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Full text of "The American journal of the medical sciences"

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Property of the 

Lancaster City and County 
Medical Society 



No. 



t.^di^^B 



i X-x-iX 



/I 



THE 



AMEEICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



EDITED BY 



ISAAC HAYS, M.D., 

SURGEON TO WILLS HOSPITAL, 

PHYSICIAN TO THE PHILADELPHIA ORPHAN ASYLUM, 

MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY, AND OP THE 

ACADEMY OF NATURAL SCIENCES OF PHILADELPHIA, 

&C. &C. &C. 



NEW SERIES. 
VOL. vn. 



PHILADELPHIA: 
LEA & BLANCHARD. 

LONDON: 
WILEY & PUTNAM, AND JOHN MILLEE. 

1844. 



69434 



Entered according to Act of Congress, in the 3^ear 1844, by 

LEA & BLANCHARD, 

In the office of the Clerk of the District Court for the Eastern District of 
Pennsylvania. 







T. K. &: P. G. COLLINS, PRINTERS. 



G\0.5 

fled. 



TO READERS AND CORRESPONDENTS, 



Communications have been received from Drs. W. L. Atlee, A. Flint, W. C. 
Roberts, P Mettaner, and W. M. Boling. 
Want of space has compelled us to omit several articles intended for this No. 

The follov^^ing works have been received. — 

Lectures on the Principles and Practice of Ph5'sic; delivered at King's Col- 
lege, London. By Thomas Watson, M. D., Fellow of the Royal College of 
Physicians, Physician to the Middlesex Hospital, and formerly Fellow of St. 
John's College, Cambridge. Philadelphia: Lea & Blanchard, 1844. (From 
the publishers.) 

Principles of Medicine, comprising General Pathology and Therapeutics, and 
a brief general view of Etiology, Nosology, Scmeiology, Diagnosis and Progno- 
sis. By C. J. B. Wir.LiAMS, M. D., F. R. S. With additions and notes by 
Meredith Clymer, M. D. Philadelphia: Lea & Blanchard, 1844. (From 
the publishers.) 

The Anatomy, Physiology, Pathology, and Treatment of Cancer. By Wal- 
ter Hayle Walshe, M. D., Prof. Path. Anat. in Univ. Coll. London, &c. &c. 
With additions by J. Mason Warren, M. D., F. M. S. &c. Boston, 184.3. 
(From the editor.) 

Observations sur nn cas de Varice Anevrismale dans la region temporale 
droite. Par le docteur Fr. Gabe de Masserellos. Munic, 1843. (From Dr. 
Oppenheim.) 

Clinical and Pathological Report on the Pneumonia of Children as it prevails 
among the Poor in London. By Charles West, M. D., Physician to the 
Royal Lifirmary for Children, and to the Finsbury Dispensary, &c. London, 
184.3. (From the author.) 

Observations on some of the more important Diseases of Childhood. By 
Charles West, M. D., &c. &c, (From the author.) 

The Nature and Treatment of Stomach and Renal Diseases; being an inquiry 
into the connection of Diabetes, Calculus, and other affections of the kidney and 
bladder, with indigestion. By Wm. Prout, M. D., F. R. S. From the 4th 
London Edition, with plates, Philadelphia. Lea & Blanchard, 1843. (From 
the publishers.) 

The Dissector; or Practical and Surgical Anatomy. By Erasmus Wilson, 
Author of a System of Human Anatomy, &c. With 106 illustrations. Modified 
and re-arranged, by Paul B. Goddard, M. D., Demonstrator of Anatomy in the 
University of Pennsylvania. Philadelphia. Lea & Blanchard, 1844. (From 
the publishers.) 

Tenth Annual Report of the Trustees of the State Lunatic Hospital at W^or- 
cester. Dec. 1842. (From Dr. P. Earle.) 

Report of a Committee of the Medical Society of Delaware, assigning reasons 
why the society should surrender its charter to the General Assembly. Pub- 
lished by order of the society. Wilmington, 1843. (From the society.) 

A Treatise on Dislocations and Fractures of the Joints. By Sir Astley 
Cooper, Bart., F. R. S. A new edition much enlarged. Edited by Bransby 
B. Cooper, F. R. S., Surgeon to Guy's Hospital. With additional observations, 
and a memoir of the Author. Philadelphia. Lea & Blanchard, 1844. (From 
the publishers.) 

Anatomical Atlas, illustrative of the structure of the human body. By Henry 
H. Smith, M. D., &c., under the supervision of Wm. E. Horner, M. D., Prof. 
Anat. in the University of Pennsylvania. Part L 130 figures. Philadelphia, 
Lea & Blanchard, 1844. (From the publishers.) 



IV TO READERS AND CORRESPONDENTS. 

The Anatomy, Physiology, and Pathology of the Human Teeth; with the 
most approved methods of treatment; including operations, and the method of 
making and setting artificial teeth. With 30 plates. By Paul B. Goddard, 
M.D., M. A. N. S., M. A. P. S., Demonstrator of Anat. in the University of 
Pennsylvania: aided in the practical part by Joseph E. Parker, Dentist. Phila- 
delphia, Carey & Hart, 1844. (From the publishers.) 

A Practical Treatise on the Diseases of the Testis, and of the Spermatic Cord 
and Scrotum. With illustrations. By T. B. Curling, Lecturer on Surgery, 
&c. Edited by P. B. Goddard, M. D., &c. &c., Demonstrator of Anatomy in 
the University of Pennsylvania. Philadelphia, Carey & Hart, 1843. (From 
the publishers.) 

A Practical Treatise on the Diseases of Children. By D. Francis Condie,M. 
D., Fellow of the College of Physicians, Member of the American Philosophical 
Society, &c. &c. Philadelphia, Lea & Blanchard, 1844. (From the publishers.) 

Review of Dr. Caldwell's Pamphlet entitled Physiology Vindicated in a 
Critique on Liebig's Animal Chemistry. By Robert Peter, M. D., Prof, of 
Chemistry and Pharm. in Transylvania tJniversity. Cincinnati, 1843. (From 
the author.) 

The Benefits accruing to Society i^om the Medical Profession. An Intro- 
ductory, delivered Nov. 18, 1843. By John P. Harrison, M. D., Prof. Mat. 
Med. in Medical College of Ohio. Cincinnati, 1843. (From the author.) 

Introductory Lecture to the Course of Chemistry; delivered in Jefferson Med- 
ical College, Nov. 3, 1841. By Franklin Bache, M. D. Published by the 
class. Philadelphia, 1841. (From the author.) 

Introductory Lecture to the Course of Chemistry in Jefferson Medical Col- 
lege; delivered Nov. 6, 1843. By Franrlin Bache, M. D. Published by the 
class. Philadelphia, 1843. (From the author.) 

Observations on Obstetric Auscultation, with an analysis of the evidences of 
Pregnancy, and an Inquiry into the proofs of the Life and Death of theFffitus in 
Utero. By Evory Kennedy, M. D., Licentiate in the King and Queen's Coll. 
of Phys. in Ireland, Lecturer on Midwifery, &c. &c. With an appendix con- 
taining legal notes by John Smith, Esq., Barrister at Law. With notes and 
additional illustrations, by Isaac Tayor, M. D. New York. J. & H. G. 
Langley. 1843. (From the publishers.) 

The Principles and Practice of Medicine. By John Elliotson, M. D., 
Cantab. F. R. S., &c. Edited by N. Rogers, M. D., and Alex. Cooper Lee. 
First American from the second London edition, greatly enlarged and improved. 
With notes and additions by Thomas Stewardson, M. D., Physician to the 
Pennsylvania Hospital. Philadelphia, 1844. (From the American editor.) 

Methodus Medendi; or, the Description and Treatment of the Principal Dis- 
eases incident to the Human Frame. By Henry M'Cormack, M. D., Consulting 
Physician to the Belfast Hospital, and Professor of the Theory and Practice of 
Medicine in the Royal Belfast Institution. London, 1842. (From the author.) 

On Asthenopia, or Weak-sightedness. By Wm. Mackenzie, M. D., Surgeon 
Oculist in Scotland in Ordinary to her Majesty the Queen, Lecturer on the Eye 
in the University of Glasgow, and one of the Surgeons to the Glasgow Eye In- 
firmary. (From the author.) 

Removal of a Dropsical Ovarium entire by the large Abdominal Section. By 
D. Henry Walne, Surgeon. (From the author.) 

Do. Do. [Second case."] (From the author.) 

Proceedings of the Medical Society of the State of Tennessee, at the Four- 
teenth Annual Meeting, held in the City Hall, Nashville, May, 1843. Nash- 
ville, 1843. (From the society.) 

The First Annual Report of the Physician of the Mount Saint Vincent's Hos- 
pital in the city of Baltimore, for 1843. Baltimore, 1843. (From the Sisters 
and Dr. Stokes.) 

On Inflammation and Abscess of the Uterine Appendages. By Fleetwood 
Churchill, M. D., &c. (From the author.) 

Medical Report of the Western Lying-in Hospital and Dispensary for the 



TO READERS AND CORRESPONDENTS. V 

years 1841-42. By Fleetwood Churchill, M. D., &c., and R. D. Speeds, 
Esq., &c. Dublin, 1843. (From Dr. Churchill.) 

Statistics of Bethlem Hospital, with Remarks on Insanity. By John Web- 
ster, M. D., Consulting Physician to St. George's and St. James's Dispensary, 
&c. London, 1843. (From the author.) 

Case of Paralysis without Loss of Sensation, from Disease of the Cervical 
Medulla. By John Webster, M. D., &c. &c. London, 1843. (From the 
author.) 

Proceedings of the American Philosophical Society, held at Philadelphia, for 
Promoting Useful Knowledge. Celebration of tiie Hundredth Anniversary, May 
25, 1843. Philadelphia, 1843. (From the society.) 

Report of the Superintendent of the Boston Lunatic Hospital, and Physician 
to the Public Institutions at South Boston, July 1, 1843. Boston, 1843. (From 
Dr. Stedman.) 

Lecture Introductory to a Course on the Principles and Practice of Surgery, 
in the University of Pennsylvania; delivered Nov. 6, 1843. By Wm. Gibson, 
M. D. Philadelphia, 1843. (From the author.) 

A Treatise on the Disease called the Milk Sickness, or Trembles. By Dr. J. 
J. M'Ilhenny. Springfield, 1843. (Frotn John Patton.) 

A Practical Treatise on the Diseases of Children. By James Stewart, M. D., 
A. M., &c. &c. Second edition, carefully revised and enlarged. New York. 
J. & H. G. Langley, 1844. (From the publishers.) 

A Lecture, Introductory to the course of Obstetrics in the Geneva Medical 
College, session 1843-4. By C. B. Coventry, M. D., Professor of Obstetrics 
and Medical Jurisprudence. Published by the Medical Class, Geneva, 1843. 
(From the author.) 

Comments on Dr. C. A. Harris's Essay on Diseases of the Maxillary Sinus. 
By H. H. Havden, M. D., Dental Surgeon of Baltimore. (From the author.) 

A Reply to Dr. C. A. Harris on " Hayden's Comments." By A- Hayden, 
M. D. (From the author.) 

London Medical Gazette, Aug. Sept. Oct. and Nov., 1843. (In exchange.) 

The Provincial Medical Journal, and Retrospect of the Medical Sciences, 
Aug. Sept, Oct. and Nov. 1843. (In exchange.) 

The Medical Times, Aug. Sept. Oct. and Nov. 1843. (In exchange.) 

The Medico-Chirurgical Review, Oct. 1843. (In exchange.) 

The Edinburgh Medical and Surgical Journal, Oct. 1843. (In exchange.) 

The British and Foreign Medical Review, Oct. 1843. (In exchange.) 

London and E^dinburgh Monthly Journal of Medical Science. Oct. and Nov. 
1843. (In exchange.) 

Zeitschrift pur die gesammte Medicin. &c. Herausgegeben. F. W. Oppen- 
HEiM. March, April, May, June, July, 1843. (In exchange.) 

Bij dragen tot Geneeskundige Staatsregaling. 7 Nos. Amsterdam, 1842-3. 
(From Dr. Oppenheim.) 

Repertorium fiir Pharmacie und Practische Chemie in Russland,&c. Heraus- 
gegeben. Von G. Gauger, D. P. und Ap. 1842. (From Dr. Oppenheim.) 

Revue Medicale Frangais et Etrangere. Journal des Progres de la Medecine 
Hippocratiqne. Par J. B. Cayol, Ancien Professeur de Clinique Medicale a la 
Faculte de Medecine de Paris. July, Aug. 1843. (In exchange.) 

Gazette Medicale de Paris. July, Aug. and Sept. 1843. (In exchange.) 

Journal des Connaissances Medico-Chirurgicales. Public par MM. J. Le- 
baudy, H. Gouraud, Martin-Laugier. Aug. and Sept. 1843. (In exchange.) 

Journal de Medecine et de Chirurgie Pratiques a I'usage des Medecins Pra- 
ticiens. Par Lucas-Championniere, D. M. P., &c. Aug. and Sept. 1843. 
(In exchange.) 

L'Experience, Journal de Medecine et de Chirurgie. Publie par M. le Docteur 
J. A. Henroz. July, Aug. and Sept. 1843. (In exchange.) 

La Lancette Fran^ais, Gazette des Hopitaux Civils et Militaires. July, Aug. 
and Sept. 1843. (In exchange.) 

1* 



VI TO READERS AND CORRESPONDENTS. 

Journal de Pharmacie et de Chernie. July, Aug. and Sept. 1843. (In ex- 

chantre.) 

The Select Medical Library. Aran on the Heart. Oct. 1843. (In exchange.) 
The Bulletin of Medical Science. Oct. Nov. and Dec. 1843. (In exchange.) 
The St. Louis Medical and Surgical Journal. Sept. Oct. and Nov. 1843. 

(In exchange.) 

Boston Medical and Surgical Journal. Oct. Nov. and Dec. 1843. (la 

exchange.) 

The Western Lancet. Sept. Oct. and Nov. 1843. (In exchange.) 

The American Journal of Science and the Arts. Oct. 1843. (In exchange.) 

The American Journal of Pharmacy. Oct. 1843. (In exchange.) 

The Western Journal of Medicine and Surgery. Oct. and Nov. 1843. (In 

exchange.) 

The New York Journal of Medicine and the Collateral Sciences. Nov. 1843. 

(In exchange.) 
The American Journal and Library of Dental Science. June, Sept. and Dec. 

1843. (In exchange.) 

The India Journal of Medical and Physical Sciences, April, 1843. (In ex- 
change.) 



Communications intended for publication, and Books for Review, should be 
sent, free of expense^ directed to Isaac Hays, M. D., Editor of the Amer. Journ. 
of Med. Sci., care of Messrs. Lea & Blanchard, Philadelphia. Parcels directed 
as above, and sent (carriage paid) under cover, to John Miller, Henrietta Street, 
Covent Garden, London^ or to Wiley & Putnam, New Yarky or W. D. Ticknor, 
Boston, or M. Hector Bossange, Lib. quai Voltaire No. 11, Paris, will reach us 
safely. We particularly request the attention of our foreign correspondents 
to the above, as we are often subjected to unnecessary expense for postage and 
carriage. 

All remittances of money, and letters on the business of the Journal, should be 
addressed exclusively to the publishers, Messrs. Lea & Blanchard. 

jjy^ The advertisement sheet belongs to the business department of the 
Journal, and all communications for it should be made to the publishers, under 
whose exclusive control it is. 



CONTENTS 

OF THE 

AMERICAN JOURNAL 

OF THE 

MEDICAL SCIENCES. 

No. XIII, NEW SERIES. 
JANUARY, 1844. 



ORIGINAL COxMMUNICATIONS. 
MEMOIRS AND CASES. 

ART. PAGE 

I. Account of the Erysipelatous Fever, as it appeared in the northern sec- 
tion of Vermont and New Hampshire, in the years 1842-3. By Charles 
Hail, M. D., of Burlington, Vt., and George J. Dexter, M. D., of Lan- 
caster, N. H. 13 

II. On the Modus Operandi of Medicines. By John B. Beck, M. D., Prof, 
of Materia Medica and Medical Jurisprudence, in the College of Physi- 
cians and Surgeons of New York. -------27 

III. Case of successful Peritoneal Section for the removal of two diseased 
Ovaria complicated with Ascites. By John L. Atlee, M. D., of Lancas- 
ter city, Penn. (With three wood-cuts.) ------ 44 

IV. Remarks on Wounds received in Dissection. Read before the Boston 
Society for Medical Improvement, July 24, 1843. By George Hay- 
ward, M. D. 64 

V. Insanity among the Coloured Population of the Free States. By Edward 
Jarvis, M. D. of Dorchester, Mass. -------71 

VI. Congenital Tumour, composed of numerous cysts. By Washington 

L. Atlee, M. D., of Lancaster, Pennsylvania. []With three wood-cuts.] 84 

VII. Notices of the History and Properties of Sulphate of Potash. By T. 
Romeyn Beck, M. D., Prof. Mat. Med. in the Coll. of Phys. & Surg., 
New York. °-88 

VIII. Report of the Diseases of Females treated at the New York Dis- 
pensary, from May 1842 to May 1843. By William P. Buel, M. D. - 96 

IX. Case of Delirium Tremens. By Blanchard Fosgate, M. D., of Au- 
burn, N. Y. 117 

X. Fungus Haematodes of the Bladder. By Emery Bissell, M. D.,of Nor- 
walk, Ct. - - - 122 

REVIEW. 

XI. A Practical Treatise on the Diseases of Children. By D. Francis 
Condie, M.D., &c., 8vo. pp.651. Philadelphia: Lea and Blanchard, 
1844. - - 125 



Vlll CONTENTS. 

BIBLIOGRAPHICAL NOTICES. 

ART. PAGE 

XII. A Treatise en Dislocations and Fractures of the Joints. By Sir Aslley 
Cooper, Bart., F. R. S., Serjeant Siiroreon to the King, &c. A new edi- 
lion, much enlarged, edited hy Bransby B. Cooper, F. R. S., Surgeon to 
Guy's Hospital, With additional observations, and a memoir of the 
author. Philadelphia: Lea & Blanchard, 1844, 8vo. pp. 499. - - 139 

XIII. Principles of Medicine, comprising- General Pathology and Thera- 
peutics, and a brief general view of Etiology, Nosology, Semeiology, 
Diagnosis, and Prognosis. By C. J. B. Williams, M. D., F. R. S. 
With additions and notes by Meredith Clymer, M. D. Philadelphia: 
Lea & Blanchard, 1844, pp. 383. 142 

XIV. A Practical Treatise on the Diseases of the Testis, and of the Sper- 
matic Cord and Scrotum. With Illustrations. By T. B. Curling, Lec- 
turer on Surgery, &c. Edited by P. B. Goddard, M. D., Demonstrator 
of Anatomy in the University of Pennsylvania. Philadelphia: Carey & 
Hart, 1843. 8vo. pp. 568. 145 

XV. Observations on Obstetric Auscultation, with an Analysis of the Evi- 
dences of Pregnancy, and an Inquiry into the Proofs of the life and 
death of the Foetus in Utero. By Evory Kennedy, M. D., Lecturer on 
Midwifery, &c. &c. With an appendix containing legal notes. By John 
Smith, Esq., Barrister at Law. With notes and additional illustrations. 
By Isaac E. Taylor, M. D. New York; J. & H. G. Langley, 1843, 12mo. 

pp. 3n. 147 

XVI. 1. Report of the Board of Visitors, of the Trustees, and of the 
Superintendent of the New Hampshire Asylum for the Insane. June, 
1843, p. 24. 

2. Seventh Annual Report of the Trustees of the Vermont Asylum for the 
Insane. October, 1843, pp. 12. 

3. Report of the Superintendent of the Boston Lunatic Hospital, and phy- 
sician of the public institutions at South Boston. July 1, 1843, pp. 28. 150 

XVII. Statistics of Bethlem Hospital, with remarks on Insanity. By 
John Webster, M. D. From the twenty-sixth volume of the Medico- 
Chirurgical Transactions, published by the Royal Medical and Chirurgical 
Society of London. London: 1843, pp. 45. ------ 153 

XVIII. Memoirs and Correspondence of Francis Horner, M.D. Edited 
by his brother, Leonard Horner, Esq., F. R. S. 2 vols. 8vo., London, 
1843. 155 

XIX. The Spleen a permanent Placenta: the Placenta a temporary Spleen. 
By John Jackson, Member of the Royal College of Surgeons. Svo. pp. 

32. London, 1843. 158 

XX. Fourth Annual Report of the Registrar-General, of the Births, Deaths, 
and Marriages, in England. London, Oct. 1842 — 362 pages. - - 164 

XXL Anatomical Atlas, illustrative of the Structure of the Human Body. 
By Henry H. Smith, M. D., F. C. P., M. P. M. S. Under the super- 
vision of William E. Horner, M. D., Professor of Anatomy in the Uni- 
versity of Pennsylvania. Part I., 130 figures. Lea & Blanchard, 1844. 
Super-royal 8vo. ----------- 174 

XXII. The Principles and Practice of Medicine. By John Elliotson, M.D., 
&c. &c. Edited by Nathaniel Rogers, M. D., &c. &c., and Alexander 
Cooper Lee. First American from the second London edition. Greatly 
enlarged and improved with notes and additions, by Thomas Stewardson, 
IM.D., Physician to the Pennsylvania Hospital. Carey & Hart, Phila- 
delphia, 1844. Svo. pp. 1046. 17 4 



CONTENTS. iX 

ART. PAGE 

XXIII. Medical Report of the Western Lying-in Hospital and Dispen- 
sary, 25 Arran-Quay, for the years 1841-42. By Fleetwood Churchill, 
M. D., M. R. I. A., Vice-President of the Obstetrical Society, and of the 
Association of the College of Physicians; Lecturer on Midwifery, &c., at 
the Richmond Hospital School, &c. &c.; and R. D. Speedy, Esq., L. R. 
C. S. I., Surgeon to the Hospital, and Lecturer on Midwifery, &c. in the 
School of Medicine, Apothecaries' Hall. Dublin, 1843, pp. 19, 8vo. - 176 

XXIV. The Anatomy, Physiology, Pathology and Treatment of Cancer. 
By Walter Hayle Walshe, M.D., &c. &c. With additions by J. Mason 
Warren, M. D., &c. Boston, William D. Ticknor& Co., 1844, pp. 351, 
12mo. - 179 

XXV. Observations sur un cas de Varice Anevrysmale dans la region tem- 
porale droite. Par le Doct. F. Gabe de Massarellos. Munic, 1843, 4to. 
pp. 16. 

Case of Aneurismal Varix in the right temporal region. By Dr. F. Gabe 
de Massarellos, &c. 179 

XXVI. The Anatomy, Physiology, and Pathology of the Human Teeth, 
with the most approved methods of treatment, including operations, and 
the method of making and setting artificial teeth; with thirty plates. By 
Paul B. GoDDARD, M. D., M. A. N. S., M. A. P. S., Demonstrator of 
Anatomy in the University of Pennsylvania, Lecturer on Anatomy, &c. 
&c. Aided in the practical part by Joseph E. Parker, Dentist. Phila- 
delphia, Carey & Hart, 1844, pp. 227, 4to. pi. 30. - - - . 181 

XXVII. The Dissector, or Practical and Surgical Anatomy. By Erasmus 
Wilson, Author of a System of Human Anatomy, &c. With one hundred 
and six illustrations. Modified and re-arranged by Paul B. Goddard, M. D., 
Demonstrator of Anatomy in the University of Pennsylvania. Lea & Blan- 
chard, 1844, pp. 444, 12mo. 182 

XXVIII. Lectures on the Principles and Practice of Physic; delivered at 
King's College, London. By Thomas Watson, M. D., Fellow of the 
Royal College of Physicians, Physician to the Middlesex Hospital, and 
formerly Fellow of St. John's College, Cambridge. Philadelphia, Lea & 
Blanchard, 1844, pp. 920. 183 



CONTENTS. 



SUMMARY 



IMPROVEMENTS AND DISCOVERIES IN THE 
MEDICAL SCIENCES. 



FOREIGN INTELLIGENCE. 

Anatomy and Physiology. 



1. Comparative Anatomy of the 
Skin in the different Varieties of 
the Human Race. By M. Flou- 
rens. . - _ - . 185 

2. Structure and Function of the 



Intestinal Villi 
and Deiafond. 
3. On Venous Absorption 
Prof. Panizza. 



PAGE 

By MM. Gruby 

- 185 



By 



- 186 



Materia Medic a and Pharmacy. 



4. New Counter-irritant composed 
of powdered Ipecacuanha root. 
By Dr. Hannay. 

5. Solution of Tartar Emetic for 
the purpose of counter-irritation. 
By Dr. Hannay. 

6. Observations and Researches 



- 188 



- 188 



upon a new solvent for Stone in 
the Bladder. By Alexander Ure, 

M.D. 

7. On some preparations of Bal- 
sam Copaiba. By Jacob Bell. 

8. Influence of Camphor on the 
Sexual Organs. . - - 



189 
190 
190 



Medical Pathology and Therapeutics, and Practical Medicine. 



9. Hgemoptysis in Phthisis occur- 
ring during childhood. By Dr. 

P. Hennis Green. - - - 191 

10. State of the blood in conse- 
quence of a chano-e occurrincr in 
the process of Hamatosis. By 
Dr. F.Simon, of Berlin. - "'-191 

11. Urine in Morbus Brightii. By 

Dr. F. Simon. - - - 192 

12. Urine in Pneumonia and Pleuro- 
pneumonia. By Dr. F. Simon. 193 

13. Urine in Typhus. By Dr. F. 
Simon. 194 

14. Urine in Bronchitis. By M. 
Becquerel. - - . . 195 

15. Urine in Pneumonia. By M. 
Becquerel. - - - _ 195 

16. State of the Urine in Cirrhosis 

of the Liver. By M. Becquerel. 195 

17. Inoculation by means of Conta- 
gious Cells. By Dr. Klencke, 

of Brunswick. _ . _ 19^ 

18. Paralysis without loss of Sen- 
sation, from Disease of the Cer- 
vical Medulla. By Dr. John 
Webster. - - - - 197 



19. Inflammation of the Nervous 
Centres. By Dr. John Hughes 
Bennett. _ . . . 200 

20. Pathological causes of Cya- 
nosis. By Dr. Craigie. - - 201 

21. Certain affections depending 
on abnormal conditions of the 
Nervous Centres. By Dr. Fa- 
vell. 202 

22. On Pulmonary Tubercles. By 

M. Boudet. - - - 203 

23. Successful employment of Bel- 
ladonna as a prophylactic during 
the prevalence of Epidemic Scar- 
latina. By Dr. Stievenart, of 
Valenciennes. _ _ - 203 

24. Treatment of Tinea Capitis. 

By Dr. A. L. Wigan. - - 204 

25. Cure of acute Hydrocephalus 
by means of large doses of Hy- 
driodate of Potassa. By Dr. 
Woeniger. - - . - 205 

26. Shivering as a diagnostic sign 
of Thoracic Inflammation. By 

M. Chomel. - - - - 206 



CONTENTS. 



XI 



Surgical Pathology and Therapeutics, and Operative Surgery. 



27. Successful case of operation for 
the formation of a New Urethra. 

By M. Ricord. - - - 207 

28. Experiments illustrative of the 
mode of formation of Dissecting 
Aneurisms. By Dr. Thomas B. 
Peacock. 

29. Extraordinary case of Varix. 
By Dr. Seidel. 

30. Fracture of the thigh by mus- 
cular contraction. By M. Mara- 
novitch. 

31. Congenital sacciform dilatation 
of the Urethra. By M. Hend- 
riksz, of Amsterdam. 

32. Scirrhous Tumour of the 
Tongue — Operation by Ligature 



- 20: 



211 



- 211 



211 



page 
— Unusual result following its 
application. By Dr. Bellingham. 212 

33. Fistula in ano in a Phthisical 
Patient. By M. Robert. - 214 

34. On Purulent Infection. By M. 
Raciborski. - . . _ 215 

35. Spermatorrhoea. ByMr. Doug- 
las, of Glasgow. - - - 216 

36. New species of Intra-abdomi- 
nal Hernia. By MM. Carleron 
and Laussier. - - - 216 

37. Pathological Researches into 
the Local Causes of Deafness, 
based on one hundred and twenty 
dissections of the Human Ear. 

By Joseph Toynbee. - - 217 



Ophthalmology, 



38. Glaucoma. By Dr. Mackenzie. 219 

39. Musca? Volitantes. By Dr. 
James Stark, of Edinburgh. - 222 

40. Propriety of operating in cases 
of Cataract, where only one eye 



is affected. By Mr. Nunneley, 
of Leeds. - - - - 223 

41. Wound of the Cornea by the 
Sting of a Bee. By Dr. Krieg, 
of Merseburg. - - - - 224 



Midwifery. 



42. Bilocular Uterus and cleft Va- 
gina. ----- 225 

43. Vaginal Pregnancy. - - 225 

44. Polypus Uteri. By Dr. Mur- 



phy 225 

45. Inflammation and Abscess of 
the Uterine Appendages. By 
Dr. Fleetwood Churchill. - - 226 



Medical Jurisprudence and Toxicology. 



230 



- 230 



231 



46. Hydrostatic Test. - 

47. New Test for Corrosive Sub- 
limate. By Dr. Frampton. 

48. Symptoms produced by dif- 
ferent narcotics. By M. Eitner. 

49. Birth of a child in the twenty- 
fifth week, which lived three 
days. By Dr. Hoist. 

50. Congenital Closure of 
Urethra. By Dr. Zohrer. 

51. Detection of arsenic in 
liver. By W. P. Herepath 

52. CEnanthe Crocata. (Hemlock 
Dropwort.) By Dr. Pickells. - 233 

53. Toxicological Experiments on 
Digitalis. By M. Bonjean. 

54. Life Insurance. - - - 

55. Effects of Hydrocyanic Acid 
in a poisonous, but not imme- 



the 
the 



231 



232 



- 232 



234 
234 



diately fatal dose. By Dr. Hayn. 235 

56. Detection of Mercury in the 
Urine and Saliva. By M. Au- 
douard. ----- 235 

57. Monstrosity of a new born 
Fffitus and its Viability. - - 236 

58. Poisonous Properties of the 
Bark of the Laburnum Tree. By 
Prof. Christison. - - - 236 

59. Toxicological effects of Sul- 
phate of Quinine. ByM. Melier. 238 

60. Action of weak Acids on Cop- 
per vessels plated by the Electro- 
type Process. By Mr. Warring- 
ton. 238 

61. Asphyxia. Sudden Death and 
its causes. By Marshall Hall, 

M. D. - - - - - 238 



Xll 



CONTENTS. 



Miscellaneous. 



62. Compliment to British Phy- 
sicians and Sursreons. - - 240 



63. Obituary. 



PAGE 

■ 240 



AMERICAN INTELLIGENCE. 



Case of Uterine Polypus. By 
John V. P. Quackenbush, M. D. 
of Albany. - - - - 241 

A case of Imperforate Hymen. By 
William Shultice, M. D., of 
Mathews, Va. - - - 243 

The Sedative Powers of Ergot. By 
Quinton Gibbon, M. D., of Sa- 
lem, N. J. - - - - 244 

Case of Derangement of Vision. 245 

Epidemic Erysipelas, known by 
the popular nam6 of " Black 
Tongue," which recently pre- 
vailed in Ripley and Dearborn 
Counties, la. By Dr. George 
Sutton, of Aurora, la. - - 247 



Singular effects of Ipecacuanha. 
By Dr.Felix Robertson, of Nash- 
ville. 252 

Intermittent Fever from birth. By 
B. W. Avent, of Murfrees- 
borough, T. - - - - 253 

Complete extirpation of the Uterus 
by ligature, after chronic inver- 
sion of the organ. By Dr. John 
M. Esselman,of Nashville. - 254 

Complicated Menstruation. By 
Dr. W. Detmold. - - - 255 

Club-foot cured at an advanced age. 
By Dr. J. B. Brown, - - 256 

Stewart's Practical Treatise on the 
Diseases of Children. - -256 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



JANUARY, 1844. 



Art. \,-^Jlccount of the Erysipelatous Fever ^ as it appeared in the northern 
section of Vermont and New Hampshire, in the years 1842-3. By 
Charles Hall, M. D., of Burlington, Vt., and George J. Dexter, 
M. D., of Lancaster, N. H. 

This disease appeared simultaneously, in the spring of 1842, in differ- 
ent localities in the northern and middle sections of Vermont and New 
Hampshire. Dr. Calvin Jewett of St. Johnsburg, Vt., writes to us that 
several cases of erysipelatous inflammation occurred in his county, as 
early as July, 1842. In that section of Vermont, bordering Lake Cham- 
plain, the residence of Dr. Hall, the erysipelas appeared early in the 
Spring of 1842. Having transfered his residence from St. Albans, Vt. 
to Burlington, he met the disease in an epidemic form, and of the most 
malignant character. At Colebrook, N. H., near the northern boundary 
of the state, and in the towns adjoining — the erysipelas was noticed in the 
winter of '41, though its character was very difl'erent from that which it 
assumed in the spring immediately following, when it became epidemic. 
At Lancaster, N. H. several cases occurred late in the fall of '41, but of mild 
character, and readily yielding to treatment. It seems, however, from report 
to have prevailed in some parts of Canada, as early as the summer of 1841, 
and the account of its ravages exhibits no material difference in the bills of 
mortality at that period, from those of later date. At Bath, N. H. early in 
the winter of '42, the disease prevailed to an alarming extent, and also 
in that whole section lying upon the Connecticut river, the disease was 
noticed in the winter if not in the spring of 1842. Dr. Colby, of Stanstead, 
Canada, a gentleman of high repute, states, "that for fifteen months he had 
been battling with this disease. At the present time, June '43, the number 
No. XIII.— January, 1844. 2 



14 UdM Siud Dexter^ s Jlccount of Erysipelatous Fever, [Jan. 

of cases had diminished, but the per centage of mortality was as large in 
proportion as at any previous time." As far as the inquiry has been ex- 
tended, the answer has corroborated the statement, that in the spring of 1842 
it was noticed as an epidemic. 

From the information received, there is no satisfactory evidence that it 
observed any particular line of progress; on the contrary, the proof is con- 
clusive, that its course has been irregular and erratic. The first case under 
charge of Dr. Dexter, occurred in Jeflerson, N. H. late in the fall of .'41; it 
was the first and only case of erysipelas in that town, during the prevalence 
of the epidemic. In the winter following, however, both in Jefferson and 
in the towns adjoining, there was evidently a predisposition to this malady, 
almost every case of acute disease being accompanied with sore throat. 
The ensuing spring, the erysipelas made its appearance, epidemically, in 
Colebrook, N. H., some thirty-five miles distant from Lancaster. In six 
months, in a section of country, including some 1500 or 1600 inhabitants, 
the number of deaths was 70. The progress of the disease from this point 
was southerly and westwardly, extending from the banks of the Connecti- 
cut westwardly, and meeting the disease as it prevailed in Derby, Holland, 
Charlestown, and other towns in this section of Vermont. 

In its southwardly progress along the valley of the river, it suddenly 
stopped about fifteen miles distant from its first point of appearance, and 
extended westwardly, leaving a circuit of about twenty miles wide and thirty 
miles long, with scarcely a trace of disease, and appearing again in St. Johns- 
buro", Lyndon, Danville, and in most of the intermediate towns to Lake 
Champlain. Its passage, after receding from the Connecticut, was northward. 
Appearing in Orford, Lynn, Haverhill, Bath, Lyman, and many towns on 
the New Hampshire side of the river, it seemed to gradually extend up the 
Connecticut river to the point where it had receded. 

It is in this section of country, from the Canada line, following the course 
of the Connecticut southwardly a distance of a hundred miles, westwardly 
from the bank of the same river to the borders of Lake Champlain, and 
eastwardly to the state of Maine, that this disease has prevailed, in its most 
malignant form; and it is to the disease, in the variety of forms wliich it 
has assumed, its symptoms, duration, and fatality, as confined to this par- 
ticular region, that we would call the attention of our professional brethren. 

With few exceptions, for two or three months after the first appearance 
of the erysipelas, there was great uniformity in the early symptoms and 
manner of attack. The disease was ushered in by many of the premonitory 
symptoms of pyrexia; sore throat more or less severe; enlarged tonsils 
and submaxillary glands; difiiicult deglutition, and sometimes painful respi- 
ration, attended with lassitude, pain in the back and limbs and frequently 
nausea and retchings. The breath and respiration were uncommonly foul 
and offensive. The tongue in most cases was covered with a grayish white 
slime, through which the tongue was observed of a deep red colour. The 



1844.] Hall and Dexter's Account of Erysipelatous Fever. %^ 

bowels more or less constipated, were generally easily moved, though some- 
times they were insensible to the action of cathartics. Tlie pulse frequent 
and depressed, the hands and feet cold and clammy, the skin contracted, and 
the general expression shrunken and haggard. 

These symptoms were ordinarily succeeded, generally in twenty-four hours, 
by a chill, sometimes a severe rigor, which was followed by general reaction, 
with frequent and bounding pulse. The chills, however, instead of sub- 
siding-, as in the accession of the hot stage in other fevers, were more per- 
sistent in their duration, and were frequently protracted through the con- 
tinuance of the hot stage, and indeed through all the stages of the paroxysm. 
In some instances also, through the remissions, even embracing the whole 
twenty-four hours; and although the chill sometimes continued during the 
period mentioned even when the body was preternaturally warm, the skin 
was at the same time bathed with a copious acrid perspiration. 

Another mode of attack was very different from that just described. The 
patient would be suddenly overtaken in apparent health and amidst his 
labours, with a sense of coldness, painful in the extreme, soon followed by 
severe chills. These symptoms were followed by pain in the head, stomach, 
abdomen, back and joints, or some or all these at the same time, and in 
the course of twenty-four or thirty-six hours, ordinarily succeeded the sore 
throat above mentioned. These symptoms v/ere the principal premonitions 
of the subsequent efflorescence, which appeared on the skin, usually about 
the third or fourth day, in form of erysipelas. This efflorescence gave 
the qualifying characteristic of the fever, and yet in our own practice, 
and that of our medical associates, it did not manifest itself in more than 
one case in six, and when it did appear it was not confined to any par- 
ticular location. Dr. Barney, of Lyman, N. H., mentions eight mdividuals 
in one family who were attacked at the same time. In each patient the 
disease appeared in the same locality and travelled over the same space, in- 
volving the same surface in its progress. Usually it was first observed on 
the side of the neck or face, presenting an acutely sensible and circumscribed 
red spot. This when first noticed might be covered with the point of the 
finger, but rapidly spread upwards with a defined line of demarcation on its 
upper margin, and in its advance embraced the whole of the face and scalp, 
on the side upon which it first appeared. 

Dr. Jewett to whom we have before referred, and than whom no man has 
had better opportunities for observing this disease, says, " not more than one 
case in twenty of those having the disease as early as January or Febru- 
ary had external erysipelas, as subsequently occurred. Occasionally, 
however, in the early season of the epidemic, there were severe cases of 
external erysipelatous inflammation affecting the head, face, body or limbs, 
and some cases of deep-seated cellular suppuration prevading all parts of the 
system." For the most part there was manifest swelling, tenderness and 
pain in the part affected, previous to the appearance of the effloresence, and 



16 Hall and Dexter's Account of Erysipelatous Fever. [Jan. 

occasionally when the attack was in the face, every vestige of expression 
was destroyed. Frequently when the constitutional symptoms were slight 
there would be extensive inflammation of the skin; and as frequently, 
when the external manifestation was extensive, the redness and soreness of 
the fauces, which preceded the attack, was uniformly modified if not entirely 
removed. As there was uniformly an inflamed condition of the mucous 
surface of the throat, preceding any constitutional disturbance of the system, 
and as this inflammation was usually modified or removed by the external 
disease of the skin; it would seem that this efllorescence upon the surface of 
the skin was not a symptom of the disease, but merely a translation of the 
inflammation from one surface to another. Often when two-thirds of one 
side of the body was covered with the erysipelatous inflammation, and the 
affection of the throat had subsided, suddenly the efllorescence would recede 
and the throat again become aflected, and this would occur several times in 
one individual during the continuance of the disease. 

The attack was also milder and for the most part freer from danger when 
it was confined to the mucous surface of the throat, passing in due time to a 
speedy and favourable recovery; but when the cuticle became the permanent 
seat of the disease, it assumed a most malignant and virulent character, and 
especially so when it pervaded the true skin and penetrated into the sub- 
cutaneous cellular tissue. Yet the most fearful and fatal seat of the disease 
was the fibro-serous membranes in the interior of the body. The external 
development was not always erysipelatous; there frequently appeared, on 
the skin, white patches or weals, which soon turned purple, not unlike 
ecchymosis; these, when opened, discharged a very foul and off'ensive 
ichorous fluid; and, if not arrested in their progress, the gangrene became 
general. Another species of ulceration was sometimes observed, resem- 
bling carbuncle — a large swelling, defined and limited in its extent, studded 
with numerous light-coloured checks upon its surface, through which the 
tumour discharged a scanty, thin, watery fluid. Like the other manifestation 
of the disease, this tumour was apt to subside in one place and appear in 
another; yielding, however, eventually to remedies and the powers of the 
system. 

The prognosis of the disease, when it affected the peritoneum and 
pleura, was decidedly unfavourable, and in several cases under our own 
observation, and in others reported by gentlemen extensively engaged 
in treating the disease since its first appearance, where the membranes men- 
tioned were either primarily or secondarily affected, death terminated the 
scene in twenty-four or forty-eight hours. The aflfection of the celhilar mem- 
brane beneath the skin was no less virulent in its character or extent, when 
the disorder was located in this tissue. The disorganization which was the 
result, detached all connection between the skin and muscles; and in not a 
few fatal cases the muscles and bones; and there was found a large quantity 
of a semi-putrid, thin fluid; in which the disorganized cellular membrane 



1844.] Hall and Dexter's Account of Erysipelatous Fever, \%^ 

seemed to float, and when openings were made into the skin, for the purpose 
of letting out this fluid, long strips of the cellular membrane protruded, re- 
sembling pieces of wet rotten linen, which could be drawn out by the forceps. 
In like manner, portions of disorganized glands and other substances were 
brought away. So corroding and acrid was the fluid discharged, that the 
hardest steel was directly penetrated by it^ as by nitric acid, and instru- 
ments used in opening an abscess, or in detaching the membrane, were found 
after being laid by a few hours, to be entirely eaten through, and unfit for 
further use. This destructive process in the cellular tissue, was unlike the 
gathering of an abscess, it was without any defined boundary, the skin over 
it assuming a dark red colour, and in some cases was chequered with pete- 
chia), and when punctured with the lancet, bubbles of foetid gas escaped 
from the opening. 

This malady frequenUy attacked the mucous surface of the bladder and 
urethra, producing suppression of the urine, and also spontaneous hemor- 
rhage from the urethra. Cases were observed, where the inflammation 
attacked the external genital organs. This singular disease has not, however, 
confined itself to the manner of attack observed on its first appearance. In- 
stead of the usual indications of the formation of pus, such as pain, redness, 
and swelling, in many recent cases the first intimation of a deposit of fluid 
was a slight elevation or fulness of the part attacked, or perhaps an (ede- 
matous state contiguous to the suppurating point. In some few cases there 
was sloughing of the cuticle, and in one case reported by Dr. Jewett, a large 
portion of the external table of the skull was removed through the incised 
scalp. 

In reply to the question, what are the symptoms, progress, duration, and 
fatality of the disease, in your practice? A gentleman of high attainments 
and reputation, replies: " For two or three months past, there has been less 
uniformity in the attack; much more of external and cellular inflammation, 
and while the sore throat and severe rigors are less severe and less frequent, 
they are not altogether wanting in many cases. All severe and many mild 
cases are sure to be accompanied with erratic pains, simulating rheumatism, 
either chronic or acute. In some cases, you would be sure these pains 
were neuralgic, in others, spasmodic; upon critical examination of the mam- 
mae, slight tenderness and fulness is frequendy observed, and if so, nine times 
in ten, suppuration takes place after a period of weeks. The whole sur- 
face under the pectoral muscle extending to the axilla, frequently under the 
latissimus dorsi running up under the muscles of the shoulder, is, in not a 
few cases, one extensive abscess. 

" The quantity of pus discharged, is in many cases very large; and it may 
not be amiss in this connection to observe, that no plan of treatment, general 
or local, by warm or cold applications— general or local bleeding — blistering 
or other counter irritants, have in one single instance, in ray own hands, or 



18 Hall and Dexter's Jlccount of Erysipelatous Fever. [Jan. 

in those of other medical gentlemen around me, succeeded in preventing the 
suppurating process. 

" Obstinate nature, and this still more obstinate disease will have its course 
— mitigate and control it you may — but the result is always the same, sup- 
puration." 

Its manner of attack was dissimilar in different sections. In the region 
of Lyndon, Danville, St. Johnsburg, &c. Vt., there was with few exceptions 
little or no derangement of the urinary or biliary secretions, while on the 
lake shore, and the country contiguous, as well as on the New Hampshire 
side of the river, there was, as before mentioned, uniformly derangement of 
these secretions, and also much gastric irritation. In Canada, according to 
Dr. Colby, the disease showed itself in attacks of accute inflammation of the 
substance of the lungs, pleura, stomach, &c., requiring prompt and efficient 
treatment, and he had succeeded in reducing the inflammation only, by 
powerful and repeated bleedings; the blood being always buffed, even 
when local depletion was resorted to by means of the cupping glass, ac- 
cording to the statements of Dr. Newell of Lyndon, Vt., and Dr. Jewett of 
St. Johnsburg. The disease assumed a typhoid character very rarely re- 
quiring bleeding. Dr. Barney of Lyman, N. H. observes, " I have several 
times, when I thought the indications warranted it, bled the patient ad 
deliquium animi, but with no effect." 

Several cases under charge of Dr. Harris of Colebrook, N„ H., were 
attacked in the onset with acute pain in the finger, resembling pain from the 
puncture of some sharp instrument, with a sense of formication along the 
whole arm. In an incredibly short time, the whole hand and arm to the 
shoulder were swollen and inflamed, accompanied with violent consti- 
tutional disturbance, quick, frequent, and bounding pulse; pain in the head, 
back, and limbs; great thirst; skin hot and dry; restlessness and anxiety; 
tongue of a deep red colour, and covered with a slight coat of grayish fur. 
The point of attack was observed to be a little raised above the surrounding 
skin, and after the lapse of a few hours, to present a jet black appearance, 
the size of a large pin head. In all cases of this kind the patients were 
somewhat advanced in years, and died in five or six days at most, with ex- 
tensive sloughing of the whole arm. Indeed the manner of its assault could 
not be anticipated, and it seemed somewhat a freak of the disease, which of 
the various organs and textures of the system, should be chosen as the first 
point of invasion. 

The duration of the disease was uncertain in most cases. Favourable 
cases, properly treated, frequently became convalescent in five or six days, 
while many other cases, apparenfly as mild in the outset, would continue 
as many months. Nor was the duration of the disease manifestly influenced 
by age or sex, though perhaps a greater number of females were attacked 
at the commencement of the epidemic; yet the duration of the disease mea- 



1844.] 'Rail ^iudDexier^s Account of Erysipelatous Fever. 19 

surably dependant upon the texture or organ seized, seemed to continue as 
long in the one sex as the other. 

The prognosis of this disease was governed as in other disorders by the 
age, sex, and condition of the patient, the organs and texture affected. When 
the manifestations were external, and the inflammation of the skin did not 
recede, there was but little danger to be apprehended. When, however, the 
cellular tissue became involved in the disease, a long season of suffering was 
to be apprehended, and unless the patient had a most vigorous constitution, 
he would ultimately succumb. No language can give an adequate descrip- 
tion of the revolting aspects of this form of the epidemic. In many indivi- 
duals of advanced age, when the inflammation of the cellular texture was 
extensive, the flesh would drop from the limb, or the whole member present 
the disgusting spectacle of a livid mass of putrefaction. The most fatal 
results, for the most part were to be anticipated in the affection of the in- 
ternal organs, particularly the bowels and uterus, and during the season when 
the epidemic might be said to be at its height, not one in seven escaped, who 
had disease of the last mentioned organ. 

In connection with the foregoing remarks, it may not be amiss to pre- 
sent a very brief view of that class of cases to which this statement would 
seem to allude — puerperal peritonitis; not that this disease can with 
propriety be called erysipelas, but that its fatality is in some manner con- 
nected with the prevailing epidemic. It has long been a mooted question, 
whether puerperal fever was communicated by contagion or by some other 
agent. Many, at the present time deny the possibility of contagious com- 
munication, while others in our own section have refrained from obstetrical 
practice, convinced that they have carried the disease from one patient to 
another. Certain it is, that while many highly respectable gentlemen, ex- 
tensively engaged in practice, deny the contagiousness of either erysipelas 
or puerperal peritonitis; others, among whom is Dr. Calvin Jewett, admit its 
contagious character. The latter remarks: — " I do not believe the disease 
(erysipelas) contagious like smallpox or measles, it approaches more nearly 
epidemic typhus. I speak of the disease generally, not of puerperal cases, 
for these are unquestionably communicated by individuals, whether physician 
or nurse, who have been much with the disease, to women, at or immedi- 
ately after childbirth. I believe the clothing, not the hand of the physician 
communicates the disease. / wish I ivere mistaken on this point.^^ 

If contagion does not contribute to the production of this malady, the ques- 
tion forcibly suggests itself, how it happens that ihe proportion of puerperal 
cases is sensibly increased during the epidemic prevalence of erysipelas? 
With ordinary care, perfect seclusion and guarded from the influence of 
infectious causes, the patient might have some hope of escape, if the disease 
was communicated by the usual agents of infectious diseases. But not so; 
entire seclusion and even living out of the circle of infected atmosphere, is no 
safeguard, if during labour the patient is attended by a physician, who is 



20 Hall and Dexter's Account of Erysipelatous Fever, [Jan. 

engaged in daily practice among individuals affected with erysipelas or puer- 
peral peritonitis. Some cases corroborative of this statement will be given> 
before we leave this subject. 

Another inquiry is here suggested. Can the origin of any cases of puerperal 
peritonitis be traced, during the epidemic, to communication on the part of 
the physician or nurse? Of one fact we are certain, that no modification of 
the disease has happened when individuals influenced by fear have removed 
from the region of the disease to a more healthy locality. This statement 
refers more particularly to parturient women, and the question just proposed 
can be answered more readily, by referring to the remark made at the com- 
mencement of this article, that " several cases of erysipelas occurred at Lan- 
caster, N. H. early in the fall of '41. Among the number of these cases 
was Mr. H., a farmer, residing at the extreme eastwardly part of the town, 
and secluded from the inhabitants around him by a dense body of forest, two 
miles in extent. He was attacked with violent and deep-seated pain in the 
palm of his left hand, from which a few days previous he had rubbed apiece 
of skin. The hand and wrist were much swollen, and a deep erythematous 
blush extended from the point of abrasion along the inside of the forearm to 
the elbow; the glands in the axilla were also tender and a little enlarged. 

This was the appearance when first seen, and it was pronounced to be a 
case of phlegmonous erysipelas, unaccompanied with much constitutional 
disturbance. The whole hand and forearm, after the lapse of a few days, 
became one extensive abscess and was opened at several points, discharging 
a semi-putrid watery sanies, very offensive to the smell. During the at- 
tendance of the junior contributor to this paper upon this case, he was called 
to a Mrs. C. in labour with her first child, a fine, healthy, well-formed 
woman. The labour was natural, and she was left with every prospect of 
speedy convalescence. On the day of the evening of her confinement, Mr. 
H. was visited, his hand and arm dressed, and a portion of cellular tissue 
cut away, which protruded from the lancet opening. Mrs. C, on the third 
day after confinement, was seized with all the symptoms of puerperal peri- 
tonitis, and after a season of acute suffering, died on the 11th day from the 
birth of her child. This was the first and only fatal case of puerperal fever, 
occurring at Lancaster during the epidemic; and it appears somewhat singular 
that this case of puerperal peritonitis should occur during the attendance of 
her physician upon the case of phlegmonous erysipelas, and about the same 
time that the morbific matter would take efl^ect upon the system, supposing 
it to have been communicated in any way by her attendant. 

In June of the present year, judge W. was attacked with erysipelatous 
inflammation of the face and scalp, and after treatment for a few days re- 
covered. While treating this case the junior contributor to this paper was 
called to a woman in labour with her third child, who resided some fourteen 
miles from Lancaster, on a settlement made on one of the spurs of the White 
Mountains, called Cherry mountain, out of the range of the epidemic; not a 



1844.] HdW 3.nd Dexter'' s »^ccount of Erysipelatous Fever. 21 

single case of erysipelas having occurred in the settlement during the 
prevalence of the disease. The labour was short and natural, as is usually 
the case with the women of this district. Three days after confinement she 
was seized with puerperal symptoms, and after treatment for a few days 
recovered. These two cases are given in brief, but constitute two of the 
most well marked and decided cases of puerperal peritonitis that came under 
treatment while the epidemic continued, and though we have been in this 
section, spared much of the suffering and desolation which has almost de- 
populated other districts in this region, yet we must attribute much of our 
success to the great care which has been exercised in keeping paturient 
women from the influence of exciting causes, and also on the part of the phy- 
sicians and nurses, in the means used to prevent any communication by 
means of the hand or clothing. 

The effects of this epidemic have been experienced in every situation and 
condition of life, in the populous town and lonely settlement, in the homes 
of the rich and the log cabin of the poorest squatter. It has ranged through 
all variety of location, of hill and valley, and has spread consternation and 
terror wherever it has appeared. In the county of Caledonia, Vt., thirty 
cases of puerperal peritonitis occurred, only one ofivhich recovered. And in 
Bath, N. H., containing a population of 1500 or 1600, twenty mothers died 
from puerperal peritonitis, and about forty with erysipelas. 

No unusual change of temperature or extraordinary exhalations from the 
earth, no uncommon draught or protracted rains were observed during the 
season of the prevalence of this disorder. Yet it was observed in some sections 
of the country, to prevail mostly in the cold and humid seasons of the year, 
and that there was a sensible abatement in steady dry weather, either hot or 
cold. From this fact in one section of the country, it might be inferred that 
the erysipelas depended more on atmospherical changes, accompanied by 
cold and moisture, than any malarious effluvia. But while this might be 
assigned as one of the causes of the disease upon the lake shore, in other 
districts there was no modification of the disorder observed by any change 
of temperature, either hot or cold, dry or moist. Dr. Hains of Colebrook 
thinks the disease yielded more readily in damp and moist weather, than 
in dry or cold. At one time, when the erysipelas was prevailing to an 
alarming extent in Burlington, Yt., it was attributed to the circumstance of 
this beautiful village being situated on a dry sandy inclined plain, near the 
broadest expanse of Lake Champlain. This supposition is disproved by 
the fact of remote situations, the hilly regions of the interior, secluded from 
any emanations of moisture, being alike obnoxious to the influence of this 
fatal scourge. 

The post-mortem examinations have been few. The constant and press- 
ing calls to attend to the living, would have precluded many physicians 
making post-mortem inquiries. " But the death of a most excellent and 
esteemed physician," says Dr. Jewett, in " this vicinity, Dr, Atherton, of 



22 Hall and Dexter's Account of Erysipelatous Fever, [Jan. 

Glover, Vt., who contracted the disease by dissection, gave an alarm which, 
added to the notice in the journals, of the death of two physicians in Massa- 
chusetts near the same time from the same cause, deterred myself and every 
other physician in this section, from prosecuting the inquiry on the dead 
subject." 

But three opportunities for post-mortem examination have by us been 
improved. 

Case L — Mrs. Mc , a labouring woman, of full plethoric habit and 

good constitution, aged about forty, was seized with the epidemic June 1st, 
and continued in the greatest agony and distress in the region of the pelvis 
and lower part of the bowels thirty-six hours, when she expired. Not being 
able to obtain her physician for the first eight hours, she had recourse to 
domestic diaphoretics, without relief; after her physician arrived, he admi- 
nistered a mild cathartic, which was immediately rejected. A dose of calomel 
was afterwards given, and a cathartic operation in due lime followed, but no 
relief until death close the scene. The examination took place six hours 
after death. The internal surface of the peritoneum was dark and much 
injected; its cavity contained about a pint of oleaginous serous fluid, evolv- 
ing a most loathsome odour. The liver and uterus were soft, dark, and much 
injected. There were no adhesions between any of the surfaces. Her 
aitending physician, who conducted the examination, on sewing up the 
body pricked his finger, and although the puncture was immediately washed, 
and spirits terebinth, applied, followed by other preventives, the same even- 
ing it became the point of erysipelatous inflammation. After several weeks 
of suffering, he barely escaped with life. 

Case H. — Mrs. C, the history of whose case has been given, was ex- 
amined three hours after death. The abdomen v/as much distended with gas; 
the peritoneum was much injected, and large patches of a livid colour were 
scattered over its whole extent. The liver was somewhat injected and rather 
softened. The whole peritoneal surface of the intestines was found very 
much injected with occasional patches, resembling gangrene. The uterus 
contracted to the usual size at that period, (eleventh day after confinement,) 
and neither from its external appearance or internal condition, could we 
detect the least appearance of disease, of its own proper structure. As the 
detail of the symptoms was omitted in the account of her case, it may be 
proper to observe here, that the lochial discharge was abundant until a very 
iew hours previous to death, and upon examination small coagula v/ere found 
upon laying open the uterus, without any other signs of disease. But from 
the cavity of the abdomen we removed some two quarts and a pint of pure 
pus, and it was distinctly remarked, that every other organ exhibited signs 
of intense inflammation, excepting the uterus. 

Case HI. — Mss S., a lady of good constitution and full habit, called on the 
senior contributor to this paper for advice, on account of acute soreness of 
the throat and muscles of the neck. Had for tv/o weeks or more been thus 
afflicted, and had complained to her female friends of a painful soreness in 
the lower part of the abdomen, for which she had occasionally taken mild 
cathartics, but found no relief; of this latter fact ihe writer was not apprised 
at that time; the tongue slightly coated; pulse full and frequent; skin pre- 



1844.] Hall and Dexter's dccount of Erysipelatous Fever. 23 

ternaturally warm and dry. She was cupped over the epigastic region; and a 
cathartic dose of calomel given, followed by diaphoretic drinks. The second 
morning the calomel had operated, but no relief was obtained. The writer 
was now made acquainted with the painful state of the patient's abdomen; she 
had acute pain in the hypochondriac regions, which cut the breath short at 
each inspiration; pulse hard, frequent and sharp; face flushed; heat of the 
skin increased; occasional chills. Eight ounces of blood were taken from the 
arm, which gave decided relief; pulse became soft and reduced in frequency; 
for twelve hours the symptoms were sensibly improved. At the end of this 
time collapse supervened; the pulse reduced to a mere vibration, which the 
most powerful stimulants did not restore. She expired the next morning. 
Seven hours after death the body was examined. Adipose substance thick; 
peritoneum, its serous surface much injected and dark; its cavity con- 
tained about a pint of thick, dark, foul serum, with patches of recently 
formed membrane floating in it; slight adhesion of the liver to the side; liver 
dark, soft, and injected portions of intestine adhered to each other, and 
easily separated. The omentum much inflamed and thickened; the lower 
portion in a state of ulceration and lay in fragments, beneath which was a 
quantity of thick pus emitting the same offensive odour as observed in the 
first case. 

It is to be regretted that no more opportunities presented to investigate the 
pathological effect of this disease. The causes mentioned by Dr. Jewett, 
together with several cases of erythema anatomicum, happening to physicians 
upon examination after death undoubtedly deterred many, who were anxious 
to investigate, from making any post-mortem researches. 

The treatment of this disease has been as varied as the aspects and phe- 
nomena which it has presented. The answers which have been received 
to the interrogatory, " What has been the most successful mode of treatment, 
and has there been much variation from a settled manner of practice?" 
exhibit distinctly the different views of physicians in regard to the disease; 
and while in a vast number of cases the utter impotency of remedial agents 
to afford relief is acknowledged, yet, it must be admitted, that the great 
number of the sick, want of nurses, and the utter impossibility of pro- 
curing early and constant medical attention, has sacrificed many a life, that 
might have been saved. The question of treatment seems to be, to bleed or 
not to bleed? and perhaps we cannot give a better view of the different views 
entertained upon this subject, than by quoting largely from Dr. Jewett's 
account of the treatment of this disease in Caledonia county, Vt. 

*' The most successful and more general mode of treatment in those cases 
when the disease commenced, or was soon followed by chills, was to place 
the patient in bed, give warm mild teas, such as sage, balm, hemlock, 
spearmint, or peppermint, as fancy or necessity dictated; apply externally 
heated bricks, wrapped in cloths wet with vinegar or strong herb tea; give 
the patient acetate of ammonia, from gii. to giij. every three hours until free 
perspiration ensued, which scarce ever exceeded two hours at farthest, when 
the pain in back, abdomen, or head was very severe. I uniformly applied 
Granville's counter irritant, but seldom so as to produce vesication. And 



24 Hall and Dexter's Account of Erysipelatous Fever. [Jan. 

to aid the perspiration, and give qniet, I early and repeatedly gave pulvis 
Dover!, applying at the same time sinapisms on various parts, when pain, 
numbness, or cold supervened. 

"In some few cases emetics were used early in the disease, and occasionally 
a cathartic at first, but the more general and successful practice was not to 
give an emetic or cathartic, until the expiration of from twelve to twenty- 
four hours, and then move the bowels gently with the oleum ricini. Bleed- 
ing has been seldom practiced by myself, or either of tlie physicians in this 
county who have had much experience in the disease, and though there has 
been some discrepancy of opinion among medical men in this section, I 
speak advisedly, when I say that the physicians who have done altogether 
the greatest share of business, have seldom practised general bleeding, or 
scarcely ever commenced treatment by an emetic or cathartic. 

"In Orleans county, where bleeding and a more active treatment prevailed, 
the proportion of fatal cases has much exceeded that in this county, where 
the sudorific and anodyne practice was fully carried out. When the disease 
was at its height in the northern section of this county, and new cases 
occurring every day, Dr. Newell and myself spent two weeks there, daily 
visiting from twenty to thirty patients, and neither of us lost a single patient 
during our stay, nor was there one which failed of ultimate recovery. In 
many cases, and especially those where external erysipelas prevailed, and 
in some others an early resort was had to sulph. quinine, carbonate am- 
monia, camphor, and in some few cases, wine or the more active alcoholic 
stimulants were used with much benefit. 

" In many cases where there was much irritability with restlessness, which 
morphine or opium in any form would not control, or when in such cases 
of the disease for good reasons I chose not to give it, I found most decided 
good effect from the use of the cyanuret of potass, given in doses from J^ 
to ^ of a grain every three, six or eight hours, as the case required. To 
control erysipelatous inflammation of the skin, lunar caustic in solution was 
rather a favourite. Iodine, blisters and various other applications were used 
both moist and dry. While in some cases I have been gratified to see the 
disease stayed at the limits set by a blister, by caustic or iodine, in another 
the disease would set all remedies at defiance, and range the whole surface 
of the body, and yet the patient recover." 

These views regarding the treatment of this disease, by Dr. J. and Dr. 
Newell, are also entertained by other practitioners. Dr. Crosby of Han- 
over, recommends bleeding only in the onset of the disease. Dr. Barney, 
of Lyman, after a full and fair trial of bleeding, is satisfied nothing perma- 
nent is accomplished by it. Dr. Mattocks of Lyndon, and very many of 
the physicians both north and south have declined bleeding altogether, and 
have adopted the sudorific, anodyne, or tonic plan of treatment. We have said 
that the disorder proved less fatal when confined to the mucous surfaces, 
than when transferred to any of the other structures. If such be the case, 



1844.] Hall and Dexter's Account of Eryfiipelatous Fever. 25 

our efforts should be exerted to relieve the congestion of these surfaces, and 
to restore the circulation to its natural state as soon as possible. Can this be 
done by stimulating diaphoretics alone, without the aid of other depletion? 

We doubt not this has been done, when the affection of this membrane 
has been merely l6cal, without any constitutional participation. But when 
in connection with this state of the membrane of the throat, we have ex- 
treme heat of skin; full, bounding, and frequent pulse; violent pain in the 
head, back, and limbs, and extreme thirst, there can be no doubt what 
course we should pursue. Bleeding, prompt and efficient bleeding is in 
such a state the only remedy to be depended upon, and in our hands the 
only one which has succeeded. 

A delay of a few hours in such a condition of affairs is fatal. Full 
bleeding, reducing the action of the heart and arteries, followed by either an 
emetic or cathartic, has rarely failed in our hands of arresting the disease, 
when applied in season. And not in a few cases where there has been but 
little affection of this membrane, but much efflorescence upon the skin, has 
one bleeding arrested the disease, and the patient become convalescent in a 
few days. 

These are the important aids to be depended upon, under the condition of 
circumstances mentioned; not, however, to the exclusion of those remedial 
agents, which serve to carry out still farther the intention of such treatment. 
After bleeding, either a cathartic or emetic, followed by the pulvisDoveri cum 
antimonialis, and the free admission of mucilaginous drinks, and in those 
cases where there is much biliary disturbance, ipecac, combined with 
calomel, rarely fails to accomplish a cure. These indications are to be im- 
mediately acted upon. Erysipelas like typhus has its inflammatory stage, 
as well as a stage of collapse, and our efforts should be directed to arresting 
the disease before the period of collapse ensues. The great object of equal- 
izing the circulation and restoring the vital energies of the system, may have 
been effected by sudorifics alone. But should we depend in the onset of 
typhus on sage tea, Dover's powders, and profuse perspiration? 

It has been urged that from the depression of the nervous system, 
and consequent prostration of the circulation, these evacuants ought not 
to be resorted to, but that the stimulating course of diaphoresis, before 
mentioned, is alone necessary to carry out the indications of nature. That 
the reduction of the system by cathartics, the revulsive action of emetics, 
increased the tendency to exhaustion. That venesection had too the same 
effect, by withdrawing from the circulation the cruor sanguinis or " life of 
the blood." But in our experience, this reduction of the circulation, and 
the removal of irritating substances, and secretions from the intestines, 
obviates not only the inflammatory tendency to the surface, but induces 
directly that increased vigour of the system, which is vainly expected from 
the opposite course. If blood-letting is contraindicated in bringing about these 
results, why should nature by her spontaneous efforts evidently strive to 



26 Hall and Dexter's Account of Erysipelatous Fever. [Jan. 

accomplish the same design, as she often does by haemorrhage from the 
nose, lungs, fauces, and other outlets? The relief that immediately fol- 
lows this kind of bleeding, affords evidence of its curative tendency. The 
same results following the abstraction of blood from the arm, and the 
controlling influence it exerts in suppressing spontaneous bleeding, is 
another and an additional proof of its welcome assistance. Experiment has 
also shown, that in inflammation of any description, the fibrinous portion of 
the blood is increased, and that venesection does not disproportionally with- 
draw this part of the sanguineous fluid, but rather that blood-letting is not 
only admissible but absolutely demanded to lessen, if possible, the accumu- 
lation of fibrine, as well as to liberate the congested state of the extreme 
vessels, the probable cause of the apparent prostration, Andral states that 
the general rule is that the quantity of fibrin will rise above the normal stand- 
ard in spite of venesection, and that during a certain time, this does not 
prove that bleeding is useless, (hurtful?) but simply that it cannot prevent 
instanter the tendency to the production of an increased quantity of fibrin. 
Thus while " theory" sustains us in our premises, the effects of this method 
of treatment have amply satisfied us in practice. The early adoption of 
venesection has not only in very many cases arrested the disease, but has 
lessened that tendency to diffuse inflammation of the cellular texture, which 
has almost invariably occurred, where it has been neglected, > , 

In commenting upon the action of emetics, we have only to observe, that 
while they evidently assist in carrying out the intention of the sudorific 
plan of treatment, they possess the decided advantage of arousing the dor- 
mant powers of the system, relieving the congested viscera, especially the 
liver, and of producing that determination to the skin, which seems to be the 
whole design of the method of practice before mentioned. 

In the stage of collapse, quinine with the diffusible stimuli, seemed very 
properly indicated, and were given with much success. When the brain was 
affected, and a low muttering delirium supervened, opium, combined with the 
tartrate of antimony, had decidedly an excellent effect. The external ap- 
plications were various. In simple erysipelas of the skin alone, the lotion 
of mur. ammon. was a favourite application. Solution of nitras argenti, liquor 
subacet. plumbi; blisters; acupuncturation, and every description of dry 
remedies were tried with varied success. As a local application to the 
throat, scarifying, followed by the lotio nit. argent., has generally afforded 
immediate relief. But, after all, it must be acknowledged that a successful 
method of practice in one section has failed entirely in another, and it 
affords another and convincing proof, that in all diseases that result in an 
uncommon sacrifice of human life, the practice and judgment of the phy- 
sician, however able and philosophical, will be frequently called in question; 
and errors, the legitimate offspring of our nature, will be sought out, which 
under other and more favourable circumstances, would be passed as enco- 



1844.] J. B. Beck on the Modus Operandi of Medicines. 27 

miiims to his credit. . Let, therefore, the charitable maxim of Sir Charles 
Bell ever be kept in view. 

" He who makes the philosophy of the human system his study, must be 
taught humility, and learn from his own errors how to look kindly on others." 



Art. II. — On the Modus Operandi of Medicines. By John B. Beck, 
M. D., Prof, of Materia Medica and Medical Jurisprudence, in the College 
of Physicians and Surgeons of New York. 

There is perhaps no subject which has attracted more attention than the 
modus operandi (as it is commonly called) of medicines, or the manner in 
which the effects of medicines are produced upon the living system. It is 
by no means singular that it should have been so. It is a subject, not merely 
interesting as a matter of theoretical speculation, but one involving results of 
great practical importance. As may naturally be supposed, the most op- 
posite opinions have been entertained in relation to it, and even at the present 
time, there is a wide difference in the doctrines and belief of eminent men 
on the subject. It is not my intention to enter into the full discussion of it, 
on the present occasion. After some general observations, the main object 
which I have in view, is to bring forward a summary of the facts which go 
to establish one principal point connected with it, and that is the absorption 
of medicines into the circulation. 

The effects of medicines are divided into those which are local, and those 
which are remote. By the first, are meant those impressions which a medi- 
cine makes upon the part with which it comes in immediate contact. By the 
second, are meant those which show themselves in distant parts of the system. 

Now witfi regard to the first of these, our knowledge is confined to very 
narrow limits. All that v/e can say about it is, that the medicine, whatever it 
may be, comes in actual contact with a living surface and produces upon it 
peculiar effects, corresponding to the nature of the substance applied, and the 
particular susceptibility of the part to which it is applied. In short, our 
knowledge does not extend beyond the simple expression of the fact itself. 
How it is, ox why it is, that such effects are produced, are subjects entirely 
beyond our comprehension. 

With regard to the remote effects, the question which presents itself is of 
a different character. In what way is it that medicines when locally applied 
are capable of producing effects upon distant parts of the system? How is it 
that agents taken into the stomach, or applied to the skin, can affect the brain, 
the lungs, die kidneys, the uterus, &c.? This is a question by no means of 
easy solution, and has been greatly embarrassed by the theories and specula- 
tions of ingenious men. In discussing it, I shall endeavour to keep aloof from 



28 J. B. Beck on the Modus Operandi of Medicines. [Jan. 

these theories, and confine myself to such views as may be sustained by 
fact as well as argument. 

There are only two ways in which different parts of the system can hold 
intercourse or be acted upon by one another. The first of these is through 
the medium of the nerves — the second, through the medium of the circu- 
lation. It is only in one or other of these ways therefore, that the effects 
of medicinal agents can be produced in distant parts of the system. In 
other words, the impression made by the medicine upon the part to which 
it is applied must be conveyed sympathetically to other parts, or the medi- 
cine must be taken into the circulation, and actually carried to different parts 
of the system, and thus produce its remote effects. A candid review of all 
the facts connected with the subject will lead us, I think, to the conclusion, 
that in neither of these modes exclusively are the remote effects of medi- 
cines produced, but that while in some cases they are produced by sympathy, 
in others they are the result of absorption into the circulation: and these 
are the points which I shall endeavour to establish. 

In the first place, of the production of the remote effects by sympathy. 
The human system is so constituted that no part of it is completely isolated 
from the rest. Impressions made upon one portion of it, are extended with 
different degrees of force to other portions. An incessant intercourse is thus 
kept up throughout the complicated machinery of the animal economy, and 
the agents through which this is accomplished are the nerves ramifying 
through every fibre of the system. Now that medicinal, like other impres- 
sions, are propagated from one part of the body to another in this way, is 
unquestionable, and the great fact which, independently of other considera- 
tions, proves this beyond a doubt, is the rapidity with which the remote 
effects are in many cases developed. Thus, for example, ammonia held to 
the nostrils, almost immediately rouses from a fit of fainting. A person in 
a state of lassitude and fatigue may have his spirits exhilarated, and tone 
given to his whole system at once by a small quantity of wine. In some 
cases of vertigo, the head is frequently relieved almost instantaneously by a 
leaspoonful of ether in a glass of water. Now, in these cases, as well as 
many others which might be adduced, the effect is too speedy to be pro- 
duced in any other way than through nervous or sympathetic agency. 

Experiments made upon animals with certain poisonous agents show this 
in a still more conclusive manner. By Majendie, the extremity of a glass 
tube previously dipped into a phial containing pure prussic acid, was plunged 
into the throat of a strong dog. The tube had scarcely come in contact with 
the tongue, before the animal made two or three long and rapid inspirations 
and fell dead. No method that could be devised, enabled him to trace the 
smallest sign of sensibility in the muscular organs of this animal after death. 

An atom of the acid was applied to the eye of another dog — the effects 
were as sudden and as fatal as in the preceding experiment. 

A drop of the acid diluted with four drops of alcohol were injected into 



1844. J J. B. Beck on the Modus Operandi of Medicines. 29 

the jugular vein of a third dog". The animal fell dead that instant, as if 
struck by a cannon shot or by lightning.* 

By Mr. Brodie, two ounces of proof spirit were introduced into the 
stomach of a rabbit, and produced perfect insensibility almost before the 
injection was completed. 

One drop of the essential oil of bitter almonds, applied to the tongue of 
a cat, caused instant convulsions. 

Three ounces of the infusion of tobacco, injected into the rectum of a dog, 
produced immediate contractions of the voluntary muscles. 

Less than a drop of the empyreumaticoil of tobacco, applied to the tongue 
of a young cat, caused instant convulsions.! 

By Dr. Christison, a dog was killed in less than three seconds, by intro- 
ducing into the left femoral vein two drops of conia, neutralized with 
muriatic acid, and diluted with thirty drops of water.J 

The foregoing illustrations are sufficient to show the rapidity with which 
impressions may be conveyed from one part of the system to another — a fact 
inexplicable, except upon the supposition of their being transmitted through 
the nerves. 

In the second place, of the production of the remote effects by the ab- 
sorption of medicines into the circutation. — In the investigation of this 
point, two things require to be noticed; 1. are medicines actually absorbed, 
and 2. are the remote eifects the result of this absorption. 

Strange as it may appear, notwithstanding the multiplied proofs to the 
contrary, it has been actually denied, and that by writers of authority too, 
that medicines are ever taken into the circulation, and the most elaborate and 
ingenious efforts have been made to establish this doctrine. 

In every discussion it is essential to settle two preliminary points, and 
these are, what the question precisely at issue is, and then what the kind 
of evidence is which is necessary to establish or refute it. In the present 
case the question at issue is this — do or do not certain medicines enter the 
circulation? and the kind of evidence necessary to determine it must be 
that of fact and experiment. This is the only kind of evidence which can 
settle it. General reasonings can do nothing more than show the proba- 
bility, or improbability of it. Further than this they cannot go, and there- 
fore as opposed to actual fact, they can be accounted of no moment. I 
make these observations, because some of the writers to whom I have 
alluded, in their discussions of this subject, overlooking the evidence of 
facts, appear to me to have trusted almost entirely to general speculations, 
a species of argumentation altogether inapplicable. To settle this ques- 
tion, then, all that we have to do is to ascertain from actual observation and 

* Brande's? Journal of Arts and Sciences, vol. 4, p. 'MS. 
t Eclectic Repertory, vol. 2, p. 270. 

t On the Poisonous properties of Hemlock and its alkaloid, conia. By R. Christison, 
M. D. From the Transactions of the Royal Sociely of Edinburgh, p. 33. 

No. XIII.— January, 1844. 3 



30 J. B. Beck on the Modus Operandi of Medicines. [Jan. 

experiment, whether or not, substances introduced into the alimentary canal 
or applied to the surface, can afterwards be detected in the fluids or solids 
of the system. It is altogether a question of fact, not of argument. Let U9 
then see what is the evidence furnished by well attested facts in relation 
to this subject. 

Of the Chyle. — Of the presence of foreign substances in the chyle, we 
have several striking proofs. Into the jejunum of a dog who had been 
kept fasting for a day previous, Dr. Musgrave injected twelve ounces of a 
solution of indigo in fountain water. After three hours, the dog was 
opened again, when several of the lacteals were observed of a bluish colour, 
showing the presence of the indigo in these vessels. Another experiment 
of a similar kind was made by him, by injecting blue stone in solution 
into the jejunum of a dog, that had been kept flisting thirty-six hours. In a 
few minutes after the injection, the lacteals became of a perfectly blue colour. 
Another experiment was made upon a spaniel that had been kept fasting 
thirty-six hours, by injecting with a syringe into one of the small intestines 
a pint of a deep decoction of blue stone with water. After three hours, the 
dog was again opened, when the lacteals were found of a deep blue colour. 
That there might be no mistake about it, several of the lacteals Avere cut, 
and a blue liquor was poured out running down on the mesentery. The 
thoracic duct was now examined and the same appearances observed.* 

By Dr. Fordyce, a solution of indigo was injected into the intestines of 
a sheep, and the chyle afterwards found quite blue.t 

ByTiedemann and GmeVm, sulphate of iron was detected in the chyle of 
a horse who had taken it. Prussiafe of potass was found in the chyle of a 
dog, and sulphuro-prussiate of potash in the chyle of another dog to whom 
it had been given.J 

By Dr. Milnor of Philadelphia, a cat was fed for several days on Prus- 
sian blue and indigo. At the expiration of thirteen days it was killed, and 
on examining the chyle it was found tinged with blue, so as to be easily 
distinguishable from natural chyle. § A dog was also fed for several days 
on madder^ and afterwards on anotta. After death, on examination, the 
chyle of the thoracic duct was found " tinged with the article given. "|{ 
Another dog was fed on indigo for ten days, and on dissection the mesen- 
teric lacteals were found distended with chyle of a light bluish tinge. ^ 

By the late Dr. Macnevin, Professor of Chemistry in the College of Phy- 
sicians and Surgeons of New York, the following experiment was made: — 
One drachm of hydrocyanate of potassa, triturated and mixed with bread 
and butter, was given to a dog. Between three and four hours after, he was 
killed by giving him hydrocyanic acid. The lacteals and thoracic duct 

* Philosophical Transactions of London — Pcrciyal's Essays. Vol. 2, p. 317. 

t A Treatise on the digestion of food. By G. Fordyce, M. D. &c. Lond. 1791, p. 122. 

\ Philadelphia Journal of Medical and Physical Sciences, vol. 3, p. 153. 

§ Ibid. vol. 4, p. 14. II Ibid. p. 16. IT Ibid. p. 17. 



1844.] J. B. Beck on the Modus Operandi of Medicines, 31 

were soon filled with milk-white chyle. On scratching the receptaculum 
and pressing down the duct, nearly half a tea-spoonful of chyle was collected. 
Into this was let fall a couple of drops of the solution of permuriate of iron, 
and a deep blue was the immediate consequence.* 

By Drs. Coates, Lawrence and Harlan, experiments were made upon 
several animals by giving them the ferrocyanate of potass, and on testing 
the chyle afterwards with sulphate of iron it struck a deep blue, showing 
the presence of it in this fluid.t By the same persons the green sulphate 
of iron was injected into the abdomen of three different kittens, and on 
testing the chyle with prussiate of potass, it struck a deep blue in all three.ij: 
An ounce oi tincture of assafcetida was injected by them, into the abdomen 
of a cat, and on opening the animal, the chyle in the thoracic duct emitted 
the peculiar odour of that article. § 

The foregoing facts appear to me sufficient to show that foreign substances 
may and do actually, sometimes at least, get into the chyle and in that way 
pass into the circulation. That this is the usual route, however, which they 
take would seem to be disproved by numerous experiments. This has been 
shown particularly to be the case with coloured substances. By Tiedemann 
and Gmelin, indigo, sap green, gamboge, madder, rhubarb, alkanet and 
tincture of litmus were given to animals, and in none could they afterwards 
be detected in the chyle either of the lacteals or of the thoracic duct, although 
they were discovered in the blood and the urine. Majendie could not detect 
in the chyle of dogs, indigo, rhubarb, madder or safl'ron which had been 
given to them. By Lawrence and Coates too, in their experiments no change 
of colour could be detected in the chyle. As the result therefore of all the 
experiments with regard to colouring matters, it would appear that although 
occasionally they may get into the chyle, yet as a general rule, when they 
pass into the circulation they do so through another route, and that is through 
the absorbing veins. |j With regard to certain saline substances, however, 
the case is different. Prussiate of potash, the article generally used in the 
foregoing experiments, not merely enters the chyle, but does so with great 
facility. In experiments made by Lawrence and Coates upon thirty-four 
animals, sixteen indicated the presence of this salt in the chyle. ^ 

* New York Medical and Physical Journal, vol. 1, p. 131. 

t Account of Experiments to determine the absorbinor powers of the veins and lym- 
phatics. Phil. Journal of Medical and Physical Sciences, vol. 3, pp. 293, 4, 5, 6. Vol. 5, 
pp. 3-29, 30, 31. 

X Ibid. vol. 5, p. 342. § Ibid. vol. 3, p. 291. 

II It is to be recollected that none of the experimentalists, mentioned above, express any 
doubt at all of the entrance of foreign substances into the circulation — the only question 
being, whether they enter it through the medium of the lacteals and thoracic duct or 
through the medium of the veins; a. question, which, however interesting in itself, has no 
important bearing on the present discussion. For an excellent view of this latter subject 
I may refer to Dunglison's Physiology, vol. 2. 

^ Phil. Journal of Medical and Physical Sciences, vol. 5, p. 328. 



32 J. B. Beck on the Modus Operandi of Medicines. [Jan, 

Of the Blood. — That foreign substances taken into the stomach are after- 
wards found in the blood, is still better established than their presence in the 
chyle. On this point the experiments are numerous and unequivocal. By 
Tiedemann and Gmelin, in their experiments upon animals, the following 
substances were detected in the blood of the mesenteric veins, viz: cam- 
phor, musk, indigo, rhubarb, prussiate of potass, sulphate of potash, 
traces of lead and iron. In the blood of the splenic veins, they detected 
musk, alcohol, rhubarb, prussiate of potash, traces of lead, iron, and of mer- 
cury. In the blood of the vena portae, they detected camphor, Dippel's 
animal oil, musk, rhubarb, prussiate of potash, sulphuro-prussiate of potash, 
iron, lead and barytes.* 

By experimenters in our own country, similar facts have been established. 
By Dr. Milnor, the odour of musk was detected in the blood of the vena 
portae of a dog to whom it had been previously given. He also found the 
smell o^ garlic in the blood drawn from the jugular vein of a dog fed upon 
it.t By Prof. Macnevin, the hydro-cyanate of potassa was detected in the 
serum of the blood of the vena portae of a dog to whom it had been given.:}: 
By Drs. Coates, Lawrence and Harlan, the same substance, introduced 
into the stomachs of animals, was in numerous experiments, discovered in 
the blood of the heart, the aorta and the vena portae. § 

Still more recently, the celebrated Orfila has established the t^act that ar- 
senic^ antimony and the salts of copper may be detected in the blood of 
animals poisoned by these metals. || With regard to arsenic too, he has 
shown that the same may be done in cases of poisoning by this article in 
the human subject. In a case, in which the patient recovered after swallow- 
ing nearly a tea-spoonful of arsenious acid, the presence of the metal was 
tletected in the blood which had been drawn from the arm for the purpose 
of relieving the inflammatory symptoms.^ 

The foregoing facts are decisive to show that foreign substances taken 
into the stomach do afterwards pass into the blood. The proof which they 
furnish is so plain and positive, that one could hardly suppose any but the 
most visionary theorist capable of undertaking to evade it. The only 
objection that can be urged, is that most of the experiments were made 
upon animals, and therefore that it can only be inferred analogically that 
similar effects would take place in the human subject. This, however, 
will scarcely be urged. If it should, the facts which we have to show the 
presence of foreign substances in the secretions, not merely in animals 

* Recherches sur la route que prennent divcrscs substances pour passer tie rcstomac 
et du canal intestinal dans le sang, «fec. Par. E. Tiedemann el Gmelin. Traduit par S 
Heller, p. 64, «fec. 

t Philadelphia Journal of Medical and Physical Science?, vol. 4, pp. 16, 18. 

t Nt w York Medical and Physical Journal, vol. 1, p. 13:2. 

§ Philadelphia Journal of Medical and Physical Sciences, vol. 5, p. 329. 

II Johnson's Journal, vol. 38, p. 429. 

IT Ibid.,vol. 38, p. 430. 



1844.] J. B. Beck 07i the Modus Operandi of Medicines. 33 

but in man, will do away entirely with this objection. These we next 
proceed to state. 

Of the Urine. — Every body knows from common observation, the effect 
of certain articles on the urine. Asparajrus gives it a well known and pecu- 
liar smell. Turpentine gives it a violet odour. Juniper berries are said to 
do the same. According to John, the urine of those who have taken vale- 
rian, has a smell like that of myrrh — and he asserts that castor, assafcetida 
and saffron communicate their peculiar odour to the urine.* By Sir Everard 
Home, rhubarb was detected in the urine of several animals, to whom it had 
been previously given both in the form of tincture and infusion. 'J'he test 
used was the caustic alkali, originally suggested by Mr. Brande.t By Dr. 
Milnor, the same substance was found in the urine of two dogs who had been 
fed upon it.t By Dr. Macnevin, the hydrocyanate of potassa was detected 
in the urine of a dog,§ and the same was done in numerous experiments on 
animals by Drs. Lawrence and Coates.H By the same persons, the green 
sulphate of iron, injected into the abdomen of a kitten, was afterwards de- 
tected in the urine. ^ One of the substances which enters the urine with the 
greatest facility, and indeed all the other fluids of the system, is iodine. Dr. 
O'Shaughnessy found it in the urine of a dog poisoned with it. in forty mi- 
nutes after taking it.** Lugol states that in some cases, it was found in the 
urineof patients using it, almost immediately after the dose was taken.tt Dr. 
Rees, of London, detected it in the urine of a person who had taken only one 
Thomson, it has also been detected in the urine of persons using it.§§ By 
grain, in three separate doses of a third of a grain each.:{:t By Dr. A. T. 
Dr. Cogswell, experiments were m.ade upon eleven individuals, by giving 
them iodine in various forms, viz: the tincture — solution of iodide of po- 
tassium and iodide of iron in solution, and in the urine of ten of them, 
the presence of iodine was distinctly ascertained. |||| 

Iodine has also been detected in the urine in consequence of the external 
application of it. This was satisfactorily proved by Dr. Madden in five dif- 
ferent experiments, by immersing his arm in a tepid solution of iodide of 
potassium, and afterwards testing the urine. ^^ 

* New York Medical and Piiysical Journal, vol. .5, p. G24. 

t On the Structure and Uses of the Spleen. By E. Mome, Esq. F. R.S. Philosophical 
Transactions of the Royal Society for 1808, pp. 45, 133. 

I Philadelphia Journal of Medical and Physical Sciences, vol. 4, pp. II', 18. 
^ New York Medical and Physical Journal, vol. 1, p. 131. 

II Philadelphia Journal of Medical and Physical Sciences, vol. 5, p. 329. 
IF Ihid., vol. 5, p 368. 

** London Lancet for March 2(), 1836. p. G. - 

ft Essays on the Effects of Iodine, &c. p. 20. 

t\ On tiie Analysis of the Blood and Urine. By G. O. Rees, p. 88. 

§4 Johnson's Medico Chirurgical Journal, vol. S9, p. 215. 

nil An Experimental Essay, &C. on Iodine and its Con)pounds. By Charles Cogswell, 
A. B, M. D,&c. £d. p. 57. 

im An Experimental Inquiry into the Physiology of Cutaneous Absorption, &c. By 
Wm. H. Madden, M. D., p. 103. 



34 J. B. Beck on the Modus Operandi of Medicines. [Jan. 

By Cantu, globules of quicksilver were obtained from the urine of per- 
sons under the action of mercurials* — and on the authority of Prof. E. D. 
Smith, of South Carolina, it is stated that M. L'Herminier, a French chemist, 
found the phosphate of mercury in the urine of a child, that had been taking 
calomel internally for some time previously.! 

By M. Piorry, the sulphate of quinia was detected in the urine of pa- 
tients under its use.X 

Tannin, which exists in a great number of veoretable matters used as re- 
medial agents, is frequently found in the urine. In this case the fluid strikes 
a dark colour with the persalts of iron. § 

Among the most curious facts, however, that we have on this subject are 
those reported by Stehberger. These are a series of experiments made by 
him, under the superintendence of Tiedemann. The subject was a young 
man, thirteen years of age, who was affected with congenital prolapsus of 
the bladder. The prolapsus formed at the lower part of the abdomen, a 
projection of three fingers breadth, which was red and fungous, always moist 
and sensible to the touch. The urine issued continually from the ureters, 
which were completely exposed, and admitted of the secretion of the kid- 
neys being collected perfectly pure and unmixed. When any substance 
had been administered, the urine was collected every ten minutes, until in- 
dications of it were perceived. It was then examined every quarter or half 
hour, until the urine had returned to its original character. In this manner 
the progressive augmentation and diminution of the foreign substance was 
observed. The period which elapsed between the swallowing of the different 
articles and their appearance in the urine was as follows: Madder was 
perceptible in 15 minutes — indigo, in 15 — rhubarb, in 20 — gallic acid, in 
20 — decoction of logwood, in 25 — the colouring principle of myrtle berries, 
in 30 — black cherries, in 45 — the astringent principle of uva ursi, in 4,5 — 
the pulp of cassia, in 55 — prussiate of iron, in 60 — rob of elder, in 75. 
The complete disappearance of the substances from the urine was as follows: 
Prussiate of iron, in three hours and three quarters — indigo, four hours and 
a half — rhubarb, six hours and twenty minutes — decoction of logwood, in 
six hours and three quarters — uva ursi, seven hours and twenty minutes — 
myrtle berries, eight hours and three quarters — madder, nine hours — gallic 
acid, eleven hours — pulp of cassia, twenty-four hours. |1 These experiments 
are eminently interesting, not merely as establishing the general fact that fo- 
reign substances do get into the urine, but as showing the rapidity with 
which some of them get there, as well as the length of time which they con- 
tinue to pervade that fluid. 

* New York Medical and Physical Journal, vol. 5, p. 381. Also, Christison on Poisons, 
p. 292. 

t American Journal of Science and Arts. By B. Silliman, M. D. &c., vol. 3, p. 306. 

X Johnson's Journal, vol. 29, p. 215. 

§ Rees on the Blood and Urine, p. 88. 

II New York Medical and Physical Journal, vol. 6, p. 130. 



1844.] J. B. Beck on the Modus Operandi of Medicines, 35 

By Wohler, a still more extensive series of experiments are reported, the 
object of which was to show, not merely that foreign substances pass off by 
the urine, but in addition to this, to point out the changes which they undergo 
in their passage through the system. The results, as stated by him, are 
that some pass off by the urine decomposed — others in a state of new com- 
bination — while a third pass off unchanged. Those which are decomposed 
are the following: the tartrates, citrates, malates and acetates of potash and 
soda, changed into carbonates of the same alkalies. Hydro-sulphuret of pot- 
ash, changed into the sulphate of potash. Those which enter into new 
combinations with substances which they find in the body are the follow- 
ing: sulphur, changed into sulphuric and hydro-sulphuric acids — iodine, 
into hydriodic acid — oxalic, tartaric^ gallic, succinic and benzoic acids into 
combinations with an alkali. Those which pass unchanged are the fol- 
lowing: carbonate, chlorate, nitrate and sulphate of potash, hydro-sulphate, 
and hydro-cyanate of potash, protoxide of iron, borate of soda, muriate of 
barytes, silicate of potash, tartrate of nickel and potash. The principles of 
many colouring matters, such as indigo, gamboge, madder, logwood, beet- 
root, mulberries and cherries — several odoriferous principles, somewhat 
altered, such as the oil of turpentine, juniper berries, valerian, assafoetida, 
garlic, castor, saffron and opium.* 

Still more recently, Orfilahas detected the presence of arsenic in the urine 
of man, as well as of animals, poisoned by it. By him, antimony too has 
been found in the urine of persons who had been put upon the use of that 
substance. In one patient, who took twenty-four grains of tartrate of anti- 
mony in the course of twenty-four hours, for pneumonia, he obtained a suf- 
ficient quantity of the metal to exhibit it to the Academy of Medicine. In 
another patient, who took twelve grains in twenty hours, he detected the 
metal in the urine voided twelve hours after its administration. In experi- 
ments upon animals with the salts of copper, he discovered the presence of 
the metal in the urine.t 

Of the Milk.— Let us now look at another of the secretions, and see 
what are the facts in relation to foreign substances getting into this. In 
animals, it is well known that the milk partakes of the character, as to taste, 
smell, and colour, of the peculiar vegetables upon which they have been 
feeding. Thus garlic, pepper-grass, and the like, impart their properties to 
the milk of cows, as well as the butter made from it. 

By Chevallier, Henry, and Peligot, some interesting experiments were 
made on the milk of asses, to whom various substances were administered, 
and it was found that distinct traces of many remedial agents were detected 
in it. Of these, common salt was found in abundance. Sesquicarbonate 
of soda passed in great quantity into the milk, rendering it alkaline. Traces 
of sulphate of soda, when given in doses of about two ounces, were readily 

* New York Medical and Physical Journal, vol. 5, p. 624. 
f Johnson's Journal for Oct. 1840, p. 340. 



36 J. B. Beck on the Modus Operandi of Medicines. [Jan. 

detected. Iodide of potassium was readily identified, when administered in 
doses of a drachm and a half. Oxide of zinc, trisnitrate of bismuth, and 
sesquioxide were also found* By Mr. A. S. 'I'aylor, of London, traces of 
lead were detected in the milk of a cow, poisoned by accidentally swal- 
lowing a quantity of carbonate of lead, which had been mixed for paint.t 

In the human subject, iodine has in more than one instance been dis- 
covered in the milk. A woman, in Guy's Hospital, had been taking for a 
fortnight, three times a day, iodine with hydriodate of potash. On testing 
her milk with sulphuric acid and starch, iodine wasdetected.J According 
to Wallace, the milk of a nurse taking iodine, has not merely indicated its 
presence, but it has been found in the urine of the child at the breast, § 

That certain medicines, too, taken by. the mother affect the child through 
the medium of the milk, is a fact well established. This is very frequently 
observed by nurses wiih regard to cathartics, || 

By. M. Vallet, iron was found in the milk of a woman, under treatment 
with carbonate of iron. In women in health he did not find iron in the milk.^ 

Opium sometimes, too, acts upon the child in this way. Barbier relates 
a case in which he saw an infant narcotized for several hours in consequence 
of having sucked the milk of a nurse, who had a short time before swallowed 
a large dose of laudanum for cramp in the stomach.** A similar case is 
related by Dr. E. D. Smith, on the authority of the late Prof. Barton, of 
Philadelphia.tt . , . .; 

That the specific effects o( mercury maybe produced in the child through 
the milk of the nurse, is established by the best possible evidence, which is 
the cure of the venereal disease in the infant. Although it would not be safe 
in all cases, to trust exclusively to this mode of introducing mercury into the 
system of the child, yet the controlling influence of the remedy given in this 
way, has been noticed in too many cases to admit of any doubt.JJ In the 
Medical Essays and Observations of Edinburgh two cases are related, in 
which the yaws were cured in children by giving mercury to the mother. §§ 

Of the Saliva, — Iodine has been detected in the saliva of persons under its 

* Johnson's Journal, vol. 37, p. 380. 

t Johnson's Journal for July, 1841, p. 256. ^ . 

$ Johnson's Journal, vol. 37, p. 380. 

§ London Luncet for Marcii '26, 1836, p. 6. 

II "The medicines wliich affect the child the least are olive oil, castor ori, eonfectio 
senna and compound extract of coloeyntli. The sahne purges are apt to affect the child's 
bowels."— JoA/Json's Journal, vol. 36, p. 380. 

IT Journal of Pharmacy, vol. 10, p. 2o3. 

** Traite elementaire de Matiere Medicale, par J. B. C. Barbier. Tome 2, p. 702. 

ft Caldwell's Theses, vol. 1, p. 244. 

iX On this subject see Swediaur on Sy|)hilis, p. 330. B. Bell on the Venereal, vol. 2, p. 
263. CoUes' Practical Observations on the Venerea} Disease, p. 169. HumilloR on IVler- 
cury, p. 47. Ryan's Midwifery, p. 483. 

§§ Vol. 6, p. 278. 



1844.] J. B. Beck on the Modus Operandi of Medicines. 37 

use by Cantu,* and by Dr. A. T. Thomson, of London.! By Dr. O'Shawgh- 
nessy, it was found in the saliva of a dog that had been poisoned by it. 
The same fact is confirmed by Dr. WaUace.J: 

That lead taken internally, makes its way into the saliva, appears to be 
now well established. Although I am not aware that the metal has been 
actually identified in this fluid, yet the peculiar effects produced by it 
upon the saliva and the gums are sufficient to prove its actual presence there 
— these are the bluish colour of the saliva, and a peculiar discoloration of 
the gums. That lead sometimes produces an increased flow of saliva, and 
renders it of a bluish colour, had been noticed by more than one observer, 
but the discoloration of the gums caused by it, was first noticed and de- 
scribed by Dr. Henry Burton, in a paper contained in the Transactions of 
the Royal Medical and Chirurgical Society of London, for 1840. According 
to him, " the edges of the gums attached to the neck of two or more teeth of 
either jaw, are distinctly bordered by a narrow leaden blue line, about the 
one-twentieth part of an inch in width, whilst the substance of the gum ap- 
parently retains its ordinary colour and condition." This discoloration is so 
peculiar, that when once seen, it may afterwards be recognized without any 
difficulty. It is very permanent, too, having continued ibr months and until 
after death. A few hours after death it appears more distinct than during 
life. Besides this, it is not an occasional, but a constant occurrence in per- 
sons under the influence of lead. § Now that the bluish colour of the saliva 
and this blue line on the gums, depends upon the actual presence of the lead, 
in some shape or other, can hardly be questioned. Pereira explains it, by 
supposing that a sulphuret of lead is formed by the action of sulphuretted 
hydrogen, evolved by the lungs, on the lead contained in the salivary and 
buccal secretion. In confirmation of this opinion, he adds that he has seen 
*'an alloy of mercury and silver, introduced into the hollow of a tooth, 
become coated in a few days with a black film of metallic sulphuret."|| 

In connection with the subject of the absorption of lead, there is an inte- 
resting occurrence related by the learned Thunberg, which is not unworthy 
of being recorded. During the voyage to the Cape of Good Hope, about 
twenty of the officers and men were poisoned in consequence of some 
white lead being accidentally mixed with their food. He himself was 
severely afl?*ected, and he gives a detailed account of his symptoms. Besides 
the ordinary symptoms of coHc, &c., he speaks particularly of the swelling 
of the gums, continued salivation, and on the tenth day after he was at- 
tacked, he speaks of lead as "perceived in his saliva."^ 

* North American Medical and Surgical Journal, vol. 7, p. 433. 

+ Johnson's Journal, vol. 29, p. 215. t London Lancet, N. S. vol. 7, p. 613. 

§ For many interesting- details in relation to this subject, see Transactions of the 
Royal Medical and Chirnrfjical Society of London, vol. 23, p. 63, 

II Pereira's Materia Medica, vol. 1, p. ( 53, Am. ed. 

IT Travels in Europe, Africa and Asia, made between the years 1770 and 1779, By 
Charles Peter Thunberg, M. D., 3d. td., Lynd., vol. 1, p. 83. 



38 J. B. Beck on the Modus Operandi of Medicines. [Jan. 

Of the Perspiration. — By Dr. A. T. Thomson, iodine has been detected 
in the perspiration of those using it, and the same has been done by Gantu.* 

That sulphur taken internally, passes off by the skin, cannot well be 
questioned. When continued for any length of time, the perspiration gives 
out a smell of sulphuretted hydrogen. Articles of gold and silver worn by 
the patients are blackened, and sometimes their linen is tinged yellow.t 

That mercury passes off by the skin is proved by the blackening of the 
skin, which has been known to follow its use after the administration of 
sulphur. A case of this kind, quoted by Pereira, is related by Rigby, 
{Lond. Med. Rep., for April, 1837.) In this case the sulphur and mercury 
are both thrown out by the skin, forming the black sulphuret of mercury on 
the surface.^ 

Of the bones and soft solids. — That the bones of animals fed upon mad- 
der are coloured red has long been known, and what is curious is, while it 
thus tinges the bones, it does not affect in any way the soft solids. The 
oldest writer who notices this interesting property of madder appears to 
have been Lemnius, in his treatise, De miraculis occidtis naturse. He 
was a physician of Zealand, a country in which the madder has been cul- 
tivated from the earliest periods. His work was published in the year 
1564.§ It did not, however, attract any attention until a much later period, 
about a century ago, when an English surgeon, by the name of Belchier, ac- 
cidentally observed that the bones of some pork brought upon the table were 
red. On inquiry, he ascertained that it was occasioned by the animals 
feeding on the water mixed with bran in which cotton cloth was boiled, and 
which was coloured by the madder used in printing it. By subsequent ex- 
periments he convinced himself that the colouring of the bones was owing 
to the madder. In 1736, he communicated the discovery to the Royal So- 
ciety of London, in a paper which was published in their Transactions. I| 
Recent experiments not merely confirm the fact, of which indeed there is 
no doubt, but prove also that the bones are tinged by other substances. — 
Dr. Milnor, of Philadelphia, found that the bones of a cat fed for several 
days on Prussian blue and indigo, exhibited the blue colour "in a remark- 
able degree."^ In a dog too, fed upon indigo for ten days, the bones, on dis- 
section, were found to be "spotted in many places with the indigo tint."** 
He also found that a dog fed upon madder and anotta for twelve days had 
his bones of a light pink colour, which on boiling, assumed a dark reddish 
hue.tt Even the bones of the foetus, have become coloured by feeding the 
parent animal on madder. To show this, some highly interesting experi- 

* Christison on Poisons, p. 13. 

t Diet, de Mat. Med. Par Merat et De Lens, torn. 4, p. 452. 

X Pereira, vol. 2, p. 590. 

§ Beckman's History of Inventions and Discoveries, vol. 3, p. 276. 

|] Philosophical Transactions, vol. 39, pp. 287,299. 

IT Philadelphia Journal of Medical and Physical Sciences, vol. 4, p. 14. 

** Ibid., vol. 4, p. 17. ft Ibid., vol. 4, p. 16. 



1844.] J. B. Beck on the Modus Operandi of Medicines. 39 

ments were made by Prof. Mussey, now of Cincinnati. He caused a sow 
to be fed daily during the last eight weeks of gestation, on madder. On the 
day the farrow was produced, several of the pigs were killed and their bones 
inspected, when every bone was found strongly tinged with red. In another 
experiment, a sow was fed for twenty days on madder — she was then bled 
to death, and half a dozen nearly full grown pigs found in the uterus — on 
examination, all the bones of the pigs were of a reddish colour. The bones 
of the sow too were dyed of a fine red, approaching scarlet.* 

The bones of the Canada porcupine, during winter, are said to be of a 
greenish yellow colour, owing, as is supposed, to the bark of the pine on 
which the animal feeds in that season of the year.t 

That mercury is deposited in the bones of those who have undergone a 
long course of mercurial medication, is an opinion which has been entertained, 
almost ever since that article was used for the cure of the venereal disease. 
By many, 1 am aware, this idea is ridiculed. Ridicule, however, is a poor 
substitute for argument. And unless we call in question the accuracy of all 
the facts reported on this subject, the occasional occurrence of it must be 
admitted .:|: That a long course of mercury does in some way or other affect 
the osseous system is certain. Thus, for example, the fact has been ob- 
served that the bones of those who have undergone such courses of mercury, 
never make such white or elegant skeletons as others. § Dr. Monro too, in 
his anatomy, mentions mollilies ossium as having succeeded a course of mer- 
cury.ll 

That the skin becomes permanently affected by the internal use o^ ni- 
trate of silver, is now established by so many cases, that no doubt can exist 
on the subject. This interesting fact appears to have been first noticed by 
Swediaur, who relates the case of a protestant clergyman, near Hamburgh, 
who took by the advice of an empiric, some nitrate of silver, for an obstruc- 
tion of the liver. After continuing the use of it for some months, his skiti 
began to change gradually, until at last it became almost black. This colour 
continued for several years and then began, as is stated, to diminish.^ It 
was not, however, until the year 1815, that the fact was fairly brous^ht 
before the notice of the profession, by Dr. Albers, a distinguished physician 
of Bremen, who gave an account of it in a paper which was published in the 
Medico-Chirurgical Transactions of London. Of one case which fell under 
his observation, he gives the following details: A woman aged thirty years, 

* American Journal of Medical Sciences, vol. 5, p. 20. 

t Pennant's Arctic Zoology, vol. 1, p. 126, as quoted by E. D. Smith. Caldwell's 
Theses, vol. 1, p. 254. 

X For a detail of facts on this subject, accompanied with some judicious reasoning-, I 
must refer to Christison on Poisons, p. 290. 

§ Principles of Military Surgery. By John Hennen, M. D., «Sz^c., p. 397. Am. ed. 

II Ibid. p. 397. 

IT La Medecine eclairde par les Sciences physiques, &c. Fourcroy. Tom. 1, p. 342. 
Lond. Med. Chir. Trans., vol. 7, p. 292. 



40. J. B. Beck on the Modus Operandi of Medicines, [Jan. 

who was attacked with epileptic fits, was put upon the use of nitrate of silver, 
in the form of pills, night and morning. By the use of this remedy the 
disease was completely arrested, but without the knowledge of Dr. Albers, 
she continued the use of the pills for nearly three years and a half. To- 
wards the end of the last year, a change of complexion became observable, 
and pariicularly in the face. " The tinge was at first bluish; it then grew 
gradually darker, till at last it became, as it remained afterwards, quite dark 
and almost black, 'i'he blue colour spread all over the body. It was most 
intense on the face, on the fore part of the neck, as far as the middle of the 
bosom, and on the hands and nails. The sclerotica was also discoloured." 
The blood appeared on examination, similar to that of a person in perfect 
health, and in every other respect she was perfectly well. Various remedies 
were used to remove the discoloration, such as sulphuric and nitric acids, 
chalybeates, baths, &;c., but all to no purpose, and at the time when Dr. 
Albers gives the account of the case, it had remained in this state for ten 
years.* In the same paper three other cases are related, in which the same 
effect was produced in epileptic patients, who used this remedy. By Dr. 
Roget of London, another case of a similar kind is related. The subject 
was a lady twenty-tive years of age who was attacked with epilepsy, and to 
whom tlie remedy was given for four or five months. What is curious in 
this case, the blackness did not show itself until some months after the dis- 
continuance of the remedy. The tongue and fauces first became black as if 
stained with ink, and gradually the whole skin became affected. No synip- 
tom of the original disease returned, t After the lapse of twelve years, the 
discoloration remained unchanged.;}: About the same time, by Bertini, of 
Geneva, in a dissertation entitled "Z)e usu inferno pr^'parationum argenti,''^ 
three cases of a similar character are recorded. In all of these cases, the 
disease for whicfi the remedy was prescribed was epilepsy. § In 1818, 
Dr. Badeley published a case in which a young man was cured of epilepsy 
by the nitrate of silver, taken in doses of from a grain to a grain and a half, 
three times daily for a year and a half. In this case, besides the skin, the 
roof of the mouth, the inside of the cheeks, and back part of tiie tongue was 
dark. The tunica sclerotica was also discoloured. || By Dr. Vetch, a case 
is related of a lady, who after a long continued use of this article, became 
discoloured in the upper ])art of the body, while the colour of the lower was 
unchanged; and in both eyes, the iris, which was naturally of a black or deep 
brown, was changed to a light blue colour.^ Dr. Paris gives the history 
of a case in which this discoloration was produced in a lady, who took 
large quantities of nitrate of silver, for a dyspeptic complaint.** Still more 

* Medico-Chirurffical Transactions of London, vol. 7, p. 284. 

t Ibid., vol.7, p. 284. 

I Cooke on Nervous Diseases, p. 397, Am. rd. 

§ Medico-Chirur^rical Transactions of London, vol. 7, p. 293. 

\\ Ibid., vol. 9, p. 2.38. IT Cooke on Nervous Diseases, p. 397. 

** Pharmacologia, p 296, Am. ed. 



1844.] J. B. Beck on the Modus Operandi of Medicines. 41 

recently, M. Rayer, of Paris, lias recorded four cases of this kind which 
fell under his observation.* By M. Lekit two cases are reported in which 
not merely the skin, but the mucous membrane of the stomach and intestines, 
presented the same appearance. One of these cases was that of a young 
man, twenty-eight years of age, who had taken nitrate of silver for thirteen 
months for epilepsy. A short time afterwards (in 1822) his skin began to 
blacken. In 1827 he died, and was then examined, and the following ac- 
count is given of the appearances observed. "All the external integument 
was of a gray slate colour of moderate intensity. This hue, which was 
nearly the same in all parts of the skin, did not prevent the vascular colour 
of the cheeks from being distinguished. The edges of the lips, their internal 
surface, the inside of the cheeks, and both sides of the tongue, presented an 
exactly similar hue; the internal surface of the whole alimentary canal was 
of the same colour as the skin and the upper opening of the gastro-pul mo- 
nary membrane. In the stomach, this tint was extremely deep; it was not 
mixed with any violet coloured marblings, depending on vascular patches or 
striae; it was uniform over the whole extent of the viscera. In both the 
small and great intestines it was a little clearer, but still very appreciable; it 
was uniform as in the stomacli, and slight traces only of vascular ramifica- 
tions were discovered in the whole extent of the alimentary canal. "t Ac- 
cording to M. Lelut, the seat of the discoloration is the chorion. He 
thinks the epidermis and the rete mucosum are not necessarily alTected. 

In addition to the foregoing, another case is related by Wedemeyer, of an 
epileptic, who was cured by nitrate of silver, but died afterwards of diseased 
liver and dropsy. His skin had previously acquired the bluish tint; on 
examination after death, all the internal parts were found similarly disco- 
loured; and on chemical examination, metallic silver was found by M. 
Brandes, in the plexus choroides and pancreas.! 

I have been thus particular in detailing the foregoing cases of the effects 
of nitrate of silver, because I look upon them as furnishing one of the most 
striking and interesting of the proofs of the absorption of medicines. That 
the discoloration in these cases is owing to the deposition of the silver on 
the affected surface, cannot, I think, be questioned. In what state precisely, 
it is thus deposited, is not satisfactorily established, but that it does exist 
there in some form or other is certain, and that it must have got there by 
being absorbed and carried into the circulation is equally certain. § 



* On Diseases of the Skin, p. 962. 

t Rayer on Diseases of the Skin, p. 963. 

t Brando's Journal of Science, new series, vol. 6, p. 430, 

§ Prof. A. T. Thomson supposes that the nitrate of silver, aflcr passing into the circu- 
lation undecomposed, is converted into the chloride when it gets to the skin. "The 
chloride, we know," says he, "acquires a gray, leaden colour, whenever it remains in 
contact with animal matter, and as it is insoluble, it is incapable of being reabsorbed, is 



42 J. B. Beck on the Modus Operandi of Medicines, [Jan. 

Besides the facts already detailed, the recent experiments of Orfila with 
arsenic, tartar emetic, and the salts of copper, furnish the most overwhelm- 
ing evidence of the absorption of these articles, and of their subsequent 
appearance in the solid viscera, both of animals and of the human subject. 
In several cases, arsenic has been extracted by him after death, from the 
liver of persons poisoned by it, and in an aged female, who died fifteen 
hours after taking ten grains of tartar emetic, distinct traces of antimony 
were found in the liver, kidneys, and spleen.* Copper was found in the 
lungs, heart, liver, spleen, and kidneys of the animals to whom it was given. 
In a case of death by poisoning by arsenic, Mr. Taylor, of London, also 
detected it in the liver.t 

I have thus, in a summary way, detailed a number of facts, from which 
the following conclusions may safely be drawn: 

1. That both in man and in animals, foreign substances may and do get 
into the circulating fluids. 

2. That among these, are several medicinal agents in ordinary use. 
With so many positive proofs of the absorption of various articles, it is 

reasonable to infer, too, that when the range of experiments shall be sufB- 
ciendy extended, and the processes for detecting substances shall have be- 
come sufficiently improved, we shall be able to establish the same in relation 
to a great number of agents concerning which, we have at present no certain 
evidence. In the mean time, it ought to be recollected, that the fact of our 
not being able to detect the presence of any article in the fluids, furnishes 
no certain proof that it does not actually exist in them. This is a point 
which has been argued with great clearness by Dr. Christison, in relation to 
poisons, and it holds with much greater force in its application to ordinary 
medicines. Among others, the two following reasons seem most conclu- 
sively to establish this. In the first place, the quantity of the article which 
enters the blood, may be too small to admit of detection, after being distri- 
buted throughout the body. Thus Sir Everard Home found, that a quarter of 
a grain of prussiate of potash could not be detected in two ounces of the 
serum of the blood. It required to be increased to a whole grain before the 
usual tests indicated its presence.^ In the second place, many substances 
entering the blood may undergo such changes as to render their detection 
by chemical reagents impossible. Of this Dr. Christison gives a striking 
illustration. He injected into the femoral vein of a dog, eight grains and a 
half of oxalic acid, which caused death in thirty seconds, yet he could not 

fixed in the rete niucnsum, and a permanent stnin is given to the skin. This effect, there- 
fore, happens whenever a more than usual quantity of muriates is separated by tiie cuti- 
cular capillaries." — Elements of Mat. Med. and Therapeutics, vol. 1, p. 714. London. 

* Medico-Chirurg. Journal for 1840, p. 43. Boston Med. and Surgical Journal for 
1840, p. 118. 

t Guy's Hospital Reports, vol. 7, p. 341. 

X Philosophical Transactions of London for 1808, p. 53. 



1844.] J. B. Beck on the Modus Operandi of Medicines. 43 

detect it in the blood of the iliac vein and vena cava collected immediately 
after death.* These considerations unquestionably prove that substances 
may exist in the blood and yet not be cognizable by the ordinary tests. 

That certain medicinal substances are taken into the circulation is then 
proved beyond question. This being so, another point remains to be settled, 
and this relates to the precise mode in which their effects are finally produced. 
On this there are two different opinions. By some, it is supposed, that the 
medicine after being introduced into the current of the circulation, is carried 
to different parts of the system and produces its effects by actual contact with 
the parts or organs in which its agency is developed. Others again have 
conjectured that the medicine mingled with the blood, merely makes an im- 
pression upon the nerves of the inner membrane of the blood-vessels, and 
that this impression is sympathetically transmitted to distant parts. With- 
out denying that some may act in this latter way, the probability is that 
the former is the more general mode of operation. 

In conclusion, the propositions, which, in the present state of our know- 
ledge of the action of medicines, appear to me to be entirely defensible, are 
the following: 

1. That medicines differ in the manner in which their remote effects are 
produced. 

2. That some produce their remote effects by sympathy, or through the 
medium of the nerves. 

3. Tiiat others produce their remote effects in consequence of being 
absorbed into the circulation. 

4. That those which are absorbed, produce their effects in different ways 
■ — some, probably, by making an impression on the nerves of the inner mem- 
brane of the blood-vessels, and having this impression propagated to other 
parts sympathetically — some, by being carried through the circulation to dis- 
tant parts and acting on them by actual contact, — while others aofain, are 
mingled with the blood, pervade every portion of the system, and thus in a 
greater or less degree, modify the condition, not merely of the fluids, but of 
the very solids of the body. 

Each of these propositions might furnish the basis for much comment, and 
many inferences of practical importance. The length to which this paper 
has already extended itself, however, forbids my entering upon them at 
present. 

* On Poisons, p. 14. 



44 Atlee's case of Diseased Ovaria complicated with Ascites. [Jan. 



Art. III. — Case of successful Peritoneal Section for the removal of two 
diseased Ovaria complicated with Ascites. By John Ji. Atlee, M. D., 
of Lancaster city, Penn. (With three wood-cuts.) 

I WAS requested to visit Miss C. R. December 6lh, 1839, in consultation 
with a highly respectable and intelligent physician of this city, from whom, 
and from the patient, I obtained the following history: 

The patient was then about twenty-five years of age, of medium stature, 
lymphatic temperament, fair and pale complexion, dark hair, dark gray 
eyes, and somewhat emaciated. She first discovered an alteration in her 
usual health in December, 183G. For about two months before, she had 
observed a gradual increase of size in the lower part of the abdomen, when 
she was attacked with a somewhat acute pain in one of the iiiac regions, 
which continued for a few days accompanied by a good deal of flatulence. 
This subsided with the pain, and she continued better for a few weeks, ex- 
cept as to the distension, which was gradually increasing. She was then 
attacked by a similar pain on the opposite side, which continued about as 
long as the other, and then disappeared in the same manner. In addition 
to this, there was considerable pain across the whole lower part of the abdo- 
men, so that the pressure of her corset, and leaning out of the window were 
painful to her. Her menstruation at this time was not interrupted. She 
had previously been subject to sick head-ache with constipation; and during 
the above period, she was afflicted with difficult and painful micturition, 
which would continue for several days. In the spring and summer of 1837 
she had consulted a physician for five or six months without relief. In the 
autumn and winter she visited some friends in Maryland and Virginia; and 
at their recommendation consulted a physician at Leesburg, who salivated 
her for two or three weeks. Finding no relief, and her size increasing, she 
returned home in June 1838, and placed herself under the care of the medical 
gentleman with whom I was called to consult. Under his care she con- 
tinued for eighteen months, and was subjected to the usual course of treat- 
ment for dropsy, with only partial relief. At one time it was supposed that 
considerable benefit resulted from the alterative and diuretic plan pursued; 
and that there was some absorption of the effused fluid; but this soon ceased; 
and when I visited her, I found the abdomen distended to the size of the 
full period of utero-gestation. There was no oedema of the lower extremities. 
She was carefully examined as to the true character of her disease, and the 
conclusion then arrived at, was that the effusion was peritoneal. The treat- 
ment agreed upon in December, and which was continued until June 1840, 
was a repetition, with some variation, of the previous course, embracing 
calomel, blue pill, taraxacum, the vegetable and saline diuretics, and hydra- 
gogue cathartics. 

The usual tests applied to the urine having failed to throw any light upon 
the cause of the effusion, and no benefit having followed the medical treat- 
ment, it was then proposed to tap the abdomen, with the view of ascertaining 
the existence of organic disease, and to facilitate the action of the kidneys, 
which for some time had nearly ceased to be influenced by medicine. Ac- 
cordingly on the 2nd June, 20 lbs. of a clear and very light straw-coloured 
serum were removed, and the abdomen very carefully examined. No ab- 



1844.] Atlee*s case of Diseased Ovaria complicated with Ascites, 45 

normal condition ofany of the viscera usually implicated could be discovered. 
There was one small spot situated about one and a half or two inches to the 
left of the umbilicus, where some tenderness on hard pressure was com- 
plained of; but this was the only point, and it was so limited that we could 
draw no unfavourable inference with respect to its influence upon her disease. 

The patient being now temporarily freed from the burden of water, visited 
her friends at York, Pa., where she remained for a few weeks, when finding 
her disease returning, she came home; and at her particular request was 
placed under my sole care. From this time until December 1842, she was 
subjected to almost every variety of treatment. Mercury, iodine, and their 
various combinations, were both internally and externally administered, 
aided by epispastics, and assisted by almost every form and combination 
of cathartic, laxative, and diuretic treatment, which my experience and in- 
genuity could devise. She was twice kept under the influence of mercury 
for three or four weeks, but without benefit. For a period of four months 
in the summer of 1841, and after the third tapping, the disease appeared to 
be permanently arrested; and she once more visited her friends in Maryland 
and Virginia; but when she returned in September, I found that the abdomen 
was again filling, but more slowly than at any previous period. Mercury 
was now thrown aside, and a tonic and diuretic plan substituted, with exer- 
cise out of doors whenever the weather permitted. This caused an improve- 
ment in her general health, and appeared to moderate the effusion, as she 
was not tapped again for an interval of fourteen months; when in July 1842, 
twelve pounds of serum, possessing its former characters, were removed. 
After each tapping a careful re-examination of the abdominal viscera was 
made; but no organic lesion discovered. 

From this time there was a more rapid accumulation of the fluid, so that 
in December, 22 lbs. were drawn off. During the subsidence of the abdo- 
men from the escape of the fluid, my brother, Dr. Washington L. Ailee, 
who assisted me, was sensible of a hard substance falling against his hand; 
which, upon examination, proved to be a rounded hard tumour just above 
the right inguinal region, rising out of that side of the brim of the pelvis, 
and as large as a turkey's egg. It was movable to some extent, but seemed 
attached to the right side. After a careful examination, we came to the con- 
clusion, that the tumour originated in the right ovarium; and, from the ab- 
sence of all other evidence, we believed, had been the cause of the ascites. 
From this time, the tumour was frequently examined, and was observed 
gradually to increase. By the month of March, however, this examination 
was rendered difficult from the increasing eflusion. The abdomen filled 
rapidly, and early in May the patient complained more than at any previous 
period of oppression in the recumbent position — her lower extremities be- 
came very oedematous, and exercise was unusually fatiguing to her. Her 
general health, however, was not much interrupted, nor had it been. For 
the last year her menstruation had been somewhat irregular, and at one time 
was absent for one or two periods — the quantity generally less than usual, 
since the commencement of her disease. Her habit of body was costive — 
and she constantly used a mild laxative pill. The pulse ranged from 66 to 
78, never below; and seldom above these numbers — until within the last few 
weeks, when it would reach 90. It was occasionally small and vibratory, 
but generally soft and compressible. The tongue generally clean, would 
now and then become coated with a thin yellowish fur, with some redness 
at the tip and edges; but the use of aperient medicine, with mild alkaline 

No. XIII.— January, 1844. 4 



46 Atlee's case of Diseased Ovaria complicated with Ascites, [Jan. 

demulcent drinks, relieved her from the irritation of the stomach and flatu- 
lence, which produced it. 

One of the most remarkable symptoms attending her case, was the occa- 
sional recurrence of a pain in the left hypochondriac region, occupying a 
space as large as the palm of the hand, and extending half way down and 
across the abdomen. Whenever this pain returned she complained very 
much of flatulence of the stomach. The pain would recur once in three or 
four weeks, continue for three or four days, and was almost invariably fol- 
lowed by an increased efl'usion of water; as was ascertained by careful ad- 
measurement in a prescribed and fixed position. At times, the pain was 
attributed to an error in diet, or exposure to cold; but it would also return 
without any obvious exciting cause, and seldom or never lasted longer than 
four or five days. With but two or three exceptions during three years, an 
increase of the efl'usion was the consequence. The operation apparently 
revealed the cause, and the fact will, therefore, be again aUuded to. 

As it now became again necessary to remove the water, 1 felt, from the 
circumsiances above detailed, very considerable anxiety respecting the ulti- 
mate fate of my patient, and the course to be adopted, should my fears 
regarding the progress of the tumour be realized. I thought it my duty to 
prepare her mind for the consequence of its increased development. On 
the 13th May last, assisted by my brother, we removed 32lbs. of serum, 
possessing all the characters of the fluid previously taken away, except that 
it was rather more highly coloured. We found that there had been a very 
rapid enlargement of the tumour previously discovered in December. It 
was now quite as large above the brim of llie pelvis as the fcetal head. The 
hard and rough portion first observed, had risen higher in the abdomen; and 
lay on the right side, extending to the median line: behind this, and to the 
right, a lari^er and smoother portion was perceptible, extending above the 
inferior margin of the lumbar region; and, in the relaxed condition of the 
integuments, permitting the fingers to pass between it and the psoas muscle. 
Between these two portions a well defined sulcus was observed. In the 
median line, and low down in the hypogastric region, behind the symphysis 
pubis, the fingers, passing down the hard and rough portion, came upon a 
smooth surface about an inch and a half wide; and, in exploring to the left 
side a second tumour was discovered just rising above the brim of the pelvis 
in the left inguinal region, and as large as an egg; this was perfectly smooth 
and its examination gave no pain. Its mobility was not so great as that of 
the tumour on the right side. On examining, /or the first time, per vaginam 
el per rectum, in a day or two afterwards, the os tincce was found in a normal 
condition, almost immovable, and pressed up close behind the symphysis 
pubis. On the right side, a tumour was rather indistinctly perceptible occu- 
pying the upper and right sitle of the {)elvic cavity. On the left, the whole 
side was filled with a soft, rounded and elastic tumour, between the rectum 
and vagina, which moved up and down with great facility, by alternate pres- 
sure above and below the brim. The true slate of the case was now ascer- 
tained, and no doubt existed on my mind that both the ovaria were diseased 
and enlargetl; and I cannot but express my regret, for the benefit of those 
of my professional brethren who may have the care of female patients 
labouring under ascites from obscure or unknown causes, that I had not long 
before proposed a similar examination. Regard for the feelings of my 
patient might have forbidden it, had its necessity occurred to me— but it did 
not, until alter the first tumour was discovered; and it was then postponed 



1844.] Atlee's case of Diseased Ovaria complicated with Ascites. 47 

until the present period, as until now, it was not tlionght to be absolutely 
required. Such an examination, at the commencement of the disease, might 
have prevented a vast deal of unnecessary speculation as to the cause; even 
if it had not led to an earlier operation for its removal. I would, therefore, 
strongly recommend a similar examination in all cases of ascites, where any 
doubt exists as to the *' fons et origo raali." 

The opinion we had now formed in regard to the existence of ovarian dis- 
ease, was confirmed in a few days afterwards by my friend Professor Horner, 
of the University of Pennsylvania, who was passing through Lancaster, and 
who visited and examined the patient. It was now my duty to communicate 
to her the above opinion, and to state to her with candour and frankness, her 
real situation. If left to itself, her disease must prove inevitably, and from 
her recent symptoms, perhaps, rapidly fatal. The tumour on the right side 
was obviously a compound ovarian tumour; were it like that on the left side 
— apparently a simple cyst — the accidental or designed rupture of it, were 
there but one, might terminate favourably; but even of this event there was 
only a remote possibility, and but few favourable cases are recorded. The 
right tumour, however, was not of this character; and but one remedy, that 
of extirpation, could prove effectual. I frankly informed her of the magni- 
tude, and of all the dangers of the operation; concealing nothing as to its 
immediate or remote consequences; and I detailed to her all the unsuccessful, 
as well as the successful, cases, so far as I could collect them from my own 
library and those of my friends. I was not then aware of what has been 
recently accomplished in England, by Drs. Clay and Walne; but the trium- 
phant results of American Surgery satisfied me, that if my patient, after a 
full understanding of her case, and the dangers of the operation, decided 
upon it, it was my duty to undertake it. To her immediate friends and 
relatives, who hold a highly respectable station in society, a similar state- 
ment was made; and after ample time for deliberation and consultation with 
them, she determined upon having it performed. 

It was not until my heroic patient made known to me this decision, that 
I felt in all its aspects the great responsibility resting upon me. I had felt it 
my professional duty to inform her that an operation could be performed for 
her relief, — but it was one which met wiih but little countenance from the 
profession. With the single exception of L'Aumonier, of Rouen, in 1775, 
Dr. M'Dowal, of Kentucky, had, so far as the records of Medicine inform 
us, been the first successfully to prove its practicability — but few had followed 
him in this country, and still fewer in Europe. On the contrary, the lead- 
ing Medical and Surgical Journal, in Great Britain, had denounced it; had 
censured those who attempted it; had pronounced it impracticable; and had 
even questioned the veracity of those who had been the pioneers in this 
much abused operation. There was, therefore, but little sympathy, and 
much censure, to be expected, should I fail of success. With my brother, 
only, did I counsel in regard to it, and he concurred with me in the propriety 
of operating. 

It was now determined to take advantage of every circumstance, which 
could exert a favourable influence. The patient was advised to observe the 
utmost care in diet and exercise — to use freely nutritious but not stimulating 
food — to take exercise in the open air, whenever the weather permitted — 
and, in short, to pursue such a hygienic course as would tend to diminish 
the natural and acquired irritability of her system. The prevalence of east- 
erly storms at this period of the year producing sudden alternations of tern- 



48 Alice's case of Diseased Ovaria complicated ivith Ascites. [Jan. 

perature, made it advisable In postpone the operation until the summer season 
had fairly arrived, and the 29th June was finally fixed upon for it. As in 
almost ail cases of diseased ovaria, the dropsy, when it exists, is encysted, 
a strict examination was again made, with the view of determining this point. 
The patient was confident, that at the beginning of her disease, the swelling 
had commenced, not at eiiher side, but at the central and inferior part of the 
abdomen; and had gradually extended upwards. The fluid at all the tappings 
had been decidedly thin, pale straw-coloured, and serous; and not gelatinous, 
greenish, nor offensive, as in encysted dropsy, particularly after repeated 
tappings. As the abdomen again filled, the intestines invariably floated upon 
the upper surface of the fluid; and could be detected upon percussion by 
their tympanitic sound in every posture of the body as occupying this posi- 
tion. Another, and a strongly marked character of ascites, was invariably 
present; this was, that the impulse on percussion was felt to be communi- 
cated in full force by the opposing fingers, and at every and all the opposite 
points of the abdomen. This cannot be the case in encysted dropsy, unless, 
which rarely happens, there be but a single cyst. Where more than one 
exists, the percussing force is evidently weakened when transmitted through 
the membranous septa which intervene between the points of examination. 
It was also observed that immediately after tapping, when the parietes of the 
abdomen were most relaxed, no preternatural thickening of the walls, such 
as would be produced by a thickened cyst, existed. For several days pre- 
ceding the operation, the urine was tested by heat, nitric acid, and litmus 
paper. No albumen was discoverable, and acidity was always present. The 
secretions from the bowels were also of a healthy character; and her system 
was considered to be in as favourable a state, as, consistently with her dis- 
ease, could be desired. 

On the evening of the 27th June, a dose of mild laxative pills, of aloes, 
rhubarb, and ipecac, was administered, which operated three or four times 
during the day preceding the operation, and with a view to lessen as much 
as possible the flatulent distension of the bowels, and thereby avoid trouble 
from them durinir the operation, all solid food was from that time prohibited; 
the nourishment limited to barley water, and on the evening of the 28th ten 
drops of McMunn's elixir of opium were given, to quiet the bowels. This 
was the only anodyne exhibited before the operation. To lessen the vio- 
lence of the shock and its depressing eflect upon the nervous system, the 
patient was requested not to conceal her. pain, but to cry out lustily, if dis- 
posed to do so. Fortunately, except during the first incision, she suflered 
but little. At the time of the operation the temperature of the room was 
about 80° Fahrenheit. It was not less than 80° out of doors, and it remained 
at about that standard until the evening of the fourth day afterwards. Early 
on the morning of the operation, the patient was visited, and found to be as 
composed and cheerfid as, under tlie circumstances, could be wislied. Her 
pulse exhibited considerable nervous excitement, ranging from GO to 100, 
from this lime until just before the commencement, when it was 104. 

Operation. — June 29, 184.3. The patient was placed upon a common 
dining table with the leaves down. Her body was slightly elevated, with 
her bead and shoulders supported by pillows, her feet resting on chairs 
about two feet apart. Standing on her right side, with juy brother. Dr. W. 
L. Atlee, as my principal assistant, and in the presence of Drs. flumes, 
Parry, i\efl^, and Elder, and of Messrs. Bare, Coxe, and Richards, our 
pupils, all of whom promptly and kindly rendered such assistance at the 



1844.] Atlee's case of Diseased Ovaria complicated with Ascites. 49 

several stages of the operation, and at such stations about the patient as 
had been previously assigned to them, I commenced by making an incision 
about nine inches long, through the skin and cellular tissue, from half an 
inch below the umbilicus to within an inch and a half of the upper sur- 
face of the symphysis pubis. The length of the incision between these 
two points was owing to the ascitic distension. An opening was now 
carefully made through the linea alba, a director introduced, and an incision 
made for an inch each way above and below the opening. Some slight 
difficulty occurred in doing this exacdy in the median line, owing to the 
adhesions between the parts, occasioned by the previous wounds in tap- 
ping. The peritoneum was now exposed, and to test the fact, whether the 
dropsy were peritoneal or encysted, which had been the subject of discus- 
sion between my brother and myself, a very small opening was made through 
it with the point of the scalpel. This was immediately followed by a dis- 
charge of thin and pale straw-coloured serum. Being now satisfied that the 
dropsy was peritoneal, and had been caused by the obstruction to the circu- 
lation, and irritation produced by the tumours, I plunged a trocar through 
the opening, and drew off about 18lbs. of a similar fluid. The abdominal 
cavity was then emptied as much as possible, by pressure on its whole an- 
terior surface, and the fascia and peritoneum opened by the probe-pointed 
bistoury, guided first by the director and subsequently by the two first 
fingers, to the extent of the first incision. About 2 lbs. more of serum 
escaped from the most dependent part of the wound. The first thing that 
presented itself, when the cavity of the abdomen was opened, was the upper 
and inner part of the tumour, as large as a goose-egg, composed of very 
small hydatids, varying from the size of a millet seed to that of a dried pea, 
and of a cream colour, projecting out of the pelvis on the right side, above 
the peritoneal investment of the tumour, and overlapping it like a mushroom 
for half an inch in every direction. Above this, and to the right, was seen 
that portion of the tumour which projected highest above the brim, covered 
by peritoneum, and extending over the iliac vessels. In the centre of the 
pelvis, and very much " in situ," the fundus uteri could be seen, forming 
the plane surface previously felt through the integuments, and closely wedded 
between two ovarian tumours. ' The left ovarium filled completely that side 
of the cavity of the pelvis, and rose 1^ or 2 inches above the brim, having 
the fallopian tube and broad ligament expanded over it. The fundus of 
the vesica urinaria, which had been emptied just before the patient was 
placed on the table, was close behind the symphysis pubis, and appeared to 
occupy but little space. The right ovarium, on the right side of the hyda- 
tid portion, was elevated about four inches above the brim of the pelvis; 
and was, to my surprise, firmly attached all round the brim and sides, from 
the crest of the pubis to the projection of the sacrum. From the sulcus 
formed between the hydatid portion, and that covered by the peritoneum, 
and strongly attach'^d to it, a bright red fillet or band of arteries, about five- 
eighths of an inch wide, and six inches long, and resembling, in regularity 
of arrangement and size, the texture of a gum elastic suspender, extended 
obliquely across the median line of the body, and was attached to the omen- 
tum high up in the left hypochondriac region. From the highly injected 
appearance of the investing membrane of this fillet, I am induced to think 
that it was the seat of the pain in the above region of the abdomen, so fre- 
quently complained of by the patient; which pain had suddenly returned 
two days before the operation, and still existed at the time of it. As these 



50 Atlee's case of Diseased Ovarla complicated with Ascites. [Jan. 

arteries, from their size and number, seemed to afford the principal supply 
of blood to the tumour, a single leather ligature was thrown around the 
whole, tied firmly, and cut off close to the knot. They were then divided 
within half an inch of the tumour. I next tried to introduce my fingers 
between the tumour and the brim of the pelvis, but this was rendered im- 
possible by the tiimness of the bands above alluded to. It was now found 
nenessary to extend the incision through the skin, fascia and peritoneum, 
down to the symphysis pubis, to fiicilitate the dissection of the anterior part 
of the tumour. I then commenced near the crest of the pubis, and by 
means of the scalpel, probe-pointed bistoury, and the fingers, cautiously 
separated the adhesions two-thirds of the way round the right side of the 
pelvis. At this point the bands were particularly firm, and in dividing them 
an artery of considerable size was cut. This was tied with a leather liga- 
ture, and cut off close. It was at this stage of the operation, that in raising 
a flap of thickened peritoneum, I discovered beneath it the proper, or albu- 
gineous coat of the ovarian tumour, and the whole character of the disease 
was disclosed. In almost all ovarian tumours, we find them covered with 
a complete peritoneal investment. In this case it appeared, that the inferior 
portion of the right ovarium first became diseased and expanded, and in 
doing so, after having separated the folds of the peritoneum composing the 
broad ligament, dipped down into the pelvis, and gradually filled it on the 
right side. As the tumour increased, it raised up the peritoneum lining that 
side to the level of the brim, and there it became firmly attached. But one 
artery passed into the tumour in that direction. After this was cut and tied, 
and the peculiar relations of the tumour were exposed, one sweep of the 
bistoury sufficed to clear it from its posterior connections, and after breaking 
up the cellular attachments in the basin of the pelvis with my fingers, I 
raised the whole out of its bed. That portion of the tumour above the 
brim, overlapped the iliac artery, and I felt it pulsating strongly when I 
separated the tumour. 

Previous to this time, the small intestines were protruding through the 
external wound, and interfered with the dissection. Drs. Neff and Parry 
had been requested to make pressure upon the sides of the abdomen, with 
the intention of confining them under the relaxed integuments; but we soon 
found that this pressure only occasioned a more obstinate protrusion; and 
during the remainder of the operation, they were easily restrained by my 
brother, who supported them within the cavity, in the palm of his hand, in 
the upper angle of the external wound. It was, therefore, unnecessary to 
use the soft flannel envelopes, wrung out of warm water, previously pro- 
vided. While engaged in doing this, the extremity of his fingers rested 
upon the aorta. The benefit of the previous treatment was strongly exem- 
plified in the collapsed appearance of the intestines. They lay flat within 
the abdomen, and quite free from flatulent distension. Their peritoneal coat 
was of a pale pink colour, and slightly injected. 

So great was the development of this ovarian tumour within the pelvis, 
and so closely adherent to the uterus, that considerable traction had to be 
made on one side, while my brother drew the uterus in the opposite direc- 
tion, before I could pass a common suture needle, armed with a strong 
double ligature, through the broad ligament between them. The pedicle was 
then tied very lightly above and below. At the moment of tying the upper 
one, or that embracing the fallopian tube, the patient complained of consi- 
derable pain. Additional force was now necessary to draw the tumour from 



1844.] Atlee's case of Diseased Ovaria complicated with Ascites. 51 

the ligatures, so as to afford space between them to sever the ligament. It 
was much thickened and very vascular. The tumour was now removed on 
the right side. That formed by the left ovarium next required attention, 
and occasioned but little difficulty. It was covered throughout by perito- 
neum and was unadherent, except by its natural attachment. As before 
stated, it filled up completely the left side of the cavity of the pelvis, the uterus 
being jammed closely between the two. It rose about two inches above the 
brim. Passing the fingers of the right hand between the side of the pelvis 
and the tumour, it was readily slipped from its bed, and given to be held by 
the assistant. Another needle, armed with a double silk ligature, was then 
passed as before, and tied above and below. The patient complained of 
similar pain when the left fallopian tube was tied. The broad ligament 
was now divided and the tumour removed. The uterus, free from disease, 
remained standing upright in the pelvis and shorn of its natural attachments. 
The cavity of the pelvis, which contained some blood and more serum, (for 
very little heemorrhage attended the operation,) was now quickly cleansed 
by a succession of very soft sponges, rapidly handed to me by careful 
assistants. This I considered preferable to turning her upon her face, as 
was done in some previous operations, for the purpose of evacuating the 
fluids. Deeming it most advisable to remove the leather ligature around the 
omental arteries, as my leather ligatures had not been satisfactorily prepared, 
I did so, and replaced it by a silk one — one end of it was cut off close and 
the other brought out at the lower orifice of the wounel. No haemorrhage 
followed the removal of the ligature, and on squeezing the extremity of 
the fillet of arteries, several circular coagula escaped from their mouths. 
The edges of the whole external wound were now carefully approximated 
and secured by seven hare-lip sutures — separated about an inch from each 
other. These sutures were made by passing common small sized sew- 
ing needles, held in a ^^ porte-aiguille,^^ deeply through the parieies, but 
exterior to the fascia and peritoneum. The intervening spaces were covered 
with adhesive strips — the ligatures, five in number — the arterial one being 
marked by a double knot — were brought out below, turned over on the left 
side, and secured by a strip of adhesive plaster. Over these strips a folded 
portion of patent lint was placed; a folded napkin as a compress; and the 
whole secured by a broad and firm bandage, carefully pinned. The wet 
clothes were replaced by dry ones, and the patient carried to bed and placed 
on her back, with her head and shoulders slightly raised, and the limbs ex- 
tended. Twenty drops of elixir of opium were then given to her. The 
operation lasted about 45 minutes— 15 of which were spent in removing 
the water through the canula. By far the largest portion of time was occu- 
pied in separating the large tumour from the brim and sides of the pelvis. 
The operation was not interfered with by the occurrence of any unfavour- 
able symptoms, neither nausea nor vomiting occurred then, nor subsequently. 
There was some eructation of wind just before removing her from the table. 
The pulse, which was 104 at the commencement, was precisely 100 at the 
conclusion, with some, and but slight, diminution of force. During the 
whole of this trying scene the patient evinced the utmost composure and 
fortitude; replyinof in a firm tone to such questions as were necessary; and 
expressed herself with cheerfulness and gratitude when informed that it was 
concluded. 

The accompanying very accurate drawings of the tumours, by an accom- 
plished and obliging friend m this city, render a verbal description of them 



52 Atlee's case of Diseased Ovaria complicated tvith Ascites. [Jan. 

almost superfluous. In the largest tumour, fig. 2., six or eight cysts are easily- 
discoverable; they were not opened; but having suspended the tumour by 
one of the peritoneal bands in a vessel of spirit of wine, the fluid in the cen- 
tral, and one of the largest cysts, burst through the delicate membrane con- 
necting the hydatids and coagulated in the bottom of the glass vessel. In 
changing the position of the tumour, a portion of the fluid was preserved; and 
in external characters it appears to be almost purely albuminous. In the left 
tumour, fig. 3., several cysts can be observed under the peritoneal investment. 
In alluding to it heretofore, I have called it a simple cyst, but a more careful 
examination satisfies me, that there are at least four. Both tumours, there- 
fore, coQie under the classification, made by Dr. Bright, in his highly in- 
teresting and instructive essay on Abdominal Tumours in the 6th No. of 
Guy's Hospital Reports, as " Compound Ovarian Tumours." 

The weight of the right one, soon after its removal, was 18 ounces; 
that of the left, 14 ounces, which together with 20 pounds of ascitic fluid, 
made 22 pounds, removed from the abdomen at the time of the opera- 
tion. 



Description of the Tumours. 



Fig. 1. 



a 







Fig. 1 represents a 
superior and anterior 
view of the right ova- 
rian tumour. «, The 
hydatid portion, or that 
which was first dis- 
covered in December 
last; 6, a large cyst, 
situated above and be- 
hind the hydatids; c, 
the band of arteries 
g from the omentum; (/, 
the broad ligament; e, 
the fallopian tube; f, 
the fimbriated extrem- 
ity expanded over the 
sac; gj the broad liga- 
ment at the place of 
attachment to the ute- 
rus; A, A, h, A, the cut 
edges and bands of the 
peritoneum which con- 
nected the tumour with 
the linea-ilio-pectinea; 
2, {, that portion of the 
tumour lying within 
the cavity of the pelvis 
and not invested with 
peritoneum. 



1844.] Atlee's case of Diseased Ovaria complicated with Ascites, 53 



Fig. 2. 



Fig. 3 represents a 
posterior and inferior 
view of the same tu- 
mour, a, the hydatid 
portion; b, b, the lar- 
gest cysts, covered 
with peritoneum; c, 
the band of arteries as 
connected with the tu- 
mour; d, c?, peritoneal 
bands; e, e, e, e, sepa- 
rate cysts lying under 
the peritoneum and 
covered only by the 
albugineous coat of the 
ovary; /, a ragged 
opening through this 
coat, and exhibiting 
smaller cysts within; 
g*, g, g, sulcus formed 
by the pressure of the 
brim of the pelvis. 



Fig. 3, the left ovarian tu- 
mour. «, the broad ligament 
at its attachment to the uterus; 
6, 6, the fallopian tube; c, the 
fimbriated extremity; (/, d, 
cysts below the brim of the 
pelvis; e, e, e, sulcus formed 
by the pressure of the brim; {f\l 
f,f, cysts above the brim. 

In relating the subsequent 
treatment of this case, I might 
adopt a summary method, and 
state, that with scarcely a bad 
symptom; certainly not one, 
after the first twelve hours, to 
excite apprehension, my pa- 
tient rapidly recovered. But 
•while on the one hand, too 
much minuteness of detail 
after ordinary operations, is 
fatiguing to the reader, and 
renders a report to expe- 
rienced surgeons uninterest- 
ing, and unprofitable; yet the 











54 Allee's case of Diseased Ovaria complicated with Ascites. [Jan. 

magnitude and infrequency of tliis operation require, that a somewhat more 
particidar report than usual, be made of the symptoms manifested for the first 
lew days subsequent to it. I shall therefore transcribe from the notes, made 
at the times stated, by myself and my brother, and by our pupils, who un- 
remittingly watched the patient for the first three days, the leading symp- 
toms. 

At 12 o\lock, M., one hour after the operation, the pulse was 100, soft 
and compressible; temperature of the feet somewhat below the natural stand- 
ard; hands and forehead, natural; slight eructations of wind at intervals of 
three or four minutes; free from pain, except some smarting in the track of 
the wound; applied more flannel to the lower extremities. 

1 o'clock, P. M., second hour. Pulse 100, skin a little below the natural 
standard; rests comfortably; feels a slight pain in the lumbar reg[ions; tongue 
natural at the edges; slightly furrerl in the middle; lower extremities still 
cool; stomach more composed, and less flatulent; feels slightly cool; ap- 
plied warm bric-ks to feet. 

2 o''clock, third hour. Pulse 102; skin of forehead and superior extre- 
mities a little warmer; tongue as before and moist all over; lower extremities 
warmer; has been dozing for the last 15 minutes; feels comfortable; took 
some barley water, and since then slighfly troubled with flatulence. 

3 o'clock, fourth hour. Pulse 100; skin very little below the natural 
temperature; complains of aching pain in the back; respiration, slow and 
regular; some dryness of the mouth, for which gave gargles of cold water; 
at 3.2 o'clock, the pulse was 103, more full and strong than before; very little 
flatulence; drank barley water. 

4 o'clock, P. M., fifth hour. Pulse 104; more volume, and regular; skin 
soft and of good temperature except the nose and knees, former cold, latter 
cool; tongue thinly coated with smooth white fur, soft and warm to the touch; 
inclined her to the right side, her back supported by pillows; legs gendy 
flexed; since which change, she feels more comfortable and less flatulent; 
complains less of her back and of soreness of the abdomen; has some incli- 
nation to pass water; advised her against making much eflbrt to do so, as it 
was considered preferable to use the catheter, if the water becomes trouble- 
some. Expressed herself rejoiced that the tumours were removed — mind 
perfectly calm and collected, and converses strongly. 4| o'clock, pulse 110. 

5 o^clock, sixth hour. — Pulse 120; skin warm and moist; extremities 
warm; removed warm applications; tonirue furred, and dry in the centre; 
clean and moist along the edges; complains of no pain; but only slight un- 
easiness in the abdomen; some flatulence; gave barley water; feels com- 
fortable and seems desirous of conversing; smiles at times. 

6 o^clock, seventh hour. — Pulse 120; no material alteration. 

7 o'clock, eighth hour. — Pulse 127; skin warm and moist; slight flatu- 
lency; but little thirst. 

8 o'clock, ninth hour. — Pulse 130, and resists pretty firm compression; 
other symptoms as before. 

9 o'clock, P. M., tenth hour. — Pulse 136; skin of extremities as before; 
face rather cooler; tongue as before. 

10 o'clock, eleventh hour. — Pulse 136; general temperature of skin 
warm; palms and soles rather hot and dry; tongue moist; no pain in hypo- 
gaslrium; slight tenderness on pressure in epigastrium and left liypo- 
chondrium. This pain, as stated before, had come on two days before the 
operation, and had not quite subsided at the time of it. Patient had passed 
no urine since before the operation — felt some inclination — introduced the 



1844.] Atlee's case of Diseased Ovaria complicated ivith Ascites. 55 

catheter, and drew ofl' 8 or 10 oz. As tlie pulse was hard and had been rising 
in frequency since 4 o'clock, I opened a vein and drew from it about 10 oz. of 
blood, when a moderate relaxation came on, the pulse fell to 120; skin of 
palms and soles moist and soft; there was a free eructation of wind after the 
bleeding. She says she is now free from all pain except the otd pain, and 
is quite comfortable. No pain in the wound. The compress under the 
bandage is a little wet with a discharge of a reddish serum from the lower 
end of the wound. 

12 o^clock, thirteenth hour. — Pulse 127; soft and compressible; changed 
her position, felt easier and inclined to sleep; general warmth and moisture 
of the whole surface; slightly flatulent. 

June 30th, 1 o^ clock, A. M., fourteenth hour. — Pulse 130; soft and com- 
pressible; feels easy; slight gastric pain on pressure. 

4 o^clock, seventeenth hour. — Pulse 125; other symptoms same. 

6 o'' clock, A. M., nineteenth hour. — Pulse 118; skin moist all over; no 
pain; doses occasionally; rests easy. 

9 o'clock, A. M., twenty-second hour. — Drs. J. L. A. and W. L. A. called — 
found that the patient had a very comfortable night, but slept very little; skin 
moist, and nearly natural in temperature; no pain on pressure, except a 
slight pain in the left hypochondrium; passed no urine durinor the night — 
introduced the catheter and removed 6 oz. slightly high-coloured. Pulse 130, 
but soft and compressible — (this frequency of pulse we attribute to the ex- 
citement produced by our presence,) tip of the nose warm; no oozing of 
serum from the wound since last night. Ordered a tablespoonful of castor 
oil, in mint water; diet absolute; drinks cold water and barley water; tongue 
rather more furred than yesterday, but moist; complains of some dryness of 
the mouth, but less thirst; mind calm, composed, and cheerful, and has quite 
a pleasant smile in conversation; countenance less pale; and more decidedly 
natural in colour and expression — at taking leave, pulse 126. 

12 oV/ocA;, twenty-fifth, hour. — Pulse 112; volume greater than before; 
skin soft, warna, and moist; tongue furred in the centre and dry; appears 
very lively — is troubled very little with flatulence since taking the oil; less 
thirst than yesterday. 

3^ o'clock, P. M. — Patient doing well in every respect; pulse 117; skin 
perfectly natural, warm, soft, and moist; tongue less dry in centre. 

7 o'clock. — Has slept; oil not having operated, an injection was given. 

10 o'clock, P. M. — Patient feels comfortable except a desire to pass water. 
Introduced catheter and drew ofl" four ounces — it was tested and it reddened 
litmus paper — colour same as in the morning; skin natural, except palms 
and soles which are warm, but moist; pulse 123; bowels have not been 
moved; tongue moist; ordered ^issol. ricini every six hours until it operates 
twice; changed her position, and feels more comfortable. 

July Is/, 6 o'clock, A. M. — Has had two hours of very sound sleep, and 
had dozed frequenfly during the night; symptoms very favourable; coun- 
tenance natural; skin soft, warm, and moist; pulse 117, soft, but slighfly full, 
yet easily compressible; oil had operated upon the bowels twice, with free 
discharge of wind; no pain on pressure over the abdomen; old pain entirely 
gone; tongue nearly natural; at her request allowed soda water with straw- 
berry syrup. 

10 o'clock, A. M. — Pulse 122, soft, compressible; skin natural as to tem- 
perature and moisture; tongue moist and lightly coated with fur; introduced 
catheter and removed 8 oz. slightly high-coloured urine; pulse fell to 118; 



56 Atlee's case of Diseased Ovaria complicated ivith Ascites, [Jan. 

countenance cheerful; all symptoms favourable. Dr. Humes also saw the 
patient this morning. 

4 o'clock, P. M. — Two copious natural evacuations from the bowels since 
10 o'clock; ordered drinks as before. 

10 o'clock, P. M. — Pulse 121; symptoms continue favourable; used 
catheter, and removed eight oz. less high-coloured urine; changed her posi- 
tion from one side of the bed to the other. 

2d, fourth day, 9 o'clock, A. M. — Had passed a very comfortable night, 
notwithstanding the excessive heat and sultriness of the weather; passed 
urine for the first time without assistance early this morning; skin and 
tongue same as yesterday; pulse 112; ordered drinks as before; more liberty 
of moving. 

7 o'clock, P. M. — Found her very comfortable; pulse 110; soft and com- 
pressible; passed urine again, without the catheter, at 3 o'clock, more natural 
in colour. The oedema of the lower extremities has been rapidly diminishing 
since the operation, and has now quite disappeared from below the knees. 
No pain on pressure over the abdomen, except a slight soreness in the right 
and left iliac regions over the linea-ileo-pectinea. 

July 3d, fifth day, 9 o'clock, A. M. — All the symptoms favourable; 
passed urine twice since last evening; pulse 104; dressed the wound for the 
first time, and removed the needles, leaving the threads and adhesive straps. 
The wound has healed throughout by the first intention, and is entirely free 
from inflammation. After dressing, pulse 100; allowed arrow-root gruel. 

8 o'clock, P. M. — Some vascular excitement, which was attributed to the 
gruel, as the patient said it had not agreed with her stomach; pulse 125; 
tongue more furred; considerable flatulency; no abdominal tenderness; passed 
urine once since morning; ordered castor oil with five drops elixir of opium; 
diet absolute. 

4th, 9 o'clock, A. M. — Symptoms all favourable; pulse 106; oil has 
not operated; urinated twice; oil to be repeated; examined wound; no sup- 
puration; lint dry and clean; tongue cleaning and quite mbist; less thirst 
than yesterday. 

8 o'clock, P. M. — Patient complains very much of the noise and excite- 
ment out of doors since twelve o'clock last night. This being the Anni- 
versary of American Independence, the firing of guns and beating of 
drums has deprived her of sleep, and rendered her very nervous; pulse 122; 
quick but not hard, more the effect of nervous excitement than inflammation; 
skin moist and natural; tongue rather more furred, but moist; no tenderness 
of abdomen; complains of no pain; oil operated twice copiously, bringing 
away at the last discharge hardened fasces; has taken to-day three or four 
ounces of oatmeal gruel; ordered twenty drops of M'Munn's elixir of opium 
at 9 o'clock, P. M. 

5th. Seventh day, 9 o'clock, A. M. — Patient slept several hours after the 
anodyne; no abdominal tenderness; passed urine once; drank but three times 
during the night; has taken a teacupful of oatmeal gruel this morning, which 
creates no flatulence; wound quite healed, except where the ligatures come 
out, and at this point the lint is slightly stained with pus; pulse 130 at en- 
tering, 120 afterwards. Ordered a teacupful of gruel every three hours. 

6th. Eighth day, 9 o'clock, A. M. — Pulse 100; all the symptoms favour- 
able; in the evening found that she had had a very comfortable day; has taken 
liberally of the gruel; no pain on strong pressure over the abdomen, except 
in the right iliac region, and but slight there. Ordered two laxative pills at 
bedtime. 



1844.] Atlee's case of Diseased Ovaria complicated with Ascites, 57 

7th. Ninth day, 9 o^cfock, A. M.— Doing well and had a comfortable 
night; no pain; pulse 90; tongue cleaning; all the symptoms highly favour- 
able; passed urine with slight pain. Ordered a poultice over the ligatures; 
propped her up in bed; this had no effect upon her pulse; allowed beef-tea 
and, bread. 

9 o'clock, V.M. — Bowels moved in the afternoon; pulse 100; did not 
relish beef-tea as well as gruel. 

8th. Tenth day, 9 o'clock, A. M. — Patient doing well in every respect; 
pulse 100; tongue perfectly clean; slept well; urine passes freely and with- 
out burning; bov/els open; tried the ligatures and found them ail adhering; 
dressed them with cerate; requested her to sit up two or three times during 
the day and walk occasionally across the floor; — -diet, bread, butter and tea. 

9 o'clock, P. M. — Had been out of bed and walked several times across 
the roon). 

9th. Eleventh day.— All symptoms favourable; permitted more exercise. 

lOth. Twelfth day.— Pulse 100; patient doing well; complains of slight 
strangury; bowels confined. Ordered laxative pills; ligatures still tight, but 
there is slight suppuration around them. 

1 \th. Thirteenth day. — Patient slept most of the night; still troubled with 
strangury, which 1 attribute to the vicinity of the ligatures to the fundus of 
the bladder; ligatures still tight; pulse 94, tongue clean, skin natural. 
Ordered moderate diet. 

I2th. Fourteenth day. — Patient rested well last night; less irritation of the 
bladder. Upon examining the wound this morning, I found a small vesicle 
filled with pus in the track of the wound about one inch above the ligatures; 
opened it with a needle, and there was a free discharge of about half an 
ounce of pure pus; some also escaped around the ligatures. Upon trying 
the ligatures, that around the omental arteries came away. I^wo of the 
others yielded about half an inch but did not separate. Pulse 95; bowels 
moved once freely and naturally. Ordered poultice to the ligatures. 

13th. Fifteenth day. — One of the ligatures of the pedicle caine away this 
morning; patient doing well. 

14//i. Sixteenth day. — Pulse 90; bowels regular; patient sat up for several 
hours yesterday; remaining ligatures light; tied one of them moderately tight 
over a roll of linen. 

15^/t. Seventeenth day. — -Patient did not rest quite so well since the liga- 
ture was put upon the stretch; had slight pain in the back, and more frequent 
inclination to pass water; in every other respect, better. 

16^A. Eighteenth day, 9 o'clock, A. M. — Patient doing well as regards 
general symptoms, but complains so much of pressure to make v/ater, that 
I relaxed the ligature; pulse 91. At 4 o'clock, P. M., pulse 76; less trou- 
bled with the pressure. 

17/A, ISth, and I9th. — Patient doing well; ligatures still tight. 

20th. Doing very well, but still troubled with a slight inclination to pass 
urine. She rode two miles. 

21 St. — Patient doing well, and up all day; pulse 72. 

22nd. — Doing well; diet ad libitum. Rode in a carriage five or six 
miles without any inconvenience. 

.^ufritst 2Qth. — Since July 22d, I have ceased visiting my patient with 
any regularity. Her health is apparently perfectly restored. She visits her 
friends, goes to church, and takes exercise out of doors on foot and in a car- 
riage, whenever the weather permits. Having undertaken the operation 
with the view, not only of removing the tumours, but of curing the ascites. 



58 Ailee's case of Diseased Ovaria complicated ivith Ascites. [Jan. 

which I attributed to the functional derangement of the abdominal and pelvic 
viscera and blood-vessels, occasioned by their presence, I felt great anxiety 
as to a return of the effusion. I have repeatedly examined the abdomen 
with the utmost care and cannot discover the slightest tendency to it. There 
is a slight dulness on percussion in the lower portion of the hypogastric and 
iliac regions, which I ascribe to the presence of coagulable lymph neces- 
sarily secreted around the cut surfaces; but not the slightest impule is com- 
municated to the opposing fingers, such as would be occasioned by fluid 
serum; nor does any, I believe, exist. On the contrary, I remarked to-day 
a much clearer sound than usual, owing to the gradual absorption of the 
effused lymph. 

The obstinacy with which some of the ligatures have adhered has been 
a source of annoyance both to the patient and to myself. The fourth one 
came away to-day. and there is now but one remaining, that around the left 
fallopian lube. Were I to operate again, I would use either the animal 
ligatures, of doe or buckskin, and cut all of them off close to the knot, 
trusting to their solution and absorption, as has been the case with that 
around the peritoneal artery; or I would divide the fallopian tube, apparently 
the most dense structure in the pedicle, with a narrow or cataract knife, and 
then tie the pedicle between the severed ends of the tube, with a very strong 
silk ligature as tightly as it could be drawn. There is a seton-like opening 
around the remaining ligature, extending to its inner extremity; but the 
adjoining parts are completely sealed up by adhesive inflammation, and 
protected from injury. 

Oct. 2\st. — The last ligature came away on the 26th Sept., immediately 
after which the fistulous opening closed and is now healed. My patient has 
just returned to town, after an absence abroad of six weeks, has much im- 
proved in flesh and strength, and appears to be restored to perfect health. 

In concluding my report of this case, I cannot avoid remarking that it 
will scarcely be believed, that an incision between 10 and 11 inches long 
could be made through the walls of the abdomen; the viscera exposed for 
half an hour; the intestines protruding for a portion of that time; the peri- 
toneum extensively divided around the whole right side of the brim of 
the pelvis; both broad ligaments and fallopian tubes be severed from the 
uterus; six ligatures applied, and the cavity sponged; and yet, that no symp- 
toms should arise to create apprehension or embarrassment. Yet such it 
will be perceived was the fact, incredible as it may appear, and I dwell upon 
it with the hope, that it will present to the profession an inducement here- 
after (added to the testimony already before us) to make a similar effort under 
similar circumstances. No one can be more disposed than myself to con- 
demn the rash or wanton use of the knife which we frequently see exhibited. 
True surgery would endeavour to banish it, if possible, from the list of 
remedies; and by a faithful application of such means as observation and 
experience have proved capable of exerting an influence upon the various 
functions of the body, endeavour to control its morbid states, and restore its 
primitive integrity. Unhappily this is not possible; our means are still too 
limited; resort must be had to the knife, and the case above detailed proves 
its efficiency and safety. 



1844.] Atlee's case of Diseased Ovaria complicated with Ascites. 59 

There are {ew maladies more certainly fatal than that with which my 
patient was afflicted. The records of medicine, as well as the experience 
of every physician, will bear me out in this assertion. There are few men 
of ten years' practice in the profession, who cannot furnish personal testi- 
mony to this painful fact. Since my operation, it has been abundantly 
proven by several medical gentlemen with whom I have conversed and 
corresponded; and a more extended inquiry would, I have no doubt, bring 
additional confirmation of it. Shall we, therefore, give our countenance to 
operations, which in their results, exhibit as great if not a greater mortality 
than has followed the American, and from very recent intelligence, the Bri- 
tish operations for the removal of diseased ovaria by the large incision, and 
not overcome our fears as to the danger of peritoneal inflammation? 

Upon this subject I shall cite the concluding remarks upon a case of ova- 
rian disease producing death, reported in the 14lh volume of the American 
Medical Recorder, by my old and highly intelligent friend. Dr. William 
Forman, formerly of this county, in which the case occurred, but now of 
Princeton, New Jersey, which coincide so much with my sentiments, that 
I prefer quoting them, to making any further comments of my own. The 
disease had existed between four and five years, and had resisted all medical 
treatment; the patient, a highly respectable and intelligent lady, died very 
suddenly in 182G, and at the post-mortem examination, " on opening the 
abdomen, its cavity was seen completely occupied by a vast sac, irregular 
on its surface, and varying in texture from a dense membrane to semi-carti- 
lage." *' The position of the tumour in the abdomen was anterior to all 
the viscera, and its adhesion to them was so slight as to require the scissors 
only in one place to free it, when it rolled out, a huge fluctuating mass, upon 
the table." After some comments upon the case, the doctor concludes thus: 
" Encysted dropsies of every kind are situated so far on the verge of the 
system as to be in a great measure beyond the control of the organic functions, 
and unless the containing sac can be removed from the body, or destroyed 
by suppuration, there is very little ground to hope that they will ever be 
cured by art. Therefore, when the ovarium is the seat of the disease, I 
think we are warranted by the successful results of the few operations of 
the kind that have been performed, in laying open the cavity of the abdo- 
men, and removing the diseased organ from it, at once. If this course had 
been pursued toward my patient as soon as the nature of the disease was 
manifest, she might at this time have been living, an honour to the healing 
art, and a blessing to all around her. I am by no means convinced of the 
correctness of Dr. Reynolds's assertions, that a moderate share of profes- 
sional sagacity is sufficient to decide upon the inapplicability of a surgical 
operation for the removal of diseased ovaria; on the contrary, these organs 
have been removed sufficienUy often without any dangerous symptom su- 
pervening, to fully justify the operation in all cases, where the general health 
of the patient is good, and the diagnosis is clear. The appaUing exposure 



60 Atlee's case of Diseased Ovaria complicated with Ascites. [Jan. 

of the viscera in this operation should, I admit, deter from its performance, 
were death not inevitable ninety limes in a hundred, without it. How the 
horror which pervades the ranks of surgery at exposing the cavity of the 
peritoneum originated, is a question almost as difficult to decide, as that of 
the generation of worms in the intestines*of animals before birth, and if its 
decision involved no more important consequences would be equally unin- 
teresting. But unfortunately this dread of attempting to do good, for fear 
that evil may grow out of it, paralyzes the hands of surgeons, and satisfies 
them to sanction inevitable death, rather than incur {he possible dangers of 
a timely operation. The time, however, has come when these degrading 
apprehensions are giving way to the light of a more correct physiology, 
and the operation of L'Aumonier and other Europeans, added to those of 
Smith, of McDowall, and the experiment of Lizars have shed a bright ray 
of practical knowledge upon this benighted subject, which now beams a 
beacon of hope toward which the unfortunate subject of diseased ovarium 
may turn as from the grave, and look forward wiih a well-grounded confi- 
dence to years of healthy existence, and the full enjoyment of social and 
domestic happiness. To say nothing further of the many successful ope- 
rations that have been performed on parts within the abdomen, do not the 
daily occurrence of accidents, under circumstances the most unfavourable 
to recovery, prove incontestably that an exposure of its cavity is a thing not 
so much to be dreaded, and clearly demonstrate the frightful pictures exhi- 
bited in lecture-rooms, to be the mere fairy tales of physic, told only to 
frighten the hearers fiom their post of duty, and induce them to yiekl the 
citadel of life to a foe so timid, that only to have resisted him would have 
prevented the breach, and ultimately have raised the siege? For my own 
part, I can see no other objection to a removal of a diseased ovarium than 
that which arises from the difficuUy of determining its existence, and should 
I be so unfortunate as to ever have the management of another case, so soon 
as that was clearly ascertained and decided upon, I should not hesitate to 
recommend and perform the operation, believing that the danger of perito- 
neal inflammation would not justify me in neglecting to discharge so im- 
portant a professional duty." 

In Bell's Eclectic Journal of Medicine, volume 3, there is an interesting 
paper from the London Medical Gazette, on the Pathology of the Ovaria, 
by Dr. Robbs, of Grantham, in which he details a case of sarcoma of the 
ovarium producing ascites, and finally death, from exhaustion, after exten- 
sive peritoneal inflammation. At the conclusion of the report, he makes 
the following observations and reflections, which must have occurred to 
many physicians after similar experience: "I was surprised, on making the 
post-mortem examination, to find how easily the tumour might have been 
removed before the inflammatory symptoms came on, and which no doubt 
were excited by the rapid growth of the tumour. I believe the operation 
for extirpating the diseased mass would not only have been justifiable, but 

I 



1844.] Allee's case of Diseased Ovaria complicated with Ascites. 61 

also very desirable; and if I had another case similar to this, where it was 
evident the disease would shortly terminate the patient's life, without any 
other hope but that of an operation, I should certainly recommend her to 
submit to it, and that at an early period of the disease, before any adhesion 
to the peritoneum had taken place from inflammation." 

A careful perusal of Dr. Bright's cases will satisfy us that many of them 
might also have been saved by a timely operation. The opponents to this 
operation deduce their arguments against it chiefly from the extensive adhe- 
sions of the tumours to the neighbouring and vital organs found after death. 
But as well might we argue against the propriety of the operation of litho- 
tomy, from the inspection of the bodies of those dying from the effects of 
stone in the bladder, where ulceration of the prostate, and destruction of the 
mucous coat of the bladder, with extensive disease of the kidneys are exhi- 
bited. Let this operation but be placed upon its legitimate basis, and let 
it receive that attention from the profession which has been devoted to other 
departments of surgery; and we shall soon arrive at such a knowledge of 
the proper time and manner of operating, and before those complications 
exist which render it impracticable, as Avill be the means of saving many 
unfortunate and hitherto hopeless victims. 

This opinion has been confirmed by several successful cases in England, 
where the operation has heretofore encountered the strongest opposition. 
To Professor Gibson, and Dr. Hays, of Philadelphia, I am indebted, since 
my operation, for the reports of three successful operations performed since 
September, 1842, by Mr. Clay, of Manchester; and two by Mr. Walne, of 
London. In each of these cases one of the ovaria was very much diseased, 
and enlarged both by solid and fluid contents. The tumours were taken out 
whole by the large abdominal section, and the patients recovered rapidly, 
with but few unfavourable symptoms. From their reports, it appears that 
English surgeons are now divided upon the kind of operation most proper 
to be performed. The " major," or that practised by M'Dowell, A. S. 
Smith, Lizars and others, by which a large and free opening is made into 
the abdominal cavity, sufficient to remove the whole diseased mass — and the 
*' minor," first suggested by Dr. William Hunter, and recommended by 
Jealfreson, viz.: "a small incision of one and a half or two inches in length 
in the abdominal parietes, through which incision the ovarian sac is to be 
punctured with a trocar, and when emptied of its contents the sac itself is 
drawn through the incision, its pedicle tied and separated." 

Mr. Clay, the first surgeon, who has successfully operated by the large in- 
cision in England, and whose experience in this operation entitles his opinion 
to great weight, condemns the " minor" operation as inapplicable to a very 
great majority of cases, and the result as more fatal than those by the large 
incision. He says, "if it were positively certain, that the ovarian tumour 
was composed of only one, two, or even three cysts, provided they could be 
No. XIII.— January, 1844. 5 



62 Atlee's case of Diseased Ovaria complicated with Ascites. [Jan. 

defined and punctured, if it were equally certain that no adhesions existed 
beyond the pedicle, and if we could be assured that no part of the tumour 
was consolidated, then I should say that the minor operation of Mr. JeafFre- 
son would be the only justifiable one; but if any one of these objections 
exist, then I am decidedly of opinion that we had better let the patient alone. 
The fatality shown by the results of those operations in almost every person's 
hands, with the exception of Mr. Jeaff'reson, and once by Mr. King, fully 
justify the remarks I have made upon it. It would be difficult to puncture 
more than one cyst; it would be impossible to draw the cyst through a small 
opening if adhesions existed, without doing irreparable mischief; it would 
be equally impossible to extract through a small opening, unpunctured 
smaller cysts, or a portion of consolidated tumour." "By the large incision 
whatever difficulty presents itself, we are prepared for it; it matters not on 
which side the pedicle may be, there is plenty of room for cutting asunder 
the adhesions, however numerous; the whole mass may be removed entire 
without puncturing the cysts, thus avoiding the disagreeable circumstance of 
the fluid escaping into the abdominal cavity, perhaps one great cause of 
death in the minor operation; and lastly, we have now abundant proof that 
peritoneal inflammation is not a whit more excited by a bold opening than 
by a smaller one. It must also be borne in mind, that the tearing aw^ay of 
the adhesions, unless very recent ones, is entirely avoided by the operation 
of the large incision. The principal opposition to the large incision consists 
of prejudice and too much dread of making openings into the abdominal 
cavity, but time, and a few more successful cases will soon overcome both 
the prejudice and reluctance of surgeons on this subject, and if I am not 
mistaken, a new era is opening upon us, as to operations on the abdominal 
and pelvic viscera. In fact what has been done, is enough to enable me to 
declare the large incision operation for extirpating diseased ovaria, a perfectly 
legitimate operation — more successful than the one proposed as its substi- 
tute." He further remarks, "looking at all the circumstances connected 
with the operation, not only by large and small incision for diseased ovaria, 
but in all operations that have taken place in respect to the abdominal cavity 
where the peritoneum has been cut, there is abundant evidence to prove that 
the peritoneum is not by any means so disposed to take on inflammatory 
action as has been generally supposed; and this simple fact in itself may 
create a great change in abdominal surgery. Hitherto extirpation of diseased 
ovaria by the large incision particularly, has been held highly speculative 
and improper; but surely the results that can now be shown, must at once 
and forever settle the question; and establish it as a perfectly legitimate and 
more than ordinarily successful capital operation. When compared with the 
results of other capital operations, lithotomy, lithotrity, and even amputation, 
it stands in a far more favourable position; and it is a very strange prejudice 
indeed, that can admit those capital and more frequently fatal operations 
above mentioned, as legitimate and advisable; whilst one less fatal is sum- 



1844.3 ^tlee's case of Diseased Ovaria complicated with Ascites. 63 

marily condemned, and forborne to be mentioned in the instructions to the 
rising faculty." 

Following the three highly interesting cases of the successful removal of 
diseased ovaria in the paper received from Mr. Clay, by Professor Gibson; 
he also reports two cases of anomalous and uterine tumours of a very ma- 
lignant character, which he attempted to remove by the large peritoneal 
section; both of which proved fatal. And at the conclusion he says, " after 
much reflection, I have no hesitation in stating my conviction that the extir- 
pation of ovarian encysted tumours may be performed with comparative 
safety. And if the age be not too advanced, I believe the cases I have here 
given will fully prove that neither extent of adhesions, size of tumour, ascitic 
deposit, worn down constitution, nor peritoneal inflammation, should prevent 
extirpation being performed. The success of the operation is more than 
equal when compared with other capital operations in surgery. I would 
not advise, however, the peritoneal section so confidently in other tumours 
of the abdomen; still it is at all times a justifiable course, when the patient 
earnestly requires it, and no other hope of prolongation of life presents 
itself. The exposure of the abdominal viscera, if the room be moderately 
heated, is attended with no bad consequences; nor yet a moderate loss of 
blood during the operation. The principal pain is confined to the first in- 
cision through the skin, and to the stretching of the pedicle, whilst it is 
secured and severed. Pain after the operation is always controllable by a 
grain of muriate of morphine. Some days after the pressure is removed from 
the abdominal viscera, there appears to be a tendency to diarrhoea, which if 
not closely watched and timely checked, may soon undo all the good that 
has been accomplished. Mere debility, arising from the ovarian disease 
only, before the operation, is more favourable than otherwise, and affords a 
good safeguard against peritoneal inflammation." 

In the London Medical Gazette for December last. Dr. Henry Walne, 
Esq., reports his first case of the removal of a dropsical ovarium entire by 
the large abdominal section. The tumour, with the contained fluid, weighed 
16 pounds: and the patient, after suffering from som.e symptoms similar to 
incarcerated intestine and which were speedily relieved, recovered perfectly. 
Dr. Hays informs me that Mr. Walne has recently removed successfully 
another ovarian tumour weighing 16^ pounds, by the major operation. 

Mr. Walne coincides with Mr. Clay in opinion, that the minor operation 
is clearly shown to be inapplicable to a large proportion of the examples of 
the disease which come under treatment. " My reasons," he says, " for 
preferring to operate by the larger section were these: that it does not appear 
that a less extent of wound diminishes the danger of the operation in any 
material degree, if at all; and that the complications which occasionally pre- 
sent without being foreseen, and which, indeed, do not admit of being fore- 
seen in every instance, can be better appreciated and more suitably dealt with 
by the surgeon, through a free opening than by a smaller one. For example, 



64 Hay ward's Remarhs on Wounds received in Dissection. [Jan. 

the effusion of blood, or the escape of fluid from the cyst into the peritoneum, 
either of which is a most dangerous compHcation of the difficulties insepara- 
ble from any method of operating, can with no certainty be avoided in the 
minor, but may assuredly be remedied if they should occur in the major ope- 
ration. Adhesions too can be divided, the parts can be cleansed and arteries 
tied with facility if necessary, and the operator's mind freed from doubt as to 
the state of the internal parts, before he carefully closes the wound. These 
are circumstances which the experienced operator can appreciate, and if he 
should not be blinded by an undue apprehension of peritoneal inflammation, 
he will be sure to estimate highly such palpable advantages." After re- 
lieving his patient from the symptoms of strictured intestine, which had been 
somewhat troublesome, he remarks that it was not so much peritoneal in- 
flammation as suffering in the viscera of the abdomen, more particularly the 
intestines, which is to be apprehended as a consequence of free incision for 
the removal of diseased ovarium. In conclusion he says, " let me not be 
supposed for a moment to recommend this operation as one to be undertaken 
in any but well-selected cases to which it is adapted; still less let me be sup- 
posed to advise that any surgeon should engage in its performance who has 
not, by habits of operating — yet more by long habits of careful observation 
and treatment of disease generally — and by very considerate and studious 
examination of the nature and connections of this particular disease, and the 
tendencies of the viscera, which maybe involved in mischief by an ill-judged 
operation, or ill-conducted after-treatment — qualified himself to cope with 
difficulties from which it is unreasonable to expect an exemption." 



Art. IV. — Bemarks on Wounds received in Dissection. Read before the 
Boston Society for Medical Improvement, July 24, 1843. By George 
Hay WARD, M. D. 

Injuries received in dissection, it is well known, are often followed by 
severe and sometimes by fatal consequences. The subject is an important 
one on every account, especially as professional men are not agreed as to 
the cause of the trouble, or the best mode of treating it. It should be re- 
collected, too, that all who practise the profession of the healing art are 
exposed to these injuries, as no certain mode has yet been found of guard- 
ing against them. In the hope of drawing your attention to the subject, 
rather than in the belief that I can throw any new light upon it, I shall offer 
a few remarks, as the result of my own observation, and, I may add, per- 
sonal experience. 

The effects arising from such injuries have been attributed by some ex- 



1844.] Hay ward's Remarks on Wounds received in Dissection. 65 

clusively to the irritable state of the patient's system ; in other words, they 
have regarded these cases as cases of morbid irritation; while others have 
supposed, that they were entirely the consequence of the absorption of some 
deleterious matter. Neither of these opinions, I think, can be adopted to 
the full extent. It seems to me that some of these cases, and perhaps a 
large proportion of them, are to be attributed to irritation alone; others again 
are the result of the absorption of some noxious fluid; while there is a third 
class, that arise from the combined influence of both these causes. 

That irritation is capable of producing elTects as alarming as any that are 
witnessed from injuries caused by dissection is well known to those whose 
attention has been called to» this subject. Tetanus is perhaps as good an 
example as can be adduced. Here is a disease, almost uniformly fatal, 
arising for the most part from a trivial wound, inflicted oftentimes by a clean 
instrument, and where there can be no pretence for supposing that anything 
poisonous has been introduced into the system. The alarming effects which 
arise in such cases must be attributed in great measure to the morbid irrita- 
bility of the patient. This state may be congenital, but it is most often 
acquired, and is induced usually by excess in the mode of living, and espe- 
cially by the immoderate use of alcoholic drinks. Hence tetanus is rarely 
met with in females or children, but its subjects, as far as my observation 
extends, have been in a great majority of cases persons of intemperate 
habits of life. 

There are various other instances of severe efl^ects following slight inju- 
ties, that might be adduced. Some of the most formidable cases of paro- 
nychia, that have ever come under my notice, have arisen from slight 
wounds of the hand, caused by needles or pins. Deep seated suppuration 
under the fascia, or in the theca of the flexor tendons, going the whole ex- 
tent of the forearm, and terminating occasionally in sloughing, which impairs 
for life the usefulness of the limb, is not an unfrequent consequence of 
trifling accidents of this nature. No one, I think, will pretend to attribute 
these ill consequences to any thing but the state of the patient's system. 
It is not possible that any poison has been introduced into it, and similar 
and more severe wounds are received daily by numberless individuals, with- 
out suff'ering or inconvenience. 

Besides these general considerations, there are some circumstances that 
may be named that render it probable that many of the cases of injury 
arising from dissection are wholly independent of absorption, and are rather 
attributable to the state of the patient's system at the time of the injury. 
Among these may be mentioned the fact, that students engaged in dissection 
are rarely troubled in this way in the beginning of the season, though they 
are much more likely then to wound themselves, from awkwardness and 
inexperience, than at a later period. But when the health becomes impaired 
from fatigue, exposure to bad air, want of proper exercise, or any other 
cause, a very slight wound is often followed by alarming symptoms. 



66 Hayward's Remarks on Wounds received in Dissection. [Jan. 

It should also be noticed that severe eases sometimes occur when there 
is nothing in the nature of the disease, or the part of the body that is exa- . 
mined, or the character of the wound itself, that is in any way likely to 
produce trouble. One of the members of this society, several years ago, 
suffered excessively from a slight scratch made by the cranium of a child 
that had died of hydrocephalus. Extensive and deep-seated suppuration 
under the fascia of the hand followed the accident, and the constitutional 
symptoms for a time were of an alarming character. There was certainly 
nothing in the history of this case to justify the opinion that any morbid 
matter had been absorbed. I have known two or three other cases as 
striking as this, and in all of them the patients' systems were in that feeble 
and irritable state that seems well calculated to invite disease. 

It may be observed, too, that the readiness with which the symptoms 
sometimes yield to appropriate remedies, render it probable that in such 
cases at least, irritation rather than absorption is the cause of the trouble. 
A blister encircling the forearm often affords considerable relief, even 
though it is not applied till the veins and absorbents are red and inflamed 
along the whole extent of the limb to the axilla. Now this effect would 
not be likely to be produced by such a remedy, if any noxious matter had 
been conveyed into the circulation. 

Though I have attempted to show that some of the cases of the injury 
of which I have been speaking, are probably the result of the irritable state 
of the patient's system, I do not pretend but that others may be attributed 
to the absorption of some noxious matter. Of this I think there can be no 
doubt. There are two facts that render it almost certain; one of these is, 
that persons in most perfect health are occasionally affected in this way; 
and the other is the well-known one, that these accidents are most often met 
with in examining the bodies of those that have died of some particular 
disease, as peritonitis, and especially puerperal peritonitis. It cannot, I 
think, be doubted, that this affection is more severe and alarming, and moro 
likely to terminate in death, when it is the result of these two causes; that 
is, when absorption takes place at the time the patient is in an irritable state, 
or, in other words, when his system is predisposed to disease. 

During the last year more persons than usual were affected in this way 
in our vicinity, and there were three or four fatal cases. To what this may 
be attributed, it is not easy to say. Erysipelas prevailed to a greater extent 
and in a more severe form than usual, and there was probably a greater 
number of fatal cases of puerperal peritonitis than in ordinary years. These 
two circumstances may perhaps aid us in attempting to account for the in- 
creased number of these accidents. The system was predisposed to erysi- 
pelatous inflammation, and it came on from slight causes; and there was 
also, no doubt, a greater number of post-mortem examinations of the bodies 
of those who died of peritonitis than usually occurs in the same length of 
time. 



1844.] Hayward's Bemarks on Wounds received in Dissection. 67 

There is great diversity, as far as I have seen, in the symptoms of this 
affection. Sometimes, and not unfreqiiently, they are wholly local, confined 
to the arm, hand, or even the finger that was injured. At other times the 
whole system is affected, either with or without much local trouble. It is 
obvious, therefore, that the same mode of treatment is not adapted to all 
cases, and this may in some measure account for the fact which I noticed in 
the beginning of this paper; and that is, that physicians were not perfectly 
agreed as to the curative methods. 

It is not my intention now, if I had the materials, to write a full article 
on this subject. To do this as it should be done, would require the indivi- 
dual who attempts it to have seen a far greater number of cases than have 
fallen under my observation. But as I suffered severely from this cause 
during the last year, I shall, at the hazard of being charged with egotism, 
give you a short account of my own case. 

I lost a patient, a child of six or seven years of ao^e, with symptoms of 
peritonitis, on the 2d of February, 1843. On the following day, at twelve 
o'clock, the body was examined by Mr. Thayer, the house physician of the 
Massachusetts Hospital, in presence of my friend Dr. J. B. S. Jackson and 
myself. While the examination was going on, I pricked the end of the 
forefinger of my right hand with several needles that were sticking in a ball 
of thread. The punctures were very slight, giving no pain or uneasiness, 
and hardly attracting any notice at the time. I have no recollection of 
having touched the body of the child at all; yet there is very litde doubt 
that I did apply the end of that finger to the mucous coat of the intestine, 
on a part, too, which was supposed to be slightly ulcerated. I felt no incon- 
venience during the day or evening, and went to bed at twelve o'clock as 
well as I had been for some weeks. For a month previous I had not en- 
joyed my usual health; I was easily fatigued, and had but little appetite, 
and frequently went without my dinner. This is not an unusual thing with 
me, and I attributed it to having a little more to do than I could accomplish 
with ease. For three months, in addition to my private business, I had been 
lecturing and attending the surgical department of the hospital. I mention 
this to show that my system was in a condition to be easily affected. 

I awoke at two o'clock in the morning, with intense pain in the end of 
my finger. It was of a peculiar kind; there was a feeling of crowding and 
distension of a most distressing character, and such as I never experienced 
before. It was confined to the last joint of the finger. As I could not 
sleep, I arose at six o'clock, took no breakfast but a cup of coffee, and the 
only way in which I could get any relief was to keep my finger immersed 
in a tumbler of cold water while I was at table. On examining the finger, 
I found it swollen, and the last joint, to which the pain was still confined, 
was almost of a purple colour. It was hot, and throbbed violently. 

On my way to the hospital, I visited one patient, and after seeing all the 
surgical patients there, as the pain in the finger had increased very much, I 



68 Hay ward's Remarks on Wounds received in Dissection, [Jan. 

had several leeches applied. Though a very considerable amount of blood 
was drawn, I obtained no relief; the finger was even more painful than before, 
and I then felt for the first time the constitutional symptoms; rigors, pain 
in the head and back, and nausea. I however left the hospital, and conti- 
nued to visit patients till half past twelve o'clock, feeling, I have no doubt, 
and looking, as I have since been told by several of them, much sicker 
than any for whom I prescribed that day. I then went home, undressed 
and went to bed, which I was unable to leave for a moment for four days. 
I can truly say, that though I have often been sick, I never felt so sick be- 
fore in my life. I had all the symptoms of sea sickness, with a great 
degree of pain superadded. The arm at this time was painful and swollen 
to the axilla; the veins and absorbents were also red and inflamed; and 
what seemed to me to be singular was, that those on the back of the arm 
were more afTected than those on the front. One of the most distressing 
symptoms at this time was the nausea; I could not raise my head from the 
pillow without fainting. I had an extreme disgust for every kind of food, 
though the thirst was intense. 

I had the arm bathed frequently with laudanum, and cloths wet with the 
same applied, so as to keep the parts constantly wet. I also had a blister 
put on just below the elbow, and in the course of the afternoon I took 
fifteen or twenty grains of the compound rhubarb pill. At about six o'clock 
I got a little sleep, which lasted perhaps for half an hour, when I awoke, 
still in great pain. The thirst was unabated, and a little iced water was the 
only thing that was in any degree tolerable. In the course of that night I 
took two ounces of paregoric and eight grains of opium, without procuring 
more than an hour's sleep, and this was not continuous. The suffering, 
however, was very much lessened for a time by the opiates. On the fol- 
lowing day I was visited by Dr. Warren. As the cathartic taken the day 
before had not operated, he directed the compound infusion of senna with 
Epsom salts, which produced ten or twelve dejections. He also advised 
the continuance of laudanum to the arm, and to take McMunn's elixir of 
opium at night. The pulse at this time was about 100, neither full nor 
strong; the arm less painful than on the preceding day, but the hand quite 
as much so. The whole finger, with the nail, was now of a dark purple, 
the cuticle was raised up from the cutis, and a bloody serum, almost black, 
was effused under it. The thirst was unabated, and the only thing which 
I took for three days, besides the opiate, was the Seltzer water, and this I 
drank in small quantities every fifteen or twenty minutes, day and night. 

I took the elixir of opium as directed, 140 drops at a dose, to be repeated 
in two hours if sleep was not procured; I took three doses in this way with 
some relief, but slept but little during the night. On the following day I 
was restless and uneasy, with headache, nausea, dry skin, furred tongue and 
parched mouth. Dr. W. ordered an emetic of the powder of ipecac, and, 
after its operation, leeches to the arm. I vomited very freely several limes, 



1844.] Hay ward's Remarks on Wounds received in Dissection. 69 

and the leeches drew well; at night I felt somewhat relieved, but the pain in 
the hand and the back was too severe to allow me to sleep without an opiate. 
I took that night and the two following nights an ounce and a half of the 
syrup of poppies with a grain and a half of the sulphate of morphia each 
night, divided into five doses taken at intervals of two hours. This pro- 
duced almost complete relief, but no quiet or continuous sleep. The 
comfort that I got from it cannot be described or imagined by any one who 
has not taken it under similar circumstances. I had none of the itching of 
the skin, the distressing headache and uncomfortable restlessness afterwards 
that so often follow as the effects of large doses of opium. The only in- 
convenience that I experienced arose from the profuse sweating, which 
seemed to be the effect of the opiate, as it ceased when this was left off. 

On the fourth day I felt much belter, I had but little suffering except from 
the hand and arm, and these gave me far less pain than in any preceding 
day since I had been sick. The finger was nearly black, almost four times 
as large as the other. The cuticle had risen up in a large vesicle, and the 
nail also had become detached, held only by cellular membrane. Free in- 
cisions were made through the cuticle, and a considerable quantity of dark 
bloody serum was discharged. These incisions gave me no pain whatever, 
the paft cut was entirely insensible. There was no pus, nor was there any 
thing about the finger that looked like healthy inflammation. The true skin, 
when the cuticle separated from it, was found to be of a dark livid colour, 
almost black, and gangrenous to a small extent in two places. I felt so much 
better at this time, that I began to think my suffering was nearly over, 
though I feared I might lose the whole or a part of the finger. I should 
have observed, also, that when the cuticle was removed four or five punctures 
could be seen on the end of the finger, and were, no doubt, those made by 
the needles. 

It was not my good fortune, however, to escape without additional pain. 
On the morning of the fifth day I was seized with a violent pain, coming on 
somewhat suddenly, in the palm of the hand, just at the point where the 
forefinger is united to the metacarpus. The part began immediately to 
swell and became exquisitely tender. Leeches were applied to it, and the 
whole of the back of the forearm and hand was covered with a blister. 
These means afforded me considerable relief, and three days from the attack 
a small abscess was opened on the back of the hand, from w^hich was dis- 
charged one or two drachms of tolerably healthy pus. From this time I 
steadily improved. The sloughs were thrown off from the finger, and the 
nail separated, the swelling and tenderness of the hand and arm gradually 
subsided, though the stiffness and loss of power continued for some time 
longer. The entire motion of all the fingers I have not yet recovered, and 
the sensibility of the end of the forefinger is far from being perfect. I feel, 
however, that I am still gaining in this particular, and my hand now for all 
practical purposes is nearly as useful as before the accident. 



70 Hayward's Bemarks on Wounds received in Dissection. [Jan. 

My recovery was rapid, so tliat I was able to attend to business in a month 
from the time I was taken. For a fortnight of my confinement I lived en- 
tirely on liquids, and for nearly a month I took no heating or stimulating food, 
my diet consisting of bread and milk, thin broth and beef-tea. I am satified 
that more stimulants would have been injurious, at the same time I am con- 
vinced, from what I have seen in similar cases, that more active depletion by 
general blood-letting and powerful cathartics would have produced extreme 
if not remediless prostration. 

One of the most constant symptoms in affections of this kind is the 
watchfulness, showing very clearly to my mind a high degree of cerebral 
disturbance. Opiates are almost always required and uniformly borne well, 
at the same time they do not commonly produce sleep even when adminis- 
tered in large doses. They allay, however, the irritability of the system and 
serve to soothe and tranquillize the patient. A medical student who was 
affected the winter before last from a wound made in dissection, took, every 
night for several weeks 400 drops of laudanum, and this large quantity only 
procured him a moderate amount of sleep. The truth seems to be, that 
these cases have a very close analogy, if they are not identical, with those of 
morbid irritation, and are but managed by the same course of treatment. 
The topical remedies must vary in different cases, but in every instance 
where there is a local affection of any consequence, I regard a blister 
applied to the arm as of the utmost importance. I can truly say that I 
had no severe pain in any part of my limb above where the blister was ap- 
plied after it had drawn, though it had pained me severely before up to the 
axilla. I have heard several other patients make the same remark. Leeches 
and bathing with laudanum, where there is much pain or inflammation, often 
afford great relief, more, I think, by far, than can be obtained by poultices 
and fomentations, though these are often useful at a late period. 

Among the general remedies, emetics and cathartics hold an important 
place, where there is much constitutional disturbance. These should be 
.administered in the beginning, but it is not necessary that they should be of 
a very powerful kind; in fact the patients that I have seen with this affection 
do not bear very active medicines well. These are to be followed with 
laxatives, mild diuretics, liquid diet and opiates according to circumstances. 
I believe that patients are more likely to do well under this course, than 
under one of a more severe and active character. It is important, however, 
to begin early; the fatal result in most of the cases of which I have had any 
knowledge may be attributed, in my opinion, to the patients having too 
long delayed the use of remedies. All the cases that have come under my 
care, I have seen at an early period, and I have never yet seen one that has 
not terminated favourably. 

I have thus thrown together very hastily the principal circumstances of 
my own case, and 1 leave it to others to decide whether the symptoms were to 
be attributed to irritation or absorption, or to the combined influence of the two. 



1844.] Jarvis on Insanity among the Coloured Population. 71 

Art V. — Insanity among the Coloured Population of the Free States. 
By Edward Jarvis, of Dorchester, Mass. 

The statistics of insanity are becoming more and more an object of interest 
to philanthropists, to political economists, and to men of science. Very many 
men in various parts of our country, and indeed in every civilized nation, 
have entered in this investigation, and their labours have developed the un- 
welcome fact, that mental derangement is among the most common of all 
grave diseases that flesh is heir to. But all investigations, conducted by 
individuals or by associations, have been partial, incomplete, and far from 
satisfactory. They failed especially of obtaining accurately the basis of their 
calculation. They could not tell the numbers of any class or people, among 
whom they found a definite number of the insane. And therefore, as a 
ground of comparison of the prevalence of insanity in one country with that 
of another, or in one class or race of people with that in another, their 
reports did not answer their intended purpose. In some states the medical 
societies undertook this work of ascertaining the number of lunatics within 
their borders. In others, committees of the legislatures were appointed to 
obtain this information, or associations of philanthropists privately made 
inquiry. But all were almost necessarily imperfect. If the survey w^ere 
intended to cover any considerable extent of country or large body of people, 
it required the active co-operalion of many individuals, who were scattered 
through every district, and familiar with the domestic conditions of every 
class, or who could have access to every family. Medical societies, which 
are supposed to have in each neighbourhood one of its members, who is 
intimate in every house, certainly have the best opportunities of obtaining 
this knowledge, but they cannot compel every member to make the desired 
report. Their investigations, therefore, rather reach to scattered points than 
cover over measured and definite surfaces of country. For a stronger reason, 
legislative committees and individuals have failed, because they had not any 
extended and connected corps of coadjutors, whose aid they could claim. 
Hence, with the exception of the returns of the insane poor in some of the 
states, we had no complete and accurate account of the number of these unfor- 
tunate sufferers in any country, or race, or class of people. The writers upon 
insanity, both in Europe and in America, have been confined to the data of- 
fered by these partial investigations, when they have spoken of the prevalence 
of the disorder. These authors have therefore differed very widely, not only 
in different countries, but among each other in the same country, and all for 
the want of an established and acknowledged basis of calculation. 

It was necessary, for perfect truth in this matter, to know exactly the 
number of people, in any district or class, in which should be found any 
definite numbers of lunatics. The instructions given to the marshals at the 



72 



Jarvis on Insanity among the Coloured Population. [Jan. 



last decennial enumeration of the people of the United States offered all that 
was desired. These were directed to ascertain, each in his own district, the 
number of white and coloured people respectively, and also the number of 
white and coloured lunatics and idiots. They were also directed to learn 
and record how many of these were supported by their own estates or by 
their friends, and how many were supported by the public* As these 
functionaries were ordered to inquire from house to house, and leave no 
dwelling — neither mansion nor cabin — neither tent nor ship iinvisited and 
unexamined, it was reasonably supposed that here would be a complete 
and accurate account of the prevalence of insanity among seventeen millions 
of people. A wider field than this had never been surveyed for this purpose 
in any part of the earth, since the world began. It was supposed, also, that 
this would show the comparative frequency of this disorder, among the 
white and the coloured races. Never had the philanthropist a better promise 
of truth hitherto undiscovered. All who were interested in this matter, waited 
anxiously for the publication of the sixth census, which came forth in large 
folio volumes, " corrected at the Department of State." Many proceeded at 
once to analyze the tables, in order to show the proportion of lunacy in the 
various states, and among the two races, which constitute our population. 

The following tables include the number of white and coloured people, as 
found in the summaries at the end of the tables for each state. The pro- 
portions in the third and sixth columns of figures are obtained by dividing the 
figures of the first column by those in the second. 



TABLE I. 

Northern States. 



Slate or 


White 


Number 




Coloured 


Number 




Territory. 


Population. 


of Insane. 


One in 


Population . 


of Insane. 


One in 


Maine 


500,438 


537 


950.5 


1.355 


94 


14 


New Hampshire 


284,0.36 


486 


584 


538 


19 


28 


Vermont 


291,218 


398 


7.34 


730 


13 


56 


Massachusetts 


729,030 


1071 


680 


8669 


200 


43.5 


Rhode Island 


10.5,.587 


203 


520 


3243 


13 


249 


Connecticut 


301,856 


498 


606 


.8159 


44 


185 


New York 


2,378,890 


2146 


1108 


50,031 


194 


257 


New Jersey 


351, .588 


369 


950 


21,718 


73 


297 


Pennsylvania 


1,676,115 


1946 


851.7 


47,918 


187 


256 


Ohio 


1,502.122 


1195 


1257 


1 7,345 


165 


105 


Indiana 


678,698 


487 


1393 


7168 


75 


95 


IHiriois 


472,254 


213 


2217 


3929 


79 


49 


Miclii^an 


211,560 


39 


5423 


707 


26 


27 


Wisconsin 


30,749 


8 


4383 


196 


3 


65 


Iowa 


42,924 


L7 


6132 


188 


4 


47 


Northern States 


9,557,065 


9603 


995 


' 171,894 


1189 


144.5 



* "The said enumeration shall further distinguish the number of those free white persons 
included in such enumeration, who arc deaf and dumb, under the age of fourteen years; and 
those of the age of fourteen years and under twenty-five; and of the age of twenty-five and 



1844.] Jarvis on Insanity atnong the Coloured Population. 



73 



TABLE II. 

Southern States. 



State or 


White 


Number 




Coloured 


Number 




Territory. 


Population. 


of Insane. 


One in 


Population. 


of Insane. 


One in 


Delaware 


58,531 


52 


1126 


19,524 


28 


697 


Maryland 


317,717 


387 


818 


151,515 


141 


1074 


Virginia 


740,968 


1053 


717 


498,829 


381 


1309 


North Carolina 


484,870 


580 


834 


268,549 


221 


1215 


South Carolina 


259,084 


376 


680 


335.314 


137 


2447 


Georgia 


407,695 


294 


1386 


283,697 


134 


2117 


Alabama 


335,185 


232 


1444 


255,571 


125 


2044 


liouisiana 


158,457 


55 


2080 


193,954 


45 


4310 


Mississippi 


179,074 


116 


154 


196,577 


82 


2397 


Tennessee 


640,627 


699 


917 


188,5p<3 


152 


1240 


Kentucky 


590,253 


795 


742 


189,575 


180 


1053 


Missouri 


323,888 


202 


1603 


59,814 


6S 


879 


Arkansas 


77,174 


45 


1715 


20,400 


21 


971 


Florida 


27,943 


10 


2794 


26,534 


12 


2211 


Dist. Columbia 


30,657 


4 


1816 


13,055 


7 


1866 


Southern States 


4,6.32,153 


4900 


945.3 


2,701,491 


1734 


1557.9 



TABLE III. 

Comparison of the Free and the Slave States. 





White 
Population, 


Number 
of Insane 


One in 


Coloured 
Population. 


Number 
of Insane. 


One in 


Northern States 
Southern States 


9,557,065 
4,632,153 


9693 
4900 


995 
945.3 

978 


171,894 
2,701,491 


1191 
1734 


144.5 
1557.9 


Total 


14,189,218 


14,503 


2,873,385 


2925 


982. 



TABLE IV. 

Summary of the whole United States. 
Population, 17,062,603 | Number of Insane, 17,428 | One in 979 

This analysis attracted much attention, and great pains were taken to 
spread it before the whole country. It was printed in some of the medical 
journals, in several of the lunatic hospital reports, and in other channels of 
information. Here were facts strange and astounding, but wliich coming 
from high official authority, could not be resisted so long as we put our faith 
in the document, the printed volume of the sixth census. The most unex- 

upwards: and shall further distinguish the number of those free white persons included in 
such enumeration who are blind; and also in like manner of those who are insane or 
idiots, distinguishing further such of the insane and idiots as are a public charge." 

"The said enumeration shall further distinguish the number of those free coloured and 
other coloured persons, included in the foregoing, who are deaf and dumb, without regard 
to age, and those who are blind, and also in like manner of those who are insane and 
idiots, distinguishing further such of the insane and idiots as are a public charge." — From 
Ike act to provide for taking the sixth census or enumeration of the inhabitants of the 
United States, sec. 1. 



74 Z2iX\\s on Insanity among the Coloured Population, [Jan. 

pected development was that of the vast disproportion of insanity in the 
coloured population of the free and of the slave states. It was here shown 
that the negroes and mulattoes of the north produced one lunatic or idiot for 
every one hundred and forty-four persons, while the same class at the south 
produced only one lunatic or idiot for every fifteen hundred and fifty-eight. 
Lunacy was therefore about eleven times as frequent for the African in free- 
dom as in slavery. More strange than this, it was shown, that in Maine 
every fourteenth negro, in Michigan every twenty-seventh, in New Hamp- 
shire every twenty-eighth, and in Massachusetts every forty-third negro was 
insane. While New Jersey, which seemed to be the least destructive to 
the mental health of the coloured population, having only one lunatic in 
every two hundred and ninety-seven of those people, presented more than 
double the proportionate number of insane blacks of that which was found 
in her contiguous neighbour, Delaware, which, in this respect, was the least 
favoured of the states south of Mason and Dixson's line. This was so 
improbable, so contrary to common experience, there was in it such strong 
prima, facie evidence of error, that nothing but a document, coming forth 
with all the authority of the national government, and " corrected in the 
department of state," could have gained for it the least credence among the 
inhabitants of the free states, where insanity was stated to abound so plen- 
tifully. 

This seemed to present a new feature among the causes of mental dis- 
order, and led many to investigate the effects of slavery and freedom upon 
soundness of mind. The facts were published in detail in the Medical 
Journal, of Boston; in the Southern Literary Messenger, of Richmond, Va., 
for June, 1843; in Hunt's Merchant's Magazine, of New York, for May, 
1843; in Dr. Stribbling's Report of the Western Lunatic Asylum, of Vir- 
ginia, and in several of the newspapers of this country. The same has been 
republished in Europe. Throughout the civilized world, the statement has 
gone forth, that, according to the experience of the United States, including 
a slave population of near two and a half millions, and a free coloured 
population in the northern States of near two hundred thousand, slavery 
is more than ten-fold more favourable to mental health than freedom. The 
writer in the Southern Messenger, founds a long and apparently satisHictory 
argument upon these data — and the slaves are consoled with the assurance, 
that although another man's will governs them, yet their minds are not 
bound with insane delusions, nor crushed in idiocy, as are those of their 
brethren, who govern themselves. This certainly appeared to be a matter 
of just consideration, with the philanthropist, who wished the early eman- 
cipation of the slave. It is offered by the Southern Messenger as a new 
reason for conservatism of the peculiar institutions of the south, and this 
apparent exemption of the slave from one of the most terrible disorders 
that has visited humanity, and the ten-fold liability of the free black to the 



1 844.] Jarvis on Insanity among the Coloured Population. 



75 



same, may become not only a fundamental principle in medical science, but 
also one of the elementary principles in political economy. 

Without attempting to refute any of the arguments or deductions that have 
been or may be drawn from the nosological statements in the tables of the 
census, or to overturn any theories that may be offered for their explanation, 
it is sufficient to strike at the very root of the matter, and show their entire 
want of truth, and demonstrate that no reliance whatever can be placed on 
what purport to be facts, respecting the prevalence of insanity among the 
free negroes, set forth, in that fallacious and self-condemning document, the 
"sixth census" of the United States. 

This census contains, in one set of columns, the number of the whites 
and the number of blacks in each town, city, county and state of the Union; 
and in another set of columns are contained the numbers of the white and 
of the coloured lunatics and idiots, in each of these respective districts and 
localities. Seeing so great a disproportion of the coloured and the white 
insane, in the free and the slave states, we were led to go back from the 
results, the gross sums, which are at the foot of the added columns, and in 
the summaries at the end of the reports concerning each state, to the details, 
of which the reports were made up. We compared the whole coloured 
population of each town individually, with the number of the insane re- 
ported as belonging to it, and here we found the secret of the error. 

We found that the town of Worcester, in Massachusetts, is stated to con- 
tain one hundred and thirty-three coloured lunatics and idiots, supported at 
public charge. These we know are the white patients in the state hospital, 
situated in that town. This single mistake multiplies the coloured lunatics 
of this state three-fold, and if this were corrected, it would reduce the pro- 
portion of coloured insane from one in forty-three to one in one hundred 
and twenty-nine. Warned by this example, we examined the statements 
respecting every town, city, and county, in all the states and territories, and 
compared in each one of these, the total coloured population with the num- 
ber of the coloured insane. These are the results of this examination. 



MAINE. 



TOWNS. 
Limerick, 
Lymington, 
Scarboro, 
Poland, 
Dixfield, 
Calais, 



Total coloured Coloured 

inhabiianls. insane 

4 

1 2 
6 
2 
4 
1 



TOWNS. 
Industry, 
Dresden, 
Hope, 
Harlland, 
Newfield, 



Total coloured Coloured 
inhabitants, insane. 

3 



NEW HAMPSHIRE. 



Coventry, 

Haverhill, 

Holderness, 

Atkinson, 

Bath, 

Lisbon, 

Compton, 



Strathann, 

Norihannpton, 

New Hampton, 

Lyman, 

Littleton, 

Henniker, 



"«^ 



76 



Jarvis on Insanity among the Coloured Population. [Jan. 



MASSACHUSETTS. 



rrnwMC Total coloured 
TOWNS. inhabiianis. 


Coloured 
insane. 


TnwiM<5 Total coloured Coloured 
iwwi>o. inhabitants, insane. 


Freetown, 





2 


Georgetown, 




2 


Plymplon, 


2 


4 


Carver, 




1 


Leominster, 





2 


Northbridge, 




1 


Wilmington, 





2 


Ashby, 




1 


Sterling, 





2 


Randolph, 




1 


Danvers, 





2 


Worcester, 


151* 


133 






CONNECTICUT. 






Water ford, 


2 


7 












VERMONT. 






Rushford, 





1 


Lyndon, 


1 


2 


Athens, 


2 


2 


Castleton, 


4 


2 


Barnet, 





1 

NEW 1 


Fairhaven, 

^ORK. 


1 


1 


Conewango, 





1 


Westville, 





I 


Olean, 





1 


French Creek, 





1 


Ellington, 





5 


Carroll, 





1 


Sherman, 





1 


Holland, 





2 


Barne, 


10 


6 


Crown Point, 





1 


Shelby, 


1 


7 


Sandy Creek, 





1 


Providence, f 


3 


2 


Hadley, 





1 


Stockholm, 





1 


Parishville, 





1 


Chester, 





1 


Groton, 





5 


Java, 





1 


Dryden,:|: 





2 


Lansing, 


8 


4 


Great Valley, 





1 


Leon, 





1 

NEW JE 


RSEY. 






Stafford, 


1 


7 

PENNSYI 


.VANIA. 






Colebrookdale, 





2 


Leba3uf, 





3 


Bloomfield, 


2 


3 


W^ashington, 






Centre, 


4 


8 


Erie Co., 





4 


Old Codorus, 





2 


Washington. 






West Providence, 


6 


3 


Indiana Co., 





1 


Armstrong, 





1 


Little Beaver, 





1 


Harios, 


3 


6 


Plum, 


8§ 


5 


Jay, 
Greenwood, Mil- 


2 


2 


Logan, 





2 






Upper Paxton, 


2 


2 


lerstown, Bor., 





2 


Oliver, New- 






Ridgebury, 





1 

OH 


port, Bor.; 

[0. 





1 


Greene, Wayne 






Bristol, 





2 


(vounty. 


1 


2 


Lordstown, 





1 


Ellsworth, 





3 


Tuscarawas, 





1 


Canfield, 


1 


1 


Salem, 


1 


1 



* Thirty-six of these are under 10 years of ag'e. 
t Providence has also two deaf and dumb negroes. 
t Dryden has also two blind negroes. 
§ Three of these under 10 years of age. 



1844.] Jarvis on Insanity among the Coloured Population. 



77 



TOWNS. Toul 


coloured 


Coloured 


TOWNS. 


Total coloured Coloured 


ibilanis. 


insane. 




inhabitants. 


insane. 


Venice, 







1 


Liberty, 











Thompson, 


1 




2 


Bloomfield 











Vernon, 


2 




2 


Greenfield, 











Porter, 







1 


Falls, 




1 






Jefferson, Madi- 








Starr, 











son Co. 







1 


Rurnley, 











Sharon, 







1 


Chester, 











Montgomery, 


1 




4 


Auburn, 











Vermilion, 







1 


Newbury, 











Greene, Rich- 








Burton, 




] 






land Co. 







1 


Plain, 











Hanover, 







1 


Jefferson, 










Munroe, 







1 


Franklin 


Co 









Washington, 








Norwich, 











Preble Co. 







4 


Harrison, 











Washington, 








Bricksville 


7 


1 






Pickaway Co. 







7 


Brooklyn, 











Spencer, 


1 




1 


Green, 










Jefferson, 








Clarke Co. 


1 






Richland Co. 







1 


Lewis, 




7 






Canaan, 







1 


Elk, 











Sylvania 


1 




I 


Alexander, 




1 






Amherst, 







1 


Lenox, 











Franklin, 







1 

INDI/ 


Pleasant, 

LNA. 




12 




8 


Noble, 







2 


Marshall, 




1 




2 


Owen, 







2 


Fulton, 




1 




1 


Marion, 







1 


Bartholomew, 







1 








ILLIN 


OIS. 












Co 


oured Coloured 






Coloured Coloured 


TOWNS. COUNTY. 


in 


habi- 


insane. 


TOWNS. 


COUNTY. 


inhabi- 


insane. 




lanis. 










tants. 




Plainfield, Will, 







1 


Taylor, 


Greene, 





3 


Scott, 




4 


5 


South Rich- 










Marshall 







I 


woods, 




u 





1 


Livingston, 


1 


1 


Township 6 










Logan, 




1 


6 


N. IE. 


Fu 


ton, 





1 


La Salle, 




2 


1 




De 


Kalb, 





2 


Council Hill, Jo. Davies, 





1 




Ch 


ristian 





3 


W'ilmington, Greene, 







5 
MICHI 


GAN. 










^rnttrvrc Total coloured Coloured 
TOWNS. ixihabilarils. insane. 


TOWNS. 




Total coloured Coloured 
inhabitants. insane. 


Rensselaer, 









Milton, 











Antrim, 









Wheatland 


» 









Vernon, 









Penfield, 











Unadilla, 









Athens, 











Rollin, 









Bertrand, 











Sandstone, 


1 






Sheridan, 











Glass Lake, 







lOW 


A. 










Jefferson Co. 







2 













To those who examine the census in its details, the statement respecting 
No. Xm.-— January, 1844. 6 



78 Jarvis on Insanity among the Coloured Population, [Jan, 

the number of coloured insane in these towns and counties, carries on its 
very face its own refutation; no one who llms studies the report, can pos- 
sibly be misled. But these palpable errors are by no means all. There are 
others almost as gross, and to observers of society almost as self-evident. — 
In manv towns all the coloured population are stated to be insane, in very 
many others, two-thirds; one half, one-fourth, or one-tenth of this ill-starred 
race are reported to be thus afflicted, and as if the document delighted to revel 
in variety of error, every proportion of the negro population from seven-fold 
its whole number, as we have shown in some towns, to less than a two- 
thousandth, as is recorded of others, is declared to be lunatic. 

How far these errors respecting insanity among the blacks extend beyond 
those which we have already pointed out, we have no means of ascertaining; 
but here are enough to destroy all our confidence in the accuracy of the 
whole. The same carelessness, which gave insanity without subjects in 
some places, may have given none in others, where it actually existed. It 
may have called those who supported themselves paupers, and ranked the 
poor among the class of the self-supporting. Certainly there is ground for 
suspicion of the former in some instances. The county of Perry, in Penn- 
sylvania, with only one hundred and fifty-four coloured inhabitants, of 
whom fifty-five are less than ten years old, is said to have twenty-four insane 
and idiots, and twenty-one of these are stated to maintain themselves. This 
would indicate not only a prevalence of insanity greater than has been dis- 
covered within our observation, but also a degree of prosperity beyond 
what we have known among the coloured people of the northern or south- 
ern states, and even greater than falls to the average lot of the whites in 
the same county, for two-fifths of the white lunatics in Perry county are 
maintained at public charge; and throughout the free states, about one- 
third are supported in the same way. In eighteen counties of New York, 
the entire coloured insane population, forty-six, are said to support them- 
selves, while more than one-fourth of the white lunatics in the same coun- 
ties are supported at public charge. In the state of New York seventy- 
one per cent, of the coloured and only sixty-eight per cent, of the white 
lunatics are able to maintain themselves. 

We have good reason for believing, that the census is in error in regard 
to the numbers of the white as well as the coloured insane. In every case 
where we have had an opportunity to compare the statements of that docu- 
ment in regard to this matter, with the results of a more trustworthy inves- 
tigation and with more accurate data, we have found the national return to 
fall short of the truth. 

According to the census, there were, in 1840, within the state of Massa- 
chusetts, only six hundred and twenty-seven lunatics and idiots, of alt 
colours, who were supported at the public cost. But the abstract of the 
returns of the overseers of the poor to the secretary of state of Massachu- 
setts for 1840, show that there were eight hundred and eighty-seven pauper 



1844.] Jarvis on Insanity among the Coloured Population. 79 

lunatics and idiots within that commonwealth. In this disagreement of 
these two reports, there can be no question as to which we must yield our 
faith. The overseers, whose testimony is the sole foundation of the state- 
ments of the pauper abstract, are residents in the towns and cities with 
the poor lunatics, whom they report, and have the entire charge of their 
maintenance. Their registers must contain the names of all the insane 
paupers, and no more; and their returns to the secretary being the copies 
of these" registers, must necessarily be accurate. There is no conjecture, 
there can be no mistake in this matter. On the other hand, the marshals, 
in taking the census, must obtain their information at second hand, from the 
reports of others; and as insanity is by many considered as a disreputable 
disorder, it is often concealed, and still more frequently is it reported spar- 
ingly to a stranger and a public officer, whose purpose is to make it a matter 
of public record. In judging of the issue of credibility between these two 
documents, we must admit the evidence of the pauper abstract, and reject 
that of the census. 

This error of deficiency is not confined to Massachusetts. The superin- 
tendents of the poor of the state of New York report one thousand and 
fifty-eight pauper lunatics within that state, while the census marshals dis- 
covered and reported only seven hundred and thirty-nine among the same 
people. 

The legislature of New Jersey appointed a committee, " to ascertain, as 
accurately as practicable, the number, ages, sex, and condition of lunatics 
in this state." This committee examined most^ of the counties accurately, 
and partially investigated the remainder, and made their report to the go- 
vernment in 1840. The ascertained number of lunatics and idiots, in the 
districts examined, was six hundred and eleven. They computed that there 
were ninety in the other portions of the state. This will make seven hun- 
dred and one for the whole state. The census reports only four hundred 
and forty-two, within the same territory. 

A few years ago the Medical Society of Connecticut ascertained and 
published the number of lunatics and idiots within that state, more than 
twice as large as that reported in the census of 1840. 

A similar examination revealed in Eastern Pennsylvania many more luna- 
tics and idiots tjian the United States marshals are reported to have dis- 
covered. 

Dr. Stribbling, of the Western Lunatic Asylum of Virginia, states that 
more lunatics were known to exist in several counties in that state, than 
the census reports. 

We have no means of ascertaining how far the census falls short of the 
truth in its report upon the insanity among the whites in other states. But 
reasoning from analogy, we presume it is no more accurate there than here. 
The records and the means of information are not more abundant at the 
South and West than they are at the North and the East; and if the mar- 



80 



Jarvis on Insanity among the Coloured Population. [Jan. 



shals could ferret out only three-fourths of the lunacy among the paupers of 
Massachusetts, whose condition is a matter of public record and notoriety, 
how much more difficult must they have found it, to obtain the entire num- 
bers of the insane in other states and classes where insanity is not regarded 
so favourably, and therefore often concealed? 

The census is equally inaccurate in its statements respecting the blind 
and the deaf and dumb, among the negroes at the north. We examined 
the details of that document in regard to these disorders among the coloured 
population in every town, city, and county of the free states, and found in 
many of these places, the record of cases of blindness and deafness and 
dumbness without subjects. These disorders exist there in a state of ab- 
straction, and, fortunately for humanity, where they are said to be present, 
tliere are no people to suffer from them. But in others the entire coloured 
population are overwhelmed with these calamities, and now and then they 
are all afflicted, not with one disease only, but with both blindness and 
insanity. 

DEAF AND DUMB AND BLIND, AMONG THE COLOURED POPULATION. 



TOWNS. 


Population. 


MAI 

Blind. Deaf and 
Dumb. 


NE. 

TOWNS. Population. 


Blind. 


Dpaf and 
Dumb. 


Lymington, 
Scarboro, 
Raymond, 
Orono, 


1 



1 
1 


2 
1 
1 


1 
NEW HAM 


Hebron, 
Hope, 
Calais, 
Anson, 

PSHIRE. 




1 

3 





1 




1 

1 
1 
2 


Danville, 
Lee, 






■^ 


1 
1 

MASSACHL 


New Hampton, 
Mereditli, 

SETTS. 




8 


1 


1 
5 


Carver, 
Leverett, 


1 




1 


1 
VERIV 


Milford, 

lONT. 


5 




4 


Fairfax, 
Rupert, 







1 


1 

NEW Y 


Hartland, 

ORK. 





1 




Harmony, 

Poland, 

Mina, 

Preston, 

Pharsalia, 

Golden, 

Pike, 

Dryden,* 




c» 
(j 
4 



2 
2 


2 

2 
1 

1 

2 
2 


4 

1 


Schroon, 

VVestville, 

Rutland, 

Ellisburah, 

Harris burgh, 

Parishville, 

Stockholm, 

Providence,* 









3 


1 

1 
1 


1 

2 
1 

1 
2 



These towns are each reported to have two coloured insane persons. 



1844.] Jarvis on Insanity among the Coloured Population, 



81 



PENNSYLVANIA. 



TOWNS. Population. 


Blind. 


Deaf and 


TO WNS. Population. 


Blind. 


Deaf and 








Dumb. 








Dumb. 


Reading, 







1 


Shamokin, 









Colebrookdale, 





1 




Mifflinburgh, 







2 


Haycock, 





1 




Lebceuf, 







2 


Ross, 





1 




Elkland, 









Franconia, 







1 


Farmington, 







1 








OHIO. 








Marion, 





1 




Canaan, 









Chatfield, 







1 


Brunswick, 


1 




I 


Sycamore, 







1 


Butler, 









Bricksville,* 


1 


1 




Salt Creek, 







1 


Falls, 


1 




2 


Washinfrton, 








Liberty,* 





1 




Pickaway Co 









York, 







1 


Jefferson,* 








Reed, 





1 




Richland Co. 









Unity, 





1 












Jefferson, 
















Madison Co. 





1 


INDI 


\NA- 








Clifty, 








Madison Co.f 


6 




3 


Bartholomew Co. 





2 




Wayne, 





1 


3 


Kosciusko Co. 





1 




Floyd, 





I 




Madison, 







3 


Suaar Creek, 





I 




Scott, 







1 


Cotton, 





3 





Porter, 



MICHIGAN. 

f Howel, 



ILLINOIS. 



Boone, 
Scott, 
Spring Creek, 



Jones, 







I 

1 



Township No. 46 
WinnebaiTo Co. 



IOWA. 

3 j Linn, 



We have been thus minute in our specifications of the errors of the " sixth 
census," in order to carry conviction to our readers in every state, and to 
show them, by instances within their own knowledge, how and wherein its 
misstatements are made, and whence the grossly erroneous inferences have 
been drawn in regard to the liability of the free negroes to insanity, and to 
loss of sight, of hearing, and of speech. So far as the census testifies in 
this matter, this extreme liability is confined to the free blacks of the north. 
No inquiry was made, and no evidence is given as to the health of the mind 



* Bricksville, Liberty, and Jefferson, according to the census, have each one coloured 
lunatic, in addition to their blind. 

+ Madison county, according^ to the census, has one coloured lunatic. 

i According to the census, Scott has four coloured lunatics beside the blind. 



82 



Jarvis on Insanity among the Coloured Population. [Jan. 



and the senses of the free blacks at the south. It certainly would be an in- 
teresting question to determine, whether the free or the slave blacks, living 
side by side in the warmer climate, with no difference of circumstances 
except those of bondage and freedom with their respective consequences, 
were the more liable to derangement or loss of their faculties, of reason, 
sight, and hearing. We regret that the marshals were not directed, in their 
inquiries relative to health, to distinguish between the slave and the free 
negro at the south. Then, if the printed record of their report had not been 
unfaithful, like that which purports to come from the north, we should have 
had belter data than we now have, forjudging of the influence of self-direc- 
tion and self-support, upon the sanity of the coloured race.* 

Here is proof enough to force upon us the lamentable conclusion, that the 



* The laws of some of the southern states, and, we believe, of all, compel every slave- 
owner to maintain all his slaves in sickness and in old age. Of course, then, their 
masters must support them in their insanity and idiocy. None of them can come to the 
public treasury for support. On the other hand, the free negroes are generally, perhaps 
almost universally, poor. They are mostly thriftless and improvident. " Most of thera 
spend their all for drink. Every effort to induce industry and care is abortive."t 
They seldom earn more than sufficient for the day's necessities or uses. They rarely ac- 
cumulate property enough to maintain themselves in sickness, still less through the pro- 
tracted helplessness of insanity. Most, if not all the free coloured lunatics must then be 
thrown upon charity or upon the public for support. If we are wrong in these state- 
ments, we beg to be corrected by sotne one who is acquainted with the laws respecting 
the maintenance of slaves, and with the domestic and pecuniary condition of the free 
negroes of the southern states. But if we are correct in our opinions, we shall be justified 
in assuming all the coloured lunatics who are supported at the public charge, and no 
others, as belonging to the class of the free; and all coloured lunatics who are supported 
at private charge, and no others, as being slaves. 

Upon these principles we have prepared an analysis of the cases of insanity among the 
free and slave blacks of the southern states, as in the following table. 





Slaves. 


Insane at pri- 




Free coloured 


Insane at pub- 




State or Territory. 




vate charge. 


One in 


population. 


lic charge. 


One in 


Dist. Columbia, 


4,694 


4 


1173 


8,361 


3 


2787 


Florida, 


25,717 


12 


2146 


817 







Arkansas, 


19,935 


13 


1533 


465 


8 


58 


Missouri, 


58,240 


50 


1164 


1,574 


18 


87 


Kentucky, 


182,2.58 


132 


1380 


7,317 


48 


152 


Tennessee, 


183,059 


124 


1476 


5,524 


28 


198 


Mississippi, 


195,211 


66 


2957 


1,366 


16 


85 


Louisiana, 


168,452 


38 


7657 


25,502 


7 


3643 


Alabama, 


253,532 


100 


2532 


2,039 


25 


81 


Georgia, 


280,944 


108 


2601 


2,753 


26 


105 


South Carolina, 


327,038 


121 


2702 


8,276 


16 


517 


North Carolina, 


295,817 


192 


1280 


22,732 


29 


7839 


Virginia, 


448,987 


327 


1372 


49,842 


54 


923 


Maryland, 


89,4:)5 


99 


904 


62,020 


42 


1576 


Delaware, 


2,605 


21 


124 


16,919 


7 


2417 


Slave states. 


2,485,984 


1407 


1766 


215,507 


427 


659 



t Soutliern Literary Messenger, from Rev. Mr. Thornton. 



1844.] Jarvis on Insanity among the Coloured Population, 83 

*' sixth census" has contributed nothing to the statistical nosology of the 
free blacks, and furnished us with no data whereon we may build any theory 
respecting tlie liability of humanity, in its different phases and in various 
outward circumstances, to loss of reason or of the senses. We confess, we 
are disappointed, we are mortified; nor are we alone in this feeling; our 
government had directed, that seventeen millions of people of various races 
and conditions, shoukl be counted and their precise amount of derangement 
ascertained. Scientific men and philanthropists looked for the results of this 
investigation with confident hope; for henceforward the statistics of insanity, 
of deafness, and of blindness, were to be no more a mere matter of conjec- 
ture, but of positive and extensive demonstration. In due time the document 
came forth, under the sanction of Congress, and " corrected at the Department 
of State." Such a document as we have described, heavy with its errors 
and its misstatements, instead of being a messenger of truth to the world, to 
enlighten its knowledge and guide its opinions; it is, in respect to human 
ailment — a bearer of falsehood to confuse and mislead. So far from being 
an aid to the progress of medical science, as it was the intention of govern- 
ment in ordering these inquiries, it has thrown a stumbling-block in its way, 
which it will require years to remove. 

Where these errors originated, whether with the thousand marshals who 
counted the people in all the districts of the nation, or with the clerks in the 
State Department, who analyzed and reduced their returns to tables as now 
published, we have no means of judging. But so far as they were made at 
Washington, the case is not without remedy. The original returns may be 
re-examined, and a new and more accurate set of tables of the numbers of 
the insane, the deaf, and the blind, may be prepared. We commend this 
matter to the attention of the next Congress. We hope they will cause all 
the original papers respecting the sixth census to be revised, and all the 
errors which were made in copying them corrected, and a new and satis- 
factory edition sent forth, so that the correction of the mistakes and the 
refutation of the errors may follow them as early and as widely as possible. 
This is due to the honour of our country, to medical science, and to truth. 



84 



Atlee's case of Congenital Tumour. 



[Jan. 



Art. VI. — Congenital Tumour, composed of numerous cysts. By Wash- 
ington L. Atlee, M. D. of Lancaster, Pennsylvania. [With three 
woodcuts.] 

March 18, 1842, I was consulted in the case of Henry Gagely, aged four 

years, for a congenital tumour situated upon the right side. It formed a 

■p. J circle, whose periphery 

extended into the hypo- 
chondriac, lumbar,iliac, 
hypogastric, umbilical 
and epigastric regions 
of the right side, and its 
centre lay upon the lum- 
bar region a short dis- 
tance from the angle 
formed by the bounda- 
ries of the u mbilical and 
hypochondriac regions, 
thus overlaying several 
of the lower ribs, the 
abdominal muscles of 
the right side, and al- 
most encroaching upon 
the internal abdominal 
ring. The tumour was 
yielding, elastic, and 
owing to its pliability, 
apparently moveable. 
The skin covering it 
was natural in colour, 
attenuated in texture, and could not be displaced or pinched up from the 
sac beneath. Its base could not be moved from its attachments below, 
evincing firm adhesions throughout its whole extent, and around its entire 
circumference. Upon shading one-half of the tumour with the hand, and 
permitting the rays of the sun to fall upon the oilier, it was semi-transpa- 
rent, as in hydrocele, indicating aqueous contents, but it differed from hy- 
drocele, inasmuch as percussion produced no perceptible fluctuation. 

Three years from the above date, when the child was one 5'ear old, the 
tumour had been punctured by the lancet, three different times, by my 
brother. A small discharge of serum followed, with very little diminution 
of the tumour, and a rapid return to its original size. 

At the birth of the child the tumour was of the same relative bulk as at 




1844.3 Atlee's case of Congenital Tumour. 65 

the time I was called in, and had since seemed to have grown with the 
growth of the child, depending, as it would appear, upon a normal state of 
nutrition. 

The peculiar character of the tumour and its location led me to suspect 
the possibility of a fistulous connection with the spine, in consequence of 
which I was very careful in its examination, and particularly so, as some 
years ago I assisted in the removal of a cyst from the abdominal parietes 
of a child in which such relations existed, but, previously to the operation, 
were not suspected. As the case here referred to is one of peculiar interest, 
and had considerable bearing on the case which I am now reporting, I 
will digress a moment, while relating a few of its prominent points. 

It occupied a large portion of the right side of the abdomen, and was 
firmly attached by its inferior border to the pubic division of Poupart's liga- 
ment and to the external abdominal ring. It was considered as an ordinary 
encysted tumour, lying between the integument and muscular tissue, and 
easy of removal. After, however, prosecuting its excision to some extent, 
the sac happened to be cut into, from which there immediately issued a 
clear serum, containing flaky matter peculiar to that of lumbar abscess, and 
at once excited suspicion of spinal communication. Now upon surveying 
the sac, we discovered a communication, through the external ring, with 
the inguinal canal, through which a probe was readily passed up towards 
the spine. The sac, however, was completely dissected out, the wound 
healed kindly, excepting at the ring, where it retained a fistulous character 
for some time, and the child ultimately perfectly recovered. 

This case, therefore, led me to suspect the possibility of a similar state 
of things in the case before me, but finding no spinal tenderness or deform- 
ity, perceiving no scrofulous or cachectic habit of body, but a full, hale and 
robust constitution, a blooming boy, full of activity and life, the apprehen- 
sion of spinal disease was scarcely felt, while the successful termination of 
the one case encouraged me in deciding to free the interesting little fellow 
of his tumour, even should it prove to be of a similar nature. 

Accordingly I made an incision in the direction of the muscular fibres of 
the obliquus externus extending across the tumour, one inch beyond it, both 
above and below. The integument was now found to be so intimately 
incorporated with the cyst, that the greatest difficulty arose in separating 
them. Indeed, there was no vestige of cellular tissue between them, and 
consequently it was impossible to carry on the dissection without wounding 
both the skin and the sac, particularly at the cicatrices formed by the pre- 
vious punctures. I therefore could not avoid penetrating the very delicate 
envelope twice, and the cyst several times during the operation. Of course, 
so soon as the sac was entered there was a copious flow of clear serum, 
free from flaky particles, and the sac became flaccid, thus increasing the 
difficulty of the operation. The whole tumour, however, did not collapse. 



86 Atlee's case of Congenital Tumour, [Jan. 

On the contrary, a firm tumour within the cyst, about three-fourths of the 
original size, still remained; and upon slitting open the cyst, this tumour 
was perceived, projecting into its cavity, its exterior surface having been 
separated from the interior of the sac by the serum which had just escaped. 
This internal tumour appeared also to be a cyst containing the same kind of 
fluid, the two cysts being concentric, like the laminae of an onion. After 
very great difficulty, I came down to the base of the tumour, and here, 
where the integument was reflected upon the tumour from the parietes of 
the abdomen, was to be discovered the only traces of cellular membrane, 
and this was very short and dense. Now proceeding to dissect up the base 
of the tumour from the sheath of the rectus muscle, its attachments were 
found to be equally strong. Owing to the condensation, I might say obli- 
teration, of the intervening tissue, I had not prosecuted this part of the 
dissection very far before I penetrated another cavity, and gave issue to 
another copious discharge of serum. The whole body of the tumour now 
collapsed, and I discovered that I had punctured the sac of the internal 
tumour through its base. After freeing the tumour from the fascia, it was 
found to be as closely bound down to the fibres of the obliquus externus, 
portions of which were removed with the cyst, in order to insure the entire 
extirpation of the sac. A large portion of the muscle, extending from its 
serratures upon the ribs down almost to Pouparl's ligament, was now ex- 
posed. Carrying on the dissection of the base, I finally freed its posterior 
border from under the latissimus dorsi, whose anterior edge presented into 
the cavity now left by the extirpation of the cyst. A few small arterial 
branches were cut, requiring no ligature. The surfaces of the wound were 
then sponged, and carefully examined, and no portions of the sac being 
discovered, the wound was dressed as usual, retaining the skin in close ap- 
position with the muscular surface by means of a compress and roller. 

In consequence of the extent, the firm adhesions, and the character of the 
tumour, the whole operation was exceedingly diflicult and tedious, occupying 
three quarters of an hour for its completion. 

20th. The wound was dressed, and appeared to have been healed by the 
first intention. Continued firm compression. 

2Sth. Continued to do well until to-day. Discovered that a small col- 
lection of serum had taken place, and that there was a tendency to sloughing 
in the attenuated skin. This was attributed to the want of support to the 
parts by the bandage, which had become considerably relaxed during the 
last 24 hours. 

»^pril 3d. Discharge of serum and sloughing of small portions of integu- 
ment; ordered emollient poultices. 

bth. A considerable amount of serum collected, which was discharged by 
penetrating through the gangrenous skin with a lancet; continued the com- 
press and roller. 



1844.] 



Atlee's case of Congenital Tumour. 



87 



7th. More serum collected, which escaped upon the removal of the 
dressings; introduced into the cavity a tent of lint. 

Sth. No collection of serum, although compress and roller were wet. 

10^^. No collection and no effusion. 

I3th. Adhesions going on. 

20th. The wound perfectly healed. 

May 20th. Examined the wound, remains well, and has continued so 
ever since. 

Upon slitting open the sacs — two of which had constituted the main body 
of the tumour— their internal surfaces were observed to be lined by a shining 
membrane, and by strong fibrous bands, resembling tendinous or aponeuro- 
tic tissue, crossing each other in various directions. The appearance re- 
sembled, in some degree, the tendinous structure of the internal faces of the 
ventricles of the heart. Numerous other and smaller cells were mingled 
with these, particularly on the right side of the tumour, and surrounding its 
base between the two cysts. Several of these small cysts were still full of 
a pinkish coloured fluid, and bulged into the cavity of the largest sac, taking 
the appearance of hydatidginous bodies. Others communicated with each 
other through small canals, and all were bound together by fibro-cellular 
interstitial substance. 

Fig. 2. 




Fig. 2, represents a perpendicular section of the tumour. 

A, A. — The external coat of the tumour. 

B. — The point at which it was first punctured in the extirpation. 

C, C, C, C, C. — The internal coat of the tumour. 

D. — The point at which it was punctured in the extirpation. The space 
between the two coats, and the space within the internal coat were filled 
with serum. 

E, E. — Small cysts between the two coats, surrounding the base of the 
internal one. 

F, F. — Small cysts external to and riding upon the right side of the ex- 
ternal envelope. 



88 T. R. Beck on Sulphate of Potash, 

G, G. — Canals of communication between the small cysts. 
H, H, H, H, H. — Aponeurotic bands lining trie large cysts. 

Fijr. 3. 



[Jan. 




Fig. 3, represents an anterior view of the tumour with the external coat 
removed within a short distance from its base. 

A. — The internal cyst entire, forming the tumour which projected into the 
cavity of the external cyst, and constituted the body of the tumour at the 
time the external cyst collapsed. 

B, B, B, B, B. — Small cysts or vesicles between the two cysts, surrounding 
the base of the internal one. 

C, C, C. — Small cysts or vesicles outside of the external cyst. 

D, D, D, D, D. — Canals of communication between the small cysts. 
Lancaster, Penna. Sept. 25th, 1843. 



Art. VII. — Notices of the History and Properties of Sulphate of Potash. 
Bv T. RoMEYN Beck, M. D. 



Sulphate of potash (vitriolated tartar) was known to the chemists of the 
middle ages, and according to Professor Christison (Dispensatory, p. 743), 
the process for making it was first discovered by Crollius, about the middle 
of the seventeenth century. "It was known," says Dr. A. T. Thomson, 
'' at a very early period, under a great variety of names, as for instance, 



1844.] T. R. Beck on Sulphate of Potash, 89 

specificum purgans, nitrum Jixum, arcanum duplicatum, panacea holsa- 
tica, sal polychrest, sal de duobus, tartarum vitriolatum. The present 
name was imposed by the French chemists in 1787." That this great 
variety of names was not used without some reason, although possibly on 
imperfect grounds, will be seen by the following extract from Bergman 
(Physical and Chemical Essays. Edinburgh, 1791. Vol. 3, p. 150). 
"Most of the neutral salts were known to them, (the chemists of the mid- 
dle ages,) but they apprehended that the alkali veg. vitriolatum, which 
they distinguished by various names, retained always some quality peculiar 
to the manner of its preparation. The direct union of alkali of tartar and 
vitriolic acid is called by Crollius tartarus vitriolatus, while the same salt 
obtained by precipitation with the alkali of tartar, from vitriolated iron, he 
denominates specijicum purgans; that procured by the detonation of sul- 
phur and nitre, is the nitrum Jixum of Schroeder, and what remains in the 
retort after the distillation of aquafortis, is the common panacea holsatica, 
the arcanum duplicatum of Schroeder, and the nitrum vitriolatum of Rol- 
finckius." 

So highly was this substance esteemed, that, according to Shaw, in his 
Life of Boyle, the Duke of Holstein, some time before 1663, purchased the 
secret of preparing it for five hundred dollars, as a remedy in fever, stone, 
and scurvy. Hence, probably, one of the appellations that I have men- 
tioned, joanacea holsatica.^ 

It is not necessary at this time, to mention the characters of the salt. All 
pharmaceutists agree that it is seldom adulterated,! and hence the uniformity 
in its appearance is readily understood and remembered. Nor is it necessary 
to trace its history as a medicinal substance from the period of its discovery. 
I prefer quoting the opinions of the present day, but shall premise with the 
remarks of Cullen: 

" With regard to particular neutrals, I have a ievi observations only to 
make. I have said just now, that the vitriolated tartar may be employed 
as a refrigerant, and as it is thereby diaphoretic, it is employed in the com- 
position of Dover's powder. {^Materia Medica, vol. 2, p. 289.) 

On referring to his repeated remarks on Dover's powder, it will be seen 
that he attributes all its virtues to the opium and ipecacuanha contained in it. 

Dr. Chapman, {^Therapeutics, vol. 1, p. 198), says: "Of vitriolated tar- 
tar, or sulphate of potash, I have litde to say. It is very seldom used, 
and seems to be less esteemed as a laxative, than any of the neutral salts. 

* The term sal polychrest is also applied to the tartrate of potash and soda. But the 
sulphate of potash is, according to Christison, the sal poly chrestvs Glaseri. That name, 
however, would seem to belong to the sulphas potassce cum sulphure of the Edinburgh 
Dispensatory. See Wood & Bache, 5th edition, p. 1094, and Mackay, in Pharmaceutical 
Journal and Transactions, vol. l,p. 319. Glaser was demonstrator of chemistry at the 
Jardin du Rol, in 1666. (Thomson's History of Chemistry, vol. 1, p. 235.) 

t I shall presently mention an exception to this. 

*. 



90 T.U. Beckon Sulphate of Potash. [Jan. 

When resorted to at all, it is in the dose of a drachm or two, united to 
jalap, or rhubarb, or some other vegetable purgative. But even in this way, 
we see little of it in practice." In another place he acknowledges its 
value in the Dover's powder, but evidently for the reason that will be men- 
tioned in further quotations. Dr. Eberle {Therapeutics, 2d edit. vol. 1, p. 
144) remarks, that " sulphate of potash acts as a gentle aperient, when given 
in doses of about twenty or thirty grains. In the dose of from five to six 
drachms, it acts as a mild cathartic, though on account of its difficulty of 
solution it acts much slower than Glauber or Epsom salts. It is, however, 
very rarely employed with a view to its purgative effects. It forms a com- 
ponent part of the pulvis ipecac, compositus." 

Dr. A. T. Thomson (Elements of Materia Medica and Therapeutics, vol. 
2, p. 324,) has the following observations on it: — " The sulphate of potash 
is a useful purgative, but from its little solubility, it is seldom given alone, 
and scarcely ever in solution. It is supposed to extend its action beyond 
the bowels, and therefore is generally preferred as a purgative in cases of 
visceral obstructions; but I am inclined to believe that any effect of this 
nature is confined to the liver and pancreas, and that it acts upon them by 
stimulating the orifices of their excretory ducts in its passage through the 
duodenum. The dose for an adult is a drachm to three drachms; it is ge- 
nerally given in combination with jalap, rhubarb, aloes, or some resinous 
cathartic. In combination with aloes, as it acts on the duodenum, and the 
bitter of the aloes supplies the deficiency of bile, it is useful in jaundice, 
dyspeptic afli'ections and habitual costiveness in persons of sedentary habits. 
It is a good mechanical agent in assisting the pulverization of opium 
and some of the tough gum resins, which are apt to become soft under 
the action of the pestled 

Dr. Paris [Pharmacologia, 8th edition, p. 641) thus notices its medical 
uses: — " On account of its insolubility, it does not possess much activity as a 
purgative, but is said to be powerfully deobstruent; it should be exhibited in 
the form of powder, and in conjunction with rhubarb, or some purgative 
medicine. Dose, 10 grains to 30. From its hardness and insolubility, 
it is a most eligible substance for triturating and dividing powders." 

Pereira {^Elements of Materia Medica, London, 1839, p. 291,) gives the 
following account. " Physiological effects. — It acts as a very mild purgative, 
without any heat, pain, or other symptoms of irritation. Its operation is, in 
fact, too mild for ordinary use. Uses. — It is particularly serviceable as a 
laxative in disordered conditions of the alimentary canal, as diarrhoea and 
dyspepsia, in hepatic disorders, and haemorrhoidal affections. It is best 
given in combination with rhubarb. Thus, from five to ten grains of 
rhubarb, with from fifteen grains to two drachms of this salt, will be found 
to act mildly and efficiently in many cases of dyspepsia and diarrhosa. It 
is an excellent aperient for children. The objections to its employment are 
its slight solubility, and that when given in large doses to children, it is apt 



^x 



1844.] T. R. Beck on Sulphate of Potash, 91 

to produce vomittng. It is useful on account of its hardness for triturating 
and dividing powders, as in the pulvis ipecacuanha composilus .-^Dose. It 
is given in doses of from fifteen grains to four or five drachms." 

In the recent '■'•Dispensatory''^ of Professor Christison, p. 744, the fol- 
lowing remarks are made by him: — "In action, sulphate of potash is a mild 
cathartic, which has been supposed to act more permanently than other 
saline remedies of the class. Though now little employed, it is really a 
convenient laxative, and undeserving of the neglect into which it has fallen. 
Soon after the discovery of the process for making it, the estimation in 
which it was held as a remedy for fever, scurvy, and calculus, was so great, 
that one of the dukes of Holstein purchased the publication of the secret. It 
may be usefully combined with other laxatives, and forms a considerable part 
of the convenient compound cathartic of the kind, the pulvis salinus com- 
posifus of the Edinburgh Pharmacopoeia. Take pure muriate of soda and 
sulphate of magnesia, four ounces; sulphate of potash, three .ounces; dry 
the salts separately with a gentle heat, and pulverize each, then triturate 
them well together, and preserve the mixture in well closed vessels. 

" Being rather an insoluble salt, it should be given dissolved in warm water. 
On account of its great hardness and little tendency to absorb moisture from 
the air, it is an excellent substance for triturating with tough vegetable arti- 
cles, to promote their thorough pulverization. 

"The doses of its preparations are, sulphate of potash, one to four drachms, 
according to the effects desired; pulvis salinus compositus, two to six 
drachms." 

Dr. Dunglison {General Therapeutics and Materia Medica, vol. 1, p. 
286,) observes, " sulphate of potash is a mild cathartic, operating without 
any unpleasant concomitants, but it is rarely employed. As a laxative, it 
might be given in the dose of twenty or thirty grains; as a purge, in doses 
of four or five drachms. It is sometimes, but not often, combined with 
rhubarb, in dyspeptic cases, and in gastro-intestinal affections of children, 
which are accompanied with constipation. It enters into the composition of 
the pulvis ipecac, compositus or Dover's powder, not on account of its 
medical virtues, but because, by reason of its hardness, it faciiitatjes the 
division of the opium." 

Lastly, Wood &; Bache {Dispensatory, fifth edition, p. 572,) give the 
following summary of its medical virtues: " sulphate of potash is a mild 
purgative, operating without heat, pain, or other symptoms of irritation. In 
small doses, from a scruple to half a drachm, it operates as an aperient, and 
is useful in removing obstructions; in larger doses of four or five drachms, it 
acts slowly as a purge. Combined with rhubarb, in the proportion of about 
a drachm of the salt to ten grains of the root, Dr. Fordyce found it an excel- 
lent alterative cathartic in the visceral obstructions of children, characterized 
by a tumid abdomen, and defective digestion and nutrition, and we can bear 
testimony to its efficacy in these cases from our own experience. Dr. A. 



93 T. R. Beck on Sulphate of Potash. [Jan. 

T. Thomson states, that this salt either in combination with rhubarb or aloes 
has proved, in his hands, more useful than any other saline purgatives, in 
jaundice and dyspeptic affections. It enters into the composition of Dover's 
powder, in which it assists in pulverizing the other ingredients when tritu- 
rated with them, in consequence of the hardness of its crystals." 

I have adduced so many modern authorities for the purpose, if possible, 
of establishing its medical character, and I conceive that I am justified in 
asserting, 1. That it is conceded to be a mild purgative in doses ranging 
from four to six drachms, but that generally, it is preferred to give it in com- 
bination with other substances. 2. That by many practitioners, it is scarcely 
ever used except in compounding Dover's powder, and in such case, ex- 
pressly for subdividing and mixing the other ingredients. 3. That no one 
has hinted, or at least appears to have been aware of its severe effects in 
large quantities, except, of course, the general inference that all medicinal 
articles may in increased doses prove poisonous. Certainly I cannot be 
mistaken, in saying that there is scarcely an article in the materia medica, 
which would not have been previously selected for inducing severe or 
poisonous effects. And yet, it would seem, that this substance is constantly 
employed in France by nurses as a domestic remedy, to diminish or stop the 
flow of milk in puerperal females, and is supposed, both in that country and 
in England, to have the power of inducing abortion. Cases are also given 
of late, in which large doses have proved poisonous. To one of these I 
have already alluded in the last number of this journal, page 497, but there 
is a misprint as to the quantity, which may be now corrected. 

The reporter. Dr. Henry Bayard, states, that a female was delivered, in 
Paris, under the most favourable circumstances, and with no untoward suc- 
ceeding symptoms. Seven days after the birth of the child, a physician pre- 
scribed as a purgative ten drachms {forty grammes) of sulphate of potash, to 
be divided into six doses, and one to be taken every quarter of an hour. The 
first induced a burning heat of the mouth, stomach, and abdomen, and this 
was followed, as the succeeding doses v/ere taken, with cramps of the upper 
and lower extremities, nausea, vomiting, and purging. The nurse declared 
that much of the medicine passed undissolved, and was found at the bottom 
of the night stool. Death followed in about two and a half hours after 
taking the first prescription. 

It was at first supposed that the apothecary had made a mistake in the 
medicine sent. The body was examined. The mucous membrane of the 
stomach was generally pale, with the exception of a few red points. But at 
the great curvature, it was emphysematous, and at the pylorus, also, there 
were several blebs (buUce,) raised between the mucous and muscular coats. 
The intestines partook of the same character; the valvulae conniventes were 
of a red colour, contrasting strongly with the paleness of the adjoining parts. 
The uterus had not yet returned to its natural condition, and contained a 



1844.] T. R. Beck on Sulphate of Potash. 93 

sanguineous fluid with the characteristic odour of the lochia. The bladder 
was completely empty. 

MM. Chevallier and Bayard were directed to make a chemical examin- 
ation. They tested the fluids found in the stomach and intestines; and a 
portion of the stomach, of the liver, and of the lungs, but were unable to find 
any indications of the presence of poison, by the ordinary mode, or by the 
apparatus of Marsh. Sulphate of potash could alone be detected. The 
liquid obtained from the stomach was evaporated down to an extract, and 
this extract was dissolved in water. On applying heat slowly, crystals of 
the sulphate were formed. 

The inference was evidently unfavourable to the medicine that had been 
employed. Dr. Bayard in commenting on this case remarks, that this salt 
although formerly much used by physicians, is now but seldom given. Still 
many midwives and nurses prescribe it as a specific in milk diseases, or to 
cause the milk to diminish in child-bed females. A common prescription is 
from one to two drachms in a laxative drink, repeated after some days. 
*' Tres souvent, cependant, les medecins, dans leur pratique, I'ont employe* 
jusqu'a soixante et soixante dix grammes," (two ounces and upwards.) 
Still there are cases on record of its severe eff'ects. Merat and Delens saw 
an instance in 1821, of a female, who took an ounce by mistake, for an 
ounce of sulphate of magnesia, and in whom there followed heat, violent 
pain in the stomach and bowels, and vomiting. Greisellius {Mem. Jicad. 
Nat. Cur. 1672,) relates an instance in which half a drachm induced 
violent purging. Raulin and Sobaux have each written on the injurious 
effects of using this salt with pregnant or puerperal females. The latter 
{Journal de Medecine^ vol. 62,) has published four cases, in which the exhi- 
bition of two drachms of sulphate of potash to females in the second and 
third weeks after delivery, induced severe colic, a tympanitic abdomen, 
cramp, and every indication of approaching peritonitis. 

Dr. Bayard, in summing up his opinion on the case, very properly ex- 
presses his unwillingness positively, to ascribe the fatal termination to the 
medicine employed, being well aware, that females after delivery are often 
severely afl*ected by mild substances. Still he inclines to the opinion, that too 
large a dose has caused this first case in which sulphate of potash had an 
action veritablement toxique. — Anyiales d'^ Hygiene, vol. 27, p. 397. 

The above publication of Dr. Bayard was read at a meeting of the Phar- 
maceutic Circle of the Upper Rhine, held at Colmar, in July, 1842. M. 
Moritz, a member, stated that about fifteen years previous, the following 
case had occurred to him at Strasburg: a dose of eight grammes (two 
drachms) was prescribed for a female, as an " ante-latieux.''^ It induced 
violent vomiting and purging, and all the symptoms of poisoning, but by 
proper means the patient recovered. This led to an examination of the 
article, and it was found to contain a notable proportion of sulphate of zinc. 
To this last, then, the violent symptoms were ascribed. Out of eight speci- 
No. XIII.— January, 1844. 7 



94 T. R. Beck on Sulphate of Potash. [Jan. 

mens, obtained from different quarters, two contained the sulphate of zinc, 
and the conchision of M. Mori'tz is, that these extraordinary effects are 
owing' to the presence in the sulphate of potash of a poisonous metal. 
[Journal de Pharmacie, March, 1843, quoted in the Ency do graphic des 
/Sciences Medicates^ for July, 1843.) 

Messrs. Chevallier and Gobley were induced, from the above statement, 
to examine the commercial sulphate of potash, of Paris. They premise, 
however, by asserting that in the case of Dr. Bayard no sulphate of zinc 
could have been present. The experiments performed demonstrate this. 

Specimens were obtained from twelve of the principal drug establishments. 
An ounce of each of these sulphates of potash was dissolved in distilled 
water, and the filtered liquor was tested with the double cyanuretof iron and 
potassium, sulphuretied hydrogen and ammonia. Neither of these tests 
affected the transparency of the liquors. In order to ascertain how small a 
quantity could be made manifest, they prepared a solution of sulphate of 
potash, containing one two thousandth of sulphate of zinc; the three re- 
•agents each produced a cloud, and proved the presence of the zinc. For 
smaller quantities, the double cyanuret proved to be the most minute test. 
It is hence inferred that the commercial sulphate of potash at Paris, is 
usually free from sulphate of zinc. — Annates d' Hygiene, vol. 29, p. 158. 

I subjoin to these, the following case, occurring in England. The quan- 
tity taken, it will be observed, was larger than in any of the preceding. 

On Thursday, the 28lh of September, 1843, William Haynes, oil and 
colour man, was charged at one of the police offices in London, with having 
caused the death of his wife by administering poison to her, with the view 
of procuring abortion. Mr. Mark Pickering, a surgeon, stated that at a 
quarter to four o'clock that morning he was requested by a neighbour of the 
prisoner, instandy to call and see a female dying from poison. On going to 
ihe house, he was admitted by the prisoner, who conducted him into the 
bed-room, where his wife was lying, but quite dead, and she had apparently 
been so about half an hour. He asked the prisoner the cause of his wife's 
death, and what she had taken? when he told him, in an unconcerned 
manner, that he had given her the night before, on going to rest, two ounces 
of sulphate of potash, mixed with water in a glass. He inquired iiis object 
in giving it to her, and iie said it was to make her miscarry. The prisoner 
then voluntarily acknowledged to having given his wife about a fortnight 
ago, in two or three doses, as much as a quarter of a pound of the same 
drug, and that he had continued administering small quantities of it to her 
up to Tuesday night, when he gave her two ounces at once, and at ten 
o'clock on the preceding night, two ounces more. He stated further, that 
the last dose excited sickness to a terrible degree, and that from the time 
his wife had taken it, she gradually sank under its effects till three o'clock, 
when she expired. The witness endeavoured to bleed her, but of course 
without effect; and as he did not consider himself justified in allowing so 



1844.] T. R. Beck on Sulphate of Potash. 93 

serious a matter to rest where it was, he went to the door, and having 
called in Woods, a policeman, informed him of the nature of the prisoner's 
offence, and consigned him to that officer's custody. Woods, the officer, 
produced one of those disgusting and pernicious books, pretending to be 
founded on medical experience, giving instructions to newly married people, 
as to what measures they should take to avoid the increase and burthen of a 
family, and in which publication the very doses administered by the prisoner 
to his unfortunate wife, were specified. This book the officer found in a 
drawer in the prisoner's house. 

The prisoner being called on for his defence, Mr. Heritage said, this was 
one of those unfortunate and foolish occurrences, which too frequently re- 
sulted from the extreme readiness which some people now-a-days exhibited 
to follow the pernicious advice and prescriptions contained in pseudo-medical 
works, and which generally resulted in the most shocking consequences. 
The unfortunate deceased, who was the mother of one child, which was now 
living, felt an extreme dread, along with the prisoner, of increasing her 
family, and to avert such a charge, she had voluntarily taken this drug for 
the purpose of producing a miscarriage, she being three or four months ad- 
vanced in pregnancy at the time. He admitted the prisoner was aware that 
his wife had taken it, but he denied mixing it for her himself, he being in 
bed at the time she did so. Neither of the parties were aware it would be 
likely to cause the woman's death. Mr. Bingham (the magistrate) said it 
was quite manifest, whether or not the prisoner gave his wife those doses 
with the intention or expectation of producing death, that he did so, with 
the intention of procuring abortion, which was an offence of the gravest 
description, and under the circumstances, he should remand the prisoner for 
a week, to await the result of the coroner's inquest and post-mortem examin- 
ation. — London Atlas, Sept. SOih, 1843. 

If it be granted, as I apprehend it is generally, that sulphate of zinc in 
small quantities, is tonic, rather than emetic, the theory of M. Moritz can 
hardly be sustained. That zinc is not usually present has also been shown, 
nor is there any thing in the ordinary process of the manufacture of sulphate 
of potash, that should lead us to suppose its existence in that salt. Even 
rejecting the case of Moritz altogether, I submit, whether sufficient has not 
been stated, to show that severe effects are to be apprehended from large 
purgative doses of this specificum purgans. 

Albany, Oct. 23d, 1843. 



96 Buel's Report of the Diseases of Females. [Jan. 



Art. VTI. — Report of the Diseases of Females treated at the New York Dis- 
pensary, from May 1842 to May 1843. By William P. Buel, M.D. 

The whole number of cases of diseases peculiar to females entered on the 
Dispensary books, exclusive of cases of pregnancy, which possessed no 
particular interest, between the middle of May, 1842, when I took charge 
of this class, and the middle of May, 1843, was 370. Of which there 
were of 





Cases 




Cases 


Amenorrhoea, - - - 


- 236 


Prolapsus uteri and vesicas. 


- - 1 


Menorrhagia, 


- 30 


Ulcerated nipples, 


- 9 


Mammary abscess, - 


24 


Dysmenorrhcea, 


5 


Leucorrhosa, ... 


- 22 


Tumour of mamma. 


- 3 


Engorgement of cervix uteri. 


25 


Carcinoma uteri, 


2 


Prolapsus uteri, 


9 


Vesico-vaginal fistula. 


- 1 


" vaginae, 


2 


Polypus uteri, - - - 


1 



1. Jimenorrho^a, — 236 Cases. 

Suppression or retention of the menstrual discharge is by far the most 
frequent of the functional derangements of the uterus. Slight causes seem 
to be sufficient under certain circumstances, to interrupt the menstrual secre- 
tion, and when interrupted, it is with difficulty, and often only after a length 
of time that it is re-established. 

With respect to age the cases of amenorrhoea were divided as follows:— 

Between 15 and 20 years, 74 cases. 

" 20 and 25 years, 76 " 

" 25 and 30 years, 37 " 

" 30 and 35 years, 41 " 

" 35 and 40 years, 8 " 

With respect to season of the year, 167 cases occurred during the warm 
months, between May and November; and 69 during the cold months, be- 
tween November and May. As cold is one of the most common causes of 
suppression, it seems at first view remarkable, that so large a proportion of 
the cases occurred during the summer months. It is probably accounted for 
by the fact, that the Irish emigrants who furnish a large share of the cases 
of amenorrhoea, arrive principally during this portion of the year. 

With so large an amount of material, it might be expected that some 
important therapeutical or pathological results should be deduced. From 
various causes, however, such cannot be the case. The Dispensary bestows 
its favours without restriction, upon all who apply for them. Benefits so 
cheaply obtained, are not apt to be highly prized. Accordingly it is found, 
that the patients generally are irregular and careless in their attendance, and 
pay but little attention to directions. The greater part are extremely 
ignorant, and in circumstances of poverty, which forbid the use of baths and 



1844.] Buel's Report of the Diseases of Females, 97 

other measures so essential as auxiliaries to the medical treatment, and 
without which it is generally of little avail. Their ignorance, too, makes 
them unreasonable in their expectations of benefits to be received. It was 
no uncommon occurrence for patients to return after one or two days had 
elapsed from the commencement of the treatment, disappointed that they 
were not already restored to health. 

With respect to the causes of the suppression, a large proportion of pa- 
tients ascribed it to the application in one form or other of cold and moisture. 
Another, and perhaps larger class, occurred among the newly arrived Irish 
emigrants, in whom the catamenia were suspended from the time of theiir 
leaving Ireland, and frequently were not restored for many months after their 
arrival in this country. 

The complete revolution in habits and modes of life, to which the emi- 
grant is subjected; the confined air, bad and insufficient nourishment; the 
crowded and uncomfortable condition of a steerage passage; the mental de- 
pression, home sickness, and despondency, which naturally follow the 
sudden disruption of all the ties of kindred and country; all these, together 
with the ennui and tedium of a sea voyage of several weeks duration, suf- 
ficiently account for the unfavourable result which so frequently followed, 
without seeking for the cause of amenorrhoea in the influence of sea air.* 

After their arrival here, the influences to which they are subjected, are far 
from being friendly to their health. All the causes of disease incidental to 
our climate act with tenfold energy upon the newly arrived emigrants, living 
in narrow alleys; in dark, damp, and filthy cellars, and garrets, where many 
families are often crowded into a single apartment. Months often elapsed, 
even under the active and persevering use of remedies, before the catamenia 
could be restored. 

The symptoms more usually complained of were, pains in the head, 
back, and limbs, dulness, heaviness, and drowsiness, cough, palpitations of 
the heart, precordial oppression, " impression about the hearth costiveness 
and loss of appetite, weakness of the limbs, occasionally cedema, depression 
of spirits. These symptoms in the newly arrived emigrants, were often 
complicated with difl"erent forms of cachectic eruptions. 

* In a paper, in the April number of this Journal for the current year, by Dr. Isaac E. 
Taylor, of New York, this frequent occurreace of amenorrhoBa ainonjr the emigrants, is 
ascribed to the influence of sea air. If the sea air produces the result, its eifects should not 
be confined to the steerage. But I have never heard, though it may be the case, that the 
ladies who cross the ocean in the commodious cabins of our splendid liners, are affected 
in a similar manner, though they get as much, perhaps rather more, of the sea air, than 
their less favoured shipmates in the steerage. 1 apprehend that sea air causes amenor- 
hoea, precisely to the same extent and no more, that it causes the typhus fever, the typhoid 
pneumonia, and the various forms of cachectic eruptions, which are so rife in. the crowded 
steerages of our emigrant ships. 



98 Buel's Report of the Diseases of Females. [Jan. 

The treatment was of course varied to meet the symptoms, and patholo- 
gical condition of the patient. More generally they required tonics, or a 
combination of tonics and purgatives. "When symptoms of fulness existed 
with determination to the head, as indicated by flushed face, throbbing, and 
severe headache, I commenced the treatment by the abstraction of a few 
ounces of blood. But few of the cases comparatively would bear this; 
generally tonics were required. Iron was the most favourite and successful 
remedy. It was given in almost all its forms — the carbonate, the iodide, 
the muriate, the sulphate, and the iron filings. A pill composed of sulphate 
of iron and aloes, was a convenient form; and was very generally adminis- 
tered with perhaps as good effects as any other remedy. A combination of 
the muriated tincture of iron, with the saturated tincture of lyttae, 20 drops 
of the former with 6 or 8 of the latter, three times a day, was followed, in 
very many cases, with a beneficial result. 

Mustard pediluvia, the hot bath, and exercise out of doors, were recom- 
mended as valuable auxiliaries to the medicinal means applied. One result 
of the treatment was to strengthen the conviction, already existing in my 
own mind, that the materia medica possesses no remedy or combination of 
remedies which exert any thing like a specific influence upon the menstrual 
secretion. 

It may not be out of place in this connection, to speak of the value of 
the areola as a sign of pregnancy. Among the amenorrhea patients there 
is a considerable number in whom the amenorrhea is not the result of any 
morbid action in the system, but of pregnancy. Of course, in the treat- 
ment, the discrimination of such cases is a matter of some importance; 
though sometimes very difficult in the first months. The areola, if it could 
be depended upon, would be among the most convenient of the tests of 
pregnancy. In first pregnancies, a strongly marked areola and a full de- 
velopment of the follicular glands, may be considered a very reliable sign, 
I have seen, however, many cases in which the areola existed to a certain 
extent, with some enlargement of the follicles, in which pregnancy did not 
exist. In females who have suckled one or more children, the areola be- 
comes so broad and so strongly marked, that the skin never recovers its 
original hue. 

2. Menorrhagia. 
Thirty cases of menorrhagia occurred, which with respect to period of 
life were divided as follows: 
Between 



15 


and 


20 


years, 


2 cases. 


20 


and 


25 


years. 


6 


25 


and 


30 


years, 


5 


30 


and 


35 


years, 


9 


35 


and 


40 


years. 


2 


40 


and 


45 


years. 


3 


45 


and 


50 


years, 


S 



1844.] Buel's Report of the Diseases of Females. 99 

With respect to season of the year, twenty-two, or nearly three-fourths, 
occurred durin^ the warm months, between May and November, and eight 
durino" the coh3 months, between November and May. The term menor- 
rhagia, as used here, is intended to be restricted to those cases in whicli the 
menstruation was regular, but excessive either in quantity or continuance, 
or both. The large excess of cases occurring in the summer over the 
winter months, seems to indicate, that a warm atmosphere strongly predis- 
poses to excessive menstruation. The females of cold and temperate re- 
gions are much less liable to excessive menstruation than those of southern 
and tropical regions. 

The cases of menorrhagia, when the state of the pulse warranted it, 
were treated by a full bleeding, followed by ergot. This generally arrested 
the discharge almost immediately. When accompanied by a feeble pulse, 
pale face, and cold extremities, the horizontal posture, cold bathing, and the 
use of ergot, constituted the treatment. The application of cold water to 
the pelvic region by sponging, in all cases accompanied with a relaxed 
condition of the system, is a remedy of inestimable value. It imparls a 
degree of tone and vigour to the uterine system, as well as to the system 
generally, of which no other remedy is capable. This alone, with the 
horizontal posture, the use of iced water and cold drinks, to the exclusion 
of tea and coffee, is sufficient to relieve most cases of menorrhagia. 

3. Leucorrhcea. 

Twenty-one cases of leucorrhcea occurred. These with respect to periods 
of life, were divided as follows:— 



Between 15 and 20 years, 2 cases. 
20 and 25 ' 3 

25 and 30 2 

30 and 35 3 



Between 35 and 40 years, 5 cases. 
40 and 45 4 

50 and 55 1 

55 and 60 1 



With regard to season of the year, we find nearly as great an excess of 
the warm over the cold months as in menorrhagia. Fifteen cases occurred 
between May and November, and six between November and May. This 
preponderance seems to indicate that the relaxed condition of the system, 
which, during the heats of summer, exhibits itself upon the skin; in the 
increased cutaneous exhalation; in the mucous membrane of the bowels by 
the disposition to diarrhoea, which it generates, is also felt by the mucous 
membrane of the uterus and vagina, by the increased amount of the mucous 
discharge, which constitutes simple leucorrhoea. 

A variety of vaginal discharges have been confounded under the common 
term of leucorrhoea. Frequently where they have been merely sympathetic 
with other and more grave forms of disease existing about the cervix uteri; 
the practitioner reflecting the means of an accurate diagnosis, has contented 



1 



100 "QueVs Report of the Diseases of Females, [Jan. 

himself with prescribing only for symptoms, and often aggravated, where 
he might have arrested the progress of formidable disease. 

Under the head of leucorrhoga, I have intended to embrace only those 
cases which consisted simply of an increased flow of the ordinary mucous 
secretion; unconnected with engorgements or ulcerations of the cervix, and 
OS uteri. 1 have not made the distinction between vaginal and uterine leu- 
corrhoea, because I do not believe it is one of practical value. In those 
cases which I have examined by the speculum, and they have been nume- 
rous, I have usually found an increased discharge both from the uterus and 
vagina. Cases occurring in pregnant females will of course generally form 
an exception, as regards the uterine discharge. There is a form of uterine 
leucorrhoea following each return of the menstrual discharge, which resem- 
bles serum with a slight tinge of colouring matter. It would seem, how- 
ever, to be more properly considered as a form of menorrhagia, requiring 
substantially the same treatment. 

The causes of leucorrhoea, properly so called, are whatever tends to pro- 
duce a relaxed condition of the system. The influence of a high tempera- 
ture has already been mentioned. The excessive use of warm drinks is 
another common exciting cause. Strong cofTee particularly disposes to 
leucorrhcsa. Lisfranc imagines that it is much more likely to produce leu- 
corrhoea when taken with milk, than if taken pure. This would seem to 
be a fanciful distinction. In Dispensary patients, the occupance of damp 
basement rooms is a frequent cause. Among females who have borne chil- 
dren, a great proportion suffer more or less from leucorrhoea. M. Gibert, a 
French writer, physician to the " Hopital de Lourcine," says, " I have ex- 
amined 800 women labouring under disease of the genital organs; it has 
rarely happened to me to find the uterus totally free from leucorrhoea, and 
that only in young females." My own comparatively limited opportunities 
for observation corroborate this assertion. 

Much has been said and written on the treatment of leucorrhoea. It has 
been regarded as an exceedingly obstinate and intractable affection. Very 
much of the difhculty has arisen from confounding simple leucorrhoea with 
other forms of uterine disease, of which the discharge was merely symp- 
tomatic, and by directing a mode of treatment, which only aggravated the real 
difficulty. Cases of simple leucorrhoeal discharge, uncomplicated with alter- 
ations of the cervix, I have generally found controllable by suitable remedies. 
While the exciting cause, whatever it may be, continues operative, we can 
of course expect only a temporary benefit. The first step in the treatment 
must be to ascertain, and if possible to remove that. Afterwards the use of 
the cold bath will alone be suflicient to cure a large proportion of cases. 
Added to this in cases more obstinate, astringent injections thrown into the 
vagina, will be serviceable; injections of alum and oak bark, either sepa- 
rately or in combination, are the best. Internally, nitrate of silver appears 



^': 



1844.] "BxneVs Report of the Diseases of Females, 101 

to be beneficial in certain cases. It may be given in doses of one-sixth lo 
one-fourth of a grain three times a day on an empty stomach. If it encoun- 
ters any muriate of soda, an insoluble and consequently inert muriate of 
silver is instantly produced. 

Port wine is a favourite popular remedy, and in cases where much debi- 
lity exists, is no doubt a useful one. 

In that form of leucorrhea termed uterine, and which depends on a re- 
laxed condition of the uterus, and of its lining membrane, ergot will often 
prove beneficial. It may be administered either in substance, or in the 
form of the saturated tincture. Of the former 5 to 10 grains, of the latter 
a leaspoonful may be given three or four times a day. 

4. Mammary JJhscess. 

Twenty-four cases of mammary abscess occurred; of which eighteen 
were during the cold, and six during the warm months. The effect of the 
temperature both as a predisposing and exciting cause of disease, becomes 
here again manifest. In menorrhagia and leucorrhea, the influence of a 
high temperature was observable, in the great excess of cases in summer 
over winter. In the production of mammary abscess, the influence of a 
low temperature is equally manifest, by as great an excess in the other 
direction. Inflammation and suppuration, in the cellular tissue of the mam- 
mae, seem to be more generally produced by exposure to cold, than from 
any other cause. 

"Whether the exposure be local and confined to the organs themselves, or 
general and applied to the whole person, the mammae during the process 
of lactation, especially its earlier stages, from their highly excited condi- 
tion, and abundant supply of blood and nervous influence, are exceedingly 
prone to suffer. 

The cases of mammary abscess did not in general come under treatment, 
until too late a period lo expect any other termination than that of suppura- 
tion. As soon as the formation of mgtter could be ascertained, giving it 
vent by a free incision, was followed generally by recovery in a few days. 
The pain was much alleviated, by taking off" the weight, by a sling from the 
opposite shoulder. In one case where the breast remained long indurated, 
and made no sensible progress either towards resolution or suppuration, 
much benefit was derived from the application of the saturated tincture of 
iodine. It was applied daily to the indurated portion with a camel's hair 
brush, the mamma being meanwhile suspended, and covered with oiled 
silk. The induration which had continued for several weeks, was by this 
treatment in the course of a short period almost entirely removed. 

5. Ulceration, or excoriation of the nipple. 

Of this affection nine cases were entered, some of them of much severity. 
The practice of applying to the chaps or excoriations, the tincture of cate- 



102 l^MeVs Report of the Diseases of Females. [Jan. 

ehu, which has been reconnmended of late, in the English journals, as one 
of great utility, was tried in several of the cases. In some it appeared to 
be followed by relief; in others it was entirely unsuccessful. Cauterization 
with nitrate of silver, or with pernitrate of mercury, was attended with 
decided relief in several cases. 

, 6. Dysmenorrhea. 

Five cases were entered. They present nothing of special interest, and 
throw no new light upon this troublesome form of disease, which often 
resists treatment with great obstinacy, and causes a great amount of suffer- 
ing to the subjects of it. , v 

7. Engorgement of the cervix uteri, congestion, hypertrophy, <^c. 

Twenty-two cases of engorgement of the cervix uteri in its various 
forms, with and without ulceration, were the subjects of treatment. 

This form of disease, which is extensively prevalent, and the cause of 
great suffering, has, until of late years, been overlooked or misunderstood. 
The writers on diseases of females, Clark. Denman, Burns, Gooch, De- 
wees, all, in fact, whose works have appeared previous to the last few 
years, have scarcely mentioned it; nor is its existence and extent even now 
very generally understood. Duparque, and some others of the French 
school, have e^iven perhaps the best description of its nature and symptoms. 
It is perhaps impossible to recognize fully and discriminately the nature of 
the affection, without the use of the speculum. A practised finger might 
indeed recognize it by the touch alone; but to become thoroughly acquainted 
with it, it is necessary that it should be seen. 

That it is a very frequent cause of a train of chronic affections, which a 
great number of females in young and middle life, suffer under, cannot be 
questioned. Nothing is more common than to find ladies who have been 
a few years married, complaining of pain and weakness in the back, 
attended with more or less of leucorrhoeal discharge; inability to stand for 
any length of time, or to walk any distance without suffering, sometimes 
severely, together with general debility and feeble health. Nor is the 
affection confined to married women, or those who have borne children. I 
have repeatedly met with it in young females, especially those of a feeble 
constitution and lax fibre: those whose occupations are sedentary, confining 
them constantly to the house, with little or no exercise in the open air, are 
most obnoxious to it. Among sempstresses, tailoresses, nurses and other 
persons of similar occupations, it is most prevalent. 

From motives of delicacy, a false delicacy it must be considered, many 
females suffer for years, without disclosing their condition lo any practi- 
tioner; or if a physician is consulted, the symptoms are often treated 
without a resort lo the only means by which their real nature can be ascer- 
tained and understood. Remedies are directed to relieve the debility, or 



1844.] BweVs Report of the Diseases of Females. 103 

check the discharge, without an attempt to strike at the root, by a removal 
of the cause. 

The symptoms which lead us to suspect the existence of engorgement of 
the cervix are, \si, pain. This is referred most frequently to the back, 
about the region of the lumbar vertebrae, and of the sacrum. Pain may, 
and generally does exist elsewhere, but wherever else we find it, the pain in 
the back is a pretty unfailing symptom. Next to this the hypogastric and 
pubic regions are the seat of the pain. It frequently affects the hips, and 
extends down the thighs in the track of the crural nerves, which are affected 
both by sympathy, and by the pressure produced by the engorged uterus. 
These pains are sometimes dull and obtuse; at other times so severe as to 
be compared to colic pains, and even the pains of labour. In addition to the 
points of pain already mentioned, it is very common to find it referred to 
the region of one or the other ovarium. 

2. Sense of weight of heaviness, in the region of the uterus, or as if a 
foreign body were in the vagina. Patients generally complain of this, they 
describe it as a sense of dragging, of bearing down, or as if something were 
falling from them. They are frequently impressed with the belief that they 
have a falling of the womb. Not unfrequently when a physician is consulted, 
relying upon the opinion of the patient alone, a pessary is introduced to 
relieve the supposed prolapsus which only aggravates the symptoms. 

3. A discharge, white or coloured, scanty or profuse, usually accom- 
panies the engorgement, if it exist to any extent. The colour of the 
discharge varies with the form of the engorgement, from the creamy while 
discharge which has given a name to the leucorrhoeal affection, to different 
shades of yellow, brown, and red. The quantity also varies from a very 
slight discharge, causing little or no inconvenience to the patient, to one so 
profuse as to be extremely debilitating to the patient aside from the incon- 
venience attending it. Often it is regarded and treated as a simple leucor- 
rhoeal discharge by astringent injections and other remedies which aggravate, 
in place of relieving the symptoms. 

4. Dysuria or strangury. — There is in general more or less affection of 
the urinary organs, particularly the bladder and neck of the bladder. Fre- 
quently this symptom is so urgent, as to be the only one complained of. The 
patient informs you that she has the gravel. Upon inquiry, it is ascertained 
that the urinary symptoms are entirely sympathetic, and that the true seat of 
the difficulty is in the cervix uteri. In one instance I was consulted by a 
woman, in whom the urinary symptoms were so urgent that she had been 
sounded by a surgeon of remarkable eminence with the expectation of find- 
ing a stone. Remedies directed to the cervix uteri, removed in a short time 
all the symptoms of calculus. 

5. Tenesmus. — The rectum, lying in such near proximity to the cervix 
uteri, and separated from it only by the thin wall of the vagina, is liable also 
to be sympathetically affected, though not as frequently as the bladder. 



104 BueVs Report of (he Diseases of Females, [Jan. 

Some time since, I was sent for to a lady wlio supposed herself suffering 
under a pretty severe attack of dysentery. She had frequent calls to stool 
with much straining, but passed nothing. Knowing her to be liable lo at- 
tacks of engorgement of the cervix, I at once suspected that to be the seat 
of difficulty; a suspicion which was confirmed on passing the finger into 
the vagina, by finding the cervix enlarged, hard, and tender. The abstraction 
of a few ounces of blood, with emollient injections into the vagina, and rest 
in the horizontal posture, speedily removed the symptoms of dysentery. 

6. Sterility and abortion. — Engorgement of the cervix, is often a cause 
of sterility, so far deranging the functions of the uterus as entirely to pre- 
vent conception. In other cases, conception takes place, but after a lapse of 
three or four months, the expulsive action of the uterus supervenes, and 
the ovum is expelled. Engorgement of the cervix is a frequent cause of 
those habitual abortions, which baffle all precautionary measures for their 
prevention. Every thing proves ineffectual, except a properly directed 
course of treatment for removing the engorgement. When this has been 
done partially, but not completely, the functions of the uterus may be so far 
restored, as to permit conception to take place, and the full term of utero- 
gestation, to be completed; while a sufficient degree of engorgement may 
remain to embarrass the process of parturition. A case of this nature oc- 
curred in my practice in a lady who had aborted once or twice, and in whom 
an engorgement of the cervix was discovered. She was treated for this by 
leeching, hot bath, &c.; and the engorgement was partially but not entirely 
removed. She became a second lime pregnant and went the full time. 
When the pains came on, the progess of the labour was greatly embar- 
rassed by the remaining engorgement. The pains commenced, were then 
suspended; after an interval of one or two days they returned, and were 
then suspended again, so that five or six days elapsed before the process 
was completed. The os uteri in its whole circumference, formed a thick 
fleshy ridge, in place of the thin sharp edge usually formed by it, and 
which seemed for a time to offer an insuperable obstacle to a sufficient dila- 
tation. This was, however, after a time accomplished, and the delivery 
safely completed. 

That engorgement of the cervix is a frequent cause of those habitual 
abortions, which are so frequently met with in practice, I am well satisfied 
from my own observation. And it appears to me probable, that by a proper 
course of treatment to relieve the engorgement, these troublesome cases 
might in many instances be remedied. 

7. A generally impaired state of the health, is a frequent symptom of en- 
gorgement of the cervix. Muscular debility, loss of apetite, paleness, las- 
situde, sense of fatigue at the most trifling exertion; and all that nameless 
train of symptoms, which usually accompany what is termed feeble health 
in females, are a common result of this affection. A large class of married 
females, particularly in cities, suffer under this train of symptoms for years, 



1844.] 'BueVs Report of the Diseases of Females. 105 

without being aware of the true cause, or if so from motives of delicacy, 
never disclosing their sufferings. 

The causes of the engorgement of the cervix uteri are various. It has 
been mentioned that abortion is a common result of engorgement. It is also 
a frequent cause; they stand to each other reciprocally in the relation of cause 
and effect. By whatever circumstances abortion may in the first instance 
have been brought about, it almost invariably leaves the cervix uteri more 
or less in a state of engorgement, which becomes the cause of future abor- 
tion. This is a state of things which may continue for years, repeated 
abortions occurring, and the engorgement all the while increasing. 

A sedentary mode of life; neglect of exercise; a plethoric condition of 
system generally, and all causes which act unfavourably upon the general 
health, may become a cause of engorgement of the cervix. 

With respect to what may be termed the proximate or predisposing cause 
of engorgement of the cervix; its peculiar situation in the body, its de- 
pending condition; the abundant supply of blood sent to it; the shocks to 
which it is exposed in parturition, in coition, &c., sufficiently account for its 
being frequently the seat of morbid action. The cervix uteri and the os 
tincse, standing in the same relation to the uterus, that the rectum and amis 
bear to the large intestines; endued like them with great sensibility, and 
thickly studded with glandular follicles, are in like manner more frequently 
the seats of diseased action than other portions of the apparatus. 

The indications of cure in the treatment of engorgement of the cervix, 
are in the first place, and of course, to remove if possible the exciting cause; 
to unload the fulness of the vessels of the part; to divert and allay irrita- 
tion, and to improve the health of the system generally. 

As we have mentioned as a cause of engorgement, the depending position 
of the uterus in the body, and the consequent determination to it, of a large 
current of blood; we may obviate this to a certain extent by the position of 
the body. Placing the patient in the horizontal posture, with the hips ele- 
vated, is of itself a powerful means of restoration. To live absque marito^ 
is another measure of primary consequence. To unload the engorged ves- 
sels, bleeding, general and local, must be practised. When the patient is 
vigorous, and the pulse full and strong, ten or twelve ounces of blood taken 
from the arm, and this repeated two or three times, at intervals of a week 
or two, is often productive of great and immediate relief, 

W^here the condition of the patient will not admit venesection, the blood 
must be taken immediately from the part affected; indeed, in all cases, local 
bleeding will perhaps be found most effectual. It may be done wiih much 
facility, and with the best results by the application ofleeches to the cervix. 
They fill themselves rapidly, without pain to the patient; and the blood con- 
tinues to flow abundantly for a considerable time, after the leeches have 
fallen off. The relief from severe suffering which follows the application of 
from four to six or eight leeches, by this method, is often surprising. So 



106 '^xxeVs Report of the Diseases of Females. [Jan. 

much so, that patients, though previously they might have objected, are often 
anxious for their reapplication. 

In cases, however, in which there is an objection to this method, the 
leeches may be applied to the labia externa, or to the pubic region, with 
good though not as decided results. A very good substitute for leeches to 
the cervix, where they cannot be obtained, or there are other objections to 
them, is scarification of the cervix. This is done without difficulty through 
the speculum, merely with a large handled scalpel, drawn quickly and lightly 
over the cervix. When the cervix is in a state of high engorgement, blood 
flows from the incisions for a few moments, nearly in a stream. In this 
manner two or three ounces may be obtained, and often greatly to the relief 
of the patient. In Dispensary practice, where leeches cannot always be 
afforded, scarification is a remedy of great value. It gives little or no pain, 
the cervix in this respect, not seeming to be endowed with a high sensibility. 
The patient would generally be aware from her own consciousness of the 
use of the scalpel. 

Blood may also be taken from the sacrum by cups, and this is a tolerable 
substitute, when the methods already mentioned are objected to. In addi- 
tion to these means of reducing the quantity of the circulating fluid; a good 
deal may be accomplished by a properly regulated diet. Indulgence in 
animal food must be forbidden, and the patient restricted to a strictly vegeta- 
ble diet; with perhaps the addition of milk. It is important also, that the 
bowels should be kept in an open condition. Accumulations of fecal matter 
in the large intestine, tend very much to increase the engorgement of the 
cervix. This cannot be better accomplished than by the administration 
every night or every second night of one or two drachms of castor oil. 

To fulfil the second indication, viz. to allay irritation, and divert it from 
the part alTected, warm bathing is an important remedy. This may be ad- 
ministered either in the form of the general warm bath, or in that of the 
hot bath. This may be used at first two or three times a week, and after 
the patient becomes somewhat accustomed to it, daily, with from half an 
hour to an hour's continuance. 

Emollient and mucilaginous preparations thrown into the vagina, are also 
useful for the same purpose. Injections of flaxseed tea, of starch, of marsh- 
mallows may be given several times in the day, and retained as long as pos- 
sible. The anodyne extracts, conium, stramonium, and hyoscyamus may be 
combined wi,th the mucilages, in the proportion of a drachm to the pint. As 
a substitute for the syringe in applying remedies to the os uteri. Dr. Mont- 
gomery of Dublin has recommended an instrument after this manner. A 
tube of tin or of glass, of a proper diameter to just fill the vagina, bent upon 
itself at right angles in such a manner, that the patient lying on her back, 
the horizontal portion being inserted into the vagina up to the os tincae, the 
fluid for the injection may be poured into the vertical portion, and kept in 
contact with the os tincae as long as may be desired. 



1844.] Buel's Report of the Diseases of Females. 107 

In certain forms of engorgement which seem to be attended with a relaxed 
condition, a want of contractable power, in the uterus and its vessels, par- 
ticularly in those cases accompanied by haemorrhage, ergot is a remedy of 
great value. It may be given in doses of five to ten grains, repeated three 
or four times a day. 

The cases of engorgement of the cervix uteri, which occurred at the Dis- 
pensary, presented themselves under several different forms, varying some- 
what, in the symptoms by which they manifested themselves, and in the 
modes of treatment they severally required. Before proceeding to speak of 
the morbid conditions of the cervix, it may not be deemed amiss to describe 
briefly its condition when in a state of health. There is a very considera- 
ble difference in the appearance, form and feel of the cervix of women who 
have never borne children, and those who have been mothers; in other 
words, between the virgin and the maternal cervix. It might readily be 
conceived that the passage of so large a body as the head of a child through 
an orifice so small as the os tincae in its natural condition, would produce an 
alteration, which would never be entirely restored. We find this to be the 
case. The virgin cervix is quite circular, slightly conical, projects but a 
little distance into the vagina, and is quite smooth to the feel. The os tincae 
presents tlie appearance of a small circular pit or depression. The mater- 
nal cervix is more elongated and flattened; projects farther into the vagina. 
The OS tincae presents a fissure of some width, into which the finger pene- 
trates a certain distance. In both when healthy the cervix feels soft to the 
finger, and the colour is of a pale red, about that of the lining membrane of 
the mouth. 

The first and most common form of engorgement may be termed simple 
engorgemeyit. This in common with the other forms is characterized by 
pain more or less severe in the back, loins hips, hypogastrium and thighs; 
frequenily with dysuria and tenesmus. It is accompanied usually by a dis- 
charge from the vagina, sometimes white, sometimes yellow. When the 
finger is introduced, it finds the cervix enlarged, elongated, harder to the 
feel than natural and painful to the touch. Of course it is only by practice, 
by frequent examinations, that the power of discriminating between healthy 
and morbid conditions of the cervix, the tactus eruditus^ as it has been 
termed, can be acquired. To the practised finger the difference is obvious. 

When tiie cervix is brought under ocular examination by the speculum, it 
has an angry inflamed look, the natural colour of the part is much height- 
ened, so as to be frequently of a deep crimson or violet colour. The cer- 
vix and adjoining part of the vagina, are usually bathed with an abundant 
whitish or yellowish secretion, tinged in some cases with blood. 

A variety of this form of engorgement to which the term granular en- 
gorgement has been applied, exhibits the cervix studded all over with slight 
elevations, resembling somewhat the papillae of the tongue, though much 



108 "Bm^Vs Report of the Diseases of Females. [Jan. 

larger. These elevations are the follicular glands of the part in a congested 
condition. 

The second variety of engorgement may be termed ulcerative engorge- 
ment. The cervix presents to the eye and to the finger, much the same 
characteristics, as already described; but in addition we discover one or more 
spots of ulceration, seated generally immediately around the os tincfe, or 
dipping into it. These ulcerations are generally superficial, and have the 
base but little depressed below the adjoining parts. They vary in diameter 
from two or three lines to that of a shilling piece. 

There is a form of ulceration on erosion, to which the term granular ero- 
sion has been applied. Generally, but not universally, it occurs in connection 
with a syphilitic taint. It is so well described by M. Gibert, the French 
writer, to whom allusion has already been made, that I shall quote his de- 
scription. " This granular erosion, which is rather superficial, is generally of 
a rounded form and circumscribed; it occupies sometimes the anterior, some- 
times the posterior lip of the os uteri, occasionally both, and still more 
rarely it seems to penetrate the canal of the cervix. Its surface is granular 
and red, contrasting strongly with the naturally smooth surface of the neck. 
It bleeds when slightly touched. The surface of the erosion is ordinarily 
concealed by a layer of thick semi-transparent mucus." 

" In the commencement this species of erosion appears in the form of 
small granular points, slightly projecting, which soon excoriate, and become 
confluent. It is very rare however for the ulceration to acquire any great 
extent." 

The third variety of engorgement is soft or hsemorrhagic engorgement. 
This differs from the simple engorgement, in having the cervix less hard to 
the touch; less painful; and in being attended with more or less haemorrhage. 
The colour of the cervix is heightened; but it generally wears a less angry 
and more of a livid appearance than in simple engorgement. It is less fre- 
quendy complicated with the granular appearance, or with ulceration, than 
the first variety. 

The fourth variety of engorgement is the hard or white engorgement. 
This is much less frequent than either of the other forms; is characterized 
and distinguished by its colour, which is a rose or pink white, in contra- 
distinction to the other varieties, in which the natural colour is heightened. 
In my experience it occurs most frequently in women somewhat advanced 
in life; and who have ceased to menstruate. It would appear to depend 
upon a deposit, of fibrine in the cellular tissue of the cervix, and not upon 
sanguineous congestion. When incised by the scalpel, but a few drops or a 
very small quantity of blood exude from the incisions, in place of the abun- 
dant flow which occurs in the other forms of engorgement. It is accom- 
panied by a sense of weight, and of a hard body in the vagina. One patient 
described it as feeling as if she had a stone in the vagina. It may be the 



1844.] BuePs Beport of the Diseases of Females, 109 

premonitory symptom of true scirrhus, to which it has points of resem- 
blance. 

I proceed now to detail a few cases, iUustrative of the several varieties 
of engorgement. 

Case I. — Simple Engorgement. — Two bleedings from the arm: — Scarifications to 
the cervix uteri. — Hydriodate of potass. — Cure. — Dec. 2%. Hannah Ley, native of 
England, aged 28 years, medium size, florid complexion, married ten or twelve 
years. Had one child ten years ago, after a severe labour, and the use of instru- 
ments. Has never been pregnant since; has always been subject to lencorrhcea 
since the birth of her child. The menses have generally been regular. For some 
months past has suffered with a severe pain and swelling in the hypogastrium, 
accompanied by sensation of weight, and falling of the womb. Coition produces 
severe pain. 

To the touch, the cervix uteri is elongated, hard and painful. By the speculum 
the colour is heightened, and it is evidently much swollen. Ordered l)leeding 
from the arm to $xiv. R. — Potassae hydriodat. ^iss; aquae menlhae giss; M. Sig. 
A teaspoonful three times a day. 

Dec. 31s^. No improvement in the symptoms; complains of very severe pain in 
the back, with abdominal swelling and tenderness. Cervix looks swollen, and 
has an angry livid appearance. It was scarified freely, but did not bleed very 
abundantly. 

To be bled from the arm ^viij. and to continue solution of hydriodat. potass. 

Jan. 3d. Is very much better; felt immediate relief from the pains, after the last 
visit. The abdomen remains somewhat tumid and hard, which may be owing to 
costiveness, under which she labours. Ordered a mild cathartic pill. 

10/A. Is entirely free from pain and other symptoms. 

March \lth. The patient returned to the Dispensary, having felt perfectly well 
until the last few days, when she had a relapse. On examination by touch and 
the speculum, the same condition of the cervix was ascertained as had previously 
existed. Scarifications to the os tincae. V. S. ad ^xij. To have ol. ricini 5j. 
every second night, and to remain several days in the horizontal posture. 

April 8th. Returned to the Dispensary, suffering under tonsillitis, but entirely 
free from any symptoms of uterine disease. 

Case II. — Simple engorgement produced by sudden check of the menstrual dis- 
charge. — Bleeding from the arm. — Scarifications to the cervix. — Cure.— Sept. \3th, 
Bridget Fleming, widow, aged 27. One child two years old. Four weeks ago, 
while menstruating, had the discharge suddenly checked,, by changing her clothes. 
Was immediately seized with chills, pain across the hips, bearing down pain, 
which prevented her walking; except with severe suffering. Had sickness at 
stomach, lancinating pains in the breast, and about a week after had a profuse 
white discharge from the vagina. Five days since a return of the menstrual pe- 
riod. The pains greatly aggravated, but no menstrual discharge. By the touch 
the cervix is hard, swollen, painful to the touch, with the heat much increased. 
By speculum, the colour of cervix much heightened. Both lips of the os uteri 
much engorged. A profuse white discharge. 

Scarifications to the cervix. V. S. to ^viij; to have infusion of quassia with 
Epsom salts, and the aromatic sulphuric acid. 

llth. Engorgement of the os tincae very much reduced, and nearly natural. 
Complains of pains in the bowels, which she ascribes to the medicine. 01. 
ricini .^j. 

19//e. Free from pain in uterus. Leucorrhoeal discharge much diminished, and 
she says is little more than what is natural to her. Complains now of no pains 
except rheumatic pains in the head and back. 

Case III. — Simple engorgement with suspension of the menses nine months. — 
Bleeding— Scarifications— Great alleviation of the symptoms. — Aug. 28th. Ellen C — , 
aged 34 years, mother of five children. Has not menstruated since December 

No. XIIL— January, 1844. 8 



110 'BueVs Report of the Diseases of Females. [Jan. 

last; but, has suffered with pain in back and lower belly, with constant vaginal 
discharge. At tfiis visit she was not examined, per vaginam, but prescribing from 
the symptoms merely, she was ordered to be bled from the arm twelve ounces, 
and to preserve the horizontal posture. 

Sept. 3d. The pains have been very much relieved by the bleeding. On exa- 
mining by touch and speculfim, anterior lip of os tincse much engorged, hard, 
complaining of pain when it is pressed; swollen, of a livid colour, abundant 
brownish discharge. The os was scarified and bled profusely. Saline cathartic; 
injections of linseed tea; horizontal posture. 

5ik. Feels very much better, bled profusely from the scarifications; says, that 
after suffering seven hours, like those of labour, she discharged a large coaguluni 
of blood from the vagina, since which she has been entirely easy. Examined by 
touch and speculum; the anterior lip of the os was found much reduced in size, 
quite soft, pale, nearly of a healthy colour; a white discharge. Ordered to con- 
tinue the emollient injections, use occasionally a saline cathartic, and return if she 
felt any return of the symptoms. We saw no more of her. 

Many more cases of simple engorgement, treated in a similar manner, and 
with the same result, might be cited. Enough, however, have been adduced 
to exhibit the nature of the symptoms, and the result of removing or greatly 
alleviating ihem, in the course of a few days, by the simple remedies re- 
sorted to. 

The inquiry may be made, whether, supposing no treatment had been 
used, but the patient left entirely to nature, the symptoms would not, after a 
time, have disappeared spontaneously; and by natural resolution, without sub- 
jecting the patients to the desagremens of treatment, and of repeated exa- 
minations by the touch and speculum. I declare without hesitation, my 
belief that they would not, but that they would probably have continued for 
years; impairing the patient's health; destroying much of the comfort of life; 
and perhaps ultimately terminating in malignant disease. 

Case IV. — Granular engorgement of the cervix, complicated with polypus uteri, 
and tumour of the breast. — Sept. \3/h. Hannah Park, widow, aged 30 years, of a 
tall spare frame; pale, unhealthy, vmxen look. Was married at 16, and lived with 
her husband five years, but was never pregnant. Her menses always irregular in 
their period, small in quantity, and accompanied with great pain. At the age of 
eighteen, during a menstrual period, she rode ten or twelve miles in a hard going 
wagon, from which she suffered much pain at the time, and soon after was 
attacked with a profuse white discharge, also attended with severe pain. About 
three years ago, she suflered with repeated severe haemorrhages from the uterus. 
She was examined by a surgeon and a polypus uteri discovered, which was re- 
moved. Seven months ago, a hard tumour appeared in the right mamma; this 
was removed by excision; and she has since suHered increased pain in the region 
of the uterus, with profuse white discharge. At this date, Sept. 13th, complains 
of pain in the small of the back and left hip. . Examined by speculum, the cervix 
uteri is enlarged, indurated, heightened in colour; red, and thickly studded with 
little granular bodies, resembling the papillae of the tongue, when much enlarged. 
The parts were bathed with a profuse whitish or yellowish discharge. 

To have injections into the vagina of linseed tea, and extr. conium ^j. to the 
pint. To take night and morning a pill composed of one grain of calomel, and 
same quantity ext. conium. 

\8th. Complains still of severe pain in the back, hips, &c.; was ordered to be 
bled eight ounces, and to continue the injections. 

Oct. ISth. After the last prescription the patient went into the country, and re- 
mained nearly a month. She returned with her general health somewhat improved; 
but with no improvement in the uterine symptoms. The pain and discharge re- 



1844.] Buel's Report of the Diseases of Females, 111 

main as before. She was ordered to be bled eight ounces, to use the warm bath 
three times a week. 

'21s^. The pain and discharore are somewhat diminished. 

Nov. 8ih. The pain remains still lessened, but the discharge is rather increased. 
It was resolved to try the effect of an astringent injection. Nitrat. argenli gr. ij. to 
the ounce of water. ♦ 

I8th. The discharge is lessened; the pain increased since using the injection. — 
Apply four leeches to the os tincee. 

22d. Both the pain and discharge seemed to be lessened by the leeching. 

For several weeks the condition of the patient remained with little alteration. 
She suffered much from the pain, and had a constant and profuse leucorrhoeal dis- 
charge. Her avocations requiring her to be much upon her feet, she was advised 
to enter the Hospital, that she might keep her bed for some weeks, as well as have 
the benefit of other treatment. She followed the advice, and remained for a couple 
of weeks in the hospital; but left it in much the same condition. 

Remarks, — This case appeared to be much more obstinate than ordinary 
cases of simple engorgement; but whether owing to the peculiar form of 
the disease, or to the bad constitution of the patient, is a matter of doubt. 
She was evidently of a strumous habit, as shown by the tumour in the breast, 
the uterine polypus, as well as her general appearance. 

Case V. — Hard or white. engors;ement occurring at the critical age, — Warm bath 
— Cathartics — Cure. — October llth. Catharine Pheeny, aged 47, but looking 
much older, and having a feeble appearance; has had twelve living children besides 
two miscarriages, the last at the age of forty-two. The menses have never entirely 
ceased, but have been irregular, and occurring only once in two or three months. 
Has suffered under profuse leucorrhoea, pain in the back, bearing down pains; 
sensation of foreign body in the vagina, with disposition to make expulsive efforts. 
Costiveness and emaciaiion. Examined by touch and speculum. Cervix uteri 
enlarged, hard. Os tincse patulous; by the speculum the cervix appears enlarged, 
rearly to the size of a hen's egg; quite pale, of a pinkish or rose white colour. 
To the feel it has the sensation of a very hard compact substance. The patient 
described it as feeling like "callus." It approached to within two or three inches 
of the external parts. 

The cervix was scarified freely, but only a few drops of blood followed the 
scalpel. The tissue appeared to be dry, as if a deposit of fibrine into the cellular 
tissue had taken place. 

She was ordered hip baths three times a week; and to take night and morning 
one of the following pills: — R. Mass. hydrarg. ^ij.— Ext. conii, 3j. — Pulv. 
rhei, 9j. M. fiat mass, in pil. No. xx. div. 

25th. The symptoms are very much relieved, the pain and leucorrhoeal discharge 
diminished. 

She complains much of costiveness, to relieve which the following prescription 
was directed: — R. 01. croton. tig. gtt. viij. 01. caryophillat. gtt. viij. 01. ricini, 
5j. M. Sig. 5j. every second night. Continue hip bath. 

Nov, 8th. The general appearance of the patient is greatly improved; she has 
gained in flesh and colour. On examining the cervix uteri, the hardness and 
swelling are greatly reduced; the leucorrhoea has ceased entirely. The patient 
was so much gratified with the effects of the croton oil purgative, that she returned 
several limes for a renewal of the prescription, and informed me that she continued 
quite free from any uterine affection. '^ . ,., 

Case VI. — Srft or hsemorrhagic engorgement — Venesection — Ergot — Cure: — 
September 20lh. Catharine Gallan, aged 24, native of Ireland, chambermaid 
in a hotel; unmarried, and has never been pregnant. Thin and spare habit of 
body; general health pretty good. Has severe pain in the region of the uterus 
with haemorrhage. At every menstrual period discharges abundant coagnla from 
the vagina. Examined by touch. Cervix uteri swollen and painful. Vagina very 



112 Buel's Report of the Diseases of Females, [Jan. 

narrow and tender. Examination caused much pain. V. S. to .^viij. R. Pulv. 
secale cornut, gij. Aq. menih. pip. Jvj. — M. A lablespoonful once in three hours, 
until the haemorrhaije is checked. 

'2-2d. The pains were entirely relieved by the bleeding. The haemorrhage ceased 
in twenty-four hours; and has not returned. 

Oct. 20ih. She was again {macked with pain, profuse hasmorrhage and dysuria. 
The remedies were repeated with the same results. 

Case VII. — Haemorrhagic engorgement complicated with cough, and with par- 
oxysms of an intermittent. — Quinine, Ergot — Cure. — September X^th. Mary 
Fowler, aged 37, has had eight children; for four years past, has been afflicted with 
coughs. During the last six weeks has had paroxysms of an intermittent. For 
a month past constant hasmorrhage, attended with bearing down pain, sense of 
weight in the uterus; pain in the back and liips; loss of appetite, &c. On exa- 
mination the cervix was found enlarged. The posterior lip was more particularly 
enlarged. Pressure produced severe pain, extending through the back. She was 
directed to have sulph. quinia? in the ordinary doses for the intermittent, and to 
take ten grains of powdered ergot, four times a-day. 

25/A. The chills have been arrested by the quinine, and the haemorrhage ceased 
in two or three days after commencing the ergot. 

She was directed to return to the Dispensary if any relapse occurred, but we 
saw no more of her. 

Case VIII. — Ulcerative engorgement supervening upon protracted lactation. — Appli- 
cation ff caustic pernitrate of mercury to the ulcers. — Great relief of the symptoms. — 
March l&lh. Emily Montague, aged 31, native of Philadelphia, tall and spare habit 
of body, flushed cheek, emaciated. Married twelve years, and mother of five 
children, the youngest twenty months old, and has suckled it till within a week of 
the present time. Her general health has been good until recently. A month ago 
was attacked with severe uterine pains, a profuse discharge, at first yellow, after- 
wards white, abdominal tenderness and enlargement. Examined by touch and 
speculum. Cervix enlarged, hard, tender to the touch. Os tincae of a livid colour, 
patulous, with ulcerations, rather on the inner portion of the lips, and extending 
into the canal of the cervix. V. S. to ^viij. caustic pernitrate of mercury to the 
ulcers. Castor oil gj. at bedtime. Hip bath, and injection of linseed tea. 

20th. — The symptoms are all much relieved. The pain and discharge dimi- 
nished. The ulcerations seen through the speculum of a decidedly more healthy 
aspect. Reapply caustic, continue hip bath. 

'22d. — The ulcers are cicatrized over nearly the whole extent. 

She did not return for several weeks, when I was sent for to visit her with a 
severe attack of diarrhoea. She was treated for this, and recovered; and as she 
did not come again to the Dispensary, it is probable that the cure of the ulcers 
was complete. 

Case IX. — Ulcerated engorgement with haemorrhage consequent upon leaving the 
bed and resuming work four days after accouchement. — Cauterization with perni- 
trate of mercury — Ergot — Cure. — March 22 d. Sarah Rooney, aged 21, native of 
Ireland, has been married a year; has an infant thirteen weeks old; was obliged 
to leave her bed the fourth day after her accouchement,and to go about her house- 
hold affairs. Since which she has had pain and weakness in the back and loins, 
swelling and tenderness of the lower belly; sense of weight and of falling of the 
womb; six weeks after confinement was attacked with haemorrhage from the ute- 
rus. Examined by speculum. Cervix uteri enlarged, hard and livid; very low 
in the vagina; a large ulcer on the inner surface of the anterior lip; a yellowish 
discharge from the cervix and adjacent parts of the vagina. 

Apply pernitrate of mercury to the ulcers; injections of linseed tea; teaspoon- 
ful of castor oil at bedtime every second night. 

30''^. Great alleviation of the symptoms; diminution of pain and discharge. 
Examined by speculum. The cervix has ascended much further in the vagina; 
appearance of ulcer better; edges have a healthy appearance; considerable en- 
gorgement of cervix still remaining. 



1844.3 Buel's Report of the Diseases of Females, 113 

April l^ih. Progressive improvement. The ulcer seen through the speculum al- 
most entirely cicatrized; slight leucorrhoeal discharge continues. The ulcer was 
touched lightly with the pernitrate of mercury. She vv^as ordered to take castor 
oil to obviate the costiveness under vi'hich she suffered. 

I did not see this patient again for two months, during which she was perfectly 
well. .Tune 14, she returned, having had an attack of haemorrhage from the uterus. 
She was ordered 10 grains of ergot every four hours. She did not return, and I 
presume the ergot was effectual in suppressing the haemorrhage. 

Case X. — Granular erosion with engorgemevt coexisting with pregnancy. — 
Jlpril 6th. Mary Hahneman, native of Germany, aged 26, thick set and siout; mar- 
ried five years, has two children, the youngest is three years of age. Says she 
has never been pregnant since; enjoys good health, and actively engaged in house- 
hold labour, menstruating regularly till three months since; at that time, during a 
menstrual period, had her feet wet while at the wash-tub; the flow was immedi- 
ately checked, and has not reappeared. Complains of pain and weight in the 
hypogastrium; has a constant discharge of yellowish matter. Examined by the 
speculum; discovered a large ulceration or erosion three-fourths of an inch in 
diameter, having a granular appearance, the granulations passing through a coat- 
ing of white opaque mucus; they bled easily when touched. The caustic perni- 
trate of mercury was applied to the ulcer, and she was bled ^x. from the arm. 

I5th. The pains were greatly relieved by the bleeding, and the ulcer seen through 
the speculum has a better appearance. 

25th. The ulceration has again an unhealthy appearance, with large granulating 
and profuse white discharge. Ulcer touched with pernitrate of mercury. 

May 27th. During the interval the patient has been much better, but the symp- 
toms are again aggravated. Examination by the speculum exhibited the cervix 
uteri engorged and livid. The ulceration was cicatrized over its entire surface, 
but is granulated and irregular. The os tincae was scarified freely, and injections 
of flaxseed tea ordered. 

June 2d. The uterine symptoms, pain,&c. are much alleviated. The colour and 
appearance of the cervix nearly natural; the ulcer cicatrized but still wears the 
granulated appearance already described. At this time, the patient had a con- 
siderable enlargement of the abdomen, and as her general health, as well as the 
condition of the uterus, were much improved since I first saw her, 1 strongly sus- 
pected the existence of pregnancy. The woman herself felt quite certain it could 
not be the case. I did not examine for the stethoscopic signs, but directed her to 
remain quiet, and to call on me again after three or four weeks. 

July 20lh. She returned to the Dispensary and informed me that she had quick- 
ened about a fortnight before, which would carry the date of conception back to 
about the first of March, a month from my first seeing her, and two months after 
the suppression of the menses. 

I carefully examined at this time the appearance of the cervix and vagina. The 
cervix was paler than it had been at first. The ulcer was healed over, but the 
granular appearance remained. The blueness of the vagina which has been men- 
tioned as one of the signs of pregnancy, was well marked. In the anterior part of 
the vagina, over the ridge formed by the canal of the urethra, it was very strongly 
marked. A string of very viscid glairy mucus was hanging from the os tincse, 
an occurrence which I have often observed in cases of pregnancy. 

'J'he cases which have been adduced, are sufficient to illustrate the seve- 
ral forms of engorgement of the cervix uteri met with at the Dispensary, 
viz. the simple, the granulated, the hard or vi^hite engorgement, the soft or 
h2emorrhagic, and the ulcerative. I have notes of many other cases; to recite 
them, would however be but a needless repetition. The frequent occur- 
rence of the affection, the suffering and inconvenience it causes to the sub- 
jects of it, and its curability in most cases by a proper course of treatment, 
are, I think, established by the cases already cited. 



114 'BneVs Report of the Diseases of Females, [Jan. 

8. Prolapsus Uteri. 

Nine cases of Prolapsus Uteri occurred. In this number are included 
only those cases which depended upon a relaxed condition of the ligaments 
of the uterus, and which were not accompanied by any great amount of en- 
gorgement of that organ. The cause of the prolapsus, was in almost every 
case the same, viz. leaving the bed and resuming work too soon after accouche- 
ment. The class of females who form the majority of Dispensary cases, 
are driven to this by unavoidable necessity, and the result is but too frequent 
of a permanent prolapse of the uterus. 

The treatment consisted in astringent injections thrown into the vagina, 
cold bathing, and in some instances the introduction of pessaries. The 
result was in general far from satisfactory. 

9. Prolapsus Vaginse. 

or this affection, which is not commonly met with, two cases occurred. 
It consists of a relaxation of the posterior part of the vagina, so that a sort 
of pouch or pocket is formed which hangs below the ei\ge of the perineum. 
The finger introduced into the rectum and turned forwards, passes directly 
into this pouch, which hangs down between the labia, resembling somewhat 
in appearance, the tongue protruded from the mouth. It causes no particular 
sufferino- or inconvenience to the patient unless it be an increased mucous 
discharge. Her apprehensions are, however, excited by discovering some- 
thing about herself different from usual, and she is led to consult a phy- 
sician. 

The most common cause, habitual costiveness, producing an accumulation 
of fecal matter in the lower part of the rectum, which having nothing in 
front to support it but the thin walls of the vagina, protrudes in that direction, 
distending an.d relaxing the rectum, until a pouch is produced in the manner 
above described. 

The obvious indications of cure, are by regulating the bowels, to prevent 
fecal accumulations, and by astringent injections to strengthen and support 
the vagina. 

Case XI. — Ann McElroy, acred 32, mother of two children, and now three 
months advanced in pregnancy, was alarmed some lime ago, by discovering some- 
thino" protruding from the vulva, which an old lady had informed her was a 
" fallino- of the womb." On examination, the protruding body was found to be 
a portio'ii of the vagina prolapsed. The finger was introduced into the rectum, and 
turning it forward, it passed directly into a pouch-like cavity. She had been at- 
tacked, about two months ago, with a violent cough, occurring in severe pa- 
roxysms. She imputes the occurrence of the prolapsus to the violent paroxysms 
of the coucrh. There was no accumulation of fecal matter in this case; on the 
contrary, the bowels were loose. The- pulse was hard and wiry. To allay the 
couo-h she was bled to ^viij, and a strong astringent injection of alum and oak 
bark was ordered to be thrown into the vagina. As she did not return, 1 infer that 
the prescription was successful, or at least that her apprehensions were quieted. 



1844.] ^uqVs Report of the Diseases of Females. 115 

10. Frocedentia Vesicas. 

Of this affection but one case occurred. The subject of it was a stout 
Irish woman, with a very wide pelvis. It had existed for two or three 
years, and since its first occurrence, she had become pregnant. During the 
pregnancy, the bladder resumed its natural position, but after delivery there 
was a recurrence of the procedentia. The bladder protruded from between 
the vulva, forming, when distended with urine, a pyriform tumour, of the 
size of a man's fist. The anterior part of the vagina, much distended, 
formed the covering of the tumour. From the great distension the rugse 
were almost entirely obliterated; and through the long exposure to the air, 
to which it had been subjected, a sort of epidermis had been produced, re- 
sembling, except in its greater delicacy, that of other parts of the body. 
This woman was subject to violent paroxysms of coughing; and suffered 
much from the dragging pain at the umbilicus produced by the tension of 
the superior ligament of the bladder, which is inserted into the umbilicus. 
It was productive of great suffering to the woman, who had a large family, 
and was obliged to be constantly on her feet. Efforts were made to relieve 
her, by astringent injections and by a pessary. By these means the bladder 
could be retained in its place for a time; but when a violent paroxysm of 
coughing came on, it would be protruded, in spite of every effort to the con- 
trary. 

11. Carcinoma Uteri. 

Two cases occurred. They were attended with the usual symptoms of 
carcinomatous ulceration. Frequent and profuse haemorrhages: an exceed- 
ingly fetid discharge of sanious matter; burning pain in micturition; nausea 
and vomiting. I shall detail briefly both cases. 

Case I. — May 17, 1843. Margaret Keyser, semptress, ao'ed 43. Married since 
the age of nineteen; has been the mother of eiufht Jiving children, and has had 
nine miscarriages. Since the last miscarriao-p, which occurred three years a^o, 
the menses have never heen regular, but suhject to frequent heemorrhages. I find 
that in December last, she was entered on the Dispensary books, as a case of en- 
g^orgement of the cervix. She says that she was twice bled from the arm at that 
time, and experienced considerable relief for some weeks. At this time (March 
17), she has a discharge of offensive matter from the vagina; pain in the back and 
thighs; has vomiting every mornin^; burning pain in micturition; a yellowish 
leaden coloiir of the face; is not very greatly emaciated. 

Examined by the speculum. Cervix uteri approaches within two inches of 
the vulva. It is hard, irregular, fissured and lobulated, of a dark livid colour. In 
parts it is ulcerated with a jagged irregular surface, it bled freely from the touch 
of the speculum. 

Prescription. — The bowels to be regulated with the compound rhubarb mix- 
ture. Injections of warm flaxseed tea to be thrown into the vagina three times 
a day. 

R. Sol. arsen. potassae ^ij; hydriodat. potass, ^ij; aq. distillat. ^iiiss. A 
teaspoonful to be taken three times a day. 

June 1st. The appearance of the ulcer somewhat improved. Her appetite is 
better. Still vomits occasionally in the morning, but less constantly than before 
she commenced the treatment. 

Ju/y 1st, The ulcer is covered with a black slough; there is an intolerably offen- 



116 Buel's Report of the Diseases of Females, [Jan, 

sive discharge. Suffers under severe colic pains and darting lancinating pains, 
through the womb. 

Frescri'ption. — A sufficient quantity of opium to be taken in pill at bedtime, to 
procure sleep. To inject the vagina with solution chloride of^ sodium in warm 
water. 

Sept. 1st, The case is rapidly approaching its termination. The pains are ex- 
cessively severe. She can take little or no nourishment. Has oedema of the in- 
ferior extremities. 

Case II.— i/ay 22c?, 1843. Margaret Donohoe, aged 67, has had three chil- 
dren, and two miscarriages. Her menses were generally regular, and ceased 
at the age of forty-five; from that time to sixty-four, she enjoyed good health. 
For three years has suffered with profuse heemorrhages from the womb. Does 
not suffer much pain; is blanched by the loss of blood. 

Examined by the speculum; cervix uteri approaches to within an inch and a 
half of the vulva. It presents an ulcerated surface, hard, irregular and lobulated, 
which bled freely when touched. 

She was directed to remain in the horizontal posture; to inject the vagina with 
a weak solution of the chloride sodium, and have a light and nourishing diet. She 
also took for a short time small doses of Donovan's liquor, tiiehydriodate of arsenic 
and mercury. The treatment did not appear to exert any influence on the pro- 
gress of the disease; the haemorrhage, with excessively fetid discharges, con- 
tinued. She did not suffer very great pain, but died about the first of August, 
three months from the time I first saw her, and something more than three years 
from the commencement of the haemorrhages; more apparently from the loss of 
blood than any other cause. 

12. Polypus Uteri. 

But one case occurred, Sprll I3th; Anne Brady, aged 48, a single 
woman up to the age of forty-two, when she was married, but did not be- 
come pregnant. The menstrual periods have continued regular up to the 
present time; for some months past has suffered with the ^^gravel,^^ on 
account of which she came to the Dispensary, and for which she has taken 
saline cathartics and diuretics. More lately a discharge from the vagina, 
sometimes watery, sometimes bloody. Suspecting the cause of the "gravel" 
and of the other symptoms to exist at the cervix uteri, the speculum was 
introduced, and the source of the difficulty revealed. A small fleshy poly- 
pus, of the size of a hazel-nut, was projecting from the os tincae; no other 
marks of disease existed. She was advised to have it immediately removed, 
but refused her consent to the operation. 

13. Vesico-vaginal Fistula. 

One case occurred. A middle aged woman who had borne several children; 
her last labour had been tedious; the head remained for a long time im- 
pacted in the inferior strait of the pelvis, and was finally delivered by the 
forceps. Ever since the labour (now six months), she has been troubled 
with incontinence of urine; after a consultation between her accoucheur and 
the surgeon who had applied the forceps, it was decided that she had a 
falling of the womb, the pressure of which upon the neck of the bladder 
produced the incontinence. She was advised, being poor, to apply to the 
Dispensary for a pessary. Introducing the finger into the vagina, the womb 
was found in situ, little if any below its natural position; the speculum was 



1844.] Fosgaie's Case of Deliriwn Tremens, 117 

then introduced. The cervix uteri appeared perfectly natural, with nothing 
about it to account for the incontinence of urine. On withdrawing the 
moveable blade of the speculum, and carefully examining the anterior por- 
tion of the vagina, the source of the difficulty was at once discovered; about 
an inch behind the orifice of the urethrae, existed a fistulous opening, about 
the size of a crow quill, and through which a probe was introduced, and 
passed directly into the bladder. The edges of the fistula were touched 
with nitrate of silver, and they gradually contracted, to such a degree as to 
be productive of only trifling inconvenience to the patient. 

Remarks. — This case with others, which have been detailed in the course 
of this report, furnish decisive evidence of the necessity of the speculum to 
a thorough investigation and correct diagnosis of diseases of the uterus and 
vagina. Long practice may give wonderful acuteness to the skilful finger; 
still the touch must ever be a very imperfect substitute for the sight. An 
additional consideration is the facility of applying leeches, caustics, and 
other remedies, through the medium of the speculum, which otherwise 
would be impossible. 



Art. IX. — Case of Delirium Tremens. By Blanchard Fosgate, 
M. D., of Auburn, N. Y. 

Isaac Seaton, aged 36 years, a stage driver of dissipated habits, 
was by his own request sent to the county jail on the morning of the nine- 
teenth of May last. His reason for requesting this confinement, was through 
fear of a conspiracy against his life. 

At six o'clock, P. M. I received notice of his situation, and found him in 
a highly excited state of both mind and body. His manner was frightfully 
furious, but harmless; his sole object being to escape attempts upon his life, 
which he said were made by sucking his breath. His respiration was 
short and hurried — pulse quick and compressible — tongue white with red 
edges — bowels natural and without pain on pressure— his voluntary mus- 
cular system in great tremor, and his extremities were cold. By conversa- 
tional address, he was soon so far controlled as to give the following history 
of his case. 

He stated that for a long time he had drank about a pint of spirits daily, 
but for the last four days he had had only two glasses, and for this period 
he had not been asleep; that his domestic affairs sorely troubled him; that 
he had a gonorrhoea of three weeks standing, and that within the preceding 
four days it had been greatly aggravated, and he sincerely wished to die 
that he might escape assassination. The secretion of urine was copious. 



118 



Fosgate's Case of Delirium Tremens. 



[Jan. 



being, according to his own statement, not less than quadruple the usual 
quantity. His appetite was indifferent, and for some weeks he had vomited 
white frothy matter every morning. This was his third attack of the 
disease. 



Dates, 
Blay 19. Evening. 

" 20. Morning. 



" 21. Morning. 

'• " F>ening. 

" 22. Morning. 

*' " Evening. 

" 23. Morning. 

" " Evening. 

" 24. Morning. 



" " Evening. 

" 25. Morning. 

" " Evening. 

" 26. Morning. 

" " Evening. 

" 27. Morning. 



" Evenini 



" 28. Morning. 



General Symptoms. 
Condition as above stated. 



Patient has slept tolerably well, and 
the (iclirium is .somewhat abated. 

Sy m ploins not i in proved, — prescription 
ha.s operated several limes. 

Disease increasing. 

No belter. 

Symptotns aggravated, — great distress 
and soreness of the epigastrium. 

Blister drew well — epigastric symp- 
toms are much relieved, but no appear- 
auce of improvement in the disease. 

Much worse, — has had no sleef), — both 
the delnium and tremor have increased 
in violence, — skin hot and dry. 

Sym[)toms no better, — blistered surface 
is much inflamed and very irritable. 

The disease has very nearly abated, 
but the poisonous effects of opium are 
developed, — a sensntion of numliness in 
the right hemisphere of the brain, and 
piiin and rigidity of the muscles of tlie 
nupe of ttte neck. The gonorrhoeal dis- 
charL'^e has entirely subsided. 

All the symptoms of the disease are 
again aggravtstcd, but the poisonous ac- 
tion has subsided. 

A little sleep during the night, but no 
improvement in the disease. 

Disease is still further aggravated, and 
the patient is getting unruly. 

Some l)etter, — no evacuation by the 
bowels for five days. 

Symptoms are all worse, — oil produced 
one good stool. No epigastric soreness 
on pressure. 

Patient no. better. The brandy in- 
creased his distress during the early part 
of the night, — pulse slow and .sott, — 
tongue white with rod edges, and during 
the intervals of delirium, great prostra- 
tion. Evidences of poisoning are again 
developed. Secretion of urine lias not 
decrf;ased in quantity. 

Has slef>t two or three hours during 
the day, and experienced eousiderab'e 
improvement in the disease. The symp- 
toms of poisoning haveaffain disappeared, 
and the urine has decreased about one 
fourth in quantity. 
Greatly improved, — has had some sleep. 



Treatment. 

Gave 60 gts. Tr. opium 
and 2 oz. l)randy in hot 
water. 

Gave 1^ oz. 01. ricini. 

Gave 3 grs, opium. 

Directed 1 gr. opium 
every hour. 

Gave 3 grs. opium and 
directed 1 gr. every hour., 

A[)plied a large blister, 
and directed 2 grs. opium 
every hour. 

Directed 2 grs. opium 
every hour. 

Directed one cold spong- 
ing, and 2 grs. opium 
every hour. 

Gave 4 grs. opium, and 
2 grs. every hour. 

Directed 1 gr. opium 
every hour. 



Directed 1 gr. 
every hour. 



opium 



Directed 2 grs. opium 
every hour. 

Continue the opium as 
last directed. 

Gave I2 oz 01. ricini. 

Gave 4 grs. opium, and 
2 oz. brandy, and directed 
2 grs. opium every hour. 

Gave 3 grs. oj)ium, and 
directed 10 grs. carbonate 
of ammonia every two 
hours. 



Gave 3 jjrs. opium, and 
directed 10 ijrs. carlnxiate 
of ammonia every two 
hours. 



Continue the opium and 
ammonia as above. 



1844.] 

Dates. 
May 28. Evening-. 

« 29. Morning. 
" " Evening. 
" 30. Morning. 

" " Evening. 

" 31. Morning. 



Fosgate's Case of Delirium Tremens. 



119 



Eveninsf. 



June 1. Morninff. 



" " Evening. 
*' 2. Morning. 
" 3. Morning. 



General Symptoms. 
Continues to in»prove. 



Not near so well, — delirium and tre- 
mors have increased. — has had but little 
sleep, — is rather costive. 

Symptoms about the same, — oil has 
operated three times. 

Symptoms of disease improved, — slept 
tolerably well during the night, but is 
very weak, — no appetite, — tongue clean, 
— a little delirious yet, but nerves moie 
steady. Urine decreased about one halt'. 

All the symptoms greatly aggravated, 
— ungovernable dt:lirium, — pervigilium 
great, — excessive fear and pulse quick. 
The cause of this unfortunate change is 
attributed to the influence of quinine. 

The piitient is no belter, — has had a 
bad night, — no sleep, — pulse full and 
strong, — trunk and superior extremities 
hot and dry, — inferior extremities cold 
and moist, and bowels costive. 



Much belter in every respect. After 
taking the third dose of ammonia he fell 
asleep, and continued in it profoundly 
for two hours. There were no symp- 
toms of poisoning, and the oil operated 
three times. 

Continues to improve, — slept all night, 
— a little delirious yet, — appetite im- 
proved. 

Continues to improve. 

Continues to improve. 

Discharged cured. 



Treatment. 

Directed 10 grs. carb. 
ammonia every two hours 
— opium omitted. 

Gave Ig oz. 01. ricini, 
and 3 grs. opium. 

Gave 3 grs. opium, and 
directed 10 grs. carb. am- 
monia every two hours. 

Gave 3 grs. opium, and 
directed 4 grs. quinine in 
• vv'o doses, at intervals of 
two hours. 

Gave 4 grs. opium, and 
directed 2 grs. every hour. 



Adminif^tered 7^ grs. 
opium, — 10 grs. carb. am- 
monia, shortly followed 
by 1 oz Ol. ricini, and 
ordered the ammonia to be 
given every iiour. Also 
directed the trunk and 
arms to have one cold 
spongit)g. 

Gave 2 grs. opium, and 
10 grs. carb. ammonia. 



Directed 10 grs. carb. 
ammonia every two hours, 
and good soup for food. 

No medicine. 

Directed his usual food. 



The preceding case of delirium tremens, associated as it was with a 
venereal affection, and the mode in which it has been treated, will upon 
examination present some features worthy of attention. And although it 
may shed no more light upon the pathology of this disease than is already 
possessed, it may add something toward rendering more valuable our remedial 
agents, by presenting a combination of them, that will strengthen their 
therapeutic power, and in this way serve to increase their usefulness. 

Opium, " the sheet-anchor of our hopes" in this disease, is the great 
agent upon which in the vast majority of cases we are to rely for success: 
but it must be apparent, that in an uncombined state, possessed as it is of 
various properties, the system can bear only a certain relative quantity, and 
that in many instances, this quantity will not be sufficient to arrest the dis- 
ease in its fatal tendency. 

In recapitulating this case for the purpose of presenting more fully the 
advantages of medicinal combination, we shall begin with the efiecls of 



120 FosgSi.ie'^s Case of Delirium Tremens, [Jan. 

opium unassisted by other substances, and then proceed to show the bene- 
ficial influence of carbonate of ammonia upon its operation. 

It will be perceived from the commencement of treatment, that the quan- 
tity of opium was rapidly increased during each period of twenty-four 
hours, up to the evening of the 23d, as follows: 2 grs.; 15 grs.; 39 grs.; 
48 grs.; and during the night of the 23d, 28 grs. more were taken, making 
in the aggregate, 132 grains of good Turkey opium, administered in four 
and one half days, without accomplishing the desired result. Under its 
therapeutic influence the afl'ection nearly gave way; but the poisonous pro- 
perty of the drug was so strongly developed, that the further exhibition of it 
in such quantity, would have been attended in all probability with fatal conse- 
quences. Could the patient have withstood this poisonous influence, an- 
other day's continuance of its use would undoubtedly have subdued the dis- 
ease. During the succeeding twenty-four hours, the quantity was reduced 
to twenty-four grains, divided in hourly doses; but this amount was inade- 
quate to control the affection, and consequently on the evening of that day, 
the symptoms of poisoning were replaced by those of the malady gready 
aggravated. 

On the 25th the quantity was again augmented to forty-eight grains, and 
through the night of the 26th it was continued in hourly two-grain doses, 
which with what had been administered the preceding day, made seventy- 
two grains, when the poisonous influence again made its appearance. 
During the 27th there were six grains administered in two doses at inter- 
vals of twelve hours, in connection with two drachms of carbonate of am- 
monia, at intervals of two hours, in ten-grain doses. Under the influence 
of this change, the poisonous effects again subsided, and with a manifest im- 
provement in the symptoms of the disease. 

Through the night of the 30th twenty-eight grains of opium were admi- 
nistered without ammonia, and morning found the patient with a strong, full 
pulse — irregular temperature, and partial sweats, with costive bowels, and 
without sleep during the time. To these twenty-eight grains were added 
seven and a half more in one dose, in connection with ten grains of carbon- 
ate of ammonia. The ammonia to be repeated in ten-grain doses every hour, 
until sleep should prevent its further administration. After taking the third 
portion, the patient fell into a profound sleep, which continued two hours, 
when he awoke, much refreshed both in body and mind. The disease had 
evidently relaxed its hold upon the system, and the opium had left no dele- 
terious influence in its stead. 

The ammonia, I apprehend, had a two-fold operation. It exerted a thera- 
peutic power upon the nervous system of organic life, by sustaining its 
functional action, and bore the patient above the prostrating influence of the 
disease, without further stimulating an already over-excited brain. A lesion 
of innervation is ultimately to be looked for in this aff'ection, and any article 



1844.] FosgSite^s Case of Delirium Tremens. 1%1 

that will assist in obviating such a condition, must be an important agent in 
treating the disease under consideration. 

But valuable as I conceive this preparation of ammonia to be in sustaining 
the system against the prostrating character of delirium tremens, its modi- 
fying influence upon the action of the only substance on which we can 
safely rely for success in treating it, is of far greater moment. Opium pre- 
sents us with a curative principle, which, if possessed separate from the 
deleterious property with which it is combined, would be a specific for at 
least one affliction of the unfortunate inebriate. What this prmciple is, or 
whether it is a result of chemical changes effected in the drug by the ammo- 
nia when introduced into the system, I am unprepared to say: but that a 
power to control the poisonous influence of opium to a certain extent, and to 
render it more potent, is to be found in the ammonia, the case before us, to 
my mind, clearly demonstrates. The obvious effect was, to render the drug 
more powerful in its influence upon the disease, and at the same time to 
withhold its poisonous property, while the sanative quality upon which its 
value depends, was left untouched. 

On the morning of the 27th, this being the thirteenth day of the disease 
and the ninth of treatment, all the symptoms of a severe case were pre- 
sent — a slow soft pulse, white tongue with red edges, large secretion of 
urine, and during the intervals of delirium, great prostration and general 
tremor of the muscles of animal life, and superadded was the poisonous 
effect of opium. Under these circumstances the use of ammonia was com- 
menced. The opium, it is true, had been much reduced in quantity, bul 
the ammonia so modified that which the system already contained, as well as 
what was administered in addition, that the curative power of the combined 
agents was soon evinced in the induction of sleep — the reduction of urine- — » 
the counteraction of poison, and a manifest improvement in all the symp- 
toms. 

The powerful influence of ammonia in permitting the curative principle of 
opium to exhibit its action, was more fully developed on the evening of the 
31st. During the night of the 30th, twenty-eight grains of opium had 
been administered, and on the morning of the 31st, seven and one-half 
grains, in one dose were added, making thirty-five and one-half grains of 
the drug taken. Within three hours, at stated intervals, forty grains of car- 
bonate of ammonia were administered, after which the specific influence of 
the opium almost entirely subdued the disease, and relieved the patient from 
his perilous situation, without having experienced any injurious effects from 
the large quantity of opium. 

The curative power brought to bear upon the disease, did not reside in 

the ammonia; for, on the evening of the 28th, when the patient was rapidly 

improving under their combined agency, the opium was omitted, and he 

immediately relapsed. Neither can the recovery be attributed to a sponta- 

^ neous termination; for when the poisonous effects of the opium subsided on 



122 BisseWs Case of Fungus Haematodes of the Bladder, [Jan. 

the evening of the 24th, from a reduction of quantity, the disease increased 
in severity: and the favourable change that occurred on the 27lh was not 
in consequence of such cause; because it will be observed, on tracing the 
case to the evening of the 30th, that so far from the disease having run its 
course, it was greatly aggravated by the use of quinine. 

Opium possesses the power of reducing the secretion of the kidneys 
when in an over-excited state, by removing the cause of excitement; but it 
exercised no influence upon their function in the early part of this case. In- 
creased secretion of urine is a symptom of delirium tremens; and so long as the 
opium did not remove the cause, the renal secretion was unabated. One pro- 
perty of ammonia is, to augment in some degree the functional action of these 
organs, so that their change to a reduced action can only be attributed to the 
opium in subduing the morbid condition of the system. But without the assist- 
ance of ammonia in this instance, the opium could not have been administered 
in sufficient quantity, to have brought about this change, and by its modify- 
ng influence, the reduction of urine was efl'ected. 

The influence of opium upon the mucous membrane of the urethra when 
narcotism is induced, is clearly illustrated in the present instance. During 
the first four days of treatment the patient was fully under the operation of 
this drug, and without any other means, the gonorrhoeal discharge was 
arrested, and a perfect cure was the result. 

In the progress of treatment, castor oil was employed to relieve the bow- 
els, which were torpid throughout the whole course, and with entire satis- 
faction. It was administered three times, when the system was under the 
influence of large doses of opium, and its operation was quite as prompt as 
under ordinary circumstances. I am inclined to believe that opium has but 
little power over the cathartic property of this drug. ■ -■ ' 



Art. X. — Fungus Hsematodes of the Bladder. By Emery Bissell, 
M. D., of Norwalk, Ct. 

I WAS summoned on the night of the 7th of June, 1842, to visit D. S. B, 
of this borough, in consultation with his family physician, on account of a 
sudden and profuse discharge of blood from the bladder, attended with most 
excruciating pain, evinced by his piercing cries and groans. He had already 
evacuated a pint or more of blood, and was still voiding it in considerable 
quantities, both in a fluid and coagulated state, at intervals of only a (ew mi- 
nutes. In the course of the night he voided not less than three pints. He 
stated that the first indications of the disease, which he had ever felt or no- 



1844.] BisseWs Case of Fungus Hsematodes of the Bladder. 123 

ticed were sometime in the month of April previous; at this time, he passed a 
small quantity of blood along with his urine, not attended or preceded by any 
pain or uneasiness, and so far as he knew without any appreciable cause. 
This attack subsided in a day or two, and he thought no more of it, until 
the present time. This recurrence of the complaint in its more aggravated 
form was induced by a long ride in a wagon on a hot day; after a day or two, 
he was now so far relieved as to be able to attend partially to his ordinary 
business, for a few days, when he was again confined by a renewed attack, 
and never again left his house, as the case was attended by his family phy- 
sician. I did not see him after the time above mentioned, until January 7th, 
1843. During this interval of seven months, I found that himself and friends 
had regarded his case as an ordinary case of gravel, and for this, he had 
taken great quantities of a nostrum, patented and sold by a physician in the 
city of New York, with whom he had been in regular correspondence, and 
to whom his urine was sent weekly for inspection. By him, he was assured 
most unequivocally, that his disease was what he termed " phosphalic 
gravel," and that he would most certainly recover if he would but persevere 
in the use of the medicine long enough. During this period I found he 
had suffered greatly from pain in discharging the contents of the bladder, 
which were blood inconsiderable quantities both fluid and coagulated mixed 
with urine, and a sort of carbonaceous matter, similar in appearance to what 
lampblack oi very finely levigated charcoal would be, when mixed up into a 
very stiff paste with some kind of glutinous liquid. The patient's habits were 
strictly temperate. From his description of symptoms, I found many of the 
indications of the presence of stone, tumour or other foreign body in the cavity 
of the bladder; but no evidences whatever of disease of the kidneys or any 
other organ, save the bladder. All his sufferings appeared to have their origin 
in the mechanical irritation of some foreign substance. On a closer inspection 
a tumour above the pelvis was evident, and on introducing the finger into 
the rectum, it encountered a solid body apparently filling the whole cavity 
of the pelvis and to the touch, seemingly as large as the vertex of a child's 
head, when fully engaged in the superior strait of the pelvis. The rectum 
sustained very considerable compression, and the stools were small, flattened 
and passed with difficulty. His sufferings at this time were indescribable, 
and apparently as severe as human nature is capable of enduring. The 
intervals of ease were of short duration, as the calls to evacuate the bladder 
were almost incessant. I frankly informed him that his case admitted of no 
more than a temporary relief from opiates, and advised the abandonment. of 
all other medicine. This he seemed somewhat unwilling to do, and yet clung 
to the belief of his disease being gravel, and still half cherished the vain 
hope of recovery from the nostrum of which he had taken enormous quan- 
tities, and which was evidently little else than a very pure soap; In this 
condition, he lingered until the 20th of March, with no relief except a partial 
.mitigation of pain from the use of opium in large and frequent doses. 



124 B'lsseWs Case of Fungus Haemaf odes of the Bladder. [Jan. 

Nature seemed evidently to yield to the effects of mere physical suffering, 
and death came to him as a welcome messenger, at the age of sixty-seven. 

^/3iitopsy.— The body was opened fifteen hours after death. All the viscera 
of the abdomen, also the kidneys, were perfectly healthy in appearance. 
Not the least vestige of disease could be discovered in any part except the 
bladder, which was occupied by an enormous tumour of that kind termed 
*' fungus haematodes." By this the whole cavity of the bladder was filled, 
except that about two ounces of semi-coagulated blood were found in its 
upper portion: not even a spoonful of urine could be seen. The distension 
of the bladder was of course in those directions where there was the least 
resistance, i. e. upwards into the cavity of the abdomen, and downwards into 
the perineum, giving it a form nearly ovate; its length being about nine 
inches, and its transverse diameter four or four and a half. So entirely 
was it filled with the tumour, that it was difficult to conceive how even the 
smallest quantity of urine could have been accumulated. This fungous mass 
had its origin near the neck of the bladder, posteriorly, to which it adhered 
firmly, seeming in fact to make a part of its very structure; its texture was 
not so firm but it could be pulled apart and torn to pieces with the fingers. 
Its weight, which I had not the means of ascertaining with precision, I 
should judge to be two and a half or three pounds. For the production of 
this unusual disease, in this instance, it is impossible to assign any cause 
whatever, and its occurrence in one of the healthiest systems I have ever 
seen examined during a professional life of thirty years, is one of those 
dark mysteries of our profession, on which not even a ray of light is shed 
by any thing yet discovered. ^ - • ■. 

Nor WALK, iVoz;. 28//i, 1843. 



Appendix to Dr. T, R. Beck's paper on poisoning by Sulphate of 

Potash. 

I AM enabled through the kindness of Dr. Hays, to add, that op dissec- 
tion, the female Haynes was found not to be pregnant, and that she died 
of sanguineous apoplexy and inflammation of the stomach. Her husband 
was inthcted for wilful murder. 

Mr, Mowbray (in the Medical Gazette) after quoting the French cases, 
which I have noticed, and which are given in detail in the Memoir of 
Bayard and Chevallier, adds the following, which came under his own ob- 
servation. " Symptoms resembling those occasioned by corrosive poisons 
supervened where a dose of four drachms of this salt had been administered 
to the wife of a friend immediately after her confinement." In a subsequent 
communication, this gendeman suggests the possibility that the injurious 
effects of sulphate of potash are solely caused by spiculae of undissolved 
salt, and hence that these occur when it is taken alone in large, doses. — 
London Medical Gazette, October, 1843. 



1844.] 125 



REVIEW 



Art. XI.— .y? Practical Treatise on the Diseases of Children, By D. 
Francis Condie, M. D. &c., 8vo. pp. 651. Philadelphia: Lea and 
Blanchard, 1844. 

The treatise of Underwood upon the diseases of children, is now looked 
upon as chiefly valuable for its practical precepts, respecting the manage- 
ment of some of the more common forms of disease, incidental to child- 
hood and infancy. These precepts have long since been incorporated into 
the works of subsequent writers, who have filled up the meagre sketches 
of their predecessors with various ability and success. The late Professor 
Dewees has left us a work replete with original observations, sound criti- 
cisms upon the opinions of contemporary teachers, successful refutations 
of popular and professional errors, and excellent directions for the physical 
and moral management of children, and for the treatment of the diseases 
to which they are peculiarly subject. The high esteem in which his 
treatise has always been held, both at home and abroad, sufficiently de- 
notes its value, and places it in a rank which has been enjoyed by no 
similar work. Messrs. Maunsell and Evanson, have produced " a concise 
practical work," which has become deservedly popular. Its very concise- 
ness has caused it to be adopted as the ordinary hand-book of British 
physicians employed in the treatment of young patients. The chapters 
in it devoted to the general pathology and therapeutics of infantile diseases 
are full of instruction, and form perhaps, its distinguishing feature. 

The late Dr. Eberle, and Dr. James Stewart, the translator of Billard, 
have also contributed to medical literature, treatises on the diseases of 
children. The recent issue of a new edition of the work of the latter, 
sufficiently attests its popularity, and refutes the objections of cavillers, 
who would have us believe, that the medical profession in this country 
is blind to the merit of native productions, and reserves all its respect 
and admiration for European works, often of very doubtful value. 

Notwithstanding the great merits of the several works here enumerated, 
there was still wanting, in the medical literature of our language, a sys- 
tematic treatise, which, avoiding controversial topics, and mere theoretical 
discussions, should furnish a full and complete history of every disease, 
incident to persons under the age of puberty; a description embracing all 
that has been discovered in various countries, up to the latest dates, con- 
cerning the etiology, symptomatology, pathology, morbid anatomy, treat- 
ment, &c. of each malady, together with the personal experience and 
particular views of the author upon these several subjects. This want has, 
we think, been supplied by Dr. Condie. Long and extensive experience, 
accurate observation, and diligent study, of English writers, not only, but 
also of the continental, and especially of the German authors, have fitted 
him, in a remarkable manner, for worthily accomplishing so difficult a 
No. XIIL— January, 1844. 9 



126 Review, [Jan. 

task. We feel assured that the resuhs of his labour will only confirm the 
propriety of his having undertaken it. It cannot, of course, be denied 
that such a work as this will have but slight attractions for the lover of 
medical polemics, and even less for the quidnuncs of the profession by 
whom no truth is i^elished, save tliat which smacks of noveUy. But for 
the practical physician who shall turn to its pages to learn all the pheno- 
mena which may be presented by the disease he is treating, and all the 
means to which he may resort for the cure of that disease, it will offer 
many and strong attractions, amongst which may be mentioned, complete- 
ness, clearness, judgment, and good sense. In it the vanity of the author 
never tempts the compiler into negligence; nor does the laborious care of 
the compiler weigh down and overlay the original vigour of the author; 
the two offices are made to strengthen and illustrate one another. 

In works embracing so great a variety of subjects, some of them are 
usually found to be treated more attractively than others; the labour re- 
quired for eludicating certain of them, and the peculiar bent of the author's 
tastes, naturally inclining him to lavish upon some a too partial care, and 
to content himself with scanty justice to others. Dr. Condie's work is 
scarcely chargeable with this fault; it is clearly seen, indeed, that he has 
written particular chapters con amore, but nowhere does he betray repug- 
nance to the matter in hand. The pains-taking fidelity with which he has 
filled up the picture of each disease, so as to render it complete in itself, 
is equally conspicuous in the descriptions of subordinate importance, and 
in the history of maladies the most serious, or the most interesting. 
Perhaps fault may be found with a method like this, which makes repeti- 
tion constantly necessary, and has no principle of unity running though it, 
no original theory at the outset, to which all subsequent particulars may be 
referred. We, however, esteem it fortunate, that no Procrustean bed has 
been constructed by our author, on which to stretch his images of disease; 
that he has moulded them after nature, and that if in their length or breadth 
they vary from the ideal model which speculative Doctors have set up, 
they will, at least, be found to tally with the forms which daily experience 
presents to the practical physician. 

We shall not attempt a formal analysis of the work before us, but content 
ourselves with mentioning some of the points in which it appears to have 
improved on its predecessors, by a more minute investigation of old sub- 
jects, or by the addition of new matter. 

An introductory chapter is devoted to the " management of children," — 
to their physical and moral education. The necessity of pure air for in- 
fants is strongly enforced, and just blame cast upon the common practices, 
amongst families who should know better, of shutting up their children in 
ill ventilated apartments, often filled, too, with the noxious vapours en- 
gendered by domestic processes. We very strongly doubt whether the 
discovery of stone coal, which has been held up as one of the greatest 
causes of modern improvement, has not created one of the most fruitful 
sources of death and disease to which young children are exposed. The 
close air of a stove-warmed nursery, the hot and desiccated atmosphere of 
a furnace-heated chamber, feel like the breath of pestilence to one unac- 
customed to these questionable refinements of luxury. Such a comment 
upon our methods of house-warming is frequently made by foreigners, 
and by our own countrymen, from regions where the blessing of a hickory 
fire is still enjoyed. We, however, quietly submit ourselves and our 



1844.] Condie on the Diseases of Children. 127 

children to be kiln-dried, and hail with delight each new invention of air- 
tight or other stove, which promises, in its advance towards perfection, 
soon to render ventilation impossible. Bitter experience will one day- 
teach us that our children, raised like hot-house fruits, will like them, early- 
decay, or grow into a precocious and insipid maturity. 

The articles on cleanliness, clothing, and food, are full of excellent pre- 
cepts, and good reasons for them; and of these we may again remark that 
the spirit of system in nowise blinds our author to the circumstances which 
must modify the application of any general rule to particular cases. 
Speaking of diet, he advises that "until the age of puberty, preparations 
of milk and the farinaceous vegetables should, in fact, constitute the prin- 
cipal nourishment." It would not be uninteresting to inquire how far the 
carnivorous propensities of our countrymen are concerned in determining 
that national leanness, sallowness, and morbid activity, which stamp an 
expression upon their faces and figures, not to be mistaken in whatever 
part of the world they may be encountered. It is quite certain that in no 
country do children partake of animal food in such large quantities as with 
ns. It may be well worth the while ofuhose who have an influence in 
the education of children, to consider how far the diseases of American 
youth may be traced to their over-indulgence in meats, and other stimu- 
lating viands. No doubt the rapidity with which children are allowed to 
despatch their meals increases the mischief arising from the use of impro- 
per food, and Dr. Condie very properly enjoins that they should not be 
hurried when eating, nor be required to finish "as soon as their parents." 
Let the parents, also, be enjoined not to eat faster than their children, and 
to set an example of moderation which will be better than a thousand 
homilies against greediness. A caution is given against permitting the 
young to be bedfellows of old or diseased persons, the author having seen 
cases of its pernicious influence. Great stress is laid upon the importance 
for children of exercise in the open air, for boys not only, but also for 
girls; and a just sentence is passed on the ridiculous custom of rearing 
females as tenderly as if they were destined to be angels, and not women. 
Let the bright sun shine, and the fresh wind blow, upon these fair plants, 
and we shall not so often be pained by seeing the pale and half expanded 
buds that now court our admiration, and demand ahomao^e due only to the 
full and perfect flower. Similar remarks are applicable to the unsea- 
sonable culture of the mind. The views of Dr. Condie upon this subject 
are sound, clear, and pertinent, and commend themselves to all, who as 
parents, or as physicians, take an interest* in the well being of the rising 
generation. The premature tasking of the mind with- books, and abstract 
ideas, dooming a little child to the confinement of a school room, a child 
whose instinct — whose impulse — is to read in the great book of Nature, is 
treason to Providence — a crime against nature — which should be punished, 
like other unnatural crimes, with infamous penalties. Who does not 
know that a child, who at four years of age shall exhaust the patience of 
his teacher, and sour his own temper for months together, in a vain attempt 
to learn his alphabet, shall at eight years acquire the same knowledge in a 
day, or even an hour. And so of the acquisition of other arbitrary and 
artificial knowledge. And yet the folly of man has devised institutions 
where lisping infants may be taught geometry and astronomy forsooth! 
Verily the fanatical philanthropy of the present age could no further go in 
absurdity! But let those who have planned and fostered such establish- 



128 Review. [Jan. 

ments beware, lest they be held to deserve the punishment of the fountain- 
poisoners of old; for their crime is even greater, they have tainted the very 
life-blood of the republic. Let the Boeotia of Pennsylvania rejoice! for 
happier is the lot of its children brought up in stupid but hardy ignorance, 
than that of the little ones in our " intellectual" metropolis, whose blanched 
faces, puny frames, and debile minds, are ghostlike witnesses against their 
oppressors. Perhaps too when our city youth, with minds exhausted iu 
childhood, and bodies enervated by the luxurious habits to which precocious 
children are unusually prone, shall have acquired for their birth-place a 
reputation for mental mediocrity and moral debasement, there shall arise 
from the despised valleys of the interior of our state, as from the Boeotia 
of Greece, such men as Hesiod, Plutarch, and Epaminondas, to redeem 
the character of our common country, and assert the triumph of Nature 
over Art in the education of children. The health of the body is the very 
first condition and element of mental and moral soundness, and the expe- 
rience of all ages has proved, that the great minds of every epoch have 
been those whose earliest efforts were unfettered by the horn-book, and 
unscared by the birch rod of the schoolmaster. " The poor village lad 
travelling on foot to the great metropolis," is the first page in the biogra- 
phy of almost every man who has illustrated the annals of his country, in 
letters or in art, in peace or in war. 

The third chapter treats of the pathology of infancy and childhood. 
The great susceptibility of the skin and mucous membranes, at these 
periods of life, is fully illustrated, as well as the extreme facility with 
which disease is then transmitted from one tissue to another, and between 
the remotest organs; as from the skin to the lungs or the intestinal canal, 
and between the latter and the brain. In the space of six years, last be- 
fore 1840, the deaths from diseases of the digestive and respiratory or- 
gans of children in Philadelphia, under the age of 15 years, formed one- 
fourth of the whole mortality of persons under that age. 

The activity of the lymphatic system in infancy, is the cause of many 
diseases, such as inflammation of the cervical, axillary, inguinal and other 
glands, connected with the absorbents. Dr. Condie notices the " tendency" 
of parotitis " to produce, by a species of metastasis, inflammation of the 
testicle in the male, and of tiie mammae in the female." We cite this pas- 
sage for the purpose of noticing its want of precision, a fault with which 
our author's style is not often chargeable, but into which he has some- 
times fallen, from the habit, no doubt, of using the phraseology commonly 
adopted by the profession. We object then to its being said that engorge- 
ment of the parotid " has a strong tendency" to produce inflammation of 
the mammae, or of the testicle, because it is impossible to determine 
whether the latter, like the former, is not also the consequence of a pre- 
vious morbid state, or whether the two inflammations really stand towards 
one another in the relations of cause and effect. The phrase " a species 
of metastasis," is likewise inexact; for since we have not even a general 
idea of the nature of metastasis, still less can we form a notion of any 
species of it. These remarks may seem hypercritical; but we maintain 
that it is the duty of a scientific writer, to be at least as precise as the 
structure of the language in which he writes will permit. We therefore, 
do not hesitate to point out such inaccuracies as the above, and the more 
readily, because they occur in a work which proves its author familiar 
with the powers of language. 



1844.] Condie on the Diseases of Children. 129 

Another example to the same purpose is the use made by our author of 
the word "irritation." According to him, it stands first in the chain of 
causes of nearly every disease arising from within the body, and of many 
produced from without. Thus we are told that convulsions are *' produced 
by certain irritations of the brain, arising originally in that organ, or trans- 
mitted to it from some other part." Now we respectfully submit that no 
one would be a whit the wiser about the causes of convulsions after 
reading this account of them, than before. It may be well enough for 
system-builders to amuse themselves and their disciples with " words with- 
out knowledge," but we protest against our being flattered into a belief that 
we are gaining ideas, when we are only receiving empty sounds, from 
those whom we approach in order to be instructed, and not amused. 
The former of the cases quoted. Dr. Condie has restated in an unexcep- 
tionable form in his chapter on parotitis. The latter case is of rather 
frequent occurrertce. We could have wished that instead of symptoms 
being referred to 'irritation' in an organ, the functional changes in that 
organ had simply been described; and that instead of our being told of 
irritations transmitted from one organ to another, we had merely been 
informed that there was such or such a sequence in the altered functions 
of the two organs. The whole truth might in this way have been told with 
sufficient conciseness, and nothing but the truth; no doubtful or unmean- 
ing hypothesis would have interfered to obscure the clearness of our ideas, 
and cheat us into error. 

But, returning from this digression to the chapter on the pathology of 
infantile diseases, we may remark that it is full and satisfactory. Some 
very interesting statistics are contained in it, relative to the influence of the 
seasons on the health of children. The semeiology of the diseases of 
infancy and childhood is treated at length. We are not aware that any 
similar work in our language contains even a partial notice of this impor- 
tant subject; and yet, every one admits that the interpretation of signs, in 
the diseases of infancy, demands a special study, and considerable experi- 
ence. They are indeed, the symbols of a separate language, and can no 
more be understood by one who has not learned them, than can any other 
language by an uninstructed foreigner. The expression, the gestures, the 
sleep, the cry, the appearance of the various parts of the body, the secre- 
tions and excretions, are all peculiar in early life, and must often puzzle 
the inexperienced physician, who, being restricted to them for making his 
diagnosis, is yet quite unable to assign to each of them its real value, and 
therefore, incompetent to prescribe intelligently for his speechless patient. 
Dr. Condie has furnished an excellent oruide in these embarrassing circum- 
stances. The physician of childhood would do well to impress upon his 
memory, his descriptions of the normal and abnormal signs presented by 
young children. 

Having devoted more than one hundred and twenty pages to the pre- 
liminary matter to which we have briefly alluded. Dr. Condie enters upon 
the proper subject of his work. First in order, he treats of diseases of the 
digestive organs, beginning with those of the mouth, and points out a dis- 
tinction, not usually alluded to by practical writers, between the curdy 
exudation and aphthae, or follicular inflammation, of the mucous tissue 
lining the mouth and pharynx. In the first stage, the inflammation of the 
follicles is shown by small, white, miliary tumours; in the second, by 



130 Review. [Jan. 

superficial ulcers. In the article upon ulcerative stomatitis we should ex- 
pect to find the diagnosis given beivt^een this affection and aphthae; but it 
is wanting. And here we may remark that our author has not adopted 
the usual method of discussing a subject under several distincls heads, an 
omission which is particularly felt when we are in search of the diagnosis 
of a disease. The practice adopted by some of the highest authorities of 
placing the essential or characteristic symptoms of a disease in strong and 
direct contrast with those of the affections it most closely resembles, is 
not only a powerful help to the learner, but a material aid to the practi- 
tioner. Few persons are aware of the contrast that may be shown to 
exist between two apparently identical affections, until they are analysed 
and compared, symptom by symptom. In this way also the memory is 
assisted, for it easily retains a short epitome of the chief symptoms when 
freed from their unessential details. 

Gangrene of the mouth is well described, and its prevE^ence in hospitals 
for children alluded to. In the children's asylum of Philadelphia, there 
were, out of two hundred and forty inmates, seventy affected with this 
disease at the same time. This was before the removal of that institution 
to its present commodious quarters, where we believe this troublesome 
malady has not very extensively appeared. 

Our author has not seen much injury arise from indolent enlargement of 
tlie tonsils; he does not allude to their influence in producing deafness, as 
demonstrated by Dr. Mason Warren, of Boston. 

An elaborate notice is given of the causes of indigestion, with an examin- 
ation of the alleged deterioration of the nurse's milk by pregnancy, and the 
menstrual discharge. The influence of the former is stated to be hardly ap- 
preciable during the first three months of gestation, and the opinion of M. 
Raciborski confirmed, that the persistence of the catamenia during lactation 
does not materially affect the health of the nursing child. A caution is given 
to the inexperienced, that they be not deceived by the extreme prostration 
and indications of collapse that sometimes attend the most acute form of 
gastritis, and be tempted to exhibit stimulants with a view of restoring or 
supporting the strength. The warm-bath, repeated daily, will be much 
more to the purpose. In the acute, as well as in the chronic forms of this 
and other varieties of inflammation of the digestive canal. Dr. Condie re- 
commends a combination of calomel, ipecacuanha, and extract of hyoscy- 
amus. The latter article, indeed, in his prescriptions constantly takes the 
place of opium in the ordinary formulae; and the above prescription vari- 
ously modified, enters into the treatment of nearly every disease in which 
the " alterative" method is admitted. How far this f^requent and some- 
what indiscriminate use of calomel in the diseases of children may be 
justifiable, we shall not pretend to determine; the great experience of Dr. 
Condie is in support of it, and his conclusions are confirmed by those of 
Dr. Dewees. But we cannot withhold a solemn caution from those who, 
in seeking to follow these examples, are deficient in that tact and skill 
which alone can make the imitation safe. The knowledge we have of the 
changes produced by mercury in the blood, would be enough of itself to 
warn us of the danger of abusing this agent, even if we had not the voice 
of authority to caution us in using " one of the most powerful but danger- 
ous medicines employed in infantile therapeutics." [Evanaon.) 

A short account of the congenital malformations of the intestinal tube, 



1844.] Condie on the Diseases of Children. 131 

introduces a history of its various diseases; these are discussed at con- 
siderable length, and in all their details, Dr. Condie describes, after the 
late Dr. Parrish, a variety of enteralgia accompanied by convulsions of an 
epileptic form. The cadaveric appearances in the only fatal case which 
was examined after death, consisted in irregular contractions of the bowels, 
and the absence of dark coloured bile in the gall-bladder. The brain was 
not examined. Dr. Condie explains the symptoms by saying that they 
were " evidently the result of a neuropathic condition of the intestines, 
combined with some degree of cerebral irritation." Would it not have 
been safer for Dr. C. to give no explanation at all, since all that we know 
of the case is that the child had pain in his belly, and irregular contrac- 
tions of the muscles of animal, and probably of some of those of organic 
life? Our whole idea of neuropathy is pain; and if Dr. C. is able to form 
any conception of cerebral irritation, he is more fortunate than ourselves. 
This form of disease is nevertheless a most interesting one, and deserves 
the closest investigation, both as regards its symptoms, and the state of 
the nervous centres after death. 

In the treatment of diarrhcea. Dr. Condie '' believes" that as " in very 
few instances," the disorder is kept up by the presence of irritating mat- 
ters in the bowels, the use of active purgatives is not only unnecessary, 
but absolutely injurious. Speaking of the treatment of mucous diarrhoea, 
he remarks that " the common practice of administering frequent doses of 
castor-oil, is one calculated to increase the irritation of the intestines." If 
it be true that the presence of undigested food and other improper sub- 
stances in the bowels, are not often the cause of diarrhoea, the rest of the 
precept should follow of course. Now, although we yield to none in re- 
specting our author's belief, considered as an opinion, yet the opposite be- 
lief is held by high authorities, and should be refuted, if erroneous, not by 
counter opinions, but by facts. Meanwhile, there can be no doubt what- 
ever that the abuse of purgatives in the treatment of diarrhoea is a serious 
evil, both medical and domestic, and that in very many cases the regula- 
tion of the patient's diet will, in itself, suffice to arrest the disease. Chro- 
nic diarrhoea without febrile excitement is often prolonged by a persist- 
ence in the use of farinaceous and mucilaginous mixtures; this fact is 
noticed by our author, who believes that in such cases we may employ 
chicken-water, or other weak broths with the happiest effects. 

The article on "summer complaint," we regard as altogether the best 
that has been written upon this scourge of our climate. This malady ap- 
pears to be indigenous to the middle, and certain of the western and 
southern states, and to prevail in some of them from May to November, 
generally attacking infants between the ages of four, and twenty months, 
'i'he mortality in Philadelphia from this disease, during fifteen years, from 
1825 to 1839, was almost ten per cent, of that of all children under five 
years of age, and about four and a half per cent, of the entire mortality 
of the city. With the symptoms of this disease most of our readers are 
doubtless acquainted. Dr. Condie has described them with singular accu- 
racy. The morbid appearances discovered after death are various. If 
the patient die early in the attack, there is commonly found only an unu- 
sual paleness of the intestinal mucous membrane, with congestion of the 
liver. At a later period of the disease, there are red points and patches 
more or less disseminated over the niucous membrane of the stomach and 
bowels; softening of this membrane, contraction of the intestines, enlarge- 



132 Review, [Jan. 

merit or ulceration of the muciparous follicles, and enlargement and con- 
gestion of the liver. The chief hope of cure is in the removal of the 
patient from the close, hot, and impure atmosphere of the town; this will 
ofien suffice of itself in the earlier stages of the disease, and is almost 
essential at any period of it. 

The proper medical treatment recommended by Dr. Condie, does not 
differ from that commonly pursued by our best practitioners. He directs 
that attention should be paid to the condition of the gums, that the diar- 
rhoea should be controlled in its acute stao^e, by the warm bath, cool mu- 
cilaginous drinks, and a combination of chalk, calomel, and acetate of lead. 
This last he has found, when given in solution, very successful in arrest- 
ing the vomiting. Leeches to the epigastrium, and warm fomentations 
are advised when there are signs of inflammation within the abdomen; 
and leeches to the temples, and blisters behind the ears, when the brain 
becomes involved. In its chronic form, revulsives, anodynes, and vegeta- 
ble astringents, with the persesquinitrate of iron, avail most to check the 
diarrhcea. An excellent form of the salt of iron just mentioned, is the 
syrup, which has the advantage of not easily undergoing spontaneous de- 
composition. 

Several instances of polypus of the rectum have fallen under the notice 
of our author, and he has not found the difficulty experienced by other 
observers of recognizing their true nature. In one of the cases seen by 
him, the tumour came away spontaneously, and without much haemor- 
rhage. In the others the tumours were easily reniioved by ligature, and 
without any untoward symptom. We are ^lad to find that Dr. Condie 
takes the only ground defensible by a scientific physician, in regard to in- 
testinal worms. He shows that all the varieties of worms may be pre- 
sent in tfie bowels without impairing the health of the patient; and that, 
on the other hand, many persons have been affected with every symptom 
attributed to these parasites, without their evacuations during life, or their 
intestines after death offering the least trace of the supposed offenders. 
Consistently with these views, our author directs that where the symp- 
toms said to be produced by worms are apparent, we should, in the first 
place, ascertain whether the worms exist; and in the second, whether the 
symptoms are fairly chargeable to them. A treatment, he says, adapted 
to restore the functions of the alimentary canal, will generally be found 
successful, without a resort to those medicines which stricdy belong to 
the class of anthelmintics. When these latter are clearly indicated, Dr. 
Condie recommends, as the best of them, the oil of turpentine, which he 
thinks may be given with perfect safety to the youngest child in whom 
worms occur. 

Inflammation of the small intestines (enteritis), dysentery, peritonitis, 
and remittent fever, are discussed very elaborately by our author. The 
last of these he considers to be no more than symptomatic of enteritis, or 
of entero-colitis, and only enters upon its history in deference to the usage 
of systematic writers on infantile diseases. For our own parts we know 
that several of the diseases above mentioned, are very often difficult to 
distinguish from one another in practice; and that when we have con- 
sulted books for enlightenment, it has only been to make our confusion 
worse confounded. In adults there are clearly three forms of disease, per- 
fectly distinct from, yet resembling one another; viz. remittent (" mias- 
matic") fever, typhoid fever, and enteritis. But the remittent fever of 



1844.] Condie on the Diseases of Children. 133 

children is a totally different disease from that of adults, and its cause is 
referred to by most writers, as residing in some affection of the intestinal 
canal, it being, as Dr. Condie tells us, an enteritis. None of our writers, 
in the English language, say any thing of infantile typhoid fever. We 
must therefore look to cases of enteritis as presenting the type of these 
cognate affections. Having done so in the work before us, we find that 
in many of them, the symptoms are those peculiar to typhoid fever in the 
adult, that the cadaveric lesions are often identical with those of typhoid 
fever in the adult; in a v/ord, that if in adults enteritis and typhoid fever 
are two diseases, they are also distinct in children. If this be true, the 
history of intestinal inflammations in children and infants must be written 
anew. The Parisian observers have led the way in this investigation, as 
they did in elucidating the pathology of continued fever. We hope that 
Dr. Condie will, in his second edition, give us the results of his own in- 
quiries upon this subject. They cannot fail to remove much of its ob- 
scurity. 

An account of asphyxia in new-born infants prefaces the section on 
diseases of the respiratory organs. Its known causes are fully detailed, 
and two varieties of it noticed, which appear to depend, respectively, on 
exhaustion and congestion. When the latter is evidently the cause, 
depletion from the umbilical cord, and active friction of the skin will 
usually overcome it. But, when the former appears to be operative, all ex- 
pedients adapted to excite the action of the respiratory muscles, and second- 
arily that of the heart, should be resorted to. One of those most relied 
upon by our author, is that of spirting forcibly upon the child a portion of 
spirituous liquor, previously held for a minute or two in the mouth. The 
warm bath is also commended, but not as it is frequently employed. If 
its influence does not speedily make itself felt, no great benefit can be de- 
rived from it. *' A prolonged continuance in the bath would, by raising 
the temperature of the infant, render it less capable of enduring the state 
of asphyxia, and would also prevent the access of the atmospheric air to 
the surface of the body, which always exerts a very powerful vivifying 
influence." Affusion, with water at a temperature of about 60°, followed 
by strong friction to the chest, has sometimes succeeded. But inflation of 
the lungs is, after all, the most certain in its results, when, as Dr. Condie 
directs, it is early, judiciously, and perseveringly practised. The opera- 
tor must not be discouraged by an apparent want of success, after the 
labour of half an hour or even an hour; for it has been necessary to per- 
sist in these humane efforts for two hours and a half, before respiration 
was fully established. Dr. Condie prefers using the mouth, without the 
assistance of a tracheal tube. 

Coryza, bronchitis, and pneumonia, are very thoroughly discussed. 
The last, especially, receives full justice at our author's hands, for he has 
evidently gleaned every thing of value from the great number of essays 
which have been written upon infantile pneumonia during the last few 
years. In the treatment of this disease, as in that of the acute stage of 
all inflammatory diseases where depletion is called for. Dr. Condie dis- 
courages venesection, if the child be under three years old, preferring to 
employ leeches and cups for younger children. We are disposed to think 
him prudent in this Hmitation, and that cautious practitioners will applaud 
his prudence. Young physicians, like young soldiers, are apt to be fond 
of the glitter of steel, and to fancy that all knots, like the Gordian, are to 



134 Review, [Jan. 

be untied by cuttinjr ihem. It is well for the veteran to caution his rash 
brethren at their outset in the professional career, and to assure them that 
as more fortresses have capitulated to a blockade than have been carried 
by the sword, so also more inflammations have been cured by starvation 
and patience, than were ever "jugulated" by the lancet. 

Dr. Condie has given us a picture of the symptoms of croyp, to which 
little could he added, and from which nothing could be taken away with- 
out serious detriment to its correctness. The description is too long for 
quotation here, but is that of unequivocal pseudo-membranous laryngitis. 
We join with our author in doubting the correctness of the diagnosis in a 
class- of cases reported to have been sudden in their invasion, and equally 
so in their cure; and of certain others where the disease is said to have 
assumed a chronic form, and to have lasted for several weeks. There is 
often much ditficulty in distinguishing stridulous laryngitis and simple 
tracheitis from croup, nor do we believe that there is any possibility of 
determining with certainty the existence of the latter disease during the 
life of the patient, without the expectoration of false-membrane from the 
larynx. For this reason we do not feel bound to admit the assertions 
quoted by Dr. Condie, that the disease may occur " seven, and even nine 
times, in the same individual." M. Valleix (in his ^^Gidde du Medecin 
Practiden'^) slates that since the diagnosis between true and stridulous 
croup has been well understood, he has not found a single case reported of 
the recurrence of the former disease in the same individual. Dr. Condie 
is of opinion, that the disease usually commences in the bronchial tubes, 
especially in those cases in which the invasion is gradual; and that when 
the attack is sudden the exudation is confined to the larynx. He regards 
the cases where croup has been preceded by pseudo-membranous angina, 
as secondary, and as "occurring always in the course of some other 
affections." The author just now quoted, has reached an opposite con- 
clusion. He says, " it is now admitted, and with reason, that these dis- 
eases (measles, scarlatina, pulmonary catarrh, &c.) have no other relation 
to croup than that of favouring its development by the peculiar condition in 
which they place the patient, and that they cannot be regarded as prodromes, 
because they precede the new disease in a few cases only. But the coryza 
and sore-throat which most frequently mark the commencement of the 
disease, are not prodromes, but symptoms of croup, because they persist, 
and even increase, during the progress of the disease." To this it may 
be added, that in a series of 120 cases examined by M. Hussenot, and in 
which the extent of the false membrane was accurately noted, there were 
only 42 in which this membrane extended into the bronchial tubes. We 
may therefore, conclude, in general, that the course of the disease is from 
above downwards. Whether, however, we regard the angina or the 
catarrh, as initial symptoms, or as exciting or predisposing causes of 
croup, the same practical result is deducible, viz., that whenever a croupal 
cough succeeds to bronchitis or sore-throat, we should act as if the worst 
might be expected, and not relax our exertions until the patient is safe, or 
his restoration hopeless. It is in treating a disease like this, where we 
have litQe time to reflect, and still less to consult authorities, that we feel 
the necessity of having clear notions regarding it, and a certainty that 
we are not confounding it with some similar but really diflerent afl^ection. 
We have already expressed our regret, that Dr. Condie has dwelt so 
lightly upon the comparative diagnosis of the diseases he treats of; this 



1844.] 



Condie on the Diseases of Children. 



135 



omission is especially to be lamented in the history of croup. We sub- 
join an example of such a comparison, borrowed partly from M. Valleix, 
and partly from MM. Rilliet and Barthez. 



LARYNGEA STRIDIJLA. 

1. Symptoms of invasion slight; slight 
catarrh; cough a little hoarse; throat 
healthy; sometimes no prodromes. 

2. Attack sudden; usually at night. 

3. Berween the paroxysms the child 
seems well, the fever disappears or de- 
clines; the voice is rarely extinct. 

4. Expectoration of mucus. 

5. The paroxysms decrease in violence. 



CROTJP. 

1. Fever of variable intensity; mem- 
branous angina; slight hoarseness. 

2. Gradual increase of hoarseness; cough 
hoarse. 

3. The fever does not remit; the cough 
hollow and feeble; the voice faint or 
extinct. 

4. Expectoration of fake membranes, 
sometimes. 

5. Dyspnoea increases; the cronpal sound 
between the paroxysms; the voice and 
cough extinct. 

The operation of tracheotomy is dismissed by our author in a few 
words. He enumerates the supporters and opposers of this operation, 
and without expressing any opinion upon its merits, presents the total 
results of its performance in 186 cases. Of these it appears that 39 re- 
covered. M. Trousseau has recently stated the results of the operation 
performed by himself, or by others according to his method, from which 
it appears that 39 out of 150 recovered, a larger proportion than that given 
by Dr. Condie. 

A very interesting discussion of the causes of stridulous croup is given 
by our author, who adopts the opinion that when arising previous to denti- 
tion, it is attributable to disorder of the digestive functions or to impure 
air, and when during, or subsequent to this epoch, it is almost invariably 
symptomatic of cerebral disease. In the treatment of pertussis, of which 
Dr. Condie furnishes a very elaborate history, he has used the much 
vaunted belladonna, but without any very constant success. He prefers 
in this instance, as in most others where a narcotic is indicated, the extract 
of hyosycamus combined with ipecacuanha. High authorities have been 
cited in favour of the use of carbonate of iron, in this disease, as a speci- 
fic. Dr. Lombard is quoted by our author in these words: "The beneficial 
effects resulting from the use of the sub-carbonate of iron are easily ex- 
plained, by its anti-periodic and anti-neuralgic properties, and it shows 
a posteriori, how much the hooping-cough resembles a true neuralgic, 
or at all events, a true nervotis disease." This exquisite specimen of 
science and logic is worthy of the author of the "Letter upon Typhoid 
Fever." 

The third section of the work before us opens with an account of a disease 
but recently investigated. It now appears that simple hypertrophy of the 
brain is a very common occurrence in infancy, and that it is often the cause 
of "convulsions, epileptic attacks, idiocy, and active inflammation of the 
organ, terminating in softening and apoplexy." It is usually congenital, 
augments very slowly, and when its increase is not more rapid than that 
of the capacity of the cranium, may not give rise to any evident symp- 
toms. When, however, it is compressed by its bony case, there is gene- 
rally observed a " singular projection of the parietal protuberances, with 
obtuseness of the intellect, irritability of temper, giddiness, habitual head- 



136 Review. [Jan. 

ache, with severe exacerbations, and an inordinate appetite." If the fon- 
tanelles are open, a sensation of firmness is communicated to the finger 
when pressure is made upon them. In the more advanced cases, the 
various phenomena of paralysis and muscular spasm may be added to 
those already detailed; the patient may be seized with delirium, fall into 
coma, and die. The diagnosis of this disease from hydrocephalus is very 
difficult. It has been most frequently observed in children of a lymphatic 
temperament, or in those afl^ected with rickets. Dr. Condie suggests no 
other plan of treatment for this affection than what might be inferred from 
established principles of therapeutics. 

"Apoplexy and paralysis," says our author, "are of much more fre- 
quent occurrence during infancy and childhood, than is generally sup- 
posed. We have met with them at every age, from one or two days 
subsequent to birth, up to the period of puberty." Many deaths attri- 
buted to convulsions and hydrocephalus are, no doubt, caused by apo- 
plexy. Effusion of blood or serum is much more rarely found after death 
than in adults, the ordinary lesion being extensive hyperemia. Hence 
the curability of paralysis in children. Another form of apoplexy coming 
on gradually, and accompanied by symptoms of hydrocephalus, has been 
recently described. In this, the lesion discovered after death consists in 
an effusion of blood and serum, with fibrine of various degrees of firm- 
ness, inclosed in a cyst, and situated beneath the arachnoid, usually upon 
the upper surface of the hemispheres. 

More than two hundred children die annually from convulsions in Phi- 
ladelpiiia. Dr. Condie has therefore had ample occasions for studying 
this alarming disease, and it is plain that he has made good use of his 
opportunities. The history he has given us of the varieties, causes, and 
treatment of convulsions, we regard as one of the most valuable portions 
of his treatise, and adapted to satisfy all reasonable inquiries on the sub- 
ject. It contains a notice of the salaam convulsion, a curious affection, 
which seems to bear a strong resemblance to certain varieties of chorea; 
and also an account of the tonic muscular contractions described by Jade- 
lot and Guersent. 

Acute, and subacute, or tubercular meningitis, are treated of very fully, 
and with ample reference to every thing that has been written upon them 
to the latest date. We can do no more than allude to it. Dr. Condie 
mentions that chronic hydrocephalus is not a very frequent disease in 
Philadelphia. He has never seen a case, either congenital, or developed 
subsequent to birth. Alluding to the operation of puncturing the brain 
for this disease, he remarks that even in the most suitable cases, " the 
operation has been found unsuccessful in numerous instances, and that it 
has been pronounced, by high authority, as one, in all cases, at once cruel 
and useless." 

An interesting article on chorea follows, and concludes the catalogue of 
nervous diseases. Our author proposes no specific for its cure, but seems 
to prefer a tonic treatment, not only by the use of tonic medicines properly 
so called, but also by such hygienic measures as may serve to invigorate 
the system. We venture to add our testimony to that of the genUemen 
quoted by Dr. Condie, in favour of the efficacy of the cimicifuga in chorea. 
In three or four cases occurring in girls between the ages of ten and fifteen, 
it seemed to effect a cure. In an adult case of several years standing it 



1844.] Condie on the Diseases of Children* 137 

had no perceptible influfince, although it was diligently administered for 
several months. 

The essay on scarlatina is altogether one of the best in the work; it 
leaves no part of the history of this formidable disease without the most 
thorough examination, and points out with great discretion the several 
methods of treatment which its various and complicated forms may de- 
mand. Of the prophylactic powers of belladonna in scarlatina, Dr. Con- 
die gives the following opinion. 

*' We have, in repeated instances, tested the prophylactic powers of 
belladonna, but although redness and dryness of the throat, and a diffuse 
scarlet efflorescence were produced in the majority of cases, we never 
found it, in any, to produce the slightest effect in mitigating the charac- 
ter or preventing the occurrence of scarlatina. The experiments were 
made during the prevalence of the disease, and in numerous instances the 
subjects of them were attacked. In one case the efflorescence was kept 
up by the use of the belladonna, for forty-eight hours; in a week after- 
wards this individual took the disease, in its most violent form, and died 
on the fourth day." 

The question of the protective power of vaccination is very thoroughly 
discussed by Dr. Condie. Having collated all the leading facts bearing 
upon this question, especially those recorded during the last ten years, he 
is of opinion that " in every instance in which the system can be fully in- 
fected with the vaccine disease, it affords a protection against the occur- 
rence of small-pox, which is unimpaired by the lapse of time." The de- 
tails of all the experiments recently made in Europe, respecting this 
interesting and important subject, are presented by our author in five 
tabular statements. From these it appears, that about 39 per cent, of 
all re-vaccinations took effect; and that about 13 per cent, of all second 
re-vaccinations were successful. Our author infers from these facts the 
importance of re-vaccination for all persons likely to be exposed to the 
variolous infection, not for fear that the primary vaccination has lost its 
power by time, but " as a test whether the susceptibility of the individuals 
to variolous disease has been fully extinguished." The Prussian army, 
it is stated, ♦* now enjoys an almost entire immunity from the contagion of 
small-pox, notwithstanding it has been repeatedly subjected to its influ- 
ence." Dr. Condie, in common with American practitioners generally, 
gives a preference to the dry crust or scab, over the recent lymph, for the 
purposes of vaccination, because it is equally efficacious, and much more 
manageable. His method of vaccination differs from that ordinarily em- 
ployed. He makes several parallel and crucial incisions through the 
cuticle only, and then smears over them a portion of the vaccine crust dis- 
solved in cool water. 

All the exanthemata are, in due course, fully described by our author, 
but we have not time to dwell upon them here. The cutaneous eruptions 
have devoted to them more than seventy pages of the work before us. So 
enlarged a consideration of these affections may seem out of proportion, in 
a work professing to treat only of the diseases of children. But from a 
very cursory examination of this part of the treatise, we are led to believe 
thai ihe modifications produced by childhood in the forms of skm-diseases, 
and in the treatment they require, will be found sufficiently great to war- 
rant the extended notice they here receive. Amongst them, however, we 
find by a sort of error loci, the morbus cseruleus. No explanation is 



138 Review. [Jan. 

given of classing an organic disease of the heart with diseases of the skin, 
especially when there is a section set apart for congenital malformations, 
and other subjects not easily arranged under any of the preceding heads. 
A great array of authorities is brought forward to elucidate the causes of 
cyanosis, and the conclusion that our author draws from a study of them 
is this, viz. that directly or indirectly, the blueness of the skin in this dis- 
ease is due entirely to the admixture of arterial and venous blood, or to 
the substitution of the latter for the former. We have the assurance of a 
gentleman who has recently been examining all the records of the disease 
accessible to him in this city, that such a conclusion is not warranted even 
by the very series of observations upon which it is confidendy rested, by 
some of the most authoritative writers. 

Sections V., VI., and VII., are devoted, respectively, to the study of 
scrofulous and tuberculous disease; diseases of the urinary organs; and 
♦' congenital affections, and accidents occurring most generally, within the 
month." Amongst those included in the last division are spina-bifida, 
club-foot, hare-lip, hernicc, &c. It is almost superfluous to say that all of 
these maladies are treated of in the most satisfactory manner. They have 
never before been so completely discussed, in any treatise upon the dis- 
eases of children, in our language. 

Having received an early copy of the work, we hasten to lay some ac- 
count of it before the readers of this journal. V/e regret, however, that 
the short period allowed for preparing this notice has prevented our render- 
ing to Dr. Condie that full measure of justice, which the importance of his 
treatise demands, and that minute examination of all its points, which our 
own interest in the subject would prompt, and which we feel assured, 
would amply repay the curiosity of our readers. Dr. Condie, from the very 
labour he has evidently bestowed upon this book, is entitled to our re- 
spect as an indefatigable and conscientious student; but if we consider the 
results of his labour, we cannot but admit his claim to a place in the very 
first rank of eminent writers on the practice of medicine. 

Regarding his treatise as a whole, it is more complete and accurate in its 
descriptions, while it is more copious and more judicious in its therapeuti- 
cal precepts, than any of its predecessors; and we feel persuaded that the 
American medical profession will very soon regard it, not only as a very 
good, but as the very best " Practical treatise on the diseases of children." 

A. S. 



1844.] 



139 



BIBLIOGRAPHICAL NOTICES. 



Art. XII. — A Treatise on Dislocations and Fractures of the Joints. By Sir Astley 
Cooper, Bart., F. R. S., Serjeant Surgeon to the King, &c. A new edition^ 
much enlarged^ edited by Bransby B. Cooper, F. R. S., Surgeon to Guy's 
Hospital. With additional observations, and a memoir of the author. Phila- 
delphia: Lea & Blanchard, 1844, 8vo. pp. 499. 

In all ages fractures and dislocations have engaged much of the attention, and 
exercised ihe pens of the most eminent practitioners and writers, and from the 
subject involving the consideration of so many of the fundamental principles of 
our science, but fevi' will be found to question their claim to frequent notice. 
The treatise of Sir Astley Cooper upon the subject, we regard as decidedly the 
best and most useful of his many valuable works, and think we do not err in as- 
serting, that as long as surgery continues to be cultivated as a science, it will be 
consulted for the precious precepts and experience embodied in it. With Mr. 
Bransby Cooper's edition of it, however, we are not altogether pleased. The 
task of editor is an important though an humble one, and when undertaken, 
should be performed with a view to illustrate what is either altogether omitted, or 
rot clearly, or with sufficient fulness or accuracy, expressed by the author. This 
rule Mr. Cooper has thought proper to depart from, and besides slighting many 
points which the progress of surgery would have allowed him valuably to have 
illustrated and enlarged upon, he has taken the unjustifiable liberty of condens- 
ing, in a few instances, the original text. In more than one place too, evidence 
is afforded of his not having carefully examined his original. At page eleven, 
for instance, we find a note to explain the facility with which a dislocated hip 
was reduced, while a little further on the matter of that note, expressed with 
equal clearness, will be found given by Sir Astley himself. With all its faults 
and defects, however, the improvement made in its form, by bringing the plates 
into the body of the work, together with the additional matter that was furnished 
by the author, will make it generally acceptable. 

Having already passed through several editions in England, and one in this 
country, and discussing as it does most of the more important questions touch- 
ing the accidents treated of, an extended notice of the work will not here bo 
looked for. One of the subjects to which Sir Astley directed very particular 
attention, and which occupies a considerable number of the pages of his admira- 
ble volume, namely, that of the treatment of compound dislocations, we shall 
briefly glance at. These accidents are more common at the thumb, wrist, 
elbow, and ankle, than elsewhere, and where attempts are judged proper to save 
the limb, the same principles and general rules should guide us as in the treat- 
ment of compound fractures about the joints. Dirt and extraneous bodies should 
be removed, loose pieces of bone, if any exist, should be carefully taken away, 
and reduction effected as speedily as possible, the wound being closed either by 
lint soaked in blood, or adliesive strips; and every attention afterwards given to 
keep the parts at perfect rest in an appropriate position, and prevent the deve- 
lopment of severe inflammation, as well by general as local means. In many 
cases, however, reduction cannot be easily effected by extension and counter-ex- 
tension, even when aided by enlargement of ihe wound; and where difficulty 
arises in the reduction, or where in consequence of the position, or extent of the 
wound, the parts are likely to be easily displaced from slight causes after being 
reduced, it becomes a question, whether a cure is not more likely to occur by 
sawing off the articular extremity of the displaced bone. In a case of compound 
dislocation, in which the humerus was forced through the integuments, Mr. 



140 Cooper on Dislocations and Fractures of the Joints, [Jan. 

Wainman, in 1759, finding there was no possibility of reducing it, sawed off the 
bone an inch above the cavity that receives the olecranon, and had the satisfac- 
tion of seeing his patient recover, with the motions of the joint but little inter- 
fered with. 

Cooper, of Bungay, being called to assist at an amputation in a subject ad- 
vanced in years, instead of cot)senting to the operation, sawed off the heads of 
the tibia and fibula, " by which means he preserved the limb, making it so use- 
ful that the poor man walked and wrought for his bread many years after." The 
same surgeon, in another subject, sawed off the head of the radius which passed 
through at the wrist, and little or no defect in the strength or motion of the joint 
followed; and Mr. Gooch, who records the cases, affirms that in the case of a 
young woman, with a compound luxation of the thumb, which could not be kept 
in place, he removed the head of the bone, after which the wound healed speedily 
without the least ill accident supervening. Mr. Park cites instances of resec- 
tion of two and a half inches of the humerus in a compound dislocation of the 
elbow, and of one and a half inches of the extremity of the tibia at the ankle, 
which were cured with motion at the joints. So favourably impressed was the 
latter gentleman with the propriety of the proceeding in compound dislocations, 
that writing in 1805, he expresses concern to find the practice not so general as 
he once believed it to be, at the same time that he adduces the following strong 
testimony in its favour. " It has been the invariable practice at the Liverpool 
Infirmary, for more than thirty years, to take off the protruded extremities of 
bones in cases of compound dislocations, and, I believe I may say, with inva- 
riable success." Hey, in his practical observations, mentions that Mr. Taylor 
removed the extremity of the tibia in five compound luxations, and all his pa- 
tients regained the power of walking well; and records a case of his own which 
had a happy termination, though attended with some deformity and turning in of 
the foot. 

By the publication in the work now before us, of many eases of the removal 
of the protruding articular ends of bones in compound dislocations, where there 
was difficulty in replacing them, which had been furnished by his friends, and 
liis own warm approval of the method, Sir Astley Cooper did much to intro- 
duce it into general practice. His testimony to the good effects resulting from 
it in the ankle is strong as it is valuable. " The constitutional irritation is very 
much lessened by the diminution of the suppurative and ulcerative process, and 
by the ease with which the parts are restored. In the cases which 1 have had 
an opportunity of seeing, there was not more irritative fever than in the mildest 
cases of compound tVacture." " I have known no case of death when the extre- 
mities of the bones have been sawed oflT, although 1 shall have occasion to men- 
tion some cases which terminated fatally when this was not done." Nine cases 
are recorded by Sir Astley in which sawing off the protruding ends was pursued, 
in all of which the limb became ultimately useful, motion in a greater or less 
degree being generally acquired, and a slight shortening in the limb with a con- 
sequent limp in walking, being the greatest inconvenience which ensued. 

In France the propriety of resecting the ends of dislocated bones was first 
urged by Bourbier, in 1776, and Manne in his treatise published some years 
after, advises the same treatment where difliculty in the reduction arose from the 
practice usually pursued. It however, was in a great measure overlooked till 
the time of Moreau, and more lately. Champion has in that country, directed 
attention particularly to the advantages to be derived from it. 

For the purpose of ascertaining the kind of union which takes place in these 
cases after excision of the articulating extremity. Sir A. Cooper removed with 
a saw the end of a tibia in a dog, and then replacing the parts allowed the 
wound to unite. On dissecting tiie limb several weeks after it had perfectly 
healed, he found, " ihat from the sawn surfaces of the tibia there grew a liga- 
mento-cartilaginous substance, which proceeded to the surface of the cartilage 
of the astragalus, to which it adheres. A free motion existed between the tibia 
and astragalus, which was permitted by the length and flexibility of the liga^ 
mentous substance above described, so as to give the advantage of a joint where 



1844.] Cooper on Dislocations and Fractures of the Joints, 141 

no synovial articulation or cavity was to be found." Chanssier and Wachter 
found a like state of parts after excision of tiie joints of the knee and ankle in 
dog's. 

The shortening which occurs after resection of the articular ends of the bones, 
is the strongest objection urged to this mode of treatment, but surely this is a 
slight disadvantage if the danger of the case is lessened by it. Another objec- 
tion is, that the joint after resection becomes anchylosed. This however, is far 
from being generally the case even in the elbow, and after resection at the ancle, 
even should the joint become anchylosed, a consequence which may follow any 
mode of treatment, still the increased degree of motion acquired by the bones of 
the foot is such as to allow of good use of the limb. 

The mildness of the symptoms consequent upon resection and the compara- 
tively short time required for a cure, has been often noticed. Mr. Park observes, 
that in the cases which he had witnessed where the bones were forcibly reduced, 
without taking off their ends, the subsequent symptoms were abundantly more 
troublesome than where this had been done, and Sir A. Cooper as we have 
already seen, believes that in those cases which he had an opportunity of wit- 
nessing, there was not more irritative fever than in the mildest cases of com- 
pound fracture. The reason of this great mildness of the symptoms, it is im- 
possible certainly to account for, but it is probable that the large openings made 
for the discharge of pus, and the relaxed state in which the muscles of the limb 
and parts about the joint are placed, by the removal of a portion of the bone, 
have not a little to do with it. The warmest advocates of resection of the ends 
of the bones have never recommended it in all cases of compound dislocation; 
our own experience leads us to believe, that the practice might be followed with 
benefit more frequently than it is now done, though we by no means advise its 
general employment; where the dislocation can be easily replaced provided the 
end of the bone be uninjured, or where the patient is not so irritable as to occa- 
sion severe spasmodic contractions of the muscles, and thus lead to subsequent 
displacement, its reduction entire is always preferable. 

The reprint before us is enriched with observations by Professor Warren, of 
Boston, upon fractures of the cervix femoris, dislocation of the hip— joint down- 
wards and backwards, as well as with some remarks upon the unfrequency of 
luxation of the hip in the female, and a memoir of the author, taken chiefly from 
the life by his nephew. The great points in the life of Sir Astley Cooper are 
so well known to the profession, and the benefits conferred by him upon surgery 
so justly appreciated, that any notice of it here need not detain us, particularly 
as we fully agree with the American Editor, in thinking that his biographer has 
*'done much to debase the reputation and fame of his uncle, and to degrade the 
profession of which he was so distinguished a member." 

Of the other matter added to this edition, one of the subjects, that of the com- 
parative infrequency of luxation of the femur in women, is new and of great inter- 
est. Dr. Warren's attention was directed to it several years since, and inquiries 
made both in this country and in Europe, leads him to believe it exceedingly rare. 
In a practice of more than 30 years, he has observed no case of the accident in the 
adult female, and but one in that sex under age. For some time after his atten- 
tion was drawn to the point, not a single well authenticated case of the accident 
could be ascertained by him. Subsequently however, Mr. Clift. of London, 
mentioned one to him, and afterwards Dr. Stevens, of New York, informed him 
of having seen it in two or three cases. Sir A. Cooper gives fifty cases of dis- 
location in the male, and but one in an adult female, and one in a girl. It may 
be added, that some cases have been published in this country, which have 
escaped the notice of the eminent and respected Professor. Dr. J. Kearney 
Rogers, of New York, has made known four examples of it, and Dr. T. F. 
Betton, of Germantown, has given another. All examination however, shows 
the great rarity of this luxation in women, while fracture of the neck of the 
fenruir in them, it is well known, is more common than in man. This difference 
led Dr. VV. to the inquiry whether the accident peculiar to each sex could be 
explained by any variation in their anatomical structure, and from nine instances 
No. XIII.— January, 1844. 10 



142 Bibliographical Notices. [Jan. 



of measurement of the cervix in the male and female 


given, 


it appears that the 


circumference of that part in the female is less 


by at 


least half an inch than in 


the male. The table we subjoin: — 








1. Male 


. 


4 ii 


nches. 


2. do. 


- 


3-9 


do. 


3. do. (African) 




3-6 


do. 


4. do. 




3-8 


do. 


5. do. 




3-8 


do. 


6. do. 




4-8 


do. 


Average in the male 






3-9 inches. 


7. Female 




3-3 


do. 


8. do. 




3-3 


do. 


9. do. 




3-3 


do. 


Average in the female, 






3-3 inches. 
G. W. N. 



Art. XI it. — Principles of Medicine: comprising General Pathology and Thera- 
peutics, and a brief general view of Etiology^ Nosolos^y, Semeiology, Diagnosis^ 
and Prognosis. By C. J. B. Williams, M. D., F. R. S. With additions 
and notes by Meredith Clymer, M. D. Philadelphia: Lea & Blanchard, 
1844. pp.383. 

As an apology for the appearance of this publication, its author adduces the 
general acknowledgment '•'that there is at present no work which fully treats 
of the subject of general pathology, and its application to practical medicine.'* 
Such a work, at least so far as English medical literature is concerned, was 
clearly demanded, and the importance of the subject, together with the high 
character of the author, should insure for it a careful perusal by every prac- 
titioner. 

The introductory chapter is chiefly occupied with enforcing the value and im- 
portance of general pathology. 'J^o the loose, indefinite, uncertain, and uncon- 
nected stale of the practice of our art, Dr. W. attributes in part the success of 
quackery, as well as the want of interest usually felt by the student in the study 
of the practice of physic, which, as usually taught, consists of a mass of dry 
detail in reference to particular diseases, without a sufficient appreciation of 
those general facts and principles, which are common to a variety of atfections; 
without, in short, such a study of morbid phenomena, as is calculated to afford 
a more or less definite conception of the nature of the different modes of dis- 
eased action, and of those states of the system which are common to many spe- 
cial diseases. " In fact," he says, " the leading rules of practice, those which 
guide the most experienced men, (although many are not aware of it, and would 
not acknowledge it,) are founded on general views of diseased (unction and 
structure — that is, general pathology." "Is it not, therefore," he asks, " most 
important that these general views, which are so practical and extensive in 
their application, should be well founded and carefully studied? Is it right that 
the leading doctrines of disease, — leading not in theory but in practice, — should, 
as hitherto, be left to be picked up irregularly, from casual retrospects of study 
or experience, when they may be learned as the very groundwork of practical 
knowledge?" At the same time, he does not wish to detract from the vast im- 
portance of the study of individual diseases, which he compares to the leaves 
and boughs of a tree, whilst general pathology is represented by the trunk and 
great branches. 

That these views of our author are highly important, will scarcely be denied 
by any well instructed and intelligent practitioner. Still, we imagine that much 
of the vagueness and uncertainty which exists in the practice of medicine, is to 
be traced to the very defective acquaintance, on the part of many members of 



1844.] Williams on the Principles of Medicine, 143 

the profession, with the history and phenomena of special diseases. For how- 
ever well instructed we may be in general pathology, it is still of the last im- 
portance that we should be able to discover the precise seat of the lesion or 
lesions in individual cases, that we should make out, in short, an accurate diag- 
nosis, in order that we may act understandingly in the administration of reme- 
dies, and at the same time speak with confidence to the friends of the patient in 
reference to the nature of the disease, its probable course and results, and the ob- 
jects and probable influence of treatment. 

In the division of his subject, our author treats first of etiology, or the causes 
of disease, then of the nature and constitution of disease itself, under the head 
of pathogeny, or pathology proper, which occupies the great body of the work; 
and concludes with a short account of semeiology, nosology, diagnosis, prog- 
nosis, prophylaxis, and hygienics. 

In the first chapter he gives a clear and succinct outline of the general causes 
of disease and their mode of operation, unobscured by vague disquisition or sub- 
tle hypothesis. 

The second chapter is devoted to the consideration of the nature and consti- 
tution of disease, or pathology proper, and occupies as just mentioned, the great 
body of the work. In treating this subject, our author considers first those ele- 
ments of disease which are most simple, and afterwards passes to those which 
are more complex. Under the first head, or that of the primary elements of dis- 
ease, are included derangements of irritability, tonicity, the constituents of the 
blood, &c.; whilst under the second, or that of the proximate elements, are 
found the various disorders of the blood-vessels, such as anasmia, plethora, con- 
gestion, &c. 

'* These primary and secondary elements of disease are the especial subjects 
of general pathology. By the study of them we become acquainted with the 
materials of disease, and their relations to each other; we learn how special dis- 
eases arise, and of what they consist; how they produce their phenomena and 
eflfects, how they are to be known, distinguished, and classified. Out of such 
a knowledge, where it is correct, sufficient, and combined with an ample ac- 
quaintance with the properties of remedial agents, arises the rational method of 
relieving, curing, and preventing disease, the great ends of the art of medicine. 

"I readily admit that our knowledge of these elements, these principles in 
patliology, is as yet too limited to be entitled to rank as a science; but I think 
that the attempt to describe and illustrate them will be useful, not only by mak- 
ing available all that is known on the subject, but also by showing what is not 
known, and needs investigation: thus suggesting fit subjects for further re- 
search." 

We shall not follow our author in his examination of these elements in de- 
tail. Among the primary elements, the diseases of the constituents of the blood 
occupy the largest space; and on passing to the subjects of the second division, 
we find it stated that " the class of proximate elements which have been most 
generally studied as the subjects of general pathology, are those aflTecting the 
circulation of the blood." The third chapter indeed, is entirely occupied with 
the account of anaemia, plethora, congestion, and determination of blood, hemor- 
rhage, flux, dropsy, and inflammation. At the conclusion is an outline, by the 
American editor, of some of the peculiarities of idiopathic fever, mainly with re- 
ference to those points which distinguish it from the constitutional disturbance 
connected with inflammation. Our author's account of the treatment of inflam- 
mation strikes us as remarkably happy, and eminently indicative of sound judg- 
ment and nice discrimination. After describing the measures calculated to 
modify the local disorder, he goes on to speak of those which are especially de- 
manded in connection with the febrile excitement which accompanies the in- 
flammation. The first of these, with a view to reduce the excitement of the 
heart and arteries, is of course, blood-letting. The fact, that in inflammatory 
disease, a much larger amount of blood may be drawn without producing syn- 
cope, than can be taken in health or in other diseases, is explained, Dr. W. 
thinks, by the increased excitability of the heart and tonicity of the arteries, 



144 Bibliographical Notices, [Jan. 

which maintain a suffifient force and tension to preserve the circulation, espe- 
cially through the brain, even when much blood is lost. The object of blood- 
letting is not merely to produce a temporary but permanent reduction of excite- 
ment, and this may be effected, as is w^ell known, where the inflammation is 
quite recent, by taking even a moderate amount of blood, if it be drawn rapidly 
from a large orifice. 

"The circulation is thus reduced, perhaps to syncope; and, relieved of the 
pressure and determination of blood, the inflamed vessels soon recover their 
normal state, if not spontaneously, at least with the aid of the subsidiary anti- 
phlogistic measures. The benefit resulting from this mode of blood-letting in 
recent cases is sometimes very striking, and the cure is effected at a compara- 
tively small expense of blood. 

"But the case is different when an acute inflammation and fever have lasted 
for two or three days. There is then not merely excitement, but sundry changes 
in the inflamed part, and in the blood, which keep up the excitement; the in- 
flammation has become established in the part, and the fever in the system; and 
no brief impression on the circulation, however sudden and complex, can remove 
them. If in this state a patient be speedily bled to fainting, reaction will soon 
come on, and renew the fever with increased intensity. Here, therefore, it is 
necessary to bleed more slowly and to draw more blood; and instead of pro- 
moting the occurrence of syncope by the erect or sitting posture, it is proper to 
keep the patient in an easy recumbent or reclining position, and to watch for the 
good effect of the bleeding in the softening of the pulse, or the relief of the pain 
or other distressing symptom. The actual occurrence of syncope is rather to be 
avoided, and may be prevented by untying the arm as soon as the lips lose their 
colour, or the patient complains of feeling sick or faint. Thus practised, blood- 
letting causes a more prominent reduction of the active elements of inflammation 
and fever, diminishes the exciting and too fibrinous condition of the blood, and 
although it cannot repair the changes already produced in the inflamed part, it 
prevents their increase, and puts them in a condition favourable for the curative 
efforts of nature and the further operation of other antiphlogistic remedies." 

After blood-letting, general and topical, our author speaks of purgatives as the 
most important of ail other evacuants in the treatment of inflammation. Of the 
internal remedies against inflammation with fever, however, he regards tartarized 
antimony as most analogous to blood-letting in its effects. He next speaks of 
the effects of calomel, alone or combined with opium. 

"The opium is useful in preventing the calomel from purging, and especially 
in subduing the nervous irritation attending inflammation, and which we have 
found to be one cause of that sympathetic excitement which, when complete, 
constitutes fever. This salutary effect of opium alone is sometimes seen when 
the vascular excitement has been subdued by a large blood-letting, and in cases 
in which nervous irritation forms a chief element of the disease: here a full dose 
of opium will subdue the remains of the inflammation better than any other 
antiphlogistic remedy; it seems to paralyze those sympathies which are con- 
cerned in renewing or maintaining the excitement of inflammatory fever. So, 
too, in combination with mercury, the opium exercises this narcotic influence; 
whilst the mercury prevents its astringent effect on the secreting organs. The 
mercury acts further: it augments the biliary and intestinal secretions; some- 
times inducing copious mucous and bilious evacuations; and from its effect in 
iritis, it may be presumed to facilitate the solution and removal of effused lymph. 
How it has this effect is quite uncertain; probably it is by changing the condi- 
tion of the blood, by a diminution of the fibrin and white corpuscles, the increase 
of which is much concerned in contributing to the changes of inflammation. 
So we find mercury chiefly useful where the blood is very much buffed, and 
there is tendency to copious fibrinous effusions, as in inflammations of serous 
membranes and croup. Calomel and opium have little influence over high in- 
flammatory fever; and the system thus excited generally resists the mercurial 
action. This remedy has no further sedative effects than those which proceed 
from its action on the intestinal canal; and unless to produce this action, it is 



1844.] Curling on the Diseases of the Testis. 145 

not well adapted for the earliest stage and most active forms of inflammation. 
In these circumstances, blood-letting is more required with mercury than with 
antimony; and if fever returns during- the action of mercury, blood-letting or 
active purging may be necessary to reduce it. In fact, the operation of calomel 
and opium is less antiphlogistic, and more alterative, than that of blood-letting 
or antimony: it is inferior to them in the power of reducing inflammatory fever 
and active inflammation; but it is superior to them in arresting and removing 
the more plastic products of inflammation." 

The fourth chapter is devoted to the consideration of structural diseases, or 
diseases of nutrition. These are treated of subsequently, and apart from the 
previous divisions, "both because the previous consideration of disorders of the 
blood and its vessels gives the best introduction to them, and because we cannot 
strictly distinguish structural disease into ultimate and proximate elements." 
Structural diseases are classed under three heads, according as they consist of 
an increase, a diminution or perversion of nutrition. Under the latter, are in- 
cluded all alterations in the quality of texture, new formations, growths and de- 
posits, such as tubercle, cancer, &c. 

The remaining portion of the work is occupied with a summary view of the 
classification, symptoms and distinction of diseases, their prognosis and the modes 
of prevention. The last chapter is chiefly supplied by the American editor, 
who, in the compass of a few pages, adduces a number of interesting data, derived 
from various sources, and affording the most conclusive evidence of the great 
value of the principal hygienic measures in the prevention of disease, and the 
prolongation of human life. 

Much of what is contained in the above pages, is, as the reader may have 
noticed, already to be met with in works on the practice of medicine. It is also 
true, as Dr. W. himself says, that our knowledge of the elements of general 
pathology, is as yet too limited to be entitled to rank as a science. Let it not 
hence be inferred, however, that a separate treatise on the subject is not called 
for; on the contrary, the advances ktely made and still making in this branch of 
study, independently of the reasons previously noticed, render it highly desira- 
ble that the profession should, from time to time, be put in possession of a 
general view of the progress which has been made in it. For this purpose a 
separate treatise is surely the most desirable, and as regards the one now before 
us, so far as we have been able to judge from a somewhat hasty perusal, it 
seems very fairly to answer the object proposed. Whoever, indeed, will con- 
sult its pages, will, we doubt not, be rewarded with both pleasure and profit, 
whilst the former will be not a little enhanced, in the perusal of the present 
edition, by the clearness and size of the type, the beauty of the paper, and all 
the other et ceteras of a handsome volume. T. S. 



Art. XIV. — A Practical Treatise on the Diseases of the Testis, and of the Sper- 
matic Cord and Scrotinn. With Illustrations. By T. B. Curling, Lecturer 
on Surgery, &c. Edited by P. B. Goddard, M. D., Demonstrator of Anato- 
my in the University of Pennsylvania. Philadelphia: Carey & Hart, 1843. 
8vo. pp. 568. 

Thk frequent occurrence of diseases of the testis, together with the importance 
of their correct diagnosis and treatinent, must ever render them of interest to 
practitioners, while at the same time their contemplation affords pleasure, as 
offering a very striking example of the great advance which has been made in 
surgical science by the study of morbid' anatomy and pathology. But a little 
more than a quarter of a century since, the chronic inflammations and indura- 
tions of this gland were confounded with malignant diseases, and in place of 
the effectual medical treatment which is now pursued in them, recourse was 
generally had to operative procedure, and castration which at this day is so 
rarely resorted to, was at that period one of the most common operations. 



146 Bibliographical Notices. [Jan. 

The endeavour of Mr. Curling in the work before us, has been to give a com- 
plete view of the anatomy of the scrotum and testis, as well as of their different 
diseases, described principally from his own observations, though he has not 
failed to avail himself properly of the works of his predecessors. 

The following remarks on varicocele present a fair example of the author's 
style, and show sound views in relation to a rather common affection. 

" In the treatment of eases of varicocele, the surgeon should bear in mind that 
as the complaint is not dangerous, seldom produces pain amounting to more 
than an inconvenience, and usually admits of relief by palliative means, it is 
not justifiable in ordinary cases to risk the loss of the testis, or to perform severe 
operations for its removal. For this reason, ligature and excision of the veins, 
and such operations as are severe or at all liable to induce phlebitis, are never 
resorted to by judicious and cautious practitioners, except in the few instances 
in which palliative means fail to afford relief and arrest the decay of the testis, 
and the pain and annoyance are really so ijreat as to require something to be 
done to alleviate the patient's sufferings, 'i'he indication for the perfect cure of 
varicocele is not merely to aid and support the dilated and weakened vessels, but 
so far to relieve them of the superincumbent weight of the blood as to enable 
them to return to their natural dimensicms, and recover their tone so as duly to 
carry on the circulation. The first indication may be fulfilled to a certain extent 
by the suspensory bandage, and in some cases permanently by the excision of a 
portion of the scrotum; and in mild cases these plans are sufficient to give all 
the relief required, and to prevent the extension of the disease; the latier ])ro- 
ceeding may be resorted to whenever the patient is tired of wearing a bandage, 
and is willing to submit to an operation which, though painful, is not under 
ordinary circumstances attended with danger. But neither artificial support, 
nor excision of the scrotum, is capable of fulfilling the second indication— of re- 
ducing the size and thickened coats of the dilated veins. The only plan which 
appears to be fully adapted to elTect this object is firm, steady, and continued 
pressure on the spermatic veins at the ring by the means of a well-adjusted 
truss. At present our experience of this njode of treatment is too limited to 
admit of any opinion of its efficacy being confidently expressed; but I look with 
no slight interest to the result of further trials of a remedy which seems to me 
to be based on sound views of the pathology of the disease. This plan appears 
to be particularly applicable to cases of varicocele in young persons, whose re- 
parative powers would be sufficient to restore the veins when relieved of pressure 
to a healthy state. In acute or severe cases of varicocele, when the distress is 
considerable, or the symptoms partake of a neuralgic character, and when the 
methods of treatment just alluded to fail in affording sufficient relief, it may be- 
come necessary to have recourse to the ligature for the obliteration of the vari- 
cose veins; and as in these cases life is embittered by the disease, the patient 
being incapacitated by it from earning a livelihood, and that too at an early age, 
it would certainly be justifial)le in such cases to incur the slitrht hazard of phle- 
bitis incidental to the ligature, and to risk even the loss of the testis, which 
would undoubtedly swffer if the disease continued, in order to obtain the relief 
and comfort which the operation is calculated to afford." 

In the matter added by the American editor, is an interesting delineation of 
elephantiasis scroti as it occtirred in a negro, operated on by Dr. Picton, of New 
Orleans, in 1837, taken from drawings presented to the VVistar Museum. The 
tumour in this case, which we do not remember to have seen reported, weighed 
fifty-three pounds, had existed for ten years, and was successfully removed. 

We can confidently recommend the treatise of Mr. Cvirlingto practitioners, as 
the best monograj)h upon the subject within their reach, and at the same time 
would observe, that the great beauty of its paper, type, and illustrations, are an 
additional recommendation for its possession. G. W. N. 



1844.] Kennedy on Obstetric Auscultation, 147 

Art. XV. Observations on Obstetric Auscultation, with an Jnalysis of the Evi- 
dences of Pregnancy, and an Inquiry into the Proofs of the life and death of the 
Foetus in TJtero. By Evory Kennedy, M. D., Lecturer on Midwifery, &c. &c. 
With an appendix containing legal notes. By John Smith, Esq. Barrister at 
Law. With notes and additional illustrations. By Isaac E. Taylor, M. D. 
New York: J. & H. G. Langley, 1843, 12mo. pp. 311. 

It cannot be necessary to dwell upon the importance of possessing some cer- 
tain test, by which the physician may be enabled to pronounce authoritatively 
and without fear, upon the existence or absence of pregnancy, and upon the life and 
death of the foetus in utero, in many cases which may present themselves to him, 
and which may involve the peace and happiness of families or the ends of pub- 
lic justice. Until recently, however, the evidences relied upon to determine 
this serious question, have been so obscure and so open to insuperable objections, 
that it is a matter of extreme wonder that men should be found willing to hazard 
their own reputations or the best interests of humanity, by decisions founded 
upon such fallible signs. Accident led Dr. Kergaradec some twenty years ago, 
to the discovery of the advantages to be derived from auscultation in the forma- 
tion of a correct diagnosis in such cases, and subsequent observations have fully 
proved the accuracy of his deductions, and extended their application. 

Convinced of the utility of this discovery by numerous personal investiga- 
tions, under the most favourable auspices, Dr. Kennedy called the attention of 
the profession in Great Britain to the subject about ten years ago, through the 
work of which the volume before us is a reprint. 

The signs of pregnancy, according to Dr. K., are those which are alone cog- 
nizable by the individual herself, supposed pregnant, and those which the phy- 
sician can ascertain by his own observation. Of the former, such as suppres- 
sion of the menstrual discharge, morning sickness, pains in the breasts, in the 
loins, along the thighs, &c., and the sensation of quickening, our author shows 
conclusively that "those who most strongly advocate their importance (in the 
diagnosis of pregnancy), cannot say that any of them are invariably met with 
in that state; neither can they say that they are not often met with in the ab- 
sence of impregnation. Besides, the fact of their being arrived at through the 
statements of the individual supposed pregnant, renders them far from satisfac- 
tory, or so deserving of reliance as to prevent our seeking for other more trust- 
worthy evidences." p. 30. 

These are undoubtedly to be found amonw" those which are cognizable to 
the scrutiny of the examiner, and not depending on hearsay testimony," and are 
either " tangible," or within the range of manual examination, " visible" or ex- 
posed to view, or "audible" as revealed by auscultation. The tangible are 
chiefly ascertained by the vaginal examination or le toucher, and among them 
the most important to determine are the position, size and condition of the neck 
and orifice of the uterus, the volume and weight of that organ, and the existence 
or absence of passive motions of a fcetus within the womb, as discoverable by 
the operation of ballot tement. 

The inferences deducible from these examinations are more deserving of at- 
tention and reliance, though, when taken alone, they may lead into errors, which 
our author clearly and sufficiently indicates in the pages devoted to their con- 
sideration. The American editor has enriched this portion of the work, with 
a valuable note, founded upon recent German investigations, showing the 
changes which take place in the neck and orifice of the uterus, and in the posi- 
tion of that organ from the earliest months to the full period of gestation, and 
also pointing out the diflferences to be observed in these respects between primi- 
paras and rnultiparae during each month of pregnancy. These facts he has illus- 
trated by fourteen well executed lithographs, conveying the writer's meaning 
with great accuracy. 

It is to be regretted that he has not deemed it necessary to correct an error 
into which Dr. Kennedy has fallen, in reference to the term ballottement. 1 his 



148 Bibliographical Notices. [Jan. 

is spoken of by him as meaninpf an examination for the passive motions of 
of the foetus in utero, by applyinsc the fingers on opposite sides of the abdomen, 
and pressing- alternately on each side of the abdominal tumour, to ascertain 
the presence of the foetus, if there is any, by the impulse it thus conveys to 
the fingers. Now, if we mistake not, every other writer on midwifery expresses 
by this term, the operation of tilting the uterus upon the finger introduced 
per vagwam, by which the foetus is made to rise in the liquor amnii, and then 
by its descent to communicate a shock to the finger. Our author calls this last 
abattement^ which term is certainly unusual, if not peculiar, and therefore calcu- 
lated to lead to confusion. 

The visible evidences, consisting of enlargement of the breasts, the forma- 
tion of the areola, the secretion of a serous or milky fluid in the breasts, &c., 
though often met with and perhaps generally in cases of pregnancy, are also 
seen under other circumstances. Nor can the test of M. Nauche, viz. the form- 
ation of kiestein in the urine, be implicitly trusted as indicative of pregnancy; 
yet as it is the earliest sign which can be noticed, and as numerous observers, 
among whom is the American editor, have testified to its being generally pre- 
sent in this condition, it is well worthy of attention and will aid materially in 
establishing a diagnosis. M. Jacquemier's observations respecting the change 
in the colour of the vagina have not been found of much practical importance. 

" Having now enumerated," says Dr. Kennedy, "those symptoms hitherto 
confided in as evidences of pregnancy, it must at least be admitted, that there 
is no deficiency in number, whatever conclusion may be arrived at with regard 
to their quality; and yei several others might have been added; but, as they 
would merit attention even less than many of those already mentioned, they 
have been omitted. Of the foregoing symptoms, there is scarcely one on whicb 
even the most conversant with the subject can so far rely in all cases as to say, 
1 am convinced, from the presence or absence of this or that sign, that a woman 
is or is not pregnant. There may appear exceptions to this rule, such as the 
active or passive motions of the child; but even in that we may be deceived; 
neither can they always be observed when pregnancy is present. The inference 
we must therefore draw is, that the means at present in general use, when there 
is difficulty or uncertainty with regard to pregnancy, are often insufficient to 
detect, or to enable us to pronoimce upon this state, and that our eml)arrassment, 
so far from being diminished, is rather increased by the number and variety of 
what are denominated the signs of pregnancy. No one therefore, can question 
the importance of having in cases of this kind, a limited number of distinct and 
demonstrable evidences (strictly so called) to depend upon, such as could be 
detected with facility, and which it would be impossible to counterfeit, in place 
of leaving it, as it is at present, to the result of inference drawn from innumera- 
ble, indefinite, and often fortuitous circumstances, many of them individually 
insignificant and worthy of our attention only when taken collectively. The 
audible evidences which we are now to consider, if they do not enable us to 
arrive at this desirable object, shall at least assist us much in doing so; and 
when taken in conjunction with a few of the leading symptoms already dwelt 
upon, we shall by their assistance, it is confidently anticipated, be enabled to 
pronounce, in almost every case, with pretty great certainty, provided the preg- 
nancy be sufficiently advanced. It is but justice to auscultation, as a means of 
diagnosis, to add, that this conclusion has not been arrived at hastily, nor with-, 
out testing it extensively, as well in the author's own practice as in that of other 
practitioners, when its efficacy has been frequently proved in cases the most 
perplexing and embarrassing in their nature." — p. 72. 

"■j'ne facts to be ascertained by auscultation, are the existence of the placental 
souffie^ the beating of the foetal heart, and in certain cases, the pulsation of the 
umbilical cord in utero. The placental souffle, as it is called by Dr. K., consists 
in a blowing or hissing sound, corresponding with the pulsations of the mother's 
pulse at the wrist, and heard over that part of the abdomen which corresponds 
with the lateral and inferior portions of the uterine tumour, and more especially 
thdt to which the placenta is attached. It has been heard as early as the lOlh 



1844.] Kennedy on Obstetric Auscultation. 149 

or 11th week of pregnancy, increasing- in intensity as this advances, and con- 
tinues until the foetus is delivered, heing- modified or even disappearing during 
the contractions of the uterus. This sound depends without doubt upon the 
change which takes place in the character of the uterine circulation, as the womb 
is developed, and strongly resembles, as remarked by M. Dubois, that which is 
met with in varix aneurismaiicus. The editor introduces here some useful 
remarks upon the investigations which have been made in reference to this sub- 
ject since the periods at which this work was written. 

"Of the practical benefits to be derived from a knowledge of the placental 
souffle^'*'' says Dr. Kennedy, " the most important is the assistance it will afford 
us in the detection of pregnancy, when taken either singly or in conjunction 
with the foetal heart's action, to be afterwards treated of. When this sound is 
perceptible, together with that of the foetal heart, the evidence of pregnancy is 
complete; when, on the other hand, the souffle cannot be discovered on repeated 
examination, and the foetal heart's action is perceptible, there is reason to con- 
clude, that the placenta is attached to the posterior wall of the uterus. This, 
however, is of rare occurrence," and a change in the position of the patient, or 
a subsequent examinaiion, will in most cases enable us to ascertain its existence. 

"Taken separately," says Dr. K. "we shall even go so far as to say, that 
were all the symptoms of pregnancy absent, and this sound could be distinctly 
perceptible, we should at least withhold our opinion until a sufficient time had 
elapsed to place the matter beyond doubt." — p. 96. 

The means of distinguishing this snuffle from that caused by aneurisms of the 
aorta, &c., and from other abnormal sounds in the abdomen are pointed out. 

The pulsations of the fcetal heart being heard by the observer, there can be no 
doubt in his mind either of the existence of pregnancy or of the life of the foetus, 
an important subject of inquiry, as is clearly shown by our author, and as every 
day's experience or a moment's reflection must convince the practitioner. We 
have delayed so long upon other portions of this book, that we can here merely 
mention, that upon examining the abdomen of a pregnant female from about the 
expiration of the fourth month or a little later, there will be heard over a space of 
three or four inches square, towards the inferior part of the abdomen, generally 
more to one side or the other of the median line, a pulsatory sound, generally 
much more rapid than the pulse of the mother, and exhibiting the characteristic 
marks of a distinct and independent circulation." It is a clear, quick, double 
pulsation, amounting to about 130 or 140 beats in a minute, and can with diffi- 
culty be confounded with any other sound. Its presence clearly indicates preg- 
nancy, but does its absence prove the contrary? Dr. Kennedy says — 

" The absence of the foetal pulsation, it may be said, although it does not in 
itself absolutely warrant us in pronouncing a female free from pregnancy, yet 
taken in conjunction with other symptoms, will corroborate our views in this 
respect. The reasons why we cannot depend exclusively on the want of this 
sound as a proof of the non-existence of pregnancy are sufficiently obvious. 
We must be aware, for instance, that when the foetus is dead, it will of neces- 
sity cease; and this very fact we shall find in the sequel, a matter of much con- 
sequence, when we wish to ascertain whether the child be dead; as in cases of 
tedious labour, when the use of instruments must be had recourse to, to eflfect the 
delivery. In the very early months of pregnancy also, we have seen that this 
sound may be absent, or rather, that we may not be able to detect it; therefore, 
the not detecting it before the period at which quickening should have 
occurred, and in some cases even until sometime afterwards, would not warrant 
us in pronouncing decidedly that a female is not pregnant. 

" The position of the child, as it may alter the situation of the fcetal heart, 
should be attended to in exploring in these cases of doubt; and we ought not 
therefore, to rest satisfied with merely examining the lower part of the abdomen, 
where we usually detect it, but must search carefully over every part of the 
uterine tumour, as we may discover it towards the fundus, or at its lateral part. 
By adopting these precautions, then we shall with considerable certainty, be 
enabled to pronounce in most cases of doubtful pregnancy, and even in those at 



150 Bibliographical Notices, []Jan. 

present looked upon as involved in the greatest obscurity, from the contradictory 
symptoms which are present."— p. 129. 

In some cases where the walls of the abdomen are very thin and the uterus 
closely in contact with them, the pulsations in the funis may be distinctly heard, 
sometimes accompanied with a souffle, corresponding, of course, in frequency 
with the pulsations of the foetal heart. The cord in favourable cases may be 
felt through the parietes of the abdomen pulsating in the uterus, and may even 
be so compressed as to check its beating altogether, showing that the death of 
the foetus might be occasioned by accidental pressure continued for some time, 
as by leaning against some hard object, the edge of a table, &c. 

We have not space to follow our author in his remarks upon the diagnosis of 
compound pregnancy, which he next considers, nor upon the question of the 
life and death of the foetus, nor upon the inferences to be drawn from the facts 
here presented, in a legal point of view. The extracts which have been given 
will enable the reader to form some opinion of the conclusions which may be 
deduced from the principles laid down in this truly excellent book. 

In conclusion, we would recommend this treatise as embracing in a clear and 
connected narrative, the facts relative to obstetric auscultation, which are else- 
where attainable only with much labour and study, and in larger works. The 
more recent discoveries, which have been published since this work was first 
given to the profession, have been added by the American Editor, who has 
executed his task with fidelity, thouerh we cannot but think that a little n»ore 
attention to clearness in style, would have given additional value to his useful 
and practical notes. C. R. K. 



Art. XVI. — 1. Report of the Board of Visitors^ nf the Trustees, and of the 5m- 
j/erintendent of the New Hampshire Jlsylumfor the Insane. June 1843. pp. 24. 

2. Seventh ^8nnual Report of the Trustees of the Vermont Asylum for the Insane, 
October, 1843. pp. 12. 

3. Report of the Superintendent of the Boston Lunatic Hospital, and physician of 
the public institutions at South Boston. July 1, 1843. jip. 28. 

The benevolent enterprise for contributing to the comfort, relief, and restora- 
tion of the insane in the United States is still in progress. As an evider)ce of 
the truth of this assertion, we tnay adduce the first annual exposition of the con- 
dition of the State Lunatic Hospital of New Hampshire. The buildings of this 
institution were so nearly completed, as to justify a commencement of opera- 
tions near the close of October, 1842; and, accordingly, the first patient was 
admitted on the 29ih of that month. 

"The asylum," says the report, " is a good building, plain and substantial, 
beautiful and of neat architectural arrangements. Its location is healthy, com- 
manding an extensive view of the village of Concord, the valley of the Merri- 
mack, and the surrounding hills, and of convenient distance from the business 
of the village. The farm consists of one hundred and twenty-one acres of land, 
the soil of which is mostly light, and easy of tillage." 

We have no correct information in regard to the number of patients which 
can be accommodated, hut the report says, "The asylum is now, in the short 
space of seven mouths, about half filled up." At that time the number was 
forty-seven. 

Admitted from October 28th, 1842, to May 31st, 1843 

Discharged - - . - - 

Remaining - - . . - 

Of those discharged, there were recovered, 12; improved, 10; unimproved, 6; 

died, 1. 
Of all admitted, "recent" cases, 38; "chronic," 38. 

" " single, 34; married, 34; widowers, 2; widows, 6. 

It is a striking fact, derived from the statistical part of the report, that in no 



Men. 


Women. 


Total, 


39 


37 


76 


12 


17 


29 


27 


20 


47 



1844.] Insane Hospital Reports. 151 

less ih?iT\ twenty-one patients, or nearly one third of the whole, the disease was 
Attributed to religious doubt, anxiety, or excitement. This source of mental 
alienation has been greatly increased, during the last year or two, by the doc- 
trines promulgated by the so called " Father Miller." As a part of the medical 
and psychological history of this popular delusion, we consider the following 
extracl'from the report, giving a description of the symptoms of those whose 
disease has originated in this source, as worthy of preservation: 

"The community at large has, during the past year, been unusually agitated 
upon this subject (religion); and the recent views of the government and deal- 
ings of the mysterious and all-wise God with man, promulgated by their zealous 
advocates, have taken strong hold of the feelings, and distracted the settled reli- 
gious principles of a large share of society. The honest believer, in his joy 
at the near approach of his translation to a happier and more glorious state, has 
too often neglected, until he has lost sight of, the common duties of life. No 
one, so far as I have seen, of those who truly believed in the speedy coming of 
Christ, has been made sad or melancholy. Some patients who have been dis- 
turbed and perplexed by these startling theories, and yet have doubts and fears 
of their reality, come to us sad and desponding. The believers are joyful and 
confident, but those who doubt are sorrowful and timid. Those who believe 
and who continue in their belief after coming here, manifest all the hope and 
confidence such inspiring anticipations are calculated to produce. They sing 
and pray aloud for the coming day. They exhort others to be ready to go with 
them, or denounce them for their unbelief, with all the pains and penalties their 
mind can conjure up. A large proportion of the ten eases of this form of reli- 
gious excitement, imagine themselves some superior beings, as Jesus Christ, or 
the Almighty. All whose insanity was produced by this cause have, on getting 
well, renounced their belief in it. One who fancied himself Jesus Christ during 
his excitement, said, after his recovery, that he became insane " from attending 
so closely to this one subject of investigating the truth of the Miller doctrine for so 
long a time. He had devoted his whole time for three mouths to reading his 
Bible, and attending the meetings." After some remarks upon the eleven cases 
which originated in the ordinary causes connected with religion, the report pro- 
ceeds as follows: "To religion has been attributed the origin of a very large 
share of the cases of insanity in the community. But of the many hundred per- 
sons made ins.ine, as was thought, by religious creeds and theories, none whom 
1 have ever heard of were made crazy by " visiting the fatherless and widows in 
their affliction, and keeping themselves unspotted from the world." 

The superintendent. Dr. George Chandler, was for many years connected with 
the Massachusetts State Lunatic Hospital, and hence derived that experience 
which constitutes an important element in the qualifications of a person occu- 
pying so important a position as that which he now holds. "The trustees, as 
is remarked in their report, "have ever found, in iheir visits to the institution, 
that the internal policy and management of the asylum were worthy of all praise. 
The neatness and good order which everywhere prevailed, the cheerfulness and 
comfort exhibited by the inmates, and the general appearance of the asylum, 
have evinced an efficiency, zeal, and humanity in the superintendent, which 
prove him to be admirably adapted to the performance of his arduous and re- 
sponsible duties." 

2. This is another of the brief but comprehensive reports by Dr. Rockwell. 
From the exposition therein contained, it appears that the Vermont Asylum lias 
been more extensively patronized and more generally successful during the past 
year, them during any previous annual period of its existence. The trustees 
have reduced the price of board, &c. to two dollars per week, and recommend an 
enlargement of the right wing of the asylum. 

Number of patients in the asylum at the commencement of the year 1 13 

Admitted during the year ------ 111 

"Whole number ------- 224 

Discharged --------88 

Remaining at the end of the year ----- 136 



152 Bibliographical Notices. [Jan. 

Of the 88 discharored, 51 were restored, 26 not restored, and 11 died. Of the 
same number, 40 were " recent" cases, and 48 "chronic;" of the former, 35,' 
and of the latter, 16 were cured. 

Since the opening of the asylum, 535 patients have been admitted, and 399 
discharcred; 230, equal to 42.97 per cent, have recovered, and 32, equal to 5.98 
per cent., have died. 

It is unnecessary that we should enumerate the many means resorted to in 
the moral treatment at this, or at other institutions, or reiterate the pre-eminent 
advantage of those means in contributino- to tlie contentment and cure of the 
patients. These are already known. Occasionally, however, new means are 
su[)eradded to those already in use, and, from time to time, experience may throw 
new lioht upon the value of the latter. These additional " lights" are worthy 
of notice. " We have had several dancing parties," says this report, " which 
have afforded much pleasant and healthy exercise. But we have found that 
those parties which were confined to one sex have had the most favourable influ- 
ence. When both sexes have united in the same dance, we have noticed that 
the patients were more excited or less quiet tlian when the sexes have had 
their dancing parties separate." 

That lusus artis of insane asylums, — that moral impossibility of every century 
other than the nineteenth — the "Asylum Journal" is alluded to, and its benefi- 
cial effects duly recorded. " During the past year we have published a small 
newspaper, called the ' Asylum Journal,' which has exerted a beneficial influ- 
ence on the comfort and recovery of the patients. We have had more than two 
hundred exchancre papers, besides many of the periodicals, to the editors and 
publishers of which we would tender our most grateful acknowledgments. We 
have been able to furnish every patient with a newspaper from his own imme- 
diate vicinity, every politician with a newspaper of his own political views, and 
every sectarian with a reliaions periodical of his own peculiar sentiments. Dur- 
ing the past year our library (of near 500 volumes) has been comparatively 
forsaken for the newspapers and other periodicals which we have received in 
exchange for the Asylum .lournal. The interest which this little paper has ex- 
cited in our little community at the asylum, has had a beneficial effect upon the 
minds of our patients. A small portion only are capable of writing for it, but 
many are employed in making selections, and this employment diverts the mind 
from its own delusions, and aids, with other means, in restoring its past balance. 
Those of our patients who have been students we employ to write and select for 
the Journal, and those who have been merchants and business men, we employ 
to fold and direct the papers. We find that the employing of our patients in 
writing, either by way of copying or of composition, is very beneficial, as it 
diverts their attention from their delusions, and presents new objects of thought 
for contemplation." 

Patients here are found to recover sooner when their occupation is such as 
that to which they have previously been accustomed. In the worshops at most 
asylums, a sane man is employed as " head workman," or "overseer." At the 
Vermont institution it appears that this duty is entrusted to patients. "We 
find," says the report, " that it would be difficult to make any of those pursuits 
profitable, if we did not accomplish the whole among ourselves. Were we to 
hire a man with a large salary, to manage the farm or garden, or conduct either 
of the workshops, they would at once cease to be a source of income to the in- 
stitution. Besides, it would not be so favourable for the recovery of the pa- 
tients. Now, when a piece of work is required, either in the workshop or on 
the farm, the patient feels a pride in the confidence that is reposed in his judg- 
ment, and it serves to create a self-respect which is one of the greatest means 
towards his restoration." 

3. The number of patients admitted to the Boston Lunatic Asylum during the 
year was 62, of whom 37 were males, and 25 females. But 40 of these, how- 
ever, were received after the present superintendent. Dr. Ctiarles H. Stedman, 
commenced the duties of his office; and to these are most of the statistics of the 
report restricted. The number discharged during the period last mentioned was 



1844.] 



Statistics of Bethlehem Hospital. 



153 



38, of whom 17 were males, and 21 females. Of these there were recovered 
22, not recovered 7, died 9. The asyhim is full and is likely to continue so, 
for, says the report, " Of the 108 patients who remain, probably not more than 
10 will ever recover." 

From the character of the patients of this asylum there is but little oppor- 
tunity of bringing the various moral remedies, or auxiliaries, strongly to bear 
upon them during treatment. Of the 108 now at the institution, 32 can neither 
read nor write! of these, 24 are known to he foreigners, and 8 Americans, while 
the nativity of 6 cannot be ascertained. The grounds belonging to the asylum 
are so limited that the most valuable of all the means referred to, — manual 
labour — has thus far been made but partially available. Thirty of the patients 
now resident are reported as being capable of " hard labour," and the same 
number of " light labour;" and yet, "the average number constantly employed, 
in and about the hospital building, is not more than twelve." 

Dr. Stedman gives the following testimony, corroborative of that of many 
other physicians of these latter times, in regard to the management of the insane. 
"■No concealment, no artifice, no form of tyranny, no display of brute force — 
nothing, in short, will control them like the conviction which, strange as it may 
appear, many of them are capable of possessing, that, in our attempts to govern 
them, we are practising the precept 'whatsoever ye would that men should do 
to you, do ye even so to them.' " P. E. 



Art. XVIT. — Statisfics of Bethlehem HospiiaU with remorJts on Insanity. By 
John Webster, M. D. From the twenty-sixth volume of the Medico-Chi- 
rurgical Transactions, published by the Royal Medical and Chirurgical 
Society of London. London, 1843. pp. 45. 

This essay is, perhaps, the most valuable special contribution to the statistics 
of insanity, which has appeared since the publication of the slaiistics of the 
Retreat, near York. It is to be hoped that the example set by the officers of the 
last mentioned institution, will continue to be followed by others, until this 
branch of the history of every asylum shall be made public. The period to 
which this history of the Bethlehem Hospital refers, dates at the origin of the 
institution in 1683, and closes with the year 1842. During that time the number 
of admissions of insane patients, exclusive of incurable and criminal lunatics, 
was 22,897. The detailed statistics, however, are of those patients alone who 
have been admitted during the last one hundred years. These are given below 
in a table, the absolute truth of which requires, according to Dr. Webster, only 
this qualification, "that, owing to defects in some of the official records of the 
institution, the exact number of patients discharged cured, from Old Bedlam, 
and the amount of deaths which took place in one or two of the years prior to 
1748, could not be accurately ascertained, and are, therefore, given from a com- 
parison with the results of subsequent years." 

Table exhibiting the total number of lunatic patients admitted into Bethlehem 
Nofpilal, discharged cured, or died^ during five different periods^ of tvjenty years 
eacA, ending the '6\st December^ respectively . 



In 20 years 
ending 


Number 
admitted. 


Number cured. 


Number died. 


1762 

1782 

• 1802 

1822 

1842 


3.286 
3,945 
3,906 
2,149 
4,404 


1,069 or 32^: per cent. 
1,366 or 34^ per cent. 
1,379 or 35^ per cent. 
892 or 41 J per cent. 
2,269 or 51 i percent. 


714 or 21| per cent. 
560 or 13| per cent. 
203 or 5^ per cent. 
1 11 or b^ per cent. 
224 or S-jijper cent. 


Total 


17,890 


6,975 or 39^ per cent. 


1,822 or lOJ; per cent. 



154 Bibliographical Notices. [Jan. 

By an inspection of this table, it will be perceived that there has been a con- 
stant increase in the proportion of cures at this institution, and a corresponding 
diminution in the proportion of deaths. 

Of the patients admitted during the last twenty years, the results in regard to 
the sexes were as follows: — 



Admitted. 


Cured. 


Died. 


M. F. 


M. F. 


M. F. 


1,783 2,622 


823 1,446 


112 112 


or 


or or 


or or 


' per cent, more 


46^ per ct. 55^ per ct. 


6^ per ct. 41 perct, 


females than males. 







Hence it appears that, at this Hospital, the females greatly predominate in 
number, that they are more curable than the men in the proportion of nearly 5 
to 4, and that mortality among them is less than among the men, in the propor- 
tion of 4 to 6. 

During the same period, the number of patients admitted into St. Luke's 
Hospital, was 1,724 males and 2,310 females, or 33^ per cent, more of the latter 
than of the former. As Bethlehem and St. Luke's are the only public institu- 
tions for the insane in London, Dr. Webster infers from the statistics, that in- 
sanity is much more frequent among females than males, in that section of the 
British empire. 

Several interesting facts are introduced to show that, in females, the disease 
is more curable than in males, that it is also less fatal among them, and that 
their lonq-evity when permanently affected by it, is greater. 

Dr. W. has not only done good service to the cause of statistical medicine, 
but has given a valuable contribution to pathology by the publication of this 
essay. It contains the necroscopic appearances of seventy-two patients who 
died affected with insanity, in the Bethlehem Hospital. The post-mortem exa- 
minations were all made by Mr. Lawrence, and hence are entitled to the fullest 
confidence. As the pathology of insanity is but very imperfectly understood, 
and as we believe that these examinations are the most valuable of any that 
have fallen under our observation, we shall extract a part of the resume of them, 
in the language of the author of the pamphlet. 

" Some pathological chanaes of structure, more or less evident, were found in 
the brain or membranes of the whole seventy-two dissections reported, of which 
it may be stated, as a summary, that fifty-five cases likewise exhibited diseased 
alterations of structure of some kind or other, in the organs of the chest, whilst 
only fourteen showed any morbid appearances in the abdominal viscera. — The 
abdomen was not opened in every instance.— In 59 cases there was infiltration 
of the pia mater. In 59, turgidity of the blood-vessels of the brain and mem- 
branes. In 41, effusion of water in the ventricles. In 27, water was met with 
at the basis of the brain. In 19, bloody points on the cut surfaces of the 
medullary substance. In 16, thickening and opacity of the arachnoid coat. In 
14, the colour of the medullary or cortical substance of the brain was altered 
from its natural hue to brown, pink, gray, violet, ochre or white: and in 13 cases 
there was an effusion of blood in the brain. Besides these diseased appearances, 
various other alterations of structure were met with in particular patients, such 
as eflfusion of pus on the brain; changed consistence of its texture; greater dry- 
ness than usual of the membranes; flattening, a shrunk or a swollen state of the 
organ itself; with other changes different from a normal condition." 

" Of the 55 instances of pectoral disease met with, on examining the bodies 
after death, 43 cases showed either recent or old adhesions in the chest, and 31 
had the lungs consolidated. In 24, suppuration had commenced. In 15, the 
pleura or lungs bore marks of recent or previous inflammation. In 12 cases 
there was effusion of lymph into the pleura, &c. In 9, considerable eflfusion 
into the bronchia and air-passages. In 9, the lining membrane of the trachea 
and bronchia was deep-red. In 8, tubercles were met with. In 6, the lungs 
had assumed a dark or blackish tint; and in 7, the lungs did not collapse when 



1844.] Memoirs and Correspondence of Francis Horner. 15i 

the chest was opened. The apparent cause of death, in many of the patients, 
could be clearly traced to disease in the organs of respiration." 

The lesions of the thorax are less important than those of the encephalon, as 
they mostly were the undoubted results of diseases other than insanity. The 
same remark will apply to those of the abdomen, and inasmuch as all the cases 
were not examined in this region, we do not copy the record of the appearances 
noticed. P. E. 



Art. XVIII.- — Memoirs and Cnrrespnndence of Francis Horner, M. P. Edited 
by his brother, Leonard Horner, Esq., F.R. S. 2 vols. 8vo. London, 1843. 

Few men have been more reg'retted than the subject of the above volumes. — 
Born in the middle classes of life, he rose before his death by his eminent in- 
tellectual and moral qualities, to a place among the most distinguished statesmen 
of his day. We know of no work that could be perused with more profit by 
those who aim at political distinction in our own country, than this plain and 
unpretending biography. 

But it is out of place to enlarge further on this point. Our only object in no- 
ticing the work before us, is to mention some curious particulars concerning^ 
his illness and death. 

Mr. Horner was born in 1787, and became a student at an early age. He was 
bred a lawyer at Edinburgh, but was subsequently admitted to the English bar. 
In a short time after this, he became a member of parliament, and thus with his 
legal, legislative and literary pursuits, was probably overworked. Nothing of 
importance is, however, mentioned concerning his health, until 1815-16, when 
he was attacked with a cough. This was attributed by his medical attendant to 
the stomach; and he does not seem to have been much annoyed by it, except that it 
continued longer than he had anticipated. He addressed the House of Commons 
for the last time, on the 25th of June, 1816, "in the cause of religious liberty 
and Ireland." Symptoms of a pulmonary affection had now appeared, which 
gave great uneasiness to his friends. He spent some time at his father's house 
near Edinburgh, consulted several eminent physicians there, and was finally 
advised by them to pass the winter in a warmer climate. 

On his return to London, preparatory to his departure for the continent, he 
was seen by Dr. Pelham Warren, who was desirous that Dr. Baillie should be 
consulted. In a letter to his father, Mr. Horner says, *' Dr. Warren said to me, 
there is a nicety in the case; an equivalent expression, I suppose, to one Dr. 
Thomson used, that there was an anomaly in it." It appears also, that at this 
time, no fever had occurred, whilst he had manifestly gained flesh during his 
sojourn in Scotland. From these circumstances. Dr. Warren decidedly inferred 
that there could be no consumptive disease of the lungs. 

Pisa was the place selected for his residence, and he reached there towards 
the end of November, 1816. In the letters written during the journey, he men- 
tions that his cough is less. *'I do not say that my breathing is easier, but my 
general feeling of health has been better;" and again, *'I cannot yet speak of 
any improvement of that oppression of my breast, which I dislike more than the 
cough, because it has never been explained to me by any of my physicians." 

Mr. Horner seems to have somewhat improved during the month of December, 
but the main symptom was not materially relieved. We have now the follow- 
ing letter from his intimate friend Mr. Allen, (Master of Dulwich College, but 
bred a surgeon,) dated London, January 7, 1817: — 

" As your breathlessness seemed not to be at all relieved either by the change 
of climate, or by the treatment recommended to you by Baillie and W^arren, I 
made out a state of your case at present, as well as I could collect the particu- 
lars from your own letters and your brother's, and sent copies of it yesterday, 
to both these physicians, with a request that they would take it into considera- 
tion and give me their opinion this morning. The enclosed paper is the result 



156 Bihlio graphical Notices. [Jan. 

of their deliberation, in addition to which Baillie desires me to say, they are 
both satisfied that your difficulty of breathing does not arise from water in the 
chest, and from the history of your illness, they are equally persuaded it does not 
proceed from tubercles, but they are not so clear as to what is the real cause of 
it. Baillie thinks it may proceed from consolidation of part of the substance of the 
lungs^ in consequence of which there is less space for air, or it may arise from a 
change of structure in the air cells by which they are become larger, and in the same 
proportion afford a smaller surface for the oxy genation, or whatever else we may 
call it, of the blood. In either of the last suppositions, there is no danger from 
the complaint, though there may be much inconvenience; if the cause is nothing 
but muscular debility in the organs of respiration, you will obtain relief from it 
as your strength returns. They recommend to you, as you will observe, to re- 
sume the use of the mercurial pill, and to try the effect of the supercarbonate of 
potash." 

Mr. Horner sent for Dr. Vacca Berlinghieri, to whom he communicated the 
instructions of his English physicians, which he meant to follow without vari- 
ation, but wished that the Doctor should visit him daily, and then give an opinion 
of his illness, which he could report at home. He expresses a confidence in 
him " from the frankness with which he has given me to understand, that he is 
very much in the dark about my case." Opium was shortly after prescribed. 
" I have taken it three nights running, a grain of the gum extract on going to 
bed, and this morning, I have begun to take the same dose before getting up. 
The power of the evening's dose is nearly exhausted next morning; all day 
however, 1 felt my breathing a great deal more easy and tranquil. The relief 
seems to me quite marvellous, and I could fall down and worship my pill like a 
Turk; what is very new to me indeed, I have got through the labours of my 
toilet, without pain and palpitations, but with scarcely any feeling of exertion, 
and I am altogether a stronger and better man than 1 have been a great while. 
You will think I write this, under the delirium of my drug, and the alteration 
of my condition looks something like a reverie; but I really consider the experi- 
ment now as having been fairly tried, the result being uniform, of all that I have 
made, before my fever and since. Even if it should be but a transient effect, what 
has taken place must surely throw some light on the nature of my disease. Dr. 
Vacca will not yet speak out about it, except in conjectures, but he seems to 
watch me with a real curiosity." — Letter to Lady Holland, dated January 29th. 

On the 4th of February, he writes to his father, that he is undoubtedly better 
on the whole in all respects. The weather had been very fine, and he had ridden 
out several times, at first in a carriage, and for two days on horseback. "Dr. 
Vacca thinks that my complaints bear none of the appearances with which con- 
sumption is ever known to commence. From the distinct and strong effects 
which opium has had upon them, he thinks it reasonable to infer that an affec- 
tion of the nerves of the lungs forms a part, at least, and a considerable part, of 
the disease; at present, he does not carry his inference farther." 

Under the influence of the feelings expressed above, Mr. Horner drew out a 
plan of study, during the expected period of his retirement, the subjects and the 
magnitude of which might astonish many a one who claims the name of a 
scholar. 

But two days after he had written the letter last quoted, the difficulty of 
breathing and the cough reappeared with some severity. On the following 
morning they were somewhat abated, but towards the evening they returned, ac- 
companied by drowsiness. His brother slept in a room adjoining, and heard 
him moaning in the night. On going to him, he said, that he moaned from diffi- 
culty of breathing, but that he wished to be left to sleep. Dr. Vacca was sent 
for, and arrived at 7 A. M. (Feb. 8th.) He found his patient labouring greatly 
in his breathing, with strong palpitations of the heart, and a low, intermittent 
and irregular pulse ; his forehead covered with a cold sweat, and his face and 
hands of a leaden colour. He was, however, perfectly sensible, and spoke in a 
clear, distinct manner, expressing neither apprehension nor anxiety about him- 
self. Various stimulating applications were tried, but they afforded no relief; 



1844.3 Memoirs and Correspondence of Francis Horner. 157 

the difficulty of breathing grradually increasing. Mr. Leonard Horner (his bro- 
ther) requested that Dr.' Vacca would bring a physician in consultation with 
him in the afternoon. They arrived soon after four o'clock, and his brother left 
the bedside to receive them in the adjoining room. '• I was absent about ten 
minutes, and returned alone to prepare him for seeing the new physician. On 
drawing aside the curtain, I found his face deadly pale, his eyes fixed, and his 
hand cold." He was dead. 

Two days after, the body was examined by Dr. Vacca. The skin, and par- 
ticularly that of the face, was of a leaden colour; at the extremities of the fingers 
it was dark. 

All the viscera of the abdomen were healthy, but the veins generally were 
gorged with blood. 

The lungs were remarkably condensed, {rapetisses^) and particularly the right 
one. They were of a livid colour, and very irregular surface, and this irregu- 
larity arose from a very large number of transparent white bodies, varying in 
size and volume, the smallest being like lentils, and the largest like almonds. 
They were much more common on the anterior face of the lungs, indeed there 
were but few on the posterior. These bodies were vesicles filled with air; under 
pressure, they disappeared, and the air passed into the bronchiae, and reappeared, 
if the air in the trachea was pushed forward. These vesicles had no connection 
with tiie cellular tissue, so that the disease was not emphysenia, but a morbid 
dilatation of the air cells. Much of the substance of the lungs was condensed, 
hardened, and in many points, entirely hepalized. The lobes of the lungs did 
not adhere, nor was there any adhesion between them and the pleura. 

The pericardium was healthy, and contained a small quantity of serum. The 
heart was quite flaccid, and readily torn. The right auricle much dilated and 
filled with blood, vv'hile the corresponding ventricle contained a coagulum. 

Dr. Vacca concludes his account by observing that Baillie and Lieutaud have 
each reported pathological cases, which bear some analogy to the above, but he 
had not met with any medical writer who has found, as in this case, in the same 
individual, a condensation of the lungs, a dilatation of a portion of the air cells, 
a hepatization of a large part of the lungs, and an affection of the heart. 

Mr. Allen communicated tlie above to Dr. Pelnam Warren, to which the fol- 
lowing answer was received, dated March 5, 1817: 

"1 have shown Vacca's account to Dr. Baillie, who considers the case as ex- 
hibiting a very unusual form of disease, and one which is evidently out of the 
reach of medicine. The state of the heart presented no unusual appearances; 
the flaccidity and tender structure of its fibres being met with very frequently in 
individuals whose constitutional powers have failed by slow decay; the appear- 
ance within the right ventricle was a coagulum of blood not uncommonly found 
in that situation after death. The condensation of the lungs is also not unfre- 
quently met with, and justifies the opinion which Dr. Baillie held to you of 
such an alteration of structure, being the probable cause of Mr. Horner's diffi- 
culty of breathing, which was never attributed to water in the chest, but to an 
obstruction of the circulation of the blood through the lungs, arising from some 
cause not easily distinguishable. Tlie enlargement of the air-cells to the extent 
mentioned by Dr. Vacca is a disorder so rare that there are only three instances 
to be found in the anatomical collections with which Dr. Baillie is acquainted. 
The immediate cause of death appears to have been owing to the increase of 
the obstruction of the lungs to such an extent, as to have prevented the free 
passage of blood through the branches of the pulmonary artery, by which the 
right side of the heart became gradually gorged with blood, and its action was 
slowly suspended." 

The medical reader needs scarcely to be reminded of the diagnosis of Dr. 
Baillie, who suggested that the disease in question, might arise from one or other 
of two causes. The dissection showed that both were present. 

T. R. B. 

No. XIII.— January, 1844. 11 



158 Bibliographical Notices, * [Jan. 



Art. XIX. — The Spleen a permanent Placenta.- the Placenta a temporary Spleen. 
By John JacksoiX, Member of the Royal College of Surgeons. &vo. pp. 32. 
London, 1843. 

There are many serious obstacles to acquiring a correct knowledge of the 
proper offices of the spleen and placenta, and which to a certain extent, at least, 
are probably insurmountable. The anatomical structure of these organs affords 
us not the least clue in the investigation of their functions, and the few imperfect 
experiments that have been attempted for the purpose of solving this interesting 
problem in physiology have been without any satisfactory results. No one of 
the various theories that have been advanced in relation to the subject, can be 
viewed in any other light than as more or less plausible conjectures; the whole 
of them being unsupported by positive evidence. These remarks are particu- 
larly applicable to the functions of the spleen. The idea originally suggested 
by Dr. Rush, that it acts the part of a diverticulum or reservoir, by which the 
portal system is relieved from undue distension, under a variety of circumstances 
of frequent occurrence during health, is now very generally adopted by physi- 
ologists; and yet, it must be admitted, that this view of the office of the spleen 
is, to say the least of it, very problematical. It is a curious circumstance that 
from no one of the several pathological conditions of the organ has the least 
degree of light been thrown upon its proper function, while, in the experiments 
performed upon the lower animals, even when the organ has been entirely re- 
moved, no perceptible interruption to any of the vital functions was discovered 
to take place. It has hence been inferred that whatever may be the office it per- 
forms, it is not one in any way essential to life. 

In the essay before us. Dr. Jackson assumes for the spleen, however, a much 
higher office than it has hitherto been generally supposed to fulfil; that, namely, 
of a true heart, for effecting the circulation of the blood of the portal system 
through the liver, in the same manner as the right side of the central organ cir- 
culates the venous blood through the lungs. In other words, that the spleno- 
hepatic vein, of the minute ramifications of which the spleen is composed, 
performs for the liver, the duties of auricle, ventricle and artery; it being the 
recipient cavity and propulsive agent of the hepatic vascular system, as well as 
the vessel by which the blood of the portal system, after it has undergone the 
changes produced in it by the action of the liver, is again transmitted to the right 
cavities of the heart. 

Startling as the first enunciation of this hypothesis will appear to most of our 
readers, the author has adduced in its support a number of very ingenious and 
plausible arguments, and although we are far from admitting that he has suc- 
ceeded in fully establishing its accuracy, it is nevertheless one deserving of a 
close and candid examination, and may, probably, by directing attention to the 
subject, lead to the true explanation of the physiology of the spleen. 

Dr. Jackson maintains, that the portal circulation constitutes a distinct, per- 
fect, and independent system. Receiving, through the spleno-hepatic vein, "not 
only all the blood which is supplied to the digestive organs by the cceliac and 
mesenteric arteries, but also all the fluids which are taken into the stomach, 
every ounce of which must enter the spleno-hepatic vein, and pass through the 
three systems of the circulation in their natural order of hepatic, pulmonary, and 
general;" the liver must, he conceives, be altogether independent, for the force 
by which the blood thus received by it, is circulated through its substance and 
subsequently transmitted to the heart, of the contraction of the left ventricle: — 
*'If," he remarks, "the hepatic system were not an independent system, or in other 
words could not propel its own blood through its own vessels, the blood would 
never get through it at all;" the left ventricle being no more able to "propel 
the blood ilirough the hepatic system, than the spleno-hepatic vein can propel it 
through the pulmonary system, or the right ventricle through the general system." 

As this position constitutes the very foundation upon which the -views of Dr. 



1844.] Jackson on Functions of Spleen and Placenta, 159 

Jackson as to the uses of the spleen are based, a general statement of his argu- 
ments in proof of it may not be uninteresting. 

"That," observes the author, "the hepatic system is an independent system, and 
not a mere part or dependency of the general system, is indicated, first, by the 
portal trunk dividing into branches, the subdivisions of which ultimately become 
capillaries, just as the pulmonary artery and aorta divide into branches which 
ultimately become capillaries; secondly, by the circulation of the portal plexuses 
being the second system of capillaries, through which blood, propelled by the left 
ventricle through the coeliac and mesenteric arteries, and their branches, has to 
pass before it can re-enter the right auricle. But there is no reason why the 
hepatic system should be regarded as a mere part or dependency of the general 
system, or rather a part of a part of the general system, which it is if not a 
perfect and independent system in itself. Nor can any reason be given why 
the vessels which proceed to and from the liver should belong to a less perfect 
and independent system than those which proceed to and from the lungs: nor 
why the blood which has to be propelled vertically through the liver, is not in 
need of an appropriate agent for its propulsion, while the blood which is pro- 
pelled horizontally through the lungs, requires a very powerful one, the right 
ventricle." 

It is further remarked, that as the only course for the fluids received by the 
stomach, is through the gastric and duodenal veins into the spleno-hepaiic vein^ 
"it follows, therefore, that not only is the portal blood a more or less diluted 
blood, but that much more diluted blood enters the heart by the hepatic veins, 
than there is arterial blood supplied to the digestive organs by the coeliac and 
mesenteric arteries." — This Dr. Jackson urges as an additional argument to 
prove "that the left ventricle is totally incapable of propelling the portal blood 
through the hepatic system;" and, he remarks, " a more positive and convincing 
proof" could not be adduced; "for it shows, that if the left ventricle were the 
agent in the propulsion of the portal blood, it would be necessary first to be 
able, by propelling a certain quantity of blood, say one ounce, into the cceliac 
and mesenteric arteries, to drive a greater quantity, say ten drachms, through 
the three divisions of the hepatic system into the right auricle; that is, through 
the sub-hepatic veins, the portal plexuses, and supra-hepatic veins. Now this 
is plainly as impossible, as for a power to overcome a resistance greater than 
itself; and therefore, he concludes, nothing can be more certain than that the 
left ventricle is not the agent in the propulsion of the portal blood." 

The opinion that the right auricle, in consequence of the tendency to a va- 
cuum produced by its dilatation or expansion, has the power of assisting the 
passage of the blood through the liver, by pumping it, as it were, out of the 
hepatic veins, the author considers to be entirely unfounded. "The fitting ob- 
jection," he observes, "to this sagacious opinion is, that if expansion of the right 
auricle is capable of pumping blood through the liver which is below the heart, 
expansion of the left auricle ought to be able to pump blood through the lungs, 
which are placed on each side the heart; and that if no peculiar agent is needed 
to propel the blood through the liver, neither ought any to be required to propel 
it through the lungs, and that the right ventricle must therefore be superfluous." 

This mode of reasoning strikes us, however, as being far more specious than 
conclusive. 

That the motion of the diaphragm and abdominal muscles does not render any 
important assistance in the propulsion of the blood through the liver, Dr. Jackson 
considers to be shown by the circumstance of the blood being propelled through, 
the liver before birth, as well as subsequent to the establishment of respiration. 

The author considering it to be proved, that neither the left ventricle, nor the 
right auricle, nor the movements of respiration are sufficient to propel the blood 
through the hepatic system; proceeds to show that this office is performed by the 
spleen, or more correctly, that the circulation of the portal blood and the other 
fluids which it receives from the splenic artery, gastric, duodenal, and mesenteric 
veins, through the three divisions of the hepatic system is eff'ected. 

" The spleno-hepatic vein may be," he remarks, " compared to a tree; for like a 



160 Bibliographical Notices. [Jan. 

tree, it is composed of roots, trunk, and branches. The spleen is the ronts\ the 
splenic vein, and its continuation, the portal vein, are the trunk; and the ramifica- 
tions of the portal vein to their terminations in the portal plexuses, are the brunches. 

" The spleen is composed of the branches of the splenic artery, their capillary 
terminations, and of the roots of the spleno-hepatic vein; but chiefly and essen- 
tially of the latter, which are remarkable for their large size, tenuity and disten- 
sibility. The trunk and branches of the spleno-hepatic vein, as well as the roots 
or spleen, are also highly distensible. The roots or spleen, are contained in 
an elastic capsule; and the branches are surrounded by sheaths of loose cellu- 
lar membrane, (prolongations from Glisson's capsule,) which accompany the 
branches through the portal canals, even to the terminations of the former in the 
})ortal plexuses. The distensibility of the whole vein, roots, trunk, and branches, 
the roots being surrounded by an elastic capsule, and the branches by loose cel- 
lular sheaths, are sure indications that the degree of distension of the spleno- 
hepatic vein, or the quantity of portal blood it contains at different times, is 
subject to great variation. If the spleen were surrounded by an '•aponeurotic,'' 
and therefore unyielding membrane, it could not suffer distension; and if the 
branches of the spleno-hepatic vein in the liver were like the supra-hepatic veins, 
simple canals, they could not suffer distension: and under those circumstances the 
vein, at least the roots and branches, would contain at all times the same quan- 
tity of blood; and could not then perform those important duties which we are 
endeavouring to show that it fulfils. But Glisson's capsule and the splenic 
capsule are proofs that it does contain a varying quantity of blood; for they are 
obviously provisions to allow of its distension; and could be of no use if the 
quantity of portal blood were always the same. It has indeed, been matter of 
actual observation with some ])hysiologists, that the size of the spleen (or in 
other words, the degree of distension of the first portion or roots of the spleno- 
hepatic vein) varies very considerably at different times in the same animal; 
from which variation in the size or distension of the spleen, and because the 
organ consists chiefly of venous roots, Beclard justly remarked, that in 'texture 
and phenonjena' it closely resembles the penis." 

After remarking that the degree of distension of any one of the three divisions 
of the spleno-hepatic vein is at all times proportionate to that of either of the 
other two— Dr. Jackson continues, — 

"As the roots, trunk, and branches, of the spleno-hepatic vein are distensible, 
it follows, that they must also possess the power of contraction. The disten- 
sion of the vein is produced by the in-pouring of blood from the splenic artery, 
gastric, duodenal, and mesenteric veins, and of fluids from the gastric and duodenal 
veins. When the vein is moderately distended, the addition of more blood and 
fluid would increase that distension, and could not by any possibility have the 
effect of diminishing it. How then could the degree of distension vary, if the 
vein were not contractile as well as distensible] To be sure it might go on 
varying by constantly increasing until some part or other of the vein gave way, 
when fatal haemorrhage would be produced; but any diminution of the degree of 
distension could not take place if the vein were not contractile. It is no less 
certain, therefore, that the spleno-hepatic vein is contractile than that it is dis- 
tensible. Its contractibility is a vital property; its distensibility a physical one. 
The distension of the vein is consequently passive, and its contraction active; 
when the distension has reached a certain point, contraction takes place; and the 
natural and necessary effect of that contraction is, what nothing else can accom- 
plish, the propulsion of the portal blood through the three divisions of the hepatic 
system into the right auricle. 

"The action of the spleno-hepatic vein is like that of the auricles and ven- 
tricles, intermittent; like them it suffers distension and then contracts; but as its 
distension is far slower and less frequent than theirs, so also is its contraction." 

To establish the truth of the position here assumed, one of two things must 
also be true, either that the contraction of the different portions of the spleno- 
hepatic vein is of a peristaltic kind, or that the vein is supplied with valves 
opening towards the liver. Now we believe, that it is generally admitted by 



1844.] Jackson on Functions of Spleen and Placenta. 161 

anatomists that the portal veins are destitute of valves, and the author offers no 
evidence that their contraction takes place successively along- their course. 

"That the spleno-hepatic vein propels the portal blood through the hepatic 
system is further proved," Dr. Jackson arjgues, " by the much greater size of the 
spleen, relatively to the liver, in man than in quadrupeds. It is, perhaps, not 
overrating- the weight of the spleen in man, to estimate it at about one-sixth of 
the weight of the liver; but in quadrupeds it is onl}' one-twelfth, one-fourteenth 
or one-sixteenth. Owing to man walking" on two legs, and quadrupeds on four, 
the axis of the trunk, and therefore, the direction of the vessels through the 
liver, are vertical in the former and horizontal in the latter; and as a greater 
power is needed to propel the portal blood vertically than horizontally, so does 
the spleno-hepatic vein of the man require a larger proportionate quantity of 
roots, or spleen, than the spleno-hepatic vein of the quadruped. If the relative 
size of the spleen to the liver were the same in quadrupeds as in man, the im- 
petus which the contraction of the spleen would give to the portal blood would 
be too great; and the propulsion of the blood through the portal plexuses and 
hepatic veins into the right auricle, would be too rapidly effected. If, on the 
other hand, the relative size of the spleen to the liver were no greater in man 
than it is in quadrupeds, the impetus communicated to the portal blood by the 
contraction of the spleen would be too little; and its propulsion through the 
portal plexuses and hepatic veins would be too slowly and with too much diffi- 
culty effected. In quadrupeds the flow or passage of tlie blood through the liver, 
is but little influenced by gravitation; in man gravitation is, most commonly, 
directly opposed to it." 

Dr. Jackson notices the objection that may be brought against his doctrine of 
the functions of the spleen, from the fact that the ablation of the organ in the 
inferior animals, has been unattended with any apparent interruption to the func- 
tions of life, and, also, from the instances upon record of the partial or even 
entire loss of the spleen in the human subject, without the health of the indivi- 
duals being in the least affected. " How long ihey lived," he remarks, " with 
only a part of the spleen, or none at all; and whether they ultimately died of 
enteritis, or of hepatic disease, or of affections not produced by the accident, are 
matters upon which no information is afforded us. It is obvious why loss of 
the spleen is not fatal, nor productive of any serious inunediate effects. It has 
been already stated, that the spleen is essentially only the roots of the spleno- 
hepatic vein, the trunk and branches of which vein, as well as the roots, possess 
the property of vital contractility. When the spleen is removed, the roots of the 
spleno-hepatic vein only are removed. The trunk and branches are left behind: 
and the loss of the roots is not followed by the loss of contractility in the trunk 
and branches. The gastric, duodenal, and mesenteric veins terminate, not in the 
roots of the spleno-hepatic vein, but in the trunk. The vein, therefore, serves 
the purpose of recipient cavity just as well after the spleen has been removed as 
before. It is impaired only as a propulsive agent; and all the effect which the 
removal of the spleen produces is, that the blood is propelled through the liver 
less perfectly and freely than before: but still that propulsion is effected, although 
slowly and with difficulty, by the trunk and branches." 

The author, therefore, concludes, that "although the spleen is not an organ 
essential to life— although it is only a part of a vein — and although physiologists 
have been accustomed to treat it somewhat contemptuously — it is, nevertheless, 
entitled to some degree of consideration and respect; for be it remembered, the 
hepatic system is the first of the three systems comprised in the circulation of the 
blood; tlie spleno-hepatic vein performs in that system the triple function of 
auricle, ventricle^ and artery; and the spleen is not only a part of the spleno- 
hepatic vein, but it is the very first part." 

Thus far, in relation to Dr. .Jackson's doctrine of the functions of the spleen 
and the leading arguments by which it is sustained — the remaining portion of 
his treatise is devoted to a consideration of the office of the placenta. The 
placenta, he maintains, is neither more nor less than a temporary spleen, ren- 
dered necessary by the peculiar circumstances of the intra-uteriue life. In other 



162 Bibliographical Notices. " [Jan. 

words, that in the fcetal state it is the organ, or heart by which the blood, trans- 
mitted from the mother to the child in utero, is propelled through the umbilical 
vein and fcetal liver. 

"Doubts," he remarks, "may have been entertained by those who have fan- 
cied there is a direct communication, by means of capillaries, between the 
uterine and placental vessels, whether the maternal heart or the fojtal heart 
propelled the blood from the placenta through the umbilical vein and foetal liver 
into the foetal auricles; but they who know that there is no such communi- 
cation, and that the placenta is composed entirely of foetal vessels — and who 
are, therefore, perfectly assured that the motion of the blood along the umbilical 
vein is not produced by the vis-a-tergo of the maternal left ventricle — have never 
called in question the capabilities of the foetal ventricles; but have given the 
'-mighiy vital or gan^ as the heart has been termed, full credit for carrying on the 
entire circulation before birth as well as after!" 

"The following circumstances, however," Dr. J. conceives, "unquestionably 
prove that the foetal ventricles do not propel the blood from the placenta through 
the umbilical vein and fcetal liver into the fcetal auricles: First, the small size of the 
foetal heart as compared with the liver and placenta; secondly, the great length 
of the umbilical cord; thirdly, the great tortuosity of the umbilical arteries which 
render them much longer even than the veins; fourthly, the small calibre of those 
arteries compared with that of the vein; fifthly, the two capillary systems, one in 
the placenta, the other in the foetal liver; sixthly, the fact that more blood passes 
from the placenta through the umbilical vein to the foetus, than from the foetus 
through the umbilical arteries to the placenta — which is evidently the case, be- 
cause the blood being the materiel of the foetal development and growth is con- 
stantly being deposited in all parts of the fcetal system; and, lastly, because the 
blood does get propelled through the foetal liver when there is no heart, as is 
proved by the acardiac foetuses." 

"The hepatic system," Dr. J. remarks, "is a distinct, perfect, and inde- 
pendent system, before birth as well as after: and as the vein, of which the 
spleen is the root, performs joer se in that system after birth, the triple function 
of recipient cavity, propulsive agent, and afferent vessel, so also does the vein, 
of which the placenta is the roots, perform ^er se the same triple function in the 
hepatic system before birth. 

"Both the spleen and placenta are composed of arterial branches, their capil- 
lary terminations, and venous roots; but chiefly and essentially of venous roots, 
remarkable for their large size, tenuity, and distensibility, and also for their con- 
tractility. 

" Before birth, the hepatic vascular system possesses two spleens; one intra- 
abdominal and permanent — the spleen; and one extra abdominal and temporary — 
the p/acen/a." 

Between these two organs there exist the following analogies and resem- 
blances: 

"]. The spleen is composed of arterial branches, and venous roots, with 
their intervening capillaries; and so also is the placenta. 2. The spleen is con- 
tained in an elastic capsule which sends prolongations through its interior. 
The placenta is also contained in an elastic capsule formed by the two layers of 
the decidua, and from the inner surface of which proceed prolongations analo- 
gous to those of the splenic capsule. 3. The circumference of the spleen is 
more or less lobulated or fissured; and so also is the circumference of the placenta, 
4. The spleen receives very few and very small nerves. The placenta, it is be- 
lieved, receives none. 5. The splenic artery is remarkable for its tortuosity. 
The umbilical arteries are even more tortuous than the splenic. 6. The spleen 
is connected with the liver by a vein, of which it (the spleen) is essentially 
the roots. The placenta is also connected with the liver by a vein, of which it 
(the placenta) is essentially the roots. 7. At the transverse fissure of the liver 
these two veins, the spleno-hepatic and umbilical, are connected together by a 
large short branch, the ductus communicans. 8. These two veins resemble each 
other, and differ from all other veins, by dividing and subdividing after the 



1844.] Jackson on Functions of Spleen and Placenta. 163 

manner of the arteries. 9. The branches of both terminate in the same system 
of capillaries, the portal plexuses. 10. The trunk and branches of the spleno- 
hepatic vein contain a diluted blood. The roots, as well as the trunk and branches 
of the umbilical vein also contained a diluted blood — the dilution of the latter is 
effected previous to its entering the placenta, by being- deprived of its fibrine, 
which is deposited in the parietes of the uterus: and by this deposition ihe rapid 
growth and development of the uterus are produced, which take place during the 
period of gestation." 

In regard to the cause of the splenic and umbilical arteries being tortuous 
rather than straight, Dr. Jackson remarks, that, "the tortuosity of the umbilical 
arteries is evidently for the purpose of minimising the quantity of blood sent 
back to the placenta; for every drop over and above that required for the nutri- 
tion and growth of the placenta is sent on a bootless errand. The tortuosity of 
the splenic artery serves a similar purpose; it greatly impedes the flow of blood 
through that vessel, and thereby prevents any very considerable or undue quan- 
tity from passing through it into the spleno-hepatic vein; for as the splenic 
artery is, for reasons already given, a large vessel, a very great quantity of 
blood would necessarily pass through it if it were straight instead of tortuous. 
Judging from the extreme tortuosity both of the splenic and umbilical arteries, 
there can be but little doubt, that the quantity of blood which passes through 
them is very much less than we have long been accustomed to suppose." 

"The spleen and placenta, therefore," observes Dr. J., "besides presenting a 
striking similarity in their external appearances, are of similar texture, and are 
connected with the same organ, the Iiver<, by a vein of which each is the roots. 
The trunks of the two veins are connected with each other; the branches of 
both terminate in the same system of capillaries; and each vein contains a 
diluted blood. With such facts as these before our eyes, we cannot help in- 
ferring that the vein, of which the placenta is the roots, performs a very similar 
function, before birth, to that which the vein, of which the spleen is the roots, 
performs after birth. It has been shown that the spleno-hepalic vein performs, 
in the hepatic system, after birth, the triple function of recipient cavity or 
auricle, propulsive agent or ventricle, and afferent vessel or artery; and it is at 
once evident that the vein, of which the placenta is the roots, performs at least two 
parts out of three of that function before birth! It is the recipient cavity^ for it 
receives blood from the uterine vessels (veins), and, also, a certain, though pro- 
bably inconsiderable, quantity from the foetus by the umbilical arteries, which 
commingles with the former in the roots of the umbilical vein. It is also the 
afferent vessel^ for through it the blood passes into the liver; in which organ it 
divides and subdivides, and terminates in capillaries; — like the three other 
afferent vessels, the spleno-hepatic vein, pulmonary artery, and aorta. But is it 
also the propulsive agent? Is it owing to the vital contractility of the vein, of 
which the placenta is the roots, that the blood which exudes into these roots 
from the uterine veins, and also that which the foetal heart sends into them 
through the umbilical arteries, is propelled a distance of some twenty or thirty 
inches, and then through the foetal liver into the foetal auricles'? Undoubtedly 
it is. The foetal heart cannot effect that propulsion, for reasons already given, 
and therefore the vein, of which the placenta is the roots, must." — "To say 
that it is not contractile, merely because we do not see or hear it contract, is idle 
and frivolous. It must be contractile, and, in addition to that necessity, its close 
resemblances, in so many particulars, to the spleno-hepatic vein plainly shows 
that it is." 

" Before birth, the liver is remarkably large, and the spleen is remarkably 
small. The latter organ, therefore, bears a much less proportion to the former 
before birth than it does some time after; for after birth, the liver, for a short 
time, actually diminishes in size; but on the other hand, the spleen, until it 
attains its full development, slowly but constantly increases; so that the splenic 
artery after birth becomes larger than the hepatic, although before birth it is 
smaller. The reason the spleen is so small before birth is obvious: it is because 
there then exists another spleen, an extra abdominal and temporary one, ihe 



164 Bibliographical Notices. [Jan. 

plg.cenia. The fcetal liver does not require two spleens to propel the blood 
through it; and therefore the permanent spleen remains very small until after 
birth; at which period it is, and not before, that its real function commences." 

We have merely attempted, in the foregoinor notice of Dr. Jackson's treatise, 
to present to our readers a fair exposition of the author's views in relation to the 
functions of the spleen and placenta — and, as far as was practicable, in his own 
lanoruage. Those views strike us as in the highest degree plausible — they are 
nnquestionably of a most interesting character — and although the arguments 
by which the author has attempted to support their truth are in many particulars 
far from being conclusive, still the office he claims for both spleen and placenta 
may probably be found to be that which they actually fulfil — its admission is 
certainly attended with much fewer difficulties than attend the admission of 
any other, with the exception at least of that ascribed by Dr. Rush to the 
spleen — and nearly all the arguments which appear to establish the correct- 
ness of Dr. Rush's views, may also be adduced in support of the theory of Dr. 
Jackson. 

In the conchision of his essay Dr. J. remarks, that the views advanced by 
him as to the uses of the spleen and placenta, or rather of the two veins of 
which they are essentially tlie roots, originated in an investigation into the 
nature oi epilepsy. "The great venons turgescence of countenance which occurs 
in the paroxysms of that disorder, and which turgescence is sometimes so ex- 
cessive that the blood will exude through the pores of the skin like sweat, led 
him to infer that an epileptic seizure was owing to something or other preventing 
the ingress of blood into the heart by the superior cava. The effects produced 
by the experiments of tying the superior cava alone, and conjointly with the 
vena azygos, convinced him that such really was the case. The question as to 
the nature of the internal process which takes place in epilepsy then became 
definite — it was simply, how can the ingress of blood into the heart by the 
superior auricular opening be suddenly and temporarily prevented] — He thought 
by a sudden and temporary rush of blood into the heart by the inferior auri- 
cular opening. But what was to produce this rush of blood through their infe- 
rior auricular opening] There was nothing directly connected with the inferior 
cam which could produce it. Could it then he Uovn \\\e cnvae hepaticas? It at 
once struck him that the heart had nothing to do with the propulsion of the 
portal blood through the liver: and that the or i^an \Nii\\. \he unknown function 
produced the disease of the unknown nature.''^ D. F. C. 



Art. XX. — Fourth Annual Report of the Registrar-GeneraU ff the Births, 
Deaths^ and Marriages^ in England. London, 1842, Oct. — 363 pages. 

This volume is made up with no less care than the preceding ones of the 
series, and the whole reflects great credit upon the government, for the enlight- 
ened policy which led to the establishment o( a department for collecUng and 
collating the most exact information in regard to the movements of population in 
England. Such works make us acquainted with the most interesting facts con- 
nected with the continued coming and going of a large mass of the human 
family peopling one of the most favoured spots in the world. They develope 
the effects of the agencies of civilization upon the human organization, and all 
the good and evil iniluences existing in country and town-life. They are there- 
fore, of importance to the philosopher, philanthropist, and statesman, and not 
only of value at the present day, but as the means of making comparisons in 
ages to come. 

In noticing the former reports,* we have condensed and extracted many of the 
most interesting results of the labours of the Registrar-General, and his assist- 
ants. The present volume treats of the marriages, births and deaths, as these 

* See Nos. for January an<l July, 1841, and October, 1842. 



1844.] 



JRegistrar-Generar s Report, 



165 



were registered during the year ending* June 30, 1841, in each of the divisions 
and subdivisions of the country; showing particularly the early marriages, and 
numbers married at different ages, the condition of those married as to educa- 
tion, etc.: the births, with many interesting particulars relating to this topic; 
the mortality in different years as these have occurred at particular ages in the 
town and country districts; with tables showing the annual mortality in England, 
the great Metropolis, and Manchester, as compared with the rates of mortality 
on which the Northampton, Swedish and Carlisle tables for Life Insurance were 
calculated. The appendix, which comprehends two-thirds of the book, is rich in 
details of very high interest. 

In the report made by the Registrar-General, George Graham, Esq., to Sir 
James Graham, Principal Secretary of State for the Home Department, we find 
the following statement, which presents a comparative view of the number of 
births, deaths, and marriages, registered in the four years ending June 30, 1841: 

1838-9 1839-40 1840-41 



Births, 
Deaths, 
Marriages 



1837-8 

399,712 
335,956 
111,481 



480,540 
331,007 
121,083 



501.589 
350,101 
124,329 



504,543 
355,622 

122,482 



The marriages registered for the last mentioned year were nearly 1 in 127, the 
births 1 in 32, the deaths I in 45 of the population. The population of Eng- 
land, in 1841, (including Wales,) was 15,911,659. So many of the men are 
engaged in the army, navy, sea and colonial services, which causes them to be 
absent at the decennial censuses, that the female portion of the population has 
been taken as the basis of the calculations. The increase of females in the 10 
years, 1831-41, was 14*17 per cent, or at the rate of 1'334 per cent, annually. 

The marriage registers show the following numbers and proportions married 
at different ages in the three years ending June 30, 1841: 





UNDER AGE. 


OF FULL 


AGE. 


Total Married. 


Number. 


Proportion 
per cent, to 
the whole 
Number 
Married. 


Number. 


Proportion 

per cent, to 

the whole 

Number 

Married. 


367,894 Couples - 

or 
735,788 Persons - 


17,266 Men. 
50,714 Women. 


4-69 
13-78 


350,628 Men. 
317,180 Women. 


95-31 

86-22 


Totals, and Mean 


67,980 


9-23 


667,808 


9077 



The men under age were, to those of full age, nearly as 5 to 95; the women, 
as 14 to 86; the proportions differ considerably in various parts of the country; 
thus in the South Midland Division, nearly 21 in 100 women, and 8 in 100 men 
were minors; whilst, in the Western Division, 14 women and 5 men, and in 
Wales, 9 women and 3 men in 100, were under age. In the county of Bedford, 
25 in 100 women marry under age; in Huntingdon, 25; in Cambridge, 23; in 
Essex, 23; in Northampton, 22; in Hertford, 22; in the West Riding"of York, 
21: in the East Riding of York, 11; Cumberland, 10; Westmoreland, 10; 
Devon, 9; Salop, 9; Hereford, 9. The facts are shown in detail in a Table, 
and upon referring to another Table, (page 126,) the proportions are found stated 
separately for each of the three years. It will be evident that the disparities are 



% 



1 66 Bibliographical Notices, [Jan. 

regulated by constant causes, as the slight fluctuations are accounted for by the 
smallness of the nunribers which enter into the calculations. 

The proportion of women who marry under age is to the men nearly as 3 to 
1; in the Metropolis as 4|^ to 1; in the North-Western Division as 2|- to 1. 

More than half of the men (10,383), and half of the women (10,424), were 
married between the ages of 20 and 25; 2,711 wom_en, and 537 men were mar- 
ried under the age of 20. The mean age of the men was 26-30 years, of the 
women 25-35 years. The first marriages have been distinguished in a certain 
number of cases; and the result is, that in 15,579 marriages, 14,311 of the 
women married were spinsters, 1,268 widows; 13,683 of the men bachelors, 
1,896 widowers. The men were on an average 25*5, the women 24-3 years of 
age, at the first marriages. 

At the respective ages of marriage, about 79 in 100 of each sex marry. Of 
100 women married, 8 were widows, and of 100 men, 12 were widowers. As 
the number of marriages, however, has increased for many years, and the ex- 
pectation of life among women at the nuptial age (24-3 years) is greater than 
that of men, it is probable that about 1 in 3 widowers and 1 in 4 widows re- 
marry. 

The fact that one-fifth of the people of England who attain the age of mar- 
riage never marry, and that the women, though capable of bearing at 16, and 
certainly nubile at 17, do not marry until they attain a mean age of 24-3, the men 
until they are 25^, proves that prudence, or "moral restraint," in Malthus's 
sense of the term, is in practical operation in England to an extent which can 
scarcely be credited when stated in numbers. It is a striking proof of the gene- 
ral needy condition of the masses. The near coincidence in the mean ages at 
which the two sexes intermarry, affords a remarkable example of the secret ad- 
justments which exist, and of the laws regulating all social combinations. 

The marriage registers have aflorded a lest of the state of education wiih re- 
ference to writing. The simplicity of this test is one of its chief recommenda- 
tions; the parties are neither asked whether they can write or read, nor formally 
requested to write; but sign the marriage registers with their name or their mark 
in attesting the marriage, and the tables show the proportion who signed with 
marks. The parties who marry are on an average about 25 years of age; so the 
test shows the state of education 10 or 20 years ago; and the subsequent induce- 
ments to the retaining of the information and skill then required. 

It appears from the average of three years that 33 men in 100, and 49 women 
in 100, signed with marks; it is therefore probable that only 67 men and 51 wo- 
men in 100 can write their own names. There is a slight increase in the pro- 
portion of men who wrote their names. 

The Table in which the divisions and counties are arranged according to the 
proportion of men married who wrote their names, shows that there are great 
differences in the state of education in different counties. Thus of 100 men 
married in Cumberland only 16 signed the register with marks, 19 in Westmore- 
land, 19 in Northumberland, 19 in the East Riding of York, 23 in the North 
Riding — 46 in Cambridgeshire, 46 in Worcestershire, 47 in Suffolk, 47 in Essex, 
and 52 in Bedfordshire. It may be vvrorth while to inquire into the systems of 
education which lead to such different results in these counties; for the differ- 
ences of intellect, habits and occupations can scarcely account for the remark- 
able fact that 84 in 100 men can write in Cumberland, 81 in the East Riding of 
York, and only 54 in 100 in Cambridgeshire, and 48 in 100 in Bedfordshire. So 
far as writing implies education, the relative education of men and women va- 
ries to a great extent in the several counties. 

The following table shows the ages at which the marriages of 40,874 persons 
were contracted. 



1844.] 



Registrar-GeneraV s Report, 



167 









Marriages, 


2 Years- 


-June 1839-41. 




AGES 


Men. 


Women. 






Bachelors 


Widowers. 


Total. 


Spinsters 


Widows. 


Total. 




15 & under 20 


378 




378 


2,022 


1 


2.023 




20 " 


25 


7,776 


71 


7.847 


7,824 


73 


7.8>7 




25 « 


80 


3,686 


267 


3,953 


2,891 


199 


3.090 


The mean age of the— 


30 « 


35 


1,149 


353 


1;502 


!i24 


254 


1,178 


Bachelors \ tyr.An 


35 « 


40 


400 


32.5 


725 


351 


201 


552 


was nearly j ^^ ^ 


40 " 


45 


174 


273 


447 


180 


218 


398 


Spinsters. . . 24 30 


45 " 


50 


71 


197 


268 


75 


122 


197 


Widowers . . 40-80 


50 « 


55 


31 


170 


201 


22 


101 


123 


Widows . . 38-95 


55 " 


60 


10 


98 


108 


16 


36 


52 


The mean age of all the 


60 " 


65 


5 


88 


93 


3 


46 


49 


men was 27 45; of all 


65 « 


70 


2 


35 


37 


3 


10 


13 


the women, 25 46. 


70 « 


75 


1 


]0 


11 


.. 


5 


5 




75 " 


80 




5 


5 


.. 


2 


2 




80 « 


85 
ons 


•• 


4 


4 












13,683 


1,896 


15,579 


14,311 


1,268 


15,579 




Proporti 


•87830 


•12170 


100000 


•91861 


08139 


I 00000 





In reference to births, it appears that the proportion to the population is above 
the average of England in the North-Western, York, North-Midland, Northern, 
Western, and South-Midland divisions; and below the average in the Welsh, 
Eastern, Sonth-Western, South-Eastern, and metropolitan divisions. 

" The births of 760,983 boys, and of 725,689 girls, were registered in the three 
last years; so that, in 100,000 births, 51,187 were boys, 48,813 girls; or the 
boys were born in the proportion of 10,486 to 10,000 girls. The excess of males 
born was greatest in the northern, least in the southern parts of England. (*) 
The greatest number of births is registered in the winter and spring quarters; 
in those quarters, also, the proportion of males to females born is greatest. In 
the two last years, 105 boys have been born to 100 girls, or 21 boys to every 20 
girls. The greater mortality of males reduces them nearly to an equality with 
females by the age of 20. When the males born were to the females born in 
the proportion of 10,486 to 10,000 the deaths of males at home were to the 
deaths of females as 10,340 to 10,000; and at the last census the males were to 



* Births registered in England from the Ist July, 1838, to the 30th June, 1841 (three years); show- 
ing the proportion of Males and Females born. 











In 100,000 Births. 


Males 




Divisions. 


Males. 


Fe- 








No. 






10,000 
Females. 








males. 


Males. 


Females. 


10 
8 

11 
9 

6 


Northern .... 
North-Western . . 

Welsh 

York 

Norih-Midland . 
Western 


41,324 
113,756 

47,678 
80,641 
54,895 
92,246 


38,839 
107,759 
45,268 
76,742 
52,272 
87,849 


51,550 
51,353 
51,296 
51,239 
51,224 
51,221 


48,450 
48,647 
48.704 
48.761 
48,776 
48,779 


10,639 
10,5.56 
10,532 
10.508 
10,501 
10,500 




England .... 


760,983 


725,C89 


51,187 


48,813 


10,48S 


4 
5 
2 
1 
3 


Eastern 

South Western . 
lr=oulh Eastern . 
Metropolitan 
South-Midland , . . 


47,323 

77,9.=)4 
66,410 
8-3,968 
55,788 


45,240 
74.709 
63 693 
79,569 
53,749 


51,126 

51,063 
51,044 
51,045 
50,931 


48.874 
48,937 
48,956 
48.953 
49,069 


10.460 
10;4.34 
10,426 
10,-126 
10,379 



168 



Bibliographical Notices, 



pan. 



the females enumerated as 10,000 males to 10,465 females, notwithstanding the 
excess of males born.* 

"Tlie annual births," says Mr. Farr in his letter to the Reaistrar-General, 
"were 503,0r)6-|-59,280=562,346; and, althouah the precise proportion of ille- 
gitimate births is not yet known, I shall assume, from the incon)plete informa- 
tion in my possession, that 5 per cent. (28,117) of the children were illegiti- 
mate, which would imply that 534,229 children were born annually in wedlock, 

. ,/534,229\ , /534, " 

namely 4-/ to each vvoman married I —-—-— 1, and 4-3 to each marriage ( „ 

The latter is the usual, the former the best mode of stating this relation; for the 
object is to show the fecundity of women in different countries at different 
times; and the second marriages of women are, in this point of view, only a 
means of extending the period of childbearing lo its natural term, and they can- 
not, on the average, be so fruitful as the first marriages, with which they are 
confounded. The marriages increased 1 per cent, annually in the previous 14 
years; and, though we do not know at what date the persons were married from 
whom the 534,229 births sprang, it would certainly be at a period sufficiently 
remote to imply a less number than 113,785. The actual fecundity of the mar- 
ried women of this country may probably he expressed accurately enough, if a 
correction be made for the increase of marriages, and for the illegitimate chil- 
dren borne before and after marriage by women who marry, at 5 children to 
every woman married, and 4-5 children to every wedding. The 5 children re- 
place the 2 parents, and those persons who from early death or from other cir- 
cumstances bear no children. 

The number of women living and enumerated, June, 1840, was in round num- 
bers, 1,630,000 aged 15-25; 1,272,000 aged 25-35; 900,000 aged 35-45; and 
these tliree ages, at which 3,802,000 were living may be considered the ages of 
childbearing, the middle period being that in which the greater number of chil- 
dren are produced. 

The 3,735,000 women living in the 2 years, June, 1839-41, between the ages 
15-45, gave birth to 562,346 children annually: G(j women produced 10 children 
every year: only 1 in 7 women {ij-Q) at the childbearing ao-e gave birth to a child 
in the year. Children are occasionally borne at 15, or as late in life as 55; but if 
the mothers of the 562,346 children had all been aged 17-40, there would have 
been only 1 annual birth to 5 women living of that age. It has been calculated 
that, on an average, 2 years intervene between the birth of every child;"j- or that 
of 2 women one has a child every year. After a correction has been made for 
unprolific women, the difference between 1 in 2, and 1 in 5 or 6, corroborates the 
previous result, and shows how much, notwithstanding the increase of popula- 
tion, the reproductive force is repressed by prudence. 

The population of England may have increased, and may yet increase by an 
augmentation in the number of marriages and births; or, by a diminution in 
the number of deaths, and the consequent prolongation of life. The annual 
number of births may be effected in two ways; by an increase of the number 
of persons married, and by earlier marriages, which shorten the interval elapsing 



* Births registered in the Four Quarters of the Two Years, June 1839-41. 



Registered in 
the Quarters ending 



September 30ih 
December 31sL 
March Sist 
June 30ih 

Total 



Males. Females. 



122,790 117,141 

123,542 ! 117,6r5 

136,485 I 12^t,540 

132,701 1 126,242 



In 100,000 Births. \ Males 
Born to 

10,000 



Males. Females. 



51,176 
51.214 
51.3115 
51,247 



48,824 
48.876 
48.695 
48,753 



ii5,518 I 490,614 | 51,238 I 48,952 10,507 

! I I 



Females. 

10,481 
10,497 
10,5:!6 
10 511 



t Dr. Granville and Mr, Finlaison, Piirl, Friendly Soc. Rep., 1825, 






1844.] Begistrar-GeneraVs Report, 169 

between successive generations. Thus 113,361 women were annually married 
(for the first time) in each of the two years endinff June 30th, 1841, when 
160,000 women attained the age of 20. If 10,000 be subtracted for sickness, 
infirmity, and incapacities of various kinds, 150,000 will remain who might have 
married, and thus have augmented the numbers married by one-third (32'7) per 
cent. The increase by birth, exclusive of illegitimate children, is about 34 per 
cent, annually; and if the marriages and births be increased one-third, or in the 
above ratio, the increase by birth will rise to 4-3 per cent., leaving, after sub- 
tracting the loss by death, (which shall be supposed to remain stationary at 2-2 
per cent.,) instead of 1-3., the present rate, 2-1 per cent, annually as the rate of 
increase, raised to this height by the greater number of married child-bearing 
women." 

With reference to the increase and decrease of mortality in the several divi- 
sions of the kingdom, it appears that the mortality attained its maximum in 
1839-40, throughout the North-Western, York, and North-Midland divisions; 
whilst it increased slightly, but progressively, from 1838-9 to 1840-1, in the 
Western, South-Midland, Northern, Welsh, South-Eastern, and South-Western 
divisions. 

Since the system of accurate registration has been so generally adopted, it has 
been found, through the results of statistical investigations, that the rate of mor- 
tality not only varies considerably in different cities, but that, as a general rule, 
the proportion of deaths is greater in towns than in the country. The facilities 
thus afforded of ascertaining the presence of injurious agencies in certain locali- 
ties, has tended greatly to awaken the attention necessary to procure their more 
speedy removal. The town mortality generally increases with the density of 
the districts. (See this Journal for July, 1841, page 157.) 

With regard to the increase of population in England with its probable re- 
sults, and the remedies suggested for the removal of the supposed impending 
evils, Mr. Farr makes the following observations and suggestions, which will 
be read with much interest: 

"Writers upon population have, perhaps, exaggerated the influence of the in- 
crease of population on the strength and prosperity of states; but its importance 
is unquestionable, and it must always be interesting to understand the laws 
which regulate the death — the reproduction of individuals; and which, in the 
midst of the struggles of the antagonist forces of disease and death, the losses 
by war, want, vice, and error, insure the perpetuity and life of nations. 

"It is not my intention — and it would be out of place here — to discuss the 
questions, whether the population of England is increasing too fast or too slowly? 
whether any steps should be taken to accelerate or retard its progress? whether 
the government should encourage or discourage population; or, after obtaining and 
publishing all the information that can be procured on the subject, leave public 
opinion and private prudence to come to their own conclusion and to take their 
own course] I shall merely notice very briefly how the rate of increase in the 
population is raised or lowered instinctively; as the indications of nature will 
be found valuable guides by all who seek to influence the opinions and conduct 
of mankind. 

" When the rate of increase is to be lowered, the usual course appears to be 
to deter to the extent required the period of marriage. If the supplies of sub- 
sistence were cut off, if science and industry were unable to convert a larger pro- 
portion of the materials of nature into food, and all the outlets and demands of 
emigration were closed, the population might unquestionably be brought to a 
stationary condition without increasing the deaths — by reducing the number of 
marriages. At present one-fifth of the women who attain the age of 24-3 years 
never marry: if one-half of the women who attain that age never married, and 
illegitimate births did not increase, the births would ultimately not exceed the 
deaths, and the population would remain stationary. But the same end would be 
almost as effectually and less harshly attained, though four-fifths of the women 
who arrived at the mean age of marriage continued to marry, if instead of be- 
ginning to marry at 18, none married under 23, and the mean ageof marriage 



170 Bibliographical Notices. [Jan. 

were raised to 30 years; for the interval from generation to generation would be 
thus extended, the children to a marriage diminished, and the number of women 
at 30 would be reduced by the loss of the younger lives. The reduction to a 
stationary condition is put as an extreme hypothetical case, and as one not likely 
to be called into requisition; but it is evident that if the population could thus 
reduce itself to a stationary condition, it possesses still greater facilities for re- 
ducing the rate of increase any number of degrees below the present standard, 
without increasing the mortality. 

"The population is increased most naturally by reversing the process de- 
scribed—by earlier instead of later marriages — while a somewhat higher pro- 
portion of women marry, leaving still a large residue, including all afflicted with 
hereditary ailments, and thus affording scope for the selection, which is invaria- 
bly, though perhaps insensibly, exercised in large masses, and must tend to ele- 
vate the moral and intellectual, as well as the physical qualities of the race. 

" Dr. Price, at the close of the last century, excited alarm by a forcibly drawn 
picture of the depopulation of the kingdom; and no sooner had the census de- 
monstrated that Dr. Price's fears of depopulation were groundless, than the 'in- 
crease of population in a geometrical progression,' enunciated in the theory of 
Mr. Malthus, turned the gloomy forebodings of speculators in quite an opposite 
direction. Both these writers contributed essentially to the development of the 
true theory of population; both rendered important services to mankind by their 
investigations; but the facts since elicited, and the further prosecution of the in- 
quiries which they commenced, have shown that while the study of the doctrine 
of population is fraught with instruction, and is suggestive of prudence, it is cal- 
culated to inspire a calmer confidence in the ordinances of nature, and to confirm 
our faith in the destinies of England. The expansion of which the reproductive 
force in the population is susceptible, and the progress of science and industry, 
must set at rest all dread of depopulation; which has apparently never prevailed 
for any length of time since the earliest historical ages. The population, it has 
been proved, has increased in a geometrical progression ever since the first census 
in 1801: and the rate of progression has been such that, if it continue, the num- 
bers will have doubled in 1850: double the number of families will exist, and 
must be supplied with subsistence in England: but there will also be double 
the number of men to create subsistence and capital for her families, to man her 
fleets, to defend her inviolate hearths, to work the mines and manufactories, to 
extend the commerce, to open new regions of colonization, and double the 
number of minds to discover new truths, to confer the benefits and to enjoy 
the felicity of which human nature is susceptible. If the proposition of Lord 
Bacon be sound, as it unquestionably is, that the 'true greatness (of a state) 
consisteth essentially in population and breed of men,' time has confirmed his 
prescient assertion, 'that out of doubt none of the great monarchies, which in 
the memory of time have risen in the habitable world, had so fair seeds and be- 
ginning as hath this estate and kingdom.' If the population of England had 
remained stationary from the age of Elizabeth, and had now not exceeded the 
population of Belgium; or even if the population had been stationary from the 
time that Malthus wrote, the empire could scarcely have attained its present 
power, or sustained its present greatness. Should the time nevertheless come, 
when the country is sufficiently populous, and it should be desirable to retard or 
stop the progress of population— the analysis of the marriages, births, and deaths, 
in connection with the census returns, will show, as has been already proved, 
that this may be effected without raising the mortality. The principle of ' an 
increase of the population in geometrical progression' has nothing in it fatal, 
irresistible, inexorable; upon a rigorous analysis of the facts, it is seen that it 
consists of nothing but an excess of births over the deaths, and becomes a negative 
quantity, or 'a decrease of population in geometrical progression,' if the births 
cease to maintain the same ratio to the population; and the births may always 
be reduced rapidly by retarding the period and number of marriages: so that the 
mathematical terror, 'a geometrical progression,' cannot alarm any one in the 
lio-ht of day. I do not desire to disguise or underrate the gravity of the fact, 



1844.] Begistrar-General'' s Report. 171 

that the population of England has increased, as the censuses prove, — and the 
excess of births over deaths leaves beyond doubt — in a geometrical progression 
for 40 years, and at a rate by which, if continued, it will double every 49 years. 
But what has called so many millions of people into existence in 40 years'? By 
what force has the high rate of increase been sustained; and what gave it the 
velocity of this geometrical progression, but the creative energy and intelligence 
of the country and racel And can any one fear for the conduct and fate of this 
people, if they should feel themselves called upon to rear fewer children— to 
marry less early than during the last 40 years'? Will not the same intelligence 
and energy which increased, diminish the rate of increase to any extent, when 
they take the form of prudence'? 

*'The fallacy to which I have referred rests on this doctrine: 'the population 
is increasing in a geometrical progression, the means of subsistence in an arith- 
metical progression, and unless wars, destructive epidemics, marshes, dense 
towns, close workshops, and other deadly agents, carry off the excess of the 
numbers born — unless the outlets of life and blood be left open — the whole peo- 
ple must be exposed to a slow process of starvation.' This has been considered 
by some the doctrine of population. The nature of the increase in geometrical 
progression has been already examined; and there is no evidence whatever to 
prove that while capital increases in geometrical progression (compound in- 
terest) the subsistence and power of the people of these islands have increased, 
or will increase, in arithmetical, and not in geometrical progression. It is not 
known how much subsistence has increased in the last 40 years; and it is pure 
empiricism to pretend to say that the rate of progression has been, or will be arith- 
metical, if any thing more be meant by that formula than the plain incontrovertible 
fact that the increase of subsistence is limited. But independently of these con- 
siderations, and any maters of controversy which it would be inconvenient to 
advert to here, the facts in the previous part of this paper dispose of the fallacy, 
—which, if it cannot be employed by any but the most depraved to sanction the 
destruction of life, might slacken the zeal of some in ameliorating the public 
health, by lending a colour to the dreadful notion that the excess of population is 
the cause of all the misery incidental to our condition or nature; and that the popu- 
lation might at the same time be diminished and saved from starvation, by epi- 
demic diseases, unhealthy employments, or pestilential localities. What are the 
facts'? An increase of the deaths can only diminish the population if the number 
of births remain stationary. It has been shown that the number of births may 
be increased to an incredible extent; experience has proved that the births almost 
invariably increase when the mortality increases; and it will be seen, in the 
Tables of the Report, that where the mortality is greatest, the births are most 
numerous, and the population is increasing most rapidly. An increase of the 
mortality is therefore no specific for establishing an equilibrium between sub- 
sistence and population. The more, in fine, the doctrines of population are 
studied, the more deeply must be impressed upon the mind the sacredness of 
human life, and of the safeguards by which it has been surrounded by God and 
the laws." 

The topics connected with the movement of population in England, thus far 
referred to, are treated in a manner which makes them as readily understood, 
and as interesting to the general inquirer, as to the physician. We shall now 
advert to some other matters specially designed for professional readers, since 
they pertain to statistical nosology, with all its array of technical terms. 

The three great corporate bodies which in England manage all concerns con- 
nected with the healing art, viz., the Royal College of Physicians, the Royal 
College of Surgeons, and the Society of Apothecaries, in 1837 took the most 
decisive steps for procuring a better registration of the causes of death, ''being 
convinced," they say in their joint circular, "that such an improved registration 
cannot fail to lead to a more accurate statistical account of the prevalence of par- 
ticular diseases from time to time." They entreated all authorized practitioners 
in the kingdom to assist in establishing a better registration, throughout Eng- 
land and Wales. The returns obtained the first year after the adoption of these 



172 



Bibliographical Notices. 



[Jan. 



measures were, on the whole, tolerably satisfactory; bnt, as might have been ex- 
pected, some of the entries were incorrect; the information in many instances had 
not been furnished directly by medical men, and had been furnished in ill-defined 
words, such as decline, fit, inflammation, visceral disease, cold, long illness. Local 
terms were employed, which appear to denote different diseases in different parts 
of the country. In many cases where inquests were held, no attempt had been 
made to inquire into the direct cause of death. 

It appeared, therefore, necessary to suggest, as far as was practicable, the use 
of a uniform intelligible nomenclature. 'J'he following remarks were made in 
the Appendix to the First Report; and a classification was adopted which has 
been followed in the subsequent Reports: — 

" The advantages of a uniform statistical nomenclature, however imperfect, 
are so obvious, that it is surprising no attention has been paid to its enforcement 
in bills of mortality. Each disease has in many instances been denoted by three 
or four terms, and each term has been applied to as many different diseases; vague, 
inconvenient names have been employed, or complications have been registered, 
instead of primary diseases. The nomenclature is of as much importance in this 
department of inquiry as weights and measures in the physical sciences, and 
should be settled without delay." 

The tabular arrangement adopted in conformity with these views, exhibits the 
greater number of the causes of death, under names convenient to medical prac- 
titioners, and sufficiently precise for statistical purposes. The common English 
name has always been adopted, in conformity with the opinion expressed above, 
except in a few obvious instances; but where no one English name existed, and 
where the disease is popularly expressed by periphrasis, the common medical 
term has been adopted. Pneumonia is used, for instance, and not inflammation 
of the lungs. The Latin or English synonyme will render the tables intelligible, 
on the one hand, to foreigners, and on the other, to the general reader. If the 
causes of death were uniformly registered under the same names, and each cause 
of death designated by one word, it would increase the accuracy of the Abstract, 
and diminish the labour of framing it very considerably. 

The following condensed statement exhibits a concise view of the public 
health in England in the year 1840, together with the mean temperature of the 
several months, and a comparison of the quarterly mortality so as to show the 
influence of the seasons: — 

"The mean temperature of the year 1840 was 50° of Fahrenheit. It was 
0°-8 below the mean annual temperature of the 10 years 1831-40, but higher 
than any year since 1835. The highest temperature attained in the year was 
83°, the lowest was 21°. The atmosphere was slightly moister, and the fall of 
rain somewhat greater than the averagre. The temperature of each month is given 
below for the three years 1838, 1839, 1840, from the observations made at the 
apartments of the Royal Society. 

MEAN TEMPERATURE. 



Months 


Jan. 


Feb. 


Mar. 


April. 


i 
May. 1 June. 


July. 


Aug 


Sept 


Oct. 


Nov. 


Dec. 


Year. 







o 


o 


o 


1 o 


o 





o 


o 





o 


o 


1838 


31 


35 


44 


45 


53,1 61 


63 


63 


57 


52 


43 


401 


48 9 


1839 


39 


41 


41 


43 


53 


621 


62 


62 


58 


51 


46 


40 


49 9 


1840 


40 


391 


39 


48 




63 


62 


65 


57 


49 


46 


35 


50 


1831-40 


38 


421 


42 


47 

1 


55 


62 


65 


64 


58 


52 


441 


41 


50 76 



*'A comparison of the number of deaths registered in the four quarters of the 
corresponding years is exceedingly instructive. 
Quarters ending March 31st. June SOih. September SOih. December 31st. 



1838 
1839 
1840 



98,114 

89,739 
98,843 



90,810 
87,965 
90,339 



72,791 
76,280 
80,820 



80,816 
84,995 
89,630 



1844.] Registrar GeneraVs Report, 173 

"The mortality by all causes was higher in 1840 than in 1838, and consider- 
ably higher than in 1839. Out of 1,000,000 living in 1839, only 21,856 died; 
while in 1840, out of the same number living, 21,856 — and 1022 more — pe- 
rished. Upon referring to the deaths by different classes of causes, it will be 
perceived that 626 of the excess (1022) arose in the epidemic class of diseases; 
the remaining excess being distributed over all the classes, except that of the vio- 
lent deaths, which diminished somewhat in each of the two last years. 

"The deaths from Small-pox fell from 16,268 in 1838, to 9,131 in 1839, and 
10,434 in 1840,- the deaths from Typhus fell from 18,775 to 15,666 and 17,177. 
From both diseases the mortality was less in 1840 than in 1838, but greater than 
in 1839. Hooping-cough progressively declined from 9,107 deaths to 8,165 and 
to 6,132. 

^'ScarlaiinawdiS the reigning epidemic of the year 1840. According to the theory 
of Sydenham, it would communicate its character to the acute diseases, and con- 
stitutes the medical constitution of the year. 

"The deaths from this severe epidemic were in the three years: — 

1838. 1839. 1840. 

5,802 10,325 19,816 

"And the deaths by Scarlatina^ out of 1,000,000 living, were in the same years 
393, 683, 1,289. The epidemic was most destructive in the North-Western, 
North Midland, York, Welsh, and Northern Divisions. In the North-Western 
Division (Lancashire, Cheshire), the aniural mortality by scarlatina was 2*5 in 
1,000; so that the mortality of children, who are the principal sufferers, must 
have been excessively high. The epidnmic had not terminated, and we shall 
have in the next Report to trace its destructive course through another year, and 
in other parts. 

"The deaths by Diarrhoea, Cholera, Tvfiuenza, and Ague, increased to a con- 
siderable extent; though not so as to assume the epidemic form, or to present 
any thing very remarkable. 

"The deaths from Hydrophobia in the three years were 24, 15, 12; and there- 
fore not half so numerous in 1840 as in 1838. 

"The mortality by the diseases of the Nervous System was nearly the same in 
the three years, viz., -003365, and -003255, and -003302. The mortality by 
Cephalitis and Paralysis was slightly higher in 1840 than in the two preceding 
years. 

" The mortality by the diseases of the Respiratory Organs was 6 in 1000; or in 
each of the three years -006149, -005989, and -006043." The deaths ascribed to 
Consumption in each of the three years were 59,025, 59,559, and 59,923; and 
the mortality was -003996, -003939, and -003897. The mortality from this dis- 
ease declined very slightly. About 4 in 1000 persons died annually of con- 
sumption, and about one-fifth or one-sixth part of the total deaths was by this 
disease. 

"The mortality of diseases of the Digestive Organswas -001307, -001373, and 
•001465. The increase was chiefly in Enteritis. 

"The mortality by diseases of the Urinary Organs was -000112, -000101, and 
•000110, in the three years. The deaths by Sto?ie (and Gravel) were 320, 299, 
and 303; the mortality -000022, -000020, and -000020. About 1 in 50,000 per- 
sons die of stone annually. It will be interesting to see whether the mortality 
be reduced in future years by the discoveries of Surgery. The mortality by Dia- 
betes is to that by Sto7ie as nearly two to three. 

"The deaths in C'A27c?-/;erf were 2,811, 2,915, and 2,989 in the three years. The 
mortality increased from -000190 to 000193, and -000195. To about 187 children 
born alive, one mother died. The proportion of mothers who perish at this im- 
portant period is unquestionably excessive; and must suggest to every humane 
person the inquiry whether the education of the nurses who attend the poor in 
labour may not be improved] 

"The number of deaths ascribed to Rheumatism and to diseases of the joints 
was 962, and 1170 in 1840. 

No. Xlll.— January, 1844. 12 



174 Bibliographical Notices. [Jan. 

"If we except 'Debility,' under which head are included 'premature births' 
— 'Dropsy' was the most fatal of the diseases of ''uncertain or variable seat.'' 
The deaths ascribed to dropsy were 12.342, 12,251, and 13,261 in the three 
years; the annual rate of mortality -000836, -000810, and -000863. Jt is scarcely 
necessary to add, that according to the present views of pathologists, Heart Dis- 
ease, or Nepkria, would, in the majority of cases, be considered the prinnary affec- 
tions. So difficult, nevertheless, appears to be the diagnosis practically, that 
nearly as many cases of simple ' Dropsy' ^re registered in the London hospitals 
as out of doors in private practice." G. E. 



Art. XXI. — Jlnatomiml Atlas, illustrative nf the Structure of the Human Body. 
By Henry H. Smith, M. D., F. C. P., M. P. M. S. Under the supervision 
of WiLLiAxii E. Horner, M. D., Professor of Anatomy in the University of 
Pennsylvania. Part I., 130 figures. Lea & Blanchard, 1844. Super-royal 8vo. 

This work is to be completed in five parts. The first, containing the bones 
and ligaments is before us. The figures have been carefully selected from the 
most accurate plates hitherto published, and where these were not deemed satis- 
factory, original drawings have been made from specimens furnished by the 
beautiful Anatomical Museum of the University of Pennsylvania. 

Tiie plan of this atlas is admirable, and its artistical execution superior to any 
thing of the kind before published in this country. The figures and their expla- 
nations are all given on the same page, so that the student is not obliged to wade 
through pages of tedious description to revive his recollection of the name of a 
process, or foramen, or ligament, &c. &c. &c.; but at a glance he sees the exact 
figure of the part and its name. It is a real labour-saving aflfair, and we regard its 
publication as the greatest boon that could be conferred on the student of anatomy. 
It will be equally valuable to the practitioner, by affording him an easy mean^ of 
recalling the details learned in the dissecting room, and which are soon afterwards 
forgotten. It would be unjust not to particularly notice tiie plate facing the title, — 
a view of the cranium and face, the bones slightly separated, — it being one of 
the most beautifully executed anatomical plates that has been anywhere produced. 



Art. XXII. — The Principles and Practice of Medicine. By John Elliotson, M. 
D., &c. &c. Edited by Nathaniel Rogers, M. D., &c. &c., and Alexander 
Cooper Lee. First American from the second London edition. Greatly en- 
larged and improved with notes and additions, by Thomas Stewardson, M. 
D., Physician to the Pennsylvania Hospital. Carey & Hart, Philadelphia, 
1844. 8vo. pp. 1046. 

In the preface to the second London edition of this work, we are told that it 
has met with the most decided success, having become a favourite class-book 
among the students of the London medical schools, and having been generally 
well received by the profession. The prejudices excited against Dr. Elliotson, 
in consequence of his sturdy maintenance of views and doctrines which have 
often been shown to be based on delusion, have not prevented a just appreciation 
of his lectures, which were found to be stamped with the impress of an original 
mind, richly stored with various and classical knowledge, and which contained 
ihe results of the author's large experience in the hospitals with which he was 
connected. As a bold and original thinker, an eloquent and forcible writer, a 
judicious and experienced practitioner and teacher, his reputation was already 
established; so that his lectures only required more systematic arrangement and 
filling up in certain portions, which had been but briefly treated of, to give them 
immediate currency as a standard work on the practice of medicine. This was 



1844.] UUiotson's Practice of Medicine, 175 

accordingly done under the superintendence of editors, who have added much 
valuable matter taken from various sources. 

Under such circumstances, we cannot but congratulate the profession in this 
country that it has now been placed within their reach, under the auspices of an 
editor whose ample experience and especial study of fevers, have enabled him 
to add several chapters and notes, which materially enhance the usefulness of 
this treatise. We refer, in particular, to Dr. Stewardson's chapter on remittent 
and yellow fevers, diseases so important and so prevalent in many sections of 
this country, and which had received but very cursory notices in the original 
work. Without attempting an analysis of the matter contained in this volume, 
we would merely state, that a well written introduction on the sources whence 
men are to derive their knowledge of disease and the means of rendering these 
available, brings the reader to the subject of general pathology, ''^■aegroti. hominis 
scieniia,^^ a chapter full of interesting and valuable information, and which will 
fully repay careful perusal. A graphic picture of inflammation, " the most 
general of all affections," is then sketched, and will be found replete with in- 
struction. Haemorrhage, the profluvia, dropsy, deficient secretion, changes and 
transformations of structures and new formations, as tubercles, carcinoma, and 
melanosis, are the subjects of as many successive chapters, and their descrip- 
tions complete the first part of the book, which it is seen embraces diseases that 
are general in their charactpr, but may affect " any part, either one or another." 

These are followed by accounts of diseases which are also general in charac- 
ter, but which "" appear to affect the whole body together." Under this head 
we find anaemia, scurvy, and fevers, whether intermittent, remittent, or con- 
tinued. The chapter on intermittent fever is exceedingly well written, and con- 
tains a large amount of very interesting matter. 

Under the head of continued fever, the author describes al§o typhoid and 
typhus fevers with much detail, but without drawing a distinctiorjibetween them, 
except so far as they are varieties of the same disease. Dr. Stewardson in a 
note points out the peculiar characters of each, so as to enable ihe practitioner 
at once to ascertain the existence of one form or the other, a matter of much 
moment, as typhus is comparatively a rare atlection in this country. 

The readers of this journal have already been made acquainted with the views 
entertained by Dr. Stewardson, in reference to remittent and yellow fevers,*" 
based upon his own experience in the Pennsylvania Hospital, and it is only ne- 
cessary here to say that he has received from various sources, and incorporated 
into his chapter on remittent fever, statements entirely confirmatory of his own 
as regards the anatomical lesions of this disease, showing a difference in this 
respect, as well as in the symptoms, between it and yellow fever. The re- 
searches of M. Louis at Gibraltar, in 1828, and these of M. Catel in Martinique, 
1838-9, are chiefly relied upon in his account of yellow fever, and the resulis at 
which they have arrived, accord with his own experience. 

In the third part, the author considers what are termed local diseases, or those 
affecting "particular parts," taking them in order "a cnpite ad ca/cem," com- 
mencing, however, with those which affect the surface, or cutaneous diseases. 
Proceeding thence to the interior, he has described with much detail tlie diseases 
of the nervous system: the chapter on the affections of the intellect is admirably 
well written. The diseases of^ the respiratory organs, and of the heart, of the 
chylopoietic viscera, and of the urinary organs, and finally those of the fibrous 
tissue, viz. gout and rheum^sm, are described in the subsequent parts of the 
book. We would mention nere, that Dr. Stew^ardson has given an account of 
cholera infantum, a disease peculiar to this country, and which therefore rarely 
attracts the attention of European writers. 

It is somewhat to be regretted, that in making their additions to these lec- 
tures, the London editors liave not endeavoured so to incorporate their selections 
with the text, as to make of these '•'• undiqxie collatis membris,''' one homogeneous 
whole. But after all, this is a fault rather of manner than of matter, and is, 
therefore, of minor importance. C. R. K. 

* American Journal of the Medical Sciences. April, 1841, and April, 1842, 



176 Bibliographical Notices, [Jan. 



Art. XXin. — Mtdical Report of the Western Lying-in Hospital and Dispensary, 
25 Arran-Quay ^ for the years 1841-42. By Fleetwood Churchill, M.D., 
M. R. I. A., Vice-President of the Obstetrical Society, and of the Association of 
the College of Physicians; Lecturer on Midwifery, &c. at the Richmond Hos- 
pital School, &c. &c.; and R. D. Speedy, Esq., L. R. C. S. I., Surgeon to the 
Hospital, and Lecturer on Midwifery, &c. in the School of Medicine, Apothe- 
caries' Hall. Dublin, 1843, pp. 19, Bvo. 

From this very interesting report we glean the following facts: — 
In 1163 cases of labour at full time, the number of children amounted to 1175, 
(691 males, and 484 females,) of which 63 (44 males, and 19 females) were 
still-born, or died at birth; of these 12 were premature, 15 still-born, 2 putrid, 
4 footling cases, 8 breech presentations, 1 head and hand presentation, 3 arm 
presentations, 3 funis presentations, 6 crotchet cases, 2 forceps cases, 1 placenta 
praevia, 4 syphilitic. 

The ages of 1067 patients were ascertained as accurately as possible: — 

77 were at or under - - - 
296 " between 

370 " " ... 

177 " " ... 

117 u ,, ... 

40 " » ... 

In 982 cases the entire duration of labour was as follows: — 

In 357 it was under 

312 " between - 

214 " *' . . 

50 " '' . - 

17 " " . - 

11 *t '» - - 

15 " " . - 

2 ^' '' - . 

3 « ti . - 
1 « " . . 

The extreme prolongation of some of these cases, was owing to the friends of 
the patient deferring their application for assistance. 

The period which elapsed between the commencement of labour and the 
rupture of the membranes, was noted in 981 cases. 

In 167 it was about 

between - 



20 years of age, 


20 and 25 




25 " 30 




30 " 35 




35 " 40 




40 " 50 




as follows: — 




61 


lours 


6 and 12 


It 


■ 12 " 24 


tt 


■ 24 " 36 


" 


■ 36 " 48 


(« 


. 48 " 60 


t& 


■ 60 " 95 


(( 


100 


a 


121 


it 


153 


n, 



335 


<,i 


165 


(( 


113 


(( 


71 


li 


33 


a 


46 


«( 


23 


a 


8 


a 


9 


ii. 


4 


u 


2 


'' 


1 


(( 


3 


i( 


1 


u 



about 



In 812 cases the interval between the rupture of the membranes and the birth 
of the child was as follows: — 



21 


lOurs, 


2 and 6 


n 


6 " 10 


(( 


10 " 14 


(( 


14 " 18 


a 


18 " 22 


li 


22 « 26 


a 


26 " 30 


(( 


30 " 38 


it 


38 " 40 


ii 


50 


ii 


60 


kk 


70 


(( 


80 


(1 


105 


ti 



1844.] Report of Western Lying-in Hospital, 177 



In 386 it 


was about 


142 


(( 


120 


(( 


50 


(( 


34 


u 


17 


it 


26 


tk 


11 


(4 


9 


U 


4 


(I 


1 


(( ' 


1 


u 


1 


(( 


;es, from the birth of th 


5 minutes in 


10 


*' 


15 


'< 


20 


" 


25 


i( 


30 


" 


35 


4' 


40 


" 


50 


" 


60 


t' 


From 1 to 2 hours in 


" 2 to 3 


" 3 


to 4 " 



1 


hour, 


2 


hours, 


4 


41 


6 


44 


8 


44 


10 


44 


15 


44 


20 


44 


28 


44 


35 


44 


40 


44 


50 


44 


120 


44 


ilsion 


of the 


98 cases, 


190 


44 


175 


44 


166 


44 


48 


44 


126 


44 


16 


44 


30 


44 


43 


44 


14 


44 


33 


44 


9 


44 


5 


44 



The latter cases, when the placenta was retained so long, were under the 
care of midwives, who applied for assistance on this account. 
In 1008 cases the presentation was as follows: — 

In 941 the head presented, 

13 the hand descended with the head, 

22 the breech presented — 8 dead, 

18 the feet " 4 do. — the funis prolapsed in 4. 

€ the funis " 4 do. 

5 the arm " 3 do. — two of them putrid. 

2 the placenta " 1 do. 

There were thirteen cases of twins. In four cases the children presented 
naturally — six children were saved, and two^ which were premature, died. In 
six cases one child presented the breech and the other the head— /en were born 
alive, two were lost. In one case one child presented footling' and the other the 
head — hath were saved. In another^ one child presented the head and the funis, 
and the other the foot and funis — both were lost. In a tJdrd case both the chil- 
dren presented the feet and funis, and were lost. 

In ten cases there was hemorrhage between the birth of the child and the ex- 
pulsion of the placenta; in six of which manual extraction was necessary, but no 
unfavourable results followed. 

In six cases flooding occurred before delivery — three were cases of accidental^ 
and three oi unavoidable hemorrhage. The rupture of the membranes was suffi- 
cient in the accidental and in one of the unavoidable cases, and the mothers and 
the children recovered. It was necessary to turn and deliver the child in the 
other two cases — one of the mothers died and one recovered: one of the children 
was saved. 

Seven patients were attacked by convulsions — all recovered. 

One fatal case of uterine phlebitis occurred, and several slight attacks of hys- 
ieritis, which were relieved by the usual treatment. 



178 Bibliographical Notices. £Jan. 

One fatal case of rupture of the uterus occurred. 

Version was performed six times (1 in 243); five times on account of present- 
ation of the arm — all the mothers recovered, and three children were saved, the 
others were putrid: and once because of unavoidable hemorrhaore. 

The forceps were used in eight cases (1 in 182). Seven of the mothers re- 
covered, and the death of the remaining one was caused by disease of the heart. 

\n eight cd-ses the perforator WdiS employed (1 in 182). Six of the mothers 
recovered, and two died — one from rupture of the uterus, as recorded above, and 
one from disease of the liver. 

Of the 1463 women attended during these two years, only Jive died, or 1 in 
292. One sank from disease of the liver, another from disease of the heart, a 
third after unavoidable hemorrhage, a fourth from uterine phlebitis, and the fifth 
from ruptured uterus. 

Since the establishment of the hospital, seven years ago, 3211 women have 
been attended, of whom 15 died, or 1 in 214. 

There occurred 4 cases of unavoidable hemorrhage — 1 in 802. 
" 6 " accidental hemorrhage, 1 in 525. 

" 34 " hemorrhage after labour 1 in 94. 

" 10 " convulsions (3 lost) 1 in 391. 

Version was practised in seventeen cases— 1 in 188. Sixteen recovered. Six 
children saved. 

The forceps were used in eleven cases— 1 in 291. Ten recovered. Seven 
children saved — two putrid. 

The perforator was employed in twenty cases — 1 in 160. Seventeen recovered. 

The following cases of puerperal convulsions are detailed: — 

Case I. — Mrs. Spalls, who had been subject to severe head-aches and epi- 
leptic fits during her pregnancy, was taken in labour of her first child on the 5th 
of June, 1841. 

We were called on to see her at 8 o'clock, A. M. on the 6th of June, as she 
had been seized with severe puerperal convulsions. We then learned that she 
had been in active labour for more than 24 hours, that the liquor amnii had 
escaped, and we found the os uteri relaxed, but not fully dilated: the head had 
entered the brim of the pelvis. The convulsive paroxysms recurred every ten 
minutes; she was quite insensible during the intervals, and her pulse was strong 
and full. 

Twenty-five ounces of blood were abstracted from the arm; the bowels were 
cleared out by calomel and a purgative enema; and her hair was cut short, and 
cold applied to the head. 

10 o'clock, A. M. — The fits have abated both in frequency and violence; but 
it was deemed prudent to bleed her again to sixteen ounces. The labour is 
steadily advancing; but she remains insensible. 

The paroxysms returned with alarming frequency and severity at 12 o'clock; 
her breathing became stertorous, and the tongue was much injured. Venesection 
was immediately repeated to the extent of twelve ounces. 

As the head now occupied the pelvic cavity, and as another violent convulsion 
took place while we were consulting about the case, it was evident that imme- 
diate delivery would alone avert the most serious consequences. Mr. Speedy 
therefore applied the forceps, and after considerable difficulty from the struggles 
of the patient, and her incessant change of posture, the child was extracted alive, 
and the placenta soon followed. During the operation this patient was insensi- 
ble, but soon after delivery became more composed, and the insensibility gradu- 
ally disappeared. 

Severe diarrhoea (which at first resisted the most active treatment) set in on 
the fifth day, and had very nearly proved fatal; but it was at length arrested by 
an enema of the solution of the acetate of lead with opium, after which her con- 
valescence took place rapidly. 

Case II. — Mary M'K. was delivered of twins on the 4th of October, 1841, at 
4 o'clock, P. M. without the occurrence of any unusual symptom. We learned, 



1844.] Case of Jineurismal Varix. 179 

however, that her spirits had been much depressed during her pregnancy and 
when in labour. 

She was seized with epileptic convulsions 8 hours after delivery, which were 
so severe that she was repeatedly thrown out of bed by the muscular contractions 
— and there was scarcely a moment's interval between them. Thirty ounces of 
blood, taken from the arm, had the effect of moderating the violence of the 
paroxysms; the head was shaved, and cold was applied to it; and the bowels 
were well cleared out by calomel purges. 

The pupils, who remained at her Ised-side for 24 hours, reported that thirty- 
six fits took place during that time. Tt was necessary to bleed her on the morn- 
ing of the 6th to sixteen ounces, and to blister the head, after which treatment 
she gradually recovered. 

Case III. — Theresa Malone, aged 19, was delivered of a female child June 7, 
1842, at 8, A. M. The labour was natural, and she continued well until the 
third day, when she was attacked by epileptic convulsions. She was bled 
largely, with great benefit; the paroxysms ceased, and she recovered well. 

Case IV. — Eliza Filzpatrick, aged 3(j, was delivered of a female child, after 
a natural labour, June 18th. On the afternoon of the same day, about 12 or 14 
hours after delivery, she was seized with epileptic convulsions, the fits recurring 
every 10 or 15 minutes. The usual treatment was adopted with success: she 
was bleed freely, her head was shaved and blistered, and calomel and purgatives 
given internally. The paroxysms diminished in frequency and violence, and 
ultimately ceased, and she recovered well. 

Case V. — Frances Finn, aged 30, was taken in labour of her first child on the 
17th of October, 1842. Assistance was applied for on the I9th, in consequence 
of her having been attacked by convulsions. The head was in the cavity of the 
pelvis; but the labour pains had diminished in force, and caused no advance. 
The fcBtal heart was inaudible. Under these circumstances we decided to de- 
liver by the crotchet, which Mr. Speedy accomplished with some diflaculty, 
owing to the violent convulsive struggles. The patient recovered well. 



Art. XXIV. — The Jiwiomi]^ Physio!uixy<> Patliolos^y and Treatment of Cancer. By 
Walter Hayle Walshe, M. iJ., &c. &c. With additions by J. Mason War- 
ren, M. D., &G. Boston, William D. Ticknor & Co., 1844, pp. 351, 12mo. 

This is a reprint of the article Cancer from the Cyclopedia of Practical Sur- 
gery. It is decidedly the most able of the pieces which has yet been contributed 
to that work, and is a good example of what an article of the kind should be, 
concise, learned, and well vi^ritten. ''I'he anatomy, physiology, pathology, and 
treatment of the affection is first entered into, and the disease is afterwards 
treated of as it affects each of the different tissues, organs, and cavities of the 
body. VVe recommend it to our readers as the best resume upon the subject 
with which we are acquainted. The American editor has enhanced the value of 
tl»e book by the additions which he has made to it, chiefly relating to the surgi- 
cal operations required, whicli in many cases were omitted by the author. 

G. W. N. 



Art. XXV. — Observations sur un cas de Varice Anevrysmale dans la region teru" 
porale druite. Par le Doct. F. Gabe de Massarellos. Munic, 1843, 4to. 
pp. 16. 

Case of Jineurismal Varix in the right temporal region. By Dr. F. Gabe de 
Massarellos, &c. 

The object of this brochure is to make known a curious instance of aneurismal 
varix in the temporal region; and the case beino- an instructive one, and, so far 



180 Bibliographical Notices, [Jan. 

as we know, unique, the following' summary of it may prove interesting. A 
student, aged 19, received in a duel in November, 1835, a sabre wound about 
three and a half inches in length, in the right temporal region. Profuse hemor- 
rhage followed, but when seen by a surgeon two and a half hours afterwards, 
this had entirely ceased, the wound being filled with a firm coagulum. The 
wound was washed, and a small vessel which then spirted, v/as treated by tor- 
sion, and the lips of the wound brought together by suture. By the 8th day 
cicatrization was perfect. A few days after this the patient noticed a purring 
sound in the right ear, and on the lower extremity of the cicatrix near the lobe 
of the ear a small pulsating tumour was perceptible. In the first months fol- 
lowing it, the tumour increased but very slowly, though the frontal veins, and 
the temporal vein of the right side in its whole course became enlarged, and the 
latter pulsative. 

In September, 1836, a surgeon proposed for its cure the ligature of the right 
external carotid artery, but after exposing that vessel found it so much dilated, 
that he judged it best again to close the wound without securing it. In October 
of the same year, the disease still progressing, the patient consulted Chelius of 
Heidelberg. By compressing the primitive carotid or the temporal artery, he 
ascertained that the tumour couid be made entirely to disappear, while pressure 
exerted on the temporal above the tumour rendered it more tense. During the 
months of November and December, different essays to cure the affection by 
compression, made by means of an instrument adapted to the case, joined with 
a rigorous diet and repose, were tried; but the inability to bear the pressure in- 
duced the Professor to take up the right primitive carotid. This operation was 
done on the 18th of January, 1836, The ligature came away on the 21st day, 
and a little time after it the wound cicatrized. For a few days the operation 
promised success, but as soon as the collateral circulation was established, the 
symptoms reappeared as before its performance. Five years and a half after this 
operation. Professor Walther of iMunich was consulted, at which time the tu- 
mour presented very much the same appearances that we have mentioned, with 
the exception of the dilatation of the veins, whicli had become much more con- 
siderable. The pulsations in the primitive carotid, which had been ligatured by 
Chelius, were perceptible in its whole course, and the right internal carotid was 
sensibly dilated. An operation by the ancient method was now proposed to 
him, and done on the 4th of May, 1842, by M. Stromeyer. The external carotid 
being compressed, an incision about two and a half inches long was made 
through the thickened parietes of the vein, after the emptying of which, and re- 
moving the compression, the blood was seen to proceed from the inferior part 
of the sac. The operator now sought by means of a probe, though unsuccessfully, 
to find the point of communication between the artery and vein, and not willing 
to make another incision to expose the vessel, "he placed a ligature upon the 
inferior part of the venous sac, as near as possible to the point where tins dilated 
vein entered into the substance of the parotid." Upon now removing the pres- 
sure, blood was no longer seen to flow from the inj'eriur part of the sac, !)ut to 
be thrown out per saltem from the superior part. This evidently proceeded from 
the posterior auricular artery, and was perfectly controlled by pressure upon the 
external carotid, which artery was now exposed and secured, after which all 
bleeding ceased. The edges of the wound were united by a single suture and 
adhesive strips, and covered by compresses and a bandage. 

On the 6th of May, the wound was erysipelatous. On the 11th, this had dis- 
appeared, and the ligature on the venous sac came away. On the 12th, the 
second ligature was detatched; the wound presenting a healthy appearance, and 
suppurating freely. On the 21st of June, cicatrization was perfect, and some 
months after the patient was examined and found to be free from any return of 
the affection. 

Fronj what was observed during the last operation, the author concludes that 
the posterior auricular and temporal arteries had been both originally wounded, 
and placed in direct communication with the temporal vein, likewise wounded 
in two different points, and thus forming a double aneurismal varix. 



1844.] Goddard on the Teeth. 181 

On former occasions in this Journal (October, 1841, and January, 1843,) we 
offered some remarks to prove the little chance of benefit to be derived from the 
method of Hunter in the cure of the species of aneurism under consideration, 
and the above is another interestinfj case going to show its inapplicability to 
them. While on the subject of aneurism, it may not be amiss to notice the 
renewed efforts that of late have been made by continental surgeons, to take 
from John Hunter the credit of that operation to which his countrymen and our- 
selves justly attach his name. They speak of his method of operating as that 
of Anel; or, as is the case with the author whom we have just noticed, as the 
method of Anel and of Hunter. True it is, that in 1710, seventy-five years before 
the date of Hunter's operation, Anel had secured the brachial artery immediately 
above the sac, in a case of aneurism, but in this he but followed the practice recom- 
mended by Pare, and if we look only to priority of date, as establishing a claim 
to originality in the m.ethod, it is to the latter that it is justly due. Anel has no 
title to the honour of it. Mr. Hunter's claim to merit from the operation, is not 
alone in having recommended the ligature to be placed above the aneurism, but 
in having been the first to point out the principles upon which the cure was 
perfected, and establish fully the truth of his doctrines by observations and ex- 
periments, thus directing general attention to the immense benefits to be derived 
from it. G. W. N. 



Art. XXVI. — The Anatomy, Physiology and Pathology of the Human Teeth; 
with the most approved methods of treatment, including operations, and the 
method of making and setting artificial teeth; with thirty plates. By Paul 
B. Goddard, M/D., M. A. N. S., M. A. P. S., Demonstrator of Anatomy in 
the University of Pennsylvania, Lecturer on Anatomy, &c, &c. Aided in the 
practical part by Joseph E. Parker, Dentist. Philadelphia, Carey and Plart, 
1844, pp. 227, 4to. pi. 30. 

This volume has been offered to the profession, the author informs us in his 
preface, to supply the demand which has existed for some years, for a plain prac- 
tical treatment on the subject of the teeth, and particularly on the manufacture 
of porcelain, which he says, has attained a higher degree of perfection in this 
country than in any other. 

The work is divided into six parts, one of which is appropriated to each of 
the following subjects: — 1st, The history of the teeth and a brief description of 
the maxillary bones, the alveoli, the articulation of the lower jaw, and the mus- 
cles of mastication; 2d, The anatomy of the teeth; 3d, The physiology of the 
teeth; 4th, Dental pathology and therapeutics; 5th, Dental hygiene; and 6th, Me- 
chanical dentistry. The whole is concluded with a very copious bibliography. 

The account of the structure of the teeth is a very valuable one, and is' illus- 
trated by some remarkably well executed views of their microscopic structure, 
taken from Retzius and Gerber, all of which have been " most carefully veri- 
fied by the author, by means of a very fine microscope in his own possession, 
and another in the hands of his relative Dr. C. F. Beck, whose liberality has 
made him the possessor of an instrument, not surpassed at the present time." 

The chapter on the origin and development of the teeth, is an extremely in- 
teresting one, and contains a full account of Mr. Goodsir's recent investigations. 

The causes of decay are very fully stated, and the explanation of the manner in 
which the ivory of the tooth is destroyed, whilst the enamel seems almost per- 
fect, is the most satisfactory we have seen offered. We transcribe this as a fair 
specimen of the author's style. 

'• Where the commencement of decay is external, it is due to a lodgement of 
some acid or acidifying article of food, (as bread, sugar, cakes, &c., which ra- 
pidly undergo the acetous fermentation, when favoured by the warmth and 
moisture of the mouth,) in the cavities or deficiencies of the enamel, or in the 
interstices between the teeth near their necks, where the protecting- coat of 



182 Bibliographical Notices, [Jan. 

enamel is thin. For a view of the spots most favourable for the commencement 
of this process, see Plates X. and XII., figures 1, 2, 3, 4, on each. The acid 
generated having reached the surface of the ivory by this minute fissure or hole, 
commences to act upon its calcareous portion, after neutralizing the alkaline 
serum which pervades its tubuli. It first dissolves the calcareous contents of 
the tubuli, and then the earthy portion of the ivory in their interspaces; this is 
readily corroborated by immersing a section of a tooth in dilute acid, under the 
microscope, when the contents of the tubuli will be seen to dissolve first with 
effervescence. Afterwards, the walls will become slowly transparent, indicating 
the loss of their calcareous ingredient. The animal portion of the ivory, thus 
deprived of its calcareous matter, becomes soft, and usually either brown or 
black, and is gradually mixed with and carried off by the saliva. There is no 
doubt, at present, that the process is hastened after once an open cavity is form- 
ed, by the presence of either animal or vegetable parasites in the decayed cavity, 
which is an exceedingly proper nidus for such forms, and it is even supposed by 
Henle,* that this may account for the spread of the decay from one tooth to 
another. This process is sometimes exceedingly insidious, in consequence of 
the original opening in the enamel maintaining its primitive size, until great 
destruction of the ivory has taken place beneath it, when it suddenly breaks in 
and a cavity is found, where a few hours before none was suspected. In the 
case where the decay commences on the surface of the ivory under the enamel, 
the explanation of the process is slightly different. In this case there is no 
perceptible fissure or hole in the enamel, but a want of union between its basalt 
like columns, a porous condition indicated by a slight and scarcely perceptible 
opacity. The ivory at the bottom of this porous spot is bathed in an alkaline 
serum furnished by its pulp, whilst the outside of the tooth is constantly ex- 
posed either to the contact of acid or acidifying substances. These are the 
conditions most favourable to the occurrence of cndosmosis or transudation, the 
alkaline matter exuding, and the acid intruding simultaneously. The ends of 
the tubuli thus bathed in acid, take it up by capillary attraction and carry it in 
the direction of the pulp, dissolving the calcareous contents of the tubuli, and 
presenting the appearance, when examined at this stage, represented in Plate 
IX. figure 20. 'rtie progress, after it has thus commenced, is the same as that 
just described. The course of the tubuli and their capillary attraction for fluids, 
causes the decay to progress in the direction of the pul[), hence its investment is 
soon exposed, and inflammation occurring, toothache is the result. The decay, 
if suffered to progress, destroys first the crown and pulp, sometimes almost with- 
out pain, and then becomes nearly stationary, because the sides and not the ends 
of the tubuli are presented to its exciting cause; the absorption of the acid fluid 
is therefore very slow, and the rapidity of the decay diminishes in a correspond- 
ing ratio." 

We must add, that the work is got up in the handsomest manner. The plates 
are indeed the best specimens of lithography we have seen executed in this 
country. 



Art. XXVII. — The Dissector, or Practical and Surgical Anatomy . By Erasmus 
Wilson, Author of a System of Human Anatomy, &c. With one hundred 
and six illustrations. Modified and re-arranged by Paul B. Goddard, M. D., 
Demonstrator of Anatomy in the University of Pennsylvania. Lea & Blan- 
chard, 1844, pp. 444, r2mo. 

The high reputation which Mr. Wilson has acquired by his valuable System 
of Human Anatomy, will secure a favourable reception for his present work. 
As modified and re-arranged by Dr. Goddard, it is well suited to the wants of 
the American student of anatomy, and is an excellent guide for him in the dis- 

* Encycluptdie Analomique,. par A. J. L. Jourdan, Tome, viii. page 453. 



1844.] Watson's Lectures. 183 

sectino- room. It is very copiously illustrated with wood-cuts, which will 
greatly facilitate the labours of the student in acquiring what must be considered 
the essential basis of our science, a knowledge of anatomy. 



Art. XXVIII. — Lectures on the Principles and Practice of Physic; delivered at 
King's College, London. By Thomas Watson, M. D.. Fellow of the Royal 
College of Physicians, Physician to the Middlesex Hospital, and formerly 
Fellow of St. John's College, Cambridge. Philadelphia, Lea and Blanchard, 
1844, pp. 920. 

These lectures were delivered in the years 1836-37, and were subsequently 
published in the London Medical Gazette. They v-^ere received with very great 
favour, and at the desire "formally expressed" of many who heard them de- 
livered or had read them, they have been recently published in a collected form. 

They constitute the most complete and judicious course of instruction in the 
leading principles of general and special pathology, and in the therapeutic 
management of disease, that has appeared. 

The first sixteen lectures are devoted to general pathology, including etiology 
and general therapeutics. In these, a general account is given of the different 
ways in which the various parts of the body are liable to be altered in structure, 
or disordered in function; and of symptoms and of their ascertained relations 
with the several forms of altered structure. The causes of disease are treated 
of, and the different ways in which death may take place pointed out. Inflam- 
mation and its peculiar phenomena, as they are presented in the various tissues 
of the body, and the modifications which morbid conditions generally undergo, 
under the influence of certain diatheses or peculiar dispositions of the body, are 
next discussed. And lastly, some generalities are laid down in regard to haemor- 
rhages and dropsies. 

These lectures present an admirable summary of general pathology and thera- 
peutics, and a very suitable introduction to the practical part of the course. 

The remaining lectures, seventy-four in number, are devoted to the exposition 
of the symptoms, causes, diagnosis, prognosis, pathology and treatment of 
special diseases. The arrangement is chiefly an anatomical one, which the 
author prefers, "as being comprehensive, and inartificial, and as tending to 
facilitate diagnosis." He treats first, therefore, of the diseases of the parts that 
appertain to the head and spinal cord; and then in succession of those of the 
parts belonging to the neck, the thorax, the abdomen, the joints, muscles and 
skin. A perfect nosological arrangement is not attainable in the present state of 
our science, and that followed by Dr. Watson may, therefore, be as convenient as 
any other, though we must confess that we should give the preference to that 
adopted by the eminent Professor of the practice of medicine in the University 
of Pennsylvania, which is ^physiological one, diseases being arranged according 
to the particular systems in which they are seated. Dr. Watson has, indeed, 
at times abandoned his own and adopted this plan. Thus in that portion of his 
course which relates to particular diseases, he interweaves "certain pathological 
considerations applicable not so much to the whole body, as to the several great 
systems of which it is made up." Thus before treating of the brain, he discusses 
the functions peculiar to the nervous system, and the obstructions and disturb- 
ances to which those functions are obnoxious. In the same way he prefaces the 
consideration of the diseases of the chest with a general view of the great func- 
tions of respiration and circulation, and of the manner in which they are liable 
to be impeded or otherwise disordered. And as prefatory to the diseases of the 
abdomen, he treats in the same way of the functions of nutrition and of waste. 

These preliminary disquisitions are drawn up in the ablest manner, and are 
full of interest and instruction. In that which treats of the functions of respi^ 
ration and circulation, there is given an excellent description of the means of 
examining the chest by auscultation and percussion; illustrated by wood-cuts, 



184 Bibliographical Notices. [Jan. 

showing the regions of the thorax. And the method of examining the abdomen 
is described in the appropriate place. 

Through the whole of his course, the author seems to have kept steadily in 
view the duties of a lecturer, as expressed by Lord Bacon, and which is para- 
phrased in the introductory lecture, thus: — • 

"The lecturer must not be the ant, collecting all things indiscriminately from 
all quarters, and using them as provender for his discourses. 

"Nor the spider, seeking no materials abroad, but spinning his web of spe- 
culative doctrine from within himself. 

"But rather the bee, extracting crude honey from various flowers, storing it 
up in the recesses of his brain, and subjecting it to the operation of his internal 
faculties, until it is fit to be produced, digested, and ready for use." 

Dr. Watson shows himself to be thoroughly acquainted with the most authori- 
tative writers on the various subjects of which he treats without making unne- 
cessary pretensions to erudition; and his appreciation of their views, prove him 
to possess a sound and discriminating mind, one not easily misled by the delu- 
sions of the day. He discusses also every subject with a candour which inspires 
confidence, and gives his judgment with a caution that proves him to be a safe 
guide. His style is remarkably clear and simple, and well calculated to impart 
to the student precise ideas of the principles and practice of the healing art. 
Indeed, we know of no other work better calculated for being placed in the 
hands of the student, and for a text-book, and as such, we are sure it will be 
very extensively adopted. 

The practitioner may also consult it with advantage. He will find it to con- 
tain the observations of a well read and experienced physician, and to present an 
excellent summary of the existing state of knowledge, in relation to the subjects 
discussed. On every important point, indeed, the author seems to have posted 
up his knowledge to the day. 



1844.] 185 



SUMMARY 

OF THE 

IMPROVEMENTS AND DISCOVERIES 

IN THE 

MEDICAL SCIENCES. 



ANATOMY AND PHYSIOLOGY. 

1. Comparative Anatomy of the Skin in the different Varieties of the Human 
Race.— Ax the meeting of the French Academy of Sciences of the 2lst August, 
M. Flourens communicated the results of some of his recent researches into 
the comparative anatomy of the skin in the different varieties of the human 
race, the more immediate subjects of his present investigation being the skins of 
the Kabyles, Arabs, Moors, and Negroes. His preceding researches have estab- 
lished the fact that the skin of the white man is composed of three lamina?, or dis- 
tinct membranes — the dermis and two epiderms; between the second, or internal 
epiderm, and the derm, there is no appearance of colouring matter. 

The colour of the skin of the Kabyle, Moor, and Arab, is bistre; but in gene- 
ral this colour is darker in the Arab than in the Moor, and in the Moor than in 
the Kabyle. Yet everything in the structure of these three skins is the same; 
there are in all two epiderms and a dermis, and in all, between the second epi- 
derm and the dermis, there is a layer of colouring matter, and a pigmental mem- 
brane. 

The skin of the mulatto and negro presents the same structure as that of the 
Kabyle, Moor, and Arab. All these coloured races have the same structure in 
common — two epiderms and a dermis, and between the second epiderm and the 
dermis a colouring apparatus— that is to say, a pigmental membrane, and a layer 
of colouring matter. 

The principal facts which result from this memoir are — 1. that the structure 
of the skin in all these races, widely different as they are in appearance, the 
Kabyle, Arab, and Moor, on the one side, and the American and negro on the 
other, are essentially and fundamentally the same. The skin of the white man 
is no exception to the common law. It also has its apparatus of colour, very 
imperfect, it is true, but yet well marked; the skin of the white man, under cer- 
tain circumstances, and at certain points, presents all the structure of the skin of 
the coloured varieties of the human race. 

M. Flourens argues from these facts in favour of the original unity of the 
human race. What he has proved from the study of the skin, he intends still 
further to confirm, by another memoir on the skeleton, and especially on the 
bones of the head. — Prov, Med. Joiirn., 23 Sept., 1843. 

2. Structure and Function of the Intestinal Villi. — MM. Gruby and Delafond 
laid before the Academy of Sciences, on the 5th of June, a paper upon the 
Anatomy and Function of the Intestinal Villi, in which they state, that '* the 
villi of the small intestine are covered not only with cylindrical epithelium, but 
also with another form of epithelium, which, from its situation, they have named 
capitate. Each cell of epithelium is provided with a cavity, the orifice of which 
is sometimes wide open, at others more or less completely closed. At the sur- 
face of the epithelium of the villi of the small intestine of a dog, some vibratile 



186 Progress of the Medical Sciences, [Jan. 

cilia not yel described, of which the function is perhaps to displace, when neces- 
sary, the coarser chyle, which is in contact with thr "[lithelinm. 

*' Underneath the epithelium, the villus is composed iner^y of a vascular and 
fibrous membrane, and within this membrane, of one chyliferous vessel, or canal 
only. 

" In contracting- according to their loncritudinal axis, the villi become short- 
ened, and take a conical form, of which the base is towards the mucous mem- 
brane. In contracting according to their transverse diameter, they become thinner 
and longer. In fine, they execute movements in every way, as we have before 
said in our note to the Academy on the 4fh of Sept. 1842. In executing these 
movements, the villi empty themselves of the blood and chyle contained in their 
vessels, and put themselves iii contact with the new parts of the coarser chyle 
digested from the aliments. Each cell of epithelium must be considered as an 
organ especially designed to receive the coarser chyle proceeding from digestion, 
and to convert it into an homogeneous chyle, formed of an infinity of small 
molecules, held in suspension in a transparent and spontaneously coagulable 
liquid. These molecules, and the liquid, are the only parts fit to pass through 
the deep orifice of the epithelium cells, in order to get into the one chyliferous 
vessel placed in the centre of the villus. 

"Each cell of epithelium has a quadruple function: — 1st. To fill itself with 
the coarser chyle proceeding from the digestive process. 2d. To divide and 
attenuate this chyle, and convert it into a pure and homogeneous chyle. 3d. To 
expel this liquid, so elaborated, and direct it towards the chyliferous canal 
through the vascular and fibrous tissue. This apparatus we have named chylo- 
genous. 4th. In fine, to imbibe the substances dissolved by digestion, and to 
make them enter the vascular apparatus." — Physiological Journal, from UEx- 
perience. 

3. On Venous Jlbsorpfioji. — Prof. Panizza in order to set at rest the disputed 
points as to whether absorption was accomplished by the vein or by the lympha- 
tics, performed a very extensive series of experiments on living animals. His 
first experiments were limited to administering certain saline substances to man 
and animals, and examining the blood, the urine, and the fa3ces. These salts 
wexQ nitrate of potash, prussiate of potash, hydriodate of potash, tartrate of 
antimony, chloride of barium, acetate of lead, sulphate of iron, &c. No very 
important results were arrived at in consequence of this mode of experimenting. 
The insoluble mineral salts, or those which became decomposed in the stomach, 
vrere found in the faeces. 'I'he soluble salts were almost entirely thrown off by 
the urine; in this case they were only found in very small proportion in the 
blood; this probably depending on those being thrown off by the kidney nearly 
as fast as they were absorbed into the circulation. The preparations of iodine, 
however, were found to be secreted pretty freely by the skin, and also with the 
saliva. A cotton shirt worn next the skin for thirteen days while taking hydrio- 
date of potash, on being tested, furnished distinct traces of iodine. Several 
insoluble metallic compounds were found to pass into the circulation. Thus 
kermes and aethiops mineral, chloride of silver, lead, metallic mercury, and iron 
filings, were recognized in the blood after being introduced into the stomach; so 
that the animal economy possesses the power of creating soluble compounds^ 
though their nature has not yet been determined by the clicmist. 

Having by these experiments ascertained what substances passed through the 
blood, and the most appropriate tests for each when mixed with the animal 
fluids, two dogs were fed for three days with soup, in which was a considerable 
quantity of prussiate of [)otash. The third day they were opened alive to test 
fluids and examine the tissues. When the inner surface of the intestinal tubes 
was touched with a solution of chloride of iron it instantly became of a bright 
blue colour — and this from the mouth to the anus. 'I'he urinary passages yielded 
the same reaction. About fifteen minims of fluid lymph were procured from the 
thoracic duct; it yielded no perceptible reaction. The blood from different arte- 
ries and veins was filtered through paper steeped in a persulphate of iron, a ^ew 



1844.] Anatomy and Physiology. 187 

drops of nitric acid being previously added; but the only blood which exhibited 
distinct reaction was that coming- from the veins of the small intestines. The 
serum of this blood ting-ed the filter of a blue colour. 

An ass was fed five days with foo(i mixed with hydriodate of potash. It was 
opened alive, and blood collected from the mesenteric veins, mesenteric artery, 
and vena portdp.^ a larg-e quantity of chyle from the thoracic duct, the urine, faeces, 
and chyme were all separately examined. Iodine was found in all, but existed 
in almost inappreciable quantity in the chyle or lymph from the thoracic duct. 

The most decisive experiment which Professor Panizza states, he has often 
repeated, one, too, which has often been made by other physiologists, and which 
seems to prove that the veins are the chief agents in absorption, was the fol- 
lowing. A horse was thrown to the ground, its intestines laid bare, and a por- 
tion of the small intestines, whose veins, after a short course, terminated in one 
trunk, was selected for experiment. This loop of intestine, about nine inches 
in length, was included within double ligatures, so as to separate it from direct 
communication with the rest of the system; only allowing it to receive a supply 
of blood by one arterial trunk, and carry back the blood by the one venous trunk 
above alluded to. A brass tube was then introduced through a puncture into the 
intestines, and a ligature passed around the only vein which carried the blood 
back to the heart; in order not to stop the circulation, however, the vein was 
punctured between the ligature and the intestine. About three drachms of con- 
centrated hydrocyanic acid were then poured into the intestine through the brass 
tube, and the tube instantly closed. I'he blood which flowed from the intestine 
was collected, and was found instantly to give out a strong odour of hydrocyanic 
acid or oil of bitter almonds. When tested, by treating the blood first with car- 
bonate of potass, then by muriate of iron, and a few drops of nitric acid, the 
characteristic blue colour was struck. The animal, in the meantime, exhibited 
no symptoms of poisoning, though the nerves and lymphatic vessels of the loop 
of intestine were untouched. 

In another case the vein was only held compressed for two minutes after the 
introduction of the acid, during which no poisonous symptoms were exhibited; 
but the moment the pressure was taken off, at least within a minute and quarter, 
all the characteristic symptoms of poisoning by that acid were manifested. 

In other cases the intestine was only connected to the body by the artery and 
vein, and then the poisonous symptoms were manifested within the minute. 
But if the blood from the vein were allowed to escape, even though the nerves 
and lymphatic vessels were entire, no poisonous symptoms were ever mani- 
fested. The poisonous acid was all thrown off with the blood. 

The same kind of experiments were repeated with hydriodate of potash, &c. 
The salt used was always found in large quantity in the blood coming from the 
loop of intestine, but not in the lymphatic vessels. 

Professor Panizza made a number of experiments on dogs and other animals 
by cutting the nerves of the lips and tongue before applying the hydrocyanic 
acid, to ascertain whether the absorption by the veins would be prevented by 
depriving the part touched by the acid of its nervous influence. The animals 
were poisoned as quickly as if the nerves had been entire. In several cases he 
used precautions to prevent the vapour being breathed, but the same result 
followed. 

Some experiments were also made with the view of determining accurately 
whether by breathing the vapours of substances they were introduced into the 
blood. It was satisfactorily found that they were, being discovered in consider- 
able quantity in the blood. From his experiments Professor Panizza concludes 
that secretion and absorption take place by means of porosities in the capillary 
system, as no free open mouths have yet been discovered: that absorption takes 
place by lymphatic vessels and by veins; that substances are the more easily 
absorbed in proportion as they are soluble, divisible, and capable of being as- 
similated. That many mineral substances continue to manifest their presence 
in the blood and urine many days after they have ceased to be administered. 
That medicines are absorbed into the blood, circulate with it, and afterwards act 



188 Progress of the Medical Sciences. [Jan. 

on the nervous system; consequently the blood is the way by which medicinal 
agents arrive at, and transmit their action to the nervons system. — Ed. Med, and 
Surg. Journ., Oct. 1843, from V Experience^ 11 i\iay, 1843. 



MATERIA MEDICA AND PHARMACY. 

4. New Counter'irritant composed of 'powdered Ipecacuanha root. — Dr. Han- 
nay, of Glasgow, in the Edinhurc^h Medical and Surgical Journal^ (Oct. 1843,) 
notices favourably a liniment first suggested to him by his colleague Dr. Easton, 
Professor of Materia Medica in Anderson's University. The following is the 
formula for its preparation: — R Ipecac- Puh\; Olei 0/ese Europ. aa. ^i].,- Adipis 
Suill 5SS.,- M, opt. fiat linimeniuni fricendo admovendum. The part we wish to 
irritate is to be rubbed freely with this liniment for fifteen or twenty minutes 
three or four times daily, and enveloped in flannels. This produces, in about 
thirty-six hours, or sometimes sooner, very numerous small papulae and vesicles, 
seated on a deep-red base of irregular extent. They become flattened in a short 
period, and assume the pustular character. Many of them run together; are 
confluent. The part feels hot to the hand of another, and a tingling sensation, 
never amounting to pain, is experienced by the patient. The eruption endures 
pretty vividly for a few (three) days, during which the pustules become covered 
with a scab-like scale, and fall off, leaving no mark. They never ulcerate, as 
do the pustules from the tartrate of antimony. Dr. H. regards the ipecacuanha as 
a very valuable addition to our counter-irritants. It is not over severe, as the tar- 
trate is occasionally found to prove. Yet, with all its moderation, it is very effi- 
cient, and extremely manageable. In feeble, young, and very irritable persons it 
will. Dr. H. feels assured, prove a very suitable counter-irritant. He specially 
begs attention to the use of it in the head diseases of a chronic kind in infants and 
young children. Many of these cases follow the suppression of eruptions and 
scabbed diseases of the scalp. Now, the ipecacuanha liniment produces a scab- 
bed state of the scalp, as nearly resembling the affections in question as can be 
imagined, and maintaining a counter-irritation on the surface. 

5. Solution of Tartar Emetic for the purpose of counter-irritation. — Dr. Han- 
NAY says that " there is one way of using the tartrate of antimony externally, 
which lessens its virulence, but still leaves enough of energy to make it also a 
valuable counter-irritant, — as more than twenty years experience has fully con- 
vinced him.* It is in solution. One drachm of the salt is rubbed up with an 
ounce of boiling water in a mortar. This is rubbed on the surface we wish to 
irritate in the same way as the liniment of ipecacuanha. This is never pro- 
ductive of the evils charged against the liniment. Its effects approach nearly 
to that of the ipecacuanha liniment. Both, particularly the liniment, may be 
continued or persisted in for a longer period, and what it wants in energy may 
be made up for by its longer agency. 

He has used the liniment in chronic affections of the chest, and, to his mind, 
with satisfactory results, certainly with as decidedly good effect as any of the epis- 
pastics, — over which its mild and manageable nature gives it a great superiority." 
— Edin. Med. and Surg. Journ., October, 1843. 

* Thes.Inaug. De Tart. Antimonii usu Externo. Edinburgh, 1823, In that 
thesis Dr. H. gave the following formula. R. Tart. Antim. one drachm, Mur, Hyd. 
Corras. five grains, Aq. Puree one ounce, Sp. Lavand. Camp. gt. ten. M. The 
muriate quickens its action in a decided manner; and Dr. H. still regards this 
lotion as a highly valuable application to the chest in pulmonary diseases. Dr. J. 
C. Williams also regards tartrate of antimony as serviceable in these cases and in 
this way. The addiiion of five grains of corrosive sublimate in the above formula 
will be found, according to Dr, H., to increase its power and efficacy. 



1844.] Materia Medica and Pharmacy. 189 

6. Observations and Researches upon a new solvent for Stone in the Bladder. 
By Alexander Ure, M. D., &o. — In perusing some inquiries relative to the 
treatment of certain forms of urinary disease, Mr. lire's attention was directed 
to the properties of carbonate of lithia, a substance of which no therapeutic ap- 
plication has been heretofore made. This substance occurs in various mineral- 
waters, some of which are said to be serviceable in certain unhealthy conditions 
of the urinary organs. 

In order to determine the solvent powers of carbonate of lithia with reference 
to uric acid and its compounds, at the common temperature of the human body, 
Mr. U. instituted the following experiments: 

A solution of one grain of carbonate of lithia in an ounce of distilled water 
was brought to a temperature of 98°, and pure uric acid gradually added in mi- 
nute portions until it ceased to dissolve. The quantity thus taken up was 2.3 
grains. The resulting solution, which remained unchanged the following morn- 
ing, being saturated with hydrochloric acid, threw down a precipitate of uric 
acid, amounting to two grains. Now it has been shown by Mr. U. that one 
grain of crystals of soda, dissolved in an ounce of water, took up only one grain 
of uric acid — that one grain of carbonate of potash lookup 1.4 grains— one grain 
of borax 1.2 grains — and four grains of bicarbonate of soda 1.1 grains. Hence 
it follows that the solvent power of carbonate of lithia is niore than double that 
of carbonate of soda; nearly double that of carbonate of potash or borax; and 
about eight times that of bicarbonate of soda, which is the active ingredient of 
the Vichy water. 

A human urinary calculus, composed of uric acid with alternate layers of oxa- 
late of lime, having been most accurately poised, after being previously brought 
to hygrometric repose, by digesting in fresh urine and then carefully dried, was 
placed in a solution of four grains of carbonate of lithia, in an ounce of distilled 
water, and steadily maintained at a blood-heat by means of a water-bath, during 
five consecutive hours. On being withdrawn, nicely w^ashed, and again dried 
as before, it was found to have lost five grains in weight, which is at the rate of 
one grain an hour. The calculus is deeply eroded in different parts, but the 
delicate lamina3 of oxalate of lime remain intact, imparting to the surface the ap- 
pearance of deep etching. The menstruum acquired a pale yellow tinge, and 
there fell down from it on cooling a light flocculent deposit of urate of lithia, in 
which silky crystalline tufts could be discerned by help of the microscope. It 
was still alkaline to litmus. Decomposed by means of hydrochloric acid, it 
yielded nearly three grains of pure uric acid. 

In another experiment, the remaining half of the same calculus being allowed 
to stand during four hours in two ounces of the natural Vichy water, from the 
spring called Hopital (containing three grains and a half of carbonate of soda), 
was found to have parted with two-tenths of a grain of uric acid; while the 
former portion of the calculus, placed under precisely similar circumstances, at 
the same time, in a solution of 1.6 grains of carbonate of lithia to two ounces of 
distilled water, afforded nine-tenths of a grain of uric acid. Thus is demon- 
strated the very superior solvent agency of the above feeble lithia solution over 
the Vichy water. 

Haifa grain of urate of soda (the ordinary basis of gouty concretions or chalk 
stones) diffused in an ounce of distilled water at the blood heat, completely dis- 
solved with the addition of one grain of carbonate of lithia, the solution con- 
tinuing limpid and unaltered; whereas, half a grain of the same urate in a simi- 
lar quantity of water at a corresponding temperature, rests apparently unchanged. 

It deserves notice, that when fresh healthy urine is rendered alkaline by car- 
bonate of lithia, no deposition ensues. 

A very large proportion of the stones which occur in the urinary bladder of 
man, are composed in whole or in part of uric acid. Of all the various menstrua 
hitherto recommended, none appears to promise more favourably. Dr. U. thinks, 
than the carbonate of lithia, from the promptitude and energy with which in dilute 
solution it attacks calculi of this description. If by means of injection we can re- 
duce a stone at the rate of a grain or more an hour, as the above experiment would 
No. XIIL—January, 1844. 13 



190 Progress of the Medical Sciences. [Jan. 

lead us to anticipate, weshallnotmerely diminish the positive bulk of the calculus, 
but farther loosen its cohesion, disintegrate it, so to speak, causing it to crumble 
down and be washed away in the stream of the urine. Cases may present them- 
selves in which it may be expedient to conjoin the use of the lithontriptor; but 
only occasionally and at long intervals. It is the frequency of repetition which 
renders that instrument so hazardous. 

It may be presumed, moreover, that the plan of throwing in a weak solution 
of this kind, would generally exercise a beneficial influence in obviating irrita- 
tion, by removing the sharp angular points and asperities of the broken frag- 
ments, where the practice of crushing is adopted. 

No apprehension need be entertained from the administration of injections, if 
judiciously directed. Sir Benjamin Brodie found that the bladder bore without 
inconvenience a stream of fluid composed of two minims and a half of nitric acid 
for each ounce of distilled water. {London Medical Gazette, June, IS3\.) An 
Austrian surgeon has recently introduced vinegar into the bladder, with excel- 
lent success, in an instance of phosphatic calculus. Mons. Lisfranc, the emi- 
nent French surgeon, has used in like mannerlincture of cantharides for the cure 
of enuresis; and Dr. U. himself has thrown a dilute solution of nitrate of silver 
into the bladder, with the best effect, incases of chronic catarrh of that vis- 
cus." — Pharmaceutical Journal, Vol. III., No. 2. 

«. "~~ 

7. On some preparations of Balsam Copaiba. — Mr. Jacob Bell in a paper in 
the Pharmaceutical Journal, notices several preparations of copaiba, and recom- 
mends the following as the best: — 

When balsam of copaiba is boiled with liquor potassas, the mixture separates 
into two portions, a white oily substance or emulsion, which floats on a yellow- 
ish clear liquid. After standing for a day or two, the upper stratum becomes 
quite clear, the potash being thrown down, and the residue consisting of essential 
oil. The clear liquid is a solution of the resin in combination with potash. 
When evaporated to dryness, it assumes the character of the soluble resin. 
Caustic soda may be substituted for potash. 

This liquid is supposed to contain the most active and efficacious portion of 
the balsam. A small quantity of sweet spirit of nitre is added to it in order to 
increase the effect. 

The following proportions have been found to answer very well. A mixture 
thus prepared is much less nauseous than the balsam; a dessert-spoonful of it 
may be taken twice or three times a day: — Balsam of copaiba, two parts. Li- 
quor potassas (or sodae), three parts. Distilled water, seven parts. Boil for a 
quarter of an hour, then add — Sweet spirits of nitre, one part. Allow it to stand 
a few hours, then draw off the clear liquid by means of an orifice in the lower 
part of the vessel. 

This, the alkaline solution of copaiba, being deprived of the essential oil which 
is generally considered to be the most irritating principle, is mild in its action, 
and is less nauseous than the other mixtures on account of the perfect union of 
the alkali with the resin. 

8. Injluence of Camphor on the Sexual Organs. — Among the ancients, camphor 
was celebrated as an anti-aphrodisiac, and several of the moderns have borne 
testimony to its influence on the sexual organs. Albert cites the case of a 
nymphomanic patient at St. Louis, whom he cured by a drachm of camphor at a 
dose; and Esquijol has successfully treated hysteric nymphomaniacs with the 
same remedy. M. Guersant speaks of a druggist whose virility failed him after 
the perpetual employment, during one day, of a smelling-bottle containing spirit 
of camphor, also of a young woman, of ardent and excitable temperament, in 
whom the use of camphor pills subdued all sexual desires; and Dupuytren at- 
tended a medical student in whom impotence had ensued after having slept in a 
room in which camphor was kept. M. Felix Le Gros asserts that he has found 
this substance the most active remedy he could use for blennorrhagic erections 
and chord ee. — Gazette des Hopltaux, 



1844.] Medical Pathology and Therapeutics. 191 

%• 
MEDICAL PATHOLOGY AND THERAPEUTICS AND PRACTICAL 

MEDICINE. 

9. Hsemopiysis in Phthisis occurring during childhood. — The Provincial Medical 
Jounial (Sept. 16, 1843) contains some interesting observations on this subject 
by Dr. P. Hennis Green, with an account of eight cases observed by him. 

It is a well known fact, though one not easily explained, that haemoptysis 
and pulmonary haemorrhage very rarely accompany any of the forms of phthisis 
to which children are extremely subject. Sir James Clark, in his work on Con- 
sumption (p. 61 ), observes, ' Haemoptysis is a rare occurrence; at least, I do not 
recollect to have met with any case in which it was present.' 

In a series of 118 cases of pulmonary tubercle in children, observed conse- 
cutively and in the same year by Dr. Green, with the object of forming a ground- 
work for the history of phthisis in children, he saw, he states, "only five exam- 
ples of haemoptysis,* although a few other cases presented themselves, in which 
the parents or patients alleged that spitting of blood had occurred at some period 
previous to the child's admission into hospital." He observes, however, that 
the absence of haemoptysis may, in part, be accounted for by the circumstance 
that children (especially those of tender years) do not expectorate, but swallow, 
every thing which may be brought up into the mouth from the pulmonary mucous 
membrane. Mr. Murdoch relates a striking example of this fact in his thesis. 
A child, two years old, died suddenly from the rupture of a blood-vessel which 
traversed a tubercular cavity in the right lung. A very small quantity of 
blood had been discharged through the mouth, for the child had swallowed the 
greater part of it, and on examination after death the stomach and upper portion 
of the small intestines were found full of enormous clots of blood, which were 
moulded over their internal surfaces. 

Dr. Green also alludes to a form of pulmonary haemorrhage which is peculiar 
to children, and which is invariably and instantly fatal. It occurs in bronchial 
phthisis, and arises from the perforation of one of the large vessels of the chest 
by a tuberculated bronchial gland. Sudden death may thus occur from perfora- 
tion of the pulmonary artery. Of this he has seen one example, and in a second 
case the artery was so conipletely flattened between two masses of the bronchial 
glands, that the passage of blood was interrupted, and death took place, as from 
disease of the heart. 

10. Sfate of the blood in consequence of a change occurring in the process of Hse- 
matosis. By Dr. F. Simon, of Berlin. — In the case of a patient 53 years old, in 
whom some morbid changes of structure of a fungoid appearance were found in 
the small lobes of the liver, and likewise in the pyloric portion of the stomach, 
with atrophy of the spleen, whose lower extrem.ities also had become swollen 
and (Edematous, whose extremely colourless and bloodless skin, weak and op- 
pressed pulse, indicated a deficiency in the quantity of the blood, and also a 
change in the composition of the blood; half an ounce of blood was drawn, at 
the suggestion of Dr. Schonlein, for the purpose of examination, in order to 
ascertain chemically the quality of its most important constituents. The blood, 
when fresh drawn, was of the ordinary colour, but extremely thin; the coagulum 
was tolerably firm; the blood allowed its blood-corpuscles to sink in a very short 
time, and these formed at the very most about the fourth part of the volume of 
the entire fluid; the supernatant serum itself was very slightly coloured, and 
was very watery; microscopical examination showed the quantity of the chyle- 
corpuscles to be proportionally greater than they are wont to be observed in 
healthy blood. The chemical examination gave the following very striking com- 
position of this fluid: — 

* In 70 other cases observed, not consecutively, but at different periods, hssmopfysis 
did not occur once, at least while the patients were under observation. 



Healthy Blood. 


. C91-9 


208'1 


20 


75-6 


112-3 


14-2 



192 Progress of the Medical Sciences. [Jan. 



Water . . . 880*0 
Solid constituents . 112'0 

Fibrine . ... 3-0 . . 

Albumen . . 55*1 

Blood corpuscles . 45*8 

Extractive matters and salts 8-9 

Dr. Sclionlein remarked the striking deficiency in the solid constituents; in 
this respect the blood resembles that of chlorotic individuals, and also that of 
persons labouring under typhus, when the morbid process has continued at a 
certain height for a long time. It is, on the contrary, distinguished from chlo- 
rotic blood by the great diminution of the blood-corpuscles and of the albumen 
which occurs at the same time; from typhous blood it is distinguished by the 
considerable amount of fibrine. There is no doubt that in this case the peculiar 
composition of the blood is to be accounted for by the serious disease existing 
in the three organs, equally important for the performance of chylopoiesis and 
haematosis — viz., that of the stomach, liver, and spleen. — Prov. Med. Journ. 
Sept. 9, 1843, from Beitrage Zur Physiol, und Pathol. Chem. und Mikroskopie. 

11. Urine in Morhus Bris^htii. By Dr. F. Simon. — About a year and a half 
ago my attention was called to the peculiar sediment which separates from the 
albumen of the urine in certain cases of albuminuria, particularly in cases where 
Bright's degenerescence of the kidneys happens to be present, and which, on 
being examined with the microscope, seems of a peculiar kind, and entirely dif- 
ferent from the ordinary sediments. Tbis appears to the naked eye as a slightly 
mucous deposit, not, however, to be confounded with the sediment from the 
vesical mucus; if the urine be carefully poured off, and the sediment be brought 
to the object-glass under the microscope, the following various forms are ob- 
served: — 

1. Mucus-corpuscles of the ordinary size, partly granulated, with grains rea- 
dily recognized. 

2. Portions of epithelium, from the vesical mucous membrane. 

3. Blood-corpuscles. 

4. Round, dark globules, apparently filled with a granular substance of a dia- 
meter between 0*00060 and 0*00090 parts of an inch. These globules bore the 
greatest resemblance to those designated by Gluge inflammation-globules. 

5. Vesicles, or vesicle-like arrangement of an amorphous matter, like coagu- 
lated albumen. These vesicles for the most part had real coverings, and were 
cylindrical, but in some the covering seemed to be wanting, and it was then only 
perceived that an amorphous, slightly granulated matter was connected together 
in a cylindrical form. The cylinders were in part entirely filled, in part they 
were empty, and contained only a small quantity of a granular substance. The 
filled cylinders contained sometimes a light, sometimes a dark granular sub- 
stance, in which cells and globules, like mucus-corpuscles, appeared to exist, of 
the real presence of which, however, I was not able always to satisfy myself 
with perfect certainty. The breadth of the cylinder differed somewhat, the 
broadest I estimated at 0*00110 parts of an inch, the smaller at 0*00060. My 
attention being once directed to this phenomenon, I examined the urine atten- 
tively in cases of albuminuria, where pains in the region of the kidney indicated 
disease of this organ; and also in several cases where a degenerescence was ad- 
mitted to exist, I observed these vesicles and globules. There is no doubt that 
these peculiar forms had their origin in the kidneys, and they are probably the 
morbidly changed epithelial linings of Bellini's urinary canals. Whether they 
occur only in cases of Bright's disease, or in other cases also, requires to be 
ascertained by more extended experience; according to my observations they 
always appear at the same time with a certain amount of albumen in the urine, 
but the blood-corpuscles are not always present. In one case, where ascites and 



1844.] Medical Pathology and Therapeutics. 193 

anasarca had already occurred; and the urine was secreted in only small quantity, 
I twice made a chemical examination of the urine: the first time the quantity of 
urine voided in twenty-four hours amounted to twelve ounces; it was of a dark- 
brown colour, contained no blood, but so much albumen, that after boiling- in a 
test-glass the latter might be inverted without the coagulated albumen running 
out; the urine had an acid reaction, contained in the white mucous sediment 
much of the above-mentioned vesicles and globules, and had a specific gravity 
of 1-014. After some days the quantity of the secreted urine was less, its 
specific gravity greater, and it still continued to have an acid reaction. In both 
cases the uric acid was in a tolerably normal quantity, but the quantity of 
nrea was diminished; some days later, with the diminished quantity of albu- 
men, yellow-coloured uric acid presented itself, secreted spontaneously in large 
rhombic plates. I think that the occurrence of this peculiar form in albumi- 
nous urine, in cases of Bright's renal degenerescence, is of sufficient importance 
to invite the attention of the physician. — Ihid. 

12. Urine in Pneumonia and Pkuro-pneumonia. By Dr. F. Simon. — In a case 
of pneumonia, and in another of pleuro-pneumonia, a species of urine was ob- 
served, which was remarkable at once for its extremely peculiar properties, the 
same in both cases, but deviating from the normal properties of urine, and also 
in this respect, that, as Dr. Schonlein ascertained, its appearance coincided accu- 
rately with the occurrence of resolution of the inflammation. In the first case 
of pneumonia the urine during the violent inflammatory stage was dark, very 
acid, and unaccompanied by any sediment; at the time of resolution it was pale 
and neutral. One morning I found the urine of this patient yellow, neutral, and 
witli a sediment of white crystals perceptible to the naked eye; the microscope 
instantly showed, by the remarkably beautiful form of the crystals, that they 
consisted of the triple combination of magnesia, ammonia, and phosphoric acid. 
The peculiar character of the urinary fluid itself surprised me; it was completely 
neutral, and every acid, even dilute acetic acid, produced in it a white precipi- 
tate, so that the .Arst instant I suspected the presence of a caseous matter, but 
soon convinced myself, however, that this was not the case, for when I allowed 
a part mixed with hydrochloric acid to stand for some time, a precipitate was 
formed of beautiful, almost colourless uric acid crystals; these were also formed 
when I heated a part with acetic acid, and let it stand for some time. Alcohol 
formed a rather considerable precipitate, which was washed on a filter with alco- 
hol; a portion of this precipitate was abstracted by warm water, which on evapo- 
rating the water remained behind; this was almost perfectly consumed on a pla- 
tinum dish; when rubbed up with caustic potash it developed ammonia; heated 
with nitric acid, the presence of a great quantity of uric acid was ascertained. 
Whatever portion of the precipitate caused by alcohol was not dissolved in warm 
water, was readily taken up by hydrochloric acid, and again precipitated from the 
acid solution by ammonia; with the microscope I recognised this precipitate oc- 
casioned by ammonia as ammonio-magnesian phosphate. From this it results 
that the white precipitate occasioned in the urine by any acid was uric acid, 
which was found dissolved in the urine in so extraordinary a manner combined 
with ammonia — a circumstance which, in my opinion, has not yet been noticed 
up to the present moment. 

In the second case of pleuro-pneumonia, which occurred at a subsequent period 
in Dr. Schonlein's clinical wards, a species of urine was voided at the time of 
the resolution which corresponded in every respect with that just described, 
especially with respect to the remarkable property now mentioned; here, too, we 
had the beautiful crystalline sediment of triple phosphate of magnesia and the 
precipitability of the urine by any acid. Two important questions arise here, 
one of which may be easily answered by accurate observation — namely, whether 
this peculiar phenomenon in the urine is connected with the process of resolution 
of the inflammation in the respiratory organs'? The second question is probably 
not so readily answered — namely, what sort of connection this is] We may 
content ourselves at once with the solution of the first question, which appears 



194 Progress of the Medical Sciences, [Jan. 

of sufficient importance for the proo;nosis, and for which every practical physi- 
cian will find an occasion at the sick bed. We may observe, that the pheno- 
menon here remarked was observed in the urine for three or four days, and that 
in both cases a recovery took place. — Ibid. 

13. Urine in Typhus. By Dr. F. Simon. — fn the second volume of my 
"Medical Chemistry," I have spoken of a peculiar character of the urine in 
typhus, to which my attention was first directed by Dr. Schonlein, and it is im- 
portant as well with respect to the development of the morbid process as for 
the prognosis. This regards the circumstance of the urine becoming- alkaline at 
certain times, which alkalinity lasts for a certain time, after having had at first 
a strong- acid reaction for some time, and the simultaneous occurrence of sedi- 
ments, which, according to their nature, may bear a different signification, and 
whose appearance together with the reaction of the urine may be of considerable 
import, if correctly appreciated, with respect to the development of the disease. 
With respect to this matter, Schonlein remarks, that in the regular course of 
tj^phoid disease the urine is found at first to be dark, and to have a very acid re- 
action, whilst subsequently it becomes neutral and then alkaline; lastly, when 
the disease is tending to improve, the acid reaction again sets in. I had pre- 
viously made observations which entirely corresponded with these; but I have, 
on the contrary, seen cases where the urine presented quite different properties, 
— it either continued permanently acid, or else became alkaline, only, however, 
for a short time, and soon again it assumed the acid reaction; in some cases an 
amendment took place, but on two occasions death followed. I afterwards fol- 
lowed up my inquiries regarding the urine in typhus with increased attention, 
and to the two cases previously observed I can now add six new ones, which 
further confirm the properties just mentioned. In the one case the urine was 
slightly alkaline on the seventh day after the patient's admission, and continued 
so, or with a neutral reaction, for seven or eight days, then it again became 
slightly acid and clear — the patient recovered. In a second more serious case 
the urine was acid up to the 21st day, the pulse rose to 120; then the urine com- 
menced to become neutral, then alkaline; the nervous phenomena became more 
mild, the frequency of the pulse diminished; this state lasted from 10 to 11 days, 
during which time the urine flowed very copiously, became pale, and evinced a 
weak acid reaction. In two other cases the change of the acid into the alkaline 
reaction occurred before the 14th day of the disease, and in one of these cases 
the urine was so very intensely impregnated with carbonate of ammonia, and 
had so very stinking a smell, that it extended entirely over the sick chamber; 
the urine deposited a considerable pus-like or mucous-like sediment, consisting 
of phosphate of lime and phosphate of magnesia, and when mixed with acids 
effervesced violently; not till 14 days after, and in the last case three weeks, did 
the urine evince an alkaline or neutral reaction, the acid reaction then gradually 
became established, and both patients recovered. It is deserving of notice that 
a secretion of urate of ammonia not infrequently precedes the occurrence of the 
alkaline reaction and the appearance of the earthy phosphates in the urine, 
which, as Schonlein remarks, is in some measure to be considered as the pre- 
cursor of this favourable change in the urine, and as the first critical effort of 
nature. The last time, when the process of the typhous disease appeared in a 
much milder form, this peculiar change of the reaction of the urine was in like 
manner observed several times, so that after the alkaline reaction has preceded 
and continued for some time, the recurrence of the acid reaction, combined with 
the clear appearance of the urine and a more copious secretion of the fluid, may 
be looked on as a favourable sign for the successful solution of the disease, 
whilst on the contrary, 1 remember some cases since the year 1840, where the 
urine came to have a neutral or alkaline reaction, but passed soon again into the 
acid reaction, in order to become alkaline again at a subsequent period, but in 
like manner only for a very short time: in one of these cases the disease was 
extremely tedious, and terminated fatally. — Ibid, 



1844.] Medical Pathology and Therapeutics, 195 

14. Urine in Bronchitis. — M. Becquerel states, {Semeiotique des Urines,) that 
in slight bronchitis, the urine may remain in the normal state; sometimes it 
assumes the febrile characters. These characters — sub-diminished quantity, 
increase of density, of colour, sediments, &c. — present themselves in general 
during the first two or three days of the disease, probably owing to this circum- 
stance, that the individuals affected have continued their ordinary employment 
notwithstanding the disease had commenced, or else to the disturbance which 
this affection, however slight it may be, had occasioned in the general syslen>; 
after two or three days' rest this state of the urine disappears, and it assumes 
its normal character. 

In severe acute bronchitis, which gives rise to strong reaction and to intense 
dyspnoea, and more especially in capillary bronchitis, the urine puts on the 
characters of the febrile state in an extreme degree; it becomes diminished in 
quantity, of a very deep colour, increases in density, and frequently presents 
sediments of uric acid, either spontaneously or occasioned by the addition of a 
small quantity of nitric acid; the urine also frequently contains in this disease 
a considerable quantity of albumen; and probably capillary bronchitis is the dis- 
ease which most frequently occasions the presence of this proximate principle 
in the urine. It is not unlikely that to the presence of this new element is to 
be attributed the very great dyspnoea which accompanies capillary bronchitis, 
and which causes a sanguineous congestion in the principal viscera of the abdo- 
men, and more especially in the kidneys. This congestion may, I think, account 
for the presence of the albumen. In the period of convalescence there is ob- 
served that which is seen in all acute diseases. The urine will either return to 
the normal state, or will assume anaemic characters (diminution in the quantity 
of the solid matters held in solution in the urine); the urine is then pale, and of 
small density. This last effect is produced, especially if the patient has been 
much debilitated, either by the disease itself or by the means employed to com- 
bat h.—Prov. Med. Journ. Sept. 30, 1843. 

15. Urine in Pneumonia. — It may be laid down as a general principle, ac- 
cording to Becquerel, {Semeiotique des Urines,) that, when an inflammation of 
the lung occurs in an individual hitherto in good health and tolerably strong, 
the urine becomes febrile, diminished in quantity, high-coloured, &c. These 
characters are more especially marked when the disease is most intense; then, 
according as the disease declines, the urine gradually returns to its normal state; 
and it is but rarely, and as an exception, that the urine presents febrile charac- 
ters when the pneumonia has reached the stage of resolution. 

In convalescence from pneumonia the urine sometimes presents the natural 
healthy appearance; sometimes it is paler, loss dense, and ansmic. The last 
case occurs chiefly when the disease has been treated by profuse blood-letting. 
When pneumonia attacks an individual whose constitution has been wrecked 
previously by any cause, it may happen that the urine will not assume the febrile 
characters, and that notwithstanding the intensity of the pneumonia and of the 
accompanying fever, this secretion is scarcely more highly coloured than in the 
natural healthy state, and presents no disturbance or sediment at any period of 
the disease. It may be well to observe that pneumonia is one of those diseases 
in vi^hich the colouring matter of the urine is most increased. — Ibid. 

16. Siaie of the Urine in Cirrhosis of the Liver. By M. Becquerel. — At 
the commencement of cirrhosis, and especially if it follow a chronic course, 
the urine may not present any perceptible changes. Whenever jaundice exists, 
the urine puts on a saffron yellow colour, and contains a variable quantity of the 
colouring matter of the bile. The presence of this substance does not prevent 
the appearance of the following properties. Every time the cirrhosis attains a 
certain degree, and gives rise to the production of functional symptoms of a 
certain intensity, the alteration of the urine is perfectly analogous to that which 
occurs in cancer of the liver. Its characters are as follows: — Quantity of urine 
is very scanty; orange yellow colour very deep, and often reddish; density in- 



196 Progress of the Medical Sciences, [Jan, 

creased; great acidity. It is charged with a large quantity of uric acid, which 
is precipitated, either spontaneously on cooling or hy the addition of a littler 
nitric acid. This precipitate, which in general is rather copious, is almost uni- 
formly of a bright red colour, and somewhat like cinnabar. What is the cause 
of such a change'? — is it owing to the venous congestion produced in the cor- 
tical substance of the kidneys by the powerful obstacle caused to the abdominal 
circulation, in consequence of the obliteration of the divisions of the vena 
portasi This may be so, since we see a similar effect produced in diseases of the 
heart and in pulmonary emphysema when they have attained an advanced stage, 
one of the consequences of which is to produce a mechanical congestion of the 
kidneys; but it is impossible to state it positively, and certainly to account for 
it. The appearance of these abnormal properties in the urine always indicates 
that the cirrhosis, in whatever state it may be, has occasioned functional dis- 
turbances independent of any complication. 

The existence of cancer of the stomach, of pulmonary tubercles, or of dis- 
eases of the heart, all affections which may coincide with, or even precede, the 
cirrhosis, does not at all prevent the modification of the properties of the urine. 
In the last case only, if the infiltration of the cellular tissue is considerable, it 
may happen that a small quantity of albumen may be found in the urine. 

If the case be complicated with Bright's disease, two circumstances may 
occur. 

First, If the cirrhosis has preceded the morbid alteration of the kidneys, and 
if it has already arrived at an advanced stage, the urine will undergo the modi- 
fication already described, only we shall find a considerable proportion of albu- 
men. 

Secondly, If, on the contrary, the two diseases are developed simultaneously, 
the change in the kidneys being always in this case more advanced than that of 
the liver, the result will be that the urine will present all the characters peculiar 
to the morbus Brightii. It is always extremely useful to examine the urine in 
cirrhosis of the liver, because the diagnosis of this disease is often difficult, and 
because, by combining the study of the changes in this liquid with the other 
symptoms of the disease, we shall possess a valuable sign which will contri- 
bute to enable us to recognize the disease.— Proy. Med. Journ., from Semeiutique 
des Urines. 

17. InocuIaiioi% hy means of Contagious Cells. — Dr. Klencke, of Brunswick, 
is preparing for publication a work on this subject, and meanwhile furnishes us 
with some of the interesting results obtained by his experiments on contagion. 
M. Klencke has succeeded in transplanting the contagious principle from one in- 
dividual to another, by means of the cells of carcinoma, tubercle, melanosis, 
condyloma, and warts; mucous membranes affected with ozaena and coryza; 
carbon, hydrophobia, the vaccine virus; small-pox, and the other acute exan- 
themata; and he concludes, from these experiments, that contagious maladies 
are transmitted by means of cells, which enjoy a semi-independent vitality. 

Cells of Carcinoma. — IjTiv^g^wheck has already shown the possibility of the in- 
oculation of carcinoma. 

Cells of Tubercle. — After being well assured of the nature of these cells by a 
microscopic examination, he introduced some of them into the veins of a rabbit, 
in which were found, twenty-six weeks afterwards, numerous tubercles in the 
lungs and in the liver. The same inoculation practised on a rook did not suc- 
ceed. 

Cells of Melanosis. — Some cells were collected from a black liquid in the orbit 
of a mare affected with melanosis, and were inoculated into the conjunctiva and 
lachrymal gland of an old horse. These merely caused a black spot on the 
conjunctiva, which extended very slowly; but, about the sixteenth week after 
the inoculation, melanosis of the lachrymal gland was very decided; it had in- 
vaded the whole organ, and pushed the globe of the eye forward. Some of the 
melanotic matter, taken from the same mare, was injected into the veins of the 
neck of a dog, who died suddenly Vvhilst hunting three weeks after the opera- 



1844.] Medical Pathology and Tlierapeutics. 197 

tion. There was found in the left lunor a melanotic tumour, which was ruptured, 
and which contained a hrown, coffee-coloured fluid, aboundinor in cells. 

Cells of Condyloma, Warts, Ozaena, and Cor.i/za.— Many inoculations were made 
with these, and the results were remarkable. The cells of recent coryza are 
very different from the confervas of ozsena; but, in proportion as coryza becomes 
chronic, the cells disappear, and g-ive place to the sporules of confervas. The 
cells of coryza are readily destroyed by the action of chloride of lime — an im- 
portant fact in the treatment of ozaena. 

Cells of Carbon {malignant pustule'). — Experiments with these are danger- 
ous. The cells are found in a yellow, lemon-coloured fluid, which trickles 
from the pustules. They have so strongly contagious a property, that, after 
having- been subjected to boiling water, and kept for fifteen days in lime, they 
were able to inoculate a young goat. 

Cells of Hydrophobia. — These are of two kinds, some as large as a lentil or 
pea, which have been noticed already by Urban and Magiotel; others, micro- 
scopic in dimensions, and remarkable for the blue tint of their parietes, appear 
to colour the large ones, in which they swim. The author says he has found 
them in the excised cicatrix of a bite, which had given reason to fear hydro- 
phobia. He has also met with the same cells or globules in the foam under the 
mucous membrane of the cheek, and in the salivary glands of hydrophobic 
dogs. Some of these globules, taken from the parotid gland, and introduced 
into a wound made in the ear of a cat, infected the animal. Inoculations from 
animals that had been dead more than a day were not followed with any result. 
The cells, if treated by boiling water, are destroyed, or rendered inert, and their 
inoculation is not followed with any effect. They readily dissolve in the^ mine- 
ral acids, and in chlorine water, which is worth noticing in practice. Treated 
by belladonna, the cells become angular and discoloured, but still remain capa- 
ble of being inoculated with effect. 

Cells of the Vaccine Virus, of Small-pox, and of the Acute Exanthemata. — Mi- 
croscopic researches prove that lymph is inoculable in proportion as it contains 
a g;reater or less number of cells. — Frov. Med. Journ.y Sept. 23, 1843, from Ar- 
chives fur die Gesammte Med. 

18. Paralysis without hm of Sensation, from Disease of the Cervical Medulla. — 
The 26th vol. of the Med. Chirurg. Trans, contains an account by Dr. John 
Webster of a very interesting case of paralysis of motion without loss of sen- 
sation. 

The subject of this case was a gentleman 36 years of age, muscular frame, 
capable of undergoing a great deal of bodily exertion without fatigue; and until 
a few years befoi^ death, had enjoyed excellent health, except that he suffered 
occasionally from severe headaches, which were generally relieved by purging. 
He always perspired very freely in warm weather, or after much exercise, but 
through the whole of his illness the culicular secretion was scanty, and latterly 
entirely suppressed. 

In 1836 he was annoyed for some months by a phagedenic ulcer on the left 
leg, and again in 1838. In the last named year he had also a large chronic 
ulcer on the posterior part of the pharynx. These ulcers were not syphilitic. 
From these ulcers the patient's constitution was impaired and he suffered also 
from a domestic affliction. 

Towards the autumn of 1839 the patient again began to suffer materially in 
health; he now complained of almost constant pains in the head, which occa- 
sionally became so severe, as even to oblige him to stop in the street, and to 
lean against the rails for support. These symptoms were also frequently ac- 
companied by sickness and considerable prostration of strength; the bowels 
being generally costive, the tongue much furred, and the appetite at the same 
time impaired. In January 1840, slight epileptic attacks supervened, at- 
tended with an exceedingly slow pulse, from 35 to 40 in a minute. From this 
distressing state he however recovered so much, as to be able to leave home 



198 Progress of the Medical Sciences, [Jan. 

about the end of February, and soon afterwards to resume, in some degree, his 
ordinary professional avocations. 

In the following March he was again attacked by several epileptic fits, but of 
a much more marked character than any of those noticed j)reviously. These 
convulsive seizures occurred repeatedly; and after some weeks, they were fol- 
lowed by severe spasmodic contractions of the lower extremities, which often 
became so violent, that both knees were thereby forcibly drawn up towards the 
epigastrium, when the patient's legs would be again suddenly extended to their 
full length; and although the sufferer appeared perfectly cognizant of their oc- 
currence, and often felt acute pain at the time, he was nevertheless quite unable 
to control any of these vehement involuntary movements of the extremities. 

At this particular period, often when talking to another person, the patient 
was unable to finish the sentence he had just commenced, in consequence of an 
involuntary propensity, which he could not restrain, of repealing many times 
over some principal word in the phrase he wished to express; or the same diffi- 
culty would occur from making use of a word quite different from the one he 
really wished to employ; and this confusion in the use of words actually hap- 
pened, without the patient being able to correct himself, although perfectly awEure 
at the moment that he was speaking erroneously. 

In the summer of 1840, the patient complained of considerable weakness in 
his back and loins, accompanied with pains of the head, and in the nape of the 
neck. He soon afterwards became unable to walk steadily without support: 
"he felt as if his body were cut in two, and the lower half falling away from 
the upper." Both hands and arms now became very weak, and were soon 
nearly powerless; and he also complained of considerable pain about tiie fourth 
cervical vertebra, increased in severity on merely bending his head backwards; 
but this sensation felt however less painful when rotatory motion of the neck 
was only attempted. 

About the end of autumn in 1840, as most of the symptoms had gradually 
undergone material alleviation, compared with their former severity, the patient 
seemed now greatly recovered in strength and could walk out occasionally, with 
only the aid of a staff. Indeed, towards the end of that year, the progress made 
was so far satisfactory, and the general health apparently so much restored, that 
he was even able to visit his friends and join a little in society. 

During this temporary amendment, the patient took a very long walk on a 
very cold and frosty night, by which he was chilled and completely exhausted. 
This misadventure brought on a recurrence of all the symptoms, and the ina- 
bility of moving his limbs; he got at last so very feeble that eventually he was 
entirely deprived of the use of both legs and arms. Ultimately, the muscles of 
the abdomen and chest were similarly affected, whereby respiration could then 
be only carried on by the diaphragm; when the patient likewise lost the power 
of coughing, and was scarcely able to expectorate. The bowels now became 
even more constipated than before, and in order to act upon them sufficiently, it 
was necessary to employ very active puro-atives, assisted by strong enemata; 
whilst the bladder required to be frequently emptied by the catheter, during 
many months consecutively. Notwithstanding the total loss of power over all 
the muscles situated lower than the neck, the sense of touch still continued as 
acute as ever throughout the entire frame; indeed, the cuticular surface appeared 
occasionally to be even more sensible to external impressions than in the patient's 
previous good health; since he could, for instance, feel most acutely the slightest 
change in the temperature of the surrounding atmosphere, especially when a 
current of air passed over any part of his person. 

At the same time all the senses continued perfectly normal, the memory ap- 
peared unimpaired, the patient had no headache, and his intellectual faculties 
were as perfect as they had ever been at any former period, although once or 
twice he seemed to be a little confused or slicfhtly delirious; but this symptom 
was of such partial duration, that it scarcely deserves observation. 

Besides the symptoms already detailed, the patient frequently complained of 
feeling intense heat over all the body, whilst the surface actually felt cold to a 



1844. J Medical Pathology and Therapeutics, 199 

bystander; and at other times he experienced alternations of heat and cold, 
although his skin appeared to others of the natural temperature. Again, if a 
foot or even a toe were touched, spasmodic twitchings of the limb, accompanied 
with pain, were always produced; the patient's sense of feeling- being, at the 
same time, so accurate, that he could distinctly tell the particular point of his 
body to which the attendant's finger was applied. The circulation still con- 
tinued languid, and sometimes the pulse was intermitting; whilst the cuticle 
remained devoid of perspiration, being perfectly dry, and exhibiting quite an 
opposite condition to that noticed during the patient's previous robust health. 

In the latter months of his illness, the patient often complained of excessive 
coldness in the epigastrium and stomach, along with considerable distension of 
the abdomen from flatus, although the trunk of the body and the extremities 
frequently felt burning hot to the patient at the same moment. At this stage of 
the disease, the spasmodic twitchings of the legs were not only more frequent 
than previously, but they sometimes even became so violent as almost to throw 
the patient off his couch, being also attended with great additional suffering. 

/rhe urine, which at first was very little altered from its healthy condition, 
how deposited a considerable quantity of a thick ropy sediment, and although 
this secretion had long been drawn off by the catheter, it now passed involun- 
tarily, and almost in drops; whilst the faeces likewise came away in a similar 
manner, the evacuations being of a watery consistence, and latterly very offen- 
sive. 

The appetite and digestion, always much impaired, entirely failed towards the 
termination of this painful and protracted malady; when frequent nausea, vomit- 
ing, singultus and aphthae supervened. Finally, notwithstanding the efforts made 
to alleviate the afflicted patient's sufferings, all the symptoms continued, with 
unmitigated severity, till the 22d of July last, when he died, quite exhausted; 
retaining however his intellectual faculties perfect to the last moment of ex- 
istence. 

Autopsy^ 18 hours after death. The body appeared considerably emaciated, 
but was not discoloured. Having removed the skull cap, some effusion of 
lymph was found under the arachnoid membrane covering the left side of the 
brain, along with turgescence of that, and the other hemisphere; both divisions 
being pale, and exhibiting a watery aspect, although their texture was firm and 
compacted. The ventricles of the brain seemed large, particularly the left; and 
about two ounces of serum were effused in these cavities; the foramen commune 
being at the same time larger than natural. The arachnoid tissue extending 
over the pons Varolii adhered to the parietal layer of that membrane; but no 
tumour, or any other change of structure was found either in the brain or cere- 
bellum, excepting that the latter organ appeared anemic, and rather softer in 
texture than ordinary. 

On opening the thorax, every part seemed quite healthy, although the pleura 
pulmonalis on the left side of the chest, adhered firmly to the pleura costalis, 
by a few strong bands, some of which were apparently of considerable stand- 
ing. The abdominal viscera likewise appeared very little changed from their 
natural condition, the liver, stomach and intestines being free from disease: with 
the exception of the kidneys, which were somewhat enlarged, anemic, and ex- 
hibited marks of chronic inflammation on the internal membrane of the pelvis 
and infundibula. The omentum and some of the small intestines also adhered 
to the bladder by strong bands, whilst that viscus was much diminislied in 
magnitude, felt very hard to the touch,, and on cutting into its cavity, it actually 
appeared not larger than the interior of an ordinary sized walnut, its muscular 
coat being unusually thickened. The mucous membrane was dark-coloured and 
rugous on the surface. 

Having carefully laid open the vertebral column, throughout its whole length, 
the theca, corresponding to the three or four lower cervical vertebrae, was found 
to be much distended; and on being cut into, the arachnoid cavity, with the sub- 
arachnoid tissue, appeared filled with lymph, which evidently had been some 
time effused; as the membranes were thereby united to each other, and also to 



200 Progress of the Medical Sciences, [Jan. 

the cord. On making- a more minute examination of the parts, the adhesions 
of the membranes to the cord were discovered to be much firmer at its anterior 
than posterior portion; indeed, they were actually so stronfr as to be inseparable 
from the medulla without rupture. At this particular part, the medulla also 
appeared larger than usual, felt soft and pulpy to the touch, and on being divided 
by the knife, its substance seemed to be in an almost diffluent state, infiltrated 
with serum, but exhibiting a natural colour. For the extent of half an inch 
above t!ie point just described, the cord had a dusky red tinge, appearing how- 
ever, of the ordinary consistence. In the anterior and posterior columns, not 
much difference was observable to the naked eye, at the first superficial exam- 
ination of the diseased part of the medulla; although both divisions of the cord 
seemed considerably softened, infiltrated and disorganized, particularly in the 
posterior columns; whilst as well above, as below the affected portion, the me- 
dulla was healthy, and quite natural in appearance. 

Since it is often very difficult by the ordinary means of investigation, to 
describe accurately all the minute alterations of structure, which disease may 
induce in so delicate a texture as the spinal cofd, the microscope becomes an 
important auxiliary to scientific anatomists. Indeed, without the aid of that 
useful instrument, it would in many cases be difficult, if not impossible, to 
ascertain correctly the actual pathological changes of structure, which have 
taken place in that organ, so as to be able to explain the phenomena and symp- 
toms characterizing cases like the one novi-- under consideration. 

Fortunately on the present occasion, such a desideratum has been supplied; 
as I am enabled to add the following minute and valuable account of its micro- 
scopical examination, made by that able physiologist, Professor Todd, of King's 
College: "The portion of spinal cord submitted to me by Dr. Webster, appears 
to consist of the greater part of the cervical segment. I find great destruction 
(from softening) of the medullary substance of the posterior columns, especially 
that of the riglit side; the antero-lateral columns seem to have been also the 
seat of the softening process to a less degree, but I do not find that they have 
suffered any loss of substance. In examining the softened parts by the micro- 
scope, I detected very few of the proper nerve-tubes; and those which 1 did 
observe, were much altered from their natural appearance; they had become 
opaque, and had assumed an indistinctly fibrous aspect. 1 w^as unable to find 
any trace of gray matter. The posterior horns must have shared in the great 
destruction of the posterior columns, and probably the anterior ones experienced 
a similar fate. It is right, however, to observe, that the specimen had been pre- 
served some time in spirits, before it came into my hands. I found throughout 
the diseased part, nutrierous small scales, (cholesterine]) such as are very com- 
monly met with in portions of the nervous centres, preserved in spirits." 

Dr. Todd then makes the subsequent very important remarks: — "I consider 
this case of the greatest physiological interest, as affording unequivocal proof, 
that the posterior colun)ns cannot perform the office assigned to them by some 
physiologists, namely, that of conducting sensitive impressions to the brain, or 
or at least, that they are not the only channels of this communication. It is 
also important in an anatomical point of vie.w, as showing that the posterior 
roots of the nerves are independent of the posterior columns of the spinal cord; 
for although the latter were destroyed to so great an extent, the former did not 
appear to have suffered in any degree." 

19. Inflammation of the Nervous Centres — Dr. John Hughes Bennett has 
published in several successive numbers of the Edinburgh Medical and Surgical 
Journal, some extremely interesting pathological and histological researches on 
inflammation of the nervous centres. We at present give only the conclusions, 
but shall hereafter notice some of the particulars. 

The author conceives that the following conclusions may be drawn from his 
observations: 

^* 1. That two kinds of cerebral and spinal softening exist, an inflammatory 



1844.] Medical Pathology and Therapeutics, 201 

and a non-inflammatory, which may always be distinguished from each other by 
means of the microscope. 

"2. That inflammatory softenino- is characterized by the presence of exuda- 
tion corpuscles and granules, whilst in non-inflammatory softening these bodies 
are never found. 

*' 3. That the nature of inflammatory softening consists in the formation and 
development of nucleated cells in exuded blood plasma; whilst the nature of 
non-inflammatory softening consists in the mechanical destruction or maceration 
of the nervous tissue in serum, or is the result of putrefaction. 

"4. That non-inflammatory softening, unaccompanied by hemorrhage, is usu- 
ally joos^ mortem., and causes no symptoms; whilst uncomplicated inflammatory 
softening always causes marked symptoms, which, however^ vary according to 
the seat of the lesion. 

" 5. That the inflammatory and non-inflammatory softenings have frequently 
been confounded together by morbid anatomists, it being impossible to distin- 
guish one from the other, with any certainty, by the naked eye. 

" 6. That inflammation in the nervous centres has, in several instances, been 
demonstrated by means of the microscope, after it had escaped the search of 
good morbid anatomists, and been indicated by the most unequivocal symptoms. 

"7. That every different coloured softening has, at various times, been found 
to be connected with inflammation, but that yellow and white softenings are 
most frequently non-inflammatory, whilst the fawn-coloured softening is com- 
monly inflammatory. 

'* 8. That red softenings usually depend on congestion, or the direct extrava- 
sation of blood; yellow softenings, on the imbibition of the colouring matter of 
the blood; fawn and gray-coloured softenings on the presence of brown exuda- 
tion corpuscles; and white softenings, in the great majority of cases, are />os/- 
mortem and the result of maceration in serum. 

*' 9. In no single instance has softening of the nervous centres been traced to 
the presence or infiltration of pus. 

" 10. That inflammation of the central parts of the brain generally produce 
well-marked lesions of sensation and motion^ whilst, in inflammation of the 
peripheral portions, lesions of intelligence are commonly well pronounced. 

"11. That in idiopathic inflammatory softening of the brain, contraction in 
one or more limbs is a common symptom. 

"12. That the fawn-coloured spots described by Dr. Sims are no evidence of 
the cure of inflammatory softening. 

" 13. That inflammation accompanying hemorrhages is usually consecutive. 

"14. The softening surrounding apoplectic clots or sanguineous infiltration 
is no proof of inflammatory action." 

20. Pathological causes of Cyanosis. — Dr. Craigie has given in the Edinburgh 
Medical and SurgicalJournal, for October last, some very interesting observations 
on the pathological causes of cyanosis. 

"It has been usually supposed," he remarks, " that the open state oiihe fora- 
men ovale, whether direct or oblique, is a primary lesion of the heart, and is per- 
nicious to the patient, in allowing the free intermixture of the blood of the right 
chambers of the heart with that of the left. Within certain limits this idea is 
well-founded; and in a certain number of cases, the open state of the foramen 
ovale tends to impede nutrition and to abridge the duration of life. 1 am, never- 
theless, satisfied, both from the facts of the case now related, and several others, 
of three circumstances; first, that the open state of the foramen ovale is rarely a 
primary and solitary lesion; secondly, that when it is a solitary lesion it is not 
injurious, and the venous blood of the right auricle is not thereby necessarily 
mixed with the arterial blood of the left auricle; and thirdly, that, in opposition 
to what has been hitherto usually taught, the open state of the foramen ovale is 
in a large proportion of cases the means of prolonging life. 

"It is unnecessary for me to enter into any formal defence of the latter con- 
clusion, which, however paradoxical it may seem, and however opposed to 



202 Progress of the Medical Sciences, [Jan. 

the usually received dogmas, flows almost directly from the facts which may be 
traced in every case of open foramen ovale. That, in short, it is not the primary 
lesion. From the phenomena of the cases recorded, on the contrary, and from 
the frequency of the arctated or contracted state of the pulmonary artery, it must 
be inferred that the obstructed state of tliat artery is the primary lesion, and de- 
termines not only the open state of theforamen ovale, but the hypertrophy of the 
right ventricle. This is the result, vi^hether the pulmonary artery is only greatly 
narrowed in calibre, or terminates in a cul de sac, or is obstructed by a membra- 
nous partition formed by the coalition of the semilunar valves. 

"The effect of such an impediment is manifest. The blood cannot pass into 
the pulmonary artery with the requisite freedom and facility. The result is 
over-distension, ^rsi! of the right ventricle, and excessive labour of its muscular 
apparatus; secondly, of the right auricle, and excessive labour of its muscular 
apparatus, with extreme dilatation of its membranous portion; thirdly, over-dis- 
tension and congestion of the whole venous system all over the body. The 
lungs, meanwhile, receive little or no blood, and, consequently, the blood is not 
duly aerated or supplied with oxygen, and cleared of carbon and carbonic acid. 
This is doubtless an evil and a great one. But Bichat has obscurely suggested, 
and Dr. Williams and Dr. Kay have clearly shown, that dark-coloured blood, or 
that which is venous is adequate to maintain vital action. It is, indeed, a less 
evil, and more tolerable than total obstruction in any of the large vessels, and 
especially in a vessel like the pulmonary artery. Every thing that we now 
know of these cases shows that the obstruction to the circulation through the 
pulmonary artery must be the main cause of the short and transitory existence 
of persons labouring under this severe lesion; and that the open state of the/ora- 
men ovale, instead of being, as William Hunter and other authors imagined, a 
cause of death, furnishes the only means by which life can be prolonged, while 
a function so important as that of the circulation through the lungs is impeded. 

"I am further entitled to infer from various facts in the history of the develop- 
ment of the ovum, that the obstructed, or, it may be, the undeveloped state of 
the pulmonary artery, is the anatomical cause of the perforated septum, and of 
the origin of the aorta from the two ventricles when that malformation is ob- 
served. 

" It would lead to some curimis and interesting results to inquire by what 
means the impeded function of the lungs is in these cases compensated; for that 
it is compensated by the action of the skin and other membranes, can scarcely 
be doubted. But this would lead me into a field too extensive for consideration 
at the present time." 

21 . Certain affections depending on abnormal conditions of the Nervous Centres. 
— Dr. Favell read a paper on this subject before the Sheffield Medical Society, 
October 19, last. He commenced by observing that there is no fact in pathology 
more clearly established than that the peripheral extremities of nerves often give 
the earliest, and sometimes the only, indication of disease existing in nervous 
centres. Hence, the syrnptoms of irritation existing in different organs fre- 
quently do not depend on any abnormal condition of the part immediately 
affected, but are to be traced to other organs situated remotely from them. The 
doctor urged the importance of this doctrine in a practical point of view. During 
the last session, he remarked, he drew the attention of his brethren to the sub- 
ject, in some observations "On certain Morbid Phenomena illustrative of the 
Reflex Functions of Nerves," and especially the occurrence of chorea in cases 
of pericarditis, where the extremities of the nerves being the seat of irritation, 
the irritation itself is thrown back upon the spinal nerves, and thus induces 
general spasmodic action. The cases to be adduced on the present occasion, 
however, he remarked, differ greatly from that to which allusion has just been 
made, inasmuch as the source of irritation in them is situated not at the extremi- 
ties of the nerves, where the irritation is perceived, but at the part from whence 
they originate. The doctor confined his observations entirely, on the present 
occasion, to affections of the spinal cord and its coverings, and illustrated his 



1844.] Medical Pathology and Therapeutics. 203 

general proposition by details of cases which had occurred to himself of the fol- 
lowing kind: — 

1. Menorrhagia, from irritation of the sacral nerves, evidenced by tenderness 
on percussion over the sacrum. 

2. Painful digestion and enterodynia depending on irritation of nerves pro- 
ceeding from the dorsal portion of the spinal cord. 

3. Pleurodynia, the brain being constant and the breathing very laborious, but 
unaccompanied by friction sound. 

4. Excitement of the heart, presenting the usual general symptoms of hyper- 
trophy. 

5. Spasm or loss of power, partial or complete, in the organs of locomotion. 

6. Loss of power over the sphincters of the bladder and rectum. In all these 
cases there was tenderness on pressure or percussion over some portion of the 
spinal column. The treatment adopted consisted in placing the patient on the 
abdomen on a prone couch, and in the earlier stages abstracting blood by means 
of leeches. Blisters were subsequently applied first to one side and then to the 
other of the spinal column. In very clironic cases the leeches were frequently 
omitted, and, after a succession of blisters, a seton was occasionally inserted 
immediately above the seat of tenderness. — Prov. Med. Jaurn., Nov. 4, 1843. 

22. On Pulmonary Tubercles. — M. Boudet establishes by his researches that 
the tubercular degeneration of the lungs and bronchial ganglia in man is much 
more common, and more curable than most physicians are aware of. Having 
examined the lungs of 197 persons who died in the hospital of various diseases, 
or were killed suddenly by accidents, he has detected tubercles in the lungs of 
one child under 2 years of age; from this age to that of 15, tubercles existed in 
three-fourths of the cases; and in those between 15 and 76 no fewer than six- 
sevenths of the bodies exhibited the tubercular deposit in the lungs. This 
result is explained, according to M. Boudet, by the facility with which the 
tubercles undergo a change in their intimate constitution, by which they become 
not incompatible with a state of health. These modes of cure he states to con- 
sist of sequestration, induration, with their cohesion increased or diminished, 
calcareous induration, absorption, and elimination. In the calcareous degenera- 
tion the carbonates and phosphates of lime form but a small proportion; seven- 
tenths of the concretions are formed of the chloride of sodium and the sulphate 
v*" potash. The cure of tubercles may take place at every period of life, but it is 

lore common as the age increases. It also occurs at all stages of evolution of 
he tubercles. M. Boudet has also observed the cure of tubercles in the living. 
In less than one year he has collected 141 cases, from the examination of which 
he draws the following conclusions. 

1. Persons who have presented marked symptoms of phthisis, even in the last 
degree, may, after a longer or shorter time, and for many years, enjoy excellent 
health. 

2. Notwithstanding this general satisfactory state it is always easy to detect 
the existence of more or less extensive local lesions. 

3. Phthisis transmitted by hereditary descent seems to be less capable of cure 
than accidental phthisis. 

4. Nature performs by her own efforts these cures. For observation has 
proved that phthisical patients, left to themselves, or treated by the most oppo- 
site means, have recovered their health. 

5. Amputation of limbs in the phthisical ought not to be absolutely pro- 
scribed. In three phthisical youths, labouring under severe affections of the 
lower limbs, the health was completely restored after the amputation of the dis- 
eased limb. — Edin. Med. and Surg. Journ., Oct. 1843, from Cumptes Rendus des 
Seances de PJlcad. des Sc, Jan. 16, 1843. 

23. Successful employment of Belladonna as a prophylactic during the prevalence 
of Epidemic Scarlatina. By Dr. Stievenart, of Valenciennes. — An epidemic 
scarlatina ravaged, during the winter ef 1840-1, several villages in the neigh- 



204 Progress of the Medical Sciences, [Jan. 

bourhood of Valenciennes, when Dr. Stievenart was inflneed to try the prophy- 
lactic properties which belladonna is said to possess ag-ainsl this disease. The 
circumstances rendered any trial of this kind of double value, as, on account of 
the fatality of the epidemic, 30 patients had already died out of 96 seized. In a 
small village, out of 250 individuals, 200 look belladonna, and were all pre- 
served from the attacks of scarlet fever. Of the 50 others, 14 were seized with 
the disease and four of them died. At the village of Curgies Dr. Stievenart ad- 
ministered the belladonna to the children at the public school, and allowed them 
to continue at their lessons and have communication with the other children of 
the village. All to whom the belladonna was administered escaped the scarlet 
fever; but a few who refused to take it were seized with the disease. 

The belladonna was administered in two forms; in solution, or as a powder. 
Two grains of the recent alcoholic extract of belladonna were dissolved in an 
ounce of any aromatic infusion, and of this two drops were given to a child of 
one year old daily for nine or ten days. An additional drop was given for every 
additional year of age. The largest daily dose was, however, limited to twelve 
drops. When the belladonna was given in the form of a powder, half a grain 
of the powder of the root was mixed with a small quantity of sugar and divided 
into ten doses. One of these was given, morning and evening, to children of 
from one to two years old; two powders, morning and evening, to those from 
three to five; three powders to those from six to nine; four to those from ten to 
fourteen; and five to adults. 

These small doses never produced the toxicological effects of belladonna; in 
fact, they scarcely ever had any marked action on the animal economy. In five 
or six cases Dr. Stievenart observed a rash similar to that of measles; and, in a 
few" other cases, headache with dilatation of the pupils, dryness of the throat, 
and slight sore throat, but which had no resemblance to that of scarlatina anginosa. 
In all the others no sensible or apparent effect resulted from the administration 
of the remedy. 

Dr. Stievenart generally continued the use of the remedy for from nine to ten 
days, in some cases, it was given for fifteen days. He thinks this period suffi- 
ciently long to put the system under the influence of the preservative powers of 
the remedy; but recommends to return to it if the epidemic return or break out 
again with renewed violence. 

A few of the recorded instances in which belladonna has been successfully 
administered as a prophylaxis are noticed. Bayle in 1830 published a notice on 
this subject, by which it appears, that of 2027 individuals to whom belladonna 
was administered, 1948 were preserved from scarlet fever, and 79 were attacked 
with it. Dusterberg, by means of belladonna administered for two weeks, pre- 
served from scarlet fever, ail those who took the medicine. In order to ascertain 
the real value of the remedy, he purposely omitted to administer it to one child 
in every family, and this child alone, according to his report, was seized with 
the disease. He adds, however, that scarlet fever occasionally seized a child 
who had only been taking the remedy for three or four days, but was always in 
this case mild, and often only manifested its presence by desquamation ensuing. 
Zeuch, physician of the Military Hospital for Children in Tyrol, after 84 children 
were seized with scarlet fever, was induced to try the prophylactic effects of 
belladonna on the remaining Gl children. With a single exception all were pre- 
served from its attacks, though the disease was raging around. Schenk, Berndt, 
Kohler, Meglin, De Lens, and other distinguished physicians speak in equally 
high terms of the prophylactic proj)erties of belladonna. — Edin. Med. aiid Surg, 
Journ., Oct. 1843, from Bulletin de VAcad., Feb. 1843. 

24. Treatment of Tinea Capitis. — Dr. A. L. Wigan's mode of treating tinea 
capitis, and which he states is uniformly successful, is as follows: — 

Unless the quantity of hair on the head is exceedingly small and offers no 
obstacle to the complete examination of the skin, I insist on the head being 
shaved very carefully, twice. 

The reason is obvious: with a moderate quantity of hair you may be curing 



1844.] Medical Pathology and Therapeutics, 205 



the parts which first attract notice, while others which have been infected are 
gradually progressing to a visible disease, and the cure is thus indefinitely pro- 
longed. I do°not, however, object to a little circlet of hair round the face, if 
there be no sign of disease apparent in it, and if it be carefully washed with hot 
common vinegar. This is a concession to parental vanity which may be safely 
made, and without which sometimes it would be impossible to obtain confidence. 

My remedy is Beaufoy's concentrated acetic acid — pyroligneous acid, as it is 
still called—though no longer made from wood. 

As a preliminary, however, I use the acid diluted with three times its weight 
of water. 1 call this the detector acid. 

On its application a number of spots which looked perfectly healthy become 
red patches. They are indications that infection had been taken, but had not 
gone through its stages, v;hich period I believe (after great experience) to be 
eight days. This assertion is not lightly hazarded. 

Having by this reconnaissance ascertained the numbers and position of your 
enemy, your course is clear. One vigorous assault, and there is an end of the 
matter. With a piece of fine sponge either tied to the end of a stick or held in 
a pair of silver sugar-tongs, I imbue each spot thoroughly with the concentrated 
acid for the space of three or four minutes, and the business is finished. 

The only reason why it is necessary to see the patient again, is, that as a 
crust is generally formed, and an appearance of "worsening" takes place, the 
friends require to have their confidence renewed from time to time by explana- 
tion and encouragement. I have often applied the acid more than once, but it 
was always (I firmly believe) unnecessary, when the preliminaries above stated 
had been gone through properly upon the shaved and tested head. 

The crust gradually grows up with the hair, which soon sprouts again if the 
eruption be recent, and as soon as a pair of fine scissors can be inserted under- 
neath, it should be removed; but this should not be done prematurely, lest a sore 
place be produced. 

When first proposed, a good deal of correspondence took place respecting the 
plan with those who had tried it without success. I found, however, that in 
every case they had either used a much weaker acid (it is sold of all strengths), 
or that they had continued the use of it long after the disease was cured, and 
thus produced that not very rare result, '^ disease of the Doctor.^'' In the latter 
cases it was only necessary to discontinue the acid, aiid wash the head with 
warm water. — London Medical Gazette, Sept. 1843. 

25. Cure of acute Hydrocephalus by means of large doses of Hydriodate of 
Potassa. By Dr. Woeniger.— A child nearly two years old, of a scrofulous 
and lymphatic constitution, and who had before sufl'ered from aff'ections of the 
head and eyes, was attacked in August, 1841, after some days indisposition, 
with a severe inflammation of the brain. Dr. W. first saw him on the 25th 
August, when he commenced a severe antiphlogistic treatment, eight leeches 
were ordered to the back of the neck, and the bleeding from the bites was long 
maintained; followed by a large blister to the neck, upon which free suppuration 
was kept up, ice-water in a bladder to the shaved head, mustard plasters to the 
calf of the legs, and powders of 1 gr. of calomel with jalap, every two hours. 
Besides this, neapolitan ointment was freely rubbed upon the top of the head 
and neck. 

No improvement was observed, notwithstanding the continued employment of 
the above means, and repeated applications of leeches, although several passages 
from the bowels were obtained. On the contrary the child grew worse, and on 
the 5th day, unmistakeable signs of water in the ventricles manit'ested them- 
selves; namely, fixed and watery eyes, immovable and widely-dilated pupil, 
entire blindness, tetanic rigidity of the muscles of the neck, retraction of the 
head, paralysis of the left extremities, deep stupor, pulse slow (50 beats), hav- ^ 

ing before been very small and quick, frequent screeching and vomiting, &c. JV 

In this desperate condition, Dr. W^. recollecting the recommendation of large 
doses of hyd. pot. in such cases by Dr. Roser, laid aside all other means and 
No. XIII.— January, 1844. 14 



206 Progress of the Medical Sciences, [Jan. 

prescribed R. Hydriod. pot. ,5j., aquas destillat. gss. of which 40 drops was to 
\)& taken every two hours, in sunrared water; and on the next day as much aa 50 
drops each dose. During the first three days no improvement was manifested, 
but upon the fourth (the ninth of the disease) there was a decided remission of 
several of the unpleasant symptoms, and especially a free secretion of urine, 
which had been very scanty before. From this time, and after nearly gij. of 
byd. potass had been taken, a rapid improvement was observed, and by the 12ih 
day, the child was considered as cured. It must also be remarked, that at the 
beoinning of the attack, there was observed an extensive, inflamed swelling of 
almost stony hardness, on the left side of the neck, immediately over the clavi- 
cle, which, treated with emollient applications, passed rapidly into a copious 
and deep suppuration of the cellular tissue. Large sloughs of the cellular tissue 
were discharged with laudable pus, so that after the entire removal of these, the 
muscles of the neck could be seen as if dissected out. The entire healing of 
this deep wound was completed about the end of September. 

Dr. W. thinks, that the hyd. potass not only produced a critical discharge in 
the copious secretion of urine, but that it also, perhaps, occasioned a beneficial 
revulsion by causing the swelling above mentioned to suppurate. He thinks 
also, that the mercury which had been taken, may have contributed to produce 
this favourable result. — Oppenheim's Zeitschrift, fiir die gesammie Medicin^ 
April, 1843. 

26. Shivering as a diagnostic sign of Thoracic infammalion. — M. Chomel, 
in one of his clinical lectures at the Hotel Dieu, made the following remarks on 
this subject, in commenting on a case of pneumonia, thnt was in the wards: — 

"•I took much pains in questioning this patient, to ascertain whether she had 
experienced any chill, before the commencement of the attack; and her reply 
was always in the negative. This circumstance appears to me of importance; 
and it is therefore designedly that I call your attention to the subject, seeing that 
it is the professed opinion of many physicians that pneumonia, like articular 
rheumatism, may generally be traced to the influence of damp and cold. The 
results, however, of my own experience, as well as of that of many others 
whom I know, are quite opposed to this opinion. No doubt it often happens, 
that pneumonic patients will be found to have been chilled some time before the 
attack came on; but assuredly, the chill is not the only, nor even the principal, 
cause of the disease. If we inquire into the particulars of a case, we generally 
find, that there was a predisposition to the malady present in the system at the 
time, and that the chill only accelerated the development of the mischief. 

"It was merely the occasion, so to speak, of the explosion of a pre-existing 
morbid state; just in the same manner as a simple indigestion may be the ex- 
citing cause of a gastric inflammation in a person, in whom there is a strong 
disposition to this disease. 

" But the same remark does not hold true of shivering when this occurs at 
the commencement of a disease. In my opinion, it is an almost invariable sign 
of pulmonary inflammation. Whenever, therefore, this symptom is or lias been 
present, the physician will do wisely to direct his attention to the chest; and 
very generally, at least according to my experience, he will find that an inflam- 
matory process has been set up in the lungs — unless indeed some well-marked 
symptoms clearly point to another organ as the seat of suflTering. I do not deny, 
as a matter of course, that an attack of peritonitis, enteritis, &c., is sometimes 
ushered in with shivering; all that I mean to assert is, that this symptom is 
infinitely more common as a precursor of pneumonia than of any other inflam- 
mation. Hence in practice, whenever any of my patients has a well marked 
shivering fit, even although other symptoms indicative of disease elsewhere be 
strongly marked, I at once suspect that the lungs are more or less seriously 
affected. On very many occasions, indeed, this symptom alone has sufficed to 
suggest to me the right diagnosis, while other medical men who have seen the 
case at the same time, have formed a very different opinion. 

"There is another character which equally deserves the attentive considera- 



1844.] Surgery. 207 

tion of the physician — and that is the pain in the side. In pleuro-pneurnonia 
the pain is jsrenerally seated in the region of the mamma, although the affected 
part of the lung does not correspond to this point, or perhaps extends much 
beyond it. It has been suggested, in the way of explanation, that there is a 
greater degree of friction between the pulmonic and the costal pleurae at this 
point than at any other, and that this may be the cause of the phenomenon in 
question. But if such were the case, the pain should surely not be limited to 
so circumscribed a spot, but should extend over all the surface where this greater 
friction is experienced; and we might expect, moreover, that it should change 
its locality — vi^hich certainly does not hold true. No satisfactory explanation 
has hitherto been offered of this symptom, and we must therefore confess our 
ignorance upon the point." — L. ^ E. Monthly Journ, Med. Sci.^ Oct. 1843, 
from Gazette des Hopitaux. 



SURGICAL PATHOLOGY AND THERAPEUTICS AND OPERATIVE 

SURGERY. 

27. Successful case of operation for the formation of a New Urethra. — M. 
RicoRD presented to the Academy of Medicine, on the 7th of March last, a man 
who had been operated on for the restoration of the urinary canal on the 27th of 
.January. At this time he made water freely by the new canal, which was of 
sufficient size to admit bougies of a large diameter. 

A phagedenic chancre had destroyed the urethral canal for the whole lenoth 
of the corpora cavernosa^ as well as the greater portion of the skin of the penis, 
so that about three-fourths of the circumference of the corpora, cavn-nosa^ as well 
as the longitudinal groove, indicating the site of the urethra, were alone covered 
by a thin cicatrix. The urine escaped from the perinasnm by an aperture con- 
cealed by the skin of the scrotum. M. Ricord thought that a new urethral canal 
might be formed between the corpora cavernosa and the thin cicatrix, which 
covered the groove between them, and he effected it in the following manner. 

A slender flattened trocar, with a lance-shaped point, was introduced into the 
meatus urinarius, and its point pushed into the cellular tissue, which lies between 
the corpora cavernosa. It was carefully pushed on in the direction of the urethra, 
taking care not to injure the thin cicatrix, till it arrived within about half an inch 
of the perinseal aperture, from which the urine escaped, A gorget was intro- 
duced by this aperture, to the depth of about half an inch, so as to form a con- 
tinuous canal with that which the trocar had made. After this operation, which 
did not produce very severe pain, the perforating instrument was withdrawn, and 
a silver canula introduced, and within two hours after the operation the urine 
came freely away through the catheter. Cloths dipped in cold water were the 
only dressings used. Very little swelling or inflammatory action occurred. The 
catheter was replaced on the fifth day by a gum elastic sound, and since that 
time their diameter has been gradually enlarged, so as to bring the new urethra 
to proper dimensions. — Ed. Med. ^ Surg. Journ. ^ Oct. 1843, from Bulletin de 
VJlcad. April, 1843. 

28. Experiments illustrative of the mode of formation of Dissecting Aneurisms. — 
Pr. Thomas B. Peacock has instituted the following experiments with the view 
of ascertaining the mode ot formation of dissecting aneurisms. 

" 1st, The aorta of a young man, 23 years of age, who died of phthisis, was 
cut across at its point of passage from the chest, and a pipe inserted. The in- 
ternal coats of the vessel having been previously divided near its lower extremity, 
and a ligature applied round the vessels passing to the head and neck, and at 
the root of the aorta, on injecting water from an eight oz. syringe, the vessel 
became distended, and the fluid then insinuated itself between the coats, sepa- 
rating and distending them as far as the subclavian artery; beyond this the 
separation could not be continued, in consequence of the fluid freely escaping by 



208 Progress of the Medical Sciences. [Jan. 

the small rupture which had been occasioned in removing- the lunor from the 
chest. The coats of the aorta were perfectly healthy, — the laceration of the 
middle and internal tunics extended nearly around the whole circumference of 
the vessel, and was occasioned by the application of a tight ligature. 

"So', The thoracic aorta of a girl, 13 years of age, who had died of scarlet fever, 
having been slit open at its lovver extremity, a pipe was inserted, and the ves- 
sels passing to the head and neck secured. Fluid was then injected, and the 
vessel much distended, and the substance of the heart became tense; a ligature 
was then applied on the origin of the aorta, and fluid thrown into the vessel with 
great force, without any rupture being produced. The vessel was then removed 
from the body and a pipe inserted at the root of the arteria innominata, the liga- 
ture on tl'.e origin of the aorta being retained, and a fissure made in the internal 
coats with the scissors. The fluid injected passed readily into the cellular tissue 
external to the middle coat, distending the external layer of condensed tissue 
with its covering of pericardium to a great extent, and escaping partly by transu- 
dation through these membranes and partly into the adjacent cellular tissue. 
The perforation of the internal coats was, in this instance, about a quarter of an 
inch in length. 

*" 3c?, The pipe was fixed in the aorta of a man, 30 years of age, who died of 
lumbar abscess, and was secured by a ligature at the art. innominata, while a 
second was placed around the origin of the aorta; an incision was made with a 
sharp knife across about half an inch of its circumference, and penetrating en- 
tirely the middle coat at one point. Fluid being injected, the external coat and 
attached pericardium were elevated, distended over the whole at least of the 
ascending aorta, and by continuing the pressure, these membranes gave way 
and the fluid escaped. On examination, no separation of the layers of the mid- 
dle coat, along the line of incision, had taken place, and the perforation by 
which the fluid had passed beneath the external coat was found to be a mere 
puncture. 

"In each of these cases, having ascertained the eflfects of injecting the fluid 
into the canal of the vessel, after the whole of the middle coat was entirely 
divided, I placed the mouth-piece of the syringe between the laminae of the mid- 
dle coat, and thus readily separated them to an indefinite extent. The two re- 
maining experiments were directed to ascertaining the effect of a laceration of a 
part only of the middle coat. 

"4/A, The aorta of a female, aged 30, who died of pneumonia attended with 
a copious puerperous eruption on the skin, having been removed from the body, 
a pipe was secured immediately behind the left subclavian artery, a ligature was 
passed tiglitly around the base of the heart, and the vessels arising from the arch. 
An incision was previously made with a sharp knife through a portion of the 
middle coat, about one and a half inch in length, and partly in a transverse and 
partly in a longitudinal direction,— it occupied the convexity of the arch, and 
was situated about a third of the distance between the arteria innominata and the 
origin of the aorta. On injecting fluid, so as to distend the vessel, little or no 
eflfect was at first produced on the coats, a portion only of the upper edge of the 
fissure being turned back; on making, however, a very slight separation of the 
edges, and continuing the pressure steadily but without great force, the fluid 
readily passed between the laminae of the middle coat, and then burst through 
the outer layer together with the external coat and pericardium. On removing 
the pipe and slitting up the vessel behind, the separation of the lower edge of 
the fissure had taken place only at the transverse portion, and the dissection of 
the laminae extended along the anterior surface of the vessel as far as its origin, 
forming a sac about one inch in width situated between the layers of the middle 
coat, — the layer of middle coat forming its external boundary of the separated 
portion had given way transversely. 

" 5/A, The aorta of a female about 60 years of age, who had died of acute 
cerebral disease, was cut across as it passed between the crura of the diaphragm, 
and a large pipe was inserted into its thoracic extremity, the large vessels pass- 
ing to the neck and upper extremity being at the same time secured by ligatures. 



1844.] Surgery. 209 

The vessel vvas distended with water from a powerful injection S5'ringe, — the 
fluid passed freely along' the coronary arteries, distending- the substance of the 
heart. A ligature was therefore placed around the origin of the aorta, and the 
injection resumed; but though the vessel became greatly distended, its coats con- 
tinued entire, and at length several of the small branches having ruptured, the 
fluid seemed to escape almost as readily as it could be thrown in. The pipe 
was then removed, and the finger being introduced into the lower extremity of 
the vessel, a laceration of the internal coats was produced by the nail. On the 
injection being again tried, the fluid at first distended the vessel moderately, and 
then readily passed beneath the external coat, producing great distension over 
its whole extent. The vessel being removed and examined, the laceration was 
found to be situated on the centre of the descending aorta and to occupy about a 
third of its circumference; from this point, the fluid had effected a separation be- 
tween the coats, extending above to the ligature at the origin of the aorta, and 
downward to the attachment of the tube. The separation having, however, 
taken place, not between the external and middle coats, but in the laminae of the 
middle coat — around the fissure, the portion of the middle coat separated in con- 
nection with the external tunic was extremely thin, but in advancing towards 
the interior portion of the vessel it gradually increased in thickness, being in the 
ascending portion about half a French inch in width. The origin of the intercostal 
arteries were in several instances torn across by the pressure of the extravasated 
fluid, and thus these vessels seemed to open into the newly formed canal; the 
separation of the coats advanced about three-fourths of an inch along the left sub- 
clavian artery, and the internal coats being again ruptured, the sac re-opened into 
the canal of the vessel; at the origin of the left carotid and arteria innominata, 
the same rupture and recommunication had taken place. The separation of the 
coats occupied about two-thirds of the circumference of the vessel at its posterior 
extremity, being apparently bounded by the points of departure of the intercostal 
arteries in the ascending and transverse portions of the arch. The separation 
occupied only the front of the vessel; but in the left subclavian, the whole circle 
of the vessel was exposed. The aorta, though as usual in elderly persons, some- 
what dilated, was otherwise healthy. 

" In all these cases, the vessels experimented upon presented no signs of dis- 
ease, and as each of the observations has been repeated in various ways with 
analogous results, so thai the whole number of observations amount to fifteen or 
sixteen, we are, I think, justified in drawing the following conclusions from 
them: — Is;;, That the coats of the aorta in a healthy state cannot be ruptured by 
the application of any ordinary force from within; in this respect the experiments 
correspond with some of those made by Dr. Davy. In attempting to produce 
rupture of the internal coats by the finger introduced into the vessel,! have often 
been struck with the extreme amount of force required. In one instance, after 
pressing forcibly against the coats of the descending portion of the thoracic 
aorta, they were felt to give way, and it was supposed, as the finger allowed of 
being readily pushed outward, so as to distend the external tunic, that the in- 
ternal had been ruptured; on injecting fluid, however, no separation was pro- 
duced, and this was explained by finding, when the vessel was slit up, that the 
internal coat was only abraded, but not ruptured, while the fibres of the middle 
coat had separated transversely, so as to allow the finger to be pushed between 
them, thus verifying the assertion, that the internal coat admits of a kind of 
hernia through the fibres of the middle coat, as in cases described by Laennec, 
and of which specimens have occurred to Dubois, Dupuytren, and Liston. 2c?, 
That when the internal coats are divided, either directly by an incision, or by a 
force acting from without, the fluid injected into the vessel readily penetrated the 
cellular tissue, between the middle and external coat, distends the latter for a 
great distance along the course of the vessel, and never forms a tumour bearing 
any resemblance to a circumscribed aneurism, and that this effect is equally pro- 
duced whether the aperture be of considerable extent or a mere puncture. 3<:/, 
That the external coat alone does not in these cases possess sufficient power to 
resist permanently the pressure of the extravasated fluid, which therefore escaped 



210 Progress of the Medical Sciences, [Jan. 

into the adjacent texture either by transudation or rupture. 4/A, That when the 
middle coat is partially divided, its different layers admit of being separated by 
the current of fluid over a greater or less extent, but that the canal thus formed 
tends rather to reopen into the original vessel, than to burst externally. 5M, That 
this separation between ihe laminae of the middle coat is less readily aflTected 
than the diffusion of the fluid beneath the external coat; to accomplish that pur- 
pose, it being necessary that the fissure should follow a transverse direction, so 
as to be opposed to the course of the injected fluid, and its edges to be separated, 
so that the current may bear directly upon the outer laminae. In several in- 
stances experiments have been performed upon the aorta after portions of the 
internal and middle coats have been scooped out with a sharp knife, yet on free 
distension of the vessel by a column of water, no separation of the layers of the 
middle coat was eff'ected, nor was any bulging of the side oi the vessel corre- 
sponding to the removed portions a[»parent, yet it seems probable that a swelling 
analogous to a circumscribed aneurism would be produced by the pressure, if 
sufficiently long continued. It also appears from the greater elasticity of the 
middle coat of the pulmonary artery, than of that of the aorta, that fluid injected 
between its laminae, do not readily efl^ect an extensive separation, but that the 
coats rather admit of being elevated into a tumour, and that it is probable from 
the circumstance of Dr. Nicholls' experiments having been performed on the 
pulmonary artery, may have led to the results which he obtained. It might also 
be objected to some of the experiments of Scarpa, that no inference drawn from 
the results of inflating the vessels can be made to apply to the explanation of 
the efllects which would attend the extravasation hetween the coats of an incom- 
pressible fluid like the blood. The application of the above experiments to the 
explanation of the mode of formation of dissecting aneurisms is obvious: \sty It 
would naturally be supposed that in most cases of the disease, the arterial tunics 
would present decided proofs of diseased lacerability, — this was noticed by Dr. 
Paterson in the case which he exhibited to the Anatomical Society during the 
last session, and occurred also in several of the cases on record, while in others, 
as in one of those examined at the infirmary, the same state of parts was shown 
by the presence of two or more ruptures in diflferent parts of the aflTected vessel, 
while in a third class of cases by the ruptures occurring while the patient was 
in a state of rest, and when no cause existed for any increased impetus in the 
circulation, 2c/, It would also be inferred, that as the external coat alone does 
not appear capable of retaining the column of extravasated fluid, while the mid- 
dle coat readily admits of separation, the sac of the dissecting aneurism would 
be more likely to be situated hetween the laminae of the middle tunic, than, as 
has been usually supposed, in the space between the external and middle coats. 
This inference is supported by the fact, that in the three cases which I have per- 
sonally examined in the recent state, including the case of which Dr. Henderson 
has recorded the particulars, the separation was found to have taken place be- 
tween the laminae of the middle coat, and Drs. Pennock and Goddard, in cases 
they have related in the Jlmerican Journal of Medical Sciences, also found the sac 
to occupy a similar situation. The fifth experiment would appear to show, that 
provided the middle coat be only partially ruptured, its diff'erent layers would 
readily admit of separation, by the action of the circulating fluid; this cannot, 
however, in all instances be the case, since from numerous trials I am satisfied, 
that in a healthy artery, it is only when the fissure affords a direct opposition to 
the current that a separation is effected, and these have occurred in cases in 
which the internal coats of the aorta have been ruptured during life, yet in which 
no extensive extravasation of the blood between the coats had taken place. A 
preparation of this kind, taken from the body of a man who died seven weeks 
after sustaining a fracture of the spine by a fall, is contained in the museum of 
Guy's Hospital; a transverse rupture of the internal coats extends across one- 
third of the circumference of the ascending aorta, yet the edges of the fissure, 
though widely apart, have been very slightly separated from the tissues beneath, 
and lymph having been eflfused around the lacerated portion, the formation of a 
circumscribed aneurismal sac lias commenced. It is therefore most probable 



1844.] Surgery, 211 

that a dissecting anenrism can only take place in arteries of which the coats are, 
as sug-CTested by Dr. Henderson, rendered more readily separated by disease, and 
unquestionably such a condition of the coats as he observed, in which ' the outer 
coat, with an adherent lamina of the middle, admitted of being detached with a 
facility not much less than that with which two moistened pieces of paper may 
be separated,'* must have greatly aided in the development of the disease; the 
readiness with which the coats admit of separation in some is also attested by 
the very varied extent of detachment in different instances; thus, in one of the 
cases which occurred at the infirmary, the coats were separated from the com- 
mencement of the abdominal aorta to the heart, yet little doubt could exist that 
death must have ensued very rapidly on the occurrence of the internal rupture, 
while on the other hand, in a case which occurred to a soldier at Chatham, the 
symptoms indicated the occurrence of the internal rupture three days before 
death, yet on examination, the sac which originated from the ascending aorta 
was found to be only two inches in extent. — Lond. and Edin. Man, Journ. Med. 
Set., Oct. 1843. 

29. Extraordinary case of Varix. — Dr. Seidel relates in the Medicin. Zeif. 
a very remarkable case of varix. The subject of it, a woman, when pregnant for 
the fifth time, had very large varices on her legs, at the end of the fourth week. 
Soon afterwards they extended up the abdomen, and two months before her con- 
finement they had even spread up to her arms, breast, neck, and scalp, so that 
there were more than fifty large knots on the upper part of her body. All mo- 
tion was painful, from the friction and pressure attending it. She rapidly sunk 
after delivery, though the hemorrhage was inconsiderable, and died shortly 
afterwards. 

30. Fracture of the thigh by muscular contraction. — M. Maranovitch relates 
in the Journal de Med. et d''histoire naturelle, published by the Imperial Medico- 
Chirurgical Society of St. Petersburg, an example of this. It occurred in a 
cavalry soldier, 29 years of age, who was in the military hospital for a scrofulous 
sore on the right knee. Whilst seated on the floor cross-legged, he made a sud- 
den effort to rise without the aid of his hands. He immediately experienced a 
sensation of fracture with crepitation, and fell to the floor. In fact, it was found 
that he had a simple transverse fracture o£ the right thigh, precisely at its 
middle. 

31. Congenital sacciform dilatation of the Urethra. — M. Hendriksz of Amster- 
dam, has published the details of a very singular congenital deformity, on which 
he operated successfully. A boy, eight years of age, was brought to him, hav- 
ing a sacculated appendix along the lower surface of the penis, extending from 
the arch of the pubes to the fossa navicularis, which received and retained the 
urine when the bladder was emptied, nor could any of it be evacuated by the 
meatus without pressure on the sacculated urethra. On exploring with the 
sound, the upper paries of the urethra was found to be natural, the lower one 
having a loss of substance supplied by this pouch. M. Hendriksz having deter- 
mined on attempting the excision of the sac, the reunion of the edges of the 
wound, and the formation of a cylindrical canal, the patient was placed as for 
the operation of lithotomy, the sac distended with warm water, a sound passed, 
and the penis turned back on the abdomen. The pouch was then circumscribed 
by two semi-elliptical incisions, commencing on the median line from behind 
the gland, and meeting behind the tumour equally on the raphe. This part of 
the skin having been removed, the proper tunic of the pouch was discovered; it 
was very thin, and consisted of the membranes of the urethra, the fibres of which 
were much separated. This was also excised with scissors, allowing the escape 
of the water, and permitting the catheter to be seen passing along the upper sur- 
face of the urethra. The urethral mucous membrane was then found to form two 

* Edin. and Lond. Medical Journal, Aujrust. 1842. 



212 Progress of the Medical Sciences, [Jan. 

valvular folds at the anterior and posterior orifices of the sac, which were de- 
stroyed, and the membrane of the urethra separated from the integument to the 
extent of several lines, in order that it might unite separately. This was effected 
by fifteen points of knotted suture, the integuments being reunited by seven points. 
A compress and bandage was applied, and the catheter retained in place as long 
as the patient could bear it. The instrument was passed afterwards whenever 
it was necessary, care being taken to direct it along the upper surface of the 
canal. The wound cicatrised with remarkable rapidity, so that eight weeks 
afterwards, there was only a small point, about two lines in diameter, unhealed 
and fistulous, through which a iew drops of liquid passed when the little boy 
made water. This gradually diminished under the influence of repeated cauteri- 
zation with the nitrate of silver, until it was only a pin's head in size. The 
child was then taken away, and M. Hendriksz has not heard from it since, so 
that he supposes a perfect cure to have been effected. — Medical Times^ July 
1, 1843. 

32. Scirrhous Tumour of the Tongue — Operation hy Ligature — Unusual result 
following its application. — Michael Geelan, a labourer, aet. fifty-four, admitted 
into St. Vincent's Hospital under the care of Dr. Bellingham, June, 1843. He 
had always been a healthy man until about five years ago, when he first ob- 
served the disease, which commenced as a crack upon the upper surface of the 
tongue. About three years ago his attention was attracted to a tumour in the 
substance of the tongue, at which time the ulcerated surface had partially healed; 
the tumour at that period was small, about the size of a pea, and it has con- 
tinued gradually to increase since. 

The tumour now is about the size of a nutmeg or a little larger; it has a solid 
hard feel; it occupies the centre of the muscular substance of the left side of the 
tongue, midway between the raphe and the edge, and nearer to the tip than to 
the base of the organ. He suffers from lancinating pain through the tumour, 
which he describes as being sometimes very acute; and he complains also of a 
darting pain towards the angle of the jaw and ear of the affected side; his speech 
is not much affected, and no enlargement of the glands under the jaw can be 
detected. 

He had been in the habit of smoking a very short pipe, the end of which fre- 
quently came in contact with the upper surface of the tongue at the point where 
he first observed the crack; but he himself attributes the disease to the irritation 
excited by lighting his pipe with linen rags; as, when he first observed it, he 
was working in a part of the country where turf was not to be had for this 
purpose. 

The patient had come to town from a distance, and was anxious to have some- 
thing done for the removal of the disease; and as there was no enlargement of 
the glands under the jaw, it was considered by Mr. Wilmot to be a favourable 
case for operation, and he recommended no time to be lost previous to its per- 
formance. 

A curved needle, armed with two strong double silk ligatures, was passed 
through the substance of the tongue from below upwards, behind the diseased 
part, and the needle was cut off: one ligature was then drawn as tightly as it 
could be with the fingers, and tied upon the side; the second ligature was then 
tightened, so as to include as nearly as possible a V shaped portion, with the 
whole of the diseased parts. Immediately upon the ligatures being tightened, 
the part included in them became of a very dark colour, and some blood oozed 
from the ulcer upon the surface. Profuse salivation followed its application, 
with soreness of the throat, and difliculty of swallowing even liquids, except in 
very small quantities, which continued more or less for several days. 

After a few days more, it was observed that the portion of the tongue included 
in the ligatures, instead of sloughing, was beginning to recover its sensibility; 
in consequence probably of the ligatures having cut through a considerable por- 
tion, and then necessarily ceasing to make further pressure. Accordingly two 
pieces of lead wire were introduced through the original opening, and one was 



1844.] Surgery. 213 

twisted upon each side, in the site of the former ligature, so as to strangulate the 
included portion. After two days they required to be again twisted, and short!}'- 
afterwards one of the pieces of lead wire had cut its way out, the loop being ex- 
ceedingly small, and the other nearly so; but the portion of the tongue was ob- 
served, notwithstanding, to have regained its fornrier appearance; and on exami- 
nation, it was found that the site of the ligature was marked merely by a deep 
groove, above and below; consequently, as the ligatures cut through the sub- 
stance of the tongue, union must have taken place behind them. A blunt probe, 
armed with a double silk ligature, was then passed without delay, and with little 
difficulty, through the centre of the tongue, in the situation where the needle first 
used had penetrated; one was then tightened upon each side, and both cut 
through a considerable portion of the granulations which had formed, yielding a 
good deal of blood: their application was not, however, attended with much 
pain, nothing compared to what the patient had experienced in the first instance. 

On the next morning the patient was eating stirabout for breakfast, when the 
diseased portion of the tongue became detached, and he stvallowed it unconsciously 
along with the ligatures. 

In eight days afterwards the patient left the hospital and returned to the coun- 
try, the wound being nearly healed, his articulation very good, and his health in 
other respects unimpaired. 

Observations. — The form which cancer, when it attacks the tongue, usually 
assumes was that observed in the present case: and the importance of the re- 
moval of the diseased mass as early as possible is insisted on by all writers; as 
after it has arrived at a certain stage, and the constitution has become contami- 
nated, operative proceedings are out of the question; and if the disease be allowed 
to progress, in order to give a trial to internal medicines, valuable time is cer- 
tain to be lost, and the risk of the return of the disease will be increased. " This 
disease in the tongue (Sir E. Home remarks) always begins in a very small 
portion of that organ, and is in the early stage more within the reach of removal 
than when situated in any other part of the body;, the part may also be removed 
with a greater degree of security against a future recurrence of the disease than 
when cancer occurs in other situations." 

The operations which have been practised for the removal of cancer of the 
tongue are excision and ligature; on the continent excision is commonly per- 
formed; in this country the ligature is usually preferred. The objections to ex- 
cision are the danger of hasmorrhage following the operation, (owing to the great 
vascularity of this organ) which, in many cases, has been with difficulty con- 
trolled, and has required either the application of the actual cautery to the cut 
surfaces, or in some cases even ligature of the lingual artery above the os hy- 
oides. The method of extirpating cancer of the tongue by ligature appears to 
have been first successfully put in practice by Sir E. Home. A paper upon the 
subject, with cases by him, is contained in the Philosophical Transactions for 
the year 1803: this was afterwards republished in a more complete form in his 
work upon cancer. 

The kind of ligature recommended in these cases varies somewhat; some sur- 
geons prefer a metallic ligature, others one of silk or fine whipcord. The prin- 
cipal interest of the foregoing case is connected with this point — a silk ligature 
was in the first instance applied, which was tied as tightly as it could well be 
drawn with the fingers, and yet after some days the part had nearly recovered 
its normal appearance. This, as I have observed, most probably depended 
upon the cords, after they had cut through a considerable portion, ceasing to act 
as ligatures. Metallic ligatures were next applied, these were twisted very 
strongly, and on their cutting their way through, adhesion was found to have 
taken place between the body of the tongue and the portion originally included 
in the ligatures. 

Every surgeon is aware that injuries of the tongue or even incised wounds of 
this part are often difficult to heal, owing to the " extreme mobility of the organ, 
and its almost continual use in eating, drinking, and speaking," and yet here 
was a complete separation, effected by a metallic ligature, of a portion of the 



214 Progress of the Medical Sciences, [Jan. 

tongue, and as it cut its way throug-h in one direction, union took place in the 
other, although all the time salivation was going on, and the parts must have 
been constantly moistened by this secretion, as well as disturbed by the mo- 
tions of the organ in speaking and taking food. This was a result which could 
hardly have been anticipated, and would induce me in future to leave ligatures 
vf reserve upon each side, which could be readily tied upon the day or day but 
one following the application of the first, in case it were considered advisable. — 
Dublin Medical Press, ivi\y 12, 1843. 

33. Fistula in ano in a Phthisical Patient. — A man affected with fistula in 
ano was admitted into the wards of M. Robert, Hopital Beaujon. He was 
apparently in good health, was operated on, and in a few weeks was discharged 
cured. A short time afterwards symptoms of pulmonary and mesenteric tuber- 
culization manifested themselves, and he returned to the hospital, where after 
some time he died. A careful autopsy was made, and in addition to the ordi- 
nary lesions produced by tubercles in the lungs and mesentery, there were found 
in the rectum several ulcerations of the mucous membrane, evidently produced 
by ulcerated tubercles occupying the sub-mucous cellular tissue. Several of 
these ulcerations communicated with small collections of tuberculous matter 
which could be raised with the scalpel. Immediately above the anus, on the 
mucous membrane, several laminae of considerable size were observed in this 
subject. 

The presence of the sub-mucous rectal tubercles in this case is interesting, as 
it bears on a debated point between surgeons and physicians, the coincidence of 
fistula in ano and pulmonary phthisis. In nearly all surgical works we find this 
coincidence and tiie connection of the two maladies mentioned as undeniable 
facts, and yet the assertion is by no means borne out by the experience of those 
who have more specially devoted their attention to the study of pulmonary 
phthisis. Thus, Andral says that he has only once met with a fistula in ano in 
about eight hundred cases of phthisis which he has seen. Louis, whose work 
on Phthisis has become classical, never even alludes to the subject. Laennec 
himself doubts whether phthisis can be considered to predispose to fistula. 
Perhaps the interpretation of this dissidence is to be found in the fact, that often 
phthisical patients affected with fistula have their attention more forcibly direct- 
ed to the latter complaint than to the former, and apply in preference for surgical 
assistance. 

There is at present in the wards of M. Lenoir, at the Hopital Necker, a patient 
whose case tends to confirm this view. Operated on for fistula in ano last year, 
he at that time presented no decided symptoms of pulmonary tuberculization; a 
very short time after his cure he returned to the hospital in a state of advanced 
phtiiisis. No doubt, had the chest been carefully examined at his entrance on 
the former occasion, the presence of crude tiibercles would have been made 
manifest. The same remark may be made on M. Robert's case. 

These two cases seem also to favour the opinion that the cure of a fistula in 
ano hastens the progress of the disease in a person labouring under phthisis. It 
would seem as if the stoppage of the continued purulent drain on the economy, 
which the anal affection created, were immediately followed by the softening of 
the tubercles, which no doubt already existed, and the generation of new ones 
as well. 

Whatever view we may adopt, these cases are sufficient to warrant M. 
Robert's caution to surgeons not to operate on fistula in ano without carefully 
examining the state of the lungs, as in the case of pulmonary tubercles existing 
an operation is not only useless, but may accelerate the progress of the more 
important disease. 

The enlargement of the mucous laminae above the anus, in the first patient, is 
worthy of notice, as an example of an anatomical disposition of by no means 
uncommon occurrence, and one which may be considered a frequent cause of 
Ustula. Alimentary detritus, by sojourning in these lacunae, no doubt are often 
J®e cause of ififlamnaation and subsequent fistulap-^X-'^iPpmence. 



1844.] Surgery, 215 

34. On Purulent Infection. By M. Raciborski. — "M. Bonnet, chief sur- 
p^eon of the Hotel Dieu at Lyons, has recently directed the attention of the pro- 
fession to the good effects of cauterizincr— either with the actual or the potential 
cautery— ulcers and suppurating- wounds, with the view of preventing or even 
of curing that very formidable affection which has been called purulent phle- 
bitis and purulent infection. It appears to me that a temperate discussion of this 
question is calculated to thow some light on several topics in pathology, that are 
a good deal canvassed in the present day. 

"In my thesis, published in 1840, 1 examined with much care the various 
theories (of metastasis, absorption, aspiration, phlebitis, &c.) which have been 
proposed by different writers, to account for the formation of those internal 
abscesses or purulent deposits, and the occurrence of the other morbid affections, 
which not unfrequently accompany open wounds in a stale of suppuration, and 
it then, as I stated at the time, seemed to me that none of them was satisfactory 
in an setiological point of view. We can at present allude to the last only of 
these theories, and shall now very briefly state our reasons for refusing our 
assent to it. 

'^The doctrine of phlebitis reposes on the assumption that there is a passage 
of the pus— secreted by the inner surface of the veins in a state of inflammation, 
after operations, injuries, accouchement, &c. — into the current of the circulation. 
But it is very far from being proved that such a passage or transmission ever 
takes place. On the contrary, it would seem, from the researches of most 
pathologists in the present day, that the first phenomenon in actual phlebitis is 
the formation of a coagulum that plugs up the inflamed vessel, and which thus 
detaches the diseased from the healthy portion of the tube. In such a state of 
things, it is obvious that any purulent matter, which may be secreted in the 
former part, cannot become mixed with the general mass of the blood. M. 
Dance himself had felt the force of this objection so much, that, in order that he 
might be able to give some degree of consistency to his ingenious romance., (to 
use the expression of M.' Tessier., to whom unquestionably belongs the merit of 
having first clearly established the importance of this point,) he was obliged to 
suppose that the secretion of pus takes place before the formation of the coagu- 
lum — a position at utter discordance with the observations of all the best patho- 
logists. But, by a curious contradiction, when he was describing the symptoms 
of phlebitis, he enumerated in the last stage those which he considered to be 
owing to the passage of purulent matter into the blood. If space permitted, we 
might adduce other arguments that are unquestionably opposed to the doctrine 
that the symptoms, of what has of late years been called purulent infection of 
the system, are attributable to a suppurative inflammation of the veins." 
# * * * * * 

" M. Bonnet seems to be one of those surgeons who attribute the constitutional 
disorders, which occasionally attend suppurating wounds, in part to an inflamed 
state of the veins, and in part, also, to the direct absorption of purulent matter 
into the system. But neither of these doctrines can well serve his purpose, 
when he attempts to give a reason for the successful results of cauterizing the 
wounds themselves, or the adjacent veins, as a means of counteracting these 
disagreeable consequences. 

"May not the following theory — derived from the study of Liebig^s beautiful 
researches — furnish-a better explanation of the subject in question] 

"It is well known to the chemist, that, if a small portion of yeast be placed 
in contact with a solution of sugar, the latter substance begins immediately to 
undergo certain changes, the result of which is the formation of alcohol and 
carbonic acid — and yet the yeast itself has lost nothing of its weight. May not 
something akin to this lake place, when a portion of purulent matter, in a state 
of decomposition, is brought into mere contact with the blood? and may not the 
entire mass of the circulating fluids in this manner undergo a certain change, as 
we daily see take place in the fermentation of large quantities of vegetable 
juices, when the minutest quantity of leaven is added to them? 

"If we examine attentively the cases, in which the symptoms of purulent 



216 Progress of the Medical Sciences. [Jan. 

infection^ or purulent diathesis appear, we shall find that these symptoms have 
almost always occurred under circumstances that are favourable to the decora- 
position of the secreted pus: indeed, the physical characters, as well as the 
chemical properties, of the purulent fluid abundantly prove the truth of this 
observation. 

"The pus, having become vitiated — whether this has been from neglect of 
cleanliness in dressing the wound, or from the mere influence of an unwholesome 
atmosphere that may, perhaps, be charged with molecules in a state of putrefac- 
tion, or from the mere influence of an elevated temperature— communicates the 
movement of its decomposition to the coagulum which stops up the extremity, 
and thence to all the mass of the blood." 

"It has usually been too much the case with pathologists to ascribe the alter- 
ations, which are met with in the veins of those who have died from suppurat- 
ing wounds, to an inflammation of the parietes of those vessels. But I am 
persuaded that, in very many cases of this sort, the pus that is found in the 
interior of the affected veins, is no more the direct consequence or result of a 
phlebitis, than is the deep red colour of their lining membrane, so frequently 
seen in fatal cases of typhus fever. 

" In support of this opinion, I might allude to the accidents which are apt to 
follow dissection-wounds. In these cases all the phenomena, from the earliest 
local symptoms observed during life, to the most serious anatomical lesions dis- 
coverable after death, might seem to justify the appellation of phlebitis, — which 
has been usually applied to this state; — and yet what is more manifest than that 
there is a primary alteration of the blood, under the influence of a fluid in the 
state of decomposition] Does not the success, which generally attends the 
immediate cauterization of the wound in such cases, abundantly prove that it is 
to the destruction of the poisonous matter by the caustic employed, and not to 
the action of this on the parietes of the veins, that the curative effects are really 
attributable? 

"It is in this manner that we should explain, I think, the cures obtained by 
M. Bonnet from cauterizing wounds in a state of suppuration; and I am, at the 
same time, led to believe that, if we were to combine this practice with irriga- 
tions of cold water — so as to establish, as it were, a continual current of water 
around the solution of continuity — we might obtain most salutary results, and 
prevent many of those distressing and fatal accidents which too frequently super- 
vene after severe accidents and operations." — Med, Cliirurg. Rev,, Oct. 1843, 
Archives Gen. de Med. 

35. Spermatorrhoea. — Mr. Douglas of Glasgow, has successfully treated a 
case of this malady by injections of one grain of opium and three grains of 
acetate of lead in an ounce of mucilage, together with the shower-bath and 
muriated tincture of iron. He believes this injection to have all the eflfect of 
the injection of nitrate of silver in allaying the inordinate irritability of the 
urethra, without any of the pain or necessity for confinement which the latter 
remedy occasions. — Lond. Med. Gaz. 

36. Nevj species of Intra-abdominal Hernia. By MM. Carteron and Laussier. 
— A female, 40 years of age, had been the subject of femoral hernia on the right 
side for about twelve years, hut continued in the enjoyment of good health, and 
had borne her husband fifteen children. October 20lh, whilst she was at stool, 
her hernia, (habitually kept up by a bandage), protruded; she immediately re- 
turned it. Soon afterwards she felt an uneasy sensation of dragging in the right 
groin, of no severity at first, but increasing rapidly to a great pitch of intensity, 
and extending to the umhilical region. The pulse was small and compressed, 
45—50; the surface rather cold; the expression that of great distress. The 
abdomen at this time was soft, no tumour could be perceived in any part of it; 
the hernia was up, and could not be brought down by any eff"ort of coughing 
that the patient could make. The patient had a bath; the abdomen was covered 



1844.] Surgery, 217 

with an ample cataplasm sprinkled with laudanum, and the nitrate of bismuth 
was prescribed. The patient soon became sick and vomited. The nature of 
the disease was extremely obscure. Things went on from bad to worse; the 
abdomen was found distended and tympanitic next morning, but not excessively 
painful; no evacuations from the bowels had been obtained. In the course of 
the day, the patient suffered from pains like those of parturition. She died on 
the 22d, at five in the mornincr. 

On examining the body, the cause of the distension of the abdomen was dis- 
covered to be the effusion into the peritoneum, and also into the intestines, of a 
quantity of blood or bloody fluid, — about a quart in the general cavity, and as 
much in the bowel. The cause of all the mischief was soon discovered: a 
noose of small intestine, with its mesentery, was found engaged in a rent of 
recent formation of a hernial sac. There was no perforation of the bowel; the 
part engaged was merely compressed, and that not very violently. The hernial 
sac was situated in the course of the round ligament of the uterus; it extended 
from the immediate vicinity of the uterus to the crural arch, under which it 
passed, and where it was fixed by adhesions. It began by an oblique orifice, 
which would have received the fore-finger, proceeded along the ligament nearly 
to the internal inguinal ring; there it left the round ligament, and passed under 
the crural arch, where it terminated in a blind sac that would have held a small 
egg. At a short distance from its upper orifice, a rent was perceived of larger 
size than the orifice itself; this rent leads to a funnel-like cavity, a true appendix 
to the sac, and in fact constituting it a double sac. This appendix was free and 
floating in the abdomen. The walls of both sacs are formed of the peritoneum, 
which descends from the ligamentum latum, to invest the ligamentum rotundum. 
It was in passing from the principal sac into the appendix, that the noose of the 
intestine had become engaged. 

M. Velpeau, in some remarks on this case, thinks it likely that there were in 
fact two hernial sacs in the groin originally, and that the second sac or appendix 
was not the eflect of the bowel bursting through the laminae of the old sac, and 
forming a second and new sac for itself towards the abdomen. On straining at 
stool, both hernise were brought down; one, the larger, was reduced, its sac 
being attached by adhesion; the other was pushed back also, but along with its 
sac, it now became incarcerated, and thence ensued all the mischief.— Zone?, ant/ 
Edin, Mon. Juurn. of Med, Sd,^ May, 1843, from Annales de la Chirurg. Francaise, 
March, 1843. 

37. Pathological Researches into the Local Causes of Deafness, based on one hun- 
dred and twenty dissections of the Human Ear. By Joskph Toynbee. — The re- 
searches of which this is a summary view, are in continuation of a previous 
paper contained in Vol. 24 of the Society's Transactions. The principal practi- 
cal conclusion to which they lead is, that the most prevalent cause of deafness is 
chronic inflammation of the mucous membrane which lines the tympanic cavity; 
and that by far the greater majority of cases commonly called nervous deafness 
ought more properly to be attributed to this cause. 

The pathological conditions to which inflammation of the mucous membrane 
gives rise are divided in the paper into three stages. 

In the first stage the membrane retains its natural delicacy of structure, though 
its blood-vessels are considerably enlarged and contorted; blood is effused into 
its substance, or more frequently at its attached surface; blood has also been 
found between the membrane and the membrane of the fenestra rotunda, and in 
very acute cases lymph is eflfused over its free surface. 

The second stage is characterized by the following pathological conditions: — 

1st. The membrane is very thick, and often flocculent. In this state the tym- 
panic plexus of nerves becomes concealed, the base and crura of the stapes are 
frequently entirely imbedded in it, while the fenestra rotunda appears only like a 
superficial depression in the swollen membrane. 

2d. Concretions of various kinds are visible on the surface of the thickened 
membrane. In some cases these have the consistence of cheese, and are ana- 



218 



Progress of the Medical Sciences, 



[Jan. 



logfous to tuberculous matter; in others they are fibro-calcareous, and exceed- 
ing'ly hard. 

ScJ. But by far the most frequent and peculiar characteristic of tbis second 
stao-e of the disease, is the formation of membranous bands between various 
parts of the tympanic cavity. These hands are at times so numerous as to oc- 
cupy nearly the entire cavity; sometimes they connect the inner surface of the 
membrana tympani to the internal wall of the tympanum, to the stapes and to 
the incus. They have also been detected between the malleus and the promon- 
tory, as well as between the incus, the walls of the tympanum, and the sheath 
of the tensor tympani muscle; as well as hetween various parts of the circum- 
ference of the fenestra rotunda. But the place where these adhesions are most 
frequently visible is between the crura of the stapes and the adjoining- walls of 
the tympanic cavity: this was the case in twenty-four instances out of a hun- 
dred and twenty dissections, being a fifth of the number. These bands of adhe- 
sion sometimes contain blood and scrofulous matter. 

In the ihirdstage of inflammation of the membrane it becomes ulcerated; the 
membrana tympani is destroyed, and the tensor tympani muscle is atrophied. 
The ossicula auditus are diseased, and ultimately discharged from the ear, and 
the disease not unfrequently communicates itself to the tympanic walls, affect- 
ing also the brain and other important organs. 

The following is a tabular view of the mucous membrane of the tympanic 
cavity in the 1'20 dissections related in this paper. 

Jn ihe first stage of inflammation. 

1. With simple inflammation of the membrane, its vessels being enlarged, 

tortuous, and distended wiih blood . . . . .10 

2. Ditto, with an accumulation of mucus . . . . . 1 

3. Membrane inflamed, with effusion of blood into its substance . . 3 

4. Membrane inflamed, with effusion of serum, tinged with blood, into the 

tympanic cavity ....... 1 

5. Membrane inflamed, with lymph effused into the tympanic cavity . 2 

6. Membrane inflamed, with blood and lymph eflused into the tympanic 

cavity ........ 2 

7. Membrane inflamed, with eflTusion of pus into the tympanic cavity . 1 



Dissections illustrative of the second stage of inflammation. 

With simple thickening of the lining membrane 

The membrane thick and pulpy ..... 

Ditto ditto and the cavity full of bands of adhesion 

The membrane thick and flocculent .... 

Membranous bands connecting the membrana tympani to the inner wall 

of the tympanum ...... 

Membranous band connecting the membrana tympani to the promontory 

and the chorda tym[)ani to the stapes 
Membranous bands connecting the membrana tympani to the incus 
Ditto ditto to the stapes - . . . . 

Ditto connecting the membrana tympani and chorda tympani nerve to 

the stapes ....... 

Ditto connecting the membrana tympani and malleus to the promontory 

Ditto connecting the membrana tympani to the incus 

Ditto connecting the membrana tympani and assecles to the inner wal 

of the tympanum ...... 

Ditto connecting the malleus to the inner wall of the tympanum 

Ditto connecting the incus to the inner wall of the tympanum . 

Ditto connecting the stapes to the promontory . 

Anchylosis of the stapes to the fenestra ovalis . 

Membranous bands, forming a network over the fenestra rotunda 

A broad membrane passing from the promontory to the mastoid cells 



1 
1 

2 

1 
1 
2 

1 

2 

1 

24 



1844.] Ophthalmology, 219 



19. The cavity of the tympanum full of bands of adhesions 

20. Membranous bands containincr scrofulous matter 

21. The cavity of the tympanum full of calcareous concretion 

22. Ditto, full of caseous concretion 

23. With ridges of bone projecting from the surface of the promontory 



Dissections illustrative of the third stage of ivflammation, 

1. With ulceration and thickening of the mucous membrane, attended by 

the formation of pus . . . . . . .3 

2. With ulceration of the membrane, and loss of one or more of the ossicula 3 

It thus appears that of the 120 dissections there were — 

20 Specimens in the first stage of inflammation of the tympanic cavity, 

65 Ditto in the second stage, 

6 Ditto in the third, 

29 Ditto in a healthy state, 

120 Lond, Med. Gaz. July, 1843, 



OPHTHALMOLOGY. 

38. Glaucoma.— The. following remarks by Dr. Mx\ckenzie, relative to this 
very imperfecUy understood disease, will be read with interest. The author is one 
of the most judicious and learned ophthalmic surgeons in Europe, and his views 
are entitled to a respectful consideration. We cannot, however, but entertain 
the persuasion, that Dr. M. has grouped together under the term glaucoma, 
sevigral atfections not necessarily corvnected, and which it would be better to 
consider separately. 

*' Glaucoma is so called from the greenish appearance which it presents behind 
the pupil. It is a reflection of the light which has entered the eye, by the cen- 
tral and posterior laminas of the crystalline lens, arising from these laminae hav- 
ing lost their r>atural colour and consistence, and acquired an amber or reddish- 
brown hue, with an abnormal degree of hardness and dryness. 

"The history of pathology sufficiently shows that dissection is the only way 
of discovering the nature of such diseases as cataract or glaucoma. If a cata- 
ractous lens is extracted from the eye of a person of 50 or 60 years of age, its 
superficial laminse are found to be of an opaque whitish appearance, like half- 
boiled white of eg^^ while the rest of the lens is of an amber colour, and rather 
less opaque than the surface. If a glaucomatous lens is extracted, its super- 
ficial laminse are found to be comparatively transparent, and the departure from 
the normal state to aflfeet chiefly its central portion. Viewed entire, by trans- 
mitted light, it appears more or less amber-coloured throughout. Divided by 
a section perpendicular to its surfaces, the kernel, and laminse immediately 
behind the kernel, are found to be of a reddish-brown colour, in a considerable 
degree opaque, hard, and drier than the superficial laminse. The lens, so 
changed, appeared while in the eye, and viewed therefore by reflected light, to 
be of a muddy-green colour, but this was in a great measure an optical decep- 
tion; for, taken out of the eye, all greenness is gone, both within the eye de- 
prived of its crystalline, and in the lens under examination. The lens, then, in 
glaucoma, is in a certain sense dichromatic, like a bit of gold-leaf; only that the 
latter viewed by reflected light is yellow, and green when viewed by transmitted 
light, whereas the glaucomatous crystalline is the reverse — green when seen 
■within the eye by reflected light, and amber-coloured when seen by transmitted 
light out of the eye. 

" In its advanced stages, the disease styled glaucoma involves many other 
textures of the eye besides the lens, so much so, that Dr. Hays, the American 



220 Progress of the Medical Sciences. [Jan. 

editor of Mr. Lawrence's Treatise on the Eye, remarks, that 'glaucoma cannot, 
strictly speakinof, be considered as a disease; the term being- applied to a group 
of symptoms which result from several and very distinct patholoaical condi- 
tions.' I cannot see, however, that glaucoma is more objectionable in this re- 
spect than hundreds of other nosological terms. In an early stage, glaucoma 
is often limited to the lens, as it was in Shaw's left eye; or to the retina and 
lens, as it was in his right eye. It is sometimes the case, as in this individual, 
that the disease may continue for a number of years, without absolutely destroy- 
ing vision, or becoming altogether irremediable. 

" The case of Shaw confirms two statements which I made respecting glaucoma 
in 1830; the one, that if the lens is removed by operation, the yreeu appearance 
behind the pupil is lost; and the other, that the removal of a glaucomatous lens 
improves the vision of the patient, unless, indeed, he be amaurotic* 

"The term glaucoma comprehends a series of morbid changes, which in 
general develops itself slowly, in the course of years, and involves at last all 
the structures of the eye. I say ' in general,' for there is an acuie glaucoma, in 
which many of the symptoms of the chronic variety are manifested often in a 
single night's time. The earliest and least important appearance of chronic 
glaucoma is merely a greenish hue, reflected from behind llie pupil in the eyes 
of old people, but which is not necessarily connected with any material dete- 
rioration of vision, as is shown by the liveliness of the iris and the sensibility 
of the retina. A muddy-green colour of the crystalline marks the second stage, 
as in Shaw; and along with this there is sluggishness of the pupil, and more or 
less obscurity of vision. The consistence of the eyeball is natural. This stage 
may last for five or six years, or more, vision declining by insensible degrees all 
the time. An unnatural hardness of the eye, with dilatation of the pupil, a vari- 
cose state of the external blood-vessels, and a still more marked loss of sight, 
are the signs of the third stage. In ihe fourth, the crystalline becomes cataractous 
as well as glaucomatous, opaque, that is to say, on its surface, as well as in its 
nucleus; it is also augmented in thickness, and pressed through the pupil, till at 
length it touches the cornea; the sclerotica is thinned, so as to allovv the choroid 
to sliine through it, and vision is totally extinguished. In the ffth stage, the 
cornea, pressed upon by the hypertrophied lens, inflames and gives way by 
ulceration, the lens escapes, and the internal vessels of the eye burst, and bleed 
through the ruptured cornea. A sixth stage presents the eye shrunk and atrophic. 

" These difterent stages of glaucoma run insensibly into each other. Although 
the disease is scarcely at any period of its course under the control of medical 
treatment, it is frequently arrested spontaneously in one or other of these stages, 
and makes no farther progress. In Shaw, it stopped, as it often does, in the 
second stage; the amber-coloured degeneration proceeding gradually towards the 
surface of the lens, but the other textures of the eye not becoming involved. 

"In the first and second stages, glaucoma is generally a disease of the crystal- 
line alone. I say 'generally,' for someti^mes amaurosis accompanies glaucoma 
from the very commencement. In its a'dvanced stages, it presents symptoms 
depending on certain morbid conditions of almost all the textures of the eye. 
The elements, in which glaucoma consists, when far advanced, reside in the 
lens, the vitreous humour, the retina, the choroid, the iris, the sclerotica, the 
blood-vessels of the eye, and even in the cornea. The order in which these dit- 
ferent parts become affected is not invariably the same, nor the proportions in 
which they take part in this complex disease. 

"It is only in the early stages of glaucoma that the catoptrical examination 
of the eye is of importance. In the first stuge, both the deep erect image formed 
by the anterior capsule of the lens, and the inverted image formed by the pos- 
terior capsule, are distinct. Both the images are rather larger than in the healtliy 
eye, and both of them are of a yellowish hue. In the second and third stac^es 
the erect image is still larger than it was in its first stage, but its outline is in- 
distinct, so that it appears as a diflfused blaze. In the second and third stages, 

* Glasgow Medical Journal, vol. iii. p. 266, Glasgow, 1830. 



1844.] Ophthalmology. 221 

the inverted image is seen for a time, if, by moving the candle to one or other 
side, it is formed near the edge of the lens, hut it appears less and less distinct 
as it is made to approach the centre of the pupil. At last, as the disease advances, 
il disappears entirely. 

*'The second stage of glaucoma is the only one in which the removal of the 
lens is a practice which can be defended. The pale muddy-green opacity behind 
the pupil, more deeply seated than the opacity in ordinary cataract; so that, 
owing to the transparency of the superficial laminae of the lens, the iris throws 
a broader shadow on the opacity than when the surface of the lens is affected; 
the consistence of the eyeball natural; the iris healthy in texture; the pupil not 
dilated; no inverted in)age, while the deep erect image forms a large yellow 
blaze; vision such as accompanies lenticular cataract; the progress of the dis- 
ease much slower than that of lenticular cataract, occupying pt-rhaps five or six 
years, whereas the formation of common cataract is generally etTected within as 
many months: these are circumstances which enable us to pronounce ihe dis- 
ease to be lenticular glaucoma in the second stage, and vision likely to be re- 
stored by the removal of the lens. This is an important fact, because practi- 
tioners are apt to conclude, when they see a green opacity behind the pu|)il, that 
the case is one of amaurosis, as well as of change in the refracting media of the 
eye. Hence patients are left as incurable, to whom the removal of the glauco- 
matous lens might restore vision. In the cases in question, a careful examina- 
tion shows that vision is not extinguished, but that the eye retains nearly the 
same degree of sight as does a cataractous eye; the eyeball is not hard and 
stony to the feeling, as it is in the third stage, when, to a glaucomatous state of 
the lens, there is added a dissolution and an accumulation of vitreous humour; 
the sclerotica is not thinned, so as to allow the choroid to shine through; nor are 
the external vessels of the eye enlarged and varicose, as in the advanced and 
hopeless stages of the disease. 

'' It sometimes happer^s, however, that incomplete amaurosis attends the 
second stage of glaucoma, as in Shaw's right eye, and then the operation proves 
fruitless. 

"In the third stage of glaucoma, the hope of doing any good by an operation 
is gone; and from the dissolved state of the vitreous humour and varicose con- 
dition of the vessels, there is much risk in attempting such a thing. 

*' I have already hinted that the diflerent elements of glaucoma do not present 
themselves in the same invariable order, 'i'he retinal, or amaurotic element, for 
example, is often the first to attract notice. VVeller thinks that it is always the 
first in the series of morbid changes, for he says, ' Primum hujus morbi symp- 
toma visus defectio est, pupillas color subviridis multo serins demum animad- 
vertitur.'* But I believe it were more conformable to the fact to say, that in 
such instances as Weller has taken for the ground of this remark, an amaurotic 
eye has become glaucomatous, than that the group of symptoms which consti- 
tute glaucoma has originated in the retina. 

"Amaurosis so generally attends the advanced stao-es of glaucoma, that it has 
been presun'.ed always, and in all stages, to do so. Mr. VVardrop even goes tb.e 
length of calling glaucoma a species of amaurosis. 'In some cases,' says he, 
* the vitreous humour acquires a dull greenish colour, accompanied with insen- 
sibility of the retina, a species of amaurosis which has generally been called 
glaucoma. 'f Shaw's case shows the erroneousness of this viev»'; his left eye 
was affected with distinct glaucoma, advanced into the second stage, yet the 
retina proved perfectly sensible. 

" Il is scarcely necessary to remark, that the notion of glaucoma being an 
opacity of the vitreous humour is incorrect. 

"In its advanced stages, glaucoma is attended by dissolution of the hyaloid 
membrane. An inordinate quantity of vitreous fluid renders the eye preternaturally 
hard to the touch, and by pressure causes pain, photopsia, and destruction of 

* Iconos Ophthahnologicse, p. 22. LlpsiiB, 1824. 

t Morbid Anntomy of the Human Eye, vol. ii. p, 127. London, 1818. 
No. XIII.-— January, 1844. 15 



222 Progress of the Medical Sciences, [Jan. 

vision. If the pressure is taken off, by puncturinop the vitreons humour through 
the sclerotica, or even by evacuating the aqueous humour through a small open- 
ing in the cornea, a transient amelioration of vision, as well as relief from the 
pain, is sometimes the result. But the aqueous humour, or the fluid which fills 
the place of the vitreous Immour, being speedily regenerated, the pressure returns 
with its former effects. 

"The primary cause of glaucoma, from whence the whole series of symptoms 
springs, is unknown. Beer supposed it to be arthritic inflammation; Taylor a 
preternatural viscidity of the blood, and a cessation of the circulation through the 
vessels of the crystalline. 

"Taylor's notions retjarding the seat and nature of glaucoma were much more 
correct than those of Brisseau, which so long prevailed. He understood it to 
be a diseased alteration of the crystalline, implicating its colour, transparency, 
and consistence, and ultimately combining with dilated pupil and amaurosis. 
He erred in supposing the capsule to be affected. His practice was to depress 
the lens and capsule, under the circumstances which 1 have enumerated as cha- 
racterizing the second stage, or, to use his own words, * where the iris, and im- 
'mediate organ of sight, maintain their healthful state.'* 

" Operating, then, for the cure of glaucoma is not a new practice. Of late 
it has been revived in France by Dr. Sichel, who styles the second stage of 
glaucoma, as above described, catarade, leiiliculaire vertt operable.^ 

•'It is necessary to be aware, that a glaucomatous eye is always very sus- 
ceptible of suffering inflammation and disorganization, even from the slightest 
operation which may be practised upon it. Arthritic inflammation, with severe 
and long-continued pain, closure of the pupil, and total insensibility of the retina, 
is exceedingly apt to be the result of the displacement of a glaucomatous lens; 
while the operation of extraction exposes the eye almost as much to the danger 
of complete suppuration. Hence the propriety of having recourse rather to the 
operation of comminuting the centre of the anterior capsule by means of a fine 
curved needle passed through the sclerotica, and afterwards repeating a cautious 
division of the lens every six weeks till it is entirely absorbed. A cataractous 
eye is generally perfectly healthy, except that the lens, and especially its sur- 
fcice, has become opaque, but in every texture of a glaucomatous eye there is a 
lurking tendency to disease, against which we cannot be too much on our 
guard."— La;w/y?i Med. Gaz.^ Oct. 1843. 

39. Muscx Volitantes. — Dr. James Stark, of Edinburgh, has investigated the 
causes and phenomena of muscae volitantes, with considerable care, and he con- 
ceives that the observations he has made seem to prove that muscae are nothing 
else than the globules of mucus which lubricate tlie external or mucous surface 
of the transparent cornea. " These globules are," he remarks, "only rendered visi- 
ble when the retina, or expansion of the visual nerve, is in an irritable state; and 
that it is so in all those cases in which this phenomenon is observed, is well 
known to every medical practitioner. It is, besides, a matter of common ob- 
servation that the eye labouring under this malady feels uneasy and heated, and 
is unusually dry. This state would, therefore, render the mucous secretion 
more viscous than usual, so that the globules of mucus, instead of floating freely 
over the eye, would be wiped by the eyelid, and motion of the eyeball on the 
lid, into irregular wavy or zigzag lines or reticulations, and give rise to that 
appearance so often described as a net-work or cobweb before the eyes, {visuS 
reticulatus.) The irritability of the retina is known to be induced by a great 
many causes. Tv/o opposite states of the circulation will increase its irrita- 
bility, viz. that of congestion from an overflow of blood to the part, or semi- 
stagnation of the circulating fluid in its vessels from want of tonic power to 
propel it. This is the reason why muscse volitantes are not only seen in almost 
all affections of the retina, as in incipient amaurosis, retinitis, &;c., but are also 

* Treatise on the Diseases of the Crystalline Humour, p, 31. London, 1736. 
t Annates d'Oculistique, tome v. p. 233. Bruxelles, 1841. 



1844.] Ophthalmology, 223 

of very common occurrence in all dyspeptic complaints, the low stag'es of fever, 
&c. It is the circumstance of this malady generally attending the first stage of 
amaurosis, — a disease commonly leading to the loss of sight, which has made 
their occurrence be so much dreaded by all. It is the circumstance of so many 
practitioners confounding these moving muscse with the fixed specks which 
depend on organic changes in the eye, (whether these arise from partial opacities 
in the humours, or their enveloping membranes, or depend on certain spots of 
the retina having lost their sensibility,) which has so often led them astray as 
to the cause of their production, and induced them to regard their presence as an 
indication of the existence of some serious disease of the eye. 

" By attending to the characters laid down above, no doubt can ever arise as 
to the true nature of the bodies which are met with in the eye, and disturb vision. 
Where muscae volitanies are found uncomplicated with fixed specks, nebulse, or 
indistinct troubled vision, we can always satisfy the patient as to the innocuous- 
ness of the malady under which he labours, and free his mind from any anxiety 
as to his losing his sight. The diagnosis of the malady, then, is of no mean 
importance in practice; for though the complaint is of itself simply annoying 
and unattended with danger to the sight, it is so often also an attendant on 
those affections which lead to the destruction of vision, that every means 
ought to be used to discover its true nature. If, with the moving harmless 
muscae, threads, lines, reticulations, or showers of fire, there be fixed specks in 
the eye, deep-seated pain, clouded or mottled vision, and the other more ordinary 
symptoms of amaurosis or affection of the retina, it is high time that the most 
active remedies be employed, as the total loss of vision is threatened. But if 
these are wanting, and it be ascertained that the museee exist alone, general 
treatment is all that is usually required to restore the vision to its accustomed 
clearness. It is worthy of remark, however, that when once muscse volitanies 
have appeared in the eye, they are scarcely ever got entirely rid of. Whether 
this depends on the eye becoming morbidly sensible to the globules of mucus 
moving over its corneal surface, or to the person attending more to the presence 
of such bodies and looking for them, or that the system once thrown into the 
condition which favours the appearance of these muscse, is easily affected in a 
similar manner, has not yet been accurately ascertained. Certain it is that, in 
the eyes of those once affected with muscae, even a trifling cause will produce 
their reappearance. A fit of indigestion, derangement of the bowels, overstrain- 
ing of the eyes, &c. will, again and again, cause the reappearance of these trouble- 
some visitors, and from these causes they may be seen at intervals, during the 
whole course of a long life, without permanently injuring vision. — Ed. Med. and 
Surg. Jourii., Oct., 1843. 

40. Propriety of operating in cases of Cataract, where only one eye is affected. 
— Mr. NuNNELEY, of Leeds, has discussed this subject in a paper read before 
the Fruv. Med. ^r Surg, j^ssociation, and published in the Provincial Journal 
(2 Sept., 1843). Mr. N. conceives that the propriety of operating, or not, must 
be mainly determined by "the state of vision after the operation," for he re- 
marks, "I suppose, although it be granted a person sees sufficiently well with 
one eye, no one will deny, thatcas/em paribus, iwo eyes are better than one; and 
from the well known fact that when the functions of any organ or structure is 
long suspended, the power of exercising the function becomes ultimately lost, 
it is, as a mere result of precaution, extremely important to keep the affected eye 
in such a state of activity, that in case any accident or disease happen to the 
other, its powers, even though somewhat impaired, may then be taken advan- 
tage of; which can only be safely and effectually secured by having removed the 
opaque crystalline lens, and permitted the light to keep up the activity of the 
retina. The fear of the sound eye being injured or lost by the operation upon the 
cataractous one, though possible, is, I consider, hardly deserving of notice; 
because, when the operation is properly performed, it must be so rare, as to be 
rather amongst the possibilities than the probabilities. While, on the other 
hand, the sympathy between the two eyes, not only in their healthy state, but in 



224 Progress of the Medical Sciences. [Jan. 

their morbid condition, is so strong, that those who have been accustomed to 
watch ophthalmic afTections will ai once admit the validity of the argument of 
removing any diseased condition of one eye lest the other also partake of it, for 
the singularity is, that when disease exists in one eye, not only is the other apt 
to become impaired, but for the corresponding structure to assume the very same 
morbid condition. Thus, if the conjunctiva in one eye is affected, that of the 
other is also very apt to assume the same diseased action; if the cornea, the 
cornea; if the iris, the iris; the lens, the lens; and so oti; while it is also incon- 
trovertible that the morbid condition of the eye primarily affected being' removed, 
that of the one sympathetically or secondarily involved is also frequently reme- 
died. Indeed, cases are on record where cataract having been removed one eye, 
commencing cataract, or even amaurosis, in the other has been cured; and there 
must have been many, if not identical, at least analogous, instances. Indeed, in 
some cases where 1 have operated upon an eye in which cataract was fully 
formed, being only in an incipient state in the other, I have strongly suspected 
the progress of this latter has been much delayed by the removal of the opaque 
lens of the opposite eye. 

" Now, although every one may not be inclined to think the remote risk of 
the sound eye being lost from injury or accidental affection very great, nor the 
danger of sympathetic disease so imminent as to justify our incurring any im- 
mediate hazard to it by operative interference with the affected eye, yet no person 
will deny, that if in reality there is no such danger to the sound eye by operating 
upon the affected one, the possibility of these remote contingencies are solid 
arguments in favour of active measures being at once resorted to. The last 
argument, of confused riess of vision being the result of an operation, is so very 
])lausible, and, indeed, imposing, that it is this which has, 1 presume, princi- 
pally determined the general practice of not interfering when only one eye is 
affected, and which, 1 confess, formerly decided my practice; for I have sent 
many persons away without doing any thing which, with what I have since 
seen, especially in the three cases to which I shall now shortly allude, I should 
certainly not do. Indeed, the fact itself that traumatic cataract sometimes dis- 
appears, as mentioned by Pott and Hey, as an argument against operating, is, in 
reality, a strong argument in favour of it; for, if not in all, at least in such of 
those cases where traumatic cataract disappears, the capsule of the lens has 
been ruptured, and subsequently has been absorbed, thus occurring what it is 
the object of an operation to accomplish; yet in these cases no mention is made 
of inconveniences resulting from the cure; and when the lens had been so dis- 
placed as to press upon the iris, every body agrees as to the necessity of manual 
interference, lest not only the one eye be altogether lost, but the other be impli- 
cated in the change." 

Mr. N. relates three cases to show that " in point of fact, the double confused- 
ness of vision, so much feared, does not occur," and concludes, that '♦consider- 
ing, on the one hand, the ease with which the operation may be performed; the 
little or no disturbartce produced, either to the other eye or general health; that 
in many cases of traumatic cataract, where the capsule is ruptured, the lens is 
ultimately removed, even when the surgeon does not interfere; and that what 
has been so much feared, and in my opinion constituted the only valid argument 
against the operation, the difference in the refractive powers of the two eyes pro- 
ducing confused or double vision, in reality does not occur; and considering, on 
the other hand, the arguments above-mentioned in favour of operating, 1 think 
we are fairly justified in recommending that, not only in traumatic, but in all 
cases vt'here a young person, one who is under middle age, has cataract in one 
eye, the lens should be broken up, and removed by absorption." 

41. Wound of the Cornea by the Sting of a Bee. — Dr. Krieg of Merseburg, 
was consulted in the summer of 1839, by a man sixty years of age, and of good 
constitution, fur an inflammation of his left eye. Five weeks previously a bee 
had stung him in the centre of the cornea, giving rise to extremely painful 
inflammation there. The medical attendant at the lime professed to have ex- 



1844.] Midwifery, 225 

tracted the stinjr, but no means which he afterwards used were capable of sub- 
duing- the morbid excitement of the orcran. When Dr. Kreig saw the patient the 
conjunctiva was greatly hypertrophied and the cornea covered with a dense 
opaque layer of membrane. There was every reason to believe that the internal 
structures, also, fully participated in the diseased process. On closely exam- 
ining the eye with a magnifying glass, a dark and slightly prominent spot 
was discovered in the centre of the cornea, around which much vascular in- 
jection was perceptible, and from this spot Dr. Kreig extracted a long filiform 
body, the remaining part of the sting. The inflammation soon began to subside, 
and in a month the cornea had j)arlially recovered its transparency, but some 
striking results became permanent in consequence of the injury. The tint of the 
iris had changed from its natural grayish blue to a perfect blue, the pupil re- 
mained dilated and immovable on the stimulus of light, and the patient, who 
before his accident was obliged to use convex glasses, now required one con- 
cave, being near-sighted, on the left side. — Gaz. des Hopitaux, 27th June, 1843, 
from Casper^s JVuchtnschrift. 



MIDWIFERY. 

42. Bihcular Uterus and deft Va<^ina. — A woman 30 years of age, pregnant, 
applied for admission into a lying-in charity in Vienna. Externally she was well- 
sha|>ed and appeared robust; but on making examination, the vagina, at the depth 
of about two inches, was found divided into a double passage by a dense fibrous 
septum stretching- across it. The posterior chamber was penetrable by the fin- 
ger for about an inch and a half higher, when it was found to end in a small 
blind sac. The anterior passage of the vagina was so long that the os uteri 
could not be reached by the finger; the foetus accordingly lay very high in the 
pelvis The birth was at first lingering, but in the progress of the labour the 
septum in the vagina spontaneously ruptured, with little loss of blood; the 
liquor amnii was immediately discharged, and in a short time afterwards a living 
child was safely expelled. The moiher, however, died of [)erilonitis four days 
afterwards, and on opening the body the cavity of the uterus, as far as the os in- 
ternum, was seen to be separated into two chambers by a vertical septum. The 
foetus had lodged in the left of these divisions, but the right cavity had also been 
dilated and lined with decidua during the pregnancy. — Zance^, Nov. 11, 1843, 
from Oest. IVochensch. Sept. 9. 

43. Vaginal pregnancy. — One of the German journals rejiorts a case of extra- 
uterine gestation in which the foetus was developed in the vagina. A circum- 
scribed enlargement was apparent between the navel and the pubis, and the 
bowels and bladder were evacuated with much difficulty. A practitioner appears 
to have been first called in at about the fourth month (die Geburt schon bis zur 
vierten period vorg. war), who found the foetus in a cross position and dead. He 
immediately proceeded to delivery by the feet, and after much difiiculty brought 
the shoulders through the vulva, and afterwards extracted the head with the for- 
ceps. The circumscribed tumour was yet unreduced, and on examination this 
was found to be due to the uterus itself. That organ was retroverted, its orifice 
being directed forwards to the abdominal integuments, and closely embracing 
the cord, 'i'he accoucheur contrived, however, to introduce some of his fingers 
within the os tines and remove the placenta, which is said to have been adhe- 
rent to the neck, and, indeed, to all the rest of the internal surface of the uterus. 
The woman recovered satisfactorily. We know of only one other recorded case of 
this very rare kind of extrauterine gestation; it is detailed in the " Journ. de 
Med,," &c., of Paris, 1779. The latter case terminated unfavourably to the 
moiher. — Ibid. 

44. Polypus Uteri. — Dr. P. Murphy, of Liverpool, in an article in the Provin- 
cial Med. Journal, (Sept. 23, 1843,) states that he has treated seven cases of 



226 Progress of the Medical Sciences. [Jan. 

polypus uteri; the termination of all which were favourable except one. *' In 
each case the woman was married, had a family, and had not ceased to men- 
struate. The symptoms were similar — namely, haemorrhage, and leucorrhoea, 
producincT anaemia. Tlie discharge, unless retained by the size of the tumour, 
was noi/oelid,- and this need not exciie surprise, as the surface of the polypus 
is similar to that of the lining membrane of the uterus. 

" If a female, after having ceased to menstruate for four or five years, is then 
attacked with a discharge of mucous blood or pus from the vagina, it may be 
regarded almost as a fatal symptom. Even if, on examination, the os tincae be 
found perfectly healthy, the diagnosis must be guarded; for 1 have notes of three 
cases in which, after death, the discharge was traced to ulcerated cancer of the 
intestines opening into the body of the uterus. Polypus is sometimes a cause 
of premature delivery. A gentleman sent for me to aid him in checking haemor- 
rhage after such a case. The placenta was retained, and, as he imagined, adhe- 
rent; the polypus and placenta were partly in the vagina; there was some diffi- 
culty in suppressing the hsemorrhage; and 1 heard afterwards that she was suc- 
cessfully operated on in Manchester. The removal of a polypus is attended 
with very little danger or difficulty. If small, it is soft and vascular, its shape 
is nearly circular, and the ligature does not hold on well, and if excised, there 
is the risk of haemorrhage. This is dangerous, for the slightest sudden loss of 
blood from an operation cannot be well borne, as the woman is anasarcous and 
exhausted before she submits. However, this may be easily guarded against 
by filling the vagina with lint or tow, and if torsion be previously practised, the 
security is increased. I'he advantages of excision are — its faciliiy, its speedi- 
ness, its sparing both the patient and the operator the disagreeable task of tight- 
ening the ligature daily, its confining the sufferer a shorter time in bed, but, above 
all, its not being attended with that foetor which contaminates the bed-chamber, 
and exposes her to an attack of low fever, similar to that generated from the non- 
ventilation of the lying-in chamber, and which is the unavoidable consequence 
of the ligature. 

" When the polypus is very large the ligature must be employed, as it is im- 
possible to reach the pedicle either with the knife or the scissors, nor can we 
draw it through the os externum. The surrounding it with a ligature is not dif- 
ficult, for 1 readily succeeded, but its removal when detached is troublesome. 
Dr. Gooch mentions one or two cases where uterine pains came on, and assisted 
the expulsion, and in another he succeeded with his liand. 

"A tenaculum is not sufficiently strong, and moreover, sharp pointed instru- 
ments should be avoided. On the other hand, it is very difficult to fix the tu- 
mour longit\idinally in a forceps." 

"After the operation the diet," Dr. M. says, "should not be lessened; on the 
contrary, we cannot too soon commence a tonic treatment." 

45. Injlammation and Abscess of the Uterine Jlppendages. — Tlte Bnb I? n Journal 
nf Medical Science, for September last, contains an exceedingly interesting paper 
on this subject, by Dr. Fleetwood (Churchill. Dr. C. relates twenty-three 
cases of this disease, some occurring in his own practice, and others collected 
from various sources, and deduces from them the following practical inferences: 

1. Inflammation of the uterine appendages may occur in an acute or chronic 
form. In the former, it constitutes one of the varieties of puerperal fever, and 
has been most ably treated by Clarke, Lee, Fergusson, Puzos, Husson, Dance, 
Tonnelle, &c. The latter author found fifty-eight cases of ovarian inflammation 
and four of abscess, in 190 cases of puerperal fever. Dr. Lee states, that in 
one case the ovary "appeared to be convened into a large cyst containing pus, 
which had contracted adhesions with the abdonnnal parietes, and discharged its 
contents externally through an ulcerated opening. In another case, which 
proved fatal, the inflamed uterine appendages agglutinated together, had con- 
tracted adhesions with the peritoneum at the brim of the pelvis, the inflamma- 
tion having extended to the cellular membrane exterior to the peritoneum, and 



1844.] Midwifery. 227 

occasioned an extensive collection of pus in the course of the psoas and iliaciis 
externus muscles, similar to what takes place in lumbar abscess."* 

As to the symptoms of this acute disease, Dr. Lee briefly remarks, — "The 
pain is Generally less acute than in peritonitis, and is principally seated in one 
or other of the iliac fossas, extending from them to the loins, anus, and thighs. 
On pressure, the morbid sensibility will be found to exist chiefly in the lateral 
parts of the hypogaslriiim. The constitutional symptoms at the commencement 
of the attack do not materially differ from those which mark the accession of 
peritonitis, being often accompanied with strong febrile action, which speedily 
subsides, and is suddenly followed by prostration of strength and other changes, 
which characterize inflanrimation of the muscular and mucous tissues of the 
uterus." Dr. Lee details eight cases of the disease which proved fatal. 

It is not my object to enter further upon the consideration of the acute form 
of the affection, but immediately to proceed to notice the chronic disease. 

It has been described, as I have said, by several authors under different 
names. Puzos calls these abscesses " depots du lait," or " depot laiteux dans 
I'hypogastre;" and Levret, •' engourdissemens laiteux dans le Bassin;" from an 
erroneous supposition that they were caused by metastasis of the milk to these 
parts. 

The disease described by Dr. Doherty is essentially the same as the one under 
consideration, but occurring in general at an earlier period after delivery; differ- 
ing very little in symptoms, but terminating more favourably, that is, in resolu- 
tion. It appears altogether a simpler aflection, quicker in its course, and much 
more manageable under similar treatment. 

2. Chronic inflammation of the uterine appendages may occur, thoucrh rarely, 
independently of pregnancy or labour, but far more frequently after labour, and 
at varying intervals: the first intimations being pereeived in some cases from 
three to ten days after delivery, and in others not until the lapse of some vi-eeks. 

3. Causes. — It is very difficult to assign any special cause for the attack. It 
may follow blows, falls, or a fright; or more frequently result from cold. 

From the coincident suppression of the milk or the lochiaf it is sometimes 
attributed to either accident. 

That it may occur in consequence of the long-continued pressure of the child's 
head in lingering labour I do not doubt, but it is evident that this is not a fre- 
quent cause, as most of the causes occurred after natural labour. 

Lastly, it may be the termination of acute inflammation. 

4. Invasion. — The mode of invasion varies a good deal. 

a. In certain cases there are few, if any, preliminary symptoms; uneasiness 
perhaps, but not amounting to pain, in one iliac region, and upon placing her 
hand on the spot, the patient detects a tumour. 

b. Or, after a favourable convalescence for some days, just as the usual term 
of our attendance expires, the patient experiences a slight febrile attack, with 
some shooting pains in the abdomen, which subside after a time, though the 
fever remains without any apparent cause, until, in the course of time, the dis- 
ease is developed. 

c. Again, in other cases, the attack is local, and its nature pretty evident; 
from the beginning there is pain in one or other iliac region, tenderness, and 
shortly after, tumefaction, with fever. 

d. Lastly, the afifection may at first assume the character of a more general 
affection of the peritoneum, the pain extending over the abdomen, occurring 
mainly in paroxysms, with tenderness on pressure, and fever, but by and by, 
the general tenderness and extended pain subsides, and becomes localized, by 
which the character of the attack is determined. 

5. Symptoms. — Having briefly alluded to the various modes in which the dis- 
ease commences, I prefer taking the symptoms in the order of their importance 
and prevalence, rather than in that of succession. 

* "On more important Diseases of Women," p. 25. 
t Mauriceau, vol. ii. p. 249. 



228 Progress of the Medical Sciences. [Jan. 

a. The presence of tumefaction, or of a distinct tumour, is invariable; it 
occurs in all cases, and characterizes the disease. It may be found completely 
above Poupart's ligament, above the linea ilio-pectinea, sometimes occupying 
one iliac fossa entirely, and even extending upwards nearly to the umbilicus, 
and forwards to the linea alba. 

Or it may be situated more deeply in the pelvis, just reachinjr to Poupart's 
ligrament, protruding the groin, and from its fixedness giving the impression of 
its being firmly connected with these parts. In the former case the tumour is 
larger, more defined, and far more moveable: in the latter it is rather undefined, 
immoveable, and more painful. In both it is equally hard, in fa^^t as hard as 
stone, until suppuration commences, and equally tender on pressure. If a 
vaginal examination be made, in the former case, we do not always discover any 
change; the vagina may be cool, no tumefaction may be detected, and movement 
of the uterus may occasion but little pain. But in the latter cases, and also in 
the former when the inflammation is much diffused, the vagina is hot, somewhat 
tender; and at one of its sides, or at its upper part, in the " cul de sac" on one 
side of the cervix uteri, a hard, painful swelling is observed, evidently connected 
with the tumour in the groin, and in these cases the uterus cannot be moved 
■without acute pain. 

b. Although it may be developed at different periods, yet sooner or later, pain 
is an accompaniment of the disease. It maintains, as it were, its seat in the 
tumour, from whence stings of pain radiate in all directions. When the tumour 
is high, that is, above the brim of the pelvis, the pain is more limited to the 
tumour: when situated in the pelvis and groin, it extends across that cavity, 
down to the anus, to the back, and down the thigh. In these cases it is almost 
always difficult, in some cases quite impossible, to straighten the thigh, so as to 
stand upright. Walking, too, is both difficult and painful. 

c. in these latter cases also, when the tumour occupies a portion of the pelvic 
cavity, we often find the patient distressed by tenesmus, and a desire to make 
water frequently the consequence, probably, of an extension of the irritation to 
the bladder and rectum. Occasionally, when the tumour is large, it offers a 
mechanical improvement to the functions of these viscerse, and the patient may 
suffer from dysuria, or be unable to evacuate the intestinal canal. 

d. ^I'he amount of fever, as well as the time of its setting in, varies. In some 
cases it precedes or accompanies the first local symptoms: in others it supervenes 
after the tumour has been detected some time. In a few cases it is almost con- 
fined to the evening, and during the process of suppuration there are, in almost 
all cases, evening exacerbations. 

The pulse ranges from 90 to 1 10; the tongue is loaded, the skin hot, the thirst 
considerable, and the urine high coloured. The appetite is always bad. 

^J'hese symptoms are somewhat nsitigated, or at least the patient suffers less 
in cases not connected with parturition. 

6. Terminations. — After being fully developed, and running on even for a con- 
siderable time, the disease may terminate: 

A. In resolution.— 'V\\\^ most frequently occurs with cases in which the tumour 
is above the brim, and limited in extent; and in such we find the pain diminish- 
ing, and ultimately ceasing, the tumour first becoming less tender, then less in 
size, until at length it disappears. This process will occupy from one to three 
months. 

B. In abscess. — W' hen suppuration takes place we can generally feel a degree 
of softening, with an obscure sense of fluctuation in the tumour either externally 
or internally; the patient complains of more throbbing, and occasionally of 
rigors, and by degrees (if not anticipated) the coverings are thinned, and the 
matter may escape— 

a. Externally, through the abdominal parietes covering the tumour. 

b. Into the peritoneum, where it gives rise to peritonitis, always alarming, but 
not always fatal. 

c. Into the vagina, through which the matter escapes 



1844.] Midwifery, 229 

d. Into the bladder* or intestinal canal, and especially the rectum, f with 
evacuation of matter per stool. 

e. Into the surrounding cellular tissue, where it may burrow until it finds an 
outlet. 

The matter may be evacuated by any of these "routes;" and if the opening 
be sufficiently large, the sac may be emptied and tiie abscess fill up and heal. 
But if the opening be small, the discharge may continue for an indefinite length 
of time, the opening remaining fistulous, and the cure being proporlionably 
difficult. 

/. Lastly. The extent of the disease, or the secondary aflTections caused by it, 
may prove fatal after an indefinite time. 

7. Diagnosis.— A good deal of light will be thrown upon the diagnosis, when 
the disease occurs within a reasonable time after parturition, and especially when 
the patient has suffered from abdominal pain: in such cases if we discover a 
tumour in one of the iliac fossae, Vviih tenderness and pain, we shall have ade- 
quate grounds for diagnosticating this aflTection. 

If, however, the attack occur independently of child-bearing, or at a consider- 
able interval afterwards, there may be difficulty in distinguishing between it and 
some of the chronic organic diseases of the ovary, especially when the tumour 
is above the pelvic brim: our safest guide, probably, will be the amount of pain 
and constitutional disturbance, which is much greater in the disease I have been 
describing. 

I have known this affection mistaken for sciatica; and when the tumefaction 
is mainly confined to the pelvis, and pressure is made upon the nerves issuing 
from the cavity, the pain may be limited to the track of the nerves, so as to de- 
ceive any but a careful observer. However, a minute investigation will probably 
enable us to trace the pain into the pelvis, and then an external and especially 
an internal examination will at once reveal the cause of the pain. 

The tlexion of the thigh, which alone might also mislead, will of itself lead 
to an examination of the groin, and so to the detection of the tumour. 

8. Treatment. — The indications of cure are 1, to procure resolution of the 
tumefaction; or 2, to promote suppuration and evacuation of the matter. 

1. If we are called in at an early period of the attack, it is often possible to 
arrest its progress, as has been well remarked by Dr. Doherty; nay, even where 
the disease has lasted some time, as in the cases I have quoted from Puzos, it is 
in some cases quite possible to procure resolution. For this purpose Mauriceau,:|: 
and the author just named, advises repeated venesection, with purgatives, alter- 
atives, absorbents, &lc. 1 believe that the repeated application of leeches will 
be found more effectual at less expense of strength. A dozen should be applied 
over the tumour, followed by bran poultices, and repeated if necessary, i. e. if 
the pain and throbbing be not relieved. If we succeed in arresting the progress 
of tlie inflammation, a succession of small blisters will be of great use. Fo- 
mentations, and an occasional hip-bath, also afford great relief to the patient; 
but still more comfort is derived from vaginal injections of warm water twice a 
day. 

Internally, we may exhibit mercury in small doses, perhaps even so far as to 
affect the gums, and an occasional purgative; but 1 confess I am not convinced 
that brisk purgation is beneficial. In some cases I am certain that it increases 
the pain. If the pain prevent sleep an opiate may be given. 

When the disease shows signs of yielding, I have seen benefit derived from 
an application of the empl. hydrargyri. The diet should be bland and nutritious, 
but unstimulating. ♦ 

2. If, however, notwithstanding the prompt and sedulous use of the means 1 
have indicated, the disease should not yield, we may be sure that suppuratioa 

* Boivin and Dug6's " Diseases of the Uterus," page 578. Trans. 

t Ibid. 

t Muuriceau, vol. ii. p. 248. 



230 Progress of the Medical Sciences, [Jan. 

will take place; and our object then will be to promote this by fomentations and 
poultices constantly applied. 

The formation of matter will sometimes be indicated by rigpors, but in many 
cases it is by the touch only that we can recognize this occurrence. I cannot too 
strongly impress upon you the advantage of making an opening into the abcess 
when it is possible, and so deciding the course which the matter is to take, in- 
stead of leaving it to burrow and make an openirig in some dangerous situation. 

The best situation for the opening is through the abdominal parietes; the 
next, through the vagina. If from the high situation and mobility of the tumour, 
we fear that, when opened, the matter mviy escape into the peritoneal cavity, we 
might adopt the plan so successfully practised in abscess of the liver by Dr. 
Graves, and cut down to, but not through, the parietal peritoneum, and then 
apply poultices, with little doubt but that the matter will ultimately make its 
appearance through the wound. 

Should the abscess open spontaneously, we must counteract as well as possi- 
ble any unpleasant consequences which may result; but whether opened spon- 
taneously or by the knife we must endeavour to empty the sac, and to secure a 
free exit for the matter as it is secreted, by which means we shall avoid the pro- 
longation of the disease, and all the distress of a fistulous communication. 

When the matter has been fairly evacuated, tlie diet must be generous, and a 
full share of wine or porter allowed. . _ 



MEDICAL JURISPRUDENCE AND TOXICOLOGY. 

4G. Fft/drnsfatic Test — A woman was confined in the Hospital Necker, Paris, 
of a female child, and died a few days after, of phthisis. The child was small 
and weak, the pulse was imperceptible in either the radial or brachial arteries, 
and the beatings of the heart were inaudible. Respiration partook of the lan- 
guor which marked the other functions, the inspirations were twenty-eight in a 
minute, without any very decided heaving or falling of the abdomen, and expi- 
rations yielding no audible sound. Yet, on auscultation, a distinct crepitant 
rale was heard botli b-fore and behind, and at the base or summit of the chest. 
The child progressively sank, and died in eighteen hours. 

On examination, the digestive organs were found to be healthy, and the large 
intestines contained a large quantity of meconium; the thymus body was very 
small; the ductus arteriosus and veuosus and the inter-auricular foramen re- 
mained open. The lungs, instead of occupying their usual place, were small, 
and confined to the posterior part of the chest; and when removed from the 
thoracic cavity, together with tlie heart, and plunged into water, the whole imme- 
diately sunk to the bottom. The lungs were of the colour of port wine lees, 
being hepatized, except in a few places, where their cellular structure was more 
apparent. On cutting into them, a sensation like that of cutting through liver 
M^as experienced, and no blood, fluid, or froth, escaped. One lobe, cut through 
in many places, and immersed under water, gave egress to only five or six small 
bubbles of air, and another lobe artificially inflated, suflfered itself indeed to be 
penetrated by air, and showed a curiously mottled aspect, and a rosy tinge; but 
as soon as the bellows was removed, it returned to its previous condition, and 
sank in water, as it had done hefure. — Gazette des Hdpitaux. 

This case has been cited as affecting the value of the hydrostatic test. It is 
strange that thosn who pretend to knowledge in the matter are not aware that 
precisely similar cases have been noticed by Haller, Brendel, and Billard, as 
exceptions to the general rukf and are thus acknowledged. T. R. B. 

47. Neiv Test for Corrosive Sublimate, by Dr. Frampton. — Dr. F. states that 
he was led to this method, by reflecting on the strong affinity of metallic silver 
both for metallic mercury and for chlorine. He rubbed a grain of corrosive 
sublimate with several grains of pure metallic silver in powder; the mixture 



1844.] MedicalJurisprudence and Toxicology, 231 

blackened, and on placing- the powder in the bulb of a small tube, he obtained 
by heat a distinct ring of metallic mercurial globules in the neck of the tube. 

He then tried this method on org'anic mixtures; and having added one grain 
of corrosive sublimate to four ounces of tea made with sugar and milk, he boiled 
the liquor vi'ith the powdered silver, and after allowing time for subsidence, the 
fluid was poured off. Liquor potassa; was boiled for some time upon the metal, 
for the removal of organic matters, and liquor ammoniae afterwards added to the 
sediment, in order to dissolve the chloride of silver. This was also poured off, 
and the sediment having been washed and thoroughly dried, was placed in the 
tube as before, and metallic mercury obtained in abundance. 

Dr. Frampton obtained similar results by operating in the same manner on 
mixtures of corrosive sublimate with a solution of gelatine and with sanguineous 
serum from a hydrocephalic patient. In these cases, muriatic acid was added, 
to acidulate the mixture, before the addition of the silver. The silver should, 
for convenience, be moistened with a little distilled water, before being added to 
the mixture. — London Medical Gazette, June, 1843. 

An anonymous correspondent, under the signature of '''•Furensis^'''' (Dr. Vena- 
bles?) objects that, although Dr. Frampton's process may answer for animal 
mixtures, yet it will be unsuited for vegetable ones. And this because bichlo- 
ride of mercury (corrosive sublimate) is reduced by vegetable organic princi- 
ples, so that hydrochloric acid will not act upon nor redissolve the mercury. 

He also ascertained that if tin (in the form of fine filings) was substituted 
for silver in the process of Dr. Frampton, that metal proved to be a reducing 
agent more generally efficient. Still later, he found that clean, bright iron 
filings were preferable to either. 

It may be doubted whether the employment of these solid metals is advisable 
to the extent indicated in the process of Dr. Frampton. At all events, in me- 
dico-legal cases, the liquid tests require to be used on account of their delicacy 
and power of detection. The writer above named prefers for this purpose, pro- 
tochloride of tin and phosphorous and hypophosphorous acids. — Ibid. August, 
1843. T. R. B. 

48. Symptoms produced by different narcotics, by M. Eitner. — Belladonna, be- 
lts narcotic effect, is productive of furious delirium and great congestion 

in the brain. Hemlock and hetibane have rather a soporific than a narcotic 
power, but they produce cerebral congestion and convulsions. Stramonium ex- 
cites a scarlatinous redness of the skin, and excitement of the genital organs 
with salacity. Nux vomica and strychnine bring on epileptic convulsions, 
and a peculiar rigidity of the extremities, symptoms lasting till a sudden pros- 
tration takes place. Alcoholic drinks produce lethargy with spasms, but no 
strikingly marked congestion. Opium and morphine cause slight delirium, 
which soon gives way to supineness; face ruddy, and extremities cool; pulse 
weak and tremulous; constipation, or else involuntary evacuations. Tobacco 
causes a state of asphyxia and syncope, paralysis and relaxation of the limbs, 
and involuntary evacuations. Poisonous fungi, with a true narcotic effect, make 
the extremities cold, and cause constipation; abdomen inflated and painful; pu- 
pils contracted. Prussic acid, bitter almonds, &c., induce a state of asphyxia 
and paralysis, and if death be not in»mediale, a soporific state, with congestion 
in the brain. — Medicinische Zeitung. Encyclographie des Sciences Medicates^ 
May, 1843. T. R. B. 

49. Birth of a child in the twenty-fifth week, which lived three days, by Dr. 
HoLST. — A woman, aged 30, was frightened, on the 2d of August, by a violent 
clap of thunder, and on the 5th was delivered of a living girl. The child 
weighed l^ lb., and was only thirteen inches long. The skin was thin and 
reddish, and no pulse was perceptible in the radial arteries. The head was 
disproportionately large, the extremities long, and the joints very flexible. The 
nails were tolerably developed on the fingers and great toes; on the remaining 
toes there were no nails, but only roots. The apex of the head was covered 



232 Progress of the Medical Sciences. [Jan. 

with tolerably thick and dark hair, and the rest of the body with a quantity of 
down, which was particularly thick and loner upon the face. The lobules of 
the ear were perfectly developed; the iris was narrow, while the pupils were 
broad, and covered with a membrane, 'i'he nympha^, which were large, pro- 
jected from liie labia majora, and the clitoris was also large. The child was 
wrapped in cotton wool, and put in its mother's bed. It could not suck, but 
was slowly fed with cow's milk, water and thin gruel. Morning and evening 
it was bathed in milk and water. It liad natural evacuations, and slept almost 
continually. VVIien it awoke, it uttered a weak, squeaking sound, and lay 
constantly quiet, almost without motion. Its strength soon diniinished, and it 
died in 66^5 hours. 

The mother, who had borne eight children before, and had always menstruated 
regularly, positively affirmed thai tlie catamenia had appeared for the last time 
in the middle of February, and that she had felt the motion of the child for the 
first time on the 23d of June. So that, if we suppose her pregnancy to have 
begun on the earliest possible day, viz. the 15th of February, it lasted only 
twenty-four weeks and three days; and the appearance of tlie child, as described 
above, agrees with this supposition. — Lojidun Medical Gazette, .Tuly, 1843, from 
Schmidlh Jahrhuchcr, > T. R. B. 

50. Concremtal Closure of the Ureihrn. — Several instances of this malformation 
are recorded in the German medical journals. Dr. Zohrer mentions one in an 
infant nine days old, the termination of whose glaus penis was covered with a 
thickened membrane, continuous with the framum of the prepuce. The urine 
exuded through the umbilicus. To remedy this evil, the membrane in question 
was removed with a bistoury, but no trace of an orifice was seen; and it was 
not till a stiletto had been plunged to a depth of two lines, that the urethra was 
met with, and the course of this was afterwards found much impeded by mem- 
branous hands. The new passage was, however, established; the urethra wa8 
maintained at its proper dilatation by means of a catgut bougie, and the wound 
and passage of the urine at the umbilicus soon ceased. A nearly similar case 
occurred in a female infant, in whom a passage of full three lines in depth, had 
to be made, before the uiethra was reached. — Oeat. Med. iVuchensch. — Lancet, 
August 3, 1813. T. R. B. 

51. Defection of arsenic in the liver. — 'I'he cases, 1 think, are few in England, 
in which the late successful researches of Orfila have been successfully applied, 
and I therefore the more readily [)resent an analysis of a recent case, investigated 
by W. P. Herepath, of Bristol. 

A female, aged 31, of irregular habits, was found ill on Sunday morning, 
(.Tune, 1842,) and in oreat pain. Shortly after, she vomited profusely, and com- 
plained to a medical man, who was sent ii\r^ of her heari, and appeared to be 
in great agony, rolling and toss^ing in her hed, but he could gain very little in- 
formation from her. She either could not, or would not, answer his questions. 
Before any medicine could l)e pre|)ared, she died. In her room iie found in her 
reticule a small paper jjacket (wiih "arsenic, poison," written on the outside,) 
containincr a white powder. 

'i'he body was examined shortly after death. The lungs were full and pro- 
minent, encrorged with blood, and on cutting into then), it flowed out in quanti- 
ties. The heart was large and flabby; the right auricle and ventricle were 
distended with black fluid IjIoog; and this was collected for ex|)eriment. The 
left cavities also contained blood, but not to the same extent, 'i'he lining mem- 
branes were all healthy. The pleura3 contained several ounces of serum. The 
stoiriach, after being tied at its two extremities, and removed, was found to eon- 
tain about half a pint of thick grumous fluid, with some half-digested food. 

These were preserved in bottles, and sealed. The mucous membrane at its 
greater curvature, had a dark livid red colour, caused, as was ascertained, by a 
clot of blood beneath it, and also upon its surface. The pyloric portion was 
scarcely affected, but its mucous follicles were enlarged, and numerous white 



1844.] Medical Jurisprudence and Toxicology. 233 

specks were sprinkled over its surface. These specks, indeed, were seen every 
where diffused. Upon raisinof the coagulum, the mucous membrane vpas seen 
highly inflamed and much sotiened, beitio- easily torn by the nail. 

The small intestines were nearly healthy, althou2^h their peritoneal coating 
was distinctly inflamed. The liver was gorg-ed with blood, but healthy in 
structure, and about half a pound of the blood was preserved for examination. 
The bladder was empty. The kidneys were congested, and the mucous mem- 
brane highly vascular. I omit a description of the genital organs, as the right 
ovary was diseased. 

Mr. Herepalh first ascertained that the powder in the reticule consisted of 
arsenic. He next examined a portion of the fluid contents of the stomach by 
deflagration with nitre, acetic acid added to the solution, and sul[)huretted hy- 
drogen gas, a brownish white precipitate was obtained. Further experiments 
with this precipitate led to no satisfactory result. He next operated on three 
square inches of the pyloric extremity of the stomach containing the white specks 
noticed above, by washing, &c., but no trace of arsenic could be perceived. A 
solid portion of the stomach was also treated in the same way, as were also four 
or five ounces of blood evaporated to dryness, but with equal want of success. 

The white specks, when closely examined and removed from the stomach, 
and tested in various ways, gave no indications of the presence of arsenic, and 
Mr. Herepath was inclined to. consider them, as they probably were, fatii/ 
granules; but after washing the mucous membrane to remove these, and then 
examining it by sunlight with a lens, he observed and obtained several small 
white grains, opaque and closely adherent. Having picked out about twenty or 
thirty of these, he placed ihem in a watch glass with water. After being thus 
washed, they were dried, mixed with carbonate of soda and charcoal as before, 
and introduced into a reducing tube. After heating it for a short time, metallic 
arsenic appeared in its usual splendour. 

Mr. Herepath now cut half a pound of the liver into small portions and in- 
troduced it into a tubulated retort. It was boiled with concentrated nitric acid, 
and after violent effervescence and disengagement of gases, an orange-coloured 
solution remained. This was evaporated to dryness, and the operation again 
recommenced as before, 'i'he residue obtained after the second evaporation 
weighed about two drachms, and was boiled in a solution of carbonate of potash. 
Effervescence ensued, and an orange-yellow solution was formed, leaving a dark 
chocolate residue, which consisted of sesquioxide of iron with animal matter. 
The solution was filtered, acidulated with acetic acid, and a current of sulphu- 
retted hydrogen passed through it. The precipitate was washed and dried, and 
on being put into the reducing tube and healed, gave -diii abundant ring of sublimed 
metallic arsenic. — Lancet^ May 27, 1843. T. R. B. 

52. (Enanthe Crocafa. — (Hemlock Dropwort.) — At the meeting of the British As- 
sociation, August, 1843, Dr. Pickells read a paper " on the deleterious effects of 
cenanthe crocata." This plant, he observed, was known to be one of the viru- 
lent poisons of the indigenous British Flora, but was stated to be very rare in 
Great Britain, by Dr. Smith, in the letterpress of " Sowerby's Botany;" this 
was by no means true, as regarded Ireland, particularly in Cork, and other 
southern counties, in which it grows in great abundance. Dr. Pickells collected 
nearly thirty cases of death by eating the root, the quantity in one instance not 
exceeding " the top of the finger;" he described the symptoms, as exhibited by 
those cases — insensibility, convulsions, locked jaw, delirium, and insanity; and 
pointed out the proper mode of treating such cases, by detailing several which 
were cured by the exhibition of strong emetics, diffusible stimulants, euemala, 
&c. He concluded by making some observations on the poisons used by the 
ancients injudicial executions. He thought that this might have been the plant 
used to destroy Socrates, and not conium maculatum of modern botany; and 
from the symptom of insanity, he thought that this was the plant designated as 
the "insane root," by the poet. This plant. Dr. Pickell stated to be equally 
injurious to black cattle and horses, as to man; he believed there was no direct 



234 Progress of the Medical Sciences. [Jan. 

antidote Ivnown; melted butter was o-iven in some of the cases which recovered, 
and is popularly deemed a preservative acrainst its effects. The root is fre- 
quently used as a discutient external application to tumours, and many of the 
accidents have occurred by it, when gatliered fur lliis purpose. — flthenseum^ 
August 26, 1843. T. R. B. 

53. Tuxicolngicnl Experiments on Diii;italh. — [Journal De Fharmacie^ July? 
1843). — M. BoNJEAN has recently published some curious results with this sub- 
stance. It would seem established by the experiments of Orfila, that the pow- 
der of dicritalis, its acqueous and its resinous extracts are energetic poisons on 
man and dog, and that their poisonous power increases in the order in which I 
have just named them. Yet M. Bonjean administered each of these in large 
quantities (two drachms of the powdered leaves; the watery extract obtained 
from two ounces of the powder of fresh digitalis, and the resinous part also thus 
obtained) to chickens without any injury. The animals continued to enjoy 
their usual health. To one chicken, four ounces and a quarter of the powder 
were given in seventeen days, without any appreciable action, and yet six 
drachms destroyed a dog in fii'teen hours. " I announce (says M. Bonjean) as 
a fact, that purple digitalis, which is a poison to men and dogs, does not exert 
on healthy chickens any appreciable action." 

As an inference from pharmaceutic experiments, he is of opinion that the 
aqueous extract is the most certain and energetic of all the preparations of this 
])lant. Ether extracts from it all the chlorophylle and only that. Hence, 
contrary to the opinion of Le Royer, Planaira and others, who regard ether as 
the best solvent of the active principle of digitalis, he is convinced that the 
ethereal tincture possesses no other properties than those which belong to ether 
itself.— CAem/s/, September, 1843. T. R. B. 

54. Life Insurance. — Meaning of the term '''■die by his own handy The fol- 
lowing case, which has occurred in the State of New York, is quite analogous 
to the one noticed in the last number of this journal. The declaration was on 
a policy of insurance upon the life of Hiram Comfort, the plaintitf^s intestate. 
The policy contained a clause, providing that in case the assured should die 
upon the seas, &c., or by his own hand^ or in consequenr-e of a duel, or by the 
hands of justice, &c., the policy should be void. The defendants pleaded that 
Comfort committed suicide by drowning himself in the Hudson river. Repli- 
cation, that when the assured drowned himself, he was of unsound mind and 
yjhoi/y uncoriscious of the act. Demurrer and joinder, VV. C. Noyes for the de- 
fendants, and T. Sherwood for the plaintitts. 

Chief Justice Nelson delivered the opinion of the court. "The question 
arising upon the demurrer is whether Comfort's self-destruction in a fit of in- 
sanity, can be deemed a death by his oivn hand, within the meaning of the 
j)olicy. I am of opinion that it cannnt. Since the argument of the case, I have 
examined many precedents of life policies used by the different insurance com- 
panies, and am entirely satisfied that the words in tlie policy in question, import 
a death by suicide. Provisos declaring the policy to he void in case the insured 
commit suicide or die by his own hand, are used indiscriminately by different in- 
surance companies as expressing the same idea, and so they are evidently un- 
derstood by the writers upon this branch of the law. 

"Tlie connection in which the words stand in the policy would seem to indi- 
cate that they were intended to express a criminal act of self-destruction; as 
they are found in conjunction with the provision relating to the termination of 
the life of the insured in a duel, or by his executif)n as a criminal. This asso- 
ciation may well characterize and aid in determining the somewhat indefinite 
and equivocal import of the phrase. Speaking legally also, (and the policy 
sfiould be subjected to this test,) self-destruction by a fellow being deprived of 
reason, can with no more i)ropriety be ascribed to the act of his oiu7i hand, than 
to the deadly instrument that may have been used for the purpose. The drown- 
ing of Comfort was no more his act, in the sense of the law, than if he had been 



1844.] Medical Jurisprudence and Toxicology. 235 

impelled by irresistible physical power; nor is there any greater reason for ex- 
empting the company from the risk assumed in the policy, than if his death had 
been occasioned by such means. Construing these words, therefore, according 
to their true, and as I apprehend, universally received meaning among insur- 
ance offices, there can be no doubt that the termination of Comfort's life was not 
within the saving clause of the policy. Suicide involves the deliberate termi- 
nation of one's existence, while in the possession and enjoyment of his mental 
faculties. vSelf-slaughter by an insane man or a lunatic, is not an act of suicide 
within the meaning of the law. I am of opinion, therefore, that the plaintiffs 
are entitled to judgment on the demurrer." Ordered accordingly. 

(Breasted and others, Administrators v. The Farmers' Loan and Trust Com- 
pany. 4 Hill's New York Reports.) T. R. B. 

55. Effects of Hydrocyanic Acid in a poisonous, hut not immediately fatal dose. 
By Dr. Hayn. — (Hufeland's Journal.) 'J'he cases related by Orfila, Viborg, 
Krimmer, and others, were so suddenly fatal, that they were unable to verify 
the truth of certain peculiarities observed by them, viz. that the primary action 
of the poison consisted in a decomposition of the constituent principles of the 
blood; that the spinal marrow and the par vagum were only secondarily affected 
in their motive functions, and finally that the paralysis of the respiratory appa- 
ratus was only the result of this pathological modification of the spinal marrow 
and the par vagum. The following case admitted of the modus operandi being 
ascertained in a very positive manner. 

An hypochondriac, of very advanced age, drank one morning an ounce and a half 
of cherry laurel water, which he had long kept with him for the purpose of com- 
mitting suicide. The symptoms of poisoning did not manifest themselves until 
after the lapse of three hours, and the patient did not deny the cause to which, 
they were due. They were — paralysis of the hands and feet, and of the mus- 
cles which support the head; it fell forward on the breast and the patient was 
unable to raise it; involuntary discharges from the bowels and bladder; the ex- 
tremities, though immovable and cold, were not insensible; the pulse was small, 
the voice hoarse, but distinct, and the intellect perfectly untouched. 

The patient observed with pleasure the incessmt progress of weakness, and 
he died in the evening, without pain or convulsions, of paralysis of the lungs. 

On dissection, the blood was found gluey and of a very peculiar, dark colour; 
but no odour of bitter almonds could be detected, which however, as is well 
known, is not a constant characteristic. — Chemist, Sept. 1843. T. R. B. 

56. Detection of Mercury in the Urine and Saliva. By M. Audouard. — {Jour- 
nal De Chimie De Midicale, May, 1843.) Previous to the publication of the ex- 
periments of Orfila on the absorption of poisonous substances, I had repeatedly 
failed in detecting the above metal, although my opportunities from constantly 
attending many venereal patients were numerous. 1 was in the habit of evapo- 
rating the urine to one eighth of its quantity, acidulating it with a few drops of 
muriatic acid, and then inserting Smithson's pile. The gold of this was regu- 
larly covered after a certain time, with white spots much resembling mercury, 
but they were instantly removed by concentrated muriatic acid. iTience con- 
cluded that the urine of persons taking corrosive sublimate would not furnish 
any trace of mercury. I was mistaken. I did not remove the animal matter, 
and Orfila has shown that this completely prevents the precipitation of the mer- 
cury, on a plate either of gold or of copper. After becoming acquainted with 
his memoirs, 1 treated with gaseous chlorine the urine of three persons, who had 
taken during fifteen days, morning and evening, a spoonful of the liquor of Van 
Swieten. Although I operated on only about five pints, yet in following the 
process of Orfila 1 obtained a copious precipitate of mercury on small plates of 
copper, and when these were washed and exposed to the action of heat in a 
glass tube, the metal was reduced in small brilliant globules. 

In another instance a young man suffering under chancre, had taken morning 
and evening, during fifteen days, one of Dupuytren's pills. After this they 



236 Progress of the Medical Sciences. [Jan. 

were increased to four daily. On the 20tli he was suddenly seized with copious 
salivation and extreme svvellina- of the g^iims. The urine now became diminished 
in quantity. M. Aiidouard obtained a quantity of the saliva, it was of the con- 
sistence of mucilage, and althouorh left at rest during twenty-four hours, gave 
no deposit. An attempt to filter it failed. A stream of chlorine was now passed 
through it for the space of three hours, and it was then allowed to stand for a 
da3^ At the end of that time there was a copious deposit of yellowish while 
flocculi. The liquor, which was now limpid, was filtered, and then evaporated 
by a gentle heat to dryness; and after adding to this residue fifteen grammes of 
warm distilled water, sliirhily acidulated, four small plates of bright copper 
were placed in it. Having remained there for twenty-four hours, all were 
covered with numerous white spots. One of them submitted to the action of 
concentrated muriatic acid, underwent no change after several hours of contact. 
The others were divided into small pieces, introduced into a glass tube, and 
acted upon by the heat of a spirit lamp. Small metallic globules, but well 
characterized and evidently mercurial, were soon produced. T. R. B. 

57. Monstrosity of a new born Fostus and its Viahility. — A female in the north 
of England, who had borne several healthy and well formed children, was de- 
livered at the full time of a female child, exhibiting some peculiarities about the 
head, which immediately attracted the attention of those in attendance. 7'he 
child was reported by the surgeon accoucheur to have breathed. This and some 
other ruiTiours led to the di.-^interment of the body nine days after delivery, and 
during the month of January, 1842, a time of severe cold, and when of course 
the body had not stiflTered from decomposition. Dr. Oliver of Carlisle, and Mr. 
Rome of Longtown made the examination. The body and limbs were well 
formed. A large tumour was found to occupy the occipital region and the pos- 
terior part of the neck; this tumour was distended with bloody coloured serum. 
The anterior and middle lobes of the brain appeared to be properly developed 
and occupied their usual position, whilst the posterior v/ere much smaller. The 
cerebellum and that portion of the occipital bone in which it is lodged were 
wanting. There was not the slightest vestige of the medulla oblongata or spinal 
cord, and the posterior arches of the vertebrff" were wanting. The lungs sank 
in water, as well separately and in cut portions, as with the heart attached to 
them. No air could be pressed out of cut portions under water. The foramen 
ovule and the ductus arteriosus were quite patulous, having evidently undergone 
no change from ilie true fojtal condition. 

The medical gentlemen reported that as certain portions of the nervous sys- 
tem, which in their belief were essentially requisite for the performance of the 
respiratory organs, were totally wanting, they had no hesitation in concluding 
that the child could not have breathed, and they were confirmed in this conclu- 
sion by finding no evidence whatever of the lungs having been inflated. The 
jury returned a verdict of "natural death." 

Dr. Lonsdfile, of Edinburgh, who communicates this case, was furnished with 
the foetus by Dr. Oliver, and he gives a minute dissection, illustrated with 
numerous references, bearing on the physiology and pathology of the appear- 
ances observed. He also considers the question whether the conditions mani- 
fested in the fretus were compatible with life, and is of opinion in the negative. 
The fevv cases on record in which the spinal cord has been found wantintr, are 
conceived to have been too imperfectly examined to warrant much reliance on 
them; and he renders it probable that in several of the cases adduced as proofs 
that the newborn child can live for some time with this deficiency, there was 
actually a part of the spinal cord present. — Edin. Med. and Surg. Journ., Octo- 
ber, 1843. T. R. B. 

58. Poisonous Properties of the Bark of the Laburnum Tree. By Professor 
ChristisOxNT. — It must be a subject of congratulation with every student in medi- 
cal jurisprudence, that Dr. Christison has resumed the publication of cases and 



1844.] Medical Jurisprudence and Toxicology. 237 

observations on that science. The present is his first renewed contribution, and 
the case is certainly a novel and interestinor one. 

The seeds of the Laburnum are known to be poisonous. Two cases of this 
description were furnished by Dr. Traill, and in this journal (New Series, Vol. 
2, p. 234) will be found an account of eleven boys affected by them at a school 
near London. The young pods^ according to Cadet, have produced severe 
vomiting' and profuse protracted diarrhoea. The leaves also are stated by Vicat, 
in his history of the poisonous plants of Switzerland, to possess the property of 
acting violently as an emetic and purgative. An active principle has been ob- 
tained from the seeds and flowers termed cytisine^ and which possesses power- 
ful poisonous qualities in small doses. There is, however, no account on record 
of the effects of the bark, and this renders the following instance a peculiar one. 

It became the subject of a late trial at the Inverness Circuit in Scotland. A 
lad (Hugh Gordon), aged eighteen years, a farm servant, was on bad terms with 
his fellow-servant, the cook, and thought to punish her by administering some 
substance which should cause vomiting and purging. On conversing with his 
acquaintances on this subject, one of them suggested the "French Broom-bark," 
the name by which the Cytisus Laburnum is there known, and it was added, that 
if he cut the bark from below, it would induce vomiting, if downwards, it would 
physic, and if he cut across, it would kill. With these instructions, he cut the 
bark in the presence of a witness for a vomit only, and carried off a piece about 
one or two inches square. The bark, in its dry state, was put into the cook's 
broth by Gordon, with the privity of another female servant, who was aware of 
his purpose. The two culprits partook of the same broth, hut without this 
seasoning, and they sustained no harm. The cook, who noticed a strong pecu- 
liar taste in it, soon became ill, and in five minutes was attacked with violent 
vomiting, and this continued throughout the whole evening and night and the 
next day, with shivering, pain in the stomach and bowels, and great feebleness. 
Purging followed on the morning of the second day. It was some time before 
she recovered so far as to be able to resume her work. The sickness, vomiting 
and purging, however, continued to recur in some degree daily, she complained 
of pains throughout the abdomen, and rapidly fell off in looks, flesh, and 
strength, so that in six weeks after being taken ill, she was forced to give up 
service. She continued ill, and was finally visited by Dr. Ross, who was sent 
by the law authorities to investigate the particulars of the case. He found all 
the symptoms of marked gastro-intestinal irritation, such as vomiting, especially 
after eating, pains in the abdomen increased by pressure, diarrhoea, with tenes- 
mus and slightly sanguinolent stools, flatulent distension of the belly, &c. 
Along with these, there were great debility, impaired appetite, hurried and 
laborious respiration, pale countenance, pale, glazed tongue and an excitable 
pulse, Willi disordered action of the circulation. No sign of organic disease 
could however be discovered in any organ except the alimentary canal; and she 
finally, though slowly, recovered. 

Dr. Christison in order fully to establish that the substance given was the 
laburnum bark, besides the confession of the culprit and the testimony of wit- 
nesses as to cutting and administering, had a portion of the bark, with a few 
pods, taken from one of a row of trees of the same species, and sent to him for 
identification, and they proved to be the undoubted product of the Cytisus La- 
burnum. 

Dr. Ross, at his suggestion, gave some of the dry bark to animals. A tea- 
spoonful in powder to a cat, caused writhing, as if in great pain, and violent vo- 
miting. It recovered however, on the next day. Sixty-nine grains of the same 
powder were administered in porridge to a dog; in ten minutes, it whined and 
moaned, then violently vomited all its food and soon got well. It was thus 
proved to be a violent irritant, but it had not remained long enough in the 
stomach to manifest the whole poisonous effects; Dr. Christison, therefore, 
selected the rabbit, as it does not vomit, and by means of a catheter introduced 
into the stomach an ounce of infusion of laburnum bark, containing the active 
matter of sixty-two grains, and this was prepared from the very bark sent to him. 
No. XIII.—January, 1844. 16 



238 Progress of the Medical Sciences. [[Jan. 

In the course of two minutes, "the animal fell on its side in violent tetanic 
convulsions, with alternatin|y emprosthotonos and opisthotonos, so energetic, that 
its body bounded with great force upon the side up and down the room. Sud- 
denly, however, all movement ceased, respiration was at an end, the whole 
muscles became quite tlaccid, no sign of sensation could be elicited, death in 
short had taken place, and that within two minutes and a half, after tlie poison 
was injected into the stomach, 'i'he body was opened in two minutes more, and 
the heart was found gorged, but contracting with some force and capable of con- 
traction under stimuli. The stomach was filled with green pulp soaked in the 
infusion; the muscles were contractile. No morbid appearance was visible 
anywhere." 

Dr. Ross subsequently repeated this experiment. One rabbit died in thirty 
and another in forty-five minutes after small doses of the infusion had been in- 
jected into the stomach with the catheter. A third one also died speedily after 
eating greens, which had been impregnated with the infusion. In all these 
instances, convulsions were the leading symptoms produced. 

These facts serve in the opinion of l)r. Christison to prove, that it is a poison 
of exceeding energy and a narcotico-acrid one; that in large doses, yet still in 
quantities of no great amount, it acts with violence and celerity as a narcotic; 
and that in small doses, it is a dangerous irritant, acting with force both upon 
the stomach and intestines. 

The young man Gordon, was tried for the crime and pleaded guilty. He re- 
ceived a mild punishment, as it was evident, that he had no intention to do 
serious injury to his fellow servant. — Ibid. T. R. B. 

59. Tuxicnlogical effects of Sulphate of Quinine. By M. Melier. — M. Melier 
read a memoir to the Academy of Sciences, in which he gave an account of 
some experiments of Magendie, on the effects of poisonous doses of sulphate 
of quinine. Dogs were poisoned with this substance, and on dissection, dis- 
tinct fluidity of the blood was observed, and morbid engorgement of the paren- 
chyma of the lungs. M. Melier, therefore, cautions against administering the 
lar^re doses that it has been the practice of late to do. — Comptts Rendus. 

T. R. B. 

60. Jlction of weak Jicids on Copper Vessels plated hy the Electrotype Process. — 
Mr. Warrington, in a late number of the Chemical Gazette, asserts that copper 
vessels such as saucepans, extract pans, &c. silvered by the electrotype process, 
are acted upon by weak acids, as lemon juice, or vinegar, if allowed to remain 
in them for a short time. This, he says, must arise from the deposited silver 
being so porous as to allow the acids to permeate its substance, and the action 
is most likely to be assisted by a galvanic current. — Medico-Chirurgical Review^ 
Oct. 1843. T.R. B. 

61. Af^phyxia. Sudden Death and its causes. By Marshall Hall, M. D. — The 
slightest addition of carbonic acid to the atmosphere, presents the impediment 
to the diffusion of this acid from the lungs, and to the equivalent absorption of 
oxygen gas, and asphyxia may be said to commence. A certain proportion of 
carbonic acid in the atmosphere would produce asphyxia as completely as sub- 
mersion itself, by totally arresting the diffusion and absorption processes. It is 
this principle which must guide us in the investigation of asphyxia from char- 
coal fires, &c. By pursuing this, we shall be able to establish the influence of 
the carbonic acid retained in the blood, in its poisonous agency on the different 
organs. 

When we compare the duration of life when an animal is made to respire 
pure nitrogen or hydrogen, with its speedy extinction in the case of submersion 
or suspension, we can scarcely resist the conclusion, that the exhalation of car- 
bonic acid is a far more immediately vital process than the absorption of oxygen 

a conclusion which we should certainly not regard, in the first instance, as a 

most probable one. 



1844.] Medical Jurisprudence and Toxicology, 239 

The question is, in other terms, whether the ingesta be more constantly- 
necessary to life, or whether the egesta, if retained, be more poisonous or de- 
structive! 

An animal will live many minutes in pure nitrogen, deprived of the stimulus 
of oxygen; but if the separation of the carbonic acid in the lungs be arrested, 
the vital powers are speedily extinguished by the poison. 

The privation of food may be sustained for several weeks; it is pure inani- 
tion; but suppression of urine, of bile, of the secretion of the faeces, is fatal in 
a much shorter space of time, the egerenda, if retained in the blood proving, 
like the retained carbonic acid in cases of asphyxia, positive poisons to the vital 
organs. Next to the excretion of carbonic acid in the lungs, that of the urine 
by the kidneys is the most important. If either be defective, dozing, followed 
by coma and convulsions and death, takes place. In albuminous urine, we have 
cerebral or true spinal attacks, hemiplegia or epilepsy. 

The whole question is one of the deepest interest in a hygienic and jurispru- 
dential point of view, and well worthy of attention and investigation on the part 
of the younger portion of my audience. 1 have myself long meditated an inves- 
tigation of the subject. 

Secondary Asphyxia. — The danger is not altogether over when the patient ap- 
pears to be restored from the state of asphyxia. The respiration and the other 
functions may proceed nearly naturally for some lime, for some hours even, and 
suddenly convulsions may seize the patient, and death may ensue. The blood 
apparently remains poisoned. Time, as in so many other cases, is an important 
element in the perfect restoration to health. 

It will be remembered, that Sir Humphrey Davy was seized with alarming 
symptoms on the evening of the day on which he had breathed the carburetted 
hydrogen gas. A soldier was taken out of the Thames in a state of asphyxia. 
Animation was restored, but many hours afterwards he was seized with con- 
vulsions, and expired. 

From these and other similar facts we may deduce the conclusion, that our 
watchful care and our remedies must be continued after apparent danger is over. 
There is a more hidden danger, the consequence of the venous condition of the 
blood, still ill arterialized — secondary asphyxia. 

The patient should be kept in a free, cool atmosphere, and be made to take 
free and deep inspirations, and active exercises should be enjoined, in order that 
the blood may be both freely circulated and respired. 

Sudden Death. — Many facts induce me to believe, that the cases oi sudden 
death arise chiefly from interruption of the coronary circulation. Ossification of 
the coronary arteries by impeding the flow of the coronary blood, produces the 
transient or the permanent cessation of the heart's action and its consequences 
— syncope or death. But this is not the only disease of the heart which arrests 
the coronary circulation. In a case presenting most accurately the symptoms of 
angina pectoris, and terminating by a predicted sudden dissolution, a fatty con- 
dition of that organ was the only circumstance which presented itself, on a post- 
mortem examination, to ex[)lain the phenomena. 'Fhe adeps probably com- 
pressed the coronary arteries in their course. It is prohable that syncope and 
sudden dissolution occur in other diseases of the heart, especially dilatation, 
from interruption of the coronary circulation. 

It is rarely that disease., eiliier in the lungs or brain, induces sudden death. 
Asphyxia is promptly fatal. And some diseases within the cranium are still 
more promptly so. But in the latter case, the disease has extended its influence 
beyond the cerebrum and affected the medulla oblongata. Sudden hasmorrhagy 
within, or adjacent to tlie medulla oblongata, or so situated, or in such abun- 
dance as to compress this organ, niay induce death as prompt as that of asphyxia 
itself, with which it is indeed identical. 

Instead of referring sudden death, therefore, with Bichat to the heart, lungs 
and brain, I am disposed to refer that fearful event in every case, to arrested 
coronary circulation, or to lesion of the medulla oblongata. 

Less sudden death may be induced in the manner described by Bichat. The 



240 Progress of the Medical Sciences. [Jan. 

heart, the lungs, and the brain may, in this sense, be the " trepied de la vie," 
and the blood may be said to be borne upon that tripod. 

Less sudden death still is induced, if the stomach and intestines, the brain, 
the kidney be morbidly affected. These organs are only less essential to life 
in degree. Rupture of the intestine is immediately marked by the sinking or 
slowly dying state. — Gulstonian Lectures, London, I8i2. T. R. 13. 



MISCELLANEOUS. 

62. Compliment to British Physicians and Surgeons. — The testimonial recently 
so publicly given by the representative of a great nation to the conduct of our 
brethren in the pursuit of their high calling, and the lustre derived from such 
conduct to the character and institutions of our country, are what every member 
of our noble profession must appreciate and rejoice in. We allude to the elo- 
quent remarks of the American ambassador, Mr. Everett, quoted by Professor 
Williams in his introductory lecture. •' Forvi'hat," said the ambassador, "was 
that which constituted the chief pride and glory of the British nation"? They 
had heard of the intercepted letter from one Chinese chieftain to another; and 
what was the characteristic which had excited the admiration of the mandarin 
of a great and important empire, reeling at the time under the blows of the 
British government? Was it the military prowess of their countrymen'? Was 
it the steam-vessels pf war, reaching coasts in defiance of the desolating simoon] 
Was it their arms, their artillery, their skill of engineering, which civilized 
nations now brought to the strategy of war"? Was it this, or any of these, 
M^hich had struck with wonder, and awe, and admiration, the barbarians of 
China"? No! It was the humanity of British physicians and surgeons — their 
management of hospitals, and the generous kindness which was extended to the 
sick and wounded, even of a hostile nation — which moved them with astonish- 
ment, and excited their sympathy and regard. These were some of the arts of 
peace which extorted the admiration of an enemy, and which other states would 
do well to imitate." 

Can any thing, as far as this world is concerned, be conceived more truly 
glorious to our country, more ennobling to our profession, than that such a testi- 
mony as this should have been spontaneously awarded by the distinguished 
individual referred to. We wish not to speak vain-gloriously; we would avoid 
even the appearance of claiming for our profession the praise which has here, 
through the voice certainly of an unprejudiced observer, been elicited; but we 
cannot refrain from expressing the confident hope that, amongst every contumely 
which our own government and its subordinate agents may be disposed to throw 
upon us, however our just requirements may be treated or disregarded, it will 
still be the animating principle of British physicians and surgeons to devote 
every energy of their minds and every resource of their knowledge to the alle- 
viation of human suffering, wherever and among whomsoever it is to be found. 
—Frov. Med. Journ., Nov. 18, 1843. 

G3. Obituary. — Medicine has lately sustained a loss in the death of Jacobson, 
principal physician to their Danish Majesties, and who died, after a short ill- 
ness, at Copenhagen, on the 29th of August, aged 61. Louis Levi Jacobson, 
born in Copenhagen, in 1782, belonged to a Jewish family of distinction. His 
numerous works on Anatomy and Medicine procured his nomination to a pro- 
fessor's chair in both the University and the Academy of Surgery in the Danish 
capital, in the face of the old, worn-out, and bigoted national regulation that 
precludes all persons from public offices who do not subscribe to the dominant 
religious faith of the country — the Lutheran. Jacobson was further raised by 
the king to the rank of privy councillor. He was a member of several orders of 
knighthood, and of numerous learned societies. The French Academy of Sci- 
ences, in 1843, elected him a corresponding member, in the place of Sir Everard 
Home, deceased, and awarded him a prize, worth 160/., for his invention of the 
lithoclasie, an instrument for crushing urinary calculi. — Lancet, Sept. 30, 1843. 



1844.] 241 



AMERICAN INTELLIGENCE. 



ORIGINAL COMMUNICATIONS. 

Case of Uterine Polypus. By John V. P. Quackenbush, M. D., of 

Albany. 

I was called to Miss , aetatis 39, June 4, 1843, and found her much 

exhausted by a severe haemorrhage, whicli had existed for a number of 
days. She informed me that she had not enjoyed good health for two or 
three years, during portions of which time she had been under medical 
treatment; that every month she suffered much from excessive flooding, 
every successive turn of which rendered her still weaker; and that she had 
given up all hopes of ever getting well. 

I made an examination per vaginam,and found the uterus in the follow- 
ing condition. The neck was entirely obliterated, as at the ninth month 
of pregnancy, and gave the same sensation to the touch, as when the mem- 
branes have been prematurely ruptured, and the head of the foetus presses 
directly upon the walls of the uterus. The os uteri was dilated one inch 
in diameter, and upon inserting my finger, I discovered a hard tumour, 
which I pronounced to be a polypus, and much encouraged my patient by 
stating that I tliought I would be enabled to remove it during the course of 
the summer. I endeavoured to suppress the haemorrhage by means of 
astringents and injections, but did not effect much by my treatment. Tn 
the course of a few days, when the haemorrhage had ceased, I prescribed 
12 drops of the muriaied tincture of iron, morning, noon and night, and 
the daily ablution of the parts with cold water. Under this treatment, my 
patient gained much. She became stronger, regained her appetite in a 
great measure, and was enabled to sleep well, which she had not been able 
to do for many months. 

She continued to improve till August 20th, when she had another very 
severe attack of raenorrhagia, accompanied with regular labour pains. I 
visited her, and on examination found that the polypus had descended from 
the uterus, and now occupied the vajjina. 

I decided upon operating, and not being able to obtain a suitable instru- 
ment at the time, 1 constructed one for myself, which has at least one 
recommendation, simplicity, and applied my ligature August 26th. 

During the time the ligature was applied, the patient appeared to grow 
weaker daily, and I was compelled to support her strength by administer- 
ing stimulants. On the sixth morning, September 1st, the ligature came 
away, and upon examination I found the polypus detached and lying loose 
in the vagina. In the evening a messenger came after me and wished me 
to visit my patient immediately, as she was much worse. I found her 
suffering severe pains, caused by the efforts of the vagina to relieve itself. 
The polypus was expelled during the evening: the patient fell asleep and 
slept soundly till morning, when she felt much refreshed, and appeared 
belter than I had seen her for a month previous. Since that time she has 



242 



American Intelligence, 



[Jan, 



been gradually improving, and is now able to attend to her ordinary- 
avocations. 

The polypus, after being deprived of all the blood it contained, weighed 
ten ounces. 

At the time I operated there was another tumour, of the size of a goose- 
egg, connected as I supposed with the left ovarium, which had existed for 
more than a year. During the last fifteen days, my patient has had a 
discharge from the vagina of a substance, which, from the description she 
gave of it, I considered to be pus. During the continuance of the dis- 
charge, the tumour has appeared gradually to diminish, and this morning, 
upon examination, I could not feel it, except when I pressed very hard 
indeed upon the walls of the abdomen. 

Fig. 1. Fig. 2. 




It does not now appear larger than a filbert. 

Was the diminishing of the tumour in any manner connected with the 
discharge? What was the nature of the tumour, and where its situation? 
All three questions I will leave you to decide for yourself. 



1844.] Original Communications, 243 

The instrument I nsed consists of three small rods, («, a,b,) one-eighth 
of an inch in diameter, eight inches in length, and perfectly straight. Two 
of the rods («, a) have each a small hole at one end, large enough to admit 
the ligature. The other rod (b) has a loop at one end, large enough to 
allow the first two rods to pass, and at tlie other end a shoulder, around 
which the ligature is to be fastened. 

The instrument is to be applied in the following manner: — The two 
rods {a a) armed with the ligature, are placed side by side, and guided by 
the finger, are to be passed up the vagina along the polypus, till their 
upper ends reach that part of the stalk, round which the ligature is to be 
applied. Then the rods are to be separated and moved quite round the 
polypus, so that a portion of the ligature will encircle the stalk: now the 
loop of the third rod [b) is to be slipped over the other two, (see figf. 1,) 
by which means they are drawn together; which being effected, the two 
rods are to be withdrawn, and the ends of the ligature with them. 

You now fasten the ligature around the shoulder of the rod (6), and 
leave nothing in the vagina but the simple rod, (see fig. 2.) 

Such is the instrument I wish to introduce, and which, I think, possesses 
three advantages over the ones generally used. 

1st. It is much more simple and easily constructed. 

2d. It is much more readily applied, and 

3d. It is much smaller, and will consequendy cause much less irritation 
during its application. 

A case of Imperforate Hymen. By William Shultice, M. D., of 
Malhews, Va. 

On the 12th of October, 1843, I was called upon to visit Miss G., of 
this county, affected with the bilious remittent fever, which was prevailing 
at that time. 

Miss G. is a young lady, jetat. 18 years, well grown for her age, and 
had enjoyed uninterrupted health until within the two years last past. 
Upon examination I found her afflicted with the bilious remittent fever of 
the season, for which I treated her in the usual manner. 

Her mother informed me she had a " lump in her side" which she did 
not like, and which caused her much uneasiness, and desired me to ex- 
amine it. I discovered upon examination a considerable tumour in the 
abdomen, reaching as high as the umbilicus. It presented the appearance 
of a female, about seven months advanced in pregnancy, and excited in 
my mind strong suspicion that she was pregnant. 

I slated to her and her mother the necessity of an examination per 
vaginam be/ore I could form an opinion as to the true nature of her disease. 
Her mother had informed me she had never menstruated. Upon making 
the examination, to my surprise, I discovered, that the os externum was 
completely closed by a dense, unyielding membrane, which presented an 
impenetrable barrier to the finger, and of course obstructed the passage of 
the catamenia, and caused necessarily the tumour in the abdomen. 

I immediately informed her and her mother of the situation in which 
she was placed, and of the immediate necessity of an operation for her 
relief. At first the idea of such an operation was revolting to her feelings; 
but the necessity for its performance was so plain and indispensable, that 
she consented. | 



«: 



244 American Intelligence, [Jan. 

After a {ew days, when the fever with which she was affected had sub- 
sided, I performed the operation by placing her on the ei\ge of the bed, in 
the position for the operation of lithotomy. Upon opening the labia 
externa a tumour presented itself, protruding externally as if pressed out- 
wards, by a fluid internally. To the touch it appeared to yield. The 
hymen had closed the passage of the vagina, by a firm, dense, fleshy mem- 
brane, which extended from the perineum to the orifice of the urethra, 
and of course presented an obstruction to the passage of the catamenia. 

With a large abscess lancet, I made a free incision, through the hymenial 
membrane, and there immediately ensued a gush of a dark, grumous fluid, 
of the colour and consistence of tar. It was not coagulated, neither did it 
emit any odour, but presented exactly the appearance described by Den- 
man, in a similar case. As related by him, the only change the menstrual 
fluid appeared to have undergone, was a lessening of the more fluid parts 
by absorption. 

The fluid continued to discharge until six pounds had passed, when the 
pulse becoming feeble and the patient exhausted, I enlarged the orifice by 
means of a probe-pointed bistoury, and placed a tent between the parts to 
prevent adhesion. She was then placed comfortably in bed, and some 
stimulants administered. 

There continued to flow through the vagina, for several days, the same 
dark, grumous fluid, until from the information I received, at least two 
more pounds must have escaped, making in all eight pounds of menstrual 
fluid. 

The health of this young lady had been for about two years affected by 
the obstruction which retained her menstrual secretions. She had been 
during that period, attacked monthly with pains in the back and lower 
part of the abdomen, which were ascribed to a want of the natural secre- 
tions. But neither slie, nor her friends, had the most vague idea of the 
true nature of her situation. The tumour in the abdomen has entirely dis- 
appeared, and her general health is rapidly improving. 

November, 1843. 

The Sedative Powers of Ergot. By Quinton Gibbon, M. D., of 
Salem, N. J. 

I am induced to ofler for your consideration the following remarks upon 
a singular property possessed by the ergot — that of diminishing the fre- 
quency of the pulse — by a desire to see the truth of the subjoined facts 
either verified or disproved by further experiment. 

Having occasion during the summer of 1841 to prescribe the ergot in a 
case of menorrhagia, I observed a manifest decrease in the frequency of the 
patient's pulse. Surprised at a result, which from my previous knowledge 
of the properties of the remedy I was unprepared to anticipate, 1 was in- 
duced to test by further experiment its reality. 

With this view I gave on the 19lh of June, 1841, sixteen grains of pul- 
verized ergot in decoction to a healthy man 20 years of age, whose pulse 
at the time of exhibition was 64. He had maintained the sitting posture 
for an hour previous, and continued it during the experiment. 

Results of experiment. — 20 minutes after exhibition, pulse 58, moderate 
full; 30 min. aft. exhib. pulse 48, small; 45 min. aft. exhib. pulse 48; 60 
min. aft. exhib. pulse 52; 75 do. pulse 55. The experiment was here con- 



1844.] Original Communications. 245 

eluded, and the patient permitted to walk about — 6 hours aft. exhibition, 
during which he took his dinner, his pulse stood at 60. 

2d Experiment, June 20th. — The same individual, and sitting as before, 
took a scruple of ergot in a well-boiled decoction of two waters, pulse 60; 
15 min. aft. exhib. pulse unchanged; 25 min. do. pulse 52, full and tense; 
35 min. do. pulse 51; 45 min. do. pulse 51; one hour aft. exhib. p. 54; 
one hour and half aft. exhib. pulse 56. 

3d Experiment, July 3d. — Gave the same with pulse at 64, a decoction 
of one drachm of ergot; 20 min. aft. exhib. pulse 52; 30 min. do. pulse 
46, slight nausea; 40 min. do. pulse 45, nausea increased; 5 minutes after 
vomiting occurred, after which pulse rose to 60; one hour aft. exhib. pulse 
stood at 46, with slight nausea; 2 hours aft. exhib. pulse 50, no nausea. 

4 th Experiment, August 7th, 1842. — Took myself 10 grains of a watery 
extract, prepared by boiling 5j of ergot in a pint of water, and evaporating 
to a consistency proper for pills. Pulse at the time of exhibition 70; 30 
min. aft. exhib. pulse 60; one hour aft. exhib. still 60; one hour and a half 
aft. exhib. pulse 57; three hours do. pulse 60. 

5th Experiment, July 29lh, 1843. — Took 30 drops of the oil of ergot, 
prepared by digesting the powder in ether and evaporating the liquor. 
Pulse at exhib. 70; 30 min. aft. exhib. pulse 64; one hour aft. exhib. pulse 
60; two hours do. pulse 56; three hours do. pulse still 56. 

Not wishing to occupy further space by a detail of my other experiments, 
I would merely remark that their results were very similar to those already 
detailed — those in which the tincture was used being the least satisfactory. 
The oil did not appear to exert so great a control over the pulse as the 
ergot in substance. 

The only work in which I recollect to have seen this sedative property 
of ergot noticed, is that of CoUins's Midwifery, page 156, in which it is 
mentioned as being very striking in almost every case where administered 
during labour. I have frequentjy watched its operation upon the female 
system under similar circumstances, but have never witnessed such well 
marked effects, as are mentioned by that author. A decrease of four or 
five pulsations in the minute is as much as I have been able to discover. 
I have obtained the most satisfactory results from the operation of the agent 
upon the unimpregnated female and upon male subjects. It is but reason- 
able to suppose that the excitement of labour would materially interfere 
with the exercise of this peculiar sedative property. 

Salem, N. J., Nov. 1843. 

Case of Berangemmt of Vision. — [The following very curious and 
interesting case of deranged vision, drawn up by the patient himself, has 
been communicated to us by our friend. Prof. S. Jackson. — Ed.] 

My sight is obstructed by dark spots or clouds, some fixed, some de- 
scend vertically, while most of them whirl about in rapid vortices at every 
movement of the eye. They take all manner of shapes, so variant and 
fantastic that they cannot be accurately described by resemblances to any 
known objects — webs, clouds, rocks, lines, chains, balls; and I have 
sometimes mistaken them for flocks of birds passing across the field of 
vision. As soon as the sight is directed to an object, they begin slowly to 
descend, but boil up again at the first motion of the eye, then recommence 
their descent as before. They exist in such numbers; that I see as through 



246 American Intelligence. [Jan. 

tattered cloth, only at intervals when they break and float away. Objects 
often appear double, always tremulous at first sight, and when they be- 
come steady, are soon overcast and indistinct. 

The internal angle of the left eye is choaked up with permanent spots 
resembling clusters of grapes, and the external with a bar passing ob- 
liquely so as to obstruct the light in that direction. In the right eye, is 
an opaque spot nearly circular, that hovers about the pupil, so as partially 
to cover the page of a book, or the face of the person with whom I am 
speaking. The labour of seeing is mostly performed by one eye at a 
time, as it happens to be free from obstruction. When I attempt to read 
it often requires repeated efforts to fix the sight upon a letter or the begin- 
ning of a sentence, the lines appearing at first confused, as if deranged in 
setting the types. 

It is less painful to write than to read, for the words bemg previously 
formed in the imagination flow easily from the pen; and so capricious is 
the disease, that I am sometimes unable to read the last sentence I had 
written. 

In broad day, there is generally a tremulous light dancing in the exter- 
nal angles of both eyes, resembling rays of the sun refracted from undulat- 
ing water. When the optic nerve is excited by wine or stimulating food, 
or even by emotions of the mind, both eyes are filled with bright spots, 
not unlike sparks struck from a flint, brilliant even in the face of the sun. 
Bright objects, as a candle, common fire, or a windovi^ with all its sashes 
and panes of glass, leave their impression upon the retina for some seconds 
after the eye is turned in another direction; 

At night, these spectra put on quite a different appearance. Luminous 
concentric circles are produced by the motion of the eyes, and instead of 
dark spots, white mists pass over the area of vision, and roll away in 
masses like vapour brightened by the sun. At first they disturbed my 
sleep; but now that they have grown famjliar I cease to regard them, un- 
less when they put on some new and threatening appearance accompanied 
with pain. 

There is no defect in the humours of the eye. The focus of vision was 
always at a proper distance, and has undergone no change except from 
increase of years. Objects are more distinct through magnifying glasses, 
but the eye is too sensible to endure the innovation without pain. I dare 
not look throusjh a telescope, and never at the sun, unless obscured by 
clouds. I seldom fix the eye intensely upon any thing, it is even painful 
to watch the expression of the features of those with whom I converse. I 
have hence acquired the habit of looking as upon vacancy, as we some- 
times seem to regard objects while the mind is abstracted towards other 
thoughts. Not an hour passes that I am not reminded of my infirmity by 
some inconvenience or actual pain, or a day that I do not feel its depress- 
ing influence upon the mind. I am never free from annoyance, whether 
in the street, parlour, public assemblies, or in addressing court or jury: 
there is always some radiant point that pierces to the nerve and distracts 
the attention. The pain, though not generally severe, always exists in 
degree, and is sometimes keenly felt quite to the back of the head. It in- 
creases at every effort of vision, beginning usually in the angle of the left 
gye, followed by a slight spasm in the lids, and a contraction of the orbit. 

I have consulted but few physicians who seemed sufliiciently acquainted 



1844.] American Intelligence, 247 

with the structure of the eye and laws of light, to form a just conception 
of my case. Their prescriptions were variant and sometimes contradict- 
ory. They administered the belladonna, applied leeches, blistered the 
eyelids and the top of the head, put setons in the leo^ and back of the 
neck, gave me drastric doses and put me on low diet. These applications 
have been several times repeated in the course of twenty years, but always 
without good effect. My constitution soon became a prey to this treat- 
ment, and the more destructive apprehension of blindness. Other medi- 
cine became necessary to heal the ravages of the first; so that in later 
years, my attention has been directed towards the restoration of health 
rather than the eyes, whose condition is altogether hopeless. 

I employed readers during the two last years of my college life, while 
studying law, and throughout a long and laborious practice at the bar. 
They read the authorities and documents as occasion required, in the 
course of my argument to the court or jury: but the process was always 
imperfect, slow and irksome. It is not enough to retain the general nature 
of a cause in the memory; the books and papers are often referred to in 
rapid succession, and the law must be made to keep pace with the de- 
velopment of facts. 

In early practice, I sought to conceal my infirmity, lest a knowledge 
of it might impair the confidence of clients. When they presented their 
papers for inspection, I generally contrived to withdraw, or to postpone 
the examination, until I could hear them read: and as there was no appear- 
ance of disease on the exterior coats of the eye, few persons beyond my 
own household knew of its existence. 

Having been told that the symptoms were of an incipient amaurosis, 
I have lived in constant apprehension of blindness. At this period of 
life, I do not expect a, cure, or even an amelioration of the disease; I can 
only hope, by proper precautions, to preserve the sight such as it is, which, 
nevertheless, is a blessing above all price. 



DOMESTIC SUMMARY. 

Epidemic Erysipelas, known by the popular name of '''•Black Tongue,'''' V)hich 
recently prevailed in Ripley and Dearborn Counties, la. Dr. George Sutton, of 
Aurora, la., has given, in our cotemporary, the Western Lancet, an interesting 
account of an epidemic erysipelas. We copy the main particulars, which are 
important, especially in connection with the valuable account of a similar epi- 
demic given in the original department of this numher. 

"This disease," Dr. Sutton states, "commenced in the latter part of Novem- 
ber last, in Ripley county, near Ripley creek, three miles east of Napoleon, and 
gradually extended in a south-easterly direction over a section of country, lying 
between Laughery and Tanner's creeks, varying from ten to fifteen miles in 
width, and ahout thirty in length, traversinof the townships of Delaware, Lau- 
ghery and Adams in Ripley county, and Manchester, Sparta, Laughery, Centre, 
and part of Union, in Dearborn county, and a few cases occurred opposite 
Aurora, in Boone county, Ky. It is something remarkable that it did not spread 
towards the west, as few, if any cases, occurred down as far west as Napoleon. 

"1 have been informed, however, that near Greensburgh, and St. Onier, and 
also in Bartholomew county, epidemics have prevailed of a similar character, 
during the winter and springy. Before the disease had. made its appearance in 
our neighbourhood, and while it was gradually progressing' towards us, we daily 



248 Jlmencan Intelligence. [Jan. 

received the most exafj aerated reports of its malignancy. It was then generally 
called the sore tiiroat, sometimes the lung fever, until a notice appeared in the 
public papers of an epidemic prevailing in Illinois called the black tongue, after 
which this was one of the names by which it was known. It did not make its 
appearance in the neighbourhood of Wilmington and Aurora, until about the 
middle of February; since that time it has continued to prevail amongst us, 
raging with the most violence during the month of March, gradually subsiding 
in the months of April and May, and increasing again, in the neighbourhood of 
Aurora, during the months of June and July. 

"From the manner in which this malady spread through the neighbourhood of 
Aurora and Wilmington, I have been inclined to believe the disease was con- 
tagious; I did not think so at first, but a more extensive acquaintance with it 
led me to think differently. With the public it was generally considered as 
such, and it became a common remark ' that when once the disease entered a 
family it generally passed tlirough it;' and the cases that 1 have selected were 
attacked in a succession that 1 cannot well account for, except by considering 
the disease contagious. Children under two years old almost universally 
escaped the disease; persons of a feeble constitution were generally attacked 
with the most violence; and with the aged, in some parts of the county, it has 
been very fatal. 

" This disease has either assumed several characters, or we have had several 
epidemics traversing the county together. One was an erysipelas, connected 
with cynanche tonsillaris, or swelling of some of the lymphatic glands. An- 
other was what we considered a typhoid pneumonia^ sometimes connected with 
swelling of the axillary glands. These two diseases have been so intimately 
connected in my practice, and wherever 1 can hear of the epidemic prevailing, 
that it has been a question with me, whether the last was not a pulmonic ery- 
sipelas. The premonitory symptoms in each disease were alike; the character 
of the fever in each was the same; it was often the case that one form of the 
disease changed into that of the other; and we frequently had, in different mem- 
bers of the same family, the two forms of the disease at the same time. This 
epidemic appeared also to attack other organs, which I wilJ notice hereafter." 

Dr. Sutton gives the details of six cases, and then presents the following 
summary. 

"The following is a synopsis of the symptoms of this epidemic. When the 
throat was the part attacked, after the usual premonitory symptoms, which have 
been frequently mentioned, had continued for two or three days, the patient was 
generally seized vi^ilh a chill, which lasted, in many cases, four or five hoursj 
this was followed by a high fever, swelling of the tonsils, submaxillary, parotid, 
and lymphatic glands of the neck; neuralgic pains, darting over the side of the 
neck and head, frequently following the temporal artery; tongue, covered at first 
with a thick brown coat, soon became swollen and often very dark in the centre; 
deglutition frequently very difficult; pulse generally full, though easily com- 
pressed; skin at first hot and dry, becoming moist and continuing so afler vene- 
section. \i\ the mild form of the disease these symptoms were frequently 
removed at once by an active antiphlooisiic course /f treatment. Sometimes 
the mild form had only the appearance of cynanche tonsillaris. But in the more 
malignant form, where the throat was affected, after the above symptoms had 
continued for two or three days, and sometimes from the very commencement, 
the pharynx became of a dark purple colour; this colour generally spread over 
the palate, tongue, and sides of the cheeks, the tongue becoming very much 
swollen, assimiing a blackish brown colour; deglutition in many cases was 
almost impossible. In most of these cases an erysipelas would commence at 
the angle of the mouth, or nose, and spread over the face and head, with all the 
symptoms peculiar to thatdisease. 'J^he inflammation of the throat was seldom sta- 
tionary; sometimes passing down the trachea, with symptoms resembling laryn- 
gitis, or cynanche tracheaiis, and at last assuming the symptoms of pneumonia. 
Sometimes this inflammation passed into the nostrils, and from them into the 
frontal sinuses; sometimes apparently into the antrum maxillary, but in nearly 



1844.] American Intelligence. 249 

every case that I saw, the throat became well, while the erysipelas was spreading 
over the skin. * 

" Sometimes this disease appeared to commence in the frontal sinuses and 
antrum; large quantities of water would be discharged from the nose, a violent 
pain felt over the eyebrows, or one of the malar bones, the face becoming very 
much swollen, the swelling closing the eyelids. These symptoms generally 
continued until an erysipelas made its appearance, or there was a copious dis- 
charge of bloody mucus from the nose. In the case th?t I met with, the neck 
was enormously swollen, from the left ear down to the sternum, without any 
redness of the skin, or but little inflammation of the pharynx; this swelling 
rapidly subsided, and was followed by a profound coma that terminated in death. 
The disease seldom presented the putrid symptoms of cynanche maligna, and in 
those cases that it did, I believe the cause might be traced to the imprudent use 
of mercury. In a number of cases that I met with, the inguinal glands were 
the seat of the disease, becoming very much inflamed, and an erysipelas first 
making its appearance there, and spreading over the abdomen. 

" In the pneumonia, the premonitory symptoms were about the same, with the 
exception of soreness of the throat; this sym.ptom was frequently present, 
though not invariably so. After the chill, which was usually very protracted, 
there was generally severe neuralgic pains in some part of the system, some- 
times darting down the arm and side, without any tenderness of the spine that 
I could discover. From the pain alone, 1 should frequently have had difficulty 
in deciding whether the disease was a pleuralgia, or pleuritis; however, in most 
cases, besides the neuralgia which was very acute and lancinating, there was a 
constant, deep-seated pain in the side, of an obtuse character. This neuralgia, 
in many cases, was very severe, and attacked various parts, as one of the toes, 
darting from thence into the leg, the fingers, arms, heel, knee, elbow, shoulder, 
and the side of the neck. It generally subsided in the course of twenty-four, 
or forty-eight hours, sometimes continuing in the arm, or the foot, until the limb 
became swollen, and an erysipelas made its appearance in the part. There was 
generally great prostration of strength; in most cases, a few ounces of blood 
drawn from a large orifice produced complete syncope, followed by a profuse 
perspiration. The blood, in nearly every instance that I saw, was huffy. Cough 
was sometimes spasmodic at first, though not generally so: it was nearly always 
connected with the expectoration of a thick, ropy sputa, frequently tinged with 
blood. The crepitating rale at first was generally very distinct, assuming more 
of a mucous character after a few days; percussion, after the third day, nearly 
always yielded a dull sound, and in several cases at the very commencement of 
the disease. There was generally dyspnoea, and an inability to expand the chest 
by a full inspiration without aggravating the pain. 

"There was frequently great vertigo at first, and if the disease did not assume 
a favourable character by the fifth or sixth day, and sometimes sooner, it usually 
put on typhoid symptoms, connected with a low muttering delirium, and sub- 
sultus tendinum. This tendency to assume a typhoid character, as I have before 
mentioned, was a prominent feature in every form of the disease. Several cases 
in Sparta township, 1 haye been informed, passed into a profound coma at the 
commencement of the disease, which continued until death. The tongue was 
generally covered with a muddy-looking coat, which usually became of a brown 
colour down the centre. The skin was nearly always hot and dry at first, but 
in protracted cases the patient was frequently bathed in profuse perspiration. 
The pulse at first was generally full and tolerably strong, becoming in protracted 
cases, feeble and very frequent. 

"I had not an opportunity of making any post-mortem examinations. The 
treatment of this epidemic at the commencement of the attack was strictly anti- 
phlogistic, bearing in mind the tendency it had to assume a typhoid character. 
With this view the patient was generally placed in the upright position, and 
blood drawn from a large orifice until a decided impression was made upon the 
system; a few ounces in the pneumonia was generally suflicient to produce that 
effect. 



250 American Intelligence. [Jan. 

"With regard to the propriety of blood-letting in this disease; the subject was 
discussed by the public before the epidemic had entered th^ neighbourhood of 
Aurora. When the disease made its appearance amonost us, from its inflamma- 
tory character, I generally considered venesection at the commencement of the 
attack necessary, not for the abstraction of blood so much, as to produce a shock 
upon the system. A large blood-letting //-om a small orifice seldom failed to 
produce injurious effects, neither did patients bear a second venesection well, 
particularly in the pneumonia. In one case 1 thought it necessary to repeat 
venesection, and although i drew each time, less than a pint of blood, yet the 
last bleeding, though it removed the pain in the side, produced such symptoms 
of prostration that I had to resort to stimulants and keep the patient under their 
influence for several days before he recovered from its effects. When the throat 
w'as attacked, emetics, followed by mercurial cathartics, nauseanls, blisters, 
liniments, and sinapisms to the throat, pediluvium, acidulated and pepper 
gargles, scarifying the tonsils, and when the throat was ulcerated, the applica- 
tion of a solution of nitrate of silver, was the course generally adopted, and in 
a large number of cases the bleeding, the emetic, and mercurial cathartic cut 
short the disease at once. In administering mercury in this form of the disease, 
a few doses generally filled the indication, and as I before mentioned, great 
caution was necessary; for wherever it produced its specific effect upon the 
mouth and salivary glands, I believe it was almost invariably attended by inju- 
rious consequences. When the erysipelas made its appearance upon the skin it 
was treated according to the character that it assumed, and its accompanying 
fever. Alternative doses of calomel and ipecac, (carefully avoiding ptyalism,) 
followed by saline cathartics, antimonial diaphoretics in the robust; wine whey, 
carbonate of ammonia, Dover's powder, in combination with calomel, followed 
by gentle laxatives, when the disease had assumed a typhoid character. As a 
local application to the erysipelas, a solution of the sulphate of copper, and the 
sulphate of iron, as has been highly recommendfd, appeared to produce good 
effects. However, in many cases, when the skin was not blistered, influenced 
by the resemblance the disease had to a burn, 1 was induced to try the spirits of 
turpentine, which I thought produced the very best effects. 

"In the pneumonia, where the tongue was much furred, as was generally the 
case, I generally gave an emetic of ipecacuanha immediately after the system 
had recovered from the effects of the venesection; although I am not in the habit 
of prescribing emetics in peripneumony, yet, in this disease, the shock which 
they produce upon the system, in addition to the effect produced by blood-let- 
ting, seldom failed to mitigate the symptoms; the skin becoming moist, the 
cough loose, the pulse slower, and the dyspnoea less difficult. If there has been 
any remedy in the course of treatment, that has caused the disease to be less 
fatal in this neighbourhood than it has in other parts of the county over which it 
passed, it has been the prompt exhibition of an emetic, after venesection, making 
a decided impression upon the disease at its very onset, without prostrating the 
system. After this, calomel, opium, and antimony, in combination, followed 
by gentle laxatives', antimonial solution, blisters, mucilages, and a light diet, 
was the principal course of treatment. 

" This epidemic has not been fatal in this part of the country; although it has 
prevailed in the neighbourhood of Aurora ever since the latter part of February, 
we have had but two deaths from the disease. One case that terminated fatally 
I have detailed in full; the other was a gangrenous erysipelas of the extremities, 
connected with pneumonia, which was the only case reported of the gangrenous 
variety. I found the disease, however, much more obstinate in the township 
of Manchester, where it was remarkably fatal. I had but few cases in this 
neighbourhood, but was informed that the disease generally attacked the lungs. 
It was also fatal a iew miles east of Hillsborough, and very fatal on Ripley 
Creek, where it first conmienced, and also near Milan.* 1 have been unable to 

* The physician residing at Napoleon, near Ripley Creek, and also the one at Milan, 
practise the Botanic system of treating disease. 



1844.] American Intelligence, 251 

ascertain the number of deaths in proportion to the number of cases, but it is 
generally considered by the oldest inhabitants to have been the most fatal epi- 
demic within their memories that has visited our country, not even excepting 
the cholera. In several townships throuprh which the epidemic passed, it was 
accompanied with puerperal fever, which was also, very fatal. 1 have seen but 
two cases of this last disease, one of them occurred in my own practice, but was 
a mild attack; the other was in Lauorhery township, and had been under the 
care of another physician. 1 was struck with the similarity of many symptoms 
with the prevailincr epidemic, and the more so, as two of the family were at that 
time confined to bed, in the same room, with the erysipelas. Expecting to meet 
with more cases I made no memorandum of this. Although I am well aware 
that "epidemics frequently make other diseases wear their livery," yet I have 
thought probable that the two diseases were so intimately connected, that the 
prevailing epidemic acted as a predisposing cause in puerperal fever; for it is a 
well-known fact, as is stated by a late writer on diseases of the skin, that "when 
a hospital is invaded by erysipelatous infection, the patients are exposed to con- 
siderable danger; all the wounds and sores in the house are liable to be attacked, 
and the medical cases also suffer."* Could it be possible that this puerperal 
fever was caused by an erysipelas of the uterus and vagina? There appears to 
me nothing inconsistent in this idea. We have seen this erysipelas attacking 
the mucous membranes of other parts of the system; it has manifested a conta- 
gious character; in the cases that I saw, there was great tenderness over the 
uterus, and swelling of the vagina, and it is highly probable, that the mucous 
membrane of the uterus and vagina, from injury received during parturition, was 
more predisposed to disease than any other part of the system. However, 1 have 
not had an opportunity of conversing with physicians who have practised in this 
puerperal fever, and my experience in it has been too limited to draw conclu- 
sions; I merely make these remarks in case the diseases should again prevail 
together, as the erysipelas has not entirely subsided, that we may endeavour to 
find if this is the link that connects them. 

"In endeavouring to ascertain the cause of this epidemic, I thought at first it 
depended upon atmospheric changes, and that those situations which were most 
exposed to the cold bleak winds, were most frequently the seat of the disease. 
It appeared during the latter part of winter, and early part of spring, to be con- 
fined to the ridges and highlands, and those portions of the country that had 
generally escaped epidemics. But a more extensive acquaintance with this dis- 
ease, has convinced me that in spreading over the country, all situations were 
equally liable to its attack. Nor was there any thing in the physical features, 
or geological structure, of the country over which this epidemic passed, in Ripley 
and Dearborn counties, that would be more calculated to produce disease, than 
in any other portion of the country. Those who believe in cometary influences 
would readily find a solution for this difficulty; and the remarkable coincidence 
must have been noticed by all who have read Webster's History of Diseases, or 
Foster on the atmospheric causes of epidemic diseases, in the occurrence of 
phenomena this year, which these authors state as generally accompanying the 
appearance of comets, viz: earthquakes, meteors, cold winter, epidemics, the 
influenza, etc. These phenomena have certainly occurred during the past year 
in a manner making it a remarkable coincidence with their statements. 

" Mental anxiety frequently appeared to be a predisposing cause to the disease; 
several persons I noticed who were grieving for the loss of friends were sud- 
denly attacked with this erysipelas, and I find that Wilson, in his late work on 
Diseases of the Skin, has considered debilitating mental emotions one of the 
predisposing causes of erysipelas. This leads to an inquiry worthy of a passing 
notice, — how far certain questions that have been agitating the public mind, 
and particularly so in this neighbourhood, for some time past, may have acted 
as a predisposing cause to the disease'? 1 allude to the discussion of the Miller 
doctrines. Their positive and dogmatical assertions that the end of time was at 
hand, and the circulation of their pamphlets into ahppst every family, which m 

* Wilson on Diseases of tbe Skin, 



252 American Intelligence. [Jan. 

connection with the occurrence of the earthquakes, the appearance of the comet, 
the brilliant meteor of the 20th of March, about which such a ridiculous story 
was published in many of our papers. The unusually protracted winter, and 
the prevalence of epidemics remarkably fatal in their character, known by the 
formidable name of the black tongue^ must undoubtedly have produced a power- 
ful effect on the minds of the credulous, and may possibly, in many cases, have 
predisposed to disease. 

" It was difficult to decide by its mode of spreading, whether this epidemic was 
really contacrious, for I have seen this summer every member of a family, eight 
in number, attacked in succession with bilious remitting fever. This last dis- 
ease, however, was endemic, the family was residing in a highly malarious 
district. But the erysipelas prevailed upon the high as well as the low lands, 
and at the lime that I was taking these notes, was principally in this neighbour- 
hood, confined to the Buffington family, or those who were in constant attendance 
on them. In Mr. Huffman's family, as I before mentioned, there were eight 
persons; seven were attacked, the youngest escaping. In John Winscott's family 
there were five, and all were attacked. In John Buffington's, Sen., there were 
four in family, and all were attacked. In Mr. Wilman's, a son-in-law, there 
were eight, and all had an attack of the disease. In Wm. Buffington's family 
there were eight, and six were attacked, the two youngest escaping. In Mr. F. 
Buffington's there were three, and two were attacked, the infant escaping. 
Young children, as I have before mentioned, almost universally escaped the 
disease. Although most of the above cases had not the erysipelas, yet they had 
all the symptoms the disease generally commenced with. 1 was attacked seve- 
ral times with the premonitory symptoms, such as swelling of the glands of the 
throat and neck, and a peculiar stinging sensation in the thyroid cartilage. The 
disease was kept back by frequently applying the volatile liniment, inhaling the 
vapour of warm vinegar, using acidulated gargles, and living on a vegetable 
d'leW-^TVe&tern Lai-icet, Nov. 1843. 

Singular effects of Ipecacuanha. — The following very curious case of ill effects 
produced by Ipecacuanha was reported to the Medical Society of Tennessee by 
the sufferer, Dr. Felix Robertson of iVashville, and is published in the Western 
Journ. of Med. §r Surg, for Aug. last. 

"The summer and^fall of 1823 and '24 were extremely sickly, fevers of a 
high grade prevailed throughout this region of country. The necessary labour 
and exposure in attending to an extensive country practice had nearly worn me 
down, had greatly reduced my strength. About the last of October, while put- 
ting up a dose of powdered ipecacuanha, I was suddenly seized with a violent 
attack of asthma, attended with the most distressing dyspnoea and oppression at 
the precordia. Bleeding and active cathartics relieved the attack in five or six 
days. This kind of attack was repeated several times before I was confident 
they were brought on by breathing the dust of ipecacuanha. This however was 
at last reduced to a certainty, but not before my weakened health, &c., laid me 
liable to attacks from other exciting causes. 

" In November 1825 I left on business for Texas, but hoping the change of cli- 
mate might have a good effect on my greatly enfeebled health. 1 of course was 
exposed in such a trip to many causes that might have been expected to bring 
on attacks of the asthma, siich as sleeping in the open air, &c &c. I was ab- 
sent on that trip six months, and returned to Tennessee in apparently belter 
health than I had enjoyed for several years past, not having had the slightest 
attack of the disease during my absence. A few weeks after resuming the busi- 
ness of my profession, I felt unwell, with deranged state of the stomach, and 
thought it advisable lo take an emetic — wishing to take a mild safe article I con- 
cluded to take wine of ipecac, and never dreamed of any unusual bad effect it 
could have on me. From the moment I swallowed it I felt in the throat and 
stomach a sensation totally indescribable, but as intolerable to be borne, (if life 
could have been sustained under it,) as if I had taken a drink of melted lead. 
It was so overpowering that I was unable to think of any method of relief, but 



1844.] A^nerican Intelligence. 253 

in the most distracting- agony leaped out of bed and rolled over the floor from 
side to side of the room. At length 1 was urg-ed to drink copiously of warm 
water, which produced some vomiting- and some mitigation of my intense suffer- 
ing. The distress slowly subsided and settled into one of my worst attacks of 
asthma. I was again subject to these attacks from the smallest particle of ipe- 
cac, breathed, or the fumes of burning sulphur; and the exciting causes seemed 
to multiply with every return of the disease, and my health became so feeble 
that I was seldom able to attend to the calls of my profession, and was compelled 
entirely to give up my country business. T at length determined to try the effect 
of reducing the thickness of my clothes, to sleep on a hard mattress under as 
light covering as possible, and avoid if possible getting into a profuse perspira- 
tion, which always appeared to invite an attack. At the same time I determined 
to use snuff for the purpose of lessening the sensibility of the nas^il membrane, 
as my attacks seemed to commence generally with a feeling of irritation of that 
membrane, which rapidly extended itself to the bronchia and all its ramifications. 
My attacks from this period became lighter, of shorter duration and with in- 
creased intervening intervals, and in the course of a year I got entirely clear of 
them, except occasionally some dysprioea from accidentally coming in contact 
with ipecac, from stepping into an apothecary's shop shortly after the article had 
been handled. 

" For some seven years. past T have not had a severe attack, and my general 
health has greatly improved. About three years since I was induced to put my 
tongue to some liquid in a vial that was believed to be wine of ipecac, a patient 
wishing to take it if 1 knew it to be that article. I had of course not forgotten 
the terrible effects of the emetic I had once taken, but believed I could taste it 
without any injury arising from it. In an instant that peculiar, burning, inde- 
scribable sensation was felt in the mouth, which rapidly extended itself to the 
fauces and down the throat and bronchia, and for two hours I suffered greatly, 
and had considerable dyspnoea, all of which gradually disappeared; and while I 
retain my understanding no such intimacy will ever be repeated with the fated 
article. What makes the case more remarkable is that ipecac, had always been 
with me a favourite article of medicine, and no one handled it freer or with less 
reserve up to the very day it committed such an unprovoked and desperate attack 
on me. v 

" I observed in some of my attacks a very curious sequela. When expectora- 
tion became free, and mucus was formed in great quantities by the mucous 
membrane of the bronchia, in the morning, after resting through the night from 
the cough, expectoration would commence freely on stirring about a little, and 
mouthfuls would be thrown up, which any person at first sight would have pro- 
nounced to be a mass of small, nearly transparent worms — on close examination 
1 discovered it was thickened mucus which had collected in the small ramifica- 
tions of the bronchial tu!)es during sleep, and was actually discharged so as to 
be real easts of those tubes. This would sometimes be thrown up in such quan- 
tities, in the morning-, that it really surprised me that sufficient air could have 
been passed through the lungs for the purposes of life while sleeping." 

Intermittent Fever from birth. — Dr. B. W. Avent, of Murfreesborough, T., re- 
ported to the Medical Society of Tennessee a very curious example of inter- 
mittent fever commencing on the very day of an infant's birth. The mother of 
the child, residing in a malarial region, was attacked with tertian intermittent in 
her fifth month of pregnancy. The disease assumed a chronic form, every 
change of weather, or deviation from a strict regimen producing a recurrence of 
the attacks. On the morning of the 21st September, she had a paroxysm, as 
had been the case on every alternate day for the preceding two weeks; and as 
this went off uterine pains came on, and she was delivered the next morning at 
nine o'clock. The child was of common size, and cried lustily. On visiting 
the patient in the evening (September 22), he learned that the child had been 
suffering very much (in the language of the nurses and. friends) from cold — that 
its extremities had become cold and shrivelled, its lips blue, and its breathing 
No. XUl.— January, 1844. 17 ;^ i 



254 American Intelligence, [Jan. 

disturbed; so alarming indeed were the symptoms, that they believed the little 
sufferer to be dying. This cold stage, though, had now given way to a general 
and pretty free reaction throughout the system. 

The child continued well until the evening of the second day after (Sept. 24). 
This evening at the same hour that the alarming symptoms appeared on the 
first day of its birth, it was again attacked, in the same wd^y— yawned, stretched^ 
grew cold, lips became blue, and breathing again interrupted — these symptoms 
lasted an hour, and gradually subsided, and Dr. A. has no doubt, from the report 
of the family, were followed by fever. 

On the evening of the 26th September, there was a recurrence of the cold 
stage, at the same hour of the previous days, and all the leading symptoms of 
confirmed intermittent were present. Fever followed, and lasted some two 
hours or morq, and was carried off by profuse perspiration, so much so, that 
Dr. A. was alarmed for the safety of his little patient. 

Dr. A. became now satisfied that the child was affected with intermittent 
fever, and treated it for ihat disease. One grain of calomel was given, and 
afterwards quinine; and on the 28th the child escaped the paroxysm. Five days 
afterwards (October 1) there was a recurrence of the disease; and again about 
the 1st of November. For twenty months the disease continued to attack the 
patient, and up to the present time, a period of more than three years, this child 
is still weakly, pale and small — though at present he is in better health than he 
has ever been, and has not had a chill for about four months. Hopes of his 
entire recovery are now entertained. — West. J. Med. ^ Surg., Aug., 1843. 

Complete extirpation of the Uterus by ligature, after chronic inversion of the 
organ. — The following case was reported to the Medical Society of Tennessee, 
by Dr. John M. Esselman, of Nashville. 

A lady, 32 years of age, married 14 years, had been in bad health ever since 
the birth of her first and only child, 12 years previously to Dr. E. being con- 
sulted. She had been attended in her confinement by an old woman; her labour 
was a protracted and painful one; she had flooded profusely; and was very ill 
for several weeks after her confinement. After she was able to leave her bed 
and walk about the house, she was much annoyed by ''bearing-down pains,'' as 
she called them, in the region of the womb, extending up in the direction of the 
lateral ligaments of that organ. She had also suffered much from pain and 
weakness of the back, and also from pain and a numb sensation down the inner 
portion of the thighs, and had been a prey to fluor albus ever since she had left 
her bed of confinement, with the exception of her catamenial periods, which are 
very irregular. The secretion was often very profuse, indeed alarmingly so; 
that she would be confined to her bed for weeks at a time, had to consult physi- 
cians, take medicine to check the hemorrhage, &c.: then she would be put on 
the use of tonics, to strengthen her system, as well as to correct the fluor albus. 
At length she was advised by her physicians that she was labouring under pro- 
lapsus of the womb, and underwent the routine of treatment in such cases; but 
all to no effect, except the relief she invariably obtained from the horizontal 
position. 

Disheartened by the little relief she received, she went to Nashville, where 
she consulted a distinguished practitioner, who diagnosticated a polypus, and 
he applied a ligature, which was productive of such alarming symptoms that 
he removed it. Various other medical men were consulted, but without relief 
being afforded. 

When Dr. E. was consulted, he found her in a deplorable situation; she 
was labouring under hectic fever, had profuse night sweats, hacking cough, 
and all the symptoms indicative of a rapid decline; on examination, he found a 
tumour occupying the vagina, about the size of a large pear, and answering in 
every respect the description usually given of a polypus. The vagina itself 
was very irritable and much ulcerated, so that it was impossible to make a very 
minute or satisfactory examination. However, from the history of the case, and 
the opinion of other medical men who had examined it previous to himself, in 



1844.] American Intelligence, 255 

some of whom he had the utmost confidence, he concurred with them in the 
opinion that it was a polypus. But being at that time a young practitioner, 
having been but two years in the profession, he requested that some other phy- 
sician should be called in to assist him in the operation. An intelligent prac- 
titioner was accordingly called in, who took the same view of the case; and 
after a few days of preparatory treatment, a ligature of sadler's silk, well 
twisted and waxed, was applied; a full dose of camphor, laudanum, and harts- 
horn having been administered two hours previously. The tightening of the 
ligature gave great pain, and the dose of camphor, laudanum, and hartshorn 
was repeated. For the first four or five hours she was very much prostrated, 
and her pulse sunk to a mere thread; she, however, then became composed, re- 
action took place, and she rested tolerably well the first night. The ligature 
was tightened every morning for 18 days, at which time it came away, and to 
the surprise of her physician, instead of a polypus, the tumour proved to be the 
uterus itself, which was much reduced in size by ulceration and strangulation. 
The vagina was much ulcerated and emitted a very offensive sanious discharge, 
for which frequent injections of a solution of chloride of lime was ordered, and 
a solution of nitrate of silver was applied to the ulcers. The general system 
was sustained by tonics, such as the rauriated tincture of iron, phosphate of 
iron, quinine, &c., and a generous diet when the absence of febrile excitement 
would admit of it. She was a long while recovering, and did not leave her bed 
for months after the operation, but finally was restored to perfect health. For 
the first 12 months after her recovery she required frequent bleeding and purga- 
tives to relieve headache and a tendency to vertigo, as well as a general ple- 
thora of the system, occasioned, Dr. E. thinks, by the "premature suspension 
of the catamenial secretion. — West. J. Med. ^ Surg., Aug., 1843. 

Complicated Menstruation — Under this title the following very curious and 
anomalous case is recorded by Dr. W. Detmold, in the New York Journal of 
Medicine, for July, 1843. 

*' Miss R., of this city, of dark hair and complexion, had, with the exception 
of the ordinary diseases of childhood, always enjoyed good health, and she was 
apparently of a robust constitution. When fourteen years of age, her menses 
first appeared, without any disturbance in her general health; and after that time 
she regularly menstruated for about one year. On the 17th of April, 1842, 
during one of the menstrual periods, she had, at the same time, (according to 
her own and her family's statement,) a bilious attack, with a severe sore throat. 
She had leeches applied to the throat, and was bled in the arm. Her menstru- 
ation stopped during the night succeeding the venesection, and the following 
morning, the patient had lost the use of her left leg, which became very painful, 
and began to swell from the hip down to the toes. Simultaneously with the 
swelling of the leg, a singular symptom appeared. The whole surface of the 
body became covered with black hair, so that the arms, legs, and chest of the 
young lady looked more like those of a hairy man of forty, while the upper lip 
and cheeks were covered with a delicate dark down, as we see sometimes in 
young men approaching the period of puberty. 

"I saw the patient about three months after the commencement of the disease 
which then had just passed its acme, and found her in the following condition. 
Her whole body was very much emaciated, and her countenance bore an expres- 
sion of suffering, which was increased to the highest degree by the mere ap- 
proach of any person to the pillows on which her leg rested. On her upper lip 
and cheeks was the above mentioned down, and her chest, arms, and legs, were 
hairy as just described. The hair showed, however, much more on the sound 
leg than on the diseased one, for as the sound leg was emaciated almost to bone 
and skin, the hair on it appeared much more dense than on the other leg, the 
skin of which was in the highest degree of tension from the enormous. swelling. 
The circumference around the knee was twenty-two inches, and the thigh and leg 
were swollen in proportion. The skin was neither changed in temperature nor 
colour; the swelling was neither phlegmonous nor oedematous; to the touch it 



256 American Intelligence, 

was solid, and felt like a plastic deposit; it resembled hypertrophia, and the 
whole limb presented somewhat ihe appearance of phleg-masia alba. Outside 
and above the knee was a superficial and limited fluctuation, which, on being 
opened, discharged for several days a moderate quantity of healthy-looking pas; 
and a similar fluctuation appeared a few weeks after directly over the patella* 
Both these abscesses were, however, in no proportion whatsoever to the size of the 
leg, and they seemed altogether secondary, that is, not connected with the causa 
proxima of the disease, but rather consecutive upon ihe enormous swelling. The 
patient suff'ered intense pain from the slightest attempt at moving the limb, over 
which she herself had no control at all. She had two large ulcers from decu- 
bitus over l^e os sacrum, and the pulse was al)out one hundred and eight in a 
minute, having been a few days previously as high as one hundred and twenty. 
Her appetite was good, and altogether the disease, as already stated, seemed to 
have passed its acme; for the patient began gradually to improve, the pulse 
became daily less frequent, the swelling of the leg diminished by slow degrees, 
the limb became daily less painful, the ulcers on the back healed up, and about 
four months and a half after she was first taken ill, she began to move about upon 
crutches. The unnatural growth of hair upon her body and limbs gradually disap- 
peared, and about six months from the commencement of the disease, the menses 
made their reappearance. From that time she continued to improve steadily, 
and she is now, in June, 1843, a fine hearty-looking woman, with no remains of 
her extraordinary illness, except a false anchylosis of the knee-joint, evidently 
caused by plastic deposit in the soft parts and ligamentous apparatus around the 
joint. Otherwise she has the full use of her limbs, with the exception that 
after much exercise she has a feeling of fatigue in that leg, and it becomes 
slightly cedematous. 

Cluh Foot Cured at an advanced JIge. — Dr. J. B. Brown, of Boston, has com- 
municated to us a case of club foot in a woman 73 years of age successfully 
treated. 

Ligature cf the External Iliac for JJneurism. — We learn that this operation has 
been successfully performed by Dr. Wm. M. Boling, of Montgomery, Alabama. 

Stewart's Practical Treatise on the Diseases of Children. We are happy to 
announce the publication by Messrs. Langley's, of New York, of a new edition 



FIG. 211. 



FIG. 213. 






MUSCLES OF THE THIGH AND LEG. 



FIG. 211. 
A View of the Muscles on the 
Front of the Thigh. 



1. 


Crest of the Ilium. 




2. 


Its Anterior Superior 
Process. 


Spinous 


3. 


Gluteus Medius. 




4. 


Tensor Vaginae Femoris. 


5. 


Sartorius. 




6. 


Rectus Femoris. 




7. 


Vastus Externus. 




8. 


Vastus Internus. 




9. 


Patella. 




10. 


Iliacus Internus. 




11. 


Psoas Magnus. 




12 


Pectineus. 




13 


Adductor Longus. 




14 


Adductor Mag-nus. 




15 


Gracilis. 





FIG. 212. 

A View of the Muscles on 
THE Back of the Thigh. 

1. Gluteus Medius. 

2. Gluteus Magnus. 

3. Fascia Lata covering the 
Vastus Externus. 

4. Long Head of the Biceps. 

5. Short Head of the Biceps. 

6. Semi-Tendinosus. 
7.7. Semi-Membranosus. 

8. Gracilis. 

9. Edge of the Adductor Mag- 
nus. 

10. Edge of the Sartorius. 

11. Popliteal Space. 

12. Gastrocnemius. 

Page 86. 



FIG. 213. 

A View of the Muscles on the 
Front of the Leg. 

1. Tendon of the Quadriceps 
Femoris. 

2. Spine of the Tibia. 

3. Tibialis Anticus. 

4. Extensor Communis Digi- 
torum. 

5. Extensor Proprius Pollicis. 

6. Peroneus Tertius. 

7. Peroneus Longus. 

8. Peroneus Brevis. 
9.9. Borders of the Soleus. 

10. Portion of the Gastrocne- 
mius. 

11. Extensor Brevis Digitorum. 



^FIE€]imE.P^. 




S'yjirLty/s L.-'/r 



THE 



AMERICAN JOURNAL 



MEDICAL SCIENCES. 



No. XIV.— April, 1844. 18 



COLLABORATORS. 



Elisha Bartlett, M. D. Professor of 
the Institutes and Practice of Medicine 
in Transylvania University. 

T. RoMEYN Beck, M. D. Professor of 
Materia Medica in the Albany Medi- 
cal College. 

John B. Beck, M.D. Prof, of Mat. 
Med. in the Coll. of Phys. ^ Surg. 
N. York. 

Jacob Bigelow, M. D. Professor of Ma- 
teria Medica in Harvard University, 
Boston. 

A. Brigham, M. D. Superintendent and 
Physician to the New York State In- 
sane Hospital at Utica. 

Jos. Carson, M. D. Professor of Materia 
Medica in the Philadelphia College of 
Pharmacy. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

B. H. CoATES, M. D. of Philadelphia. 

D. Francis Condie, M.D. of Philadel- 
phia. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Meddcal College of the State of 
South Carolina. 

Gouverneur Emerson, M. D. of Phi- 
ladelphia. 

Charles Evans, M.D. Attending Phy- 
sician to the Friends'' Asylum, Frank- 
ford. 

Paul F. Eve, M. D. Professor of Sur- 
gery in the Medical College of Geor- 
gia. 

John D. Fisher, M. D. of Boston. 

E. Geddings, M. D. Professor of Sur- 
gery in the Medical College of the State 
of South Carolina. 

W. W. Gerhard, M. D. one of the 
Physicians to the Philadelphia Hospi- 
tal, Blockley. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

R. E. Griffith, M. D. late Professor of 
Medicine in the University of Virgi- 
nia. 

Thomas Harris, M. D. Surgeon U. S. 
Navy. 

E. Hale, M. D. Physician to the Mas- 
sachusetts General Hospital. 



Hugh L. Hodge, M. D. Prof, of Mid- 
wifery in the University of Penn. 

George H ayward, M.D. Professor of the 
Principles of Surgery and Clinical Sur- 
gery in Harvard University, Boston. 

Charles R, King, M. D. cf Philad^a. 

T. S. KiRKBRiDE, M. D. Physician to the 
Pennsylvania Hospital for the Insane. 

Samuel Jackson, M. D.Professorofthe 
Institutes of 31edicine in the University 
of Pennsylvania. 

Samuel Jackson, M. D. Philadelphia. 

William E. Horner, M. D. Professor 
of Anatomy in the University of Penn- 
sylvania. 

Valentine Mott, M. D. Professor of 
Surgery in the University of New York. 

James McNaughton, M. D. Professor 
of the Theory and Practice of Medicine 
in Albany Medical College. 

Reuben D. Mussey, M. D. Professor of 
Surgery in the Medical College of Ohio. 

T. D. Mutter, M. D. Professor of Sur- 
gery in Jefferson Medical College. 

G. W. Norris, M. D. one of the Sur- 
geons to the Pennsylvania Hospital. 

C. W. Pennock, M. D. one of the Phy- 
sicians to the Philadelphia Hospital, 
Blockley. 

Wm. Pepper, M. D. one of the Physi- 
cians of the Pennsylvania Hospital. 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

Nathan R. Smith, M. D. Professor of 
Surgery in the University of Md. 

Thomas Stewardson, M. D. one of the 
Physicians to the Pennsylvania Hos- 
pital. 

Alfred Stille, M. D. of Philadelphia, 

John A. Swett, M. D. of New York. 

A. F. Vache, M. D. of New York. 

John Ware, M. D. Professor of the 
Theory and Practice of Physic in 
Harvard University, Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

Edward Warren, M. D. of Boston. 

John Watson, M. D. one of the Sur- 
geons of the New York Hospital. 

G. B. Wood, M. D. Professor of Ma- 
teria Medica and Pharmacy in the Uni- 
versity of Pennsylvania. 



EDITOR — Isaac Hays, M. D., one of the Surgeons to Wills Hospital for the 
Blind and Lame, ^c. 



TO ^EJIDERS JiND CORRESPONDENTS, 



The following works have been received : — 

Lectures on the more important Diseases of the Thoracic and Abdominal 
Viscera. Delivered in the University of Pennsylvania. By N. Chapman, M.D., 
Professor of the Theory and Practice of Medicine, &c. &c. Philadelphia, 1844. 
(From the author.) 

The Contagiousness of Puerperal Fever. Read before the Boston Society for 
Medical Improvement, and published at the request of the Society. By Oliver 
W. Holmes, M. D. (From the author.) 

The Position and Prospects of the Medical Student. An address delivered 
before the Boylston Medical Society of Harvard University, Jan. 12, 1844. By 
Oliver W. Holmes, M. D. Published by request of the Society. Boston, 1844. 
(From the author.) 

Human Physiology, with upwards of three hundred illustrations. By Robley 
DuNGLisoN, M. D., Professor Institutes of Medicine, &c., in Jefferson Medical 
College, &c. &c. &c. Fifth edition, greatly modified and improved, 2 vols. 
Philadelphia: Lea & Blanchard, 1844. (From the publishers.) 

An Essay towards a correct Theory of the Nervous System. By John Har- 
rison, M. D., Professor Physiology in the Medical College of Louisiana. Phila- 
delphia: Lea & Blanchard, 1844. (From the publishers.) 

Report of the Surgeon General of the U. S. Army. Washington, 1843. 
(From the author.) 

The Anatomy and Surgical Treatment of Abdominal Hernia. With numerous 
plates. By Sir Astlev Cooper, Bart., F. R. S., Surgeon to the King, &c. &c. 
From the second London edition. By C. Aston Key, senior surgeon to Guy's 
Hospital. Philadelphia: Lea & Blanchard, 1844. (From the publishers.) 

An Elementary Treatise on Human Physiology, on the basis of the Precis 
Elementaire de Physiologie. Par F. Magendie, Membre de I'lnstitut de France. 
&c. Fifth edition, 1838. Translated, enlarged, and illustrated with diagrams 
and cuts, especially designed for the use of students of medicine. By John 
Revere, M. D., Professor of the Theory and Practice of Medicine in the 
University of the city of New York. New York: Harper & Brothers, 1844. 
(From the publishers.) 

Pharmacologia, being an extended inquiry into the operations of Medicinal 
bodies, upon which are founded the theory and art of prescribing. By J. A. 
Paris, M.D., Cantab., F. R. S. &c. &c. From the ninth London edition. Re- 
written in order to incorporate the latest discoveries in Physiology, Chemistry, 
and Materia Medica. With notes by C. A. Lee. M. D., A. M., &c. New York: 
Harper & Brothers, 1844. (From the publishers.) 

The Select Medical Library, Jan. 1844. (In exchange.) 

Statistical Report of one hundred and ninety cases of Insanity, admitted into 



260 TO READERS AND CORRESPONDENTS. 

the Retreat, near Leeds, during ten years, from 1830 to 1840. By Samuel Hare. 
London, 1843. (From the author.) 

Fifth Annual Report of the Ohio Lunatic Asylum. Columbus, 1843. (From 
Dr. Awl.) 

A Dictionary of Medical Science, containing a concise account of the various 
subjects and terms; with the French and other synonymes; notices of climate 
and of celebrated mineral waters; formulas for various officinal and empirical 
preparations, &c. By Robley Dunglison, M.D., Professor Institutes of Med., 
&c. in Jefferson Medical College, &c. &c. Fourth edition, extensively modified 
and enlarged. Philadelphia: Lea & Blanchard, 1844. (From the publishers.) 

Annual Report of the Managers of the State Lunatic Asylum. Made to the 
Legislature, Jan. 18, 1844. Albany, 1844. (From A. Brigham.) 

Annual Report of the Board of Trustees of the Massachusetts General 
Hospital for the year 1843. Boston, 1844. 

Address on Insanity, delivered before the New York State Medical Society, 
February 5th, 1844. By Samuel White, M.D., President of the Society, and 
senior proprietor of the Hudson Lunatic Asylum. Albany, 1844. (From the 
author.) 

A Lecture Introductory to the course of Anatomy and Surgery, delivered at 
the opening of the Rush Medical College, Dec. 4, 1843. By Daniel Brain- 
ARD, M. D., Chicago, 1843. (From the author.) 

Medical Ethics, a lecture delivered Dec. 23, 1843, before the Ohio Medical 
Lyceum. By John P. Harrison, M. D., Prof, of Mat. Med. in the Medical 
College of Ohio. Cincinnati, 1844. (From the author.) 

Catalogue of the Faculty and Students of Jefferson Medical College of Phila- 
delphia, for the Session 1843-44, with a list of graduates, March 10, 1843. 
Philadelphia, 1844. (From the Dean of the Faculty.) 

Drawings of the Anatomy of the Groin ; with anatomical remarks. By W. 
Darrach, M. D., Prof. Princ. and Pract. of Med. in Med. Depart, of Penna. 
College. Philadelphia: Lindsay & Blakiston, 1844. (From publishers.) 

Anatomical Atlas, illustrative of the structure of the human body. By Henry 
H. Smith, M. D., Fellow of the Coll. of Physicians, &c. &c. Under the 
supervision of Wm. E. Horner, M.D., Prof. Anat. in the University of Penn- 
sylvania. Philada.: Lea & Blanchard, 1844. Part II. 91 figures. (From the 
publishers.) 

Statement of the Deaths, with the Diseases and Ages in the city of Lowell, 
during the year 1843. (From Dr. John O. Green ) 

Valedictory Address delivered before the Graduates of the Medical Depart- 
ment of the Pennsylvania College. Session 1843-44. By Henry S. Patter- 
son, M. D., Prof. Mat. Med. and Pharm. Published by request of the class. 
Philadelphia, 1844. (From W. D. Darrach, M. D.) 

Report of the Pennsylvania Institution for the Insane, for the year 1843. By 
Thos. S. Kirkbride, M. D., Physician to the Institution. Philadelphia, 1844. 
(From the author.) 

Two lectures on the Natural History of the Caucasian and Negro Races. By 
JosiAH C. NoTT, M. D. Mobile, 1844. (From the author.) 

Report of the Medical Missionary Society, containing an abstract of its his- 
tory and prospects; and the Report of the Hospital at Macao, for 1841-2, 



I'd readers and correspondents. 2G1 

together with Dr. Parker's statement of his proceedings in England and the 
United States in behalf of the Society. Macao, 1843. (From Dr. Chaloner.) 

Catalogue of the Trustees, Officers, and Students of the University of Penn- 
sylvania, 1843—44. Philadelphia, 1844. (From the Faculty.) 

State of the New York Hospital and Bloomingdale Asylum for the year 1843. 
New York, 1844. (From Dr. Wilson.) 
The Edinburgh Medical and Surgical Journal, Jan. 1844. (In exchange.) 
The Medico-Chirurgical Review, and Journal of Practical Medicine, Jan. 
1844. (In exchange.) 

The British and Foreign Medical Review, or Quarterly Journal of Practical 
Medicine and Surgery, Jan. 1844. (In exchange.) 
The London Medical Gazette, Dec. 1843, Jan., Feb., 1844. (In exchange.) 
The London and Edinburgh Monthly Journal of Medical Science, Dec. 1843, 
Jan., Feb., 1844. (In exchange.) 

Braithwaite's Retrospect of Medicine and Surgery, Jan. 1843. (In ex- 
change.) 

Provincial Medical Journal, Dec. 1843, Jan., Feb., 1844. (In exchange.) 
The Medical Times, Dec. 1843, Jan., Feb., 1844. (In exchange.) 
The Dublin Medical Press, Dec. 1843, Jan. and Feb. 1844. (In exchange.) 
Boston Medical and Surgical Journal, Jan., Feb., and March, 1844. (In ex- 
change.) 

The New York Journal of Medicine, and the collateral Sciences, January and 
March, 1844. (In exchange.) 

The Western Journal of Medicine and Surgery, Dec. 1843, Jan. and Feb., 
1844. (In exchange.) 

The Bulletin of Medical Science, Jan., Feb., and March, 1844. (In ex- 
change.) 

The Medical Examiner and Record of Medical Science, Jan., Feb., March, 
1844. (In exchange.) 

The American Journal of Science and Arts, Jan., 1844. (In exchange.) 
The Western Lancet, Dec. 1843, Jan. and Feb., 1844. (In exchange ) 
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exchange.) 

Communications intended for publication, and Books for Review, should be 
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3:7* The advertisement sheet belongs to the business department of the 
Journal, and all communications for it should be made to the publishers, undey 
whose exclusive control it is. 





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CONTENTS 

OF THE. 

AMERICAN JOURNAL 

OF THE 

MEDICAL SCIENCES. 

No. XIV, NEW SERIES. 

APRIL, 1844. 



ORIGINAL COMMUNICATIONS. 
MEMOIRS AND CASES. 

ART. PAGE 

I. Observations on the Pathological Relations of the Medulla Spinalis. By 
Austin Flint, M. D., of Buffalo, N. Y. 269 

II. Case of Molluscum, associated with Fibro-Cellular Encysted Tumour 
and Encephaloid Disease. By Washington L. Atlee, M. D., of Lan- 
caster, Penn. [With a wood cut.] 296 

III. On the Pulse of the Insane. By Pliny Earle, M. D. - . -306 

IV. Statistics and Cases of Midwifery; compiled from the Records of the 
Philadelphia Hospital, Blockley. By Geo. N. Burwell, M. D., Resi- 
dent Physician. ----------- 317 

V. On the Congestive Fever of Mississippi, with Cases. By R. G. 
Wharton, M. D., of Grand Gulf, Miss. 339 

VI. Enteritis — with Cases, exemplifying the decidedly beneficial effects of 
Blood-letting, and the Sedative Treatment. By P. M. Kollock, M. D., 

of Savannah, Georgia. 348 

VII. Case of Inversion of the Uterus, in which Reposition was effected on 

the tenth day. By Joseph P. Gazzam, M. D., of Pittsburg, Pa. - - 357 

VIII. Ligature of the external Iliac Artery for Aneurism. By W. M. 
Boling, M. D., of Montgomery, Alabama. 359 

IX. Eupatorium Perfoliatum in Epidemic Influenza. By J. F. Peebles, 

M. D., Petersburg, Va. 362 

X. Case of Polypus of the Uterus expelled by the action of Ergot. By 
Thomas J. Garden, M. D., of Wylliesburg, Va. 368 

XI. On the Extraction of Retained Placenta in Abortion. By Henry 
Bond, M. D. - - - - - 369 

XII. Improved Catheter-Bougie. ByR. J. Dodd, M. D., Surgeon, U. S. N. 373 
[jPor additional Original communications^ see American Intelligence, p. 499.] 

REVIEWS. 

XIII. De Erysipelate Ambulanti Disquisitio, quam ad summos in Medicina 
Honores rite obtinendos publico eruditorum examini submittet C. E. 
Fenger, Lie. Med. et Chirurgus secundarius nosocomii Regii Frederi- 
cani. Havinae, 1842. 

A Dissertation on Erysipelas Ambulans. By C. E. Fenger, Licentiate of 
Medicine, and Assistant Surgeon to the Royal Frederick's Hospital of 
Copenhagen. Copenhagen, 1844 : 8vo. pp. 208. - - - . - 375 



264 CONTENTS. 

ART. PAGE 

XIV", Medical History of the Expedition to the Niger, during the years 
1841-2, comprisincr an account of the fever, which led to its abrupt ter- 
mination. By James Ormiston McWilliam, M. D., Surgeon of H. M. S. 
Albert, and senior medical officer of the expedition ; with plates. Lon- 
don, 1843 : pp. 287, Bvo. 

Some Account of the African Remittent Fever, which occurred on board 
her majesty's steamship Wilberforce, in the river Niger, and whilst 
engaged on service on the western coast of Africa; comprising an In- 
quiry into the Causes of Disease in tropical climates. By Morris Prit- 
chett, M. D., F. R. G. S., M. R. C. P., London ; F. R. M. C, Society, 
late Surgeon of H. M. Ship Wilberforce, &c. London, 1843: pp.216,8vo. 387 

BIBLIOGRAPHICAL NOTICES. 

XV. An Essay towards a correct Theory of the Nervous System. By 
John Harrison, M. D., Professor of Physiology and Pathology in the 
Medical College of Louisiana. Philadelphia: Lea & Blanchard, 1844 : 
8vo. pp. 292. - 395 

XVI. Annual Report of the Resident Physician of the Eastern State Peni- 
tentiary for 1843. Presented to the Board of Inspectors Feb. 1844. By 
Edward Hartshorne, M. D. Philadelphia, 1844. 405 

XVII. 1. Report of the Pennsylvania Hospital for the Insane for the year 
1843. By Thomas S. Kirkbride, M. D., Physician to the Institution: 
pp. 36. 

2. Fifth Annual Report of the Directors and Superintendent of the Ohio 
Lunatic Asylum, Dec. 13th, 1843: pp. 77. 

3. Annual Report of the Managers of the State Lunatic Asylum, (New 
York), Jan. 18th, 1844 : pp. 7G. 

4. Fourth Annual Report of the Superintendent of the Maine Hospital, 
Nov. 30th, 1843. --.------- 412 

XVIII. Pharmacologia, being an extended inquiry into the operations of 
Medicinal bodies, upon which are founded the theory and art of Prescribing. 
By J. A. Paris, M. D., Cant. F. R. S. &c., from the ninth London edition, 
rewritten in order to incorporate the latest discoveries in Physiology, 
Chemistry, and Materia Medica. With notes, by Charles A. Lee, M. 
D., A. M., late Professor (elect) of Materia Medica and Medical Juris- 
prudence in the University of the city of New York, &c. 8vo. pp. 353. 
Harper &; Brothers, New York, 1844. 420 

XIX. Statistical Report of one hundred and ninety cases of Insanity admit- 
ted into, the Retreat near Leeds, during ten years, from 1830 to 1840. 
By Samuel Hare. Extracted from the Provincial Medical and Surgical 
Journal of June 10th, 17th, and 24th, 1843. 421 

XX. Address on Insanity, delivered before the New York State Medical 
Society, February 5th, 1844. By Samuel White, M. D., President of 

the Society, and senior Proprietor of the Hudson Lunatic Asylum, pp. 20. 423 

XXI. Report of the Surgeon General U. S. Army, pp. 10. 8vo. Washing- 
ton, 1843. - - - 424 

XXII. Human Physiology, with upwards of three hundred illustrations. 
By Robley Dunglison, M. D., etc. etc. Fifth edition, greatly modified 
and improved. 2 vols. 8vo. pp. 648 — 656. Philadelphia: Lea & Blan- 
chard, 1844. 425 

XXIII. A Dictionary of Medical Science, containing a concise account of 
the various subjects and terms: with the French and other Synonymes; 
notices of climate, and of celebrated mineral waters ; formulae for various 
officinal preparations, &c. By Robley Dunglison, M. D., Prof. Mat. 
Med. &c., in Jeff. Med. Coll., Lect. on Clin. Med., and Attending Phys. 
at Phil. Hosp., Sect. Am. P. S., &c. &c. Fourth edition, extensively 
modified and enlarged. Philada., Lea & Blanchard, 1844: pp. 771, 8vo. 427 



>• ^ 



CONTENTS. 265 

ART. PAGE 

XXIV. Observations on some of the more important Diseases of Child- 
hood. By Charles West, M. D., member of the Royal Collegre of Phy- 
sicians ; Physician to the Royal Infirmary for Children ; and Physician- 
accoucheur to the Finsbury Dispensary. (From the London Medical 
Gazette:) pp. 19. 8vo. 427 

XXV. An Elementary Treatise on Human Physiology, on the Basis of the 
Precis Elementaire de Physiologie. Par F. Magendie, &c. 5th edition, 
1838. Translated, enlarged, and illustrated with diagrams and cuts, 
especially designed for the use of Students of Medicine. By John 
Revere, M. D., Professor of the Theory and Practice of Medicine in the 
University of the city of New York. 8vo. pp. 539 : New York, 1844. 429 

XXVI. On Spasm, Languor, Palsy, and other disorders termed Nervous, 
of the Muscular System. By .lames Arthur Wilson, M. D., Fellow of 
the College of Physicians, and Physician to St. George's Hospital. 
London: John W. Parker, West Strand, 1843: pp. 203, 12mo. - - 430 

XXVII. Clinical and Pathological Report on the Pneumonia of Children, 
as it prevails among the Poor in London. By Charles West, M. D., 
Member of the Royal College of Physicians ; and Physician to the 
Royal Infirmary for Children, &c. London, 1843 : pp. 32, 8vo. - - 431 

XXVIII. The Anatomy and Surgical Treatment of Abdominal Hernia. 
With numerous plates. By Sir Astley Cooper, Bart, F. R. S. &c. From 
the second London edition. By C. Aston Key, Senior Surgeon of Guy's 
Hospital. Philada.: Lea & Blanchard, 1844: 8vo. pp. 427. - -431 

XXIX. Practical Remarks on Rheumatic Gout, Fever, and Chronic Rheu- 
matism of the Joints ; being the substance of the Croonian Lectures for 
the present year, delivered at the College of Physicians, by Robert 
Bentley Todd, M. D., F. R. S., Fellow of the College of Physicians, 
Physician to the King's College Hospital, and Professor of Physiology 
in King's College, London. London: John W. Parker, West Strand, 
1843: pp. 216, 12mo. - - - 432 

XXX. Anatomical Atlas, illustrative of the structure of the Human Body. 
By Henry H. Smith, M. D., Fellow of the Coll. of Physicians, &c. &c. 
&c. Under the supervision of W^m. E. Horner, M. D., Prof. Anat. in 
the University of Pennsylvania. Philada.: Lea & Blanchard, 1844. 
Part II. 91 Figures. - * 433 

XXXI. Quarterly Summary of the Transactions of the College of Physi- 
cians of Philadelphia. May to December, 1843, inclusive, and January 
and February, 1844: pp. 52, 8vo. 433 

XXXII. Lectures on the more important Diseases of the Thoracic and 
Abdominal Viscera. Delivered in the University of Pennsylvania. By 
N. Chapman, M. D., Professor of the Theory and Practice of Medicine, 
&c. &c. Philadelphia, Lea & Blanchard, 1844; pp. 383, Bvo, - - 434 



266 



CONTENTS. 



SUMMARY 



IMPROVEMENT« AND DISCOVERIES IN THE 
MEDICAL SCIENCES. 



FOREIGN INTELLIGENCE. 

Anatomy aND Physiology. 



PAGE 

1. Period at which the foramen 
ovale, the ductus arteriosus and 
ductus venosus become oblite- 
rated. By M. Elsaesser. - 435 

2. Absorption. By M. Lacau- 
chie. 435 

3. Blood in the brain. By Dr. 
Georjre Burrows. - - - 435 

4. Optic nerves. By Professor 
Erdl. 435 



PAGE 

5. Nervus vagus and nervus ac- 
cessorius. By Mr. Spence. - 436 

6. Escape of ova independent of 
fecundation, and the connection 

of menstruation. - _ . 436 

7. Age of puberty in girls. By 
Mr. Roberton. - - - 438 

8. Urachus pervious after birth. 

By Dr. T. H. Starr. - - 439 



Materia Medica and Pharmacy. 



9. Species of Veratrum. By M. 
Galleoti. - - - - 440 

10. Species of Similax. By MM. 
Martens and Galleoti. - - 440 

11. Formula for fluid extract of 



Senna. ----- 440 

12. Gurjum Balsam. By Dr. 
O'Shaughnessy. - - - 441 

13. New preparation of Quinine. - 
By Dr. Kingdon. - - - 441 



Medical Pathology and Therapeutics, and Practical Medicine. 



14. Meningeal Apoplexy. By M. 
Prus. 441 

15. Communication between the 
aorta and pulmonary artery with- 
out Cyanosis. By Prof. Huss. 442 

16. Remarkable case of Cyanosis. 

By Prof. Huss. - - - 443 

17. On the connection of Insanity 
with diseases in the organs of 
physicallife. By Dr. J. C. Prit- 
chard. 443 

18. New treatment of Sciatica. 

By Dr. Rossi Fioravente. - 445 

19. Ulceration of the Appendix 
Vermiformis. By Dr. Volz. - 445 

20. Rupture of the Trachea. By 



Dr. Bredscheider. - - - 

21. Epistaxis. By M. Negrier. - 

22. Blood and urine in chlorotic 
subjects. By Herberger. 

23. On Tubercles and Phthisis. 
By James Black, M.D. 

24. Antagonism of typhoid and in- 
termittent Fevers. By M. Bou- 
din. - - - . 

25. Double intussusception. By 
Mr. Taylor. - 

26. Epidemic Remittent Fever 
v/hich prevailed in Glasgow in 
1843. By William Mackenzie, 
M.D. 450 



445 
445 

- 446 

446 



- 449 



- 449 



CONTENTS. 



267 



Surgical Pathology and Therapeutics and Operative Surgery. 



PAGE 

27. Abortive treatment of Gonor- 
rhoea, by the Nitrate of Silver, 
and on the employment of caus- 
tic injections at all stages of 
Urethritis. By M. Debeney. - 453 

28. Cancerous diatheses. By. M. 
Leroy d'Etiolles. - - - 454 

29. Dislocation of the Femur — 
head of that bone upon the 
pubes, — fracture of the neck of 
femur. By James Douglas, 
Esq. - - - - - 455 

30. Ovarian dropsy successfully 
treated with ioduret of Iron. By 

S. Tuton, Esq. - - - 456 

31. Amputation of the Leg- — Ves- 
sels so diseased as to preclude 
the use of ligatures — Recovery. 

By J. P. Mackesy. - - - 458 

32. Disarticulation of the ramus 
of the lower Jaw, without open- 
ing the cavity of the mouth. By 
James Syme, Esq. - - 459 

33. Penetrating wound of the 
Abdomen — Prolapse of the 
Stomach — Recovery. By M. 
Lepine. 460 

34. Ununited Fracture of the Hu- 
merus — Excision of the frac- 



PAGE 

tured extremities — Cure. By 
Sir John Fife. - - - 461 

35. Trismus following the extrac- 
tion of a tooth. By T. Purefoy, 
M.D. 461 

36. Extirpation of an Ovarian 
Cyst. By Bransby B. Cooper, 
Esq. - - - - - 463 

37. Tracheotomy in the last stage 

of Croup. By Dr. Scoutetten. 466 

38. Diagnosis of Aneurism of the 
Aorta. By Dr. O'Bryen. - 467 

39. Fibrous tumour mistaken for 
Aneurism. By M. Englehardt. 468 

40. Painful affection of the breast. 

By Dr. Rufz. - - - - 469 

41. Suture of the perineum per- 
formed immediately after deliv- 
ery. By M. Danyeau. - - 473 

43. Cure of encysted Tumours. 
By M. Berard. - - - 474 

43. Remarkable case of Calculus. 

By M. Segalas. - - - 475 

44. Dislocation of the os innomi- 
natum on the sacrum. By M. 
Lenoir. . _ _ _ 475 

45. Polypi of the rectum in young 
children. By Dr. Gigon. - 478 



Ophthalmology. 



46. Postfebrile Ophthalmitis. By 

Dr. Mackenzie. . - . 480 

47. Amaurosis from concussion 
of the retina. By Dr. La- 
vergne. ----- 484 

48. Foreign bodies in the Eye. 

By Dr. Ansiaux. - . - 484 

49. Foreign body in the Eye. By 

M. Guepin. - - - - 485 



50. Efforts of nature to form a 
pupil at that point of the eye 
whereit will be most useful. By 
Mr. J. B. Estlin. - - - 485 

51. Anatomical researches on the 
excretory ducts of the lachrymal 
gland. By M. Gosselin. - 485 

52. Cyst in the orbital cavity. 

By Dr. Dornbluth. - - 486 



Midwifery. 



53. Artificial rupture of the mem- 
branes to accelerate delivery. 

By M. Chailly Honore. - - 486 

54. Contagiousness of Puerperal 
Fever. By Dr. Elkington. - 487 

55. New method of compressing 
the aorta in uterine hemorrhao-e. 

By Dr. Guillon. - - ° - 488 

56. Extra-uterine Foetation. By 
Dr. John Wilson. - - - 488 



57. Perforation of the bladder by 
mistake during parturition. By 

Dr. E. Sherman. - - - 488 

58. Absence of the uterus. By 

Dr. Mondini. - - - 489 

59. Caesarean operation. By Dr. 
Kayser. - - - - - 489 

60. Kiestine. By Prof. Vannoni. 489 

61. Uterine Sound. By Prof. 
Simpson. - - - - 489 



268 



CONTENTS, 



Medical Jurisprudence and Toxicology. 



62. Perforation of the intestine by 
Arsenic. - . . . 492 

63. Action of Hydrocyanic Acid 
and the alkaline cyanurets on 
Calomel. By M. Mialhe. 

64. Professional confidence. 

65. Malconformation of the Fe- 
male Sexual Organs. By M. 
Villaume. - _ - - 

66. Sensibility and power of loco 
motion after severe injuries. 

67. Death from Calomel and Blue 
Pill. 496 



493 
494 



494 



- 495 



68. Pregnancy in a Female who 
had never menstruated. By M. 
Vandersavel. - - - - 496 

69. Orfila on Reinsch's process 

for detecting Arsenic. - - 496 

70. A new process for the abso- 
lute distinction and separation 
of Arsenic from Antimony. By 
W. Behrens. - ~ - - 497 

71. Cold affusion in poisoning by 
Prussic Acid. By M. Louyet. 498 

72. Death from large doses of 
Quinine. By M. Recamier. - 498 



AMERICAN INTELLIGENCE. 

Original Communications. 



499 



500 



Case of Extirpation of the Paro- 
tid Gland. By Dr. John Mc- 
Clellan, of Green Castle, Frank- 
lin County, Pa. - - - 

Cases of Ovarian Disease, with 
remarks. By Emery Bissell, 
M. D., of Norwalk, Conn. 

Lithotomy — Bilateral operation, 
with Cases. By Paul F. Eve, 
M. D., Prof, of Surgery in the 
Medical College of Georgia. - 504 

Remarks on the Vegetable Acids 
as correctives of acidity of sto- 
mach. By Stephen Tracy, M. D. 508 



Notice of a new Flexible Stetho- 
scope, invented by Dr. J. L. 
Ludlow. By C. W. Pennock, 
M. D. 509 

Improved Cupping Apparatus. By 
R. J. Dodd, M. D. Surgeon, 
U. S. N. - - - - 510 

Unusual case of irregularity of the 
incisors and canine teeth of the 
superior jaw, remedied in seven- 
ty-six days. By John M. Crow- 
ell, Dental Surgeon, Philadel- 
phia. - - - - - 511 



DOMESTIC SUMMARY. 



Ovarian Disease. By Wm. Judkins. - . - 
Vaginal Hysterotomy. By G. S. Bedford, M. D. - 



- 512 

- 512 



New Medical Works in preparation. 



512 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



APRIL, 1844 



Art. I.— Observations on the Pathological Relations of the Medulla 
Spinalis, By Austin Flint, M.D., of Buffalo, N. Y. 

In the prosecution of investigations which relate to principles of science 
not yet fully known or established, and involve personal observations, it is 
useful, and indeed necessary, to pause at certain stages of progress, and to 
review the ground which has been passed over, the method pursued and 
the results already attained. Such a retrospection, it may be expected, will 
enable us to determine whether the field of our inquiries promises to yield an 
adequate return for our labour, and to enjoy some of the early fruits, although 
the matured harvest is far distant. It will, also, probably lead us to correct 
some faults of system, and qualify us to recommence our efforts, not only 
with fresh enthusiasm, but with more enlightened and extensive views, and 
with better directed exertions. These general remarks are offered as pre- 
iatory to the few observations which will follow respecting an interesting and 
important department of medical inquiry, viz: the pathological relations of 
the spinal cord. This subject having engaged much of my attention for the 
past two years, and having recorded a considerable number of cases, I was 
desirous to render available, for my own satisfaction and improvement, the 
conclusions which would follow from a careful examination and comparison 
of the facts thus accumulated. I venture to submit for publication the results 
of this analysis, together with such remarks as will be suggested in preparing 
them for the public eye, because, in the first place, although none can be 
more sensible of their imperfections than myself, I really believe them to 
have some value ; but, in the next place, I am led to do so from my own ex- 
perience and observation, of the peculiar position in which an inquirer in this 
department of research is placed. 

As has been justly remarked by a late writer, medical literature contains 
No. XIV.— April, 1844. 19 



270 Flint on Pathological Relations of the Medulla Spinalis. [April 

very little respecting the pathology of the spinal cord. Hence, an observer 
and practitioner instead of simply verifying the truths which preceding in- 
quirers have recorded, is obliged to shape out principles from his own expe- 
rience and appeal to others for their confirmation. What has been written on 
this subject furnishes no criterion by which to estimate what is actually 
linown by medical men. There is reason to believe that a vast many phy- 
sicians in our country, regard the spinal cord as immeasurably more im- 
portant in its pathological relations than they are authorized to do by the 
standard text-books of medical practice, and daily act under the direction of 
principles which have resulted wholly from their own observations, or been 
obtained by means of colloquial communication, in addition to the few 
articles which have been contributed to our medical periodicals. 

I have, therefore, presumed to think that those who have devoted attention 
to similar investigations will be interested to compare the results of the in- 
quirers of a co-labourer, even if many have arrived in their researches at a 
point much in advance of the writer. This consideration has entered into 
nsy reasons for preparing this memoir, in addition to the hope that some 
service may be rendered at the same time to some of those who have 
hitherto despised, neglected, or overlooked the merits of the subject. 

It is a curious and significant coincidence, that while some practical phy- 
sicians have of late years been profoundly impressed more and more with the 
pathological importance of the spinal cord from their experience alone, dis- 
comiected from all theoretical views, the progress of physiology, on the other 
hand, carried on by men whom we have no reason to suppose have been 
actuated in the least by pathological deduction, has developed and is now 
developing more and more the extent and importance of the physiological 
connections of this portion of the organism. The enthusiasm which some 
practitioners have exhibited, has heretofore occasioned, and even now some- 
times leads to, professional odium. The manual examination of the spine 
has been very frequendy sneered at as an empirical demonstration, or at 
least an inane manoeuvre ; and perhaps a large proportion of the profession 
even nov/, if they do not ridicule, entirely forbear such examinations in iheir 
own practice. While a few declare tliat in more than two-thirds of the cases 
they are called upon to treat, the spinal cord is more or less involved; 
others make no account of it whatever as an element of diagnosis. The 
time has arrived, however, when it may be safely said that no intelligent 
physician who is conversant with the present condition of the science can 
fail to treat the subject with respect if not with attention, and henceforth 
without presumption, \ve may fairly consider expressions of contempt or 
entire neglect of this department of pathology as indicating ignorance of the 
labours of the most profound physiologists of the present day. The re- 
searches of Hall, Grainger, Miiller, Mayo, and others, which render pro- 
bable, if they do not demonstrate that the medulla spinalis is the fountain of 
innervation upon which all the vital processes are dependent, to which the 



1844.] YYmi on Pathological Relations of the Medulla Spinalis. 271 

(so called) sympathetic system is subordinate, and which is the centre of a 
reflex influence in every automatic and sympathetic movement, have invested 
this portion of the organism with an importance of so fundamental a character 
that pathologists cannot shut their eyes if they would, to its agency in dis- 
ease. For one, I cannot but believe that these new physiological develop- 
ments are destined to exert a radical influence upon the theory and practice 
of medicine — an influence, which can only be rivalled by the progress of 
organic chemistry. And had I any reputation for prescience in such mat- 
ters, I would be willing to risk it upon the fulfilment of this prediction. 

The number of cases which I have collected is fifty-eight. This does not 
embrace all the cases which have fallen under observation since the plan 
of keeping a record of them was commenced. I kept notes, in the first place, 
only of those which were in my view exceedingly well marked, passing by 
many in which I was sufficiently satisfied of the correctness of diagnosis, to 
make it the basis of treatment, but in which the evidences were not so clear 
that I was willing to include them in my collection. Many cases have also 
been left unrecorded, owing to difficulties which those who have undertaken 
to keep a journal of their cases in private practice cannot fail to appreciate. 
In reviewing the. cases recorded, /ot^r have been rejected from the analysis 
owing to some defect or uncertainly in the case or in the record. The re- 
maining fifty-four cases were carefully analysed by forming, in the first place 
a table of the classes of symptoms which were frequently found to exist in 
connection with the aff'ection under consideration, and indicating under each 
head the existence or non-existence of the symptoms, together with the 
modifications peculiar to each case. Afterwards, the facts thus collected in 
each cfass were compared and enumerated. I beg leave to remark, that I 
do not off'er the inferences drawn from this analysis as accurate statistical re- 
sults. As the plan of analysis was formed subsequent to tlie records of the 
cases, and not had in view, especially in those first collected, probably suf- 
ficient care was not in every instance taken to include all the details in the 
records, but only the more prominent points are preserved. The importance 
of preserving data for negative facts was not fully appreciated until the 
analysis was commenced, so that, as will be perceived, it is often not stated 
distinctly that certain symptoms were not present, although generally the 
inference is fair from an omission of any statement on the subject, that this 
was the case. But, imperfect as they are, I will not hesitate to say that in 
my estimation they are far more valuable than materials can ever be which 
are simply stored in the memory. And since it is not generally deemed im- 
proper to communicate the results of unrecorded experience, when I disclaim, 
as I do, all pretensions to precise quantitive facts possessing the " inflexibility 
of arithmetic," I have probably said enough to be acquitted of undue pre- 
sumption. Being satisfied, that for medical experience to possess much 
value it must be written, not recollected experience, the remarks which I 
shall oflfer will be almost exclusively based on the facts disclosed by the com- 



272 Flint on Pathological Relations of the Medulla Spinalis. [April 

parison of the cases recorded. No effort will be made to determine what ex- 
traordinary phenomena may be produced by a morbid condition of the spinal 
cord, but only to throw a little light on the relations which ordinarily exist. 
It has so happened that no cases of a very anomalous character are included 
among my collection, but they are all such as occur under the observation 
of every practitioner, although it is certain that they are not always ac- 
knowledged as cases in which the spinal cord is chiefly involved. 

The inquiry will now arise, if it has not before, what characters were 
deemed sufficient lo entitle cases to be embraced in this category ? I will 
answer this inquiry, first, in general terms, by saying that whenever there 
"Was to my mind unequivocal evidence that the disorder or disorders were 
induced by morbid influences derived from the medulla spinalis, whether the 
action of the remote or external causes were central or peripheral, they were 
recorded as cases of '^spinal affection^ A difficulty at the outset of these 
investigations arises from the deficiency of a proper title by which to dis- 
tinguish this class of affections. '•'Spinal irritation,''' the term commonly 
employed, is objectionable, because it involves the hypothesis that the 
proximate cause consists in irritation of the cord or its meninges. That this 
is the case may be highly probable, but it is not sufficiently established to 
warrant this application of the name as a distinguishing epithet. The term 
*' spinitis" is liable to the same objection. I have used the expression 
^^ spinal affection,"' which, at least, has the negative merit of being sufficiently 
comprehensive, and not presupposing any theoretical views. 

But another inquiry immediately follows the answer just given, viz. in 
what does the evidence that disorder or disorders are attributable to influences 
emanating from the spinal cord consist? This is an important inquiry which 
will be kept in view in the course of my remarks, and also considered briefly 
as a separate topic. I would observe here with reference to the cases which 
have been analysed, that the efficacy of the remedies and the issue have 
been in the majority of instances taken into account to substantiate the diag- 
nosis, in addition to the convictions derived from the evidence presented 
when under treatment. I am quite sure that from the very fact that the af- 
fection under consideration is, in the opinion of many, hardly entitled to any 
nosological existence, it must follow that it will be a matter of doubt with 
such persons whether the cases were properly diagnosticated. But to this 
there is no demonstrative rejoinder, and the writer can only invite those who 
dispute all the premises in the case to make the trial of applying to instances 
which will fall under their own observation, the same principles of diagnosis, 
and to pursue a method of practice in conformity with the pathology thus 
assumed for the sake of experiment. If those who insist that spinal affec- 
tion is a delusion or a humbug, will accept this appeal to the direct observa- 
tion of facts under their own inspection, it is all that need be asked, I do not 
say for the correctness of the observations submitted in the article, but in 
behalf of whatever merit and importance the subject possesses. 



1844.] Flint on Pathological Belations of the Medulla Spinalis. 273 

With these preliminary considerations, somewhat extended, but which 
could not be avoided, I proceed to remark seriatim upon the several topics 
with reference to which the history of the cases have been compared. 

1. Of tenderness over the vertebral column. — In one case nothing on this 
subject is recorded ; in two cases it is recorded indistinct; in three cases 
not discoverable. Of the remainder in which it was present, the tender- 
ness was distinguished as extreme in twenty-two. The location of the 
tenderness was over the dorsal vertebrae alone in tiventy-one cases; over the 
lumbar and dorsal in ten\ over the cervical and dorsal in three; location 
tiot specified in ^ve; over the entire column ^z;e. The cases also differed 
in respect to the extent of tenderness, in some it being confined to a single 
vertebra, in others embracing several, or extending over a whole division; 
but it is not deemed important to enumerate with respect to this point. It 
will be perceived by the above, that in much the larger number, the dorsal 
vertebras were either the seat of Increased sensibility, or were implicated, 
which accords with the observations of the Messieurs GrifRns. (See Med, 
Chir. Review^ No. for January, 1835.) 

With respect to the variations in the degree of tenderness, in those re- 
corded ea?/reme, very slight pressure was painful, and much force insupport- 
able. The cases, as regards this symptom, presented a marked difference. 
When not very acute, the effect of the examination is generally surprising 
to the patient, because it has never been suspected. The request to prepare 
for such an examination, is apt to excite a smile or expression of incredulity, 
or, perhaps, is opposed by a stout assertion that there is no fault in the back. 
On the other hand, such is the increased sensibility in other cases, that con- 
tact with every thing is avoided, and even the pressure of clothing is a source 
of inconvenience. Lying on the back is sometimes painful, from the same 
cause. It will be observed that patients under these circumstances, are 
indisposed to violent exertions, and their movements in walking, &c., indi- 
cate a carefulness to preserve the spine from the effects of concussion. 
They cannot long sustain the erect position without a support to the shoul- 
ders, from a painful weariness in the spine. Even when these indications 
are detected by the physician, it is often surprising how little the patient 
has observed them. This is, however, perhaps attributable to the fact, that 
before coming under the cognizance of some one who is in the habit of 
examining the spine, the patient's attention has never been directed to these 
symptoms, as possessing any degree of importance. In some instances, the 
effects of pressure over the tender portions will be felt in other parts of the 
body, than the spine. If neuralgic pains coexist, they may be aggravated 
or a paroxysm excited. Nausea, oppression of breathing, cough, faintness, 
sense of sinking, &lq>. may also be excited. I have been informed of cases 
in which instantaneous insensibility was in this way produced, but none 
have ever fallen under my observation. Patients will frequently exclaim 
that painful sensations shoot through the chest, abdomen, or even over the 



274 Flint on Pathological delations of the Medulla Spinalis. [April 

whole body; I have observed, also, a general subduing effect, which I can 
only compare to the peculiar sensations occasioned by compression of the 
testes. In one of the cases recorded, the examination produced highly in- 
teresting results, pressure over successive vertebrae, giving rise, first, to 
dyspnoea; second, to palpitations; third, to nausea, a burning sensation in the 
region of stomach, and a sense of sinking. 

The important inquiry concerning this topic is, what degree of value is 
to be attached to it as a diagnostic symptom? In the first place, the ques- 
tion arises, is it absolutely essential, in order to indicate an aiTeciion of the 
cord? My answer to this question is in the negative. I am aware that this 
is opposed to the general impression, and that in cases where it is not dis- 
coverable, notwithstanding all the rational symptoms exist, it is common to 
decide that the evidence is insufficient. That it is in a greater or less de- 
gree present in the great majority of cases is certain, and that thence it is of 
great importance to ascertain the fact of its presence, will, of course, be 
obvious ; but that it may be absent, and the affection still present, in other 
words that it is not an invariable essential element in the diagnosis, it is 
equally important to know. That it may be dispensed with I arn sufii- 
ciently convinced by reference to my cases. In the Jive cases in which it 
is recorded either indistinct or not discoverable, the other circumstances of 
the general history furnish unequivocal evidence that the diagnosis was 
correct. In one case it was absent in the early part of the disease, 
and, subsequently, highly developed. In fact, the numerical ratio of 
its absence is, probably, not fairly represented in this analysis, since, for 
the sake of caution, I was suspicious of the one case in which it could not 
be detected, and omitted to record several on this account. The correct- 
ness of this view is sustained by another important fact, viz.: that the 
degree and extent of the tenderness do not furnish a certain index to the 
extent, location, and severity of the disorder seated in the peripheral 
nerves. In examining my tables with reference to this point, I find some 
cases, in which sensibility to pressure was not acute, are characterized by 
severity of symptoms presumed to be dependent on a morbid condition of 
the cord ; and, on the other hand, in some cases in w^hich the morbid effects 
were mild, the tenderness was extreme. Two of the five cases in which 
no distinct tenderness was discoverable, were among the gravest of the 
series ; one, perhaps, the most so. A fact worthy of notice in this connec- 
tion is, that when tenderness exists in several portions, it does not inva- 
riably follow, that we shall find apparent disorder in the extremities or trunks, 
arising from the medulla at points, corresponding with all the tender por- 
tions; nor is it always the case that the portions manifesting the greatest 
degree of tenderness sustain immediate nervous connections with the parts 
of the body in which local pains or disorder exist. I do not say that this 
coincidence is not frequent, and perhaps, generally found, but the exceptions 
are sufficient to show that it is not a fixed law. In one case in which ex- 



1844.] TYmX on Pathological Relations of the Medulla Spinalis, 275 

treme tenderness existed over a single dorsal, and the most inferior lumbar 
vertebrae, I could discover no especial disorder of any other functions. 
The patient, who was a robust, hard-working Irishman, complained only of 
pain in the affected portions of spine, a general sense of weakness, and, to 
use his own expression, "sickness at heart," which compelled him to forego 
laborious exertions until relieved. I also observed in one instance, that 
pressure over the dorsal, produced pain in the lumbar vertebrae. 

Tenderness over the spine may reside in the integuments or soft parts. 
This was strikingly illustrated in one of the cases, in which such exquisite 
sensitiveness existed, that the lightest possible touch was painful. In this 
one case the excited state of the sensibility was present over the whole cuta- 
neous surface, being greatest over the spine, and gradually diminishing with 
the distance from it. 

I have compared the cases to determine whether any relation was disco- 
verable, between the presence of acute tenderness over the spine, and pain- 
ful effects elsewhere; but I do not find that any such relation is apparent. 
Cases in which the tenderness was slight, or even absent, are not distin- 
guished by affection of the motor or organic nerves in preference to the 
nerves of sensation; and, on the other hand, in cases in which the tender- 
ness was acute, affection of the nerves of sensation are not uniformly 
present. It is very probable that relations may hereafter be discovered 
between this symptom of some important circumstances relating to the 
disease which will increase its value as a pathognomonic sign, but, in the 
present state of our knowledge, ils utility in diagnosis appears chiefly to 
consist in our being enabled thereby to decide positively, when, without it, 
we might feel some hesitancy. 

It may not be inappropriate to make in this connection a few remarks 
concerning the method of examining for spinal tenderness. The only 
procedure which I employ, is, pressure with the palmar surface of the thumb 
and the index finger flexed at the second joint. Percussion does not appear 
to me to be applicable, and the use of a sponge with warm water I have 
never tried. The manoeuvre, although extremely simple, may yet be prac- 
tised, so that a fair result will not be obtained. Sudden and short pressure, 
I have found to be delusive in obscure cases. It should be continued, with 
a gradual increase of force. In a careful examination, pressure should be 
made upon the interval between each spinous process, so as to bring the force 
to bear on the posterior and lateral portions of the column, and also on each 
vertebra over, and on the sides of each spinous process. The fingers can 
be adapted so as to direct the pressure directly and laterally at the same 
time. Sufficient interval should be allowed between each act of pressure 
upon different points, for the patient to observe his sensations. The best 
position for the patient is sitting, with the body bent forward, the elbows 
resting on the knees. If the subject be of the male sex, he should divist 
himself of his coat and vest, and in females, the corsets should be removed. 



276 Flint on Pathological Relations of the Medulla Spinalis. [April 

It is better that some articles of dress intervene between the spine and the 
hand of the operator, to prevent any shrinking from the mere pinching of 
the skin on the direct exertion of force upon it. In cases where the sensi- 
tiveness is acute, it will readily enough be discovered, without the exercise 
of any especial tact in manipulating. The patient not only complains, but 
shrinks, throwing the shoulders backward convulsively. Where tenderness 
is present, but not in an extreme degree, more force of pressure is required; 
but on exerting it beyond a certain degree of force, (much less than a sound 
spine will sustain,) the same convulsive effect is often induced. 

The vertebral column in a perfectly healthful condition, should bear strong 
pressure, even if the individual be of a delicate or feeble habit. By com- 
parison with persons in health it will be easy to estimate a condition 
morbidly sensitive. This comparison can, also, in most cases be instituted 
in the same individual between different portions of the column. Frequently 
when over one or two vertebrae, slight pressure will cause the patient to shrink 
convulsively, the vertebrae immediately successive, will sustain all the force 
that can be conveniently exerted without producing any unpleasant sensation. 

2. Mffeciions of sensibility. — In all but seven cases modifications of sen- 
sibility were more or less prominent symptoms. They are, however, 
exceedingly various in their character and location. Any precise classifica- 
tion is not practicable. To give any thing like a full historical account, it 
would be necessary to quote the description under this head in all the cases 
individually. In this branch, the imperfections of the record are greater 
than in the others, because, in general, the variety of the symptoms were so 
great that only the more prominent were noted. Care was probably not 
taken, also, to go back and ascertain all the diversities which had existed 
previous to the cases coming under observation, in most instances numerous. 
Every one who has devoted any attention to this class of affections, must 
have been struck with the fact, that patients thus disordered, are liable to 
sudden and transient attacks of pain or uneasy sensations, in various succes- 
sive locations. This is so general, that it may be considered as constituting 
a characteristic which it is very useful to take into consideration in the diag- 
nosis of obscure cases. The enumeration of the facts contained in my col- 
lection of cases must not be received as exhibiting the truth just stated 
sufficiently, since slight, evanescent and previous pauis were not always 
recorded, but those chiefly which were sufficiently severe and persistent to 
be prominent features in the history of the disease. 

\n fourteen cases pain in the head was a prominent symptom. It was 
located, in the frontal region most frequently; and in some cases in the 
occipital, temporal and on the summit. Frequendy it affected different por- 
tions at different periods, and in some instances two or more at the same 
time. 

In nine cases pain in the chest was prominent. It occurred sometimes in 
severe paroxysms, and sometimes was constant. In some instances it was 



1844.] Flint on Patliological Relations of the Medulla Spinalis. 277 

aggravated by inspiration, in others it appeared to be iinafTected by the respi- 
ratory movements. 

In ffteen cases the location was in the abdomen, or abdominal parietes. 
Several of these cases had been treated for inflammation and " Liver Com- 
plaint." 

In six cases the uterus appeared to be the seat of the principal sensations. 
In two of these cases examination per vaginam disclosed an exceedingly 
sensitive condition of the os uteri, and the whole organ by examination 
through the whole walls of the abdomen, was also discovered to be ex- 
tremely tender. In all, the pain was paroxysmal, or rather much increased 
at times. 

In seven cases pains in the lower extremities were complained of, generally 
shooting downward, extending sometimes to the inferior portion of the thigh, 
and sometimes below the knee even to the feet and toes. 

In four cases the location of similar pains was in the upper extremities. 
In two cases both upper and lower were simultaneously affected with 
pain. 

In three cases pain was felt in the spine itself. The small proportion in 
which painful sensations were referred to the seat of the affection is an in- 
teresting fact. 

In two cases the trifacial nerve was affected. 

The character of the pains was very various. Sometimes it was described 
as acute and sharp, and sometimes dull and heavy ; as a burning sensation by 
two patients especially ; by another a sense of gnawing, as if by a small 
animal ; by another, sense of numbness ; and in two cases a painful sensation 
of heat, in each instance shooting down the inferior extremities. In one 
case a shooting sense of coldness in the same locality was experienced. It 
is probable this embraces but a portion of the diversities which were ex- 
pressed in almost every case in terms denoting some peculiarity. 

Tenderness to touch over the seat of pain existed in some cases, and was 
absent in others. It was different in degree, being sometimes excessive, and 
in other instances slight. 

Distressing sensations not amounting to actual pain, were frequently com- 
plained of. 

The grand practical point as regards lesions of sensibility is to deter- 
mine the fact of its being a dependent symptom of spinal affection in 
distinction from its presence as an indication of local inflammation. That 
the mistake is often made of deciding upon the latter, when the former is the 
correct explanation, I have had occasion to observe. The error in these cases 
however, has not arisen from the difficalty of diagnosis, but from the exclu- 
sion of all reference to the spinal cord. Those who fall into this mistake, 
are those who reject, or who do not recognize the fact of morbid influences 
emanating from this source. That cases do occur, in which to make the 
discrimination requires close observation and reflection, I do not deny; but. 



278 Flint 07i Pathological Relations of the Medulla Spinalis, [A.pril 

in the great majority of instances, the diagnosis, for one who appreciates the 
pathological importance of the medulla spinalis, does not demand an unusual 
sagacity. The circumstances which should guide our decisions in such 
cases, will be briefly considered, hereafter, under the head of diagnosis. 

3. Effects manifested in the muscular system. — The motor nerves termi- 
nating in the muscles doubtless frequently sympathize with affections of the 
spinal cord, from which arise convulsions and spasmodic contractions both 
tonic and clonic. I do not hesitate to accept the pathology of hysteria, 
tetanus, &;c., which attributes the various forms of these disorders in the 
great majority of cases to a morbid condition of the excito-motory system. 

I have had occasion to treat cases of general convulsions and partial con- 
tractions, which I attributed to this source, but, among the collection of 
cases analysed, there are none in which any sensible or violent movements 
of the muscular system were present. In two cases spasms of different 
muscles successively existed, in one case permanent or tonic contraction of 
the flexor muscles of the thigh, and in one, a disposition to general mus- 
cular tremor which followed any case of excitement, were marked symp- 
toms. A few other effects manifesting themselves, in fact, in this system, 
wall be noticed in other connections. 

I wish more especially to distinguish under this head certain phenomena 
which occur in so large a proportion of cases that they are to be regarded 
as highly characteristic of spinal affections. Nearly every patient in whom 
this affection becomes confirmed, complains of a sense of general debility, 
usually conjoined with painful weariness or lassitude. In some, this diffi- 
culty occurs in paroxysms; in others, it is nearly, if not quite, constant. 
The actual loss of muscular power does not correspond with the degree of 
diminution of which the patient is conscious. That this is so, is shown by 
the fact that at times the muscles are capable of exerting their usual force of 
contraction. The degree of this oppression of muscular energy will vary, 
in some instances amounting to a feeling of great prostration, in others com- 
paratively slight. This symptom I have long observed, and I remarked 
upon it in a former number of this Journal (February 1840) — I confess, 
however, I did not then understand its connection with the affection now 
under consideration. 

Of the cases collected, two are rejected from this analysis; because in 
one the patient had just passed through the remittent fever, and was, besides, 
too young to define his sensations; the other case was one which came 
under observation soon after confinement. 

Of the remainder (42) this symptom was either absent, or no mention 
was made of it in the record m fifteen cases. I am, however, satisfied that 
in several of these it was present in a greater or less degree. It is mentioned 
as present, and its degree of prominence not stated in sixteen cases. It is 
recorded as a prominent symptom in nineteen cases. It was a principal 
feature in two cases. In all thirty-seven. 



1844.] YYmi on Pathological Relations of the Medulla Spinalis, 279 

Recent physiological views, which attribute the tonic contractility of the 
voluntary muscular system to a vis-nervosa originating in the medulla spi- 
nalis, enable us to appreciate the fact that the morbid state just described, is 
connected so frequently with spinal affection. It is not difficult to imagine 
that an influence occasionally so intense as to induce convulsions and various 
spasmodic affections, may, more generally, be sufficient to modify the cur- 
rent of innervation in constant transmission from the nervous centre, and, 
thereby overcome the peculiar effects alluded to. 

4. Mental characters. — Another class of symptoms also quite character- 
istic, appertains to the condition of the mind, and is especially manifested by a 
perversion of the feelings. These peculiarities consist in loss of energy 
and buoyancy of spirit, despondency, melancholy forebodings, great anxiety 
on the subject of health, apprehension of some severe disease, susceptibility 
to emotions from slight causes, &c. The great majority of those in whom 
this affection becomes confirmed, evince some or all of the above symptoms. 

Of the cases in which there were records made relative to this subject, I 
find that this unnatural condition was in some of its various forms a pro- 
minent circumstance in twenty-seven. 

Seven cases are rejected, as the subjects were too young, or the cases too 
transient to be included in the comparison. 

In Jive cases the characteristic symptoms are recorded absent. 

Of the remainder (15) in which nothing is stated, I do not doubt that in 
several instances the mind was more or less perverted, but probably, not to 
the same degree as in the cases in which it is mentioned. These modifica- 
tions of the feelings have been supposed to illustrate the close sympathy 
existing between the mind and the digestive organs, I wished to ascertain if 
the cases under consideration were capable of communicating any informa- 
tion on this point, and I therefore compared them to discover, in the Jlrst 
place, in how many cases the mental characters were recorded, in which no 
derangement of the alimentary canal existed. This was the case in Jive 
instances. 

In the second place, the number of cases in which the mental character- 
istics were recorded in which derangement of the digestive organs also 
existed — these were seventeen. 

The number of cases in which both were absent, nine. 

The number of cases in which no mental characteristics were recorded^ 
but in which derangement of the digestive organs existed, ten. 

Thirteen cases, for various reasons, are not included in this analysis. 

These results of course for reasons already assigned, are not presented as 
accurate statistical facts. It is highly probable that some of the mental charac- 
ters may have been present in several cases and not communicated by the 
patient; and, on the other hand, it would be very Hkely to happen that some 
slight derangement of the digestive organs might exist without being promi- 
nent and escape the record. Nevertheless, the enumeration is not without 



280 Flint on Pathological Felations of the Medulla Spinalis. [April 

some value. Rejecting the numbers which were objectionable (13) and the 
number in which the mental characters and the digestive disorder were both 
wanting (9), leaving the number thirty-tuw, it will be perceived that in 
more than one half both were coincident, while the number of those in 
which the derangement of digestive organs was present without any mental 
characters being present is very small (5). When in addition to this we take 
into account that the peculiar modifications of the feelings may not be mani- 
fested in some individuals from a deficiency of susceptibility of the mind to 
morbid impressions; and that by others they may be successfully resisted by 
a superior force of the will ; while, others, again, from pride or an exces- 
sive sensitiveness, will not lay open to the physician the condition of their 
feelings — considerations which tend to diminish the degree of reliance to be 
placed on the number of those in whom derangement of the digestive 
organs existed without the mental characters — we are led by this method of 
reasoning to regard it as highly probable that the connection exists in much 
the greater number of instances. The fact, however, of the frequency of 
this connection does not demonstrate the dependency of the morbid state 
of the mind upon the derangement of the alimentary canal. The latter may 
not only be produced by the same cause, and simply be coincident; but, 
perhaps, may result in many instances from the former. The discussion of 
this subject, however, is not appropriate to the present purpose. 

5. Affection of the digestive organs. — In the majority of cases the diges- 
tive organs will present some evidences of disturbance. On this subject 
the records of the cases which I have kept, are presumed to be sufBciently 
accurate. More or less disturbance was present in thirty-seven cases. 

There was no disturbance in thirteen cases. 

One case has been rejected as too transient. 

Three cases have no record on this subject, and, probably, in these cases 
no disturbance existed. But it would not be proper to infer from this enu- 
meration that the affection under consideration is characterized especially by 
its association with disorders of the digestive system ; because, in a great 
number of the cases in which derangement existed it was very slight, con- 
sisting, in several instances, of mere disposition to costiveness, or some 
distension or uneasiness occasionally after eating — in fact, no more than is 
connected with almost every disorder, and even present in numerous indi- 
viduals who do not call themselves invalids, and would not on this account 
alone ask medical advice. In some, therefore, these symptoms were, 
probably, merely accidental ; in some there was every reason to suppose it 
might have been induced by the mental anxiety so commonly incident to 
spinal affection ; and in several it was fairly attributable to the use of cathar- 
tics, emetics and other remedies, taken or administered without any 
reference to the true character of the disease. In other instances, however, 
the disorders were among the most prominent symptoms. The stomach 
was the part of the canal most frequently affected. In eight cases vomiting 



1844.] Flint on Pathological Relations of the Medulla Spinalis. 281 

was the mode in which it was manifested. In two of these it had the cha- 
racter of pyrosis; in the others of obstinate irritabihty. Most practitioners 
who recognize spinal affection, have, probably, observed its connection with 
gastric irritability, and found that applications to the spine frequently relieve 
it as if by magic, when the usual remedies are utterly worthless or perni- 
cious. 

Acidity I have observed in several cases as a prominent symptom, and 
more frequently flatulency of stomach or intestines. In five of the cases 
the throat was affected. In one of the patients the difficulty consisted in 
spasmodic contractions apparendy of the pharyngeal and laryngeal muscles, 
occurring in paroxysms, which were particularly excited by cold fluids, and 
so severe as to give some faint resemblance to hydrophobia. In conjunction 
with this was a painful sensation which the patient compared to that pro- 
duced by the contact of ice upon the skin. In two others the difficulty was 
manifesdy spasmodic, in one being slight, in the other not consisting of 
severe paroxysms, but the disorder had been of long continuance. 

In the other cases alluded to, the powers of deglutition were unaffected. 
One of these patients complained only of a disagreeable sensation which he 
could not describe, which had troubled him for many months continuously, 
and was relieved by the measures which relieved the other symptoms con- 
nected with the spinal affection, without any remedies addressed especially 
to the throat. In the other patient, the fauces were inflamed, and nothing 
peculiar existed to distinguish it from ordinary paristhmitis. 

6. Affections of genito -urinary organs, — Disorders of these organs of 
various kinds are frequently found associated in this connection. In enume- 
rating the cases with reference to this point I find that too frequent recur- 
rence of the catamenia existed in three cases. Menorrhagia in six. Leu- 
corrhcea in eleven. Uterine pains in four. Amenorrhoea in one case. 

The number of females is 25. 

Some difficulty in urinating was present in eight cases; all, with one 
exception, being females. I have termed the difficulty in my records gene- 
rally strangury. In several cases I recollect this was the character of the 
disorder, but, perhaps, I did not investigate the matter sufficiently in each 
instance. In one case in which I had occasion to do so, the obstruction 
appeared to consist in a loss of voluntary power over the muscular coat of 
the bladder, accompanied by diminished susceptibility to the presence of the 
urine. 

In five cases pregnancy existed at the time when they first came under 
my observation. It was evident, however, that the spinal affection had ex- 
isted prior to this occurrence, but the symptoms were aggravated by this 
new condition of the system. In each of these cases the period of gesta- 
tion was completed, but in two of the patients uterine pains were trouble- 
some, giving rise to apprehensions of abortion. In one case I was called a 
short time after abortion at the seventh month, but the circumstances of the 



282 Flint on Pathological delations of the Medulla Spinalis. [April 

patient sufficiently accounted for this accident, viz. deprivations, exposure 
and over-exertion. Anotlier of the patients had miscarried twice during a 
period of twelve months, during which time she suffered from the affection 
of the spine ; but in this case after a former confinement metritis had occurred, 
which we may reasonably suppose disqualified the uterus for carrying the 
foetus afterward to the full period. As far as any thing is proved by these 
facts, they go to show that this affection does not prevent conception, nor 
exert a strong tendency to interrupt the term of pregnancy, but that they 
render the patient more uncomfortable during gestation. 

In two cases increased secretion of urine of a limpid character was observed 
by the patient. In both speedy relief was obtained, so that it is pre- 
sumable no important derangement of the constituent urinary principles 
took place; in one it was a prominent symptom, and the urine was tested for 
albumen without success. 

7. Affections of the heart and circulation. — Increased and irregular action 
of the heart are among the disorders incident to spinal affection. Of the 
cases analysed, palpitations constituted a prominent difficulty m ffteen. In 
two cases intermittency, occasioning a distressing sense of impending dis- 
solution, was present; and in one of the cases of palpitations there was 
also an intermittent action. A continued acceleration of the pulse, how- 
ever, so as to constitute a febrile movement is found in a very small propor- 
tion of cases. It is recorded in only six of the number analyzed. In these 
instances it was connected with a general disorder of the functions, which 
was probably occasioned by the action of spinal disturbing causes, the 
system being rendered peculiarly susceptible by the pre-existence of the 
spinal affection, so that as far as the pulse furnishes characteristic indications, 
it may be regarded as almost invariably not increased in frequency. This 
is a very important consideration in diagnosis, enabling the practitioner in 
cases of doubt whether local pain or disordered function may not be attribu- 
table to inflammatory action, to decide generally with certainty. An instance 
illustrating this point fell under observation within the past week, in which 
tenderness over the abdomen complicating severe pain was so intense that 
the lightest pressure, even the weight of the bed-clothes was insupportable, 
while the pulse if at all altered was less frequent and full than usual. I 
confess I felt some apprehension lest I might err, and fatal lesions occur in 
default of the proper remedies for peritonitis. But as other circumstances 
co-operated to sustain the diagnosis, and extreme spinal tenderness was 
present, means were employed, in conformity with this view of the case, 
which speedily confirmed by their efficacy its correctness. Other instances 
equally pertinent could be cited, but doubtless the same experience has at- 
tended others who have bestowed attention upon spinal disorders. 

8. Affections of the respiratory organs. — In several cases certain morbid 
symptoms, referable to the respiratory organs, were present — in all sixteen 



]844.] Flint on Pathological Relations of the Medulla Spinalis. 283 

cases. The character of the disorders is variously described as follows: — 

A sense of suffocation occuring in paroxysms at night, in one case. 

Dry cough simply, in four cases. 

Paroxysmal cough without expectoration, in one case. 

Cough, with slight mucous expectoration, in one case. 

Tearing hacking-cough, without expectoration, in one case. 

Sense of oppression in breathing complicating palpitations, in four cases. 

Dry hacking, almost constant cough, in one case. 

Convulsive catching inspirations with sense of suffocation, in two cases. 

Some of these were doubtless occasioned by the mere effect of irregular 
cifculation through the pulmonary system of vessels. In every instance in 
which cough existed, the fact of its neurotic character was abundantly tested 
by the efficacy of remedies, in addition to other evidences. None of the 
cases included in this collection presented that peculiar barking or crowing 
cough which Tate describes as connected with irritation of the spinal cord. 
I have, however, met with this symptom in a well marked case of affection of 
the spine, which resisted a great variety of inappropriate remedies until its 
connection with spinal tenderness was discovered, and irritating applications 
made over the sensitive portions. 

9. Paroxysms of sinking, ^c. — Having observed that patients with this 
affection are sometimes seized with sudden attacks of fainting, sinking, pros- 
tration, &c., I have examined many cases with reference to this point. 

In six cases there occurred at times paroxysms in which the patients com- 
plained of faintness, sinking, &c. in one instance, attended for a few moments 
"with loss of consciousness. In one case is recorded the occurrence fre- 
quently of paroxysms of indescribable distress. In one case paroxysms of 
sudden debility, accompanied with slight tremor, lasting ten or fifteen 
minutes, and succeeded by extreme languor. This patient was a robust 
labourer. 

In one case paroxysms of giddiness and tinnitus. 

Jn one case paroxysms of sense of impending dissolution, connected with 
coldness of surface and extremities, and some muscular rigidity. 

In one case, paroxysms of prostration, restlessness, and anxiety, attended 
with slight chills and rigors. 

All these symptoms, although differently described, are supposed to have 
some similarity. They invariably excited much alarm, in part from their 
novel character, and in part from the peculiar susceptibility to alarm which 
generally exists in this class of patients. 

It will, perhaps, be said that these phenomena, when they occurred in 
females, (which however was not the fact in all the cases,) are nothing more 
nor less than hysteric paroxysms, which are common enough. I will not 
dispute this remark. But to those who have carried the modern physiology 
of the nervous system into the department of nosology occupied by hysteria, 



284 Flint on Pathological Relations of the Medulla Spinalis. [April 

this assertion does not in the least conflict with the fact of their dependency 
on a morbid condition of the medulla spinalis. 

The measures immediately effectual in such attacks, are sinapisms or 
active stimulating liniments to the spine, conjoined with diffusibles and 
measures to excite the cutaneous surface, as warm pediluvia, &c. 

10. Occasional complications. — Under this title were indicated in this 
analysis those affections which were not sufficiently frequent to have indi- 
vidually distinct places in the titles assigned to them. They were not 
numerous, and are as follows: — 

Pain in motion of the eyes was complained of in three cases. 

Hypertrophy of uterus, which was much diminished under the use of 
remedies addressed to the spine, one case. 

Sense of throbbing over the whole body, tivo cases. 

Perspirations without febrile movement, three cases. 

Coldness of extremities, three cases. 

I have cause to suspect that this symptom would have been much more 
frequent, if attention had been more directed to the point in the record of the 
cases. 

Chills and rigours, in three cases. 

Mild icterus, in one case. 

Enlarged spleen consecutive to intermittent fever, in one case. 

11. Of thephysical habits of the patients. — Tiie facts relating tothephy- 
sical habits of the patients (by this I mean the temperament, development of 
the various systems, &c.) were not recorded with sufficient minuteness to 
render a comparison productive of very satisfactory results. Nothing is said 
relative to this subject in four cases. 

With reference to the remainder I am only able to enumerate with respect 
to the general developments, and especially the deposition of the adipose 
substance. I made notes with regard to this point, because I was early 
struck with the fact that this class of patients very often presented tlie appear- 
ance of "full flesh," and sometimes even corpulency. One of my patients, 
a female, aged about 34, is the most corpulent woman I ever saw. 

In twenty-five cases the habit in this respect is recorded either " spare''^ or 
" rather spare.^^ In twenty-Jive cases, either '•'■embonpoint,^'' or " moderate 
embonpoint.'''' To be precise with reference to the last, seven were thus 
recorded. From this curious fact of exact equality, it would be inferred 
that no indications were to be drawn from the general aspect of the patient 
in this particular. The result, possesses not only some interest but value. 
Most chronic diseases, it is well known, are attended by adipose absorption; 
and hence, in obscure cases, when the uncertainty concerns the existence or 
non-existence of chronic affections, the presence of embonpoint would be 
entided to considerable weight in determining our diagnosis. It is to be ob- 
served, that this enumeration is not to be received as indicating in how large 
a proportion of cases, spinal affection causes a diminution of the adipose 



1844.] Flint on Pathological Relations of the Medulla Spinalis. 285 

deposit. To settle this question numerically, it would be necessary to as- 
certain in how many of the patients recorded *' spare," their condition of 
body was natural. Could this be ascertained, the conclusion would probably 
be, that the affection under consideration does not tend to emaciation — a pre- 
sumption, which, when more accurately determined, will form an important 
fact in the history of the disease. 

With regard to temperament, in some cases in which the characteristics 
were well marked, it has been so recorded; but generally, I confess, the 
difficulty of satisfying myself on this point, prevented conclusions in most 
instances. 

12. Of the time during which the disease had existed, previous to coming 
under observation. — A large proportion of the cases which will offer them- 
selves to the practitioner at the present time, probably in most localities, are 
cases in which the affection has been of long continuance. I say at the pre- 
sent time, because I cannot but believe that when physicians generally come 
to recognize fully the spinal cord as the source of so many and various dis- 
orders, and when the subject has received more investigation, and farther 
progress has been made in reducing its pathology and therapeutics to 
more exact and definite principles, a vast number of cases which are 
now treated under other names, and in an empirical manner, will be dis- 
criminated in their early stages, and obtain such attention as will insure 
prompt relief. The remote period then to which the affection can now fre- 
quently be traced, does not prove that it is one of a peculiar obstinate 
character, possessing an inherent tendency to continuance. So far from this, 
the reverse is, I believe, nearer the truth. But in many of the cases which 
come under observation, from circumstances just alluded to, the affection has 
not only received no appropriate treatment, but probably been aggravated by 
the remedial measures pursued. In reviewing my collection with reference 
to this point, I can only make a rough enumeration from the data recorded. 

I have counted, first, those in which the disorders manifesting connection 
with the affection under consideration, had been present for years, more or 
less, and find that they amount to seventeen. 

Second, those in which it had existed for months in contradistinction 
to years, fifteen. 

Third, those in which it had existed for weeks, in distinction from months, 
eight. 

Fourth, those in which it had existed for days, in distinction from weeks, 
nine. 

The number to be rejected from want of data, five. 

The remaining topics with reference to which my tables exhibit com- 
parison, are the sex, occupation, and ages of the patients. In reviewing 
their data, I do not discover any thing which would repay the attempt to 
reduce the facts to any classification for enumeration — which, indeed, in the 
two latter would be almost impracticable. Suffice it to say, that the "ofo-es" 
No. XIV.— .April, 1844. 20 



286 Flint on Fathological Relations of the Medulla Spinalis. [April 

exhibit every diversity from Jive the youngest to Jifly the eldest, but by far 
the larger number are under thirty-Jive. The "occupation," also, presents 
almost every variety. The general results of my observations respecting 
remote causes will involve whatever I have been able to infer from this 
head, and it is with reference to this point that any enumeration would 
possess value. 

The number of females has been already stated to be thirty-Jive. 

The number of males will consequently be nineteen. 

13. Of the result of medical treatment. — It is obviously difficult to express 
the results of the remedial measures employed with great precision; I might 
perhaps have succeeded better had I appreciated, while making the analysis, 
the importance of this subject as fully as I do now. Considering that this 
department of pathology is somewhat a "disputed territory," the effect of 
the treatment instituted must have considerable influence in producing con- 
fidence in the correctness of diagnosis. This did not strike me with the 
same force while preparing my tables, and hence, under the head of "resz^Z/," 
I have not observed so muchdefiniteness as might have been practicable. In 
nine cases there was no data for this object, either the record being omitted, 
the patients passing Irom observation or not returning to report. In several 
of these it is fair to conclude that the result was satisfactory to them, and, on 
the other hand, some may have been disappointed and sought aid elsewhere. 
Practitioners, from their experience of human character, can form their 
own conclusions on this score. 1 hree of the cases are too recent to report 
any result at this time. 

As regards the remainder, (forty-two,) I have made use of the expressions 
^'•successful,"'' and ^'•immediately successfid,^" to signify by the latter that 
all appreciable evidences of the aflfection were removed within a short period, 
specifying the exact duration, and by the former that the same end was ac- 
complished within a very short period — a few days. The number recorded 
^^ successful is four. The number "immediately successful" is five. I 
think I shall not be accused of strivingto magnify the results of my practice. 
If I have erred in this department of the investigation it is on the side of caution. 
In much the larger proportion of cases, as they at present offer themselves, 
we cannot expect to have the satisfaction of declaring the result to be suc- 
cessful under the above strict definition, certainly within a very short period 
of time ; although in almost every instance our prescriptions may be quite 
satisfactory, both to the patient and to ourselves. The explanation of this 
is, that the afTection having been of long continuance, has become confirmed; 
and although painful or distressing symptoms may be at once alleviated or 
entirely removed, a morbid condition still remains which exposes the patient 
to relapses in some of the various forms by which the disease expresses 
itself. To designate the result in such cases I have employed the terms: — 

'' Relieved''' without specifying time in six cases. 



1844.] Flint on Pathological Relations of the Medulla Spinalis. 287 

" Speedily relieved''^ embracing a period of a few days or a very few weeks 
in thirteen cases. 

^'Immediately relieved''' when the effect of the remedies was apparent 
in a few hours or days, in nine cases. 

The result is expressed " much improved'^ in tivo cases. 

Termination in hemiplegia and still under treatment, one case. 

In this report I have been careful (as already remarked) not to present a 
more favourable issue of cases than facts authorize. But it is to be observed, 
that the results in those cases, which, for the sake of caution, are said to be 
relieved instead of recovered, cannot be considered as impeaching in any 
way the accuracy of the diagnosis; but only as confirming what has been 
before stated with reference to the tendency to continue, for reasons, which, 
it is believed, are more applicable to the present time than they will be to a 
future period. 

14. Of the probable remote causes. — It is a matter of much interest to ascer- 
tain the nature of the remote causes which generally induce this complaint. 
This object was had in view in the present analysis, but in a large propor- 
tion of the cases no data were discoverable on which to base any positive 
conclusions. Sufficient attention, probably, was not directed to this point 
in recording the history of the cases. In several, however, the evidence 
and connections were such as to lead me to assign certain circumstances as 
standing in a causative relation. It would occupy too much space to discuss 
the grounds upon which the conclusions in the individual cases were 
founded. Without any quantitive enumeration, I will confine myself to a 
brief statement of them, severally. 

They are as follows:— Exposure to cold; over-exertion; severe exertion 
of upper extremities, especially as in lifting, &c. ; remittent and intermittent; 
fever; prolonged lactation, and too frequent child-bearing; mental anxiety 
and afflictions; intemperance conjoined with sexual excesses; leucorrhoea ; 
sudden cessation of the menses; deranged menstruation; development of 
the catamenia; sedentary positions; local injury. Judging from the above 
views as well as from theoretical considerations, it will appear that the pro- 
bable remote causes admit of a division into two classes, according as, 1st, 
the effect is exerted directly and primarily upon the spine ; and, 2d, indirectly 
and secondarily by irritative influences transmitted through the incident 
nerves, or as consecutive to certain general conditions of the system. Belong- 
ing in the first class, are, the effects of cold, when directed immediately on the 
spine; over-exertion of the extremities, which is intelligible when we con= 
sider that in all movements both of the superior and inferior extremities the 
spine is the point d'appui or pillar of support for the degree of force 
exertedi Sedentary position is also to be included, especially when from 
the nature of certain occupations, the column is constrained to preserve a 
certain direction for long periods. Lasdy, direct injuries to the spine by 
concussion or otherwise. The remainder will be included in the second 



288 Flint on Pathological Relations of the Medulla Spinalis. [April 

class. And of these, in females, menstrual difficulties and leucorrhcsa are 
presumed to be by ftir the most common. There is reason to suspect that 
sexual indulgence is a frequent cause in males. 

Treatment. — The remarks under this head will be made in general terms, 
and will, of course, embody the principles followed in the cases which have 
been considered, and the very few conclusions on this subject, which have 
resulted from the writer's experience. Local irritation over the spinal column 
in some of the various forms employed, is generally chiefly relied upon as 
the means of curing or relieving affections of the cord. In nearly every 
ease, it may be confidently stated, that by this method, the particular morbid 
symptoms, whatever they may be, will speedily either be removed, or 
alleviated, or a transfer of location or change of form of the disorder induced. 

But it does not follow that the morbid affection is, consequently, speedily 
cured. Too exclusive attention, in my opinion, is generally directed toward 
this class of remedies. That they should rarely, if ever, be omitted, and 
that they will sometimes be of themselves sufficient, I am well assured by my 
own observation; but the latter is tlie case only in those instances where the 
action of the remote cause has been immediate, or where the indirect influ- 
ence has been exerted by causes which have ceased to continue operative. 
Disappointment has, probably, frequently followed when the morbid 
symptoms have been justly attributed to the centre of the nervous system, 
but when the practitioner has failed to trace beyond this centre to the locality 
where the remote cause primarily existed, and perhaps is still exerting its 
causative influence, it is very important to recollect that in a large propor- 
tion, probably by far the greater number of cases, the cord assumes a morbid 
condition from causes received through some of the incident nerves con- 
necting it with the nervous portions of the organism. The duty of the 
physician, then, in all cases, after having arrived at the medulla spinalis as 
the origin of the particular difficulties for which his services were solicited, 
is to commence at this point a new exploration to discover what has occa- 
sioned the morbid condition at the centre of the nervous system from which 
emanate to various parts, morbid influences. If he omits to do this, or is 
unsuccessful in his efforts, he may by his remedies procure temporary relief, 
but his patient will not always recover, or there will occur from slight 
causes speedy relapses. This brings us again to the subject of remote 
causes; but I allude to it again to enforce its importance, not with the design 
of discussing it more fully in this connection. Suffice it to say, that the 
several functions, the digestive, the condition of the mind, habits, occupa- 
tion, &c. &LQ,. are all to be examined, and whatever may be discovered 
which warrants suspicion of its causative agency, is, if practicable, to be 
corrected. It is sometimes a difficult problem which of the local disorders 
stand to the affection of the spine in the relation of cause, and which of effect. 
To arrive at a correct solution of this problem, is, of course, in individual 



1844.] VWnX on Pathological Relations of the Medulla Spinalis. 289 

cases, of the first importance; but to consider here the various circumstances 
bearing on the question, would be difficult, and inappropriate to the present 
purpose. The great principle to be borne in mind, is, that in addition to 
the local applications to the spine, whatever irregularities or disorders may 
coexist which have preceded or appear to have produced the spinal affection 
are to be treated by appropriate measures. 

The means of local irritation which may be addressed to the spine are 
exceedingly numerous. I have made trial of a great many, hoping to find 
some which were peculiarly applicable ; but, I confess, I have not been able 
to determine for myself any fixed principles on this point. It is highly 
probable that no settled rules can be ascertained which will apply equally to 
all cases — that here, as in other instances, the circumstances peculiar to each 
case, and experiment, must actuate our selection. Of all the means the one 
most generally applicable, and producing the most satisfactory results, is 
cupping, with or without scarifications, according to circumstances, but 
more generally without. Large cups should be employed, (small tumblers 
or wine-glasses are generally preferable,) and as many should be applied as 
practicable, bearing them in contact as long as the patient will endure them. 

The instantaneous relief from local pain, or disordered function, perhaps 
of long previous duration, which sometimes a single cupping occasions, is 
truly astonishing, and quite as much appreciated by the patient as by the 
physician. But, in many cases other modes will possess more efiicacy, and 
this in fact very little. 

The other measures may be divided into two classes, according as 
the impression is desired to be immediate ; or, less speedy, but more per- 
manent. For the former end, which is especially desirable to relieve urgent 
pain or paroxysms of distress, sinapisms will often suffice, or friction with 
some stimulating liniment. The common pepper vinegar used as a condi- 
ment, I have found convenient in many cases. In employing friction it is 
often important to direct the observance of care not to employ too much 
pressure or force. The difficulty is sometimes aggravated by overlooking 
this precaution. 

For a permanent irritation I have been in the habit of employing the tart, 
ant. et potas. combined with pix. burg., emp. roborans and resin united in 
proper proportions to form a plaster, which is spread on leather, and worn 
until the requisite degree of irritation is induced. The size of the plaster, 
and the relative proportion of the tart. ant. et potas., may be varied according 
to the degree and extent of the irritation required. I frequently use a plaster 
with the same ingredients omitting the tart. ant. and potas., and sometimes 
substituting in its place, capsicum invariable proportions. This is especially 
applicable after the other methods of irritation have been continued suffi- 
ciently long. The use of irritating applications requires caution. If too 
severe in susceptible individuals, they may, I am satisfied, aggravate the 



290 Flint 07i Pathological Relations of the Medulla Spinalis, [April 

disorder. In two cases of those analyzed in which the symptoms were 
severe, I felt convinced this was the fact. 

It will, however, frequently be observed that the disorder is temporarily 
aggravated but subsequently relieved. 

I have been informed by a friend of extensive experience, and for whose 
opinion I entertain the higliest respect, (Dr. Reid, of Rochester, N. Y.) that 
in confirmed cases he is in the habit of making issues with caustic potassa 
over the spine. That this may be done safely, and to great advantage, I 
am satisfied from my confidence in Dr. Reid's experience, but the first case 
in which I made trial of it terminated so unfortunately, that I have not yet 
dared to repeat it. A patient at the almshouse who had previously, as I had 
been told, had some species of convulsive paroxysms, but had been under care 
for several weeks without their recurrence, was the subject selected. He 
had complained of wandering pains in his limbs, and general debility without 
any distinct disorder of the vital functions. These symptoms were con- 
nected with great spinal tenderness. Three eschars were made simulta- 
neously of the size of a twenty-five cent piece. For two or three days 
subsequent he expressed relief, when he became affected with a species of 
tetanic convulsions accompanied with delirium, which terminated fatally. 
This case is not included in my collection, all of them being taken from 
private practice. An examination was had of the spinal marrow, and an 
increased effusion within the membranes alone discovered. The brain was 
healthy. An examination of the viscera was necessarily omitted. I do not 
cite this case because I am convinced that the caustic applications induced 
the fatal result, but the connection was such that I could not avoid this sus- 
picion, which has prevented the application of the remedy in any other case 
under my charge. 

The local neuralgic pains and disorders incident to the affection, at the 
central connection of the nerves, will, also, be palliated by opiates adminis- 
tered under the usual restrictions; and the former, also, by the specific 
remedies quinia, carb. ammon. &;c., in many instances. I am accustomed 
generally to prescribe to patients with this affection, in addition to local irri- 
tation, medicines of the tonic class, especially the preparations of iron. To 
the sulphate I have usually given the preference either combined in pill with 
a minute proportion of Socotrine aloes and capsicum, or in combination with 
myrrh, as in Griffith's mixture. It may be useful to state here, that as far 
as my observation extends, druggists and apothecaries in this locality, at 
least, are in the habit of selling and using the mercantile copperas, instead of 
that prepared for medical purposes. Diet, exercise, and regimen are doubt- 
less very important matters in the treatment of this disease. The former 
should be digestible, but nutritious and devoid of stimulating properties. 
Coffee and tea ought frequently to be interdicted; so, also, the excessive 
use of tobacco, and all alcoholic beverages. The peculiar condition of the 
mind disposes to the use of the two latter. 



1844.] Flint on Pathological Relations of the Medulla Spinalis. 291 

In regulating habits of exercise, it should be remembered, that violent 
exertions and prolonged erect posture are presumed to be among the remote 
causes. Patients are often injured by injudicious exercise. It is frequently, 
important to direct patients to lie down a portion of the day. Late hours, 
for these reasons, as well as others, should be avoided. 

With regard to dress, the only remark that need be made, is, that the im- 
portance of protecting the body from vicissitudes of temperature is quite as 
manifest in this as in any other chronic disorder. 

Finally, I cannot forbear saying, that, as regards treatment, one of the 
most important circumstances appertaining to a correct diagnosis of this 
class of disorders consists in this — viz. it will probably prevent the use of 
medicinal agents for other imaginary diseases. Some of the cases upon 
which this report is based, had been drugged for a great length of time, first 
by various regular physicians, next by irregular practitioners, and had after- 
ward gone the rounds of patent medicines, and the suggestions of friends 
until, from this cause alone, the powers of the constitution were much 
impaired. One of the most common of the fancied affections is " Liver 
Complaint." 

If the different organs of the body had individually, tongues wherewith 
to give utterance to their sufferings, I am sure the poor liver (whose deport- 
ment in this portion of country at least appears to be very exemplary) would 
complain bitterly of the many slanderous imputations heaped upon it, and 
the frequency with which it is compelled to become the unwilling apologist 
for ignorance, and an involuntary party to the " nimia diligentia medici." 

In the foregoing remarks my purpose has been to exhibit a general view 
of the phenomena associated with, and chiefly dependent upon a certain 
morbid affection of the medulla spinalis. As I have before said, I am far 
from professing to have investigated the subject sufhciendy long to be able 
to present even a complete historical view of its multiform expressions, and 
the various phases which it may assume. The cases upon which my re- 
marks are based have occurred within my private practice principally within 
the past eighteen months, and are presumed to furnish a tolerably correct 
representation of facts which will occur under the observation of every prac- 
titioner who enjoys moderate opportunities, within the same period. Local- 
ity may have some influence. I imagine that patients with this affection 
are more abundant in large places where the physical and moral evils inci- 
dent to deprivations and degradation on the one hand, and luxurious habits 
on the other, are more rife. But this requires an investigation founded on 
a comparison of facts. That many other phenomena than those which have 
been noticed in this article, occur in connection with the affection we have 
considered, I do not doubt; and that those which have been presented re- 
quire much farther minute examination than I have been able as yet to 
bestow, none can be more fully convinced than myself. 



292 Flint on Pathological Relations of the Medulla Spinalis. [April 

There are various inquiries appertaining to this subject which have been 
passed by unnoticed, and concerning which I do not propose to say any 
thing at this time. Such are those concerning the relations between this 
affection and a variety of disorders nosologically classed, named, and gene- 
rally treated without reference to the spinal cord. Here is a wide field for 
•exploration which, perhaps, at some future time I may venture to enter upon. 
The grand and most important inquiry of all, indeed, has been entirely 
omitted, viz. — in what consists the pathology of this affection? Is it inflam- 
mation of the medulla, or its meninges? Is it irritation of either or both? 
Or is it a condition differing both from inflammation and irritation, to appre- 
ciate which, requires a more profound knowledge of the essential properties 
of the nervous system than we at present possess ? Other questions still 
suggest themselves, for example, what is it that determines the localities of 
the reflected disorder ? Doubtless relations and principles exist, which, if 
they were discovered, would render clear this now obscure department of 
inquiry. All these interrogatories, however, I leave for others to answer, 
nor will I presume without more facts than I as yet possess, or know where 
to find, to submit any reflections upon the topics to which they relate. 

In the course of my observations, I have kept in view, as a prominent aim, 
to exhibit circumstances in a light to assist the diagnosis of obscure cases of 
spinal affection. Next to th