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






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THE 



AMERICAN JOUKNAL 



OF THE 



MEDICAL SCIENCES. 



EDITED BY 



ISAAC HAYS, M.D., 

SURGEON TO WILLS HOSPITAL, 

PH"XSICIAN TO THE PHILADELPHIA ORPHAN ASYLUM, 

MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY, OF THE 

ACADEMY OF NATURAL SCIENCES OF PHILADELPHIA, 

&C. &C. &C. 



NEW SERIES. 
VOL. XL 




PHILADELPHIA: 
LEA & BLANCHARD. 

LONDON: 
WILEY & PUTNAM, AND JOHN MILLEE 

1846. 



WMH 



^9437 



Entered according to the Act of Congress, in the year 1846, by 
LEA AND BLANCHARD, 

HI the Clerk's Office of the District Court for the Eastern District of Pennsylvania. 




PHILADELPHIA: 

T. K & p. a. COLLINS, 

PRINTERS, 



-) i Kb 
Mel 



TO READERS AND CORRESPONDENTS. 



The following works have been received : — 

A System of Practical Surgery. By Wm. Fergusson, F. R. S. E. 
Surgery in King's College, London, &c. &c. With 252 Illustrations, from draw- 
ings by Bagg, engraved by Gilbert. Second Edition. With Notes and additional 
Illustrations. By George W. Norris, Surgeon to the Pennsylvania Hospital. 
Philadelphia, Lea & Blanchard, 1845. (From the publishers.) 

Caloric; its Mechanical, Chemical, and Vital Agencies in the Phenomena of 
Nature. By Samuel L. Metcalfe, M. D., of Transylvania University. London. 
1843. 2 vols. 8vo. (From the author.) 

Du Hachisch et de FAlienation Mentale, etudes Psychologiques. Par J. Mo- 
REAU, (de Tours,) Medecin de FHospice de Bicetre. Paris, 1845. (From the 
author.) 

Removal of a Dropsical Ovarium. By George Southam, Surgeon to the Salford 
and Pendleton Royal Dispensary, Manchester. (From the London Med. Gaz.) 
(From the author.) 

Ovariotomy. Removal of an Encysted Tumour of the left Uterine Appendages. 
By George Southam, Surgeon, &c. Read at the Anniversary meeting of the Pro- 
vincial Med. and Surg. Association, July 31, 1845, (From the author.) 

Urinary Deposits; their Diagnosis, Pathology, and Therapeutical Indications. 
By GoLDiNG Bird, A. M., M. D.^ &c. &c. &c. Philadelphia, Lea & Blanchard. 
1845. (From the publishers.) 

The Chemistry of Man. By Dr. J. Franz Simon. Translated by Thomas E. 
Day, M. a., &c. To be completed in two parts. Philadelphia, Lea & Blanchard, 
1845. Part I. (From the publishers.) 

A System of Surgery. By J. M. Chelius, M. and S. D.. Public Professor of 
General and Ophthalmic Surgery, Director of the Surgical and Ophthalmic Clinic in 
the University of Heidelberg. Translated from the German, and accompanied 
w4th additional Notes and Observations, by John F. South, Surgeon to St. Thomas' 
Hospital. Edited, with further additions, by Geo. W. Norris, M. D., Surgeon to 
the Pennsylvania Hospital. Philadelphia, Lea & Blanchard, 1845. Part II. III. 
(From the publishers.) 

On Diseases of the Liver. By George Budd, M. D., F. R. S., Professor of Medi- 
cine in King's College, London, &c. With coloured plates and numerous wood 
cuts. Philadelphia, Lea & Blanchard, 1845. (From the publishers.) 

Elements of Pathological Anatomy: illustrated by coloured engravings, and 
250 wood cuts. By Samuel D. Gross, 'M. D., Professor of Surgery in the Medi- 
cal Institute of Louisville, &c. &c. &c. Second edition, thoroughly revised and 
greatly enlarged. Philadelphia. E. Barrington & Geo. D. Haswell; Louisville. 
Ky., James Maxwell, Jr., 1845. (From the publishers.) 

Medico-Chirurgical Transactions. Published by the Royal Medical and Chi- 
rurgical Society of London. Vol. X. London, 1845. (From the society.) 

Report of the Superintendent of the Boston Lunatic Hospital, and Physician of 
the Public Institutions at South Boston. Boston, 1845. (From Dr. Stedman.) 

An Address delivered before the associated Alumni of Castleton Medical Col- 
lege, at their Annual meeting, June 18th, 1845. By Horace Eaton, M. D. Pub- 
lished by request. Albany, 1845. (From the author.) 

The Twenty-first Annual Report of the Officers of the Retreat for the Insane at 
Hartford, Conn. Hartford, 1845. (From Dr. J. S. Butler, Physician and Superin- 
tendent.) 

A Tabular View of the Signs furnished by Auscultation and Percussion, and of 
their application to the Diagnosis of Diseases of the Lungs. By O'Brien Bel- 



4 TO READERS AND CORRESPONDENTS. 

LiNGHAM, M. D. First American from the Second London Edition, with Notes. 
By Usher Parsons, M. D. (From the editor.) 

Elements of Materia Medica and Therapeutics. By John P. Harrison, M. D., 
Professor of Materia Medica and Therapeutics, in the Medical College of Ohio. 
Vol. II, Cincinnati, 1845. (From the author.) 

A Manual of Auscultation and Percussion. By M. Barth and Henry Roger. 
Translated, with additions, by Francis G. Smith, M. D., Lecturer on Physiology 
in the Philadelphia Medical Association. Philadelphia, Lindsay & Blakiston, 
1845. (From the publishers.) 

The Anatomical Remembrancer, or Complete Pocket Anatomist; containing a 
Concise Description of the Bones, Ligaments, Muscles, and Viscera; the Distri- 
bution of the Nerves, Blood-vessels, and Absorbents; the arrangement of the seve- 
ral Fascise; the Organs of Generation in the Male and Female; and the Organs 
of the Senses. From the second London Edition, revised. New York, S. S. & 
Wm. Wood, 1845. (From the publishers.) 

A Treatise on Corns, Bunions, the Diseases of Nails, and the General Manage- 
ment of the Feet. By Lewis Durlacher, Surgeon Chiropodist (by special ap- 
pointment) to the Queen. Philadelphia, Lea & Blanchard, 1845. (From the 
publishers.) 

Report on the Progress of Practical Medicine in the Department of Midwifery 
and the Diseases of Women and Children, during the years 1844-5. By Charles 
West, M. D., Member of the Royal College of Physicians, &c. &c. London, 1845. 
(From the author.) 

Summary of the Transactions of the College of Physicians, of Philadelphia. 
From May to Oct. 1845, inclusive. (From the college.) 

An Address, delivered before the class of the Philadelphia Medical Association, 
at the close of the Session of 1845. By Alfred Stille, M. D., Lecturer On Gene- 
ral Pathology and the Practice of Medicine. [Published by the Class.] Phila- 
delphia, 1845. (From the author.) 

Manual of Diseases of the Skin. From the French of MM. Cazenave and 
ScHEDEL, with Notes and Additions, by Thomas H. Burgess, M. D., &c. Revised 
and corrected with additional Notes, by H. D. Bulkley, M. D., Lecturer on Dis- 
eases of the Skin, &c. New York, J. & H. G. Langley, 1846. (From the pub- 
lishers.) 

An Introductory Lecture delivered by Gunning S. Bedford, A. M., M. D., Prof. 
Mid. and Diseases of Women and Children in New York University. New 
Y^ork, 1845-6. 

The Reciprocal Obligations of Professors and Pupils ; an Introductory Lecture, 
delivered by Thomas D. Mitchell, M. D., Professor Materia Medica and Thera- 
peutics in Transylvania University. Published by the Medical Class. Lexing- 
ton, 1845. ( From the author.) 

Enchiridion derGeburtskunde. Von Dr. Th. J. Iwersen. Berlin, 1845. (From 
Dr. Oppenheim.) 

Zeitschrift fiir Therapie und Pharmakodynamik. Von L. A. Szerlecki, M. D. 
Drittes Heft. Freiburg, 1844. (From Dr. Oppenheim.) 

Lectures on Puerperal Fever. By Williaim Harris, M. D. Philadelphia, 1845. 
(From the author.) 

A Dictionary of Practical Medicine. By James Copland, M. D., &c. Edited, 
with additions, by C. A. Lee, M. D. New York, Harper & Brothers, 1845. Part 
XL (From the publishers.) 

La Morve du Cheval peut-elle se communiquer a, I'Homme? Par le Doc- 
teur S. EscoLAR, M. D., &c. &c. &c. Bruxelles, 1845. (From Dr. Oppenheim.) 

Om Lakarebetyg ofver Dodande Koppsskador, med hanseende till Svenska 
Lagens sladgande om dodande mikhandel. Af. Dr. A. G. Wistrand. Stockholm, 
1842. (From Dr. Oppenheim.) 

Zeitschrift fiir die Gesammte Medicin. Herausgegeben von F. W. Oppenheim. 
June, July, August, 1845. (In exchange.) 



to READERS AND CORRESPONDENTS. 5 

Zeitschrift fiir Therapie und Pharmakodynamik. Herausgegeben von Lad A. 
SzERLECKi. Freiburg, 1844-5. 

Archiv fiir Physiologische und Pa,thologische Chemie und Microskopie. He- 
rausgegeben und redigiret von Dr. John F. Heller. Jan. 1844. Wien und 
Berlin. 

Archief voor Geneeskunde. Dr. J. P. Heije. Amsterdam, 1844. Vol. IV. 

Bericht iiber das gymnastich — orthopadische Institut. zu Berlin, abgestattet. 
Von Dr. H. W. Berend. Berlin, 1845. (From Dr. Oppenheira.) 

Zweiter Berecht do. Berlin, 1845. (From the same.) 

Journal des Connaissances Medico-Chirurgicales Public. Par MM. Lebaudy, 
H. GouRAUD, Martin-Lauzer. July, August, 1845. (In exchange.) 

Journal des Connaissances, Medicales pratiques, Revue de Pathologie et de 
Therapeutique; Bulletin de Pharmacie. June, July August, 1845. (In exchange.) 

Journal de Medecine. et de Chirurgie pratiques a I'usage de Medecins prati- 
ciens. Par Lucas-Championniere. July, August, 1845. (In exchange.) 

Journal de Pharmacie et de Chimie. June, July, August, 1845. (In exchange.) 

Journal de Medecine. Par M. Trousseau. Sept., Nov., 1845. (In exchange.) 

Journal de Chirurgie. Par M. Malgaigne. Sept., 1845. (In exchange.) 

Annales Medico-Psychologiques, Journal de FAnatomie de la Physiologic et 
de la Pathologie du Systeme Nerveux. Par MM. les Docteurs Baillarger, 
Cerise, et Longet. July, 1845. (In exchange.) 

Revue Medicale Fran^aise et Etrangere. Par J. B. Cayol, M. D., &c. June, 
July, 1845. (In exchange.) 

Gazette Medicale de Paris. Nos. 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 1845. 
(In exchange.) 

Annales de Therapeutique Medicale et Chirurgicale et de Toxicologie. Pub- 
liees par M. le Docteur Rognetta. July, August, September, 1845. (In ex- 
change.) 

The Edinburgh Medical and Surgical Journal. October, 1845. (In exchange.) 

The Medico-Chirurgical Review, and Journal of Practical Medicine. October 
1845. (In exchange.) 

The London Medical Gazette, or Journal of Practical Medicine and the Collate- 
ral Sciences. September, October, 1845. (In exchange.) 

The British and Foreign Medical Review, or Quarterly Journal of Practical 
Medicine and Surgery. Edited by John Forbes, M. D., &c. October, 1845. (In 
exchange.) 

Monthly Journal of Medical Science. Edited by John Rose Cormack, M. D., 
&c. October, 1845. (In exchange.) 

The Dublin Hospital Gazette. Nos. 12, 13, 14, 15, 16, 17, (In exchange.) 

Guy's Hospital Reports. October, 1845. (In exchange.) 

The Northern Journal of Medicine. Edited by Wm. Seller, M. D., &c. &c. 
September, October, November, 1845. (In exchange.) 

The Provincial Medical and Surgical Journal. Edited by Robt. J. N. Streeter, 
M. D. September, October, November, 1845. (In exchange.) 

Dublin Medical Press. September, October, November, 1845. (In exchange.) 

The Medical Times. September, October, November, 1845. (In exchange.) 

British American Journal of Medicine and Physical Science. Edited by A. 
Hall, M. D., and Robert Macdonnell, M. D. September, October, November, 
December, 1845. (In exchange.) 

The American Journal of Insanity, October, 1845. (In exchange.) 

The Ilhnois Medical and Surgical Journal. September, October, 1845. (In 
exchange.) 

The Pennsylvania Journal of Prison Discipline and Philanthropy. Published 



6 TO READERS AND CORRESPONDENTS. 

under the direction of ^^ The Philadelphia Society for the alleviation of the Mise- 
ries of Public Prisons." Instituted 1787. October, 1845. (In exchange.) 
The Missouri Medical and Surgical Journal. November, 1845. (In exchange.) 
The American Journal of Science and Arts. October, 1845. (In exchange.) 
The New York Medical and Surgical Reporter. October, November, Decem- 
ber, 1845. (In exchange.) 

The American Journal of Pharmacy. October, 1845. (In exchange.) 
The New York Journal of Medicine and the Collateral Sciences. Edited by 
Charles A. Lee, M. D., Professor of Pathology and Materia Medica, in Geneva 
Medical College. November, 1845. (In exchange.) 

Stockton's Dental Intelligencer. November, December, 1845. (In exchange.) 
The Select Medical Library. (Commentaries on the History and Cure of 
Diseases. By Wm. Heberden, M. D.) 

The Bulletin of Medical Science. October, November, 1845. (In exchange.) 
The Boston Medical and Surgical Journal. October, 1845. (In exchange.) 
The Western Lancet. September, October, November, 1845. (In exchange.) 
The St. Louis Medical and Surgical Journal. September, October, November, 
December, 1845. (In exchange.) 

The Western Journal of Medicine and Surgery. September, October, Novem- 
ber, December, 1845.) (In exchange.) 

The Medical Examiner. October, November, December, 1845. (In ex- 
change.) 

The Southern Medical and Surgical Journal. October, November, 1845. (In 
exchange.) 
The Buffalo Medical Journal. October, November, 1845. (In exchange.) 
The American Journal and Library of Dental Science. October, 1845. (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 York; 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. 

0^ The advertisement-sheet belongs to the business department of the Jour- 
nal, 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. XXI. NEW SERIES. 
JANUARY, 1846. 



ORIGINAL COMMUNICATIONS. 

ART. PAGE 

I. On the Odoriferous Glands of the Negro. By W. E. Horner, M.D., Profes- 
sor of Anatomy in the University of Pennsylvania. (With a wood-cut.) 13 

XL On the Modification of the Voice and Respiration in Pleural Effusion. 
By J. B. S. Jackson, M. D. (Read before the Boston Society for Medical 
Improvement, May 12, 1845.) -.---- 16 

III. Facts in relation to Epidemic Erysipelas, as it prevailed in Petersburg, 
Virginia, during the winter and Spring of 1844-45. By J. F. Peebles, M. D., 

of Petersburg. - - - - - - - -23 

IV. Sequel to the case of the Removal of seventeen inches of the Intestine 
and the Recovery of the Patient, published in the American Journal of the 
Medical Sciences, April, 1845. By A. Brigham, M.D,, Superintendent of 
the State Lunatic Asylum, Utica, N. Y. - - - - - 44 

V. On the Contagiousness of Puerperal Fever. By Samuel Kneeland, Jr., 
M.D., of Boston. ........ 45 

VI. Contributions to Pathology ; being a Report of fatal cases taken from the 
records of the U. S. Naval Hospital, New York. By W. S. W. Ruschen- 
berger, M.D., Surgeon U. S. Navy. - - - - - 64 

Vn. Medical Notes on a Cruise in the U. S. Ship John Adams. By John A. 

Lockwood, M.D., Surgeon U. S. Navy. ----- 75 
Vni. Excessive Mortality of Male Children, with the causes explained. By 

Gouverneur Emerson, M. D. - - - - - - 91 

IX. The relation of the Dew Point to the Diseases of marshy lands. By D. 
P. Gardner, M.D., formerly Professor of Chemistry, &c., in Hampden Sid- 
ney College, Va. - - - - - - - - 95 

X. On the Use of the Phosphate of Ammonia, as a new remedy for Gout and 
Rheumatism, as a solvent of uric acid calculus, and for diseases, acute 
and chronic, connected directly with the lithic acid diathesis. By T. H. 
Buckler, M.D., of Baltimore. --...- 108 

XI. On the Effects of Extract of Conium Maculatum. Hy Hosea Fountain, 
M.D., of Somers, Westchester Co., New York. - - •• - 123 

XII. Case of Phrenic Hernia through a congenital opening in the Diaphragm. 

By Oilman Daveis, M.D., of Portland, Maine. - - - - 126 

Xni. Osteo-Sarcoma of the Lower Jaw. — Resection of the body of the bone. 
— Cure. By J. Marion Simms, M. D., Montgomery, Alabama. (With a 
wood-cut.) - - - - - - - -128 

REVIEW. 

XIV. Caloric, its mechanical, chemical and vital agencies in the Phenomena 
of Nature. By Samuel L. Metcalfe, M.D., of Transylvania University. 2 
vols. 8vo.^ pp. 1100: London, 1843. - - - - - 133 



CONTENTS. 



BIBLIOGRAPHICAL NOTICES. 

ART. PAGE 

XV. A Manual of Auscultation and Percussion. By M. Barth, Agrege to the 
Faculty of Medicine of Paris, &c. &c., and M. Henry Roger, Physician to 
the Bureau Central of the Parisian Hospitals, &c. &c. Translated, with 
additions, by Francis G. Smith, M. D., Lecturer on Physiology in the Phila- 
delphia Medical Association; &c. &c. Philadelphia^ Lindsay & Blakiston, 
1845: 12mo. pp. 160. -.--... 160 

XVI. 1. Ninth Annual Report of the Trustees and Superintendent of the Ver- 
mont Asylum for the Insane. September, 1845. 

2. Report of the Superintendent of the Boston Lunatic Hospital. July 1st, 
1845. 

3. The Twenty -first Annual Report of the Officers of the Retreat for the In- 
sane, at Hartford, Conn. May, 1845. - - - - - 161 

XVII. Ueber die Historische Unwandelbarkeit der Natur und Krankheiten. 
Der zweiundzwanzigsten versammlung deutscher Naturforscher und Aertze 
zu Bremen gewidmet. Von Dr. A. Muhry, &c. &c. 12mo. pp. 50. Ha- 
nover, 1844. 

On the Historical Immutability of Nature and Diseases. Dedicated to the 
Naturalists and Physicians at their Twenty-first Convention held in Bre- 
men. By A. Muhry, M. D., &c. &c. - - - - - 163 

XV ill. On the Nature, Causes, Prevention, and Treatment of Acute Hydro- 
cephalus, or Water-Brain Fever. By Thomas Smith, A. M., M. D., Senior 
Physician to the Leeds Dispensary, &c. &c. — " Veritas est simpleXj error 
est complex.'' London, 1845, 12mo. pp. 168. - - - . 165 

XIX. Medico-Legal Treatise on Homicide by External Violence^ in relation 
to the causes of death by violence and the signs of death by the different 
kinds of injury to the nervous, circulating, respiratory and nutritive sys- 
tems, also to the circumstances which modify the Medico-Legal characters 
of injuries, and exculpatory pleas. By Alexander Watson, M. D., Fellow 
of the Royal College of Surgeons of Edinburgh, &c. &c. Second edition, 
enlarged, 8vo. Edinburgh, 1842. - - - - - 170 

XX. An Elementary Treatise on Midwifery ; or Principles of Tokology and 
Embryology. By Alf. A. L. M. Velpeau, M. D., etc. etc. Translated from 
the French, by Charles D. Meigs, M. D., Member of the American Phi- 
losophical Society, Professor of Midwifery in the Jefferson Medical Col- 
lege, etc. Third American edition, with Notes and Additions, by William 
Harris, M. D., Member of the American Philosophical Society ; Lecturer 
on Midwifery and the Diseases of Women and Children. Philadelphia, 
1845. Lindsay & Blakiston. 8vo. pp. 600. 

Lectures on Puerperal Fever. By Wm. Harris, M.D. Philadelphia, 1845: 
pp. 50, 8vo. -..-..-- 179 

XXI. Animal Chemistry, with reference to the Physiology and Pathology of 
Man. By Dr. I. Franz Simon, Fellow of the Society for the Advancement 
of Physiological Chemistry, at Berlin, &c. Translated and edited by 
George E. Day, M. A. and L. M., Cantab., Licentiate of the Royal College of 
Physicians. Part. I. Philadelphia: Lea & Blanchard, 1845. 8vo. pp. 292. 181 

XXII. On the Theory and Practice of Midwifery. By Fleetwood Churchill, 
M. D., M. R. I. A., &c. &c. With Notes and Additions by Robert M. Huston, 
M. D., &c. &c. Second American edition. With one hundred and twen- 
ty-eight illustrations, from Drawings by Bagg and others: Engraved by 
Gilbert. 8vo. pp. 525. Philadelphia, 1845: Lea & Blanchard. - 182 

XXIII. Report on the Progress of Practical Medicine in the Departments of 
Midwifery and the Diseases of Women and Children, during the years 
1844-5. By Charles West, M. D., M. R. C. P., Physician to the Royal Infir- 
mary for Children, Lecturer on Midwifery at the Middlesex Hospital, &c. 
&c. London, 1845. -....-- 182 

XXIV. Accidents — Popular Directions for their immediate Treatment; with 
Observations on Poisons and their Antidotes. By Henry Wheaton Rivers, 
M. D., Surgeon to the U. S. Marine Hospital, Providence, R. I. 12mo. pp. 



CONTENTS. 



9 



ART. PAGE 

108, Boston : Thomas H. Webb & Co. Providence : B. Cranston & Co., 
1845. --...-.-. 182 

XXV. A Dictionary of Terms used in Medicine and the Collateral Sciences. 
By Richard D. Hoblyn, A. M., Oxon. First American from the Second 
London edition. Revised, with numerous additions, by Isaac Hays, M.D., 
Editor of the American Journal of the Medical Sciences, pp. 402. Phi- 
ladelphia: Lea & Blanchard, 1845. ----- 183 

XXVI. A Treatise on Corns, Bunions, and the Diseases of Nails, and the ge- 
neral Management of the Feet. By Lewis Durlacher, Surgeon Chiropodist 
(by special appointment), to the Queen. Philadelphia: Lea and Blanch- 
ard, 1845. 12mo. pp. 134. .--.-- 183 

XXVII. Modern Cookery, in all its branches: reduced to a system of easy 
practice, for the use of private families. In a series of Receipts, which 
have been strictly tested, and are given with the most minute exactness. 
By Eliza Acton. Illustrated with numerous wood-cuts, &c. &c. The 
whole revised and prepared for American Housekeepers, by Mrs. S. J. 
Hale. From the second London edition. Philadelphia : Lea & Blanchard, 
1845. 12mo. pp. 418 - - - - - - - 184 

XXVIII.— A System of Practical Surgery. By Wm. Fergusson, F. R. S. E., 
Prof, of Surgery in King's College, London; Surgeon to King's College 
Hospital, &c. With two hundred and fifty-two illustrations, from drawings 
by Bagg: Engraved by Gilbert. Second American edition. With Notes 
and Additions by G. W. Norris, Surgeon to the Pennsylvania Hospital. 
Philadelphia: Lea & Blanchard, 1845. pp. 639, 8vo. - - - 184 



SUMMARY 



IMPROVEMENTS AND DISCOVERIES IN THE 
MEDICAL SCIENCES. 



FOREIGN INTELLIGENCE. 
Anatomy and Physiology. 



1. Contributions to the Physiology 
of the Human Ovary. By Charles 
Ritchie, M. D. - 

2. Physical and Physiological attri- 
butes of the Blood. By Dr. G. 0. 
Rees. - - - 

3. Formation of the bufFy coat. By 
Mr. Gulliver. . - . . 



PAGE 



185 



190 



193 



Lacteal absorp- 
By Mr. 



4. Intestinal villi, 
tion. - - - 

5. Centres of Nutrition. 
Goodsir. - - - 

6. Functions of the Cerebrum and 
Cerebellum. By Dr. Cowan. - 

7. Structure of the Human Placenta. 
By Mr, Goodsir. 



193 



195 



195 



196 



Organic Chemistry. 



8. Nature of the Green Alvine Eva- 
cuations of Children. By Geld- 
ing Bird, M.D. - - - - 198 

9. On the Effects of Food on the 
Blood. By Dr. Buchanan. - 199 



10. Method for detecting the pre- 
sence of a minute quantity of 
Bile in the Animal Fluids. - 200 

] 1 . Mode of detecting Morbid Bile. 
By Dr. Heller. - ^ - - - 201 



Materia Medica and Pharmacy 



12. Therapeutic Properties of Vera- 
trine and Strychnine. By Dr. F. 
A. Gebhard. - - - - 20 1 



13. New Caustic formed by a mix- 
ture of Saffron and Sulphuric 
Acid. By M. Velpeau, - - 203 



10 



CONTENTS. 



Medical Pathology and Therapeutics and Practical Medicine. 



14. Survivance for Forty days after 
the Separation of forty-four inches 

of Intestine. By Mr. Hill. -204 

15. Varicose Tumour of the Pia 
Mater. By M. Baillarger. - 204 

16. Combination of Valerian and 
Oxide of Zinc in Dysmenorrhcea. 

By Dr.JohnAldridge. - -205 

17. Extra-thoracic Pneumothorax. 

By Dr. Stokes. - - - - 205 

18. Treatment of Disease by Moist 
Air. By Dr. Golding Bird. - 206 

19. Death from Calculus in Appen- 
dix Vermiformis Cseci. By Dr. 
Bury. 207 

20. Chlorotic Palpitation. By Dr. 
Corrigan. - - - - 207 

2 1 . Functional Disorder of the Heart 
depending on Spinal Irritation. 

By Dr. Corrigan. - - - 208 

22. Functional Disease of the Heart 
in persons who have led Disso- 
lute and Intemperate Lives. By 
Dr. Corrio-an. - - - - 209 



page 

23. Epileptic Palpitation. By Dr. 
Corrigan. 210 

24. Functional Diseases of the Heart 
in Sedentary Persons. By Dr. 
Corrigan. 211 

25. On Thymic Asthma. By M. 
Trousseau. - - - - 211 

26. Aneurism of the Basilar Artery. 

By Dr. Pfeufer. - - - 213 

27. Effects of large Doses of Ether 
in cases of Enlarged Spleen . By 

Dr. Corrigan. - - • - 213 

28. Ptyalism produced by Colchi- 
cum. By Dr. John Aldridge. - 215 

29. On Certain Pathological condi- 
tions of Milk as the cause of dis- 
ease in Infants. By M. Albert 
Donne. 215 

30. Fatal Haemoptysis in a Child 
four years of age. By Dr. E. 
Walker. - - - - - 218 

31. Laudanum in the delirium oc- 
curring in the last stage of Dothin- 
enteritis. By Dr. Morand. - 218 



Surgical Pathology and Therapeutics and Operative Surgery. 



32. Note on the use of Nitrate of 
Lead in Ulcerated Cancer. By 

M. Lemaitre. - - - - 219 

33. On the character of Cancer. 

By Prof Sedillot. - - - 219 

34. On an affection of the right hand 
which prevents the person writ- 
ing, and on the means of reme- 
dying it. By M. Cazenave. - 219 

35. Foreign body in the Air-pas- 
sages expelled spontaneously af- 
ter a lapse of four years. — Reco- 
very. By Dr. James Duncan. - 219 

36. Taxis combined with continued 
irrigation and the cold water 
douche, for the reduction of Stran- 
gulated Hernia. By M. Moreau- 
Boutard. 220 

37. Fissure of the Anus. By M. 
Blandin. 220 

38. Fissures of the Nipples. - - 220 

39. Amputation at the hip-joint for 
Osteo-medullary Sarcoma of the 

Os Femoris. By Dr. Handyside. 221 

40. Gunshot Wound of the Brain, 
attended with extensive Cranial 
Fracture, and followed by com- 
plete Recovery. By Mr. Ford. - 221 



41. On the use of Piper angustifo- 
liura (matico) in certain Hsemor- 
rhoidal Affections. By Dr. O'Fer- 
rall. - - - - - 224 

42. Excision of the Elbow-joint. 

By Dr. Sanders. - - - 224 

43. Report of a Committee of the 
Royal Academy of Medicine of 
Belgium, on the "Amovo-ina- 
movible" method in the treat- 
ment of complicated fractures. 

By Mr. Phillips. - - - 225 

44. Blood-vessel communicating 
with the cavity of an Abscess. 

By Dr. A. M. Adams. - - 229 

45. Aneurism treated by Electro- 
Galvanic Action. By Dr. Petre- 
quin. 229 

46. Case of Evulsion of the Left 
Arm and Scapula. By Dr. Alex- 
der King. - - - - 230 

47. Treatment of Venereal Warts. 

By M. Vidal (de Cassis). - - 230 

48. Yeast in Treatment of Burns. 

By Dr. Szerleski. - - - 230 

49. Ovarian Tumour successfully 
removed. By Mr. John Dickin. 230 



CONTENTS. 



11 



Ophthalmology. 



50. Nerves of the Cornea. By Prof. 
Purkinje. - - - - 231 

51. Motions of the Iris. By Signer 
Guarini. 231 

52. Remarks on Effusion of Blood 
within the Eyeball. By C. Lock- 
hart Robertson, M. D. - - 232 

53. Ascension of a depressed Lens 



PAGE 

twenty-two months after couch- 
ing. By Dr. De Abren. - -235 

54. Case of sudden and temporary 
Presbyopia. By Dr. James Hun- 
ter. 235 

55. Adhesion of the Eyelids to the 
Globe of the Eye. By M. Petre- 
quin. 237 

56. Keratoplastie. ByM.Plouviez. 237 



Aural Surgery. 



57. New method of treating 
eases of the Ear. 



dis- I 58. Polypus of the Ear. By M. 

- 237 Bonnafont. - - - - 239 



Midwifery. 



59. Placenta Prsevia — Extraction of 
the Placenta before the Child. - 241 

60. Perforation of the Cervix Uteri 
by the foot of the child occurring 
during Parturition. By Thomas 
Williamson; M.D. - 

61. Supposed Fatal Effects on the 
child of the Ergot of Rye. By 
Prof. Beatty. - - . - 

62. On the Contagious Effects of 
Puerperal Fever on the male sub- 
ject : or on persons not child- 
bearing. By Robert Storrs, Esq. 

63. Abdominal Supporter. By Dr. 
Edward Rigby. 

64. Kyesteine as a Sign of Pregnan- 
cy. By MM. Moller and Kley- 
bolte. 

65. Fatal Vomiting during Preg- 
nancy. By Dr. Chailly. - - 249 

66. Twin Labours — Complete Sus- 



244 



244 



245 



248 



- 248 



pension of Uterine Action be- 
tween Birth of two Children. 
By Dr. Pfau. - - - - 249 

67. Extreme Obliquity of the Ute- 
rus. By Drs. Pellegrini and Bre- 
sciani di Borsa. - - . 249 

68. Retroversion of the Uterus until 
the Commencement of Labour. 

By Dr. De Billi. - - - 249 

69. Rupture of the Uterus and La- 
ceration of the Vagina. - - 250 

70. Uterine Hemorrhage. By M. 
Loir and Mr. Thompson. - - 250 

71. Puerperal Fever. By M. Bot- 
rel. 251 

72. Management of the Breast dur- 
ing Pregnancy. By Dr. Witte. 251 

73. Singular Deformity of the Ute- 
rus causing the presentation of 
the child's arm in three consecu- 
tive labours. By Dr. Lecluyse. 251 



Medical Jurisprudence and Toxicology. 



74. Professional Confidence. 

75. Poisoning by Sweinfurt Green 
(Scheele's Green) . By M. Blan- 
det. 

76. Poisons administered to the 
mother, detected in the Fcetus. 
By M. Audouard. 

77. Life Assurance. - . . 



252 



252 



253 
253 



78. Injury to the Vertebrse and Spi- 
nal Marrow, not fatal until seven 
years after. - - - . 254 

79. A Fall or a Blow. - - - 255 

80. Rapid Delivery and its bearing 

on the question of Infanticide. - 255 

81. Pulmonary Emphysema as a 
cause of Sudden Death. - - 257 



Statistics. 
82. Statistics of Lower Canada in 1844. 



258 



12 



CONTENTS. 



AMERICAN INTELLIGENCE. 
Original Communication. 



PAGE 



Case of Suddenly formed Tumour of the Neck. By Eugene Parmer; M D. 259 
DOMESTIC SUMMARY. 



Disputed Personal Identity. - 
Deaf and Dumb. - - - - 
On the Powers of Turpeth Mineral 
in certain diseases. By Dr. Hub- 
bard. 

New Remedy for Strangury. By 

Dr. F. H. Gordon. - 
Bilateral Operation in Lithotomy. 
By Prof. R. D. Mussey. - 



260 
262 



262 
264 
264 



Further Observations on some of 
the more obscure and remote ef- 
fects of Syphilis. By John Wat- 
son, M. D. . - - - 265 

Neuralgia instantaneously relieved 
by the extraction of a tooth. By 
D. Alfred C. Post. - - - 265 

Medical Profession in the United 
States. - ' - - - 266 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 

FOR JANUARY, 1846. 



Art. I. — On the Odoriferous Glands of the Negro. By W. E. Horner, 

M. D., Professor of Anatomy in the University of Pennsylvania. [With a 
wood-cut.] 

The glandular structure in immediate connection with the skin, is by the 
modern authorities on anatomy resolved into the perspiratory glands, dis- 
covered by Gurlt; — the sebaceous follicles, considered to exist everywhere 
on the surface of the skin, but in a more distinct manner on the nose, the 
upper lip, and the ears ; and lastly, the small sebaceous glands whose ducts 
appear to discharge preferably near and within the capsules for the hairs. 
The translator of Wagner's Physiology* says that these ducts, instead of 
ending independently on the surface of the skin, seem always to terminate 
in the sheaths of the hair. This opinion is perhaps rather too unqualified ; 
it expresses, however, the generally admitted fact of the sebaceous glands 
being the appendages of the pilous tissue. The points above are now suffi- 
ciently familiar to anatomists, and are introduced into the most modern sys- 
tems. The sebaceous follicles are many of them at least visible to the 
unassisted eye from their magnitude ; the perspiratory and the sebaceous 
glands are too small for such examination, and require largely the aid of 
the microscope, even to distinguish them with certainty. 

The existence of subcutaneous glands of a larger size is occasionally 
but not uniformly alluded to, and in rather an indefinite manner by writers. 
Among those glands which I conceive to be slighted by anatomists, is a 
fine strong layer, in the negro, just under the skin of the arm-pit, and inter^ 

» Robert Willis, M. D., p. 388, Lond., Edit., 1841. 
No. XXI.— January, 1846. 2 



14 



Horner on the Odoriferous Glands of the Negro, 



[Jan, 



mixed with the bulbs of the hairs, they being imbedded in common adipose 
and cellular matter. 

It is well known in our country that the smell of negroes is particularly 
redolent from the axilla; (the same maybe said, in a qualified way, of persons 
of all complexions ;) and that some of them, with the strongest efforts to free 
themselves from it, are so organized that they may be traced by the effluvium 
with which they impregnate the air. The layer of glands represented in 
the accompanying figure will, I think, go largely towards an explanation of 




that fact, and in doing so they may not be improperly called the QlanduldS 
odoriferae of the axilla. They belonged to an almost coal black male subject, 
of fine development of skeleton and muscle, not advanced in hfe, and which 
was used for the anatomical lectures of the last session. The piece is 
represented as it stands suspended in a round bottle of some sixteen or 
eighteen ounces, and under the magnifying influence which enlarges the 
diameters about one-third. 

From the representation it will be seen that these glands amount to from 
two hundred and fifty to three hundred, and make a circular plate about the 
size of a large Spanish dollar. In raising the skin of the axilla, they are 
found very near it, and as the skin there is very thin, the principal thick- 
ness of the tegument is derived from the subcutaneous cellular layer. These 
glands are so invested and masked by the layer, that unless a special ex- 
amination be made for them they are almost certainly overlooked ; with the 
attention, however, directed to them they are found with unerring certainty; 
and become still more conspicuous by a coloured injection and by maceration 
in water, which infiltrates the cellular substance. They are heaped up near 



1846.] Homer on the Odoriferous Glands of the Negro, 15 

the centre, become more and more sparse towards tlie circumference, and at 
the latter have distant intervals between them, some few being so scattered 
«is io form the outposts of the circle. 

These glands are of a fuscous colour, and vary in size, some being only 
the half of a line or less in diameter and others reaching to two lines. The 
central ones aro the larger. They bear upon their surface the granular 
aspect so common to similar composite glands as the labial and buccal — 
the pancreatic and the mammary ; and though I have not yet succeeded in 
injecting their ducts, we may consider them as presenting in that respect an 
analogous formation. Their magnitude is too great to suppose that they are 
a simple appendage of the hairs of the axilla, which indeed in this subject 
are few and small ; neither do they admit of being placed in the category of 
perspiratory glands, whose existence most determinate in the soles and 
palms, has even there to be seen by the microscope. 

The largest sebaceous glands of the skin, as stated by Gerber,* con- 
sidered now excellent authority, are the Meibomian glands as encoun- 
tered on the eyelids. He also says with others, (p. 327.) that the sebaceous 
follicles of the skin " generally open laterally into the hair sheaths — they 
always occur isolated, and are not so universal as the more compound seba- 
ceous glands." In regard to the perspiratory glands of Gurlt, the same 
authority says, (p. 144,) " that their contents being watery and uncoloured 
with pigmentary matter, they are highly transparent, and much more dif- 
ficult to discover and to examine under the microscope than the sebaceous 
glands," 

These odoriferous ghnds cannot be considered as peculiar to the negro, 
since, in our researches, subsequent to their observation in the above subject, 
they have been invariably found, but of a much diminished size, in the 
white subject. 

The necessity or rather probability of a distinct glandular apparatus, for 
the peculiar effluvium of the human skin, has been heretofore frequently 
conjectured. Thus, besides others, we have a recent distinguished authority 
advancing that it is probable that by glands of special functions are elabo- 
rated the odorous secretions which are exuded from particular parts of the 
surface, especialty the axilla.t The same idea is presented in the learned 
work on Physiology, by Prof, Dunglison, (p, 95, vol. i., Philadelphia, 1844,) 
in the declaration that the sebaceous foUicular secretions differ materially 
according to the part of the body where they exist, as manifested by the 
varying fluids discharged in the axilla, groins, feet, &c. The real ana- 
tomical views of those gentlemen, however, as well as of MuUer:]: and of 
other physiologists, do not seem to go beyond the admission of the ordinary 
sebaceous cryptas and of the sebaceous glands in connection with the hairs. 

* Elem. G«n. AnaU, p. 142: London, 1842. 

f Principles of Hunoan PJiysiology, p. 584> By W. B. Carpenter: Loadon, 184SI« 

?t Physiology, p. 48 1: London^ 1840, 



16 Jackson on the Voice and Respiration in Pleural Effusion. [Jan. 

Until a more finished inquiry be completed, the precise anatomy of these 
axillary subcutaneous glands must remain in doubt. Their granular and 
composite character is sufficiently evident, but the point is yet to be settled 
whether their excretory ducts have the tortuous doublings of those of the 
ceruminous glands, as drawn by Wagner, {loc. cit., p. 385,) or whether 
they are branched and racemous like those of the salivary glands. Admit- 
ting the classification of Henle, (Encycl. Anat., vol. vii. p. 484, et seq,,) 
they must at any rate be enrolled among the glands in the form of clusters 
of grapes, (racemosi,) and not in the form of pouches, (cceca,) so common in 
other respects in the skin. 



Art. II. — On the Modification of the Voice and Respiration in Pleural 
Effusion. By J. B. S. Jackson, M. D. Read before the Boston So- 
ciety for Medical Improvement, May 12, 1845. 

There have lately occurred at the Massachusetts General Hospital two 
cases of disease of the heart, accompanied with effusion into the chest — and 
attended by physical signs, upon which last I would offer some general re- 
marks, and conclude by giving the cases themselves. It is not often that 
we have a better opportunity to compare the diseased appearances with the 
signs than these cases afforded, and, however they may accord with the 
established laws of auscultation, the facts, I believe, cannot be questioned. 
The signs to which I refer are the bronchial respiration, and bronchophony, 
jEgophony, or something intermediate, as connected with the effusion. The 
fact of bronchial respiration in pleurisy is now perfectly established, and 
it is only surprising that Laennec, who discovered so much, should have 
overlooked so obvious and frequent an occurrence ; to whom the discovery 
is due, does not appear ; it probably was, with many, an original observation, 
and in my own case I am sure that it was. I remember the case perfectly 
well of a man to whom I was called in the early part of the night, taken 
very suddenly with severe pain in the side, and high fever, having pleurisy 
without doubt ; there was probably also some pneumonia, there being cough, 
with rusty expectoration, but this could not have been of any great amount, 
as on the fourth day he was sufficiently well for me to discontinue my 
visits ; the bronchial respiration, and modification of the voice were strongly 
marked when I first saw him, though he stated that in the evening he had 
been quite well ; this was on the 28d of April, 1835. This observation was 
communicated to Dr. Fisher, and afterwards to Dr. James Jackson, and 
Dr. J., who was then in attendance at the hospital, had repeated opportu- 
nities to verify the truth of it, as shown by the records of the institution ; I 



1846.^ Jackson on the Voice and ^Respiration in Pleural Effusion, 17 

think I may say that it was confirmed also by Dr. F. The earliest published 
record of the fact that I have seen, is in Dr. Gerhard's work, and that ap- 
peared in 1836. With regard to the frequency of the occurrence of bron- 
chial respiration in pleurisy, there is a difference of opinion ; Barth and 
Roger, in the first edition of their work, found it in three or four cases out 
of ten ; this was criticised by GrisoUe, who, in his work on pneumonia, states 
that in fifty cases of pleurisy, he found bronchial respiration in nearly one 
half, whereupon, B. and R. re-examine the points, collect twenty-six cases, 
and still find traces of the peculiar sign in nine only, as appears in their 
second edition, (1844.) My general impression is that it is very much 
more common than even GrisoUe makes it. As to the character of the 
bronchial respiration in pleurisy, as distinguished from that of pneumonia, 
I should differ entirely from those whose descriptions I have seen, my 
observations being made, of course, principally upon the living body, but 
receiving strong confirmation from the two fatal cases which will presently 
be related. Barth and Roger say that in pneumonia, the bronchial respi- 
ration is strong, clear, and tubular, as if the air tubes were metalHc ; in 
pleurisy it is oftener indistinct, feeble, not tubular ; sometimes harsh, or 
sharp and bleating, as if the air traversed flattened tubes. The harsh 
bleating character is what I have almost always observed, and the term 
used by Dr. Jackson, in the hospital records, is strongly expressive of the 
same idea — he called the respiration in such a case, not bronchial, but 
" 8Bgophonic ;" this bleating tone, then, not indistinct and feeble, but strongly 
pronounced, I should regard as highly characteristic of the bronchial re- 
spiration of pleurisy, and not as an occasional occurrence. The bron- 
chial respiration is often to be heard, they say, only when the respiration is 
forced, and sometimes with the expiration only, and it has more or less of 
a distant character ; I have generally heard it at once on applying the ear, 
without forcing the respiration, during the inspiration quite as well as dur- 
ing the expiration, and, as to the idea of distance, I should say that the 
chief characteristic, above all others, is that the sound seems to be formed 
beneath the ear, seems to come from the pleura itself, as the voice does in 
SBgophony. As to the seat of it, these authors maintain that the bronchial 
respiration is generally heard only about one-half way up the back, that it 
ceases at the base, and that in the nine cases last analyzed by them, it was 
never heard in front ; cases do occur, however, they say, though they are 
very rare, in which it is heard strongly under the ear, without forcing the 
respiration, over a considerable space, and even to the base of the lung, but 
these are the cases that I am sure I have often met with. This sign, 
again, is less durable in pleurisy than in pneumonia, according to Barth 
and Roger, and to this statement I would strongly object ; the duration in 
some cases of pleurisy that I have seen being longer than pneumonia, gene- 
rally lasts in all its stages ; in a patient now in the hospital, and who has 
been there for some weeks, with undoubted chronic pleurisy of eight 



18 Jackson on the Voice and Respiration in Pleural Effusion, [Jan, 

months' duration, the bronchial respiration i« intensely marked over the 
whole left side of the chest, front and back. 

So much for the character of the bronchial respiration in pleurisy ; and 
now, as to the amount of effusion it indicates, there would not seem to be 
much question in the opinion of MM. Barth and Roger^ nor, do I thi-nky 
with observers generally; as this, therefore, is considered as a settled point, 
the direct contradiction offered by the two cases, which will presently be 
given, is very important to observe. The authors just quoted, remark that 
this sign is heard in the first days of pleurisy, where the slight degree of 
flatness shows a small amount of effusion ; as the effusion increases the 
lung is pushed back ; it is prevented by the false membranes which fcwcm 
about it from expanding ; the bronchia are compressed and become inaccessi- 
ble, and, as the movements of the thorax diminish, the air penetrates with 
less force ; then the bronchial respiration becomes more distant, and it is 
heard only about the large bronchia, but returns if the respiration is forced* 
Finally, when the effusion is considerable, and the lung is greatly reduced 
in size, the bronchial respiration cannot be heard, even by forcing ; there 
are cases, however, they say, of such effusion apparently where the bron- 
chial respiration is heard, but it is possible in these that the lung is bound 
to the diaphragm by adhesions, and a thin layer of fluid only exists between 
it and the parietes ; now they are such cases as these last which I shall pre- 
sently relate, and which show by dissection that we may have marked 
broncliial respiration, where the effusion is large, the lungs greatly com- 
pressed, and where there are no adhesions. They afterwards remark, we 
must allow that all the conditions of the bronchial respiration are far from 
being determined. 

I have now only a few words to say with regard to the modification of 
the voice. In bronchophony there is rather an increased resonance, and in 
aegophony a modified tone, but the two signs, though generally well defined, 
not unfrequently run into each other. The state of the organs, also, in con- 
nection with these signs, is far from being a settled point. iEgophony was 
formerly associated with pleurisy, and with that only, but Chomel, GrisoUe 
and Louis have found it in case of hepatization of the lung, where the pleura 
was perfectly healthy. According to Barth and Roger, it shows an effu- 
sion in the pleura, which is almost always serous, the circumstances of the 
case showing whether there is pleurisy or simple hydrothorax ; I was not 
before aware that it was ever heard in simple serous effusion, and the state- 
ment will, perhaps, strike some others as new ; it is, however, fully con- 
firmed by the following case. 

Mrs. Davis, a large, fleshy woman, of a nervous temperament, and seventy 
years of age, entered the Hospital on the IBth of last October, with symp- 
toms of disease of the heart, but no other trouble apparently about the chest, 
except for some bronchitis, and on the 4th of December she was discharged. 
On the 6th of March she was again admitted, having had a return of her 



1846.] Jackson on the Voice and Respiration in Pleural Effusion, 19 

symptoms about four weeks before. She appeared decidedly to have bron- 
chitis, and I supposed that it was the supervention of that disease which 
caused the renewal of her cardiac trouble. The rales over the chest cor- 
responded with the cough. On the 12th, there was noted more free respi- 
ration than formerly below left scapula, but less below right with dullness 
on percussion, and, on the following day, bronchial respiration with modifi- 
cation of the voice below the right scapula ; it is not so often specified as it 
should be whether bronchophony or segophony was intended^ but I have a 
distinct recollection of the very frequent segophonic character of the voice 
in this case, and, moreover, the term "modification" rather corresponds to 
aegophony as resonance of the voice does to bronchophony ; as to the ex- 
planation of the bronchial respiration, there had been no indication of 
pneumonia, and t therefore set it down to an afiection of the pleura, and as 
there were no especial indications of pleurisy, and there was an extensive 
oedema of the lower extremities connected with the disease of the heart, I 
concluded, on the whole, that the physical signs were the result of simple 
hydrothorax, and I never saw any good reason afterwards for changing my 
opinion, though there was occasionally some variation in the physical signs. 
On the 5th of April, there is reported bronchial respiration with modifi- 
cation of voice in both lower backs, but no rale, and on the 8th bronchial 
respiration with " segophony," more marked over lower right back, on the 
left the respiration being more free, and the percussion nearly clear. On 
the 10th there was a new sign, crepitus along the left of the spine inferiorly, 
and base of the left lung, with modification of the voice ; this was supposed 
to indicate oedema of the lung at that part. On the following day the same 
signs were more marked, those on the right back being the same as before. 
On the following day again, April the 12th a new observation was made ; 
below the fourth rib, on the right side, anteriorly, dullness on percussion 
with feeble respiration ', but above this fine the respiration was supplementary 
and the resonance was good ; this fine was supposed to indicate the height 
to which the fluid rose in front as the patient laid back upon a bed chair ; 
on the back the physical signs were the same as before ; this was the last 
examination that was made, being five days before death. The patient had 
been gradually getting worse, the cedema was very great, the dyspnoea often 
very urgent, and under the increase of these, and the usual symptoms of such 
a case, the patient sank and died on the 17th of last month. On dissection, 
th.ere was found a quart of clear serous fluid in the right pleural cavity, and 
"^x in the left, but without a trace of inflammation acute or chronic ; not 
even an adhesion on either side. The lower and middle lobes of the right 
lung were compressed into a small rounded ball, and, on being cut through, 
they were found flaccid, perfectly free from air, and without the slightest 
trace of pneumonia or there ever having been any; the upper lobe was 
expanded and quite healthy, the contrast between this and the two lower 
being very remarkable, and such as I do not remember to have seen before* 



20 Jackson on the Voice and Respiration in Pleural Effusion. [Jan. 

The left lower lobe was greatly compressed, though less than the right 
lower ; and along its root and base, corresponding precisely to the situation 
of the crepitus heard a week before death, there was found a red stain and 
nothing more ; a marked appearance, but without the shghtest degree of 
congestion or induration, the compressed lobes having, all of them, the usual 
wilted, dryish look ; the upper left lobe was healthy like the right, except 
for a httle acute pneumonia in the anterior inferior part. Here, then, was 
strong bronchial respiration and asgophony or bronchophony in simple hy- 
drothorax from disease of the heart, a case which would probably have been 
diagnosed correctly by a good observer who did not auscult, but would very 
naturally lead a sanguine auscultator, who saw the patient for a single 
time, into the error of supposing that there was pneumonia in the second 
degree. 

As the disease of the pleura is the principal point, very little will suffice 
for the rest of this case, though it was one of great and compHcated interest. 
In the first place, the pulmonary artery and its branches in the two lobes 
of the right lung, were plugged up with fibrin and coagulated blood, evi- 
dently formed long before death ; this I have never before met with in com- 
pression of the lung from effusion in the pleura. The bronchi were exten- 
sively and deeply inflamed, corresponding to the symptoms, and it was 
interesting to observe the amber-coloured secretion in the right lung, which, 
if it had been expectorated during life, would have been considered une- 
quivocal evidence of pneumonia, though there was not a trace of it on the 
side on which it was found. With regard to the heart the patient had had 
symptoms of the disease for eight or nine years ; the pulse was small, and 
very rapid towards the last, and always extremely irregular ; impulse not 
remarkable ; faint soufflet over the mitral valves in place of or with the 
first sound when the patient was in the hospital the first time, but not after 
her second admission, and this was only heard with the firmer strokes ; 
second sound perfectly healthy ; the mitral valves were found greatly dis- 
eased and permanently open, admitting one finger and no more, the aortal 
being healthy ; in October the case was diagnosed as mitral disease with 
regurgitation. Last July the patient had an apoplectic attack followed by pa- 
ralysis for several days, and a weakness of intellect which continued, and in 
connection with this were found traces of former hemorrhage in the brain, 
and increased serum in the ventricles. Last autumn she had nausea and 
vomiting, flatulence, anorexia, and severe pain in the stomach which pre- 
vented sleep ; these symptoms were explained by a deep chronic ulcer in 
the small curvature of the stomach. There were also cirrhosis of the liver, 
Bright's disease of the kidneys, obhteration of both orifices of the cervix 
uteri, with distension of its cavity by clear mucus, the cavity of the body 
being filled with bloody fluid and ecchymosed on the inner surface, as de- 
scribed and figured by Cruveilhier ; the ovaries were diseased, with some 
ossification, and in the upper part of the vagina was a large superficial 



1846.] Jackson on the Voice and Respiration in Pleural Effusion. 21 

ulceration ; a disease was also found of which I do not remember to have 
heard except in the living body, a dark red, bright vascular tumour, about 
the size of a large pea, growing from the very orifice of the urethra, pro- 
jecting through it into the vagina, having a broad attachment, and upon the 
inner surface of the urethra dilated vessels running to it, as seen on the inside 
of the rectum in case of hemorrhoids ; whether it was sensitive, as it usu- 
ally is, was not ascertained. Lastly, there were found numerous specimens 
of trichina spirahs in the muscles of the trunk, some in the recti muscles 
of the eye, and one or two in the oesophagus, this being the only instance, 
so far as I am aware, in which they have been found in the involuntary 
muscles. 

The second case which I have to relate is that of Thomas Slee, who en- 
tered the Massachusetts General Hospital on the 22d of January, and died 
on the 25th of March. He was a respectable Irish mechanic, 32 years of 
age, of medium stature and flesh, pale and somewhat bloated countenance, 
confused in his intellect, and having symptoms of disease of the heart, which 
began in the autumn of 1841. In connection with the state of the intellect 
there were found, on dissection, the remains of an old apoplectic effusion. 
Both ventricles of the heart were enlarged, and the aortal valves were greatly 
diseased, being thickened, contracted, and curled up, so that on pouring 
water into the ascending aorta, it ran through into the ventricles as through 
a continuous tube ; there can be no doubt then of free regurgitation during 
life; the mitral valves were healthy. The pulse was quite rapid, 182 to 
144, perfectly regular as to frequency and force, with one or two excep- 
tions, and particularly characterized by a strong thrill, feehng as if a column 
of mercury was shot under the finger ; I presume that this was " the jerk- 
ing pulse," "the pulse of unfilled arteries," which Dr. Hope describes as 
diagnostic of aortic regurgitation, a disease which, from the concurrence of 
this and other physical signs, was supposed to exist in the present case ; 
there was also the purring tremor felt over the heart very distinctly, this 
and the jerking of the pulse being perhaps more distinct than they other- 
wise would be in consequence of the anemic condition of the patient. Over 
the ventricles there was a marked souffiet synchronous with the impulse of 
the heart, but, on approaching the sternum there was a gradual change, 
and, on arriving over the aortal valves, I never, after repeated examina- 
tions, could satisfy myself that it was synchronous with either the first or 
second sound ; this last, the second sound, was almost, if not entirely, 
masked. On percussion over the heart the flatness was increased. The 
case, then, was a very interesting one for the disease of the heart, but, as 
above stated, it is on account of the effusion in the pleura and its physical 
signs that I make this report. The right pleural cavity contained two and 
a half quarts of clear serous fluid ; the membrane was everywhere crusted 
over with lymph, nowhere very thick, much of it evidently an old forma- 
tion, though about the base were some appearances of a recent addition.; 
the lung compressed and the lower lobe greatly so, as in the case of Mrs, 



22 Jackson on the Voice and Respiration in Pleural Effusion. [Jan. 

Davis, and, as in her case, without a trace of adhesion to the parietes which 
could favour the production of the physical signs ; neither was there a trace 
of pneumonia ; the left side was well. On the 1st of March, twenty-five 
days before death, there was noted healthy and supplementary respiration 
over the left half of the chest, sufficiently loud over the upper half of the 
right back and heard when forced below the right clavicle, but elsewhere 
over the right side inaudible, the dullness on percussion corresponding with, 
the diminished respiration ; right side of chest enlarged. On the 5th 
marked segophony about angle of scapula, with bronchial sound transmitted 
from throat when breathing is forced. On the following day the signs were 
less, and on the 10th the bronchial respiration was heard, when forced, on right 
of spine inferiorly. On the 12th the bronchial respiration was less, but the 
segophony more marked than before, the dullness on percussion continuing 
the same, and on this day it was recorded that there were no symptoms 
indicating the presence of pneumonia or pleurisy ; I attributed the physical 
signs to simple hydrothorax. On the 17th of March, five days later, the re- 
cord was perfect flatness over lower half of right back, the dullness extend- 
ing anteriorly, as on the 1st, as high as the third rib, on the upper half of the 
same back the resonance being considerable ; respiration over upper half of 
right back distinct, though much less than on left, and below the right cla- 
vicle still more diminished ; some bronchial character, when forced, about 
lower right back towards spine, the segophony in the same situation being 
well marked. On the 22d he was found in bed quite pale, faint, nauseated, 
having up to this time kept about the ward, and occasionally, I believe, 
walking out ; the change took place the day before whilst he was at dinner. 
On the following day he was much revived and I ausculted him ; the left 
back was well as formerly ; over upper half of the right back the respira- 
tion was more free, and there was less dullness on percussion, but the lower 
half was dull as formerly, and the bronchial respiration, and bronchophony, 
(this is the term used, though I think I remember that it was quite as much 
like segophony,) were more marked than ever: probably some inflamma- 
tion had arisen, connected with the appearance of recent lymph that was 
formed near the base of the right pleural cavity, though there was no ins- 
creased pain. On the 24th the record was segophony rather than broncho^ 
phony over lower half of right back, the signs being otherwise as on the 
preceding day ; hmits of bronchial respiration and segophony on back well 
marked, these corresponding probably with the level of the fluid within the 
chest ; no rale. This was the last examination made, the patient continu- 
ing in a pretty comfortable state till between five and six o'clock the next 
morning, when he suddenly fell off* and died. This case, then, as well as 
the last, shows, contrary to the opinion of Barth and Roger, and, I beHeve, 
all other authorities, that we may have strong bronchial respiration and 
modification of the voice though the effusion may be abundant, the lung 
greatly compressed, pushed to a distance from the parietes and perfectly 
free from all adhesions. 



1846.] Peebles on Epidemic Erysipelas, 2^ 

Art. III. — Facts, in relation to Epidemic Erysipelas, as it prevailed in 
Petersburg, Virginia^ during the winter and spring 1844-45. By 
J. F. Peebles, M. D., of Petersburg. 

Graphic descriptions of this formidable epidemic have already been given 
the profession. The abk account of Drs. Hall and Dexter, of New Hantp- 
shire, which appeared in this Journal for January, 1844, and a report by 
Dr. Sutton, of Indiana, published in the Western Lancet, Nov., 1843, fur- 
nish details so complete and comprehensive, that but little has been left fot 
subsequent observers to add respecting its sympt(Kns and character.. 

Without hoping, therefore, to subjoin much to that which is already 
known to those who have examined these papers, yet the grave character 
of this disease, and certain peculiarities in its history, together with the 
many varied aspects it assumes at the onset of its attack, all embolden the 
writer to record the facts coming under his own observation. 

We shall begin by setting forth in detail, the facts connected with its 
history and progress in Petersburg, and in so doing, the reader must be 
struck with the manner in which we are enabled to trace out the disease, 
from its first appearance amongst us, until its more or less general preva- 
lence and final decline. It was in the early part of December last, that 
the first case of Erysipelas appeared in Petersburg. It occurred in the 
person of a healthy young man named Stevens, a potter by trade, living 
in that part of the town known as Blandford. The patient stated that his 
brother, whom he had sent to the town of Weldon 60 miles south of this 
place, to dispose of some wares, had, after being sick some time in that 
place, returned a few days before his attack with his face red and swollen, 
and he confidently beHeved that his disease (dubbed the big head) had been 
contracted from him. But this account must not be received without quali- 
fication ; for conceiving this a point of great interest, I was induced to in- 
vestigate it carefuUy. It is true that during the winter, the disease did 
prevail in Weldon and its neighbourhood to a considerable extent, although 
I could not ascertain whether any cases had existed or did exist there dur- 
ing the time of Stevens' sojourn. I learned, moreover, that the man, after 
having temporarily reformed, had been excessively intemperate whilst at 
the latter place, and hence it was found impossible to separate its effects 
from any attack of illness which he might have had, or from its results on 
the face already described. The young man had left town before my at- 
tention was called to this question, hence nothing further could be elicited. 
On the second week of Stevens' illness, a man named Petway and seve- 
ral of a family named Jones, all living in the same neighbourhood, were 
attacked with the disease. The neighbours generally, from a fear of con- 
tagion, had refused to visit Stevens, but these persons had all seen him, 
most of them several times a day. 



24 Peebles on Epidemic Erysipelas, [Jan. 

A young woman, sister to Petway, came six miles from her residence in 
the country to act as his nurse. Faithfully did she perform her duty, sit- 
ting up night after night with the sick and raving man. At the close of 
the second week of his illness, however, she was herself taken down. 
Awaking in a chill of unusual violence, she ascribed her attack on my 
visit next morning to her having, when overcome with fatigue and watch- 
ing, accidentally fallen asleep, under an open window as the night drew to 
a close. Contrary to advice, she obstinately persisted in leaving on that 
day for her home in the country, where her disease proved to be erysipe- 
las, and of which she in a few days died. Two other members of the 
family died of the complaint in quick succession, and there were six cases 
of erysipelas in this neighbourhood, all occurring in persons who had 
visited the Petways. 

Returning to Blandford, the family of Jones— under the care of Dr. 
French, who obligingly gave me the information, all had the disease, and 
Mrs. Jones, an old lady already broken down by a protracted chronic com- 
plaint, fell a victim to its violence. And from this event it would seem, 
we can trace the disease in a yet more remote ramification. For the body 
of the deceased was conveyed 14 miles into the country for interment, at 
the residence of her brother in Sussex county. Her nephew, the only 
member of her brother's family who had visited her during her illness, 
accompanied the corpse. On the 7th day from the time he had seen his 
aunt, according to my talented friend Dr. William J. Harrison, of Sussex, 
who saw his, as well as all the other cases which occurred in this county, 
and from whom I obtained these particulars, this young man broke out 
with erysipelas. Fourteen cases in all occurred in this family and neigh- 
bourhood, and Dr. H., clearly convinced of its contagious nature, observed 
that in every case the period of incubation of the disease was the same, 
namely, seven days. On this latter point my attention was never aroused, 
the fact therefore was unobserved. It certainly is an interesting one, and 
both from Dr. Harrison's high attainments, as well as from his well-known 
powers of accurate and practical observation in relation to disease, it is en- 
titled to the highest consideration. 

But one of these cases proved fatal. A negro woman, in her sixth 
month of pregnancy, aborted during the progress of a severe attack of 
erysipelas of the face, but whilst convalescing from this disease was sud- 
denly seized with puerperal peritonitis, which speedily carried her off. 

We have now seen how this disease, diverging from its starting point in 
Blandford, ramified into the neighbouring counties of Dinwiddle and Sussex, 
where it speedily exhausted itself in the production of the comparatively 
limited number of cases cited : we will next consider its progress through 
town, where, in the midst of which, up to the middle of February, no case 
had occurred. 

Hitherto, occurring in the suburbs of the town, the disease had only 



1846.] Peebles on Epidemic Erysipelas. 35 

existed among the poorer classes ; the next case I was called upon to attend, 
however, was different ; it took place in the most populous and best built 
street, and occurred in the person of Mr. V., a merchant of the first stand- 
ing. The origin of his attack could not be traced. The patient could not 
call to mind any error or imprudent exposure, nor had he seen a case of 
erysipelas. This gentleman's attack proved an uncommonly severe, 
troublesome, and protracted one, and two nurses engaged to attend on him 
were successively seized with the disease. In addition to these two other 
persons, those too who were most frequently in the sick room were at- 
tacked besides myself; I suffered severely with symptoms of a poisoned 
wound created by dressing the patient's face when there was an exceed- 
ingly shght abrasion on one of my fingers. It was when in the room with 
this patient that I received a hasty summons to visit Mrs. P., living in the 
same street, although several blocks of buildings distant. This proved to 
be a case of parturition. The patient's accouchement had been intrusted 
to a female accoucheur, in whom the family had every confidence, and 
medical aid had only been sought respecting some symptoms not immedi- 
ately connected with her delivery. 

It being necessary for her to lose blood, I performed the operation my- 
self and withdrew, soon after which the patient had a safe and easy deli- 
very. On the morning of the second day after this occurred, traceable to 
no cause or act of imprudence, Mrs. P. was seized with a severe rigor. 
In consequence of my own illness at the time she was most carefully 
attended by Dr. Robinson, but in despite of his admirable skill and most 
devoted attention, she perished on the fourth day of her attack with puer- 
peral peritonitis. This melancholy and exceedingly interesting case, to 
be hereafter referred to, had for its sequel facts of still further interest. 
The mother-in-law of the deceased and a young lady, resident of the house, 
fell ill on the day of her burial. Upon these two had fallen the burden of 
constantly nursing the unfortunate lady ; they were in consequence fatigued 
and worn out by the protracted exertion, besides which the latter rode to 
the interment, on a cold damp day in an open carriage. Both of these 
proved to be cases of erysipelas. Nor did it stop with them, for two other 
young ladies, attendants in their sick room, and also inmates of the same 
house, long before their convalescence, became affected with the same dis- 
ease. With these cases, the disease stopped in this house, and besides 
the residence of Mr. V. no other house in this neighbourhood became in- 
fected. 

The next case of erysipelas occurred in a very different quarter of the 
town, but, in accordance with its previous character, its appearance there 
could be fairly traced to Mrs. P.'s residence. It occurred in the person of 
a lady who had visited Mrs. P. during her illness, and who had taken her 
child in charge after her death. As usual, her husband, the other mem- 
bers of her family, and those persons, besides, who were most frequently 



S6 Peebles on Epidemic Erysipelas, Pan. 

in the sick room, had erysipelas. Her mother and sister, living apart, and 
in different quarters of the town, carried the disease to their respective 
homes, where it ran through both their famiHes. These cases were all 
successfully treated by Dr. Mitchie, from whom I obtained these particu- 
lars. 

Setting aside entirely the question of their dependence upon each other, 
the reader must be struck with the manner in which the cases we have 
detailed up to this time progressed, the one succeeding the other in regular 
gradation. Fully six weeks had elapsed after the breaking out of Mr. V.'s 
case, during which erysipelas had only advanced thus far on its course. 
This, therefore, it must be understood, was the manner it progressed. It is 
true many simultaneous cases afterwards occurred, but never, until the 
disease had made many lodgments in various quarters. And in propor- 
tion as these multiplied, did the difficulties, from obvious causes, of further 
tracing the meanderings of the disease increase, until its thread was finally 
lost in its prevalence and decline. Confining itself to particular houses in 
these various quarters, this epidemic, never going from house to house, pre- 
vailed universally in any locality, and the number of cases, though sufficient 
to fill our inhabitants with no small degree of concern, when compared with 
the entire population of the town, was quite small. During the month of 
March and April the disease was at its height of prevalence, afterwards 
it gradually declined, although occasional cases have occurred during the 
whole summer. But as before remarked, its course was no longer trace- 
able. The writer saw two cases afterwards, occurring in individuals who 
had waited on those sick of the disease, and Dr. Robinson informed him 
that most of his cases of the disease could be traced to that of Mr. V. 

Having thus far detailed the progress of those cases of erysipelas which 
were apparently dependent upon each other, it would not be right to con- 
clude the account of facts connected with its history, without alluding to 
those which bore no such connection. The pecuharity of Mr. V.'s case, 
in this respect, has been already referred to. Another well-marked one 
occurred in the person of a medical friend, Dr. Couch, of this town. 
Overtaken by a shower, after walking briskly homeward from church to 
avoid it, this gentleman imprudently fell asleep shortly afterward in a 
draught of air* He awoke indisposed, and the result was a severe attack 
of erysipelas. The Dr. had not attended or seen a case of the disease, 
as his attack began about the 1st of March, before there was anything like 
a distribution of erysipelas through the town. 

Another fact of some importance requires to be stated in connection with 
this part of our subject. There was an unusual amount of sickness in Pe- 
tersburg during the winter and spring. The weather presented no appre- 
ciable condition sufficient to account for this ; the winter was unusually 
mild, and the spring extraordinarily early. The modifying influence so 
dwelt upon by Sydenham, which epidemics exert upon the character of all 



1646.] Peebks on Epidemic Erysipelas. 2T 

diseases, occurring during the time of tlieir prevalence, was observed to 
some, though certainly not to a great extent, whilst the one under consi- 
deration existed. Ordinary cases of catarrh did not often run their course 
without inducing some stiffness of the neck and soreness of the throat ; fre- 
quently they were accompanied by glandular enlargements of the cervical 
region, and obstinate inflammatory fevers. In a few cases, slight wounds 
were found troublesome, and in two instances coming under the writer's 
observation, erysipelas running up the arm, originated from a shght punc- 
ture in the hand. 

With this imperfect, although somewhat detailed account of the progress 
of this epidemic ; I shall, carrying out the design implied in the heading 
of this paper, proceed without comment to give some further particulars 
respecting its character. A point of vast interest next opens itself to our 
consideration ; I allude to the apparent connection between erysipelas when 
epidemic, and puerperal fever. The facts touching on this question, oc- 
curring in Petersburg, shall next be carefully detailed. Only two cases 
of puerperal fever, both of which proved fatal, came within my knowledge 
during the whole time of the prevalence of the epidemic. The one was 
the case related by Dr. Harrison, and the other that of Mrs. P., mentioned 
above. Whilst in attendance on cases of erysipelas, I saw only two other 
obstetrical cases, and visited besides but one lying-in patient. Such being 
the only cases with us, usually intrusted to the physician's care, both of the 
former were of extreme difficult management — one being a case of much 
neglected tedious labour, the other was complicated with puerperal con- 
vulsions of unusual violence. Notwithstanding these circumstances, both 
of these patients, without any symptoms of puerperal fever, did well. Dr. 
Robinson, who is most employed in these cases, informed me that no case 
of puerperal fever occurred in his pjactice. I was aware that he attended 
two cases of protracted parturition, at the time he was consulting with me 
twice a day on the case of Mr. V. In one of these cases, I was informed, 
there was a retained placenta from hour-glass contraction of the womb, 
which was exceedingly difficult to overcome. Yet, nothing like puerperal 
fever appeared in any of these cases. One other fact remains to be noted 
in connection with this subject ; at the time of Mr. V.'s attack, so often 
referred to, his lady was in the first week of her confinement with her first 
child. During the whole time of his illness, their chambers adjoining on 
the same floor, were thrown into one by the folding back of the doors be- 
tween ; she did not approach his bedside, but persons who waited on him 
were not restricted in their intercourse or approach to her. Besides his 
nurses, we have seen her mother, brother, and infant's nurse, all had the 
disease, the two latter only passing in and out his room without attending 
by the bedside. This lady escaped the disease. 

In the practice of other physicians in the town, puerperal fever, from all 
I can learn, was not a frequent disease. The above facts are sufficient, 



28 Peebles on Epidemic Erysipelas. [Jan. 

few as they are, from the nature of the cases related, (in four of them the 
necessary manipulations were such as most frequently lead to peritonitis,) 
to prove as they are detailed, that there certainly was no marked tendency 
to puerperal fever during this epidemic. But \hey must not be received 
without some explanation. To estimate fully the testimony they furnish 
in relation to the question at issue, some other particulars must be under- 
stood. 

Dr. Robinson, long aware of its importance, attributed the exemption of 
his patients to the cautions which he practiced. When not convenient to 
change his clothes, he invariably carefully washed his hands, and securely 
tucked up his wristbands and cuffs, so as to allow no portion of his dress 
to come in contact with the sick lady. In the successful cases mentioned 
as attended by myself, there are circumstances, too, which require to be 
mentioned. 

Besides the advantages of my approaching these cases with my hands 
well washed, they had, perhaps, another one. To reach both of them I 
had to ride some distance on horseback ; one resided in the suburbs of the 
town some distance from any house, the other lived six miles in the coun- 
try. It would certainly be a gratifying circumstance to know that these 
measures were of avail in preventing the communication of the disease ; 
and that it is probable that they are so, derive some confirmation from the 
opinion of those most conversant with the facts relating to the question : 
yet the testimony in its favour is certainly weakened by the facts connected 
with the case of Mrs. V., who, during the whole time of her confinement, 
was momentarily liable to a contact with the clothes of persons attending 
her husband. Since we have deviated so far from our prescribed course 
as to pass the above hasty comments upon the facts presented, we will 
not leave this portion of our subject without some remarks on the case of 
Mrs. P., so painfully interesting. It has been shown that my visit to her, 
was directly after a short walk from the room of a patient confined with a 
most malignant case of erysipelas, and that I remained sufficiently long 
with her to perform blood-letting ; this was on Wednesday evening ; on 
Friday morning succeeding, rigor came on, and Monday evening following 
she died. She was a woman of fine constitution, and although no post- 
mortem could be made, there can be no doubt about peritoneal disease. 
Her attendants, as we have stated, had erysipelas. These are striking facts. 
Admitting that she received her disease from infection, the fact that her 
attendants, who must have got their attacks from the same source, had 
erysipelas, furnishes certainly the strongest proof of the identity of this 
disease and puerperal fever. 

The patient before mentioned, whom I attended in child-bed, and whom 
I frequently visited under circumstances precisely similar, namely, directly 
from the room of Mr. V., I should have mentioned before escaped the 
disease. 



1846.] Peebles on Epidemic Erysipelas. 2S 

Nature and symptoms of the disease. — We open this portion of our 
subject with what we conceive to be highly important points in relation to 
this epidemic. I allude to the varieties in the modes of seizure which it 
assumed in different individuals. An attention to this point will remove 
much obscurity in the onset, and save many vexatious errors in diagnosis^ 
and on inquiry into its causes will tend to throw some hght upon the 
nature of the disease. This fact is referred to by all who have written 
upon the subject. Drs. Hall and Dexter, for instance, declare in their 
report that "its manner of assault could not be anticipated;" it seemed, 
they further continue, a freak of the disease which of the various organs 
and textures of the system should be chosen as the first point of invasion. 
This, indeed, constitutes the great peculiarity of the malady, and it is what 
has induced many of my medical friends to doubt whether it is not alto- 
gether a new disease, instead of that described by systematic authors as 
erysipelas. To what, therefore, is owing that peculiarity in its modes of 
attack which presents this disease to the practitioner in so many varied 
aspects ? This question can best be answered by offering some remarks 
respecting the nature of the disease. 

The view entertained by the best modem writers on the subject, that 
the cutaneous inflammation in erysipelas does not constitute the disease, 
was strikingly confirmed by its character in this epidemic ; for when this 
took place, the patient was most generally reheved of the most dangerous 
and distressing symptoms; in many cases convalescence had positively 
begun. The great danger, therefore, existed before this result was fairly 
induced; in the source of this danger, then, hes the object of the present 
inquiry. 

Erysipelas, therefore, as it existed in this epidemic, (that is, all grave 
cases of the disease,) invariably manifested itself as invading, in the form of 
severe inflammatory action, some important internal organ ; chiefly, accord- 
ing to my observation, the internal mucous membranes. Sometimes more 
internal organs than one were simultaneously affected ; most usually, how- 
ever, the attack was confined to but one. Now this internal inflammation 
was of a peculiar character, for when firmly seated, it seemed that it was 
only to be permanently reheved by the external appearance of the erysipe- 
latous inflammation. It is true, there were many cases which none could 
doubt belong to the epidemic disease, in which the patient had the pecu- 
liar erysipelatous fever of Drs. Hall and Dexter, but in whom no cutaneous 
inflammation appeared, nor was such a result necessary for their conva- 
lescence. Now in these cases, the fever and the throat affection were most 
that the patient complained of, but where an internal organ had received 
the invasion and had become decidedly involved in the disease, the rule 
was never departed from that the relief was followed by, and apparently was 
consequent upon, the external appearance of erysipelas. This latter result, 
therefore, invariably took place in all severe and dangerous attacks of the 
No. XXI.— January, 1846. 3 



30 Peebles on Epidemic Erysipelas. [Jan, 

disease ; and it is a fact of great practical importance, as we shall hereafter 
endeavour to show, in relation to the treatment of such cases. The danger 
and the distress attendant upon the disease, therefore, were in every case 
in proportion to the importance of the internal organ seized, and the extent 
of the mucous surface involved. After this brief review of its prominent 
characteristics, nothing further need be said respecting the cause of the 
many different symptoms which the disease assumed at the onset of its 
attacks, since it must be clear that the distress in that particular organ 
formed its leading symptom in the early, always the most dangerous 
periods of the attack. A question of no httle importance next arises as to 
the means or possibihty of diagnosing such attacks of this disease, and ordi- 
nary cases of idiopathic inflammation of the same internal organs. 

This point, we think, can best be illustrated, and also the character of 
the symptoms at the same time be more fully disclosed, by extracting from 
our case book a succinct account of a prominent case, as it appeared when 
assailing the different internal organs. We will then first give a brief 
account of a case, detailing its symptoms as they appeared from the begin- 
ning, in which the stomach and its adjacent auxiliaries received the first 
invasion; it occurred in the person of Mr. V., so often referred to in this 
paper. 

After retiring to rest very late, feeling, as he expressed it, unusually 
well, Mr. V. awoke at 3 o'clock, A. M., with a feehng of extreme nausea, 
which was speedily followed by both vomiting and purging of bilious mat- 
ter. Fever, with pain in the head, came on, and when 1 saw him two 
hours after his attack, he was in extreme distress. The nausea had never 
abated in the slightest degree, and although thin and copious bilious dejec- 
tions continued at extremely short intervals, he had ceased to vomit bile ; 
that fluid had been replaced by a thin, frothy mucus, which, in astonishing 
quantities, he continued every tw^o or three minutes to throw up, apparently 
without any effort whatever. 

Though questioned on this point, he at that time complained of no un- 
easiness about the throat, save a slight stiffness of the jaws ; his face was 
flushed, and he complained of intense pain in the head, darting at intervals 
through the ears. Although his pulse was exceedingly variable— being at 
one time indistinct and extremely frequent, at another full and bounding — • 
yet this distress about the head became so alarmingly increased, by his 
efforts in raising his head, that the fluid which was constantly ejected from 
the stomach might be thrown off, or the secretions in the fauces dislodged, 
that bleeding became necessary in the course of the day for the safety of 
the brain. His thirst was distressingly urgent, yet his tongue so far from 
being dry, was covered with a viscid slime, which gradually changed as 
the case wore on to a thick, dirty-coloured coat, through which, in various 
spots, the organ might be seen of a dark red colour. The condition of the 
patient, so alarming from the first, was but only amehorated by the ti^at- 



1846.] Peebles on Epidemic Erysipelas* Si 

ment pursued; it was true, that the purging was checked after the first 
day, and that the loss of blood had somewhat relieved the brain, yet the 
gastric distress was but little abated. No pain was complained of in the 
stomach after the first few hours, and there was no tenderness in the epi- 
gastrium ; the counter-irritants which were employed produced only tem- 
porary relief, and the nausea from day to day remained so great as not to 
allow the slightest fluid when taken to remain on the stomach. In addition 
to this extreme irritabihty of this organ, the feeling of stiffness about the 
throat, already spoken of as existing, gradually increased ; on the third day 
the pain in the fauces became so great as to render deglutition difficult, 
whilst at the same time there Was a profuse secretion of viscid mucus 
from these parts, which produced an uncontrollable and a persisting dispo- 
sition on the part of the patient to clear the throat by a violent expiratory 
effort. In his weak state, this was an exceedingly unfortunate complica- 
tion of the symptoms, for by these efK)rts, so urgent and so irresistible, he 
was several times a day thrown into an alarming state of syncope. The 
trachea was slightly involved in the disease, but the lungs remained unaf- 
fected. This latter was a curious, and perhaps fortunate circumstance, 
since the patient had been subject for three years past to alarming attacks 
of hasmoptysis. Such, however, remained his condition — and it cannot be 
denied, of extreme distress — allowing him scarcely a moment's repose, until 
the eighth day of his illness, when erysipelas of the face appeared. From 
that time all the symptoms above noted were gradually, some of them, par- 
ticularly the vomiting, immediately relieved ; and although his conva- 
lescence was slow and tedious, and his suffering from the local disease was 
great, yet nothing after that time occurred to mar our hopes of his recovery. 
The cutaneous inflammation in this case appeared at the root of the nose, 
on the mesial line of the face exactly at its junction with the septum 
nasum: advancing symmetrically, exactly alike on either side, it first 
spread over the nose, then descended on the face, mounted on the forehead, 
traversed the scalp, and finally declined on the neck. The features were 
entirely obliterated by the extent of the swelling, and the countenance was 
greatly distorted ; the eyes were fast closed for more than a week, and the 
hearing remained impaired for some time after convalescence. This was 
far from being an unfrequent form of attack during the prevalence of the 
epidemic. When unrestrained by treatment, its tendency was to speedy 
fatality. 

A young girl whom I saw, and who was in perfect health before her 
attack, died in less than twenty-four hours of similar symptoms. The 
history of her case is comprised in a few words. — After spending the 
morning out, she was suddenly seized, late in the afternoon of the same 
day, with vomiting and purging ; a dose of calomel and Dover's powder 
was administered by her mother, but the symptoms increasing in violence, 
continued all night ; at 9 o'clock next morning I saw her, and found her 



32 Peebles on Epidemic Erysipelas. [Jan. 

case hopeless : although sensible, she was lying on her back, with a cold 
skin, and an extremely feeble, vacillating pulse ; she complained of no 
pain, save a stiifness of the neck, and a sore throat, and her jaws were 
clenched so completely, as not to allow the shghtest separation of the 
teeth. She was having frequent involuntary discharges from her bowels 
of a thin watery fluid, of a deep golden colour, and as she lay, without 
effort, matter of precisely the same appearance from time to time flowed 
from her mouth in considerable quantities. Without being again able to 
swallow, she died on that day about noon. 

We shall next record a case, followed also, and likewise apparently reheved 
by, erysipelas of the scalp and face, but in which the symptoms at the onset 
were of an entirely different character. In it, as will be seen, the mucous 
membrane of the air-passages, involving not only the larynx and trachea, but 
the remotest air-cells of the lungs, received the invasion. This attack oc- 
curred in the person of Mr. W., a healthy, middle-aged man: this patient was 
likewise seized in the night ; he had, however, retired to bed unwell, having 
complained of what he considered a catarrhal affection for several days. I 
saw him at 4 o'clock, A.M., and found him sitting up in bed considerably 
distressed. He complained of pain in the fauces, stiffness of the neck, some 
dyspnoea, and severe pain low down on the right side of the chest. His 
voice was hoarse and cracked, and he breathed like a patient with pleu- 
ritis. Unable to remain recumbent but a few moments at a time, he was 
constantly rising for the purpose of clearing his throat, which he did with 
a violent expiratory effort : and he discharged quantities of frothy mucus. 
There was no redness or ulceration in the throat ; the fauces presented at 
that time that appearance to be hereafter described as pathognomonic of 
the disease. He could not be said to cough, but that symptom was evi- 
dently replaced by frequent violent expiratory efforts, plainly to dislodge 
the mucus so freely secreted by the lungs, the presence of which being 
evidenced by audible wheezing. The pain in the side was obviously 
the result of pleurodynia simply, and he was suffering under symptoms 
similar to an attack of acute bronchitis, very much resembhng the form of 
that disease which frequently supervenes an attack of measles. Accom- 
panying these symptoms there was an extremely unsteady, frequent pulse, 
and his tongue had a coating of viscid shme. 

It being unnecessary for our present purpose to give a further account 
of this case, we may only add that the distress in the lungs and the throat 
affection were the prominent symptoms for ten days, when they disap- 
peared, or at least were overshadowed by the intervention of a still more 
alarming state of things. Partial coma then came on with low muttering 
delirium ; symptoms which were in turn most happily relieved by the 
appearance of erysipelas of the face, which took place on the thirteenth 
day of the attack. The cutaneous inflammation first seized the left ear, 
then advanced across the face to the right ; it closed the eyes, and finally 



1646»] Peebles on Epidemic Erysipelas. ^S 

enveloped the scalp. Of the severer forms of attack this was the most fre- 
quent; I need not add it was always highly dangerous. 

Another case, which we shall next briefly detail, as showing the peculiar 
nature of this disease in first assailing some internal organ, presented fea- 
tures different from any we have yet recorded. It occurred in the son of 
Mr. W., a httle boy of thirteen. He was seized with painful micturition, 
soon followed by chill and high inflammatory fever. There was a profuse 
discharge of mucus from the urethra, tinged yellow, closely resembling gonor- 
rhoeal matter. The age and general character of the child precluded the pos- 
sibiHty of his having that disease ; besides, it was evident that the bladder, 
in its whole mucous surface, was more involved than it usually is in gonor- 
rhoea, at least its early stages. His urine was thick and ropy, leaving on 
standing a dense sediment composed entirely of mucus, which, indeed^ 
constituted more than two-thirds of the matter voided. On the fourth day 
of his attack, the skin covering the prepuce, which congenitally covered 
the glans penis, became red, sensitive and swollen, and in the course of 
the next twelve hours, that covering the whole organ became involved in 
decided erysipelatous inflammation, which afterwards traveled over the 
pubes, down the thighs, and on the abdomen. The cutaneous inflamma- 
tion in this case was different, inasmuch as it was not so deep, the skin 
being only shghtly raised and of a deep erythematic blush, and when it 
reached the top of the thighs, it exhausted itself apparently in the prod uc- 
tion of large phlyctsena, which were exquisitely sensitive, and which 
closely resembled the herpes zoster of authors. This was the only case 
which I saw, in which the disease assumed this form, and I only heard — 
and that from an unprofessional person — of one other, in a boy also. Yet 
it would seem that such cases are not to be regarded as altogether unique ; 
for "this.malady," say Drs. Hall and Dexter, " frequently attacks the mucous 
surface of the bladder and urethra, producing suppression of urine and 
spontaneous hemorrhage from the urethra. Cases were observed," they 
further state, " where the. inflammation attacked the external genitals." 

In the fourth and last case, which we shall cite at length, the symptoms 
exhibited another different form of attack, one which, if not the most com- 
mon, was certainly the less obscure, since it more nearly approached the 
character of erysipelas as described by systematic authors. It is the 
case of Petway, already spoken of, who was a man of intemperate habits, 
although in full health at the time of the attack. This man left home in 
the morning as well as usual, but whilst attending to some business at the 
market, was seized at 10 o'clock, A. M., with a severe pain on the right 
side of the neck, which was confined to a single spot beneath the angle of 
the lower jaw. This symptom was speedily followed by severe chill and 
fever, the feeling of chilHness, however, alternating through the day with 
flushes of heat and faintness. I saw him in the afternoon of the same day» 
and found him complaining only of the pain in the neck, which he said 



34 Peebles on Epidemic Erysipelas. [Jan. 

was excruciating. His complaint of this symptom was so disproportionate 
to any cause I could detect as likely to give rise to it, there being neither 
redness nor swelling, nor alteration in any way from its natural condition, 
that I was led strongly to doubt the accuracy of his statement. There was 
at that time, however, one thing which clearly diagnosed the disease as 
erysipelas ; it was a profuse secretion from the fauces, posterior nares, 
and salivary glands, and the constant spitting resulting from it, although 
he then complained of no soreness of the throat. This symptom came on the 
next day, attended by considerable distress about the larynx. On the 
third day, the pain in the neck continuing all the while, erysipelas ap- 
peared. The cutaneous inflammation was first observed, covering exactly 
the spot occupied from the first by this pain in the neck,* whence it after- 
wards slowly traveled up on the face and scalp. 

The traits of these individual cases will convey a very accurate idea criT 
the general character of the symptoms, the nature, and the diagnostic 
marks of this epidemic, as it appeared in Petersburg. Of course in many 
cases the symptoms were not so distinctly set forth, whilst in others they 
were but partially exhibited, and others again possessed a combination <^ 
many of these most distinctive characteristics. But the above analysis 
does not comprise all the phases which the disease assumed ; for occasion- 
ally it may be further added, cases occurred which were followed, too, and 
apparently reheved, by the external disease, which were wanting in any of 
the characterizing symptoms above mentioned. 

In them the whole system was oppressed, and there was no manifestation 
of local disease. 

The disease was certainly not the less dangerous on this account, as the 
attacks were protracted and difficult of management. The characterizing 
symptoms in such cases were lassitude, great restlessness, and a disposition 
to syncope on slight exertion ; in them the whole system seemed oppressed 
with the struggle to ehminate the morbid poison, the pulse being quick, 
thready and feeble, and the state of the skin variable. Such attacks were 
always protracted for two or three weeks ; during that time the symptoms 
bore a striking analogy to those of typhus fever. That these typhoid 
symptoms were but the result of the oppression, and the difficulty of elimi- 
nating the morbid poison to the surface, is rendered highly probable, by 
the fact, that frequently when this occurred, when the cutaneous inflam- 
mation appeared, or was about making its appearance, reaction came on, 
changing entirely the character of the fever to a synochal grade, often 



• How strikingly are the views expressed by Dr. Billing {First Prin. Med.), con- 
firmed not only by this fact but by what takes place in the throat, to be hereafter de- 
scribed : namely, pain long before there is any trace of diseased action. *' When the 
disease (erysipelas), says he, is about to appear, the part becomes painful long be- 
fore there is any redness ; it begins in fact with lesion of the nerves. 



1846.] Peebles 01% Epidemic Erysipelas, ^ 

requiring active antiphlogistic means for its management. Instances of 
this sort several times occurred in my practice, and the following sketch of 
a case prepared by Dr. French, of this town, still further confirms the fact. 
It occurred in a little girl aged seven, who had lain in the same bed with 
her mother confined with erysipelas of the face. For twelve days her 
symptoms — low typhoid fever, and great prostration — were extremely unfa- 
vourable when erysipelas appeared on the abdomen. Immediately after- 
wards the fever became synochal, requiring rather active antiphlogistic 
measures at first, and remained so during the three weeks which the exter- 
nal inflammation lasted, it finally terminating on the shoulders. Although 
assuming this obscure type, there were always certain symptoms in these 
cases, even in their early stages, which unerringly pointed out their true 
nature, at once affiliating them with the epidemic. This, therefore, leads 
us to speak of the particular symptoms peculiar to the disease. Before 
doing this, however, we will make a brief summary of the facts which are 
elicited in the course of the above remarks. 

The disease, it has been shown, presented three distinct varieties, or grades 
of violence, according to the circumstances attending each particular case. 
First, there was only simple erysipelatous fever, characterized by the pecu- 
liar throat affection, accompanied by enlargement and tenderness of the glands 
of the neck, and stiffness of the cervical muscles. This was the least danger- 
ous form of the disease, and rarely lasted more than from four to seven days. 
Secondly, to these symptoms, usually coming on with a chill of greater or 
less violence, there was after the third or fourth day superadded, the exter- 
nal erysipelatous inflammation, generally on the face and scalp. In these 
cases the disease was much more dangerous and severe, and the patient 
rarely recovered under from three to five weeks. Thirdly, the disease 
assuming totally different features, much increased in severity and danger, 
was first manifested in the form of severe inflammatory action located in 
some important internal organ, which symptom was only ultimately 
relieved by the appearance of the cutaneous inflammation. This was the 
most malignant and fatal form of attack, and from which recovery rarely 
took place under from seven to nine weeks. 

In relation to the seat of the internal disease in these cases a few words 
are required. 

According to our observation, it was always located in the internal 
mucous membranes, and the cases which we have detailed above, prove 
that it was liable to seize that membrane in the lungs, including the 
larynx, as well as the minute bronchial ramifications, the stomach and 
bowels ; arid lastly, the bladder and urethra. I saw no case where it 
spontaneously seized a serous membrane ; excluding, of course, the two 
attacks of peritonitis occurring in child-bed women, which we mentioned. 
The disease, however, is reported as occasionally seizing this membrane 
spontaneously, as the pleura and peritoneum, and such cases are reported 



36 Peebles on Epidemic Erysipelas. [Jan. 

as being generally fatal. A review of the nature of the disease will easily 
satisfy one that this last result is highly probable. The efforts which the 
mucous membrane made to relieve the diseased action in its structure, by 
pouring out a copious secretion from its whole surface, cannot fail to have 
struck the reader of these remarks, and could but be noticed by all atten- 
tive observers of the disease. Whether assailing the throat, the lungs, 
the stomach or the bladder, the discharge of mucus from the diseased 
surface was always enormous. Now it is easy to see that no such advan- 
tages could occur when a serous membrane was assailed ; hence, unless 
speedily relieved, cut short in its very onset, an attack of pleuritis, peri" 
carditis, peritonitis, preceding this disease, would be Hable to run rapidly 
into copious effusion, or disorganization of the structure assailed ; either 
result being attended with, under the circumstances, nearly equally fatal 
consequences. 

Resuming an account of the particular symptoms peculiar to the dis- 
ease, we will first treat of one — and the only one which always attended it, 
whatever might be the form assumed. I allude to the throat affection. 
In the mildest form of the disease, as we have before said, this was the 
chief symptom complained of; in the severe and mahgnant attacks, it was 
one of the most formidable complications. In simple erysipelatous fever 
there was always much pain in the fauces, which was jorecec^ec? and accom- 
panied by a free discharge of frothy saliva, and there was pain, attended 
by difficulty in swallowing. The pain in deglutition was always referred 
to the larynx, and seemed to result from the motion of the organ during the 
act. Now in all attacks of the disease, considering the amount of distress 
complained of, which w^as always urgent when the attack was likely to 
prove severe, the throat, in the onset, presented a surprising freedom from 
all apparent traces of disease. A few vessels, more distinct than usual, 
might be seen coursing in bundles over its mucous surface, but this mem- 
brane in its whole extent, if altered at all, wore a paler and more lax 
appearance than was natural. One thing was always to be observed in 
this condition of the throat, even at the earliest moment of which complaint 
was made respecting it, and which we considered in itself an excellent 
diagnostic mark of the disease, at once sufficient to distinguish it from all 
other forms of anginose affections — a point of no little importance in the 
beginning of the complaint. It was this, the uvula, singularly relaxed 
and elongated, was always observed to have suspended from its extremity 
a pellicle of viscid limpid mucus, sometimes resting on the tongue, which 
could be with difficulty removed by the efforts of the patient to clear the 
throat, or by the use of a sponge to clean the fauces, and, when displaced, it 
was almost immediately reproduced. The condition of the mucous mem- 
brane of the throat, taken into consideration, as just referred to, the cause 
of this phenomenon is perhaps sufficiently obvious ; it certainly is peculiar 
to this form of anginose disease, and in the early stages one of the best 



1846.] Peebles on Epidemic Erysipelas. 37 

means of diagnosing it. The above condition of the throat, with the pain 
in the fauces, and the free saHvation which oftener preceded any distress, 
and always accompanied the whole affection throughout, constituted the 
first, and in mild cases, the only stage of anginose disease pecuHar to this 
epidemic. But in severe cases, as the disease wore on towards a termina- 
tion in cutaneous inflammation, the whole mucous surface of the fauces, 
extending, doubtlessly, from the symptoms, into the posterior nares, became 
xjovered in patches with minute white vesicles, surmounted on a dark red 
base, which exhaled an acrid viscid secretion of a dirty, and in malignant 
cases, offensive mucus. The amount of irritation which was created by 
this matter was always distressing; the disease in many cases was to be 
at once recognized by the constant hawking, and violent expiratory efforts 
which it created in the patient for its dislodgment. In malignant cases, 
the whole fauces, the mucous membrane of the mouth and tongue became 
of a dark purple hue, the secretions exhaling an exceedingly offensive 
odour, and there was great difficulty in opening the mouth. 

Respecting the symptoms of the first stage of the throat affection in this 
disease, so important for its diagnosis, some additional remarks are required. 
It is clear, from the above account of them, that these can be legitimately 
divided into two distinct classes. The first, to consist of the free discharge 
of saliva; the second, of the state of the throat as it regards pain in the 
fauces, &c. &c. Now when the two were not present in the early 
periods of the attack, one or the other always was ; hence there was inva- 
riably furnished a ready means of discriminating in their earliest stages 
all such attacks as we have above referred to, in which the disease was 
unattended by its ordinary characteristics. In these cases, therefore, 
where the disease was preceded by a protracted fever of a typhoid type, 
these means of diagnosis became of great value. In the first or second 
week of these attacks there was rarely any complaint of the throat or 
fauces, but there was always a constant spitting and an inordinate dis- 
charge of frothy saliva. The disposition to clear the throat and to spit 
was irresistible ; and one of the first things calculated to strike the practi- 
tioner, when called to a case of this sort, was the quantity of frothy mucus 
in the vessel, which the patient kept near for this purpose. 

The initiatory chill next claims some remarks. That this was not 
always present, two of the cases which we have above reported, sufficiently 
prove ; nor can we corroborate the remark of Dr. Allen, (whose admira- 
ble paper on this disease in the Boston Medical and Surgical Journal has 
only been met with since a greater portion of the above was penned,) who 
says, that the severity of the attack might be estimated by its length and 
violence. 

In the majority of cases which we attended, this symptom, if present, 
was not distinctly marked. It was evident in every case of the disease, 
that the function of the skin was strangely disturbed, and in no manner 



38 Peebles on Epidemic Erysipelas. [Jari. 

was this more marked than in its morbid sensitiveness to external impres- 
sions. In the majority of severe cases, whatever might be the form of 
attack, for the first two or three days, the patient's condition was one alter- 
nating between a feeling of chilliness and disagreeable flushes of heat ; the 
slightest contact of air with the surface, as that induced by a removal of 
the clothing, would induce the former, whilst on replacement of the same 
covering, the latter would be complained of. 

A distinctly marked initiatory chill, however, did occur in many casesj 
and in some it was attended by an additional peculiarity ; namely, a tend- 
ency to periodicity, taking on, in fact, the form of a regular intermittent, 
and was only checked by the administration of quinia. The cutaneous 
inflammation is the last symptom of this epidemic which we shall notice. 
Its chief characteristic consisted in its unusual severity. When attacking 
the face — where, indeed, in a majority of cases, it appeared— ^the counte- 
nance became horribly distorted, and so deep was the inflammation, that 
the cellular tissue became frequently involved, and convalescence was often 
accompanied with the formation of abscesses under the eyes and throat. 
The disease was liable to attack the eyes in their entire structure, and in 
some cases the organ actually bursted, discharging its humours. A case of 
this kind, involving one eye, occurred in the practice of Dr. R* E. Robin- 
son, of this town. 

There is one other peculiarity of the disease which thus fair I have omit- 
ted to mention, and although it is one not unnoted by systematic writers 
on erysipelas, yet I deem it of so much practical importance viewed in 
connection with this dangerous epidemic, that, to keep it constantly before 
the minds of practitioners, I cannot refrain from adding a few words. I 
beheve that I would not be saying too much, when I assert, that two-thirds 
of those who fell victims to this epidemic perished from the result of this 
singular trait of the disease. I allude to its exceedingly treacherous cha- 
racter. We have before laid it down as a rule, that no case of the disease 
whose onset was characterized by severe and protracted inflammation of 
some important internal organ — to which we may now also add those 
attacks accompanied by a continued oppression and disturbance of the 
vital powers — ever permanently recovered without the appearance of the 
cutaneous disease. All cases, therefore, of apparent convalescence under 
these circumstances (far from being unfrequent), without this result, were 
to be viewed with the greatest distrust; since a fresh and violent outbreak 
of the disease was liable, suddenly, to occur either in the same or another 
important organ. Two striking instances of this took place in the writer's 
practice, and he heard of a number of others. A young lady, whom it 
assailed in the form of a severe bronchitis, was confined three weeks with 
the epidemic, when the symptoms gradually dechned, the fever left her, 
her appetite and strength began to return, in every respect she seemed 
convalescent ; and after still watching her a day or two longer, I left her, 



1846.] Peebles on Epidemic Erysipelas, 9i 

satisfied that her recovery was complete. But late in the evening of that 
very day I was summoned in some haste to visit her. An attack of acute 
laryngitis had suddenly supervened, and I found her in an extremely 
alarming and dangerous condition. 

The most active treatment (as blood-letting, emetics, and blistering the 
throat), was required, yet there was no permanent relief until the third 
day, when the erysipelas of the face appeared. Another patient had 
three separate attacks of acute laryngitis, at intervals of from ten to twelve 
days between each, during which time so perfect was his convalescence 
that he resumed his usual employment. Each seizure was accompanied 
by the general characteristics of the epidemic, and the last attack was fol- 
lowed by erysipelas of the face, since when his health has continued per- 
fect. It is to be regretted that we cannot further illustrate the nature of 
this disease by a reference to post-mortem appearances. The writer had 
the good fortune to see but few fatal cases, in all of which the circumstances 
precluded the possibility of the investigation. 

With this record of facts, touching upon the nature and the general and 
particular symptoms of this epidemic, and which conveys at the same time 
some useful hints respecting its means of diagnosis, we shall next pass on 
to add some iew remarks respecting its mortahty and prognosis. Though 
so formidable in its character, and when existing in other places, even in 
other portions of our own state, so maHgnant and rapidly fatal in its tend- 
ency, yet in Petersburg, the mortahty from this epidemic, it can but be said, 
was far from being great. From the best information we could obtain, its 
rate of mortality, if placed at one in twenty of those who had the disease, 
will certainly not fall below the mark ; yet the disease was truly a formi- 
dable one, and the favourable issue of every case had its contingencies ; the 
prognosis, therefore, was always to be considered as more or less doubtful. 
In relation to this point, the writer's previous remarks prove that he coin- 
cides with Dr. Allen, who states, in his paper before referred to, " that 
when the manifestations are external, and the disease of the skin does not 
recede, there was but little or no danger to be apprehended." I have 
before dwelt upon the fact, that the external inflammation invariably took 
place in all the most severe and mahgnant cases of the disease, and that 
the symptoms of the internal affection were relieved or were speedily re- 
moved by the result — it invariably was the case in my practice. But the 
rule regarding the patient out of danger after the breaking out of erysipe- 
las is only to be considered a general one, since several deaths occurred in 
town, I am informed, after that result. 

Perfectly wilhng as I am to believe, a priori, that such a thing would 
influence the result and modify the disease, yet my experience in this epi- 
demic has taught me, that the state of the constitution, and the previous 
bad health of the patient had but httle to do with the disease ; it seemed to 
run regularly its course despite these circumstances, maintaining its owa 



40 Peebles on Epidemic Erysipelas, [Jan. 

character distinctively throughout. I attended two well-marked cases in 
chlorotic females who recovered, and one of my patients had the disease and 
did well — the eruption seizing the face and scalp — during an attack of deli- 
rium tremens. Nor did locality seem to exert any influence upon its cha- 
racter, the disease, without being more fatal, presenting in Blandford, a 
highly malarious district, the same distinctive features which it wore in 
Petersburg, which is comparatively exempt from such an influence. 

During convalescence from severe attacks of the disease, the cuticle 
covering the whole body desquamated, accompanied with a falling off' of 
the hair. But for all these evils the patient received some compensation ; 
this consisted in the thorough and healthful manner in which the constitu- 
tion was renovated by an attack of the disease. All of my patients, some 
of them hitherto invalids, have become healthy and robust, perfectly and 
marvelously freed from their old ailments. 

We hasten to bring our paper to a close by subjoining a few remarks 
respecting the method of treatment which was employed in this epidemic. 
Of course, according to the various aspects it wore, was this diversified ; 
generally, however, it may be added, the antiphlogistic plan was adopted. 
In simple erysipelatous fever unattended by local disease other than the throat 
affection, we found an emetic of tartarized antimony to answer best in the 
beginning ; indeed, in most cases, this, followed by a mercurial cathartic 
when the state of the secretions required it, and a strong counter-irritant to 
the throat, together with the internal sponging of the fauces when there 
was much soreness, with a strong solution of argent, nitrat., (ten grs. to the 
oz. distilled water,) was found amply sufficient for the treatment of such 
attacks. In severe cases, leeches in the beginning of the disease were 
apphed to the throat with benefit, but later in the attack blistering was 
greatly to be preferred. I may here remark, that I found bhstering the 
throat superior, in its certainty and promptness of relief, to all other methods 
of treating the anginose, or the sudden laryngeal attacks peculiar to this 
disease. Because of the unpleasant nature of the remedy, leeching was 
occasionally substituted, but experience taught me never to rely upon their 
application, where a decided and prompt effect was necessary for the safety 
of the patient. No amount of blood topically drawn from this region 
seemed to give anything like the relief which speedily followed the inflam- 
matory action on the surface, created by a Mister. Objection has been made 
to blistering the throat, and particularly in this disease, yet the writer 
saw no unpleasant consequences attend their application ; on the con- 
trary, everything encouraged him in their early employment ; for in many 
cases a blister not only relieved the throat, but still further promoted the 
patient's welfare by bringing out on the surface the erysipelatous inflam- 
mation, a result which I need hardly now say was always desirable. Its 
good effect in this way was strikingly exhibited in the case of an old lady 
whom Dr. Michie saw with me ; her attack assuming the low typhoid 



1846.] Peebles on Epidemic Erysipelas, 41 

type, before referred to, had lasted more than two weeks without pros- 
pect of amendment, when, for the increasing disease there, it was deter- 
mined to blister the throat. At the second dressing of the bhster, erysipe- 
latous inflammation was observed traveling upwards from the edge of the 
bhstered surface ; it rapidly overspread the face, and there was an end to 
further trouble in the management of the case, since her recovery was gra- 
dual and progressive from that time. Returning to the question of its 
general treatment, the management of the disease, when manifesting itself 
in severe and protracted inflammation in some important internal organ, 
next claims our attention. Here, again, it must be obvious, that the par- 
ticular treatment was to be varied according to circumstances ; and here, 
again, we may remark, that that general plan which gave us the most 
satisfaction was the antiphlogistic one. The indications were obviously, 
first, to abate and control the violence of the local disease ; secondly, to 
restore the healthy action of the skin ; thirdly, to correct the vitiated secre- 
tions ; and fourthly and lastly, to promote the patient's comfort by proper 
attention to the cutaneous inflammation when it appeared. 

The most rigid antiphlogistic plan was often required to answer the first 
indication ; indeed, to control the violence of the local disease, blood-letting 
became, sometimes, the best and most eflicient remedy, and occasionally 
we found its use necessary to abate the violence of the general inflamma- 
tory action. The use of the lancet in this disease required the greatest 
discrimination and care, so much so, that many interdicted its employment 
altogether. Our views upon this question can be easily stated. It has been 
before clearly shown that these internal inflammations required for their 
relief, and that they were often only permanently relieved by, the revulsive 
effects of the external cutaneous disease. This internal disease, therefore, 
seemed but a type of that which should be without ; — the disease here 
had been jostled from its legitimate course : and hence the whole attack 
seemed but a struggle to replace this derangement ; but a deep effort of the 
system to eliminate the morbid poison on the surface where it belonged. 
It is clear, therefore, that no power of medication, however well directed, 
that no degree of depletion, however actively or wisely pursued, could effect 
this desirable result, nature evidently having to accomphsh it in her own 
good time. But how if nature failed, how if the suffering organ gave early 
evidence of its own disorganization, or the symptoms betokened that life 
itself was in immediate jeopardy through the disturbance of its own proper 
function ? — It was here, under circumstances like these, that bleeding be- 
came at once the best, and, indeed, the only remedy, in many cases likely 
to do good in the treatment of this epidemic. When thus indicated, we 
freely resorted to it in several cases ; in a single one we never had occa- 
sion to regret its employment. But its employment required discrimina- 
tion ; unlike its use in pure idiopathic inflammation of the same internal 
organ or organs, it should here be resorted to for the rehef of symptoms, to 



43 Peebles on Epidemic Erysipelas. [Jan. 

remove an impending danger, rather than with a view to an eradication of 
the disease. We hold, therefore, that the indiscriminate use of the lancet 
in this disease would have been as absurd and mischievous as its total in- 
terdiction was unwise. In a majority of cases it certainly was not required, 
and when indicated, the rule guiding its employment was the same every 
one follows in the treatment of acute diseases. Whenever the symptoms 
were urgent, betokening that either the suffering organ was hastening to* 
wards disorganization, or that life itself was in jeopardy through the dis- 
turbance of its own proper functions, and there was nothing in the pulse 
positively contra-indicating it, I drew blood until an evident impression was 
made on the circulation, whatever might be the stage or period of the dis- 
ease. Again, where it was important to subdue high inflammatory action 
with a full tense pulse, even without the above conditions, I bled my patients, 
and they always seemed the better for the operation. Bleeding was only 
called for, as I have just intimated, in a small minority of cases ; but when it 
was, and the opportunity was not embraced, I can but believe that the 
patient became a sacrifice. Old, I need not say as Sydenham, it is no 
new thing for me to declare that it is my firm belief that many of these 
symptoms of putrescency of the fluids, marking the last stages of fatal 
cases of this disease might have been prevented by a timely recourse to 
the lancet : in most of my patients after bleeding the disease progressed 
satisfactorily; but this was not always the case. We have said that the 
disease was one not to be cut short by active treatment ; the lancet, there- 
fore, being but a choice of evils, its requirement in any case, for two obvious 
reasons, was always unfortunate. It in the first place implied the danger- 
ous and malignant character of the attack ; in the next, whilst it removed 
immediate danger, its ultimate result might be disadvantageous, since the 
system, weakened by its employment, has still to bear the course of the dis- 
ease and to eliminate the morbid poison. What practical lesson does this 
impart ? — Clearly that the first tendency to sink in the system after blood- 
letting should be met by appropriate treatment. In the case of Mr. W., above 
reported at length, bleeding was resorted to on the eleventh day of the 
disease to save the brain ; it had the desired effect, but it was necessary 
in a few hours to give him quinia freely, to prevent the tendency to col- 
lapse, which was kept up daily until convalescence was established. The 
sedative influence of tartarized antimony was of more universal application 
in this disease. In all cases where the stomach and bowels remained unaf- 
fected, I employed this remedy with great advantage ; when the air-pas- 
sages were involved, indeed it was indispensable, and to relieve high 
inflammatory action without local disease, it was generally amply sufficient. 
The pulv, ipecac, comp. was a valuable diaphoretic in this disease. In 
the day it was administered with the antimony ; at night calomel, ac- 
cording to the end required, was generally combined with it. Purga- 
tives could rarely be administered with benefit ; indeed, active catharsis, 



1846.] Peebles on Epidemic Erysipelas, 4$ 

from the nature of the disease, could but be detrimental, since the revulsive 
effect in the bowels was likely to interfere with the eUmination of the dis- 
ease on the skin. Laxatives were preferred, therefore, to keep the bowels 
in a proper condition, without designing to produce anything like a spe- 
cific effect; full doses of the mild chloride hydrarg., repeated according to 
circumstances, were generally required at the commencement of every 
attack to correct the vitiated secretions generally. In cases similar to that 
of Mr. v., where the stomach and bowels received the invasion, accompa- 
nied, as they usually were, by great derangement of the biliary organs, 
full doses of calomel and opium, at intervals of from four to six hours, were 
administered until the symptoms gave way. Laryngitis and bronchitis in 
this epidemic were met by the ordinary methods of managing these affec- 
tions ; namely, by blood-letting — when positively required — emetics, free blis- 
tering, and the use of tartarized antimony, with a view to its expectorant 
and sedative effects. In the attack characterized by protracted typhoid 
symptoms, no active treatment was employed ; anodynes were adminis- 
tered at night, with laxatives during the day, if required, with cold drinks, 
&c. Q,uinia was occasionally administered when the oppression was 
great, and we always found its effects improved by combining it with the 
cold infusion of eupatorium perforatum. 

Having, by the judicious use of these remedies, according as they were 
indicated, conducted the disease to the period of the appearance of the cuta- 
neous inflammation, but little further treatment usually became necessary. 
Measures to secure sleep at night, attention to the state of the bowels 
and proper nourishment, were the chief indications which then arose, 
except the proper attention to the external cutaneous afl^ection. The suf- 
fering from this was always great. Nothing seemed to have any power 
in arresting its progress. Pledgets of linen soaked in alcohol and laid 
over the inflamed surface, constitute a favourite method of managing this 
symptom. The comfort from any appHcation was only temporary; we 
tried various ones ; and if any one was possessed of advantage, we should 
say it was the solution of the argent, nitras, in proportion of four grains to 
the ounce of distjUed water. Leeching to the sound skin was accompa- 
nied with temporary benefit ; all unctuous substances seemed to increase 
the discomfort of the patient ; free exhalation from the skin being neces- 
sary to relieve the intolerable burning heat in the inflamed part, and 
hence cooling apphcations, or an evaporating liquid like alcohol, were great- 
ly to be preferred. 

With a brief allusion to another remedy which we found beneficial in 
certain cases of this disease, we will conclude our subject. In a narrow 
and fikhy alley, among the squalid and ill-fed children of some extremely 
poor people, I had several cases of erysipelas of a pecuHar character. It 
assumed the erratic form, traveling over the face, body and limbs very 
slowly, and was accompanied with, low typhoid symptoms and great ema- 



44 Brigham's Sequel to the case of the Removal of Intestine. [Jan. 

ciation ; as the disease would leave a portion of the body, large cold 
abscesses would follow, suddenly formed in the cellular membrane ; as 
many as nine of these were opened in one child aged one and a half years, 
with a great discharge of pus. In two of these cases, after the third week, 
the child greatly emaciated, the cheek became eroded, presenting in fact 
the gangrenous erosion of Drs. Dease and Underwood. 

According to the suggestion of Dr. Hunt, of Manchester, Eng., the chlo- 
rate of potassa was prescribed with great benefit in these cases ; and con- 
trary to my expectations, both recovered, leaving a deep fissure in the 
cheek where the ulceration had existed. The effect of this remedy was to 
increase the appetite and to improve the secretions ; under its use the 
tongue became moist, the skin, hitherto harsh and shriveled, became natu- 
ral, and the bowels regular. In all such cases of this disease, therefore, 
we feel that we cannot too highly recommend this remedy. 



Art. IV. — Sequel to the case of the Removal of seventeen inches of the 
intestine and the Recovery of the Patient, published in the American 
Journal of the Medical Sciences, April, 1845. By A. Brigham, M.D., 

Superintendent of the State Lunatic Asylum, Utica, N. Y. 

The readers of this Journal will recollect the case referred to. I wish 
now to inform them that the patient died on the 2d day of April, 1845, 
about six months after the removal of the intestine, which occurred, Octo- 
ber 24, 1844. The patient, Mrs. W., was able to be about the house and 
to work some until the 1st of March, when her strength and flesh began to 
fail, and she complained occasionally of sickness of the stomach, and pain 
and tenderness of the abdomen, which was somewhat bloated. The bowels 
continued regular, though with some tendency to diarrhoea, which was 
easily controlled by enemas of laudanum. Her death was not preceded or 
accompanied by any remarkable symptoms, and had we not known of the 
injury, should not have thought that her illness and death presented any- 
thing particularly singular, as many patients that have been long insane, 
die with diarrhoea and symptoms such as we witnessed in this case. 

Autopsy. — On examining the body after death we found the membranes 
of the brain highly injected and thickened. The cortical portion of the 
brain was harder than natural, the medullary injected and of a grayish 
colour. The phrenological organs of hope were small, while destructivenes^ 
and cautiousness were very large. 

The abdomen was considerably distended, and on being opened a quan- 
tity of yello ish serum with fioccuK of pus was observed within the cavity. 

The peritoneal membrane in the region of the wound was highly con- 



1846.] Kneeland on the Contagiousness of Puerperal Fever, 45 

gested, thickened and adherent to the intestines, which in many places 
could not be separg.ted from each other, but with considerable difficulty. 

The portion of the intestine removed at the time of the injury was found 
to be the colon : it having been divided about four inches from the entrance 
of the small intestine. The divided portions were drawn together at the 
place of injury and united by organized lymph, which also connected the 
intestines to the parietes of the abdomen where the wound was made. 
The passage between the divided ends of the intestine was small and 
crossed by a few ligamentous-like bands — but still large enough to permit 
the passage of semi-liquid feces. 

Judging from the size of the intestine removed, which was diminished 
by being drawn out at a small opening, we had erroneously supposed, 
without particular examination, that it was a portion of the small intestine, 
and so stated in our former communication. 

Utica, Nov, 15, 1845. 



Art. V. — On the Contagiousness of Puerperal Fever, By Samuel Knee- 
land, Jr., M. D., of Boston. 

Having arrived, often after numerous inconveniences and even dangers, at 
the ordinary term of pregnancy, many women, at the moment of enjoying 
the "sweet prerogative" of being mothers, are still far from having no- 
thing to fear from the interesting and painful function which they have 
fulfilled. It is but too common to see them, at this period, fall the helpless 
victims of a complicated, fearful disease ; which, from its being developed 
in the puerperal state, has received the name of puerperal fever. Of so 
fatal a nature is this affection, that, in some of the epidemics of Paris, Lon- 
don, Dubhn and Edinburgh, hardly one in thirty of those seized with it 
recovered. To combat this Protean disease, all the resources of medicine 
have been often tried in vain ; the very multiplicity of the means employ- 
ed attests their want of success. 

But, it may be asked, what is this disease known by the name of puer- 
peral fever ? 

We shall not here enter into the consideration of the various theories 
which have been entertained on this subject; these will find a more appro- 
priate place hereafter. Some have objected to the term " puerperal fe- 
ver," as conveying no idea to the minds of those not familiar with the 
disease ; indeed, since morbid anatomy has of late years so absorbed the 
attention of physicians, constant attempts have been made to localize the 
disease in question. Having been supposed, from the time of Hippocrates 
to that of Boerhaave, to be dependent on an inflammation of the uterus, it 

No. XXI. January, 1846. 4 



46 Kneeland on the Contagiousness of Puerperal Fever. [Jan. 

was afterwards localized in the peritoneum by Johnston, in England, Wal- 
ter, in Prussia, and Bichat, in France; and the name of peritonitis was 
given to it. Then as inflammation of the uterus was found combined with 
that of the peritoneum, the name was changed to metro-peritonitis ; metri- 
tis was the next appellation ; then uterine phlebitis, pus having been found 
in the veins of the uterus ; as this was sometimes found only in the lym- 
phatics, it was hence called lymphangitis ; others, especially the Germans, 
(with Boer at their head,) discarded all these as false, and substituted 
putrescence or softening of the uterus ; this again did not satisfy the French 
pathologists, who, having met with pus in the cellular tissue, in the viscera, 
and the articulations, without lesion of the uterus or peritoneum, came to 
the conclusion that it was a purulent fever, which is the prevailing opinion 
in the present French school. Thus, by attempting to localize and sim- 
plify, this system has only rendered still more confused and difficult this 
important subject. Each observer has described faithfully his epidemic ; 
each has been so far in the right : but all have been wrong in maintaining 
that the type of disease observed by them was the true type of puerperal 
fever, to the exclusion of all others. To avoid this confusion, then, which 
has a direct bearing on the subject of contagion, we shall consider puerpe- 
ral fever as a general diseased condition of the system, which may at one 
time manifest itself by a peritonitis, at another by a phlebitis, &c. The 
term puerperal fever is, we think, the best, as it conveys a sufficiently clear 
idea to the minds of all : which could be conveyed by none founded upon the 
different anatomical lesions found after death — and besides it is not confined 
to any one theory. 

The history of the disease is very imperfect in the old authors ; and it is 
not till the middle of the 17th century, when it occurred as a malignant 
epidemic at the Hotel Dieu, of Paris, that it seems to have occupied the 
attention of physicians to any great extent. Since then, it has continued 
to rage with more or less severity, so that it has been constantly before the 
medical world. It is allowed by all that there is an epidemic spread of 
this affection ; but it is not by any means a universal opinion that it may 
become contagious. 

This brings us to the subject of contagion, the most difficult question, 
perhaps, in medicine ; and one which will forever remain a question to those 
who require mathematical proof before they can yield assent. 

There have been usually admitted three causes in accounting for the 
spread of epidemic diseases in general : some peculiar miasm existing in 
the atmosphere ; some telluric emanation ; or effluvia generated in the 
human body, and capable of exciting disease in a healthy individual. We 
do not think that any one will maintain that puerperal fever originates from 
any limited, or diffused telluric emanation, as it is not confined to certain 
localities, resembhng one another in any respect ; but, on the contrary, it is 
met with in districts the most dissimilar in all respects ; (excepting that it 



1846,] Kneektid on the Contagiousness of Puerperal Peder. 4T 

becomes more rare, as we approach the tropics). We have, then, left the 
trnknawn atmospherical condition which causes its epidemic spread and 
contagion ; the former needs no discussion here. 

B-efore proceeding to enumerate the reasons for our belief in the conta- 
gious character of this disease, it will not be amiss to state briefly what we 
mean by the different forms of contagion. Very nice distinctions are to be 
found in various authors between contagion and infection, which need not 
be insisted on in treating of an affection where both probably operate ; in 
fact, contagion is used by many as including infection. Dr. Elliotson 
remarks, that " the word * contagious' is used in the same way as the term 
* horse.' The latter is used to include both a horse and a mare ; but it is 
frequently applied to the male only ; and so these diseases are all continu- 
ally spoken of as contagious ; but the word ^ contagious' is also employed 
in a limited sense, to signify those diseases which are communicated by 
actual contact ; or by touching something which the patient has touched ; or 
something which has palpably proceeded from him." 

There are, then, two ways in which diseases may be communicated 
from one individual to another, contagion and infection. When the sick 
exhale miasmata, which, by traversing the air, excite the same disease in 
a person before healthy ; or v^hen they secrete a matter which will pro- 
duce the like effect by direct contact either with it, or things impregnated 
with it ; contagion is said to exist — when the same deadly influence is 
exerted by an infected place upon a mass of sound individuals, infection is 
said to operate. Contagion supposes, therefore, a disease transmitted from 
a sick person to a sound one ; w'hile infection generally arises from animal 
or vegetable matter in a state of putrefaction. Those contagions, in which 
the atmosphere is the means of communication, are alone Hable to be con- 
founded with infection ; and this is precisely the case with puerperai 
fever. Contagion, when once produced, has no need of the causes which 
gave it birth ; it, in a manner, reproduces itself, and is independent, to a 
certain extent, of atmospherical conditions : while infection supposes, from 
its commencement, and during its course, an alteration of the atmosphere ; 
the infected places affect individuals only within their sphere of acti- 
vity, in whom there may be a predisposition ; but these may become so 
many foci of infection, impregnating the air with miasmata capable of 
exciting the disease in the predisposed ; here, infection becomes a species 
of contagion. Some diseases are communicable by contagion alone ; others 
by infection alone ; others by both contagion and infection : as instances of 
the three may be mentioned syphilis, hooping-cough, and small-pox — in 
the latter class we would place puerperal fever. Finally, contagion is 
indicated by a succession of cases, in narrow limits, and during a conside- 
rable period ; while, in infection, there is a simultaneous attack of many 
individuals, and in more extended limits. 

We, then, use contagion as a generic term, signifying the transmission 



4B Kneeland on the Contagiousness of Puerperal Fever. [Jan. 

of diseases from a sick to a healthy person, both by immediate contact, and 
by means of the air, or fomites impregnated by the effluvia arising from 
those afiected. 

Having premised these general remarks, which tho non-contagionists 
have usually overlooked, we shall novf take up the question of the conta- 
giousness of puerperal fever. As it is not the long array of well authenti- 
cated facts which alone will carry conviction to the skeptic, it will be our 
object to present, and, if possible, to invalidate some objections which are 
always made when the contagiousness of this affection is discussed. 

The chief fear of the non-contagionists seems to be, lest, by allowing 
that it may become contagious under certain circumstances, they be forced 
to admit that it is an essentially or uniformly contagious disease. This 
arises from a too prevalent opinion that contagion is a necessary incident 
of a given disease, that it constitutes its very essence ; while, in reality, it 
is a mere accident : the effluvia, or morbid secretions from a diseased body, 
^vhich constitute contagion, are not necessarily a poison to all exposed to 
them ; a predisposition is necessary. M. Michel, and others have gone to 
the other extreme, and maintain that any continued fever, under the influ- 
ence of peculiar individual conditions, and favoured by external circum- 
stances difficult to determine exactly, may become contagious. 

Perhaps if all the authors who have written on this subject were arrayed as 
contagionists, or non-contagionists, the latter would outnumber the former j 
but even admitting that the majority were to decide a disputed question in me- 
dical science, the opinions of the latter require some investigation. Every 
physician who brings instances of the action of contagion, if only a single au- 
thenticated case, makes a real, valuable addition to the mass of facts, while 
he who cites a hundred instances where the contagion did not take effect, 
merely adds a negative fact, having no real value in our present question. 
There may be circumstances of place, intervals of time, and collateral cases, 
which may well explain the seeming inconsistency, even if there were not 
another more satisfactory explanation. Many have supposed that, because 
every one exposed to the contagion is not attacked, therefore the affected 
are not attacked in consequence of their exposure. This most brilliant 
method of jumping at conclusions betrays an ignorance, or a neglect of one 
of the simplest principles in medicine ; viz., that, before any exciting 
cause of disease can exert its morbific influence on the animal economy, 
there must exist a certain unknown alteration in it, a certain susceptibility, 
which is called predisposition : were not this predisposition requisite, every 
one exposed to the exciting causes of a disease should have always that 
disease, and no other; and every epidemic should have completely depopu- 
lated the locality it happened to attack. Like causes produce like effects ; 
but in order that this may hold true, there must be a similarity of circum- 
stances in which the causes are applied. From the complex nature of the 
structures of the human body, and its various functions, acting and being 



1846.]] K-neeia-nd on the Contagiousness of Puerperal Fever, 49 

acted upon by an infinity of agents imperfectly known to us, it must ever 
be impossible to demonstrate the above principle by an appeal to the 
senses ; both parties must then prove, or disprove, approximatively, that ex- 
posure to the contagion is followed by the disease, as the effect follows the 
cause. If it be argued, then, that, because exposure is not always followed 
by the disease, the affection is not contagious, the same arguments would 
equally shake our belief in the contagious character of small-pox, and other 
diseases admitted by all to possess this character. There is no epidemic 
which affects every individual placed within its range ; no sure contagion 
attacking all exposed to it. Inoculation from the same pustule of variola, 
or vaccinia, communicates the disease to one child, and not to another, 
under circumstances as far as can be determined, perfectly similar ; of 
two persons bitten by a rabid animal, one shall be seized by hydrophobia, 
and the other escape ; cohabitation with individuals affected with the itch 
and syphilis, is not invariably followed by these diseases ; courageous phy- 
sicians have inoculated themselves with the matter of the plague with 
impunity, while the poor soldier, less exposed, has contracted it — these 
singular immunities are common to all contagious diseases. To require, 
then, before allowing the contagious character of a disease, that its propa- 
gation should form a continuous, unbroken chain, is to require an impossi- 
bility-; to deny its transmissibility, because it is not infinite, is an absurdity. 
Another point which has much confused this question is the vague sig 
eification of the word " epidemic," which by many is understood as imply- 
ing some mysterious quality of a disease, in virtue of which it attacks a 
great number of individuals. This word means " upon" or " among the 
people ;" a disease spreading over a more or less numerous population. — ■ 
Again, a disease is said to be " epidemic," when its propagation is attri- 
buted to a morbific principle contained in the air. Strictly speaking, the 
term "epidemic" implies a number of persons affected, and not a quality 
of a disease. It is bj the number of patients that such an affection is 
judged to be epidemic ; and it is also by the epidemic quality attributed to 
the affection that the number oi patients is explained — here, then, is a circle 
of confusion, in which the cause becomes the effect, and the effect the 
cause, according to the will or caprice of the observer. For those v^^ho 
consider as epidemic diseases those propagated by a morbific atmospheric 
principle, it will always be easy to make objections to the contagionist, 
unless the proofs are so convincing as to silenco all opposition ; which is 
rarely the case. Whether this double meaning of the word " epidemic" 
should be done away with, it is not our business to inquire at the present 
time — for our part, we do not believe that epidemic diseases are always 
the results of an atmospheric principle, but are frequently, as in puerperal 
fever, the results of contagion — we would not think thie epidemic always 
the cause of the contagion ; for, though in an epidemic, the chances of con- 
tagion increase in proportion to the number of patients, if we analyze most 



BO Kneeland on the Contagiousness of Puerperal Fever, [Jan, 

of the so called epidemics of puerperal fever, we shall see that the order of 
succession of those attacked shows that the epidemic was the effect of the 
contagion. If this can be shown, hne of the strongest arguments of those 
who maintain that the spread of this affection is always owing to an epi- 
demic influence, will, we think, fall to the ground. We would not be 
understood as implying that the disease is entirely independent of epidemic 
and endemic influences ; on the contrary, hke all other contagious diseases, 
it has shown such eccentricities in its occurrence and recurrence in various 
parts of the same district, that it must be allowed that its spread is often 
due to external agents acting upon many individuals at the same time — in 
other words, that it is not exclusively propagated by contagion ; that an 
epidemic constitution is necessary to co-operate with the contagion, before 
it can spread extensively. 

Let us now examine some of the best authors, and see if the succession 
of cases, in a single physician's practice, does not, in the history of almost 
every epidemic, furnish an immense body of incontrovertible evidence in 
favour of the contagiousness of puerperal fever. 

In most contagious diseases, occurring in large cities, it is difficult to 
trace the communication from one individual to another, from the continual 
intercourse carried on ; and therefore, it is chiefly the physicians of such 
large communities who are the strangest opponents of contagion — -but in 
puerperal fever the circumstance of a large population has no relation to 
the question of contagion, owing to the peculiar state of those exposed to 
its attacks. When, therefore, we see this disease occurring solely, or 
chiefly in the practice of a single physician, in a large town, to use the 
expression of Dr. Blundell, " stalking behind him, wherever he goes, like 
his evil genius," we are surely justified in attaching some importance to 
such facts. 

This coincidence has been mentioned by most v/riters on puerperal fever, 
the opinions of som.e of whom we shall now mention. 

Dr. Gordon, in his account of the epidemic which raged at Aberdeen, 
in the years of 1789 to '93, says, that he could foretell what woman would 
be attacked, upon hearing by what midwife they were to be delivered ; and 
that in almost every case his prediction was verified. 

Mr. White, of Manchester, observes, that he is acquainted with two 
physicians who have the whole business of midwifery, in a large town, 
divided between them ; one loses several patients every year by the disease, 
while the other has not a single case. 

Dr. Armstrong in his essay on the Sunderland epidemic, mentions seve- 
ral instances of a similar confinement of the disease to one man's practice. 

Drs. Ramsbotham, Lee, Gooch, Roberton, Hutchinson, Blundell, and a 
host of others, mention the fact of the greater number of observed cases 
occurring in the practice of single individuals, while their medical bxeth- 
rent had no cases^ 



1846.] KneelanA on the Contagiousness of Pueiyeml Fever. 51 

Dr. Holmes (in the N. E. Quarterly Journal of Med. and Surg.), 
speaks of a series of cases in an American Journal, observed by Mr. Da vies, 
who says, " in the autumn (1822) he met with twelve cases, while his 
medical friends in the neighbourhood did not meet with any, or at least 
very few." He also mentions nine cases occurring in the practice of Dr. 
Pierson, of Salem, in 1829 : " Up to this period," says the latter, " I am 
not informed that a single case had occurred in the practice of any other 
physician," admitting, however, that his information may have been defec- 
tive. In a letter addressed to Dr. Storer, it is stated : " About three years 
since, a gentleman in extensive midwifery business in a neighbouring state, 
lost, in the course of a few weeks, eight patients in child-bed, seven of 
them being undoubted cases of puerperal fever. No other physician of 
the town lost a single patient of this disease during the same period." 

In the Ainerican Journal of the Medical Sciences (for Oct., 1842, p. 410), 
is the Gluarterly Summary of the Transactions of the College of Physicians 
of Philadelphia, from which we extract the following : Dr. Condie, having 
alluded to the prevailing puerperal fever of a peculiarly malignant cha- 
racter, observes that, "in the practice of one gentleman, extensively en- 
gaged as an obstetrician, nearly every female he has attended in confine- 
ment, during several weeks past, within the above limits, had been attacked 
by the fever." If it be not contagious, " how otherwise can be explained 
the very curious circumstance of the disease, in one district, being exclu- 
sively confined to the practice of a single physician, a Fellow of this col- 
lege, extensively engaged in obstetrical practice — while no instance of the 
disease has occurred in the patients under the care of any other accouch- 
eur practising within the same district. Scarcely a female that has been 
delivered by this gentleman for weeks past, has escaped an attack." 

These, and many other authorities which might be adduced, prove, be- 
yond doubt, the singular confinement of the disease to one man's prac- 
tice. But how can this fact be explained? We should not wonder at it, 
if occurring in the pestilential wards of a hospital ; but, in private practice 
it is certainly very strange, that the disease should follow precisely the 
steps of one unlucky individual, tracing him far and wide with the cer- 
tainty of a blood-hound. Considering the exceeding rareness of the dis- 
ease (comparatively) even in private practice, it certainly seems impos- 
sible to attribute to mere chance the numerous well-authenticated instances 
of the above fact ; they who can swallow the immense improbability of the 
doctrine of chance in this matter, need hardly strain so much at the 
infinitely less improbability of contagion. 

Clearly connected with the above fact is the question of its propagation 
by being carried by physicians and nurses. The whole question turns 
upon this ; for, although the succession of effects to causes does not abso- 
lutely prove the dependence of the former on the latter, if it can be shown 
that the instances of contagion (supposed) occurred very much more fre-- 



52 Kxieehxidi on the Contagiousness of Puerperal Fever. [Jan. 

quently, (and in many instances solely,) where there was communication 
between a physician and those affected, than where there was no such 
communication, are we not justified, in a measure, in estabhshing the rela- 
tion of causation ? The question of the contagious nature of a disease, 
according to Dr. Alison, (and the same reasoning may be applied to all 
sciences, as well as medicine,) always ultimately turns on a calculation of 
chances. " The question always comes to this — is the circumstance of 
intercourse with the sick followed by the appearance of the disease, in a 
proportion of cases so much greater than any other circumstance common 
to any portion of the inhabitants of the place under observation, as to make 
it inconceivable that the succession of cases occurring in persons having 
that intercourse should have been the result of chance ? If so, the infer- 
ence is unavoidable, that that intercourse must have acted as a cause of 
the disease. All observations which do not bear strictly on that point are 
irrelevant, and, in the case of an epidemic first appearing in a town or 
district, a succession of two cases is sometimes sufficient to furnish evidence, 
which, on the principle I have stated, is nearly irresistible." 

Let us submit this question to the test of Dr. Alison, by quoting the opin- 
ions of some of the best authors. 

Dr. Gordon says, "The disease seized such women only as were visited, 
or delivered by a practitioner, or taken care of by a nurse who had previ- 
ously attended patients affected with the disease. I had evident proofs 
that every person who had been with a patient in the puerperal fever, 
became charged with an atmosphere of infection, which was communicated 
to every pregnant woman who happened to come within its sphere. It is 
a disagreeable declaration for me to mention, that I myself was the means of 
carrying the infection to a great number of women." 

Dr. Gooch mentions the case of a physician who had several deaths in 
his practice from this disease in quick succession ; when thinking he might 
have carried the contagion in his clothes, he changed them, and had no 
more cases. 

Dr. Ingleby, in the Edinburgh Medical and Surgical Journal, (vol. 49, 
p. 415,) observes, that Dr. Campbell thinks that, " unless the practitioner 
has been engaged in the dissection of the bodies of those who have fallen 
victims, the disease cannot be conveyed by him from females labouring 
under it to others recently dehvered." "But the fact of the extension of 
the disease in this manner from the living subject has been most satisfac- 
torily shown by Mr. Roberton. I have repeatedly observed the same 
myself, and have submitted a number of cases in illustration. I have also 
adduced the strongest ground for beheving, that the effluvia derived from 
the body of a woman who died from puerperal fever were conveyed in this 
manner by two practitioners, and rapidly produced the same disease in two 
other females." 

Dr, Blundell, Abercrombie, Rarasbotham, and many others, assert that 



1846.] Kneeland on the Contagiousness of Puerperal Fever,' 53 

the contagion is often carried about by physicians and nurses, and many of 
them accuse themselves of having been the vehicles of its conveyance. — 
When to this testimony is added the hundred fold more which is buried 
with the hapless victims, we have an amount of facts which it is obstinacy, 
or willing blindness not to perceive the force of. 

But, unfortunately, we have no need of crossing the Atlantic to search 
for evidence of this fearful truth. 

In the American Journal of the Medical Sciences, (Oct., 1842,) Dr. 
West stated some facts communicated to him by Dr. Jackson, of Phila- 
delphia, who, when practising in Northumberland County, had seven 
cases of delivery in rapid succession, in all of which puerperal fever super- 
vened ; of which five proved fatal. " Women," said he, " who had 
expected me to attend upon them, now becoming alarmed, removed out of 
my reach, and others sent for a physician residing several miles distant. 
These women, as well as those attended by midwives, all did well ; nor 
did we hear of any deaths in child-bed within a radius of fifty miles, 
excepting two, and those I afterwards ascertained to have been caused by 
other diseases. I now began to be seriously alarmed on the score of conta- 
gion. Although I had used some pei-sonal precautions before, I now feared 
that they had not been sufficient." 

Dr. Holmes, in the Journal before alluded to, gives a series of cases 
occurring in- the practice of a physician of a town at some distance from 
Boston. There were seven cases, which happened between the 20th of 
March and the 8th of May ; the first five proved fatal in from four to seven 
days after delivery ; the other two recovered. These were the only cases 
attended by this physician during the above period ; " and no other cases 
of a similar character with those of Dr. C. occurred in the practice of any 
of the physicians in the town or vicinity at the time." 

In the first letter to Dr. Storer, (in the same article,) is found the follow- 
ing statement : between the 10th and 28th of February, 1830, " I attended 
six women in labour, all of whom did well, except the last, as also two 
who were confined March 1st and 5th. Mrs. E., confined Feb. 28th, 
sickened and died March 8th. The next day, the 9th, I inspected the 
body, and the night after attended a lady, who sickened and died on the 
16th. The 10th, I attended another, Mrs. G., who sickened but recovered. 
March 16th, I went from Mrs. G.'s room, to attend a Mrs. H., who sick- 
ened and died on the 21st. The 17th, I inspected Mrs. B. On the 19th, 
I went directly from Mrs. H.'s room to attend another lady, who also sick- 
ened and died on the 22d." " Up to the 20th of this month I wore the 
same clothes. I now refused to attend any labour, and did not till April 
21st, when having thoroughly cleansed myself, I resumed my practice, 
and had no more puerperal fever. These cases were not confined to a 
narrow space. The two nearest were half a mile from each other, and 
half that distance from my residence. The others were from two to three 



54 Kneeland on the Contagiousness of Puerperal Fever. [Jan, 

miles apart, and nearly that distance from, my residence. There were no 
other cases in their immediate vicinity which came to my knowledge." — 
" Of the six cases you perceive only one recovered." 

The successive communication of the disease by single physicians and 
nurses to their patients cannot always be thus satisfactorily traced ; and 
hence the non-contagionists maintain that the doctrine of exclusive, if not of 
occasional, contagion must fall to the ground. Without again showing that 
this negative kind of evidence is of no weight against the more positive 
kind which has been now brought forward, or that we do not argue for the 
exclusive contagion of puerperal fever, we shall merely state, for the care- 
ful study of those who consider this argument as unanswerable, that it is 
quite as strong for small-pox and other contagious diseases, in which this 
communication cannot always be satisfactorily traced. Of a hke unsatis- 
factory and negative character is such reasoning as the following : in the 
Philadelphia epidemic of 1842, the physician in whose practice most of 
the cases occurred, says that he cannot easily believe in the transmission 
of the disease from female to female by a contagion conveyed in the per- 
son or clothes of a physician, because, having absented himself from the 
city, after the occurrence of the disease in his practice, for a week, and on 
returning, having entirely changed his clothes, his first case of labour was 
followed by a fatal attack of the fever. 

It becomes an interesting question for the conscientious physician, how 
the contagion is conveyed ; as by the knowledge of this he is enabled to 
regulate the conditions of his intercourse with his patients. Is this disease 
transmitted by direct inoculation, by the atmosphere carried about by the 
physician, from patients before death ? and is it not also conveyed from the 
examination of the bodies of the deceased ? As to the channel by which 
the poison enters the system, it is probably both by the vascular and respi- 
ratory system in the majority of cases ; by the uterine surface and by the 
lungs. Many have limited its introduction to the " wounded surface" of 
the uterus — but that the blood is frequently poisoned from its entrance by 
the lungs, is shown by the fact, that puerperal fever (though the term be 
misapplied), may seize a woman before delivery ; or that the poison may 
be introduced, and produce the symptoms of this disease, before the local 
action in the uterus has taken place. Mr. Ingleby says the attack may 
commence before deUvery, and that he has seen a single case. We think 
we have seen another—- -a woman entered the Hospital de la Faculte, in 
the service of M. Paul Dubois, with all the symptoms of puerperal fever 
of the low type which then existed in the city — she Avas in the sixth month 
of her pregnancy, and had never carried a child to the full term' — she had 
the "facies of puerperal fever ;" with the abdomen moderately swelled and 
painful, though not exquisitely so ; weak pulse, and great prostration — on 
examination the os uteri was found dilated, and delivery imminent — a few 
hours after she was delivered of a child, dead, though not at all putrefied — the 



1846.] Kneeland on the Contagiousness of Puerperal Fever. 55 

symptoms were aggravated after delivery, and death took place in a few 
hours — at the autopsy, the peritoneum presented evident traces of inflam- 
mation, its cavity containing the milky fluid, with membranous flocculi 
found in the form of the disease, we shall hereafter mention as the erysi- 
pelatous ; the uterine veins contained pus ; and the placental insertion pre- 
sented that softened, semi-putrid aspect, which the Germans have called 
*' putrescentia uteri." 

It probably principally affects the blood, though its first violence may 
often fall upon the nervous system. It is impossible to determine this point, 
which is fortunately of secondary importance. 

It is, doubtless, very often propagated by direct inoculation from the 
living subject. Dr. Rigby observes, in his System of Midwifery, " the 
discharges from a patient under puerperal fever are in the highest degree 
contagious." " The puerperal abscesses are also contagious, and may be 
communicated to healthy lying-in women by washing with the same 
sponge ; this fact has been repeatedly proved in the Vienna Hospital." — 
He also observes, that they are also communicable to unpregnant womeii ; 
and that frequently abscesses and diffuse inflammation attacked those who 
washed the bed-linen soiled by the discharges. Of the acrid nature of 
these, the following case from the Dublin Journal of Medical Science^ 
(Nov., 1844,) will afTord sufficient illustration. It was here necessary, for 
the removal of the retained placenta, to pass each arm in succession into 
the uterine cavity, where they were tightly grasped by the neck. Two 
days after, pustules appeared on the arms, one of them being surrounded 
by a livid base, the part of the arm near it becoming hard and swollen. — 
The writer hence concludes, that a morbid poison was generated epidemi- 
cally in the blood, contact with which communicated the taint, and con- 
verted a common furuncle into a malignant pustule ; and this altered con- 
dition of the blood was sufficient to produce all the phenomena of puerperal 
fever in the patient, who was, however, free from the common symptoms of 
uterine inflammation. 

Such being the malignant character of these discharges, that even those 
who have washed the linen soiled by them, have communicated the dis- 
ease to others, and that even the simple operation of passing a catheter has 
been the cause of propagating it, we should naturally expect to find the 
fluids, after death, of a peculiarly virulent nature. Many cases are on record 
of the most serious accidents from wounds received in post-mortem exami- 
nations of puerperal fever ; these cannot be accounted for on the supposi- 
tion of a common poison acting on an enfeebled constitution, as several 
cases happen in the course of every epidemic ; whereas such cases are 
comparatively rare in diseases infinitely more common, and in which the 
same enfeebled condition of the system is always a predisposing cause. 
From the comparatively greater frequency, then, of serious and even fatal 
symptoms in autopsies of this afTection, we are compelled to recognize the 



56 Kneeland on the Contagiousness of Puerperal Fever. [Jan. 

existence of a most deadly and peculiar poison. This is so deadly that no 
wound is necessary, in order that the fatal effect may take place. Dr. 
Duncan, in the Transactions of the Medico-Chirurgical Society of Edin- 
burgh, mentions an instance, where Dr. Gumming was present at the dis- 
section of one who died of puerperal fever. " He took no share in the 
dissection, excepting introducing a fresh thread into the needle which was 
employed in sewing up the body, and was not aware of any abrasion, or of 
having p'tinctured himself in the act of threading." In about a week after, 
he experienced an uneasy sensation in the middle finger of the left hand, 
where was discovered "an angry pimple"^— death took place on the 11th 
day, with evident signs of a profound alteration of the blood. 

With these startling facts before us, we are prepared for the long list of 
victims to the physician's ignorance and negligence ; a list, which we fear 
is yet to be swelled, before the fearful truth we have endeavoured to bring 
forward shall be graven on the tablets of Medical Science. 

From the mass of authority showing that the contagion of puerperal 
fever is liable to be conveyed by physicians to their patients, from their 
being present at, or taking part in the post-mortem examinations in this 
disease, we shall select enough, we trust, to convince the most skeptical. 

In 1821, Dr. Campbell, of Edinburgh, attended the autopsy of a mar- 
ried woman, who died of puerperal fever, after an early abortion; he re- 
moved the pelvic viscera and external parts, and carried the whole in his 
coat pocket to his class room; the next morning, having on the same 
clothes, he assisted, with some of his pupils, at an instrumental delivery 
at Bridewell ; this woman was attacked with puerperal fever, and died — 
(in the autumn). The same night, he went with another physician to 
deliver a woman, who also died ; three others shared the same fate. Simi- 
lar instances occurred in his practice in the summer of 1823 : assisting at 
a dissection of this disease, (at the time having no cases of it,) from the 
poverty of the people, he could not properly wash his hands; without 
any farther attention, he went, when he returned home, to two cases of 
labour; both were seized with the disease, and died. Other physicians of 
the city, who had similar misfortunes, convinced of the contagious nature 
of the disease, gave up, for a time, the practice of midwifery. 

Dr. Rigby, in the Library of Medicine, (vol. 6,) says that it is highly 
unsafe for one to attend a case of midwifery after a post-mortem of puer- 
peral fever ; and that it is impossible to remove the smell from the hands 
for several hours, even by frequently repeated washing. 

In the British and Foreign Medical Review, (Jan., 1842,) the same au- 
thor states, m a review of Dr. Kiwisch's work on the diseases of child-bed 
women, (who does not believe in the contagion of this disease,) that a young 
physician, contrary to advice, examined the body of a woman who had 
died from puerperal fever ; there was at the time no epidemic ; the case 
seemed to be purely sporadic : three other women were soon after deli- 



1846.] Kneeland on the Contagiousness of Puerperal Fever, 57 

vered by him, all of whom died of this affection, the symptoms of which 
"broke out soon after dehvery. " The patients of his colleague did well, 
except one, where he assisted to remove some coagula from the uterus ; she 
was attacked in the same manner as those whom he had attended, and died 
also: we trust that this fact alone will forever silence such doubts, and 
stamp the well-merited epithet of * criminal,' as above quoted, upon such 
attempts." 

Dr. Gooch remarks : ** A practitioner opened the body of a woman who 
had died of puerperal fever, and continued to wear the same clothes, 
A lady whom he delivered a few days afterwards was attacked with, and 
died of a similar disease ; two more of his lying-in patients, in rapid suc- 
cession, met with the same fate." 

The following is a still more striking example : Dr. Merriman, as quoted 
by Dr. Holmes, " related an instance occurring in his own practice, which 
excites a reasonable suspicion that two lives were sacrificed to a still less 
dangerous experiment. He was at the examination of a case of puerpe- 
ral fever at two o'clock in the afternoon. He took care not to touch the body. 
At nine o'clock the same evening he attended a woman in labour ; she was 
so nearly delivered, that he had scarcely anything to do." She died in 
48 hours; and the child also died of erysipelas, two days afterwards. 

In the London Cyclopedia of Practical Medicine are several cases of 
physicians who had examined the bodies of those affected with this disease, 
all of whose patients, in quick succession, fell victims to a similar affectiou. 

In the American Journal (above quoted) it is stated that Dr. Warrington 
examined the body of a woman who died of this disease, and laded out the 
contents of the abdominal cavity with his hands. A few days after, he 
was called upon to deliver three women in rapid succession. One was 
attacked with metritis, another with partial peritonitis ; both were very 
sick, but recovered : in the third case, the patient was seized with perito- 
nitis, and died on the fifth day. Two other women in his practice were 
also attacked with it, and both died. He would not be present at the autop- 
sies of these cases, for fear of communicating more readily the disease. 

Farther proof of its communication in this manner will be adduced 
hereafter. 

Having attempted to show that puerperal fever may be communicated 
by physicians and nurses, either by direct inoculation of, or by an atmo- 
sphere impregnated with the miasmata and fluids of the hving and the 
dead, we would not be understood as implying that all forms are equally 
contagious, or the same form at different times ; from inattention to this we 
are convinced arises the contradictory testimony of authors, in the different 
epidemics. That there may be some forms rarely, if ever, contagious, we 
do not deny ; but we are equally convinced that the erysipelatous form (of 
which more hereafter) is contagious when purely sporadic. When a par- 
ticular epidemic constitution is prevalent, favourable to the extensive spread 



58 Kneeland on the Contagiousness of Puerperal Fever. [Jan. 

of the disease, its strictly contagious character is less distinctly seen, from, 
the operation of other causes which agree better with the laziness or inte- 
rest of the physician ; but when the disease is purely sporadic, if (as we 
have seen) the cases be confined to the practice of a single physician, 
there is a strong probability, to say the least, of the existence of a conta- 
gious principle; when, moreover, in different countries, and at different 
times, we see this same fact continually mentioned, the probabiHty ap- 
proaches so near to certainty as to deserve to influence the conduct of the 
physician, in his intercourse with his patients. Neither does it follow 
that, because it is contagious, it does not arise from common causes ; its 
origin must have been once other than contagion, and we have no ground 
for supposing that it may not be occasionally so at the present time. 

A few additional remarks may be made, tending to strengthen the opin- 
ion of contagion in puerperal fever. 

It has been often noticed, that when the mothers have died of the preva- 
lent epidemic, most, if not all, of the children have also been attacked with 
fatal peritoneal inflammation, as in the epidemic in the Philadelphia Hos- 
pital. Similar facts have been noticed at the Hospitals " de la Faculte" 
and "Maternite" of Paris. 

Contagious diseases have many points of resemblance, which should not 
be lost sight of; one of the most striking is the remarkable insufficiency 
of all treatment, both rational and empirical. Examine the records of hos- 
pitals, and the reports of private practice, during most of the epidemics of 
malignant puerperal fever, and you will find upon every page the fearful 
truth, that it Vv-as possible to save but an exceedingly small portion of the 
patients — the loss of life in lying-in hospitals, according to Dr. Lee, more 
than counterbalances the benefits derived from them. This insufficiency 
of remedies shows that the grave forms of puerperal fever are something 
more than simple inflammations, to which many would reduce them ; that, 
although in the course of an epidemic, there may be cases of an inflam- 
matory character which will yield to a vigorous treatment, or the atmo- 
spheric constitution may give an inflammatory type to the great majority of 
cases, still the malignant form, whether inflammatory or not, whether spo- 
radic or epidemic, is not arrested in its course by any treatment, as it 
depends on some element at present unknown to us. What is said by all 
in regard to variola, rubeola, typhus, &c., will equally apply to puerperal 
fever. 

The contagious form diflers also from the inflammations, which are often 
called puerperal fever, in that the symptoms and gravity of the affection 
are not in proportion to the extent or intensity of the accompanying in- 
flammation ; while in the latter the symptoms are generally the faithful 
expression, to a practised eye, of organic disorder. Insufficiency of reme- 
dies being peculiar to diseases capable of transmission, or, more properly 
speaking, these diseases always presenting this pecuharity, we may rea- 



1846.] Kneeland on the Contagiousness of Puerperal Fever. 59 

sonably add this fact to the evidence in favour of the contagious nature of 
puerperal fever. 

It is an interesting question whether puerperal fever ever attacks a second 
time ; and if it does, whether this should be an argument against its con- 
tagious character. It is said that among acute diseases, those only which 
are contagious, are not produced a second time in the same individual ; 
that there is no pure inflammation which cannot* be reproduced several 
times : if, therefore, puerperal fever show itself more than once, that there 
is good reason to suppose it is not contagious. Here an important dis- 
tinction may be made among contagious diseases : one class, in which may 
be placed small-pox, and the other exanthemata, generates a powerful virus 
which transmits the disease ; the other, in which may be ranked typhus, 
puerperal fever, in which, though communicated by a morbific principle 
generated by them, different kinds of miasmata, or infection, may originate 
the disease, whose activity is increased by encumbered, ill-kept wards, and 
whose virulence is usually readily destroyed by separation, cleanliness, and 
ventilation. In the former, the disease is rarely originated, and the conta- 
gion is manifest ; in the jatter, the action of general causes often originates 
the affection, the contagion of which is less easily shown, from the very 
multiplicity of these causes. 

We think the views of Professor Liebig tend to throw some light on this 
subject. This eminent chemist compares the action of certain poisons 
upon the animal economy to the process of fermentation. In this process, 
yeast (or oxydized gluten) undergoes putrefaction, and decomposes the 
sugar of the wort, which is converted into alcohol and carbonic acid ; the 
gluten, also contained in the wort in large quantities, becomes oxydized, 
so that the original yeast seems to have been greatly multiplied. On the 
contrary, if the yeast had been placed in a solution of sugar free from glu- 
ten, the conversion of the sugar into alcohol and carbonic acid, would not 
have taken place in the same manner ; but the yeast would have completely 
disappeared, instead of being reproduced. In small-pox, the poison con- 
verts some constituent of the blood into a matter similar to itself, and after 
its action has ceased, it leaves the system unsusceptible of the same action ; 
and the poison can no more be reproduced than can yeast be formed in a 
solution of sugar, when the gluten is exhausted. From this he argues that 
the poison acted upon an element of the blood not absolutely essential to 
life, and which, when once removed, is not reproduced; thus explaining 
the action of those poisons which leave the system unsusceptible of a 
second attack. In this class of diseases, it is very rarely, if ever, that the 
poison is originated by any favourable combination of external circum- 
stances; the virus acts continually, without generation "(Ze novo.'''' In the 
second class, in which we place typhus, puerperal fever, erysipelas, &c., 
(most of which may attack an individual more than once,) the poison acts 
upon an element of the blood, which is essential to health, if not to Hfe ; 



60 Kneelsind. on the Contagiousness of Puerperal Fever. [Jan, 

this element is constantly supplied, as yeast is continually formed, when 
gluten is added to the fermenting fluid, capable of causing a similar action 
in another solution of sugar. These diseases (the last two particularly, in 
which contagion is but an accidental element), are constantly being ori- 
ginated from a coincidence of favourable external circumstances and sus- 
ceptible economies, and are afterwards propagated by contagion, till the 
virus loses more or less of its power from changes in the individuals, or 
their conditions — we should naturally expect to find them frequently re- 
produced, as the system is predisposed by the very circumstances in which 
they are originated. The immunity from second attacks is not, however, 
absolute in the first class of contagious diseases ; may we not, then, rea- 
sonably suppose that, in the rare instances in which these are reproduced, 
the element of the solids, or the blood, upon which the poison spends its 
force, is also reproduced. [For more detail on the action of poisons, in 
this point of view, we may refer to the New York Lancet, for December 
1843, p. 384.] 

As every contagious disease has a period at which it is especially liable 
to be communicated, it may be asked at what time puerperal fever is most 
contagious. By a knowledge of this, many lives may perhaps be saved, 
or at least many well-founded fears quieted, by a timely separation of the 
aflTected, or the removal of the recently delivered from a suspected locality. 
Some diseases, as small-pox, are very contagious at their commencement, 
and far less so at their decline ; others, as typhus, are most contagious at 
their dechne. This point is not, so far as we can find, touched upon by 
writers on puerperal fever ; but from the fatality attending communication 
with patients at all stages of the disease, from the fatal termination in from 
three to seven days, and the undoubted propagation from assisting at au- 
topsies, we think we may conclude that it is more or less contagious from 
the commencement, according to the epidemic, and that this property goes 
on increasing with the duration of the affection ; its latent period, if there 
be any, being so exceedingly short, as to announce an almost instantaneous 
action of the poison, and the reproduction of a similar one almost imme- 
diately. 

An important question for the physician to ask himself is, how long a time 
should elapse, after attending a case of this disease, before he can safely visit 
a woman in labour. This is difficult to answer, as it is often almost im- 
possible to know, in case a woman is seized with puerperal fever, (in the 
practice of a physician who has had other cases some time before,) whether 
she may not have been exposed to receive the contagion from another 
source than himself; and in many instances, sporadic cases in a single 
man's practice, have ceased for three or four weeks, when on attending 
his next case of midwifery, the patient has been attacked with the fever, 
no other case having occurred in the interim. Dr. Holmes concludes, that 
the physician should allow some weeks to elapse, if he has a single case 



1846.] Kneeland on the Contagiousness ofPuerpetal Fever. 61 

of the disease, before he attends another woman ; that if two cases follow 
each <3ther in quick succession, when there are no cases in the neighbour- 
hood, he should relinquish the practice of midwifery for at least one month, 
and endeavour by all possible means, to free himself from any noxious 
influence^ 

It does not appear that this c<jntagi<?n is conveyed to any great distance 
i^y the air. This seems indicated by the fact of the cases being confined 
to the practice of a single person in a large town, in whose crowded streets 
and lanes next door neighbours are not affected, unless visited by him ; by 
the fact that seclusion affords almost complete security ; by its being con- 
fined to single wards in large hospitals, &c., &c. 

We will adduce, in conclusion, other authorities on the contagion of puer- 
peral fever, which will strengthen, if possible, the evidence already brought 
forward. 

Dr. Leake inclined to the belief that it depended on atmospheric 
changes ; but he afterwards admitted that there might be an acquired con- 
tagion : exactly what we are contending for, viz: — that, though not neces- 
sarily contagious, it may become so. 

From its prevalence in London, in 1787-8, Dr. Clarke, though he would 
not frankly allow its contagious character, confessed that its non-contagious 
nature could not be determined. 

Dr. Denman admitted that it might sometimes be, at others not be, con- 
lagious. 

Dr. James Hamalton, of Edinburgh, says, that the cause is a peculiar 
miasm ; and that in certain atmospherical conditions it is contagious. 

In the Dublin Lying-in-Hospital, the Edinburgh Infirmary, the Lying- 
in-Hospital, of Vienna ; and during most of the London epidemics, it appears 
to have been propagated by contagion. 

Hey, in speaking of the Leeds epidemic, seems to have strong doubts as 
to its non-oontagiousness, and to be willing to allow a slight degree of con- 
tagion. Dr. Armstrong, who is opposed to its contagiousness, mentions 
that forty out of forty-three cases occurred in the practice of a single sur- 
geon and his assistant, at Sunderland ; this somewhat invalidates his 
opinion. 

Dr. Hannay, of Glasgow, in his pamphlet on puerperal fever, observes, 
that many maintain that it is never communicated from one individual to 
another ; while others refer nearly every case to contagion. He infers " that 
the disease may at its origin be sporadic and independent of contagion, and 
so generated become the source, where in epidemic rage, it may be com- 
municated by contact to others." 

Mr. Moore, on puerperal fever, remarks, ** the facts bearing on the con- 
tagious nature of puerperal fever are numerous and forcible." 

M. Voillemier, in speaking of the epidemic which raged at the Hopital 
de la Faculte, in 1838, says, that it may be contagious ; to which opinion^, 

No. XXL January, 1846. 3 



6^ KneeJaitd on the Contagiousness of Puerperal Fever. [Jan, 

he adds, M. Dubois inclines. Duges, and other French authors deny its 
contagious character ; but, (independently of the httle value of negative 
facts,) it was at a time when the contagious character of all diseases was 
there called in question. 

In the Registrar General's Report, {London Medical Gazette, March, 
1844,) it is stated that a certain number of deaths are caused by the con- 
tagion of this disease, communicated by the nurses and medical attendants. 

Dr. Alison, {Outlines of Pathology and Practice of Medicine,) says, 
that puerperal fever is a " specific inflammation of the peritoneum, attend- 
ing a contagious disease." 

Mr. Ingleby, {Edinburgh Medical and Surgical Journal, 18B8,) ob- 
serves that, at Aylesbury, the contagiousness of puerperal fever was " as 
palpable as that of the small-pox." " Moreover, the great fatality of the 
disease at every period of its occurrence in the numerous lying-in-hospitals, 
both at home and abroad, admits of no other explanation." 

Dr. Condie, {Jlmerican Journal, above mentioned,) though not in gene- 
ral a contagionist, was convinced from the cases which he saw in the Phi- 
ladelphia epidemic, that the puerperal fever at the time prevalent was 
capable of being communicated by contagion. 

We have thus brought forward a mass of facts, (and many more might 
be adduced,) with the intention of showing that puerperal fever is fre^ 
quently propagated by contagion. We have endeavoured to meet the 
objections made to this opinion, by showing that the same objections equally 
apply to many other diseases universally allowed to be contagious : though 
this does not solve the question at issue, but only postpones the difficulty, 
it may at least remove some stumbling-blocks from the path, placed there 
by our pretended guides, or left by the receding waters of ignorance. — 
We have seen that strict mathematical proof on this subject is impossible ; 
until, then, the opponents of contagion can explain the phenomena of puer- 
peral fever in a more probable or satisfactory manner than by our views, 
let them not reject these as unfounded and theoretical — nor, fixing their 
attention on some obscure point, require its full explanation before yielding 
a reluctant assent : this may be showing a praiseworthy unwillingness to 
allow the continuance of supposed dangerous error, but it is not certainly 
manifesting that candour and judgment which should animate the inqui- 
ries of the sincere lover of truth. 

From the above series of facts, carefully collected and fairly stated, let 
every one reason for himself, and we think he will come to the same con- 
clusions. 

We think we may deduce the following propositions, from a careful ex- 
amination. 

1. From the confinement of cases to the practice of single physicians 
and nurses in populous cities ; from the fatal results attending post-mortem 
examinations ; from its ravages in hospitals ; that puerperal fever is conta- 



1846.] "KxiQQhindi on the Contagiousness of Puerperal Fever. 63 

gious : that it may have other modes of propagation, in certain states of 
the atmosphere, and among strongly predisposed individuals ; but that the 
fact of its conveyance by practitioners attests its contagiousness. 

3. That it may be propagated by direct inoculation with the fluids of the 
living and the dead ; by the effluvia arising from the bodies of the sick, 
inhaled in the very chamber of death, (as in the v^^ards of a hospital,) or 
carried about by the person of the physician ; by clothes, bedding, (fomites,) 
which have been in contact with a diseased individual. 

3. That the order of propagation from the physician to the patient, and 
the regular succession of cases, show that the epidemics of puerperal fever 
are, in almost all cases, the effects and not the causes of the contagion. 

4. The contagion acts according to the frequency of communication 
between the physician or nurse, (in whose practice are cases,) and lying- 
in women, independently of insalubrity of places, wretchedness of patients, 
or the neighbourhood of dwellings — for, although poverty and misery 
seem to predispose to it, communication is none the less fatal to the higher 
classes. 

5. A case, to all appearance sporadic, may communicate the disease ; a 
mild case may communicate a severe disease, and vice versa. 

6. Immunity proves nothing against contagion ; it may be the effect of 
an acquired or temporary inaptitude — it is equally inexplicable in all con- 
tagious diseases. 

7. The rapidity of its propagation shows that it is contagious at the com- 
mencement ; the fatal results of attending autopsies indicate this character 
after death. 

8. That a physician should not make, or be present at an autopsy of 
this disease ; or, if he does, should take proper measures to cleanse him- 
self and dress, for the safety of his next patient — that if a case (or several 
cases) occur in his practice, he should consider himself, in the language of 
Dr. Holmes, " a private pestilence," and regulate his conduct accordingly 
— that persons who have washed, or have otherwise handled the clothes or 
bedding soiled by the discharges of this disease, should not approach,, 
much less nurse, a woman after delivery. 

9. That when the disease is prevalent, a prompt removal from possible 
intercourse with a " pestilential" physician, and a strict attention to venti- 
lation, cleanliness, quiet, proper food, &c., are the dictates of a reasonable 
fear. 

Boston, November 1845. 



64 Ruschenberger's Contributions to Pathology, [Jan« 



Art. VI. — Contributions to Pathology; being a Report of fatal cases taken 
from the records of the U. S. Naval Hospital, New Yorh By W* S. 
W. RuscHENBERGER, M. D,, Surgeon U* S. Navy. 

A REPORT of fatal cases, given from the note books of the hospital, with- 
out modification or dressing up for the pubhc, may be advantageous, we 
believe, to the younger, and of interest to the older members of the profes- 
sion. Such records may serve to correct impressions derived from read- 
ing general descriptions, usually relating to the more common forms, pre- 
senting the most usual features and characteristics of the disease described. 
Comphcations, though often mentioned, are not always fully described by 
systematic writers, or lecturers. It does not always happen the human 
body suffers in one organ alone; that pleurisy for example, or hepatitis, or 
pneumonia exists by itself, nor is it always as easy to recognize complica- 
tions, as the student may suppose, from reading treatises on disease. To 
the younger members of the profession especially, a brief record of such 
facts as may serve to assist in the recognition of disease must be of inte- 
rest. 

Case I. — Aneurism of the basilar artery. — Alay 24th, 1845. Christian 
Wahlman, marine, setat. 47, native of Hanover, admitted from the U. S. 
Ship Lexington "affected with paralysis." No history of the case accom- 
panied the patient. He states, he was several months in hospital at Ma- 
hon, and has been sick about fourteen months. He is a stout man, has a 
large head, and would probably weigh 180 pounds. Hemiplegia of left 
side perfect; both motion and sensation being lost; ptosis of left upper 
eyelid; talks with great difficulty ; passes faeces involuntarily; no distor- 
tion of countenance; confined to bed; appetite good; tongue clean, and 
slightly incHned to left side when protruded ; swallows sohds and fluids 
with difficulty. 

26th. R. — Gum ammoniac, ^ij ; cyanuret. ferri. 3j ; aloes gr. x; oL 
carui gtt. x. — M. ft. pil. No. xl, one every four hours. Half diet. 

29th. Offensive from dripping of urine. Frictions with tinct. cantharid. 
to abdomen. 

315^. Emp. lytts UxU to hypogastric region. Urine drawn off twice 
daily. Electro-magnetic current to lumbar region. 

June 1st. Bowels confined ; croton pill.* 

4:th. Bowels not free ; repeat croton pill. 

7th. No effect perceptible from electro-magnetism ; suspend pills. R. — 
Strychnia gr. j'g- in pill every six hours. 

9th. Croton pill. 

llth. Croton pill; suspend strychnia. 

14:th. Resume strychnia. P. M. — Breathing slightly oppressed ; dry 
cups to chest. 

* A house pill, composed as follows: — R.— 01. tiglii gtt. xvj ; mas hydrarg. 9jj 
■extr. colocynth. comp. ^ij ; tart, anlim. gr. x,— M. ft. mas et in pil xl dividend. 



1846.] Ruschenberger's Contributions to Pathology. 65 

16th. Bowels confined; croton pill. R. — Assafoetid. ^i; ol. terebinth. 
Jj; chlor. sodii aq. tepid, Oij. — M. ft. enema. P.M. — Repeat enema. 

17th. Bowels free; slight uneasiness of stomach. R. — Emp. visicat. 
3x3, to epigastrium. 

ISth. R. — Strychnia, gr. j; sulph. morphige gr. j. — M. ft. pil. No. viii. 
One every six hours. Nearly strangled while at dinner by an unsuccess- 
ful attempt to swallow an over large piece of meat; was insensible during 
several hours and restored only by most active treatment. 

19th. Again sensible of surrounding objects; but generally not so well 
as before the accident ; all medicine suspended. 

20th. Slight oppression ; dry cups to chest. P. M. R. — Mas. hy- 
drarg. gr. x. 

2ist. R. — lod. potass, gr. v.; Inf. gentian, ^ij. — M. ft. haust. ter in die. 
P.M. — Dry cups along the spine. 

22d. Rather more animated this morning : continue treatment. 

2Sth. Croton pill; bowels not open yesterday. 

July 2d. R. — Pulv. jalaps comp. 3j. 

3^. R. — ^Pulv. jalapse comp. ^j. 
; 4th. Dry cups to nucha and spine. 

6th. Croton pill. 

7th. Dry cups to nucha and spine. Seems to derive benefit from cup- 
ping. 

8th. R.-^-Pulv. jalap, comp. ^j.; dry cups to nucha and spine. 
, 9th. Croton pill. 

10th. R. — Emp. visicat. 6x6 to epigastrium. While the left side is 
entirely paralyzed, the right seems to be suffering from chorea. 

11th. Croton pill every four hours until freely purged. 

Ifith. Since the seventh has been gradually declining ; is usually in a 
torpid condition ; ofTensive from dribbling of urine. Wine whey. 
,' 14:th, Died a half hour after midnight. 

•Autopsy. — Fourteen hours after death. (Thermometer 93° F.) Limbs 
flexible. Subcutaneous adipose tissue greatly developed ; countenance 
of nearly a natural colour. 

Brain somewhat softened ; an effusion of limpid serum, amounting perhaps 
to a pint and a half, completely inundating the organ, and fiUing the ven- 
tricles. On elevating the anterior lobes, and tearing the corpus callosum 
slightly at its anterior extremity, there was a, jet d^eau, at least three inches 
in height, which seemed to be produced by contraction of the parietes of 
the cavities in which the serum was contained ; just above the posterior 
clinoid processes, part of the pons varohi, and the sella turcica, a thin gela- 
tenoid matter of a rust colour, slightly stained in places by blood, presented; 
and an aneurism al enlargement of the basilar artery of the size of a 
pigeon's egg pressed on the pons varolii. The aneurismal sac contained 
an irregular, very hard and dry clot of blood, surrounded in a red fluid of 
the consistence of pus ; but notwithstanding this, the communication with 
the artery was easily traced : the vertebral arteries were seen entering the 
lower part of the sac, about a quarter of an inch apart. An extravasation 
of blood, from rupture of the sac, had taken place into the substance of tho 
pons, which was considerably softened and of a blackish colour. 



66 Ruschenberger's Contributions to Pathology. [Jan. 

All the viscera of the abdomen were found perfectly healthy in appear- 
ance. The thorax was not inspected. 

The symptoms in the case, and death, were undoubtedly caused by the 
pressure of the aneurismal tumour on the base of the brain. The tumour 
seemed to be central, and to press not more to one side than to the other. 

Remarks. — The above is from the prescription book of the house, and 
notes of the case by Passed Assistant Surgeon, Jas. B. Gould, U. S. Navy. 

When seated on the side of the bed, from which he could not rise with- 
out assistance, he required to be supported ; and then there was an antero- 
posterior vibration of the head and body independent of the will. While 
lying, the right foot was in constant, quick motion, being alternately flexed 
and extended on the leg ; this was uninterrupted while awake, and occa- 
sionally observed when he was seemingly asleep. He slept deeply, snored 
loudly, and was often roused with difficulty. His intellect seemed to be 
perfectly clear, but very slow. When spoken to, he seemed cheerful, al- 
though his attendant states he was despondent, often expressed a wish to 
die, and even asked for means to commit suicide. 

The paralysis of the left side was complete ; a small piece of burning 
sponge, wet with alcohol, fell accidentally upon the skin of the left side of 
his body while he was being cupped, and, although it rested some seconds, 
the patient did not feel it. 

From an intelligent marine (a ship-mate and also an invalid, returned 
from the Mediterranean squadron in the U. S. S. Lexington), we learn 
some other particulars of this case. 

Wahlman enlisted in Boston in 1843, and went to sea in the U. S. S. 
Plymouth. He very soon became unable to " mount guard" in conse- 
quence of weakness of the knees. It was current among the men that he 
had been long sick in the "poor house" in Portland, before he enlisted, 
and was remarkable for the quantity he ate — " he would eat the allowance 
of three men." From the Plymouth he was transferred to the U, S. Ship 
Cumberland, the Flag ship of the Mediterranean squadron, and in Sep- 
tember, 1844, sent to the U. S. Naval Hospital at Mahon, where he re- 
mained until March or April 1845, when he was put on board of the Lex- 
igton for a passage home. It was believed by the men, that, in the opin- 
ion of the Fleet surgeon of the Mediterranean squadron, when Wahlman 
was sent to the hospital he would not live three weeks, and fjr this reason 
he was not sent home at that time. 

While at Mahon, Wahlman walked about with a stick in the right hand, 
which was always " very shaky," and he had great difficulty in standing 
still without leaning his back against something. He ate voraciously, and 
several times came near choking from attempting to swallow large masses 
of food. Sometimes his difficulty of articulation was so great that he asked 
for paper to communicate his ideas. He felt persuaded he could not 
recover, and often requested that his will might be made. 



1846.^ Ruschenbergei's Contributions to Pathology, ■ Gt 

Treatment for the first few days seemed to benefit the patient, but after- 
wards produced no rehef. Purging and dry cupping appeared to aflbrd 
more alleviation than any other remedies. 

The aneurismal tumour was to the eye symmetrical, and did not press 
more an one side of the brain than on the other ; it was central. Accords 
ing to received opinions, the anormal condition of the brain, judging from 
the symptoms, ought to have been confined to the right side exclusively. 

Case IL — Death from internal use of sulphate of copper taken for the 
cure of gonorrhoea, — Sept, 26th, 1843. Nicholas Mollineux, Quarter 
Gunner, setat. 63, admitted from the U. S. ship-of-the-hne North Carolina, 
on account of " general infirmity," having recently been sent home as an 
invahd from the coast of Brazil. Veins of both legs varicose ; laced stock- 
ings applied. 

December Sth, 1843. A few days since contracted syphilis ; phimosis, 
and ulcer under prepuce. Poultice. 

10th. Ten small, defined, excavated ulcers, covered with white sloughs 
on the glans penis. Tinct. iodine to ulcers. R. — Biniod. hydrarg. gr. — 
ter in die. 

11^^. Ulcers look better. 

l^th. All the ulcers nearly healed. Continue treatment. 

ISth. Cured. Suspend treatment. 

January 26th. Has been pretty well since last report. At the morning 
visit was found lying in bed with hot, dry skin ; pulse small and frequent ; 
tongue dry, hard, yellowish; abdomen tender, intellect dull. States he 
had a chill, last night, and complains of pain in the back and right side. 
Apply five cut cups to abdomen. R. — Calomel gr. xv ; opii gr. j. — M. Stat, 
sumend. Infusion of flaxseed acidulated with currant jelly for drink. 

5 o'clock, P. M. More comfortable ; tongue not so dry. Neutral mixture 
every two hours. 

2!7th. Seems better. Abdomen not tender ; tongue still dry. Persist. 

29th. 5 o'clock, P. M.— Tongue moist ; coughs occasionally ; says he 
has no pain ; bowels regular ; pulse small. R. — Pulv. Doveri gr. viij ; carb. 
ammon. gr. ij ; syrup, simp. q. s. — M. H. ss. 

SOth. Worse : lies on his back with eyes closed : answers questions and 
relapses ; tongue dry and hard ; pulse rapid, small ; abdomen again ten- 
der; respiration costal. Dry cups to abdomen. R, — Ol. ricinigj. Broth; 
lemonade, 

5 o'clock, P, M. Worse; failing; bowels not moved; repeat ol. ricini, 
R. — Pulv. Doveri gr. xij ; camphor gr. ij ; carb. ammon. gr. vj. — ^M. To 
be taken after the operation of the oil. 

^Ist, Slightly improved ; bowels not free. R. — Calomel gr. viij ; pulv. 
ipecac, gr. ij ; opii gr. j.' — M. Ft. pil. iv. One every two hours. 

5 o'clock, P. M. As last evening. Arrow root, ilavoured with brandy* 
R- — Tinct. opii acet. gtt. xx. H. ss. 

February 1st, FaiHng ; eyes dull, injected : dark red flush efface ; ab- 
domen not tender ; tongue very dry ; stomach irritable. R. — Sulph. 
^quiniae gr. x ; vin. Hispan. gv. — M. Ft. sol. An ounce every four hours. 
Broth, brandy and water in small quantities. Sinapism to epigastrium.— 
5 o'clock, P. M. Worse : intellect clear ; pulse frequent, very feeble ; ex- 
pectorates a dirty brown matter ; no abdominal tenderness ; stomach rejects 



6S Riiscfienberger'"s Contributions to Pathology, [Jan. 

every thing. R. — Opii gr. j ; camphor gt, ij ; carb. ammon. gr. t. — M. Ft. 
pil. No. ii. H. ss. 

2^. Calomel gr. j. every hour. R. — 01. terebinth. ; ol. ricini aa ^j ; aq. 
sahn. tepid Oij.*— M. Ft. enema stat. admin. — 5 o'clock, P.M. Failing: 
mucous rale over trachea. Refuses medicine ; no abdominal tenderness ; 
complains only when strong pressure is made over epigastrium : the mild- 
est drinks provoke emesis. 

3c?. Died at half past twelve last night. It was ascertained this morn- 
ing that more than a month since Moilineux contracted gonorrhoea, and 
through a sense of shame did not report, but applied for advice and medi- 
cine to some advertising practitioner in New York — and during three or 
four weeks he had been taking three times daily, a tablespoonfui of what 
proved, on examination, to be a strong solution of sulphate of copper. 

Autopsy twelve hours after death. Larynx, Lining membrane thick- 
ened, dark coloured, injected. 

Thorax, Right costal and pulmonary pleura adherent throughout ; 
large patches of recent lymph effused on both surfaces. About a pint of 
serum in the cavity of the right thorax. Old, firm pleuritic adhesions in 
left thorax. Both lungs crepitant ; they contained a few scattered tubercles. 

Mdomen. Liver enlarged and softened ; stomach injected throughout 
its coats ; small intestines of a dark colour, the jejunum being almost 
black: large intestines dark, injected; mucous coat of intestines generally, 
darker than natural, and in the jejunum of a lead colour. Mesenteric 
glands generally enlarged, one of v«rhich contained a calcareous mass of 
the size of a walnut. The mesentery injected throughout. Kidneys 
dark coloured, of the natural consistence, but of twice the usual size ; the 
right kidney contained some purulent matter. 

i?emarA;5.— -The above case is from notes by Passed Assistant Surgeon 
Silas Holmes, U. S. Navy. It is regretted that time did not permit a more 
minute record of this case. It is worthy of attention, however, because it 
shows us that an infirm man of sixty-two years of age, (an advanced age 
for a seaman,) was capable of contracting syphilis, and subsequently gonor- 
rhoea — and that the internal use of sulphate of copper, in solution, is con- 
sidered a remedy for gonorrhoea, and that it was taken for a considerable 
time without manifesting poisonous effects. The strength of the solution 
was not exactly ascertained ; but I think it was not less than three or four 
grains to the ounce. 

Between the 18th of December and the 26th of January, MoUineux was 
seen, at least twice daily, either by Passed Assistant Surgeon Holmes or 
myself ; but we did not perceive anything to lead us to suspect his gene- 
ral health was not as usual. We were very much at a loss to account for 
the condition in which he was found on the morning of the 26th. What 
part of the post-mortem appearances were due to the remedies, and what 
to the poison, or to previous disease, must be determined by the reader. 

Case III. — IMseane af the kidneys. James Marshall, seaman, aetat. 37, 



1846.] Ruschenberger's Contributions to Pathology, 69 

tall and of spare habit ; admitted into hospital from U. S. ship Columbus, 
June 3, 1844, for abscess in the perineum, which formed in the preceding^ 
April, and was subsequently opened, and issue given to a small quantity 
of purulent matter. Deserted on the night of admission into hospital, so 
that no treatment was attempted here. 

Re-entered hospital, September 18, 1844, affected with a fistula in 
perinsBO, situated about an inch from anus, and a httle to the left of me- 
sial line. Urine constantly dribbhng through orifice, keeps him in a 
state disgusting to himself and others. States that more than half of his 
water passes through this channel. General health does not appear to be 
very good. Skin habitually dry and harsh, and tongue red and shining, 
though usually free from fur. Half diet. 

Sept. 19th. Ascertained the existence of a stricture of urethra of long 
standing, but passed a good sized instrument into bladder. 

Sept. 21st. Passed metalhc bougie. No. xiii, through stricture without 
difficulty, but immediately afterwards he had a chill followed by a smart 
febrile reaction. Stream perceptibly larger, and less urine flows through 
unnatural channel. 

Sept. 29th. Milk diet. Stricture giving way, and freer discharge of 
water per vias naturales. 

October 1st. Vomiting of thin fluid ; furred tongue, and general, though 
shght ieeWng oi malaise complained of. K. — Gtuiniee sulphat. gr. xxiv; 
massae hydrai^. 9ijss; ipecacuanhaB pulv. xij. — M. Ft. mass, in pil. no. 
xxiv dividenda. Sig. sumend. una ter die. 

Oct. 6th. Irritation of system rather on the increase. Omit pills. 
R, — Mist, neutral, ^ss q. 2 h. Free use of acidulated gum water. 

Oct. 7th. Febrile symptoms, &c., have subsided. Suspend neutral 
mixture. R. — Fol. diosmae crenat. gj ; aqua bullient. Oj. — ^M. Ft. infu- 
sio. Sumend. in die. 

Oct» 9th. Return of febricula. Suspend buchu. R. — Sp. mindereri 
§ss. q. 2 h. 

Oct, 11th. Within a day or two patient has had chills and fever, but of 
no great severity nor protracted duration. Skin is at all times remarkably 
arid and harsh; countenance pinched and expressive of suffering; tongue 
clean, smooth and glossy. Micturition frequent, particularly at night. 
Very little water now comes through the fistulous orifice. Since his ad- 
mission patient has lost a good deal of flesh. Omit all other medicine and 
take the following: R.— -Massas hydrarg. ipecacuanhae pulv. aa gr. x ; opii 
pulv. 9j. — M. Ft mass, in pil. No. xx dividend. Sig. sumend. unaq. 6 h. 

17th. Cardialgia, suspend pills. R. — ^Magnesia calcin. ^i; barley water. 
An opiate at bed time to check too frequent incHnation to urinate ; frictions 
to abdomen with a hniment composed of equal parts of tinct. capsici. and 
tinct. sap. camph. 

20th. Progressive and rapid emaciation with entire loss of appetite; 
voids habitually a large quantity of urine, which on standing deposits a 
dirty mucous sediment, without any offensive odour ; moderate soreness of 
abdomen, not referred to any particular organ. R. — .Nitrat, potass, gr. iij; 
Pulv. Doveri gr. iij. — M. Ft. pulv. una sumend. q. 8» h,; dry cups to abdo- 
paen ; diet exclusively of animal food ; diluent drinks. 

2Sd. Reapply dry cups ; an opiate, hor. somn, 

24:th. Has lost so much flesh and shows such a disposition to drink, let 
him take a pint of ale at dinner. 

26th. g. — Veratrise 9j; axungiae gj, — M. ft. unguent; apply to spine 



to Ruschenberger's Contributions to Pathology, [Jan. 

twice a day. Ale offends stomach ; suspend it ; ordered essence of beef 
freely ; continue nitre and Dover's powder ; opiate regularly at bedtime. 

28^A. Omit medicine. R. — Hydrarg. chlor. mit. gr. j; Pulv. Doveri 
5ss; nitrat. potasssB 9j. — M. ft. in chart. No. xij. dividend. Sumend. 
una ter die. 

30^^. Much as at last report ; substitute for present treatment the fol- 
lowing, viz. R. — Hydrarg. chlor. mit. gr. j; Nitrat. potass^ gss. — M. ft. 
in chart. No. xij. dividend. Sumend. q. 2. h. 

November 3 J. Urine perhaps a little copious but very turbid ; no other 
change, except that patient is gradually growing weaker, and more ema- 
ciated ; ordered chocolate for breakfast and a dozen of oysters at dinner, 
with former diet. 

4f/i. Suspend powders. — R. — Nitrat. argenti gr. |; mica panis q. s. — 
M. ft. mass in pil. j. dividend. Sum. ter die ; mush and milk diet, as sto- 
mach refuses to retain any other food. 

\Oth. Tongue continues very red and glossy ; stomach highly irritable ; 
constant slow fever; countenance invariably pinched ; soreness of epigas- 
trium; bowels sluggish; urine copious and full of mucus; no pain com- 
plained of in region of kidneys or bladder. Croton oil to pit of stomach; a 
simple enema of salt and water. 

Wth. Suffers very much from emesis which supervenes from the slight- 
est causes ; debihty so considerable that patient can just stand alone and 
no more ; inunctions to inside of thighs with ung. hydrarg. camph. bis. 
die. 

13//i. Bowels confined; an enema of common salt and ol. terebinth. 

\^th. Bowels regularly opened ; somewhat weaker; tongue more natu- 
ral ; — on the whole has rallied a little. 

\9th. Subsultus tendinum; all symptoms aggravated. R. — Lac. assa- 
fcetid. ^ij. q. g** hor. 

20//i. Complains merely of debility and the dripping of urine from fis- 
tula; countenance anxious; voice hollow; intellect wandering; at 10 
A. M. moribund. Died at 3| P. M. without a struggle. 

Autopsy twenty hours after death. (Thermometer 40° F.) 

Body much emaciated ; adipose tissue throughout nearly absorbed ; cel- 
lular tissue both internal and external almost free from blood and of a 
marked pearly whiteness. Head not examined. 

Lungs sound with the exception of a few scattered tubercles ; left lung 
adherent to costal pleura anteriorly by long white very extensible cellular 
tissue. 

Heart of normal size, pale, and filled with blood. 

Stomach natural as to size and external appearance ; mucous membrane 
of greater curvature somewhat softened; that of lesser curvature slightly 
injected and rather more softened ; elsewhere this organ was healthy. 
Small intestines exhibited the mucous membrane softened in small patches, 
but not very notably so: shght vascularity of lower portion of ihum. 
Large intestine filled with dry yellow feeces ; no change in mucous 
lining. Mesenteric glands and lymphatic glands of abdominal cavity, in 
general, somewhat enlarged and containing cheesy matter, with here and 
ihm^ a spot of purulent fluid. Pancreas^ spleen, and liver natural ; the 



1846.] Ruschenberger's Contributions to Pathology. 71 

latter shedding liquid black blood freely on incision. The greatest mass 
of diseased structure was found in the kidneys. The right kidney was 
reduced to one fourth of its natural size and occupied by two large cysts 
which contained two ounces of clear urinous fluid, and a third one, filled 
with cheesy and purulent matter intermixed. The left kidney lobulated 
exteriorly, and enlarged to at least three times its normal size. Dissection 
revealed ten or twelve large cavities, filled with the same cheesy, purulent 
matter; — the cavities communicating with each other and with the pelvis 
of the kidney, of which indeed they seemed to be merely the developed 
calices. The tubular portion of the organ between these cavities was hy- 
pertrophied and at the same time indurated. Hardly a vestige of sound 
structure was left in either kidney. 

Bladder, genitals, and parts involved in fistula, were removed and set 
aside for further examination. On a cursory inspection they presented 
nothing abnormal. 

Remarks. — The above case is from the prescription books of the house, 
and notes by Passed Assistant Surgeon Joseph Beale, U. S. N. 

Case IV. — Fracture of Skull. — November 14, 1844. Wilham Smith, 
2d ordinary seaman, Eetat. 26, admitted from the U. S. ship North Ca- 
rolina, " affected with primary syphilis." Placed on the usual treatment. 

Dec. 22d. Venereal disease nearly cured. Complains of severe head- 
ache, caused, as he states by falhng down stairs and striking his head 
against the flagging. Cut cups freely ad nucham. Cold douche to sum- 
mit of head. R. — Pulv. jalap, comp. ^j. — P.M. Bowels not well moved. 
R. — Ext. sennas, ^j. 

Dec. 23c?. No mitigation of headache, which is referred to super-orbital 
region ; eyes suffused ; pulse frequent ; heat of skin. R. — Spts. minde- 
reri ^ss every hour— magnesia calc. gj, stat. — P.M. Bowels not freely 
moved. Vs. ad .^xxx. K. — Sulph. sodse gij ; spts. aether, nitros. ^ss ; 
aq. font. Oj. — M. Ft. sol. A wineglassful every hour. Hot pediluvium. 

24:th. Has been freely purged. Complains of severe pain across fore- 
head ; was delirious during the night. Cut cups to nape of neck ; ice to 
head, and hot bottles to feet. Suspend spts. mindereri. R. — Tart, antim. 
et potas. gr. iv ; nitras. potassas ^ij ; aq. destillat. giv. — M. Sumend, ^ss. 
q. h. — P. M. States that he feels certain he cannot recover, and thinks best 
the truth should be told. On Friday night, (the 20th,) being nearly well, 
he scaled the wall of the hospital enclosure, and, having drunk freely, he 
attempted to return in the same way, but losing his balance was precipita- 
ted from a height of about ten feet, striking on his head and left shoulder. 
He was insensible for some time, and on recovering found blood running 
from his mouth and nose. To conceal all trace of his injury and delin- 
quency, he succeeded in washing himself at the pump. Cups to temples. 
Continue treatment. 

25^/i. Passed a very restless and sleepless night ; incoherent ; constant 
jactitation and muttering. Is not able to answer questions ; constantly 
sighing ; pulse 120 ; tongue dry ; teeth covered with sordes. Shave the 
head : continue treatment. — Mid-day. Great jactitation. R. — Acet. opii 
■ges instanter.'— 6 o'clock, P.M. Soon after taking the opiate he became 



72 Ruschenberger's Contributions to Pathology. [Jan. 

quiet, and seemed to be in deep, tranquil sleep. He is now comatose ; 
pupils contracted ; left eye very sensitive to light. Continue treatment. 
26th. No favourable change during the night. Died at 10 o'clock, A. M. 

Autopsy eight hours after death. (Thermometer 31° F.) 
Head. No external appearance of injury. On removing the scalp an 
extensive ecchymosis was discovered on the right side, over the occipital 
bone, and a fracture of the bone passing upwards and backwards : squa- 
mous suture of the left side separated. On removing the skull-cap, a clot 
of blood was found resting upon the tentorium cerebelli, under the left pos- 
terior lobe of the brain ; and another on the ethmoid bone, and a laceration 
of the cerebrum just above it ; the sphenoidal cells were filled with coagu- 
lated blood. A very firm clot, two inches long by one wide, was discovered 
on removing the brain, lying between the dura mater and bone, and ex- 
tending into the right occipital fossa. The extent of the fracture could 
now be traced from the jugular fossa upwards and backwards, nearly in 
the line of the lambdoidal suture for about five inches in length. 

Remarks.' — The above ease is from notes by Passed Assistant Surgeon, 
James B. Gould, U. S. Navy. Smith fractured his skull on the night of 
the 20th, and his companion informed me, some time afterwards, that he 
rubbed him for more than an hour before he roused, and it was nearly 
daylight before the bleeding from his nose and mouth ceased, although he 
pumped on his head. On the 21st Smith appeared as usual and exhi- 
bited the venereal sore for inspection, and on the 22d, although complain- 
ing of headache, was walking about. On the 23d he stood up at the side of 
his bed at the morning visit, but in the evening remained in the horizontal 
position. Although he confessed on the evening of the 24th he had a 
severe fall, he steadily denied that any one assisted him ; and previously 
to that he was disposed not to attribute his headache to any blow or injury. 
It is remarkable that Smith was able to conceal all signs of an injury so 
severe as a laceration of the brain, and fracture of the skull for so long a 
time as twenty-four hours ; from his own account, and that of his compa- 
nion in the nocturnal froHc, it was full forty hours before headache was 
complained of. 

Case V. — Fracture of Skull. — June 23f?, 1844. — Patrick Hunt, setat. 
25, landsman, native of Ireland, admitted from U. S. Steamer Fulton for 
"injury of the head." About seven o'clock, A. M., being intoxicated, he 
fell from the spar to the berth deck, a distance of about eight feet, striking 
his head and shoulders, it was supposed, on a chain cable. He was 
brought to the hospital at 2 o^clock, P. M. He was insensible to sur- 
rounding objects; comatose; respiration oppressed; skin cool; pulse 75, 
small, weak ; pupil nearly insensible to the stimulus of fight. An ecchy- 
mosed swelling existed over the superior and posterior squamous portion 
of left temporal bone ; blood flowed from both ears. Warm applications 
were made to the feet and cold to the head. 

Q o'clock^ P*M, — Kestless; moans incessantly; spasmodic flexion and 



1846.] Ruschenberger's Contributions to Pathology, 73 

extension of the arms and forearms principally, and also of the lower ex- 
tremities, but in a less degree ; motion of left leg considerably less than that 
of the right; has vomited repeatedly ; reaction has taken place ; pulse 100, 
ad ^xxx. R. — Sulph. magnes. |i ; tart, antim. gr. j; aqu« font. gvj. 
fuller and stronger; skin warm; head hot: passed urine in bed. Vs. 
M. cap. Stat; a blister eight inches square to abdomen. R. — Spts. tere- 
binth, gij ; aq. tepid Oj.< — M. ft. enema ; to be administered an hour hence. 
8 o^clock P. M. — Extremely restless ; spasms continue at intervals ; re- 
peat enema^ 

Monday, June 24tth» — No improvement; respiration rapid, interrupted 
and oppressed; pulse 120, small and feeble; dress blister; enema did 
not operate well; repeat it. 

Half past 2 o^ clocks P. M. — Has just expired. 

Autopsy, three hours after death. (Thermometer 74.°) No superfi- 
cial marks of injury on the body, excepting at the opening of each ear^ 
and a contusion above and behind left ear. Hemorrhage from both ears. 
Tympanum of each ruptured, and a portion of brain found in the left meatus 
auditorius externus, and between it and the labyrinth ; the incus was lying 
detached. On removing the scalp a fracture was exhibited, extending from 
temporal bone, above left ear, anterior to the mastoid process, through the 
meatus and petrous portion of the bone, and across the base of the skull, 
through the basilar process of occipital bone, a httle posterior to its arti- 
culation with the body of the sphenoid, and thence through the meatus 
auditorius of right temporal bone, and terminating about two inches above 
the right ear, in a direction upwards and backwards. The brain corres- 
ponding with the fracture was ruptured ; a considerable quantity of coagu- 
lated blood lay anterior to the petrous portion of left temporal bone, and 
also in the vicinity of petrous portion of right temporal bone; similar 
morbid effects existed in different parts of the brain. So complete was 
the fracture that, after the skull cap was removed, the whole face was 
movable on the skull. 

Remarks, — The above case is from notes by Passed Assistant Surgeon 
James B. Gould, U. S. Navy. 

The injury was inflicted on Hunt between half past six and seven o'clock, 
A.M., and he died at half-past two P.M. the next day, having survived 
nearly thirty-two hours. At the time of the accident he was uproariously 
drunk. From the time reaction came on his extremities were in constant 
motion ; but the motions of the right side were very much more energetic 
than those of the left. His moans were so loud through the night as to 
disturb the whole house. The blister vesicated well, and the bowels were 
freely moved. 

Case W,'-^ Sudden formation of Cataract,'^ May 21st, 1845.' — Tho- 
mas Stanton, ordinary seaman, BBtat. 28, admitted from U. S. ship Columbus 
with pneumonia of right side, with the usual characteristic symptoms. Has 
been sick eleven days and has had active antiphlogistic treatment. 

22d. Passed a tolerable night and is more comfortable. R,- — ^Pulv, 



T4 Ruschenberger's Contributions to Pathology. [Jail. 

Doveri ^j; calomel gr. ij.- — M. ft. pulv. No. vi; one every three hours. 
Fever diet, barley water. P.M. — Severe pain in right side ; cut cups. 

2Sd, Continue treatment; an enema. 

24:th, Pulse 80; cough distressing; expectoration free; skin hot but 
moist; tongue covered with a whitish fur; debility marked. Continue 
treatment. 

25^/i. Symptoms aggravated; suspend powders. R. — Inf. serpentariee 
gij; ter in die. Chicken broth ; toastwater. 

26th. Belly tender to touch; bowels frequently moved. Suspend ser- 
pentaria. R. — Protochlor. hydrarg. gr. ss. every four hours ; chicken 
broth. 

27th. Seems better; continue treatment. 

28th. Suspend calomel. R. — Pulv. ipecac, gr. j; tinct. opii gtt. xv ; 
aq. font. ^j. — M. ft. haust; repeat every four hours. 

29th. Sputa still tenacious, but generally better ; stimulating liniment to 
chest. 

BO^A. Improving. R. — Protochlor. hydrarg. gr. j ; continue ipecac, 
draught. 

Slst. Not so well; delirious at times ; tongue foul and dry ; cough hard; 
looks haggard, and eyes have a dull expression; suspend medicine. R.— 
Pulv. Doveri gr. xij ; calomel gr. ss. — M. div. in chart. No. iv ; one every 
third hour. P. M. — Not so well as in the morning, r. — Ung. hydrarg. 
to inside of thighs. 

June Is/.— Some acceleration of pulse; tongue more moist and cleaner. 
Continue. 

2d. Patient worse ; a cataract has formed in the right eye within thirty- 
six hours without any appearance of local inflammation; it is ashy white, 
and vision is totally extinct. Wine whey freely. 

Sd. More comfortable; tongue cleaner; pulse less frequent; bowels 
loose. Suspend powders. R. — Ext. quinise gr. xij ; hydrarg. chlor. mite 
gr. vj ; pulv. opii gr. iij. — M. ft. mas et in pil No. vi. dividend. One 
every four hours. 

4th. Not so well; tongue dry and very foul; skin warm and bathed in 
profuse perspiration ; delirium with occasional stupor ; bowels loose, stools 
watery; daily sinking. Suspend pills. R. — Monesia gr. xij ; pil. hydrarg. 
gr. vj. — M. ft. pil No. vi. One every two hours. 

5th. R. — Tinct. opii gtt. xl; mucil. acaciae ^ij. — M. ft. enema. Repeat 
every two hours until diarrhoea is checked. Wine whey; clam soup. 

6th. Lies in a torpid state nearly the whole time ; pulse 140, very feeble ; 
tongue very dry and black ; expectorates but little ; blister four inches 
square to left side of abdomen. Continue. 

7th. Died at half-past ten o'clock A. M. 

Autopsy^ eight hours after death ; (thermometer 64° F.;) emaciation 
very great. What was supposed to be a true cataract proved to be an 
effusion of lymph within the margin of the pupil, slightly adherent to the 
iris. This lymph formed a disc covering the anterior face of the lens, 
which was transparent. 

Chest. — ^Left lung crepitant at upper part, but below and behind it had 
undergone red hepatization. Right lung much more crepitant generally, 
but the lower lobe was greatly engorged. Heart rather above normal size ; 
mitral valve ossified, and the opening occupied by a partial vegetation. — 



1846.] Lockwood's Medical Notes on a Crtdse. 76 

Pericardium contained about two ounces, and the cavity of right pleura 
contained a pint of clear serum. Old adhesions existed between the pul- 
monary and costal pleura on both sides, and between the pericardium and 
heart. 

Abdomen. — Stomach and intestines healthy. Liver very much enlarged 
and friable ; kidneys somewhat friable. 

Remarks, — The above case is from notes by Passed Assistant Surgeoa 
Joseph Beaie, U. S. Navy, 



Art. VII. — Medical Notes on a Cruise in the U. S. Ship John Mams, 
By John A. Lockwood, M. D., Surgeon U, S. Nary. 

It is but reasonable to suppose that the medical history of a tropical 
cruise, such as those taken by the vessels of the United States Navy, would 
contribute more or less to the stock of professional knowledge, if the dis- 
eases incident to the various ports visited were observed with attention, and 
narrated in a spirit of candour and truth. I trust therefore that even these 
imperfect notes, destitute as they may be of any merit of execution will 
repay perusal from the interest inherent in the subject. 

The complement of men attached to the United States ship John Adams 
(being a sloop of war of the first class) was about two hundred. Their 
ages ranged from sixteen to fifty-five, averaging as near as I am able to 
judge about thirty. Their places of nativity and former residence were 
pf course various and irregular. Unluckily for the class, we can speak 
with more accuracy of their modes of hving, as but few men-of-war sail- 
ors are to be found unaddicted to drinking of spirituous liquors. This of 
course does not apply to the officers and apprentices, who aggregately 
composed about one-fifth of the w^hole number. When shipped at the 
rendezvous, they are examined by an attending surgeon, who is directed 
to reject all of unsound health. The presumption, therefore, i&y that none 
but the seaworthy are detailed for a ship. This, however, does uai always 
hold good. The rules for passing or rejecting a recruit which each sur- 
geon lays out for himself may be different, and give origin to some lati- 
tude of opinion and practice. 

The ship was commissioned on the 5th December, 1837, at New York, 
from whence she sailed a few days afterwards for Norfolk, and there re- 
mained until the following May, awaiting the preparations of her consort, 
the frigate Columbia. The exposure of our crew to the inclemencies of 
an American winter, without fire, afforded a pretty fair test of their stamina. 
In the spring, about twenty who had not come up to the assumed standard 
of hardihood were exchanged at the receiring ship for others. I will not 



76 Lockwood's Medical Notes on a Cruise. [Jan. 

venture to assert how much the exposure, and consequent sufferings of the 
test, prepared them to experience additional harm from future liabilities. 
Previous to sailing, a medical survey was requested on those individuals 
whose health was supposed to incapacitate them from a cruise in the East 
Indies. The experience of the following year satisfied me that all old men, 
whatever may be their apparent health or hardihood, should be included in 
such a category. In the case of sailors, all over fifty might justly be de- 
nominated aged, for among a class of men so much exposed, so irregular, 
and so thoughtless under all circumstances, but few attain that senectitude. 
In support of this opinion, I will adduce the cases of all those whose ages 
exceeded fifty, and trace their history through the trying climate to which 
they were sent, although in so doing, I shall anticipate somewhat the regular 
narrative : these vt^ere four in number. 

1st. John Bali, boatswain, astat. 53, corpulent person, and intemperate 
on shore, where he was subject to gastric irritations. The first few months 
of the cruise he was restrained from drink, and enjoyed tolerable health. 
At Singapore, in February 1839, he took his first and last frolic in the East 
Indies. Shortly after it he was seized with a violent cholera morbus, in a 
few days settling into a fixed pain over the epigastric, and right hypochon- 
driac regions, accompanied by constant gastric irritability. After fourteen 
days' illness, his sufferings terminated in death during a severe rigor. On 
examination, a fevv^ hours after death, in addition to various lesions of sto- 
mach and bowels, lungs and heart, the liver was found in the following 
state: "Eiilarged and indurated m left half, right lobe friable, and exca- 
vated in posterior portion, containing at least a quart of illaudable pus. 
This cavity communicated with the cavity of abdomen under the suspen- 
sory ligament, in which matter also existed." This case is interesting as 
displaying the extensive progress an hepatic abscess is capable of making 
in the short period of a fortnight under circumstances favourable to its de- 
velopment. Induration, as found in the left lobe, probably existed pre- 
viously to the attack, throughout the viscus, but it is pretty certain from 
Ihe observed symptoms during life, that the formation of the abscess oc- 
curred but a few days before death. The first note of a pain in hypochon- 
drium was made eleven days prior to this event. 

2d. C. Trusty, eetat. 53. When the ship had been in the East Indies 
about six months, and others were beginning to suffer from dysentery, this 
man was attacked with hemiplegic epilepsy affecting right eye, right side 
of tongue, and right arm. These attacks increased in frequency and se- 
verity until death ensued five months after their incursion. 

3d. Silas Cooper, sstat. 55. This individual remained on duty ten months 
after doubling the Cape of Good Hope, when he was admitted on the list 
for debility. For three months he sank without apparent cause, and then 
died, to all appearances purely from the debilitating influence of chmate 
acting on old age. 

4th. John Hamilton, ?Etat. 54, went through the East Indies unscathed 
by disease, but on a protracted passage from China, on the appearance of 
scurvy among the invalids, he was attacked more severely than any other, 
and would have fallen a victim to it but for our timely arrival in port. 

5th. John Smith, setat. 56. Was not afflicted with any serious malady, 
but still his case is apposite to our subject. From ordinary exposure (late 



1846.] Lockwood's Medical Notes on a Cruise, 77 

in the cruise) he was subject to intermittent fever, sometimes sufficiently 
active to excite apprehensions for the consequences. On one occasion a toe 
took on that peculiar condition designated gangrena senilis, and part of it 
sloughed off. He had shght scorbutic symptoms during the progress of 
the disease on board. 

But there are many other causes of disqualification besides old age that 
should be regarded in selecting a crew for the East India station. It is 
hazardous hkewise for the young, as constitutional predispositions, which 
might be overcome on attaining manhood, are hkely to be developed there. 
Our own experience verified this. Of twelve apprentices assigned the 
ship in the United States four died before leaving the East Indies, of whom 
one fell victim to psoas abscess. Tubercles were developed in two young 
individuals, and ran an exceedingly rapid course. 

All those of infirm health, and all who have suffered from orofanic dis- 
eases should be unhesitatingly rejected. But a class more objectionable 
than all others are those who have been previously much exposed to that, 
or a similar climate, especially if they have been the subjects of dysenteric 
complaints. It certainly is not with the dysenteries of the East, as some 
say it is with the yellow fevers of the West Indies, that the stranger be- 
comes acclimated by time, although the British army reports controvert 
even this position, hitherto so confidently assumed. It is well known, as 
the distinguished editor of the Medico-Chirurgical Review remarks, that 
the intestines become more irritable by every subsequent attack, and even 
without an attack, by those partial derangements which annually increase 
among those exposed to the causes of dysentery. The consideration of 
this physiological fact should have its weight with those who have the dis- 
position of our naval forces, and direct speedy relief to ships, that their 
cruises in the tropics, and especially in the East, be as little protracted as 
possible, for after all it is not the unhealthiness of particular ports, so much 
as the general delay on the station that causes so great a mortality among 
our public vessels. 

It is at least curious, although it may have been a coincidence, that with 
us the blacks, who constituted about one-twelfth of the whole, were in a 
great degree exempt from the peculiar diseases of the climate. The same 
remark applies to those of Asiatic extraction, whereas among those of Eu- 
ropean descent, during the six or seven months dysentery prevailed on 
board, one in four were attacked by it. 

During the period of our stay at Norfolk, (four and half months,) we 
lost two by death. One with catarrh, who was suddenly carried off by 
congestion of the brain, a form of disease then endemic in the'neighbour- 
hood, and frequently fatal. The other was an officer's servant, upon whom 
the variolous eruption appeared a few days after leaving his friends in 
New York. The contagion was communicated to some others, who recov- 
ered. At this time all those who had not distinct marks of vaccination 
No. XXI.—January, 1846. 6 



78 Lockvvood's Medical Notes on a Cruise. [Jan. 

were subjected to the operation, and the disease did not obtain a foothold 
among us afterwards, aUhough we visited some ports where it raged most 
violently, and where the Columbia suffered to a considerable degree. The 
average number on the " sick list," whilst in the waters of the United 
States was twelve. 

May eth, 1838. Sailed from the United States. 
3Iay 26th. Arrived in Funchal, Madeira. 

The salubrity of this island is universally known and acknowledged, the 
pleasantness and equanimity of its climate having long recommended it to 
the valetudinarian. It would be superfluous to add my testimony to the 
mass already on record by dwelling at length on its peculiar advantages of 
location, as the valuable writings of Sir James Clarke, and others, have 
familiarized those with the professional reader. Average sick in Fun- 
chal, 10. 

June 3c/. Sailed from Madeira. 
July 10th. Arrived in Rio de Janeiro. 

This city is in south latitude 23°, and west longitude 43°. Screened by 
its position among mountains from most winds, excepting those blow- 
ing immediately into the mouth of the harbour, its heat is excessive during 
nearly all seasons of the year. The effects of its high temperature are 
manifested in the cachectic appearance of the inhabitants after a few years 
residence, and their obnoxiousness to diseases consequent on a relaxed 
fibre. It is estimated that one half of the population are affected with 
some variety of hernia. The magnitude which oscheoceles sometimes 
attain, well nigh exceeds credibility. It is reported of one individual, now 
dead, that the scrotum had descended so low from the weight of the con- 
tained parts, as to render it necessary for the subject to wheel it in a hand- 
barrow in advance. However this may be, the most casual observer cannot 
fail to remark the number of these enlargements amons: the labourino- 
classes, whose dress serves to display the deformity ; some of these may 
result from dropsical effusions, which are likewise exceedingly common. 
Agreeably to my experience of a year on the Brazil station, the most fre- 
quent termination of all diseases .of any standing is in dropsy of the peri- 
cardium and chest. This is especially the case with those of depraved 
habits or impaired constitutions. Among children effusions of the brain 
are exceedingly common, so much so as to communicate very generally to 
those children born in Rio, the peculiar conformation of skull observed in 
hydrocephalic patients. It was very evident in the young emperor when 
I first saw him in 1834. 

Writers on the medical topography of Rio, enumerate fevers and dysen- 
teries as rife disorders. To the shipping this certainly does not apply. 
Indeed it has been rare in vessels in which I have served to witness acute 
diseases of any kind. Our crews are usually healthy, when care has 
been taken to secure sound men. Those subject to the sequelae of chronic 



1846.] Lockwood's 3Itdical Azotes on a Cruise^ 79 

affections, the offsprmg of previous tropical cruises, are the first to succumb 
to the influence of its enervating climate. Cutaneous diseases are very- 
common among the blacks, especially that most disgusting affection, Ele- 
phantiasis, The city hospitals are seldom without cases of Small-pox, 
generally introduced by slavers from the coast of Africa, and often pre- 
vailiiig to a frightful extent. Average sick in Rio, 9. 

July 2Gth. Sailed from Rio de Jaaeiro, 

Sept, 14th, Arrived in Zanzibar. 

Zanzibar, the first port visited east of the Cape of Grood Hope, is situated 
on the island of the same name, in latitude 6° north, and longitude 39° 20' 
east. The island is of coralline foundation, and but slightly elevated above 
the level of the sea. Its fertile soil yields luxuriantly, rice, sugar cane, 
spice, and various palm trees. The coast of Africa, for many miles in 
view, is separated from Zanzibar by a channel twenty or thirty miles 
broad, interspersed with verdant islets, and coral reefs. The town contains 
a population of nearly thirty thousand, consisting of Arabs, Africans, and 
the native inhabitants, or Sowailies. The construction of the city is in the 
Arab style, with its usual accompaniments, filth and misery. The better 
kind of buildings are those erected by the former possessors of the country, 
the Portuguese, in the better days of their early navigators. The others 
are oblong huts, composed of stakes, and reeds, or palm leaves, with the 
interstices in some instances plastered with a tenacious mud. 

We arrived off this place during the healthy season, near the close of 
the southwest monsoon, a steady southerly wind blowing through the 
channel in the direction which the land trends. Zanzibar has the charac- 
ter of unhealthiness, but our crew escaped with a few cases of fever and 
diarrho&a, attributable to a change from salt provisions to a fruit and vege- 
table diet, and their unavoidable exposure to the sun. All practicable 
precautions were enforced to avoid the causes of disease. As these were 
the same in all parts, it may not be impertinent to mention some of them 
here in detail. No unripe fruits were permitted to be purchased by the 
men, and no kinds the medical officers disapproved of. The watering of 
the ship, with other labour subjecting the crew to exposure, was performed 
as far as practicable by the natives of the country. To thorough ventila- 
tion every possible attention was paid. At night-fall the awnings were 
tented, and most of the crew slept on the spar-deck. The other prophy- 
lactic regulations enforced, are common to all well governed ships of our 
navy ; such as regards attention to cleanness of the hold, the airing of bed- 
ding, the prevention of liquors being smuggled from on shore, &c. An 
intoxicating beverage is here made from the juice of the cocoa-nut tree, 
obtained by lopping off the upper leaves. When fermented it is quite 
palatable, but invariably produces diarrhoea in those who partake of it at 
all freely. None o[ the officers or men slept on shore in Zanzibar ; this is 



iO Lockxvo'od^s Medical Notes on a Cruise^ pan, 

the principal source of danger on the west coast of Afjrica, few escaping a 
liighly dangerous ferer who do so. 

From the testimony of the officers of H. B. M. ship Andromache, the 
eHmate of Zanzibar under similar circumstances is eqally hazard mis to 
Europeans. That ship^ under the command of Commodore Noursje, visited 
the island in Atigust, 1824, A number of officers, among whom was the 
commodore, slept for one night at the house of the governor, a short dis- 
tance in the country. The greater number, including Commodore Nourse, 
Were seized with fever, all of whom died. Captain Owen, the celebrated 
hydrographer, relates that one of his boat's cfew, five in number, were una- 
f oidably prevented from returning on board ship at night on one occasion. 
*' Four out of the five who formed the party, instead of sleeping in the 
boat, landed, and lay around a large fire which they had kindled in the 
jungle. For nearly a fortnight no effects were visible, but at the end of 
that time, three fell ill and died, while the fourth was obliged to be sent 
home with an emaciated body and worn out constitution." Still the appear- 
ance of both the native and foreign population indicate a soil and climate 
infinitely more propitious to the health of all varieties of the human species 
than can be found on the Grain Coast, the seat of our colonization settle- 
ments, which I visited in the autumn of 1836, There man exhibits, as 
Dr. James Johnston correctly remarks, "the lowest varieties of formation." 
The four or five American and English residents we met with in Zanzi- 
bar, displayed a far more rubicund visage than we foun4 ordinarily in 
British India. It is worthy of remark, that they entirely eschew the 
almost universal practice of the latter, of applying " hot and tempestuous 
liquors to the blood." 

The water of the island not being so good as might be, is almost entirely 
superseded by the bland and delicious juice of the young cocoa-nut. — 
Here, as everywhere else, probably, in the East Indies, the water is 
usually filled with animalcuh, which grow to rather an alarming size after 
being on board a few days. At first it required some fortitude to overcome 
a natural repugnance to svi^allow them, b^^t I am not aware that any preju- 
dicial effects ensued therefrom ; some attribute to these little animals most 
of the calamities flesh is heir to in these parts, a notion I myself may have 
entertained at first to a slight extent, but soon discarded in toto, 

Cassada and rice, with a few fish, constitute the chief articles of native 
diet. Besides these, the animal kingdom furnishes in the greatest abun- 
dance, bullocks of the humped species, {bos indicus,) goats, and dunghill 
fowls ; and among the fruits arid vegetables, sweet potatoes, cocoa-nuts, 
melons, juck fruit, &c., &c. Average number of sick in Zanzibar, 18. 

September iSth. Sailed from Zanzibar. 

October 6th. Arrived in Muscat. 

Muscat, the capital of the classical province of Oman, in Arabia Felix, 
is on the west point of the Persian Gulf, in north latitude 23° 37', and east 



1846.] 



Lockwood''s Medical Notts on a Cruise, 



81 



longitude 58° 3(y« Completely eacircled by a lofty rock of mica scist, 
except at the entrance of the harbour, the circulation of the air is prevented, 
and the sun's rays so powerfully reflected as to render the heat always 
most excessively oppressive. As its intolerable heat is the distinguishing 
characteristic of the place, I shall present without apology the following 
thermometrical table, copied from a work published some years since by 
an Italian physician in the Imaum's service, and for a long time a resident 
in Muscat. 







>. 














u 




^ 


« 






























Id 

*-5 










c 

1-5 




to 

< 


■2 







S 



S 

OJ 


Temperature of 
air at F, 


80O 
to 


€50 
to 


870 
to 


90O 
to 


980 
lo 


960 
to 


960 
to 


940 

to 


920 
to 


910 
to 


980 
to 


850 

to 


840 


880 


890 


920 


9GO 


990 


990 


980 


950 


940 


930 


880 


Rain. 


never 


never 


* 


never 


nearer 


t 


never 


never 


t 


never 


never 


never 


Fogs. 


never 


— 


— 


— ' — 




— ' — 




— 




— 



In corroboration of the above, I am able to state that I have seen the 
thermometer at midnight as high as 96° F., and at aio period of the day 
or night was it common to find it below 90^ F., the average range for the 
ien days of our stay being 93". 

The town is exceedingly filthy, and ili-ventilated. Palm leaf mats are 
thrown across the streets from house to house, with a view of excluding the 
sun, and which answers the purpose of excluding the air quite as efTec- 
tually. Its houses are crowded together as closely as possible, merely 
permitting a narrow alley to intervene, which is at all times redolent with 
the most noxious odours, derived from animal excrement, and decayed vege- 
table matter. The harbour is formed of a small cove as well placed as the 
city itself to receive the reflected rays of the sun, without an avenue for a 
current of air to circulate except in oae direction from which the wind 
seldom blows. The city contains about 25,000 inhabitants principally 
Arabs, Hindostanees, and African slaves* Their principal diet consists of 
dates and fish, both of which are abundant, and very good. Ships are 
readily supplied with bullocks, sheep, and fowls, all of excellent quality in 
addition to a variety of vegetables and fruits, as dates, grapes, pomegran- 
ates, and figs. These are all brought from some distance, as 'm. the imme- 
diate neighbourhood the soil is rocky and barren, without a verdant spot 
to relieve the sterile prospect, except within a iew feet of some wells where 
a leguminous plant is cultivated for forage, by artificial irrigation. About 
these oases are small villages, consisting of the miserable hmts of the poor- 
est classes who are fcrbid to construct substantial dwellings without the 
wails, lest they be turned to the disadvantage of the city in the event of a 

* Sometimes two or three days in Mareh^ but ©ot antauall^r. 

i Sometimes with lightning, but without a thunder-bolt ever falling. 

i Tbere ai^ soaie years in wJzich it raias two or tbiiee days in Septfiojfoer^ 



82 LockwoodV Medical Notes on a Cruise, [Jan-, 

In ike popniaticm of suck a city as Muscat, vigorous health it would be' 
unreasonable to- expect. We accordingly find among them an universal 
ieuco-phlegmatic appearance, indicative of their feeble stamina, together 
with more marked manifestations of disease, as leprous affections, ophthal- 
mias, visceral obstructions, and dropsical effusions. Much evil may be 
attributed to the baneful effects of their social and religious customs, autho- 
rizing a plurality of wives, the intermarriage of relatives, early marriages, 
and the seclusion of females. But to these there are partial offsets in the 
prevalence of strict temperance, both in eating and drinking, their frequent 
ablutions, their loose and floAving dresses, and that serenity of mind which 
never deserts the Arab. It is among the pitiable wretched who drag out. 
their miserable existence outside the walls, where the chronic maladies I 
have specified mostly abound. 

The medical profession is in the hands of a few ignorant Persians, who 
never trust themselves beyond certain indigenous plants. As these indi-. 
viduals do not enjoy the confidence of the Muscatians, the arrival of a fo- 
reign physician is hailed as a godsend, and he is forthwith beset by all 
the sick and complaining of the pkce. Arnong the " black-eyed houries" 
of the wealthy his aid is most frequently called for. These unfortunates 
being constantly immured within doors of an ill-ventilated city> seldom en- 
joy their health. I met among them one case of tubercular phthisis, but 
their complaints in most instances are referable to a deranged state of the 
generative system* During the summer months, fevers a.nd dysenteries- 
are rife : it is considered almost necessarily fatal to the European to reside 
there during this season. Three agents of the Hon. E» I. Company suc- 
cessively fell victims within a short period of each othen No European- 
has resided there of late years. 

The crew of the John Adams experienced no ill effects of climate during 
the week of our stay beyond a few ordinary cases of fever and cholera 
morbus. A slight exposure to the sun's rays was apt to induce cephalal- 
gia from partial coup-de-soleiL A case of this kind on board our consort 
was so violent as to terminate fatally^ Notwithstanding our immunity from 
sickness we were all happy to leave "Oman's green waters," satisfied that 
one week's residence was more agreeable than any longer period. Ave- 
rage sick in Muscat twelve. 

October I2th, 1838.— Sailed from Muscat. 

October 2Sd, 1838.— Arrived in Bom.bay. 

The city of Bombay, the capital of the presidency of British India of 
that name, in north latitude 19°> east longitude 73°,. is situated on a low, 
and level island, eighteen miles in circumference. It contains a popula- 
tion of three hundred thousand, but a small minority of whom are Euro- 
peans, or of European descent. The soil is a rich black loam, subject to 
annual inundations, and well calculated for the growth of rice, for which 
jiiuch of it is used,. Formerly, probably the whole island was a thick 



1846.] Lockwood's Medical Notes on a Cruise, 83 

jungle, teeming with disease and death. From the earhest periods of its 
settlement, Bombay has been regarded as eminently deleterious to the Eu- 
ropean constitution. Although British wealth and British enterprise have 
removed many of the sources of its fatality, and rendered the island as con- 
genial as art can effect, or nature permit, we find still the victims of avarice, 
necessity, and philanthropy alarmingly numerous. 

Bombay is subject to extreme vicissitudes of weather, and presents the 
different seasons of the year in striking contrast with each other. From 
October to April, or in the north-east monsoon, the atmosphere is dry, and 
comparatively cool and pleasant, whilst in the south-west, or rainy monsoon, 
it is humid, oppressively hot, and in every respect uncomfortable. It is 
during the rainy season, from April to October, that fevers prevail. 

Our sick list was smaller in Bombay than it had been previously, or was 
afterwards for so long a period. Still we were breathing an atmosphere 
replete with disease, as was sadly manifested on the eve of sailing. On 
the 11th of November, a few hours before we left our anchorage, Edwin 
Clary, a marine, was seized with Asiatic cholera in its most violent form, 
terminating fatally in ten hours from the first decided symptoms. Two 
days subsequently, another fell a victim to the same malady, and five days 
after that again a third died under similar circumstances. As these cases 
did not difier from each other materially in the symptoms, or mode of treat- 
ment, I will detail one as a sample of the others. 

''^November ISth, 1838, at sea, off the coast of Malabar. Edward Tay- 
lor, seaman, aged twenty-four, sanguine temperament; good habits. Has 
had diarrhosa for two or three days, which he neglected to report to the 
medical officers. At general quarters to day, he was stationed in the 
ward-room to pass powder. Hatches being battened down, it was exceed- 
ingly close and warm. Violently exercised for an hour or more under 
these circumstances, when the retreat was beaten, he was in an exhausted 
state, and very thirsty. He forthwith rushed into the cooler air on deck, 
and took a copious draught of water. A violent pain in the region of the 
stomach immediately followed. The pulse then not appearing to forbid 
depletion, he was blooded to a small amount, when syncope ensued. At 
the same time a pill containing five grains of calomel and one of opium 
was administered. The epigastric suffering was in no measure relieved, 
and vomiting commenced shortly afterwards. At two P. M. (between two 
and three hours after the incursion) an attempt was made to apply cups to 
the epigastrium, when the patient was seized with the most violent spasms, 
alternating from one limb to another, and occasionally affecting the abdomi- 
nal muscles. These continued for five or six hours. The countenance in 
the mean time became sunken and cadaverous, with a livid circle around 
the eye : coolness of surface except abdomen, rice water stools, and pro- 
fuse vomitings. During this period, various stimulants were administered 
internally to bring about reaction, together with the free application of sina» 



84 Lockwood's Medical Notes on a Cruise. [Jan. 

pisms, hot sand, dry frictions, &c., externally, but all without any eleva- 
tion of the animal powers. At 10 P.M. he expired. On examination the 
stomach was found flabby, and rather larger than natural; shght erythism 
about the pyloric orifice. Peritoneal coat of intestines exhibited traces of 
inflammation throughout, much more so than the mucous coat. Gall blad- 
der empty, and contracted. Spleen large and filled with grumous blood ; 
liver natural; cavity of abdomen only opened." 

The Medical Journal records the cases of a number treated about this 
time for the ordinary premonitory symptoms of cholera, who were readily 
relieved. It contains likewise the case of the recovery of an individual in 
whom decided symptoms of the disease were manifested. He was a robust 
man, and stood a copious bleeding. Taylor was the only one of those who 
died, on whom blood-letting was attempted. The treatment varied some- 
what in the case of the last victim, an apprentice of about fourteen years 
of age. All cold drinks were withheld, and sipping of water as hot as 
could be imbibed prescribed : active frictions at the same time being per- 
sisted in. The disease did not appear again on board at any subsequent 
period of our cruise, although it prevailed in Manilla to an alarming extent 
at the time of our visit. No cases occurred on board the Columbia, proba- 
bly because she, having arrived in Bombay eight days after the John 
Adams, was exposed for a shorter period to the exciting causes. During 
our stay in Bombay the city was entirely free of cholera, but it prevailed 
epidemically shortly after our departure. There, as indeed throughout 
India, sporadic cases are liable to occur among strangers at all seasons, 
besides appearing in the character of an epidemic at intervals more or less 
remote. 

The crews of ships visiting Bombay frequently suffer from dysentery, 
which many attribute to the water they are supplied with. This indispen- 
sable beverage is collected during the rainy seasons in capacious tanks, 
erected in some cases by government, but mostly through the eleemosynary 
offices of individuals, such being inculcated in the religious books of Brah- 
ma as the most meritorious of charities. It is probable the water in some 
of these tanks is of a pernicious quahty, but others contain as good as is 
generally met with in the neighbouring parts. Average number on the 
sick list at Bombay, five. 

November 11th. Sailed from Bombay. 

November 2Sd. Arrived at Columbo, Ceylon. 

Columbo, the capital of Ceylon, is in latitude 7° north, and in longitude 
80° east. It has been selected as the military station of the island on ac- 
count of its healthiness, and is frequented by the European invahds from 
India in order to escape the effects of the baneful climate of the continent. 
It is built upon a promontory, subject to the full influence of the sea-breeze 
in either monsoon. The neighbouring country along the coast is level, 
and rather low, with a loose sandy soil. Thirty miles in the interior are 



1846.] Lockwood's Medical Notes on a Cruise, 85 

lofty mountains, where the inhabitants from the lower parts of the island 
can readily attain a cooler atmosphere. When held by the Dutch, Columbo 
was as fatal to European hfe as the other possessions of Mynheer in the 
East proverbially are. This arose from the extensive lowlands in the 
vicinity being cultivated and kept partially drained. The present owners 
have converted these meadows into beautiful lakes by throwing a dam 
across a stream which flows through them, and have thus removed the 
most prolific source of disease. Although this dehghtful settlement con- 
trasts favourably with many other parts of India in salubrity, yet it is very 
far from enjoying an immunity from its peculiar diseases. Cholera has at 
various periods been exceedingly destructive to the population, both native 
and European, and still occasionally prevails. Dysentery, fever, and he- 
patitis are sometimes quite rife, and, in common with the rest of the island, 
small-pox has raged with a virulence and frequency unknown among the 
other British possessions. Average number on sick report at Columbo, 10. 

November 31s^. Sailed from Columbo. 

December 20th. Arrived off west coast of Sumatra. 

The west coast of Sumatra trends from east-north-east to west-south- 
west, and lies between the parallels of four and five north latitude. Along 
the sea side the country is flat and level, having a rich loamy soil covered 
with rank vegetation. A chain of mountains runs in the direction of the 
island's length, giving origin to numerous streams which pass into the 
plains below, and thence flow sluggishly into the ocean. On the banks of 
these streams the natives have made clearances for paddy fields, which 
are annually inundated by the overflow of the rivers' banks. So near the 
equator, and under the influence of the high lands of the interior, a large 
quantity of rain falls at all seasons. During our stay we had daily copious 
showers, although in the middle of the north-east, or fair monsoon. 

The Malays of Sumatra are below the medium height of Europeans, 
but possess a frame apparently capable of more physical endurance than 
any of the numerous Asiatic tribes we had previously seen. Th'e face is 
broad and angular, olive complexion, coarse and straight black hair. — 
Their teeth and lips are deeply stained with the juice of the betel nut ; 
the teeth being dyed black, and hps red. We met with but few chronic 
diseases among them, and they probably escape with as small a share of 
bodily ills as any other people of the eastern world. This may in a 
great measure be attributed to their superior manner of living, and their 
active habits of hfe. Many of their dwellings are comfortable, and well 
adapted to a tropical climate. Curried rice constitutes the important item 
of their daily food, and is used with fish, flesh, or fowls, according to the 
taste or means of the individual. They may be addicted in some degree 
to the use of spirituous liquors obtained from pepper ships, but the substi- 
tute for this excitement among them is found in masticating the betel nut. 
This nut, inclosed in the leaf of a native plant, together with chunamj 



86 ' Lockwood's Medical Notes on a Cruise. [Jan. 

(a preparation of lime,) and tobacco, provokes when chewed a highly- 
stimulating effect upon the sensorium of an individual unaccustomed to its 
use. It is said to harden the gums, and prevent the tartar incrustation 
on the teeth. 

On the coast of Sumatra, where we remained between three and four 
weeks, the crew began to experience the effect of the climate upon their 
health, although it was probably procrastinated for a time by the excite- 
ment attending the anticipated attack upon different towns along the coast. 
The sergeant of marines died upon the first of January, of dysentery, 
supervening upon chronic peritonitis. Average number on sick report on 
the coast, 12. 

January Wtli. Sailed from coast of Sumatra. 

February 6th. Arrived off' Singapore. 

It was not until ten days after leaving the coast for Singapore that dysen- 
tery manifested itself in a decided manner. As I propose devoting to this 
disease hereafter a separate paper, I shall proceed in my narrative of the 
ship's progress. It is proper, however, in this connection, to refer in gene- 
ral terms to its history ; the causes of its progress and extent with us. — 
To this period of our cruise, affections of the bowels were not more common 
than in most ships on other stations. Immediately on leaving our anchor- 
age, 03*800 Soo, the cases daily multiplied until, upon our arrival at Singa- 
pore, there were six or more of a serious character. During the remainder 
of our cruise in the East Indies, new cases were constantly occurring, and 
old cases relapsing, nor was it until the ship reached the Sandwich Islands, 
the following October, that no more new cases occurred. I am not aware 
that being in port or at sea affected the number of cases, or violence of the 
attacks ; nor can I assign to any port visited from January to October, a 
pre-eminence over any other in being more or less obnoxious to dysentery. 
It is, however, worthy of remark, that the disease both in the John Adams 
and Columbia never seized upon an officer, except in an instance where it 
was clearly traced to imprudences on shore. This circumstance I regard 
as furnishing a solution to the question of the cause of its prevalence 
among us. I know not that the officers were more free from hardships 
than the rest of the crew, or enjoyed superior comforts, except in having a 
better diet. The crew were subsisted upon the rations furnished by govern- 
ment ; the officers' messes provided themselves with provisions and stores 
from on shore. The ship's ration was of a very inferior quaUty, and well 
calculated to derange the functions of the digestive organs in any part of 
the world ; to its agency I attribute mainly the general prevalence of 
dysentery in the squadron. It is unnecessary to enter into detail of the 
condition of the ship's provisions, further than to state that most of the 
articles had been sent from the United States, and were probably old before 
leaving, as many were really unfit for use before we received them. This 
especially applies to the bread, flour and beans. My opinion now is, that 



1846.] Lockwood's Medical Notes on a Cruise, 87 

ships in the East Indies should serve out fresh provisions eveiy day in 
port. The practice of giving sailors salted meats three or four times a 
week, or even once a v^eek, in any tropical climate when fresh can he 
procured, is of very douhtful propriety so far as health is concerned. That 
dysentery was so rife with us is not due to any neglect of prophylactic 
means to guard against it. Captain Wyman, the accomplished commander 
of the John Adams, was ever alert in consulting the health and comfort of 
his crew, and never delayed to adopt any suggestions coming from the 
medical officers, which tended to promote that object. The number of cases of 
dysentery which terminated fatally, was ten : the number under treatment 
from January to October, inclusive, which embraces all of those displaying 
the type of the disease as prevailing in the China Sea, was seventy-three. 

February hth. A boy, R. A. Hunter, died this day of psoas abscess, 
whose first complaint of it was dated the 4th of the preceding November. 
He then attributed the pain in the hip to a " wrench" received in ascend- 
ing the rigging. Dissection showed the lumbar vertebrsB in a state of 
extensive caries, with a large amount of pus in the pelvis, derived from an 
abscess which radiated in various directions, dissecting the muscles of the 
thigh. 

In this passage, especially that part through the strait of Malacca, we 
found the weather extremely adverse to our sick, which had now become 
numerous, rains being frequent and the temperature high. On reach- 
ing Singapore, the number of our sick was about two dozen, and con- 
tinued to range between twenty and forty through the succeeding nine 
months, dysentery being the most conspicuous complaint. At Singapore 
we buried three of the crew, two seamen who fell victims to dysentery, 
and Mr. Ball already alluded to. 

The island of Singapore, one of an Archipelago in the strait which 
gives it a name, is in north latitude 1° 22', and east longitude 184°. The 
monsoon blows freshly through the strait, and to this free circulation Sin- 
gapore is supposed to be indebted for a comparatively salubrious chmate. 
Meteorological ^tables kept here, show it to have an uncommonly humid 
atmosphere. Rain falls in about two hundred days in the year. Average 
range of thermometer, 80° F., and of barometer, 29.9. We found the 
temperature of the air cool and pleasant, except for an hour or two at mid- 
day, frequent showers and passing clouds moderating the heat. The 
island is fifty miles in circumference, being throughout a succession of hill 
and dale : the soil is fertile, and well covered with wood. It was origi- 
nally settled by emigrants from Sumatra, but the Chinese at present out- 
number them. The English population is less than two hundred. — • 
Although the climate of Singapore may not be so noxious to Europeans as 
its rival Batavia, still strangers are far from being exempt from any of the 
maladies which are so often fatal in all parts of the China sea. Average 
number on sick report at Singapore, %U 



88 Lockwood's Medical Notes on a Cruise, I^Jan. 

March 28th. Sailed from Singapore. 

May 1st. Arrived in Manilla. 

This long passage of thirty-four days between two ports scarcely one thou- 
sand miles apart, was characterized by oppressively hot weather, light 
airs, calms, and rain squalls. Two seamen died of dysentery on the pas- 
sage. 

Manilla, or Luconia, is the capital of the Philippine islands. It is situated 
on the river Passig, which discharges its waters into the eastern and re- 
mote end of a magnificent bay, ninety miles in circumference. The site 
on which the city is built, and the country in the neighbourhood of the city, 
is flat and but slightly elevated above the level of the ocean. It is in lati- 
tude 14° 36' north, and longitude 121° east. Few parts of the world have 
been more obnoxious to fevers, dysentery, and cholera. During our visit 
the latter raged to a considerable extent among the lower classes, presumed 
to have been induced by the scarcity of food which a failure in the rice 
crop had occasioned. All vessels remaining for any time during the south- 
west monsoon are liable to suffer more or less from sickness. Our Hst 
doubled during a stay of ten days. Ships water in the Passig, but care 
should be taken to go far enough up the stream, as the water near its 
mouth will be found brackish, or otherwise unfit to be taken to sea. 

The Tagalos (natives of the Philippine islands), are of a bright olive 
complexion, rounded symmetry of form, considerable embonpoint, and 
altogether possess greater personal attractions than I have seen among other 
Asiatics. The favourable influence of religion and government is illus- 
trated in their present condition. In no partially civihzed people have I 
seen so happy an aspect of health, comfort and contentment, as may be 
witnessed among the Tagalos. In embracing Christianity, they have done 
so through a form intelligible to their understandings, adapted to their 
usages, and agreeable to their sentiments of propriety. Its tenets are 
famiharly explained by the benevolent priesthood of the Roman Catholic 
Church, who have given to this disinterested service all their powers of 
mind and body. By means of these excellent men, the civil institutions 
are assimilated to the patriarchal character, affording a striking and favour- 
able contrast to what may reasonably be supposed to have been their 
condition in former ages. Average number on the sick report at Manilla, 
21. 

May lOth. Sailed from Manilla. 

May 20th. Arrived in Macao Roads. 

We remained in Macao Roads about three weeks, and afterwards lay in 
the securer anchorage of Tong Koo,the greater part of the sutnmer. It is 
between Canton and Macao, fifteen miles from the former. At these 
anchorages five of the crew died : two of dysentery, one of phthisis, one 
of epilepsy, and one of tetanus. The latter I will present in detail. 

^^ Benjamin Parvin, apprentice, aged seventeen — whilst in Zanzibar the 



2846*3 Lockwood^s Medical Notes on a Cruise. 8@> 

preceding September, had been ^founded in the elbow by the accidental 
discharge of a fowling piece. A load of small shot entered the forearm 
posteriorly about two inches below the elbow joint, and passsing through 
the interosseous space over the ligaments of the joint, escaped (the greater 
part of the load) anteriorly above the elbow, taking with it a portion of 
integuments larger than the palm of a man's hand. As the space through 
which the nerves and vessels of the arm pass was included m this course? 
a large nerve (the median), was w^ounded and left exposed partially.— 
Little or no blood was lost ; there was no pulse at the wrist for a ^ay or 
two, and ever after the pulsation there was very feeble. The wound 
healed kindly, but both the flexioB and extension of the joint were impaired. 
The arm and hand gradually diminished until his death, a sensation of 
numbness and pain being a concurrent symptom. 

" On the 30th of June following this accident, Parvin received an incisecl 
wound on the front of the thighy two or three inches above the patella.- — - 
The wound, perhaps two inches deep and one long, was inflicted by a 
small carving knife. It bled profusely at the time, but was soon arrested 
by pressure, dressed with a pledget of lint, and rest in the horizontal posi- 
tion enjoined. A week afterwards it bled afres-h, but was again arrested 
without difficulty. This hemorrhage recurred on the eighth and tenth 
day from the injury. On the thirteenth day suppuration had commenced % 
poultices were applied, and everything seemed favourable until the six- 
teenth day, when the patient complained of severe pain across the lum- 
bar region, a rigidity of the muscles of the face, without the ability to open 
the mouth. The weather at the time was oppressively hot, except at 
night, vfhen a cool breeze circulated. He attributed the symptoms of 
the morning of the sixteenth to a cold caught from sleeping under the 
wind-sail. In the treatment, the main reliance was placed upon cups 
and counter-irritants to the spine, and morphia internally. In my ab- 
sence from the ship, on consultation, he was blooded the afternoon of the 
second day from the appearance of the rigidity of the muscles of the face^ 
and expired in two hours afterwards in tetanic spasms* There was no- 
thing remarkable in the appearance of the wound a^ seen after death. It 
contained a small quantity of clotted blood. A minute artery may have 
been cut, but it escaped notice. In the cicatrized wound near the elbow 
joint about tv/o dozen small shot were found. It is difficult in this case to 
say whether the wound of the thigh was the sole cause of the tetanic 
symptoms, or whether it only determined the course of an ordinary 
catarrh. Again, how far the previous wound of the elbow and nerves of 
the arm predisposed the patient's system to nervous complaints/' 

The crews of ships trading to China do not suffer so severely from fevers 
and dysentery at Macao, or the securer anchorages in the vicinity, as the 
Typa, Lintin, Tong Koo, &c., as at Whampoa, the port of Canton, where 
they are surrounded by paddy fields. Pernicious consequences often f©I- 



90 Lockwood's Medical Notes on a Cruise, [Jan. 

low the smuggling on board a vile drink called " samshu,^'' made of fer- 
mented rice-water, with certain hurtful ingredients. Average number on 
the sick list in China, 20. 

August 6tL Sailed from Tong Koo. 

October lOth, Arrived in Honolulu, 

During this long passage the sick list was sometimes as high as forty.— 
Three deaths occurred of dysentery, and one of debility and old age. The 
weather was frequently tempestuous and rainy, conveying to our feelings 
a sensation of coldness, although the mercury but once fell below 50° F. 
The numerical force of the crew being diminished by the many sick and 
invalids, necessarily imposed on the remainder additional duties. To these 
circumstances, the appearance of the scorbutic affections on board both ships 
of the squadron is to be attributed, rather than the length of time at sea or 
the absence of vegetable diet. 

John Hamilton, already referred to in speaking of old men, was the 
first subject of attack. He had had dysentery in Macao Roads, but reco- 
vered perfectly in a Aveek. On the 3d of October, fifty-eight days at sea, 
he reported himself with (Edematous legs, for which a purgative was pre- 
scribed. The day following there was less oedema, but a number of spots 
resembling erysipelas had appeared on each leg. Two days subsequently, 
the veins of the leg were in a varicose condition ; the spots had increased 
in number and size, and the gums were spongy and bled freely. He was 
directed to use a vegetable diet as far as practicable. Extract of taraxa- 
cum was prescribed, and a mouth-wash of creosote-water. 

October 7th. Mucous lining of mouth and fauces presents a number of 
mottled spots, wath pain ; bleeding from gums increased. 

Sth. Spots on the legs larger and more painful ; mouth swollen, and 
saliva freely secreted. Lemonade for common drink. Continue other 
treatment. 

9th, Worse. Offensive effluvium from the mouth ; the whole mucous 
surface of which is affected. 

10th. Arrived in Honolulu. Sent on shore and allowed a free diet. — 
On the 28th he returned to his duty entirely restored to health. 

The symptoms in all the other cases bore a mitigated resemblance to the 
foregoing, excepting the existence in some of them of one symptom here 
not manifested : nyctalopia. On board the Columbia, where the disease 
prevailed to a far greater extent, this was of frequent occurrence. More 
than a dozen oases were under treatment with us for scurvy, but there 
Tvere many, doubtless, which, being slight, the medical officers knew nothing 
of. The gums of all those who had taken much mercury became spongy 
and red. 

A mode of treatment prevails among the whalemen resorting to this 
port, which they regard as an infallible cure. It consists in burying the 



1846*] ISime't&on on Excessive Mortality of Male Children. 91 

nether extremities, and frequently the whole body, in the earth, for which 
the taro beds offer admirable facilities. 

The Sandwich Islands, or, agreeably to modern orthographers, the Ha- 
waiian Islands, are a group embraced between the parallels of north lati- 
tude 18° 50', and 22° 20', and between 154° 53', and 160° 15', of west 
longitude. Of coralline and volcanic formation, their surfaces are inter- 
spersed with, or rather constituted of, mountains and valleys. The latter 
abound with the most luxuriant vegetation, furnishing everything required 
by the inhabitants, in the rude state they have hitherto Hved. The prin- 
cipal article of native diet is derived from the taro plant, or arum esculen- 
turn, for which the soil and climate is peculiarly suited. It is said, and I 
believe admits of ready proof, that more individuals can be subsisted upon 
the same given quantity of land planted in this article than in any other 
vegetable product. To prepare this for eating, it is first boiled, then 
pounded, and set aside for a day or two to ferment, after which it is eaten 
in a state resembling paste in appearance, and sour starch in taste. The 
islands may be regarded as highly salubrious. Diseases are not of a 
severer grade than are met with in temperate climates. Small-pox has at 
times appeared as a fatal epidemic, but not to any extent of late years. — 
The visits of whalers have introduced venereal diseases, and many attri- 
bute to them the declining state of the population, but I feel assured with- 
out cause. The disease could not exist without visible manifestations 
somewhere, but on pretty extensive observation and inquiry, I could not 
satisfy myself that its efTects upon the population of these islands had been 
more pernicious than among any civilized people. 

At Honolulu we tarried long enough to recruit the health of our crew. 
Their convalescence was rapid, and from the period of our saihng from 
thence may be dated their recovery. The narrative of our homeward voy- 
age may be properly omitted, not being characterized by any incident of 
professional interest. 

U. S. Naval School, Annapolis, Md., 
September, 1845. 



Art. YllL— Excessive Mortality of Male Children, with the causes ex- 
plained. By GouvERNEUR Emerson, M. D. 

Ever since correct registers of mortality have been kept, it has been ob- 
served that the proportion of males dying in the first years of life is much 
greater than that of females. It might be supposed that in the very early 
stages of infancy, whilst the external circumstances to which both sexes 
are subjected are so nearly the same, boys and girls would be placed upon 



92 Emerson on Excessive Mortality of Male Children. [Jan, 

an equal footing as to the risks of life. But this is so far from being the 
case that the greatest mortality of boys takes place in the first months of 
existence. 

Of the infants born the number of boys greatly exceeds that of girls. 
This excess of males at birth is in Europe about five or six per cent. In 
the United States the male preponderance is generally considerably greater. 
In Philadelphia, for example, the boys outnumber the girls at birth more 
than seven and a half per cent. 

But notwithstanding this great numerical advantage on the part of the 
males at the beginning, the boys and girls are found on enumeration very 
nearly equalized at the tenth year, and by the fifteenth year the females 
outnumber the males almost as much as the males did the females at birth. 
Hence, up to the fifteenth year of life, the deaths of boys in Philadelphia 
exceed those of the girls about fifteen per cent. 

One might be led to suppose that this excessive mortality of the male 
children was owing to greater exposure to weather and accidents, falls, 
drowning, etc. So readily are plausible explanations admitted when par- 
ticular attention has not been devoted to the subject, that I readily adopted 
the popular error, when, in 1827, 1 published the first series of the Medical 
Statistics of Philadelphia.* Having however been subsequently led to 
investigate the subject with more care, I discovered the fallacy of the con- 
clusion by which the excessive mortality of boys is ascribed to greater ex- 
posure to accidents. I showed that, in Philadelphia, at least, the deaths 
reported under the head of casualties constitute but a very small proportion 
of the whole infantile mortality, in which, when the deaths from "burns 
and scalds" are included, the females exceed the males.i 

Pursuing the investigation by examining into the particular diseases 
which had proved fatal to many thousands of infants of both sexes, I was 
compelled to take an entirely new view of the subject. The excess in the 
deaths of male children I found was not attributable to accidents, but must 
be ascribed to certain physiological peculiarities in the sexes, favouring the 
termination of some diseases in fatal disorganization. 

I found that in Philadelphia the diseases which had proved particularly 
fatal to male children were — inflammation of the brain, and its conse- 
quences — convulsions and hydrocephalus ^ — inflammations of the lungs, 
stomach, bowels, etc., and fevers of all kinds, some of the eruptive excepted. 
On the other hand the diseases in which the deaths of female children pre- 
ponderated were few in number, the chief being whooping cough, scarlet 
fever, and consumption. The diseases most fatal to male children seem there- 
fore to be of the sthenic class, characterized by excessive inflammatory and 
febrile action, such as attend upon constitutions in which the energies of 
organic life are highly exalted. Whereas, wnth female children, the most 

* Vide American Journal of the Medical Sciences for Nov. 1827. 
f See American Journal of Medical Sciences, vol. xvii. page 56. 



184^,] Emerson on Excessive Mortality of Male Children. 93 

destructive diseases are of the asthenic class, characterized by less energy 
in the forces of organic life, and feebleness of the system. 

It remained to be ascertained whether these facts deduced from statisti- 
cal investigations made in this part of America, were in accordance with 
those derived from observations upon infantile mortality made elsewhere, 
and especially in Europe, In London, where the immense amount of 
deaths opens such a wide field for examination, the diseases proving most 
mortal to male and female children are distinguished by nearly the same 
general characteristics as those of Philadelphia. In the fifth and last report 
of the EngHsh Registrar-General, we find the following facts bearing up- 
on the subject. 

One of the tables shows the proportional numbers out of 100,000 dying 
io. London at all ages of particular diseases; 51,023 were males, and 
48,977 females. The deaths under the fifth year from ail causes, were 
16,665 males, 15,006 females. 

Of these there were from 

Males. Females. 

Cephalitis, or Inflammation of the Brain, - - ^ . 328 281 

Convulsions, . 2550 2081 

Hydrocephalus or Dropsy of the Brain, - _ . - 1481 1151 

Pneumonia, or Inflammation of the Lungs, - - - 2659 2411 

Phthisis, or Consumption of the Lungs,=^ - - > _ 967 920 

Croup, ---------- 343 303 

Thrush, ---------- 208 206 

Measles, ..-.„-.-. 1048 1020 

Scarlatina, 753 690 

Gastritis and Enteritis, Inflammation of the Stomach and 

Bowels, - - - - 487 376 ' 

Almost the only diseases in which the female deaths exceed the males, 
are 

* Males. Females, 

Whooping-cough, - - - - - - - -1115 1445 

Small-pox, --------- 232 240 

In measles and thrush the proportion of female deaths exceeds that of 
the males, since under the fifth year the number of males living conside- 
rably exceeds that of the females. 

The facts thus developed through statistical research, lead, I think, to 
most important deductions bearing upon the medical treatment appropriate 
to the two sexes during infancy. The proneness of boys to succumb to 
diseases of high inflammatory or febrile action, must surely call for the 
adoption of prompt and vigorous means of reducing the exalted actions of 
the system which sustain local inflammations and tend to their termination 
in disorganization and death. On the contrary, when girls are the subjects 

* Of the whole number of deaths from consumption under the 20th year, there 
were 1753 males and 1742 females. 
No. XXL— January, 1846, 7 



^4 Emerson on Excessive Mortality of Male Children, [Jan, 

of treatment, more than ordinary caution should be observed not to push 
antiphlogistic measures too far ; to guard against the effects of enfeebhng 
agencies, and afford timely support to the exhausted energies of the system. 

Common observation mJght indeed lead to very similar conclusions in 
regard to discriminating in practice. But still the authority of striking 
facts derived from exact numerical calculations, tends to endow the subject 
with that higher degree of importance necessary to give it proper control 
over medical treatment. 

It will be observed that the few diseases which prove most fatal to fe- 
males are located in the cutaneous and mucous tissues; such are scarlatina, 
measles, whooping-cough and thrush. 

The influence of atmospheric temperature upon the welfare of children 
is often very conspicuous, extremes of heat and cold, when protracted, 
exerting very deleterious effects. In the United States, returns of deaths 
are only obtained from the large cities in which the indirect effects 
of high temperature are found to swell the lists of infantile mortality to a 
melancholy extent. In some tables published in the American Jour- 
nal of the Medical Sciences in Nov., 1831, 1 exhibited the deaths in Phila- 
delphia at different seasons and ages for a period of five years, and at seve- 
ral ages under the twentieth year. 

The mortality occurring under the second year in the months of June, 
July and August, (our three warmest months,) was about four times greater 
than that which occurred during the same months in the whole eighteen 
years of life succeeding. But the sum of mortality for the months of No- 
vember, December, and January, little exceeded that of the succeeding 
eighteen years during the same months. Perhaps the most interesting 
fact connected with this subject is — that the deleterious operations of heat 
are almost entirely confined to the first few months of existence. After the 
first year the influence of the seasons is scarcely perceptible in increasing 
mortality. 

Since these investigations were made by me in 1831, the results of other 
inquiries carried on in Europe, upon the effects of temperature on life, have 
come to hand. These generally show an increased infantile mortality dur- 
ing the winter months, but still they sustain the law — for such I think it 
may be considered — that the influence of atmospheric temperature upon 
the infant in predisposing to disease, seems almost lost after it has weather- 
ed the first months of existence. Among others who have devoted atten- 
tion to this topic, with confirmatory results, I may refer to M. Gluetelet, in 
his account of the influence of the seasons upon mortality at different ages, 
published in Brussels in 1838, 



1846.] Gardner on relation of Dew Point to Malaria, 95 



Art. IK.'-^The relation of the Dew Point to the Diseases of marshy lands. 
By D. P. Gardner, M. D., formerly Professor of Chemistry, &c., in 
Hampden Sidney College, Va. 

Marshy lands, in which an extensive surface of wet soil is exposed to 
the action of the sun, and which are more or less perfectly sheltered from 
winds, are notoriously unhealthy. The diseases prevailing in such situa- 
tions, differ according to several conditions of temperature, and the nature 
of the soil. We wish, distinctly, to separate the morbific agents, supposed 
to be associated in producing the gravest marsh diseases. They may be 
enumerated under three heads : — 1st, the atmospheric condition of marshes 
and swamps : 2d, the effects of high temperatures : 3d, the specific miasm 
of marshes and swamps. In this place we confine ourselves to the first 
topic ; the second may be considered hereafter, and the third has already 
been discussed in this Journal, January, 1843. 

While it is certain that a class of diseases is universally attributed to 
marshy countries, it is not to be overlooked that many of these may arise 
independently of such localities. Intermittents, bihous fevers, and yellow 
fever, have been seen in persons and places where the agency of marshes 
could not be discovered. Such instances enforce the truth that in medicine 
as well as in physics given results may be reached by various means, and 
that general laws are to be promulgated with extreme caution. 

The atmospheric condition of marshes. — The atmosphere im.mediately 
over marshy lands betrays the remarkable feature of a nearly saturated dew, 
point. This is especially the case in such places as are sheltered from 
winds by forests, or other natural objects. Those who are famihar with 
such districts, will not be surprised at this condition — the morning fog and 
evening haze which hang over them, are proofs of the high state of the 
dew point. This evidence is not however sufficient. 

During the summer of the year 1842, I kept a register of the dew point 
over a marsh situated at a short distance from Hampden Sidney College, 
Va. The place was of limited extent, and quite protected from winds ; 
on three sides it was bounded by steep hills, and on the fourth was ex- • 
tended into a dense forest. The dew point was taken at intervals during 
the months of July and August, the days selected being clear, and the time 
of examination 2 o'clock P. M. The means used for taking the dew point 
were a thermometer, a small flask of very thin glass, and spring water 
obtained on the spot. The place of observation was four feet above the 
soil, under the shade of a dense tree, and where no direct or reflected rays 
of heat could reach the thermometer. The flask being perfectly clean, 
spring water was poured in to half its contents ; a film of dew instantly 
appeared on the outside ; the thermometer was then introduced and moved 



196 - Gardner on relation of Dew Point to Malaria, [Jan. 

to and fro, until the dew was about disappearing. The temperature ob- 
served at this moment is the true dew point, or that degree of heat which 
represents the amount of vapour of water existing in the atmosphere. 

My object being to test the amount of vapour in the air over a sheltered 
marsh, the measures were not made so frequently as for meteorological 
purposes. I found that there was seldom a difference exceeding six degrees 
between the dew point and atmospheric temperature, and the average differ- 
ence between these measures did not often exceed 4° Fahrenheit. There- 
fore, so far as these observations can be adduced, the air four feet above 
a sheltered marsh is, even during the height of summer, so fully charged 
with vapour of water as to be within a few degrees of saturation during the 
day, and surcharged with vapour at night. The temperatures taken, 
varied between 75° and 92° Fh., and the average dew point at 2 o'clock 
P. M. was nearly 80° Fh. These measures were made, it is to be remem- 
bered, in calm air. 

From some observations made in the college, at a distance of seven 
hundred feet, and elevated about one hundred and fifty feet, the air during 
the same season exhibited a dryness of 12, 16 and 21 degrees Fahrenheit 
above the marsh. The measures in this place were not, however, intended 
at the time for comparison, and are imperfect in this respect. The condition 
of the air for three months in the year 1841, was, however, measured by 
other observers, and I find that it exhibited a dryness of 17 degrees at 
Gettysburgh, and 20 degrees at Lancaster, Pennsylvania. The drying 
power would probably be rather higher in Virginia from the greater summer 
temperature. 

I would suggest to future observers the expediency of conducting a 
cotemporaneous examination at the marsh, and an adjacent elevation out 
of the influence of the column of air over the former position. In this 
w^ay the comparative dryness of the two stations is fully ascertained. 
Daniell's hygrometer is superior to the arrangement used by myself, and 
will give results in cold weather, when spring water is useless; it is an 
instrument of great delicacy, and acts with rapidity. A year or two ago 
the military stations were furnished with this valuable implement, but by 
the report made, it appears that some parties have discarded them as un- 
suited to " our arid climate." This report is, however, opposed to the 
experience of persons abundantly competent to use the hygrometer, as 
Professor Loomis and Captain Sabine. The former gentleman has mea- 
sured a drying power of 37° Fahr., which is the greatest in the United 
States during seven years. Captain Sabine, and others, have used it in the 
Tropics. The effect of the report is much to be regretted, because there 
is no substitute for Daniell's implement. The wet bulb hygrometer which 
has been substituted is valueless ; the results vary with different observers, 
and the measures obtained have to be submitted to calculation to reach the 
dew point. It is to be hoped that the proper authorities will not persist 



1846.] Gardner on relation of Deiv Point to Malaria. 97 

in discarding the best instrument extant, and using the worst in endeavour- 
ing to obtain hygrometrical observations, the value of which to meteorology 
and the etiology of disease is above all calculation. 

For stationary observatories, where it is desirable to ascertain the dew 
point repeatedly during the day, Professor Bache's instrument is the most 
desirable, but it requires a supply of ice, and cannot be transported with 
the same facihty as that of Daniell. 

The air of sheltered marshes being constantly saturated with moisture, 
an interesting consequence follows. The same bulk of air contains appre- 
ciably less oxygen gas than in salubrious and dry localities at the same tem- 
perature and elevation. The average summer temperature at Lancaster, Pa. , 
as ascertained by Dr. Atlee, is 81° Fahr. ; in Va. it would be rather higher ; 
the average dew point during the season was 61*8, leaving a drying power 
of 19*2° Fahr.,'which may be taken at 20° Fahr. ; — the summer dew point 
of the marsh was nearly 80° Fahr. in Va. — Here is a difference of 20° 
Fahr., or from 60° to 80° in the dew point of two places which severally 
represent a marshy site and a healthy ordinary location. 

The amount of oxygen gas displaced by the excess of 20° Fahr. dew 
point is nearly equal to g'^th of all that is present at 80° Fahr. temperature. 
Thus, the elastic force of vapour of water at 60° Fahr. is 0-52 inch ; at 
80° Fahr. is 1*00 inch — [Dalton;] therefore the displacement of air in 
the first case will be g^th, and in the second gjSt; the difference will be 
nearly eV^^ ^^ *^® whole bulk. The actual amount of oxygen thus driven 
out from a cubic foot is readily discovered, for the vapour at 60° Fahr. is 
6*22 grs., and at 80° Fahr. is 11'33 grs. — [Daniell;) the amount of air dis- 
placed in each cubic foot to make way for this vapour will be 8*41 grs. at 
60° D. P., and 16*03 grs. at 80° D. P., the temperature in both cases being 
80° Fahr. Thus there will be dislodged 28-32 cubic inches of air in the 
former case, and 54*0 cubic inches in the latter, of which 10*8 cubic inches 
will be pure oxygen. There will be a difference of 5-13 cubic inches of 
oxygen between the two situations. 

This case exhibits in a striking manner the vitiated condition of the 
atmosphere of marshes in warm countries. The instance is by no means 
extreme. The diminution of oxygen in the air of hot climates has been 
adduced, by Liebig, as a cause of hepatic diseases. But however elevated 
the temperature or moisture may be, so long as they do not reach 98° Fahr. 
there will be no effect on the aeration of the blood, for all the air inspired, 
whether in the arctic or tropic zone, is warmed by its passage through the 
nares to the temperature of the lungs. The only effect that ensues is the 
exhalation of moisture when the dew point is under 98° Fahr., and the 
separation of heat from the mucous surfaces to give the inspired air a 
temperature of 98° Fahr. So far as the aeration of the blood in the lungs 
is concerned, the absence of ^^^th or more of oxygen gas will produce no 
result, the presence of moisture will depress exhalation. On the skin 



98 Gardner on relation of Dew Point to Malaria. [Jan. 

the absence of oxygen may produce some effect, but to what extent we are 
unprepared to state. 

The atmospheric condition of marshes is different from that of the sea 
or of deep waters. — The amount of vapour of water over marshes is sup- 
posed to be the cause of their pecuhar unhealthiness : hence most persons 
suppose that over the sea similar effects should exist. It is a general im- 
pression that the air of seas and the ocean is saturated with water. Under 
this behef we find it universally objected to that theory of malaria which 
regards the moisture of the air as the injurious cause, that marsh fevers 
should prevail extensively at sea. But the dew point over the sea does 
not appear to be relatively higher than in dry places, and to be, for the 
most part, much lower than that of marshes. 

In laying down the position that the atmosphere over the sea, where it 
is uninfluenced by currents, is dryer than that over stagnant marshes, I place 
myself in opposition to the received notions or prejudices of most persons 
and even of apparent truth. The subject is, however, worthy of serious 
investigation, for whereas those authors who are opposed to the theory of 
the malarious nature of a high dew point, confidently appeal to the salubrity 
of the ocean, the advocates of the theory either avoid the difficulty, or, with 
Mr. T. Hopkins, {Lo7id. Edinb. Phil Mag., No. 86,) take it for granted that 
intermittents do occur thereupon. The hygrometrical condition of the ocean 
has never been made the subject of general investigation ; none of the great 
meteorological writers seem to have turned their thoughts to the subject, 
so far as the dew point is concerned. The only series of observations which 
I have met with is by Captain Sabine, during his voyage to the tropics, to 
ascertain the length of the seconds' pendulum ; these are, however, nume- 
rous, exceeding four hundred, and many being made on shore, a means of 
comparison is presented by the same observer. The great accuracy of 
Captain Sabine renders this series worthy of the highest confidence. Ex- 
aminations, at sea, with Danieil's hygrometer, are often made between 
decks, and do not indicate the atmospheric dew point, but that of a con- 
fined and damp room. So small a number of observations as four hun- 
dred would be of little value for meteorological purposes, but are amply 
sufficient to enable us to form a correct idea of the average drying power of 
the air. 

The register was first kept between Madeira and Sierra Leone, and 
commences Feb. 20th, 1822. In this voyage three measures were made 
daily at 8 A. M., 1 and 6 P. M., the temperature of the air and water and 
dew point being taken : the observations were continued in the Gambia and 
Rio Grande rivers — The mean temperature was 70° Fahr., and it did not 
rise above 74^, or fall below 66° Fahr. — the mean dew point was 57*7° Fahr. 
■—hence the average dryness, or drying power was 12'3° Fahr. — this was 
never depressed below 7°, and rose during the Harmattan to 39° Fahr. — 



1846.] Gardner on relation of Dew Point to Malaria. 99 

and to 16*4 during a brisk breeze. In this register are contained several 
measures over rivers, the water of which was 5° to 8° Fahr. above the 
temperature of the sea. 

Contrast these measures at sea with those made on shore at Sierra Leone» 
from the 25 Feb. to March 22; during this season, the average mean of the 
thermometer was 78°.85 Fahr., the average dew point 72*7, seldom sink- 
ing two degrees beiow this, so that the drying power was but 6*15, or only- 
half of what it was in the adjacent seas. 

The same admirable observer furnishes us with materials for rectifying 
errors springing from imperfect examinations of the moisture of the atmo- 
sphere over the ocean. We find that along the shore of Guinea, and in 
the equinoctial current, where the sea is warmer than the air, either by 
the ingress of the tepid waters of rivers, or the circulation of tropical waters, 
the drying power falls to an average of 5 degrees : in other words it is then 
as high as at Sierra Leone. In sailing to the island of Ascension, from the 
river Gaborn, in Africa, the drying power over the equinoctial current was 
6° Fahr. at 8 hours A. M., and rose to 9° Fahr. at the same hour, when 
they had passed out of it. 

Observations made at Ascension, from June 25th to July 5th, give a mean 
ipf 75° Fahr. at 8 hours A. M., and 84° at 3 hours P. M., the dew point 
being 65° Fahr., and 70° Fahr.— the drying power 10° Fahr. at 8 A. M., 
and 14° Fahr. at 3 P. M., — measures ahnost identical with those of the 
adjacent seas. These measures are true for Bahia at the end of July ; the 
average dryness of the air from Bahia to Pernambuco, was 8° Fahr. at 8 
A. M.. 

The examination of all these observations, which are to be found ia 
Danieii's meteorolgy, shows that the drying power of the air, when the ship 
was not sailing through warm currents or on coasts, where many rivers were 
discharging tepid waters, attained from 6° to 10° Fahr. in the morning at 
9 A. M., and may be taken at an average of 12° Fahr. for the whole voyage, 
lasting from February to November, and between Madeira and Bahia. Ln 
this time the thermometer ranged, between 65° and 84° Fahr., it was there- 
fore the most favourable season for examining the question. 

In comparing these with the measures made at inland situations, free 
from malaria, as at London, Greenwich, Hudson, in Ohio, Toronto, Lancaster 
and Gettysburgh, Pennsylvania, we find the average drying power at sea 
equally high and even greater than in some of these places. 

At Hudson, Ohio, by Professor Loomis's observations, made during seven 
years, we find the average drying power at 9 hours A. M. but 6°.2 Fahr,. 
in the months of May, June, July, Aij gust, and September, the temperature 
ranging between 58° Fahr. and 72° Fahr. at the same time. 

In London, from observations made at the rooms of the Royal Society, 
the average drying power at 9 hours A. M. is only 5° .3 Fahr., during the 
months of June, July, August, September, and October; the temperature 



100 



Gardner on relation of Dew Point to Malaria. 



[Jan. 



during this season, at the same hour, varying from 47°.2 Fahr. to 64° .3 
Fahr. 

The measures at Greenwich, and Toronto, Upper Canada, are almost 
identical with London, and Hudson, Ohio. 

The registers at Lancaster and Gettysburgh, kept by Dr. Atlee and 
Professor Jacobs, are not comparable with the preceding, because the dew 
point is given for 2 hours P. M., and is not ascertained directly by Daniell's 
hygrometer, but by means of that miserable contrivance, the wet bulb 
thermometer. The dew point at 9 A. M. is necessarily lower than at 2 
P. M., which latter is near the moment of maximum ; in Captain Sabine's 
observations the drying power at 9 hours A. M. was often 6° Fahr., and 12° 
Fahr., or 14° Fahr. at 2 hours P. M. — a difference of one half; in Professor 
Loomis's observations, the difference is nearly half, between the measures at 
9 hours and 3 hours ; if, therefore, we reduce the measures in the tables 
for Lancaster and Gettysburgh to this extent, they will then compare with 
the preceding averages. 

Table of the mean dew point, temperature, and drying power at 2 h. P. 
M., at Lancaster and Gettysburgh during the Winter, Spring, Summer, and 
Autumn of 1841. 



PLACES. 


WINTER. 


SPRING. 


SUMMER. 


AUTUMN. 


Lancaster 
3eltysburgh 


Temp. 

357 
291 


Dew 

point. 
24-S 
226 


Drying 

power. 

10-9 

6-5 


Temp. 

57-4 

4S-7 


Dew 

point. 
42-0 
42-6 


Drying 

power. 

15-4 

61 


Temp. 

81 -0 

78-3 


Dew 

point. 
61-8 
61-5 


Drymg 

power. 

19-2 

16-8 


Temp. 

59-1 
51-6 


Dew 

point. 

47-8 

45-6 


Drying 

power 

11-5 

60 



The drying power at 9 h. A.M. will therefore be 7°'7 and 3°*0 Fahr. in 
Spring— 9°'6 and 8°*4 Fahr. in Summer — and 5°-7 and 3°-0 in Autumn; 
measures not much diflerent from those of the sea for Lancaster and lower 
at Gettysburgh. I am not, however, quite certain of the time of observa- 
tion at the latter place . 

We have, therefore, as a mean drying power at sea 8 degrees at 9 h. 
A. M., and 6°'2, 5^-3, 7^-7, 9°'6, 5°-7, during similar seasons and tempera- 
tures inland — the average dryness, it v.^ill be seen, is therefore one degree 
in favour of the atmosphere of the ocean. This result is not presented as 
perfect, but as extremely remarkable, and pointing to a fact altogether new, 
for no meteorologist has any notice or suspicion of it. I think the data, 
although very imperfect, are sufficient to establish the general fact, that the 
degree of dryness can only be reached by numerous observations, which 
must be made, like Capt. Sabine's, with the greatest care, and on the 
upper deck, under an awning, and not in confined cabins, like those of 
Mr. Caldcleugh. 

It may be interesting to consider the theoretical reasons of this high dry- 
ing power. There are two^ — the influence of winds— and the traucalesency 
©f the ocea,n,. 



1846.] Gardner on relation of Dew Point to Malaria. 101 

The influence of winds is seen directly in the voyage from Madeira to 
Sierra Leone, when, on the 25th Feb., a fresh breeze raised the drying 
power from 8°-7 to 16°*4 during its existence, and on the 5th of March, 
when a shght Harmattan on the Gambia River produced a drying power 
of 29 degrees. The ocean is nearly constantly under the influence of 
winds, and therefore this cause is ever active. The extent to which a 
moderate wind increases evaporation, or, in other words, the drying effect 
produced thereby, has been measured by Dr. Dalton, and a table con- 
structed, by Dr. Ure and others, to express it for every degree within pro- 
bable Hmits. We find that 189 grs. of water are evaporated during a high 
wind; 154 grs. during a medium breeze; and only 120 grs. during a calm ; 
from the same surface of water maintained at the same temperature. These 
numbers may severally represent the rates of drying power under similar 
circumstances, and they are nearly in the ratio of 1 to H and I5. As the 
dew point is the measure of the capacity of the air for moisture, the in- 
creased power of receiving it necessarily reacts on this measure. 

By the transcalesency of the sea is meant the power its clear waters 
possess of transmitting heat of low refrangibihty without being heated 
thereby. Melloni [Scient. Memoirs^ Nos. 1 and 2), first drew the atten- 
tion of scientific men to the different properties of radiant heat derived 
from various sources, as from non-luminous substances, incandescent bodies, 
and the sun. The more heated the sources the lower the refrangibihty. 
The same observer designates the rays from different sources by giving 
them the names of the colours of light, and thereby associating in the mind 
their degree of refrangibihty. Heat from warm water or bodies below in- 
candescense belongs to the violet end of the spectrum, and is entirely 
absorbed by the clearest water, none being transmitted by radiation. Of 
heat from a lamp, that is of lower refrangibihty, 1 1 rays per cent, were 
transmitted by radiation. The per centage of the rays of the sun trans- 
mitted is not given, but is very much larger. This fact is readily appre- 
ciated by filling a thin glass vessel of a spherical form, and an inch or more 
in diameter, with clear water, and exposing it to the sun's rays ; a focus 
will be formed in the same way as with a magnifying glass, and sufficient 
heat transmitted to cause the combustion of inflammable bodies. So that 
of every hundred rays which fall upon the sea, a large number will be 
transmitted to unknown depths, and probably never directly expended in 
heating it, for of those rays which penetrate to several feet, few only are ab- 
sorbed at greater depths. As the sea derives no heat except from the sun's 
rays, it will be seen that its temperature will be below that of the dry 
earth, and less evaporation will take place from it than from a contiguous 
surface of damp soil heated by the same source. 

The position we have endeavoured to sustain is that the dew point of the 
marsh sheltered from winds will be higher than over the sea. In the case 
of marshes little heat will be lost by transmission ; it will be entirely ex* 



102 Gardner on relation of Dew Point to Malaria. [Jan. 

pended in producing evaporation. This results from the shallowness and 
colour of the water, and the extent of solid surface. Whatever rays fall 
on the mud will be absorbed, and becoming converted into heat of high 
refrangibihty, {violet heat,) be absorbed by the moisture and effect its vapour- 
ization. The shallow waters of marshes are not only heated by all the direct 
rays of the sun which they are capable of absorbing, like the sea, but in 
addition, unhke the ocean, by the absorption of more heat from the soil. 
Being thus placed between two fires, the amount of evaporation will be much 
greater than at sea in the same season ; the elastic force of the vapour will 
be higher, and a condition nearly approaching to saturation will be main- 
tained in the contiguous air. How great the increased evaporation is, may 
be inferred from the fact that a dry soil, of light texture and dark colour, has 
been measured at 113°-5 Fahr. when the air was 77° Fahr. (Schubler); 
and I have measured the soil of a marsh 5° below that of the air in con- 
sequence of the great evaporation going forward. In the latter case the 
excess of heat absorbed and five degrees upwards were employed in 
vapourization. 

Relation of the high dew point of marshes to evaporation, and the in* 
sensible perspiration. — The dew point is a means of ascertaining the eva- 
porative force, or rapidity of vapourization, from any wet surface for a given 
temperature. At a temperature of 80° Fahr., the abstract evaporative force 
may be represented, either in terms of the elasticity of vapour (1*01 inch 
Bar.) or using Daniell's table, [Meteorological Essays,) deduced from Ure 
and Dalton, may be taken at 4*28 grs. of water per minute, from a circular 
vessel of six inches diameter, placed in calm air. The force in either case 
is that exerted by 80° Fahr., when there is no vapour already in the air, 
and it will rapidly diminish with the amount pre-existing, which latter is 
shown by the dew point. Thus at 80° temperature, and 0° dew point, the 
force equals 4-28 grs.— at 22° D. P., it is 3-72 grs.— at 50° D. P., 2-68 grs. 
—at 60° D. P., 2-04 grs.— at 70° D. P., 1-20 grs., and at 80° temperature 
and dew point, the force is zero. This diminution of force results from the 
pressure of vapour already existing in the air. The force is increased as 
already explained by the action of winds, which by constantly presenting 
fresh bulks of air, raise the dew point or evaporative energy. 

The human body presents an evaporative surface, varying in tempera- 
ture at the skin between 95° and 98° Fahr., which is ever throwing off 
vapour, or insensible perspiration. The exact amount of vapour, thus 
thrown off, has been imperfectly measured. Lavoisier and Seguin esti- 
mated the cutaneous and pulmonary exhalation at quantities varying be- 
tween 98 oz. troy, and 32 oz. troy, or as averaging 53 oz. 38 grains daily, of 
which 32 oz. were from the skin, and 20 oz. 38 grs. from the lungs. Dalton 
attained a mean of 27| oz. daily for both exhalations ; of which 6| oz. 
were from the skin, and 20^ oz. from the lungs. We learn from these 
discordant results, how much the amount of exhalation is under the influ- 



1846.] Gardner on relation of Dew Point to Malaria. 103 

ence of physical and vital causes, and that no measure of this important 
function can be obtained of utility to physiology, without an accompanying 
register of the state of the dew point and other data. The value of a 
healthy condition is seen distinctly in the amount of the evaporation, for 
even assuming the minima of 272, and 38 oz. per diem, the quantity is 
sufficient to convince us of its great moment. The distinction between 
cutaneous and pulmonary exhalation is not to deceive us, for these are 
vicarious and intended to counterbalance one another; it is indeed transpira- 
tion from the skin, or mucous membrane of the air passages, and equally 
under the physical influence of the atmosphere. It is also maintained by 
some writers, that there exists a distinction between the transpiration car- 
ried on under physical laws and that which is an excretion elaborated by 
the cutaneous foUicles ; this does not affect the question of the influence of 
physical agents ; a portion of the constituents of the insensible perspiration 
is of glandular origin, a portion is pure vapour of water ; it is over the latter 
only that the dew point can exert any action. Transudation of moisture 
or sweat is not influenced by the dew point as to its quantity. Irritation 
of the cutaneous follicles, or nervous fibrils, producing various results, is 
not primarily the effect of a high dew point. It is over the vapour of water 
only that the dew point exercises a controlling influence. 

The pressure of the vapour existing in the air, will exercise the same 
influence on the amount of insensible perspiration as over the evaporation 
from a surface of water. The degree of dryness necessary to a full dis- 
charge of the function, has never been directly measured. Mr. Hopkins 
thinks that a pressure of 60° Fahr. dew point, will arrest it sufficiently to 
produce agues. He obtains this measure from the supposed average dew 
point in summer and autumn, in Holland, Lincolnshire, &c., where inter- 
niittents prevail. But this point is probably exaggerated, for in the registers 
kept in the United States, the dew point seldom attains 60° Fahr. during 
the summer at 2 P. M., when the average temperature is 80° Fahr., and 
in the tropical island of St. Vincent, averages but 68°.8 Fahr. Mr. Hop- 
kins, however, compHcates the effect with the temperature, urging that a 
low saturated temperature at 60° Fahr. will be injurious, whereas a dew 
point of 60° Fahr., under a high temperature, would be salubrious. This 
seems to be unphilosophical, and can be understood only by supposing that 
the temperature of the skin is liable to great changes, and that with a high 
atmospheric temperature, the skin will also be much above 98° Fahr. The 
fluctuation measured by Dr. Davy was but little, and we cannot understand 
how the temperature should rise, without abnormal conditions, so long as 
the atmospheric degree is below 98° Fahr. If we take 60° Fahr. dew 
point, the temperature of the skin being 98° Fahr., which is the normal 
degree in temperate climates, we have a drying power of 38° Fahr. as the 
theoretical limit of healthy transpiration. 

Taking 38 degrees as the amount of dryness, and Lavoisier's average 



104 GatX(\x\eY on relation of Dew Point to Malaria. [Jan. 

exhalation of 11 grs. by the skin and 7 grs. by the pulmonary apparatus 
per minute, we are prepared to consider the effect of higher dew points 
than 60° Fh. in arresting the quantity of insensible perspiration. The 
highest mean dew point measured at the unhealthy island of St. Vincent 
during July, 1832, was 70°'25Fh.; it is not stated at what time of the day. 
Captain Sabine's register at Bahia gives an average at 6 P. M. of 67°'6 
Fh., this was on shore at the end of July. Capt. Alexander measured the 
dew point at 76° Fh. and 79° Fh. off the Bight of Benin, where it is to 
be remembered the sea off the coast is heated by the waters of the adjacent 
marshes. It is probable from these observations that a dew point of 80° Fh. 
is never attained except over small marshes sheltered from winds. 

With a dew point of 70° Fh. the drying power would be reduced to 
28° Fh.; with a dew point of 80^ Fh. it would be reduced to 18° Fh. The 
depression in either case under normal circumstances would affect the 
vapourization, reducing it from 18 grs. per minute to less quantities. The 
physical effect would be identical upon the cutaneous and so called pulmo- 
nary exhalation. The vessel of water employed by Dalton and Ure being 
of six inches diameter, presented a surface of nearly 28*5 square inches. 
A man exposes a surface of at least 2160 square inches, which is the per- 
pendicular superficies of a cylinder five feet high and three feet in circum- 
ference. These surfaces are to one another nearly as 1 to 76. The 
evaporation at 98° Fh. under a pressure 60° D. P. is taken at 18 grs. per 
minute ; this quantity becomes 15*0 grs. per minute at 70° D. P., and 
finally 10-9 grs. per minute at 80° D. P. — these measures being all taken 
in calm air. Thus from the human surface, quantities of only 18, 15 and 
10'9 grs. would be evolved in a minute, whereas, under similar circum- 
stances, water would throw off 376*9, 313*1 and 221*9 grs. From this it 
will be seen how exceedingly slow the cutaneous evaporation is and to what 
a great extent it may be developed under any abnormal condition. The 
evaporative surfaces are as 1 to 76 — the exhalation as 20*9 to 1 — and this 
on a calculation for the superficies of a man very much below the average, 
and without estimating the air passages. From these data it will be seen 
that the pressure of the highest dew points does not produce such a marked 
effect as at first might be supposed ; that even at 80° D. P., which is un- 
warrantably high as a mean for a summer season, there is only a falling off 
of 7*1 grs. out of 18 grs,, and this from a surface which may be supposed 
capable of a very much more extended evaporation, as it throws off but 2ySt 
part of that vapourized by a like surface of water under similar forces. 

It does not matter whether the mean of 18 grs. evaporation be true or 
not, the relative deficiency under different dew points will be in the same 
ratio, and this arises from the fact that the elastic force of vapour does not 
increase in the simple ratio of temperature, but much more rapidly ; thus 
by Dakon's table the elastic force at 60° is 0*52; at 70° is 0*72 ; at 80° is 
1*00; at 98° is 1 '74 inch, 



1846.] GdiX^ner on relation of Dew Point to Malaria. 105 

The office of the insensible perspiration, and the consequences floiving 
from a high dew point.— li is scarcely necessary to premise that insensible 
perspiration consists almost entirely of vapour of water — the carbonic acid, 
lactic acid, azotized matters, and oily parts it contains being in no way con- 
cerned in the present discussion. The production of the latter by the 
sebaceous follicles, or the direct transmission of gases is in no wise depend- 
ent upon the condition of the dew point primarily. The pressure of water 
in the atmosphere has no influence on the passage of carbonic or other 
gases, as many writers suppose ; it is only effective in arresting the aqueous 
particles. We have therefore no concern for the office of insensible per- 
spiration, except so far as the vapour of water is involved. The duty 
discharged by this is evidently not the simple separation of an excess of 
fluid, for all that rises during the day might be discharged vicariously in a 
few minutes. This part of the function is distinctly the effect and not the 
cause. But in the vapourization of so much fluid, we discern its prominent 
if not sole office ; the removal from the body of an amount of heat — the 
function which is to antagonize the calorific forces and serve to attain the 
constant and all important healthy temperature of the body. 

Direct radiation of heat from the body is not influenced by the dew 
point; this, with the caloric rendered latent in vapour amounting to 1114 
degrees at 98° Fahr., is the most important means of keeping down the 
temperature of the system. Fluids evacuated are merely warmed, and 
remove only the excess of heat which they may have acquired. Thus it 
becomes evident that if the amount of insensible vapour be diminished by 
physical causes, the quantity of heat carried thereby from the body will be 
diminished. But before we examine this conclusion, it is necessary to pre- 
sent two positions affecting the case : first, that under the same circum- 
stances, the number of respirations in a minute is the same at all ordinary 
temperatures in persons enjoying sound health; and secondly, that the 
amount of oxygen inhaled into the tissues of the lungs is the same at every 
terrestrial temperature not exceeding 98° Fahr. The first position is rea- 
dily conceded by physiologists, but I am apprehensive that it is not strictly 
correct, although it is here assumed ; of the second I have already treated. 
These two conditions insure the production of an uniform amount of heat in 
the body, whatever may be the external temperature. During cold weather, 
whatever excess is produced over the amount necessary to warm the sys- 
tem to a proper degree, will be thrown out by radiation, the latent heat of 
vapour, &c. In this case the amount removed by radiation will be large, 
and, perhaps, exceed that by vapourization. As the temperature of the air 
rises, the duty of cooling the body devolves on the insensible perspiration ; 
and when it attains 98° Fahr., the latter removes nearly all the excess of 
heat. It is in high temperatures that the depressing effects of the high 
dew point may be expected to act. 

There is scarcely a place in the southern half of the United States, not 



106 CTardner on relation of Dew Point to Malaria, [Jan. 

mountainous, which does not present us with a dew point of 60° Fahr., 
and a mean temperature of 80° Fahr. during the months of July and Au- 
gust, and notwithstanding are perfectly salubrious. In Hudson, Ohio, the 
mean dew point for seven years was found at 2 h. P. M. to be 67° '2 Fahr., 
in July, and 66°*0 in August, with the maintenance of perfect health. In 
July, 1840, at Lancaster, the mean was 68° Fahr. — at Milford, Pa., the 
mean for August of the same year 67°*4, without any malarious diseases. 
It has already been showTi that a dew point of 70° Fahr. is probably the 
highest mean for a month in any part of the world except where there is 
no circulation of air, yet there is no malaria developed by it, as the fore- 
going cases amply demonstrate. 

At 70° dew point the evaporative force is but 28° Fahr. from the human 
body, yet we discover that health is maintained ; this, it will be remem- 
bered, is the highest mean during July at the tropical Island of St. Vin- 
cent. Above this point the measures must be very few, and only obtained 
during calms and under extraordinary circumstances, for Prof. Daniell has 
abundantly shown that a direct consequence of the law of diffusion of va- 
pours is that the condition of the dew point which exists at the earth's sur- 
face will be maintained to a considerable elevation ; and this cannot rise 
much higher than 70° as a mean, because of the limiting effects of the 
atmospheric temperature. It is perfectly possible for the air of a shel- 
tered ravine to attain a dew point of 90° Fahr., but where there is a play 
of winds, or free diffusion laterally, it becomes absolutely impossible at any 
terrestrial temperature. 

It has been shown that at a mean of 18 grains evaporation from the 
body per minute for 60° dew point, the insensible perspiration will be 15 
grs. at 70° Fahr., or a diminution of only 3 grains. We have seen that, 
in the direct attempts to measure the amount of insensible perspiration^ 
quantities were procured at different times from the same persons during 
health, varying between 11 grains and 82 grains per minute, for both cuta- 
neous and pulmonary exhalation. From these experimental data we dis- 
cover to how great an extent the fluctuation occurs without derangement 
to health, and that whilst Dalton measures the daily cutaneous exhalation 
at 6^ oz., Lavoisier and Seguin give us a mean of 32 oz. The measures 
of the latter philosophers are probably too high, yet we find only a diminu- 
tion of 3 grains per minute as the result of elevating the dew point from 
60 to 70 degrees. Whatever be the true exhalation at 60°, the reduction 
is pro rata ; if it be but 9 grains, the falling off is but 1^ grain. In the 
extremest case but only 3 grains. 

What will be the effect of diminishing the insensible perspiration by 3 
grains per minute ? Experience suggests two consequences : 1st, that an 
amount of sensible perspiration will accrue sufficient to compensate for this 
detention ; 2d, that some other vicarious discharge will occur. Theory 
also indicates that the temperature of the skin will be increased to produce 



iB46.'] Gardner on relation of Dew Point to Malaria, 107 

a higher evaporative force, or, secondly, that the very much greater capa- 
city of evaporation v^hich belongs to a texture such as that of the body will 
instantly compensate for the momentary deficiency. It has been shown 
that a similar surface of water evaporates 21 times as fast as the body ; if, 
therefore, an increase in the last respect amounting to only y^o-th part of 
the total power be estabhshed, it will compensate the 3 grains. The effect 
of a slight wind, by increasing the evaporation from 15 to 20 grs., would 
more than compensate for the detention. 

A slight elevation of the cutaneous temperature would rectify the defi- 
ciency; thus at 100° Pahr. the evaporation would be 16-2 grs. — at 101°, 
16-9 — at 102°, 171 grs., or within half a grain of the fttll quantity ; and 
this temperature has been measured in healthy persons by Dr. Davy. The 
sweat would act rapidly in carrying off the amount of heat, for, b^ing ex- 
uded, it would in a great measure evaporate from the exterior, and thus 
reduce the temperature of the body in the same way as the 3 grs. of in- 
sensible perspiration. The mistakes into which those who have urged the 
theory of the malarious nature of a high dew point have fallen, are that 
they have supposed the detention of insensible vapour much more con- 
siderable — the dew point much higher than it exists ; and many are under 
the erroneous impression that a high dew point arrests the separation of 
carbonic acid and the other constituents of sweat. 

It is often an advantage to discuss at length a plausible theory which 
has been fully embraced, but little investigated, for, being set forth in its. 
details, it may lose much of its force. But, on other grounds, the doctrine 
that a high dew point is productive of marsh diseases, is altogether unte- 
Kabie, for it will be found that the mean dew point of the summer is, in the 
United States, upwards of 15 deg. above that of the autumnal season, and 
that the dew point of 60° Fahr. in the U. States is often e:iperienced 
months together without ill health. On the other hand, the fens of Lin- 
colnshire, Walcheren, the marshes of Holland, are pestiferous with a dew 
point of less than 50 degrees. 

We do not in this paper refer to the influence of dampness, heavy dews, 
and the constant liability to wetness which the inhabitants of marshes ex- 
perience, and which are abiding causes of sickness. These have nothing 
to do with the physical effects of a high dew point, and are often present 
when the dew point is very low. 



108 "^xxc^Qx on the use of the Phosphate of Ammonia. [Jan. 



Art. X» — On the Use of the Phosphate of Ammonia, as a new remedy 
for Gout and Rheumatism, as a solvent of uric acid calculus, and for 
diseases, acute and chronic, connected directly with the lithic acid dia- 
thesis. By T. H. Buckler, M. D., of Baltimore. 

It is not our present purpose to write a treatise on gout and rheuma- 
tism, but merely to propose in their treatment the use of a remedial agent, 
which is not to be found in our Pharmacopoeia, having never, it is believed, 
been used in medicine, and one which seems hkely to prove of the great- 
est possible value in the treatment of these diseases. 

My attention was called particularly to this subject quite accidentally, and 
in this way. A gentleman of high intelligence, great acuteness of mind, and 
a subject of gout, came under my care in an attack of this disease. Some 
days after my visits to him had ceased, he addressed me a note in which 
he complained that his finger joints, which had been for a long time thick- 
ened, were more swollen than usual, and that since his last attack, they 
were quite sensitive, so much so as to give him great uneasiness. He 
further remarked, that, in reading the life of Lord Eldon, he had seen it 
stated that he, (Lord Eldon,) had been sent, while suffering from an attack 
of gout, to drink the Bath water, the effect of which was instantly to cut 
short the gouty paroxysm. He begged me to send him an analysis of the 
Bath water, and asked, at the same time, if there was not some agent known 
to physicians, which would neutralize the matter of gout. 

I wrote him in replj^, that gout and rheumatism were the opprobria of 
medicine. That Lord Eldon might just as naturally have gotten rid of his 
gout had he gone to any other place than Bath, and that because Lord 
Eldon had been cured by the use of the Bath water, it by no means fol- 
lowed that the same remedy would relieve him. That we knew of no 
solvent which would deprive the fluids of the matter of gout ; that this 
had long been a desideratum with physicians, and that there was no doubt 
that the investigations which were now being made by chemists, would 
shed such light upon the disease, that we should not be very long without 
a suitable and philosophical mode of cure ; information which, in an he- 
reditary point of view, might have been very consolatory to his children, 
but not hkely to prove so to him. 

Fearing lest my patient might think that the difficulty lay not in the 
science of medicine, but in his physician, I sent him an analysis of the 
Bath water, and with it all the treatises on gout which I had in my posses- 
sion, in order that he mJght see for himself how contradictory the obser- 
vations and statements of experience were in regard to it. And now hav- 
ing been forced to this confession of ignorance on my own part, and on 
that of the profession generally, I begged, in conclusion, to reassure him 



1846.] 'Bm(M.qx on the use of the Phosphate of Ammonia. 109 

of the hope entertained by some that the day was not far distant when we 
should have a direct solvent of the matter of gout. How far my expecta- 
tions have been already realized, remains to be seen. 

The truth is, that little more is known of gout and rheumatism now, 
than was recorded in the days of Hippocrates — pathological investiga- 
tions having, so far, done little or nothing to elucidate their true cha- 
racter, and our present knowledge of physiology serves but poorly in 
explaining the varying and wayward phenomena and symptoms which 
belong to either. 

If we examine the testimony in relation to the treatment of these dis- 
eases, we find it conflicting and contradictory in the extreme. While one 
author says that colchicum is a specific in both gout and rheumatism, 
another avers that it is sovereign in gout, but that its reputation in rheu- 
matism is ill deserved, and that the confidence reposed by some in this 
remedy, arises from the fact, that in the cases on which faith is based, acute 
gout has been mistaken and treated for rheumatism. Another author tells 
us that this remedy is efficacious in synovial, but that it is of no service in 
the fibrous form of rheumatism. One writer extols topical afl^usions in the 
acute form of these diseases, while another pronounces them death and 
destruction, and so on. 

Gout and rheumatism are indeed so little understood, that while some au- 
thors pronounce them identical in character, others declare them to be widely 
dissimilar; and to reconcile their differences (it being easier to invent 
words than to discover truth), we have the compromise terms of rheumatic 
gout and gouty rheumatism. While these diseases are strikingly differ- 
ent in many essential particulars, they at the same time present points of 
resemblance which are very marked. In gout, for example, there is no 
risk of structural disease of the heart, while this organ and its investing 
membrane are the most common seats of rheumatic inflammation and con- 
sequent transformation of tissue. In rheumatism, we find a larger amount 
of fibrin in the blood than in almost any other disease, while in gout, its 
excess is not remarkable. The stomach is generally disordered, and its 
instincts perverted in almost every case of gout and rheumatism, but while 
it is often violently affected in the first, it is seldom or never the seat of the 
last of these affections. These are barely some of the differences, now for 
the resemblance. 

During, and after an attack of either of these diseases, thickening often 
takes place in the fibrous and cartilaginous tissues. In gout this thicken- 
ing most generally occurs in the small joints of the fingers and toes : but 
in rheumatism it is oftener seated in the larger articulations, and about the 
valves of the heart, and when chronic, often converts the fibrous tissues into 
fibro-cartilage, and cartilage into bone. And where chemists have exam- 
ined these structural thickenings, they have found a variable abnormal 
per centage of earthy matter, consisting for the most part of soda and lime. 

No. XXI.^January, 1846. ' 8 



110 'BmqMqx on the use of the Phosphate of Ammonia. [Jan. 

Both diseases are frequently associated with what is called the uric or lithic 
acid diathesis ; that is to say, when a man has a gouty or rheumatic habit, 
it is generally found that lithic acid is in excess in the secretions of his 
skin and kidneys. When an individual labours under an acute attack of 
gout or rheumatism, his recovery is generally heralded by a redundant 
deposit of lithic acid in his urine. This harbinger of a favourable termina- 
tion to the disease may happen on the second day of his attack, or on the 
sixth w^eek, as may be ; but whenever it does appear, it may very safely be 
said that the patient is convalescent. 

By what mode this acid is eliminated, or what accident it is which de- 
termines its separation, we are unable to say ; it stands merely as an isolated 
fact that by some chemical or vital change taking place, uric acid is sepa- 
rated in great quantity and the individual is relieved. The urine in the 
course of such an attack may be examined and found as clear as water, 
and the fluid passed ten or twenty hours after, so loaded with lithic acid 
as to resemble the washings of a wine cask or beer barrel. From whence 
is this enormous quantity of lithic acid so suddenly derived 1 Not from, any 
sudden defect of assimilation occurring in the course of the disease, or from 
the solids of the body. It is most likely then derived from the blood ; but 
uric acid cannot have existed there in a free state, or it would have been 
passed from day to day. If then it existed in the blood, it must have been 
in some state of combination with soda, or lime, or both. And this is the 
more likely, when we reflect, that the concretions and thickenings which 
take place in the fibrous, cartilaginous, and white tissues generally, as be- 
fore stated, are owing to the deposit in them of soda and lime in variable 
proportions with lithic acid. Taking into account these two prominent 
facts above stated, namely, the excess of lithic acid found in the urine at 
the period of convalescence from an attack of acute gout or rheumatism, 
and the subsequent deposit of soda and lime in the white tissues, it oc- 
curred to me, that during the existence of these diseases, the lithic acid 
might exist in the blood in a state of combination with soda and lime in 
the form of insoluble compounds, which the kidneys and skin refuse to 
ehminate. If then any agent could be found capable of decomposing the 
lithates of soda and hme existing in the blood, and of forming in their stead 
two soluble salts, which would be voided by the kidneys and skin, we 
should thereby get rid of the excess of fibrin in the blood, the sympto- 
matic fever and the gouty and rheumatic inflammation, wherever seated, 
which have been excited by the presence of these insoluble salts. It oc- 
curred to me that phosphate of ammonia might be the agent, provided it 
could be given in doses sufficient to answer the end without producing 
any unpleasant physiological symptoms. If our theory were true, phos- 
phate of ammonia seemed to be the proper reagent, for it would form in 
place of the insoluble lithate of soda, two soluble salts, the phosphate of 
soda, which is remarkably soluble, and the lithate of ammonia, which is 



1846.] Buckler on the use of the Phosphate of Ammonia. Ill 

also soluble, and both capable of being readily passed by the skin and kid- 
neys. The excess of uric acid would thus be get rid cf in the form of 
lithate of ammonia; and the soda, floating in the round of the circulation, 
(instead of being deposited, as it were, like an allu\'^ial formation in the 
substance cf the fibrous and cartilaginous tissues,) would be taken up by the 
phosphoric acid and eliminated from the circulation. Based on this theory 
I determined to try this salt, and it was not long after that a favourable 
opportunity presented itself. 

Case I.-— A gentleman, aged 60, a luxurious liv-er and subject to gout, 
liaving suffered for a day or two with slight pain in the last joint of the greai 
toe, was taken suddenly in the night with violent spasm.odic pain in the 
stomach, when he sent for me to visit him. The pain ^seemed to be most 
agonizing, but in other respects his condition presented nothing remark- 
able. His pulse was small, soft and som.ewhat quickened. Surface moist 
and cool. Under the use of brandy, laudanum., and aromatic sulphuric 
«ther, given in full doses, and several times repeated, the violence of the 
pain yielded, and he fell into a sound but uneasy sleep. On the following 
morning he still had pain, but it had shifted its position to about an inch 
below, and to the right of the umbilicus ; this pain was at tim.es acute, and 
seem.ed to resemble the tormina which occur in dysentery, but there was 
MO tendency to stooi. Ordered for him. a mustard foot-bath in hot salt and 
water, and gave him. magnesia usta .:;iss ; mass hydrarg. grs. xij ; and hy- 
oscyamus x grs. at one dose. The following day he had some pain and 
redness in. the ball of the great toe. The bowels, habitually regular, had 
feeen twice acted on ; excessive meteorism, v/hich gave rise to a m.ost pain- 
ful sense of distension ; there is slight tenderness on pressure over the 
small intestines, and the same spasmodic pain is still felt at irregular inter- 
vals. He is also troubled with eructations of wind from the stomach ; ball 
©f the great toe slightly sensitive. Ordered for him moschus m.oschat. 9j ; 
aromatic sulph, gether 5SS ; aqua m.entha) 5JSS. A teaspoonful every four 
or six hours. At the same time ordered Sir H. Halford's gout mixture, 
a tablespoonfui thrice daily. He continued the use of these remedies 
for two weeks v/ithout im.provement ; during this time he was constantly 
annoyed with a disposition to stool, but never passed anything, except 
hj the aid of enemata, which brought away stringy mucus, mingled 
occasionally with some feculent matter. For six days the gout left the 
foot, but at the end of this time returned in the great toe on the other side. 
The m.usk was omitted once for a day, when the meteorism returned with 
singultus, nausea and catchings in the muscles of the arnis and legs. 
The meteorism and sick stomach were always relieved by the musk, which, 
he now took in three grain doses, (the granular m.usk of the shops,) and 
the most marked physiological effect of this agent was the irritability 
w^'iich it excited in the muscular fibres, producing subsultus, (peculiar, it 
seemed,) and resem.bhrag that which occurs at an advanced period of fever. 
He is very weak and languid, and having lost m.uch flesh, looks exces- 
sively dejected and haggard* He says, with the puerile voice of great 
debility, that he has already lost four brothers at about his own age, and 
that on the living he has no hold. He has the same pain below and to 
the right of the umbilicus ; says that the uneasiness is constant, and that it 
is a sort of gnawing sensation, accompanied occasionally with acute pain. 



112 Buckler on the use of the Phosphate of Ammonia, [Jan, 

Phosphate of ammonia 5SS ; water distilled gvj ; a tahlespoonful every four 
hours, and the musk to be continued. After thirty-six hours' use of this 
remedy, the pain in the foot is gone, and the sense of uneasiness in the 
abdomen somewhat mitigated. Has taken no musk for the last twelve 
hours, and has had no unpleasant symptoms. Directed for him a little 
sohd food, with a glass of whisky and water, for which he expressed a 
desire. The phosph. ammonia to be taken thrice per day. In eight days 
after, and nearly a month from the date of his attack, he sat up, and was 
apparently convalescent, eicept that he complained of the same gnawing 
sensation in the abdomen, and finally felt well enough to ride out every 
day ; and I ceased to observe his case, except occasionally, when he would 
always say, " I should be well if it were not for the gnawing in my belly." 
At length, eight weeks from the date of his attack, he passed while at" 
stool a perfectly organized false membrane about seven inches in length, 
and having the appearance of a segment of intestine deprived of its perito- 
neal coat, except that it was distinctly fibrous in its character. It was so 
perfectly cylindrical that I threaded it on my finger. His health has since 
been excellent, and during the past summer he took an extended tour, 
from which he returned as light and corky as a boy. It may be well to 
add, that ten days ago, the above patient was taken with acute gout in the 
left knee, which was painful, tumid and red. Phosphate ammonia 3VJ ; 
water, (no brandy,) a tablespoonful after each meal. In four days he was 
out and well. 

Case II. — C. R., aged 62, has been all his life a good liver, and accus- 
tomed to indulge freely. For the last thirty years he has been subject to 
gout, and has suffered repeatedly from acute attacks, which generally 
lasted from one to six weeks, and on one occasion he was confined to his 
bed for six months. 

Nov. Wth. He was taken in the evening with acute pain in the side, 
and suspecting pleurisy, requested medical aid. He has severe pain in 
the right side between the fifth and sixth ribs; no cough ; pain in the right, 
shoulder, elbow and back of the hand, with increased suffering when he 
attempts to flex the arm. Lateral decubitus, and when he makes an effort 
to move, the pain in the side is greatly increased. Some of the joints of 
the fingers are dislocated by calcareous deposit, and all of them are more 
or less enlarged ; this tophus is also felt along the course of the tendons. — 
Had on going to bed a slight sense of rigor, tongue sKghtly frosted, bowels 
regular, urine limpid, some fever and heat of skin. Phosph. ammonia 5 j ; 
water ^vj. — M. A tablespoonful every six hours. 

12/A. Lies on his back in a fixed position ; wrist and back of the hand 
red, tumid, and exquisitely tender to the touch ; pain in the side nearly 
gone, while in the arm it is greatly increased; considerable fever and heat 
of skin. 

V^th. Wrist and hand more swollen than yesterday, but less red and 
tender to the touch ; can gently flex the fingers and elbow ; has had some 
sleep ; one thin stool yesterday and one in the night. 

V7th. He can flex the arm freely, and has no pain or soreness in any 
part of the body ; sat up yesterday ; the solution was dropped the day 
previous. There is, and has been, no appearance of lithic acid in the 
urine. 

ISth. Well, ceased attendance. In this case the ammonia was the only 
remedy used. 



1846.] Bncklei on the use of the Phosphate of t^mmonia, 113 

Case III. — Mrs. F., aged 31, in the winter of 1843 had an attack of 
acute articular rheumatism, which confined her to bed for five weeks. In 
the following autumn I saw her for the first time, October 6th, in a violent 
attack of asthma ; the face and hands purple ; breathing extremely labour- 
ed ; pulse scarcely perceptible ; a short suffocating cough. Took about 
^xx of blood and ordered gum ammoniac ^ij ; Hoffman's anodyne ^^ss ; 
assafetida gr. xv ; water gvj. A tablespoonful every three hours, which 
entirely relieved the dyspnoea. On the following day, countenance leuco- 
phlegmatic; has had for six months past a dry, hacking cough ; the heart 
is sHghtly hypertrophied, and has a marked blowing murmur with its first 
sound ; a moist subcrepitant rale is heard at the base of the right lung ; 
urine deposits, on cooling, a pink sediment. Ordered iodide potass, gr. v, 
after each meal. This she took for a long time without any marked im- 
provement. The iodide of iron was then substituted for several months, 
with some improvement to her general health, but without any alteration 
in the local mischief. She has suffered repeatedly from severe attacks of 
asthma, which came on generally in damp weather. The mixture of gum 
ammoniac always relieved the dyspnoea very promptly. 

Finally, she took the phosph. ammonia in ten grain doses, thrice daily, 
for several weeks, and with marked good effect. The lithic acid, which 
had been very constantly present in the urine, disappeared under the use 
of this agent, the blowing sound about the heart diminished considerably, 
and her general health improved very much. I may add that, shortly 
after she commenced the use of this remedy, she ceased to suffer with 
dyspnoea. The absence of this symptom., and the comparative feebleness 
of the bellows sound, are no doubt owing to the diminished thickening of 
the mitral valve. 

Case IV. — Margaret, a coloured servant, aged 29, came under my no- 
tice for swelling in the knee and ankle joints. This rheumatism, subacute 
in form, made its appearance a week previous in consequence of exposure 
to wet. The knee joint is puffy on the inside, and about the ligament of 
the patella, and the ankj^ quite swollen and tender below and at the side 
of the outer malleolus. Catamenia and bowels regular. A pinkish white 
precipitate in the urine. Shght acceleration of the pulse. Phosphate 
ammonia gss ; water §vj. A tablespoonful thrice daily. Advised her to 
keep her bed, for although very lame, she had not laid up. At the end of 
four days she supposed herself well and went to work as usual. Some 
ten or twelve days after, renewed exposure to dampness in doing work, 
which required her to stand for some time on moist ground, brought 
back the attack and forced her to go to bed. The knee and ankle not so 
much swollen as at first, but more painful when flexed. Advised rest in 
bed, diet and no medicine. At the end of three days there was no im- 
provement, tongue frosted, some fever, a pinkish white deposit in the 
urine. Ordered a renewal of the solution, under the use of which the 
swelling in the joints decUned, the urine became quite limpid, and in a 
few days she was entirely well. 

Case V.' — A medical gentleman, after loss of rest and exposure to night 
air, complained for several days of great sensibility to light in the left eye, 
with pain over the brow and in the temple of the same side. On the 
evening of the 12th, these symptoms grew so distressing that he deter- 
mined. to lay up. The sensibility in the eye is so great that he cannot 



124 Buckler on the use of the Phosphate of Jimmonia. [Jan* 

bear to have it examined by candle lig^ht ; there is a profuse secretion of 
scalding tears, and considerable puffiness over both eyelids. Has just 
taken, at his own suggestion, calomel gr. x ; rhei gr. v. The next morn- 
ing his condition was as follows : has rested badly ; the bowels have been 
twice acted on ; cellular tissue surrounding the eye more puffed than yes- 
terday ; great intolerance of light ; a deep pink zone about half a line in 
breadth nearly surrounds the cornea; some blepharitis and slight injection 
of the conjunctiva, particularly towards the inner canthus ; two red vessels 
are seen extending over the margin of the cornea. Phosph. ammoniae grs. x 
every three hours, and bathe the eye in warm water. 

14^A. There being no visible trace of anything wrong about the eye^ 
this gentleman is out visiting his patients as usual. Was this a case 
of sclerotitis ? I so regarded it, and supposed the patient would be sick a 
week, at least, having generally found rheumatic inflammation of the eye 
one of the most obstinate and intractable diseases we have to treat. 

The following cases have been furnished by Dr. Charles Frick, senior 
student at the Baltimore Aims-House, and collected in the wards of Dr. 
Power. 

Case VL — David Wilson, a printer, setat. 43, entered the hospital, Oc- 
tober 20, 1845 : he has been sufl^ering with an attack of acute rheumatism 
for four days, and has had, during the last sixteen years, about a dozen 
attacks — the more severe lasting for three or four months, and the mildest 
that he remembers, at least six weeks. He has had it in nearly all his 
joints, but principally his wrists and ankles. During the intervals between 
these attacks he felt perfectly well, all stiffness and swelling would subside, 
and he would be able to pursue his occupation as before. He has never 
had any palpitation of his heart, nor any pain over the praecordial region 
during any of his attacks. At the time of entrance, his attack was con- 
fined to his wrists and ankles ; both of which were m,uch swollen, pain- 
ful, and capable of but slight movement. He suffered the most from his 
wrists, and the present attack w^as attended b|r very slight fever. He 
remained in the hospital three days before any treatment was administered; 
he was then ordered phasphat. ammoniac gr. xij three times daily. In 
six days the swelling of his hands and feet had subsided so as to. scarcely 
be perceptible ; his joints were fl-exible, and there v/as scarcely any pain. 
The sounds of his heart are perfectly natural and regular. His condition 
changed but little during the following week, and on the 10th of November, 
it was as follows i. he moves his feet perfectly well, and there is no pain or 
swelling ; he does not walk very v/ell, but this he ascribes to general debi- 
lity, and not to any pain or want of strength in his legs ; his right wrist is 
perfectly natural in appearance, and he moves it as well as ever ; the left 
hand is still a little swollen, and he has som.e pain when he flexes his fingers 
on the palm.. 

Case VII. — JamiCS Maguire, setat. 57, entered the house May, 1844 ; he 
has had rheum.atism of the right hip joint for seven or eight years, which 
totally incapacitated him from work. He never had an attack of rheuma- 
tism previously. At the time of his entrance he walked with som^e dif- 
ficulty with the aid of crutches ; his right hip was painful on any move- 
ment, but not red, and there was a murmur after the first sound of his 
heartj caused by a stricture of the aortic valves. He was put upon tJie 



1846.] ^Moklex on the use of the Phosphate of Ammonia. 115 

use of blue mass and opium, &c., without any benefit, and in the course 
of a few weeks was sent from the ward as incurable. In October, 1S44, 
he was seized w4th pain and swelling in both his ankles and knees, his 
right wrist and elbow, in addition to the hip joint, which remamed in the 
same condition. Various treatment was administered, but he continued in 
nearly the same condition, without evidencing much improvement, until the 
middle of March, 1845, scarcely able to get out of bed, with the joints men- 
tioned above much swollen and painful. He was ordered phosphat. ammo- 
nias gr. xij three times daily. In the course of ten days the improvement 
was exceedingly manifest. The joints had become supple and pliant, and 
.the swelling had nearly subsided. He continued to improve rapidly, and 
-on June 1st, his condition was as follows : he had then been walking about 
the yard for two or three weeks ; his joints all look natural ; they are 
pliant and free from pain ; he still uses one crutch, but walks well with- 
out it; he says he has no pain, but that he still feels a little stiff in his 
hip joint ; he has gained flesh and improved much in appearance. 

Case VIII. — William Brooks, aetat. 20, entered the hospital July 12th. 
He has had an attack of inflammatory rheumatism, during the previous 
winter, which confined him to his bed for three months. He has had more 
or less rheumatism since he was nine years of age. In the present attack, 
the disease had located itself in all his joints, but principally his wrists 
and shoulders ; the wrists were so much swollen, and so painful, that he was 
unable to make any movement with them. He took colchicum, but found 
no benefit from it. After the lapse of three months, he was able to get out 
of bed, and walk with assistance, but unable to do any work. He conti- 
nued in nearly the same condition, up to the time of his entrance, when 
finding himself getting worse, he entered the hospital. At the time of 
entrance he was brought bodily into the ward, being unable to walk, very 
pale, and emaciated; a " bruit de diable^^ murmur very distinct in his caro- 
tids, free from fever, and complains of pain in all his joints, but particu- 
larly the ankles, knees, shoulders, and wrists. These were much swollen, 
red, and incapable of motion. There was a friction sound of the pericar- 
dium at the base of his heart, and a murmur after the first sound, pro- 
duced by regurgitation through the mitral valve. He suffered a good deal 
from dyspnoea and palpitation, and he first perceived that there was any- 
thing wrong about his heart the previous winter. He was put on blue 
mass and opium, salts, and colchicum, &c., without the least benefit. 
His condition remained the same as at entrance. On August 5th, he was 
ordered phosphat. ammonia gr. ij three times a day, and this after the 
third day was increased to gr. xij three times daily. In the course of a 
week, the swelling and pain were manifestly diminished, and in two weeks 
and a half, he was ordered to walk in the yard for exercise. September 
14th, his condition was as follows : His joints have lost nearly all swelling 
and redness. They are perfectly supple, and he uses his arms and fin- 
gers nearly as well as ever. The friction sound of his heart has disap- 
peared, the murmur is by no means so loud, and he suffers scarcely at all 
from dyspncea or palpitation. He has gained considerable flesh and 
strength, and looks well, with the exception of a little puffiness about his 
eyelids. He walked last week to town, a distance of three miles, and re- 
turned the same day without being much fatigued. He has been taking 
the phosphate up to the present time, (Nov. 16,) except occasionally when 
he stopped it himself, for a week or two, because he felt so well. He no- 



116 ^MokXex on the use of the Phosphate of Ammonia* [Jan. 

ticed, once or twice lately, that when he stopped taking it, there would be 
a red sandy deposit in his urine, which would immediately cease on his 
resuming it again. 

Case IX. — John Conolly, aBtat. 44, entered the hospital, June 20th, 
1845. He has had more or less rheumatism for the last 12 years. At 
the time of entrance, he was suffering with an attack in his ankles, knees, 
and wrists. All these joints were more or less swollen and painful on 
motion, particularly the wrists, and had been in this condition for six 
months. The joint of the middle finger of his right hand is anchylosed, 
from a previous attack. He was also suffering from a sclerotitis, in both 
eyes, the left being the most diseased; this commenced four weeks pre- 
vious to his entrance. There were also traces of an old iritis in his left 
eye. He was ordered salts and colchicum, blue mass and opium, &c., 
with various local treatment to his eyes. His rheumatism under this 
treatment improved a little, but his eyes remained in the same condition. 
On October 25th, he was ordered phosphat. ammonice, gr. xij three times 
daily ; and he still continued the salts and colchicum. In three days, his 
eyes were nearly clear ; he had lost all pain, and there was but little injec- 
tion left. The improvement in his joints was not so perceptible till the 
end of two weeks. At that time the swelhng had much subsided, and he 
expressed himself as being nearly free from pain. On November 25th, 
his condition is as follows : he walks well ; the swelhng in all his joints, 
except the right knee, has subsided, and he still has some pain on motion, 
in this joint and the left ankle. He has exposed himself to cold, and has 
had, once or twice, an increase of inflammation in his eyes, but in two or 
three days, the injection would subside as before. At present, there is no 
pain, the right eye is clear, but the left has still some injection in the scle- 
rotic coat. 

Case X. — Wm. Taylor, setat. 40, has had rheumatism for the last seven 
years. Nearly all that time he has been in the hospital in bed, unable to 
go about the ward without the assistance of crutches. He has taken 
various remedies, but with slight and temporary benefit. He has suffered 
more or less in all his joints, but principally his knees and wrists, which 
have been so much swollen as scarcely to admit of any motion. He has 
been taking the phosphate of ammonia for the last two months, gr. xij 
three times daily. He says he is better than he has been for the last five 
years. The swelhng has subsided in a remarkable manner, particularly 
about his fingers, which are more phant and useful than they have been 
since his entrance. 

For the three following cases I am indebted to Dr. Power, a rigid, con- 
cise and accomplished observer of the school of Louis and Chomel. 

Case XI. — Mr. O. D , astat. 22, of robust, vigorous constitution, 

never having had any severe illness except an attack of acute articular 
rheumatism, two years ago, which confined him to the house for more than 
three months, was hunting all day of the 12th November, through marshes 
and a penetrating cold rain, by which he was thoroughly wet to the 
skin. He returned home at eight P. M., with contusive pains and head- 
ache, accompanied by constant shivering, so that he could not thoroughly 
warm himself. On "the morning of the ISth, he had intense headache 



1846.] '^xjioMex on the use of the Phosphate of Ammonia. 117 

from thirst; anorexia; the contusive pains continued, but he suffered less from 
them than from violent pain in his articulations, particularly the wrists, 
fingers, knees, and ankles. He came to Baltimore, where he resides, and 
where he arrived on the 14th. His symptoms were all aggravated, and 
his physician bled him twice that day, taking each time sixteen ounces of 
blood, which was highly buffed and cupped, and administered gi sulph. 
magnesia, which caused copious evacuations. On the 15th, he was or- 
dered Epsom salts, and tartar emetic, and his attending physician being 
taken sick, I was called to see him for the first time on the evening of this 
day. His pulse was 106 ; skin warm but moist ; complaining of headache, 
and some sore throat; lying rigidly on his back in bed; afraid to move 
from the pains. His knees were painful; pain in the loins. The hands 
were flexed on the arms, and the fingers on the hand ; the wrists were 
swollen, pink and tender; the knuckles very much swollen ; impossible to 
shut the hand ; pain and impossibility of motion in the left shoulder; thirst; 
inappetence ; frosted tongue ; bowels not moved to day ; urine irritating ; 
small in quantity and high coloured. R. — Dover's powder grs. xv. imme- 
diately ; sal. Rochelle^j; vin. colch. 3ij ; aqua ^viij; ft. solut. ; take in 
the twenty-four hours. Phosphat. ammon. grs. x three times a day. 

\Qth. Slept some last night; skin bathed with sweat; urine increased 
and pale; no irritability of the neck of bladder. Pulse 98; softer; can 
touch his palms with his fingers. Phosphat. ammon. Bi three times a 
day. 

nth. Pulse 90 ; can turn as he pleases in bed ; skin moist ; appetite 
returning, and wants food ; contusive pains gone ; urine free and pale ; 
bowels relaxed by the Rochelle salts and colchicum; continue. 

\Sth. Entirely free from pain; pulse 80; some little puffiness about the 
articulations, and a little stiffness of the fingers. 

20^/i. Well; no signs of disease. On the 21st, went out, and has been 
attending as usual to his occupations, feeling entirely well. 

Case XII. — Ehz. J., a woman, setat. 28, enjoying habitually good 
health, of a tolerably robust frame, a chamber maid, entered the Baltimore 
Infirmary on the 3d of November ; fourteen days previously she had gone 
some distance to set up with a sick friend. The evening was inclement, 
and heated by exercise, she stepped over her ankles into a puddle ; 
her feet were thoroughly wet ; perished, as she said ; she remained five 
hours in these wet feet, and felt sick ; had headache, nausea and contu- 
sive pains in her back; she returned home, and the next day was scarcely 
able to go about the house ; that night she had a chill, followed by fever and 
pains in all her articulations. She remained at home in bed without any 
treatment other than rubbing herself and using mustard plasters, until she 
came to the hospital. 

Dorsal decubitus. Arms and wrists flexed as well as knees ; ail the arti- 
culations of the fingers tense and swollen ; wrists doughy and tender ; left 
knee much swollen ; complains of both shoulders and left hip ; screams 
when moved in bed; face flushed, expressive of fear and suffering ; skin 
hot, moist ; pulse small, tense, 120 ; dry, hacking cough, which causes 
her to weep from the motion it produces ; slightly prolonged sound with 
first sound of heart ; urine, small in quantity, high-coloured and irritating. 
Venesection ^xx ; cups to pra3Cordial region. No. iv ; sulph. magnes. gi; 
vin. colchicil^ij ; aqusB ^viij. A tablespoonful every 4 hours. Phosphat* 
ammon. grs. x three times a day. Dover's powder grs. xv at night, 



118 'EMckiex on the use of the Phosphate of Ammonia. [Jan. 

I need not detail the changes in this case from day to day. The salts 
and colchicum were continued for four days, when they produced hyper- 
purgation and nausea ; they were discontinued, and then ten drops of wine of 
colchicum given twice daily. This also producing nausea, was withdrawn 
after two days, and the phosphate of ammonia, increased to twenty grs. three 
times a day, alone persisted in. There was steady improvement from day 
to day until the 18th. The pulse fell to 72 ; the rheumatism shifted from 
joint to joint, but daily its intensity was less and less. The sounds of the 
heart were normal on the 10th ; the urine pale and abundant ; the skin 
moist and without heat; the appetite good ; and on the 18th she was, as 
she said, as " supple as an eel," and proved it by dancing. On the night 
of the 20th, she was up while in a state of perspiration, with a sick wo- 
man, and had a slight relapse ; the finger joints again became puffy and 
swollen, and stiff. But confinement to bed, and the phosphate sufficed in 
two days to reheve this. I called to see her on the 24th; she is well with 
her friends ; complains of no pain ; looks a httle pale ; the heart is normal, 
and the joints natural in size. 

Case. XIII. — Stewart, a seaman, aetat. 32, fell under my care on the 31st 
November, at the Baltimore Infirmary. Six weeks previously he had 
been in the nightly habit of sleeping on the deck of the small vessel on 
which he was employed running up and down the Chesapeake. One 
night he woke up with pain and chill ; the pain in his right ankle and left 
shoulder, with fever and general malaise ; on arriving he at once entered 
the hospital, when he was bled, freely leeched, cupped over the shoul- 
der, purged with salts and colchicum for ten days, and then placed upon 
blue mass and opium until freely sahvated, without belief; the pain went 
on to increase, and the fever never left him ; he had been seven days well 
of his ptyalism when I first saw him. 

His expression was one of great suffering ; the left arm hung power- 
less, as if broken, flexed, and resting upon his breast. The right ankle 
was much swollen, livid on either side of the tendo-Achillis, as if phleg- 
monous inflammation were occurring there ; puffy and tender in front, 
with the superficial veins above and below it enlarged. The slightest mo- 
tion either in arm or shoulder caused agonizing pain. Tears streamed 
from his eyes when they were handled. Pulse 78, moderately tense ; skin 
moist, little heat ; tongue frosted ; shght appetite ; thirst ; scanty, high- 
coloured urine. Phosphat. ammon. grs. xv three times daily; ung. sim- 
plici 3J ; hydriod. potass. '^]. — M. Rub in upon ankle. 

This man after the second day said he could feel himself growing bet- 
ter ; the same means were persisted in ; his appetite returned ; his urine 
became abundant ; his thirst abated ; he was able to sleep at night ; for 
before he was awakened constantly by involuntary jerkings moving his 
ankle and shoulder. The ankle is so well, that he has been walking upon 
it for a fortnight, and the shoulder is so much better that he can put his 
hand on his head. In these fixed rheumatisms, I am aware the duration 
of the disease is very indeterminate; generally much longer, however, than 
in metastatic rheumatism ; but in this case the symptoms only going on to 
increase under the two classic modes of treatment; and the phosphate 
alone being trusted to without any other adjuvant, but an occasional ano- 
dyne at night, its effects seem to me to have been important and well 
marked. 



^846.] 'BMcklex on the use of the Phosphate of Ammonia. 119 

I have also used the phosphate in many old hospital cases of chronic 
rheumatism, that opprobrium of medicine ; without a single exception, the 
patients have declared themselves better, and begged for a continuance of 
the medicine. The conditions in which it has been administered have 
not been so accurately noticed that I could report those cases so as to 
satisfy others. But the impression made upon my own mind is, that it 
is in these cases the best medicine I have ever employed— for in many 
of these cases, the patient had undergone for years various modes o<f 
treatment without benefit — and all were relieved in some degree under 
the use of this agent, when iodide of potash and other means had failed. 

The foregoing carefully-observed and well-drawn up cases, by Drs. Frick 
and Power, should have their full weight, and induce others to verify his 
results. 

In reviewing the cases which I have published, it will be noticed that 
thickening in the white tissues, of long standing, has disappeared under 
the continued use of phosphate of ammonia. Now it is in such cases that 
the lithic acid diathesis generally prevails, and this agent seems to act here, 
by depriving the blood for a long time of uric acid and soda, thus creating 
a demand for these elements in that fluid, and thereby bringing about a 
re-absorption, as it were, and solution of the superfluous lithate of soda which 
is deposited in the w^hite tissues. As a result of rheumatism, we some- 
times see arthrosis of long standing, where the joints are deformed or dis- 
located from transformation of tissue, and in gouty subjects we find calca- 
reous deposits, often cripphog the joints and interfering with the free play 
of the tendons. In such cases, w^e cannot hope for relief in this, or any 
other agent ; but we may relieve the acute attacks which supervene in 
these chronic cases, and thus save suflering to the patient, and prevent the 
further increment of calcareous deposit. I have reported only those cases 
of acute rheumatism in which the phosphate of ammonia was, for the time 
being, used as a single agent, believing that these would prove more satis- 
factory to the reader ; but I would not be understood as advocating the 
exclusive use of this remedy; to do this would be the w^ork of an empiric. 
The leading remedies should be adopted here, as they are in pneumonia^ 
in which disease the lancet is not dispensed with because antimony is 
used, notwithstanding the efficacy of this last remedy is universally ac- 
knowledged. 

In acute rheumatism, the disease is seated in the blood, but then there 
are painful symptoms related with the alteration of this fluid, such as local 
pain, heat, and swelling in some part of the body, and increased force i^- 
the circulation ; anodynes will mitigate the one, and the lancet moderate 
the other, until the primary indication is fulfilled in restoring the blood to 
its healthy condition. In the case of a boy aged thirteen, v/ho suffered 
with acute rheumatism in the shoulder and back of the head, and in whose 
case there seemed to be some implication of the pneumogastric and glosso^ 
pharyngeal nerves, there being difficulty in deglutition, great aversion to 



120 Buckler on the use of the Phosphate of Ammonia. [Jan. 

drinks, and irritable stomach, cups were applied to the back of the head, 
and the following remedies given with the most perfect rehef. Tinct. 
digitalis ^j ; cyanide potass, gr. iij ; hyoscyamus Bij ; phosph. ammonia 
3;ij; water ^iv. Two teaspoonfuls every three hours. 

In the cases reported, it may also be observed, that in every instance in 
which lithic acid was present in the urine, it at once disappeared under 
the use of the phosphate of ammonia ; and that in all those cases of gout 
and rheumatism in which, under ordinary circumstances, we might very 
naturally have looked for a lateritious sediment at the period of convales- 
cence, the urine was remarkably limpid and free from precipitate of any 
sort. Under both circumstances the lithic acid must have been evolved 
in the form of soluble Hthate of ammonia, the other element of the salt 
given having united with the soda of the blood, and formed the phosphate 
of soda, which was also eliminated in a state of solution. From the rapid 
disappearance of Kthic acid from the urine in each case in which this salt 
was administered, we are led irresistibly to the conclusion, that the phos- 
phate of ammonia must prove the best agent for dissolving uric acid cal- 
culus. I have thus far had no opportunity of testing its efficacy in this 
respect, but w^e know that the common uric acid deposit is nothing more 
than a collection of very small crystals, each one of which is a very minute 
calculus, and that it is nothing but an assemblage of these particles which 
enters into the composition of the ordinary uric acid stone. When, there- 
fore, these particles are collected into a mass in the pelvis of the kidney, 
ureter, or bladder, it is only necessary to saturate the fluids of the body 
with the phosphate of ammonia a sufficient length of time, and the calculus, 
however large, must be decomposed. When the lithic acid is combined 
with ammonia, a form of calculus sometimes met with, the phosphate of 
soda must answer a better purpose, and where the calculus is triple in its 
composition, the phosphate of ammonia and soda will no doubt be found 
to answer a better purpose than either of the single salts. 

It is somewhat strange that the phosphate of ammonia should not have 
been brought into notice by Golding Bird, whose mind seems so peculiarly 
fitted for the work that he has undertaken, and so well calculated to de- 
duce practical results from his own observations, and from those of others. 
The nearest approach which we find to the suggestion of this remedy, is 
that of Liebig, who proposes the use of phosphate of soda as a means of 
neutralizing lithic acid, and this agent might answer the purpose well 
enough, if this were all that we desired to accompHsh. But when the 
urea of the blood is converted into uric acid, and this is found in the fluid 
excreted by the kidneys, it is always in excess, having already saturated 
the soda which it met with in the blood, and formed the insoluble lithate 
which the kidneys refuse to eliminate. When, on the contrary, the phos- 
phate of ammonia is given, a double reaction and decomposition take 
place, and two nQ\Y salts are formed, both of which are readily soluble and 



1846*] 'BucWex on the use of the Phosphate of Ammonia. 121 

capable of being evolved. But it is very strange that Golding Bird should 
not have used the phosphate of ammonia, at least as a means of dissolving 
uric acid calculus, and that he should not have brought it formally into 
notice as a remedy. For after stating the case of a lady who used, at his 
suggestion, the artificial Vichy water at Brighton, for uric acid gravel, 
and whom he afterwards treated successfully with phosphate of soda, he 
remarks, that the ammonio-phosphate of soda would, perhaps, be a more 
successful remedy than the simple phosphate, but its disagreeable flavour 
constitutes an objection to its employment. 

How is it that the valuable researches of Ancell, Christison, Andral and 
Gavarret, Prout, Liebig, and lastly, those of Franz Simon, should have fur- 
nished so few practical suggestions? For the last five years the medical 
press has been teeming with articles on the morbid conditions of the urincy 
bsematology and animal chemistry generally, and yet how very few prac- 
tical results, or even hints have grown out of these very numerous investi- 
gations and discussions. Those who have devoted their labour to the sub- 
ject of hsematology, have giyen their attention too exclusively to the organic 
constituents of the blood, and have bestowed less pains in inquiring into the 
relative proportions of the chemical ingredients of this fluid. We have; 
information, valuable and conclusive, as to the abnormal alterations in the 
quantity of fibrin, globuline, albumen, but as to the excess or deficiency of 
soda, lime, magnesia, iron, urea and uric acid in the blood in difTerent 
pathological conditions, w^e are not informed. 

, For example, Andral, in his immortal treatise on the blood, has established 
the fact beyond the power of contradiction, and contrary to the previous 
belief of the whole medical world, that in certain forms of ans&mia, the 
fibrin is relatively increased over and above the normal standard. But he 
does not tell us at the same time, whether the iron contained in the blood 
is increased or diminished in quantity in this condition. And yet from the 
fact that the prepa,rations of iron serve more than any other remedies to 
relieve chlorosis and ansemia, it is very natural for us to suspect that this 
abnormal condition may result from a deficiency of iron in the blood ; this? 
however, may not be the case, for probably the action of iron in this con- 
dition is vital rather than chemical. But still an inquiry into the actual 
amount of iron would at once estabhsh or refute the assumption. 

On the other hand, those who have examined the morbid conditions of 
urine, have, v/e think, fallen into error also in regarding an excess of each 
salt found in this fluid, as a disease in itself, instead of which the presence 
of any abnormal ingredient ought to be regarded rather as an expression 
of disease, or an index of the morbid condition of the fluids, or of the sys- 
tem generally. The elements composing a calculus in the pelvis of the 
kidney are in point of fact just as much without the body as if they were 
in a basin. It is unphilosophical to suppose that the kidneys can elaborate 
a salt without having derived the materials of such salt from the blood. 



122 Buckler on the use of the Phosphate of A^nraonia* [Jan. 

And the inquir}^ is at once suggested, Avhat part has the salt (which may 
be found evoh'-ed by the kidney), or the elements of its composition, played 
in relation with the other ingredients of the blood from which it has been 
derived? .As, for example, it has been attempted here to prove that the 
matter of gout and rheumatism is an excess of lithate of soda in the blood, 
and the action of the phosphate of ammonia in the cases in which it has 
been tried, goes far to establish the proof. It is reasonable to suppose, then, 
that the presence of hthate of soda in the blood determines the formation 
of the excess of fibrin V\4iicli is found in this disease, and why may this 
not be the case, whether the conversion of fibrin into albumen, or the re- 
verse, be either a vital or a chemical act ? If the conversion of the one 
into the other depends on the laws of life, then the presence of lithic acid 
or its combinations with other ingredients, is as foreign to the normal con- 
stitution of this highly vital fuiid, and capable of giving rise to changes 
quite as great ixi the hving elem.ents of the blood as we see a sequestrum 
or any other foreign body produce in the organized tissues which surround 
it. And if, on the contrary, the conversion of albumen into fibrin is accom- 
plished through chemical agency, still the lithate of soda may play a part 
in bringing about this change, analogous to that which is effected by vari- 
ous agents, when brought in relation with different organized matters ; 
as in the conversion of oil into a material resembhng spermaceti, or the 
influence of a single drop of oxalic acid in changing a large quantity of thin 
syrup into a saccharine mass of greater density. So that whether the 
agency of urate of soda is purely vital, or chemical, or partly both, its pre- 
sence in the blood may play a part in relation to the other elements of this 
fluid, resem^bling that which the sequestrum is seen to do in the one case, 
and the drop of oxalic acid in the other. And thus each chemical ingre- 
dient of the blood, from its excess or deficiency, or hj forming new com- 
pounds in different diseases, m.ay, through vital or chemical agency (as 
before explained), modify the quantity or consistence of the organic ele- 
ments of the vital fluid. But again, through vital or chemical agency, the 
fibrin and album.en are mutually convertible into one another, each in its 
turn retaining its proper vital integrity and primary chemical composition, 
as to the due proportions of oxygen, nitrogen, carbon and hydrogen, Avhich 
enter into its formation. Now an excess or deficiency of some chemical 
ingredient of the blood m^ay so modifj/ this process as to cause an abnor- 
mal formation to take place. This nev\^ formation m.ay onh^ differ from 
fibrin in some slight alteration in the proportion of its ultimate elements 
and its unfitness for the purposes of the economy in health. But far- 
ther, the fibrin in this abnormal condition may, for aught we knoAV, con- 
stitute the matter of tubercle, which, wafted in the rounds of the circu- 
lation, m.ay be arrested in any of the tissues of the body, and there becoming 
endowed with new vital properties, take the form of gray semi-transparent 
particles which are first recognized by the aid o{ the microscope. And so 



1846.] ■ Fountain on the Extract of Conium Maculatum. 123 

an abnormal matter, similar in its mode of formation, bat differing again 
as to its ultimate composition, may lay the foundation of the disease of 
Bright. It may be said by some that the physical appearance of these 
deposits is so very different from anything met with in the blood that such 
an idea is absurd. But it may be said, on the other hand, that honey is 
very different in its physical properties from wax, and so is oil from sper- 
maceti, and yet, chemically, they are so very similar that it is extremely 
difficult to point out any real difference. 

Indeed any one at all familiar with organic chemistry, is only too well 
aware, in making an analysis of the trivial accidents which often intervene 
in similar processes, to bring about different results ; and he can readily 
see how an excess or deficiency of any one of the chemical ingredients of 
the blood may modify the organic elements of that fluid, and thereby con- 
vert them into materials for diseases of the solids. 

Is it not to the pursuit of animal chemistry that we must look at last for 
the means of curing cancer, phthisis, the disease of Bright, and other affec- 
tions which in the present state of our knowledge are without remedies ? 
And is it not on the careful analysis of the blood and fluids generally, that 
we must rely mainly for a sound, rational and physiological system of the- 
rapeutics ? To those engaged in these pursuits, we Vv^ould say, go on in the 
good work which you have so well begun ; the materials which you have 
collected are as imperishable as truth ; but they still require to be moulded 
into some more definite and tangible form : will this be done by you, or 
must it be left to the genius of another age ? The humble labourer who 
quarries a block of pure imperishable marble is overlooked and forgotten, 
while he who fashions this same block into some form of beauty or of grace, 
lives for ever. 



Art. XL — On the Effects of Extract of Conkmt Maculatum. By 
HosEA Fountain, M.D., of Somers, Westchester Co., New^ York. 

I WAS m.uch interested in reading an article in the number of the Ameri- 
can Journal of the Medical Sciences for July last, from the pen of Doctor 
Earle, of New York, on the effects of the extract of conium maculatum. 
As I have been in the habit of prescribing this remedy occasionally, and 
always observing marked effects from its use, I was much surprised at the 
shght results obtained from the large quantities mentioned by your corre- 
spondent. 

His communication describes the symptoms arising from the internal 
use of the drug as usually found, I suppose, in the shops, which were so 
shght and transitory, that Ave may safely concluofe that the medicine is 
either inert, and should therefore be discarded from the m.ateria medica, 



124 Fountain on the Extract of Conium Mactdatum, [Jan, 

or that the extract experimented with, was improperly prepared, or had 
lost its virtue by age or some other cause. 

That conium is an active agent, few who have Avitnessed the effects of a 
well-preparedyVesA extract, will be disposed to doubt ; and that it is useful 
in disease must be admitted, when such troublesome complaints as chronic 
affections of the liver, habitual costiveness, jaundice, &c., are relieved, and 
often cured by this remedy alone. 

To show that conium does act with some energy on the system in less 
quantities than taken by Doctor Earle, I will describe the effects of a 
single dose on myself. The extract was prepared from the fruit, or seeds 
of the plant, with no other care than that the infusion was not at any time 
allowed to reach the boihng point. When of a syrupy consistence, the 
evaporation was finished in shallow pans in the open air. 

Fearing, from its dark colour, it had been injured in its preparation, I 
swallowed about twelve grains, to test its activity, and quietly awaited its 
effects. Half an hour passed away without any alteration in my feelings, 
when supposing the medicine worthless, I threw part of it, from which I 
Avas preparing some pills, in the street, and started on my daily ride. In 
a few minutes, however, I observed a dimness of vision, with bright points 
scintillating, or rather quickly moving, in the distance. This caused me 
to turn from side to side, to notice them : and from this cause, I suppose, I 
found myself reehng in the saddle. There was no vertigo or unpleasant 
sensation about the head, to produce this effect, save a shght feeling of 
lightness. Very soon, a numb, pricking sensation was felt in the fingers, 
extending gradually to the elbows, producing a stiffness of the muscles of 
the parts, making it difficult to move the forearm and hand. In a few 
minutes the same sensation was observed in the feet, creeping slowly up- 
ward, until it reached the upper part of the thigh. The eyes now began 
to feel uncomfortable, causing me to brush them frequently, to clear appa- 
rent obstructions from the hds. The pulse was soft and feeble, but not 
more frequent than usual. In dismounting, about an hour from the com- 
mencement of the symptoms, I found so much difficulty in walking, as to 
require assistance to reach the house, the inferior extremities appearing 
nearly paralyzed. So little pain or distress was felt, however, that I laughed 
heartily at the predicament I had so unwittingly placed myself in. Feeling 
anxious to get rid of this annoyance, as well as from the solicitude of those 
around me, I tried what effects smoking of tobacco would produce. I had 
been in the habit of using this luxury occasionally, and at this time had a 
strong desire for it. Whether from this cause, or from rest and composure, 
I soon felt very much relieved. Vision became clearer ; the limbs less 
troublesome; and whilst sitting, little or no apparent effects of the poison 
remained. On rising, however, the inferior extremities persisted in their 
unwillingness to move; but much less so than before. The whole day 
passed away without being entirely rid of these feelings, and it was not 



.1846.] Fountain on the Extract of Conium Maculatura. 125 

until I enjoyed my usual sleep, that perfect vision was restored. I will 
observe, that the intellect appeared unaffected, the bowels and kidneys 
were not disturbed, neither was any soporific effect produced. The action 
appeared to be confined to the brain, exhausting it of blood and diminishing 
its energy. Hence the partial paralysis, v^^hich a few more grains would, 
perhaps, have rendered complete. The aberration of vision arose from 
the same cause: and convulsions from exhaustion, as from loss of blood, 
would probably have followed, had a larger quantity been taken. 

As I quote this case from memory, I cannot speak positively as to the 
lapse of time between the taking of the extract and its effects, otherwise, 
this statement is as correct as one can be expected to describe from one's 
own experience and feelings. 

In this instance it will be observed that a small quantity compared with 
what Dr. Earle took, produced symptoms of the poisoning of hemlock: 
so much so, that I could not be persuaded to experiment on myself with a 
larger quantity of the same extract. A single pill of this, of three or four 
grains, produced very unpleasant effects on a young man affected with 
chronic peritonitis. He described his feehngs as a snapping and crackling 
of the eyes with a drooping of the lids : and darkness before him — this 
was attended with a feeling of great weakness generally. An aged lady, 
affected with chronic inflammation of the liver, attended with constipation 
and indigestion, as well as extreme vigilance, the pulse frequent and tongue 
coated, was put under the use of this remedy. She took four grains of 
the extract thrice daily. On the second day, she complained very much 
of soreness of the globes of the eyes and a feeling of weight and tightness 
over the eyebrows, and dimness of vision. The pulse became softer and 
less frequent ; in a few days the bowels moved naturally, and she was soon 
able to enjoy calm and refreshing sleep. The disease, in this case, was of 
more than twenty years' duration ; and as no other medicine was given her 
at this time, the rehef must be attributed entirely to the conium. 

I mention these cases to show that it was not from any peculiarity of 
constitution that caused the small quantity taken to produce the efiects as 
described, on myself. And although the seeds of the plant furnish the 
most active extract, I have known ten grains of that prepared from the 
fresh leaves cause very severe effects. 

From these cases, I think we can safely conclude that the extract of 
conium is an active remedy ; and that a iew grains of a well-prepared/res/^ 
article, are sufficient to prove its nature and efficacy in disease. As the 
plant grows luxuriantly through the country, would it not be better for 
physicians to obtain the fruit or fresh leaves, and prepare an extract that 
would not deceive them, rather than prescribe "hundreds of dollars' 
worth" of such inert preparations as those experimented with by Dr. 
Earle? At least, should not druggists be industrious enough to prepare it 
in such a manner as to insure an uniform effect from its administration? 
No. XXI.— January, 1846. 9 • 



126 Daveis' Case of Phrenic Hernia. [Jan. 



Art. XIT.—- C«5e of Phrenic Hernia through a congenital opening in the 
Diaphragm. By Oilman Daveis, M. D., of Portland, Maine. 

August 22(1, 1843, I was summoned to attend Mrs. , in labour 

with her first child, and arrived at the house at 3 o'clock, P. M. On inquiry 
I learned that the membranes had ruptured a short time previous to my 
arrival. I immediately made an examination, and found the os uteri par- 
tially dilated and the head of the child presented. The pains were the 
dilating pains, and slight. Towards 6 o'clock, the os uteri became fully 
opened, and I found the presentation to be the first of Baudelocque. The 
labour progressed slowly and painfully, but with perfect regularity till the 
child was born, which occurred at 3 A. M., the following day : — towards the 
latter part of the labour the patient slept between the pains. The external 
organs were unusually small, and I was fearful that the perineum would 
become lacerated ; this was, however, prevented by careful support, and 
by directing the patient not to bear down during the latter stage of the 
labour. 

The child respired in about a minute after the head was born, and the 
shoulders and body rapidly emerged. After removing the child I examined 
the uterus externally, and finding it firmly contracted, I at once introduced 
my haad into the vagina and removed the placenta which was lying in its 
cavity. 

Immediately upon the birth of the child I was struck with the great 
size of its chest, and the flattened appearance of the abdomen, and called 
the nurse's attention to it. The child was then dressed and I remained 
till that was completed, without noticing any trouble in its respiration. I 
left the house at 4 o'clock. Upon my return at 8 o'clock, I found the 
child labouring in its respiration, with purple lips and lividity of the whole 
surface. The chest appeared immensely large, and the child's head was 
thrown far back. I at once stated to those present that I thought the child 
had organic malformation, and would not survive. As it had had no alvine 
evacuation, however, I ordered it to have some castor oil, and followed 
this with an injection, and subsequently with two more, but without any 
effect, except that the medicine given by the mouth evidently increased 
very much the difficulty of respiration, and I gave nothing more. The 
child died at 10 o'clock, ten hours after birth. 

I requested an examination of the body, which was at once granted. — 
This I proceeded to make the next morning in the presence of a medical 
friend. Before opening the body we both again remarked upon the size 
and expansion of the chest. There was great lividity of the surface of the 
body. 



1846.] Daveis' Case of Phrenic Hernia. 127 

An incision being made from the throat to the pubis, and the whole 
cavity of thorax and abdomen laid open, the difficulty was at once apparent. 
The diaphragm on the left side from the spine to the walls of the chest was 
completely patent, not including in its space, however, the oesophageal open- 
ing. The stomach lay in its usual situation, but every inch of the intestine, 
except the rectum, and so much of the descending colon as would reach to 
the diaphragm, was found in the thorax. The left side of the chest was en- 
tirely filled by the intestines, and the lung lay at the back part, without any 
appearance of having received any air, sinking at once upon being put 
into water. The right lung had received air in its two upper lobes, but 
apparently none in its lower lobe. The heart with its envelop was 
pushed entirely on the right side of the sternum, but was itself natural. — 
After removing the intestines I repeatedly placed the heart in its natural 
site, but it instantly returned to its abnormal position. The ribs were very 
prominent, arching out very much, and making the thoracic cavity appear 
extremely capacious. These I pressed down several times, but they were 
very resilient, and returned at once to their former prominence on removal 
of the pressure. I at first supposed the aperture in the diaphragm to be 
caused by a rupture, but the fact of the instantaneous return of the heart 
and ribs to their place after pressure was withdrawn, together with the 
appearance of this aperture, which I then examined more carefully, satis- 
fied me that it was an original malformation. Upon a most careful exami- 
nation there was no appearance of laceration, but the opening presented in 
its entire circumference a smooth and doubled edge, feeling precisely like 
the OS uteri when lax and fully expanded in labour. There was no other 
abnormal appearance of the viscera. 

This patient had suffered a good deal during the latter part of her preg- 
nancy from an inabiHty to remain in the recumbent posture ; and for four 
months previous to her confinement had not laid down in her bed, but had 
slept in a rocking chair, bolstered up and made as comfortable as such a 
position would admit of. Notwithstanding the severity of the labour, she 
had but one bad after symptom. The bowels were carefully regulated 
and the diet restricted. The breasts were covered with the ointment 
recommended by Dr. Hamilton, {Practical Observations,) composed of 
unbleached bee's wax §j ; olive oil 5iiss; pure honey gij; melted to- 
gether. 

The milk was drawn off by the nurse's mouth as it formed ; on the third 
day the breasts were tumid and painful, but the swelling and pain soon 
subsided; the secretion of milk gradually ceased, without any trouble, and 
the patient rapidly recovered. 

Sir Astley Cooper, in his Avork on Hernia, in alluding to two cases of 
phrenic hernia from malformation, says, " in each preparation the malfor- 
mation appears in the left muscular part of the diaphragm, whence the 



128 Simms' Case of Osteo- Sarcoma of the Lower Jaw. [Jan. 

viscera protruded into the left cavity of the chest." He also refers to two 
cases pubHshed by Dr. Macauiey ; in the first, which was very similar 
to the present case, the opening was in the left side ; — in the second the 
malformation was in the right side of the diaphragm. 



Art. XIII. — Osteo- Sarcoma of the Lower Jaw. -^Resection of the body of 
the hone. — Cure. Bjr J. Marion Simms, M. D., Montgomery, Alabama. 
(With a wood-cut.) 

The subject of this case was a negro man about 26 years of age. The 
disease involved the body of the bone, extending from the third molar tooth 
on the left to its fellow on the right side. From the left lateral incisor to 
the third molar on the right, the teeth had all been removed and their 
places were occupied by a large granulated, fungo-fleshy looking mass, con- 
stantly discharging a fetid sanious secretion. On the left the teeth were 
firm, but somewhat displaced, being pushed upwards, their crowns inclin- 
ing slightly inwards. The protuberance on each side of the bicuspids 
was very elastic to the touch. The whole under-surface of the jaw was of 
a bony hardness, the right of the symphysis being larger than the left and 
projecting a little lower. (See fig.) 

The following account of the history of the case is from the master of 
the boy, R. R. Mosely, Esq. 

" Some five years ago Sam had syphilis, and was some time under the 
influence of medicine before a cure could be effected. About a year after he 
got well, a rising commenced on the inside of the jaw, on the right side, re- 
sembHng a gum boil ; but it continued so long that I began to think it was the 
effect of the medicines he had taken to cure the disease. I got a Doctor to look 
at it, who pronounced it a gum boil and as such opened it, but it did not 
go away. Some considerable time afterwards, I got the Doctor to examine 
it again. He found all his teeth on that side loose, entirely out of their 
sockets, and just sticking in the gums. The Doctor then cut down to the 
jaw bone and found it diseased, and matter on it similar to brains. That 
was fifteen or eighteen months ago. Sam has been taking some kind of 
medicine for it ever since. This is a short and imperfect account of his 
case, but about the best I can recollect at present." 

The accompanying figure is a correct representation of the part diseased, 
and also a very accurate likeness of the boy. 



1846.] Simms' Case of Osteo-Sarcoma of the Lower Jaw. 



129 




The tumour was never 
painful, but had put on such 
a frightful appearance, that 
it warned his master of the 
necessity of having some- 
thing done for his relief. 
He accordingly sent him to 
one of the most distinguished 
surgeons of the whole coun- 
try, who immediately took 
steps for the performance of 
an operation. The patient 
Avas seated: an incision 
about an inch long was made 
on the left side of the jaw, 
when he resisted the efforts 
of the surgeon by springing 
suddenly from his seat and 
refusing to submit to the 
cutting: — nor could any en- 
treaty induce him to do so. He persisted so obstinately in his foolish deter- 
mination that the surgeon was compelled to send him home, trusting that 
time and a little reflection might bring him to a sense of his danger and 
show him that his only safety consisted in the extirpation of the disease. 

Soon after his return home, his master sent him to Montgomery, hoping 
that he might yet be induced to undergo an operation. I was not long in 
ascertaining that it would never be done loith his consent^ his only ob- 
jection being that "it would hurt too bad." 

Having made up my mind to give him the only chance for his life, and 
having determined not to be foiled in the attempt, I contrived the following 
method of securing him. 

Everything being ready, the operation was performed on Thursday, 15th 
May, 1845, at 11 A. M. The apparatus consisted of a barber's chair, on 
which was placed a plank about twelve inches wide and five feet long, the 
other end of it resting on a common bench or stool, of the same height of 
tbe chair. Persuading him to sit down on the chair with his legs extended 
out on the plank, he was secured tightly to it by means of straps made of 
surcingle webbing, which were passed successively over the thighs, knees 
and ankles. A strap around the abdomen, or rather pelvis, fastened behind, 
and another across the upper part of the thorax and points of the shoulders 
running downwards and backwards, held him so firmly that it was im- 
possible for him to move his body forwards. Some bands made of the 
same substance, (surcingle webbing,) fitting accurately each wrist, (after 
the manner of " handcuffs,") were buckled together with a strong leather 



130 Simms' Case of Osteo-Sarcoma of the Lower Jaw. [Jan. 

strap, and this made fast to the band that passed over his knees, thus keep- 
ing his arms extended. His elbows were pinioned to his sides by a strap 
buckHng behind. His legs, body and hands being now immovable, it 
only remained to fix his head, which was done by a band passing around 
it, and having attached, at the occiput, a strong leather strap. By laying 
hold of this and pulling directly downwards in the course of the spine, 
his head was so far controlled that an assistant could hold it in any posi- 
tion that I wanted. He appeared to be very much alarmed. Dr. Bald- 
Avin counted his pulse, and found it varying from 122 to 128 beats in a 
minute. 

Taking my position on his right, an incision was commenced on the left 
side, a little more than half an inch anterior to the angle of the jaw and con- 
tinued along the base of this bone to the symphysis. At this cut he made 
a most furious effort to get loose, which proved that I had not put myself 
to any unnecessary trouble in securing him. 

The facial artery being secured, each end requiring a ligature, the in- 
cision was continued from the chin, along the right side of the jaw, to a 
point corresponding with its commencement on the left. The divided ends 
of the right facial artery, (like the left,) each required a ligature. 

The upper flap was dissected rapidly from the tumour and held up in 
the usual way by an assistant. The lower flap was in like manner dis- 
sected off and turned down. This was somewhat tedious in consequence 
of the thinness of the skin and its close adherence to the diseased mass. 
The posterior fang of the second molar on the left (its crown being decayed), 
was extracted to make room for the saw. I attempted to cut the bone with 
a small, long, narrow saw, but made such slow progress that I laid it aside 
and picked up a very strong pair of Liston's bone forceps, with which I 
was equally unsuccessful. I then resorted to the chain-saw, passing it 
around the bone in the manner usually directed, by which it was severed 
in a few seconds. Its apphcation on the right side was quite as successful, 
dividing the maxillary just anterior to the third molar tooth. A strong 
double ligature was now passed through the frasnum hnguas to prevent the 
spasmodic retraction of the tongue, and the operation was completed by 
dissectino- the lino-ual muscles from their attachments to the bone. The 

o o 

retraction of the tongue was pretty strong at the moment of separation ; 
though easily controlled by the hgature, which proved the safety and utility 
of this precautionary measure. There was a good deal of hemorrhage 
from the nutrient vessels of the diseased part: but no ligature was 
needed. The operation lasted forty minutes. From his constrained posi- 
tion and loss of blood the patient was quite exhausted. He was loosed from 
his fetters, laid on a bed, and took some brandy and water; which, by the 
by, had been given to him occasionally during the operation. The wound 
was not adjusted, till reaction had been fully estabhshed and the oozing of 
blood entirely checked. The hgatures of the facial arteries were left hang- 



1846.] ^imms' Case of Osteo- Sarcoma of the Lower Jaw. 131 

ing from their respective places. The ligature of the frsenum and those 
of the ranular arteries were drawn through the opening at its central point ; 
the wound was closed by some six or eight interrupted sutures, and a 
water dressing applied. He had taken sixty drops of laudanum previous 
to the operation, which did not appear to produce any effect till it was 
over, when he seemed almost narcotized, sleeping profoundly the whole 
afternoon and all night. Mr. Norris, one of my students, sat by his bed- 
side the whole night, watching his tongue and keeping the dressings 
constantly moistened with cold water. 

The frsenum linguae ligature was cut loose and drawn out on the second 
day ; but the dressing was not disturbed till the fourth, when I found the 
wound healed through its entire extent by the "first intention," except just 
at the points where the ligatures hung out. They came away in due 
time, and their points of exit at the chin and on the right side granulated 
directly ; but on the left there remained a fungous growth sprouting up 
above the level of the surrounding skin, about the size of a pea, which 
did not get well till an exfoliation of bone was thrown off through this 
opening. On the right there was a like exfohation, but it was discharged 
by an opening on the inside of the mouth. 

For several days I observed that when he would he on one side, the 
large, flabby, skinny chin would gravitate to that side ; and when he would 
lie on his back, its own weight, assisted by the inspiratory act, would cause 
it to cave in, as it had no support on the interior. 

Sam left Montgomery on the 12th July, perfectly well. Previous to 
the operation, he was never known to laugh or even to speak to any of the 
other*patients in the Infirmary; but now, his mouth is almost always on 
the broad grin, and he is continually cracking jokes and playing pranks on 
his companions. I have rarely ever seen a patient exhibit more real heart- 
felt gratitude than he does. 

His mastication is very good, having the third molar tooth left on each 
side ; but the action of the pterygoid muscles has a tendency to draw the 
ends of the bones inwards, and thus mastication is performed, not with the 
crown, but rather with the outer edge of the tooth. This, I fear, will, by 
and by, cause them to become displaced, loose, and useless. 

The operation was performed in the presence of a large number of medi- 
cal gentlemen,* and I am under especial obhgations to Drs. Doling, Bald- 
win, Blakey, Beilangee and Vickers for their valuable aid. For the draw- 
ing I am indebted to my friend, Joseph T. Moore, Portrait Painter. 

A review of this case presents to my mind the following points of in- 
terest. 

1st. It adds another to the long list of successful operations for this 
disease. 

• Tea medical students, and fifteen doctors. 



132 Simms' Case of Osteo- Sarcoma of the Lower Jaw. [Jan. 

2d. It proves the practicability of the operation, whether the patient is 
wiUing or not. 

8d. The chain-saw is to be preferred for the division of the bone, when 
it is of a healthy hardness. It is a labour, time and pain-saving instru- 
m,ent. 

4th. There is safety in the frsenum hngusB Hgature. 

5th. The water dressing is preferable to every other. 

6th. If any apology were necessary for the length of time (forty minutes) 
taken in the performance of the operation, it might readily be found in the 
constrained posture of the patient, and consequently the increased urgency 
for rest, which, according to my experience, is all important in any capital 
operation. 

If I had to do this operation again, I would not bring a single ligature 
through the wound, but I would leave them long, bring them out at the 
angles of the mouth and fasten them to the cheeks with adhesive plaster, 
thus allowing the wound to heal up entirely by the first intention, and 
avoidinsf the deformity of a cicatrix from granulation. 



1846.] 133 



REVIEW 



Art. XIV. — Caloric, its tnechanical, chemical and vital agencies in the 
Pheno7nena of Nature. By Samuel L. Metcalfe, M. D., of Transyl- 
vania University. 2 vols. 8vo., pp. 1100 : London, 1843. 

Notwithstanding two years have elapsed since the publication of this 
work, the importance of the subject of which it treats, and the very fa- 
vourable notice it has received in several of the scientific journals abroad, 
it is as yet but little known in this country. This neglect it is difficult to 
account for — the leading views of the author — as well from their novehy 
as from the very ingenious and plausible chain of reasoning by which they 
are enforced — presenting strong claims to the attention of all who are inte- 
rested in the study of the natural sciences. 

That the agency of caloric — which is omnipresent and unceasing — in 
the production and modification of the phenomena of nature, whether me- 
chanical, chemical, or vital, has been too much overlooked, or, when 
recognized, greatly underrated, will become very apparent from a close 
examination of the prevailing doctrines in relation to mechanical, chemical 
and vital dynamics, and the confused and contradictory views entertained 
of the nature, cause, and action of heat. And although, upon a more 
close and accurate investigation of the subject, the position of Dr. Metcalfe, 
that caloric " is alone, of every form of being, quick or dead, the active prin- 
ciple," may not be sustained, the agency of caloric in the production of all 
the various phenomena of the universe will be found, we are persuaded, 
more potent and constant than is now generally supposed. 

The work before us is evidently the production of an original mind, 
well versed in the natural sciences, and habituated to close and laborious 
investigation ; and although replete Avith unnecessary repetitions and 
much that is irrelevant to the main subject of inquiry, or, at least, unadapt- 
ed to either illustrate or confirm the views advanced by the author, it is 
one calculated to excite deep interest in the reader, and to impart much 
valuable information. 

It would not comport with the plan and objects of this Journal, to enter 
into an examination of the pecuhar views of Dr. Metcalfe, or to test the 
validity of the arguments adduced by him to prove that caloric alone is the 
efficient cause of motion and life throughout creation — it is only in the 
apphcation of his views to the explanation of the phenomena of Hfe and 
disease that they chiefly interest us on the present occasion. 

A brief outline of the leading views contained in the first three books 
of the treatise before us, was first promulgated by the author in an essay, 
entitled, " a New Theory of Terrestrial Magnetism," pubhshed in New- 
York, in 1833 ; and somewhat extended in a series of papers in the Knick- 
erbocker Magazine of 1834-5. This first portion of the work it was his 
intention to have pubhshed separately, and it was actually printed in 1837, 
the prehminary chapter excepted. " But," he remarks in his preface, 
" as more enlarged views of the subject opened on him, he clearly per- 



134 Review. [Jan. 

ceived that a development of the physiological and pathological views of 
caloric was essential to the completion of his undertaking ; which, at that 
time, he supposed would not require more than twelve months : — 

* But more advanced, beheld, with strange surprise, 
New distant scenes of endless science rise.' " 

Dr. Metcalfe maintains, in opposition to the views of Sir H. Davy, and 
a host of modern naturalists, the materiality of caloric. That it does not 
consist in mere motion or vibration among the particles of ponderable mat- 
ter, would appear, he observes, from the following considerations — 

" 1. That it may be added to, and subtracted from other bodies, and measured 
with mathematical precisioii/Hs all good thermometers demonstrate. 

" 2. That it augments the volume of bodies, which are again reduced in size by 
its abstraction. 

" 3. That it modifies the forms, properties, and conditions of all other bodies, in 
an endless variety of ways. 

" 4. That it passes by radiation through the most perfect vacuum that can be 
formed by means of the air pump, in which it produces the same effects on the 
thermometer as in the atmosphere. 

^' 5. That it exerts mechanical and chemical forces which nothing can restrain, 
as in volcanoes, the explosion of gunpowder, and other fulminating compounds. 

" 6, That it operates in a sensible manner on the nervous system, producing 
intense pain, and disorganization of the tissues when in excess.'^ 

After noticing the various objections to the doctrine of the materiality of 
caloric, and adducing various additional arguments to establish its truth, the 
author proceeds to show, that caloric is " a self-active principle," capable 
of moving itself, and of generating motion in all other bodies. This is in 
fact the substance of Dr. Metcalfe's theory of caloric, the proof of which, 
and its application in explanation of the phenomena of dead and living 
matter, being the main object of the publication before us. 

The cardinal facts which connect its agency with the general theory of 
physics, may, according to the author, be reduced to the following propo- 
sitions : — 

" 1. That the activity or moving power of all bodies is directly in proportion to 
the amount of caloric around their particles. 

''2. That all molecular motions, whether centrifugal or centripetal, maybe 
resolved into the law by which caloric repels its own particles, and attracts those 
of ponderable matter, with forces that vary inversely as the squares of the dis- 
tance. 

^' 3. That the quantity of motion in the world, whether mechanical, chemical, 
or vital, is in proportion to the mean temperature of different latitudes, cceteris pa- 
ribiiSj and diminishes from the equator to the poles. 

'• 4. That the centrifugal force by which the planets are impelled through their 
orbits, is directly in proportion to the heating power of the sun ; and like gravita- 
tion, is inversely as the squares of the distance. 

" 5. That the aggregate vital energy of animals, and the development of their 
organization, are exactly in proportion to the amount of caloric obtained by respi- 
ration, and combined with their tissues. 

'■ 6. That every variety of electricity is convertible into caloric, and the latter 
again into electricity ; consequently, that they are modifications of one and the 
same principle. 

"7. That the directive power of the compass needle diminishes from the iso- 
thermal equator to the points of lowest mean temperature, which are the magnetic 
poles; and that all its variafions correspond with the variadons of terrestrial tem- 
perature. 

"8. That caloric is the active principle in light, whether radiated from the sun, 
or generated by ordinary combustion, friction; percussion, phosplj^rescence, or 
the electric discharge,'^ 



1846.] Metcalfe on Caloric. 135 

Dr. Metcalfe advocates, in fact, the doctrine of some of the most distin- 
guished of the ancient Greek philosophers, that everything in nature is 
composed of two descriptions of matter, the one essentially active, and the 
other passive ; while he has attempted to show that the active matter is 
caloric — which in its various manifestations assumes the different forms of 
S'olar heat and light — of artificial heat and light — of lightning, or of electri- 
city as excited hy friction, or produced by the galvanic battery. 

'• If it be a fact, he remarks, that the elastic force of bodies is augmented by 
every addition, and diminished by every abstraction of caloric, it is obvious that 
the entire privation of it would destroy the repulsive power of their particles. — 
And as we have seen that, without caloric, they could have no power of motion, 
it is evident that they could neither approximate nor recede from one another, 
consequently, that both attraction and repulsion are modified effects of one and 
the same agent; moreover, if it can be proved that this agent is everywhere pre- 
sent — in the pores of bodies, as in the stellary spaces — and cannot be traced to 
any more comprehensive principle — ir must be allowed to possess all the attri- 
butes of a primary efficient cause. For nothing can merit the title of a vera causa^ 
unless it be something which has the powder of moving itself, and of generating 
motion in other bodies. 

" It is equally evident, that whatever the cause of attraction and repulsion may 
be, it must determine all the phenomena of cohesion, chemical affinity, crystalli- 
zation, elasticity, decomposition, and recombination. When I come to treat of 
the mode in which caloric produces opposite effects, it will be found, that in cer- 
tain proportions it causes the particles of ponderable matter to separate^ while 
in other proportions it forces them to unite: — that the aggregate force of attraction 
by which it tends to unite with the particles of gross matter, holds them together, 
and maintains the earth in the globular form : — in short, that all the phenomena of 
nature may be referred to the law by which caloric repels its oiun particles, and at- 
tracts those of ponderable matter J^ 

But it is impossible for us to follow our author as he develops and ap- 
plies the'law here announced — in his examination of the agency of caloric 
in meteorology, in the production of evaporation and rain — and of winds — 
the influence of the heating power of the sun upon the number and forces 
of volcanoes — and the agency of caloric in the production of planetary 
motion. It is with the physiological and pathological laws of caloric that 
we, as physicians, have principally to do ; and hence, we shall proceed to 
a consideration of the author's views in regard to caloric as the cause of 
life, and its phenomena in health and disease. 

According to Dr. Metcalfe, organized bodies are composed chiefly of 
those elements which contain the largest amount of caloric around their 
particles, by which they are rendered proportionally active, and endowed 
with the faculty of entering into vital combinations, so as to form highly 
complex tissues ; the vital energy of animals, the activity of their func- 
tions, and the development of their organs, being in proportion to the 
amount of caloric which circulates through them, and which is employed 
in combining arterial blood with the solids. 

The last three books of the treatise before us are devoted to a full de- 
velopment of the position here stated. 

After presenting, in the first chapter of Book IV, a sketch of the opinions 
entertained by the ancients and the leading modern authorities on the 
nature and cause of life, the author proceeds to consider the nature of the 
ultimate elements of organized bodies, and the cause of their uniting into 
ternary and quarternary compounds so as to form living tissues. 

He denies that the phenomena of life are wholly distinct from those of 
inorganic matter, an opinion which has arisen, he conceives, from our im- 



136 Review. [Jan. 

perfect knowledge in regard to the primary physical cause of motion 
throughout nature. 

^'Tt has been asserted by innumerable writers on physiolojjy; that the pheno- 
mena of life are as far removed from those of ordinary chemistry as the latter is 
from mechanics. But the Great Architect of the universe has so completely con- 
nected all the operations of nature together, that it is often difficult to draw the- 
boundary line between mechanical^ chemical, and vital action. The mechanical 
force of steam is generated by the chemical union of caloric with the particles of 
water, to the expansion and contraction of which we are indebted for all the phe- 
nomena of evaporation and rain, the nourishment of vegetation, and the suste- 
nance of animal life. And if it be true, as there is every reason to suppose from 
analogy, that solar light, like that of a lamp or common fire, is generated by com- 
bustion, all the phenomena of nature must be referred to chemical action. The 
circulation of sap through the vessels of plants is no less the result of attraction 
than the absorption of water by a sponge, or its elevation in the capillary tubes of 
dead matter, but with this difference, that the force is much greater in living ves- 
sels, owing to their extreme minuteness, compared with artificial tubes. The 
conversion of sap into organic molecules, and the latter into woody fibre, bark, 
leaves, flowers, fruits, and different secretions, is no less the result of attraction 
than the generation of water, salts, rocks, and other chemical compounds. 

"The first process of germination consists in a chemical fermentation in the 
seed, by which a portion of its substance is converted into sugar and carbonic 
acid, while another portion is changed into living organic molecules, that are ar- 
ranged in symmetrical order, corresponding with the parent type from which it 
sprung. The generation of confervae, and animal infusoria, during the putrefaction 
of organic maUer, is no less the result of attraction than the conversion of sap into 
trees, and blood into the structure of animals, whether produced from seeds and 
eggs, or without the concurrence of parents, as maintained by Needham, Priestley, 
Ingenhouz, Monti, Wrisberg, Tiedemann, Miiller, Treviranus, and many other 
distinguished philosophers. The same is true of the different species of entozoa, 
found in the liver, brain, eyes, veins, and other parts of warm-blooded animals, 
which seem to be formed by the immediate combinations of morbid secretions 
in the parenchyma of their organs, according to the observations of Pallas, Miiller, 
Treviranus, Rudolphi, and many others. But caloric is no less essential to fer- 
m.entation, germination, circulation, nutrition, or the generation of microscopic 
plants and animals from the proximate constituents of dead organic matter, than to 
the combinations of ordinary chemistry." 

That all the modifications which inorganic substances undergo in their 
conversion into the different forms of organic matter — both as it exists in 
the vegetable and in its more advanced elaboration, in the animal tissues — 
are the result of chemical changes, in all respects identical in their nature 
with those which take place between the different forms of inorganic mat- 
ter out of hving bodies, and are governed by the same laws, and that caloric 
is not only essential to the occurrence of these modifications, but is a prin- 
cipal agent in their production. Dr. Metcalfe has rendered very probable. 
But after we have proceeded thus far, we have only arrived at an ac- 
quaintance with the nature of the molecular changes which take place in 
living matter, and with, if you please, one of their chief motors, under the 
dominion of vitality. For it cannot be shown that by the action of caloric 
alone upon inorganic or dead organic matter an organized living tissue can 
be produced, or that living beings of the lowest organization have ever 
sprung into existence, excepting from seeds, or eggs, or germs, proceeding 
from parents of similar organization with themselves. 

The important service which Dr. Metcalfe has rendered to Physiology 
by his investigations, does not consist in the discovery of the perhaps in- 
scrutable principle of vitality, but in pointing out the important office per- 
formed by caloric as a promoter of all its phenomena. 



1846.] Metcalfe on Caloric, ^ 137 

^•So far as digestion depends on the solvent power of gastric juice, it is — as our 
author very justly remarks — a chemical process, by which dead matter is con- 
verted into chyme. And that it is owing chiefly to the agency of caloric would 
appear from the fact, that the digestive function in all animals is performed with a 
rapidity exactly in proportion to their mean healthy temperature ; being greater in 
birds than in mammalia, and very much greater in both than in cold-blooded 
animals, which require many days, and some of them several weeks to digest a 
single meal. We also learn from the experiments of Spallanzani, that the solvent 
power of gastric juice, when taken from the stomach, increases from 50° to 120° 
F. ; and from the late researches of Dr. Beaumont, that when put in vials, and 
kept at the temperature of 100°, it converted food into a species of chyme that 
could scarcely be distinguished from what was formed in the stomach, but re- 
quired a longer time to produce the effect. The fact is, that cooking may be re- 
garded as the initiatory process of digestion ; for it is not only the softening of raw 
animal and vegetable matter by the action of fire, and thus preparing it for enter- 
ing into new combinations in the living body, but greatly changes its taste, odour^ 
and other sensible properties. 

"The all-important function of respiration, so essential to animal life, is strictly 
a chemical process, by which a portion of atmospheric oxygen unites with carbon 
to form carbonic acid, with an evolution of caloric; who then can say at what pre- 
cise point the operations of chemistry are merged in the affinities of life, as in 
germination, spontaneous generation, the nourishment of plants, &c., or when the 
latter terminate in the actions of ordinary chemistry, as during the ripening of 
fruits? 

^'^ There is nothing more calculated to excite our admiration of the infinite 
wisdom by which the universe is governed, than the intimate relation that exists 
between all its physico-chemical and vital operations. By the mechanical diffu- 
sion of water through the atmosphere, organized bodies are supplied with the 
greatest part of their substance. The carbonic acid generated by chemical action 
during the processes of combustion, fermentation, and the respiration of animals^ 
affords nourishment to plants — being decomposed in the tissue of their leaves, 
where crude sap is converted into cambium by the evaporation of water, and the 
absorption of carbon ; then into starch, sugar, oils, &c., which, in their turn, become 
the appropriate nourishment of animals. It v/as justly observed by Sir Charles 
Morgan, that, ' the distinctions which the subtilizing genius of man has invented 
to separate and to isolate, are contradicted and deranged at every new^step of suc- 
cessful investigation.' {Philosophy of Life^ p. 62.)" 

Dr. Metcalfe proceeds next to a consideration of the ultimate elements 
of organized bodies. He notices, as the most remarkable circumstance 
connected with the chemical composition of these bodies, the fact of their 
being composed chiefly of the most light, active, and mobile species of 
matter, such as oxygen, hydrogen, nitrogen, and carbon; the three first of 
which are always found in the gaseous state, when not united chemically 
with other bodies ; w^hile their elasticity is such, that no mechanical pres- 
sure has ever yet been sufficient to overcome it. And, again, while all 
the other elements of ponderable matter are capable of entering into simple 
binary combinations alone, the ultimate principles of organic bodies possess 
the additional power of forming ternary and quarternary compositions. 

" In the formation of the simplest plant, it has been found that at least three 
elements, oxygen, hydrogen, and carbon, are united together in a direct manner, 
without any previous binary combination ; and that the various tissues of all ani- 
mals, if we except the very lowest species of zoophytes — the real character of 
which is doubtful — are formed by the immediate union of the same elements 
with nitrogen. From the ternary and quarternary combinations of these active 
principles in various proportions, are generated all the diversified organizations 
that make up the living world, as shown by the analytical researches of Thenard, 
Gay Lussac, Berzelius, Prout, Thomson, Saussure, Berard, Chevreul, Ure, and 
others. {Tiedemann^s Comparative Physiology^ p. 67.) 

"■ But in addition to the power of oxygen, hydrogen, carbon, and nitrogen, to 



188 Review. [Jan. 

form ternary and quarternary compounds, it is worthy of especial notice, that 
many more atoms of the same elements unite together in forming organic combi- 
nations than are found in those of inorganic bodies. For example, water is com- 
posed of one atom of oxygen to one of hydrogen; carbonic acid — of carbon one 
atom to two of oxygen ; and so of innumerable other binary compounds ; w^hereas, 
the acid, saccharine, oily, and resinous constituents of plants, are generated by 
the immediate union of many oxygen, hydrogen, and carbon atoms. Starch is 
composed of seven atoms carbon, six of oxygen, and six of hydrogen; sugar of 
twelve atoms of carbon, eleven of oxygen, and eleven of hydrogen ; while the oil 
of peppermint consists of carbon atoms ten, hydrogen ten, and oxygen one. The 
resinous and fixed oils contain still higher numbers of the same atoms, as may be 
seen by referring to p. 146 of the first book, where it has been shown that this 
constitutes the principal difference between the volatile and more tenacious com- 
pounds of organic matter. From which it is probable that the quarternary unions 
of oxygen, hydrogen, carbon, and nitrogen, to form the proximate constituents of 
the blood and solid tissues of animals, contain still higher numbers of atoms of 
the same elements. So that, whether the affinities of life be owing to the same 
physical cause which governs those of inorganic matter or not, the former evince 
at once a far more complex and refined mode of operation. Hence the beautiful 
remark of Kielmyer, as cited by Tiedemann, that crystallization represents in 
some degree, the simple elements of geometry; while in the production of organ- 
ized bodies, nature has employed a high geometry." 

After showing that organic molecules, generated from the ternary and 
quarternary combinations of oxygen, hydrogen, carbon, and nitrogen, form 
the proximate constituents of all living bodies, whether fluid or solid, 
from the simplest plant or gelatinous animalcule up to man ; that by their 
arrangement in series and aggregates, they generate the primary tissues 
of all living organisms, in accordance with laws no less fixed and definite 
than those of crystaUization ; that, by the union of three primary tissues thus 
formed, the different complicated organs of the animal fabric are built up, 
and that, in all probability, the structure and functions of all organized 
bodies are determined by the chemical constitution and fundamental pro- 
perties of their ultimate elements, which are modified by every increase or 
diminution in the quantity of caloric around their atoms ; Dr. Metcalfe 
enters into a consideration of "the great question that lies at the founda- 
tion of organic chemistry : whether, namely, the power of forming ternary 
and quarternary compounds, with the aptitude for renewing their composi- 
tion by assimilation and elimination, be owing to the same cause which 
governs the affinities of dead matter, or to some peculiar principle of a to- 
tally distinct nature, as maintained by Berzelius, Tiedemann, Miiller, and 
nearly all the most distinguished physiologists of the present day." 

Dr. Metcalfe considers it to be evident that the power of oxygen, hydro- 
gen, carbon, and nitrogen, to form the proximate constituents of living 
bodies, is owing to the fundamental properties of these elements, from the 
fact that no others are capable of entering into ternary and quarternary 
compositions ; in short, that no plant or animal was ever formed or nour- 
ished by any other elements. And, that the tendency of dead organized 
bodies to undergo decomposition, is owing to the same active principle 
that enables these elements to form ternary and quarternary combina- 
tions, he believes to be proved by the circumstance that this tendency is 
augmented by every addition of caloric, which he maintains to be not only 
the universal bond, but the great decomposer of all matter. 

Dr. Metcalfe is a strong advocate for the doctrine of spontaneous genera- 
tion; it is, in fact, essential to his theory of vitality, that by the action of 
caloric upon the vitalizable elements, oxygen, hydrogen, carbon, and nitro- 



1846.] Metcalfe on Caloric. 139 

gen, living structures should be generated — for with him, life and all its 
phenomena are produced by the agency of caloric. 

^' During the decomposition, he remarks, of organized bodies, under the influ- 
ence of a summer temperature, a portion of their substance enters into binary 
compounds of water, carbonic acid, and ammonia. But, during this process, 
another portion of the same elements unites to form the simplest species of micro- 
scopic plants and animalcules, without the concurrence of parents, seeds, eggs, 
or the addition of any other principle than was concerned in the generation of 
water, carbonic acid, &c. And as it has been shown, that the form of crystals 
depends on the nature of their atoms, modified by the temperature at which they 
are aggregated, so has it been observed that the specific character of infusoria, 
generated during the fermentation of albumin, fibrin, starch, gluten, and other 
organic compounds, varies according to the different species of matter employed. 
Those simple organizations, termed entozoa, generated in the parenchymatous 
substance of many animals, without the visible existence of any parents, eggs, or 
germs, also vary according to the nature of the animal, and even of the organ in 
which they are formed. Nor is there anything more mysterious in this, than in 
the ordinary process of generation, only that we are more accustomed to the lat- 
ter ; or, that specific contagions should be generated by certain combinations of 
filth, and vitiated animal secretions, as in gonorrhoea, lues venerea, small-pox, the 
itch, 4c., that have the power of propagating themselves in a mode analogous to 
the production of fermentation by yeast, which, according to the observations of 
De la Tour, is composed chiefly of organic molecules that have the faculty of mul- 
fiplying themselves in all fermentable matters." 

The question of spontaneous generation, or the formation, by the occur- 
rence of certain chemical changes in particular forms of dead matter, of 
living organized beings, is as j^et unsettled : no positive, conclusive evi- 
dence has yet been adduced to estabhsh the fact, and until such is done, 
it ought not to be made use of either as a proof or illustration of an im- 
portant doctrine, much less should its truth be taken for granted, as in the 
sentence just quoted. 

All must admit with our author, that the " essential attribute of the ele- 
ments of organized bodies is that of mobility or activity, by which they are 
kept in a state of perpetual transformation, or transition from death to life, 
and from life to death." And, according to Dr. Metcalfe, it is " owing 
to the large amount of caloric around these elements, that they are enabled 
to form ternary and quarternary combinations, with the aptitude for life ; 
and when reduced to the condition of dead matter, they are constantly en- 
tering into binary combinations of water, carbonic acid, &c., or into the 
simplest forms of hving organizations. If reduced to a low temperature, 
all their chemical and vital affinities cease, when they assume that condi- 
tion of repose which characterizes the elements of mineral bodies." 

Aptitude for life is, unquestionably, in an emphatic sense, the charac- 
teristic of the elements of organized matter; and the necessity of caloric 
for the production and maintenance of life is equally certain. But the 
question is, what is it that endows certain combinations of these elements 
with life ? that imparts to them peculiar powers which, although not 
perhaps independent of their pecuhar chemical combination, is evidently 
something which does not necessarily result from, nor depend solely upon 
it — a something which, though it do not change, nevertheless controls and 
modifies chemical action, and causes combinations and decompositions which 
never take place beyond its domain ? Is this principle of vitality a mere 
effect of the agency of caloric? or is it a something totally distinct from all 
the known physical and chemical powers ? 

Of the correctness of the following position of our author there can be no 
dispute. 



140 Review. [Jan. 

^^That the power of living bodies to renew their composition by assimilation, 
and to reproduce their species by generation is governed by the emphatic agency 
of caloric, is evidfent from the fact, that the power of nature to multiply organic 
forms, is directly in proportion to the temperature of the earth, from the equator 
to the polar circles.'' 

This is shown by a brief sketch of the vegetable and animal produc- 
tions of the different parts of the earth — the number of species, variety of 
structure, and magnitude of form of which are developed in full perfection 
only in the regions of perpetual summer, and gradually diminish in num- 
bers, variety, and magnitude on to the polar circles. 

^' If the whale and a few other mammalia attain to a great size in high lati- 
tudes, it is because they are supplied with an apparatus for obtaining caloric from 
the atmosphere by respiration, which maintains their mean temperature about 20° 
above that of the earth under the equator. The caloric thus acquired, is preserved 
by means of a warm fur coat, or a subcutaneous layer of fat, that in the whale 
varies from eight to fifteen inches in thickness ; and if there be some species of 
plants that remain evergreen throughout winter, it is because they abound with 
oily and resinous matter, which retains a sufficient amount of heat to prevent the 
destruction of their foliage, but not to maintain their growth.'' 

'' Now," our author remarks, " whatever the cause maybe by which organized 
bodies are enabled to renew their composition, it must determine the actions that 
modify their structure and functions ; for the elements of which they are formed, 
are the same in all parts of the world, with this prominent exception, that within 
the tropics they are continually receiving from the sun a larger proportion of that 
ethereal principle (whatever men may choose to call it) , which preserves all na- 
ture in a state of activity. The elements of the air, water, and crust of the earth 
are the same in South America as at Melville Island; which is also true of all the 
plants and animals that inhabit the earth. The number of species, the magnitude 
of their forms, and complexity of organization, must, therefore, be regulated by 
the energy of the principle that causes their development, which diminishes from 
the hottest to the coldest parts of the globe ; because in the former, the affinities of 
life are continually in action, but suspended for six or nine months every year, in 
the middle and higher latitudes." 

The next subject discussed by our author, is the theory of respiration, as 
connected with animal temperature. 

After examining the various theories of animal heat that have been 
advanced by the leading physiologists and chemists, Dr. Metcalfe adopts, 
as the one most consonant with all the well-established facts in relation 
to the process of respiration, and best adapted to explain the various cir- 
cumstances connected with the temperature of the animal body, its aug- 
mentation, diminution, and fluctuations under particular circumstances, 
and the phenomena thence resuhing, that of Black, Crawford, Lavoisier, 
EUis, and Dalton, that, namely, animal heat is evolved in the lungs during 
respiration, by a chemical process, as in ordinary combustion. 

This is one of the most interesting portions of the work before us; the 
author has very clearly indicated the sources of many of the errors into 
which physiologists and chemists have fallen in their investigation of the 
subject of animal heat, and has adduced very powerful arguments in favour 
of the doctrine that the lungs are the sole source of the heat by w^hich the 
temperature of the body is steadily maintained, and that it is there pro- 
duced by the combustion of carbon. It would be impossible, within the 
compass of a notice like the present, to follow the author in all his argu- 
ments and expositions — to do him justice it would require that the entire 
section should be presented to our readers ; we shall content ourselves with 
quoting the general conclusions of the author. 

Dr. Metcalfe remarks, that 



1846.] Metcalfe on Caloric. 141 

^' If it can be shown that there is more carbon in the venous than arterial blood of 
all animals, it must be given oiT while passing through the lungs, because it is 
found to be diminished immediately afterwards. And if the proportion of carbon 
be greater in the venous blood ofherbivora than of carnivora, it will explain why 
the former generate more carbonic acid in proportion to the amount of oxj-gen 
consumed by respiration. For the same reason, if the Y^tio oUiydrogcn be greater 
in the venous than arterial blood of carnivorous than of herbivorous animals, it 
must also be given off in the air cells of the lungs, whether it unites with oxygen 
to form water or not. And if there be more nitrogen in the arterial than venous 
blood of animalsj it must be derived from the atmosphere by respiration." 

That there is more hydrogen in the chyle of carnivorous than of herbi- 
verous animals, our author infers from the researches of Dr. Marcet on 
chyle taken from the thoracic duct of dogs nourished for several days on 
animal food alone. [Medico-Chirurg. Trans,, vol. i.) And he adduces 
the analysis of Michaelis to showth?tt the proportions of carbon and hydro- 
gen are greater in venous than arterial blood ; viz., immediately before, 
than after passing through the lungs. 

^^ They also show that the ratios of oxygen and nitrogen are greater in arterial 
than venous blood. That a portion of nitrogen is absorbed from the atmosphere 
and united chemically with the blood, might reason ably be inferred from the fact, 
that there is very little of it in the food of herbivorous animals, in whose blood it 
is no less abundant than in that of carnivora." 

'■'■ Now, if it be true, that carnivorous animals consume from twenty to fifiy per 
cent, more oxygen by respiration than is returned in the form of carbonic acid, as 
shown by the experiments of Dulong, Despretz, Edwards, and Treviranus, (the 
latter makes the difference still greater in fishes.) what, I repeat, becomes of the 
surplus oxygen? Does it unhe with the hydrogen exhaled from the lungs, or 
with the blood, as supposed by Edwards and others'? That it combines w^ith hy- 
drogen to form water, and contributes largely to the evolution of animal heat, 
would appear from the fact, that the temperature of carnivorous animals is not 
inferior to that of herbivora, although the former generate much less carbonic 
acid; whereas, it has never been proved that the combination of the oxygen with 
the blood is attended with an elevation of temperaturCj unless carbonic acid is 
formed.'^ 

After quoting the experiments of Magnus, showing the proportions of 
carbonic acid, oxygen, and nitrogen which were found to exist in a state 
of mechanical mixture with the arterial and venous blood of the horse and 
calf, and were capable of separation from it by means of the air-pump, Dr. 
Metcalfe observes — 

'^ These experiments show that there is more oxygen and nitrogen in arterial 
than venous blood, and a little more carbonic acid in the latter. Bat if they prove 
anything in regard to the theory of respiration, it is, that carbonic acid is not 
formed in the general circulation. For if generated in the arterial blood, it ought 
to contain more carbon than venous blood, which is not the case; and if in ve- 
nous blood, its temperature ought to be higher than that of the arteries; for the 
obvious reason, that caloric is always evolved during the formation of carbonic 
acid. But the most decisive proof that the latter is generated in the lungs, and not 
in the general circulation, is, that the temperature of arterial is higher than that of 
venous blood, as long ago observed by Haller, Black, Plenck, and Menzies." 

In proof of this fact, the experiments of Dr. John Davy, Magendie, and 
Holland are referred to — and the results of those of the first named gen- 
tleman given. It is also shown, from the experiments of Dr. Dav}^ that 
the lungs have a higher temperature than other parts of the body. As 
this fact has been called in question by other physiologists. Dr. Metcalfe 
several times repeated the experiments of Dr. Davy on sheep and oxen, 
and found in every trial, that the temperature of the lungs and left side of 
No. XXI.^January, 1846. 10 



142 Review. [Jan. 

the heart were from 2° to 8° higher than that of the stomach, liver, and 
brain, or the blood of the vena cava and jugular veins. 

That a small proportion of oxygen is absorbed by the blood, and contri- 
butes to its formation, Dr. Metcalfe considers to be highly probable — but 
he maintains that by far the greater part of it unites in the lungs imme- 
diately with carbon and hydrogen, for the formation of carbonic acid and 
water, and the evolution of caloric. 

The objections to this view of the respiratory function are candidly stated 
and refuted, and its truth is enforced and illustrated by a variety of facts 
and arguments. 

From the facts adduced, Dr. Metcalfe considers, then, that we are author- 
ized to conclude, 

'■'• 1. Tliat during the passage of dark venous blood through the hings^ it gives 
off variable proportions of carbon and hydrogen, that unite chemically with atmo- 
spheric oxygen to form carbonic acid and water, as in ordinary combustion, by 
which it acquires an addition of caloric, with a bright florid hue ; and 2d, that 
during its circulation through the systemic capillaries, the caloric obtained from 
the atmosphere is transferred to the solids, by which their temperature and vitality 
are maintained ; %vhen the blood returns to the right side of the heart of a dark 
modena hue, having lost its power of stimulating the organs, until it acquires an 
additional quantity of caloric from the lungs." 

In reply to the arguments of Brodie, Phihp, Tiedemann, Edwards, and 
others, who contend that animal heat is generated by nervous influence, 
secretion, nutrition, the condition of the blood, and muscular contraction, 
Dr. Metcalfe proceeds next to prove that the mean healthy temperature of 
all onimah is directly in proportion to the amount of their respiration ; 
and that the organizing po\ver of animals, and the activity of their respect- 
ive functions, are directly in proportion to the quantity of caloric derived 
by them from the atmosphere by respiration. 

While the respiratory apparatus of birds is larger, in proportion to the 
size of their bodies, than in any other description of animals — extending 
through all the cavities of the abdomen, and even of the bones — they also 
consume more oxygen, generate more carbonic acid, and have a higher 
mean temperature. Next to birds, mammiferous animals have the largest 
organs of respiration— which, though confined to the thorax, consist of in- 
numerable cells that present a vast extent of surface to the atmosphere. — 
The consequence of which is, that many of them are capable of maintain- 
ing their temperature in the coldest parts of the world. From the tables 
given by Dr. Metcalfe, the mean temperature of birds is found to vary from 
105' to nearly 113° F., which is about 28° above that of the tropical re- 
gions — while in mammalia it varies from 96° to 106° in their active and 
healthy state. 

-' But if we descend to the lower orders of air-breathing vertebrated animals, 
sucli as ChelonianS; Saurians, Ophidians, and Batrachians, in which the heart is 
so constructed that only a portion of blood is sent through their imperfectly de- 
veloped lungs, we find, that the power of obtaining caloric from the air by respi- 
ration is small ; that their temperature rises and falls with that of the surrounding 
medium, and rarely exceeds it more than a few degrees in their most active con- 
dition ; w^hile in fishes, Crustacea, mollusca, annelida, and all the more imperfect 
animals that live in water, and breathe by means of branchias or gills, it is still 
less. 

^- It w^as discovered by Lavoisier, more than fifty years ago, that two sparrows . 
confined in a vessel of air, generated more carbonic acid in a given time than a 
youniz guinea pig under the same circumstances. And it has been recently esti- 
mated by Treviranus, from the experiments of different physiologists, that for 



1846.] Metcalfe on Caloric, 143 

every 100 grains weight of birds, they generate in 100 minutes nearly twice as 
much carbonic acid as mammaUa, and the latter above eight times more than the 
frog." 

Corresponding with the facts exhibited in the tables, which are present- 
ed by Dr. Metcalfe, the whole organization of birds, he remarks, is more 
highly developed, and their difTerent functions are performed Avith greater 
rapidity than in mammaha. 

'^ The stomach is more concentrated, digestion more vigorous, the heart larger 
in proportion to their weight, its walls thicker, and its pulsations more frequent. — 
Their blood is more highly organized, or richer in fibrin and red particles, their 
secretions more copious, and the renewal of their composition by nutrition more 
rapid. Their bones are harder, their muscles more firm, and their vital power of 
contraction greater, as shown by the activity of all their movements, and the im- 
mense velocity with which many of them glide through the pathless air, in oppo- 
sition to the force of gravity. For it is well known that the hawk and eagle are 
capable of flying forty-five miles per hour, the carrier pigeon from fifty to sixty, 
and a species of the swallow termed the swift at the rate of ninety miles per hoar 
— which, if continued for twelve hours, would make 1,080 miles a day." 

Dr. Metcalfe examines next the several orders and species of mammalia, 
and shows that those in which the organs of respiration are most fully de- 
veloped, possess always the highest degrees of vital energy. For exam- 
ple, he remarks, the chest of the dog, wolf, fox, goat, deer, horse, ox, sheep, 
hare, rabbit, and some other species of quadrupeds, is larger, in proportion 
to the size of the body, than that of man, and their temperature several de- 
grees higher. The consequence of which is, that they are capable of 
resisting much greater degrees of cold, and of enduring muscular exertion 
for a much longer time, without exhaustion. 

" The thorax is larger in men than in women, its mean circumference being 
about thirty-six inches in the former, and thirty-two in the latter. It is, there- 
fore, not surprising that the blood of men is more highly organized, their muscles 
more fully developed, their brains from four to eight ounces larger, (as shown by 
Tiedemann,) with a corresponding superiority of muscular and intellectual power. 
Nor was there ever an individual of great vital energy, whether of brain, stomach 
or muscles, without large and sound lungs, which are essential to the sanguine 
and heroic temperament. The muscular and intellectual powers of small men 
with large and sound lungs, are greater than in large men W'ith narrow chests^ 
who naturally belong to the phlegmatic temperament." 

Descending through the scale of beings to the lowest. Dr. Metcalfe 
shows that the same general law obtains — that their aggregate vital ener- 
gies, the temperature of their bodies, and their intelligence are always in 
direct proportion to the extent of their respiratory functions, and the amount 
of oxygen they consume, and of carbonic acid they generate. Thus by 
means of stigmata or holes, arranged along their bodies, and minute vesi- 
cles for conveying air throughout the system, the active insects are more 
fully suppUed with organs of respiration than any other description of ani- 
mals, not excepting birds. 

" As an example of the large amount of oxygen they consume, Spallanzani 
found that a caterpillar generated more carbonic acid in a given time than a frog^ 
and butterflies still more. We learn, also, from the experiments of Mr. Newport, 
recorded in the Philosophical Transactions for 1836-7, that wasps, hornets, bee- 
tles, moths, and some other insects, have a much higher temperature than that of 
the surrounding air, and that it is always in proportion to the quantity of oxygen 
they consume by respiration, which is always augmented by exertion, and dimi- 
nished by repose." 

The author proceeds next, by a somewhat abrupt transition, to consider 



144 Review. [Jan. 

the primary seat of vital energy — which he maintains to be the arterial 
blood — the vitality of which, and its capability of imparting vital energy 
to every portion of the organism, are dependent upon the caloric which it 
receives in its passage through the lungs. 

After a brief review of the various hypotheses which have been advanced 
to account for the functions and phenomena of life, Dr. Metcalfe contends 
that the vitality of the system is independent of the organs the actions of 
which it excites ; and consequently, that the phenomena of hfe, properly 
speaking, are not produced by the agency of the nervous system. He 
contends — 

'• 1. That contractility is a property of all living matter, including every de- 
scription of plants, and even the medullary tissue ; for the brain undergoes con- 
traction and expansion during violent emotions, or active thinking. 2. That all 
the operations of life, whether voluntary or involuntary, are organic. 3. That 
among all the lower orders of animals which have neither brain nor spinal mar- 
row, but only ganghonic nerves, and some of them only a single cord extending 
alonii; the body, as in the earth worm, there is not a single species destitute of 
sensibihty, consciousness, and volition, for the low^est worm seeks nourishmicnt, 
and recoils from the approach of harm : while the more active insects are en- 
dowed with far higher degrees of intelligence than many animals which have a 
brain and spinal marrow — with emotions of love, anger, fear^ and, perhaps^ to a 
certain extent, the sentiments of justice and benevolence." 

Dr. Metcalfe conceives it to be shown, by an appeal to comparative 
physiology, that the office of the ganglionic nerves is identical with that of 
the brain, spinal marrow, and their nerves. 

•^^The truth is," he remarks, '■^ that the brain may be regarded as a large gan- 
glion, or concentration of nervous matter, of which the spinal marrow is a mere 
continuation, and the nerves of both, as expanded branches, with which the gan- 
glions in the higher animals are connected; and the object of which is to endow 
the involuntary organs with so much sensibility as may be requisite to their well 
being. But as the heart, stomach, and all secretory organs, are excited to action 
by the stimulus of blood, there is no necessity for their being subject to the com- 
mands of the sensorium commune^ like the locomotive muscles^ or even the sphinc- 
ters of the bladder and rectum." 

This view of the nervous system will probably be found to be the cor- 
rect one. The idea of the functions of organic life being produced, go- 
verned, and modified, by the action of a special set of nerves, notwithstand- 
ing it is the one generally adopted by physiologists, is encompassed by so 
many difficulties, and apparently contradicted by so many of the pheno- 
mena that occur during the healthy and diseased conditions of the organism, 
that we are surprised so few before now have doubted its accuracy. 

•' The fundamental error," remarks our author, " of regarding the brain or any 
part of the nervous system, as the source of vital energy, will appear evident from 
the following undeniable facts: — 1. That life exists throughout the vegetable 
world, and in many species of the lower animals termed zoophytes, polypi, en- 
tozoa, &c., in none of which has the slightest trace of nervous matter ever been 
discovered ; consequently, that all those physiologists who have regarded nervous 
influence as the source of vital energy, have vainly endeavoured to explain a uni- 
versal by a partial fact : 2. That the germs of all the higher animals are developed 
and endowed with vitality, before any part of the nervous system — consequently, 
that the latter must be a secondary effect or product of the organizing principle: — 
3. That the aggregate vital energy of animals is directly in proportion to the quan- 
tity of their respiration, or of caloric that passes through their tissues, and bears 
no uniform relation to the development of the brain and nerves : — 4. That the 
}iervous system, like all the other organs, is formed from, and vitalized by the 
blood, which is formed in the lungs by the same active principle that causes the 



1846.] Metcalfe on Caloric. 145 

seeds of plants to germinate, and the germs of animals to unfold^ from a simple 
albuminous mass into highly organized bodies.'^ 

By reference to comparative physiology, Dr. Metcalfe proves that the 
muscular strength and locomotive power of animals are not in any propor- 
tion to the development of the nervous system : and he believes himself 
authorized to conclude, that while the intelligence of animals is directly in 
proportion to the development of their nervous system, cseteris paribus^ 
their powers of digestion, circulation, secretion, nutrition, absorption, 
muscular motion, and cerebration, depend on the amount of caloric they 
derive from the atmosphere by respiration. 

"The specific office of the brain, spinal marrow, and their nerves, including 
those of the ganglionic system, is to endow animals with sensation, perception, 
memory, volition, instinct, and all the attributes of mind;— tp direct the various 
movements of the body, but not to supply the moving power — to generate idcas^ 
but not organic products. It is very true, that the nervous system is far more 
highly developed in warm than in cold-blooded animals, but we shall see pre- 
Sv^ntly, that this is owing to the greater activity of nutrition in the former. It is 
also very true, that when the nerves going to a voluntary muscle are irritated, 
contractions are produced, and that, when divided, it can no longer contract in 
obedience to the commands of the will. But if the locomotive organs be not 
supphed with arterial blood, they become cold, insensible, and paralytic, what- 
ever the condition of the brain may be. And if the blood be not continually sup- 
plied with caloric by respiration, it cannot excite the brain to think and will, the 
nerves to feel, the muscles to contract, and the glands to secrete. 

" It is because the voluntary muscles are more abundantly supplied with nerves 
than the heart, stomach, liver, bowels, &c., that they are enabled to obey the 
mandates of the brain. But it has often been asked, what is the use of nerves in 
parts not subject to the wiin I answer, that without nerves in the stomach, we 
could not be informed, by the sense of hunger, when and how much nourishment 
to take — that without nerves, the heart, liver, bowels^ and other viscera, could 
not warn us of approaching disease by the sensation of pain, nor direct in the 
employment of suitable remedies. Through the agency of nerves distributed to 
the lungs, we ai'e enabled to regulate the process of breathing, and thus to obtain 
the principle of life from the atmosphere. To this act the infant is first prom.pted 
by the painful sensation of a pressing vital want, which forces the little being to 
utter a cry, when the lungs expand for the reception of air, and all his embryo 
faculties are exalted. This half unconscious feeling continues to operate through- 
out the remainder of existence, and when all the outward senses are steeped in 
oblivion ; for, ^ not even in sleep is will resigned,' as proved by the fact, that respi- 
ration slill goes on, though somevi'hat diminished; while all the higher functions 
of the brain are suspended. Hence it is, that when the vagus or eighth pair of 
nerves is divided, the process of breathing is diminished, the temperature of the 
body reduced, sanguification, secretion, nutrition, &c., impaired — or even v/hoUy 
suspended by destruction of the brain and spinal marrow — simply because respi- 
ration is a voluntary process, and the primary function of life, on which all the others 
depend. Division of the nerves going to the stomach, pancreas, kidneys, and 
other glands, does not prevent them from secreting their respective fluids'; but if 
cut off from the supply of living blood by dividing or t3'ing their arteries, the 
powers of secretion, nutrition, seiisation and motion are wholly suspended. 

'- The sensorium may be compared to the commander of an army, whose office 
is to direct its movements, but the moving power resides in the army and not in 
the general. The external senses may also be compared to the sentinels which 
give information of what is going on, while the nerves operate as messengers 
that convey orders from the chief to the ranks, and bring back information in 
regard to their condition. So long as the commander fuKiis his duty, the evolu- 
tions of the army are performed with order and intelligence, but should he be 
slain or wounded, and his place not taken by another chief — or should his means 
of communication with his subordinate ofhcers be cut off, the operations of the 
army become irregular^ confused, and inefficient, because no longer guided by 



146 Review. [Jan. 

superior intelligence. In like manner, where the sentient power of the brain has 
become destroyed by suffocation, strangulation, or a violent concussion, the loco- 
motive muscles contract spasmodically, because no longer directed by the organ 
of thought. 

" So far is the brain from being the source of moving power in the animal eco- 
nomy, that arterial blood is more essential to its vitality than to any of the other 
organs ; for if the carotid and vertebral arteries be divided or tied, it dies almost 
immediately — and long before the heart and other muscles cease to contract. — 
The reason of which is that the brain is supplied with five or six times more 
blood in proportion to its magnitude than the general system — corresponding with 
its exalted vitality, and the important office it has to perform as the organ of mind, 
by Avhich we are enabled to hold communion with the external world, and to en- 
joy whatever is beautiful or excellent in the universe. For the same reason 
birds die much sooner after decapitation or the privation of oxygen than mamma- 
lia, and the latter than cold-blooded animals. In other words, it is because arterial 
])lood is more essential to the vitality of the brain than to any of the other organs, 
that it dies in a few moments when deprived of that fluid, or when the latter is 
]io longer arterialized by respiration ; whereas the contractile power of the 
muscles remains for a long time, and is not wholly extinguished until the body 
becomes cold, as shown by the rigidity or stiffening that takes place after death. 

•■ This brings us to one of the most important laws of the animal economy, 
which, when fully understood, will unfold the rationale of spasmodic diseases, and 
lead to the true method of curing, or rather of preventing them — viz., that the 
tJiiratio'n of life in any part of the body, when deprived of arterial blood, is inversely as 
Ike quant'ity of blood reipdred to maintain its activity. The consequence of this law 
is, that whenever the chemical function of the lungs is diminished, and the vital 
properties of the blooJ are impaired, the voluntary power of the brain ceases to 
operate some time before the moving power of the muscles, which contract with- 
o\\{ its orders, and, therefore, in a convulsive manner. The more suddenly the 
power of the brain is arrested, the more decided and energetic is the spasmodic 
action, vrhich ahvays follows decapitation, excessive and rapid hemorrhage, stran- 
gulation, the action of hydrocyanic acid, and other narcotic poisons, the inhala- 
non of mephitic gases, and whatever prevents the arterialization of the blood. It 
is therefore manifest, that convulsions are owing chiefly to diminished power of 
the brain, (which cannot direct the locomotive organs with intelligence, unless 
supplied with good arterial blood,) and not to the • influx of a nervous fluid into 
the muscle?,' as supposed by Boerhaave — nor to ' a preternatural energy of the 
cerebral functions,' as maintained by Bichat — nor to some peculiar condition of 
the ganglionic nerves, as imagined by others." 

We present the foregoing long extract from this portion of Dr. Metcalfe's 
treatise, as it affords a very full exposition, in his own words, of his lead- 
ing views of the nature as well as of the exciting and controlling causes of 
the living functions of the animal organism, and of the pathology of a very 
important class of diseases, the spasmodic. The true theory of these must, 
he maintains, be sought in a vitiated condition of the blood, or some de- 
ranged condition of the system, by which the brain and nerves are pre- 
vented from guiding and restraining the actions of the voluntary muscles, 
— as in the convulsions of hysteria, the contractions of chorea, the more 
obstinate spasms of tetanus, hydrophobia, epilepsy, and cholera, — or the 
cramps that often follow immersion in cold water, and the universal tre- 
mors wdiich attend the cold stage of fever. 

That convulsions depend upon a loss of the direction and control of the 
brain over the muscles is very evident, and in ah probability the loss of the 
directing and controlling power may depend in many cases upon diminished 
jDOwer of the brain, the result of a diminished supply of vitalized blood — but 
we know that this is not their only cause ; for in not a few cases, violent con- 
vulsive action of the muscles is dependent upon direct irritation of either 
the central or peripheral portion of a nerve or set of nerves — which is 



1846.] ■ Meicelfe on Caloric. 147 

proved by our having it in our power to remove the irritating cause, and' 
to obtain by this means an almost immediate cessation of the convulsions. 

From all the facts and arguments adduced, Dr. Metcalfe considers that 
the conclusion forced upon the common sense of every unbiased mind, is, 
that caloric is not only the cause of all excitement, but directly or indirectly 
of excitability also — that it is not only the most potent and universal stimu- 
lant in nature, but the cause of stimulability. The source of vitality, ac- 
cording to oar author, enters the system through the lungs, and in connec- 
tion with the arterial blood, is distributed to every portion of the organism 
in quantities proportionate to the wants of each, and in this manner is 
brought in contact with all the different tissues and organs, exciting them 
to action while it imparts to them the power to act. 

The cause of the blood's motion through the capillaries remains a vexed 
question with physiologists — some ascribing it to the action of the heart 
alone, and others, to an independent contractile power of the capillary ves- 
sels. That the action of the heart is unnecessary to effect the circulation 
through the capillaries. Dr. Metcalfe believes to be proved by the follow- 
ing facts. 

'■^ 1. Because the circulation of sap in plants, and of blood through many of the 
lower animals which have no heart, is active during summer, checked by cold 
nights, and wholly arrested during winter. 2. Because the circulation of chyle 
through the lacteals, and of lymph through the absorbents, is obviously independ- 
ent of the heart's action, and, hke that of the blood, is in proportion to ihe healthy 
temperature of animals — being more rapid in birds than in mammalia, languid in 
cold-blooded animals, and suspended in all by intense cold, or by arresting the 
supply of caloric by respiration. 3. Because, after decapitation and removal of the 
heart from rabbits, or placing a ligature around the aorta, the blood has been seen, 
with a good microscope, to move with considerable velocity through the capillaries 
of the mesentery for thirty-five minutes, and in one case for an hour and a quarter, 
as proved by the experiments of Dr. Philip. 4. Because, in many cases after 
death and apparent cessation of the heart's action, the large arteries have been 
found empty, all their blood having been conveyed to the veins by capillary attrac- 
tion; and 5. Because, after the amputation of a limb and the stoppage of its capil- 
lary circulation, the motion, of its blood may be restored and carried on with con- 
siderable activity. for fifteen minutes, by the application of heat, as proved by the 
experiments of M. Guillot. {Journ. de Physiol, t. xi. p. 170.) " 

It is the same capillary attraction which causes fluids to ascend into dead 
tubes of small calibre by which, according to our author, the blood is caused 
to pass through the minute capillary vessels in the living body ; and to the 
objection that the fluids drawn up by small tubes of glass and other dead 
matter are not expelled from their upper orifices, while, when the minute 
blood and sap vessels are divided daring their hving state, blood and sap 
continue to flow from them, he rephes, that the force of capillary attrac- 
tions, cxteris paribus, is always inversely as the diameter of the tubes, 
which are much smaller in plants and animals than any employed in our 
experiments. 

^ ^' Hence the great force with which the sap issues from the stump of a cut grape 
vine, as shou^n by the experiments of Mirbel, who found it equal to the pressure 
of thirty-four inches of mercury; and such is the vis-a-tergo generated by the 
capillary circulation of chyle and lymph through the absorbents, that when the 
thoracic duct of a dog is secured with a ligature below the subclavian vein, it has 
been known to burst from the pressure. In all such cases the vis-a-tergo is gene- 
rated by virtue of an attraction between fluids and their containing vessels — the 
former being plus and the latter minus. The organic particles of blood are forced 
through the pores of the systemic capillaries, andcombined with the several tissues 
by virtue of the same attraction; and it has been found that the worn-out particles 



148 Review, [Jan. 

of the solids are not taken up b}'- the months of the lymphatics only, but are ab- 
sorbed by the pores of their coats ; and finally, that neither in plants nor animals 
is any contraction of their capillaries essential to their circulation." 

The ensuing chapter treats of the agency of caloric in the functions of 
digestion, sanguification, coagulation, secretion, nutrition, muscular motion, 
and sensation. We regret that the length to which we ha\^e already extended 
this notice, will prevent us from noticing the very ingenious views of the 
author on these important points. He has very fully established the im- 
portance of caloric to the regular, vigorous, and perfect performance of all 
the functions enumerated. His peculiar views will be in some measure 
understood by recollecting that all those offices or results which are ascribed 
to what has been termed the vitality of the organs, or the vital force or 
energy of the system, Dr. Metcalfe refers to the agency of caloric. 

The leading facts connected with the theory of the coagulation of the 
blood are thus stated by our author : 

'^ 1. That the coatractile power of the blood when removed from the body, like 
that of the muscular fibres, is in proportion to the quantity of respiration, mean 
healthy temperature, and aggregate vital energy in the different orders of animals; 
being greater in birds than in mammalia^ and greater in the latter than in reptiles 
and fishes. 

" 2. That as the temperature of arterial is higher than that of venous blood, so 
does the former coagulate more quickly and firmly than the latter. 

^' 3. That as the vital energy of animals is always diminished by reducing their 
temperature below the natural standard, so is the coagulation of the blood retarded 
by the same means, and wholly prevented by long-continued cold. 

'•4. That the blood of individuals belonging to the sanguine or dynamic tem- 
perament, coagulates sooner and more firmly than in such as are of a weak or 
phlegmatic constitution; while its contractile power is diminished by whatever 
impedes the function of respiration, as in phthisis, asthma, disease of the heart, 
the cold stage of fever, and all maladies of long standing, by which the powers 
of life are greatly reduced." 

Dr. Metcalfe remarks that the temperature, vital activity, and renovation 
of all the organs, are constantly maintained at the expense of arterial blood 
during its conversion, while it passes through the systemic capillaries into 
the venous state — the temperature of the blood being at the same time 
reduced, the number of its organic particles diminished, and its power of 
sustaining the healthy state of the different functions greatly impaired, 
when it is returned to the lungs for a fresh supply of organic particles, and 
of living fire. 

'•'■ If, he adds, the temperature of the blood were not raised above that of the 
solids while passing through the lungs, there could be no transition of caloric from 
one to the other — no combination of its proximate constituents with the membra- 
nous, bony, muscular, and nervous tissues. Nor could chyle and venous blood 
be converted into the arterial state, without giving off carbon and hydrogen in the 
lungs, by which caloric is evolved, and the temperature of the blood elevated, 
and its composition renewed." 

^•The principal mystery connected with the process of nutrition, is the law of 
elective affinity by which the proximate constituents of the blood unite v»-ith 
their respective tissues. This much, however, is cerlain, that if the temperature 
of the blood be not raised above that of the solids, there could be no transition of 
caloric from one to the other, — no combination of fibrin with the muscles. — of 
albumen, oily, phosphuretted, and other matter, with the brain and nerves, — of 
albumen with the membranes, ligaments, and cartilages, — nor of lime with the 
bony textures. The proof of which is, that after the temperature of arterial blood 
has been reduced to an equilibrium with the solids, and its properties changed to 
the venous state, it fails to nourish the brain, nerves, muscles, and other tissues, — 
to maintain their temperature, and specific modes of action, and to elaborate the 



1846.] Metcalfe on Caloric. 149 

various secretions. The inference is therefore obvious, that animal heat is the 
agent by which these vital affinities are produced, and the activity of the various 
tissues maintained." 

Dr. Metcalfe conceives that it is proved by the following undeniable facts, 
that animal heat is the cause, and not the effect of secretion, as maintained 
by Philip and many others. 

" 1. The secretion of perspiration is much more copious during summer than 
winter, and in tropical than in the higher latitudes; while it is known to be greatly 
augmented by the high artificial temperature of glass works, founderies, &c. 
Sweating is also the natural termination of the hot stage of fever. 2. In cov.'s, 
goats, and other domestic animals, the secretion of milk is more abundant during 
summer than winter, especially ia cold climates, and the growth of all young ani- 
mals is greatly retarded by cold weather, unless they be protected by suitable 
shelter. 3. The menstrual secretion, like that of the skin, is checked by exposure 
to cold damp air, getting the feet wet, by wearing too thni garments, and by what- 
ever causes the abstraction of vital heat from the system more rapidly than it is 
obtained by respiration; or whenever the latter process is diminished by the de- 
pressing emotions of grief, fear, and anxiety, which are attended with cold extremi- 
ties, languid circulation, and a general loss of vital energy. 4. As the quantity of 
secretion throughout the vegetable world is always in proportion to the heating 
influence of the sun, and wholly arrested during winter — so are all the secretions 
of animals, during health, in proportion to the amount of caloric they derive from 
the atmosphere by respiration, and wholly arrested or greatly diminished, v/heii- 
ever the temperature of the body is reduced much below the normal standard by 
immersion in cold water, or during the cold stage of fever, cholera, &c. 5. If the 
temperature of blood be not raised above that of the solids, it cannot excite the 
stomach to secrete gastric juice, nor any of the other glands their respective fluids." 

According to Dr. Metcalfe, the science of human physiology, when 
stripped of all hypotheses, and reduced to its utmost simphfication, may be 
embraced within a very small compass ; namely, that a difference between 
the temperature of arterial blood and that of the solids is absolutely essen- 
tial to all the phenomena of life— that the transformation of blood into the 
different organs depends on the same attraction of fluids for solids that 
determines the growth of vegetables, and the capillary circulation in ani- 
mals that have no heart, like that of the lacteal and lymphatic absorbents. 

" As it is a universal law of nature, that the cause of force is always expended 
in producing motion, the caloric which is employed in uniting the proximate con- 
stituents of the blood with the different organs, and in maintaining their healthy 
activity, is carried off and removed from the system, with a rapidity correspond- 
ing with the energy of the brain, muscles, stomach, &c., until the vital affmities 
by which the molecules of arterial blood are transferred to, and kept in a state of 
combination with the solids, is gradually diminished, and finally dissolved— when, 
having performed the office of renewing the structure and vitality of the different 
tissues, they successively fall from their places, and are taken up by the lymphatic 
absorbents, which convey them into the general circulation as worn-out materials, 
to be again renovated in the lungs, and finally removed from the system by the 
several emunctories ; while their places are immediately taken up by fresh organic 
particles that are continually supplied from the living fountain of arterial blood. 
Thus we perceive, that the vital energy of the brain, nerves, stomach, muscles, 
and all other parts of the body, is maintained by the successive additions of new 
matter, which no sooner unites with the different tissues, than it begins to die; — ■ 
that when the caloric by which the particles of arterial blood are united with the 
solids, is expended by their action, their vital attraction begins to diminish ; that no 
healthy individual preserves his absolute identity for a single moment; that every 
part of the body is in a state of perpetual motion, and transition from life to death, of 
organization and disorganization, renovation and dissolution; that M'lienever the 
worn-out particles are not replaced by new and living ones, emaciation ensuesj 



150 Review. [Jan. 

and all the powers of life decay — in short, that whenever the process of nutrition 
is arrested, death speedily closes the scene. 

'■'■ It has been repeated a hundred times by different physiologists, that the affini- 
ties of life are superior to those of dead matter. That this is actually the case, 
■would appear from the rapidity with which birds and mammalia convert the con- 
stituents of dead matter into blood and their respective tissues; and from the fact, 
that a strong man has been known to lift about len times his own weight from the- 
ground, in opposition to tire force of gravity — while the cohesion or contractility of 
a living muscle is about ten times that of a dead one, ccetcns paribus. But, adds 
our author, I have shown that this power depends on the rapidity with which the 
composition of the part is renewed by fresh arterial blood, and is' in proportion to 
the amount of caloric that passes through it from the lungs in a given time. For 
example, it is because more caloric is received from the atmosphere, and more 
blood generated in the lungs of warm than of cold-blooded animals, that the com- 
position of the former is renewed more rapidly, their organization more highly 
developed, their powers of resisting the ordinary forces of chemistry much greater; 
and it is because the nutritive process is more rapid in birds than in mammalia, 
that the muscular power of the former so greatly exceeds that of the latter. 

"So long as any part of the body is supplied with good arterial blood, and with 
a copious How of animal heat, by which its particles are united with the solids and 
kept in a state of perpetual motion, chemical decomposition i^ prevented. But 
whenever the process of nutrition is greatly diminished, as in scurvy, typhus, yel- 
low fever, and other malignant diseases termed putrid, chemical action commences 
even before the entire extinction of vitality." 

Dr. Metcalfe maintains that the proximate cause of all diseases — from 
the simplest state of inflammation to general fever, consumption, dropsy, 
tetanus, and other spasmodic affections — is to be sought in the theory of 
nutrition. 

" For, he remarks, if the blood be the fountain of life, from which all the organs 
are immediately formed, it follows, that whatever impairs its naiural properties, 
must derange the nutritive process by which the healthy condition of the body is 
maintained. Nor is it possible that disease of the stomach, brain, or any other 
organ could exist for any length of time, while supplied with an abundance of 
good arterial blood ; for if the latter be sound and healthy, so must be its products. 
But if its natural condition be so far deranged, that its power of uniting with the 
Bolids, and of maintaining the various secretions, is seriously diminished, a por- 
tion of the caloric obtained by respiration, that is transferred to the solids during 
health, and expended in carrying on the various functions, is given out in the 
free state, or rather accumulates in the blood, causing a preternatural elevation of 
temperature, and loss of power in the general system. In other words, so long 
as the balmy vital warmth received in the lungs, is employed in combining the 
proximate constituents of blood with the solids, and in elaborating the various 
secretions, the temperature of the body remains at the natural standard ; all the 
functions are perfonned with heahhful regularity, and there is no preternatural or 
morbid accumulation of heat. Here, then, is a key to the whole theory of fever, 
which depends essentially on a diminution and derangement of the formative 
process, as shown by the rapid emaciation that takes place during its progress, 
and which always terminates on the restoration of secretion and nutrition." 

The next chapter, which is the first of the Fifth Book, treats of the influ- 
ence of climate and season on the physical, intellectual, and moral cha- 
racter of the human race, as shown by the difference of stature, magnitude 
of the chest, configuration of the brain, complexion, &c., among the various 
nations of the earth. 

This is truly an interesting chapter — embracing questions upon which, 
so far as they have received the attention of physiologists, the most oppo- 
site views have been advanced. The object of the author is to demon- 
strate, from the well-established influence exercised by season and climate, 
upon the human organism especially, the agency of caloric in imparting 



1846.] , Metcalfe on Caloric. 151 

vigour, activity, due development, health, and intellectual activity to man. 
The subject is discussed with great ability, most of the views advanced by 
the author are just and philosophical, and deserving of the closest attention. 
All indeed that he has written upon the subject is replete with good sense, 
and though we may not always be prepared to accede to the correctness of 
his conclusions, the mass of facts and illustrations by which his views are 
explained and enforced is interesting and instructive. His observations 
in relation to the influence of climate on the duration of human life, on the 
mortality of town and country, the influence of season upon health, and on 
the fecundity in different chmates, are especially sound, being founded, in 
general, upon a very accurate and extensive series of observations, while 
their practical application is in no degree impaired by their being connected 
with his pecuHar views in relation to the agency of caloric as the origina- 
tor and constant supporter of all the phenomena of the living animal system. 
But we must pass them over without further notice. 

The succeeding chapter on the influence of cHmate and season in modi- 
fying the diseases of mankind is also replete with ingenious and interest- 
ing observations. To understand clearly the views of Dr. Metcalfe on the 
manner in which climate and season produce a modification in the charac- 
ter and progress of disease, requires that the whole chapter should be care- 
fully read. A brief analysis of it would not convey to our readers a cor- 
rect idea of the manner in which the subject is treated. 

In the chapter which follows, in which the agency of external tempera- 
ture in producing hybernation and suspended animation is considered, facta 
are adduced to sliow that the duration of life in animals after respiration 
has ceased, is inversely as the quantity of their hfe, and the general ac- 
tivity of their functions. But the most important part of the chapter is 
that which relates to the philosophy of bathing, the modus operandi of the 
warm and cold bath, and the circumstances under which the one or the other 
becomes proper. The views of the author on this important subject are per- 
fectly sound, and if they were more generally understood by the public, 
and by the medical profession, they would be calculated to do away with 
many absurd practices from which not a little mischief has resulted. 

^'It is a matter of the highest practical importance, observes Dr. M., to compre- 
hend distinctly why it is that the cold bath is invigorating, and in what states of 
tlie system it is indicated. We are told by medical writers that it operates by 
prodacing reaction. But they seem to have overlooked the fact, that in modera- 
tion, cold augments the process of respiration, on which reaction entirely depends, 
as proved by the pleasurable glow of warmth that pervades the system shortly 
after leaving the cold bath. The consequence of which is, that a greater amount 
of caloric passes through the body in a given time, and all the functions of hfe are 
proportionally invigorated, for the same reason that they are more active during 
winter than summer, and more so in temperate than in hot climates. I have also 
shown, that besides the influence of cold in augmenting respiration, it has the 
immediate effect of increasing the nutritive process, especially during very warm 
weather, or whenever the temperature of the solids is raised nearlylo an equili- 
brium with that of the arterial blood. Hence the importance of cold applications 
to the head and general system during fever, when the nutritive process is greatly 
diminished. It must not, however, be forgotten that among young children, the 
aged, and all persons of delicate and feeble constitutions, the mortality is much 
greater in temperate climates during winter than summer — by which we are in- 
structed to observe great caution in the employmentof the cold bath in such cases. 
I have had repeated proofs that the temperature of strong and active young men 
is reduced from 3° to 4° in about ten minutes, by bathing in the sea during sum- 
mer, when the water was at 62°, and that when continued for fifteen or twenty 
minutes^ it caused shivering, blueness of the surface^ small and feeble pulse, great 



152 Review. • [Jan. 

reduction of strength, headache, nausea, and even vomitmg in one case. What 
then must be the effect of sea-bathing on delicate females with a languid circula- 
tion, cold extremities, and torpor of the general system, but an aggravation of the 
symptoms'? And what can be the general effect of the cold bath on very young 
children^ but to augment the bills of mortality 1'^ 

The first chapter of Book VI, treats of air and exercise — we dare not 
pause to notice the interesting matter it contains, lest we prolong this re- 
view by too copious extracts — which we have been tempted to commit 
already to a perhaps unpardonable extent. 

The ensuing chapter on ahments contains much curious and interesting 
speculations, and a vast amount of statistical matter.' — The opinions of 
Liebig are very freely canvassed, and many of his errors and inconsisten- 
cies pointed out — we can afford room only for the recapitulation of the 
cardinal facts embraced in the chapter — 'Which the author has reduced to 
the following general propositions : — 

^' 1. That each zone affords in the greatest abundance those descriptions of ali- 
ments best suited to maintain the well being of its inhabitants. 

" 2, That excessively cold climates abound with animals which contain a large 
amount of oil and fat, that are rich in carbon and hydrogen^ which afford an abun- 
dant supply of animal heat where it is most required. 

" 3, That the middle latitudes abound with grass, grain, and domestic animals, 
which are less numerous, and contain a much smaller proportion of fat in hot 
climates, where there is an inexhaustless profusion of saccharine fruits, gum, and 
farinaceous aliments, that afford less carbon and hydrogen^ therefore^ less caloric 
by respiration, than animal food. 

^^4. That the various species of grain afford a much larger amount of actual 
nourishment, than an equal w^eight of animal food, if we except cheese, butter, 
fat, and lean meat deprived of water. 

" 5. That during the process of respiration, starch, sugar, gum and fat, are con- 
verted into blood, by absorbing nitrogen from the air, and by giving off carbon 
and hydrogen ; consequently, that the elements of respiration, when combined in 
due proportion, are employed in nourishing the solids, like the fibrin, albumen, 
and casein, of both animal and vegetable food. 

'■^ 6. That as the chemical composition of all animals is the same, herbivora 
must derive a portion of their nitrogen from the atmosphere, because their food 
does not contain enough of that element to maintain their nutrition and growth, 
w^iich are even more rapid than in carnivora. 

'^7. That the living body is a self-repairing machine, which has the power of 
transforming both ternary and quarternary compounds into its own tissues; and 
when wholly deprived of food, is capable of living many days on its own ruins, 
Vv^hich are repeatedly renovated in the lungs, where they are also gradually con- 
verted into carbonic acid, water, and other inorganic compounds. 

•' 8. That the rapid increase in the weight of the body after long abstinence or 
illness, the speedy healing of broken bones, the filling up of ulcers, and the rapid 
growth of herbivorous animals, all tend to prove, that the nitrogenized portions 
alone of vegetable food are insufficient to account for the renovation of their com- 
position, and the supply of waste. 

^^ 9. That a suitable variety of vegetable aliment is better adapted to the organi- 
zation, health, strength, intelligence, and moral excellence of the human race, 
than a diet of animal food alone. 

"10. That although spirits, wine, and malt liquors, when taken in moderation, 
elevate the temperature of the body, augment the circulation, produce a tempo- 
rary flow of spirits, remove the sensation of hunger, fatigue, and other disagree- 
able feelings — they impair the vital properties of the blood, and diminish its co- 
agulating power, when used to excess — derange the nutritive process, cause a 
dropsical or phlegmatic condition of the solids, and gradually destroy the vis 
medicatrix naturcE, as shown by the slowneSs with which wounds and ulcers heal 
in intemperate drinkers.'' 



1846.] Metcalfe on Caloric. 153 

Next follows a very admirable chapter on sleep — in which the author 
endeavours to show, that the proximate cause of sleep is an expenditure 
of the substance and vital energy of the brain, nerves, and voluntary mus- 
cles, beyond what they receive when awake — and that the specific office 
of sleep, is the restoration of what has been wasted by exercise. The 
most remarkable difference between exercise and sleep is, according to 
Dr. M., that during the former the expenditure of the organic particles 
and vital energy of the organism exceeds the income ; whereas during 
sleep, the income exceeds the expenditure. 

Some interesting and ingenious observations follow on the influence of the 
mind on health and disease — with an explanation of the rationale of sea-sick- 
ness, trance, mesmerism, &c. The author's remarks, in relation to the lat- 
ter, are a^ follow : — 

^' 111 those cases of partially suspended animation, termed trance, which occur 
chiefly in persons of weak or disordered m.inds, especially females of irritable 
constitution, the brain is paralyzed by over excitement of the nervous system, 
caused by religious emotions of ecstasy, fear, &c. Respiration is so far arrested^ 
that the temperature of the patient has been known to fall 20° or 30° below the 
natural standard, when the action of the heart becomes almost extinguished, the 
surface pale, and the individual exhibits scarcely any appearance of life. In 
many respects, the phenomena resemble the eflects produced by the influence of 
what has been termed animal magnetism. After mesmerizing about one hun- 
dred persons of different classes of both sexes. Dr. Sigmond states, that he 
found females much more easily affected by his manipulations than males ; that 
in some they brought on sleep or stupor — in others fainting, hysteria, convulsions, 
and even trance ; — that respiration became imperceptible, the pulse feeble, the extre- 
mities cold, and the features pallid ; — that in the case of a lady in Fitzroy Square, 
it induced all the symptoms of suspended animation, "which lasted four hours. — 
{Lancet, Dec. 9, 1837.) 

"The function of respiration is diminished by swinging, whirling round, or 
riding backwards in a carriage, which interferes with the voluntary power of the 
brain, causing giddiness, weakness, nausea, and sometimes fainting. Nor is it 
more strange that the passes of the animal magnetist should induce sleep, faint- 
ing and catalepsy, than that the rocking of a cradle should put children to 
sleep. Dr. Wollaston informs us, that while at sea, he caught himself holding 
his breath, as if waiting till the lurch of the vessel was over. And he very justly 
referred to the languid action of his pulse, the great prostration of strength, together 
with the nausea and vomiting, to the influence of the ship's motion on the function 
of respiration." 

The section next in order treats of the modus operandi of medicinal 
agents. This is the weakest and most exceptionable part of the whole 
work. The views of the author are partial and one sided, while in their 
apphcation, they are adverse to the united experience of the whole medi- 
cal profession. Built upon truths illogicafly applied, and a few imperfect 
and deceptive experiments, were they to be received, they would unsettle 
the best established principles of therapeutics, and blot from the lists of the 
materia medica nearly all those remedies upon which alone we can rely 
for the removal of acute diseases. 

The whole class of narcotics, according to Dr. M., operate upon the 
brain and nervous system by entering the circulation, and by becoming 
mixed with the blood, they impair its healthy condition. It is therefore 
evident, he remarks, that if, in small doses, they afleviate pain, it is owing 
chiefly to their influence in diminishing sensibility, by impairing the vital 
properties of the blood; that if hydrocyanic acid relieves pain in the sto- 
mach, it is by inducing torpor of that important organ, and so of all the 
other narcotics. 



154 Review, [Jan. 

The operation of emetics, we are told, is attended with all the leading 
symptoms of intermittent fever, consequently, that they operate in the same 
way as malaria and other morbific agents. It is, therefore, not surprising-, 
it is added, that when tartarized antimony is given in small doses, for 
several days in succession, it should generate malignant typhus, as proved 
by the experiments of Andral and other pathologists. 

Mercury, iodine, digitaHs, and some other medicines, usually supposed 
to produce their effects by augmenting the activity of the absorbents, 
Dr. M. maintains operate by diminishing the process of nutrition, while 
that of absorption continues to go on, causing a more or less rapid waste of 
the whole body, by which effusions and morbid growths are removed. — 
Nor can there be a doubt, he adds, that nearly all the more active articles 
in our materia medica impair the vital properties of the blood, and, rela- 
tively, increase absorption. 

^^ In a practical point of view" — he observes, in conclusion — " caloric^ air, and 
food are of infinitely more importance, in the prevention and treatment of dis- 
eases, than all the articles of the Materia Medica, because they are the natural 
agents by which all the healthy operations of life are maintained. Next to these, 
are the artificial stimulants, such as wine, spirits, ether, ammonia, the essential 
oils, balsams, spices, and terebinthinates — all of which owe their active proper- 
ties to the large amount of caloric which they contain, as shown by the hot and 
burning sensation they produce in the mouth and stomach. Hence it is that, 
when the powers of life are reduced below par, they are often useful in restoring 
the circulation to its natural vigour. It is also worthy of notice, that the stimulat- 
ing influence of the Spanish fly, mustard, turpentine, pitch, and many other exter- 
nal applications, is owing chietly, if not w^iolly, to the heat which attends their 
operation. It has been generally supposed that blisters and rubefacients relieve 
internal inflammations and congestions by acting as revulsives and evacuants. — ■ 
But the same beneficial effects are produced by the permanent application of a 
heated iron or vessel of hot water, without any evacuation of serum and lymph. 
I am, therefore, inclined to believe, that they operate by augmenting the par- 
tially suspended circulation of the capillaries, which is the proximate cause of in- 
flammation. As for the balsams, they stimulate the mucous membranes, which, 
in chronic catarrh and gonorrhcca, are in a weakened state. 

" The opinion of Cullen, that Peruvian bark, and other tonics, render the tis- 
sues more firm, and augment their cohesion, has been rendered highly probable 
by the researches of Dr. Adair Crawford, wdio maintains, in his 'Experimental 
Inquiry into the Effects of Tonics,* that their operation is chiefly mechanical, and 
owing to their astringent properties. Should it be objected that alum, acetate of 
lead and many other astringents, are greatly inferior, as permanent tonics, to the 
cinchona, other bitters, pepper, and spices; I answer, that the former operate as 
poisons, and gradually impair the vital properties of the blood; whereas the latter 
remedies do not produce this effect. It is consoling to find that the most agree- 
able of all remedies are the most speedy, elhcacious, and safe, in the prevention 
and treatment of diseases. For example, what is so pleasant and effectual in 
arresting and preventing the chilliness by which they are all ushered in. as the 
warm bath, hot drinks, and the application of dry heat ? or when the temperature 
has been raised above the natural standard, what so delightful and salutary as fresh 
air, W'ith cooling drinks and ablutions." 

Passing over so much of the next chapter as treats of the Theory of 
Temperaments, we arrive at those sections in which the author's theory of 
vitality is applied to explain the pathology of disease. 

Spasmodic diseases are owing. Dr. M. conceives, in nearly all cases, to 
diminished vitahty of the brain, as he beheves the following facts will 
prove. 

" 1. In all the higher orders of animals, convulsions are invariably produced by 
a great and sudden loss of bloody as when they are bled to death. 



1846.] Metcalfe on Caloric. 155 

'^ 2, But convulsions are also produced by the sudden abstraction of animal 
heat from the body, without any loss of blood, or where its temperature is reduced 
several degrees below the natural standard, as shown by the cramps induced by 
the exertion of swimming in cold water. 

'^3. It is well known that all the more active narcotic and other poisons^ when 
taken hito the stomach, or absorbed into the circulation, produce convulsions and 
death. 

'- 4. When the temperature of the body is reduced several degrees below the 
natural standard, as during the cold stage of intermittent fever, there is a con- 
stricted state of the skin, chattering of the teeth, trembling of the limbs, and a 
spasmodic state of the whole system, as when exposed to a very cold bath. In 
short, whenever the temperature is reduced below the natural standard, whether 
by the abstraction of animal heat from the surface, or by diminished respiration, 
owing to the influence of an impure atmosphere, the vital properties of the blood 
are impaired and a tendency to spasmodic action induced. 

" 5. Convulsions are produced by strangulation, as in hanging or drowning, or 
by whatever arrests or greatly diminishes the process of respiration, whether it be 
exposure to the mephitic gases, to rarefied atmosphere of high mountains, a blow 
on the head, or violent emotions of terror, and other depressing passions."— 
"■ When the vital energy of the brain is much exhausted, every sudden impres- 
sion, whether by sight, hearing or touch, causes the whole frame to start, and, in 
many cases, brings on repeated spasms, which, in persons of extremely shattered 
nerves, are induced by the shutting of a door, or by the slightest current of air. 
At the same time, it is equally manifest, that in cases of hydrophobia^ and trauma- 
tic tetanus, spasms are caused by the irritation of a wounded nerve, in the same 
way that pricking the nerve of a frog excites involuntary or spasmodic contraction 
of the muscles. The convulsions of infants are far more prevalent and require more 
prompt treatment in hot climates than in the middle latitudes, and more so in the 
latter durigg summer, when the atmosphere is in a rarefied and impure state, than 
during the winter, especially in large towns, and crowded or ill-ventilated dwell- 
ings. But cold and moisture are by far the most general exciting causes of cholera 
infantum, and other spasmodic diseases (?) ; to which may be added, the process 
of teething, irritation from worms, and improper diet — all of which tend to diminish 
the fimction of respiration^ and to prevent the due arterialization of the blood, as 
shown by the frequent coldness of the extremities, the pale or livid hue of the 
features, loss of appetite, general debility, and derangement of all the secretions." 

Chapter V, is devoted to the theory of fever. We shall present a short 
abstract of the leading views of the author on this important point as nearly 
as possible in his own words. 

Dr. M. maintains that fever or inflammation, whether general or local, is 
an essential condition of all diseases, except in those cases in which the 
reaction is not sufficient to induce a preternatural temperature; as in syn- 
cope, apoplexy, the worst forms of cholera, cold plague, tetanus, hydro- 
phobia, and other spasmodic affections. Every variety of constitutional 
disease is ushered in with a loss or deficient supply of animal heat. There 
never was a general fever Avithout a previous reduction of temperature, 
which is the first prominent link in the chain of morbid phenomena, and 
the invariable cause of all the following symptoms. 

During the chill the respiration is diminished — the temperature of the 
body is reduced in proportion to the intensity of the chill- — the force and 
frequency of the heart's action are diminished' — the vital properties of the 
blood are diminished — the surface is pallid or livid, because the blood is 
imperfectly arteriafized, while the features are shrunken and the extremi- 
ties diminished in bulk, because they are not duly suppHed with blood, 
which accumulates in the central organs. The brain and nervous system 
being no longer supplied with good arterial blood, there is loss of sensibi- 
lity, impaired memory, confusion of thought, headache, and stupor, which 



156 Review, [Jan. 

in some cases, approach the condition of apoplexy. There being a de- 
ficiency of good arterial blood in the capillaries of the stomach, the chill is 
attended with loss of appetite, nausea, and sometimes vomiting. No chyme 
being formed to unite with the bile, the latter accumulates in the gall- 
bladder and duodenum, until discharged by vomiting or in the form of 
bilious stools. The cardinal symptoms that mark the cold stage of inter- 
mittents are diminished respiration, circulation, sanguification, secretion, 
nutrition, and all the vital forces. 

'^ But as the process of breathing, although much impeded, is still carried on 
during the cold stage ; and as very little of the heat thus obtained is employed in 
combining the blood with the solids, and in maintaining the various secretions, it 
gradually accumulates, until the temperature under the tongue rises to 104°, and 
sometime to 107°. according to the observations of Currie, and some other patho- 
logists. The immediate consequence of which is, that the action of the heart be- 
comes more frequent and vigorous, by which the blood is propelled with increased 
force into all parts of the body, and the general torpor that existed during the cold 
stage is gradually removed. Moreover, it is worthy of special notice, that as a 
larger amount of blood is sent through the lungs, more carbon and hydrogen is 
given off to unite with atmospheric oxygen; so that more caloric is obtained by 
respiration during the hot stage, and imparted to the blood, than even during 
health, as proved by the experiments of Turine, Nysten, and more recently by 
those of Mr. McGrigor, who found that during the climax of scarlet fever, mea- 
sles, and small-pox, from twenty to fifty per cent, more carbonic acid was exhaled 
from the lungs of pafients in the Glasgow Infirmary than in a state of health. — 
And it is a striking coincidence, that the pulsations of the heart are augmented in 
about the same ratio during the hot stage, the tendency of which is to improve 
the vital properties of the blood by increasing the chemical function of the lungs 
in which it is formed and renovated, as shown by the bright and florid hue which 
it assumes, the redness it imparts to the skin, and its increased power of coagu- 
lating when drawn from the body, compared with its dark, grumous and vitiated 
state, during the cold stage. But as it is some time before the nutritive proper- 
ties of the blood are restored, even after respiration is re-established, the caloric 
thus obtained is imperfectly transferred to the solids; so that there is often a feel- 
ing of chilliness while the patient feels preternaturally warm to another person, 
until the full development of the hot stage ; attended with general debility, and a 
dull pain in the head, back and limbs, not unlike that which is produced by 
the immediate influence of external cold ; but with this difi'erence, that in the 
former case it is more permanent and diflicult to remove, because owing to a 
radical derangement in the vital properties of the blood. The consequences of 
which are, that the secretions remain for some time suspended, as shown by the 
clammy state of the mouth, furred tongue, dry skin, and thirst. The urine is also 
scanty and high coloured during the hot stage, 'but contains a larger amount of 
urea and other nitrogenous compounds than in a state of health, according to the 
experiments of Dr. Prout, and other chemists. Yet it must be observed, that 
whatever amount of animal heat may be obtained by respiration, it is incapable 
of performing its healthy vital oflice until the blood is restored to its natural state. 

''But in ordinary cases of intermittent fever, the natural tendency of the hot 
stage is to limit its own duration, and put an end to the paroxysm. This it does 
by augmenting the action of the heart, and the quantity of respiration, by which 
the vital properties of the blood are improved, and sent freely into all parts of the 
body, when the previous torpor of the brain, stomach, intestines, and voluntary 
muscles is succeeded by an increased activity of all the functions. The effete 
matter of the system that had accumulated in and still further vitiated the blood 
during the cold stage, together with the superfluous amount of caloric that marks 
the hot stage, are carried off through those natural sewers, the skin, kidneys, and 
bowels, when the sweating stage comes on and puts an end to the paroxysm. — 
Such are the leading symptoms that mark the progress of intermittent fever, 
which may be regarded as the type of all the other variefies. 

" The reason why the paroxysms of intermittent fever return at nearly regular 



1846.] Metcalfe on Caloric, 157 

intervals of time, must obviously be sought in those general laws of periodicity 
which mark the revolutions of the animal economy in health, under the influence 
of season, changes of temperature, day and night, sleeping and waking- all of 
which modify the various functions in a regular and uniform manner." 

Dr. M. maintains that all the varieties of fever are modifications of the 
same disease, and arise from different degrees in the intensity or duration 
of the causes which produce them. This he conceives to be proved from 
the fact of the liability of one variety to change into another ; from the 
hot stages of intermittents becoming always more protracted before they 
pass into remittents or assume the continued form ; from there being a 
gradation in the malignity of fever, and the debility of the patient, from 
the quartan, which is the mildest of the intermittents, and therefore has 
the longest interval, to the most deadly forms of typhus, yellow fever, and 
plague ; from the fact that, in temperate climates, intermittents prevail in 
spring, remittents in the early part of summer (?), while after the powers 
of life have been exhausted by long exposure to impure air, they become 
merged in the continued form of fever ; from the most malignant varieties 
of continued fever being most prevalent in tropical and warm climates, 
where the predisposing causes are more intense and constant in their 
operation ; from the fact, that in all climates and seasons, very fatal forms 
of continued fever are generated by constant exposure to the concentrated 
malaria of crowded, ill ventilated apartments, or from concussion of the 
brain, compound fractures, lacerations and other violent injuries — all of 
which tend to diminish respiration, impair the vital properties of the blood, 
and bring on a chill; and, lastly, from it being evident, 'that the causes of 
fever act with less intensity or for shorter periods when they produce the 
intermittent than the continued form of the disease — in the former the pa- 
roxysm running its course in five, ten, and fifteen hours, on an average, 
and being followed by a complete intermission of all the symptoms. 

But it would extend this notice to an unreasonable length were we to 
attempt to follow the author in the application of his theor}'' to the explana- 
tion of all the phenomena of fever. Sufficient has been presented to 
enable our readers to judge of its general character. We shall proceed to 
give a brief exposition of the subject of the concluding section — the theory 
of inflammation. 

Dr. M. believes it to be undeniable, that inflammation and fever are 
modifications of ^Uhe same radical disease,''^ and that both are generally 
attended with increased action of the heart. 

'^ It might even be said," he adds, ^'•'that inflammation is a local fever, and 
that idiopathic fever is a general inflammation- for they are both ushered in with 
more or less of a cold stage, which is followed by a preternatural elevation of 
temperature. Nor is it less certain, that all extensive or serious local inflarn- 
mations are attended with general fever, the leading symptoms of which are 
essentially the same as if produced by malaria." 

Dr. M. presents a series of general facts to prove, that inflammation is 
always attended with diminished circulation in the affected part. 

In nineteen cases out of twenty, he remarks, inflammation is brought on 
by the immediate influence of cold, which retards the circulation through 
the capillaries, and diminishes their contractility. 

'^' The consequence is, that they are dilated by means of the vis-a-tergo, en- 
gorged with blood, and tumefaction induced. In the, mean time, owing^o the 
weakness and diminished cohesion of the vessels, there is an effusion of serum, 
lymph, and sometimes of red blood, into the cellular tissue, or other surrounding 
parts, by which the sweihng is still further increased. And as the onward motion 
No. XXL— January, 1846. 11 



158 . ■ Review. [Jan. 

of the blood is impeded, it is prevented from receiving the vitalizing influence of 
respiration J by which its nutritive properties are impaired; so that the animal 
heat sent to the part in combination with arterial blood, is not properly united 
Avith the solids, as during liealth, but given out in the {ree state^ causing a local 
fever. Hence, the redness, tension, swelling, and heat, which are attended with 
more or less pain, owing partly to compression of the nerves, partly to morbid 
sensibility, produced by the preternatural temperature, and still more, perhaps, 
to a failure of the nutritive process, any derangement of which is always accom- 
panied with disagreeable sensations."' 

As to the manner in which local inflammation induces general fever — 
the explanation of our author is as follows — 

^^ The modus operandi of what is called morbid sympathy, may be illustrated 
by the following facts. In the first place, when the feet have been exposed for 
some time to the influence of cold and moisture, the temperature of the whole 
body is gradually reduced by the abstraction of caloric, which is brought to them 
in combination with the blood, causing more or less torpor of the general circula- 
tion ; so that if the lungs are in a feeble state, they become still farther paralyzed, 
until congestion or inflammation is established, as in pneumonia and bronchitis, 
which are the usual forerunners of consumption. But as the blood is formed, 
renovated, and purified in the lungs, it is evident that its free circulation through 
them must be greafly retarded, respiration diminished, and its vital properties 
impaired; so that the animal heat, which in its natural state is employed in com- 
bining it with the solids, and in maintaining the various secretions, is given out 
in the free state, causing more or less fever, prostration of strength, headache, 
delirium, and a diseased condition of the whole body. Again: as respiration is 
partly a voluntary process, it is diminished by concussion of the brain, or violent 
emotions of grief, and other depressing passions. The consequence of which is, 
that the chemical function of the lungs, the supply of animal heat, sanguification, 
secretion, and nutrition, are greatly diminished. Owing to the weakened state of 
the brain, the circulation through it is impeded; and as it is no longer supplied 
with good arterial bloody stupor, syncope, or symptoms of apoplexy follow. — 
When the injury has been so serious as nearly to arrest the process of breathing, 
the extremities remain cold, and the pulse feeble, for two or three days, or until 
death. And as the stomach is no longer supplied with good arterial blood, the 
secretion of gastric juice is arrested, causing a loss of appetite, nausea, or even 
vomiting. For the same reason the voluntary nmscles, being no longer duly 
nourished, lose the power of contraction, and the healthy state of all the functions 
is no less certainly destroyed than by a dose of arsenic, oxalic acid, or any of the 
narcotic poisons, which, as I have already shown, never produce their deleterious 
efTects by sympathy, or nervous influence, but always by impairing the vital pro- 
perties of the blood." 

The transfer of disease from superficial to deep seated parts — or what 
has been termed metastasis, is, according to our author, the. most frequently 
produced by the local application of cold, when the body is in a feeble 
state. As the application of cold to an inflamed part reduces the activity 
of the circulation through the lungs and all the other organs, they are thus 
rendered more liable to congestion or inflammation, especially if previously 
debilitated by intemperance, or the abuse of drugs. 

In regard to the treatment of inflammation, the general indication, ac- 
cording to Dr. M., is to remove the proximate cause, by increasing the 
circulation through the capillaries of the affected part, and thus promote 
resolution, before effusion, suppuration, ulceration, or mortification comes 
on. His great remedy to effect this is the application of heat to the part. 

^^ That blisters and rubefacients produce their good effects in deep seated in- 
flammations, by increasing the acfion of the capillary vessels, and thus relieving 
congestion, might naturally be inferred from the elevation of temperature they 
produce in the parts to which they are applied, and from their influence in aug- 



1846.] Metcalfe on Caloric. 159 

meriting the vigour of the general circulation." — " Another indication in the treat- 
ment of inflammation is to diminish the action of the heart, when too violent, by 
which more blood is forced into the weakened vessels than can be circulated 
through them, and the local congestion augmented. This may be done by 
moderate blood-letting, which may also be resorted to in cases of extreme ple- 
thora, or when there is more blood than the heart has the power of forcing freely 
through the body. And local plethora may be relieved by the application of 
leeches, should fomentations fail. But we ought never to bleed in health, be- 
cause blood is the immediate source of life and power to all the organs ; and 
very rarely in disease, because the process of sanguification is then diminished.'' 
^' The leading object should always be to restore the action of the weakened ves- 
sels, by a judicious and varied application of the agent on which all the powers of 
life depend.^^ 

Notwithstanding the length to which we have extended our notice of the 
work of Dr. Metcalfe, we have not been able to notice many of the import- 
ant subjects noticed by the author, and pressed by him into the service of 
Iiis theory of caloric, either to enforce or illustrate its application to the 
various physical and vital phenomena of the universe. The entire w^ork 
is one deserving of a close study— -upon almost every page it presents views 
worthy of a candid examination ; and a vast amount of interesting and 
important facts. Closely criticized, the conclusions of the author will not, 
we suspect, be found to be invariably the most legitimate deductions from 
his premises — nor are his premises always of undoubted vahdity. He 
has succeeded, certainly, in proving the important agency of caloric in 
many of the operations of nature, where it had been before almost entirely 
overlooked, and he has shown conclusively the very important part it plays 
in exciting and regulating the vital functions of the animal system, and 
maintaining it in a state of health. That, however, caloric is itself the 
principle of vitality and the sole cause of organization will admit of consi- 
derable doubt. His pathological and therapeutical views will, we suspect, 
meet with but little favour. His theory of fever and inflammation is, ne- 
vertheless, unquestionably ingenious and far more clear, consistent and 
plausible than many that have received the sanction of some of the most 
distinguished physicians of the past and present centuries. D. F. C. 



160 [Jan. 



BIBLIOGRAPHICAL NOTICES. 

Art. XV. — A Manual of Auscultation and Percussion. By M. Earth, Agrege to 
the Faculty of Medicine of Paris, &c., &c., and M. Henry Roger, Physician to 
the Bureau Central of the Parisian Hospitals, &c., &c. Translated, with addi- 
tions, by Francis G. Smith, M.D., Lecturer on Physiology in the Philadelphia 
Medical Association, &c., &c. Philadelphia, Lindsay & Blakiston, 1845 : 12mo. 
pp. 160. 

Physicians \\\\o have applied themselves to the study of physical diagnosis, must 
generally be familiar with the first edition of MM. Barth & Roger's work, published 
in 1840, or with the English translation of it by Dr. Newbigging, although we are 
not aware that the latter was ever republished in the United States. This work is 
by far the best essay that has yet been written upon the subject of which it treats. 
It was so much esteemed in Europe as to receive the honour of translation into 
several languages, and to reach a second edition in the space of three years.^ 
This second edition was carefully revised, amended, and enlarged, by the authors, 
and a short treatise on percussion appended to it. The latter, with the authors' 
own summary of the treatise on auscultation, has now been translated by Dx. 
Smith. The summary contains, in an abridged form, all the practical portions of 
the text, without any of the discussions there entered upon for the purpose of 
explaining the causes of the natural and morbid phenomena concerned in the 
physical study of disease. It is thus, as the authors expressly state, adapted 
to beginners, whom they advise to confine their attention, at first, to it alone, as 
presenting the simplest notions of the subject, and to leave the more intricate and 
doubtful questions until their studies are farther advanced. 

The manual treats of auscultation and percussion as applied, not only to dis- 
eases of the lungs, but to those also of the heart, the abdomen, the head, the 
extremiues, and the gravid uterus; and, as a necessary introduction to the study 
of these, describes the physiological phenomena of which each may be the seat. 
The pathological varieties of each phenomenon are then severally examined, and 
their value as signs distincfiy pointed out. They are smdied, moreover, not only 
in their relations to positive but also to ditferential diagnosis. The authors are not 
content with informing us that a physical symptom may belong to any one of 
several affections, but they tell us when it indicates one, and when another of 
them. To arrive at this result they make use of that potent instrument, analysis, 
in employing which their countrymen so far excel all other nations, and which 
MM. Barth and Roger wield with unusual effect. Method, logical arrangement, 
and analysis, put it in the power of even a half-taught writer to convey much in- 
struction, but when, as in the present instance, they are the instruments of men tho- 
roughly conversant with the subject to be explained, they produce a result as near 
perfecfion as possible. 

To illustrate what we mean, let us take one example out of the many that pre- 
sent themselves. Absent or suppressed respiration is a complete negation of the 
respiratory sound in some part of the chest. Dr. Walshe, in his excellent manual, 
informs us that it is a sign either of obliteration of a bronchus, or tubercular infiltration, 
or vesicular ephysema, or pleurisy, or hydrothorax, or spasmodic asthma, &c.; 
and this is well, but not w^ell enough, for it fails to give us the most definite idea 
possible of the value of the sign in question. And such an idea, we think:, is con- 
veyed by MM. Barth and Roger in the following passage : " Absent respiration 
depends on the same condition of things as feeble respiration, and it announces, 
consequently, the same diseases, with this difference, that it indicates more decided 
anatomical lesions. But the entire absence of the respiratory murmur being, in 
exceptional cases only, attendant on emphysema and tubercles — the diseases of 
the larynx manifesting themselves by peculiar phenomena — the obliteration of 



1846.] Reports of Insane Asylums. 161 

the bronchi; their obstruction by foreign bodies, as well as pneumothorax without 
perforation, &c., being rare in connparison with liquid effusions into the pleura — 
it follows that absent respiration is a sign of very great value, and a common indi- 
cation of these effusions ; and as pleurisy is more frequently single, and hydro- 
thorax double, it also follows, that well marked absence of the respiratory mur- 
mur, on one side of the chest, announces almost with certainty a pleurisy with 
effusion." 

The account given us by Dr. Walshe is certainly true, as far as it goes, but how 
much does it fall short of the beautiful, and almost demonstrative truth, contained 
in the passage quoted from MM. Barth and Roger ! Upon similar principles do 
these gentlemen reduce the several physical signs to their truest and simplest 
expressions, and in this manner do they render remarkably interesting and-attrac- 
tivOj a subject which, as hitherto presented by English writers, is, to the student 
especially, somewhat dull and repulsive. No one can read such a manual as 
theirs, without feeling that it is just what every inexperienced practitioner needs at 
the bedside — a concise, clear, and satisfactory explanation of his difficulties. 

The translator has appended several useful notes on obstetrical auscultation, 
(taken from Dr. Hope's treatise,) on prolonged expiration ; and on the production of 
the crepitant ronchus. quoted from Dr. Carr's paper upon the subject, in the Octo- 
ber Number, for 1842, of this Journal. He claims for Prof. Mitchell a priority of 
right to this rationale, which is unquestionably the true one, but which, simple as 
it is, had never before been made by any one since the time of Laennec. Dr. 
Carr was certainly the first to publish the explanation referred to ] but Dr. Walshe, 
within a month afterwards, and probably before he could have seen Dr. Carr's 
paper, thus accounts for the production of crepitus: '■^ Its physical cause," says Dr. 
W., '^is the sudden and forcible expansion of the parenchyma, glued together, as 
it were, by the viscid exudation with which it is infiltrated ; each single crepitus 
would thus signify the expansion of a cell, &c." — an explanation which differs 
from that of Dr. Carr in placing the seat of the sound outside of the cells instead 
of within them, but assigning the same mechanism for its production. 

The tables of auscultation and percussion in Dr. Smith's manual are modified 
from those of Dr. Walshe, and, by their modification, we think they have been 
improved, inasmuch as they have been shorn of many of those varieties of sound 
which an expert auscultator and percussor may and ought to recognize, but which 
are more curious than usefnl to the learner of physical diagnosis. 

The translation appears to us much superior to many of more pretension. It 
reads like an original English book, and where we have taken the trouble to col- 
late it with the French text, we have, with trifling exceptions, found it to be a 
faithful version. The paper and type in which the publishers have dressed it, 
render the work not less attractive in its exterior than it is intrinsically valuable, 
and we trust that, for their profit, as well as for the advantage of the large medical 
classes of the present season, it may have an extensive circulation. A. S. 



Art. XVI. — 1. Ninth Annual Report of the Trustees and Superintendent of the Ver- 
mont Asylum for the Insane. September, 1845. 

2. Report of the Superintendent of the Boston Lunatic Hospital, ^c. July 1st, 1845. 

3. The Twenty-first Annual Report of the Officers of the Retreat for the Insane, at Hart- 
ford, Conn. May, 1845. 

1. From the report by Dr. Rockwell, which is more elaborate than most of its 
predecessors emanating from the same source, we learn that the Vermont Asy- 
lum is in a flourishing condition, that large additions have recently been made to 
the buildings, and that the number of patients during the past year has been greater 
than in any previous year. It appears, also, that this asylum is furnished with 
the facilities for " moral treatment," which are now considered as essential to in- 
stitutions of the kind, and that manual labour is extensively introduced among the 
patients. 



rlales. 


Females. 


Total. 


23 


9 


32 


82 


58 


140 


17 


3 


20 


65 


55 


120 


9 




9 


7 


2 


9 



162 Bibliographical Notices. [Jan. 

Number of patients at the close of last year, - - - , - 1 58 

Do. do. do. admitted during the year, - - r - 204 

Whole number -------- 362 

Discharged during the year, ------ 89 

Remaining at the end of the year, August 1st, - - - - 263 

Of those discharged, there were cured, - ... - 59 

Died, - - - 20 

Whole number of patients since opening of asylum, . - - 835 

Do. do. cured '• u u u . . . 340 

Died u u ^c u . . , 59 

It is to be regretted that Dr. R. in his statistics makes no " distinction in regard 

to sex." 

2. From the report by Dr. Stedman, we glean the following items : 

Admitted at the Boston Lunatic Asylum, during the 

year, ending June 30th, 1845, 
Whole number during the year. 
Discharged " '' " 

Remaining at the end of the year, 
Of the patients discharged, there were cured, - 
Died, - - - . • 

Causes of Death — consumption 3, marasmus 2, epilepsy 1, 

chronic inflammation of brain 1, exhaustion 1, scrofula 1. 
Whole number of patients since opening of hospital, 320 

It would be inferred from Dr. Stedman's remarks, that the patients at this insti- 
tution labour under great disadvantages, from the entire inadequacy of means for 
carrying out an enlightened system of moral treatment. They have little employ- 
ment, and but few resources for reading, recreation and amusement. By an 
appended note, however, it appears that swings and a bowling alley are about to 
be introduced. 

The following extract from the report records an instance of success in the treat- 
ment of delirium tremens, such as will rarely find a parallel. 

••From an experience of sixteen years spent in public hospitals, where de- 
lirium tremens was almost always to be found, I am prepared to say, that no 
malady is surer to terminate in health than this, provided that no other disease attends 
it. It is most commonly complicated with inflammation of the lungs, or with 
epilepsy. When these occur, death is most often the result. 

'■' Of 76 cases of delirium tremens treated in the House of Correction, (one of 
the public institutions at South Boston of which Dr. S. has the medical charge) — 
and these are all that have occurred there during a period of two years and eight 
months — no death has taken place, unless we except that of a patient who w^as 
attacked with pleuro-pneumonia. the severest form of lung fever, just as delirium 
tremens was leaving him. Epileptic convulsions attended a few of the cases. — 
The only treatment adopted — and this in every case — was cold water, adminis- 
tered as often, and in as large quantities as the patient could be induced to take 
it." Will the disciples of Priessnitz fmd an argument in this? 

3. The report by Dr. Butler, of the Hartford Retreat, is unusually brief. Aside 
from the statistics of the institution, the principal subject therein discussed, is the 
importance of early treatment in cases of insanity. Extensive additions have re- 
cently been made to the buildings of this establishment. 

Number of patients, April 1, 1844, 

Admitted during the year, - - . 

Whole number, - - - 

Discharged '^ (.(■ ct 

Remaining, March 31st, 1845, 

Of the patients discharged, there were cured. 

Died, 



Males. 


Females. 


Total. 


47 


36 


83 


56 


49 


105 


103 


85 


188 


50 


35 


85 


53 


50 


103 


23 


22 


45 


7 


4 


11 



1846.] Muhry on Historical Immutability of Nature and Diseases. 163 

Causes of Death — Marasmus 2, general debility 2, consumption 1, paralysis 1^ 
typhoid fever 1, exhaustion 1, exhaustion from traveling 1, old age 1, congestion 
of brain 1, suicide 1. The case of suicide was probably not reckoned in the sta- 
tistics of deaths, there being a disparity of one between the numbers in the statis- 
tics and those in the causes of death. 

Males. Females. Total. 

Whole number of patients since the opening of the ) ~,g ggi ^^^2 

Retreat, in 1824, j 

Of whom, there have recovered, _ . - 791 

Died, --.-... 103 

The number of admissions, and the average number of patients for the past 

year, exceed those of any preceding year. P. E. 



Art. XVII. — Ueher die Historische Unwandclbarkeit der Natur und Krankheiten. Ber 
zweiundzwanzigsten versammhmg deutscher Naturforscher und Aerzte zu Bremen 
gewidmet. Von Dr. A. Muhry, &c. &c. 12mo. pp. 50. Hannover, 1844. 

On the Historical Immutability of JSfature and Diseases. Dedicated to the Naturalists 
and Physicians at their Twenty-first Convention held in Bremen. By A. Muhry, M. D., 
&c. &c. 

Whether the diseases to which the human organism is now subject are, in ail 
respects, the same as those that have prevailed in every age of the world, is a 
question replete with interest, and the solution of which would be attended with 
at least one important result — the enabling us, namely, to compare, with greater 
confidence, the observations of cotemporary physicians with those recorded by 
the medical writers of former days. 

The doctrine is maintained by many, that not only those forms of disease which 
have prevailed from the earliest periods, of which the medical history has come 
down to us, have undergone successive modifications, but that entirely new dis- 
eases uniike any previously described have, from time to time, made their appear- 
ance. Consequently, that although a general system of pathology and therapeutics 
may, with some degree of confidence, be established, the special nosology and 
plans of treatment of any former period would be no certain or safe guides now. 
That, with all our boasted improvements in the several departments of the healing 
art, the best digested system of medicine of the present day would have been as 
little adapted to point out the characters, diagnosis, and treatment of the diseases 
which prevailed in the days of Hippocrates, as are the writings of the Father of 
medicine in relation to those which now occur. 

We are, unfortunately, not possessed of all the materials requisite for the satis- 
factory solution of this question. Independently of the changes which medical 
nomenclature has undergone — many of the ancient terms having become obsolete 
and now unintelligible, whilst not a few of those that have been handed down to 
us, are now used in a very different sense from what, it is evident, they were 
intended originally to convey — the descriptions of diseases given by the older 
writers are too brief, loose, and defective to enable us to determine their prototypes 
with any degree of certainty. Even when the descriptions are more precise and 
full, they are deficient in accuracy of diagnosis, and apply rather to various kin- 
dred groups of morbid phenomena than to individual diseases. 

If we except the admirable and accurate descriptions of diseases contained in 
the writings of the Arabian physicians, w^e have scarcely any of an earlier date 
than the beginning of the sixteenth century, sufficiently full and correct to enable 
us, by comparing the phenomena of the diseases which now prevail with those by 
which the same diseases were accompanied at former periods, to detect their 
points of resemblance or discrepance. 

Judging, however, from the few and imperfect details furnished us by the medi- 
cal writings of former days, we believe that there are good reasons for concluding 
that the more prominent diseases to which the human organism is now liable are 
essentially the same, in all their leading features, with those to which it was sub- 
ject as far back as medical history leads us. 



164 Bibliographical Notices, [Jan. 

The modifications that have, from time to time, been observed in the character 
of certain diseases, would not appear to affect their diagnostic phenomena, but to 
consist in a change in certain of the concomitant symptoms, resulting from differ- 
ence of climate, location, food, clothing and other extraneous circumstances. 

It is very certain that a few diseases which once prevailed extensively — for a 
long period of time, and over a wide extent of country — we are no longer familiar 
with — while, at different periods, forms of disease were of common occurrence, 
corresponding in their phenomena, course, and termination, with none of those 
described by preceding or subsequent medical writers. 

Is it, however, true that diseases which formerly prevailed have entirely 
disappeared? This is by no means improbable. The history of endemics proves 
very clearly that certain forms of disease depend upon cases of a strictly local 
character, and no longer occur when these local causes are removed. — It is 
equally reasonable to suppose that morbific causes of wider extent may become 
extinct either spontaneously or through the agency of man, and with their extinc- 
tion would of course cease the diseases produced by them'. But it is not so very 
certain, that among the diseases to which the human organism is still subject, 
some at least of those which are presumed to have disappeared are not to be 
included, but in a form so far modified that the resemblance between them and 
their prototypes is overlooked. It is, also, probable that diseases which formerly 
l^revailed as endemics or epidemics, still occur sporadically; isolated cases ap- 
pearing occasionally and at long intervals, and hence attracting little attention, or 
being view-ed as anomalous forms of some one of the more prevalent affections. 

In regard to what are supposed to be new forms of disease, it is by no means 
certain that they may not have prevailed at some earlier period, notwithstanding 
"vve meet with no account of them in the imperfect histories that have come down 
to us of the diseases of the olden times. We know that various diseases have 
repeatedly prevailed for a longer or shorter season, and then disappeared — not a 
single case occurring for a series of years — when, perhaps, all of a sudden, they 
will again make their appearance, often as an epidemic of wide extent and attend- 
ed with an appalling mortality. This recurrence of an old and forgotten malady, 
has not unfrequently been described as the appearance of a new form of disease. 

That entirely new diseases have and may hereafter present them selves it is still 
by no means unreasonable to suppose. The healthy as well as the diseased actions 
of the various portions of the human organism are modified to a very great extent 
by the external agents to the action of which it is exposed. 

By the operaUons of man, the surface of the earth and nearly all that appertains 
to it are continually undergoing important changes, in consequence of which the 
action of the various physical agents by which he is surrounded becomes essen- 
tially modified, and, at the same fime, new morbific causes are constantly deve- 
loped. A change is hkewise rapidly taking place in the condition of the human 
race at every step it makes in civilization and knowledge: the influence of those 
moral and mental stimuli which formerly were only experienced by a small por- 
tion of mankind become extended with augmented force over large communities 
or even entire nations. From these various causes the human organism has 
itself become to a certain extent modified ; organs that had for a long series of 
ages remained inactive are now called into morbid activity — while those which 
had formerly been in constant exercise are now left at rest, and the balance 
between the difierent portions of the system is materially changed. In an organ- 
ism thus predisposed in a different manner than formerly to disease, and con- 
stantly acted upon by morbific causes, that previously could scarcely be said to 
have an existence, we can easily conceive that morbid actions may be excited 
altogether dissimilar from any to which it had been previously liable. 

It is too common to date the first appearance of a disease from the period when 
the first accurate account of it was written. This, however, is very seldom cor- 
rect. Certain circumstances causing an increased number of cases of a given 
disease, which had perhaps prevailed for ages before, to occur in a certain local- 
ity or in the practice of an observing physician, an account of it is accordingly 
published and the attention of the profession becomes especially directed to it, and 
from that time it is included in the list of prevailing diseases. It may have been, 
indeed, described before, but so inaccurately, or by one so little known to fame, 



•1846.] Smitli on Acute Hydrocephalus, or Water-Brain Fever. 165 

that the fact is soon forgotten. This circumstance has so frequently happened 
that a large volume might be filled with the prior description of diseases^ the first 
account of which has been credited to subsequent writers. 

We are indebted for our acquaintance with many of the diseases of which no 
account is to be met with excepting in the systems of medicine of a very recent 
date^ to the improvement and multiplication of our means for the investigation of 
the several morbid states of the tissues and organs. As a more accurate know- 
ledge of the structure and functions of the animal organism was acquired by the 
cultivation of general anatomy and physiology, and the relation between the 
lesions of its several parts and the general phenomena of disease was submitted 
to a closer scrutiny, and the indications presented by the latter more accurately 
determined, groups of symptoms, that, with others, had before been referred to the 
same morbid condition of one or other of the internal organs, were shown to be 
dependent on very dissimilar lesions, and in this manner the physician has become 
acquainted with diseases, which, though they may have occurred in every age of 
the world, had entirely escaped the notice of preceding pathologists. 

In the short treatise before us. Dr. Muhry has presented a very able outline of 
the several points connected with the question we have thus very briefly and 
imperfectly discussed. He has pointed out the difficulties Avhich stand in the 
way of its satisfactory solution — but so far as he has been able to arrive at any 
positive conclusions, these appear to him to prove the unchangeable character ri 
all the leading forms of disease — the modifications observed in certain of their 
features depending upon a modification which the human organism has itself 
undergone from a change in the external circumstances with which man is sur- 
rounded, and the new and multiplied mental and moral stimuli to which he is 
subjected. 

The whole subject is one worthy of a more extended investigation, and we 
recommend it to the consideration of those who have the time, the talents, and 
the means for its prosecution. D. F. C. 



Art. XVITI. — On the Nature^ Causes ^Preventions ami Treatment of Acute Hydrocepha- 
lus, or Water-Brain Fever. By Thomas Smith, A.M., M. D., Senior Physician to 
the Leeds Dispensary, &c., &c. — " Veritas est simplex^ error est complex.'''' Lon- 
dou; 1845, 12mo. pp. 168. 

The treafise of Dr. Smith is intended rather for the unprofessional than the pro- 
fessional reader ; its leading object being to teach parents how to prevent the 
occurrence of hydrocephalus in their children by a judicious course of infantile 
hygiene, and not to instruct the practidoner as to its proper remedial treatment. 

"Nearly a century has elapsed,'^ the author remarks in his preface, "since our 
countryman, the intelligent and acute observer, Dr. Whytt, gave his first essay on 
this, at that time, rare disorder. Many are the treatises, domestic and foreign, 
since published on the subject ; yet, with the fact universally admitted, that science, 
advancing as it does with giant strides, has hitherto done nothing towards the pre- 
vention, if it has towards the cure of this, one of the chief of the opprobria of 
our art, no friendly hand has been employed, so far as I know, in warning parents 
to guard against the impending danger. I venture to hope that, in occupying 
ground never before trodden upon, while I take the initiative in supplying the 
non-medical public with an insight into the nature, treatment, and above all, the 
prevenfion of one of the most, if not the most, fatal visitations of infancy, indul- 
gence may be conceded to me, both by my own professional brethren, and by the 
non -professional reader." 

We admit the importance of the task which Dr. Smith has undertaken, and the 
valuable service he will render to the cause of humanity should he be successful 
in impressing upon parents the necessity of a strict attention to the well being of 
their offspring during the period of their intra-uterine existence, and to their proper 
physical treatment subsequent to their birth. — tt is not a mere matter of opinion, 
but a fact capable of demonstration, that the tendency not only to hydrocephalus 
and nearly all the more fatal maladies of infancy and childhood, may by this 



166 Bibliographical Notices. [Jan. 

means be prevented, but that the predisposition, also, to the maladies liable to 
occur in after life may also be effectually warded off. To the fulfilment of this 
task many obstacles, however, present themselves, which can with difficulty 
be overcome. — To reach the popular ear, when w^e would communicate to it 
the lessons of wisdom, is by no means easy; and to induce their general adop- 
tion in opposition to the dictates of prejudice, of false but deep-rooted theories, 
the requirements of fashion, or the absolute sway of indolent habits, custom, and 
example, is still more difficult. Even with the better informed and more tractable 
classes, we meet with only partial success in imparting correct views of hygiene, 
or in inducing a course of practice in strict conformity with its precepts, in conse- 
quence of their imperfect acquaintance with the vital laws of the human organism, 
and their misconceptions of the intiuence exerted upon it by exterior agents.— 
Much, it is true, may be etiected by a series of judicious publications, but we 
doubt whether we shall ever fully succeed in teaching to all those rules of living 
which are calculated to impart due development, health, and vigour to the human 
frame, until the study of physiology and hygiene shall be embraced in the course 
of instructions given in our public schools. 

The work before us is replete wdth good sense, and, with a few exceptions, its 
directions for the prophylaxis of hydrocephalus are sound and practicable — they 
<ire nearly all founded upon correct principles, and may be carried into effect in 
ihis country by all classes of society raised above that of abject pauperism. Not- 
withstanding this, it is very questionable whether the work is one well calculated 
to effect the important object aimed at by its author. It treats too much of disease 
to adapt it to those who are altogether ignorant of pathology, and too superficially 
to render it a useful treatise for the physician. 

The description which Dr. Smith has given of the premonitory symptoms, 
stages, phenomena and diagnosis of hydrocephalus is full and accurate — but, v/ith 
all its minuteness and accuracy, it will, we suspect, rather perplex and mislead 
than convey useful instruction to those wdio are unaccustomed to a close obser- 
vation and careful discrimination of morbid phenomena. — Nor do we perceive the 
necessity of all the details that are given upon the symptomatology of hydrocepha- 
lus ; the treatise is, confessedly, not intended to teach parents to treat "the water- 
brain-fever," as the author affectedly terms it, after it has ma.de its attack, but to 
remove the predisposition to its occurrence — and we may remark, that the hy- 
gienic precepts of Dr. Smith are as important for the welfare of the child in which 
no predisposition to the disease is apparent, as of the child in whom an attack is 
imminent. 

Dr. Smith's views of the general character of the disease are in the main 
correct, though not expressed with any great clearness: the exposition he has 
given of its pathology is, in fact, deficient in details — and in many particulars 
vague and indefinite. In Chapter V, which professes to treat of the "morbid 
anatomy" of hydrocephalus — though we shall consult it in vain for any informa- 
tion on that subject — the author remarks — • 

" A careful comparison of the innumerable cases which have, after death, pre- 
sented no positive signs of inflammatory action, with those also very numerous 
cases which have manifested such signs, will serve as matter for deep considera- 
tion and elucidation to those who choose to view this malady in the light in which 
I have felt it to be my duty to present it to my readers, viz. — as an idiopathic ner- 
vous fever of infants, strongly allied to ihefebris Icnta nervosa of adults." 

We should like to know what information the above sentence can possibly con- 
vey to the unprofessional readers to whom the work of Dr. Smith is addressed 
— even the professional reader can form from it but a very imperfect notion as to 
the view entertained by the author of the true nature of hydrocephalus — 

" To enumerate a variety of cases, continues Dr. S., in which limpid effusion, 
softening, slight opacity of the membranes, either on the surface of the hemi- 
spheres, above or at the base of the brain — the bronchial, thoracic, or abdominal 
signs of tubercular deposit, or granular disease, is, in the view of the pathology of the 
disease less important, and almost unnecessary. For I should no more expect to ar- 
rive at just notions of the pathological conditions of its admonitory and subsequent 
stages, by meditating upon the accumulated and curious statistics furnished by 



1846.] Smith on Acute Hydrocephalus, or Water-Brain Fever, 167 

necropsy, than I should expect to arrive at a true knowledge of the essence of any 
idiopathic fever, simply by contemplating its ravages after death." 

That " the idiopathic nervous fever of infants" is usually attended with or pro- 
ductive of disease of the brain, Dr. S. would seem indirectly to admit. 

'^ In the gradually advancing condition of more perfect ossification, when the 
more intimate continuity of structure between the dura mater and the pericranium 
is in a great degree cut off, hydrocephalus is said no longer to beset the path of 
the juvenile adult, simply because although the adult may have the same condi- 
tion of blood, the same strumous diathesis, and the same high susceptibility of 
nervous system, he w^ill not have the readily yielding texture of the soft contents 
of the cranium, nor the same facility of hyperaemial condition of the external and 
internal blood vessels of the cranium, and, therefore, not manifesting those early 
symptoms which Dr. Cullen denominated hydrocephalic apoplexy. The fever of 
such adults will maintain the name oi febris lenta nervosa, or pure nervous fever. 
All that has been said touching the contradictory phenomena of inflammatory 
appearances, confidently adduced as a set-off against those innumerable cases in 
which such appearances have been wanting, se-rves only to confirm this opinion, 
and is so far a proof that hydrocephalus is not in essence an inflammation, much 
less a dropsy; but that it may or may not be accompanied with inflammation in 
its progress — may or may not lead to effusion in its progress^ just like any other 
idiopathic fever." 

The account of the premonitory symptoms — stages of the disease and their 
phenomena — its diagnosis, etiology, and morbid anatomy, occupy the first five 
chapters of the w^ork; the succeeding seven chapters are devoted to a considera- 
tion of the means of prevention, under the heads of conduct of the mother during 
pregnancy and lactation, and the treatment of the child during lactation, and sub- 
sequent to weaning. 

As already hinted, this portion of Dr. Smith's essay is, in general, marked by 
good sense — his hygienic rules, as well in regard to the mother as to the. infant^ 
are, with few exceptions, correct and easily carried into practice — they are not, 
however, any more adapted to guard against an attack of hydrocephalus than of 
any other disease to which infants and young children are liable. They are, in 
fact, the general rules of regimen and diet which are essential to promote the 
health, the due development and the vigour of children generally — and while 
they are unquestionably prophylactic of hydrocephalus, they are no less prophy- 
lactic of every other ailment of the earlier periods of existence, and have been 
taught to, and urged upon parents by numerous writers of the past and present 
centuries. We make this remark, because Dr. Smith has claimed to himself the 
credit of being the first to point attention to them. " Science, he remarks, has 
hitherto done nothing towards the prevention" of hydrocephalus. — ^^ I have found 
medical and popular literature equally deficient in suitable admonitions to parents 
and nurses." — ^' I have determined to try to lay down a beacon or two, by means 
of which even a few lives may be saved, and much misery prevented. It ought 
rather to excite surprise that I have not long ago been anticipated in the perform- 
ance of what may justly be called a duty of humanity long neglected. Although 
others after me may perform the same duty more ably, and perhaps more suc- 
cessfully, I may at least claim to myself the credit of first pointing the way.''"' 

We have already admitted, more than once, the general accuracy of Dr. 
Smith's hygienic directions — on one or two points, however, we must differ from 
him. 

The author is a great advocate for the cold bath — it ranks in fact among his 
indispensable means for increasing the vigour of the human body — and for im- 
parting to it renewed strength when its energies have become from any cause 
depressed. Speaking to parents, he says — "let them practice cold bathing, and 
daily ablutions, the sooner after rising the better.^' " The child should be early 
inured to immersion, first in tepid and afterwards in cold water" — " I think that 
children should be accustomed to wash their feet daily in cold water" — ^"In sum- 
mer time, those who have the convenience, should provide movable tub-baths, 
let into their grass plots, in which children should be encouraged to disport them- 
•selves, and, in hot weather, to run about very lightly clad, or, if you like it, all but 
naked on the well trimmed carpet grass."" *' It required not the hand-book of 



168 Bibliographical Notices. [Jan. 

hydropathy to convince the physician of the importance of this great means of 
invigoration. Every one, writes Locke, is now full of the miracles done by the cold 
bath, in decayed and weak constitutions, for the recovery of health and strength !"— 
*^^ Its practicability and tolerance for improving and hardening children whose 
springs of vitality are less likely to fail, and who are therefore under better cir- 
cumstances for its use, need not be feared, unless where disease is already pre- 
sent." 

The foregoing directions in regard to the use of the cold bath are particularly 
dangerous in a work written for the instruction of unprofessional readers — they 
will, we fear, be calculated to instil erroneous notions productive of injurious 
consequences of a very serious character. The cold bath we believe to be under all 
circumstances improper for infants during health — at this period of life the warm 
or tepid bath is much better adapted as a means of ablution and to secure the free 
and healthful action of the cutaneous capillaries and exhalents. For infants gene- 
rally the cold bath is calculated rather to retard growth and produce disease, than 
to promote the full and equal development, health and vigour of the body. The 
immediate effects of cold water applied to the surface of the body are invariably 
sedative — if there is sufhcient vigour of constitution to produce reaction, the tem- 
porary impression of the cold bath may become indirectly a means of invigora- 
tion — its use, however, for this purpose demands so great a degree of precaution 
as to render it an improper agent to be employed by parents generally. 

Speaking of the drink of children after weaning. Dr. Smith, although he ad- 
mits that '■'■ a healthy child requires, and indeed wishes for nothing but water" — 
that notwithstanding '-light, fresh table beer, would not be injurious to a child 
four or five years old ; yet it is unnecessary, and no advantage would, in this 
instance, resuh from the creation of a new want." Yet he states, immediately 
afterwards, his belief '4hat a stomach to crave, with habits to insure a craving for 
good bread and beer, is one of the essentials to produce a fine race of British lads 
and girls" — and again, "small-beer, domestic lemonade, or water, constitute very 
good drinks. The first for children taking mere exercise, the second occasionally 
when they have scorbutic eruptions; and the third at any time. Now,"" he adds, 
" although I advocate the use of good small-beer, treacle beer, mild porter, &c., I 
am decidedly and strenuously opposed to the use of strong drinks, wine, cordials, 
liquors, and to everything which stimulates beyond a wholesome refreshment, but 
when lads are under strong exercise in long strolls, rowing, cricketing, or skating, 
the allowance of a half pint of porter per day, and, in hot weather, mixed with a 
bottle of good ginger beer, is very proper, unless they are to he brought up milk-sopsP 

Water alone is unquestionably the best drink for children, under all circum- 
stances of health — to use the language of our author, — "that you may have a fine 
race of men in any cold climate^ living on water alone for drink, provided they 
get good nourishing flesh meat we doubt not" — no one can in fact doubt it, if he 
will merely consult the evidence of physiology in conjunction with that of expe- 
rience ; why then create an appetite for alcoholic drinks by recommending beer 
and porter as essential to prevent boys from becoming milk sops? Lads are prone 
enough to partake of these drinks without this additional recommendation, but 
with it we shall soon find them transgressing the half pint of mild porter and one 
bottle of ginger beer, in order that they may effectually avoid the dreaded cha- 
racter of " milk sops." 

The thirteenth and fourteenth chapters treat, the one of the prophylactic remedial 
treatment of the hydrocephalic diathesis, and the otherof the treatment of the disease 
after its occurrence. The direction contained in the first of these chapters is upon 
the whole sufficiently judicious, but too loosely detailed to be of much avail to 
the young practitioner, while it is altogether out of place in a work for the use of 
the unprofessional. Nearly the same remarks may be made in reference to the 
second chapter. He differs from most writers upon the disease in regard to his 
appreciation of the eftects of mercury, " when used largely, from within and with- 
out, to produce its specific effects, it promises and realizes," he observes, "no 
more benefit than might be expected (from it) in the nervous fever of the adult." 

The following remarks of the author on the duty of municipal governments to 
provide for the health and well being of the citizen are admirable so far as they 



1846.] Smith on Jicute Hydrocephalus^ or Water-Brain Fever, 169 

go; they might be extended, with profit, could, they find access to the attention and 
understandings of those addressed. 

"As the conservation of the peace is the especial function of the magistracy, so 
the preservation of the health and comfort of the inhabitants is the special province 
of the corporations, who are morally bound, in ther corporate capacity to promote, 
by every available means, the health of those whose interests they are understood 
collectively to represent, and over whom their jurisdiction extends. Yet how 
lamentably do they fall short of a faithful execution of their trust ! Where are the 
walks publicly and gratuitously provided for a people, that they may enjoy the 
calm' scenes of nature in an atmosphere no longer black, filth}^, and vitiated? 
Where are the pleasure grounds purposely devoted to those who, immured within 
the precincts of a manufacturing town seek to sweeten their labour by the inter- 
change of innocent recreation? Where are the public amusements, provided for 
those whose minds and bodies, harassed by a continual struggle for subsistence, 
seek to escape anxiety in the relaxing influence of rustic sports and diversions'? 
Where are those temples dedicated to Cloacina, through whose channels the 
accumulated soil of 1 50,000 persons may find a ready egress, and human beings, 
as they pass along the alleys and the lanes, feel themselves no longer annoyed 
by its polluting and odoriferous exhalations? With the paltry exception of two 
or three drains commenced under the influence of fear from a reigning epidemic, 
no adequate provision has been made to expurge the town of that pernicious ma- 
terial which frightfully increases the victims of disease. The result of a mistaken 
and false economy. Where are the public conduits from which water may flow 
without hindrance into every dwelling, and personal and general cleanliness pro- 
moted by the erection of suitable bathing and swimming baths, either free, or at 
charges within the reach of the lowest inhabitant? Where have rewards been 
offered, and domestic happiness and comfort encouraged, by a judicious distribu- 
tion of prizes to those who, under every privation, have, by a well regulated sys- 
tem of cleanliness, frugality, and religious deportment, succeeded in rearing a 
family in the principles of virtue, and with a horror of uncleanliness and vice? 
Surely there is more merit in training the members of one family in the paths of 
virtue, than in rearing a thousand horned catfle for a prize show. Yet with what 
diffisrence the successful competitor in the latter instance is treated ! Are good 
citizens worth nothing? Is it wise, is it just, is it rational to view them as of less 
importance than the brute creation? If w^e except the trifling instances of a few 
praiseworthy individuals or private speculators, not one of these dudes, to their 
eternal disgrace be it said, has originated with our public corporations. When 
physicians have lifted up their voice, and complained of these things, what assist- 
ance have they received from the leglislator? Except temporarily, when our 
leaders and nobles were quailing, trembling and panic struck at the approach of 
cholera, what board of health have we had formed by government? When 
medical men have pointed out the means of purifying the air of crowded districts, 
or of avoiding putrid exhalations, has it not ended in a report of the House of 
Commons which has lapsed into nothingness ? When several of our metropolitan 
physicians have from time to time insisted on the necessity of a fresh supply of 
pure water, what aid has been given to them by the authorities of the realm? 
When the most revolting and disgusting exhibitions have been perpetrated under 
the guise of philanthropy, with a view to forward the hallucinations of Mesmer, 
and have also been countenanced and imitated by professors of the medical art, 
who have attempted and even obtruded their obscene performances on the vulgar 
eye, and have covertly made Mesmerism a means of seduction and rape — what 
castigation have they received from the hands of the State? When those dcemons 
of Mammon, homceopathy, and hydropathy, the former the fruitful offspring of an 
impotent and imbecile German physician, the latter of an ignorant and merce- 
nary Lusatian peasant, have stalked through the length and breadth of the land, 
destruction and misery following in their wake — what board has government insti- 
tuted, in whom might be confided the task of examining their systems, exposing 
their delusions^ and withstanding their unprincipled and deliberate attempts to immolate 
the victims of English credulity at the shrine of modern speculators in human life? When 
it has been indicated through the coroners of large towns that the habitual admi- 
nistration of narcotic drugs, recklessly supplied by druggists of every grade, is 



170 Bibliographical Notices. [Jan. 

not only the cause of rendering many children weak and puny, but also not un- 
frequently of sudden death, what interposition has government made? Has it not 
left this dishonest department of the pharmaceutical business — the counter practice 
of prescribing druggists — as free and uncontrolled by authority as ever? Even in 
adults, is not opium eating in our large manufacturing towns yearly on the increase? 
To repress the habitual use of narcotics is no easy task: with regard to that of 
tobacco, which has done more to damage the breed of the human race than any 
other single article of luxury, it is neither the policy nor interest of our government 
to oppose it, although they are too intelligent to (exclude the conviction that insanity, 
hydrocephalus and other hrain diseases have gone on increasing with its consumption, 
as may be seen from the statistics of New York and London." D. F. C. 



Art. XIX. — Medico-Legal Treatise on Homicide by External Violence, in relation to the 
causes of death by violence and the sigiis of death by the different kinds of injury to 
the nervous, circulating, respiratory and nutritive systems, also to the circumstances 
which modify the Medico-Legal characters of injuries and exculpatory pleas. By 
Alexander Watson, M. D., Fellow of the Royal College of Surgeons, of Edin- 
burgh, &c., &c. Second edition, enlarged, 8vo. Edinburgh, 1842. 

This treatise is valuable as a record of cases, most of them original ; and, when 
they are selected, the author is careful to quote his authorities. It is hence also 
trustworthy. 

The second edition is correctly designated. We have compared it with the first, 
published in 1837, and find that 350 pages, (being the whole contents of the 
first edition,) are republished in the present work, without the least addition or 
alteration. There is, however, annexed in the appendix, a valuable paper, pre- 
pared at the request of the Law Officers of the Crown in Scotland and circulated 
by them. We think that we shall do a service to the cause of justice, in making 
it accessible to the physicians of this country and therefore present it in full. 

Suggestions for the Medico-Legal Examination of Dead Bodies, by Professors 
Train, Christison and Syme. With additions, by A. Watson, M. D. 

Section I. — General Duties of Inspectors. 

1, It is of great moment that the authorities intrust the performance of medico- 
legal dissections only to practitioners of eminence and respectability, chosen in 
general from the nearest considerable town ; and that, in particular, the medical 
man who attended the deceased before death, or was the first to see him after, 
shall not, according to a common practice at present, be appointed one of the two 
inspectors as a matter of course, nor unless he be known to be qualified for the 
duty. Where the medical man who saw the deceased before death, or was the 
first to see the body after it, is not one of the official inspectors, he should be requested 
to be present, to communicate informafion. [If an accused person, or his friends, 
desire the presence of any particular medical practitioner, it seems fair and proper 
that he should be allowed to attend also.] 

2. More attention should be paid than is at present usual by the law authorities 
to supply the Medical Inspectors with information previously acquired on all 
points which are likely to bear on the medical part of the inquiry. For this end 
it appears to us, that Procurators-fiscal should supply the Inspectors with such part 
of the precognifion as may have been previously taken; and that one or more of 
the persons best acquainted with the circumstances of the case should accompany 
the Inspectors, and be at hand during the examination to answer their questions; 
and that in complex cases advantage would often be derived from requesting one 
of the Medical Inspectors to aid the law authorities in conducting the precog-nifion, 
wherever it touches the medical evidence.^^ 

* In many cases of poisoning, &c., it is impossible to arrive at a correct knowledge 
of the medical facts in any other way. We understand there is nothing in the Scotch 
Law of Evidence to prevent a medical man being so employed, who may afterwards 
have to appear as a witness on the trial. 



1846.] Watson's Medico-Legal Treatise on Homicide. 171 

3. Medical men ought to be on their guard against performing dissections in 
cases evidently judicial, without previously warning the proper authorities, or with- 
out a warrant; for instances have come under our notice, where, owing to the 
want of proper support, obstructions were thrown in the way, which might have 
proved fatal to the value of the investigation: and besides, the premature disclo- 
sure of the results of the inspection might frustrate other important steps of the 
precognition. 

4. It is desirable that the Medical Inspectors shall have an opportunity of viewing 
the body before it is undressed or moved from the spot where it was first found. 
If the body has been previously removed or meddled with, they ought to inform 
themselves accurately as to its original position. In many cases it is material that 
they personally visit the place where it w^as first seen; and they should inquire 
minutely into all the particulars connected with the removal of it. 

5. In cases where the body has been buried, and disinterment becomes neces- 
sary, it ought not to be removed from the coffin, except in presence of the in- 
spectors. 

6. Where a considerable period has elapsed between death and disinterment, 
the inspection must in all cases be proceeded with, although the body be found 
in a state of decay, unless the inspectors can positively say that the progress of 
decay is such as to render the examination nugatory in relation to its special ob- 
jects. The degree of decay which will justify such an opinion will differ with a 
variety of circumstances which cannot be properly specified here. It may be 
observed, however, that where injuries of the bones are to be looked for, or the 
traces of certain poisons, it is scarcely possible to assign the limit at which an 
inspection must of necessity be fruitless. It is of moment to remember, that the 
internal organs are often in a great measure entire, although the external parts are 
much decayed. The inspection, where the body is much decayed, will be rendered 
greatly less annoying to those present, by frequently washing the parts successively 
exposed with a solution of chloride of lime, of the strength of one part in forty ; 
but this must be carefully kept clear of any parts which may afterwards require 
to be examined for poison. 

7. No one should be allowed to be present at the examinafion out of mere curi- 
osity. But especially every individual, not of the medical profession, ought to be 
excluded, who is likely to be a witness either on the precognition or trial; and, 
consequently, any one who attends to give information, if likely to be a witness, 
should remain in an adjoining room. The reason for this rule is, that the medical 
inspection often furnishes good tests of the value of otherwise doubtful evidence of 
a general nature; and it is therefore necessary that the general witnesses should 
not have an opportunity of knowing what is observed in the dissection of the bod)''. 

8. The examinafion and dissection of the body should not be undertaken, if 
possible, except with sufficient dayfight in prospect to allow the whole inspection 
to be made without artificial light. 

9. While the one inspector conducts the practical details of the examinafion, 
the other should take notes of its successive steps, — indicating all the points in- 
quired into, with the observations made, and appearances presented, negafive as 
well as positive, — and stating simple facts only, without either generalizations or 
opinions. These notes should be looked over by both inspectors before the body 
is sewed up, so that omissions in the notes or in the inspection itself may then be 
supplied; and the notes, properly signed, dated and sealed, must be lodged with 
the law-authorities, a copy being preserved, if thought advisable, by the inspectors. 

10. The inspectors must deliver to the same authorities, and within two days, 
where no further examinafion is required, a distinct report containing their opinion 
on the case, with the reasons succincfiy but clearly stated. They must understand 
that they cannot found their opinion on any facts, represented to have been ascer- 
tained by themselves during the inspection, which are not specified in their notes. 

11. Great attention must be paid not to express any premature opinion of the 
nature of the case, from appearances presented on a partial examination; because 
the real cause of death often turns out very different from what it seems in the 
first instance to have been. In cases of injuries or apparent drowning, hanging, 
strangling, burning and the like, it should always be remembered, that the appear- 
ances of such death may have been accidentally induced or purposely contrived 



172 Bibliographical Notices. [Jan. 

after death^ while the actual cause of death is different, and only to be detected by 
a careful and thorough inspecti,on of the whole body. 

12. It is a good general rule, that all injured or diseased parts should be removed 
and preserved, wherever thi?' is practicable. Soft parts, except what are to become 
the subject of analysis in the search for poison, are best preserved in a concentrated 
or strong solution of common salt. 

13. When any portions of the body, or any substances found in or near it, are 
to be preserved for further examination, they ought never to be out of the custody 
of the inspectors, or of a special law-officer. They must be locked up in the ab- 
sence of the person who keeps them. When they are to be transmitted to a distance 
they should be labeled, and the labels signed by the inspectors; and, after being 
properly secured and sealed, they should be delivered by the inspectors themselves, 
or the special law-officer, at the coach-oflice by which they are to be forwarded. 

Section II. — Necessary Implements. 

14. Besides the ordinary instruments used in common dissections, the inspectors 
should be provided with a foot-rule and an ounce-measure graduated to drachms, 
for measuring distances and the quantities of fluids, — a few clean bladders for 
carrying away any parts of the body which it may be necessary to preserve for 
future examination, — and, in cases of possible poisoning, three or four bottles, of 
8, 12 and 16 ounces, with glass stoppers or clean corks, for preserving fluids to be 
analyzed. [It is also necessary to be provided with paper, pens, ink, and sealing- 
wax.] 

15. All distances, lengths, surfaces, and the like, whose extent may require to 
be described, ought to be actually measured; and the same rule ought to be fol- 
lowed in ascertaining the volume of fluids. Where large quantities of fluids are 
to be measured, any convenient vessel may be used whose capacity is previously 
ascertained by the ounce-measure. Conjectural estimates and comparisons, 
however common even in medico-legal inspections, are quite inadmissible. 

Section III. — External aspect and examination of the body. 

16. The importance of the external examination, and the particulars of it to be 
chiefly attended to, will vary in different cases with the probable cause of death. 
It comprehends: 1. An examination of the position of the body when found. — 2. 
Of the vicinity of the body, with a view to discover the objects on which it rested, 
[might have fallen upon, or been suspended from,] marks of a struggle, signs of 
the presence of a second party about the time of death, or after it, weapons or other 
objects, the property or not the property of the deceased, the remains of poisons, 
marks of vomiting; and, where marks of blood are of importance, and doubts may 
arise as to their really being blood, the articles presenting them must be preserved 
for farther examination. — 3. Of the dress, its nature and condition, stains on it of mud, 
sand, or the like, of blood, of vomiting, of acids, or other corrosive substances, in 
the case of suspected poisoning, marks of injuries, such as rents or incisions; and 
where injuries have been inflicted on the body, care should be taken to compare 
the relative position of those on the body and those on the clothes; and where 
stains apparently from poison are seen, the stained parts are to be preserved for 
analysis. — 4. Ligatures, their material and kind, as throwing light on the trade of 
the person who applied them, the possibility or impossibility of the deceased 
having applied them himself, their sufficiency for accomplishing their apparent 
purpose, &c. 

17. The inspectors will commence the examination of the body itself by survey- 
ing the external surface and openings. Before cleaning it, they will examine it 
on all sides, not neglecting the back, as is often done, and look for marks of mud, 
blood, ligatures, injuries, stains from acids, and the like, foreign bodies, or injuries 
within the natural openings of the body, namely, the mouth, nostrils, ears, anus, 
vagina, and urethra. If there are impressions of finger-marks, they will consider 
w-hich hand produced them. If there be any doubt about stains being blood, the 
skin presenting them must be preserved for analysis. If there be acid stains, or 
other probable remains of poison, these must also be preserved. Marks of in- 
juries are not to be minutely investigated at the present stage, unless they consist 



1846.] Watson's Medico-Legal Treatise on Homicide. 173 

of such stains as may be removed by the subsequent washing of the body; and in 
that case, among other points to be attended to, the inspectors will consider, from 
their shape, surface or colour, what weapons might have produced them. The 
ordinary places for the impressions of ligatures are the neck, the wrists, the ankles 
and the waist. The degree of looseness or rigidity of the joints, and the degree of 
warmth of the trunk and extremities, should be noted in the present stage of the 
proceedings; in other cases the progress of putrefaction, as indicated by the odour 
of the body, the looseness of the cuticle, the colour of the skin, and formation of 
dark vesicles on it, the evolution of air in the cellular tissue, the alteration of the 
features, the softness of the muscles, the shriveling of the eyes, the looseness of 
the hair and nails. 

]8. In this part of the examination, it will sometimes be necessary to observe 
the particulars by which the body may be identified. These are numerous. But 
the most important are the stature, [the age and sex,] the degree of plumpness, 
the size and form of the nose and mouth, the colour of the eyes and hair, the state 
of the teeth, warts, naevi, deformities, scars of old wounds; [and, if a woman,' 
marks of her having had one or more children.] 

19 The body is next to be washed and the hair of the head shaved, or at least 
closely cut; and a thorough examination of the whole integuments is again to be 
made. At this stage the inspectors will look particularly for the appearance of 
lividity, noting its chief seat and its relation to the posture in which the body was 
found, — for impressions on the skin of objects on which it had rested, — for marks 
of injuries, more especially contusions, taking care to ascertain their real nature, 
by making incisions through the skin, — for marks of disease, such as eruptions, 
ulcers, and the like, more especially on the genital organs, — for marks of burning 
— for marks of concealed punctures in the nostrils, mouth, external openings of 
the ears, the eyes, the nape of the neck, the arm-pits, the anus, the vagina, and 
beneath the mammae or scrotum ; infants, also, in the fontanelles and the whole 
course of the spine. At this stage, wounds and other injuries should be carefully 
examined, but not probed, except very cautiously, above all, if situated over any 
of the great cavities. 

Section IV. — Dissection or internal examination of the body. 

20. In commencing the dissection of the body, it must be laid down as an in- 
variable rule, that all the great cavities should be examined, and also every im- 
portant organ in each, however distinctly the cause of death may seem to be 
indicated in one of them. In general, it is right even to examine the cavity of 
the spine, at all events its upper portion. 

21. In examining the organs situated in the several cavities of the body, the 
inspectors must be guided in a great measure by their ordinary anatomical and 
pathological knowledge. 

22. The inspectors should begin with that cavity over which there is a wound 
or other mark of injury. Or, if there be an injury on the extremities, the dissection 
ought to commence there. In the absence of any such guide, that cavity should 
be taken first where the circumstances of death, so far as they are ascertained, may 
lead the inspectors to expect unusual appearances. In other cases, it is best to 
lay open the chest and abdomen : to take a general survey of the parts exposed, 
without disturbing them materially; or to proceed to the head, which may be 
examined thoroughly in the first instance ; afterwards to examine carefully the 
chest and belly: and the spine maybe reserved till the conclusion. Wherever 
unusual appearances are discovered in the first cursory survey, the anatomical 
examination ought in general to be begun there. 

23. In examining the several regions of the body, it is to be observed, that 
wherever a wound, or other obvious injury of the external parts, lies in the way 
of the ordinary incisions, that part must be avoided, so as to leave the external 
injury unaltered. 

24. The most approved mode of opening the head in medico-legal cases is, 
after dividing the integuments from ear to ear, and reflecting the scalp over the 
forehead and occiput, to make the usual circular incision through the bone about 
an inch above the orbits in front and over the occipital protuberance behind, cutting 
through the outer table of the skull only, and finishing the incision with the chisel 

No. XXL— January, 1846. 13 



174 Bibliographical Notices » [Jan. 

and mallet;*^ — and to raise the skull cap from before backwards, taking care to 
detach the dura mater from the skull with the handle of the scalpel or a spatula, 
where it adheres firmly. 

25. The ordinary mode of examining the membranes of the brain and the brain 
itself answers well in medico-legal dissections. Effusions of fluid within the skull 
should always be measured. After the brain is removed^ the dura mater ought 
to be stripped from the base of the skull to facilitate the search for fractures there ; 
which will of course indicate external violence. After the removal of the brain, 
the upper part of the spinal canal should be examined through the foramen mag- 
num, before any part of its course be laid open ; and search should be particularly 
made for the dislocation or other injury in the region of the atlas and dentata. In 
cases of fatal fractures of the head, the strength of the bones should be attended to. 
In cases of extravasation within the head, the state of the coats of the larger cere- 
bral arteries should be examined. 

26. The best mode of opening the spine is, after having finished the examina- 
tion of the brain. — to cut through the integuments from the occiput to the coccyx, 
— to lay the vertebrce thoroughly bare on each side by cutting away the muscles, — 
to make an incision with the saw on each side of the skull, from the postero- 
inferior angle of the parietal bones into the lateral edge of the occipital hole, — to 
remove the triangular portion of the occipital bone thus detached, — and then to 
cut the rings of the vertebrEc on each side with the bone-nippers or spine-knife, t 
beginning with the atlas. The only exception to this course occurs where there is 
reason to think that the bones are injured; in wdiich case, the laying open of the 
canal should stop at the distance of two or three vertebras from the injury, and 
the injured bones, wiih two or three adjacent vertebra3 on each side, should be 
removed entire before the examination is extended farther down the spine. 

27. The best mode of exposing the organs of the throat is to cut through the lower 
jaw-bone at the chin, to cut the soft parts close to the inner surface of each half of 
the bone backwards, and then to turn the two segments outwards. 

28. The best mode of examining the organs situated in the throat is — after dividing 
the jaw-bone at the chin, and turning its two segments outwardly, as advised 
in ^ 27, — to dissect the solt palate from the bone, and, proceeding backwards, to 
detach the whole soft parts from the base of the skull and vertebrae down to the 
sternum, leaving them connected with the organs in the chest. Besides the ordi- 
nary points to be attended to in this part of the examination, the presence of vene- 
real or other ulcerations is a matter requiring attention in many cases. 

29. It is necessary to examine the pharynx and gullet, the larynx, trachea, and 
its greater ramifications, the lungs, the heart, and the great vessels, with particular 
care ; because here are most frequently found the causes of sudden natural death. 
In examining the heart, each auricle and each ventricle ought to be laid open by 
an independent incision of its parietes; and this should not intersect either any of 
the valvular openings or the septum cordis. 

30. For laying open the chest and abdomen, the most convenient method is to 
make an incision through the under lip, down the forepart of the neck, chest, and 
abdomen, to the pubes, — then to dissect back the integuments along the whole 
line, taking away the muscles of the chest with the skin, but leaving those of the 
abdomen, — next, to divide the cartilages of the ribs and the remaining parietes of 
the abdomen round its circumference, — to raise the muscles of the belly, and, 
proceeding upwards, to raise also the sternum. In separating the sternum from 
the clavicles, care must be taken not to wound the subjacent vessels; and this may 
be avoided by the dissector moving each shoulder so as to show the exact position 
of the sterno-clavicular joints, and then dividing both joints caufiously. In dividing 
the cartilages of the ribs, the saw is sometimes necessary. The cartilages should 

* [Here we completely differ as to this being "the most approved mode of opening 
the head in medico-legal cases." The chisel and mallet should never be used where 
there is any likelihood of finding a fracture of the skull j for how could this be dis- 
tinguished from fractures made with the mallet?] 

+ [Here a preference should be given to the saw, by which it is not only more easily 
accomplished, but there is no risk of confounding previous fracture with that madeia 
dissecting.] 



1846.] Watson's Medico-Legal Treatise on Homicide. 175 

be cut as far from the sternum as possible, to give free space for the subsequent 
examination. 

31. In inspecting the organs in the chest, a cursory examination should be first 
made by turning them over, ascertaining the nature, and measuring the quantity 
of effused fluids, feeling for [fractures of the ribs] tumours or other diseases, and 
opening the pericardium to obtain a view of the heart. The most convenient 
course to pursue next is, to lay open the left ventricle and right auricle of the heart, 
in order to judge of the quantity and state of the blood in both sides of that organ."* 
— and then to remove the whole organs in the chest, namely, the lungs, heart and 
gullet, together with the parts dissected downwards from the throat, in one mass, 
and to examine them in detail on a table. But previously, a ligature should be 
applied on the gullet, just above the cardiac orifice of the stomach. 

32. The organs in the abdomen ought to be turned over, like those of the chest, 
before any of them is minutely examined* and, in the subsequent examination, 
that organ is to be first proceeded with, in which there may appear to be disease. 

Section V. — Examination in cases of Wounds and Contasions. 

33. The most approved mode of examining injuries is, if they be not situated 
over great cavities, to expose the successive layers of muscles in the manner of 
an ordinary dissection, observing carefully what injuries have been sustained by 
the parts successively exposed before they are divided. No advantage will be 
derived from previous injections of the blood-vessels, even supposing this were 
always attainable. Careful dissection, with a knowledge of the structure and 
relations of parts, is a safer guide. 

34. The seat of wounds must be described by actual measurement from known 
points, — their figure and nature also carefully noted, — and their direction ascer- 
tained with exactness. 

35. Before altering by incisions the external appearances of injuries, care must 
be taken to consider what weapon might have produced them; and, if a particular 
vv^eapon be suspected, it should be compared with them.f 

36. Apparent contusions must be examined by making incisions through them; 
and the inspectors will note whether there be swelling or puckering of the skin — ■ 
whether the substance of the true skin be black through a part or the whole of its 
thickness, — whether there be extravasation below the skin, and whether the blood 
be fluid or coagulated, generally or partially, — whether the soft parts below be 
lacerated, or subjacent bones injured, and whether there be blood in contact with 
the lacerated surfaces. By these means the question may be setfled, whether the 
contusions were inflicted before or after death. 

37. In the case of wounds, too, the signs of vital action must be attended to, 
especially the adhesion of blood to their surfaces, or the injection of blood into the 
cellular tissue around, or the presence of the signs or sequelae of inflammation.! 

38. Where large arteries or veins are found divided, care must be taken to cor- 
roborate the presumption thus arising by ascertaining in the subsequent dissection, 
whether the great vessels and membranous viscera be unusually free of blood. 

39. In the course of the dissection of wounds, a careful search must be made 
for foreign bodies in them. Where fire-arms have occasioned them, the exami- 
nation should not be ended before discovering the bullet, wadding, or other article 
lodged; and whatever is found must be preserved. Where the article discharged 
from fire-arms, or indeed any other weapon, has passed through and through a part 

* [It should be recollected that if the blood is in a fluid state, the quantity contained 
in the right auricle of the heart may be materially affected by the head having been ex- 
amined previously, as the blood may have escaped from the heart by the jugular 
veins.] 

j- [The characters of injuries should never, if possible, be altered by incisions. The 
wounded parts should be cut out entire and carefully preserved.] 

t The gorging of the cellular tissue in the vicinity of wounds with coagulated blood 
or true ecchymosls, should be carefully distinguished from what Continental writers 
term suggUkition, or the cutaneous infiltration of the colouring matter of the blood, 
which takes place in the depending parts of a body after death. 



176 Bibliographical Notices. [Jan. 

of the bodyj the entrance-wound and exit-wound must be carefully distinguished 
by their respective characters. 

40. When wounds are situated over any of the great cavities, they ought not to 
be particularly examined till the cavity is laid open: and, in laying open the 
cavity, the external incisions should be kept clear of the wounds. 

41. The organs in the abdomen furnish the best source of information, as to the 
signs of bloodlessness in presumed death by hemorrhage. [The state of the brain 
is also a good criterion.] 

Section VI. — Examination in cases of Poisoning. 

42. In examining a body in a case of suspected poisoning, the inspectors should 
begin with the alimentary canal, — first, tying a ligature round the cardiac end of 
the stomach, and two round its pyloric end, — then, removing the stomach and 
whole intestines, — next, dissecting out the parts in the mouth, throat, neck and 
chest, in one mass, — and, finally, dissecting the gullet, with the parts about the 
throat, from the other organs of the chest. The several portions of the alimentary 
canal may then be examined in succession. 

43. In all their operations they ought to make sure that the instruments, vessels 
and bladders used, are quite clean. 

44. In cases of supposed poisoning, a minute inquiry must, in the first instance, 
be made into the symptoms during life, — their nature, — their precise date, espe- 
cially in relation to meals, or the taking of any suspicious article, their progressive 
development, — and the treatment pursued. It is impossible to be too cautious in 
collecting such information \ and. in particular, great care must be taken to fix the 
precise date of the first invasion of the symptoms and of the previous meals. The 
same care is required in tracing the early history of the case, where the inspector 
happens to yisit the individual before death; and if suspicion should not arise till 
his attendance has been going on for some time, he ought, subsequently to such 
suspicions, to review and correct the information gathered at first, especially as to 
dates. All facts thus obtained should be immediately committed to writing, and 
ought to form part of the narrative of the inspection to be delivered to the law 
authorities. — See ^ 9, 10. 

45. Before inspecting the bodies, the inspectors, after ascertaining the history of 
the case, should proceed, if they see cause, to search, in company with the proper 
law-officer, for suspicious articles in the house of the deceased. These are sus- 
pected articles of food, drink, or medicine, — the vessels in which they had been 
prepared or afterwards contained, — the family stores or the articles with which 
suspected food, &c.. appears to have been made. All such articles must be secured 
according to the rules in s^ 13 for preserving their idendty. In this examination, 
the body-clothes, bed-clothes, floor and hearth, should not be neglected, as they 
may present traces of vomited matter, acids spurted out or spilled, and the like. 

46. When a medical man is called to a case during life, where poisoning is 
suspected, he ought as soon as possible to follow the instructions laid down for 
securing articles in which poison may have been administered. 

47. In the same circumstances, it is his duty to observe the conduct of any sus- 
pected individual, — were it for no other reason than to prevent the remains of 
poisoned articles from being put out of the way and to protect his patient against 
farther attempts. 

48. The whole organs of the abdomen must be surveyed, but particularly the 
stomach and whole tract of the intestines, the liver, spleen, and kidneys, the blad- 
der; and, in the female, the uterus and its appendages. The intestines should in 
general be slit up throughout their whole length ; and it should be remembered 
that the most frequent seat of disease of their mucous membrane is in the neigh- 
bourhood of the ileo-ccDcal valve. 

49. In cases where the possibility of poisoning must be kept in view, the con- 
tents of the stomach should be preserved, — also sometimes those of the small and 
great intestines, — and occasionally even those of the gullet. 

50. It is generally necessary to ascertain whether any spirituous fluid [or opium] 
be contained in the stomach. This may sometimes be done by the odour of its 
contents, but oftener not: so that, where the point is one of evident consequence, 



1846.] Watson's Medico-Legal Treatise on Homicide. 177 

it may be necessary to search for alcohol, by distilling the contents [if any], and 
examining the distilled liquid, as directed in works on poisons. 

51. The intestines maybe examined at once by laying open their whole course. 
The parts where appearances are most frequently found in poisoning are, the duode- 
num, upper part of the jejunum, lower part of the ileum and rectum. Care should 
be taken to preserve their contents in a bottle, and the intestines themselves in a 
bladder, if they present any unusual appearance which will keep. The stomach 
should be taken out entire and its contents emptied into a bottle. The smell pro- 
ceeding from its contents should be observed when it is first laid open, as this 
often alters speedily. If the stomach present any remarkable appearance, its ex- 
amination may be reserved, if convenient, till a future opportunity; but in every 
circumstance it must be preserved and carried away. The throat and gullet may 
be examined at once, and preserved with their contents; which, if abundant, may 
be kept apart in a bottle. 

52. No person ought to undertake an analysis in a case of suspected poisoning, 
unless he be either familiar with chemical researches, or have previously analyzed 
with success a mixture of organic substances, containing a small proportion of the 
poison suspected. 

53. The inspectors will learn from the law-authorities, whether, in the event of the. 
discovery of poisoning by them, it is probable that the opinion of some other person 
practised in toxicological researches may be required; and, in that case, they will 
take care to use only one-half of the several articles preserved for analysis. They 
will remember that the stomach itself is one of the articles for analysis, because 
poison may be found there, though not present in the contents. The identity of 
the subjects of analysis must be secured by the rules in ^ 13. 

Section Vll. — Examination in cases of Suffocation. 

54. In cases of suspected drowning, the inspectors will observe particularly 
whether grass, mud, or other objects are clutched by the hands, or contained under 
the nails; whether the tongue be protruded or not between the teeth; whether any 
fluid, froth or foreign substances be contained in the mouth or nostrils, the trachea 
or bronchial ramifications: whether the stomach contain much water; whether 
the blood in the great vessels be fluid. When water, with particles of vegetable 
matter or mud is found within the body, these must be compared with what may 
exist in the water in which the body was discovered. Marks of injuries must be 
compared diligently with objects both in the water and on the banks near it. 

55. In cases of suspected death by hanging, strangling or smothering, it is im- 
portant to attend particularly to the state of the face as to lividity, compared with 
the rest of the body ; the state of the conjunctiva of the eyes as to vascularity ; of 
the tongue as to position; of the throat, chin and lips, as to marks of nail-scratches, 
ruffling of the scarf-skin, or small contusions ; the state of the blood as to fluidity; 
the state of the membranous organs in the abdomen, and of the lungs, as to con- 
gestion. The mark of a cord or other ligature round the neck, must be attentively 
examined; and here it requires to be mentioned, that the mark is often not dis- 
tinct till seven or eight hours after death, and that it is seldom a dark livid mark, 
as is very commonly supposed, but a pale greenish-brown streak, if made with a 
rope, presenting in general no ecchymosis, but the thinnest possible line of bright 
redness at either edge, where it is conterminous with the sound skin. Neverthe- 
less, effusions of blood and lacerations should be also looked for under and around 
the mark, in the skin, cellular tissue, muscles, cartilages and lining membrane of 
the larynx and trachea. Accessory injuries on other parts of the body, more 
especially on the chest, back, and arms, must also be looked for, as likewise the ap- 
pearance of coagulated blood having flowed from the nostrils or ears, and the dis- 
charge of feces, urine, or semen. 

Section VIII. — Examination in cases of Burning. 

56. In supposed death by burning, the skin at the edge of the burns should be 
carefully examined for redness, or the appearance of vesicles containing fluid. 



178 Bibliographical Notices. [Jan. 

Section IX. — Examination in cases of Infanticide. 

57. Tn cases of suspected infanticide, certain peculiarities must be borne in mind. 
The cavity of the head shoukl be laid open with a pair of scissors. In opening 
the abdomen, the incision maybe carried through the whole parietes at once; and 
the navel should be avoided^ so that the state of the vessels of the navel-string may 
be examined correctly. 

58. The inquiry in cases of infanticide should be conducted with a distinct 
reference to the five folJowing questions: — 1. The probable degree of maturity of 
the child ? 2. How long it has been dead ? 3. Whether it died before, during, or 
after delivery, and how long after? 4. Whether death arose from natural causes, 
neglect or violence ? And, 5. Whedier the suspected female be the mother of the 
child? 

59. The points to be attended to for ascertaining the probable degree of maturity 
of the child are the state of the skin, its secretions and its appendages, the hair and 
nails; the presence or absence of the pupillary membrane; the length and weight 
of the whole body; the relative length of the body and its members; and the 
point on the abdomen corresponding with the mdddle of the length of the body: 
the relative size of the lungs and heart; the relative size of the liver, indicated by 
the position of its margin; the situation of the meconium in the intestines; the 
site of the testicles in the case of males.* 

60. The points of chief importance in reference to the period which has elapsed 
after death are those specified in the last clause of ^ 17. 

61. The circumstances which indicate whether the child died before, during or 
after parturition, and how long after it, are the signs of putrefaction within the 
womb; the marks on the crown, feet, buttocks, shoulders, &c., indicating presump- 
tively the kind of labour; the state of the lungs, heart and great vessels, showing 
whether or not it had breathed; the nature of the contents of the stomach and of 
the intestines; the presence or absence of urine in the bladder; the presence of 
foreign matters in the windpipe ; the state of the umbilical cord; or of the navel 
itself, if the cord be detached. 

62. In order to examine properly the state of the lungs, heart and great vessels, 
with a view to determine whether or not the child had breathed, the inspection 
should be made in the following order: — Attend, first, to the situation of the lungs, 
how far they rise along the sides of the heart, — to their colour and texture, — and 
whether they crepitate or not. Examine next, but without displacing them, the 
condition of the ductus venosus and umbilical vessels. Then secure aligature round 
the great vessels at the root of the neck, keeping clear of the ductus arteriosus, and 
another round the vena cava above the diaphragm. Cut both sets of vessels beyond 
the ligatures, and remove the heart and lungs in one mass ; which must be weighed 
and put into water, to ascertain whether the lungs, with the heart attached, sink or 
swim. In the next place put a ligature round the pulmonary vessels, close to the 
lungs, and cut away the heart by an incision between it and the ligature. Com- 
pare now the relation of the diameter of the ductus arteriosus to that of the pul- 
monary trunk and of the pulmonary branches, and look for any indication of partial 
contraction in the dnct towards its aortal end. Lastly, ascertain the weight of the 
lungs; their relative weight to that of the whole body; whether they crepitate 
when handled; whether they sink or swdm in water; whether blood issues freely 
or sparingly when they are cut into; whether any fragments swim, in the instances 
where the entire lungs sink; and, in every instance of buoyancy, whether frag- 
ments of them continue to swim when well squeezed in a cloth. 

63. The points to be considered in relation to the cause of death, are the signs 
of natural death before parturition, and of natural, accidental and violent death 
during parturition, as well as after delivery. The most frequent forms of violent 
death during labour are, puncture of the fontanelles, orbits, or nucha; twisting of 
the neck after delivery of the head; compression of the head; detruncation of the 

* Those who have studied carefully the development of the nervous system and the 
progress of ossification in the foetus, may attend also to the stale of the brain, more 
especially of its convolutions, and to the advancement of ossificalion in the head and 
vertebrae. But the indications drawn from these sources are not so precise or plain as 
to be appreciated accurately by ordinary observers. 



1846.] Velpeau's Midwifery. 179 

head; strangling; and smothering. The chief varieties of violentdeath after delivery 
are^ smothering by overlaying or otherwise ; hemorrhage from the umbilical cord: 
simple exposure; starvation ; injuries of the head from falls, blows, or compression; 
wounds of the throat; puncture of the fontanelles, nucha, orbits, cribriform plate, 
spine, ears or heart ; laceration of the great gut, or of the internal parts of the 
throat, by instruments thrust into the anus or mouth; drowning; poisoning; burn- 
ing; strangling with the hand or a ligature; choking by foreign bodies thrust into 
the back of the throat, or by dividing the frcenum linguas and doubling back the 
tongue. 

64. The circumstances noticed in ^ 59, 61, 62, compared with the signs of recent 
delivery in the female, will lead to the decision of the question, whether the sus- 
pected female be the mother of the child. These are the signs of the degree of 
maturity of the child; the signs on the body of the kind of labour; the signs which 
indicate the date of its death, and the interval which elapsed both between its 
birth and death, and between its death and the inspection. 

Thos. Stewart Traill. 



R. Christison. 
James Syme. 



January 19, 1839. 



Art. XX. — An Elementary Treatise on Midunfery ; or PrincipJcs of Tokology and 
Embryology. By Alf. A. L. M. Velpeau, M. D., etc. etc. Translated from the 
French, by Charles D. Meigs, M. D., Member of the American Philosophi- 
cal Society; Professor of Midwifery in the Jefferson Medical College, etc. 
Third American edition, with Notes and Additions by William Harris, M. D.. 
Member of the American Philosophical Society; Lecturer on Midwifery and 
the Diseases of Women and Children. Philadelphia, 1845. Lindsay & Bla- 
kiston. 8vo. pp. 600. 

Lectures on Puerperal Fever. By Wm. Harris, M.D. Philadelphia, 1845 : pp. 50, 
Svo. 

The Treatise of Velpeau has been so long before the profession, and its cha- 
racter has become, in consequence, so well and generally understood, that it is 
unnecessary to enter here into an examination of its peculiar merits. While we 
assign to it a very high rank among the modern elementary works on the princi- 
ples of midwifery, we must, at the same time, confess, that we possess more than 
one treatise, which, in our opinion, are better adapted, in many points of view 
for the use of the student, both to induct him into the leading principles of the 
theory and practice of midwifery, and to serve him as a text book in following a 
course of obstetrical lectures. 

It is in consequence alone of the notes and additions of Dr. Harris — to whom, 
in the absence of Dr. Meigs, the editorship of this third American edition has 
been confided — that the work fails under our notice at the present time. 

It is with exceeding regret that we have found it to be a mere reprint of Dr. 
Meigs' translation of the first edition of Velpeau, without the slightest reference 
to the additions and emendations made by the author in his later editions. — 
Nor are the deficencies of the tirst edition supplied in the notes of Dr. Harris, which 
are but few and short; the principal addition being a chapter on puerperal fever. 
Instead of presenting a concise account of the recent investigations in reference to 
the physiology of menstruation, impregnation and conception — the early stages of 
development of the fa3tus in ovo, and to other questions of interest, that have 
been advanced in reference as well to the practical as to the theoretical subjects 
embraced in the treatise of Velpeau, since the publication of its fiirst edition, the 
editor has contented himself with merely appending explications of what is ex- 
pressed with sufficient accuracy and fullness by the author; or etymologies which, 
when not positively erroneous, are unnecessary, because given by M. Velpeau 
himself with greater accuracy ; or in remarks which throw no light upon any point 
of obscurity or have, so far as we can see, any important practical bearing. 

Some of the editor's notes are, moreover, very unfortunately introduced and 



180 Bibliographical Notices. [Jan. 

worded. Thus on page 27, after the words ^- at birth'^ we have as a note, '^ihat 
iSj at the end of the seventh month of foetal hfe." 

The case detailed in the note on page 60 would be a highly interesting one — 
did we know anything in relation to the patient or of the existence of a "hyper- 
trophied clitoris'^ from a less exceptionable source than what was "indirectly'' 
learned •' from her early friends and from her partner." 

In a note on page 62, we are told that " several females have been cured of 
nymphomania and masturbation by extirpating the clitoris, after every other 
remedy had failed."' It is to be regretted that a detailed account of these cases is 
not given — we are entirely unacquainted with them, and doubt very much whether, 
in any instance, true nymphomania can be removed by such a procedure.— 
Levret and others we know have performed the operation — but without the slightest 
advantage. The suggestion of Dr. Blundell, to extirpate the ovaries in cases of 
ujmiphomania, were we warranted in carrying it into execution, would afford 
perhaps a more certain remedy. 

On page 65, M. Velpeau states that "the perineum separates the vulva from 
the anus," but in a note Dr. Harris informs us that " under the term perineum, 
the accoucheur includes all the space between the posterior commissure of the 
vulva and the point of the coccyx," which is certainly a novel idea. 

But it is unnecessary to notice any further the notes appended to this third 
American edition, unless it be to express the regret with which we have observed 
the very great inaccuracy in the orthography of the names of the several authori- 
ties referred to — thus we have Tonelle^ Peauteau, M'Intosh, and Stall, for TonnellC; 
Pouteau, Mackintosh and Stoll. 

The chapter added by Dr. Harris on puerperal fever, though loose and imper- 
fect, contains, with not a few inaccuracies, some very good ideas in relation to 
the character and treatment of several of the forms of febrile disease that have 
been included under the general denomination of puerperal fever. 

It has been for us a most unpleasant task to be compelled to point out what we 
conceive to be the deficiencies in the editorial labours of Dr. Harris as exhibited 
in the work before us, but we had no other alternative^ in the faithful perform- 
ance of our duties as bibliographists. 

The lectures of Dr. Harris on puerperal fever furnish a very good outline 
of some of the more important points connected with the pathology and treat- 
ment of that all-important disease — but M^e have in vain sought in them for 
anything either novel or particularly striking. While they are neither very well 
arranged, very profound, always perfectly clear, nor adapted in all respects for 
the instruction of the student — there is, nevertheless, much to praise in the patho- 
logical and practical views presented by the lecturer. His style and modes of 
expression are not always the most correct, and he also here makes the same 
sad work with the orthography of the names of the authorities quoted by him. — 
Still, in relation to the nature and treatment of puerperal fever, the teachings of 
the lecturer, so far as they go, are very judicious, and better calculated to lead 
to a rational practice than the one-sided views inculcated by several of the 
modern writers on the disease, notwithstanding their opinions may be enforced 
Avith greater skill and eloquence, and supported by a more elaborate and specious 
chain of reasoning. 

The readers of these lectures may not, perhaps, perceive any great necessity for 
their publication, or conceive that the author could have expected to reap any credit 
from their appearance in print. They certainly add nothing to our knowledge in re- 
gard to the subjects discussed — they contain no series of observations founded upon 
the personal observation of the lecturer — no new deductions in relation to the cha- 
racter and treatment of any one of the forms of puerperal fever — nor do they 
even place the facts and observations already upon record in any new light. It 
must be recollected, however, that they were published in compliance with the 
request of the author's class — and however inadequate judges students may be 
esteemed of the "a6/e" character of any given series of lectures; to their urgent 
requests for publication, grave professors^ as well as private lecturers , have occa- 
sionally found it their policy to accede. D. F. C. 



1846.] Simon's Animal Chemistry. 181 

Art. XXI. — Animal Chemistry, with reference to the Physiology and Pathology of Man. 
By Dr. I. Franz Simon, Fellow of the Society for the Advancement of Physio- 
logical Chemistry, at Berlin, &c. Translated and edited by George E. Day, 
M.A. and L.M., Cantab., Licentiate of the Royal College of Physicians. Part 
I. Philadelphia: Lea & Blanchard, 1845. 8vo. pp. 292. 

This is a reprint of one of the valuable series of works issued by the Sydenham 
Society, and we have been much pleased that it has been selected for repub- 
lication in this country, as it will enable our medical brethren to avail them- 
selves of the great mass of information contained in its pages on the chemistry 
of man. Among the numerous essays and treatises on organic chemistry that 
have appeared within the last few years, the "Chemistry of Man," by Dr. 
Simon, is generally acknowledged to be the most complete and satisfactory, 
and as containing the best conducted series of observations on the constituents of 
the animal system. The present publication not only includes the original work^ 
but is also greatly enriched by extracts from the subsequent writings of the author, 
and by an able introduction by the translator and editor, based on a former treatise 
of Dr. Simon's, and containing an abstract of the researches of other investigators 
in this difficult branch of science. Dr. Day's introduction is by no means the 
least instructive portion of the work, as it gives a brief but clear view of the con- 
stituents of animal matter, thus much facilitating the perusal of the work, to those 
who have not paid close attention to the progress of organic chemistry within the 
last few years. 

What renders Dr. Simon's work more peculiarly interesting to the physician is^ 
that it treats not only of the physical and chemical relations of the solids and 
fluids in a state of health, but also of the modifications they undergo in disease. 
The order he has adopted is more exactly physiological, but at the same time is 
the most natural. Thus, after treating of the circulating fluids, he takes up the 
consideration of the secretions and excretions, which is followed by that of the 
solids, and concludes with a description of solid and fluid morbid products. The 
part now published contains only the analysis of the circulating fluids in a healthy 
and morbid state. The author's views on the blood, and its relations to nutrition and 
animal heat are thus summed up by him. '^ The blood is subjected to a continuous 
metamorphosis, which may be regarded as the expression of its vitality. The nutri- 
tion of the peripheral system is effected by the liquor sanguinis, not by the blood cor- 
puscles. The liquor sanguinis affords nutriment to the cells and organs which pos- 
sess an inherent power of selecting proper material, or of forming it from new 
homologous matter, at the same time secreting the products of decomposition. The 
principal nutritive matters in the liquor sanguinis are albumen, fibrin and fat, — 
The chief products of this metamorphosis are the extractive matters and lactic 
acid, which occur in the excretions, especially in the urine. Urea, bilin and 
carbonic acid are either not products of the metamorphosis of the blood during 
the act of nutrition in the peripheral system, or at most they are only in part formed 
by it. They must be regarded as products of the vital energy of the blood cor- 
puscles, which, doubdess, possess the same power of attracting nutriment and of 
throwing off" decomposed products as other living cells. The proper nutriment 
of these corpuscles is oxygen, albumen, and probably also fat, which are furnished 
them by the liquor sanguinis. The most important products of their metamor- 
phosis are carbonic acid, urea, fibrin, extractive matters, and very probably some 
of the constituents of the bile. The leading and most important object of this vital 
energy of the blood corpuscles is the production of animal heat, "without which 
every function of the organism, nay, even life itself, would be instantaneously 
annihilated. The production of animal heat is due to the combination of oxygen 
with the carbon of the globulin ; the principal products of this reaction are carbonic 
acid and urea, or uric acid. The urea excreted may thus be regarded as a mea" 
sure or equivalent of the animal heat developed.*' 

The tables of analysis of the fluids in different forms of disease are highly in- 
teresting, though we are more than skepfical as to the practical importance of 
them as a guide in the treatment of these maladies, as we find so great a variation 
in the results, both of the normal and abnormal fluids, that it is impossible to 



182 Bibliographical Notices. [Jan. 

admit more at present, than that in health a certain average of the constituents 
prevails, which is variously modified in disease; at the same time we cannot deny 
their utility, but it will require a long time, and a vast number of analyses, before 
we can connect the greater or less proportion of these constituents in a definite 
manner with functional derangements of the organs, and still more with sym- 
pathetic phenomena. The work we are noticing is an excellent model for 
these investigations, and is well worth an aUentive study, both to the chemist 
and pathologist, and we hope that the second portions of it may soon appear, 
when vce shall endeavour to give a full view of the whole subject. R. E. G. 



Art. XXn. — On the Theory and Practice of Midwifery. By Fleetwood Churchill, 
M.D., M.R.I. A., &c., &c. With Notes and Additions by Robert M. Huston,' 
M.D., &c., &c. Second American edition. With one hundred and twenty-eight 
illustrations, from Drawings by Bagg and others: Engraved by Gilbert. 8vo. pp. 
525. Philadelphia, 1845: Lea & Blanchard. 

Our opinion of Dr. Churchill's treatise having been already, on more than one 
occasion, very fully expressed, it will be unnecessary again to repeat our high 
estimate of its merits. Few treatises will be found better adapted as a text book 
tor the student, or as a manual for the frequent consultation of the young practi- 
tioner. 

The edition before us is enriched by the very judicious labours of the American 
Editor. Without loading the text of the author with unnecessary and frivolous 
notes — the additions of Dr. Huston will be found very materially to augment the 
value of the treatise of Dr. Churchill — by bringing it up to the present state of our 
knowledge of the physiology of the female sexual organs, and the practice of ob- 
stetrics generally. 

All the more important '-'facts and observations which have transpired since 
the publication of the last edition," have been carefully supplied : — the work 
may, consequently, be received as a very complete summary of the most ap- 
proved views in relation to the theory and practice of midwifery, which are well 
arranged and clearly detailed. . - , D. F. C. 



Art. XXin. — Report on the Pros;rcss of Practical Medicine in the Departments of Mid - 
unfery and the Diseases of Women and Children, during the years 1844-5. By 
Charles West, M. D., M.R. C.P., Physician to the Royal Infirmary for Chil- 
dren, Lecturer on Midwifery at the Middlesex Llospital, &c., &c. London, 
1845. 

This is a very full and well drawn up report, and reflects credit on the author 
for the research, and the discriminating and critical judgment which it displays. We 
shall enrich our summary with such facts as have not already been noticed by us. 



Art. XXIV. — Accidents — Popular Directions for their immediate Treatment: ivith Ob- 
servations on Poisons and their Antidotes. By Henry Wheaton Rivers, M.D., 
Surgeon to the U. S. Marine Hospital, Providence, R. I. 12mo. pp. 108. Bos- 
ton : Thomas H. Webb & Co. Providence : B. Cranston & Co., 1845. 

t 

In the motto of this useful little compendium, " For the want of timely care, 
millions have died of medicable wounds" is to be found the necessity and utility of a 
work, which professes to teach, to the unlearned in medical matters, the means of 
relieving persons who have met with " sudden accidents under circumstances 
where a surgeon cannot be immediately obtained." The author states that his 
exclusive object is ''to impart advice to the people generally, rather than to the 
profession," and desires to be understood as not intending " to preclude the neces- 



1846.] Durlacher's Treatise on Corns and Bunions. 183 

sity of calling surgical advice in the cases of which he treats, but to place within 
the power of the patient, or his friends, sufficient knowledge to enable them to 
take such preliminary steps as will facilitate the operation of the surgeon when 
he is obtained. In order to carry out fully this design, the author has endeavoured 
to give the directions in the plainest and most simple language — avoiding as far 
as possible the use of technical terms — and stating the modes of treatment so that 
they can be understood by persons entirely unacquainted with the science of sur- 
gery." 

The author has adhered strictly to the course laid down above, and has com- 
piled a work, of which the circulation cannot be too wide-spread, for its sound 
and sensible directions may be understood by men of the most moderate capaci- 
ties, and it has been published in a form which places it within the reach of the 
most limited means. C. E,. K. 



Art. XXV". — A Dictionary of Terms used in Medicine and the Collateral Sciences. ?>j 
Richard D. Hoblyn, A. M., Oxon. First American from the second London 
edition. Revised, with numerous additions, by Isaac Hays, M. D., Editor of the 
American Journal of the Medical Sciences, pp. 402. Philadelphia: Lea& Blan- 
chard, 1845. 

This Dictionary, from the second London edition of which the present American 
edition is printed, has received the unanimous praise of the English medical jour- 
nals, as being comprehensive in its contents, accurate in its etymology, and clear 
and concise in its definitions. The task of the American editor, thereifore, consist- 
ed solely in a careful revision, — supplying many words M'hich had been omitted by 
the author, — and in an adaptation of it to the wants of the American practitioner. 
^^ With this view, he tells us in the preface, he has added the native medicinal 
plants, the formulas for the officinal preparations, &c., and made the work conform 
with the Pharmacopoeia of the United States. For the greater convenience of re- 
ference, he has also introduced into the body of the work most of the interesting 
(and, we may add, instructive) articles placed by the author in an Appendix."''' 

For reasons which will be at once understood, this is not the place to express 
an opinion as to the ability and completeness with which the American editor has 
fulfilled his portion of the task, but we may without impropriety commend the 
work to the student and medical man, as containing within a small compass all 
that they would require for the elucidation of medical terms, and as presenting, 
besides, in a compendious form, much useful information on a variety of points of 
practical importance. C. R. K. 



Art. XXVI. — A Treatise on Corns, Bunions, and the Diseases of Nails, and the general 
Management of the Feet. By Lewis Durlacher, Surgeon Chiropodist (by spe- 
cial appointment), to the Queen. Philadelphia: Lea & Blanchard. 1845. 12mo. 
pp. 134. 

The disorders treated of in this little work, though extremely common and pro- 
ductive often of great discomfort, and sometimes even of much actual suffering, 
have received but little attention from the regular practitioner. Those afflicted 
with them have consequently been compelled to submit to the inconveniences 
they entail, to resort to domestic remedies, or to submit themselves to the care of 
charlatajns, who too often aggravate by their operations these complaints, instead 
of affording relief. We are pleased, therefore, to meet with a work in which the 
nature of these afl^ections is satisfactorily discussed, and the most judicious and 
effectual methods of treating them pointed out. 



184 Bibliographical Notices, [Jan. 

Art. XXVIl. — Modern Cookery^ in all its branches : reduced to a system of easy prac- 
tice, for the use of private farailies. In a series of Receipts, which have been strictly 
tested, and are given with the most minute exactness. By Eliza Acton. Illustrated 
with numerous wood-cuts, &c., &c. The whole revised and prepared for Ame- 
rican Housekeepers, by Mrs. S. J. Hale. From the second London edition. 
Philadelphia: Lea & Blanchard, 1845. 12mo. pp. 418. 

We are by no means departing from our legitimate objects, in calling attention 
to this work of Miss Acton. Cookery is a branch, and a very important one, too, 
of hygiene, and is entitled to full consideration by physicians. 

Lideed, in some affections, a good cook can render as much service to the 
patient as a physician, and, in convalescence, the latter could accomplish but little 
without the aid of the former. 

We commend the work of Miss Acton to the young practitioner, and are sure 
he will find in it much useful information for the benefit of his patients. 



Art. XXVIIL — A System of Practical Surgery. By Wm. Fergusson, F.R.S.E., Prof, 
of Surgery in King's College, London; Surgeon to King's College Hospital, &c. 
With two hundred and fifty-two illustrations from Drawings by Bagg: Engraved 
by Gilbert. Second American edition. With Notes and Additions by G. W. 
NoRRis, Surgeon to the Pennsylvania Hospital. Philadelphia : Lea & Blanchard, 
1845. pp. 639, 8vo. 

Having already recorded our opinion of the great merhs of this work — a judg- 
ment confirmed, we are pleased to find, by the verdict of the profession — it is 
only necessary to say, in noticing the publication of this edition, that it is enriched 
by some additional notes by the judicious and learned editor, and that it is '^got 
up" in the same style of excellence that characterized the previous edifion. 



1846.] 185 

SUMMARY 

OF THE 

IMPROVEMENTS AND DISCOVERIES 

IIT THE 

MEDICAL SCIENCES. 

ANATOMY AND PHYSIOLOGY. 

1. Contributions to the Physiology of the Human Ovary. — The London Medical Ga- 
zette contains a series of very interesting articles on the physiology of the human 
ovary, by Charles Ritchie^ M.D.^ of Glasgow. The following are his general 
conclusions. 

1. The ovary is the primary sexual organ in the unimpregnated human female, 
as the uterus is in the gravid, and the mamma in the lactating, and exercises a 
remarkable controlling power both on its own functions as a gland, regulating 
them according to existing circumstances, and also on the character of the deve- 
lopment of the other organs; properties recognized at least tacitly by the ancients, 
in their designation of the ovaries as the female testes. 

2. The vesicles of the ovary were known to anatomists long anterior to the 
work of De Graaf; but were supposed to be dilated continuations of the seminal 
blood-vessels, in which, as in so many subsidiary chambers, the conversion of 
the blood into semen was completed. 

3. The term ova, as applied to the germs of the mammalia, was employed 
from the time of Hippocrates, but they were supposed to be exclusively of uterine 
formation, and the result of fecundation, at least in their normal form, till the pe- 
riod when Kerckring, De Graaf, and others, attracted to the subject seemingly by 
Harvey's Exercitationes, demonstrated their origin to be in the ovaries, and ante- 
cedent to impregnation. 

4. The fact of the discharge of sterile ova by virgin birds, and by fishes and 
insects, was familiar to Aristotle and others, but Kerckring, who wrote about a 
year before De Graaf, made the additional statement, that such ova are evacuated 
from the ovaries of quadrupeds, and also unconsciously by the unimpregnated 
human female, '4nstante purgatione menstrua., aut stimulante libidine;'^ and the 
physiologists who commented on his treatise indulged in analogical generaliza- 
tion on the oviparous origin of the whole animal series, and on the spontaneous 
emission of germs from the ovaries, and their fecundation in the uterus, precisely 
as has been done in the present day. 

5. There is reason to believe that what Kerckring supposed to be ova were 
merely portions of fibrin, but it is probable that the demon strafi on of the truth of 
the first and second of the views now referred to, of his commentators, which has 
been accomplished in our own time by MM. Bischotf and Raciborski, was pre- 
vented being reached, when they were first propounded, by the course of inves- 
gation having been turned by De Graaf and succeeding inquirers from the con- 
dition of the ovaries in the virgin, to their state in animals which had received 
the male. 

6. The ovarian vesicles formerly mistaken for amphoric enlargements of the 
seminal vessels, were, after Kerckring and De Graaf, mistaken for ova, although 
by Morgagni in particular, and also, but on erroneous premises, by Malpighi, and 
even after a confused manner by De Graaf, the discovery made recently by Von 



188 Progress of the Medical Sciences. [Jan. 

Baer of these vessels as being alveoli only in which the ova are retained, was dis- 
tinctly anticipated. 

7. The statements made by Baron Haller, and repeated by his followers, that 
ova are formed from the fluid of the ovarian vessels changed by impregnation, and 
afterwards discharged into the tubes, in which it assumes the ovoid form by co- 
agulation : and that the number of follicles in the ovaries is limited absolutely to 
from twenty to thirty in each female, are equally erroneous ; ova at least, and 
generally their containing cells, being formed and secreted in indefinite numbers 
from the ovaries by the inherent organism and power of the latter as glands, through- 
out every period of female life. 

8. The opinion held by Galen, and resuscitated after a long interval of renewed 
belief in their csecity, by Fallopius, of the perviousness of the uterine tubes, and 
that of their systolic and diastolic action, and of their conducting power from with- 
in at the ovaries, outward to the uterus, are correct. 

9. The antrum tubi of Roederer is a hernial extrusion of the mxucous and perito- 
neal coats of the tube, arising from the separation of the muscular fibrils, most pro- 
bably by some mechanical cause, as the pressure of the fluid of the tube during 
the orgasm of the latter. 

10. The incurvated distal extremities of the tubes are true receptacula ovarum, 
in which ova discharged from the ovaries may be retained for a short but indefi- 
nite time. 

11. The tubes are at once oviducts and vasa ejaculatoria. 

12. In early infancy, extreme old age, and long-continued organic disease, the 
ova are minute, transparent, and structureless cells; and in advanced childhood, 
soon after the critical age, and during pregnancy and lactation, they are more or 
less organized, larger, and in the latter state are often so well maturated, that 
about one-third of the renewed pregnancies of married women take place while 
they nurse. 

13. In the children and others in the circumstances now mentioned, the exer- 
cise of organic power which occasions the secretion and extrusion of ova, is at- 
tended also by that of an opaque mucous fluid in the tubes and uterus ; but on the 
attainment by the female of maturity, and onward to the period of critical life, 
[when the animal powers become again diminished, and the calibre of the arte- 
ries reduced,] the ovarian orgasm, like many other vital actions, undergoes peri- 
odical augmentations of power, during which, unless when prevented by the 
disturbing influence of other functional processes or by disease, it extends to the 
nervous and vascular tissues of the uterus, and gives rise to the formation within 
this viscus of decidual vessels, which exude lymph and red globules, the latter be- 
ing evacuated, mixed with watery fluid, m.ucous matter, and some of the salts of 
the blood, in the form of menstruation. 

14. Every sanguineous uterine discharge, even when of moderate quantity and 
proceeding from a healthy uterus, is not necessarily of the normal menstrual kind 
here described, that is, the product of an ovarian orgasm, or natural function, act- 
ing through the medium of arterial villi shot out from the inner surface of the 
uterus, the blood in some such cases having been seen after death, proceeding 
from the open mouths of the uterine veins; and there being reason to believe that 
such a hemorrhage may be excited by whatever either temporarily or more per- 
manently obstructs the venous circulation of the uterus, as the action of sudden 
fear, or of disease in the lungs or left heart, on the circulation of the right side of 
the heart ; of tight lacing or other causes on that of the abdominal cava ; and that 
of extensive ovarian enlargement on the corresponding veins of the uterus ; but 
that to confound such discharges, which are generally coagulable, and met with in 
abnormal circumstances, with the catamenia, is to mistake a paihological pheno- 
menon for the result of a vital and healthy function. 

The frequent intermixture, again, of both arterial and venous blood with the 
ordinary menstrual secretions, which may be asserted to happen in women with 
profuse menstruation, is explicable on the principle, in the one case, of the opera- 
tion of an unnatural intensity of the proper catamenial orgasm, and in the other, of 
that of an augmented irritability of the muscular fibres of the uterus, retarding by 
their spasmodic contraction the flow of blood in its veins. 

15. The fact that the ovaries do undergo a periodical increase of size before and 



1846.] Anatomy and Physiology. 187 

at the usual menstrual terms, is capable of diversified proof in various forms of 
disease of these glands, and has also been demonstrated in their healthy condition, 
as in the case of their hernial protrusion. 

16. That this congestion is not caused by the presence or bursting of ripe vesi- 
cles i^ plain from the consideration that the ovaries are often crowded with such, 
some of which also occasionally give way, and empty themselves by capillary- 
sized openings in the surface of the glands in women who have never menstru- 
ated ; and in others who have ceased to menstruate, one and two large and fully 
developed vesicles are frequently seen. 

17. The catamenia are never regularly secreted without the Graafian vesicles 
attaining a state of high organization, and being, in general, ruptured before they 
reach a Jarger bulk than that of a dried, or at most of a recent pea, the breach in 
their w^alls being facilitated by a considerable absorption of their peritoneal cover- 
ing ; while, when follicles of great natural strength exist in the ovaries independ- 
ently of menstruation, as often occurs before its establishment and at its cessation, 
they are perforated with difficulty, remain long intact, often acquire an abnormal 
size, and their discharge, when it happens, is by a minute opening in the perito- 
neum, which corresponds with the size of that in their own walls. 

18. The elimination of ova, and the process of menstruation, are correlative 
effects of the vital powers of the ovaries (just as the secretion of mucus, and of 
gastric juice, and the chymification of the blood, are of those of the stomach), 
and to suppose the rupture of the Graafian vesicles to be the cause of the menses, 
is to mistake a frequent association, and, to some extent, effect, for a uniform 
cause. 

19. The principal use of menstruation is, in regard to the ovary, to provide an 
accessory by which the maturation of its vesicles, and the absorption of their peri- 
toneal and tenacious proper coats, and their extrusion generally, may be promot- 
ed throughout the child-bearing period of life ; and, in reference to the uterus, to 
furnish a nidus within its walls by which the ovary may be entangled, retained, 
and nourished. 

20. Despite the discovery, in three or four instances, of zoospermes on the ova- 
ries of some quadrupeds, post coitum, the amount, variety, and character of the 
proof against the ovarian theory of generation in the human subject, appear to 
be insurmountable ; and, in addition, the positive evidence in favour of the uterus 
being, at least in man, the normal seat of conception, and its occurrence in the 
tubes or ovaries exceptional only, seems conclusive • the cases of the latter which 
take place depending probably on the escape of spermatozoa along the tubes 
during menstruation, or on some accidental and rare arrangement of the mucus 
in the uterine ends of these, by which it becomes a conducting medium for the 
passage of the seminal corpuscles towards the ovaria. 

21. Although menstruation may return for several successive periods without 
being attended by the formation of any of the organized bodies called corpora 
lutea — and that, simply because every menstruation is not necessarily preceded 
or accompanied by the rupture of a vesicle — the bodies so named are yet never 
found in the human female unless in association with that function, and in vesi- 
cles which have been ruptured in immediate connection with one of its returns; 
the vascular orgasm of the ovaries, which is the essential element of menstrua- 
tion, being, also, the cause of corpora lutea. 

22. A more correct descriptive generic term for these bodies, therefore, would 
be that of corpora menstrualia, or, in reference to the lower animals, corpora pe- 
riodica; the different species being arranged according to their physical peculiari- 
ties, as corpora cephaloidea, and corpora albida, after the manner described in 
the first series of these Contributions. 

23. Of these organized forms of corpora menstrualia, some, as the white and 
intra-mural cerebriform species, are primary, being formed exclusively under the 
influence of the congestive menstrual nisus ; and others, as the red, and extra- 
mural cerebriform varieties, are secondary, being transformations respectively of 
the two primitive species, and are produced by the reflex action on the still patent 
vessels of the recently ruptured vesicles, of the excited and congested gravid 
uterus. 

24. The thickened; movable, (Edematous, and yellowish state of the inner 



188 Progress of the Medical Sciences, [Jan. 

membrane of the unruptured Graafian vesicles, described by MM. Baer and 
Wagner, as the consequence of impregnation, and the initiative of the corpus 
luteum, and which M. BischofF observed in a dog which, had not received the 
male, is often seen in the unbroken follicles of the human ovary, and is totally 
unconnected with pregnancy. 

25. The swollen, puffy, or congested condition of the lining membrane, is best 
observed, in woman, in the larger vesicles, in which it projects as a vascular cor- 
rugated pulp, apparently produced by the effusion beneath the inner layer at 
points where this does not adhere organically, but merely by juxtaposition with 
the external, of a transparent fluid • the adhering portions of the two laminse 
often remaining opaque or slightly yellowish, and communicating, from their 
arrangement in the form of decussating lines, a reticulated or chess-board aspect 
to the whole. 

26. There is reason to believe that those changes are caused by the congestive 
orgasm of menstruation, and constitute the first stage in the growth of both spe- 
cies of primitive corpora menstrualia, the effusion in the one, or that of the white 
bodies, being limited to the cellulated structure of the ruptured membranes, 
which speedily becomes opaque, thickened, and inorganic: while in the other, 
or cerebriform bodies, the effusion is more copious, is granular, well organized, 
and deposited in the shape of convolutions between the layers of the vesicular 
parietes precisely in those spaces where the surfaces of the latter are free, the 
form of the convolutions being contingent on the situation of the adhesions or 
septa. 

27. Immediately on the establishment of pregnancy, a reflex vascular influence 
arises towards the ovaries from the engorged and excited uterus, which, in the 
event of the existence in these glands of either of the above primitive menstrual 
bodies, terminates, in the case of the last described species, on the vessels of its 
membranes and granular matter, increasing the size of the former, and the tena- 
city, bulk, and succulency of the latter, till, in the last months of pregnancy, its 
yellow tissue assumes a rose colour, and the body is transformed into the variety 
called corpus rubrum ; while in those other cases, in which the primitive body 
has been of the species termed a corpus albidum, the uterine nisus, in consequence 
of the obliteration of the vessels ramifying immediately on the vesicle, does not 
extend further than the still patent vessels which connected the exterior of the 
follicle to the stroma of the ovary, in which situation a granular deposit takes 
place, as a secondary formation, arranged in an annular form around the thickened 
vesicle: and sometimes, in consequence of the continued plethora of the parts, 
this structure, which constitutes the extra-mural cerebriform variety of corpora 
menstrualia, may be found in the last months of pregnancy undergoing a third 
transformation, and exhibiting a reddish hue. 

28. The perfection of development in a corpus menstruale, whether primary or 
secondary, will be proportioned to the number, size, and vital activity of the 
vessels of the ruptured vesicle at the periods respectively of menstruation and 
impregnation : and as such properties in the vessels of the follicle must alter 
speedily, and also progressively, on the evacuation of the latter, it is reasonable 
to conclude that the changes wrought on its coats, either by menstruation or gra- 
vidity, will be much modified by the length of the period which intervenes 
between its rupture and their accession — a fact which explains, not only the dif- 
ferences of degree in which such bodies are developed, but which also indicates 
the possibility of both menstruation and impregnation taking place in some ab- 
normal instances without being succeeded by the formation of their characteristic 
sequela? in the ovaries. 

29. Should two or more Graafian vesicles have been recently and simulta- 
neously ruptured before fecundation, the series of changes which make up the 
concrete of what is called a true corpus luteum of the species described in this 
paper as cephaloid, in its two forms of extra and intra-parietal, and, although not 
yet verified by the writer, also, he believes, in the only remaining form — that of 
the corpora rubra, will take place indifferently in them all ; while, should there 
have been only one Graafian vesicle ruptured, which has yet happened to con- 
tain two ova, both of which have been impregnated, or two vesicles ruptured, 
the vessels of one of which only remained permeable to the transudation of gra- 



1846.] Anatomy and Physiology. 189 

nular matter at the commencement of the pregnancy, there will, should both ova 
be impregnated, be two foetuses in the uterus, and no more than one secondary 
menstrual body in the ovaria. 

30. Taking into view the extra-ovarian and reflected nature of the cause which 
converts the primitive corpora menstrualia of the unirapregnated female into their 
secondary varieties during utero-gestation, connectedly with the previously ascer- 
tained facts of the subject, there does not appear to be anything impossible in the 
supposition, that, in the event of a morbid orgasm of the uterus, such as might 
accompany several of its diseases of structure, being set up immediately on the 
formation of a corpus menstruale, that the irritation and plethora of the uterus 
might become extended to such body, and control its development, somewhat in 
the manner of pregnancy. 

31. Yellow or black, unorganized deposits (the corpora florida and nigra of the 
former series), enclosed either in unruptured or broken vesicles, having their 
coats stained, but of natural consistence, are seen in the ovaries in every stage of 
life ; but they are, so far as the writer has ascertained, nothing more than mere 
blood marks — the colour of the vesicles being the product of mechanical and not 
of vital changes. 

32. In regard to the bearings of the subject as they involve questions of 
jurisprudence, the facts are, summarily, that pregnancy may exist without the 
presence of any other structures within the ovaries than that, 1st, of one or more 
ruptured, but otherwise unchanged vesicles. 2d. Of one or more discharged 
follicles, stained yellow or black with blood. 3d. Of one or more broken vesi- 
cles partially converted into white or into brain-like bodies. 4th. Of one or more 
fully developed white bodies. 5th. Of one or more similar intra-mural cerebri- 
form bodies. 6th. Of a single or of plural more or less perfect extra-mural cere- 
briform bodies. 7th. Of a single or of plural more or less developed corpora 
rubra, of either the intra or extra-parietal kind. 8th. Of any of the appearances 
now enumerated, associated with either of the others ; and that these phenomena 
are to be regarded as having an essential connection with the state of pregnancy 
with a measure of probability which, as refers to the first four, is at present 
strictly hypothetical, but which, with the succeeding three, augments directly in 
the order in which they are arranged ; while, on the other hand, it is proper to 
state that there is an abstract or hypothetical possibility that the appearances 
which are indubitably the usual adjuncts and indications of pregnancy, may yet, 
in certain presumable combinations of circumstances, (never, however, hitherto 
proven,) present themselves independently of conception. 

33. The inherent faculty of the ovaries, owing to which they vary their func- 
tional action according to their relative condition, is illustrated by their secretion 
of structureless cells in childhood, so that these can then be discharged irrespect- 
ive of the aid of any special orgasm of the parts; and, again, in pregnancy — by 
which the occurrence of superfoBtation, otherwise a probable event, is rendered 
rare ; and, again, during lactation — to the avoidance of the early renewal of im.- 
pregnation ; and, lastly, in the amenorrhoea of disease and age, when — the evo- 
lution of the vesicles not being any longer aided by menstruation, is anew facili- 
tated, as in childhood, pregnancy, and early lactation, by the extreme tenuity of 
their coats. It is, again, illustrated in the formation of well-organized tenacious 
vesicles in the child-bearing period of hfe — so well adapted equally to the specific 
functions of that period, and also to prevent their w^asteful rupture on the frequent 
occasions of excitement to which adult life is exposed ; and receives, again, 
another proof in the superinduction of the menses at this time, without which the 
normal rupture of the follicles, for the purposes of reproduction, could not, on 
accourit of their increased organization, have been secured. The same accom- 
modating quality of the ovaries is seen in cases where the menses have been 
suddenly arrested w^hile the ovaries contained a number of the ripe vesicles 
always associated with that function ; by such vesicles, no longer able, from the 
absence of menstruation, to penetrate the peritoneum, being translated, still covered 
by the peritoneum, to some part of the adjacent organs, where, separated from 
their nutrient vessels, they pass into the condition of inorganized bodies. The 
same principle comes into operation when, from any cause — such as the chronic 
peritonitis of children, the peritonitis which often follows abortion and pregnancy, 

No. XXI.— January, 1846. 13 



190 Progress of the Medical Sciences. [Jan. 

and that inflammation of the fimbria and tubes which so frequently takes place in 
prostitutes^ — the tubes have become impervious, by the prevention, or speedy ar- 
rest, in such circumstances, of menstruation, and the consequent hindrance of the 
secretion of any other than such fragile, structureless, and small-sized vesicles, as 
can be easily and safely discharged without the aid of the tubes ; — a species of 
amenorrhcra, therefore, which, should this view of its nature prove correct, ought 
to be regarded as inevitable, salutary, and not suited for treatment. 

34. From De Graaf to Drs. Lee and Paterson, on the one hand, and from Mal- 
pighi to Negrier, on the other, physiologists have hitherto universally regarded 
the extrusion of ova from the ovaries as being effected by the agency of corpora 
lutea, only that, by the former series, these yellow bodies were supposed to be an 
effect of impregnation — a bastard modification of them being produced by sexual 
excitement and menstruation ; while, by the other line, the same structures were 
believed to be formed by the coalition of several Graafian vesicles, the central 
bodies included within many of them, and which are nothing else than the con- 
tracted cadavers of the ruptured vesicles, being represented by most writers of 
both classes as the genuine ova. 

35. In a like way, as Kerckring's announcement of ova being formed within 
the testes of mammals, was followed by speculations on their spontaneous excre- 
tion by the whole animal series, which would probably have terminated in a cor- 
rect exposition of the physiology of the ovary but for the false principles intro- 
duced into the inquiry by De Graaf and Malpighi ; so the demonstration, by Von 
Baer, of ova within the vesicles of the ovary, (although involved theoretically in 
the opinions previously held of the rupture of these by venereal orgasm, and in 
animals at the season of rut, and very tardily appreciated by those who treated 
the subject afterwards,) is probably to be regarded as the true point of departure 
of the opinions now entertained of the spontaneous elimination of ova from the 
ovaries of all classes of animated beings, and is equaled in importance only by 
the discovery made more recently by MM. Raciborski and BischofT, of the same 
bodies — escaped from the ovarian vesicles without the aid of the males, within 
the tubes of the virgin mammal. 

2. Physical and Physiological attributes of the Blood. — Dr. G. 0. Rees has re- 
cently offered some new views concerning the physical and physiological attri- 
butes of the blood. 

1st. He has proved beyond doubt that the red corpuscles are vesicular, as is 
now generally supposed. Their vesicular character is clearly shown in the 
readiness with which they become collapsed or distended by increasing or di- 
minishing the specific gravity of the medium in which they float. In order to 
collapse the corpuscles, a solution of sp. gr. 1060 is sufficient, but a soludon of 
1070 or more is required to produce a decided effect. Solutions cease to dis- 
tend the corpuscles when of sp. gr. 1050 to 55, and to distend them well when 
a solution of 1015 or 10 is desirable. The sp. gr. of blood is about 1057 to 60; 
and since the corpuscles remain unaltered by solutions of from 1050 to 60, it 
may be concluded that the average sp. gr. of liquor sanguinis lies somewhere 
between these two points; and this proves that the fibrin of the blood is dis- 
solved, and not merely suspended in the liquor sanguinis. 

2d. He has also rendered decisive the question as to where the red colouring 
matter of the corpuscle is seated, proving it to be contained in the fluid within 
the vesicle, and that the envelops themselves are white or colourless membranes. 
This is shown by increasing the sp. gr. of the liquid in which the corpuscles float, 
the result of which is the escape by exosmosis of the red-coloured fluid from within 
the corpuscles ;* and again by applying water to the corpuscles, and so inducing 
cndosmosis, the vesicles become distended and burst, their colouring matter mixes 

* This is effected by a method somewhat similar to the one employed by M. Figuier 
for estimating the quanuty of red corpuscles in the blood (British and Foreign Medi- 
cal Review, Jan. 1845, p. 254, Mr. Pagei's Report). M. Figuier's method consists in 
adding a strong saline soludon, as of sulphate of soda, to the fibrinated blood, by 
means of which the corpuscles (their contents being exosmosed) will subside, and 
may be collected on a filter. 



1846.] Anatomy and Physiology, 191 

with the water; and their envelops subside to the bottom of the vessel, forming 
a white layer. 

3d. By examining the white layer deposited in the manner just mentioned (in 
which, together with graww/es and shreds of membrane, are found numerous white 
bodies resembling blood corpuscles, though smaller,) and from analogy, he enter- 
tains no doubt that the red corpuscles contain nuclei, which, however, are so highly 
refractive of light, that they are not distinguishable in the corpuscles themselves. 
He describes the nucleus as beins about — =L-=- of an inch in diameter, or ^ the 

• ••nil 

Size of the red corpuscle, in the centre of which it is situated ; it is flattened and 
circular like the corpuscle, though it differs from it in not being rounded at its 
edgej it is adherent to the envelop only at its centre, leaving a canal all round 
its free edge, which canal contains the red colouring matter. 

4th. The whole of the iron of the blood is contained in the red colouring matter; 
the envelops and nuclei do not present a trace of it. The corpuscles obtain their 
iron from the chyle, the serum of which holds a large quantity of it in solution ; 
the sp. gr. of the chyle is considerably lower than that of liquor sanguinis; conse- 
quently, when the former becomes mixed with the blood, it dilutes the liquor 
sanguinis, and so induces an endosmodic current rich in iron to enter the corpus- 
cles. How the colour of the contents of the corpuscles is produced remains a 
mystery: it is within the red corpuscles alone that it is effected; there is no red 
colouring matter in lymph or chyle : any admixture of red corpuscles found in 
these latter is an accidental circumstance attending the mode of examination. 

5th. Dr. Rees seems to admit the probability of the exudation and fibrinous 
corpuscles observed so abundantly in effused coagulable lymph, having their 
origin in the pale corpuscles of the blood, for he sees no difficulty in these pale 
corpuscles passing through pores in the blood-vessels which would not admit the 
red corpuscles ; the latter he compares to bladders filled with fluid, and which 
are not capable of yielding until their membrane be ruptured, but the former 
being soft solids may be compressed like a sponge, and pass through an opening, 
the orifice of which is smaller than the corpuscles themselves. 

6th. He justly condemns the coarse and necessarily inaccurate method hitherto 
pursued in the quantitative analysis of blood. Amongst other fallacies attending 
the present method, the corpuscles are estimated as hematosine alone, no allow- 
ance being made for the envelops or nuclei. Again, a certain quantity of fibrin 
will be estimated as hematosine, because, as the fibrin of the liquor sanguinis 
coagulates, the sp. gr. of the medium in which the corpuscles float, becomes 
lowered, and the corpuscles will thus draw into their interior more liquor san- 
guinis, and so absorb a certain quantity of fibrin with which they will subside. 
When the fibrin coagulates slowly, the quantity thus disposed of will be large, 
for each of the immense number of corpuscles will absorb a little. Again, all the 
water of the corpuscles should not be estimated as belonging to serum, because, 
although the corpuscles must have endosmosed some serum during coagulation 
of the liquor sanguinis, yet, in their natural condition, they contain a fluid which 
is quite distinct from serum. To obtain pure hematosine by a method free from 
these fallacies, Dr. Rees recommends the corpuscles to be cleaned by repeated 
washings in a solution of salt and water, or sugar and water, the sp. gr. of which 
is equal to that of the liquor sanguinis, so that the corpuscles maybe unaffected by 
endosmosis. When thus cleansed, they are to be moved into a vessel of water, 
the result of which is, that the individual corpuscles swell and burst, their colour- 
ing matter is discharged into the water, whilst the nuclei and envelops subside 
as a precipitate ; both ingredients are thus in a fit condition for estimation and 
further examination. 
^ 7th. In regard to genesis^ or the original formation of blood corpuscles, he con- 
siders that they multiply by division, for on examining a portion of blood main- 
tained at about its natural temperature, he observed the corpuscles to assume an 
hour-glass form, which increasing, eventually divided each corpuscle into tAvo 
unequal sized circular bodies, which, when treated with a strong saline solution, 
underwent the same exosmotic changes as observed in common blood-corpus- 
cles. When worn out, the blood-corpuscles become disintegrated and their debris 
exist floating in the liquor sanguinis. By diluting the serum of coagulated blood 
with water, a precipitate forms, consisting of the envelops and nuclei of old cor- 



192 Progress of the Medical Sciences, [Jan. 

puscles disintegrated; this disposal of the worn-out corpuscles will account for the 
traces of iron occasionally found in the serum. 

8th. Dr. Rees considers the explanation offered by Miiller regarding the mode 
in which the change of colour from dark to bright red is effected in the blood 
during its passage through the lungs^ to be entirely hypothetical and erroneous. 
Miiller accounts for the change of colour from venous to arterial^ and from arterial 
to venous blood in this way.* He supposes that ^' in traversing the capillary sys- 
tem of the lungs the proteine of the blood combines with oxygen, generating a 
compound analogous to ' buffy-coat,' which forms a contractile covering to the 
blood-corpuscles, causing them to become more opaque, and giving them the 
figure of doubly concave lenses ; that in the general capillary circulation, this 
layer of oxyproteine surrounding the corpuscles is decomposed, the oxygen being 
used for dissolving old tissue, and the proteine deposited to supply its place. 
The corpuscles lose their reflecting concave figure, and become more transparent 
by this change. That the difference of colour between arterial and venous blood 
depends solely upon a physical difference in the surfaces of the coipuscles, being 
semi-opaque concave mirrors in the former and more transparent convex bodies 
in the latter ; and that during respiration the colouring matter itself of the blood 
undergoes no change, and indeed plays no part, either as a whole, or in regard 
to the iron which exists merely as a simple element in it.'^ To these several 
views Dr. Rees is entirely opposed; he rejects the idea of a layer of plastic oxy- 
proteine being deposited on the blood-corpuscles during respiration, and instead 
of considering the hematosine as undergoing no change, and maintaining the 
same condition in arterial and venous blood, he looks upon it as being the cause 
of the change in the colour of the blood in virtue of some chemical alteration 
which takes place in it. In this view he agrees with Liebig, though he does not 
adopt the explanation offered by this chemist as to the nature of this alteration. 
According to Liebig, the change in colour observed to take place during the pas- 
sage of venous blood through the lungs is due to the formation of a carbonate of 
the peroxide of iron in the red corpuscle, which, during the passage of arterial 
blood through the system, is resolved into carbonate of the protoxide, by the 
abstraction of oxygen for the general purposes of the system, and thus the dark 
colour is again restored to the blood. This hypothesis is mainly disproved by the 
impossibility of obtaining any trace of an oxide of iron from the red corpuscles 
by treating them with a weak acid, by there being no difference in the quantity 
of oxygen in arterial and venous blood, and by all the iron admitting of extraction 
from the hematosine. without the other chemical constituents of the hematosine 
being interfered with, and especially without any diminution in the quantity of 
its oxygen being effected. What may be the nature of this change, therefore, in 
the hematosine [if any does really exist] on which the alteration in the colour of 
blood depends, remains still a mystery. 

Having accounted for the change in colour in the blood whilst in the body by 
the alternate deposition and removal of a layer of plastic material by which an 
alteration in the form of the corpuscle is produced, and the change in colour 
follows as an optical effect, Miiller proceeded to explain in a similar manner the 
changes in colour undergone by the blood under various circumstances out of the 
body, such as result from exposure to the action of saline solutions of water and 
other reagents ; in all these cases he considers that an alteration in the figure of 
the corpuscle is the cause of the change in colour observed, and that anything 
which produces this alteration in figure is capable of modifying the tint of the 
blood. Thus he considers that solutions of salt render a coagulum of blood of a 
bright red colour by exosmosing the corpuscles, and thus making them assume 
a biconcave form, and that when the corpuscles are endosmosed, and assume a 
convex form [as by washing the reddened coagulum in water] the colour of the 
blood is darkened in consequence ; but Dr. Rees considers this statement to be 
incorrect, for saline matters will render a coagulum of a bright red colour, whether 
an endosmotic or an exosmotic action be induced ; besides, blood-corpuscles may 
be changed in form, without any variation in the colour of the blood being pro- 
duced in consequence. Moreover, strong saline solutions cause the corpuscles to 

* Dr. Gelding Bird, in London Medical Gazette, December 27, 1844. 



1846.] . Anatomy and Physiology, 193 

become flaccid and empty, and not to assume that biconcave form which Miiller 
considers so well calculated for the reflection of light. Miiller and others con- 
ceive that the iron in the hematosine has nothing to do with the colour of the 
blood, inasmuch as this metallic ingredient may be removed without the colour 
being destroyed: Dr. Rees objects to this being received as a conclusive argu- 
ment against the iron being essential to the formation of the red colour. — Ran- 
king^s Abstract. Vol. I. 

3. Formation of the huffy-coat. — Mr. Gulliver^ has given the results of some 
experiments on the coagulation of the blood, which seem to add confirmation to 
the view entertained by Mr. Wharton Jones and others, that the formation of the 
bufFy coat is due in great measure to an increased aggregation . between the red 
corpuscles, by which these latter tend to arrange themselves in rolls, and conse- 
quently to subside to the bottom of the vessel more readily than they would do as 
individual corpuscles. With this tendency to rapid subsidence there is also usually 
combined a slowness in the coagulation of the liquor sanguinis, so that the cor- 
puscles have time to leave the upper layers before coagulation commences. Mr. 
Hewson and Dr. Davy, however, maintain, that the rapid sinking of the corpus- 
cles is due to an attenuation of the liquor sanguinis, but against this Mr. Gulliver 
argues, that if we admit the sinking of the red corpuscles to afford an accurate 
test of the consistency of the liquor sanguinis, we must also admit what seems 
improbable, that the liquor sanguinis becomes thinner some minutes after the 
blood has been withdrawn, for at that time the falling of the red corpuscles is 
most rapid. Following are some of Mr. Gulliver's conclusions : — 

1st. There is a remarkable acceleration after a few minutes, in the rate of which 
the blood-corpuscles sink into the liquor sanguinis. 2d. This acceleration may 
be increased by increasing the aggregation of the corpuscles ; and prevented or 
reversed by preventing or destroying the aggregation of the corpuscles. 3d. The 
sinking of the corpuscles is slower in blood thickened by weak saline solutions, 
than when mucilage is added with the salt. 4th. The sinking of the corpuscles 
may be slower in serum artificially made thicker and heavier. 5th. In the cruor 
of horse's blood, the corpuscles are more aggregate, and have a greater appear- 
ance of agglutination, than in very buffy human blood. 6th. There may be a 
buffy coat, or only a comparatively thin one, in the blood of the horse, when the 
blood has been made thinner, and its coagulation retarded. 7th. The corpuscles 
of the horse sink much more quickly in his serum than the corpuscles of man do 
in his. 8th. Increasing the proportion of corpuscles in the blood hastens coagula- 
tion, and prevents or diminishes the formation of the buffy coat, more than in- 
creasing the serum only. — Ibid. 

4. Intestinal villi. Lacteal absorption. — It has long been a matter of difficulty to 
explain how chyle, or the nutritive portion of chyme, found its way into the lac- 
teals. The fancied existence of mouths or openings at the extremities of the 
lacteal tubes, as described by Mr. Cruikshank and Dr. William Hunter (and 
generally admitted during the period in which they wrote), as explanatory of the 
mode in which the lacteals and lymphatics in general performed their functions, 
seemed to remove this difficulty ; but the researches of Krause, Valentin, and 
others, having disproved the existence of orifices in the lacteals, the mystery of 
absorption remained as great as before. Mr. Goodsir,t a few years ago, was one 
of the first to suggest that the process of lacteal absorption is effected through the 
medium of cells ; and by recent observations, he has proved almost beyond ques- 
tion that cells are the real agents by which the selection and absorption of the 
nutrifive portions of the chyme take place. When viewed in this light, the mat- 
ter is greatly simplified, especially since it is almost certain that nearly all the 
changes which are constantly occurring in the whole organic kingdom, on the 
grandest as well as the simplest scale, are effected throug-h the agency of those 

* In a paper read to the London Medico-Chirur^. Society, an abstract of which is 
contained in the Meflical Times, Feb. 22, 1845, p. 453. 
f Edinburgh Philosophical Journal, July, 1842. 



194 Progress of the Medical Sciences, [Jan. 

minute^ yet all-important bodies — nucleated cells. These cells seem endowed 
with a peculiar independent vitality, by means of which, at the time that they 
grow themselveSj they are absorbing into their interior, from the surrounding me- 
dium, materials which they can convert either into the elements of tissue, as of 
muscle, nerve, bone, &c., if nutrition be the function assigned to them: or into 
some peculiar fluid of secretion, as of milk, bile, saliva, &c., if secretion be their 
especial object. Thus, growing themselves, they produce the growth of others, 
and by feeding themselves, they draw off waste materials from the body, and 
render them subservient to further useful purposes in the economy, or eject them 
from the system as refuse, by the natural outlets. The following comprises the 
substance of Mr. Goodsir's paper on the intestinal villi.* 1. Each lime chyme 
passes along the intestines, the villi receive an increased supply of blood; they 
become turgid and erect, and the epithelium covering them is cast off, so that the 
chyme can come into actual contact with their exposed surface. 2. At the same 
time, the epithelia lining the follicles of Lieberkiihn are also thrown off, and mix 
with the chyme contained in the intestines : they probably contain a secreted 
fluid, subservient to the process of chylification. 3. Each villus, besides its one 
or two looped lacteals, and the minute network of blood-vessels lining its walls, 
contains, in its quiescent state, scattered amongst the terminal loops of the lacteals, 
numerous granular particles which are the germs or nuclei of absorbing vesicles ; 
during the process of chyme absorption, these minute germs become gradually 
developed into vesicles, probably by deriving nutriment from the neighbouring 
blood-vessels. Whilst they increase in size, these vesicles, by virtue of their 
peculiar absorbing power, draw into their interior certain materials from the 
chyme surrounding the villi, which they probably elaborate; having attained their 
full size, they burst, and discharge their contents either directly into the lacteals, 
or, more probably, into the texture of the villus, whence they are taken up by the 
lacteals. The function of the lacteals thus seems to consist in removing the debris 
and contents of the dissolved chyle cells. 4. Each villus is permanently covered 
(as also are the follicles of Lieberkiihn lined) by a fine, smooth, germinal mem- 
brane,! containing in its substance germinal centres of an oval form, situated at 
pretty regular distances, the office of which is the production of fresh epithelium 
cells to cover again and protect the surface of the villus, after the absorption of 
chyme is ended. 5. This mode of absorption by the chyle cells renders the 
analogy very striking between intestinal villi and the spongioles of plants: the 
latter of which most probably absorb nutriment for the plant through the medium 
of their cells. The soil in this latter case holds a relation towards the spongioles 
somewhat similar to that of chyme towards the villi. 6. It is probable that in the 
villi, as also in the spongioles of plants, the absorbed alimentary matters undergo 
the first steps of the organizing or vitalizing process. 

The only difficulty which presents itself in the above theory of Mr. Goodsir, 
regarding the mode of absorption by the cells of the intestinal villi, is to under- 
stand how these cells can absorb materials for their own growth from the neigh- 
bouring blood-vessels, at the same time that they are also absorbing materials for 
the formation of chyle from the matters contained in the intestines ; but this diffi- 
culty vanishes when we remember the wonderful endowments of cells in gene- 
ral, the power of selection and disposal of materials which they possess, together 
with other properties, showing that they are gifted with a peculiar independent 
vitality, to enable them to discharge certain important functions, the kinds of 
which vary according to the organs or tissues in which the cells are placed; be- 
sides, it does not seem improbable that, in the case of the cells of the intestinal 
villi, their own growth may be effected by means of the materials which they 
absorb from the chyme for the formation of chyle, and thus may be independent 
of the blood-vessels; for it does not appear that they ever grow, except when 
chylificalion is going on. 

The epithelial coat of the villi seems to be chiefly destined for the protection 

* Anatomical and Pathological Observations, by John and H. D. S. Goodsir, 1845, 
p. 4. % 

+ See account of Germinal Membranes and Germinal or Nutritive Centres, by 
Goodsir. 



184B.] Anatomy and Physiology, 195 

of their surface at those times when absorption is not going on, since it is in all 
cases cast off when the process of absorption commences ; probably, also, in com- 
mon with the epithelium lining the follicles of Lieberkiihn, it serves some fur- 
ther purpose in preparing the chyme for absorption. Proof that the epithelial coat 
is thrown off during the passage of chyme along the intestines, removes the diffi- 
culty which it was conceived the cells would experience in effecting their absorp- 
tion through the layer intervening between them and the chyme. The thin ger- 
minal membrane would be no impediment to the process of absorption ; on the 
contrary, it would rather be favourable to it. Mr. Fenwick, of North Shields, has 
performed numerous experiments, and worked out very elaborately the subject 
of lacteal and lymphatic absorption, though the results he has attained do not help 
much in clearing the mystery which still, to a certain extent, hangs over this de- 
partment of physiology.* — Ihid. 

5. Centres of Nutrition. — Mx. Goodsir, {Anatomical and Pathological Observations, 
p 1,) has recently made several important additions to the doctrine of cell-forma- 
tion. Amongst other observations he states that, besides all organs and tissues 
having their origin in and consisting essentially of simple or developed cells pos- 
sessed of a peculiar independent vitality, these component cells are moreover 
divided into numerous departments, each of which consists of several cells arranged 
round one central or capital cell, which latter is the source whence all the other 
cells in its own department have derived their origin. To each of these several 
central nucleated cells, he applies the name of nutritive centre^ or germinal spot. 
Each nutritive centre possesses the power of absorbing materials of nourishment 
from the surrounding vessels, and of generating, by means of its nucleus, suc- 
ssive broods of young cells, which from time to time fill the cavity of the parent 
cell, and carrying with them its cell-wall, pass off in certain directions and under 
various forms, according to the texture or organ of which their parent forms apart. 
There are two kinds of nutritive centres, those which are peculiar to the textures, 
and those which belong to the organs. The former are in general permanent, the 
latter are mostly peculiar to the embryonic state, and ultimately disappear. There 
is one form in which the nutritive centres are arranged both in healthy and morbid 
parts, which constitutes what Mr. Goodsir calls a germinal membrane; it is only 
met with on the free surface of organs or parts; it is a fine transparent membrane, 
and consists of cells arranged at equal and variable distances within it ; the cavi- 
ties of these component cells are flattened, so that their walls form the membrane 
by cohering at their edges, and their nuclei remain in its substance as the germi- 
nal centres. One surface of the membrane is attached to the surface of the organ 
or part, and is therefore applied upon a more or less richly vascular tissue ; the 
other surface is free, and it is on it only that the developed or secondary cells of 
its germinal spot are attached. These secondary cells, whilst forming, are con- 
tained between the two layers of the germinal membrane, but, as they become 
fully developed, they carry forward the anterior layer and .become attached to the 
free surface, whilst the nuclei are left in the substance of the posterior layer, in 
close contact with the blood-vessels from which they derive the materials for the 
formation of new cells. — Ibid. 

6. Functions of the cerebrum and cerebellum. — Dr. Cowan {Provincial Medical and 
Surgical Journal^ April 16th, 1845), has related two cases of encephaloid carcino- 
ma of the brain, the details of which offer some points of considerable physiolo- 
gical interest. One case is peculiarly instructive, as showing the great amount of 
cerebral lesion which may exist without being accompanied with any disturbance 
of the intellectual faculties, and with but slight interruption to the functions of the 
nervous system generally. The case was chiefly characterized during life by the 
occurrence of paroxysms of severe pain in the head, which was at first limited to 
the left side, but eventually became general. These paroxysms were accompa- 
nied by severe pain in the right arm and right leg, during the continuance of 
which the right arm was relaxed and motionless, but regained its power when 

* The results of his investi°:ations are contained in four consecutive numbers of 
the Lancet, commencing Jan. 11, 1845. 



196 Progress of the Medical Sciences. [Jan. 

the pain subsided; this was the only appearance of paralysis noticed; as far as 
could be ascertained, the sensibility of the arm was not diminished, and the right 
leg did not participate in the temporary paralysis of motion. There was occa- 
sional disturbance of vision in the right eye; and tinnitus of the right ear was a 
constant symptom; it consisted of a whizzing pulsating noise. There was no 
appreciable mental disturbance, and the patient walked down stairs the day on 
which she died. On examining the brain, the greater portion of the medullary 
substance of the right hemisphere, as also a large portion of that of the left hemi- 
sphere, was found converted into a red pulpy mass, presenting all the characters 
of ordinary encephaloid carcinoma. The gray portion was perfectly healthy to 
all appearance, which seems to support the favoured doctrine that it is the feat of 
the intellectual powers. Dr. Cowan suggests that the constant tinnitus may be 
explained by considering it to have been dependent on the pulsation of the dis- 
eased and softened middle lobe resting on the temporal bone, combined also with 
the morbidly increased sensibility of the parts. 

The second case is still more interesting and instructive. It seems to prove 
very strikingly the truth of the now generally admitted opinion, that the chief 
function of the cerebellum is to produce a combined and harmonious action of 
the several muscles called into movement for the attainment of a given end, as 
in locomotion, &c. It also, as well as the last, illustrates the apparent dependence 
of the intellectual faculties on a healthy condition of the gray cerebral matter. — 
On examining the brain in this case, there was found a mass, presenting the 
characters of encephaloid carcinoma, incorporated with the anterior extremity of 
the left lobe of the cerebellum, of which it seemed a prolongation ; passing for- 
ward in inseparable connection with the pons, and following the emerging fibres 
of the corresponding crus cerebri, it terminated about an inch further (without 
penetrating the ventricle), in the medullary substance of the middle lobe of the 
left hemisphere ; the principal seat of the morbid change was in the commissural 
fibres which contribute to the formation of the pons. The medullary substance 
was alone diseased, the gray matter being distinct, and to all appearance healthy. 
The several nerves passing through the diseased mass were more or less vascu- 
lar and soft, which would account for the various disturbances in function pre- 
sented during life by the parts to which they were distributed, as deafness, &c. 

The chief points in the symptoms of this case to which attention need be directed 
in this notice are, that there was no paralysis of motion or sensation to the last, 
no convulsive movements, neither was one side of the body more distinctly im- 
plicated than the other, but the controlling, the co-ordinating power of the mus- 
cular system appeared abolished or nearly so ; thus, in the early part of the 
afieclion, the patient staggered during walking, as if slightly intoxicated, and 
was unable to direct her progress in a straight line, she constantly deviating to 
the left; as the disease advanced, the irregularity in the voluntary movements 
increased, and gradually affected the arms as well as the legs. She required to 
be held and directed in every act, supported at times by two assistants, and 
pushed forwards by a third to enable her to move about the room ; and if by acci- 
dent she fell when attempting any effort alone, she was quite unable to rise 
or to assist herself She was perfectly sensible throughout, and the only change 
in her mental condition was a kind of restless excitement, with a certain inde- 
scribable feeling of distress, a childishness of thought with great feebleness of 
memory and attention: often intervals of unexpected and remarkable revival of 
natural feelings and mental powers would occur, the cause of which is quite in- 
explicable. — Ibid. 

7. Structure of the human Placenta. — In giving an abstract of the following ob- 
servations on the structure of the placenta by Mr. Goodsir, it will render the subject 
more intehigible to divide it into three heads, as adopted in the original memoir: — 

1st. Each placental tuft consists of a trunk, of primary branches, and of second- 
ary branches or villi. Each villus is made up of the following parts: (a) An 
external fine transparent membrane. This membrane is common to the whole 
tuft, passing from one villus to another, and closely covering the free surface of 
each. (6) A layer of flattened nucleated cells beneath this membrane, {external 
cells of the villus:) here and there these cells are grouped together into heaps, in 



1846.] Anatomy and Physiology, 197 

the centre of which is a germinal spot, which is engaged in the constant forma- 
tion of new cells. It seems probable that the internal aspect of this layer of 
cells is lined by a fine membrane, as in the case of the intestinal epithelium, (c) 
Beneath these structures, and immediately surrounding the blood-vessels within 
the villus, is another still finer and more transparent, but firm and strong mem 
brane (internal membrane of the villus) . This is readily separable from the layer 
of cells described : the space between them is probably occupied by a peculiar 
fluid, {d) Within this membrane are the blood-vessels of the villus, consisting 
of one or sometimes two vessels, which form a simple or contorted loop occupy- 
ing the cavity of the villus ; they are derived from the umbilical arteries and 
veins; they differ from capillaries in their large size, and from arteries and veins 
in preserving the same mean diameter throughout : one such vessel occasionally 
passes from one to two or more villi, forming a loop in each, before it becomes 
continuous with a vein, (e) Between these vessels and the internal membrane 
are some other cells, nucleated and highly transparent, called the internal cells of 
the villus. 

2d. (a) The substance of each tuft of the chorion is made up of nucleated cells 
of various sizes, containing a granular fluid. (6) The surface of the tuft is covered 
by a fine membrane, which consists of flattened cells united by their edges, (c) 
The free extremity of each villus of the tuft is bulbous, and consists of transpa- 
rent cells arranged round a central germinal spot. These groups of cells are the 
active agents by which the villi grow. (cA As gestation advances, and the al- 
lantois becomes applied to the internal surface of the chorion, blood-vessels be- 
come developed within the villi, w^hich then communicate with the umbilical 
vessels, (g) Thus, then, the villi of the chorion form the internal (or fcetal) por- 
tion of the placental villi, previously described, — the loops of vessels, internal 
cells, and internal membrane of which have their origin in the villi of the cho- 
rion. 

3d. (a) When impregnation has taken place, the mucous membrane of the 
nterus becomes greatly developed ; the epithelial or cellular secretion of its fol- 
licles becomes augmented, and the vascular network occupying the outer fol- 
licular spaces becomes increased in size and extent. By this means a new layer 
or membrane is produced, the membrana decidua, which consists of two portions, 
the thickened vascular mucous membrane and the non-vascular cellular substance 
secreted by the follicles. The former constitutes at a later period the dccidua veraj 
the latter the decidua rejlexa. (b) As the (impregnated) ovum reaches the uterus, 
the developed mucous membrane or decidua begins to secrete, the os uteri be- 
comes plugged up with a portion of the secretion, and the cavity of the uterus is 
filled with fluid — around the ovum this secretion consists of spherical nucleated 
cells, which possess the power of undergoing further development after being 
detached from the germinal spots or membrane of the secreting organ. These 
cells around the chorion of the ovum come to constitute the decidua reflexa. (c) 
Thus the tufts of the chorion are imbedded in a mass of nucleated cells, which 
cells are constantly being secreted from the follicles of the uterus, and which in 
all probability contain within them, as they become fully developed, the nutritive 
materials, which the absorbing cells of the villi of the chorion are constantly 
taking up for the nourishment of the ovum. This cellular secretion seems thus 
to be to the ovum of the mammal M^hat the albuminous fluid is to the ova of ovi- 
parous animals, {d) As the ovum increases in size, the amount of nutriment 
absorbed by the cells alone, is not sufficient for its wants; the allantois becomes 
applied to the inner surface of the chorion, and blood-vessels become developed 
within the tufts and villi. The vessels of the decidua vera at the same time en- 
large and assume the appearance of sinuses encroaching on the space formerly 
occupied by the cellular substance of the decidua reflexa, in the midst of M^hich 
the villi of the chorion are imbedded. Thus the lining membrane of the vascular 
system of the mother becomes the external membrane surrounding the villi of the 
placenta. It lines the whole placental cavity, passing from tuft to tuft, and vil- 
lus to villus, forming in this way threads and bands of venous membrane, which 
are tubular and filled with cells. These cells are continuous in the one direction 
with the external cells of the placental villi, and in the other with the gelatinous 
cellular substance constituting the parietal portion of the placenta] decidua, which 



198 Progress of the Medical Sciences, [Jan. 

is in connection with the wall of the uterus. The central portion of the placental 
decidua consists of the external cells and external membrane of the placental villi. 

It appears from the above : — 

1st. That the placental tufts and villi are made up on the one hand by the tufts 
and villi of the chorion, comprising umbilical vessels, internal membrane, and 
internal cells; and on the other hand by the lining membrane of the maternal 
vascular system, with a layer of cells beneath it, comprising the external mem- 
brane and external cells — the first portion is peculiar to the foetus, the latter to the 
mother. 

2d. These external cells are the remains of the decidua refiexa; they are still 
continuous with the cellular substance of the parietal placenta, by means of the 
cells filling the tubular threads of venous membrane, 

3d. The function of the external cells is to secrete from the maternal blood 
(from which they are separated only by the external membrane) the materials of 
nutrition destined for the fcetus ; this function is analogous to the digestive one 
performed by the intestinal mucous membrane in extra-uterine life. 

4th. The function of the internal cells or those belonging to the fcetus is to 
absorb through the internal membrane the materials secreted from the maternal 
blood by the external cells. This matter is then taken up by the umbilical ves- 
sels and carried away for the nourishment of the foetus. These internal cells 
perform a function analogous to that effected in extra-uterine life by the absorbing 
chyle-cells of the intestinal villi. 

5th. Hence the placenta discharges not only the functions of a lung, but also 
of an intestinal canal to the foetus. — (^Anatomical and Pathological Researches^ by 
John and H. D. S. Goodsir.)— J6zrf. 



ORGANIC CHEMISTRY. 

8. Nature of the Green Alvine Evacuations of Children. — By Golding Bird, M. D., 
{London Medical Gazette, Sept., 1845.) Whilst the attention of the practitioner 
has been constantly drawn to the frequent occurrence of bright green dejections 
in the aliments of infants, but little has been done towards determining their real 
nature and chemical composition. Dr. Bird has recently examined the green 
evacuations passed by a hydrocephalic child whilst under the influence of mer- 
cury, and which presented the following characters. " It was a dirty-green turbid 
fluid, which, by repose in a glass vessel, separated into three very distinct por- 
tions — 1, a supernatant fluid, of oil-like consistence, presenting a brilliant emerald- 
green colour; 2, a dense stratum of mucus, coagulated albumen, and epithelial 
debris, mixed with red particles of blood ; 3, a deposit, occupying the lower part 
of the vessel, of large crystals of triple phosphate of magnesia and ammonia^ in 
fine prisms of an apple-green colour. 

The supernatant emerald- green fluid was decanted for examination. 

The following is a view of the results of the examination : — 

Alcoholic Extract f Organic 24-50 
I Inorganic 5-50 

Aqueous Extract Organic 11-25 
^ / Inorganic 1-75 

Insoluble Matter Organic 56-00 
( Inorganic 1-00 
Water and Volatile matter 900- 



1000 
Regarding the chemical constitution of the organic portion of the alcoholic and 
aqueous extracts, the former consisted chiefly of fatty matter, cholesterine, and a 
green substance, probably identical with the so-called Biliverdin^^ with mere traces 

* Medizinisch-Analylische Chemie, von Franz. Simon : bd. 1., s. 333. 



1846.] ^ Organic Chemistry, 199 

of bile, barely sufficient to communicate a bitter taste to the extract, and in too 
small a quantity to leave any carbonate of soda in the residue of incineration. 
The aqueous extract consisted chiefly of ptyalin, and the extractive matters com- 
prehended under the general term of -^extrait de viande" by Berzelius. The 
composition of the fluid part of the green evacuation may therefore be thus 
expressed: — 

Biliverdin, alcoholic extractive, fat, cholesterine, with traces of bile . 24-5 

Ptyalin, aqueous extractive coloured by biliverdin . . . 11-25 

Mucus, coagulated albumen, and hsematosine . . .56-0 

Chloride of sodium, with traces of tribasic phosphate of soda . 5-5 

Tribasic phosphate of soda . . ._ . . . 1-75 

Sesquioxide of iron . . . . . . .1-0 

Water . . . . . . . . . 900- 



1000 



^^ That bile may, and often must, be present in large quantity in faecal dejec- 
tions in disease,'' Dr. B. remarks, " is certain; but that it is necessarily present in 
the green evacuations so common in early infancy, and under the influence of 
mercury, may be questioned." 

The colouring matter of blood is capable of being converted into green pig- 
ments under the influence of different agents, and Dr. B. thinks it must be ad- 
mitted that '^ we are not to assume the green colour of an animal excretion as of 
necessity depending upon the presence of an excess of bile. And when chemical 
analysis fails to indicate the presence of any quantity of this secretion in a bright 
green evacuation, it is but legitimate to seek for some other cause of this tint. 
The proportions of the so-called biliverdin very closely approach to those of the 
xanthe-hsematin before alluded to, and I confess that I am induced to regard the 
green colour of the emerald and ' chopped spinach' stools of children as depend- 
ing upon the presence of modified blood, rather than on an excess of bile. 

" Believing that the green stools alluded to are but a form of melsena, I have 
often closely questioned the nurses of children voiding them, regarding the ap- 
pearance of the evacuafions before and after the development of the green colour, 
and have almost constanfly been told that streaks, or even clots of blood, had 
been observed. 

''I regard, then, the presence of green stools as indicative not of a copious secre- 
tion of bile, but of a congested state of the portal system, in which blood is exuded 
very slowly, and in small quantities, so as to allow of the colour being affected 
by^the gases and secretions present in the intestines; a state of things capable of 
readily ending in melsena, in which the effusion of blood is so copious and sud- 
den as not to give time for the occurrence of the changes alluded to. 

^' There is, moreover, a peculiarity in the green dejections of children and others 
whose portal circulation is congested, which, so far as I know, is quite distinct 
from any property presented by mere bile under similar circumstances; — I allude 
to the effect of exposure to the oxygenating influence of the air upon them. When 
first voided the ' chopped spinach' stools are in the majority of cases of a bright 
orange colour, and they assume their characteristic grass-green hue only after 
exposure to air. The time required for this change varies remarkably. I have 
seen an orange-coloured stool become green in a few minutes; and in the same 
patient, only a day or two afterwards, many hours may have been required to effisct 
the same change." 

9. On the Effects of Food on the Blood. — Dr. Buchanan has drawn the following 
conclusions on the state of the blood after taking food: — 

1. The serum of the blood of a healthy man fasting, is perfectly transparent, 
and of a yellowish or slightly greenish tint. 

2. A heterogeneous meal, such as that usually set on the tables of the richj 
renders the serum white. 

3. The whiteness may commence as early as half an hour after eating, and 
may continue ten or twelve, and sometimes as long as eighteen hours, accord- 



200 Progress of the Medical Sciences, [Jan. 

ing to the kind and quality of the food, and the state of the functions of primary 
and secondary digestion. 

4. Starch and Sugar, probably all vegetable substances destitute of oilj give no 
whiteness to the serum of the blood. 

5. Fibrin, Albumen, and Casein, and probably Protein- Compounds in all their 
forms, if destitute of oil, give no whiteness. 

6. Oils combined, whether naturally or artificially, with protein-compounds or 
with starch, render the serum of the blood white; probably, therefore, oils pro- 
duce that efliect in whatever way taken. 

7. Gelatin seems to render the serum of the blood white; this, however, can- 
not be considered as certainly established, as there may have been some fat in 
the beef-tea which was taken along with the calf-foot jelly in both experiments on 
which the above conclusion rests. 

8. The coagulum of the blood very frequently exhibits, after taking food, a 
crust of pellucid fibrin, or a pellucid fibrin dotted with more opaque particles, and 
with little of the contraction technically named "cupping." 

9. The appearances of the coagulum just mentioned are much more common 
after azotized than after non-azotized food. 

These conclusions relating to the visible characters of the blood may be con- 
sidered, with the single exception above-mentioned, as well established. The 
conclusions which follow relate chiefly to the chemical properties of the blood, 
and are not worthy of the same reliance ; but the evidence on which they rest has 
been laid before the reader, and he must judge of them for himself. 

1. The substance defined above under the name of Pabulin,"^^ is most abundant 
in the blood a few hours after taking food, sooner or later, according to the rapidity 
of digestion. 

2. It is less abundant as the time w^hen the food has been taken is more re- 
mote, and is small in quantity after a fast of twenty-four hours. 

3. It is much more abundant after azotized, than after non-azotized food. 

4. It varies in quality, floating or subsiding, according to the kind of food takem 

5. It is probably analogous in nature to the while substance which gives colour 
to the serum of the blood. 

6. The difference between these two forms of this substance probably is, that 
it is sometimes combined with an alkaline, or earthy salt (chloride of sodium, 
sulphate of soda, &c.), and sometimes with an oily body, (stearate of glycerine, 
&c.) In the former case it seems to dissolve completely in the blood, while in 
the latter it is only partially dissolved, and renders the serum opaque. 

7. The azotized principles of the food are probably made to combine, in the 
digestive tube, with the alkaline, earthy, and oily salts mentioned above ; and 
thus become capable of being absorbed into the blood. 

8. The alkaline and earthy compounds are probably absorbed directly by the 
blood-vessels, while it seems to be well ascertained that the oily compounds are 
absorbed through the lacteals. — Lmid. Med. Gaz., Oct., 1845. 

10. Method for detecting the presence of a minute quantity of Bile in the Animal Fluids. 
— The ordinary method pursued for the purpose of detecting the colouring matter 
of bile (biliphaein of Simon, choleptyrrhin of Berzelius) in fluids supposed to con- 
tain it, consists in adding a portion of nitric acid to the suspected fluid, when, if 
bile be present, there is immediately produced a beautiful green colour, which by 
degrees becomes changed successively to blue, violet, red and yellow. It is 
essential, however, that the quantity of bile should be considerable, in order that 
these various changes of colour should take place on the addition of nitric acid ; 
if the quantity is but small, there is only produced a greenish colour, which shortly 
becomes changed to yellow without passing through the degrees of blue and red, 
for the production of which the quantity of bile present is not sufficient. Dr. 
Heller,! moreover, observes, that he has frequently known bile to exist in urine 

• A white substance obtained by precipilation either from limpid or opaque serum, 
or dissolving in it common salt to saturation. Neither phosphate of soda nor bicar- 
bonate of soda threw down this body from serum. 

f Archiv. fur Physiol, und Pathol. Chemie and Microsc, Heft I. 



1846.] Organic Chemistry. 201 

and other fluids without its presence being indicated, or any change of colour 
effected by nitric acid in the ordinary way of applying this test. He states, how- 
ever, that if any fluid in which bile exists, contains a portion of albumen, the nitric 
acid, by coag-ulating the albumen, will detect the'^smallest possible quantity of bile, 
for the coagulum assumes at once either a bluish, or perfectly blue, or a greenish 
colour, and if the bile exists in large quantity the coagulated albumen will accord- 
ingly assume a green, and then a reddish colour. In pursuing this mode of test- 
ing for the presence of bile. Heller recommends that to the suspected fluid, say 
urine, a considerable excess of strong nitric acid is to be added, and should there 
be produced by this means none of the ordinary colours indicative of the presence 
of bile, then that to another portion of the fluid some albumen dissolved in water 
(serum of blood, if at hand) is to be added, and well mixed; a litfle nitric acid is 
now to be poured into the mixture, which, after being stirred up, is to be left at 
rest for the albuminous precipitate to form : if bile be present, this precipitate of 
coagulated albumen presents a bluish or greenish-blue colour, but if it be not, then 
the coagulum is simply white (though, after a time, it assumes a yellowish tint, 
owing to the action of the nitric acid, but this is quite independent of the presence 
of bile). Thus, therefore, the simplest plan to detect bile in a non-albuminous 
fluid consists in making the fluid albuminous, and then treating it with nitric acid ; 
should blood be the fluid requiring to be tested, nitric acid may be added at once 
to the serum, which contains albumen in abundance. 

The microscope is capable of still further improving upon this mode of pro- 
cedure, and of rendering this test applicable in cases where the suspected fluid 
is too small in quantity to be examined satisfactorily in an ordinary test-tube; for 
this purpose, Donne^ recommends that a drop of the suspected fluid be placed 
between two slips of glass, and a litfle nitric acid added whilst the object is be- 
neath the microscope; immediately upon the acid coming in contact with the 
fluid the characteristic colours are struck, should bile be present. In this way 
Donne was enabled to determine that an abscess communicated with the intestine, 
by simply examining a drop of the pus discharged. — Ihid. 

11. Mode of detecting Morhid Bile. — In some diseases, however, as in cholera, 
&c.. Dr. Heller has found that the colouring matter of bile may undergo a very 
considerable morbid change, in consequence of which, when treated with nitric 
acid, it assumes at once a red instead of a green colour. He has found that for 
bile which has undergone this change ammonia is a better and a more certain 
test than nitric acid, for although this latter reagent will detect it when in any 
abundance, yet it is apt to prove deceptive in cases where urine is the fluid under- 
going examination, especially if much hsematosine be present, which substance 
becomes more or less red by nitric acid. In using the ammonia test, a small 
quantity only should be at first dropped in, immediately upon doing which a 
bright red colour is struck; more of the ammonia may then be added until a 
reddish-brown fluid is obtained. In this way it is possible to detect the presence 
of a very minute quantity of altered bile pigment,- even when nitric acid fails to 
afibrd the smallest evidence of its existence. — Ibid. 



MATERIA MEDICA AND PHARMACY. 

12. Therapeutic Properties of Veratrine and Strychnine. — Dr. F. A. Gebhard, of 
Moscow, has published an interesting paper on Veratrine studied comparatively 
M'ith Strychnine, in Dr. Szerlecki's Zeitschrift fur Therapie und PharmakodynamiL 
An abstract of its contents is presented in the following summary : — 

The experiments of Magendie and Andral prove the incredible rapidity with 
which strychnine is absorbed; those of Verviere and Segalas show that it may be 
actually detected in the blood, which is changed by its admixture with it; and 
post-mortem examinations disclose marked bloody infiltrations, turgidness of the 
veins, apoplexy, congestion, and even appearances of inflammation. Its primary 

* Cours de Microscopie, page 212. 



202 Progress of the Medical Sciences. [Jan. 

effects, in small doses, are irritating and exciting ; it appearing, at the same time, 
by its bitter principle, to improve the digestion, and unquestionably, in certain 
kinds of chronic diarrhcea, to be very useful. Yet the continued employment of 
strychnine in small doses, or even its administration in larger ones from the com- 
m.encement, appears to cause, in some unknown manner, such a change in the 
blood as to result unexpectedly and suddenly in a powerful reaction on the nerv- 
ous system, manifested by convulsions, tetanus, exhaustion, paralysis and death. 
In paralysis of the motor nerves, it has often been of great advantage, without 
having any effect upon any organ of secretion or of excretion ; but in neuralgia, 
in which M. G. formerly employed it internally and externally, it gives no relief; 
while in many other diseases, as cramps and convulsions, it has been employed 
without success. Under these circumstances, and in view of the dangerous effects 
it often produces, M. G. thinks that some other remedy should be sought for even 
in those cases in which it has proved advantageous. The remedy which he pro- 
poses to substitute is veratrine. Of this he speaks, in substance, as follows : — In 
small doses, administered internally, veratrine occasions peculiar pricking, sting- 
ing sensations, like those of electricity, in the extremities, shoulders, &c., followed 
by composing effects upon the portions of nerves affected with neuralgia, and 
somewhat after, with nausea, salivation, vomiting, flow of urine and diarrhcea. 
It ought also to favour the menstrual evacuation. Rubbed in externally, peculiar 
sensations of the skin are also excited by it, which reach, by means of the reflex 
action, upon other nerves under the influence of the spinal cord. M. G. does not 
believe that veratrine acts first through the blood, but, it appears to him, by the 
immediate specific irritations from the part to which it is applied, at one time by 
reflex action through the spinal marrow, at another by irradiation and the laws of 
contiguity, without reference to the relation of tissue and function, and to the 
known connection between nerves and blood-vessels, to cause an uniform excite- 
ment and distribution of the nervous powers, and thus to remove the symptoms 
of pain and paralysis — as w^e see after rubbing it in upon the back or over the 
region of the heart, the strongest nervous palpitations, pain, convulsive cough, and 
nervous pains of all kinds allayed; and in the same manner, absorption (in cases 
of dropsy) favoured, and in many cases the urine evidently increased. 

The indications for its employment are pain, cramp, effusion and paralysis, the 
result either of effusion or of exhaustion. The chief contra-indications are, in- 
creased activity of the circulation, fever, inflammations in general. Against its 
internal administration are, gastricismus ?Lndi organic disease of the intestinal canal. 
A great degree of torpor and of weakness does not prevent its employment, as it 
animates, especially when rubbed in, the sunken and irregular nervous action by 
the excitement it produces, without directly affecting the blood, in consequence 
of which strychnine is so dangerous. Care must be taken, however, not to employ 
it externally in marked inflammatory turgescence of the skin, and especially in 
certain erysipelatous, herpetic dispositions, &c.; which so often manifest them- 
selves in many dyscrasias. 

Dr. G. employs veratrine internally in doses of the sixteenth of a grain twice a 
day, increasing it gradually, according to the susceptibility, the early or late occur- 
rence of nausea or diarrhcea, to four pills and over. Externally, he prescribes 
5-20 grains of it to be rubbed up with an ounce of lard. As, however, it is very 
expensive, and we can never reckon upon its acting very rapidly, he orders gene- 
rally half to one grain of veratrine to ten to fifteen grains of lard, which may be 
used in two or three apphcations, and repeated if necessary. He always uses it 
with lard in children, and in women with delicate skins, or after recent inflamma- 
tory rheumatism, in which we are never sure, if it will, the part is in condition to 
bear it, even though fever and inflammation appear to be removed. Riecke 
recommends the veratrine to be dissolved in alcohol, and then mixed with the 
lard — a practice which M. G. approves of In chronic cases, on the other hand, 
and when there is a torpid condition of the skin, M. G. employs a spirituous 
embrocation, which, indeed, he found effectual in much weaker doses of from 
2-10 grains to the ounce. The rubbing in should be continued, according to the 
condition, ten to fifteen minutes^ and until a pricking and burning sensation is 
experienced. 

M. Gebhard has made advantageous use of this remedy in rheumatism, both 



1846.] Materia Medica and Pharmacy. 203 

acute and chronic — in the former, when, after the subsiding of the fever, there 
remain gastric derangements and local pains which will not yield to the usual 
treatment, and in the latter, after long perseverance and when there is no altera- 
tion of structure. Since 1839, says M. G., I have treated about sixty cases of 
rheumatism of all kinds, among which only four did not experience a radical 
cure; and in these marked enlargements and anchylosis had occurred, and the 
patients, partly from impatience and partly from fear of the expensive medicine, 
sought other assistance. In all the other cases, there resulted partly an entire 
cure of the most unpromising cases, partly decided relief I have never employed 
veratrine internally in rheumatism, only externally. For the most part, I have 
abstained from all internal remedies : in some cases only assisting the cure by 
means of colchicum, iodine — especially the latter, in combination with veratrine, 
in chronic swellings of the joints without pain, in which this treatment was very 
serviceable. In neuralgia, M. G. sustains the opinion of Turnbull, that veratrine is 
especially useful in those cases in which the pain is not fixed in any one point, 
but spreads itself over the extremities of the nerves^ as is the case in rheumatic 
prosopalgia. 

In all, nine cases of prosopalgia have been treated by him with veratrine, four 
of which came under his care from the commencement of the attack, and were 
cured in from three to four days — the longest being seven to eight days — ^by 
means of veratrine rubbings. In two epidemics of whooping-cough, M. G. found 
that by rubbing in veratrine over the vertebrae of the neck and upper part of the 
back, there was great relief experienced where the second stage was protracted 
in its length. The striking influence of veratrine on the urinary secretions has 
often been ascertained in general dropsy, as well of the skin as of the cavities, 
especially in cases where no organic disease was apparent: even where this was 
evident, M. G. has often observed benefit, even if only of a palliative character. 
The cases treated were some of them the result of cold, causing, instead of 
inflammatory rheumatism, an enormous exudation into the serous cavities, and 
other secondary dropsies after previously existing inflammations. But more 
marked effects were observed in dropsies consequent upon long and exhausting 
disease ; as, in particular, after a severe typhoid epidemic he observed. 

The last disease noticed, and that to which M. G. first directed his experiments 
with respect to the employment of veratrine, is paralysis. In three cases of 
paralysis of the facial nerve, consequent upon colds, the frictions with veratrine 
were employed with the most complete success, the power being restored in from 
six to thirteen days. In two cases of paralysis after apoplexy, one in a man 74 
years old and the other in a man 62 years old, after all evidences of congestion and 
irritation had been removed, by means of antiphlogistic treatment, and the para- 
lysis alone was left, M. G. employed the veratrine frictions with entire relief of 
this symptom. These are the only instances of this affection which he has as yet 
had an opportunity to treat; but they were so successful that he would recur to 
the use of this medicine whenever a similar condition presented itself to his 
observation. — Zdtschrift fur Therapie et Pharmakodynamik. Freiburg, Dec. 1844. 
No. 3. 

13. New Caustic formed by a mixture of Saffron and Sulphuric Acid. — After a 
number of experiments on various kinds of potential caustics, M. Velpeau has 
lately adopted one which seems to give very excellent results. It is prepared by 
concreting sulphuric acid into the consistence of a ductile paste by means of a 
sufficient quantity of saffron^ which, without destroying its caustic qualities, pre- 
vents the acid from spreading beyond the limits to which it has been applied. 

''This substance being carbonized by the acid, there remains a beautiful black 
paste, which resembles China ink or dry blacking. This paste is placed in an 
earthenware pot; the surgeon takes a portion of it on a spatula, and spreads it on 
the affected part, like ointment, a little hard; he then lays on a layer of it from 
two to four millimetres in thickness, more or less; rounds its edges, and circum- 
scribes its limits to the exact extent of the disease ; he then leaves it thus exposed 
to the air till such time as it dries. A crust soon forms, which is to be covered 
with a compress and a bandage. The caustic which remains in the pot will not 
keep for any length of time, the sulphuric acid attracting readily the moisture 



204 Progress of the Medical Sciences, [Jan. 

from the air ; but that which has been apphed upon the flesh forms a hard crust, 
resounding like a piece of charcoal, perfectly dry, circumscribed in its limits, 
and of a depth equal to the thickness of the layer which was applied. 

"This eschar began to separate between the eighth and tenth day, in a patient 
who had only been subjected to a slight application. In a patient affected with 
scirrhus, to whom more than a hundred grammes of the caustic ointment had been 
applied, it was satisfactorily seen that none of the phenomena of absorption 
occurred; and that, besides, the caustic had the effect of completely removing 
the disgusting smell which the cancer had hitherto had, and which annoyed both 
the patient and his neighbours. The cauterized tissues exhaled even an odour 
rather agreeable than fetid. Till new facts permit us to appreciate better the 
value of this new agent, we think it proper to direct attention to three important 
conditions which it presents, viz. : — 

'■' I. The exact circumscribing of its action to the limits traced by the ointment; 
2. The quick throwing off' of the slough; and, 3. The absence of serious absorp- 
tion." — Northern Journ. of Med.y Sept. 1845, from Annates de Therapeutique. 



MEDICAL PATHOLOGY AND THERAPEUTICS AND PRACTICAL 

MEDICINE. 

14. Survivance for Forty days after the Separation of forty four inches of Intestine. — 
This remarkable case is recorded by Mr. Hill in the Monthly Journal of Medical 
Science for August last. The subject of it was a lady sixty-five years of age, who 
had been long in delicate health and a sufferer from constipation. Whilst on a 
visit to her friends she neglected the use of laxatives. She became constipated 
on the 18th of August. This was followed after eight days by severe pain in the 
abdomen, tympanitis, the rejection of every kind of food, &c. The constipation 
persisted in spite of medicine until the 31st August, when she had several co- 
pious and very offensive motions, which relieved tenderness of abdomen, &c. 
Diarrhoea succeeded, and on the 5th September Mr. H. was sent for in conse- 
quence of something protruding from the rectum. On examination Mr. H. found 
a shriveled substance about four inches long hanging down and attached to some- 
thing soft within the sphincter. Gentle and continued traction brought away a 
portion of the entire intestine, which, with what had been protruded, measured 
forty-four inches ; — it was so decayed as to taint the whole apartment with its 
putrid odoar. The tendency to diarrhoea continued for ten days after this, but was 
kept in check by opiate enemata. A little food was taken with relish, and the 
patient complained only of debility; she became extremely emaciated, and on 
the 14th of October, forty days after the separation of the portion of intestine, she 
sunk exhausted. 

On examination, the intestines were traced from the stomach downwards, and 
found healthy onwards to the colon, which, from the left iliac region upwards to 
the lower rib, had formed strong adhesions to all the neighbouring parts: it was 
dark and fragile at its lower part. A large cavity was formed, on a line with and 
above the os ilium, by adhesions : it was full of feculent matter — the upper part 
of the rectum and the lower portion of the colon opened into this cavhy. The 
sigmoid flexure was wholly wanting; and the colon, from the caput caecum to its 
termination in the cavity, as above described, measured only fourteen inches. 

''In this highly interesting case," Mr. Hill remarks, '' involution of the bowels 
must have taken place, leading to amputation and throwing off of the sigmoid 
flexure. The adhesions formed a strongly walled cavity, which prevented the 
escape of feculent matter into the general cavity of the abdomen. The ingesta 
had traversed the intestines in the natural way; and first filling completely the 
cavity described, had then forced their -way down through the rectum. This is 
obviously the explanation of the motions being latterly so regular and so appa- 
rently natural." 

15. Varicose Tumour of the Pia Mater. — M. Baillarger presented to the Medical 
Society of Paris a pathological specimen; exhibiting an example, probably unique 



1846.] Medical Pathology and Therapeutics. 205 

in the annals of science, of a varicose tumour of the vessels of the pia mater 
penetrating into the substance of the right hemisphere of the brain. No tumour 
was visible on the surface of the brain, but at the base of the right hemisphere 
a vein distinctly dilated was visible, and which could be traced into the interior of 
the cerebral substance, where a considerable group of varicose veins existed 
which extended to the right ventricle. 

This specimen was obtained from a woman 46 years of age, who, during her 
life, presented symptoms having no relation with the alteration of the brain. 
Thus she was affected with general paralysis, which was afterwards complicated 
with a gangrenous diathesis. Gangrenous spots appeared on the inside of the 
arms and thighs, and what was very curious, on the palatine arch, all the soft 
parts of which were destroyed. The arteries and veins of the gangrenous parts 
exhibited no alteration of structure. — Revue Medicale. Nov. 1844. 

16. Combination of Valerian and Oxide of Zinc hi Dysmenorrhcea. (Dublin Hos- 
pital Gazette, Sept. 1, 1845.) — Dr. John Aldridge has employed the following 
formula, in a number of cases of dysmenorrhcea, with advantage: — R. Infusi va- 
leriansB ^ivss; Tincturas valeriana3 ^j ; Sulphatis zinci gr. xij; Aquce ammonisE! 
q. s. ; Aq. purse ^ss. Solve sulphatem zinci in aqua, dein adde guttatim aquas 
ammoniee q. s. ad solutionem, denique misce simul. omnise. Sumat unciam ter 
in die. 

The relief afforded by this remedy in ordinary cases, Dr. A. says, is very rapid, 
the pains being often relieved within twenty-four hours. 

17. Extra-thoracic Pneumothorax. — Dr. Stokes communicated to the Pathologi- 
cal Society of Dublin, April 26, 1845, a case, remarkable as exhibiting an ex- 
ample of the phenomena of pneumothorax being produced by a cavity situated 
external to the walls of the chest. It was that of a soldier, aged twenty, and it 
was important to remark, that although at the time he came under professional 
observation, he presented the most extensive lesions, he had up to that period 
performed his duties without complaint. He was taken into the Royal Infirmary 
on the 25th of February last, and it was then found that he had a large elastic 
tumour, situated upon the inferior angle of the right scapula, and extending to- 
wards the spinal column. He stated that the swelling had been gradually in- 
creasing for some time ; but that he had no pain in the part, nor had he ever 
received any injury. Upon examining the tumour, the inferior part was found to 
contain liquid, while the remainder was filled with air. He had cough unattended 
with expectoration, and he was able to sleep on either side or on the back. At 
this period, the respiratory murmur could be heard ail over the swelling, and loud 
rales developed themselves whenever he coughed. 

On the 6th of April he came under the care of Dr. Tice, who made the follow- 
ing note of his state at that time : — 

''Cough frequent, accompanied by trifling expectoration of frothy mucus; re- 
spiration hurried; dyspnoea, and considerable debility; percussion over the tumour 
tympanitic, except at the inferior angle of the scapula, where it is dull ; a loud 
respiratory murmur heard throughout, with metallic resonance; on coughing, a 
rush of air takes place into the tumour, accompanied by much noise, as if "tra- 
versing liquid. Below the clavicle of right side, trifling dullness exists; respiration 
is cavernous, and here metallic tinkling can be distinctly heard; percussion over 
the remainder of the right side normal, as also upon the left; loud moist rales 
accompany inspiration and expiration." 

From this period the tumour rapidly filled with liquid, without alteration in the 
symptoms until the 20th, when he became hectic, and now the cough was attended 
by purulent expectoration. Upon examining the swelling, it was found to extend 
from the outer border of the right axilla across the superior part of the spine of 
the scapula, across the vertebral column, as far as three inches from the spinous 
processes: it spread downwards to the last rib; but laterally it seemed limited 
within two inches of the border of the axilla, so that all the lateral and anterior 
part of the chest remained free. Over the whole posterior and lateral parts of the 
right side not occupied by the tumour, there was some dullness on percussion ; a 
large moist crepitus heard most distinctly in inspiration, with occasional bronchitic 
No. XXL— January, 1846. 14 



206 Progress of the Medical Sciences, [Jan. 

rales. The same crepitus was audible over every part of the tumour except along 
the left side of the spine, when a loud sonorous rale replaced the natural respira- 
tion, both in inspiration and expiration, and here a metallic resonance was audible, 
especially when he coughed or spoke. A similar moist crepitus existed over the 
front of both sides of chest, mixed with bronchitic rales infariorly. 

An incision was made into the tumour at its most depending portion, and 
about four ounces of healthy pus was discharged. Nature had made an opening 
at the inferior angle of the scapula, and the pus discharged was similar to that 
found in empyema. On making him cough, the force and the quantity of air 
discharged through the inferior opening were remarkable. The operation afforded 
some relief; but he sunk on the night of the 24th. 

Dr. Stokes said, that for the foregoing particulars of this case he was indebted 
to Dr. Tice. He (Dr. Stokes) had examined him a short time before his decease, 
and was enabled to confirm the description of the symptoms. He was present 
at the autopsy made on the 25th, when a large cavity was found in the integu- 
ments in the situation of the tumour: this was lined by a thin membrane and 
traversed by bands, and so far resembled a tuberculous abscess. It communicated 
by a narrow fistula, passing under the capsular ligament of the shoulder joint, and 
through the first intercostal space with a very minute cavity in the superior part 
of the right lung, just at the place where cavernous respiration and metallic phe- 
nomena were audible during life. 

Dr. Stokes considered that there were many points deserving of attention in this 
case. First — the latency with which the disease commenced; that a man labour- 
ing under such an amount of disease could perform the arduous duties of a private 
.soldier, must appear extraordinary. Secondly — the manner in w^hich the signs of 
a large cavity under the right clavicle were simulated by an exceedingly small 
cavity communicating by fistula with a large extra-thoracic abscess, was worthy 
of attention. He (Dr. Stokes) thought that the great amount of flattening which 
existed in this case might have served to clear the diagnosis; for he believed that 
flattening under the clavicles was rather the result of atrophy and pulmonary 
induralion than of ulcerative excavafion. Thirdl}" — the rapid supervention of 
profuse purulent expectoration towards the close of this case, although the only 
cavity that could be discovered after death was very small, was deserving of 
notice. It was now generally conceded that purulent expectoration was no evi- 
dence of ulceration; but he (Dr. Stokes) would go still farther, and state his con- 
viction, that in many cases the pus contained in sputa, even where cavities exist, 
does not proceed from them, but is the product of bronchial secretion. He believed 
that the contents of cavities are but rarely expectorated, and he regarded the pus 
spit up as the result of a vicarious secretion from the bronchial tubes, just as he 
looks on the purulent expectoration synchronous with the disappearance of an 
empyema, as in cases described by Dr. Green; and with the absorption of an 
hepatic abscess as reported by Dr. Corrigan, as the product of vicarious bronchial 
secretion. Lastly — this case was remarkable as presenting an example of a 
pneumothorax located external to the ribs; so that now we are acquainted 
with three forms of pneumothorax — the common form described by Laennec; 
secondly, the form to which he had drawn the attention of the society on a former 
occasion, where the air had occupied a space between the pleura and the lung; 
and thirdly, the present, which might be considered an extra-thoracic variety. 

18. Treatment of Disease by Moist Air. — Dr. Golding Bird read a paper before 
the Medical Society of London (Sept. 29, 1845), on this subject. After showing 
the great importance of attention to the skin, and its secretion, and the influence 
it exerted in degenerating internal organs, particularly when in a state of conges- 
tion, he drew attention to the mode in which he carried out his practice. He 
claimed no merit on the score of novelty; for the plan of treatment was as old as 
the hills; the particular mode, however, of carrying it out had some claim to ori- 
ginality. 

Selecting, if the choice be permitted, a bed-room as small and as free from 
draughts as possible, the windows are carefully closed, and if the casements do 
not fit accurately, strips of paper should be pasted over the junctures. A stout 
eheet or blanket should then be fastened with a nail or two to the lintel of the 



1846.] Medical Pathology and Therapeutics. 207 

door outside, so as to hang down and prevent currents of cold air entering the 
room during the ingress and egress of the attendants, a large fire being lighted in 
the grate, which should never be allowed to go out during the treatment. A ther- 
mometer should be suspended over the patient's bed, so as to be about two or 
three feet from its centre, and carefully watched : the indications of this instrument 
should be the sole guide for raising or depressing the fire, and a temperature of 
from 70° to 78° should be constantly maintained. A large kettle of water is 
placed on the hob, and kept boiling, so that a current of steam may be constantly 
poured into the room from its spout, which, for this purpose, must be elongated 
by the addition of a few feet of gas-pipe; and until this be procured, with a tube 
of stiff paper, or thin mill-board. 

By these precautions, the room may, without the slightest difficulty, be kept at 
a nearly constant temperature for the requisite time. Indeed, it is remarkable 
how little variation is observed in the thermometric indications, when the most 
ordinary care is taken to prevent the entrance of long-continued draughts of air. 
Let us now suppose that a child, the subject of capillary bronchitis or pneumonia, 
be exposed to the influence of a bed-room arranged with these precautions, placed 
in bed, and supplied freely with diluents, as tea, toast- water, or common water, 
for which the little patients generally crave, and inquire what are the. probable 
results of this treatment, independently of any other. 

The first thing observed, generally, is a slight diminution in the rapidity of the 
respirations, which, for the most part, assume soon a less panting character ; this 
may be accounted for by the more soothing effect of a genial temperature on the 
surface of the body, and by the warmer air inspired proving less stimulant to the 
lungs : and, cotemporaneously with this, the cough, if present, diminishes in fre- 
quency and violence. 

In a short time afterwards, the surface of the body, especially the extremities, 
if previously cold, as in suffocative pneumonia and bronchitis, become warmer; 
but if previously pungent and hot, they become moist, and in both cases a free per- 
spiration bursts out, and continues in most cases for days. Should this not occur 
so soon as is wished, enveloping the chest in a large and thick hot linseed-meal 
poultice will generally turn the scale in favour of diaphoresis. It is here, indeed, 
that we find the advantage of rendering the air of the room moist by the evapora- 
tion of water. If mere dry air, of the temperature of 75<^', be allowed to exert its 
influence on the parched skin of acute pneumonia, it seldom, if ever, excites per- 
spirafionj the orifices of the spinal sweat-ducts seem closed against the escape 
of perspired fluid — nay, it is not uncommon to meet with a sort of false miliary 
rash, really being sudamina, each formed by a drop of sweat, imprisoned by the 
cuticle. 

He then detailed some interesting cases in which this plan had succeeded in 
effecting a cure. — Lmicet^ Oct. Ath, 1845. 

19. Death from Calculus in Appendix Vermiformis Cceci. — Dr. Bury relates in the 
Provincial Medical and Surgical Journal, (Oct. 1, 1845,) a case of fatal peritonitis 
from calculus in the appendix vermiformis cseci. The calculus, which had caused 
ulceration and perforafion of the appendix, was the size of a horse-bean, soft and 
pultaceous externally, and consisted of inspissated mucus, with a considerable 
proportion of phosphate of lime, and some carbonate of fime, with a small portion 
of crystallizable fatty matter, probably cholesterine. 

20. Chlorotic Palpitation.— Dr. Corrigan, in his lectures on diseases of the heart, 
now in the course of publication in the Medical Times, gives the following account 
of a peculiar funcfional disorder of the heart accompanying chlorosis. The fol- 
lowing are its symptoms: — ^^^AnsBmia, characterized by the bloodless, tallowy 
appearance of the surface of the body ; cough, oppressed breathing, dyspnoea, 
emaciation, loss of muscular strength, anasarcous feet, and effusion, perhaps, into 
the cellular fissue of the body. To these symptoms, alarming enough in them- 
selves, are added palpitation of the heart, and bruit de soufflet. Here we have a 
train of symptoms alarming enough to induce us to suppose our patient labouring 
tinder organic disease of the heart. We find these palpitations increased on taking 
exercise, and sometimes accompanied by pain in the region of the heart. Have 



208 Progress of the Medical Sciences. [Jan. 

we any characteristic mark by which we can distinguish whether the above train 
of symptoms denotes organic disease of the heart or not ? Yes. Ahhough the 
other signs might readily deceive us as to its existence^ yet by carefully examin- 
ing the bruit, we can from it discover a means of arriving at the wished-for con- 
clusion. The bruit, from the peculiarity of its sound, in these cases has been by 
the French writers termed bruit de diablc. The sound closely resembles that pro- 
duced by the schoolboy toy (with which, I am sure, you are all familiar), made 
of a piece of iron, or stiff leather, nicked at the edge, and strung on a cord by a 
hole through its centre. This, on being twirled through the air pretty briskly, 
produces a peculiar sound. The bruit here differs from that in organic disease 
in the following particular: — In organic affection the beats of the pulse being 50, 
60, 70, 80, or 90 in a minute, the number of times bruit is heard will tally exactly 
with this, except in cases of permanent patency of the aorta, when the sound of 
the returning portion of blood causes double bruit. In chlorotic palpitation, no 
matter what the number of pulsations may be, the bruit does not correspond with 
them. You cannot count the number of times in which you hear bruit de soufflet 
in this affection. There it goes on continuously, whirring away for one-half, one, 
two, three, or ten seconds ; there is no intermission in it as in organic disease ; it 
may hold on thus for half a minute or a minute, but during this time there is no cessa- 
tion. In this distinction we possess a never-failing criterion between functional 
disorder and organic disease of the heart. In the chlorotic bruit de soufllet you 
can hear this sound also in the internal jugular vein, when the stethoscope is 
applied to the neck, — this sound proceeding here from exactly similar physical 
causes as those which I have detailed in the lecture explanatory of the causes 
which operate in producing bruit de soufllet. In the disease before us we have 
the physical cause acting in full force, which is absolutely essential in producing 
this sound — namely, an incomplete distension of the large vessels with blood, 
owing to the deficient supply of it in the system. But you must bear in mind, that 
in a person of perfectly sound heart, and enjoying excellent health, you may have 
bruit de soufflet present, from some cause or other, of only momentary duration. 
'•The treatment of this chlorotic palpitation may be divided under two heads: — 
1. To remove the constipated state of the bowels which always exists here, by 
means of purgative medicines, which are supposed to exert some specific stimu- 
lus on the uterus: of this class I think aloes the most preferable. 2. To improve 
the general state of health by the administration of a full diet of animal food, a 
m.oderate allowance of fermented liquors, by taking a sufficiency of exercise — 
walking, if possible, is to be preferred — and by the use of medicines which are 
supposed to possess the property of promoting materially the formation of red 
blood — chalybeates, for instance. By the use of these, and all other means which 
may suggest themselves to you as being useful in raising the debilitated system 
to a proper degree of vigour and to the highest possible tone, you will, in the 
majority of instances, quickly and effectually restore your patients to health." — 
Med. limes, Aug. 9, 1845. 

2 1 . Functional Disorder of the Heart depending on Spinal Irritation. — Dr. Corrigan 
describes this affecfion as "consisting solely of palpitation, without any other 
irregularity of this organ, which we find attacking females about or at the period 
of puberty — say from fourteen to sixteen — and in some instances continuing until 
the persons so attacked have attained the age of thirty or thirty-five. The state of 
the catamenia here has no influence in producing this complaint, for we meet it 
in persons where this secretion is regular, irregular, wholly defective, or, on the 
contrary, morbidly profuse, and we often meet it co-existing with leucorrhoea. It 
may attack males as well as females, but the latter principally, parficularly such 
of them as have given themselves the custom of wearing tightly-laced stays, and 
it is often met with in persons who have naturally narrow chests. In these cases 
the heart may be felt beating violently, and over a large extent of surface, some- 
times accompanied by pain. In no case, no matter how violent the palpitation 
may be, is there any abnormal sound heard. The palpitation is much increased 
whenever the patient takes much pedestrian exercise, though (and the fact which 
I am about to menfion is curious), if the person has been accustomed to horse 
exercise, she can take any amount of it without feeling any inconvenience from 



1846.] Medical Pathology and TTierapeutics. 209 

palpitation. We often find persons who, having been delicate in early life, and 
subject to this affection, on being surrounded by a numerous family in after life, 
tell us that they have outgrown their disorder, have become stronger than it, and 
that they are no longer troubled with it. A curious circumstance connected with 
the pulse occurs in this affection. If the pulse {as most often happens in it) he irre- 
gular and intermittent during the prevalence of the disorder, it still continues so after 
the complaint has disappeared, and will continue, too, irregular and intermittent, during 
the patienVs lifetime. If unacquainted with this fact, we might be led to infer, from 
the irregularity and intermission of the pulse in persons otherwise healthy -looking, 
the speedy accession, or even the presence of some severe disease of the heart. 
We frequently find this state of the pulse in delicate young females labouring 
under the affection of the heart in question, joined vi'ith pain of the left side, fre- 
quently extending towards the right. The existence of this pain makes them 
uneasy, fearing from its situation some fatal disease of the heart, and I have not 
unfrequently seen the whole train of symptoms treated by medical men as incipient 
pericarditis. Such an opinion is groundless, and one likely to lead to some 
aggravation of the functional disorder already existing. We often find this affec- 
tion dependent upon spinal irritation, and the part of the column which is gene- 
rally affected is the first or second, or sometimes the last of the dorsal vertebrae. 

''This cause of the disease is frequently overlooked both by patient and phy- 
sician in their anxiety about the palpitation, until evident symptoms of spinal 
disease show themselves either in the usual form of curvature where the body is 
bent forward, or in the more severe and unmanageable form, called by the French 
' syphosis,' when the curve is lateral and angular. 

'' In cases where this affection depends on spinal irritation, we must immediately 
have recourse to the means best calculated to subdue this. For this purpose, the 
first step should be topical bleeding, from whatever situation the spinal irritations 
occupy. This we can determine by pressure along the spinous processes of the 
vertebrae. After this topical bleeding by leeches or cupping, we must direct the 
use of counter-irritation over the seat of disease. I do not know a better remedy 
for this purpose than the tartar-emetic ointment rubbed in every morning and 
night until it produces pustulation. Along with these radical means of cure, we 
shall derive very great advantage in controlling the distressing palpitations by the 
use of prussic acid or laurel water, in half drachm doses three times a day. 
Observing to follow up this line of treatment, we shall have the gratification of 
finding the heart symptoms disappear, according as the primary exciting cause 
is removed. In the cases which do not depend upon spinal irritation, we shall 
find our best account in a tonic plan of treatment, supporting the strength by every 
means in our power, and by keeping the digesUve organs in proper order." — Ibid. 

22. Functional Disease of the Heart in Persons who have led Dissolute and Intemper- 
ate Lives. — Dr. Corrigan, in his lectures on the diseases of the heart, describes a 
form of functional disease of the heart arising in persons who have led dissolute 
and intemperate lives. "In such persons," he remarks, "the complaint com- 
mences with palpitations, which are excessively troublesome, and annoy the 
patient to such an extent as to induce a fear that organic disease of the heart may 
be present, and which may prove quickly fatal. The action of the heart is vio- 
lently strong and tumultuous, and is often accompanied with pain shooting down 
the left arm as far as the elbow : these palpitations are much increased when he 
walks or takes exercise, if at all of a violent nature. In this state he is miserable, 
dreading nothing so much as instantaneous death at some period (of course) 
unforeseen by him ; yet, with all these complaints, when you examine the heart 
you find its sounds natural. The tongue, in this disease, presents an appearance 
which you could not, h priori, conjecture ; — on examination, its sides, fip and 
dorsum, present a red and glazed appearance, indicadve, in some degree, of 
subacute gastric inflammation. In this disease the stomach acquires the power 
of secreting air, which often takes place to an enormous extent; and if we press 
upon it towards its great arch, we shall find it somewhat elastic, and if we apply 
the stethoscope in this situation, we shall find the stomach tympanitic, and the 
sounds of the heart in this region become preternaturally clear and distinct. 
The reason of this is obvious. The stomach, being enormously distended with 



210 Progress of the Medical Sciences, r [Jan, 

its gaseous secretionj irritates the heart, and throws it into irregular action, while 
the sounds of the organ are transmitted with preternatural distinctness through 
a medium so well adapted for their conveyance as the air, which is secreted by 
the stomach in its present disordered state. I have seen this form of functional 
heart disease, as I have remarked already, in persons who have led dissolute, 
intemperate lives, addicted to excesses of every kind. I have seen more of it, 
however, in those persons who have returned from the civil wars in Spain than 
among any other class. I think that their mode of living while in Spain accounts 
satisfactorily for its very great prevalence among them. They were persons who, 
for the most part, were deprived, in a great measure, of a due supply of whole- 
some food: but who, in order to make up for this deficiency, addicted themselves 
to the intemperate use of stimulants of every class, such as green tea, tobacco, 
and. last not least, to the use of those which the country itself supplies with such 
lavish profusion — wine and brandy. Here we have all the causes necessary to 
produce gastric inflammation, and it is this which is the root of the disease. 

" We shall find the appearance of the tongue of material benefit to us in pointing 
out the treatment to be adopted, which is nothing more than the removal of the 
gastric inflammation which exists in a subacute form. In our treatment of this 
affection, our first step should be the applicafion of counter-irritation over the epi- 
gastrium, and this continued, too, for a considerable time. For this purpose I 
generally prescribe the croton oil liniment, made with a drachm of the oil to an 
ounce of spirit of turpentine, or compound camphor liniment. This is to be 
rubbed in every morning and night until pustulation is produced. Along with 
this topical treatment, I am in the habit of prescribing oxide of bismuth, in con- 
junction with bicarbonate of soda, or, better still, a combination of these two with 
the saccharine carbonate of iron in the following proportions: — 

'•' R. — Sodse bicarbon. gr. x.; Bismuth trisnitrat., Ferri c. saccharo, aa gr. viij., pro 
pulvere, ter. in die sumendo. 

"This must be persevered in for some time, until the tongue becomes im- 
proved in appearance, the stomach loses its power of gaseous secretion, and the 
patient no longer complains of palpitation or any other irregularity of the heart. 
It will be needless for me to mention that, in addition to these means of cure, 
you must prohibit your patient most strictly from the use of tea and all other 
stimulants. Let his diet be one of a nutritious, non-stimulating character, contain- 
ing animal food in quantity and quality suited to his enfeebled digestive powers." 
Med. Times ^ Aug. 16. 

23. Epileptic Palpitation. — In the same lecture, Dr. Corrigan makes the follow- 
ing remarks relative to a functional affection of the heart which is caused by dis- 
eases of the brain. "It seems strange," he observes, "that an affection of the 
brain could cause palpitation of the heart, but, though strange, it is nevertheless 
true. You will be consulted by a young man, or by one probably in the prime 
of life, who will te]l you that he has been attacked by palpitations for some time 
past, which render him uneasy, anxious and uncomfortable, and that they come 
on him when he takes exercise or is at all agitated. These palpitations frighten 
him very much, but wdien you examine the heart you find its sound perfectly 
normal. On questioning him as to the first occurrence of this irregular action of 
the heart, he will tell you, perhaps, that some short time ago he was attacked 
with a fainting fit, which he says has recurred since, and that, after the first attack 
of syncope, the palpitations began to annoy him. This is what the older writers 
termed epilepsia silens — silent epilepsy. About the fainting fits themselves, the 
pafient has not the least concern; he fears only for the palpitation, and to this he 
directs your attention exclusively. These fainting fits, if allowed to proceed 
unchecked, will terminate, perhaps, in a very short time, in well marked and 
regular epilepsy. However, they may run on for a period of two years before 
the disease perfectly shows itself Your attention will be awakened here by 
finding these fainting fits coming on at a period of life when they should be natu- 
rally absent, from the vigour which the constitution enjoys. You v\'i]l, therefore, 
proceed to inquire from what cause it is that they arise. The heart, as I have 
said before, is perfectly normal in its sound; no disease there; no symptoms of 
irritafion along the vertebral column. Where, then, does the mischief spring 



1846.] Medical Pathology and TTierapeutics, 211 

from'? The head, as I have remarked, is the cause of these alarming palpitations, 
and of those fits of syncope which have preceded the palpitations. 

" We have now to consider the means best adapted to relieve both the cause and 
its effects. The medicine which I have found to possess properties the most ser- 
viceable and advantageous in arresting this disease is the digitalis purpurea, or 
fox-glove. I have witnessed more benefit in cases of this kind from the use of 
the digitalis (bleeding from the arm having been in every instance premised), 
tlian from any other remedy or class of remedies which I have seen tried. To 
produce its beneficial effects here, you must not content yourself with administer- 
ing it in the small doses of the pharmacologists. The form of the drug which I 
have found most beneficial is the powder; it must be given in doses of two or 
three grains at bedtime every night , and in some cases, in Jive grain doses, until it 
exerts its peculiar effects on the constitution. You will, therefore, consider this 
affection of the heart only as it really is, one of secondary importance; and, in 
the selection of your remedial measures, you will proceed at once to strike at the 
root of the evil where it really exists — in the brain ; and not until every trace of 
mischief has vanished from thence can your patient be free from these palpita- 
tions, which are to him a source of such needless alarm. Without my having 
told you, your own common sense would at once have made you acquainted with 
the propriety of keeping your patient as free as possible from every source of 
mental irritation, as this has been known to prolong the disease to an extremely 
protracted period of time." — Ibid. 

24. Functional Diseases of the Heart in Sedentary Persons. By Dr. Corrigan. — 
'^ We often meet, in persons of sedentary habits, an affection of the heart, consist- 
ing of violent palpitation, which, as in all these cases of functional derangement 
of the heart, give the patient a great deal of unnecessary alarm. There is no 
abnormal sound here, though the heart may be felt acting with great vigour. If 
we examine these cases minutely, we shall find, in every one of them, evidences 
of venous congestion ; the pulse is full and quick, the eyes are suffused, the 
patient feels more or less drowsy; there are sometimes a turgescence and lividity 
of the face, and swelling of the legs, and, occasionally, an inclination to syncope. 
These signs, if neglected for any period of time, will terminate in an attack of 
apoplexy, in all probability fatal. It is easy to conceive why, in these cases, the 
heart should become affected with palpitations, in consequence of the extraordi- 
nary quantity of blood thrown upon it by the sedentary habits of the patient — these 
palpitations being nothing more than the struggles of the overloaded ventricle to 
discharge completely the quantity of fluid contained within it. 

" The treatment here is obvious and simple. Take blood from your patient to 
the extent of eight or ten ounces, so as partially to unload the ventricle ; after that 
give a purgative, so as to unload the alimentary canal; and, in my opinion, you 
will have done everything requisite for your patient — in fact, you can do no 
more." — Ibid. 

25. Ont Thymic Asthma. By M. Trousseau. — A great deal has been written of 
late in Germany, says M. Trousseau, on thymic asthma — a disease first described 
a few years ago by Mr. Hood, of Kilmarnock. In this "newly-discovered" 
disease, the thymus gland is stated to give rise to convulsions and sudden death 
in infants by its enlargement. The existence of such an affection was from the 
first questioned by French pathologists, and M. Trousseau now states that his 
researches have proved to him, in the most satisfactory manner, that there is no 
such disease. The facts brought forward by the German physicians must be 
admitted, he states, but the interpretation which they give of these facts is erro- 
neous. Instead of being instances of an undescribed form of disease, they are 
merely illustrations of partial convulsions. The analysis of the phenomena of 
convulsions in children has proved to M. Trousseau that such is the real nature 
of the cases narrated by Kopp and other physicians as examples of thymic asthma, 
as well as, partly, of others described under the name of laryngismus stridulus, or 
acute asthma of Millar. The following is a brief analysis of M. Trousseau's views 
on this subject : — 

In children, convulsions (cclampsie) generally present the epileptic form. The 



212 Progress of the Medical Sciences. [Jan. 

child screams, becomes stiff, twists its body, the thorax being fixed and the respi- 
ration suspended. The face, at first pale, becomes violet; the veins are distended; 
then follow clonic spasms, at first rapid, then slow; after which a deep expiration 
and general muscular relaxation close the fit, leaving more or less somnolence 
and stupor. The attack lasts one or two minutes. One paroxysm may be followed 
nearly immediately by another; indeed, they may succeed each other indefinitely, 
constituting an "etat de mal." But when this is the case, the convulsions are not 
continuous, although sometimes considered so. They may, however, be continu- 
ous, and last for hours, or even days. When this is the case, the attack is often 
ushered in by an epileptic paroxysm, as above ; but the spasms, instead of ceasing, 
are repeated every second, or at very short intervals. The convulsions are con- 
tinuous, because there is never any complete cessafion, nor the deep stupor which 
follows an ordinary paroxysm. In this form of convulsion, the child, although 
convulsed, does not lose all consciousness — an important feature in the disease. 
He cries to express a want or to complain of a pain, and is able to withdraw his 
hand when it is pinched or tickled. The convulsion is not^ therefore, as universal 
as it appears; it is, rigorously speaking, partial. 

Convulsions may be still further localized. After a severe epileptic attack, one- 
half of the body may remain for some hours affected with clonic spasmodic 
motions, and yet the intellect of the child be clear, and the motions of the other 
side of the body harmonious. 

The convulsions hitherto described are easily recognized ; but convulsions may 
be internal as well as partial, and then they are by no means so easy to appre- 
ciate; then, also, it is that difference of opinion as to the interpretation of the 
symptoms begins to be entertained. Internal convulsions are partial convulsions, 
occupying more particularly the muscles of the globe of the eye, of the pharynx, 
of the larynx, and of the apparatus of respiration. The most ordinary form of 
internal convulsion is characterized by turning of the globe of the eye with 
mobility, nearly total loss of consciousness, or, at least, a certain amount of stupor, 
extreme difficulty or impossibility of deglutition, and by respiration, uneven, some- 
times scarcely perceptible, sometimes deep and blowing — in a word, by an attenu- 
ation of most of the phenomena of epilepsy, and by the absence of the violent 
convulsions of the limbs and face. 

Sometimes the diaphragm and the inspiratory muscles of the abdomen and of 
the chest alone act, and then, for one, two or three minutes, a peculiar laryngeal 
blowing sound is heard, as if there existed an obstacle to the entrance and to the 
exit of the air. If the proper muscles of the larynx are at the same time con- 
vulsed, as their motions do not coincide, the disordered condition of the respira- 
tion appears alarming, although it is only really so when this state is much pro- 
longed. Such is the real explanation of those states of disordered respiration 
which have been called thymic asthma, or laryngismus stridulus. A want of 
harmony between the spasmodic motions of the diaphragm, and of the muscles 
which move the arytEEnoid cartilages, is sufficient to produce the laryngeal sibilus, 
the orthopncea. In the regular act of inspiration, the superior part of the larynx 
opens at the same time that the diaphragm descends, and produces a vacuum in 
the chest. If the contraction of the diaphragm takes place too rapidly, and if, at 
the same time, there is spasm of the larynx, as in whooping-cough, the inspira- 
tion becomes nearly impossible, and is accompanied by a violent sibilus. In the 
case which we are examining, however, it is not necessary to call to our assist- 
ance a want of harmony between the movements of the diaphragm and those of 
the muscles of the larynx ; it is sufficient to suppose that the will or the instinct 
no longer presides, for a moment, over the movements of the ar3't8enoidean car- 
tilages; the muscles which move them, no longer obeying any nervous impul- 
sion, are for the time in the condition of those of animals in whom the recurrent 
laryngeal nerve has been divided. 

The above details explain how it is that thymic asthma, so frequent in the eyes 
of some observers, is never found by others. The former attribute to an increase 
in size of the thymus, accompanied by paroxistic accidents, what the latter con- 
sider to be merely one of the forms of convulsions in children. The thymus, 
like the supra-renal capsules, is an organ of transition, destined to become atro- 
phied after the birth of the human foetus, and less than any other organ likely to 
be hypertrophied. During the six years that M. Trousseau has been at the head 



1846.] Medical Pathology and Tlierapeutics. 213 

of important wards for very young children, he has not once rnet with the thymus 
gland sufficiently enlarged to give rise to the slightest accident. 

M. Trousseau concludes his essay by promising, in a future article, to point out 
the connection which exists between convulsions and laryngismus stridulus and 
the acute asthma of children. At the same time, he thinks it right to state that 
these diseases are not mere forms of infantile convulsions, as is the case with 
thymic asthma. — Lancet^ Aug. 30, from Journ. de Med. 

26. Aneurism of the Basilar Artery. — An example of this very rare affection is 
recorded by Dr. Pfeufer, in Allgemeine^s Repertorium for March, 1844. The sub- 
ject of it was a man forty-one years of age, who had for many years experienced 
an occasional sudden inability to swallovi^. After suffering for a long time from 
severe headache, he was suddenly seized as with an apoplectic stroke, during 
which the breathing was stertorous, the eyes open ; the feces and urine passed 
involuntarily. He recovered, however, in a few days, when he had a second 
similar attack commencing with constriction in the pharynx, but not followed by 
complete loss of consciousness. He recovered, but on his entry into the hospital 
presented the following symptoms. He was thin and weak -looking, and com- 
plained of a pain and stiffness along the spine and in the lower extremities. He 
had headache, with sensation of pressure on the brain, and constant ringing in 
the ears. His speech was quick, indistinct, and his voice hoarse. He was seized 
again with loss of sensation, &c., a few days after being in the hospital, with 
dilated, insensible pupil, stertorous breathing, involuntary evacuations of urine and 
feces, &c. He continued to scream without being able to speak, but recovered 
under copious blood-letting, ice to the head, blisters, &c. Fifteen days after this 
attack he suddenly expired. 

The pia mater was raised by serous infiltration. The surface and posterior part 
of the hemispheres of the brain were tinged with alternate spots of deep and faint 
red, and reddish-yellow, due to a layer of extravasated blood, partly old, partly 
recent, lying between the membranes. Bloody serum filled the ventricles. The 
fornix was in part destroyed; the median parts of the brain softened and injected; 
the aqueduct of Sylvius filled with a fresh coat of blood; and the peduncles of the 
brain injected and softened in their superficial layers. The pons Varolii, medulla 
oblongata, and cerebellum, were covered by a layer of recently coagulated blood. 
On the right side of the basilar artery there existed an aneurismal sac of a reddish- 
blue colour, four lines long and three lines broad, filled with clotted blood, and 
pierced at its anterior and lower part with an orifice the size of the head of a pin. 
The artery in the neighbourhood was atheromatous, and several of the other 
arteries presented patches of the same degeneration. In the spinal canal there 
was a thick, newly-formed clot of blood between the pia mater and arachnoid 
membrane. On many points, marks of old sanguineous extravasations were 
remarked of a brown colour. The external layer of the spinal cord was coloured 
of a saffron-yellow colour. The abdominal and thoracic viscera were healthy. — 
Ed. Med. ^ Surg. Journ., Oct. 1845. 

27. Effects of large Doses of Ether in cases of Enlarged Spleen. — In an account of 
some cases of ague, treated by Dr. Corrigan at the Whitworth Hospital, and 
recorded in the Hospital Gazette, he alludes to the statement of Piorry in reference 
to the action of quinine, of which a single dose had the effect of reducing almost 
instantaneously the enlargement of the spleen which so generally accompanies 
ague ; and then cites the following case, illustrative of similar effects produced by 
a large dose of ether given by himself: — 

Henry Magee, a sailor, aetat. 34, who had been exposed to a great deal of wet 
in various ways, had, while at work one day about two months previous to his 
admission, suddenly felt a general lassitude, with dull boring pains in his loins. 
After being two or three hours in this state, shivering supervened, which lasted 
for the two succeeding hours. Since that period he has had shivering fits almost 
every twenty-four hours, being pretty well during the intermissions. About a 
month before coming to the hospital; his abdomen became enlarged without pre- 
vious pain or tenderness. On admission, December 2, 1844, he had shiverings 
almost every night, preceded by a feehng of creeping over his skin, a sense of 



314 Progress of the Medical Sciences. [Jan. 

lassitude and depression, and an inclination to stretch himself. The duration of 
the rigours was very irregular, sometimes continuing a quarter of an hour, at 
other times two or three hours ; usually followed by sleep, during which there 
was copious perspiration. The abdomen was swollen to a considerable size, 
with a distinct feeling of fluctuation; no tenderness in the liver or spleen; whites 
of the eyes not discoloured ; tongue clean ; urine considerable in amount, and 
high-coloured. Ordered, on the 4th, a senna mixture, and the day after pills with 
half a grain of aloes and half a grain of calomel three times a-day. 

9. — Abdomen thirty-five inches, with a good deal of tympanitis over it; spleen 
much increased in size, encroaching on the thorax. To take ten grains of quinine 
at night. At the morning visit at eight o'clock. Dr. Corrigan found that the usual 
rigor had been absent the night before, but had come on at this moment, and on 
examination he was enabled to trace out with Bonnet's pleximeter the area occu-^ 
pied by the spleen, the information afforded by percussion being so distinct, that 
there was no difficulty or danger of mistake in marking the boundaries. The 
margin of the spleen having been several times traced out in this way, its area 
was thus marked on this surface, and was found to occupy a space measuring six 
inches in length and seven and a half inches in breadth. The rigor being still 
on him, he was given two drachms of ether with twenty drops of tinct. opii. 
Five minutes after the rigour had entirely disappeared, the pulse had come down 
from 120 to 96, skin got warm, and the spleen only measured six inches and 
three-quarters by four inches and a half The subsequent treatment consisted in 
the administration of a few ten-grain doses of quinine at bed-time ; no rigor took 
place from the time the dose of ether was given, and the fluid in the abdomen 
disappeared under the use of a solution of iodide of iron, taken three times a-day. 
The man was discharged on the 30th of December. 

The following facts are. Dr. Corrigan observes, established by the foregoing 
case: — 1. That the spleen can suddenly alter its volume; 2. That other agents as 
well as quinine can effect this sudden alteration of size; 3. A confirmation of an 
old observation, that a cure of the disease may be effected by other remedies as 
well as quinine. Here, he observes, the ether acted even better than the quinine, 
large doses of which failed to cut sliort the disease, having merely prolonged the 
interval and made the supervention of the attack later than usual ; but the two 
drachms of ether with opium at once cut short the cold fit, and the attack never 
returned. 

To a woman who laboured under tertian ague. Dr. Corrigan gave, in the inter- 
vals of the fits, ten-grain doses of quinine, under which she recovered. A singular 
result in this case, he observes, followed the administration of the first dose. In 
two minutes after there was a reduction in the size of the spleen, similar to the 
former case, but in an hour or two the organ regained its former bulk ; in the 
afternoon of the same day, however, it had again diminished, and the patient 
gradually recovered. 

M. Keffy, setat. 32, a sailor, had been attacked with ague several times in the 
course of nine months previous to his admission on the 3d of February, 1845, to 
the Whitworth Hospital. 

4. — Had a fit of ague which lasted half an hour; during the fit there was con- 
siderable tenderness over the region of the spleen, and percussion showed it to 
be considerably enlarged. Skin cool and of a jaundiced hue; eyes also yellow. 
Spleen enlarged, occupying the space from the last rib to the crest of the ilium; 
tongue rough and furred in the centre; appetite bad; bowels regular; urine 
copious and high-coloured; sleeps badly at night; epigastrium tender on pressure. 

A dose of ether was given to this man on the day after his admission in the 
cold stages, by a pupil who had seen its efficacy in the former case. The next 
day there was no fit, but the day after the attacks returned and continued. A pill 
of Pil. hydrarg. gr. ij. Calomel gr. j. Ext. taraxici gr. ij, Opii gr. i, was given three 
times a-day until the gums were touched, and under this treatment, directed 
against the local subacute inffammation of the liver, the cold fits shortened from 
about two hours' duration to twenty minutes. By the use of the ordinary treat- 
ment of quinine the spleen now considerably decreased in size, and the man was 
discharged on the 13th of April. 

Dr. Corrigan observes, in reference to chronic enlargement of the spleen, inde- 



1846.] Medical Pathology and Therapeutics. 215 

pendent of ague, that he has seen it occupy nearly the whole of the left side of 
the abdomen, remaining so for years without causing dropsy. He believes that 
considerable enlargement, where there is also induration, cannot be removed, 
having tried mercury, iodine and quinine, with no benefit, and has known 
counter-irritation to be equally inefficacious in the hands of others. The actual 
cautery, he observes, is a remedy in constant use in India. He is of opinion that, 
in cases of this kind, attention to the general health is better than trying to act on 
the local disease ; and that if the constitution be not tampered with, there will 
probably be little injurious effect for many years- but that, as in all chronic cases, 
circumstances may arise requiring interference. For the relief of the oppressed 
breathing, difficulty of lying down at night, and inability to walk much, which 
most persons of large spleen complain of. Dr. Corrigan recommends the use of 
small bleedings, to the amount of four ounces repeated two or three times, at 
intervals of two or three days. There seems, in these cases, he observes, a great 
disposition to an accumulation of venous blood, as evidenced by the enlargement 
of the superficial veins over the body. The smallness of the pulse and coolness 
of the skin must not prevent the employment of the lancet; at the same time that 
large bleedings, which would depress the strength, must not be ventured on. The 
other means to be used to assist the bleedings must depend on the indications to 
be fulfilled.— ilied Times, Sept. 13, 1845. 

28. Ptyalism produced by cokhicum . — Dr. John Aldridge states {Dublin Hospital 
Gazette, Oct. 1, 1845), that he has seen three cases in which profuse ptyalism re- 
sulted from the use of half a drachm of tincture of the seeds of colchicum three 
times a-day during some time. In one of these cases at least, mercury had never 
been taken, nor had the patient ever been salivated. They were all cases of 
ophthalmia. 

29. On certain Pathological conditions of Milk as the cause of disease in Infants. — • 
M. Albert Donne, in his Cours de Microscopie, (Paris, 1844, page 412,) observes, 
^^ Our ignorance in the present day with regard to the characters of good and bad 
milk in nurses, and the mode of distinguishing that which possesses qualities 
requisite for the life and health of the child, from that which only affords to it an 
unwholesome kind of food, is so great, that it is almost impossible to find a prac- 
titioner, nurse, or even chemist, capable of giving an opinion whether a given 
specimen of milk be of good or bad quality. The indiflerence with which this 
important question is regarded, is no doubt in great measure attributable to the 
difficulty of the subject, to the insufficiency of the results which chemical analyses 
have hitherto aflforded, and to the want of a proper method in the examination of 
this substance. We cannot in reality attribute it to any lack of interest, or to the 
trifling importance of the question, for there is perhaps none which in a higher 
degree concerns the public health, the happiness and welfare of families, or which 
more frequently presents itself for solution ; and I have no hesitation in stating, 
that all which has hitherto been said and written on the subject of milk, so far at 
least as regards its peculiar qualities in relation to the nourishment of infants, is 
absolutely valueless. No one, certainly, is likely to be deceived by the colour, 
consistence, or even the taste of milk; yet nothing can be more vague than are 
such characters; it is impossible to attach any real value to them; ahd since they 
are based on nothing positive, each person may interpret them as he pleases; 
consequently the attention of medical men is directed much rather to the general 
health of nurses than to the properties of their milk; and the examination of this 
secretion, if undertaken, is performed merely as a matter of form. Undoubtedly 
the general health is an indispensable condition, and one to which especial atten- 
tion ought to be directed in the selection of a nurse; yet this condition is far from, 
being the only one deserving of consideration, and it is well known that the best 
health is not always a guarantee for the good qualities of a nurse, or the nutritive 
properties of her milk; the lacteal secretion may be insufficient, or abnormal, in a 
woman otherwise perfectly healthy. Is it not a matter of daily observation, that 
one woman, although of a meagre sickly appearance, makes a better nurse than 
another woman of the healthiest aspect ; and are we not frequently deceived as 
to the state of the constitution by external appearances'? It is evident that the 
organs endowed with the function of secreting milk are, so to speak, placed too 



216 Progress of the Medical Sciences, [Jan. 

much without the general economy, to allow of the qualities of this secretion 
being estimated by the integrity of other organs and the regularity of other func- 
tions. It is in the milk itself, therefore, that we must search for the characters of 
its good and bad qualities- and until we possess the means of observing its pro- 
perties, and its good or bad nature in relation to the nourishment of infants, prac- 
tice will be deprived of rule, the choice of nurses will be made in an empirical 
manner, and the determination of mothers who wish to suckle will more fre- 
quently be regulated by chance or caprice, than by reason, or with a due regard 
to the interest of their children." The subject has recently attracted the attention 
of M. Girard, who has furnished the following cases and observations. {Archives 
Gmcrales de Mededne^ June, 1845.) 

Case I. — In September. 1840, a child, aged five months, was brought to me. 
I was informed that it was strong and vigorous when born, and that it was at once 
delivered to the charge of a nurse, who had been suckling for fourteen months. 
It shortly became uneasy, cried incessantly, and was only quiet when at the 
breast; it gradually grew thin, and diarrhoea was established, the stools being of 
a green colour. When brought to me it presented the following condition: Its 
face was thin and pale, tongue red, with a few scattered aphthous points; belly 
tense; there was a bright erythematous redness over the thighs and nates; there 
was frequent diarrhcBa, the stools green ; vomiting of curdled milk several times 
a day ; the child slept badly, frequently awaking. This was the third time the 
child had been attacked whh an almost similar set of symptoms, except that the 
aphthous spots now appeared for the first time, and the attack generally was more 
severe than the former ones, which had disappeared under the use of baths, starch 
injections, and abstinence from food; the diarrhoea, however, had continued. 
Baths, injections, gargles were now in vain made use of; the diarrhoea obstinately 
remained, and the aphthous spots increased. The nurse's milk was very alkaline ; 
it was not examined microscopically. Since the child did not mend, it was de- 
termined to change its milk, and a nurse was engaged who had only been suck- 
ling for three months. The beneficial effects of this change were very marked ; 
in two days the diarrhoea had considerably abated; and after a week all the symp- 
toms finally disappeared. 

Case II. — Madame S., aged 25, was on the 14th of November, 1844, delivered 
of her first child, a male, strong and well formed; she suckled this child for ten 
days, at which time her breasts becoming enlarged and painful, a nurse was 
engaged. This nurse was a middle-sized, dark-complexioned woman, about 30 
years of age. She had no appearance of disease ; her breasts were small ; her 
milk was sweet, of good colour, consistence, and quantity, and about three weeks 
old. The child when delivered to her charge was in good condition, and its 
evacuations were healthy; but in a few days its sleep became disturbed; it grew 
thin; its stools became liquid, and very frequent, sometimes green, at others 
black ; it had nausea and vomiting ; a bright redness extended over the thighs 
and nates, and the child became very restless. On the 3d of December it pre- 
sented the following appearances : emaciation extreme ; skin dry and rough ; diar- 
rhoea frequent; stools green; the belly tense and painful; extensive erythema 
over the surface of the body; some vesicles on the scrotum; constant vomiting 
after taking the least quantity of liquid or milk; tongue red, and, as well as the 
mucous mem^brane lining the lips and cheeks, covered with numerous aphthous 
spots. I prescribed bran baths, water containing white of egg for drink, injec- 
tions of linseed infusion with a drop of laudanum twice daily, and poultices to 
the abdomen. In spite of this treatment, however, the symptoms became more 
intense, the erythema extended, the aphthous spots became more confluent, ec- 
thymatous pustules formed on the legs, the diarrhoea became more frequent, and 
the emaciation increased. This state of things continued until the 9th of Decem- 
ber, when the nurse's milk was examined microscopically by M. Duforse, and 
the following results obtained :— There was nothing peculiar in its colour; its con- 
sistence was that of milk containing much cream; treated with ammonia it be- 
came slightly viscous ; it was neither acid nor alkaline. When a drop of this 
milk was examined with a microscope magnifying 300 diameters, it was observed, 
1st, that the milk globules were in great abundance, such as is found to be the 
case in very rich milk; they were generally of a considerable size, and the largest 



1846.] Medical Pathology and Therapeutics. 217 

resembled small bladders half filled with liquid, and collapsed. Instead of having 
a pearl-like brilliancy, most of them, especially the large ones, were of a duU 
white colour, somewhat resembling opal ; some of them, aggregated together, 
formed small groups, which could be moved about in all directions, without a 
single globule being detached. When submitted to slight pressure, these several 
groups spread out so as to occupy a surface five or six times greater than they 
presented at first, and they assume various forms. The smallest quantity of sul- 
phuric ether introduced between the plates of glass dissolved a large quantity of 
them very rapidly. 2d. The field of the microscope was beset with roundish 
granular particles, perfectly colourless, and presenting all the characters described 
by J. Henle, Donne, Mandl, Giiterbrok^ and other micographers. 

[To these particles Donne first applied the name of corps granuleux^ and de- 
scribes them as invariably existing in colostrum, but disappearing gradually as 
the milk becomes older ] so that after about the twentieth day, and usually much 
sooner, not a trace of them is to be found. They differ from ordinary milk glo- 
bules (with which they co-exist) in form, size, general aspect, and internal com- 
position. They are not always globular, but present all possible varieties of form, 
and also of size, the smallest being about one-hundredth of a millimetre, the 
largest many times this size • they are slightly transparent, usually of a yellowish 
colour, and of a granular aspect, appearing as if composed of a number of small 
granules aggregated together, or enclosed within a transparent envelop. Very 
often there exists in the centre or some other point of these little heaps a single 
globule, which is apparently nothing but a true milk globule imprisoned within 
the granular matter. The nature of these granular bodies is unknown ; Donne sup- 
poses that they consist of fatty matter, and a peculiar mucous substance : they are 
not soluble in alkalies, but like true milk globules dissolve in ether, and after the 
evaporation of this reagent small heaps of acicular crystals remain on the glass. 
(Cours de Microscope, par Alb. Donne, p. 400.) Although the existence of these 
granular bodies is commonly peculiar to colostrum alone, yet Donne (page 421), 
observes that they and the other peculiarities of the colostrum (as the large irre- 
gular size of the milk globules, which, instead of floating free, are agglomerated 
together into small masses), may persist for many months, or even to the end of 
suckling. The existence of this condition can only be discovered by the micro- 
scope, for the ordinary physical properties of milk, such as its whiteness, consistence, 
and other characters, are preserved; and the nurse may continue in perfect health : 
the child, however, usually grows thin, although it is continually at the breast, 
and it commonly becomes attacked with diarrhcea. The milk in this case of M. 
Girard seems to have retained many of the characters peculiar to colostrum; he 
thus continues the narration of it : — ] 

The propriety of changing the nurse was now suggested and adopted: the milk 
of several was examined microscopically, and one selected whose milk appeared 
perfectly pure. This change had scarcely been effected two days, when the diar- 
rhcBa and vomiting diminished, and speedily ceased altogether; the aphthous 
spots disappeared, the tongue resumed its natural colour, and the erythema faded. 
From this time the child speedily recovered its good looks, and became fat, its 
stools being natural, and sleep good. 

Case III. — Madame R., aged 28, was delivered of her seventh child in Febru- 
ary, 1842; a male, strong, and well formed. One of her children had died when 
six months old from an affection characterized by ardent thirst, extreme emacia- 
tion, diarrhcBa, with green stools, and glairy vomiting. The present child took 
the breast readily, and was apparently in good health, yet vomited occasionally 
after suckling ; the milk to all appearance was perfectly good. About the begin- 
ning of the second month the vomifings increased in frequency. Supposing that 
the child filled its stomach too full, the breast was given to it less frequently, and 
a little eau sucree substituted, yet after each time of taking the breast it still 
vomited, though it could retain other liquids: it soon grew thin and pale, and its 
bowels were alternately constipated and relaxed. 

Towards the middle of the second month, the following symptoms suddenly 
occurred : the child screamed out, ceased to breathe, and became unconscious 
its face and hands assuming a livid hue: this condition lasted for a few seconds, 
and then passed off spontaneously, leaving the child weak and faint for some 



218 Progress of the Medical Sciences, [Jan. 

hours. Within the next twenty days the child had many similar attacks, which 
came on at uncertain periods, both day and night, without any obvious cause: 
blisters, antispasmodics, and baths were employed, but without benefit. The 
vomiting still continued. The milk was now examined microscopically several 
times, at intervals of some days, and was found to present an enormous quantity 
of mucus without any other alteration. I informed the mother that it was essen- 
tial the child should have other milk: this was repugnant to her, and she requested 
a few days' delay. Eight days afterwards, the vomitings having diminished, the 
milk was again examined, and presented a diminution in the quantity of mucus; 
but it again increased after a few days, and with this increase the vomitings re- 
turned as before. The child continued to grow thin ; a little diarrhoea showed 
itself, and the chest affection remained. The mother, now becoming alarmed, 
consented to employ a nurse : the milk of seven different women who successively 
offered themselves, although to all appearance good, presented beneath the mi- 
croscope either mucus granular bodies, or other alterations ; therefore they were 
rejected. At length one was obtained whose milk microscopically was perfectly 
pure. Two days after taking this milk the vomitings entirely ceased, so also did 
the symptoms of asthma, and neither of them ever reappeared; the child speedily 
became fat, strong, and well, and remains so to the present time. 

At the conclusion of these cases, M. Girard remarks, that " without wishing to 
generalize too much, or to establish a theory from a few facts, is it not, however, 
logical to observe here a relation of cause and effect? What do we see in the 
second case ? A severe and frequently fatal affection, which was rapidly on the 
increase, had resisted all rational means adopted for its removal, and Avhich 
yielded with the greatest facility to a change in the milk with which the child 
■was fed. We observe this disease to coincide with the ingestion of milk impure 
and of bad quality, and we witness its disappearance with a truly marvelous 
rapidity so soon as milk of good quality is administered. And in the third case, 
although the symptoms were somewhat different, yet we observe them to occur 
coincidently with the ingestion of impure milk, and to cease when milk of a pure 
quality is substituted. Is it unreasonable to conclude that certain severe patho- 
logical conditions may be produced by alterations in the milk alone, and may be 
dissipated even when they have attained a very high degree, by a return to milk 
of good quality'? It would be a point of much importance to ascertain whether 
these alterations in the condition of milk could at any time coincide with the 
maintenance of perfect health in the child ; also, it would be important to deter- 
mine, if possible, whether a given alteration in milk most commonly or constantly 
induces such or such a pathological affection. Thus of the two cases last narrated 
we observe that in one a granular state of the milk induced an aphthous affection 
(the muguet), whilst in the other, a mucous condition gave rise to symptoms 
referable to the stomach and to the lungs; at any rate that these states were coin- 
cident with such affections. Of course it is not meant to be here implied that the 
pathology of infants is entirely under the influence of milk, but it seems probable 
that many hitherto inexplicable conditions may be so, and, moreover, that they 
might be explained by a simple examination of this liquid." — London Med. Gaz., 
Oct., 1845. 

30. Fatal Haemoptysis in a Child four years of age. — A case of this is related by 
Dr. E. D. Walker, of Teinmouth; in the Provincial Med. and Surg. Journal^ 
Aug. 13, 1845. 

31. Laudanum in the delirium occurring in the last stage of Dothinenteritis. — Dr. 
MoRAND, of Tours, is of opinion that great advantage may be derived from certain 
preparations of opium in the treatment of the delirium which supervenes in the 
last stage of dothinenteritis. He relates a case of a girl 1 1 years of age, who, on 
the 32d day of an attack of dothinenteritis, seemed in the most hopeless condition. 
She had continued delirium, and screamed without cessation. A potion contain- 
ing fifteen drops of laudanum Avas ordered to be given every hour, which quieted 
her cries, procured sleep, and in 18 hours the delirium ceased. The potion was 
afterwards continued for a few days to prevent a return of the delirium, and with 
a nourishing regimen the patient entirely recovered. — Journ. de Med.^ Nov., 1845. 



1846.] Surgery, 219 



SURGICAL PATHOLOGY AND THERAPEUTICS AND OPERATIVE 

SURGERY. 

32. Note on the use of Nitrate of Lead in Ulcerated Cancer. By M. Lemaitre. — 
(Comptes Rendus, 11th Aug., 1845.) In a memoir presented to the French Aca- 
demy of Sciences in 1841, by M. L., in which he gave the results of his investiga- 
tions relative to the mode of action of chemical agents employed in the treatment 
of wounds, ulcers and other external affections, he stated that the decomposition 
of diseased parts can be arrested, and the formation of plastic matter, which causes 
their restoration to the healthy state, be promoted, solely by precipitating the 
albumen of the blood. Later researches have confirmed him in this opinion, and 
he thinks he may assert that all agents which precipitate albumen without irritating 
the nervous system, are endowed with curative or cicatrizing powers. 

Guided by these principles, and also recalling to mind the fortunate application 
made by M. Ledoyen of the nitrate of lead for disinfecting fecal matters, it occurred 
to M. Lemaitre, on a recent occasion, to employ the same salt for correcting the 
fetid odour of a cancerous ulcer, which odour was very distressing to the patient and 
attendants, and whiph the different preparations of chlorine had failed to remove. 
A solution of the nitrate was accordingly injected into the cavities of the ulcer, and 
its surface was covered with charpie moistened with the same. The fetid odour 
was not only entirely destroyed by this application, but the fungous growths have 
diminished, and this treatment having been now continued for a month, the disease 
is manifestly better. 

[Dr. RoGNETTA reports {Annates de Therapeutique, Sept. 1845), two cases, in 
which M. Robert experimented with this article at the Hopital Beaujon. The 
solution was used of the strength of 20 degrees of the aerometer. In both cases, 
the fetor was entirely destroyed and the condition of the sores much ajneliorated.] 

33. On the character of Cancer. — {Comptes Rendus, 7th July, 1845.) Prof. Sedil- 
LOT presented to the French Academy, on the 30th of June last, a memoir on this 
subject, which he stated contained some new facts. Thus, he said, it resulted 
from his researches, that the ulcerated tumours generally considered as cancers 
and operated on as such, were simple epidermic tumours, susceptible of cure by 
an easy and mild method of treatment. 

He also points out in this memoir a symptom of ulcerated cancer of the sto- 
mach not yet noticed. In an old man who died of an affection of this kind, Prof. 
S. observed in the matters vomited, the presence of disaggregated cells of cancer, 
plainly distinguishable by the microscope, in the midst of the globules of pus with 
which they were mixed. 

34. On an affection of the right hand which prevents the person writing, and on the 
means of remedying it. By M. Cazenave. — {Camptes Rendus, 7th July, 1845.) M. 
Cazenave, in a memoir presented to the Academy of Sciences, June 30th, states 
that he has met with some persons whose thumbs or fingers were affected with 
weakness, which rendered them incapable of writing, whilst it did not incapaci- 
tate them for the other uses of the hand. After having in vain endeavoured to 
remove the cause by direct medication, setons, &c., he endeavoured to relieve 
at least the symptom. This he accomplished by the use of an apparatus by means 
of which the pen is maintained in a suitable position, and the operation of writing 
is thus easily performed. 

[In one case of this defect which has fallen under our notice, the debility ex- 
isted not in the thumb or fingers, but in the pronator muscle, the hand falling 
supine on the table so soon as the patient commenced writing, and he is com- 
pelled to write in that very awkward position. It would of course require for its 
correction a different apparatus from that employed by M. C. — Ed.] 

35. Foreign body in the Air-passages expelled spontaneously after a lapse of four 
years. — Recovery. — Dr. James Duncan records, in the Northern Journal of Medicine, 
(Aug. 1845,) a case of this^ which occurred in the practice of Dr. Spence, and 



320 Progress of the Medical Sciences, [Jan, 

which is remarkable for the length of time which the foreign body remained im- 
pacted in the air-passages, without producing fatal consequences, and for the 
complete recovery which followed its ejection. 

The subject of the case was a gentleman, 42 years of age. Early in Feb. 1841, 
while at dinner, a piece of bone accidentally passed into his trachea. A violent 
paroxysm of coughing and difficult breathing followed. A sharp pain was like- 
wise felt, referred to a point about three inches below the clavicle and to the left 
side, and a small quantity of bloody mucus was expectorated. 

The violence of the paroxysm subsided, and the accident was forgotten, but a 
somewhat troublesome cough continued. This increased, and was not mitigated 
by any of the means employed. The patient could not rest on the left side, and 
considerable quantities of mucus, streaked with blood, were expectorated, more 
particularly after exposure. 

These symptoms continued, varying in intensity, until the spring of 1844, when 
for a time they were exceedingly troublesome, but were alleviated by the use of 
tonics. 

During the winter months of 1845, they again became much aggravated, the 
patient was harassed by violent spasmodic cough, and was unable to rest in any 
posture. He now came to Edinburgh for consultation, and the affection was 
treated as a bronchitic one, but without relief. 

On the 2d of March, 1845, he was seized with a violent fit of coughing, and a 
small piece of bone was discharged. The paroxysm still continued, and in about 
half an hour a still larger piece was ejected. The larger piece was of a very per- 
fect rhomboidal figure, the diagonal between the two very acute angles measuring 
one inch, that between the obtuse angles three-quarters of an inch. The smaller 
piece was three-quarters of an inch in length, and three lines in breadth, and 
somewhat curved. From this time the symptoms improved; he began to rest 
well at night, and could sleep on either side with ease, but the cough still con- 
tinued for some time troublesome during the day, and considerable quantities of 
muco-puriform fluid were expectorated. He still for a time felt the pain on the 
left side, but his strength and the general state of his health continued to improve. 
He is now, June 1845, perfectly recovered. 

In the majority of the recorded cases of this description, in which the accident 
did not prove fatal, by inducing immediate suffocation, it has done so when not 
removed by surgical interference, either by exciting extensive bronchitis or pneu- 
monia, und.er which the patient sank rapidly, or these have passed into a chronic 
state, and the patient has perished at a later period. Cases, however, are not 
wanting in which, as in the present instance, the foreign body has been expelled 
by the efforts of nature, and the patient has recovered. 

36. Taxis combined with continued irrigation and the cold water douche, for the reduc- 
tion of Strangulated Hernia. — {Journal de Chirurgie, June, 1845.) In this memoir, 
which was addressed to the Royal Academy of Medicine, the author, M. Moreau- 
BouTARD, extols the efficacy of the taxis, combined with continued irrigation with 
cold water under the form of douche, as more successful in the reduction of stran- 
gulated hernia, than the taxis alone, and relates three cases in which the last 
named measure failed, and in which the former was then resorted to with entire 
success. 

37. Fissure of the Anus. — M. Blandin has succeeded in effecting a cure of this 
complaint in 47 cases by the subcutaneous division of the sphincter ani. The pain 
instantly ceases ; defecation is performed without suffering; and the small ulcer 
heals in a few days by the aid of a few applications of the nitrate of silver. — An- 
nales de Therapeutique, Sept., 1845. 

38. Fissures of the Nipples. — These are treated at the obstetrical clinic of Padua, 
in the following manner: — Lactation is suspended; the nipple is covered with 
compresses wet from time to time with a solution of some drops of tincture of 
arnica in distilled water : and small doses of sulphur are given internally. The cure 
is prompt, and the women are then allowed to suckle their children. — Annates de 
Therapeutique^ Sept. 1845, from Memoriale della Med. Contemp. Avril.^ 



1846.] Surgery. 221 

39. Amputation at the hip-joint for Osteo-medullary Sarcoma of the os Femoris. — The 
Monthly Journal of Medical Science^ for April last, contains an account of a case of 
osteo-medullary sarcoma of the os femoris. for which amputation at the hip-joint 
was performed on June 30th, 1843, by Dr. Handyside, at the Royal Infirmary. — 
The patient, a lad aged fourteen, was affected six years previously (1836) with 
pain in the thigh subsequent to scarlatina; the bone did not, however, become 
materially enlarged until Dec. 1842, subsequently to which time it grew rapidly, 
and previously to removal had attained a considerable magnitude. 

The removal of the limb was easily effected by anterior and posterior flaps. — 
The ligaments and cartilaginous surfaces of the joint were healthy, but the head 
and neck of the thigh-bone had partially undergone interstitial absorption. The 
wound healed for the most part by the first intention, and the patient left the hos- 
pital on the 5th August, six weeks after the operation. Soon after leaving the 
hospital he complained of occasional frontal headache, which was followed by 
pain in the left orbit and eyeball, with increased sensibility to light, and lachry- 
mation. About the 1 1th September the course of the lymphatics along the stump, 
as well as the forepart of the stump itself, became indurated and glazed. Six 
weeks afterwards, the left hypochondriac region became the seat of pain, and 
shortly after a small round tumour evidently of a malignant character arose there; 
while at the same time the left eye began to obtrude, and the whole of that orbit 
and side of the brow became suddenly enlarged. 

Towards the end of October, Dr. H. saw the patient and found him in the fol- 
lowing condition : — The left eyeball w^as very prominent and discoloured, with 
almost complete loss of vision. The eyelids were so much tumefied, as almost to 
conceal the eyeball, — and the veins of the eyelids were very conspicuous, being 
enlarged and tortuous. The orbit itself appeared to be also enlarged and promi- 
nent, especially towards its upper and outer part, forming there a hard inelastic 
swelling. These parts were the seat of continual stinging pain, which prevented 
sleep, and was fast undermining his strength. Three chronic abscesses were situ- 
ated over various parts of the head. There was a tumour of the size of an egg 
on the left hypochondrium, w^hich was firmly adherent to, and connected with the 
cartilages of the upper false ribs. It was slightly elastic to the feel, had grown 
rapidly, and was the seat of acute darting pains, — being, like the tumour of the 
orbit, decidedly of a malignant character. The disease seemed to be fairly begun 
in the stump, particularly in that part of it which had been irritated by the long 
retention of the ligatures, — as, at the part where the last ligature had lain, a small, 
pale-coloured fungus protruded. The patient's body, generally, was emaciated, 
and his strength was worn down by the continued pain, and the malignant hectic. 
To procure sleep, he had been for some time in the habit of taking frequent and 
full doses of the solution of the muriate of morphia. 

His appetite was not much impaired, as he had a great desire for food ; but he 
w^as unable to eat much. 

He was now evidently sinking fast. He lived, however, getting gradually 
worse, till the 11th of November. 

No sectio cadaveris could be obtained. 

The patient thus lived for two months after leaving Edinburgh, and about four 
and a half months after the operation. 

40. Gunshot Wound of the Brain, attended with extensive Cranial Fracture, and fol- 
lowed by complete Recovery. — The following very remarkable case is related b} Mr, 
Ford, of the Madras Medical Establishment, in the L. Sf E. Monthly Journal of 
Medical Science, Sept., 1845. 

On the morning of the 31st January, 1845, a lad about 15 years of age was 
brought into hospital with a gunshot wound of the head. He was quite in!-en- 
sible, and breathing stertorously upon admission. Examination, after shaving the 
head, disclosed the following amount of injury. 

The ball had entered the head on a level with, and three-fourths of an inch an- 
terior to, the summit of the right ear, and had made its escape through the leJt os 
frontis, an inch and a quarter above the centre of the eyebrow, fractuiing ihe 
skull irregularly between both wounds, in such a manner as to implicate and 
depress the right orbit. The right os frontis, over its sinus, had likewise met with 
No. XXI.--JANUARY, 1846. 15 



222 Progress of the Medical Sciences. [Jan. 

a comminuted fracture, which gave to the touch the crepitating sensation of a 
broken egg-shell. In addition to this varied fracture, one proceeded upwards and 
backwards, from the spot where the ball entered to the lambdoidal suture. The 
vertex was raised and inclined over to the left side, to such an extent as to enable 
the finger to be laid in the sulcus formed by the gaping margins of the fracture, 
especially betw^een one w^ound and the other, and considerable pressure failed to 
approximate appreciably the edges. The right eye was completely closed by 
tumefaction, and the sinking of the orbit; strabismus had occurred in the other, 
and its pupil was but a speck. From the wound in the forehead, blood was trick- 
ling, and much had evidently escaped from it, as large clots were still adherent 
to his face. No spiculsc of bone were detected in either wound. The hemor- 
rhage was soon checked by a cold application, which w^as continued to the 
head; the orbit was raised to its proper position; and saline and camphor mix- 
ture administered. 

The following is a brief abstract of the most prominent symptoms, and treat- 
ment of this extraordinary case : — 

On the 3d February, he became in a slight degree sensible, and answered, Yes, 
(in Hindostanee,) to each and every question. The brain had gradually protruded 
since admission, through the outlet at the forehead, and on this date a mass larger 
than a walnut, and about half an ounce in weight, consisting of cortical and me- 
dullary substance, w^as excised. Pulse 130, and of moderate strength. The 
saline mixture and lotion were continued, and a purgative draught exhibited. 

Oa the evening of the 5th, delirium, incoherent speech, and other symptoms of 
cerebral inflammation supervened. The head was freely leeched: and the sero- 
sanguinolent contents of a large swelling at the posterior extremity of the fracture, 
contiguous to the occiput, were evacuated by free incision. The whole scalp 
was puffy. Pulse 160, and distinctl)^ computable. The purgative draught was 
repeated, and the mixture and lotion continued. 

6th. The leeches were again applied. 

7th. Some thin semi-transparent pus was seen oozing through the three wounds, 
including the scarification at the back of the head. Pulse 140, and soft. Medi- 
cines continued. 

Sth. Discharge more copious and purulent, and pieces of brain, unaccompanied 
by any fraunients of bone, were passed from the wounds caused by the bullet. — 
Delirium had increased. Was directed to take half a grain of the bi-sulphate of 
quinine, three times a-day; and mutton broth frequently. The wounds were kept 
open by dry lint. 

9th. Stools and urine were passed involuntarily. The delirium continued una- 
bated. The discharge from the wounds was free and healthy. 

10th. A puncture was made in the right upper palpebra, near the inner canthus, 
and exit afforded to about two ounces of thick fetid pus. He remained insensible, 
and the excretions were voided without his will. 

12th. The pus, somewhat fetid, has been plentifully poured forth from the four 
openings, which have been kept open by pledgets of lint. The puncture made 
the day before yesterday in the palpebra, is found to communicate now with the 
wound in the forehead. Pulse feeble, and 130. To have his broth as before, and 
a grain of the bi-sulphate of quinine thrice a-day. 

nth. He appeared to know what was said to him, and the left eye, which he 
now opened and directed to any object, seemed to possess perfect vision. Made 
signs for the bed pan. Discharge free. Delirium at night. The treatment con- 
tinued. 

16th. He evidenced by his acts more perception and intelligence. Discharge 
healthy and profuse. He took two grains of bi-sulphate of quinine every six hours. 
Allowed as much animal food as he wished. 

17th. Much confusion, anxiety, and irritability of manner existed to-day. Fre- 
quent paroxysms of incoherence during the night. Pulse 130, and small. A 
quarter of a grain of acetate of morphia was ordered to be taken with each dose 
of the quinine. 

19^/z. Was cal:per. Discharge diminished. No incoherency. Treatment con- 
tinued. , ■.•,^ 

2 1st. Discharge'liad gradually decreased. Laboured under symptoms of fatuity, 



1846.] Surgery, 223 

and replied only "yes," to any question. Had compresses applied to the right os 
frontis and to the occiput^ (the incision near which had almost healed,) and adhe- 
sive plaster to the ball wounds. Continue the quinine and morphia. The bowels 
remained free, without the use of any purgative. 

2Sth. Since last date, the wound at the occiput has healed; and the discharge is 
now slight from the other three. Constitutional irritability has been much ahayed. 
Slept and ate well. Was quite idiotic, and constantly attempted to remove his 
bandages. Opened his right eye, of which the vision has been uninjured. The 
motor power only of the left side has been partially lost. The mouth is drawn to 
the right. Pie cannot project his tongue : and his endeavours to do so caused 
laughter. The doses of morphia and quinine were augmented respectively to half 
a grain, and three grains. Nitrate of potash, and nitric acid, w^ere likewise pre- 
scribed. Compresses, &c., were applied as before. 

March 5. Some dawning of intellect was perceptible to-day, and a word of 
rebuke had a temporary efi'ect in checking his propensity to remove his bandages 
and destroy his bed-clothes. Vision was perfect, and the axes of both eyes were 
simultaneously directed to any object. Has been disposed to speak. Urine passed 
in abundance. The exposed surface of the brain at the frontal wound has nume- 
rous small vessels traversing it, and it has put on the character of mucous mem- 
brane, yet without any attachment to the surrounding integuments of the forehead. 
Pulse large, and 100. 

lOth. Has decidedly improved in his mental capabilities, and has recognized 
his friends, including an officer who came to see him., and whose name he dis- 
tinctly pronounced. When any question has been put to him with a caution, he 
has replied sensibly. The pieces of the right os frontis have consolidated with one 
exception, and an angle of a small fragment projects under the integuments at the 
upper part of the forehead. Contrary to my expectation, no pus has ever been 
discharged by the nose. The space between the edges of the fracture, posterior to 
where the ball entered, has closed, but in no way between that and the wound of 
the forehead. The discharge has been trivial. Two small squamoB of bone have 
been removed from the wound near the ear. Has walked a little with assistance. 
No improvement in the use of his left upper and lower extremities; they are em- 
ployed at will, but feebly ] their sensibility, however, has never been involved. — 
The new membrane, remarked as covering the surface of exposed brain, has 
thrown out exuberant granulations, which have been with difficulty kept down to 
the level of the frontal teguments, by the liberal application of lunar caustic. Or- 
dered to take, three times a-day, an ounce of compound infusion of gentian, half 
a grain of morphia, and four drops of muriatic acid. Compresses continued. 

To render this report as concise as possible, I conceive I may. without any dis- 
advantage to it, conclude by recording, that from this last date, a progressive 
amendment to complete and perfect restoration of the patient's health of mind and 
body took place, under a continuance of the treatment above noted. On the 3d of 
April he was discharged from the hospital. The vertex is permanently settled to 
the left side. The skull has not united for about two inches over the temple, 
where, and at the cicatrix of the frontal wound, the pulsations of the brain can be 
conspicuously observed. A ridge exists where union has occurred in other parts of 
the fracture. The wound in front of the ear has closed with ossific matter. The right 
eye cannot be opened quite so widely as the left, and there exists some thickening 
of the orbital margin of the frontal bone. The right commissure of the mouth is 
but slightly retracted. His sleep is refreshing, his appetite hearty, his secretions 
normal, and he is fleshy and strong. His memory is tenacious, and he can sum- 
mon to it any bygone event to which he has been a party, with accuracy and 
promptitude; and he is subject to no hallucination. In shorty his senses of hearing, 
smell, taste, sight and touchy have not been one tittle deterioratedby the violent and exteri- 
sive nature of the injury to the brain. 

He presents himself occasionally for examination; and he has just now paid me 
a visit. I cannot learn that his disposition has been in the least altered by his ac- 
cident and consequent loss of cerebral substance. He is good-tempered and cheer- 
ful; which his friends say he has been from infancy. 



224 Progress of the Medical Sciences. [Jan. 

41. On the use of Piper angystifolium {maiico) in certain Hemorrhoidal Affections. 
By Dr. O'Ferrall. {Dublin Hospital Gazette, Oct. 1, 1845.)— Dr. O'Ferrall has 
found the matico to produce unequivocal and raj3id amendment of a form of dis- 
ease engaging the verge of the anus, and a portion of the raucous membrane 
above it. "This condition appears to be/" he observes, "the simple result of 
chronic inflammation of the integument, at the verge of the anus, and of a portion 
of the mucous membrane above it, the latter assuming the appearance of that hy- 
pertrophy, which is usually termed the villous state. 

" When examined externally, the verge of the anus presents a considerable 
swelling, of a purple colour, and divided into separate tumours or prominences, 
by fissures or folds of the skin. When these tumours are separated, (v^^hich gives 
exquisite pain if hastily done.) the bottom of the clefts is exposed, and the cuticle 
is there found to be abraded, and the surface covered with a sero-purulent dis- 
charge. These fissures are sometimes deep, and penetrate through the cutis to 
the cellular tissue beneath. The consistence of the swellings is firmer than that 
of the true hscmorrliGid in the recent state, but wearing its purple tint. They can- 
not be emptied by pressure. They are, on the other hand, less firm than the 
hsemorrhoid in the state of chronic consolidation. The cellular tissue of the part 
appears to be in a state of a-dema, and covered by a thickened skin. Where the 
parts are forced or draw^n out. the mucous membrane is found to be tumid, vas- 
cular, and apparently deprived of its epithelium ; it is easily made to bleed. 

"This condition of the mucous membrane does not extend very far upwards, 
and its prominence is little, compared with that of the vascular tumour of the rec- 
tum. It is not protruded at stool, and therefore, perhaps, yields litde blood, com- 
pared with what oozes from the former when occasionaUy strangulated by the 
sphincter. 

"These are the anatomical characters of the condition, in w^hich the maficowill 
be found to succeed. It appears to consist of chronic inflammation of the inner 
and external integument and cellular tissue, the prominence of the skin throwing 
it into folds, the clefts of which are apt to ulcerate, and, when stretched during 
defecation, may occasion pain, which resembles, in some respects, that of fissure. 
I have not seen any case of true varix, internally or externally, in this affection. 
The purple tint appeared to depend on congestion of the extreme venous radicles 
only. 

" This complaint begins gradually, and is chronic in its formation, but at length 
becomes so painful, that the erect or sitting posture can scarcely be borne. There 
is pain in defecation, which persists for a short time only afterwards. There is 
occasional, but not constant bleeding, and only in trifling quantities, but there is 
constant painful uneasiness, with sense of weight, increased by walking, and at 
length rendering the erect position almost intolerable. 

"I have seen this state, in several persons, at or beyond the middle periods of 
life. Both sexes are liable to it. It is called ' piles,' but leeching and cold appli- 
cations produce only temporary benefit, and warm applications have been found 
to increase the morbid sensibility of the parts. 

" The mode of employing the matico, in this affecfion, is in the form of ointment, 
or lotion. Dr. Young of Winslow recommends the ointment in ^external haemor- 
rhoids.' In the affection here described, the decoction appeared to me to succeed 
best, A dossil of lint, soaked in a decocfion, made by boiling two drachms of the 
leaves in six ounces of water, is to be introduced within the anus three times 
daily; another piece of lint in form of a compress, similarly charged, is laid out- 
side, and covered by oiled silk : the whole is supported by a T bandage. 

" If the resemblance to vascular tumour should induce the application of nitric 
acid in this afiecfion, it will be found to have done too much. The tumour of the 
mucous membrane is too slight to bear the escharotic, and the patient will be 
worse than before. It may, therefore, be found practically useful to describe a 
state of parts in which the matico is really an innocuous and adequate remedy." 

42. Excision of the Elbow-joint. — Dr. Sanders related to the Belfast Medical So- 
ciety a case of injury of the elbow-joint, for w^hich excision of the joint was per- 
formed with complete success. A young man was admitted into the Belfast 
Hospital on the 1st May, 1843, who received a severe wound of the left elbow 



1846.] Surgery, 225 

from a sythe, which completely separated a portion of the olecranon process, 
opening the joint. He had slight faintness from the shock, and but a trifling loss 
of blood at the time of the accident; water-dressing, and a supporting bandage 
were used, and a proper regimen, &c., enjoined. On the third or fourth day, how- 
ever, violent inflammation set in, and involved the whole arm. Notwithstanding 
appropriate treatment extensive suppuration ensued ; and, ultimately, the bones 
constituting the joint, took on diseased action. On the 18th day after the injury a 
consultation was held. The discharge at this time from the joint was very pro- 
fuse, and it was a matter of surprise that the patient existed at all. Two views 
were suggested as the only resort — amputation, or excision of the joint. Although 
the majority were in favour of the former course, it was finally agreed upon to 
adopt the latter, as Dr. Sanders was sanguine as to the possibility of saving to the 
poor boy a valuable member. Accordingly, on the same day, Doctor S. removed 
the ends of the humerus, radius, and olecranon (a portion of the latter had been 
partially removed at the time of the accident) ; having made the usual H incision, 
the sides being made parallel to the long axis of the arm. No arterial hemor- 
rhage occurred; but a good deal of venous blood, proceeding from a sinus along 
the humerus, gave some annoyance. This cavity was, however, filled with lint 
dipped in a solution of alum, and the edges brought into apposition by a few 
points of interrupted suture. Water-dressing, and a light bandage completed the 
dressing. So litte disturbance of the system ensued, that on the second day after 
operation, his pulse was only 108. On the following day the lint was removed 
from the cavity and some matter escaped ; this created little disturbance, for soon 
this discharge diminished, and (which is curious) just as it decreased, abscesses 
formed in different parts of the body — first over sacrum, next in calf of leg, and 
lastly over shoulders. This condition was attended with great debility, and re- 
quired the administration of wine. In three weeks the incisions and abscesses 
had all healed, and passive motion of the elbow was made. In two months after 
the operation the patient was discharged from the Hospital, with considerable 
power of motion of new joint, which he was instructed to exercise gently but 
regularly. It is now more than two years since the receipt of the injury. 

The patient was here presented for the inspection of the members, several of 
whom minutely examined the state of the part, and expressed their surprise and 
admiration at the completeness of the cure. Pronation and supination, extension 
and flexion seemed perfectly natural, and by a mere spectator scarcely any trace 
of deformity could be detected. — Dublin Hospital Gazette^ Sept. 1, 1845. 

43. Report of a Committee of the Royal Academy of Medicine of Belgium^ consisting 
of MM. Lebeau, Graux, Tallois, andSANGLET, on the '■'■ Amovo-inamovible^^ method 
in the treatment of compficated fractures. By Mr. Phillips. — The committee of 
which I have the honour to be the reporter, has been charged to examine the pro- 
position thus put by M. Seutin : — 

^'In the present state of our knowledge, the opinion of practitioners is not yet 
definitely fixed respecting the utility of employing the amovo-inamovible method in 
the treatment of every case of fracture, and more especially on the expediency 
of its immediate application in complicated fractures as an efficacious means of 
preventing consecutive mischief Several remarkable cases of comminuted frac- 
ture being now under treatment in the Hopital St. Pierre, I have the honour of 
requesting the Academy to appoint a committee to verify the great advantages 
which have followed the immediate application of this method in each of those 
cases." 

You easily understand that M. Seutin's object in thus putting the question was 
to remove the doubts still entertained by many practitioners by presenting a num- 
ber of authentic facts. 

Your committee being desirous to proceed by the method of comparison, re- 
peatedly visited the Hopital St. Pierre and the Hopital St. Jean, in which difi'erent 
methods of treatment are adopted. As M. Seutin's proposition involves "every 
case of fracture," your committee requested him to exhibit cases, whether under 
treatment or consolidated, of fracture of the neck of the femur, of the clavicle, or 
of transverse fracture of the patella ; but M. Seutin intimated that he never intended 
to extend his proposition so far, that his object was merely to show the advantage 



226 Progress of the Medical Sciences. [Jan. 

of the immediate application of his apparatus in the cases of comminuted and 
compKcated fractures at present in his hospitaL The inquiries of your committee 
were therefore confined within those narrow limits. It was with regret that your 
committee found their labours thus circumscribed, for in following out M. Seutin's 
original proposition, they would have had an opportunity of examining the influ- 
ence of compression, one of the most powerful, but at the same time one of the 
most dangerous resources of surgery: the more dangerous as the safety of its ap- 
plication entirely depends on the tact of the surgeon. An opportunity would have 
been then had of explaining the cases of partial or total gangrene of limbs com- 
pressed during the treatment of fracture, and by such explanation answering, it 
might be satisfactorily, the objections of those practitioners who constantly adduce 
lhose cases in opposition to the employment of the starched bandage. There 
would also have been an opportunity of proving by numerous cases, all of which 
were observed by your committee, that compression chiefly acts by preventing 
inflammation; that it arrests the progress of inflammation when it has already set 
in, and that the disasters, so constantly adduced in objection to the method, are 
all attributable to a faulty application of the apparatus. The immovable appara- 
tus would have been examined, not only as applicable to fractures, but also as 
applicable to luxations, contusions of the extremities, and penetrating wounds of 
the joints. It must be understood that by the term immovable apparatus, is 
meant not an absolute immobility, but an apparatus, portions of which, after it has 
been applied and consolidated, can be removed at pleasure, so as to allow the 
state of the limb to be ascertained, and wounds to be dressed without causing 
disturbance — always painful, and often dangerous — of the fragments of the bone, 
or of the open joint. Immobility, as understood by M. Seutin, is a middle term, 
something intermediate between the practice of absolute immobility and that of 
frequently renewing the entire apparatus. It would have been also important to 
have shown, by facts, how easily, during the application of M. Seutin's appara- 
tus, the joint above the fracture may be moved ; and thus have answered the ob- 
jection, that the use of the starched bandage in the treatment of fracture causes 
anchylosis. It would have, moreover, been desirable to adduce conclusive facts 
in reply to the objection, that the apparatus becomes relaxed, and that by the 
shrinking of the soft parts, the femur, for example, becomes perfectly movable in 
its starched sheath. The only question, however, which it came within our pro- 
vince to examine, according to M. Seutin's views, was the immediate application 
of the starched apparatus in cases of comminuted and complicated fractures. 

In the Hopital St. Pierre we examined thirteen patients who were actually 
under treatment — six w^ith fracture of the leg, three with fracture of the thigh, two 
with fracture of the humerus (one being fracture of the epicondyle with luxation 
of the elbow), and two fractures of the forearm. Of the six cases of fracture of 
the tibia, we eliminate two, as they were simple and uncomplicated fractures; 
and also, for the same reason, one case of fracture of the femur, and one of frac- 
ture of the forearm. Nine cases then remain, the treatment of which your com- 
mittee carefully observed. The following is a summary of the cases of fracture 
of the leg: A man, named Vincent, aetat. 71, while drunk, fell and fractured the 
bones of the leg, in or close to the ankle ; the integuments were lacerated, the 
fragments protruded, and the limb was covered with phlyctena?. The bandage 
was applied immediately, and durina; the night was torn off by the patient. The 
apparatus was again applied, and was again torn off the following night. Not- 
withstanding the uneasiness of the patient, and the severity and extent of the 
accident, no fever supervened, and the patient, admitted to the hospital on the 
18th of February, was discharged cured on the 10th of April. The second pa- 
tient had the tibia broken at its upper third by a large stone. The fracture was 
complicated by a wound three inches long, and two broad, which exposed the 
anterior muscles of the leg. The apparatus was applied immediately, and the 
patient, who never complained of any suffering, left the hospital well on the 4th 
of April, having been admitted on the 18th of the preceding February. 

The third case was that of a mason, who, on the 15th of February, fell into a 
trench when drunk, and fractured the tibia in its lower third : the upper fragment 
projected greatly anteriorly, and there was so much displacement that the limb 
was shortened two inches; there was also very considerable ecchymosis The 



1846.] Surgery. 227 

bandage was applied immediately; there was no fever, and the patient left the 
hospital on the 12th of April. The fourth case was that of a man, aged 43, who 
fell from a table on the floor, and sustained a comminuted fracture of the lower 
third of the tibia, with a wound of the soft parts. The apparatus was applied 
immediately; there was no inflammatory reaction; the wound was dressed every 
day through a small fenestrum formed in the bandage. This patient, admitted to 
the hospital the 21st of February, was discharged cured the 26th of April. 

Your committee observed, with interest, the treatment of a comminuted frac- 
ture of the forearm. The radius was broken in two places, the ulna was fractured 
at its centre, and projected through a laceration of the soft parts. The starched 
bandage was immediately applied. For several days the pain was so great that 
the bandage had to be removed, when it was found that there was very consider- 
able inflammatory swelling. Pounded ice was applied round the limb, and the 
inflammatory symptoms soon subsided. Those alarming symptoms occurred 
between the 3d and the 29th of May, and it was only when the swelling and 
pain of the limb were subdued by the application of cold, that the immovable 
bandage could be applied with safety. This patient was discharged cured. 

In one of the cases of fracture of the humerus, the bone was broken about its 
centre, and there was sanguineous effusion throughout the entire inner surface of 
the limb, together with considerable inflammatory swelling. The bandage was 
applied immediately on the admission of the patient, and no accident retarded 
the cure. The second case was one of dislocation of the elbow backwards, with 
fracture of the epiphysis. After reducing the dislocation, the bandage was ap- 
plied, notwithstanding the swelling of the joint. The elbow retained its mobility, 
and the patient, aged 15, having been admitted to the hospital the 1st of May, lelt 
it^ cured, on the 30th of the same month. 

We shall further mention two cases of fracture, so severe as to hold out little 
prospect of recovery. A man, aged 28, was carried to the hospital on the 10th of 
July. There was an oblique fracture of the right thigh, an oblique fracture of the 
patella, rupture of the ligament of the patella, with a transverse wound of the 
knee, fracture of the left ulna, and concussion of the brain. The immovable band- 
age was applied immediately, and the lower limbs extended by means of bags 
filled with sand. Delirium set in, and on opening the apparatus, the knee was 
found to be greatly swollen. Two bladders, filled with ice, were applied, and 
the severity of the symptoms soon subsided. On the 31st of August the man left 
the hospital. The callus was consolidated, but the limb was a little shortened, 
and the motions of the knee were slightly limited. 

The second case was as severe as the preceding one. A man, aged 29, fell 
from a tree and fractured the right femur and the forearm. The radius projected 
through the skin. The lower jaw was also fractured in three different places ; 
great tumefaction existed in all those situations. The bandage was immediately 
applied to all the fractures, and extension of the thigh was effected by means of 
bags of sand. Venesection was practised several times, delirium having set in 
to such an extent that the patient had to be tied in his bed. Under a strict anti- 
phlogistic treatment, the delirium subsided, and the fractures were treated as sim- 
ple fractures; the patient left the hospital the 20th of November with the lower 
extremity slightly shortened, but the motions of the leg and of the thigh were free, 
and he walked without limping. The jaw was somewhat deformed, but it re- 
tained the full extent and freedom of its motion. Those results are certainly very 
remarkable. The absence of inflammation in those complicated comminuted 
fractures of the leg, with wounds or lacerations of the joints, is attributable, with- 
out doubt, to the methodical application of uniform pressure. 

The immovable apparatus in fractures of this kind has undoubtedly advantages 
which belong to no other method of treatment. The chief, the most important of 
those advantages, is the facility which it affords for the patient being removed 
from his bed. This advantage also obtains in fractures of the upper extremity, 
whatever may be their complications. 

But are those advantages as real in very oblique fractures of the femur? We 
have already said that it has been objected to the starched apparatus that it be- 
comes relaxed because of the diminution of the swelling, and that then the oblique 
fragments being no longer in apposition, overlap and lead to the shortening so 



228 Progress of the Medical Sciences, [Jan. 

frequent in oblique fractures of the thigh. M. Seutin can, it is true, adduce, in 
answer to this objection, the two cases we have detailed above, but two cases are 
not sufficient to establish the superiority of a method to the general exclusion of 
others, and it must be observed that the immovable apparatus, when immediately 
applied in fractures of the fem.ur, loses its chief advantage, which is its permitting 
the removal of the patient from bed. We have seen that in order to maintain the 
fragments in apposition, M. Seutin is obliged to keep up extension and counter- 
extension by a bag of sand suspended to a cord and passing over a pulley; the 
patient is therefore compelled to remain in bed. Moreover, we have to contrast 
with the first-mentioned very remarkable case treated by M. Seutin, another 
treated by M. Uytterhoeven. A workman fell from a scaffolding and sustained 
an oblique fracture of the femur, complicated with a wound of the soft parts, a 
fracture of the lower jaw, and complete suspension of the intellectual faculties. 
The immovable apparatus was applied, but the patient being very restless during 
the night, the apparatus was in the morning relaxed, the fragments overlapped, 
and the patient suffered great pain. The immovable apparatus was again applied, 
but was again found deranged the next morning. M. Uytterhoeven now aban- 
doned the immovable apparatus, placed the broken limb on the double inclined 
plane, and thenceforward all the bad symptoms subsided. We shall adduce a 
second case: — A young person was admitted to the Hopital St. Jean with a very 
oblique fracture of the femur, with protrusion of the fragments, the upper frag- 
ment projecting on the external, the lower on the internal side of the limb. M. 
Uytterhoeven covered all the limb with poultices, and placed it on the double 
inclined plane. The patient, who suffered extremely when the limb was ex- 
tended, was free from pain when the thigh was flexed. It is knowai that mishaps 
have followed the constant use of the sfarched apparatus as well as that of other 
methods, and the important point is to determine what is the difference between 
those failures. But in order to efTect this, it would be necessary to compare a very 
considerable numiber of cases, for the safety of the immediate application of the 
starched apparatus, in comminuted and complicated fractures, is still a question 
with many practitioners. Most practitioners who adopt the immovable apparatus 
precede its application by certain precautionary measures. Thus, for example, 
at the Hopital St. Jean, the fractured limb is first covered with cataplasms for 
several days; and in very severe cases, when the reduction of the fracture cannot 
be effected without severe pain, it is not attempted until the muscular erythism 
has subsided. At the Military Hospital, the fractures treated by M. Lebeau are 
not immediately done up in pasteboard splints; inflammation is first subdued by 
irrigations of cold \vater, and when the limb can be manipulated with impunity, 
it is then, but only then, placed in the immovable apparatus. It must not be con- 
cealed that numerous and serious accidents have arisen, which have been solely 
caused by the immediate application of the immovable apparatus. Every practi- 
tioner is aware of such occurrences, and your committee cannot but regret that M. 
Seutin has not been able to give them the necessary details of the results of his 
practice for several years past, as undoubtedly we should then have been informed 
respecting some of those unfortunate cases which are greatly more instructive 
than are successful ones. 

Our task is a very limited one. We would gladly have been enabled to test 
and establish a comparison between the immovable method and that of frequent 
renewal of the apparatus, in cases of bad fractures. It would have been most 
interesting to have been able to inform you that, by the immediate application of 
the immovable apparatus, a certain proportion, out of a given number, of frac- 
tures of the neck of the femur, of oblique fractures of the shaft of the femur, are 
cured without shortening of the limb. But we have not been put in possession of 
the materials necessary to enable us to make such a report; M. Seutin has not 
consented to abide by the general proposition which he at first enunciated. From 
the facts observed by your committee, they conclude : 

1. That, in simple fractures, the immovable bandage, immediately applied, has 
great advantages compared with other methods of treatment. 

2. That formidable accidents sometimes occur during the application of the 
immovable apparatus, as is also the case with the ordinary modes of treating 
fractures. 



1846.] Surgery. 229 

3. And with the view of completing the investigation now commenced, your 
committee would request M. Seutin to give the greatest possible publicity to the 
cases that occur in his hospital. — Duh. Med. Press, Oct. 8, 1845. 

44. Blood-vessel communicating vjith the cavity of an abscess. — Dr. A. M. Adams 
records, in the London and Edinburgh Monthly Journal of Medical Science, April, 1845, 
a case of fatal hemorrhage from a blood-vessel communicating with an abscess. — 
It affords additional proof of the danger of allowing abscesses to remain a long 
time, particularly in delicate children, pressing upon important vessels. The sub- 
ject of the case, a girl fifteen months of age, was attacked, May 17, with parotitis 
of right side, following scarlatina anginosa. At this period, the throat, internally, 
showed no appearance of disease. As no fluctuation could be detected in the 
tumour, poultices were ordered, and directions given for the child to be brought 
back to Dr. A. in a couple of days. The poultices were applied; but the mother 
neglected showing me the child at the time appointed, wishing, as she said, "that 
the beating should be quite ripe before it was lanced." The consequence was, 
that the tumour burst in the throat, and the hemorrhage which ensued was so 
great, as speedily to prove fatal. The account given to me was, that the tumour 
had become much softer, and appeared to the friends sufficiently ready for open- 
ing, when, on the evening of the 23d, the child suddenly gave issue to a large 
mouthful of scarlet-coloured blood. It continued to flow from the mouth, of the 
same colour, for the space of six or seven minutes. A considerable quantity of a 
darker-coloured and coagulated blood was next vomited, making the quantity 
lost amount altogether, as nearly as the bystanders could guess, to about sixteen 
ounces. Shortly after this the child died. The swelling on the side of the neck 
Was found to have decreased considerably in size. 

From the preceding description, it is tolerably clear, why the blood vomited 
first and last should have diftered so much in appearance ; for in the former in- 
stance it must have proceeded directly out of the mouth, from the suppurating 
cyst, and in the latter it must have trickled first into the stomach, and been again 
discharged, from thence altered both in colour and consistence. 

45. Aneurism treated by Electro- Galvanic Action. — Dr. Petrequin, chief surgeon 
of the Hotel Dieu at Lyons, in a communication read to the Academy of Sciences, 
November 3, stated that he had applied electricity to the cure of aneurism in 
three cases. Two of these he had unfortunately lost sight of before the influence 
of the treatment could be duly appreciated. The third case occurred in a man 
nineteen years of age, who was brought to the hospital senseless on the 4th of 
August, 1845, immediately after a violent fall on the head. The lower maxilla 
was fractured at the symphysis, and the left orbit was the seat of considerable 
ecchymosis. The symptoms of cerebral commotion had given way in a great 
measure when variola declared itself The eruptive fever accomplished its 
periods in the usual manner, and it was only on September the 9th, five weeks 
after the accident, that M. Petrequin could direct his attention towards a tumour 
occupying the left temporal region, and which he had noticed long before. The 
swelling was of the size of an almond, soft, and almost indolent on pressure; it 
was seated on the course of the temporal artery, and presented pulsations isochro- 
nous with those of the arteries. These pulsations ceased when pressure was 
exerted on the temporal artery below the tumour, and reappeared on the pressure 
being removed. These signs left no doubt of the nature of the case, and aneurism 
of the temporal artery, probably due to the injury experienced by the vessel during 
the accident, was diagnosed. On the 10th of September, galvano-puncture was 
performed by the introduction of two sharp steel pins crossing each other at right 
angles in the tumour; the heads of the pins were then placed in communication 
with the wires of a voltaic pile, and a shock and a sharp pain were experienced 
by the patient, the pain increasing with the intensity of the electrical action. The 
operation lasted ten minutes, and fifteen plates were employed. The pulsations 
gradually diminished in the tumour during the operation, and at its close had 
entirely disappeared. No accident followed the experiment, but a solid indurated 
swelling took the place of the tumour, the temporal artery ceasing to beat above 
the aneurism, whilst its pulsations remained distinct below. On the 20th of Sep- 



230 Progress of the Medical Sciences. [Jan. 

tember, absorption had achieved the cure, and neither tumefaction nor pulsations 
could be detected in the spot where the malady had existed. M. Petrequin gives 
the following precepts, which he deems will ensure a complete coagulation of the 
blood contained in aneurismal tumours: — 1. Compression of the artery between 
the aneurism and the heart during the application of the galvanic agency. 2. The 
pins introduced into the tumour should be numerous, cross each other at right 
angles, and their surface should be protected by a coat of varnish in order to pre- 
vent unprofitable loss of the electric fluid. 3. After the operation ice should be 
applied to the tumour. This is the first case on record of aneurism cured, or even 
treated, by this method, which has been of late employed in the treatment of a 
large number of diseases. — Med. Times, Nov. 15, 1845. 

46. Case of Evulsion of the Left Arm and Scapula. — Dr. Alexander King com- 
municates a case of this to the Medico-Chirurgical Society of Edinburgh, January 
22, 1845. The patient was a stout boy, aged fifteen, whose left arm got entangled 
between the wheels of a grain mill, and was torn completely off. He fainted 
immediately after the accident, but soon recovered sufficiently to be carried home, 
a distance of half a mile. No blood flowed from the wound at the time, and the 
whole quantity lost did not exceed two teacupfuls. The wound left by the acci- 
dent extended from an inch from the sternal extremity of the clavicle to the right 
side of the upper portion of the dorsal vertebras posteriorly. The axillary artery 
projected two inches and a half from the wound, and pulsated strongly to within 
an inch of the orifice, but gave exit to no blood. Its external coat was divided 
into three irregular pieces, which encircled each other, and held a small coagu- 
lum in their embrace. The artery was secured by a ligature, and the ragged 
edges of the wound approximated by adhesive plaster. Very trifling reaction 
followed, the wound granulated kindly, except a portion of the skin, and the mass 
of the end of the nerves, which sloughed. Touching the latter caused great terror 
to the patient. The recovery was complete in about six weeks. Dr. King, in 
remarking on the case, called attention to the comparatively trifling amount of 
shock and the absence of hemorrhage, and quoted the experiments of Jones and 
others on the part which the laceration of the internal coats of the artery plays in 
preventing bleeding. 

With respect to the treatment, he suggested the propriety, in similar cases, of 
cutting short the nerves, so as to save the pain and danger from their being left so 
much exposed as in the present case. — Northern Journal of Medicine, May, 1845. 

47. Treatment of Venereal Warts. — M. Vidal (de Cassis) recommends for this 
purpose the application of a powder of equal parts of alum and savin, afterwards 
increasing the proportion of alum to two-thirds. This is applied twice a-day, 
the parts being previously moistened with equal parts of water and aromatic wine. 
If the glands is naturally covered by the pressure, in retaining the latter, the pow- 
der is retained in its place. If the glands is not covered by the pressure, a simple 
dressing, such as a piece of dry lint, ought to be employed. By the contact of 
this powder, the vegetations dry up, shrivel, and lose their adhesion, so that they 
crumble off without any pain. — Archives Gmerales de Medecine, July, 1845. 

48. Yeast in Trecdment of Burns. — Dr. Szerleski (Zeitschrift fiir Ther. und Phar- 
makodynamik, No. 1), states that he has found the external application of yeast 
extremely serviceable in relieving both the pain and inflammation of burns. 
Pieces of linen saturated with it should be laid upon the part as soon after the 
accident as possible^ care being taken to renew the application as fast as the rags 
become dry. 

49. Ovarian Tumour successfully removed. — Mr. John Dickin records, in the Pro- 
vincial Medical and Surgical Journal (Oct. 1, 1845), a case of ovarian tumour suc- 
cessfully removed by the large abdominal incision. The patient was unmarried, 
18 years of age, and the abdomen had commenced to enlarge about 20 months 
previously to operation. The tumour w^eighed nearly 28 lbs., and consisted in 
great part of a series of cysts in different degrees of development, and distinct 
from each other. The patient recovered without a single unfavourable symptom. 



1846.] Ophthalmology. 231 



OPHTHALMOLOGY. 

50. Nerves of the Cornea. — Schlemm and Bochdalck have traced the ciliary 
nerves into the substance of the cornea. Prof. Purkinje says that, ^- By the use 
of acetic acid, the human cornea, the cornea of the cow, sheep, dog, and rabbit, 
after appearing a little opalescent for a short time, become perfectly transparent; 
and when examined from within, a rather complex networkof nerves will be seen 
running from the circumference to the centre. The elementary filaments of this 
network combine in a complex manner with each other, presenting the appear- 
ance of looking through a kind of continuous basketwork. None of the filaments 
seem to be lost in the substance of the cornea, nor do any pass to the conjunctiva." 
Lond. Med. Gaz., Oct. 1845, from MilUer^s Archiv., 1845. 

51. Motions of the Iris. — Signer Guarini endeavours to proVe that the motions 
of the iris are the joint result of the contraction of muscular fibres and of vascular 
turgescence. He believes that it is impossible by mere vascular erethism to ac- 
count for the extreme rapidity of the motions of the iris. An erectile organ requires 
a certain time to attain erection, and does not reach that state with the lightning- 
quickness which characterizes the action of the pupil ; motions so instantaneous 
can only take place through the play of muscular fibres. Again, organs formed 
of erectile tissue can readily undergo the various gradations between flaccidity 
and turgescence; but we do not see them pass immediately from one extreme to 
the other, then return abruptly to their former condition, to reassume not less 
quickly the second : but the pupil does exhibit all these variations. Thirdly, with 
erectile organs the state of repose is that of relaxation; but, on the contrary, the 
passive state, the repose of the pnpil, is an extension midway between dilatation 
and contraction ; and lastly, the condition of medium extension is that in which 
we find the pupil of the dead subject, whilst erectile organs are left by death in 
complete flaccidity. Signer Guarini, however, does not on these accounts deny 
the share taken in production of the pupillary movements by turgescence of the 
iridal vessels ; only, in his opinion, the latter exerts but a secondary and acces- 
sory influence which he explains in the following manner : — 

All the erectile organs of the economy are environed with muscles or contractile 
fibres, the contracfion of which, by pressure on the veins, of which these organs 
are principally composed, produces a momentary stasis of the blood within them, 
w^ithout compressing them so strongly as to impede the entry of arterial blood. — 
The vessels of the iris being interlaced with the circular fibres which effect con- 
traction of the pupil, these fibres cannot act without arresting the blood in the 
vessels; a stagnafion which contributes to augment contraction. Signer Guarini 
then admits the two orders of circular and radiating fibres in the structure of the 
iris, the former to diminish, the latter to dilate the pupil; and describes that the 
circular receive their motive power from filaments of the third pair, which emerge 
from the ophthalmic ganglion ; whereas the radiafing fibres are supplied by 
minute branches, which, arising from the superior pair of cervico-spinal nerv.es, 
enter the first cervical ganglion of the sympathefic, and, subsequently united with 
the sixth pair, pass into the orbit. 

The following experiments tend to establish this particular distribution. If, as 
Professor Valentin has shown, we divide the third pair of nerves in a living ani- 
mal, the pupil dilates ; if we remove the first ganglion of the great sympathefic, 
it contracts. Now, Signor Guariin having observed that in animals killed with 
strychnine the pupil is dilated, conceived he could make use of this fact to deter- 
mine the nervous sources of the different iridal movements : so, having extirpated 
an animal's superior cervical ganglion, and thus produced contraction of the 
pupil, he administered strychnine. The pupil of the side operated on only dilated 
a little, for the filaments of the third nerve, now unopposed, maintained its con- 
traction ; but the pupil was seen enormously dilated on the other side, as ordina- 
rily occurs in poisoning with strychnine. Again : if, on a body still irritable, we 
prick the third nerve, or the ophthalmic ganglion, the pupil slowly contracts, and 
does not afterwards dilate ; but if we lay bare the superior cervical ganglion 



232 Progress of the Medical Sciences. [Jan. 

while the animal is alive, then kill it, and irritate the third pair, we shall still 
observe contraction of the pupil, which will now, however, disappear on irritating 
the cervical gangUon. " This," says the author, "proves incontestably the exist- 
ence of muscular fibres in the iris; for muscular tissue alone has the property of 
contracting after death under the influence of mechanical or chemical irritation. 
I defy those who admit vascular erethism only as the cause of the motions of the 
pupil, to produce erection of the penis or clitoris in the dead subject by those 
means which so unequivocally determine the movements of the iris." 

In conclusion, according to Signer Guarini, contraction of the pupil depends not 
only on the action of the circular fibres^ but also on the stasis of the blood within 
the veins of the iris produced by that muscular action. The reality of the influ- 
ence of this supplementary cause is placed beyond doubt (?) by the following 
fact : — In essaying by the strongest stimulation of the third pair in a body yet 
irritable, to produce contraction of the pupil, one can never succeed in rendering 
it as circumscribed as in the living; for the circulation having ceased, the blood 
is not confined in the vessels so as to impart, as during life, the utmost degree of 
narrowness to that aperture. It appears that the dilatation of the pupil, on the 
contrary, takes place as the effect entirely of contraction of the radiating fibres; 
since the enlargement we obtain in the subject by irritating the superior cervical 
ganglion is quite as considerable as that which ensues on the application of bella- 
donna to the living. 

Mr. France, in commenting on these views, remarks : — The author's endeavour 
to prove that venous erection is superadded to circulo-muscular contraction, as at 
once its effect and consummation, appears to me singularly unfortunate ; for even 
if we admit the anatomical relation of vessel to muscular fibre, which he assumes, 
the hypothesis will be found inadequate to explain what it professes to do. The 
circular fibres are only supposed to exist at the immediate margin of the pupil, 
and the flow of venous blood in the iris is necessarily, in general direction, cen- 
trifugal; hence, if Signer Guarini's notion were correct, erection by venous 
obstruction would arise from a mechanical impediment situate at the distal side of 
the obstructed part, which is impossible. That arterial congesdon should result 
from this mechanism is not, however, unlikely; yet either idea derives but little 
countenance from the inconclusive reasoning with which the author supports his 
own : for, 1st, equally vigorous contraction of pupil could not be expected in the 
dead as in the living body ; and 2dly, though dilatation is reported to have been 
disproportionately great, yet the standard of comparison (the effect produced by 
belladonna in the living) is too variable to allow a legitimate inference to be 
founded on the observation as thus recorded : the actual and positive degree of 
dilatation should have been specified. 

Valentin's invesfigations of this subject, referred to by the author, are of course 
worthy of the highest consideration: he fully confirms the truth of the conclusions 
arrived at by Mayo, with respect to the powers of the third cerebral nerve over 
the contractions of the pupil; but he advances further, and claims an active dilat- 
ing influence for nervous fibrils, originally emerging from the superior cervico- 
spinal nerves, and after intimate connection with the superior cervical ganglion 
of the sympathetic, and that of the vagus, reaching ultimately the ganglion ciliare 
and iris, by means of the carotid plexus or branches of the fifth. — Lmid. Med. Gaz., 
Sept., 1845. 

52. Remarks on Effusion of Blood within the Eyeball. By C. Lockhart Robert- 
son, M. D. — When effasion of blood into the eye is the result of injury, it generally 
takes place into the aqueous humour. The iris and ciliary processes being the 
only textures in this part supplied with vessels conveying red blood, the effusion 
must evidenfly arise from one or other of these. When present in the anterior 
chamber only, it must proceed from the vessels on the anterior surface of the iris, 
and the effused blood may be equally diffused through the aqueous humour, ting- 
ing the whole of a deep red hue, or lie unmixed at the junction of the iris with 
the cornea. 

On the other hand, when blood is effused from the ciliary processes or posterior 
surface of the iris, and presents itself in the anterior chamber also, it must have 
escaped in quantity sufficient to have enabled it to pass through the pupil, and, 



1846.] Ophthalmology. 233 

in such instances, the whole of the aqueous humour will be found uniformly 
tinged with the colouring matter of the blood. Such cases are of very rare occur- 
rencCj probably owing to the distension of the eyeball, caused by the effused 
blood acting mechanically as a means of compressing the blood-vessels, and ar- 
resting their discharge before such a result could take place. 

When the effusion of blood into the posterior chamber is in smaller quantity, 
and does not reach the pupillary margin, it will of course escape observation. 

The effusions of blood into the aqueous humour are usually absorbed in the 
course of three or four days, provided no inflammation supervene. 

Although effusion of blood, the result of injury^ generally takes place into the 
aqueous humour, it occasionally occurs into the cells of the vitreous humour. "I 
have met with cases," says Mr. Travers, {A Synopsis of the Diseases of the Eye, p. 
201,) '' in which hemorrhage into the vitreous cells occurred in consequence of a 
blow. Inflammation and swelling of the globe ensued, and the cornea, yielding 
to the pressure, sloughed, when the humour protruded gradually in the form of a 
large spongy mass, loaded with coagula of blood, so as forcibly to separate and 
distend the lids, and occupy the entire circle of the orbit. In these cases a severe 
pain is felt in the head and temple. The occasional hemorrhage is profuse. — 
The pain is relieved by opiates, and the eyeball ultimately sinks with a total loss 
of figure. I have reason to believe that this disease, which at one period assumes 
much of the aspect and character of a fungus (in its third stage), has sometimes 
been mistaken for one of a malignant character.'^ '^ I have also known," says 
the same author, (Op. cit., p. 200,) " blood effused into the cells of the vitreous 
humour within twelve hours after the operation of extraction, in consequence of 
straining upon the night-chair, which was instantly followed by severe pain dart- 
ing towards the occiput." In this instance, the effusion was more likely to occur 
in consequence of the vessels being deprived of their natural support, the cornea 
having been laid open, and a part of the usual contents of the eyeball evacuated. 

Laceration or wounds of the iris, in extracting a cataract, or forming an artificial 
pupil, and penetrating wounds of the globe, are often followed by extravasation 
of blood into the anterior chamber, and acute inflammation is sometimes attend- 
ed by a similar effusion. 

Effusion of blood into the eye not unfrequently occurs spontaneously, and, in 
such instances, it generally takes place into the aqueous humour. 

Such spontaneous eftusion of blood into the anterior chamber may be the re- 
sult of any over-exertion either of the body {BeWs Surgery, vol. iii., p. 350), or 
of the eye, (Mackenzie. Practical Treatise, ^c, 3d edit., p. 597,) or it may occur in 
weak subjects during the progress of scrofulous ophthalmia. (Zeitschrift fiir die 
Ophthal. Erster Hejt, art. viii. Demours Traite, i^'c, tom. ii., p. 249.) Again, these 
spontaneous extravasations may be vicarious with the menstrual discharge, ( Wal- 
ther. Merkwurdige Heilung eines Eiterauges. Zwieter Auflage, s. 395. Landshut, 
1819,) recurring at monthly intervals, and disappearing on the establishment of 
the catamenia, (Tyrrell. Practical Work, Sfc, vol. ii., p. 40,) or they may occur in 
consequence of the cessation of this function. (La Lancette, copied in Med. Ga- 
zette, Oct., 1829.) A hemorrhagic diathesis may cause a similar result. (Dublin 
Journal, vol. xi., p. 395.) 

In such cases there is generally, after any excitement, bodily or mental, a return 
of the effusion. (Bell, loc. cit., Sfc, ^c.) Walther, (Op. cit., p. 61^) in connection 
with this subject, relates a curious case, in which the patient could, at will, cause 
the effusion to occur, which, although occupying half of the anterior chamber, was 
each time re-absorbed in the wonderfully short period of from eight to ten minutes. 

In all the cases of spontaneous effusion which have been hitherto recorded, the 
extravasation took place into the anterior chamber, and the only notice I have 
met with in surgical works, of blood being spontaneously effused in the chamber 
of the vitreous humour, is in a paper by Dr. Robertson, in the second volume of 
this journal ; and it is there noticed in connection with the diagnosis of incipient 
medullary carcinoma, which it very nearly resembles. 

The following is a well marked case of such effusion of blood into the chamber 
of the vitreous humour, occurring without direct injury, and probably dependent 
on a diseased state of the vessels of the part. The appearances presented in the 
eye so exactly resembled those of medullary carcinoma, that the true nature of the 
disease could only be determined by the history of the case. 



234 Progress of the Medical Sciences » [Jan. 

Miss , setat. 29, suffered when fifteen years of age from red spots appear- 
ing before the right eye. which in about a week yielded to the use of laxatives. 
When twenty years of age, she remarked that the left eye retained the image 
presented to it for some seconds after the object had been removed, and vision 
graduaUy became more and more impaired in that eye, till August, 1839, at 
which time she could not distinguish light from darkness. Under the use of 
leeches and blisters, and of mercury, given so as to affect the system, the sight in 
December began to improve. 

In June 1840, she had an attack of blindness in both eyes, accompanied by se- 
vere pain in the eyes and forehead, which yielded to leeches, blisters, and mer- 
curials. 

In January, 1842, she had another attack in both eyes, of a slighter character. 
In December of the same year, the disease suddenly recurred in both eyes, and 
again yielded to the use of leeches and mercurials. While still under treatment, 
she had in January, 1843, a sixth attack in both eyes. The same remedies were 
continued. Subsequently electro-magnetism was tried, with temporary improve- 
ment of vision. 

In August, 1843, the disease suddenly recurred, for the seventh time, in the 
right eye, (owing, it was supposed, to a sudden fright,) and again yielded to 
leeches and mercury. 

Sight continued improving until May, 1815, when she had another slight attack 
in the same eye. Under the employment of leeches and mercury, vision is being 
again restored. 

The right eye, after each attack, presented the following characters: — 

The conjunctiva and sclerotic were healthy, the pupil dilated but perfectly regu- 
lar, the colour and texture of the iris natural. On a minute examination of the 
posterior chamber,* it was observed that an effusion of blood had taken place 
into the vitreous humour at the nasal side, and about half-way between the iris 
and optic nerve. The red colour gradually disappeared, leaving a mass of a 
brownish yellow colour, and of semi-nietahic lustre. Under the action of mercu- 
rials, the bulk of this deposit was lessened and vision improved. At present it is 
about the size of a hazelnut. 

No eftasion can be traced in the left eye. 

The pale coloured mass in the right eye presented appearances nearly resem- 
bling those observed in \\ie first stage of medullary carcinoma, from which it was 
distinguished, — 

Firstly. By the red colour presented by the tumour, after each effusion, which 
contrasted with the unvarying dark amber or greenish hue {Wardrop on Fungus 
HcBmatodes, pp. 10 and 41), of the incipient medullary carcinoma; while the sin- 
gle red vessels, {Dr. Robertson, Northern Journal, vol. ii., p. 66.) which, in the 
latter, may be traced over the tumour, were not present. 

Secondly. The pupil, instead of being, as it is in medullary carcinoma, irregu- 
lar, and having the transverse diameter the larger, was equally and regularly 
dilated; while the colour and texture of the iris remained unaltered, instead of 
being reduced in thickness, (Dr. Robertson, loc.cit.,) or presenting the injected, 
{Wardrop, op. cit., p. 47,) or reddish-yellow hue, {Dr. Robertson, loc. cit.,) which it 
does in incipient medullary carcinoma. 

Thirdly. The tumour decreased in size, and sight w^as gradually restored under 
the employment of mercurials ; while in the malignant affection, the size of the 
tumour never decreases, and vision becomes more and more impaired, in spite of 
all remedial means. 

Similar appearances requiring most minute attention in the diagnosis, are like- 
wise presented after deep-seated inflammation of the globe, terminating in the 
deposition of a clot of lymph, {Lawrence, Practical Treatise, ^c, 2d edit. p. 697,) 
or proceeding to the effusion of pus into the cells of the hyaloid membrane. 
{Mackenzie, op. cit., p. 607.) 

Our prognosis in spontaneous effusion of blood, be it into the anterior chamber 

* By the application of belladonna, and by allowing the focus of a double convex 
lens to fall on the eye, we are enabled more readily to appreciate any alteration in 
its deeper seated textures. 



1846.] Ophthalmology. 235 

or into that of the vitreous humour, must be very doubtful, the primary cause, in 
most cases, being a diseased state of the vessels, which are liable again to give 
way on the application of any exciting cause. 

In spontaneous effusion of blood into the vitreous humour, we have further to 
fear that this constantly recurring extravasation, and the presence of the organized 
lymph resulting, may, by compression of the retina, cause at last permanent in« 
sensibility to the stimulus of light. 

The treatment most to be relied on, on the occurrence of any such sanguineous 
effusion, is general or local depletion, according to the circumstances of the case, 
accompanied by cold applications and quiet both of mind and body; while, far- 
ther to promote absorption of the effused mass, mercurials must be employed 
so as to affect the system. 

The recurrence of the extravasation must be guarded against by attention to the 
general health, due regulation of diet, moderate and regular exercise, avoiding all 
stooping or over-exertion, more particularly of the eye, keeping the feet warm 
and the head cool, and sleeping with the head more than usually raised. — North- 
ern Journal of Medicine, August, 1845. 

53. Ascension of a depressed Lens twenty-two months after couching. — Dr. De Abren 
records in the Annalcs cV Oculistique, a case in which the crystalline lens which had 
been couched, reascended twenty-two months after the operation and passed into 
the anterior chamber. It had lost about one-sixth of its original size. No irrita- 
tion of the iris followed from the presence of the lens in its new situation, and its 
absorption was there rapidly effected. 

54. Case of sudden and temporary Presbyopia. — In our number for May 1840, p. 
228, will be found an example of this, recorded by the late Dr. James Hunter of 
Glasgow. An account of a second case, precisely similar, was found among the 
papers of the physician just mentioned, and is published in Northern Journal of 
3Iedicine (May, i845). This latter case is the more interesting from the exact 
degree of loss of sight and focal lengths of the glasses required to correct it being 
carefully given. 

Case.— On the 17th of last April, a person from the countiy brought his son to 
me that I might examine his eyes. He was a strong, well-conditioned looking 
boy, eleven years of age, of a nervo-bilious temperament, very active, and fond 
of out-door sports; but withal a good scholar, and fond of reading. Fifteen days 
before I saw him, he was at school, and in his usual health: W about seven 
o'clock at night, when he set to prepare his next day's tasks, he found he could 
not read common-sized book type, nor distinguish accurately any very small and 
near object. There was no pain, nor any apparent symptom of disease in either 
eye, both of which were equally affected. His general health was unimpaired, 
and he had not received any injury of the eyes, or of any other part. During the 
two following days the sight became rather worse; but from that time till t saw 
him it had been quite stationary. Excepting the administration of some laxatives, 
no treatment had been adopted. Previously to the invasion of this attack, his 
sight had been extremely good, and he had never before experienced any similar 
affection, nor been subject to fits or other nervous diseases, although his father 
described him as of a very excitable disposition, nor had he been troubled with 
intestinal worms, at least since infancy. 

The eyes appeared perfectly healthy in every respect ; in particular, the promi- 
nence of the cornea, the shape, size, and motions of the pupil and iris, the size 
and configuration of the images of a lighted taper reflected by the cornea, and the 
surfaces of the lens, were perfectly normal, as far as could be judged by a careful 
examination. The only complaint was the inability to read common-sized print, 
or to see minute and near objects; for distant ones he thought were as distinct as 
ever, but I afterwards ascertained that his distant vision was very slightly affected. 
To ascertain the state of his sight, I gave him a printer's specimen-sheet, contain- 
ing a series of paragraphs in all the various sizes of book type, from '^English'' 
to " Nonpareil" and the smallest "Diamond." He could read the '^English" 
type, though not very fluently, and saw it best at eleven inches from his eye. 
Of the paragraph printed in " Pica No. 1," he could make out a word here and 



236 Progress of the Medical Sciences. [Jan. 

there. The paragraph " Pica No. 2" was almost quite illegible, and the smaller 
sizes of type could not be read at all. Directing his attention to a dark green 
stable door in my back garden, he could distinguish the key-hole, which was 
two inches long by five-eighths of an inch wide, the distance being seventy-one 
feet; but he could not see some black iron spikes about seven inches long and 
probably one-sixth to one-fifth of an inch in thickness, in a dovecot at a distance 
of nearly seventy-eight feet ; but which even to a good eye were not very per- 
ceptible, from their being in contrast with a slated roof. The power of the two 
eyes seemed to be perfectly equal. In order to know the effect of different kinds 
of glasses, I first gave him concave spectacles of different foci, but they rendered 
his sight much less distinct. I then tried him with convex ones, beginning with a 
pair of twelve inches focus. These improved his sight very much, so that he 
could read any size of type, from the largest to " Brevier No. V inclusive. With 
a pair of ten inches focus he could read " Minion No. 1.'^ With a pair of nine 
inches he could read " Nonpareil No. 2," and even a few words of a still smaller 
type, " Diamond," though with difficulty. With glasses of eight inches focus he 
saw better; but with those of seven inches focus he saw better still, and could dis- 
tinguish the smallest type I could procure. Still he could not count a series of 
black spots, 0-007 of an inch in diameter, placed on a white ground, without using 
a glass of six inches focus, and with this again he could not see ordinary sized 
type so distinctly as with glasses of nine inches focus. 

When he looked at a distant object through any of the above-mentioned glasses, 
it appeared less distinct. With convex spectacles of fourteen inches focus, objects 
at nineteen feet were seen very distincffy, but at a greater distance, as from eighty 
to one-hundred and fifty feet, he saw best with glasses of from sixteen to twenty 
inches focus. When his eyes were fitted with convex spectacles of a focus best 
suited to the size of any one near object, the point of most distinct vision was at 
the distance of twelve inches; but six inches nearer, or ten inches farther off" than 
this, vision became very indistinct. With the naked eye he could not see to read 
'^ English" at less than five and a-quarter inches, or beyond nineteen inches, and 
then only imperfectly, the range of distinct vision being from eight to seventeen 
inches; whereas an eye whose power of accommodafion is unimpaired can read 
the same type, though with difficulty, at any distance from three and a-half to 
eighty- five inches, and quite easily from five to forty -three inches; thus proving 
that the eye of a healthy person in the prime of life has a mean power of accomo- 
dation to distances from five to six fimes greater than was possessed by the 
patient. 

From the favourable term of my former similar case, I resolved to adopt an 
expectant treatment, after first of all administering some anthelmintic remedy, 
with the view of ascertaining if the patient was infested with intestinal worms. I 
therefore recommended that the boy should get two doses of a mixture of ol. tere- 
binth, and castor oil, and his evacuations should be carefully examined; and that 
if no worms were found, he should be kept from school, made to take acfive out- 
door exercise, with a rather spare diet. I strictly prohibited the use of spectacles 
on any account, as being very likely to confirm the disease, whilst, if it should 
become a permanent affection, they could always be resorted to. Along with this 
regimen I prescribed a weak solution of sulphate of quinine with compound tinc- 
ture of valerian to be taken twice a-day, more as a j)lacebo than with the hope of 
any specific benefit from its action ; and at the same time I gave a favourable 
prognosis, and warned his friends that the cure might probably be tedious, 

I heard nothing more of this case from the I7th April to the 26th June, when I 
had a letter from his father, informing me that the castor oil and turpentine were 
administered twice according to my directions, and had acted powerfully as a 
purgative, but that there was no appearance of worms in the evacuations ; after 
that, he had rigidly pursued the regimen and taken the medicine I had prescribed, 
without any apparent benefit, till about the last week of May, when the sight 
began to improve. 

This improvement increased daily, and in about ten days after the eyes were 
as well as ever, and the boy had returned to school, where he had been for three 
weeks without any recurrence of the disease. 



1846.] Mral Surgery. 237 

55. Adhesion of the Eyelids to the Globe of the Eye. — M. Petrequtn says lie has 
succeeded in curing that most unmanageable deformity, adhesion of the eyelids 
to the globe of the eye, by the foUou'ing method of operating : — He passes a needle, 
with a double ligature, through the adhesion; he then ties that portion of the liga- 
ture next to the eyelid loosely, and the portion next to the eyeball very tirmly. 
The consequence is, that the latter ligature rapidly cuts its way through the adhe- 
sion and separates, while the former one remains for some days longer: the 
wound on the eyeball is thus allowed to cicatrize before the opposed surface of 
the eyelid is exposed by the separation of its ligature, and all danger of a rehipse 
by reunion of the divided surfaces is thus prevented. — Northern Journal of Medi- 
cine, from Traite d^Anatomie Medico- Chirurgicale Topographique. 

56. Keratoplnstie. — M Plouvif.z, of Lisle, communicated to the French Aca- 
demy of Sciences, on the 18th of August last, a note in which he gives the results 
of his numerous researches relative to Keratoplastie. M. P. has been six years 
engaged in this investigation, during which period he has performed numerous 
operations, without, in a single case, succeeding in obtaining perfect transparency 
of the transplanted cornea. In the most successful operaitions the new cornea 
always continued more or less opalescent; vision, however, was several times 
re-established partially, but partially only. Among the cases related, is one of a 
girl, aged 23, w^ho was blind from three years of age, in consequence of small- 
pox. M. Plouviez, after removing ihe opaque cornea, which was effected with 
great difficulty, because of its great density and thickness, replaced it with the 
cornea of a young dog which was killed at the moment. The sole result of the 
operation was, that the patient could better distinguish day from night, and could 
discern a strong light and the sun, but she could not gnid'^ horsclf without help. 

The following are the conclusions of M. Plouviez's noie: — 

1st. The cornea of one animal can be transplanted to the eye of another animal. 

2d. The human cornea can retain its vitality when transplanted to the eye of a 
rabbit. 

3d. A cornea taken from a body five days dead can be grafted on, and become 
attached to the eye of a living animal. 

4th. A cornea may adhere, when attached with one, two, or three sutures ; but 
four are usually necessary. 

5th. Flax or silk sutures are the best. 

6th. Life is communicated to a dead cornea by means of a plastic fluid, which 
becomes gradually organized on the iris and between the edges of the dead and 
living corneas. 

7th. Reunion by the first intention never occurs. 

8th. A transplanted cornea always shrinks considerably — generally one-half. 

9th. The remaining portion of the old cornea is always elongated concentric- 
ally towards the end of the process, and retains its transparency. 

10th. Complete transparency of the transparent cornea has not been obtained 
by any mode of operation hitherto employed. 



AURAL SURGERY. 

57. New Method of treating Diseases of the Ear. — At the meeting of the Academy of 
Sciences, on Jan. 6, 1845, a communication was read from M. Wolff, upon a new 
method of treating diseases of the internal and middle ear. 

In substituthig aerial for liquid injections, in the treatment of diseases of the ear, 
a marked advancement was made in this branch of therapeutics by M. Deleau. 
But the change has not been advantageous in every respect; for whilst air-douches 
exercise an influence purely mechanical, and always identical, liquid injections 
enable us to fulfill very difl'erent indications, the water serving as the vehicle for 
substances which may be varied according to the nature of the case. Indeed, M. 
H. Valleroux has lately recommended injections of air charged with emanations 
from resinous and balsamic substances, which, being volatilized at a moderate 
temperature, have often a beneficial influence in aural catarrhs. But it is evident 
No. XXL— January, 1846. 16 



238 Progress of the Medical Sciences. [Jan. 

that the greater part of the remedies which it would be desirable to make use of 
in diseases of the ear cannot be employed in this jorm • some because they are not 
volatile, others because they require for conversion to the aeriform state too high 
a temperature. Water, which, in being evaporated, generally carries with it a 
portion of the substances to which, in its liquid form, it served as a menstruum, 
cannot be employed in the state of vapour, because the high temperature required 
for its maintenance is unsuilable to the sensibility of the organs upon which it is 
necessary to direct it; but the ebullition of water gives rise to a current of humid 
air, which may be readily brought to d temperature capable of being supported 
without inconvenience by the walls of the Eustachian tube ; and if the water has 
been previously medicated, some part of the principles with which it has been 
impregnated will thus accompany the moist air. This method requires for its 
employment a very simple apparatus. The water contained in an iron retort is 
heated by means of a spirit-lamp; the vapour escapes by a tube into a second 
and larger vessel, which contains a third, filled with cold water; to the upper part 
of the second vessel is attached a tube, by which the moist air escapes. The 
same apparatus may serve for the administration of remedies not previously dis- 
solved in water. If, for example, it is wished to employ acetic ether, or other 
medicines wiiich volatilize at a temperature slightly elevated, on placing them in 
the third vase their vapour will mingle v^atli the moist air. 

As to the mode of introducing the vapour, if the Eustachian tubes are permea- 
ble, all that is requisite is to pass an elastic canula from two to three inches within 
the inferior nasal canal, so that one extremity shall be near the orifice of the Eus- 
tachian tube, whilst the opposite end is adapted to the discharging tube of the 
apparatus. 

One grand recommendation of this very simple proceeding is, that it occasions 
no pain or pruritus, and may be practised by any medical man, or even by the 
patient himself. 

It is requisite, however, that the diagnosis of the disease should precede its 
treatment, and the former will always demand the exploration of the middle ear 
by means of the sound. Hence, catheterism of the Eustachian tube remains as 
the principal means indicated in the diagnosis of diseases of the internal and 
middle ear; and it is equally necessary in their treatment when there exists any 
material obstacle to the passage of the air. All the ditferent methods of perform- 
ing this operation may be referred to two principal divisions — catheterism by 
means of the solid silver sounds of Itard and Kramer, and by means of the flexi- 
ble sounds of Deleau, each of which has its advantages. The former mode is 
recommended by greater security in the execution of the operation, from the 
larger size of the instrument generally, and of its beak in particular. The latter 
method has also several advantages, of which the principal is very important, viz.: 
the ability to introduce the instrument much further within the tube; for whilst 
the metallic sounds are arrested at its orifice, the small elastic ones are able to 
traverse the greater part of its canal — three-fourths, according to Deleau. JVI. 
Wolff has attempted to unite the chief recommendations of the sohd and elastic 
sounds. He describes two new forms of this instrument, one being metallic, 
the other elastic. Both are double ; consisting of an external sound, equal in size 
to the instrument of Kramer, and of an internal one, corresponding in size to 
that of Deleau. The outer sound is of the usual length, 6 inches; the inner one 
is 2 2 inches longer. The former is graduated throughout its whole extent; the 
latter only at the inferior extremity, which projects from the outer sound. In one 
form of his catheter the inner sound is composed of silver nearly or quite pure, 
and consequently flexible; whilst the material of the outer sound is ordinary 
silver, i. c, an alloy with copper, and on this account inflexible. In the elastic 
form the inner sound may be deprived of its stilet, as its passage is rendered suffi- 
ciently sure by the external sound which contains it. 

The principal advantage gained by these aUerations is this: that whilst they 
give to the operation all the sureness afforded by the large and solid instruments 
of Kramer, they enable us to penetrate equally far within the Eustachian tube as 
when the elastic instrument of Deleau is employed. 

The metallic and elasiic sounds are respectively preferable in certain cases. 
The doable silver sound is more suited for the exploration of the middle ear, cis 



I846„] ^iiral Surgery, 239 

well as in cases of contraction or obliteration of the canal. The elastic sound, on 
the other hand, has the advantage of being much more tolerable to the patient. — 
Lond. Med. Gaz., Sept., 1845. 

58. Polypus of the Ear, — -M. Bonn^afont presented, a short time since, to the 
Academy of Medicine, Paris, an interesting memoir on polypus of the ear, of 
which we present the following abstract. 

The author discusses, 1st. The seat and character of these morbid products. 
2dly. The symptoms which accompany them, and the bad effects to which they 
may give rise. 3dly. The treatment which they require. 

J St. Their characters vary: they may be hard, resisting and irregular, or smooth, 
yielding, and elastic: painful or insensible. In considering this latter symptom, 
however, it is important to distinguish between the sensibility of the polypus 
itself and that occasioned by its pressure upon the surrounding parts. 

Polypi may have their origin in any part of the auditory tube, or upon the 
membrana tympani; and, contrary to the opinion generally entertained, M. Bon- 
nafont believes that they are met with more frequently upon, and in the neigh- 
bourhood of the membrana tympani than elsewhere. They assume a variety of 
shapes: they may be rounded or oval, flattened or elongated, and attached by a 
pedicle v/hich may be long or short : but after the attainment of a certain size, 
their form becomes similar in all cases, owing to the pressure of the parietes of 
the tube, which compels the excrescence to extend either outwards or inwards 
upon the membrana tympani. 

When the polypus springs from some point in the outer two-thirds of the meatus, 
and its direction is outwards, the symptoms are simply those arising from m.ore 
or less obstruction of the canal; such as a sense of fullness in that part of the ear, 
and some degree of deafness; a constantly purulent discharge, the nature and 
abundance of which will vary according to the state of the tube ; pain is rarely 
felt except when the polypus is large, and then it is much increased by mastica- 
tion. 

If the polypus increase in the opposite direction, so soon as it comes in contact 
with the membrana tympani the patient begins to experience a vague pain, espe- 
cially in the throat, about the orifice of the Eustachian tube. The excrescence 
continuing to extend inwards, very acute pain is commonly felt in the interior of 
the ear, and is augmented by yawning, coughing, mastication, and especially by 
deglutition. Although it is not usual for the patient to complain much of pain in 
the head,— vertigo, a sense of dazzling, and sometimes vomiting, are not uncom- 
mon symptoms. During the period of acute suffering, the gait is staggering, like 
that of a person in an early stage of intoxication. All these symptoms suddenly 
disappear on a discharge of blood taking place from the polypus. It might be 
supposed, that as the cause is permanent, so the effects would be constant; but, 
whether' from the gradual yielding of the parts upon which pressure is made, or 
the influence of habit, this is not always the case; and some degree of deafness 
may be the only symptom of the existence of a polypus. Its pressure may occa- 
sion adhesion between the membrana tympani and the inner wall of that cavity, 
anchylosis of the malleus and incus, &c. At other times, instead of yielding to 
the pressure which the polypus exerts upon it, the membrane bursts, and allows 
the entrance into the tympanum of a portion of the excrescence, which there in- 
creases in size so far as the capacity of the chambers will admit. 

The existence of a polypus may be detected by a careful examination of the 
auditory tube. If it originate upon or near the membrana tympani, pressure upon 
it will occasion acute pain, sometimes vertigo, and lachryraation of the correspond- 
ing eye. On the other hand, in proportion to its distance from the tympanum, 
pressure will occasion but slight local pain. 

Polypi arising from the membrana tympani have generally a larger base than 
others; they are also usually flattened, of a mushroom shape, and granulated upon 
the surface. This latter character, when they have not attained a large size, may 
render them difficult of detection, as they present considerable resemblance to the 
membrane in an ulcerated condition. The ability, however, to impart a slight 
rotatory motion by means of a fine probe, will serve to decide their nature. The 
prognosis will depend upon the degree of change in the tissues on which the 



240 Progress of the Medical Sciences, [Jan. 

polypi grow; upon their point of insertion; their peculiar organization; the size 
of the pedicle ; and the amount of disorder which they may have occasioned in 
the auditory apparatus. 

1st. The polypus being a morbid product, developed in a tissue itself altered; 
it will be understood that the prognosis will vary with the cause of this aheratioii 
and the constitution of the individua], 

2d. The case has a more unfavourable aspect when the polypus arises upon or 
near the membrane of the tympanum. 

3d. Considered separately, soft and spongy polypi are less serious than those 
of a firmer tissue ; the first easily yielding to any resistance, whilst those of the 
second class, by their pressure, may occasion severe sulfering. But viewed with 
reference to their cause, spongy and bleeding polypi have a more gTave character, 
indicating, according to the observations of Sturd, a cachectic state of the consti- 
tution. 

4th. The larger the base of a polypus, the more difTicuIt is its removal, and the 
more probable its return. If a polypus with a large base originate upon the mem- 
brana tympani, it almost always occasions the destruction of the membrane, and 
sometimes the loss of the chain of bones. 

5th. Still more serious results may be produced by the excrescences. If so 
large as to compress the w^alis of the tube, they may give rise to ulceration of the 
mucous and subjacent tissues, exposure and caries of the bone. If the discharge 
of the secretion be prevented, it will accuniulate in the tympanum, and seek an 
exit by the FAistachian tube or the mastoid cells; thus producing inflammation 
and suppuration in the latter sitaation. The inflammation may extend to the parts 
in the licighbourhood of the ear; the parotid maybe implicated, and by com- 
pressing the nerves w^iich traverse it, occasion excruciating pain in the side of the 
face, paralysis of the fascial nerve, &c. Conjoined with these painful symptoms^ 
there may*^be vomifing so obstinate that even the simplest food is rejected. 

In addition to these sufferings and dangers, the pent-up secretion may penetrate 
into the internal ear, and inflammation may be propagated from this part to the 
brain or its membranes. Under these circumstances, the disease may prove 
quickly fatal, if relief be not afforded by the extirpation of the polypus, or by 
dilatation and catheterism of the Eustachian tube. 

Treatment. — As soon as the existence of the polypus has been ascertained, some 
operative procedure should be determined upon. The surgeon may choose re- 
moval by avulsion, the ligature, cauterization, or the knife. 

When the polypus has a narrow pedicle, and is inserted into the walls of the 
tube, no matter at what depth, avulsion may be employed with advantage ; but to 
avoid the inconveniences attending powerful traction, w hen the pedicle is resisfing, 
it is advisable to combine traction and torsion. This method is less painful, and 
less likely to occasion hemorrhage than avulsion. If the polypus arise from the 
merabrana tympani, this procedure will be obviously inapplicable in the majority 
of cases. After the removal of the polypus, the bleeding may be allowed to con- 
tinue for ten or twelve minutes, and after syringing out the canal, the remains of 
the pedicle should be touched with the nitrate of silver;— this cauterization may 
be repeated in a few days, if the first has not proved effectual. 

The ligature is useful in the same class of cases as the preceding mode of treat- 
ment, but it has the advantage of being applicable to polypi arising from the 
membrana tympani. It is requisite, however, for its successful employment, that 
the polypus be small, or the canula containing the ligature cannot be introduced. 
The peculiarity of the instruments recommended by M. Bonnafont consists in their 
being exceedingly delicate. 

Cauterization is almost useless in bringing about the removal of large polypi, 
but it is very serviceable in destroying that portion of the pedicle which the other 
methods have failed to remove, and also in opposing the reproduction. The most 
useful caustic is the nitrate of silver. 

M. Bonnafont resorts exclusively to excision, or the ligature, for all polypi 
springing from the membrana tympani, and, wherever it is possible, he prefers 
the former. — Lond. Med. Gaz.^ Aug., 1845, from Bulletin de F Academic, 1845. 



1846.] - Midwifery, 241 



MIDWIFERY, 

59. Placenta PrcBvia—Extr action of the Placenta before ihe Child. — In our No. for 
April, 1845, (p. 504J we noticed the recommendation of Prof. Simpson to extraci 
the placenta before the child in certain cases of placenta praivia, and in our No. 
for July were given some statistical data collected by Prof. Simpson^ which seem 
to sanction the adoption of such a course. 

More recently, in an interesting paper in the London and Edinburgh Monildy 
Journal^ March, 1845, Dr. Simpson has given the statistics of 141 cases of placental 
presentation, in which that body was expelled or extracted before the child, only 
10 of which were followed by the death of the mother, while of 399 cases of 
placenta prajvia. treated in the ordinary metliod, 115 proved fatal. 

Dr. Thomas Radford also advocates this practice, (see No. for April, p. 505). 
Much attention has been drawn to the subject by the papers just alluded to, and 
a number of cases have been brought forward in the recent English journals, 
confirmatory of the propriety of the plan of treatment under consideration. Some 
of these we shall briefly notice, 

Mr. W. C. Wilkinson records, in the Provincial Medical and Surgical Journal., 
(July 23, 1845,) the case of a woman to whom he was called on the 7th of June. 
He learned that she was between 6 and 7 months advanced in pregnancy; that 
three weeks before the patient had great hemorrhage, which continued more or 
less up to the time of Dr. W. seeing her. On the 7th it became excessive. Dr. 
W. found the os uteri dilated to the size of something less than a five-shilling 
piece; the placenta presenting; the hemorrhage excessive; the pains very feeble; 
she was greatly exhausted; the pulse scarcely perceptible; the countenance 
blanched, and Dr. W. felt that she must sink. Dr. W. directed some brandy and 
w^ater to be got down immediately, and also a scruple of ergot of rye. He 
passed first three fingers, and, with as little delay as possible, the whole hand 
into the uterns; the gush of blood was at first great; the placenta, however, was 
quickly and completely detached, and the hemorrhage almost at once ceased. He 
waited awhile with his hand in the uterus; he then brought away the placenta, 
and immediately re-introduced his hand with a view of bringing on contraction. 
The head of the child presented; he turned; but feeling that his patient was not 
in a state to bear immediate delivery, he waited an hour and a half; she then 
having somewhat rallied, he delivered. She remained during the first two or 
three days in a most exhausted state, from which, however, she gradually recovered. 
Dr. W. feels satisfied that had the usual plan been adopted in this case, so 
great had been the hemorrhage previously to his seeing the patient, that she must 
have sunk. 

Mr. Tennent relates in the same journal a case of placental presentation, in 
which the placenta was spontaneously expelled before the child. The patient in 
this case was seized with flooding at the seventh month of pregnancy, which 
recurred at intervals of some days until considerable anxiety was felt for the 
result. On the placenta, however, becoming detached the hemorrhage ceased. 
The patient recovered without any bad symptoms. 

Mr. H. E. Walker, of Chesterfield, records in the same journal, Sept. 3, 1845, 
the case of a woman in labour with her sixth child, whom he saw four hours after 
labour had commenced, and found her in a most alarming state of exhaustion 
Flooding had come on soon after the accession of labour pains, and continued 
unabated, the quantity increasing with each pain. On making an examination, Mr. 
W. found the vagina filled with clotted blood, the os uteri fully dilated, and a large 
porfion of the placenla presenting, nearly closing the orifice of the uterus. With 
some ditficulty he passed his finger round the anterior edge of the placenta, to 
ascertain the presenUng part of the child, and felt what he thought was either a 
shoulder or the nates. The attempt increased the hemorrhage slightly, and 
fearful of further reducing the already too exhausted powers of his patient, he 
desisted. Having previously determined to adopt the plan of treatment lately 
brought before the profession by Drs. Radford and Simpson, he proceeded to 
remove the placenta. Introducing his left hand, he completely and in one mass 



243 Progress of the Medical Sciences, [Jan. 

separated the placenta^ which was immediately expelled with his hand into the 
vagina; alter its complete removal, the hemorrhage, which before was con- 
siderable, entirely ceased. At this time the pains were feebi6} and not of frequent 
occurrence. At his next examination he found that a hand had followefl the 
placenta, and now" presented at the os externum. With the usual precautions, 
version was easily accomplished and the woman safely delivered of a still-born 
child. The uterus contracted with tolerable firmness, and no further hem.orrhage 
supervened. On the day following he found his patient was comfortable, though 
suffering slightly from the effects of the hemorrhage^ and in a few days she was 
perfectly recovered. 

Mr. T. M. Greenhow, of New^castle-upon-Tyne, records in the same journal, 
(Sept. 10,) a case of placenta prsevia, in which the separation of the placenta 
from its vascular connections with the uterus was, in two labours, successful in 
checking the hemorrhage. 

The subject of this case, Mrs. L., w^as 44 years of age, has had 13 children, all 
excepting the first born at 7 months; three only are living. Excepting the first, 
nearly all were preternatural presentations, many of them placental, w^hen pro- 
fuse hemorrhage took place, demanding immediate delivery by turning. 

In February 1844, the placenta w^as found consideral)ly separated, the breech 
presenting behind it, the discharge excessive, and the patient much exhausted. 
By introducing the finger within the os uteri, and making a circular movement^ 
the placenta w^as altogether detached from its connection with the uterus, and 
withdrawm: the hips of the fcetus soon followed, and dehvery w^as rapidly com- 
pleted. No further hemorrhage took place, and the patient recovered well, with 
the exception of an attack of phlegmasia dolens, which yielded to appropriate 
treatment. 

On the 13th of May, 1845, w^hen in the sixth month of pregnancy, hemorrhage 
to some extent took place, attended wdth shivering and sickness; a recurrence of 
the same symptoms at uncertain intervals, until the completion of the seventh 
month, with, on one or two occasions, great discharge of florid blood. 

July 1st. Labour pains came on, with mtich hemorrhage; the placenta was 
found separated to a considerable extent, and protruding at the os externum. The 
finger w^as introduced, as on the former occasion, and the connection of the pla- 
centa w^ith the uterus completely destroyed, when all hazard of further discharge 
was etTectually prevented. The head was found at the brim of the pelvis, 
accompanied by a hand of the fcetus. Uterine action ceased for a wdiile, but soon 
returned with considerable power; at first the hand showed a tendency to advance 
and the head to recede, but by carefully pressing the hand back during the pain, 
the head soon descended so as to occupy the cavity of the pelvis. It was, how- 
ever, accompanied by the hand, which could not be entirely pushed back, 
although, by the efforts made to prevent its advance, the shoulder was probably 
prevented from occupying the brim of the pelvis instead of the head. 

The pains increased in force, and in about an hour after Mr. G.'s arrival the de- 
livery w^as completed. The ovum came aw^ay entire, except that the membranes 
had been lacerated at one side, and the liquor amnii discharged. The preparation 
show^s the placenta in advance of the head; the arm retains the position it occu- 
pied during birth, by the head of the fostus; the funis is twisted round the chest 
and neck, and the low^er extremities remain enveloped in the membranes. 

July 3d. Patient going on well; no inordinate discharge followed delivery. 

29t'h. Recovered well; in her ordinary health. 

Mr. Jones states, {Lancet, 27th Sept., 1845.) that he was summoned on the 
14th March to a poor woman in labour Mith her sixth child, who had been flooding 
for four hours. He found her in a most precarious state from exhaustion, almost 
speechless, &c. Having rallied her with twenty drops of tincture of opium com- 
bined w^ith weak brandy and water, he proceeded to make an internal examina- 
tion. Before he could exactly ascertain the state of the parts, he was deluged 
with a frightful gush of blood. The cs uteri was fully dilated, the membranes 
entire, the presentation of the head natural ; and the placenta covered nearly 
two-thirds of the os uteri. The hemorrhage persisting, and there being now 
considerable uterine pains, he, without the least difficulty, insinuated his fingers 
between the adherent portion of the placenta and the uterus, and in less than a 



1846.] " Midwifery. 243 

minute the latter was freed from the placenta. He now administered a full dose 
of the tincture of ergot, which brought on strong expulsive pains, and the woman 
was delivered of a still-born child in one hour and thirty-five minutes after 
his entering the house. After the placenta had been extracted, he does not think 
she lost altogether more than a teacupful of blood: she recovered as soon as 
females generally do after an ordinary labour, excepting that she continued 
unusually weak for a considerable time, as was to be expected after the great loss 
of blood. 

The Northern Journal of Medicine (August, 1845,) contains a case of placenta 
prsevia treated successfull}^ by extraction of the placenta before the child, com- 
municated by Dr. John Maclean, of Edinburgh. The patient was the mottier of 
seven children, 37 years of age, who was taken in labour about four o'clock, P. 
M., June 18th. About three o'clock the next morning the pains were accompa- 
nied with hemorrhage. When seen by Dr. M. at 12j o'clock, he found the os 
uteri dilated to the extent of a half crown, the placenta presenting and protruding 
through it about one and a half inches. The hemorrhage, which had recurred 
with the pains, had caused such a degree of faintness and collapse, that the fatal 
termination of the case appeared inevitable ; and the pains, which now came on 
frequently, from the great weakness of the patient, had but little effect in dilating 
the OS uteri and advancing the labour. 

The child having been ascertained by the stethoscope to be dead, and the 
"mother alone therefore requiring immediate attention, and the state of collapse 
to which she M'as reduced renderina" forced delivery by turning exceedingly dan- 
gerous, whilst the evacuation of the liquor aranii had entirely failed to moderate 
the hemorrhage, it was determined to endeavour to suppress the discharge bj 
separating the whole body of the placenta from the uterine parietes, when the 
patient might be allowed to rally a little before removing the child, supposing 
the views of Dr. Simpson to be correct. Accordingly, having administered a 
small quantity of spirits with a few drops of laudanum to the patient, Dr. M. imme- 
diately introduced his hand into the v,^omb so as to remove the placenta. This 
he was easily enabled to do, afier dilating the os uteri, by pressing down the 
placenta, with the fingers introduced behind it into the palm of the hand. A few 
minutes were sufficient to effect this; and all hemorrhage ceased as soon as the 
whole placental mass was detached. The placenta being carried down into the 
vagina, a dose of ergot was administered, and in about a quarter of an hour the 
natural pains expelled the child. There was no after hemorrhage, and only slight 
lochial discharge. 

The mother recovered without the slightest drawback, and was out of bed in a 
few days. 

The following case is related by Mr. J. C. Parker, in the Provincial Medical and 
Surgical Journal, Sept. 24th, as tending to confirm the propriety of the rule of prac- 
tice advocated by Prof. Simpson. 

Mr. P. was sent for to a woman in labour with her second child, and learned 
that she had been suffering from hemorrhage about a fortnight previous, which, 
after confinuing a short time, had suddenly ceased ; that it had again recurred 
about four hours before Mr. P.'s arrival, and had ceased after continuing about an 
hour, accompanied by active labour pains. 

On making an examination, to his astonishment he found the placenta lying on 
the bed, completely expelled from the vagina, and about two inches of the umbi- 
lical cord also protruded with it; the arm of a full-grown foetus was also present- 
ing and protruded from the vagina as far as it could. There was not the slightest 
hemorrhage; there were regular pains ^t short intervals; the patient complained 
of feeling faint and weak; she had a small quick pulse. After giving her a full 
opiate in a little warm brandy and water, Mr. P. slowly and cautiously introduced 
his hand, got one foot, and with little comparative difficulty, turned; the delivery 
was soon effected ; there was not the slightest hemorrhage, and the patient reco- 
vered without one unfavourable symptom. 

Dr. Steuman mentioned to the Medical Society of London, (Lancet, Oct. 25, 
1845,) that he had met with three cases of placenta proevia in which the pla- 
centa was discharged by the natural parturient efforts, and in each the hemor- 
rhage had immediately ceased. 



244 Progress of the Medical Sciences. [Jan. 

Dr. Lee, in some articles publislied in the London Medical Gazette, strongly 
opposes the propriety of the practice, recommended by Prof. Simpson in certain 
cases of placenta praivia, and asserts that the statistics given by the Professor 
represent the maternal mortality under the old treatment as much greater than 
it really is, and he presents some statistical tables in support of his statement. 
The accuracy of these tables is, however, contested by Prof. S. and a contro- 
versy is now going on between them in relation to it. 

Dr. AsHWELL (London Medical Gazette, 'Nov. 7th, 1845). also states that he is 
persuaded that Dr. Simpson's rate of maternal fatality in placental presentations 
is far too high, and he urges the limitation of the practice, which he fears has far 
more of novelty than of safety for its recommendation. It is but justice, how- 
ever, to Prof. S. to say that he does not press its adoption in all cases of placenta 
prasvia. The subject is one of great interest and we may recur to it in a future 
Number. 

60. Perforation of the Cervix Uteri hy the foot of the child occurring during Parturi- 
tion. — Thomas Williamson, M. D.^ of Leith, records in the Northern Journal of 
Medicine for Sept. last, an example of this extremely rare accident. 

The subject of the case was a female, 19 years of age, who was seized with 
regular uterine pains on the morning of the 15th May. Examination enabled Dr. 
W. to discover the os uteri dilated to about the circumference of a half-crown 
piece, with a thin and yielding margin. The left foot presented, and not\i'ith- 
standing the previous escape of the liquor amnii, was still fully retained within 
the uterus. 

For about an hour and a half previous to Dr. W.'s second visit, the pains had 
been recurring every five minutes, but w^ere by no means severe. He had not 
been above twenty minutes in the house, and certainly not more than a quarter 
of an hour elapsed from the period of his second examination, when the patient 
was seized with three strong and remarkably violent pains, following each other 
in close succession. 

From the character of these pains, Dr. W. was induced to make a third exami- 
nation. His surprise was very great at finding the change which had taken place. 
Instead of the left foot being still witldn the uterus, and fairly placed for exit through 
the OS, as formerly, he now found that it had effected a complete passage through 
the substance of the anterior section of the uterus, about an inch from the margin of 
the natural orifice. In fact, not only had the foot passed through this oblique rent, 
but the whole leg up to the knee : the limb to this extent lying in the vagina. No 
hemorrhage resulted. 

Scarcely had he time for deliberating as to the proper mode of procedure under 
these circumstances, ere another pain, as violent as the three preceding, forced 
the foot, leg and thigh, beyond the external parts, carrying with them a thick band 
of uterine substance, formed by the tissue between the natural and preternatural 
openings. 

Dr. W. found himself called upon to adopt some immediate step for the safety 
of the patient. The thigh was riding as it were over this thick uterine band, and 
he was not without much apprehension that, should another labour-pain of similar 
violence with the preceding supervene, one of tv/o effects would inevitably result; 
either the thick band of uterine fibres would give v/ay, or, more likely, the rent 
would extend through the uterine wall and peritoneum. The former termination, 
as the least of tw^o evils, he was now determined to anticipate (provided uterine 
action should supervene), by at once cutdng through the tight encircling band. But 
tlie immediate performance of this operation was rendered unnecessary by the 
suspension of uterine action. 

The cessation of labour-pains favouring the undertaking, Dr, W. returned the 
protruding member through the lacerated opening, and brought the foot through 
the proper os uteri. Shortly thereafter the ulerus again commenced to act. and in 
iitde space of time the body was delivered of a living child. 

61. Supposed Fatal Effects on the child of the Ergot of Rye. — Prof. Beatty, in an arti- 
cle in a recent No. of the Dublin Medical Press, stated "that when deliver)-- was 
not accomplished within two hours from the exhibition of the ergot of rye, the 



1846.] Midwifery. ' 245 

child's life was generally lost," and this statement has been since reiterated by Dr. 
Hardy, m a paper read before the Dublin Obstetrical Society, and published in the 
fifth No. of the Dublin Hospital Gazette, In the 17th No. of the last- mentioned 
Journal, Mr. J. Pratt relates several cases which disprove the above statement. Lu 
one case three hours elapsed between the taking of the medicine and delivery ] 
in another five hours, in another three hours and a half, and in a fourth case six 
hours, and all fine healthy children were born. 

62. On the Contagious Effects of Puerperal Fever on the male subject : or on persovs 
not child-bearing. — Robert Storrs, Esq., of Doncaster, in a highly interesting 
paper on this subject read before the Sheffield Medical Society, and published in 
the Provincial Medical and Surgical Journal^ (May 7th, 1845,) maintains that puer- 
peral fever once set up is again capable of imparting to any person not in the 
puerperal state, by actual contact or close approximation, the following diseases. 

Is. Inflammation of the peritoneum or other serous membranes, accompanied 
by low fever, both in the male and female subject. 

2d. Erysipelas; local, as in the hand or arm, from post-mortem inspections; or 
general, as in the face or person. 

3d. Typhus fever, with its various accompaniments, and in a variety of forms. 

He adduces in support of these propositions the lollowing cases : 

First Proposition. — Inflammation of the Peritoneum and Pleura produced by Puer- 
peral Fever. — Case I. — Wife and Husband. — Ann Richard, aged 25, mother of one 
living child, had had eight miscarriages at the sixth or seventh month, was pre- 
maturely confined at two A. M., on Thursday, October 3 1st. She had two shaking 
fits during her labour, and the surgeon, Mr. Clarke, did not arrive until after the 
birth of the child ; she had very considerable draining discharge during and after 
the labour. On Friday night she complained of pain and weight at the stomach, 
and in the right hypogastric region, increased by pressure, or on taking a deep 
breath. On Saturday morning she was seen by Mr. Stockil, of the Dispensary, 
and seven leeches were applied to the part, a dose of calomel and Dover's pow- 
der was given, and two grains of calomel every six hours. The leeches were 
re-applied on Sunday, the following morning. 

These remedies relieved the pain considerably, and she was considered to be 
doing well. On Sunday evening 1 saw her for the first time, and found her in the 
following state: — Pain and tenderness over the whole of the abdomen, but chiefly 
on the right side; great tympanitis; has had three stools since morning, all of 
them nearly involuntary; pulse 130, and weak; tongue coated, and somewhat 
dry in the middle; mind perfectly quiet; breathing extremely rapid and laborious. 
She was ordered one grain of calomel and one of opium every six hours; a large 
blister over the abdomen; and a desert spoonful of brandy in water every three 
hours. I did not see her again, but understood from Mr. Stockil that she wavS 
better on the following morning; she died, however, on that day, Monday, at five 
P. M., having been barely ill three days. 

Though there had been no cases of puerperal fever in our tov/n for some time, 
I considered this case had so many of its characters that it might prove infecfious; 
I determined, therefore, to avoid all danger of communicating it to others, by dis- 
continuing my visits after the first. I therefore left her under the charge of Mr. 
Stockil, who attended her closely until her death. I did not, however, expect so 
soon to find my prognosticafions of the infectious nature of the disease verified 
as they were; for the husband began with a seizure exactly similar on the Tues- 
day morning, whilst the corpse was yet unburied. He had shivering, pain in 
the right hypogastric region ; great tenderness on pressure : laborious and rapid 
breathing; a quick, soft, and somewhat feeble pulse, between 130 and 140; pain 
on inspiration. He was bled immediately in the arm, to about twelve ounces ; 
blood not in the least buffy ; subsequently, leeches were repeatedly applied to the 
side, followed by blisters. After the bowels were well moved, calomel and opium, 
at frequent intervals, with salines and digitalis; and when in intense pain, an opiate 
draught was given. Great dullness on percussion gradually came on on the right 
side of the chest, and gradual infiUrafion into the lungs; the abdomen was slightly 
tympanific ; the breathing became more and more difficult: and he died on Mon- 
day, at five A, M., having been ill scarcely six days. 



246 Progress of the Medical Sciences, [Jan. 

The effects of these cases spread no further, as e\e\j possible precaution was 
taken. 

Case II. — Daughter and Mother. — I need scarcely detail the case of Mrs. Boyd, 
of Cautle}^, No. 2 of ray series of puerperal cases in 1841. (Provincial Medica.1 
Journal, December 2j 1843^ p. 168 :) suffice it to say, that it was a rapid and malig- 
nant one. 

The mother-in-law of Mrs. Boyd, an old woman of 70, or thereabouts, was 
seized a few days after her daughter's death with intense symptoms of a combina- 
tion of peritoneal and pleuritic inflammation; rapid typhoid and sinking symp- 
toms came on, and she died in three days. Had shebeen young enough, and the 
fever had occurred after child-birth, I should have had no hesitation in pronounc- 
ing it a malignant case of puerperal fever. The efiects of this case spread still 
furdier, as will be hereafter related. 

Case III. — Wife and Husband. — Another case, in which the husband was the 
victim, where the wife had previously died of puerperal fever, occurred in the 
practice of my friend, Mr. .James Allen, of York. The man was seized imme- 
diately on the death of the wife with peritoneal inflammation, with all the cha- 
racteristics of puerperal fever, and died in three days. I have no details of the 
circumstance, as I am not aware that Mr. Allen took notes of it at the time; but 
I have often heard him say how much he was struck with the similarity of the 
symptoms in the male to those of true puerperal fever; indeed he has no doubt 
of the identity of the disease in each case. 

Case IV. — Woman and Friend. — Dr. Paley. of Ripon, in a history of cases of 
puerperal fever, arising from one of gangrenous erysipelas of the scrotum, relates 
the case of a married lady, aged 54, who had been in close attendance on one of 
the fatal cases, who was seized with violent pain in the abdomen, and died, under 
similar symptoms to the puerperal cases, in twenty-six hours after the seizure. 

The circumstance of the seizure of the husband or relatives with the symptoms 
of puerperal fever, at or after the death of the woman, cannot necessarily be of 
very frequent occurrence; but I have no doubt when the secrets of the chambers 
of the dead from this disease are more fully known, that many more melancholy 
histories of a similar nature will be brought to light. (See Nunneley on Ery- 
sipelas.) 

Second Proposition. — The production of Evjisipelas, local or general in the person 
rf the Attendant on cases of Puerperal Fever. Case I. — A few years ago a medical 
friend of mine had a number of cases of fever, and amongst them one had a very 
large abscess in the neck, which required his daily attendance. One evening, 
when engaged in this duty, he vras fetched from thence to attend a lady in her 
accouchement; he wished to go home before he saw her, but her husband would 
r!Ot allow it; he was consequently prevented from changing his clothes, and 
ridding himself of miasma. He however excused himself from wearing his coat, 
under the plea of heat, and was obliged to render the lady immediate assistance. 
The labour terminated favom-ably, and the patient was very well for the first 
twenty-four hours, but after that time she was seized with symptoms of regular 
puerperal peritonitis, of the lowest character. In spite of all the assistance that 
he, (a man of considerable eminence,) and another first-rate practitioner in that 
department, could afford her, she died on the seventh day from her accouchement. 

This lady's maid, who attended her most affectionately through this dreadful 
state, happened to cut her finger, which she brought into use in sponging her 
mistress. The day before her mistress died she was attacked with violent shiv- 
t^ring, &c., &c.; the finger inflamed; the absorbents connected with the wound 
erdarged; she soon became delirious; and in spite of all he could do for her, 
she died on the fifth day from the first shivering fit. 

Case II.— -A Mrs. Manby, who was in close attendance on a woman of the 
name of Briggs, who died of puerperal fever under my care, (No. 3 of my series,) 
was seized with erysipelas of the whole of the cellular texture of the ria'ht side 
of the chest, and with severe pleuritis. She recovered with great difficulty. 

Case III.=— Miss Scothorpe^ the sister of Mrs. Bullas, (No. 6 of my series,) who 
died of puerperal fever, was seized with phlegmonoid erysipelas of the mamma, 
;ind was in a very dangerous state for some time^ but recovered after the forma- 
tion of an immense abscess. 



1846.] Midwifery. 247 

Case IV.— My friend, Mr. Allen, on inspecting a post-mortem case of puerperal 
fever, wounded his hand, and had a severe attack of pustular erysipelas, extend- 
ing up the arm, which endangered his life. 

Case V. — His assistant, in passing a catheter for a female in puerperal fever, 
absorbed some of the poison, and had a severe attack of erysipelas of the hand 
and arm. 

Case VI. — Dr. C — , an American physician, in opening the body of a puerperal 
fever female, w^ounded his hand, and had an attack of erysipelas, with accom- 
panying illness. 

Case VII. — The nurse who laid out the body of No. 3 of Dr. C.'s puerperal fever 
cases, was taken on the evening of the same day with erysipelas and sore throat, 
and died in ten days. 

Case VIII. — Mr. Gregory Sm.ith passed his hand into the uterus of a woman, 
in the dissecting room of the Windmill Street School, who ha.d died of puerperal 
fever; he was seized wath severe pain afterwards, and his hand was covered with 
erysipelatous inflammation and pustules. 

I w^ould not willingly enter into tedious details, and shall therefore consider that 
I have said enough already, to satisfy the unbelieving of the effects of puerperal 
fever in producing erysipelas; but, did I require further evidence, I w^ould adduce 
the immense number of cases of erysipelas of the navel and genitals, occurring 
in the infants of those dying of the disease, a fact which goes far to prove the 
power of puerperal fever to reproduce the disease from which it had been pre- 
Tiously propagated, (erysipelas,) and also in generating a poison, Vv'hich, accord- 
ing to the condition of the part affected, and other circumstances, may be either 
erysipelas of the hand, of the face or throat, or of the navel and genitals, as the 
case may be; or it may be one bearing a most close resemblance to puerperal 
fever itself, both in its seat, symptoms and fatality .*= 

Third Propositiotm. — Typhus Fever, ivith its various accGiiipamments, produced hy 
Puerperal Fever. — To complete my proposition of its production of a disease simu- 
lating itself, of erysipelas, and of tj'phus, I will now relate some cases of ordinary 
typhus which I have seen arising from puerperal fever. 

Case I. — Mrs. Ridge, the sister of Mrs. Downes, (No 1 of miy cases.) was 
seized immediately after the death of the latter with typhus fever, and was in great 
danger. 

Case II. — Mrs. Lockwood, who attended the case No. 2 of my series, and her 
mother, (both fatal,) was immediately attacked with typhus, but recovered. She 
w^as ill at her own home. Her son was also seized with typhus, and had a tedious 
recovery. There were no other cases of typhus in the village at the time. 

Case III. — The nurse of Mrs. Manby, the person who suffered so severely from 
erysipelas, after attending No. 3 of my series, was seized with typhus, and died. 

Here we have a complete chain of disease and death in four persons in one 
month, fairly traceable from one to the other, viz. : — Mrs. Richardson, the person 
from whom I suppose all my cases arose, had gangrenous erysipelas. I con- 
veyed the poison from her to Mrs. Briggs, No. 3, as above stated; she died. Mrs, 
Manby, Mrs. Briggs' friend and neighbour, was immediately seized with ery- 
sipelas and pleuritis, but recovered. Mrs. Manby's nurse was a few days after- 
wards obliged to be sent home from an attack of typhus fever, under which she 
died, long before Mrs. Manby had recovered from her attack of erysipelas. 
Plence, there seems to be the strongest reason to believe that a poison was gene- 
rated by the gangrenous erysipelas, which was capable of passing through the 
bodies of others, and of producing this or that form of disease, to which unknown 
conditions of their respective systems rendered them liable,-— sometimes general 
or constitutional disease, and sometimes local disease, with more or less of con- 
stitutional symptoms, guided in sopie degree by the niode of its production, whe- 
ther of actual contact, of intermediate contact, or of close approximation. 

Mr. Nunneley, of Leeds, I believe, considers the diseases of puerperal fever 
and erysipelas to be identical; and so far as they seem to arise from the same 

* See Nunneley on Erysipelas, article Puerperal Fever, a book which, though not 
professedly written on the latter subject, contains mure information respecting its 
true nature, causes and consequences, than any I have met with. 



248 



Progress of the Medical Sciences. 



[Jan. 



animal poison, I think a review of the cases above related will corroborate his 
opinion. But Vv'hether we can consider diseases so dissimilar as they appear to 
be, as differing from each other only from the texture of the body affected Ijy them, 
I leave others to judge, for though the poison may be the same, the varieties 
of the disease produced by the condition of the party affected by it, by the con- 
stitution of the patient, by the strength and severity of the poison, and by many 
other circumstances, may be almost as great as in ail those diseases which arise 
from such a source as checked perspiration, derangement of the stomach, or 
from any other single cause, which may produce either cholera, inflammation, or 
diseases of a directly opposite nature, according to the predisposition of the party 
affected. 

The certain knowledge, however, of the capability of one or other of these 
diseases affecting the persons of the nurses or attendants may lead to many bene- 
ficial prophylactic means; for not only may puerperal fever be prevented, by a 
knowledge of its origin, from erysipelas, or from typhus, but typhus and erysipelas 
may also be in some measure prevented from arising in the persons of those who 
are in attendance on fatal puerperal cases^ by the various precautions which a 
knowledge of the danger would inculcate. 

63. Abdominal Supporter. — Dr. Edward Rigby describes (Medical Times, Se^t. 13, 
1845), an abdominal supporter, which he has been in the habit of recommending 
for many years, and which possesses the merit of cheapness and great simplicity 
of construction, and which will, doubtless, in many cases answer all the purposes 
of the costly contrivances used in this country. 

^^ It is generally supposed,'' he remarks, " that a properly adapted bandage, or 
belt, to support the abdomen in cases of prolapsus or advanced pregnancy, is a 
comfort which is unattainable by a poor person on account of the expense; but so 
far from recommending any of the elaborate pieces of workmanship which are 
made for that purpose, I have generall}^ found that, independently of their costli- 
ness, they were not only uncomfortable from their thickness and consequent 
warmth, but failed in the main object of supporting the abdomen. I have for many 
years been in the habit of recommending to my patients a belt, which they can 
make themselves with the greatest ease, and the cost of which is so trifling as to 
be within the means of the poorest hospital patient. The annexed diagram gives 
a representation of it; the material is either linen or calico, and therefore may be 
worn at all seasons without inconvenience. 




aa. The lower edge sloped so as to fit closely into the hollow of each groin. 

bb. The upper edge. 

cc. The ends of the belt furnished with eyelet holes for the purpose of lacing be- 
hind. 

dd. Wedge-shape portions cut out for the purpose of contracting the lower mar- 
gin, and thus making it sit closer into the hollow of the groin. 

e. A thin strip of whalebone running down the centre, so as to keep it quite smooth, 
and prevent the lower edge from sucking. 

64, Kyesteine as a Sign of Pregnancy.— -Ohsevvaiions have been made by MM. 
MoLLER* and KleybolteI on the value of kyesteine in the urine as a sign of 
pregnancy. Tire former gentleman does not attach much importance to it, since 



Casper's Wochenschr., Jan. 11-18, 1845. 



I Ibid., April 26, 1845. 



1846.] Midwifery. 249 

he found a very thin pellicle of it in the urine of two women who were not preg- 
nant. In another case in which a woman was pregnant no kyesteine was formed 
in the urine, while the person was suffering from a cold which was attended with 
a large deposit of lithic acid, but it re-appeared on the urine again becoming 
natural. Irom ten observations on pregnant women M. Kleybolte arrives at con- 
clusions favourable to the importance ot kyesteine as a sign of pregnancy; but he 
has not examined the urine of other persons, and is therefore unable to say whe- 
ther it may not be formed independent of the existence of pregnancy. — Dr. West's 
Report on the Progress of Midwifery in Bnt. and For. Med. Rev., Oct. 1845. 

65. Fatal Vomiting during Pregnancy. — Dr. Ciiailly {Bull. Gen. de Thcrap., Oct. 
30, 1844) relates the particulars of three cases of vomiting during pregnancy, which 
proved fatal by its severity. In the first case the patient died hi the 14ih week of 
utero-gestation ; and vomiting, unattended by fever, had existed for three months. 
There was no lesion of the stomach, but "evident inflammation'" of the decidua. 
In the second case, death took place at the same period, and obstinate vomiting 
had existed from the very beginning of pregnancy. Very slight lesions were 
found in the stomach, but there was sanguineous engorgement of the decidua and 
of the uterine tissue, with softening and thickening of the uterine parietes. In the 
third case death took place at four and a half months, the patient being then in a 
state of complete marasmus, from vomiting, which had existed for two months. — 
Ibid. 

66. Tivin Labours — Complete Suspension of Uterine Action between Birth of two Chil- 
dren. — Dr. Pfau"^ relates a case of twin labour in which there was complete sus- 
pension of uterine action for seven days, between the birih of the first and second 
child. A similar case, but in which the interval was thirty-two days, is recorded 
by Mr. Irvin;t and a third is related by Dr. Wildberg,t- in which it extended to 
two months. In this last case no milk was secreted till after the birth of the 
second child; when it at once became very abundant. — Ibid. 

67. Extreme Obliquity of the Uterus. — Two cases of extreme obliquity of the uterus 
are detailed by Dr. Pellegrini and Dr. Bresciani di Borsa.\^ In the former case 
the abdomen was so pendulous that the uterus rested on the patient's thighs. De- 
livery was effected by turning, but the woman died of metro-peritonitis on the 
fourth day. In Dr. Di Borsa's patient the obliquity of the uterus was lateral, the 
womb hanging like a retort over the right ileum. This malposition was appa- 
rently owing to great deformity of the pelvis, which rendered the Caesarian sec- 
tion necessary^ from which the patient recovered. — Ibid. 

68. Retroversion of the Uterus until the Commencement of Labour.— Dr. De BilliH 
relates the history of a patient whose uterus became retroverted at an early period 
in her second pregnancy, and continued so, attended, as utero-gestation advanced, 

, with very urgent symptoms, unfil the middle of the eighth month. A discharge 
of fluid then took place, and three days afterwards labour-pains came on. Ex- 
ternally the uterus seemed of natural size and form, but a large round tumour was 
felt between the uterus and rectum, and the os uteri was very high up, tilted five 
fingers' breadth above the pubes, quite beyond the reach of the hand. Notwith- 
standing this misplacement the patient had always voided her urine, though with 
great difficulty. Dr. De Billi reduced the uterus by pressure on its fundus, ex- 
erted through the vagina, while counter-pressure was made externally. The child, 
which presented by the breech, was still-born, but the mother recovered welL 
[This case fully substantiates the accuracy of Dr. Merriman's observations in his 
Dissertation on Retroversion of the Womb, and adds another to the very sm.ali 
number of cases in which the womb has continued retroverted up to the com- 
mencement of labour.] — Ibid. 

* Oesterr. Med. Wochenschr., April 20, 1844. 
j- Medical Times, Dec. 28, 1844. 
t Oesterr. Med. Wochenschr., April 5, 1845. 
§ Archives Gen. de Medecine, Fevr., 1845. 
II AnnaU Univ. di Med., Feb., 1845, p. 312. 



250 Progress of the Medical Sciences. [Jan. 

69. Rupture of the Uterus and Laceration of the Vagina. — References are contained 
in the note to several fatal cases of rupture of the uterus or vagina, all of which 
occurred spontaneously, independent of any manual interference, or of the exist- 
ence of disproportion between the mother and child.* In five of these cases^ 
(those related by Messrs. Rendell, Arnold, Bond and Pavetti,) softening of the 
uterus appears to have preceded the occurrence of the rupture- but in the other 
four it is difficult to assign any cause as having predisposed to the accident. In 
Dr. WagstalT's casef two exostoses on either side of the symphysis pubis appear 
to have caused the accident; in the cases recorded by M. Laborie and Professor 
Trefurtjt- the uterus gave way during the operation of turning, and in the instances 
related by Dr. Fahnestock and Dr. Feldraann,'^^ the child was hydrocephalic. In 
these cases likewise the patient died. Drs. Briihl, Majer, C. H. Kiihn, Graus and 
Morgan II have detailed cases of recovery after alleged rupture of the uterus. Dr. 
Briihl's case is not very clearly reported; but it appears that the treatment adopted 
by him as well as by Dr. Majer was decidedly antiphlogistic. The injury in Dr. 
Major's case consisted in laceration of nearly half of the vagina from the cervix 
uteri : but the rent healed speedily, and the patient left her bed in four weeks. In 
Dr. Kiihn's case some of the symptoms of ruptured uterus having occurred, he 
nevertheless administered the ergot of rye, and repeated it at intervals during 
eight hours. At the end of that time the child passed into the abdominal cavity, 
on which he performed gastrotomy, and having removed the child, the woman 
recovered without any very grave symptom. M. Graus's case is a still more 
extraordinary instance of recovery after the most unwarrantable interference, such 
as injecting iiuid into the abdominal cavity through the laceration in order to favour 
the escape of pus. It is by no means clear that Dr. Morgan's was a case of rup- 
ture of the uterus ; no sign of rupture occurred during labour, and when seen by 
Dr. Morgan, thirty-six hours after delivery, the patient was suffering from consti- 
pation of ten days' standing, and indications of abdominal inflammation. Blis- 
tering the abdomen, the use of calomel and purgatives, were succeeded by 
amendment, though the uterus continued large, hard and painful. Ten days after 
delivery violent hemorrhage occurred per vaginam, and after the lapse of another 
seven days the feces began to pass by the vagina, and continued to do so for thirty 
days. The patient gradually recovered. — Ibid. 

70. Uterine Hemorrhage. — M. Loir and Mr. Thompson'^ both record a case of 
fatal internal hemorrhage, occurring before the birth of the child. In M. Loir's 
case the symptoms of faintness, exhaustion, &c., occurred in the seventh month 
of pregnancy, and were almost unattended with uterine action. The os uteri waa 
undilatable, and delivery was effected by incising it, and extracting the child. 
The patient soon died; and on a post-mortem examination the placenta was found 
detached at its centre by an immense effusion of blood between it and the uterus. 
Mr. Thompson's case closely resembles the preceding in the sudden accession of 
faintness, and the almost total absence of uterine action. The patient died unde- 
livered, the placenta being completely detached from the uterus, and an immense 
effusion of blood having taken place between the membranes of the ovum and 
the womb. In neither case was there the slightest escape of blood externally. 
[Cases similar to the above have been collected by Baudelocque in his essay on 
this subject, and are referred to by Velpeau, Traite dcs Accouchemens, tome ii, p. 88; 

* Rendell, Med. Times, May 4, 1844; Arnold, Prov. Med. and Surg. Journal, July 
24, 1844; Wright, Boston Med. Journal, June, 1844; Elkington, Prov. Med. and Surg. 
Journal, Sept. U, 1844; Griscom, New York Journal of Medicine, May, 1844, Adler, 
Neue Zeitschrifif. Geburt^k. Bd. xvii,Heft 1; Bond, American Journ. of Med. Sciences, 
Jan. 1845; Pavetti, Gaz. des Hop., 14 Juin, 1845. 

f New York Journ., May, 1844. 

i Gaz. des Hop., July 20, 1844; Abhandiungen, etc, p. 301. 

§ New York Journal, May, 1844; Med. Zeitung, No. 10, 1844. 

!| Casper's Wochenschrift, 18 Mai, 1844 ; Schmidt's Jahrb. Bd .xliii, No. viii, p. 47 ; 
Oesierr. Med. Wochenschr., Oct. 12, 1844; Dr. Ranking's Retrospect, p. 168; and 
American Journal of Medical Sciences, April, 1845, p. 521. 

1 Revue Medicale, Aout, 1844; Med. Gaz., Nov. 29, 1844. 



1846.] Midwifery, 251 

a case is likewise mentioned by Mr. Crowfoot, in Ed. Med. and Surg. Journal, Oct., 
1824; and another by the late Dr. Ingleby in his Lectures. — Ibid. 

71. Puerperal Fever. — M. Botrel describes {Archives Gen. de Med.., April, May, 
June, 1845) two epidemics of puerperal fever which prevailed in the city and 
hospital of Rennes, in 1842 and 1844. He proposes for the disease as he observed 
it, the name of angioleucite uterine, since it was characterized by inflammation of 
the uterine lymphatics without any affection of the veins. The blood presented 
various deviations from a healthy condition, and purulent deposits in the lungs 
w^ere by no means unusual. He believes that it depended on atmospheric causes, 
especially on dampness and highly electric conditions of the air, but rejects, though 
scarcely on adequate grounds, the influence of deiicient ventilation in its produc- 
tion, as well as the notion of its being propagated by contagion. Its attacks usually 
commenced with violent febrile symptoms, soon follow^ed by a condition of stupor. 
The abdominal pain, at first confined to the uterine region, extended speedily over 
the whole abdomen, and for a short period was very excruciating, but ceased almost 
entirely as the state of depression increased. The prostration of all the powers, 
and the affection of almost all the functions of the body when this typhoid state 
supervened were very remarkable, and terminated, afler a short period, in death. 
Some patients died in 36, others in 40 hours, but the fifth day was the period of 
the greatest mortality. Very few of those who were attacked survived; in 1842, 
only 4 recovered out of 24 who were attacked, and in 1844, only 2 out of 22. In 
those cases in which recovery took place local and general bleeding, purgatives, 
and mercurials were employed, and when these remedies failed to do good, all 
other means proved perfectly useless. — Ibid. 

72. Management of the Breast during Pregnancy. — Dr. Witte {Ncue Zeiischrijl 
filr Geburtskunde, Bd. xvi, Heft. 1, s. 75) has made some valuable practical re- 
marks on the management of the breast during pregnancy, in order to fit it for 
suckling. In cases where the nipple is imperfectly developed, he recomm.ends 
that, after it has been brought into a state of erection by the application of a warm 
sponge, an apparatus should be employed, consisting of a wooden nipple-shield 
perforated at its apex, and fitted to an India rubber bottle, while its inner surface 
is rendered adhesive by the application of some adhesive plaster. This is adapted 
to the nipple when in a state of erection, and the pressure of the hand being 
removed from the bottle a vacuum is at once formed, by which the nipple is 
gradually elongated as surely as by an ordinary breast-pump, and with less dis- 
comfort. The employment of this apparatus must be confinued for five or ten 
minutes daily^ during a longer or shorter period, according to the state of the 
nipple. — Ibid. 

73. Singular Befurmiiy of the Uterus causing the presentation of the child'' s arm in 
three consecutive labours. — We have already noticed two remarkable examples of pre- 
sentation of the shoulder in successive labours, one in six and the other in nine. (See 
Nos. of this Journal for Oct. 1843, and July, 1845.) In the former of these, the only 
anomaly observed, was an unusual width atthe hips. Dr. Lecluyse records in the 
Ann. de la Soc. de Pled. d'Anvers, Feb. 1845, a third case in which the arm presented 
in three consecutive labours. On careful examination he found the uterus instead of 
being pyriform vertically, presented an ellipsoid figure, the long axis correspond- 
ing to the hips. The width of the uterus, or its transverse diameter, was thus 
greater than its height. Dr. L. attributed to this form the horizontal position of 
the farlus; the greatest diameter of the fo3tal ovoid being then in parallelism with 
that of the elliptic cavity of the uterus. 



252 Progress of the Medical Sciences. [Jan. 



MEDICAL JURISPRUDENCE AND TOXICOLOGY. 

74. Prcfessional Confidence. — The 378lli article of the French penal code directs, 
that if medical men and all other persons, depositaries of secrets, either through 
their condition or their profession shall reveal those secrets, (except in cases 
where the law obliges them.) they shall be punished by fine and imprisonment; 
and in another place, it is clearly indicated that the exception has reference to 
crimes that put the safety of the state at hazard. 

On the 7th of December, 1844, Dr. Saint-Pair, surgeon in the French navy, 
was summoned before a judicial officer at Point Petre, in the Island of Guada- 
loupe, and the following questions were put to him. " Are you in attendance on 
M. Giraud, wounded some days since in a duel? Where is the wound situated, 
and for how many days will he be incapacitated from pursuing his ordinary avo- 
cations'?" 

Dr. Saint-Pair replied, that an answer to these questions would elicit facts ac- 
quired in the exercise of his profession, and which, by the terms of the code, he 
supposed he ought not to answer. 

This judge, in his opinion stated, that the 378th article was intended to forbid 
the revelation of secrets, with an intent to defame or injure ; but it did not follow 
that professional persons could be absolved from answering when summoned 
before legal tribunals for that purpose, and when their answers were necessary for 
the preservation of good order and the public morals. That the revealing forbid- 
den in the article certainly could have no reference to information concerning a 
wound criminally received; that Dr. Saint- Pair would, undoubtedly,. not refuse 
answering, if called as a witness in a case of poisoning; that duefiing was now 
also a crime, and not one sui generis, and therefore the fashionable prejudice 
about that practice ought not to be allowed to interrupt the course of the law. — 
He therefore fined the witness 150 francs. 

Some time after, Dr. Saint-Pair was summoned before the court of assizes on 
the same matter, and again objected, but. as it appears, on different grounds, to 
answering. 

The court, on the 29th of January, 1845, decided, that although the general 
principle was correct, that a witness should answer in a court of justice, still in 
the instance of physicians, there ought to be an exception in the case of facts 
confidentially communicated. And although they could not admit the broad 
defence made by the witness, yet as he had testified before the court, that in this 
instance the communication had been confidential, and that he had been secretly 
brought to the wounded person, they would not hear him as a witness. 

From the decision of the Judge ^^ d^ Instruction^^ Dr. Saint-Pair appealed, and 
from that of the court, the king's attorney. 

The Doctor called to his aid a medical association in Paris, to which Orfila, 
Fouquier, Adelon, &c., belong. They caused an elaborate pleading to be pre- 
pared by eminent counsel, and the cause was argued before the court of cassa- 
tion, on the 28th of July, 1845. 

The decision was as follows: — The court is of opinion, that no text of law, no 
principles of justice, or of morals, can absolve physicians from the obligation of 
answering on all matters about which they may become acquainted during the 
practice of their profession, and that hence the Judge of Instruction has properly 
applied the provisions of the penal code. 

But it was very difi'erent when an oath of secresy had been taken, and there- 
fore, as to the second appeal, it was decided, that as it appears from the reasons 
of the court of assizes, that the witness was confidentially introduced to the 
patient, and was sworn to secresy in his medical attendance, the court violated no 
law in refusing to punish him. — Gazette des Tribunaux, July 27, and August 2, 
1845. T. R. B. 

75. Poisoning by Swcinfurt Green, (Scheele's Green). — M. Blandet, communi- 
cated to the Royal Academy of Sciences of Paris, May 24, 1845, a paper on this 
subject. The poison is composed of verditer and arsenious acid, and is much 



1846.] Medical Jurisprudence and Toxicology. 253 

used in staining paper hangings. It produces injurious effects when merely ex- 
lernally applied, and still more severe ones, when the dust or emanations are 
inhaled. Colics, prostration of strength and headache are common. The exter- 
nal application induces pustular eruptions on the skin, catarrh, and a painful 
swelling of the scrotum, preceded by a puffiness of the countenance. This last 
is peculiar to this kind of poisoning. On the other hand, the internal inhalation 
causes bloody stools, vomitings, cramps and delirium. The manufacture of this 
colour, as well as its application to paper, is dangerous. M. Blandet has found 
great advantage from the use of the hydrated peroxide of iron as an antidote. — 
Encydop. des Sciences Medicales. T. R. B, 

76. Poisons administered to the mother, detected in the FcEtus. — At the same meet- 
ing, M. AuDouARD stated, as the result of a numberof experiments, that poisonous 
agents of the class of soluble salts, penetrate to the foetus, provided the mother 
does not die too suddenly. In this last case, the placenta alone is impregnated 
with the poison, or if the fcetus receives any portion, it is so extremely minute, as 
not to be appreciable by analysis. The inference from this, taken by M. Audouard, 
is that when a pregnant female dies from poison, it should be sought for in the 
placenta, the waters of the amnios and the foetus. — Ibid. T. R. B. 

77, Life Assurance. — Liverpool, August 18, 1845. This day was tried before Mr. 
Justice Creswell, the cause of Schwabe, administratrix v. Clift. The plaintiff 
claimed 900/., the amount for which Louis Schwabe's life had been insured in the 
Argus Office. At his death, the office refused to pay, on the ground now pleaded, 
viz : that the party insured had terminated his own life by suicide. 

The facts were the following. The deceased, whose residence was at Plimp- 
ton Grove, Manchester, was a native of Germany and a silk manufacturer, carry- 
ing on his business, which was in a large way, at some distance from his dwell- 
ing house. He was a man who paid much attention to his business, and had 
greatly exerted his mind, which was of an imaginative turn, in the invention of 
new patterns. There had been five policies effected on his life, but so long ago 
as 1836. In 1843 he was observed to be very much excited, and this being 
noticed by his medical attendant, that gentleman remonstrated with him on his 
loo close application to business, and urged his going to the sea-coast for relaxa- 
tion : he went, and was partially benefited. But at one period of 1843, it was 
deemed necessary to place him under some personal restraint, and a man was 
placed in his house to take care of him. He was a very kind and attentive per- 
son to his family, and on one occasion, during the illness of his daughter, had 
watched himself over her night and day, exhibiting, as stated by Mr. Ransom, 
his medical attendant, extraordinary coolness, apparently from the effort which 
he made for the sake of his child. On Tuesday, the 7th of January last, being at 
his place of business in Manchester, he spoke with Mr. Chapel about removing 
some acids, which were employed in the manufacture there carried on. The 
next day, the witness observed him looking at some of the acids in a manner 
which attracted his attention. On the Friday following, the 10th, Mr. Schwabe 
came to Mr. Chapel and asked for some sulphuric acid, of which about half a 
wineglassful was given to him. This was put in a phial, which the deceased 
put in his pocket. At this time, Mr. Chapel remarked something peculiar in his 
look. He seemed wild. But the witness did not apprehend his intention, as he 
was in the habit of making experiments, though he was not considered to be inti- 
mately acquainted with the use of these preparations. It would seem that he 
must have taken the phial into a room at the works, shortly after having received 
the contents, and there swallowed the acid, the empty bottle being discovered 
with a cork, some stains on the floor, and a portion of the acid apparently vomited 
up, after being drunk off. 

The cabman proved, that he was beckoned to by the deceased in Oxford street, 
took deceased up, and observed that he held a handkerchief to his mouth. On 
arriving at his residence, whither he desired to be conveyed, he said something 
to Mrs. Schwabe, in which he M^as understood to say that he had taken poison ; . 
and on Mr. Ransom being called in, though deceased was unable to articulate, he 
gave that gentleman to understand that he had taken sulphuric acid. Mr. Ran- 
No. XXL— January, 1846. 17 



254 Progress of the Medical Sciences. [Jan. 

som enumerated other acids, appealing to him as a man of honour to say, if he 
had swallowed any of the acids mentioned. He shook his head several timeSj 
but finally, when asked if it was sulphuric acid, he nodded his head as if to say 
'• yes."' He lingered until the next morning and then died. 

The case of Borrodaile v. Hunter (See American Journal of the Medical Sciences, 
New Series, vol. vi, p. 242), was animadverted upon by counsel on both sides. — 
In that, however, it appears that the policy contained an exception, "if he should 
die by his own hands." Here the exception was, '■'■if he should commit suicided — 
The Solicitor General, (Sir Fitzroy Kelly,) for the defendants, asked what was 
the meaning of a man ••' committing suicide." If a man was in such a state of 
consciousness that he knew that death ^vould be the consequence of his act, that 
was enough. He did not mean to say, that it would be sufficient, if the poison 
acted by mere accident, as if he were to shoot himself unintentionally. But if 
they were to hear of a man having voluntarily shot himself, or taking poison, how 
would they describe it, but by saying that he had committed '^suicide'?" Here 
the deceased took sulphuric acid and died in a few hours after in consequence. — 
It was then the plain natural meaning of the words, according to plain natural 
interpretation, to call this a case of " suicide," and there must have been some- 
thing else in the language of the policy to show that the words in question should 
be accepted in any different sense. Were it not so, it must happen, by and by, 
that no similar clause of exception in a policy could be effective, for it might be 
argued that, as no man destroying his life can be in his right mind, no such case 
of destruction can be one of suicide. 

Mr. Knowles, for the plaintiff, urged that there was no doubt of the deceased being 
of unsound mind, when he swallov/ed the poison; he was morally and legally irre- 
sponsible. Not that the deceased did not precipitate his own destruction, but that 
being in the state of mind, which had been clearly proved already, he was inca- 
pable of committing an act of crime, and the counsel contended, further, that the 
term '• commit"" did of itself alone imply the doing of something criminally. 

His lordship, after recapitulating the facts, as stated in the evidence, told the 
jury that it was alleged on the part of the defendant, that the policy was void, 
because the deceased had "committed suicide." To make that out they must 
find, first, that Mr. Schwabe died by his own voluntary act, and secondly, that at 
the time he did the act he could teh right from wrong, so as to be a responsible 
moral agent, and to be capable of appreciating the quality of his action. His 
lordship observed that he stated this disfinctly, anticipating that his judgment 
might be disputed. If in this case, the language had been "dying by his own 
hands," the decision, no doubt, would have been in favour of the plaintiff. These 
words were of different meaning from those here discussed. ' The lord chief jus- 
tice had said in Borrodaile v. Hunter, that "suicide" must mean a "felonious 
suicide." His own opinion was that the party must have been a moral agent (or, 
as he subsequently stated, in a state of mind capable of disfinguishing between 
right and wrong), in order to make the policy void. 

The jury almost immediately returned a verdict for the plaintiff, for the full 
amount claimed. — London Pictorial Times, August 23, 1845. T. R. B. 

78. Injury to the VertehrcE and Spincd MarroWj not fatal until seven years after. — I 
do not recollect that the following case is mentioned in the common works on 
surgery. Or that it has found its way into medical periodicals. I copy the princi- 
pal particulars from Dodsley's Annual Register for 1840. 

1840, April 8. W. S. Poyntz, formerly member of Parliament, and aged 71 
years, died suddenly at his house, when at dinner, with convulsive movements 
of the face and hands, the consequence of the want of power in the heart to carry 
on its circulation. This was the result of an injury received in 1833. He then 
fell from his horse on his head when his chin was forced on his breast and pro- 
duced a dislocation of the spine, which was found on the examinafion made by 
Mr. Listen and Mr. Holberton, his medical attendants. Since that accident, he 
had never been so well as before, and during the last two or three years had 
occasionally experienced brief faintings from a total cessation of the heart's action, 
presenting symptoms precisely similar to those which occurred the last time. 
The surgeons found the processus dentatus displaced forwards, diminishing the 



1846.] Medical Jurisprudence and Toxicology. 255 

spinal canal, and consequently the spinal cord, one-third in diameter, just 
below the skull, where the cord begins to meet the brain. It was proved that 
Mr. Poyntz was apparently better than usual on the day of the fatal attack, although 
he was rather depressed in spirits. He had taken nothing unusual, nor been 
from home on that day. He always lived by medical rule. When the fainting 
fits came on, stimulants and dashes of cold water on the face were formerly used, 
but the surgeon directed the former to be discontinued, as they did not lessen the 
duration but rather increased it; and as the attacks were more frequent when the 
stomach was disordered, it was desirable to withhold spirits and medicinal stimuli 
on account of their subsequent injury to the stomach. It is singular that no para- 
lysis or injury of the intellect followed the injury of the spine in 1833. All the 
valves of the heart were healthy, and no unnatural sounds were ever detected in 
the chest. The dura mater was found firmly attached to the skull, and there was 
effusion under the arachnoid membrane. When well, the pulse counted about 
twenty-five or twenty-six in a minute, at other times not more than eiiiht or nine. 

T. R. B. 

79. A Fall or a Bloiv. — Two persons, one, Jacques Charles, the head of a 
family, and the other, a youth, scarcely twenty years old, beardless and of an 
inoffensive character, were drinking with others at an inn in France, when the 
discussion turned on their respective strength. They were merry, but not intoxi- 
cated. Jacques repeatedly dared the young man to a contest. When he had 
done this for the third time they went out alone and both returned in a few 
minutes. Jacques had a severe contusion over the left eye, and there was con- 
siderable swelling. He remarked to one of his companions, ''I have received 
quite a thump." No questions were asked as to the manner in which it had 
happened. The party separated soon after. Jacques returned home, went to bed 
without making any complaint, but the next morning told his wife that he had 
received his death blow. She asked him how, and he replied, "■ in falling." 

Dr. Melet was sent for that morning. Jacques was delirious and could not 
speak. Leeches were applied to the injured part, but he grew worse, and died 
on the 2 2d. The injury was received on the evening of the 18th. Dr. Melet, 
when called, observed no lesion except the swelling on the lower part of the 
frontal bone. The epidermis was not injured. The wound did not appear to 
have been made by a smooth or a rough stone. In either case he supposed there 
would have been a solution of continuity of the skin. Nor could it be from a 
fall, since then the top or the base of the head would first be struck, and thus the 
lower part of the frontal bone would have been protected from injury. Dr. Melet, 
however, considered it equally improbable that so severe an injury could be caused 
by a blow of the fist. 

On dissection, the left eyelid and a part of the front of the left cheek were ob- 
served to be much swollen and of a black colour. A fracture was traced from the 
left eyebrow across the left eye. The inflammafion here induced had extended 
to the brain, and thus caused death. The examiner (Dr. TuefFert) found no 
other mark of contusion. When asked whether a blow with the fist could have 
caused this fracture he replied that it must have been a very powerful one. It 
was possible, that it might have occurred from the deceased falling with great force 
wdth his head foremost. 

The characters of both the individuals concerned were proved to be good and 
not quarrelsome. The prisoner, when arrested, stated that the accident happened in 
this wise. Jacques on leaving the door, jumped at him from behind. He knelt 
down to avoid him, and Jacques fell head first on a stone and the prisoner fell at 
the same time on him. 

After hearing counsel and the charge of the judge, the jury brought in a verdict 
of acquittal. — Gazette des Tribunaux, August 5, 1845. T. R. B. 

80. Rapid Delivery and its bearing on the question of Infanticide. — 1. Mrs. B,, of 
Quebec, aged 30, married, and pregnant with her first child, was seized during 
the night of the 20th with labour pains. Being a refugee from the late fire, she 
occupied part of a garret, in which two or three other families, and some young men 
were sleeping. Feeling a natural delicacy, at being confined under such circum- 



256 Progress of the Medical Sciences* [Jan. 

stances, she suppressed her cries until daylight, when she descended into a lower 
apartment, in which resided a woman who had recently been confined by me, 
to whom she detailed her feelings, requesting, at the same time, that some warm 
water might be given her to " set over," to relieve what she described as a great 
pressure at the lower part of the bowels. She had hardly seated herself upon the 
edge of a rather high chair, when a severe bearing-down pain seized her, and 
before any assistance could be afforded, (although one or two women were in 
the room.) the child was forcibly expelled and fell head foremost on the flooTj 
being killed upon the spot. When Dr. Serrell arrived about twenty minutes after 
delivery, the child; although dead, was still attached by the cord to the placenta, 
which came away shortly after the infant. — Dr. James A. Serrell, of Quebec, in 
British American Medical Journal. 

2. When a pupil, I was engaged to attend a poor Irish woman, well-formed, 
and already the mother of two children. On the day of her delivery, I was request- 
ed to call on her as she thought her confinement was near at hand. Her attend- 
ants said that she was in no pain, but that she appeared uneasy. I found her in 
bed, smiling and expressing a hope that she had not summoned me unnecessa- 
rily, but that as she never suffered much in labour, I would excuse her if she was 
wrong. On examination, I found the head of the child in the upper part of the 
vagina. No sooner was my hand withdrawn and my back turned to speak to 
the attendants, than there occurred one single effort of the uterus and the child 
was born. — J. B. Prowse, Surgeon, Lancet^ July 12, 1845. 

3. February 26, 1823. At about mid-day, I was hurriedly called to the wife of 
a clergyman, in labour with her second child. She had been sewing, and occa- 
sionally reading in the parlour for an hour before, but without suffering any pain 
or uneasiness to lead her to suppose that labour had commenced, when in an in- 
stant she experienced a strong bearing-down pain, which induced her to get up 
and endeavour to walk into an adjoining bed-room. But before she had pro- 
ceeded more than a few yards, another pain threw the infant on the carpet. The 
cord was ruptured near the umbilicus, but fortunately did not bleed from the foetal 
portion. The placenta was partially detached and an alarming flooding en- 
sued. But in the end, both mother and child survived. — Dr. Blacklock, of Dum- 
fries, Lancet. July 26, 1845. 

4. I was sent for to Mrs. M. D., four and a half miles distant. Mrs. D. was 
alone in the house, her husband being absent. She stepped out of the door just 
at dark when she was taken in labour with her second child. She succeeded in 
getting into the door and just at that moment the child was forcibly expelled upon 
the floor, within one and a half minutes from the time she was taken. The cord 
was long, so that it was not broken by the falling of the child. She commenced 
flooding profusely, which alarmed her very much. She immediately seized the 
cord and broke it in two pieces and succeeded in passing through that room and 
entry into her bed- room, where she was found in a few minutes by a small boy 
sent there on an errand and who summoned the neighbours. They found the 
child lying upon the floor where it was born, and the mother on the bed quite 
exhausted. Both mother and child, however, by proper attention, did well. — Dr. 
Larkin, of Wrentham, Boston Medical and Surgical Journal., September 10, 1845. 

5. Ann Pendry, unmarried, and pregnant with her fourth illegitimate child, 
was known to be about ten minutes absent in the water closet. From appearing 
to be weakly on her return, and being seen to wipe her hands in her apron, sus- 
picions were excited, connected with her previous appearance, and an individual 
immediately went to the w^ater closet and saw something dark lying in the soil ; 
on moving it with a stick, he found it was the head of an infant. The girl, on a 
surgeon and her mother arriving, at once declared, that w^hile sitting on the seat 
the pains came on so suddenly that she was unable to get off. 

Before the coroner, the surgeon deposed, that on visiting her she appeared to 
have lost a great deal of blood ] that the internal organs of the child were healthy, 
that air had entered the lungs, although not to their full extent, and that the child 
had been born alive; that under the scalp, under one of the parietal bones, was 
effused half a drachm of blood, and in the bone a fracture, which might have 
been one or two inches in length, that there was no indentation or depression, 
and that the brain and its membranes were uninjured ; that there were no marks 



1846.] Medical Jurisprudence and Toxicology. 257 

of violence, except at the umbilical cord, which was broken an inch and a half 
from the abdomen. The surgeon could not depose as to the cause of death. 

The coroner advised the jury to bring in a verdict of ''found dead, but what 
was the cause of death, there was not sufficient evidence to show," but they re- 
turned " wilful murder." The grand jury, however, ignored the bill. 

Mr. Ryan, who relates this case, adduces several similar ones of rapid delivery. 
Amongst others, one in his own practice of a first child. — Lancet^ June 21, 1845. 

I have brought together these cases, (and of which the records of medicine 
furnish us with many similar examples,) to corroborate the conceded doctrine, 
that the child may be born so rapidly, that the mother, alone and unassisted, can- 
not preserve its life. But its bearing on infanticide is another matter. Guilt 
excites suspicion, and when a female, suspected of being pregnant, denies the 
charge, and when she is seized in labour, retires away from observation, asks no 
assistance, and returns to her accustomed avocations without confession, and then 
the child is found dead, she at least has been guilty of acts of omission for which 
she should be punished. 

The difficulty is mainly in the law. I consider it a moral impossibility to hang 
a female for the crime of infanticide. No jury can be found in England, or this 
country to convict, unless under the most self-evident and atrocious circumstances. 
But the concealment of pregnancy, and particularly of birth, should be signally 
marked by our law-makers. 

After all, what a contrast is there between the conduct of the strumpet and the 
mothers in the above narratives. And why should physicians expend so much 
sympathy on these murderers by omission'? Why did not Ann Pendrycall for 
instant aid, if her story be true 1 T. R. B. 

81. Pulmonary Emphysema as a cause of Sudden Death. — The readers of this Jour- 
nal will find a notice of the labours of M. Prus, on pulmonary emphysema, in 
vol. V, p. 234, and vol. vi, p. 198. Very recently, (September 9, 1845,) M. 
Piedagnel has read a memoir on the same subject before the Royal Academy of 
Medicine at Paris. He considers vesicular dilatation to be a natural process, the 
consequence of the growth of the lung from infancy to manhood. It cannot, 
therefore, be a disease. 

As soon, however, as the vesicles have attained their permanent development, 
a new phenomenon may occur. The walls of the vesicles are torn, and a single 
cavity is produced out of many ; the torn walls are absorbed, and the pulmonary 
tissue, instead of remaining cellular^ becomes areolar. Such is that organization of 
the lungs of old persons, and they are emphysematous. Thus advanced age may 
induce it: so also accidental causes. Cellular emphysema, he is of opinion, only 
happens in the cellular tissue that unites the lobules of the lungs. 

In seven cases of sudden death related by the author, pulmonary emphysema 
was present, more or less, in both lungs. On examining the vascular system, air 
was discovered in the heart and the vessels of the brain, and still in all of this 
description, the symptoms of the complaint had been very striking during life. 

But in three of the above, no symptom of it had been noticed, yet the emphy- 
sema was present as in the others. Here the coats of the vesicles were seen 
ruptured, and cavities were present in the lobules. Air was found in the vascu- 
lar system, as in the preceding. 

M. Piedagnel is hence of opinion, that death in these cases is the result of the 
passage of the air of the lungs into the blood-vessels, and consequently inducing 
fatal effects on the brain. He assimilates it to the sudden deaths produced by 
the passage of air into the veins. 

The conclusions of his memoir are as follows: — 1. There is no dilatation of the 
pulmonary vesicles in what is called emphysema. 2. Pulmonary emphysema is 
the rupture of the coats of the vesicles, in order to increase their size. 3. Cellu- 
lar emphysema occurs only in the interlobular cellular tissue. 4. Pulmonary em- 
physema causes sudden death. 5. These sudden deaths are produced by the 
passage of air into the arterial system. 6. In medico-legal cases of sudden death, 
we should inquire whether the vascular system does not contain air. — Bulletin de 
r Academic Royale de Medecine. T. R, B. 



258 



Progress of the Medical Sciences. 



[Jan. 



STATISTICS. 



82. Statistics of Lower Canada in 1844. — (From a report made to the Legislative 
Council, March 26, 1845.) 

Total population, 693,649 

Ages. 

Total under 5 years . . . 

Between 5 and 10 years - . - 

Do. 10 and 15 years - 

Total under 15 - 
Between 15 and under 21 

Total males of 15 and upwards 
Do. females do. do. 

Total over 15 

Total of all under 15 _ . . 

Total of all over 15 



Males. 


Females. 


66,230 


66,241 


46,490 


46,517 


45,727 


44,586 


158,447 


157,344 


Males married. Females married. 


2,111 


6,705 


Unmarried. 


Married. 


73,783 


112,765 


74,446 


114,508 


148,229 


227,273 


- 


375,502 


Males. 


Females. 


158,447 


157,344 


186,548 


188,954 



344,995 



Leavingr unaccounted for 



346,298 
344,995 

691,293 
2,356 











693,649 




Males. 


Females. 


Total. 




Deaf and dumb 


- 447 


278 


725 




Blind 


- 273 


250 


523 




Idiots 


- 478 


472 


950 




Lunatics 


^ 156 


152 


308 


T. R. B. 



1846.] 259 



AMERICAN INTELLIGENCE. 



ORIGINAL COMMUNICATION. 

Case of suddenly -formed enormous Tumour on the Neck. By Eugene 
Palmer, M.D., of the Parish of St. James, La. (Communicated in a letter 
to Professor Jackson.) — On the 14th of April, 1845, I was called in great 
haste to the convent of the Sacred Heart (where I attend between 200 
and 300 inmates). On being ushered into the Infirmary for the nuns, I 
saw an old lady extended on a couch, surrounded by the priest, the lady 
superior, and several nuns, with her shoulders elevated and her head re- 
chning backwards ; her countenance anxious and pallid; and respiration 
apparently hurried. She had an enormous tumour over the region of the 
thyroid gland, extending out in front of the trachea more prominently than 
I have seen ever in true goitre. The lady superior of the convent, Madame 
Galway, told me in regard to this tumour, that it rose up instantaneously, 
while the patient was in the act of conversing with, and standing directly 
in front of her; that she broke off in the middle of a remark by the cry of 
"Oh! mother, I am suffocating!" and pointed to her neck, when the supe- 
rior observed the above-named tumour rise up on the neck in the space of 
less than a minute. There was no evidence of physical or mental excite- 
ment; the patient is between 50 and 60; remarkable for a calm and bland 
disposition, for uninterrupted tranquillity of mind, and is devoting the re- 
mainder of her life to the instruction of orphan children sent to the institu- 
tion. She was born at Savoy in France, where I believe goitre is not an 
uncommon disease. She stated that there was a partial enlargement of the 
thyroid gland long ago, and that she had been treated in Europe with the 
burnt sponge. She was under my treatment two years ago for a severe 
intermittent fever, when the gland was so small as not to have attracted 
observation, and continued in the same state up to the 14th of April last, 
when, it seems to me, that the blood was thrown suddenly and with great 
force into the parenchyma of that gland ; but by what means, except by 
rupture of one of the thyroid arteries, remains to me (in the absence of any 
parallel case), an entire mystery! The tumour was at first tense and ele- 
vated ; the patient complained of constant pain about the ears and back of 
the head, for the sterno-mastoid m^uscles were forced outwardly and put 
violently on the stretch by the pressure of the tumour. On the 2d day its 
base began to spread laterally; it became more soft; and in a few days more, 
began spontaneously to diminish, and has now the appearance of a very 
inconsiderable goitre. The vertical circumference of the tumour was 3^ 
inches; the lateral circumference from one edge of the base of the tumour 
to that of its opposite edge 5 inches 1 line. 



260 American Intelligence, [Jan, 



DOMESTIC SUMMARY. 

Disputed Personal Identity. — The following case has been noticed in many of 
our newspapers. It now appears in a more authentic shape in the "Law Re- 
porter" (published at Boston), for Sept., 1845. 

The plaintiif, Salome Muller, sued for her liberty before the courts of Louisiana. 
She was now a little more than thirty years of age, and she alleged that she was 
unlawfully held in slavery, by one Lewis Belmonti; that she was a free white 
woman, of German parentage ; that she left Germany with her parents when 
about three years old, in an emigrant ship, which arrived at the port of New 
Orleans in the year 1818; that her mother died on the Atlantic passage; that her 
father died of the fever of the country a few weeks after their arrival; and that 
then, before she attained a consciousness of her rights, she was reduced to slavery, 
and from that time until the institution of the suit, had been treated, kept and sold 
as a slave. 

Belmonti replied to the petition by a simple general denial of its averments, 
and annexed to his answer a copy of the act of sale, from John F. Miller to him- 
self, and he prayed that Miller might be cited to take upon himself the defence of 
the suit, which was granted. 

Miller, in his answer as filed, denied that Salome is white and free, and alleges 
her to be of African descent, and rightfully a slave. He denies that he purchased 
the service of her father with his children as redemptioners, and avers that he 
received her as a mulatress slave, named Bridget, in 1822, when she was twelve 
years old, from one Anthony Williams, of Mobile, who left her with him for sale. 
He annexed to his answer, the power of attorney from Williams for this purpose. 
He also annexed the legal deed of sale in 1823, of Bridget, then twelve years old, 
to his mother, Mrs. Canby, and lastly the deed of sale from Mrs. Canby to him- 
self, in 1835, of Bridget, then called twenty-three years of age, and her three 
children, the eldest, a boy, being five years old. In the deed of sale to Belmonti, 
in 1838, the plaintiff is declared to be twenty-two years old. 

It is proper to add that Mr. Miller is one of the oldest residents of New Orleans, 
of large property, and, as testified to, of high character for honour and honesty. 

It appeared in tesUmony, that a large number of Germans (1800) emigrated 
from Alsace to this country. They were defrauded by the person with whom 
they contracted for their passage, suffered much in Holland, wete nearly starved 
on board ship, and finally, after a great mortality among them, the survivors 
landed at the Balize in March, 1818. In Louisiana they were subjected to the 
redemption laws, sold for their passage, and scattered over the country, although 
a number remained in New Orleans. 

The mother of Salome and an infant son died on the passage. The father, a 
son and two daughters, survived. A brother of the father, and a sister and 
cousin of his wife, with their families, were also among the emigrants. Daniel 
Muller, the father, and his children were carried by their purchaser to the parish 
of Attakapas, one hundred miles above New Orleans. His brother and family 
were taken to Mississippi, and the others of his relatives remained in New Or- 
leans. In a few weeks the last heard that Daniel Muller had died of the fever 
of the country, and that the boy was drowned in the river. They immediately 
&ent for the two girls, but could gain no informafion concerning them. And 
nothing was known of Salome (1818 to 1843) until this time, and nothing is yet 
known of the other daughter. 

In the summer of 1843, one Madame Karl, a fellow emigrant in 1818, hap- 
pened to be in a part of New Orleans but little frequented by any but the Spanish 
population, and passing the cabaret of Belmonti, looked in and there saw Salome 
perfoi-ming some menial service. She was so instantly attracted by her peculiar 
features, and their strong resemblance to those of her friends and fellow-passen- 
gers, the Mullers, that she entered the shop and began to question the young 
woman. In reply, the plaintiff told her she was a slave, belonging to Belmonti, 
and purchased from Miller. When told by Madame Karl, that she was a white 
woman, she gave no credit to the story. Madame Karl, however, insisted on 



1846.] Domestic Summary. 261 

taking her to those whom she declared were her German relatives. She carried 
her to the house of her cousin and god-mother, Mrs. Schubert, who instantly and 
without any previous intimation of the discovery exclaimed, " My God, here is 
the long-lost Salome Muller!" As many of the German emigrants of 1818 as 
had any recollection of the lost girl, were collected, and immediately identified 
her. Among the witnesses was the midwife who assisted at her birth, and who 
took Mrs. Schubert apart, and asked her if she recollected two very peculiar 
marks on the child, resembling moles, and about the size of coffee grains upon 
the inner part of each thigh. Mrs. Schubert distinctly remembered these ; since, 
on the Atlantic passage, after the mother's death, the care of the child devolved 
upon her, and she dressed and undressed it for several months. The plaintiff 
was then called in, and, on examination, these marks were found. On the trial, 
also, surgeons appointed by the court, made an examination and found them, and 
testified they were ncevi materne, congenital, and could not have been artificially 
produced. 

As to the appearance of the plaintiff, she has no traces of African descent in 
her features. She had long, straight black hair, hazel eyes, thin lips, and a Roman 
nose. The complexion of her face and neck is as dark as that of the darkest bru- 
nette. The witnesses testified that both her parents were of very dark complexion. 
Salome had been exposed, for many years of her servitude, to the sun's rays, with 
head and neck unsheltered, as is the custom of the female slaves. But it was 
proved that the parts of her person which had been sheltered from the sun were 
comparatively white. 

The trial in the inferior court lasted several days, and induced great interest; 
the supposed relatives of the plaintiff being among the most wealthy and respect- 
able of the German residents of New Orleans. The broker who conducted the 
negotiation for the sale from Miller to Belmonti in 1838. swore that he then thought, 
and it had always been his opinion, that the plaintiff was white. Two or three 
witnesses, an old Creole woman, who for many years had lived in the immediate 
vicinity of Miller's residence, and men who were in his employment in 1823, '24 
and '25, identified the plaintiff, with the greatest certainty, as the same person whom 
they had often seen, at that time, in Miller's possession; that she was then a little 
girl, who spoke the English language quite imperfectly, and with a German ac- 
cent, and that they were told by Miller, or some of his household, that she was an 
orphan girl who came from a ship, and was taken by Miller from charity. 

For the defence, there was urged, the improbability of the plaintiff's story — the 
numerous cases on record, where hundreds have testified to a person's identity, 
and yet it has proved otherwise ; the peculiarly excitable and imaginative charac- 
ter of the Germans, and the proved character of Miller for kindness to his slaves. 
Several persons spoke of seeing the plaintiff in Miller's possession in 1824-25, 
living as a slave, and perceived no German accent in her speech. Their opportu- 
nities for conversation had, however, been very limited. 

No "Anthony Williams, of Mobile," who sold her to Miller, was known. A 
reward was offered for information of his existence or residence, but it was never 
claimed. 

The main point of defence, however, was derived from the testimony as to ages 
and dates. 

The petition averred that Salome was three years old in 1818. The defence 
brought forward a witness who swore that the plainfiff was delivered of her first 
child in 1825. It was, however, subsequently proved that the child was born in 
1829 or 1830. The plaimiff's counsel asked for delay, until they could obtain a 
cerfificate of the registration of birth from the place of Salome's nativity in Ger- 
many, but this was denied. 

The court decided in favour of the defendant, on the ground that he could not 
divest a citizen of his property, upon such testimony of identity as that offered by 
the plaintiff— although he admits that the wonderful resemblance to the Muller 
family, and the congenital marks are a very remarkable coincidence, and further 
said he was satisfied, from the evidence of the plaintiff's delivery in 1825, that 
she was not the lost Salome. 

An appeal was made to the Supreme Court of Louisiana, and the case came up 
in May, 1845. In the meanwhile, the Consul for New Orleans from Baden-Ba- 



262 American Intelligence. [Jan. 

den had visited Europe, and brought back with him a certified copy of the regig"- 
try of birth, from which it appeared that Salome was born on the 10th of July, 
1813, and therefore, in 1818, was Jive years old. and not three. 

The cause was argued by numerous counsel, and on the 21st of June, the court 
decided that they were fully satisfied that the plaintiff was " Salome Miiller,^' and 
if not so, if there was another person, of the same age, with the same peculiar 
marks, and bearing so strong a family resemblance, " it would be one of the most 
wonderful facts in history." She w^as therefore declared free. T. R. B. 

Deaf and Dumb. — The following facts have been communicated to me by a 
highly respectable clergyman, acquainted with the family, and at the time resi- 
dent near them. 

William FuUerton and Elizabeth his wife, in 1822, resided in the town of He- 
bron, county of Washington, and State of New York. They had twelve children, 
seven of whom were deaf mutes, and the remaining five not. The deaf and 
dumb children were born alternately to those that were not so. The names and 
ages, in 1822, of the mutes were as follows : Nancy FuUerton, aged about 22 years, 
John FuUerton, 20 years, Jane FuUerton, 19 years, William FuUerton, 14 years, 
Walter FuUerton, 12 years, David FuUerton, 9 years, Ann FuUerton, 5 years. The 
ages of the second and third approximate quite nearly, but I am stUl assured that 
there w^as one intermediate. These facts were shortly after the date, communi- 
cated to Dr. Samuel Akerly, and they may be stated in one of his annual reports 
of the New York Deaf and Dumb Asylum. 

On the powers of Turpcth Mineral in certain diseases. — The following very interest- 
ing letter from Dr. Hubbard, of HalloweU, Maine, addressed to Dr. Bond, was 
lead before the PhUada. College of Physicians, Oct. 7th, 1845. and is published in 
their proceedings. 

" In reply to your request, that I would give you the result of my experience in 
the use of turpeth mineral, (Hydrarg. subsulphate,) I will submit to you the fol- 
lowing remarks : 

'• My attention was first directed to the use of this substance, from feeling the 
want of some article, reliable, as an emetic of certain, prompt, efficient, and safe 
action, with the least tendency to run off by the bowels. For, w^hatever may be 
thought of the value of emetico-cathartics, in many other cases, it must be admit- 
ted by all, that simple emesis is, in many pathological conditions, alone desirable; 
and that its compUcation with catharsis will, in such conditions, not only defeat 
the beneficial effects of the emesis, but will prove positively injurious, and often 
extremely hazardous. It is under precisely such conditions of the system, that the 
emetics, in common use, such as tart, antimon., ipecac, sulph. zinci, &c., will most 
frequently fail of producing efficient em.esis, and are most liable to run ofi'by the 
bowels. There are certain diseases — for instance, croup, and scarlatina maligna 
— during all the stages of which, there is great insensibility of the stomach to the 
impression of emetics, and, when procured by inordinate doses, emesis is likely 
to be very imperfect, and to be followed by catharsis. The same insensibility 
also exists in all diseases, under circumstances of great prostration of the system, 
whether that prostrafion be owing to the violence of the disease or to its duration. 

" Every practitioner of experience must have felt the importance of availing 
himself, under some of the above-named pathological conditions, of the revellent 
and equalizing effect of simple emesis; and he must also have experienced the 
difficulty and uncertainty of obtaining it by any of the emetic substances in com- 
mon use. Take, for instance, a case of spasmodic and intermittent croup. The 
patient is suddenly seized, for the most part in the night, with croupy cough and 
spasmodic breathing, which symptoms continue, attended with great distress and 
anxiety, for several hours, and then pass off to return on the preceding night with 
redoubled violence. In many instances, the intermissions of all morbid pheno- 
mena have been so perfect, as to lull the friends of the little sufferer into a fatal 
security, until, by the accumulated power of repeated paroxysms, the patient is 
overwhelmed with disease, almost beyond the hope of recovery; when, for the 
first titne, medical aid is called for. A single case will better illustrate the diffi- 
culfies the physician has to encounter than any general descripfion. 



1846.] Domestic Summary, 263 

" I was called, in the night of Feb. 5, 1845, to see Miss C, aged about twelve 
years. In the three preceding nights, at about the same hour, she had been seized 
with paroxysms, similar to the one in which I found her, — each one contmuing 
several hours, each of progressively increased severity, and each leaving her able 
to be about, during the day, with respiration so easy as to excite no alarm, and 
only a slight croupy cough. I found her with breathing extremely quick, laborious, 
and stridulous, the chest heaving with convulsive throes, the countenance liyidj 
the eyes wild and distracted, extreme jactitation, the pulse thread-like, vacillating, 
and too rapid to be counted, the extremities, up to the body, of an icy coldness, — 
in short, the patient appeared like one in the last agonies. Strong rubefacients 
were immediately applied to the whole surface, sinapisms to the spine and extre- 
mities, and heated blankets to the lower limbs. As soon as she could swallow, — 
for deglutition was at first extremely difficult, — five grains of the turpeth mineral 
were given at once, and followed with the free use of mustard whey; this not 
vomiting her. after fifteen minutes I gave her five grains more, immediately upon 
swallowing which, vomifing commenced, and continued smartly for more than an 
hour. During this operation, and for some hours after, a free use was made of a 
decoction of seneka, as a stimulant diaphoretic. Her respiration began to im- 
prove immediately on vomiting, and at the end of about four hours, it was com- 
paratively good ; the skin open, natural warmth restored, and the circulation equal- 
ized. The patient was then put upon the use of the following powder : K. pulv. 
ipecac, comp. 9j; hydrarg. chlorid. mit. 9] ;. camphor, pulv. grs. xij. M. ft. 
Chart. No. vj : One to be taken every four hours, a free use to be made of the de- 
cocfion of seneka in the intervals, and the bowels to be moved after twenty-four 
hours. 

'-' The emetic did not produce purgation. No paroxysm of difficult breathing 
returned. In forty. eight hours, my attendance ceased. I know of no other emetic 
substance that would have effectually met such a case. Ipecac, sulphate of zinc, 
&c., would have proved too feeble at best. Tartarized antimony would, I con- 
ceive, have been hazardous, from its nauseating and sedative effect, setting aside 
the uncertainty of its procuring emesis in any reasonable dose, and the almost 
certainty of its producing exhausting catharsis. 1 repeat, then, that in this form 
and condition of croup, my experience furnishes me with no substitute for the 
turpeth mineral as an emetic. 

" In the more inflammatory and less paroxysmal forms of this disease, with 
decided arterial excitement, and hot skin, from the commencement, tartarized an- 
timony, as a nauseant and emetic, may be, and unpoubtedly is, with certain limi- 
tadons, preferable. Still. I must say, that in all stages and conditions of this dis- 
ease, where the equalizing and revellent effect of emesis is alone desired, I have 
never regretted having used the turpeth mineral, in preference to all other eme- 
tics. These remarks might easily be extended to the use of this remedy in some 
other forms of disease, and especially in some of the anginose affections. The 
hints above given will, however, enable the experienced physician to determine 
its applicability to such conditions, and I am warned to bring to a close these re- 
marks, which you may find already too prolix. 

'' It remains, then, only to say a few words upon the peculiarity of this sub- 
stance as an emetic, and upon some of the objecfions urged against it. In the 
first place, the promptness and certainty of its operation belong to no other sub- 
stance within my knowledge. It has seldom, if ever, failed to vomit efficiently, 
when administered in a proper dose, in any of the various conditions of the sto- 
mach, and of the system, in which I have given it. It usuall)^ acts in ten or fifteen 
minutes, and the dose should be repeated at those intervals, if the first fail, which 
rarely happens. In efficiency and revellent power, it is not, perhaps, quite equal 
to the tartarized antimony; it is, however, vastly superior, in these respects, to 
ipecac, or any other substance known to me. In safety, it is greatly superior to 
anfimony. Its emetic operafion usually continues from an hour to an hour and a 
half, accompanied and followed by none of the distressing nausea, prostration and 
depletion of antimony; but, on the contrary, leaving the patient with the invigo- 
rated feeling arising from equalized warmth and circulation. In its emetic opera- 
tion, it has seldom, never, in my recollection, been accompanied or followed by 
catharsis. I have never known it to be violent, nor otherwise than entirely safe 



264 American Intelligence. [Jan. 

in its operation, although I have given it in much larger doses than are usually- 
directed • nor have I ever seen salivation follow its use as an emetic. So safe do 
I consider it, that in urgent cases I have not hesitated to put my patient under its 
full emetic operation, two or three times within twenty- four hours; nor have I 
seen ill consequences result from such practice. I am inclined to think that the 
dose should be somewhat larger than is usually recommended. From two to 
three grains may be given to a child two years old, and repeated in ten or fifteen 
minutes, until emesis is produced. If the fi.rst dose fails, the second usually acts 
as soon as it touches the stomach. 

^'I have thus given you, as you requested, the result of my experience in the 
use of this article — an experience somewhat extensive, during the last ten years : 
— such as it is, it is at your disposal." 

New Remedy for Strangury. — Dr. F. H. Gordon, of Wilson Co., Tenn., in an 
article on Epidemic INIetritis, {West. Journ. Med. and Surg., Noy. 1845,) gives 
the following account of a new remedy, which, he says, was successful in the 
treatment of strangury which was a common attendant on the disease. This 
remedy was an infusion of the apis melifica, or honey bee. '' Sweep 40 to 60 
bees into a pan of water^ so as to make them manageable; put the whole into a 
teacup, pour one gill of boiling water on them, and cover the cup securely. When 
it has remained twenty minutes, pour off the infusion and let the patient take the 
whole at a draught. This remedy relieved the strangury in from two to fifteen 
minutes with great certainty, 

" It was introduced into the practice of medicine some years ago by Mrs. Perry, 
an old woman in the habitual practice of midwifery in the county of Smith; and 
experience proves that its efficacy is not less considerable because of its unsci- 
entific origin. Some six or seven practitioners in that section of country (some 
of whom do honour to the profession) , have given the remedy numerous fair trials, 
and, so far as I have learned, all estimate it highly. The writer has tried it re- 
peatedly in the retention of urine from inflammation of the bladder, and from the 
effects of cantharides, and found it to be more prompt and certain than any other 
remedy. There can be no question but that the • bee tea' will prove a valuable acces- 
sion to our materia medica. How far it maybe found to be useful in ischuria and 
dysuria from every variety of cause, remains to be tested; and its known value 
aftbrds abundant encouragement for further investigation. 

" As to the class to which this agent naturally belongs, I have but little hesita- 
tion in placing it among the narcotics. That it acts as an antispasmodic there can 
be no doubt, but whether it is a specific for the sphincter muscle of the urinary- 
bladder, as the ergot is supposed to be a specific for certain fibres of the uterus, 
has not been clearly determined. 

^'It is probable that the virus ejected by the bee in poisoning the wound it in- 
flicts upon its enemy, is the material which gives virtue to the bee tea. This virus 
is secreted and collected in a sac in the abdomen of the bee, near the base of its 
lance or sting. When war is made upon its enemy, the virus is injected into the 
puncture made by the lance, and the wound is poisoned. It is also emitted during 
the anger of the insect, as is known by its peculiar pungent odour; and that the 
virus which gives out this odour is the same which imparts the antispasmodic 
virtue to the infusion, is evinced by two facts. 

" 1st. The tea, when recently made, has a taste and smell identical with the 
odour of the incensed bee, and now the infusion is efficacious. 

'^ 2d. But if the infusion be allowed to stand and cool, and especially if allowed 
to remain uncovered, its characteristic odour and taste disappear, and the tea is 
correspondingly inefficient. These facts justify another conclusion — that the virus 
is quite volatile, and requires care to prevent its escape. 

"Whether this valuable virus may not be collected and concentrated, or com- 
bined with some chemical element, so as to render it portable and convenient, is 
a matter of interest and well worth the attenfion of the chemist." 

Bilateral Operation in Lithotomy. — Prof. R. D. Mussey, of Ciscinnati, in a letter to 
the editor of the Boston Med. ^ Surg. Journ., writes, " Within the last fifteen months 
I have operated in this method upon five paUents, all of whom recovered speed- 



1846.] Domestic Summary. 265 

ily. The last, a gentleman of 38 years of age, was able to leave, by boat, for his 
home, 150 miles distant, on the 19th day after the operation. 

'' With a scalpel rather narrow, I make the superficial incision crescentic, with 
its convexity anterior, and cut upon the staff at the usual place, the membranous 
part of the urethra. I tlien pass a straight, probe-pointed, narrow bistoury, its edge 
turned towards the left side, along the groove of the staff into the bladder, and slide 
the point of the left fore-finger upon the back of the bistoury, pressing it upon the 
prostate to cause a division of that body sufficient to admit the extremity of the 
finger into the bladder- the staff is then withdrawn, by an assistant, and the pros- 
tate further divided if necessary. The finger is then rotated, so as to bring the 
palmar surface of its point to rest upon the right side of the prostatic portion of the 
urethra; next the bistoury is turned, and the right side of the prostate divided, ad 
libitum, under the guidance of the finger. The stone is then extracted ; if small, 
with the scoop — if large, with the forceps. 

^^ This mode of making the section of the prostate is to be preferred to that which 
is done by Dupuytren's double-bladed, concealed bistoury, as the blades of that 
instrument are so slender as to yield considerably, making a section of the parts 
less in extent than the distance between the edges of the blades when projected 
from their grooves, and still narrower if a little dull than when sharp. If, pre- 
viously to the operation, a satisfactory estimate of the size of the stone has been 
gained, the deep secfion of the parts with the straight, probe-pointed bistoury, 
guided by the finger, may be made in conformity with that estimate. When a 
large stone, in being extracted, hangs in the prostatic or muscular opening, the lat- 
ter of which is probably the most common, a narrow, straight, sharp-pointed bis- 
toury may be carried along each blade of the forceps in succession, and the ten- 
sion relieved. I am in the habit of leaving a piece of elastic gum catheter in the 
wound for two days, to give a sure outlet to the urine. 

^' The bilateral operation for stone has an advantage over the lateral in giving 
greater security against injury to the rectum and the pudic arteries : and in expos- 
ing not at all the vesicular seminales, and the plexus of veins at the neck of the 
bladder, as the lateral does, when the deep-seated section of the parts is made to 
correspond in direction with the superficial incision. On the whole, I regard this 
operation as far more safe than any other operation in lithotomy which has yet 
been invented." 

Further Observations on some of the more obscure and remote effects of Syphilis. By 
John Watson, M. D. (New York Journal of Medicine, Nov., 1845.) — In a memoir 
published in the New York Journal of Medicine, July, 1843, Dr. Watson endea- 
voured to show that the venereal disease, in its progress through the system, may 
extend to several organs usually supposed exempt from its immediate influence, 
— that it may affect the brain and its meninges, the oesophagus, the bronchial 
tubes, and the testes, and that it may simulate other diseases, as pulmonary 
phthisis, and diseases of the digestive organs. 

The author, in the present article, offers additional facts in support of the opinions 
advanced in the above-mentioned memoir, and brings forward cases to show that 
other organs, in addition to those just menfioned, may also be involved. With 
some further observations on the disease as it affects the brain and testicle, he 
attempts to show that it may extend to the liver; that among the cervical ganglia, 
it may simulate strumous adenifis ; that in the lower extremities it may simulate 
elephantiasis : and that there is reason to suppose it may occasionally involve the 
rectum and the prostate gland. He also offers some remarks on the variety of 
secondary syphilis after sloughy primary sores ] on the frequent and early occur- 
rence of superficial necroses, in connection with notes; on the co-existence of 
syphilis with other constitufional diseases; and on mercurial cachexia, as liable 
to be mistaken for the remote effects of syphilis. 

Neuralgia instantaneously relieved by the Extraction of a Tooth. — Dr. Alfred C. Post 
gives an account, in the New York Journal of Medicine, (Nov. 1845,) of a severe 
attack which he experienced of neuralgia affecting several of the teeth of the 
left upper jaw, the left side of the head and the larynx, and which was cured 
instantaneously by the extraction of the left dens sapientise of the lower jaw. 



266 American Intelligence. [Jan. 

There was no pain or tenderness in this tooth, but it was extensively affected 
with caries. The absence of pain and morbid sensibility in the carious tooth and 
all the teeth of the lower jaw, Dr. P. conceived it could have nothing to do with 
the neuralgic suffering, but he was induced to have it extracted after suffering five 
days, because he thought it might be a source of future inconvenience. The 
moment after the extraction of the tooth he felt at once that the whole source of 
his sufferings was at an end. 

We have seen several cases of an analogous character, and in some instances 
have found great difficulty in persuading the patient that a tooth which itself 
was not the seat of pain, could occasion the severe pangs of neuralgia in the 
other parts. 

Medical Profession in the United States. — " From the law, the medical profession 
[in the United States] receives neither encouragement nor protection. It is laid 
open alike to every one who may think proper to enter it — without question as to 
his competence for the faithful performance of his duties as a member. Whoever 
assumes to himself the title of doctor, belongs of right to the profession — there 
being no legal provision by which his claims to membership may be tested or 
denied. In fact, the individual upon whom the title of Doctor in Medicine has 
been conferred by the most distinguished university, to indicate that he has com- 
pleted a regular pupilage, and is qualified to practise the art he has fully and 
faithfully studied, and he who but yesterday deserted the workshop of the me- 
chanic or the counter of the tradesman, and without either natural abilities, or any 
preparatory study, announces himself as a doctor of the healing art, are both 
equally recognized and protected by the law. 

With the limits of the profession thus undefined, and the proper qualifications 
of its members entirely disregarded by the state, it is in no degree surprising that 
the public should be deceived — and that in their selection of a medical adviser, 
their choice should fall more frequently upon the charlatan — who officiously 
obtrudes his pretensions upon their notice — and boasts loudly of his unerring skill, 
than upon the really meritorious, but modest and unpretending physician. 

In most of the states, the title of doctor has become, in popular estimation, 
synonymous with that of practitioner of medicine — without the slightest reference 
to the mode or place in which the individual who bears it, has qualified himself 
for the office it implies; — and, we are persuaded, that the title is assumed by 
many, in entire ignorance that such is not actually the case. We could point out 
more than one of the members, and even public teachers, of the most rigid of our 
religious sects, who practise medicine under the assumed title of doctor — nay, 
who even affix the initials of the degree to their names, in apparent unconscious- 
ness of the falsehood and imposition upon the public they are thus perpetrating. 
Whether there are any provisions of the common law by which this species of 
fraud may be punished we know not. But we are persuaded, that, if there be 
any meaning in the act of assembly of this state, which purports to provide a 
remedy against cheating by false pretences, it will fall within its provisions." — 
Condieh Oration before the Philad^a Medical Society. 



THE 



AMERICAN JOURNAL 



EDICAL SCIENCES. 



No. XXII.— Aprii, 1846. 19 



COLLABORATORS. 



Elisha Bartlett, M. D. Professor of 
the Institutes and Practice of Medicine 
in the University of Maryland. 

T. RoMEYN Beck, M. D. Professor of 
Materia Medica in ike Albany Medi- 
cal Colkire. 

John B. Beck, M.D. Prof, of Mat, 
Med, in the Coll. of Fhys. ^ Surg.., 
m 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. Coaxes, 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 Medical College of the State of 
South Carolina. 

Pliny Earle, M. D. Physician to the 
Bloomingdale Asylum for the Insane. 

Charles Evans, M. D. ^tending Phy- 
sician to the Friends'' Asylum, Frank- 
ford. 

John D. Fisher, M.D. one of the Physi- 
cians to the Massachusetts General Hos- 
pital, 

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 Pennsylvania Hos- 
pital. 

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, 

George H ayward, M.D. Professor of the 
Principles of Surgery and Clinical Sur- 
gery in Harvard University, Boston. 

EDITOR—IsAAC Hays, M. D., one of the Surgeons to Wills Hospital for the Blind 

and Lame, ^c. 



Hugh L. Hodge, M. D. Prof, of Mid- 
wifery in the University of Penn. 

E. Hale, M. D. Physician to the Mas- 
sachusetts General Hospital. 

Thomas Harris, M. D. Surgeon U. S, 
Navy. 

Charles R. King, M. D. of Philad^a. 

T. S. KiRKBRiDE, M.D. Physician to the 
Pennsylvania Hospital for the Insane. 

Samuel Jackson, M. D.Professorofthe 
Institutes of Medicine 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, 

Nathan R. Smith, M. D. Professor of 
Surgery in the University of Md. 

Thomas Stewardson, M. D. of Phila. 

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, 

GouvERNEUR Emerson, M. D. of Phi- 



TO READERS JIND CORRESPONDENTS. 



The communications of Drs. Boling, Mendenhall^ Savage, Metcalfe, and of 
Prof. Meigs and Dr. PfeifFer shall appear in our next. 

The paper of Dr. Blackman was crowded out of our present No. ; it shall, how- 
ever, have a place in the next. 

Other communications are under consideration, and the authors shall hear from 
us by letter, in relation to them, in a short time. 

We have been unable to notice various works which have been sent to us, in 
consequence of want of space, though we have largely exceeded our limits. They 
shall receive due attention. 

The following works have been received : — 

Lectures on the Operations of Surgery, and on Diseases and Accidents requir- 
ing Operations. By Robert Liston, Esq., F. R. S., Senior Surgeon to the Uni- 
versity College Hospital, and Professor of Clinical Surgery in the College. With 
numerous additions, by Thomas D. Mutter, M. D., Prof. Surgery in Jeff. Med. 
College, &c. &c. &c. &c. Philadelphia, Lea & Blanchard, 1846. (From the 
publishers.) 

A Manual of the Diseases of the Eye; or. Treatise on Ophthalmology. By S. 
LiTTELL, Jr., M.D., one of the Surgeons of the Wills' Hospital, Fellow of the Col- 
lege of Physicians of Philada. Second Edition, revised and enlarged. Phila- 
delphia, 1846. (From the author.) 

General Therapeutics and Materia Medica. With 120 illustrations. Adapted for 
a medical text book. By Robley Dunglison, M. D., Prof. Inst, of Med. in Jeff. 
Med. College. Third edition, revised and improved. In 2 vols. Philadelphia, 
Lea & Blanchard, 1846. (From the publishers.) 

Phrenology Examined. By P. Flourens, Member of the French Academy, 
Perpetual Secretary of the Royal Academy of Sciences, &c. &c. Translated 
from the second edition of 1845, by Charles De Lucena Meigs, M. D., Memb. 
Am. Philos. Soc. Philadelphia, Hogan & Thompson, 1846. (From the trans- 
lator.) 

Physical Education, and the Preservation of Health. By John C. Warren, 
M. D., Prof. Anat. and Surg, in Harvard University. Boston, William D. Ticknor 
& Co., 1846. (From the author.) 

Fragments of Medical Science and Art. An Address, delivered before the 
Boylston Medical Society of Plarvard University. By Henry Jacob Bigelow, 
M. D., President of the Society. Published by the Society. Boston, Wm. D. 
Ticknor & Co., 1846. (From the author.) 

A Manual of Chemistry. By Richard D. Hoblyn, A. M., Oxon., &c. New York, 
Saral. S. & Wm. Wood, 1846. (From the publishers.) 

New Elements of Operative Surgery. By Alf. A. L. M. Velpeau, Prof, of 
Surgical Clinique of the Faculty of Medicine of Paris, &c. &c. &c., carefully 
revised, entirely remodeled, and augmented with a treatise on Minor Surgery. 
Illustrated by over 300 engravings, incorporated in the text, accompanied with an 
atlas in quarto, of twenty-two plates, representing the principal operative pro- 
cesses, surgical instruments, &c. First American, from the last Paris edition. 
Translated by P. S. Townsend, M. D., late Physician to the Seamen's Retreat, 
Staten Island, New York. Augmented by the addition of several hundred pages 
of entirely new matter, comprising all the latest improvements and discoveries 
in Surgery in America and Europe, up to the present time. Under the supervision 
of, and with notes and observations, by Valentine Mott, M. D., Prof, of the 
Operations of Surgery, with Surgical and Pathological Anatomy in the University 
of New York. In three volumes. Vol. II. New York, J. & H. G. Langley, 1846. 
(From the publishers.) 



4 TO READERS AND CORRESPONDENTS. 

Outlines of the Nerves, with short descriptions. Designed for the use of Medi- 
cal Students. By John Neill. M. D., Demonstrator of Anatomy in the University 
of Pennsylvania, Physician to Wills' Hospital, &c. Philada.: Ed. Barrington and 
Geo. D. Haswell, 1845. (From the author.) 

Examinations in Anatomy, Physiology, Practice of Physic, Surgery, Chemistry, 
Materia Medica. and Pharmacy, for the use of Students. By Robert Hooper, 
M. D. Third American, from the last London edition, revised and enlarged. New- 
York, J. & H. G. Langley, 1846. (From the publishers.) 

Homosopathy, Allopathy, and Young Physic. By John Forbes, M. D., F. R. S., 
&c. Philada., Lindsay & Blakiston, 1846. (From the publishers.) 

An Essay on the Use of Narcotics, and other remedial agents calculated to pro- 
duce sleep in the treatment of insanity. For which the author obtained the Lord 
Chancellor's Prize in Ireland, awarded by the President and Fellows of King 
and Queen's College of Physicians. By Joseph Williams, M. D. London, 1845. 
(From the* author.) 

The Diagnosis, Pathology, and Treatment of the Diseases of the Chest. By 
W. W. Gerhard, M. D., Lecturer on Clinical Medicine to the University of Penn- 
sylvania, one of the Physicians to the Pennsylvania Hospital, &c. Second edition, 
revised and enlarged. Philada., Ed. Barrington & Geo. D. Haswell, 1846. (From 
the publishers.) 

Clinical Lectures on Surgery. Delivered at St. George's Hospital. By Sir 
Benjamin Brodie, Bart., V. P. R. S., &c. &c. Philada., Lea & Blanchard, 1846. 

A Compendium of Lectures on the Theory and Practice of Medicine, delivered 
by Prof, Chapman, in the University of Pennsylvania. Prepared with permis- 
sion, from Dr. Chapman's manuscripts, and published with his approbation. By 
N. D. Benedict, M. D., F. C. P. P., Phys. to the Lying-in department of the Phila- 
delphia Hospital. Philada., Lea & Blanchard, 1846. (From the publishers.) 

Report of Special Committee of the House of Assembly of the State of New 
York, on the present Quarantine Laws, 1846. Albany, 1846. (From Dr. A. F. 
Vache.) 

A Dictionary of Practical Medicine, comprising general Pathology, the Nature 
and Treatment of Diseases, Morbid Structures, &c. Edited, with additions, by 
Charles A. Lee, M. D. Part XH. New York, Harper & Brothers, 1846. 

The Natural History and Diseases of the Human Teeth. By Joseph Fox, M. R. 
C. S. L., &c. &c .First American, from the third London edition. Remodeled, with 
an Introduction, and numerous additions., by Chapin A. Harris, M. D., D. D. S., 
Prof, of Tract. Dentistry and Dental Pathology, in the Baltimore College of Dental 
Surgery, &c. &c. Illustrated with thirty plates. Philadelphia, Ed. Barrington and 
Geo. D. Haswell, 1846. (From the publishers.) 

Elements of Surgery. By Robert Liston, Surgeon to the North London Hos- 
pital, &c. &;c. Fourth American, from the last London edition, with copious notes 
and additions, by Samuel D. Gross, M. D., Prof, of Surgery in the Medical Insti- 
tute of Louisville, &c. Illustrated with numerous engravings. Philada., Ed. Bar- 
rington and Geo. D. Haswell, 1846. (From the publishers.) 

Seventh Annual Report of the Directors and Superintendent of the Ohio Lunatic 
Asylum, to the forty-fourth General Assembly for the year 1845. Columbus, 1846. 
(From Dr. Awl.) 

Report of the Commissioners of the State Lunatic Asylum, or Indiana Hospital 
for the Insane, to the General Assembly, Dec, 1845. Indianapolis, 1845. (From 
Dr. Jno. Evans.) 

Annual Reports of the Keepers, Clerk, Physicians and Visitors of the Peniten- 
tiary, Frankfort, Kentucky, 1846. (From Drs. L, andW. C. Sneed, Physicians to 
the Institution.) 

Seventeenth Annual Report of the Inspectors of the Eastern State Penitentiary 
of Pennsylvania, Philadelphia, 1846, (From Dr. Given.) 

The Select Medical Library. Tamplin on Deformities. Philadelphia, Jan. 1846. 
(In exchange.) 

State of the New York Hospital and Bloomingdale Asylum, for the year 1845. 
New York, 1846. 

Lecture on Medical Obedience, Introductory to the Course of Theory and Prac- 
tice of Medicine, in the Medical Department of Pennsylvania College. Phila- 



TO READERS AND CORRESPONDENTS. 5 

delphia, for the Session of 1845-6. By William Darrach, M. D. Published by 
the members of the class. Philada., 1845. (From the author.) 

Amiiversary Address to the New York Medical and Surgical Society. By F. 
Campbell Stewart^ M. D. Delivered Jan. 3. 1846. New York, 1846. (From 
the author.) 

Catalogue of the Trustees, Officers and Students of the University of Pennsyl- 
vania, Session 1845-46. Philada., 1846. 

Catalogue of the Medical Department of Transylvania University, for the Ses- 
sion of 1845-6, with the circular for the coming Session. Lexington, Ky., 1846. 

An Address to the class of Graduates of the Albany Medical College, delivered 
at the commencement, Jan. 27th, 1846. By D. D. Barnard, President of the 
Trustees. Albany, 1846. (From Prof. Beck.) 

Fourth Annual Report to the Legislature, relating to the Registry and Returns 
of Births, Marriages and Deaths in Massachusetts. For the year ending April 
30th, 1845. By John G. Palfrey, Sec'y of the Commonwealth. Boston, 1845. 
(From Lemuel Shattuck, Esq.) 

Third Annual Report of the Managers of the State Lunatic Asylum, [New 
York,] made to the Legislature, Jan. 23d, 1846. Albany, 1846. (From Dr. 
Brigham.) 

Twenty-fifth Annual Report of the Bloomingdale Asylum for the Insane. For 
the year 1845. (From Dr. P. Earle.) 

Report of the Pennsylvania Hospital for the Insane. For the year 1845. By 
Thomas S. Kirkbride, M. D., Physician to the Institution. Philada., 1846. (From 
the author.) 

Annual Report of the Directors and Physicians of the Kentucky Lunatic Asy- 
lum to the Legislature. December Session, 1845. Frankfort, Ky., 1846. 

Journal de Medecine. Par M. Trousseau, Dec. 1845, Jan., Feb., 1846. (In 
exchange.) 

Journal de Chirurgie. Par M. Malgaigne. Jan. 1846. (In exchange.) 

Medico-Chirurgical Transactions, published by the Royal Medico-Chirurgical 
Society of London. Second Series, vol. the Tenth. London, 1845. (From the 
Society.) 

Monthly Journal of Medical Science. Edited by John Rose Cormack, M. D., 
Nov., Dec, 1845. Jan., 1846. (In exchange.) 

British and Foreign Medical Review. Edited by John Forbes, M. D. Jan., 
1846. (In exchange.) 

The Medico-Chirurgical Review, Jan., 1846. (In exchange.) 

The Edinburgh Medical and Surgical Journal, Jan., 1846. (In exchange.) 

The Provincial Medical Journal, Dec, 1845, Jan., Feb., 1846. (In exchange,) 

The London Medical Gazette, Dec, 1845. Jan., Feb., 1846. (In exchange.) 

The Northern Journal of Medicine, Dec, 1845. Jan., 1846, (In exchange.) 

The Dublin Medical Press, Dec, 1845. Jan., Feb., 1846. (In exchange.) 

The Medical Times, Dec, 1845.' Jan., Feb., 1846. (In exchange.) 

The British American Journal of Medical and Physical Sciences, Jan., Feb., 
1846. (In exchange.) 

The Half-yearly Abstract of the Medical Sciences: being a practical and analy- 
tical digest of the contents of the principal British and Continental Medical Works 
published in the preceding six months. Together with a series of Critical Reports 
on the Progress of Medicine and Collateral Sciences during the same period. 
Edited by W. H. Ranking, M. D., Cantab., Phys. to the Suffolk General Hospital, 
Part IL Vol. I. July—Dec, 1845. London, 1846, (In exchange.) 

Same, New York, J. & H. G. Langley. 

The Retrospect of Practical Medicine and Surgery, being a half-yearly Journal, 
containing a Retrospective View of every Discovery' and Practical Improvement in 
the Medical Sciences. Edited by W. Braithwaite, Surgeon to the Leeds General 
Eye and Ear Infirmary, &c. &c Vol. XII., July — ^Dec, 1845. London, 1846. 
(in exchange.) 

The American Journal of Insanity. Edited by the OfHcers of the New York 
State Asylum, Utica. Jan., 1846. (In exchange.) 

The Buffalo Medical Journal, Edited by Austin Flint, M.D. Jan., Feb., 
March, 1846. (In exchange.) 

18* 



6 TO READERS AND CORRESPONDENTS. 

The New York Journal of Medicine and the Collateral Sciences. Edited by 
Cpiakles a. Lee, M. D., Prof, of Gen. Pathol, and Mat. Med. in Geneva Med. 
College. Jan., March, 1846. (In exchange.) 

The Southern Journal of Medicine and Pharmacy. Edited by J. L. Smith, 
M. D., and S. D. Sinkler, M. D. Jan., March, 1846. (In exchange.) 

The American Journal of Pharmacy. Published by authority of the Philadel- 
phia College of Pharmacy. Jan., 1846. (In exchange.) 

The St. Louis Medical and Surgical Journal. Jan., Feb., 1846. (In exchange.) 

The New York Medical and Surgical Reporter. Jan., Feb., March, 1846. (In 
exchange.) 

The Bulletin of Medical Science. Jan., Feb., 1846. (In exchange.) 

The American Journal and Library of Dental Science. March, 1846. (In 
exchange.) 

The Boston Medical and Surgical Journal. Jan., Feb., March, 1846. (In ex- 
change.) 

The Western Lancet. Nov., 1845. Jan., Feb., 1846. (In exchange.) 

Southern Medical and Surgical Journal. Jan., Feb., March, 1846. (In ex- 
change.) 

The American Journal Sf Science and the Arts. Jan., and March, 1846. (In 
exchange.) 

The Illinois Medical and Surgical Journal. Dec, 1845. Jan., Feb., 1846. (In 
exchange.) 

The New Orleans Medical and Surgical Journal. Jan., March, 1846. (In ex- 
change.) 

The Pennsylvania Journal of Prison Discipline and Philanthropy. Jan., 1846. 
(In exchange.) 

The Medical Examiner. Jan., Feb., March, 1846. (In exchange.) 

The Western Journal of Medicine and Surgery. Jan., Feb., 1846. (In ex- 
change.) 

Stockton's Dental Intelligencer. Jan., Feb., 1846. 

Communications intended for publication, and Books for Review, should be 
sent,/rfc 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 York; 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. 

(t^ The advertisement-sheet belongs to the business department of the Jour- 
nal, and all communications for it should be made to the publishers, under whose 
exclusive control it is. 



CONTENTS 

OF THE 

AMERICAN JOUENAL 

OF THE 

MEDICAL SCIENCES. 

NO. XXI. NEW SERIES. 
APRIL, 1846. 



ORIGINAL COMMUNICATIONS. 

MEMOIRS AND CASES. 

ART. PAGE 

L Ligature of both Carotid Arteries for a remarkable Erectile Tumour of the 
Mouth, Face, and Neck. By J. Mason Warren, M. D., one of the Surgeons 
to the Massachusetts General Hospital. [With two coloured plates.] - 281 

II. Observations on Remittent Fever, as it occurs in the Southern parts of 
Alabama. By Wm. M. Boling, M. D., of Montgomery, Alabama, - - 291 

III. Notes of Cases of Remittent Fever which occurred in the Baltimore 
Almshouse Infirmary, collected by W. F. Anderson, M. D., and Charles 
Frick, M. D., Resident Physicians of the House. With an Analysis of the 
Cases, and Remarks, by Alfred Stille, M. D., of Philadelphia, - -312 

IV. On the Connection between Puerperal Fever and Epidemic Erysipelas, 
in its origin and mode of propagation. By Samuel Kneeland, Jr., M. D., 

of Boston, - _ . 324 

V. Description of a New Operation for the Cure of Hemorrhoids. By M. 
Amussat, M. D., of Paris. [With a wood-cut,] 346 

VI. Extra-Uterine Pregnancy — Retention of the Fcetus fifteen years in the 
cavity of the abdomen, during which time the patient was delivered of a 
full-grown child at term — removal of the extra-uterine fcetus — complete re- 
covery. By Thomas H. Yardley, M. D., Consulting Physician to the Lying- 
in Department of the Northern Dispensary, 348 

VII. Case of Extra-Uterine Pregnancy. By Edward Whinery, M. D., of Fort 
Madison, Iowa, 351 

Vin. Thoughts on Serous Polya3mia. By R. E. Little, M.D., Quincy, Flo- 
rida, 354 

IX. Enormous Steatoma removed from the side. By J. M. Foltz, M. D., Sur- 
geon of the Fleet, Brazil Station. (Communicated through Thos. Harris, 
M.D., Chief Bureau Med. and Surg., U.S. N.,) - - ^- - -358 

X. On the Topography of Singapore. By D. C. McLeod, M.D., Surgeon U. 
S. N. (Communicated in a letter to Thos. Harris, M. D., Chief Bureau 
Med. and Surg., U. S. N.,) 361 

XL Trismus Nascentium — its Pathology and Treatment. By J. Marion 
Sims, M. D., of Montgomery, Alabama. [With two plates, and two wood- 
cuts,] 363 

Xll. Practical Observations on Purpura. By John P. Mettauer, A. M., M. D., 
of Virginia, "' 379 

XIH. Case of Angio-Leucitis with abscess, from the introduction of pus into 
a slight wound. By Henry Hartshorne, M. D., 386 

XIV. Placenta Prasvia, — removal of the Placenta before the child. By Geo. 
N. Burwell, M. D., of Buffalo, N. Y. (Communicated in a letter to the 
Editor,) „....- 390 



O CONTENTS. 

ART. PAGE 

XV. Anomaly of the Desceiidens Noni Nerve. By Samuel Parkman, M. D.. 
Demonstrator of Anatomy in the Medical School of Harvard University^ 
Boston, - - - - 392 



REVIEW. 

XVI. A Practical Treatise on Inflammation, Ulceration, and Induration of 
the Neck of the Uterus : with Remarks on the value of Leucorrhcca and 
Prolapsus Uteri as symptoms of uterine disease. By James Henry Ben- 
net, M. D., Licentiate of the Royal College of Physicians ; formerly House 
Physician (by concours) to the Hospitals Saint Louis, Notre Dame de la 
Pitie, and la Salpetriere, Paris; formerly Vice President of the Parisian 
Medical Society, &c.; Graduate in the Faculty of Arts, and in the Faculty 
of Sciences of the University of Paris. London, 1845: 12mo., pp. 212, - 393 



BIBLIOGRAPHICAL NOTICES. 

XVII. Fragments of Science and Art. An Address delivered before the 
Boylston Medical Society of Harvard University. By Henry Jacob Bige- 
low, M. D., President of the Society. Pubhshed by the Society, - - 405 

XVIII. Elements of Pathological Anatomy : illustrated by coloured engrav- 
ings, and two hundred and fifty wood-cuts. By Samuel Gross, M. D., Pro- 
fessor of Surgery in the Medical Institute of Louisville, &c. Second edi- 
tion, thoroughly" revised and greatly enlarged. Philadelphia and Louis- 
ville, Ed. Barrington and Geo. D. Haswell, 1845 : royal 8vo., pp. 822. - 409 

XIX. Fourth Annual Report to the Legislature, relating to the Registry and 
Returns of Births, Marriages, and Deaths in Massachusetts, for the year 
ending April 30th, 1845. By John G. Palfrey, Secretary of the Common- 
wealth. Letter to the Secretary from Lemuel Shattuck, Esq. Boston : pp. 
106, 8vo., ----- 412 

XX. Elements of Materia Medica and Therapeutics. By John P. Harrison, 
M. D., Professor of Materia Medica and Therapeutics in the Medical Col- 
lege of Ohio. Vol. n. 1845: pp. 619, 419 

XXI. On Diseases of the Liver. By George Budd, M. D., F. R. S., Professor 
of Medicine in King's College, London; and Fellow of Caius Cohege, 
Cambridge. With coloured plates and numerous wood-cuts. 8vo. pp. 
392: Philadelphia. Lea & Blanchard, 1846, 421 

XXII. Du Hachisch et de P" Alienation mentale ; Etudes Psychologiques. Par 
J. Moreau, (de Tours,) Medecin de THospice de Bicetre. Membre de la 
Societe Orientale de Paris. Paris, chez Fortin, Masson, et cie., 1845: 8vo. 
pp.431. 

Psychological researches in reference to the Indian Hemp and Mental Aliena- 
tion. By J. Moreau, 423 

XXIII. 1. Seventh Annual Report of the Directors and Superintendent of the 
Ohio Lunatic Asyhim for the year 1845 : pp. 72. 

2. Report of the Commissioners of the Lunatic Asylum, or Indiana Hospital 
for the Insane. December, 1845 : pp. 20. 

3. Public Documents of the Senate of the State of New York. Nos. 12 and 
23: Jan. 16th and 23d, 1846, 428 

XXIV. Twenty-fifth Annual Report of the Bloomingdale Asylum for the In- 
sane. By Pliny Earle, M. D., Physician to the Institution, pp. 48, - - 430 

XXV. A Manual of the Diseases of the Eye, a Treatise on Ophthalmology. 
By S. Littell, M. D., one of the Surgeons of the Wills' Hospital, Fellow of 
the College of Physicians of Philada., &c. &c. Second edition, revised 
and enlarged. 12mo., pp. 372, 431 

XXVI. Physical Education and the Preservation of Health. By John C. War- 
ren, M. D., Professor of Anatomy and Surgery in Harvard University, pp. 
90.' Boston, Wm. D. Ticknor & Company: 1846. 



CONTENTS. 



9 



ART. PAGE 

Lecture on the Necessity of the Study of Physiology. Delivered before the 
American Institute of Instruction at Hartford, August 22d, 1845. By Ed- 
ward Jarvis, M, D., of Dorchester, Mass. pp. 55. Boston, Wm. D. Tick- 
nor & Company: 1845, 

XXVII. Phrenology Examined. By P. Flourens, Member of the French 
Academy, &c. &c. Translated from the second edition of 1845, by Charles 
De Lucena Meigs, M. D., Memb. Amer. Philo. Soc, etc. etc. Philadelphia, 
Hogan and Thompson, 1846: 18mo., pp. 144, ------ 

XXVIII. Clinical Lectures on Surgery. Delivered at St. George's Hospital. 
By Sir B. C. Brodie, Bart., V. P. R. S., &c. Philada.: Lea & Blanchard, 
1846. 8vo., pp. 352. 

XXIX. General Therapeutics and Materia Medica. With 120 illustrations. 
Adapted for a medical text-book. By Robley Dunglison, M. D., Prof. Inst. 
of Med. in Jeff. Med. College, &c. &c. Third edition, revised and im- 
proved. In 2 vols., pp. 504 and 482. — Philadelphia, Lea & Blanchard, 
1846, - . - ■- - 

XXX. A Compendium of Lectures on the Theory and Practice of Medicine, 
delivered by Prof. Chapman^ in the University of Pennsylvania. Prepared 
vi^ith permission, from Dr. Chapman's manuscripts, and published with his 
approbation. By N. D. Benedict, M. D., F. C. P. P., Phys. to the Lying-in 
department of the Philadelphia Hospital. Philada., Lea & Blanchard, 
1846 : pp. 258, 

XXXI. Outlines of the Nerves, with short descriptions. Designed for the use 
of Medical Students. By John Neill, M. D., Demonstrator of Anatomy in 
the University of Pennsylvania, Physician to Wills' Hospital, &c. Philada., 
Ed. Barrington & Geo. D. Haswell,' 1845. 8vo., pp. 30. Plate ix, 

XXXII. Manual of the Diseases of the Skin.— From the French of MM. Ca- 
zenave and Schedel, with notes and additions, by Thomas H. Burgess, 
M. D., Surgeon to the Blenheim Street Dispensary for Diseases of the Skin, 
etc. Revised and corrected, with additional notes, by H. D. Bulkley, M, D,, 
Lecturer on Diseases of the Skin, Fellow of the College of Physicians and 



435 



437' 



- 437 



437 



438 



438 



Surgeons, New York, etc. 



New York, J. & H. G, Langley, 1846, 



438 



SUMMARY 



IMPROVEMENTS AND DISCOVERIES IN THE 
xMEDICAL SCIENCES. 



FOREIGN INTELLIGENCE. 

Anatomy and Physiology. 



PAGE 

1. Sudoriparous Glands of the Ax- 
illa. By Ch. Rolin. - - - 439 

2. Cynosis. By Mr. W. T. IlifF. - 439 

3. Experiments on the Absorption 
and Reproduction of the Heads 

of Bones. By M. Flourens. - 440 

4. Development of Capillaries. By 
Mr. Platner. - - - - 441 

5. Minute Anatomy of the Kidneys. 

By Dr. Gerlach. - - - 442 



PAGE 

6. Taste. Papillary Structure of 
Tongue. By Dr. Todd and Mr. 
Bowman. 443 

7. Function of Taste. By Dr. 
Todd and Mr. Bowman. - - 444 

8. Effects of Alcohol on the exhala- 
tion of Carbonic Acid from the 
Lungs. By Dr. Vierdont. - - 445 



10 



CONTENTS. 



Organic Chemistry. 



9. On the Detection of Pus in the 
Blood and other Animal Fluids. 

By J. F. Pleller. - - - 445 

10. Chemical and Microscopical 
examination of several kinds of 
Sputa. By M. Scherer. - - 447 



11. Blood in Scrofula. By Mr. Ni- 
cholson. 448 

12. Urine during Pregnancy. By 

Dr. Simon. . ". . . 449 

13. Tubercle. By Dr. Wright. - 451 



Materia Medica and Pharmacy. 



14. Aconite. By Dr. Fleming. - 455 

15. Preparation of the Caustic of 



Filhos. By M. Boudet. 



■• 457 



Medical Pathology and Therapeutics and Practical Medicine. 



16. Turpentine in Large Doses in 
the Treatment of Purpura Hem- 
orrhagica. By Dr. J. Moore Neli- 
gan. 458 

17. On the minute Anatomy and 
Pathology of Bright's Disease of 
the Kidney, and on the relation of 
the renal disease to those dis- 
eases of the liver, heart, and 
arteries, with which it is asso- 
ciated. By George Johnson, M.D. 459 

18. Chorea and its consequences. 

By Dr. Branson. - - - 461 

19. Softening of the Pons Varolii. — 
Lead detected in the Cerebellum. 

By Thomas Inman, M. D. - - 462 

20. Case of Apoplexy of the Pons 
Varolii. By E. Parker, Esq. - 463 

21. Case of Intestinal Obstruction; 
Sigmoid Flexure strangulated by 

the Ileum. By E. Parker, Esq. - 464 

22. Treatment of Dilatation of the 
Heart. By 0. H. Bellingham, 
M.D. 465 



23. On the treatment of Diabetes 
Mellitus. By G. Owen Rees, 

M. D. 466 

24. Headache accompanied with 
Alkaline Urine. By Dr. Shear- 
man. 468 

25. Action of excessive doses of 
Mercury on the Pancreas. By 

Dr. Copland. - - - - 468 

26. Danger of Mercury in Bright's 
Disease. By Mr. Harrison. - 468 

27. Modification of Small-Pox by 
Vaccination. By Dr. Flandin. - 469 

28. On the Occupations of those who 
are most exposed to Metallic Co- 
lic. By M. Chevallier. - - 470 

29. Colic from Copper among the 
Workers in that Metal. By M. 
Blandet. 470 

30. Strychnine in Chorea. By Dr. 

A. Ross. 471 

31. On Constipation from Indolence 
of the Bowels, and its Treatment. 

By Dr. Teissier. - - - 471 



Surgical Pathology and Therapeutics and Operative Surgery. 



32. Effects of Obliteration of the 
Carotid Arteries upon the Cere- 
bral Circulation. By Dr. Norman 
Chevers. 474 

83. Ligature of the Common Caro- 
tid for Tumours of the Diploe. 
By M. Lewis Bos. - - - 484 

34. Vascular Tumour at the Orifice 
of the Meatus Urinarius. By 

Dr. Lever. _ . - . 484 

35. Account of the dissection of a 
subject who had been cured of 
Popliteal and Femoral Aneurism 
(in opposite limbs) by compres- 
sion ; with observations upon this 
method of treatment. By Dr. 
Bellingham. - - - - 486 



36. Aneurism at the commence- 
ment of the Femoral Artery, — 
Ligature of the External Iliac. 

By A. Kidd, Esq. - - - 492 

37. Aneurism of the Abdominal 
Aorta, simulating Calculus in the 
Bladder. By Mr. Fenwick. - 492 

38. Aneurism by Anastomosis of 
the Scalp. By Wm. Eraser, M.D. 493 

39. Bony Tumour in a Nerve. By 
Mr. Colborne. .... 494 

40. CEderaa of the Glottis from 
slight injury of the Mucous Sur- 
face — Laryngotomy — Cure. By 
Mr. J. F. Crookes. - - - 495 

4L Observations on some diseases 
of Bursse Mucosa3. By Mr. J. 



CONTENTS. 



11 



PAGE 

Kirby. 496 

42. Removal of a portion of the 
Liver from the Human Subject. 

By John Macpherson, M. D. - 498 

43. Resection of the entire Upper- 
Jaw. By Dr. Heifelder. - - 499 

44. Compound Fracture of the Os 
Frontis in a child 18 months old, 
— three pieces of Bone remaining 
in the Cerebrum during four 
months. Recovery. By Thomas 



Inman, M. D. 



ByM. 



45. Fractures of the Ribs. 
Lisfranc. - 

46. Amputation at the Ankle-joint. 
By Dr. Handyside. - - - 



500 



500 



500 



PAGE 



47. New Form of Varicose Aneu- 
rism. By M. Berard. 



501 



- 501 



502 



48. Early operation for Hare-lip. 
By P. Dubois. - 

49. Ovarian Dropsy. By Dr. Ben- 
net. 

50. Foreign Body in the Tongue 
for Thirty-two Years. By Dr. 
Krahe. -...-- 

51. Expulsion of a piece of Bone 
from the Gullet at the end of eight 
months. By Robert Brown. - 

52. Statistics of Lithotomy. By Dr. 
F. H. Brett. . „ - . 

53. Treatment of Seminal Losses by 
Compression. By M. Brachet. - 503 



502 



503 



503 



Ophthalmology. 



54. Periostitis of the Orbit. By J. 



Hamilton, M. R. L A. 
55, MuscsB Volitantes. 
Mackenzie. 



- 504 



By Dr. 



- 505 



56. Cure of Strabismus. — Ligatures 
on the Recti Muscles of the Eye. 
By M. DiefFenbach. - 



507 



Midwifery. 



507 



508 



509 



57. Two cases of Labour protracted 
by Insuperable Rigidity of the Os 
Uteri. By John C. Lever, M. D. 

58. On the Development of the 
Placenta within the Fallopian 
Tube. By J. M. Pagan, M. D. - 

59. New Sign of Pregnancy. By 
Dr. Pallender. - - - - 

60. Case in which Caesarean Sec- 
tion was performed on account of 
a Pelvic Tumour [a prolapsed 
ovarium containing a fcetus] pre- 
venting delivery. By William 
Lyon, Esq. . - _ - 509 

61. Contagiousness of Puerperal 
Fever and its connection with 
erysipelatous and phlebitic in- 
flammation. By Dr. Peddie. - 513 

62. Puerperal Fever — Death of 
Husband from somewhat analo- 



gous Symptoms. By Dr. Jas. 
Reid. 

63. Prolapsus of the Cord, and es- 
cape of Meconium, without death 
of the child. By Dr. Kisker.