastered, and attributes their want of success to the
want of certain optical instruments which have since been in-
vented.

M. Desormeaux overcomes the difficulty of causing a suffi-
ciency of light to traverse a tube of the calibre of the urethra,
by employing a mirror with an orifice in its centre, similar to
that used by M Leon Foucault for illuminating obaque bodies
under the microscope. This mirror is placed upon a prolon-
gation of the axis of a straight catheter or rather canula, adapt-
ed for the urethra. A bright light is reflected on this mirror
by means of a large reflector, the rays being concentrated by
a lens, and it is so inclined as to throw the luminous rays it re-
ceives directly into the canula. The observer looks through
the orifice in the mirror, and sees the illuminated objects at the
extremity of the canula inserted into the urethra.

These are the principles on which the instrument is con-
structed. The inventor was unwilling to weary the academy
by entering into the details of execution, but presented the
apparatus itself with drawings illustrative of its application.
If these are published we shall take care to have them repro-
duced for the satisfaction of our readers.

Dr. Desormeaux goes on to mention several cases in which
his instrument had been applied. M. Melier had examined
with him a patient affected with stricture about the bulb, and
they distinctly saw a transverse septum in part obliterating the
canal. At the hbpital du Midi, M. Ricord and many visitors
had seen the mucous membrane beyond the canula, and had
noted its great redness, indicative of chronic inflammation.

If a piece of printed paper be placed at the extremity of the
canula, the light being cut off, the letters can be seen easily
by the reflected light ; the furrows on the epidermis of the

242 Plaster of Paris in Spasmodic Asthma. [April,

palmer surface of the fingers can be made out with equal
facility.

The inventor believes that his instrument will be useful not
only as an aid to diagnosis, but as a means of deciding certain
doctrinal points, such as the reality of urethral chancre, etc.

Dr. Desormeaux has found that a lateral opening does not
interfere sensibly with the illumination obtained by his instru-
ment, and an opening of this sort will allow the passage of in-
struments. He has passed a fine probe through a very narrow
stricture in this way- The other applications for which a way
is thus opened are obvious. We may now apply with some
certainty to diseased portions of the urethra those local appli-
cations which are so useful in inflammations of the vagina and
cervix. Uretrotomy will no longer be a cutting in the dark.

The author makes one more remark. In the case of the
uretroscope the object itself is seen in a right line. It will be
easy however to reflect the image of the object laterly by a
mirror, as Xewton did in one of his telescopes. Do our
readers perceive the corrollaries of this invention? We are
to see into every cavity of the organism into which a straight
tube can enter. The stomach and colon are already threaten-
ed with invasion. Hereafter a "coloscope" will be as neces-
sary in treating dysentery as a speculum in treating "ulcera-
tions of the neck !" [Virginia Med. and Surg. Jour.

Plaster of Paris in Spasmodic Asthma. By J. P. Root, M.D.,
of New Hartford Centre, Ct.

Not having noticed anything in the medical works of the
day, touching the use of the above-named article, in the treat-
ment of spasmodic asthma, I am led to believe it is not in gen-
eral use. In my hands it has proved more effectual than any,
or even all other remedial agents, in the treatment of asthma.

Some three years since, I was called to see a severe case of
this disease in the person of a young lady of 18. After going
through with the articles commonly used in such cases, with
but little effect, I accidentally hit upon the use of "plaster of
Paris," in mixture, with almost magic-like results. The only
thing previous to this, that gave her much relief, was the
smoking of stramonium leaves. Since using the plaster, how-
ever, she has been constantly improving; in fact, for the last
two years or more she has nearly forgotten what formerly
alarmed not only herself and friends, but troubled her physi-
cians. I have used this article ever since, with similar results.

About two months since I was called to witness the agony
of a little girl of 12 years, lately moved into this vicinity

1854.] Phrenic Nerve. 243

more to console her friends than to relieve the sufferer, as they
had given up the idea of ever seeing her cured or even made
better; for, to use their expression, they had "been to all the
doctors, and they didn't do her any good." She had not been
in a recumbent position for a week. I immediately commen-
ced the use of my favorite remedy, with results as before.

The mixture should be prepared similar to lime water, and
used freely, diluted in water or milk, on each recurrence of
the spasm.

I am in the habit of prescribing for my asthmatic patients,
cold sponging about the neck and chest every morning, follow-
ed by brisk friction. The modus operandi of this remedy I
leave for others to enlarge upon. Boston Med. and Surg. Jour.

Phrenic Nerve.

The following are Luschka's conclusions respecting this
nerve :

" 1. The phrenic is not merely a motor nerve, but a mixed nerve,
containing sensory filaments distributed to the pleura, pericardium,
and the peritoneum, covering the diaphragm, and on the anterior
wall of the belly. It is also distributed to the coronary and suspenso-
ry ligaments of the liver.

"2. It brings about a double interchange of fibres between the
sympathetic and spinal nerves, since organic nerve fibres go to it from
the inferior and occasionally the middle cervical ganglion, and it gives,
by its abdominal portion, fibres to the solar plexus.

" 3. In the majority of cases, the phrenic arises but from one cer-
vical nerve the fourth.

" 4. The diaphragmatic branches he traces to the tendinous centre,
the inferior vena cava, the right auricle, and the liver.

"5. In its course over the pericardium it appears to be endangered
in diseases of the pleura and lungs, especially tubercular. Hence,
probably, some of the disturbances of respiration in these com-
plaints." [Brit, and For. Medico-Chirurg. Review, from Schmidts
Jahrbuch.

Camphor in Erysipelas.

Dr. C. H. Spoerer endeavors to establish camphor as a spe-
cific in erysipelas. His extensive experience in the St. Mary's
Hospital, in St. Petersburg, has convinced him that this remedy
has no less effect in erysipelas, than the preparation of Peruvian
bark has in intermittent fever, and not only in all grades of
exanthematic erysipelas, but also in phlegmonous and consecu-
tive pseudo erysipelas, after surgical operations and lesions.
Gastric or violent cerebral symptoms are by no means contra-
indications, according to S. In the latter, he cautions against

244 The Cholera Fly. [April,

abstractions of blood, and internal antiphlogistic remedies.
Also, in erysipelas neonatarum, camphor proved beneficial, with
a bath of milk or soap-suds at the same time. The same good
effect it had in parotitis, which is connected with erysipelas
faciei. S. prescribes internally fromgr. \ to 2 grs. every two
hours, while externally the parts are occasionally washed with
lukewarm water, and covered with linen. In pseudo erysipe-
las, after lesions and surgical operations, especially in gangrene,
also the external application of camphor, vinegar, or spirits of
camphor takes place, according to circumstances, with an infus.
arnicae, decoc. cart, quercus, xv. S. derived no benefit from
preparations of lead in erysipelas; they proved mostly obnox-
ious He denies, according to his observations, that camphor
decreases the vitality of the sexual organs. [Mediz. Zeitung,
RusslanoVs, and Ibid.

The Cholera Fly. By Robert Knox, M. D.

Public attention has been repeatedly called of late to the
sudden appearance of vast swarms of flies, coincident as it
would seem with the advent of the Asiatic cholera. As the
phenomenon is almost equally interesting, whether it be a mere
coincidence, or stand in the important relation of cause and
effect, I have ventured to place before the public what I have
myself observed in respect of the coincidence. In the absence
of any true theory of cholera, speculation becomes legitimate.

I resided in Edinburg when the Asiatic cholera first appear-
ed in Britain. This Eastern plague, for such no doubt it is,
started at once from Sunderland, where it first appeared, to the
village of Fisherrow, situated on the sea-side, a short distance
from Edinburgh, one of the healthiest spots imaginable. The
devastation it caused here was very great. All this took place
during the finest winter weather I ever witnessed.

Lecturing, at the time, to a very numerous class of medical
students, I felt anxious for the results, for it could scarcely be
hoped for, that the disease would spare the capital of the coun-
try. I dreaded the breaking up of the class. It was rumored
also that a meeting had been held by the persons connected
with the University, at which the question of closing the ses-
sion, and recommending the students to repair to their homes,
had been mooted.

The course I determined on was as follows : I urged the
students to remain perfectly quiet for the present at least, pro-
mising that I shuld address them in a day or two, especially
as to the course most advisable to follow under the then exist-

1854.] The Cholera Fly. 245

ing trying circumstances. In the mean time I visited Fisher-
row. Jt was a Sunday morning, the only day on which I could
well leave town. In the village all was quiet as death. My
brother, who accompanied me, called on a family to whom he
was known. A young man half opened the door; he seemed
a stranger, had a bewildered look, and spoke in an under-tone,
as if afraid to awaken the dead. My brother asked for Mr.

T . " He is dead," was the reply. " For Mrs. T . u She

is also dead." For the younger branches of the family ; and
the replv was, "They are all dead, save one, who is now dy-
ing." The plague had swept out the house and left none. I
felt for the first time that a plague had entered Europe and
Britain, not an ordinary disease, but a desolating plague, and
one probably, like its predecessors, beyond all human means to
control.

The healthy villages along the high lands of the Marquis of
Lothian's estates were next visited : a healthier spot cannot be
imagined, but the plague was laying waste three villages, at-
tacking the inmates of detached cottages, and causing general
terror. A gentleman who had been my student was surgeon
to the district. He was a man of great courage ; boldly deny-
ing the existence of any peculiarity in the Asiatic cholera, he
affirmed it to be no new disease, but merely an aggravated
form of the usual autumnal complaint. The local authorities
had established a sort of cordon sanitaire around the village,
to prevent the egress of the inhabitants. They complained of
this to me. My advice was to walk straight up to the consta-
bles, who would naturally take to their heels. This is the way
I always treat the impertinent interference of impertinent gov-
ernment officials, whose aid sought in moments of alarm is sure
to end in mischief. Look at Newcastle. A supine, grasping,
grovelling, money-getting magistracy suffer buildings to be
erected unfit for human habitations ; nay, not only permit the
erection of these buildings, but profit by them ; adopt no meas-
ures to abate the most shameful nuisances ; a local and general
government, in fact, rigorous in exacting the last farthing of
the enormous taxation required to support the crown and aris-
tocracy, but reckless and utterly indifferent to the condition of
the people, gradually assist in ruining the physical condition of
the place. A plague at last comes, and now a stir is made, not
to strike at the root of the evil the institutions, in fact, of the
country but to fasten on the nation a host of government
commissioners, tools, officials, to add to the patronage of the
crown and the cabinet, at the expense of a profession, never
highly esteemed, and now all but despised. To a town abound-
ing in medical men of the highest abilities, competent, if ever

K. B. VOL. X. NO. IV. 16

246 The Cholera Fly. [April,

men were, to meet any difficulty, some government officials are
sent, or rather invited (for they would not have been sent un-
less invited), to point out that which the youngest medical man
in Newcastle could easily have pointed out. The plague of
cholera, and the terror it excites, is artfully connected with
the existence o( these nuisances, though not in the slightest
degree dependent on or connected therewith. But to return.
On entering the cottages just alluded to, I found the people in
great alarm. They were abandoning the sick and dying. By
handling them freely, raising them up, and offering them any
assistance in my power, I partly convinced the people that
there existed no danger from contagion ; but on leaving this
village, I explained to my young friend, the surgeon, that there
was no use in concealing the fact from him namely, that the
plague was in the village, and that we had a disease to combat
which had never before been seen in this country.

Having made up my mind as to the circumstances, my ad-
vice to my class was very simple Remain where you are;
avoid all excess; dine on a little animal food and a glass of
port wine ; have no fear ; with opium and warmth you may in
general arrest any diarrhoea ; but should a case of disease ori-
ginate in the house in which you reside, leave it on the instant.
I do not recollect of any student having died of the disease.

At the time these sad events were going on, the physicians
of the city had each his own theory and his own treatment to
propose. Prior to its reaching the capital of Scotland we had
at least fifty doctors who pledged themselves to treat it suc-
cessfully. I urged the authorities to employ the loudest talkers,
the largest boasters, not forgetting the sneakers, who, if not
called on to come forward, would, when the disease had sub
sided, show themselves, and declare that had they but been
employed the mischief might have been, if not wholly averted,
at least greatly mitigated. I rememberd that Thucydides said
of the plague of Athens: " When it raged in the city the physi-
cians had no remedy for it ; but as it was about to disappear
many remedies were discovered." As men never change, but
simply move in circles, the same occurrence has taken place in
Britain many times within my own recollection.

The " Suppression of Nuisances Theory," invented by Dr.
MacCulloch, of the Ordnance, and applied by him to the origin
of typhus and other fevers, had not then come into vogue. The
theory is now fermenting, and may not subside until the coun-
try be saddled with a serious expenditure, jobbing and patron-
age by crown and minister being simply the aim of the parties
who now keep up the excitement. I should not be in the least
surprised if it ended in the organization of a staflfof government

1854.] The Cholera Fly. 247

flunkies, whose existence and duties would be tantamount to
the destruction of whatever respectability and responsibility
still remain in the hands of the medical profession. For this
the profession has to thank the corporate bodies with which
they have the misfortune to be connected.

Whilst the cholera raged at Fisherrow and along the high-
lands separating the valley of the Esk from that of the Tyne,
but had not yet appeared seriously in Edinburgh, a lady called
my attention to a phenomenon she had never observed before.
On the window there stood, dead, two or three flies of a some-
what peculiar form and color, having yellow stripes on the
abdominal region ; around them, on the glass, was a circle of
white, opaque particles, evidently discharged by the fly ; the
amount of these whitish particles was such that they could be
scraped from off the glass, and collected in a paper like any
other fine powder. The appearance was new to me, but, ex-
tremely occupied with the duties I owed my class, I took no
further notir.e of the matter, recommending the lady to speak
to an esteemed friend, the late Mr. MacGillivray, who knew all
about natural history matters. He thought the fly peculiar and
strange, and the circumstance of its position in death still
stranger, but offered no opinion.

The circumstance being mentioned by the lady to an ac-
quaintance, a bold and firm person, without fear, he said he
would test the theory by swallowing some of the powder. He
accordingly took about half of the quantity deposited on the
glass by one fly at bed-time. From three to eight next morn-
ing he suffered from an alarming attack of the cholera, which
greatly weakened him for a day or two.

But now the cholera left Edinburgh, and, if I rightly remem-
ber, Scotland, and no more was heard of it for some time. ATo
new case had appeared for eighteen months, when the lady
called my attention to a "cholera fly," as she was pleased to
call these flies which died standing on the windows. I assured
her that the disease no longer existed in Scotland ; but willing
to ascertain the fact, I spoke confidently to the late Dr. John
Reid, my most esteemed friend and former student and assistant
for several years. His position in the hospital enabled him at
the time to know well the disease movement in Edinburgh and
its neighborhood, and he informed me that although it was
thought not advisable to say much on the subject, two cases of
unquestionable Asiatic cholera had occurred the day before in
Leith, and had proved fatal.

The coincidence of the re-appearance of "the fly" and of
cholera took me by surprise. Hitherto the coincidence has
never failed. About a week before the appearance of the dis-

248 The Cholera Fly. [April,

ease at Newcastle, I cnlled the attention of some friends in
London to the cholera flies which stood dead on the windows ;
it was easy to foretell its approach. It raged in the north of
Europe, and in a few days it fell on Newcastle. 1 leave the
matter in the hands of future observers.

In addition to the phenomenon of dead flies, singly, coin-
ciding with the re-appearance of cholera, public attention has
been directed to another phenomenon equally curious; I allude
to the vast flights of flies seen to hover over particular towns,
in which cholera either has or is about to appear. Respecting
this view, the following circumstance came under my own
notice ; it is the earliest observation perhaps of the kind which
has been made in Britain.

During the autumn of the year the cholera attacked the in-
habitants of Dumfries, I had repaired to the banks of the Sol-
way, partly for recreation, partly to continue a series of obser-
vations on the salmon, commenced long before. My brother
accompanied me. On a chill autumn day, with the wind as
usual easterly, we examined the banks of the Sol way, or mouth
of the Annan, easterly, until the ground became troublesome
to traverse. At this point my brother became exceedingly
unwell, I felt unusually languid, but ascribed the languor and
weakness to my old enemy, the east wind. My brother's
.weakness and illness I could not ascribe to such a cause, for
these winds did not affect him. I pave him my arm, and we
reached the main road with some difficulty. Here resting for
awhile we proceeded, on foot, to Annan, where we had left a
horse and gig.

As we neared Annan I remarked, in the extreme distance,
seemingly over the town of Dumfries, a vast cloud in motion ;
it extended from earth to heaven. In one sense it was station-
ary that is, it remained on the same place, but every particle
of it seemed to be in motion. I called my brother's attention
to it, and we agreed that it resembled a cloud of flies.

A secret instinct led me to leave Annan that afternoon, and
proceed at once to Lochmaben. The languor and feeble-
ness left us as we receded from the valley of the Solway, and
next morning found us in the best health and spirits ; but on
that day, if my memory be correct, a messenger brought news
to Lochmaben that on the previons evening the cholera had
rested on the unhappy town of Dumfries, the population of
which it decimated.

I leave these observations in the hands of the reader. I
myself lean to the theory of M. Schonbein, whom I have the
pleasure to call my friend and former student. With a genius
peculiarly his own he has offered a new view or theory of

1854.] Infusoria in Woman's Milk. 249

cholera, which no doubt must be familiar to most. It amounts
I think to this, "that the absence or rather deficiency of oxy-
gen in the atmosphere coincides with the re-appearance of
cholera." If this be not the true theory, it still is a step in the
right direction. It does not exclude the " Fly Theory," which
I trust will be followed out to some legitimate conclusion for
or against. [London Lancet.

Infusoria in Woman's Milk. By Dr. Vogel.

No general directions can be given as to whether a woman
may suckle or not. In every case the question must be deter-
mined by an examination of the milk ; and here the microscope
proves eminently useful. The author found in that milk which
produced sickness in the child, and destroyed the health of the
mother after prolonged lactation, immediately after its removal
from the breast, infusoria similar to those found in the incrusta-
tions upon the teeth (vibrio bacillus.) Such vibriones are
found especially in women who menstruate or suffer from
haemorrhages during this period, the good or bad aspect giving
no important indication. The milk has often a fine thick
white colour, or is of paler hue; its consistence may be either
thick or watery ; its re-action is often alkaline, but generally
neutral. Under the microscope it exhibits, according to its
richness, sometimes but few, at other times many, milk and
cream corpuscles; these differ from the corpuscles of healthy
milk by their pale yellow colour, their want of metallic lustre,
and their speedy decomposition. As regards the infusoria, they
are little rod-shaped bodies, dark in the middle, surrounded by
a lighter line, but exhibiting neither head nor tail under a mag-
nifying power of 600 diameters ; there are, however, feet in
great number and of considerable length. The movement of
these animalcules was swimming, and occasionally it was very
active. Forward movement was worm-like, and an annular
structure of four rings was observed. Mostly they twist screw-
like, upon their axes. When they swim in a circle, they
always move from right to left. The length is rJ-* mmtr.,
their breadth four times less. They are best seen when the
milk is diluted with water. In ammonia-diluted acids (even
the lactic) they die immediately.

Children fed upon milk containing thes,e infusoria, become
sooner or later attacked by diarrhoea, and the evacuations are
of a green colour. This condition disappears as soon as healthy
cow's milk is substituted. The author believes that this effect
does not proceed from the infusoria as such, but from the same
cause which produces the infusoria, namely, a process of fer-

250 Progressive Atrophic Muscular Paralysis. [April,

mentation in the milk itself. The ferment is, according to him,
the congested and increased heat in the breasts, connected
with the general excitement of the sexual system.

But a fermentation, as Jul. Clarus observes, cannot be pre-
sent, because the author always found the milk alkaline or
neutral, and never sour. Were there fermentation, the evolu-
tion of lactic acid would, upon the authors own showing, have
immediately destroyed the infusoria. [Schmidt's Jahrb, and lb.

On Progressive Atrophic Muscular Paralysis. By M. Cruveilhier.

We directed the attention of our readers to this newly described
form of disease in our April No. for 1851, (p. 244,) and then related
the case of a valued professional brother who had been its victim for
a number of years. He has but recently died, after a very short ill-
ness of (it is said) congestive Ccxer. No post-mortem examination
was made in this case ; but the following notice of the researches of
the indefatigable Cruveilhier, contained in the British and Foreign
MedicoChirurgical Review, will serve to throw some light upon the
subject. [Ed. S. M. & S. Jour.

M. Aran has described, in the 'Archives Generates,' a form of
muscular paralysis, under the term "progressive muscular atrophy ;"
and M. Thouvenet has described the same lesion under the title
"atrophic muscular paralysis." Since 1848, this form has been fa-
miliar to M. Cruveilheir ; and in the present memoir various cases of
it are related. The first case was that of a lady, aged 40, with gen-
eral paralysis, more marked in the upper than in the lower extremities,
and unaccompanied by lesion of sensation, or alteration of intellect.
Death ensued by extension of the paralysis to the diaphragm and
laryngeal muscles. A profound lesion of the spinal cord was diag-
nosed, but after death the nervous centres were found to be perfectly
healthy. The true nature of the case was not recognized, and M.
Cruveilhier, not content with the term "nevrose," given to the case
by other physicians who witnessed it, accused pathological anatomy
of want of power to recognize some lesions of the brain and cord.
The second case was that of a man, aged 18, with general paralysis,
sensation and the intellectual faculties being unaffected. An affec-
tion of the anterior column of the cord was diagnosed, but after death
the cord was found perfectly healthy. The muscles were carefully
dissected, and were found to be atrophied in two ways viz-, by sim-
ple atrophy, and atrophy with fatty degeneration. The state of the
nerves was not examined. In the third case there was gradual mus-
cular atrophy and paralysis, with retention of intellect and sensation.
In addition to the paralysis there were tremors, or little convulsive
shocks, of the muscles of the extremities, as long as the atrophy was

1854.] Progressive Atrophic Muscular Paralysis. 251

not complete. There was also, occasionally, a kind of general tremb-
ling or shivering. Death finally ensued from general bronchitis, and
" cedematous pneumonia." Many of the muscles were atrophied and
in a state of fatty degeneration, exactly resembling, as M. Cruveilhier
remarks, the state of the muscles described by Dr. Meryon in the last
volume of the * Medico-Chirurgical Transactions.' M. Mandl, in
drawing the microscopic appearances, produced plates precisely simi-
lar to those of Dr. Meryon. The brain was perfectly healthy ; so
also was the spinal cord and the posterior roots of the nerves. But
the anterior roots, especially in the cervical region, were found to be
greatly diminished in size : in fact, atrophied. This condition was
traced till the union of the roots ; in the conjoint nerve on the distal
side of the ganglion no change could be detected ; the trunks forming
the brachial plexus, and this plexus itself, were healthy. The nerves
running in the thickness of the muscles were, however, atrophied ;
and this was traced most exquisitely in the tongue, of which there
had been perfect paralysis. The lingual (gustatory) nerve was well
fed and of proper size, but the hypoglossal (motor) nerve was extreme-
ly atrophied ; many of its branches seemed to consist of nothing but
neurilemma.

M. Duchenne had electrolized this patient, and found that as the
paralysis advanced, the muscles became inexcitable.

M. Cruveilhier remarks on these three cases, that the first case
showed only paralysis without disease of the nervous centres ; the
second, more completely examined, exhibited great muscular atrophy
and degeneration ; while the third, still more carefully dissected,
showed, in addition, atrophy of the anterior roots and of the muscular
branches of the nerves. He remarks, also, that the clinical history
and the morbid anatomy exactly accord. There is conservation of
intelligence, and want of disease in the brain; conservation of sen-
sation, and the cord and posterior roots are unaffected ; paralysis of
motion, and the motor nerves and muscles are atrophied.

But what is the connexion between the atrophy of the muscles and
of the nerves 1 Which is primary and essential ?

The coincidence of nervous and muscular atrophy cannot properly
be regarded as an exceptional case; nor, in all probability, is it a
simple coincidence. Cruveilhier, after referring to the rapidity with
which the atrophy occurs ; to the great influence of the nerves: and
to a case (of Dupuytren's) in which atrophy of one-half of the tongue
succeeded compression of the hypo-glossal nerve by a cyst ; regards
as demonstrated, that the atrophy of the nerves is the primitive lesion
and the atrophy of the muscles is consecutive, and a consequence
merely of diminution of function.

But what is the cause of the nervous atrophy ?

Here observation at present fails, and future clinical experience
must solve the problem. M. Cruveilhier believes that he has ac-
complished one step of progress in showing the implication of the
nerves. How the nerves become implicated must now be learned.

252 Editorial and Miscellany. [April,

EDITORIAL AND MISCELLANY.

BIBLIOGRAPHICAL.
A Treatise on Venereal Diseases. By A. Vidal (de Cassis), Sur-
geon of the Venereal Hospital of Paris, &c, &c with colored
Plates. Translated and Edited by Geo. C. Blackman, M.D., &c.
New York : S. S. and W. Wood. 1854. 8vo., pp. 500.

The work of Vidal is a necessary complement to those of Hunter
and Ricord issued from the American press within the last twelve
months. The writings of these three practitioners constitute as com-
plete a library on Syphilis as can he found upon any other department
of medical knowledge. With Hunter, to ?'epresent the doctrines of
the 18th century, and Ricord, those of his own school, we have also
Vidal, who, though not without prepossessions himself, is nevertheless
the ablest adversary of the dogmatism of his colleague. Ricord and
Vidal may now be properly designated as the great rival authorities
of the day upon one of the subjects most interesting to the welfare of
the human family. Whoever, therefore, wishes to be thoroughly
posted up, should read both.

The treatise before us is remarkably complete, and worthy the
distinguished author of the most perfect work extant upon Surgery.
The additions by Dr. Blackman are judicious, and contribute much to
enhance its value.

A Treatise on the Diseases of the Eye. By W. Lawrence, F.R.S.,
Arc , <Scc. a new edition. Edited, with numerous additions and
243 illustrations, by I aac Hays, M. D., Surgeon to Wills Hospi-
tal, &c, &c. Philadelphia : Blanchard & Lea. 1854. 8vo., pp.
94^. (For sale by T. Richards & Son.)

The very high position long occupied by Lawrence's work upon
the Eye, as well as that of Dr. Hays, as a sound practitioner of occu.
listic medicine, renders the present combination of the views of both
eminently valuable. We know of no work to which we would refer
with more confidence : indeed, it is decidedly the best in our lan-
guage. The publishers are entitled to high commendation for the
beautiful style in which they have issued the work, and we take great
pleasure in recommending it to the profession.

A Practical. Treatise on Inflammation of the Uterus, its cervix and
appendages, and on its connexion with Uterine disease. By James
Henry Bennet. M. D., M.R.C.P., &c.,&c. 4th American, from
the 3.1 and revised London edition. Philadelphia: Blanchard &
Lea. 1853. 8vo., pp. 430. (For sale by McKinne & Hall.)

The work before us is so generally known to the profession, that

1854.] Editorial and Miscellany. 253

our commendation is not necessary to insure its continued patronage.
We must acknowledge that we are among those who regard the views
and practice of Dr. Bennet as decidedly tinctured with the ultraism
too common with specialists. The judicious observer and practition-
er will readily, however, detect these errors of zeal, and find in this
book a vast amount of valuable matter and sound practical informa-
tion.

Elementary Chemistry, theoretical and practical. By George Fownes,
F.R.S ., vice , ckc. Edited, with additions, by Robt. Bridges. M.D.,
Prof, of Chemistry in the Philadelphia Col. of Pharmacy, <kc, &c.
A new American edition, from the last revised London edition
with numerous illustrations on wood. Philadelphia: Blanchard &
Lea. 1853. pp.450. (For sale by McKinne <k Hall. Price 81 25.)

This is one of the most popular text books with medical students,
who are good judges of merit. It contains enough of Physics, ele-
mentary chemistry, organic chemistry and general principles, to make
it peculiarly adapted to their wants.

Honiozovathy : its tenets and tendencies, theoretical, theological, and
therapeutical . By James Y. Simpson. M. D., F.R.S.E.. <kc, 6zc.
1st American, from the 3rd Edinburgh edition. Philadelphia:
Lindsay & Blakiston. 1S54. Svo., pp. 304. (For sale by Thos.
Richards & Son.)

Homoeopathy has had its day in Europe, and is now in the ascend-
ant in some of our cities. Like Thompsonianism, it will soon give
way to some other delusion ; for it is a singular peculiarity of the
human mind, that although common sense will repudiate one absurdi-
ty, it does not the less remain open to imposition by another. History
is valueless if it has not taught us this much. Ever disposed to learn
the truth, from whatever source it may originate, we early (as far
back as 1?30) carefully perused Hahnemann's organon, the funda-
mental work upon Homoeopathy, and became satisfied that the learn-
ed author (for learned he certainly was) was either grossly deluded,
or was endeavoring to practice what he may have deemed M a pious
fraud " upon poor human nature, which was suffering the baneful
effects of undue faith in therapeutic agents, and consequently of ex-
cessive medication. He, perhaps, thought that it would be better for
man to be without physic than to abuse it, as was done in and out of
the profession. By framing a new system for credulity to fasten upon
in lieu of the errors then considered scientificallv orthodox, the sa^a-
city of Hahnemann may well have foreseen that even after the down-
fall of its supremacy, the valuable lesson would have been taught,

254 Editorial and Miscellany. [April,

that much of the healing art may be left to nature without serious
detriment to the cause of health. Whichever view of the author's
motive be adopted, we must say that the best antidote of Homoeopathy
we know, is the perusal of Hahnemann's organon. Like Thompson's
Life and narrative, it carries with it its own refutation, and can
therefore do no harm to the reader, whilst it ma\ interest him deeply
specimen illustrative of human nature under the influence of
mental delusion, if nothing worse.

Professor Simpson's able exposition of the absurdities of Homceopa-
thy, may serve to open the eyes of those who have placed, and retain,
in one of the most important Chairs of the .Medical School of Edin-
burgh, a man weak enough to believe ihem. Those physicians in
our country who have not had access to Hahnemann's writings will
do well to procure Prof. Simpson's work. But it is especially desira-
ble to have the book placed in the hands of such non-professional
persons as may be inclined to look favorably upon this nonsensical
system. By keeping a copy for this purpose, each practitioner will
exert more influence in his neighborhood than by personal controver-
sies, in which he may be regarded as an interested witness by those
who do not know how to distinguish between the love of truth and the
love of 1 uc-

Prize Essay: On the use and abuse of Alcoholic. Liquors in health
and disease* By Wm. B Cabpbtttbr, M.D., F.R.S., &c, &c,
with a preface by 1>. F. Condie, M. I).. &c, &c. Philadelphia:
Blanchard ov Lea. L888. 12mo., pp. 178. (For sale by McKinne

& Hall. Price $1 00.)

A prize of 100 guineas having been offered, in England, for the
best essay on the use of alcoholic liquors in health and disease, it was
unanimously awarded by the learned adjudicators to the work before
us. It is eminently calculated to be useful to both professional and
non-professional readers, and ought to be extensively circulated.

On the Etiology, Pathology, and Treatment of Fibro- Bronchitis and
Rheumatic Pneumonia. By Thomas H. Buckler, M. D., former-
ly Physician to the Baltimore Almshouse Infirmary. Philadelphia :
Blanchard & Lea. 1854. 8vo , pp. 150. (For sale by T. Poch-
ards & Son.)

Although the vast amount of research bestowed upon the diseases
of the pulmonary apparatus had induced many to think that this de-
partment of pathology was fully understood, Dr. Buckler has opened
a new field for observation by the detection of a rheumatic element in
an organ hitherto regarded as beyond the limits of its intrusion. It

1854.] Editorial and Miscellany. '255

is true, that the subject had been hinted at by others, but to our author
is due the credit of directing attention to it by a distinct monograph.
We regret that the limits of this Journal do not allow us room for
more than a mere bibliographical notice of Dr. B.'s work and, al-
though we are not prepared to admit the full force of his conclusions,
we earnestly commend it to the attention of the profession, as drawn
up in a philosophical and eminently practical manner.

Clinical Report on Chronic Pleurisy, based on an analysis of forty-
seven cases. By Austin Flint. M. D.. Professor of the Principles
and Practice of Medicine in the University of Buffalo, X. Y.. and
in the University of Louisville, Ky. Burialo: Jewctt. Thomas &
Co. 1853. Bvo., pp. 58.

Clinical Report on Dysentery, based on an analysis of forty-nine cases.
With remarks on the causation, pathology, and management of the
disease. By Austin Flint. M. D . &c, kc. Burialo: Jewell,
Thomas & Co. 1?53. 5vo , pp. 90. (Both works for sale by
H. C. Morton, Louisville, Ky.j

The two works at the head of this notice belong to a class of prac-
tical productions, which no man in our country is better qualified to
make useful than the learned and industrious author. Prof. Flint is
setting a good example to those whose position enables them to see
large numbers of cases of similar disease, and to keep careful records
of their progress. This is the true method of studying pathology and
the value of therapeutic agents. We trust that these reports will be
carefully read, and adopted as models by those who may have the
ambition to add their mite to American medical literature.

OTHER WORKS RECEIVED.

In addition to the works above noticed, we have received a large
number of pamphlets, among which are :

An Essay on the Mechanism and Management of Parturition, in the
shoulder presentation by Win. M. Boling, M.D., of Alabama.

The Medical Application of Electro-Magnetism by Samuel B.
Smith, Electro-magnetic Therapeutist, and inventor of the direct
to-and fro current electro-magnetic machine, New York.

Functional and Sympathetic Affections of the Heart by John W.
Corson, M. D., of New York.

Quarterly Summary of the Transactions of the College of Physi-
cians of Philadelphia, from November to January, 1854.

The American Journal of Science and Arts conducted by Pro-
fessors Silliman, vkc. The March Xo. before us is very superior,
and fully sustains the high reputation of the work.

*250

Editorial and Miscellany.

[April,

An Address before the association of the Alumni of the University
of the city of New York by C. S. Henry, M. D.

An Address to the Alumni of the University of the city of New
York by Prof J. W. Draper, M. D.

A Lecture, by Jonathan Knight, M. D., introductory to the course
of lectures in the Medical institution of Yale College.

Doctors' Commons: an Ethic Address before the District Medical
Society for the county of Burlington by S. VV. Butler, M. D.

A reply to the attacks of Dr. Charles Caldwell by L. P. Yandell.

We understand that a medical periodical has been issued in Atlanta,
but we have not received a copy of it.

Medical College of Georgia. The Commencement exercises in
this Institution took place on the first day of March. From the
Dean's Report, it appears that there were in aitcndance upon the
course of Lectures just terminated one hundred and fifty-four Stu-
dents, of whom 111 were from Georgia, 21 from Alabama, 13 from
South Carolina, 3 from Florida, 3 from Tennessee, 2 from North
Carolina, and 1 from Mississippi. The Degree of Doctor of Medi-
cine was conferred upon the following gentlemen:

Alabama. \
Georgia. -

P. De L. Baker, of
R. L. Bird,
A. F. Bignon,
VV. T. Bailey,
Josiah Brown,
J. J. Cartledge,
O. VV. Crowder,
Dennis Collins,
VV. E. Collier,
J. B. Dunn,
J. T. Davenport,
B R. Doyle,

A. S. Fowler,

C. H. Gorman,

D. G. Gardner,
J. R. Godkin,
W. B. Hurst,
T. O. Heard,
J. W. Hunter,

T. Y. T. Jameson,

B. F. Lindsey,
J. O. A. Lewis,
J. C. Lee,

Alabama.
-S. Carolina
Georgia.

J. L. Mills, of S.Carolina.

Samuel Mcintosh, Georgia.

VV7. F. Maharrey, . Alabama.

VV. H. Murray, Georgia.

T. J. Murph,

Robert .Wilson,

J. VV. Osline,

( '. f >. Parmer,
E. D. Pitman,

S F. Pendergrass,

A. R. Sheppard,

G. A. Stephens,

Isaac Schatz,

W. F. Shelton,
Alabama. A. A. Trammell,
Georgia. S. J. Threadgill,
Alabama. W. VV. Tison,
Georgia. H. B. Tutt,
Alabama. D. B. Tabb,

A. F. Verdery,
S.Carolina D. D. Westmoreland, S.Carolina
Florida. J. L. Wofford,
Georgia. VV. D. Young, Tennessee.

Alabama.

Georgia.

Alabama.

Georgia.

S. Carolina.

Alabama.

Georgia.

Alabama.
u

Georgia.

Dr. Wm. B. Thomason, a graduate of the Med. Col. of Memphis

1854.] Editorial and Miscellany. 257

Medical College of Savannah. We learn that the recent Class in
this Institution numbered thirty-six, and that the Doctorate was con-
ferred upon the following gentlemen :

John W. Armfield, of S. Carolina/Richard G. Xunn, of Georgia.
Elisha W. Harral, " rge W. Cleland,

Joseph J. Hankins, Florida. (Joseph J. West, u

We are informed that Dr. H. V. Wooten has resigned his Profes.
sorship in the Medical College of Memphis.

Non-recurrence of Dysentery. In his clinical Report on Dysen-
tery, Prof. Austin Flint seems inclined to adopt the belief, that persons
once affected with Dysentery are not liable to another attack of it.
If this can be established, it will be quite a novel fact in the history of
this disease.

Meeting of the Medical Society of the State of Georgia. We are
requested, by the Secretary of the Medical Society of the State of
Georgia, to state that the next annual meeting will be held in the city
of Macon, on the second Wednesday of the present month (12th April).
It is to be hoped that the profession will be fully represented.

Dr. Alexander Turnhill. The last No. of the Charleston Medical
Journal administers a merited rebuke to this notorious charlatan, who
has been recently duping the good people of our sister city.

Dr. Long's claim of priority in the use of Ancesihesia. The Trans-
actions of the Med. Soc. of the State of Ga., contain the following
action in reference to the claims of Dr. Long :

" Dr. Dickinson read the following report and resolution of the
committee on Dr. Long's claims, which were unanimosly adopted :

" The Committee to whom was referred the claims ofDr. Crawford
W. Long, (formerly of Jefferson, Jackson County, Geo., but now of
Athens.) to originality in the use of sulphuric ether as an anaesthetic
agent Rkport :

" That Dr. Long has exhibited to your committee, evidence proving
conclusively to us, that, as early as the 30th March, 1842, he success-
fully used Ether as an Anaesthetic Agent, in removing a tumour from
the neck of James M. Yenable, of Jefferson. On the 6th of June,
1842, he also used the ether in removing another tumor from the
neck of the same person. On the 3d July, 1842, he also used ether
successfully as an anaesthetic, in amputating a toe for a negro boy,
the property of Mrs. Hemphill, of Jackson County, Geo. On Sept.

258 Editorial and Miscellany. [April,

9th, 1843, he used the ether in like manner, in the removal of a
tumor from the head of Mrs. Mary Vincent, of Jackson County ; and
on the 8th of January, 1845, he also used it successfully in the am-
putation of a finder for a negro boy, the property of Ralph Baily, Jr.,
of the same county. In every case the ether was used by inhalation
from a towel or handkerchief. Your committee are unacquainted
with any of the witnesses who testify in favor of Dr. Long's use of
the article, but after a careful examination of all the certificates and
affidavits exhibited to us by Dr. Long, we see no circumstance cal-
culated to cast the slightest suspicions upon their truth and correctness.

" The character of Dr. Long, in the opinion of your committee, is
sufficient to shield him from the suspicion of using a witness for a
dishonorable purpose. We therefore recommend to the society the
adoption of the following resolution :

M Reso/ced, That it is the opinion of the society that Dr. Crawford
W. Long, of Athens, Geo., was the first person who used Sulphuric
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 own State, we recommend him to present his claims, to
priority in the use of this most important Igeotj to the consideration
of the American Medical Association at its next meeting."

Amputation of the Tongue. By M. Maisonneuve. M. Maison-
neuve performed an operation upon the tongue of a patient, so remark-
able, not only for the results of the operation but in the origin of the
malady, as to be well worthy some details. The patient was a dis-
tinguished confrere, Dr. J., member of the Imperial Academy of
Medicine of Paris, and President of the Committee of Vaccination.
In the exercise of his functions on the committee of vaccination, he
was in the habit of handling large numbers of small glass tubes con-
taining the vaccine liquid in their ends. He often held these for a
moment in his mouth, and they had several times caused slight piqftres
on his tongue, followed by enlargement. These generally disappear-
ed at the end of several days ; but at length an induration was estab-
lished of a grave character. To remove the induration the doctor
employed first the nitrate of silver, then the acid nitrate of mercury ;
but this medication, far from arresting the progress of the malady, only
aggravated it ; epidermic plates developed themselves over the entire
surface of the tongue, and later, a deep ulceration invaded the centre
of this organ. Adopting the advice of some medical friends, he sub-
mitted to an energetic cauterization of the part with the hot iron ; but
this also only served to give the disease new activity : all the anterior
part of the tongue, as far as the calciform papillae, a distance of eight
centimetres, became the seat of an induration, while the central ulcer
continued to make rapid progress. To these symptoms were soon
added lancinating pains, which left to the patient no rest. By the
advice of M. Ricord, he took the iodide of potassium : but, notwith-
standing this treatment, the malady progressed from day to day, and
the tongue, now enormously tumefied, obstructed the buccal cavity,

1851.] Editorial and Miscellany. 259

and the saliva flowed continuously. Speech had become impossible,
and the patient's diet was limited to liquid substances. All rational
treatment having failed to arrest the disease, he sought M. Maison-
neuve's services. Amputation was immediately proposed, and ac-
cepted as the only resource. The patient was submitted to chloro-
form. M. Maisonneuve then made an incision through the soft parts
in the median line from the edge of the inferior lip down to the chin,
passed a chain saw around the inferior maxillary bone, and made a
section of it. The section of the chin was then drawn apart, which
enabled the surgeon to seize the tongue and draw it well out of the
mouth. By a rapid dissection, the diseased organ was separated from
the healthy parts, at a point beyond the anterior half, an extent of
eight centimetres a little over three inches. The sublingual gland
was sacrificed; ligatures were applied to the important vessels, and
no hemorrhage followed. After the operation, the branches of the
separated jaw were brought into apposition, and secured by threads
passed around the teeth. The ligatures placed on the vessels were
brought out, under the edge of the jaw, at the lower angle of the
wound; and the borders of the division were united by the twisted
suture. Notwithstanding the extreme gravity of this operation, no
unpleasant results followed. The external parts cicatrized by first
intention, the bones consolidated, the enormous loss of substance filled
up rapidly, and what is remarkable, the patient has recovered his-
speech, as well as the power of seizing and masticating his food I
The anatomical examination demonstrated that the disease belonged
to the class of epithelial cancroids, which permits the hope that it
will not be re-produced. [N. Y. Medical Times.

Existence of Syphilis in France in the First Century of the Chris-
tian Era. M. Becquerel communicated to the Medical Society of
the Hospitals of Paris the inductions of an antiquary of the Cote-d'Or,
who, in the ruins of a temple situated near the source of the Seine,
where it was the custom to take baths, met with a number of inscrip-
tions, ex-voto, attesting the cure of different diseases of the genito-
urinary apparatus by the use of the waters. These ex-voto were li-
thographed, and they were seen to record examples of tumours of the
scrotum, of buboes, of destruction of the penis, and of other alterations
which might be referred to syphilis. If these conclusions be correct,
it establishes the fact of the existence of syphilis in the thirtieth year
of the Christian era. A commission consisting of MM. Legendre,
Requin, Becquerel, and Gillette, was appointed to examine the
evidence. [L' Union. London Lancet.

Spontaneous Evolution. By J. Jones, Esq., Llanfair, Montgomery-
shire. The following, I presume, somewhat extraordinary case oc-
curred to me a few days ago :

A female, aged forty-three, the mother of five children, was taken
in labour of her sixth. It was a footling presentation, both feet being
low in the vagina, but the uterine contractions being almost nil, and

260 Editorial and Miscellany.

the os uteri amply dilated, I did not hesitate to administer strong doses
of ergot. Having entrusted the nurse to administer the ergot accord-
ing to my directions, 1 left the apartment, but was summoned back in
about three-quarters of an hour, when, to my astonishment, 1 found
the feet and head had exchanged positions. It was now a natural
presentation, and the child was born in a few minutes after the ergot
had produced sufficient uterine contraction. The infant was small,
otherwise it is improbable that the contractions of the womb could
have effected such a change in its position.
P. S. The child is alive. [London Lancet.

Silk instead of Sponge for Laryngeal Probangs. By J. H. B.
Having had occasion to use topical remedies within my own vocal
organs, I was surprised at the apparent harshness of the finest sponge
I could procure, and was induced to try a ball of silk floss or ravel-
ings. well fastened by sewing through-and-through loosely. It holds
sufficient of any solution, and does not produce as much involuntary
contraction as a sponge ; hence it can be passed through the " rima
glottidis" in most patients, in the first or second application to the
throat, whereas a sponge often requires repeated trials, and is more
painful than is necessary. [Peninsular Journal of Medicine.

Early Operation for Hare-Lip. Andrew Nolan records a case of
operation for single hare lip on an infant six hours after birth. The
child did not seem to Buffer much after the operation was complete,
and took drink, apparently without suffering, next day. The lower
needle was removed in sixty hours, and the upper in seventy-two.
Union was perfect. [Dub. Med. Press.

Recipes for Cologne Water, from Redwood Gray's supplement.

B Oil ofNeroli 3 i j

Oil of Orange Peel Jiss

Oil of Citron 3j

Oil of Bergamot 3ij
Oil of Lavender

Oil of Rosemary aa 3ss

Oil of Cinnamon 3j
Cardamoms, powdered

Balsam Peru aa 3ij

Rectified Spirit tt>. vii

Macerate ten days, then distill

six pounds with a gentle heat.

Pharm. Badensia, 1841.

ft Oil of Bergamot jSiij

Oil of Lemons Jij

Oil of Lavender 3iiiss

Oil ofNeroli 3iiss

Oil of Origanum 3ij

Oil of Rosemary 3j

Essence of Vanilla 3 ij
Musk gr. x

Rectified Spirit Oxiii

Rose Water Oij

Orange Flower Water Oj
Mix the oils ; dissolve them in
ten pints ofthe spirit ; then add the
musk, and finally the waters, previ-
ously mixed with the remainder of
the spirit, and after standing two
weeks' filter. [Am. Jour. Pharm.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES MAY, 1854. [So. !

ORIGINAL AND ECLECTIC.

ARTICLE XIV.

Remarks upon some of the Diseases dependent upon Spinal Irri-
tation. By Augustus F. Attaway, of Madison Co., Ga.

There is, probably, nothing to which the attention of the medi-
cal profession is oftener called than to Spinal Irritation, and
those diseases consequent upon it. Upon this occasion, I have
neither space nor time to treat of all the affections developed
within the spinal column, nor to theorise as to how these are pro-
duced. This would indeed require a volume ; but my object,
here, is only to speak briefly of some of the diseases which I be-
lieve depend upon spinal irritation, and which manifest them-
selves in organs distant from the seat of disease. In doing this,
I shall, therefore, only mention some of the diseases, the most
prominent characteristics of which are well known. And, first,
as a disease dependent upon spinal irritation, I will mention In-
termittent Fever : this is so common in all our miasmatic dis-
tricts, that its phenomena are familiar to all. This disease is
generally ushered in by a chill or rigor, followed by a febrile
reaction these passing off, a third or sweating stage ensues,
and this is followed by a complete intermission of varied du-
ration. These fevers are named in reference to the length of
the interval. The most common are the Quotidian, Tertian
and Quartan. There are others of less frequent occurrence,
viz., Double Tertian, Double Quartan, Quintan and Sextan.

n. s. vol. x. no. v. 17

262 Attaway, on Spinal Irritation. [May,

The familiarity with the symptoms, course, and treatment of
these (even among the unlearned,) has doubtless caused many
to whose care their treatment is consigned, to overlook the true
pathology of these diseases ; and hence it is, that we so fre-
quently see the paroxysms return after having been, apparently,
arrested. In the treatment of this disease, I do not think we
should rely wholly upon the great specific quinine, but should
turn our attention directly to the location of the disease, which
will be found to exist in the spinal column. There we have
pointed out to us important indications ; upon pressure the ver-
tebrae are found to be sensitive and tender, and if this be relieved
we have much greater probability of effecting a permanent cure.
And this relief is accomplished by revulsives, sinapisms and
blisters, applied over the tender region of the spine.

Intermittent and remittent fe\ -<> closely allied to. and

connected with each other, that their cause and pathology must
be the same. So, if intermittent fever i> dependent upon spinal
irritation, so also must be remittent fever. I consider that both
these depend upon a diseased condition of the spinal marrow,
produced by marsh miasma. The premonitory symptoms of
each are about the same: indeed, so similar are they, that in
many instances we ircely able to discriminate ber

them. Both t; ieties of lever are preceded by languor

and disquietude. Remittent fever, also, is often ushered in by
a chill, followed by high febrile reaction ; the greatesl difference
being that the exacerbation is of longer duration than in inter-
mittent fever. In remittent fever the paroxysms are follow-
ed by a remission only, instead of a complete intermission, as
is the case in the other variety of fever mentioned above.
Seeing they are so analogous in their symptoms, we are forced
to the conclusion that both are dependent upon the same cause;
and hence I think we may rationally determine that the same
general treatment is applicable to both. This, as before stated,
should be anti-periodics and revulsives. Quinine should be
administered in doses proportionate to the violence of the pre-
ceding paroxysm. This course should be promptly and perse-
veringly pursued; for if this disease be treated upon the expect-
ant plan, and thus left to run its course, it almost invariably
proves fatal. I will not omit to mention, that in all these cases

1854.] Attaway, on Spinal Irritation. 263

the spinal column should be examined with the greatest scrutiny,
and if, upon investigation, we find it affected, (which will ap-
pear from its sensitiveness upon pressure,) we should be prompt
in our local treatment, which should consist as before, of revul-
sives, sinapisms, blisters, and local blood-letting. This I deem
of great importance; for in the treatment of remittent and
intermittent fevers, when we have relieved the spinal irritation,
the greater part of the work is accomplished. Phlebotomy, I
think, should only be resorted to in rare cases, such as those
in which congestion supervenes.

In the treatment of the foregoing diseases, my success has
been decidedly greater in effecting permanent cures, when I
directed due attention to the nervous centres, than otherwise ;
and I now feel fully authorized in going to the spinal marrow
for the true pathology of those periodic fevers produced by
marsh miasma.

In miasmatic districts, we are frequently called to patients
suffering almost insupportably with colic, or cramp of the stom-
ach and bowels. The most common treatment in these cases
is the administration of opiates, anti-spasmodics, cathartics,
&c, and yet, when these alone are administered, it is frequently
the case that we have repeated calls to the same patient, and it
sometimes happens that we can never effect permanent relief
until we resort to the revulsive plan of treatment. In these cases
we seldom fail upon examination, to find some of the vertebras
tender, upon removing which by sinapisms or blisters, we have
little difficulty in accomplishing a permanent cure.

Hepatitis is another variety of disease, which has its seat, I
think, in the great nervous centre. This variety of phlegmasia
can only be successfully treated, I am persuaded, by revulsives.
The mode of administration has been mentioned before.

Rheumatism is another disease frequently treated without
entire success, in consequence of overlooking the spinal column
and nervous centre. I have seen several cases of this disorder,
characterized by all the common symptoms of rheumatism, re-
sisting all other treatment, finally cured, as if by magic by put-
ting the patient upon a quinine and revulsive course of treatment.

Pleurisy is another disease caused frequently, I think, by spi-
nal irritation, or, at least greatly increased by it. This, perhaps,

264 Howard, on Gestation. [May,

the most violent of all internal inflammations, in the active form,
is known by acute lancinating pain in one side of the chest, (in-
creased by inspiration, coughing, and pressure,) dyspnoea, short
and frequent inspiration, dry cough with little expectoration,
and pain upon lying on the affected side. I have seen cases
with all the above symptoms of pleurisy, and apparently uncon-
trollable, speedily relieved by proper applications to the spinal
column. I think, therefore, I may with propriety consider that
this affection is consequent also upon spinal irritation. There
are many other diseases, which I think I could appropriately
include in the class of which I have been treating. In con-
clusion, I would only remark, that I think it always of the last
importance in the treatment of disease, especially in malarious
sections of country, ever to bear in mind the necessity of de-
voting due attention to the nervous centres, and particularly to
the spinal marrow, as it is so liable to irritation, and this irrita-
tion so productive ct" disease. This should not seem strange
when we consider how intimately connected the spinal marrow
is with many, indeed all. of the most important organs in man
and that upon its normal condition depends the proper perform-
ance of many of their most important functions.

ARTICLE xv.

Remarks upon the Computation of the Term of Gestation. By
C. C. Howard, M. D., of Lowndesboro', Alabama.

Dear Sir : Believing that, by a correct computation of the
term of gestation, time on the part of the practitioner may be
economised, and much anxious expectation on the part of the
female avoided, I am about to submit a few thoughts, which you
may dispose of as you think proper.

There are few practitioners, probably, who have not been
informed that their services would be wanted on a certain occa-
sion, say a few weeks in the future, and that they are particularly
requested to be near home about that time. After the obste-
trician has exerted himself to comply with such a request for
weeks beyond the time, expecting every day to be called, he
may happen to be but a little way in the country, to return in
a few hours, when alas ! perhaps the first person he sees on his

1854.] Howard, on Gestation. 265

return is the lady's husband, buoyant with joy on account of
the birth of a fine boy. Probably, too, this piece of information
is given in language not less expressive than this: ' The
long expected has appeared at last.' Long expected ! truly ;
and should the period of this long expectation be calculated by
the amount of anxiety that has attended it. we ought not to
wonder, if the glad parent should report this fine boy as being
possessed of the instruments of mastication and powers of loco-
motion.

Now, the question very naturally arises, why all this un-
certainty, when we are told, and correctly too, that the ordinary
term of a gestation is attained in about two hundred and eighty
days, and it is customary among medical men to assign the two
hundred and eightieth as the day on which the child may be
expected to be born. Reckoning from the day of the disappear-
ance of the menstrua, I answer, that what is here said to be
customary among medical men, there is reason to suspect is not
customary among women. I conclude, from my now limited
observation and experience, that women generally make their
reckoning, not from the last catamenial period, but rather, from
the period of quickening, which cannot but be very uncertain,
whether this quickening depends on motion of the foetus, which
is probable, or ascension of the uterus.

Xow, since it is certain that the point of time from which
medical men compute is the nearest correct, and indeed suffi-
ciently so, ordinarily, it would be well for married females to
know this, so that the obstetrician, when directly or indirectly,
called on to compute the time, may be able to ascertain the
absolutely necessary fact, viz., when did the last sickness termin-
ate. Having this fact for a starting point, it only remains to
ascertain the two hundred and eightieth day.

But, not an unimportant question arises here how shall this
be done ? Says Professor Meigs u That experienced prac-
titioner, and most judicious author, Professor Xaegele, of Heid-
elberg, in his Lehrbuch der ejeburtshuelfe, 8vo., 1842. in a re-
mark at the foot of page 82, gives the following method of
computing term. Let the woman reckon three months back
from the day her menses ceased, and to the said three months,
let her add seven davs. The dav thus found, is the one on

26G Howard, on Gestation. [May,

which she ought to expect her confinement. If, for example,
she had her courses last on the 10th of June, let her reckon
backward three months to March 10th, to which she should add
seven days, which would bring the calculation to the 17th of
March. This would be the day, to-wit, March 17th, on which
the woman ought to expect her lying-in."

Such, he says, is the method of calculation recommended by
Dr. Naegele, and it must be admitted that no man in Europe
enjoys a more enviable reputation as a teacher and practitioner
in our art. One might feel safe in following his example in
the practice of it. Still, I cannot perceive why the seven days
should be added to the three months, or, rather, to the whole
term, since the professor gives do reason for us to suppose that
the ovulum is not both mature and ready for fecundation, as
soon as the catamenial How has ceased, and the genetalia have
recovered their fitness for the c of the sexes. "As] have

no reason hitherto to find fault with my own method, I shall
continue to compute from the <l;i\ that, if my

patient informs me she saw the last stain on August 27th. I should
reckon backwards to July 27th, June 27th, and May 27th,
proximo, which day 1 should indicate as the one on wbieh the
labour might be expected to commence, and not June 3d.

It is readily perceived, that there are seven days difference
in the computation of these two able professors. By no
means an unimportant dilference; so much so, that if the rule
of the one be correct, that which is laid flown by the other ought
to be done away. Now, so far as the correctness of the com-
putation is concerned, if we wish to determine the two hundred
and eightieth day, with the utmost respect for Professor Me
from whose treatise on Obstetrics I have derived as much in-
formation, as, perhaps, from any work on the subject, I think we
must adopt the method of the Professor of Heidelberg, in so far,
as he adds the seven days.

There cannot be found any consecutive nine months of the
twelve, which, when added together, will make more than two
hundred and seventy-six days; and nine-twelfths of the consec-
utive nine months, must necessarily include the short month of
February. When that month is included, you cannot, possibly,
have more than two hundred and seventy-four days ; generally,

1854.] Effects of Digitalis upon the Genital Organs. 267

two hundred and seventy-three, to which, if we add seven, we
shall have the number two hundred and eighty. Thus, to make
a general rule, I think we should add one week to the nine
months, believing that women who have borne children, will
usually occupy two hundred and eighty days, in gestation proper.
Whilst, however, I would add one week to the nine months,
I would reject the rule laid down by professor N., for the reason,
that, it is both an unnatural and somewhat complicated process,
to calculate backwards and forwards as is there done. It is
only necessary to refer to the quotation of the rule itself, for
strong proof, that many women would never make their calcu-
lation correctly. It is much easier to compute straight forward.
If a woman, for example, sees the last stain on the 10th of June,
let her say, 10th of July, 1 month ; 10th of August, 2 months ;
10th of September, 3 months, &c, to 10th of March, 9 months ;
to which add seven days, which would bring the calculation to
the 17th of March the day she ought to expect her lying-in.

ARTICLE XVI.

The Effects of Digitalis upon the Genital Organs, and its
Use in their Affections By M. Brughmans. (Translated
for this Journal, from the Revue de Therapeutique Medico-
Chirurgicale, 1st Feb., 1854.)

The action of Digitalis upon the generative apparatus, hither-
to but little known, or confounded with its sedative -effect upon
the general system, has not been sufficiently studied ; yet its
adaptation and advantages are incalculable. This will appear
when we show that it may be used most successfully in all the
affections of the genital organs attended with or followed by
congestion or inflammation, or consequent upon these condi-
tions. If this be true, its action upon these organs must be
eminently antiphlogistic. Any one may satisfy himself upon
this point, by taking for five or six days from 35 to 40 centi-
grammes of the powdered leaves of digitalis. By so doing,
the genital organs will be reduced to such a state of hypos-
thenia, to such a degree of relaxation or flaccidity as to lead
one almost to forget their existence. All sense of warmth, of

268 Effects of Digitalis upon the Genital Organs. [May,

tension, of congestion ; all disposition to erections, to voluptuous
feelings and desires, will have vanished. I have administered
it with the greatest advantage for the purpose of subduing such
conditions, whether dependent upon peculiarity of temperament,
sedentary life, high living, continence or even excessive in-
dulgence in venereal pleasures. In short, digitalis, whether
given before or after the states just mentioned, lessens the se-
cretion of semen, and consequently the tendency to congestion,
heat and erethism. It matters not how these phenomena are
explained; whether they be attributed to the agency of digitalis
in lessening the activity of the testicular functions and the con-
sequent repletion of the vesicuke seminales; or whether they be
regarded as induced by a diminished afflux of blood to the
genital organs, thus modifying assimilation, secretion, calorifica-
tion, innervation, &c. What is most important to know is the
action of digitalis and not its modus operandi, that we may
appreciate its therapeutic value.

I have already stated that digitalis is efficacious in inflamma-
tory affections of the genital organs ; it is an admirable adjuvant
in the treatment of syphilitic disorders, so often attended with
inflammatory symptoms, and which it will prevent if early ad-
ministered. By subduing the heat, congestion, erethism, and
irritation attendant upon chancres, gonorrhoea, posthitis, bala-
nitis, &c, digitalis will overcome the elements of inflammatory
action, modify the secretions, prevent or dissipate tumefactions
of the glans, prepuce, urethra, prostate, testicles and lymphatic
glands with a degree of certainty not to be attained by any
other remedy. It is therefore especially useful in cases in which
phimosis, paraphimosis, cordee, epididymitis or adenitis exists or
may be apprehended, as the following facts will prove.

Case I. I was called to a farmer, affected with blennorrha-
gia and epidydymitis, and whose scrotum was so much distended
as to be chafed in several places. Being a married man, he
would use no local application which might lead to detection by
his wife. Knowing the sedative effects of digitalis upon the
organs of generation, I determined to resort to no other anti-
phlogistic. I neither bled nor leeched him ; but prescribed low
diet, repose, and 40 centigrammes of Digitalis the first day, 35
centigrammes the second day, and 30 centigrammes the third

1854.] Effects of Digitalis upon the Genital Organs. 2G9

daw* On the third day the swelling of the epididymis had al-
most entirely disappeared. The dose was continued at 30
centigrammes, with repose and low diet, and in two days more
there was nothing left of the epididymitis ; the discharge, which
s then very slight, ceased entirely in fifteen days. Thus was
this patient cured of a violent epididymitis in five days, and of
gonorrhoea in a fortnight.

Case II. A young man applied to me with six indurated and
diphtheritic chancres upon the prepuce, which had become so
swollen, indurated and inelastic as to leave scarcely any passage
for the urine. Phimosis was complete, and several of the in-
guinal glands were affected. The case was therefore serious,
and it became necessary to combat the local disease, and also
to prevent general infection by active mercurial treatment. I
therefore ordered \ grain corrosive sublimate per day, with
two spoonfuls of the " SiropdeCuisinier" (a compound syrup of
sarsaparilla Translator.) For the local symptoms, I pre-
scribed 40 centigrammes Digitalis, repose and low diet. In
three days the swelling of the prepuce was considerably lessened,
its meatus free, and the adenitis (glandular inflammation) dimin-
ished. On the seventh day the glands were well, the prepuce
could be partially retracted, and nothing remained but the indu-
ration of the chancres. In order to overcome this induration,
I continued the digitalis in 30 centigramme doses, enjoined re-
pose and light diet, and directed injections with a weak solution
of tannin after each micturition. Under the influence of this
plan of treatment, the induration gradually disappeared, and in
thirty-three days the chancres were all cicatrized, and the pre-
puce had resumed its normal state. I should observe that the
mercurial and syrup were continued for fifty days, the dose of
the former beincr gradually lessened.

Case III. This was a case of chronic articular Rheumatism.
I ordered digitalis in doses of 30 centigrammes, camphorated
liniment. &c. The patient then asked if I could not give him

* A gramme is about 15i grs., Troy; consequently, a centigramme is about
one-sixth of a grain, Troy.

The author is not sufficiently explicit as to the mode of administration
Hence we do not know, whether the quantity of digitalis recommended io be
taken in a day was subdivided into smaller doses or given all at once. We
have usually considered one grain an average dose, which might be repeated
more or less frequently during the day according to its effect. It is probable
thai author's dose was subdivided. Translator.

270 Effects of Digitalis upon the Genital Organs. [May,

something for a gleet (" goutte militaire"), which had res
every treatment for two years. I told him to await the effect
of the powders just prescribed. In a week his gleet had disap-
peared and returned no more.

Case IV. An enlargement of the epididymis of s
standing, and which had resisted mercurials and iodides, disap-
peared in fifteen days under the influence of digitalis, repose and
light diet. The patient had been married four years and had
no children: hut his wife has since conceived, which circum-
stance he attributes to the cure thus effected.

Case V. A thick and abundant discharge from the urethra
of six months duration, attended with an inflammatory stricture
attwoor three centimetres from the meatus urinarius, disap-
peared in sixteen days' use of digitalis, after which the flo
urine was a> free as it had ever been.

Cast. VI. An urethral stricture consequent upon an en-
menl of the sub-mucous cellular tissue, of the extent of a
centimetre, and situated in the spongy portion of the canal, was
removed in four weeks by the same treatment.

Casi VII. A patient affected with chronic blennorrhea and
seminal discharges applied to me. During the last year he has
become considerably emaciated; his complexion is sallow;
sunken; he has no appetite ; and complains of gastralgia,
palpitations of the heart, buzzing in the ears, and vert i 'jo. which
are frequently induced by attempts at defecation.or micturition.
In order to establish a diagnosis, ! examined the muco-purulent
discharge, and found it clear, whitish and viscid. With the
microscope I detected spermatic particles in it. On exploring
the canal with a sound, the patient suffered so much when this
reached its prostatic portion that I was compelled to desist. An
examination of the perineum and rectum revealed no tumor.
Concluding that there existed an ulceration in the prostatic
portion of the urethra,. I desired to cauterize it with Fromont's
instrument, but yielded the more willingly to the patient's re-
luctance to submit to another introduction after having suffered
so much from the first, inasmuch as I wished to test the effica-
cy of digitalis. I ordered 30 centigramme doses of digitalis,
substantial diet and stimulants. In eight days he was better,
and felt comfortable; for three days had had no vertigo; the

1854.] Effects of Digitalis upon the Genital Organs. 271

palpitations had diminished; the dischare was not so viscid and
less copious. In seventeen days the discharge had ceased, and
I then reduced the dose of digitalis to 10 centigrammes, and
advised its continuance for a fortnight longer in order to make
the cure certain. At the end of the fortnight I catheterized
him without any pain whatever. His general appearance, his
moral and his physical condition, had undergone a complete
metamorphosis ; his strength and cheerfulness had returned, and
he complained of nothing more than a little oppression about
the stomach and some nervous excitability.

Case VIII. A young man annoyed with nocturnal emissions
which had resisted the use of cathartics, enemata, cold baths,
cinchona, quinia, chalybeates, &c., under the direction of several
physicians, applied to me for relief. I prescribed 40 centigrammes
digitalis the first day, and advised a light and early supper, not-
withstanding the keenness of his appetite. The following day
he called upon me and stated that he had no emissions during
the preceding night. Prescribed 35 centigrammes; similar
effect the next night. He then took 30 centigrammes daily for a
fortnight, during which time he had no emissions. Six days af-
ter its discontinuance, an emission occurred ; on the following
day he took 40 centigrammes of digitalis and had no emission
that night. This treatment was kept up for two months and
the nocturnal emissions ceased entirely. If they recur, they
may doubtless be checked in the same way again.

Such are the facts I have deemed it a duty to lay before the
profession. They establish beyond doubt that digitalis may be
useful in many affections of the genital organs. The patients
were all gratified with its action and expressed their surprise at
the rapidity with which it dissipated the heat, congestion,
erethism, and morbid sensibility of the affected organs. These
inconvenient and disagreeable symptoms were subdued in a few
days, and their disappearance was soon followed by return to
health. Every one knows how it is often difficult to cure the
primitive symptoms of syphilis ; whether in consequence of the
carelessness of the patient in carrying out the prescriptions
made, of the violence of the disease, or of the insufficiency of
the means empirically used. Digitalis obviates all these diffi-
culties. When its antiphlogistic action upon the genital organs

272 Uterine Catarrh and Internal Metritis. [May,

shall have heen well understood and duly appreciated, a con-
siderable check will be given to the use of bougies, caustics
and injections means that require much time, experience and
judgment to be advantageously used. In most cases it will of
itself suffice for the removal of the inflammations, congestions
and ulcerations, both acute and chronic, of the genital apparatus.

It is not my design at present to enumerate all the circum-
stances in which digitalis may hereafter be found advantageous.
I will however suggesl its value in surgical operations which
require the suppression of erections of the penis. The sympathy
between the oculo-palpebral and the genito-urinary mucous
membranes may indicate digitalis as a valuable remedy in va-
rious forms of ophthalmia'. 1 have not yet tested it in these
affections, and I regret not having had the opportunity of doing
so in the diseases of the female organs of generation. If it be
found to act upon the female as it does upon the male organs,
it will be a valuable acquisition.

I may be permitted, in conclusion, to advance an hypothesis.
Since digitalis is such a complete hyposthenic with regard to
the genital organs, since it modifies and lessens so considerably
their functions, might it not. if administered during several days
after impure coition, prevent the development of syphilis and
thus become the best prophylactic in this disease ? This js a
bold proposition, perhaps far fetched and an indication of ex-
travagant confidence in the remedial agent, lie this as it may,
1 am disposed to express even my hopes in relation to it.

On the Pathology and Treatment of Uterine Catarrh and In-
ternal Metritis. By E. J. Tilt, M. D., Senior Physician to
the Farrin^don General Dispensary and Lying-in Charity,
and to the Paddington Free Dispensary for Women and Chil-
dren.

Before drawing attention to several pathological conditions
of the mucous membrane lining the body and neck of the womb,
which have hitherto been included by pathologists under the
denomination of uterine catarrh and internal metritis, I must
be permitted to glance at the present stale of uterine pathology.

If we consult the numerous writers on diseases of women
previous to 1816, when Recamier showed the advantages to
be derived from an ocular examination of the womb, and even

1854.] Uterine Catarrh and Internal Metritis. 273

some of the works written since that time, we shall find great
space given to leucorrhceal and uterine discharges, to displace-
ments of the womb, and to cancerous affections' and ulcerations ;
but that the various organic lesions of the os uteri, the erosions,
exulcerations. ulcersr and other forms of idiopathic inflammation
of the neck of the womb, are either not described at all or
very imperfectly. It matters not that a speculum uteri has
been discovered at Pompeii, nor that Morgagni, in his 14th and
46th epistles, should have stated, that by means of an ivory
tube introduced into the vagina, he was enabled to see an
ulcer on the neck of the womb, to Recamier will be given the
credit of having originated a vast improvement in uterine pa-
thology. By showing the possibility of an ocular examination
of the womb, and urging the frequent necessity of doing so,
Recamier enabled his disciples to ap^ply to diseases of the
womb the recognised sound principles of general pathology ;
and if we consult the best pathologists of the day, either in
France or England, we shall now find the various forms of
uterine inflammation more or less carefully studied, while
leucorrhoea occupies less and less space.

Pathologists are as much divided abroad as at home respect-
ing the terms by which we should designate idiopathic morbid
lesions of the os uteri, which frequently cause leucorrhceal
discharges ; but I scrupulously adhere to truth in asserting, that
in the conviction of the great majority of enlightened prac-
titioners in France, Germany, America, or at home, chronic
leucorrhceal discharges generally depend upon organic lesions
of the os uteri and its vicinity. My paper does not refer to
these lesions, for their pathology and the treatment they require
are now well known, having been elaborately treated by many
writers. But although lesions of the os uteri are the most fre-
quent causes of leucorrhceal discharges and uterine symptoms,
these may likewise be caused by various morbid states of the
mucous membrane lining the womb. So long as the lesions
affect the os uteri, the hand can heal what the eye can see,
and the treatment is satisfactory; or if relapses occur, through
the patient's negligence or the neglect of constitutional meas-
ures on the part of the medical adviser, they can again be cured ;
but when the lesions exist beyond the field of vision, in the
lining membrane of the neck and body of the womb, great un-
certainty reigns respecting their diagnosis and treatment : for
although during the last few years many French pathologists
have written on what they call uterine catarrh, when their
cases are carefully investigated, it is often evident that they
cannot be admitted as samples of simple inflammation of the
uterine mucous membrane ; for ulceration mav exist in the

274 Uterine Catarrh and Internal Metritis. [May,

cavity of the neck of the womb, and remain undetected be-
cause unsought for.

Can we wonder after all that there should still be much ob-
scurity in this department of uterine pathology, when, until
1842, most anatomists did not recognise a mucous membrane
in the body otthe womb, and had but an imperfect knowledge
of that which lines its neck. The structure of the mucous
membrane of the body of the womb, was fust clearly made
out by Coste, and we owe to Dr. Tyler Smith the best de-
scription of the mucous membrane lining the neck of the womb.
In the course of this paper, we shall have to refer to some of
the results arrived at by these investigators; I now merely
observe that the different anatomical texture of the two mem-
branes permits us to understand why the lesions of one are
not necessarily transmitted to the other, although this often
occurs.

Inflammation of the mucous lining membrane of the neck of
the womb may be acute or chronic. In the acute form, pus,
alone or mixed with mucus or blood, may be seen to ooze out
of the os uteri. If it be susceptible of being dilated by ihe
valve of a bivalvular speculum, the mucous membrane may he
found very red or ulcerated. Hence two forms of acute
inflammation of this membrane ; but as they have been well-
described, I shall merely observe, that this acute form of
inflammation is generally called uterine catarrh by French
authorities. It was, for instance, in seven cases of this descrip-
tion that Becquerel tried the effects of uterine injections. As
I shall hereafter mention, most English pathologists consider
the discharge to come as well from the body of the womb as
from its neck. Believing this to be an error, we suggest that
the term catarrh should he reserved for cases of inflammation
of the lining membrane of the neck of the womb in which it is
but little swollen, attended by a small amount of heat, and by
a discharge oftener mucous or sanious than purulent ; or, in
other words, catarrh is a subacute inflammation, and as this
affection never attacks the body of the womb, it would be bet-
ter to adopt the expression of cervical catarrh.

The subacute, or chronic inflammation, of the lining mem-
brane of the neck of the womb, is well worth attention, on
account of its frequency, an assertion corroborated by many
authorities, as well as by Melier, who was one of the first to
notice it in the "Memoires de l'Academie de Medecine." Burns
and Jewel! have recognized it as a subacute affection of the
cervix uteri. Lisfranc and F. Churchill have called it acute
uterine leucorrhoea, and Dr. Bennett, cervical catarrh. Its
long duration and tendency to relapse, and to cause erosion, or

1854.] Uterine Calairh and Internal Metritis. 275

= # -===- =

ulceration of the os uteri, renders it still more deserving of your
attention. The following cases will exemplify the complaint :

Case 1. A year ago a lady was placed under my care by
Dr. Stone. She is tall, stout, aged twenty-six. and of a florid
complexion, but the pulse is habitually weak. She first men-
struated at thirteen, and the function was regularly performed,
and with little pain. Married at twenty-one, but never con-
ceived. At twenty-two her feet got very wet at a menstrual
period : the flow was not checked, but from that time she be-
came much subject to back pains, and to a constant pain in
the left ovarian region. She had a slight brown discharge
during the whole intermenstrual period ; was nervous ; had
hysterical symptoms, such as involuntary tears and choking,,
but no fits. Intercourse was seldom painful, and did not in-
crease the discharge or the usual pains. Menstruation retained
its regular type, but was accompanied by a much more
abundant flow, more pain, and by hysterical fits. This state
of things had lasted two years when I was consulted. There
was then considerable pain on making a digital examination,
and I found the neck of the womb spotted with numerous ex-
ulcerations. These were cured by several applications of
nitrate of silver and vaginal injections, with a solution of
acetate of lead, but the back and ovarian pains remained un-
abated, so did the hysterical symptoms. There was no lesion
to account for these symptoms ; but as on pressing laterally
all down the neck of the womb I gave considerable pain, and
as the brown discharge continued, though the body of the
womb was neither painful nor enlarged, I concluded that the
lining membrane of the neck of the womb was subacutely in-
flamed, and, with the view of substituting a healthy inflam-
mation instead of one of a low type, I painted the inside of the
neck of the womb with the solid nitrate of silver. This was
followed by much abdominal pain and protracted hysterical
fits. A second application, made ten days afterwards, being
followed by similar accidents, I resorted to the application of
tincture of iodine inside and outside of the neck of the womb.
This was done every four or five days for the first three
months, and then only once a week, while at the same time
the patient took thirty drops of Bullock's syrup of citrate of
quinine and iron three times a day. Menstruation continued
extremely profuse for the first three months of treatment, being-
often accompanied by hysterical fits ; but the morbid symptoms
gradually abated, and the patient has been for the last six
months free from all suffering, uterine discharge, and hysterical
symptoms.

276 Uterine Catarrh and Internal Metritis. [May,

Case 2. Mrs. C , aged twenty-six, of middling stature,

delicate complexion, light hair, and with all the characteristics
of a lymphatic constitution, consulted me four years ago. She
first menstruated at fourteen, and the flow was regular and at-
tended by little pain until about her eighteenth year, when the
flow was suddenly checked by remaining several hours in
damp clothes. Intense pain was felt in the right ovarian
region, and pus is said to have been passed several times by
the vagina. When I was called in, the lady suffered from
intense back pain, profuse discharge of viscous fluid from the
uterus, mild hysterical symptoms, and the os uteri was slightly
ulcerated. A few applications of nitrate of silver healed the
ulceration, and the patient took sulphate of iron pills and the
bitter infusion of gentian. Notwithstanding the healing of the
erosions, the symptoms remained about the same, and I found,
as in the preceding case, that no pain was felt when the body
of the womb was pressed, but a considerable amount when
lateral pressure was made to the neck of the womb. The
uterine symptoms were alleviated by the application of the
solid nitrate of silver to the internal surface of the neck of the
womb, and instead of white the discharge became brown.
This was checked by seven or eight applications of the tincture
of iodine, and the patient experienced no further suffering. A
few months back, however, I was again sent for, as there was
a fresh attack of uterine pain and brown discharge, which was
cured by topical applications of tincture of iodine, by the
internal exhibition of steel, and by a sea voyage. In this case
also the patient has never conceived. Menstruation remained
regular, and there was no flooding.

These cases are given to illustrate, not to substantiate, my
practice ; so without detailing others I shall proceed to the re-
marks they suggest.

Causes. The principal causes are imprudences committed
during the menstrual epochs ; the excitements of a prurient
imagination, which too often lead to masturbation ; the too
frequent practice of matrimonial rites ; miscarriages and con-
finements.

Symptoms The presence of the usual uterine symptoms,
in absence of all visible lesions. A digital examination is
sometimes painful to the os uteri ; at other times not. The
same holds good with the application of the speculum, or with
matrimonial intercourse ; but pressure applied laterally to the
neck of the womb gives more or less pain, which is not the case
in a healthy state. A glutinous discharge is seen oozing out of
a somewhat turgid os uteri, and long threads of it may be re-
moved ; but when uncomplicated by erosions, ulcerations, or

1854.] Uterine Catarrh and Internal Metritis. 277

vaginitis, we have not observed that the discharge was fre-
quently abundant. Whether the mucous follicles lining the
neck of the womb can be affected by some other lesion, so as
to warrant Dr. Tyler Smith's position, that the mucous mem-
brane of the neck of the womb is the most frequent origin of
leucorrhoea, remains to be decided by further researches ; this
opinion having been also held by Boivin and Duges, it demands
very careful consideration.

Sometimes the discharge is of a brown colour, as in the
cases related; not mucus streaked with blood not the sero-
sanguinolent discharges of the body of the womb, but an inti-
mate mixture of mucus and blood, as in the rusty sputa of
pneumonia. This discharge we consider to be very characteris-
tic of subacute inflammation of the mucous lining of the neck
of the womb; and on a microscopical examination, it is found
to contain globules of blood more or less difformed, and mixed
with mucus and epithelial scales. It is very annoying to
women, from the manner in which it stains the linen. This
discharge may last the whole intermenstrual period, or only
during the ten days which follow the flow ; and we have
found iodine applications of great utility in such cases. Judging
from my own practice, I believe that the viscous discharge is
more frequently met with than the brown, which generally ac-
companies a very mild type of inflammation.

Chomel, in his Clinical Lectures, has drawn attention to
cases in which there is a red stain on one of the lips of the os
uteri ; instead of being sunken, it is slightly raised, of a vivid
redness, velvety to the touch, not surrounded by pus, but by the
well-known viscous fluid of the neck of the womb. This is no
more an ulceration than the port wine stains or erectile spots on
the skin, and may be considered an exaggerated development of
the bloodvessels of the villi, which in the normal state are cover-
ed with cylindrical epithelium, and, when hypertrophied,form a
piece of living crimson velvet, which in four instances I have
seen lining part of the cavity of the neck, giving rise to the
symptoms I have just described. Such lesions predispose to
metrorrhagia, and their detection suggests the necessity of ac-
tive local treatment, as in an exaggerated instance of this lesion
which was related by Dr. Forget to the Society of Emulation
at Paris. A woman had experienced repeated metrorrhagia :
and on being examined, the neck of the womb was found lined
with a soft, red, and bleeding substance, elastic, crepitating,
and offering most of the characters of erectile tissue. This sur-
face was repeatedly cauterized, and after a few months of
treatment, was completely cured. We think that Dr. Kennedy,
of Dublin, has described similar appearances under the name

N.B. VOL. X. NO. V. 18

278 Uterine Catarrh and Internal Metritis. [May,

of doughy or boggy ulcers of the womb. In my four cases,
the women had been several years married, and had been
sterile. This is in harmony with Chomel's experience.

Prognosis. Dr. Kennedy has stated that " although the in-
flammation of the internal surface of the neck of the womb
may be borne without great inconvenience for years, still it
leads to the serious implication of the sub-mucous tissues,
which undergo a change which may be termed uterine ramol-
lissement, attended by frequent haemorrhages, unhealthy, gru-
mous, and muco-purulent discharges." Now, with due deference
to high authority, we think that Dr. Kennedy has described
exceptional cases. All mucous membranes may remain chro-
nically inflamed for years, without entailing more serious le-
sions than were first visible, and in general the mucous mem-
brane lining the neck of the womb may remain subacutely
inflamed, without causing any thing like uterine ramolliteement,
but it fosters hysterical phenomena, keeps up a vaginal dis-
charge, and causes repeated relapses of erosions, or ulcerations
of the neck of the womb. I believe Dr. Tyler Smith's views
are correct, and that the inflammatory action of the glandular
mass of the neck of the womb, determines the too abundant
secretion of its alkaline products, and that, by their presence
on the os uteri, accustomed to acid secretions, they cause the
rapid shedding of the epithelium, with that destruction of the
subjacent villi which warrants the name of erosion or exulcer-
ation. Whatever form it assumes, all observers agree that
subacute inflammation of the mucous lining of the neck of the
womb is a frequent cause of sterility.

Treatment. Dr. Melier advised the injection of emollient
fluids into the cavity of the neck of the womb, but they would
be ineffectual to modify the inflammation of the mucous mem-
brane, while their entrance into the cavity of the body of the
healthy uterus might be attended by dangerous results. If
emollient injections into the cavity of the neck of the womb
are objectionable, how much more so must be injections of a
solution of nitrate of silver, as used by some French prac-
titioners for what they call uterine catarrh. Although the
cavities of the healthy body and neck of the womb are separated
by a stricture, sufficiently tight to prevent the easy passage of
the uterine sound, nothing proves that this stricture could pre-
vent the passage of fluid, and the numerous and fearful accidents
which have attended the practice of uterine injections, permit
the belief that the stimulating fluids sometimes cause fatal
metro-peritonitis, by passing into the healthy fundus uteri, and,
perhaps, into the peritoneum through the oviducts. Dr. Bennet
states, in his work on Uterine Diseases, page 269, " that

1854.] Uterine Catarrh and Internal Metritis. 279

nothing but strong cauterization with acid nitrate of mercury,
or the potassa fusa cum calce to the lining membrane of the
neck of the womb, can overcome the tenacity of the disease."
If this refers to exceptional cases, I commend the practice, but
in cases similar to those related, I prefer the tincture of iodine,
or the iodide of iron, because it enables us to effect a solid
cure, without inducing much pain, or running the chance of
the serious accidents which sometime follow caustic appli-
cations. After clearing away the uterine mucus I apply the
tincture of iodine with a sable paint-brush, introducing it as
far into the neck of the womb as can be done without using
much force. Ou withdrawing the brush, I paint the vaginal
portion of the neck of the womb. This is a mode of practice
that I have now used for several years, and I can safely re-
commend it, as I find that something similar has been recom-
mended by Dr. F. Churchill. A drachm of acetate of lead, in
a pint of decoction of poppy-heads, forms the best injection in
such cases.

With regard to the crimson elevations on the mucous lining
of the neck of the womb, tincture of iodine is of little use. The
solid nitrate of silver is the best application, or the acid ni-
trate of mercury ; and it must be borne in mind that this con-
dition is often more difficult to treat than simple ulceration.

With respect to constitutional measures, I shall merely say,
that in all chronic uterine affections the practitioner will find a
sheet-anchor in the various preparations of iron, and that the
syrup of citrate of quinine and iron, or the syrup of iodide of
iron, are very good preparations.

The pathology of internal metritis is yet to be written.
Hints may be gathered from works on uterine inflammation,
on uterine catarrh, on dysmenorrhoea, and on menorrhagia ; but
all this information must be tested by a considerable number of
cases, collected with a severity of diagnosis, unattainable until
the recent improvements in uterine pathology. My object is
to place before the profession the present state of our in-
formation on this point ; and if in so doing I only quote from
foreign authorities, it is because internal metritis has been over-
looked by English writers. Dr. Bennet is, we believe, the only
English writer who has treated of this disease ; but in noticing
it he has ignored the principal documents relating to its history
those derived from the practice of Recamier and his pupils.

Before commenting on the morbid conditions of the mucous
membrane lining the body of the womb, I must recall to mem-
ory that the researches of Coste, confirmed by many micros-
copical observers, show that the unimpregnated uterus is lined
bv a verv thick mucous membrane. The skeleton of this mem-

280 Uterine Catarrh and Internal Metritis. [May.

brane is formed by fibro-plastic tissue, and it is completely
studded with follicles, which have a vertical direction, and are
so closely pressed one against the other, that they appear
to constitute the whole of the membrane when observed in the
womb of a woman dying during menstruation. These glands
are follicles like those which line the mucous membrane of
the neck of the womb ; but their secretion is less viscid, if not
watery. In the body of a healthy womb is found a small quantity
of a grey or pink fluid, which is semi-transparent, and contains
cylindrical epithelial cells, blood-globules more or less difibrmed,
and fragments of fibrine. The abundance of this glandular
apparatus, and the more watery nature of their secretion, allow
us to understand the abundant discharge of serous or sero-san-
guinolent fluid, which comes from the body of the womb in some
of the morbid conditions of its mucous membrane.

With regard to the blood vessels of this mucous membrane,
the abundance of their reticulations, which is sometimes shown
by a natural injection, and the delicacy of the epithelial mem-
brane which covers them, gives a satisfactory explanation of the
frequency of uterine hemorrhage as a complication of interna]
metritis. Having thus premised, 1 may affirm that as we rise
from the os uteri to its fundus, disease becomes less and less fre-
quent, and more and more difficult to detect and to cure.

Although the mucous membrane of the body of the womb has
been found acutely inflamed, inl 1, and covered with pus

and false membr.v :i)is condition being generally as-

sociated with similar changes in the body or neci of the womb,
forms apart of acute metritis, of which I do not now intend to
treat.

In some cases of dysinenorrhoea and very profuse menstrua-
tion, the intense sufferings and the floodings are evidently caused
by inflammation of the lining membranes of the womb. In proof
of this, I exhibited to the fellows of the London Medical Society
the uterus of a young woman who was under the care of Dr.
Watson at the Middlesex Hospital, and who died from profuse
menstruation. Dr. Watson cannot remember all the details of
the case, but he recollects that it was not marked by the symp-
toms of acute metritis. The morbid specimen is preserved in
King's College museum. The mucous membranes of the womb
were alone diseased ; they seem to have been both acutely in-
flamed, since both are covered with a thick false membrane.
This membrane is not an exfoliation of the mucous membrane ;
for in one form of dysmenorrhea the mucous membrane of the
body alone exfoliates, whereas this false membrane covered both
the cavities of the body and the neck, and even covers part of the
os uteri ; neither can this membrane be considered to be merely

1854.] Uterine Catarrh and Internal Metritis. 281

the fibrine of a blood-clot; for on closer examination it will be
found to be of a loose texture, and more pointed with red where
it lines the body of the womb, pale and denser where it lines the
neck. If it were a blood-clot would not its texture be uniform ?

If menorrhagia be frequent the opportunities of ascertaining
its cause are extremely rare, and this morbid specimen proves
that in some of the cases merely described as menorrhagia the
flooding is really caused by acute organic lesions hitherto un-
suspected.

What is known of internal metritis leads us to consider it as a
subacute or chronic inflammation of the mucous membrane
lining the body of the womb.

There is a form of dysmenorrhoea characterized by a more
than usual amount of suffering, and by the ejection of membranes
from the womb. As the exacerbations occur only at the men-
strual periods, it is probable they occur under the influence of
some unknown ovarian impulse, as Dr. Oldham has contended ;
but, in many cases of this description, the persistence of uterine
symptoms during the intermenstrual periods, shows that the
mucous membrane of the body of the womb is permanently
diseased.

The researches of Coste and others seem to prove that during
pregnancy the mucous membrane increases in thickness, in vas-
cularity, and, if Pouchet's observations are to be relied on, a deli-
cate cast of the mucous membrane is thrown off from the body
of the wombat the end of each menstrual epoch, and its frag-
ments pass away in the mucous discharge. Under the com-
bined influence of some ovarian influence, and a low type
of inflammation, the mucous membrane of the body of the
womb exfoliates, as it does in pregnancy, and there is cast
from the womb a perfectly organized membrane, in which
the characteristic glands may be seen, thus differing from the
patches of grey, well-organized fibrine, which are sometimes
thrown off with great pain during menstruation. The pathology
of these cases of dysmenorrhoea is doubtless very obscure, be-
cause on such cases post-mortem examinations are extremely
rare : but if in some of our hospital museums you compare
the womb of women who were affected with the form of
dysmenorrhoea, with the womb of women who died during
menstruation, you will in general find that when the mucous
membrane of the womb was in the habit of exfoliating, its
internal cavity was much larger than usual, and the mucous
membrane much more injected.

The mucous membrane of the body of the womb is some-
times affected with a variety of subacute inflammation which
might be termed hcemorrhagic, inasmuch as the sanguineous

282 Uterine Catarrh and Internal Metritis. [May.

discharge by which it is attended constitutes its chief symp-
tom and danger. The following case will illustrate this va-
riety.

Eliza B , admitted to the Farringdon Dispensary Nov.

21st, 1851 ; was twenty-three years of age ; of middling stature
and size ; looks delicate, and has been so from childhood. The
menstrual function began at fifteen, after three years of con-
tinued headache, giddiness, and drowsiness. The flow on its
first appearance was very abundant, and returned once again
at the regular time. Although the daughter of a major, she
brought endless trouble on herself by marrying a workman,
by whom she had a child at sixteen and three months, and
three more children since then She always weaned her chil-
dren at nine months, because she felt weak ; but she never
menstruated until about twelve months after parturition, and
then, in consequence of some fright or domestic altercation,
after the appearance of which flow she has always fallen preg-
nant. She is always delirious after confinements, but makes
good recoveries. When first admitted a patient, she was suck-
ling a child four months old, and was sullering from mild hys-
terical symptoms, which were soon subdued.

On the 28th of April, 1852, she returned with an attack of
menorrhagia, which yielded to cold aluminated applications
and to the internal exhibition of acetate of lead.

In May there was slight leucorrhoea, burning pain in the
back and in the left ovarian region; the patient felt a swelling
there I could not ; but on malting a digital examination, the
body and neck of the womb were uniformly tender, but no
lesion could be seen in the neck of the womb. I ordered alum
injections and mercurial inunctions to the ovarian region ; se-
datives, opiate enemata ; and the bowels were kept open by
small quantities of sulphur and borax.

June 16th. The same symptoms persisted; the neck of the
womb was more congested. I painted it internally with nitrate
of silver, in hopes of modifying some morbid condition which
might remain unseen high up in the cavity of the neck. This
was repeated every week several times without ill effects.

July 14th. Flooding returned, and resisted cold applica-
tions and the injection of a solution of acetate of lead, as well
as its internal exhibition. It was at last checked by ten grains
of ergot of rye three times a day ; when no blood came away,
a serous fluid did ; but this did not come from the vagina
that was seen to be healthy ; it did not come from the neck of
the womb, for the absence of pain on lateral pressure showed
it was not diseased, and when chronically inflamed the secre-
tions of that part are viscous. The uterine sound entered free*

1854.] Uterine Catarrh and Internal Metritis. 283

ly, and seemed to move on a smooth surface of an enlarged
uterus. I left off the application of caustic, as it was no longer
indicated ; and as the liver was out of order, I gave blue pill,
and ordered inunctions with mercurial ointment to the lower
part of the stomach.

In September salivation came on ; the sero-sanguinolent
flow suddenly stopped, and she became delirious. The next
day the discharge came from the womb, at first sero-purulent,
then bloody, and then again sero-purulent w7ith flakes of co-
agulated mucus described as " skins " Saline draughts, opiate
injections and applications, iodide of lead ointment to the abdo-
men, were then had recourse to, to allay the abdominal pain.
During this time the strength of the patient diminished ; but
little emaciation had taken place, although, even when the pa-
tient was not feverish, scarcely any food was taken or sleep
enjoyed. Hysterical attacks became more and more violent,
and for a few months it was necessary to remove the urine
every day. Active uterine treatment was out of the question,
for if, while the patient was lying quietly in bed, a digital ex-
amination was made, she would go off in an hysterical attack
so soon as the finger touched the womb. Tonics and steel
were given, and acetate of morphine.

About February, 1853, Dr. Bennet saw the patient with me,
and we agreed on the urgency of pushing the exhibition of
morphine to saturation point. For several weeks the patient
took from two to three grains of acetate of morphine daily, at
first without any appreciable result, then the pains in the hypo-
gastric region gradually abated, and some time after sleep was
induced. The dose of morphine was then diminished.

After the uterine discharge had lasted for more than twelve
months, sometimes as a flooding, at others to a trifling amount,
it ceased towards the end of August, and about the same time
the patient brought up a considerable quantity of blood from
the lungs ; and notwithstanding repeated haemorrhage to a less
amount, she had all the appearance of health, and was able to
keep a day-school.

In October, menstruation returned, being attended by great
pain and a clotty discharge. Thus a highly nervous tempera-
ment, early marriage, repeated pregnancies, were the predis-
posing causes of a complaint for which it is impossible to trace
a determining cause. She was often despaired of, and the
cure is perhaps to be attributed as much to nature as to art.
Although cured, the patient's constitution remains unaltered,
and she is liable to relapses from over-work and over-excite-
ment.

I have seen several cases more or less resembling this, in

284 Uterine Vivaces. [Mav,

which long continued haemorrhage was the principal symptom
of a low type of internal metritis. One is related at page 387
of Dr. Hennen's translation of Boivin and Dagis. Light is
thrown on such cases by one observed by Dr. Mackenzie, in
which the uterus being inverted, the effects of stimuli on its
internal surface could be demonstrated. The irritation of this
surface was always followed by a sanguineous discharge,

[Londoji Lancet.

Uterine Vivaces.

The Association Medical Journal (June 17, 1853) contains an
interesting contribution towards a pathological history of uterine
" vivaces," by Eben Watson, M. D., Professor of the Institutes
of Medicine in the Andersonian University, Glasgow*

M. Levret, in the Mcmoires de VAcadi mie Royale de Cltintr-
gie for 1777, published an elaborate paper, Sur les Polype* de la
Matrice et du Vdgint in which he makes mention of a kind of
polypus under the name of" vivaces."

The following is an abridgement of his description of them :
They are, he says, ordinarily unattended by lancinating pains,
or by sanious discharges, such as occur in malignant* diseases of
the uterus; but they cause frequent hemorrhages, like common
polypi. They diner from them, however, in having no en-
veloping membrane, or, at all events, a very delicate one. They
are found in two forms ; either like digital vegetations, more
or less long, thick, and numerous, parts of which break off,
and come away from time to time with a hemorrhage; or
they may be found in one mass, somewhat globular in form, and
rendering the womb large and painful; and. though the vagina
be found full of this mass, the womb is not at all emptied of it
" ainsi, comme il est communement impossible de parvenir a
detruire la cause immediate de ces fongosites, e'est peine perdue
de travailler a les retrancher." " Ces excroissances," he writes
at another place, "doivent etre censees incurables, parceque ces
ne sont que trop communement des vegetations de quelque ul-
cere de Pinterieur de la matrice."

M. Herbiniaux, in his Traite sur divers Accouchments labo-
rieux, et sur les Polypes de la Matrice, published at Brussels in
1794, gives a more lengthened account of vivaces. He expresses
the same opinion with M. Levret, of their origin and in-
curability.

Cases of this disease have also been recorded by Herbiniaux,
Gooch, Dr, Jas. Hamilton, Dr. D. D. Davis, and Dr. Bullen of
Cork; and a case is related by Dr. Watson, in this paper, which
occurred in his practice.

1854.] Uterine Viuaces. 285

From the cases which have been recorded, Dr. Watson
gives the following generalization of the chief features of
vivaces :

" In the first place, then, vivaces generally indicate their presence
suddenly and without previous warning. There are no symptoms as
yet recorded, from which any physician can infer their presence with-
in the womb, until a discharge of blood occurs ; and even then the
diagnosis is obscure. The excessive pain in the lower part of the
belly, taken along with the profuse hemorrhages, seems, at this period,
to be the only mark fitted to excite a suspicion of the real nature of
the case. But we are not kept long in suspense, for the progress of
the growth is always very rapid. Within three months, in my case,
it had fully distended the womb. The physical signs are then suf-
ficiently marked ; viz., the bloody discharge, the stretching of the
uterine neck so as to form a tense diaphragm with an aperture in its
centre, and the granulated and insensible growth, felt through it, fixed
by a broad base to some part of the internal surface of the organ.

" The termination of the case has hitherto been invariably fatal,
sooner or later ; death being caused either by gradual exhaustion, or
more rapidly, by the occurrence of colliquative diarrhoea, which is
the common liberator of the victims of inveterate uterine disease.

' What, then, is the nature of this growth? Is it composed of
vegetations from an ulcerated surface, as supposed by Levret, or, is
it identical with the cauliflower excresence of Dr. Clarke, as has
been asserted by Dr. Gooch ?

"In attempting to answer this question, I would observe that I do
not regard the obvious difference of position or site as establishing
any essential difference between vivaces and the cauliflower excresence.
At all events, as Dr. Gooch has remarked, they do not, in that respect,
differ from each other ' more than polypus of the neck and orifice
from polypus of the fundus of the uterus.' And Sir B. Brodie's case,
referred to by Dr. Gooch (op. citat. p. 304.) would seem to be an
instance of the occurrence of the cauliflower excresence within the
womb.

' But, while I acknowledge that the growth just named may occur,
though very rarely, within the uterus, still, I believe that certain
marked differences exist between it and vivaces. The most import-
ant of these is the pre-existence of ulceration of the internal surface
of the uterus. This occurrence was very clearly evinced in the case,
which I have narrated as having occurred in my practice, by the pain
and tenderness on pressure above the pubes. But I must confess that
the profuseness of the hemorrhage, at this stage of the affection, re-
mains unexplained ; nor do I know of any circumstance capable of
throwing light on the phenomenon. There was no evidence, at that
period, of a growth within the womb ; and the pain of the fundus
uteri was not felt until after several severe hemorrhages. If we could
suppose that some one or more enlarged and atheromatous vessels had
been ruptured by the shock of the patient's fall, and that the wound,

280 Uterine Vivaces, [May,

thus occasioned, ulcerated instead of healing, we might, perhaps, ex-
plain the history of the case; and, although it is a theoretical, it is
the only feasible explanation I am able to give. But, however this
may be, there can be no doubt of the reality of the inflammatory
action which speedily ensued, and which, though actively treated,
terminated in vegetations.

"On the other hand, the cauliflower excrescence of Dr. Clarke is
seldom accompanied by pain; indeed, I may say, never by pain so
severe as that which precedes the formation of vivaces. The former
is a still more insidious disease than the latter ; and hence Dr. Clarke,
in his original paper, lately republished by the Sydenham Society,*
informs us that he had never found it less in size than a blackbird's

egg-

11 Another remarkable point of distinction seems to flow from the
preceding. It regards the nature of the discharge. That from cauli-
flower excresence is generally limpid and watery, hardly soiling the
linen, and becomes only occasionally bloody, as at the menstrual pe-
riods, which are not often disturbed at the first, or after some violent
bodily exertion, capable of breaking the delicate structure of the
growth. Whereas, in cases of vivaces, the discharge is cither bloody
or purulent, and ere long it becomes very fetid ; evidently proving the
much greater vascular action going on in the latter than in the former
instance. The watery discharge from the cauliflower excresence
seems to he a mere mechanical transudation of serous fluid mixed with
the increased mucous secretion of the irritated vagina, and sometimes,
also, with the cast-oil* cells of the growth itself. In all such cases,
too, when hemorrhage occurs, small brainy masses may be found in
the discharge, identical in structure with the cauliflower excresence.
Such hemorrhage, therefore, is likewise mechanical, flowing from
ruptured substance of the growth. But it is far otherwise with
vivaces. They often die and come away as putrid matter, but new r
seem to break from delicacy of structure ; and the hemorrhage in
these cases must proceed either from the progress of the original
ulcer, or from the smaller vegetations from its surface, which still re-
tain their vascular nature. The longer and more bulky growths are
to all appearances evascuhir, being white and spongy, and filled with
cheesy substance like concrete pus. For, as I remarked above, the
ordinary discharge, in cases of vivaces, is always purulent when it is
not bloody ; this, of course, arises from the progress of the ulceration,
which is continually sustained and prevented from healing by the
mass of its own unhealthy vegetations

" This leads me to mention, as a fourth distinction between these
two kinds of uterine growth, that vivaces do not shrink in bulk after
death, as happens in such a remarkable manner with the cauliflower
excrescence from the os uteri. But I regret that, for reasons former-
ly mentioned, I cannot speak with precision on the minute internal
structure of vivaces. If, however, I am warranted in concluding,

* Essay on Diseases Peculiar to Women.

1854.] Uterine Vivaces. 287

from the history of such cases, especially those points in it to which
I have just adverted, that vivaces are nothing more than exaggerated
vegetations from an ulcer of the womb, matted together by inflam-
matory effusions, and perpetuating the morbid lesion from which they
originated, then nothing can be more different than their internal struc-
ture compared with that of true cauliflower excrescence. For, as I
have elsewhere more fully explained (Edinburgh Monthly Journal of
Medicine, for Nov., 1849), the latter growth consists of a congeries
of simple and compound cells, some of which are expanded into deli-
cate bags containing blood-corpuscles. These bags exist chiefly on
the margin of the excrescence ; and, when they burst, they leave the
fibrils or hair like processes, which mark the latest period of its his-
tory. It seems to be the peculiar property of these cells to withdraw
serum from the blood in the uterine vessels, and to permit its exuda-
tion through their walls, thus constituting the greater part of the
discharge. But, of course, this ceases at death ; and then the cells
collapse, or, in other words, the excrescence shrinks away. But no
such function is performed by vivaces, and no such shrinking occurs
in them after death ; and therefore I do not think the inference un-
fair, that no such mechanism exists in them as in the cauliflower
excrescence.

"I have not hitherto introduced the question, whether or not viva-
ces are malignant in their nature. The opinion of Levret as to their
being incurable, and some of the cases recorded by Herbiniaux and
others, would seem to indicate that such really was the case. But I
am inclined to think that vivaces may or may not be malignant, ac-
cording to the character of the ulcer from which they spring. This
opinion is founded on that which has already been stated and proved,
with such data as I possess, regarding the pathological significance
of the vivaces themselves ; and I think it unnecessary to enlarge
upon this point at any greater length. Suffice it to remark, that on
this important feature of the case will depend the prognosis and the
treatment.

" I do not assert that all cases of malignant disease are incurable,
when I say that malignant ulcer of the body of the womb belongs to
that category. Its advance is generally considerable before it is
clearly diagnosed, and even then it is out of the reach of efficient
means of eradication. And when the vivaces have sprung from a
non- malignant ulceration, it may still be impossible to root out the
morbid parts before the patient's condition has become a hopeless one.
In some cases, however, it may be attempted by ligaturing the long
vegetations, making the cord cut as well as strangulate the growth,
and then cautiously but effectually applying a caustic substance. I
should myself prefer the common caustic, because its action, as well
as the bleeding, might be conveniently arrested by injections of vinegar
and water. As soon as possible thereafter, alteratives and tonics
should be given to change and improve the action of the internal
surface of the womb. But I feel that I cannot, with propriety, even
attempt to frame directions for the treatment of vivaces ; and I there-

288 Milk Sickness. [May,

fore leave it to others to draw the practical inferences deducible from
the preceding pathological data regarding that very rare but most
interesting affection of the uterus." [Amer. Jour. Med. Sciences.

Ergodelateria. By Prof. Slack, of the Cincinnati College of
Medicine and Surgery.

I send you an essay on a vexed theme, which has occupied
the Medical Faculty since the first settlement of the Valley
of the Mississippi. Much speculation and observation have
been expended on it, and I believe, up to this time, without a
satisfactory solution. It is vulgarly called milk sickness, be-
cause the disease seemed to arise from using the milk of cows
somehow affected by a strange distemper, which, when exert-
ing an influence, produced on the animals various appearances
of 'disease, such as weakness of parts, trembling, convulsions,
&c. ; oftentimes death ensued. Where cattle were sensibly,
though perhaps not perceptibly, affected, the calves of such
dams, depending on the milk of the latter for support, almost
invariably died. The butter made from infected cattle, as well
as the milk, have proved a source of serious disease to many
families, spread throughout the country ; especially in different
newly settled parts. The flesh of cattle even but slightly af-
fected has been found unwholesome, and even poisonous. The
old physicians know well, the many instances of this distressing
malady, called milk sickness, in the neighborhood around Cin-
cinati. Even a number of deaths have occurred in the great
Valley, traceable to no other source than the products of the
milk cow, and the beef of infected cattle. Though the disease
has passed from us, it still lingers on many of our borders and
new settled places.

It is, therefore of the utmost importance that its cause be de-
ciphered, in order that the deadly effects may be parried and
removed.

The conjectures in regard to the cause, from time to time
have been uttered or published. Respectable men have written
or affirmed, that the disease arose from the cattle poisoned, by
cropping the Ranunculus, or vesicating crow-foot, found fre-
quently in meadows and pasture grounds; a course of action
which cattle never pursue. They always discriminate their
food unless insidious. Some have referred the cause to local
miasmatic influence. Some to the water near which the malady
prevailed, supposing a peculiar mineral or metal to have con-
taminated the watering place. The writer of this has been
called on, more than once, to analyze waters thus situated.

Some have invoked the aid of certain creeping, and, reputedly,

1854.] Milk Sickness. 289

poisonous vines running in pasture flats, as the cause. To the
writer of the present essay, all these particulars are but guesses,
most of them fanciful, and fall quite short of the truth. The
cause is, I conceive, not difficult, taking into view the amount
of botanical and chemical facts and principles, for some time,
and especially, recently accumulated.

It is found that grasses, of which wheat and rye are but va-
rieties, in producing their seeds, or corn, as termed in Europe,
are sometimes in a diseased state when the seed is maturing
under certain circumstances, so that many seeds in a head or
spike are not natural, but a monster or a changed result. Af-
ter a careful examination, it has been discovered that numerous
seeds, in a grass head, spike or panicle are affected by a small
parasitic fungus, so as entirely to change the form and char-
acter of each seed affected, from a nutricious bercal to a
poisonous and very unwholesome substance. The spurred rye,
"secale cornutum," is an example in point. Grasses growing
in certain grazing lands, hereafter to be noticed, are equally af-
fected with rye, in the ears, spikes or seed heads in many
grains, a like parasitic fungus, so as to change the character
of each seed affected, just like the " secale cornutum," or horned
rye, whose character, as ergot and the pulvis jarturiens of
Drs. Stearns and Aperly, is, to a considerable extent understood
by the profession.

The proofs of this poisonous principle in diseased grass seed
grass being the direct food of cattle are seen in various
botanical authors, as well as noticed in my own researches. In
Chambers' dictionary, the basis of Rees's great Encyclopedia,
published in 1783, this character of the diseased seeds of grasses
in general is noticed, and the very calamitous results to the
poor and others from eating rye bread made of flour, prepared
from grains filled with secale cornutum or spurred rye, the
latter disclosing a virulent poisoning principle, are very par-
ticularly detailed. The poisoning is presented as quite perma-
nent, and the diseases resulting many, and most distressing.

In Wood & Bache's Dispensatory, of 1845, page 311, it
is remarked "in all the Graminacece, or grass tribes,"' "the
place of the seeds is sometimes occupied by a morbid growthr
which, from its resemblance to the spur of acock, has received
the name of Ergot." The celebrated James T. W. Johnston,
F. R. S. S., Professor of Agricultural Chemistry in the Uni-
versity of Durham, England, invited by the State Agricultural
Society of New York, delivered at Albany, the capital, a course
of very able agricultural lectures in 1850. His remarks on
this subject will be found in his published lectures, by SaxtonT
of New York city, page 72. He fully endorses the permanent

290 Milk Sickness. [May,

poisoning character of the secale cornutum, and the distressing
results of the use of infected bread to the poor classes of Europe,
in serious and long continued disease. He adds (in his own
words,) "it is a curious fact that this same Ergot is found, not
only in rye, but in various kinds of common grasses, on which
cattle feed, particularly among the rank grasses that grow in
marshy places. It was immediately inferred that this kind of
fungus thus produced in these grasses on which cattle feed,
and which, in rye, produced the remarkabe feverish effects on
the human body, was the cause of similar effects in cattle,
which, in many districts" of Great Britain, "prevails to such
an extent that the farmers find it impossible to secure calves."
Many other proofs, if necessary, might be adduced. My ex-
perience coincides entirely with the latter gentleman's positions.
1. That the poisoning in cattle, which affects their milk, butter,
beef and calves, results from an Ergot or fungus production
in grass seeds which the cattle, at certain seasons, eat in
grazing. 2. That this poisonous principle, affecting the cattle
through their products, forms, in our communities, what is de-
signated as the cause of milk sickness, formerly so common all
around us. 3. That the Ergot in rye results from much wet
just before seed or grain setting, followed by great heat or
high temperature. The spurred rye is found more especially
in low or wet grounds; if at all on np-lands, in very wet
seasons. The same principles hold good in regard to all grazing
or pasture grasses. The seeds are found diseased or ergotised
chiefly in low, wet grounds, great heat having prevailed, in
rank and vigorous grass. Hence, milk sickness prevailed fear-
fully, some years since, up the Licking river and in adjacent
lands, opposite Cincinnati, near Brookville, and in perhaps one
hundred other places, where it is now unknown. Why now
unknown? The cause has been removed by clearing and
cultivating the land, and draining the swamps. The remedy,
then, is easy. Whenever drainage and cultivation are vigor-
ously pushed, the disease is no longer found ; because the
strong pasture grass having air and sun light, the nidus of the
fungus seeds is not furnished, and the fungus, which is a poison
parasite, will not grow and ergotise the seed of the grass.

Early in November of 1839 and '40, by request, I visited a
very respectable family. I found them all laid down with milk
sickness. The house was an hospital all were sick. The
lady was retching and vomiting in a manner unusual to me.
She died during the night after. What was the condition of
the lands around? The family lived in a fertile place, 1^ miles
from Memphis, Tenn., on the east bank of the Wolf river.
The whole space, except a small strip of land, was frequently

1854.] Milk Sickness. 291

overflowed by water. In this particular case I looked round
carefully for a cause of the very distressing malady, and was
satisfied it resulted from something produced in the vigorous
grasses of those low lands, since which time botanical facts
confirmed my impressions, and led to the sentiments above.

It has been noticed, that at harvest onward to the middle of
winter, the disease is found in its worst form. It may have
occurred in the spring, but of that I have no information. If
so, it must have resulted either from some of the infected seed
still remaining, or from the cattle, previously poisoned con-
tinuing diseased, grazing in the low swamp pastures

The chemical character of ergot of rye and of grasses, I
have not space to furnish. Indeed, no very reliable analysis
of its poisoning parts and simple elements has been given. The
smut in maize, Indian corn, is produced by a parasitic fungus
of poisonous character. I have known many cattle, in the fall
season, to die from eating the smutted corn ears left by the
huskers when gathering the corn. The ergot of rye and other
grasses, as shown, is produced by a parasitic fungus of the
same genus as the smut in Indian corn. The ergot is possessed
of a concentrated poison, or that which is quite active in its
operation. In the deleterious principle of both Indian corn
smut, or ergot of rye and other grasses, there is, no doubt, a
small proportion of nitrogen. This is found to be the fact in
regard to all poisonous vegetables. Let the nitrogen be in
large quantity, and the vegetable article is, in general, nutricious
as tea, coffee, chocolate ; but in tobacco the nitrogen is small
in quantity, and the poisonous character is frightful ! It ranks,
notwithstanding the unnatural use made of it, as a near relative*
in poisonous character, to prussic acid, the most terrific poison
in the catalogue, to which arsenic is almost nothing in com-
parison. The essence of tobacco and prussic acid are both
vegetable products. Let tobacco users beware ; the affirmation
here is no tale, but a solemn and impressive truth.

In conclusion, I propose to call the poisoning principle of
ergot of rye and other grasses, Ergodeleteria. from ergot,
(French) a spur or cock spur, and Deleterion (Greek.) poison.
Translation : The poisonous principle of ergot of rye and
other grasses. [Western Lancet.

* "Near relative." What the essence of tobacco is has not been decided, sa
that the expression " near relative," is in point. The prussic poison is an acid
of peculiar character, not sour, but by combination with bases forming salts is
its constitution decided. Nicotine C 10 HS N, by Turner ; not very certainly-
decided, is an alkali, yet our positions above are by no means disproved.

In regard to the treatment of ergodeleteria I have said nothing; that is obvi-
ous to the experienced practitioner ; it is to be removed from the system.

292 Black Cohosh in Chorea. [May,

On the Use of Black Cohosh in Chorea. By T. J. Garden,
M. D., of Wyliesburg, Va.

We present you a detailed and circumstantial account of
two cases of Chorea of deeply interesting character, reported
to us by our request, in a letter from Dr. L. T. Wootten, of
Lunenburg; and, as the Doctor writes with precision and
clearness, we give his letter entire, although we have no au-
thority for so doing ; yet we feel assured he will pardon the
liberty we have taken.

" H. L. Coleman, set. ten years, was taken, after exposure, with
acute rheumatism, or arthritic inflammation of the knee joints, in the
winter of 1842, attended with much swelling, and pain and high ar-
terial excitement. He was visited and attended by Dr. H. May, of
Lewiston. He was confined about six weeks. Early in the spring
he commenced school, walking daily the distance of about two miles
to and from school, and at night complained of fatigue and aching in
his extremities.

" After attending school for about three weeks, he was unable to
continue bis exercise, on account of his inability to walk, symptoms
of chorea having manifested themselves to such an extent as to alarm
his parents, and Dr. May was again requested to visit him. He con-
tinued his services, in connection with Dr. Irby, for nearly twelve
months. Failing to receive any benefit from the treatment of these
two intelligent physicians, who tried all of the usual and ordinary
remedies used in such cases, his parents sought the aid of two Thomp-
sonians, who also drugged and steamed him for about twelve months,
without any palliation or alleviation of the symptoms. The above is
the imperfect history I obtained of the case when I first saw him
(rather accidentally) about two years subsequent to his first attack.
During the warm months of summer he suffered less than during the
winter and spring. I found him much emaciated ; anaemic ; light
hair, blue eyes and fair complexion ; tongue thickly coated with a
brown yellow fur, pointed and very tremulous ; breath loaded and
offensive ; thirst ; great difficulty in deglutition ; pulse about one
hundred and ten, soft and very compressible ; bowels constipated ;
loss of appetite, &c. He was unable to control a single voluntary
muscle for a moment. Pressure along the spine threw him into vio-
lent agitation, evincing much tenderness and suffering when the
pressure was even moderate. With scarcely a ray of hope, I pre-
scribed an alterative and laxative pill, composed of equal parts of
rhubarb, aloes and blue mass, every other night, and directed, as soon
as the pills evacuated the bowels thoroughly, to commence with the
powdered cohosh in teaspoonful doses, mixed in syrup of molasses.
I left about 1 oz. (all I had at the time), and did not see or hear from
him again until the 1 oz. was taken, when his brother applied to me
for more, stating that H. Lee was evidently much improved. I sent
him another oz. of a fresher and better article than the first, such as

1854,] Black Cohosh in Chorea. 293

I always use, and greatly prefer if I can get it, viz., the article which
is put up in pound papers by the Shakers of Western New York.
I directed it to be used as before, in teaspoonful doses three times a
day ; the root as it comes to us, having been previously reduced to a
fine powder. In ten days or two weeks, without having taken all of
the last oz., he was well, entirely free from every vestige of the pecu-
liar symptoms which characterize chorea, and in a very short time
again commenced school. The following winter he had a return of
the pains in his knees, attended with symptoms of chorea, but in a
much milder form. The cohosh was again resorted to without any
adjuvant whatever, not even restricting his diet; the symptoms gave
way as if by magic, and he was able to resume his usual exercise in
about a week. The next winter the symptoms were again manifest-
ed in a still milder form. By proper attention to his clothing, and a
few doses of the cohosh, he was very soon relieved, and has since had
no return of the disease, and is now a grown young man, of active,
industrious habits, and quite sprightly for his opportunities.

"John Wood, set. about nine years, was exposed to the variable
and inclement weather of the spring of 1850; was taken with fever-
ish symptoms at night, restlessness and aching in his limbs, with loss
of appetite, furred tongue, &c. In a very few days, which was about
the 1st of March, symptoms of chorea came on, with occasional head-
ache. The disease was so mild that his father brought him on
horseback to my house. Before taking his seat, 1 observed to his
father, that his son had St. Vitus's dance. He had never heard of the
disease, and evinced all the anxiety of the parent ; but upon being
told that his son would in all probability soon recover, became recon-
ciled, and carried him to a public gathering, where he remained all
day, exposed to the excitement and curiosity of a large crowd, and
reached home at night. John complained of great fatigue, with
headache, and the symptoms of chorea greatly aggravated. The fe-
ver continued until morning, when he was observed to be delirious.
He had taken, the night after reaching home, a small blue pill, which
operated freely on the bowels, attended with a good deal of griping.
The fever and delirium continued for twenty-four hours before I saw
him. I found him with a hot skin, a tense and bounding pulse, dry
tongue, relaxed bowels, perfectly furious with wild delirium, and un-
able to protrude his tongue, or to control a single muscle I have
never witnessed such violent and continued agitation of the whole
muscular system. It was in a constant state of the most violent agi-
tation, asleep or awake. I opened a vein and abstracted 10 oz. of
blood, which was sizy and buffed, with great amelioration of the
symptoms. Directed cold applications to the head, with warm pedi-
luvia, with mustard in the bath, and cool elm injections, and directed
a repetition of the bleeding if the fever returned, beinn; unable to see
him again until the next day. His fever and delirium returned, but
he was not depleted until the day after the first bleeding, when I
again resorted to the lancet, taking 8 or 10 oz. of blood, with decided
relief to all the symptoms, and applied a blister to the nape of his

X. S. VOL. X. XO. V. 19

294 Passive Rcemorrhage from the Kidneys. [May,

neck. He became rational after the blister was dressed, but the
symptoms of chorea continued still in an aggravated form. I was
unable to obtain any of the cohosh until the 6th or 7th day after his
attack or confinement. I commenced it in teaspoon ful doses, given
in syrup three times a day. In one week he was able to walk about
the room, and at the end of the second week was apparently well
free from any muscular tremors whatever. The powders seemed to
occasion distress, making him sick at the stomach after the first week,
and the tincture, prepared in the proportions of 1 oz. of cohosh to 1
pint of good rye whiskey, was substituted, which was also given three
times a day, which entirely eradicated every trace of the disease.
During the last winter he had a slight return of chorea. The cohosh
was used, and a bottle of the comp. syrup of sarsaparilla ; since
which time he has had no return of the disease, and is now in the
enjoyment of robust health. In some six or eight cases in all, I have
only seen one in which the cimicifuga failed to cure, and that one had
suffered for some two or three years before any remedial measures
were used. The child's mind was almost fatuitous, and attended with
irremediable organic lesion of his physical system. To you alone
am I solely indebted for the knowledge of the use of the remedy in the
treatment of chorea; and allow me to tender my grateful and kind
acknowledgements and obligations for this as well as other equally
important suggestions, which you have so frequently and so kindly
made. Faithfully, your ob't serv't,

Pleasant Grove, Sept. 24, 1851. L. T. Wootten."

As you express a desire for short practical papers, we close
this communication, with a single additional observation. We
are fully satisfied the cohosh is adequate to the cure of all
cases of chorea not complicated with incurable organic lesions,
and where the intellectual faculties have suffered no impair-
ment. We, ourselves, have witnessed a solitary failure only,
and that was such an one as last described, nor do we know of
any failures on record. The promptness too with which it
arrests the disease, after the system has been properly prepar-
ed by purgatives, is almost incredible to those persons who
have never witnessed or tested its action. For its mode of
action, see our first paper. The doctrine we teach is, that
one well authenticated medical fact is worth all the theory in
the world. [Stethoscope.

On Passive Haemorrhage from the Kidneys. By E. G.
Crooke, M. D., Edin., &c, Chorley, Yorkshire.

Of the many phases of renal disease, there is one so insidious
in its progress and indefinite in its characteristics, that although
attention cannot but be drawn to the condition of the urinary

1854.] Passive Hemorrhage from the Kidneys. 295

organs, yet the exact locality of the disease is by no means
evident. This arises from the obscure nature of the general
symptoms ; for as the local ones refer rather to the bladder
than to the kidneys, the former may possibly be looked upon
as the affected organ. Moreover, the action of chemical re-
agents upon the urine secreted in this form of disease, and the
average specific gravity and quantity of that fluid, give little
aid in leading to an accurate diagnosis, unless the microscope
be used to assist in the investigation, when the presence of
blood corpuscles, epithelial cells, with occasional casts of uri-
niferous tubes, evidence that the kidneys themselves are suf-
fering from some lesion, functional or organic. When the
urine, upon the application of proper tests, clearly indicates the
presence of albumen, and when the blood-globules are in such
quantity as to color that fluid, and subside to the bottom of the
containing vessel, there can be no doubt as to the existence of
haemorrhage, active or passive, from some part of the urinary
organs, but this form of " passive haemorrhage from the kid-
neys " is not so easily discerned.

Several cases of chronic haematuria having occurred in the
practice of the writer, he ventures to bring their general history
under notice, more especially as he has been induced to think
it probable that this form of renal disease is much more fre-
quent than is supposed, and that it is often the first stage or
forerunner of that condition in which free albumen is present
in the urine viz., of "chronic albuminous nephritis," and that
when the "acute desquamative nephritis'' following upon the
exanthemata is supposed to have yielded to treatment, chronic
haematuria is apt to remain, or to be induced upon the applica-
tion of a slight exciting cause.

Symptoms. Passive renal haemorrhage offers to our notice
two classes of symptoms the general and the local. The
general are those of anaemia, the result of a continual draining
away of that vital fluid, the blood ; the local refer chiefly to
the bladder. The general symptoms are, a pallid complexion,
of a dirty-white or muddy color, with dilated pupils ; occasional
headache and sineinir in the ears; the tongue is large, flabby,
and furred, the edges thereof indented by the teeth; the bowels
are open and loose ; there is much flatulence and nausea, with
irregular appetite ; palpitation is frequent ; the surface of the
body is cool ; the skin soft and relaxed, but dry ; the pulse full,
soft, and bounding, or small and soft, putting on the former
condition upon change of posture ; there is gradual but pro-
gressive emaciation, irritability, and gloominess of temper,
with great disinclination to any exertion, bodily of mental.

296 Passive Hemorrhage from the Kidneys. [May,

These symptoms vary in degree according to the longer or
shorter duration of the disease.

2nd. The local symptoms are in some cases an aching pain
in the loins, but this is, perhaps, rather an exception than the
rule. They, the loins, are rather the seat of an uneasiness and
feeling of weakness, which is increased upon pressure: the
calls to micturate are frequent and urgent, attended with pain,
sometimes referable to the penis, sometimes to the inside of the
thighs and to the perinaeum: the urine is not much, if at all, in-
creased in quantity when compared with the amount of fluids
imbibed.

Pathological Indications of the Urine. The usual quantity
of fluids being taken into the stomach, the average daily amount
of urine excreted may be stated at about fifty ounces. The
specific gravity ranges from 1015 to 1035, the latter being the
standard of the urina sanguinis. A gradual reduction in the
weight of the urine has been observed in those cases which
have been attended with frequent relapses. The colour is that
of pale golden sherry ; the odour is sweet ; when recently
passed, it has barely any action on litmus paper. A distinct al-
kaline re-action upon reddened litmus has not, however, been
observed. When poured into a test-tube, a very slight cloud
may be seen floating near the bottom ; if allowed to stand for an
hour or so, a small opaline deposit, easily dispersible, will form.
The recent urine is unaffected by heat, or NO5 HO; but if
allowed to stand after their action, a small flocculent precipitate
sometimes forms ; occasionally, however, no precipitate is
visible to the naked eye. Of that portion which is allowed to
stand, the supernatant liquid is unaffected by heat and NO5 HO;
the deposit, however, is dissolved by the latter, indicating the
presence of phosphates ; and when heat is applied to the mixed
fluid, as in the recent urine, a precipitate may or may not be
the result. Upon submitting a drop of the recent urine to the
field of the microscope, blood-discs, turgid or collapsed, single
and not aggregated, together with epithelial cells and occasional
casts of the uriniferous tubes are seen; no pus-globules have
been detected. Such are the usual characteristics of the urine ;
but the action of concurrent causes, as exposure to cold and
the imbibition of diuretic fluids, renders the urine acid for a
time, when crystals of uric acid and of the lithates, together
with blood-discs, are seen.

It will be observed that the symptoms, general and local,
are those of that form of renal disease termed by Rayer " Chronic
Nephritis," but that there is an important difference in the
character of the urine. In treating of this " chronic nephritis. '?

1854.] Passive Hemorrhage from the Kidneys. 297

Dr. Christison states (" Lib. of Med." vol. iv. p. 270) "that the
urine very seldom contains blood or albumen, unless other re-
nal diseases concur." However, of that form of renal disease
now under notice, blood-globules have been invariably con-
tained-in the urine, but could only be detected with certainty
by the microscope. Liability to passive renal haemorrhage
appears to be either constitutional or acquired. Persons con-
stitutionally predisposed are those of lax fibre, fair complexion,
with skin soft and supple, easily excited to action, but as readily
depressed : persons of a tuberculous tendency, prone to af-
fections of the mucous membranes, as catarrh, bronchitis,
diarrhoea, &c, whose arterial system is in that state which may
be termed irritable. Such a constitution appears, as it were,
acquired by two other classes, who are specially prone to this
haematuria viz., those who are in the habit of consuming
large quantities of diluent fluids, as hay-makers, reapers, engi-
neers, stokers, bleachers, tenters, dressers, and spinners in
cotton-mills persons who, after exciting great cutaneous action
by severe manual labour, or by working in a high artificial
temperature, check the same by exposure to a much cooler at-
mosphere after the cessation of their daily employment. The
habitual dram-drinker is most prone to the acute form of Bright's
disease, or to that stage which probably supervenes upon this
viz., that in which the urine is of low specific gravity, and con-
tains free albumen. May not the frequent use of spirits, from
their direct action upon the kidneys, by over-stimulating the
organs, produce this haematuria which may ultimately pass on
to "chronic albuminous nephritis ?" It may be observed, that
of several cases of "passive renal haemorrhage" which have
occurred in the practice of the writer, not one could, as far as
the patient's recollection served, be traced to any dropsical af-
fection, proximate or remote.

The average age of the persons affected was above thirty-five
years ; they were chiefly of the male sex, probably on account
of the greater exposure of males to the predisposing and exciting
causes, which latter appeared, as far as they were traceable,
to be exposure to cold, damp air when in a state of perspiration,
frequent use of diuretic spirituous liquors in fact, any circum-
stances which, depressing the heat of the body, produced con-
gestion of the viscera.

The Pathology of the Disease. The presence of blood in
the urine affords ample proof of the existence of haemorrhage
from some part of the geni to-urinary passages; the state in
which the blood-discs are found, the inadequacy of chemical
re-agents to detect them, the occasional casts of uriniferous

298 Passive Hemorrhage from the Kidneys. [May,

tubes, and the natural colour of the urine, indicate that the
haemorrhage is renal, yet not of an active kind. But the com-
parative paucity of the globules discharged would lead to the
conclusion that the kidneys are not suffering from any organic
lesions, but from an unbalanced state of their circulations This
state of venous engorgement may probably exist for some time
without any structural change in the glands themselves, but
unless relieved, it is apparent that exudation will ultimately
occur, and derange the whole action of these excernant organs.
The actual progress of this haematuria into chronic albuminous
nephritis has not been traced, the remedies used in the cases,
of which this paper is a general history, having had the effect
of checking, if not of curing the haemorrhage.

The therapeutical indications are three in number. First,
to check the haemorrhage by relieving the congestion ; secondly
to restore the general health; thirdly, to guard against relapse,
and this is an important point, as there is a great tendency
thereto upon the application of any exciting cause. The first
indication may be effected by rest, daily use of the warm bath,
with friction to the bodily surface, local depletion, abstinence
from diuretic drinks, bland farinaceous diet, and the use of
astringent remedies. To relieve the gastro-hepatic derange-
ment, a small quantity of blue-pill, with a sedative saline draught,
will be found useful at intervals dining the exhibition of
astringent remedies, the best of which is gallic acid. It has
been given in the following form : Gallic acid, a drachm ; dilute
hydrochloric acid, two drachms; solution of hydrochlorate of
ammonias (E. P.) one drachm ; distilled water, five ounces and
a half, as a mixture ; a tablespoonful to be taken every fourth
hour. The therapeutical effects of gallic acid are well described
by Dr. Golding Bird : " Gallic acid acts as a direct astringent,
reaching the renal capillaries, and finding its way into the urine,
which becomes strongly charged with it, &c." To relieve the
irritability of the bladder, five grains of soap-and-opium pill
should be used every night as a suppository. These medicines
should be continued until the haemorrhage ceases, and the vesical
irritability which remains for some time after the cessation of the
haemorrhage, is relieved by tincture of cantharides, in doses of
from ten to twenty drops, combined with an anodyne. When
the urine is free from blood-discs, the general hygienic rules for
restoring tone to the system should be enforced; animal diet,
with a few glasses of sherry daily, may be allowed, and quinine
with iron prescribed. As preventive measures, the warm bath
with friction should be daily persisted in ; flannel should be
worn next the skin, and all exposure to exciting causes
studiously avoided. [London Lancet.

1854.] Treatment of Psychical Disturbances, 299

Treatment of Psychical Disturbances in their First Stage.
By Dr. Erlenmeyer.

Upon the treatment of psychical disturbances at their com-
mencement, often depends the whole course of the disease, and
especially the final issue in recovery or hopeless idiocy. A
very common method consists in making large abstractions of
blood, which seem required by the frequently exalted tempera-
ture of the head, the accelerated circulation in the cranial
arteries, and the over-distension of the veins; in a word, the
cerebral congestion, as it is usually expressed. Although the
experience of all countries declares this treatment inappropri-
ate, in most cases even positively injurious although the tes-
timony of all our hospitals for the insane is opposed to it ; yet
numerous cases still occur in which patients are brought, with
rapid strides, to incurable idiocy, by means of copious blood-
letting.

The time is not long gone by, when in our best insane hospi-
tals, the use of narcotics, in the treatment of psychical diseases,
was wholly interdicted. This view was first changed by the
recommendation of opium by Dr. Herman Engelken; and this
remedy now began occasionally to be tried, and, indeed, in
somewhat larger doses than usual. The excellent results which
followed this practice, in certain cases, continually encouraged
to further trials; so that now it is considered indispensable by
our best physicians.

The form of psychical disturbances in which opium succeeds
best, is melancholy, in its various shades. It animates the pa-
tient, exalts innervation, and gives to the despairing sufferer
new courage. I have tested this remedy in private practice.
With few exceptions, mental disturbances, in their first stage,
accost us as a melancholic temper, so that these cases also ap-
pear appropriate for the administration of opium. Upon dif-
ferent occasions, when I have been called to the treatment of
commencing mental disturbance, I have, therefore, decided
upon the exhibition of opium, and have seen really surprising
results from it, since many patients have not only been tempo-
rarily improved thereby, but for the most part have been
completely cured.

Opium, administered in large doses, operates, in many re-
spects, entirely different from small doses. It produces no
congestion of the brain; it does not induce constipation on
the contrary, I have, in several cases, observed severe diar-
rhoea following the use of this remedy, which required its dis-
continuanae. I have, in all cases in which constipation followed
the exhibition of small doses at the commencement, seen this

300 Treatment of Psychical Disturbances. [May,

disappear upon its continued and increased administration.
The nutrition of the patient is very quickly increased, and
I have repeatedly seen the weight of the body gain from
two to three pounds a week. The courage of the patient,
which, in melancholy, is so depressed, becomes exalted ; the
constant complaints and lamentations are silenced ; in short,
the patient, in a brief time, is both corporeally and mentally
changed.

In the hospitals, the exhibition of opium has been carried to
six grains at a dose; and several physicians, especially those
who first commended the practice, have carried it still farther,
without observing any injurious effects. At the comencement
of psychical disturbances, such doses, though they may be well
borne, are not at once necessary ; and the exhibition of from
two to four grains twice a day will suffice completely to allay
incipient melancholy.

The best form of opium is the powder, as such, or made into
pills; whilst the tinctures and alkaloids have not been so effi-
cient in my hands.

Whilst I now proceed to the indications and contra-indica-
tions, I should observe, in the first place, that the data brought
forward are imperfect; and that I here mostly appeal to symp-
toms, will be excused by the reader, who knows full well that
the diagnosis of the condition lying at the basis of mental mala-
dies is infinitely difficult.

The highest indication for the exhibition of opium is the
hyperesthesia, which presents itself at the commencement of
psychical disturbances in so manifold a manner. It matters
not whether this hyperesthesia be of peripheric or central
origin.; nor is it of any consequence in which division of n
it occurs. The excellent effect of opium in pure neuralgias,
should have long since led to its administration in hyperesthe-
sia of other nerves; and would certainly have done so, had
not various fears, which were based more upon theory than
practice, deterred therefrom. That opium is not so dangerous
a remedy as it is generally represented in the manuals of Ma-
teria Medica, I have thoroughly convinced myself; and many
of our German physicians, at the head of insane hospitals, will
agree with me, whose authority must be acknowledged by
every one.

Almost two-thirds of all psychical maladies commence as
hyperesthesias. One of the most common is the hyperesthesia
of the Nervus Vagus, with greater or less participation of the
sympathetic, in the well-known form of precordial distress,
which Fleming has so well described, and which, together
with headache, he enumerates as the most constant symptoms

1^54.] Treatment of Psychical Distui bances. 301

of psychical disturbances. I have observed the precordial
distress in very different constitutions, as well of central as of
peripheric origin, and always perceived good effects from
opium.

The result is surprising when this praecordial distress is con-
nected with psychical hyperesthesia, a condition which is
usually designated as hypochondriacal melancholy. These pa-
tients are tearful tormenting spirits to the physician, because
they cannot be dissuaded from their hypochondriacal ideas by
any process of reasoning.

A more numerous class of hyperesthesia?, which occur
mostly at the commencement of psychical diseases, are the
sensual. It is wonderful to what perversities patients are of-
ten led by this kind of alienation of the nerves of sense. A
great part of the aversion to food occurring at the beginning
of mental maladies, depends upon the hyperethesia of the
glossopharyngeal or olfactory nerve. In food prepared in
the ordinary manner, the patients smell and taste all possible
singularities: when there is also simultaneously hyperesthesia
of other nerves, often of the vagus, they are sorrowful, anx-
ious, distrustful, smell poison in their food, which increases and
justifies their anxiety, and they begin to resist nourishment.
Another complaint which we frequently meet with in patients
of this kind, is that those about them know their thoughts. I
have found this in many cases, where there was as yet no par-
ticular mental derangement ; it is evidently a minor degree of
hallucination of hearing, induced by hyperesthesia of the
acoustic nerve. Such a condition very commonly precedes
the outbreak of peculiar hallucinations, as I have repeatedly ob-
served in a patient who suffers periodically from hallucinations
of hearing. A short time before the particular hallucinations,
he has the sensation as if his thoughts were expressed by those
about him, only that he does not clearly hear the particular
words, as is the case upon the full development of the halluci-
nation.

Most of the conditions which occur at the beginning of
mental diseases, may be referred to these hyperesthesia?, which
are usually designated by all sorts of other names, nervous
irritability, exalted nervosity, nervous derangement. <$c.

When these hyperesthesia? exist in the manner just des-
cribed, independent of any organic disease of the brain, mani-
fested by anaesthesia, paralysis, &c, without the existence of
any mote serious affections of other important organs, of the
heart, the lungs, the digestive apparatus, &c, which must be
looked upon as the cause of the incipient mental disturbance,
opium tt'ill do excellent service, and if it does not completely

302 Sulphuric Acid in Diarrhoea. [May,

and permanently cure, it still effects an important alleviation ;
but in the last-mentioned cases it does no good, and often may
do harm.

There is also another contra-indication, vyiiich is not, how-
ever, very frequently in the wav : it is vomiting occurring after
administration of small doses. We need not be much disturbed,
nevertheless, on this account, since no greater disadvantage is
to be feared than that the opium will do no good. I must
especially insist, that a coated tongue and other gastric symp-
toms should not deter us from the use of opium, since this is
observed in almost all cases of psychical disease, immediately
at the opening of the scene, and very commonly occurring as
the fii st expression of alienated nervous function. Opium allays
these so-called gastric symptoms generally very quickly, en-
livens the appetite, and stimulates nutrition better than all
stomachics. There are individuals in whom there exists an
idiosyncrasy against the smallest doses of this remedy, who be-
come thereby more excited, in whom anew train of symptoms
is induced, as palpitation of the heart, ringing in the ears,
greater disquiet, complete sleeplessness ; in these persons we
should desist at once from the farther use of opium

Opium does excellent service, not only in melancholy, but
in all other forms of psychical alteration which depend upon
hyperesthesia, if it is employed in the first stage of the difficulty,
whilst in all psychoses of a torpid character, it produces little
or no benefit. [Deutsche Klinik. Amcr. Med, Monthly.

The Efficiency of the Sulphuric Acid in Diarrhoea. By Good-
eve Bowra, Esq., M.R.C.S.E.

As much has been said and written lately on the treatment
of diarrhoea, I beg to offer my testimony on the happy effects
of sulphuric acid on persons of all ages, with the full conviction
that it is the quickest and most palatable, consequently the best
remedy for that disease.

I was requested two years ago to send medicine to a young
lady subject to diarrhoea, who had taken a passage to China in a
ship not carrying a surgeon. Thinking there must be some
mistake, I went on board the vessel and saw the chief officer,
who thought himself quite competent to treat (from books and a
medicine chest) any disorder likely to arise on the voyage. On
asking this gentleman what he would do in cases of diarrhoea, his
off-hand reply was, " Never care for that ; always carry plenty
of sulphuric acid on board, and I have never known it fail."

On the same evening I was called to a lady, seventy-five years
of age, very subject to these attacks, which always lasted a week

1S54.] Ergot of Rye in Retention of Urine. 303

or more, and as it was of creat consequence she should return
into the country in two days, I made up my mind to try the sul-
phuric acid, believing I should not be more successful with the
old chalk mixture than her medical friend at home.

The following morning I found her up, and so much better,
that she had only taken two doses; I gave her a third, which
completely cured her. Since then I have used nothing else
(save a mustard poultice) in all cases, either with or without
pain, both in private practice, and at an institution to which I was
attached, and I confidently state that during the whole period I
have used it I have not met with one unsuccessful case. The
only difficulty is, to persuade some people that acids would not
increase their disorder, particularlv those accustomed to the old
chalk and aromatic confection treatment.

I now constantly recommend patients subject to diarrhoea,
or who are nervous about cholera, to keep a bottle of the sul-
phuric acid mixture in the house, and on the first symptom of
their complaint instantly to take a dose, which is generally
sufficient to effect a cure. Maoy of these patients (I fear,
jokingly) tell me they shall expect double charges, as two or
three draughts of the acid mixture have more effect than the
same number of bottles of the chalk mixture ; and I may add,
I feel so satisfied with the success of a two years' trial, that
I have no hesitation in asserting it as my full belief, that deaths
from cholera and diarrhoea would be very materially diminished
if the authorities would appoint an agent in all poor neighbor-
hoods, to give a dose of the sulphuric acid mixture to every
necessitous applicant suffering from bowel complaint. They
would have plenty of persons desirous of availing themselves,
of this remedy, it I may judge from the gallons I gave away
last summer. [London Lancet.

Ergot of Rye in some forms of Retention of Urine. By
M. Passot, of Lyons.

Ergot of rye has not only the property of exciting the uterine
contractions in cases of inactivity of the uterus, but is also very
efficacious in the retention of urine which is caused bv atony
and paralysis of the bladder. MM. Baudin and Payan of Aix
were the first who endeavoured to demonstrate that this agent
does not act on the uterus alone, but rather on the lower part
of the spinal cord. They also speak very highly of it as well
in the affection which we have now under consideration, as in
weakness or paralysis of the lower extremities.

Drs. Kinsley, Canuto-Canuti, Sainmont de Rocroy, Allier of
Marcigny, have also recorded cases which bear favourable

304 Ergot of Rye in Retention of Urine. [May,

testimony to the utility of ergot in paralysis of the bladder. I
will now briefly mention some of them:

Captain B., aged 60. suffering from dysuria, which had in-
creased greatly during the last three months, until it suddenly
changed to a complete retention, which necessitated the em-
ployment of the catheter several times a day. For two months
a host of remedies were used without avail ; there was not the
slightest improvement. The prostate became enlarged, and
the patient suffered much from the use of the catheter, which
had to be passed twice every day.

Fifty centigrammes (about eight grains) of ergot of rye. in-
fused in a cupful ofboiling water, was administered three times
a day. At the expiration of six hours, the patient passed a
smali quantity of urine, and required the use of the catheter
only once in the day. Afterwards it was only passed once in
the forty-eight hours, and after ten days the bladder was left
to itself (Kinsley's Journal des Con. Med. C/iir. March, 1844.)

A lady, aged about 75, was affected with paralysis of the
bladder, which for a long time required the use of the catheter.
Ergot was prescribed in doses of fifteen decigrammes (about
twenty-eight grains) in infusion. On the sixth day of this
treatment, it was no longer necessary to piss the instrument,
the patient being able to pass water spontaneously (Canuto-
Canuti, Bull, des Sciences Med. (U Bologns, 18 45.)

A man. named Rousseau, aged 58, of a nervous temperament,
was, in consequence of a lit of passion, attacked with a com-
plete inability to urinate. The bladder was obliged to be
emptied by the catheter. The inertia of this organ continued
in spite of cold injections into it, cold enemata. the application
of ice, also a blister to the hvpogastrium.

Strychnia applied, by means of ointment, as a dressing to
the blister, also by frictions in the axillae, on the following day
produced cramp in the legs and arms, and was presently
accompanied by stiffness, so that it became necessary to dis-
continue the use of this remedy. There was not the slightest
action on the bladder. It was at this stage that the author
conceived the idea of giving ergot of rye. He prescribed
six grammes (about ninety-two grains,) coarsely powdered, to
be put into a litre (about thirty-four ounces) of water, macerate
for two days, filtered, and injected cold into the bladder. Seven
minutes afterwards the patient experienced a desire to urinate,
which, however, he could not then satisfy. The next morning
the injection was again administered. Eight minutes after he
had vesical tenesmus, and then spontaneous emission of urine.
The injections were continued for some days. The cure was
complete. (Sainmont, Gazette des Ilopitaux, 1848.)

1854.] Chloroform in Hooping- Congh. 305>

In 1848, Dr. Allier, of Marcigny, sent a letter to the National
Academy of Medicine, in which he gives as the result of his
observations, that in only one out of fourteen cases ergot proved
of no use.

I also am in possession of some cases which, in an incon-
testable manner, prove that ergot is capable of restoring the
contractility of the bladder. The following is the most re-
markable : In the month of July. 1846, I was consulted by
M. H., aged 60, of a dry constitution and a very well-marked
nervous temperament. M. H. admits having indulged both in
venereal excesses and in the excesses of the table, and it is
these that he blames for the vesical paralysis from which he is
now suffering, and which requires the catheter Twice a day;
otherwise there is no symptom of organic alteration, no fever,
no enlarged prostate. The canal of the urethra is free through
its entire length, and the urine when drawn off is perfectly
clear. After having experienced the uselessness of tincture of
cantharides and blistering the hypogastrium, I used the follow-
ing prescription :

Freshly powdered ergot . . . 2 grammes (30 grains.)

Mucilage ....... 120 " (31 ounces.)

A tablespoonful every half hour. Shake the bottle.

Ergot of rye, powdered . . . 15 decigrammes (23 grains.)

Cocoa butter a sufficiency.

To be made into two suppositories ; one of them to be introduced
night and morning.

On the same day, at the expiration of some hours, M. H.
felt a desire to micturate. At my evening visit, I ordered a
bath. The patient was scarcely in it before micturition took
place spontaneously and with force. From this time to his
death, M. H. has always passed water freely and without the
assistance of the instrument. I should add that, to make certain
of the cure, I continued the remedy for three or four days, but
in a decreasing dose. M. H. died the 30th of January, 1848,
of an acute pleuropneumonia, during the course of which not
a single morbid symptom appeared in the bladder. It is there-
fore certain that ergot cures retention of urine which depends
on pure and simple atony or paralysis of the bladder. But
with regard to paralysis consecutive to apoplexy, or depending
on other affections of the nervous centres, it is well known
that they are unaffected by the remedy we are treating of.
[Dub. Med. Press, from Gaz. Med. de Lyon.

Use of Chloroform in Hooping-Cough.
Dr. Fleetwood Churchill, in a letter to Prof. Simpson, pub-
lished in the Monthly Journal of Medical Science, (Aug. 1853.)

300 Chloroform in Hooping Cough. [May;

alludes to his having mentioned, in his work on Diseases of
Children, his having tried the inhalation of sulphuric ether in
hooping-cough, with great benefit, in about a dozen cases, and
states that he has since tried chloroform with equal benefit.
But he always found, he remarks

" Two obstacles to its full and fair administration to young chil-
dren. In the first place, you cannot get them to give notice of the
approach of a cough, so as to enable you to have the chloroform in
readiness before the paroxysm commences ; and when the paroxysm
has commenced, as it consists of eight or ton expirations to one inspi-
ration, the chloroform will have evaporated before it has been fairly
inhaled. And secondly, )roung children have such a horror of any-
thing near their mouths during the cough, that they will resist your
trying the chloroform as much as possible, until they themselves have
felt its power in relieving the cough. Owing to these two causes,
and perhaps also to a want of clever management on the part of the
mother, we shall find it fail altogether occasionally, and in other*
only partially succeed. But when it is fairly tried, as I have already
remarked, its use is most beneficial.

11 1 have all along felt very anxious to try it in young persons of
twelve or fourteen years old and upwards, because with them we can
avoid the two difficulties I have mentioned; but it was not until this
year that I had an opportunity. Four cases have come under my care,
and the results are as follows :

"Cask I. Miss D., act. 16, had had hooping-cough a month, when
I prescribed chloroform. There was no complication, hut the hooping
was frequent, especially during the night. She was directed to have
the chloroform in readiness, and to ust- it with each paroxysm ; and
she assures me that in two days the hoop ceased. The cough lasted
a few days longer, but it was alight, and not in kinks.

"Case II. Miss A., ant. 20, had heen ill with hooping-cough for
about three weeks, when I prescribed chloroform. The cough was
not very frequent, and there was no complication. Two days sufficed
with her also to relieve her of the hoop ; and the slight cough which
remained subsided after a week or ten days.

" In these two cases, the effect seemed quite magical ; both had
the disease well marked, and the families of both were prepared for
a disease of two or three months' duration, as was the case with these
other children.

" Case III. Miss B., aet. 18, took the complaint from her brother,
whom I was attending, and I therefore had an opportunity of giving
chloroform from the commencement. She did not hoop any time she
coughed ; but she was directed to use the chloroform whenever she
felt the tickling in the larynx, without waiting for a cough. By doing
so, she found that she could postpone the cough indefinitely ; and if
it came on suddenly, the use of the chloroform instantly suspended it.
About three weeks elapsed, before the tendency to cough and the use
of chloroform ceased ; but during that time she Lost neither appetite

1854.] Internal Administration of Chloroform. 307

nor flesh. She slept well, was in good spirits, and able to follow her
usual occupation. She went to the country quite well.

"Cask IV. Master B., aet. 16, the brother of the last case, when
I first saw him. had the disease most severely. The kinks were vio-
lent and prolonged, the efforts to inspire and the hoop excessive ; it
really seemed as if he would be choked, or that something would give
way. He had lost appetite, sleep, and spirits, although the disease
had not lasted three weeks when 1 saw him. I tried chloroform wiih
him, and it at once reduced the number of paroxysms one-half, but
without mitigating them when they did occur. He took the chloro-
form very I reel v : and as he was not readily influenced by it, the
quantity seemed to give him a headache, and he begged to be allowed
to suspend its use. I the more willingly agreed to rhiisras he had a
severe attack of diarrhoea. I therefore substituted two drops of prus-
sic acid (Dub. Pharm.) with two or three of black drops three times a
day. The improvement begun under chloroform-, continued under
this treatment, and at the end of five weeks from the beginning of the
disease the cough had ceased, and he had regained rest, spirits and
flesh.

" Although this last case cannot be regarded as cured by chloro-
form, the paroxysms were first dinv'nished by it. and I have no doubt
tbat it contributed to the beneficial effect of the prussic acid. The
first three cases are, I think, very conclusive as to its value ; and, if
farther experience confirms them, we shall possess a means of cutting-
short this disease in adults, who, when attacked, suffer so severely.

" One word as to the mode of exhibition. In order to avoid the
possibility of an overdose, I have never given the chloroform on a
handkerchief, or by means of an inhaler, but have directed the mother
(in the case of young children) or the patient to spill a little, say about
thirty drops, in the palm of the hand, and hold this before the mouth
and nose, sufficiently near to inhale it folly, but not so close as to ex-
clude a portion of atmospheric air. The best rime to begin is just as
the patient feels the irritation in the chest increasing to a cough, but,
if possible, before the cough commences; and the inhalation should
be repeated with each return of irritation, unless headaehe be pro-
duced." [Amer. Jourx. Med. Sciences.

Internal Administration of Chloroform*

[The following interesting facts, bearing upon the value of
chloroform internally administered, are derived from the pro-
ceedings of the Medico-Chirurgical Society of Richmond, pub-
lished in the Stethoscope :]

" The regular business being voluntary communications, Dr. Snead
related the following very remarkable cases :

"I. Called last year, at 9 P.M., to visit a gentleman in intense
agony ; had been on duty as fireman and extremely fatigued ; evU

308 Internal Administration of Chloroform. [May,

dently suffering from severe colic ; gave opium in large quantities,
200 drops of laudanum, and 2 or 3 grains opium with camphor, calo-
mel, &c, without relief; in my opinion there was spasm of the intes-
tinal canal ; gave chloroform half teaspoonful in water ; in a few
minutes gave a teaspoonful more, and in 30 seconds the patient was
asleep ; he continued relieved during the half hour I remained with
him : next morning found him as well as usual ; learned that he had
awakened in two hours, and then uspd a small quantity of laudanum.

' II. Called to see a negro man at night, suffering from colic, with
diarrhoea and spasm of the legs ; gave a pill of morphine and calomel
with a teaspoonful of chloroform : he was relieved in ten minutes and
slept two hours.

" Called at night, to see a negro who had been suffering from colic
the whole afternoon, with vomiting, purging, cramps of abdomen and
legs ; gave Dover's powder 10 or 15 grains, then a teaspoonful of
paregoric; he had already taken calomel 15 grains, with morphia
sulph. \ grain : as he was not relieved, and the symptoms urgent, I
gave half a teaspoonful of chloroform, and in ten or fifteen minutes
half a teaspoonful more, after which he vomited. So soon as his
stomach became quiet I gave a teaspoonful more; in ten minutes he
was asleep, and got well without further treatment.

M IV. Was one of lead colic in a house painter ; found him suffering
from excessive irritable stomach ; had had no evacuation, and could
retain no medicine upon his stomach ; after suffering three days with-
out relief, I gave a teaspoonful of chloroform, which put him to sleep
in fifteen minutes; his stomach was quieted so that a purgative was
retained, and he was relieved. I believe that but for the chloroform
he would have died.

"V. A stout athletic negro ; suffering from violent spasmodic pain
with vomiting; no evacuation from Saturday until Monday; sterco-
raceous vomiting ; patient's countenance presenting a very bad ap-
pearance ; I feared there was intussusception ; felt a hard tumor in
the abdomen with tenderness; gave calomel grs. xx ; croton oil gtt.
iv ; used powerful emena, which merely unloaded the lower bowel ;
followed by three or four evacuations, but they did not indicate relief
of the whole tract; gave a teaspoonful of chloroform ; he was asleep
in four minutes, and slept two minutes ; gave another teaspoonful,
which produced sleep in four minutes ; in twenty minutes he expelled
flatus ; next morning he showed the action of calomel ; eventually he
recovered; suffered very little pain after taking the chloroform.

"Dr. Cunningham asked if its internal use was followed by irrita-
tion of the mucous lining of the stomach ?

" Dr. Snead. No ; the patient always went to sleep in five minutes
at the farthest.

" Dr. Johnson. Chloroform is one of the greatest discoveries of the
present age. He related the following cases :

**I. Gave 3i to a lady for a violent colic, and she was asleep in
less than one minute, although she had been suffering pain all night.
During this sleep she discharged flatus freely ; and had a large bil-

1854.] Internal Use of Chloroform. 309

ious evacuation unconsciously. She was perfectly relieved, without
the use of any other remedy.

"II. Last night called to see a case of colic from over-eating.
Gave a salt and water emetic without relief. Then gave chloroform
3i internally, and the patient was asleep in thirty seconds. In a few
minutes an immense discharge of flatus occurred, and the patient was
entirely relieved. Believes it worth all other remedies put together.

" Dr. Bolton had given chloroform internally but rarely uncom-
bined. He frequently gave it with camphor, according to the formula
of Smith of Edinburgh, viz: R. Chloroform 3i, camphor 5iii, and ft.
solut. From 10 to 15 drops of this gave very prompt relief. At the
close of the cholera season many cases of violent colic occurred, in
which he gave this remedy with remarkable success.

"Dr. Wilson asked if the effects of the internal administration were
similar to those from inhalation.

" Dr. Snead considered them different. Certainly there was less
risk in the former than in the latter, since it did not interfere with the
due supply of oxygen to the lungs."

On the Internal Use of Chloroform. Bv Hexry Hartshorxe,
M. D., Philadelphia'.

Since 1848, when some account was given in this journal of
experiments with chloroform, internally administered, it has
been variously and extensively used by practitioners in differ-
ent parts of the world. It is now generally recognized as being,
when so used, a narcotic of the mildest and yet most powerful
character, and as possessing in its pungency, also, a quality
which recommends it in some cases above other anodynes.

The object of this article is chiefly to make some remarks
upon its dose and mode of administration. Many practitioners
within the writer's knowledge hesitate, from their recollection
of its power as an anaesthetic to give it in doses of more than a
few drops; and as the drop is exceedingly small, such doses
are really often insignificant. The writer can assert, from
positive experience, that a fluidrachm of chloroform taken by
the stomarh, is not more than equal, in soporific effects, to 3*0
or 35 drops of laudanum. In doses of 50 to 75 drops (about
15 minims,) I have given it every half hour for several hours
together. It differs from the opiate preparations in the prompt-
ness of its hypnotic action, the much shorter period of its dura-
tion, a less degree of cerebral oppression, and the absence of
all stimulus to the circulation. It might be called a 'diffusible
narcotic," comparing in this respect with opium as ammonia
does with alcohol. To produce much effect with it, repeated
doses, at short intervals, will be necessary.

X. S. VOL. X. XO. V. 20

310 Chloroform in Hypochondriasis. [.May,

The pungent property, already alluded to, causes it to re-
quire plentiful dilution, which is, of course, facilitated by the
addition of some demulcent. Perhaps the orgeat syrup is the
best. Every fluidrachm of chloroform should have at least two
fluid ounces of water with it when taken ; and it will need, if
in ordinary gum mucilage, considerable agitation to resuspend
the particles immediately before swallowing. When taken in
aqueous mixture alone, however, unless in very small doses, it
produces nausea with some persons. This is entirely prevent-
ed by the addition of a strong aromatic, or, still better, by giv-
ing the chloroform in aromatic tincture. From the ready so-
lution and kindred action of camphor with chloroform, their
combination has become a very common one. For many pur-
poses, however, a still better preparation is a sort of chloroform
paregoric, or tincture of chloroform, e. g. fy. Chloroform f 3ij ;
sp. camph. et tint. opii. aa foiss; 01. cinnamom. gtt. viij ;
Alcohol f 3iij. M. et fiat tincture. Dose, from 5 to 30 minims,
or more, as required.

The most admirable effects have been witnessed from the
administration of chloroform, as above combined, in malignant
cholera. In the summer of 1849, my attention was first called
to it while attending a very severe case of cholera with the
late Prof. W. E. Horner. The prompt and signal restoration
accomplished in that case, from a state of collapse, was evi-
dently due to the exhibition by Prof. Horner, every five min-
utes, of a few drops of a combination of chloroform, oil of
camp+ior, and laudanum, with ice, and warm frictions, external-
ly. The writer's conviction was very strong that the short
interval between the doses was an important item in the treat-
ment. [American Jour. Med. Sciences.

Chloroform in Hypochondriasis.

At a meeting of the College of Physicians in Ireland, in
June, Professor Osborne stated that he had lately, in two cases,
opportunities of observing a peculiar effect of chloroform taken
into the stomach, in controlling the depressing and saddening
feelings belonging to hypochondriasis. Considering that state
to be produced by a depraved sensibility of the stomach or
colon, and frequently of both, he was led to the internal em-
ployment of chloroform, which being promptly volatilized at
the temperature of the stomach and before long being decom-
posed by the process of digestion, ought to be expected to act
as a local anaesthetic, even though the dose should not be suffi-
cient to produce any change in the functions of the brain.

1854.] Chloroform in Hypochondriasis. 311

The first patient who presented the conditions requisite for
this experiment was a married woman, and a mother aged 33,
of a querulous disposition, as well marked by her countenance,
and who had been on a former occasion under his care, and
that of another practitioner, complaining of a variety of pains
in the abdominal region; and she, although relieved, still per-
severed in the belief that she still had some internal disease.
She now appeared to labour under spinal neuralgia. After
this had yielded to the application of nitrate of silver to the
spine, and some other remedies, she still continued to feel an
indescribable sensation of depression, and of internal annoy-
ance, no longer to be referred to the spinal nerves no cause
for it could be detected. The appetite was good, and the ac-
tion of the bowels regular. In two days after taking ten drops
of chloroform thrice daily, she began, for the first time, to ac-
knowledge that she was better, and in a few days afterwards was
free from complaint. The second case was that of a caretaker
in the Linenhall, aged 29. He complained of the deepest de-
jection of spirits, and of an uncontrollable aversion to any ex-
ertion. His countenance expressed sadness and moroseness.
All the functions were in a healthy state, except that the heart's
action became tumultuous when excited by either motion or
exercise ; but no organic disease could be detected. He stated
that he had not been addicted to excess of any kind, and that
there was no cause for his lowness of spirits. He got valeri-
anate of zinc, and also pills to regulate his bowels ; but, although
the heart's action became steadier, yet the depression and in-
ward sensation continued the same. After taking twenty drops
of chloroform thrice daily for two days, he began to confess,
what he never did before, that he was better. His sleep being
still unsatisfactory and disturbed by disagreeable dreams, he
was ordered to take forty drops at bedtime. He now stated
that he slept with a pleasing dream of seeing his brother, who
had gone to America. During the two following nights he
took the same dose ; and although the sleep was interrupted by
the disturbance attendant on a man in a dying state in the
same ward, yet when he did sleep his dreams were pleasant,
being usually that he was enjoying the company of the most
agreeable of his friends. He was dismissed with a marked
improvement in his countenance, and acknowledging that he
was better.

These cases are selected as being nearly free from compli-
cation. It must, however, be recollected, that there are sever-
al other uses to which chloroform may be applied in affections
of the stomach and intestinal tube, but this appears to be one
of the greatest value, insomuch as no other medicine can be

312 Chloroform in Hypochondriasis. [May,

named which in this respect seems to come into competition
with it. How far the effect is permanent and capable of com-
pletely removing the sensation of hypochondriasis, or in what
degree it may require to be resumed or repeated, Dr. Osborne
as yet has not been able to determine ; neither did he think it
necessary before this association to clear himself from the ab-
surdity of bringing it forward as a universal napenthes.

With regard to the mode of administering chloroform inter-
nally as its specific gravity is nearly 1-5, and it is insoluble
in water, it must, when swallowed, soon settle at the bottom of
the fluids in the stomach, and although it is votallized, yet be-
ing covered, and under pressure, it may remain in contact
sufficiently long to irritate the stomach at the part of the
contact, as was proved to take place in the case of camphor
by Orfila.

Hence, then, it is desirable that it should be diffused or dilu-
ted before it is taken. In aqueous mixtures, even when shaken
up, it soon falls, so that it cannot be equally measured out, and
its pungency is annoying even to the mouth. In gum Arabic
mucilage it soon collects in larger globules at the bottom of
the bottle, covered with a white powder of arabine which it
has precipitated. To obviate this inconvenience, it has been
proposed to give it suspended in syrup, but to make a syrup of
the same specific gravity 1009 grains of sugar to the ounce of
water would be required, while that of the Pharmacopoeia con-
tains only 874 grains; besides, chloroform has a heavy sweet
taste which renders the addition of syrup peculiarly objection-
able. The menstruum which Dr. Osborne used in the above
and other cases was the decoction of Irish moss (carrageen.)
With this chloroform forms a uniform mixture, and in the pro-
portion often drops to the ounce they remain for an indefinite
time without separation taking place. The taste of the mix-
ture is sweet like that of a heavy syrup, to relieve which it
may be well to add a few drops of some aromatic or bitter
tincture.

Another mode of avoiding the pungency of chloroform,
is by giving it in combination with tinctures, as it is solu-
ble in alcohol, and remains dissolved even in proof spirits
The following is a specimen of this kind of formula, and is
peculiarly grateful to the taste, and susceptible of various ad-
ditions and alterations, according to the requirements of the
individual cases Chloroform, and tincture of ginger, of each
half an ounce; aromatic spirit of ammonia, two drachms.
Mix Twenty-five drops to be taken thrice daily in a wineglass-
ful of milk. {Dublin Quarterly Journal.

1854.] Local Ancesthesia. 313

Local Anaesthesia Employment of Hardy 's Instrument.

The first essay with this instrument was made by M. Nela-
ton, at the Clinique, upon a girl who was suffering from abscess
of the axilla, and from a small wound upon the back of the
wrist, both extremely painful. The instrument was composed
of a caoutchouc reservoir of air adapted to a copper pump,
made to receive the sponge for the chloroform. A valve at
one extremity permitted the air to enter the instrument, which
terminated in a caoutchouc tube. The first application of the
chloroform upon the tumour of the axilla produced an insensi-
bility which lasted three hours, during which time the part
could be handled and examined with impunity. In the second
essay, M. Dubois plunged a knife into the abscess, which was
ripe, after the employment of the chloroformic fumigation.
The patient declared that she was not conscious of pain, and
became aware of the fact that the abscess was opened only by
touching the part with her hand. From this time she had no
more pain. The little wound on the wrist, fumigated in the
same manner, remained quite insensible. [Med. Times and
Gazette.

Non- Recurrence of Dysentery.
We noticed in our last No. Prof. Flint's suggestion in refer-
ence to the non liability of persons to a second attack of Dys-
entery. We now make, from the St Louis Medical and Surgical
Journal, the following extract, showing the views of Dr. A. F.
Jeter on the subject.

" Seeing, however, that a number of journals have published the
article referred to, and knowing the importance that justly attaches
itself to whatever emanates from Dr. Flint, I have thought it might be
proper to give a few facts, and thereby prevent the permanent intro-
duction of an error into medical literature.

" In 1846, I was the subject of an attack of dysentery, and judging
from the amount of pain attendant, thought it a severe case. In 1847,
however, I had an attack more violent and protracted than the one of
the former year. Since that season I have practiced every year,
where it prevailed epidemically during which lime I have had four
additional attacks, two of which were of a character so grave as to
render recovery for a time doubtful. So you will perceive, I have six
several times in my own person, and in different seasons, suffered
severe and unequivocal attacks of dysentery. Although I have kept
no record of the number of cases, yet more than thirty instances of
"recurrence" of dysentery among my neighbors and acquaintances,
now occur to my memory, in some of whom the disease has occurred
three or four several times. I have recently (Nov. 10, 1853,) at-

3H Dangers of Cauterization. [May,

tended four members ot a family severely afflicted with dysentery, all
of whom I treated for the same disease, two years ago, and another
member of the same family living in an adjoining county, has had the
disease every summer for the last five. Inasmuch as the attack I
had in 1847 was worse than the one of the preceding year, I was for
a time inclined to the belief, that one occurrence of dysentery might
render each succeeding attack worse ; but farther acquaintance with
the complaint has not confirmed the opinion ; but that one attack
does not destroy our susceptibility to the ' recurrence ' of dysentery,
let the foregoing facts declare. As regards dysentery proving a safe-
guard against other diseases to some extent, as Dr. Flint seems to
imply, it may be remarked, that a considerable portion of our physi-
cians believe in the malarious origin of dysentery, and that their
principal argument in favor of their doctrine is founded in the fact,
that in this district, at least, dysentery is almost uniformly followed
by intermittent fever, which comes on as usual at intervals, during
the remainder of the season.

" The above statement is concurred in generally by the medical
men in this region, so far as 1 have made inquiry. Among others 1
may mention Drs. White, Bailey, Kibby, and Taylor, all of whom
are reputable practitioners."

On the Dangers of Cauterization in Purulent Ophthalmia.
By M. DlSMAftRBB.

If there is one part of surgery in which the rashness of igno-
rance and the danger of limited knowledge is exemplified more
than in others, it is the treatment of inflammations of the eye.
We have long been struck with amazement at the routine
practice adopted by many practitioners who were otherwise
judicicious, in this speciality. Medical men are not ignorant
of the differences in texture of the component parts of the eye
and of the influence which these structural diversities must
exert upon pathological processes, but they seem to be forget-
ful of them. Whatever the disorder implicating the external
tunics, it is met by the inevitable caustic. We have been led
to regard the indiscriminate use of the nitrate of silver as a
great evil, and we gladly give admission to the following re-
marks on the subject by M. Desmarres, whose opinions, deduced
from an experience which probably equals that of any living
ophthalmologist, are entitled to the highest respect;

" A child two weeks old was brought to my consultation, with
purulent ophthalmia, which commenced in the right eye, and had ex-
isted for eight days. The cornea was gone, there was hernia of the
iris, and the lens had escaped.

" On the second day ot the disease, according to the mother's ac
count, there was much suppuration, the lids were swollen, but tho

1854.] Dangers of Cauterization, 315

cornea was clear. The physician who was summoned cauterized
the lids, and from that moment the swelling diminished, and the eye
became perfectly white.

'Six days afterwards the left eye became involved; the conjunc-
tiva was red, the lids tumefied, and pus escaped freely when they
were separated. I feared that cauterization would destroy the cor-
nea of this eye also, and accordingly scarified the conjunctiva of the
globe and lids freely, and directed frequent injections of a feeble col-
lyrium of alum. The next day the scarifications were repeated ; the
swelling had nearly disappeared, and on the third day the inflamma-
tion was completely subdued.

u The pencil of nitrate of silver is a two-edged sword, and in some
hands a. most dangerous weapon in inflammations of the eye. My
experience on this point makes me perfectly positive, and I do not
hesitate to affirm that it would be well if this remedy had never been
employed in eye diseases, so greatly has it been abused. Whether
the cornea is the seat of abscess or ulceration, the disease chronic or
acute, the iris protruded or not, the caustic is applied, without caution,
the surgeon forgetting that a very different treatment is requisite and
that the use of caustic is full of danger.

** A patient is suffering from catarrhal ophthalmia caustic is ap-
plied whether the cornea is involved or not, whether or not it is capa-
ble of resisting traumatic inflammation.

u But it is in purulent ophthalmia, especially, that the greatest abuse
is made of the solid nitrate ; and it is in this affection that it produces
the most disastrous consequences.

"If the conjunctiva is cautiously touched, in points remote from
each oiher, in the incipiency of the ophthalmia, benefit results, for we
then produce a relatively slight traumatic ophthalmia for a most
dangerous inflammation. But when the solid caustic is applied
extensively after pus has begun to form, and there is considerable
tumefaction, the mucous membrane being pale, and especially if there
is no certainty that the cornea is not involved, then, certainly, the eye
is exposed to the risk of destruction in a few hours. I have often
witnessed this melancholy result, but never in a more striking instance
than that of a young man who had already lost the left eye by puru-
lent ophthalmia, and whose right eye was invaded by the same disease.
At a consultation at which I was present, there apparently existed
only an intense conjunctivitis, without appreciable alteration in the
cornea ; vision was perfect. The palpebral conjunctiva was freely
cauterized. The next day the cornea was completely destroyed, the
iris was prolapsed, and the lens escaped the moment an attempt was
made to separate the lids.

" My aim, in these remarks, is simply to induce practitioners to be
cautious in the use of the nitrate of silver, and if I attain this end I
shall be well satisfied. I am convinced that cauterization with the
solid nitrate is often dangerous, and that it is a remedy which cannot
be employed too cautiously. I know that many surgeons will exclaim
against this doctrine, and assert that they have cured this and that

316 Editorial and Miscellany. [May,

affection, and have met with no accidents. I reply that I, like them-
selves, and, assuredly, oftener than they, have had occasion to judge
of the effects of this remedy, and fortified by my experience, lam
certain that the lapis infemalis should be applied in rare cases, and
with the greatest reserve." [Gaz. des Hupitaux, and Virginia Med.
and Surg. Journal.

EDITORIAL AM) MISCELLANY.

BIBLIOGRAPHICAL.

Pneumonia : Us supposed connection, pathological and etiological, with
autumnal fevers ; including an inquiry into the existence and morbid
agency of Malaria. By R. La Rochr, M. D., &c, &c. Philadel-
phia : Blanchard & Lea. 1854. 8vo., pp. 502. (For sale by T.
Richards & Son.)

It is always to us a source of much gratification to have to chronicle
the appearance of a work altogether American, and in the present
instance the pleasure is enhanced by the consciousness that the pro-
duction must redound very much to the honor of our medical literature.
The work before us is decidedly one of the most erudite which has
emanated from the American press, and would do credit even to an
encyclopedic German. While we thus freely accord merited praise
to the distinguished author's learning, we regret that we cannot agree
with him in the conclusions he deduces from his patient investigation.
That Pneumonia, as it prevails in Northern regions, may be, and is,
generally, a simple phlegmasia, recognizing no connection whatever
with autumnal fevers, we do not deny ; but that pneumonia, as seen
in this section of the country, especially for the last seven or eight
years, is intimately connected, pathologically and etiologically, with
our fevers, termed malarial, is a fact too well established to be set
aside by theory or by any array of written authority. We know of
no physician of respectable standing, who has practised medicine for
twenty years in this part of the country, who is not fully satisfied on
this point, and who has not modified his treatment accordingly, and
most manifestly to the advantage of his patients. The history of
medicine is worth but little if it has not taught us that the type of dis-
eases varies from time to time, and that the treatment found to be
most successful for an affection in certain localities and at certain
periods, may prove the reverse in other places and at other epochs.
We believe that there is no point in which the sagacity of Southern
practitioners stands in bolder relief than in the readiness with which

1854.] Editorial and Miscellany. 317

they have detected the peculiarity or the change of type to which we
refer, and the success with which they treat pneumonia since they
have recognized its connection with our fevers.

We regret that our limits do not allow us to go into a minute exam-
ination of the grounds upon which the learned author predicates his
views. We hope, however, to be able to do so at some future time,
as the subject is one of vast importance and should be freely and
fully canvassed-

A Treatise on acute and chronic diseases of the Neck of the Uterus ;
illustrated with numerous plates, colored and plain. By Charles
D. Meigs, M. D., Professor, &c, &c. Philadelphia: Bianchard
& Lea. 1854. 8vo., pp. 140. (For sale by T. Richards & Son.)

We are much indebted to Prof. Meigs for having published in a
separate volume this interesting and valuable monograph, originally
comprised in the Transactions of the American Medical Association.
This work will add another wreath to the brow of our distinguished
countryman, and prove eminently useful to the profession.

Homoeopathy fairly represented. A reply to Professor Simpson's
''Homoeopathy" misrepresented. By Wit. Henderson, M. D.,
Professor of General Pathology in the University of Edinburgh.
Philadelphia : Lindsay & Blakiston. 1S54. 8vo., pp. 302. (For
sale by McKinne & Hall. Price $1 25.)

We noticed in our last the work of Prof. Simpson upon Homoeopa-
thy. We have now to direct attention to the reply of his colleague.
Prof. Henderson is evidently fretted, and winces at the castigation
received. A considerable portion of the work is devoted to the
biography of the "persecuted" Hahnemann. Whatever others may
think of the argumentative parts of the book, we regard it a complete
failure. Prof. H. is, however, a spirited writer, and has probably done
as well as he could under the circumstances. Those who have read
Simpson ought certainly to read Henderson.

Tlie Transactions of the American Medical Association vol. 6.
1853. 8vo., pp. 870. (For sale by T. Richards & Son.)

We have been unusually late in receiving ihis volume of Transac-
tions, probably in consequence of some error of address. It is by far
the best volume yet issued by the Association, and reflects great credit
upon the contributors to its pages. We understand that it can be
purchased for $3 a small sum for a work which ought to be patron-
ized by every physician in our country. It contains, besides the

3iS Editorial and Miscellany. [May,

Minutes of Proceedings and the Reports of Committees, the following
papers :

On the Agency of the Refrigeration, produced by upward Radiation
of Heat, as an exciting Cause of Disease by Dr. G. Emerson.

On the Results of Surgical Operations in Malignant Diseases by Dr.
S. D. Gross.

Report on the Epidemics of Tennessee and Kentucky. by Dr. W.
L. Sutton.

On Acute and Chronic Diseases of the Neck of the Uterus by Dr.
Charles D. Meigs.

An Inquiry into the Nature of Typhoidal Fevers, based upon Consid-
erations of their History and Pathology by Dr. Henry F. Camp-
bell.

On Coxalgia, or Hip Disease by Dr. Aldcn March.

On the Surgical Treatment of Morbid Growths within the Larynx,
illustrated by an Original Case and Statistical Observations, eluci-
dating their Nature and Forms by Dr. Gurdon Buck.

On the Sympathetic Nerve in Reflex Phenomena by Dr. Henry F.
Campbell.

Prize Essay. The Surgical Treatment of Certain Fibrous Tumours
of the Uterus, heretofore considered beyond the Resources of Art
by Dr. Washington L. Atlee.

Prize Essay. The Cell : its Physiology, Pathology, and Philosophy ;
as deduced from Original Investigations, to which is added its His-
tory and Criticism by Dr. Waldo J. Burnett.

We return thanks for the following interesting papers some of
which we hope to notice hereafter :

History of the Epidemic Yellow Fever at New Orleans, La., in 1853.

By E. D. Fenner, M. D.
A Report on the Health and Mortality of the City of Memphis, for the

year 1853. By Charles T. Quintard, A. M., M. D.

A Report to the Indiana State Medical Society, on Asiatic Cholera,
as it prevailed within the State of Indiana, during the years 1849,
1850, 1851 and 1852 ; with Observations on the Laws which gov-
its progress. By George Sutton, M. D.

Eleventh Annual Report of the Managers of the State Lunatic Asy-
lum of the State of New York.

Outlines of the Principles and Practice adopted in the Orthopaedic
Institution of Brooklyn. By Louis Bauer, M. D. and Richard
Barthelmess, M. D.

On the Subject of Priority in the Medication of the Larynx and
Trachea. By Horace Green, M. D.

1854.] Editorial and Miscellany. 310

Remarks on Throat Diseases and Consumption, and the newest me-
thods of treating them. By Ira Warren, If. D.

Constitution and By-Laws of the Medical Association of Texas.

Constitution, By-Laws, Charter, &c , of the Medico-Chirurgical Col-
lege of Philadelphia.

Catalogue of the Officers and Students of Starling Medical College,
for the Session of 1853-4.

Address to the Graduates of the Kentucky School of Medicine, Ses-
sion 1853-4. By R. Breckinridge.

Editorial Changes. There have been of late quite a number of
changes in the corps editorial of the medical press of the United States.
Dr. J. B. McCaw has become associated with Dr. Otis as Editor of
the Virginia Medical Journal. The Stethoscope has been sold by
Dr. Gooch to the Medical Society of Virginia, and is edited by Drs.
Atkinson, Haxall, Bolton, Lewis, Merritt and Cabell, a committee of
the Society. Dr. Bennet Dowler takes the place of Dr. Hester, de-
ceased, as Editor of the New Orleans Medical and Surgical Journal.
The New York Journal of Pharmacy has passed from the hands of
Dr. McCready into those of Dr. Thos. Antisell. Dr. Bell has retired
from the Western Journal of Medicine and Surgery, which is now
conducted by Prof. Yandell alone. Dr. S. R. Hollingsworth has now
the supervision of the Philadelphia Medical Examiner, in place of Drs.
F. G. Smith and J. B. Biddle. In consequence of the death of Dr.
Howard,. the Ohio Medical and Surgical Journal is edited by Dr. John
Dawson. Dr. Joseph Parrish having retired from the New Jersey
Medical Reporter, Dr. G. M. Butler has taken his place. Dr. G. S.
Jones is associated with Dr. J. V. C. Smith in editing the Boston
Medical and Surgical Journal.

We cordially welcome our new confreres, and hope that they may
realize their most sanguine anticipations.

Necrological. Our exchanges announce the death of R. L. How-
ard, M. D., Professor of Surgery in the Starling Medical College of
Columbus, Ohio of Dr. John Ester Cooke, formerly Professor of
Practice in the Transylvania University and of L. W. Chamber-
layne, M. D., Professor of Materia Medica in Hampden Sydney Col-
lege, Va.

Deaths from Scarlatina. It is stated, that in 1852 there were 843
deaths from Scarlet fever in Massachusetts.

320 Editorial and Miscellany. [May,

Lilkotrity Forty -eight times on the same Patient. Mr. Coulson re-
cently exhibited to the Medical Society of London the bladder taken
from a man aged 83, on whom lithotrity had been performed 46 times
in the course of twenty years.

[We take pleasure in calling attention to the following circular.
Dr. Wooten is an able man, and will doubtless present the profession
a valuable work. J

TO PHYSICIANS OF THE SOUTH AND SOUTH-WEST.

The undersigned has in preparation a work on the Fevers which
prevail in the South and Southwest, together with the Diseases of the
Respiratory and Digestive Systems, with a view, in part, to examin-
ing their connections with each other, in aetiology and pathology, and
the influences which they exercise in modifying the characters, spe-
cial and general of one another, &c, &c.

In connection with this matter, I wish to procure all the correct
information possible, concerning the Epidemic Dysentery which has
prevailed so extensively, and severely, in many parts of the country
tor the last few years. I wish to know the circumstances attending
its production, or origin its relation to other diseases, which may
have exerted an influence upon its character what form, or type of
disease, usually prevails in the localities of its occurrence what were
the peculiar, or special symptoms, or phenomena, which gave it iden-
tity of character, and distinguished it from the ordinary endemic
inflammatory Dysentery, and, in short, any thing of interest con-
cerning it.

Physicians who have had opportunities of observing the disease,
and studying its character, will confer a special favor by communi-
cating to me, as early as convenient, the results of their observations.

My address will be, until the 15th of September, "Red Sulphur
Springs, Hardin County, Tennessee." After that date, " Lowndes-
boro\ Alabama."

Suit for Malpractice. In the recent case of James McWha vs.
Dr. Alexander McCandless, in Maryland, the decision of the court
was rendered against the doctor, as follows : " That the defendant
was bound to bring to his aid the skill necessary for a surgeon to set
the leg so as to make it straight and of equal length of the other when
treated ; and if he did not, he was accountable for damages, just as a
stonemason or a bricklayer would be in building a wall of poor ma-
terials, and the wall fell down, or if they built a chimney, and it
should smoke by reason of a want of skill in its construction." Dr.

1854.] Editorial and Miscellany. 321

McCandless appealed to the superior court, who decided " that the
implied contract of a physician or surgeon is- not to cure or restore to
natural perfecfness. but to treat the case with diligence and skill. He
does not deal with insensate matter, but has a suffering human being
to treat, a nervous system to tranquilize, and a will to regulate and
control. The ruling of the lower court is therefore set aside."

[Stethoscope.

Prof. Mott's Letter. The following letter from the venerable,
and celebrated Mott, shows that he is making an effort to have his
name disgorged from the gTeedy stomach of charlatanry, into which
it seems, without his knowledge or consent, it has been swallowed.
We give place to the letter with great pleasure, and as a conse-
quence, the statement of the November number of the Journal stands
corrected. [Ed. Ohio Med. and Surg. Journal.

New York, Dec. 26, 1853.

Sir : Will you be so kind as to correct a mis-statement in the
Nov. number of the Ohio Medical and Surgical Journal, of which
you are Editor.

I never recommended Dr. Hartly as an Occulist or Curisf. ff he
refers to me therefore, it is wholly unauthorized.

In various directions of our country, I find myself set forth in con-
nection with Pills, Powders and Balsams, which I know as much of
as I do of Dr. Hartly, as an Occulist.

I hope you will give me the pleasure of seeing your Journal more
frequently hereafter. Respectfully vours.

VALENTINE MOTT.

Guano in Cutaneous Diseases. By Dr. Desmartis, of Bor-
deaux. Guano is very worthy of the attention of physicians as a
remedy in skin diseases. I have experimented with it, and have been
struck with the results which I obtained. In a case of pemphigus,
the eruption was permanently cured by two or three baths containing
sixteen ounces of guano in solution; and I have observed several
cases of tinea completely cured by lotions of this substance,

I have also seen cases of psoriasis, and of chronic eczema that had
been called incurable, which yielded to a persevering employment of
this remedy. By means of collyria, consisting of solutions of guano,
I have succeeded in curing radically extensive opacities of the cornea.
Leucomas, and even thick albugos have disappeared under this treat-
ment, and the eye has regained its natural transparency.

I have found guano of great service in arresting the excessive sup-
puration and degeneration of tissue occurring in ulcerations of
scrofulous subjects ; in these cases, however, the lotions, injections
and baths, should be very dilute, in order to avoid pain and severe
irritation in the ulcerated surface.

In open cancer, guano causes great pain unless it is very mnch
diluted ; it acts as an astringent, however, in contracting these ulcer?*

322 Editorial and Miscellany. [May,

and prevents the development of the erysipelas which is so frequently
manifested in their vicinity.

Although the curative agents contained in guano enter the economy
by absorption, yet it is still proper to administer internal remedies;
the iodide of sulphur in the case of favus ; Donovan's solution, or
arsenious acid in certain grave herpetic affections; iron and iodine
in scrofula; mercury and iodide of potassium in syphilis, etc., and
purgative in all cases.

What is the active principle in guano ? We cannot say with pre-
cision. It contains potash and lime, which may act as detergent and
siccative ; ammonia, which stimulates the skin ; oxide of iron, an
excellent tonic ; a fatty substance ; uric, oxalic and phosphoric acids.

When guano is prescribed in skin diseases, sixteen ounces are
usually dissolved in a bath.

In lotions, we must be governed by the inflammatory condition of
the diseased parts. From one to four ounces of guano to a pint of
water in the proper proportion. The lotion should be boiled and
filtered. It then assumes a clear golden color. An ointment may
be made with a drachm of guano to an ounce of lard.

If, Recamier was the first to recommend baths of guano; that
celebrated practitioner has employed them with the best results. I r
DIJ own part, I am convinced that they are destined to render immense
services, not in the place of sulphur baths, or as succedanea to these ;
we believe that both remedies have their distinct applications. RevtM
Therapeutique du Midi. Western Land.

Fistula in Ana, treated by Iodine Injections. By M. Boinet. At a
meeting of the Institute of August 1st, M. Boinet read a memoir, de-
,<trate the efficacy of injections of iodine in the radical
cure of fistula in ano, whatever their form, extent, or complications.
Seven cases are detailed, which offer examples of almost evi rj varie-
ty of fistula complete, blind, or incomplete fistula, deep fistula, with
loss of substance of the intestine, and fistula in tuberculous subjects.
These observation! tend to prove that iodine injections may be advan-
tageously employed in all cases of fistula, but especially in those in
which the method by incision is dangerous or ineffectual, such, for
example, as extend deeply, or occur in phthisical patients, or depend
upon some alteration of the ischium, the coccyx, or sacrum.

The advantages of iodine injections over the ordinary method, con-
sist, in obtaining a cure more easily, and in a shorter time, in avoiding
pain and the danger of hemorrhage, and in permitting the patients to
continue at their usual avocations.

The following are the conclusions of the memoir :

1. Iodine injections, properly administered, can cure radically all
cases of fistula, whether complete or incomplete, simple or complica-
ted.

2. They cure them more promptly lhan the method by incision
commonly employed, and with less danger.

3. They produce no pain, and are easily practised.

1854,] Editorial and Miscellany. 323

4. They permit patients to follow their occupations, and relieve
them from daily painful dressings.

5. They are applicable to all cases, and especially to those in which
incision or excision are dangerous or in) possible.

6. They do no harm, even if they are ineffectual, and do not pre-
vent the subsequent use of the knife. It is therefore rational to employ
them before having recourse to a cutting instrument. [Gazette des
Hopitaux. Neu- Orleans Med. and Surg. Jour.

New method of Testing Quinine. By Signor Pagliabi. Signor
Pagliari, a chemist of Rome, the inventor of a new haemostatic com-
pound, has published in the Corrispondenza Scientifica of Rome, a
procedure for determining the purity of the compounds of quinia with
the greatest exactness; and, after repeated experiments, he has ren-
dered the execution of his method extremely simple.

This method consists in heating a small quantity of the preparation
of quinine in a spoon over burning charcoal. In a very short time
the powder melts, leaving a residue of which we shall speak present-
ly. The examination of this residue must be conducted with the
greatest care, for its peculiar tint serves to characterize each com-
pound.

Characteristics presented by perfectly pure sulphate of quinine
residue of clear ruby colour ; very pure quinine residue of the colour
of oil of sweet almonds ; citrate of quinine residue of clear citron co-
lour, with excess of acid, dark citron colour ; valerianate of quinine
residue of the colour of the preparation itself

When either of these preparations is adulterated with foreign mat-
ter, the residue, after fusion, will be wanting in polish and transparen-
cy, and will present a blackish, porous appearance. If they are mixed
with cinchonine or salacine, they become opaque; to be certain of
the presence of salacine, concentrated sulphuric acid may be added,
which will give rise to a red colour.

These trials should be made with about a half a grain of the salts
in question. The author hopes that these simple experiments will
add one more obstacle to the falsifications of the salts of quinine.

[ Virginia Med. and Surg. Jour.

Exsection of the entire Ulna. The American Medical Monthly for
March contains the report of an exsection of the entire ulna by Prof.
Carnochan, which resulted favorably.

" The functions of the arm are preserved in a remarkable degree
of perfection. The power of prehension is unimpaired ; and flexion
and extension at both the elbow joint and at the wrist joint can be
performed with facility supination and pronation can also be ef-
fected abduction and adduction at the wrist joint can be performed ;
as also flexion and extension of the fingers, as before the operation ;
sensation and nutrition are as perfect as on the arm and hand of th
opposite side."

324 Editorial and Miscellany.

New Instrument for injecting the Perchloride of Iron in Cases of
Nanus, fyc. During the last two months we have wil
trials of the acid solution of the perchloride of iron, as an injection
for producing the coagulation of the blood in nSBTUS, etc. In more
than one instant -vere inflammation of the part has foil

its use, and in one, a na?vus on the scalp, sloughing, and even exfolia-
tion of a portion of bone resulted. There appeal
reason to think that the powerful agent had been too freely Used, and
that, had a much smaller quantity been injected, the promise! made
by its introducers might possibly have been home out. Other objec-
tions also applied to the method and instruments in ordinary use ; they
required that an opening should be made l<>r the introduction of the
syringe ; and the flow of blood produced by the puncture, I
nothing of the smallness of the aperture, s.m.-tim< l I the latter

difficult of accomplishment. We have 1mm n town, during the past
an ingenious little instrument contrived by .Mr. I". rgUSSOn, of
Giltspur-street, which looks Likely to aid very materially the efl
accomplishment of this procedure. It consists of a wry small glass
syringe, the point of which terminates in a tine platinum tube. This
tube is encased in another one, about a quarter of an inch longer than
the first! ending in a sharp trocar like point, and having, near il
tremity, an oblique opening in one side. \\y rotating the outer tube
on the contained one, their apertures may be made to correspond
or Otherwise, St the will of the operator. Thus, then, tie
for tWO instrument.*, is CjttttS done away with. The syringe having
been charged, the operator rotates the outer tube. BO as to conceal the
oritice of the inner one entirely, and protect it from the [ngn
blood. In this state the inurnment is pissed into the centre of the
tumour, and, having been stirred about M much as may be thought
ble, the tube is turned back, so as to expose the orifice ; and
the piston bring at the same m >rai nl d b drop or two of the

solution i squeezed out. It may be supposed, that the smalln
the whole instrument, and the diminutive size and oblique position of
Iti aperture, will atlbrd considerable guarantee against the injection
of too large a quantity, while on it- advantages, in case of employ-
ment, it is scarcely necessary to insist. [Med. Times and Gaz.

Remedy for Poisonings. A French chemist recommends, in cases
in which the nature of the poison taken is unknown, the immediate
use of an emetic after which, equal parts of calcined magne-ia,
pulverised charcoal, and sesqui-oxide of iron (precipitated carbonate
of iron of oar shops will answer), should be freely administered in
water. This combination may neutralize most of the mineral poisons,
especially those of arsenic, mercury, and copper.

The Minutes of the Proceedings of the recent meeting of the Medi-
cal Society of the State of Georgia were received too late for this
number.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL

Vol. 10.] NEW SERIES JCNE, 1554. [No. 6.

ORIGINAL AND ECLECTIC.

ARTICLE XVII.

On Epidemic Dysentery. By D. C. O'Keeffe, M. D.3 of
Greenesboro', Georgia.

Et primum de dysenieria loquemur, horribile isto, ac consuetissimo his
region ibus malo, quod plares hie homiDes necat, quam affectus quispiam alius
prater naturam.

Nearly two centuries and a half have elapsed since Bontius
(de Medicina Indorum) used the above language in his history
of oriental dysentery, and the same sentiment may, not in-
appropriately, be entertained in regard to its prevalence in many
sections of our own country at the present day. For manv
years past, the popular, as well as the professional mind, cherished
a well grounded fear of pneumonia and typhoid fever visitations ;
but of late, all of this trepidation has, for the best of reasons,
been reserved for dysentery.

This disease has prevailed in an epidemic form from time
immemorial: Thus, Hippocrates (1st Book of Epidemics.) al-
ludes to it in these words. " In the summer and autumn dvs-
enteries, tenesmuses, and lienteries were complained of; so were
bilious purgings, of a thin, crude, griping nature, and much in
quantity. Others again were watery ; and many complained
of painful fluxes that were also bilious, watery, ragged, purulent,
and strangurious ; not from any fault in the kidneys, but from
one humor or complaint coming upon another. They likewise

N. S. VOL. X. NO. VI. 21

326 O'Keeffe, on Epidemic Dysentery. [June,

vomited bile, and phlegm and indigested food. They sweated
too,in general, the humidity being great everywhere. To many
these things happened without a fever or confinement, to others
with a fever as we shall see hereafter. Where all that is here
mentioned happened, they became consumptive, not without
pain." In this record of the Coan sage, no one will fail to
recognise the principal features of epidemic dysentery.

Again, among the earliest medical records of our own country,
and during the prevalence of the devastating epidemics of yellow
fever, that occurred in different parts of the country about the
close of the last and beginning of the present century, we find
that epidemic dysentery existed in many states of this Union.
In Hanover, N. H., the whole number of inhabitants in the
summer of 1797, including members of the college, (Dartmouth)
was 520; of this number 203 had dysentery, and 16 died.*

In 1805, New York and vicinity suffered from its visitation,
as we learn from the following paragraph: "In delineating the
character of the season just passed away, it ought not to be
omitted that intermittents were extremely prevalent in this city
(N. Y.) and its vicinity, during the last spring, and throughout
the month of June. With the beginning of July, the dysentery
appeared, and continued to be more or less epidemic till the
middle of September. In some parts of the country, we learn
that this disease raged for many weeks with great violence and
mortality. "t Heberden informs us that " dysentery is common
in camps, but does not often infest those who live in healthy
places with the conveniences of life about them, except at cer-
tain seasons, when it becomes epidemical, particularly among
children, old women, and infirm men, and it is then fatal to
many." (Commentaries.) It is in tropical climates, however,
that this disease displays unusual virulence ; in Bengal 13,900
persons were attacked with dysentery from 1820 to 1825. Du-
ring a series of years, when the troops (Bengal army) were not
actively employed in the field, the annual rate of admissions in
hospitals was 35 per cent, of the effective strength. J In Lon-
don, during the seventeenth century, the number of deaths set

* Medical Repository, 1804. t Ibid, 1805.

X On Dysentery, its Forms and Consequences, in Warm Climates, especially
in India. By James Annesley, Esqr.

1854.] O'Keeffe, on Epidemic Dysentery. 327

down in the bills of mortality was never less than 1000 annually,
and in some years exceeded 4000. For five and twenty years
together, viz., from 1667 to 1692, they every year amounted to
above 2000. During the last century, the number gradually
dwindled down to twenty ; and this decline is alleged to be
cotemporary with that of the plague, agues, and continued
fevers, and is ascribed by Dr. Watson to the great fire of 1666,
which consumed every thing that was efficient in producing
these several disorders.

Thus, it will appear that the disease we are considering has
existed in an epidemic form from the earliest dawn of medicine,
and for aught we know to the contrary, may be coeval with
the history of the human race ; that no country is exempt from
it, but that its ravages are most destructive between the tropics.

The first notice of its appearance in this State was published
by Dr. H. F. Campbell, of Augusta, under the caption : " Cases
of an unusual form of fever and dysentery," that had occurred
in his practise in the month of July, 1851, and proved of a very
malignant character.* Dr. J. S. Weatherly, a few months
afterwards, favored the profession with an account of an endemic
that commenced about the 1st of June, and swept over the
country (Gordon and Cass counties) u with a baneful and noxious
influence." Scarcely a family escaped in the visited region,
" and many, particularly the very young and very old, suc-
cumbed to it."'t Dr. W. C. Brandon also reported the pre-
valence (in 1851) of epidemic dysentery in Floyd and adjacent
counties of this State and Alabama, which commenced in the
early summer months, but presented nothing to distinguish it
from ordinary sporadic dysentery until the month of October,
when its type was changed, and it invariably assumed a typhoid
character. J During the year 1852, we heard of its ravages in
various parts of this state, but have seen no authenticated account
of it.

In our own practice, sporadic cases appeared in the spring
and summer months of 1851, and although not numerous enough
to indicate an epidemic prevalence, still it was noted that the
tendency to bowel affections was more strongly marked than

Southern Medical and Surgical Journal, September, 1851.

t Ibid, December, 1851. x Ibid, March, 1852.

328 O'KeefFe, on Epidemic Dysentery. [June,

usual. Pulmonic affections are generally the gravest forms of
disease in our section during the spring months, and after sum-
mer sets in, diarrhoea and sporadic cases of typhoid fever.
During the spring of 1852, pulmonic disease was unusually rare,
and we were, at the time, impressed by the fact that the season
heretofore devoted to the treatment of the latter, was now
occupied in the management of dysentery. This substitution
of intestinal, for pulmonic disease, is very remarkable in tropical
countries. British physicians who visit India are struck with
the difference in the morbific influence of atmospherical vicissi-
tudes in that climate; an exposure which, in Great Britain,
would produce a catarrh, a pleurisy or pneumonia, would be
followed in India by an intestinal deraageraent probably dys-
entery. Would that we could appreciate the changes in our
climate that produce this substitution!

About the middle of October (1852) the cases began to mul-
tiply, and to assume a graver character. On the 21st, we saw-
Mrs. M., aet. 35, and her son act. 17, who were seized about the
same time with acute dysentery ; in six days from its inception,
six white members of this family were prostrated with the disease
two only remaining intact. From this time till the 1st of De-
cember, our whole timi upied with it; there were few
instances of an isolated case occurring in any family, and this
gave rise to the popular opinion that it was contagious.

In the following year (1853) it set in early in summer and
continued, though not extensively, till late in autumn, the cases
being more isolated, (at least in our county, but not so in others)
and more manageable, with a few exceptions, than the preceding
year. It is proper to state, however, that in other parts of the
State, it prevailed with unprecedented malignity.*

Symptoms, fyc. For convenience of description, and not
upon any pathological grounds of difference, dysentery may be
divided into two species, viz. (1) Acute, and (2) Chronic.

Species 1. Acute dysentery presents two distinct aspects,
viz. (A) the sthenic or highly inflammatory variety, charac-

* A Medical friend who has practiced Medicine upwards of forty years in
this State, informs us that he had never seen dysentery prevailing in an epidemic
form until within a few years.

1854.] O'Keeffe, on Epidemic Dysentery. 329

terized by high febrile action ; and (B) the asthenic or typhoid
variety in which the inflammatory action is of a low grade and
the vital powers very much depressed.

(A) The sthenic variety of acute dysentery may be profitably
considered as presenting two degrees of existence, viz. (1) the
mild, and (2) the severe form the intermediate degrees being
almost as numerous as the subjects affected.

(1) The mild form of sthenic dysentery offers but few points
for consideration. The stools are not frequent, consisting
principally of mucus and serum, sometimes tinged with blood ;
the pain and tenesmus may be considerable at the periods of
evacuation, but there is entire ease in the intervals. There is
seldom pain or tenderness in the abdomen ; no fever, and the
tongue is generally of a normal appearance. A single cathartic,
followed by an opiate, will, not unfrequently, cure these cases.

(2) The severe form of sthenic dysentery is surpassed in
violence by few diseases. The following case, from Dr. Camp-
bell's article already alluded to, so accurately represents this
form of the disease as it occurred to us, that we take the liberty
of inserting it in detail for the illustration of the symptoms :

"Case 3rd. Mr. E. A., aged about 35 years, was attacked
with dysentery on the 14th of July. The passages were frequent
and bloody, but not attended with much pain ; skin hot and dry ;
pulse somewhat depressed, and 90 per minute. He manifested
great depression of spirits. Prescribed 5 grs. of calomel with
one gr. of opium every three hours, with laudanum and camphor
in the intervals when the passages were frequent. The passages
became less frequent, were dark and very offensive, but were
followed by great prostration of strength. The calomel was
omitted and 5 grs. of blue mass substituted, with acetate of lead,
nut galls and opium after each passage. The discharges became
less frequent, and the quantity of blood and bloody mucus was
greatly diminished, but the prostration of strength was still very
great. Fever continued without remission; pulse 110 per
minute. On the fourth day the skin is hot and dry ; thirst very
urgent ; the dysenteric appearances had subsided from the
passages, but they were thinner than previous. On the fifth day,
the pulse is more rapid and weaker, the skin cooler and clammv ;
the passages are very frequent and watery, having the appear-

330 O'Keeffe, on Epidemic Dysentery. [June,

ance of the washings of bloody beef, though sometimes darker,
resembling muddy coffee ; they contained no mucus, or fecal
matter whatever. After consultation with Dr. J. A. Eve, we
prescribed a large blister to the abdomen, and directed laudanum
injections with starch in combination with acetate of lead after
each evacuation. These injections were speedily rejected ; the
passages were very copious and passed involuntarily, often un-
consciously. The pulse ranged from 130 to 140 per minute
every thing marked a state of actual collapse. Brandy and other
stimulants were administered in large quantities, but the pulse
did not respond. The passages continued large, and were often
of clear water. A blister was applied over the sacrum, but
without effect. All stimulants were of no avail, only serving to
distract the last moments of the patient, which, without them,
were characterized by great calmness and collectedness of mind.
He died on the morning of the 7th day.''

(B) The asthenic or typhoid variety of acute dysentery does
not present such a formidable array of violent phenomena as
that just described by Dr. Campbell, and yet the issue, not un-
frequently, is little more satisfactory. The subject is not so
speedily hurried to his doom, but his fate is not the less certain ;
the tyrant dallies with his victim, engendering painful anxiety
and flattering hopes, destined, with cruel certainty, to bitter
disappointment.

This variety of the disease can be readily distinguished from
the preceding. At its onset, it rarely happens that the typhoid
features are present, for the first few days, if dysenteric symp-
toms appear, they are of a mild character ; and it more fre-
quently happens that they are absent, and nothing marks the
case but a moderate fever, which, if it have fully declared itself,
is apt to be of the typhoid type. In due time however generally
from three to six or eight days the dysenteric condition be-
comes manifest, and continues to be the paramount element of
the case during its whole progress.

The case maturely developed stands thus : Temperature a
little elevated, sometimes not at all ; sometimes the skin is cool
and clammy, moist, or dry and harsh. The tongue may be red
from the beginning, or it may have been furred, then cleared off,
and finally red, glazed and fisssured blood may be seen some-

1854. J O'Keeffe, on Epidemic Dysentery. 331

times oozing from these fissures. The pulse is usually feeble,
about 100 to the minute, and perhaps always exhibiting more
or less remittency the remission, however, is not as notable as
in the severe sthenic variety. Thirst here is urgent, though,
a priori, we might expect but little ; nevertheless, there is an in-
cessant craving for cold drinks even ice is urgently demanded.
The dysenteric distress is not as great as in the sthenic form
the stools are not as frequent, and consequently the tormina
and tenesmus are not as troublesome ; the character of the
evacuations is also different instead of being small, and of a
muco-sanguinolent appearance, they are generally large, thin,
dark, and offensive, resembling in colour and consistence a
watery solution (or mixture) of snuff or soot, and not often pre-
senting many traces of blood. Perhaps the most troublesome
and persistent of all these symptoms is a tympanitic state of the
abdomen, accompanied by an incessant and painful flatulence ;
this, in some cases, is an early developement, and harasses the
patient beyond endurance. Delirium seldom occurs at any
stage of this variety, but we have noticed a sluggish torpid state
of the mind in nearly all.

Species 2. We have, now, according to our arrangement,
arrived at that part of our subject which, to physician and patient,
is the most perplexing feature of the disease under consideration.
Chronic dysentery is a termination of the disease little preferable
to death itself; for in many cases, after months or even years
of unparallelled suffering after the cup of affliction has, so to
speak, been sipped to the dregs the grave puts an end to this
painful bondage. It is fortunate, however, that the chronic
state is not a common termination of the disease in this part of
the country ; according to our observation, it would not exceed
three per cent, of those affected with the acute species. In
tropical climates, it is a not unfrequent disease among Europeans
who visit those countries, and particularly among armies, and
has its origin, no doubt, in irregular modes of life and dissipated
habits.

It usually happens that after the subsidence of the inflammatory
symptoms of the acute stage, the bowels are still loose the pa-
tient may have six to twelve evacuations a day, attended or
not with pain the stools are moderately large, containing mu-

332 O'Keeffe, on Epidemic Dysentery. [June,

cus, and sometimes even a little blood. This condition may
last several days, and sometimes two or three weeks ; but
under the use of opium and the astringent tonics, it will gradu-
ally improve, and convalescence will be finally established.
Under this state of things, the patient will improve in appetite
and strength, and yet it is not devoid of danger; for the least
intemperance in food or drink will convert this otherwise safe
condition into an acute disorder. But sometimes, and especially
in feeble constitutions, this great diarrhoeal drain will not yield
as indicated, but continues for months producing great emaci-
ation and debility. The following case will serve to illustrate
this state of the disease.

A medical friend, of delicate habit and who was incessantly
engaged in treating this disease, had an attack of sthenic dys-
entery in the summer of 1853 ; the acute symptoms were sub-
dued by bleeding, purging, opium and astringents. In due time
his appetite became normal, but did not gain any strength.
About one month from date of seizure, there was great debility
and much emaciation, having from one to three discharges a
day ; these were copious and loose, containing sometimes an
ounce or more of thick tenacious mucus entirely separate and
distinct from the fecal part of the evacuation. (It is thought
that the debility attendant on such a state as this is owing to
the impoverishment of the blood from the large proportion of
fibrin these mucous passages contain.) There was no pain nor
tenesmus, nor any other derangement, but an uneasy sensation,
sometimes amounting to a pain, in the sigmoid flexure. The
quantity of mucus in the stools gradually but slowly diminished
until at a period of about four months from the time he was
taken, it did not exceed a tea-spoonful. During this time, he
improved but little in strength ; and even now (seven months
from its onset) he is feeble, though enabled to attend to the
duties of his profession. In other cases, (and these are the most
numerous) the patient is a constant sufferer. He may have
three to six stools a day, attended with tormina and tenesmus,
and containing more or less pus ; he may have an occasional
fecal evacuation entirely devoid of purulent matter, as well as of
pain and tenesmus. These cases prove more rebellious to treat-
ment, and are marked by a greater fatality than the preceding.

1854.] O'Keeffe, on Epidemic Dysentery. 333

Complications. Epidemic dysentery is said to be compli-
cated with periodical and continued fevers, and that its epidemic
prevalence is owing to its being associated with one or the other
of these affections. It is urged, moreover, that when the disease
is marked by high febrile action, or a low adynamic state of the
system, other pathological elements co-operate with the colitis
in the production of these phenomena. How far these suppo-
sitions are correct, our observation does not satisfactorily enable
us to ascertain ; but a limited number of autopsies has satisfied
us that the intestinal lesion is sometimes extensive enough to
give rise to the most intense symptomatic fever. In sporadic
dysentery, but little, if any. symptomatic fever is generally found
to exist ; and hence it is inferred that when fever is present, it
is not a simple but compound disease, for an uncomplicated
colitis gives rise to but little constitutional disturbance. All
this may be readily granted ; but to give force and precision to
this reasoning, we would require to know what extent of the in-
testinal mucous membrane was inflamed in these apyrexial
sporadic cases, as well as in those marked by high inflammatory
fever. It is well known that no disease presents greater diversity
in degree than dysentery ; in some, the inflammation may be
limited to a small extent of the mucous lining of the rectum; in
others, the disease may involve the whole track of the intestinal
canal from the stomach to the anus. Is it not reasonable to ex-
pect a wide difference in the amount of constitutional disturbance
produced by these causes? Such a result would be produced
by a similar state of things in other parts of the animal economy.
A case bearing on the point under consideration is subjoined:

A negro man, strong and athletic, aged 28, was attacked with
dysentery on the 20th of May, 1853, and seen by Dr. Hall on
the 22nd. His pulse was 100 ; skin hot and drv ; discharges,
consisting chiefly of blood, were passed every 30 minutes. 23rd
Pulse 120 other symptoms the same. Evening of 24th the
pulse rose to 140, and the next evening it ranged from 140-
150, and feeble. No permanent improvement took place and
he died on the 13th day ot his illness. Autopsy seven hours
after death : Rectum highly inflamed and as thick as sole leather,
and thickly ulcerated in small pitts. The colon presented the
same appearance as the rectum, except that the thickness had

334 O'Keeffe, on Epidemic Dysentery. [June,

diminished, and the ulcerations enlarged, varying in size from
two to four lines in diameter. Above sigmoid flexure it pre-
sented a dark (nearly black) appearance, and continued so to
and in the arch of the colon. In the ascending colon and
ccecum the mucous membrane was of a deep blue colour through-
out. Nothing noteable at the ileo-ccecal valve, but the whole
extent of the ileum presented a blue congested appearance.
The remainder of the small intestines and stomach were not as
much diseased as the ileum, but they too were highly congested.
Liver healthy.

Is it necessary in this case to invoke the aid of remittent or
any other form of idiopathic fever to explain the exalted febrile
action ? Is not the intestinal phlegmasia (which, in extent of
surface, has no parallel in the human system) amply adequate
to account for it ? But, although we deem it best to regard in-
flammation as the main pathological element of epidemic dys-
entery, and that the ends of treatment will be more securely
attained by acting upon this opinion ; yet we must admit that
in a few cases the fever was of the remittent, and in many of
the typhoid type. In one case only were the remissions more
decided than ordinarily occur in most, if not all, inflammatory
diseases ; but there was no abatement of the dysenteric symp-
toms corresponding with the febrile remission. The sulph.
quinia relieved this case of the febrile action, but the dysentery
continued the usual time ; the quinia was used in other cases
of less marked remittency, but the phlegmasia was uniformly
aggravated by it.

In many of our cases the typhoid condition was very promi-
nent so much so that if the colitis were not considered, the
disease would be very readily denominated typhoid fever. In-
deed, the evidence of the connection of typhoid fever with the
dysenteric inflammation, was so palpable in some of our cases,
that we must, though reluctantly, admit the fact. Our un-
willingness to this admission arises from the apprehension that
the name of typhoid fever may bias the practitioner's judgment,
and induce him to rely on a palliative course of treatment,
which, while it is usually the most judicious plan in this affection,
is wholly inadequate to the management of dysentery.

We subjoin two cases tending to illustrate the connection

1854.] O'Keeffe, on Epidemic Dysentery. 335

under consideration, the notes of which have been kindly fur-
nished us by our friend, Dr. J. E. Walker, of this place.

Reuben D., aged 18, was attacked, August 28th, 1853, with
a burning fever, preceded by a chill ; furred tongue, great thirst
and headache. The fever being remittent, he was treated with
a mercurial followed by quinine, with mitigating effect on the
fever. Dysentery set in on the fourth day of his illness, slight
at first, but continued to increase. The bowels became very
tender, and much distended, the tongue became dry, red and
glazed ; the discharges, at first composed of mucus and blood
resembling the washings of fresh meat were attended with
great tenesmus and pain, but very soon changed to the colour
of snuff or rather soot. There were few shreds of mucus in the
matter voided, but to me (Dr. W.,) it appeared to be decomposed
blood. About this time, tympanitis, harassing and persistent,
came on which was but mitigated by anything that was used.
Turpentine, nit. argt. per oram et rectum, chlor. soda, acet.
plumbi, quinia, the saline and opiate treatment, were all used at
different stages of the case with but temporary benefit, and he
died on the 21st day of his sickness. This was but one of three
deaths which occurred among the white members of this family
in the course of a week or two from this disease, despite the
well directed efforts and solicitous care of the attending physi-
cians ; the third case, however, was treated by the family, un-
der the conviction that "doctor's medicine did no good," which,
in this instance at least, was painfully true.

Thos. B., aged 19, was seen by Dr. Walker for the first time
on the 24th of June, 1853. Had been sick ten days of a mild
dysentery, which was at this time converted into a diarrhoea.
Dr. W. found him with headache, feeble pulse 98 per minute^
tender bowels, red tongue and considerable thirst ; dejections
now three to five a day, much reduced and great loss of
strength.

There was a profuse perspiration on the surface almost the
whole time, and the temperature was not elevated ; the tender-
ness in the bowels, especially in the right iliac fossa, was
prominent and persistent ; there was considerable dullness of
intellect, but no delirium. He was dismissed as convalescent
on the 36th dav from the first invasion. " I accord." savs Dr.

336 O'Keeffe, on Epidemic Dysentery. [June,

W., " to opium, turpentine and brandy the credit of cure in
this case ; quinia, although used freely, I doubt not, did little, if
any good."'

In the first of these cases, the febrile condition existed four
days before the dysenteric action commenced, and in the last,
the latter was replaced by a laxity of the bowels so common in
typhoid fever. In cases like these, the dysenteric inflammation
must be regarded an epi-phenomenon of typhoid fever, but
very important in a therapeutical point of view. The compli-
cation with periodical fever, if it ever exist, is not of much
practical importance, as the intestinal disease is the controling
indication for treatment.

It is said, also, to be complicated with typhus fever, an instance
of which we have not seen, and to which we have nothing to
say. Its connection with hepatic disease has been wonderfully
magnified by Dr. James Johnson ; but this connection, as well
as all of this author's views of dysentery and hepatic derange-
ments has been disproved by modern pathologists, though the
treatment founded on these same views still lingers in the pro-
fession.

In one case, about the fifth day of the disease, there was a
slight erysipelatous affection of the face, but soon yielded to
appropriate remedies. Prolapsus ani is a not uncommon oc-
currence among children affected with dysentery, and proves a
distressing complication.

Pathology. " I am in every case inclined to regard in-
flammation rather as a sequence than a cause of dysentery, as
a contingent effect, and not an uniform result."

Such was the teaching of that truly enlightened physician
a writer almost of the present generation Dr. Johnson ; and
he contended strenuously for this pathology to the end of his
life. The first links in the morbid chain of action, insists Dr. J.,
are a suppression of the cutaneous and biliary functions, and that
the other conditions, viz., inflammation and its consequences,
are effects from this first cause ; the success of treatment, too,
will depend, in his opinion, in the restoration of these functions
to healthy action.

It is, of course, unnecessary to pronounce these views exploded
at the present day ; and we only mention them for the purpose

1854.] O'Keeffe, on Epidemic Dysentery. 337

of introducing the remark, that although the pathology of Dr.
Johnson is condemned, the treatment founded thereon is still in
vogue with some practitioners.

Thus the observation is frequently heard that the liver is tor-
pid, and overwhelmed with vitiated bile that its secretionsr
viscid and poisonous as they are, are locked up in this vitally
important organ, and that no peace can accrue to the organism
until this peccant humor is removed. These views prevailing,
it is easv to conjecture the remedy for this indication, and
mercury is literally 'thrown'" into the stomach ; so that instead
of suffering this reputedly poisonous bile (which Dr. J. says is
like boiling lead) to remain harmlessly in the liver, (which, for
aught we know to the contrary, has little else to do during the
presence of dysentery than to accomodate it) it is "thrown out"
and " brought down " over an acutely inflamed mucous mem-
brane.

We admit that this reasoning is sustained by all the force of
venerated authority, yet we cannot but suspect it of a want of
logical argument.

On the whole, we are disposed to take issue writh the very
name of the disease ; dysentery conveys to the mind the idea
that one symptom (tenesmus) constitutes the disease, and the
fact cannot be gainsayed, that there is to some, something in a
name. We therefore cheerfully agree with Sir G. Ballingall.
that colonitis is a better name than dysentery indeed, we would
have it so named that its inflammatory nature should stand out
prominently to the practitioner's gaze, so that for one moment,
he could not lose sight of it. Not should it be considered that
the inflammation is confined to the colon alone, for as in the
autopsy given previously, the small intestines and even the
stomach may participate in the disease. It is unnecessary to
give in detail the pathological appearances of this disease, for
they may be all comprised under the head of inflammation and
its consequences, variously modified according to the intensity
of the disease and peculiarities of the patient.

Cause, The etiology of this, as of most other diseases, is in-
volved in much obscurity. Dr. Rush enumerates it among the
summer diseases produced by miasmata, and so does Dr. McCul-
loch ; Dr. Cullen records his opinion of it thus : " And upon the

338 O'Keeffe, On Epidemic Dysentery. [Juner

whole, it is probable that a specific contagion is to be considered
as always the remote cause of this disease." Heberden states
that he has seldom seen two dysenteric patients in the same
house ; yet the belief in its contagiousness was prevalent in his
time. Watson thinks it may depend indirectly on marsh ef-
fluvia, but that it prevails where there is no other evidence of
the presence of malaria. Dr. Wood is of opinion that " exhala-
tions from putrid animal substances, and vegetable miasmata
are also among the causes." These conflicting opinions could
be multiplied, and the truth of the maxim " quot hominum tot
sententiae," established ; but it would serve no useful purpose.
Of fifty epidemics of this disease in Europe, thirty-six occurred
in summer, twelve in autumn, one in winter and one in spring.
Of 13,900 persons attacked with dysentery in Bengal from 1820
to 1825, 2,400 were attacked in the cold season, 4,500 in the hot
and dry season, and 7000 in the hot and moist season. Thus,
it will be seen that epidemic dysentery usually prevails in sea-
sons of the year favorable to the production of malaria, and yet
there are some exceptions.

Dr. Wragg relates (Charleston Med. Journal, Nov. 1851), the
extensive prevalence of dysentery in the vicinity of Charleston
in the month of March, 1851, which existed in different localities
during three seasons of the year, viz., winter, spring, and summer.

In the limits of our practice, the disease is of most frequent
occurrence in autumn, though spring and summer are not exempt
from it. Dr. Wragg excludes every other agency from the
production of his epidemic, but some altered condition of the
atmosphere.

Thus it follows that the same causative theory will not answer
for all its epidemic visitations ; for while in one, its miasmatic
origin may be very plausibly entertained the hygrometric and
thermometric conditions of the atmosphere being favourable to
that hypothesis in another it would be wholly inadmissible.
No one could suspect the agency of malaria in its production
in the depth of winter.

On the 21st. of October, 1852, we saw Mrs. M., and son who
were labouring under a severe form of sthenic dysentery ; six
days from this time, six of the white family were prostrated with
it, two only remaining intact. The febrile phenomena reminded

1854.] O'Keeffe, on Epidemic Dysentery.

one of remittent fever, but the remissions availed but little foi
the administration of quinine. This family resided on the brow
of a hill about a quarter of a mile from a branch, which, after
the heavv rains of the previous month, inundated the .flat lands
through which it ran, to a very great extent.

The atmosphere, after these rains, was humid and warm, and
the materials for vegetable decomposition were abundant on
the banks of said rivulet. So that in this instance we regarded
it as of malarious origin, the more so that in previous years, in-
termittent and remittent fever abounded in the same locality.
The adynamic or typhoid type of the disease we look upon as
of analogous origin with typhoid (continued) fever, viz., an ani-
mal poison. And as to its contagiousness, we consider it con-
tagious in the same sense, and to the same extent that typhoid
fever is contagious.

There was, according to our observation, a remarkable ex-
emption of the negro race from this disease. In 1852, the
proportion was one black to eight white cases ; in 1853, perhaps
the ratio of blacks was a little greater. The same fact is re-
corded by Dr. Campbell ; " It will be observed from our report,"
says Dr. C, " that the disease attacked only the white residents
of the neighborhood, and although a number of negroes were
subjected to exactly the same morbid influences as those whites,
still not one of them, that we are aware, was the subject of this
form of dysentery." Dr. Brandon's experience on this point is
thus recorded : " Dr. Campbell, in his article before referred tor
remarks it as a singular fact, that negroes were not attacked bv
the disease, as it occurred to him. My observation was the same,
at a distance of two hundred miles from where Dr. Crs cases
were located, and at a different season of the year. While the
disease was prevailing, I heard of one case in the person of a
negro child, in the neighborhood of my practice." It may not
be out of place to state that negroes enjoy an immunity from
typhoid fever also within the limits of our practice, but not to
such a degree as in dysentery.

On the other hand, observers in other parts of the South have
met with the disease (dysentery) chiefly among negroes. Such
was the case with Dr. Wragg's epidemic already referred to.
He says s " It had been confined principally to the negroes, but

340 O'Keeffe, on Epidemic Dysentery. [J

not entirely, for several white persons had also suffered." Here
are conflicting facts, for those who interest themselves in the
morbific peculiarities of the different races. We have already
with-held too long the main object of this paper, and we there-
fore enter upon the

Treatment of the Sthenic Form. Blood- Letting. From
what has been advanced under the head of pathology on the
inflammatory nature of this disease, it will be expected that
blood-letting should occupy a prominent rank among remedial
measures. We sincerely regret that this remedy was but little
used in our practice, and the sole cause of its omission was an
inadequate appreciation of the highly inflammatory character
of the disease ; and we would here frankly state a fact, deduced
from our own experience, that the practitioner must have strong,
and unequivocal views of the pathology of this disease to coun-
ter-act the influence exerted against blood-letting by its apparent-
ly prostrating tendency. It requires a firm and decided judgment
to practice venesection, for a case that is being depleted already in
the ratio of twenty to forty bloody evacuations a day ; and yet
most mortem revelations will demonstrate the absolute indis-
pensibleness of its use. Blood-letting then should be practiced
at the very outset of sthenic dysentery, and if the case be not
seen at this stage, it should not be neglected at any time there-
after that the general condition of the patient would seem to
tolerate it ; and if the symptoms do not moderate after the first
venesection, it should be repeated in connection with other
remedies hereinafter specified, again, and again until the disease
is subdued.

Fears may be entertained that this treatment itself may be
fatal to the patient ; but we believe it to be far better to take
such cases as those entirely out of nature's hands, and carry
them to the very confines of eternity, if necessary, than to suffer
the intestinal inflammation to continue in any degree. If pros-
tration be produced by the treatment, we have stimulants and
tonics to restore the sunken energies, which can be safely and
profitably given after the subduction of the phlegmasia.

Veratrum Viride. As an adjuvant to venesection, veratrum
viride may exercise an important influence, and this would be a

1854.] O'Keeffe, on Epidemic Dysentery. 341

legitimate deduction from its effects in other inflammatory
affections; we cannot recommend it. however, but from a limited
experience.

Mrs. S. was seized, while riding in a carriage, with fever and
dysentery. Saw her soon afterwards, and found her with high
febrile excitement, (pulse 120) and all the symptoms of acute
dysentery. Ordered four-doses of hydr. submur, and Dov. powd.,
to be followed next morning by a dose of ol. rici. ; other minor
remedies were employed. Next morning her condition was no
better. Prescribed 10 gtt. tr. ver. vir., with as many drops of
tr. opii. every three hours until the pulse is reduced. About
12 o'clock at night was sent for in haste to see Mrs. S., whom
I found quite prostrated from nausea and vomiting. After having
taken the third dose, she commenced vomiting, which continued,
inter mittingly. for three or four hours, and the bowels had not
acted during the same time. Her pulse was at 60, and the sur-
face was cool two quarter grain doses of sulph. morph., at
intervals of half an hour, promptly arrested the vomiting, and
ensured a good night's rest. Her pulse continued under the
healthy standard for a few days, and the dysenteric inflammation
was, as it were, jugulated. Convalescence was complete in a
few days.

In such cases as the above, where there exists high febrile
action, and no tendency to depression of the energies of the
system, the veratrum cannot fail to exercise a beneficial effect.

Salines. The first notice we have seen of the saline treat-
ment of dysentery in modern times was published in the Charles-
ton Medical Journal for 1849 ; in former times the neutral salts
were recommended by Heberden, on account of '; their power
of controlling and quieting the irregular motions of the bowels,
and their aptness to stay upon the stomach without being vomited
up. At first I gave (says Dr. H.,) only one drachm everv six
hours, which evidently soothed the pains very soon, and before it
had any effect as a purge. In other cases, larger quantities
were given, and with the double good effect both of affording:
present ease, and afterwards of entirely removing, bv effectual
evacuations, the cause of the disorder."'* (Commentaries, p. 124.)

A true and faithful medical historian may be profitably con-
sulted at all times by the physician of the present dav, even

m. s. vol. x. no. vi. 22

342 O'Keeffe, on Epidemic Dysentery. [June,

though the lapse of centuries has intervened since the ob-
servations were recorded; and so we find the effects of the
saline treatment of dysentery nearly a century ago almost
identical with those of our own time.

We have used the neutral salts in the management of the
sthenic form of this disease, since it became an epidemic in our
section, and have had much reason to regard them with favor.
Sulph. mag. and sulph. of soda were generally preferred, but. in
a few cases, the phos. soda and Seidlitz powder were used. Our
method of giving them was as follows : Half an ounce of sulph.
mag. or soda was given every three hours, until several free,
copious and water}' evacuations were obtained. These dis-
charges being large and serous, devoid of blood and unattended
by tenesmus or tormina, are readily distinguished from the small
dysenteric actions, and afford more respite from suffering than
can be secured by any other remedy. Opium was then given
after each discharge, generally by the mouth, until the dysenteric
actions returned, when it was suspended, and the salts given as
before. This course was kept up. alternating the salts and opium,
until the disease was subdued. Should it occur again in our
practice, we should, in connection with the above plan, avail
ourselves of the valuable aid which, in our opinion, may be de-
rived from blood-letting. Of all the neutral salts, the sulph. soda
seen is to be the most efficient, and consequently we gave it the
preference. Dr. Walker informs us that he has used the phos-
phate of soda with as good, if not better effects, than any of the
others ; but our experience on this point is different. We used
the phos. soda, sulph. mag. and sulph. soda, successively in the
same case, with the result that the sulph. soda alone answered
our purpose. Yet, in young children, the phosphate ought to be
preferred on account of the facility with which it may be given.
It may be taken in gruel or chicken broth, without the child
knowing that he is taking medicine.

We cannot too strongly insist on the advantages of this saline
treatment over any other method that has come to our knowl-
edge ; it is the only one known to us, that will effectually, and
with certainty, relieve the patient of the distressing pain and
tenesmus. As sure as two to four half ounce doses are given,
the bowels will act freely and without pain ; and then the opium,

1S54.] O'Keeffe, on Epidemic Dysentery. 343

given with that freedom which ensures its effects on the system,
will bring quiet, and calm, and rest, from the most distressing
agony and pain. But the tenesmus and suffering will return in
the course of eisrht to twelve hours ; combat it again with the
saline, and give opium afterwards, as before, and continue this
alternation until the disease is subdued.

Dr. Wragg, already alluded to., treated his epidemic with the
super, tart. pot. and Dov. powd.. with occasionally a mild ca-
thartic ; and the practice was signally successful. He treated
eighteen severe cases, with but one fatal case; and this could
not be fairly attributed to the failure of the remedies, but to the
patient's own imprudence. His success is the more striking,
because, under every other system of treatment, the mortality of
the same epidemic was considerable. The proportions of the
remedies varied from 5 to 10 grs. Dov. powd., and 15 to 30 grs.
super, tart. pot... every three hours for 36 or 4S hours ; and when
it was necessary to open the bowels, the powders were sus-
pended, and castor oil given. Dr. Wragg thinks it acts on the
secretions ; the discharge, under its use, soon lost their bloody
mucus and lumpy character, and became, first serous, then
bilious. It may have a chemical effect, also, observes Dr. W.,
not only on the matters already excreted from the blood, but on
morbific matter in the blood, which has caused the disease.

The therapeutic value of the cream of tartar must depend on
different principles from those that govern the agency of the
sulphates of magnesia and soda ; the former acts not by purgation,
but by its influence over the secretions the latter generally
relieve the complaint by the free serous evacuations produced.
This, however, cannot be their sole mode of action; for we have
seen (what Heberden saw before us) small doses of salts afford
more relief from suffering have more actual control over the
dysenteric actions than large doses of opium, and that too with-
out any purgative effect whatever. We have seen and heard
many theories of the methodus medendi of salines in this disease ;
but they are of little value in a practical sense. We conclude
our notice of this class of medicinal agents by the remark, that
wherever, to our knowledge, they have been tried, they have
been attended with better success than any other plan of medi-
cation.

344 O'Keeffe, on Epidemic Dysentery. [June,

Mercurials. We introduce this class of remedies for the
sole purpose of pronouncing unqualified condemnation on them
in the treatment of epidemic dysentery. Most, if not all, the
practitioners in this locality have abandoned mercury, and taken
up the saline treatment ; and we have heard of no regrets for
the change. Dr. Walker says : " My cases all died that took
mercury, but not one that was exempt from it." So we will
not detain the reader with any further consideration of this
article.

Astringents, in the acute stage, we have found decidedly
pernicious; they increase the tormina, and. in our opinion, are
of minor importance in the management of this affection. The
acet. plumbi produced tympanitis in one case, and was attended
by no beneficial result in any shape whatever. When, how-
ever, the acute dysenteric symptoms give way, and there is yet
frequent action from the bowels perhaps six to twelve stools a
day astringents will exert a good influence, and of these the
tannate of quinine will fulfil the double indication of astringent
and tonic. The following combinations will be found service-
able in this stage :

fy. Quiniae Sulph.

Acid. Tannicum aa xlviij grs. M. F. pill. xxiv.
One three times a day.

$. Morph. Sulph. iij. grs.

Hyos. Extr. xxxvi. "

Acid. Tannicum xxiv. " M. F. pill. xii.
Dose One after each stool.

Opium and brandy must be given freely in this stage
particularly the latter.

Enemata, especially if astringent, are of little value; indeed
we consider them prejudicial in the acute stage, and if used at
all, nothing but opium should be entertained. In most of our
cases, there was such excessive irritability of the rectum, that
nothing would be retained an instant ; in very few instances,
did we perceive any good result from injections.

Of blisters, we know but little, experimentally, in this disease;
when used, no advantage seemed to accrue from them. Cup-
ping, leeching and cataplasms to abdomen, are important adju-
vants in the management of this affection.

The typhoid type of epidemic dysentery, will not admit of the

1854. J O'Keeffe, on Epidemic Dysentery. 345

saline treatment ; at least, in some cases where it was tried, it
seemed to exert but little influence, and we are much at a loss
to know what will have much influence in violent forms of this
type. We cannot but think, however, that even in some cases
of this form, when the skin is hot, pulse frequent, and thirst
urgent, blood-letting would be beneficial at the very outset, aad
that local depletion with cups and leeches would be proper at a
later period of the disease. In the majority of cases, however,
our main reliance will rest on spts. turpentine, nit. arg., opium,
brandy, and quinine. We have seen marked benefit from the
simultaneous use of turpentine and nitrate of silver, ten to thirty
drops of the former, and one-fourth of a grain to a grain of the
latter, given alternately every two or three hours, and continued
for twenty-four or forty-eight hours ; after this, omit the reme-
dies for a day or more, and resume them again as before, keeping
up this course until the symptoms improve.

Blisters are more advantageous in this than in the sthenic
type, and opiate and astringent enemata are better borne.
Opiates and stimulants are indispensable in some of these cases,
and they will be freely tolerated.

The tympanitis which is present in some of these cases, will
tax the medical attendant's therapeutical resources to their ut-
most extent. Cloths wrung out of hot water and applied to the
abdomen will relieve it quicker than anything else we have seen
tried ; an injection of a warm solution of assafcetida will some-
times answer a good purpose, and frequently every remedy will
fail until a purgative action is obtained from the bowels. The
spts. of turpentine and creosote will also have a tendency to
improve this condition.

For the treatment of chronic dysentery-, we will recommend
only such remedies as we have derived marked advantage from.
These are nit. argt. by the mouth and rectum ; sulph. cupr. when
the stomach will bear it ; extr. nux vom. in combination with
opium, and opiate injections. Many other valuable remedies
are spoken of in the works on practice, which may have to be
used if the above fail ; but those we have specified have suc-
ceeded with us after the failure of many others. The chalk
mixture in combination with opium is a good auxiliary to any
of the above remedies.

31G Wilson : Common Salt in Fever. [June,

We have now presented our experience in epidemic dysentery,
and fear that our views may be considered too exclusive. Very
many and able physicians have urged upon the profession modes
of treatment totally different from ours, and totally differing one
from the other.

This diversity arises, no doubt, from some essential modifi-
cations of different epidemics, requiring corresponding modifi-
cations of treatment. We cannot better conclude this paper
than by inserting, in his own words, the following judicious ob-
servations of Sir James Macgrigor on this point :

" My opportunities of seeing this disease (dysentery) have
been no common ones. Rarely, I believe, has it fallen to the
lot of an individval to see so very many cases of one disease in
such a diversity of climate and situation. In the 88th Regiment,
during the course of upwards often years, I saw the same man
the subject of this disease on the Continent of Europe, in Ame-
rica, in both extremes of Africa, and in India. Of late, it has
afforded me not a little amusement to review my notes, as well
as my journals ol practice, in this disease, in all these quarters.
#######j Decame convinced, in Alexandria,
that with change of climate and country, we had a different
disease. This is one proof, how improper, and how unsafe, it is
for the practitioner of one climate to sit down and describe the
diseases of another. They, only, who have studied the same
disease, in various opposite climates, can fully comprehend the
extreme absurdity, as well as fallacy, of this." (Med. Sketches.)

ARTICLE XVIII.

An Obstinate Quartan cured with the Chloride of Sodium.
By Jno. Stainback Wilson, M. D, of Airmount, Ala.

Participating in the desire, now so prevalent in the profession,
to obtain that great desideratum, a cheap and efficient substi-
tute for the costly preparations of Cinchona, in the treatment of
Intermittents, I have been induced to try common salt, in ac-
cordance with the recommendations of M. Piorry, Professor
Dugas,* and others. And as the desire alluded to can be con-

* Vide Transactions Med. Soc. State of Georgia, 1852, p. 79.

1854.] Wilson : Common Salt in Fever. 347

summated onlv by experiments and reports, to which each
should contribute a share, I hope that no apology is necessary
for reporting even a single case, especially when its interest is
somewhat enhanced by an obstinacy which defied the more
ordinaiy and established remedies.

Case. On the 24th March, I was requested to prescribe for
G. W., a young man of sanguine temperament, and of sound
constitution, naturally ; but this had been impaired by frequent
attacks of intermittent fever, which had produced, as usual, a
pale cheek, and tumid spleen ; these effects were accompanied
by headache, mental and corporeal torpor, together with that
indescribable sense of general indisposition characteristic of
this abominable disease. And, as an evidence of the severity
of the paroxysms, it may be added, that the last-mentioned symp-
toms were persistent, continuing, more or less, on his " well
days."' He stated that several physicians had prescribed for
him that they had given him opium, and (perhaps) quinine.
&c, &c, without "breaking them;" and I had, myself, several
weeks previously, put him on Fowler's solution, with the same
unsuccessful result.

Prescription : Blue mass, 10 grs., to be followed by castor
oil, if necessary. Then, on chill-day. (-26th.) begin ten hours
before the time of the paroxysm, and take one of the following
powders every two hours, with camphor mixture and laudanum,
in willow-bark tea: $. Chloride Sodium, 360 grs. Make six
powders.

27th. Says that he had his paroxysm at the usual time, and
that it " shook him worse than usual ;" pain in side (spleen) less,
while fever was on : this was shorter, also. These symptoms
considered favorable. Prescription : Omit all other remedies,
and take 60 grs. chloride sodium, three times a day, on well
days. Then begin nine hours before chill time, (29th.) and take
40 grs. of the same every hour, in warm gruel.

31st. Has had no paroxysm. Take Fowler's solution, 5 gtt.
ter in die, as a prophylactic.

Remark. The cure in this case must be attributed to the salt
as he took nothing else on 29th ; for it can hardly be supposed
that the cruel had anv asrencv in it.

348 Attaway's Case of Twins of different color. [June,

ARTICLE XIX.

A Case of Twins of different color. Reported by A. F. Atta-
way, M. D., of Madison county, Ga.

Mrs. C , a white woman, the mother of three children,

gave birth to twins on the 16th of January, an interval of an
hour intervening between the births.

The first born was very dark, and had every appearance of
being of African paternity. Not being willing to suggest such
a thing, I tried to explain the matter, by attributing the color to
cyanosis. At the expiration of one hour, the second child was
born, and had very light colored hair, fair skin, and blue eyes,
which made the contrast very striking.

The condition of the mother and children was such, that they
required medical treatment for several weeks, during which
time I marked the great difference between the children with
peculiar interest.

After the recovery of the woman and her children, seeing
the African characteristics more and more developed, I asked
the mother to give me a correct relation of the circumstances
connected with her conception, &c.

After some hesitation, she gave me the following history of
her case: She said that five days after the cessation of her
last menstruation, she had sexual intercourse with the white
man, whom she considered the father of the white child. Three
days thereafter, making eight days after menstruation, she co-
habited with a negro man, who she said was the father of her
other child. She assured me that this was the only coitus she
had with the negro man for more than one month after she
menstruated. If this be true, she conceived at that time.

The precise period of her other conception is less definite, in
consequence of the fact that she had connection with the father
of her white child, at different times, during the month follow-
ing her last menstruation.

1854.] Uterine Catarrh and Internal Metritis. 349

On the Pathology and Treatment of Uterine Catarrh and
Internal Metritis. By E. J. Tilt, M. D., Senior Physician
to the Farringdon General Dispensary and Lying-in Charity,
and to the Paddington Free Dispensary for Women and
Children. (Continued from May No. of this Journal.)

In the preceding case was exemplified that form of metritis
in which the internal surface of the womb remains free from
all organic growth, but in other cases symptoms similar to
those described seem to depend on the presence of various or-
ganic productions on the surface of the mucous membrane of
the body of the womb, as in the following case:

Mrs. L , an American lady, placed herself under my

care in 1850. She was thirty years of age, anaemic, and much
debilitated. The menstrual flow first came at fifteen years of
age, and she was regular until pregnant. She married at twenty-
five, had a child at twenty-seven, and soon recovered her
strength. At twenty-eight she again conceived, and during the
whole of that pregnancy suffered much from abdominal pain.
The placenta was adherent, and removed with difficulty. It
was long before she recovered her health, but it remained
tolerable for a few months, when she was obliged to wean the
child for want of milk. Menstruation then returned, and was
unusually painful and abundant. When the flow ceased, the
abdominal pains remained, and hysterical symptoms super-
vened ; the menstrual flow returned several times at the regular
epoch, but always more or less as a flooding, and the abdominal
pains increased. . The flooding next came on during the inter-
menstrual periods, and when that ceased there was a discharge
like water, which sometimes had an offensive smell. Alum in-
jections had been tried, steel and tonics given ; but the patient's
health completely failed, and a sea-voyage was recommended.
During the sea-sickness the uterine discharge had almost ceased,
and the patient rallied ; but a few weeks after her arrival in Eng-
land the old symptoms returned, and the patient, when I saw her,
had been for some time confined to her bed or the sofa.

On examination, the neck of the womb was found larger than
usual, but pressure gave no pain ; the os uteri was patulous,
but the mucous membrane lining the neck was pale, and the
os uteri without any lesions. The body of the womb was
double its usual size, and very painful on pressure. On intro-
ducing the curette, the os internum was found dilated, and the
end of the curette, evidently moved in an enlarged womb; its
internal surface felt rough. I gently moved the instrument
backwards and forwards, and brought away about half a tea-
spoonful of what I could only compare to proud flesh, broken

350 Uterine Catarrh and Internal Metritis. [June,

oft from the surface of a wound. This was followed by con-
siderable pain and flow of blood, but both abated during the
next day, and there was evident improvement during the week.
Ten days after, the operation was repeated, and I removed
about a teaspoonful of similar products. This operation was
also followed by great pain and loss of blood, but both symp-
toms soon abated, and the patient had no more sanguineous or
serous discharges. The abdominal pains and tendency to
hysteria lasted for a long time, but steel and tonics removed
them at last. About three months after the last operation,
menstruation returned, and on making an examination some
time afterwards, I found that the os internum admitted the cu-
rette with difficulty, and the body of the womb had contracted
to little more than its habitual size. In this case the adherence
of the placenta seems to have originated the disease, and the
menstrual nisus gave it a first impulse. The flooding and the
serous discharges were evidently caused by the morbid pro-
ducts on the internal surface of the womb ; after their removal
the patient rapidly recovered. This sudden improvement has
been noticed in some of the cases published by Recamier in
the Union Medicate, 1850. Recamier first drew attention to
this form of disease; cases have been recorded by many
French practitioners of note, and Professor Nelaton has met
with these uterine vegetations in some women who died of
cholera at the Hospitals of St. Antoine and St. Louis, of Paris.
I have seen cases of this description in Recamier 's practice,
and three in my own during the last three years. Still, this
form of disease has not been noticed in the most recent works
on uterine pathology, either as a form of internal metritis or a
cause of menorrhagia, most likely because it has been con-
founded with other lesions under the name of menorrhagia. It
deserves, however, to be taken into consideration on account
of its being the cause of sero-sanguinolent discharges lasting
for years, notwithstanding all treatment, and reducing the
patient's strength to the lowest ebb, even if the result be not
fatal. In the last case the symptoms were caused by the pro-
duction of flesh-like excrescences on the internal surface of
the womb. They are fragile, and can easily be detached with
the finger nail. Recamier has termed them uterine vegetations.
Robin, of Paris, a well-known microscopist, has examined them
microscopically, and says, "they are formed of a small amount
of cellular tissue, while the proportion of fibro-plastic tissue is
even more abundant than it is in the uterine mucous membrane
itself."

In other cases the uterine curette has removed from the
womb round bodies varying from the size of a hemp seed to

1854.] Uterine Catarrh and Internal Metritis. 351

that of a pea, which Robert (Des Affections du Col de
l'Uterus Paris, 1848) supposes to be the hypertrophied glands
of the uterine mucous membrane. The products removed
from some patients by Recamier had the appearance of bunches
of small currants, leading to the inference that they were
hydatid formations in the earliest stage of their development,
and it is open to discussion whether such products can in any
way be said to depend upon inflammation.

With respect to the symptoms by which these various ab-
normal productions may be recognised : they are likely to be
met with in women who, having borne children, continue to
suffer from uterine symptoms, notwithstanding prolonged ju-
dicious treatment, although nothing amiss can be found in the
neck and orifice of the womb, while its body is larger than
usual, and painful on pressure, the more so if there have been
frequent miscarriages not to be explained by the patient's an-
tecedents. Internal metritis is also to be suspected in patients
who have for years been subject to abundant sanguineous dis-
charges, or of red coloured serum, a species of discharge
which the French call u eaux rousses."

With regard to the sanguineous discharges as a symptom of
internal metritis, there is a concordance of testimony ; some
authors even regard it almost as characteristic of internal me-
tritis, as rust-coloured expectoration is of pneumonia. Here I
must observe that this abundant sero-sanguinolent discharge
cannot be confounded with the scanty, thick, brown discharge
of the sub-acute inflammation of the mucous membrane of the
neck of the womb. As for the menstrual flow, it is sometimes
very abundant : but it is often absent, or at least is not to be
distinguished from the habitual sero-sanguinolent discharges.
The diagnosis is confirmed by the freedom with which the
uterine sound enters the body of the womb; and if the uterine
curette is made use of, it will sometimes detect roughness on
the internal surface of the womb, or at all events will bring
away some of the morbid products I have described.

When the foregoing facts were lately brought forward at the
Medical Society of London, Dr. Bennett implied that the uterine
curette had only removed the products from the neck of the
womb ; but it seems to me that when the uterine sound or the
uterine curette are used by intelligent practitioners, the diag-
nosis must acquire in their hand the greatest precision. If
an instrument be passed to the depth of from two to three
inches into the neck of the womb, where can it go except into
the body of the womb, unless it makes a false passage? Re-
camier used to say that in the space of fifty years he had seen
and operated on about 100 of these cases, and that three ter-

352 Uterine Catarrh and Internal Metritis. [June,

minated fatally. A post-mortem examination showed that the
instrument had penetrated into the womb, the fundus of which
in two instances offered evidence of its having been softened
before the operation in which it had been transfixed by the
curette a warning to use the instrument only when absolutely
required, and then to use it with the greatest caution.

Having sketched the pathology of internal metritis, as far as
it is now possible to deduce it from the recorded experience
of others and myself, I shall now discuss the treatment of the
disease, which is beset with difficulties, and often unavoidably
protracted to a great length of time.

There are certain general indications of treatment available
in all cases, whether the uterine mucous membrane does or
does not present organic products on its surface. Thus it is
necessary to ascertain by a careful examination, whether the
haemorrhage does not depend upon some erectile development
at the orifice of the neck of the womb, as in cases alluded to in
the previous papers. The menorrhagia must be restrained by
the means usually recommended, among which we may mention
the horizontal position in a cool temperature ; the application of
cloths steeped in cold vinegar and water to the pubis and the
inner part of the thighs; the injections of cold water, or cold
aluminated water, to the vagina and rectum, two or three times
in the course of the day. Such measures, however, will seldom
succeed unless they be associated with the internal exhibition of
ergot of rye in doses of from five to ten grains three or four times
a day, from which we think the most benefit is to be derived,
though in some cases the practitioner will be obliged to ring
the changes on mineral acids, acetate of lead, tannin, gallic
acid, &c, according to the rules laid down in works on thera-
peutics, to which I refer the reader.

The patient's strength must be kept up by such an amount
of food as can be digested; but it should be taken cold. Wine
and stimulants should be avoided, and all drinks should be as
cold as possible. Water, or cream ices, flavoured according
to the patient's taste, may be advantageously given between
meals. Should the complaint determine continued insomnia
and hysterical symptoms, acetate of morphine must be given,
and the doses progressively increased until such symptoms abate.
In the interesting case I related in a previous paper, the patient
for many days took from two to three grains of acetate of
morphine, and I believe that it not only brought on sleep
and diminished hysterical phenomena, but was also instru-
mental in curing the uterine disease, for the manifest im-
provement only set in when the patient was brought under
the influence of opium.

1854.] Uterine Catarrh and Internal Metritis. 353

When the violence of the disease has abated, and instead of
flooding, there remains, amongst other symptoms, a moderate
discharge of serum, sanguineous or not, then benefit will be
derived from the application of a seton or issue above the pu-
bis, either of which should of course be kept open for several
months. This is a disagreeable remedy, and therefore seldom
proposed, but it will be found beneficial not only in cases of
internal metritis, but also when dysmenorrhcea is attended by
uterine exfoliation ; indeed we have found nothing so useful in
this obstinate complaint.

If it has been ascertained by means of the uterine curette
that the internal surface of the womb is free from all morbid
products, all further instrumental interference would be ob-
jectionable, inasmuch as it could do no good, and must do harm.
Should the curette, on the contrary, detect roughness, and
bring away some of the morbid growths previously described,
their removal from the womb is an indication of first-rate im-
portance, since a rapid cure has sometimes followed the op-
eration, and no improvement can take place so long as they
remain.

As this method of treatment is almost unknown amongst us,
and as it is also applicable to the cure of menorrhagia when
caused by retained portions of placenta, or by hydatid growths
in the early stage of their formation, I shall enter into some
details. Recamier, in one case, finding the neck of the womb
much dilated, introduced his finger into the cavity of the womb,
and scraped off the vegetations with his nail. This suggested
to him, some forty years ago, the idea of doing the same with
an uterine sound made of pewter or steel, and he called it a
curette, because it was destined to remove morbid growths from
the cavity of the womb. The curette is an uterine sound,
blunt, somewhat curved at its extremity, and hollowed out
on its curved side. It should be introduced into the cavity
of the womb like Dr. Simpson's uterine sound, and then
gently pressed on the internal surface of the womb so as to-
detach any soft bodies that may be there. In some rare cases
in which the internal orifice of the womb was widely dilated,
Recamier used a larger instrument. Whatever instrument
was used, the speculum would only render the operation more
difficult. Recamier generally followed up this treatment by
cauterizing the internal cavity of the neck of the womb with
the solid nitrate of silver, by means of an instrument resembling
Lallemand's porte-caustique. Two cauterizations were in
general sufficient, and in some of the cases published by
Recamier, this treatment had for effect not only to stop the
menorrhagia, but also to cause the womb to contract, and

354 Uterine Catarrh and Internal Metritis. [June,

thereby to return to a right position from retroflexed, that
it had been for years. These operations have been performed
in the presence of Paul Dubois, Blandin, Guerin, and many
others; and repeated by Maisonneuve, Robert, Gosselin, and
myself. In the course of last year, Nelaton and Nonat have
published several cases of it in the Gazette des Hopitaux.
The first effects of the operation are to increase considerably
the habitual hypogastric pain, but this does not last long, and
when it disappears, the habitual pains likewise disappear, as
well as the fcetidity of the discharge, and those sero-sanguino-
lent discharges which have lasted for years sometimes com-
pletely cease in a few days.

Many will doubtless be afraid of this operation, but is noth-
ing to be risked when menorrhagia is interminate, and when
the patient's health is sinking from the effects of abundant sero-
purulent discharge, for which the neck of the womb gives no
explanation ? In such cases, fortunately rare, is it not rational
to enter the cavity of the womb with a blunt instrument, in
order to interrogate its surface, and to remove those superficial
abnormal productions which have been known to produce the
symptoms I have detailed? The risk is not so great as might
be supposed, for Recamier performed the operation on 100
patients, and only lost three by peritonitis. In two cases, peri-
tonitis was caused by the passage of the curette through a
previously softened portion of the womb, which was thus trans-
fixed by the instrument. In the third case, Professor Nelaton,
who made the post-mortem examination, was not convinced
that death was caused by the operation ; no trace of metritis
was found, neither had the curette made a false passage. Pus
was found in both the Fallopian tubes, but as the patient was
opened twenty-four hours after the operation, it is difficult to
suppose that it was produced by the operation. I have not
heard of any other fatal termination to the numerous similar
operations performed by other surgeons. A very large volume
could be filled with the fatal effects of false passages made in
attempting to sound the bladder, and still surgeons continue to
perform this operation. We have heard of several fatal results
of false passages made with the uterine sound, and still most
practitioners feel justified in using an instrument of which Dr.
Simpson has well indicated the utility. For the same reason
I feel justified in advocating the use of the uterine curette, not-
withstanding accidents, which will impress upon you the ne-
cessity of using it with intelligent gentleness. You will, more-
over, doubtless observe that the plan of treatment I have shown
to be uesful in some rare instances is not more dangerous than
that proposed by others for similar cases. Velpeau advocates

1854.] Uterire C atari h and Internal Metritis. 355

injections and cauterization of the internal cavity of the womb ;
and Dr. Bennet, in his notice of internal metritis, says "that he
has carried the solid nitrate of silver into the cavity of the
womb in internal metritis, or else the acid nitrate of mercury
as a last resort, and sometimes without success."

I must not omit mentioning that you will find the curette,
very useful to remove portions of retained placenta from the
womb, when its size and sensibility, as well as continued flood-
ing subsequent to confinement, lead to such a diagnosis. Re-
camier first used it for this purpose, I and others have imitated
his example. Vidal de Cassis, Hourmann, and other French
practitioners, have tried injections of a solution of nitrate of
silver in what they call uterine catarrh. Acute peritonitis oc-
curred in some of their cases, several of which ended fatally ;
but I have already shown that French pathologists have con-
founded some half-dozen different diseases under the name of
uterine catarrh.

To give an idea of the kind of cases in which the French
have tried uterine injections, I shall relate what Becquerel did
at La Pitie in 1850. He chose seven women, in all of whom
the neck of the womb was more or less acutely inflamed ; the
orifice of the womb was larger than it ought to have been, and
surrounded by erosions; the discharge was muco-purulent.
An india-rubber sound was introduced into the womb to the
depth of an inch and a half, and by means of a syringe, a so-
lution of nitrate of silver of two grains to the ounce of water
wTas injected. Three out of the seven patients were suddenly
seized with symptoms of severe metro-peritontis, from which
it is true they recovered, but without even being cured of the
original uterine disease, of which only one out of the seven
was cured. These cases could not have been worse chosen,
for while the neck of the womb was acutely inflamed, the body
of the womb was most likely in a healthy state ; and although
the india-rubber sound did not penetrate into the cavity of the
womb, the solution of nitrate of silver did, and coming in con-
tact with a surface, the sensitiveness of which had not beer*
blunted by long-continued morbid action, metro- peritonitis-
ensued.

The fatal results of uterine injections in such cases does not
imply that they would not be useful in well-selected cases.
Although such is my opinion, I have never employed injections
into the womb, for I have been deterred from their employ-
ment by the knowledge of the uncertainty of their action.
Sometimes a strong solution of nitrate of silver can be injected
into the womb without much reaction ; at others, a decoction
of nut-leaves brings on acute peritonitis. This uncertainty of

356 Uterine Catarrh and Internal Metritis. [June,

action is met with even in the same patients ; thus, in one of
Recamier's cases, the vegetations had been removed from the
womb, its cavity had been twice cauterized without determining
any reaction, when it was thought advisable to inject a little
tepid water into the womb, but this was very soon followed by
violent symptoms of peritonitis. In three of Becquerel's cases
peritonitis ensued after a second, a third, and a fourth injection,
the previous injections having produced no ill effects.

In case uterine injections should be deemed useful, a weak
solution of tincture of iodine would be the best fluid to be used,
and the best instrument, that which was suggested to Dr. Mac-
kenzie by the sight of Mr. Coxeter's ingenious instrument for
laryngeal injections. I should, however, caution those who
might use it to press lightly on the fundus of the india rubber
receptacle, otherwise the fluid would be projected with too
great force.* In 'two instances I have removed the vegetations
from the internal cavity by means of the curette, and Nature
did the rest.

In another case, after applying the speculum, and removing
as much as possible of uterine mucus, I covered the extremity
of the uterine sound with cotton wool, which, when saturated
with tincture of iodine, I introduced into the cavity of the womb.
The neck of the womb took up part of the tincture; so,
removing the sound, I again saturated it, and re-introduced
and pressed it about in various directions. .This was not
followed by much pain. Three days afterwards some of the
vegetations came away, with a sero-purulent discharge. Ten
days after, I repeated the operation with similar results, and
then the case did well.

In the wards of Baudeloque, at the Hopital des Enfants at
Paris, 1 had been often struck by the good effects which fol-
lowed the application of caustic iodine to the ulcerated surfaces
of scrofulous patients, and I was led to try the same application,
according to the strength indicated by the Pharmacopoeia, or
diluted with water, to various morbid lesions of the mucous
membrane of the womb.

The benefits to be derived from the topical applications of
iodine to the womb are little known to the profession, and are
well deserving of more extensive trial than has hitherto been
given to them, not only on account of the favourable results of
their application in the cases under consideration, but also
from the well-known fact of the innocuity of the introduction
of iodine into our tissues. Within the last few years, in France,

* For further details relative to the dangers of uterine injections/ 1 may refer
the reader to p. 156 of my work on Diseases of Women and Ovarian In-
flammation, 2nd edition.

1854.] Rheumatism and Rheumatic Gout. 35?

tincture of iodine has not only been injected into the tunica
vaginalis, to cure hydrocele, but also in fistulous passages of
acutely inflamed extensive mammary abscesses, into large
ovarian and other cysts, and even into the peritonceal cavity
to cure ascites, and without determining those symptoms of
violent inflammation that might have been expected.

Having thus briefly sketched what is known relative to
uterine catarrh and internal metritis, it may be well to state
some of the points in which they differ, as the last complaint
has but little occupied the profession of this country.

Uterine catarrh is very frequent ; internal metritis very rare.
Uterine catarrh almost exclusively affects the neck of the
womb; internal metritis, its body. Uterine catarrh is as fre-
quently observed in the single as in the married ; internal me-
tritis seems to affect almost exclusively those who have borne
children. In uterine catarrh the discharge is viscous : in internal
metritis, serous or sanguineous, and very abundant. Uterine
catarrh gives rise to no abnormal growths; internal metritis
frequently does. In uterine catarrh life is never compromised ;
it is not unfrequently so in internal metritis. Injections have
been found useless and often dangerous in uterine catarrh, but
are sometimes serviceable in internal metritis. [London Lancet.

MEDICAL SOCIETY OF LOXDOX.

Dr. Fuller read a paper On the Excretions as guides to the
Administration of Remedies in Rheumatism and Rheumatic
Gout.

The author began by stating that no great advance can take
place in our knowledge of disease, nor any material improve-
ment in its treatment, unless we endeavour to discover the
primary cause of each morbid action, and trace its influence in
modifying and deranging the various functions of -life. After
briefly illustrating this important truth, he proceeded to point
out how close a relationship the amount and character of the
various excretions must necessarily bear to the condition of the
general system, and how certain an index they afford to the
energy of those processes by which the effete materials of the
body are got rid of. Hence he deduced the inference, that no
plan of treatment can be proposed, with a well-founded rational
prospect of success, which is not based on a due regard to the
different excretions, and varied with their varying condition.

He then proceeded to apply this general law to the elucida-
tion of the treatment of rheumatism and rheumatic gout, and
showed that, inasmuch as these disorders depend on the pre-
sence of a morbid matter, the product of imperfect or faulty

M. 8. VOL. X. NO. VI. 28

358 Rheumatism and Rheumatic Gout. [June,

assimilation, a proper action of the excretory organs is more
than usually necessary. The alterations usually produced on
the character of the excretions by the existence of rheumatism
and rheumatic gout, were next alluded to, and some remarkable
exceptions pointed out; and the author stated his opinion that
the chief aim of treatment should be, by producing, as far as
possible, an increase of those excretions which are scanty or
deficient, to make each and all of the excretory organs assist in
eliminating the materies morbi, and to endeavour, by close at-
tention to the character of the excretions, to correct their morbid
condition. He then referred to the good effects resulting from
treatment regulated according to these views, and mentioned
many facts to prove and illustrate the ill success which attends
every mode of treatment in which the condition of the excretory
organs is not attended to. Having fully established these gen-
eral principles, his next endeavor was to point out the means
by which they can best be carried out. He first premised that
if all the excretions are scanty or suppressed, and if at the same
time the pulse be full and bounding, venesection will not only
relieve the general tension of the system, and alleviate the pain
and general distress, but will be followed by action of the ex-
cretery organs. He then proceeded to discuss each of the
excretions separately, and in regard to the perspiration, stated
his conviction that much mischief is often done by interfering
with Nature's mode of operation. No bath should be admin-
istered as long as perspiration takes place naturally, but if the
skin is dry or acting sluggishly, a bath is essential to stimulate
its action. He strongly recommended a water bath of 100
Fahr., rendered alkaline by potash or soda, but in the event of
its being impracticable to make use of a water bath, the vapour
or hot-air bath may be substituted. In either case the effects
of the bath should be sustained by guaiacum and Dover's pow-
der, or tartarized antimony and saline diaphoretic medicines.
The only exceptions to this general rule are met with in per-
sons of a weakly constitution, or towards the close of lingering
cases. In such instances the perspiration is sometimes very
profuse, but loses its distinctive empyrheumatic odour, and
much of its peculiar acid character, and is accompanied by a
soddened state of skin, a quick, feeble, irritable pulse, and not
unfrequently by an eruption of sudamina. Tonics, such as
quina and sulphuric acid, are then requisite, instead of diapho-
retics and salines, and as soon as all feverishness has subsided,
the cautious administration of iron is almost always beneficial.
The urine was next appealed to, and made to furnish its quota
of evidence. Dr. Fuller insisted strongly on the fact that the
mere appearance of the urine, its colour, clearness, or torpidity,

1854.] Rheumatism and Rheumatic Gout. 359

affords no clue to its real condition to the amount and char-
acter of its solid ingredients, which can only be ascertained by
careful examination. This he proved by reference to facts,
and then went on to show that the amount of solid matter ex-
creted by the kidneys is usually much diminished, and that
diuretics are necessary to increase their action. A most im-
portant question is, as to what diuretics should be employed.
A state of congestion and irritation exists consequent on the
abnormal condition of the blood, and the exhibition of ordinary
diuretic medicines, which operate merely as renal stimulants, is
more likely to increase that congestion, than to cause an abun-
dant flow of urine. Hence cantharides, squills, nitric ether,
scoparium, and other similar remedies are of little or no service,
whilst alkalies and the neutral salts, such as the acetate of pot-
ash and the potassio-tartrate of soda, which correct the condi-
tion of the blood, are most active in promoting diuresis. So
also are the preparations of colchicum. Water, too, proves of
service by promoting the absorption of the salts, and assisting
not only in the excretion of the solid matters, but in their sub-
sequent solution. The condition of the urine, as to specific
gravity, turbidity, and activity, was shown to be the best prac-
tical test as to the dose in which alkalies should be administer-
ed, the frequency of their repetition, and the propriety of
persevering in their use. The alvine evacuations were next
referred to, the necessity for strict attention to their character
was pointed out, and the peculiar conditions which call for the
administration of different remedies were clearly indicated.
Dr. Fuller insisted upon the powerful cholagogue influence of
aloes and the acetous extract of colchicum in these cases, and
urged the administration of these remedies, in conjunction with
blue pill or calomel, whenever it appears desirable to excite an
increased flow of bile. The principles of treatment already
laid down were next applied to chronic rheumatism, and subse-
quently to rheumatic gout, and it was shown that in the latter
form of disease the treatment requisite to produce the desired
effects need considerable modification according to the stage of
the disorder, and the constitution of the patient. A disregard
of this fact, together with the practice, too prevalent in the
present day, of prescribing each medicine separately, constitute,
in Dr. Fuller's opinion, the chief cause of the frequent failure
of the treatment ordinarily employed in rheumatism and rheu-
matic gout, and form additional grounds for a close examination
of the excreta, inasmuch as such an examination proves that
no two cases are alike, but necessarily require remedies differing
widely in their character, no less than in the dose in which, and
the period of the attack at which they should be administered.

360 Pathological States of the Blood. [June,

Dr. Semple, after speaking of the unsatisfactory results of
the treatment of rheumatism which he had formerly pursued,
by bleeding, &c, observed, that for some time past he had
treated all cases of acute rheumatism with lemon-juice, and the
result had been invariably satisfactory. For the first few days
of treatment he placed the patient on strictly low diet, and ad-
ministered the juice of six lemons daily ; this, with opium, given
in the form of the soap-pill, formed his entire treatment. The
opium was given in doses sufficient to relieve the pain, and
might consist of one, two, or even three grains. Under this
plan the pain gradually became less, the fever subsided, and
the disease abated. The return to health was more rapid than
when exhausting treatment had been resorted to. Care was
requisite, after convalescence, that the diet was not too stimu-
lating. This treatment had the advantage of allowing us to
use more energetic measures when any local complication, as
heart disease, took place, as the system had not been previous-
ly exhausted by treatment. The plan had also the advantage
of simplicity, and surely that was a very great one. He did
not profess to determine the modus operandi of the lemon-
juice, hut its beneficial results were unmistakable.

Dr. Theophilus Thompson thought that in Dr. Fuller's paper
the importance of the state of the excretions as an indication
of the mode of treatment to be employed, had been overrated.
The author had accidentally touched upon a more important
point viz., the state of the blood in rheumatism. In this dis-
ease we must have a careful regard to the general condition of
the patient, as well as paying a strict attention to the state of
the secretions, for a similar state of the excretions might exist
under very different conditions of the syptem, and different
modes of treatment be therefore indicated. The excretions,
too, instead of being guides to treatment, might only show that
the disease was passing off*. Respecting lemon-juice in rheu-
matism, he had found it of more service in inflammatory cases
of the disease,in which the patient was not robust, and depletion
could not be resorted to. [Ibid.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

Of Certain Pathological states of the Blood, and of their
Treatment. By James Copland, M.D., F.R.S., President.

The author, after describing various symptoms and signs of
irritation of the blood, and noting more particularly the changes
observed in the excretions, &c, deduced a series of inferences
as the bases upon which he founded his practice and treatment.
He arranged the vitiations of the blood under certain heads or

1854.] Pathological States of the Blood. 361

categories, according to the causes, extrinsic or pathological,
producing them, with reference to the indications of treatment,
and these comprehended the following seven orders :

1. Vitiations produced by imperfect assimilation or develop-
ment of the blood-globules.

2. Vitiations occasioned by the increased action of the or-
gans, which waste or decompose the haemato-globulin which
increase the fibrine and augment the urea.

3. Contaminations arising from the absorption of purulent,
sanious, or other morbid matters, into the circulation, or from
the imbibition of any of these by the veins or cellular tissue.

4. Alterations sometimes supervening on the foregoing, or
complicating the latter, such as fibrinous coagula or concretions,
or inflammation of arteries, veins, or lymphatics, puriform in-
filtrations, or fomentations.

5. Vitiations occasioned by the imperfect performance, or by
the interruption or suppression of a depurating function.

6. Contamination produced by morbid miasms, or by specific
seminia, as in malignant, pestilential, and septic maladies.

7. The inoculation of poisonous secretions or fluids, as the
fluids from erysipelatous inflammation, from asthenic or diffu-
sive inflammation, from bodies recently dead from malignant
diseases, or from putrid animal matters.

The treatment appropriate to each of these orders or cate-
gories of blood vitiation might be differently estimated by dif-
ferent observers ; the author professing, however, to give only
the results of his own observation and experience. His practice
had been based upon a close observation, and upon rational
inferences from such observation. The treatment adopted by
the author in these various conditions was then detailed, illus-
trated here and there by some very instructive cases. The
author dwelt at some length on the treatment of that morbid
state of the blood which occurred in acute rheumatism, and
which is characterized by the redundancy of the fibrinous and
ureal constituents of the blood. What medicines would coun-
teract the disposition to fibrinous attraction in the blood, or
such as might exist? Calomel, and calomel and opium, dia-
phoretics, emetics, purgatives, were doubtless excellent initiato-
ry means to diminish excrementitious plethora ; but to promote
the depuratory functions he had found the greatest advantage
from magnesia and its citrate, the carbonates and citrates of
the fixed alkalies, the biborates of soda and potass, the nitrate
and chlorate of potass, sublimed and precipitated sulphur, &c,
&c., as well as the various preparations of cinchona and turpen-
tine. For the treatment of the sixth category, the advantages
derived from large doses of turpentine were detailed ; and the

362 Prognosis and Treatment of Epilepsy. [June,

author concluded by expressing his hopes that he should be ex-
cused for having made so frequent reference to his own writings,
where many of the matters comprised in this extensive subject
were more fully discussed ; but he had his own originality in
some topics to vindicate, as several authors who had recently
written, had considered that opinions and ideas were fair objects
of plunder, if they could be conveyed away without reference
to their originators, and in a different array of words. [Ibid.

Prognosis and Treatment of Epilepsy.

The Union Medicale for May 17th and 19th, contains an
article by Dr. Herpin, of Geneva, on the above subject, of which
we now give an abstract.

In the Union Medicale for December 1, 2, and 7, 1852, M
Moreau, of Tours, relates nine cases of epilepsy, in which ox-
ide of zinc had failed to arrest the disease, a remedy stated by
Dr. Herpin to be of considerable efficacy. Seven of the cnses
were of the class stated by Dr. Herpin to be most amenable to
treatment, and the medicine was administered according to the
rules laid down by him in his essay, Du Prognostic et du
Traitement curat if de I Epilepsie, published last year at Paris.
Dr. Herpin points out the causes of M. Moreau's want of suc-
cess, in the following manner:

1. The first remarkable point which may account in a great
measure for the different results obtained by M. Moreau and
Dr. Herpin was, that eight of M. Moreau's cases were hospital
patients, while Dr. Herpin's were private patients. Dr. Herpin
observes, that physicians who have the charge of epileptic
wards in hospitals regard the disease as almost always incurable ;
while those who see the patients at home, as far as can be
judged from their writings, form a very different prognosis.
Tissot, Odier, De la Rive., and C. Vieusseux, all believe in the
curability of a fair proportion of epileptic cases. A principal
cause of the difference between the opinions of the two classes
of practitioners is, that those in private practice generally see
the disease from its commencement, while hospital physicians
almost always have to treat severe or obstinate cases.

2. M. Moreau had only male patients ; Dr. Herpin had more
females than males. From an analysis of his cases, Dr. Herpin
arrives at the following results:

Of twenty-six female epileptic patients, sixteen were cured,
six were improved, and four were incurable.

Of twTenty-four male epileptic patients, twelve were cured,
four were improved, and eight were incurable.

1854.] Prognosis and Treatment of Epilepsy. 363

There were thus twice as many incurable cases among males
as among females.

3. With regard to age.. Dr. Herpin has obtained the following
results:

Of thirty-five patients under 20 years, eighteen were cured,
nine improved, and eight were incurable.

Of nine patients aged from 20 to 50, five were cured, one
was improved, and three were incurable.

Of six patients aged from 50 to SO, five were cured, and one
was incurable.

The period of life from 30 to 50 furnishes a third of incurable
cases: while the other two do not together supply a fourth.
All M. Moreau's cases were from 19 to 50 years of age, the
most unfavourable period.

4. With regard to the previous duration of the disease, Dr.
Herpin finds that

Of twenty-three cases, which had existed less than a year,
fifteen were cured, five were improved, and three were in-
curable.

Of twenty-seven cases of from one to twenty years' duration,
thirteen were cured, five were improved, and nine were in-
curable.

While nearly one-half of Dr. Herpin's cases were of less than
a year's duration, three of M. Moreau's patients had been ill
from fourteen to twenty months, one for two years at least,
three for six years, and one for about twenty years; the ninth
had recent attacks of vertigo, but had probably had an epileptic
attack six months before.

5. With regard to the number of attacks previous to treat-
ment :

Thirty epileptic patients, who had had less than twelve at-
tacks, furnished only three incurable cases.

Twenty-two patients who had had at least from thirty to a
hundred attacks, furnished twelve completely obstinate cases,
being at least five times as many as in the preceding category.

OfM. Moreau's nine cases, one, who was seized with vertigo,
had perhaps had a fit ; one patient had had only four attacks ;
one had had about fifty ; four from seventy to eighty ; one
more than a hundred ; and one more than five hundred. Be-
sides this, one of the patients had, before the commencement
of treatment, paralysis, denoting organic lesion of the brain,
which was proved by the autopsy : and another had been twice
insane. This latter circumstance was met with in one of Dr.
Herpin's cases, in whom, though the conditions for treatment
were otherwise favourable, the disease remained incurable.

Besides these causes of failure in M. Moreau's cases, Dr.

364 Prognosis and Treatment of Epilepsy. [June,

Herpin points out that the want of sufficient judgment in the
choice of treatment is perhaps a- more powerful obstacle. He
observes that as long as we are unacquainted with the indi-
cations of each remedy for epilepsy, we must begin by giving
that which experience has shown to have succeeded in the
greatest number of cases ; then, in case of failure, we must
have recourse in succession to other remedies of efficacy. By
employing only one, especially in a number of patients placed in
the same conditions as to age,sex,etc. we render ourselves liable
to fall on the medicine which is not indicated. This is precisely
what, it seems, has accidentally happened to M. Moreau.

Oxide of zinc is believed by Dr. Herpin to fail generally in
epileptic patients in the vigour of their age, especially in men.
Taking the whole of the cases placed in favourable conditions
as regarded the number of previous attacks, and which were
treated by oxide of zinc, he finds that there were twenty-six
cures and five failures ail the latter being in patients between
the ages of seventeen and fifty-nine years. On examining into
the results of the treatment by oxide of zinc in men of bet ween
20 and 50 years, in order that the conditions of. sex and age
might be the same as in M. Moreau's patients, Dr. Herpin finds
six patients who were almost all in the most favourable con-
ditions for treatment. In one, venesection appeared to have
more influence than the zinc in producing improvement. Of
the remaining five cases, there were one cure without relapse,
in a patient who had had only three attacks ; two cures followed
by i elapse in one of these the oxide of zinc failed on the sub-
sequent trial ; one in whom improvement was produced at the
age of 15, but in whom the same remedy failed ten years later ;
and lastly, one in whom the disease altogether resisted treat-
ment, although it had been commenced five days after the
first attack. Thus, while the tctal number of favourable cases
treated by zinc are in the proportion of five to six, adults fur-
nish only three cases out of five, and in only one of these was
the cure permanent.

In adult age, it is necessary to give zinc in large doses and
for a considerable time ; in childhood and old age, the same
result is obtained from smaller doses, and, in some cases, from
almost insignificant quantities.

The preceding observations appear to Dr. Herpin to afford
sufficient reason for arriving at the following conclusions :

1. Oxide of zinc seems to be indicated as an anti-epileptic
in children and old persons.

2. It often fails in persons of middle age, especially in men.

3. If it be employed in females, it must be given in large
doses and for a long time,

1854] Cause of Permanent Flexion of the Knee Joint. 365

Whatever, Dr. Herpin observes, may be the remedies em-
ployed, it is of the highest importance that the disease be
treated at as early a period as possible. He is convinced that,
by perseveringly treating epilepsy from its earliest mani-
festation, there is a certainty of cure in a large majority of
cases. At present, some mistake the first symptoms of the
disease; others treat it for a time by means almost always in-
efficacious, such as bleeding, anthelmintics, etc. ; others again
try useful remedies, but timidly, and without effect. A small
number, chiefly hospital physicians, form a tolerably accurate
notion of the choice of medicine and of the results obtained;
but they are placed in the worst conditions for acting at the
most favourable moment.

Dr. Herpin promises, at a future period, to publish in the
Union Medicale the details of some cases in the private practice
of himself and others, giving both the successful and the un-
successful cases in the proportions in which they have been met
with. [Associatio?i Medical Journal. American Journal of
Medical Sciences.

On the Cause of Permanent Flexion of the Knee Joint, after
Amputation of the Leg. By J. M. Carnochan, M. D., Chief
Surgeon to the State Emigrants' Hospital, &c.

The improvements of late made in mechanical inventions to
supply the defect resulting from amputation of the lower ex-
tremity, have been practically useful as regards amputation
made below the knee. It is now no longer good surgical
practice, in injuries or diseases of the foot and of the lower part
of the leg, to amputate at the former place of election that is,
four fingers' breadth below the tuberosity of the tibia. The
more rational principle is adopted, to remove the offending part
by incisions made as far as possible from the trunk, or from the
centre of circulation. The former reason given for amputating
the leg, in injuries or diseases of its lower third, was the ne-
cessity of having a short stump, in order that the knee might
be more conveniently flexed and adjusted to the mechanical
apparatus intended to serve as a substitute for the original limb.
It was supposed that the knee bent would presenT the most
suitable surface to rest upon the artificial member, such as those
formerly in use. From this doctrine two evils resulted. Jn
the first place, nearly two-thirds of the leg were sometimes
unnecessarily removed; and in the second, the motion of the
knee joint was unavoidably lost.

Artificial limbs, as they are at present made, are constructed

3G6 Cause of Permanent Flexion of the Knee Joint. [June,

upon a different principle, so as to preserve the motion of the
knee joint ; and to attain this end, it is necessary to preserve
the power of flexion and extension, and the capability also of
maintaining the stump and the remaining portion of the leg in
a straight position. These important points are to he accom-
plished by attention to the manner of fashioning the flaps or
the incisions of the operation, to the care observed in applying
the dressing, and to the position in which the limb is placed and
maintained during the process of cicatrization.

It frequently happens, after amputation of the leg below the
knee, from neglect of proper precaution, that the stump, or re-
maining portion of the leg, becomes permanently flexed, so that
it cannot be extended in a straight line with the thigh ; and, on
this account, it is not possible to adjust an artificial limb made
according to the recent improvements. Under such circum-
stances, it happens that a patient presents himself, some four or
five months, or longer, after the ampation, to have the stump
made capable of perfect extension by an operation. In such a
case, it might be supposed that the flexion of the joint was
maintained by the long flexors running from the pelvis to the
upper part of the leg, such as the semi-tendinosus, the semi-
membranosus and biceps.

A recent dissection which I had an opportunity of making
upon a limb amputated many months pieviously, satisfied me
that such was not the fact. The limb had been amputated
about five inches below the joint by the posterior flap operation,
and had been kept in a flexed position during the healing of the
stump. When examined by me, it was found that the stump
could not be extended farther than to make an obtuse angle
with the thigh, although natural flexion could be easilv effected.
In a similar case, I had known the entire muscles bounding the
popliteal region on both sides of the limb, to be divided without
producing the desired straight position of the limb. The opera-
tion in this instance was performed for the purpose of effecting
extension of the joint, preparatory to the adjustment of an arti-
ficial leg.

Observing the entire failure of the division of the muscles of
the ham to change the mal-position of the joint, I concluded
that the heads of the gastrocnemii or the ligamentary part of
the joint must be at fault. The recent dissection I made in
relation to this point verifies the supposition, that the joint is
maintained in the state of permanent flexion by the action of
the upper part of the gastrocnemius. While the dissection
was being made, Dr. Gould, one of the House Surgeons to the
Hospital, noted down the following details : The subject placed
face downwards, the integuments and subcutaneous adipo eel-

1854] Cause of Permanent Flexion of the Knee Joint. 3G7

lular layer of tissue were removed from the posterior surface
of the lower half of the thigh and the posterior portion of the
leg forming the stump. The fascia thus exposed was found
perfectly healthy, neither contracted nor thickened. The sar-
torius was relaxed, and its tendon being divided, no extension
of the limb could be effected. In like manner the tendons of
the gracilis, semi-tendinosus, semimembranosus, and biceps
were divided successively, but still no disposition of the limb to
become extended was manifested, although considerable force
wa? used to effect this result.

The tendons of the above-named muscles were neither con-
tracted nor bound down by effused lymph, thus proving con-
clusively that they were not the cause of the permanently flexed
position of the knee joint. The ligaments of the knee joint
were then closely examined, but not cut away ; they also
seemed perfectly natural. On severing a fold of the fascia lata
attached to the external margin of the vastus externus. the leg
yielded slightly, but by no means to any extent. Thus far
everything had been removed on the posterior aspect of the
thigh down to the bone, and nothing detected which could ac-
count for the obstinate flexion. The external head of the gas-
trocnemius was next separated from its insertion at the femur,
and the leg yielded considerably ; the internal head being also
separated from its origin, the leg at once resumed the extended
position to the full extent. The popliteus was found relaxed
the crucial ligaments slightly contracted from want of the na-
tural movements.

The cause of the permanent flexion of the knee joint, after
amputation of the leg:, is thus clearly shown to be seated in the
faulty condition of the upper portions of the gastrocnemii run-
ning between the posterior surface of the lower part of the
femur and the extremity of the stump. The fascia lata may be
slightly contracted ; but the flexor muscles, which take their
origin from the pelvis, and form the lateral boundaries of the
popliteal region, are in no way implicated in maintaining the
permanent flexion of the joint. "

It is apparent, from what has been stated, that tenotomy of
the ham string muscles would be unavailing to restore the limb
to a straight position. The dissection of the heads of the gas-
trocnemii from their origin is an operation of too serious a
character to be practised in such a case upon the living; and
when the angle of permanent flexion is considerable, and has
been of long standing, it is improper to resort to such mechani-
cal violence as would be requisite to effect extension of the
limb. It is better, under such circumstances, to use an artifi-
cial limb, which can be adapted to the flexed condition of the

368 Signification of the Milk-crust in Infants. [June,

knee joint. In order to preserve to the patient the power of
full extension of the stump after amputation below the knee,
attention must be given to maintain the extended position of
the knee joint during the cicatrization of the stump ; and by
accomplishing this, an artificial limb can be adjusted to the
stump, and in such a manner as to retain the free extension and
flexion of the knee joint during progression an advantage
which, it possible, should always be secured to the patient.

[New 1 ork Med. Gazette.

On the Signfication of the Milk-crust in Infants.

Dr. F. Van Willebrand observes, that, both among the pro-
fession and the public, the idea prevails that the milk-scab
is innocent and curable, and that it is the result of an effort
of the system to throw off some acrid scrofulous humour by
the skin. He denies the scrofulous nature of the above-men-
tioned disease, and proceeds to offer some remarks upon
scrofulosis generally.

Recent investigations, and especially those of Lebert (Traitc
(! s Malad. Scrof.,) have shown that in scrofula there is no
peculiar matter or deposit,.nor anv special disease of the organs ;
and that, therefore, we are not justified in regarding scrofula
as a specific disease. The glandular swellings upon the sur-
face of the body, which have for so long been regarded as
characteristic of scrofula, are, as proved by Andral, Velpeau,
and Rokitansky, only a secondary affection, which arises from
irritation in parts from which the absorbent vessels proceed,
but which may continue long after the cessation of the local
irritation. As a cause of glandular swellings in the neck, the
author mentions irritation of the mucous membrane of the
mouth by dentition ; in older children, by carious teeth ; irri-
tation of the Schneiderian membrane; chronic conjunctivitis,
inflammation of the mucous membrane of the ear, inflammation
of the brain (according to Griesinger,) and especially cutaneous
eruptions of the head and face. The peculiar ramifications of
the lymphatic vessels in the places here enumerated explain
the frequent occurrence of glandular swellings of the neck in
consequence of affections of the skin, in which the different
degrees of irritability of the lymphatic system exercise a most
important influence. As instances of glandular swellings oc-
curring at a distance from the local irritation, the author men-
tions swellings in the axilla, consequent upon vaccination, and
remarks, that he has seen glandular swellings, terminating in
suppuration, in the neck from the same cause. As, however,
a morbid irritation once excited in the lymphatic system may

1854.J Signification of tJie Milk- crust in Infants. 3G9

spread after the cessation of the local cause, so may glandular
swellings continue or increase after the cicatrization of the
vaccine puncture ; a fact which the author affirms he has often
witnessed. He considers these swellings in no way connected
with the protective influence of vaccination ; on the contrary,
he pronounces them the results of a morbid process compli-
cating vaccination, and he deems it best for the health of the
child to make as few punctures in the arm as possible, because
many of them tend to excite glandular swellings. Although
these enlargements of the cervical glands depend, in by far the
greater number of instances, upon no corruption of the blood,
but are secondary, and excited by different external causes, yet
it cannot be denied that morbid conditions of the lymphatic sys-
tem, let them proceed from whatever cause they may, exert a
prejudicial influence upon the composition of the circulating
fluid. All investigations, however, upon the deviations from
the normal constitution of the blood in scrofula are valueless,
because our conceptions of the disease are too fluctuating and
arbitrary.

From the preceding, the author concludes that the milk-scab
is not to be regarded as dependent upon scrofula; he rather
supports a totally converse view to that, which attributes a
purifying effect upon the blood to these cutaneous eruptions.
He thinks that most eruptions of a chronic character proceed
from external causes, and he especially mentions eczema and
impetigo. As external causes, he enumerates deficient attention
to the skin, both dirtiness and excess of cleanliness, especially
constant bathing in hard water, by which the integument loses
its oil, so necessary for its lubrication and protection; rubbing
and irritation of the skin by rough coarse hands. The custom,
in Finland, of washing and dressing children before a stove is
to make up for the want of the sun's warmth. The author
has often noticed the first appearance of an eruption after
exposure of the child to a sharp raw air. As internal causes,
he speaks only of dentition and disturbances of the digestive
organs. The spread of eruptions he explains by the ramifica-
tions of the lymphatic vessels under the skin. The effect of
prolonged irritation is to cause congestion and inflammation of
particular spots of integument, upon which vesicles, and pus-
tules, and other simple forms of skin disease may appear. For
an example, he brings forward the itch ; the occurrence of
eczema, after the application of blisters. No hypothetical
acrid state of the blood is allowed by him under any conditions.
All Dermo-pathologists agree that this eruption viz. the milk-
scab so long as it is of limited extent, may be cured without
harm, and, indeed, must be cured. But, when the disease has

370 Treatment of Erysipelas Analyzed. [Jane,

existed for a Ions' time, its sudden cure may seriously disturb
the organism. The author mentions, as instances of what may
ensue, inflammatory affections of the mucous membranes,
especially those of the eye and ear; catarrh of the air-passages
or of the alimentary canal, difficult of cure. He thinks that
chronic cutaneous affections of the head confirm the disposition
to congestion of the brain and its consequences in young
children ; but he does not consider it yet proved that the ex-
ternal inflammation is directly propagated to the dura mater
by the freely anastomosing vessels of the cranium, which pass
from the pericranium to the parts within the skull. Finally,
such widely-diffused eruptions bring on disturbances in the
digestive organs a statement which is confirmed by the ob-
servation that the vasa chylifera are inactive in proportion as
the external integument is coated with a varnish, or any other
application excluding the air. The practical rule in these
diseases, to attend to the functions of the digestive organs,
appears well grounded. The blood may become more serous
in consequence of such digestive disturbances, and hence
comes the tendency to watery effusions, cedema, etc. They
may take place upon the brain or the lungs, and with imminent
peril to life ; most commonly in the latter organ, and in the
advanced stages of cutaneous disease. (Edema of the lungs
often alternates with hydrocephalus in children. The author
does not consider it proved that the speedy cure of an eruption
is attended by risk of such watery effusions. At all events, no
such case is recorded by Hebra, although he used every means
to produce the rapid clearance of the skin. But the author
attributes Hebra's success to the custom of putting the pa-
tients into warm baths, or employing wet dressings, as is now
the custom in some hydropathic establishments. He never
employed salves or unctuous applications, believing that their
constituent parts could become absorbed and act injuriously.
[Med. Times and Gazette, from Finstra Liikare Sallskapets
Hand I .

The Treatment of Erysipelas Analyzed. By San ford B. Hunt,
M.D.

I propose to bring the various remedies employed in the
treatment of erysipelas to the test of a critical analysis, based
on the ascertained facts of the disease ; laying down first the
proposition, that we should exhibit no remedies without know-
ing why we do so.

When a few years since malignant erysipelas first prevailed
to an alarming extent in this section of country, the views of

1854.] Treatment of Erysipelas Analyzed. 371

medical men both as to its pathology and tendencies, and as
to its treatment, were unsettled and unsatisfactory. The
epidemic of 1844 and '5, was exceedingly fatal, as might have
been expected in this state of medical opinion. Sundry points
of pathology were at that time settled in the minds of thinking
and observing men. Among these the following may be laid
down as propositions, then verified and placed among the facts
of the profession :

1st. Ervsipelas is a contagious exanthem, originating in the
presence of a specific blood poison, either conveyed into the
system by contagion, or developed there by certain morbid
processes not understood.

2d. The tendency of erysipelas is toward recovery by the
self elimination of the blood poison.

3d. The action of this poison depresses the vital power.-,
but not usually to a fatal degree. When the poison is directed
from the surface toward the nervous centers, we shall have
symptoms much more alarming than when it expends itself in
cutaneous inflammation.

Probably these propositions are no novelties, and will be
readily acceded to by all who have carefully watched the
disease in question. I shall not, therefore, enforce them by
any argument, but shall confine the scope of this article to
sundry deductions as to treatment, devised from these data.

1st. If erysipelas is a contagious exanthem, analogy would
lead us to suppose that its management should be governed by
the same rules which guide us in the other principal exanthe-
mata, viz., scarlatina, rubeola, variola, varicella, and continued
fever. All these disorders belong to the same family, and are
subject to the same laws. All have their origin in contagion,
though some of them may be self-developed. All of them
depend upon blood poison as their cause. All are self-limited ;
in all of them an abortive treatment is perhaps impossible; in
all of them the degree of danger depends upon the degree to
which the nervous centers are affected by the poison ; and in
all of them that treatment will be most successful which most
favors the elimination of the specific poison. These analogies
are worthy of consideration. We may argue with tolerable
certainty from one to the other, and may readily conclude that
one principle of treatment should govern the whole. And in
the whole art of therapeutics no principle is better established
than that depletion is inadmissible in all this class. Erysipelas
is a blood poison. Therefore any merely local treatment must
be generally insufficient. I say generally, because there are
many cases in which this poison expends itself almost as locally
as does vaccinia in its usual mild career. Of course* in suck

372 Treatment of Erysipelas Analyzed. [June,

cases local treatment will be not only sufficient but superfluous.
Prof. Bennett saw in the Hotel Dieu, a number of cases which
were receiving no treatment M. Louis assertingthat erysipelas
of the scalp was never fatal. And this accords with all our
pre-conceived notions of eruptive disease. When the eruption
comes out fair, thus affording the best chance for elimination,
when it occupies only its natural locality, the skin, and is thus
uncomplicated with visceral inflammation, we expect a re-
covery tuto, citoque, jucunde, without much, if any medical
interference, and the only judicious treatment in any of these
diseases, is that which directs the morbid matter in common
with the whole tide of circulation toward the surface.

The elimination of the specific poison of erysipelas is con-
ducted by the usual emunctories the skin and the kidneys.
Free diaphoresis exerts a most favorable influence upon the
progress of the disease, tending to shorten the process of
elimination. The occurrence of desquamation, even when no
bullae exist, indicates the effusion of fluid beneath the cuticle,
and it is not improbable that this effusion subtracts its quantum
from the sum total of disease. The relative quantity of urea
in the blood seems to have in this, as in all other exanthemata,
an influence upon the severity of the disease. But what tl.is
influence is we do not know, though we may hope that with
our present means of investigation, the thing may soon become
clear.

In erysipelas, as in other desquamative disease, we find fre-
quently not always the accompanying si<jn of albuminuria.
This occurs at the period of declination, and depends upon the
solution of the renal epithelium in the urine. That this is a
part of the process of elimination is not proven, and it may be
found to depend upon a local disorder of the kidneys, incident
to the increased secretion of urea occurring at the period of
declination. The plain indications of treatment derived from
these natural phenomena, are to encourage the secretions of
both the skin and the kidneys.

2d. The tendency of erysipelas is toward recovery. This
is proven by the small average of deaths the recovery of very
many cases in which the disease has run its course uninfluenced
by medication, and finally by the analogy derived trom the
natural history of other eruptive diseases.

3d. Whenever the symptoms become alarming it is not
from the acute or destructive character of the inflammation,
but from a depression of the nervous energy. Gangrene is of
extremely rare occuirence. Abscess is more common, but
still so unusual as not to be classed among the natural sequelae
of the disease. When erysipelas assumes a bad type, we find

1854.] Treatment of Erysipelas Analyzed. 373

the inflamed surface loses its lively red, and acquires a dark,
purple hue ; the skin is dry ; the urine suppressed ; the tongue
has a dry, brown crust; the teeth are covered with sordes ;
the pulse grows frequent and fluttering ; delirium and coma
are present ; in a word, we have typhoid symptoms. All this
retinue of bad signs have their origin in a morbid impression
on the great nervous centers, and we readily draw the indi-
cation of a supporting treatment. If the disease pursues its
natural course, finding outlet by the skin and kidneys, we shall
have the vital powers unimpaired, the reason dear, and the
pulse the great indicator of nervous disorder undisturbed.
But when from any cause, the poison is retained in the circu-
lation, and goes on increasing by zymosis, we shall find that
the brain becomes congested that the disease has left its
wonted channels, and is expending itself upon organs more
important upon the great moving power the nodus vita;
itself.

It seems to me that if what I have advanced be true, we have
a sufficient basis for a scientific and successful treatment of
erysipelas, which by a parity of reasoning will apply to the
ot^er eruptive zymotics. It is not probable that those things
yet unexplained will have the same important bearing upon
treatment as the facts already in our possession.

Treatment. Most of our systematic authors speak of bleed-
ing as admissible, and even praiseworthy, in the country, but
not admissible in the form seen in cities. But if what has
been said about the tendencies of the disease to typhoid action,
the little danger of an unfavorable result from the extent or
violence of inflammatory action, and the importance of main-
taining the nervous system in full vigor be of any moment,
then is a bleeding in erysipelas as unphilosophical as in con-
tinued fever, variola, or any other exanthem. The safety of
the patient lies in the activity and lively character of the local
inflammation : for the extent of the inflamed surface is only an
indication of the amount of blood poison and the activity of
zymosis.

The diaphoretic treatment seems, at first view, to be the-
oretically and practically correct, as indeed it is. But to secure
diaphoresis, we should not administer those dru^s which, by
their depressing influences, lessen the nervous energies e. g..
antimony. There are, however, diaphoretics of a different
class to which no such objections can apply, as the acetate, and
carbonate of ammonia. Whiskey punch, which at first view
would seem a good stimulant diaphoretic, is objectionable on
account of the reaction and torpor of the nervous system fol-
lowing its use.

n. s. vol. x. NO. vi. 24

374 Treatment of Erysipelas Analyzed. [June,

Diuretics are also indicated, but the antagonism of the skin
and kidneys renders it difficult to meet both these indications
at once. Perhaps colchicum, tending directly to the removal
of urea, might be found the best diuretic.

But even these indications, important as they are, yield to
the necessity, in serious cases, of supporting the nervous
powers. Quinine is thus valuable, and here do we find what
I conceive to be the true theory of Hamilton Bell's treatment
by the Tinct. Ferri Muriatis. He himself argues that the
capillaries are in an atonic state, and that the system being
rapidly saturated by this powerful astringent, the atony is
removed. Evidently if this were true, cold affusion would be
equally successful. In the only case in which I have had the
opportunity to observe the action of this remedy, it was com-
menced twelve hours after the appearance of the eruption.
The pulse was 100, full, and firm. Fifteen drops of the mu-
riated tinct. were given every two hours. A cathartic was
given with the first dose. The patient was a blacksmith,
aged 35. There was no other treatment, either general or
local. Under the remedy he sweat profusely, and forty-eight
hours after the treatment commenced, the pulse was 72 acd
soft, and the swelling, which had occupied the whole face
above the mouth, closing both eyes, was declining. He con-
valesced rapidly. This is a single case. Perhaps a collection
of cases might give a different result, though this case is similar
to those reported by Dr. Bell in all particulars. In attempting
to explain the action of the remedy we say this much: The
iron is a good tonic, and is prima facie, as well adapted to the
disease as quinine. Perhaps by the action of the iron, the
nervous system is exalted to a pitch which enables it to exert
its whole energies in throwing off the poison.

Cathartics. Probably there is no case of erysipelas which
will not at some time in its course, be the better for cathartic
action.

Another corollary to our proposition is, that all local appli-
cations further than those tending to relieve itching and pain,
are unnecessary and mischievous. If by local applications
you cut short the inflammalion, you lengthen correspondingly
the disease. This may not hold true in a far advanced stage
of the disease.

It will be seen that by this process of analysis from established
facts, we rather subtract from, than add to our armamentaria
against this disease. The whole treatment is reduced to a
simple combination of tonics, diaphoretics, and diuretics. The
peculiar remedies which have my preference I have indicated,
viz., iron, colchicum and the acetate of ammonia ; but it is

1854.] Sesquichlorideof Iron, etc., in Erysipelas. 375

probable that other articles of the materia medica may fulfil
the same indications, nearly, if not equally as well. [Buffalo
Medical Journal.

Sesquichloride of Iron, etc., in Erysipelas.

Many instances have lately occurred in the London hospi-
tals, in which the treatment of erysipelas by the much-vaunted
tincture of iron has appeared to be very successful, but none of
the experiments have been sufficiently crucial in their charac-
ter to warrant us in considering their results as conclusive.
Still, however, the evidence in favor of the remedy is very
strong. Some of the patients on whom it has been tried have
been young children. With regard to local applications in this
disease, it may be stated that the wrapping up the affected part
in a large and'thick sheet of cotton wool, appears to be very
superior in its protecting influence to all others. In several
severe cases of erysipelas of the scalp, lately, in St. Thomas's
Hospital, Dr. Goolden had the whole affected parts smeared
over with a thick coating of white paint. The patients did
very well, but the remedy is not an agreeable one to use. It
is, we believe, in common employment in some of the pottery
districts, where erysipelas of the face and head, from the alter-
nate exposure to cold draughts and to furnace heat, is very
frequent. [Med. Times and Gazette.

Pityriasis Versicolar curable by Local Application.

This common disease, known vulgarly as "liver spots," and
in the nosology of Wilson as chloasma, is one generally ac-
knowledged to be of extreme intractability. Mr. Paget, we
notice, among his out-patients at St. Bartholomews, does not
adopt any constitutional treatment whatever, but simply orders
a wash of the bichloride of mercury (gr. j. ad 3j). He informs
us that he has never known a case long resist the influence of
this remedy regularly applied to the whole affected surface
once in the day. At the Skin Hospital, although an arsenical
course of internal medication is always prescribed at the same
time, yet a mercurial lotion is also used, and may possibly be
the chief curative agent. In the hands of Dr. Jenner, at the
University College Hospital, the sulphurous acid has, we un-
derstand, succeeded very well. There can be little doubt but
that the disease is almost invariably curable by local applica-
tions solely (parasiticides ?). In relation to this mode of cure, it
is important to connect the observation of Eichstedt and others
as to the eruption depending on the presence of a cryptogamic

376 Cure of Toothache by Emetic. [June,

plant. Another interesting link in the same chain of evidence
has recently been made out at the Skin Hospital, namely, that
it is not unfrequently contagious. [Med. Times and Gaz.

Cure of Toothache by Emetics. By Cesar Frederics, of

Ghent.

The pain caused by a carious tooth, observes the author, is
sufficient to induce the sufferer to try every means for relief.
Of all topical anti-odontalgics, creasote, as a cautery, appears to
me to possess most advantage. But besides these remedies,
there is one too much neglected in my opinion : I mean, the use
of emetics. Ipecacuanha, given in a vomitive dose, in case of
toothache, has been followed by a success wholly unexpected.
It answered even in cases where the neuralgia has remained
after the extraction of the tooth. Emetics constitute a valua-
ble resource in cases of odontalgia without caries. There are
many varieties of toothache. It may be symptomatic of other
affections, or it may be produced by an ephemeral cause.
Commonly the pain is attributed to the caries, but, if so, why
should not the pain be permanent in a carious tooth? Why
do not people suffer continuously ? Some determinate cause
must be at work for the production of pain ; and this varies
considerably. The author believes that gastric disturbance
often coincides with odontalgia, and that the close sympathy
which exists between the stomach and the brain, explains why
a powerful impression made on the former should exert an in-
fluence on the nerves of the head. [L 'Observateur des Sciences
Medicates, and London Lancet.

MISCELLANY.

Minutes of the Fifth Annual Meeting of the Medical Society of the
State of Georgia, held in the City of Macon, April 12th, 1854.

Macon, Georgia, 12th April, 1854.
The Society met in Adelaide Hall at 10 o'clock, A. M., Dr. R.
Q. Dickenson, 1st Vice President, in the Chair. Dr. O'Keeffe
being absent, Dr. Nottingham was appointed Recording Secretary,
pro tem.

On calling the roll, the following members answered to their names:

Drs. R. D. Arnold, of Chatham County; H. L. Battle, of Bibb Co.;

Thos. W. Bell, of Houston Co.; J. R. Boon, of Bibb Co.; S. W. Bur-

ney, of Monroe Co.; H. Coe, of Fulton Co.; P. B. D. H. Culler, of

Houston Co.; R. Q. Dickenson, of Dougherty Co.: L. A. Dugas, of

1854.] Miscellany. 377

Richmond Co.; J. A. Eve, of Richmond Co.; M. A. Franklin, of
Bibb Co.; J. M. Gordon, of Chatham Co.; J. M. Green, of Bibb Co.;
W. S. Lightfoot, of Bibb Co.; C. B. Nottingham, of Bibb Co.; H. A.
Ramsay, of Fulton Co.; R. C. Mackall, of Chatham, Co.

The minutes of the last annual meeting having been read, were
confirmed.

On motion, the rules were suspended, and the following gentlemen,
upon written application, were duly elected members of the Society,
viz.

Drs. D. W. Hammond, Macon, Bibb County ; J. S. Weatherly,
Palmetto, Campbell Co.; G. H. Cornwall, Hillsboro', Jasper Co.; F.
M. Pitts, Indian Springs, Butts Co.; C. T. Woodson, Wilna, Houston
Co.; J. S. Clements, Albany, Dougherty County.

The election of officers being next in order, a ballot was ordered,
and the following gentlemen duly elected :

R. Q. Dickenson, M. D., President.

S. W. Burney, M. D., 1st Vice-President.

J. M. Green, M. D., 2nd " "

G. F. Cooper, M. D., Corresponding Secretary.

D. C. O'Keeffe, M. D., Recording Secretary

C. B. Nottingham, M. D., Treasurer.

On motion of Dr. Arnold, the election of Delegates to the ensuing
meeting of the American Medical Association, was deferred for the
present.

Reports having been called for, Dr. Arnold stated that he was
prepared to report in the matter of Dr. H. A. Ramsay.

Wherepon, Dr. Dugas begged leave to state, that as soon as he
learnt that he had been appointed on that Committee, he addressed a
note to the President of the Society, declining to serve.

Dr. Ramsay stated, that he had never been officially notified that
any action was to be taken against him, and that he had never re-
ceived any written communication.

Dr. Arnold replied that he had not sent any manuscript notice to
Dr. Ramsay, but that soon after the publication of the Transactions
of last year, he had had a copy mailed to Dr. R., at his residence.

Dr. Mackall, Chairman of the Committee on Publication, then
said that he had mailed a copy to Dr. R. in November last.

Dr. Ramsay replied that he had not received a copy until February
last, which was less than three months ago, and therefore he had not
received the notification in the time required by the Constitution.

Dr. L. A. Dugas offered the following preamble and resolution,

378 Miscellany. [June,

which, together with the whole matter pertaining to Dr. Ramsay's
case, was, after some discussion, on motion of Dr. Nottingham, re-
ferred to a Committee of five, (Drs. Nottingham, Burney, Franklin,
Mackall, and Gordon,) with instructions to report at the earliest prac-
ticable moment :

By Dr. Dugas : Whereas, Dr. H. A.. Ramsay affirms that he did
not receive until last February the copy of the Transactions of this
Society, which was mailed to his address in October or November last
by the Chairman of the Committee appointed to notify Dr. Ramsay of
the action of the Society in reference to the tender of his resignation :
And whereas the Constitution of this Society requires that any mem-
ber of the Society accused of a violation of its sections shall be notified
of such accusation in writing three months anterior to the next regular
meeting:

Resolved, That the whole subject be now laid upon the table, and
that the resignation tendered by Dr. Ramsay be accepted.

Dr. Mackall offered the following resolution :

Resolved, That the President appoint a Committee of one from
each Congressional District represented at this meeting to prepare
business for the Society. (Passed.) The President reserving the
appointment until the afternoon meeting.

On motion the Society adjourned to half-past three o'clock, P. M.
C. B. NOTTINGHAM, Rec. Sec'y, pro tern.

Afternoon Session.

Society met at half-past three o'clock. The President called to
order and business was resumed ; requested Committees to report
according to Article 5th of Constitution.

The President having called for reports from auxiliary societies,
Dr. H. Coe stated that the report of the auxiliary society of De Kalb
County was ready, and in the possession of the proper officer, who
had been detained on account of sickness.

Reports from Special Committees.

1st. Dr. Dugas, after stating the general purport of his report
"On the relative value of Lithotomy and Lithotrity," was, on motion,
permitted to amend it, and hereafter to submit the same to the
Committee on Publication.

2nd. Dr. J. A. Eve made a report on the use of anaesthetic agents
in obstetric practice. Report received and referred to the Committee
of Publication, with a request that the author add cases illustrative of
of the report.

1854.] Miscellany. 379

Dr. Arnold presented the excuse of Dr. P. M. Kollock for failure
of his report.

Dr. Nottingham presented the report of the Committee on Dr.
Ramsay's case, which was as follows :

We, the Committee appointed to investigate the charges preferred
by the Medical Society of the State of Georgia, against Dr. H. A.
Ramsay, in consequence of his voluntary retraction of all harsh
epithets and accusations, charging the Society with corruption, here-
by recommend the adoption ot the following resolution :

Resolved, That the difficulties heretofore existing between Dr. H.
A. Ramsay and the Medical Society of the State of Georgia have
been amicably and honourably adjusted.

C. B. NOTTINGHAM,^
R. C MACKALL,
S. W. BURNEY, [Committee.

M. A. FRANKLIN, I
J. M. GREEN, J

Dr. Ramsay's Retraction.

Believing that the various charges of cliqueism and corruption,
which I have from time to time preferred against the Medical Society
of the State of Georgia, have had their foundation in a misconception
of what has in fact been the action of that body in reference to me
and my publications, I respectfully beg to say that I have done the
association injustice, and hereby unconditionally recant all matter
which may be found in a Pamphlet issued by me (in the form of an
Address to the Medical Profession) in 1852; in an Essay designated
the " Necrological appearances of Southern Typhoid Fever in the
Negro " ; as well as in any anonymous publications that I mav, at
any time, have penned, which may be considered as disrespectful or
offensive to the Society. H. A. RAMSAY.

Macon, Ga., April 12th, 1854.

The above Report and Retraction were received and accepted by
the Society.

Dr. Wm. Bunn, of Wilna, Houston County, was elected a member
of the Society.

The President announced as the Committee on Business, consisting
of one from each Congressional District represented at this meeting
the following gentlemen :

1st. Dr. R. C. Mackall; 2nd. Dr. J. S. Clements; 3rd. Dr.
Harrison ; 4th. Dr. Coe ; 5th. Dr. Weatherly ; 7th. Dr. Corn-
wall ; 8th. Dr. Dugas.

Drs. G. F. Cooper, of Sumter County, and D. C. O'Keeffe, of Greene
County, arrived and took their seats as Secretaries of the Society.

The following statement and report on the finances of the Society
were submitted by the Treasurer :

380 Miscellany. [June,

Statement.
C. B. Nottingham,

1853-'4. In Acct. with Med. Soc. State of Georgia.

To Cash of Dr. S. W. Burney, former Treasurer, $60 00

" " " " R. C. Black' " " 15 57

" " " J. F. Alexander. " " . 20 00

$95 57

To Cash arising from Initiatory Fees, $24 00

" " " " Assessment of 1852, 50 00

" " " " 1853, 198 00 272 00

$367 57

((

II

it

II

ft

a

M

M

K

M

102 10

5 50

50

1 80

1 00

338 09

By Cash p'd J. T. Blain, for Trans-

actions of 1852, $202 00

" " " Sundry Pap'rs for adv'ng 24 70
Postage, 49

Dr. Mackall Ch'man Com.
mittee Publication, 1853,
1 Ga. Tel. for Circulars &c.
Frt on box Transac. 1852,
For Treasurer's Ledger,
,i m u por cash Book.

Balance $ 29 48
Macon, Ga., April 12th, 1854.

The Treasurer of the Medical Society of the State of Georgia, begs
to make the following

Report.

In compliance with a resolution passed at the last annual meeting,
I early, after my return from Savannah, issued a Circular to all the
members of the Society, who were in arrears under the several acts
or assessments, stating the amount of their dues, &c. Many of them
responded promptly to my notice. I regret, however, that some have,
in their forgetfulness, entirely overlooked their obligations; so that
the dues remaining unpaid amount to about four hundred and seventy
(470) dollars. The Society is, I am happy to say, nevertheless, out
of debt, and has a small surplus in the Treasury.

I also addressed, as instructed, a communincation to Drs. Burney
and Alexander, former Treasurers, calling upon them for a settle-
ment, and am pleased to say that they both turned over to me the
funds in their hands.

All of which is respectfully submitted.

C. B. NOTTINGHAM, Treasurer.

The report was received and referred to a Finance Committee,
consisting of Drs. Arnold, Burney, and Bell, who reported as follows :

1854] Miscellany. 381

The undersigned, the Committee to whom were referred the
accounts of the Treasurer, respectfully leport that they have examined
them and the accompanying vouchers, and find them correct.
RICHARD D. ARNOLD, )
THOMAS W. BELL, } Committee.
S. W. BURNEY, )

On motion of Dr. Harrison, an assessment of one dollar each was
levied to defray expenses of current year.

Dr. Mackall, by request of Dr. J. J. Robertson, presented the
following resolution, which was passed :

Resolved, That a Committee of eight, one from each Congressional
District, be appointed by this Society to investigate the question
what quantity of Opium, and preparations from Opium are sold and
used in the State of Georgia for non-medicinal purposes.

Committee. 8th District, Dr. J. J. Robertson, Wilkes Co. ; 1st.
Dr. R. C. Mackall, Chatham Co.; 2d. Dr. J. Killsman, Lee Co.; 3d.
Dr. D. W. Hammond, Bibb Co. ; 4th. Dr. R. F. Stell, Fayette Co. ;
5th. Dr. S. J. Word, Floyd Co. ; 6th. Dr. C. W. Long, Clark Co. ;
7th. Dr. A. Means, Newton Co.

On motion, the Society adjourned to 10 o'clock to-morrow morning.

Thursday Morning, 10 o'clock

The Society met pursuant to adjournment, the President Dr.
Dickenson, in the Chair.

Minutes of yesterday were read and confirmed.

Dr. A. Means, of Newton Co., and Dr. Ira E. Dupree, of Twiggs
Co., appeared and took their seats as members of the Society.

The first business requiring action, being the election of Delegates
to the approaching meeting of the American Medical Association, the
following gentlemen were duly elected :

Dis. W. M. Charters, of Chatham County: Juriah Harriss, of Rich-
mond Co.; W. B. Jones, of Fulton Co.; Ed. Fitzgerald, of Houston
Co.; R. C. Word, of Floyd Co.; W. S. Lightfoot, of Bibb Co.; R.
C. Mackall, of Chatham Co.; A. Means, of Newton Co.; D. W.
Hammond, of Bibb Co.; I. E. Dupree, of Twiggs Co ; H. R. Casey,
of Columbia Co.; W. L. Jones, of Morgan Co.; R. D. Arnold, of
Chatham Co.; H. J. Oglesby, of Morgan Co.; D. C. O'Keeffe, of
Greene Co ; S. W. Burney, of Monroe Co.; C. T. Woodson, of
Houston Co.; M. G. Slaughter, of Cobb Co.; J. R. Boon, of Bibb Co.

On motion of Dr. Dugas, each Delegate to the American Medical
Association was authorized to select an alternate in case he could not
attend.

382 Miscellany. [June,

On motion, the rules were suspended, and Dr! R. H. Nesbit, of Bibb
County, on written application, was elected a member of the Society.
On Motion of Dr. J. M. Green :

Resolved, That a Committee of three be appointed to consider
whether the constitution requires any changes, or amendments, and
that the said Committee report at the next meeting of the Society.
(Drs. J. M. Green, Thos. W. Bell, H. Coe, Committee.)

A report was read from Dr. T. S. Denny, Secretary DeKalb County
Auxiliary Society, which, on motion was received.

In reference to said report, Dr. Arnold stated that this Society
was not a representative body ; that every duly qualified physician
has a right to its membership, and consequently that there is no need
of sending Delegates from Auxiliary Societies.

A letter of resignation from Dr. B. O. Jones of Fulton County, was
read by the Treasurer ; whereupon Dr. Arnold moved to grant his
petition after he shall have paid his dues. (Carried.)

Dr. L. Holt arrived and took his seat.

Dr. H. A. Ramsay signified, through the President, his desire to
to withdraw his letter of resignation, which he had tendered last year.

On motion, his petition was granted.

The following Communication was read and received from the
New-Hampshire Medical Society, viz :

" At the Annual meeting of the New-Hampshire Medical Society,
holden at Concord, June 1, 1853, the following Resolutions were
unanimously adopted :

Resolved, That it is the decided opinion of the New-Hampshire
State Medical Society that no Delegate should be admitted to member,
ship in the American Medical Association, who represents a Medical
Society which numbers among its members any person or persons
who adopt as their system of practice any form of empiricism.

Resolved, That the Secretary of this Society be instructed to trans-
mit a copy of this Resolution to the Secretaries of each of the State
Medical Societies, and to the Secretaries of the American Medical
Association, previous to their next Annual meeting."

E H. WEBSTER,
Sec. N. H. Med. Society.

Boscawen, June, 1853.

Whereupon, on motion of Dr. Arnold it was

Resolved, That this Society concur with the Resolution of the New-
Hampshire Medical Society, and that it adopts it ; and that its Secre-
tary be requested to transmit a copy of the proceedings in this matter
to the American Medical Association at its ensuing meeting in May
next, and also to the New-Hampshire Medical Society.

1854] Miscellany. 383

The Committee on Business reported the following subjects and es-
sayists for the next Annual meeting :

1. On the relations between Remittent and Yellow fever. Dr.
R. D. Arnold.

2. Diseases of the Cervix Uteri. Dr. J. A. Eve.

3. On the connection of Pneumonia with Remittent fever in the
South. Dr. L. D. Ford.

4. Upon the Diseases of the Spinal Marrow. Dr. C. B. Nottingham.

5. Typhoid fever as it prevails in Georgia. Dr. R. C. Word.

6. Relations of Epidemic Dysentery to Remittent and Typhoid
fever. Dr. D. C. O'Keeffe.

7. Is Urinary Infiltration necessarily followed by Sloughing. Dr.
S. N. Harris.

8. On the treatment of Strictures of the Urethra. Dr. L. A. Dugas.

9. On the use and abuse of the Speculum Uteri. Dr. G. Harrison.

10. Upon the value of Diet in the Management of Disease. Dr.
G. F. Cooper.

11. On the Causes of Abortion. Dr. J. M. Green.

12. On the Influence of the Culinary Art upon Health. Dr. R. C.
Mackall.

13. On the Operation for Lacerated Perineum. Dr. J. M. Gordon.

14. Changes in the diseases of the State of Georgia during the last
thirty years, and in their treatment. Dr. R. Q. Dickenson.

Dr. Dugas moved that each essayist be authorized to select an al-
ternate in case he cannot perform the duty assigned him. (Carried.)

On motion of Dr. Dugas, Dr. H. L. Battle of Macon was appointed
Orator for the next annual meeting, and Dr. R. H. Nesbit of the
same place his Alternate.

On motion, it was decided that the Annual Address be delivered at
12 o'clock on the second Wednesday in April next.

On motion to select a place of meeting for next year, a considerable
discussion sprung up, in which many of the members participated.
Finally, it was, on motion of Dr. Arnold, unanimously agreed that
the city of Columbus be selected as the place for the next annual
meeting.

Drs. Thos. Hoxey, Wm. Flewellen and F. A. Stanford were ap-
pointed the Committee of Arrangements.

On motion of Dr. Nottingham a committee of three (Drs. Notting-
ham, Hammond, and J. M. Green,) was appointed, to whom shall be
referred the Transactions of this meeting, with power to print, or not
to print, such portions of the same as may seem to them proper.

384 Miscellany. [June,

On motion of Dr. Arnold, the Recording Secretary was directed
to have published with the forthcoming Transactions, a corrected list
of the members of the Society, together with their address, and a
proper indication of the deceased members.

On motion of Dr. Dugas, the Committee on Publication were in-
structed to publish the Constitution and By-Laws with the proceedings
of this meeting.

On motion of Dr Arnold, it was

Resolved, That the following Amendment be made to the Con-
stitution :

Resignations.

All resignations shall be tendered to the Society in writing, and no
resignation shall be accepted until all dues to the Society shall have
been paid.

On motion of Dr. Mackall :

Resolved, That the thanks of the members from abroad, present at
this annual meeting of the Medical Society of the State of Georgia,
are due, and are hereby cordially tendered to their medical friends of
the city of Macon for the politeness and courtesy with which their ar-
rival in this beautiful city was greeted, and the kindness and hos-
pitality which has rendered their short sojourn so entirely agreeable.

The minutes having been read and confirmed, on motion, the So-
ciety adjourned sine die.

D. C. O'KEEFFE, Recording Secretary.

Greenesboro', April 21st, 1854.

American Medical Association. The St. Louis papers contain full
reports of the proceedings of the National Medical Convention, which
convened in that city on Tuesday, May 3d.

After the delivery of an address from Dr. Washington, of St. Louis,
welcoming the members to St. Louis, and a speech from the senior
Vice President, and the usual preliminary business, the following
officers were elected :

Charles A. Pope, M. D., of Missouri, President. Vice Presidents :
E. D. Fenner, M. D., of Louisiana ; N. S. Davis, M. D., of Illinois ;
Win. T. Wragg, M. D., of South Carolina; John Green, M. J)., of
Massachusetts. Secretaries: E. S. Lemoine, M. D., of Missouri ;
Frank West, M. D., of Pennsylvania. Treasurer: D. F. Condie,
M. D., of Pennsylvania.

On the second day the reports of the various standing committees
were read. These are generally elaborate papers upon important
medical subjects.

The committee on the prizes offered by the association reported
that they had resolved to award but a single prize, and that would be
to Professor Daniel Brainard, of Chicago, the author of the essay

1854.] Miscellany. 385

entitled " An essay on a new method of treating ununited fractures
and certain deformities of the osseous system."

Resolutions were unanimously adopted commending the sugges-
tions of the Secretary of the Treasury to abolish, or materially modify
the duty on such crude drugs, not producible in this country, as are
used in the laboratories of the country in the manufacture of chemi-
cals.

Dr. Mendenhall, of Ohio, read a report on the epidemics of Ohio,
Indiana and Michigan, during the years 1852 and 1853.

Dr. Holmes, of Missouri, read a paper on erysipelas.

Dr. Fenner, of Louisiana, read a report on the epidemics of Louisi-
ana, Mississippi, Texas and Arkansas, with particular reference to
yellow fever and cholera.

Dr. Linton, of St. Louis, gave his views on yellow fever, in which
he repudiated the idea of malarious influence in producing the disease,
and attributed it to heat and northern blood.

Dr. Davis read a report on typhoid fever.

Dr. Davis, of Illinois, called attention to the necessity of supply-
ing large cities and towns with wholesome milk, and referred to
some specimens of milk prepared, so as to make a voyage of any
distance without losing its nutritive qualities. This was tested with
perfect success by Dr. Kane on the Arctic expedition.

On the third day, a resolution on spirituous liquors was referred to
Dr. Mussey, of Cincinnati.

Dr. W. S. Edgar offered a resolution in regard to the compound-
ing of medicine, and recommending apothecaries to use different
colored paper in putting up poisonous drugs, with an appropriate
stamp upon it, in contradistinction to other medicines.

[From the New Orleans Medical and Surg. Journal.]
Prof. J. L. Riddell's Opinion on the Causes of Yellow Fever, fyc.,$c.
To the Sanitary Commission of New Orleans:

Gentlemen Incompliance with your resolution of Dec. 21,1 have
the honor to present you the accompanying records of testimony, re-
specting the origin and spread of Yellow Fever this year, in some of
the Southern towns, as high up the Mississippi as Lake Providence.

Deep interest is universally manifested in the labors of our commis-
sion; and all possible facilities were tendered me in the prosecution
of my inquiries. My constant regret has beeu, that want of time
would not permit me to prosecute them further.

Of course I found conflicting opinions, and now and then statements
more or less contradictory ; yet from all, as well as from data previ-
ously in possession, it appears to me the following inferences are de-
ducible :

1st. That our yellow fever of 1853 has not been personally con-
tagious ; that the poison, virus or material cause producing it. does
not emanate in an active condition from the person of the patient la-
boring under the disease.

2d. That the disease has been marked by characters of infection

386 Miscellany. [June,

and infectious communicability, the poisonous matter (doubtless-
some species of living organism) maturing its germ or spores on the
surface of solids devoid of life, surrounded by confined or impure air ;
which germs become diffused in the impure atmosphere.

3d. Three peculiar conditions seem to favor the developement of
the infection 1st. The absence of ozone, the great chemical pro-
moter of oxidation, which absence permits the undue developement
of obscure cryptogamic life. 2d. Abundant emanations from decom-
posing and disintegrating organized matters, complex products, gase-
ous, liquid and solid, the pabulum or blastema of cryptogamic growths.
3d. The presence of the specific organism, whose perfected spores
constitute the material cause of yellow fever,

4th. That the towns and plantations of the Southwest have this
year derived their yellow fever from New Orleans.

5th. That although black vomit fevers or types of yellow fever
may perhaps originate in this region, yet that the germs of our epi-
demic of 1853, have probably been derived from countries further
Soulh.

6th. That the mixture of equal parts by weight, of black oxide of
manganese, sulphuric acid and water, which in the cold will continue
for many days to develop ozone, promises to be the most convenient,
most economical and most efficient disinfectant ever used ; and there-
fore deserves hereafter a fair trial.

7th. It is proper and feasible for New Orleans to have some kind
of quarantine in certain months of the year, which will exclude filthy
persons, filthy clothing and filthy ships, until they are fumigated ;
and goods from West Indian, South American and Mexican ports,
until they are fumigated.

8th. The city should be kept cleaner than heretofore, by efficient
drainage, and sanitary regulations carried into effect.

9th. Legal ordinances should be framed and carried into effect, to
prevent the undue huddling together of human beings within the
limits of the city.

Respectfully, J. L. RIDDELL,

Member of the Sanitary Commission of New Orleans.

New Orleans, January 1, 1854.

Uses of Strychnia. Perusing a reference to Dr. Corson's late
paper on functional disease of the heart, we noticed an allusion to his
use of strychnia in debility of the heart.

This drug is but little in use among the generality of practitioners.
Probably its active poisonous nature has deterred them ; yet it is no
more dangerous in its use than many other drugs which we employ
without hesitation. Early in onr practice we prescribed the solution
of strychnia in acetic acid, in a number of cases of habitual consti-
pation with very satisfactory results. We looked upon the consti-
pation in these cases as a result of debility, inaction, or perhaps par.
tial paralysis of the muscular coat of the intestines. By restoring
vigor to the muscular tissue we reinstated the function of the bowel.

1854.J Miscellany. 387

All those who have made nervous disease a subject of special study,
are inclined to enlarge its boundaries, and to include the nervous
pathology in many of those diseases considered as purely zymotic.
But it is evident that blood poison operates not unfrequently, (and
perhaps always) first upon the nervous system. And it is the gan-
glionic system which is especially affected by these poisons. Tne
elimination of the poison is a natural process, but its rapidity musl
depend very much upon the integrity of the nervous centers which
govern secretion. It is from looking at the subject in this light, that
we were first enabled to recognize the philosophical nature of the
quinine treatment in typhus. This theoretical opinion has since been
confirmed by actual observation.

Now there is no great difference in the actions of quinine and
strychnia. Both of them are stimulants directed especially to the
ganglionic system ; both are, therefore, anti-periodics, and they dirler
only in relative activity. Cases of typhoid fever occurring under the
care of Prof. Rochester at the Buffalo Hospital of the Sisters of Charity
during the past winter, which were in that low, sinking condition,
verging towards coma, and marked by great debility of those organs
depending on the ganglionic system for life, were greatly benefitted,
and apparently saved by the administration of strychnia. \

We have not space to pursue this matter further, but we express
our conviction that strychnia is a remedy of application almost as
universal as brandy or quinine. In another number it is our intention
to write more fully upon it. [Buffalo Medical Journal.

Gonorrhoea. Dr Boinet (L'Un. Med.. Sept.) speaks highly of the
effect of tincture of iodine when applied to the mucous membrane
of the vagina in the gonorrhoea of women ; a single application was
sometimes sufficient. At the same time a solution of equal parts of
tincture of iodine and water was injected into the urethra, but was not
allowed to penetrate into the bladder. Dr. Boinet has employed the
local application of iodide in inflammations and ulcerations of other
mucous membranes, and with great success. [British and Foreign
Med. Chir. Review.

Gout. Dr. Goolden (Med. Times & Gaz., Nov.) uses with good
effect, as a local application, spirits of wine. The relief to the pain
is said to be sometimes very great. In the same journal the utility of
an old remedy, the carLonate of soda, as a local application in gout
and rheumatism, is refeired to. A drachm of the carbonate is mixed
with a hot bread poultice, and applied over the joint. [Ibid.

Menorrhagia. In cases of abundant menstmal flow without physical
uterine lesion, Dr. Tanner speaks highly of the effect of tincture of
cinnamon, in drachm doses in cinnamon water every six hours. [lb.

Neuralgia. Periodic neuralgia of the face and head have lately
been common in Paris, and have occasionally withstood the action of

388 Miscellany.

quinine. M. Aran (Bull. Gen.deTher., 1854, ii. p. 84) has employed
in such cases the aconite in large doses. The preparation employed
was the extract of the French Codex. [Ibid.

Grave-Yard Poison. The following paragraph "is copied from a
late number of the London Lancet, and is a specimen of many cases
that are reported, showing conclusively that intramural burials may
be injurious to the living, in large towns and populous cities. " Dr.
Sutherland, one of the grave-yard inspectors to the Home Office, has
been seriously indisposed from inhaling poisonous gas, the escape from
decaying corpses in a grave-yard that he inspected. He is however
now recovering. Dr. Walter Lewis is ill from the same cause." [lb.

Died, in Boston, March 18th, Dr. Geo. C. Shattuck, in the 71st year
of his age. Dr. S. was a man of great professional and personal
worth, as well as a liberal patron of Dartmouth College and Har-
vard University.

Legacies of the late Dr. Shattuck. It will be recollected that mention
was made in this Journal, sometime since, of a donation of $14,000
by Dr. George C. Shattuck, towards sustaining the professorship of
Morbid Anatomy in Harvard University. At his death it appears
by his will that he has given $10,000 more to the same institution ;
but the specific object to which it is to be appropriated, we have not
yet learned. In addition to the above legacy, he has given the third
of the income of certain manufacturing stocks for three years to the
Massachusetts Medical Society, of which he was once the honored
President. It is said that this income will amount to ten thousand
dollars in the three years. Besides the above legacies, he gave some
$40,000 to several charitable and religious societies in this city.

[ Boston Medical and Surgical Journal.

Too good to keep ! A newly appointed Professor of Theory and
Practice in a Western medical school, more familiar with politics
than physic, started on a pilgrimage to the east. At Buffalo he called
upon one of the magnates of the profession. In the course of the con-
versation the nouveau ne Professor inquired as follows: "Can you
tell me, Sir, what there is about this matter of physical diagnosis ?
Is it really, now, worth knowing?"

The host indicated very politely that it was, perhaps, desirable that
teachers should have some knowledge of it ; whereupon the newly
elected one said "that if it was really worth while, he would go down
to New York for a fortnight, and acquire it. For his part he hadn't
much faith in it."

Whether or no our ambitious teacher followed the advice of his
host, " to go by all means," we cannot say. [Buf. Med. Journ.

Prof. Roux, the Nestor of French surgeons, died in Paris on the
23d March, in the 74th year of his age.

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES. JULY, 1854. [No. 7.

ORIGINAL AND ECLECTIC.

ARTICLE XX.

Remarks upon the Vertex Presentations of the Foetus. By
C. C. Howard, M. D., of Lowndesboro', Ala.

Professor L. A. Dugas :

Dear Sir The principal object of this communication, is to
offer some theory, to account for the great frequency of the first
position. Vertex Presentation of Baudelocque ; and so little do I
find on the subject, in the obstetrical works examined, that I
indulge the hope that this paper will be read with some interest,
if derived alone from considerations of its novelty.

Before proceeding, however, I desire to say, that the two
most prominent opinions as to the cause of the relative frequency
of the head presentation, I regard as very improbable. The
first, as well, perhaps, as the most generally received opinion, to
which reference is made, is that the child is dependent from the
cord, and the attachment of the navel string being nearer to the
pelvis than to the head of the child, the head therefore hangs
downwards.

In the latter stage of pregnancy, the child certainly cannot
present the cranial or caudal extremity, as if by chance ; yet,
in the earlier stage of pregnancy, this can be done, as is implied
in the opinion disagreed to. This ready possibility of the foetus
to be turned in the uterus, I have no doubt, exists long after the

n. s. vol. x. NO. VII. 25

390 Howard : Vertex Presentations. [July,

cord is entirely too long to suspend the foetus, if, indeed, it ever
did. This, therefore, is of itself sufficient reason for me to
reject the theory. The uncertainty, too, of the point of the
placental attachment, presents strong objection to it ; both of
which objections are urged by others. But, the character and
known office of the cord present other and insuperable objec-
tions to the theory. What is more improbable, than that, two
or three little blood-vessels would be used in this way, to accom-
plish so important an end, as that, the accomplishment of which
is so necessary to the population of the world? What can be
more important than to keep up a healthful and regular circula-
tion between the foetus and placenta? And what would be
better calculated to disturb this circulation than this very sus-
pension ?

The other somewhat prominent opinion, to which I desire to
offer some objection, is that advanced by M. P. Dubois, in a
memoir read at the Academy of Medicine in 1838. as J learned
from M. Chailly's work on Midwifery, page 04 viz: "An
instinctive determination of the foetus itself presides over the
accomplishment of this law, and this instinct is proved," &c.
It is an almost universally admitted fact, that the head of
the foetus in utero is not only usually downwards in the last
periods of gestation, but in the earlier also ; and that after
the sixth month, changes from one presentation to another
are not frequent. If, therefore, instinctive determination of
the foetus presides over this matter, does it not do so at an
astonishingly early period of its existence even before it pos-
sesses sufficient strength to make itself felt by the highly sen-
sitive and ever watchful female, carrying it ? I submit then,
that this decision is made at too early a period, even for instinct.
But, admitting that the foetus is instinctively led to select this
position, what power has it at three or four months ot intra-
uterine life to assume it? Even at birth, and for weeks after,
it is so feeble, that if you place it in one position it cannot as-
sume another. How, then, I ask, is it possible for the foetus,
unaided by gravity, to assume that most difficult of all positions,
viz., the inverted ? Aye, more, to put its head to a certain
point and keep it there, opposed by the force of gravity. The
new born infant has strength to seize the mother's breast and

1854.] Howard: Vertex Presentations. 391

extract nourishment from it: the young of the opossum may
graft themselves on the tits of their mother; but the fetus per-
form the manoeuvres mentioned above: never, never.

Is it not much more reasonable, than either of the theories
remarked on, to suppose that the embryo approaching a state
of floating in the liquor amnii (as it does), and being easily
agitated in that liquor by the movements of the mother (as it is),
under the force of gravity finds a resting place, and the cranial
extremity being heavier than the caudal, thereby much oftener
obtains and occupies the region of the os uteri ? Says Moreau,
page 96. (speaking of the first theory.) " This mechanical ex-
planation would be satisfactory and readily admitted. 1st, if the
insertion of the umbilical cord were the same at all periods of
intra-uterine life; 2d, if this cord were shorter than one half the
body of the foetus ; 3d, if the placenta were always inserted into
the fundus of the uterus ; so that the foetus would be constantlv
fixed to the fundus of the organ, and suspended in the amniotic
fluid by a very short cord." These objections to the theorv
founded on suspension by the cord, are the valid objections,
which, however, in that last proposed are removed, bv attri-
buting all necessary suspension to the liquor amnii. The dif-
ference between the two theories being in the means of a partial
suspension, it may be well to notice two or three objections
made by M. Dubois to the first theory, as they will apply with
equal force to the last. 1st. the fact, "that he has repeatedlv
pluDged, horizontally, into a quantity of water, a dead foetus, and
has uniformly observed that all the parts of the foetus descend
with equal rapidity,''' has no bearing on the question ; for neither
gravity, nor the instinctive effort of the foetus, nor any other ordin-
ary influence would cause the head to remove from the fundus
to the os, since the longitudinal diameter of the foetus, is much
greater than the transverse diameter of the uterus, at full term.
Besides, this objection is entirely yielded in a fact involved in
this 2d objection : " Before the full term, head presentations are
less frequent, although, at this period, the head is really heavier
than the pelvic extremity."' But why are head presentations
less frequent in premature labours ? They ought not to be, if
instinct presides over this matter; for the law of instinct is a
very certain and safe law. So is the law of gravity ; and if this

392 Howard : Vertex Presentations. [July,

last governs in this case, we ought to expect that head presenta-
tions would be less frequent in premature labours ; because, the
cavity containing the foetus is much more spheroidal in the first
six months of gestation, than in the last three. 3d. He still fur-
ther adds, says M. Chailly, (for I have never seen the memoir.)
that "in women who, during their pregnancy, retain the hori-
zontal posture, the foetus as commonly presents the head."
Though there would be some decided difference in the position
of the uterus, whether the woman be in the horizontal or verti-
cal posture during pregnancy, yet. " in* both cases the os uteri,
in consequence of the inclination forward of the pelvis, is"
(usually) "the most depending part of the organ." Again: it
must, I think, be a very small number of women who, in any
strict sense, during their pregnancy retain the horizontal pos-
ture. 4th. In foetuses who have a tumour on the pelvic ex-
tremity, the tumour being even heavier than the head, this latter
still presents. Like the cases just referred to, these hist are
very rare, and it is not shown by any means, that, in a number
of such cases, the proportion may not be changed: the position
maybe determined before the tumour destroys the usual relation
of weight. Lastly, those accidental causes which sometimes
carry the head to the fundus, might, under reversed circumstan-
ces, carry the breach there.

Concerning the objection, 'that inanimate, where the inferi-
or portion of the organ does not correspond to the cervix, but to
the fundus, head are more common than footling presentations,"
I cannot speak advisedly. But even if it is so, without any
modifying influence, I do not see in that any sufficient reason
for rejecting a theory, in so many respects plausible, when ap-
plied to a very different animal. Notwithstanding so much
more space has been occupied with the question of the cause of
head presentation than was intended, yet, before entering on
the subject proper, I desire also to refer to the cause of the pre-
sentation of the vertex not that I have anything whatever new
to say on that subject; but, because it may enable the reader
more readily to comprehend the theory about to be proposed.

In consequence of the relative size of the foetus and the cavity
it occupies, it is compelled to fold itself up in some way, in order

* Moreau.

1854.] Howard: Vertex Presentations. 393

to find accommodation, ordinarily. The most natural, indeed
the only natural way of doing so, is by flexion, thus : the thighs
are bent on the abdomen ; the legs on the thighs ; the arms on
the breast ; the chin approaching the breast, and the entire spine
more or less flexed. Now, as labor begins and progresses, so,
the relative size of the fetus and the cavity in which it is con-
tained is diminished, and before the uterine contractions are
sufficiently great, to thrirst any part of the fetus into the supe-
rior strait, the chin has been compelled to approach the breast,
so that the vertex becomes the cranial pole. But the vertex not
only becomes a pole, for the uterus, compelling the diameters of
the fetus to correspond with its own diameters, the vertex far-
ther becomes the presenting part.

Allow me now to say, that the fetus can have little to do, by
instinct or otherwise, with its birth or position in the uterus, but
acts as it is acted on. Farther, that it is not from mere chance that
we have one position oftener than another, or that it is so merely
because it is so, i.e., that there is a natural law consisting of the
abstract will of the Creator ; but, that the manner in which a
fetus presents in parturition is determined by its relation to the
cavity it occupies, and this relation is such, that those presenta-
tions and positions which are most favorable to the mother and the
child, always have been, and will be, infinitely the most frequent.
We are not to understand, then, that the 1st position of vertex
presentation is to be expected, merely because it has been the
most frequent heretofore ; and we are not to practice the art of
midwifery ten or twenty years, before we acquire confidence in
this expectation; but, in my humble opinion, we are to expect
this position in consequence of appreciable influences, generally
existing. What those influences are, it is the object of this pa-
per to define.

That the reader may see the points aimed at, it may be well to
say at once, that the theory about to be proposed rests upon a cer-
tain relative configuration believed to exist between the fetus
and the cavity in which it is contained ; which cavity has for its
walls, not only the uterus, but the abdominal walls also. Added,
to this configuration is the ftree of gravity.

Let us now turn our attention to the shape of a fetus folded
up in utero, as it is compelled to be to find accommodation. Is

394 Howard : Vertex Presentations. [July,

it not evidently erroneous to assume, that the lateral and antero-
posterior diameters of this body are of equal length ? With the
chin approaching the breast, and the spine flexed admitting
that the anterior face of this foetus is curved at all is it not cer-
tain that the line describing that curve, is not equal to the line
describing the certain curve of the posterior face ? If these
questions are answered in the affirmative, (and they ought to
be,) it is seen at once, that this folded up fetus does not form an
oval, as is sometimes said. But. for lack of a better term, we
consent to call it an ovoid, flattened on three sides, viz.. anteri-
orly and laterally. It would be fortunate for me had I the
advantage of plates; but it must suffice to refer to any of the
plates in our midwifery works, shewing the 1st position of a
foetus in utero, head presentation. When the chin is removed
from the breast, the foetus more nearly approaches an oval ; but
before, the posterior line from pole to pole, never should be mis-
taken for the anterior line from the same point to the same point.
The above description is certainly very imperfect, and very far
from being satisfactory to the writer; but the light in which the
shape of the foetus in utero is to be viewed, is so far indicated,
that the indulgent reader will obtain the general idea, and form,
in his own mind, a distincl notion of said shape, which he is now
requested t<> d<>; and 1 ask, can ho doubt that said firtus can be
better accommodated, when looking towards a vertical line
intersecting the right sacro-iliac symphisis, than in any other
position ?

But let us proceed to state some facts in relation to the brim
of the pelvis, and the abdomen.

The anatomical peculiarities of the brim bearing on the ques-
tion, viz., the promontory of the sacrum posteriorly, the length
of the antero-posterior diameter of the superior strait, as com-
pared with its other diameters, and with the occipito-frontal
diameter of the foetal head, are generally and sufficiently dis-
tinctlv set forth in obstetrical works, as determining the position
in which the head in labour is compelled ; but I submit that these
peculiarities have little less influence during the latter periods of
gestation ; and as by this arrangement the head is better ac-
commodated during labour, so it is better accommodated during
the last weeks of gestation. It is not to be understood, then,

1354.] Howard : Vertex Presentations. 395

that we very frequently have the 3d position, vertex presenta-
tion, and the antero-posterior diameter of the foetal head, be-
ing so much greater than the antero-posterior diameter of the
superior strait, the position is necessarily changed to the 1st,
or any other ; but, on the contrary, before, and for weeks
before the labour begins, the relation of the head to the brim is
such that the position is, must, and will be the 1st. I do not
think, however, there would be any great difference in the ac-
commodation given to the head, in the 1st, 2d, 4th, or 5th posi-
tions, but the peculiarities of the pelvis would only affect these
as compared with the 3d and 6th. It is, therefore, not to the
peculiarities of the pelvis that I would attribute the greater
frequency of the 1st position, as compared with the 2d, 4th, and
5th, but to the abdomen.

The anatomical facts in relation to the abdomen, to which
attention is called, are 1st. That its posterior wall is composed
of materials which cannot be made to give way to an enlarging
uterus, but will compel said uterus to seek room in some other
direction : Farther, that this wall, so far from presenting a con-
cavity to accommodate a convexity, such as is offered in the
back of a foetus when folded up in utero, rather presents a con-
vexity, to turn off the back of said foetus.

2d. That the anterior and lateral walls are just the reverse,
in the above respects, of the posterior wall : they are yielding ;
and the muscles, which contribute so much to make up these
walls, being attached to the bony frame above, below, and lat-
erally, yield in just such a way as to form a concavity to receive
the convexity of the foetus's back.

3d. The right hypochondriac region is occupied by the largest
solid viscus in the body, viz., the liver ; and in the latter stages
of pregnancy, when the uterus would intrude upon its location,
the attempt is so far resisted that the right side of said uterus is
compressed its diameter here diminished, and the bodv of the
contained foetus is thus naturally thrown around to the left side :
so that, when a foetus lies with the head bearing the relation to
the brim in the first position, its body is in the abdomen corres-
ponding to the same position.

The 1st position, then, is not only the most easy and natural
in parturition, but also in the latter stages of gestation.

396 Howard : Vertex Presentations. [July,

A probability in favor of this view of the subject, is derived
from a fact already mentioned, viz., premature labours are less
apt to be of this position, than labours at full term. The proba-
bility is inferred in this way. In the latter stages of pregnancy,
the abdomen is more nearly filled than in the first stages, and
the peculiarities which have been pointed out are more fully
developed.

Again: turn the foetus round, so that its back will nearly Or
quite correspond with the back of the mother, (and this you will
do if you turn the face to the pubes or acetabulum.) and what
is the inevitable tendency of the contractions of the abdominal
muscles, so common in pregnant women ? Certainly, in the
event they fail to throw the foetus round, they are to produce
extension, instead of flexion. If they produce extension, the
effect must be onpleasanl to the mother, and perhaps to the foetus
also; and this, necessarily, if the foetus occupies less room in
flexion than extension; and if the former remark, 'that the
foetus is compelled to fold itself up in utero in order to find ac-
commodation ordinarily.' be hue. To be more explicit : When
a foetus lies with its back corresponding to the maternal back,
the abdominal muscles expend their force upon its cranial and
caudal extremities ; and the maternal back successfully resist-
ing these contractions, the foetus is either thrown round or ex-
tended. If extended, uneasiness is produced at least on the
part of the mother ; this uneasiness farther induces contractions,
which, ordinarily, compel the foetus to pass round, and accom-
modate itself to the cavity containing it. The exceptions are
numerous, it is true about as many as present the head other
than in the 1st position : and though to state the causes of those
exceptions might throw more light on the subject, yet, we will
onlv say that they are mainly to be found in the absence of a
healthful and favorable relation in size of foetus and cavity.

The second great cause determining the position of a foetus
in utero, both in the last stages of gestation and in parturition,
is to be found, I submit, in the force of gravity. About the
period to which reference has been so often made, though the
woman, to maintain the centre of gravity, may throw the shoul-
ders and body back, (which last increases the convexity of the
posterior wall already referred to,) yet the posterior wrall of the

1854.] Howard: Vertex Presentations. 397

abdomen will not be carried so far back, as that the foetus will
occupy a vertical position will be balanced on its head. So
far from this, it will be removed several degrees from a perpen-
dicular. For the reasons apparent, if not already given, this
leaning will be anteriorly or laterally, and the evident tendency
is to the first ; but counteracting agencies, as I have tried to
shew, and as experience, I think, shows, make it left-laterally,
usually. Now, as by a well-known law of gravity, the heavier
seeks the lowest point, and as the posterior side of the foetal
ovoid is the heavier side, so it should take the most dependent
position.

The foetus, then, lying in utero, in a position corresponding
to the 1st position of Baudelocque, has its diameters to corres-
pond more nearly with the diameters of said cavity; and the ten-
dency to deviate from this position is, usually, prevented by the
action of the abdominal muscles, aided by the force of gravity.

Since writing out these remarks originally, I have found the
following, in the beautiful and able Treatise on Midwifery, by
F. J. Moreau, in which I am not very sure that he dicf not in-
tend to put this whole matter in a nut-shell. Treating of " atti-
tude and position of the foetus in utero," page 95, he says
"Generally, this position is as follows: the head rests on the os
uteri ; the hips and feet are toward the fundus of the organ ; the
back is turned toward the anterior paries of the abdomen of the
mother ; and the belly toward the lumbar vertebra? of the latter."
Then, in the last paragraph on that page, he says, "this position
may be explained by the laws of gravity, and in a purely me-
chanical manner. Thus, the back of the embryo, by virtue of
its convexity and weight, should lodge in the most concave part
of the uterus, which is the anterior surface ; it can adapt itself
more accurately to this surface, which coincides with the ante-
rior soft wall of the abdomen, whilst the lumbar column and a
portion of the viscera of the mother, which project posteriorly,
accommodate themselves more easily to the unequal surface of
the anterior region of the foetus."

So far as I am aware, nevertheless, these remarks attribute to
the abdominal parietes an importance not, hitherto, fully recog-
nized. Much that has been said may be ideal. I do not doubt,
however, in the least, that the facts mentioned have their influ-

398 Casey's Remarks upon Hepatic Abscess. [July,

ence, and that influence is great. But without deciding on the
value of these remarks, further than is indicated by writing them
out, and forwarding them to you, they are placed at your dispo-
sal, with the assurance, that if in your estimation they will not
be read with interest or profit, you will do me a favor to sup-
press them.

Although the practical bearing of the above theory has not
been referred to, and though it is regarded as being great
since this article has been extended much beyond my design, I
only desire to mention, in this connection, the question of posi-
tion or decubitus in parturition.

In the theory, is contained the best reason, in my judgment*
yet offered, for the left side. In comparison, the questions of
convenience to the accoucheur, and modesty of the female, fall
into insignificance. Still, they do not much affect an objection
to that position, in the last throes of labour, which I have long
had, and which is, there seems to be less force and agreement
in the expulsive efforts in that position. But, without contra-
indication, I shall, unhesitatingly, hereafter give preference to
the left side, at least until the head engages in the superior strait.

May 22d, 1854.

ARTICLE XXL

Additional Remarks upon a case of Hepatic Abscess. By
H. R. Casey, M .D., of Columbia county. Georgia.

Dear Doctor I wrote you some time since, giving you an
account of a Case of Hepatic Abscess that had occurred in my
practice ; which letter you placed before the medical public,
through the columns of your valuable Journal. (Vide S. M.
Journal, Sept. No. 1853.)

If the circumstances giving origin to that letter, were of
sufficient importance to justify me in presenting them to your
notice, I think I am authorized in giving you this letter, which
may be taken as a sequel to the former.

In the conclusion of my former communication to you, I
stated that the different orifices which gave vent to the sup-
puration, were at the time of my writing, all cicatrized, and the
woman in the enjoyment of fine health.

1S51.] Casey's Remarks upon Hepatic Abscess. 399

For some months thereafter I had frequent opportunities of
meeting with her, and the facial expression, the lively air, the
embonpoint, in fact, every appearance was the heraldry of
health. She remarked- to me, that she felt better and stronger
than she had done for years.

Some short time subsequent to this, she became enceinte, a
situation considered most interesting and desirable by " ladies
who love their lords."

But the consumnation of her hopes was not to be realized.

About the third month of Utero-gestation, she was taken
down with pains and a flowing, and I was summoned to see her.
I immediately put into requisition the means usually resorted
to on such occasions to prevent the threatened catastrophe.

There being a decided proclivity in the uterus to throw oft*
its contents about this period of its gravidity, (she having
aborted two or three times,) I did not hope, nor did I expect to
succeed, particularly as the uterine contractions were very
forcible, and the hemorrhage great. Things continuing thus
and rather aggravating for two or three days, and being satisfied
that the maternal and foetal connection was severed, I ad-
ministered the vinum ergot which soon had its effect in the
expulsion of a dead foetus.

She was put to bed, and had no untoward symptoms. She
had a good " getting up," was doing well in every respect and
began in three weeks from the accident to attend to her domestic
duties.

Her circumstances in life being such as disqualified her from
having menials to go at her bidding, and come at her beck, she
unfortunately sought the wash tub too early, and at night after
a hard days washing she was taken down, and the following
morning I was sent for.

I found her quite ill, with great febrile excitement, pulse 130,
skin hot and dry, complained of no particular pain, but a general
malaise. I gave her forthwith 10 gtt. verat. viride, and directed
its repetition in 7 drop doses until the pulse was brought down
to 90, when I directed 15 grs. sulph. quinine to be given. At
bed time to take 12 grs. blue mass, followed in the morning
with sulph. magnesia, and after its operation, she was again to
resort to the great febrifuge.

400 Casey's Remarks upon Hepatic Abscess. [July,

Called to see her on the third day, found her somewhat im-
proved, but still with considerable fever, pulse 98, strong, tongue
coated, with pain in right side. Fearing the suppurative
termination, and dreading to go through the scenes that were
enacted on a former occasion, I boldly set to work by the aid
of all those means that would be conducive to that end. To ward
on the dire tendency, I put her upon mercurial alteratives, had
croton oil freely rubbed over the right hypochondrium. and
restricted her as to dietetics. I continued this treatment for
several days, using saline purgation on alternate days, but found
at length I would have to give up the contest. The inflamma-
tion would not yield to my treatment, and suppuration became
evident. Again the hectic, like the bright red coral of the
ocean, began to play upon the cheek.

A change in her symptoms called tor ;i change in my Thera-
peia. The depressing treatment was laid aside, and an in-
vigorating one, with a generous diet, substituted.

Directing my efforts t<> the pointing of the abscess, externally,
I was in a few days called on to use my lancet. Finding a
fluctuating tumour opposite the side of the affected viscus, I
punctured the most prominent point, and gave vent at once to
about two gills of matter. The puncture was directed to be
kept open, and warm althea poultices applied.

From this time to the closure of the wound in health, I sup-
pose some half a pint more of matter escaped.

She recovered from this attack sooner and with less con-
stitutional disturbance than in her former trial, owing in a
great measure to the fact that in the present instance, the
abscess was smaller, judging from the relative amount of mat-
ter excreted.

There was nothing peculiar in the treatment or subsequent
management of the case. The obvious indications being to
build up the system, such remedies were ordered the known
tendency of which was to increase the stamina.

She was put upon mineral tonics, and iodine and an appro-
priate dietetic treatment instituted.

I am happy to have it in my power to say that my patient is
again in the enjoyment of fine health.

In the course of my remarks in the former letter to you, I

1854.] Attaway's Case of Ulceration. 401

stated that a suppurative termination of this Phlegmasia in this
country was of rare occurrence, and that its existence was even
denied by some.

This unfortunate yet fortunate lady stands to-day a living
witness of the susceptibility of the liver to suppuration, and to
re-suppuration.

I will make one other remark in connection with this case.

This lady, previous to her first attack of hepatic abscess, had
been for several years a victim to Haemorrhoids, from which at
times she suffered greatly. During the treatment of her case
she found that her piles had disappeared and from that time she
has never felt them.

Now, in her case, in all probability, the piles were caused by
her liver disease checking the return of the blood of the haem-
orrhoidal veins. Her liver beins: torpid, 'congested and enlarged.
acted as a mechanical impediment to the passage of the blood
of the portal circulation; and hence the induction of piles.
This, however, is but a speculation, which I think, however,
warranted from the facts of the case.

May 25th, 1854.

ARTICLE XXII.

A Case of Ulceration of the Cervix and Os Uteri, successfully
treated. By A. F. Attaway, M. D., of Madison county,
Georgia.

The following is a case brought to me on the 2d day of May
last, supposed by the friends of the patient to be one of prolapsus
uteri, for which they wished me to operate. By interrogating
the patient a few minutes, I was convinced of their delusion,
and induced to believe that I had a case of ulceration to con-
tend with.

The woman was thirty years old; had given birth to three
children, the youngest of which was six years of age. Six
weeks after the birth of this child she got her feet wet, in con-
sequence of which, she thinks, she had a sudden and violent
attack of sickness. The best medical aid was procured that
could be had, and, after an illness of several weeks, hej health

402 Attaway's Case of Ulceration. [July,

was only partially restored. Since then, she has been subject,
more or less, all the time, to pain in the loins ; a sense of heat
and forcing in the pelvic region; general debility, and unnatu-
ral vaginal discharges. She had been under the care of vari-
ous physicians for the last five years, without realizing any
permanent benefit.

By the touch, per vaginajn, I found the uterus considerably
swollen, and slightly prolapsed ; the cervix and os soft and patu-
lous, presenting an irregular surface, in consequence of cicatri-
zation, and very sensitive to pressure, the least of which caused
lancinating pains in the pelvis, and more especially in the region
of the ovaries. Upon introducing the speculum, an extensive
ulceration of the cervix and os uteri was perceptible, and that
part of the organ which was not covered with deep ulcers, (for
there was more than one, varying in size from that of a pea, to
a shilling, or larger.) was of a deep red or livid color, presenting
such an aspect of malignancy, that I was disposed to doubt the
efficacy of any treatment I might prescribe. I, however, treat-
ed the case as follows :

Patient confined to recumbency as much as possible, without
too much inconvenience the speculum introduced, and the
organ well cleansed with a camel-hairbrush, and a piece of fine
Bponge affixed to the end of a stick of whalebone, dipped in the
suds of Castile soap then, with the best quality of nitrate of
silver, I cauterized the ulcerated surface thoroughly. This was
done once every three days, for three weeks; after this, only
once a week, for nine weeks at the lapse of which there was
no ulcer to be seen, and the organ looked of a natural and
healthy color.

In addition to the above, I washed the vagina and cervix
uteri, once a day, with cold water, impregnated with Castile
soap, followed by a solution of the sulphate of zinc, 10 or 12grs.
to the ounce of water. Her diet was nutritious, and easy of
digestion ; her bowels were attended to ; and occasionally cha-
lybeates were used. Such was the treatment which resulted
in a permanent cure. The woman is now in vigorous health.
Nine months have elapsed without any symptoms of the disease
returning.

1854.] Wilson, on Magnolia Tripetala. 403

ARTICLE XXIII.

The Leaves of the Magnolia Tripetala as a Dressing for
Blisters. By Jxo. Stainback Wilson, M. D., of Airmount,
Alabama.

As this Journal is eminently practical, it is hoped that, a
brief notice of the remarkable species of Magnolia which heads
this article, will not be unacceptable.

The M. Tripetala is known by the common names of " um-
brella tree " and " wild cucumber," the latter being, we think,
the most common in Alabama, where it grows abundantly ; al-
though it seems that this name is most generally applied to the
M. Acuminata.

The species of Magnolia under consideration, is one of the
most remarkable productions of the United States, and will not
fail to attract the attention of the most unobservant, by the
wonderful size of its leaves and the beauty of its flowers : " the
former are eighteen or twenty inches long, by seven or eight in
breadth," and even larger than this : while the latter are of
corresponding magnitude, being " seven or eight inches in di-
ameter." We are informed that "this species of the Magnolia
extends from the northern parts of New York to the southern
limits of the United States," but we have never seen it in any
pait of the State of Georgia. Still, as it is no doubt a common
production of the rich lime lands of the South Western and
Western states, its " medical properties and uses " should be
known to the physicians of that region; and it should not suffer
unmerited neglect like too many of our useful indigenous reme-
dies. The M. Tripetala (the bark) is highly esteemed by the
common people as a tonic, and some of them even consider it
an infallible specific in dropsies ; this of course cannot be con-
ceded, but the estimation in which it is held is, at least, an evi-
dence that it is not by any means destitute of medicinal virtues.
And in addition to this, we have the higher evidence of our
Dispensatory that it has been found useful in chronic rheuma-
tism, and intermittent and remittent fevers. We have had no
experience with it in the treatment of the above diseases ; but
we have used the leaves as a dressing for blistered surfaces with

404 Experiments with Phosphorus, fyc. [July,

satisfactory results, and the main object of this article is to com-
mend this application to the attention of the, profession.

We will simply, in conclusion, mention why we think this
dressing should be considered worthy of notice : ]st. The leaves
of the Magnolia are not officinal, and it may therefore, be pre-
sumed, that their uses are unknown. 2nd. We think that they
are equally as good as the collard or cabbage leaves, so much
used ; while they are often more readily obtainable, much larger,
and less otfensive in smell.

Before using, we scald them, but think it possible that they
would answer every purpose, it' applied in the natural state.

Experiment* with Phosphorus, and remarks upon its Dose
and Action, when given in the form of Alcoholic Tincture
or Solution. By Wm. M. Boling, M. D., of Montgomery,
Alabama.

More especially since I have used in my practice the Vera-
trum Viride, the discovery of an article equally certain, prompt,
powerful and reliable in its action as a cardiac sedative, but
without some objections that have seemed to me to pertain to
the operation of this remedy, I have thought a great desidera-
tum. By an article presented to the Alabama State Medical
Association, at its meeting in Selma, in December, 1852, with
impressions that I had previously received in regard to it, my
attention was directed to the Gelseminum Sempervirens, or
Yellow Jessamine. I entered upon my experiments with this
article, somewhat sanguine of success, but disappointment was
the result. After a number of experiments with it, in which
certain effects said to result from its use, such as dimness of
vision, trembling, &c., were produced in a marked degree, I
could not discover that it at all reduced the frequency of the
pulse. My experiments with it were upon healthy subjects.

In a well written and exceedingly plausible paper, which
was published in the New Orleans Medical and Surgical Jour-
nal for January, 1854, on Pneumonia, by Doctor S. Ames, of
Montgomery, Phosphorus is mentioned as a remedy of great
value in this disease, and its curative influence, if I mistake
not, ascribed to a cardiac sedative operation. I have been in-
duced to make some experiments also with this article ; the
results of which I will give.

Two preparations of the article are mentioned by Doctor
Ames, to wit : a saturated Tincture in Anhvdrous Alcohol,

1854.] Experiments with Phosphorus, tyc. 405

which he supposed to be equal in strength to the Ethereal
Tincture, or to contain four grains to the ounce ; and a diluted
tincture, made by adding nine parts of alcohol to one part of
the saturated tincture. As a dose of the saturated tincture,
from half a drop to two drops are spoken of, but it is stated
that the medicine " cannot be continued in the smallest quantity
just mentioned for any great length of time, without inducing
considerable disturbance of the stomach, as shown by nausea
or vomiting, burning heat, and a feeling of oppression at the
epigastrium.'"' It is also remarked that "its effects are cumu-
lative; that is to say, a dose which singly is not large enough
to produce any sensible effect, may become very troublesome,
or even dangerous, after several repetitions at intervals of
three or four hours;" and that "this quality was developed in
one instance by repeating it in a dose of two drops of the
strong alcoholic solution three times at intervals of twenty-
four hours." In regard to its sedative action, Dr. Ames re-
marks, that "its sedative or contra-stimulant, is its medicinal
or therapeutic action/' and in a note, makes the following
statement: "Two young gentlemen, my personal as well as
professional friends, have been recently engaged in some ex-
periments to test the effects of phosphorus on persons in health ;
they themselves being the subjects of the experiments. These
gentlemen (Doctor Pollard and Doctor Oliver) found that a
single dose of two drops of the saturated alcoholic solution in-
variably reduced the force and frequency of the pulse. The
changes in frequency ranged in the number of pulsations to the
minute, between eight and twelve beats. A change was per-
ceptible in about twenty minutes, which reached its maximum
in from an hour to an hour and a half."

Doctor Ames, however, for reasons given in his paper, prefers
the weaker solution, and his method of administration is to add,
sixteen drops of it to four ounces of water, of which he gives a
teaspoonful every " third or fourth hour usually every fourth."
As there are thirty-two teaspoonfuls in four fluid ounces, the
quantity of the diluted tincture thus given at a dose, would be
half a drop. This dose Doctor Ames prefers " after many
trials with larger ones."

I have been thus particular in referring to the peculiar ef-
fects said by Doctor Ames to result from the use of these two
preparations of phosphorus, but more especially to the dose and
method of administration, that comparison may be conveniently
instituted with the dose and manner of administration followed
by myself, and any fault or deficiency in the latter, detected and
pointed out. I feel inclined to pursue the subject further, if I have
failed in any way to conduct my experiments satisfactorily.

n. s. vol. x. NO. VII. 26

406 Experiments with Phosphorus, tyc. [July,

The pulse as most persons know, and as any one may
satisfy himself of will be found to vary in many persons, if
not in everyone, somewhat in frequency at different times in
the twenty-four. hours ; and often, even when felt at short
intervals, will be found so to vary from trivial or inappreciable
causes. To prevent any fallacy from this circumstance, it will
be noticed, that in my experiments on some days, the frequen-
cy of the pulse at different hours is given, though the phospho-
rus was omitted. A comparison may thus be made between
the pulse on the days that the phosphorus was, and on the days
that it was not, given.

My first subject was Sam, a healthy mulatto boy, seven years
old. On the 25th of February, having kept him in the recum-
bent posture sometime, his pulse being 102, at 1 o'clock, P. M.
I gave him seven drops of the saturated tincture. At 2 o'clock,
P. M., pulse variable, from 90 to 108. 3 P. M. (subject asleep,)
pulse 94. The dose of seven drops were repeated. 4 P. M.,
(subject asleep,) pulse 104.

Feb'y. 26th 1 o'clock, P. 11, pulse 100; 1| o'clock, pulse
114; 2 oxlock, pulse 100. No phosphorus was given to-day.
The subsequent experiments with Sam were with the diluted
tincture. The experiments already given were conducted
with the subject in the recumbent posture. In the following,
he was generally, when a dose was to be given or the pulse
counted, called in from play.

March 10th 11 A. M., "pulse 100 ; halfa drop of the diluted
tincture given. 12 AM., pulse 103 ; halfa drop given. 1 P. M.
pulse 100 to 106; one drop given. 2 P. M., pulse 104; two
drops given. 3 P. M., pulse 108 ; two drops given. \\ P. M.
pulse 92 ; two drops given. 6 P. M., pulse 88, and five minutes
later, 96.

March 11th Half after twelve, pulse 96. 1 P. M., pulse
104. 2 P. M., pulse 100. 3 P. M., pulse 10 L 5 P.M., pulse
86. 6 P. M., pulse 92. No phosphorus was given to-day.

March 12th 10 A.M., pulse 98; 50 drops given. 11 A.M.,
pulse 102. 1 P.M., pulse 96; 100 drops given. 2 P. M., pulse
104. 5 P.M., pulse 100; 200 drops given. f>\ P. M., pulse 100 ;
200 drops given making in all 550 drops in seven and a half
hours. 6| P. M., pulse 107. 1\ P. M., pulse 94.

Mareh 13th 8 A. M.5 pulse 92 ; 500 drops given. 9\ A. M.,.
pulse 92.

March 17th 4 P. M., pulse 104 ; nine hundred and ten (910)
drops, being exactly one ounce, given at a dose. Here a child
seven years old took, at a single dose, one thousand eight hun-
dred and twenty (1820) of Doctor Ames' doses for the adult.
Half after four P. M., pulse 116. 5 P. M., pulse 120. 7 P. M.r
pulse 104, and the subject " feels very well."

1S54.] Experiments with Phosphorus, fyc. 407

The two hours immediately succeeding each of the last two
doses, Sam spent riding in my baggy with me, and attended to
my horse at the different stopping places; and though I
noticed him carefully, no appreciable effect was manifested
the variation in the pulse alone excepted otherwise than that
he seemed a little merry, which was fairly. I think it will be
admitted, attributable to the alcoholic part of the dose about
half an ounce in one instance, and an ounce in the other. It
would scarcely seem necessary, while the large quantity of al-
cohol would render it improper, to repeat, or to carry the

joke any further with Sam.

My second subject was a negro man, about 25 years oil,
under treatment by means of the bandage and the recumbent
posture, for a small ulcer on the foot. Otherwise, he was
healthy. He lay in my office during the experiments, which
were all conducted with the saturated tincture.

Feb. 27th 1 P. M., pulse 78 ; ten drops given. 4 P. M.,
pulse 72.

Feb. 28th 12 M., pulse 78 ; ten drops given. 1 P. M.,
pulse 80. 3 P. M., pu!>e 72. 4 P. M., pulse 78.

March 1st 11 A. M, pulse 74. 2 P.M.. pulse 74. 3
P. M., pulse 68. 4 P. M., pulse 80. Xo phosphorus was
given to-day.

March 2d 12 M., pulse 72 ; 20 drops given. H P. M..
pulse 71. 2 P. M.. pulse 67.

March 3d 12 M., pulse 74 ; 25 drops given. 2 P. M., pulse
74 : repeat the dose. 3 P. M., pulse 67. 3i P. M., pulse 72.

March 4th 11 A. M., pulse 80. 12J, pulse 72. 3 P. M..
pul>e 68. No phosphorus was givin to-day.

March 5th 12 M., pulse 74 ; 40 drops given. 1 P.M..
pulse 74. 3 P. M., pulse 66.

March 6th 9 A. M. pulse 70; 60 drops given. 10 A. M..
pulse 71. 1 P. M., pulse 74 ; 70 drops given. 2 P.M., pulse
72. 3 P. M,. pulse 80. 4 P. M., pulse 80.

March 7th 12 M.5 pulse 78. 12 pulse 64 ; 80 drops given.
2J P. M., pulse 76.

March 8th Half after twelve o'clock, pulse 74 ; 100 drops
given. 1 P. M., pulse 76. ' 2 P.M , pulse 74. 3 P. M., pulse
74 ; 10 drops given. 4 P. M., pulse 84 ; 21 drops given. Q\
P. M., pulse 84.

March 9th 8 A. Iff., pulse 74 ; 2 drops given. 9 A. M., pulse
74 ; 30 drops given. 10 A. M., pulse 76 ; 40 drops iven. 10
A. M., pulse 76. 2 P. M.. pulse 70. 3 P. M., pulse 78 : 50 drops
given. 3^ P. M., pulse 75 ; 50 drops given. 4 P. M., pulse
84. 5 P. M, pulse 84 ; 100 drops given making in all 272

408 Experiments with Phosphorus, fyc. [July,

drops of the saturated tincture administered during the day.
6 P. M., pulse 82.

March lOlh 7J A. M., pulse 76. S\ A. M., pulse 70. 10
A.M., pulse 80. 11 A. M., pulse 80. 12 M., pulse 82. H
P. M., pulse 76. 2 P.M., pulse 68. 3 P. M., pulse 74. 4)
P. M., pulse 80. 6 P. M., pulse 82. No phosphorus was ad-
ministered to-day.

March 11th No phosphorus was given, but the pulse being
counted at intervals, was found to vary about as it did yester-
day.

March 12th 10 A. M., pulse 76; 100 drops driven. 11 A.
M., pulse 82. 1 P. M., pulse 74. 2 P. M., pulse" 82.

March 13th 8 A. M., pulse 72 ; 2 drops given. 9j A. M.,
pulse 80. 10| A.M., pulse 84; 2 drops given. H P.M.,
pulse 78; 2 drops given. 2\ P. M., pulse SO; 2 drops given.
3 P. M., pulse 78 ? 2 drops g'iven. 4^ P. M . pulse 80.

March 14th 9 A. M , pulse 74 ; 150 drops giren. !U A. M.
puUe71. I2J pulse 84. H P. M.. pulse 80.

March 15th 9 A. M., pulse 72; 200 drops of the saturated
tincture given. 10 A. M.. pulse 72. 11 A. M., pulse 74. the
subject was questioned and examined particularly. There was
no nausea or vomiting; no burning sensation, or feeling of op-
pression in the stomach or epigastric region ; in fact, he says
he feels " very well. ' 1 P. M , pulse 76. A short time before
he took the two hundred drops he ate a hearty breakfast, and
at 2 P. M., with decided relish, a substantial dinner of bacon.
Cabbage, potatoes and corn bread. 4 P. M., pulse 80.

How much further the (Jose might be augmented with safety
and without appreciah/>' effect, I am at present unprepared to
say; but reasons I think will appear as we proceed, that will
render it not very improbable that the quantity of alchohol
rather than any suppositious quantity of phosphorus, the pre-
parations, as prescribed and given may contain, should form the
only necessary limitation of the dose. To be ready for the
press, I must here close my experiments so far as they are to
be used in the present paper, though I shall probably continue
them hereafter.

In my experiments, two methods of administration were
principally pursued. In one, the tincture was dropped into a
glass with water and given to the subject, sometimes before the
entire disengagement of the whitish vapor that rises as the
solution is mixed widi water; and often a part of the vapor
would escape with the first expiration after the dose was swal-
lowed. In the other method, the solution was dropped into a
vial with water; the vial was then corked and shaken, and the
dose poured into a glass when given. These are the two plans

1S54.] Experiments with Phosphorus, fyc. 409

pursued it would seem by those who have used the article here
as a curative agent in pneumonia. The latter seems to be the
one adopted in the prescription given by Dr. Ames in his
paper. The preparation that I at rii^t used in my experiments
I obtained from the Apothecary from whom I am in the habit
principally of procuring medicines for my own use, and who
prepared it at my request; but though 1 had no reason to sup-
pose that the article thus procured was not of good quality, I
subsequently supplied myself with both the diluted and satura-
ted tinctures from the Apothecary who prepared the tinctures
used by Doctor Ames.

As to the effect of the article upon the pulse, others may
judge from the experiments recorded as well as myself. To
me as a sedative it appeared to be entirely null; and this I ap-
prehend will be the ultimate verdict of the profession. From
my previous reading I had been led to expect a stimulant action
from the larger doses, but no appreciable effect of the kind was
observed that was not fairly attributable to another and more
obvious cause than the phosphorus, to wit, the alcohol. This
I think, as the subject is further developed, will not seem at all
strange. In not one single respect was any effect that I could
discover produced by the phosphorus. In no instance was
there either disturbance of the stomach, nausea, vomiting, a
burning sensation or a feeling of oppression at the epigastrium,
though from the quantity of alcohoi alone in the last two doses
taken by Sam, something of the kind might not unreasonably
have been expected. In no instance was there any alteration
in the appearance of the tongue, diminution of appetite, or ap-
preciable alteration or disturbance of the system in any way.
My subjects ate with a good appetite, drank, slept, and in every
respect deported themselves while all their functions appar-
ently were performed as if nothing had been given ; a tempo-
rary alcoholic excitement in the case of Sam after the last two
alone excepted. When my subjects were asked how
they felt after taking a dose, large or small, the answer general-
ly given was. "very well," or * first rate."

It is stated in effect by Doctor Ames, that when the dose of
phosphorus is enlarged beyond a certain point, the sedative in-
fluence is counteracted or prevented by a stimulant action, the
result of the f local inflammation it excites" in the stomach and
bowe's. Now, as nothing of this preventive or counteiacting
character occurred in my cases the sedative action of the
article therefore not being in the slightest degree interfered
wiih, seeing that in the experiments mentioned by Dr. Ames
the pulse was invariably reduced in frequency from eight to
twelve beats in the minute in the course of from an hour to an

410 Experiments with Phosphorus, fyc. [July,

hour and a half by a single dose of two drops of the saturated
tincture to what an extreme state of sedation should my sub-
ject have been depressed who took two hundred (200) drops
of the same at a single dose, and again one hundred drops at
one dose, and two doses of fifty drops each, besides several
smaller doses, making in the aggregate two hundred and seven-
ty-two (272) drops, all in nine hours and a half; while the de-
gree of inflammation of the stomach and bowels that should
have occurred, but did not, is awful, even to think of.

Further, in regard to the stimulant action of these tinctures.
It will be observed, that after the administration of several of
the doses, a slight increase in the frequency of the pulse took
place. Still, the variation does not seem greater, omitting the
doses of the 13th and 17th of March taken by Sam (in which
so obvious a cause for the excitement was present, as in one
instance an ounce, and in the other about half an ounce of al-
cohol,) than on other occasions where the smaller doses were
given, or when it was omitted entirely. If, however, it should
be supposed by any that a stimulant action from phosphorus
was manifested on the occasion referred to, the absence of all
symptoms of the local inflammation of the stomach and bowels,
to which Doctor Ames regards the stimulant action as secon-
dary and consequential, would show that it could not in my
experiments be fairly attributed to any such cause. It would
seem not improbable then, admitting that any stimulant effect
reallv was produced by the phosphorus, that the received ex-
planation of authors of a diffusive operation may be the correct
one. It will not be doubted, however, that phosphorus may be
so administered as to produce a local irritant action upon the
stomach, consequent upon which there would be a febrile re-
action.

Besides the experiments given, I have also taken a good
deal of the article ; indeed, had taken it sometime before I
commenced its administration to Sam. I took it at first for a
while with the occasional omission of a dose on account of ab-
sence from my office on professional business; hut in one in-
stance I took for eight successive days as much as five drops
of the saturated tincture three times a day without the omission
of a single dose, and in no respect did I ever experience any
appreciable effect from its use. Though in every instance I
was careful to drop out the full number intended, of five drops,
I did not regard it as a matter of any importance when a few
drops, say a half a dozen or so, more than that number
happened to escape, but took the dose as if but the intended
number was contained in it.

In connection with this experimental practice upon myself,

1854.] Experiments with Phosphorus, fyc. 411

I will again call attention to the views of Dr. Ames in regard
to the effects of the tinctures of phosphorus and their dose.
Thus he says, speaking of the saturated tincture, that it "can-
not be continued in the smallest quantity just mentioned,"
half a drop " for any great length of time, without inducing
considerable disturbance of the stomach, shown by nausea or
vcmiting, burning heat, and a feeling of oppression at the epi-
gastrium." Though he admits that in the quantity of two drops,
"a single dose, or perhaps a few doses may be given with im-
punity," he would evidently regard any lengthened use of it in
such a dose, as a very grave and serious matter, and tells us of
one instance in which dangerous effects resulted from the ad-
ministration of three doses of two drops each, at intervals of
twenty-four hours. It is most desirable that we should yet be
able to discover and explain the cause of these discrepancies.
While Dr. Ames tells us that doses of half a drop cannot be
continued for any great length of time, without the most serious
results, I have myself taken it in doses of five drops being just
ten times the quantity a long time, and for eight days without
omission of a single dose, without effect. While under his ob-
servation, from a cumulative action, dangerous effects resulted
from three doses of two drops each, administered at intervals
of twenty-four hours, being in all six drops taken in the course
of three days, yet I have taken for eight successive days three
doses of five drops each, or fifteen drops per day, without effect.
Indeed, unless I should discover something in its action, which
has never as yet been manifested in any of my experiments,
from my own experience with the article, and with all the
lights at present before me, I should not hesitate, were it not
for the mere trouble of the thing, to continue it in the same
manner for years.

In the healthy subject at least, any effect of the article re-
sulting in nausea and vomiting, could be easily appreciated,
and not readily mistaken ; yet not only did the subjects of my
experiments take it in doses as mentioned, so immeasurably
greater than the doses with which such effects are said by Doc-
tor Ames to have been produced by it, but they took it under
circumstances that were well calculated to favor the production
of such an operation. Thus, while they sometimes took it in
the middle of the intervals between the meals, they also took it
at times immediately before eating, and at others immediately
after eating. On several occasions I myself having forgotten
my dose, which I usually took just before eating, until I had
partly finished my meal, have called for my vial, taken the dose,
and proceeded with my meal without disrelish or any sub-
sequent manifest effect.

412 Experiments with Phosphorus, c. [July,

A word or two of explanation in reference to the dose re-
commended by Doctor Ames, that I may not be charged with
rashness or temerity on account of the doses given to my sub-
jects, may not be out of place. Jt will be seen that these took
at different times doses of various sizes, from the favorite one
of Doctor Ames half a drop of the diluted tincture up to
two hundred drops of the saturated tincture.

It is supposed by Doctor Ames that the saturated alcoholic
tincture contains four grains to the ounce. The diluted tincture
would in that case contain four grains to ten ounces, or there
would be one grain in two and a half fluid ounces. Doctor
Ames' dose then of half a drop, supposing the drop to be equal
to the minim, would be the one-twent y-four-hundreth (34'00)
part of a grain, there being twelve hundred minims in two and
a half fluid ounces. But the drop is not equal to the minim.
While there are but sixty minims in the fluidrachm Professor
Wood tells us that it takes one hundred and thirty-eight drops
of alcohol to make a fluidrachm it would seem scarcely
probable that the small quantity of phosphorus held in the di-
luted tincture would cause any material variation in the size
of the drop. In sundry trials made by myself in which several
vials were used. I found that the number of drops of the diluted
tincture necessary to make a fluidrachm varied with the shape
of the vial and the thickness of the lip, from 100 to 125. Let
us take, however, the smallest number, though the drops in
that case will be found above the average size. Of these there
would be just two thousand in the two and a half ounces of the
diluted tincture, and each drop therefore would contain the one-
two-thousandth (20\Q) part of a grain, consequently the half
drop dose would contain the ooe-four-thousaqdlh (40,00) part
of a grain ; or there are four thousand of Dr. Ames' doses in a
single grain. The strength of the saturated tincture is ten
times that of the diiuted tincture, consequently my subject who
swallowed two hundred drops of the former at a single dose,
took what was equal to four thousand (4000) of Doctor Ames'
doses of the diluted tincture, and this without any effect.

The above estimates are all based upon the supposition of the
correctness of the assumption of Doctor Ames, that the satura-
ted alcoholic tincture contains in solution 4 grs. of phosphorus to
the ounce, as the etherial tincture it is said does. We are not told
by Doctor Ames whether he has any authority for this opinion,
nor does he speak of any experiments pei formed by himself to
test the solubility of phosphorus in alcohol. It would appear
to be then a mere supposition, that an ounce of the saturated
tincture contains four grains. Without some experimental
tests we cannot feel certain that it may not contain more, or

1854.] Experiments icitli Phosphorus, fyc. 413

that it may not contain less, than the quantity mentioned. Xo
author that I have consulted says anything as to the exact
quantity of phosphorus that any given quantity of alcohol will
dissolve. Many of our very highest authorities on the Materia
Medica do not even speak of an alcoholic solution : and th<
who refer to it at all, at least all that I have consulted, speak
of phosphorus as very insoluble in alcohol as compared with
its solubility in ether.

In the absence then of any definite statements on the subject,
I was led to institute myself a series of experiments with the
view of ascertaining with greater certain! v the solubility of
phosphorus in alcohol. In a vial containing one ounce of an-
hydrous alcohol. I placed four grains of phosphorus, in another
two grains, and in another one grain. At the end of fourteen
days the time usually considered necessary for the preparation
of tinctures by maceration, the time directed bv a majority of
the pharmacopoeias of the four grains., about one-fourth or less
was dissolved ; of the two grains, about one-half or less, and
of the single grain, there still remained a portion undissolved.
On testing these several tinctures by dropping them in water,
they all gave off the white vapors as freely as any of the tinc-
tures supplied to me by the apothecaries. It is fair I think to
say then, that the saturated alcoholic tincture, instead of con-
taining in solution four grains to the ounce, contains in reality
but about one grain to the ounce. It may possibly be a little
more: it would seem as likely to be 'ess. The favorite pre-
paration then of Dr. Ames the diluted tincture would con-
tain one grain to ten ounces. Allowing, as heretofore, one
hundred drops to be equal to sixty minims, or a fluidrachm
and this is a low estimate we have in the ten ounces eight
thousand (8000) drops. Eight thousand drops then of the di-
luted tincture will contain one grain of phosphorus, and one
drop will contain the one-eight-thousandth (,/) part of a
grain. The favorite dose of this tincture with Dr. Ames is
half a drop, and the quantity of phosphorus consequently con-
tained in it is the one-sixteen-thousandlh (16100) part of a
grain.

But it is very probable, even, that not all, indeed that but a
small proportion of the almost inconceivably minute quantity
of phosphorus contained in the dose is received by the patient.
In using the saturated tincture or solution at the moment of
contact between the drop and the water, a quantity of vapor
is given off in the form either of phosphorus as such set free,
or as one of its acids formed in consequence of chemical de-
composition and combination. Possibly this may be the cause
of the apparent nullity of effect in my experiments; and i:

414 Experiments with Phosphorus, fyc. [July,

we are necessarily forced to the supposition of an equal nullity,
from the same cause, in the hands of others, who use the al-
coholic solution suspended in water; and this is the method
pursued by Dr. Ames. Now it does not seem at all improbable,
on the contrary extremely probable, that the action or chemical
change alluded to, attended with a proportionate loss, also takes
place when the diluted tincture is combined with the water,
though the disengaged vapor, on account of the minute quantity
of phosphorus contained, may not be appreciable to the sight.
The alcoholic solution or tincture, it is more than probable
then, is not the best preparation of phosphorus, by which to
secure with any certainty, its full and peculiar operation, what-
ever this may be, upon the system. Lobstein, who seems to
have made the subject of phosphorus something of a hobby,
prefers its administration in the form of etherial tincture, and
tells us that such a preparation u is not decomposed by cold
water," as seems to be the case with the alcoholic tincture.

I have heard it remarked by individuals that certain physi-
cians* (naming them) must be in the habit of using very strong
medicine, for that when they dropped it in water "it fairly
smoked." Had the dropping been conducted in the dark, the
conflagration from which the smoke was given off, might also
have been seen. It would not, therefore, however it is prob-
able, have been believed, that the strength of the medicine was
all smoke vapor but rather that " 'twas spirit Pandemonium,"
at the very least.

Lobstein who from the case to be referred to, there is
grounds to suspect, must have been decidedly something of a
Charlatan once, from his own account, took advantage of one
of the singularities of phosphorus, to operate to an extent
beyond the influence of mere smoke, upon the imaginations of
the persons surrounding a patient that he had been called to
see. A woman fainted. He gave her a few drops of phos-
phoric ether. " In two minutes after," he tells us, "a flame
was observed to proceed from her mouth, which caused all
present to cry out with astonishment. I observed, humorously,"
he goes on, " that she had a devil in her. Nevertheless, I gave
her a second dose, and after a short time she opened her eyes
and exclaimed 'ah, I teel very well!' The bystanders were
so much surprised that they really believed that the "devil had

* With several of the physicians of Montgomery, who are no doubt indebted
principally to Doctor Ames for directing their attention to it, phosphorus, in the
form spoken of in the text, has been for some three or four years past, quite a
favorite remedy in pneumonia, and one to which a remarkable degree of suc-
cess claimed, in the treatment of this disease, is, in a considerable degree,
ascribed by them.

1854.1 Observations on the Human Eye. 415

flown out of her mouth," exorcised, as a matter of course, by
the medicine given.

I have the permission of my friend Doctor Baldwin to say,
that he lias performed a series of experiments somewhat similar
to mine, has even given larger doses and with like success.

In conclusion, I would remark, that though prior to the ex-
periments here recorded, I had taken and given, experimentally,
a good deal of the alcoholic solutions of phosphorus, I have
never, in any instance, given them in a case of acute or
dangerous disease. It would seem to have been truly said,
that " there are more false facte than false theories in medicine."
[New Orleans Med. and Surg. Journal.

Observations on the Human Eye by means of the Speculum
OculL

[The first and second numbers of the Deutsche Klinik (Ber-
lin) for January, 1854, contain an able article by Dr. Oscar
Ssemann, on the Speculum Oculi of Helmholtz, and its appli-
cation to the diagnosis of diseases of the organ of vision. The
first part of this paper is chiefly devoted to a description of the
mechanism of the instrument, the manner of its application,
&c. The second part is that which we present to the readers
of the Monthly, under the above title, h. n. b.]

In order that we may be able to distinguish with our eye the
pathological alterations existing in any organ, it is necessary
that we should be familiar with the appearances which that
organ presents in its normal condition. It becomes necessary,
therefore, that I here give a brief sketch of what we perceive
in the healthy eye by means of the speculum oculi.

If we give the reflector such a position that it sends the
rays of the taper passing through the convex glass into the eye
to be examined by which the dark spot, which corresponds
to that point of the speculum not covered with foil, must fall
directly upon the pupil and look through the transparent por-
tion of the reflector, we see the pupil clearly illuminated. The
degree of its lucidity is, under otherwise equal circumstances
and with a sufficiently dilated pupil, different in different eyes,
and depends upon the greater or less capacity of the back-
ground of the eye to transmit and reflect light. A part of the
rays of light, for example, is reflected by the retina and its
vessels; another part passes through these to the choroidea.
Of this transmitted light, again, one portion is reflected by the
vessels of the choroidea, whilst another is absorbed by the pig-
ment of this membrane, and the remaining portion penetrates
the more transparent parts of the same, to be at last reflected

416 Observations on the Human Eye. [July,

by the sclerotica. The stronger the pigment of the choroidea
is developed, the more the light is absorbed ; the less it can
penetrate, so much the more dimly will appear the illumination
of the pupil: the less the pigment is developed, the more the
light is reflected; so much the clearer will be the pupil. The
color of the light presents all shades, from whitish-yellow to
yellowish, from yellowish-red to the finest rose, which latter
color I observed in an albino. Van Trigt directs attention to
the fact, that the abundance of the choroid pigment is in direct
ratio with that of other tissues, especially the hair ; and that con-
sequently in blonde individuals the pupil appears much clearer
than in individuals with brown or dark hair. If we now apply
to the instrument the concave lens corresponding to the state
of refraction ol both eyes, we perceive, in the back-ground of
the eye, vessels of larger or smaller size, which sometimes
run isolated ly, sometimes so that artery and vein lie together.
The background of the eye itself appears in a reddish light,
which passes to a dark brown when the pigment is very abun-
dant, but shines of a clear rose color when the choroid pigment
is less. The particular parti of the retina also do not appear
equally colored; the color is clearest round about the optic
Tierce, and grows gradually darker towards each side. If we
direct the eye somewhat inwards, it is not difficult, after some
practice, to discover the Papilla nervi optici, which exhibits a
truly splendid appearance. It presents itself generally as a
circular, more rarely as an elliptical, clear white disk, which,
shining like the full moon in a blood-red sky, is more or less
net! ly bounded by the surrounding parts, and at its periphery
is girdled by a dark, often not wholly closed ring of various
breadth. At times, here and there, single dark spots may be
distinguished upon the shining disk, caused by little inequalities
of the papilla. Somewhat inward from its middle point issue
the Artcria and Vena centralis, the first of which is marked by
its clearer red color and smaller circumference, sometimes sin-
gle, sometimes forming a coil. For the most part these vessels
extend upwards and downwards over the papilla, and divide
near its periphery into two or more branches ; but they do not
always take so regular a course, but wind about in all direc-
tions, sending out their twigs over this disk. The artery, as
well as the principal trunk of the vein, exhibit at the summit of
their curve a light streak, which proceeds from the reflected
light, and is not observed in the neighboring venous branches,
because their walls are too little arched, more level. The fal-
ciform line of shade lying inwards from the papilla, which
Helmholtz has always, and Van Trigt never, seen, I have also
at times, but not always, been able to discern.

1854.] Observations on the Human Eye. 417

If we cause the eye of the individnal examined to look di-
rectly at the image of the taper present in the reflector, we
have before us the point of direct vision, the macula lutea.
Helmholtz says it rises less abruptly from the surrounding
parts, has a darker gray-yellow color, and shows no vessels.
According to our observations, however, it is distinguished in
nothing from the rest of the background of the eye, neither by
a different color or a greater want of vessels.

If we examine the normal eye with convex glasses, through
which the eye of the observer is adapted also for the anterior
parts of the same, cornea, iris, lens, corpus vitreum, we see the
magnified pupil shine with uniform clearness.

After this short description of that which we perceive by
means of our instrument in the normal eye. I proceed to the
observations which we have made upon the diseased eye.

Diseases of the Lens. The most frequent diseases of the
lens are opacities, cataractoe. When the opacity is far ad-
vanced, and its color a clear gray, there is no difficulty in t he
diagnosis: but the cognizance of opacities in their first com-
mencement is extremely difficult, and the difficulty is increased
from the fact that in elderly persons generally the pupil does
not appear of a pure black. But, by the aid of the speculum
it is possible to detect even the slightest opacities of the lens
and its capsule, since the latter are very accurately defined
when the background of the eye is illuminated, and we examine
through a convex lens of 3 6" focal distance.

We have observed commencing opacities of the lens, which
were wholly inaccessible to observation according to the ordi-
nary methods of examination, in 24 individuals eight of whom
had a perfectly normal vision, and were examined only experi-
ment! causa, the rest suffering from disturbed or extinguished
vision, which had its origin, however, in other diseases of the
eye.

The most frequent opacity was that of a nucleiform cataract
(Kernstaar,) and was absent in only three of these 24 individuals.
Upon application of a convex lens, No. 3, it was seen in all gra-
dations of size, from the smallest point to a deep black disk of
nearly V" in diameter, and was always conformable, no single
dark atoms being distinguished as composing the opacity. Its
periphery was mostly circular, in two cases elliptic, with the
greater diameter running obliquely; also dentate, stellate. It
occurred in 20 cases bilaterally, and had but rarely reached
the same stage of development in both eyes. This deeply
dark disk was sometimes surrounded by gray, irregularly
formed specks, which, in one young lady, represented a

418 Observations on the Human Eye. [July,

second circular concentric disk in both eyes: in other cases
by a large number of dark points of various size, but which
never equalled the nucleiform cataract, and were sometimes
very irregularly placed, sometimes appearing, more or less
clearly, as a concentric layer, sometimes as a vincular, or
as a stellar stratum. We saw these dark points, also, in
those three individuals in whom the nucleiform cataract was
wanting. In seven cases an opacity was seen at the outer
border of the lens, which twice was encircled by a ring ac-
curately defined and circular within, once by two concentric
rings, separated from one another by a clear line, and consist-
ing of thickly crowded points, while four times dentations
were sent out towards the middle of the lens, by which
the existing nucleiform cataract was rendered dentate or
stellate.

The examination of more perfectly developed opacities of
the lens, which may be already diagnosticated by the mere
Bight, slmws that such cataracts always have a greater circum-
ference than one would suppose from an exterior view. Here
the speculum can accomplish something in the determination
of the time at which the cataract will attain sufficient maturity
for operation, since we have, in the visible progress of the opa-
city, a sure guide independent of the self-delusions of patients.
In the examination ol such strongly developed opacities of the
lens, at times a deep black figure appears to us, which consists
of three radii proceeding from the pole of the lens, growing
smaller towards the equator; their direction corresponds ex-
actly to the meridian lines, and there is no doubt that we have
to do in such cases with the cleaving of these, often observed
in cataractous lenses. Since the meridians of the anterior and
posterior hemispheres of the lens have an opposite course, so
we can easily determine from the course of these dark radii in
which hemisphere the cleaving has taken place.

For the exact history of the development of cataracts, the
speculum will be of the greatest use. Already it is proved' with
greater certainty that most opacities of the lens, taking their
origin in the nucleus, extend in a centrifugal direction. This
centrifugal extension is at times met by a second opacity, be-
ginning at the border of the lens, and progressing in a centrifu-
gal direction ; but the latter is exceedingly rare. The opacities
of the lens are composed of single dark atoms, which increase
in number, become thickly crowded together, and at last con-
glomerate to a conformable mass. This conglomeration often
proceeds with a certain regularity, and two special forms of it
may be observed, namely, either these dark atoms unite to
form concentric rings, or radiate lines. Only the opacity of

1854.] Observations on the Human Eye. 419

the nucleus of the lens has appeared to us, hitherto, always
conformable ; probably the cause of this lies in the denser strati-
fication of the fibres which exist in the nucleus, and the want
of abundant uniting tissue. If the speculum enables us on the
one hand to recognize the least beginnings of the cataract
formation, so also, on the other hand, it often teaches us
that there is no opacity of the lens existing, when, from the
mere sight, we should conclude that such was the fact. The
pupil, especially in older persons, is not a pure black ; it appears
gray-yellow, whitish-yellow. Several cases have occurred to
me, in which physicians had declared to eye-patients that
they had a cataract, and might be eventually cured by
operation, when the speculum proved that there was absolutely
no opacity of the lens existing, and that the disturbance of
vision was dependant upon a very different lesion of the eye.

Diseases of the Corpus Vitreum. The circumstance that
the vitreous body is almost completely withdrawn from ob-
servation, without illumination of the background of the eye,
had made the diagnosis of its diseased conditions impossible.
The disturbances of vision dependant upon this body, on account
of the want of all externally perceptible alterations, were re-
ferred to lesions of the retina, and placed in the Augean stable
of amblyopia and amaurosis. The speculum now teaches us,
that diseases of the vitreous body, especially obscurities of the
same, occur no more rarely than in the lens. These obscurities
are of a twofold character: either the vitreous body loses its
natural transparency, the capacity to transmit rays of light
to the retina, in which case, by the application of a convex
lens, No. 6, the background of the eye appears wholly or in a
greater part very dimly illuminated, and the retina-objects to
be found behind the obscured spots, as well as the vessels and
papilla of the optic nerve, are either not at all or only very in-
determinately made visible by the concave lens; or black cor-
puscles are found floating in this body.

The first, from the analogy of opacities of the lens, we must
consider as true obscurations of the vitreous body ; they appear
to us like cloudy opacities, which have a diffused extent, and
almost always involved the greater part of the vitreous body.
In sixteen individuals, six of whom were completely blind, and
the rest all suffering from important disturbances of vision, we
diagnosticated this diffuse obscuration, since the retina-objects
could not be perceived by any concave lens, and the back-
ground of the eye appeared dim, as if washed away. A con-
founding with opacities of the lens could not occur here, since
cataracts, which so materially obstruct the vision, could scarcely

420 Observations on the Human Eye. [}u\y,

escape an exterior view, to say nothing of the examination by
the speculum. Besides, in five cases there were simultaneously

slight opacities of the lens, which, however, appeared as small
points, and could by no means explain the above symptoms.
The conclusion may be drawn, that obscurations of the vitreous
body of relatively slight intensity produce serious injury to
vision, whilst cataractous lenses, which show exteriorly a
tolerably intensive gray color, often allow the patient the read-
ing of coarser prints.

Still more frequently than these obscurations, we observe
those dark floating corpuscles in the vitreous body, which are set
in lively motion by the slightest oscillations of the globe of the
eye, and cross before the clear, shining pupil in the most dif-
ferent directions. These corpuscles present the most manifold
forms; sometimes they resemble small coiled serpents, some-
times polyhedric cells, sometimes long, irregularly formed
ila, sometimes they appear as innumerable floating points.
We observed, also, the most various forms in the same eye,
and, indeed, sometimes in such great number, that the vitreous
body, after a movement of the globe, appeared like dirty swamp
water. When the globe returned to rest, these corpuscles
sank to the bottom from the force of gravitation. We made
this observation upon 26 individuals; four of them had normal
sight ; the most, however, complained to us of their own ac-
cord that they saw dark bodies floating in the air, and the
description which they gave of their form frequently agreed
very exactly with that observed through the speculum. They
were often very short-sighted, so that they required acute con-
cave spectacles. The vessels of the retina and choroidea were
mostly clearly visible, nevertheless, we were obliged to use
strong concave glasses, which corresponded well with the near-
ness of vision.

Concerning the nature of these corpuscles, nothing definite
can be said ; pathological anatomy and microscopy must fur-
nish an explanation of them. We have not, hitherto, detected
in them a spontaneous motion, so that we cannot at least con-
sider them living entozoa. They may, indeed, often be blood
or exudation coagula; and the circumstance that in two cases
we found a tolerably extensive extravasation of blood upon the
retina, favors this view in some measure. From their exterior
form, we might often also be led to consider them as cells ; but
it would be remarkable that such cells should remain so many
months in the same stage of development. Perhaps they are
many times residua of the lameliae of the vitreous body,
which, according to Bowman, exist in early life, and later are
broken up.

1854.] Observations on the Human Eye. 421

The frequent, manifestly swift movement of these corpuscles
in the substance of the vitreous body, which, according to
Kolliker's latest investigations, consists, in adults, of a more or
less consistent mucus, permits us, nevertheless, to decide upon
the fluidification of this body with some certainty, which ac-
cords also with the short-sightedness of such patients so fre-
quently observed by us. Fluidification of the vitreous body
makes its coefficients of refraction smaller ; but this is not suffi-
cient to explain the frequent high degree of nearness of vision,
if we do not admit that through this means the diameters of
incurvation of the refracting media are altered. In one man,
who complained that upon motion of the eye he saw small,
clear, shining corpuscles floating about in the air, I observed
in the vitreous body little glittering points, visible sometimes
here, sometimes there, which disappeared upon rest of the
globe. Could they have been crystals of cholesterine?

Diseases of the Retina and Choroidea. The background
of the eye appears to us, as we have already described above,
as afield of vision shining with a reddish light, intercrossed by
larger superficial vessels of the retina sending out single smaller
branches, and by a deeper lying convolute of smaller vessels
of the choroidea, upon which the Papilla nervi optici is ac-
curately delineated through its intense brightness and the cen-
tral vessels so clearly visible upon it. The truly surprising
clearness with which all this is seen, did not allow Helmholtz
to doubt that vascular distentions, varicosities, exudations be-
fore the retina, in its substance, and between the retina and
choroidea, would be easily recognized. The observations
hitherto made public have dispelled every doubt; and we also
have not rarely observed pathological processes of the retina
and choroidea. If we have not been able hitherto to recognize
all visible abnormities in their true essence, if we even overlook
much which is abnormal, nevertheless, we can already assert
that a large number of amauroses, which have heretofore been
considered as neuroses, depend upon visible textural alterations
of the retina and choroidea.

Most frequently we have observed distention of the vessels
of the retina, by which their main trunks appeared enlarged,
sent out many branchlets not formerly visible, and the whole
background of the eye appeared of an unusually intense red
color. It is true, that the size of the vessels, the number of
their branchlets, the color of the background, are very different
in different men, and, therefore, error is very easy ; but the
correctness of the diagnosis is favored on the one hand by the
subjective symptoms, the pain in the eye and frontal region,

N. 8. vol. x. NO. VII. 27

422 Observations on the Human Eye. [J uly,

the feeling of unusual fulness in the eye ; on the other hand, by
the frequent favorable result of treatment by the abstraction of
blood.

The true inflammation of the retina with exudation seems
also not to be rare. The spots covered with exudation appear,
sometimes, whitish, reflecting the light strongly ; sometimes
reddish; sometimes they have a more greenish tint, and when
of greater extent, are surrounded by an irregular dark border ;
sometimes, especially upon the papilla, they appear as dark
specks. The exudation-mass, for the most part, encloses the
vessels of the retina in such a manner that they become com-
pletely invisible, or at least appear only very dimly as white-
red, not well defined marks. Only twice have I seen tolerably
clearly the vessels of the retina running over the exudation-
mass. In one case, already alluded to above, in which the ves-
sels of the retina were surrounded by a reddish exudation, we
observed simultaneously in the vitreous body those coagula-like
corpuscles, which probably had become loosened from the floor
of the retina, and floated free in the vitreous body.

Injuries of the retina and its vessels from external violence
very rarely occur, and are then mostly connected with such
important lesions of the whole bulb, that examination with the
speculum can furnish no results; it may also happen that a
cataract needle in unskilful hands, or the lens dislocated by ity
injure the retina. We have not observed cases of this kind.
Van Trigt has wounded the internal eye of cats, dogs, and
other canines, with needles, and in this manner made highly
interesting observations upon the results of these injuries and
the cicatrization of the wounds. On the other hand, we have
observed a case of spontaneous rupture of the central vessel,
which I may be allowed to report in detail.

A man, 55 years of age, plethoric, was suddenly seized with
giddiness, and sank into unconsciousness. As he aroused from
this condition after an hour, he was blind in his right eye, which
before was perfectly normal. The physician called first, made
a venesection, and otherwise conducted the treatment lege
artis. Upon the fifth day after this mishap, he came to my
office to consult me on account of his eye. The pupil of the
right eye was more strongly dilated than that of the norma}
left eye; both had a yellowish grey mucus, otherwise nothing
abnormal exteriorly. The examination with the speculum
gave the following result : the papilla nervi optici was ac-
curately bounded on the outer side, nevertheless even here
was more dimly illuminated than usual ; at the inner and in-
ferior side it was covered with a red blood-coagulum. From
the upper border descended a vessel, which,, irregularly den-

1854.] Observations on the Human Eye. 423

tated, terminated free ; all the other vessels of the papilla
were covered wilh the coagulum. Otherwise all is normal.
There could be no doubt that here a laceration of the central
vessel had taken place at the point where it issues from the
porus nervi optici. Ten days later, the coagulum, now of a
less dark red, was still visible only at the inner border ; all the
rest of the papilla was of a greenish color, with occasional
clear spots interspersed; out of its midst was now seen passing
downwards a rose-colored, not well defined line, which glim-
mered but dimly, and at its superior border vessels were dis-
tinguished which represented two arches. In the vitreous body
floated single dark specks. The power of vision continued
totally extinguished.

Morbid dilatation of the vascular walls we have never ob-
served except in veins, which thenappeared like dark, undulatory
or spiral cords running over the field of vision. We never
found them upon the papilla.

in a young man, who saw objects perfectly clearly only in
a bright sunlight, but recognized them very imperfectly with a
cloudy heaven, at evening, and by lamplight, we found the reti-
na covered round about [he papilla, here and there, with black
specks; the papilla itself likewise contained several dark specks,
but appearing less black, and less accurately circumscribed.
Otherwise nothing ahnormal. The supposition that here a
pigment-transudation had taken place, sufficiently explains the
perfectly normal perceptibility of the patient existing only in
an intense light.

In conclusion, I will make mention of one other case, in
which the speculum showed us, with tolerable certainty, that
a lesion of the optic nerve itself was the cause of the blindness.

F. S., 11 years of age, with brown hair, brown -yellow iris,
and very dilated pupils, was born amaurotic in the left eye;
the right eye normal. The left ocular globe is a little smaller
than the right, and sits deeper in the orbit. The pap ilia nervi
optici appears as an unusually small elliptic disk whose lesser
horizontal diameter is about half as large as the great perpen-
dicular diameter ; the arteria and vena centralis give off as
usual two branches, but very fine, and besides the branchlet
passing inwards, a second is also here visible running outwards ;
the macula lutea and the rest of the background of the eve
present nothing abnormal. By means of a concave lens. No. 3,
we discovered a central punctiform opacity of the lens. The
right papilla is circular and quite large. While here, on the
one hand, the circumstance that the amaurosis of the left eve
was congenital, and on the other the obstructed development
of the bulb warranted us in concluding upon an analogous con-

424 Observations on the Human Eye. [July,

dition of the optic nerve, so also the examination with the
speculum confirmed this diagnosis.

Sanguinous distention of the choroidal vessels is a very fre-
quent phenomenon, which is characterized by abnormal size
and intensive dark color of the choroidal veins. We have also
observed, in many cases, genuine choroiditis with secretion of
the exudation-mass. When the exudation is deposited in small
circumscribed spots, the background of the eye appears uneven,
and reflects the light from those spots stronger than from others ;
if the exudation has a greater extent, the retina becomes mostly
separated, as it were, at the point of entrance of the optic
nerve, and projects like a large eminence, whilst it crowds the
corpus vitreum out of its position ; such an eye has then lost
the normal relation of internal parts, and the vessels coursing
upon the hill-like tumor may be seen by mere illumination from
the mirror without the application of a concave lens. Since
such extensive exudations are mostly serous, of a fluid nature,
so the retina, together with the vessels, may be seen floating
after a movement of the globe. Ruptures of the retina from
exudations crowding upon it from behind, in consequence of
which it floats about freely in the exudation and disorganized
vitreous body, we have not observed. In one case of choro-
iditis, which had had its seat more in the region of the ova
serrata, we found the following. If we looked through a
convex glass, No. 6, in the direction of the axis of the eye, the
pupil being nearly normally illuminated, a dark body appeared
at the lower border of the papilla, which was bounded above
by three convexities, and floated hither and thither upon motion
of the bulb, without leaving the border of the iris; si-
multaneously there appeared several other dark dentations,
also black coagula-like corpuscles floating free. If we looked
inward, the eye being directed inferiorly, we saw behind this
dark body a yellowish green exudation-mass projecting inwards
deep into the eye, which formed several strata lying behind
one another, representing mountains as viewed from a distance.
Through a concave lens we beheld, in the very depth of the
eye, other well defined black specks ; but the vessels were seen
only very imperfectly with the eye directed strongly upwards.
The exudation, in this case, penetrated the vitreous body.

If we now review the truly surprising results which the
speculum oculi has furnished us in so short a time, we can not
only concur in the expectation cherished by the highly esteemed
inventor, that all the alterations of the transparent media, the
retina, and choroidea, found in the corpse, will also be recog-
nised in the living eye ; but also assert, with safety, that it will
be possible for us now to pursue with exactitude the progressive

1854.] Medical Treatment of Cataract. 425

development of the pathological processes of these structures,
as well as their recession, whether effected by nature or not.
The advantages which will be derived by the practising
physician, irrespective of the cure of these diseases, we have
not hitherto considered ; but one thing is certain, that an exact
knowledge of the diseased objects must be the basis of a
rational therapia : without this knowledge w7e grope in the dark.
We shall not be able to cure all diseases, even in this manner;
but the physician gains a great advantage thereby, when, from
his knowledge of their incurability, he holds himself aloof from
fruitless, perhaps injurious, attempts to cure. [Amer. Med.
Monthly.

On the Medical Treatment of Cataract. By Dr. Garcia Lopez.

The majority of surgeons consider the cure of cataract with-
out an operation a chimera. And yet it is impossible to deny
that cataract is sometimes spontaneously cured. Is it, then,
impossible that therapeutics may some day realize what nature
occasionally accomplishes by herself? This question is often
asked by unprofessional persons. Medical men have uniformly
denied the possibility of the cure of complete lenticular cata-
ract by medical treatment, while impudent and shameless
charlatans have industriously propagated the opposite opinion
among all classes of society. In the clinical reports of Dr.
Beauvais* are recorded five homoeopathic cures of cataract,
one of which, treated by Dr. Caspari, was evidently a case of
corneal opacity depending on trichiasis. The offending cilia
were removed surgically, the patient took one drop of cannabis
daily, and recovered entirely.

In the work of Tavignot the reader will find an account of
the experiments of Professor Pugliatti, of Messina, on the cura-
bility of capsular or capsulo-lenticular cataracts without an
operation. This surgeon supposes that a strong solution of
ammonia, applied at the internal orbital angle, penetrates the
tissues of the eye, and exerts a curative effect upon the opaque
crystalline system. He combines with this treatment the ad-
ministration of five grains of iodide of potassium daily. He
reports several cases which were benefitted, and one or two
which were supposed to be cured by this means. In every
case the treatment lasted many months. In the majority o'f
cases no amelioration was perceived. In the Spanish Journal
ElPorvenir Medico, for December, 1853, we find four cases in
support of the efficacy of the treatment of Pugliatti, reported by
* Annales d'Oeulistique, tom.ii., p. 218.

Medical Treatment of Cataract. [July,

the author, whose name we have placed at the head of this arti-
. Garcia Lopez :

1 Araan of -early complete capsular cataract

had existed for three months: vesication with ammonia, with-
out any internal treatment, procured resolution in two mon'.hs.
I A man of thirty iated, lenticular cataract, two years

old: capsule healthy. After six weeks of treatment the patient
demanded an operation. Dr. Lopez found the lens diffluent
and lactescent. 3. A woman of forty : hard, incomplete cap-
sulo lenticular cataract in both eyes, developed within a year.
She could only distinguish ve: objects. After seven

months of treatment the patient recovered her vision, and
could sew and follow her usual avocations; the opacity had
disappeared except in a limited central point. 4. A woman of
: capsulo-lenticular cataract had existed for three years
on th Tiilar opacity was forming in the left

complicated with amblyopia. In six months, after the
constant employment of ammoniacal vesication and iodide of
a decided amelioration took place in the left eve ;
the - unaffected.

Dr. Lopez reports th hout any desire to attach

nndue weight to them, and can hardly be supposed to be pre-
ed in behalf of a method which he did not originate.

There is another remedy to which much consequence is

attached, to which Dr. Lopez does not allude, we refer to the

iodine ointment allowed to dissolve on the conjunctiva. The

r of the Paris Gazette hebdomad air t% (De

f double capsulo-lenticular cataract cured by this method.

In a succeeding article we have given a fall account of ihe
mode of treatment of cataract depending on capsulitis. The
reports of the Medico-Chirurgical Society of Richmond, con-
tained in the present number of the Journal, contain the histo-
ries of two cases of traumatic cataract, and one of supposed
congenital cataract, in which the advantages of a free use of
mercury in opacities of the crystalline system connected with
inflammatory action are strikingly exemplified.

In all such cases, and in immature cataracts, no harm can
:rom instituting medical treatment during a period which
would be otherwise lost in awaiting the opportune moment for
an operation. It must be confessed, however, that Lebert's
researches into the structure of cataract demonstrate that in
the great majority of cases medical treatment must be unavail-
R jnetta was of the opinion that an absolute denial of
the efficacy of remedies in cataract was unwise ; we concur in
this sentiment, and trust that farther researches will be made
in this interesting and obscure subject. [Virginia Med. and
Surg. Journal.

1854.] Value of Phosphate of Lime in Nutrition. 427

On Insufficient Alimentation, and the Value of Phosphate of
Lime in Nutrition.

In the Bulletin de VAcademie Imperiale de Medecine, for
January, 1S54, we find a report by fi Bouchardat, on the re-
searches of a young and learned chemist. M. Mouries in regard
to the effects of phosphate of lime in the nutrition of animals,
and the influence which the judicious employment of this salt
is capable of exercising upon the mortality of children in large
cities.

It has been a comparatively short period since physiologists
began to appreciate properly the importance of inorganic prin-
ciples in the phenomena of life. The farther we penetrate into
this complex problem, the greater is the importance attributed
to bodies, the presence of which in the human organism was
regarded as quite accidental.

Very dissimilar organic compounds may be substituted for
each other in our diet without any disorder in the general har-
mony, but the inorganic principles can only be replaced by sub-
stances very closely analogous to them. Albumen, fibrin, and
casein, and other more complex aliments, though differing in
origin and composition, may fulfil the same physiological end,
but it is different with inorganic principles. Lecanu has shown
that iron is indispensable for the proper constitution of blood-
globules ; chloride of sodium is of primary importance also as
a constituent of the liquor sanguinis, and it is only as an excep-
tion that we find, in certain gramnivora, this salt partially re-
placed by the phosphate of soda or of potash. Liebig has
shown that the chloride of potassium of the muscles cannot be
replaced by chloride of sodium. Each inorganic constituent
of the organism has, therefore, its definite and limited sphere
of action, to which it is exclusively adapted.

Among the indispensable inorganic salts, the phosphate of
lime holds an important rank. M. Mouries has devoted him-
self to the elucidation of its peculiar action. He deduces from
his experiments the following conclusions:

1. Phosphate of lime plays a more important part in nutrition
than lias heretofore been believed. Independently of its neces-
sity as a constituent of bone, this salt maintains that irritability
without which there is no assimilation, and consequent!;- no
nutrition. Its insufficiency, therefore, produces death with all
the symptoms of inanition, while its insufficiency in a less de-
gree, produces a series of lymphatic diseases.

2. The food consumed in cities is deficient in this respect
Nurses' milk has, consequently, the same defect. The infant
as well as the foetus suffers from the deprivation of this element

428 Value of Phosphate of Lime in Nutrition. [July,

so indispensable to its development and life. Hence one of the
causes of the increase in the number of still-born children,
and of the mortality of infancy.

3. The addition of this salt, in combination with animal mat-
ter, to alimentary substances, obviates one cause of disease
and death.

The following are the principal facts on which M. Mouries
relies to establish these conclusions:

The blood of animals contains a constant proportion of earthy
phosphates, which is independent of their ingesta. The pigeon
ingests phosphate of lime slightly in excess, in the grain and cal-
carious gravels which it picks up ; the horse swallows an ex-
cess, in its fodder ; the dog procures a still greater excess from
the bones on which he is fed ; and yet the blood of the pigeon
contains in 1000 grammes 1.20 of phosphate of lime ; the horse
0.5; the dog 0.4. This result is not accidental ; all birds whose
blood has been analyzed have 1.5 to 1.2 of phosphate of lime,
while the proportion in the blood of the carnivora and herbivo-
ra varies from 0.9 to 0.4. The proportion thus regulated by
nature, is modified by age and sex. The bull, cow, and calf,
have the same food, yet their blood contains respectively 0.5,
0.9, 0.8 of phosphate of lime.

The requisite proportion of alkaline phosphates varies, there-
fore, in different animals. A pigeon weighing one pound died
at the end of ten months, during which period he was fed daily
on one ounce of wheat, with common water for a drink, by
which rather more than a grain of phosphate of lime was in-
gested daily: on the other hand, a woman weighing 100 pounds
enjoyed perfect health upon a diet which furnished her daily
with 90 grains of phosphate of lime. Thus health in the one
case, and death in the other, with relatively equal quantities of
this salt.

We shall recur to this example to show how complex are the
conditions of these experiments, and what reserve is necessary
in drawing conclusions from them.

M. Mouries asserts, and the fact has already been noted by
Chossat, that if the proportion of alkaline phosphates of the
food is deficient, there ensues atony of the digestive organs,
imperfect assimilation, and death. To prove that pigeons die
from want of phosphate of lime, we may observe that their
death is hastened if they are allowed only distilled water, while
their lives may be preserved by adding earthy phosphates to
their food.

M. Bouchardat observed that the grain on which MM. Mou-
ries and Chossat fed their pigeons contained only traces of
common salt. The birds, therefore, should be expected to suf-

1854.] Value of Phosphate of Lime in Nutrition.

429

fer from the deprivation of this principle. M. Bouchardat
accordingly made this experiment ; he confined two pigeons,
and fed them on dried grain. In two months the health of the
female became impaired : she suffered from thirst and diarrhoea
and laid no more eggs. She was set at liberty. She flew im-
mediately to a window-sill impregnated with alkaline chlorides,
and began to peck eagerly; there was a larger quantity of salts
on the interior of the window-frame ; the pigeon entered
through the open window, and permitted herself to be re-cap-
tured, so imperious was her demand for these principles. Her
health was re-established ; in three days she laid another egg.
It is wrong, therefore, to conclude with M. Mouries that a de-
ficiency of phosphates is the only cause of the symptoms he
observed ; in this case the absence of chlorides was the obvious
cause.

M. Mouries has established, by interesting calculations, that
grain furnishes a sufficient supply of phosphate of lime for the
reparation of bone, but not for other essential functions of the
economy. From the curious fact that there is a constant pro-
portion between the temperature of animals, and the amount
of phosphate of lime contained in their blood, he deduces the
principle that this salt keeps up animal irritability, without
which nutrition is impossible. The following table must in-
terest physiologists :

PHOSPHATE OF LIME.

TEMPERATURE

M

ouries. Poggiale.

QDC

I of the duck, - -

.

1.50

425 cent.

u

" the hen, - -

.

1.35 1.25

415 "

u

" the pigeon, - -

- -

1.20 1.23

40 "

<(

11 man, -

.

0.80 0.6

375 "

'i

" the horse, -

.

0.40 0.5

368 "

u

" frogs, - -

.

a trace.

9 "

If these results are confirmed, it will appear that the inges-
tion of phosphate of lime is not only indispensable for the
reparation of bone, but that it is connected with the function of
calorification.

In the second portion of his memoir, M. Mouries, starting
from the principle demonstrated by Chossat, verified by Bous-
singault, taught by Berard, and now admitted by all physiolo-
gists, that diet is defective which does not contain enough
phosphate of lime to repair the waste which is continually going
on in the economy, attempts to prove that the food commonly
consumed in cities does not contain the quantity of this salt
which is required by nurses and pregnant women.

He commences by calculating the quantity of phosphate of
lime which ought to be ingested in the twenty-four hours, which

430 Therapeutical Value of Ox Gall. [July,

he estimates from analyses of the excreta at 110 grains. He
then attempts to show that this quantity is not contained in the
food of nurses in cities. The urine of women in the country
contains 90 grains of phosphate of lime in the twenty-four
hours, while the amouut of this salt in the urine of women in
cities varies from 20 to 90 grains. M. Mouries has sought to
confirm his hypothesis by direct proofs; he has examined the
food consumed in cities, and shown that it exhibits a deficiency
of one half in alkaline phosphates. He has examined the milk
of nurses, and shown that in 18 healthy country women the
proportion of earthy phosphates in the milk varied from 1.2 to
2.4 per cent., while in the milk of 10 Paris nurses the propor-
tion varied from 0.5 to 0.9, and in 7 others there was only a
trace of phosphate of lime.

In the third portion of his essav, M. Mouries adduces clinical
facts in illustration of the advantage of supplying this deficien-
cy of phosphate of lime in aliments. In 13 cases, in which the
proportion of phosphate of lime averaged 0.7, 75 grains of this
salt with twice that quantity of albumen was daily administered
in soup; in a week the proportion of earthy phosphates in the
milk rose to 2.1. In 5 cases pregnant women were subjected
to the same treatment; the milk, after delivery, contained 1.9
to 2.1 of phosphate of lime. Only 3 of the 18 children died.

These results though insufficient to determine such a serious
question, are yet very worthy of attention. In the debate to
which they gave rise, M. Gibert vehemently condemned the pre-
sent tendency of chemists to interfere in medical inquiry. The
question of lactation was a medical one, he said, and was only
to be solved by clinical observation. M. Bouchardat, on the
other hand, feared only ignorance, and was not alarmed at the
application of chemistry to medicines, especially when its re-
sults were as inoffensive as those he had discussed. [Ibid.

[From the New-Hampshire Journal of Medicine.]
Therapeutical Value of Ox Gall.

Mr. Editor: In the Journal for January a treatise on the
medical virtues of Ox Gall met my eye; I can indorse every
idea there advanced, and more; I have been in the frequent
use of the article for quite a number of years, as an injection
in constipation, taken in pills in a dried preparation, and in a
fluid state to arrest spontaneous emesis. It is an anti-emetic
of much power, and entirely safe. A little anecdote occurs to
my mind which took place in this vicinity some twenty years
since.

A man of small intellect, and less cultivation, had a receipt

1854.] Sciatica.

for preparing a strengthening plaster, and some other medicated
preparations; of course was dubbed Doctor; he was a mem-
ber of the Baptist church, the pastor of wrhich was attacked
with spontaneous emesis, which was not promptly arrested;
some brother named Dr. Green ; he had done great things in
this way ; a messenger was sent eight miles to inquire for his
remedy ; he had promised never to divulge, but he would go
and see the man ; arriving, he called for a hen, secludes him-
self, removes the liver, punctures the gall bladder, takes the
bile and gives it to the patient, the vomiting is arrested, and the
church enamored. They would have conferred on him M. D.,
had it been in their power. If my memory serves me he was
canonized.

This article is here much used by the inhabitants in domestic
practice, as a specific in most diseases. I recently listened to
praises of a butcher touching gall. He recommended that of
the hog as being far preferable to any other. I thought there
might be some truth in the remark, for it must be admitted,
the lords of creation resemble that animal more than any
other.

In cases of convalescence, where the liver is torpid, the pa-
tient does not improve, has no appetite, how many of us have
been benefitted, or at least our patients, by a recipe in a book
on the liver by Dr. Saunders consisting of soap, rhubarb,
quassia, gin, &c, but gall is far preferable ; use this until
the liver resumes its healthy function.

I will insert a recipe, for a preparation of gall which I
have used many years as a carminative in the griping and
flatulence of infants, and to arrest emesis in adults.

$. Essence of anise, iij., essence of cinnamon, ij., mix
thoroughly; to the* above add iv. ox gall, mix well by
agitation.

One drop of this for an infant in some herb tea (from a drop
to a teaspoonful, according to age.)

In order to preserve gall pure, I put in a two quart bottle,
O.ss. strong alcohol, carry my bottle to the butcher and request
him to fill it. I keep it in the cellar. It will keep good for
years. Ariel Huston.

Hyde Park, Vty, 27th Feb., 1854.

Sciatica.

Mr. Hancock read a paper on the causes and treatment of
Sciatica before the Medical Society of London, Feb. 28, (Med.
Times and Gaz.,) of which the following is an abstract: He
alluded to the various causes assigned as producing sciatica

432 Sciatica. [July,

viz., disorder of the stomach and bowels, inflammation and dis-
ease of the sciatic nerves, syphilis, gout, obstruction and dis-
tension of the caput coli, tumors, or accumulated faeces in the
course of the nerve, effusion of fluid into the sheath of the
nerve, irritation and disordered state of the kidneys, and
rheumatism, either acute or subacute ; but that from the cases
which had fallen under his observation, the prevailing opinion
appeared to be that sciatica depends mostly upon rheumatism
an opinion which he considered erroneous, as having had ample
opportunities of arriving at a conclusion, he felt convinced that
the cause most productive of the complaint was irritation within
the pelvis, either from loaded colon or caecum, or from tumors
formed within that cavity, or, as had been suggested to him by
his friend and colleague, Mr. Goldsboro, by the haemorrhoidal
vein, which, forming a complicated plexus over the sacral plexus
of nerves, would, when congested and engorged, cause undue
pressure and irritation of the nerve; that although he would
not presume to assert, in opposition to the high authorities who
differed from him, that the disease never depended upon rheu-
matism, still he maintained that it so seldom did so, as to con-
stitute the exception to the general rule, and not the rule itself.
Mr. Hancock then enumerated some of the modes of treat-
ment, recommended such as bleeding, cupping, calomel and
opium, colchicum, quinine, carbonate of iron, Indian hemp,
acupuncture, actual cautery, blisters, moxas, puncturing the
limb, and introducing morphia and creosote into punctures.
He did not consider the disease difficult of cure; on the con-
trary, he had found it readily and speedily yield to the reme-
dies he had adopted, which consisted in thoroughly purging
the patient with small doses of croton-oil, combined with blue
pill, henbane, and compound extract of colocynth, and re-
moving the sensation of bruising in the course of the nerve
by sulphate of quinine, in doses of three grains thrice daily.
He had commonly given croton-oil, because he had found it
useful and convenient, but he did not attach any specific in-
fluence to this medicine, as he had found equally good results
from turpentine and castor-oil, the aloetic purgatives ; and he
considered that any medicine acting upon the lower intestines
would be of service. He did not consider local applications
at all necessary, but that they were frequently injurious, by
adding to the patient's sufferings. He narrated five cases
which had fallen under his care, having been previously treated
for rheumatism by the remedies appropriate for the affection,
but without success. In one the sciatica had existed for nearly
two years; in another, for above twelve months; and in the
remainder, from four to two months. The most obstinate of

1854.] Upon Filtration of the Air, $c.

these was cured in three weeks, and the remainder in a fort-
night, the latter period being that usually required. He conld
give many more cases of a similar character, but he thought
those he had described were sufficient to prove the validity of
his position, that in a vast majority of instances the disease
did not depend upon rheumatism, but upon the cau>es which
he had already alluded to ; and he directed the attention of the
Society to an interesting fact, which he had not found noticed
elsewhere namely, that sciatica almost always occurred on
the right, and very seldom indeed on the left, side of the body ;
and when it did, he believed it was caused by impaction in the
sigmoid flexure of the colon. In the majority of cases the af-
fection commenced with stiffness, weight, and pain in the lum-
bar region, resembling lumbago. He was inclined to attach
some importance to this fact, as affording a means of diagnosis
between those cases depending upon loaded intestine and those
resulting from tumor in the pelvis ; and that where this symp-
tom is absent, it is desirable to institute a careful examination,
not only above Poupart's ligament, but in the perineum within
the tuber ischii. and also by the introduction of the finger with-
in the rectum. He had in two instances detected the exist-
ence of tumor in the pelvis by adopting these measures: and
he thought this the more desirable from the importance of
avoiding irritation as much as possible in cases of this descrip-
tion. [N. T. Jour. Med.

Upon Filtration of the Air in connection with Fermentation and
Putrefaction. By H. Schroder and Dr. Th. Vox Dusch.

I. In the year 1837, Dr. Schwann, of Berlin, communica-
ted a series of experiments, which proved that putrefaction did
not occur in a freshly boiled infusion of flesh, and that the vinous
fermentation did not take place in a freshly boiled fluid, previ-
ously susceptible to fermentation, if the air that was suffered to
enter had been first exposed to a red heat. It was proved by
these experiments, that it is not the oxygen, at least not it
alone, that causes the vinous fermentation, the putrefaction of
an infusion of flesh, or even the formation of mould and infuso-
ria, but a substance contained in the atmosphere and destroyed
by heat.

Schwann considered it probable that fermentation and putre-
faction were induced by sporules of microscopical cryptogami
and infusoria, contained in the air, which developed themselves
and increased at the expense of the fermenting or putrefying
substance, and thus continued the process. These sporules or

434 Upon Filtration of the Air, <^c. [July,

germs existing in the air, are, however, destroyed by heat.
Similar experiments, with like results, were made by Ure and
Helmholz.

2. Regaud de l'lsle has shown in his examination of the
miasmatic influences of the Pontine marshes, that an interposing
wood is a protection from the noxious effects,* and Becquerel
says, "Une foret interposee sur le passage d'un courant d'air
humide, charge de miasmes pestilentiels, preserve quelquefois
de ses effets tout ce qui est derriere elle, tandis que la partie
decouverte est exposee aux maladies. Les arbres tamisent
done I'air infecte, et 1'epinent en lui enlevant ses miasmes. "|

Finally, Lowel communicated last year a series of remarka-
ble experiments, upon the crystalization of an oversaturated
solution of sulphate of soda, and proved that such a solution,
which, when in contact with air, crystallises almost instantane-
ously, does not crystallise if the air has been previously filtered
through a layer of cotton.

3. The facts above mentioned, being all that rs known with
regard to fermentation and putrefaction, in connection with the
filtration of air, led one of us in January, 1853, to the supposi-
tion, that a freshly boiled organic substance, in contact only
with air properly filtered, would be protected from fermenta-
tion or decomposition. In order to test this supposition, we
performed the following experiments :

4. Cotton was selected as a means of filtration, because it
is known that it retains upon its surface infectious diseases, and
is even capable of conveying them to a distance.

The apparatus used for filtering the air, consisted of a tube,
about 1 inch in diameter and 20 inches in length, filled with
raw cotton, moderately compressed ; both ends were closed
with waxed corks, through one of which was passed a short,
open glass tube about j inch in diameter ; the other end was
connected by a tube of similar diameter bent at right angles,
with the flask containing the meat or infusion to be experi-
mented upon. The flask itself was connected by a tube of the
same diameter, with a gasometer or air-tight vessel holding
about one cubic foot of water, and provided with a dis-
charge cock at the bottom, and another cock to intercept
the communication between it and the flask; besides an
opening for introducing water which cculd be perfectly
closed. The joints all being air-tight, it is evident that as
the water ran out of the gasometer, fresh air must enter
through the cotton and the flask to replace it. When all was
in order, the discharge cock was so regulated that the water
could escape in drops only, and the air constantly passed

* Bibl. Univers. vol. xiii. t Compt. Rend. hebd. xxxvi. 13.

1654.] Upon Filtration of the Air, fyc. 435

through the apparatus in proportionate amount. Before being
put into the glass tube the cotton was heated in a water-bath,
and the contents of the flask in all the experiments were
brought to ebullition, which was continued until the tubes were
heated up to the part where the cotton commenced.

5. The first experiment was commenced on the 9th of
February, 1S53. Two flasks, placed side by side, each con-
taining meat, and the freely boiled decoction thereof, were
made use of. One vessel was connected with the filtering ap-
paratus described above, the other was left open. The meat
and the decoction in the open flask, began in the second week
to develop an intolerable odor of putrefaction, so that it was
necessary to remove it from the laboratory.

On the Oth ofMa,rch, we opened the other flask, through
which during the whole time that is during 23 days and nights
filtered air had been passed. The appearance of its con-
tents was entirely unchanged. There was no trace of odor.
but upon being heated, the pure characteristic smell of fresh
unseasoned broth was developed.

6. The experiment was repeated in a warmer season of
the year. 20th of April.

a. We placed some meat in water, as described in 4. The
treatment was the same as in 5, except that the current of
air was only passed through during the day, and the vessel
closed at night.

b. Besides this, was placed in an open flask, fresh meat
boiled in water.

c. At the same time, a flask containing similarly prepared
meat was closed with a waxed cork, through which was inser-
ted a glass tube about 12 inches in length, and 1 line in diame-
ter, the object being to retard the entrance of air.

d. In the fourth flask, we put meat boiled in water, and
closed with a loose stopper of cotton, over which a large pad-
ding of cotton was placed, fastened to the neck of the flask by
a silken thread. Upon the cooling of the flask the fresh air
entering must necessarily be filtered in passing through the
cotton.

In the second week, the meat in the open flask (b.) under-
went stinking putrefaction, and was obliged to be removed
from the laboratory.

On the ] Oth day, a thick growth of mould was observed in
the flask with the narrow glass tube, (c.) At the expiration of
19 days, upon being opened, only a mouldy smell was perceiv-
ed, not the odor of putrified meat.

The two flasks, (a. and d.) through which filtered air alone
had been passed, were opened on the 14th of May, at the expi-

436 Upon Filtration of the Air, fyc. [July,

ration of 24 days; no mould formation or any striking change
of substance was perceived; a whitish appearance was obser-
ved in some parts of the meat, which had not been noticed at
least by us before.

The substance in both flasks was found, upon opening, to be
without odor; upon being heated, the unchanged smell of fresh
broth was developed ; the taste was that of fresh unseasoned
broth. Like fresh broth, it reacted slightly acid. The distil-
late of a part of this, was entirely neutral.

By these experiments it is therefore established, that meat,
freshly boiled in water, and freshly boiled broth, remain for
several weeks completely unchanged, if only such air as has
been previously filtered through cotton is suffered to enter.

7. On the 14th of May we took from Grohe's vinegar
manufactory of this place, some freshly boiled sweet malt-wort,
to which some hops had been added. It smelt and looked like
beer wort, tasted sweet, and reacted only slightly acid. Thia
wort was put in the flask connecting with the filtering appara-
tus, and treated for 23 days, as described in 4. In the last
eight days a cubic foot of air was daily drawn rapidly through,
so that a visible depression was caused upon the surface of the
liquid. An open flask was at the same time placed beside it
and filled with freshly boiled wort. After eight days the for-
mation of mould commenced in the open flask ; the liquid be-
came also cloudy, whilst that in contact with the filtered air
was perfectly clear, and remained free from mould. On the
6th of June, 23 days after, we opened the flask; the liquid was
as clear as at the beginning of the experiment, and developed
upon being heated the odor of unchanged wort. The taste
was sweet and unaltered, and the reaction slightly acid, as be-
fore the experiment. Examined with Steinhold's beer test, we
obtained 0. p. c. of alcohol, and 7.9 p. c. of extract of malt.
We had: previously, neglected to make a determination of the
value of the liquor experimented on. We could only, therefore,
compare it with a new sample of fresh wort, taken from the
same manufactory. This gave with Steinhold's test, 0. p. c. of
alcohol, and 7. 7. p. c. of extract of malt, therefore of the same
value, excepting the slight concentration of the first fluid by
evaporation during the experiment. We believe to have estab-
lished by these experiments, that at the temperature of May and
June of this year, a sweet fermentable wort will remain entirely
unchanged for weeks, if only such air has access to it as has
been previously filtered through cotton.

8. With the new sample of wort above mentioned, we
commenced on the 6th of June another experiment. We
wished to see, as a farther check upon the experiment, if upon

1854.] Upon Filtration of the Air, fyc. 437

the removal of the cotton from the filtration tube, (the treat-
ment otherwise being the same as in 4.) the contents of the
flask would remain unchanged. An open flask was again
placed beside it. The formation of mould commenced in the
latter, wilhin the first week, but not until after 12 days in the
one connected with the tubes. It commenced with a rapidly
growing speck of mould, exactly on the spot where the current
of air came in contact with the surface of the liquid. The li-
quids in both flasks became cloudy. It was, therefore, evident
that protection from these changes could only be found in filter-
ing the air through cotton.

1). It was now of interest to ascertain, whether under like
circumstances, boiled fresh milk would remain unaltered, or
whether it would curdle or putrefy. But all the experiments
which we made in the months of June and July, gave only ne-
gative results. The milk coagulated quite as rapidly in filtered,
as in open air ; and in every case, the odor of putrefying casein
was developed, as soon with the former as with the latter. The
formation of mould was, however, entirely prevented by the fil-
tration of the air.

This negative result reminded us ot a similar one, obtained
by one of us, in connection with L. Gmelin, in 184G, in regard
to the behaviour of milk, when placed in contact with a large
amount of confined air previously heated.

Negative results were also obtained in all experiments with
fresh meat that was heated in a water-bath, first being placed
in a flask without the addition of water; the flask while yet hot,
was closed as in G. d, with a stopper of cotton, and the neck
surrounded by a thick padding of the same material. The
meat became offensive, as quickly as in the open air or in a
flask, which was corked as in 0. c. communicating with the
air onlv through a long narrow tube. The only difference
was, that the greenish-brown liquid, that in the open flask sur-
rounded the putrefying pieces of meat, was observed under
the microscope to be alive with infusoria, with Monas termo
or at other times with Fihrio lineola ; whilst in the same liquor
that putrefied in filtered air, Fibrio lineola decidedly did not
appear, and even Monas termo could not be recognized with
certainty: no other infusoria were present. We believe,
therefore, that in all these experiments, the meat had not been
sufficiently heated to its centre, and that the experiment should
be repeated in another manner.

10. On the 18th of July, unfortunately the hottest season
of the year, we again boiled meat in water, and while hot,
corked it, and padded it over with cotton, as in 6 d. ; a test
fluid in an open flask beside it, showed, on the 22d of July, the

n. s. vol. x. NO. VII. 28

438 Upon Filtration of the Air, <SfC. [July,

odor of putrefaction, and on the 23d, a species of large infuso-
ria could be recognized under the microscope, which we were
not able to determine. They were globules or cells of the size of
yeast globules, in constant voluntary motion, drawing them-
selves together like balls, and then stretching themselvesout ; we
were, however, not able to perceive any further organization.

Upon the liquor that was under the cotton, we perceived a
kind of fat skin, that covered the whole sutface and gradually
thickened. In the third week, the liquid acquired a reddish
color; and upon being opened on the 15th of August, gave the
odor of stinking f;>t, which, however, upon being warmed, was
mixed with the odor of fresh broth.

We feel obliged to merit inn this experiment, because we do
not consider ourselves justified in withholding it; not because
we think any particular sties* should be laid upon it ; conclu-
sions must not be drawn from a single experiment of this kind.
Our idea is, that the meat in question, had not been boiled long
enough, for the boiling had been stopped as soon as the liquid
foamed up, so that probably all the serum in the interior of the
meat was not coagulated. It is also very possible that from the
high temperature at that time, the fat became rnncid, which
might have taken place even after boiling a long time. This
can only be determined by further experiments; but even in
this experiment, made during the hottest weather, putrefaction
did not occur within 2^ days.

11. Although we believe that we have obtained from
these experiments decidedly positive results, yet they should by
no means be considered as concluded.

It appears then settled that there is a spontaneous decompo-
sition of organic substances, as the putrefaction, of meat without
water, of the casein of milk as well as the transformation of
the sugar of milk in the milk into lactic acid, that requires for
its commencement only the oxygen of the air, and that there
are other phenomena of fermentation and putrefaction, which
are improperly placed in the same category ; viz : the fermen-
tation of malt wort, and the putrefaction of meat under brolh,
which require for their commencement, besides the oxygen,
some unknown admixture in the atmospheric air ; which accor-
ding to Schwann's experiments, is destroyed by bent, and
according to ours, removed by filtration through cotton. It
will be a problem for future experiments, to divide into two
classes those phenomena, which are now united under the gen-
eral idea of fermentation and putrefaction. Our attention here-
after will be particularly devoted to certain simple organic com-
binations, viz : pure aibumen, pure fibrine, casein free from
fat, &c. <fec.

1854.] Editorial and Miscellany . 439

12. We have as yet only made use of cotton, as n means,
of filtration. It will be the object of future experiments to
try a number of other substances for tbis purpose. We shall
first use coal, sulphuret of lead, pumice stone, powdeied glass,
g\ psum, ccc. &c.

It is yet to be investigated, whether certain filtering substan-
ces will not remove the germs of one species of putrefaction
and fermentation, permitting those of another to pass through
which in its turn may be removed by some other filtering
medium ; thus dividing the filtering substances into different
classes.

Since there is still so much that remains undecided in an ex-
perimental way, we at present withhold all theoretical deduc-
tions from our researches.

The experiments mentioned above, will require from their
nature, so long a lapse of time, that we do not think it right to
withhold any longer from the public, the positive results alrea-
dy obtained. [Leibig's Annalen. Med. Examiner,

EDITORIAL IBB MISCELLMY.

Scarlatina The subjoined extract from the letter of an esteemed
correspondent, who resides in middle Georgia, will explain the object
of the remarks which follow it. We have had, in Augusta, no epi-
demic of scarlet fever this year, although a few cases have occasion-
ally occurred.

M We have had an eruptive fever here for a month or two, and I
understand you have had the same, or a similar disease, In Augusta.
There is diversity of opinion among the '; faculty " here, as to its
character. I think the majority of the cases are Roseola, and a few
cases of Scarlatina ; the other physicians say it is all scarlatina. If
you have had the same epidemic in Augusta that we have had, I, for
one, would like to have your views on it through the Journal."

Scarlatina was, we believe, first introduced into Georgia in 1834,
by a family who came from New York to Augusta, and one of whose
inmates was seized with the disease on the day after their arrival.
From that case it spread over the whole city, causing the most fright-
ful mortality ever experienced among the children of this community.
From this place it was carried into the country and has ever since
been domiciliated in Georgia, and has from time to time manifested
itself in the form of distinct epidemics in various localities.

440 Editorial and Miscellany. [July,

Epidemics of Scarlatina, like epidemics of any other disease, must
be induced by a deleterious agent, which is probably diffused through
the atmosphere. It is also probable that this morbific principle is
unequally distributed, and that the mildness or the severity of the
epidemic depends upon the relative quantities brought to bear upon
the human system. Judging from analogy, may we not infer that
those who have the disease in a mild form have imbibed a smaller
quantity of the scarlatina poison than ihose who suffer a violent at-
tack. May we not indeed admit that the degrees of intensity of the
disease must be as various as the doses of poison inhaled or that the
manifestations of the disease are in a direct ratio with the potency of
its productive cause. Scarlatina being induced by a specific agent,
must necessarily in each case be an indication of the force of the ac-
tive cause; and this force may vary ad infinitum, from the smallest
quantity susceptible of being felt by the human system, to the over-
whelming amount which produces inevitable and prompt annihilation
of the vital forces.

Hence it is that during the prevalence of epidemic scarlatina we
find it sometimes revealing itself in such a mild form as to induce a
mere efflorescence of the surface without febrile disturbance, which
may well be mistaken for simple erythema or non specific roseola.
In other cases an equally slight anginose affection, either alone or in
combination with the cutaneous element, will constitute the only
symptom.

The propositions just enunciated, although true in the abstract,
must be viewed in connection with other circumstances, which are
equally well known to exert more or less influence upon the causation
and development of disease. Climate, seasons, age, sex, temperament
and stamina, are fruitful sources of perturbation and modification in
the sequence of cause and effect, which ought not to be overlooked in
estimating the relation of the one to the other. As in the administra-
tion of remedial agents, which may be weighed or measured accurately,
the dose is known to act with various power, according to the cir-
cumstances just referred to, so will equal quantities of an atmospheric
ao-ent inhaled be followed by very different results, in different climes,
seasons, ages, sexes, temperaments, and degrees of resistance. With
regard to scarlatina, for example, its violence and consequent fatality
will be usually found to be much greater in northern latitudes than in
the more temperate in New England than in Georgia. Yet we have
not observed any special difference induced in its intensity in Georgia
by the seasons. While, in our section of country, adults are very

1854.] Editorial and Miscellany. 441

generally exempted from its inroads, they are much more susceptible
in New England. Of the few adults who have taken this disease in
Georgia, the great majority have been females ; and it is among these
alone that the writer recollects ever knowing of a fatal termination.

Although the stamina or power of resistance to disease is usually
regarded as less developed in the lymphatic than in other tempera-
ments, our observation does not authorize us to consider this to be
true with regard to scarlatina for we are rather, on the contrary,
disposed to the belief that the greatest proportion of mortality occurs
in children of apparently robust constitution. In this respect scarla-
tina obeys the same law as yellow fever, which is, we think, more apt
to take off the hale and hearty, than the more delicate members of
society. But yellow fever is more fatal with adults than with chil-
dren, whereas the converse obtains in scarlatina.

The name by which mild cases are to be designated is by no means
unimportant ; for while simple erythema, roseola, or sore-throat, need
but little attention, there is no case of scarlatina so slight in its first
stages, that it may not, by contagion, impart the more formidable dis-
ease to other persons, or be itself followed by the most serious sequelae.
Some of the worst cases of anasarca we have ever seen to follow
scarlatina, occurred in patients who had had only a roseolar erup-
tion and been subject to no treatment directed to the kidneys. It is
therefore not a matter of indifference whether we call such cases
roseola, or mild scarlatina. Every parent knows that scarlatina ought
to be avoided by his children; but he may not be equally careful to
keep them away from those who are said to have mere roseola.

There is a peculiarity in relation to the fatality of scarlatina in
children, which we do not recollect to have seen noticed by authors,
and which we cannot account for satisfactorily. It is the fact that by
far the greatest number of deaths occur in subjects between the a^es
of 4 and 8 years. As a general rule, the younger a child is, the less
effectually will he resist the inroads of disease although the non-
professional not unfrequently seem to think it better for their children
to take measles, hooping cough, &c, in early life. We believe that
statistics will always show the mortality from these diseases to be in a
direct ratio with the youthfulness of the patient. In scarlatina, how-
ever, there seems to be (in Georgia) comparatively little danger prior
to the age of two years the danger reaches its maximum of intensity
at 4 years of age and continues equally so until 8 years gradually
lessening from this until 12 years of age, and then becoming, as in
infancy, very rarely fatal.

442 Editorial and Miscellany. [July,

As we have so much digressed from our original purpose, we may
be permitted to add another remark. Writers generally affirm that
the eruption in scarlatina occurs on the second, or within a few days
after the inception of the febrile symptoms. According to our obser-
vation of the disease in this section of countiy, from its first appear-
ance in H34 to the present time, the eruption may always be seen
upon a portion of the body, or upon the whole of it, within the first 24
hours of febrile excitement ; and in the majority of cases, it mny be
seen upon the trunk, especially the back, within the first 12 hours.
Such has been the uniformity of this rule, that the writer has for many
years felt quite safe in declaring that the case would not prove to be
one of scarlatina if the patient hud had fever 24 hours, and that no
eruption was yet perceptible.

Finally: the milliary vesicles which sometimes show themselves in
this disease, are much more frequently seen in negroes than in whites
and the desquammation is also more extensive or in larger plates in
the African than in the Caucasian.

The above remarks, hastily thrown together, and consequently
without much regard to order, are based upon a long observation of
the phenomena of scarlatina as manifested in this part of Georgia.
That these may difter in various climates and during other epidemics,
we readily admit. If what we have observed here docs not accord
with the experience of other Southern practitioners, we would like to
be apprized of the fact

Delirium Tremens among the Troops in Canada. The Medical
Chronicle (of Montreal) contains an interesting statistical account of
the occurrence of delirium tremens amongst the troops in Canada for
'the last thirty years, by Dr. Henr^ from which we derive the fol-
lowing Recapitulation :

Number of cases of Delirium tremens in thirty years, - - - 1769

Number of deaths, 143

Ratio of cases to army, first fifieen years, as 1 to 175

Do , second fifteen years, as 1 to 75

m Do., the whole thirty years, as 1 to 93

Ratio of deaths to cases, first fifteen years, as 1 to 16

Do., second fifteen years, as 1 to 12

Do., the whole thirty years, as 1 to 12

Dea'h from the sting of a Wasp. We perceive in the newspapers
the statement that a gentleman in Madison county died in 15 minutes

1854.] Editorial and Miscellany. 443

from the sting of a wasp. Will some physician who knows the cir-
cumstances of the case, oblige us with an account of them. It would
be interesting to know by what kind of wasp the injury was inflicted
and whether any blood-vessel or nerve was stung.

BIBLIOGRAPHICAL.

The Science and Art of Surgery ; being a Treatise on Surgical inju-
ries diseases, and operations. By Johx Ekichsox. Professor of
Surgery in University College, and Surgeon to University College
Hospital. Edited by John H. Bkinton. M. I). Illustrated bv :3il
engravings on wood. Philadelphia: Biancbard & Lea. 1So4.
8vo , pp. 90S. (For sale by T. Richards & Son, and McKinne &
Hall. Price So 00.)

This work is the substance of the course of Lectures delivered for
some years by the distinguished successor of Liston and bears the
inpress of learning, wisdom, and experience. Although works upon
Surgery have been very much multiplied of late years, the advances of
art demand their reproduction at short intervals, in orde r to facilitate the
diffusion of new facts and opinions. The work before us appears to
be well posted up, so far as it goes. It contains nothing, however,
upon the very important class of diseases peculiar to the eye the
author hiving preferred to leave this branch to be studied in special
treatises. The wood cuts are not as good as they might be ; but will
answer very well. We think that we may honestly recommend the
book to the profession.

Woman : her Diseases and Remedies. A series of letters to his class.
By Ciiaules D. .Meigs, M. D., Professor in Jefferson Med. College,
<kc. ccc. 3rd edition, revised and enlarged. Philadelphia : Blan-
chard & Lea. 1^54. 8vo., pp. 072. (For sale bv T. Richards
d: Son.)

Having already had occasion to notice this work, it is at present
merely necessary to state that a third edition of any work upon med-
ical subjects is at least prima facia evidence that it has been approved
by the profession. We doubt not that in the present instance, the
patronage will be conlinued.

Lectures on the Diseases of Infancy and Childhood. Bv Charles
Wrw, M. I)., F. R C.P.. &c., &c. '2d American, from the 2d
and enlarged London edition. Philadelphia: Blan. haul & Lea.
1854. pp. 4^5. (For sale by T. Richards &: Son.)

As physician to the " Hospital for Sick Children," Dr. West hns
had practical advantages probably not inferior to those of any practi-
tioner in England. The substance of his course of Lectures is here

444 Editorial and Miscellany. [July,

presented with such improvements as have been suggested since the
publication of the first edition. The work is eminently practical, and
as such must be favorably received by the profession.

Clinical Lectures on Pulmonary Consumption. By Theophilus
Tho.mpson, M. D., F. R S., Physician to the Hospital for Con-
sumption and Diseases of the Chest, &c, &c. Philadelphia :
Lindsay & Blakiston. 1854. pp. 240. (For sale by T. Richards
& Son.)

A monograph upon pulmonary consumption would seem to be
scarcely worth reading when it is remembered that we know of no
radical cure for this disease. Yet no physician ought to be satisfied
to rest with folded arms, and witness the ravages of such a scourge,
without making some attempt to stay its effects. It is only by mono-
graphs that we may expect to perfect ourselves on any medical sub-
ject ; and the lectures before us are calculated to do a great deal of
good. Many persons annually die in our country with consumption,
who might have been saved by judicious management.

On Rheumatism, Rheumatic Gout, and Sciatica, their pathology,
symptoms and treatment. By II. YV. FuLLCB, M.D., Cantab., F.R.
C. P., assistant physician to St George's Hospital, &c. New York:
S. S. & W. Wood. Ib54. Svo., pp. 322. (For sale by T. Rich-
ards & Son.)

This is a very complete monograph upon a class of affections alike
painful and intractable. The learned author has advanced many
original views worthy of mature consideration. As we hope to no-
tice some of them hereafter, we will at present merely say that prac-
titioners should welcome any new light upon the subject, and buy this
book.

A Universal Formulary : containing the methods of preparing and
administering officinal and other medicines. The whole adapted to
Physicians and Pharmaceutists. By R. Eglesfikld Griffith,
M. D. A new edition, carefully revised and much extended, by
Robert P. Thomas, M. D. With illustrations. Philadelphia:
Blanchard & Lea. 1854. 8vo., pp. 651. (For sale by McKinne
& Hall.)

We are happy to announce a new and improved edition of this,
one of the most valuable and useful works that have emanated from
an American pen. It would do credit to any country, and will be
found of daily usefulness to practitioners of medicine. It is better
adapted to their purposes than the Dispensatories.

1854.] Editorial and Miscellany. 145

Handbook of Chemistry Theoretical, Practical, and Technical. By
F. A. Abkl, Profe.-r-or of Chemistry at the Royal Military Acade-
my, Woolwich. iicc . &c, and C. L. Bloxau, formerly tirst a-- st-
int to the Royal College of Chemistry. With a Preface, by Dr.
Hoffmann : and numerous illustrations on wood. Philadelphia :
Blanchard & Lea. 1864. Svo., pp. 681. (For sale bv McKinne
<k Hall. Price 84 00.)

This is a very elaborate woik, containing, besides the Introduction,
divisions treating of chemical manipulations, elementary chemistry,
and analytical chemistry. The numerous beautiful illustrations added
to this American edition enhance the value of the work very much.
It is a very valuable addition to our stock of chemical works.

In addition to the works above noticed, we have to acknowledge
the reception of a large number of pamphlets, <kc, among which we
may name the M Transactions of the Medical Association of the State
of Alabama,'' a very creditable volume of 190 pages, to which we
expect to refer again. Alabama is among the foremost in medical
talent and industry.

Quarterly Summary of the Transactions of the College of Physicians
of Philadelphia, from February to April, 1S54 a work containing
much valuable information.

Remarks on Croup audits Treatment. By Horace Green. M. D.
Quite an interesting paper.

The Amerian Journal of Science and Aits. A capital number of a
work which ought to be extensively patronized.

Archives de Physiologie de Therapeutique et cT Hygiene. This is
the first Xo. of a series o( monographs to be issued in Paris, semi-
annually, by M. Bouchardat, Prolls?or of Hygiene in the .Medical
School of Paris. The present Xo. contains 376 pages upon Digitalis
and Digitaline, by MM. Homolle and Qlevenne, and is calculated
to satisfy the most inquiring mind with regard to this remedial agent.

Inhalation and other Treatment in Phthisis. Read before the Suf-
folk District .Medical Society, May 27th, 1S54. by Wi M. Cornell,
M. D In the Boston Med. and Surg. Journal for April 19, are the
following editorial remarks : " It is said that the benefits of inhaling
the vapor of iodine in pulmonarv affections, have been underrated.
Until within a short time, there has been but little notice taken of
iodine in this form of medication ; and we are pleased to learn that
several medical gentlemen in Europe have lately jiiven their atten-
tion to the practical application of it in cases of confirmed phthisis.
It is hoped that their use of it will be attended with good results, and

446 Editorial and Miscellany. [July,

that it may prove a successful remedy in some cases of this intracta-
ble disease."

In 1351, in the 43d volume of the same "Journal," the writer
communicated some remarks on the subject of " Inhalation in diseases
of the air passages and of the lungs." In that paper the belief was
expressed that "more benefit may be derived from inhalation than has
generally been experienced." The vapor of iodine is there named,
among other articles, for inhalation, and cases given from Sir Charles
Scudamore, Murray, Barton, and Corrigan. where it had been advan-
tageously employed. Some physicians in this country were disposed
to give it. and other articles there named, a trial ; among whom, was
the late Dr. Peirson, of Salem. The American Medical Association,
by their committee on the treatment of these diseases, referred re-
spectfully to these inhalations ; and Dm. Wood and Bache, in the last
edition of the United States Dispensatory, have mentioned the inhala-
tion, quoted from the Boston Journal. But others looked upon the
whole scheme as chimerical, and useless, if not worse.

Since that period, however, medical men abroad, and some in this
country, have looked more carefully into the matter, and put the
treatment in practice. The writer has watched the reported cases,
he believes, in all the Journals, as they have appeared, and still be-
lieves, as then expressed, that, if we are ever to find realised the
remark by Dr. Armstrong that "at some future period the whole
class of tubercular diseases will be arrested" by medical treatment,
no small share of that treatment will consist in remedies addressed,
by inhalation, directly to the diseased organs, and to the integument,
rather than the stomach of the patient.

It is by no means strange, when phthisis is weekly sweeping to the
grave a larger number of victims than any other disease, and this
under the most approved treatment, that physicians should look with a
somewhat sceptical eye upon any new plan of treatment which prom-
ises to be in any measure successful. They doubt (and they ought
to doubt) the utility of any plan of treatment, till they have evidence
of its success. But they ought, also, to give any feasible plan, which
has been stated to be suceessful, a fair trial. No one doubts that
phthisical patients sometimes recover, both with and without treat-
ment. But il docs seem incumbent upon the medical profession to
put in action all possible means to stay this great ravager of our land.

During the last three years the writer has treated (among many
who have died) some phthisical patients who have recovered, among
whom were the following:

Mr. M., a young man aged 23 years; well marked phthisis ; right
lung cavernoiH. Several remedies were tried, but without any good
effect. At last, he was put upon the following : IJ. Cod-liver oil,
giv. ; sol. cirb. po'ash, gss. ; pulv. g. Arabic, Jj ; syr. orange peel,
%] ; spirit peppermint, 3ij. Of this compound, a large tablespoonful
was taken four times a dav. The patient began to grow better from
the commencement of taking the medicine. He also inhaled the va-
por of tinct. iodine and creosote, five drops of each in conjunction,

1854.] Editorial and Miscellany. 447

several times a-^ay. The inhalation quieted rather than provoked
coughing. But what part of the cure is to be asctibed to the medi-
cine taken, and what to the vapor inhaled, or whether any to either or
both, he is not prepared to say. This was the treatment under which
he recovered, and he has now remained apparently well more than a
year.

Miss C, a young lady from the country, had 'phthisis. Cough
excessively harassing; expectoration of viscid pus profuse; night
sweats, &c. Was treated the same as the above. She gradually
improved in strength and flesh, the cough and expectoration dimin-
ishing daily, for eight weeks, when she returned to her home in New
Hampshire. Two months after her return, she wrote me a letter, in
which she says, M my health is now go^d, and 1 am married."

Mr. L., a gentleman aged 27 years, married ; residence one hun-
dred miles fom this city. Wishing to visit a brother in this vicinity,
was recommended to my care by Dr. H., his physician at home. He
had disease of the right lung, but did not appear to be a strumous pa-
tient. He was short, stout built, and had a broad chest. His cough
and night sweats were very troublesome. The cod -liver oil he was
reluctant to take ; and when, at my earnest request, he did take it,
it would not set on his stoma eh. He therefore soon abandoned its
use. He was put upon the leo ni od ine, the concentrated chemical ex-
tract of the taraxacum, and the cornine of the cornus Florida, of
Kei'h &; Co., according to the following : ft. Cornine, grs. ij. ; Le-
ontodine, grs. ij. M. Sum at once, three times a-day. lie also
inhaled the vapor of iodine, gutt. x , three times daily. Under this
treatment, for eight weeks, he gradually improved, and returned home
in much better health than when he first came to me. Each of these
patients was freely rubbed with equal parts of warm sweet oil and
New England rum, morning and evening.

1 am not prepared to say how much of the benefit, which appeared
to result from this treatment, was to be ascribed to either the medi-
cine, the inhalation, or the unguent, or whether either did any good.
The patients improved while being treated, and that it is all 1 would
say about it.

I have employed inhalation of creosote, for more than three years,
in phthisis, in bronchitis, and in a few cases of gangrene of the lungs.
1 was first led to use it in gangrene, hy supposing, from its name, and
the Greek words from which it is derived (kreas, flesh ; and soter,
preserver, that is, flesh preserver), that it might possibly be useful, as
an antiseptic, in a gangrenous lung ; and as the best way to introduce
it to the lung, resort was had to inhdation. At the time when I
commenced the inhalation of creosote, I had not seen any account of
its having been employed, as a remedial agent, in that form, not even
in European journals. Hut in the second volume of the last edition
of Pereira's Materia Medica, re-published in ihis country at the com-
mencement of the present year, 1 tind the following remarks: " The
inhalation of creosote vapor is occasionally useful in relieving exces-
sive bronchial secretion. This inhalation mav be effected bv dillu-

448 Editorial and Miscellany. [July,

sing a few drops of creosote through water or a mucilaginous liquid,
and breathing through this by means of the ordinary inhaling bottle."

In the first volume of the same work, Dr. Pereira says, " Inhalation
of iodine vapor has been used in phthisis and chronic bronchitis. In
the first of these diseases, it has been recommended by Barton, Sir
Charles Scudamore, and Sir James Murray. I have repeatedly
tried it in this, as well as in other chronic pulmonary complaints, but
never with the least benetit."

I think I can say it has been beneficial in my hands, and I shall
continue to use it.

I have also, up to the present time, used with benefit the powder of
nilras argentii and lycopodium, prepared according to the formula of
Dr. Chambers, as published in the 43d volume ot the Boston Medical
and Surgical Journal, in chronic laryngitis, bronchitis, and incipient
phthisis.

I will add in conclusion, that though I never use inhalation of any
kind to the exclusion of a general treatment, yet I consider it a useful
adjuvant in the management of these generally chronic and often fatal
diseases; and if a patient puts himself under my care, I never feel
that I have done my whole duty to him, unless I have tried both gen-
eral and local treatment. I believe the pathology of phthisis has been
but imperfectly understood ; and that, in most cases, the skin is first
in fault. But this is a point on which I will not enlarge at present,
only to say, that every one knows how very intimate is the sympathy
betweed the integument of the body and the respiratory organs.
Hence, in the treatment of all phthisical patients, I have always paid
special attention to the skin. For the last five years I have been in
the habit of applying the alcoholic lotion, recommended in such cases
by Marshall Hall ; but for three years 1 have directed my patients to
be rubbed over the whole surface of the body with equal parts of warm
olive oil and New England rum ; and it is my opinion that no part of
my prescriptions has been more beneficial. If opportunity should
offer, I may say more on this treatment at a future time.

I have recently treated a case of aphonia of more than a year's
standing, with the alcoholic tincture, iodine 3j. to j of alcohol, ac-
cording to the recommendation of Dr. Bennett, in the Medical Times
and Gazette, and republished in the 28th Part of Braithwaite's Retro-
spect. The tincture was applied, externally, over the larynx, with a
camel-hair pencil, every other day for a week. The pain produced
by so strong a solution was considerable, and the friends of the young
lady, seeing her suffering, desired her to desist. I had concluded to
forego its further application, when she suddenly surprised us by the
return of her voice. Galvanism had been used for two weeks, pre-
vious to the application of the iodine ; the current being passed, for
fifteen minutes daily from the larynx to the cervical vertebrae. In this
case there was no disease of the lungs, but chronic inflammation and
enlargement of the chordae vocales. The voice still continues. [Bos-
ton Med. and Surg. Journal.

1854.] Editorial and Miscellany. 449

On the Production of Local Ancesihesia. Dr. Snow read a paper
before the Physiological Society on the above subject.

He said that the only means they as yet possessed of causing com-
plete local anaesthesia was that of applying cold, as recommended by
Dr. James Arnott. When a piece of tblded lint, wetted wiih chloro-
form, was applied to the skin, and covered with oiled silk, or any
other impermeable material, it caused redness of the part, and a sen-
sation similar to that caused by a mustard poultice. In about half an
hour there were numbness and a diminution of sensibility, so that
pricking with a needle caused less pain than at other times ; but he
had not been able to produce complete anaesthesia either with this or
any other medicine applied to the sound skin. The reason of this
was the very slow and sparing manner in which fluids permeated the
cuticle, and the circumstance that the small quantity which did per-
meate the cuticle was afterwards carried away from the part in the
circulating blood. When denuded of cuticle by a blister, or any
other means, the skin was readily made insensible, even by the va-
pour of chloroform, so that the raw surface might be. rubbed without
causing pain. The insensibility caused by the application of a mix-
ture of pounded ice and salt extended only to a very slight depth, as
he had ascertained in the following way : He had congealed part of
the palmar surface of the hand and fingers, making a space of two
inches square quite hard and insensible, when, on examining the skin
which connects the roots of the fingers on the dorsal surface, he found
it quite sensible to pricking, even when separated from the palmar
surface by a thickness of only the tenth of an inch. The application
of ice and salt caused great pain, and the pain was still greater as the
sensibility returned in the part, which remained tender for upwards
of twenty-four hours. He, therefore, considered this application hard-
ly suited, even for operations confined to the skin, except in cases
where the surgeon or patient had an objection to the inhalation of
chloroform. The French had lately introduced a plan of refrigera-
tion by dropping ether on the part, and increasing the evaporation by
a current of air from a bellows Some minor operations had been
performed in Paris with scarcely any pain, when this process had
been applied, and he (Dr. S.) had tried it on a patient of Mr. Ure, in
St. .Mary's Hospital, with an uherofthe leg, the callous edges of
which it was desirable to divide. The incisions on that ed^ie ot the
ulcer where the ether had chiefly been applied were not felt at all,
and the others caused very little pain. This process was attended
with less pain than the application of ice and salt, and probably might
be much improved in efficacy.

Mr. Richardson had succeeded in producing local anaesthesia by-
placing folds of cloth over an ulcer, with an opening in them; over
this he placed a piece of lint saturated with chloroform. The whole
was enveloped in oil silk covering, and insensibility in the part ex-
posed to the chloroform was the result.

Dr. Crisp had seen Dr. Simpson perform some experiments with

450 Editorial and Miscellany. [July,

chloroform in 1848. The hand was found to become numbed when
placed in a jug containing the agent, although the liquid was not
touched. When certain portions of a worm were touched by chloo-
form, Ihey become paralyzed. There was one curious circumstance
about chloroform viz., nineteen out of twenty persons might take it
with impunity, whilst the twentieth, though apparently healthy, might
die. The same fact held good with respect to cats, the influence being
upon the heart and dependent, upon some peculiarity of constitution.

Mr Potts mentioned a case of severe rheumatism which had been
treated with complete success by the application of cold, as recom-
mended bv Dr. Arnott. In this case the cold was applied for the
space of five minutes, and the patient did not complain of pain.

Dr. O'Connor had succeed -d in producing local amesthesia on
ulcerated surfaces by saturating folds of linen with chloro orm, and
placing them over the part.

Dr Gibhe said that strong extract of tobacco, when applied locally,
acted in some cases as an anaesthetic. [London Lancet.

Vegetable growth in the "fur''1 of a coated tongue. Prof. Alonzo
Clark presented to the New York Pathological Society, the results of
some recent inquiries made by him, into the nature of the "fur"
found in large quantities on the tongue of a patient in a very low con-
dition.

The fur had a mossy white appearance, and was even | of an inch
thick, or more, covering the mucous membrane of the lips and cheeks
as well as the tongue."

It was found under the microscope, to consist of

1st. Epithelial scales.

2d. Vibriones, and

3d. An abundant vegetable growth.

In the scale, there was nothing remarkable. The vibriones were
very large and active animalculaR. The spores from which the vege-
table fibres were produced, were "sometimes imbedded in the epith-
elial cells, and sometimes packed between them" Its quantity was
astonishingly great. Dr. Clark found, after research, that he had
been preceded by M. Robin a few months in this discovery This
growth is probably common in many exhausting diseases. It is be-
lieved to be constantly present in the disease called "muguet" by the
French. The sulphurous acid is found to destroy this parasitic vege-
tation, and may be considered the most appropriate remedy for it.

[Buffalo Med. Journal,

Death from Chloroform. Three more cases are to be added to the
melancholy list of deaths caused by the inhalation of this potent arti-
cle.

A woman 37 years of age, who was to have a chronic mammary
tumour removed from her left breast, by Mr. Hawkins, at St. George's
Hospital, was given chloroform ; not more than twenty minims were
inhaled, when death quickly ensued.

1854.] Editorial and Miscellany. 451

A man, 18 years of age, died May 3, 1854, at llie Locke Hospital,
after inhaling chloroform, prior to the operation for phymosis.

The subject of the third case was a woman, about 40 years of age,
who was to be operated on by M. Richard, of Paris, for uterine poly-
pus. M. R. feared the consequence of giving chloroform, as the
paitent was much weakened by loss of blood per vajrinam, but she
required its administration. Chloroform was poured on a piece of
folded linen, and held a short distance from her nose and mouth by M.
Richard himself. She breathed regularly and quietly, and chloroform
was twice added to the compress. The patient became, after a few
minutes, very much excited, and required to be held ; she was then
turned to one side of the Led, and hardly had the surgeon disposed his
ligature, when he was told by an assistant, to whom he had given
charge of the chloroform, that the pulse had ceased. All efforts at
revival were fruitless. The post mortem did not afford any feature of
interest. [Medical News.

Treatment of Psoriasis. By A. Hunton. M.D. Medical writers
have so many different names and descriptions of squamous and papular
diseases, that it is rather irksome to follow them ; and the multiplici-
ty of varieties serve only to perplex. I would call attention to one
form of psoriasis, which appears to be a hereditary disease, and vul-
garly called salt rheum, as also are many other varieties of this as
well as some other diseases.

If the following remedy will succeed as well in other hands as it
has in mine for thirty years past, it will be found very valuable. For
an external application, night and morning, in case of the above com-
plaint, in its varieties, (which are many where writers split hairs )
for chapped hands, sore lips, or for cicatrizing ulcers :

ft. Mutton suet, yellow wax, pine resin, lard of eacheqnal quan-
tities; melt and stir a longtime, as the ingredients do not readily
incorporate.

In addition to the above an internal alterative is demanded. The
article I use for this purpose is one grain of corrosive sublimate dis-
solved in one ounce of water, and its taste covered by some sacchar-
ine substance. For an adult administer of this gtt v. morning and
evening; increasing one drop every seventh day till the dose reaches
to ten drops. Minute doses of mercury in some form, administered
internally or applied externally, or both, constitute the most potent
alterative and discutient known tome.

The above preparation applied to indolent tumors, or any tumor
which it is desirable to discuss, is a judicious application. Brethren
try the above remedies. [J\'ew Hampshire Jour, of Medicine.

Medicine in Spain. The Gazette publishes a Royal decree to the
following effect: "Art 1. Every town and locality in the kingdom
are in future to be provided with physicians, surgeons, and apotheca-
ries, whose duty it will be to dispense medical aid to the indigent class-
es, and any other persons who may require their attendance. 2.

452 ^4 Editorial and Miscellany.

The existence of these physicians shall not prevent the free exercise of
the medical professions in the same localities. 3. The authorities
will maintain in the fiee exercise of their profession the persons who
have been legally accredited, in virtue of the present decree and
other ordinances in force. 4. The physicians, independently of
their attendance on the sick, will have to lake charge of fondlings, to
decide whether substitutes are fit for the military service, and to visit
sick soldiers passing through their districts. They are not to absent
themselves from the town in which they practice during more than
twenty- four hours without the permission of the Alcalde, and for a
long r period without providing a substitute. Their salary is to be
propoi tinned to the population of the district, the wealth of its inhabi-
tant-, and other local circumstances. They will he entitled to a pen-
sion after practising thirty years in the same district.'" [Times.

The. worst enemy of the Soldier. Civilians think that shot kills
most soldiers, but Colonel Queach, a Peninsular officer of some expe-
rience, and an authority upon the subject, having served throughout
the Peninsular campaigns with the old 95th Rifles, says that 40,000
men were killed in action or died of wounds 120,000 died of du
a great deal of which was rendered fatal by the want of proper medi-
cal attendance; whilst 120,000 more were, by disease, rendered
unfit for service. What a melancholy retrospect ; a numerous and
Well appointed medical staff is of the tirst importance in military ope-
rations, and would be cheap at any cost, however high or beyond the
usual rate. [London Lancet.

The late Dr. Daltoji. The subscriptions towards a memorial of this
highly gifted and distinguished man, the author of " Atomic Theory,"
already amounts to 5,312, of which 1,175 is to be expened upon
a bronze statue, to be erected in front of the Royal Infirmary, Man-
chester, close to those of the Duke of Wellington and Sir \{. Peel,
and 4,125 is to be used in founding scholarships in the New College,
Manchester. Of the latter sum 2,500 will be sunk in 4 percent,
corporation bonds, to be divided into two scholarships of 50 psr an-
num, in chemistry. 1,250 for two mathematical scholarships of 25
per annum, and 375 towards an annual prize of 15 for natural
history. [Ibid.

Venereal Ulcers. The use of iodide of zinc in venereal affections
is highly recommended by Dr. Sewell, of Canada, in the Montreal
Medical Chronicle. In venereal ulcerations of the throat and nose.it
was found effectual, after the disease had resisted the use of the acid
pernitrate of mercury. To apply it, twist a little cotton wool round the
point of a wooden skewer, and having dipped it in the caustic, apply it
to the ulcer. One application usually suffices to destroy the morbid
action, and is to be followed up with the metallic washes for the throat,
and dilute citrine ointment for the nose. [ Virginia M. and S. Jour.

SOUTHERN

MEDICAL AID SURGICAL
JOUMAL.

Vol. 10.] NEW SStlES ACGDST, I8S1. [\"o. 8.

ORIGINAL AXD ECLECTIC.

ARTICLE XXIV.

Cases from the yote-Book ofW. H. Robert.. M. D., of Orion,
Pike county. Alabama.

Cancer of the Pems. The subject oi the present sketch
was a man aged 54 years, who had been very intemperate du-
ring the whole course of his life, besides being a most excessive
libertine : in fact, his whole desire to live seemed to be for the
gratification of his animal passions. One of the consequences
of his loose life, was a pbimosed prepuce; and, in September,
1849, he sent for me to circumcise him. At the time appoint-
ed, I repaired to his house, and found the prepuce in a state of
phimosis, thickened and firm to the feel ; I could also detect, by
a close examination, an ulcer within the prepuce, the nature of
which I could not ascertain, because of the unyielding nature
of the prepuce. My patient's heart failed, and he refused to
submit to the operation. After this, although I frequently saw
him, I did not examine his penis until February 20, J 85*2. wh?n
he sent for me again to operate on him. The ulcer had ma le
its appearance externally, and the prepuce had a hard and
scirrhous feel. I operated by making a longitudinal inc
before and behind, and taking off one side of the prepuce at a
time. The ulcer had extended to the dans penis nn the 'eft
side, and was about the size oi a thumb-nail. The cut cd^es

n. s. vol. x. NO. VIII. 29

454 Robert's Report of Cases. [August,

healed very well in a couple of weeks, but the ulcer on theglans
gradually extended, in spite of my efforts to prevent it I was
satisfied that the ulcer was cancerous. The rest of the glans
gradually became hard and knotty to the feel. I proposed, as a
last resort, to amputate the penis beyond the diseased part, and
requested a consultation. Dr. Haygood, of Montgomery coun-
ty, was called in, who fully concurred with me as to the nature
of the disease and the necessity for the amputation. To this
the old man refused to submit, and passed out of our hands.
He then put himself under the care of a "conjure cancer Doc-
tor:'

I saw him occasionally in passing, and perceived that the
ulcer was extending its ravages toward the body. I ceased to
see him from September, of the same year, until about the mid-
dle of January, 1853. His condition was now as follows :
The penis was entirely destroyed, up to the arch of the pubis;
a large bubo had broken in the left groin, and produced a cavity
that could conveniently hide a turkey's egg, and in the right
groin there was another bubo nearly ready to burst. The scro-
tum was about the size of the head of a child a year old, hard
and solid to the feel. On the 22d of February he died, just
about one year after I excised the prepuce.

In all probability he might have lived a longer time if he had
submitted to the amputation of his penis. When the operation
was proposed to him, as a last resort, he said he would die be-
fore he would submit to it and sure enough he did; but not
before he lost his penis.

Retroversion of the Uterus, with Paralysis of the
Lower Extremities. August 5th, 1852. I was called to-day
to see Mrs. S., a lady aged about 45 : she had enjoyed good
health until about two years past, when she took a cough, which
has been gradually wearing her down ; she is the mother of six
or eight children; has been confined to her bed only four days.
I found her in the following condition : She was sitting up in
her bed, and propped up with pillows; she said that she could
not lie down, for every attempt to do so would cause violent
pain in the back, hips, and pelvis generally. I was given to
understand that there was some deranged condition of the uterus.

1854.] Robert's Report of Cases. 455

After much persuasion, I succeeded in inducing her to lie upon
her back.

By a very careful digital examination per vaginam, I detect-
ed the most perfectly marked case of Retroversion of the Uterus
I have ever seen. The fundus of the uterus could be plainly
felt in the hollow of the sacrum, and the os tineas was resting
against the pubes. She complained of a great deal of difficulty
in evacuating both rectum and bladder. The difficulty in
evacuating the bladder had existed for some months. With
one index finger in the rectum and the other in the vagina, I
gradually returned the uterus to its proper position. She expe-
rienced instant relief from her more distressing: pains. I ad-
vised the recumbent posture, (which now could be borne with-
out suffering. After waiting an hour, I questioned her as
to her feelings : she replied, that she was free from all acute
pain. There was some soreness of the back and hips.

She was very much troubled with a cough. The upper part
of the right side of the chest presented a very dull sound upon
percussion: I suspected the existence of a cavity in the lung;
but was not expert enough to detect any. The matter expecto-
rated was a mixture of blood and pus.

She said the flesh on her legs felt dead. As there appeared
no urgent necessity. I simply prescribed rest and an opiate, and
promised to see her again on the 7th inst.

7th inst. I was sent for in great haste, before day this morn-
ing, to see Mrs. S. On my arrival, I found her suffering very
much from retention of urine. Not only was this the case, but
I found the lower extremities completely paralysed, as well as
the bladder ; the rectum would empty itself, but she said she
was not aware of the act of defecation. The uterus occupied
its normal position. The opiates prescribed on the evening of
the 5th procured no rest; I drew off the urine by catheterism,
and prescribed } gr. strychnine every six hours, and frictions to
the spine and posterior parts of the thighs with stimulating lini-
ment.

8th. Patient very much as yesterday ; has passed no urine
since yesterday morning; some slight motion in knees. V>ed
the catheter again, and drew away 35 or 40 ounces of pale-
colored urine ; ordered muriated tincture of iron 15 drops, three

450 Robert's Report of Cases. [August,

times a day, in connexion with the strychnine, as before ; fric-
tion to the back and thighs continued; to keep the bowels open.
10th. Patient but slightly improved since last report there
appears to be a little more power to move the knee. She is
still unable to evacuate the bladder, without the aid of the ca-
theter; still complains of pain in the back and hips, (which she
has done all along) ; bowels open enough ; appetite good ; cough
and expectoration about the same. I applied a large blister
over the sacrum and lumbar vertebrae, instructed the husband
how to use the catheter, and ordered a dose of castor oil to be
given in the morning.

12th. The oil had operated well ; the husband had to intro-
duce the catheter once or twice every twenty-four hours I
directed the blister to be dressed with strychnine ointment. In
every respect, she appeared to be the same as at last report.

One fact I forgot to mention in my previous reports, and that
was with regard to the pulse. At each of my visits I found it
perfectly natural in frequency, but weak and small.

In addition to the strychnine and tinct. iron, I gave vegetable
tonics, and ordered the catheter to be used as often as necessa-
ry ; also, the use of enematas, if the bowels should become cos-
tive.

I saw her occasionally; there was no improvement. My
treatment was persevered in faithfully. I used every means in
my power to relieve the paralysis, but failed. She gradually
sunk lower, and died on Oct. 1st, 1852.

My principal object in the report of this case, is to notice the
very unusual complication of paralysis with a mal-position of
the uterus. That the woman had phthisis is true, and that this
seemed to hasten a fatal termination, I believe to be the case ;
yet the point of interest was the occurrence of the paralysis at
that particular time. She had had nothing like apoplexy, and
but a few hours before I paid my first visit she had stood upon
her feet. She was setting up when I first saw her, and said she
could not lie down. After a good deal of persuasion, she was
prevailed upon (not forced) to lie down and by as gentle means
as the nature of the case would admit, the uterus was examined
and replaced. There was no more difficulty in this, than is in
ordinary cases ; yet after this she never was able to move her

1854.] Robert's Report of Cases. 457

legs, or but very slightly. When I became aware of the exist-
ence of the paralysis, on my second visit, I suspected the exist-
ence of a tumour pressing upon the sciatic nerves ; but a care-
ful examination failed to detect any.

No post-mortem examination was allowed, and consequently
I could not ascertain the cause of the paralysis. The uterus
remained in its natural position the last time I examined her.

Case of Occlusion of the superior portion of the Rec-
tum. The subject of the present case was a lady, aged about
24 years ; been married 16 months had one child, about four
months old.

For ten months previous to her death, she had suffered with
repeated attacks of colic and costive bowels; which was gener-
ally relieved by a dose of castor oil. The attacks became more
frequent and more obstinate, until March 1st, 1853, when the
fatal attack set in. This time, her accustomed dose of oil failed
to relieve her, and enemas were used without any success. On
the second day of the attack (March 27th) my friend Dr. M. A.
Martin, of China Grove, Pike county, was called to the case :
all his most strenuous efforts to open the bowels were unavailing.
1 was called to see the case (March 3rd) in consultation, and
found it presenting the following appearance : Excessive rest-
lessness, with periods of repose which generally lasted about 15
minutes then would commence again the restlessness, with
loud complaints of pain which was referred to the right hypo-
gastric region. She complained very much of pain when pres-
sure was made on any part from the liver to the right iliac
region; she felt no pain in the left iliac, though she had done so
when first taken. She vomited every thing taken into the
stomach. I gave it as my opinion that a stricture existed in
some part of the bowel which had been gradually closing until
it had produced total occlusion. She sometimes retained arti-
cles of medicine one and two hours ; her tongue was moist,
slightly furred and a little red at the tip. There was very little
tympanitis; her pulse was firm and 100 to the minute. She
had been freely blistered over the abdomen. I advised large
and repeated doses of calomel say J 00 grains at once. The
reason for such doses was obvious : because more easily retained,

458 Robert's Report of Cases. [August,

and if retained, would be move likely to operate without further
assistance. Every dose was vomited. Croton oil could be re-
tained only a short time. This state of things continued for
three days after my first visit daring which time the pain in
the right hypogastric region increased, and we suspected that
the peritoneal covering of the liver was becoming involved.
Cups to this part gave temporary relief. We made repeated
attempts to introduce a tube high up the rectum, so as to facili-
tate the use of injections ; but without success. She continued
to grow worse, and died on the 8th of March in convulsions.

A post-mortem examination was allowed six hours after death.
The first thing which attracted attention after opening the ab-
domen was the intensely inflamed ccecum and colon. At that
point where the ccecum and colon passes under the edge of the
liver, the inflammation was so intense as to involve all the coats
of the intestine and the peritoneal covering of the liver. The
liver and intestine had become agglutinated. We took out all
that portion of the large intestine which was inflamed, to exam-
ine it more carefully. On opening the bowel, the mucous coat
\v;i< almost black, and each coat was very dark until they passed
to the peritoneum, which was ot mahogany colour. One small
spot, about the size of a twenty- five cent piece, was very little
removed from sphacelus. The mucous, cellular and muscular
coats were very much softened and the peritoneal covering of
the bowel at this point was aLT'jlutinated to the corresponding
covering of the liver. The colon, as it passed on to become
flexed, was more healthy, and at the termination of the sigmoid
flexure, and commencement of the rectum, we found the stric-
tured portion of the bowel. This had evidently been caused
by a deep seated inflammation of the tissues of the section ;
producing an extensive thickening of the mucous membrane, in
a circular direction. There was no ulceration of the mucous
membrane, but at one point an ulcer appeared to be about to
burst in the peritoneum. At this point the bowel was very
easilv torn in the examination. The bowrel was as firmly
contracted, circularly, as if a cord had been tied around it.
When the strictured portion of the bowel was taken out, we
found the contraction so perfect that water would not pass
through it.

1854.] Goss, on Epidemic Dysentery. 459

Operation upon the Hand to relieve a Contraction
caused by a Burn. Gabriel, a little nesro boy, aged 4 years, was
presented to me., by his master, Oct. J 9th, 1851, to devise some
operation to relieve a very bad deformity of the hand, caused
bv a burn, when he was about eight months old. The left hand
was the one affected, and the contraction of the burn was so
great as to draw the hand backwards and confine it closely to
the arm. The burn extended all around the arm, so as to make
it impossible to get any sound skin on that arm near enough to
answer my purpose.

My plan of operation was that adopted by Professor Mutter,
of Philadelphia, in cases of a similar nature viz., to divide the
contracted skin, and, if necessary, to dissect away a section
across the old cicatrix, and fill up the space with sound skin.

In my case, I divided the contracted skin which confined the
hand down, and found that motion of the wrist-joint was good,
but a little stiff. The whole of the metacaipal bones were con-
fined, and when dissected up there was about three inches in
length and about one and a half in breadth of denuded surface
exposed. I drew upon the right arm for skin t<5 supplv at least
a part of the deficiency. I dissected from the right forearm
a flap about one and a half inches long by one inch wide,
leaving one edge attached to keep up the vitality, turned the
skin up and confined the free edges with sutures across the
wrist of the left hand, then, by splints and bandages, firmlv se-
cured the forearm of the right side to the back of the left wrist.

At the end of eight days, I carefully examined the condition
of the parts, and found the patch adhering. I then care full v
separated the right arm from the left. The skin adhered firmly,
and the rest of the wound healed up by granulations. The
flexibility of the hand remained good, and at this date (July 1,
1854) the left hand is almost as good as the right.

article xxv.

Observations of Epidemic Dysentery. By J. J. M. Goss, M.D.,
of Jackson county, Ga.

I see it stated in the May No. of this Journal, that Dr.
Wooten wishes to collect all the facts relating to Dysentery

4G0 Goss, 07? Epidemic Dysentery. [August,

that can be obtained from different localities. As I have prac-
ticed in several sections of Georgia, and have treated dysentery
under a variety of types, I will contribute my mite of experi-
ence. The first of my practice was in the year 1842, when I
saw dysentery prevail in the most violent inflammatory form,
in Harris, Talbot and Muscogee counties, carrying off a num-
ber of both children and adults. The attacks, generally, were
sudden and violent, commencing with high irritability of the
stomach and bowels. The tormina and tenesmus were very
gr3at, and if not checked by opiates, warm fomentations to the
bowels, or warm hip-baths, soon terminated in great prostration
of all the vital powers, and death. The diseases most frequent
in that section, then, were remittent, scarlet, typhoid and
typhus fevers, in the spring and summer months; and in the
winter and early in the spring, pneumonia, pleurisy, bronchitis,
and influenza.

In 1843, I practiced in the upper eS^e of Harris and lower
edge of Troup counties: there I met the disease in its most
violent form again, spreading terror and dismay wherever it
prevailed. I ribw found some change in its peculiarities, owing
to a change in locality and atmos] heric vicissitudes. The year
before, we had a very wet summer, but very dry fall. This
year, 1843, we had a very rainy winter, with a moderately
rainy spring and very wet, warm summer. The disease now
seemed more aggravated in its symptoms, commencing with
nausea and frequent bilious vomiting; tormina and tenesmus
very great; stools at first bloody mucus mixed with fecal mat-
ter, soon changing to bloody mucus, and sometimes bloody
serum without faeces. Great prostration soon followed, and if
net met by prompt and efficient treatment, proved fatal in a
few hours or days. The treatment I found most successful in
this epidemic, was, at the onset, calomel and opium together, to
remove offensive matters from the alimentary canal, and quiet
nervous irritability: this, not unfrequently, cut short the dis-
ease ; but if it failed, I generally kept up daily action on the
bow-els with rhubarb or castor oil, and lulled the nervous system
with injections of starch and morphia, or opiates by the mouth,
if the stomach would retain them. This course failing, which
was sometimes the case, I then resorted to astringents by the

1S54.] Goss, on Epidemic Dysentery. 461

stomach and rectum, combined with morphia. The subacute
or chronic stage of the disease, characterized by less heat of the
surface, diarrhea and great prostration of the whole system,
was very difficult to arrest. The diseases most prevalent, then,
were remittent, intermittent and congestive fever; during the
summer and fall and the winter following, we had pneumonia,
which appeared to assume a remittent type, and was much bene-
fited by the addition of quinine to the common treatment.

During the next two years I practiced in Hamilton, Harris
county. There were not many cases under my observation,
nor was the disease characterized by any great fatality or pe-
culiarity. In 1846, I practiced on the line of Oglethorpe and
Madison counties, where I treated a large number of cases ; but
they were much like those of former years. In '47 and '48. I
again met the disease as an epidemic of great severity, as re-
gards frequency and fatality: there were, those years, noun-
usual atmospherical vicissitudes ; the summers were seasonable
and warm ; winters moderate ; the spring of '47 was very cold
and wet, and this year, the disease was most severe. The
above-mentioned treatment was the one I now relied on, and
was generally successful, when resorted to early in the disease ;
but if delayed, the disease was very fatal, particularly among
children. The diseases that prevailed here these two years,
were remittent, intermittent, and typhus fevers, in the summer
and fall, and pneumonia, extensively and severely, in the winter,
and early in the spring.

I now changed my location, left Oglethorpe, and settled on
the corner of Walton and Gwinnett counties. Here I met the
disease under its ordinary forms, until 1852, when, after a very
cold and pretty dry winter, warm, wet spring, and seasonable,
but not very wet summer, we had inflammatory dysentery, in
all its malignancy, to such an extent that very few persons, in
some localities, escaped it. It was now attended with high
febrile excitement, excessive vomiting, headache, and some-
times delirium ; constant tormina and tenesmus; very frequent
stools of blood and mucus, or bloody serum. This epidemic
was unusually fatal for this climate ; it proved fatal in a few
days, if not arrested. The treatment I varied; where there
was high arterial excitement, I resorted to venesection, with

462 Carithers Slow Action of the Heart in Fever. [August,

marked effect ; for the purpose of quieting the stomach and
bowels, I resorted to calomel and opium together. I gave the
opium, or some of its preparations, according to the case, in
doses sufficient to produce its specific effects, and the calomel
in doses sufficient to remove from the bowels all offending mat-
ters at once ; after this, I gave some of the preparations of
opium to keep the nervous system quieted and mitigate pain.
I also used warm hip-baths, warm poultices, and exciting em-
brocations of turpentine, camphor, aqua ammonia, &c. I
never suffered the bowels to remain locked up with the opi-
ates; but, with oil, blue mass, or rhubarb, I kept up daily evac-
uations of the small intestines, until the stools became mixed
with consistent fecal matter. If there was great tenderness of
the bowels and very obstinate tormina and tenesmus, after the
above remedies had been previously used, I usually applied a
large blister, and let it remain on four or six hours, and gave
injections of starch and morphia, which I found to be prefera-
ble to any other preparation of opium, and by injections, the
best way of administration. When the disease assumed a
chronic form, characterized by prostration, cold extremities,
coolness of the surface, frequent thin or watery evacuations, I
usually united to the morphia, the nitrate of silver, and gave a
little old brandy, or wine whey, to support the system. In re-
gard to diet, I enjoined the utmost strictness, in quantity and
kind, during the continuance of the attack and during conva-
lescence; for I found the relapses very frequent, from imprudent
indulgence in improper kinds and quantities of food. I generally
found most subject to it those who were enfeebled by dissipa-
tion and indolence, or those who lived grossly, &c. Among
children, I found those who were teething, or wormy, most sub-
ject to dysentery.

ARTICLE XXVI.

Two cases of Slow Action of the Heart in Fever. By James
Y. Carithers, M. D., of Hendricksville, Ala.

October 1st, 1853, was called to see Mr. S., aged 20, who
was taken with slight chill, with pain in head, back and ex-
tremities; skin hot and dry; tongue covered with a white fur,

1854. J Carithers Slow Action of the Heart in Fever. 463

attended with nausea and vomiting ; pulse 90. Ordered 20 grs.
Ipecacuanha, which caused free vomiting to take place, to be
followed at night with blue pill: on the following morning to
take five doses of sulph. quinine, 3 grs. each. At 4 o'clock,
P. M., had a light chill.

3rd. Slight fever, with great thirst to have oil to act on his
bowels ; to take next day three doses sulph. quinine, 4 grs. each,
and blue pill at night.

4th. No chill since last call : pulse 75 to take 1 gr. sulph.
quinine every two hours during the day, and a blue pill at night.

On the 10th he relapsed the skin became hot, and the pulse
rose to 94; on the 12th, the pulse fell to 70, and continued to
decline until the 17th, when it was down to 42 or 43, although
French brandv was given freelv. 18th. Pulse 40: has taken 10
ounces of brandy. 19th. Pulse 40 ; brandy continued. 20th.
Pulse 40 ; ordered brandy with iron. 21st. Appetite good, and
feels well ; treatment the same. 22d. Brandy increased to 12
ounces. 23d. Pulse 50 ; spirits improved. The pulse continu-
ed to rise until the 26th, when it was 84, and 84 when the
brandy was omitted, and the iron continued. I saw him
again on the 30th, and found him apparently well with his
pulse 64.

Case 2. Mr. A., aged about 34. was taken, Nov. 10th. 1S53,
with pain in the head, back and extremities : shin hot and dry ;
tongue moist, with a white fur; pulse 86. Ordered Ipecac. 25
grs., and five hours after to take 3 blue pills. 12th. To take
quinine. 4 o'clock, P. M., had a heavy chill. 13th. To take 4
grs. quinine every hour until he takes 16 grs., with 3 grs. opii.
14th. Slight fever to take castor oil. 15th. No chill to day.
He continued to improve until the 22d, when he was caught in
a shower of rain, and had a light chill and slight fever; pulse 74.
23d. Pulse 60. On the 24th, it was down to 52, when French
brandy was resorted to, 6 ounces. 25th. Pulse 46; stimulants
increased to 8 ounces, with iron. 26th. No change in pulse.
27th. Brandy, 10 ounces. 28th. Pulse 84: appetite good to-
day. 29th. Pulse 68 ; slight fever and headache ordered cas-
tor oil to act on bowels. 30th. Pulse 56; brandy and iron
continued. Dec. 2d. Pulse 56 : his spirits good to-day, and

404 Ergot : its use during Labor. [August,

says the brandy is the most palatable medicine he has ever ta-
ken. Dec. 4th. Pulse 60. He now considers himself well.

We are at a loss to account for the diminution of the heart's
action in these cases the number of beats per minute having
ranged from 40 to 50 without any evident cause.

TRANSLATIONS FOR THIS JOURNAL, FROU FRENCH PERIODICALS.

Ergot: Circumstances which contra-indicale its use during

Labor. By M. Paul Dubois.

Ergot, besides its well known hemostatic properties, is useful
when, from inertia, the uterine contractions are insufficient to
complete delivery. It is, however, to be regretted that this val-
uable remedy is so often improperly used. We have frequently
known it given when it was entirely unavailing, because unsuit-
ed to the case. This abuse, and the sad effects consequent upon
it, have contributed very much to discredit ergot in the minds
of many practitioners. We should, nevertheless, not be de-
prived of so precious an agent from the mere fact that it has
been injudiciously administered. We should rather endeavor
to ascertain the circumstances under which it may be advan-
tageously prescribed, and distinguish these from the contra-
indications to its use. The circumstances under which the
uterine contractions may be impaired without calling for the
use of ergot are sufficiently numerous to merit attention. The
following are some of the most common :

1st. Debility dependent upon a natural state, or induced by
previous disease. This requires tonics, broth, wine, &c, for
the purpose of improving the strength of the patient during
labor.

2d. Extreme distention of the uterus from an excessive quan-
tity of liquor amnii, which induces incomplete paralysis. The
uterine fibres being inordinately distended, the membranes
should be punctured whenever the os tineas is one-fourth dila-
ted, or about the size of a half-dollar.

3d. Congestion of the face, attended with impaired contrac-
tions from plethora. The patient should then be bled.

1854.] Hydrocyanate of Iron in Epilepsy. 4G5

4th. Mental disturbance from whatever cause, sometimes
from the presence of particular persons in the chamber, may
suspend the uterine contractions. The woman must be quieted
and the causes of annoyance removed.

5th. Great elevation of temperature in the apartment may
lessen the contractions by the cerebral congestion it induces.
The room should, in such cases., be well ventilated and cooled
if possible.

Gth. Pain, other than that of labor. Retention of urine, may
be so painful as to impair the contractions; catheterism should
then be practiced. Very great pain in the loins may likewise
affect them, in which case we should apply the forceps if labor
is sufficiently advanced if not, wait patiently. The same may
be said with regard to the headache which sometimes attends
each abdominal contraction.

7th. The premature discharge of the waters makes labor
slow, because, like all hollow organs, the uterus contracts most
forcibly upon unyielding contents, and that when the mem-
branes are ruptured the descent of the fetus at each contraction
lessens its force.

8th. The uterine contractility may become exhausted by the
tardy rupture of the membranes in consequence of the firmness
of these; rupture them. Rigidity of the os tincae from phlogo-
sis may do the same ; resort to belladonna or to general bleed-
ing. If the cause be unyielding induration of the tissues of the
cervix uteri, of which we have recently seen a case, the knife
should relieve the resistance.

9th. There may be posterior obliquity of the cervix which
will lessen the force of the contractu -ns. If the os does not
dilate of itself (and cannot be rectified by the finder Ed.) we
may have to divide its anterior lip with a probe- pointed bis-
toury.

Epilepsy treated with Hydrocyanate of Iron.
Dr. Jansion, of Bruyere (Tarn) published in the August No.
for 1841 of the " Journal des Connaissances" a paper contain-
ing an account of several cases of Epilepsy cured with hydro-
cyanate of iron. The first of those cases was dated as far back
as 1827. M. Fabre has also just published in the " Revue Med*

466 Hydrocyanate of Iron in Epilepsy. [August,

ico-Chirurgicale" similar facts derived from the practice of
M. Roux de Brignolles, Professor in the Medical School of
Montpellier. The first of these cases goes back to 1829. M.
Roux's case was that of a general, who having in 1814 retired
from the army, and changed from an active to a sedentary life,
experienced various impairments of health, the most serious of
which consisted of epileptic attacks, which were rare at first,
but which subsequently recurred as often as three times a day.
The patient felt the premonitory aura epileptica ascending from
the lower extremities to his head. The general would stagger,
sometimes with loss of consciousness, but most frequently with
mere vertigo. In 1829 he was subjected to antiphlogistic treat-
ment, which only aggravated the case. It was then that M.
Roux prescribed for him the Hydrocyanate of Iron. Pills con-
taining i grain of this preparation and 1 grain Pulv. Valerian
were ordered night and morning. The daily number of pills
was gradually carried up to 16 ; at the end of three months the
general was free of attacks and he has had none since, although
24 years have elapsed.

M. Roux reports six cases cured by this remedy one of
which we have just related ; the remainder will be briefly no-
ticed. One of the most remarkable was that of a country lad
20 years of age, who upon being greatly frightened, had a com-
plete attack of epilepsy ; fell into convulsions, foamed at the
mouth, urinated involuntarily, with prolonged unconsciousness.
These attacks recurred frequently during four years. The hy-
drocyanate was administered, at first with pulv. valerian, with-
out effect. The disease, however, yielded very soon upon the
use of the Hydrocyanate alone, in doses of a grain (5 centigr.),
and gradually disappeared entirely. The treatment was con-
tinued 8 months, and 20 years have now elapsed without a re-
turn of the disease.

An epileptic patient, aged 16 years, whose case was recent,
but the paroxysms frequent and violent, was completely cured
in six months by the use of the hydrocyanate and valerian. A
girl of sixteen, who menstruated badly and was affected with
complete epilepsy, was also restored to health by its use 8 months.
The other 3 cases were equally successful. The quantity, in
pills, was gradually increased from 1 to 16 grains per day.

1854. J Sciatica treated by medicated tissues. 467

Sciatica treated by medicated issues.
M. Trousseau observes that morphia applied to blistered sur-
faces answers very well; but that this plan is both painful and
expensive. He has therefore adopted the following method of
introducing remedial agents within the tissues. The patient,
lying upon his abdomen, a crucial incision is made over the
sciatic notch with a bistouri, and a medicated pea is fixed in the
centre ; thus answering the double purpose of an issue and of
a local anti-neuralgic application. This is M. Trousseau's for-
mula: $. Opii.

Ext. Belladon., aa 2 gram. (30 grains;)
Pulv: Guaiac: Res: et mucilag. q. s.
M. pt. Pil. No. xx.
Each of these pills will therefore contain 3 grs. of active
matter. They should be dried by gentle heat, and will, in con-
sequence of the guaiacum become very hard. They ought not
to be used the first day. The incision having been made, force
down into the centre a common pea, which has the advantage
of a fine polish, is unirritating, and will by swelling enlarge the
cavity for the reception of the medicated pill. On the second
day, one of the pills is to be introduced with two common peas
and the whole covered with lint and adhesive plaster. If, on
the third day, the patient has not been too much narcotized, two
pills may be introduced and thus the number increased to 3 or
4, according to the necessities of the case. In a week the cure
will generally be nearly completed. As this disease is liable to
return, M . Trousseau advises to keep up the suppuration of the
issue for two or three weeks after the cessation of pain. We
thus secure a good revulsive and at the same time keep open
the door for the introduction of narcotics, if they again become
necessary.

Perchloride of Iron as a Hemostatic.
M. Moissenet has used a solution of this preparation, more
or less strong, at the Salpetriere, in cancerous affections accom-
panied by hemorrhage, instead of cauterization and tamponing.
As it has as yet been tried only in a few cases, its beneficial
effects cannot be positively asserted ; but in one case of cancer-
ous breast, and four cases of uterine cancer, it has been of great
utility in arresting the hemorrhage and prolonging life.

468 Solidification of Cod-liver Oil. [August,

In cancers situated externally, within reach of the hand, M.
Moissenet passes a small brush wet with the solution over the
seat of the hemorrhage for two or three minutes. In the deep-
er parts, he inserts small pieces of lint, having first wet them
with the solution. He washes the fungous parts for some days
with a solution of 30 grammes of the perchloride and 250
grammes of water, (or 1 part to about 8* water). This solu-
tion is used in injections for uterine cancer.

Solidification of Cod-liver Oil.

M. S. Martin, apothecary, of Paris, proposes the following
process for the solidification of cod-liver oil, by which its admin-
istration may be rendered much less objectionable.

Take of Cod-liver oil 125 parts Spermaceti 23 parts in sum-
mer or 20 parts in winter. Mix, and heat in a closed vessel
over a sand-bath then pour it into a large-mouthed bottle
and allow it to get cold without being agitated. The remedy
may be made aromatic by the addition of some essential oil.
Cod-liver oil thus prepared resembles jelly ; it may be taken
rolled up in bread moistened with sweetened water, or covered
with pulverized gum, liquorice or starch.

On Irritability nf the Bladder. By Hevry Thompson, Esq.,
F. R. C. S., M. B. Honorary Surgeon to the Marylebone
Infirmary.

The phrase, irritability of the bladder, is a term which hns
long been employed both in and out of the profession, and
which has become popular, rather on account of a certain con-
venient comprehensiveness and indefiniteness of meaning of
which it is suscepiible, than for any value which can be attri-
buted to it as an explicit or perspicuous expression.

The usage of it, which is commonly adopted, comprehends a
verv wide and varied extent of signification, presenting at least
two very distinct and different ideas; occasionally one of these
only is implied, although much more generally the term is em-
ployed in a manner which renders it impossible to say which
of the two is intended, or which conveys a confused notion,
involving a joint consideration of both.

In one of these senses, irritability of the bladder denotes
nothing more than the phenomenon of unnaturally frequent

1854.] On Irritability of the Bladder. 469

micturition, and it is thus employed in describing one of the
prominent symptoms of calculus or urethral stricture. In the
other, it is used for the purpose of designating some affection
of the bladder assumed to be present as the occasion of that
symptom, especially when the cause does not appear to the
inquirer to be very obvious or explicable.

Now, nothing can be more objectionable than the unguarded
use of a term to which are attributed two such very different
significations. Neither can it be otherwise than mischievous
to employ it in the very loose and uncertain manner of which
the latter is an example.

The simple condition described by the term in the sense
which was first named is one of veiy frequent occurrence
among individuals of both sexes, and it is always attended with
much annoyance, and often with severe distress to the sufferer.
It can rarely or never be overlooked by the patient, and can
scarcely fail to be recognised by the surgeon, while the right
interpretation of it is often of the greatest importance to both.
It is a condition which constitutes the whole of the objective
as well as the subjective signs in some diseases of the viscus in
question ; while in many it is the most distressing to the patient,
and the most wearing to the constitution of all his symptoms.

It is not surprising, then, that it should, not only by the pa-
tient, but even by the medical practitioner, come to be regarded,
not merely as a sign or symptom of some morbid slate, the seat
of which may in reality be very remote, but as the manifesta-
tion of a disease localized in the bladder itself a state which,
in the absence of the sicns of inflammation there, comes to be
denoted by a term which I think it will appear can be rightly
applied only to the symptom in question. Hence we often find
"irritable bladder" prescribed for, apart from any distinct
views of itj cause, and even without much investigation I here-
of at ail events with so much only as shall exclude its better
known and more geneially recognized causes, such as cystitis,
prostatitis, urethritis, and stricture of the urethra ; and if these
are absent, there appears to be a tendency to refer the symp-
tom to some ideal condition of the bladder assumed to be pre-
sent, which it saves our trouble, and shields the imperfection of
our knowledge, to express by this term of irritable bladder.
Hence we find the subject treated somewhat in this manner by
authors on Diseases of the Bladder. A chapter on " Irritabili-
ty," as a disease, usually follows or precedes the sections which
are devoted to the consideration of those morbid states which
we understand by the terms acute and chronic inflammation.

Thus, Dr. Gross, of Louisville, in his large treatise on
"Diseases of the Urinary Bladder," &c, after discussing the

X. S. VOL. X. NO. VIII. 30

470 On Irritability of the Bladder. [August,

acute and chronic inflammations, classifies "irritability" under
the "nervous affections of the bladder," and commences the
chapter with these words: *' The characteristic symptom of
this disease is frequent micturition."* Mr. Coulson, id his well-
known and useful work en the same subject, remarks that " this
term is usually employed to denote any affection of the bladder
attended with frequent desire to void the urine. I wish, how-
ever, to express by it a frequent and often irresistible desire to
micturate, not arising from inflammation, nor from any organic
affection of the bladder or prostate gland, and sometimes, but
not always, attended with pain. The frequent desire to mic-
turate is the chief symptom of this complaint. "f Sir Benjamin
Brodie appears carefully to guard against the source of error
alluded to above, commencing an exceedingly short paragraph
upon the subject, in his valuable work on the "Urinary Organs,"
with these words: "III the greater number of cases of disease
of the bladder the "most maiked symptom under which the pa-
tient labours is a too frequent inclination to void the urine.
The bladder is irritable ; and those who have not combined
wilh the observation of symptoms the study of morbid anatomy,
are apt to confound with each other diseases which are essen-
tiallv different, under the general appellation of irritable blad-
der"!

Now, in harmony with the spirit of tl e last quotation, I
venture to suggest that we shall be more likely to advance the
true pathology of the important organ under consideration If
we will consent to exclude from the term ''irritable bladder"
any kind of nosological import, to permit it to convey to the
mind no suggestion in the light of a disease, but to limit its
meaning to that which in truth is all that it possesses viz.. the
expressing a symptom, and a symptom only, of which it is the
province of the surueon to determine, if possible, the true
cause; and if it should appear that the seat of the complaint,
the cause of the frequent micturition, is generally not in the
bladder at all, but in some adjacent or remote part of the body,
we shall, I think, at the same time, see the propriety of reject-
ing that usage of the term which involves a pathological sense
in connexion with the bladder, and limited to that organ alone.
At present its employment in the signification of a disease tends
greatly to prevent the formation of a true diagnosis, inasmuch
as a consent to accept the term in any given case satisfies some
minds, and checks further inquiry, so that the common error
of substituting an unmeaning name for a thing of reality is apt

* Pase 192.

t Diseases of Bladder and Prostate Gland, fourth edition, p. 84.

; Leciures on Diseases of ihe Urinary Organs. Fourth edition, p. 90.

1854.] On Irritability of the Bladder. ill

to be committed. On the other hand, its employment as the
designation of a symptom only will stimulate us in the attempt
to elicit from nature the real seat of the morbid action.

On these grounds, therefore, I propose to regard this com-
mon and troublesome cause of complaint on the part of the
patient, this symptom of frequent micturition, as a matter for
inquiry, in relation chiefly to its etiology, in the present and
two or three succeeding papers: and in order to prevent mis-
understanding, I shall propose to define irritability of bladder
to be a condition in which expulsive efforts are made by the
organ with unnatural frequency, whether contents are present
or not, whatever may be the cause which gives rise to the
contractions. This condition is found in practice to manifest
very widely-differing degrees of severity, and to be attended
with some concomitant circumstances of a varied character.
Generally speaking, irritability is denoted when a constant or
almost constant desire to pass urine exists. Of this sensation,
recurring exacerbations usually take place with more or less
frequency. These may be wholly irresistible, compelling the
patient to yield to overwhelming efforts at expulsion, in which
he passes a few drops of urine, or perhaps none at all, for the
bladder may be perfectly empty. So far from relieving the
sufferer, the effort of contraction is often productive of great
agony, and its recurrence is dreaded. In other cases the de-
sire is by no means constant, but is only felt at intervals of
some minutes, or it maybe of half an hour or an hour, and then
great pain is experienced unless the wish be gratified. To all
those cases which exhibit much involuntary paroxysmal effort
the term spasm is commonly applied.

The usual number of times which a healthy man requires to
empty the bladder is from three to five in the twenty-four hours,
although perhaps a greater frequency may be occasionally as-
sociated with some peculiar idiosyncracy or particular state of
the system, which it would not be correct to characterize as
morbid. Any marked deviation from this habit in the direc-
tion of frequency becomes a svmptom conveniently expressed
by the term ''irritable bladder."

One of the most potent causes of irritability of the bladder
is inflammation, generally chronic, rarely acute, affecting most
commonly its mucous lining only, at all events at the outset of
an attack. Any degree of inflammation in this coat gives rise
to irritability; the extremities of the sensory nerves distributed
to it forming afferent communications with the neighboring
centres, from which motor impulses are propagated to the
muscular coat of the viscus, and to the auxiliary muscles em-
ployed in the act of micturition. Excito-motory acts, however.

472 On Instability of the Bladder. [August,

are produced in a great variety of ways. Sources of irritation
are to be found, net only in the organ itself, but at a distance
from it. On taking a close survey of these, as far as my means
of observation have enabled me, I beg leave to suggest the fol-
lowing classification of causes of irritability of the bladder, and
by means of it to attempt an arrangement which shall be natu-
ral and comprehensive, and practically useful in assisting our
diagnosis in relation to this important symptom. We shall do
well, however, to bear in mind that its object is to facilitate the
process and to improve the method of diagnosis, and that it
should be regarded merely as a means to this end a means
necessarily imperfect, and in the details of its arrangement
probably open to some objections, on account of the varied
points of view from which many of the causes themselves may
be regarded by different minds.

Irritability of the bladder, regarded as a symptom only, may
be considered as resulting from various causes, which are clas-
sified under the following heads:

A. Certain conditions of the bladder itself.
B Abnormal character of its contents.

C Some abnormal and acquired conditions of adjacent or allied vis-
cera and other pints, the disease being of a locl character.
J). Certain derjngements of the assimilating and nervous systems.

A. Certain Conditions of the Bladder itself.

1. Inflammation, acute.

' chronic or subacute.

2. Cystorrhopa or congestive catarrh, from atony and relaxation
of the capillaries of the mucous membrane, and usually a se-
quence of inflammation.

3. Abrasions and ulcerations of the mucous membrane.

4. Abscesses in the walls of the bladder.

5. Thickeningof all the structures of the bladder from inflammatory
deposi;, so that the capability of the orgm for contraction and
dilatation is much impaired. The capacity being thus consid-
erably diminished in some cases, a frequent desire to pas9 urine
exists.

6. Guilty and rheumatic affections of the bladder, when, as is
sometimes the case, thes<* are the only local manifestations of
constitutional derangement. The rheumatic affection appearing
to he occasionally a sequence of gonorrhoea, and probably be-
longing to the same category as gonurrhoeal affections of the
joints.

7. Increased or modified sensibility, usually of the neck of the
bladder, no inflammation being present. Severe pain in the re-
gi m of the bladder (neuralgia) from the same cause.

8. Tumours: simple mali^uuut.

1854.] On Irritability of the Bladder. 473

B. Abnormal Character of its Contents.

1. Urine containing an unusual quantity of acid or alkali, especial-
ly in Oxaluria and Phosphuria, also when there is an excess of
uric acid ; often associated with some form of chronic dvspep.i.a.
Urine passed in an unusuails large quantity.

2. Urine containing an admixture of certain drugs; ascantharides,
the turpentines, &c.

3 Foreign bodies in the bladder, giving rise to spasmodic contrac-
tions of its muscular parietes; as calculi, not only when large,
but sometimes when of small size, and termed gravel; coagula-
ted blood, and lymph.

C. Some Abnormal and Acquired Conditions of adjacent or allied
Viscera and other parts, the disease being of a local character.

1. Obstructions in the urethra.

" from organic stricture.
" " growths in the urethral canal.

l< " prostatic enlargement, whether from senile de-

generation with hypertrophy, or other tumour.

2. Malformations of the prepuce, when its oritice is small, or when
it is long and narrow.

3. Urethritis, balanitis, and inflammatory phymosis.

4. Prostatitis, acute and chronic.

5. Vaginitis.

6. Painful vascular tumour of urethra meatus in the female.

7. Perinaeal, ischio rectal, or other adjacent abscess.
8 IJcemorrhoids.

9. Fissure of the anus, prolapsus recti, and other organic diseases
of the bowel.

10. Prurigo about anus.

11. Scyba'a in the intestines.

12. Intestinal worms, particularly ascarides.

13. Organic diseases of the kidney; the irritability not being caused
by the unhealthy character of urine secreted (Division B), but
by means of some other medium of relationship between the kid-
ney and bladder.

14. Impregnated uterus.

15. Diseases of the uterus and appendages. Misplacement of ute-
rus, as prolapse, retroveision, &c.

D. Certain Derangements of the Assimilating and Nervous Systems.

1. The gouty and rheumatic diathesis, no evidence of distinct local
implication existing.

2. Hysteria, "spinal irritation," as associated with irregularities
of the menstrual function.

3. Irritable or mobile conditions of the nervous system ; in elderly
patients, probably connected with organic cerebral changes; in
middle age and youth generally resulting fiom anaemia and
spansemia, caused perhaps not uufrequcnlly by venereal excess-

474 On Irritability of the Bladder. [August,

es; in childhood and infancy, a naturally active state, in which
dentition and other remote sources of irritation are exciting causes.

4. Diseases and injuries of the brain and spinal cord.

5. Mental emotions. Anxiety, fear, &c.

Frequent micturition may be a habit due entirely to false mental
impressions; it may have been induced by some of the causes above
mentioned, and persist in this manner after the cause is removed.-

PART II.

It is no part of my intention to expatiate here on the more
generally recognized causes of frequent micturition those, in
short, with which all are sufficiently familiar; but rather to re-
fer to some of those which have received less attention, and
appear to be capable of less easy solutions. Instead, however,
of indicating them at once, it will be more advantageous, per-
haps, to arrive at their consideration through a brief notice of
the diagnostic signs, presented by the various morbid affections
named in the Table, commencing with those which are most
commonly known and readily identified.

In attempting to form the diagnosis of any case of difficulty
or obscurity, it will be desirable to proceed by process of ex-
clusion, and set aside in their order as many as possible of the
affections to which it is known irritability may be due. Thus,
in the first place, there will be no difficulty in detecting a form
of disease, very uncommon, but sufficiently marked viz., the
acute inflammation of the bladder by the intense pain felt
about the pubes and perineum, with excessive tenderness,
especially in the former situation; by severe and darting pains
constantly experienced in the groins, sacral and lumbar regions;
while incessant spasmodic straining is present, with fruitless
attempts to micturate, often of a most agonizing character.
Together with these, severe constitutional symptoms are inva-
riably present. The subacute form, much more frequently
met with, is easily recognized by the presence of pain, gener-
ally dull and heavy, referred chiefly to the suprapubic region,
often to the penis, testicles, and thighs; and by the tenacious
mucous discharge, in greater or less quantity, which, mingling
with the urine, is so characteristic of this condition of the vesi-
cal mucous membrane. In connexion with these symptoms,
the patency of the urethral canal is to be determined by the use
of the catheter, in order to ascertain the presence or absence
of obstruction either from organic stricture or prostatic disease.
The complication of calculus is indicated by the ordinary
symptoms superadded to the foregoing, such as occasional sud-
den stopping of the stream of urine, some haematuria, pain in
the glans penis and at the neck of the bladder after micturi-
,tion, these pains being increased at all times by sudden or

1854.] On Irritability of the Bladder. 475

violent movements of the body, such evidence being confirmed
by the practice of careful sounding, repeated as frequently as
may be necessary. The same process may reveal the presence
of any growth within the viscus, from which all the subjective
symptoms of calculus may arise, and even physical sign of
rough grating to the sound may be communicated from ad-
hering sabulous matter. The careful employment of exploring
instruments, generally in such cases a painful and somewhat
injurious process, repeated as often, and not oftener than is ab-
solutely necessary, with the simultaneous examination of the
base of the bladder from the rectum, will assist in determining
the size and situation of the growth. This may spring from
the prostate, generally from the neck or base, rarely from the
sides of the bladder. There will be bloody and frequently of-
fensive urine, often with thick, clotted, or sanious discharge ;
and in a later stage, the debris of tissues may appear by the
urethra, if the disease be of malignant character. Among these,
the microscope will sometimes but it would seem not invari-
ably, according to the experience of observers detect the
existence of ceils similar to those met with in carcinomatous
formations found elsewhere. One of the strongest confirma-
tive signs of the malignant character of the complaint will be
found in the cachectic condition of the patient, and in the pre-
sence of that peculiar sallow tint, which never appears more
strongly marked than in these cases.

The fluid contents of the bladder must, in all cases, be sub-
mitted to close inquiry, a proceeding which is of the first
importance, in order to ascertain correctly the chemical and
microscopical character of the urine and its deposits that is
to say, the degree of acid or of alkaline reaction, the nature of
the salts present, the existence of albuminous matters, of sugar,
&c. Following these inquiries, the condition of the kidneys
should be the subject of careful investigation. Some organic
renal diseases, or some stages of such diseases, are not attended
with vesical irritability, but the reverse is more commonly the
case. The evidence of structural degeneration will be found
in part from the constant appearance of albumen in the urine,
from the presence of diseased epithelium and urinary casts
under the microscope, generally found co-existing with in-
creased quantity and low specific gravity of the secretian itself,
as well as from the cachectic condition of the patient, the dry
and pallid skin, the stomach derangement, pains in the loins,
and about the pubes, and, lastly, from the anasarca of the cellu-
lar tissue which more or less at some period or another, makes
its appearance.

Simple inspection is sufficient to determine the existence of

476 On Irritability of the Bladder. [August,

malformation of the prepuce, as when it is unusually long and
narrow, of the meatus externus, of balanitis, of phimosis, or
paraphimosis. An inquiry for recent attacks of urethritis in
any form, but particularly the gonorrhoea!, and an examination
of the prostate gland per rectum, where other symptoms indi-
cate such a course, together with the presence of perinaeal
swelling or tenderness, will furnish evidence respecting inflam-
mation of that organ. The various affections of the rectum
are febrile sources of too frequent micturition, and must be
strictly inquired for, especially with patients of the female sex,
such being exceedingly prone to consult their medical adviser
respecting the symptom in question, and at the same time, fail-
ing to mention or denying the existence of any hemorrhoidal
or allied affection, which is very often the sole cause of the evil
complained of. Vaginal, uterine, and ovarian affections of va-
rious kinds, come next in course, and are by no means unfre-
quent causes; such are ulcerations in any part of the female
passages, misplacement of the womb, &c. Among them, a
small growth of the so-called florid vascular tumour of the
urinary meatus is by no means an uncommon cause of a whole
train of painful symptoms, among which vesical irritability is
prominent. It may be no bigger than a full-sized pin's head;
its existence, perhaps, is unobserved and unsuspected by the
sufferer; nevertheless, it may be the sole cause of ail her suffer-
ings. I have but very recently met with an apparently very
obscure case, in which a distressing irritability was due to one
of these giowths, situated entirely within the urethral orifice,
and, theielbre, unseen except by opening the meatus. On the
other hand, in young patients of both sexes we daily find intes-
tinal worms, and, in elderly people, hemorrhoidal and pruri-
ginous affections occasioning unnaturally frequent micturition.
Such as these are some of the more easily recognised and
common causes of irritability of the urinary bladder. Still it
is obvious enough that there are not unfrequently cases pre-
senting themselves to the surgeon, in which, having excluded
all these by rigid inquiry, the morbid symptom remains unex-
plained and obscure. Such are the cases termed nervous or
neuralgic, or simply irritable bladder, by some writers. I have
contended that we are not justified in stopping here to employ
such terms, but may with advantage push our inquiries further
in search of the pathological seat of the disease, whether it be
of a functional or an organic character.

Among the less obvious causes of irritable bladder, no or-
ganic lesion having been detected, is some abnormal condition
of the urine itself, which, while it often indicates certain errors
either in the assimilating or in the excreting functions, may

1854.] On Irritability of the Bladder. 477

also be an early Bfgn of organic changes occurring in the kid-
ney. I believe that a chronic and insiduous form of kidney
disease is sometimes presented first to the surgeon, in an early
stage, in which a superficial examination of the patient will de-
tect no other sign than a somewhat unintelligible and obscure
irritability of the bladder, although close investigation may
render probable the existence of incipient organic disease;
while in more advanced stages of the affection other signs
manifest themselves, and the patient is often committed to the
care of the physician, to whose province the treatment of renal
disease is commonly supposed to belong. Jn the absence of
apparently serious lesions, the persistent deposit of an undue
amount or' oxalic acid in the urine, in the form of the oxalate of
lime, is often associated with irritability of the bladder, and may
occasionally be the only marked deviation from health which
can be noted respecting it Dyspeptic ailments, are, however,
commonly present, and a more or less impaired condition of
the vital powers generally. Individuals who are much engaged
in close mental occupation, or who are the subjects of excite-
ment and anxiety, seem especially prone to mamfest this parti-
cular derangement. Too much attention can scarcely be given
to the continuous examination of the urine, where the concur-
rence of obstinate dyspeptic symptoms and vesical irritability,
pain, or uneasiness are presented, ff oxalates appear in a
regular and persistent manner, we shall in very many instances
ol this really frequent affection find reason to regard the whole
train of symptoms as due to that form of mal-assimilation which
has been indicated by the phrase oxalic-acid diathesis. The
researches of Dr. Prout especially, as well as of Dr. G. Binl,of
Dr. Begbie of Edinburgh, and others, have rendered this subject
familiar to practitioners. 1 have met with some examples ot
supposed local disorder of the urinary organs among patients
.who were labouring under the derangements alluded to, but
who proved to be quite free from vesical or renal disease. In
one of these, the urine, which was daily examined, exhibited on
three occasions the rare form of dodecahedral in the place of
octahedral oxalates. In that, as well as in other cases, 1 have
found great benefit to accrue from the persevering use of the
nitro-muriatic acid, as first recommended by Dr. Prout. com-
bined with attention to the functions of the bowels and skin.
Under the remedy named, the oxalate of lime disappears, the
uric acid gradually replaces it in normal quantity, and the irri-
tability of the bladder ceases to be complained of. As conva-
lescence advances, the addition of the tincture of the sesqui-
chloride of iron to the acid appears to be often exceedingly
serviceable.

478 On Irritability of the Bladder. [August,

Uric ncid in excess, met with, however, in a very different
class of patients to those last considered, is very often associa-
ted with unnaturally frequent micturition, generally perhaps
in cases where there appears to be some tendency to the
gouty or rheumatic diathesis. That vesical irritability and
even urethritis, may be the only very obvious manifestations
of the gouty tendency exhibited by some patients, is a belief,
now at all events commonly accepted. That they sometimes
appear in conjunction with the most common manifestations of
the gouty diathesis is well known. When any doubt in rela-
tion to this cause exists, inquiry into the family and personal
histoiy of the patient will assist the diagnosis; at the same
time we shall seek for the presence of other signs of gout, ap-
pearing usually in persons of middle age ; the predominance of
lithic acid in the urine; undue vascularity of the skin and mu-
cous membranes ; disposition to chronic cutaneous eruptions ;
the better recognised symptoms of masked gout, as it is termed,
such as sudden pains in the precordial region; palpitation of
the heart ; wakefulness and restlessness at night, &c., all these
taken together will confirm the existence of a complaint, the
judicious treatment of which, on principles which are generally
recognis -.1. will do more to allay the irritability of the bladder
than any other means supposed to have a more direct influence
upon that organ. Thus it is not uncommon to meet with these
patients beliving themselves to be sundering from stricture or
prostatic disease, but whose symptoms disappear under a care-
ful regulation of the diet, with sufficient exercise, and the judi-
cious use of mild mercurial alteratives, with colchicum and
alkalies. In regard of these latter most useful agents, in cases
for which they are indicated, perhaps there is no form so suffi-
cient or so well borne by the stomach, and certainly none so
agreeable, as solutions of the carbonates and citrates of potash
which have been well charged with carbonic acid. They are
prepared in the ordinary form of aerated waters, and are great-
ly preferable to water containing the carbonate of soda. On
this ground, and on that of practical obseivation of their use,
I believe them to be more potent and more certain than the
Vichy water, for most of the purposes for which that agent is
commonly employed, while at the same time they are so much
more economical. Thus, where deposits of uric acid assume
the form of gravel a condition very frequently associated
with irritability of the bladder the potash water may be most
advantageously taken as a solvent, while relief of the symptom
referred to is experienced simultaneously. There is another
good reason, also, why these waters should be more valuable
agents than the same doses of alkali given in the usual form of

1S54.] Diseases of the Scalp. 411

draught or mixture. Pure water itself is the best solvent of
saline matters in the urine, and the large quantity taken with
the dose by the former mode probably accounts to some extent
for its efficacy as compared with the latter. Besides, water in
quantity acts as a diluent to all the urinary principles, and so
renders the urine less irritating to the vesical mucous mem-
brane already become more susceptible than in health, a condi-
tion arising in part from continued exposure to the unduly acid
secretion, and in part from the primary malady, whatever it
may be. which more or less induces a morbid condition of the
mucous tracts of the body generally. The action of the
carbonic acid extricated in the stomach appears also to be
beneficial, and when we take into account the fact that some
derangement of the assimilating functions lies at the root of the
evil, that deficiency of tone is manifested in the reducing organ
itself, it is not improbable that the gas may be regarded as an
additional element of some value in the compound. [London
Lancet.

(To be continued.)

The Pathology and Treatment of Diseases of the Scalp, popu-
larly known by the name of Ring- Worm. Bv Dr. William
Jenxer.

[The difficulty of diagnosing (diagnosticating Ed.) eruptive
diseases of the scalp, is owing partly to their similarity to each
other and partly to the different names given by different authors
to the same thing. Popularly, ringworm is looked upon with the
greatest anxiety and annoyance, as the term is supposed to
represent a very obstinate and contagious disease.]

What is populaily meant by ringworm was by some of the
older writers on skin diseases expressed by the word tinea :
but the technical name being found, as our knowledge ad-
vanced, to have no definite signification, gradually fell into
disuse. "

It has been recently proposed to employ this word tinea
again, and to give to it a precise signification. Under the
eric name tinea it is proposed to include all diseases of the hairs
produced, kept up. or attended, by the development of parasi-
tic plants.

In this genus are included the following species: Tinea
favosa; Tinea tonsurans ; Tinea decalvans ; Tinea sycosa.

It is to this genus tinea, and to these species of that genus,
that I desire especially to call your attention ; and I am confi-
dent that if you remember the names of the species of tinea I
have just repeated, if you learn what I am about to tell you of

430 Diseases of the Scalp. [August,

those species, and observe well the things I shall presently
show you, the remaining and more common diseases of the
scalp will be mastered in a very few hours spent in the out-
patient's room.

Tinea favosa most commonly affects the hairy scalp, but
now and then it is found on other parts of the surface. It is
characterized by thick, dry, yellow crusts, which, if small, are
circular in outline and depressed in the centre, cup-shaped.
Passing through the centre of each of these crusts, is a hair.

It the crusts are very large they have an irregular shape, but
still they indicate their origin from distinct centres by the semi-
circular outline of the masses which project from their margin.
These larger, irregularly-shaped crusts, are pitted on the sur-
face, and. from their fancied resemblance to ihe cut surface of
a piece of honey-comb, the disease has received the name of
fa\ us.

The margin of the large crusts rises considerably above the
level of the cutis; internally, they seem as though hall buried
in the substance of the cutis. Carefully detach the crusts from
the cutis, and a distinct layer of epithelium is found below
them ; examine the surface of the smaller crusts, and you find
a layer of epithelium cover them.

The hair, at an early period of the disease, can be pulled out
from the centre of each little crust with great facility ; subse-
quently it falls oil from the diseased parts, and permanent bald-
ness results.

The crusts, then, of tinea favosa are remarkable for their
tin kness, dryness, brittleness, and depressed centre. Tinea
favosa is not a pustular disease, but it is said, by those who
have seen much of it (it is a rare disease in London), to be often
consecutive to eczema, impetigo, chronic lichen, and herpes
ciicinatus; pustules are sometimes formed subsequently to the
tinea favosa, in consequence of the inflammation excited by the
crusts, and the injury inflicted on the scalp by scratching.

Tinea tonsurans is olten mistaken for herpes circinatus of
the scalp, with which it is now and then conjoined. It is char-
acterized by pallor, decolorization, and brittleness of the hairs,
and the presence of thin white powdery scales around the base
of the hairs, and on the skin between them. The diseased hairs
have been likened to "tow." "They are," Mr. Wilson says,
"remarkable lor their bent and twisted shape, and resemblance
to the fibres of hemp in colour and apparent texture." Their
brittleness is sometimes such, that every hair on the affected
spot is broken off just above the surface of the skin.

In Tinea decalcans the hair falls out rapidly from one or
more circular spots, leaving a smooth bald surface. There is
no eruption of any kind, no crusts, no scales.

1854.] Diseases of the Scalp. 481

Tinea sycosa is characterized by inflammation of the hair
follicles. Sometimes the inflammation leads only to the effu-
sion of serosity. and the exudation of lymph around and into
the capsule of the hair. At other times, and more commonly,
pus is formed, and then, when the pustule breaks, a brownish
s<-ab is formed on the surface. The usual seat of tinea sycosa
is, the chin, upper lip, and sides of the cheek. I had a case
lately under my care in which the pustules occupied the inner
surface of the nares, that part from which the hairs spring
that protect the orifice of the nose. Tinea sycosa rarely occurs
on the scalp, and it does not spread circularly ; so far as I know,
the name of ringworm has never been applied to it. I mention
it to you to-day, althougli I have no example of it among my
patients to show yon, because of its relation to the species ot
tinea of which we have examples before us.

You will have remarked, then, from the characters of the
species of linea I have mentioned, that

Tinea favosa is especially characterized by its crusts.

Tinea tonsurans is especially characterized by decolorization
and brittleness of the hair.

Tinea decalvansis especially characterized by baldness, not
preceded or accompanied by an eruplion.

Tinea sycosa is especially characterized by inflammation,
tenderness, hardness, and suppuraiion of the hair follicles.

] told you that these diseases are arranged together in one
genus, because in all a parasitic plant is developed in connexion
with the hairs. Now, the plant present is different tor each
species of tinea ; and the situation occupied by the parasite is
aiso different in each species of-lhat genus.

In tinea favosa, the parasite is the achnrion ScLbnleinii.
This plant has mycelium, sporule-bearing branches and spor-
ules. The sporules are round or oval, and their diameter va-
ries, according toGruby, from 0*003 mm. to 001 mm.

The vegetable growth is first perceptible between the layers
of the epithelium, just at the orifice of i he hair follicle; from
this point it may spread downwards between the hair an<l its
capsule, and upwards around and in the substance even of the
hair.

Such of you that visited ward 4 during the time Jacobs was
in the hospital, had frequent opportunities of seeing the myceli-
um, the snoi ule-bearing branches, and the sporules of the achn-
rion Sc/ibnUinii. You will recognise it in these very excellent
drawings of Robin.

In tinea tonsurans, the parasite is the trichophyton tonsurans.
This plant is composed of spores only ; the spores, however,
are occasionally somewhat elongated, and arranged in a linear

482 Diseases of the Scalp. [August,

series. They are round or oval, and their diameter varies from
0.003 mm. to 0 01 mm.

The primary seat of the trichophyton tonsurans is the root
of the hair; subsequently, it extends up into the substance of
the hair, and even outwards, according to Bazin, on the skin
between the hairs. I have under the microscope some hairs
removed from the head of one of these children. You will see
in one specimen the spores in the hair follicle ; and, in another,
the hair split up with the spores among the fibres, as figured in
this plate by Bazin, and in this more highly magnified drawing
by Robin.

In tinea decalvans, the parasitic vegetable is the microsporon
Audouini. This plant is formed of branch filaments, on which
the spores are developed. The spores are very small from
0 00] mm. to 0.005 mm. The seat of the growth is the outside
of the hair; it forms a sort of sheath around the hair, from the
surface of the skin upwards, from 1 mm. to 3 mm. Gruby first
described this plant, and its relation to tinea decalvans ; and Ro-
bin says, he can confirm the accuracy of Gruby's description.

Jn tinea sycosa, the parasite is the microsjtoron mentagroph-
ytes. It is also composed of filaments and spores } but the
spores are larger, and the filaments broader, than those- of
microsporon Audouini.

The seat of the growth is the hair folicle between the hair
and the capsule.

I have told you the names I would have you employ to sig-
nify the diseases I have described and demonstrated to you;
but you ought also to know the names employed by the
writers on skin diseases most popular in this country, to signify
the same things.

Tinta favosa, then, is called Porrigo favosa by Willan and
Bateman; Favus by Dr. A. T. Thomson, Simon and many
other writers.

Tinea tonsurans is called Porrigo scutulata by Willian, Bate-
man, and Dr. A. T. Thompson ; Herpes tonsurans by Cazen-
ave ; and Trichinosis furfuracea by Mr. Wilson.

Tinea decalvans is called Porrigo decalvans by Willan and
Bateman ; Vitiligo of the hairy scalp by Cazenave.

Tinea sycosa is called Mentagra by Willan and Bateman ;
Sycosis by Mr. Wilson.

As to the etiological relation of the parasite to the disease,
it appears that the spores of the vegetable growth require for
their developement a peculiar nidus. I say so, because all
persons who mix with children suffering from tinea do not have
the disease. But if a soil highly favourable to their growth
exists, then a spore having found its way on to that soil develops

1854.] Diseases of the Scalp. 482?

and forms other spores, and so the parasite spreads over the
surface of the individual more or less rapidly, according to the
more or less favorable nature of the soil.

[As tinea commonly appears amongst strumous and dirty
children, we must first in the treatment enforce cleanliness,
then strengthen and improve the general health of the patient,
and then endeavour to destroy the parasite. The two first in-
tentions are to be fulfilled on common principles, the last by a
series of remedies termed 'Parasiticides.' Corrosive subli-
mate and acetate of copper have been much used, but there
are many serious objections to their use. one of which is, that
the hairs have to be forcibly removed from the affected parts.]

It is highly probable that, if sulphurous acid be employed as
a parasiticide, epilation will be found to be altogether uni eces-
sary to its complete action. This agent w7as first introduced
to the notice of the medical officers of the hospital, by Profes-
sor Graham, as a possible remedy for cholera, at the time that
disease was said to have its origin in the presence of an enfo-
phyte in the intestinal canal. It was first employed by myself
to check fermentation, and to destroy the lorulas cerevisiae and
sarcinse Goodsirii.* When lecturing on this subject, some
time since. I expressed myself thus: ''Considerable benefit
may be anticipated from the employment of sulphurous acid in
all diseases attended with the developement of parasitic plants.
I would especially mention por:_

The case I am about to read to you, of Hyman Jacobs,
proves, that in regard of tinea (pom^o) favosa, these anticipa-
tions have been fully realized; while the case of the girl now
in the room, and who is still under treatment, renders it highly
probable that the beneficial effects of this parasiticide will be
as manifest in tinea decalvans as they are in tinea favosa.

In some forms of thrush, too, I may mention that it acts most
rapidly, one application of a solution of sulphite of soda (a
drachm to an ounce of water) sufficing to remove the disease
from the mucous membrane of the mouth in twenty-four hours.
The secretions of the mouth being acid, the salt is decomposed,
and sulphurous acid is set free; in this, as in all other cases,
the sulphurous acid is the active agent in the destruction of the
parasite.

Hyman Jacobs, aged 27 years, a Jew pedlar, a native of
Amsterdam, and resident in London fifteen months, was ad-
mitted into the hospital on March 21, 1S53.

* St- veral medical men have lately administered the hyposulphite of soda,
instead of the sulphite; but the latter is the preferable salt, and for this reason,
that when the hyposulphite is decomposed by the hydrochloric acid of the gas-
tric juice, nut only is sulphurous acid generated, but sulphur is precipitated,
a au balance it is verv undesirable to have in the stomach in some of these cases.

484 Diseases of the Scalp. [August,

He was as most of you remember, a man of cheerful disposi-
tion, dark complexion, rather short, muscular, moderately stout ;
in fact, he looked generally in robus health. Mis habits were
those of his class; he slept in the low common lodging-houses,
fared badly, rarely eating meat, and judging from his appear-
ance, was not very cleanly in his person.

He affirmed, and I believed him, that he was temperate in
regard of i he use of alcoholic liquor. His general health, he
said, had always been good.

The scalp affection was of nine years' duration at the time
he came inio the hospital. He had been in many hospitals but
had never derived any marked benefit from treatment. When
Jacobs came under observation, his condition was as follows :

Cerebral, circulatory, respiratory and digestive functions
healthy in all particulars.

The whole of the scalp, excepting the margin, was covered
with the crusts of tinea favosa. The largesl crusts were of a
greyish yellow colour, of the consistence of dried putty or
mortar, and brittle. Their thickness generally was considera-
ble. Where thickest, the surface of the crust was below the
level of the cutis ; so that it looked at the first glance, as if the
latter had been partially destroyed by ulceration. The surface
oi these crusts was very irregular; it had a pitted, worm-eaten,
or eroded appearance. At the edge of the large, irregularly-
shaped crusts, were many small circular crusts, depressed in
the centre. A hair passed through the centre of each of these
small crusts. When ihe crusts were forcibly detached from the
scalp by mechanical means, the exposed surface of the cutis
\v;i< very red and raw.

The head itched much ; and though scratching gave consid-
erable pain, it was evident, from the traces of blood on the
surface, that he h ,d been applying his nails to the part.

'i'he odour of the head was very offensive, something like
that emitted by mice, only as one of you remarked at the time,
sweeter and more nauseous. Scattered over the trunk and
extremities were a very larjje number of circular favus crusts.
There were as many as forty on the back alone. The smallest
of these appeared, when seen through a lens, to be constituted
thus: in the centre was a hair, around and touching that a
brownish yellow crust, and aiound that again a dusky-red halo;
thediameter of the whole not exceeding two-thirds of a line.
On the back no crust was more than one-fourth of an inch in
diameter; on the leg there was one one-third of an inch in
diameter. These crusts were circular, raised about a line above
the level of the cutis, hard dry, and appeared as though made
up of concentric rings of pale, greyish-yellow, and brown

1854. J Diseases of the Scalp. 485

colours alternating. The surface of these crusts was readily
detached, and then a cup-shaped cavity was exposed, filled
with a brimstone yellow powder. The base of the crust being
removed, the surface of the cutis, from which it had been de-
tached, was raw.

We saw, you may remember, the mycelium, sporule-bearing
branches, and sporules of the achorion Schonleinii, when por-
tions of the crusts, or of the yellow powder, were placed under
the microscope.

No treatment teas adopted for some time after the mans ad-
mission. On April 13//* his state ivas exactly the same as
when he entered the hospital. Rags, wet with a solution of
sulphurous acid, were now ordered to be kept constantly on the
scalp ; the head to be covered with an oil-silk cap.

On April 18th, large quantities of crust had separated from
the scalp, and those that remained attached had entirely lost
their yellow hue ; they were now of a dirty brown colour. All
itching of the scalp ceased shortly after the application of the
sulphurous acid. Xo sulphurous acid had been applied to the
crusts on the trunk and extremities, and they had still the char-
acters they presented on the man's admission into the hospital.

A piece of lint, wet with sulphurous acid lotion, was applied
to one of the largest crusts on the leg.

On the 22d April a mere trace of the favus crust remained
on the scalp; but the surface of the cutis was red, and there
was an inflamed pnpula near the vertex. Thinking this condi-
tion might be partly due to the acid, which was a very strong
solution, I ordered its use to be discontinued for twenty-four
hours. The crust on the leg to which the sulphurous acid was
applied on the 19th, had separated; the exposed surface was
red, but not raw. Two favus crusts which were seated in the
vicinity of that to which the acid was applied on the 19th, were
observed to be turning brown ; subsequently they dropped off
spontaneously. The effect of the sulphurous acid gas on these
two patches is of great interest, as illustrating the mode of
action of the solution. The crusts on the scalp turned brown
shortly after the acid was applied to them, and before they
separated from the cutis.

On the 29th April the lotion was discontinued, and zinc oint-
ment applied to the scalp.

On May 2nd the head was free from crusts, but the scalp
was still red, and several inflamed papulse were seated on it.

On May 9th the skin of the scalp was here and there more
natural in hue, and one or two papulae had suppurated ; the pus
was healthy in appearance, and there was no trace of the para-
sitic plant to be detected by the microscope.

n. s. vol. x. xo. VIII. 31

486 Remedy for Favus. [August,

On the 18th, the head continued free from favus ; the scalp
was much less red ; the hair was growing. As the crusts on
the trunk and extremities were still in the same state as on the
patient's admission into the hospital, he was immersed, about
nine in the evening, for half an hour, in a full-sized tepid bath,
containing sixteen ounces of saturated solution of sulphurous
acid ; no friction was employd. During the night all the crusts
save three fell from the surface.

On the 20th he was again immersed in the acid bath, and the
next day no trace of a crust was to be found on the trunk or ex-
tremities. My note says : " No fresh crusts on head ; a small
pustule occasionally appears, and dries up in two or three days,
and then disappears entirely ; the skin of the head generally is
much paler and more healthy in aspect."

3 1st. The scalp was still paler than at the previous report.
There were only two small pustules on the scalp. By the
microscope, no trace of the parasite could be detected. The
skin generally appeared healthy ; and, on June 2d, Jacobs left
the hospital, at his own desire, to return to Holland.

I cannot conclude without expressing my confident belief,
that a very great advance was made in pathology when the
vegetable nature of the disease I have to-day referred to, as
well as of some others, was demonstrated ; and my equally
confident belief, that the foundation for a very great advance
in therapeutics was laid when Professor Graham introduced to
notice the power of sulphurous acid to destroy vegetable life,
and explained how it could be given internally without injury
to the patient.

Note. The solution of sulphurous acid I have used is made
by passing a stream of the gas through water till the latter is
saturated. Of this saturated solution, two ounces may be
added to six ounces of water, to make the lotion.

The saturated solution of sulphurous acid I have employed
has been either prepared in the Birkbick Laboratory of Univer-
sity College; or procured from Button's, Holborn ; Hopkins
and Williams, New Cavendish-street; or Burcham's, Albany-
street. [Medical Times and Gazette.

Remedy for Favus.

From the observation of about a dozen cases of severe favus
(diagnosis by the microscope in all) recently treated by Mr.
Startin at the Hospital for Skin Diseases, we can speak with
great confidence of the efficiency of the following ointment.
It is the Ung. sulph. comp. of the Pharmacopoeia of that Insti-
tution. $. Sulph. sublimati Ibss.; hydrarg. ammoniochloride.

1354.] On Epiphytes and Entophytes. 487

5 5s. ; hydr. sulphureti cum sulph. 3ss. Leviga simul. dein
adde olivae olei 3iv. ; adipis recentis 5 xvj. ; creosoti \ xx. :
misce. To correct the state of general health, Mr. Startin
commonly orders simultaneously a mild course of the iodide of
potassium, but this, we suspect, has but a small share, if any,
in the local result. Often when the scalp has been for many
years thickly covered with the peculiar favus crust, four or five
nightly applications of the above ointment have sufficed to
make it perfectly clean. So loner as the patient will continue
regularly to use a small quantity every day, the disease may
be prevented from re-appearing, and the condition assumed by
the scalp under its influence might easily be mistaken by the
inexperienced for one of complete cure. As soon, however, as
the inunction is suspended, the eruption re-appears. This lia-
bility we have known, in more than one case, to extend over
nearly a year, and probably it may for much longer periods.
The ointment, however, which does not smell much, need only
be applied at night, and may be washed entirely away every
morning, so as to entail but little inconvenience on the patient.
The hair will, to a considerable extent, grow during the treat-
ment, provided that the scalp have not been too much destroyed.
In a most disgusting disease, for which as yet no real cure is
known, it is much to be in possession of an almost certain
means of ensuring its absence. The ointment no doubt acts
as a parasiticide. Before its first application it is desirable to
clear away the crust as much as possible, either by fomenta-
tion or a poultice.

We may remark, that the ointment mentioned is used by
Mr. Startin in the treatment of scabies, and also in that of the
contagious form of porrigo. [London Med. Times.

On Epiphytes and Entophytes.

From a Review of Dr. Robin's '' Natural History of the Parasitic Vegetables
which grow on Man and on Living Animals;" and of Dr. Bazin's "Re-
searches into the Nature and Treatment of Tinea ;" by Dr. E. A. Parkes.

[It may be observed that all the vegetables Which grow on
living beings are low forms of Alga?, or Fungi.]

Most of these plants are composed of simple cells, or of cells
placed side by side ; the unicellular algae being distinguished
from the unicellular fun^i by containing chlorophylle or some
analogous substance, and usually one or more colored vesicles.
The more highly formed algae are composed of interlaced fila-
ments {Triehomata.) simple or ramified, cylindrical or flatten-
ed, and containing colored molecules; and of a reproductive
system viz., vesicles sporangia, conceptacles) and spores

488 On Epiphytes and Entophytes. [August,

(sporidia.) The fungi are represented by filaments, at first
simple, then ramified, and formed by a single elongated cell,
or more rarely, by several cells placed end to end (mycelium.)
The reproductive system is constituted by spores, which are
seated on a receptacle, either at once or by the mediation of
certain special structures, or are contained in a distinct vesicle
(sporangium )

It would lead us too far to go into the minute anatomy of
these plants, nor shall we attempt an account of the various
genera and species which are found on the lower animals.
We shall content ourselves with enumerating those which are
found on the bodies of men.

The conditions of growth of the parasitic plants on human
bodies are the same in all other cases. Whenever the normal-
chemical processes of nutrition are impaired, and the incessant
changes between the solids and the fluids slacken, then if the
parts can furnish a proper soil, the fungi will appear.

The soil on which these plants grow is for the most part
composed of epithelium or cuticle, acid mucus, or exudation ;
acidity, although favorable for their growth, is not indispensa-
ble, since some of the cryptogamia grow in an alkaline or neu-
tral ground, as on the ulcerations of the trachea. On the skin,
and in the buccal and pulmonary cavities, the plants are ex-
posed to atmospheric air, and many of the fungi absorb oxygen,
and emit carbonic acid. In the intestines, the nature of the
gas is somewhat different ; but some species grow here also.
Humidity and warmth are important conditions of growth, and
these, of course, are always to be found in connection with the
animal body.

An useful division of the subject for our purpose is afforded
by the anatomical seat of the cryptogamia on the skin, or on
the mucous membranes of man.

A. Cryptogamia on the skin. Ten varieties have been
noted in this locality. We shall enumerate them in the order
in which they are given by M. Robin.

1. Trichophyton tonsurans (Malmsten). Syn. Trichomy-
ces tonsurans ,% Mycoderma of the Plica polonica ; fungus of
the hairs in Herpes tonsurans ; fungus of Porrigo scutulata ;
Achorion Leber tii; fungus of the Teigne tondante (Bazin) ;
Rhizo-phyte (Gruby). This fungus was discovered and de-
scribed in 1844 by Gruby, in the disease called by the brothers
Mahon ' Teigne tondante ;' byCazenave ' Herpes tonsurans ;'
by Erasmus Wilson ' Trichoses furfuracea,' (one of the diseases
called ringworm and porrigo scutulata in this country). It
exists also, as pointed out by Giisberg, in the plica polonica,
although the two plants were formerly described as different.

1854.] On Epiphytes and Entophytes. 489

The trichophyton is formed by oval transparent spores, which
give rise to articulated filaments. Its anatomical seat is in the
interior of the roots of the hairs. The hair and fun^i simulta-
neously increase ; the former seem larger than usual, are paler
in color, lose their elasticity, soften and break off when they
have risen someone or two lines above the surface of the scalp;
in the short cvlinder then left the fungus grows still more ra-
pidly, so that the normal structure of the small stump of hair
soon becomes indistinguishable. Sometimes the hair breaks
off before emerging from the skin, and the fungus, epidermis,
and cebaceous matter fill the ends of the piliferous conduits,
and form the little prominences which can be seen by the na-
ked eye in this disease, and give the skin a rough, anserrine
appearance The sporules and mycelium of the plants can
sometimes be seen, in the form of a white powder, on the roots
of the broken hairs; sometimes the cutis becomes congested
and thickened, and then the plant is mixed up with scales of
epidermis, with fatty and albuminoid granules, with pus, &c. ;
and crusts are formed of greater or less thickness, in which the
growth of the fungus can go on.

MM. Robin and Bazin adopt unreservedly the opinion that
the trichophyton is the cause of the disease known under the
various names above given ; and each author relates examples
of the contagion of the disease by transmission of the spores.
Bazin has made the very important observation that the same
disease will attack horses, and can be communicated from them
to men. But both Robin and Bazin, however, admit that there
is some condition of the hairs (dependent, no doubt, on consti-
tutional causes) which is essential for the growth of the plant,
as sometimes the disease disappears i. e., the fungus dies
without treatment.

The diagnosis of this disease is extremely easy. The usual-
ly round bald patches, with the little elevations caused by the
swollen roots, and the divish scales of epidermis covering the
skin more or less, and accumulating round the elevations, are
very distinctive marks. Occasionally, when the cutis is more
congested, and the crusts are thicker from abundant cuticle and
exudation, some doubt may exist, but then the trichophyton can
be usually found in the crusts.

The treatment of this species of ringworm has been long one
of the most difficult points in dermatology. Its principles, how-
ever, are now well understood, and few cases resist the proper
measures. The essential point is to apply to the roots of the
hairs a preparation which may destroy the trichophyton ; if
this can be done, the disease is cured. It is first of all necessa-
ry to remove the hair; this is in part generally accomplished

490 On Epiphytes and Entophytes. [August,

I

before the case comes under treatment, by the course of the
disease; if it has not been sufficiently done, 'epilation' can be
accomplished by a chemical agent, or by extraction with pin-
cers. M. Bazin recommends the ointment given below,* or
the oil of cade, which appears to be the best depilatory known
or with these means epilation with the pincers may be com-
bined. The removal of the hair permits a "parasiticide" solu-
tion to be applied to the hair- follicles, within which are the
prolific spores of the fungus. For this purpose M. Bazin re-
commends either a solution of bi-chloride of mercury (I part
to 250 of water), or ao ointment of the acetate of copper (1 part
to 500 of lard). We have used also, with excellent effect, a
solution of the pernitrate of mercury, about 1 part to 30 or 40
of water; this is, however, a very powerful remedy, and is to
be cautiously used, as it easily blisters the scalp. We have
used also an ointment composed of sulphate of copper (1 part),
alum (3 parts), and lard (20 to 30 parts, according to the age of
the patient). Probably, however, a better parasiticide agent
than any of these is the sulphurous acid, which we have seen
Dr. Jenner employ lately in a case of favus, with astonishing
results, and which doubtless would be equally successful in
tinea tondens. Chlorine water might also possibly answer the
same purpose.

With respect to the name of the most common disease in
which the trichophyton tonsurans appears, the term used by
Cazenave (herpes tondens) is extremely unfortunate ; nodoubt
vesicles are sometimes seen, and sometimes the cryptogamic
disease succeeds to true herpes circinata of the scalp, but in
many cases there are no vesicles at all throughout the whole
course of the disease. The term used in this country, porrigo
scutulata, is inconvenient, as it is applied with greater justice
to favus. The old term of tinea is, after all, by far the best,
and the specific affix tondens expresses well one great feature
of the disease, the baldness arising from the brittleness of the
hairs.

[The second species, which has been little studied, is the
Trichophyton sporuloides. The 3d is the Trichophyton ulcer-
um. M. Lebert has described a fungus in the crusts covering
an atonic ulcer of the leg. The 4th is the Microsporon Au-
douini, present in the disease termed Porrigo decalvans by
Willan. The 5th is the Microsporon mentagrophyta, found in
a case of mentagra. This disease is easily cured by epilation,
and subsequently using a lotion of bichloride of mercury. The
6th the Microsporon furfur, has been discovered in the

* Lime and carbonate of soda, of each one part ; lard 30 parts.

1854.] On Epiphytes and Entophytes. 491

Pityriasis versicolor of Willan. The 7th, the Achorion Schoji-
leinii, is the most important, being the fungus of Favus.]

Schonlein was the first to suggest that the honeycomb, or
yellow favous crusts in the so-called porrigo lupinosa (Willan)
and porrigo scutulata, were constituted by a vegetable growth.
This has been repeatedly confirmed, and many excellent des-
criptions have been given of the disease, now called indifferent-
ly favus, tinea favosa, or porrigo scutulata ; but none, we think,
better than that which is contained in the work before us.

M. Robin believes he has discovered that the primary seat
of the achorion is in the depth of the hair follicle, against the
hair, and, as we can understand the description, outside the
layer of epithelium which covers the root of the hair, and
which forms " the inner root-sheath" of Kolliker. In this
observation, however, he has been anticipated by Wedl, who
has pointed out that by using a concentrated solution of liquor
potassae, to make the parts transparent, the fungus is found in
the follicle around the hair at the place where it passes through
the epidermis. In addition to this, the plant is found in depres-
sions on the surface of the skin, forming the yellow honeycomb-
like masses which gave the specific name, favus, to the disease;
and which, from their frequent buckler-like shape, suggested
the term 'scutulata.' The development of the achorion in
this situation is described by Robin after Remak and Lebert.
A cuticular elevation is seen, beneath which is a small favus ;
when the cuticle is raised a drop of pus sometimes issues ; hence
the error of those who have considered this disease always
pustular; generally, however, (Robin, Simon, and HcerTe.) there
is no pus or liquid of any kind ; the plant grows, and the cuticle
over it (supposing it has been forcibly detached) finally separa-
tes, leaving the favus exposed to the air.

M. Robin does not notice the important statement of Simon,
that at first there is at the point where the favus is about to form
only an increased secretion of epidermis ; he notices brieflv the
fact, that sometimes the under surface of the favus is coated by
cuticle, which separates it from the compressed and attenuated
derma.

The structure of the favus is given at length by both authors,
but it is scarcely necessary to do more than notice that Robin,
in addition to the mycelium, the spores, and the receptacles of
the achorion, describes a finely granular amorphous layer,
which forms the external coat of the favus. and is the represen-
tative of the amorphous ' stroma' which often accompanies the
mycelium of alga? and fungi. In the favus also, as we shall
presently see, another and distinct fungus can sometimes be
found.

492 On Epiphytes and Entophytes. [August,

M. Bazin describes the favus under three heads, which are
fundamentally identical and different only in respect of form.

1. Favus urceolaria dissemina : this corresponds to the por-
rigo favosa, Favus dispersus, Teignealveolaire, of other authors.

2. Favus scutiformis: this is the porrigo scutulata, or favus
confertus.

3. Favus squamosa ; a form usually called scutulata, but
distinguished chiefly by the irregular distribution of the
achorion, and by the furrowed masses formed by the fungus,
the hairs, epidermis, and exudation.

The treatment of favus recommended by Robin and Bazin is
epilation, and the application ofthe corrosive-sublimate solution,
or of acetate of copper ointment (1 part to 500 of lard,) to kill
the plant still remaining adherent to the hair follicle. We sus-
pect that the sulphurous acid employed by Dr. Jenner will be
found a more effectual application than either of these two.
[The remaining species of this division are unimportant.]

B. Cryptogamia on the Mucous Membrane. The plants
forming on mucous membranes, or in the contents of cavities
lined by mucous membrane, are of less interest than those which
grow on the skin, as in most cases they are decidedly only
secondary. We shall merely enumerate them.

1. Cryptococcus cerevisice Kutzing. (Syn. Torulacerevi-
siae the yeast-plant,) in the bladder, stomach, intestines,
&c.

2. Merismopcudia ventriculi. Robin. (Syn. Sarcina,) in
the stomach, intestines, &c.

3. Leptothrix buccasis. Robin. (Syn. Alga of the mouth.

4. Oscillaria (?) of the intestines. Farre.

5 Leptomilus urophilus. Montague. (An alga, described
as forming in the urine. It has as yet been scarcely
studied.)

6. Leptomitus (?) Hannoverii. Robin. (Alga found by
Hannover in the pharynx and oesophagus.)

7. Leptomitus (?) of the uterus.

8. Leptomitus ofthe uterine mucus.

9. Leptomitus of the eye.

10. Oidium albicans. Robin. (Syn. Cryptogamia of diph-
theritis and aphtha.) Aphtophyte (Gruby.)

11. Fungus ofthe lung. Bennett.

12. Fungus in the discharge of glanders. [Braithwaite s
Retrospect, from Brit, and For. Med. Chirurgical Review.

1854.] Transjnission of Secondary Syphilis. 493

On the Transmission of Secondary Syphilis from the Male
Parent to the Fattus in Utero. and the subsequent infection
of the Mother through the medium of the Fatal Circulation.
By W. Tyler Smith, M. D., Physician Accoucheur to St.
Mary's Hospital. (Read before the Harveian Hospital.)

In bringing before the Society a few cases bearing chiefly on
the trausmissibility of secondary syphilis to the fcetus in utero,
from the male parent, I cannot pretend to offer anything novel,
or to claim any interest beyond that which attaches to a very
important subject ; but 1 trust I may elicit the experience of
the Fellows of the Society, many of whom have without doubt
seen, cases similar to those about to be described.

When we consider the length of time during which syphilis
remains in the constitution after it has once passed into the
secondary form, the Protean shapes it may assume, and the
great difficulties which attend any attempt to trace the moral
histories of individual cases, it is not surprising that discrepan-
cies of opinion should exist respecting the transmissibility of
constitutional syphilis. After John Hunter, the greatest name
in syphilis is undoubtedly that of M. Ricord. I believe I may
briefly state the doctrines of this indefatigable observer to be
as follows :

He believes that when the primary poison i3 taken, it remains
during several days in a state of incubation, during which time
the poison may be destroyed, without any danger of the sub-
sequent occurrence of constitutional disease. That after this
time chancres take on certain characters, and infect the whole
constitution, giving rise to the train of evils known as consti-
tutional syphilis. He does not believe that a sore or chancre,
capable of communicating syphilis by inoculation, can ever
arise as a secondary symptom. He believes that for the pre-
sence of constitutional symptoms it is absolutely nece^
that a primary sore should have pre-existed, except under two
conditions namely, that a man suffering from constitutional
syphilis may impregnate a healthy woman, and the germ may,
in the first place, have constitutional syphilis, and, in the second,
communicate it to the mother, without the existence of any
primary disease in either mother or child. Here. I believe,
syphilitic contagion stops, in the opinion of Ricord. He does
not believe in the communication of syphilis by the secretions,
or by the discharges from secondary eruptions or sores. \ r
does he believe that a child affected with secondary syphilis
can communicate the disease to a healthy nurse, or that a nurse
affected with constitutional syphilis can convey the disease to
a healthy infant through the medium of the milk.

494 Transmission of Secondary Syphilis. [August,

Other French writers, and authorities upon the subject in
this country, assert, on the contrary, that a man or woman
having secondary syphilis may communicate it during inter-
course in a direct manner; that a child having congenital or
secondary syphilis, may infect its nurse in the act of sucking,
the nurse having been previously free from the disease; that
the nurse, thus diseased, may become a medium of infection to
others ; that an infected woman, suffering from secondary syph-
ilis only, may infect a healthy child, through the milk. These
are the views held by Dr. Whitehead, in his work on " Here-
ditary Diseases," published in 1851, and by Mr. E. Wilson, in
his work on "Syphilis," published in 1852. Mr. Wilson goes
so far as to assert the identity of gonorrhoea in which no ureth-
ral chancre existed. Cases are given which appear to warrant
these views, but the whole question of the transmission of se-
condary disease is in such an unsettled state that no apology
can be needed for introducing it in a Society like the present.
The following cases bear upon some of the points in dispute,
and it will be impossible for any one who pays attention to this
subject not to acknowledge, that it is cne whose importance,
both as regards medical science and the physical degeneration
of mankind, is much underrated or overlooked.

Case 1. The following case came under my observation at
St. Mary's Hospital, and I was as careful as possible in tracing
its history :

R S , a healthy young woman, married a cabman in

1842. She had successively three children, all of whom are
living and in excellent health. No spot or blemish has ever
been observed upon them. For some time she remained with-
out becoming pregnant, but in December, 1850, her fourth child
was born. This child, shortly after its birth, had red spots
upon its face and neck, and an eruption upon its buttocks. The
child also had a profuse secretion from the nose. It died of
what was called bronchitis, at the age of seven weeks and
some days. She again became pregnant in 1852, and gave
birth to a fifth child, which, like the preceding child, appeared
healthy at the time of its birth. In April, 1852, this child was
brought to me, and certainly presented one of the most wretch-
ed spectacles I ever beheld. The child had remained healthy
until it was three months and a half old, when it got hooping-
cough ; a month afterwards it was brought to the hospital. Its
eyes and mouth were surrounded by deep rings of coagulated
blood, and its ears and nostrils were plugged with coagula;
blood had also been lost by the bowels. All these orifices,
mouth, nares, ears, eyes, and anus, had bled some days every
time the child had had a fit of coughing. It was scarcely liv-

1854.] Transmission of Secondary Syphilis. 495

ing when I saw it; the pulse was almost imperceptible; the
face and surface of the body were blanched from loss of blood ;
it appeared insensible. I ordered the child to be put in a milk
bath, and to have broth enemata, but I heard that convulsions
came on shortly afterwards, and soon ended in death. In
signing the certificate of this child's death, I returned it as dy-
ing of convulsions consequent upon hooping-cough, and loss of
blood. I had then no suspicion whatever of syphilis, as nothing
was said of the death of the former child.

In the month of March, 1853, the same woman brought me
a child, born in December, 1852, about whose condition there
could be no mistake. Its buttocks were covered by large
erythematous patches in a state of ulceration; the scrotum
looked as if it had been covered with yellow varnish ; the
mouth and nostrils were fissured; the eyelids gummy; and the
mucous membrane of both eye and nose secreting a profuse
gummy matter; the inside of the lips and the surface of the
tongue were aphthous ; the cheeks were varnished and wrin-
kled. This condition of the child had come on gradually about
a month previously ; before this it had appeared healthy. The
mother herself had never had any eruption, sore-throat, cata-
menial irregularities, leucorrhcea, or any symptom which, on
the most minute inquiry, gave evidence of the presence of the
syphilitic poison. During the whole of her married life she
had not been conscious of any change in her health. 1 saw the
husband of this woman, and he admitted that five years ago
he had an outbreak of secondary syphilis, the primary disease
having occurred four or five years before. He then became
an out-patient at the Lock Hospital, and was mercurialized.
During the presence of the secondary disease he avoided inter-
course with his wife, and was confident that he did not com-
municate the disease to her. He had severe sore-throat, and
a copper-coloured eruption. When I saw him the only signs
of disease were a few acne upon his forehead, and he declared
that nothing more than this had appeared upon him for the last
two or three years. The wife has, at the present time, a mam-
mary abscess, but she has had abscesses while suckling the last
four of her children.

In this case, if the statement of the man can be relied upon,
the syphilitic poison remained in abeyance during the first five
years of his marriage, and the children born during this were
not affected. After this, two children were destroyed, and a
third poisoned, with syphilis. This woman, it will be observ-
ed, never aborted. Can the mammary abscesses in this woman
be referred to syphilis? It certainly appears as though the
poison in this case affected the children without influencing the
constitution of the mother.

496 Transmission of Secondary Syphilis. [August,

Case 2. A woman applied during the course of last year
at St. Mary's Hospital, with a nurse-child which she was suck-
ling, and she also suckled at the same time a child of her own.
The nurse-child was four months old. The skin of its face was
like yellow tissue-paper; its nostrils and eyes were secreting
an abundance of gummy mucus and pus, and the nates and
scrotum were covered with erythematous patches in a state of
ulceration. Numerous blotches appeared on other parts of the
body. The mouth and anus were deeply fissured, and the
child's mouth bled every time it took the breast. The woman
applied both -children to either breast without reservation.
When I first saw the diseased child, she had suckled it about a
month. The woman herself, and her own child, were at this
time free from any obvious signs of disease. The nipples were
healthy, although the discharges from the nurse-child's mouth
were so acrid, that on the spots where it sucked its own fin-
gers erythema and ulceration ensued. The nature of the case
being evident, the woman was cautioned not to apply her own
child to the same breast with the nurse-child, and the case was
narrowly watched, during treatment, for upwards of three
mouths. In answer to the first inquiries on the subject, it was
stated that the father of the diseased child had last year been
an out-patient at the hospital, under the care of Mr. Spencer
Smith; and on referring to the hospital registration books, I
found he had been treated for an eruption of the leg, which
was set down as "probably syphilitic."

The man himself, on being examined, gave me the following
account of himself : He had contracted syphilis in 1849; a
chancre appeared on the foreskin, and remained there three
weeks. It was followed by an inguinal bubo. For these
symptoms mercury was given him, but he was not salivated.
He, however, became apparently well under its use. Last
year he got his fellow-servant with child, and married her
when she was large in the family-way. The child the dis-
eased nurse-child already referred to was born in January,
1853. From the time of the chancre up to the time immedi-
ately previous to that at which his wife fell pregnant, he had
observed no signs of any secondary affection. But just before
this he had lost his situasion, that of a butler, and, faring worse
than usual, he became out of health. His hair now fell off; he
had no sore-throat, but the eruption appeared on his legs, for
which he was treated by my colleague, Mr. Henry Smith, and
he had a scaly, copper-coloured eruption on his forehead,
which became very distinct after eating and drinking. He
also suffered at intervals from severe rheumatic pains.

The wife remained in apparently good health. She was

1854.] Transmission of Secondary Syphilis. 497

confined, I believe, in Queen Charlotte's Lying-in Hospital,
and was subsequently recommended by Dr. M. Babington as
wet-nurse to a lady living in the country. The husband is in
constant communication with his wife, and states that she has
given satisfaction as a nurse, and is in perfect health, with the
exception that she menstruates somewhat profusely, and often-
er than natural. It has not been hidden from the lady whose
child the woman is suckling that the nurse's own child had
fallen into bad health.

It became, of course, a very interesting question to deter-
mine, as far as possible, whether the diseased child would com-
municate secondary syphilis to its foster-nurse, and whether
the foster-nurse would communicate the disease to her own
child or her husband, and also to ascertain whether the mother
of the diseased child could communicate constitutional syphilis
to her foster-child. Here was a case in which secondary
syphilis might have at once been communicated to at least four
persons, besides the parents of the diseased child and the child
itself, if we recognize the transmission of constitutional syphilis
through the medium of the secretions. In all, six persons were
exposed to the danger of syphilis by the intercourse of the fa-
ther of the diseased child with his fellow-servant. As far as
this case goes to the present time, and I have now had it under
my observation nearly four months, it tells against the commu-
nication of secondary syphilis from one person to another,
either by means of the matter from secondary sores, or the
secretions of a person suffering from secondary syphilis.

Some time after the child had been under treatment, its
foster-nurse had two or three pimples upon her neck, between
the breasts; but she stated she had had the same kind of pim-
ples before she began to nurse the foster-child. When she
began to confine the diseased child to one nipple, that nipple
became sore, and a large serpentine ulcer formed upon. The
ulceration had not, however, the yellow base or other appear-
ances of a syphilitic sore, and three times I performed inocula-
tion with matter taken from this sore, without any effect. The
woman has had no signs of secondary disease in any other part
of the body, and is as well as a woman could be expected to be
who was suckling two children. Her own child is perfectly
free from all signs of disease, and so is her husband, at the pre-
sent time. I have purposely limited the treatment to the dis-
eased child itself, so that I might observe the condition of the
nurse.

The state of the mother of the diseased child is perhaps sus-
picious, as menorrhagic losses are among the most common
signs of seeondary syphilis in the female ; but still it is extreme-

498 Transmission of Secondary Syphilis. [August,

Iy frequent in wet-nurses who menstruate during lactation. I
have seen Dr. Babington, and cannot learn that the child
shows any signs of desease. It is fat and healthy, and although
the suspicions of the mother have been excited, she appears
perfectly satisfied with the health of the nurse. Thus, as far
as this case goes, the syphilized father begot a diseased child.
The mother suffered slightly, if at all probably not at all and
has not communicated disease to her foster-child. The syphi-
lized child has not communicated disease to its foster-mother
and father, or to its foster-brother, though it would be difficult
to conceive a mouth in a more aggravated state of disease than
was the mouth of this child when I first saw it. The eruption
and other signs of disease were relieved by grey powder, a
mercurial girdle, the iodide of potassium, and cod-liver oil.

These cases show the amount of disease which may follow
marriages in which the husband has had syphilis previously,
and in which even slight signs of the disease remains in his
constitution.

I have also arrived at the conclusion, that where the placenta
and membranes become so diseased as to cause abortion, the
child remaining free from disease, the mother is pretty sure to
be affected with the disease ; but when the child is born living,
and is apparently healthy at the time of birth, the mother may
in some cases escape contagion. When the children are born
healthy, the eruption generally comes on a few weeks after
birth, and is probably excited by the alternations of tempera-
ture, and the irregularities of nutrition to which the infant is
exposed after birth, as compared with that of the foetus in
utero. Probably in some infants born of healthy mothers and
syphilised fathers, the eruption may not appear until long after
birth; at least, I have seen cases which seemed to warrant
such a conclusion. When the ovum is affected by secondary
syphilitic disease, we can easily understand that the blood of
the fetus should infect the mother through the placenta. By
pre'gnancy, through the medium of the blood of the ovum, the
blood of the male parent is, as it were, positively transfused
into the blood of the female. There can be no doubt I think,
that in practice, in all cases of repeated abortion, and eruptions
in the early months of infancy, the health of the male parent
before marriage should be strictly inquired into.

With respect to the contagiousness of secondary sores, it
appears to me to be at present an undecided question, but I
have not seen a case in which it could have been pronounced
with certainty that a secondary malady was communicated
from one person to another by intercourse without the pre-
sence of primary sores. I might have added many other cases

1854.] General Bloodletting in Insanity. 49{>

but those I have related are two of the most interesting which
have come under my own observation, and in which I was able
personally to verify most of the facts relating to them. Not the
least important of the results, as I have observed them, is the
frequency of leuconhcea as a leading symptom of secondary
disease when communicated to the mother by the ovum.

[London Lancet.

General Bloodletting in Insanity.

The American Journal of Insanity, edited by T. Romeyn
Beck, M. D., for April, 1854, contains an elaborate article of
118 pages upon ''Bloodletting in Mental Disorders," by Pliny
Earle, M. D., of New York city, in which the latter analyzes
with much ability, one hundred and thirty-six authorities, illus-
trative of this proposition, namely, "to what extent, in regard
to both frequency and quantity, is the abstraction of blood re-
quired in the treatment of insanity:" from all of which he
draws the conclusions which follows:

" A. reply to the propositions at the commencement may now be
attempted. It is evident, however, from the very nature of the case,
that no positive, definite answer, couched in terms as fixed as the
figures representing numbers, can be given. It must be merely ap-
proximative. I shall endeavor to convey it in a series of facts, truths
or inferences, which 1 hope are fairly deduced from the substance of
the foregoing pages.

1. Insanity, in any form, is not, of itself, an indication for blood-
letting.

2. On the contrary, its existence is, of itself, a contra-indication.
Hence, the person who is insane should, other things being equal,
be bled less than one who is not insane.

3. The usual condition of the brain, in mania, is not that of active
inflammation, but of a species of excitement, irritability, or irritation,
perhaps more frequently resulting from or accompanied by anaemia,
debility, or abnormal preponderance of the nervous over the circula-
tory functions, than in connexion with plethora and enduring vital
power.

4. The excitement, both mental and physical, produced by this
irritation, can, in most cases, be permanently subdued, and its radical
sources removed by other means, more readily than by bleeding.

5. Yet insanity may be co-existent with conditions, such as
positive plethora, a tendency to apoplexy or paralysis, and sometimes
sthenic congestion or inflammation, which call for the abstraction of
blood. Therefore,

6. Venesection in mental disorders should not be absolutely aban-
doned, although the cases requiring it are very rare.

7. As a general rule, topical is preferable to general bleeding.

500 General Bloodletting in Insanity. [August,

8. In many cases where the indication for direct depletion is not
urgent, but where bloodletting, particularly if local, might be practi-
ced without injury, it is safer and better to treat by other means,
equalizing the circulation and promoting the secretions and excretions.

9. The physical conditions requiring bloodletting more frequent-
ly exist in mania than in any other of the ordinary forms of mental
alienation.

10. Insanity following parturition, other things being equal, is to
be treated by bleeding less frequently than that which has its origin
in other causes.

11. If the mental disorder be the direct result of injury to the head,
the treatment must be directed to the wound, or its physical effects,
not specially to the psychic condition.

12. In many cases where insanity is accompanied by typhous
symptoms, and in some where the aspect is that of acute phrenitis,
active stimulants alone can save the patient, and direct depletion from
the circulation is almost certainly fatal.

The following extract from the last number of Ranking'?
Abstract, exhibits the state of opinion on the continent of
Europe with respect to venesection as a remedy for insanity,
and corroborates the conclusions of Dr. Earle :

Prejudicial Effects of General Bleeding. Dr Webster in bis
report on French Asylums, says :

''Although it was not originally intended in the present remarks
to discuss the medical treatment usually pursued in French Asylums,
one point seems, however, of so much importance that it deserves
some notice in these pages ; particularly, as great unanimity of opinion
prevails among the physicians of departmental institutions, with
whom I had an opportunity of conversing upon the question. I now
refer to the employment of bloodletting as a remedy in cases of in-
sanity. Without an exception, every practitioner was decidedly op-
posed to the general abstraction of blood in maniacal patients, as they
consider it not only unnecessary, but often injurious. In many cases
venesection produced so much depression, that attacks of mania,
which otherwise might have been of short duration, under a different
but more judicious mode of treatment, were thereby prolonged, and
even ended in fatuity.

Exceptions Requiring Bloodletting.

Of course particular cases of insanity presented themselves where
inflammatory symptoms appeared so decided, or in which apoplectic
congestion existed to such an extent, that local or general abstraction
of blood was then absolutely necessary ; nevertheless, these examples
were exceptional, and only confirmed the observations made by
the most experienced officers, medical officers of French asylums,
respecting the baneful consequences of bloodletting in most cases of
mental disease, which came under their cognizance. Indeed, one
gentleman remarked 'the delirium of insane patients was never
modified by frequent and copious bleedings, but often the reverse.'

1854.] Night Sweats in Phthisis. 501

Being supported in these practical conclusions by the opinions of
many English physicians, it cannot be too strongly impressed upon
the minds of young practitioners, or of those who may not have had
much experience in treating cases of insanity, to be always exceed-
ingly chary of using the lancet." [N. O. Med. and Surg. Journal.

To prevent Night- sit: eats in Phthisis.

Xight-perspirations in the course of phthisis are often ex-
tremely annoying to the patient; they appear, also, to be
simply debilitating, and unattended by any degree of collateral
benefit. Some cases which were carefully noted by Mr. Hutch-
inson, the Clinical Assistant at the City Hospital for Chest
Diseases, with a view to the determination of that question,
appeared to show that they may be artificially checked, not
only with impunity, but with great benefit. The patients who
were so treated, and who, in the course of a week or a fort-
night, got quite rid of sweatings which for months had been
profuse, thought themselves much better, and did not complain
of increase, either as regards the expectoration, the feverish-
ness, or the sense of stuffing in the chest. Under the usual
treatment of phthisis, (full diet, cod-liver oil, and tonics,) the
tendency to night-perspiration often ceases spontaneously. If
it becomes desirable to expedite the process, it may be done by
the sesquichloride of iron, the mineral acids, or, best of all, by
the gallic acid. The following is the prescription for a night-
draught containing the latter :

$ Acidi gallici. gr. vij.; morph. acet. gr. \ ; alcohol q. s. (a
few drops) ; syr. tolutan. 3ss. ; aquae sj.

The night-pill, as we find in the Pharmacopoeia of the Bromp-
tom Hospital for Consumption, is

$. Acid, gallic, gv. v.; morph. hydrochl. gr. \\ mist. acac.
q, s. Ft. pil. ij.

It is also of advantage to adopt an astringent regimen as far
as convenient. The patient should be directed to sleep on a
mattress, alone, and not heavily clothed ; he should wear no
flannel in bed; as dry a diet should be taken as conveniently
can be borne, and fluid should be especially avoided in the lat-
ter half of the day, none whatever being allowed later than
several hours before bed-time. [London Med. Times.

Ergotine. By E. Doxxelly, M. D.

According to Bonjean, Ergot contains two active principles, essen-
tially distinct and constant in their effects, to wit : an active poison
and a powerful and useful remedy ; the first is an oil, very soluble in
cold ether, and insoluble in boiling alcohol, and in which exists the
toxicological properties of Ergot; the second he denominates Ergo-
tine, which is a dark red extract, very soluble in cold water, and pos-
sessing in the highest degree the precious obstetrical and haemostatic

x. s. vol. x. xo. VIII. 32

502 Ergotine. [August,

properties that it has always been acknowledged Ergot possessed.
The very different nature of the two products of Ergot, permits their
easy separation, and we are enabled to obtain the remedy entirely free
of the poison. Thus, then, does the oil of Ergot and Ergotine contain
in themselves all the properties, whether medicinal or toxicological, of
Ergot, and it was for this discovery that the Pharmaceutical Society
of Paris honored Mr. Joseph Bonjean with a gold medal, at their
meeting on the 21st of December, 1842. Ergotine has been gener-
ally considered as one of the most useful acquisitions that has for a
long time enriched therapeutics. The good results that are obtained
in affections against which medicine has frequently been ineffectual,
has already spread its use in different regions of the globe, and every
day practice confirms the marvelous properties that its author attribu-
ted to it from its first discovery. Ergotine is one of the most power-
ful specifics known against hemorrhages in general; it is equally
approved of in metrorrhagia and bloody flux, in epistaxis, and in
spitting and vomiting of blood, and hematuria, <Slc. It has also been
employed with good results in cases of spermatorrhea, and in trouble-
some periodicals, vomitings of blood, and in diseases brought on by a
deranged state of the nervous system, and that have resisted other
remedies. Moreover, it promotes uterine contractions, and causes to
cease the hemorrhages that succeed parturition ; as well as prevents
them when administered some time previous to this event. Ergotine
presents an immense advantage over Ergot in the quantity that can be
administered at discretion in a lose, without the fear of resulting in
any of those accidents that are caused by Ergot taken in its natural
state. Dr. Chevallay, professor of medicine in Chamberg, adminis-
tered live drachms of this extract in the space of five hours to a wo-
man who would infallibly have succumbed to a most terrible attack of
metrorrhagia, if it had not been for this auxiliary, which in two days
afterwards Mas completely Bup pressed, and the woman finally recov-
ered. After this, many celebrated doctors have endeavored to extend
the use of this remedy, and to this end Dr. Arne of the Paris asylums,
has used it with happy effect in some chronic affections of the uterus.
Drs. Sacchero and Teissier, professors of medicine in the University
of Turin, Dr. Mosea, and some other practitioners connected with
hospitals of the same capital, have used it with happy success in
chronic and acute pain, from which we conclude that Ergotine has
direct action on the mucous surfaces, when found in a state of super-
excitation or active hyperemia; it is also useful in dry and obstinate
coughs, with or without spitting of blood, which so often accompanies
consumption. Dose from 20 gr. to 1 oz., according to circumstances
given in pills or solution.

Mode of Preparing Ergotine. Powdered Ergot one pound, and
as much water as it will absorb (cold water), and allow it to stand for
twelve hours; then place in a porcelain or glass percolator, and pour
over it successive portions of cold water, until the menstruum passes
through the mass colorless ; the liquid thus obtained is to be* evapor-
ated by means of a water bath, unto the consistence of an extract.
This extract is the Ergotine of Bonjean. [Philad. Med. and Sur. Jl

1854. J Editorial and Miscellany. 503

EDITORIAL AND MISCELLANY.

Epidemic Dysentery.

"I would be very much obliged if you will give me your views of
ihe pathology and treatment of Dysentery as it has prevailed in
Georgia for some time. # It is carrying ofFhundreds in this District."

The above extract from the letter of a friend who resides in Spar-
tanburg District, S. C, is entitled to serious consideration. We do
not know that we can throw any new light upon the subject of epidemic
Dysentery, either in relation to its pathology or its treatment ; nor
are we aware of the mode of treatment under which such a frightful
mortality as that alluded to by our correspondent has occurred. We do
know, however, that many practitioners both in Georgia and in South
Carolina, as well as in the adjacent States, entertain views of the
pathology and treatment of the disease in question very widely at vari-
ance with our own ; and we may add, that we have not found the
disease very fatal, nor difficult to manage, when treated in accord-
ance with the principles we approve. We will not hesitate, there-
fore to state, although we shall do so as briefly as possible, what we
consider the true state of the system and the best plan of treatment
in the Epidemic Dysentery observed in this region of country for a few
years back. We are happy to say that we are not alone, and that
among the many who entertain the same views with us may be found
some of the most distinguished practitioners in the South and South-
west.

With regard, then, to the pathology of this form of dysentery, we
think it a complication or modification of remittent fever, the compli-
cation constituting in some cases the lesser and in others the greater
evil. The perturbations of innervation, and consequently of the cir-
culation, which characterize our malarial or ordinary periodic fevers,
may continue for some time without the manifestation of decided con-
centration of morbid action upon any organ in particular. These
are, however, exceptional cases ; and we find that, unless checked by
remedial agents, some organ will, sooner or later, become implicated
to such a degree as to mask the original affection and perhaps to
mislead the inexperienced. Thus we may find the liver, the spleen,
the stomach, the intestines (small or large), the brain, or the lungs
taking on disease more or less readily, according to particular sea-
sons, localities, or causes which escape detection or cannot be appre-
ciated.

504 Editorial and Miscellany. [August,

At one time the stomach and liver will be the organs most
frequently the seat of this concentration of morbid action, and the
distressing nausea and bilious vomiting be found exceedingly difficult
to control. At another time the supervention of coma, or of delirium,
reveals but too clearly that the brain is suffering the inroads of dis-
ease. Again, the recession of blood' from the surface and extremities,
and the impairment of the process of calorification, constituting the
algid form of our fevers, is more common some years than others.
Some eight or nine years ago we began to observe the pneumonic
complication, which has continued ever since to show itself at various
points throughout the Southern States in the form of epidemic pneumo-
nia, and occasionally with remarkable fatality. During the last three
years the tendency has been to the large intestines, and this dysen-
teric feature has proved exceedingly disastrous in some of our coun-
ties.

We are aware that some will, with our learned friend Dr. La Roche,
object to this mixing up of diseases, and argue that Dysentery, as well
as Pneumonia, is always an idiopathic phlegmasia, and should be treat-
ed upon the general principles termed antiphlogistic. Yet the history
of medicine, as found in the writings of practical men, such as Syden-
ham, foi example, does not permit us to doubt that diseases do from
time to time change their phases, their type, and their amenablcness
to particular plans of treatment. While pneumonia, therefore, prior
to the time above named, was most successfully treated here by blood
letting and antimouials, such is far from being the case at present.
So it is with Dysentery, which, when an uncomplicated phlegmasia,
may be advantageously mot with the lancet, calomel and opiates,
under a different state of things proves rebellious to these agents.

The epidemic dysentery which has ravaged so fearfully some of
our districts of country for the last few years, shows itself evidently as
a complication of periodic fever, in the great majority of cases. It
requires but little observation to detect in it the quotidian remissions
and exacerbations peculiar to the class of fevers termed malarial, and
the aggravation of the local affection by each returning paroxysm.
As bloodletting will not cure remittent fever, so is it ineffectual in
this form of dysentery, and may induce fatal prostration while
quinine, the great specific in periodic fevers will also prove all im-
portant in the epidemic dysentery to which we refer.

In the management of this disease, two objects must be kept in
view ; the daily paroxysms of fever must be arrested as soon as pos-
sible, and the determination to the large intestines subdued. In order

1854.] Editorial and Miscellany. 505

to accomplish the first purpose, we direct the administration for
several successive mornings ofogrs. quinine at day-break and at
intervals of two hours until twenty grains be taken. We generally
find that 20 grs. of this remedy during the remission, which usually
occurs in the morning, is sufficient, and that the febrile exacerbations
will be prevented in a day or two. The quinine should then be con-
tinued in smaller quantities a few days longer in order to prevent
relapse.

The tormina, tenesmus, and bloody flux will yield more readily to
saline cathartics than to anything else with which we are acquainted.
Indeed, if a full dose ofSulphate of Magnesia or of Sulphate of Soda be
given at the onset of the bloody discharges, or soon after, it will very
often cut short the attack. If it does not, the saline should be continued
in teaspoonful doses every two, three, or four hours so as to keep up
the serous discharges until the fever may be arrested with quinine.
The physician is, however, especially in the country, seldom called
on to prescribe on the first day of the disease and often only when
the case has assumed a dangerous aspect. The patient is then found
more or less prostrated by the fever, by the frequency of the bloody
discharges and the distressing tenesmus. It may be then hazardous
to administer a full dose of salts; but serous discharges may be in-
duced by teaspoonful doses, given every hour, or less often, until the
desired effect be secured. In short, the dysentery must be, by the
use of salines, converted into diarrhoea and the serous stools be kept
up as long as the dysentery seems disposed to return upon their sub-
sidence.

There are instances, of which we have just seen one, in which
the stomach is so irritable as to reject the salines above mentioned.
Others, as Cream of Tartar, or Rochelle Salts, may be then substitu-
ted. We have used the chloride of sodium or common table salt in some
cases with equal advantage, especially in the advanced stages of the
disease, and in children who take it with less reluctance than they do
Epsom salts.

We sometimes find that even after the fever has been subdued and
the serous discharges kept up for one, two or three days, the irritabil-
ity of the rectum will persist and seriously annoy the patient. It is
under such circumstances that we order washing out the lower bowels
with a pint of tepid flaxseed tea or 1epid water, and throwing into
the rectum with a small glass syringe a fourth or a half grain of
Sulph. Morphia in a drachm of water, to be retained as long as pos-
sible. If this anodyne enema be returned before it has had time to

506 Editorial and Miscellany. [August,

be beneficial, it should be repeated. Starch and Laudanum may be
used for the same purpose. These local anodynes are often productive
of the most delightful relief and composure ; but as their effect wears
off they may have to be repeated.

It is scarcely necessary to add that we allow die patient to drink as
freely as may be necessary to relieve his thirst either cold water
(without ice) or any bland tea he may desire. When the case is
protracted and exhaustion considerable, we order small quantities of
good animal broth slightly thickened with flour to be given at regular
intervals, even though the patient may have no appetite. This will
generally be induced by the influence of a little such food upon the
stomach.

The plan of treatment now laid down possesses, besides the advan-
tage of marked efficacy, that also of great simplicity.

In answering the call made upon us for our views, we have done
so in as few words as possible and do not deem it necessary to allude
more particularly than we have done to the opinions of those who dif-
fer with us, nor to fortify our position by special reference to the
authority of those who participate with us in the views expressed.

Epilepsy cured by Trephining. We find in the Transactions of
the Iowa State Medical Society an extraordinary operation, reported
by Dr. J. D. Elbert, under the following caption : " Case of Epilep-
sy of several years1 standing ciued by operation.^

The cranium had been fractured, and six inches square depressed
about one inch at the centre. This injury was soon followed by
Epilepsy, which recurred every two or three days, had existed
for eight years and impaired very much the mind and physical pow-
ers. Dr. Elbert trephined the patient, and " six inches square of the
frontal and parietal bones were removed." The lad was eleven years
of age, and has completely recovered. We should observe that the
operation was performed in the spring of 1852, and the "report"
made in January following.

The Virginia Stethoscope contains an able editorial article upon
the subject of " Protection of Domestic Interests," in which after re-
marking upon the duty of every government to protect the various
interests of the community, the writer goes on to show that in Virginia
much more attention is given to the protection of pecuniary interests
than of the health and lives of the citizens ; that while the Legislature

1854.] Editorial and Miscellany. 507

is ever awake to the interests of agriculture, commerce, the mechanic,
arts, &c, little regard is paid to those of physicians. Thus :

"Now let us see how fully the legislature has applied these well
established principles to the practice of medicine how carefully they
have protected the interests of a large and influential class of their
constituents, the physicians of Virginia, and the dearest interests of
every citizen of the state, their lives and reputations.

11 The state is in want of money to support the expenses of govern-
ment and construct works of internal improvement. She taxes
various employments, and in return affords them adequate protection.
The doctors, too, must be made to pay something into the treasury.
To be sure he pays his poll tax, his horse tax, his carriage tax, his
watch tax, &c. &c. &c, but he must pay in addition for the privilege
of practising his profession, of obtaining a livelihood out of the com-
munity. The carpenter, the shoemaker, the blacksmith, the architect,
&c. may derive larger profits from their business, but no professional
tax is laid upon them. The doctor, I suppose, according to the ideas
of the agrarians, is an aristrocrat, and must be fleeced for the privilege.
Well, the doctor pays his license tax, and what protection does he en-
joy in return for his contribution to the resources of the state ? Why,
the very first Yankee quack who comes along, an ignoramus and un-
principled swindler, who knows that there is nothing in regard to
which the community is so easily duped and defrauded, applies to the
same commissioner of the revenue for a license to speculate upon the
lives, health and reputation of the community, and the officer is re-
quired by law to take the price of blood and put it into the treasury of
the state. Aye, and the impudent foreign imposter will find even
some of the press sufficiently venal to side with him against their own
fellow citizens. The foreign mercenary wretch who would have
been arrested for exposing for sale in the streets a few papers of
needles, a package of jack-knives, or a piece of calico, whose mouth
would have been shut by the stern voice of the sheriff if he had dared
to open it in a court-room, is fully authorized by law to tamper with
the lives of unsuspecting and defenceless men, women and children.
The foreign state doctor goes his rounds with no eye upon him to
watch and expose his wanton sacrifice of life and health. Lucre is
his only aim ; for that he sacrifices everything most dear to the com-
munity. At last, when some of his victims detect and expose his im-
postures, he decamps, carrying away a rich harvest of ill-gotten gains*
to enrich other communities who despise us for our credulity, and
laugh at us for our defenceless situation. By these persons the Vir-
ginia physician is elbowed out of the way to engage in some other
employment, or seek some other place where his talents and learning
will be better protected.

"These are not all the evils of the system. If the foreign pedler
was a dangerous ally of the abolitionist, who so fit to carry on in the

One of the most unprincipled quacks who ever infested this community,
boasted that he had made upwards of twelve thousand dollars in Richmond in
a few months.

508 Editorial and Miscellany. [August,

dark his secret, nefarious schemes as the foreign quack doctor ?
He has unrestrained private interviews with our slaves, and what
more fit opportunity for whispering the abolition sentiment and sup-
plying the deadly draught ? The license to practice includes also
the license to peddle any sort of wares if he can only persuade the
ignorant into the belief that ihey are useful in the treatment of di-
Let us examine how the law works in this respect. A fellow who
is known only as a pedlar of trusses comes to the state of Virginia,
and the law brings him to a stand. But the low cunning of the ped-
ler is not to be so easily circumvented. He sees a fine rich field, but
the gates are closed and well barred and the fence too high to be
scaled. He examines the law and finds that it has provided a most
convenient stile, as if just for his use, by which he may most easily
climb the formidable barrier. lie goes to the commissioner of the
revenue, pays him five dollars, and receives the state's authority to
practice medicine. This is the toll for entering the rich harvest field.
' Every patient who applies to him he discovers to be in need of a
truss, and his is one of extraordinary quality. A patient applies with
swelled testicles ; the state doctor prescribes a truss ; another lias
hydrocele, for which be is induced to buy a truss; another has vari-
cocele, which he is easily convinced can Secured most readily by Dr.
Wooden Nutmeg's patent truss, and soon and soon.

These are some of the abominations, the iniquities, the absurdities
of the laws of Virginia in regard to the practice of medicine.

" Why, let me ask, has the state invested some thirty thousand
dollars in a medical school in Richmond, besides making annual ap-
propriations for medical education in other schools? ' Why does she
appoint trustees to select well qualified teachers of medicine and to
guard the title of M. D. against degradation by b"ing conferred upon
unworthy men, if it is her policy to confer every legal privilege of
the diploma upon every foreign quack, ignoramus and imposter who
may pay five dollars into the treasury ? Do medical men intend al-
ways to submit tamely to this legalized outrage upon them ? Let
them at least make some well arranged, organized effort, and they will
obtain some redress of their grievances."

An extraordinary case of Pin- Swallowing. In September last, a
girl at Vienna, who labored under an aberration of intellect, attempt-
ed to destroy her life by swallowing a quantity of pins. The first
dose consisted of seventy, which she took one after the other, each
pin being enveloped in a wafer; but in consequence of their small-
ness they passed away without doing any mischief. Subsequently
she again took to swallowing pins of a larger size, some of them two
inches long. She was then seized with such severe illness, that she
was taken to the hospital of the town, when it was instantly detected
what she was suffering from, and she was placed under a course of
treatment, which had the effect of dislodging the whole of the pins in
succession from the bowels. There were no less than 242 pins
passed, all of them of a black colour. The girl is now in a fair way
of recovery. [London Lancet.

1854.] Editorial and Miscellany. 509

Medical College of Atlanta. The newspapers announce the ap-
pointment of the following gentlemen as Professors in the contempla-
ted Medical College of Atlanta.

Horace Nelson, M. D., of New York, Professor of Anatomy.
John W. Jones, M. D., of Auburn, Alabama, Professor of Theory and

Practice of -Medicine.
Willis F. Westmoreland, formerly of this State, but for some time

past resident at Paris, France, Professor of Surgery.
James M. Gordon, M. D., of Savannah, Georgia, Prof, of Surgery.
John S. Duval, M. D., of Texas, Professor of Chemistry.
R. A. T. Ridley, M. D., of Lagrange, Georgia, Professor of Physi-
ology and Pathological Anatomy.
John G. Westmoreland, M. D., of Atlanta, Georgia, Professor of Ma-
teria Medica.
J. B. Calhoun, M. D., of Newnan, Georgia, Professor of Surgical
Anatomy and Medical Jurisprudence.

Death of Dr. Waldo J. Burnett. We perceive by the Boston pa-
pers, that our learned friend, Dr. Burnett, has finally yielded, in the
the 26th year of his age, to the pulmonary affection under which he
was laboring when he visited this city. As a microscopist, Dr. B.
had few if any superiors. Quite enthusiastic in the pursuit of know-
ledge, he would have reached very soon the highest professional
eminence had his life been spared. The death of such a man cannot
be too much deplored.

Deaths by Chloroform. Mrs. A. W. Richardson, of North Adams,
Mass., died from the inhalation of chloroform, administered by Dr.
C. E. Streeter, for the extraction of a tooth.

Also, Mrs. Jane Morgan, in the British Royal Infirmary, 21st Feb.,
1854, died from the effects of inhaling chloroform for the reduction
of a dislocation of the arm ; death was sudden.

Dr. Beverly R. Wellford has been appointed Professor of Materia
Medica, and Dr. B. Sequard Professor of Institutes and Medical Ju-
risprudence in the Medical College of Virginia.

Prof. N. S. Davis has become associated (in place of Prof. Herrick)
with Dr. H. A. Johnson in the editorial management of the North-
western Medical and Surgical Journal ; and Dr. A. B. Palmer with
Dr. Andrews, in that of the Peninsular Medical Journal.

Editorial and MisctOaay.

_. _f^-S;-;:: in S_-5.I1 amal:

Dw Sir Having seen it isrii ti ri that frets ought to be collected
m order to expose the absurdities of the Thompson i an system of
practice I have thought that the following, which came under my
:- 1 ::>--. i- :. ~ is :--i :- : j ; : , ! -: :

iing In the country, sometime since, I fell in company with a
xg lis* inn* fellow, who had lately emerged from the plough
and looked as if he would make a noble axeman or black-
Txs called - Doctor *' was mounted, with his saddle-
with roots, and was going to see his patients. This
had lor a time mate a run of practice, and was considered
Asm at the hnrmrrs The Doctor," after a while, began to enquire
of me, what could be the matter with t 1 n apparent

that she had been delivered of a child some weeks a.
rery badly offerer since, and continued 10 get worse was
rery low indeed, and had now become so offensive it was hardly pos-
sible to stay in the room where she ii. requiring a little into
her maafirino, the lamentable ignorance of this u Doctor " manifested
itself in the fact, that his wife had never been fully delivered, and
Li: :'.: - . ~ -.- --.--.- ,.7 - -._ :' ...:'- ..;.._:....-... ^.
has knowledge ! Qoere: Wonder if our late Legislature would not
hare licensed this- Doctor.** tx>! " O tempora, O mor

*y respectfully, yours, H. N ***-

wokjls axcxrvro.

The Transactions of the Iowa State Medical and Cbirurgical So-
ciety, 3d and 4th sessions, held at Fairfield lad Daven-
port, June. 1*53. This production indicates the onward tend-
the people of the far West, and is highly creditable to our pioneer
::. -::.-. :: ;.-.--

}mXmmm Medical Journal, a quarterly record of the Medical sciences
of "-.e S -..-. --.: "."-:-. K . _. y\V H. BctwCB, M. D, Piufc sf
Practice in EvansriUe Medical College, and H. B ' I) . Prof,

of Anatomy in the same College. Published at Evans?:

The Georgia Blister and Critic, a monthly Journal. Edited by
H. A. Rxjuxt. M D.. iinhrnhtil at Atlanta.

I il Report of the City Inspector of the City of Sew York for
the year 1-

A large inmhrr of Pamphlets, College Circulars, die.

1 -54] Editorial and Miscellany. 5 1 1

On the new method of preserving Anatomical and Pathological
Specimens. By JohzvH. Buxton, M. D. The preservation of the
anima in such manner as to present unchanged, their normal

and abnormal relations, has ever been an object of study and interest
to the practical Anatomist, the Pathologist and the Surgeon. But as
yet, all attempts to retain, in an unaltered state, the siz?, shape and
color of parts, have to a certain degree been unsuccessful.

Anatomical objects have hitherto been preserved in one oT two
states, either wet or dried. Both of these methods are, however, in-
adequate ; for if fresh animal tissues be immersed in alcohol, or any
other antiseptic fluid, they become blanched in color, condensed in
structure, and consequently modified in size and shape. At the
time, they present inconveniences for demonstration. The method of
preparation by drying is open to even more serious objections, since the
parts are so shrivelled and displaced as to convey but an imperfect
idea of their primitive relations.

No is shrinking of the tissues and their decomposition,

depend most probably upon atmospheric influence, it recently occur-
red to me, that should I be able so to exclude the air as to ca-
evaporation to cease. I would effectually prevent, not only the desic-
cation of the part, but also its decomposition. Acting upon this idea,
I commenced a series of investigations; th attendant upon

which, up to the present time, has led me to submit the results to the
profession.

My object being to encase hermetically every portiou of the speci-
mens, I selected for my earlier experiments a solution of gun cotton
in ether, the ordinary collodion. By means of a brush, I applied this
carefully upon every portion of the external surface of the object to
be preserved. The ether quickly evaporating, a thin pellicle of the
cotton was left, coating the entire preparation. This process was
then repeated, and the preparation finished by the application
:\e layers of daraarra, copal and shellac varnish r

But it early became evident to me, that collodion was entire.;
fitted for the preservation of the generality of specimens, especially lor
those of any size and bulk. It possesses too slight a degree of tenaci-
ty, and is liable to become fissured, and to chip off; at the same time
its tendency to form white opaqu- when moisture is present-

ed, renders it unsuitable as a transparent coating. I was, therefore,
obliged to make use of some other protective material, and for this
purpose I selected gutta percha. This I dissolved in benzole, adding
at the same time to the solution a few grains of caoutchouc in order
to increase the elasticity of the pellicle. By filtering the Tiscid dark-
colored result through animal charcoal a perfectly colorless solution
may be obtained, which upon application deposits a tenacious film.

This film, unlike that lelt by the evaporation of the ethereal
portion of the collodion, evinces but little tendency to opacity; and,
indeed, for all practical purposes, may be said to be perfectly trans-
parent. The tenacity of the thinnest pellicle i - _ at ; it possesses
sufficient elasticity, is not liable to crack, and thus far has proven

512 Editorial and Miscellany. [August,

amply sufficient to prevent the occurrence of evaporation, shrinking
and decomposition. At the same time, by repeated applications of
the solution, the coating of gutta percha can be increased to any desi-
rable thickness.

To prepare a muscular specimen, as, for example, one exhibiting
the relations of the arm and forearm, a limb should be selected which
has been previously injected with the chloride of zinc, arsenic or
other antiseptic solution. When the parts have been sufficiently
exposed by dissection, the whole limb should be coated with the col-
orless solution of gutta percha: a transparent pellicle will then be
left by the evaporation of the benzole. This process should be repeat-
ed until a layer of considerable thickness is obtained. Upon the
muscular mass, the gutta percha may be applied in much greater
quantity. Should opacity here result it matters little, as in conse-
quence of the blanching of the muscle, dependent upon the previous
antiseptic injection, an artilicial coloring process will be necessitated.
In preparations, however, of perfectly fresh muscles, or of those which
have been injected with Horner's solution, this will not be the case.
The layers of gutta percha having been obtained of sufficient thickness,
it will be found desirable to apply next a coating of collodion, which
has been filtered, and then mixed with Venice turpentine. This
preparation possesses no contractile powers whatever, but is of great
body and consistency. It splints, as it were the specimen securely,
and ensures stability and firmness.

In order to impart a proper hue to those muscles, whose color may
have been affected by the preceeding processes, I make use of collo-
dion stained with the wood of the Pterocarpus santalinus, (the ordina-
ry red saunders.) The resulting color, when varnished, simulates
closely that of fresh muscles. The specimen should then be com-
pleted by the application of damarra and copal varnishes. The adi-
pose tissues, the tendons, fasciae, nervous and cutaneous surfaces
will present almost the appearance of a recent dissection ; the
muscle alone will possess an artificial color, and even this can be
avoided.

Each specimen should be mounted on a board separately, and I
have found the most convenient method for so doing, to consist in the
preparation first of its dorsal surface. The object should then be
placed upon the board ; when the anterior surface, that intended for
inspection and exhibition, can be finished in situ. I have also found
it advisable to keep them covered by glass cases. The period re-
quired for the preparation and mounting of an object by the above
process does not exceed five days.

I have now in my possession specimens of meat which have been
preserved by the preceding method sixty days, without having been
previously saturated by any antiseptic fluid. In one preparation
which I examined, after removing the gutta percha coat at the expira-
tion of forty-five days from its completion, no decomposition whatever
had taken place. The fibres of the muscle were, however, some-
what blanched, and afforded a slight odor of the benzole used in the

1854.J Editorial and Miscellany. 513

preparation. Exposed to the air, decomposition ensued at the expira-
tion of four or five days.

I have prepared, in a similar manner, a number of specimens, not
only of muscular, but also of nervous tissues, as the biain and spinal
marrow. In these no shrinking has occurred, and no evidence of
decomposition exists. On the contrary, the preparations now present
a harder, firmer and more natural appearance, than at the date of
their completion. In the nervous preparations the natural color is
retained, and is visible through the transparent coatings. I am at
present engaged in making application of the process to the preserva-
tion of pathological tissues, and with every prospect of success. I
believe also that botanical specimens may be preserved in a similar
manner, and, indeed, it seems to me not impossible, that, at some
future day an extension of this method may be rendered subservient
to the preservation of meats, and all fresh animal tissues.

A longer period than has as yet elapsed, is required of course, to test
fully the value of the above proceeding; at the same time the results
already obtained seem to me so satisfactory, as to warrant me in
laying them before the profession. [Medical Examiner.

On the Venom of Serpents. By J. Gilmah, A. M., M. D., LL. D.
There is much in the history and habits of the reptile tribes, however
repulsive they may be in appearance, that is very interesting. During
a sojourn of two or three months in the interior of Arkansas, which
appears to me to be the paradise of reptiles, I paid some attention to
that branch of natural history called ophiology : I found four distinct
varieties of rattlesnakes (Crotalus), of which the Crotalus Horridus
and Crotalus Kirtlandii are by far the most numerous. The former is
the largest serpent in North America. The family of moccasin
snakes (Colluber) is also quite numerous, there being not less than
ten varieties, most of which are quite as venomous as the rattlesnake.
By dissecting great numbers of different species I learned that the
anatomical structure of the poisoning apparatus is similar in all the
different varieties of venomous serpents. It consists of a strong frame
work of bone, with its appropriate muscles in the upper part of the
head, resembling and being in fact a pair of jaws, but externally to
the jaws proper, and much stronger. To these is attached by a ging-
lymoid articulation, one or more moveable fangs on each side, just at
the verge of the mouth, capable of being erected at pleasure. These
fangs are very hard and sharp and crooked, like the claws of a cat,
and hooking backwards, with a hollow from the base to near the point.
I have occasionally seen a thin slit of bone divide this hollow, making
two. At their base is found a small sac, containing two or three drops
of venom which resembles thin honey. The sac is so connected with
the cavity of the fang during its erection, that a slight upward pres-
sure forces the venom into the fang at its base, and it makes its exit
at a small slit or opening near the point, with considerable force : thus
it is carried to the bottom of any wound made by the fang. Unless
the fangs are erected for battle they lie concealed in the upper part of

514 Editorial and Miscellany . [August,

the mouth, sunk between the external and internal jaw bones, some-
what like a pen-knife blade shut up in its handle, where they are cov-
ered by a fold of membrane which encloses them like a sheath ; this
is the vagina dcniis. Then can be no doubt but these fangs are
frequently broken off or shed, as the head grows broader, to make
room for new ones nearer the verge of the mouth; for, within the
vagina dentis of a very large crotalus horridus, 1 found no less than
five fangs on each side in all stages of formation the smallest in a
half pulpy or cartilaginous state, the next something harder, the third
still more perfect, and so on to the main, well-set, perfect tang. Bach
of these teeth had a well defined cavity like the main one. Three
fangs on each side were frequently found in copper-heads, vipers,
and others.

The process of robbing - of their venom is easily accom-

plished by the aid of chloroform, a lew drops of which stupilies them.
If, while they are under its influenc \ they are carefully seized by the
neck, and the vagina dentis held out of the way by an assistant, with
a pair of forceps and the fang be erected and gently pressed upwards,
the venom will be seen issuing from the fang and dropping from its
point. It may then b<j absorbed by a bit of sponge, or caught in a
vial, or on the point of a lancet. A tier robbing several serpents in
this manner, they were found after two days to be as highly cha
as ever with venom of equal intensity with that first taken.

During the process of robbing several species of s< rpenta, I inocula-
ted several small but vigorous and perfectly healthy vegetables, with
the point of a lano t well charged \\ ith venom. The next day the} were
withered and dead, looking as though they had been scathed with light-
ning. In attempting to ;i few drops of venom, for future
experiments, in a small vial with two or three parts of alchohol, it was
found in a short time to have lost its venomous properties. But after
mixing the venom with aqua ammonia, or spirits turpentine, or oil of
peppermint, or of cinnamon, or of cloves, or with nitric or sulphuric
acid, it still seemed to act with undiminished energy. It is best
preserved, however, for future Use by trituration with refined sugar
or sugar of milk.

A very fine large cotton-mouth snake, being captured by putting a
shoe-string around him, became excessively ferocious, striking at even
the crack of a small riding-whip. Finding himself a prisoner, without
hope of escape, he turned his deadly weapons on his own body, strik-
ing repeatedly his well charged fangs deeply into his flesh. Not-
withstanding this, he was put in a small basket and carried forward.
In one hour after he was found dead, and no amount of irritation could
excite the least indication of life. Four hours after, while removing
the skin for preservation, the blood oozed slowly from the vessels in a
dissolved state. No violence was done to his snakeship, except what
he did to himself.

Another mocasin, shot by a pistol about two inches back of the
head, and skinned immediathly, gave decided evidence of vitality four
hours after being flayed, by writhing the body whenever it was irri-
tated by a scalpel.

1854.] Editorial and Miscellany. 515

A large rattlesnake beheaded instantly with a hoe, would, an hour
and a half after, strike at any thing that pinched its tail. Of several
persons who were testing their firmness of nerve, by tning to hold the
hand steady while the serpent struck at it, not one could be found
whose hand would not recoil in spite of his resolution, and one man,
a great bully, by-the-by, was struck on the naked throat with consid-
erable violence by the headless trunk of the serpent, and staggered
back, fainted and fell, from terror. Mr. Stewart, of .Miss., tells me
he witnessed a similar scene once. An old hunter shot a rattle-snake's
head off, and after reloading his gun and standing sometime, he stooped
to pull off the rattles, and the bloody but headless trunk of the snake
struck him in the temple and he fainted and fell down with terror.

Seven venomous serpents belonging to five different species were
made to fraternize and dwell amicably in one den. A beautiful pair
of long bodied speckled snakes, known as kingsnakes, and found to be
fangless, and consequently without venom, were duly installed as
members of the family. Some uneasiness was perceivable among
the older members, but no attempt was made to destroy the intruders,
though they might have been killed instanter. The next morning four
of the venomous serpents were found to have been destroyed by the
kingsnakes, and one was still within their coil, and the two remaining
ones would make no effort at self defence. A large rattlesnake
seemed stupid and indifferent to his fate. He could not be made to
threaten or give warning even with his rattles. The smallest king-
snake was afterwards inoculated with the poison of one of the serpents
he had destroyed, and died immediately after thus evincing thatthey
must have exercised some power besides physical force to overcome
their fellow-creatures.

In short, the results of a great number of experiments performed
with the venom of a great variety of serpents, seem to lead to the fol-
lowing conclusions :

1st. That the venom of all serpents acts as a poison in a similar
manner.

2d. That the venom of some varieties is far more active than that
of others.

3d. That a variety of the colluber, known as the cottonmouth, is
the most venemous serpent in Arkansas.

4th. That the venom of serpents destroys all forms of organized life,
vegetable as well as animal.

5th. That alcohol, if brought in contact with the venom is, to a
certain extent, an antidote.

6th. That serpents do possess the power of fascinating small animals
and that this power is identical with mesmerism.

?th. That the blood of small animals, destroyed by the venom of
serpents, bears a close resemblance to that of animals destroyed by
lightning or hydrocyanic acid ; it loses its power of coagulation and
cannot be long kept from putrefaction. [St. Louis Medical and
Surgical Journal.

496 Editorial and Miscellany.

Puerperal Convulsions and Albuminuria. By MM. Depaul and
Mascaret. M. Depaul has read an able report upon a very instruc-
tive memoir by M. Mascaret, to the Academic de Medecine, upon this
important subject, The author divides the cause of eclampsia into
predisposing and occasional. He regards as special predisposing
causes, first labours, the sanguineous and lymphatico-sanguineous
temperaments, infiltration of the legs ; but he does not consider albu-
minuria, and in this M. Depaul confirms the views of the author, as
an essential cause of the disease. M. Depaul cited three cases of
puerperal convulsion, in which no trace of albumen could be discov-
ered in the urine ; one which had occurred in his own practice, one
recorded by Dr. Leuer, and a third by Professor Dubois. Two ad-
ditional cases are recorded in M. Mascaret's memoir. M. Depaul
again refers to the frequency of albumen in the urine of pregnant
women, and the comparative and absolute rari'.y of convulsions. Out
of 41 women in whom the urine was found albuminous, observed by
Dr. Blot at the Maternity, only 7 were seized with eclampsia. In
order to collect these 41 cases, he examined the urine of 205 women,
taken indiscriminately from the wards of the hospital. Further, M.
Depaul cites two cases, in which, having examined the urine before
labour without finding any albumen present, convulsions broke out,
and the urine was found to contain albumen after the second fit in the
first case, and after the fourth lit in the other case. M. Depaul also
observed that the albumen disappears with remarkable rapidity after
delivery, whilst not seldom convulsions only appear some hours or
even some days after parturition. The reporters, however, admitted
that albuminuria was too frequently observed in the course of gesta-
tion, and coincided too frequently with puerperal convulsions, not to
render the investigation, of the relation of these conditions necessary.
M. Depaul observed that the common explanation of albuminuria in
pregnant women was not to be found in inflammation of the kidney.
In the autopsies he had made, the kidneys were found cither perfect-
ly healthy, or simply congested. The true point of departure he
believes to be, the modifications that gestation caused in the blood.
U Union Med. British and Foreign Medico-Chirurgical Review.

Fever, Intermittent. Dr. Harting (Schmidt's Jahrb., 1853, ix.)
has employed quinoidine with alcohol and sulphuric ether in ague,
and, from twelve year's experience, states that it is superior to com-
mon quinine. He considers the quinoidine to be an amorphous
quinine, (an opinion which has been strongly opposed by Muller.)

Dr. Castiglioni (Schmidt's Jahrb., 1853, ix.) has used the tannate
of cinchona ; it requires to be given in larger doses than quinine, but
is much less expensive. [lb.

Cataract. M. Lopez (Bull. Gen. de Therap., 1854, ii. p. 89) has
employed with advantage iodide of potassium taken internally, and
vesication on the temples, in cataract. The treatment was persevered
in for five or six months, and in 3 cases out of 4 was productive o
great benefit. [lb.

SOUTHERN

MEDICAL AID SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES. SEPTEMBER. 1844. [No.

ORIGINAL AND ECLECTIC.

ARTICLE XXVII.

On Epidemic Dysentery. By Z. P. Landrum. M. D., of Lex-
ington. Georgia.

When we consider the general prevalence of this disease, its
frequent obstinacy under all plans of treatment, and its fearful
mortality in certain localities, it would seem to demand the
earnest and patient investigation of all philanthropic physicians.
As an epidemic in Georgia for the last few years, we know of
no disease that has prevailed among us with bounds as wide or
mortality as great ; frequently selecting for its ravages those,
who, in the pride of manhood, boast of their vigour of consti-
tution ; at other times, attacking the infant at the breast the
child at its sports the young man or lady of temperate habits,
and the old man or woman tottering under the infirmities of
age. Thus it has prevailed, without regard to age, sex, or con-
stitution. We have known of instances of individuals whose
vigour of constitution and general habits of temperance, had
defied the onsets of the ordinary causes of disease, who, when
attacked by this epidemic, have sunk with fearful rapidity, dy-
ing in a few days from the commencement of the attack.
Could its causes be ascertained, thereby affording opportunity
to avoid its attacks, or remedying its effects, a great end would
be attained. That its origin is atmospheric, we do not doubt ;

N. S. VOL. X. NO. IX. 33

518 Landrum, on Epidemic Dysentery. [September,

but whether it be identical with the cause of malarious fevers,
we think admits of many doubts. In malarious districts dysen-
tery may occur, and occur also in conjunction with remittent
or intermittent fevers, prevailing in the same subject, at the
same time, mutually aggravating each other. When prevail-
ing in such localities, and in such alone, we may be justified in
assigning for its cause, that state of the atmosphere brought
about by the decomposition of animal and vegetable matters.
This, however, we would doubt exceedingly, if the disease as-
sumed such unvarying features in its incipient stage as has
been noticed by us in the present epidemic. As an objection
to this malarious origin of the present epidemic, we would offer
the extent of country and variety of climate over which, and in
which, it has prevailed. Next, we would remark, that the dis-
ease has prevailed with undoubted malignancy at places and in
localities where malarious fevers rarely ever did, and have not
made their appearance at all for a number of years. Lastly,
we would object to identifying in cause a local phlegmasia,
beginning as such, with malarious fevers, whose first symptoms
are peculiar to themselves especially so, when we find that
dysentery, taken in its incipiency, is frequently relieved by ac-
tive stimulants, which is rarely the case with malarious fevers,
these almost invariably demanding from the judicious practi-
tioner the free administration of quinine, from the use of which
we have scarcely derived benefit in the treatment of dysentery.

Symptoms. Every case in the treatment of which we have
had an opportunity of seeing at the outset, has begun as a local
disease, with tormina, tenesmus, and frequent discharges of mu-
cous or muco-sanguinolent matter, sometimes mixed with the
natural contents of the bowels. This has not only been the
case, but we have seen this state of things continue for days,
and sometimes a week, without involving disturbance, but little,
if any, of the general circulation; the pulse remaining of moder-
ate frequency, of ordinary volume and rythm ; the skin dis-
charging its functions without unusual heat, and the tongue
clean and moist. This, however, has occurred in the mildest
cases, such as were not amenable to treatment. In cases of
marked severity, but a short period elapses before the func-

1854.] Landrum, on Epidemic Dysentery. 519

tions of the heart and circulatory organs are sympathetically
involved ; the pulse increases in force and frequency, ranging
from one hundred to one hundred and twenty ; the skin be-
comes hot and dry, abdomen excessively so ; tongue red about
its edges, slightly furred and dry, and urine high-colored and
scanty. In other cases, when the inflammatory action has in-
volved a larger extent of bowel, extending through the small
intestines to the stomach, there has been prostration of the vital
forces those pertaining more particularly to organic life from
the commencement attended with a quick, feeble pulse, and
coolness of the surface. We have seen this enfeebled action of
the heart and extremities to such an extent as to render the
pulse scarcely perceptible at the wrist ; the hands and feet of
an icy coldness, when there was sufficient strength in the vol-
untary muscles for the patient to spring up in bed.

In a patient, under the treatment of a brother practitioner in
this village, we learn that this was the case to such a surprising
extent, that the patient, but five minutes before his death, sprung
from his back, and getting on his hands and knees, died in this
position.

Cases of this kind appear to bid defiance to our best directed
efforts, and ride in unmolested sway until its ravages are com-
plete. When the fever runs high, without this prostration,
from the commencement, there is frequently light delirium ; if
it continues its course, unchecked in its ravages, the peristaltic
movements of the bowels, when not under the influence of
quieting remedies, become more disturbed, the discharges
more frequent, consisting of blood and vitiated mucus, with
colored serum and pus, sometimes mixed with fibrinous mat-
ter, or shreds of the lining membrane of the bowel. The
discharges now become exceedingly offensive, sometimes so
much so as to impregnate the air of the whole room. In chil-
dren, we have noticed a protrusion of the rectum, fissured and
swollen to an enormous extent. As the patient merges into
this condition, there is rapid emaciation, with hollow cheeks,
eyes deeply sunk in their sockets, the upper lid appearing as
though it was pressed on the ball ; coldness of the extremities ;
pulse scarcely perceptible ; clammy perspiration about the face
and neck ; jactitation, sighing, hiccough, involuntary dischar-

520 Landrum, on Epidemic Dysentery. [September,

ges, and death. This is the ordinary course of the disease, if
nol arrested.

Pathology We agree entirely with the views entertained
by Sir G. Bellengal. and expressed in the June No. of this Jour-
nal by Dr. D. C. O'Keeffb. of the pathology of this disease:
that it is an idiopathic phlegmasia, situated most usually in the
descending and transverse colon, but at other times involving
the whole length of the alimentary canal. We are very far
from admitting the causative influence formerly ascribed to
hepatic congestion by high authority. Though we readiy ad-
mit that this organ is sometimes involved to such an extent as
to aggravate the disease, if not relieved.

Treatment. Bloodletting. This is the great remedy with
which destructive inflammations, such as exist in this disease,
in our judgment, should be controlled ; we can, however, readily
imagine cases indeed we have seen such in which it could
not be used to any considerable extenl with safety. Persona
attacked, whose force of constitution has been impaired by
chronic disease or intemperate habits, especially habits of drunk-
enness, would be liable to fatal prostration, if subjected to the
use of this remedy to a sufficient extent to produce a decided
impression on the system. But in robust constitutions, before
the vires vita? have evidently given away under its ravages, wo
have no doubt that nine cases out of ten may be relieved by
the decided and judicious use of bloodletting, both local and
general ; and when we recommend bloodletting, we do not re-
commend it to the hands of the over-cautious and timid prac-
titioner, who is governed in the abstraction of blood by a cer-
tain number of ounces because, if used in this way, without
impressing the system with its peculiar effects, it will invariably
aggravate the disease. Unless the bleeding is carried to a suf-
ficient extent to make a decided impression on the 'congested
capillaries, the heart, freed from the over supply of blood accu-
mulated in its larger vessels, will rebound with such force as to
increase the very obstacle we intended to remove. We would
say bleed then, without regard to quantity, in the cases speci-
fied, until symptoms of decided syncope appeal*, and after the

IS54.] Landrum, on Epidemic Dysentery. 521

free use of cups or leeches in the course of the colon, should
the local symptoms return, bleed again and again, until they are
to some considerable extent subdued.

We remember the case of a robust negro man, from whom
we abstracted blood, in the sitting posture, to the extent of a
half gallon, and then had to make him stand erect before the
desired result was obtained. The result was, that although the
attack was violent, his symptoms were so much abated, that
after the free use of cups next morning, we dismissed him con-
valescent.

In the treatment of the disease in children, where there are
no decided symptoms of worms, after the contents of the bowels
have been evacuated by castor oil mixed with laudanum, the
proportions depending on the age of the child, we have found
that cold water injections with a large syringe entirely super-
cedes the necessity of bloodletting : indeed, we doubt not that
such would be the case with adults, if timely used. Our plan
is, to have a large bucket of fresh well or spring water prepared,
the patient placed across the lap of an assistant, and syringe-full
after syringe-full injected into the bowel until all the pain is
relieved and the bowel quieted. This may require some fifteen
or twenty minutes, and will be indicated by the diminished
force with which the bowel ejects the water after it has been
injected. The patient is then put into a large tub of warm
water, prepared whilst the injecting process was going on, and
suffered to remain with a blanket thrown around the shoulders,
until full perspiration is established. Taken from the water,
the patient must be wiped dry. a teaspoonful of laudanum rub-
bed over the bowels, and a thick folded blanket or flannel, wrung
out of hot water, applied. this to be changed for a fresh piece
as it becomes cold. Should the discharges return in the course
of seven or eight hours, the same course is to be adopted again.

Purgatives. When the disease has not been followed by
diarrhoea, for the purpose of evacuating the faecal matter of the
intestines, we would invariably give- a mild purgative of some
kind, preferring for this purpose castor oil, in doses of a table-
spoonful for an adult, with twenty-five drops of laudanum.
After we have once secured the thorough evacuation of fecal

522 Land rum , on Epidemic Dysentery. [September,

matter from the bowels we have no farther use for cathartics.
They are recommended by some after this, to effect the evacua-
tions of morbid secretions. We would remark, on this point,
that we do not believe in the irritable nature of any secretion
to the surface secreting it. That vitiated bile will irritate a
healthy mucous membrane that urine harmless to the mucous
membrane of the bladder, will irritate the skin or mucous mem-
brane of the intestine, we do not doubt ; but that vitiated mu-
cus secreted by an inflamed intestine, is irritating to the part
secreting it, we do doubt exceedingly. We believe that the
vitality of the part is so modified by the inflammation as to be
adapted to the nature of the secretion poured out from its sur-
face ; and when we say vitality, we use no unmeaning phrase,
we mean the sensibility, irritability, vital affinity, &c., of the
part. Entertaining these views of the nature of the secretions
and satisfied of the irritating effects of most cathartics, we have
used them heretofore only with the view of relieving the bowels
of their faecal contents. As to the use of saline cathartics, as
recommended by Dr. O'Keeffe and other-, we have not had
sufficient experience to express an opinion of their value; we
have used them in but one instance, and then with decided in-
jury to the patient, producing marked debility whilst the patient
was under their influence, without changing the nature of the
discharges, only for a short time. Except in cases where there
is pain, weight or tension in the region ofthe liver, with yellow-
ish skin and conjunctiva, we would condemn unreservedly the
use of mercury in any of its forms. We have found its use to
be only evil, and that continually. The peculiar irritating effect
of the mercury on the inflamed bowel increasing with unerring
certainty the severity of the symptoms.

Opium. After the free use of bloodletting, we think opium
well calculated to fulfil many important indications in the case,
whether it be used in pills or given in injections with cold water
or starch. It calms the exquisite sensibility of the bowel, which
renders it so susceptible to impressions external or internal.
We have seen this susceptibility so great, that a teaspoonful of
cold water taken into the stomach would produce an evacua-
tion, with straining, the moment it was swallowed, the im-

1854.] Landrum, on Epidemic Dysentery. 523

pression having been transmitted through reflex action as quick
sls electricity on wires. It diminishes this susceptibility to
impressions, quiets the peristaltic action of the bowels, and re-
lieves pain. The fulfilment of these indications is much to be
desired in the treatment of this disease ; for we have no doubt
that cases have died from the prostrating effect on the action
of the heart and arteries of extreme suffering, before there was
any organic lesion sufficient to produce death. We sometimes
use, to fulfil these indications, after the free use of the lancet,
the following prescription :

Acetat. plumbi, . . . 4 gr.

Opium, 1 "

Ipecac, 1 "

To be repeated according to the urgency of the case. When
the discharges become offensive, and assume such appearances
as indicate ulceration, we have found nothing which would
reach such cases but nitrate of silver. This I have given in
grain doses, every half hour, until the bowels were checked.
The same indication that demands the use of this remedy, we
think also requires a blister, and in accordance with this view
we apply, at this stage of the disease, a large blister over the
bowels. With these two remedies we remember to have saved
a case, which seemed hopeless. When the inflammation is
situated low down, indicated by the urgency of the tenesmus,
we have used the nitrate of silver, by injection, in the propor-
tion of two grains to the ounce of water. We would remark,
here, that we use poultices to the bowels, made irritating with
pepper, or mustard, from the commencement, until we apply
the blister. As to the use of stimulants, we deem it unneces-
sary to say any thing ; for we never have seen a case recover
from this disease after the extremities became cold.

Diet. We give our patients nothing to eat at all, so long as
we can possibly avoid it, and then resort sparingly to boiled
milk, thickened with arrow-root. We unhesitatingly condemn
the use of ice. The water used as a drink, we think, should
have the chill taken off, to avoid the impression of cold of which
we have spoken, and then used in as sparing quantities as the
case will allow. The patient, however, may be allowed fre-
quently to wash his mouth with water to relieve dryness.

524 Floyd's Cases of an Epidemic Affection. [September,

ARTICLE XXVIII.

Cases of an Epidemic Affection. By Larkin Floyd, M. D.,
of Chambers county, Ala.

Case I. Thursday, April Gth, I was called to see W. A., a
little boy aged 9 years, who had for some ten days previous
been unwell from a cold and cough. He was attacked on the
4th April, with high fever, headache, occasional vomiting, rest-
lessness, &c, and on the 5th had sore throat and a peculiar
distressing pain in the back and extremities, particularly about
the joints. I found all the above symptoms continuing, except
the vomiting; bowels costive ; urine suppressed; tongue coat-
ed and edges red; eyes sensitive to light, watery and red ;
lymphatic glands of the neck swollen and tender ; skin hot and
dry, with an eruption resembling measles over the entire sur-
face, with itching and burning; thirst; no appetite, &c. He
continued in this condition, with exacerbations of fever in the
evening, delirium, and the tonsils swelling to danger of suffoca-
tion at night, until the morning of the 8th, up to which time I
had been unable to get a motion from the bowels, in conse-
quence of obstinate costivec

8th. Bowels moved freely this morning, with copious flow of
urine, and profuse perspiration soon after. The fever abated,
and also, within twelve hours, every symptom except the erup-
tion, and the affection of the throat and neck. The eruption
disappeared in a few days, with desquammation of the cuticle,
great prostration, &c.

On the 12th, when he was permitted to get out of bed, he
could scarcely walk, from the soreness and swelling of the in-
guinal lymphatic glands, which had been unobserved up to this
time, but, no doubt, previously existed. This also subsided in
a few days, with slow but perfect convalescence.

Case II. Miss W., who also had been affected with cold and
cough for some time, and who had had a few days some fever-
ish excitement, headache, peculiar aching of extremities, &c.
Discovered, April 23d, an eruption of an erysipelatous char-
acter, on the face and neck, (at first supposed to have been
occasioned by handling me while wet with dew, and washing

1S54.] Floyd's Cases of an Epidemic Affection. 525

the face and neck soon after,) which soon spread over the body
and extremities, with itching and burning : eyes red, sensitive
to light and watery ; tongue slightly coated ; slight soreness of
glands, &c. Eruption disappeared about the fifth or sixth day.
with some desquammation, prostration, &c.

Case III. B. S., a young man. previously in good health,
except slight headache the evening before was attacked May
9th. in the morning, with chilly sensations, which continued for
about four hours, followed with high fever, excruciating pain
and aching of the head, back, and extremities, particularly about
the joints so much so, that he remarked, :; if nothing else was
the matter, I would be in agony from the pain of my little
toes:'"'' skin punsrently hot and dry; bowels costive: tongue
coated, with edees red ; eyes injected, watery, and sensitive to
light; lymphatic glands of the neck swollen and tender, 6zc.
These symptoms continued (with some delirium at night) until
the evening of the next day, when, from active purgation, fol-
lowed by a prompt opiate and diaphoretic, the symptoms all
abated with profuse perspiration, leaving only extreme prostra-
tion and slight soreness of the glands the following morning.
Slow but perfect convalescence, with no eruption.

These cases will show the general as well as the diversified
character of this disease ; and notwithstanding the striking re-
semblance to Scarlatina in some instances, (as case i..) yet it is,
to the close observer, evidently all the same disease. The
characteristic feature is not the eruption, but the arthritic or
neuralgic and glandular affection ; and although these neuralgic
and glandular symptoms were overlooked in many instances
from the mildness of the disease, yet observation leads me to
conclude that, by close examination, they would have been
found to exist, to some degree, in every case. Many instances
presented not only the pain, but the swelling, tenderness, and
stiffness of the joints, with the eruption or without it, as case iii.

Like previous epidemics of Dengue, of which I am disposed
to regard this as one. it was harmless, except from the sufterincr.
and previous attacks of scarlatina, measles, or any of the exan-
themas common in this country, afforded no immunity against

526 Pitts's Case of Buccal Inflammation. [September,

it. It assailed equally the young, the middle aged and the old
but was much milder, however, in the young.

ARTICLE XXIX.

A Case of Idiopathic Buccal Inflammation, attended with
profuse salivation. By James W. Pitts, M. D., of Harris
county, Ga.

The following case is respectfully submitted, more from the
rarity of such cases, than any other peculiarity :

June 1st, 1854. Requested to visit John Hamilton, a Scotch-
man, aged 54 or 55 years, of scorbutic habit is consumptive ;
has been for several years subject to severe paroxysms of
asthma. Found him traversing his room in great agony ; re-
ferred most of his suffering to his teeth and jaws. Face, in the
region of the inferior maxilla, swollen; lymphatic ganglions en-
larged, hard and painful ; deglutition difficult, the effort causing
considerable pain can separate his jaws only to a very limited
extent. The mucous membrane of the entire mouth and fauces,
as far as could be seen, was red and highly inflamed ; surface
of cheeks, tongue, soft-palate and gums swollen and very pain-
ful ; teeth loose; gums separated from the teeth, presenting an
ulcerated, flabby and fungous appearance, bleeding freely from
the slightest touch in the course of the disease large portions
of the gums sloughed off; salivary glands highly excited, eject-
ing profusely a dark grumous frothy saliva; breath strongly
impregnated with the peculiar offensive fetor of mercurial
salivation ; no metallic taste mentioned ; teeth very much de-
cayed.

He was ordered saline aperients daily. To use, freely, warm
collutories, such as infusion of slippery elm, simple warm water,
a solution of nitras argenti, three or four times per day ; in the
latter stages of the case, decoction of Seneka snake-root, with
sulph. alumina, honey, etc. ; Hoffman's anodyne at night, to
procure rest. Under this treatment, the case progressed, gradu-
ally improving, and terminated in about thirty days.

The flow of saliva and mucus was abundant, and lasted, in
all, about twenty days. The quantity ejected was not accu-

1854.] Nature and Treatment of Spermatorrhoea. 527

rately measured, but would have averaged, for twelve or fif-
teen days, from two to three pints, or more, per day.

Mr. Hamilton assures me he has never taken any preparation
of mercury, within his knowledge has taken no medicine,
whatever, for several weeks, save a dose of castor oil the day
prior to my first visit, and some days after his mouth had be-
come sore. Hence I am inclined to consider this a well-mark-
ed case of spontaneous salivation, originating, perhaps, from
the irritation consequent upon the bad or decayed condition of
the teeth, The teeth and gums are represented as feeling
somewhat loose and sore, at this time, the cavity of the mouth
otherwise looks normal.

On the Nature and Treatment of Spermatorrhoea. By John
L. Milton, Esq., M. R. C. S.;Eng.

Preliminary remarks: divisions of spermatorrhoea ; complications. Treat-
ment 1." Of night discharges, quinine, blisters; 2. Of night and day dis-
charges, opium, nitric acid, cauterization of the urethra.

It has always appeared strange to me that this affection
should remain abandoned by the profession to a few solitary
specialists, and for the benefit of the vile harpies who prey on
this class of victims. Surgery, which has wrested so much
from empiricism and ignorance, seems disposed to yield up
this, as if it were debateable land, to chance, philosophy, utter
neglect, or quackery.

Although of late years several publications have appeared
from men of the most unquestionable talent, such as Lallemand,
Phillips, Curling, Russell, &c, yet I very much doubt if our
knowledge of spermatorrhoea is exactly what it should be, or
if the treatment, except as regards the employment of caustic,
has advanced materially since the days of Hunter. Thus
during three-fourths of a century the shadow has moved but
once on the dial.

To the treatment alone, then, this paper refers, a branch of
this art almost forsaken, I think, by the general practitioner,
and not too well cared for by the pure surgeon. This neg-
lect, and the twofold indisposition of the patient either to
trust his ordinary medical attendant with the secret of his dis-
ease, or to permit him to exercise that operative interference
which the specialists will perhaps insist, on; the extent, the
manner in which the question has been studiously burked, and

528 Nature and Treatment of Spermatorrhoea. [September,

the absence of any well-known source to which he can turn for
information, have had the natural effect of driving him to those
who will make it their business to let him know, that so long
as he has money, there is one city of refuge to which he can
always fly, and that there ore men who can treat his complaint
with medicine alone, at the moderate rate of "five guineas a
bottle."

Yet with strange inconsistency men wonder at and deplore
the growth of quackery, though this hydra would soon perish of
inanition if deprived of the food supplied by our neglect. Ad-
vance in the treatment of disease, aided by the revival of the
pillory or stocks for the more audacious of the quacks, would
do a good deal to strengthen the arm of medicine.

As I have already stated that the treatment of the disease
was to be the chief subject of discussion, J shall delay no fur-
ther than seems absolutely necessary to explain the plan of the
remarks I wish to make. All questions as to the nature and
causes of this affection I have left out, as too long for this paper,
and I have only laid down divisions of this disease, in order to
have something tangible to which the divisions of the treatment
could be appended.

Spermatorrhoea admits of a very natural division into 1.
Niglit Discharges; 2. Day and Wight Discharges; and 3.
Imperfect Secretion of Semen.

1. Night Discharges. These constitute the mildest form of
the complaint, and are, as is well known, a common result of
seminal plethora; they seldom require much treatment, unless
in execs-, or when complicated with gleet, stricture, or dischar-
ges in the daytime.

2. Night and Day Discharges a more advanced grade,
and in their worst form often dordering on the third class.
The urethra is then red and highly irritable, and the health
severely impared ; but happily for the patient both varieties
are for the most part easily curable.

3. Imperfect Secretion of Semen the most severe of all, and
necessarily accompanied by temporary impotence. Instead
of properly eliminated, healthy, consistent semen, a thin rank
fluid, unaccompanied by almost any signs of erection of the
penis, is thrown off under the influence of the slightest excite-
ment. Intense irritability of the urethra, and a marked dread
of examination, usually complicate this form.

There is a variety of the disease which is generally consid-
ered as spermatorrhoea, and with which most surgeons are
familiar: I mean the discharge after stool of large quantities
of glairy, tenacious fluid, supposed to be the contents of the
seminal vesicles. Now, I very much doubt if this be an evacu-

1854.] Nature and Treatment of Spermatorrhea. 529

ation of semen : great part of it, I suspect, comes from the
prostate; an>i in my work on Gonorrhoea (p. 101), I ad veiled
to 1 he cure of a case of this kind as being probably an instance
of prostatic gleet. Even if it comes from I he seminal vesicle,
I should scarcely be disposed to admit it to be a discharge of
semen, for I have not been able to satisfy myself that these re-
ceptacles receive the superabundant secretions of the testicle;
but whatever it be, it demands our urgent attention, in order as
weli to allay the patient s uneasiness about so disagreeable a
symptom, as also to leave no chance for the germs of any dis-
ease to ripen.

Complications. It is almost superfluous to say, that all com-
plications require immediate removal. Gonorrhoea and strict-
ure have their appropriate remedies, upon which I shnll not
touch. It has, however, been asserted that spermatorrhoea
mav depend upon fissures in the anus, ascarides, &c. To
which I reply, that 1 have strong doubts about the fact : but
as these causes would require removing for their own sake, it
is obvious that the treatment must be much the same. I must,
however, demur to M. Lallemand's plan of excising the pre-
puce in every case where accumulations of sebaceous matter
behind it coincide with spermatorrhoea. Where there is also
contraction of the prepuce, so that the glans cannot be uncov-
ered without pain ; or where a firm, constricting ring has
formed underneath the mucous membrane, I grant that the
remedy is circumcision; but where the prepuce passes freely
over the glans, plenty of soap and water every morning, and
the use of zinc or tannin, in the form of a lotion, will almost
always effect a cure.

When circumcision is imperatively called fori have found it
best to slit up the skin and mucous membrane to the reflection
of the latter, and then to cut away the frasnum as far as I could.
The constricted part, which is mostly near the edge, is removed
in a circle, and the bleeding being stopped, the skin and mu-
cous membrane are brought together by ceveral fine stitches,
and the intervening spaces may be covered with collodion.
Of all the operations 1 have seen, this leaves the neatest pre-
puce.

1. Treatment of Night Discharges. Even in cases where
it might be supposed, from the healthy frame of the patient,
that tonics are not called for. it will often be found that quinine
will stop these discharges. Hunter says, "the idea that has
been formed of the disease leads to the practice generally re-
commended, such as giving strengthening medicines of all
kinds, but 1 never saw any good effects from any of them, and
I should rather be inclined to take up the soothing plan to pre-

530 Nature and Treatment of Spermatorrhoea. [September,

vent all violent actions, and keeping the body open will in some
degree moderate the discharge, and may probably effect a
cure in the end." (On the Venereal, p. 301.)

Yet there can be little doubt, I think, in the minds of those
who have given it a fair trial, that quinine does assist power-
fully in controlling spermatorrhoea, especially in those cases
where physical weakness is the predominant symptom. I wil-
lingly admit that in otheis its good effects are not so marked;
that where the tongue is foul, and there is a good deal of irrita-
bility, headache, and dyspepsia, with costiveness, it is more
necessary to subdue these symptoms by mild aperients, seda-
tives, &c, than to give any tonic, however useful in other
conditions. M. Lallemand has urged against it, that it produ-
ces considerable irritation, but I apprehend this mostly arises
either from unsuitable cases being chosen, or from giving too
lar^e doses.

When violent and painful erections arise from the irritation
occasioned by the presence of, or remaining after, gonorrhoea,
the spirit of camphor will generally at once relieve them. A
teaspoonful in a little water is the dose. The patient should
place all his apparatus in readiness by his bed-side, and as soon
as he is awakened by an erection should rise and take a dose.
If the erections come on as soon as he lies down, he had better
take a dose before going to bed.

Few means of controlling spermatorrhoea could be devised,
so simple and natural a ^.especially gymnastics, which

the common experience of mankind lias extolled from the most
distant times. Every abnormal action is marked by the fail-
ure of vital power at one or more parts of the frame, and an
accumulation of it in the suffering organs. The generative
power, animal life, and cerebral development, antagonize each
other; and sedulous attention to train the two latter to the
highest degree of activity they are capable of, will rarely fail
to subdue anything short of excessive action in the generative
system, and bring the performance of this valuable function
under the mild and healthful sway of reason.

True physiology will always conduct us to the same goal
as experience founded on correct observation. Hence every
writer who has attentively watched this disease has strenuous-
ly insisted on the necessity for gymnastic exercise. But owing
to the iniquitously late hours kept up in many London houses,
it is impossible to resort to this remedy. It is useless to talk of
the advantages of boating, cricketing, &c, to young men pent
up in shops and warehouses till ten or eleven o'clock at night.
Thus, like the baths, douches, mattresses, &c, which are re-
commended, they are liable to one grave objection, that of

1854.] Nature and Treatment of Spermatorrhoea. 531

being inapplicable in perhaps nine case? out of ten, and to make
true progress in treatment our main object must be to find out
remedies suitable for every case.

Accordingly. I have long accustomed myself to rely princi-
pally on morning exercise., as the question then becomes one
rather of conformity than of ability on the patient's part, and
if he be really determined to save himself from the results of
his own indiscretion he may do half the surgeon's work if he
will rise at five or six o'clock, sponge with cold salt water, use
the dumb bells for half an hour, and follow this up with a brisk
walk. It will not be long before the eye grows brighter and
the skin clearer : before he sleeps sounder and again feels com-
fort in existence.

Dr. Carpenter recommends his readers as a preventive to try
the effects of close mental application. The frantic acts of
self-mutilation performed by devotees show that the most ab-
sorbing study will not suffice to quench entirely a natural pas-
sion. But this is not the only objection to this plan. In the
greater number of bad cases, I believe it is useless to inculcate
study; the depression and irritation are too great to allow the
attempt to succeed, and with all the good will possible, most of
these patients cannot make a beginning till their physical con-
dition is somewhat improved. I therefore advise those who
have time to spare, to begin study by reading aloud for an
hour every night, and then to go out as much as they can into
society a plan from which I have seen better results than
from attempting to impose on an exhausted brain a task it can-
not possibly execute.

But should all this fail to remove the disease should it per-
sist from habit, as it is called, but which is nothing more than
the result of our inability to cope with the diseased action,
perhaps no remedy will act more quickly and surely than a
blister. Notwithstanding the strong opinion M. Lallemand
has pronounced on the subject, I have no hesitation in asserting,
after the numerous trials I have given it. that if some proper me-
dium, as blistering tissue, vScc, be used.no strangury or "exasper-
ation efTrayante" of the spermatorrhoea need ever be feared.

'2. Night and Day Discharges. Here we have rather a
more serious affair to deal with, though the greater part even
of these more severe cases will yield to a persevering use of
the remedies already spoken of. Where, however, these are
inapplicable, as for instance, in cases complicated with severe
indigestion, or a high degree of nervous excitement, with
severe pain in the urethra, or excessive sensibility in this canal,
or when imperfect secretion of semen has begun to show itself,
we must have recourse to further means.

532 Nature and Treatment of Spennatorrhcea. [September,

Among these we may safely rank opium. Under its use the
secretions become thicker, and less pain is occasioned by their
being thrown off, as if at one and the same time it blunted the
sensibility and checked the secretion of the watery and irrita-
ting elements. And besides all this, it is not too much to say,
that opium is a tonic both to the exhausted frame and irritated
mind. Where there is a frequent desire to pa^s urine, and in
- marked by excessive watery secretions from the Schnei-
deriao membrane, aggravated by cold easterly winds, opium
often effects a most beneficial change.

It may be objected that it tends to produce constipation,
destroy the appetite, and favour congestion of the brain; but
tiie two latter seldom if ever result when it is used, as it re-
quires to be, in modbration and at intervals. The constipation
also is not an unmixed evil, for in some of these cases there is
considerable irritability of the rectum.

In this variety of spermatorrhoea also, few patients are met
with who are not benefited at some period of the treatment by
quinine. Where the patient is very pale and nervous, and
where there is any tendency to spasmodic stricture, the tinc-
ture of muriate of iron may be given, and so far as I can jud^e
this and some of the chalybeate waters, are the only forms in
which steel is, if not injurious, at least not useless.

In some casei the patient complains of a foul tongue and
thirst, with nausea ami lassitude; the urine is turbid, and the
itomach disordered ; or the stools occasion smarting and heat
at the anus. Sometimes he is harassed by a cough, and a good
deal of mucus is expectorated. These symptoms indicate a
disordered state, which is often instrumental in keeping up the
spermatorrhoea, without having been perhaps the primary
cause. In such cases I have used the nitrate of potass with
success.

After the statements M. Lallemand has made respecting this
salt, I could not well pass over his views. He says that nearly
all those who took squill, nitrate of potass and digitalis, obser-
ved a marked exacerbation of the seminal discharges (une
augmentation notable des pertes seminales,) and that the nitrate
proved injurious in every instance an opinion founded upon
forty cases, he says, some of which were certainly lamentable
enough.

But to what was this due? M. Lallemand has left us per-
fectly in the dark as to the dose, the most important point of
all. In one case only can we arrive at any estimate, and here
we are briefly informed that an ounce was taken in three days.
No one who has seen the irritability of the bladder and kidneys
produued by nitrate of potash, or any strong diuretic salt, in

1854.] Nature and Treatment of Spermatorrhoea. 533

gonorrhoea, will be much surprised to learn that such needless
overdosing brought on a "notable augmentation" of the symp-
toms.

When constipation is much complained of, and the patient
has in vain taken large quantities of medicine to overcome it, I
would venture to advise the surgeon to desist from any at-
tempts to remove it by drastic purgatives. &c. Not that I at
all denv the injurious effects of cosliveness, if not on the health,
at least on the mind of the patient, whose anxiety is always
kept alive so long as this costiveness is followed by a mucous
discharge, but that I think the irritation and exhaustion occa-
sioned by repeated purging are even more injurious, and that
we may effect the same purpose by less hurtful means.

The remedies I have to suggest may not perhaps meet with
the approbation of my readers. I generally trust a good deal
to time and improvement of the health, or, when the costive-
ness is very obstinate, recommend the patient to take a pill of
gentian and a small quantity, as the onetwelfth of a grain, of
strychnia, with a tumbler of unsweetened gin and hot water at
night, and one of cold water in the morning. Even when the
constipation has become so extreme that the patient has not
had a stool more than once in nine or ten days, a little perse-
verance in this plan has soon restored the functions of the in-
testines.

Nitric or nitro-muriatic acid may be given when there is
much irritability of the bladder or scalding. If the patient
complains of spasmodic pain at the neck of the bladder, and we
find the urine loaded with lithatesor clouded with mucus, these
acids, along with laudanum, may be exhibited in decoction of
Pareira Biava or cbimaphila. Occasionally he describes an
annoying pain at the epididymis, which sometimes shifts to the
vicinity of the prostate, or lie is tormented by a sensation like
that of a worm creeping along the urethra or vas deferens.
Sometimes the uneasiness is indefinable, but not the less disa-
greeable. Strong veratria ointment, or some mild counter-irri-
tant, will generally succeed in subduing these symptoms,
which, however, now and then linger on for a long time.

The high reputation which M. Lallemand most deservedly
gained by his work on spermatorrhoea, and the writings of Mr.
Phillips and Mr. Curling, have attached to the i: caustic-holder"
an amount of prestige, which however well merited, has, I
think, had the effect of retarding improvement in the treatment
of this disease by other means. So far from denying that it is
both a safe and a valuable remedy, I never hesitate in certain
cases to avail myself of it; what I object to is, that so many
surgeons look to it as the remedy, while, in truth, it is not very

n. s. vol. x. NO. ix. 34

534: Nature and Treatment of Spermatorrhoea. [September,

often culled for. It has been engraved,* described and com-
mented upon, till an impression has arisen that it is an unfail-
ing hut very formidable remedy, whereas it has not only
occasionally failed in the hands of Phillips, (airline:, Acton,
and others, but also in those of its great inventor. "Cauteri-
zation," says M. Lallemand, "is most useful in spermatorrhoea
from menoi rhagia, venereal <>r non-venereal, and often useful
in at<>ny; it is not of much value in cases of irritation, hut
even here it may aid by modifying the tissues.n~"JMi. Phillips,
in the answer he was kind enough to send to some que)
laid before him, says that "it has not only often" failed to effect
a cure, hut even to relieve spermatorrhoea;" and Mr. Curling,
in a communication he favoured me with, says, "Cauterization
is not an infalible remedy. Some cases are too aggravated
or too well established readily to admit of cure by any treat-
ment. Many circumstances lend to counteract the beneficial
effects of the caustic, such as. want of self-control to check
bad habits and the thoughts dwelling on impure subjects, oc-
cupations and modes of living detrimental to health, &c."
But again he snvs, "cauterization has rarely failed to give
more or less relief."

Of its safety there can he no doubt when it is properly em-
ployed. Lallemand used it for twenty years, and even cau-
terized the lower part of the bladder, without any untoward
result ; and Mr. Acton, commenting upon this statement, says
he can fully bear it out. Mr. Curling says, "in no instance
has any harm resulted from the application of the caustic;"
and Mr. Phillips, in one of his answers tome, says it has never
produced injurious results in his hands, though his experience
extends over many hundred cases.

We might suppose that some part of this was owing to the
excellent surgery of those who employed it. M. Lallemand
does not allow the caustic to remain an instant longer in con-
tact than is absolutely necessary. " I cannot," he says, " pro-
test two strongly against those who give a fixed period (une
duree quelconque) for the action of the caustic, and measure it
off by the watch. Even to look at the dial takes too long a
time.'" And Mr. Curling attributes the absence of severe
symptoms in the case where he has used it to his having ap-
plied it still more gently. But Mr. Phillips, though he has
seen some discomfort caused by it, has rarely heard of any
complaint on the patient's part ; the pain on passing urine is
"very bearable," although he uses the caustic very freely.
"I have never applied," he says, "too much caustic, but I

* In the ensravin^s I have seen of this instrument, the knob is round like a
small pea, while Lallemand says it ought to be oliveshaped (olivaire.)

1S54.] X ature and Treatment of Spermatorrhoea. 535

have more than once failed by using too little." Had any
severe symptoms occurred, Mr. Phillips would, we may rest
assured, neither have overlooked nor suppressed the mention
of them. All that is left us is frankly to admit that in his cases
no harm resulted from the application of the caustic. M. Lal-
leman, however, has seen severe retention of urine, haemor-
rhage, intense pains which only yielded after a long time, and
it seems that stricture has also followed. J have myself seen
cases where intense and long-continned suffering ensued with-
out any amendment in the patient's condition.

Want of success in some cases, the urgent objections raised
by some patients to the introduction of instruments, and the
decided benefit which has followed from an opposite plan, have
induced me to think that it is better, first by every means in our
power, to strengthen the frame, and diminish all local and gen-
eral irritability before resorting to the use of caustic.

A iarge opium plaster to the loins will generally allay the
aching pain so much complained of; I have often added a
scruple of camphor to the plaster, without being able to give
any good reason for so doing beyond the beneficial effect which
resulted from it.

The chief remedy in cases complicated with gleet, severe
pain, and purulent discharge from the posterior part of the
urethia, and when cauterization has failed, is blistering, which
is even more called for than in the other forms of the disease.
It very frequently not only relieves the seminal discharges, but
it relieves the cause, and I know of no other remedy which
does both at the same time.

In every diseased action there appears to be increased vital
action at the parts attacked : and as all the functions demand
the presence of a certain amount of vital power for their due
performance, there is a constant tendency to restore the ba-
lance deranged by disease. In chronic disorder the strain on
the economy seems too slight to rouse up any violent action in
the other parts, and we can only effect a cure by irritants,
which carry the vital action so high, that when the rebound
takes place it reverts to the normal stale; like a bent spring,
which, when bent still further, straightens itself by the recoil.

Although with blistering I have sometimes used injections of
nitrate of silver to any part of the urethra which seemed dis-
eased, employing only a syringe with a button at either end of
the part perforated for the pns?age of the injections. By this
means the urethra is kept sufficiently on the stretch to admit of
the injection penetrating into every nook of the d.seased part,
while the buttons prevent its escape. The injection ought to
be allowed to remain in contact till the nitrate is decomposed,

536 Nature and Treatment of Spermatorrhoea. [September,

so that the anterior part of the urethra may not be affected
by it.

The highly sensitive state of the urethra, which makes these
patients shrink instinctively from the approach of an instru-
ment, appears to be caused by, not to be the cause of the sper-
matorrhoea ; nnd Dr. Tyler Smith has given us a satisfactory
reason why the frequent presence of a crude fluid in a canal,
which nature only intended to traverse it occasionally and in a
consistent slate, produces inflammation. Those who upheld
an opposite view thought to find a convincing argument in the
results which follow cauterization:* but one gentleman who
was appealed to proved rather too much, for, rinding his patients
suffer severely from cauterization, he gave them injections of
nitrate of silver to use, which also cured them ; and. "a well-
known and experienced Scottish surgeon observed that, when
cauterization of the urethra failed, he had applied the cautery to
theexternal orifice of the urethra with wore decided adoanta

I presume the truth is, thai the source of suffering is the
irritation set up in the testicles, and that any active and whole-
some counter-irritant, applied sufficiently near, will allay or
even cure it, upon which the redness and tenderness of the
urethra will soon subside. However the caustic if often of
great service in these cases, for <u<-l) patients will bungle with
every remedy put into iheir hands, as though they derived
gratification from thus giving evidence of the miserable state
to which they are reduced. With the application of the caus-
tic they have nothing to do; it is sufficiently powerful to keep
the fingers quiet for a little time, and in cases complicated with
gleet, arising from the "granular urethra,'' it seems almost in-
dispensable.

Instead of Lallemand's instrument, I very often make use of
one I had constructed for the purpose. It consists of a plati-
num canula and a stilet The instrument is passed down to
the diseased part, and the stilet bein^ withdrawn, a small flexi-
ble bougie is introduced, armed in the following way: the tip
being scraped so as to make it rough, it is dipped in fused
caustic, and then in melted tallow; by this means a thin film
of caustic is secured, which acts on every part, without the risk
of excessive cauterization at any one point.

In all forms of spermatorrhoea, the food ought to be as plain
but as nourishing as it can be procured ; no pastry, pickles, or
beer ought to be admitted into it, but plenty of meat and pota-
toes, or bread, for dinner, with a little tea or coffee morning
and evening; if possible, meat twice a day. The worst cases
have always seemed to be more benefited by a full meat diet

* British and Foreign Medical Review, April, 1843.

1854.] Xature and Treatment of Spermatorrhoea. 537

than by any medicines; and it is not uncommon to find that a
patient has grown worse in every symptom in proportion as
he has become a more thorough vegetarian. The further
south we go, the more do we find a vegetable diet supplanting
the animal food of northern nations, and the more prominent a
place does spermatorrhea assume in the catalogue of diseases.
Difference of race I shall be told is sufficient to account for this :
the Spaniard and the Moor are by nature more ardent than the
Esquimaux; the Persian and the Arab than the Livonian.
True, but not therefore by nature more prone to spermator-
rhoea ; it is, that, degenerating by civilization, they fly more
readily to that kind of diet and to those habits which produce
spermatonhcea. From what I have been told of those going
to hotter climates, and using the diet prevailing there, it is so
invariably to aggravate the symptoms, that it seems only reas-
onable to infer, that men liv;ng altogether in an abnormal
condition, habit, climate, and diet, will approximate the diseas-
ed states of individuals, though possessed of no power to influ-
ence the original state of each recurring generation.

But while I strongly urge the use of plenty of meat, I exclude
none of the four varieties of nutriment ; and I say this advised-
ly, for I have seen some of the most obstinate cases of sperma-
torrhoea in ascetic patients, who religiously excluded sometimes
all oily, sometimes all sugary mattei s. and thus appeared to give
full swing to the oxalic acid diathesis with which many of them
were afflicted.

3. Imperfect secretion, &.c. ; impotence. Treatment by 1, Sulphite of soda ;
2, Diet; 3, Local means. Casrs a, of night discharges; b, prostatic gleet;
c, night discharges with prostatic and with recurrent and prostatic gleet,
with stricture; d, of night and day discharges; c, day discharges; ft sper-
matorrhoea and imperfect erection;' concluding remarks.

3. Imperfect secretion, c. Although this state may arise
from either of two separate causes, viz, inherent weakness, or
excessive irritation set up in the testes, yet as both causes are
generally in action to such an extent as to render it difficult in
many instances to assign to either its true amount of influence
and as they converge to a common point imperfect secretion
of semen, and, as a necessarv consequence, impotence, I have
judged it best to take them both at this stage, which is that
most generally presented to our observation.

When imperfect secretion or true spermatorrhoea has mere-
ly followed as a result of youthful excess, we may. even when
it is accompanied by the most alarming symptoms, as breathless-
wasting, with loss of strength and spirits, generally
promise a cure in every case where neither phthisis nor anv
pathognomonic signs of organic change in the nervous centres

538 Nature and Treatment of Spermatorrhoea. [September,

have set in. This class embraces, I presume, the more serious
cases of Mr. Acton. As this gentleman, like M. Lallemand,
has not divided his system of treatment, I have sometimes had
great difficulty in making out exactly to what branch of dis
he refers in speaking of some of his remedies, and he will
therefore excuse me if 1 have misunderstood him.

In the foregoing division I have discussed every remedy
which I believe to be called for here, aril due perseverance in
their use will mostly effect a cure. There are, however, a
few points to which I should like to draw attention.

1. The indigestion which accompanies many of these cases
is often best relieved by the use of aromatic confection in com-
bination with sulphite o( soda and mint-water. Of the way in
which it acts I do not profess to oiler an explanation ; I limit
myself expressly tostating the results of my experience.

2. Where practicable, I would advise a gradual transition to
the diet on which prizefighters are put when in training. A
mild diet has been recommended on good authority, but it
soon becomes insupportable; it. often causes a most uncomfor-
table state of distension ; and, finally. I have no great faith in
its good effect?. Whatever plan the surgeon resorts to he will
have to persevere with, for many of these patients have an ob-
jection ready so soon as anything is proposed.

3. I think it is imperatively n y to attempt, by every
means in our power, as blisters, occasional injections, &c, to
diminish the sensitiveness of the urethra before resorting to the
caustic or even the bougie. We thus not only secure a
number of patients, whom the dread of some operation of this
kind drives to the quack, but we materially lesson their suffer-
ings without really loosing time.

Spermatorrhoea, as a complication of congenital imperfect
erection, is a more rare and more formidable matter. Both,
singly, are common enough, but they are not often seen togeth-
er. In the cases I have met with there was generally extreme
derangement of the assimilative and digestive processes ; the
urine contained oxalates ; a faulty state pervaded the organs
of the senses, &c. 1 need scarcely say that it is necessary to
draw a wide line of distinction in treatment between congenital
and occasional imperfect erections, both of which may co-exist
with an otherwise healthy system.

Sufficient materials do not appear to have been accumulated
to found any comprehensive plan of treatment for cases belong-
ing to this subdivision, but, except in rare cases, they do not
present any insurmountable difficulties, unless the imperfect
erections are congenital, and combined with an otherwise faulty
development.

1854.] Nature and Treatment of Spermatorrhoea. 539

I shall now, in conclusion, offer a few cases to illustrate the
most salient points in the treatment I have vetured to bring for-
ward. I have simply used a series of initial letters in compli-
ance with what appeared to be a general wish on the part of
the patients.

a. Case 1. Night Discharges from Masturbation. A ,

a good-looking lad, aged seventeen, applied Jan. 20, 1851, with
spermatorrhoea, arising from masturbation, which he was con-
tinuallv performing in his sleep. To use an ointment of deu-
to-iodide of mercury, sufficiently strong to occasion vesication,
and have a mild aperient. A few days subsequently tonics
were begun with, and he was soon well.

Case 2. Night Discharges from Gonorrhoea. Mr. B

applied, Feb. 12, 1850, with severe seminal emissions arising
from gonorrhoea, under which he had been laboring. A sur-
geon to whom he had previously applied, wished to apply the
caustic, to which he objected. He complained of constipation,
but otherwise enjoyed good health, and though pale, he was
strongly formed. A grain of quinine with ten minims of dilute
sulphuric acid, and a drachm of sulphate of magnesia twice a
day; a small blister to the perinaeum.

14th. He has not been able to apply the blister To do so
now, and continued the mixture.

March 7th. Improving. To continue the mixture, and
dress the blistered surface with zinc ointment.

April Uth. He has had no emissions lately. To apply
another blister, and continue the mixture. He had no more
emissions, as I subsequently learned from him.

b. Case 3. Prostatic Gleet. C applied March 5, 1850,

for the treatment of a discharge of thick mucus, like the unboil-
ed white of an egg, after going to stool. It arose from a gon-
orrhoea, he thought, which had yielded to a tedious treatment
extending over twelve months; among other remedies he had
used salines and injections. On crossing his legs, pain was felt
in the vicinity of the prostate. Copaiba and turpentine were
tried in vain ; mercury with chaik and rhubarb, were then
given, and a blister was applied to the perinceum. which rose
freely. The nitric acid and decoction of Pareira Brava were
subsequently administered, but as the discharge was not quite
gone by the 20th of the ensuing month, he was ordered a
second blister, which completely cured him.

c. Case 4. Night Discharges, with Prostatic Gleet. Mr.

D applied, March, 1849, wiih these affections. He had

been addicted to great venereal excesses, and sometime pre-
viously, while in a bad state of health, had contracted syphilis,
for which he had taken so much mercury that his health had

540 Nature and Treatment of Spermatorrhoea. [September,

suffered severely. There was a constant discharge after stool,
and sometimes, after passing urine, of tenacious, glairy mucus,
and he suffered greatly from night pollutions. In the left groin
was a hard mass, apparently swollen glands and cellular t
To this a large blister was applied, and for three weeks not a
single discharge was noticed; they subsequently reappeared to
a slight extent, but were removed in a lew weeks by quinine
and exercise.

Case 5. Night Discharges, Recurrent Gleet, and Prostatic

Gleet. M. E applied to me, July 18, 1853, with th

lowing symptoms: He suffered from periodical attacks of
great excitement, indigestion, and constipation ; a free puru-
lent discharge from the urethra and glans then set in, followed
by several emissions, after which all the worst symptoms sub-
sided ; occasionally a mass of mucus was thrown out after
going to stool. He had been addicted to masturbation, and
had then caught a gonorrhoea, which made him worse. Hav-
ing relieved the indigestion and costiveness, and got him into
habits of morning exercise, I injected the urethea with the per-
forated syringe, and then applied the nitrate of silver with my
own instrument; still the urethral gleet continued, and he had
occasionally an evacuation of mucus after a stool. A blister
was therefore applied to the penis, and in this case, also, there
was not a single discharge for three weeks after; quinine was
used and a cure speedily followed.

Cask G . Night Discharge* and Stricture. F , aged

twenty-two, applied Aug. 15, 1853, with seminal emissions
which occurred every night, and had now lasted, he said, seven
years. He looked pale and shattered, and had been recently
under the care of a surgeon, who had used the bougie, and ma-
terially relieved him. A slight stricture was now detected,
which the bougie soon removed. Salines, containing nitrate
of potass, were given, and these, with quinine and mustard
poultices to the perinaeum, effected a comparative cure to his
previous state.

d. Case 7. Night and Day Discharges, with accumulation
of Sebaceous Matter, G , a stout, healthy young man, ap-
plied, June 18, 1853, with seminal emissions, occurring two or
three times a day, exclusive of those at night; they appeared
to have resulted from gonorrhoea and a very unhealthy em-
ployment; never guilty of masturbation. Ordered, quinine
twice a day; exercise and cold sponging.

25th. He is much better; there is some sebaceous matter
about the neck of the glans. To wash this well with soap and
water, and afterwards apply a zinc lotion; the mixture to be
continued.

1854.] Nature and Treatment of Spermatorrhoea. 54 1

30th. He is just well, and has only had three seminal emis-
sions the last week. He has removed all the sebaceous matter,
and the prepuce is seen to be very red inside. To continue.
As complete a cure ensued as ever does in these cases, a semi-
nal emission at night occurring from time to time.

Case 8. Night and Day Discharges. H , a pale, deli-
cate young man, applied, June 25, 1853, with gleet and seminal
emissions, occasionally in the day, but mostly at night He
complained of great weakness, pain in the back, and cough.
An opium plaster to the loins, quinine twice a day, meat diet,
and volatile liniment to rub on the chest; morning exercise,
During the latter part of July he had a few days' sea-bathing,
which did him a great deal of good; the opium plaster relieved
the pain in the back, and was accordingly repeated as often as
it fell off. By the 12th of September he was no far improved
that he had no seminal discharges for three weeks; but the
gleet grew so much worse, that I wTas obliged to order him
injections. Having left off his medicines, he had a slight re-
lapse, but, on resuming them, was rapidly cured of all but an
occasional discharge at night.

e. Case 9. Day Discharges. Mr. J applied, Novem-
ber, 1852. He had two to six times a day faint erections, and
immediately after a thin discharge. The urethra was red, and
there was a strong smell from the glans. He was pale, nervous,
and so weak that he thought he could not live, and he was tor-
mented by a constant cough, with indigestion and costiveness.
Salines, containing a little syrup of red poppies, and five grains
of nitrate of potass, three times a day; mustard poultices to
the perinoeum; veratria ointment to the testicles. Soon after
quinine was commenced. He gradually recovered, and at the
end of ten weeks wTas so far advanced towards a cure that he
gave himself no further trouble about the matter.

f. Case 10. Spermatorrhoea and Congenital Imperfect

Erections. Mr. J applied, Aug. 12, 1852. Erections

never had taken place, and there was a constant discharge
from the urethra, which was in an inflamed state, of rank, thin
fluid. He was, and always had been very week. Cauteriza-
tion had been tried, and failed. He was the type of this class
of patients. Every secretion and every sense was at fault, as
if the whole constitution suffered from the struggle to establish
the defective virile power. Blisters, quinine, and nitric acid
&c, were all tried in succession, with little improvement in
either the spermatorrhoea or the erections.

Lastly, I would only urge the patient to banish from his mind
the idea that a perfect absence of seminal emissions at night is
compatible with health and continence. Those who tell him

542 Treatment of Cancer by Congelation. [September,

so deceive him, or are deceived ; and I cannot conclude better
than by quoting a part of Mr. Curling's letter. "I assume,"
he says, "the cure of spermatorrhoea to mean, not the arrest
altogether of involuntary emissions, but the prevention of their
frequency to such a degree as to weaken the powers and impair
the health. [London Lancet.

On the Treatment of Cancer by Congelation. By James
Arnott, M. D.

Since the publication of a paper in The Lancet four years
ago, on the application of intense cold in cancer, I have had
considerable further experience in the use of this remedy, and
an opportunity of fully confirming the opinion of its utility
therein expressed. The treatment of cancer has eng
much of the attention of other inquirers during this period,
who probably expected some greater practical benefit from
the discoveries which the microscope had led to, than an assist-
ance merely to diagnosis; but, with the exception of congela-
tion, no advance has been made in this respect. Our know-
ledge, indeed, of the treatment of cancer, may, in a certain
sense, be said to have increased, independently of this excep-
tion, not, however, by advancing, but by wise retrogression ;
the addition to it has only been the detection of error. We
have had further evidence that the confidence which some
practitioners had in certain curative measures was misplaced.
As respects the curability of cancer by excision, Mr. Paget
Bays, after a close investigation of the records of upwards of
300 hospital cases, "that though he will not call such a thing
impossible, yet it is so highly improbable, that a hope of its
occurring in any single case cannot be reasonably entertained,"
(Surgical Pathology,'' vol. ii., p. 351); and with respect to the
question of the utility of the same measure as a paliative and
means of prolonging life, lie states, in a communication to The
Lancet the year before, that the result of his statistical inquiries
is, that persons operated upon for scirrhous cancer of the breast
die "thirteen months sooner of this disease than persons not
operated upon." It must not be forgot that in this calculation
the cases are omitted of all who die from the immediate effects
of the operation, which is more dangerous than had been sup-
posed, the mortality amounting to ten percent.' If chloroform
has diminished the suffering, it has not diminished the danger,
from the operation, several cases (the last occurring about a
month ago, at Sheffield) having proved fatal from its use. The
other remedy the application of caustic in which some con-

1854.] Treatment of Cancer by Congelation. 543

fidence has also been placed, especially in malignant affections
of the womb, is commented upon by Dr. Robert Lee, in his
recentlv published account of one hundred cases of cancerous
disease of the uterus treated in the ordinary manner. He con-
cludes his analysis of these cases by the observation "that the
fatal progress of the disease was never arrested by cauterizing
the morbid structures through the speculum, nor by any other
means of treatment."

The use of cold in cancer is by no means a new proceeding ;
no practice is of older date, or has been in more general use.
All that I have done is to exhibit the remedy in a greater dose
than it had previously been exhibited. Having ascertained
the important facts that the circulation in a morbid part may
be temporarily suspended by intense cold, without, in the
slightest degree, endangering the vitality of the part, and that
such a suspension, and other concomitant effects of this degree
of cold, are highly curative in inflammatory and neuralgic
affections. I merely applied it in cancer to arrest the inflamma-
tion accompanying the disease, on which the rapidity of its
progress, and many of its most distressing consequences, de-
pend, and at the same time to assuage the pain by its perma-
nently benumbing or narcotic property. I at first expected
only to find a substitute for the very inefficient and otherwise
objectionable remedies of inflammation and pain in common
use in cancer; and had congelation only fulfilled these indica-
tions, it would have been very valuable ; but experience has
shown that it has stiil more powerful effects in this disease,
although, from the unknown nature of cancer, it is as difficult
to account for these as it is to explain how the exhibition of
bark or quinine cures an ague. Prof. Bennett, of Edinburgh,
expresses (in his able work on Cancer, the opinion, that " were
it possible to bring down the temperament of an entire cancer-
ous growth below the vegetating point, we must inevitably kill
it;" and it is not improbable that to such destruction of the
vitality of the cancer-cells to the killing of these parasitic
animalcules the curative influence of congelation may be
chiefly due. But however satisfactory it might be to ascertain
the mode of operation of the remedy whether it acts in I
manner, or by some unknown change produced in the fuucti
of the vessels or nerves of the part, in addition to its obv:
power of suppressing inflammation and assuaging pain the
chief point is to know whether it has great control over can-
cer, and this can be ascertained only by experience.

In further evidence of its possession of such power, I adduce
the two following cases. I have selected them, not because
they afford illustrations of the most beneficial application of

544 Treatment of Cancer by Congelation. [September,

intense cold, (for the publication of extraordinary results is,
from exciting incredulity, apt to be as pernicious to the repu-
tation of a novel remedy as the publication of failures,) but to
show what may be always expected from congelation in ad-
vanced stages of unequivocal cancer, and after the trial of all
other measures, when the remedy is had recourse to before the
disease is so very far advanced, and the strength and spirits of
the patient so far reduced, as to render her hopeless and indif-
ferent about any further effort. These two cases illustrate the
power which congelation possesses of arresting the progress
of the disease, when it does not at once cure it, and of immedi-
ately terminating whatever Buffering the patient may have
before endured from it. In earlier stages the nature of the
disease is not so certain, and therefore its removal in these
stages by intense cold may not be admitted to be the removal
of malignant disease. I could adduce many instances of this
description from my own practice and that of others, particu-
larly where the disease attacks the uterus, but shall, for the
reasons assigned, prefer the cases of an est, which have the
additional advantage of being recorded in great part by other
hands one by the husband of the patient, the other by the
patient herself. The first of these patients had been attended
for some time by Dr. Foi bes, of Inverness; the second by a
practitioner at Tun bridge Wells.

I saw the first patient during a visit which I made to the
north of Scotland in the Spring of 1852. I learned from her
that there had been a hard and painful swelling in her breast
for upwards of two years ; that lotions, ointments, and other
remedies had been tried for its removal in vain; and that since
she had refused to have the breast amputated, about nine
months previously, she had consulted no medical man on the
subject, and had only used the mildest applications.

The patient was about fifty years of age. Her general
health was not good, but much of the derangement of the stom-
ach and other organs was attributed to the increasing and
intense anxiety she laboured under on account of the affection
of her breast. On examining this, I found a hard tumour of
considerable size, or what appeared to be two contiguous tu-
mours; the nipple was considerably retracted, and there was
a slight morbid exudation from it ; the pain was of a plunging
character, and of such frequent recurrence as much to disturb
her night's rest. The disease was evidently gradually pro-
gressing.

I applied a mixture of ice and salt for about five minutes on
two occasions, with only about a week's interval between
them, as I was anxious, before leaving Inverness, to make a

1854.] Treatment of Cancer by Congelation. 545

second application in the presence of her husband, who was to
continue the remedy, and to whom accordingly I gave the ne-
cessary instructions respecting it.

The results of his administration of the remedy were com-
municated to me from time to time, and the following are ex-
tracts from his letters:

M .May 25th, 1852. In writing to you I feel intense pleasure in
having to communicate that .Mrs. M has been regularly and pro-
gressively improving since you saw her. We have got the caddis,
goldbeaters' skin, oil skin, &c, and the gutta percha frames for the
net and bladder have been nicely formed. In fact we have got every
thing you suggested, so that our apparatus and accessories are com-
plete. We get the ice now daily, if necessary, and the applications
have had the most desirable effect. * * * There is no internal
pain whatever; the tumours are at least decreased two -thirds, and
she sleeps well and comfortably at night. Everything is very en-
couraging, and as you could wish."'

May 31, 1852. I am truly happy to say that Mis. M 5s breast

exhibits a daily improvement, and there is consequently the greatest
encouragement for perseverance in the same course. The severe
application of the ice and salt has not been tried since you left, but
the other (the milder) has been several times, and always with the
best results. We shall try the severe application in a day or two
however."

"June 14, 1852. A severe application of the ice and salt was
made on Wednesday, and although kept on for four minutes, and un-
til the colour of the skin became entirely changed, it produced no
blistering. The bladder with iced water was kept on for half an hour
afterwards, and there has been jzreat ease since from occasional ap-
plications in that way. The tumours are perceptibly decreasing. ,;

It is necessary, in explanation of this question, to state that
the bladder with iced water, applied after the congelation, was
employed to prevent the smarting that would otherwise occur
from the too speedy return of the natural temperature of the
part. This would otherwise be sometimes severe ; at other
times, the patient scarcely complains of it, and dispenses with
the application of the bladder. The description of the effects
of the frigorifice on the appearance of the skin would show
that the materials had not been properlv prepared or mixed, as
when they are so, the skin is generally immediately blanched
by them.

"July 14, 1S52. The tumour continues very evidently, though
slowly, to lessen in size and hardness. The general health I consid-
er to be in a better condition than when you saw Mrs. M . The

ice and salt has been strongly applied four times since you left Inver-
ness."

%< 27th. I now write, owing to our being disappointed of ice as

546 Headache and its Varieties. [September,

calculated on when I last wrote. Mr. , of the , who always

supplied us, has sustained a severe loss by the man who had the
charge of the ice-house leaving the door open for three days, so that
the whole stock was dissolved, and there is not a bit to be got in the
north."

After mentioning some details respecting the difficulty of
procuring ice, (which might have been artificially made by a
chemist at small expense,) he continues

"I am glad to say, thai the long interval has not been so prejudi-
cial to the breast as I dreaded."

As matters appeared to my correspondent to go on in a satis-
factory state, 1 did not hear from him until after a lapse of
nearly a year.

"June 16, 1853 The ice and salt had not been applied since I
last wrote to you. There hi- r. been no relapsing. The

nipple has -unk or receded considerably since you saw it, but the
tumour has almost disappeared that is, there is very little hardness
or tenderness remaining. There is. however, a hollow or kind of
indentation across the breast, near the nipple, but not the slightest
indication of a tendency to suppuration. There is, also, a frequent
feeling of shooting or twinging pains.*"

In reply to this letter, 1 expressed regret that so long an in-
terval had been allowed to elapse without using congelation,
as there appeared reason to fear that a remnant of the disease
was still present; and, in the next communication from the
husband of my patient, (the last which I have received,) dated
Nov. 15th, he mentions that the ice and salt had again been
once applied. The only interesting circumstances noticed in
this letter, respecting the condition of the breast, are, that
"there is no hardness or tumour;" although there was occa-
sional annoyance from the sticking of the lint to the skin in
consequence of the ''exudation of a gummy substance close
round, but, so far as I can see, not out of the nipple." [lb.

(To be continued.)

On Headache and its Varieties. By Patrick J. Murphy, M.D.

Unfortunately a great difficulty of diagnosis exists in our
profession when co-existing simptoms arise from different dis-
eases. The anaemic headache may exist lor years, and then
have the neuralgic superadded, but this is not of so much prac-
tical importance, as the remedies for the one form do not
make the other worse; on the other hand a delicate female,
long suffering from anaemia and its headache, is often attacked
with fever, and the anaemic is thus replaced by the congestive

1854.] Headache and its Varieties. 547

headache. If stimulants be now given, serious mischief may he
the consequence, while, on the contrary, a practitioner who
sees her (ov I he first time may deplete too largely and produce
a tedious convalescence. These mistakes can occur only on the
invasion of the fever, for in a few days, the thirst, heat of skin,
and loaded tongue, point out clearly what is to be contended
with. Cupping or leeching will relieve the head for a few
hours, hut if the (ever be ataxic a degree of prostration may be
induced from which the patient can never be roused. ] have
never seen the anaemic and rheumatic headache combined: the
combination is rare, but there is no reason why such may not
occur.

Treatment. As debility not only attends, but is often the
sole cause of this form of headache, ihe treatment must, of
course be directed in accordance with this view. The diet is
most important, and the proper kind at once suggests itself; it
should be nutritious, and as the muscular coats of the stomach
and intestinal tube have lost their tone, or, more correctly
speaking, have their conlractile power weakened, common
sense points that it should be easy of digestion. Animal food
is indispensible ; it may be taken twice a day. Mutton is to be
preferred. Beef, unless stewed, lies heavy on the stomach of
weak people. The lean of roast pork may be permitted; it is
a variety, and digestible. The flesh of young animals is
neither as nourishing nor digestible as those of mature age.
Wild fowl, hare, or rabbit, seldom disagree. Roast meat con-
tains more nutritious matter than boiled, but either may be
taken according to the fancy of the patient. The richest soups
and strongest jellies are in every way inferior to the meat from
which they are produced ; even in a healthy stomach they
cause flatulence and distention, and, a fortiori, the weak stomach
cannot escape. The more solid-fish, such as sole, turbot, &c,
may be permitted. Stewed eels are wholesome and agreeable.
Oysters fresh, uncooked, and cut into three or four portions,
never disagree. Vegetables, unless potatoes, should be cau-
tiously used. Bread should be stale, nothing is more indigesti-
ble than fresh bread or buttered toast. An excellent evening
meal can be made with tea and rusks. Of fruits, strawberries,
raspberries, goosberries, pears, peaches, and plums are agreea-
ble and aperient; uncooked apples usually disagree. Nuts,
almonds, and raisins frequently give rise to painful feelings in
the stomach. There is a craving for stimulants, which ou^ht to
be indulged in moderation. Ale or porter may be allowed at
dinner and supper ; perhaps porter is preferable, as it usually
contains a chalybeate. Bitter ale is useless. A glass of wine
between breakfast and luncheon, with a buiscuit, is always

548 Headache and its Varieties. [September,

found grateful and invigorating. To alcoholic drinks the ob-
jections are self-evident, especially when young females are the
patients. Very delicate females are much benefited by break-
fasting in bed. The meals should be light, and repeated when-
ever the faintness or sinking of the stomach is approaching.
Many cases, however, will occur, more particularly in young
men, where no directions for diet will be needed, almost all
kinds of food being digestible.

All causes of exhaustion should be guarded against. There
is nothing more injurious to a flaccid heart than smoking, many
j being tracable to this cause alone.

The medicine on which the greatest reliance may be placed is
iron. Fortunately, this remedy can be exhibited in various
formsand combinations. The formulas in the Pharmacopcea
areas numerous as those of mercury. Griffith's mixture is an
elegant mode of prescribing iron, but as the myrrh is unpala-
table and useless, il may be omitted ; or a form for which we
are indebted to Mr. Donovan may be more advantageously sub-
stituted ; it is as follows: pure sulphate of iron, onedrachm;
magnesia, ten grains; purified sugar, one ounce; rose or cin-
namon water, eight ounces; mix. This is a scientific pre-
scription; and if the iron be Uqq from red oxide, the green
colour is preserved for eight or ten days. The magnesia neu-
tralizes the sulphuric acid, and converts the sulphate into a pro-
toxide. The sugar prevents decomposition, and it. may be
flavoured with mint or peppermint water. In hospital prac-
tice it would be found most economical, and treacle might be
used instead of sugar. In the hysterical female, infusion of
valerian adds to its value ; and if there be great sense of ex-
haustion, ammonia in combination is most beneficial. Persons
will take pills who object to fluid medicines. The compound
iron pill might be improved by using treacle and potash, which
keep tl.e pill soft ; and by omitting the myrrh, which only
adds to the size. If the cause of the debility be from leu-
corrhcea, or haemorrhage, the tincture of sesquichloride of
iron in doses of fifteen drops, three times a day. will be the
most certain form to employ at first. Young unmarried fe-
males, from about their twenty-second year, are very subject to
a chronic gastritis, or rather irritable stomach ; lor these the
best preparation is the carbonate of iron, with sugar, of the
Edinburgh Pharmacopoeia. If the appetite is bad, sulphate of
quinine may be combined with iron. The occasional consti-
pation, which is caused by the loss of tone, the sulphate of zinc,
with small doses of sulphate of strychnia, relieved. In severe
chlorosis, the crystallized citric acid aids the iron ; and in scro-
fula, iodide of potash may be joined with the iron mixture. If

1854.] Headache and its Varieties. 549

there be a periodical neuralgia, the most effective form is the
precipitate of carbonate of iron. In a severe case of chorea
and anaemic headache, Fowler's solution of arsenic was com-
bined with Donovan's mixture, and in fourteen days both dis-
eases were relieved permanently. When there is a tendency
to oedema, and there is any objection to the tartrate of iron and
potash, a chalybeate in another form may be prescribed, and
supertartrate of potash taken as common drink. The bowels
should be kept gently open by an electuary of senna or the
compound rhubarb pill. Friction over the cutaneous surface
is very useful ; in cold weather, the hands and feet ought to be
well rubbed two or three times a day, to guard against the ex-
istence of chilblains, to which there is a great tendency in these
constitutions. In a case of polypus growing from the fundus
uteri, attended with profuse discharges and anasarca of the
lower extremities, chalybeates kept the symptoms in check, and
relieved the severe headache, until the protrusion of the tumour
permitted the application of a ligature. Minute directions for
the treatment, however, are not necessary, for the form of head-
ache being ascertained, the proper remedies are obvious.

Congestive Headache. There are two forms of congestive
headache (independent of phrenitis) the passive and the ac-
tive. The passive congestive headache is what is commonly
termed cephalalgia. Its causes are various, numerous, and dis-
similar. The importance of understanding fully its pathology
will be acknowledged when we recollect that it is very com-
mon, very alarming; that the pain originates from distension
of the intra-cranial sinuses and veins; that it is symptomatic
both of adynamic fevers and of those purely inflammatory,
therefore requiring opposite treatment; and that it may end in
what some call phrenitis, one of the rarest of the phlegmati.
How often, in adynamic fevers, which are always ushered in
with passive congestive headache, has reaction been checked,
and a fatal termination been the consequence, from the loss
of even a few ounces of blood, injudiciously prescribed to relieve
a symptom erroneously supposed to be a precursor of effusion.

Cause. The immediate cause of the headache is distension
of the intra-cranial veins, the blood having receded from the
surface in consequence of a chill or rigor. Hence it is one of
the earliest symptoms in all adynamic and most of the inflam-
matory fevers, in the exanthemata, and also in the cold stage
of ague. It is the headache of those exposed to severe cold;
and this exposure, when prolonged, induces that tendency to
sleep (coma) so fatal if not resisted. When cold bathing is
injudiciously prescribed, especially to weak and delicate sub-

n. s. vol. x. no. ix. 35

550 Headache and its Varieties. [September,

jects, or to anaemic females, this form of painful headache is
the consequence, commencing sometimes even before they
leave the water. The passive congestive headache is also the
headache induced by the depressing passions, by mephitio va-
pours, by the inhalation of carbonic acid gas in crowded rooms,
by intense mental occupation, or by tight stocks. The head-
ache complained of in diseases of the heart or lungs, when the
circulation is much impeded, is attributable also to congestion.
The weak and delicate, being least able to resist the eifects of
cold, are therefore more obnoxious to congestive headache, and
hence the anaemic is often replaced by the congestive. Phre-
nitis may of course be preceded by congestion, but it is a
phlegmasia very rarely encountered, unless from injury or dis-
ease of the cranial bones. This assertion may be considered
rash; but during a long practice, and sufficiently extensive to
hazard a medical opinion, I think time will confirm its truth.
Concussion of the brain is a temporary passive congestive
headache.

Diagnosis. The headache is sometimes a solitary affection,
or rather other symptoms are disregarded. A tensive pain, as
if the cranium were too small for its contents, is frit, but not
referrible to any defined part of the head ; the pain is constant,
increases in the recumbent position, and hinders sleep; is ex-
asperated by exercise, mental occupation, and, if reaction has
set in, by stimulants. The headache may continue a week or
two without any other well-marked symptom. If the head-
ache be the result of a blow or exposure to cold, and it be not
relieved by reaction in two or three days, the pulse becomes
slow, the heart labours, the surface is chilly, the countenance
pale, the appetite fails, the gait is unsteady, and there is a con-
fusion of ideas. These symptoms, when combined, are seldom
of long duration; and if the congestion be not relieved by
epistaxis or medical treatment, it will end either in coma or
reaction when the phenomena change. Coma need not be
described. In reaction nausea or vomiting are primary symp-
toms, the pain of the head becomes more severe, the face
flushes, the eyes are suffused, the pulse quickens, the skin be-
comes warm, the tongue white, the desire for food is lost and
replaced by thirst. Fever is now present, what Cullen termed
synocha, and the treatment cannot be misunderstood. Con-
cussion of the brain, when followed by reaction, admirably
illustrates the above history.

When this form of headache is the prelude to fevers of the
adynamic type, and before reaction commences, most of the
following symptoms co-exist, all also denoting a retrocession
of the blood from the surface to the deep-seated veins ; a chil-

1854. J Headache and its Varieties. 651

ly surface; lumbago, from congestion of the deep-seated spinal
veins; nausea, from cephalic congestion; precordial oppres-
sion, from distension of the right side of the heart, and, as a
consequence, a slow, labouring pulse. In the exanthemata,
either from the intensity of the poison, or from a peculiar con-
stitutional debility, their invasion is occasionally attended with
delirium and that of small-pox, frequently with convulsions.
Similar symptoms are said to be occasionally witnessed in
rubeola, but in scarlatina the poison is sometimes so powerful
and depressing that within twenty-four or thirty-six hours from
the seizure, death is the result, reaction being overpowered.
In such diseases, and especially in typhus gravior, our principal
aim should be to hurry on reaction, for if we succeed early, the
danger is much diminished. In adynamic fevers, the failure
of reaction is more to be dreaded, and its failure is more dan-
gerous than in those of the inflammatory type. Hydrencepha-
lus of the non-tubercular form has its history and treatment, as
a passive congestive headache, where perfect reaction fails. It
is this form of hydrencephalus which is occasionally cured, and
no doubt the cures would be more frequent were the diagnosis
more exact; but it is sometimes mistaken for infantile remit-
tent fever until the overloaded veins and sinuses relieve them-
selves of the watery parts of the blood by effusion into the
ventricles, and lessen the chances of relief. It would be a
worthy task to write a short treatise on the curable and non-
curable form of hydrencephalus.

The treatment must depend on the cause. The length of
time the headache has existed must also guide us in selecting
remedies. If it follow cold bathing, or exposure to cold other-
wise, and if not more than twenty-four hours in duration, the
production of reaction as speedily as possible is the undeniable
plan. For this purpose the sufferer should go to bed in a warm
chamber, and be well covered with bed-clothes, a large glass-
ful of mulled wine or hot spiced ale may then be taken, and, if
necessary, repeated, a few hours elapsing. If the headache
persist, and the skin be cold, an emetic of fifteen or twenty
grains of ipecacuanha should not be neglected, for the act of
vomiting forces the blood to the surface, and experience has
taught us that the headaches of the primary stage of fevers, or
of the cold fit of ague, are frequently removed by spontaneous
vomiting, forcing the blood to the skin, and inducingdiaphore-
sis. Should perspiration be still delayed, diaphoretics com-
posed of acetate liquor of ammonia and spirit of nitric ether
should be freely exhibited, together with white wine whey, until
they act freely, which usually terminates the pain of the head
and the danger of synocha. If, however, reaction be delayed

552 Headache and its Varieties. [September,

for several days, we have to apprehend one of two effects
coma, or fever. The former is by far the more dangerous.
Although in diseases of the head there is a prejudice against
hot baths, yet they may be prescribed in these cases with con-
fidence ; but if objected to, the hot air-bath may be substituted.
In addition, a blister to the nape of the neck, and sinapisms to
the calves of the legs. Leeches to the temples, and the scarifi-
cator to the nape of the neck, is in these cases oftentimes or-
dered without due discrimination. If the skin be warm, they
may relieve ; but where the skin is coldish and the pulse weak,
to say the least, they are uncertain; but as nature sometimes
relieves these headaches by epistaxis, she may be imitated safe-
ly by applying two or more leeches to the septum narium,
about half an inch above the Dares, with the aid of a curved
leech-glass; the application is easy. As the bleeding which
follows is sometimes very profuse, especially in children, a
second leech need not be applied until the bleeding from the
first has ceased. This method has many advantages ; it is the
most cleanly and the least troublesome, as, to encourage the
bleeding, it is sufficient to hold the head over a bowl of hot
water ; it leaves no marks, a matter of some consequence when
young females in the higher classes of life are the patients; it
relieves the head at the least expense to the sanguiferous sys-
tem, for there is very little communication although opinion
is otherwise between the vessels of the scalp and those of the
brain ; while the mucous surface of the nose has a direct com-
munication with the longitudinal sinus. The transition to
reaction sometimes takes place without relief, and is so gradual
that it is difficult to decide on the exact moment for depletion ;
but if the surface is warm and the face flushes, the difficulty
ceases. The headache continuing after reaction is fully estab-
lished constitutes fever. We now know what to do. Twelve
or fourteen ounces of blood should be taken from the arm in
the upright posture, saline purgatives prescribed, low diet and
mental quietude rigidly enforced. If the headache be not re-
lieved, small nauseating doses of tartar emetic are very valua-
ble, and we are not justified in withholding mercury, and it
ought to be given until there is tenderness of the gums. This
is one of the fevers (synocha) which so many physicians have
remarked yield on the appearance of salivation. The applica-
tion of cold lotions to the head are useless, perhaps injurious, in
simple congestive headache, before reaction, for the effect must
be to repel the blood from the external vessels. This form of
headache rarely continues a month without producing mischief.
If the headache be the consequence of a blow or fall, it must be
treated actively as soon as the depressing effect of concussion

1854.] Headache and its Varieties. 553

ceases; if nausea or vomiting succeeds, and the skin be hot,
we may be certain that inflammation of the cranial contents is
in progress.

The exanthemata and adynamic fevers commence with this
form of headache, and for several days it alone is complained
of. The hurried, slovenly practitioner overlooks the cause,
and irreparable injury mav be done by the loss of even a few
ounces of blood ; venesection to any extent is almost fatal, and
even local bleeding jeopardizes the recovery of the patient ;
for, to the congestion we have added a poison depressing the
heart's action, and still further impeding reaction, which the
additional cause of loss of blood renders almost impossible.
How many cases o{ typhus gravior have I seen terminate un-
favorably, solely, I may venture to say, from the application of
ten or twelve leeches to the temples, to relieve the intense
headache of the very early stage. The proper remedy at this
period is the exhibition of an emetic of ipecacuanha, to which
may be added eight or ten grains of sesquicarbonate of ammo-
nia. The treatment of these diseases does not enter into my
remarks on headache. Their invasion is sometimes so violent
that convulsions attend, but convulsions do not foretell so dan-
gerous a form of exanthemata as when we find a child after a
few hours' illness become insensible, speechless, with a very
weak pulse, and a cold surface. These symptoms are more
common from the poison of scarlatina than from any other ; all
those so affected have died within thirty-six hours of the attack,
no matter what remedies were employed, except one treated
by galvanism. The symptoms were very properly regarded
as congestion in the most intense form without the power of
reaction. The electro-galvanic battery was employed exact-
ly as it is for the congestion of those poisoned by opium ; a
flexible tube was afterwards passed into the stomach, and port
wine and ether introduced, and also friction to the surface, with
hot, dry, flannel cloths. In alluding to the treatment for the
coma which follows exposure to cold, the necessity of employ-
ing this powerful remedy was omitted. There is also another
remedy for the simple congestive headache, which should not
be despised, although it is constantly employed by empirics ; it
is popularly termed "traction," or dry cupping. Those who
have never seen it employed cannot imagine what a powerful
effect it must have when used in the following manner. The
back of the neck, between the shoulders, and, if deemed neces-
sary, even down to the loins, is smeared with spermacetti oint-
ment ; the exhausted glass, is then fixed ; it moves with the
greatest facility over the anointed surface, acting powerfully on
the cutaneous bloodvessels, leaving every portion of the skin

554 Exhaustion from Heat. [September,

over which it hns travelled of a vivid redness. Dr. Graves
speaks highly of it in his last published work, as applicable to the
hysterical (congestive?) headaches of females.

The only difficulty in treating-this form of headache is when
it has existed for several weeks without the attending fever;
for when once fever appears it ceases to be recognised as a
mere variety of headache. [lb.

Observations on Exhaustion from the Effects of Heat. {Coup
de Soleil) By H. S. Swift, M. D., "Resident Physician of
the New- York Hospital.

Owing to the oppressive and long-continued hot weather of
the past summer, an unusually large number of cases were
admitted to the New-York Hospital of what is called coup de
soleil, or, as now regarded by the profession, extreme prostra-
tion produced by exposure to excessive heats, combined, per-
haps, with the effect of receiving large draughts of cold water
into the system, when overheated.

So prevalent, indeed, was this disease, that at one time it was
regarded almost as an epidemic, not only in this, but in neigh-
boring cities. Several cases occurred in the country, where,
heretofore, it has seldom appeared. It will be recollected that
a large per cent, of the cases were fatal. The report of the
City Inspector of this city alone shows 2G0 deaths from coup de
soleil, without including many cases designated as "congestion
of the brain" and the "effects of cold water."

It is now only five or six years since the nature of this dis-
ease was pointed out, and yet the profession, generally, have
but vague and indefinite ideas respecting it. and it is a matter
of surprise that medical literature is so deficient on this sub-
ject. A few short monographs, and a few reported cures, are
all that can be found in regard to it. Cases are not so infre-
quent, nor is this affection so devoid of interest, as this silence
would seem to indicate.

1 have no new theories to propose, or any new light to throw
upon the pathology or the treatment of this disease; the object
of this paper is simply to call the attention of the profession to
this suhject, more especially as the season is now approaching
in which we may reasonably expect a return of this " calamity."

The term coup de soleil, as applied to this disease, is a misno-
mer. It is a popular rather than a professional appellation.
All our authors agree that "cerebral apoplexy" is occasionally
produced by exposure to the direct rays of the sun. This I
regard as true coup de soleil. The subject now under consid-
eration is an entirely distinct affection. It is now almost

1854.] Exhaustion from Heat. 555

uuiversally admitted to be mere nervous exhaustion produced
by protracted and violent exercise in an over-heated atmos-
phere.

Of the large number of cases observed by me, none were
strictly apoplectic, and no lesions were noticed in those which
proved fatal, sufficient to account for death. Those two oppo-
site conditions the "cerebral congestion" and "nervous de-
bility" require opposite modes of treatment, and should be
carefully distinguished from each other.

The subjects of this affection are usually laborers who have
been exposed several hours during the day to the direct rays
of the sun, the thermometer being over 90. A great majority
of the following cases were foreigners, many of whom had but
recently arrived in this country, and who, after the deprivations
of a long passage, were ill-adapted to endure great fatigue in
so high an elevation of temperature.

The same condition may result after exposure to artificial as
well as solar heat. Eleven patients were attacked one morn-
ing in the laundry of one of our principal hotels; several were
brought to us from a sugar refinery, where, after working sev-
eral hours in a close and overheated apartment, they fell down
suddenly in a state of insensibility ; and we had an opportuni-
ty of comparing their symptoms and lesions with those who
became exhausted after laboring in the sun, but were unable to
satisfy ourselves of any distinction.

Whatever tends to enfeeble the vital powers must be regard-
ed as the predisposing cause. This may result from muscular
debility or preexisting disease. Heat acts as the exciting cause.
One patient had suffered for several weeks from an obstinate
diarrhoea. He had eaten nothing on the morning of the attack,
and, after imprudently walking only a short distance in the
sun, fell down insensible. Another patient was suffering at the
time of the attack, as we afterwards learned, from the usual
malaise of fever, and after convalescing from this disease, pass-
ed through the ordinary attack of petechial typhus. Still ano-
ther was in a cachectic condition from the influence of malaria.
He was also picked up in the street, and brought to the hospital
in an insensible condition. These cases were not included in
our Report, though they were evidently suffering from this
disease at the time of their admission to the hospital.

An attempt has been made to distinguish those cases which
are the result of exhaustion merely, and those who have been
suddenly seized after drinking large draughts of cold water
when over-heated either from exposure to the sun or by vio-
lent exercise. If such a distinction exists, by far the greater
number of cases which fell under rny observation would be

556 Exhaustion from Heat. [September,

included in the latter class, though only in a single instance
were we able to trace any immediate connection. A seaman
had been employed, during the day, in the rigging of a vessel,
exposed to the direct rays of the sun. At 3 P. M., he com-
plained of a severe pain in the head and a "sense of sinking
within him." After drinking very freely from a bucket of
hydrant-water, he plunged his head into it, and immediately
fell down insensible. Most of the patients had been drinking
water freely during the day, some moderately, while others
had scrupulously avoided it. But a large majority of them
were attacked immediately after dinner, when probably large
draughts of water were employed.

For this reason I am inclined to believe that the effect of the
cold water in these cases is merely to hasten the development
of the disease, and that a majority of the cases reported as
deaths from "drinking cold water,"' are really occasioned by
"solar exhaustion." Nearly all the patients were exhausted
by severe labor, and at their dinner they were in just the con-
dition to suffer from the shock of receiving a large quantity of
water suddenly into the system.

Deaths from the effects of cold water are not so frequently
met with as is generally supposed. Dr. Dickson, of Charleston,
So. Ca., says: "I have never seen a death from drinking cold
water, nor have I been able to obtain any authentic account of
such an event having occurred since I have been engaged in
the practice of medicine in this city. Yet here, if anywhere,
such accidents should occur. Immense quantities of ice and
iced fluids are daily consumed here by persons subjected to the
several conditions which are regarded as calculated to favor
the morbid influence of the agent in the highest degree. The
cases described by Rush, I believe to have been generally cases
of isolation, and that, being sensible of rapidly approaching
disease, and at the same time feeling an internal heat, the pa-
tients were just procuring relief when overtaken by sudden
death.'5 Such, undoubtedly, was the case of the sailor above
referred to.

The disease is usually stated to be confined to patients of
irregular habits; but only a small portion at least less than
one-half of the following cases could be regarded as intemper-
ate, and many of these had restricted themselves during the
day to a single glass of ale or brandy.

The premonitory symptoms are usually slight, and of short
duration. A laborer may, perhaps, have been employed until
a late hour the previous night, and the next morning complains
of a slight headache and a general feeling of languor. He takes
his breakfast with less relish than usual, but resumes his or-

1854.] Exhaustion from Heat. 557

dinary duties. But, in the great majority of cases, even these
slight symptoms are wanting. They are suddenly seized,
while in the performance of their labors, with pain in the head,
and a sense of fulness and oppression in the epigastrium, occa-
sionally nausea and vomiting, general feeling of weakness,
especially of the lower extremities, vertigo, dimness of vision,
and insensibility. Surrounding objects appear of uniform color.
In a great majority of cases, this was, so far as could be ascer-
tained, blue or purple. In one instance, everything appeared
red ; in another, green ; and in another, white. One stated
that objects retained their natural color, but expressed them as
being very beautiful, while to another every thing appeared
greatly magnified.

This may be regarded as the first stage of the disease. It is
usually of short duration. In the milder forms of the disease,
the stupor is only momentary. The patient is at first, perhaps,
aroused with difficulty, but he gradually regains his conscious-
ness. If, however, the attack is severe, the patient shortly
passes into a state of coma. The skin is hot and pungent to
the touch, and by actual experiment, according to the observa-
tions of Dr. Dowler, the temperature is elevated to 112 Fahr.
The pupils are dilated and insensible to light; the breathing
hurried and labored ; the pulse is sometimes slow and full
sometimes frequent and feeble, though the action of the heart
may continue inordinately strong up to the last moment of life.

In the third stage, the symptoms are those of collapse. The
pulse becomes more frequent and feeble ; the respiration, which
at first was hurried and labored, now becomes stertorous, and
accompanied with sighing and moaning; the skin cool, or the
surface of the body may retain its natural temperature, though
the head may be hot ; the sphincters become relaxed ; ex-
tremities cold ; the countenance swollen and livid ; the pupils
may be dilated, but are often firmly contracted ; tracheal rales
appear; either the patient is quiet, as if completely paralyzed,
or else convulsions, often violent in character, supervene, and
he dies suddenly, or he may remain in this condition for sev-
eral hours.

The first stage corresponds very nearly to that condition
described by Southern writers as "solar exhaustion." Dr.
Dowler makes a distinction between this "solar exhaustion"
(the coup de soliel of northern latitudes) and what he calls
" solar asphyxia." The former he regards as " a mere fainting,
in which the face is pale, skin cool, or not above the natural
standard, while, in the latter, the skin is burning hot, face
flushed, and the mind and body are utterly insensible to im-
pressions." It runs its course rapidly, and often proves fatal

558 Exhaustion from Heat. [September,

in 30 minutes. Dr. Cartwright says, the cases of " asphyxia
are often incurable from falling into an incurable state before
medical aid can be obtained "! while those of exhaustion sim-
ply, if properly treated, will yield as readily as a ease of com-
mon intermittent, and almost as fatal as "solar asphyxia," if
improperly treated.

The second and third stages, described in the progress of
the disease, are so intimately connected that it may seem an
unnecessary division ; but it is more convenient to regard them
separately. They differ usually in the mode of attack, and
for this reason some have regarded them as a distinct condi-
tion. The stage of collapse is most frequently noticed in those
who are seized late in the afternoon, " without the signs of
apoplexy," after exposure to the heat and fatigue of the day.
But the same condition may occur in those who have been
seized suddenly "with the signs of apoplexy," and yet patho-
logically there may be no difference.

Of GO cases which came under my observation during the
past year, 44 were insensible at the time of admission, ami J b*
were either stupid or sensible. The pupils were dilated in
30, contracted in 19, and natural in 11. The temperature of
the body was hot in 34, warm or natural In 14, and cool in 12 ;
while that of the head was elevated in 3J, warm in 11, and
cool in 18.

The respiration was hurried in 44 ; the pulse was uniformly
accelerated, varying from 100 to 1G0, and even more per min-
ute. Convulsions were present in 24, delirium was noticed in
only a few. 52 of the patients were males. The average du-
ration of the fatal cases was about 4 hours.
The time of the attack in 3 cases was between 8 and 11 a.m.

" " " 40 " " " 11 a.m. and 4 p.m.

" " " 17 " " " 4 and 9 p.m.

Convalescence is usually speedy, after the severity of the
disease has passed, and reaction is fully established, varying
from a few minutes to five or six hours ; the patient sinks into
a deep slumber, and awakes somewhat exhausted, and the
cerebral functions disturbed ; but this soon disappears. Two
patients only complained of severe pain in the head, and at
intervals exhibited great forgetfulness for nearly a week ; and
one was occasionally delirious.

A case was reported to me in which delirium supervened,
resembling that of delirium tremens. I can conceive that such
a condition may exist, but this patient was intemperate, and
had been drinking to excess previous to the attack.

Dr. Pepper reports 20 cases, 10 of which died, and 3 result-
ed in insanity. This termination was not noticed in over 100

1854.] Exhaustion from Heat. 559

cases received at the New- York Hospital. In the reports of
lunatic asylums, however, few cases of insanity are referable
to an attack of coup de soleil. One patient was delirious, and
with the greatest difficulty restrained.

The statistical reports are too inaccurate to furnish any sat-
isfactory data for the mortality of this disease, as no attempt
has been made in the reports to distinguish it from u cerebral
apoplexy ;'" but this latter class is, I believe, less frequently
met with than was formerly supposed ; and that their number
will somewhat diminish as the facilities for post-mortem exam-
inations are furnished, and that by far the greater number of
cases included under the head of coup de soleil are nothing
more than " nervous prostration." About one-half of the cases
are usually fatal. The mortality of the past year will, howe-
ver, be above this estimate.

The total number of cases admitted to this Hospital since
1845, is 150, of which 78 died. The morlaiity of the cases ad-
mitted in 1853 is 33 in 07.

The mortality of hospital practice must be greater than that
in private, as very many were admitted in a moribund condi-
tion, and died before any treatment could be adopted, while
others were rendered hopeless by being brought a long dis-
tance, several hours after the attack.

The prognosis will depend on the stage of the disease. In
the first stage, the prognosis is usually favorable ; much, how-
ever, will depend upon the treatment adopted. The symptoms
indicating collapse are always unfavorable.

In 33 fatal ca-^es, the pupils were contracted in 20, moder-
ately dilated in 7. and markedly so in 6 ; while, in the succ-
ful ones, the pupils were dilated in 19, and nearly natural in
15. Xo case recovered in which the pupils were contracted.
3Iere stertorous breathing is not necessarily fatal ; but after
the respiration becomes sighing and moaning, the prognosis is
very unfavorable; only two patients recovered after this char-
acter of the breathing was present.

To these two symptoms the condition of the pupil and the
character of the respiration I attach much value ; and if other
observations shall confirm this, they will furnish the most relia-
ble basis for prognosis.

The respiration was sighing or moaning in 31 of the 33 fatal
cases; convulsions were noticed in 24. This is a grave symp-
tom, but 6 recovered after they were present. The pulse alone
is no safe criterion of the actual condition of the patient, for it
may continue of fair strength throughout the whole course of
the disease, with no perceptible alteration either in force or
frequency, though the patient may be under the free use of

560 Exhaustion from Heat. [September,

stimulants. This will frequently surprise those who are unac-
customed to observe it.

A fatal relapse occurred in one instance. This patient was
attacked suddenly while at his work, and lost all consciousness.
As soon as he had sufficiently recovered, he walked a long dis-
tance to the hospital, exposed to the direct influence of the sun.
This exertion, combined with his previous prostrated condition,
probably induced another attack. He again partially conva-
lesced, but immediately sank into a comatose condition, from
which he did not rally.

The pathology of this disease is uncertain. We have as yet
failed to discover any satisfactory lesion to account for the
phenomena noticed before death. It is now, however, gener-
ally admitted to be merely " exhaustion," produced by fatigue
either in the sun, or, less frequently, in a close and over-heated
apartment.

The post-mortem appearances, though of a negative charac-
ter, are precisely opposite those found in "congestion" of the
brain or apoplexy produced by insolation in other words,
coup de soteil. And it is of great importance that this relation
should be correctly understood, for they obviously require an
opposite course of treatment. Unfortunately these two condi-
tions are too indiscriminately called coup de so/eil. Our nomen-
clature, in this respect, is imperfect, and calculated to mislead
those who are unaccustomed to observe it. But we must not
infer, simply because a disease has been erroneously called coup
de soleil, that we have apoplexy to contend with. " It is de-
bility we have to meet, and not repletion." Depletion, which is
essential in the one, is almost necessarily fatal in the other.

In some cases we have apoplectic symptoms with those which
properly belong to the opposite condition. And we may per-
haps be puzzled to know to which class they belong. But even
in these cases, we rarely find any lesion. Sometimes there will
be found a moderate congestion of the brain, but no more so
than we often find in cases where we suspect no lesion of that
organ.

The following case may perhaps be interesting, as illus-
trating this :

An unknown woman was picked up in the street in a state
of exhaustion, and brought to the hospital at 8 P.M., Aug. 14th.
Nothing could be learned of her previous history. She was
completely insensible, pulse frequent (120) and feeble; respi-
ration hurried and labored ; skin burning hot ; temperature of
head elevated ; pupils contracted and insensible. The prog-
nosis was unfavorable. Our ordinary treatment was adopted.
Sinapisms were applied to the calves of the legs and abdomen,

1854.] Exhaustion from Heat. 561

ice to the head. Stimulating enema of spts. tereb., brandy, and
tr. capsici were administered moderately. Frictions with mus-
tard were also ordered. Four hours after her admission, her
condition became decidedly worse. The slight convulsive
movements of the body, which were noticed at the time of her
admission, were more marked and violent, and it was only with
the greatest difficulty that she could be confined to the bed.
The breathing was exceedingly labored, and accompanied with
sighing and moaning pupils dilated ; the pulse very frequent,
and scarcely perceptible at the wrist ; the countenance swollen
and livid; extremities cold; the stomach refused to retain the
stimulants. The bronchial tubes became clogged with an in-
creased secretion of mucus ; and deglutition was very difficult.
The slightest attempt to swallow threatened almost immediate
asphyxia. She was ordered injections of brandy and carb.
ammonia.

On the following morning reaction was fully established
the pulse 130, but fair strength. The head and surface of the
body hot ; eyes suffused, red, and injected, fixed and motionless ;
pupils contracted to a point and inactive ; fane flushed ; coun-
tenance swollen and turgid ; respiration deep and stertorous ;
and the patient was completely comatosed. The quantity of
stimulants wTas diminished, and an aloetic enema repeated ; ice
reapplied to the head, and sinapisms to extremities.

The physician in attendance now regarded these symptoms
sufficiently indicative of cerebral congestion to warrant deple-
tion. Otdered a moderate abstraction of blood from the tem-
ples by cupping, and the treatment adopted during his absence
to be continued. She died 21 hours after admission.

Autopsy 18 hours after death. No marked congestion of
the brain or lungs was observed. The heart was flaccid and
filled with fluid blood. The liver was much congested other
organs healthy.

This case was, doubtless, one of " nervous exhaustion," a
condition so often mistaken for, and associated with, "cerebral
apoplexy," and it was the only one in which reaction ran suffi-
ciently high to indicate depletion. But even in this the post-
mortem disappointed us. I have only seen a few, a very few
cases, of insolation verified by a post-mortem examination,
certainly not one duiing the past year, although examinations
were made in all the cases in which we suspected any cerebral
lesion.

The diagnosis of those cases, which simulate apoplexy is
often difficult. The remarks of Dr. Condie, though inapplica-
ble to the case just given, may perhaps be generally useful.
He says : " In those cases requiring depletion, the head parti-

562 Exhaustion from Heat. [September;

cularly, and often the entire surface of the body, is hot. The
eyes injected ; pupils contracted ; pulse small, quick, and cord-
ed. Tongue red and dry. Patients are delirious, restless, and
in a constant state of agitation ; and if not speedily relieved by
prompt and active treatment, coma ensues, and the patient dies
as in acute meningitis."

The true pathology of this disease, like those cases of death
produced by lightning, will probably never be correctly ex-
plained, unless, perhaps, the microscope may aid in removing
the veil of mystery which surrounds it. But it must be re-
marked en passant, that there are many points of resemblance
in the appearance of those who have died from the effects of
heat, and the cases reported of death from lightning.

Does the heat produce death by destroying the ''vital prin-
ciple/' as Hunter supposed was the effect of lightning? Does
it produce some chemical change in the blood itself, so that it
can no longer subserve the purposes of innervation ? or does
it produce its effect primarily upon the nervous system. This
is the most plausible theory. The vital powers, already enfee-
bled by fatigue, and the heat of the atmosphere, are unduly
stimulated. The natural balance of the circulation is destroy-
ed, and the heart contracts with a "morbid activity." The
lungs are engorged with blood, and the heart labors to over-
come the increased obstacle, until at length it is exhausted by
this "morbid activity," and passive congestion takes place in
the capillaries throughout the body.

The pathology of this disease is too obscure and uncertain,
and observation too limited, to arrive at any satisfactory con-
clusions in regard to the treatment. It is at best empirical.
We regard the disease as one of debility, and we partially treat
it as such.

The great practical point to be regarded in the treatment
is, that this affection is entirely distinct from coup de soleil, as
generally understood by the term. It is a disease of " debility,"
and not one of " repletion." Depletion is generally contra-
indicated, and stimulants are usually required.

In cases of Insolation, the lancet is often employed. But
these are very rare. During the summer of 1818, there were
13 cases admitted into the hospital. These were largely bled ;
60 ounces were taken from the arm by repeated bleedings ;
and in one case as many as 80 ounces. And the " recovery
in this one was much more marked and speedy." Three of
these died, and the post-mortem appearances were precisely
those of " cerebral congestion." But in cases of exhaustion, I
have never seen a patient recover after he had been bled.

This practice is now nearly abandoned. Formerly, nearly

1854.] Ammonia in Coup de Soleil. 563

every case treated before admission to the hospital had been
bled. But not a single patient had been bled of those admit-
ted during the past summer. ^They do not bear well even the
local abstraction of blood by cupping.

The plan of treatment usually adopted is to place the patient
in a hot bath, rendered stimulating perhaps by mustard or cap-
sicum or counter-irritation to the whole body by means of
mustard ; a stimulating enema of tr. aloes c., or, what is pre-
ferable, spts. terebinth ; ice to the head when the temperature
is elevated; brandy and tr. capsici, or even carb. ammonia if
required.

The indiscriminate use of cold affusions is productive of
harm. Injurious and often fatal effects result from them. It
is a popular and erroneous idea that a patient, as soon as he is
attacked, should be completely deluged with cold water. To
employ it in every case would be as absurd as in cases of col-
lapse from any cause.

Another important consideration in the treatment of the ear-
lier stages is rest. In crowded cities, to which this disease is
mostly confined, this caution is too much disregarded. As
soon as a patient is attacked, he should be placed in a horizontal
position, in as cool a place as possible, and perfect rest re-
quired. Nothing can be more serious for a patient in this con-
dition, than to be carried, as is too often the case, upon an
ordinary cart for a longdistance, or allowed to remain exposed
to the influence of the sun.

The length of this paper will prevent any detailed account
of the cases themselves. They were admitted during the at-
tendance of Drs. Joseph M. Smith and H. D. Bulkley, and the
treatment adopted during their absence was approved of by
them. In conclusion, 1 desire to express my special acknow-
ledgements to my senior assistant, Dr. John B. Chapin, for his
valuable assistance, not only on this, but other occasions.

[N. Y. Journal of Medicine.

On the Use of Hydrochlorate of Ammonia in Coup de Soleil,
By J. R. Leaming, M. D., Physician to the Northern Dispen-
sary, N. Y.

Case 1. I was called in the afternoon of June 16th, 1852,
to see a man at the Knickerbocker stables, on Eighth avenue,
overpowered by heat. He was insensible, breathing somewhat
stertorous, pulse slow and weak. Having used muriate of
ammonia in the comatose condition of typhus fever with ap-
parent benefit, and believing the nervous prostration in thi3

564 Ammonia in Coup de Soleil. [September,

case to be very similar, I prescribed it in about 8 grain doses,
in solution, every half hour. He was removed to his home and
mustard applied to the epigastrium. With some difficulty he
was made to swallow the medicine, but in about fifteen min-
utes after the first dose the stertor ceased. In an hour he was
sleeping quietly, and when disturbed, answered questions inco-
herently. In about three hours, he could sit up in bed and
converse, but complained of great lassitude and fullness about
the head. The next day he was able to walk out.

Case 2. I was called in the afternoon of June 22d, 1853, to
see a blacksmith who had been sent to his home in 28th street,
overpowered by heat. I found him entirely unconscious, with-
out any action of the voluntary muscles, deep stertor, pulse
slow and full.

I gave him the ammonia and applied mustard. I left him,
but returned in an hour and a half, and was surprised to find
the patient sitting up, able to converse. He complained of
general lassitude and a dull pain in the head. The next day
he was walking about.

Case 3. I was called in the evening of June 28th, 1853,
to see a bricklayer, who had fallen insensible a moment after
returning home from his work in the evening. I found him
without stertor, but breathing slow and heavily, pulse slow and
weak, entirely unconscious. I gave him the ammonia and
applied mustard, then sent a messenger for Dr. Tucker, his
family physician. In about an hour the Dr. called on me, and
requested me to see the patient with him. We found him able
to converse, complaining of debility and pain in the head.
The medicine was continued, and the patient walked out the
next day.

Dr. T. assures me that he" has since used the muriate of
ammonia, in similar cases, with gratifying success.

Case 4. August 12, 1853, I was called in the afternoon to
see a man in 2Gth street, suffering from sun-stroke. Mustard
had been well applied before I arrived. He was entirely un-
conscious, labored breathing, pulse weak and frequent. 1 gave
him the ammonia, and when I returned, in about an hour, he
was sitting up.

My notes of these cases are very meagre, but the impression
left on my mind at the time, and by other cases of which I
have no notes, is, that the ammonia produced speedy and satis-
factory relief. If the pathological condition of sun-stroke be
excessive nervous exhaustion, as I believe it is, diffusible stim-
ulants are indicated, and I think the muriate of ammonia is the
best. The patient should not be bled, ice should not be applied
and continued to the head. The face and temples may be

1854.] Primary and Secondary Amputation, 565

sprinkled, or sponged with cold water. Mustard should be
thoroughly applied, the extremities kept warm, and muriate of
ammonia dissolved in cinnamon water,given at short intervals
till consciousness is restored, and afterwards at longer intervals,
till the sensation of pain and fullness in the head has disap-
peared. [Ibid.

Observations upon Piimary and Secondary Amputation. By
Professor W. Stoxe, M. D., of New Orleans.

The principle of immediate amputation, although beyond all
doubt correct, has caused the loss of countless limbs unnecessa-
rily, and, I believe, of as many lives as it has saved. The
error, evidently, is from over-estimating the security afforded
by primary over secondary amputation. The first duty of the
surgeon certainly is to secure, if possible, the life of his patient;
and the second, to preserve as much of his person in as per-
fect a manner as possible. In the anxiety to fulfil the first
dutv, by over-estimating the security which amputation affords,
limbs are often sacrificed that are curable, and by disregard-
ing the proper time for amputation, a life may be lost that
would have been safe without an operation. In severe inju-
ries of the extremities, if fatal, death is produced either by the
concussion, or subsequent pain and suppuration which exhausts
the patient; or it may occasionally be from tetanus or gangrene.
Against the first cause of death, amputation affords no security,
on the contrary it favors it. The question of amputation be-
fore reaction, 1 believe, is settled by every American surgeon
of experience in the negative. This subject was sharply dis-
cussed in England on the occasion of the death of the celebra-
ted statesman. Huskisson, who had both legs or thighs crushed
on the Liverpool and Manchester Railroad. The Liverpool
surgeons attempted to bring on reaction, but evei y means fail-
ed, the concussion had thrown him into a fatal collapse. The
London surgeons took the matter up, blamed the Liverpool
surgeons, and ur^ed that immediate amputation should have
been resorted to, and talked nonsensically of the stimulus of the
knife. When one hears such reasoning, he feels the truth of
the remark made by some one in the hist century, that sur-
geons were bad pathologists and worse physiologists.

In severe injuries, where the patient is thrown into collapse,
and amputation isnecessary or unavoidable, if the case is critical,
it is a nice point to decide when, exactly, it can be performed
with the most safety. If the patient were in great agony and am-
putation could relieve it, there could be no doubt of the propriety

N. 3. VOL. X. NO. IX. 3G

566 Primary and Secondary Amputation. [September,

of amputating at once, no matter what the state of the pulse
might be; but this is not the case, the shock has been receiv-
ed, the mischief has been done, the parts are in a measure par-
alyzed, and no very severe pain takes place until reaction.
The question in such cases is, whether the injured limb is a
greater source of pain than the stump would be after amputa-
tion, and considerable allowance should be made for the shock
of the operation. The discovery of chloroform enables us in a
great measure to avoid the shock of the stimulus of the knife,
but not entirely. My experience is, that when amputation is
unavoidable, it is best to do it as soon as reaction has fairly
commenced, while the patient is under the influence of the first
shock of the injury, the pulse flickering, etc.; any disturbance
of the system, pain or loss of blood, might cause a fatal col-
lapse in a case that would be perfectly safe, managed with tact
and judgment. By reaction, I do not mean a full resistant
pulse. The nervous system receives the shock and is the first
to react, as is shown by the increased sensibility and improved
capillary circulation before any perceptible improvement in the
pulse is observed ; this, however, soon follows, and the pulse
becomes more steady. When the system is suffering from a
severe injury, it is often the case that stimulants do not act as
such when put upon the stomach. In extreme cases, when the
patient is in danger from collapse, it is evident to me that the
stomach does not absorb, but is nauseated, and all the depress-
ing effects of nausea are produced. The rectum can scarcely
be said to sympathize with the system in general, and always
preserves an active absorbing surface. Stimulants given by
injection produce a ready effect, and I always use my stimu-
lants in this way where the patient is in danger, even when he
is perfectly able to swallow, for they are much more prompt
and effective. If too long a time elapses, after an injury, be-
fore amputation, the sensibility of the limb, which at first was
partially paralyzed, becomes highly exalted, and although we
can, by the use of chloroform, prevent the shock from the
operation, we have a fresh wound in parts in a morbid slate ;
the stump is much more painful, and as a general rule does not
do as well as when the operation is performed earlier. By
the above, I mean a state of the parts before any decided in-
flammatory action has taken place, and my firm conviction is
that where no large joints are involved, or parts injured that
will give extreme pain to the patient, he will have a better
chance for his life if we give him a chance for his limb also,
even if we have to resort to secondary amputation ; I mean if
the most favorable period for operating has passed. [New Or-
leans Med. News.

1854.] Treatment of Cholera. 567

Treatment of Cholera by Muriatic Acid, tyc.
Dr. Caron reports most favorably of the effects of this acid,
with bark, calumba, 6cc in many cases of cholera. He gives
the following formula for the preparation : Vinous tincture
of cinchona, twenty five parts; tincture of orange peel, three
parts; tincture of juniper, three parts; tincture of calumba,
three parts; muriatic acid, four parts; mix. He considers its
effects to be tonic, anti-spasmodic, and slightly excitant. Ac-
cording to the nature of the case, the intensity of the symptoms,
and the patient's susceptibility, he employs it in doses of a small
spoonful every quarter of an hour, every half hour, or every
hour; in some instances, to favor its tolerance, syrup of tolu or
of poppies may be added. The first effect o( this medicine is
a sensation of warmth in the epigastrium, which speedily ex-
tends over the body ; the vomiting moderates, and finally
ceases; after the fourth or fifth dose, the alvine ejections gen-
erally diminish in quantity and frequency ; and the secretion of
urine is re-established, but more slowly. The indulgence of
thirst, by the free use of cold water, Dr. Caron considers pro-
ductive of most serious consequences; and even in cases which
otherwise promised a favorable issue, he has seen it prove fatal.
He does not advise the acid to supercede the employment of
other suitable treatment, as general and local rubefacients,
sinapisms, frictions, &c. He further slates that, in the hands
of M. Malin, muriatic acid, combined with opium, has been
found effectual in the treatment of dysentery. [Gaz. des Hop.
Montreal Med. Chronicle.

EDITORIAL AND MISCELLANY.

Remarks upon the use of Pessaries in the Treatment of Prolapsus Uteri.

By the Editor.

We took occasion in one of our preceding numbers (January,
185 L, p. 61) to animadvert upon the injurious effects of the various
modifications of the, so styled, ' Utero-Abdominal Supporters/' and
endeavored to show that they must exert an influence upon the
pelvic organs directly the reverse of that for which they are specially
designed. Whether our arguments have been deemed conclusive or
not, by all our readers, we are not able to determine. We have,
however, seen no attempt to refute them. Yet. some of our corres-
pondents have asked us by what means we would remedy prolapsus
or procidentia uteri ; and, apparently taking it for granted that some
mechanical support is necessary in such casts, have requested us to
indicate the kind of pessary to which we would give the preference.

568 Editorial [September,

We beg leave to lay our reply before the readers of this Journal, in the
hope that attention may be directed to a subject we have long deemed
of great importance in a curative and likewise in a moral pointofview.

As, with reference to literature, it has been observed by a no less
witty than sagacious rhetorician, that " la critique est facile, viais
Tart est dijicile" (criticism is easy, but art difficult,) so may it be
said with regard to plans proposed for the management of disease,
that it is more easy to object than to remedy. We accordingly find
no difficulty in making out an argument against the use of the pessa-
ry, at the same time that we may not be able to suggest any very
effectual relief for the affection in which it is used. If we can suc-
ceed in establishing the fact that the pessary, in neither of its multi-
plied varieties, can be beneficial, but must, on the contrary, be more
or less mischievous, we think that an important advance will have
been secured a worthless practice will have been rejected, and the
mind of the practitioner left free to seek something betler.

Before we can appreciate correctly the effects of the pessary, it is
necessary to take into consideration the mechanical and pathological
causes which induce the uterine displacement. In doing so, we
shall make no reference to written authorities, but be guided aloiu by
the dictates of common sense. When a female stands erect, the
uterus is maintained in its proper position by its attachments and by
the approximation, more or less complete, of the vaginal parietes.
These are the physiological forces opposed to the influence of gravity
and of the downward pressure by the abdominal contents, when these
are thrown upon the pelvic axis. In virgins, therefore, the tonicity
of whose vagina and uterine attachments has suffered no impairment
by extension, we find prolapsus uteri to be of very rare occurrence ;
whereas it is most frequently met with in those who have borne many
children and whose tissues are naturally deficient in firmness. The
relaxation of the uterine attachments and the flaccidity of the vaginal
walls are in some instances such as to afford no support to the uterus,
and consequently to allow it to fall more or less considerably when-
ever the female stands or walks. The os tincae may then either rest
upon the perineum or present itself at the vulva.

In laboring women, our female field hands for example, the dis-
placement is not unfrequently occasioned by the powerful action of
the abdominal muscles, forcing down the abdominal upon the pelvic
viscera, and thus overcoming the physiological resistance of the vagina
and uterine attachments which would otherwise have been sufficient
to prevent the prolapsus. Women should therefore abstain from

1854.] Editorial. 569

great muscular efforts, and, in the case of our field hands, should not
be allowed to use the axe nor to carry heavy baskets of cotton.

Such are the usual circumstances under which we believe prolap-
sus uteri to occur. It is true, that some imagine that it may be
induced by the increased weight acquired by the uterus in conse-
quence of morbid enlargements. While we are not prepared to deny
this, positively, we doubt it very much, seeing that it does not occur
under the influence of impregnation. We would rather, in such cases,
regard the descent of an enlarged uterus as merely coincident with
abnormal relaxation, and as insufficient in itself to overcome a healthy
degree of resistance. To suppose, with some, that a mere engorge-
ment, or even ulceration of the os tincae, may be the cause of prolap-
sus uteri, is simply preposterous.

Let us now see what are the evil effects of prolapsus uteri. One
of the first and most common indications of such a state of things is a
sense of heaviness or of downward dragging about the uterus, which
increases upon walking or taking exercise, and proves more or less
inconvenient, according to the sensibilities of the patient. Hence a
degree of prolapsus wh^h might pass unnoticed by those who are less
irritable, may become a source of annoyance to the sedentary and
nervous ladies of the city. In some cases, the sensations just stated
are attended with a feeling of weakness or pain in the loins, and more
or less tenderness, with or without pressure, in the lower part of the
abdomen, just above the pubis. This is probably induced bj' the
traction exercised upon the peritoneal folds attached to the uterus and
its ligaments, followed by irritation of this highly sensitive serous
membrane. We are aware that this soreness is, by some, supposed
to exist in the uterus itself. The prompt relief derived from recum-
bency, as well as by pushing up the uterus with the finger, would
seem, however, to corroborate our views, independently of other con-
siderations. It is indeed difficult to understand, otherwise, how a
mere descent of the uterus could induce, perse, pain or tenderness of
this organ ; still less can we admit that such a state, unless in ca^es
of actual procidentia, can be the active cause of ulceration or phlo^o-
sis of the os tineas. These we regard as coincidences, and not as
effects of the displacement; yet the frequency with which they are
met must have a very important bearing upon the treatment, espe-
cially by the use of the pessary.

We are now prepared to estimate, understanding, the value of
pessaries for the relief of prolapsus uteri, in its simplest form, as well
as prolapsus complicated with organic lesions of the uterus. The

570 Editorial [September,

difficulty of getting a pessary that can be tolerated by the patient, or
even worn without material inconvenience and injury, has led the
advocates of its use to tax their ingenuity to the utmost for the inven-
tion of new forms and new principles of action. No person has yet
succeeded, however, in designing one which unites the approbation of
all practitioners and the pessary most highly valued by one physician
of distinction, may be condemned unqualifiedly by another of equal
reputation. We cannot .say how it is in Europe; but we doubt that,
of the leading obstetricians who, in our country, use the pessary, any
two can be found who recommend the same variety of this instrument.

We may, perhaps, accomplish our purpose by adverting to the prin-
cipal forms which are typical ut* sub-varieties. We find then p
ries in the form of a dUk, others globular, and some consisting of an
elongated vaginal plug ; all of which support the uterus at the expense
of pressure upon the walls of the vagina. Whether they be made of
metal, glass, wood, caoutchouc, wool, sponge, or other material, the
mechanical principle remains the same: the os tinea; rests upon a
foreign body, which is itself sustained by the vaginal parietes. and by
immediate pressure upon an exquisitively sensitive and irritable mu-
cous surface. Fully appn dating the objections to these forms of the
instrument, some practitioners reso.'t to the expedient of stem pessa-
ries, the lower extremity of which may be sustained by bandages
more or less complicat ...1.

By the stem pessaries we certainly avoid the consequences of pres-
sure upon the vaginal walls; but the contact of the os tincue with a
foreign body of sufficient resistance to support the uterus, still re-
mains, and is very properly deemed injurious by some. In order to
obviate this objection, therefore, the uterine extremity of the stern
pessary is made to consist of a ring through which the os tineas hangs
as through a collar. It will be observed, that by this modification the
point of contact is merely removed from the mucous surface of the os
tineas to the mucous surface adjacent, which is probably quite as irri-
talile, and certainly more sensitive.* A serious objection to the use of
this pessary, is the liability to injury by inadvertently sitting in such a
manner as to bear upon the stem and to thrust the instrument abruptly

against the uterus.

To resume : Every form of pessary bears upon one or more points
of the mucous surface with a force equal to that necessary to support
the uterus in its proper position, although the sum of this force

* M. Jobert's observations go very far to prove that the os tincae is nearly, if
pot quite, insensible, though not devoid of irritability.

1854.] Editorial 571

must vary very much, according to the degree of relaxation of the
natural supports of the organ and the downward pressure of the ab-
dominal viscera. All pessaries, with the exception of those provided
with a stem, exert compression upon both the os tincae and the vaginal
walls. And, finally, the stem pessaries come in contact with either
the os tincae or the adjacent vaginal surface, according to the mode
of their construction.

Several questions now present themselves: 1st. Are these me-
chanical contrivances adequate to the support of the displaced uterus ?
2d. Can they be tolerated without more or less injury to the surfaces
of contact ? 3d. Does their use remedy the state of things by which
the prolapsus is occasioned ? The reply to the first query must be in
the affirmative : the uterus may unquestionably be maintained in its
proper place by a pessary. The second question, however, cannot
be so unequivocally answered. The pessary must evidently be intol-
erable or injurious whenever the surfaces of contact are in a patholo-
gical condition, which we know to be not unfrequently the case. It is
true, that when the os tineas is alone affected, the ring and stem pes-
sary may be used ; and the cup and stem pessary may be reserved for
cases in which the lesion exists in the vaginal membrane only. But
may not the ring pessary aggravate the lesion of the os tincae by its
constriction or strangulation of the capillaries so near the seat of
disease? And may not the in itating contact of the cup and stem
pessary occasion an extension to the os tineas of the pathological con-
dition of the mucous surface in its vicinity ?

Whether the pessary can be used without injurious effects in cases
of simple and uncomplicated prolapsus, is another branch of the ques-
tion. The answer, here, would depend very much upon the length
of time deemed necessary to use the instrument; for while its con-
tact for a short period might induce no serious disturbance, it must
be admitted that persistent or continuous pressure upon any living
tissue, and especially upon a mucous surface, cannot be long endured
without pain, irritation, inflammation, and even ulceration. If the
mucous surfaces in question constitute an exception to the general
rule, we have yet to learn the fact. Is the result of experience in-
voked ? are we told that the application of a pessary is often attend-
ed with immediate relief, and that many women have worn them with
impunity for weeks and months? We shall not insist upon "the fal-
lacies of experience," nor do we feel disposed to reject the testimony
of honorable men, of men who have nought but the welfare of their
patients at heart. We therefore readily admit, that in cases in which

572 Editorial. [September,

the traction upon the peritoneal folds implicated in the support of the
uterus, has made this serous membrane the seat of the soreness refer-
red by patients, (and occasionally by physicians themselves,) to the
uterus that, in such cases, immediate relief may be obtained by re-
cumbency, or by pressing up the uterus with the finger. The same
relief may be derived from the application of a pessary. But is tempo-
rary relief all the patient needs under such circumstances? If so,
she can obtain it as effectually by remaining upon her couch a few
days. It is true, that with a pessary she may walk about without
serious inconvenience a few days. Yet, we must insist that the ob-
ject of the conscientious physician should be, not temporary, but
permanent relief; not such a patching up of the case as will ensure
his recall in a short time, and place the patient under the disagreea-
ble necessity of submitting to repealed manipulations highly revolting
to delicacy, however much this may be tempered by reason. The
mere relief of a sense of heaviness, lassitude, or even positive pain, is
but a small part of our duty; and if this can be done without resorting
to the pessary, we cannot admit the propriety of a measure which
certainly does violence to every sentiment of modesty. Whatever
may be the experience of others, we have never had any difficulty in
securing this relief, by means of recumbency and suitable lotions, in
a few days, as effectually as ever did those who substitute the pessary
for these simple means.

If it be now alleged that the pessary accomplishes more than the
relief to which we have just alluded ; that it cures prolapsus uteri, its
claims to our respect become more serious. Did you, reader, ever see
a case of real prolapsus uteri cured by the use of a pessary ? Did you
ever see a woman in whom it was at one time necessary to introduce a
pessary, who did not need it as much at some subsequent period ? We
have never known a case of prolapsus uteri cured by this instrument,
nor have we ever known its use to accomplish any thing more than
the temporary relief already admitted. We have, however, known
many cases in which the pessary had been used repeatedly, and for a
long time, without any benefit whatever, or with decided disadvantage,
until, when the patients, wearied with the remedy, as well as with the
pertinacity with which its farther use was insisted upon, would an-
nounce themselves cured in order to get rid of the importunities of
tht ir adviser. Subsequently, coming under the care of another prac-
titioner, they would candidly acknowledge the above history. Every
man who has long practiced medicine must know how extremely diffi.
cult it is to appreciate correctly the true effect of any remedial agent ;

1854.] Editorial. 573

to discriminate between coincidence and effect ; or even to determine
whether his prescriptions have been faithfully carried out or not.
Who has not. encountered cases in which he was attributing his suc-
cess to remedies which he subsequently ascertained had never been
taken ? And the more unpleasant the prescription, the more apt will
the patient be to practice deception. We know of no prescription more
apt to be disregarded, after one or two applications, than that under pre-
sent consideration. This is the result of our own observation, and of
that of many practitioners and non-professional persons of intelligence
with whom we have conversed. We do not deny that many women,
when once imbued with the idea that they have "a falling of the womb,"
will submit, with heroic sacrifice of feeling, to endless treatment of this
kind. And, unfortunately, the influence upon the mind of any kind of
uterine disease, real or imaginary, is such as frequently to amount to a
monomania, under which the sufferer becomes a ready prey to the arti-
fices of the charlatanical " womb doctprs " who infest large cities, and
may occasionally be found in more circumscribed spheres.

We insist that the use of pessaries does not and cannot remove the
cause of prolapsus uteri ; viz., relaxation of the physiological sup-
ports of the uterus. In the first place, unless all our principles of
physiology and of pathogenesis be erroneous, the presence of a foreign
body wedged into the vagina and against the os tincae, with sufficient
force to obviate prolapsus uteri, and continued for any length of time,
must necessarily induce a pathological condition of the mucous sur-
face, more or less serious, if there existed none before, and materially
aggravate such as may have been present previously. This is so
self evident that no argument can be adduced against it, save such as
may be derived from experience of the value of which we have
already spoken sufficiently.

Pessaries cannot remove the relaxation upon which principally de-
pends prolapsus uteri, because instead of increasing the tonicity of
the tissue?, they lessen it. This is especially true with regard to
every variety of pessary, except those provided with a stem. All the
instruments of the kind which derive their support by resting upon
the vaginal walls, whether their form be that of a disc, of a globe, or
of a plug, must of necessity dilate the canal and thus impair its pow-
ers of resistance the contractility of its muscular fibres and the
elastic retraction of its other tissues will be diminished to such a
degree that the size of the instrument itself will soon have to be in-
creased. And )et we are asked to believe that a canal thus dilated
to the uttermost and relaxed in a corresponding degree can, after

574 Editorial. [September,

ceasing to use the pessary, prevent the descent of the uterus which it
could not accomplish before ; in other words, that the prolapsus can
be cured by dilating the vagina ! We must confess that our credu-
lity is not adequate to the requisition. We have already observed
that our experience is utterly opposed to the admission of that of others.

W7e have thus, in a very unsatisfactory manner, we admit, (for our
remarks have been written hastily and without time for revision)
thrown together the principal objections to the use of pessaries. It
remains for us to answer that portion of our correspondent's inquiry
which relates to the plan we would recommend in lieu of both the
u utero abdominal supporters " and the pessaries. In doing this we
must be brief, for we have already far exceeded the limits we had at
first proposed to ourselves. Rejecting all mechanical appliances in
cases unattended with procidentia, we limit our endeavors to the im-
provement of the general stamina and of the local tone in particular.
The internal administration oC tonics will usually accomplish the
former indication, and the horizontal position for a short time will
favor the action of local applications in subduing the unpleasant sen-
sations. Irrigations of the vagina with tepid emollients by means of a
large syringe (not the miserable little instruments in common use)
should be made three times a day, until the irritation be subdued ;
after which we may resort to cold water in the same manner, and
subsequently to astringent solutions. The cold hip-bath, with or
without the cold shower-bath, according to the general state of the
patient, will be found of material advantage in bracing the tissues.
The female being admonished to avoid such muscular efforts as may
impel the uterus downwards, and being apprized that the infirmity will
not lead to serious consequences if managed in this manner, will
cease to be in a state of continual mental anxiety, and may get
through life with a degree of comfort utterly at variance with the
mechanical treatment.

In cases of procidentia, such as we often meet in the laboring
classes, in which every muscular effort brings the os tincae in the
vulva or still lower, to be chaffed beyond endurance, we would still
resort to the above plan for subduing irritation and bracing the sys-
tem, after having replaced the organ by digital manipulation, or by
causing the patient to elevate the pelvis by resting a few minutes
upon her knees and breast. In addition to these means, and looking
to the necessities of one who cannot afford to dispense with daily labor,
it becomes necessary to offer some obstacle to the protrusion of the
uterus. We know of only two methods of accomplishing this ; the

1654.] Miscellany. 573

one is palliative the other radical. The former consists of a perineal
bandage and pad, which, by forcing up the perineum, will effectually,
(if well applied) close the vaginal oririce and thus allow the ostincae to
rest in contact with a natural and lubricated surface without serious
discomfort.

The radical treatment is episi.oraphy, or the closure of the lower
half of the vulva by denuding the surfaces and maintaining them in
apposition by means of quill sutures, until their perfect union be ob-
tained. This operation is. we are aware, repugnant to most women;
but this is principally because of an erroneous appreciation of its effects.
It does not impede sexual intercourse, nor even impregnation and par-
turition, inasmuch as women have borne children after its performance,
without inconvenience. We have ourselves performed the operation
with the happiest results, and have long felt surprised that it is not
more common, especially upon our plantations. We have known field
hands, who were utterly incapacitated for their duties, thus restored to
complete usefulness in a short time.

In conclusion, we must beg the indulgence of our readers if we have
not done justice to the subject, or if we have, in our eagerness to impress
our faith upon others, evinced too much incredulity with regard to the
views and practice of men who stand deservedly high in the estimation
of all. We are all fallible, however, and if we may perchance succeed
in opening the eyes of any of our professional brothers to a common
error, we shall have accomplished all we have a right to expect.

Poisonous effects of Soda Water from Copper Fountains and Lead
Pipes. By R Ogdex Doremus, M. D. Having within a few days,
had several friends relate their sudden illness after taking a single
glass of soda water, and suspecting some poisonous impregnation to
be the cause. I was induced to obtain several gallons of this favorite
beverage, from different parts of the city, and to submit them to a
chemical examination.

The substance which first attracted attention was copper.

This was very abundant in soda water obtained from several ob-
scure shops, where it was presumed the traffic was limited, and conse-
quently the acid water remained longer in the copper condensers. It
was so evident that, on boiling off the excess of carbonic acid gas, a
green scum made its appearance, which, on further evaporation, set-
tled. This was carbonate of copper, previously held in solution by
the carbonic acid.

The amount of metallic copper in a quart was one grain and a
half!

Soda water obtained from the same establishment on different days,
was found to contain varying amounts of the poisonous carbonate.

576 Miscellany. [September,

The source of this copper, and the cause of these differences, may
be accounted for in several ways.

The copper condensers purport (o be tinned internally ; but where
they have been in use a long time, the tin, by chemical and mechan-
ical action, has been removed, at least in part ; thus exposing a
surface of copper to the corrosive action of the carbonic acid, aided
by sulphuric acid, which is occasionally found in the soda water.

Although the carbonate ot copper is insoluble in pure water, it is
capable of being held in solution in water highly charged with car-
bonic acid gas ; for the soda water which yields this green scum after
discharging the gas, is clear and colorless previous to the operation.

The soda water drawn shortly after changing the condenser, would
necessarily yield less copper on analysis, than that obtained from the
same fount after having several days to exert its corrosive influence.
Again, the tinning (for all are professedly thus lined) would be more
perfect in some than in others dependent not only on the length of
time the condensers had been used, but also on the completeness of
original coating. I have been informed that, in order to facilitate
the flow of the tin, soft solder is at times resorted to, or the copper is
washed with a salt of mercury. Under these circumstances the
chemical and electrical action would be rather complicated, and the
soda water possessed of remarkable medicinal virtues.

The second poisonous compound which, from its abundance, de-
manded investigation, was a white precipitate, the carbonate of lead.
This was found, to a greater or less amount, in most of the waters
examined.

In the quart whence the grain and a half of copper was obtained,
0.65 of a grain of metalic lead was found.

The chief source of this impregnation is the lead pipe used in
many fountains to convey the carbonated water from the condensers
to the jet.

It is an established fact, that the free carbonic acid found in spring
waters, is capable of dissolving or facilitating the solution of many of
the salts of lead, such as are found encrusting lead pipes which have
been used for conducting said waters.

By the investigations of Dr. Ellet, published in this city last year, it
was clearly shown that even the trivial amount of carbonic acid found
in Croton water, is sufficient to act upon the lead pipes.

This lead may be readily found in any kettle which has been used
for boiling the Croton water passed through a lead-pipe, by adding a
little acetic acid to it. The acetate of lead will respond to sulphuret-
ted hydrogen, by assuming a black tint (the sulphuret of lead,) or a
yellow tint with the iodide of potassium, etc.

Since carbonic acid is possessed of such solvent powers, soda water,
which is surcharged with it, must become poisonously contaminated
by contact with lead, either in the pipes or the soldeiing; and as
much of the tin of commerce is alloyed with lead, even this metal, to
which we look for protection, may be another source of evil.

Many are impressed with the belief that the first few glasses may

1854.] Miscellany. 577

be impregnated with lead to an injurious extent; and hence the cus-
tom, in the more respectable establishments, of discarding the soda
water which is first drawn, and has lain in the tube over night.

Wherever lead pipes are used to conduct the water to the jet, and
especially where in order to secure a cool draught, from thirty to sixty
feet of lead pipe are coiled in a tank and covered with ice, the highly
acid liquid must necessarily dissolve the metal, and communicate the
poison to all contained within the condenser.

These remarks are not applicable to pipes of pure tin, or of led prop-
erly coated with tin.

I have examined the soda water obtained from a manufactory where
it is bottled, but could discover neither copper nor lead.

The effervescent liquid which is at times t4 palmed off" upon the
public, made by forcing atmospheric air into water (most truly,
"aerated water,") would from the very want of the carbonic acid, be
nearly free from these contaminations.

It might be asked, "If these poisonous bodies exist in soda water,
why are not the effects more commonly known?" I would reply,
they are more generally known than is supposed.

Sinre commencing these investigations, I have learned from sever-
al medical friends, that a coppery taste, violent vomiting, colic pains,
purging, etc., have not been uncommon results from such draughts;
and most with whom I have conversed, have experienced these effects
personally.

In Dr. Mitchell's Therapeutics, mention is made that soda water
from old copper fountains is strongly marked with the copper taste.

My assistant informs me that five years since, while in a drug store,
he observed that vomiting and other symptoms of poisoning by copper,
followed frequently after drinking soda water, and that many thought
it was cholera ; and after being similarly affected himself, he tested
the water and found copper.

I am informed by a resident of St. Louis, that while the cholera
prevailed, most persons abandoned the use of soda water ; it was a

common remark, " Mr. took a glass of soda water, and was

immediately attacked with cholera."

Probably the syrups which are the usual accompaniments of the
soda draught, act in many cases as an antidote ; for although the
efficacy of sugar in this respect, as originally proposed by Duvalr
was denied by Orfila, it has lately been reasserted by Postel.

I regret that, for want of time, I have not been able to complete
other experiments on this subject ; yet, as I am convinced that in-
many cases this poisoned soda water has proved the exciting cause
of cholera in those predisposed to this disease, and in others that it
has by its inherent properties been injurious to health or destructive
to life ; and as at this time the cholera question is again agitating the
public mind, I have thought it advisable to relate the results of this*
partial investigation.

With the knowledge of these facts, we may conclude that although
soda water may be retained in a welLtinned copper condenser, and

578 Miscellany. [September,

discharged through a thoroughly tinned lead pipe, without poisonous
impregnation ; yet as any imperfection in the tinning of either, or
long or careless usage may expose the copper or the lead (or both)
to the solvent powers of this carbonic acid, and thus render the
beverage dangerous, therefore these vessels should be discarded or
only permitted in the hands of trustworthy persons.

Condensers of stone, of iron, or of the purest block tin supported
by iron bands, orofgutta percha, aided in a similar manner, would
be free from poisonous impregnation. Conducting pipes of these
latter materials are likewise unobjectionable.

In another paper I shall present the results of more extended inves-
tigations, and shall be indebted to any physicians or pharmaceutists
who feel disposed to assist in this work of common interest, by favor-
ing me wiih reports of cases, or samples of suspected liquid for
analysis. If those engaged in the fabrication of this article would
afford an opportunity of examining some of the old soda fountains, it
might aid materially, and perhaps result in the suggestion of better
methods of protection. [American Medical Monthly.

Hints for Young Doctors. By C. D. Ghiswold, M. D., of New

York. For ten years. I have led a somewhat variable and busy life,
always devoted to the interest of my patients when 1 had them to
care for and niv profession : yet notwithstanding my predelictionfl
for the use of the pen, 1 have seldom contributed anything of my
experience, or inexperience, to strictly professional journals; pre-
ferring always to read for my own instruction, rather than to write
for the information of others. The principle is wrong, although it
is better to be silent than to affect to be oven* i

How much more attentively we watch the different phases and
behaviour of a disease, when it is our intention to report it how
much more definitely each symptom is impressed upon the memory;
and with what readiness its stages and the treatment may be re-
called at any time afterwards. In tin's way a habit becomes confirm-
ed, and holds good in all cases. In travelling formerly, I noticed
everything for the purpose of giving a description. Nauvoo Temple
has long since been crumbled to the earth ; yet the peculiarities of
that structure, and the ground and beautiful scene I looked out upon
from its tower, are still distinctly visible in my recollection. The
habit of observation thus formed, has led me ever since to the upper
deck of a steamboat, or the top of a stage coach, that I might look
out ; and to detest cars, because they shut me up.

There is more utility in this habit of close observation, than most
physicians are inclined to acknowledge in practice I can remem-
ber distinctly the details of cases that I attended years ago, with the
modifications in the treaiment to meet indications I held in view,
and do still, intend to publish them and yet I have by no means a
retentive memory upon general subjects.

This habit any one can acquire by proper discipline, and it is one
exceedingly important to the physician. The young physician who

1854.] Miscellany. 579

writes out his cases, will be most sure to read the reports of others,
and in this way his experience will be trebled in value, besides most
likely escape that worst of all obstacles lo progress, routine habits of
practice.

In reading your Journal, which I always do with interest, I seldom
pass over the report of a case ; and if I know it to be from the pen of
a young physician, I peru>:e it with a sort of "do by others as you
would that they should do by you" principle respect and encourage
them by reading their productions, as we would cherish the memory
of one departed although both alke are obvious to our good inten-
tions. In this way we not unfrequently fall in with good ideas, which
like seed sown, spring up at a future time and multiply.

As I shall have no room in this for a u report," as I had intended,
I will add one other hint for such of your readers as may be younger
than myself, and put off the "case" to another day or rather night.

In the first place, write out all your important cases; if time will
not admit its being done immediately, keep thinking them over with
that intention. When this is done, if you find any of them to contain
facts which you believe to be of value, send them to a publisher, post
paid. Do not make the mistake that many young writers do, by sen-
ding to the largest and most important Journals, for such are usually-
supplied with more matter than they can print ; and therefore, in all
probability, in such a case your production would never find a place
in their pages, and you would most likely get discouraged with the
first attempt. On the contrary, send your articles to a small Journal
first, or to a new one that has little patronage of which there are an
abundance thankful for small favors; and in order that you may be
sure to see them if printed, it is a good plan to enclose the subscrip-
tion price with the production, and but very few if any comments,
aside from your name and address plainly written. Draw no infe-
rences on your cases your readers will do that, and save you your
time, and paper, and likely enough no small amount of future regrets
but simply the medical facts, plainly and concisely stated. Re-
member, if you have any desire to see your article reprinted in other
Journals, that it never will be iHong. Follow these rules persever-
ingly, and you will ultimately not only succeed as authors, but as
good physicians.

A regular medical man told me, not long ago, that he subscribed
for but one Journal and that I will not mention which he never
found time to read. Now I shall remember this man as long as I do
the Nauvoo Temple, for I have a habit of remembering such " cases."
I shall never apprehend, on meeting him, that he has seen this com-
ment for did he read this Journal he would know better than to make
such a statement.

I remember calling on Dr. John W. Francis, late one evening, and
finding him in bed, he not being very well ; yet his light was safely
arranged, and within reach there was reading matter enough to last
all night. If there is no other time, an hour may be spent nearly
every night in reading, before the eyelids drop ; and he who culti-

580 Miscellany.

vates his intelligence, as a physician should, will improve even (his
hour, if he has no other. If you do not read, never tell of it, for it
is more creditable by far to have time for this, than too much business.

[Boston Med. and Surg. Journal.

Method of detecting whether Olive Oil or other Non- Drying Oils
have been adulterated with Poppy or other Drying Oils. Nitric acid
has the property of converting the olcine or the liquid constituent of
almond, olive, and other non drying oils into a crystalline substance,
termed elaidin, while it has not the same action upon the drying oils.
Wimmer has accordingly proposed a process to detect whether olive
or almond oil has been adulterated with any of the cheap drying oils,
founded upon this property. He introduces some iron filings into a
flask, provided with a cork, into which he inserted a long bent tube,
and then pours some strong nitric acid upon them ; a part of the nitric
acid will be decomposed, and nitrous acid fumes evolved, which pass
off by the bent tube, and are made to pass through a sample of the
oil to be examined, placed in a glass with a little water. In perform-
ing the experiment the end of the tube must be just in contact with
the water upon which the oil is made to float. In a shoit time the
whole of the non drying oils will solidify into a semi-crystalline mass,
while any poppy or other drying oil, if present, will float on the sur-
face. In a similar way the adulteration of drying oils with non-drying
ones can of course be detected. [Month. Jour, oflndust. Progress.

Chronic Urticaria. A severe case of this eruptive disease was
lately successfully treated by Mr. Staitin, at the Hospital for Skin
Diseases London, in the following manner : R. Quin. disulph, gr.
xij ; am. sesq. carb., 3j. ; magnes. carb.. gss. ; aq. pur., 3 v i i j . Ft.
mist. A tablespoonful to be taken thrice daily.

The quinine in this formula is undissolved, and is held in suspension
by the magnesia. Mr. Startin advises the use of dilute nitric acid
to relieve the itching, as being equally efficacious as the hydrocyanic
acid, and much less expensive. [Virginia Med. and Surg. Jour.

Rheumatism. We recommend to our readers the following pre
scription for the cure of this most unmanageable disease : R. Liq
potassae, gtt. xv. ; potass, iodidi, grs. ij ; mucil acacias, 3j. ; aq
distill., 3xi. M. ft. haust. R. Potass, iodidi, 3ij. ; morph. muriat.
3ss. ; ung. cetacei, giss. Ft. ung. R. Opii. purif, gr. j : extr
colch. acet., grs. ij. ; pulv. scam, co., grs. iij. M. ft. pil. ij. [lb.

Pityriasis of the Scalp or Dandruff. In two cases of this disease
of the scalp occurring in patients in the Middlesex Hospital, glycerine
was found effectual in clearing away branny scales from among the
hair. It is used as a hair oil, once or twice a week. Mr. Shaw
(Med Times and Gazette) states that he has often used it with great
success. [lb.

SOUTHERN

MEDICAL AM SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES. OCTOBER, 1854. [\o. 10.

ORIGINAL AND ECLECTIC.

ARTICLE XXX.

The importance of Local Treatment in certain Female Diseases.
By Jxo. Stainback Wilson, M.D., of Airmount, Alabama.

When verv frequent and almost uniform lesions of the muco-
crenital tissues, in a class of affections considered heretofore as
constitutional and functional, have been conclusively demon-
strated, bv a host of the most intelligent and distinguished
pathologists, it would seem to be supererogatory, if not pre-
sumptuous, to attempt a further elucidation of the subject, and,
indeed, we disclaim any such design ; our object will be to give
a summary of the most important evidence in favor of what
may be termed the local, organic, uterine pathology of Leueor-
rhcea, Dvsmenorrhcea, Menorrhagia. <x;e. : and we will then
endeavor to inculcate the importance of certain therapeutic
measures founded on this pathology : in short, we will strive to
show the great advantage, and the indispensable necessity, of
local remedies in the management of the interesting, very com-
mon, and often intractable diseases above mentioned. With
such a bright array of names as those of Recamier, Lisfranc,
Dupuytren, Gendrin, Duparcque, Gilbert, Kennedy, Murphy,
Locock, Roberts, Bennett, and others scarcely less celebrated,
all of whom have ably advocated the "organic pathology," \ve
might safely rest the evidence, had not the equally distinguish-
ed Kobdrt L?i. Ashwell, Tyler Smith, Hall, and som.3 others,

N. S. VOL. X. NO. X. 37

582 Wilson, on Female Diseases. [October,

denied the correctness of the statements made by the first men-
tioned writers, and denounced their favorite instrument, the
speculum, as immoral, indecent, unnecessary, and destructive
in its tendency. But, in addition to these contradictory opin-
ions, there are other very forcible reasons why the pro-organic
evidence should be adduced, and they are these : A mere
opinion or name cannot be received in lieu of established facts ;
again, this "organic pathology" is comparatively new is
in its minority, while at the same lime it is forced to wage a
contest against its hoary rival, the constitutional or functional
pathology, fortified, as the latter is, by all the prejudices and
prepossessions (>t* early education : and lastly, we think that it
is proper and necessary to sum up this evidence, because it
tends to confirm, what we believe to be. one of the most im-
portant truths, in practical medicine, to which the presenl
century has given birth. We will then, briefly, present the
views of Dr. J. H. Bennett, and some others, on the affirmative
side of this question, and also advert to those on the negative ;
and finally, we will attempt to explain and harmonize the differ-
ence apparently existing between the contending parties.

The first disease to which we shall direct attention is
Dysmenorrhaia.

Dr. Bennett divides this affection into Constitutional, Acci-
dental, and Inflammatory DysmenorrhcBa. The firsl form he
considers as " evidently functional, the result of the distension
produced by over-congestion, or of a peculiar susceptibility of
the uterine innervation." And this, he says, "can scarcely be
considered a morbid condition, although verging on disease."
He informs us that the distinguishing characteristic of this form
is its presence during the menstrual function, and the absence
of all morbid symptoms during the intervals. Should the
symptoms become persistent, he looks upon it as " a suspicious
circumstance, as indicating the possible, or even probable ex-
istence of some inflammatory condition of the cervix uteri, or
of some morbid ovarian condition." The accidental variety is
regarded as the result of transient or temporary causes, and,
like the first division, not permanent. It will thus be seen,
from this brief analysis, that this distinguished writer really
recognizes but one morbid condition as the principal and almost

1S54.] Wilson, on Female Diseases. 583

exclusive cause of dysmenorrhcea, and that is. inflammation or
organic disease of the uterus.* Under the head of inflammato-
ry dysmenorrhcea, he says : '; When menstruation, naturally
easy, becomes permanently painful ; or when, naturally but
slightly painful, it becomes extremely so, we are warranted in
looking for a local disease. Such a change does not take place
without a cause, and that cause is. generally speaking, inflam-
mation of the cervix or body of the uterus : dysmenorrhcea
being one of the most prominent and most ordinary symptoms
of that disease." Dr. Bennett, we think, very properly, em-
braces under this head, the pseudo-membranous variety of
dysmenorrhcea. The views of our author on this disease, and
other points of uterine pathology, are so well known, that we
consider it useless to multiply quotations on this almost inex-
haustible subject; we will therefore refer those who wish to
consult him further, to Ranking's Abstract, Xo. 15, 1852, p. 151.
Before dismissing the pathology of dysmenorrhcea, it may be
proper to add that we are not ignorant of the fact, that Dr.
Bennett has been charged with exclusiveness and ultraism,
even by those who are willing to admit the truth of his posi-
tions, in the main ; and we confess, candidly, that we belong to
that class still, we are firmly convinced at the same time, that
the pathology and treatment of uterine affections advocated by
him is founded on the immutable basis of truth; and, conse-
quently, that his doctrines must and will prevail, with such
modifications as future and more dispassionate investigations
may suggest.

The next subject which will engage our attention, for a short
time, is, the Pathology of Menorrhagia, as enunciated b
Bennett. This disorder (op. cit., p. 158) is divided by him
into 1st. Accidental Menorrhagia ; 2nd. Inflammatory ; 3rd.
Menorrhagia from Ovaritis ; 4th. Menorrhagia at the dawn and
close of Menstruation ; 5th. Menorrhagia during Pregnancy ;
6th. Menorrhagia after Parturition.

To the first, he applies the same mode of reasoning that he
does to the accidental variety of dysmenorrhcea, viz : that it is

* Of course physical dysmenorrhcea, arising from contraction of the os
internum, is admitted as an exception; but even this is declared to be a not
unfrequent complication of inflammation, &c.

584 Wilson, on Female Diseases. [October.

transient, and generally passes off with the cause that produced
it, without treatment. The third he considers very rare. The
fourth, like the first, he says, is seldom permanent, " in th<
sence of tumors or malignant disease, unless there be inflamma-
tory ulceration of the cervix." He admits, however, that the
hemorrhage will persist, in some few cases, even after " the
removal of the inflammatory and ulcerative disease of the
vix, which had probably, in the first instance, given rise to it."
The fifth variety he regards as a hemorrhage, produced by
"inflammatory ulceration of the cervix," when "it is not merely
temporary, and DOl proceeding fron 'on of the ovum.'"

The menorrhagia after parturition, (Gth.) h is nearly

always complicated with, and occasioned by, inflammatory
ulceration of the neck of the uterus, with or without
the body of the uterus." It should be remen: thai this is

intended to apply only to tl and obsti-

nate hemorrhage"' which sometimes continue for months aftei
delivery. It appears, then, from the evidence of Dr. Bennett,
that the vast majority of uterine hemorrhages belong to the
second, or inflammatory division ; while he at the same time
admits that the sanguineous not always

with the subduction of the inflammation, or the healing of the
ulcer that gave rise to it.

As we do not expect to treat of amenorrhnna separately, we
would here mention that Dr. Bennett regards -the development
of inflammatory disease in the neck or body of the uterus, or in
the ovaries, and of cystic and scrofulous tumors in the ovaries,
as one of the most frequent causes of amenorrheca, in those in
whom the function has once been fairly established ; and espe-
cially of partial amenorrhcea."

Having now very briefly adverted to the "organic pathology"
of dysmenorrhoea, menorrhagia and amenorrhea, as promulga-
ted by one of its most distinguished and able champions, we
proceed to the last division of our subject Leucoi rhasa : a dis-
ease of exceeding interest, and one that can command a stronger
array of evidence in support of its organic origin than any other
of its class, unless dysmenorrhoea be excepted.

Dr. E. J. Tilt, who has himself directed much attention to
the subject of Uterine Pathology, and more especially to Leu-

1S54] Wilson, on Female Diseases. 585

corrhcea, says : M I scrupulously adhere to the truth in asserting,
that in the conviction of the great majority of enlightened
practitioners in France. Germany.. America, or at home, chronic
leucorrhoeal discharges generally depend upon organic lesions
of the os uteri and its vicinity."'

Some of the distinguished physicians who have ably defended
the ;- organic pathology" of the several uterine diseases which
we have passed in review, but more particularly of leucorrhcea,
have already been mentioned : the views of others, equally enti-
tled to our confidence, will now be adduced.

Dr. C. D. Meigs, in a late work "on Acute and Chronic
Diseases of the Xeck of the Uterus," uses the following lan-
guage : " One of the most common of sexual disorders is
leucorrhcea. Most women suffer from this affection at some
period of their lives. In general it is not profuse and ceases
spontaneously. When the discharge consists only of vaginal
products it is of little consequence. It is hurtful only when it
comes from the canal of the cervix.'' In another place, he says:
" The excretion from the follicles and glands of the canal of the
neck is always gluey or albuminous, and resembles fresh white
of eggs; and when the patient, in describing the disorder, in-
forms us that she discovers a slimy mucus, and especially if it
appears at intervals of once a day, or oftener, we may take it
for granted that she labors under inflammation of the neck of
the womb/' .(Med. Examiner, July. 1S54. p. 419.) We may
take this occasion to add, that Sir C. M. Clark made a similar
observation, long since ;. but being denied the aid of the specu-
lum, he may have confounded the vaginal and uterine dis-
char.

Dr. E. Han 1 -York, in ;: A comparison of the State-

ments and Facts advanced by the leading Uterine Pathologists
on the Xature and Source of Leucorrhoeal Discharges,'' while
he admits, to some extent, the doctrines of the reflex nervous,
or constitutional pathology, thus expresses himself: M But there
are physiological alterations, and lesions of structure that are
found very constantly in connection with leucorrhcea. 1st
gement of the uterus or its cervix. 2d. Congestion and
inflammation of the utero-vacrinal mucous membrane. 3d
coriation and ulceration of the cervix uteri. 4th. A peculiar

586 Wilson, on Female Diseases. [October,

abnormity of the glandular structures of the canal of the cervix,
probably depending upon other and more general pathological
conditions of the uterine organs, or of the whole body." We
have been thus particular in giving the words of this writer,
because it is our design to recur to them again when we come
to notice the negative side of this question, and attempt to
'harmonize the apparent differences" existing between the op-
posing parties. But, before doing this, let us advert to the
views of those who belong to the nervous or constitutional
school of uterine pathologists.

Dysmenorrhcea is divided, by Colombat. into idiopathic and
symptomatic: of the former, he says, the causes are but little
known; and he does not attempt to give its pathology. With
regard to the latter variety, he informs us that it "is much more
common than idiopathic dysmenorrhcea;" and that its most
frequent cause is engorgement of the neck and body of the
uterus.

Dr. Churchill, who may be regarded as the representative of
the constitutional school, it is well known, treats of this di
under three heads : 1st. Neuralgic dysmenorrhcea. 2d. Con-
gestive or inflammatory. 3d. Mechanical. The first form, he
says, "may last from twenty-four hours to four or five days,
alter which the patient (unless afflicted with headache) speedily
recovers," &c. He considers it most frequently of a simple
neuralgic character, but admits that this explanation will not
do for "those cases where the membrane is expelled." It will
thus be seen that Dr. Churchill confirms the statement made by
Dr. Bennett, in reference to what he terms "constitutional
dvsmenorrhoea," which answers to Dr. Churchill's "neuralgic"
form, viz., that the morbid symptoms exist only during the men-
strual function. And this we believe to be the true condition
of things in simple neuralgic or constitutional dysmenorrhcea :
So long as it retains this simple form the general health is not
impaired, unless there be some other co-existent disease ; but
this periodic nervous excitement, combined with the hyperaemic
congestion of the uterine vessels, which is a concomitant even
of physiological menstruation, constitutes a strong predisposi-
tion to inflammation or other organic affection. And should
this periodic excitation and congestion become habitual, per-

,.] Wilson, on Female Diseases.

manent, organic, uterine disease., with grave and complicated
symptomatic derangement of the general health, is the result.
And this conclusion is formed, not only on the concurreiv
timony of the distinguished writers to whom we have referred,
but it is in strict accordance with the teachings of our own
experience ; for we can truly say. that we have never seen a
case of continued, obstinate and intractable dysmenorrhcea,
where an " examination"' did not reveal some organic lesion of
the uterus. And we may add, with equal truth, that we have
never given permanent relief in a single case of this disease,
treated on the plan prescribed by those who found their thera-
pia on the nervous, rheumatic, or constitutional pathology ; and
this is doubtless the experience of most practitioners. When
it is remembered, then, that this pathology is only suppositive,
speculative, and incapable of positive demonstration, while
the practice inculcated by its advocates, has been weighed in
the balances of experience, i: and found wanting," we think it
will be conceded that such an unsatisfactory theory should be
but little regarded, if not entirely discarded, even in the absence
of the " organic pathology," with its ''cloud of witnesses"
its solid, safe and sure anatomico-physical basis, and its conse-
quent capability of mathematical demonstration. This being
admitted, then, we would suggest that neuralgic, constitutional
and rheumatic dysmenorrhcea. (all of which are different names
for the same condition,) be stricken from our nosology; that
these terms be no longer coupled with dysmenorrhcea ; and that
the transient pains to which many females are subject at the
catamenial period, be designated as utero-menstrual-neuralgia.
By adopting this name, we would at once convey an idea of
the nature, seat, and exciting cause of the disorder to which it
should be applied, while it would tend strongly to prevent many
grave errors of practice which, no doubt, spring as often from
an unfortunate and incorrect nomenclature, as from a false
pathology. We would then have but one kind of dysmenor-
rhcea the organic, with its sub-divisions : for we would exclude
(though it minht be embraced under this head) physical or me-
chanical dysmenorrhcea from the division, and define it in
accordance with the well-established physical condition of the
cervix, or os internum, which causes the symptom of dysmenor-
rhcea.

588 Wilson, on Female Diseases. [October,

In accordance with the programme of our subject, we should
next present the teachings of the Constitutional school on Men-
orrhagia; but for fear of protracting this article too much, we
will omit this, and return again to the last disease, in our order
of arrangement Leucorr/icea.

It is well known that all the older, and many modern writers
have failed to distinguish vaginal from uterine leucorrhoea;
while Drs. Churchill, Hamilton, and some few others, among
the English, and almost all of the French writers have insisted
on the distinction in the symptoms, pathology, and treatment of
the two affections. It is equally well known, also, that most
authors consider the leucorrhceal discharge as the result of gen-
eral debility, accompanied with relaxation of the uterine vessels,
as a kind of passive exudation or white hemorrhage from the
uterine and vaginal capillaries. Now, while this may be true
concur fully in the pathology of uterine leu-
corrhoea, as expressed by Dr. Churchill, who is, by the way. a
very good authority, as he may be considered as belonging to
the constitutional school. Ho uses the following words: "That
the general system may be in such a state (debility) is very pro-
bable, but it by DO Mows that the individual organs are
so. On the contrary, we know that in many cases of constitu-
tional weakness, the cause must be sought in the inflammatory
condition of certain organs. In the present instance this ap-
pears to be the case ; for if we consider the local distress, the
increased secretion, the course of the d'\> 1 the remedies
which are most successful, we can have but little hesitation in
attributing all to the effects of inflammatory action, generally
sub-acute or chronic, of the mucous membrane lining the
uterus." It may not be amiss to add, in this place, that this
author takes a similar view of vaginal leucorrhoea. (Diseases
of Females, pp. 68 and 147.)

Having now succeeded, as we hope, in establishing the or-
ganic or local origin of many, or most cases of amenorrhcea and
menorrhagia, and more particularly of dysmenorrhea and leu-
corrhoea, it only remains now for us to conclude the pathologic
branch of our subject, by a notice of the objections to the views
advocated in this article, and by an attempt to reconcile the
contradictory opinions expressed by the opponents and friends
of the "organic pathology."

1854.] Wilson, on Female Diseases.

Now, it seems that Dr. Bennett, and the other English and
French pathologists referred to in the beginning of this article,
have insisted on the frequency of ulceration as a cause of leu-
corrhoea and dysmenorrhea, (the diseases to which we shall
confine our attention) ; while Drs. Lee, Ashwell and Tyler
Smith have denied the correctness of the statements made by
the former writers, and pronounced ulceration of the cervix
uteri to be a comparatively rare disease ; having found, as the
result of their experience, "only about one case of ulceration in
fifty of uterine disease." Here, then, is a direct disagreement,
between writers of equal authority, each professing to give facts
founded on personal experience and observation. But we think
that these differences can be reconciled by a proper understand-
ing of the lesions to which the term ulceration has been applied.
If a cavity or excavation be a sine qua non of ulceration, then,
indeed, in all probability, ulceration of the uterus is not a very
common affection. But we will be able to show that there are
several other uterine conditions to which the term ulceration
has no doubt been applied, by the organic party, and moreover'
that the frequency of the organic changes alluded to, has been
admitted, by Dr. Smith and others of the constitutional party.
The pathological conditions of the uterus in leucorrhaea, as
enumerated by Dr. Harris, have already been given ; and it has
been seen that he embraces in his 3rd division excoriation and
ulceration of the cervix uteri. Now, there can be no doubt
that the Bennett party have considered many of these cases of
"excoriation," abrasion, &c, as cases of ulceration; for we
have the authority of Dr. Harris for saying that the structural
alterations, denominated by them as ulcerations and granula-
tions, "do not differ from abrasion, erosions, aphtha?, morbid
vascularity, granulations of the conjunctiva." 6cc. We may
add, that Dr. Harris objects, perhaps with propriety, to calling
simple epithelial abrasion ulceration ; still he admits the great
frequency of this organic change. (Ranking, No. 18. pp. 195-
96.) Dr.'Smith, while he expresses the opinion that the glandu-
lar portion of the cervix uteri is the chief source of the discharge
in leucorrhcea and that this discharge is a secretion suggests
the following divisions, founded on microscopic and minute
anatomic investigations: " 1st. The mucous variety, secreted

590 Wilson, on Fe?7iah Disuses. [October,

by the follicular canal of the cervix. 2d. The epithelial varie-
ty, in which the discharge was vaginal. With respect to the
so-called ulcerations of the os and cervix, two kinds of morbid
change would be observed 1st, epithelial abrasion, by far the
most common, in which the epithelium alone was deficient;
2d, villous abrasion, erosion, or ulceration, in which the villi
are affected by superficial ulceration.*' It is hardly neces
for us to say that we do not agree with Dr. Smith, as to the
follicular secretion of the canal of the cervix, as a frequent
cause of leucorrhoca ; for it strikes us very forcibly that this
secretion would never transcend its normal limits, unless some
irritation or other morbid condition of the mucous membrane
or the glandular structure, existed as a cause of the exci
discharge; and of course it would be proper in that case to
regard the cause as the ipse morbus, and to treat it accordingly.

We have now seen that Dr. Smith and Dr. Harris, (and others
might be adduced) both admit the frequency of various lesions
of the genito-mucous membrane in leucorrhoea ; and moreover,
that these lesions have been denominated, by Dr. Bennett and
others who belong to his party, ulcerations : the contest having
originated then only in a misunderstanding as to the proper defi-
nition of the term ulceration; while all parties agree as to the
great frequency of structural alterations of the genital organs,
as a cause of dysmenorrhea and leucorrhoea, the controversy
should here end. But whether the latter continue or not ; whe-
ther ulceration be defined or not; whether the frequent exist-
ence of excavated ulcer of the cervix uteri, be proven or not ;
still the ''organic pathology" would stand unshaken, when we
have the evidence of daily experience, together with the testi-
mony of the most distinguished observers, to prove to a demon-
stration, that a vast majority of the cases of leucorrhoca and
dysmenorrhea, (to say nothing of amenorrhoea and menorrha-
gia) owe their existence to some of the various local organic
conditions to which allusion has been made.

As we will be compelled, by the length of this article, to post-
pone our remarks on the treatment of the diseases to which we
have directed attention ; we will briefly recapitulate the evi-
dence adduced in support of the " organic pathology," and we
will then conclude by some deductions which, we think, may be

1S54.] Wilson, on Female Diseases. 501

legitimately predicated upon this evidence. We have shown,
then. 1st That Dr. Bennett recognizes really but one morbid
condition, as the principal, and almost exclusive cause of dys-
menorrhea viz: inflammation, or organic disease of the uterus.
2d That the same writer considers the vast majority of uterine
hemorrhages as the result oi inflammation or organic disease.
3rd That he attributes a large class of cases of amenorrhoea,
to similar pathological conditions. 4th That leucorrhcea is
declared to be a symptom or effect of organic disease, in most
cases, by Drs. Tilt, -Meigs and Harris ; while Dr. Tilt appeals
confidently to the most "distinguished physicians" at home and
abroad, to sustain his position. 5th That the above opinions
are confirmed by Churchill and Colombat. 6th And by our
own observation. 7th. That Drs. Lee, Ashwell and Tyler
Smith, while they deny the frequency of ulceration, still admit
that there are many other organic alterations which are acknow-
ledged to be common causes of leucorrhcea. 8th That many
of these organic changes have been denominated ulcerations by
Dr. Bennett and his partisans. And lastly That the "organic
pathology" is thus established: 1st, by daily observation; and
2d, by the concurrent testimony of the most distinguished wri-
ters of the two contending parties into which the medical world
is divided.

Deductions. 1st. That leucorrhcea and dysmenorrhea are
very common symptoms of local organic uterine affections ; and
that the constitutional complications are generally resultant
symptoms alike with the leucorrhcea and dysmenorrhcea and
but seldom causative. But. 2d. Whether the constitutional af-
fections be resultant or causative, the local treatment is of essen-
tial, if not of primary importance, and should never be neglected.
3rd. That constitutional symptoms should not be disregarded in
our therapeutic means, for whether they be the cause or the
effect of the uterine affection, they may and will react injuri-
ously upon it. 4th. That many cases of amenorrhoea and
menorrhagia are produced by ulceration, congestion, tumors, and
other organic uterine affections. 5th. That the principles alrea-
dv announced, should govern us in the treatment of such c

* We might with great propriety make a 6th deduction, viz., that our nomen-
clature of uterine diseases should be changed ; for it is as vague and uncertain
as the treatment connected with it.

592 Howard, upon Vertex Presentations. [October,

And lastly, that "dioptric instrumental examinations" are all
important and absolutely indispensable in the diagnosis and
treatment of a great number of cases of amenorrhea, menorrha-
gia, dysmenorrhcea, and leucorrhoea.

ARTICLE XXXI.

Additional Remarks upon Vertex Presentations. By C. C,
Howard, M. D., of Lowndesboro,' Alabama.

Professor L. A. Dug as :

Dear Sir In the July No. of the Southern Medical and
Surgical Journal, are contained some remarks on the cause of
the great frequency of the 1st position. Vertex Presentation
of Baudelocque. Allow me, now, to offer a few remarks on
the other positions of the Vertex Presentation, somewhat in
continuation of the article referred to. In that article it is
intimated, if not clearly stated, that there is an evident tenden-
cy for the foetus to bear the relation to the mother, of the 3d
position; but counteracting agencies make it usually the 1st.
It is also admitted, that the peculiarities of the pelvis, have
much to do in determining the frequency of the 1st, 2d, 4th and
3rd positions, as compared with the 3rd and Gth ; but little ;is
compared with each other. The explanation, then, of the
cause of the greater frequency of the 2d position, as compared
with the 4th and 5th. must involve the facts* mentioned ;is
determining the 1st position, except the peculiarity of the right
hypochondriac region. The resistance offered by the liver, to
the extension of the uterine globe in that direction, is such, I
think as usually to throw the body of the foetus around to
the left side ; but the variable size of that viscus, the variable
length of the abdominal cavity, the relaxations of the abdomi-
nal muscles, as well as the lying much on the right side during
gestations, are facts sufficiently well known, for us to under-
stand that all the causes of the 1st position may not always be
brought to bear on the foetus, and consequently we often have
the 2d. Indeed, when the peculiar means by which the child
is turned to the left side are wanting, I cannot see why we

* See July No. Southern Medical and Surgcial Journal.

1S54.] Howard, upon Vertex Presentations.

should not have this 2d position as readily and frequently as the
1st. If the foetus be relatively small, or the amniotic fluid
relatively srreat ; in a won!, if the cavity containing the foetus,
be sufficiently commodious, to allow it to be quiet., with the
back somewhat to the maternal back, and yet the liver brought
to flatten the right side of the uterine globe, then, and then only,
it would be probable that the 4th position might occur. I am
very far from thinking that this position is owing to an impac-
ted rectum. &o., as some suppose. But by accident, the child
may lie on the right side rather than the left : and then, if the
conditions just stated exist. I should expect the 4th position.
On the other hand, if the circumstances favorable to the 2d
position exist, and still the relative size of the foetus and cavity
in which it is contained be such as to give it accommodation in
the 5th position, I see no reason, other than the force of gravity,
why we might not have this 5th position as readily as the 2d ;
but under ordinary circumstances, the force of gravity would
exert a very controlling influence, and therefore, though abso-
lutely, the 5th position might not be unfrequent, yet, as com-
pared with the 1st or 2d, it ought to be, and I think, is, most
decidedly so.

to the 3d and 6th positions of the vertex presentation.
I have already indicated this opinion, viz., that the peculiarities
of the pelvis would make them very unusual : and as to the
latter, i.e.. the 6th. I have never seen a pregnant woman whom
I thought in a condition for it, by any possibility.

I am quite aware, that in attempting to account for the
greater frequency of the 2d position, as compared with the 4th.
I am undertaking to account for a fact most distinctly denied
by gentlemen who occupy a position in the profession to which
I do not so much as dream of attaining; and surely. I should
not have the temerity to express an opinion, if only supported
by jny experience or the reasonableness of any theory. But
how does this question stand ? Let us see, In Baudelocque's
practice, in 10322 labors the occiput was to the right and
anterior portion of the pelvis 1754 times, and to the right and
posterior portion only 25 times. In Madame Boivin's practice,
in 195S4 births, vertex presentation, there were of the 2d
position 36S2, and of the 4th only 109. In Madame Lacha-

594 Howard, upon Vertex Presentations. [October,

pelle's practice, of 20698 vertex presentations, there were of
the 2d position 4659 and of the 4th only 1(5 1.

Although Dr. Dewees says, " the 4th position is by no
means unfrequent," I do not understand at all, that he regards
it as occurring near so frequently as the 2d.

Dr. Bedford, in a note to his translation ofChailly, page
183-4, insists on the correctness of Baudelocque's observations,
and wishes especially, to direct the attention of the student to
the different view of the subject, which he calls an error.

But, here we have something of the other side of the ques-
tion : M. Na?gele, who, I believe, was the first to contend for
the greater frequency of the 4th position as compared with the
2d, in 100 presentations of the Vertex, found the occiput 70
times to the left, and in front, and 30 times posteriorly, and to
the right. In another series of thirty six labors, there were
twenty two of the 1st, and eleven of the 4th position.

M. P. Dubois, in 1913 presentations of the vertex, found
that in 491 the occiput corresponded with the right sacro-iliac
symphysis, and in 55 only was the occiput turned forward, be-
hind the right cotyloid cavity.

J. F. Moreau (page 1 19) we have for a long time

been of the opinion of M. Baudelocque ; but enlightened by
experience, we now agree with M. Naegele ; we think that
Baudelocque has mistaken the exception for the rule, &c."

Murphy, in his lectures on Parturition, referring to this sub-
ject, says : " Being anxious to determine this question, I availed
myself of the opportunities afforded me in the Dublin Lying-in
Hospital, of putting it to the test, and found that in nearly an
equal number of cases the head entered the brim in the third
position as in the second, that of those which descended in the
third, the majority passed without any difficulty into the second,
and were so expelled, while a very few remained in their
original position. The whole evidence, establishes Naegele's
accuracy of description, and it may be admitted that, as a gen-
eral rule, the head rotates from the third (that is our 4th,) into
the second position, when it is passing through the pelvis."
Here is his table of seventy-four cases : First position, 43 ;
fourth (our 5th,) into first, 3; second, 11 ; third (our 4th) into
second, 9 ; third, 2, &c.

1S54.] Howard, upon Vertex Presentations. 595

Says Professor M In a conversation I had with this

venerable and most honored professor at Heidelberg, in 1845,
(referring to M. Xaegele.) he gave me convincing proof of the
correctness of his opinions of this circumstance. Indeed. I
kept a register of presentations a few years since., upon learn-
ing through a publication of Dr. N's Mechanism of Labor,
made by Dr. Edward Rigby. now of London, that the common
view as to the greater frequency of the vertex right position,
was erroneous. I am fully convinced, by my registry, and by
the course of my clinical experience ever since, that Prof. X
is quite correct in his statements, and I venture to assure the
medical student, that while he shall surely meet with vertex left
positions more frequently than any others, he shall as surely find
the forehead left positions next in point of frequency."

" Prof. Simpson agrees with Dr. X's views."

Now, what under the sun does all this mean ? this astonish-
ing exemplification of the adage, that "doctors disagree'
The forceps have been applied again and again special rules
are given in relation to them applied when the head is high up
in the pelvis, and yet. until within a few years, we were taught
that the head was frequently in a position, which indeed, we are
now told, is very unusual.

As I have undertaken to account for the frequency of a cir-
cumstance which is represented as being very unfrequent, the
discussion of this question unavoidably comes up : and if I only
shew the awkward position in which it now stands, and induce
others of more extended opportunities and riper judgement, to
turn their attention more particularly to it, will it not be render-
ing valuable service to the profession ?

I used to think, if we knew any thing about the subject of
positions, it was those of the vertex presentation. If Baude-
locque and his followers blundered so dreadfully, about the re-
lative frequency of the 2d and 4th positions, how do we know
that they are right about any of them ? I thought they spoke
from observation, and though my experience is very limited, I
thought that, as to this question, it coincided with theirs for
the few cases I have had, I have tried to understand, and if I
ever saw a 4th or 5th position, of the vertex presentation. I do
Treatise on Obstetrics, p. 271.

596 Howard, upon Vertex Presentations. [October,

not know it. Very certain it is, I never saw any case in which
the forehead passed under the pubal arch. I have seen the
shoulder presentation. The breach is said to occur only, in
about two cases out of every hundred, and yet I have seen that
presentation several times and in passing, I may state, no less
than four times in the same woman, viz., her tenth, eleventh,
twelfth and thirteenth labors. And what is farther remarkable
about it, so far as the lady knows, she had never previously,
had such a presentation. Another fact, in this woman's expe-
rience, allow me to mention, viz,, that after two of her confine-
ts she had an "abdominal abscess" (in the anterior wall)
either of which ran a very protracted course the first, before
I ever saw her, which was probably mistaken for disease of the
left ovary: the second, after the first confinement in which
. her. It occupied near six months in running its course.
and was also mistaken for disease of the ovary; but that of the
right side. Under the error in diagnosis, her first physician pre-
dicted a discontinuance of child-bearing : and now, astheother
ovary was believed to be radically diseased, the prediction was
confidently repeated. Long before the termination of the
however, it was evident, that the diagnosis was wrong that
the disease was one of Abscess, confined to the wall of the abdo-
men. The prognosis therefore was reversed, as to the liability
to pregnancy, and its corrects Iready stated, has been

demonstrated three times since.

To return : Under this state of the question, let us proceed to
examine the observations of the 4th position advocates, and
this we do with all possible respect ; for no man ought to
have a higher respect, for his predecessors, and the aged and
experienced of his own day, than the writer. Far be it from
me to breathe a breath, that would raise one gray lock upon the
head of the time honored, or deepen or lengthen one single fur-
row on his brow. But farther research ought to be made ; the
errors of former observations ought to be corrected, or progress
has ceased. And should we wait until we grow old before
commencing, how little may we hope to accomplish !

The following objection, I think, ought to lead us to receive
this new statement with some hesitancy, viz., a want of agree-
ment in the result of observation, and this want of agreement

1854.] Howard, upon Vertex Presentations. 597

is very apparent. M. Naegele, in 100 cases, had 30 fourth
positions, and not one second. M. P. Dubois, in 1913 cases,
had 461 of the 4th position, and 55 of the 2d : and Dr. Mur-
phy found nearly an equal number of 4th and 2d positions in
his series of 74 cases.

But let us notice the observations of some of these gentlemen
farther. Now, I hold, that to be very far from right on a part
of the positions, is to be so probably, on the whole. If we
diagnosticate twenty 2d positions, and twenty 4th, and it turns
out that all are 2d positions, in our diagnosis we are twenty
wrong in each, therefore, in equal error on the whole. M.
Naegele disagrees with almost all modern observers, on the
positions of the Vertex Presentation. I read in J. F. Moreau's
work on Midwifery, page 149, subject u Third Direct Posi-
tion Occipito-pubal." " The ancients, and Levret among the
moderns, consider this position as the most natural. Baude-
locque, on the contrary, says, that it is very rare. He only
observed it twice in 10329 labors; Madame Boivin 6 times in
20517. and Madame Lachapelle not once in more than 30000.
Nevertheless, Drs. Dewees and Radford have reported authen.
tic cases of it. 31. ~Xa?gele even goes so far as to say, that it
occurs originally in all the anterior occipito-iliac positions,
and that the latter are merely a secondary transformation of it,
which is (not ?) recognized only because we make our examina-
tions at too advanced a period." How does this observation
coincide with the general experience of the profession ? and yet,
is it not as probable as that stated by this observer in relation
to the 4th position ?

But again : The reason that the fact is not recognised is "we
make our examination at too advanced a period." I cannot say
at what period M. Naegele makes his examinations, for I have
never seen any work of his ; but we have several pages in Dr.
Murphy's Lectures on Parturition, in relation to " making a
Vaginal Examination." On page 94, he says : 'The only
position that should be ascertained before the waters are dischar-
ged, is the shoulder presentation." On page 98, he says : The
head if presenting, may also be felt; but the position cannot be
determined until the dilatation is more increased, and the head
fully in the brim. And on page 100, we read: "In ordinary

n. s. vol. x. no. x. 38

598 Howard, upon Vertex Presentations. [October,

cases of labor, such as we are now speaking of, the membranes
seldom give way until the second stage has made some pron
and often remain entire until the head of the child is almost
expelled." The presumption is that the Doctor observes the
rule laid down in his book, and if so, tell me who does not at-
tempt, at least, to note as much, and as soon, in the management
of cases, as he advises ? Shall we then admit, that Baudelocque
and his followers have failed to come to a correct conclusion,
because they have made their examinations at too advanced a
period ? By no means.

Professor Meigs also advises a similar course. On page 259
he says : " For the most part, we only ascertain, in such an ex-
amination, the presentation, and being satisfied with that, we
wait until a great dilatation, or the discharge of the waters al-
low us to discover the position.''' Farther on he says: "As
soon as "practicable after the escape of the liquor amnii, the
touching should be repeated, and now there is little difficulty in
determining the position of the head, though it may often be
ascertained through the unruptured membranes." I again ask,
is it possible, that Baudelocque. who was deeply interested in
the question of positions especially, failed to attain a correct
conclusion, because his examinations were made at too advan-
ced a period ?

But again : Why should one position be so constantly con-
verted into another, as M. Naegele seems to think ? What
reason is there, that the very positions which are the most usual
eventually, and the safest, should not be original ? Nearly all
children presenting the Vertex, are born in the 1st or 2d posi-
tion ; and yet according to this obstetrician, those are not the
original positions. Let us examine farther, the 4th converted
into the 2d. When the occiput is to the right sacro-iliac sym-
physis, the body of the foetus doubtless, corresponds with that
position. Now in the 1st, as well as some other positions, one
important mutation is rotation of the head, at the expense of the
neck. This is true, I think, in the 4th position also, and if so,
when the occiput is carried from the sacro-iliac junction, to the
pubes, the rotation must be very great at the expense of the neck,
or else the body of the child changes its relations to the body of
the mother, which, in the 1st position, Professor Dewees, as

1854.] Howard, upon Vertex Presentations. 599

well perhaps as some others, is particular to tell us it does not
do. If this is not done in the 1st position, why should it be
done in the 4th? I cannot see a reason. And if the rotation
is at the expense of the neck, who would undertake to say that
" coeteris paribus, the 4th position, is as safe for the mother and
the child as the 1st" Bat. it is said, the relation of the body of
the foetus to the mother is changed. * How is that ? Is there
any peculiar action in the uterus changing it ? I cannot think
of any. I suppose it must be, that the direction given by the
modifications of the pelvis, irresistably carry the occiput under
the pubal arch, and the body is twisted forcibly around. If that
be so, can the 4th position be "coeteris paribus as safe for the
mother and the child as the 1st?"" But, even suppose there is
none of this twisting, and by some peculiar action of the uterus
the body of the child is changed in its relations to the mother.
When the occiput is passing under the pubal arch, the shoul-
ders. I suppose are entering the superior strait ; now do they
(the shoulders) follow the head in their relation to the pelvis ?
or do they pass the superior strait transversely ? or are they
carried round to the 2d position? If the first, then the rotation
must be at the expense of the neck. If the second, then the
greater diameter of the shoulders, would pass a smaller diame-
ter of the pelvis, than the oblique ; neither of which can be safe
or easy; or lastly, if the third, why would not the force which
carries the body to the 2d position in the latter stage of labor,
carry the head there in the commencement ?

Again: In the former article of July, I attempted to show,
that under the uterine and abdominal contractions, if the back
of the foetus was to the back of the mother, the tendencv of the
latter contractions was to throw the child around to the 1st or
2nd positions; or else extend it. Trusting that will be granted,
I now wish to show that the 4th and 5th positions, though they
will, perhaps in most cases, be converted into the 2d or 1st, if
the head enters the superior strait, in the Vertex Presentation,
yet they are extremely liable to be converted into face or shoul-
der presentations. If the contractions of the uterus are not
sufficiently great to effect the foetal flexion ; but the abdominal
muscles on the contrary acting with more energy extend the
* Most of the Italics are mine.

600 Howard, upon Vertex Presentations. [October,

child,* since the direction of the expulsive force is not exactly
in the direction of the pelvic cavity ; the forehead now impin-
ging the anterior pelvic border, is it not clear, that instead of
flexion of the head on the breast, the extension may inc.
and thus the face continue to roll over, until it shall become the
presenting part? The facts just mentioned, viz., that tl.
pulsive force is not precisely in the direction of the pelvic
cavity, and the head impinging the anterior border of that cavity.
have no little influence in the 1st or 2d position of effecting the
flexion; but here, in the 4th or 5th position, the relation of
- is just reversed, and the very occurrences which aid
much in flexion, now make their entire contribution to exten-
sion, and to bringing the face to present rather than the vertex.
I entirely agree with Dr. Meigs, that the face is but an accident
of the vertex presentation; and though I never saw a fac;
sentation, I know of no more probable way in which it could
occur.

Reverse the forces spoken of, viz., the contractions of the
uterus and abdominal muscles let the first be great, producing
the utmost flexion of the foetus ; now, instead of the head
ing into the superior strait in the vertex presentation, is it not
more than possible, that the occiput Impinging the anterior bor-
der of the pelvic oaVlty, will glance, and instead of the head
entering at all, will retire to make way for the shoulder, or
whatever part below the shoulders may chance to be brought
down ?

Had I time, and did I not fear extending this article beyond
a readable length, much more might and would be said; but,
permit me to recapitulate and I close.

1st. Seeing no reason to believe, that Baudelocque and his
followers have examined this matter of the frequency of the
2d position, as compared with the 4th, with less care than M.
Naegele and those who receive his opinion ;

2d. The opinion not according with my own observation ;
and,

3d. Being wholly out of keeping with what I regard as the
most plausible theory on the subject of the positions of the ver-
tex presentation ; I prefer to be in the ranks in which this
* It being at an angle of near 30

1854] On Irritability of the Bladder. 601

paper shews me ; but avowing at the same time, a sincere de-
sire to know the right, and an unqualified willingness to em-
brace it.

On Irritability of the Bladder. By Hexry Thompson, Esq.,
F. R. C. S., M. B., Honorary Surgeon to the Marylebone
Infirmary.

(Continued from August Xo., page 479.)

PART III.

There is a species of rheumatic affection, so-called, which
appears as one of the latter consequences of gonorrhoea, among
those pseudo-secondary symptoms, if I may use the term,
which are sometimes observed to follow the primary complaint.
Here the patient complains of undue frequency of micturition,
but there are no concomitant symptoms of inflammation, or of
simple catarrh. There is no narrowing of the urethra. In-
quiry may elicit the fact that there has been some slight erup-
tion of the skin, or a swelling of the knee, or other joint, or
wandering pains may have been complained of; conjoined to
these, a gradual depreciation of the general health will com-
monly have been observed ; the skin is often dry and harsh,
and the digestive functions are impaired. Under such cir-
cumstances, the patient will often derive great benefit from a
persevering use of the iodide of potassium, and active tonics,
such as the cinchona, with small doses of Plummer's pill. Some-
times, however, more benefit seems to result from small doses
of colchicum in the form of tincture, or in that of the acetic
extract, with an equal quantity of blue pill added occasionally ;
sometimes from guaiacum, which is advantageously given in
powder with calcined magnesia ten or twelve grains of each,
well mixed, may thus be taken in milk, or water, once or twice
in the day. Warm baths, especially when of salt water, and
the vapour bath also, are often very valuable adjuncts to other
treatment. Added to these, the removal to a warm and dry
locality, where this has not previously been enjoyed, may
confirm or complete the cure of an obstinate case. In most
instances, however, it is necessary to persevere continuously
for some time in the course of the treatment which is decided
upon, whatever it may be, and not hastily or unnecessarily to
change it for another.

Frequent micturition is sometimes associated with an affec-
tion of the prostate, or more properly speaking, of the urethra
as it passes through that sland, when the symptom occurs in
youth, or at an early adult age. Thus, after an habitual inor-

602 On Irritability of the Bladder. [October,

dinate indulgence of venereal appetites, sometimes after re-
peated attacks of gonorrhoea, or quite as commonly after one
attack only in certain constitutions which manifest undue ex-
citability of the urinary apparatus, and in which catarrhal dis-
charges generally are very obstinate and hard to cure, the
patient complains of vesical irritability, attended or not with
some gleety discharge. On passing a middle-sized catheter,
no organic narrowing is discovered, but there is extreme sen-
sibility of the canal, after the instrument has traversed some
five or six inches of the anterior part. Acute cutting pain is
then complained of as it is carried onwards to the bladder.
The catheter may be tightly grasped, and is not to be removed
without some pain. Perhaps it is not possible to say what is
the exact condition of the urethra here : probably there is
some vascular congestion, or subacute inflammatory action
existing in the mucous membrane, analogous to that met with
elsewhere. This, however, wo know, that in four cases out
of five, the passing of a catheter, repeated at two or three days'
intervals, for a short time, almost entirely removes the hyper-
sensibility. The muscular constituents of the canal are per-
haps stimulated to contract by the presence of the foreign
body ; the enlarged or relaxed capillaries thus emptied of their
contents, gradually return to their normal size, and the con-
gestion cea-es to exist.

Thus it happens that on the first or second time of using the
instrument, some slight bleeding may occur, which appeals to
have a beneficial effect rather than otherwise, and it rarely
takes place afterwards. The actual presence of the patholo-
gical state described, is, in most instances, a matter of conjec-
ture only, it must be confessed, but there is a strong probability
that it may not unfrequently be affirmed. Now sometimes it
seems to happen that this affection, when much neglected, or
if marked by more than usual severity, may implicate the neck
of the bladder also to a greater or less extent, and set up con-
siderable irritability of this organ. Such a condition, as might
naturally be expected, is aggravated by the stimulating diuret-
ics frequently employed, which contain some volatile or acrid
principle, such as buchu, copaiba, &c. I have met with sev-
eral cases notably illustrating these remarks. In this compli-
cation, also, if there be no purulent discharge with the urine,
which is sometimes the case, I have found the benefit of passing
instruments into the bladder, beginning, say with No. 7 or 8,
and passing on to 10, 11, or 12. But if these fail, or if there is
some little purulent discharge, an application of the nitrate of
silver to the prostatic portion of the urethra and neck of the
bladder is exceedingly useful as a curative means. Sometimes

1854.] On Irritability of the Bladder. 603

the whole bladder is advantageously injected with solutions of
the nitrate ; it is, I believe, however, generally sufficient to cau-
terize the parts indicated. Nevertheless, there are conditions
of the vesical mucous membrane in which such injection is
highly beneficial. When the neck of the bladder has thus be-
come affected, the urine may be decidedly albuminous, and yet
no serious renal disease may co-exist. It would then seem to
be a result of irritation, secondary to, and depending upon, the
condition of the bladder ; for on remedying this, the albumen
disappears. In such a case, the absence of the constitutional
signs of organic disease of the kidney, and the non-appearance
of diseased epithelium or casts in the urine, will lead the ob-
server to watch closely for the source of the albuminous pro-
duct, and perhaps to connect it with some functional, and not
"with any organic derangement.

We meet with vesical irritability, accompanied by more or
less of mucus in the urine, or muco-purulent deposit, in which
no evidence of inflammatory action being present, we cannot
feel justified in regarding it as a condition of cystitis, although
it is often, but not necessarily always a sequel of it. It seems
to be due rather to an atonic or relaxed condition of the mucus
membrane, in which the phenomena described occur, and in
which much distress from frequent calls to pass urine is expe-
rienced, but wrhich will not be combated successfully by any
antiphlogistic treatment. It is for this class of cases especially
that stimulating injections for the bladder are so useful. Among
them may be mentioned the nitrate of silver, in the proportion
of half a grain to two grains to the ounce of water. The
strength, however, may be greatly increased, even to ten or
fifteen grains for some cases. Another useful formula is half a
grain to a grain of the acetate of lead, with two grains of the
extract of opium, to the ounce of water. The nitric acid is
particularly indicated when the urine is charged with the
earthy phosphates, and may be added to water in the propor-
tion of one or two minims to the fluid ounce. Creosote and
copaiba have both been employed by continental surgeons in
these circumstances; the former in the proportion of one min-
im, the latter in that of thirty to sixty minims, to the ounce of
fluid ; but I have no experience of the effect of these. Plain
warm water is often of great service in most cases where much
mucus is present, and it may then be advantageously injected
once or twice a day. The employment of a continuous stream
by means of the double current catheter, with a free opening
for the transit of mucus, is best adapted for the purpose-
When there is much pain, as well as irritability, the extract of
opium may be added to the water ; but, generally speaking, a

604 On Irritability of the Bladder. [October,

sedative effect is much more efficiently obfained by the use of
a suppository. When the contents of the bladder are extreme-
ly offensive, a weak solution of chloride of soda is sometimes
of considerable value as an injection. It may be repeated
every day. The strength to be employed should range between
six and ten minims to the ounce of tepid water. In the opera-
tion of injecting the bladder, instead of fixing the nozzle of
the syringe directly upon the catheter itself, it conduces greatly
to the comfort of the patient to connect the two by means of a
pliable or elastic tube, so that no impetus be transferred to the
sensitive organ from the hand employed in propelling the fluid.
The vulcanized india-rubber bottle, fitted with pipes and valves,
like those of the ordinary enema apparatus, is very preferable
to the syringe for this purpose, because it can be worked by
the operator with one hand only, leaving the other free to ad-
just the catheter or turn the stop-cock. With regard to inter-
nal remedies, the alkalies before alluded to, provided the mine
is not already alkaline, as a general but not invariable rule, or
the mineral acids if it be strongly so, combined with the infu-
sions of diosma or buchu, or of the uva ursi, with full doses of
hvoscyamus or of camphor, and sometimes with copaiba or
Chios turpentine, appear to be the most efficient in non-inflam-
matory conditions of the bladder. The tinctures of iron and
hvoscyamus together, or of iron and hop, sometimes exercise
marked benefit in weak and anaemiated subjects. From de-
coction of the pareira brava, in doses of the ordinary Pharma-
copoeia strength, and also when augmented greatly beyond
that standard, I have been disappointed in obtaining the good
results attributed to its use, and in cases which have been ap-
parently adapted for it. We have the highest authority, how-
ever, for its value in some circumstances.

I may appropriately mention here a form of irritability, with
sometimes mucous urine, of which I have had three examples.
In these cases the patients had experienced a variety of treat-
ment without benefit, until the simple proceeding about to be
described was adopted, with complete success in two of them.
The occasion was unquestionably an organic narrowing of the
urethra close to the external meatus that is, within half or
three-quarters of an inch, but so slight in degree as not at first
to be recognised as the cause. In the first case, No. 5 cathe-
ter, in the second and third No. 7, were passed with tolerable
ease into the bladder, the only obstacle to larger sizes being
the slight narrowing described. Having tried all ordinary
means in vain, having dilated the obstruction somewhat, but
finding that the irritation so occasioned rather rendered the
subsequent contraction, which was certain to take place in a

1854.] On Irritability of the Bladder. t>05

few days, if anything, rather more obstinate than before, I
divided it in each case by carrying a director and tenotomy
knife in its groove through the constricting part, and passing a
No. 10 and 11 catheter afterwards. The operation is exceed-
ingly simple, and was attended with the best results. In the
two former cases, all the vesical symptoms rapidly disappeared ;
the latter stiil remains under treatment, the mucous membrane
of the bladder having suffered, I fear, some change from chronic
disease. The patient has, nevertheless, improved since the
operation, which was performed a month ago. It is remarka-
ble how exceedingly resilient these contractions are, how-
inefficient mere dilatation is to render their disappearance per-
manent, and how speedily the frequent micturition and supra
pubic* pains vanish after the simple act of division has been
performed.

It might have been considered by some impossible that an
obstruction so slight as those which have been described should
occasion serious symptoms. I confess I should have thought
so some time ago. Not, however, until after meeting with two
of these cases, 1 became acquainted with Civiale's observations
made some years ago in relation to this very subject. They
are so pertinent that I may be permitted to quote them here,
from the last edition of his work on '"Diseases of the Genito-
urinary Organs," published in 1850, vol. ii., p. 34. He speaks
of "the co-existence of very slight strictures of the urinary
meatus with -neuralgia of the vesical neck, which latter disap-
pears immediately after the meatus has been divided.'' He
continues, "I have seen many examples of it, and I own that
I have not admitted without some hesitation the influence of a
cause which appeared to me at first sight not to have any
weight, yet I have had but to incise the urinary meatus, and to
introduce some bougies, in order to hinder the little wound
from immediately re-uniting, and I have seen all the symptoms
disappear. In muitiplving themselves, these facts have dissi-
pated my doubts, and the result now presents itself so clearly
that I am enabled to announce it as certain.

M. Civiale has written at great length upon ;: Neuralgic
Affections of the Neck of the Bladder,' by which phrase lie
appears to designate any condition in which the patient expe-
riences abnormally frequent desires to micturate, attended with
pain about the pubes and perinaeum, but without throwing
much light upon the exact pathology of the complaint so de-
nominated. In respect of the treatment, however, his o!
vations tend to show the value, in a certain proportion of
cases, of passing bougies, and thus subduing the abnormal sen-
sibility, as he calls it, of the vesical neck. Entertaining the

GOO On Irritability of the Bladder. [October,

utmost consideration for any opinion advanced by that expe-
rienced observer, I am nevertheless compelled to believe that
an undue sensibility of the prostatic urethra already alluded to,
giving rise to all the symptoms which he describes, is a much
more frequent affection, at least in this country, than an altered
or abnormal innervation of the neck of the bladder. I have
been frequently consulted for pains and uneasiness referred to
the neck of the bladder, in which the passing of a catheter has
shown that the point of extreme tenderness was situated dis-
tinctly anterior to the neck and most certainly in the prostatic
part itself. I should not feel warranted in expressing an opin-
ion on this subject, had I not possessed the opportunity of ob-
serving a very considerable number of such cases amongst
patients who have applied for suspected organic strictmv of
the urethra, or for some other affections of the urinary oigans,
supposed, but often erroneously, by the sufferer to be present.

PART IV.

Irritability of the bladder is a symptom which frequently
occurs in children and young people, and often proves the oc-
casion of much annoyance and even distress when it persists,
as it sometimes does, up to the age of puberty. The patient
generally exhibits no sign of it during the day : but the act of
micturition takes place involuntarily, and may be repeated
during the hours of sleep, appearing to overcome the retentive
power of the urinary apparatus when volition is suspended.
Whether the natural retentive power is weakened, or whether
the expulsive function of the urinary organs is unnaturally
called into action, it may not always be possible to ascertain.
While some cases exhibit more of the former character, tl.e
great majority probably depend chiefly upon causes of the lat-
ter kind. The sources of excitement which may thus act are
extremely numerous and various in their nature and locality.
Among them are the irritations occasioned by dentition, intes-
tinal worms, and other foreign matters in the bowels, food of
an improper kind, or taken shortly before going to bed, &c.
Very commonly there is an abundance of uric acid deposit in
the urine, which seems to act as the disturbing cause. The
health is sometimes temporarily deranged, and requires only to
be set right. The general tone of the body may be deficient,
the muscular fibre being lax and debilitated, and an invigora-
tion of the vital powers may be accompanied by a disappear-
ance of the evil. The force of habit alone may sometimes
perpetuate it when the originating cause has been removed.
But these conditions appear not to include all the causes which
occasionally give rise to the complaint in question. We look

L] On Irritability of the Bladd f>07

in vain for these sources of excitement in some patients, and
after employing empirically a lon^ list of approved remedies,
are still doomed to be disappointed. In the spring of last year
I had an extremely obstinate case, in which the affection had
existed from childhood to the age of fifteen years. The youth
was brought to me from the country, where he had received
treatment of various kinds, including medicines, blisters to the
sacrum, (Sec. He was intended by his family to be articled to
some profession of business, but was disqualified by this most
disagreeable infirmity. Not being able to detect any cause in
the condition of the urine, or in adjacent organs, I decided upon
simply passing a catheter every other day for twro or three
weeks. As only a slight improvement followed this means, I
then cauterized the neck of the bladder with a solution of one
drachm of the nitrate of silver to the ounce, by means of an
instrument which I designed some time ago for the purpose of
enabling us to apply to the prostatic urethra and bladder solu-
tions of various strengths in place of the solid caustic. During
the subsequent four weeks there was no re-appearance of the
incontinence. He then returned home, and six months after-
wards I heard from him, stating that he was perfectly free
from his annoyance, and had entered upon the business engage-
ments for which he had been intended. I have had no other
similar cases of sufficient obstinacy to warrant me in employ-
ing this remedy in the manner described. It is nevertheless a
sale and efficient one, when the employment is indicated, if
properly applied. I have used it between forty and fifty times
for cases previously alluded to, and have never observed any
ill effects to result.

I may now briefly glance at a different class of cases, com-
prised beneath the latter term of the last division of the table,
viz., those in which irritability of the bladder is due to "certain
derangements of the nervous system.*'

Anomalous affections partaking more of the character of
unnatural retention of urine than of vesical irritability, although
sometimes assuming the latter form, are met with among many
of those remarkable phenomena which are presented in the
female economy, and generally termed hysteria. It is not con-
ceived to be within the scope of this paper to enter upon the
consideration of these.

Irritability of the bladder in either sex, but especially in the
male, may be the result of cerebral or spinal injuries of various
kinds. Chronic organic diseases of the organs indicated also
play their part in producing the same symptom. Thus, bv
those who have passed the meredian of lite we are sometimes
consulted respecting its appearance. Inquiry elicits the fact

G08 On Irritability of the Bladdi r. [October,

that it has occurred in an almost imperceptible manner, and
that of late it has attracted the patient's attention by becoming
a source of inconvenience rather than of discomfort or pain.
The urine presents no character to account for the occurrence,
and there are no signs of obstruction to its flow. In short, no
indications appear for any direct line of treatment; neverthe-
less, the evil increases, and almost disqualifies the individual for
society, and for many of the ordinary engagements of life. At
the same time, however, unmistakeable signs of impaired
nervous function are exhibited. Probably there will be some
uncertainty in the gait ; perhaps some inequality in the power
of grasp by the hands. The organs of special sense may be
impaired in some degree, apparently without the occurrence
of any organic changes in their structure. The appearance
of such indications, and ii fortiori, of any more marked signs
of chronic change in the nervous centres, together with the
absence of any causes hitherto pointed out, will go far to de-
termine the nature of the case. For these, by such a dietetic
management and regimen as shall tend to invigorate the animal
functions generally, by absolutely insuring, if possible, the ne-
cessary amount of relaxation from wearing occupations, both
mental and physical, in the case of those who are too closely
engaged in business habits and pursuits, together with the em-
ployment of well-adapted mechanical contrivances where their
use is indicated, we may conduce materially to mitigate the
evil and afTort support to the undermined constitution, but little
or nothing can be done to repair it.

On the other hand, at the outset of life, while the nervous
agencies are extremely mobile, easily excited to undue action,
and erratic muscular movements are prone to occur from slight
disturbingcauses, irritability of bladder, when presented, usually
gives way without difficulty, on the discovery of the disturb-
ing agent. A like condition occurs at the approach of puberty
in the female sex, and thus we often find the same symptom
severely complained of, ushering in the exercises of the men-
strual functions. Perhaps there is less of what we are accus-
tomed to call hysteria about the affection in such instances than
of ordinary sympathetic action on the part of the bladder with
the neighbouring uterus, through the agency of which, in taking
on a new relation to the rest of the animal economy, the gan-
glionic nerves become the media of disturbing action reflected
to adjacent viscera. Thus, also, the same thing appears to
happen at the critical period of female life, when menstruation
is about to cease. Excited action of the bladder is often asso-
ciated with the uterine derangement then experienced, and
sometimes so early as to offer the first announcement of

1854.] On Irritability of the Bladder. 609

the approaching change. The recognition of this fact will
point out the appropriate treatment, and may save the patient
much that is ill-directed, painful and unnecessary.

But even in matured adult age we frequently meet with an
equal susceptibility to the effect of stimuli, displaying itself by
that proneness to habitual disturbance in the equanimity of the
individual which gains for him the popular epithet of "nervous."
Whatever the cause, whether it be a hereditary disposition, or
a condition acquired, as not unfrequently, either through severe
and long-continued bodily or mental exhaustion or both, one
of the most obvious manifestations in a few cases is the symp-
tom under consideration. Under some more than usually ex-
citing circumstances, particularly if of a disagreeable nature,
the want becomes perfectly uncontrollable, continuous and dis-
tressing, while at most times it amounts to an annoyance. On
the other hand, the enjoyment of congenial society, and a mod-
erate indulgence in alcoholic stimulant, (so contrary to its effect
in all other cases), for the time improves his condition by giv-
ing temporary stability to the weak, inconstant, and purpose-
less activity of the nervous centres. Such a case it is difficult
to mistake, while an observation of the character given renders
the diagnosis a matter of almost absolute certainty. With time
and perseverance much may be accomplished for such pa-
tients. Strict attention to every means for improving the gen-
eral health and promoting the tone of the body, as by generous
diet, exercise, country air, sea and other bathing, cheerful so-
ciety, regular but congenial employment, tonic medicines,
especially quinine and the chalybeates, constitutes the neces-
sary treatment. Local applications of belladonna, opium and
camphor combined, in the form of plaster, or otherwise, and
occasionally the use of opium, conium, or Indian hemp, inter-
nally, are often temporarily very useful to patients of this class.
The causes, however, of the constitutional condition must be
ascertained, and no longer be permitted to exercise their influ-
ence. Now, it is partly with such individuals, or among those
who are possessed of a similar constitution, that we find an
irritability of bladder, originally induced by some palpable
physical cause, as by a gonorrhoea, obstinately persisting des-
pite of all treatment, although the lesion has long ago disap-
peared. The relationship between the nervous centres and
the genito-urinary organs is of that peculiar and intimate char-
acter, that the symptom exists through the existence of an
erroneous mental impression, while all physical cause is want-
ing, purely as a matter of habit ; the bladder havmg been during
some time accustomed to retain only a few ounces of urine,
resents any addition, the individual becomes conscious of the

610 On Spermatorrhoea. [October,

want, and feels impelled to gratify it. It requires some deter-
mination to resist the suggestion, but in such case nothing more
is needed in order to conquer the habit. We must only be
assured that the cause is that which has been described, or the
advice will be calculated rather to increase than to remove the
evil complained of.

I have thus endeavoured to present a slight and hasty sketch
of a considerable number of diseases, many of them widely
differing, but in all of which the disordered function under
consideration is a prominent symptom, dwelling chiefly not
upon those which appeared to be most important in themselves
but upon two or three which appear to me to have received
less of notice or elucidation in any work upon the suhject with
which I am acquainted. The degree of attention which cir-
cumstances have led me to give to this class of disorders,
arising in part from advantages which I have long enjoyed at
the Marylebone Infirmary (unquestionably one of the best
existing fields for their study which can be presented to the in-
quirer,) hut convinces me how much remains to be achieved,
how much more needs to be known respecting their pathology,
and how much they deserve and will repay a laborious and
patient study. At the same time there are perhaps no disor-
ders to which humanity is exposed for which well-adapted
treatment can afford so much valuable aid, either in the way
of removing actual disease, or if this cannot be accomplished
by checking the progress of the malady, or at least by mate-
rially palliating its most painful and distressing symptoms.

[London Lancet.

On Spermatorrhoea. By John L. Milton, Esq., M.R.C.S.
(Concluded from Sept. No. p. 511)

On Impotence. There are one or two points connected
with the pathology of impotence which are not quite so clear
as one might wish; or rather, to speak more plainly, respecting
which considerable confusion seems to prevail.

The function of generation being the most truly remittent
of all we are acquainted with, being liable to cease for years or
even for life without any injury to the health, may be supplant-
ed by disordered innervation of some other part. By disor-
dered innervation I mean pain, either gouty, neuralgic, &c, in
some near part, especially about the neck of the bladder, or else
exalted function in some distant part, as indigestion, cerebral
excitement; and by supplanted I mean, that when these actions
are set up, the function of generation ceases, as if the vital

1854.] On Spermatorrhoea. 611

force necessary for it were absorbed by the diseased action.
Thus

Observation 1. From Neuralgic Pain. A patient, an
elderly man, had suddenly become impotent; it had not occur-
red, as it mostly does on the advance of old age, with a gradual
decay, the emissions becoming less and less frequent ; on the
contrary, it had come on quite suddenly, and at the same time
severe pain had set in at the neck of the bladder. This con-
tinued with great irritability of the bladder and pains at the
glans penis; sometimes a little blood came after passing urine.
He was sounded for stone, but none being found, it was consid-
ered ulcer of the neck of the bladder. To relieve this, injec-
tions of nitrate of silver were tried ; the first produced great
pain, but some relief followed, and a second was given ; the
pain after this grew more severe, and now never left him day
or night. While at the height of his sufferings, he was attacked
with dysentery. I was in the country at the time, and on my
return to town I found him rapidly sinking. He died shortly
after, and I examined the body. Great part of the colon, and
about eighteen inches of the ileum, were almost gangrenous;
but nothing abnormal was discovered in the genito-urinary
organs, except that the mucous membrane of the prostatic part
of the urethra was of a vivid red ; the testes, ducts, &c, seem-
ed quite natural.

When Rousseau, in whom both cerebral excitement and
spasmodic pain at the neck of the bladder, with retention of
urine, occurred at a very early age, producing temporary im-
potence, died after a life of suffering, no organic change was
found, although the organs were examined with the greatest
care, so that the physicians concluded that his sufferings had
been occasioned by a spasmodic state of the parts near the
neck of the bladder, or of the neck itself.

Obs. 2. From Gouty Pain. A gentlemar, a strong, healthy
active man, in the prime of life, consulted me respecting impo-
tence, of which he gave the following account : After having
been long tormented with flying gout, notwithstanding a very
temperate life, he had been suddenly relieved from it in the
great toe, the last spot it had settled in, and had been at-
tacked with great pain in the urethra, and some difficulty in
passing urine. A bougie was passed, and as the obstruction
yielded and recurred very suddenly, the disease was pronoun-
ced spasmodic stricture ; but from the history of the case, and
having met with several very analogous instances, I am indu-
ced to suspect that gout in the urethra was the disease, and the
stricture and impotence (which was not caused here by the
stricture) were its effects.

612 On Spermatorrhoea. [October,

Obs. 3. From Heightened Function in other Parts.. A
gentleman applied in extreme terror at having become sudden-
ly impotent. As he appeared young and healthy, I felt surpri-
sed at this. It turned out that having neglected his studies
until his examination was close at hand, he had become alarm-
ed, and had betaken himself to them in the most irrational
manner, going to bed with his book in his hand, ready to begin
in the morning, and sitting up in bed to sleep, for Tear, if he
lay down, he should sleep too long. He had become exceeding-
ly nervous, and found that on thinking of connexion vigorous
exertions came on ; but that on attempting connexion they
immediately subsided, and, while subsiding, emission took place.
Quiet, relaxation, and mild aperients, soon restored the balance
of the functions.

From Stricture. When impotence comes on gradually in
patients still in the prime of life, as from forty to fifty yean of
age, the emissions growing gradually more feeble and fewer
in number a mere sensation accompanying them, like thai of
evacuating urine or passing faeces, stricture may often be sus-
pected. It is the more important to attend to this, as many of
these patients persist in stating that the stream of urine is as
as ever it was ; or never have had gonorrhoea, and having
heard that strictures followed upon neglected disease of this
kind, they cannot understand how one can occur without the
other. When in case of this class the stricture appears to
arise from a fold of the mucous membrane growing up, I pre-
fer the application of a film of caustic on a broad bougie, on the
principle so ably advocated by Sir Everard Home.

Ous. 4. In the autumn of 1852, I dissected with great care
the genito-urinary organs of a gentleman who had died of ir-
ritative fever, consequent on an operation performed by Mr.
Gay for the relief of an impermeable stricture. He had be-
come impotent about the time he began to notice a material
diminution of the stream in passing urine. On examination,
the urethra was found extremely narrowed near the bulb. Close
to this part were two passages, one lying behind the other;
they were on the lower side of the urethra, and were both larger
than the contracted part of the tube ; they were about four
lines long, and were lined throughout with mucous membrane ;
the posterior lip of the second almost entirely overlapped and
occluded the natural opening. No instrument could have
been introduced into the bladder, and the exit of urine could
only have taken place by the force of the stream passing down
the valvelike fold of the mucous membrane ; that of the semen
must, I think, have been very imperfect, if not impossible, and
I am induced to believe that this case might have been advan-

1854. On Spermatorrhoea. 613

tagiously treated by caustic, as I have suggested. I have
cured in this way cases which appear to me very similar, for
no two are exactly alike, and at this present moment I have
one under my care. I invariably adopt it when there is a
false passage difficult to steer clear of.

Diagnosis of Spermatorrhoea. Like many longstanding
functional disorders spermatorrhoea may, in time, induce struc-
tural change either in the genito-urinary or in the vital organs
producing, on the one hand, impotence, on the other paralysis,
phthisis, or marasmus, &c. But, in the first place, it is very
rarely that these serious changes ensue before the patient seeks
for advice. Spermatorrhoea i. e. imperfect secretion of semen
from masturbation, accompanied by impotence from congenital
imperfect erection admits of very limited relief. Impotence
consequent on disease of the spinal cord is necessarily incura-
ble. All other cases may, I think, be cured ; but it must be
borne in mind that in this, as in every long-standing disease,
no sudden cure by sleight-of-hand, no miraculous restoration to
health can be looked for. Steady perseverance in a rational
eclectic plan of treatment will generally effect all that is neces-
sary the restoration of the balance. The dark fears which
beset the minds of patients, and even of medical men labouring
under this disease, are as fictitious as the formless shades which
Fingal beheld issuing from the halls of Gurth-Loda.

It will thus be seen that I differ widely from M. Lallemand,
whom I cannot altogether acquit of lending his great authority
to the dissemination of exaggerated views as to the incurability
and serious results of spermatorrhoea. Not only has he attri-
buted effects to it which it is not proved to have induced, but
he lias inferred spermatorrhoea where it appears to me never
to have existed.

Thus in a patient who died of stricture, complicated with
cystitis and abscesses in every part of the prostate, M. Lalle-
mand referred death, not to these causes, but to the "profound
alteration of the spermatic organs;"* this profound alteration
consisting in an abscess of the left testicle; the corresponding
ejaculatory duct and seminal vesicle being full of pus. Now,
how could he believe that such slight disease as this of the tes-
ticle and seminal vesicle could produce death, when he must, I
suppose, have seen much more extensive disease, not merely of
one, but of both testicles, without the health suffering material-
ly ? How could he overlook the fact, that patients very often
die of cystitis and stricture, and that the testicles may be re-
moved without danger ? In another case he attributes the
derangement of the patient's health " to the growing influence

* Vol. 1. p. 45.
n. s. vol. x. no. x. 39

614 On Spermatorrhoea. [October,

of the seminal discharges on the whole animal economy," al-
though in the next page he informs us that long before the cere-
bral symptoms, which he attributes to the seminal discharges,
set in, there was most serious derangement of the digestive ;nd
nervous system, &c.

Again, 1 will just ask the reader to look, among others, at
M. Lallemand's thirty-eighth case. I cannot find a single proof
that spermatorrhoea was present, yet M. Lallemand comes to
this conclusion, because the patient had lately become indiffer-
ent to connexion, and passed semen on going to stool. But
the explanation seems easy enough. Disgust at the idea of
passing semen, the ill-health which generally accompanies this
state, and the alarm and nervousness, often render these patients
temporarily impotent. In many of these cases M. Lallemand
tells us that the patients were not aware of their having daily
pollutions till he extracted the fact by cross-questioning; these
were, I should say, simply cases of vesicular gleet.*

But if I were asked whether any given case was likely to
become incurable, I should at once answer that there seems an
inevitable tendency in spermatorrhoea to get worse if neglec-
ted ; that I know of no instance o( a spontaneous cure when
once day pollutions have set in. and few of well-marked remis-
sion ; that there seems a very limited power in the generative
organs of throwing offdiseased action, as if from their represen-
ting a system quite unconnected with those of the animal and
ftic life, marked by a highly remittent function, the steady
influx of nervous energy necessary to effect a cure was want-
ing. When a patient therefore, from day to day puts off the
trouble and irksomeness of systematic treatment, it is he who is
responsible, not his medical adviser. Then indeed, we may
see ''a degraded nature and a ruined constitution embittering
the best days of the existence, and sometimes leading to insani-
ty or suicide. "f

Yet it is scarcely to be wondered at that incorrect ideas pre-
vail respecting this disease, when no one has as yet taken the
pains to collect and arrange the many valuable but scattered
monographs of Curling, Phillips, Acton, Thomson, and others.
Most of the great English works on surgery are silent, or con-
tain little that is calculated to give a comprehensive view of
the evil and its proper remedies. lb.

*I really can scarcely help thinking, that if M. Lallemand had read M.
Louis Oclier's account ot the death and post-mortem examination ol'Saussure,
he would have attributed the death of his illustrious countryman to spermator-
rhoea!

1 Curling,

1854.] Appearance of the Eyes in othrr Diseases. 615

On the Condition and Appearance of the Eyes in Diseases of
other parts. By Prof. C. G. Th. Ruete.

After some introductory remarks on the value of eye symp-
toms for diagnosis and prognosis, the author proceeds to the
consideration of the condition of the eyes in particular groups
of diseases.

] . Dyscrasia. In these are especially noticeable, alterations
of color in the eyelids, the conjunctiva, the aqueous humor and
the crystalline lens, which, nevertheless, rarely indicate a mere
abnormal composition of blood, but rather defects of nutr"';: a,
circulation and innervation. In chlorosis, anaemia, hydraemia,
and similar conditions of the blood, we find bluish or whitish
rings about the inferior eyelids, paleness of the conjunctiva
and lachrymal caruncle, isolated bluish vessels of the conjunc-
tiva, dull look, and frequently swollen eyelids. Venosity in
its higher degrees produces blue rings about the eyes, and
reddish blue coloration of the sclerotica; the latter proceeds
from the delicacy of the sclerotica, which permits the deep part
of the eye to shine through. This is also found in some dis-
eases of nutrition ; in children it is not a morbid symptom. In
typhus petechialis and putridus, besides the reddish-blue color
of the eyelids, often appear, also, as in scorbutus and morbus
Werlhofii [purpura hemorrhagica], bluish spots (ecchymoses)
upon the upper eyelids, and reddish spots and lines beneath the
discolored, dirty conjunctiva, first at the border of the cornea,
and extend thence over the whole conjunctiva bulbi. When
the coloring matter of the bile passes into the blood in icterus,
yellow fever, &c, the sclerotica, and in higher degree also the
aqueous humor, are the first to appear yellow, and correspond-
ing with this an alteration of the color of the iris; e.g. a pre-
viously blue iris appears greenish. Moreover, a pale yellow
color of the conjunctiva is found in old persons, and even in
young individuals, when many and somewhat varicose veins,
or at times little masses of fat, penetrate this membrane. This
latter coloration appears especially in a direct transverse line,
whilst the icteric is first observed at the periphery of the globe.
The melanotic cacaemia changes the extravasations of blood
existing at the time beneath the conjunctiva sometimes into
yellow, dark brown, even black, often somewhat marked,
melanotic spots, which almost always indicate the existence of
similar alterations in other organs. The alteration of the eyes
in other dyscrasic diseases, as diabetes, uraemia, lead colic,
menostasia, hemorrhoids, scrofulosis, scirrhus, &c, are only
derived from the relaxation of the tissues in consequence of dis-
turbances of nutrition, circulation, secretion, and innervation.

616 Appearance of the Eyes in other Diseases. [October,

2. Disturbances of the circulation, are expressed in the eye
by hyperemia, stasis, or anaemia. Active hyperemia of the
eye, by which the vessels of the eyelids and conjunctiva be-
come turgescent, and thus determine a red coloration with
increased secretion of tears and increased lustre of the eye,
indicates increased action of the heart, or irritation of the
nerves of the head and eye. The former is induced by psy-
chical disturbances, inflammations, fever, cardiac hypertrophy :
the latter by inflammations of the brain, of the Throat, of the
eyes, and neuralgia of the trigeminus. Special signs for special
diseases in reference to color and vascular distribution are not
found, except that in bilious fevers a yellowish coloration is
observed. Hyperemia indicates merely determination of
blood to the head ; and the special form and distribution of the
vessels in particular inflammations of the eye do not depend
upon the exciting causes, but upon the anatomical structure of
the parts concerned. Passive hyperemia of the eyes and their
neighboring parts arises in consequence of obstructed reflux
of the blood, or of relaxation of the vascular walls on account
of debility of the whole body or of the nerves concerned. We
see, then, the vessels of the temporal region, of the eyelids, and
of the conjunctiva, in different parts thickened, varicose, livid,
often with extravasations of blood beneath the conjunctiva,
cedematous swelling of the tissues, aversion to light, and other
disturbances of vision. The abnormities of the lesser circula-
tion, induced by diseases of the trachea, the bronchii, the lungs
and their envelopes, of the heart, of the abdomen, by swellings
in the proximity of the great veins of the neck, obstruct the
reflux of blood from the head. Typhus (ever, and all chronic
ises which impair nutrition, scrofula, gout, tuberculosis,
rachitis, chlorosis, scirrhus, retard the peripheric circulation,
and induce an over-fulness of the small vessels, which lie, like
those of the conjunctiva and lids, in easily distensible tissues.
In tvphous diseases, and in central and peripheric torpor of the
nerves of the eye, hyperemia is induced by weakened inner-
vation. Nevertheless, the causes of hyperemia must also be
inferred from other signs, and this alone affords no pathogno-
monic sign. Anaemia of the eyes owes its origin to oblitera-
tion of the vessels inconsequence of chronic inflammations, or
of constriction of the same from debility of the cerebral nerves,
with simultaneous increased power of resistance of the vasomo-
tor}7 nerves. If the anaemia of the eyes is accompanied by
anaemia of the brain, with obscurity of vision, giddiness, faint-
ing, paleness of the face, especially when the long-confined
patient gets up again, we must infer a general anaemia, or de-
bility of the muscular power of the heart, which either becomes

1854.] Appearance of the Eyes in other Diseases. G17

diminished by wasting of the body in chronic diseases, or sud-
denly from psychical and other depressing influences.

3. Anomalies of secretion and resorption in the eye, are the
result either of abnormal composition of blood, or disturbed
circulation and innervation. The qualitative alterations of the
fluids of the eye ; the presence of bile, sugar, urine, calcareous
salts in the tears, in icterus, diabetes, uraemia, gout ; the want
of alkalescence of the aqueous humor, in rheumatism, scrofu-
losis, &c., are not yet sufficiently determined to become con-
sidered as diagnostic signs. We can, nevertheless, conclude
upon a perverse composition of blood, from the progressing
development of soft cataract, since the nutritive fluid of the
lens, of the aqueous and vitreous humors, are secreted without
the intervention of glands directly from the blood, the compo-
sition of which is thus indirectly manifested in the crystalline
lens. The quantitative alterations afford more definite signs,
the causes of which are circulatory disturbances. Hyperemia
produces an increased, mostly watery secretion, therefore, in
nervous excitation from psychical or other influences, profuse
secretion of tears and mucus, even oedema of the lids. Remo-
val of the moderating nervous influence either prevents the
secretion, or in consequence of relaxation of the vascular walls,
permits the blood-plasma, or even the blood itself to exude;
the eye assumes a venous coloration, and is covered with tears,
and tough, often blood-colored mucus. Hence conies a wild
or vacant expression of countenance, slight dilatation of the
pupil, oedema of the half-closed dependent lids. In the highest
degree of the disease, even colliquation of the eve follows.
These phenomena are found in debilitated states of the trigemi-
nus which do not affect simultaneously the svmpathetic, in
typhous, putrid fevers, cerebral inflammations, &c, in the last
stages of chronic diseases, with long-continuing agony.
(Edema of the eyelids, especially observable in the morning,
and yielding at evening to swelling of the feet, shows itself
often in chlorosis, hydraemia, and in all the conditions which
determine cutaneous dropsy. Delicate blondines not seldom
have oedema of the lids without inflammation of the circumja-
cent parts after agitation of mind, colds, and similar affections.
Dryness of the eye without previous ophthalmia, in conse-
quence of obstructed secretion of the lachrymal and conjunc-
tival glands, proceeds from a debilitated condition of the cere-
bral nerves. We find it, e.g. in debility of the trigeminus,
after fatigues of mind, as a precursor of insanity.

4. Disturbances of nutrition are not without influence upon
the habitus of the eye; but they cannot by this be recognized
according to their specific nature, whilst their consequences,

618 Appearance of the Eyes in other Diseases. [October,

general plethora, anaemia, fatty disease, emaciation, collapse,
laxness of the tissues, are accompanied by very different siijns
in the eye. The effects of the first have been already men-
tioned: immoderate general deposition of fat becomes obser-
vable, also, in the orbit of the eye and the lids; the globe
becomes somewhat prominent, nevertheless, being more than
usually covered by the relaxed eyelids, the space between the
latter appears diminished. On the other hand, if the orbit
becomes narrowed by local swellings, when the anterior lobes
of the brain are enlarged, or chronic hydrocephalus occurs,
the ocular globes become more prominent, without being
covered by the thin, somewhat livid lids. Moreover, the wild
or expressionless appearance in cerebral diseases, the intelli-
gent look in rachitis and panatrophy, the projection of the
frontal bone, &c, furnish here sufficient evidences for diag-
nosis. In gradual emaciation, the fat ol the orbit, also, disap-
pears in due time; the globes of the eye retreat, but appeal
larger on account of simultaneous emaciation of the eyelids,
the expression is lax, but cheerful and intelligent when there
is no cerebral lesion ; the lids, pale at first, become somewhat
livid, and when closed permit the iris to shine through as a
ring. The condition of the conjunctiva is the same as in
anaemia; through it and the attenuated sclerotica we can see
the dark background of the eye, presenting a blue appearance.
The circumference of the eye shows, especially upon the lower
lid, the living ring which proceeds from the thinness and col-
lapse of the tissues, through which hyperaemic veins become
visible. If the eyes fall quickly back into their orbits, if they
are surrounded with a reddish-brown, violet, or livid ring, the
color of which extends, also, to the upper eyelids, this indi-
cates, especially when the features are stiff and immovable,
an important sinking of the nervous power and collapse of the
tissues, in consequence of loss of fluids, internal hemorrhage,
and decomposition of the fluids. We observe this alteration
in typhus and putrid fevers, poisonings with acrid poisons,
cholera asphyxia, and in the agony after most chronic diseases ;
it is a sign of approaching death.

5. The innervation of the eyes yields to the most frequent
disturbances, and furnishes the most important signs, especial-
ly in reference to prognosis. Uniform, fair, yellowish-red
coloration ; moderate turgor, and neither too slow nor too swift
movement of the eyelids ; soft redness of the conjunctiva pal-
pebrarum, and caruncula lachrymalis ; moderate tension, and
mild lustre of the globe ; single, delicate red vessels playing in
the white of the sclerotic conjunctiva; in adults a white, in
young subjects a uniform bluish white, in the old a yellowish

1854.] Appearance of the Eyes in other Diseases. 019

sclerotica; a certain neither too slow nor too quick changing
of the convergence of the axes of vision, which correspond to
the object seen ; and a dilatation and contraction of the pupil
conformable to the degree of light, these are the signs of an
undisturbed innervation. Abnormities are manifested in le-
sions of the motory nerves by spasm and paralysis, in those
of the sensitive nerves and of nutrition, by hyperaesthesiae and
anaesthesias.

a. Spastic phenomena in the eye, which do not depend upon
idiopathic affections of its different parts, point to an idiopathic
or consensual lesion of the brain, without, however, designa-
ting more exactly its nature. Trembling and blinking of the
eyelids, with a wandering, unsteady look, are found in cerebral
irritation, therefore, in disquiet of mind, anxiety, shame, per-
plexity ; also in erethistic, inflammatory fevers, at the com-
mencement of cerebral inflammation, of acute hydrocephalus,
delirium tremens, chorea, eclampsia, and epilepsy. A wild look,
with quick motions, and parallel direction of the axes of vision,
without fixidity upon objects of vision, is a higher degree of the
wandering look. It is sometimes connected with fiery redness,
sometimes with paleness of the face and is often a precursor
of cerebral inflammation and mania, often an indication of sink-
ing of the forces, loss of consciousness and approach of death.

A staring look, immobility of the parallel axes of vision,
wide openness of the eyelids, and dilatation of the pupils are
found when the thoughts of the patient are directed to one
point, in psychical diseases, in corporeal lesions in which the
brain is affected, as in violent pains, typhus fever, gastro-mal-
acia, &c. A sad, earnest look, a slight degree of the staring,
indicates a mental or corporeal affection with consciousness,
and is especially observed in diseases which seriously affect
the organism without weakening the mental powers, e. g. in
scirrhus ventriculi, diseases of the liver and spleen, secondary
syphilis, chronic diseases of the lungs and throat. In these the
corrugators are contracted, the eyelids half closed, the axes of
vision move slowly from one object to another and fall easily
into the staring look. Another form of the staring look is
observed in severe affections of the brain, with loss of con-
sciousnes ; the eyelids are wide open, and the globe prominent
or sunken, the first from tension of the oblique, the latter from
contraction of the recti muscles. This phenomenon is not to be
considered an indextothe natureof the disease. The same cause
occasions the eyes to become distorted. Although in encephali-
tis., acute hydrocephalus, epilepsy,eclampsia, hysteria, apoplexy,
&c, they are mostly turned upwards; yet in the same diseases
they also take other directions. In psychical diseases, also, the

620 Appearance of the Eyes in other Diseases. [October,

direction of the eyes shows only jn general a cerebral affection.
The searching look of the insane has not at all its apparent
significance ; it merely reaches the surface, and does not j
trate the thought of the person seen, and very soon loses this
appearance itself. Herein are the insane very different from
an angry man of sound mind. Many let their eyes fall upon
objects without perceiving them, often even the axes of vision
intersect each other before they reach these objects; others
direct their eyes where nothing is to be seen, mostly because
thev see spectra. At times the eyes are continually moved
and distorted. Most patients cannot beai our glance, they
cast, down their eyes or turn them away. The eyes have often
a peculiar, glassy appearance, and are then more or less Btar-
ing, which indicates the beginning of a Bevere attack. Finally,
in the more violent attacks ih land with extinguished

look, and are then a sign of beginning idiocy.

b. As to the diagnostic importance of the eyes in paresis and
paralysis, we can often draw a conclusion, in reference to the
seat of the difficulty, from the paralysed muscles themselves.
Upon this point the author lays down the following proposi
tions : 1. The nearer the torpor to the ends of the particular
nervous filaments, the more ground have we for considering
the cause peripheric. 2. When the paralysis affects all
branches of a nervous trunk, the cause lies in that trunk before
its division into the peripheric branches. II When, besides
all the branches of our nerve, neighboring nerves are also
paralysed, the cause is to be sought in the central organ itself,
or near the place where the first nerve leaves the central
organ. 4. When nerves corresponding to one another are
disturbed in their function upon both sides of the body, it is
supposed that the seat of the evil may be in the central organ ;
since, however, the distribution of the nervous roots in their
central organ, and their connection with the cerebral fibres is
yet little known, we must be cautious in adopting this opinion.
A dull look only indicates diminished innervation, and is found
when the eyelids are somewhat dependent, or even somewhat
oedematous, and move but slowly ; when the axes of vision fall,
indeed, upon the fixed object, but soon deviate from it and move
sluggishly and without energy ; and when the globe itself takes
on a dull lustre. If an inattentive mien is accompanied by signs
of sadness or pain, in the first case the axes of vision are turned
downwards, in the latter downwards and laterally. We find this
in the beginning of typhus and putrid fevers of chronic cerebial
diseases, of hydrocephalus, of cerebral softening, in profuse fluid
losses, in strong, especially depressing emotions of mind, in the
latter stages of severe inflammatory diseases, chronic diseases of

1854.] Appearance of the Eijes in other Diseases. 621

the liver and spleen, lungs and kidneys. It is not, however a
key to any definite disease. The extinguished look, which is
only a higher degree of the dull look, is a sign of very great
cerebral torpor, and of great danger. The eyelids are then,
even in sleep, half closed, the upper one depends loosely,
especially towards the outer angle, and moves but seldom and
slowly. The eye is dirty, and when the resorptive power of
the lachrymal puncta is paralyzed, dirty tears run from the
outer corner of the eye, the conjunctiva is traversed by dark
veins, the pupil is somewhat frilated and almost insensible to
the irritation of light, the axes of vision are parallel, and the
movements of the eyes, which are never fixed on one object,
are slow. If these phenomena are more perceptible in one
eye than the other, the same side of the brain is the special
seat of lesion. A dull look during waking, which approaches
the extinguished look, and is connected in sleeD with distor-
tion of the eyes upwards, even with divergence of the axes of
vision, indicates always a severe cerebral lesion, which either
proceeds from exudation in the sinus of the brain, or from
great weakness in putrid and typhus fevers, cholera, asphyxia,
or narcotic poisonings. Squinting dependent on torpor, obli-
que vision, and anaesthesia of particular parts of one or both
i eyes, are to be judged according to the above-stated proposi-
tions, and indicate, when a peripheric lesion of the nerves is
not to be detected, that the difficulty is limited to a small part
of the brain, which can often be exactly determined. General-
ly, the cause is a circumscribed exudation or extravasation.
If, however, the symptoms are intermittent, the difficulty is of
a spasmodic character, and arises from a temporary irritation.
c. In hyperesthesia of the optic nerves we observe some-
times aversion to light, with or without dark or colored or
shining appearances before the eyes; with reflex or spasmodic
contractions of the muscles of the forehead, of the eyebrows,
of the eyelids, of the globe, of the iris, with profuse secretion of
tears ; sometimes pressing pains in the supra-orbital region
and in the globe with aversion to light and nausea ; sometimes
neuralgic pains in the course of the twigs of the optic branch
of the trigeminus, upon which follow secondary lesions of the
muscles, of the blood-vessels, and of the secretory organs of the
eye. Hyperaesthesia indicates a cerebral lesion, the cause of
which, frequently, as in epilepsy, hysteria, and other diseases
of the brain, remains fully concealed, but which is not seldom
connected with other abnormities, as in gout, hemorrhoid, fluid
losses, &c, finally, also, with congestions and inflammations,
e. g. hydrophobia, encephalitis, acute hydrocephalus, synochal,
erethistic, and typhus fevers. Since the hyperaesthesia? fre-

G22 Surgical Cases. [October,

quently arise from cerebral lesions, the expression of the old
physicians is not wholly to be reproached, who declared it a
precursor of a new attack of delirium.

d. Anaesthesia of the optic nerves, that is, totnl or partial
abolition, either of the power of sense alone or of all the influ-
ences which are reflected upon the other parts from irritation
of the nerves of sensation, produces in the eye the most various
symptoms, according as it is complete or incomplete, and ac-
cording as the seat of its cause is central or peripheric. The
central anaesthesia?, e. g. the amauroses, are either constant or
intermitting. How the latter arise is not yet sufficiently
known. The transient amauroses and amblyopia?, which we
often observe in anaemia and congestions, in fevers before the
crisis, in intermittent fevers, in nervous or hysteric subjects,
indicate, indeed, a cerebral lesion, but they afford no very un-
favorable prognosis; if however, they occur at the end of
severe diseases, e. g. in phthisis, they always announce death.
Anaesthesia?, especially amauroses, which are developed in a
short time, without having their foundation in alterations of the
eye itself, are connected through chronic and acute diseases,
often with disorganisation of that portion of the brain which is
in connection with the organ of vision, and are, at times, the
first symptoms of this disorganization. Amauroses, without.
diseases of the eye or brain, except those arising in diseases of
remote parts through consensus, do not occur. Schmidt's
Jahrbucher. American Medical Monthly.

The following interesting cases reported by Dr. J. F. San-
ford of Keokuk, are found in the Transactions ol" the Iowa
State Medical Society :

Two cases of false joint have occurred in my practice one within
the last 13 months both successfully treated by subcutaneous scari-
fication of the ends of the bones. The last was a case of ununited
fracture of the humerus in a boy 17 years of age, from Missouri, in
which there was free motion between the ends of the bones after the
removal of the primary dressings, and which continued, notwithstand-
ing the re-application of a fracture apparatus, 5 months subsequent
to the reception of the accident, at which time I saw him. By pass-
ing a strong tenotomy needle down the ends of the bones, free scari-
fications of the surfaces was effected, after which the application of a
retentive apparatus secured firm union. The object of this procedure
is to break up the cartilaginoid investment, which after a time cover
the rounded ends of the fragments, and to excite effusions of plastic
material to serve as the medium of union.

This operation, which I believe originated with me, is not urged as

1854.] Surgical Cases. 623

a substitute for the treatment recommended by Dr. Physick in
of Pseudarthrosis ; nor do I think it will supercede other analagous
operations for the same disease. Each proceeding has its appropri-
ate adaptation to particular cases, and should be held in reserve by
the surgeon. An important principle in Surgical Ethics is, to adopt
the simplest and least painful or dangerous operation in the treatment
of cases that will be efficient: and it is upon this principle that we rest
the claims of the subcutaneous section in cases of false joint. It is in
recent cases, before that entire transformation in the tissues is com.
pleted, which ultimately happens, that we would recommend this ope-
ration. We are thoroughly convinced that at this period, besides
being the simplest, it is the best treatment that can be adopted. The
seton, ab'ati'on, boring, <kc, although perhaps in a majority of cases
successful, are more painful and dangerous.

Restoration of Lips destroyed by Calomel without a distant trans-
plantation. This was the case of a boy 18 years old, who at the age
of 5, suffered destruction of both lips from mercurial ulceration.
The chasm in the lips was of a triangular shape, the apices upward
and downward and the base of the triangle extending nearly from one
angle of the mouth to the other. To restore the lower lip, an incis-
ion was commenced after extensive separation of the alveolar adhe-
sions, six lines below each angle of the mouth, and carried downward
in a semi circular direction and terminating within four lines of each
other. The direction was then changed, and they were carried
obliquely upward until they met at the commissure of the opening in
the lip. The included flaps were then brought upward and united
in the median line by the harelip suture. The upper lip was treated
in the same way, and both lips were to a great extent restored. The
patient did will. Before the operation, there was a hideous defor-
mity the patient could not pronounce the labial words and the
saliva constantly escaped from the mouth. After recovery these
evils were all remedied. I am not aware that this method of labial
restitution has before been executed. We shall hereafter practice it
in all cases to which it is applicable.

Immobility of the lower Jaw of 14 years standing, cured by Extensive
section of the Muscles. I need not enter into a full description of the
history of this case. My principal object is to give a brief detail of
the operation, which it will be perceived presents some novel points.
Miss B. was submitted to my attention about the middle of March,
1852. She had been profusely salivated in 1837, during an attack
of bilious fever. The mercurial ulceration which extended rapidly,
destroyed the alveolar processes of the upper and lower jaw-
these processes, together with the contained teeth separated by the
ulcerative action, were taken away. A large portion of the cheek
was also destroyed. After recovery, the lower jaw was firmly fixed
against the upper. The lost teeth had been replaced by others
which had grown irregularly some inwards and some outwards.

624 Surgical Cases. [October,

The undestroyed portion of the cheek was firm and hard like cartilage
and the posterior angle of the open space was bound together by a
band of similar substance. The patient had taken no solid food for
14 years; she subsisted on fluids and alimentary substances reduced
to a pultaceous mass and forced between the teeth.

IsL Case. On the 18th day of March, 1852, I performed the fol-
lowing operation in the presence of several medical gentlemen, assist,
ed particularly by Professors Hughes, Armor and Hudson :

The patient was placed in a recumbent position, lying upon the
right side. The incisions to separate the adherent lips and cheek
were carried upward to the lower margin of the malar bone, back-
ward and downward to the parotid gland and angle of the jaw ; every-
where the parts were tightly adherent, and bo dense as to oppose
considerable obstacle to the progress of the scalpel. To avoid branch-
es of the facial nerve these incisions were made close to the bone.
All the tense and attached parts being free, an attempt was made to
insinuate a wooden wedge between the teeth, but without success,
as the jaw did not seem to be affected in the least by what had been
done. A broad bladed tenotomy knife was thru passed into the
mouth, and carried to the posterior margin of the masseier muscle,
(which was dense and rigid,) and the whole of this muscle freely
divided. A further attempt was made to open the mouth, but in vain,
and the knife waa again introduced, and carried backward and
slightly upward into the Temporo-. Maxillary region and turm d against
the Temporalis, Alter the division of this muscle, the point of the
knife was depressed, and carried *till deeper into the Pterygo- Maxil-
lary region, and again tinned against the Internal Pterygoid, the
complete division of which seemed to remove all the obstacles on that
side of the face. It was found that the jaw would now yield a little,
and the wedge was with difficulty insinuated sufficiently to allow the
application of a lever, which I had previously prepared to open the
mouth. But with all the force that could be safely applied, the mouth
opened only to the extent of one-fourth of an inch. Passing my finger
into the mouth to ascertain, if possible, the cause, I found that the
Masseter muscle of the sound side was extremely tense and forming
quite a prominent ridge in the cheek. The knife was therefore
passed beneath the mucous membrane a little anterior to the muscle,
passed backwards, and a submucous division of it effected. The
fibres gave way with a cracking noise, the ends retracted some dis-
tance, and upon the application of comparatively gentle force with
the instrument, the mouth was opened to the extent of an inch and a
quarter. The instrument was suffered to remain in its position for
an hour, and lint passed into the cut parts to stay the hemorrhage.
The margins of the open space in the cheek, where now found to
be so far separated, that no attempt to bring them together was
deemed proper, and this part of the operation was postponed till a
future day.

During the whole of this operation the patient was entirely insen-

1854.] Surgical Cases. G25

sible. She readily came under the influence of Chloroform, and no
disagreeable symptoms occurred during the operative process.

The instrument being removed, and some wedge like blocks placed
between the teeth, on either side, to prevent clusure of the jaw, the
water dressing was ordered to the face, and the patient requested to
remain quiet.

We need not detail the course of the treatment during the subse-
quent six weeks. There was considerable swelling of the face during
the week following the operation, but inflammatory action was not ex-
cessive. Pledgets of lint were kept between the gums and cheek to
prevent adhesion, and after two weeks, she was directed to move the
jaw frequently, the blocks being left out during the day, and replaced
at night. The Dens Sapientiae, above and below, on the left side,
which were cut after the mouth became closed, were found, as the
swelling subsided, to interfere with the closure of the jaw, and the
lower one was removed. This permitted the approximation of the
teeth, and mastication was periormed with facility. In six weeks all
the parts were healed and on the 20th of April we proceeded to close
the opening in the cheek.

The extent of this opening, when the case was first presented, was
so great as to demand, in our opinion, a transplantation for its closure,
but the separation of the soft parts, which had been firmly bound to
the bone, the stretching and lubrication which was constantly main-
tained during the healing, had almost brought together the margins of
the opening in the cheek, so that it was now obvious, that a very sim-
ple operation would complete the cure.

Accordingly, on the day above mentioned, the patient having been
placed under the influence of Chloroform, the margins of the open
space having been pared, and a slight band which in spite of our
efforts had bound the lower lip to the gum separated, the edges
were accurately brought together, and maintained in contact by the
harelip Suture. The principal care in these incisions, was to secure
a proper symmetry of the mouth, and this was effected by previously
marking in ink the course of the knife. Upon bringing the parts
together, the deformity immediately disappeared. It was now thought
proper, in order to prevent undue stretching of the parts, to keep the
jaw closed and to remand the patient again the fluid diet.

Nothing unusual occurred during the subsequent progress of the
case. The wounds healed rapidly, and on the 13th of May the patient
having entirely recovered, prepared to go home.

Remarks. The extensive destruction caused by the mercurial
ulceration, left room for the formation of those extensive cartilagi-
nous bands, and for the extreme contraction of parts which occurred
in this case, and which rendered the extensive division of the soft
parts above described essential to a cure. The change of structure
in the muscles and ligamentous apparatus of the jaw, and formation
of new tissue, precluded the possibility of opening the mouth without
the incisions, as has been practiced by some surgeous. We are con-

626 Surgical Cases. [October,

vinced that a more speedy and less painful cure was accomplished by
cutting as we did, than could have been secured by any other process.
Even the masseter of the sound side was so changed in structure, and
so firmly contracted, that no force which could be judiciously applied
could overcome it.

Result. Perfect cure. The muscles regained their power, and
the jaw was separated and brought together with great facility so that
mastication was entirely satisfactory. The space in the cheek was
closed with accuracy, and the healing was so satisfactory as to remove
every vestige of deformity. The speech became clear and perfect
and the disagreeable escape of saliva was at once arrested.

The following case presents some new features, and may bear
upon the question of similar operations at a very early age :

2d Case. Deformity of the Face. Gordon, infant, aged 7 days.
Presented early in January, In tore the medical class, at the college.
This was a most extensive deformity of the mouth, there being entire
absence of the upper lip. of the hard and soft palate and of the middle
portion of the superior Maxillary hone. The Septum Narium pro-
jected beyond the level of the face, and the portion of the maxillary
bone whose absence at the proper place seemed to allow this unusual
developement, was firmly fixed directly upon the point of the nose;
passing over this bone, and projecting somewhat beyond, like a kind
of proboscis, was the Columns Nasi, the whole presenting at first
t horrid resemblance to a miniture elephant. Four teeth, fully
developed, were loosely fixed in the upper jaw, on each side of the
fissurea above described.

The great extent of this deformity, and the horrible appearance
which it presented, induced the parents to seek immediate relief. The
child in other respects healthy and vigorous, was accordingly present-
ed, when only seven days old for this purpose. After consultation
with Prof's McGugin, Armor, Hudson and Hughes, who coincided in
the propriety of an operation, the infant was brought into the amphi-
theatre, and delivered to an assistant, with its hands securely fixed.
The process was commenced by dissecting up the integuments inclu-
ding the displaced columna nasi from the protuberance on the nose.
Carefully preserving the columna to be used in a subsequent step of
the operation. The bony growth upon the nose was then removed,
when it was found to be firmly connected by cartilage, with the sep-
tum and alas nasi. The projecting portion of the septum was also
removed to the extent of half an inch, and was found quite ossified. A
question now arose as to the proper manner of closing the large fis-
sure of the upper lip, the margins being separated to the extent of an
inch. The plastic and yielding condition of the parts, finally induced
me to bring the margins together, previously pared, with the common
hair lip suture. A needle was therefore passed deeply through the
lip at the prolabial margin, and approximation effected by a few turns
of the thread. A second needle, was then passed through the lips at
the base of the nose the pendent portion of the Columna, cut off and

1854.] Plan of removing Hcemorrhoidal Tumours. G27

pared at the lower end, being pulled down placed in proper position
and included in the course of the needle. \Vhen the parts were all
brought together by this means the deformity immediately disappear-
ed. It was feared the decree of tension in bringing the parts together,
and the feeble powers of nutrition in so young a subject would prevent
a kindly union, and this fear was ultimately realized. The child
seemed to suffer but little from this severe operation, but when the
dressings were removed, on the third day, it was found that union had
not taken place. The parts composing this portion of the face, had
yielded and the chasm was reduced at least one half. Adhesive plas-
ters were drawn across the upper lip, with the view of still further
approximating the bones and soft parts, and the parents were reques-
ted to return with the child in the following April or .May.

April 27th. Child was present at the hospital. The constant
traction upon the parts with the plaster had brought the labial mar-
gins sufficiently close to justify the ordinary operation for hare-lip,
which was accordingly performed. The needles were removed on
the second day, but the coating of Collodion previously applied pre-
vented an accurate inspection of the part at that time. On the tenth
day, the lip was fully exposed and found to be united in such a way
as to perfectly remove the great deformity at first existing, and relieve
the unhappy and anxious parents. The child has remained well and
vigorous thro' these operations, and grown as rapidly as do children
under ordinary circumstances.

Remarks. The extraordinary extent of the deformity in this caser
seemed to call for an operation at an early age ; also the progress of
development in the parts would have increased the difficulties, had
it been deferred. The yielding condition of the osseous structures at
the age of 6 days, facilitated the closure and accurate apposition of
the parts. The space to be traversed, rendered so much stretching
necessary, that adhesion was prevented, yet the amount of necessary
cutting was so great that v.he lateral parallel incisions through the
lips, were not deemed advisable, especially as it was known that re-
munerating benefit would be obtained, whether there was adhesion
or not. I never had a patient who seemed to suffer so little after an
extensive operation about the mouth, and although the case proves
the propriety and safety of the operation at a period, when the age
has been generally thought to contra-indicate it.

On an improved plan of removing Hemorrhoidal Tumours.

Mr. Henry Lee read a paper upon this subject before the
Medical Society of London.

* * * The instances to which the application of nitric
acid was adapted were those where haemorrhage constituted
the prominent symptoms, and those in which a protrusion of

628 Plan of removing Hemorrhoidal Tumors. [October,

unaltered mucous membrane had taken place. The cases in
which the application of the strong nitric acid was not suffi-
cient were those in which the submucous tissue had become
thickened by inflammatory deposit, or in which the mucous
membrane had become hardened and altered in structure from
long exposure. In the latter class of cases, when any opera-
tion was called for, the plan recommended was as follows :
The patient was first directed to protrude the affected parts.
The haemorrhoid, or a portion of the relaxed mucous mem-
brane, was then embraced by a kind of broad forceps, called a
"clamp," and the part which projected beyond the blades of
the clamp were cut oft' with a sharp knife curved upon the flat.
When this was done, the clamp still embracing the base of the
tumour prevented the cut surface from either retracting or
bleeding. The operation was then completed by touching the
cut surface either with the nitric acid or with the actual caute-
ry. The clamp is then removed, and the parts returned to their
natural position. In the cases operated upon no trouble from
bleeding had ever been experienced after the application of
the cautery, which gave little pain and was for this operation
to be preferred to the use of the nitric acid. In cases where
the parts to be removed could not be sufficiently protruded,
the operation was very satisfactorily performed by means of a
rectum speculum. The instrument has a slide upon one side,
which may be removed. This is made to fit accurately into
grooves, so that by being withdrawn to a greater or less ex-
tent, a corresponding aperture is left in the side of the instru-
ment. When the speculum is introduced the slide is partially
withdrawn, and the instrument is moved about until the tumour
or portion of mucous membrane requisite projects through the
aperture. The slide is then closed upon the point to be re-
moved, which is thus firmly held between the sides and the
rest of the instrument; the portion of tumour or of mucous
membrane which projects into the speculum is then removed
with a long narrow knife, and the cut surface is touched with
the actual cautery as in the first instance. It is not requisite
or even desirable to destroy any depth of surface with the
cautery. The object in applying it is simply to prevent hae-
morrhage, which it effectually does. The advantages of this
plan of operating in cases where the application of the strong
nitric acid was not sufficient, were : 1. That it is less power-
ful than any other plan equally efficacious. 2. That it is safer
than the common operation now in use. 3. That it requires
less confinement, and the patient is sooner convalescent than
after the application of the ligature in the ordinary way.

[London Lancet.

1854.] Old Ulcers treated by Anaplasty. 629

Elkoplasfy. (eXxog Ulcer andtXouftfu); or Old Ulcers treated by
Anaplasty. {Read before the Buffalo City Medical Associ-
ation, June 21th, 1854.) By Frank H. Hamilton-, A.M.,
M. D , Professor of Surgery in the University of Buffalo, and
Surgeon to the Buffalo Hospital of the Sisters of Charity.

Some writer has said, "old ulcers in 1830 will be old ulcers
in 1860," which not to be understood always in a literal sense,
was intended only to express, in a brief and pertinent foim the
proverbial obstinacy of this class of sores.

In most cases, the integument has been broken and destroy-
ed by ulceration, and then, usually, bad health, or, perhaps en-
larged veins, have helped to perpetuate the lesion. In other
cases, however, the ulcers are directly in consequence of severe
lacerating injuries, which have at once torn away the skin be-
yond the power of nature to repair; and that although the
health of the body and of the limb may be perfect. In such
cases, the refusal of the ulcers to heal is entirely owing to the
extensive loss of integument.

Actual loss of skin is repaired by one or both of two pro-
cesses. By the development of new, from or upon the free
margin of the old skin, or by the contraction of the granula-
tions and of the cicatrix, in consequence of which, the adjacent
skin is drawn towards the chasm, and made, as it were, to slide
over and cover it in.

This rule admits of but few exceptions. Occasionally, after
a very lonsr delay, the granulations acquire the power of form-
ing new skin at various and isolated points of the sore. This
process may now and then be observed in the healing of exten-
sive burns, or, perhaps, in the closing up of an ulcer whose sur-
face is excluded from the air. New skin may even find a
matrix in the periosteum, as I have witnessed, and maintained
several years since. {Buffalo Medical Journal, vol. vii. p.
205 ) But the conditions are very rare under which these ex-
ceptions can occur. The rule remains as we have stated, and
if ulcers are not closed by either the projection of new skin
from the margins of the old, or by the contraction of the gran-
ulations and cicatrix, then usually, they must remain open.
To the action of both of these processes there is, however a
limit. The formative power of the old skin does not extend
beyond a few lines. The new vessels, becoming more and
more attenuated as they stretch inward from the periphery,
lose, at length the power of generating epithelial cells, or, if
formed, they are too imperfectly organized to sustain an exist-
ence, and they crumble away from the slightest provocation.
Slowly, but perceptibly, the opaque diaphragm proceeds to

n. s. vol. x. no. x. 40

630 Old Ulcers treated by Anaplasty. [October,

shut in the granulations, and for a long time encourages a hope
that a cure is to be accomplished. But just when the woik is
almost consummated, a rapid disintegration sweeps away in a
few hours the patient labor of many months. Again and again
the reluctant labor is renewed, and as often suddenly, and
without provocation, is it arrested and broken up. At the same
time the granulations have ceased to condense, and the cicatrix
to contract, either because these actions have attained their
natural limits, or because the adjacent skin has reached its
utmost tension, and affords effectual resistence" to further
stretching. Here the process of closure forever ends, and the
"old ulcers of 1830 will be old ulcers in I860."

Nature has done its utmost, and hitherto art has failed to
complete the work.

I beg to suggest a procedure, which, hereafter, in some un-
fortunate cases of this class, may deserve a trial.

I propose to close the ulcer by an operation of anaplasty.
In short to imitate one of the processes of nature, by sliding in
old skin to repair a waste, where the process of forming new
skin has ceased, and been finally given up.

If we seek to obtain this supply from the neighborhood of
the ulcer, around which the skin has already reached its utmost
tension, we shall only substitute one ulcer for another. We
must, therefore, generally look to the opposite limb, or to the
limb of some other person, for the material with which the
transplantation or engrafting is to be made.

The mode of accomplishing this, will not differ materially
from that which has been generally adopted in anaplasty from
remote parts, except that the ulcerated surface ought to be
excised freely before the new skin is laid upon it.

By this means, I hope, gentlemen, not only to supply an
amount of skin equal to the size of the piece transferred, but to
furnish, also, a nucleus from which additional skin shall be
formed. I hope to establish a new centre of life an oasis
from whose outer v^rge a true and healthy vegetation shall
advance in every direction over the exhausted soil.

It is not improbable, also, that the graft will itself expand, or
be drawn centrifugally by the contraction of the surrounding
granulations and cicatrix, conversely, as the skin about the
ulcer had before been stretched and drawn centripetally, by a
similar action of the granulations and cicatrix situated within
its free margin, so that, after a time, it will cover more space,
independent of any actual growth, than it did originally. The
opposite of this happens usually in anaplasty, and would occur
here, did the flap equal or exceed in size the wants of the parts
to be supplied. The flap would contract, thicken, and pro-

1854. Old Ulcers treated by Anaplasty. 631

ject itself above the surface. But in old ulcers, it will gen-
erally be found impossible to furnish a direct supply of integu-
ment equal to the loss. A deficiency must probably still exist,
and sufficient, it is believed, to determine in the transplanted
skin a necessity of expansion.

The value and practicability of these views are, I trust, in a
measure' established bv the results, in the case which I shall
now take the liberty of bringing before you.

You will excuse me, however, if I detain you a moment
longer to explain to you that, so loner as eight years since, I
proposed the same operation, and had anticipated most of the
results which I have now actually obtained.

In the report of my surgical clinic, for 1S46, at Geneva
Medical College, published in the Bvffalo Medical Journal,
vol. ii, p. 50S, occurs the following passage :

M Indolent Ulcer. M , of Geneva. This lad, now about fifteen

years old, had the right leg and part of the thigh terribly lacerated,
and almost deprived of its integument, by a threshing-machine, eight
years ago. The wound has never closed entirely, but an indolent
ulcer of great extent exist*, surrounded by a broad margin of hard
integument, from which sometimes new skin will form, and then it
will rapidly crumhle away, and the ulceration will extend, perhaps,
beyond its original bounds. Thus it has continued to partially close
and again open, during all this time; meanwhile, the health and
strength of the lad have remained excellent, but the leg has become
bent at the knee, and he walks with a halt Two years ago Dr.
Hamilton took a cast of the ulcer, which is now seen to correspond
almost precisely with its present extent.

Dr. Hamilton and others having tried almost every plan of treat-
ment which would offer a prospect of success, and having so complete-
ly failed, as Dr. Hamilton believes, because the indurated margin
near two inches in breath all around the sore, is incapable of pro-
jecting from itself sound skin, the Dr. has proposed to the boy a plas-
tic operation, with the view of planting upon the centre of the ulcer
a piece of new and perfectly healthy skin He proposes to take this
from the calf of the other leg (having secured the two together.) not
intending to cover the whole sore, but perhaps two or three square
inches, which he believes will be enough to secure the closure of the
whole wound in a short time."

Two years before the date of this clinic, when I took the
cast alluded to in the above report, I had made the same
proposition to the tad, and when he declined submitting to it, I
appealed to his father, who was a worthless inebriate, to allow
me to secure one of his legs to his son's, that I might make the
transplantation from him. In no other way. I assured him,
could he so much benefit his family.

632 Old Ulcers treated by Anaplasty. [October,

I need scarcely say that permission was never obtained, and
that I have never found an opportunity of determining the
practicability of my suggestions until during the last year, and
in the person of the man who is now before you.

The following is the report of the case, copied, in part, from
the Hospital Records:

Horace Driscoll, aged 30 years; Irish laborer; had the skin
and flesh extensively torn from the right leg by a dirt cart, on
the 3rd of November, 1852. He has been in the hospital most
of the time since then until now. The wound has nearly
healed several times, but never entirely ; after exercise the
whole would give way, and the ulcer again extend itself com-
pletely around the leg.

Jan. 21, 1854, I made the following operation :

The patient was laid upon his belly, upon the operating table
before the class. A flap of skin measuring seven inches by
four was then raised carefully from the calf of the opposite leg,
extending in depth through the cutaneous and cellulo-adipose
textures, until the fascia was in sight. Its remaining attach-
ment to the body was by a broad and thick base. The
haemorrhage was slight ; no vessels were tied. Lint, spread
on both surfaces with simple cerate, was laid between the flap
and the surface from which it had been detached, other pledgets
of lint similarly covered were placed on the outer surface,
wf.ile over all and around the entire limb was wrapt a large mass
of cotton batting, secured in place by a lightly turned roller.

He was then laid in bed and perfect quietude enjoined.

Jan. 22. During the night the wound has bled until the
patient looks pale from the loss. The bleeding has now ceased.

Feb. 4th. Two weeks since the flap was raised. The
patient has had to be sustained with beer, his appetite having
failed very much since the operation. The flap has been
dressed in the same manner as at first, nearly every day. It
looks healthy. No part of it has sloughed.

To-day the operation was recommenced before the class,
by dissecting out the granulations and part of the cicatrix from
the diseased leg, and thus forming a deep bed of the size and
shape of the flap as it now appeared, both contracted and thick-
ened. The flap was then made raw again on its margins, and
its lower surface was shaved off, with the double purpose of
removing the granulations, and of diminishing its excessive
thickness. When the bleeding had ceased, the left leg was
carried across the right, so that the tendo-Achilles and heel of
the left leg rested upon the instep and ankle of the right a
thick cotton pad being interposed to prevent painful pressure.
The flap was now brought snugly into its new bed, on the right

1854.] Old Ulcers treated by Anaplasty. 633

leg, and well secured with interrupted sutures, a moderate
compress, and roller. The two limbs were further secured
immovably to each other by bands, and protected at various
points by well made compresses, and the wounds carefully
covered with lint spread with cerate.

Feb. 5th. The wound has bled again, as after the first opera-
tion, although ice was applied diligently from the moment the
dressings were completed. Much pressure was regarded as
inadmissible. Bleeding ceased when he became faint, about
three hours after the operation.

Feb. 18th. Two weeks since the last operation, and four
weeks from the first. Patient has required to be sustained
constantly with beer and nourishing diet. His appetite still
remains bad. Bowels have not been moved in two weeks.
He has not suffered much pain, only fatigue. To-day the base
was separated from the left leg, the flap having united through
most of its edges and under surface, to the opposite leg. No
bleeding of consequence followed. The parts were thorough-
ly washed and dressed with ung. basil, and a snug roller ap-
plied. Ordered sulph. mag. 3j.

Feb. 19th. No movement of bowels. Repeat sulph. mag.

Feb. 20th. One corner of the extreme end of the flap is
beginning to slough.

Feb. 21st. Bowels have moved. Sloughing of flap contin-
ues. Ordered yeast poultice.

Feb. 25th. Line of demarcation formed, insulating about
one inch and a half of the flap, at the corner where the slough-
ing commenced.

Beyond this the sloughing never extended. The surfaces
continued to close, and about one hundred days after the flap
was laid down the healing was finally consummated, and now
after a laps of nearly three months, during which he has been
acting as a subordinate dresser at the hospital, the ulcer has
not re-opened or shown any tendency that way.

The wound made by the removal of skin from the left leg
was completely healed over in about the same length of time
as the ulcer on the right, and the whole left limb is now as
sound and as perfect as before the operation.

Driscoll is, however, at present, by no means a well man.
His health has suffered considerably from his long illness, and
from his prolonged confinement in bed, which dates from the
time of the accident, through most of the period, up to the time
of the closing of the wounds since the operation. The cicatrix
around the new skin is tender, and especially at one point
where several pieces of bone exfoliated soon after the accident
and precisely over which, unfortunately, the sloughing of the

634 Old Ulcers treated by Anaplasty. [October

flap took place. The ankle is also somewhat stiffened by the
contraction of the skin, and of the gastrocnemii and tendo-
Achilles, which latter were seriously involved in the original
injury. These, however, are conditions which the operation
did not propose to remedy, at least only in a small degree, or
they are temporary accidents, and will certainly yield to time
and careful use. If they were to continue, however, it will not
be denied that, in the permanent sealing up of a sore, which,
but for this operation, must probably have remained open du-
ring life, he is amply repaid for all that he has suffered at my
hands. I venture to predict that, within one year from this
time, he will be able to labor nearly or quite as well as before
the accident.

On the 12th of March, five weeks after the flap had been
transplanted, it had united by adhesion to the adjacent skin.
(hrough about one half of its circumference. The other half
surrounded by a border of granulations and of new skin,
varying in breadth from one to ten or fifteen lines ; hut only at
a few points was the bridge of new skin complete. It was
especially noticed that nearly all, probably nine-tenths, of this
new skin had sprung from the margins of the flap, and only the
remaining fraction from the adjacent cicatrix ; demonstrating
that after transplantation and complete separation from the
parent limb, its vitality was unimpaired, and that its reproduc-
tive power, if 1 may so speak, was vastly superior to the re-
prodiu tiw power of the old cicatrix.

You may notice to-day also, that since t hie cicatrization was
completed, the cicatrix formed by growth from the flap, has
contracted ; and, that, in consequence of this contraction, the
flap has become expanded, or been stretched outward, and its
surface has become flattened and firm, whereas, it was, at first
and for a long time, elevated above the surrounding skin, and
flabby.

Summary. 1st. Ulcers, accompanied with extensive loss of
integument, do generally refuse to heal, whatever may be the
health of the body or of the limb.

2d. Anaplasty will sometimes succeed in accomplishing a
permanent cure, and especially where the health of the body
and of the limb are perfect, and where, by inference, the refu-
sal to health is alone attributable to the extent of the tegumen-
tary loss.

3d. The graft must be brought from a part quite remote ;
generally from an opposite limb, or from another person.

4th. If smaller than the chasm which it is intended to fill,
the graft will grow, or project from itself new skin to supply
the deficiency.

1854.] Simaba Cedron,a Substitute for Quinine. 635

5th. It is not improbable that the graft will expand during
the process of cicatrization at its margins, but especially for a
time after the cicatrization is consummated.

6th. In consequence of one or both of these two latter cir-
cumstances, it will not be necessary to make the graft so large
as the deficiancy it is intended to supply. [N. Y. Jour, of Med.

Simaba Cedron, a Substitute for Quinine.

Dr. Samuel S. Purple publishes in the New York Journal of
Medicine, practical observations of interest in relation to the
medicinal properties of this new agent. The author used the
cotyledons or seeds, reduced to a powder by grating, in doses
of 10 grs. The following are his conclusions :

Finally: From the declared experience of various observ-
ers of the medicinal effects of the Simaba cedron, we are war-
ranted in drawing the following conclusions regarding its ther-
apeutic action :

That it possesses decided anti-periodic, properties and is
therefore applicable in the treatment of periodic diseases.

That it is less likely than quinine to produce the aggregate of
encephalic or neuropathic phenomena, induced by overdoses.

That it may, in large doses, repeated often, produce griping
of the bowels, and even diarrhoea; but that these conditions
are easily controlled by appropriate medicaments.

That, as a remedy in intermittent fever, it possesses proper-
ties, in many respects, equal to quinine, and in most cases is
equally adapted to the curation of this disease.

That in the treatment of yellow (ever, it does not appear to
possess any particular advantages over quinine, but neverthe-
less is equally well adapted to fulfill the indications which call
for the use of this latter remedy.

That it possesses marked tonic properties, and deserves a
prominent place in this classification of the Materia Medica.

That in chronic dysentery, diarrhoea, dyspepsia, and all states
of the stomach, accompanied with impaired or difficult digestion
its use will be found to be attended with benefit.

That, should a demand arise for its use in medicine, it is
believed that it will be found not difficult to obtain a supply, in
quantities sufficient to afford it at a much less price than quinine.

Treatment of Cancers.
Prof. M. L. Knapp, of Cincinnati, advocates strongly (New
York Journal of Medicine) the treatment of schirrous affections
by systematic compression and low diet. In lieu of Recamier's

636 Differential Diagnosis of Hydrocele, tyc. [October,

bandages for compressing the mamma he suggests the use of a
modification of Hull's truss, one of the pads resting upon the
back of the chest, and the other upon the tumor. The idea
is a good one, but the author is reminded by the Editors
that a somewhat analogous instrument was invented by Dr.
Arnott, which is thus described in Dr. Walsh's work upon
Cancers :

" His apparatus consists of a spring, an air-cushion supported
by a flat resisting frame or shield, a pad, and two belts. The
spring, which is of steel, is the compressing agent, its strength
being varied with the amount of pressure it may be desirable
to obtain. The shield, varying in shape, somewhat, with the
circumstances of particular cases, is generally slightly convex
on the external surface, of circular or oval outline, and formed
of a rim of strong wire, connected at two opposite points by a
flat piece of iron, which serves for the support of the spring,
screwrs, etc., the whole being covered with jean. To the rim
of this shield is sown a sort of conical cap of soft linen, designed
to receive the air-cushion, to keep it constantly slack, and pre-
vent it from slipping about when applied. The air-cushion
thus kept slack, fashioned into a sort of double nightcap, lying
in apposition with the inner surface of the shield, and sufficient-
ly filled with air to prevent the latter from pressing directly on
the part which receives within it the tumor to be compressed.
One end of the spring is attached by screws to the external
surface of the frame, and the other end to a solid, but soft pad
placed wherever the contre-pressure is to be made. The
straps are used to keep the apparatus steadily fixed."

On the Differential Diagnosis of Hydrocele, and the Diseases
with which it may be confounded. By R.G.H. Butcher, Esq.

HERNIA. HYDROCELE.

Begins above. Begins below.

Changeable in bulk. Unchangeable.

Engages ring. Ring free.

Feeling of weakness. Feeling of weight.

Can often feel intestines, or omen- Can feel nothing.

turn.

Testicle at the bottom. Testicle at back part.

Opaque : in child sometimes trans- Often transparent.

parent.

Base of tumor above. Base of tumor below.

Flatulence, dyspepsia. Bowels not deranged.

1854.] Differential Diagnosis of Hydrocele, c.

637

VARICOCELE.

Soft, like earth-worms.
Changeable, like hernia.
Ring dilated often.
Testicle distinct.
Testicle wasted.
Tumor whole length of cord.
Tumor light.

VENEREAL TESTICLE.

Both engaged generally .

Tumor very heavy.

Hard ail over.

Size moderate.

No fluctuation ; sometimes small

quantity of fluid.
Tumor slanting.
Painful to handling.
Solid contents.
Eruption or sore throat.

SCROFULOUS TESTICLE.

Round in form.

Never very large.

Solid.

Heavy.

Lies at the bottom of the scrotum.

Inflames in spots

Suppurates, fungates.

Scrofula in other glands.

FUNGUS H.EMATODES.

Tumor irregularly hard and soft,
hardness predominating in ear-
ly stages.

Shape, globular generally.

Rapid in growth.

Painful.

Opaque.

Elastic.

Chord becomes hard and knobby.

Pains up loins.

Health impaired.

Fungates.

CANCER OF THE TESTICLE.

Hard, knobbed.

Small.

Round.

Painful on handling.

No fluctuation.

Chord knobby.

Adheres to scrotum.

HYDROCELE.

Tense, elastic.
Unchangeable.
Ring closed.
Testicle indistinct.
Enlarged, if distinguishable.
Tumor at bottom.
Tumor heavy.

HYDROCELE.

One tunica vaginalis generally.
Tumor not so heavy.
Hard only at back part.
Often very large.
Fluctuation.

Tumor perpendicular.
Not painful.
Fluid contents.
None such necessarily.

HYDROCELE.

Oval in form.

Often very large.

Fluctuating.

Light.

Grows upwards.

Never so.

Never suppurates.

Not so.

HYDROCELE.

Uniformly smooth.

Oval generally.
Slow in formation.
Free from pain.
Transparent.
Fluctuating.
Chord sound.
No such pains.
Not so.
Never.

HYDROCELE.

Soft, smooth.

Large.

Oval.

Not so.

Fluctuation.

Chord soft.

Never.

G38 Editorial and Misceltany. [October,

CANCER OF THE TESTICLE. HYDROCELE.

Glands in groin enlarged. Never engaged.

Shooting pains. Never (in loins).

Fever peculiar. No fever.

Fungates. Never.

Death. Never.

In hydro-sarcocele the testicle will be found hard, painful,
irregular, large at the back part, with some fluctuation in front.
Testicle distinguished in hydro-sarcocele, not. so in hydrocele
generally. Shooting pains on handling the former, not so in
the latter. If obscure, the tumor may be tapped, and then the
enlargement of the testis will be discovered, and the water small
in proportion to the size of the tumor. [Dublin Jour, of Med.
Science.

EDITORIAL AND MISCELLANY.

BIBLIOGRAPHICAL.

The Modern Treatment of Syphilitic Diseases, both primary and
secondary ; comprising the treatment of constitutional and confirmed
Syphilis by a safe and successful method ; with numerous cases,
formula, and clinical observations. By Langston Fakkkk, Sur-
geon to the Queen's Hospital, Birmingham. From the third and en-
tirely re-written London edition. Philadelphia: Blanchard & Lea.
1854. pp.316. (For sale by McKinnedc Hall. Price $1.75.)

However much may have been already written upon the subject
of Syphilis, the field is yet fruitful, and the results of twenty years'
practical observation, comprehending the treatment of upwards of
eight thousand cases by a judicious man cannot be without value.
We have had occasion, heretofore, to direct the attention of our read-
ers to some of Mr. Parker's views, and are now happy to see that
they can obtain his matured work in full. It is so eminently practi-
cal, and in some respects original, that we would advise its attentive
perusal.

Auscultation and Percussion. By Dr. Joseph Skoda, Translated
from the 4th edition, by W. 0. Markham, M. D., Assistant Physi-
cian to St. Mary's Hospital. Philadelphia: Lindsay & Blakiston.
1854. pp. 380. (For sale by McKinne & Hall. Price $1.00.)

A Clinical introduction to the Practice of Auscultation and other
modes of Physical Diagnosis, in Diseases of the lungs and heart.
By H. M. Hughes, M.D., F.R.C.P., Assistant Physician to Guy's
Hospital, &c. 2d American from the 2d and revised English edi-

1854.] Editorial and Miscellany. 039

tion. Philadelphia: Blanchard & Lea. 1854. pp.304. (For
sale byMcKinne& Hall. Price Si. 00.)

The advances that are being continually made in diagnosis by
means of auscultation and percussion, demand the frequent issue of
new works upon the subject. Whilst beginners will generally pre-
fer the ''clinical introduction" of Dr: Hughes, the more advanced
will find the production of the German author exceedingly valuable,
and full of practical details as well as original views. We have re-
peatedly expressed our surprise that so many physicians are willing
to practice medicine without a knowledge of auscultation and percus-
sion ; we need scarcely say anything more at present than that the
opportunity is now furnished of supplying the deficiency at a small
cost.

The Pathology and Treatment of Pulmonary Tuberculosis ; and on
the local medication of Pharyngeal and Laryngeal diseases frequent-
ly mistaken for, or associated icith Phthisis. By J. H. Bennett,
M.D., F.R.S.E., Professor of the Institutes of Medicine, <kc, in
the University of Edinburgh, &c, &c. Philadelphia: Blanchard
& Lea. 1854. pp. 130. (For sale by T. Richards & Son.)

This is essentially a, practical book, and is therefore intrinsically
valuable. Prof. Bennett has had ample opportunities for observation
and has made good use of them. The main object of this work is to
show that tubercular diseases will heal of themselves, if the faulty
nutrition of the svstem can be removed: and that our efforts should
be directed to the digestive rather than the respiratory system. His
experience in the use of cod-liver oil is especially valuable, now that
this remedy is so much resorted to.

Healthy Skin : a -popular treatise on the Skin and Hair, their preserva-
tion and management. By Erasmus Wilson, F.R S., &c, &c.
2d American from the 4th and revised London edition with illus-
trations. Philadelphia : Blanchard & Lea. 1854. pp. 290. (For
sale by T. Richards & Son.)

The able author of the treatise on Diseases of the Skin has furnish-
ed us in the above-mentioned little volume, an interesting and useful
hygienic guide. It is proper that such a work be written in a popular
style, and it ought to be extensively patronized by the non-professional
public, as well as by their medical advisers.

We have upon our table a large number of pamphlets, circulars,
&c, some of which will be noticed hereafter.

640 Editorial and Miscellany. [October,

Yellow Fever. The prevalence of yellow fever in Charleston and
Savannah, its importation and tendency to evolution in this city, and
its probable occurrence in various parts of the country in the persons
of those who leave the infected districts, makes it desirable to know
the views of those who have tried new remedies in its treatment
We therefore willingly depart from our usual course in giving
place to the following publications found in the Savannah newspa-
pers. We are not disposed to rind fault with the writers for having,
under the circumstances^ made non-professional papers the medium
of their communications.

" Messrs. Editors Gentlemen : I notice in your papers of this
morning an allusion to the ' Muriated Tincture of Iron,' as a remedy
in cases of Yellow Fever.'

Several reasons, which I cannot now enumerate, have prevented
me from hitherto giving this remedy publicity through the columns
of the city papers. Peeling, however, that it is my 'duty to place
this new mode of treatment before the public,' I beg to publish the
following facts in connection with it :

1. I have treated over one hundred and fifty cases of Yellow Fever
since 21st ult., and of that number not one has died who commenced
this remedy prior to 'Black Vomit.' And,

2. Since 21st ult., 1 have not administered Jive doses of any other
medicine.

I i^ive the Tincture in doses varying from 20 to 60 drops every two
(2) hours in a table-spoonful of water for adults; anil smaller doses
for children. The cure is generally perfected in three days. This
preparation of Iron acts by medicating the blood and exerting its styp-
tic qualities upon the coats of the stomach.

1 would respectfully call the attention of the medical profession to
this preparation of Iron, as an invaluable remedy in Yellow Fever.

In conclusion, I would suggest that 10 drops of this medicine in a
little water be taken by every citizen remaining in Savannah three
times daily, as a preventive of the Yellow Fever.

I am yours respectfully,

Sept. 2, 1854. P. H. Wildmax."

M Messrs. Editors : Having read the remarks of my friend Dr.
Wildman, I take pleasure in adding my testimony to the truth of what
he has stated in reference to the general efficacy of the Muriated
Tincture of Iron in the epidemic now prevalent in our city.

It has been observed by some of my medical brethren that its use
was at variance with all our preconceived ideas of the pathology of
Yellow Fever, and I confess myself to have entertained similar views
when it was first suggested to pe in consultation with another practi-
tioner, as a remedy for the fatal black vomit. But I am sure that

1854.] Editorial and Miscellany. 641

many of the articles of our Materia Medica have been from time to
time improperly classified, and from the experience, during the last
two or three years, of Tincture of Iron in Erysipelas, it cannot rea-
sonably be considered as contra-indicated by the existence of inflam-
mation. I am confident, from close observation of its effects in a large
number of cases of Yellow Fever, that its aciion is that of a refriger-
ant diaphoretic that it allays pain, and produces sleep, and by pre-
serving the integrity of the blood, enables the system to resist the
depression so universally attendant upon the second stage of the
disease. It presents, in fact, a very happy combination of Hydro-
chloric acid, in excess, with iron, the former of which, it is well
known, has been given with great success by the celebrated Dr.
Paris in malignant forms of fever, while the latter, Iron, has been
universally acknowledged as an incomparable tonic from time im-
memorial.

I concur entirely with Dr. Wildman, that it should be exhibited at
the earliest possible stage of the fever, and, when possible, without
awaiting the preliminary action of any other medicine. It is well
known that the revulsive influence of a salivation has always been
regarded as the great desideratum of the Mercurial treatment in Yel-
low Fever; and I am convinced that it will be no small recommenda-
tion of the Muriated Tincture of Iron to the profession when it is
understood, as I am now prepared to assert, that it will produce sali-
vation in a much greater number of Yellow Fever cases, than Calomel
will. This effect, due to the free Hydrochloric acid, is very far from
being attended by the pain and discomfort of Mercurial ptyalism, and
is moreover, not at all indispensable to a cure.

With respect to the dose, it must necessarily be discretionary with
the practitioner, and it cannot be necessary to remind the profession
that even the U. S. Dispensatory allows a maximum of two fluid
drachms. There cannot, I think, be any question of its decided
utility ; and in conjunction with sinapisms and blisters will be found
to diminish the mortality to a very inconsiderable proportion when
brought into action before the supervention of black vomit.

In conclusion, I beg to remark that the presence of a terrible pes-
tilence amongst us, and the necessity for immediate action, must
constitute "my apology for departing from strict medical ethics in
addressing the profession through the daily press.

Savannah, Sept. 3d, 1854. S. N. Harris, M. D.

Muriated Tincture of Iron.

To the Editor of the Morning News :

I feel very little inclination to obtrude my opinions, and especially
my medical opinions, on the community, through the secular press ;
yet, as many of my personal friends and patrons have desired an ex-
pression from me in regard to the use of the Muriated Tincture of
Iron in the existing epidemic, I cannot do otherwise than frankly
state, through the medium of your paper, that under certain circum-
stances it is a remedy of much value ; while in the great majority of

642 Editorial and Miscellany. [October,

the cases of yellow fever such as have fallen under my observation-
it was not only not beneficial, but absolutely injurious. 1 have given
considerable attention to the use of this remedy, as it was recommend-
ed to the attention of the profession by the able and accomplished Dr.
John Bell, of Philadelphia, in erysipelas, two years ago. Acting
upon his suggestion, I tried the remedy in that disease, and had rea-
son to bs pleased with its use when appropriately administered.
When scarlatina prevailed in this city during the past year, I used it
in that disease with much success, and published the more important
cases in the Charleston Medical Journal, conceiving the analogy, in
a pathological point of view, quite as striking between the present
epidemic and scarlet fever, as between the latter disease and erysipe-
las. I suggested the remedy to some of my medical friends before
the present epidemic made its appearance, and used it in three ruses
prior to the 15th August last. In some cases it proved a valuable
remedy, but, unless I am very much mistaken, it is not the particular
preparation of iron that should be used universally.

Iron I believe to be the very best remedy that the Materia Medio*
offers us in yellow fever, but it must be borne in mind that it has sev-
eral preparations, and these preparations may be used in conjunction
with other remedies, so, as when judiciously combined, to meet all
the indications for iron. I do not believe in specifics in medicine, nor
in the indiscriminate use of any one remedy or combination of reme-
dies, in any particular form of disease.

Every practitioner must have met with cases in which a remedy of
known efficacy in a particular form of disease quinine for example
in intermittent fever was wholly inadmissible, yet quinine is perhaps
the very best anti-periodic known. How then is it possible that the
Muriated Tincture of Iron is the remedy when in yellow fever the
liver in one case, and the kidneys in another, refuse to eliminate or
secrete the bile or urine. Would it not be more in accordance with
reason and therapeutics to select some preparation of medicine. Iron,
if you please, in the first place, calculated to relieve the one or other
of these conditions, and not apply the same remedy, regardless of these
or other functional derangements. I have kept such notes as the
pressure of business would allow, of several of the more important
cases of yellow fever, which have fallen under my observation, with
the treatment, &c, with a view of publishing them through a Medi-
cal Journal. H. L. Byrd, M. D.

Mortality among the Physicians of Savannah. We regret to find
among the victims of the epidemic prevailing in Savannah, the names
of Drs. P. H. Wildman, F. W. Schley, S. N. Harris, T. M. Ellis,
and C. H. Welles.

Professors Bartlett and Sweet, of New York. We regret to
learn that the ill health of this distinguished teacher (Prof. Bartlett)

1854.] Editorial and Miscellany. 643

will prevent his lecturing next week. It is also intimated that Prof.
Sweet will not be able to discharge his duties in the University.

Gastroiomy. Dr. John T. Gilman, of Maine, reports intheAmer.
Journ. of Med. Science, an interesting case in which Gastrotomy was
performed twenty-one hours after rupture of the uterus, and a dead
child removed from the abdominal cavity, with successful result.

Removal of the Astragalus. Dr. F. M. Robertson, of Charleston,
S. C, has successfully removed the astragalus, in a case of irreduci-
ble dislocation. (Am. Journ. Med. Sc.)

" The People's Gazette," edited by Dr. Davis, of Abbeville, S. C,
has been discontinued.

Circular. The undersigned, having been appointed by the Ameri-
can Medical Association, to report upon "the physiological peculiari-
ties and diseases of negroes," invites communications upon the subject
from the physicians of the Southern States.

A. P. Merrill, of Memphis, Tenn.

Gleet. The '' Rep. de Pliarmacie" recommends the following pre-
scription as being useful in gleets of long standing. R. Pulv. secale
cornut , 5j.; ferri sulp., gr. j. ; camphorae, vanillse, aa gr. ss. M. et
to divide in chart., No. xx. One to be taken morning and evening.

[Boston Med. and Surg. Jour.

Tooth-ache. An American practitioner recommends a solution of
copal in chloroform, as a specific in tooth-ache, dependent on caries.
The cavity of the tooth is washed, and filled with a bit of cotton dip-
ped in this solution ; the pain disappears as by enchantment. Cos-
mos. [Va. Med. fy Surg. Journal.

Haemorrhage from Leech Bites. Lastelle, in the Repertorie de
Pharmacie, suggests the use of the carbonate of iron in obstinate hae-
morrhages from leech bites, and states that it is very effective. [lb.

Leucorrhoea. M. Arendt, a German physician, states that he has
generally been able to cure ordinary cases of leucorrhcea in three or
four days by weak injections of creosote He uses two drops to the
ounce of water, repeating twice or thrice a day. Some mucilage, we
think, ought to be added, to make this a proper mixture. [lb.

Transparent Cement. According to Leuhers Belgique Industrielle,
this may be prepared by dissolving 75 parts of caoutchouc in 60 parts
of chloroform, and adding to the solution 15 parts of mastic. [lb.

644 Editorial and Miscellany.

Anasarca. In the dropsy which supervenes upon scarlatina, Prof.
Mauthner, of Vienna, {Journal fur Kinderkrankhcilen,) employs with
success urea, or else the nitrale of urea, as a powerful diuretic. The
dose of this remedy is the third of a grain, given in powder with sugar,
every two hours. [lb.

Cure of Itch. Take finely powdered brick dust and rub the body
well with it, so as to expose the acari to the sulphur ointment, which
is then to be applied ; the friction to be carefully kept up for half
an hour. After this the patient is subjected to a good ablution of
soap and water. The whole time occupied by this proceeding i9 less
than an hour and a half. A perfect cure will be the result. [lb.

Hiccough. After sugar and water have failed, Raver advises that
the pharynx should be touched with a pencil dipped in liquor ammonia.
On the continent it is common to administer syrup of currants, or the
vinegar of beer; different etherial preparations, and Hoffmann's ano-
dyne liquor especially, are relied on by many physicians ; some
authors advise chloroform in potion and even in inhalations. Dr.
Ossieur states, in the Ann. Med. de Roulers, that having treated a
case of hiccough, which had lasted for eight days, with the remedies
we have enumerated, without success, he finally checked it by ad-
ministering fifteen drops of aromatic sulphuric acid, with forty-five
drops of currant syrup in three table-spoonsful of water, every half
hour. [lb.

Purpura Hemorrhagica. Dr. George Willis [Edinburgh Monthly
Journal) reports a case of purpura which was promptly cured by the
administration of oil of turpentine. This case corroborates the opin-
ion of Nelligan in respect to the efficacy of terebinthinate preparations
in this disease, which has been advocated by Dr. Patterson, in the
March No. of this Journal. (See vol. ii., p. 483, et seq.) lb.

Chloroform Vapor in Tenesmus. Ehrenreich relieves the tenesmus
of dysentery by the vapor of chloroform passed into the bowel through
a syringe and common canula. [N. Y. Journ. of Med.

Belladonna in Salivation. Erpenbeck used the extract of bella.
donna, grs. ij ss. in an emulsion in 24 hours with perfect relief. [lb.

Vlcer from Irritation of Nails. Mr. Ure applies a hot saturated
solution of alum continuously to the part. This induces rapid absorp-
tion of the thickened cuticle and prompt cicatrization of the ulcerated
surface. [lb.

The Hahneman Hospital. This institution has ceased to exist:
furniture and effects were sold by auction, on the 14th inst. by Messrs.
Debenham and Storr. It has scarcely carried on its miserable exist-
ence even for the time which we allotted it. [London Lancet

SOUTHERN

MEDICAL AND SURGICAL
JOURNAL.

Vol. 10.] NEW SERIES. NOVEMBER, 18*4. [No. 11.

ORIGINAL AND ECLECTIC.

ARTICLE XXXII.

Remarks on Roseola, fyc. By G. T. "Wilburx. M. D., of
Brownville, Alabama.

Dr. Dug as In the July No. of your Journal is found the
following extract :

" We have had an eruptive fever here for a month or two,
and I understand you have had the same, or a similar disease,
in Augusta. There is diversity of opinion among the 'faculty'
here, as to its character. I think the majority of the cases are
Roseola, and a few cases of Scarlatina ; the other physicians
say. it is all Scarlatina. If you have had the same epidemic in
Augusta that we have had. I, for one, would like to have your
views on it through the Journal.'"'

The disease here spoken of, of a similar one, prevails to a
considerable extent in this section. The majority of the cases
were Roseola none Scarlatina. I have notes of the cases at-
tended, which were taken at the bed-side. The first case within
my neighborhood I did not see, but I noted its details from the
description of it by the patient, who is quite an intelligent lady.

Case 1. Miss M. W., aet. 22 plethoric had visited a fami-
ly some distance from her residence, and remained some four
or five days. About a week after her return, she felt unwell.
Several children of the family visited had what was supposed
ed to be scarlatina. She expected to be similarly affected.

Symptoms. Fever, sore throat, head-ache, cough; tongue,

n. s. vol. x. NO. xi. 41

640 Wilburn's Remarks on Roseola. [November,

gums and teeth were sore; some swelling of the throat; red
spots first appeared upon the face and spread over the entire
surface, irregular in form, producing a burning, smarting sensa-
tion. No sloughing, no scales, no roughness of the skin. The
efflorescence continued nearly a week. Felt relieved after the
disappearance of the spots. She did not take anything, and got
well in a week.

Such are the symptoms as related by the patient, and I do
not think that any intelligent physician would select this as a
case of scarlatina. It is to my mind a case of roseola estiva.

Case 2. Miss E. A., aet. 10: Sanguine temperament; fine
figure, robust, and of good constitution; complains of giddiness
and head-ache; considerable thirst ; distressed with heat, and
aching of her limbs: tongue slightly furred; costive: restless.
No efflorescence discovered on first visit. Considering it. how-
ever, a case of roseola, I gave an emetic of ipecacuanha. On
the second visit, found the rose-colored efflorescence over the
entire surface, and variously figured some very small, others
as large as a half dollar. Gave no medicine; she recovered in
four or five days.

This case differs slightly from the first, though I think the
disease the same.

Case 3. Miss D. P., aet. 28 : Nervous temperament ; not
very healthy. Complains of constant and acute pain in the
head ; aching of the eyes ; general weakness ; loss of appetite ;
flushing of heat ; the pulse full; head hot; bowels costive; pe-
riods irregular no efflorescence discovered. Considering the
attack due to costiveness and irregular menstruation, I bled
freely ; applied a cataplasm to the spine, gave a cathartic, or-
dered mustard foot-bath, and hip bath at night. On second
visit, discovered spots about the face and neck, arms and hands.
The efflorescence was not general and soon disappeared, leav-
ing the patient in more distress than at first. Every attempt
failed to reproduce the eruption. The headache continues in
despite of every remedy.

Of the nature of this case I am not satisfied. That it was
partly due to the arrest of the catamenia cannot be denied; but
that this arrest was the cause of the efflorescence is another
question. I leave this to the savans.

1854.] Wilburn's Remarks on Roseola. 647

Case 4. Miss S. W., set. 6 : Nervous temperament ; gen-
erally healthy. Complains of pain in the right side; breathing
short and quick ; pulse full ; some fever. Considering it an at-
tack of pleurisy, cupped and scarified the affected side; ordered
warm poultices; gave ipecac and veratium; ordered the ascle-
pias. On second visit, after removing the poultice, discovered
small red spots. She was greatly relieved. Attempted, by
warm baths and an emetic, to produce general efflorescence.
Did not succeed. Continued the aselepias the efflorescence
of the side continued five days, and the case gradually conva-
lesced.

Manv more cases have occurred within the limits of my
practice ; but these are a fair selection of the varieties which
have been observed. Many patients I have not treated at all,
and they recovered in about the same time as those who were
treated. I am firmly of the belief that these cases are neither
scarlatina nor rubeola.

Bateman, in his synopsis, gives the following as the symp-
toms of roseola. The roseola is a rose-colored efflorescence,
variously figured, without wheals, or papulae, and not conta-
gious. He then mentions seven varieties: R. aestiva, R. au-
tumnalis, R. annulata, R. infantalis, R. variolosa, R. vaccini,
R. miliaris. Of Roseola aestiva, he says : " Roseola aestiva is
sometimes preceded for a few days by slight febrile indisposi-
tion. It appears first on the face and neck, and, in the course
of a day or two, is distributed over the rest of the body, pro-
ducing a considerable degree of itching and tingling. The
mode of distribution is into separate small patches, of various
figure, but larger and of more irregular forms than in the
measles, with numerous interstices of the natural skin. It is at
first red, but soon assume^ the deep roseate hue peculiar to it.
The fauces are tinged with the same color, and a slight rough-
ness of the tonsils is felt in swallowing. The rash continues
vivid through the second day, after which it declines in bright-
ness, slight specks only, of a dark red hue, remaining on the
fourth day, which, together with the constitutional affection,
wholly disappear on the fifth."

The first case related appears to give the disease a conta-
gious nature. She had visited a family where the disease was

648 jMusgrove's Case of Stabbing. [November,

prevalent, and in seven or eight days after she is attacked in
like manner. But I should have added, whilst stating that case,
that none of her sisters or brothers contracted the disease,
though she was constantly with them. This case, therefore,
cannot be considered as a violation of Bateman's and Wi Han's
rule that the disease is not contagious.

I believe all writers upon the Exanthemata freely acknow-
ledge, that the efflorescence of Roseola is frequently partial, and
that its retrocession is accompanied by headache, giddiness,
disorder of stomach, &c. This remark may serve to reconcile
the anomalous cases which 1 have related, and to sustain the
opinion that all are but varieties of Roseola.

These thoughts I have hastily grouped together, and. in your
own language, if what we have observed here does not accord
with the experience of other Southern practitioners, we would
like to be apprized of the fact.

AETICLE XXXIII.

Case of Stabbing Reported by W. C. Musgrove, M. D., of
Burke county. Ga.

Dear Doctor In the August No. of the Journal I notice a
communication from an old chum, which reminds me thnt we
physicians should be true to our profession, by aiding and pro-
moting the advancement of the science. How may this he
done ? By drawing upon the note-books of Southern physi-
cians, many interesting cases may be bronght to light, and
valuable points of practice deduced therefrom.

In sending you the within case, I must acknowledge that it
was in some respects unsatisfactory, as, owing to the nature of
the wound, no opportunity was afforded me for a correct ana-
tomical examination.

J. A. S., (white,) set. 25; robust, weighs 180 lbs.; intemper-
atewas stabbed, on the 28th December, 1852, at 4 P. M., in
the right side of the neck, with a knife, the blade 3} inches long,
J inches wide, TVth thick on the back ; the wound was diagon-
ally across the external jugular vein, which was divided .
The direction of the wound could not be ascertained, owing
to extreme hemorrhage. The wound was, as before stated, on

1854.] Musgrove's Case of Stabbing. 649

the right side of the neck, about midway, and lj inches above
the clavicle. The thrust was an over-thrust, and the only re-
sistance met with was a very thin silk cravat, which was
through in its upper edge; the violence of the blow was such
that he was thrown back several paces. He was not aware
where he was struck ''crying out that his hand was cut all to
pieces.'5 The hemorrhage was excessive, spirting from him
some three feet. Being present, and from the alarm of those
about him not having any aid. I applied my fingers to the
orifice, and in ten seconds he fell. Compression, in this man-
ner, was applied for two hours, when a coagulum having form-
ed, the edges of the wound were brought as near together as
possible, compresses and bandages applied, morph. sulph., in
| gr. do<es. was given every two hours until 2 grs. were taken.
(He had been under alcoholic influence for several days previ-
ously.) He slept well until 3 o'clock. A. M., when he became
agitated, the pulse quick, small and tremulous; owing to jactita-
tion the bandages became displaced, and hemorrhage recurred,
which, however, was soon arrested. Brandy was now given;
his pulse soon reacted, became full and soft remained quiet
during the night.

Dec. 29. Assisted by my friend. Dr. Hainey. the compresses
were removed, and the wound was found to be filled by a strong
coagulum; the lips of the wound were brought together by two
sutures, and light compresses and bandages applied. At 3
o'clock. P. M.. patient was removed home, (in an ox-cart, filled
with fodder, upon which a mattress had been placed,) a distance
of three miles: he bore the trip well better thrn I anticipated :
a slight oozing from the wound. Ordered 1 oz. sal. eps. lit
moved because the affray occurred at a grocery, where
no accommodation could be afforded.

Dec. 30. There is some febrile action ; complains of numb-
ness of the fingers and fugitive pains in the right side ; no
cough; great thirst ; no movement of the bowels. R. sal. eps.
1 oz. ; acidulated drinks in small quantities.

Dec. 31. Cathartic has acted finely ; the febrile symptoms
have passed away: the pain in the chest removed; arm much
less painful. The wound examined; healing finely, and the
coagulum nearly absorbed.

650 Rives's Cases of Dysentery. [November,

January 3. Patient has been doing well, cpagulum nearly
gone, size of an ordinary bullet; previously as large as a guinea
egg ; some numbness of the arm. Consider him out of danger.

August 27, 1854. Patient convalesced, and has been pursu-
ing his ordinary avocations, but an unfortunate sequent has
been the result ; the fingers of the right hand have become very
much contracted, particularly the '2d, 3d and 4th; there is no
wasting or loss of muscular substance.

The blade of knife presented to the scapula, and if my
anatomical views are correct, the knife after dividing the ex-
ternal jugular | must have touched the subclavian without
penetrating, the back of the knife passing across the artery and
penetrating the ti Death the scapula and wounding

some portion of the brachial plexus, perhaps the flexor and ulnar
nerve.

ARTICLE XXXIV.

Cases of Dysentery. Reported by B. R. Rives, M. D., of

Milford, Baker county. Ga.

Dear Doctor I have for some time wanted to write to you
on the subject of Dysentery, as it has been, and is now prevail-
ing in various portions of the State: but owing to the short
time that I have been engaged in the business of the profession,
together with the limited number of cases that have been con-
fided to my care, I have hesitated doing so until now. How-
ever, since noticing your article on the subject, in the August
No, of the Journal, I feel relieved, to some extent, of the em-
barrassment I would have labored under in giving my views,
with the treatment I have found to be invariably successful,
so far.

The disease was said to be raging to a frightful extent in the
adjoining counties, and hard by our own neighborhood, for some
time before it reached the bounds of my practice. The follow-
ing cases are related from memory, as I took no notes at the
time. They will, however, suffice to the end in view.

Case 1. Mr. N., on the evening of the 23d of July, 1853,
called on me to prescribe for his child, aged 18 months: he

1854.] Rives' 's Cases of Dysentery. 651

stated that it had the fever and bowel complaint. I prepared
him some paregoric and chalk, to control the bowels, and order-
ed quinine next morning to meet the fever, requesting him to
let me know if it got no better.

On the evening of the 25th, I found it with high fever pulse
150; tongue rather dry and coated, edges and tip very red ;
stomach distended ; would rest for a few minutes on one side,
and then turn rapidly over on the other ; countenance marked
the degree of suffering ; bowels acting every five or ten min-
utes ; character of stools would change alternately from bloody
mucus, with or without fecal matter, to bloody serum, with but
little or no faeces.

Treatment. Calomel and opium ; laudanum, camphor, pare-
goric, and chalk; tannin; chalk and gum-water as a common
drink ; starch and laudanum injection; warm bath and warm
fomentations to the bowels, were all used in their turn, up to the
night of the 26th, when the child died.

Case 2. July 25th. Mrs. B.'s child, aged2 years, was taken
in the same way as case 1st. Treatment, about the same ; ter-
mination the same.

Case 3. August 1st. In this case the writer had himself to
treat. I was just convalescing from an attack of intermittent
fever, when taken with dysentery. Knowing that I had been
unsuccessful in the cases above reported, and that my condition
was such as demanded speea'y relief, I determined upon trying
the saline treatment, and accordingly got a tumbler half full of
cream of tartar, added water to it, and swallowed the whole at
one draught. The result was,, that in about two hours I had a
copious serous discharge, unaccompanied with pain or tenes-
mus, freed from all griping in a word. I was relieved of all the
distressing feelings I had previous to taking the medicine. Af-
ter suffering it to act three or four times, I found no difficulty
in checking it with laudanum. I was annoyed but verv little
the next day, and, without taking anything else, was soon well.

After this, I treated seven other cases, in rapid succession,
the same way. and with like success. It would be well,
perhaps, to remark, thai these enses were seen at their very
onset, and that they were accompanied with neither nausea nor
bilious vomiting.

652. Rives's Cases of Dysentery. [November,

Case 4. August 12th, 1854. Mr. E., aged 44 years, constitu-
tion much impaired, commenced throwing up al 9 o'clock A. M.
3 P.M. Still throwing up, and passing blood from the bowels,
with much pain and tenesmus ; frequent desire to go to stool ;
griping of the bowels ; thirst urgent ; tongue rather dry and rod.

Treatment. Attempted to allay the vomiting, which 1 par-
tially succeeded in doing with internal remedies and mustard
externally. Then gave a large dose of cream of tartar, which
soon caused serous discharges and a manifest improvement in
the symptoms. Ordered morphia to be given, so as to allay all
pain and to keep the stomach quiet, and if his bowels should
again become active, to give laudanum after each stool.

13th. All the symptoms had greatly improved ; bowels had
not been disturbed; passed a good night, and thought he would
soon be up.

17th. In the same condition as the 12th, except that he had
considerable fever. Ordered a large dose of cream of tartar,
with instructions to give laudanum after it acted three times,
in order to check it. Morphine and sinapism, if necessary, to
quiet the stomach ; and quinine (15 grains) to be taken in three
portions, at intervals of three hours, commencing at sunrise to-
morrow. Under this treatment he soon convalesced.

Case 5. August 20. Was requested to see the Rev. T. C,
aged 55 : found him having alvine evacuations, every ten or
fifteen minutes ; character of discharge the same as in first case
reported; some nausea; tongue heavily coated, with point and
edges red; pain in bowels; tenesmus great; some fever ; had
been sick for several days. Ordered cream of tartar in full
dose ; in four hours had serous discharge, but was not entirely
free from griping. After three or four serous actions the bow-
els were checked, as in the other cases, with laudanum. Elm
water was used as a common drink. As he had great aversion
to quinine, I did not prescribe any for him the next day. The
case went on gradually improving; but was rather tedious, and
he had on the 24th to take another dose of cream of tartar.
Morphine was used all the time to allay pain. He soon conva-
lesced after the second dose of the saline, and is now well.

In conclusion, I must say, that I firmly believe that quinine,
cream of tartar, laudanum, morphine, and elm and chalk water,

1854.] Headache and its Varieties. 653

are all the remedies needed in the treatment of dysentery.
Mustard may be used over the stomach, and cups applied to the
back of the neck when the head is affected, &c, &c. ; but in
most of the cases cream of tartar and quinine will do alone.

On Headache and its Varieties. By Patrick J . Muephy, M.D.

(Concluded from page 554.)

Active Congestive Headache. By active congestion is
meant plethora, or too much blood within the cranium. It
differs, however, widely from passive congestion. In the for-
mer, the arterial system is in lauli ; in the latter, the venous.
In the one, there is too much blood sent to the brain ; in the
other, the blood moves too slowly in the veins. Arterial ful-
ness shows power ; venous distention is an evidence of obstruc-
tion or weakness.

Causes. A general plethora, in which the brain shares ;
hypertrophy of the left ventricle; adhesion of the pericardium,
when menstruation is ceasing.

Diagnosis. This form of headache is easily diagnosed, either
from the organic causes or the symptoms of constitutional
plethora, as the full habit, the florid complexion, the incompres-
sible pulse, the resistance to cold, the giddiness attendant on
stooping the head, and the obtuseness of hearing. This habit
of body is oftentimes the precursor of gout. The heart should
always be examined, especially if the person has passed his
fortieth year; and before the twentieth year, adhesion of the
pericardium from rheumatism is more frequent than is usually
believed. The pain of the head is trifling, unless when the
heart is in fault.

Treatment is almost obvious, but it is very difficult to change
a plethoric constitution. We should recommend moderation
in diet, especially in animal food ; abstinence from alcoholic
drinks, and from any other liquid ; the lessening the hours of
sleep; to lie with the head high; to avoid much stooping, for
a temporary apoplexy is not rare in those who stoop and exert
themselves to pull on their boots; not to wear any thing tight
round the neck, and to exercise as much as possible in the open
air.

If there be a persistent giddiness, ten 6r twelve ounces of
blood may be taken from the nape of the neck bv cupping, or
from the arm. If an issue or seton be deemed advisable it will
be better to insert it in the left arm than in that most inconve-
nient part the nape of the neck. The tinctures of digitalis or

654 Headache and its Varieties. [November,

or hyoscyamus will be found useful, also pills of ipecacuanha,
or nauseating doses of tartar emetic. Dr. Cheyne's favorite
remedy was the pulvis antimonialis.

The sick headache, to which females are such martyrs when
menstruation is ceasing, comes under this denomination of
headache. It comes on at their usual period, but the menses
either cease flowing, or escape very scantily ; it is very dis-
tressing, and attended with an inclination to vomit, hence the
expressive term sick headache. The face is flushed, the appe-
tite lost, and the temper disturbed. It will be found both a
preventive and cure to take blood, for several periods, either
by lancet or otherwise, some days previous to the attack ; to
keep the bowels very lax, especially with the acetous extract
of colchicum and saline purgatives; setons and issues are wry
useful when inserted in the lower extremities ; the diet must
be moderate ; the feet kept warm, and exercise prescribed.
During the attack, the feet placed in very hot water, and sinap-
isms to the lumbar region give great relief. Vomiting, if
spontaneous, sometimes relieves, but an emetic often fails. In
treating females, no matter what the disease may be, it should
never be forgotten that it is exasperated, and a headache some-
times added a few days previous to menstruation.

The Neuralgic Headache. Neuralgic headache is synony-
mous with those headaches described by some old authors as
hemicrania, by others as clavus hystericus, and by Dr. Graves
as hysterical congestion. It is peculiar to females, and to fe-
males during a certain period of their existence only from
puberty until the final cessation of the menstrual secretion.
Dr. Graves gives a graphic description of the symptoms and
of the injurious effects of the usual routine treatment. lie
calls it hysterical congestion ; but he seems not to have under-
stood its true pathology. There is no doubt of its being hys-
terical, but there is no congestion, for the seat of the pain is in
one of the nerves of the scalp, which can be easily proved by
a slight examination, and it is therefore an external headache.
The error may have arisen from his having met with cases
where this headache was in combination with the anaemic
headache. The proper name which should be bestowed on
this headache, in order to facilitate the diagnosis, is spinal irri-
tation of the sub-occipital nerve. Spinal irritation is beginning
to be well understood in this country; we are indebted to a
French physician, M. Valleix, for the discovery. Since then
manv other disorders, such as irritable mammae, pleurodyne,
and neuralgic headache, are discovered to originate in func-
tional derangement of the spinal cord ; and I believe whoever

1854.] Headache and its Varieties. 655

will carefully compare these disorders with cases related by
Dr. Tilt must come to the conclusion that they are nothing
more than symptoms of subacute ovaritis. They are hysteri-
cal disorders, and hysteria is subacute ovaritis, which displays
its phenomena on the sensitive and motive nerves of the spinal
column.

On comparing the neuralgic headache with the phenomena
of spinal irritation in other parts, we find how exactly they
coincide. Like spinal irritation, it is a form of hysteria, and
therefore peculiar to females. It is not only peculiar to fe-
males, but attacks them only during the menstruating period
of their existence that is, from about the thirteenth to the
fiftieth year. It is exacerbated just previous to menstruation,
makes its first attack on the left side, and rarely passes over to
the right side.

Cause. As this form of headache is peculiar to the female
sex, it must therefore have its origin in some organ peculiar to
them ; and as it is felt during a certain period ot existence
only, the organ must have the performance of its functions
limited to that period. As there is no organ by which these
two facts are explicable, unless the ovarium, it is not unphilo-
sophical to conclude that the disorder proceeds from the ova-
rium. There is certainly also the uterus, but the functions of
this viscus cease on the removal of the ovaria. We daily meet
with the uterus inflamed, ulcerated from cancer or cauliflower
excrescences, distended by hydatids or pregnancy, producing
moles and polypi, but none of the phenomena of spinal irrita-
tion are present. In the married female who bears children
regularly it is scarcely ever known. Before the commence-
ment of menstruation, or after its termination, it is equally
rare.* What is the state of the ovarium I do not pretend to
affirm. If inflammation, yet it has often yielded to tonics ; it
may depend on moral causes, but such explanation has never
satisfied me. An accumulation of fasces in the rectum has
appeared to me as occasionally the source of irritation ; in a
few cases I think it was traceable to ascarides in the rectum.
We witness the action of cold in paralysing the trunk of a
motor nerve, the portio dura, as it escapes from its cranial
foramen, but cold cannot be a cause of this headache, otherwise
why should not the male sex equally suffer.

Occasionally spinal irritation, in other parts, has been ob-
served earlier in life, but I have not met with the headache ;

* "While wiiting the above, I referred to Dr. Tilt's work on Diseases of Fe-
males, fir>t edition, and in page 58, he gives the valuable fact, that he found the
right ovary affected in onlvfive out of seventeen cases. >'ow. it mightbe worth
inquiry to ascertain whether the left had not been previously affected, but that
the irritation was transferred to the right, as we see in ophthalmia occasionally.

650 Headache and its Varieties. [Nvember,

and, as the headache has occurred some years before the ap-
pearance of the menses, so I believe it possible it may arise a
few years alter their total cessation. The headache resembles
spinal irritation, also, in a curious and hitherto unexplained
phenomenon: commencing on the left half of the body, we oc-
casionally meet with it also on the other side ; but I have never
discovered that it began there, nor is it ever restricted solely
to that side. When both sides are attacked they are unequally
so, the left being by far the more painful. As another proof of
its being spinal irritation, if further proof be necessary, we find
it under two distinct forms, and these forms are easily distin-
guished by the nature and extent of the pain. In the one it is
confined to the exact track of the sub-Occipital nerve, it is lan-
cinating or shooting, intermitting, and chiefly felt at its deter-
mination in the integuments of the temporal region; when
severe in this spot it is the clavus hystericus. When the whole
course of the nerve and its branches are implicated the entire
left side of the scalp is very tender, sometimes exquisitely so;
this is the hemicrania. It is singular how much this disease is
confined to the left side of the head ; we find such to be the fact
in ninety cases out of a hundred. It seldom reaches the ag-
gravated form of clavus hystericus without being accompanied
with other well-known hysterical symptoms winch, of course,
facilitate the diagnosis.

Diagnosis. This headache attacks females exclusively. I
have never heard or read of men Buffering from tins kind of
headache. It is only during the menstruating period of life
that even females are liable. The pain is referred to the left
side of the head ; it is worse on the approach of the menstrual
flow; it is found on the track of the sub-occipital nerve. The
course of this nerve is well known ; it accompanies the sub-
occipital artery, emerging from the spinal canal ; it |
along the back of the head, midway between the mastoid pro-
cess and the mesial line, sending branches to the integuments
which cover the parietal protuberance, and terminating in the
temporal region. Its course from its exit to its termination,
can oftentimes be accurately ascertained, from the pain induc-
ed by pressing upon it. Although the head suffers, pressure
may not always produce the pain, for it is intermitting. In
general, however, pain may be thus detected in one of three
places; on the left side of the neck, where the head and verte-
bras join, at the parietal protuberance, or in the temporal re-
gion ; when concentrated in the last spot it is the well-known
clavus. It is sometimes painful in all three, and, sometimes in
its whole track. It is, however, rare that the tenderness is
absent in the occipital region. The parts suffer more when

1854.] Headache and its Varieties. 657

pinched than when pressed. When the branches as well as
trunk suffer, we then have hemicrania a most painful form,
less intermitting than the other, and preventing the unfortunate
girl from lying on the affected side. It is more commonly met
in the unmarried female, from the twenty-second to the thirty-
fifth year, but the married females who are childless do not
escape.

This headache is chronic, intermitting, may continue for
days, weeks, or months, then subside, and return after the lapse
of months, or even years. A first attack is seldom felt before
the twentieth year, nor after the thirty-fifth. The pain is gen-
erally of a shooting kind, darting from the neck towards the
temple, and never towaVds the neck, by which it is easily dis-
tinguished from odontalgic pain. Neuralgia of the left mamma,
(irritable breast,) or of the seventh or eighth intercostal, (pleu-
rodyne.) frequently co-exists. It is sometimes found in com-
bination with the anaemic, but more rarely with the congestive
headache. From caries of the body of a vertebia it is easily
distinguished by the pain being superficial, being confined to
the left side of the spine, by its not becoming worse when the
head is flexed on the chest, nor by jumping, nor by pressing the
head against the spinal column.

This neuralgic pain sometimes accompanies the rotated
spine. It is singular how often toothache is mistaken for head-
ache, especially for this form. In both, the pain is described
as shooting in the course of the nerves, but in toothache the
pain shoots towards the neck and ear, leaves no tenderness of
scalp, never goes so high as the parietal protuberance, and is
more correctly discovered by learning that a paroxysm is
brought on by food, sometimes when warm, at other times
when cold.

Treatment. If the disease be not complicated, we can pro-
mise relief. The bowels should be kept open by regulated diet,
and by aperients, such as castor oil, olive oil, lenitive electuary,
powdered rhubarb, soluble tartar, or the compound rhubarb
pill. If the bowels are obstinate, an enema of a pint of cold
water daily answers the double purpose of removing the con-
tents which may irritate the ovary, and as a local application
to the organ chiefly in fault. The cold hip-bath is a valuable
remedy when the constitution is vigorous, but all these things
are infeiior to sea-bathing. Stimulants should be abstained
from, employment should be found for mind or body, but physi-
cal efforts are preferable. The sedentary position required
by the needle, especially in solitude, is very injurious. A si-
napism over the exit of the nerve gives great temporary relief;
a vesicating planter of cantharides is better, but it oftentimes

058 Treatment of Cancer. [November,

leaves a mark, and therefore, on account of sex, age and posi-
tion in life, may be objectionable. A croton-oil liniment, made
with one drachm of oil and one ounce of camphorated tincture
of opium, and rubbed until pustules appear, is preferable, as it
leaves no permanent blemish. The belladonna plaster, mixed
with powdered opium, or a liniment of extract of belladonna,
rubbed with mucilage, are useful and unobjectionable remedies.
Speedy relief is occasionally afforded by vera trine or aconi-
tine ointment, made with from four to six grains to half an
ounce of spermaceti ointment. The finger used in rubbing
should have a piece of bladder interposed.

One ounce of tincture of aconite, with seven ounces of rose-
water, is a safer remedy to trust to inexperienced hands than
the veratria. The internal medicines are not so easily chosen.
Tonics are frequently required, and they may be combined
with anti-hysteric remedies. The disulphate of quinine may
be exhibited in a strong infusion of valerian, compound iron
pill, with asaafoetida in large doses, is very beneficial. If there be
irritability of the stomach co-existing with profuse menstruation
and leucorrhcea, pills of valerianate of zinc, hall a grain three
times a day, with one drop of creosote, answer many intentions.
If there be much debility, the sulphate of iron may be com-
bined with infusion of valerian and ammonia, or the ammoniated
tincture of valerian may be prescribed. The pain is some-
times so acute that some relief is quickly demanded, and half
a grain of morphine will lessen the pain for a while until other
remedies have time to act. For the leucorrhcea one drachm
of acetate of zinc to one pound of distilled water is useful as
a lotion. But we are sometimes perplexed, for ihe tonic treat-
ment is not the best for a full plethoric female; leeching or
even general bleeding is required, but the cases are rare which
require general bleeding.

If the patient be not very weak, and there is much leucorrhcea
and metrorrhagia, the treatment laid down by Dr. Tilt for sub-
acute ovaritis should be adopted. He leeches in the menstrual
interval, and then blisters the iliac regions ; but as his work is
universally read, the treatment is well known. Sea-bathing,
when practicable, should never be omitted, [London Lancet.

On the Treatment of Cancer by Congelation ; and Local
Ancestkesia from Cold. By James Arnott, M. D.
(Continued from page 546.)
It has unfortunately resulted from the circumstance of ex-
treme cold having been recommended as a mode of producing
insensibility in surgical operations, as well as a remedy of great

1854.] Treatment of Cancer. G5lJ

antiphlogistic and anodyne powers, that the sphere of its action
in the latter capacity has been reckoned much more limited
than it ought to have been. It is true, that complete insensi-
bility cannot be produced by the common frigorific mixture,
and without the aid of pressure, or the arrest of the circulation
for a time, beyond a very small depth from the surface ; but its
remedial efficacy will extend as deep, at least, as the depression
of temperature produced, and this may be much more exten-
sive than the insensibility. Consequently, when in a recent
criticism of my publication on the impropriety of using the
dangerous expedient of chloroform in cases where cold might
be safely substituted, and with other advantages in addition to
its anaesthetic power, the reviewer would limit the remedial
action of congelation to erythema, boils, and other cutaneous
inflammations, he shows that he has not reflected on this cir-
cumstance ; and that he is not better acquainted with the effects
connected with the remedial use of severe cold than he is with
the important fact in connexion with its anaesthetic use, that in
at least three-foui ths of the reported 50 cases of sudden death
from chloroform, (and probably in as large a number of the 150
unreported cases,) complete anaesthesia might have been safely
produced by it.* If cold 60 or 70 above zero Fahr. is em-
ployed with well-merited confidence in diseases of the joints,
in gun-shot and other severe wounds, in inflammation of the
brain or its membranes, in ophthalmia, in phlegmonous erysip-
elas, and, in fact, in all external inflammations, surely it is not

unphilosophical to suppose (to say nothing of the results of ac-

, , w .

* Medico- Chirurgical and British and Foreign Revieic, for April, 1854. There
are other statements and opinions in this notice of my pamphlet equally objec-
tionable which it would be irrelevant to mention. But if the reviewer's admis-
sion, that congelation is "a very valuable remedial measure" in the disease
he mentions, and that the pointing it out as a substitute for chloroform in cer-
tain minor operations is "conferring a great benefit on operative surgery" if
these admissions are generally acted upon, I cannot doubt that the sphere of its
utility will soon be extended ; that many dangerous diseases will be promptly
cured by it; many formidable inflammations prevented, and many lives saved
that would be otherwise sacrificed by chloroform Before concluding these re-
marks on cold as a local anaesthetic, I may be permitted to rcler to some exper-
iments connected with this subject lately made in the Hotel Dieu, of Paris, and
recorded in the Gazette des Hopitaux of the 18th ult. Cold in these was produ-
ced by the evaporation of ether. Although it matters little how the principle is
carried into operation, if carried out effectually, I think Irisorific mixtures,
appropriately modified, will be tound the best plan, and certainly the least trou-
blesome. Amongst other devices that might be adopted, it has occurred to me
that a continued jet of air, cooled to the requisite degree, mi?ht be projected on
the part from a gasometer; or the air might be cooled by passing through small
tubes of sufficient length immersed in a frigorific, or, through a tube containing
solid carbonic acid, connected wiih a gasometer of French bellows The pro-
bable benefit from intense cold, in certain important cases where the ordinary
means of applying it cannot be employed, as in inflammation of the larynx,
would in the opinion of a conscientious practitioner, render the trouble and
expense of such a device no legitimate objection,

660 Treatment of Cancer. [November,

tual experience) that a cold of zero would produce a greater
amount of benefit ; and, to return to the subject of this paper,
if much benefit in cases of cancer has been produced by com-
mon refrigerating lotions, much more might have been expected
from pushing farther this therapeutical principle. The effect
of congelation is merely the fulfilment of the surgeon's inten-
tion when he applies cold in the common modes, but he has
hitherto never attained his object because he has always (ever
since the origin of the medical art) been under the erroneous
notion that a severe degree of cold applied, for however short
a period, would endanger the vitality of the parts subjected to
it. The mistake has originated from making no distinction
between short and lon applications of extreme cold.

Every one knows that long-continued congelation will de-
stroy the vitality of a part, and M. Velpeau has used such con-
gelation with this view in certain cases of cancer. In his re-
cently published work on Diseases of the Breast, he speaks
approvingly of this practice;* but though whatever is appro-
ved by a surgeon of his great and justly acquired celebrity is
entitled to every consideration, my own experience convinces
me that the minor effects of short congelation, produced with-
out the slightest hazard to the vitality of the skin, would, under
ordinary circumstances, and if properly carried out, be perfectly
sufficient. It is true that in certain cases, where the only alter-
native would be the use of the knife or caustic, such a proceed-
ing might be preferable to either ; but cases of this description
must be of rare occurrence.

It is almost unnecessary to mention that M. Velpeau makes
a marked distinction between long and short continued congel-
ation. In enumerating the various operations in which he has
employed the latter as a local anaesthetic, he does not deem it
necessary even to allude to the perfect safety, as respects the
vitality of the skin, with which it may be employed for such
purposes.

In the following case of scirrhous cancer of the breast, the
tumour was not only larger, but it was more deeply seated in
the breast than in that related in the former number of the
journal, and consequently there has been more difficulty in
causing the remedial influence of congelation to pervade it.
It constitutes, however, a better example of the mere arrest of
the disease, for I have little doubt that had the other case con-
tinued under my own immediate care, all trace of cancer
would have soon disappeared ; and the case now to be related
would, I think, have made quicker progress to recovery had the
treatment been modified.

* Maladies de Sein (p. 677), par A. Velpeau, Membre de l'lnstitut., &c.

1854.] Treatment of Cancer. 661

It was early in May of last year that I was consulted on this
case. The patient had previously left her residence in Kent
to ask the opinion of Mr. Lawrence, who not only agreed with
her usual medical attendant that the tumour in the breast was
cancer, but said that unless she immediately submitted to its
excision, it might prove fatal wilhin six months. She preferred
the treatment by congelation. On examining the breast, I
found a hard, flattened, hemispherical swelling, of about three
inches diameter, knotted on its surface, contiguous with, but
not adhering to the skin, excepting at the nipple, which was
retracted and slightly ulcerated. There was at times a lan-
cinating pain. The disease had existed more than two years,
and although the usual routine had been had recourse to, no
kind of treatment had appeared to be ofany service. The dis-
ease gradually but steadily progressed.

The frigorific mixture of ice and salt was applied for about
four minutes, the usual precautions being taken to prevent the
smarting that would otherwise take place on the return of sen-
sibility to the parts which had been congealed. A similar
application was repeated about every month by her medical
attendant in the country; and after about six such applica-
tions I again received a visit. The tumour appeared to be
smaller than when I first saw it, the decrease being chiefly
in its thickness ; and in other respects there was great im-
provement. She continued the same plan of treatment, and
the principal results are recorded in the following extracts
from a letter which I have lately received from her, dated
April Gth :

The substance of this letter is, that the tumour continues of
nearly the same dimensions; though it appears to be a little
longer, it is less thick. She has not "for the last four months
known what a bad night is, being always free from pain,"
though during the day there is, "at times, three or four, or
perhaps more, transient pains, while, at other times, she passes
some days without any pain.'"' Her "general health is very
good, and is kept good by regular exercise in the open air."
As I had expressed the opinion that she should make longer
intervals between the applications than a month, in order to
ascertain whether the tumour was not now merely a lifeless
mass, like a bullet in the flesh, which might give occasional
uneasiness, particularly when the mind was intent on the sub-
ject, she states, in reply 'Five weeks have intervened be-
tween the last applications; I have these renewed, because,
while I feel there is life in the tumour, I think they are neces-
sary." She concludes a letter written a month previously
(March 4th) by the expression of a wish "that every sufferer

N. S. VOL. X. NO. XI. 42

602 Treatment of Cancer. [November,

from the same disease were as happily delivered from the effects
of a cancer as she has been by this remedy."

As in almost every case which I have treated by congelation
a certain degree of hardness and swelling remained alter the
disappearance of other symptoms, it is important to investigate
the cause of this. On the supposition that cancer is essentially
a congeries of living cells, we may reasonably think that the
absorption of these, after their vitality has been destroyed,
must be slow, if it takes place at all ; and perhaps the irritation
that has induced patients to apply for the frigorific application
afresh, may have proceeded from the presence of this inert
mass of dead cancer-cells. J should be sorry, however, to
think that the absorption of these never takes place, because
in a voluminous congeries of cells it were difficult to under-
stand how the cold could reach the inner surface of the mass
without the absorption of the more superficial layers having
previously taken place after the extinction of the life of the
cells constituting them ; unless, indeed, the layers of dead cells
were to form so good a conductor as scarcely to resist its pas-
sage. But in their living state, the tumour in which they are
interspersed is so dense and so little intermixed with blood-
vessels as to form a substance easily permeable by cold as
easily, perhaps -tic tumours are, the fluid contents of

which I have congealed in applying cold to them, as an anaes-
thetic, previous to their excision.

If it be objected to the cases which I have now related that
they do not furnish satisfactory evidence that cancer is com-
pletelv curable by cold, they show, at least, that it will produce
much more benefit in this disease than any other remedy. If
an unequivocal cancerous tumour subjected to this treatment,
instead of increasing in size, gradually decreases, while the
patient becomes free from pain (excepting such uneasiness as
a mass of dead cancer-cells might excite), and the general
health improves, if no glandular enlargement takes place in
the armpit, or extension of the disease to any other part ap-
pears, and if this condition continues without change for along
period, it is surely a very satisfactory change in the patient's
condition. I question much if it be possible entirely to re-
move the hardness in the majority of such cases, but this hard-
ness is no proof of the presence of malignant affection, and no
source of inconvenience to the patient. What other remedy
yet employed in cancer will effect as much ? Too many of the
measures employed as remedies only precipitate the unfortu-
nate patient's fate.

Before concluding this paper, I must advert to a statement
which appeared some time ago in a medical journal, that a pa-

1854.] Treatment of Cancer. 663

tient had been seriously injured by a prolonged application of
ice to her cancerous breast of upwards of twenty-four hours.

As every one has not yet learned the essential difference
between the application of ice and congelation in disease, it
may be advisable now briefly to point it out; and as the sub-
duing of the inflammation usually accompanying cancer is one
of the objects in using either of these methods of treatment, it
may simplify the matter to speak of this difference as respects
their use in preventing or removing the inflammation after
wounds or other mechanical injuries. Ice, or a temperature
of 32 Fahr., acts as minor degrees of cold do, in lessening the
increased vascular action which accompanies (if it does not
constitute the chief element of) the morbid condition called
inflammation ; but congelation, by causing a temporary sus-
pension of the circulation and sensibility of a part, does this and
a great deal more. It effects such a change in the vital actions
of the part, perhaps by removing for a time the tonicity of the
small arteries, as not only immediately to arrest inflammation,
but to render the part unsusceptible of this condition for some
time afterwards. If this suspension of vitality be of short du-
ration, there is not the least hazard of the part being perma-
nently injured, and when congelation is purposely effected by a
powerful frigorific, its duration and extent can be exactly lim-
ited. But if it should happen that owing to a debilitated state
of the body, or other circumstances, a prolonged application of
ice should at length congeal the part, as the surgeon may not
be aware of this unintended effect until after it has lasted for a
long time, (as has happened in applying ice to gunshot wounds
and in strangulated hernia,)much injury may be the conse-
quence. Fortunately, the aching usually caused by a continued
application of ice is a preventive of such mischief, and another
reason why it has been so little employed in surgery.

P. S. Since the above article was forwarded to the office
of The Lancet, on the 10th ult., Dr. Hardy has published a
proposal similar to that contained in the note to the first para-
graph, in the Dublin Medical Press of the 19th ; but a stream
of artificially cooled air was suggested as a substitute for other
refrigerating means in the introduction to my collected essays
on Congelation, published last year. Within this short period,
likewise, Dr. Snow, who I believe is reckoned an authority on
the subject of general anaesthesia, and who is much employed
as a chloroformer, has, naturally enough, thought fit to attack
its rival local anaesthesia from cold in a paper read before
the Medical Society of London. Notwithstanding the fact,
not unknown to his hearers, that intense cold has already been

664 " The Tongue as a means of Diagnosis. [November,

extensively employed for this purpose by some of the most em-
inent surgeons of the day, he indulges them with the recital of
some hypothetical notions upon its applicability ! When Dr.
Snow spoke of the great pain produced by a frigorific mixture
applied to his hand, he must have forgotten that both hands and
feet often become benumbed in very cold weather without any
preceding pain. Complete anaesthesia to the small extent he
speaks of, may be produced by cold, properly applied, with
scarcely the slightest uneasy sensation ; and when the circula-
tion is quite arrested by cold, the smarting or tingling does not
exceed that produced by mustard, and is never complained of
by the patient. It is much less disagreeable to him than the
sense of suffocation which accompanies, and the headache and
sickness that follow, the exhibition of chloroform; to say no-
thing of his dread of losing consciousness and life.

1 may probably on some future occasion, notice certain other
statements in Dr. Snow's paper ; but I cannot advert to them
at all without expressing a feeling of surprise, that a practition-
er, who has himself experienced all the horrors attendant on
causing death by chloroform, should still talk of employing it
on the most trifling occasions. The case of death from chlo-
roform which has just occurred in France, and in the hands of
so careful a surgeon as M. Richard, will, it may be hoped, be
amongst the last ; for surely a recourse to chloroform in pre-
ference to cold must very soon be confined to the compara-
tively small number of operations which involve the incision of
deep-seated and sensitive parts; and even in these (as I have
explained in my late pamphlet on the subject) a combination of
cold with chloroform would render the exhibition of a large
dose of the latter unnecessary, while it would very much pro-
mote the healing of the wound. [Ibid.

On the Tongue as a means of Diagnosis. By Tuos. Newham,
Esq., M.R.C.S.E., L.S.A.

Every practitioner is in the habit of looking at the tongue
in all cases of internal, and in most cases of external, disease.
From a glance at its general appearance, he forms an idea of
the amount of irritation which may exist in the digestive ap-
paratus, large or small intestines. In a surgical case, also, the
tongue informs him what may be the amount of constitutional
irritation present. I believe, however, that the tongue is an
organ which requires looking into much more minutely than
is commonly done, that certain portions of it may be allotted
to particular diseases, and that our remedies may consequent-
ly be given with greater precision. In making this assertion,

1854.] The Tongue as a means of Diagnosis. GG5

I am advancing no new theory, but merely supporting an old
one, as well as a neglected one, proposed by Dr. Ridge. I
read his work, tested it to the best of my ability, and have
arrived at the following conclusions :

1. The tongue points out to us the particular organ affected
in all chylo-poietic derangements.

2. It indicates the seat of disease in the respiratory appara-
tus.

3. The tongue gives unmistakeable appearances in affec-
tions of the circulation and media thereof.

4. It is a most valuable guide in levers.

Many of the readers of the Lancet may not have seen the
book 1 allude to, and therefore, without some little explanation,
will scarcely understand some of the terms used in this com-
munication. Dr. Ridge divides the tongue longitudinally into
three parts: central laterals, small portions on either side the
raphe ; laterals, to the outer side of the foregoing; and edges.
He then divides these, bv means of transverse lines, into

Anterior, ^

Second, I r .*
n ,' > fourths,

Central, (

Posterior, J

giving a part of the anterior fourth of the central laterals to
the "'tip'' and the junction of the anterior and second fourth,
to the " oval."'

The central laterals show the respiratory organs.

The laterals, the chylopoietic viscera.

Edges, the brain.

The tip shows the state of the large intestines.

The oval is given to the pleura.

The heart seems to influence the whole of the tongue.

In support of my first conclusion, I would wish to call at-
tention to any ordinary case of dyspepsia, with sluggish liver.
Here the tongue may almost always be found covered with a
thin, white film, the whole length of the laterals, these poitions
being thrown prominently forward, and most clearly defined ;
and in nearly all those cases where sickness and pyrosis have
been present, the posterior and central fourths have been most
thickly coated. It sometimes occurs in this affection that the
tongue is slightly coated over its whole surface; but on desi-
ring the patient to protrude it forcibly, the posterior fourth of
the laterals is seen thickly furred. As the affection extends to
the liver and duodenum, the laterals become coated their whole
length; and on the application of remedies, embracing the
stomach and liver, the disease quickly yields. If the posterior
and central fourths are alone affected, our treatment must be

666 The Tongue as a means of Diagnosis. [November,

confined to the stomach alone, and, I believe, with a certainty
of success. In one instance of stricture of the oesophagus,
near the cardiac orifice of the stomach, I observed the poste-
rior fourth of the laterals to be thickly coated, and as the
disease advanced, doubtless affecting the extremity of the
stomach, the furring progressed anteriorly. Again : in a case
of malignant disease of the pylorus, which rapidly extended to
the duodenum, and formed a mass of disease easily felt external-
ly, the laterals were the only parts of the tongue coated, the
other portions of the organ being perfectly clean and glassy.
I could produce many other instances of derangement of the
primae viae which my note-book, informs me invariably present-
ed the same appearances, but I will not occupy the pages of
the Lancet with "twice-told tales."

Secondly. The appearance of the tongue in cases of phthi-
sis (which have come under my observation) has been varied,
not in the position, but in the degree of coaling. We are to
remember that the central laterals are the portions of the
tongue given to all thoracic disorders, as well as to those of
the larynx and trachea, and it is to these parts we must look
for our indications of disease. Accordingly, we shall find
them covered with fur thrown up, as it were, by injection of
the vessels, and clearly defined. I am not now referring to
pneumonia and pleuritis, (neither of which diseases I have
seen during the last two years.) but to cases of tubercular
deposit, and ultimate softening, with all its attendant symptoms.
With regard to the degree of coating, I have found, that
although well-marked as to position, it has been in some of the
recent cases less than in more advanced ones. I will quote a
case, illustrating in a remarkable manner that the diseases of
the air-passages, as well as of the substance of the lungs, are
indicated by the state of the central laterals.

" A patient of broken-down constitution was afflicted with
secondary symptoms ulceration of the fauces and soft palate
among the number. After the usual remedies had been ap-
plied, and persisted in for some time, the parts became sound,
and the case progressed favorably, when suddenly great diffi-
culty of breathing came on, approaching to strangulation, and
rendering it a matter of doubt whether the operation of trach-
eotomy should not be performed. The symptoms were relieved
by anti-spasmodics and sedatives in powerful doses. The at-
tacks recurred at intervals of fourteen hours during three days
and were subdued by the same treatment. On the sixth day,
the disease was apparently checked, but only for a short time,
for within a few days unmistakable symptoms of gangrene of
the lungs made their appearance, and rapidly carried off the

1S54.] The Tongue as a means of Diagnosis. 667

patient. I watched this case narrowly, and I found that
immediately the difficulty of breathing came on then did the
posterior and middle fourths of the ceniral laterals become
coaled, which coating disappeared on the cessation of the
urgent symptoms; but after the lungs had been attacked, a
thick creamy deposit covered the whole of the central laterals
as far forward as the tip."

Thirdly. In all cases of chlorosis, where the system is
deprived of proper nutrition, the tongue assumed a Habby as-
pect ; it is tremulous, and its papilla), particularly those at the
tip and sides of the tongue, assume a fringe-like appearance,
but are pale, and almost (Edematous. In these cases there is a
loud aortic bruit, with the bruit de diable. Upon the applica-
tion of the proper remedies in such cases, the papillae first
became very slightly coloured, then contract into their normal
dimensions, and, lastly, the whole tongue assumes a healthier
aspect some time before the struggle of the patient returns.

In some instances of hypertrophy, with and without dilatation
the tongue becomes covered with sulci, more particularly on
either side of tl.e raphe. It is also drier than usual, thickened,
and appealing as if it laboured under some congestive disease.
I have had no opportunity of seeing a case of aneurism lately,
but I have frequently searched for and found disease of the
heart after observing these deep fissures of the tongue.

Fourthly. A large number of cases of fever occurred in
this city last autumn. It was always a simple type at the onset
presenting all the usual symptoms of derangement of the pri-
mae viae with rapid pulse, hot skin, &c. After the initiative
measure of purging and an emetic, I found the tongue remain-
ing, if possible more coated than before; and in some cases
repeated the purge and emetic given, at the same time, saline
aperients and diaphoreties. Alter four or five days the coating
of the tongue became dry, but did not disappear, and I was
compelled to have resourse to stimulants, which performed
their task most satisfactorily, for the tongue became moist, and
in twenty-four hours, was nearly clean. In all my fulure
cases I pursue this course. 1 gave, first, an emetic, then a
purge, and waited until the second day ; I then examined the
tongue, and if I found the tip (which is the part given to the
large intestines) in a clean stale, in ever so small an extent, I
gave ammonia and bark, and had the pleasure of seeing my
patients recover more rapidly than 1 ever remember under any
other plan of treatment.

In these cases I ought perhaps to have waited until the
tongue gave evidence of the small intestines having recovered
themselves. I did not do so, and never lost a case afterwards.

668 Hemorrhage in Separation of the Placenta. [November,

It is not only in fevers that we must study the appearance
of the lip of the tongue. It is a most valuable guide in consti-
pation of the bowels. It is then slightly furred, and covered
with papillae, which are so injected as to appear some distance
above the fur. In these cases violent purges only render
matters worse, and it is only by gentle and long-continued
medicines that we shall restore our patient.

In affections of the small intestines we all are accustomed to
the appearance of the tongue; but on looking at the anterior
fourth of the laterals, by its injection or non-injection, by its
ulceration or non-ulceration, shall we detect the true stale of
the mucous membrane of the small intestines as far as the coe-
cum.

In conclusion, I beg to say that with respect to the brain my
observations have been so limited that I have not ventured to
deduct any inferences, but that whatever I have now advanced
1 hive repeatedly proved. I have not given any anatomical
proofs of the intimate connexion of the several divisions of the
tongue with the parts they represent, as I consider that would
be trespassing on Dr. Ridge's province, and I trust that my
professional brethren will derive as much pleasure and profit
irom his book as I have done ; or, ralher, that it may encourage
abler heads than mine to investigate his theories for themselves ;
and, in the end, to impart them to the profession as facts, as
both he and I believe them to be. [lb.

Source of Hemorrhage in partial separation of the Placenta.

Dr. Mackenzie, in a paper read before the Medical Society
of London, Dec. 17th, 1853, pointed out that three different
opinions prevailed at the present day respecting the anatomical
source of hemorrhage in cases of partial separation of the pla-
centa; the first affirming that it was principally or wholly
uterine ; the second, that it was principally or wholly placen-
tal ; the third, that it was both uterine and placental. He
further directed attention to the fact, that puerperal uterine
hemorrhage, whether occurring in connection with partial or
entire separation of the placenta, was generally considered to be
principally venous, and he quoted passages from the writings
of Drs. Simpson, Radford, Murphy, and Lee, in support of this
statement. On reflecting upon these circumstances, he was led
to believe that some light might be thrown upon the question
by ascertaining experimentally the source of hemorrhage in
an animal whose placenta, like that of the human female, was
both decidual and fcetal. A pregnant bitch was accordingly

1854.] Hemorrhage in Separation of the Placenta. CGO

obtained, which had nearly completed the full period of gesta-
tion; the uterus was opened, several placentae were detached,
and the following observations made: 1. On separating each
placenta, it was found that blood flowed freely and continuous-
ly from the denuded uterine surface, increasing with the de-
tachment, while none escaped from the detached portion of the
placenta. 2. That the blood which escaped from the uterus
was distinctly arterial. 3. On rupturing a placenta while still
partially adherent to the uterus, that a small quantity of dark
venous blood escaped from the torn part. Thus it would ap-
pear that in the canine species, the source of hemorrhage in
cases in which the placenta is partially detached is exclusively
the denuded uterine surface so long as the placenta is entire,
that the hemorrhage is of an arterial character, and that a
small quantity of dark venous blood escapes from the placenta
on being lacerated while still partially adherent to the uterus.
The results of this experiment were not, however, deemed
conclusive as to the source of hemorrhage in cases of partial
separation of the placenta in the human female, on account of
the different distribution of the veins in the maternal portion of
the canine and human placenta respectively. Their anatomi-
cal peculiarities were briefly pointed out ; and in the early
part of April, 1853, the author had an opportunity of perform-
ing a more decisive experiment with the assistance of Dr. Shar-
pey. In this, the hypogastrc arteries of the uterus of a woman
who had died of internal hemorrhage during labour, and in
whom the placenta was partially adherent, were injected with
defibrinated blood, and the organ, as well as the vessels from
whence the blood escaped, were carefully noted. It appeared,
on injecting the hypogastric artery, that blood escaped freely
from the torn utero-placental arteries on the surface of the
uterus ; that none escaped from the torn uterine veins, or from
the detached portion of the placenta; and it was ascertained,
that the blood was not injected with greater force than that of
the heart acting under ordinary circumstances. The opposite
hypogastric artery was next injected, with the following re-
sults: The blood escaped freely from the torn utero-placental
arteries on the surface of the uterus ; none escaped from the
torn utero-placental veins; while, in this case, a small quantity
escaped from the detached portion of the placenta contiguous
to that which was still adherent. Repeated injections led to
no other results; while it was particularly remarked, that the
torn utero-placental arteries on the surface of the uterus were
free from any plugging previously to being injected. Two
things were thus clearly shown from this experiment : 1st. The
readiness with which blood escaped from the torn utero-pla-

670 Hemorrhage in Separation of the Placenta. [November,

cental arteries when the hypogastrics were injected ; and, 2dly.
That these arteries had not been plugged by any coagula du-
ring life. Such facts, coupled with the results of the previously
related experiment, and taken in connection with various clini-
cal circumstances, appeared to the author to afford strong
grounds for the belief that the principal source of hemorrhage
in cases of partial separation of the placenta was arterial rather
than venous, and uterine rather than placental ; and he pro-
ceeded to consider the data upon which the opposite opinion
had been affirmed. In doing so he quoted the following pas-
sage from Dr. Simpson's writings, as containing a reference to
the several grounds upon which the occurrence of arterial
hemorrhage has been denied incases of partial separation of
the placenta. ''Uterine hemorrhage, after separation of the
placenta," says Dr. Simpson, ''in ;my of the stages of labour
is not arterial in its character, because the uteroplacental arte-
ries are so long and slender as to become readily closed ; Jst,
by the tonicity of their coats ; 2d, by contraction of the uterine
fibres upon them ; and 3d, principally by the changes in their
tissues produced by the mechanical rupture of their coats, torn
arteries being little, if at all, liable to bleed, and the placenta
being separated by a true process of avulsion." With refer-
ence to the first statement, that uterine hemorrage, after separ-
ation of the placenta in any of the stages of labor, is not
arterial in its character, the author observed that, so far as he
was aware, it was one which was not only unsupported by
any evidence, but directly at variance with many observations
which he and other medical men had made. He referred to
cases in which he had distinctly observed that hemorrhage
occurring between the birth of the chiid and the complete
separation of the placenta was of an arterial character; and he
relerred to the fact, that the blood which escaped from the
uterus of the bitch when the placenta was detached was of a
bright arterial colour. With regard to the second point
affirmed, that arterial hemorrhage from the uterus is prevented
by the tonicity of the utero-placental arteries, he observed,
that, while he believed this to be generally the case in a slate
of health and tranquility of the circulation, that, under other
circumstances, it might be doubted whether such was the fact.
The third doctrine affirmed, that hemorrhage from the utero-
placental arteries is prevented by contraction of the uterine
fibres upon these vessels as they pass through and amid the
uterine structure, was in the author's opinion, completely in-
validated by the well-known fact, that there is often no direct
relation between the degree of uterine contraction and the
degree or tendency to uterine hemorrhage ; and he further

Hemorrhage in Separation of the Placenta. GT1

appealed to the two following series of facts as being opposed
to its correctness : 1st. That in several instances the placenta
ha? been spontaneously or artificially separated from the uterus
before the birth of the child, and, consequently, under circum-
stances in which contraction of the uterus could not take place
without any hemorrhage supervening; and 2dly, that when it
has been attached to the os and cervix uteri its separation has
been effected, in many cases, without any particular hemor-
rhage resulting, although it is affirmed by some anatomists that
there are few or no contracting fibres in the structure of the
os and cervix uteri. The last proposition affirmed, that hem-
orrhage from the utero-placental atteries is prevented by
the chancres in their tissues produced by the mechanical
rupture of their coats, torn arteries being little or at all liable
to bleed ; and the placenta being separated by a true process
of avulsion, was completely negatived by the author's experi-
ments upon the pregnant bitch, for on detaching the placenta
from the uterus, and thereby lacerating or tearing through the
utero-placental arteries, arterial hemorrhage was actually
observed to follow; that is to say, having separated the pla-
centa by a true process of avulsion, and thereby having torn
across the utero-placental arteries, it was demonstrated that
such proceeding was not productive of those changes in their
torn coats which are assumed to foUow such operation, and by
which it is alleged, arterial hemorrhage is prevented. Upon
the whole, it appeared that two things were certain; first, that
no necessary relation existed between the degree of hemor-
rhage, and the degree of separation of the placenta ; or, secondly,
between the degree of hemorrhage, and the degree of contrac-
tion of the uterus : uterine hemorrhage having been variously
moderate or excessive under similar degrees of separation of
the placenta, and similarly moderate or excessive under the
opposite conditions of relaxation and contraction of the uterus.
Could it, then, be doubted, that the absence or disposition to
uterine hemorrhage depended, in many cases, upon other causes
than the anatomical connection of the placenta with the uterus
on the one hand, or the contractile mechanism of this organ
on the other ? Or, further, that these were to be sought for in
the occurrence of arterial hemorrhage, and the varying condi-
tions of the utero-placental arteries, as modified by the general
condition of the arterial system. Bearing in mind this view
of the case, the author maintained, that we could best account
for the phenomena of puerperal hemorrhages. We could un-
derstand how it might happen, that the tonicity of the arterial
system being great, uterine hemorrhage would be prevented
when the uterus was most relaxed, and when, consequently,

672 Hemorrhage in Separation of the Placenta. [November,

venous hemorrhage would be most liable to occur that, under
the influence of morbid excitement of the heart and arteries,
it might be profuse when the uterus was contracted, and when
venous hemorrhage would be most effectually prevented ; and
that it might vary, in different cases, with the same amount of
separation of the placenta.

Dr. Crisp was of opinion, that, in cases of partial separation
of the placenta, the hemorrhage is not from the denuded uterus,
but from the free portion of the placenta. He had been re-
quested to see a case of Mr. Howell's in which serious hemor-
rhage had followed delivery, and, on examination, observed a
portion of partially adherent placenta projecting from the os
uteri, and was assured, from the touch, that the blood flowed
from that structure. The placenta was entirely removed, and
the hemorrhage ceased. He thought that abnormal position
of the placenta frequently led to hemorrhage, and that the latter
is quite independent of an enfeebled state of system. He at-
tached but little importance to the experiments of Dr. Mac-
kenzie.

Dr. Winn, on the other hand, believed that similar experi-
ments performed on animals would ultimately set the question
at rest, and, while agreeing in the author's results so far as to
affirm that hemorrhage proceeds from the uterus, he differed
with him in believing that the immediate source is the uterine
sinuses, and not the uterine arteries. He thought that the dis-
tinction between the colour of arterial and venous blood, is
sometimes liable to fallacy, since it is possible that the state of
extreme nervous excitement of a patient in labour might render
the venous blood of a more florid colour. A friend of his had
observed, that on drawing blood from the arm of a patient
labouring under pneumonia the colour was quite florid.

Dr. Murphy was quite confident, from his own experience,
that, whatever may be the immediate source of hemorrhage in
these cases, the flow of blood ceases on the entire removal of
the placenta. He thought it important to separate these prac-
tical facts from any theories. He then referred to the two
classes of opinions ; the one, held by a section whom he termed
the Protectionists, that it proceeds from the uterus, and the
other, supported by the Reformers, that it flows from the pla-
centa ; and believe both to have built their theories upon hypo-
thesis, and not upon experiment. He congratulated the author
on having taken a first step in the required direction, and
advised him to repeat his experiments again and again. He,
however, cautioned him to bear in mind the great difference
which exists between vital and dead structures, since, after
death, the parts lose their tonicity, and any plugs which may

1854.] Trismus Nascentium. 673

have once been formed remain, and prevent the passage of the
injection ; but, in the living structures, any new flow of blood
may detach the plugs, and permit the vessels to pour out blood
anew. The author had referred to Dr. Gooch's case, in which
no hemorrhage occurred, although the uterus remained of large
size ; and thought that so exceptional a circumstance could not
support the deduction that, therefore, the contraction of the
uterus exercised no influence over the flow of blood.

Mr. Clark had assisted the author in his experiments, and
bore testimony to the truthfulness of his descriptions, and the
fairness of his deductions. He illustrated the latter by refer-
ring to those cases of post-partum hemorrhage in which the
flow of blood begins long after the placenta has been expelled ;
and also by stating that, as the direction of the current is from
the placenta to the uterine sinuses, the latter can supply but
little, if any, blood in such cases.

Dr. Snow Beck was prepared to defend each of the author's
opinions seriatim ; but stated, that the author's facts might be
admitted and referred to apart from his deductions. He did
not think that the uterine veins could be the sources of hemor-
rhage, and had met with several cases of partially detached
placenta, in which the hemorrhage did not cease on perfect
.separation of that organ. He also had met with a case so far
resembling one mentioned by the author, that the colour
of the blood was distinctly florid, and the source, as he believed,
arterial, and the hemorrhage in that case diminished or in-
creased with the state of contractility of the organ. He would
make a distinction between the contractility of the uterus as a
whole, and that of the walls of the organ, and believed that the
flow of blood through* the vessels is rather due to the latter
circumstance. This state is induced when the uterus is manipu-
lated either within or without ; and in those instances in which
the hemorrhage was arrested on detachment of the placenta,
the arrest might have been due solely to the contraction in-
duced by the manipulation. [ Med. Times and Gazelle.

On Trismus Nascentium. By Nicholas Meriwether, M.D.,
of Montgomery, Ala.

This disease generally appears sporadically, but sometimes
endemically, rarely attacking white children ; which is to be
accounted for by the superior cleanliness of the white race. To
show the great prevalence of this disease in some portions of
the Southern States, I will quote the following from a paper in
the May number of the New Orleans Medical and Surgical

674 Trismus Nascentium. [November,

Journal, on the negro and his diseases, by S. L. Grier, M. D.,
of Miss. :

"The first form of disease which assails the negro race among us,
is trismus. The mortality from this disease alone is very great. No
statistical record, we suppose, has ever been attempted, but from our
individual experience we are almost willing to affirm that it decimates
the African race upon our plantations within the first week of inde-
pendent existence- We have known more than one instance in
which, of the births for one year, one half became the victims of this
disease, and that too in despite of the utmost watchfulness and care on
the part of both planter and physician Other places are more fortu-
nate, but all surfer more or less; and the planter who escapes a y < a r
without having to record a case of trismus nascentium, may congratu-
late himself on being more favoured than his neighbours, and prepare
himself for his own allotment, which is surely an. I speedily to arrive."

When this disease appears endemically on a plantation, it
may be arrested by having the negro-houses whitewashed with
lime inside and out ; by raising the floors above the ground;
by removing all filth from under and about the houses ; by pay-
ing particular attention to cleanliness in the bedding and
clothes of the mother, and in the dressing of the child so as to
prevent any of the matter from the umbilicus lying long in
contact with the skin of the latter. To effect this last, I usu-
ally slit a small piece of old linen, and, after greasing it, pass it
between the abdomen of the child and the dressing usually ap-
plied to the umbilicus. This is to be renewed every day.
The planter or overseer should be requested to examine and
see whether there is any disturbance of the bowels for the first
ten days after birth, so that the physician may have early no-
tification. So much for prevention.

From the similarity of trismus to traumatic tetanus, it has
been supposed that the disease is caused by absorption of pus
by the umbilical vessels. I am inclined to that opinion, and
base my treatment accordingly. In all the cases I have seen
there was an unhealthy appearance of the navel, and disturb-
ance of the bowels ; the passages were generally greenish and
ill-looking. When called early to a case (that is, as soon as
there is spasmodic action in the muscles of the extremities and
back, which appears usually before the affection which charac-
terizes the disease as infant lock-jaw), I commence the treat-
ment by giving the following mixture: fy. 30 gtt. paregoric;
2 gtt. oil turpentine; 4 grs. gum kino; 1 teaspoonful prepared
chalk, to be mixed in 8 teaspoonfuls of water; a teaspoonful to
be taken every hour or two, taking care not to narcotize the
child. If the disturbance of the bowels continues, or if the
spasm of the muscles does not cease, I apply a blister immedi-

1854.] Strangulated Hernia. 675

ately over the navel ; the blister should be circular, and larger
than a dollar. With this treatment, I have rarely failed to ar-
rest the convulsions, and save the patient. [American Jour, of
the Med. Sciences.

On the propriety of opening the Bowels soon after the operation
for Strangulated Hernia. By J. S. Gamgee, Esq.

The various conditions in which we find cases of hernia at
the time of operation, admit of their arrangements under four
heads. 1. Those cases in which the intestine is in good con-
dition, and inflammation has not yet manifested itself; 2.
Those in which, though the bowel is in very fair condition,
there are local and general signs of a moderate amount of
peritonitis; 3. Those in which the bowels are notably discol-
ored, but of good consistence; peritonitis being intense; 4.
Those in which there is threatening gangrene of the gut.

Let us consider the first class of cases. Since it is reasona-
ble to suppose that in a case of strangulated hernia that has
been operated upon, a part at least, of the uneasiness depend-
ent upon the intestinal function is immediately due to its res-
toration, we should in this class of cases theoretically be dis-
posed to promote the action of the intestines, when it does not
occur spontaneously, a short time after the constriction has
been removed. Such practice seems the more reasonable, in
that there can be no fear of aggravating inflammation which
does not exist, and in that there is reason to believe that the
expulsion of the accumulated faeces is tantamount to the exclu-
sion of a possible, if not probable, cause of inflammation.

In the second class of cases, the first part of the argument
used above applies, but not the second ; for inflammation exists,
and the question arises, whether the administration of purga-
tives, theoretically indicated by the necessity of restoring the
intestinal functions, may not be productive of evil by aggrava-
ting the inflammation. From what I have seen, however,
these fears would not disquiet me. I think there is more
chance of the progress of inflammation being checked by the
expulsion of irritating faeces, and restoration of the gut to its
function, than of its being aggravated by the stimulant action
of the purgative.

In the third class of cases, in which the bowel is in moderate
condition, but the peritoneum intensely inflamed, it is reasona-
ble to believe that the constipation, although in great measure
dependent upon the atony which has resulted from long inac-
tivity, is likewise due to the disturbance of innervation incident
upon the inflammation. It seems hence prudent to respect the

676 Hydrophobia. [November,

objections of those who allege that the inflammation may be
aggravated by purgatives; but while an tiph logistics are being
actively employed, there is no reason for objecting, if the bow-
els do not act, to enemata ; the probabilities of their doing good
are much greater than those of their possible perniciousness.

In the fourth class of cases, (threatening gangrene of the
intestine,) inasmuch as there is more to fear from the action of
the intestines, though it be but moderate, than from their ac-
tivity, though it be extreme, enema and purgatives appear
contra-indicated so long as there is reason to fear disorganiza-
tion of the gut.

From the foregoing considerations, flow three rules for prac-
tice, in cases in which the operation of herniotomy is not
followed by spontaneous action of the bowels.

1. When the condition of the gut is good and there is little
or no peritonitis, an oleaginous enema should be given an hour
or two after the operation, and repeated after three or four
hours in case of failure, or a purgative exhibited by the mouth.

2. When the peritoneal inflammation is intense, even though
the bowels be in fair condition, antiphlogistics must be perse-
veringly employed ; and though a simple enema may be given
in the first six hours, it is inadvisable to excite the action of the
bowels until the next day, either by more active enemata or
purgatives by the mouth.

3. In the case of mortification threatening the gut, the bow-
els should be kept quiet by opium, and purgatives and enemata
abstained from until the danger of perforation has passed.

[Assoc. Medical Journal.

On Hydrophobia as it occurred in France in 1852. By M.
Ambrose Tardieu.

In the year 1850. the minister of agriculture and commerce,
on the recommendation of the committee of public health, sent
a circular to every prefect in France, requesting him to give
information regarding any cases of hydrophobia which might
occur in his department. A number of reports were in conse-
quence sent in. but as these were in some respects incomplete,
a fresh circular was issued, detailing more particularly the
manner in which the cases should be recorded. From the in-
formation so obtained, M. Tardieu drew up a report regarding
the cases which occurred in the years 1850-51, as well as in
1852. As the report for the year 1852 is much more complete
than the others, we subjoin an abstract of it.

1. The number of cases of hydrophobia which occurred in
France during the year 1852, was 48. These were observed

1854.] Hydrophobia. 677

4

7

14

=

30

11

=

15

9

=

12

37

=

54

7

=

8

6

=

6

0

=

4

in 14 departments : the department in which the greatest
number occurred was that of the Hautes Alpes, (in the south-
east of France, latitude between 44 and 45) ; while the de-
partment of Lozere (also in the south, and having the same
latitude as the other) came next.

2. With regard to the sex ; 36 of the 48 cases were males,
12 females; the proportion in the two preceding years was
almost the same.

3. The following table exhibits the ages of the subjects af-
fected with hydrophobia:

Below 5 vears, in 1852, 3 in two former vears,

From 5 to 15 ' " " 16

" 15 to 20 " 4

" 20 to 30 ' 3

M 30 to 60 " 17

" 60 to 70 " " 1

Above 70 ' " 0 M "

Not mentioned ; " 4 u "

48 88 =136

This table shows the incorrectness of the opinion which as-
cribes the disease to the effects of terror, for it shows that 7
children under five years of age have been attacked.

4. All the cases which occurred in 1S52 originated in the
bites of dogs, except one, where the bite of a cat was the cause
of thedisease.

5. The situation of the wounds inflicted by the rabid animals
was as follows in 48 cases: On the face. 13 times ; on the up-
per extremities, 15 ; on the lower extremities, 12 ; not mention-
ed, 8. In two of the cases the disease was communicated by
pet dogs which were accustomed to lick their master's faces,
and where excoriated lips were the seat of the inoculation.

6. In 40 out of the 48 cases the date of the inoculation has
been observed. It occurred in March, April and May, in 10
cases; in June, July, and August, 16 ; in September, October,
and November, 4; in December, January, and February. 10.

7. It seems a considerable number of individuals who are
bitten by rabid animals escape the disease. During 1S52 some
observations were made on this point, and it appeared that out
of 44 persons bitten, about the same time 23 only were attack-
ed.

8- The period of inoculation of the disease was exactly noted
in 20 cases. It was as follows: Less than a month in S cases :
from 1 to 3 months 10; from 3 to 6 months 1 ; 11 months, 1.

9. The duration of the disease in 20 cases was 2 days in 6
cases : 3 days in 8 ; 4 days in 5 ; 6 days in 1.

n. s. vol. x. NO. xi. 43

678 Placenta Prcevia. [November,

10. The termination of confirmed cases of hydrophobia was
constantly fatal. Of the 48 cases, it appears that only 27 came
under this category ; in the others I he effect was merely local.
In 12 of these 27 cases no precaution was taken, in 4 no men-
tion is made of this circumstance. In 8 of the remaininn 11
cases cauterization was resorted to immediately, in 3 at a late
period. Of the 21 individuals who escaped (see H 7) cauteri-
zation was energetically performed in 12 cases ; the details of
the other 9 have been omitted.

11. As to the mode of cauterization employed, the actual
cautery was used in all cases but 5, and these were treated by
protonitrate of mercury, nitric acid, ammonia or butter of an-
timony. In Germany it has been proposed to excise the bitten
parts and then to wash the wounds with a solution of caustic
potash. [Annates a" Hygiene. Peninsular Journ.

Placenta Prcevia. By O. H. Taylor, M.D., of Camden, X. J

In examining the recent medical report from Gloucester
County, X. J., I observe that Dr. Sickler has presented, with
some interesting remarks, two cases of presentation of the pla-
centa, in each of which the placenta was spontaneously deliv-
ered before the birth of the child.

The question, whether the result so happily effected by
nature in these instances, should ever be promoted by art, is
one that has been canvassed of late, by obstetricians, with deep
interest and anxiety. Nor is this surprising, when we consider
the extreme urgency of the dangers threatening the mother
from hemorrhage, and the vital importance of the function of
the placenta, even during labor, if at all protracted.

From my own observation and reflection on several cases
of attachment of the after-birth over the os uteri, coupled with
severe hemorrhage, which have occurred in my practice with-
in the last twenty-eight years, I am induced to coincide with
Dr. Sickler in opinion, not only as to the propriety and safety,
but the absolute necessity, in certain circumstances, of remov-
ing the placenta before the delivery of the child. That the
established method of turning the infant in cases of severe
hemorrhage, duringparturition, may be impracticable, without
great delay, when the os uteri is but slightly dilated, and pre-
sents rigid and unyielding edges, every experienced practition-
er is aware. The strength of the mother may be fatally
exhnusted before the hand can be introduced. Even in the
most favorable cases, the condition of the placenta during the
delivery, with much of its surface still adherent, and prevent-
ing the contraction of the bleeding vessels beneath the detached

1S54.] Placenta Prcevia. G79

portions, is incalculably more favorable for an arrest of hem-
orrhage, than if it were entirely detached ; and the question of
danger to the child, from the removal of its external lungs
before its mouth reaches the atmosphere, is one of time only.
If there be a possibility of a rapid delivery, we should not
hastily allow this danger to prevent us from giving the greatest
possible security to the patient.

Three cases of placenta implanted over the os uteri, occur-
red to me in the early part of my practice, and their history
proves how fatal may be the results of uterine hemorrhage,
even during the act of turning and delivering the child. In
each of these ca<es, the operation of perforating the after-birth
was performed in the presence and by the counsel of the late
distinguished professor James, of the University of Pennsylva-
nia ; Dr. Charles D. ZNIein-s, now Professor of Obstetrics in
Jefferson Medical College, being also present in consultation in
one ot these cases. All these cases terminated fatally in a very
short time after the delivery of the infants, which were still-
born. Neither of the mothers survived more than three
hours, and all died from the exhaustion caused by excessive
hemorrhage.

That the operation of removing the placenta immediately,
when found to present itself at the os uteri, is capable of being
performed with safety to both mother and child, under favora-
ble circumstances. I am fully convinced ; but as Dr. Sickler
very pertinently remarks, " the advisability and determination
of the conditions in which it should be practiced, must be de-
cided by an induction from a iarger number of cases than have
as yet been submitted to the profession."

My own experience leads me to the conclusion, that when
the placenta is fairly implanted over the os uteri, and is firmly
attached throughout its borders, it can be removed before de-
livery, with more safety both to the mother and child, than can
be secured by perforating or elevating the edges, and bringing
the child down by the feet.

In nearly all the cases that I have witnessed, expulsive and
efficient pains have been brought on soon after the placenta
has been completely detached ; and these pains have continued
so as to produce the prompt expulsion of the child whenever
the presentation has been natural.

Even when the complication is coupled with a preternatural
presentation, it does not appear to me lhat the immediate de-
livery of the placenta is necessarily contra-indicated. It would
be folly to dwell upon the imminent danger to the child in such
cases; and if the hemorrhage be permitted to continue un-
checked during the protracted delivery by the feet (supposing

680 Placenta Prcevia. [November,

this to be possible in the case) what will be the fate of the
mother ? Should we not give her the advantage of that arrest
of hemorrhage which appears so generally to follow the entire
detachment of the placenta, even before its positive expulsion?
Certainly we should, at least whenever the presentation or the
condition of the patient can be ascertained to be such, that
very prompt delivery by the feet is impracticable; for then
the death of the child is insured at all events ; and as has been
already hinted, it is precisely when such prompt delivery is
most easily effected, that the danger to the child from the pre-
vious detachment is least, and the advantage to the parent, I
think, indisputably the greatest.

I throw out these few suggestions to the profession, in the
hope of inducing the report of every fact which may tend to
decide one of the most important practical questions which has
been mooted by obstetrical practitioners for many years.
Uterine hemorrhage has long been the terror of both patient
and physician, and any thing which tends in the least degree,
to lessen its dangers, is worthy of the most profound respect
and serious consideration.

Permit me, then, to offer, in concluding this note, the abstract
of a recent cnse, in which the effect upon uterine hemorrhage
produced by the expulsion of the placenta before the delivery
of the child, is happily illustrated.

On the 27th of April, 1853, I was requester! to visit Mrs. B.,
on account of a profuse and unnatural flow of blood from the
uterus. She considered herself as being eight months advanced
in pregnancy. At the time of my first visit, she was not com-
plaining of much pain, though the hemorrhage was very con-
siderable in amount.

A digital examination proved that the os uteri was but slightly
dilated. I directed pulv. acetat. plumbi et opii, but found it
necessary, also, to apply the tampon, by means of which the
bleeding was restrained, and I was enabled to leave my patient
in an hour.

After the lapse of eight or ten days, the flooding recurred,
and the same treatment was repeated, with a similar result.

On the 15th of May following, being the 19th day after the
first attack, I was again summoned to the case, and found the
patient laboring under a hemorrhage quite as profuse as at the
time of the first visit, or even more so. By examination per
vaginam, I found the os uteri dilated about two inches. The
placenta was evidently implanted immediately over it. By
pressing the index finger firmly towards the right ilium. I de-
tached a portion of the adherent placenta, and was able dis-
tinctly to recognize the presenting portion of the foetus, which
proved to be the head.

1854.] Treatment of Fractured Humerus. 681

Periodic pains of the regularly expulsive character, were
now established, but each was accompanied with an excessive
discharge of blood.

The imminency of the danger to the mother from hemor-
rhage, induced me to decide that nothing would be forfeited by
following any plan of action calculated promptly to arrest it.
I therefore proceeded to separate the attachments of the pla-
centa to the uterus in the hope that possibly I might be able to
thrust the after-birth back from the orifice, and thus enable the
head to engage itself in the superior strait. On making the
attempt to push the placenta beyond the presenting part of the
head, however, I found myself opposed and thwarted by the
descent of a large portion of the mass into the vagina. The
result accorded with the experience adduced from the history
of other and parallel cases; for two or three more pains com-
pletely expelled the placenta into the vagina, and the hemor-
rhage then instantly ceased. In five or six minutes more the
child was born, and although reasonably a little languid at first,
it soon began to cry, and has since been a healthy and promis-
ing child. [jSew Jersey Medical Reporter.

New mode of Treatment for Delayed Non- Union of a Fractured
Humerus. Read before the Medical Society of the County
of Erie. By Frank H. Hamilton, M. D.

It has been observed by surgeons that non-union results
more frequently after fractures of the shaft of the humerus,
than after fractures of the shaft of any other bone. This ob-
servation is confirmed by my own researches.

Comparing the humerus with the femur, between which,
above all others, the circumstances of form, situation, &c, are
most nearly parallel, and in both of which non-union is said to
be relatively frequent, I find that of forty-nine fractures of the
humerus, four occurred through the surgical, neck, twelve
through the condyles and twenty-nine through the shaft. In
one of the twenty-nine, the patient survived the accident only
a few days. In four of the remaining twenty-eight, union had
not occurred after the lapse of six months, and in many more
was it delayed considerably beyond the usual time. Two of
the four were simple fractures, and occurred near the middle
of the humerus; the third was compound, and occurred near
the middle also ; the fourth was compound, and occurred near
the condyles.

This analysis supplies us, therefore, with four cases of non-
union, from a table of twenty-eight cases of fractures through
the shaft.

682 Treatment of Fractured Humerus. [November,

Of eighty-seven fractures of the femur, twenty occurred
through the neck, one through the trocanter major, and one
through the condyles. The remaining sixty-live occurred
through the shaft and generally near the middle, and in not
one case was the union delayed beyond six months.

To make the comparison more complete, I must add that of
the twenty-eight fractures of the shaft of the humerus, six we/e
compound; and of the sixty-five fractures of the shaft of the
femur, six were either compound, comminuted, or both com-
pound and comminuted. The six compound fractures of the
shaft of the humerus, furnished tw<> rases of non-union. The
six cases of either compound or comminuted, or compound and
comminuted fractures of the femur, furnished no case of non-
union.

I be to the Society what seems to me to be the

true explanation of tit-
It. is the universal practice, so far as i know, in dre
fracl the humerus, to place the forearm at right, angles

with the arm. Within a few days, and generally, 1 think,
within a few hours, alter the arm and forearm are placed in
this position, a rigidity of the muscles and other structures has
ensued, and to such a degree, that if the splints and sling are
completely removed, the elbow will remain flexed and firm;
nor will it be easy to straighten it. A temporary false anchy-
losis has occurred, and instead of motion at the elbow joint,
when the forearm is attempted to be straightened upon the arm,
there is only motion at the seat of fracture. It will thus happen
that every upward and downward movement of the forearm
will inflict motion upon the fracture, and inasmuch as the elbow
has become the pivot, the motion at the upper end of the lower
fragment will be the greater in proportion to the distance of
the fracture from the elbow joint.

No doubt it is intended that the dressings shall prevent all
motion of the forearm upon the arm ; but I fear that they can-
not always be made to do this. I believe it is never done
when the dressing is made without angular splints, nor is it by
any means certain that it will be accomplished when such
splints are used. The weight of the forearm is such when
placed at right angles with the arm and encumbered with
splints and bandages, that even when supported by a sling, it
settles heavily forwards, and compels the arm dressings to
loosen themselves from the arm in front of the point of frac-
ture, and to indent themselves in the skin and flesh behind.
By these means the upper end of the lower fragment is tilted
forward. If the forearm should continue to drag upon the
sling, nothing but a permanent forward displacement would

1854.] Treatment of Fractured Humerus. G83

probably result. The bones might unite, yet with a de-
formity.

But the weight of the forearm under these circumstances is
not uniform, nor do I see how it can be made so. It is to the
slir.g that we must trust mainly to accomplish this important
indication. But you have all noticed that the tension or relax-
ation of the sling depends upon the attitude of the body, whether
standing or sitting upon the erection or inclination of the
head upon the motions of the shoulders, and in no inconsid-
erable degree upon the actions of respiration. Nor does the
patient himself cease to add to these conditions by lifting the
forearm with his opposite hand whenever provoked to it by a
sense of fatigue.

This difficulty of maintaining quiet apposition of the frag-
ments while the arm is in this position, at whatever point the
arm may be broken, becomes more and more serious as we de-
part from the elbow joint, and would be at its maximum at the
extreme upper end of the humerus, were it not that here a
mass of muscles, investing and adhering to the bone, in some
measure obviates the difficulty. Its true maximum is therefore
near the middle, where there is less muscular investment, and
where, on the one hand, the fracture is sufficiently remote from
the pivot or fulcrum to have the motion of the upper end of
the lower fragment multiplied through a long arm, while on
the other hand it is sufficiently near to the armpit and shoulder
to prevent the upper portion of the splint and arm dressings
from obtaining a secure grasp upon the lower end of the upper
fragment.

It must not be overlooked that the motion of which we speak
belongs exclusively to the lower fragment, and that it is always
in the same plane, forwards and backwards; but especially
that it is not a motion upon the fracture as upon a pivot, but a
motion of one fragment lo and from its fellow. This circum-
stance I legard as important to a right appreciation of the diffi-
culty. Motion, alone, I am fully convinced, does not so often
prevent union as surgeons have generally believed. It is ex-
ceedingly rare to see a case of non-union of the clavicle. Of
forty-seven cases of fracture of the clavicle which have come
under my observation, and in by far the greater majority of
which considerable overlapping and consequent deformity has
resulted of this number only one has resulted in non-union,
and in this instance no treatment whatever was practiced, but
from the time of the accident the patient continued to labor in
the fields and hold the plow as if nothing had occurred. I
have therefore seen no case of non-union of the clavicle where
a surgeon has treated the accident. Indeed, what is most re-

684 Treatment of Fractured Humerus. [November,

markable, its union is more speedy, usually, than that of any
other bone in the body, of the same size. Yet to prevent mo-
tion of the fragments in a case of fractured clavicle with com-
plete separation and displacement, except where the fracture is
near one of the extremities of the bone, I have always found
wholly impracticable. Whatever bandages or apparatus I
have applied, I have still seen always that the fragments would
move freely upon each other at each act of inspiration and ex-
piration, and at almost every motion of the head, body or upper
extremities. It is probable, gentlemen, that you have made the
same observation.

From this and many similar facts I have been led to suspect,
for a long time, that motion has had less to do with non-union
than was generally believed.

1 find, however, no difficulty in reconciling this suspicion
with my doctrine in reference to the case in question ; and it is
precisely because, as I have already explained, the motion, in
case of a fractured humerus, dressed in the usual manner, is
peculiar. In a fracture of the clavicle through its middle third
(its usual situation,) the motion is upon the point of fracture as
upon a pivot; although, therefore, the motion is almost inces-
sant, it does not essentially, if at all, disturb the adhesive pro-
cess. The same is true in nearly all other fractures. The
fragments move only upon themselves, and not to and from
each other. I know of no complete exception but in the case
now under consideration.

Aside of any speculation, the facts are easily verified by a
personal examination of the patients during the first or second
week of treatment, or at any time before union has occurred,
both in fractures of the humerus and clavicle. The latter is
always sufficiently exposed to permit you to see what occurs,
and as soon as the swelling has a little subsided in the former
case, you will have no difficulty in feeling the motion outside of
the dressings, or perhaps in introducing the finger under the
dressings sufficiently far to reach the point of fracture. I be-
lieve you will not fail to recognize the difference in the motion
between the two cases.

Such, gentlemen, is the explanation which I wish to offer for
the relative frequency of this very serious accident non-union
of the humerus.

I know of no other circumstance or condition in which this
bone is peculiar, and which therefore might be invoked as an
explanation. Overlapping of the bones, the reason assigned
by some writers, is not sufficient, since it is not peculiar. The
same occurs much oftener, and to a much greater extent, in
fractures of the femur, and equally as often in fractures of the

1S54.] Treatment of Fractured Humerus. CS5

clavicle ; yet in neither case are these results so frequent.
Nor can it be due to the action of the deltoid or of any oilier
particular muscles about the arm, whether the fracture be
below or above their insertions, since similar muscles, with
similar attachments on the femur and on the clavicle, tending
always powerfully to the separation of the fragments, occasion
only deformity, but not non-union.

If I am correct in my views, we shall be able sometimes to
consummate union of a fractured humerus where it is delayed,
by straightening the forearm upon the arm, and confining them
to this position. A straight splint, extending from the top of
the shoulder to the hand, made of some firm but moulding
material, and made fast with rollers, will secure the requisite
immobility to the fracture. The weight of the forearm and
hand will only tend to keep the fragments in place, and if the
splint and bandages are sufficiently tight, the motion occasion-
ed by swinging the hand and forearm will be conveyed almost
entirely to the shoulder joint. Very little motion indeed, can
in this posture be communicated to the fragments, and what
little is thus communicated, is a motion which experience has
elsewhere shown not disturbing or pernicious, but a motion
only upon the ends of the fragments as upon a pivot.

I do not fail to notice that this position has serious objections
and that it is liable to inconveniences which must always,
probably, prevent its being adopted as the usual plan of treat-
ment for fractured arms. It is more inconvenient to get up
and lie down, or even to sit down, in this position of the arm ;
and the hand is liable to swell. But 1 shall not be surprised to
learn that experience will prove these objections to have less
weight than we are now disposed to give them. Remember,
the practice is yet untried if I except the case which I am
about to relate, and in which case, I am frank to say, these ob-
jections scarcely existed. The swelling of the hand was trivial
and only continued through the first fortnight, and the patient
never spoke of the inconvenience of getting up or sitting down,
or even of lying down.

The following is the case to which I have just referred.

Michael Mahar, laborer, set. 35, broke his left humerus just
below its middle, Dec. 14, 1853. The arm wras dressed by a
skilful surgeon in Canada West, and who is well known to me
as exceedingly " clever.'7 After a few days from the time of
the accident, "the starch bandage was put on as tight as it
could be borne, and brought down on the forearm so as to con-
fine the motions of the elbow joint."

Six weeks after the injury, Jan. 29, 1854, Mahar applied to
me at the hospital. No union had occurred. The motion

686 Paralysis. [November.

between the fragments was very free, so that the}- passed each
other with an audible click. There was little or no swelling
or soreness. In short, every thing indicated that union was
not likely to occur without operative interference. The elbow
was completely anch)losed. His health was unimpared.

I explained to. my students what seemed to me to be the
cause of the delayed union, and declared to them that I did not
intend to attempt to reestablish adhesive action until I had
straightened the arm. They had just witnessed the failure of
a precisely similar case in which 1 had made the attempt with-
out straightening the arm and without success.

Feb. 6, J 854. I had succeeded in making the arm nearly
straight. I now punctured the- upper end of the lower frag-
ment with a small steel instrument, and as well as I was able,
thrust it between the fragments. Assisted by Dr. Boardman,
I then applied agutta percha splint from the top of the shoulder
to the fingers, moulding it carefully to the whole of the back
and sides of the limb, and securing it firmly with a paste roller.

March 4th. (Not quite four weeks after the application of
the splint.) I opened the dressings for the second time, and
carefully renewed them. A slight motion was yet perceptiBle
between the fragments.

March 18th. I opened the dressings for the third time, and
found the union complete. This was within less than forty
days.

The patient was now dismissed. On the 29th of April follow-
ing the bone was refractured. Mahar had been assisting to
load the " tender'' to a locomotive. While the train was just
getting in motion he was hanging to the tender by his sound
arm when another laborer seized upon his broken arm to keep
himself upon the car, and with a violent and sudden pull
wrenched him from the tender and reproduced the fracture.

The next morning I applied the dressings as before, and did
not remove it during three weeks, at the end of this time the
union was again complete. The splint was, however, re-
applied and has been continued to this time a period of about
six weeks. [Buffalo MedicalJournal.

Paralysis occurring during Gestation and in Childbed.

The Dublin Quarterly Journal of Medical Science (May,
1854) contains a very interesting article on this subject, with
the particulars of 84 cases collected from various sources, by
Dr. Fleetwood Churchill.

The following is a summary of these cases, with his remarks
upon the more important points connected with them. The

I.] Paralysis. 081

number of cases he admits, however, are too few to justify de-
cided conclusions from them : [Am. Jour, of Med. Sci.

'Of the 34 cases, in 22 the attack occurred during pregnane
in 12, either daring or after labour.

11 In 23 cases where it is mentioned, I find that with 10 it was their
first child, with 1, the second ; with 4, the third ; with 2, the fourth ;
with 3, the fifth ; with 1, the sixth ; with 1, the thirteenth ; and one
had several children, but the number is not specified.

" Of the 34 cases, there were 17 of complete hemiplegia, and 1
partial ; 4 of paraplegia, in 2 of which only one leg was affected ; 6 of
facial par 5 of amaurosis, and 3 of deafness: but in some of

these latter local palsies were combined with the cases of hemiplegia.
Of 14 cases of hemiplegia, in which the side atfected is mentioned, I
find that 11 were of the right, and 3 of the left side.
" Of the 34 cases, 4 died.

u It may be well, however, to consider these cases somewhat more
closely, and for that purpose they may be divided into two classes,
tfcose which occurred during pregnancy, and those which were at-
tacked during or after labour.

M Of the 22 cases in which paralysis occurred during pregnancy,
12 were examples of hemiplegia ; 1 of paraplegia, which had occur-
red previously ; 4 ot facial paralysis ; 2 of amaurosis ; and 3 of deaf-
ness. There is no regularity as to the period of gestation at which
the seizure took place, for of 13 cases. in which this is mentioned, in
1 it occurred in the second month; in 1 in the third or fourth ; in 1
in the fifth ; in 1 in the sixth or seventh; in 3 in the seventh ; in 2
in the eighth ; and in 4 in the ninth month : from which it would
seem, upon the whole, that it is in the latter months that pregnant
women are most liable to the attack.

" Of 19 cases, 11 appear to have been cured before or by delivery,
and in S the disease continued for a longer or shorter time afterwards.
"Of the 20 cases, only 1 died, and in this case it is evident that
death was rather owing to disease of the brain, of longer standing than
the pregnancy, than to the paralysis which increased during that pro-
cess ; so that 1 do not think we can reckon it as impairing the com-
paratively innocuous character of these attacks during gestation.

u In 3 cases only was the paralysis preceded by convulsions. In
most of the cases it does not appear that there were any premonitory
symptoms, little or no headache, or any other circumstance calcula-
ted to excite apprehension until the paralysis supervened. The char-
acteristics of the palsy resembled very closely those of similar attacks
unconnected with pregnancy ; the motor power was enfeebled or al-
ogether lost; in some the sensibility was increased, diminished, or
xlified ; but in others, I infer from the silence of the reporter, that
s little, if at all. changed from its natural condition. The intel-
?ms to have preserved its integrity in all the cases. A pecu-
ccrreat interest in many of these cases, and to which 1 shall
nd by, is the pres?nce of albumen in the urine, whenever
n was carefully examined.

688 Paralysis. [November,

"The second class, consisting of 12 cases, is characterized by the
attack occurring during or after labour. It is remarkable that in 3
cases only (Cases 23, 24, 25) did the paralysis take place during la-
bour, and of these, 2 were cases of convulsions; in all the oth
not merely succeeded labour, but in most cases after an interval
sometimes considerable : for example, in Case 23, it took place on
the first day after delivery ; in Case 27, two days afterwards ; in Case
32, three days; in Case 34, seven days ; in Cases 26, 29, 31, eight
days; m Case 30, ten days ; and in Case 33, a month afterwards.

"Of these 12 cases, 5 were cases of complete hemiplegia; in 1
only the arm was affected ; 1 was a case of complete paraplegi
1 the right, and in 1 the left leg only was paralyzed ; 2 were exam-
ples of amaurosis ; 1 of facial paralysis; and in 3 only of the cases
of hemiplegia the face participated in the attack. In Dr. Levy's very
remarkable case, the paralysis of the motor power of one side was
accompanied by loss of sensibility on the other. In some of the cases
the sensibility was diminished, in others unaltered, but in none in-
creased. The phenomena of the disease were not peculiar: in the
majority of the cases the attack occurred generally without w.irninjr,
and without anyobvious cause. In 2 cases convulsions terminated
in amaurosis, but in Mr. Forrest's case the paralysis preceded the
convulsions, and during the latter, the paralyzed limbs shared in the
convulsive movements.

"The duration of the disease varied a good deal, the paralysis
gradually subsiding in most cases: in Case 22, after Beveral days;
in Case 23, in six v\ >>e 31 recovered the use of the arm in a

fortnight, but vision remained imperfect for some months; in C;.
in a month ; in Cases 28, 29, in two months ; Case 22 recovered the
power of walking in two months, but was then attacked by another
disease which proved fatal; Case 26 left the hospital without improve-
ment.

"In 3 cases death occurred: in Case 32, on the fourteenth day,
and in Case 34, on the twenty-fourth day after the paralytic seizure.
Dr. Ley does not mention on what day his patient died.

"I have already alluded to the fact that in most of the cases the
attack occurred without warning, and without apparent cause. Some
cause there must be, of course ; but it is much easier, in most cases,
to say what it is not than what it is. For example, in none of these
examples except one, did it appear to depend upon any external influ-
ence upon cold, exposure, violence, &c or upon mental distress;
in few, if any, was there evidence of previous cerebral congestion, or
disease of any other organ.

"It has been suggested that the palsy may be merely the termina-
tion of convulsions, and certainly some of these cases would seem to
support this view ; but if this were generally true, we should find
convulsions more frequently preceding the paralysis; and, also, we
should meet with more cases of convulsions terminating in paralysis ;
Now, in all the cases I have quoted, a large majority exhibited no con-
vulsive movements at all, and, on the other hand, of all the cases of

1854.] Paralysis. 6S9

convulsions related by Drs. Collins, and McClintock and Hardy,
there is not a single instance of such a termination : we must there-
fore refer both convulsions and paralysis to some common or different
cause.

" I have no doubt, as Dr. Romberg has observed, that in a number
of cases, especially those which occur during gestation, the palsy is
due to a reflex action from some organ or structure in a morbid con-
dition, and In which the nervous system seems to be merely the
channel of transmission, offering no central disorganization. In such
cases the exciting cause may possibly be some injury or morbid con-
dition of the generative organs, or perhaps merely a transient excite-
ment, such as that of pregnancy. It is possible, also, that some of the
instances occurring during gestation ought rather to be classed under
the head of hysterical paralysis, as described by Drs. Laycock and
Romberg; but it is not always easy to make the distinction.

Obstruction of the arteries has been recently shown by Professor
Simpson* to be an occasional occurrence in child-bed, either from
arteritis, a coagulum, or a detached vegetation : and a degree of par-
lay be the result ; but inasmuch as the death of the limb, and
ultimately of the patient, is the direct consequence of such an occur-
rence, the history of the cases I have quoted removes from them the
suspicion of being thus caused.

night naturally be supposed that the stress and exertions cu-
ring labour, which give rise to such great congestion of the face and
head by also occasioning congestion of the brain, might be considered
one of the principal causes; but such a supposition is not borne out
by facts, for, excluding the cases of convulsions, in only one case did
the paralysis occur at the time of labour ; in all the others it either
supervened before labour, or subsequently, at a time when all such
direct action must have ceased, and in some, after such an interval
that we cannot suppose it even a remote effect of the parturient agony.
On the other hand, when we remember the number of severe labours
in which no such attack occurs, or compare its frequency with that of
convulsions during labour, we can scarcely attribute much influence
to this cause.

gain, as we have seen, paraplegia hns been attributed to severe
and prolonged labour, and to the consequent mechanical pressure upon
the nerves and muscles of the pelvis, and at rirst sight this seems an
adequate and feasible explanation, and of which no one could deny
the possibility : yet so far as our cases are concerned it can hardly
have been so. for in all but one the labour was natural, easy, and not
prolonged : in the exceptional case the patient had been delivered by
the forceps : moreover, the period at which it occurred was too dis-
tant to justify our attributing it to this cause in the other cases. On
the other hand, if we recollect the number of severe, prolonged, and
instrumental deliveries which take place, without any such result, no
example being recorded by Drs. Collins. McClintock, and Hardy, or
with the exceptions I have quoted, in any of the reports of the British

* Edinburgh Monthly Journal, February. :

000 Paralysis. [November,

and foreign hospitals, so far as I am acquainted with them, I think we
must also reject this peculiarity of labour as a necessary or frequent
cause.

" In two cases the attacks seem to have been connected with an
anemic condition, consequent upon hemorrhage, either from the
direct effect of a deficiency of the circulating fluid, or indirectly
from the increased susceptibility of the nervous system, under these
circumstances, to ordinary exciting causes. In another case para-
plegia appeared to result from cold ; but, in the majority of i
as [ have already observed, there was neither plethora nor anemia ;
neither exposure, want, injury, advanced age, mental distress, nor
sudden shock ; in short, there was no apparent cause.

" Unfortunately for the cause of science, there are very few post-
mortem examinations on record, from which we might decide with
some degree of certainty upon the nature of the affection. In all the
slighter ami more partial cases, life is preserved, and when death oc-
curs in the more severe instances, permission t> examine the body
cannot always be obtained. Of the four fatal cases I ha\
tailed, two only were examined : in these, and I doubt not in the other
two a'so, disease of the brain or its membranes existed. In Dr. Ley's
case, he states that 'no positive disorganization of the brain could be
detected. The ventricles, however, contained more than the usual
scrum : and there was found, more especially opposite to the original
teat of pain, thickening and increi alarity of the membranes,

with moderately firm paiis; in others an apparent

tinous, transparent, and colourless deposit interposed between
tip in ' In short, there appears to have been an attack of partial
meningitis, and the contra>i between the peculiar train of symptoms
to which it gave rise, and the absence of all symptoms except the
palsy in Dr. Duke's case, is very interesting, when we remember the
remarkable disorganization we discovered in the latter case.

14 Now in these Cases We may fairly assume that the palsy and death
itself were the result of the disease of the brain and its membranes,
but to what are we to attribute the slighter and more numerous c
Do they not appear to belong to the class described by Dr. Abercrom-
bie, as 'depending upon a cause which is of a temporary nature, and
capable of being speedily and entirely removed V

11 What is this temporary cause, producing so serious a disturbance,
and yet scarcely, if at all, endangering life ? May it be the one to
which Dr. Latham refers, as observed in those convulsions and apo-
plexies which appear and disappear, the chief circumstance which
attracts our attention being albuminous urine?' At any rate, it de-
serves our careful attention. Of the fact of the occurrence of albu-
minuria with certain affections of the nervous system during pregnan-
cy and child-bed, there can be no doubt whatever. Both Drs. Lever
and Simpson have detected it in cases of convulsions during pregnancy
and labour; the former observes: 'I have carefully examined the
urine in every case of puerperal convulsions that has since come un-
der my notice, both in the Lying-in Charity of Guy's Hospital and in

1854.] Paralysis. 691

private practice, and in every case but one the urine has been found
to be albuminous at the lime of the convulsions.' 'I have further
investigated the condition of the urine in upwards of fifty women, from
whom the secretion has been drawn during labour by the catheter,
care being taken that none of the vaginal discharges were mixed with
this fluid ; and the result has been that in no cases have I detected
albumen, except in those in which there have been convulsions, or in
which symptoms have presented themselves which are readily recog-
nized as precursors of puerperal fits.' Dr. Simpson's observations
about the same time, and those of more recent observers, Sabatier,
Legroux, Richelot, and others, have confirmed the conclusions of Dr.
Lever as to the presence of albumen in the urine in cases of puerperal
convulsions, so that no doubt now exists as to the fact, although we
occasionally meet with cases of convulsions without albuminous urine,
and of albuminuria without convulsions.'*

11 Now, as paralysis in some cases occurs in connection with con-
vulsions, if not as a consequence of them, we might, not unnaturally,
expect albumen in the urine of such patients, and accordingly, in a
patient of Dr. Lever's and in others, we find that it has been detected.

" But we may go a step further, and state that in cases where no
convulsions have preceded the paralysis albuminuria has been equal-
ly observed. Dr. Lever says of his cases, that in none in which he
examined the urine did he ever fail to find albumen, and the great
experience of Professor Simpson is in close accordance with this, as
may be seen by the quotations I have given, and by the cases with
which he has favored me. This was observed also in Dr. Duke's
case, where the paralysis succeeded the delivery ; and in which I
think there is ground for believing that the albumen had diminished
at the time the urine was first examined. In all probability it would
have been detected in many others, had an investigation been made.

"Thus we find that albuminuria maybe a marked symptom in
puerperal convulsions, whether terminating in paralysis or not ; and
in the palsy of pregnant and puerperal women, whether partial or
complete, whether local or general ; and if the observations are yet
too few to draw any very positive conclusions, it is, I believe, because
our attention has not been drawn to the subject. And when, in addi-
tion, we find, as Dr. Lever states, that as the albumen diminishes,
the paralysis subsides, we can hardly doubt that there is some im-
portant connection between them.

* It may be of interest to append Dr. Seyfert's conclusions on this subject.
" 1. Albuminuria is not an essential accompaniment of normal, healthy preg-
nancy. 2. The theory, ascribing albuminuria to the pressure of the enlarged
uterus on the renal vessels, is inadmissible. 3. When anasarca, from Brighi's
disease, occuis during pregnancy, the patients are seldom attacked by eclamp-
sia. 4. The albuminuria, in cases of eclampsia, is occasioned by the interrup-
tion of the functions of the respiration and circulation by the "attack. 5. In
such cases the albuminuria terminates with the attack. 6. Albuminuria is not
present in all cases of eclampsia. 7. Albumen is found in large quantities in
the urine of epileptics, imvicdiatcly after an attack ; but not invariably alter eve-
ry seizure, or in every case of the disease. 8 Provided there be no Bright's
disease, this albuminuria among epileptics ceases soon after the convulsions,
and only returns after the next attack." [Edinburgh Monthly Journal

G92 Paralysis. [November,

11 What, then, is the precise pathological significance of albuminuria ?
We may assume as established, that although it occurs in Bright'l
disease, it alone is no proof of the -presence of that disease ; hut in the
present slate of our knowledge it is very difficult, perhaps impossible,
to come to any very decided conclusion upon the matter. It is con-
ceivable that an unusual, morbid, or noxious ingredient in the urine
may be produced in either of three ways : 1. By simple elimination
from the blood, in which ii was present; 2. As the result of diseased
action of the kidneys, excited either by some noxious principle in the
blood, or by a morbid condition of these organs; or, 3. As a new
compound, the result of chemico pathological action, which we may
or may not be able to explain.

"Now, albumen in the urine cannot be placed under the latter
iy. as it is not a new principle, but one already existing in the
blood. Nor does it come under the first, for although it is possible
that it might be eliminated from the blood in which it is pre sent, it
cannot be as a noxious element, nor would this simple elimination
account for the condition of the kidneys or for the concomitant symp-
toms. So that it would appear this secretion of albumen must be
owing to some disordered action of the kidneys, excited by some mor-
bid element, in kind or degree, which they arc endeavoring to
rate from the blood. This seems at least to be the opinion of a high
authority, Dr. George Johnson, of London, who, in describing acute
desquamative nephritis, in which albumen is so largely secreted, ob-
: 'that all the chang< s of structure commence in the secreting
cells of the gland, and are the result of an effort made by the cells to
eliminate from the blood some abnormal products, some materials
which do not naturally enter into the composition of the renal secre-
tion.5* This view is further confirmed by a post-mortem examination
into the state of the kidneys themselves in albuminuria. Dr. Hand-
feld Jones, in a recent paper, has described three varieties: 'The
first is the condition of engorgement, such as is seen in those who die
in the early stages of acute anasarca, or in that of dropsy succeeding
scarlatina. The organ is enlarged, dripping with blood in every
part; its tissue not destroyed, but many of the tubes are seen,
under the microscope, to contain coagula of exuded fibrin, entangling
blood-globules, and more or less of epithelium.' 'The second form
of diseased renal structure is that of the large, heavy, often mottled
and pale kidney. In this there is no hyperemia, but rather the re-
verse state usually exists. The cut surface has not the appearance
of healthy structure, and gives one the idea of some matter having
been implanted among the natural constituents, so as to obscure them
and to produce a confused aspect. The tubes are found impacted
with epithelial matter, but not by any means constantly obstructed or
blocked up, although they may be irregularly dilated, &c.' * The
third variety of morbid change is that so familiar to observation as
the dwindled, glandular kidney.'f

" When we consider the temporary nature of the albuminuria in

* Diseases of the Kidney, p. 105. t Medical Times and Gazette.

1854.] Paralysis. 693

many of the cases of paralysis, we need have little doubt that the
condition of the kidneys answers to the first variety here described,
or that of extreme congestion, and this opinion is confirmed by the
examination of Case 34, in which we found a high degree of conges,
tion, which had indeed passed into a more advanced stage. I think,
therefore, that we may fairly assume the albuminuria is due to a
congested state of the kidneys, and I confess I cannot but think that
the explanation given by Dr. G. Johnson and others, that this conges-
tion is excited by the effort to eliminate some noxious element from
the blood, is more in accordance with our present knowledge than
any other, yet I must not omit to mention that by some this congestion
has been attributed lo pressure of the gravid' uterus upon the renal
vessels. Dr. Seyfert, as we have seen, rejects this mechanical ex-
planation, and seems to attribute the albuminuria to the eclampsia, in
consequence of the interruption of the functions of respiration and
circulation.

"But, if the former theory be true, what is this morbid element,
morbid in kind or degree? It is very difficult to answer this question.
Dr. Simpson suggests that it may be an excess of urea or some mor-
bid quantity or quality of caseine in the blood. Dr. George Johnson's
observations seem to prove that in these cases, in addition to a change
in the proportion of the normal constituents of the blood, of which the
diminution of its albumen is one, there is always an excess of urea.

"Then it may be asked, 'to what is the effect upon the nervous
system owing V One can conceive that it may result either 1.
From the continued presence of the noxious principle in the blood ;
or, 2. From the balance of the constituents of the blood having been
destroyed ; or, 3. From the diseased condition of the kidney though
to which of these we ought to attribute it, would be difficult to decide.

" But at whatever conclusion we arrive with respect to these inter-
esting points, I am sure all will agree with me, that, taking the cir-
cumstances into consideration, it is probable the kidneys play a more
important part in these paralytic affections than has been suspected,
and -that the subject deserves more attention than it has received.
For, we find that in cases of convulsions terminating in paralysis, we
may have albuminuria; in paralysis before delivery, without convul-
sions, we may have albuminuria ; in paralysis occurring after deliv.
cry. we may have albuminuria ; and further, that in the slighter
cases, both the convulsions and paralysis diminish with the decrease
of the albuminous secretion. Whether, therefore, the paralysis be
caused by the state of the kidneys, or the renal congestion and paral-
ysis be both the result of some morbid matter in the blood circulating
through the system, it is clear that a new element may be added to
those which have usually been considered as giving rise to paralysis.

"Nor is this barren theory only ; but, if it be true, it has a direct
bearing upon practice, inasmuch as our attention ought not to be
confined to the secondary affection of the nervous system in such
cases, but must be directed to the relief of the renal malady, and to
the restoration of the kidneys to such a state of efficiency as may

n. s. vol. x. NO. xi. 44

694 Treatment of Epilepsy. [November,

enable them to remove the morbid constituents of the blood ; and for
our encouragement, we have seen that a diminution of albumen in
the urine is followed by mitigation and cure of the paralysis. For
the latter affection, bloodletting, general when the system will bear it,
or local by means of leeches or cupping; blisters, purgatives, and
mercury, are the remedies usually employed ; these must be modified
according to the condition of the patient, the circumstances of the at-
tack, and the duration of the disease. When much blood has been
lost during labour, bloodletting must be omitted, and we must confine
ourselves to counter-irritation ; perhaps a series of small blisters to
the neck, down the spine, or along the limb, will be the best mode of
proceeding. The patient's strength must be supported judiciously by
good diet, and it is quite possible that some stimulant, such as ammo-
nia or camphor, may be necessary. When the paralysis has become
chronic, strychnia or galvanism may be found useful ; and I believe
Dr. Stokes has found galvanic acupuncturation very beneficial in fa-
cial paralysis.

"The renal disorder should never be treated by diuretics, but by
external irritants, such as mustard poultices, or rubefacient liniments
to the loins, and internally by diaphoretics, as suggested by Dr. Os-
borne,* of this city, and when more chronic, by gallic acid, iron, &c."

Treatment of Epilepsy.

Dr. R. B. Todd, in an interesting clinical lecture delivered
at King's College Hospital, offered the following valuable
practical observations on the treatment of epilepsy. In refer-
ence to the drugs which have been generally employed, he
observes :

" Most of these have been used in consequence of their exhibiting
a certain amount of physiological influence on the nervous system.
As to others, it is difficult to trace the circumstances which led to their
admission among the juvanlia in this disease. First in the list I would
place those drugs which belong to the narcotic class opium and its
various preparations, belladonna, henbane, conium, camphor. These
certainly exercise a very powerful influence in calming the excitable
state of the nervous system which accompanies epilepsy. They are
applicable chiefly to the more acute cases, and especially when epilep-
tic delirium is threatened or present. You should never administer
them except when you have full opportunity of watching your patient,
or of confiding him to the care of another. This remark, I need hard-
ly add, applies chiefly to Belladonna and the preparations of opium.

Belladonna has been greatly extolled by some French writers, far
more than it deserves, as far as I can judge from my own experience.
It is a remedy which leaves no permanent ill effect, and which, I
think, is worthy of a more extensive trial in this country than it has yet
received. That it exercises a physiological influence on the nervous

* On the Nature and Treatment of Dropsies, &c. 1837.

1854.] Treatment of Epilepsy. 695

system, no one can doubt, who has administered it for forty-eight
hours; but as it induces a state of pupil very like that which is so
common in epilepsy, one might fear that it rather favoured the epilep-
tic state. A good series of clinical observations are yet wanting upon
the effects of this drug. The preparation chiefly used in France is
the powdered leaves of the plant.

Opium is often useful in cases in which the fit is apt to occur in the
night or early morning. A full dose given at bedtime will prevent
the development of the tit.

The valerian was used formerly in epilepsy more extensively than
now. It is a medicine, however, which should not be despised or dis-
carded. Its u^e promises most in the complications of hysteria and
epilepsy. Its virtue depends upon the presence of an oil or acid
which is capable of entering into combination with metallic bases, as
zinc and iron, and which also combines with quinia and other alka-
loids. You may give it either in scruple doses of the powder two or
three times a day, or in infusion, or as an ammoniated tincture, or in
combination with quinia, or the metals.

Other nervine remedies may be added to your list, and you should
keep them in reserve, to employ as occasion may require, such as
musk, castor, assafetida, stramonium, sagapenum, garlic, remember-
ing the moral influence of a change of drug. I cannot say that the
evidence of any special power of an anti-epileptic nature in any of
these drugs is at all satisfactory.

In this class of drugs you may place the Sumbul, of which a tinc-
ture is prepared by .Mr. Savory, of Bond-street. One of the earliest
cases in which I employed it, seemed to benefit very decidedly by it ;
and I have since used it many times with unequivocal good, so as to
lead me to look upon it as a useful stimulant, and antispasmodic reme-
dy.

Digitalis has been greatly lauded by some. It may act favourably,
partly by its diuretic properties, and partly by its influence on the
heart's action. There is quite sufficient evidence of its utility to war-
rant its being retained among the list of remedies applicable to this
disease, and to justify its occasional cautious use.

The cotyledon-umbilicus may rank with digitalis as a remedy for
epilepsy. I cannot say that I have met with a case distinctly benefit-
ed by its use ; but the cases published by Mr. Salter, and those record-
ed by the late Dr. Graves, indicate that it possesses a certain anti-
epileptic power. I incline to think it acts by a diuretic influence.

There are other drugs obtained from the vegetable kingdom, which,
I think, deserve a trial in epilepsy. One of these is the Achillea
millefolium, which, in the form of a decoction, exerts a very decided
diuretic Influence. On the same principle, taraxacum may do good
in certain cases, as in those in which the epilepsy has relation to gout
in the system.

The alkaline salts, especially the bicarbonate and the nitrate of
potass, appear to me often to be very useful on a similar principle,
namely, by increasing the activity of the kidneys.

696 Treatment of Epilepsy. [November,

The cardamine pratensis was greatly extolled by Sir George Baker.
Turpentine has been used chiefly from its anthelmintic properties. It
is a remedy that should be used very carefully, and never, if there be
suspicion of organic disease of the brain.

The selinum palustre, or peucedanum montanum, is highly com-
mended by Herpin, on, as I think, insufficient grounds. The plant
is very difficult to procure, and I have not yet been able to try it.

The various metallic tonics have been and are extensively used in
epilepsy. Of these, the safest is zinc, the sulphate, or the oxide.
Either of these preparations may be given without any disadvantage
that I know of, for a considerable time, and in large doses. Some
time ago I gave to a patient in this hospital as much as half a drachm
of sulphate of zinc, thrice a day without any sensible ellect. The
dose had reached that amount by gradual increase. Whether these
.ii ul- exercise any special favourable influence, 1 am unable to say;
all 1 know is, that, under th<ir long-continued use, patients sometimes
cease to be troubled with fits.

The various salts of iron are also applicable to the treatment of this
disease, and especially to cases in which the blood is poor in hematin.
But they are not so harmless as the salts of zinc. Their tendency in
some persons to excite headache precludes their use with them ; and
they often disturb digestion, and on this account cannot be persevered
with. The saccharine carbonate, the sulphate, the citrate, and the tinct.
of the sesquichloride, as wi 11 as Griffith's mixture, are the preparation*
of iron which you will find most suitable to the generality of c;i-

Salts of copper and of silver are also used lbr epilepsy, with, I think,
at best, but very doubtful eflicacy. To the cautious use of the ammo-
nio-sulphate of copper, I see no material objection ; in too lar^e doses
it may irritate the gastro-intestinal mucous membrane, but such irrita-
tion is easily removed.

There is, however, a much more serious objection to the use of the
salts of silver. The nitrate and the oxide are the salts employed.
Now, there is no doubt that the nitrate discolours the skin. We see
repeated examples of this in the streets ; scarcely a day passes that I
do not recognize persons in the streets, as epileptics, who had been
treated with nitrate of silver. If the nitrate of silver were a certain,
or even a very frequent cure for this formidable disease, well and good ;
but, seeing that it is very far from being entitled to the credit of being
such a remedy, I say, that we have no right to make blackamoors of
our patients, and to stigmatize them forever as epileptics, and too often
as epileptics uncured, on the mere chance of doing good by nitrate of
silver. No doubt few would hesitate long between choosing a disco-
loured skin, and being the subject of a disease so fearful as epilepsy.
But it seems to me, that the remedy ought to be a specific, to justify
the practitioner in administering it, with the strong probability there
is of producing such an effect. Remember, too, that the nitrate of
silver stain communicated in this way, is probably indelible, and that,
by an experienced eye, it is not to be mistaken. I have seen it after
ten and fifteen years from the administration of the drug.

1854.] Treatment of Epilepsy.

Finding, then, no special virtue in the nitrate of silver as against
epilepsy, and that it is very apt to produce the serious result to which I
have referred, with whatever care it may be administered, I have
long since abandoned its use. I fear the oxide of silver is not more
promising, either as to its influence on the disease, or its freedom from
the discolouring power.

Indigo has likewise been given in epilepsy, but with no other result,
as far as I can learn, than what Penil observed, that it turned the nails
of his patients blue.

The time has, I think, now arrived, when we must look in another
direction for an anti-epileptic remedy. We must turn our attention
more particularly to those substances which are capable of being ex-
hibited by inhalation, of being brought to bear upon the nervous sys-
tem, without being subjected to the action of the gastric fluid.

Ether and chloroform, it is now well known, are capable of being
taken into the blood in this way. Some years ago, I tried experiments
as to their power of controlling the convulsions induced by strychnine,
and with the result of finding that they possessed that power very com-
pletely. As long as an animal is fully under the influence of ether or
chloroform, no convulsion can he produced. I was thus led to try their
inhalation in epilepsy. I have chiefly employed for this purpose chlo-
roform, because it is less disagreeable to patients to take. The results
of my observations so far, are these that in the more acute forms of
epilepsy, the inhalation of chloroform has considerable influence in
controlling and modifying the attacks ; it has also a very decided
power over epileptic delirium ; and over some of the concomitants of
epilepsy, as the violent convulsive jerks of the muscles of both upper
and lower extremities, which are always most distressing, and often
very dangerous. It has a marked and immediate power over puer-
peral convulsions ; and I am glad to see that my friend, Prof. Simpson,
of Edinburgh, sanctions, by his high authority, its use in such cases.
It is also applicable, and with advantage, to the convulsions of infants,
and to laryngismus stridulus.

There is no use in employing chloroform in epilepsy unattended by
other symptoms, when the attacks are at uncertain times and at long
intervals ; nor do I advise you to attempt its use, unless the patient is
fully under your control, or will heartily co-operate with you. And
in cases where the heart is affected, either functionally or organically,
it should never be used. Its inhalation, at two or three stated times
of the day, exercises a very calming effect on the nervous system,
diminishing its excitability very materially. But this must be carried
on over a long period of time many months, and even years ; and
the dose may vary from twenty to sixty minims, according to the
effect produced, and you should aim at obtaining a gradual, not a
rapid effect. The patient should always remain in the horizontal
posture during the inhalation, and for at least half an hour after it.

You will expect me to say something on a proposal made within
the last few years to open the trachea of patients suffering under se-
vere epilepsy, with the twofold object of preventing the fits, or of

698 Treatment of Epilepsy. [November,

obviating their effect, in creating undue distension of the cerebral
bloodvessels, if they should occur.

Before a proposition of this kind can meet with general favour
from practical men, it must be satisfactorily proved that the hypo-
thesis, or theory, if you will, from which the proposal emanates, is
essentially sound : and next, it must be shown that the operation is
in itself one that is not seriously dangerous to life ; and lastly, it
ought to be in the highest degree probable that the attacks will not
recur after the operation has been performed. It is, as you know,
contrary to all principles of sound surgery to perform an operation,
unless it be for the complete removal of the disease, or, at worst, to
stave off the reappearance of the malady to the latest period.

The hypothesis from which this proposal emanates assumes that
the exciting cause of all the evil in severe epileptic paroxysms, is the
contraction of the muscles of the neck and glottis, which induces and
maintains a congested state of brain, which, in its turn, excites and
keeps up the convulsions. I have elsewhere examined this conges-
tion theory in detail, and I am not aware that the arguments which I
then advanced against it have ever been fairly met. I have also
shown, by experiment, that epileptic convulsions may be excited in
dogs which had been freely tracheotomized previously, full provision
having been made for the free ingress and pf the air; and

also in a dog in which the muscles of the glottis were paralyzed by
section of the recurrent nerve. These experiments, the advocates of
tracheotomy in epilepsy have found it convenient to ignore.

Again, I would ask, is tracheotomy either a very simple or a very
safe operation ? I do not think that the results of the operation
either for other diseases, or for epilepsy, are very satisfactory. Pa-
tients often die from the effects of the operation ; exhaustion, erysipe
las, diffuse inflammation of the areolar tissue spreading into the me-
diastinum.

And lastly, what are the prospects that, the opeiation having been
done, the evil will not recur? This can only be ascertained by that
which I cannot recommend, frequent experiments. I would only
make this remark : that those who have the courage to try these ex-
periments, and feel themselves justified in so doing, must carefully
watch the results, and endeavour to draw a proper distinction between
the actual physical effects of the operation, and that mental influence
which, as I have shown you in a former part of this lecture, undoubt-
edly tends to stay the disease, when any new treatment is adopted, or
any considerable change takes place in the patient's position and
circumstances.

But, gentlemen, let us look on, and watch the result of these oper-
ations in the hands of others. No one will be more ready to acknow-
ledge himself in the wrong than I shall be, should it turn out that, in
this proposal, an important remedy has been found for a most terrible
malady.

In conclusion, I have to express my fears that I have drawn but a
sorry picture of the power of our art to,deal with this formidable

1854.] Editorial. G99

disease. But let not this discourage you ; and do not fall into the
notion, nor countenance it in any way, that epilepsy is an incurable
malady, and that epileptic patients may as well be abandoned to their
fate. There is no doubt that some may be completely cured, many
very greatly alleviated, and that all should, as far as possible, be the
objects of medical scrutiny and care, with at least the object of finding
out more and more of the natural history of the malady, and of the
juvantia as well as the Icedentia ; and with a hope that, at some time
or other, a remedy may be vouchsafed to us, or at least that we may
gain some insight into the intrinsic nature of this formidable scourge
of mankind. [Med. Times and Gazette.

EDITORIAL AXD MISCELLANY.

Remarks upon the use of Beverages in Sickness. By the Editor.

Without intending for a moment to undervalue the importance of a
judicious selection of the more active remedial agents in the treat-
ment of disease, the writer nevertheless feels persuaded that much of
the success of these, very often depends upon the use of proper adju-
vants. The signal advantages frequently derived from the opportune
administration of an enema, a footbath, cold affusion to the head, or
even a cup of tea, broth, or gruel, must have been obvious to every
discerning practitioner. And yet, it is only at the bed-side that the
young physician can derive much information upon the subject, as
these matters of detail cannot be or are not included in such works
of general practice as are usually placed in their hands. Treatises
and Lectures upon the general principles of Practice are unfortunate,
ly but little relished by students, while they read and listen with
avidity to specific plans of treatment, and never fail to note down any
recipe that may be proposed. The more violent, heroic and pertur-
bating methods are, however, gradually giving way to milder and
more judicious medication ; and palliatives consequently increase in
importance. The skill of the practitioner will be found to consist
more in the relief of existing symptoms, than in the prescription of
special formulas learnt by rote and aimed at a name.

The use of aqueous beverages, especially in acute affections, is now
so common that it cannot be a matter of indifference whether the pa.
tient partake of the one or the other of the many varieties ordinarily
resorted to. The belief that the water they contain is the sole agent
of value in their administration, is too exclusive and prevails to too

700 Editorial. [November,

great a degree. By the ingestion of large quantities of water, and
the great facility with which it is imbibed by the coats of the stomach
and intestines, carried into the portal system, and from thence intro-
duced into the general circulation, the blood is diluted and render-
ed less plastic, whilst the repletion of the vessels thus induced,
increased activity to the emunctories viz., the skin, lungs, and kid-
neys. The experiments of Magendie demonstrate very satisfactorily
that the secretions are increased in a direct ratio with the repletion of
the bloodvessels, and vice versa-; thai absorption is promoted in pro-
portion to the diminution of the circulating mass. While, therefore,
in the treatment of acute diseases, which are generally inflammatory,
copious beverages are usually found to be useful, by diminishing the
plasticity of the blood and promoting the elimination of noxious or
effete principles, their propriety is very questionable when it becomes
necessary to favor absorption, as is frequently the case in chronic
engorgements, serous effusions, or other deposits. When venesection
is practiced, the volume of blood abstracted is very soon replaced by
water ; whereas, by witholding such beverage, the partial vacuum
of the vessels brings into them the circumjacent fluids with whatever
disintegrated matters they may hold in solution. Thus it is that we
may satisfactorily account for the agency of depletion and abstinence
in the promotion of absorption. Yet it cannot be a matter of indiffer-
ence whether the drink be acid or alkaline, stimulating or sedative,
mucilaginous or acrid, laxative or astringent, nutricious or not. We
resort daily to beverages which, in addition to the diluent property of
water, unquestionably present one or more of the peculiarities just
referred to ; and we should endeavor to select such as may be best
adapted to each particular case. A brief enumeration of some of
those in common use, and an appreciation of their peculiarities, may
enable us to present our views more forcibly. They may be advan-
tageously arranged under distinct heads indicative of their most
prominent properties.

Diluents. Of all beverages, water, at the ordinary temperature
of spring or well water, will be generally found the most agreeable,
as well as the best, when the desired effect be simply to allay thirst
or to dilute the blood. Indeed, the cravings of nature so strongly
indicate the propriety of cold water as a beverage in the fevers of our
climate, that one cannot look back without a sense of horror upon the
time when patients were pertinaciously denied this luxury, notwith-
standing their heart-rending entreaties ; when they were compelled
to linger through long attacks of sickness with parched lips and crack-

1S54.] Editorial 701

ed tongue, lest a sip of cold water might perchance disagree with the
stomach, check the perspiration, or expose them to mercurial saliva-
tion ! In no particular has modern practice displayed more good
sense and humanity, unless it be in the abolition of chains and the
lash in the treatment of Insanity, than in allowing the sick the free
use of cold drinks, especially in Southern fevers. A draught of good
cold water will often act like a charm, quieting the stomach, and in-
ducing copious excretions from the skin, kidneys and lungs.

The facility with which ice is now procured in most of our towns
has led to the very free use of iced water ; and, however grateful and
beneficial this may be in many cases, there are circumstances in
which the propriety of its use is at least questionable. In irritability
of the stomach, with or without phlogosis of this viscus, iced water
very generally gives great relief: but in affections of the bowels we
think it decidedly objectionable. In both diarrhoea and dysentery,
its bad effects are almost immediately marked by the supervention of
pain and a desire to go to stool. It should also be avoided in all
colicky affections, whether partaking of the nature of obstructions, of
spasms or of flatulency. In bowel affections we always give the pre-
ference to warm or hot drinks. According to our bed-side observa-
tions, iced beverages should be also avoided in pulmonary diseases
and in affections of the head. We have frequently found them to
induce paroxysms of coughing and dyspnoea in lung complaints, as
well as pain and cerebral disturbance in affections of the brain, while
tepid or warm drinks do not produce such effects. The rationale of
such consequences is so evident as scarcely to need an explanation.
The principle is here the same as that upon which we account for the
injurious effects resulting from the exposure of one part of the body
to cold when another part is predisposed to or actually suffering from
inflammation. No one would think of plunging in iced water the feet
of a patient laboring under affections of the bowels, thorax, or head ;
nor should the stomach be filled with iced water under such circum-
stances, although this organ may be benefitted by cold applications of
the kind to its own surface when this is affected. The same remarks
may be applied to acute affections of the skin, and old women are
therefore not wrong in objecting to iced drinks in scarlatina, measles,
and smallpox, however much they may err in insisting upon keeping
the body excessively warm.

In the cold stage of our fevers we think warm drinks preferable
to cold ones. They hasten the termination of the chill and bring on
perspiration much sooner ; and though they may be more apt to induce

702 Editorial. [November,

emesis, the very efforts to vomit materially determine the circulation
to the surface and consequently abridge the cold stage.

Demulcents. Under this head we may place all the mucilagin-
ous infusions, as those of Flaxseed, Slippery-elm bark, Prickly. pear,
Bene leaves, Gum arabic, &c. These are nothing more than dilu-
ents in combination with bland materials. They are regarded as
especially appropriate in irritations, more or less intense, of the ali-
mentary passages, of the respiratory organs, and of the urinary appa-
ratus. Their use has been so long sanctioned by the Profession, that
it is not without some hesitation that we intimate a doubt as to their
real value, or rather as to their superiority over mere diluents. It can
hardly be presumed that the gummy or mucilaginous materials they
contain, pass into the circulation unchanged or without previously un-
dergoing the digestive process. They cannot therefore be viewed as
bland applications to any other than the surfaces of the digestive tube.
Yet they are continually prescribed as though they were destined
to reach unchanged the mucous surfaces of the lungs and urinary
organs. We must confess that we have ourselves been so much in
the habit of prescribing infusions of Slippery-elm and of Prickly-pear
in affections of the kidneys, bladder and urethra, that we would dis-
like to abandon them, however much we may be led by theory to
doubt their intrinsic efficacy and to attribute the relief to the water
and other medicinal agents with which they are administered. We
must also say that we, have never perceived any advantage in the
use of demulcents, as such, in pulmonary diseases, and that we re-
ally consider the one in most common use (flaxseed tea) often injuri-
ous, in consequence of the rancidity of the seed usually obtained from
the shops, and the -indigestibility of the infusion when made very
mucilaginous, to say nothing of the unpleasantness of the dose. The
other demulcents can be so readily procured in a fresh state, and are
so much more agreeable, that we see no good reason for the very gen.
eral use made of flaxseed tea.

The Aromatic beverages are infusions of Mint, Balm, Sage, Cat-
nip, Sassafras, &c. Their chief merit consists in being generally
palatable and therefore well received by the stomach. In many in-
stances they will relieve nausea, when this unpleasant symptom would
be aggravated by demulcents. They are also decidedly anti-septic,
preventing the evolution of gas by averting the tendency to fermenta-
tion, and improving the general tone of the digestive organs, without ex-
erting injurious stimulation of the general system. They are particu-
larly well adapted to Typhoid fevers and diseases of similar character.

1854.1 Editorial 703

Catnip tea is a favorite prescription of mothers for crying babes,
under ihe impression that the cries always indicate the existence of
colic and that catnip is a specific for this. It cannot be denied that
the little creatures very frequently become quieted and go to sleep
shortly after partaking freely of the well sweetened tea ; but whether
this effect is to be attributed toVelief from colic, to some anodyne or
soporific property of the tea, or simply to the fact that this operates
as a substitute for the nourishment the child required, remains to be
determined.

Sassafras tea is not unfrequently used in the South as a substitute
for Coffee and Hyson tea, and is certainly more palatable than either
of these, when as wretchedly prepared as they are in many families.
Sassafras has been long supposed to possess alterative properties, and
has therefore entered into the composition of most of the so-called Diet
Drinks. As we do not, however, profess to understand the true mean-
ing of the term alterative, as used technically, and that we consider the
Diet Drinks in common use as mere tonics or restoratives of the general
stamina, we presume that Sassafras exerts a beneficial influence upon
the digestive organs. And, yet, it is difficult to determine the origin
of a' prejudice which exists in the minds of many of our people against
its habitual use, in consequence of its supposed tendency to the pro-
duction of Intermittent fever. This prejudice is so general in Georgia,
that it is supposed to have contributed largely, some years ago, to the
defeat of a candidate for the gubernatorial chair, who had in Congress
urged an increase of the duty upon tea and coffee, adding that if the
enhanced price of these articles proved onerous to some, they might
drink sassafras tea. The good people proudly refused to vote for any
man who was willing to see them all take the ague and fever, merely
for the sake of filling the National Treasury ! We believe the pre-
judice to be unfounded but would like to know if any facts can be
adduced in support of it.

Astringents. The only beverages in common use in disease
which possess any astringency, are the Green and Black table teas
and the Sage tea. This effect is, however, sc slight as to be unim-
portant in general.

Laxatives. We may class as such the infusions of Tamarinds,
of dried Apples, of dried Peaches, of Raisins and of Cream of Tartar;
to which may be added Saratoga water. These are all more or
less grateful and remarkably well adapted to a large class of our dis-
eases, in which the intestines are disposed to be torpid. Those pos-
sessed of acidity promote an abundant secretion of bile as well

704 Editorial. [November,

as of gastro-intestinal fluids ; hence their common use in warm cli-
mates.

Acids. Lemonade and Orangeade are such general favorites in
diseases of tropical climates, that they are in some of the West India
islands considered as the most important medication in all affections
implicating the hepatic secretion. Affan antibilious remedy, Lemon-
ade is held in an equally high esteem by the Creoles as Calomel is
by the English, and those who borrow their views. Lemonade,
besides being exceedingly grateful to the palate, is highly promotive of
the mucous, hepatic, renal and cutaneous secretions. The free flow
of salivary fluids excited by its contact with the mucous surface of
the mouth and the orifices of the ducts that open upon it, will gi?e
some idea of its effect upon the gastro-intestinal surfaces and the
glands whose ducts terminate in them. The capillary circulation of
these mucous membranes and glandular structures mutt therefore be
much relieved of congestion, if any exist. But besides this local
action, Lemonade doubtless penetrates the general circulation by im-
bibition, and is carried to the kidneys and skin, whose secretions it
manifestly increases. If the fluids of the system are alkaline, this
is changed and they become acid by the free use of this bevei
Producing such decided local and general effects, it would seem
more proper to class Lemonade among the potent agenti of the materia
medica, than among the mere adjuvants. We feel satisfied that the
therapeutic value of Lemonade, in the treatment of our fevers, from
the simple intermittent to the dreaded yellow fever, has not been fully
appreciated by those who indite most of the books upon our shelves
the British and our Northern brethren.

Antacids. There are states of the system in which Antacids may
be eminently useful, especially if taken largely diluted or in the form
of beverages. The officinal Lime water, or small quantities of Bi-
carbonate of Soda, or of carbonate of Potass, may be thus used with
plain water. The well water of blue limestone districts is sometimes
of great advantage to dyspeptics. A very common error prevails
with the non-professional public, who believe that soda enters into
the composition of the beverage vended in our cities under the name
of " Soda Water," which is nothing but water strongly impregna-
ted with carbonic acid gas, and without any alkaline properties.
The name of Soda Water had its origin in the fact that the carbonic
acid gas was formerly obtained for the purpose by the action of acids
upon the carbonate of soda, whereas it is now usually derived from
marble or some other carbonate of Lime. By the addition, however,

1554.] Editorial 705

of a little bi-carbonate of soda to this aerated water, a very pleasant
and useful antacid beverage may be made.

Sedatives. During the prevalence of the Broussaisian doctrine,
which regarded nearly all diseases as abnormal irritations or inflam-
mations, sedatives were eagerly sought after, in the vain hope that
they would prove to be of general applicability. The distinguished
French reformer, however, refused to acknowledge as such any other
articles than Prussic acid and Asparagine. We may perhaps then
be excused for placing under the head of Sedatives the infusions of
the leaves of the Orange tree, the Lemon tree and the Peach tree,
all of which we believe contain more or less Prussic acid. Be this
as it may, there is no doubt that they are exceedingly valuable bever-
ages in our autumnal fevers. The orange-leaf tea is remarkably
palatable to most persons, and in addition to being a good diluent,
diaphoretic and diuretic, has a soothing effect that can scarcely be
appreciated by one who has not realized it in his own person. To
secure its full influence, it should be taken freely when hot and just
made (by pouring boiling water upon the fresh leaves), for it very soon
deteriorates and becomes insipid. In the nervous affections of fe-
males, and especially in nervous head-aches, it often acts like a
charm. The French make great use of the distilled orange jlower
water, a tea-spoonful of which they add to a glass of sweetened wa-
ter ; but we think the orange-leaf tea equally valuable, and this is
within the reach of every one who has a garden, as the orange tree
grows finely in this region of country, and with less trouble than is
required to keep the usual supply of balm, sage, &c.

The infusion of Peach tree leaves is peculiarly useful in cases of
irritable stomach, whether occurring in our fevers or after a debauch.
In such cases, however, it should be made strong and given in small
quantities at a time ; say a table-spoonful or two, frequently repeated.
In cases of Hooping-cough, if given freely three or four times a day,
it tends materially to lessen the violence of the paroxysms and the
duration of the disease. We took occasion many years ago to allude
to this use of it, and to recommend it in plantation practice as safe and
valuable.

The last class of beverages to which we shall allude, comprehends
those in which Nutritious elements are added to the diluent. The
most common are water holding in solution Gum Arabic, Sugar and
the various syrups, and teas made with Toasted bread, Rice, Barley,
&c. The value and applicability of these beverages are so evident,
that we mention them merely for the purpose of completing the subject.

706 Editorial [November,

Indeed we have extended our remarks so much more than we had in-
tended when the theme first presented itself to our mind, that we now
entertain serious apprehensions that the reader will be poorly repaid
for the trouble of perusing them. We would accordingly withhold
them from our pages, were it not that we still feel that the subject is
one entitled to more attention than it has heretofore received, and
that the imperfections of this hasty paper may induce others to do
better.

We find in the October No of the American Journal of the Medical
Sciences, Reports by Dr. Charles A. Lee, of an interesting case of
Paraplegia, caused by Concussion of the Spine ; by Dr. F. M. Robert-
son, of a successful case of operation for laceration of the Perineum;
by Dr. Alexander Dunlap, of several cases of successful Ovariotomy ;
and by Dr. J. B. Brown, of a case of Epilepsy, treated by Ligation
of the common Carotid Artery. The same number of this valuable
quarterly contains an able paper upon Neuralgia, by Ch. W. Par-
sons, M. D., being the Fiske-Fund Prize Essay.

11 A Farmer" writes to the St. Louis Medical Journal, that he has
found Soda (probably the bi carbonate) to relieve, very promptly, the
stinging of insects, and snake-bites. The soda, moistened with water,
is to be applied to the part.

In addition to the Physicians reported in our last, as victims of yel-
low fever in Savannah, it is our painful duty now to record the names
of Dr. J. M. Gordon, Dr. A. B. Brantly, Dr. Saussy and Dr. Cullen.

The community for the relief*of which men are willing thus to
sacrifice their lives, ought, in accordance with the plainest dictates of
gratitude, to provide pensions for the support of the bereaved families.
Why should not the pension system be applied to such cases as well
as to those which occur in the army and navy ? We understand that
services of Plate have been awarded (very properly) to the Physicians
who magnanimously came from a distance to the relief of Savannah.
Will nothing be done for the widows and orphans of those who nobly
stood to their post until stricken down by the pestilence ?
~ ~~ ""~

On Glycerin Lotions of Morphia, Strychnia, Veratria, and Atro-
pia% The importance of applying active medictnes externally until
absorption occurs sufficiently to cause their peculiar effects on the
patient, has often been resorted to with great propriety in cases where
their internal administration was rendered unadvisable from gastric
derangement. Quite recently M. Soubeiran has proposed glycerin

1854.] Miscellany. 707

as a vehicle for morphia, in lieu of the "oil of morphia" of M . St.
Lager, and a writer in the Bulletin Generate takes advantage of this
suggestion, and brings forward formulae for similar preparations of
strychnia, veratn'a, and atropia, under the generic title of " Glyce-
rols," or glycerin lotions.

M. Soubeiran's formula is as follows :

Take of Acetate of morphia, three grains.

Glycerin, five drachms, troy. Dissolve.

The Lotion of Strychnia is made thus :

Take of Sulphate of strychnia, six grains.

Glycerin, five drachms, troy.

Dissolve the salt in the glycerin in a porcelain mortar.

A teaspoonful of this lotion is applied by friction in paralysis of the
limbs, on the vertebral column in chorea, on the temples in cer-
tain cases of amaurosis. It is necessary to remember that it is not
the alkaloids but their salts that are soluble in glycerin, and when
only the free alkaloids are officinal in the materia medica, as veratria
or atropia, it is necessary to dissolve the organic base in a little dilu-
ted chlorohydric acid.
Lotion of Veratria.

Take of Veratria, fifteen grains.

Diluted muriatic acid, q. s.
Glycerin, five drachms.

Dissolve and mix.

A teaspoonful applied by friction in chronic rheumatic pains of the
joints, orin the sacro-lumbar region to relieve painful menstruation.
Lotion of Atropia.

Take of Atropia, six grains.

Diluted muriatic acid, q. s.
Glycerin, two and a half drachms.

Dissolve and mix.

Forty or fifty drops applied by friction, repeated three times a day
on the track of the sub and super orbital nerves, on that of the facial
nerve, &c. [Jour, de Pharm. Amer. Jour. ofPharm.

Urinary Calculus formed upon a Leather Shoestring. Dr. Brown,
of Bangor, Maine, exhibited (to the Boston Society for Medical Im-
provement) the specimen, and reported the case. The patient was a
man, set. 27, and grossly addicted to onanism. Fifteen months ago
he passed the string into the urethra after he had gone to bed, and
went to sleep without removing it ; in the morning it had disappeared.
One or two months afterwards, urinary symptoms appeared ; and these
became so urgent, that he was obliged to give up work last autumn,
and for sometime past has kept his bed. About a week ago the cal-
culus was removed by Dr. Rich, of Bangor, assisted by Dr. Brown ;
the lateral operation of lithotomy was performed, and the patient has
done well since.

The calculus is of a regular, oval form, somewhat flattened, and
measures nearly two inches in length. The chemical composition,

708 Miscellany.

according to the analysis of Mr J. C. White, student of medicine, is:
''Phosphate and carbonate of lime the latter being slight with a
slight trace of double phosphate of ammonia and magnesia. No uric
acid nor urates in the portions examined." One extremity of the
calculus having been broken away in the removal, the foreign Lody
has been fully exposed.

Prof. Mussey, of Cincinnati, who was present at the meeting, men-
tioned a similar case in which he had operated, about two year- since.
Hie patient was a young man who had introduced (in accordance
with medical advice, as he stated) a piece of cord into the urethra, for
the purpose of allaying irritation. While introducing it, an unex-
pected occurrence surprised him, and caused a suspension of the
operation, during which time the cord disappeared*

Dr. Mussey saw the patient three months afterwards, and was l< d
from the symptoms to sus| calculus in the bind*

it that time, howevi impossible to detect any stone on

examination by the sound. Two months later, a calculus was at once
distinctly frit, and the operation of lithotomy was performed. The
calculus extract nbles a petrified lumbricus. The nucleus

was the cord introduced, as above mentioned [American Journal
of Med. Sciences.

Charcoal Coverlet for the Prevention of Smell from (l<ni<rrcnous
In souk hospital phagi ntly under his care,

Bartholomew's Hospital, Mr*. VVormald made an ingenious and
very useful application of the disinfecting powers of charcoal. It is

well known that dry charcoal will effectually absorb any noxious or
offensive gas which can be made to pass through it. On this power,
Dr. Stenhouse's disinfecting rs depend for their efficiency.

The difficulty in applying il in hospital practice i arisen

from the difficulty of keeping it at the same time dry and in a uniform
layer around ti, to effluvia. Dr. Wormald's plan

consists in sprinklinic freely between two sheets of cotton wool a tol-
erably thick layer of powdered charcoal, an J then "quilting" them
together in small segments, so that the powder is retain d securely in
its place. The pads thus prepared may be of any size, accorduw as
required to wrap round the end of a stump, or to cover a superficial
ulcer. The sloughing sore having been dressed in the ordinary man-
ner, and a little lint or wool so placed as to absorb any discharge
which may flow, over all is laid the charcoal quilt, which is then
lightly confined by a bandage. It forms, in addition to its disinfectant
properties, a very soft and comfortable envelop, more especially if the
sore be in such a part that the patient is obliged to lie on it. [Medical
Times and Gazette.

O^T Medical College of Georgia. The Course of Lectures
in the Medical College in this City will not be commenced before the
third Monday in November in order that Students may feel entirely
safe in coming.

SOUTHERN

MEDICAL AND SURGICAL
JOUMAL.

Vol. 10.] NEW SERIES. DECEMBER, 18*4. [No. 12.

ORIGINAL AND ECLECTIC.

ARTICLE XXXV.

Typhoid Epidemic Dysentery. By J. A. Loire, M. D., of

Long's Cross-roads, Tennessee.

From the wide-spread prevalence of this scourge, and its fatal
tendency, I feel it a duty to contribute my might of experience
on the subject. About the 20th of May, 1S53, I saw the first
cases of this epidemic, whose increase and spread were rapid
and fearful, until about the middle of June, when it began to
decline, and had pretty much ceased by the last of July. There
were sporadic cases through the fall and winter, and some few
cases became chronic, and lasted for months, until the disease
wore itself or the patient out. It again commenced its ravages
in the present year, about the first of June, and is yet, up to the
present time (Sept. 20th). prevailing to some extent.

Symptoms.- -The onset of the disease, in certain cases, was
not unhke most acute diseases, preceded by premonitory symp-
toms of a disordered state of the stomach and bowels, wandering
pains in the abdomen, or a sense of fullness, weight or oppress-
ion in the epignstric region ; in other cases the attack was
sudden r.n:l violent, in the form of a cholera-nun bux, quieklv
fo! lowed by the bloody discharges. At other times the onset
was no less rapid with bloody evacuation-, mucous, or muco-
sansruinolent matter, attended with tenesmus and totmina from
the first. But a large proportion of cases were gradual and

2*. b. vol. x. No. zii. 45

710 Long, on Typhoid Epidemic Dysentery. [December,

slow, without a chill or even a sense of coldness; little or no
fever in fact, many cases had no appearance of fever from the
onset to their termination, whether in recovery <>r death. In
this latter class there was little complaint of pain in the abdo-
men or elsewhere. In some cases (particularly in the robust)
the inflammatory symptoms ran high, attended with severe head
and back ache; pain in the back was one of the most constant
symptoms attendant on the The discharges were

sometimes scant, of mucus and blood, or blood and serum, re-
sembling beef-brine, an 1 these briny discharges were attended
with mo v.s- ami tormina than any other character of

the discharge. Alternately with the above character of evacua-
tions there would be passed fecal matters of various appearaa-

. from pitch-black ton natural yellow. These dark dischai .
ry common and c | proach "f conva

cence, and were always looked upon as ;i favorable symptom.
More or less soreness was always present in the abdominal
especially if pressure were mi i nines tym-

panitis, though rare. The tongue was always more or less

'(I by a white, yellow, or brownish fur, with its tip and

ges more i d, or of raw beet" appearance. This hitter

aspect of the tongue only existed where there were decided

Iritis OT gastro-enlei i/is. 1 have seen 00 CS

where the disease of itsell ran into gatlro -enteritis only such
as had undergoo i a rigid course of mercury. The present year
have ha section, and man;.

cases of flux were attended will, 1 choleric symptoms,

such as cramps, cold sweats, irrout heat, and e thirst.

In one case the rice-colored discharges supervened copiously.
Another variety of cases occasionally met with, I denominated
the bound cases, from the extremely small quantity of blood
discharged; sometimes small mucous stools, slightly streaked
with blood, once or twice in the twenty-lour hours the patient
being obstinately bound unless under the influence of a purga-
tion, at which time the stools were generally larjje and always
dark. These cases were attended with the usual amount of
abdominal pain, tenesmus and tormina. I attended one of this
class of cases which proved to be very tedious; had all the
characteristics of a common case of Jlux, save the bloody dis-

1854.] hong, on Typhoid Epidemic Dysentery. 711

charges, no traces of which were ever seen in the evacuations,
notwithstanding there were tenesmus, tormina, and almost con-
tinual abdominal pain.

The pulse in many cases varied slightly from the natural
state ; in others it was accelerated more or less, according to
the amount of fever present. In many cases it was of a typhoid
character; but in none did I find it full and strong or bounding,
or what I really considered a bleeding pulse. The bound va-
riety of dysentery, towards the decline of the disease in the
summer of '53, greatly predominated, and so gradually emerged
into. a common bilious fever, that the diagnosis was not very
easy in the onset of many cases. The epidemic the present
season is more uniformly spread over the whole country, and
less in certain localities, than in the summer of '53. Two or
three cases of congestive chill also occurred in this section since
the appearance of the epidemic dysentery probably the first
cases that ever occurred in McMinn county. Bilious colics,
and inactions and congestions of the liver have been exceeding-
ly common the two last seasons ; also, congestive determinations
of blood, carbuncles, &c. Horses, cattle and hogs, suffered
to some extent, and some deaths from a disease to all appear-
ance identical with the flux with which the people were suffer-
ing.

In giving a history and treatment of the Epidemic Dysentery
that has prevailed among us the two past seasons, I shall con-
fine myself to facts I observed myself, and leave the reader to
his own thoughts and inferences. The disease has been whollv
unlike any that ever prevailed in this section of country : strictly
a typhoid flux denominated congestive flux by one of our most
eminent practitioners (Dr. Cooke, of Madisonville, Meriwether
county). The fact is, the disease is both congestive and tj/phoid.
It has not been confined to age or sex; but all have been equal-
ly obnoxious to the fell destroyer, from the infant at the breast,
to the most athletic and aged of the land. In one case only
were the bloody discharges followed by a very singularlv look-
ing white, glairy, tenacious discharge, which was accompanied
by prostrating cold sweats, &c. Of the diagnosis of this dis-
ease nothing need be said, as it would be hard to mistake it for
any other.

712 Long, o?i Typhoid Epidemic Dysentery. [December,

Prognosis. When the discharges became less frequent,
more scant, and mixed or alternated with fecal matters, more
especially if they were of a dark, bilious character, it was always
a favorable symptom, and more especially if they were accom-
panied with a fuller and slower pulse ; but this was not always
the case, for bilious discharges were in some cases occasionally
seen throughout the entire course of the disease, which termina-
ted fatally : such was generally the case when mercury was
used freely in the treatment. In children, drowsiness and gen-
eral languor, accompanied with cold extremities, indicated
great danger; and in general the disease has proved much more
fatal in children than adults. The most unfavorable symptoms
in adults were a stubborn persistence in the discharges these
becoming more frequent, darker, red, and more offensive; sink-
ing and softening of the pulse, wandering delirium, prostration,
&c. In many grave cases, especially in children, the extremi-
ties were cold from the onset, which indicated great danger.

Treatment. From the obvious symptoms of bilious derange-
ment, I cautiously attacked the disease with small doses of
calomel, combined with Dover's powders, and sometimes ipecac
and sugar of lead, variously combined. But I quickly found
that I was not only doing no Lr<'d. but most certainly;
vating the complaint I then tried, in succession, almost every
remedy reputed to be a curative in dysenteiy. until the whole
catalogue was exhausted, with but little or no benefit. I now
determined to give opium ind its vnrious preparations a fair
trial, before condemning that most excellent drug. It was used
alone, both by the mouth and in the form of suppositories and
injections, in large doses, from 1 to 3 grains, every two or three
hours, according to the urgency of the symptoms, and large
suppositories after every discharge. To my great surprise and
gratification, it almost completely controlled the flux. Dr.
Cheyne says, that had he to go over his practice again in dys-
entery, he would not hesitate to give opium in 4 or 5 gr. doses,
as it was the opium that he did use that appeared to arrest the
inflammation. Dr. Christison expresses the belief, that the cure
of epidemic dysentery may often be effected by opium alone.
(Cyclopaedia Pract Med., vol. 1, p. 727.) This latter opinion
coincides with my own experience in the present epidemic of

1854.] hong, on Typhoid Epidemic Dysentery. 713

dysentery in this section of country. In addition to the free
use of opium, I found the warm bath and warm fomentations to
the abdomen, excellent adjuvants in the treatment of the more
grave cases. In some instances the hip-bath alone was used ;
in others, the patient was repeatedly bathed up to the axilla, and
suffered to remain from fifteen to thirty minutes. In cases of
moderate severity, nothing was used but the opium, and some-
times that in the form of suppository. This drug was seldom
used any other way with children, after every discharge. If the
attack commenced with, or was preceded some days by a diar-
rhoea. I commenced at once with the use of opium. If small
bloody discharges characterized the attack, I had the alimentary
tube cleared by a dose of oil or salts, before using opium. Af-
terwards it was sufficient to give salts or castor oil in small and
repeated doses to move off the contents of the upper portion of
the bowels. Notwithstanding there was manifest biliary de-
rangement in a majority of the cases, I do not believe in the old
doctrine of inaction of the liver, and congestion of the portal
circle being the cause of the disease. The disease, as it showed
itself in this country, was purely an idiopathic affection, and
called loudly for means to be directed to the local disease, of
which nothing was so happy in its effects as opium, and its pre-
parations. I have met with no case in which the opium was
contraindicated, notwithstanding I saw many in which the fever
ran high, the pulse was quick, and the pain in the head severe,
&c. In such cases, I did not hesitate to administer the opium,
in full doses, with the happiest effect. It never failed, in my
hands, when given in sufficiently large doses, to lower the pulse,
and make it more full ease the pain in the head as well as ab-
domen lessen the discharges, and induce sweating.

In this way I treated, this season and last together, two hun-
dred and forty cases, of all ages and sexes, and of every variety-
above mentioned, and lost eleven, or five per cent. In a few
cases, where the symptoms were not urgent, and the liver ap-
peared to be inactive, the blue pill was used in connexion with
the opium with good effect.

I have already lengthened out my remarks too far, or I would
give cases illustrative of these different varieties and complica-
tions of dysentery.

714 Harris's Cases of Surgery. [December,

ARTICLE XXXVI.

Surgery, in the Country. By E. G. Harris. M. D., of Carroll
county, Mississippi.

Physicians living in the country are seldom called on to
perform surgical operations, in consequence of which they are
apt to become rusty in this branch, and are generally very badly
provided with instruments. Notwithstanding this, they some-
times have to take the place of the surgeon, and have to operate
with such instruments as they may have, and often have to
manufacture them. Having performed a few simple operations,
and most of them without the right kind of instruments, I thought
I would report them, and show that, although performed with
the pocket-knife, they do as well as when done with more cost-
ly instruments.

In the winter of 1815. I was travelling in the steamer Enter-
prize, on the Yazoo river, on my way to New Orleans, when
one of the deck hands had his great toe dreadfully lacerated;
the skin and tissues for an inch above his toe were torn loose
and pealed down to the first phalanx, which was dislocated.
The skin was still pealed off further down to the middle joint,
leaving a little cuticle on the under side. After carefully exam-
ining the case, I was perfectly satisfied it would have to come
off. Having no instruments with me, I procured a razor, and
amputated his toe at the dislocated joint, where it is attached
to the foot. Having nothing to cut but the inferior integuments,
it bled but little. There was no flap to draw over the stump.
I dressed it with adhesive strips, and in six weeks it was well,
except a small scab over the end of the bone. He had received
his injury by placing his foot inadvertently in the fly-wheel of
the boat.

In 1846, while practicing on the Yazoo river, in this State,
a Mr. Chapman brought me his little son, six years old, who
had not made water for twenty-four hours. I found the penis
swollen about an inch back from its end, and felt at this place
something very much like a pea, or a bean in the urethra. I
could introduce a catheter to this point, but could get it no far-
ther. I introduced a very small pair of twezers, and could get
a slight hold on the substance ; but they would invariably slip

1854.] Harris's Cases of Surgery. 715

off whenever I attempted to grasp it. After vainly using every
means I could think of for more than an hour, I plainly saw it
would have to be cutout so we laid him on a table, and while
two men held him, I drew the penis back on the pubis and made
an incision into the urethra about half an inch long down to the
substance; I then took hold of the object with the twezers and
lifted it out very easily. It was a calculus, about the size and
appearance of a large white coffee grain ; was rather rough ;
flat on one side, and round on the other; \ of an inch long, and
i inch wide ; firm, hard and compact ; weight 22 grs. I dress-
ed the wound with an adhesive strip, and he went out and
made an enormous quantity of urine. This operation was per-
formed with a common pen-knife.

On the 2Sth of October, 1S49, in Fayette county, Alabama,
I was called a distance of seventeen miles to see R. S., a farmer,
in his 42d year, and of bilious temperament. He had phymosis
from infancy, for which no operation had ever been performed.
It had at no time ever troubled him until about two weeks pre-
vious to the time he called on me, when he felt some itching
and soreness under the prepuce. By degrees inflammation and
swelling came on ; pus began to ooze out from between the
prepuce and glans, and it was with difficulty he could urinate.
When I saw him on the 28th, the prepuce and glans were enor-
mously swollen; he was in perfi ct agony, enjoying scarcely
any rest, day or night. I gave him an anodyne, and directed
him to keep soothing applications to the sore, and promised to
come back with assistance on the 30th. and try to relieve him
by an operation.

Accordingly, myself and Dr. S. B. Abernathy went to his
residence prepared to operate. We found him pretty much in
the same condition he was at my first visit. Having no chlo-
roform, I gave him ^ gr. of morphia. As soon as he got under
its influence, I introduced, with a good deal of pain to him, a
grooved probe on the right side of the penis, between the glans
and prepuce ; I then ran a sharp-pointed bistoury along the
groove and split the prepuce up to its attachment ; I then oper-
ated on the left side in the same way. and turned back the flaps.
There was but little hemorrhage ; nearly one half the glans
penis was destroyed. We enjoined perfect rest, light diet, and

716 Harris's Cases of Surgery. [December,

the bowels to be kept open by epsom salts, and dressed the penis
with lint, kept constantly wet in cold water.

On the 21st of November he sent after us again, and request-
ed us to bring with us our instruments, as he expected we would
have to cut it off. We accordingly went, and found him much
worse. The flaps were swollen a great deal more, and ulceration
both of the prepuce and glans had advanced rapidly since our
last visit. The glans was nearly all gone, and the inflammation
and swelling had extended nearly to the root of the organ. In
viewing the case as to its probable result, we came to the con-
clusion it would be best to amputate it, and therefore, in the
presence of Drs. Morton and Black, and another person, we
laid him on a table, placed him completely under the influence
of chloroform, and performed the amputation in the usual man-
ner, at an inch and a quarter from the body. I took up the
arteries and dressed the wound with cold water dressings. He
did very well until the 24th, when the ligature came off the
largest artery, and he bled considerably before he was aware of
it. I tied the artery again. On the 26th. the ligature came off
a second time, and 1 was again called, and I could not now get
hold on the artery. 1 applied the actual cautery, which effectu-
ally arrested the hemorrhage. He then continued to improve,
and in two months was quite well.

In the spring of 1N50, he made a crop, and enjoyed as good
health as ever he did in his life. In June, he felt some soreness
and enlargement of the glands in the left groin. They continu-
ed to enlarge and increase in soreness until about the first of
Jul}7, when the cuticle gave way, and the ulcerated glands dis-
charged a large quantity of pus, mixed with blood and water.
On the 23d of this month, I was called to see him, and became
satisfied the case was cancerous, and informed him that I was
fearful there could be but little done for him. The edges were
rough and ragged, and discharged a very offensive, watery,
bloody matter; the ulceration continued to enlarge and get
deeper. I tried a little of almost everything to satisfy him, but
nothing did him any good. Faith and Cancer Doctors prom-
ised to cure him in a week ; but they left just before he got well,
and reported that they had cured him wherever they went. He
became emaciated ; lost his appetite ; the glands in the other

1S54.] Milner's Case of Poisoning. 717

groin began to ulcerate when, one day in December, just after
having dressed his wound with a little simple cerate, and eaten
a little dinner, he felt his left hip and side unusually warm where
he lay in bed ; he raised the cover, and discovered a puddle of
blood some two inches deep ;. he called to his family became
sick fainted, and never recovered. Thus he died, after nearly
a year's intense suffering, by the rupture of a large blood-vessel.

In July, 1852. I was sent for to see a young man in his 18th
year, who had been accidentally shot by an uncle ; but could
not go. Another physician was called, who could do but little
more than give him a purgative. On the twenty-second day
from the time he received the shot, I was in his neighborhood,
and he came to see me. The rifle ball (about 60 to the lb.) had
entered his right breast, about an inch and a quarter below the
right nipple, passed through the body, and lodged against the
skin, close to, and on the left of the spine, and about an inch
lower than where it went in. He suffered with paralysis of the
lesr for some four weeks, and an occasional shooting pain in that
ankle. I cut the ball out with a razor, and he gradually recov-
ered, and is now quite well.

He was running in a bent position, nearly in the direction to
the one who shot him at the time he received the wound. How
many could be shot through in the same place, and get well ?
Was not his position of being bent forward at the time he re-
ceived the shot favorable to his recovery ? At the crack of the
gun he fell, and had no power to use his lower extremities for
several days, showing the spinal marrow had suffered consider-
ably. In about five days he recovered the use of his right leg
entirely ; but not of his left, for some time after I took out the
ball.

ARTICLE XXXVII.

A Case of Poisoning. Reported by M. A. Milxer, M. D., of
Fairfield, Texas.

Dear Sir The comparatively rare occurrence of poisoning
by Hydrocyanic Acid, or preparations containing it, as Cyanide,
or Cyanuret of Potassium, is admitted; vet it does sometimes

718 Milner's Case of Poisoning. [December,

occur, and this induces me to report the following case, with the
hope th.it it may elicit furl her enquiry for a certain antidote,
and the proper management of such accidents.

On the 6th inst. (October), Col. W.s little daughter, Fanny,
three years old, in company with others, visited a Daguerreian
Gallery, in the second story of my ofllce. While the artist was
preparing a plate, one of the ladies gave the child (for water)
a solution of the chloride of silver and cyanide of potassium,
used to galvanize plates. The mistake was discovered imme-
diately, and the child brought into my office, with the cry
"Do something quick! it is poisoned with the Chloride of Sil-
ver." One glance revealed to me the truth of the alarm. Her
face was flushed, her breathing slow and stertorous, and she was
apparently insensible. With all possible haste, I tried a mus-
tard emetic, but found she could not swallow, and immediately
resorted to the stomach pump, and succeeded in drawing off a
good portion of the fluid contents of the stomach. It being a
short time after dinner, however, the imperfectly chewed and
undigested bits of meat, &a, would fill the eyes of the tube, and
prevented as effectual an emptying of the stomach as was de-
sired, I then forced salt water into the stomach, but to no pur-
pose, for the child was dead,

The length of time from the drinking of the poison, until the
last gasp for life, was between four and five minutes.

None of the antidotes, as laid down by authors, were used,
such as chlorine water, ammonia, cold water, &c.

In conclusion, I would respectfully ask. where such prominent
poisons are taken, and the paralytic effect on the nervous sys-
tem so instantaneous, should emetics, or the stomach pump, be
thought of for relief? or should we depend upon inhalations and
the administration of antidotes. .

The composition of the poison was about siv. Cyanide Po-
tassium, I i. Chloride Silver, and three pints water.

1854.] Dugas, on Lithotrity and Lithotomy. 719

Report " on the relative value of Lithotrity and Lithotomy"
Presented to the Medical Society of the State of Georgia, at
its last annual meeting, by L. A. Dugas. M. D.

The subject assigned us for elucidation, as above enunciated,
is by no means one of easy solution, for, in order to render the
comparison of different plans of treatment at all satisfactory,
we should first be prepared to admit that they are applicable to
the same cases, or to the varied forms and circumstances in
which the disease may be found ; an admission which cannot
be made in the present instance. Equally valuable in cases
adapted to each particular operation, they cease to be so under
different circumstances. While Lithotomy is alone advisable
or piacticable under certain conditions of the case, there are
others in which it were unpardonable not to give the preference
to Lithotrity.* A case in which Lithotomy would be attend-
ed with comparatively little danger, might be made much worse
by a resort to Lithotrity : whereas another in which Lithotrity
would be harmless, would become very serious if treated by
Lithotomy. As well might we attempt to determine the rela-
tive value of Mercury and of the Iodide of Potassium in the
treatment of Syphilis, in certain stages of which the one would
be as baneful as it would prove beneficial at other periods of
the disease ; and vice versa.

We are aware that some of the enthusiastic advocates of the
one or the other of these methods for the removal of vesical
calculi, have from time to time invoked the aid of statistics to
demonstrate the relative success attendant upon the perform-
ance of these operations ; but after all, these researches have
been exceedingly unsatisfactory. As Lithotomy is the only
operation justifiable in some of the worst cases of stone, and
Lithotrity the proper one in recent and uncomplicated cases, it
is not to be marvelled at that the former should have proved
oftener fatal than the latter procedure, in the hands of those
who conscientiously practice either the one or the other accord-
ing to the exigencies of each particular case. What would be
the result if any one were so injudicious at present as to resort
exclusively to Lithotomy or to Lithotrity in all cases indiscrim-
inately, we cannot determiue. It is true that we have some
knowledge of the results of Lithotomy prior to the discovery of
Lithotrity; but we know of no instance in which any practi-
tioner of note or of extensive opportunities has treated all cases

"We retain the word Lithotrity in the sense used by the Society, in prefer-
ence to adopting-, as is sugsested by some, the term Lithotripsy. Although the
latter may be, etimologically, more correct as the operation is now perloriaed,
ttere is a" manifest inconvenience in multiplying technicalities.

720 Dugas, on Lithotrity and Lithotomy. [December,

indiscriminately by Lithotrity, for even Civiale, Amussat, Le-
roy, Heurteloup, and Costello, the strongest advocates of Litho-
trity, do not hesitate to cut such cases as they deem inappro-
priate to their favorite method. To be, at this enlightened day,
the exclusive champion of either operation, would indicate a
disregard of the plainest inferences of reason and a reckless-
ness of human life entirely unworthy of the high calling of the
Surgeon.

Under existing circumstances, then, we propose to point out
the relative advantages of these operations in such cases as an
equally adapted to both, and. subsequently, to indicate the con-
ditions in which either the one or the other should be preferred.

In cases equally favorable to either operation. Lithotrity pos-
sesses the following advantages over Lithotomy :

1. It is a much less alarming procedure ; there is nothing
repulsive in the instruments, which are constructed upon beau-
tiful mechanical principles, and evidently calculated rather to
avert than to give pain. Instead of subjecting the patient to
the terror of being bound band-and-fool in a most uncomforta-
ble and humiliating position, he comes forward unshackled,
and submits with the cheering hope of relief by a bloodless
operation.

2. The operation is intrinsically less painful. With dexteri-
ty qn the part of the operator, it may be performed with very
little inconvenience: whereas DO degree Otexpertness can ren-
der Lithotomy otherwise than extremely* painful. It is true,
that the discovery ot'ana sthetics lessens the force of this argu-
ment very materially : but while it prevents the evil effects of
the shock of pain upon the nervous system, it adds an element
of danger not to be entirely disregarded.

3. The bladder is more easily entered by the Lithotrite than
by cutting instruments. The Lithotrite is passed through a
natural opening with comparatively little difficulty; whereas,
the bladder can only be reached, through the perineum, by a
complicated process, requiring intimate anatomical acquaint-
ance with the region, and the most complete self-possession on
the part of the Surgeon. The introduction of an instrument
into the bladder per urethram completes an important stage of
Lithotrity ; but is only the preparatory step towards the opera-
tion of Lithotomy.

4. By Lithotrity we avoid the danger of hemorrhage, prima-
ry and secondary, to which some of the French authors attri-
bute one fourth of the deaths that occur after Lithotomy. The
most skillful Surgeons have sometimes wounded the bulb of the
urethra, the internal pudic and the hemorrhoidal arteries, thus
giving rise to serious or fatal accidents. Cases are on record

1854.] Dugas, on Lithotriiy and Lithotomy. 721

of deaths even from the opening of the transverse artery of the
perineum, which is necessarily done in all such operations.
But, if it be urged that such accidents might have been avoided
by more prudent and dexterous operators, we may reply that
there are sometimes anomalous dispositions of the blood-vessels
which cannot be known to exist before the operation, and in the
avoidance of which, therefore, skill is unavailing. A danger
that no skill can avert is not easily overrated. Hemorrhage, it
must be confessed, may be consequent upon Lithotrity ; but it
is here rarely, if ever, fatal.

5. We incur no risk of injuring the rectum in Lithotrity a
very serious accident.

6. There is much less danger of urinary infiltration. Yet,
this may occur in Lithotrity in consequence of laceration of the
urethra by a bit of the calculus adhering to the instrument
when it is withdrawn or by the efforts made to extract a frag-
ment lodged in the urethra. But this is extremely rare in com-
parison with the accidents of Lithotomy, and not so aj|t to
prove fatal.

7. Phlebitis and purulent infection are more common after
Lithotomy than Lithotritv.

8. There is no danger of urinary fistula, which occasionally
results from Lithotomy.

9. Lithotrity does not necessarily confine the patient to bed
after its performance, and may in many instances not interfere
with the pursuit of his usual avocations.

In enumerating the advantages of Lithotrity. we ought not
to omit the very important consideration, that, if it were more
generally practiced, and its merits better understood by the
people, no one would suffer long from calculous affections, with-
out applying for relief; and by thus early invoking professional
aid, the cases would not become so complicated and aggravated
as to render Lithotomy preferable. The patient would come
to the surgeon before the stone had acquired such dimen-
sions as to preclude Lithotrity ; the bladder would not have
become the seat of dangerous lesions; the general health would
be comparatively unimpaired; and every thing, in short, would
be found in the most advantageous condition for easy and suc-
cessful Lithotrity. Lithotomy, instead of being, as it is now,
generally preferred in the majority of cases, would be resorted
to only in exceptional ones.

Let us now see what are the intrinsic advantages of Ltthoto-
my. in cases equally adapted to either ore rati Off. We find,
in the first place, that it is more promptly effectual ; in the se-
cond, that it leaves the subject less liable to recurrence of the
disease ; and in the third, that it can be performed with instru-

722 Dugas, on Lithotrity and Lithotomy. [December,

merits less complicated, less liable to be made of bad materials,
and more easily procured by the mass of practitioners.

Lithotomy is more promptly effectual, because the bladder is
by it at once relieved from a source of irritation more or less
injurious to the whole urinary apparatus and to the system in
general, at the same time that the inconveniences and accidents
attendant upon the discharge of calculous concretions through
the urethra, after having been crushed by the Lithotriptic in-
struments, are obviated.

That a recurrence of the disease ia less frequent after Lithoto-
my than after Lithotrity. seems to be generally conceded ; and
it is even affirmed that relapses are six times as frequent after
Lithotrity as they are after Lithotomy, from the data far-
nished by Mr. Coulson, (Lithotrity and Lithotomy London.
1853 p. 88.) we find that in an aggregate of seventeen hun-
dred and forty-seven case* of Lithotomy, relapses occurred
thirty-eight times, or once in forty-six eases. According to M.
Civiale there were fifty-five relapses in tour hundred and forty-
eight cases treated by Lithotrity. or one in ten cases showing
relapses to be four and a half times as frequent after Lithotrity
as after Lithotomy. The difficulty of getting reliable statis-
tics <>n this pnim is so obvious that we place little confidence
in the correctness of the above figures, except SO far as they
indicate the number oflEPOBTED cases of relapse. We cannot

regard them as establishing conclusively that all the relapses

which took place, were necessarily known and recorded by the

reporters. The more frequent recurrence of stone after Litho-
trity. is probably owing rather to the incomplete extrusion of all
the fragments (thus leaving a nucleus for additional deposits)
than to any difference in the effect of the operation upon the
calculous diathesis. Yet. the section of the neck of the bladder
in Lithotomy, may. perhaps, more readily than Lithotrity, tend
to heal a morbid condition of this viscus favorable to the forma-
tion of calculous concretions. Still another explanation pre-
sents itself: inasmuch as the peculiar condition of the urinary-
secretion, upon which such concretions usually depend, may be
changed after a certain time, the longer the operation is defer-
red the greater will be the probability that the calculous diathe-
sis has ceased to exist. Lithotrity is most frequently resorted
to in cases in which the disease is of comparatively recent date,
and may therefore be done before the subsidence of the diathe-
sis, and consequently, be followed by a relapse, even though
every vestige of calculus may have been passed off after the
crushing. Lithotomy, on the contrary, is performed in all such
cases of long-standing as have become unfit for Lithotrity, and
in which it is exceedingly probable that the constitutional dia-
thesis has changed.

1854.] Dugas, on Lithotrity and Lithotomy. 723

It is to be regretted, that we possess no correct data by which
these considerations might be tested. We would require for
this purpose, statistical information as to the relative proportion
of relapses, after both Lithotomy and Lithotrity, and also a spe-
cification of the age of the patient, the duration of the disease,
the degree of relief experienced after the operation, and the
length of the interval between the operation and the relapse.

The instruments required for the performance of Lithotomy
are exceedingly simple, and may be readily procured by any
one who may desire to use them ; whereas, it is more or less
difficult to obtain those for Lithotrity of sufficiently good work-
manship and tried metal, to be safe. Indeed, there are few
"Surgeons who would feel justified in using any other Lithotritic
instruments than those made by the distinguished Charriere, of
Paris, or Weiss, of London: for the success of the operation and
the safety of the patient, are as much dependent upon the per-
fection of the instruments as upon the skill of the operator.
Again, the same Lithotrite cannot be adapted to all cases, and
it therefore becomes necessary for the Surgeon to keep a variety
of them, in order to be prepared for any emergency. This can
scarcely be expected of the mass of practitioners, and conse-
quently limits the performance of this operation to the few who
may be more favored by circumstances. It is true that these
considerations ought not strictly to be urged against Lithotrity;
yet. they certainly account, to some extent, for the rarity of this
operation in comparison with Lithotomy. While Lithotrity has
as yet been performed by very few Surgeons in the L'nited
States, Lithotomy, on the contrary, has been and is daily being
resorted to by a large number of our Physicians.

Having now enumerated the relative advantages of Lithot-
rity and Lithotomy, in cases equally adapted to both operations,
the task of setting forth their disadvantages becomes compara-
tively easy ; for the arguments in favor of the one, constitute so
many objections to the other.

To Lithotrity, then, it may be objected that it very rarely
relieves the patient of his troubles at one sitting: that these, on
the contrary, must usually be repeated more or less often, and
at intervals more or less great; thus consuming time, to the
serious inconvenience of the patient, especially when away
from home. Parents who bring their child from a distance are
usually impatient to return, and will prefer the more speedy
result of Lithotomy to the more tardy progress of Lithotrity,
especially now that the painfulness of the former may be miti-
gated by anaesthesia.

The frequent repetition of Lithotritv, necessary in some cases,
may so aggravate the irritation of the bladder as to forbid its

724 Dugas, on Lithotrity and Lithotomy. [December,

continuance, and occasionally to prove fatal. Each application
of the Lithotrite is sometimes followed by considerable consti-
tutional disturbance, which may not be renewed too often with
impunity. In such cases the operation would have to be dis-
continued, and Lithotomy resorted to.

The manipulations in Lithotrity require a degree of dexterity
and familiarity with the instruments that can only be attained
by much practice upon the dead body ;in<l experience upon the
bring; whereas, any one who has the requisite anatomical
knowledge and self-possession may perform Lithotomy tolera-
bly well. An unskillful hand may seize the bladder with the
Lithotrite, and thus do much mischief. However careful and
expert the operator may be. fragments of the calculus will some-
times become so fixed in the blades of the instrument that these
cannot, lie closed so as to permit the withdrawal of the Litho-
trite : or, if the fragments are not so large as to prevent the
withdrawal of the Lithotrite. they may produce laceration of the
urethra and the danger o( urinary infiltration ; or the instru-
ment may be broken in the bladder, and thus render Lithotomy
indispensable. The difficulty of procuring lt* >< < 1 instruments ^(
Lithotrity has been sufficiently adverted to. We have also seen
that patients are more liable to a return of the disease alter
treatment by Lithotrity than by Lithotomy.

The objections to Lithotomy ;ire very serious. It is infinite-
ly more alarming to the patient than Lithotrity. With fear and
trembling, he presents himself to the Surgeon with more appre-
n than hope, with the terrors of an operation ever re-
garded as one of the moSl dreadful in Surgery, and with the
Uncertainty of surviving it He comes, in short, after having
suffered until life has become intolerable, and submits to the
pain and risk of the operation as a dernier resort as the last
sad alternative ofs man doomed to die unless this csn afford
relief. Nor are the preliminary steps tor the operation calcula-
ted to change his feelings ; tor. although assured that by the use
of anaesthetics he will be prevented from experiencing any pnin,
the strong bands by which his limbs are pinioned indicate but
too unequivocally the writhings ihus sought to be obviated.

In order to reach the bladder through the perineum, the pa-
tient has to be subjected to a wound in itself of dangerous char-
acter, even under the most favorable circumstances. Arterial
and venous plexuses may be opened and give rise to alarming
or fatal consequences; the 7'ectum may be cut ; the inc'sion of
the prostrate may prove to be too small for the passage of the
stone, and require to be enlarged; and, finally, infiltration of
urine may take place in consequence, according to Prof. Patti-
son, of injury to the vesical reflection of the pelvic fascia.

1854.] Dugas, 07i Lithotrity and Lithotomy. 726

In the extraction of the calculus, some difficulty is occasion-
ally experienced, in consequence of the contractions of the
bladder, or of the position of the stone ; the prostate and neck
of the bladder may be seriously contused or even lacerated by
the irregular surface of the stone, or because of the smallness of
the opening made with the knife.

After the operation has been completed, the patient has to be
confined to bed, and is there liable to suffer from the flow of
urine over a raw surface, from phlebitis, from purulent infection
from peritonitis, and finally from secondary hemorrhage. The
shock to the nervous system, even notwithstanding anaesthesia,
will occasionally take off a patient when least expected, as may
be seen in a case reported by the writer in the Southern Medi-
cal and Surgical Journal, for February, 1S53.

Inasmuch, however, as many cases are found which are not
equally adapted to Lithotrity and Lithotomy, it may be well
to study and to indicate the circumstances that would in such
cases militate against either the one or the other of these oper-
ations.

The obstacles in the way of Lithotrity may be found in the
condition of the urethra, in that of the bladder, or in the nature,
volume and position of the calculus.

If the urethra be so irritable as to render catheterism painful
and difficult, and that this state cannot be readily removed ; if
the canal be the seat of stricture which cannot without much
inconvenience and delay be sufficiently overcome to allow the
ready introduction of the Lithotrite; if there exist fistulous
openings which seriously impede catheterism. and which would
have to be cured before the instruments of Lithotrity could be
easily used ; and, finally, if the urethra were so compressed or
deviated from its natural position by tumors situated along its
course, whether in the perineum or prostatic region, as to offer
an impediment to the introduction of large instruments : it is
obvious that Lithotrity should give way to Lithotomy, and more
especially if the early removal of the calculus, were deemed of
urgent necessity. In such cases, the conduct of the Surgeon
should be governed by a careful appreciation of all the peculiar-
ities of the case. If the patient could, without incurring addi-
tional risk, be relieved of the obstacles and thus prepared for
Lithotrity, all other things bein^ equal, it would perhaps be ad-
visable to adopt this course, for the operation of Lithotomy
would not dispense with the necessity of subsequently combat-
ting the strictures and tumors to which we have referred.
Moreover. Lithotomy requires the introduction of a sound for
the detection of the stone, and of a staff to guide the cutting in-
strument, although it is true that the sound and staff need not

N. S. VOL. X. XO. XII. 46

726 Dugas, 071 Lithotrity and Lithotomy. December,

be as large as a Lithotrite, nor would they probably have to be
so often passed into the bladder. In such cases, if circumstan-
ces render it imperative to remove the stone as early as possible.
Lithotomy will, of course, be the only alternative.

The prostate gland is sometimes so much enlarged, or the
neck of the bladder compressed to such a degree by tumors, as
to impede materially the introduction of the Lithotrite, and
hence to preclude its use.

A very tender and irritable bladder will often prove an insur-
mountable obstacle to Lithotrity, notwithstanding the aid of
anaesthetics. Sometimes the bladder is the seat 01 fungous ex-
crescences, which will bleed more or less freely whenever instru-
ments are introduced ; or its capacity may be so much dimin-
ished as to render it difficult OT impossible to distend it suffi-
ciently with water to permit the safe use of the Lithotrite.

In cases in which the bladder is sacculated or affected with
hypertrophied bands, th cannot be seized with the Litho-

trite without great danger to the ?is<

The difficulty of crushing very bard and large stones is such
as to render Lithotrity under such circumstances very objec-
tionable. If the density of the stone is not great, however, its
size will present but little difficulty, provided it be not too large
to be seized by the Lithotrite.

Acute inflammation of the bladder, as well as atony or para-

of this organ, will preclude a resort to Lithotrity. unless

they be of Buch recent date as to warrant a delay sufficient for

their subsidence before the operation be performed.

Most authorities are averse to Lithotrity in children, not only
because of the greater difficulty of operating upon them, but
also because of the very general success of Lithotomy in the
young. The difficulty ofoperatinc upon children does not de-
pend upon the mere Bmallness of their urethral canal, but also
upon their lack of self-control upon the almost impossibility of
keeping them sufficiently quiet, even with the aid of stroD
sistants. Although the limbs and trunk may be firmly held, the
convulsive movements of the diaphragm and abdominal muscles
in crying and sobbing, will impart a degree of impulse to the
bladder which may incommode the operator very much. But
these difficulties are now measurably obviated by aneesthesia.
M. Civiale however, (Traite Prat. et. his. de la'Lithotritie, p.269)
considers as very strong objections to Lithotrity in children,
the existence of calculi too dense to be crushed with a small
Lithotrite, and also the fact that in children the vesical orifice
of the urethra, being very dilatable, will often allow fragments
to pass into the urethra, which are too large to make their way
out.

1854.] Dugas, on Lithotrity and Lithotomy. 121

The circumstances that contra-indicate Lithotomy are gen-
erally admitted to be more rare than those that preclude a resort
to Lithotrity. Among these, however, may be enumerated great
exhaustion from long continued suffering or from other causes ;
the existence of an acute or chronic disease, which might be
aggravated by so severe an operation ; the presence of a stone
of extremely large dimensions : deformities of the pelvis, or such
morbid conditions of the hip joints as would prevent placing
the patient in the proper position; great obesity, or the existence
of perineal tumors, which would render it difficult to penetrate
to the bladder : impenetrable strictures of the urethra ; a saccu-
lated or encysted stone ; malignant disease of the bladder. &c.
A very irritable or contracted state of the bladder that would
prevent its being sufficiently distended with water before oper-
ating, would constitute a serious difficulty and so would a
reticulated or columnar state of the viscus. Considerable en-
largement of the prostate will sometimes impede very much the
extraction of the stone, even after the bladder has been penetrated.

If we now endeavor to determine how many out of any given
number of cases of stone, would be adapted to either Lithotrity
or Lithotomy, we will find no small amount of discrepancy
among authors. We should rather say that we have no data
from which we can deduce the proportion of cases in which
Lithotomv. if exclusively used, could be resorted to or, in
other words, the proportion of cases of vesical calculus in which
Lithotomv would be found impracticable or unadvisable. with-
out regard to Lithotrity. Exclusive Lithotomists are not back-
ward in furnishing the results of their operations ; but they make
no allusion to the number or proportion of cases rejected as unfit
for operation. Yet such data would be necessary to judge cor-
rectly of the relative success of different Surgeons. It is evident
that he who would eliminate or reject all cases of doubtful suc-
cess might appear to very great advantage over those who feel
bound to consult the best interests of the patient, rather than
their professional reputation.

The only statement bearing upon the question, which I have
seen, is that made by 31. Civiale, who collected statistics from
various parts of Europe, embracing no less than five thousand
nine hundred cases of calculous disease. Of these 5900 c;
4446 were operated on as follows : 3991 by cystotomy : 62 by
extraction without incision: 73 by urethrotomy; and 320 by
Lithotrity thus leaving the large number of 1454 without being
operated on or about one-fourth who were probably deemed
unfit for any operation. Although M. Civiale remarks that the
details of the reports thus collected r.re incomplete, inasmuch as
they only record 859 as not having been operated on. the infer-

728 Dugas, 07i Lilhotrity and Lithotomy. [December,

ence we have drawn appears to us legitimate; for if the remain-
der had been operated on, the fact would have been staled.
595 cases are not accounted for. Sir Philip Crampton found
two out of 35 cases unfit for any operation. The reliable sta-
tistics to which we have access refer to the number of cas
adapted relatively to both Lithotrity and Lithotomy. Thus,
according to Mr. Coulson (p. Ill) "M. Velpeau asserts that
Lithotritv is applicable in about a quarter only of the eases of
calculous patients which may come before the Surgeon. M.
Amussat. even so far back as 1835, declared that he found Li-
thotrity applicable to three-fourths of the calculous cases in his
extensive practice. Sir Philip Crampton had occasion i<> treat
thirty-five calculous patients within a period of eleven years,
and of these two were considered unfit for any operation, twenty-
four were Lithotritized, and nine were submitted to Lithotomy.

Thia 'arlv the same proportion as thai of M. Amussat,

viz: three-fourths of calculoi to which Lithotritv was

applicable. The late Mr. Key. who was no warm advocate of
Lithotritv. said, "that more than half the number of adults who
came under his care with stone were fit subjects tor Lithotritv."
Between the years ISO 1 and ls.'>(>. M. ( 'iviale saw 506 calculous
patients; of these he rejected 199 as unsuited for the operation
of Lithotritv, and operated on the remaining 307. Hence about
two cas ryfivev cted during this period. Prom

1830 to 1845, M. Civiale saw 332 calculous patients, 91 \\<
rejected, and 241 operated on: tv in every seven v.

rejected during this period or, taking both periods together,

have 290 cases out i d. being a proportion

about one-third. This latter i< perhaps ;i< near to the true pro-
portion n net ; hut we must remember that it applies
to adults only."

Civiale (Tr. Prat.et llist.de la Lithotritie, 1847, p. 567) states
that in six years (from 1836 to '42) then- were in the Parisian
Hospitals 73 cases of Lithotomy, of which 45 were cured, 25
died, and 3 result unknown. During the same period Lithojri-
tv was performed by others than himself in Paris 38 times, and
death occurred in 11 of them Civiale therefore infers that
Lithotritv was deemed appropriate in 38 out of 111 cases
of stone. He then states his own results during the same pe-
riod to be as follows: In 97 cases of stone, he found 15 unfit
for Lithotrity; 78 were subjected by him to Lithotrity, of whom
5 died.

From the ignorance, improvidence, or timidity of many of
those affected with calculus, professional aid is not often invoked
in the early stages of the disease ; but is, on the contrary, made
the last resort. In this way a larger number of cases become

1854.1 Dugas, on Lithotrity and Lithotomy. 729

unfit for Lithotrity than would be found under a different state
of things.

In treating the subject assigned us, the question of the rela-
tive fatality of the two operations presents itself as one of pri-
mary importance. By reference to the works of M Civiale,
and to the more recent treatise of Mr. Coulson. we find a very
considerable collection of statistical information ; a portion of
which we will use without further reference.

Mr. Coulson has collected well authenticated reports of no
less than 6369 operations of Lithotomy, "more than two-thirds
of which have been performed since the commencement of the
present century,'"' in which "the number of deaths was (J58,
and the general mortality, therefore, 1 in 6.02 cases."' From the
tables published by M. Civiale, it appears that of 582 lateral
operations performed in France, 10] resulted fatally, making
the proportion of deaths 1 in 5.70, and of 2278 cases of Lithoto-
my performed in various parts of Europe. 443 terminated
fatally or 1 in 5.14. From the tables of Mr. Coulson, the
results in Great Britain were, in 1744 operations, 251 deaths,
or 1 in 6.93.

According to Mr. Coulson's estimates the fatality of Li-
thotomy at different ages may be thus stated :

Below 10 years of age, it is 1 in 13

From 10 to 20 " ". " " " 1 " 9

20 to 30 " " " " 1 " 6

" 30 to 40 " " " " 1 " 5

" 40 to 50 ' " " " 1 " 4

" 50 to 60 " " " " 1 " 3.65

" 60 to 70 " " " " 1 " 3.23

0 to 80 " " " ' 1 " 2.71

Aggregate proportion,

M. Civiale arrives at the following result :
From 1 to 10 years of age, the deaths are
11 to 20 " < " "

u

21 to 30 "

<(

" 31 to 40 " "

" 41 to 50 " M

" 51 to 60 " " "

61 to 70 " " "

" 71 to 80 " "

1 "

8.37

t :
are

1

in 8.47

(<

1

in 7.41

tt

1

in 4.62

u

1

in 5.32

u

1

in 6

u

1

in 2

11

1

in 1.S9

M

1

in 1.20

Aggregate proportion, 1 in 5.94

The Records of Pennsylvania Hospital, according to Dr.
Norris (Report in Trans. Am. Med. Association, vol. 1) show
that from J 752 to 1848, there were 83 operations of Lithotomy,

730 Dugas, on Lithotrity and JAthotomy. [December,

-

of which 72 were cured, 10 died and 1 was relieved. The pri-
vate practice of Surgeons, both in Europe and in this country,
has in many instances presented a striking contrast with the
statements derived from hospital records. It is unnecessary,
however, to furnish farther statistics upon this portion of our
subject.

With regard to the fatality of Lithotrity, we find oursi
restricted to the writings of M. Civiale for anything spc
The success of this distinguished Surgeon in the treatment of
calculous affections is without a parallel ; and, although his
statements were at one time (doubtless from a narrow spirit of
envy), made the subject of serious imputations, they are row
generally conceded to he fairly established, and are, we be-
ieve, so recognized by the French Academy. M. Civiale has
published a complete account of each case, as well as tables of
results. From L824 to 1848, he had 84 i of calculous

disease upon 501 he performed Lithotrity, of whom 11 died,
or 1 in 42.21.

The following will exhibit the number of cases, at different
ages, so far as recorded :

kJ") cases, from 1 to 20 years of .

80 " " 21 to 40 " " M

124 " " 41 to 50 " " "

44 " " 51 to 60 " " "

u u 61 to 80 " " "

.") " " 81 to 90 " " "

M. Leroy d'Etiolles reports 11 deaths in 11(> operations.
M. Heurteloup states that he has lost but 1 in 8

The conclusions of M. Civiale (op.cit., p. 48), with rei^ard to
the relative value of Lithotrity and Lithotomy, are as follows :

1st. Lithotrity when well performed, in appropriate cases,
will save from 96 to 98 patients in 100. _

2nd. The remaining fourth of calculous subjects unfit for
Lithotrity may be subjected to Lithotomy.

3rd. By Lithotomy, if exclusively practised and without dis-
tinction of age, from 20 to 30 per cent, will be lost.

4th. If applied to children exclusively, Lithotomy will save
nine-tenths.

5th. If applied to adults of all ages, Lithotomy saves from
50 to 75 per centum.

Having now presented, even at the risk of tedious repeti-
tions, the arguments which might be urged for and against both
Lithotrity and Lithotomy in cases deemed equally adapted to
either of these operations, and also indicated the circumstances
that should be taken into consideration in determining upon
the adoption of one or the other operative procedure, it may

1854.] Observations on Aphonia. 731

be expected of us to be more definite, and to avow a preference
for either Lithotrity or Lithotomy, as a general plan of treat-
ment. In deciding upon the propriety of surgical operations,
or upon the merits of particular processes, it will be often found
a wholesome rule, and one by which the solution may be readi-
ly obtained, to suppose ourselves in the condition of the patient,
and then to ask what would be our election under such circum-
stances. We have very frequently, in this manner, determined
at once the course to be adopted in cases previously involving
much doubt and hesitation. With regard to Lithotomy and
Lithotrity, we are free to acknowledge that if we wTere affect-
ed with stone, and that the circumstances were equally favora-
ble to the success of either operation, we would not hesitate a
moment in giving the preference to Lithotrity. The advan-
tages of Lithotrity are numerous and important, whereas the
only intrinsic or valid objections that can be alleged against it,
under the circumstances referred to, are to be found in the
facts that the operation may have to be repeated, and that it
leaves the patient more liable to a recurrence of the disease
than Lithotomy. The advantages of Lithotrity unquestiona-
bly very far outweigh all the objections to it. So thought those
justly celebrated practitioners, Lisfranc, Dubois, Boisseau, &c,
who did not hesitate to do homage to Lithotrity, and to the skill
of Civiale, by submitting to be Lithotritized by him.

Some important Observations on Aphonia arising from organ-
ic lesions. By Horace Greex, M. D.

[The following article was read before the London Medical Society (having
been furnished at the request of a corresponding member of that Society,) by
the Secretary, at its session, in April, 1854.]

Since the publication of my work on "Diseases of the Air-
Passages," in which are recorded several cases of aphonia,*
dependent as it appeared to me at the time, on the presence of
ulcerations of the vocal cords, I have had an opportunity of
observing a large number of cases of aphonia, in many of
which the alterations of structure were quite different, in their
character and location, from those of the above cases. In
other words, the lesions on which the aphonia depended, were
not constantly lesions of the vocal cords, nor did they always
occur in their immediate vicinity. As such instances are
frequently to be met with, in which the changes of structure
are in some degree remote from the vocal ligaments, and as the
voice in these cases cafhot be restored until the primary lesion

* A Treatise on Diseases of the Air-Passages, &c, p. 75, cl seq.

732 Observations on Aphonia. [December,

is discovered and arrested, it has occurred to me that a history
of some of those cases of aphonia which arise from causes not
alluded to by authors, may add something to our knowledge
in medical pathology.

Dr. Cullen has enumerated three species of aphonia, namely,
aphonia gulturalis, aphonia trachealis, and aphonia atonica ;
and most subsequent writers have followed this division.
But these varieties do not include some of the most difficult
and severe forms of this symptomatic affection ; for aphonia is
not an idiopathic disease, but has its origin either in lesion of
sensibility or lesion of structure. Under the first head are in-
cluded those forms of nervous aphonia to which writers on this
subject have generally alluded. In this variety, which occurs
from lesions of sensibility, no organic changes whatever take
place. It is the aphonia atonica of Dr. Good, and consists of
" a total exhaustion of nervous power in the vocal organs.''*
In the succeeding cases, the causes of Aphonia proceeded from
structural changes. They belong, therefore, to the second
variety. Aphonia, under my observation, has been found to
follow, or to be perpetuated by, the following changes.

1. Ulceration of the mucous membrane of the vocal liga-
ments.

2. Thickening of the mucous membrane of the vocal liga-
ments.

3. (Edema of the aryteno-epiglottic folds.

4. (Edema of the epiglottic cartilage.

5. Ulcerations of the fossae at the roots of the tongue and
on the sides of the aryteno-epiglottic cartilages.

1. Aphonia from ulcerations of the mucous membrane of the
vocal cords.

It is the opinion of both Andral and Ryl^pd, that simple
ulcerations of the lining membrane of the larynx, unless they
invade the vocal cords or the thyro-arytenoid muscles, cause
but little change either in the power or tone of the voice.
When the mucous membrane covering one of the vocal liga-
ments only is ulcerated, the voice is rendered raucous and
hoarse. If the investing membrane of both vocal cords is
affected, the voice loses its power, and is reduced to a rough
whisper only.f

It has been observed by Louis and Andral, J that the effects
produced on the voice by ulceration of the larynx, differ mate-

* Good's Study of Medicine, article, Aphonia. *

t A Treatise on the Diseases and injuries of trie Larynx and Trachea. By
Fred. K. Ryland,. p. 95.
;Clinique Medicale, Tome II., p. 208.

1854.] Observations on Aphonia. ^S

rially, according to the seat and extent of the ulceration. In
fourteen patients, whose cases of laryngeal ulceration, compli-
cated with phthisis, are recorded by M. Louis, where small,
superficial ulcerations were found seated, either within the
ventricles, between the arytenoid cartilages, or at the point of
junction of the vocal cords, the symptoms present were, hoarse-
ness, a marked alteration in the character of the voice, with
heat and pricking pains in the larynx, followed, ultimately, by
a complete extinction of all vocal sounds.

During the past five years, many cases of aphonia, conse-
quent upon ulcerations of the mucous membrane of the vocal
cords, occurring in the progress of follicular laryngitis, have
come under my observation, in all of which the ulcerations
have been arrested and the voice restored by topical medica-
tion, except in those cases in which the vocal ligaments had
been previously destroyed by long-continued disease, or in
such as were complicated with tuberculosis. Jt will be suffi-
cient, by the history of a single case to illustrate this variety of
aphonia, which has its origin in ulceration of the investing
membrane of the vocal cords.

Case I. A gentleman forty years of age, from an adjoining
State, who had suffered under follicular laryngitis for two
years, came to New York several months ago, for medical
advice. Two years before this visit, whilst actively engaged
in business, he found his voice beginning to fail. He became
hoarse, and a constant feeling of uneasiness, with pain, was ex-
perienced about the throat. These symptoms, first observed
early in autumn, continued to increase in severity during the
subsequent winter and spring, attended with debility and great
nervous irritability, until May following when he became com-
pletely aphonic. Obliged to relinquish his business on account
of his feebleness, he passed fourteen months after the loss of
his voice, before I saw him, in the employment of different
measures for the recovery of his health. But failing in all
these efforts, he came to this city for aid. His condition, on
examination, was found to be the following : He was much
debilitated, with a feeble pulse, and his voice reduced to the
lowest whisper ; he complained of pain in the larynx and under
the sternal bone, and of a sense of uneasiness and constriction
in the upper part of the throat. The mucous membrane lining
the pharynx was covered with enlarged follicles, some of
which were ulcerated ; the tonsils were slightly enlarged, and
the epiglottis much thickened, and its upper border serrated
by ulcerations. This condition of the mucous membrane, as
far as it could be seen, the pain and soreness in the larynx, the

734 Observations on Aphonia. [December,

loss of voice, and other symptoms present, indicated ulcerations
of the involving membrane of the vocal ligaments. This
opinion was confirmed by the difficulties encountered in the first
attempts to pass the sponge probang through the rima <ilottidis.

A strong solution of the argent, nit. ('2 scruples to the oz) was
applied to the fauces and pharyngeal membrane. The second
day, the application was carried down to the epiglottis, and to the
opening of the glottis; and on the third day, the vocal cords were
reached, and fully cauterized. This last application caused much
irritation, and for a short time severe pain directly in the larynx.
This I have always found to be the case when a strong solution
of the nitrate of silver is tor the fust time applied to ulcerations
of the vocal cords. Subsequently, this pain diminishes on each
application, and very soon ceases altogether. Ferruginous
tonics, with other appropriate general treatment, were em-
ployed; and the topical remedy was continued daily for a week,
when the ulcerations about the mucous membrane of the
pharynx were found to have healed; and about the same time
the soreness and irritation in the laryngeal cavity, and the pain
under the sternum had entirely disappeared. In two weeks
from the time when the local remedy was first employed, the
voice of the patient returned, and vocalization in the com
a few days was fullyTind permanently established.

That the aphonia, in the above case, had its origin in an
ulcerated condition of the mucous membrane of the vocal cords,
was inferred from the presence of the symptoms which have
been enumerated ; from the fact that the sponge containing the
caustic fluid, at the moment of passing the rimaglottidis (the
space between the vocal ligaments,) produced at this point a
distinct painful sensation, as when an ulcerated surface of the
mucous membrane is touched with the argentine solution ; and
also from another fact, which when existing, reveals to the
experienced operator, with much certainty, the presence of
ulcerations of the mucous membrane in the cavity of the
larynx. I refer to the fact, that when the sponge-probang is
applied to an inflamed or thickened mucous membrane it glides
smoothly over the part, as if passing over the surface of moist-
ened glass ; but when ulcerations of the membrane exist within
the larynx, a distinct sensation of roughness is conveyed to the
hand of the operator when the instrument is introduced into
this cavity; and this sensation will continue, but diminishing
as the ulcers heal, until the membrane is restored to its nor-
mal condition.

Several years ago, I had an opportunity of treating a gentle-
man in this city, who had labored many years under chronic
laryngitis, or ''laryngeal phthisis." All the symptoms oful-

1854.] Observations on Aphonia. 736

ceration of the larynx were present, and when the cauteriza-
tions were made into the laiynx this sensation of roughness of
the lining membrane was very apparent. It diminished as the
applications were continued, as did the unfavorable symptoms
which attended this condition.

Some years afterwards, I had an opportunity of examining
the larynx of this patient (who died of another disease,) and
found the mucous membrane of the ventricles and of the larynx
covered with the cicatrices of old ulcerations, but which were
quite healed. This morbid specimen I have still in my posses-
sion.

2. Aphonia from a thickening of the mucous membrane of
the vocal cords.

This lesion is of more frequent occurrence, I am confident,
than is generally admitted. Many of those supposed cases of
atonic aphonia were the loss of voice has been attributed to
lesions of sensibility, have proceeded, I believe, from a slow
hypertrophy or thickening of the investing membrane, and of
the follicles of the vocal cords. It has been shown by Roki-
tansky, that not only hypertrophy of the mucous membrane of
the airpassages may occur, but that the follicles of the larynx
and trachea are frequently found in this condition. When this
altered state of the lining membrane of the air-tubes is moder-
ately developed, it presents the ordinary characteristics of
hypertrophy of mucous membranes; but in a higher degree,
Rokitansky remarks, "it especially affects the mucous glands,
and in the larynx gives rise to glandular swellings of the
mucous membrane, at those parts where the glands are most
abundant, as for instance, on the vocal cords, in the ventricles,
over the transverse muscles, and on the epiglottis."^

This variety of aphonia is generally complicated with, or the
result of chronic follicular inflammation. Some ten cases of
the disease originating in these changes of structure have come
under my observation within the last few years. Most of these
cases have occurred in females, and in a large portion of them
the disease had been considered as dependent upon impaired
sensibility of the laryngeal nerves. You will recall one or two
of these cases which were under treatment last fall, one of
which was present when I had the honor of a visit from Dr.
Marshall Hall, whose skepticism at this time, with regard to
the medication of the windpipe, was somewhat dissipated by
seeing the sponge-probang passed repeatedly into the trachea
of some of the patients then present.

* Manual of Pathological Anatomy, by (Jarl Rokitansky, M. D., vol. IV. p.
13, Sydenham edition.

730 Observations on Aphonia. [December,

The history of this last case, which both of you, I believe,
had an opportunity of seeing, will illustrate that change of
structure of the vocal organs on which depends this most obsti-
nate form of aphonia.

Case II. Miss B., aged twenty-six, consulted me, December,
1852. At this time she had not spoken aloud for fourteen
months. Six years before, in the spring of 184(5, she took a
hard cold, which was followed by a severe cough, sore throat,
pain in her side, &c, for which she was treated by her family
physician. She passed the following summer in the country,
and was improved in her health ; but in the succeeding winter
the cough, pain in the chest, and irritation of the throat returned.
In the summer of 1847 she was again in the country, by which
her health was again improved. The return of the cold season
of 1848 brought back all her unfavorable symptoms: and
although relieved as at former times by the recurrence of t fie
warm season, yet cold or damp, and cold weather, invaribly
aggravated the disease. In the summer of 1849, after a slight
exposure, she contracted a cold, and for three or four weeks was
very ill. The thoracic symptoms were urgent ; pain in the
chest, severe cough and fever, for which active treatment was
employed. After* this attack she was more feeble than ever,
and during the winter of 1850 her OOUgh and other pulmonary
symptoms were more persistent and severe than at any former
period. But in the succeeding spring and summer a change of
climate, as in former seasons, was resorted to, which was again
followed with some degree of relief. Throughout this year
she was attended by two intelligent physicians, who, together
with a distinguished auscultatorof this city, by whom her chest
was examined, considered her case and treated it as one of
confirmed phthisis. From November to May, 1851, Miss B.
was not able to leave her house. During several months of
this year she was affected with a chronic diarrhoea, by which
she was greatly prostrated. Her voice, which had been hoarse
for a long period, grewr gradually weaker until October, J 851,
when it became permanently extinguished. In this condition
she remained, with but little change in her general symptoms,
except some slight mitigation of them during summer weather,
until the 25th of December, 1852, when at the request of her
attending physician I saw her for the first time.

Miss B. was quite feeble, emaciated, and had a pale, anxious
countenance: a cough, with muco-purulent expectoration, was
present. The respiration was hurried, and rendered more
difficult on making the least exertion ; and the voice was re-
duced to the lowest whisper. In the throat, the follicles of the

1854.] Observations on Aphonia. 737

pharyngeal membrane were enlarged and indurated, both
tonsils were partly destroyed by disease, the epiglottis was
twice its natural thickness and had a pale aspect. The aryte-
noid cartilages, examined by touch, were not cedematous. On
examining the chest, the respiration was found weak in the
upper portions of both lungs, with bronchial respiration.
There was also slight dullness on percussion under the left cla-
vicle. A few applications of the nitrate of silver had been
made, by her attending physician, to the pharynx; and it was
proposed to carry these applications at once, into the larynx;
and a teaspoonful night and morning of the following prepara-
tion was ordered,

^. Potass, iodid... 5 ij.,

Proto. iodid. hydrarg., gr. ij.,

Tinct. columbae,

Syr. sarsa. co. aa. f 1 ij.
and on the second day the attempt was made to pass the instru-
ment through the rima-glottidis, but the space between the
vocal cords proper was found to be too narrow for the passage
of a sponge-probang of the smallest size. After continuing the
applications, however, for several days, a small sponge was
passed through the rima ; and this application was continued
every second day through the month of January. At the end
of six weeks from the commencement of the local treatment,
the general health of the patient had somewhat improved ; but
the voice was unchanged, except that the whisper, which at first
was not above the ordinary respiration, was a little increased
in volume; but by no exertion could the patient utter a word
above the whisper. It was observed, moreover, that a larger
instrument could be passed through the rima-glottidis than at
first. Yet. still, the thickened and unyielding nature of the
vocal cords could be distinctly felt, as the sponge passed be-
tween them. This local treatment was continued, though
at longer intervals, through the months of February, March,
and April, combined with appropriate constitutional reme-
dies. In May, Miss B. was absent from the city a part of
the lime, and only a few applications of the caustic were
made during this period. In Jply, the topical treatment was
renewed and with a confident hope of success ; for although
the aphonia had been unusually persistent, yet it was found
that the induration and thickening about the vocal ligaments
continued steadily, though very slowly to diminish ; and along
with this local improvement, the cough, and other unfavorable,
general symptoms, had greatly diminished. At this time, too,
a sponge, more than double the size of the one first employed,
could be passed readily through the rima-glottidis. Inhalations

738 Observations on Aphonia. [December,

of creasote were occasionally employed, and the applications
of nitrate of silver continued until the 18th July, when for the
first time for a period of twenty-one months. Miss B. spoke
aloud.

Her voice at first, was feeble, but it rapidly increased in
strength and volume; and vocalization, in a few weeks more,
was fully restored. A change equally favorable occurred with
respect to her general health : as the local symptoms improved,
the cough, pain in the chest and other indications of thoracic
disease diminished. She improved in strength and flesh, and
has now (Feb. 1851) passed a period of eighteen months, since
the recovery of her voice, in the enjoyment of excellent health.

In this case of Miss B., the disease proved the most obstinate
of any 'the kind 1 have ever treated. I have had several

instances of this form of aphonia come under my notice, in
none of which was so long a course of treatment required.

In the cast.' of a lady from Massachusetts, who had been for

perfectly aphonic, ti was fully restored by

the employment of the local treatment tor six weeks. In another

instance, a patient from Connecticut, voiceless for more than

three years, was perfectly restored in as many weeks.

In all these instances, symptoms, more or less marked, of
thorac a ere present: and it nan been a matter of

great interest to myself and others to observe in these cases,
how constantly the pulmonary symptoms have disappeared, as
the causes of the local irritation have diminished.

'.I. Aphonia from oedema of the a />;/ no- epiglottic folds.

That form of inflammation which occasionally attacks the
superior aperture of the larynx, and which is termed avleina of
the glottis, is characterized, anatomically, by an infiltration of

the >ub-mucous areolar tissue of the aryteno-epiglottic cartila-
ges; and whether the disease is idiopathic or secondary, it is
always attended by entire loss of voice. The aphonia conse-
quent upon this morphological change, does not exist in conse-
quence of any alteration of structure about the vocal cords, for
infiltration is here prevented by a very beautiful arrangement.
Over these ligaments the mucous membrane is thin and adhe-
rent, having no sub-mucous areolar tissue interposed between
the vocal cords proper and their lining membrane.

The loss of voice, in this affection, proceeds from the almost
complete closure of the opening of the glottis, and the oedema
of the arytenoid cartilages ; and, also, from the morbid impres-
sion produced on the laryngeal nerves by the disease located in
their immediate vicinity. In a small work, published by me
some months ago, on " Polypi of the Larynx and (Edema of the

1854.] Observations on Aphonia. 130

Glottis," I have given several cases of cedema-glottidis, in all
of which the voice was completely lost. But there occasional-
Iv occurs an intumescence of the aryteno-epiglottic folds of a
character less intense than that of true oedema. It accompa-
nies catarrhal inflammations of a sub-acute character, and con-
sists in an infiltration of the sub-mucous areolar tissue of the
above folds, and is frequently attended with aphonia as in true
oedema of the glottis.

The following case will illustrate this variety : Sept. 1, 1853 :
J. C. F., a young gentleman, aet. 25, came up from his residence
on Staten Island, this morning, to consult me in regard to the
loss of his voice. Several weeks ago, Mr. F. took ** a slight
cold," to which, at first, he gave but little attention. Some
degree of fever, with cough and expectoration, were present,
and his voice, which was hoarse from the first, continued to
lose its power until, on rising one morning two weeks before
I saw him. he found himself quite incapable of uttering a sound
aloud. His physician, finding the fauces and posterior wall of
the pharynx inflamed, applied daily a solution of iodine to
these parts, and administered an emetic, followed by expecto-
rant remedies. These and similar measures, constitute the
treatment before I saw him. The aphonia, at this time, was
complete. A cough, with considerable expectoration, which
appeared to come from the throat and upper part of the wind-
pipe, was present. The patient suffered also from dyspnoea,
which was much increased by the least exertion. The dys-
pcena was characterized by that peculiarity which, more or
attends all cases of oedema, when located at the aperture
of the glottis; that is the act of inspiration occurs with much
difficulty, whilst expiration is performed wiihout obstruction.

On examining the throat of the patient, this condition, indica-
ted by the above symptom, was found as anticipated. Bv pres-
sing the finger over the laryngeal face of the epiglottis, a small
soft tumor was readily detected, occupying each lateral border
of the glottis. Having learned, from past experience, that in-
filtrations of the opening of the windpipe are rapidly removed
(as I have shown in my work on oedema glottidis) by applica-
tions to the parts of a concentrated solution of nitrate of silver,
I immediately applied this remedy, by means of the ordinary
sponge-probang, freely to the injected borders of the glottis.
The applications were repeated daily, and the iodide of potas-
sium was administered internally. Under this treatment the
oedema rapidly diminished.

As the intumescence subsided, the dyspnoea, cough, and ex-
pectoration, diminished ; and at the end of a week the patient
could speak aloud. The local treatment was continued for

740 Observations on Aphonia. [December,

another week, when all the unfavorable symptoms had dis-
appeared, and the voice was restored to its normal condition.
As I have before stated, this cedematous condition of the
arvteno-epiglottic folds is the frequent concomitant of catarrhal
inflammations. The aphonia consequent upon it will some-
times remain for months under ordinary treatment, before the
infiltration is sufficiently removed to allow vocalization to be
performed. Besides, the swelling acting as a local irritant, at
the opening of the air- passages, is very likely to awaken more
serious organic disease, particularly in constitutions predispos-
ed to tuberculosis. It is therefore, of the utmost importance
to detect this lesion in its earliest stage : and it may be discov-
ered readily by the touch, as well as by the characteristic res-
piration. Once detected, it is most certainly and rapidly re-
moved by the topical medication.

4. Aphonia from, aidema of the epiglottic cartilage.
(Edema of the epiglottis is an alteration of structure of more
frequent occurrence than the lesion of the arvteno-epiglottic
folds, to which I have just referred. It proceeds from the
same cause, namely, catarrhal inflammation, and consists in
an infiltration of the sub-mucous areolar tissue of the epiglot-
tis. The infiltration occurs on the lingual side of the carti-
Inge, because of the great amount of areolar tissue on its
anterior face. This causes the epiglottis to asume a very
anomalous aspect ; its edges are rolled back and aproxima-
ted, and when the intumescence is considerable, it presents
much the appearance of a round tumor at the base of the
tongue. That variety of aphonia consequent on this lesion
of the epiglottis, is frequently observed in epidemic catarrhs.
During the prevalence of an influenza that occurred to some
extent, in New York, in the winter of 1853, I observed
many cases of total loss of voice from this cause. Even within
the present month (Feb. 1854,) during the cold and unusually
damp weather which has occurred, some four or five patients,
laboring under this form of aphonia, have presented themselves
at my office for medical treatment. I will give a single in-
stance of this form of the disease, arising from cedema of the
epiglottis.

Case IV. A young gentleman, who, three weeks before, had
had an attack of the prevailing epidemic, called on me, Janua-
ry 29, 1853. The disease, in its early stage, was attended by
a total loss of voice ; and it was in reference to this voiceless
condition that my opinion was desired. Some degree of cough
was present, attended with slight expectoration, but the respi-

1854.] Observations on Aphonia. 741

ration was but little affected. On depressing the tongue of
the patient, the epiglottis was readily brought into view, and
it certainly presented that very anomalous aspect to which I
have alluded.

Extensive infiltration having taken place in the sub-mucous
tissue on its anterior face, the cartilage was enormously enlar-
ged, its lateral edges were turned backwards and approximated
and its whole appearance was that of a round, puffy tumor,
lying at the opening of the glottis. Examining, with the finger,
for the arytenoid cartilages, they were found to be not involv-
ed in the cedematous infiltration ; and this exemption from
the disease, in this location, accounted at once for the slight
degree of difficulty presented in the respiration of the patient.

To procure a re-absorption of the infiltrated serum, a strong
solution of nit. argent, was applied freely to the epiglottis, and
to the whole faucial region. A profuse expectoration of ad-
hesive mucus, from these parts, followed the application. The
topical remedy was continued daily, for ten days. Under its
use the tumefied epiglottis diminished constantly; and at the
end of a week, the patient could speak aloud, although his
voice had a muffled sound. Continuing the applications a few
days longer, the epiglottis, at the end of this time, was found
reduced to its normal size, Emd the patient's voice and general
health were fully restored.

That the loss of voice, in this case, as well as in many simi-
lar cases which have been observed, depended on the intumes-
cence of the epiglottis, has been proved repeatedly by the fact,
that when the epiglottis has been thus cedematous, voiceless-
ness in most cases has been present ; and, also, by the other
fact, that the voice in some of these cases returned after the
oedema of the cartilage had been removed.

5. Aphonia arising from ulcerations of the mucous mem-
brane of thefossce which are situated between the columns of
the palatine arch, but at their base, and external to the aryte-
noid cartilages.

It has lcng seemed to me that the very great frequency with
which ulcerations are found to exist in the lateral fossae at the
base of the tongue, and the equally important truth that very
serious consequences not unfrequently follow their long con-
tinuance in these locations, are facts far from being generally
known or appreciated by the profession. In connection with
long-continued follicular disease of the throat, these ulcers are
of every-day occurrence ; and they not only affect vocalization,
but through constant irritation, kept up by their presence near
the opening of the air-tubes, they awaken, quite frequently,

n. s. vol. x. yo. XII. 47

742 Observations on Aphonia. [December,

more serious disease in the pulmonary organs. But, at pre-
sent, I have only to speak of that variety of aphonia which is
caused, occasionally, by these lesions.

Ulcerations of the thyro-arytenoid mucous folds may exist
without inducing, necessarily, a loss of voice. When one fossa
only is involved in the change of structure, vocalization is not
ordinarily interfered wilh to any considerable extent. But,
when both fossce are ulcerated, the voice soon becomes hoarse
and uneven, and is followed, at length, in some cases, by total
aphonia. During the past ten virus. I have observed many
such instances of the disease ; several cases have occurred,
within a few months, in my practice. One of these, that of a
gentleman from Kentucky, you will recollect having noticed.
I will therefore illustrate this variety of aphonia by reference
to his case.

Case V. This patient first called to consult me in October,
1853. lie had then been for several months voiceless; and
for twelve months, or over, he had suffered front) chronic ulcer-
ation of the throat ; for which, general treatment, with the
use of astringent gargles, had been employed by his attending
physicians, one of whom recommended him to visit New York
and consult me. On examining the patient's throat, the pha-
ryngeal mucous membrane was found thickened, and ulcerated
at many p ints. Between the anterior and posterior columns
of the palatine arch, on depressing the tongue, a large and deep
ulcer was observed on either side, commencing at the base of
the tonsillary gland, and extending down into the fossa as far as
the eye could see. The epiglottis and the arytenoid cartilages
were in a normal condition. An abundant muco-purulent se-
cretion was being constantly hawked up from tlfese parts.

There was difficulty of deglutition ; but no cough existed,
nor were there any other indications of disease within the
larynx ; still, this gentleman had been aphonic for several
months. His general health had suffered from the local disease;
for he was feeble, pale, and emaciated, exhibiting, in short,
many of the external or rational signs of phthisis. But auscul-
tation failed to discover any abnormal state of the lungs.
With a small sponge-probang, the lingual fossae were cauter-
ized with a strong argentine solution (80 grs. to I i.,) and a
drachm of the following mixture ordered to be taken twice
daily : ty Potass, iodid., 3 ij.

Proto-iodid. hydrarg., gr. ij.

Tinct. columbae.

Syr. sarsae, co., aa. f. 1 ij. M.

The cauterizations were repeated daily, until the 13th, when

1854.] Observations on Aphonia. 743

the ulcerated fossae were nearly healed, and the patient could
speak at this time in a loud, although a hoarse voice. After
t his he improved rapidly; the expectoration diminished, the
' i!t\ of deglutition was gone, and in the course of another
week, the patient had gained several pounds of flesh. He was
able to converse with a voice as loud and clear as at any
period of his life; and he left for his home with the intention,
as he declared, of "stumping it for Congress*' on his arrival
in his district, in Kentucky.

That the loss of voice in this case, as well as in many simi-
lar instances which have come under my observation, depend-
ed upon the above lesions of the fossa?, may be fairly inferred
from the results of the treatment. As no disease existed with-
in the larynx, the applications were not made to the vocal
cords, but external to the opening of the glottis, where the
ulcerations were located. When these were healed, and not
till then, vocalization and, ultimately, the general health of the
patient were fully restored.

These lesions on which depend this last variety of aphonia,
are, I repeat, of very frequent occurrence, and are very fre-
quently overlooked. Within a few days, since I commenced
drawing up this paper, I have had an opportunity of seeing, in
consultation with our distinguished friend, Dr. Valentine Mott,
an interesting case of aphonia having its origin in ulcerations
of the above fossae. The disease, in this instance, had been of
twelve months' standing; the lesions during this time remaining
undetected, whilst constitutional remedies had been address-
ed, by the patient's medical attendant, to the general symp-
toms, which, although of a grave character, were only seconda-
ry, and of course remained unrelieved by the treatment.

Aphonia, then, I do not hesitate to declare, will be found to
originate, at one time or another, in each and all of these struc-
tural changes, to which allusion has been made. Some of these
lesions, I am aware, may exist without, in all cases, inducing
aphonia ; but I have the records, and could give you the history
if necessary, of a large number of cases which have followed
each of the pathological conditions. Some of these cases, as
well as their treatment, you have observed ; and many of them,
you are aware, have been seen at my office, from time to time,
by medical men from almost every part of the Union. .

It will be unnecessary to enter into any details with regard to
the treatment to be employed in the management of these dif-
ferent forms of aphonia. Whether the alterations of structure,
on which the disease depends, consist in oedema of the parts,
in ulcerations of the mucous membrane or its follicles, or in a
thickening of the investing membrane ofthecordae vocales,

744 Laceration of the Urethra. [December,

topical medication in the form of a concentrated solution of the
crystalized nitrate of silver has proved in my hands to be alto-
gether the most effectual remedy that has yet been adopted.
Constitutional remedies, when indicated, are to be emp^red,
as in other cases where local disease is found complicated with
general derangement. The different preparations of iodine,
chalybeates, and other tonics, with the inhalation of creasote,
are valuable adjuncts ; but without topical medication, these
latter measuies are ordinarily of no avail.

[American Medical Monthly.

Cure of Laceration of the Urethra. By Dr. J. Gautier, M.D.,
of Tuskegee, Alabama.

James Hall, aged 35 years ; has light hair, blue eyes, fair
complexion ; a sound and vigorous constitution ; weighs about
one hundred and fifty pounds. In May, 1852, be was engaged
as a deck-hand on board of a steamboat running from the city
of Galveston to Brazoria, and while in the latter port, and en-
gaged in discharging freight (at night), he attempted to cross
over the hatch, and in doing so missed his footing, and fell
astride of a square bar of iron extending across the hatch, upon
which the doors rested. Laceration of the urethra, and great
contusion of the perineum resulted. The injury occurred about
10 o'clock at night. I did not see Hall until the next morning
between 8 and 9 o'clock. He wai then complaining of excru-
ciating pain, with great distension of the bladder, and an
inability to pass urine. By the forcible contraction of the
bladder, occasionally a few drops of bloody urine would pass
through the penis. On investigation, I at once concluded that
there was laceration of the urethra. The only case of the kind
I had ever seen before, was in a little boy, treated in the Penn-
sylvania Hospital, under the care of Drs. Norris and Fox, in
1850. The experience furnished by the case, together with
the valuable instruction given by the doctors above-mentioned,
rendered the treatment of this case, to my mind, positive and
clear.

At once, I attempted to introduce a silver catheter into the
bladder, but could only pass it up to the seat of laceration.
After working with him an hour or two, and trying every size
of gum-elastic catheter, I at last succeeded in introducing one
of the latter, of very small size, into his bladder, and drew off
by measurement twenty ounces of urine considerably coloured
with blood. Having got a catheter beyond the point of lacer-
ation, I knew, from the facts of the case seen in the Pennsylva-
nia Hospital, that it was wise to keep the instrument as long

1854.] Laceration of the Urethra. 745

as possible in the nrethra. On the second day, I had to remove
the catheter ; but I immediately introduced another of a larger
size.

The perineum was kept constantly bathed in cold water, or
a solution of sugar of lead. Hall had high fever and costive
bowels, and saline purgatives were administered and an anti-
phlogistic treatment adopted. In a few days his fever subsided,
and he was doing well. In six or eight days after his injury, I
was able to introduce a large silver catheter into his bladder.

From the time of his injury, I have endeavoured to make it
an established rule with Hall that he should never attempt to
pass urine while the catheter was out of his bladder. On the
morning of the fifteenth day of the injury, professional duty
compelled me to be absent, and during my absence, Hall took
the catheter from the urethra, and left it out for several hours.
When he wanted to make water, he was unable to introduce
the instrument. As he was suffering from distension of the
bladder, another physician was sent for, and Hall was told to
pass water without the catheter.

On my return home in the afternoon, I went immediately to
see my patient. I found him in a condition vastly more dan-
gerous than he had been upon the morning of his injury. The
penis, scrotum, perineum, and cellular tissue about the pubis,
were enormously distended from infiltration of urine. He had
high fever, and his mind was considerably disturbed. Some of
the by-standers supposed him to be dying. With considerable
difficulty I again succeeded in introducing a catheter into the
bladder. I then freely scarrified the scrotum, to allow the in-
filtrated urine to escape. In a few days, mortification of the
scrotum took place, and both testes were left entirely denuded
of skin and cellular tissue, hanging only by the cords. The
posterior and under part of the penis, and a portion of the
perineum, were in a state of sphacelation. About two inches
of the urethra was destroyed. From the destruction of the
perineum, under part of the penis, and the urethra, at least two
inches of the silver catheter could be seen. The bulb of the
urethra was not injured, the destruction being anterior and
posterior to the bulb. To add still another pang to Hall's mis-
fortunes, one day, when asleep, flies deposited their ova on his
testes and perineum. In the course of four or five days, at
least fifty large maggots were taken from the perineum. My
patient was now troubled with constant hectic fever, and great-
ly emaciated. In this condition, I had but little hope of his
recovery. For ten or twelve days he lay feeble and prostrated
almost unto death. I watched his case closely, removed all
disturbing causes, and kept the catheter constantly in his blad-

746 Diabetes Meflitus. [December,

der, removing it only to be washed. I gave him but little
medicine, principally tonics. Rich, nutritious diet was allow-
ed. The case was left as much in the hands of nature as pos-
sible.

About the latter part of June, Hall began to show evidences
of recovery. His general health was gradually improving.
Nature was throwing off the putrid mass, and beginning to
reproduce new tissue. Indeed, the rapidity with which the
parts were restored to their normal condition was truly aston-
ishing. In less than six weeks from the commencement of the
formation of new tissue, the testes were enveloped in a new
scrotum; the penis, urethra, and perineum were entirely re-
stored.

By the latter part of August, Hall was well, and hoe from
deformity. He could retain his water as well as he ever did,
and void \tper via* naturales, and with ease. He has not used
a catheter since the 12th of August. When 1 saw Hall again,
early in September, he was riding an unbroken mustang horse ;
and he assured me he was perfectly well, and had as much
strength, and as perfect use of himself, as he had before the fall.

[Note by run Editor. In connection witU the above inter-
esting case, we will refer to some observations which we pub-
lished in the number of this Journal for Feb. 1837, on accidents
of this character, their nature and mode of treatment, illustrated
by a large number of cases.] Amer. Jour, of Med. Sci.

Diahctes Mcllitus.

Probably one of the most elaborate papers ever written on
this disease has just been published by Dr. Th. Von Dursch, of
Manheim. It is founded upon two very interesting cases of
diabetes, of which he has given very careful clinical reports,
and also accounts of the pathological lesions found after death.
With indefatigable perseverance and most praiseworthy zeal,
he carefully ascertained, every day for several months, the na-
ture and amount of the food and drink taken by his patients ;
the amount of fluid contained in the aliment; the quantity of
urine excreted, its specific gravity, and the amount of sugar it
contained ; the number of the stools, the proportion of their
watery constituents ; the amount of water exhaled by the lungs
and transpired by the skin, &c. The results of these most la-
borious and minute investigations he has condensed into two
large synoptical tables, which are appended to the memoir.
In one of these: full particulars are given of the effects of differ-
ent kinds of diet upon the total amount, specific gravity, and

1854.] Diabetes Mellitus. 717

saccharine constituents of the urine. As far as our limited
space permits, we shall now glance at the general results thus
tabulated. First, when the patient was put upon a mixed diet
for forty days; second, when a farinaceous diet alone was al-
lowed during eight days ; and, third, when animal food was
given during a period of five days.

1. Effects of mixed diet on

(a). The specific gravity. The average density of the urine,
while this regimen was adhered to, was 1037.8 ; it was high-
er in the mornings and evenings (1038) than during the day
(1036).

(b). The amount of the urine. The daily average was 5234
cubic centimetres. The quantity voided was greater in the
morning (1971 c.c.) and evening (1831 c.c.) than during the
day (1430).

(c). The percentage of sugar. The average amount of sac-
charine matter was 9.134 in the 100 grammes. The percentage
was lower in the morning and mid-day urine (8.9) than in that
passed at night (9.4).

(d). The total amount of sugar. The average daily amount
of sugar excreted during the whole period was 477.7 grammes ;
the lowest was 350, and the highest 615 grammes.

2. Effects of farinaceous diet on

(a). The specific gravity. This continued nearly the same
as with mixed diet: the average was J 037.6. With this
regimen, also, it was lower during the day than at night or
morning.

(b). The amount of the urine, This was increased to 5604
cubic centimetres as its daily average. It was greater in the
morning (2165 c.c.) than during the dav (1737 c.c.) or at night
(1701),

(c). The percentage of sugar. This continued nearly un-
changed, being on an average 9.39 in 100 grammes.

(d). The total amount of sugar. In this a considerable
increase was visible, while the farinaceous diet was continued.
The average quantity of sugar daily excreted amounted to
526.4 grammes ; and the urine in the morning contained more
(201 gr.) than at noon (159 gr.) or at night (165 gr.)

3. The effect of animal diet on

(a). The specific gravity. It remained nearly unaltered by
this regimen, as happened with both the other diets. Its aver-
age was 1037.2 ; and it was lower in the morning (1036) than
at other times (1037).

(b). The amount of the urine. This was considerably di-
minished, the average quantity per diem being 4588 cubic

748 Epidemic Disorders of the Bowels. [December,

centimetres. The average amount was much greater in the
morning (1816 c.c.) than during the day (1324 c.c.) or at
night (1448 c.c.)

(c). The percentage of sugar. This was also lessened, being
on an average 8.232 in 100 grammes.

(d). The total amount of sugar. Here, likewise, a striking
diminution was manifest. The average quantity daily excreted
was 379.8 grammes; this was greatest in the morning (131) grs.)
and less during the day (114 grs.) than at night (126 grs.)

Dr. Von Dursch discusses several of the questions relative
to diabetes, and brings to bear upon them the weight of his
experience aud careful observations. As regards the disputed
point, whether the quantity of the urine voided in this disease
surpasses the amount of the fluids absorbed, he thinks that the
question has not been properly considered, and that we ought
to compare the amount of water in the urine, 6cc, with that
contained in the food and drink taken. During his investiga-
tions, he ascertained the amount of the cutaneous transpiration
and pulmonary exhalation by frequently weighing his patient ;
and he also carefully noted the quantity of water contained in
the feces. He has succeeded thereby in satisfying himself that
the water given off by the patient equals exactly the amount
of the water absorbed by him.

In conclusion, the author believes, from all his researches,
that diabetes principally depends on the sugar normally exist-
ing in the blood being undestroyed and unappropriated; and
he is of opinion that all kinds of ten, I are capable of producing
sugar. [Monthly Jour. Med. Sci., from llenle und Pfeuffer's
Zeitscji. fur Rationelle Medici n.

On the use of Vegetable and Mineral Acids in the Treatment,
Prophylactic and Remedial, of Epidemic Disorders of the
Bowels.

An interesting paper on this subject was read before the
Epidemiological Society, July 3, 1854, by J. H. Tucker, Esq.
The author commenced by alluding to the remarkable, but
well-established fact, that in 184U the cider districts of Here-
fordshire, Somersetshire, and part of Devonshire, were, to a
great extent, exempt from the epidemic ravages of cholera,
while the disease was raging around. Upon further inquiry,
it was ascertained that this exemption was confined a good deal
"to those individuals who drank cider as a common beverage,
and that those who partook of malt liquor occasionally suffered.
He also remarked that, in some parts of France, and Norman-
dy more particularly, where cider is the common beverage,

1S54.] Epidemic Disorders of the Bowels. 719

cholera is seldom known to exist ; and further, that Switzer-
land was reported to have been free from its visitation.

Having adduced these and other facts in proof of the pro-
phylactic power of cider, the author expressed his opinion that
other vegetable acids would be found of service, such as lemon-
juice, orange-juice, and sour wines made from grapes, or even
from gooseberries. And as it would be found impossible to
supply the whole of London with a sufficient quantity of pure
cider, Mr. Tucker suggested that vinegar might be found a
useful substitute in case of onother outbreak of cholera, pro-
vided that it could be obtained in a state of purity. In con-
firmation of his view of the sanative and medicinal virtues of
vinegar, the author quoted Hippocrates, who (de natura mu-
liebri) "employed white vinegar medicinally"' Plutarch and
Livy, who refer to the use of vinegar by Hannibal, in his pas-
sage over the Alps, when he is said to have "softened the rocks
with fire and vinegar," an operation which the author face-
tiously regarded as rather metaphorical than chemical, as the
vinegar, swallowed by the troops, probably sustained their
strength, and thus in effect softened the asperities of their rough
'. The author also quoted from Roman history the story
that " Scipio Africanus is said to have gained a great battle
with a few skins of vinegar," the troops refusing to march until
the general had obtained a supply. Caesar was also reported
to mention in his Commentaries the supply of vinegar to the
troops; and Mr. Tucker remarked that the drink of the Ro-
mans in all their campaigns was vinegar and water, and, sus-
tained by that beverage they conquered the world. Modern
authors (Sir John Pringle, Sir Gilbert Blane, and others) were
also quoted in proof of the antiseptic and medicinal qualities of
vinegar. The author then proceeded to show that acid drinks
were not only preventive, but remedial in epidemic disorders
of the bowels. Cases were related, in which not only persons
were exempt from attacks of cholera raging around them, who
drank large draughts of cider, but a case of severe cholera was
also related, which yielded to the diluted juice of sour apples.
The efficacy of the Mineral Acids, especially the sulphuric, in
diarrhoea, and especially in choleraic diarrhoea, was also advo-
cated by reference to numerous facts and authorities. He also
referred to some established facts connected with the spread
of epidemic dysentery in the army, showing the efficacy of
vegetable acids in that disease.

In conclusion, Mr. Tucker suggested a necessary caution
relative to the use of the wretched and unwholesome substitute
for vinegar commonly sold in the London shops.

The discussion which followed the reading of the paper, elicit-

750 Nitric Acid as an Anti-Periodic. [December,

ed many facts in confirmation of the author's views ; and, as to
the efficacy of sulphuric acid largely diluted with water, in cho-
leraic diarrhoea, there was not a dissentient voice. [Lancet.

On the use of Nitric Acid as an Anti- Periodic. By George
Mendenuall, M. D., Prof, of Obstetrics, &c, in the Miami
Medical College of Cincinnati.

My attention has recently been called to the use of Nitric
Acid in the treatment of intermittent fever ; and as a substitute
for quinine in this class of diseases is a matter of some conse-
quence on many accounts, I am induced to lay it before your
readers that it may more fully undergo the ordeal of experience
and its true value be tested by different observe

The facts upon which this paper is based, are taken mainly
from an Inaugural Dissertation, presented to the Trustees and
Faculty of the Miami Medical College, for the Degree of I doc-
tor of Medicine, by E. T. Bailey, M. IV. of Emmetsville, Jnd.

He states, that in the section of country in which he resides,
there is a large portion of marshy land, and therefore the cir-
cumstances are favorable to the development of autumnal
fevers. His attention was first attracted to the use of nitric
acid in the treatment of intermittent fevers, by noticing its
effects iji a case of chronic intermittent, which was attended
with profuse night sweats, and for which complication he ad-
ministered the remedy. In this case, there had been daily
paroxysms for the preceding five days ; night-sweats profuse,
the tongue coated, and the bowels constipated. Nitric acid
was given in doses of six drops, diluted with water, in the
evening ; and he was agreeably surprised to find that the par-
oxysms did not return on the following day ; and this circum-
stance induced him to try its effects in other cases as an anti-
periodic.

Since that time he ha3 treated over ninety cases of inter-
mittent fever with tjiis article, with remarkable success. Of
this number, all recovered promptly except ten, and in every
one of these unsuccessful cases, the remedy was discontinued
contrary to directions.

Fifteen of the whole number were of the tertian type, and
seventy-five of the quotidian. In fifty cases, there was no re-
turn of the chill after commencing the use of the acid. The
others were rarely attended by more than one paroxysm, and
in no case by a third. When the patient had a paroxysm after
taking the medicine, it was in every case diminished in inten-
sity and duration.

In Dr. Bailey's practice, this remedy has entirely superseded

18541] Nilric Acid as an Anti-Periodic. 751

every other article for the purpose of interrupting the parox-
ysms of intermittents. His mode of proceeding is to give
from five to eight drops of the commercial nitric acid, properly
diluted, once in six hours, without regard to intermissions or
exacerbations. Cathartics and alterants may be necessary for
the purpose of changing certain conditions of the system ; but
so far as the interruption of the paroxysms is concerned, the
acid may be given without any preparation of the system
whatever, if we choose to do so.

The following cases are selected from among many others,
in order to show the different varieties of the disease, and the
mode of treatment pursued :

Case I. Mr. L. S., aged do, of temperate habits, called up-
on him on the 12th of July, 1852. In May previous, he was
attacked with intermittent fever, which was cured by quinine,
but relapsed in six weeks, since which, the disease has contin-
ued with daily paroxysms. The tongue was furred, and the
bowels constipated. A purgative of calomel and rhubarb was
ordered at bed time. A violent fever followed the chill, which
occurred at 1 1 o'clock, A. M., of this day. Five drops of nitric
acid wTas directed to be taken every six hours, diluted so as to
make a pleasant drink, to be commenced on the following
morning at 6 o'clock, the 13th. The calomel and rhubarb
produced two copious operations from the bowels, prior to
commencing the nitric acid. Three hours after the exhibition
of the remedy at 6 o'clock, as directed, a chill came on, follow-
ed by a high fever. The medicine was continued through the
day/

14th. The patient is free from a paroxysm ; no fever ; the
tongue clean and moist ; and the medicine was directed to be
continued as before.

15th. The tongue improving: bowels regular, and pulse
very little excited ; no chill. Medicine continued.

16th. Patient has entirely recovered.

Forty-five drops only were taken in this case, as the medi-
cine was not given at night.

Case II. Sept. 10th, 1S52, was called to see Master L. A.,
aged six years. He has had intermittent fever since the 6th
inst., with daily paroxysms, followed by high fever. The
tongue was moist, and the bowels open. Four drops of nitric
acid were ordered, which was diluted as before, so as to be
easily taken ; one dose to be taken at 12 o'clock, and the se-
cond at 6 in the evening: : to be resumed at 6 the following
morning, and repeated at 12 o'clock.

11th. Visited the patient in the afternoon. He had not

752 Influence of Opium, fyc. [December,

had any chill ; the tongue was clean and skin moist, with no
excitement of the pulse. Discharged cured.

In this case, the medicine was discontinued to see whether
the effect would be permanent.

12th. No return of the paroxysm. Sixteen drops wore
taken in this case.

Case III. Sept. 20th, 1853. Saw Miss D. N., aged 28.
Three days a^o. she was attacked with intermittent fever, the
paroxysms of which commenced at 10 o'clock every day, and
the chill was followed by high fever. A mild purgative was
ordered at bed time ; and sixty drops of nitric acid were diluted
with two ounces of water, and directed to be taken in nine
doses, at the rate of three doses per day, commencing on the
morning of the 21st.

25th. Saw the patient to-day, and found that there had
been no return of the paroxysms for three days. In this case,
sixty drops were taken.

Several other cases are reported with the same result, but it
is not necessary to repeat them here.

It is stated that relapses seldom occur much less frequently
than after the use of quinine, but upon this point more precis-
ion is required. It has been administered in all the various
forms of intermittent fever which were presented to the author
of the essay, and do unpleasant effects observed in any case.
Should they be verified by the experience of others, this rem-
edy will be found to be a valuable agent, and to possess the
following advantages:

"First. Certainty as an Anti-Periodic. Second. The power
of invigorating the general system, while at the same time it
has alterant properties. Third. Facility of exhibition, being
much easier taken than quinine, barks, &c. Fourth. Freedom
from the unpleasant effects which sometimes follow these reme-
dies. Fifth. Cheapness of the article, which is often of consid-
erable importance in miasmatic regions. [ Western Lancet.

On the Influence of Opium as a means of Preventing and Re-
moving some of the Injurious Consequences of Over-work
and Anxiety. By Dr. Johnson, Assistant- Physician to
King's College Hospital.

The following interesting and practical remarks are from a
course of lectures on materia medica and therapeutics, deliver-
ed before the College of Physicians in 1853. Dr. Johnson
proceeds :

When all that is possible has been done for avoiding the
cause of mental worry, and when all needful advice and en-

1 S 5 4 . ] Influence of Opium, $c.

couragement has been given, we have next to direct our atten-
tion to the consequences, some of which will often continue
long after their exciting cause has ceased to operate; while
others are perpetuated by some persistent and unavoidable
source of anxiety. Xo\\\ the first and the most frequent con-
sequence of over- work or anxiety the one too, which, more
than any other, is productive of further miscjiief is restless-
r some form of disturbed and unrefreshing sleep. And
the chief cure for this, after the causes have' been as much as
possible avoided, is an opitate at bedtime. So far as 1 can see,
it is of little importance what preparation of opium or of mor-
phia is used. For hospital patients I generally order the com-
pound soap-pill ; one advantage of which is: that its name does
not indicate its opiate nature. The dose must vary according
to circumstances. In ordinary cases five grains, of the pill,
that is, one grain of opium, may be taken every night at bed-
time. In a case of much excitement, with extreme res
ness or a threatening of delirium, the dose must be double or
treble that which I have mentioned. In such cases, however,
the opium would be best given in a liquid state in the form of
tincture, or the solution of the muriate or acetate of morphia.

The time for the continued exhibition of the opiate must
vary according to circumstances, and will be much influenced
by the success of the treatment. The object is to break the
habit of dreaming restlessness, and to procure sound and re-
freshing sleep. In many cases this object may be attained by
the nightly repetition of the dose for one week. It is seldom
necessary or desirable to continue the medicine for more than
a month, though in some cases, it may be expedient and bene-
ficial to extend the period considerably. In many cases 1 have
found that the beneficial effects of the medicine have been im-
mediate ; the patient has slept soundly, the distressing dreams
have ceased, the appetite has returned, and all the symptoms
which depended on loss of sleep and loss of appetite have
quickly disappeared. After a few nights of sound sleep have
been procured by the opiate, the dose should be discontinued,
and in most cases the patient will continue to sleep as well
without the medicine as with it. There is, probably, no one
medicine which has the power of quickly removing such a
multitude and a variety of distressing symptoms as opium,
when its action is really favorable in the case to which I refer.
It is not, however, to any specific efficacy residing in the opium,
but to the marvelous influence of sleep in refreshing both body
and mind, that the benefit is really .due. The value of the
opiate consists in the fact, that, on the whole, it is the safest
and most certain means of procuring sound sleep.

754 Influence of Opium, $c. [December,

The use of opium as a medicine is sometimes attended with
unpleasant consequences, and it does not always effect what is
desired. I proceed now to indicate some of the unfavorable
results of the opiate treatment, and the precautions which
ought to be observed in the use of the medicine. One of the
most frequent discomforts attending the use of opium is a feel-
ing of nausea and faintness, either with or without headache,
in the morning after waking. The best cure for this is a cup
of coffee or tea, with some solid food, followed by a walk in
the open air. In many cases the opium, although at first it
may disagree, yet produces no unpleasant effect after the
ad or third d<

The nervous patients who require the method of treatment
which I am advocating, almost invariably sutler from constipa-
tion, a torpid condition of the bowels, being, in fact, one of
the natural consequences of the general debility which charac-
terizes the patients in question. Although the immediate effect
of the opium is to increase the constipation, yet its ultimate
tendency is to restore the regular action of the bowels, by
means of the invigorating influence derivable from sound re-
freshing sleep, and an i 1 appetite for food. The tem-
porary constipation may readily be obviated by an occasional
mild aperient a seidlitz powder, or a compound rhubarb or
colocynth pill. The inconvenience arising from the astrin-
gent effect of opium upon the bowels is so easily met and re-
id, that it would never deter me from giving the medicine
in any case which appeared to require it.

One of the most serious objections to the use of opium, is its
tendency, in some cases, to produce an effcet the direct
opposite of that which we require, to produce wakefulness
xcitement. instead of sleep and composure. It is only in
a small proportion of cases that this difficulty arises. It may
sometimes be overcome by changing the form of the medicine,
or by increasing the dose of the opium or morphia, and, in other
cases, by combining the opiate with a moderate dose of anti-
mony James's powder, or tartar emetic a combination which
has been strongly recommended by Dr. Graves to procure
sleep and check delirium in some cases of fever. It must,
however, be admitted, that some patients cannot tolerate opium
in any form or in any dose ; and nothing can better show the
value of this drug than the difficulty of finding a substitute for
it. We may try henbane and hop, and these will sometimes
effect our object ; but their action is very uncertain in compari-
son with that of opium. '

* Since this lecture was delivered, I have found reason to believe that one of
the best substitutes for opium in the cases referred to, is Chloroform, in doses
of from in x to m xx, made into a draught with mucilage.

1S54.] Influence of Opium, tyc. 755

It is well to remember that an opiate enema will sometimes
procure refreshing sleep, when opium, in any form administered
by the mouth, is either quite inoperative, or productive only of
distressing excitement or sickness.

But may not the frequent repetition of an opiate dose be-
come a necessity for the patient? May we not be instrumen-
tal in making him an opiumeater ? I admit that the danger of
such an evil, if real, would be a very fearful one. There are
few results of medical practice which I should regret more
than the reflection, that I had in any way contributed to ren-
der a recourse to narcotics or stimulants habitual or necessary
to a single patient. I believe, however, that a cautious use of
opium is attended with little danger of leading to so terrible an
abuse of the drug.

In giving opium to hospital patients, I never tell them what
they are taking: and one reason for preferring the compound
soap-pill, in such cases, is, as I have before intimated, that the
nature of the medicine is not apparent from the prescription, if
the patient should read it. The opium should be discontinued
as soon as it can be dispensed with, as soon, that is, as rest-
lessness and frightful dreams have ceased to harass and exhaust
the patient. The rapid convalescence, and the renewed health,
and strength, and spirits, which are wonderfully promoted by
securing sound and refreshing sleep, will generally enable the
patient at once, and without difficulty, to dispense with the
use of opiates. I should withhold opium from a patient who
neglects any directions which I have given him as to exercise,
diet, and the general management of himself, and whose rest-
lessness and nervousness appear to result from such negligence.
In other words I would not encourage a patient to trust habitu-
ally to opium for the removal of discomforts which might be
avoided by the exeicise of self-control, and by obedience to
natural laws.

I beg to make an earnest protest against the routine prac-
tice of giving opiates to every patient who complains of inabili-
ty to sleep. Our first care must be to discover, and then to
remove the cause of the sleeplessness. We shall meet with
some indolent patients, for whom the best soporific is regular
employment and daily active exercise in the open air ; for
others, who are feeble, tonics and nutritious food will be the
appropriate remedies; and again, in other cases, dyspeptic
symptoms will cease, and refreshing sleep will return, under
the influence of an occasional aperient and carefully regulated
diet. In most cases of this kind, the exhibition of opium would
not only be unsuccessful, but positively hurtful.

756 Influence of Opium, fyc. December,

The cases in which the opiate treatment is most rapidly and
completely successful are those in which the nervous symp-
toms are the result of some past grief, or anxiety, or fatigue,
the impression of which remains, and is perpetuated by the pa-
tient's inability to obtain refreshing sleep. In such instances,
a few nights of sound sleep, procured by means of the opium,
rarely fail to effect a rapid cure, and this, too, after the ner-
vous symptoms have continued for many months, or even for
years.

Another class of cases in which equal benefit is often derived
from a similar method of treatment, are those in which nerv-
ous restlessness has been induced by continued overwork,
whether mental or bodily. In such instances, it is obviously
desirable, as I have before intimated, that the patient should
rest, or diminish his labors, if possible : but the patient may as-
sure us that he has no alternative but to go on with his work,
or to lose his employment, and with it his means of living. In
such a case, we may often prevent overworked men and wo-
men from breaking down, and enable them to go on in com-
parative comfort, by giving an opiate nightly for a week or
two. Refreshing sleep will be indued, the appetite will return,
and, as a consequence, the strength and spirits will revive,
and the strength and spirits thus obtained are not false and
artificial in the same pernicious way as the stimulus obtained
from alcohol, by which too many are tempted in the circum-
stances to which I have referred. The temporary help which
a languid body or mind derives from alcohol is generally fol-
lowed by a corresponding amount of depression, and with this
there comes a craving for the repetition of the stimulant. Ano-
ther bad result of the too free use of alcohol is a loss of appetite
and an impaired power of digestion. Now. the effects of the
opiate plan of treatment, conducted with ihe precautions to
which I have before alluded, are in most respects the opposite
of those produced by alcoholic stimulants; for we seek, by
means of opium, a natural remedy for fatigue, that remedy be-
ing sleep, which brings with it a desire for food, and the power
to digest it. Alcohol is taken for the sake of the immediate
stimulus; the subsequent depression is the drawback upon its
utility as a means of keeping up the working powers. The
object in giving opium is to obtain, not its stimulant effects,
which are comparatively slight and transient, nor immediately
its composing influence, but the refreshment which follows the
latter, and which has nothing corresponding with it among the
ordinary consequences of alcoholic stimulants.

My objections to the abuse of alcohol as a stimulant do not,
of course, apply to the use of wholesome wine and beer as arti-

1S54.] Influence of Opium, tyc. 757

cles of diet by those who require them, and who appear to
derive benefit from them. Moreover, there are certain cases
of nervous disease in which some form of alcoholic stimulant
may be given with great advantage, either alone or in conjunc-
tion with opium. I refer to cases of extreme restlessness, either
with or without delirium, and whether resulting from intem-
perance or from grief, or watching or fatigue, when the bodily
powers are very feeble, although under the mental influence
there may be great excitement. In these cases repeated large
doses of opium sometimes fail to procure sleep, but appear ra-
ther to have a depressing influence : the patients skin becomes
cold, and is bathed in perspiration, while the delirium and ex-
citement continue. In such circumstances, the continued use
of the opium is not only useless, but injurious and dangerous;
and the surest mode of arresting the collapse, and of procuring
sleep, is to give freely either wine or brandy, or in cases of
intemperance, the stimulant to which the patient has been
accustomed, with beef-tea, or some other form of nourish-
ment.

It is scarcely necessary to observe, that in all cases of nerv-
ous disease we must carefully watch the signs of functional
disturbance or of structural change in any organ of the body,
and that we must meet such symptoms by the appropriate
remedies. And although, in most instances, a tonic plan of
treatment is required, yet we must not hesitate to resort to
measures of depletion if they are called for by the occur-
rence of such organic disease as appears to need this treat-
ment.

The cases which are least favorable either for the opiate or
for any other plan of treatment are: 1st, cases of confirmed
hypochondriasis or melancholy of very long duration, and espe-
cially when these have the character of religious despondency ;
2dly, cases in which extreme nervousness has resulted from
great terror, or from a sudden shock, which has left a deep and
durable impression upon the mind and nervous system ; and
lastly, cases in which the symptoms are perpetuated by some
constant source of anxiety or sorrow.

These classes of cases, although very unfavorable, and often
little benefited by any plan of treatment, whether medical or
moral, are yet by no means hopeless nor always incurable.
Their unfavorable and unmanageable character is. however,
greatly confirmed when they are complicated with epile]
and this whether the epilepsy has been induced by a sudden
shock of grief or terror, or whether it has supervened upon
long-continued anxiety and nervousness. [Buffalo Medical
Journal.

n. s. vol. x. NO. XII. 48

758 Veratrine in Febrile Diseases, c. [December,

Researches on the use of Veratrine in the treatment of febrile
diseases, and particularly Pneumonia, Typhoid Fever and
acute articular Rheumatism, Syc, by Dr. Aran. Translated
from the French, by A. Sager, M. D.

In a patient with acute articular Rheumatism, the medicine
was given alone for twenty-four hours. Three centigrammes
had been quite accidentally combined, in six pills. The phy-
siological effect was of the most marked character. But what
more especially attracted attention was the great diminution
in frequency of pulse, falling from 112 to 64, and even to 48 per
minute.

In reading the more recent researches on the therapeutic
action of veralrum viride, the author learned that an American
physician, Dr. Norwood, regarded that plant as a certain rem-
edy against all febrile affections, whatever might be their
origin.

He immediately resorted to clinical experiments ; and from
the first series of observations our learned associate furnishes
us with results of his investigations on veratrine in pneumonia.

In order to give an idea of the nature of the cases in which
it has been tested, we will furnish here merely the heads of his
observations, viz :

1st Obs. Double pneumonia with pleuritic effusion in the
right side. Antiphlogistication, veratrine, amelioration, re-
lapse, cupping and vesication of the chest, veratrine in large
doses, rapid recovery.

2nd Obs. Pneumonia of the right side, treated by blood
letting; persistence and aggravation from accidents, us
veratrine ; rapid recovery.

3c? Obs. Pleuropneumonia of the right ride in a tubercu-
lous subject, treated exclusively with veratrine; rapid cure.

4th Obs. Pneumonia of the right side in a tuberculous
subject treated by veratrine ; rapid amelioration, then signs of
relapse; blister and veratrine continued ; cure of the pneumo-
nia; formation of a tuberculous cavity in the opposite side
during convalescence.

5th Obs. Pneumonia of the left side in a female of 70 years,
treated without success with venesection and Tart. Ant et Pot.;
veratrine used. Patient cured.

Qth Obs. Capillary Bronchitis and double pneumonia in a
female of 69 years, the gravest complications, veratrine used
in full doses; unexpected amelioration, relapse, death.

The detailed observations, furnished by the author in refer-
ence to those cases show

1st. That in most cases, even after the first dose, but more

1S54.] Veratrine in Febrile Diseases, fyc. 759

frequently still, after the second or third dose of 5 milligram-
mes, the patient was affected with nausea, retching and vomi-
ting, sometimes with hiccough, seldom with alvine dejections,
and still more rarely with a sensation of bnrning in the esopha-
gus and stomach. These symptoms, continued as long as the
veratrine was exhibited in sufficient doses.

2d. That in each of these six cases the pulse fell, in the first
24 hours of its exhibition, from 24 to 60 beats. The rhythm
was not at first affected, but while it became slower, it like-
wise grew smaller and feeble. In some cases, however, it
became also vibrating, dicrotic, and very depressible, when
the slowness became extreme, the regularity was. frequently
interrupted by the intermission of two or three pulsations.

3d. That from the first to the second day of the treatment,
the respirations were diminished to six per minute.

4th. That in every case the depression of temperature was
extremely marked, the skin however dry and burning at first,
became moist, cool and often bathed in perspiration.

To these deversified modes of physiological action, we must
add its therapeutic agency, viz: The cough was always much
diminished, the dyspnoea entirely disappeared, and the expecto-
ration becoming much more easv, lost also much of its charac-
teristic rusty hue. The physical signs were, however, less
influenced by the medication than the general symptoms
enumerated. In conclusion, Dr. Aran, in consideration of its
violent action, thinks it should only be used in cases of great
gravity and complication. It should be cautiously employed
in a great number of cases, and the indications for its employ-
ment clearly made out before it should be admitted into the
list of therapeutic articles.

In a second memoir, the author treats especially of its use
in acute articular rheumatism.

From the considerations which he adduces on this subject,
it results that veratrine is not a remedy of great utility in
arthritic affections, and especially that it exerts but little influ-
ence over the pain which accompanies the disease.

He has observed that while in this disease as in pneumonia,
nausea, vomitimg and hiccough occur ; the depression of tem-
perature and of the pulse was much less marked. He exhibits
in conclusion the effect of the treatment of 8 cases of acute ar-
ticular rheumatism with veratrine. In two cases of very
acute disease, it completely failed ; in four cases, a cure was
rapidly effected, and in two similar cases it was impossible to
continue it, because of the perfect intolerance of the remedy.
He infers therefore that it is not entitled to the first rank as a
therepeutic agent in this disease ; that it should not be relied on

7(30 Prolapsus of the Rectum. [December,

as a general method of treatment, and thinks it more especially
indicated in cases with endocardial or pericardial complica-
tion. Gazette Medical de Paris. Peninsular Jour, of Med.

Cause and Treatmeat of Prolapsus of the Rectum. By M.

DUCHAUSSAY.

In a short but interesting memoir, M. Duchaussay reviews
the circumstances attending this troublesome complaint, and
fixes attention in particular upon the loss of power in the
sphincter and muscle as the chief cause of the descent of the
bowel. Moreover, he endeavors to show that Dupuytren's
operation, by excising the radiating folds of skin around the
anus, and the operation by four touches with the actual cautery,
practiced by Guersant, act not by causing any subsequent re-
traction of the cellular tissue, skin, and mucous membrane, but
rather by stimulating the sphincter muscle so that, it regains
its contractility, and therefore its retentive character. ll<>w
else*, asks M. Duchaussay, do we explain the fact, that the pro-
lapsus is often cured, or does it return after two days, or even
after one day, or not at all after the operation ? He points out
the fact, that in case of this disease in infants, three fingers may
sometimes be introduced without causing contraction of the
sphincter, before the operation by cautery, whilst afterwards,
if one be passed, a powerful contraction of the sphincter imme-
diately ensues. As proof that this recovery of contractile pow-
er by the sphincter is the cause of cure, a case is mentioned in
which M. Guersant had used the cautery too superficially, the
sphincter failed to contract, and the disease returned. A se-
cond cauterization was followed, on the contrary, by return
of the muscular contractility, and the cure was complete.

According to the author, the cautery acts as a stimulant to
the paralyzed muscle, just as it will to the deltoid in a like con-
dition. After pointing out the inconveniences and apparent
severity of M. Guersant's method, M. Duchaussay suggest that
a slighter cautery, or some other stimulant to muscular con-
tractility, might act as well, and he suggests strychnine. This,
with M. Guersant's permission, has been tried in the Hopital
des Enfants, in the case of a girl aged eleven years. The pro-
lapsus here arise from obstinate constipation ; it had lasted for
four years ; the bowel protruded at each evacuation about ten
centimetres ( 4 inches). During the first month of her ad-
mission she was treated by laxatives only, with no other result
than that of diminishing the length of the protruded portion of
bowel to about four centimetres (H inches). Strychnia was
then employed endermically near the region of the sphincter :

1854.] Foramen Ovale and the Ductus Arteriosus. 761

the next day there was no evacuation ; on the following day
the bowels acted once, only a slight bulging of the rectum
taking place ; on the third day the protrusion was still less after
an ordinary evacuation ; and during the next thirteen days it
did not occur again.

Blisters were made in the cleft between the nates, and on
the right thigh close to that cleft ; one-sixth of a grain of strych-
nia was applied the first day, one-third on the second, and one-
third on the fourth day. On the fifth day. about half a grain of
sulphate of strychnia was used, and this was repeated for the
last time on the sixth day. In the case of a boy, it is recom-
mended to be applied between the scrotum and anus, immedi-
ately over the anterior interlacement of the sphincter ani fibres,
The remedy certainly deserves further trial. [Archives Gen,
de Med. North Western Med. and Su?*g. Jour.

Note on the Foramen Ovale and the Ductus Arteriosus. By
M. Flourexs

1. Of the Ductus Arteriosus. 1. The period when the
Duct is completely closed. In the India pig, at 12 days ; the
rabbit, 16 days ; dog, 23 days; the calf, between one and two
years. In man it is not closed at the 18th month.

2. Filaments of the Ductus Anteriosus. These exist in no
animals examined by me except the calf and the horse. In the
calf, I have found them at two months.

3. How these filaments are disposed at first, and the mode in
which they unite to effect the Closure of the Duct. The fila-
ments never exist alone ; they are always developed with a
membrane, whose margin is adherent to the posterior edge of
the opening. The filaments rise to the number of twelve or
fifteen at least, from the free margin of the membrane. But
they almost immediately unite together, separating again to
unite a second time, thus forming a net work, increasing in
size as it leaves the margin of the membrane. This mesh, so
to speak, suspended in the left auricle, terminates by three or
four filaments, which go to be inserted into the left surface of
the wall of the auricles, at one-half a centimetre from the ante-
rior margin of the foramen ovale. These terminal filaments,
in lieu of their insertion in the wall of the auricles, form the
arches of a bridge; the middle arch is larger than the rest.

In proportion to the development of the animal, the net of
filaments thicken; in proportion to this thickening the meshes
disappear. The terminal points of insertion are alwaysin the
same number, and in the same situation. After a while there

r62 Remedy for Hydrophobia. December,

remain but three or four arches formed by the free margin of
the membrane, and ils filaments much thickened and much
shortened. The arches finally disappear by the same process ;
the communication between the auricles is cut off. Before
this orifice is entirely closed, there exists a very oblique canal,
whicn extends from the right auricle to the left. Sometimes
this passage continues in the adult, (cow, sheep, etc.)

In animals which have not these filaments, the mechanism is
somewhat similar. Here, also, it is by the thickening of the
membrane, and by its insertions in the left auricle, that ihe
foramen is closed ; and there is a very oblique canal which
may exist in the adult, (dog, rabbit, man, etc.)

II. Ductus Arteriosus. Period when the Duct is con,,
ly obliterated. In the dog, in 36 days; in the rabbit, in 26
days. In man, 1 have examined the duct on at 18 month
years it was not entirely closed. The ductus arteriosus ap-
pears to close first at its middle, the two extremities remain
open for some time after the centre is closed. {Philadelphia
Med. and Surg. Jour.

Remedy for Hydrophobia, ByW. N. Hurt, of Kilmichael,

Miss. *

There is no disease to which the human family is liable, that
has been the object of so much speculation and experiment as
Hydrophobia ; in order to find out an appropriate remedy and
with so little success. Every remedy heretofore that appeared
to be successful at first, has on further trial been found useless.
It is my present object to offer to the public a remedy, the effica-
cy of which is so well attested that I think it well worthy of a
fair trial ; it was given me by my old friend Thomas Harvey,
who states he has used it in a great many cases, and assures me
it has never failed in a single case. I have also seen many of
his patients who fully corroborate Mr. Harvey's statement.
It not only proves an effectual remedy in all stages of the
disease but as a prophylactic of superior efficacy, always pre-
venting an occurrence of the disease when given to a person
that has been bitten by a rabid animal and before the period of
incubation.

$. root of Phytolacca 1 Ife
new milk, xiv oz.

Slice the root and boil it in the milk down to 7 oz., press the
liquid thoroughly from the mass through a fine cloth. Half a
tea-cupful to be taken every hour until the disease disappears,
when it should be gradually discontinued. When given as a
prophylactic the above amount may be given four or five times

1854.] Editorial 7G3

a day for eight or ten days, it will nauseate, vomit and purge.
The patient should take nothing but low diet during the treat-
ment. Be particular to get out all the pulb of the root from the
liduid. [Southern Journal of Med. andPhys. Sciences.

EDITORIAL AND MISCELLANY.

BIBLIOGRAPHICAL.

Principles of Comparative Physiology. By Wm. B. Carpenter, M.D.,
F.R.S., F.G.S., &c. with 309 wood engravings. A new Ameri-
can, from the 4th and revised London edition. Philadelphia : Blan-
chard dc Lea. 1854. 8vo., pp. 752.

The intrinsic merits of Prof. Carpenter's works upon Physiology
have secured to them a position that cannot be bettered by any indi-
vidual encomium. The splendid and valuable book above named is
eminently creditable to both the author and his publishers. Every
physician should own it, for there is no better way to learn human
physiology than by the study of the functions of life as modified by
the various organizations of animated nature. To every man who
has any taste for natural history, the perusal of this work will be
quite a treat, as it is certainly more complete than any of the kind in
our language.

The Principles of Animal and Vegetable Physiology : a popular trea-
tise on the functions and phenomena of organic life to which is
prefixed a general view of the great departments of Human Know-
ledge. By J. Stevenson Bushnan, M. D., &c. with 102 illus-
trations on wood. Philadelphia : Blanchard 6c Lea. 1854. 12mo.,
pp. 230.

It is always pleasing to see attempts made to popularize the love of
science. The object of the little book before us is not so much to
teach science as to awaken a desire for its knowledge in those who
would shrink from such a volume as that of Carpenter, and yet be
willing to look through a small one, purporting to impart pleasure as
well as information. This is one of the series published in 'England
under the title of " Orr's Circle of the Sciences," and is remarkably
well adapted to the purpose for which it is intended.

The principal forms of the Skeleton and of the Teeth. By Professor
R. Owen, F R.S., <kc. Philadelphia: Blanchard & Lea. 1854.
12mo., pp. 330.

This, like the work just noticed, is one of "Orr's Circle of the

764 Editorial. December,

Sciences. It is written by the most distinguished Comparative Anato-
mist of England, the Cuvier of Great Britain. As a popular mono-
graph upon a topic of general interest, it will doubtless be extensively
read.

On the Nature. Signs and Treatment of Child-bed Fevers ; in a series
of letters addressed to the Studeiiis of his Class. By Charles D.
Meigs, M. D., &c., &c. Philadelphia: Blanchard & Lea. 1854.
8vo., pp. 360.

Our indefatigable confrere, Professor Meigs, has just favored us
with another of his valuable contributions to practical medicine. The
work before us is in the epistolary, free, and familiar style which has
made the writings of our distinguished friend so popular. This mono-
graph will be found to till an important gap in our medical literature,
and to sustain the high reputation of the author.

A Dictionary of Medical Terminology, Dental. Surgery, and the Colla-
teral Scie?ices. By Chapin A. 11 vuius, M.D., D.D.S., &c , &c.
2d edition, carefully revised and enlarged. Philadelphia: Lindsay
ec Blakistou, 1855. 8vo., pp. 800.

The title page of this work explains its character; and the demand
for a second edition shows that it has been found useful. It is intend-
ed more especially for those who practice Dental Surgery than for the
general practitioners of Medicine, but may be consulted advantage-
ously by all. The multiplication of works upon Dentistry, their ex-
tensive sale, and the liberal patronage of the several schools of Dental
Surgery, constitute an American peculiarity to which no one has so
much contributed as Prof. Harris, who by his zeal and ability has
placed his profession upon higher grounds in the United States than
it enjoys in any other country.

On the construction, organization and general arrangement of Hospitals
for the Insane. By Thomas S. Kirkbride, M. D., Physician to
the Pennsylvania Hospital for the Insane. Philadelphia: Lindsay
& Blakiston. 1854.

The Profession should feel under obligations to Dr. Kirkbride for
the collection in this small volume of much useful information, not
otherwise attainable without much labor. In no particular is the
nineteenth century more marked for benevolence than in the manage-
ment of the Insane. This work is full of valuable suggestions, and
ought to be carefully studied by all who may be connected with the
establishment or supervision of Lunatic Asylums.

1854.] Editorial and Miscellany. 7G5

Resume de Recherches CUniques sur lafievre continue la DysseJiterie,
la Pleuresie Cluomque, et sur les variations du ion dans lessons.

This is a French translation of the several clinical works of Prof.
Flint, to which we have already adverted at the time of their publi-
cation in this country. It is gratifying to perceiye in this a just
appreciation of our countryman's genius and talent for observation.

The Physician's Visiting List, Diary, and book of engagements, for
1855. Philadelphia : Lindsay & Blakiston.

A most convenient pocket-book, which every practitioner ought to
procure.

We are indebted to authors and publishers for a large number of
pamphlets, among which are the following works :

Transactions of the Medical Society of the State of Pennsylvania,
at its annual session held in the city of Pottsville, 1654.

The Minutes of the fifth annual meeting of the Medical Society of
the State of (Georgia, held in the city of Macon, April, 1854.

Besides the Minutes of the proceedings of the Society, this work
contains a list of the Officers and Members, the Constitution and By-
Laws, a Report "on the relative value of Lithotrity and Lithotomy,"
by L. A. Dugas, M. D., and a Report "on Chloroform in Surgical
and Obstetric Practice." by Joseph A. Eve, M. D.

Proceedings of the American Pharmaceutical Association at the
third annual meeting, held in Cincinnati, July, 1854.

Report of the Special Committee of the Board of Regents of the
Smithsonian Institution, on the distribution of the income of the Smith-
sonian fund, Arc. 1

The Voluntary System of Medical Education, instituted by the In-
dependent Medical School of Pennsylvania. 1854.

Insanity in Italy. By John M. Gait, M. D., of Virginia.

Elkoplasty or Anaplasty applied to the treatment of old ulcers;
also, a new mode of treatment for delayed or non-union of a fractured
Humerus. By Frank H. Hamilton, M. D., <kc, &c., of Buffalo.

Statistics of the Medical Profession of the United Slates. By
C. A. Lee, M. D. By the census of the United States of 1850,
we learn that there are 40,564 Physicians in the United States.
Whether this includes the irregular practitioners and quacks we are not
informed, but presume that it does not. The reader will perceive, by
consulting the following table, the number of practitioners in the U.
States and in each State of the Union, the ratio of practitioners to the

760

Miscellany.

[December,

population, and the number of square miles in each State and Ter-
ritory :

STATES.

-

.e, 669

New Hampshire, 683

Vermont, 663

ichusetts 1643

Rhode Island, 217

Connecticut,

New York,

Pennsylvania, W71

Delaware 114

Maryland,

District Columbia, ml

inia,

North Carelina,

South Carolina,

Georgia,

Florida,

Alabama, 1364

Mississippi, 1-17

Louisiana,

Texas, 616

Arkansas, 1 1'

Tennessee, 1523

Kentucky, 1818

Ohio,...'

Michigan, 854

Indiana,

Illinois, 1402

Missouri, 1351

Iowa, 542

>nsin, 581

Calitbrnia, 626

TERRITORIES.

Minesota, 13

New Mexico 9

Oregon, 45

Utah, 16

Total, 40,564

583 169
317,976
314,120
994 51 1
147,545

2,311,786

583,034

51,687

1,421,661

87,445
771,623

2 1 2,592

851,470

192,214

305,391

6,077
61,547
13,291
11,380

a* a

.2 o

510

07!)
612

588
657

647

610
498

346

658
540
Hit
165
155
607

354

147

467

6838

295

711

' '3

12.52

39.6

137.17

78.06
67.33
71.46

13.17
53.00

23.17
19.1

15.62
1.48

15.21

12.52
0.65
4.09

2607
19.55
7.07

29.24
If) 37
10.49

3.77
5.66
0.49

0.04
0.29
0.04
0.06

The total population is 23,191,876 ; the ratio of practitioners to
the whole population is one to 571. California is better supplied
with Physicians than any other part of the United States, there being
one to eveiy 147 inhabitants, while New Mexico is the most deficient,

Considering the sparseness

there being but one to 6,838 inhabitants.

1864.] cellany. '. 1

and thinly scattered state of the population, in most parts of the Union,
it may well admit of doubt, whether the surplu- great That

it is so in the older and comparatively more settled States is sufficient-
ly obvious.

The mortality edical practitioners is greater than among

any other class of men : we believe, taking the whole I :es,

that it will not fall short of one in twenty-five, annually. This will
give a total of 1622 deaths, which are to be supplied from our medi-
cal graduates. Considering that large numbers of young men, espe-
cially from the Southern States, are educated to the profession, without
any view to practice, and that many more enter upon other pursuits,
and engage in other and more profitable callings, the number of those
who annually graduate from our medical colleges will not appear dis-
proportionately _ : we do not know the exact numb .r, but suppose
.2000. [Buffalo Med. Journal.

Mortality among Children. By W. A. Alcott, M. D. The Boston
Journal for A has au article, copied from the Baltimore Pa-

riot, on the mortality of children, which is deserving the attention of
those whose office should be not only curative but preventive. 1 copy
from the article as follows:

" In the cities of New York. Philadelphia and Baltimore, last
out of a total i 25 within a fraction of two-thirds of

the whole number were children under live years of age. ?'"

as there is no date to the article of which the foregoii._
part, it is not in my power to say precisely what week the writer refers
to; but it is a fair inference that it was recent. Nor am I able to
by what arithmetic or logic, 1,025 is made out to be ' within a frac-
tion of two-thirds'' I. It would be more nearly three-filths of
the whole. Still the fact is a terrible one. Many have thought the state-
ment so often made by myself and others, that two-fifths of our popu-
lation, taking the year together, die under five years, an exaggerated
one; but here is a mortality of three-fifths for a particular period.

The writer in the Baltimore Patriot, in his comment on the dreadful
fact, justly observes: ''There is certainly some cause for this, and
it is due to the science as well as the philanthropy of the age. that this
cause should be distinctly ascertained and pointed out."'" Again he
sa}? : -A close examination of the subject, we doubt not, would show
that it is chiefly among those who are surrounded with all the comforts,
and, in many instances, with the lnxuries which riches command, that
infantile diseases find their most numerous and unresisting victims."

With one qualification, Messers. Editors, I can subscribe most fully,
to the truth which is suggested in the latter quotation. Instead of say-
ing M riches " in a country where almost every pauper is rich enough
to have his appetite tickled and gratified, I would say M money and a
shortsighted selfishne.-

In regard to the cause of this fearful and fearfully increasing infan-
tile mortality for there are doubtless more causes than one I have
something to say, suggested by the study of the subject for thirty years

'68 Miscellany. [December,

or more. And though I lay no claim to infallibility, I do greatly de-
sire to be heard.

My first suspicion rests on the too free use of alkalies among us. I
say "the too free use," because, although I should not be likely to
encourage their dietetic use, in any quantity, or in any circumstances
of health, yet there is certainly a wide difference between excess and
moderation. It is one thing to use just so much saleratus as shall be
neutralized by the acetic acid it meets with, so as to leave no residu-
um but a little acetate of potash, and quite another to use the alkali so
freely that a portion of it remains in the stomach and intestines unneu-
tralized. Yet the latter is an eveiy-day occurrence. Our children,
generally, have their first passages in a state of sub-inflammation,
from this and other kindred causes ; and though the use of mild acids,
especially those of fruits, may do som< thing to soften or mitigate the
condition, is it any wonder that bowel complaints, in these circum-
stances, become ven iid unmanageable .? Is it any wonder
that two-fifths, and in summer three filths oi' all who are bom, die
under live yean

1 have no doubt that quackery and humbuggery. as well as many
more things, tend to a fatal result in these eases; but 1 can say no
more in a single number. You may possibly hear from me again.

Auhi'kx 1) \le, August 15th, 1854.

Mortality among Children, No. 2. When I call to mind that the char-
acterofyoui work varies somewhat from that of its predecessor whose
motto was "The best part of the medical art is that of avoiding pain," I
begin to doubt whether you have room for short articles from time to
time on prevention. And yet, medical men in general are not so lost
to philanthropy, and even to common humanity, as not to look a little
at prevention now and then. They know som< thing of the pain I have
often experienced on reflecting that while 1 have been the means, ap-
parently, of extending the lives of some of my consumptive patients
from one to thirty years, it has had one terrible effect which philan-
thropy herself scowls at it ha< served to propagate and perpetuate a
feeble race. Still, cure we must have, and will have ; and postponement
and palliation. It wont do to let the ieeble die oil" if we can help it.

The subject I broached in a late number of the Journal on infantile
mortality is one of serious and alarming import. The paper from
which I quoted was probably correct, for during the week ending
about the middle of August, the New York Independent states the
whole number of deaths in the three cities I have mentioned, at 1,790 ;
while that of those under 5 years of age was 936, considerably more
than half, still. Such a mortality is indeed frightful. What are we
to think of the habits of people when half the children in families die
under 5 years of age ? What would be thought of the good sense
and right treatment of domestic animals where half the lambs, pigs
and chickens should die thus prematurely?

I spoke of the use of salaeratus as in the front of a long list of trans-
gressions. I ought to have particularized. Dr. Hammond, of Kil-

1S54.] Miscellany. 769

lingly, Ct., first called my attention to this subject, ten or twelve years
ago. He confessed to the use often pounds in his small family in a
year, and said he was very far from being alone. Soon after that I
went down East, and learned something of the state of things in New
Brunswick and Maine. I found that in Bangor ten or twelve pounds a
year were very common. So I found it afterwards in some portions of
Massachusetts and Connecticut. Col. Ivers Phillips, of Fitchburg,
five or six years ago, told me that in a family often persons they used
twenty -five pounds a year: and Mrs. P., who was present, endorsed
the assertion. The smallest quantity 1 have known used in any ordi-
nary family, except my own, is about five pounds. In Ohio, families
who were at first disposed to sneer at my statements, confessed to the
use of six or eight pounds yearly.

My deliberate conviction is, that the families of twenty millions of
people in our United States population amounting to about four mil-
lions use the average quantity of five pounds of this alkali yearly
or one pound to each individual. This is an aggregate of twenty mil-
lions of pounds. How much of this goes into the alimentary canal
and courses its devious way without meeting with any free acid or
other substance calling into play new affinities, cannot easily be told.
In these days of excess in its use, I fearone half. But to be safe, I
will place it at one-fourth. Is it so, then, that the lining membranes
of our people our children among them must be irritated yearly by
5,000,000 pounds of uncombined unneutralized salaeratus ? The
very thought is enough to make one shudder !

From ten to twenty grains of this substance is sometimes put down
in our medical dictionaries as a dose. Place it at thirty. Do we
swallow 960,000.000 doses of medicine a year, in this careless, un-
called for manner? What effect can medicine be likely to have,
when given in an emergency, to childron who have been irritated day
after day, and year after year, in this way ? I have said irritated
not poisoned. Yet, Orfila, I find, calls salaeratus an irritating poison,
and gives us a long list of its terrible symptoms. I need not detail
them in a Journal designed for the profession ; but they ought to be
hung up in letters so large that they could be read at any distance sll
over the country. They would make some of our house-keepers
stare and it ought to be so.

Let us make one more estimate. I have not facts to bear me out in
what I am going to do, because I have not the patience to gather them
up scattered as they are up and down the earth's surface. But I
suppose four maximum medical doses of this article, taken at once,
would be called excess ; and this excess would be evinced by some or
all of Orfila's "symptoms." In short, the individual who should
take such a dose would be poisoned. I do not say he would certatnly
die, for I am not warranted in this. But I do say that, in all proba-
bility, he would not greatly desire to take another such dose immedi-
ately. B it 5,000,000 pounds of this alkali the quantity we suppose
to be swallowed yearly unneutralized would at this rate be 240,000,-
000 doses of the poison. It would poison all our 20,000.000 of white

770 Miscellany. [December,

people in the Union, twelve times each, or once a month, for the whole
year. But enough for the present.
Auburn Dale, August 25, 1854.

Mortality among Children No. 3. One fruitful source of infantile
mortality is medicine. Let not my medical friend saccuse me of net-
erodoxoy, in making this statement I have reason for my belief.

When I speak of medicine as a cause of infantile mortality, 1 have
no reference not the remotest to that small amount of it which is
given at the prescription of the family physician. There may have
error here; th nly has been, in all time and countries,

it is our 07rn. But I waive all this. Nor do 1 refer in particu-
lar to the enormous quantity of drugs and medicines taken without the
ription of any person duly qualified for th.' purpose, beyond the
pale of the family a hundred times greater than the quantity
by all our regular physicians of every school.

But I would aim chiefly, in these paragraphs, at what I have been

nccustomed to call maternal dosing and drugging. Bad as the world

is in other departments of drugging, thi prolific of infantile

and premature death than all ele, except bad cookery; of

which, by the way, I have said something in a former number.

era assume to understand the constitution of their own children j
and almost deem it an insult to be told of their mistake. Vet they are
mistaken. Reasoning a priori, it is impossible, or at least next to im-
possible, for those who are situated as mothers generally are, to under-
hand enough of the laws of hereditary descent, temperament, &C, to
be able to understand what is almost impossible to the wisest physi-
- and physicians. And then, in matter of fact,

their mi-take is still more obvious. They almosl every day, for ex-
ample, treat their scrofulous children amounting to one third or one
fourth of the whole in a manner diametrically opposite to what they
would have done had they understood the nature of the case and how
the first symptoms of latent scrofula manifi st themselves.

And yet it is almost as much as one's reputation is worth, whether in
the profession or out of it, to run the risk of giving to our mothers this
little piece of information. And the hazard is great in exact propor-
tion to their ignorance. An ignorant mother is, next to the Pope of
Rome, the most infallible of all human beings ! I mean, of com
her own estimation. You may reason, sometimes, with an intelligent
mother seldom with an ignorant one.

But whether ignorant or somewhat enlightened, the vast majority of
our mothers doctor, more or less, their own children. At least, if they
refuse to call it doctoring, they give them a vast amount of small elixirs,
cordials, &c. The closets of not a few house-keepers are a complete
apothecary's shop. They may, it is true, have smaller parcels than
the regular apothecary ; but they have almost as great an assortment.
And they not only keep it ; they administer it. They may not intend
it ; they do not mean to give much ; sometimes they really think they
do not give much. But it comes to pass, in the course of the year, that

1854.] Miscellany. 771

much is given by somebody ; and I greatly fear that the mother must
be held responsible for it.

True it is, that no mother confesses to this crime of dosing and drug-
ging. As it used to be with light lacing of the chest, that no one was
guilty herself, but almost everybody else was, so in this matter of drug-
ging and dosing children. Yet how often have I seen these very mo-
thers with their bottles or phials on the steamboats and railroads of our
country hardly willing to wait for the arrival of the cars at a "sta-
tion," before they administered the needful elixir, butactually admin-
istering it on the road !

But now for the consequences of this maternal dosing ; for this it is
with which medical men have chiefly to do. Next to bad food and
wretched cookery, as I have before intimated, this error is productive
of more sickness and premature death than any other. Xo physician
knows what to do with a sick child, who has been thus tampered with.
He may indeed guess a little letter than others ; but even he will often
guess wrong. Their first passages are irritated, and perhaps inflam-
ed ; and if it were possible to make the right appliances either inter-
nally or externally, it would still puzzle the wisest head to know how
to apportion the. quantity so as to be more likely to do good than harm.
Diseases, in these circumstances, as you know, are more apt to be
severe and complicated, and the termination more likely to be fatal,
especially if much medicine is used.

The worst remains to be told. As it is not always easy to trace the
cause of severe, protracted or fatal infantile disease to maternal error,
we not only contrive to kill, from generation to generation, by thou-
sands and tens of thousands ; but we partly kill by millions. If all the
mischief that is done could be concentrated, as it were, in a few, and
were to kill them outright, so that every body might see that they fair-
ly died of violence, there might be hope. But no; we seem to be
left to grope on in ignorance, and not only to kill, continually, but to
partly kill many more. We bring on, gradually, some disease or
other; or we render an inherited disease, which might have been
mild, very severe, or early fatal; or we aggravate, by over-dosing
the symptoms of acquired diseases from other causes. We clip from
the existence of one child or person, a year ; from another, two or
three years; from all, or almost all, something. The aggregate of
these clippings, so to call them, every year, though it cannot be exact-
ly ascertained, is, no doubt, fearfully great, and fearfully increasing.

I have sometimes thought maternal dosing was a little more mis-
chievous in the families that confide in the homoeopathic and botanic
treatment, than in those who adhere to the old system.' I will tell you
why. They seem to think vegetable medicine, and even small doses
of mineral medicine, so harmless that they may dabble with them
when and where they please almost without reserve or limitation.
Perhaps this is not justly chargeable on the systems themselves, but
only an incidental evil. But this does not alter matters of plain fact ;
and if the public are killing their children with too many small shot,
as well as with musket and cannon balls, it should be known, that

772 Editorial and Miscellany.

that the evil may be guarded against, or. if possible, removed. Boston
Med. and Surg. Journal.

bubnDale, Sept. 9. 1854.

Viviparous Fish. Dr. Bennet Dowler has recently discovered in
the vicinity of New Orleana a small osseous fish, which proves to be
viviparous, having no less than twenty-two well formed young in its
body at the time of examination. Dr. I)., however, yields the priority
of description of viviparous fish to Dr. Gibbons, who found them in
California.

A case of total Inversion of the Uterus of many years' standing, in
which extirpation of the entire organ was successfully practised by
Dr. E. Geddiogs, is reported in th larleston Medi-

cal Journal.

Professor Trousseau recommends the extract of belladonna, in

i grain, th, a day, as .'i remedy par excellence

for habitual constipation. With great deference to this distinguished
savan of Trance, we would BUggest thai his remedy will be far more
successful if he will add thereto -\ grs. of P. Rhei and l gr. of P.
I being the constituents of Professor Chapman's " Peris-

taltic persuaders." Tin1 latter will succeed when the Belladonna
fails. [N. Y. Med. G

Professor Simpson propounds the theory that Phlebitis is contagious,
and, like epidei and puerperal fever, may be communi-

cated by the bands or instruments of th-' operator. Hospital '_ ; 1 1 1 -

grene be would place in t!i" I . If this theory be true,

a new corps of surgeons should be enlisted lor tl, . ork Hospi-

tal at this present writing, for those on duty are making sad havoc by
spreading the poison, if the reported fatality by the Latter
correctly stated. [Ibid.

In Chlorosis, the salts of manganese are now very generally sub-
stituted for those of iron, in Germany, and the testimony is very strong
in their favor, as appears by the Foreign journals [Ibid.

Medical Prize Question. The New York Academy of Medicine,
through the liberality of a few of its members, offers a prize of $100
for the best essay on The Nature and Treatment of Cholera Infantum,
to be presented during the ensuing year. The trial for the prize is
not restricted to the fellows, but is open to the Profession throughout
the country. [Boston Med. and Surg. Journal.

INDEX TO VOL. X.

Abel's Chemistry 445

Abscess, pel vie 21 1

Acid, sulphuric, in diarrhoea 302

Acids, in bowel affections 748

Acid, nitric, an antiperiodic 750

Adhesive plaster 196

Alimentation, insufficient 427

Albuminuria and Puerperal convul-
sions 516

American Medical Monthly 131

American Medical Association 132

do do do 317

do do do 384

Amputation of the tongue 258

do of leg, effects of 365

Amputations, primary and secondary 565
Anatomy, preservation of specimens. 511

Anaplasty 629

Anasarca 644

Anaesthesia in midwifery, &c 132

do fatal effects of 132

do discoverer of 257

do local 449

Antiperiodic, nitric acid an 750

Aphonia, observations on 731.

do electro-magnetism for 174

Asthma, spasmodic 36, 242

Astragalus, removal of 643

Atmospheric phenomenon 191

Atrophy of muscles 250

Atropia, lotion of 706

Attaway, on spinal irritation 261

do on ulceration cervix uteri.. 401
do case of twins of differ't color, 348

Baber, biogr^rphy of Dr 187

Belladonna in salivation 644

Bennett, on pulmonary tuberculosis.. 639

Bennet, on the uterus 252

Beverages in sickness 699

Black Cohosh in chorea 292

Bladder, irritability of 468, 601

Blood, pathology and treatment of dis-
eases of the 360

Booth, chloroform in delirium trem's ' 17

Bowel affections, acids in 748

Buckler's Pathology, &c 254

Burn, operation for deformity 459

Burnett, death of Dr 509

Bushnan's Physiology 763

Calculus, urinary on shoe-string 707

Camphor in erysipelas 213

Campbell, on typhoid fever 175

Cancer of Penis 453, 715

Cancer, treatment of 635

do treated by congelation.. 542, 658

Cancrous growths 44

Cantharides, acetous infusion of 164

do ethereal solution of 164

Carithers, on mammary abscess 19

do on action of heart 462

Carpenter, on alcoholic liquors 254

do Comparative Physiology.. 763

Case-book 196

Casey, on typhoid fever in Georgia. . 197

do on hepatic abscess 398

Cataract, medical treatment of 425

Caustic, new 131

Cauterization in Ophthalmia 314

Cement, transparent 643

Charcoal coverlet in gangrene 708

Children, emphysema in 223

do mortality of 767

Chloroform, in delirium tremens 17

do its uses. 24

do deaths by ....... . 130, 450, 509

do in hooping cough 305

do internal use of 307

do in hypochondriasis 310

do vapor in tenesmus 644

Cholera fly 244

Chorea, black cohosh in

Cinchona, sulphate of 186

Cod-liver oil cause of hemorrhage ... 52

do do solidified 468

Colchicum, ethereal tincture of 165

Cologne water, recipe for 260

Connel's case of dry gangrene 87

Constipation, belladonna in 772

Coup-de-soleil 554, 563

Crusta Lactea 368

Cubebs, ethereal tincture of 165

Cutaneous diseases, guano in 325

Dalton, the late Dr 452

Dandriff. 580

Delirium tremens, chloroform in 17

do do 412

Diabetes 34, 37, 746

Diarrhoea, sulphuric acid in 302

Digitalis, ethereal tincture of 167

do action on genital organs... 267

Dislocations of hip and shoulder 169

Dugas, on utero-abdominal supporters 61
do on treatment of fractures. . . 69

do non-congenital talipes 210

do on scarlatina 439

do on dysentery 503

do on use of pessaries 567

774

iXDEX.

Dugas, on beverages in sickness... 699
do on lithotrity and lithotomy . . 719

Dysentery, non-recurrence of.. . 257, 313
do epidemic 325, 459, 503, 517, fi50
do typhoid TOD

Eclampsia, puerperal 85

Editorial 61, 117. 175

do changes 310, 5! i9

Electro-magnetism in aphonia 171

Elkoplasty 629

Ellis, on ether and chloroform ('>.">

Emphysema in children 223

Epiphytes and entophytes 187

Epilepsy, prognosis and treatment of 302

do ' treatment of 694, 706

do Hydrocyanate of iron in . . . 466

do cured by trephining

Ergodel.aeria 287

Ergot, ethereal tincture of 110

do in retention of urine 3()3

do in labor 46

Ergotine 601

n's Surgery 1!!!

Erysipelas, camphor in

do treatment of. 370

do sesqui-chloride fer. in 375

Evolution, spontaneous

ion of ulna

Eye, speculum occuli in dissectioi,

Eye in diagnosis 015

Favus, remedy for 186

erati ine in 758

Fecundation, Burnett on 17

medical education 5

r'emale diseases, local treatment of. . 581

Fermentation and putrefaction 433

Fever, salt in intermittent j:

do typhoid in Georgia 107

do ' do by Dr. Campbell 17.">

do atmosphere during yellow.. 191

do ' yellow . .".

do yell I with it. ii

do slow action of heart in 469

Flstula-in-ano, iodine injections in.. 322

Fish, viviparous 772

Flint'.- Clinical Reports 255, 765

Floyd, on epidemic affections 524

. Fowne'a Chemistry 253

Foramen ovale and duct. arteriost.

Fractiu nt of 69

do non-united 681

Fuller, on Gom, Rheumatism and
Sciatica 444

Galvanism in obstetrics 239

Gangrene, dry 87

do charcoal coverletin 708

Garvin's Introductory Address 127

Gastrolomy 043

Genital organs, digitalis in dis. of. . . 207

Gelseminum Sempervirens 28

Gestation, term of 264

do paralysis during 686

Gleet, recipe for

Gonorrhoea, tincture iodine in

Goss, on dysentery

Gout, alcohol, &c. in

Gossipii herbac, ethereal tinct. of...

Griffith's Formulary

Guaiac, ethereal tincture of

Guano in cutaneous affectioi

Hahnemann Hospital

Bandy's Anatomy

Harris*' Address

do on Varicocele

Han is Surgery in the oountry

do Medical Dictionary

Hare-lip, early operation for

Head-ache and its varieties 510,

Heat, exhaustion from

Hemorrhage from throat

do of kidneys

do from leech-bites

do from placenta

Hemorrhoids, removal of

1 [emostatic, per-chlor. fer. an

Henderson, on Homoeopathy

I [epatic abscess

Hernia, radical cure of

do operation for strangulated. .

Hiccough

i lints for young Doctors

Hippochondriasis, chloroform in

Howard on gestation

"do on vertex presentations, 389,

Hunter, on venereal diseases

Hydrocele, treatment of

do diagnosis of

Hydrophobia in France

do remedy for

Hydrarg. cum creta, new formula . . .

Insanity, bloodletting in

Iodide Potass, in mammary abscess.
Iodine injections in fistula in ano..

Ipecae, ethereal tincture ok

Iron, per-chloride of in Nsvus

Iron, eesqui-chloride in Erysipelas..
Itch, cure of

Jaw, immobility of.
I Joints, false

Kidneys, hemorrhage of

Kirkbride, on Insane Hospitals

Knee-joint, permanent flexion of

Landrum, on puerperal convulsions,

do on epidemic dysentery

LaRoche. on Pneumonia

Laryngeal probang

Lawrence, on the eye

Leech-bites, hemorrhage from

Leucorrhcea, infantile

Leucorrhcea

Lip, restoration of

Lithotrity 48 times in same person . .

013
3,s7
643
387
100
444
100
321

644

03
190

205
711
701
260
653
554
68
294
643
668
697
107
317

675
644

310
264

592

01

129

636

076
702
107

499
19
322
166
324
375
644

623

622

294
764
305

162
517

316
260
252
043
195
043
023
320

IXDF-X.

775

Lithotritv and lithotomy, relative va-
lue of. 719

Long's discovery of anaesthesia 257

do on typhoid fever 709

Magnolia Tripetala 403

Malpractice, suit tor 320

Mammary abscess, iodide pot. lor. . . 19

Medical prize question 772

do Society of' G-a., Transactions of 117

do do do 131,186,190, -257, 376

*"do College of Georga . . . 256, 516, 708

do do of Savannah 257

do do of Atlanta 509

do do of Virginia 509

Medical Profession in the U. States,

statistics of the 765

Medicine in Spain 451

Meigs, on the uterus 317

do on diseases of women 443

do on child-bed fevers 764

Mental diseases, treatment of 299

Menorrhagia, tinct. cinnamon for.. . 387

Merrill, circular of Dr 643

Metritis, internal 272

Milk, human, in health and disease. . 30

do do infusoria in 249

do from spayed cows 229

Milk sickness 288

Milk-crust in infants 368

Miller's case of Monstrosity 79

Milner's case of Poisoning 717

Monomania 196

Monstrositv, double 79

Morphia, lotion of 706

Mortality among children 767

Mott, letter of Dr 321

Mouth, inflammation of the 526

Muscular atrophy 250

Musgrove's case of stabbing GiS

Nrevus, per-chloride fer. in 324

Nerve, phrentc 243

Neuralgia, aconite in 387

do prize essay on 706

Nux vomica, ethereal tincture of 167

Obstetrics, gal vanism in 239

O'lveeffe on epidemic dysentery 325

Gils, adulteration of 580

Opium 65

do in over-work and anxiety. . 752

Ophthalmia, caustic in purulent 314

Ovariotomy 70;;

Owen, on skeleton and teeth 703

Ox-gall, therapeutical value of 430

Paget's SurgicaVPathology 63

Paralysis of lower extremity 15-1

do during gestation 686

Parker, on syphilis 638

People's Medical Gazette 643

Peritonitis in infants 38

Perineum, laceration of 706

Pertussis, chloroform in 305

Pessaries, on the use of 567

Phthisis, signs of incipient 31

do inhalations in 445

do night sweats in 501

Pharmacy, contributions to 164

do apparatus in ,.. 192

Piiosphorus, its uses, etc 404

Phosphas calcis, in impaired nu-
trition 427

Physicians, munificence of 130

do death of 130, 319, 388

do death of in Savannah . . 642, 706

do tax on 131

do interests of 506

do diary 765

Piggot's Chemistry and Metallurgy, 64

Pills, process for coating 192

Pin- swallowing, case of. 508

Pitts, on buccal inflammation 526

Pityriasis, virsicolor, treatment of. . . 375

do of scalp 580

Placenta, separation of 668

do prsevia 678

Plaster Paris in asthma 242

Poisonings, remedy in 324

Poisoning, case of 717

Poison of grave-yards 388

Poisonous effects of soda water 575

Probang, new 260

Prolapsus uteri, now treatment of. . . 60

do do pessaries in 567

Progressive muscular atrophy 250

Psychical disturbances, treatment of. 299

Psoriasis, treatment of 451

Puerperal eclampsia 65

do convulsions 162

do do and albuminuria, 516

Purpura hemorrhagica 644

Putrefaction and fermentation 433

Gluackery in England 130

do 510

Gluinine in rheumatism 33

do in spinal meningitis 161

do new test for 323

Rectum, prolapsus of 194, 760

do occlusion of 457

Rheumatism, treated by quinine 33

do expectant method in 107

do excietions in 357

do recipe for 5.^0

Ricord's letters on Syphilis 20

Rives, on Dysentery , 650

la 645

Robert's cases 453

Roux, death of Prof 388

Salivation, belladonna in 644

Salt in intermittent fever 233, 346

Sanguinaria canad., ethereal tinct.. . 166

Scarlatina, deaths from .. 319

dc remarks on 439

Scalp, diseases of 479, 486

Sciatica 431

776

INDEX.

Scialica, treated with medicated is-
sues if>7

Scilloe mar., ethereal tincture 166

Serpents, venomous

Shattuck, legacies of Dr 388

Simpson, on homoeopathy 253

Simaba cedron GlJf)

Skoda, on auscultation 638

Snake-bites, soda lor 706

Soda nit., medical properties

Soda water, poisonous

Soldier, worst enemy of the 4.V2

Speculum occuli .. ll.">

Spermatorrhoea 627, 610

Spinal meningitis, quinine in 161

do irritation 261

Spine, concussion of

Spontaneous evolution

Strabismus, new operation for 115

Stabbing, case of

Btrychn of

do Glycerine lotion of 70l

tion,caseof 37

Syphilis. Ricord'a letters on

do in Franc<

do transmitted to fetus

Talipes, non-congenital

Tatom, on spinal meningitis 161

Tetanus, ice in 179

ins, chloroform in (ill

Thompson, on consumption Ill

Tongue, amputation of

do vegetal^ the 150

do

Tooth-; for

do

Trismus Dascenlium

Turning, new method of

Turnbull. Dr

Typhi : - Dr. Campbell 175

of different color

Ulcers of legs

do treatment of 629

do from irritation of nails 644

Ulna, exsection of 383

Urethra, laceration of 711

Urine, sugar in 134

do retention of >* *3

Uretroscope 241

Uiticaria, chronic

Ulero-abdominal supporters

Uterus, inversion of B8

do retroversion of 15 1

do inversion and extirpation . . . 77*2
Uterine catarrh, etc 21

do vivaces

do diseases 211

Uteri ulcer of cervix 401

Vagina, injury of the I

Varicocele 205

UH

mi viiiile 196

ulion of 70b

i e

Maiions :i89, 592

Vidal, "ii v. : ases

Vomiting, new mode of inducing. . . 131

/, biography of Dr 186

death by sting of 442

rely, on put rperal Eclampsia, 86

l children 143

Willbuj 'la

I .on female Med. Education.. 5
on salt in Intermittent fei

do ilia ti ipetala 403

do on female 581

on the hair and skin ....

'.. circular of Dr

ived... 66,255,318,44
do do 765

Yellow Jessamine 28

\

f

Date Due

FEB f4,9

.

Bonn?

1

MAR 3 65

Library Bun

au Cat. No. 1137

1395

Sc

Sou4:'

Southern Medical and Surgical Journal

volume 10, 1851;
New Series