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THE 


Cindnnati  JaMt  ^  §ktxiiiX, 


EDITED  BT 

EDWARD  B.  STBTEfflS,  M.D.  .  .  JOHN  A.  MURPHY,  M.D. 


OINOIHNATI: 


00BTBIBUT0B8  TO  VOL.  VU.,  1864. 


J.BOWMAN,  M.D Flora,  111. 

J.  R.  BLACK, ^..\ Newark,  Ohio. 

ROBERTS  B ARTHOLOW; Trdir.  bf  Chemistry,  Med.  College,  of  Ohio. 

STEPHEN  BONNER..... ;.-.i.,, .?. Cincinnati. 

GEORGE  S.  COURTRIGHt, ^Aesifltant  Surgeon  U.S,Vol., New  Mexioo. 

WILLIAM  COMMONS,  Auistant  Snrgeon,  US.  Narr. 

I.  A.  COONS, Bliddletown,  Ohio. 

CHARLES  COCHRAN, Toledo,  Ohio. 

M.  T.  CLELAND Kewanna,  Ind. 

A.  P.  DUTCHER,  Prof.  Prino. and Pract  Med.Charity Hospital, Coll., ClereUnd. 

D.W.  C.  DENNY AlUon,  Indiana. 

J.  H.  DOUGLAS,  Aaaiatant  Secretary,  UJ3.  SaniUry  Comminion,  New  York. 

W.  H.  DAUGHERTY, Little  Eagle,  Ky. 

J.  A.  FORD Lexington,  Ky. 

J.  W.  FINFROCK,  Assistant  Surgeon,  11th  O.V.I ,  Fort  HaUeek,  Idaho. 

W.H  FLETCHER, Indianapolis. 

JAMES  W.  HUGHES, Beriin,  Ohio. 

A.  B.  HALL, Boston,  Mass* 

B.  HOWARD,  Assistant  Surgeon,  U.8.A. 

D  B.  HEFFMAN,  Asdstant  Surgeon,  4th  Inlkntry«  Cal.  Vol. 
THOMAS  H.  KEARNEY,  Suigwm  45th  O.VJ. 

W.  H.  MUSSEY, Cindnnati. 

ALEX.  McBRIDE, Berea,  Ohio. 

ISAAC  MENDENHALU New  Oastle  Ind. 

W.  H.  M ATCHETT,  Asstslttit  Surgeon,  40tfi  O.VX 

A.  McMAHON.  Surgeon  64tfa  CVX 

B.  F.  McREEHAN, Claiksburffh,  Va. 

A.R.  McKEE, DanTilTe,  Ky. 

B.  NELSON, «.... New  York  City. 

THE0PHILU8  PARVIN,  Prof.  Materia  Mediea,  Medical  College,  Ohio. 
vAn£<o  1  rvOOKlS K, •.•*.••..••••«.•  ....VM.. ••.••••...••.•••••••.•••••- .■••••••••^asudon,  mu. 

THOMAS  C.  SMITH,  AisislaBt  Surgeon,  llftth  O.V.I. 

A.  H.  STEPHENS,  Surgeon  6th  O.V  L 

B.  W    SIPE. 

A.  H.  SMITH,  AB<(t  Surgeon  U.S.  Army,  Las  Cruces,  New  Mexico. 
EDWARD  B.  STEVENS Cincinnati. 

C.  P.  WILSON,  Secretary  of  Academy  of  Medicine,  Cincinnati. 

E    WILLIAMS, n**  ••»•- Cincinnati. 

F.  WAGN EK, Kelio,  Indiana. 

ROBERT  WALLACE, Nashrille,  Tenn. 

W.  S.  HAYMOND, ^ Monticello,  Ind. 

8.  E.  JONES, Wapello,  Iowa 

F.  a  PLUNK ET,  Marine  Hospital,  Cincinnati. 


'     K.' 


.■x. 


CONTENTS  FOR  1864. 


•-^ 


A  New  Year ^ 46 

Asthma 62,  265 

Anesthetics 66,  164 

Aneurism  Popliteal,  A  Case 29 

Annj  Medicai  Intelligence. . .  .59, 128,  184,  244,  250,  808,  870,  446 

498,  567,  619,695 

Amaorosis —  from  Tobacco 70 

Ambulance  Bill 121 

Authority  of  Military  Commanders  over  General  Hospitals 126 

Aconitine 132 

A  State  Board  for  Examining  Oradoates  in  Medicine. 182 

Acapressnre 872 

Atmospheric  Cure 876 

AmenorrhoDa — by  W.  H.  Dangherty,  M.D 899 

Annual  Report  of  Sxurg.  Qen.  of  Ohio 302 

Aphonia— by  Tnos.  0.  Smith,  M.D 259 

Albnmenuric  Aphonia ^ 504 

A  Plea  for  the  Hand  Maiden,  by  Edward  Parrish 481 

A  Physician  Punished 498 

Army  Medical  Museum 489 

Alfred  StiUe,  M.D 492 

Abortion — Chloroform  in 525 

Atrophy  of  the  Tongue 582 

Artificial  Velmn 588 

American  Medical  Times 617 

Atropia  Poison  Cured  by  Opium 621 

Albinism «84 

A  Monkey  Surgeon 692 

Beiiuhire  Medical  College 52 

British  Treatment  of  Prisoners 57 

Blood-letting,  its  History--by  W.  B.  Fletcher,  M.D 73 

Bequest  for  a  New  Hospital 128 

Bums-— belladonna  in 874 

Boms— Simple  Dressing,  etc 197,  311.  314,  574 

Bronxed  Diseases-  A  Historical  review,  (A  Translation.) 164 


IV  CONTENTS. 

Breastplates  of  Armor 243 

Bursae 310 

Brown  Sequanl 410,  693 

Bloody  Tumors  of  the  Scalp '. . .  .573 

Bright*8  Disease — with  Oedema  Glottidis 505 

Basedows'  Disease 702 

Bitter  Almonds — Poison  of  the  Oil 131 

Civil  War  in  America 35 

Comp.  Cathartic  Pills 63 

Chloroform  in  Labor 106,  230,271 

Cerebro-Spinal  Meningitis, , 187,  243,  843.  345,  392,  499,  517 

Cronp,  Cold  /•  pplications 1 92 

CrouD,  Solution  Per  Chloride  of  Iron 525 

Cow-Pox,  and  Vaccine  Disease 256 

Calabar  Bean 270,  685 

Camp  Diarrhoea,  by  I.  A.  Coons,  M.D .325 

Camp  Diarrhcea,  by  J.  R.  Black,  M.D  ...... *.w... 262 

Qhilblains,  Remeilies^ . . • * 319 

Cough  Mixtures 319 

ChickenPox  in  Adults,  by  G.  S.  Conrtright,  M.D 330 

Campbell  Dr.  J.  B 443 

Cerebro-Spinal  Mepingitis,  by  Roberts  Bartholow,  M.D 392 

Cerebro-Spinal  Meningitis,  by  J.  I.  Rooker,M.D 517 

Creosote  and  Arsenic  in  Skin  Diseases 668 

Constipation,  podopyllin. >. 630 

Delirium  Tremens w . . . .   60 

Dysenteiy,  Treated  with  Ipecac 63 

Diphtlieria,  by  B.  F.  Richardson,  M.D. 99 

Diphtheria,  by  W.  S.  Haymond,  M.D ,i... 641 

Discoverer  of  the  Circulation 127 

Diarrhoea  and  Dysentery*  ...*,. 41,  273,  376 

Disease  in  Whites  and  Blacks.. 632 

Ehnpyema,  by  J.  I.  Rooker,  M.D. 385 

Empyema,  by  W.  T.  Cleland,  M.D.. 585 

Empyema. 666 

Embalming,  by  W.  H.  Mussey,  M.D.... 525 

Equinea 495 

Electro  Galvanism.* ^ 509 

JBxerciso  in  Pulmonary  Tuberculosis,  by  A.  P.  Dutcher,  M.D.. .  .208 

Fine  Clay  as  a  Dressing  for  Sores 377 

Fitietur<?8  in  Children. 690 

Fevers,  A  Chemico,  Physiological  Classification,  by  A.  McBride,     9 

Fevers,  Remittent • 62 

Fissure  of  Anus. .  ,* 66 

Fraxinus  Nigra — as  an  Antiperiodic,  by  W.  C.  Denny,  M.D...  .216 

Ferri  per  Bulph,  in  Hemorrhoids,  by  G.  S.  Conrtright,  M.D 257 

Ferri  Por  Chloridi,  in  Croup. 625 

Ferri  Per  Chloridi,  and  Collodion 182 

Gnnshot  Wound  of  Intestine  and  Bladder 195 

Gunshot  Wounds,  by  B.  Howard,  M.D 137 


C0HTBNT8.  -V 

Governor  Tod 118 

Gravel,  Extracted  from  Male  Urethra,  by  B,  F.  McKcehan,  M.D.390 

Gastrotomy,  by  R.  Nelson,  M.D 

Huxley  vs.  Owen ; 53 

Hernia — Strangidated  in  Aged  Persons G5 

Hernia,  Femonrf^  in  Pregnant  Women,  by  W.  B.  Fletcher,  M.D .466 

Hemorrhagic  Diathesis,  by  J.  W.  Hughes,  M.D 84 

Homorrhage  Diathesis,  by  F.  Wagner,  M.D 142 

Homeopathic  Globules 121 

Homeopathy 487 

Hermetically  Sealing  Gdnshot  Wounds  of  the  Chest 172 

Hospital  for  Consumptives ; 308 

Ht»<pital  Gangrene,  by  A.  H.  Stephens,  M.D 321 

Hospital  Gangrene 598 

Haematuria ...•••• , .  .379 

Hfnnaphrodism 637 

Hypodermic  Medication 252 

Hypodermic  Medication  of  Uterine  Pain,  J.  Henry  Bennett 505 

Hypodermic  Medication  of  Uterine  Pain,  by  G.  T.  Elliott,  Jr. . .  .622 

Ho^piub,  Militar}',  at  Nashville,  by  R.  Wallac^  M.D 587 

Hospital  Reports  : 

Clinical  Reports  of  West  End  Gen*l  Hospital,  Cincinnati 598 

(  linical  Reports  of  Marine  U.S.  Gen*l  Hospital,  OinciniMti ....  605 

Hr'morrhage  Post-mortem,  by  F.  Wagoner,  M.D 388 

Iridwtomv ' 49.  199 

Inlvpendent  Journalism 362,  558 

InrL-ion  of  Os  Uteri  in  Sterility 879 

Inci>ion  of  Uterus 380 

Iodide  of  Lime,  A  Substitute  for  Iodide  of  Potassium 200 

Itch  Treated  with  Bergamot 580 

Iiin«'m*^nata  (artery)  Successfully  Lignted 704 

LiTTEBs  :— From  Bo8ton,103,  228,  431,  676,  735  ;  Dr,  Parvin,476, 
545.007.  674,  732;  Dr.  Day,  105  ;  J.  O.  Marsh,  166  ;  Dr.  Scoby, 
167  ;  Dr.  MoKee,  343  ;  New  Mexico,  33  ;  Dr.  HefTman — San  Diego, 
479  :  Dr.  Finfrock.  Idaho  Temtory,  479  Dr.  Sipe,  Pumpkin-seed  in 
Taj  L-worm,  480  ;  Dr.  Reeve,  487  ;  Dr.  Kearney,  549. 

Liquor  Calcih  in  Diarrhoea 41 

Lt*w>on  L.  M.  Death  of 115 

Liili"t«>my,  R'cto- vesical.. . 268 

Lar:^'^  Brains 488 

LiiDjvnons  Eves 570 

L-'fi  Ion  lancet '. 692 

Literar}'  ExcbangoH 125,  442,  618 

Mrf'icAL  Societies  : 

A  ••'ieray  of  Medicine,  Cincinnati,  28,  99,  221,269,  331.  400,469 

59 

Iiidianapolih  Medical  Association 48,  146,  274 

OWo  State  Medical  Society 306,  365,  423,  489 

JndianA  State  MetUcal  Societv 305,  365, 448 

Triplrt-  Medical  Societv ' 217,  242 


▼1  •  OOHTERTfl. 

Medical  Formulary,  Ellis 113 

Orthopordic  Surgery,  Bauer's  Lectures 168 

American  Medical  Association 247,297,  407,  440 

Miami  Drake  Medical  Society,  Organization 486 

St.  Lonis  Medical  Society — Proceedings 522 

Medico-Ghirurg.  Society  of  London 582,  668 

American  Pharmaceutical  Association ^  .567,  616 

McMunn's  Elixir  of  Opium 318 

Medical  College  of  Ohio 363,  688 

Medical  Colleges — Various  notices 248,  368,  565 

Military  Surgery,  Cases  by  A.  McMahon,.M.D 203 

Medical  and  Surgical  Reporter 492 

Metallic  Mercury  Found  in  Bones 521 

Medicine  in  Cincinnati 685 

Medicine,  its  Nobility. 57 

Milk  in  the  Human  Breast— To  Cause  its  Flow  636 

New  Editorial  Arrangement 121,687 

New  Mode  of  preparing  Beef-tea 121 

Nitrate  of  Silver  to  Preyent  Pitting  in  Small -pox 199,  575 

New  Hospital  in  Boston 367 

New  Remedies — A  Report  by  Bdward  Steyens,  M.D. . .  / 449 

New  Fee  Bills 444 

Obituary  Noticbs  : 

Dr.  L.  M.  Lawson,  115,  Dr.  D.  8.  Gans  47,  Drs.  Fleming,  Cox, 
Bache,  307  Drs.  Spahr,  Armstrong,  448,  Drs.  Huston,  Ware,  Morris, 
618,  Drs.  Guthrie,  Morris,  Knight,  Cassidy,  705. 

Oxygen  as  a  Therapeutic  Agent 508 

Oxygen,  its  action  on  Wine 127 

Obstruction  of  the  Bowels,  by  Will.  Commons,  U.S.N :201 

Ophthalmoscope,  its  Clinical  Uses,  by  Dr.  Tumbull 290,  351 

Ophthalmia,  Phlyctenular,  by  E.  Williams,  M.  D 460 

Ophthalmological  Department,by  E.  Williams,  M.D 697,  749 

Oxone 489 

Officers'  Hospital,  Dr.  Gobrecht 557 

Ovariotomy,  is  it  justifiable. 683 

Phloridzine 133 

Purpura  Hemorrhagica,  by  J.  Bowman,  M.D 144 

Present  State  of  Therapeutics,  by  J.  Hnglies  Bennett 312 

Purpura  Hemorrhagica 272 

Parvin— Letters  from  Abroad, 865,  476,  545,  607,  674,  732 

Permanganate  of  Potash,  its  Therapeutical  Use 373 

Paracentesis  Thoracis 198 

Perforation  of  Membrana  Tympani  for  Deafness 269 

PlacenU  Previa 525,  686 

Pneumonia . . .  .567,  620,  Acet.  of  Lead  in 620,  Chlorides  in,  613 

Pharmaceutical  Humor 617 

Quinine,  its  Substitutes "...  .271 

Quack  Medical  Literature  of  Religious  Newspapers 244,  614 

Rheumatic  Fever 61,    64 

Report  of  Operations  in  the  Field,  by  W.  H.  Matchelt,  M.D ....  78 


C0VTIVT8.  Vi^ 

RemoTft]  of  Piece  of  Catheter  from  the  Bladder 257 

Bnptnre  of  Fundus  Uteri,  by  Stephen  Bonner,  M.D 516 

Bnpture  of  Fundus  Uteri • 531 

Bupture  of  Fundus  Uteri,  by  S.  £.  Jones,  M.D 664 

RKTnws  Aim  Notioxs  : 

Manual  on  Extracting  Teeth,  Boberson 42 

Materia  Medica,  Carson's  Synopsis  of  Lectures 48 

Camp  Diseases,  by  Woodward 44 

Physicians'  Hand  Book 45 

Asthma,  by  Salter 112 

Illinois  State  Medical  Society ^ 168 

American  Pharmaceutical  Association 170 

Pharmacy,  Parrish 171 

Medical  Education,  Chew 238 

Medical  Society,  State  of  New  York,  1868 239 

Human  Physiology,  Dalton 240 

Lunatic  Asylum  Reports 297,  241 

Diseases  of  the  Ear,  Von  Troltsch 360 

Venereal  Diseases,  Bumstead 432 

Rheumatism,  Fuller 486 

Obstetrics,  Hodge's  Principles  and  Practice 487 

The  Uterus,  Byford 483 

Weak  Lungs,  and  how  to  make  them  Strong,  Dio  Lewis, 553 

Physicians'  Dose  and  Symptom  Book,  Wythes 556 

Military  Medical  and  Surgical  Essays,  Hammond, 610 

Gonorrhoea  and  Syphilis,  Durkee. 611 

Movement  Cure,  Taylor /. 612 

Memoranda  of  Poisons,  Tanner 618 

Medical  Dictionary,  Thomas 681 

Alcohol,  Tobacco — Miller — Lizars 682 

Philosophy  of  Marriage,  Ryan 688 

Strychnine — poisoning,  by  Isaac  Mendenhall,  M.  D 26 

Strychnine — Antidotes 255,  314 

Surgeon  Oeneral  Hammond, 119,  128,  558,  fll9,  689 

Syphilis  Conveyed  by  Vaccination 124 

8yphilis  Prolonged  Incubation.  ..v. 827 

8mall-poz  and  Vaccination 496 

Stricture  of  the  Urethra 510,  535 

SaliTary  Calculus 512 

Scarlatina,  by  Charles  Cochran,  M.D 677 

SabclaTian  Artery— Ligature 311 

Sore  Nipples 878 

Sarracenia  Purpurea^ 200,  320 

SdmnlanU  in  Feyer 282 

Specificity — Translated  from  Trosseau,  by  Dr.  Douglass...  .278,  335 

Ql  John's  Hotel  for  Invalids 229 

Sodden  delivery 685 

St.  Mark's  Hospiul  Africa. 692 

Stricture  of  Nasal  Duct 697 

TeUBos  Woorara  in 64 


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TRUSS,  BRACK  AND   BANDAGE   INSTITUl 


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THE 

CIXCIXIVATI  LANCET   AND  OBSERVEK. 

rONDL'C'TKD    UT 

E.  B.  STEVENS.  M.D..  AND  J.  A.  MURPHY.  M.I>. 


VoKVlI.  JANUABT.  1804.  No.  1. 


Grldinnl  C^oicmunUntixmiS. 


ACTHM.r.    I. 

A  ClMffiico-Patliological  Classification  of  FovcrSi  and  Hints  at  Treat- 
ment Based  Thereon. 


BT    ALK.X.    SfCr.RlI'i:,  M.I),   tIGRE.V,  OHIO. 


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■  ■  ■ 

^rrb  aD>l  T'tii'lor  couM  m^k  Utr  my  vii"W!«,  nml,  n!*!or  r<Tiiliii«r  the:ii,  ciM!fc?*s 
TO"ar»-*!f  e'lifi"!  ih'-n'hy.  ari«I  riTtuninoii'l  th^ir  }<u1>]i<'atifiii,  1  i-i>i;l'l  no  h)ii;!vi* 
fear  ih"*  hizi'llin;*  ihcv  iiiijrh*.  receive  at  the  hninl:!  of  less  iutelli^^Liit  and  lod 
•ii-l  critiM. 
If  I  h*T«»  brought  in  l!;:ht  n  inoilicil  subjecr  v;iliinhl«  t^  flu*  prof.s-ion  or  to 
imtitin-l.  I  nri«i  nwml  \^\\l^:]\  f'T  lh*i  cie'lil  «»t  il  ti)  ynuj-M-lf ;  for.  Ic-iilcs  muoh 
>r  valiinML-  in^'orin  ii:>>n  nii<i  iminy  ii*iefn]  hints  whicli  I  h-ive  ohiiiii:''-!  t'vnui 
iver«%»»«»in  w.fh  \\''i  thr.>".i!:h  iiumv  vesir.-*,  one  liint  droiir-O'I  hv  vour^clf  ii 
hy  T«»»r^  up  I  r-»r..-../riiiii;  iiiure'i-"^  !iaj»  hf-cn  <>f  nmcli  vni:i«'  lo  nie  in  <jiiic!;en- 
n.y  «.  h««TVji:iori  n;oa  the  j-ulij^ct  of  i!;c  follouitnf  .'iriii'K. 
Tt.«  jii.hli«'»tii»:i  ii '.y  !»e  preni-nun*.  hmI  1  i:now  iu'.l  w'l  thit  the  stibj*'-*  \n 
>:•  J  r-TV  inij'Orf-rtly  :  i.iii  whit  «if  lrn»h  if  c  i:i::;iii:-«  is  n«»«v  ilio  junp'-ly  <»f 
r-  rVi**  'n.  au*\  i*  wiil  I-.-  their  «!ufy  fur  i!j..*  fitmo.  u.s  will  as  mj  i:wn,  lo 
fari:"  .t  yf  it*  eriwi!!  :inl  r"i.j'\v  i's  «!"r!<-i»Mi'-u-'«. 

I  &!»,  wiih  ;rt:»tel'iil  xc«jcct, 
»i%XA.  P-'-mUr  ?.  I'*  •;.  *  AT.r,.\.  ?!■  liUIM:. 


£hftRt.''on  ftf  Fever. —  I'l.'^  (Ii-iluiilo.Ms  of  fov.-r  wltl- h  ]jav.»  i»i'ii"ially 
W**!  ::i-.-'-ri,  hiive  pr.'p'^.-ol  S')inc  <iii'»  or  n>'»ic  f»f  \\w  pn>iiiini>iit  sym',- 
totts  of  Trvcr  as  ihe  il'  "a^^'.'  par  ^r,  tiiiis  nuikiiig  no  inutciial  iiiipiovu- 
■ler.t  •in-'c  ihc  time  of  l.iai'.'ii. 

Patbologihts  of  the  present  n;^o  have  pro-sontcd  htnutiiral  lo^i^lns, 
ac*  onlj  as  causes,  but  p.ilhognomonic  of  the  dilTeront  kiiuls  of  fever, 
\B«t  if  these  lesions  were  the  causes,  they  ou^^ht  (o  be  found  to  cxUt 

1'  Tl,— 1. 


xanEB  M)i :aiii:i>  w»:«v  ur  tuii  ui.n  HTAnn. 

New  CentraJ  Office,  -  -  -  -  Opened  April,  181 

B.    FBANK   PALMER, 

Xynro»-ArlU  l«  lU'    M'Jiral  r.M'-u.,  ami  U.mil»!t,    JiiHo.  .«■  ,V.w 
^,-p,,r»..M«.i    l..n.,.,.rn/ f  I.,  -  IWm.r  ,,.„,■■  L^:^. 

[Ij...  rrinovod  lo  U«^  STONE  Kt)lt*ICK. 

Xo,   ItHN)   Cli*Httii)t   atrc«t,    PtilliKleliililn. 


"T?.'pr..pt"i 


the  bv. 
Paii-r  . 


rdipccti 


.<  |»it 


\>w  Ruka  tnt  Aii'|iiiMl)nna,  KiuJ  (nil  ii^on 
,  i>ent  4rw ' '  '  .(utiu,  lij  mail  or  oltitint 
lii<i|.  1      ,»nil  nil  pPiMii*  Lnllvniltit,  It 

fxpitti  bT  IlmlUllnn.     AddrtH 

B.  FRANK.  PAUlEft,    „ 
Nu-  lODD  Cli»tiint  mnft   FliiliiilulpU 


8.  N.  HABBH,  CORLISS  A  CO.,  Afivuo, 


TKriLLIAM    Z.     RBBS, 

TUUSS,  BIUCE  AND   BANDAGE   INSTITUf 


VliaciCAt'  Atm  DBI«TAL  lIlMTHIinKilTK,  AUTSFKIABij 

Lcua.  AUMH,  aANnst  A»n  ?iiMea, 

90. 71  w.  Btx.vn  ST.  oxNcinnATi.  oaio. 


THE 


CIXGINNATI  LANCET   AND  OBSERVEU. 

roXDfCTF.D    BT 

E.  B.  STEVEN'S,  O.,  AND  J.  A.  JIUKPIIY.  SI.P. 


▼ol.  VIT.  JANUABT.   1804.  No.  1, 


0riOin;iI  (!^o)nmnnifntiiCi»<s. 


ARTK-I.r.    1. 

A  Ch»mico-Pathologic3i  Classification  of  Fevers,  and  Hints  at  Treat- 
ment Based  Thereon. 


ET  ALKX.  Mrnnn>K,  m.i>,  mrhea,  oiiio. 

To  pB-ir.  J.  r.  Ktrtlamk 

Ha!  i»  Tiftt  l»<»rn  fi»p  your  rc<ni"«t  that  I  wnnlil  ivri»<*  out  in  full  Jli(»  views 
tij«*fi  f«»Tcr  wMch  I  M»nji'  tlmo  hi'i'ure  j»:i»'ti:illv  O-Xj-liint'il  to  yn'i.  it  ini;r!it  li:ivo 
K-rrn  «  1  >u;;  liiiif*  l-('!nrc  I  slioiiM  liivi.'  hti'l  (lif  ftirMtii'ie  (o  jitihli.^h  to  tlio  wniM, 
in  fuM.  A  tiiJij'cr  »hic!i.  ilio-i^li  vi-ry  th-.u*  lo  invscll".  ini^rlit  imt  lie  ifriMvi-il  m 
%  c»»riliil  I'.innrior  hv  iiiniiv  ip  i'1»m?«.  lint  wiicn  ii  tiMii  dT  vmir  I'xti'ii.^ivo  re- 
*C!krrU  iin«l  rirnlor  cuiiM  iiJ*k  lnr  my  xiowii,  ninl,  n!*ii'r  ri'juliiig  tlH-tii,  cohIVhs 
Tw:jr«"lf  e'l.Sf  I  ihiMiliv.  nnil  riOnniirM'ii'l  lli^ir  f<ii1>lic'ation,  I  ri'iiM  im  Imip'^r 
fe%r  th-  liiniliii^  ihry  iiiii.»:i!  xoicive  \\i  the  hiruli  of  Ivy:*  iiitolli'!:';iit  uiul  k-ss 
can  ill  Clitiri. 

If  I  hiv.'  ti:-o?iphl  tft  ji^lit  ft  mnlicil  siiliiocr  valiiuM**  (n  the  pr<)r'*<it»n  or  to 
BarAin  I.  1  fi"i«t  nwiii.l  :iiiit'?i  •  f  ih-J  (Tr»'«lii  ot"  it  to  v«»u!>«''ir;  f'H'.  Icnilis  iniioh 
i^'her  taliiiM  ■  inform  it:'»n  :iTni  iiiiiiy  iMoftil  h\ul<  wliicli  I  \i\\c  <i]»tali:f»<l  frnin 
r-inver^Ji'i'-iin  wl'li  A  o::  ilir-'ii^li  ni.'iiiv  vni^,  om-  hi'it  ilr«»;ifi*"l  l»v  vuiP'^clf  a 
r«»w  XfkT*  M^  •  r-«..'...'riiii;r  ij-uri'i*"!  !i:iH  !»•  CM  of  nMi('!i  VfiliM'  III  iiiL*  ill  qtiickcii- 
isff  imv  •  ''•••rv:i'i«':i  iijori  i)io  s-n'ij'cl  <»l"  i!:e  tVillowitur  article. 

T'ii*  |-».' ".i'*.it..';i  i-.'.y  III-  ['r«.'in-i»iir«».  iin-i  I  hrmw  iitll  wf-il  thit  slic  s;;lj<"^'.  i^ 
trr*!»- J  T."v  :ru»-o- f- f'.v  :  l«!it  what  ftf  truth  't.  r  ;!r:iiii.<  i.n  no  a-  tl.*-  |ini|"-"iv  »«r 
iL^  S'T-  :'*•*•*  7t.  ntki)  i'  will  In-  tl.r-r  «lu!v  fur  ili;  fitmo.  u-i  wtll  :is  hit  twn,  to 
J'irw*'  :l  ■•!  .'<  •■rmiM  :inl  "•■IJ''y  i'-^  il'-flfiiMi'.-ii-s 

I  a:n,  will  j^r:iti*:»il  M'^ied, 

P  '.r*.  I'  -♦ml.rK.  1-  •:.  AT.KX ,  M.  IJKM'i:. 

I\rini*'t>n  fif  Fcrer. — 'IT.'^  fl«'iiiiiiI'iMs  of  fowr  wlii- li  liriv-*  gcn'Mally 
\'t' ',  ji^K'Ji,  li.ive  pr««p.).-0'l  sijiiic  on-  di-  n>'U'  (*(  iho  j'-nMuiniMit  .•.ymj'- 
toxci  i.f  f'vcr  ai  the  il.- •.'.!<:•'  ^jcr  sc,iU\is  in-ikiiig  ii4i  imitcMiuI  iiiipiovc- 
ttie'.t  i»in»c  the  ii?ij«?  nf  <ia!.'ii. 

Parbilogists  of  iIh*  i»:o>cnt  a;;!jo  have  prc.-»fntcil  strtntural  !o>i*ins, 
■ol  onljr  as  cau^t'S,  bin  patho^nomunic  of  the  difTcrpnt  kiinls  of  fever. 
Bat  if  iheso  lesions  were  the  cause**,  they  ouijht  to  be  found  to  exist 
VI. —  1. 


10  Original  Communications,  f  January, 

universally  ;  that  is,  any  given  lesion  which  is  the  cause  of,  or  pathog- 
nomonic of  any  particular  fever,  ought  never  to  be  absent  when  that 
fever  exists.  To  illustrate  the  fallacy  to  which  this  structural  expla- 
nation of  fever  is  liable,  consider  typhus  one  of  the  beet  characterized, 
perhaps,  of  all  the  severer  fevers.  Various  morbid  appearances  and 
etrnctural  changes  are  found  to  exist  in  subjects  who  die  of  this  fever, 
such  as  congestions,  inflammations,  softenings,  etc.,  but  no  one  of 
these  is  constant.  The  same  may  b.e  said  of  typhoid  fever  ;  for,  not- 
withstanding that  ulceration  of  the  intestinal  glands  is  very  common- 
ly found  in  the  subjects  who  die  of  it,  yet  it  is  well  known  that  we  see 
continued  fevers  of  typhoid  type  in  which  these  ulcerations  are  not 
found  after  death,  neither  have  we  any  warrant  for  supposing  that  they 
exist  in  many  who  recover.  It  seems  to  me  more  compatible  with  our 
present  state  of  knowledge  to  consider  the  lesions  of  both  typhus  and 
typhoid  as  contingent  consequences  of  the  fever,  than  as  essential  to  it. 

A  definition  of  fever,  it  appears  to  me,  ought,  in  order  to  rank 
with  scientific  definitions  generally,  to  comprehend  the  essence  of  the 
object  defined,  and  not  merely  some  of  its  appearances  or  symptoms. 
It  is  not  true  that  increase  of  heat  is  always  present  in  every  stage  of 
fever,  and  that  therefore  it  should  be  set  forth  as  the  proximate  cause 
or  essence  of  that  disease.  It  is  not  true  that  the  pulse  is  always  in- 
creased in  frequency.  Otherwise  it  might  be  said  of  intermittent 
fever,  of  some  forms  of  congestive  fever,  and  of  yellow  fever,  during 
their  intermissions,  that  the  patient  has  no  fever.  But  this  statement 
could  not  be  true,  for  the  patient  as  verily  has  the  fever  or  the  disease 
during  the  intermission  as  during  the  paroxysm.  Besides  these  fevers, 
eveiy  physician  who  has  had  large  experience  for  several  years  has 
seen  cases  that  have  passed  through  all  the  phenomena  of  fever  with 
the  pulse,  nearly  or  quite  the  entire  time,  at  or  below  natural  frequency. 

I  propose,  then,  the  following  definition  as  an  expression  of  the 
fact  of  fever :  Fever  is  that  disturbed  state  of  the  fu.ictions  which  is  caused 
by  acute  disintegration  of  matter  in  the  whole  or  in  a  part  cf  the  organic 
elements  of  the  body, 

I  assume  that  it  will  be  generally  admitted  that  acute  disintegration 
(by  which  I  mean  more  rapid  disintegration  than  in  health,)  takes 
place  in  fevers,  and  that  this  is  the  chief  or  sole  cause  of  increase  ot 
heat,  and  the  chief  source  of  the  several  evacnations. 

It  may  be  objected  that  the  above  definition  would  necessitate  the 
including  of  cholera  and  cholora-morbus  among  the  fevers.  I  am  not 
sure  but  these  might  with  propriety  be  called  fevers,  their  chief  differ- 
ence from  other  fevers  appearing  to  be  that  they  in  a  few  hours  effect 


18M.]        licBfLix^z^GlMt'^UatumMd  TreaimeiU  of  Feven.  11 

as  «i«eli  ^aste  of  ike  body  as  the  fevers  proper  aceonplish  in  as  many 
d»j*  #r  fs«ek8.  I  bave  for  several  years  been  in  die  habit  of  teUin|v 
wtademiM  of  saedticiRe  tkal  cholera-morbms  appeared  to  me  to  be  a  rapid 
erolutioii  oi  bilious  feiror.  The  definitioa  here  givea  iaeludes  not  only 
aU  ferers  eooinioiily  «o  called,  but  all  trannaatcc,  syiapiomatie  and 
emptire  fe^iers,  whether  regular  or  irregular. 

Whea  a  late  author  cm pnesscs  upon  his  class  and  bis  readers  tbft 
VAxim  "  that  fever  is  not  inflammatiom/'  he  u tiers  a  common  tniiwn  ; 
bat  there  can  be  bo  doubt  that  in fla«i nation  may  be  the  cause  of 
feTer,  aud  that  iafUmmatiou  may  be  caused  hy  fever,  or  by  the  reten- 
tion m,  the  system  of  that  detritus  of  the  ong^anic  ciemeBts  which  it  is 
the  office  of  the  fever  process  to  dischai*gc  Witness  the  variety  of 
inflanamatory  complicatious  which  are  liable  to  aapcrveae  upon  a  case 
of  typhoid  fever.  But  it  wae  no  part  of  my  decigu  to  write  a  criti- 
ci«ai  or  a  review. 

I  MOV  propose  the  followtug  simple  clossificatioa  of  fevers,  which  I 
coBoeive  to  bo  founded  iu  nature  and  upon  a  chcmico-pathological 
baais.  aad  from  which  is  dcducible  important  hiats  toward  correct 


Class  I. — Nilrogtmmt  Feoert, — ia  wbieh  tke  n'trojenou^  elemomts  &re  ehieijr 
coaeersed,  sod  in  wbich  elimrn&lioa  ef  effete  matters  must  take |»lA«eohiefl/' 
tbrosgh  tlis  kidaeyt,  slse  bj  maeoai  sa4  seress  discharge,  sappur&tiea  and 
bspasrrhsfc. 

Cla»9  it. —  Ctrbani/erout  FfVfn, — ^la  whlcli  thti  carhonl/erons  elfm^nU  are  ehicflj 
r«»ae«rned,  sad  ta  wbieh  the  ehief  elimiuutieas  mast  u4e  place  throagk  the 
liver. 

CL%n  ITT.— CSnpoiini  or  Mixed  Feven, — which  partake  ef  th-o  characters  tf 
ibsss  «f  Classes  I.  sad  IL 

Th'Mta  three  classes  for  purposes  of  cAnremence,  or  to  suit  the  fancy 
of  wriiers  and  teachers,  may  be  suluiiviiod  into  orders,  genera  and 
species,  bat  this  I  do  not  propose  now  to  d«i  systematically. 

Class  I.  embraces  the  continued  levers  pruper  and  the  iaflammatory 
fevers  iacladiag  the  erysipelatous,  diphtheriiie,  eruptive,  syphilitic. 
gonorrho^al,  and  hectic. 

Class  IL  embraces  the  marKh  miasmatic  or  bilious  fevers  propr;r. 
The  miasmatic  intermittent  fevers,  or  agues,  probably  belong  to  this 
caas  ftod  perhaps  some  otberc. 

Claiit  III. — All  fevers  of  tiits  class  must  uccessarily  he  somewhat 
inegniar  ia  their  characters,  being  composed  of  the  elements  of,  or 
acted  opoo*  by  the  causes  of  both  the  otiier  classea.     The  coucep- 


12  Original  Cemmwrnkaihrn,  [January, 

tioA  is  naiuralr  wliicli  we  find  to  he  trne  by  obfierTAtiorr,  that  the 
two  sets  of  canics  coraixined,  operate  in  difiercnt  degree?,  thus  produc- 
ing a  great  variety  of  effect.  Hence  we  have  a  proper  typho-malarial 
or  malario- typhoid  fever,  the  bilioue-typhoid  of  some  regions.  Thi« 
is  the  autumnal  fever  which  so  often  boulke  the  practitioner  in  its  early 
»tage  to  dccifdc  whetlicr  the  case  be  one  of  interiBitteBt,  remittent  or 
continued,  and ^  which  sonaetimea  puts  on  a  very  typhus  aspect.  (It 
seems  to  have  been  from  The  contemplatioa  of  fevers  of  this  kind  that 
the  illnstrious  Cullen  was  kil  to  suppose  that  fevers  were  transferable 
from  one  type  to  another  without  any  change  of  their  nature.)  Gas- 
iro-enteric  fever,  or  that  variety  of  bilious-remittent  in  which  more 
or  leus  irritation  or  inflammation  is  the  canse  of  hs  obstinacy,  belongs 
to  this  ckss.  Inflammatoiy  dysentery  and  diarrhcea  and  rheumatism 
of  miasmatK  rcgionsy  belong  to  the  mixed  fevers.  It  appears  to  mo 
that  yellow  fever  is  compound  also,  and  its  protean  character  is  well  ac- 
coanted  for  by  the  supposition  that  it  is  fornoed  by  the  varying  pro- 
portions of  the  elements  or  causos  of  Classes  I.  and  II.  This  view  is 
confirmed  by  the  veiy  diflerent  kinds  of  treatment  to  which  it  yields 
in  difTerent  localities  and  different  seasons,  and  sometimes  in  different 
localiiies  in  the  same  season. 

Whoever  has  carefully  observed  the  progress,  termination  and 
sequclas  of  fevers,  and  noted  the  characters  of  tlie  excretions  which 
occur  during  their  progress,  wmII  perceive  by  a  little  reflection  that  this 
svstem  of  classification  is  not  without  a  substantial  basis.  Let  us  now 
consider  a  case  of  typhoid  fever.  What  are  the  excretions  ?  What 
are  the  contingencies  ?  And  what  are  the  sequelae  ?  The  chief  ex- 
cretion from  day  to  day,  and  from  week  to  week,  till  its  termination, 
is  dense  urine  loaded  with  nitrogenous  salts,  the  detritus  of  the  nitro- 
genous elements ;  or  if  the  urine  does  not  continue  of  this  quality, 
becoming  limpid  or  very  small  in  quantity,  the  patient  becomes 
ikliiious,  local  inflammations  and  congestions  arise,  and  if  the  den- 
sity or  quantity  is  not  restorevi  in  a  faw  days,  he  dies.  The  diischargo 
of  bile  is  at  no  time  a  marked  feature  in  the  progress  of  pure  typhoid 
fever.  A  considerable  quantity  is  sometimes  discharged  during  the 
first  few  days,  while  the  patient  takes  little  or  no  food,  but  when  a 
moderate  amount  of  food  is  digested,  the  accomplishment  of  whicU 
should  always  bo  sought  for  in  this  disease,  the  bile  discharged  will 
not  be  a  notable  quantity.  Those  green,  brown,  or  pitchy  stools,, 
called  bile,  which  sometimes  follow  the  use  of  mercury  in  this  fever, 
can  hardly  be  called  a  natural  evacuation,  and  have  consequently  no 
place  in  an  estimate  of  its  nature.    The  other  evacuations  are  mneus^ 


1S64.]        McBniDK — Classificaiion  tmd  Treatmnt  of  Ftven.  13 

vrom,  pas  aod  blood,  of  one  or  more  of  wbick  there  is  Bometimes  ft 
eoouderAbla  qiastitj.  AH  these  are  nitrogenous,  from  the  decompo- 
•ilioB  of  tKe  tissoes  and  from  the  blood.  The  contingencies  of  the 
dii^asa  are  local  congestioDS,  ioflammatioas,  haemorrhages,  suppura- 
tioAa.  These  are  liable  to  occur  in  various  parts  of  the  body,  wher- 
•rer  aitro^nous  tissue  exiats,  and  without  the  accession  of  one  or 
More  of  these  coatiagencies,  death  rarely  occurs.  The  nitrogenous 
liesoeti'  alone  are  concorued  in  these  changes,  and  their  repair  does 
not  take  place  without  the  evacuation  of  nitrogenous  matter.  The 
avqnelje  are,  wasting  of  muscular  tissue,  sometimes  peimanent, 
wasting  of  cellular  tissue,  caiies  and  necrosis  of  bones,  anchylosis  of 
joiats,  destruction  of  more  or  less  of  the  lungs,  rigidity  of  muscles, 
cnfeeblemeot  of  the  nervous  system,  cicatrization  of  the  bowels,  affect- 
ini^  more  or  less  their  functions,  alopecia,  more  or  less  permanent. 
To  eliect  these  changes  the  wasting  of  nitrogenous  elements  is  neces* 
tary ;  and  to  effect  their  repair,  the  addition  of  nitrogenous  ibod  is 
wential. 

From  a  consideration  of  these  facts  the  error  is  pilpable  which  some 
liflie  ago  pr^'ailcd,  of  trying  to  sustain  and  recuperate  all  fever 
paticats  by  means  of  a  sloppy  farinaceous  diet,  gum  water,  etc., — food 
which  did  not  contain  the  elements  which  could  possibly  acoompHsh 
ike  object  The  necessity  of  animal  and  other  nitrogenous  food  also 
becomes  apparent,  the  good  eflects  of  which  have  of  late  years  been 
amply  proven  by  practice.  la  the  purely  inflammatory  fovcis,  such 
ac  pneumonia,  pleurisy  and  erysipelas,  the  nitrogenous  character  of 
the  excretion  becomes  Ktill  more  apparent,  and  the  amount  of  urea  and 
the  arates  discharged  bears  strict  proportion  to  the  extent  and  iuten- 
tity  of  the  inflammation  and  the  amount  of  disintegration  that  takes 
place.  The  bilious  evacuation  in  these  cases  is  of  small  amount,  nor 
does  it  demand  our  attention  except  in  some  cases  which  occur  in 
malaiious  districts,  where  they  become  properly  compound. 

llie  depressing  and  fatal  character  of  typhus  fever  seems  to  be 
owing  to  the  fact  that  the  urine  does  not  .carry  off  sufficient  of  these 
compoands  ^witness  the  pa*e,  limpid  urine  of  some  of  the  worst  cases 
of  typhus  at  their  oqs<.<,  and  the  uniformly  fatal  termination  of  those 
caaet  ia  whick  this  corditioa  of  the  urine  doos  not  improve.  There 
ia  not  a  compensatory  discharge  of  bile,  nor  will  the  discharge  of  any 
qnaatity  whatover,  either  spontaneously  or  by  the  action  of  medicine, 
coaipeaiaia  for  the  retention  of  nitrogeaous  compounds.  Uraemia 
will  follow  in  every  such  case,  and  uncmia  means  nothing  but  tlie 
of  poisoning  by  urea  and  the  urates. 


14  OripiniU  Coftimunkeihn^.  [Jtnnarj, 

When  these  compoiinds  are  not  dn)y  discharged,  there  19  no  oi'gan 
of  the  body  exempt  fron  the  danger  of  destructive  miammatioo,  and 
it  is  aoi  unreasofta^  le  to  suppose  that  Peyer's  axnl  the  solitary  g^anda, 
instead  of  becoming  diseased  per  se  and  actiDg  as  a  canse,  become  in- 
Hamed  ia  consequence  of  the  retained  nitrogeaons  compounds  attempt- 
ing a  lodgment  in,  or  escape  throngb  them.  That  these  inflammatioDS 
are  thus  pro«hiced  seems  the  more  leason^ible  when  wo  reflect  that 
neither  chemislry  nor  the  mioroseope  has  detected  in  the  blood  or  tissues 
of  the  body  any  snbtle  poison  which  has  been  supposed  to  be  the 
eause  of  fever. 

Why  the  intestinal  glands  do  not  so  constantly  become  inflamed  in 
typhua  fever,  may  be  in  consequence  of  its  greater  depression  and 
shorter  duration,  or  because  of  the  more  general  action  of  the  original 
cause  of  the  ( i sense  and  the  different  distribution  of  nerve  force. 

Recovery  is  always  slow  in  these  fevers,  and  is  not  always  complete 
till  a  long  time  after  the  body  has  attained  to,  or  above,  its  natural 
bulk,  for  the  reason  that  more  time  is  i*equired  to  recuperate  the  nitro- 
genous tissues,  than  simply  the  adipose,  as  in  Glass  II.  ;  and  in  too 
many  cases  recovery  is  never  complete,  from  the  inabilify  of  nature  to 
restore  parts  which  have  been  destroyed. 

We  come,  then,  to  this  conclusion,  that  the  essence  of  a  continued 
fever  is  a  process  cf  acute  disintegr.  iiim  and  elimination  of  matter  from 
the  nitrogenous  tissues. 

This  view  is  similar  to  that  of  the  ancients,  that  fever  was  an  effort 
of  the  Ry^tem  to  cast  off  some  noxious  agent.  It  is  not  at  variance 
with  the  septic,  putrefactive  and  fermentative  doctrines  of  a  hundred 
years  ago,  wl  ich  kst  diflers  in  no  essential  from  zymosis,  so  much 
talked  about  of  late.  The  present  view  defines  what  classes  of  tissues 
are  being  disintegrated  and  the  channels  through  which  the  detritus 
must  be  evacuated,  and  chemistry  and  rational  obsetvation  prove  that 
there  is  but  one  chief  outlet  for  the  harmless  discharge  of  the  matter 
in  the  class  of  fevers  now  under  consideration ;  and  that  if  it  is  dis* 
charged,  or  its  discharge  attempted  elsewhere,  local  disease  is  the  con- 
sequence— and  if  it  be  retained,  congestion,  inflamnnation  and  nerve 
poisoning  and  death  mvs   be  the  resnlr. 

Any  attempt  to  euro  this  class  of  fevers  by  active  purgation,  or  by 
action  of  cholagogne  alteratives,  ^  as  a  tendency  to  enfeeble  the  patient 
and  to  precipitate  that  very  difficulty  whkb  of  all  things  should  be 
avoided — inflammation  of  the  intestinal  glands,  because  the  bile  and 
intestinal  secretions  contain  but  little  effete  nitrogen,  and  that  which 

15  contained  in  the  mucus  which  is  forced  by  the  cathartics  is  not  wh  % 


1864.  J        "McBBivw-^Clasnfication  and  Treafmeni  of  Fivers.  15 

the  sjstcin  is  laboring  to  discharge.  And  if  the  alterative  aids  in  the 
general  disintegration,  withoat  at  the  same  time  largely  enhancing  the 
tmonni  of  solid  matters  discharged  through  the  kidneys,  it  is  obvious 
that  the  danger  to  the  intestinal  glands  and  other  organs  niuet  be  pro- 
portionately greater.  Because  patients  sometimes  recover  after  this 
kind  of  treatment  proves  nothing  but  the  large  amount  of  their  vital 
force ;  and  that  the  alterative  sometimes  acts  favorably  upon  the  renal 
fanction.  The  employment  of  occasional  mild  purges  to  empty  the 
bowels  of  their  irritating  contents  docs  not  fall  under  this  censure* 

To  illustrate  Class  II.  or  the  carboniferous  fevers,  we  will  take  a 
plain  case  of  bi  ions  fever,  or  bilious-remittent,  as  some  prefer  to  cal 
it.  In  simple  bilious  fever  we  find  do  local  inflammation,  and  it  is 
of  extreme  rarity  that  any  inflammation  supervenes  upon  this  disease, 
neither  do  we  have  any  kind  of  ulceration  or  suppuration.  The 
entire  distress  of  this  fever,  after  the  head-ache  and  back-ache  have  dis- 
ippcarcd,  and  chiefly  from  the  beginning,  is  mferable  to  the  region  of 
the  stomach  and  associated  organs.  The  patient  has  no  appetite,  and 
even  loathes  food,  especially  animal  food,  constantly  till  the  fever  is 
finbdned ;  his  only  desire  seeming  to  be  to  get  relief  from  a  weight 
that  oppresses  the  epigast  ic  and  hypochondriac  regions  ;  and  as  often 
as  he  freely  vomits  or  purges  bile,  either  spontaneously  or  by  the 
proper  action  of  medicine,  he  experiences  relief  and  the  fever  and  dis- 
tnf&«  are  mitigated.   Naturc  prompts  even  the  vulgar  how  to  treat  this 


*NoTC. — We  are  well  aware  that  carefullj  conducted  mercurialization  in 
these  feTerfl  sonetiraes  seems  to  aid  their  favorable  termination  ;  but  a  close 
•tcerTer  will  call  to  mind  that  in  such  cases  an  improved  density  of  urine  was 
coincident  with  the  improved  moisture  of  the  mouth  and  relaxation  of  surface 
and  pulse  ;  but  when  the  urine  does  not  improve,  by  its  action,  the  other  sjmp- 
toBis  do  not  improve. 

i>r,  will  some  claim  the  operation  of  a  principle  recognized  before  the  dajs 
of  Haboemann,  **  Similia  timiUbiu  evrantur^'  and  saj  that  fever  is  a  disintegrat- 
iag  proceas,  and  mercurial  action  is  a  disintegrating  process,  therefore  it  is 
raiiunml,  because  like  cures  like  ?  This  would  be  good  argument  for  a  llomoc- 
opal  List,  for  fever  disintegtates  organic  elements,  and  so  does  mercury.  Bu. 
It  appears  to  be  a  fact  in  these  fevers  generally  that  nature's  effort  disiute 
grates  as  fast  or  faster  than  the  emnnctories  can  cany  off;  therefore  anything 
tkAi  would  cause  a  larger  amount  of  disintegration  (more  active  fermentation 
ec  tjmmlt)  must  increase  the  evil,  unless  it  at  the  same  time  in  equal  or 
graaur  proportion  increased  the  discharge. 

Tk«ro  should  always  bo  a  broad  distinction  made  between  that  kind  and 
aaonnt  of  alterative  action  which  helps  out  of  the  economy  peccant  matteis 
alroady  formed  or  forming,  and  that  which  effects  tht  formaiion  ot  aucVi  mt^V 


IG  Original  Communicatlom.  [January, 

disease,  and  there  is  hardly  a  farm  or  ^well-ordered  house  but  contaius 
some  one  or  more  of  the  simple  nauseants  or  purgatives,  to  which  they 
instinctively  resort.  Bile  is  generally  vomited  in  considerable  quantity 
spontaneously,  and  relief  is  never  obtained  till  this  is  freely  discharged 
I       I  or  purging  or  both,  successively  for  several  days,  and 

besides  this  and  sweat,  which  is  common  to  all  fevers,  there  is  no 
notable  evacuation.  The  urine  contains  urea  and  uric  acid  in  propor- 
tion similar  to  that  of  health.  It  sometimes  contains  bile  in  ndditipn 
to  its  natural  constituents.  When  it  is  small  in  quantity  and  dense, 
it  is  in  conHcquence  of  the  watery  portion  having  been  discharged  by 
sweat.  When  the  bile  has  been  in  a  proper  manner  evacuated  at  sue 
ccssive  intervals  for  a  week,  the  patient  is  ordinarily  found  to  be  con- 
valescent on  the  eighth  day,  the  fever  having  terminated  at  the  end  of 
the  seventh.  Some  cases  terminate  at  a  later  period,  but  they  will 
seldom  go  beyond  a  week  with  good  management,  unless  they,  are 
more  or  less  compound. 

Whether  these  fevers  generally  would  spontaneously  terminate  in 
this  manner  without  any  treatment,  we  have  not  much  data  from  which 
to  determine.  I  have  no  doubt  that  some  modes  of  treatment  are 
beneficial,  but  it  is  well  known  to  careful  physicians  who  have  seen 
mu  h  bilious  fever  that  harsh  or  too  much  purgation  is  liable  to 
transform  a  case  of  this  fever  to  one  of  a  continued  form,  resembling 
typhoid,  but  more  intractable.  If  this  is  effected  in  the  beginning, 
before  the  bile  is  evacuated,  the  case  becomes  one  of  our  Class  III., 
and  is  an  artificial  malario-typhoid. 

Mercurial  action  beyond  what  is  barely  sufficient  to  aid  the  evacua- 
tion of  bile,  initiates  general  disintegration,  which  also  transforms  the 
case  to  one  of  Class  III.  and  of  an  irritative  kind.  There  will  be  in 
both  these  cases  before  convalescence  an  increase  of  the  nitrosrenous 
salts  in  the  urine.  By  either  of  these  methods  of  spoiling  the  case,  it 
is  liable  to  be  made  double  or  triple  its  usual  length  of  duration,  and 
the  convalescence  will  be  similar  to  that  of  the  continued  fevers  proper. 

In  the  natural  course  of  this  fever,  as  stated  above,  convalescence  is 
apt  to  commence  on  the  eighth  day,  the  patient's  appetite  becoming 
good  almost  immcdi  ttely,  he  regaining  his  strength  and  returning  to 
his  business  in  a  week  or  less.  The  reason  of  this  rapid  return  of 
strength  is,  that  the  nitrogenous  tissues  (organs  of  motion)  have  not. 
been  attacked;  the  muscles  and  organs  generally  are  neither  wasted 
nor  in  any  manner  c  nfeebled,  except  from  the  fast  which  has  been 
endured.  It  seems  ii  many  cases  that  the  convalescent  does  not 
suffer  80  much  wcakuoss  as  would  have  i^ulted  from  fasting  a  simihir 


18S4.]       McBride — Classification  and  Treatment  of  Fevers^  17 

leogth  of  time  withont  fever.  The  substances  that  have  been  acted 
Bpon  mainly  in  this  fever  are  the  adipose  tissues  and  tbecarboniteroas 
nautr  in  the  blood,  and  it  actually  happens,  as  might  be  supposed 
from  these  facts,  that  lean  persons  are  not  the  usual  subjects  of  this 
lerer.  It  seems  highly  probable  that  the  chief  pabulum  of  the  fever 
it  the  carboniferous  matter  in  the  blood,  and  that  the  adipose  tissue  is 
Qoftmach  concerned  in  it,  for  neither  the  duration  nor  the  force  of  the 
hxfr  are  wholly  in  proportion  to  the  amount  of  the  patient's  fat, — 
fortbermore,  that  the  patient  recovers  frequently  without  extensive  loss 
of  this  substance. 

In  what  has  been  said  upon  the  nature  of  continued  fevers  no  men- 
tion was  made  concerning  the  consumption  of  fat.     The  fact  with 
regard  to  it  seems  to  be  that  the  fat  undergoes  natural  consumption  as 
10  health  ;  it  does  not  waste  in  a  few  days,  but  is  employed  gradually 
for  the  supply  of  respiration,  calorification,  and  for  the  production  of 
vital  force. 

It  is  a  common  opinion  in  regions  where  bilious  fevers  prevail  that 
the  too  free  use  of  pork  (carbo-hydrogenous  food),  especially  in  warm 
weather,  is  favorable  to  the  development  of  this  fever.  This  idea, 
which  is  corroborated  by  the  observation  of  many  physicians,  is  in 
bannony  with  the  carboniferous  view  of  the  disease. 

The  followinp^  facts  illustrate  in  part  the  different  remote  causes  of 
fifvers  of  our  Classes  I.  and  II.,  as  illustrative  of  their  different  natures. 
The  carboniferous  or  bilious  fevers  abound  most  in  rural  districts,  and 
especially  in  marshy  regions,  either  in  the  country  or  in  the  suburbs 
of  cities  where  tlie  ground  is  not  improved,  or  in  elevated  situations 
ezf<osed  to  the  miasms  which  arise  from  such  sources.  Now  in  these 
aitOAtions  there  is  a  greater  evolution  of  carburetted  hydrogen  and  car* 
bonic  acid  than  in  tho^e  which  are  more  dry  and  improved.  It  is 
notorious  that  the  inhabitants  of  such  localities  live  more  upon  a  cheap 
aod  farinaceous  diet,  together  with  pork,  than  the  people  of  cities.  On 
ilie  other  hand,  it  is  now  well  known  that  when  any  section  of  country 
Wcomes  well  improved  and  the  inhabitants  wealthy,  and  consequently 
live  luxuriously  on  rich  animal  and  other  nitrogenous  kinds  of  food, 
in  khort,  approach  in  their  style  of  living  to  that  of  the  cities,  that 
the  bilious  class  of  fevers  become  rare,  and  continued  fevers  become 
prevalent.  The  cities  of  London  and  Edinburgh  and  the  adjacent 
ccantry  afford  good  illustrations  of  this,  for  the  bilious  diseases  pre- 
Tailed  at  both  these  places  for  ages,  up  to  comparatively  a  recent  date. 
Now  aincc  the  cities  are  improved,  the  streets  drained  and  paved,  and 
the  sarronnding  country  drained  and  highly  cultivated,  the  cout\u\kbd 


18  Original  Communications,  [January, 

or  nitrogenous  fevers  prevail.  The  snmc  is  the  history  of  many  cities 
and  rural  districts  of  this  country,  with  (his  difference,  however,  that 
the  change  takes  place  in  this  country  with  great  r  rapidity,  for  the 
i-eason  that  the  country,  hoth  cities  and  rural  districts,  more  rapidly 
emerge  from  their  primary  crudeness,  and  the  population  in  one  life- 
time arise  from  poverty  and  simplicity  to  wealth  and  luxury,  so  that 
one  generation  which  has  suffered  from  agues  and  hilioas  fevers  live 
sometimes  to  see  their  progeny  die  of  continued  fevers. 

Class  III.  is  well  illustrated  in  the  autumnal  fevers  of  many  parts 
of  this  and  other  countries.  We  have  no  fevers  more  irregular  in 
their  onset  and  course  than  these,  nor  which  more  tax  the  discrimina- 
tive ability  of  the  practitioner  and  his  tact  at  managing.  A  case 
which  to-day  is  prescribed  for  as  ague,  is  to-morrow  pronounced  re- 
mittent, and  the  next  day  typhoid,  and  perhaps  a  few  days  later  it 
presents  a  black  crust  on  the  tongue  and  the  coma  of  typhus.  It  was 
no  doubt  from  the  observation  of  cases  of  this  sort,  which  abounded 
in  the  vicinity  of  Edinburgh  a  hundred  years  ago,  that  the  great 
Cnllen  drew  his  conclusions  that  intermittent,  remittent  and  continued 
fevers  were  not  essentially  different  in  their  natui-e.  (First  Lines,  Part 
Ist,  Book  Ist,  Chapter  iii.)  Bat  it  is  difficult  to  understand  how  he 
conceived  the  notion  that  the  large  amount  of  bile  evacuated  so  con- 
stantly in  the  intermittent  and  remittent  fevers  which  he  describes, 
marked  no  essential  difference  of  the  disease,  for  he  mentions  this  cir- 
cumstance particularly  and  attributes  it  to  the  accidental  circum'stanco 
that  these  fevers  happen  to  occur  in  that  season  of  the  year  when  bile 
abounds  in  the  system.  (First  Lines,  Aph.  51.)  This  was  a  singular 
error  for  so  great  a  man  ;  but  his  remarks  on  the  bilious  accompani- 
ment, or  contingent  of  the  continued  fevei-s,  of  typhus  even,  (First 
Lines,  Aph.  71,)  afford  a  rich  mine  of  observation  upon  this  part  of 
our  subject.  If  space  permitted,  we  might  quote  largely  and  profit- 
ably in  this  place. 

In  the  course  of  a  fever  of  the  kind  now  under  consideration,  autum- 
nal or  typho-malarial,  two  facts  will  be  observed :  First,  that  there  will 
be  no  abatement  of  the  distress  till  bile  is  removed  in  considerable 
quantity,  neither  will  food  be  regularly  borne  till  this  has  taken  place  ; 
second,  that  after  the  bile  has  been  evacuated,  which  takes  a  week  or 
more,  the  case  runs  on  like  a  true  continued  fever.  In  putting  the 
bile,  it  requires  the  greatest  of  caution  to  avoid  irritating  the  bowels, 
to  which  they  are  frequently  very  prone.  After  this  evacuation  has 
been  accomplished  properly,  the  patient  takes  food  and  the  disease  is 
eventaally  cured  by  the  evacuation  through  the  kidneys. 


t 
18&I.]        McBridk — Claisification  and  Treatment  of  Fevers,  19 

I  am  of  the  opinion  tbat  the  emploTment  of  mercnrj  in  the  treai- 
■ent  of  continued  fevers  by  some,  (Wood,)  has  arisen  from  the  fact 
of  its  tolerance  in  this  form  of  fever  ;  for  during  the  first  week,  or 
biiiom  stage  of  the  disease,  mercury  can  frequently  be  used  with 
apparent  advantage,  at  least  without  obvious  harm.  It  is,  perhaps, 
■oc  eseential  that  the  carboniferous  evacuation,  bile,  should  take  place 
vholly  before  that.ofithe  nitrogenous,  urine,  begins  ,*  but  the  fact  that 
the  patient  can  take  little  or  no  food  till  this  is  effected,  affords  a  good 
reason  for  its  accomplishment  without  unnecessary  delay.  At  the 
same  time  it  should  be  borne  in  mind  that  over  hasty  means  of  pur- 
gation are  liable  to  cause  that  amount  of  irritation  in*tho  bowels,  or 
cbylopoietic  viscera,  which  effectually  locks  up  the  bile.  It  will  be 
perceived  that  the  evacuations  here  pmcurcd  are  of  two  kinds,  one 
cmrboniferons,  the  bile,  and  the  other  nitrogenons,  the  urine  ;  and  tliat 
the  retention  of  either  in  the  system  produces  its  own  set  of  conse- 
qaences.  The  retention  of  bile  causing  nausea,  heaviness  at  the 
ttomach  and  hypochondrium,  loathing  of  food,  loaded  tongue  icterus* 
amd  sometimes  coma.  Congestions  also  sometimes  ensue  in  the  pri- 
mary stage  of  this  fever.  The  retention  of  the  nitrogenous  compounds 
caosiog  inflammation  of  various  parts  ;  congestions,  especially  in  the 
later  stages  of  the  fever  ;  ulcerations  and  purulent  deposits  ;  subsultus 
it2>dinum,  nriemic  intoxication,  coma,  insensibility. 

This  difference  will  generally  be  observed  between  bilious  fever  and 
continoeii  fever  proper, — that  the  congestions  which  occur  in  a  bilious 
fever  and  the  worst  distress  of  various  kinds  are  at  its  onset,  or  the 
irat  or  second  day,  or,  to  use  a  vulgar  illustration,  it  comes  like  a 
weiigc,  with  the  large  end  foremost.  The  continued  fevers,  and  espe- 
cially that  variety  called  typhoid,  on  the  other  hand,  come  on  like  the 
wtdge  point,  or  small  end  foremost.  In  the  continued  or  mixed  fever 
aow  QiMler  consideration,  the  mode  of  attack  is  subject  to  almost  infi- 
mite  variation,  depending,  probably,  upon  the  amount  of  each  opera- 
tive cause.  This  further  difference  is  observable,  which  of  itself  is 
almost  pathognomonic,  that  bilions  fever  destroys  entirely  the  appetite 
or  the  digestive  function  at  the  onset,  whereas  in  continued  fevers  proper 
there  is,  generally,  a  relish  for  food,  a  toleration  at  least,  through  its 
whole  course. 

It  will  not  be  necessary  to  particularize  other  fevers  of  this  class, 
Wt  merely  to  state  that  it  embraces  all  those  fevers  which  have  the 
tiamenti  of  continuance,  or  wasting  of  the  tissues,  combined  with  the 
ktliooa  dement.  The  following  are  probably  inclnded  :  Gastro-enteric 
Severa  «f  miasmatic  regions,  yoUow  fever,  biiioas  pnenmoma,  V\\\otia 


20  Ortffinal  Communicaiiont,  [Januarj, 

pleurisy,*  bilious  dysentery,  some  cases  of  phlegmonoTis  erysipelas* 
rheumatism  of  miasmatic  regions,  and  sometimes  camp  fever.  The 
mixed  or  compound  character  of  camp  fever  will  be  seen  to  abound  ia 
those  regiments  which  have  been  encamped  in  malarious  localities  and 
Ave  at  the  same  time  or  soon  after  exposed  to  the  causes  proper  of  camp 
or  scorbutic  fever.  These  cases  resemble  typhus  so  closely  that  it  is 
not  strange  that  they  have  by  some  observers  been  confounded  with  it. 

I  have  placed  intermittent  fevers  among  the  carboniferous,  or  in 
Class  II.,  in  consequence  of  its  analogy  to  the  bilious  fevers  ;  that  is, 
it  occurs  iu  the  oamo  regions  with  the  bilious  fevers  proper,  and  there 
is  in  it  frequently,  if  not  generally,  manifest  disturbance  of  the  biliary 
organs,  and  a  considerable  discharge  of  bile  also.  It  lacks  every  ap- 
pearance and  character  of  the  continued  fevers,  except  that  in  inter- 
mittents,  as  in  many  cases  of  continued  fever,  the  patient  relishes  food 
through  the  entire  course,  wherein  they  both  differ  from  the  bilious  or 
bilious  remittent.  It  differs  from  the  bilious  and  continued  fevers  in 
the  fact  that  it  has  no  naiural  limii,  whereas  they  have  ;  also  in  the  fact 
that  emaciation  is  not  a  necessary  consequence.  Further,  the  intermit- 
tent is  not  curable  by  ordinary  means  of  elimination  or  the  stimulating 
of  any  particular  secretion,  or  secretions  generally  ;  the  other  fevers  are 
more  or  less  thus  curable.  Still  I  am  inclined  to  regard  it  as  a  carboni- 
ferous fever,  but  sui  generis.  The  fact  that  ague  sometimes  seems  to 
glide  into  a  remittent  fever,  and  remittent  to  blend  off  into  an  ague,  cer- 
tainly seems  to  show  a  strong  analogy  between  them  ;  but,  neveitheless, 
the  particulars  above  stated  mark  a  particular  difference.  It  seems 
that  in  this,  more  than  any  other  fever,  the  offending  cause  operates 
upon  the  nervous  system,  both  spinal  and  organic. 

Hectic  fever  is  regarded  as  similar  to  miasmatic  intermittent  in  its 
obvious  behavior,  but  I  think  it  is  an  error  to  call  hectic  intermittent, 
for  in  all  the  cases  of  hectic  that  I  have  ever  seen,  there  has  not  been 
one  case  in  which  the  pulse  indicated  an  intermission, — that  is,  the 
pulse  did  not  come  down  to  the  standard  of  health  ;  and  I  think  if  this 
was  always  made  the  test  as  to  intermission — and  it  is  the  only  reliable 
one — many  supposed  intermittents  which  have  eventnated  in  remittents 
and  continued  fevers,  would  have  been  found  to  be  remittents  from  the 
beginning.  I  am  constrained  to  think  that  CuUen,  with  all  his  erndi- 
tiou,  commits  an  oversight  on  this  point. 

Some  of  the  most  important  indications  of  the  differential  treatment 
of  fevers  follow  directly  from  this  view  of  their  differences,  and  these 
indications  must  inevitably  be  correct  if  this  classification  be  based 
upon  fact.     For  the  truth  of  the  statements  made  and  opinions  ad- 


18M.]        McBride — Clatsifaciian  and  Treatment  of  Fevers,  21 

TtBced  I  appeal  to  chemistry,  to  the  history  of  fevers  and  to  the  expe- 
rieDoe  and  obserration  of  evcrj  practitioner. 

I  do  Bot  mean  to  announce  that  all  we  have  <to  do  to  cnre  fevers  is 
to  hasten  the  elimination  of  carbon  and  nitrogen  by  administering 
dtvetica  and  cholagognes,  but  it  follows  from  the  pathological  view 
Wre  advanced  that  the  elimination  of  these  substances  shonld  be  held 
M  a  iin€  qua  non  to  successful  treatment,  and  that  in  each  class  of 
(erers,  that  class  of  evacnants  and  stimulants,  if  any,  should  be  em- 
ployed which  the  particular  element  to  be  discharged  demands.  The 
evil  effects  of  the  retention  of  these  elements  in  the  system  have  fre- 
^■mtly  SQpervened  before  the  case  falls  into  onr  hands,  such  as  inflam- 
vacion  or  congestion,  or  the  patient  may  have  become  exhausted  by  a 
diarrhcea  which  has  not  aided  in  the  proper  elimination,  so  that  theie 
■ay  be  more  to  do  than  to  administer  these  classes  of  remedies  ;  nor 
M  it  always  necessary  to  urge  these  remedies  in  the  onset,  or  even  later, 
for  the  eliminations  will  not  unfrequently  take  place  spontaneously,  if 
pfoper  hygienic  measnres  be  adopted. 

I  think,  however,  that  the  process  of  cnre  may  bo  said  to  consist  in 
mintaiMing,  or  restoring,  if  lost,  the  equilibrium  of  tonicity  of  the 
anerial  and  capillary  systems,  and  maintaining  the  vital  force  ;*  which 
are  to  be  accomplished  mainly,  after  proper  hygiene,  by  tonics  and 
■timnlants  ;  allaying  pain  and  irritability  by  means  of  proper  ano- 
dyneit ;  and  aiding,  when  necessary,  the  secretion  which  must  carry  off 
the  morbid  product.  If  the  tonics  and  stimulants  can  bo  made  to 
MTve  also  as  cxcretants,  there  is  a  point  gained.  If  an  anodyne  can 
be  made  to  have  a  tonic  effect  and  to  serve  as  an  excretant,  tlie  effect 
will  be  excellent ;  and  when  we  come  tipon  diuretics  and  cholagogucs, 
if  wc  can  make  these  serve  also  tl>e  purpose  of  tonic,  stimulant  and 
anodyne,  we  have  all  that  can  be  desired.  Most  of  those  combinations 
can  generally  be  consummated.  I  can  hardly  conceive  any  thing  to 
go  amiss  in  the  case  if  the  tonic  equilibrium  of  the  vascular  system 
l«  maintained. f  When  inflammation,  congestion,  tilceration,  diar- 
rhoea, or  other  contingency  to  which  fevers  are  liable,  supervenes,  or 
ni^tM  when  we  6rst  see  the  case,  or  subsequently,  it  must  be  treated 
for  what  it  is,  not  neglecting  in  onr  choice  of  remedies  the  channel 
tfaroogh  which  elimination  must  take  place. 

It  is  not  my  purpose  at  this  time  to  treat  minutely  of  the  cnre  of 


•  "Okvlato  tiM  tendency  to  death.** — Ccllxk,  and  many  other  anthort. 
f  **  Faltelof  kal  anatomy  ebowa  oa  what  a  remarkable  tendency  there  k  in  this  dipeaee  to 
h&  4kttat%mme»  of  tha  eqniUbrlnm  of  the  circnlation.  and  tha  determination  of  an  Inordinato 
tjml  klood  to  tho  laroaa  and  mncoos  enrfacee  of  the  abdomen.*'— LTOSit.    He  might 
i:  to  til  the  wroQi  and  mucoua  earface*,  and  tome  o'  the  TiKtra. 


22  Origind  CamnutnicaiUmt.  [January, 

fever,  but  a  few  illustrative  remarks  upon  certain  remedies  and  their 
application  are  necessary  in  this  place. 

There  is  probably  no  remedy  which  has  received  higher  praise  in  the 
treatment  of  typhoid  and  typhus  fevers  than  oil  ot  turpentine,  (see 
Wood's  Practice,  volume  i.,  page  357  ;  Lyons,  pages  136  ei  sequiier^ 
and  page  220.)  It  has  been  spoken  of  as  peculiarly  adapted  to 
that  stage  of  the  fever  in  which  the  intestinal  glands  are  supposed 
to  undergo  ulceration.  Wood  seems  to  think  it  has  some  local 
healing  virtue.  Others  also  give  it  when  the  tongue  is  dry  in  this 
fever  without  reference  to  ulceration.  A  peculiar  curative  effect  is  at- 
tributed to  it.  That  its  good  effect  does  not  result  from  local  action 
on  the  diseased  bowels  is  shown  by  the  fact  that  its  effect  is  the  sam^ 
upon  the  state  of  the  fover  when  applied  externally  in  such  manner  as 
to  secure  its  absorption.  6alts  of  ammonia  and  many  other  salts,  and 
recently  cider,  and  the  sour  wines,  have  been  given  with  similar 
results.  What  arc  all  these  but  different  kinds  of  diaretics.  There 
was  a  time  when  cantharides  was  given  in  the  advanced  stages  of 
fever  for  its  rousing  or  stimulaliug  action,  and  this  practice  has  been 
recently  revived  (see  Lancet^  Jan.,  1862.)  Have  wa  not  in  this  rem- 
edy a  powerful  diuretic.  Whisky  is  much  used  of  late  in  the  sustain- 
ing treatment  of  fever,  and  is  justly  preferred  to  brandy.  Is  not  this 
preference  owing  to  its  greater  diuretic  effect?  Tincture  of  iron  has 
lately  been  used  with  good  results  in  the  treatment  of  typhoid  and 
camp  fever,  also  in  erysipelas.  Here  we  have  a  most  powerful  diuretic 
as  well  as  tonic,  with  sometimes  anodyne  and  diaphoretic  effect. 
What  is  more  common  than  the  occasional  use  of  nitras  aether  as  a 
temporary  expedient  for  heat  of  &kiu,  dry  mouth  and  headache,  and 
have  we  not  in  this  a  quick  diuretic  ? 

Who  ever  expects  to  cure  a  case  of  typhus  without  restoring  den- 
sity to  the  urine  ?  Who  ever  cured  a  case  of  this  disease  by  the  dis- 
c'lkarge  of  bile,  or  any  means  whatever,  if  the  urine  did  not  become 
charged  with  its  proper  salts  ?  The  same  may  be  said  of  camp  fever, 
with  this  difference  usually,  that  the  urine  is  sufficiently  dense,  but 
very  small  in  quantity  at  first.  The  quantity  must  be  materially 
increased  before  the  patient  improves.  This  condition  of  paucity 
or  levity  of  urine  in  these  diseases  explains  why  the  patients 
will  bear,  and  be  benefitted,  by  such  large  quantities  of  the  sour  wines 
and  cider  ;  olso  why  bitartrate  of  potash  and  other  salts  of  the  same 
alkali,  arc  so  beneficial  in  scurvy,  which  has  such  close  affinity  with 
these  fevers.     Food  of  ordinary  kinds,  and  medicine  and  tender  care 


1%4.]         McBride—  Clcusificatlon  and  Tr$aiinent  of  Fevert.  23 

will  be  adminifitered  in  vain,  unless  the  condition  of  the  urine  is  im- 
proved.* 

On  the  other  hand,  it  may  be  asked,  who  ever  saw  a  case  of  bilious 
ferer  recover  before  the  frequent  and  copious  discharge  of  bile, — a 
conipoand  which  contains  a  large  amount  of  carbon,  and  but  a  trace, 
or  very  small  amount,  of  nitrogen.  The  dark  color  of  the  urine  in 
this  fever  is  chiefly  owing  to  the  bile  which  it  contains,  and  which 
fihoold  pass  by  the  liver,  and  sometimes  to  its  natural  density  being 
increased  by  copious  draughts  of  sweat.  The  profession  arc  aware  that 
aeiiher  increased  density  nor  quantity  of  urine  are  sought  for  in  tliis 
disease.  In  short,  that  if  the  liver  discharge  freely,  whether  by  nature 
or  the  proper  action  of  medicine,  there  is  but  little  or  no  further  in- 
terference demanded  in  the  case. 

(I  would  not  have  it  supposed  that  I  sympathize  with  those  physi- 
cians, and  they  are  now  too  numerous,  who  prate  to  you  about  not 
giving  much  medicine.  Such  talk  betrays  infidelity  to  the  healing 
art  or  to  one's  own  ability,  which  is  equivalent  to  a  confession  of  ig- 
■orauco.  There  is  a  right  amount  as  well  &s  kind  of  medication, 
proper  for  every  case  of  disease,  and  ho  who  administers  less  or  more 
thaa  this  does  not  perform  his  duty.  When  the  physician  does  not 
know  what  to  do — which  too  often  happens  to  us  all — then  is  the  time 
for  placebos  or  cxputation.) 

There  are  few  cases  of  disease  in  which  the  prudent  physician  can 
do  more  towards  bringing  his  patient  to  a  comfortable,  at  least  toler- 
able condition,  than  one  of  bilious  fever.  I  may  also  cay  there  are 
few  cases  in  which  the  bungler  is  liable  to  do  his  patient  more  harm. 
Uanth  purging  may  inflict  damage  upon  the  bowels,  and  hypcremesis 
may  derange  the  functions  of  the  stomach  and  liver,  from  either  of 
vhich  the  patient  is  liable  to  not  recover.  But  the  prudent  physician 
carefolly  excites  vomiting  after  one  or  mote  gentle  nauseating  doses  ; 
or  he  gently  excites  catharses  by  repeated  mild  doses  of  cathartic  med- 
icice,  after  exciting  the  secretion  by  a  mild  alterative  or  a  gentle  nau- 
iesiat.  By  this  process  bile  is  discharged,  and  after  a  few  such  opera- 
tions the  patient  is  convalescent  with  almost  a  mathematical  certainty. 
Toni'.*t  may  or  may  not  be  given,  according  to  the  circumstances  of 
the  case. 

Further  to  illustrate  the  subject,  I  adduce  a  case  of  bilious  gastro- 


•  Lj0mM,  la  hi*  Uto  tr«*tiM  on  ferer,  repudi*tea  their  treatmeut  by  dfotetica,  (the  continued,) 
7«l   vborvev  car»falljr  rM«U  what  ke  h%a  written  coDcerning  the  treatment  of  typbua  and 
full.  wiU  pereaiTa  th*t  tarpentioo  i«  the  medicine  of  which  be  ejieaka  with  more  aa- 
aaj  otbar  for  tha  cure  o/  the  moat  dang erooa  complkalioaj  of  thaec  fcvon. 


24  Original  Communications,  [January, 

enteric  ferer,  or  one  of  those  cases  of  obstinate  remittent  fever  in 
which  the  ordinary  course  of  emulging  bile,  etc.,  will  have  little  or  no 
carative  effect,  and  in  which  cathartics  and  emetics  must  be  given  with 
extreme  caution.  What  is  the  course'  here  necessary  for  a  cure  ? 
Emulsion  of  turpentine,  with  a  suitable  amount  of  an  opiate,  is  per- 
haps the  best  means,  ^fter  this  we  have  an  increase  of  urine  with 
its  salts.  This  part  of  the  treatment  is  precisely  such  as  belongs  to 
the  continued  fevers. 

Let  rfny  one  who  has  successfully  treated  typhoid  fever — by  which 
I  mean  cured  most  of  his  patients — call  to  mind  the  remedies  he  has 
used  with  the  greatest  success  to  meet  the  particular  emergencies  of  the 
disease,  or  those  remedies  which  have  obviously  caused  the  disease  to 
progress  through  its  difliculties,  and  he  will  find  that  they  favored  or 
caused  directly  or  indirectly  the  evacuation  of  nitrogenous  matter,  and 
generally  through  the  kidneys.  Tonics,  stimnli  and  anodynes  are  ad- 
juncts to  the  natural  eflForts  of  the  system,  but  in  many  cases  very 
necessary  and  beneficial.  When  these  alone  prove  sufficient  for  a  cure 
without  other  remedies,  it  is  because  they  maintain  a  just  balance  of 
the  vascular  system,  in  which  case  the  secretions  are  performed,  and 
no  direct  diuretic  is  necessary.  But  it  is  a  fact  that  most  <if  the  gtim- 
uli  used  are  diuretics,  such  as  the  wines,  whisky  and  the  ethers,  and 
the  tincture  of  iron.  Some  of  the  best  expectorants  used  are  diuretics. 
I  have  elsewhere  shown  that  the  most  important  effect  of  blistering 
with  the  fly  plaster  results  from  the  absorption  of  the  cantharadin, — 
here  we  get  a  powerful  stimulant,  diuretic  effect,  one  which  causes  the 
flow  of  dense  urine.  Urinary  crisis,  which  occurs  oftener  than  is  taken 
notice  of,  is  the  result  of  a  powerful  effort  of  the  system  to  clear  itself 
of  nitrogen.* 

One  further  illustration  before  closing  this  part.  What  are  oar 
means  of  discussing  threatened  abscess  ?  Turpentine  is  perhaps  onr 
most  potent  remedy.  This  and  alkalies  and  neutral  salts  are  chiefly 
used.  For  the  discussion  of  chronic  swellings  and  tumors,  we  use 
iodides  and  alkalies.  To  discuss  hepatization  of  the  lungs,  we  use 
similar  means.  These  medicines  are  diuretics,  and  the  substances  to 
be  discharged  are  nitrogenons  chiefly.  Mercury  has  been  used  suc- 
cessfully for  similar  purposes,  and  especially    when  combined  with 

*  The  bencflta  of  blood-letting  are  eo  generally  discredited  in  this  conntry  in  aU  kindi  of 
f«Ten,  that  I  do  not  deem  it  neceMaiy  to  dlscnsi  tbii  mode  of  elimination.  I  do  not  Xnow  aa 
any  writer  at  the  present  time  clalmB  seriously  that  it  has  a  cnratire  eflbct  In  ferers  proper.  I 
bare  said  bnt  little  abont  excretion  by  sweating  becnose  I  beUere  the  practice  of  forced  sweat* 
ing  is  generally  considered  Bow.a-days  a  haaardoos  one.  Nor  do  I  know  the  partlovkur 
dilforence  in  the  sweat  of  the  different  classei  of  feTers,  if  there  be  any. 


1864.]        McBbidi —  CloBilfcuHon  and  JVetdtneni  </  Fevers.  25 

dimedcs  or  expectorants,  bat  its  beneficial  effiots  are  measnred  not  by 
the  amoont  of  bile  discbarg^  in  such  cases,  bnt  by  the  amount  of' 
aolid  matters  dissolved  in  the  urine,  and  sometimes  by  expectoration. 
In/lammaiorif  Fevers. — I  shall  not  attempt  lengthy  remarks  upon  the 
application  of  this  classification  to  the  phlegmasia,  bnt  make  this  ob- 
•enration» — ^that  after  the  abortive  treatment  of  inflammation  has  fail- 
ed, or  the  time  for  its  attempt  gone  by,  there  remain  only  the  follow- 
ing modes  of  its  cure  and  discharge :  Evacuation  of  mucus,  serum, 
pas,  blood  and  urine,  the  latter  of  which  is  the  chief.     Cathartics  do 
not  effect  these  evacuations,  for  they,  unless  urged  to  the  effect  of  irri- 
tating the  bowels,  which  would  be  the  creation  of  a  new  disease,  do 
not  carry  off  nitrogenous  matter.     The  salines  employed  mostly  or 
all  favor  the  urinary  discharge.     The  cathartic  effect  of  antimonials 
is  not  generally  salutary,— excretion  by  the  lung^  and  the  kidneys  are 
(he  final  results  of  their  proper  action. 

Take  an  example  of  inflammations  of  the  chest.     Turpentine  is 
given  in  nearly  all  stages  of  pneumonia,  pleurisy  and  bronchitis  ;  also 
•qaills,  colehicum  and  senega  are  given  in  the  different  stages.     Can- 
charides  is  given  in  large  doses  (Wood  and  Bache,  also  Lancet,  Jan.» 
1862, )  in  the  advanced  stage  of  engorgement,  or  in  typhoid  engorge^ 
sent,  and  blisters  of  the  same  are  extensively  used  in  the  advanced 
stages,  and  when  the  type  is  typhoid,  they  are  used  in  any  stage. 
Hie  action  of  mercury  is  very  much  discredited  now-a-days  in  these 
diseases,  except  in  pleurisy.     The  long-established  use  of  digitalis, 
nitre  and  colehicum  in  the  cardiac  inflammations,  which  are  frequent- 
ly of  rheumatic  nature,  is  too  familiar  to  require  comment.    The  effects 
of  turpentine  and  blistering,  in  the  treatment  of  both  peritonitis  and 
enteritis,  after  abortive  efforts  fail,  are  also  well  known.     The  inflam- 
mations within  the  cranium  are  treated  with  the  greatest  success  by 
the  remedies  above  mentioned.     Inflammation  of  the  liver  is  the  only 
one  of  the  phlegmasia  that  is  wholly  and  almost  indisputably  given 
over  to  the  domain  of  mercurial  alteratives  and  purgatives,  and  there 
teems  some  reason  in  this,  for  it  is  the  great  thoroughfare  of  the  bile. 
Erynpelas,  wherever  located,  especially  the  phlegmonous  and  gangren- 
.  18  now  treated  mainly  with  tincture  of  chloride  of  iron,  one  of  our 
t  thorough  diuretics,  and  diphtheria  is  treited  in  the  same  way  : 
the  urioe  in  both  of  these  becoming  dense  and  copious. 

The  application  of  these  principles  of  clasHifyingand  treating  fevers 

will  be  better  understood  if  we  call  to  mind  an  idea  or  view  which 

▼cry  mnch  guided  practice  a  hundred  years  ago.     In  the  writers  of 

that  tiine,  and  earlier,  frequent  mention  is  made  of  the  c<mco€iion  of  the 

▼a.— 2« 


26  OriginQi  CcmtMoncaiiont.  [Jannarj, 

disease,  or  eancodion  of  the  humorSt  with  the  advice  that  the  chief  evac- 
oadons  should  not  be  attempted  till  cocton  had  taken  place.  This 
idea  and  practice  should  be  deeply  graven  in  the  memory  of  every 
practitioner  ;  nay,  it  mi>i^ht  with  profit  be  graven  on  a  marble  tablet, 
and  ^xed.  to  the  door-post,  or  upon  the  table,  of  every  doctor's  office. 
It  means,  simply,  that  we  should  not  try  to  expurgate  the  body  of  bile 
nor  urine  till  they  are  separated  or  ready  to  be  separated  from  the 
blood,  nor  force  the  patient  to  sweat,  against  a  natural  tendency. 


ART.  n. 

A  Case  of  Strychnine  Poisoning. 

BT   ISAAC   MKNDKNHALL,  M.D.,  RKWOASTLK,  IHD. 

I  was  called  on  the  20th  day  of  September  to  see  Ann  Lowe,  set.  21 
years.  Her  general  health  had  been  somewhat  indifferent  for  the  last 
three  months.  She  had  been  afflicted  with  chills  and  fever,  occasion- 
ally accompanied  with  biliary  derangement.  She  was  taken  unwell 
on  yesterday  morning,  the  19th,  with  vomiting  and  general  malaise, 
(according  to  her  statements,)  and  continued  quite  sick.  Dr.  Joel 
Eeed  was  summoned  to  see  her  on  the  next  morning,  the  20th,  and  in 
the  evening  I  was  called  in  consultation.  She  continued  to  vomit 
everything  she  had  taken  until  I  saw  her.  Trismus,  contractions  of 
all  the  voluntary  muscles,  occurred  occasionally  to  such  an  extent  that 
the  attendants  could  hardly  keep  her  on  the  bed.  Tongue  red  around 
the  edge  and  tip,  but  little  fur  on  the  dorsum ;  extreme  tenderness 
over  the  scrobiculus  cordis  and  bowels  ;  bowels  had  not  been  moved 
for  the  last  four  days  ;  pulse  130  beats  to  the  minute  ;  also  dilatation 
of  the  pupils  and  spasmodic  breathing. 

Diagnosis. — Tetanus,  or  strychnine  poisoning  ;  inflammation  of  the 
stomach  and  bowels  ;  congestion  of  the  brain  and  lungs.  The  pre- 
scription agi*eed  upon  was  to  give  ten  grains  of  calomel,  followed  by 
oleum  ricini  in  four  hours,  and  use  the  inhalation  of  chloroform  when 
the  spasms  were  present.  These  seemed  to  quiet  her  vomiting  and 
nervous  and  muscular  system  partially ;  but  she  continued  to  gradu- 
ally sink,  and  died  on  the  evening  of  the  23d,  four  days  after  taking 
sick. 

Poat'Mortem  Twenty  Hours  after  Dealh, — Drs.  Reed,  Ferris,  Rea 
and  Benedict,  Wheeler  and  Zimmerman,  medical  students,  were 
present.  Notes  taken  at  the  time  by  Mr.  Wheeler.  The  subject  was 
small  in  size,  pale,  but  not  much  emaciated,  rigor  mortis  present.  I 
made  an  incision  from  the  ensiform  cartilage  to  the  symphysis  pubes» 


1864.]  MxNDENHALt — Cas€  of  Stfyehnim  Poiionmg.  27 

and  anoUier  at  right  angles.  Two  cords  were  tied  around  the  cardiac 
and  two  around  the  pjloric  orifice,  the  parts  divided,  and  connections 
bioken  up  ;  the  stomach  with  its  contents  was  placed  in  a  clean  glass 
jar.  Uterus  was  found  noimal ;  bowels  were  found  to  be  inflamed  and 
congested  more  or  less  their  full  length.  The  stomach  was  brought 
to  mj  office,  and  contents  tested.  We  took  eight  ounces  of  pure  rain 
water  and  put  it  in  a  clean  new  tin  cnp,  put  it  over  the  fire  and  raised 
it  to  a  boiling  heat,  then  poured  the  water  into  the  stomach,  agitated 
it  briskly,  then  turned  the  stomach  inside  out  and  washed  it  with  the 
fluids  carefully  and  thoroughly.  This  was  the  fluid  tested.  We  first 
tested  for  arsenic,  but  found  none.  We  then  put  some  of  the  fluid  in 
a  test-tube,  added  sulph.  acid  and  bichromate  of  potassa.  We  found 
that  the  flaid  changed  to  a  bright  red  color,  and  in  a  short  time  to  a 
deep  blue.  We  took  a  solution  of  strychnia  and  added  to  another 
Ifisl-tabe  sulph.  acid  and  bichromate  of  potassa,  and  we  got  the  same 
tint  of  colors  in  about  the  same  time.  This  we  considered  sufficient, 
•■  far  as  color  was  concerned. 

We  then  took  a  portion  of  the  fluid,  about  two  ounces,  and  added 
folph.  acid,  and  inserted  the  test-tube  into  a  water-bath  and  boiled  it  for 
aa  boor,  then  strained  the  fluids  through  a  fine  clean  linen  cloth,  wash- 
ed tlie  residne  with  water  and  alcohol,  and  strained  them,  washed  the 
tabc  again,  re-added  the  fluids,  and  boiled  for  half  an  hour  more,  in  a 
r-bath.  The  fluids  were  then  filtered  through  white  bibulous 
We  then  added  bicarbonate  potassa,  q.  s.  to  render  the  fluids 
alkaline,  then  added  two  volume  of  washed  sub-ether  to  one  volume 
of  tlie  fluids,  agitated  briskly,  and  poured  them  out  into  watch-glasses. 
Tkia  was  left  in  the  open  air  until  next  day,  and  evaporation  of  all  the 
floida  had  taken  place.  These  glasses  were  placed  in  the  microscope, 
and  transparent  octahedral  chrystals  were  plainly  to  be  seen.  A 
•olatioa  of  strychnia  was  treated  in  the  same  way,  with  the  exception 
of  tlie  boiling,  and  chrystals  were  found  analogous  to  those  found  in 
tkt  fluids  of  the  stomach.  Those  were  considered  conclusive. 
Many  other  experiments  were  performed,  but  these  are  the  ones  we 
idied  on. 

After  the  community  found  that  we  had  got  through  with  tlie  ex- 
periments and  found  strychnia,  a  neighbor  woman  said  that  Ann 
L.we  lold  her  the  day  before  she  died  that  she  '*  had  taken  stryclinine 
vith  her  own  hands."  I  do  not  know  of  any  case  on  record  that 
lived  RO  long  after  taking  strychnine,  and  no  thoroughly  reported  case 
when  tbe  poison  was  detected.  It  is  supposed  that  she  took  the 
^oiioa  on  nccoont  of  love  aflairs. 


28  PT0c$Mng9  cf  SQcUti4f.  [ Januarj, 


^tfttttAlnqi  nt  Sfntittitt. 


Proceedings  of  the  Cincinnati  Academy  of  Iffedloine. 

Beportdd  by  W.  T.  Bsowb,  M.D.,  SecreUry. 

Hall  of  Acadbmt  of  Medicinb,  October  5,  I8684 

Popliteal  Aneurism, — Dr.  Goode  reported  the  following  case  of 
popliteal  aneurism  :  On  the  16th  of  August,  1863, 1  waa  called  to 
see  a  child  with  scarlet  fever.  At  my  third  visit,  the  mother  direoiod 
my  attention  to  a  tumor  in  the  popliteal  space,  which  she  said  abe 
had  discovered  a  few  weeks  before.  The  child  first  complained  that  it 
was  painful.  The  patient  was  a  little  girl  of  eight  years.  The  mother 
could  assign  no  cause  for  the  tumor,  except  that  the  child  might  have 
sustained  some  injury,  from  falling  from  a  pile  of  lumber  a  short  time 
before.  The  surface  over  the  tumor  was  of  the  sanM  appearance  a« 
the  surrounding  parts.  It  corresponded  to  the  direction  of  the  artefy, 
was  about  threee  inches  long,  with  a  transverse  oval  surface  of  two 
and  a  half  inches.  Qn  taking  the  tumor  in  the  hand,  pulsation  could 
be  felt  distinctly  all  over  its  surface.  I  pronounced  it  an  aneurism. 
On  account  of  the  child's  health,  treatment  was  not  commenced  until 
the  Slst  of  August.  I  directed  the  mother  to  compress  the  artery 
above  and  below  the  anearism,  for  two  hours,  morning  and  evening. 
On  the  7th  of  September  saw  her  again.  Could  find  no  pulsation. 
The  mother  said  she  thought  there  had  been  none  since  the  third 
after  my  last  visit.  The  tumor  was  a  firm  mass.  It  has  decreased  in 
size  regularly,  and  at  the  present  time  is  not  more  than  three-eighths 
of  an  inch  in  diameter. 

Prof.  Baker  remarked  that  in  an  aneurismal  tumor  the  pulsation  is' 
due  to  the  rush  of  blood  in  and  through  the  aneurismal  sac.  He 
would  like  to  ask  the  Doctor,  if  this  was  an  aneurismal  tumor,  and  as 
lai-ge  as  he  mentioned,  what  became  of  the  blood  ?  He  stated  the 
tumor  became  indurated .  Now  if  it  was  filled  with  blood,  would  it 
not  act  as  a  foreign  body  ?  or  would  it  be  absorbed,  or  would  canae 
suppuration  ? 

Dr.  Goode  replied  that  he  presumed  the  contents  of  the  tumor  became 
fibrinous,  or  absorption  would  not  occur,  but  he  would  like  Dr.  Fries 
to  give  his  views  on  the  subject. 

Dr.  Fries  said  it  was  a  question  not  easily  answered.  He  presumed 
the  contents  of  the  tumor  to  be  fibrinous,  or  absorption  would  not 


1864.]  Prwfeedinffs  ^  SodetUs.  39 

take  place.  Compression  m  a  means  of  caring  anenrisms  had  been 
qvlte  sQCoeesfiil,  and  in  cases  of  popliteal  aneurisms  flexion  of  the  1^ 
wpon  the  thigh  has  been  tried  successfully.  The  compression  as  ap- 
^ied  in  the  case  reported  is  somewhat  novel,  and  deserves  to  be  re- 
flMmbered. 

Prof.  Baker  asked  Dr.  Fries,  if  he  would  open  a  pulsating  aneuris- 
nud  tumor,  what  he  would  expect  to  find  ? 

Dr.  Fries  said  he  would  answer  this  question  by  reporting  a  case. 
8ome  years  ago,  he  was  attending  a  patient  with  fever.  One  day,  as 
ha  was  leaving  the  house,  the  patient  called  his  attention  to  a  small 
tumor  behind  his  ear.  Examining  it  hurriedly,  he  thought  he  detect- 
ed fluctUAtion,  and  immediately  plunged  his  bistoury  into  it,  and  found 
■uwh]  to  his  surprise,  he  had  opened  an  aneurism  of  a  branch  of  the 
occipital  artery.  He  made  use  of  compression,  and  the  sac  closed  up, 
bat  the  rush  of  blood  at  first  was  very  great. 

Ob§Uineal. — Dr.  Bramble  reported  the  following  case  :  Last  Tues- 
day a  week  ago,  he  was  called  to  see  a  German  woman,  26  years  of 
■gt«  the  mother  of  two  children,  and  then  in  the  sixth  month  of  preg* 
nancy.  He  was  informed  by  her  friends  that  at  the  third  month  she 
was  as  laige  as  a  woman  at  full  term.  Four  weeks  before  he  was 
caDed,  she  had  been  attended  by  two  other  physicians,  who  told  her 
she  would  die.  When  he  saw  her,  her  abdomen  was  very  large.  She 
oould  neither  lie,  sit  nor  stand  with  any  comfort,  breathing  exceeding- 
ly difficult.  Upon  making  an  examination  per  vaginam,  he  found  the 
OS  as  large  as  a  quarter-dollar.  Thursday  morning  at  one  o'clock,  he 
was  again  called  to  see  her.  He  found  she  was  in  actual  labor.  After 
watching  the  case  some  time,  he  ruptured  the  membranes.  Her  bed 
was  made  as  follows :  first  a  straw,  then  a  feather  bed,  covering  this 
was  a  blanket  and  sheet.  The  waters  saturated  all  and  filled  a  wood- 
en bucket  within  one  inch  of  the  top.  She  was  pregnant  with  twins. 
The  first  child  was  bom  in  a  short  time.  He  then  ruptured  the  mem- 
hcaaea  of  the  second  child,  but  there  was  not  near  so  much  water  in 
the  membranes  of  this  child.  Both  children,  males,  lived  a  few  min- 
irtce  and  died.  He  found  the  placenta  completely  adherent.  He  en- 
iaavored  as  long  as  he  dared  to  remove  it,  bat  on  account  of  the 
kwnarrhage,  had  to  desist  and  commence  stimulating  her.  She  rallied. 
Hfl  gave  her  no  medicine,  only  a  good  nourishing  diet.  On  T>i*«^*w 
hit,  at  1  p.  M.,  he  was  again  called.  She  had  been  bleed} 
He  fOBKrred  the  clots  from  the  uterus  and  also  the  afl 
eotttraded  well.  He  ordered  stimulants  and  i 
amd  lived  until  thi^  momiag 


so  Proeeidinffs  qf  SoctdUs.  [January, 

Typhnd  Fewer  in  Children. — Dr.  Mendenhall  reported  two  cases  of 
typhoid  fever,  occurring  in  children  aged  respectively  nine  and  five 
years.  The  usual  symptoms  were  manifested  and  began  to  subside, 
there  was  less  fever,  tongue  moist,  etc.  About  this  time  the  youngest 
child  had  a  diphtheritic  effusion  covering  the  tongue,  fauces,  and  roof 
of  mouth.  She  sank  rapidly,  and  died,  In  the  older  child  there  is 
less  effusion,  and  she  will,  probably,  recover.  This  seemed  to  him  a 
very  unusual  complication  of  typhoid  fever. 

Scarlatina, — Dr.  M.  also  stated  he  had  noticed  an  unusual  amount 
of  sequel  89  of  scarlet  fever ;  dropsical  effusions,  and  in  some  cases 
swelling  of  the  joints.  He  inquired  if  the  diphtheritic  complication 
had  beeh  observed  by  others. 

Dr.  Richardson  remarked  in  regard  to  sequelse  that  he  had  never 
noticed  so  many  instances.  Most  of  his  cases  gave  him  a  great  deal 
of  trouble,  but  he  had  not  noticed  very  many  cases  of  dropsical  effu- 
sion in  the  joints.  He  related  a  case  that  progressed  well  for  a  time, 
but  the  sequelas  was  ascites,  pulse  small,  bowels  torpid,  etc.  He  gave 
him  blue  mass  for  a  short  time,  then  put  him  on  muriate  tincture  of 
iron  and  quinine.  Under  this  treatment  the  patient  recovered.  The 
Doctor  also  reported  two  other  cases  that  were  very  slight  at  first. 
About  the  tenth  day  one  of  them  became  anasarcous.  The  respirations 
were  very  frequent.  There  was  torpidity  of  the  bowels,  and  an  almost 
entire  want  of  secretion  of  prine.  This  patient  died.  The  second  case 
died  from  effusion  in  the  brain.  In  several  cases  he  had  noticed  a 
decided  exasperation  every  evening,  instead  of  subsidence. 

Dr.  B.  P.  Goode  stated  that  he  had  had  fifty  cases  of  scarlet  fever, 
and  in  some  of  these  cases  dropsy  occurred  as  a  sequelie.  It  was  man*- 
ifested  in  various  ways  from  simple  puffiness  about  the  face  to  general 
anasarca.  Convulsions  also  occurred  in  several  cases.  In  one  little 
girl  the  disease  was  well  marked,  and  she  passed  through  it  kindly. 
On  the  16th  or  I7th  day  she  went  out  doors  and  sat  down  on  the 
ground,  though  not  more  than  two  minutes,  yet  in  two  days  after 
general  cedema  commenced.  He  noticed  that  she  appeared  rather 
more  stupid  than  usual,  and  that  her  pupils  were  dilated.  He  acted 
upon  her  bowels,  applied  cantharidal  collodion  behind  her  ears  and 
revulsives  to  her  feet,  bnt  in  a  short  time  she  was  seized  with  a  con- 
vulsion. Fearing  meningeal  trouble,  and  as  it  was  some  distance  from 
a  leecher,  he  tied  up  her  arm  and  bled  her  to  the  amount  of  six  ounces. 
She  then  came  out  of  the  convulsion,  and  in  two  hours  she  spoke. 
At  the  time  he  bled  her  she  was  quite  livid.  He  then  put  her  on  jalap 
and  cream  of  tartar,  squills  and  nitrate  of  potash,  afterwards  prescrib- 


1863.]  Proceedings  of  SoeieUee.  31 

•d  mnriate  tincture  of  iron.  She  recovered.  A  little  boy  in  the  same 
family  had  a  slight  attack,  dropsy  ensued.  He  recovered  speedily. 
Another  child,  only  eighteen  months  old,  had  the  disease.  On  the 
third  day  vomiting  came  on.  She  rejected  "everything ;  her  pupils 
were  contracted.  There  was  nothing  to  account  for  this  vomiting. 
Anticipating  meningeal  tronble,  he  prescribed  two  grains  of  calomel, 
acted  well  on  her  bowels,  then  prescribed  muriate  tincture  of  iron. 
She  recovered.  The  Doctor  also  reported  meeting  with  rheumatic 
complications.  He  treated  these  cases  in  a  similar  way,  giving  muri- 
ate tincture  of  iron,  and  they  recovered. 

Dr.  Fries  said  he  must  congratulate  his  old  friend  Dr.  Carroll, 
upon  the  addition  to  his  army.  A  few  months  ago  if  any  one  would 
have  advocated  blood-letting  or  the  administration  of  mercurials  in 
such  cases  as  reported  this  evening,  he  would  have  been  excommuni- 
eated.  But  now  his  progressive  friend  Richardson  reports  that  he 
gave  with  benefit  blue  mass  in  a  case  of  anasarca,  with  disease  of  the 
kidneys.  And  his  yonng  friend  Dr.  Qoode  reports  having  bled  a 
patient  after  scarlet-fever.  He  now  desired  to  report  a  case  in  point. 
He  had  treated  six  cases  of  scarlet  fever  in  one  family.  One  of  the 
eases  terminated  in  anasarca,  accompanied  with  bloody  urine.  He 
prescribed  squills  and  nitrate  of  potash,  also  muriate  tincture  of  iron, 
bat  the  case  prog^ssed.  He  concluded  he  wonld  return  to  the  old 
plan  of  treatment,  and  prescribed  calomel,  nitrate  of  potash  and  squills. 
Epithelial  cells  were  plainly  seen  in  the  urine,  and  albumen  was 
present  in  large  amount.  Modem  pathologists  would  tell  us  in  such 
eases  mercariah  would  destroy  the  patient,  but  in  this  case  in  twenty- 
foar  hours  the  urine  was  increased,  the  amount  of  albumen  diminish- 
ed, and  the  general  swelling  reduced.  This  treatment  he  continued 
for  three  days,  then  rested  one  day  and  prescribed  muriate  tincture  of 
iron.  His  patient  recovered.  '  The  use  of  mercurials  in  some  cases 
where  the  anasarca  depends  on  a  morbid  action  of  the  kidneys  will  do 
good  in  a  certain  stage.  He  had  not  noticed  in  his  practice  an  unusual 
number  of  dropsical  cases. 

Dr.  Richardson  was  of  the  opinion  that  sequel®  of  scarlet  fever 
occurred  just  as  often  where  the  best  of  care  was  taken  of  the  patients. 
Tliat  exposure  was  not  at  all  necessary  to  occasion  dropsical  effusions, 
thoogh  it  may  be  the  exciting  cause,  particularly  about  the  tenth  day 
after  the  subsidence  of  the  eruption.  In  most  cases  he  would  have 
gmU  hesitancy  about  giving  mercurials.  He  frequently  found  cases 
TWj  obscure  as  to  pathology.  Daring  the  eruptive  stage  the  kidneys 
act  ricarioiisly ;  an  nnaaaal  amount  of  arine  is  secreted ;  local  inftusi- 


82  Proceeiii^t  qf  SodOm.  [Januftrj, 

matory  lesions  often  occur.  If  the  patients  are  not  an»mic»  mercu- 
rials may  be  beneficial,  but  chlorotic  patients  are  more  liable  to  these 
local  difficulties. 

Dr.  Carroll  remarked  that  great  men  differ  in  their  opinions,  and 
the  gentleman  who  had  just  taken  his  seat  differs  from  all  the  best 
authors.  Watson  considers  the  dropsy  following  sgarlet  fever  an  in- 
flammatory difficulty.  The  gentlemen  who  adopt  the  stimulating 
treatment  have  no  good  authority  for  it.  Young  Physic,  as  they  have 
been  pleabed  to  term  themselves,  have  been  of  more  injury  to  the  pro- 
fession than  war,  pestilence  and  famine.  The  Doctor  said  he  had  six 
cases  in  one  family.  In  one  case  dropsy  and  convulsions  ensued* 
He  knew  that  bleeding  was  the  only  safe  remedy,  and  he  bled  the 
patient  to  the  amount  of  six  ounces,  gave  purgatives  and  prescribed 
calomel,  digitalis  and  squills.  His  patient  got  well.  He  had  tried 
such  treatment  over  and  over  again,  and  he  had  the  best  authority  for 
doing  so.  When  the  liver  is  disordered,  and  the  kidneys  are  deficient 
in  their  action,  you  give  mercurials  to  act  upon  the  secretions.  It  is 
not  necessary  to  salivate  the  patient.  Young  Physic  must  bring  au- 
thority and  experience  to  convince  us  they  are  right. 

Dr.  Comegys  spoke  of  the  benefits  derived  from  the  use  of  elaterin 
in  the  dropsy  following  scarlet  fever.  It  never  fails  in  producing  a|i 
active  hydragogue  effect.  Dropsy  is  due  to  an  impaired  function  of 
the  skin,  and  whatever  interferes  with  the  healthy  action  of  the  skin 
must  be  mischievous  on  the  system.  Urate  of  ammonia,  which  escapes 
largely  by  the  skin  in  health,  is  voided  with  the  urine  after  the  patient 
has  undergone  exposure.  He  made  it  a  rule  always  to  direct  parents 
to  dress  their  children  in  flannel  during  the  desquamative  stage  of 
scarlet  fever.  The  Doctor  also  reported  the  case  of  a  little  boy  living 
on  Eighth  Street.  He  was  recovering  from  an  attack  of  scarlet  fever. 
One  fine  day  he  went  out  on  the  back  porch,  and  though  he  was  not 
there  more  than  a  quarter  or  half  hour,  general  oedema  was  manifested 
in  less  than  two  days.  The  patient  recovered  under  the  use  of  elaterin. 
He  never  had  any  fear  of  using  mercury  to  act  on  the  portal  system, 
but  did  not  think  it  had  any  effect  on  the  kidneys.  Elaterin  he  pre- 
scribed for  a  child  six  or  seven  years  old,  one-sixteenth  of  a  grain  ; 
for  an  adult,  one-twelfth  to  one-sixth  of  a  grain.  In  old  drinkers 
with  hob-nailed  liver,  it  surpasses  everything  he  had  used. 

Dr.  B.  8.  Lawson  inquired  of  Dr.  Oomegys  if  by  purging  alone  he 
cured  dropsy. 

Dr.  Comegys  said  sometimes  he  depleted  generally  and  locally,  and 
afterwards  gave  iron.    The  elaterin  he  never  prescribed  oftener  than 


I 


1864.]  CScMT»i2>ond(flMr.  88 


a  dftjy  and  sometimes  not  more  than  onoe  in  two  or  three  days. 
Tbe  elaterin  is  the  alkAloid  of  elaterium,  and  will  produce  copious, 
waleiy  evacuations. 

Dr.  La wson  thought  the  gentleman  drew  nnfair  deductions  from  the 
nea  of  elaterin,  because  he  used  other  articles  at  the  same  time,  and 
wuug  elaterin  so  seldom  he  thonght  it  could  have  no  more  effeet  than 
as/  other  active  hjdragogoe  cathartic. 


entttivnuAtntt. 


Letters  firom  flew  Mexico. 

ExcBAVOB  HoTKL,  Santa  Fb,  Niw  Mixioo,  Nov.  7,  1868. 

Dkar  Doctor  : — You  will  please  send  my  journal  to  my  address  at 
Fon  Sumner,  New  Mexico.  I  am  to  he  stationed  at  the  above-named 
Fort  in  this  Department,  It  is  situated  about  one  hundred  and  ten 
(110)  miles  south-east  of  this  town,  and  about  the  same  distance 
S(>mh*w«st  of  Fort  Union,  and  Fort  Union  is  about  the  same  distance, 
bj  the  road  we  travel,  north-east  of  Santa  Fe.  We  came  through  the 
the  last  named  Fort  on  our  way  here,  and  will  have  to  return  on  the 
same  road  for  some  distance  on  our  way  to  Fort  Sumner.  This  Fort 
is  also  known  as  what  is  called  the  Basque  Redondo,  on  the  Pecos 
Rivsr.  It  is  considered  an  important  post,  as  all  the  Indians  that  are 
captured  are  sent  there.  I  am  informed  there  are  over  five  hundred 
there  at  this  time. 

My  trip  out  was  very  pleasant  for  about  half  of  the  way,  when  a 
saow  storm  struck  us  on  the  prairie  about  one  hundred  miles 
from  Fort  Lyon.  It  was  very  severe,  and  we  were  fearful  part  of  our 
Mies  would  perish.  But  we  brought  them  into  the  Fort  alive.  One 
of  tb«  drivers  had  his  feet  frozen  and  one  of  the  passengers  his  nose. 
Othtrwise  we  escaped  without  any  accident. 

I  eonlssa  I  am  disappointed  in  legard  to  New  Mexico,  and  especial- 
Ij  Iht  eity  of  Santa  Fe.     The  houses  are  all  built  of  dobies  or  mud, 
aemble  a  collection  of  neg^o  huts  rather  than  a  city  of  some  note. 
is  DO  enterprise,  no  industry,  no  manufacturing  establishmenU  ; 
jp  het,  tbey  have  nothing  except  what  ia  brought  from  the  &ta.Vs^ 


f 


84  Corretpondenee.  [January, 

The  only  redeeming  quality  is  the  climate,  which  is  delightful.    There 
has  been  no  rain  here  for  fonr  months. 

But  I  will  close.   I  should  be  pleased  to  hear  from  you  at  any  time. 


Fort  Sumner,  Nxw  Mexico,  Nov.  23d,  1868. 

♦  ♦  ♦  ♦  I  have  but  little  to  do  ;  having  from  two  to  five  patients 
at  surgeon's  call  in  the  morning  and  from  three  vo  six  in  the  hospital ; 
beside,  I  have  somq^  Indians  each  day.  The  disease  with  them  is 
chicken-pox  and  catarrhs.  I  have  one  very  interesting  case  of  the 
former  in  an  Indian  woman  about  seventeen  years  of  age.  The  erup- 
tion is  extending  from  the  neck  down  over  the  chest  and  arms,  accom- 
panied with  fever  and  some  debility  of  the  system.  She  has  lately 
been  married  to  one  of  the  tribe.  There  are  at  present  near  six  hun- 
dred Indians  at  this  post,  and  we  expect  about  two  hundred  and 
fifty  more  within  ten  days.  They  are  mostly  Apache  Indians* 
with  some  few  Navajoes,  but  they  live  separate.  The  former  are  con- 
sidered better,  but  I  see  but  little  difference  among  them.  I  have  the 
medical  supervision  of  them,  and  but  few,  if  any,  have  ever  been  vac- 
cinated. 

The  weather  has  been  pleasant  most  of  the  time,  although  we  hare 
had  two  or  three  small  snow-storms,  but  the  snow  soon  disappears. 
We  are  on  the  east  side  of  the  Pecos  River,  from  which  we  get  our 
Bupply,  and  it  is  impregnated  with  sulphate  of  soda,  or  ''glauber 
salt."  I  can  not  say  that  I  fancy  it,  as  I  do  not  like  it,  and 
its  effects  are  unpleasant  to  me.  We  are  about  one  hundred  and  forty 
miles  south  of  Fort  Union,  at  what  is  known  as  the  Basque  Bedondo. 

I  am  yours,  etc., 

Geo.  S.  Courtright,  Assist.-Surg.  U.8.Y . 


^m^ 


The  Late  Sir  Benjamin  Brodie,  Bart, — An  admirable  bust  of  this 
distinguished  surgeon  has  just  been  placed  in  the  council -room  of  the 
Royal  College  of  Surgeons.  It  has  been  executed  by  Mr.  Weekea, 
R.  A.,  and  although  evidently  posthumous,  is  a  most  excellent  like- 
ness of  the  distinguished  original,  and  a  worthy  companion  of  those 
other  great  men  now  adorning  the  hall  of  that  institution,  as  Hunter, 
whose  pupil  he  became,  Sir  Astley  and  Samuel  Oooper,  Pott,  Bell, 
Travers,  Cline,  Dairy mple,  Liston,  etc.  Mr.  Weekes  is  making  rapid 
progress  with  the  statue  of  John  Hunter,  toward  the  expense  of  which 
from  our  American  friends,  who,  notwithstanding  the  unhappy  state 
of  that  quarter  of  the  world,  still  remember  the  old  country,  as  their 
handsome  subscription  list  to  the  Hunter  Statue  will  shortly  testify. 
'  mdon  Lancet. 


1864.J  Special  SdectUms.  85 


J(9frial  »tU(Ufsni. 


The  Civil  War  in  America. 

(Vroin  a  OMrrMpondant  of  tiM  **  London  Modieal  Timet  and  OaMtto.**J 

Ih  Camp  north  of  thb  Rappahannook,  Ya.,  Aug.  27. 

Mj  last  communicaiion  to  you  was  written  on  the  evening  previous 
to  the  departure  of  the  operative  Surgeons  from  the  Gettysburg  Hos- 
ntalf  to  rejoin  their  commands.     The  work  they  had  been  left  to  per- 
iDfin  was  accomplished,  and  they,  however  unwilling  to  lose  sight  of  the 
mam  over  which  they  had  for  so  long  watched,  had  to  leave,  as  rumor 
ipoke  of  impending  battles  between  the  opposing  forces,  and  as  in 
nch  cases  their  services  would  be  of  infinitely  more  valne  near  the 
mne  of  strife  than  on  the  then  comparatively  deserted  field  of  Gettys- 
ViTg.     The  wounded  they  left  behind  them  in  the  care  of  contract 
SiigeoDS  were  capital  operations,  and  severe  cases,  such  as  were  as  yet 
nable  to  undertake  without  great  risk  the  fatigues  of  traveling,  and 
tkoee  in  whose  cases  the  prognosis  was  regarded  as  unfavorable  ;  their 
Mmber,  however,  was  lessening  rapidly  ;  one  or  two  hundred  of  the 
fetmer  classes  were  daily  dispatched  to  the  railway  station,  and  every 
Mning  saw  a  few  of  the  latter,  each  enveloped  in  his  blanket,  depos- 
ilid  in  a  neighboring  field.     During  the  first  fortnight  after  the  battle 
te  weather  was  remarkably  cool,  on  account  of  the  continued  rains, 
btt  after  this  two  or  three  days  of  intense  heat  developed  so  faetid,  so 
B^y  an  atmosphere  around  these  Hospitals,  that  it  became  necessary 
to  shift  ground  in  order  to  avert  the  occurrence  of  fever  and  diarrhoea. 
Well !    the  wounded  did  sufier  severely  after  the  battle,  more  so 
<Wii  after  any  of  the  previous  actions  of  the  war.    To  look  back  upon 
those  scenes  in  calmness,  now  that  the  excitement  of  marching,  of 
expected  battle,  of  actual  conflict  and  its  consequences,  has  passed 
tvaj,  one  wonders  that  wounded  men  could  have  survived  the  expo- 
dret  and  sufferings  of  the  six  days  immediately  succeeding  the  fight. 
Maoy  of  thoee  with  flesh  wounds  have  now  returned  to  their  regiments 
I     far  doty,  and,  as  reclining  in  the  shaile  they  tell  their  more  fortunate 
coBrKies  the  story  of   their  Hospital  experiences,  they  shake  their 
httds  and  smile,  and  say,  "  Well,  these  were  hard  times."  They  were 

fiiBce  then  we  have  had  no  general  engagement,  but  our  energies 

k?e  been  exhausted  by  heavy  marching  and  arduous  picket  duty  in 

the  hoi  sun,  and  by  the  feverish  anxiety  to  which  the  continual  expec- 

tatioQ  of  a  battle  gives  rise.     The  rocky  defiles  and  eastern  slopes  of 

lb  Blue  Ridge  Mountains  put  the  finishing  stroke  to  us,  so  that  it 

a  military  necessity,  as  it  already  was  a  medical  one,  for  the 

to  have  rest  to  recruit  their  physical  powers.     After  leaving  the 

passes,  the  proportion  of  men  requiring  transportation  in 

ths  sAbnlances  increased  to  a  grest  extent.     Many  fell  bebind  IYm 


S6  Special  SeUctbmB.  [Juiimk7» 

oolumn,  and  were,  I  have  no  donbt,  picked  np  by  the  gnerillas  that 
hovered  in  onr  rear,  while  others  fell  down  in  the  line  of  march  ex- 
hausted, or  from  the  effects  of  the  snn,  and  died.  The  army  conld  not 
march  mnch  longer  and  be  effective  in  case  of  a  struggle  with  tlie 
enemy.  Repre8entatit)n8  were  made  by  the  medical  officers.  Official 
answers  were  returned  to  a  series  of  questions,  such  as  :  **  What  nnm* 
her  of  men  in  your  command  rode  in  ambulance  yesterday  ?  How 
many  men  died  from  exhanstion  on  yesterday's  march  ?  How  manj 
from  sunstroke  ?  How  many  days  do  you  think  it  necessary  for  the 
troops  to  rest  in  order  to  render  them  capable  of  performing  efficient 
service  in  the  event  of  an  engagement  ?  "  and  so  on. 

In  the  commencement  of  August  active  operations  were  for  a  tiint 
suspended,  and  the  Army  went  into  summer  qnarters,  much  to  tka 
satisfaction,  I  presume,  of  every  one  in  it ;  for  campaigning  in  aiibk 
weather  as  we  now  experience  is  enough  to  perspire  patriotism  out  of 
the  most  patriotic.     Our  summer  camp  is  a   very  comfortable  aoll 
healthy  arrangement  ;  plenty  of  room  is  allowed  to  each  command- 
one  grand  point  in  a  sanitary  view  of  the  matter,  for  hence  the  streets 
are  wide,  the  tents  well  separated,  and  the  stables  and  latrinea  are  poi^ 
mitted  to  be  «t  a  wholesome  number  of  yards  from  where  the  meii 
pass  their  hours.     The  foot  of  each  tent  is  raised  at  leaat  a  foot  and  % 
half  from  the  ground,  so  that  whatever  breath  of  air  there  may  ba 
may  permeate  every  nook  and  secret  comer  of  the  camp.     The  moa 
have  built  bedsteads  for  themselves  at  a  height  of  twelve  inches  or 
more  from  the  surface  of  the  ground,  that  the  damp  dews  which  ooea* 
sionally  fall  at  night,  or  the  rain  storm,  may  not  sow  in  them  thegerma 
of  disease.     To  shelter  them  from  the  solar  rays  a  vast  parasol  ia 
thrown  over  their  heads  ;  a  large  number  of  forked  stakes,  twelye  or 
fourteen  feet  high,  are  driven  into  the  ground,  and  these  supported  a 
plexus  of  slender  spars,  on  which  is  strewn  so  thick  a  layer  of  bruah* 
wood  and  branches  that  the  sun  can  rarely  find  a  crevice  throagk 
which  to  intrude  into  the  cool  and  shady  camp  below.     Wells  aia 
sunk  in  favorable  localities.    The  sinks  are  readily  attended  to,  and 
police  duties  generally  well  performed.     The  consequence  is,  that  wa 
are  all  in  perfect  health,  although  relaxed  and  languid  from  excess  of 
heat.     But  this  was  far  from  being  the  case  during  the  first  few  dajrs 
after  our  arrival  here,  for  then  circumstances  the  reverse  of  those  ena* 
merated  contributed  to  the  generation  and  propagation  of   disease. 
We  were  crowded  together,  men  and  horses,  wagons  and  mules,  with 
but  little  shelter,  with  surface  water  muddy  and  lukewarm,  with  fresh 
meat  which  a  few  hours'  exposure  tainted,  and  with  the  refuse  of  campa 
everywhere  around.     Every  other  man  had  an  attack  of  diarrhoea,  bat 
it  did  not  continue  long ;  the  removal  to  the  new  grounds  stifled  the 
disease  on  its  onset. 

We  see  by  the  papers  that  sunstroke  is  killing  large  numbers  in  the 
cities.  Among  the  troops  we  have  now  no  such  cases,  for  in  camp 
we  are  well  sheltered,  and  in  performing  almost  the  only  duty  required 
of  us — picket  duty  every  fourth  or  fifth  day — we  are  not  much  expoe* 
ed,  since  the  march  to  the  picket-station  is  usually  made  in  the  eaily 
morning  or  in  the  cool  of  the  evening.     The  teamsters  in  the  Quar* 


1864.]  Special  Selediona.  37 


Department,  whose  duty  occasions  them  to  be  much  more 
tzposed,  famish  the  verj  few  cases  which  are  to  be  seen  in  this  part 
of  Yirginia. 

Regimental  snrgeons  have  nothing  whatever  to  do  at  present.     One 
nMon,  becanse  few  cases  of  sickness  occur ;  another,  the  principal 
eat,  because  when  a  man  does  get  so  ill  as  to  be  unfit  for  daty,  he  is 
imncdiately  sent  to  the  Hospital  of  Division  by  order  of  the  medical 
iMkarities.     This  hospital  is  established  near  the  camping  grounds  of 
tbe  Ambulance  Corps.     It  consists  of  a  dozen  hospital  tents  under 
ikt  shade  of  a  huge  arbor,  which  the  ambulance  men  have  constrncted 
ever  them.     It  is  a  very  quiet  place,  and  the  patients  seem  comfort- 
dble  and  clean  ;  they  have  plenty  of  attendants,  plenty  of  supplies. 
There  are  no  iron  bedsteads,  such  as  are  common  in  military  hospitals 
farther  from  the  front,  but  the  stretcher  makes  a  useful  substitnto  in 
Ac  ieki.     A  surgeon  with  one  assistant  is  detailed  in  charge.     This 
fliB  of   collecting  the  sick  of  a  division  near  the  ambulances  has 
■rored  very  useful  in  the  late  campaign.     There  is  not  a  sick  soldier 
m  the  camp  of  any  regiment;  all  are  inmates  of  this  hospital.     If, 
tei,  aa  order  arrived  directing  us  to  march  immediately,  we  would 
hKW9  no  trouble  with  our  sick.     The  regiments  fall  in  and  march  off, 
m4  bj  the  time  they  are  in  motion  the  men  unfit  for  duty  are  lodged 
kthe  ambulances,  which  then  bring  up  the  rear  of  the  column,  so  as 
to  piek  up  those  who  fall  out  exhausted  or  footsore.     At  evening  the 
md  men  rejoin  their  regiments,  and  a  night's  sleep  prepares  them  for 
dtt  march  next  morning,  while  the  sick  men,  if  the  movement  is  to  be 
iwmed  on  the  morrow,  pass  the  night  in  the  wagons  ;  but  if  a  halt 
if  a  day  or  two  is  anticipated  the  tents  are  pitched,  the  stretchers  made 
lidodotj  as  beds,  and  an  impromptu  hospital  is  formed.     The  regi- 
iBtil  ^nrgeons  have  thus  nothing  whatever  to  do  except  when  a  man 
gilt  tick  to  see  him  safely  dispatched  to  hospital.     The  plan  answers 
fwy  well  now  when  we  have  but  two  or  three  thousand  men  in  our 
4idmated  divinions ;  but  when  the  conscription  has  filled  up  our  ranks 
lo  their  normal   strength  of  fifteen  or  twenty  thousand  men,  every 
igeon  shall  have,  I  presume,  to  attend  to  his  own  men.    Kegimental 
MpiiAls  will  be  reestablished,  and  that  of  the  division  broken  up,  on 
•eeonnt  of  being  then  too  large  an  affair  to  work  smoothly  in  the  Held. 
had  now  in  these  hospitals  there  are  but  few  patients,  and  the  number 
rf  thoee  affected  with  acute  diseases  is  very  small  ;  the  majority  are 
■m  who»  as  the  expression  is  here,  have  got  '*  used  up''  on  the  late 
aarchea,  and  who  are  now  regaining  strength  on  goo<l  diet,  quinine, 
md  whisky. 

When  one  puts  the  question  to  himself — Why  have  the  meilical 
mihonties,  by  the  establishment  of  these  hospitals  in  each  division, 
lihm  the  direction  of  the  cases  of  disease  entirely  out  of  the  hands  of 
(he  surgeons  in  charge  of  regiments  ?  it  is  difTicult  to  arrive  at  a  sat- 
i^rtory  answer.  Is  ic  on  account  of  the  utility  of  the  arrangement 
vhen  the  army  is  in  motion  ?  Perhaps  the  idea  was  originated  with 
tkat  end  in  view  ;  but  why  continue  the  institution  now  that  the 
tioope  are  ijuiet  in  camp  ?  The  patients  can  not  have  better  attention 
bj  nnrsesy  atn^ngers  to  them  perhaps,  in  hospital,  thau  \>]f 


38    ^  Special  Seleeiiom,  [Januaiy, 

men,  their  comrades,  detailed  to  the  hospital  department  of  their  own 
regiment.    They  can  not  he  hetter  sheltered,  better  furnished  widi 
supplies  than  they  would  be  if  in  charge  of  their  own  medical  men* 
since  division  and  regimental  hospitals  are  equally  distant  from  tlie 
base  from  which  those  supplies  are  derived.     They  would  have  iht 
same  air,  the  same  water,  and  an  equally  salubrious  camping  ground 
in  the  one  case  as  in  the  other.     It  is  not  to  prevent  the  spread  of 
disease  among  us  by  contagion  that  the  sick  are  in  some  meaaara 
removed  from  us,  for  we  have  no  contagious  diseases  ;  and  the  small- 
ness  of  the  percentage  of  sick  negatives  the  supposition  that  their 
removal  was  intended  to  prevent  any  depressing  influenoe  their  pret- 
ence might  occasion  among  the  troops.     Dare  we  look,  then,  to  th« 
regimental  medical  officers  themselves  for  an  explanation  ?     Is  it  that 
the  authorities,  who,  by  the  recent  suppression  of  the  use  of  calomel 
and  tartar  emetic,  showed  the  distrust  they  had  of  the  capabilities  of 
these  gentlemen,  have  come  to  the  conclusion  that  it  would  be  of  more 
benefit  to  the  service  for  them  to  lock  their  medicine  chests  and  tnm 
over  their  sick  for  tendance  to  a  man  of  tried  professional  qualifion* 
tions — the  surgeon  in  charge  of  the  division  hospital.    This  is  an  nglj 
view  to  take  of  the  matter,  but  one  is  at  liberty  to  look  so  at  it  when, 
knowing  that  there  are  men  sick,  one  sees,  and  has  seen  for  four  weeks 
past,  regimental  hospitals  deserted,  their  stewards  unoccupied,  their 
attendants  drawing  rations  from  their  companions  instead  of  on  sur- 
geon's requisition,  and  their  medical  men  seating  themselves  quietly 
to  breakfast  while  sick  call  is  being  beat,  aware  that  it  it  is  now  bat 
an  empty  sound.   The  arrival  of  the  conscripts  will,  I  think,  as  I  said 
before,  put  an  end  to  this  state  of  matters.     These  unwilling  patriots^ 
or  their  substitutes,  are  already  joining  us,  although  as  yet  but  in 
small  detachments.     An  order  has  been  issued  requiring  surgeons  to 
examine  and  report  on  the  physical  condition  of  every  man  sent  to 
join  their  commands.   If  this  order  be  rigidly  carried  out  it,  will  saTO 
an  immense  amount  of  expense  to   Government,  and  of  subsequent 
trouble  to  the  surgeons  themselves.     When  this  army  was  first  oi*gan- 
ized,  examining  surgeons  were  very  careless,  or  duped  perhaps  bj 
roguish  recruiting  officers.     Almost  every  one  who  volunteered  was 
accepted,  and  the  consequence  was  when  active  service  commenced  a 
heavy  bill  of  sickness  and  mortality.     The  surgeons  then  in  the  field 
felt  sorely  the  necessity  for  a  strict  examination  of  recruits,  and  now, 
having  tiiemsclves  that  duty  to  perform,  it  may  safely  be  augured  that 
the  physique  of  the  conscript  will  be  far  superior  to  that  of  the  volun- 
teer army  when  it  first  entered  the  field. 

In  a  late  number  of  the  Medical  Times  which  reached  me,  I  observed 
some  remarks  of  yours  on  tlie  volunteer  surgeons  of  America,  apropos 
of  tlie  proscription  of  calomel  and  tartar  emetic  by  the  Burgeon- 
Goncial.  I  have  not  the  article  beside  me.  but  I  think  you  jocularly 
predict  that  tiio  next  edict  will  be  that  no  more  field  instruments  are 
to  bo  issued,  and  that  those  already  in  the  possession  of  army  surgeons 
are  horowilh  ordered  to  be  turned  in,  since  the  Surgeon-General  believes 
that  the  country  has  derived  more  harm  than  benefit  from  the  indis- 
criminate use  of  these  edged  tools.     Well,  the  majority  of  surgeons 


1864.]  Special  SeUdhm.  89 


JD  ikis  Army  since  the  battle  of  Antietam  in  September,  1862,  have 
been  as  tboronghlj  cnt  off  from  the  use  of  the  amputating  knife  as  if 
s«ch  an  order  bad  actually  been  published  and  stringently  insisted 
npoo.     PreTious  to  that  time  it  was  the  duty  of  the  senior  medical 
officer  of  a  regiment  to  decide  upon  all  the  cases  occurring  in  his  com- 
Qaad,  and  should  his  decision  be  operation,  to  operate  ;  but  the  evils 
sriaiDg  from  this  license,  this  want  of  supervision,  became  plainly  ap- 
parent, and  to  prevent  yi  a  great  measure  in  future  ill-timed,  ill-judged, 
sad  badly-executed  interference,  a  staff  of  officers  in  whom  confidence 
covld  be  placed  was  commissioned,  in  the  event  of  a  battle,  to  exam- 
iae.  decide,  and  operate,  the  duty  of  the  others  being  restricted  simply 
to  dreaaing.      That  this   plan   works   admirably  the  experiences  of 
Fredeiickaburg,  Chancellorsville,  and  Gettysburg  have  fully/  demon- 
minted.    ^Not  only  do  the  patients  receive  the  best  professional  skill 
vkidi  tlie  division  can  afford,  but  the  surgical  history  of  the  battle  is 
bttter  preserved.     One  officer  in  the  hospital  does  nothing  but  record 
ia  fall  the  histories  of  the  various  cases,  whereas  formerly  every  regi- 
■est  had  a  record  to  hand  in,  althongh  every  one  did  not  furnish  it. 
)^«aM  surgeons,  through  ignorance  of  the  routine  of  military  duty, 
md  oUiers  through  neglect,  did  not  comply.     It  is  not  unusual  also 
iv  papers  in  the  field  to^get  lost  during  their  transmission  from  one 
rfmnf  to  another. 

Siaoe  this  civil  war  has  lasted  now  two  years  and  a  half,  since  so 
■say  great  battles  have  been  fought,  and  since  time  and  opportunity 
fasre  been  afforded  the  surgeons  for  familiarizing  themselves  with  the 
faases  common  in  camp,  it  might  be  said    that  surely  thoy  now 
«fhl  to  be  able  to  treat  skilfully  most  of  the  cases  which  fall  under 
thor  observation  ;  and,  undoubtedly,  those  who  have  had  those  ad- 
viatages  are  so.     But  men  who  have  been  in  the  field  since  the  first 
of  the  rebellion  aie  rarities  in  camp.     There  is  a  continual 
going  on  in  the  constituents  of  the  medical  force,  which  pre- 
it  from  improving  as  a  body,  although  the  members  of  it  are 
Uy  being  tanght  lessons  by  experience.     It  is  very  unfortunate  that 
tbtanny  can  not  retain  in  its  service  the  surgeons  it  has  made.     The 
,  I  think,  during  the  last  six  months  has  deteriorated,  the  skill 
sOainments  lost  to  it  by  men  leaving  the  ranks  have  been  greater 
the  additions  brought  by  those  to  fill  the  vacancies.     Many  med- 
ial Men  come  out.  and  after  a  few  months  trial  of  soldiering,  get  tired 
rf  ic,  jnst  a(  the  time,  perhaps,  when  experience  has  begun  to  render 
4ar  services  valuable.     Others  spend  a  longer  or  hhorter  period  with 
^  anny,  when  they  become  prostrated  by  sickness  ;  they  obtain  a 
*oft  leave  of  absence  to  recruit  their  health,  and  the  home  comforts 
'•acy  then  experience  contrasts  so  strongly  with  the  fatigues  and  priva- 
^oBi  of  camps  and  campaigns,  that  when  reoovci-ecl  they  have  nut 
%4rsl  coorage  sufficient  to  enable  them  to  undertake  a  icturn  to  the 
i^.     Others  enter  the  bervicc  with  the  intention  of  leaving  it  a^ain 
t^icr  a  ibort  time,  their  object  being  bimply  the  possession  of  ihe  c-uui- 
aftiMiofi,  which  they  intend  using  as  a  reputation  trap  tosnaa'  patients. 
h  vAs  oaly  the  other  day  that,  in  looking  over  the  advc.ii>euieni 
of  the  Arolcf »  I  observed  a  notification  to  the  pubh"  of  New 


40  Special  StleetionM,  [  Jtnutry, 

York  city  that  So-and-so,  late  surgeon  of  the  Sach-and-Sneh  regi* 
meat,  bad    resumed  the  practice  of  his  profession,  etc.      Again,  a 
number  of  the  surgeons  attached  to  the  nine  months'  and  two  years' 
regiments  did  not  return  to  the  army  when  mustered  out,  in  conse- 
quence of  the  disbandment  of  their  commands  at  the  expiring  of  their 
term  of  service.     But  the  greatest  loss  the  surgical  force  in  the  field 
has  suffered  has  been  caused  by  the  institution  of  the  United  Statse 
Corps  of  Volunteer  Surgeons.     The  members  #f  this  body  are  com- 
missioned by  the  President,  and  are  employed  as  Stirgeons  of  Divisions, 
Medical  Directors  of  Army  Corps,  or  are  attached  to  the  varions  mil- 
itary hospitals  now  so  common  throughout  the  country.     No  ineffi* 
cient  men  belong  to  this  corps^-that  of  the  U.S.V.,  as  it  is  termed,— 
the  searching  examination  to  which  they  are  subjected  before  being 
commissioned  obviates  all  chance  of  the  admission  of  any  but  those 
possessed  of  superior  talents.     The  surgeons  in  chai^  of  regiments 
hold  their  commissions  from  the  Governor  of  that  State  which  has 
furnished  the  troops  to  which  they  are  attached,  and  their  duty  is  to 
be  with  their  commands  wherever  stationed.     Now,  although  the  paj 
in  both  services  is  the  same,  the  superiority  of  the  position  attraets 
the  best  talent  in  the  field  to  the  ranks  of  the  U.S.V.  coi*ps.     The  mea 
who  come  from  civil  life  to  fill  the  vacancies  ape  but  poor  substitutes 
for  those  we  lose.     Good  men  come,  as  may  be  supposed,  but  the  pro- 
portion of  indifferent  practitioners  is  very  large.     They  are  young  men 
of  no  experience,  and  of  superficial  education  from  the  schools ;  men 
good,  bad,  and  indifferent  from  the  cities,  who,  having  but  poor  prae- 
tices,  attempt  to  better  their  fortunes  by  going  a-soldiering ;  men  fronk 
the  country,  whose  duty  for  years  previously  had  been  to  attend,  mid- 
wifery cases.   A  few  creep  into  the  service,  too,  possessed  of  no  papei^ 
but  the  commission  which  by  some  means  they   have  managed  Uy 
obtain,  such  as  dentists  and  druggists  who  have  read  perhaps  a  little* 
But  the  purest  example  of  ignorance  commissioned  in  the  Americaii 
Medical  Service  that  I  have  yet  met  was  in  the  person  of  one  who- 
might  have  been  styled  a  political  surgeon.     The  case,  I  believe  and 
hope,  is  unique.    He  had  been  a  politician.     He  had  represented  a 
County  in  a  certain  State  during  the  previous  session,  and  to  reward 
him  for  party  services,  probably,  he  had  received  the  appointment* 
He  knew  nothing  of  medical  science,  nor  of  any  other  science  what- 
ever.    He  was  very  illiterate.     It  amused  me  to  look  over  the  books 
of  the  regiment,  as  kept  by  him.     From  his  Register  I  learned  that 
diorhe,  rheumatism,  and  chUU  &nd/ever  were  the  only  diseases  of  which 
he  was  cognizant,  with  the  exception  of  one  case  of  sore  leg.     His 
prescription-book  showed  that,  in  his  opinion,  the  compound  cathartic 
pill  of  the  U.  S.  Pharmacopoeia,  or,  as  he  ordered  it,  j9t/  cat,  co,,  iii.» 
was  a  specific  for  all  the  diseases  to  which  the  soldier  is  liable.     His 
ignorance  was  too  gross  for  him  to  keep  up  appearances  for  any  tim's, 
and  on  a  gentle  hint  having  been  dropped  him  concerning  the  existence 
of  a  Board  of  Examiners  at  Washington,  he  took  sick,  and  found  not 
the  least  difliculty  in  having  his  resignation — based  upon  his  ill-health 
— accepted. 

To  tell  now  a  more  agreeable  tale  of  the  service,  I  shall  mention  to 


IS64.]  EdUor'8  Table.  41 

Ton  the  establishment  of  a  Medical  Society  in  one  at  least  of  the 
divisions  of  this  army.  Its  meetings  are  weekly,  when  they  can  con- 
veniently be  held,  and  are  well  attended,  and  there  matters  interesting 
to  the  military  snrgeon  may  be  heard  discussed  with  a  freshness  that 
smells  of  the  field  and  the  vigor  which  experience  gives. 

Having  been  in  ^Vashington  a  few  days  ago,  and  having  a  spare 
hoar,  I  paid  a  visit  to  the  Army  Medical  Museum,  feeling  an  interest 
in  it  from  having  seen  so  many  specimens  preserved  after  the  late 
battle  to  enrich  it.     Its  formation  was  commenced  in  August,  1862, 
iQ'I  the  proportions  which  it  has  now  assumed  at  the  end  of  its  first 
Tear  of  existence  speak  strongly  in  testimony  of  the  energy  and  en- 
fihnsiastic  zeal  displayed  by  its  curator,  Dr.  J.  U.  Brinton.    It  numbers 
iLont  two  thousand  objects.     The  majority  of  them  are  cases  of  sur- 
gical interest,  but  there  is  a  goodly  nucleus  of  medical  preparations, 
an.l  which  is  daily  increasing  in  magnitude.     There  is  quite  a  number 
ftf  missiles  of  all  soils — grape,  spherical,  case,  and  buck  shot,  rifle 
aii<l  round  bullets,  and  pieces  of  shells,  even  Indian  arrows,  most  of 
litem  extracted  from  the  body.     There  is,  in  addition,  a  complete  set 
of  projectiles  for  small  arms  and  field  guns,  presented  by  the  Ordnanco 
Department  of  the  army.     The  collection  is  at  present  in  a  room  in 
the  building  used  by  the  Surgeon- General  as  an  office,  but  it  will  not 
remain  long  th<»re.     A  house  is  being  fitted  up  for  it — a  sombre  brick 
bailding  it  is,  that  seems  as  if  it  hfid  been  built  with  a  view  to  its  one 
dij  l<eooming  a  museum.     It  is  small  somewhat,  on  account  of  the 
funds  Voted  for  the  purchase  of  a  house  having  been  small,  and  then 
probably  because  the  collection  was  not  expected  to  grow  so  rapidly 
AK  it  has  grown.     I  dare  say  that  in  the  course  of  a  short  time,  if  it 
niece«ds  to  well  as  it  has  been  doing — and  as  there  is  every  reason  to 
expect  that  it  will — a  mansion  will  be  assigned  worthy  of  it.     Tho 
r^jta  on  the  ground  floor  of  the  house  in  preparation   is   being  fitted 
■p  aa  a  class  room.     By  and  by  the  student  of  military  surgery  will 
hert  have  opportunities  which,  if  taken  due  advantage  of,  will  place 
tb«  American  surgeon  on  a  higher  professional  footing  than  he  holds 
at  pre«ent. — London  Lancet, 


Li%Hor  Calcit  in  Diarrhcca. — In  a  note  from  Thos.  May.  L.P.F.S., 
rf  <jla>gow,  to  the  London  Lancet^  he  says  :  •*  Now  that  diarrluea  is 
fo  very  pa^valcnt,  an«l  when  it  attacks  infants,  so  frequently  fatal,  its 
vioi-'u'e  tesi^ting  all  the  routine  treatment,  may  I  inquire  if  any  ^itw- 
ibman  limd  tried  that  very  old-fashioned  remedy,  liquor  calcis  ? 
Am'iO^t  a  very  poor  class  of  patients,  living  in  ill-ventilated  nparl- 
Meats  in  close,  cujitine^l  localities,  I  have  fotmd  it  act  like  a  charm  ; 
pring  at  the  same  time  one-grain  doses  of  compound  ipecacuanha 
|iowd«-r  wiih  two  grains  of  mercury-with-chalk.  The  vomiting  and 
pQrgalion  cease,  and  the  child  gradual'y  recovers  from  what  seemed 
lo  be  a  ffttal  attack.  I  have  found  it  particularly  serviceable  to  infants 
aa  the  brcmatv  and  it  has  frequently  done  g;pod  service  to  a<lults  in  com- 
IciukCioa  with  castor  oil  and  tincture  of  opium  in  fall  doses." 


42  Bevitwt  and  Nolicei.  [Janaaiy, 


%t)i\tm  and  ^it\Ut%, 


A  Manual  on  Eztractinff  Teeth :  By  Abraham  Robertson,  D.D.S.,  M  D.,  aatbor 
of  Prize  Essay  on  Extracting  Teeth,  etc.  Philadelphia :  Lindsay  &  Blakis- 
ion     1868. 

As  the  author  of  this  useful  little  book  very  truly  remarks,  The 
operation  of  extraeting  teeth  is  at  best  a  painful  one,  yet  it  is  one  to 
which  almost  every  individual  is  obliged  at  some  time  or  other  to 
submit.  It  is  therefore  very  manifest  that  *'  the  comfort  of  humanity 
demand  that  those  who  perform  the  operation  should  be  so  instructed 
as  to  be  able  to  do  it  in  the  most  skillful  manner."  Dr.  Robertson's 
Manual  is  founded  on  the  anatomy  of  the  parts  involved  in  the  oper- 
ation, and  embraces  in  its  contents  the  kinds  and  proper  construction 
of  the  insti-uments  to  be  used,  the  accidents  liable  to  occur  from  the 
operation,  and  the  proper  remedies  to  retrieve  buch  accidents. 

We  believe  our  author  has  very  satisfactorily  carried  out  the  plan 
he  announces  in  his  title  and  preface,  and  has  produced  a  book  that 
will  be  of  good  service  not  only  to  dentists  proper,  but  to  most  phy- 
sicians, for  there  is  still  the  requirement  of  physicians  more  or  less 
frequently  to  extract  teeth,  and  we  know  of  no  operation  in  minor 
surgery  wherein  so  much  awkwardness  and  want  of  ordinary  tact  and 
skill  is  displayed  as  in  that  of  extracting  teeth,  simple  as  it  is  some- 
times regarded. 

After  giving  a  brief  chapter  on  the  anatomy  of  the  jaws  and  teeth, 
our  author  proceeds  to  treat  briefly  on  the  pathology  of  toothache,  in 
which  we  observe  very  judicious  suggestions  as  to  the  effect  of  the 
health,  the  condition  of  the  stomach,  the  action  of  various  articles* 
medicinal  and  otherwise,  taken  into  the  mouth,  the  character  of  the 
saliva,  etc.,  in  their  reactions  upon  the  condition  of  the  teeth,  espe- 
cially in  their  tendency  to  decay,  which  of  course  is  the  most  frequent 
cause  of  toothache. 

We  next  have  a  careful,  and  as  it  appears  to  our  meagre  knowledge 
of  dentistry,  a  very  judicious  description  of  the  instruments  concerned 
in  extracting,  and  the  value  and  special  application  of  each.  With 
most  all  dentists  Dr.  Robertson  rejects  the  old-fashioned  turnkey,  de- 
pending on  a  few  well  selected  forceps,  elevators  and  the  gouge. 

A  chapter  is  devoted  to  lancing  the  g^ms,  which  while  considered 
in  many  cases  absolutely  necessary  and  important,  yet  "  as  a  general 
rule,  ought  to  be  entirely  omitted."    He  proceeds  at  some  length  to 


1864.J  BeviiWM  atid  NotkeB.  43 

give  his  retsons  for  this  opinion,  and  to  give  special  directions  for  the 
manner  of  proceeding  when  necessary. 

We  have  finally  two  important  chapters  :  one  treating  on  the  acci- 
dents attendant  npon  the  extraction  of  teeth  and  their  remedies  ;  the 
other  on  the  n«e  of  anaesthetics.  On  the  latter  topic  the  author,  in 
the  whole  tenor  of  his  remarks,  decidedly  discourages  the  use  of 
Aniesthetics  in  the  extracting  of  teeth.  He  has  hut  little  faith  in  the 
Availahtlity  of  local  anaesthesia  for  this  purpose.  The  local  applica- 
tion of  chloroform,  the  use  of  freezing  mixtures,  electricity,  etc.,  all 
have  their  objections  in  his  opinion  seriously  overbalancing  the  utility 
of  each. 

Dr.  Robertson's  Manual  is  a  small  book,  but  as  wo  think,  embraces 
the  whole  substance  of  the  matter,  and  we  heartily  commend  it  to 
physicians  who  are  compelled  to  regard  this  part  of  surgery  amongst 
their  leqairements  or  acquirements. 

For  sale  by  Bobt.  Ckrke  k  Co.     Price  81.50. 


Sjfmopsii  of  ike  Covrte  of  Lectures  on  Materia  Medica  and  Pharmacy :  Delivered 
in  the  UniTersitj  of  Pennsylvania;  with  Three  Lectures  on  the  Modus 
Operandi  of  Medicines.  Bj  Joseph  Oarsos,  M.D.  Third  Edition  Revised. 
PhiUdelphia :  Blanchard  &  Lea.    1868. 

W«  have  placed  on  our  table  this  new  edition  of  a  work  already 
kaown  somewhat  familiarly  to  the  profession.  It  is  exactly  what  it 
professes  to  be,  a  synopsis  of  the  course  of  instruction  given  by  the 
Profe«iior  of  Materia  Medica  and  Pharmacy  in  the  University  of 
Pennsylvania.  No  one  would  buy  Dr.  Carson's  book  as  a  text-book 
or  work  of  reference  in  Materia  Medica,  and  yet  it  is  a  most  useful 
bouk«  and  especially  to  any  student  who  desires  to  have  at  hand  a 
fimmework  of  the  study,  it  is  most  acceptable  and  convenient.  Of 
CMirve,  it  is  more  particularly  intended  for  the  class  who  follow  Dr. 
Carton's  course  of  instruction.  For  them  this  condensed  outline  is  a 
Boat  eapiial  thing,  which  may  be  either  filled  up  by  notes  taken  by 
Ike  student  while  the  course  progresses,  or  by  reference  to  the  text- 
books specified. 

In  tha  classification  adopted  we  observe  that  essentially  the  same 
tabcilar  form  is  retained  as  was  adopted  by  Dr.  Carson's  distinguished 
predacessor  in  the  same  chair — Dr.  George  B.  Wood.  Students  of 
Materia  Medica  will  romemoer  this  as  based  upon  the  physiological 
actioa  of  remedies.  There  are  objections  to  the  classification  of  Dr. 
Wood,  bat  so  there  is  to  any  arbitrary  arrangement,  and  perhaps  this 
ifa  it*  as  convenient  as  any  other. 

In  tha  piasani  edition  the  nomenclature  of  the  Tarions  ariiclea  aiwi 


44  RevlewB  and  NodeeB.  [ Januaiyy 

preparations  are  made  to  conform  to  the  United  States  Pharmacopcea 
of  1863. 

The  volume  concludes  with  three  lectures  on  the  modus  operandi  of 
medicines  ;  three  carefully  prepared  lectures  which  very  amply  repay 
their  careful  reading.  A»  we  have  already  said,  this  is  not  a  work  of 
reference,  but  a  work  of  arrangement,  **%  synopsis."  Nevertheless, 
the  student  will  always  find  it  a  desirable  book  to  own,  and  most  con- 
venient for  refreshing  the  memory  in  all  the  outline  and  framework  of 
the  study. 

For  sale  by  Robert  Olarke  &  Co.     Price  82.25. 


OutUru8  of  the  Chief  Camp  DisMS69  of  the  United  Stak$  Armies,  m  observed 
during  the  Present  War.  A  Practical  ContributioQ  to  Military  llediciner 
Bj  Joseph  J.  Woodward,  M.P.,  Assistant-Surgeon  U.S.A.,  etc.,  etc.  Phila- 
delphia :  J.  B.  Lippincott  &  Go.   1868. 

This  is  another  contribution  to  military  medicine,  and  will  be  re- 
garded as  a  very  excellent  one  by  every  one  who  has  had  any  obser- 
vation in  the  treatment  of  the  diseases  of  soldiers  during  the  present 
war.  It  must  serve  also  as  a  book  of  reference  and  consultation  for 
the  future.  We  are  sorry  in  some  respects  that  Dr.  Woodward  did 
not  postpone  its  publication  until  he  could  use  all  the  material  in  the 
Burgeon-General's  office.  He  has  had  charge  of  the  reports  and 
classification  of  the  medical  diseases  proper  sent  into  the  Surgeon- 
General,  and  has  not  felt  at  liberty  to  use  them  in  advance  of  their 
publication  by  the  Surgeon- Oeneral.  Again,  we  think  he  would  have 
written  with  more  authority  and  usefulness  if  he  had  waited  longer. 

Dr.  Woodward's  position,  however,  in  the  Surgeon-General's  office, 
that  of  curator  of  the  medical  and  microscopical  departments  of  the 
army  Medical  Museum  entitles  him  to  respect,  and  with  the  reserve 
we  have  already  expressed,  we  must  accord  our  good  opinion  to  his 
book. 

We  are  right  glad  to  have  a  work  on'  military  medicine.  Surgery, 
Eurgery,  surgery, — the  lopping  off  of  arms  and  legs,— ^the  resection  of 
this  joint  and  that  joint  has  been  the  great  topic  with  men  entering 
the  army.  The  people  too  have  estimated  the  army  surgeon  for  his 
skill  as  an  operator.  The  medical  student,  sitting  on  the  benchee, 
looking  forward  anxiously  to  the  hour  when  he  might  be  able  to  pass 
an  examining  board  as  assistant-surgeon,  has  been  unable  to  see  any 
interest  in  any  lecture  unless  it  had  reference  to  operative  surgery. 
Ko  man  can  be  a  good  surgeon  unless  he  is  a  good  practical  physician. 
The  knowledge  of  external  pathology  is  a  ban^en  acquisition,  unless  it 
'    accompanied  with  an  intimate  and  thorough  knowledge  of  internal 


1864.]  Reviews  and  Notices.  45 

ptthologj,  etiology  and  therapentics.  Tbis  book  will  at  least  remove 
the  delasion  ander  which  many  have  been  laboring — that  the  chief 
dnties  of  the  medical  man  in  the  army  are  surgical. 

The  contents  of  the  work  are  considered  in  Chapter  I.  as  an  intro- 
ductory ;  Chapter  II.  Conditions  determining  the  character  of  camp 
diseases.  Section  I.  Malarial  Influence.  Section  2.  Crowd  Poison- 
ing. Section  3.  The  Scorbutic  Taint ;  Chapter  III.  Camp  Fevers. 
Section  1.  Typho-Malarial  Fever.  Section  2.  Diseases  which  may  be 
confounded  with  Typho-Malarial  Fever ;  Chapter  IV.  Intermittent 
Fevers.  Section  1.  Simple  Intermittent  Fever.  Section  2.  Conges- 
tive or  Pernicious  Intermittent.  Section  3.  Chronic  Malarial  Poison- 
ing ;  Chapter  V.  Jaundice  ;  Chapter  YI.  Camp  Diarrhoea.  Section 
I.  Simple  Diarrhoea.  Section  2.  Acute  Enteritis.  Section  3.  Acnte 
Dysentery.  Section  4.  Chronic  Diarrhoea  ;  Chapter  VIII.  Catarrh  ; 
Chapter  IX.  Pneumonia  ;  Chapter  X.  Pseado-Hhenmatism  Affections. 

There  are  many  points  in  the  book  which  we  would  be  glad  to  pre- 
sent to  our  readers,  did  space  permit.  The  chapter  on  typho-malarial 
fever  is  by  all  odds  the  best  as  it  is  the  longest.  The  subject  of  camp 
fever  has  commanded  much  attention  from  Dr.  Woodward  as  from 
every  reflecting  army  surgeon.  Great  confusion  and  misunderstanding 
existed  for  the  first  year  of  the  war  in  regard  to  the  nature  of  camp 
lever.  Every  case  of  low  fever  was  regarded  and  called  typhoid,  hav- 
ing for  its  pathological  anatomy  the  ulceration  of  Peyer's  glands. 
"So  one  can  read  the  chapters  on  fever  without  giving  assent  to  the 
views  of  the  author. 
^  The  book  is  for  sale  by  Robert  Clarke  <fe  Co." 


The  Pkyndan's  Hand-Book  of  Practice  for  18C4.     By  Wm.  Elmkr,  M.D. 

This  IB  one  of  the  convenient  labor-saving  little  manuals,  already 
well  known  to  the  profession,  for  recording  daily  business  and  as  a 
book  of  ready  reference.  Its  arrangement  is  entirely  different  from 
that  of  the  Visiting  List,  in  use  by  a  great  many  physicians.  The 
Hand-Book  contains  the  usual  blank  pages  for  daily  visits,  and  the 
▼arions  memoranda  of  case  book,  obstetric  records,  etc,  etc.  There 
is  also  a  large  space  devoted  to  a  classification  of  diseases,  ready 
method,  poisons  and  antidotes,  examination  of  the  urine,  list  of  in- 
ipndblee,  a  complete  materia  medica,  together  with  considerable 
ail  Talaable  in  itself,  but  as  it  appears  to  us,  scarcely  valuable 
a  book.  Oar  own  experience  is  that  the  physician  wants  in  a 
lailim  list  bat  little  more  than  the  tabulated  daily  visltiiig  diary  , 


46  SdUor'B  TMe.  [January, 

and  perbaps  a  moderate  space  for  miscellaneoos  memoranda.   Beyond 
this  is  mostly  cumbrous  lumber,  inconveniently  bulky  and  unpleasant 
in  tlie  pocket. 
For  sale  by  Robert  Clarke  &  Co.    Price  $1.25. 


(Sauov'j!  Satfle. 


Another  Sew  Year  has  dawned  upon  us  with  its  living  cares,  anxi- 
eties and  responsibilities.  Entering  upon  the  labors  which  go  with 
these,  we  extend  once  more  to  our  readers  the  sincere  greetings  of  the 
season.  In  the  midst  of  this  terrible  civil  war,  which  has  carried 
monrning  to  every  American  hearthstone,  this  journal  has  pursued 
the  regular  tenor  of  its  way,  yet  constantly  sympathizing  with  the 
earnest  struggle  which  surrounds  us.  While  this  struggle  is  for  a 
continued  national  existence,  it  has  at  the  same  time  been  of  the  sad- 
dest interest  to  our  profession  from  its  first  incipiency.  The  surgeon 
on  the  battle-field  and  in  the  prolonged  tedious  days  of  the  hospital, 
is  the  one  above  all  others  who  has  been  brought  into  constant  pain- 
ful contact  with  the  suffering  results  of  conflict,  disease  and  privation. 
And  when  this  great  rebellion  shall  be  crushed  out,  there  will  be 
nothing  more  worthy  of  an  enduring  remembrance  than  its  medical 
history.  We  are  glad  to  have  it  to  record  in  this  connection  that  this 
medical  history  is  in  good  hands,  and  that  the  fair  name  and  honor 
of  the  profession  will  be  carefully  protected  and  sustained. 

As  we  enter  upon  this  new  year  let  us  hope  that  the  trials  of  this 
struggle  are  well  nic^h  past ;  and  that  the  blessed  Messiah,  whose  birth 
day  we  have  so  recently  celebrated,  will  speedily  come  down  amongst 
us,  and  restore  to  this  land  once  more  peace  and  good-will  amongst 
men.  Let  us  hope  that  long  before  another  New  Year's  greeting 
shall  come,  we  shall  be  permitted  to  unite  in  the  general  shout  of 
jubilee  that  will  go  up  all  over  this  land,  when  it  shall  be  flashed  from 
one  end  to  the  other  that  we  are  again  one  united  people. 


'    Medical  Officers  Released  from  Richmond  Prisons. — It  is  already 

known  that  a  large  number  of  surgeons  and  assistant-surgeons  have 

recently  been  released  from  the  rebel  prisons  at  Richmond.     Of  these 

-notice  quite  a  number  of  &miliar  names,  friends  and  subscribers  to 


JEdUor's  Table.  47 

this  jonrnal.  Thus  we  find  Assistant- Sargeon  R.  P.  McGandless, 
110th  O.V.I. ;  Assistant- Snrgeon  Spencer,  73d  Ind.  ;  Surgeon  J.  L. 
Wooden,  68th  Ind.  ;  Surgeon  Daniel  Meeker,  U.8.V.  ;  Surgeon  aeo. 
P.  Ashmun,  93d  O.V.I.  ;  Assist. -Surgeon  J.  K.  Moore,  13th  O.V.I. ; 
Assisunt- Surgeon  R.  H.  Fallis,  7th  O.V.C.  ;  Assistant-Surgeon  C. 
P.  0.  Hanlon,  OOth  O.V.C.  ;  Assistant- Surgeon  W.  A.  Carmichael, 
2d  O.V.I.  ;  and  doubtless  others,  if  we  should  look  over  the  lists  care- 
folly.  We  take  this  opportunity  to  express,  our  sympathy  for  these 
worthy  gentlemen  in  their  late  privations,  and  our  congratulations  in 
their  return  to  their  homes  and  regiments. 


Our  Terms. — Our  Prospectus,  with  terms  for  1864,  will  be  found 
elsewhere.  It  will  be  seen  that  we  have  made  no  change.  We  ex- 
pect, however,  a  prompt  and  strict  adherence  to  our  rates.  We  can 
sustain  ourselves  in  no  other  way.  Especially  we  desire  all  our 
friends  who  wish  to  subscribe  for  the  London  Lancet  or  other  publica- 
tions in  connection  with  the  Lancet  and  Obaerver,  to  remit  as  soon  as 
practicable,  that  we  may  forward  names  in  one  list. 


Death  of  Dr,  Oan$, — It  becomes  our  painful  duty  to  announce  the 
death  of  Dr.  D.  S.  Gans,  of  Cincinnati.  He  was  one  of  the  most 
iidus»trious  members  of  the  profession  in  our  city — in  everyway  ready 
to  do  his  full  share  of  professional  drudgery.  In  the  Academy  of 
Me<licine  he  was  one  of  the  most  constant  attendants  and  most  fre- 
qtcn'participant.s  in  its  exercises  and  discussions — in  all  of  which  he 
was  ever  listened  to  with  respcL't  and  attention.  Ho  was  well  known 
to  tlw  readers  of  this  journal  as  one  of  its  most  frequent  and  volurai- 
noos  contributors.  One  of  his  most  recent  papers  published  in  tho 
Lamctt  ami  Observer,  on  the  ba}m()rrlingio  diathesis,  has  elicited  con- 
friderable  intere:»t  and  has  already  called  out  two  papers  from  other 
Contributors  on  the  same  subject.  Thin  was  one  of  the  peculiarities 
of  his  essays,  reports  and  debutes — tho  faculty  of  being  suggestive. 

Dr.   Gans  was   a  native   of  Hanover,  Ocrmany,  and  received  his 

meiliral  education  at  the  University  of ,  bsfore  his  emi^^ration  to 

thit  country.  He  practiced  variously  in  this  city,  in  Dayton  in  this 
State,  in  New  Orleans,  Havana,  and  finally  returning  here,  remained 
in  Cincinnati  nntll  his  decease. 

Dr.  Gans  died  emphatically  in  the  harness,  and  not  only  so,  his 
dcftth  was  the  result  of  one  of  those  labors  of  charity  so  often  and  so 
sahmtrntingly  imposed  upon  the  medical  profession.  On  the  evening 
of  tbe  2d  of  December,  he  was  called  to  attend  an  obstetrical  ctL^Q 


48  Editor^s  Table,  [January, 

where  he  was  obliged  to  sit  in  a  very  cold  room  for  several  honrs  with- 
out fire.  He  returned  to  his  home  chilled  through,  indisposition  fol- 
lowed, developing  speedily  in  doable  pneumonia,  of  which  he  rapidly 
sunk,  departing  this  life  Monday  evening,  December  14. 

At  the  special  meeting  of  the  Academy  held  Tuesday  evening,  Dec. 
15,  the  following  resolutions,  presented  by  Dr.  Williams,  chairman 
of  the  committee,  were  read  and  adopted  : 

"  WhereaSy  It  has  pleased  Almighty  God  in  the  inscrutable  dispen- 
sations of  his  Providence,  to  call  from  among  us  our  highly  esteemed 
friend  and  co-associate  in  the  Academy  of  Medicine,  D.  S.  Gans,  M.D. 
Therefore. 

"  Resolved,  That  in  the  death  of  Dr.  D.  S.  Gans,  Cincinnati  has 
lost  a  valuable  and  patriotic  citizen,  and  the  profession  one  of  its 
brightest  ornaments. 

*'  Resolved,  That  in  his  demise  the  Academy  of  Medicine  especially 
feels  that  it  has  been  deprived  of  one  of  its  most  useful  and  active 
members :  who,  by  the  constancy  of  his  devotion  to  his  academic 
duties,  afforded  a  bright  example  for  the  younger  members  of  the  pro- 
fession. 

**  Resolved,  That  we  offer  to  the  family  and  relations  of  our  deceased 
brother  and  friend,  our  sincere  sympathy  in  their  sad  bereavement. 

**  Resolved,  That  these  proceedings  be  published  in  the  daily  papers 
and  in  the  Cincinnati  Lancet  and  Observer,  and  that  the  Secretary  of 
the  Academy  be  instructed  to  transmit  copies  to  the  family  of  the 
deceased.  Dr.  E.  Williams,  ^ 

Dr.  Chas.  Woodward,     | 
Dr.  a  liosENFELD,  )-     Com. 

Dr.  W.  B.  Davis,  | 

Dr.  E.  II.  Johnson,         J 

To  Contributors. — ^The  following  articles  are  on  file  for  insertion  : 
A  Report  of  Operations  after  the  Battle  of  Chickamauga.  in  Field 
Hospitals ;  Exercise,  its  Physiology,  etc.  ;  Anti-Periodic  Properties 
of  the  bark  of  Fraxiuus  Nigra,  or  Swamp  Ash  ;  Two  Articles  on  the 
Hemorrhagic  Diathesis ;  The  History  of  Bloodletting ;  Case  of 
Purpura  Hacmorrhagica.  The  authors  will  please  accept  our  sincere 
thanks. 


Chicago  Medical  College, — ^This  school  (organized  as  the  Medical 
Department  of  Lind  University,)  is  enjoying  in  common  with  other 
medical  schools  of  the  country,  a  good  degree  of  prosperity.  Some 
time  since  we  noticed  the  fact  that  the  energetic  Faculty  of  this  College 
has  entered  into  the  occupancy  of  a  new  edifice.  W^e  learn  that  the 
school  has  a  class  this  winter  of  abont  one  hundred.  We  have  not 
learned  the  number  in  attendance  on  Rush  Medical  College. 


1864.]  FdUor's  Table.  49 

Imdianapdli  Medical  Association. — ^The  Indianapolis  Medical  Asso- 
ciation was  organized  in  October  last.  The  plan  of  organization  was 
drawn  from  that  of  the  Cincinnati  Academy  of  Medicine.  Dr.  Jas. 
8.  Athon,  President,  Wm.  B.  Fletcher,  Secretary,  and  Dr.  Willey, 
Treasurer.  The  meetings  have  been  well  attended,  and  a  spirit  of 
good  fellowship  and  a  desire  for  advancement  in  medical  knowledge 
baa  sprung  np  in  a  degree  unknown  befbre  in  that  city.  Tlie  Associ- 
ation have  rented  rooms  and  furaished  them  comfortably,  where  they 
hokl  their  meetings,  and  it  is  hoped  wil)  soon  add  a  medical  reading 
room. 

We  have  already  received  one  contribution  from  this  Association, 
and  shall  hope  to  have  regular  reports  of  its  papers  and  discussions. 
The  medical  profession  of  Indianapolis  is  abundant  in  ability  to  sustain 
one  of  the  most  useful  medical  associations  in  the  country,  and  its 
members  will  find  its  meetings  a  source  of  professional  and  social 
pleasure  far  beyond  even  their  own  highest  anticipations. 


IriJedomy. — We  hove  had  our  attention  called  to  the  following  in- 
genions  suggestions  in  a  contribution  by  I>r.  Homberger,  editor  of  the 
American  Journal  of  Ophthalmology,  in  the  American  Medical  71m£s. 
Coming  as  it  does  from  so  respectable  an  authonty,  the  proposed  plan 
of  operating  will  doubtless  attract  the  attention  of  eye  surgeons,  but 
we  apprehend  they  will  find  serious  objections  to  its  practical  opera- 
tion. It  will  be  observed  that  Dr.  Horaberger  does  not  detail  the 
results  of  actual  operations,  and  we  are  left  to  presume  that  his  plan 
is  theoretical,  and  it  doubtless  remains  for  time  and  "  numerous  ex- 
periments on  living  subjects"  to  test  the  practical  value  and  conveni- 
eDce  of  the  plan  suggested. 

A  great  difficulty  in  performing  iridectomy  for. the  purpose  of 
diminiKhing  intra-ocnlar  pressure,  consists  in  the  removal  of  the  iris 
to  its  ciliaf^  insertion.  Another  necessity,  which  is  also  not  easily 
ao'oropliahed  in  many  cases,  is  the  excision  of  a  large  piece  of  the 
iri!*.  As  it  is  necessary  to  go  far  beyond  the  margin  of  a  dilated  pupil 
with  a  lanceolar  knife,  in  order  to  get  a  large  corneal  wouad,  the  dan- 
^  arises  of  injuring  the  lens,  which  is  considerably  pressed  forward 
la  eUocoma.  Again,  the  instances  are  not  rare  where  even  experienced 
aaaifttants  fail  to  cut  off  the  iris  to  the  edge,  and  thus  cause  a  negative 
nanh  of  the  operation . 

It  is  not  my  intention  to  analyze  or  to  criticize  the  different  modifi- 
cations which  have  been  invented  by  Von  Graefe,  Arlt,  Froebolius, 
Bowman*  and  others,  with  a  view  to  do  away  with  these  difficulties. 
So  practical  eye-surgeon  will  deny  that,  in  spite  of  all  modem  propo- 
•itiooaythe  execution  of  iridectomy  is  still  attended  by  the  above- 


50  Editor's  Table.  [January, 

named  inconveniences.  Therefore,  though  the  method  ^ich  I  am 
going  to  describe  has  not  yet  stood  the  test  of  numerous  experiments 
on  living  subjects,  I  do  not  hesitate  to  recommend  it  to  the  readers  of 
this  journal  for  further  trial,  confiding  in  the  easiness  of  its  perform- 
ance and  the  certain  results  which  it  seems  to  promise. 

With  a  catamct  knife,  the  point  of  which,  directed  toward  the  centre 
of  the  globe,  is  pushed  into  the  sclerotic  at  a  distance  of  half  a  line 
from  the  margin  of  the  cornea,  a  linear  openin^r  is  made,  which,  by 
mere  pushing  forwards  of  the  knife,  is  lengthened  in  a  radial  direc- 
tion, until  the  cut  reaches  three-quarters  of  a  line  beyond  the  edge  of 
the  cornea.  During  the  performance  of  this  cnt  the  back  of  the  knife 
does  not  for  one  moment  leave  its  direction  toward  the  centre  of  the 
eyeball.  The  knife  is  then  gradually  withdrawn,  so  that  the  aqueous 
humor  is  slowly  evacuated.  By  this  first  act  of  the  operaiion  the  an- 
terior chamber  is  opened,  and  the  iris  fissured,  from  its  ciliary  inser- 
tion, up  to  a  point  about  half  a  line  distant  from  its  periphery. 

The  second  act  of  the  operation  consists  in  the  i::troduction  into  the 
wound  of  one  branch  of  a  fine,  but  strong  pair  of  scissors,  slightly 
curved  laterally.  The  point  of  one  branch  of  the  scissors  is  introduced 
along  the  posterior  surface  of  the  cornea  into  the  anterior  chamber,  and 
its  cutting  edge  laid  into  the  angle  formed  by  the  junction  of  the  iris 
and  cornea.  By  one  or  two  movements  of  the  scissors,  a  wound  is 
produced  corresponding  with  the  size  of  the  piece  of  the  iris  which  is 
intended  to  be  remov3il.  It  will  be  necessary,  in  order  to  introduce 
the  scissors  far  enough,  to  enter  first  but  a  little  way  into  the  wound 
made  by  the  knife,  and  to  enlarge  it  by  a  small,  almost  rectangular 
incision. 

In  the  third  act,  a  common  iris-forceps  is  introduced  into  the  ante- 
rior chamber,  but  not  in  a  diagonal  direction,  as  usually.  With  its 
points  the  operator  takes  hold  of  that  part  of  the  iris  next  to  the  angle 
of  the  wound,  and,  by  a  slight  traction  (in  the  direction  of  a  tangent 
touching  the  margin  of  the  cornea  in  the  wound),  he  tears  the  already 
fissured  iris  up  to  the  pupillar  margin,  and  then,  by  continued  pulling, 
he  severs  it  from  its  ciliary  insertion.  As  soon  as  the  iris  is  torn  off 
up  to  the  opposite  angle  of  the  corneal  wound,  the  operator  himself, 
or  an  assistant,  removes  the  separated  segment  of  the  iris,  with  either 
knife  or  scissors. 

The  advantages  of  this  method  I  wish  to  condense  in  the  following 
points,  and  would  be  glad  if  by  my  proposition  of  a  more  convenient 
way  of  performing  iridectomy,  I  had  contributed  a  mite  to  the  univer- 
sal diffusion  of  this  important  operation. 

1.  The  opening  in  the  anterior  chamber  is  made  in  such  a  way  that 
the  instruments  do  not  in  any  way  come  in  contact  with  the  pupillary 
region,  and  there  is  therefore  no  danger  of  injuring  tlie  lens. 

2.  The  inner  edge  of  the  corneal  wound  is  made  with  much  more 
certainty  in  the  junction  of  iris  and  cornea  than  with  either  knife  or 
lance. 

3.  The  tearing  of  the  iris  from  its  insertion  loses  by  the  previously 
made  fissure  of  that  membrane  the  danger  of  an  accidental  dialysis, 
while  it  insures  a  peripheral  pupil  with  more  certainty  than  if  the  iris 


18M.  I  Ediior'8  Table.  51 

k  eat  off  aAer  having  been  dmggcd  oat  id  the  maniier  hitherto  prac- 
tised. 

4.  The  catting  off  of  the  iris  may  be  performed  by  assistants  of 
little  experience,  because,  even  if  not  well  executed,  it  docs  not,  as  in 
tlie  asaal  methods,  make  it  dangerous  or  even  impossible  to  resume 
kold  of  the  iris. 

Finally,  I  may  be  permitted  to  remark  that  I  do  not  consider  the 
division  of  some  fibres  of  the  ciliary  muscle  (Hancock)  of  great  ther- 
apeotical  importance,  but  that  I  think,  that  the  angular  opening, 
which  allows  a  part,  at  least,  of  the  aqueous  humor  to  escape  for  some 
time,  is  very  favorable  to  a  gradual  diminution  of  intra-ocular  pres- 
wre.  The  importance  of  a  compressive  bandage  during  the  after- 
treatment,  may,  by  this  circumstance,  be  considerably  lessened,  or 
even  totally  annulled. 

Medical  Deparlmeni,  University  of  Michigan. — The  medical  class 
thiii  winter  at  Ann  Arbor  is  near  three  hundred  and  fifty.  With  such 
a  large  class,  and  with  its  independent  position  by  virtue  of  its  en- 
dowment as  a  State  institution,  it  occupies  the  place  to  achieve  a  great 
deal  for  the  advancement  and  interests  of  the  medical  profession. 


XumberB. — We  take  great  pleasure  in  supplying  any  lost 
or  missing  numbers  of  the  Lancet  and  Obierver  when  we  have  them 
OQ  hand.  Of  the  last  year,  however,  we  now  have  left  no  complete 
let.  Our  issue  for  January,  February  and  October  being  entirely  ex- 
liaa«tod,  any  one  having  either  or  all  of  theso  numbers,  who  do  not 
wish  to  preserve  their  files,  will  confer  a  favor  on  subscribers  who 
have  lost  these  numbers,  by  forwarding  them  to  this  office.  New  sub- 
scribers are  coming  in  with  pleasant  frequency,  but  we  start  off  with 
an  edition  that  we  expect  will  meet  all  demands. 

Omission. — By  an  accident  the  meeting  and  resolutions  of  the  med- 
ical profession  of  this  city  on  the  death  of  Dr.  Orr,  failed  to  appear 
in  oor  last  issue. 


7%£  Union  Washing  Machine. — Wo  do  our  readers — particularly 
doctors'  wives — a  favor  by  calling  attention  to  the  card  of  Van 
Name  <t  Co.  in  our  advertising  department.  Some  of  the  military 
bospitaltf  in  this  city  are  using  the  Union  machines  with  great  satis- 
fiictioD.  Recently  the  Woodward  Hospital  commenced  its  use,  and 
the  Unndry  department  find  it  a  wonderful  labor-saving  machine — the 
work  of  three  persons  being  done  quite  as  well  by  one — not  forgetting 
fkut  aaTiojiria  wear  and  tear  of  clothing.  This  is  certainly  the  long- 
4c«irad  desideratam  in  this  field  of  invention.  We  shall  watch  this 
r»  And  r^ort  farther  in  due  time. 


52  EdUar'a  Table.  [Janaaiy, 

Bedford' i  Obstetrics. — The  third  edition  of  this  excellent  text-book 
is  issued  within  the  space  of  thirteen  months,  and  as  we  notice  is  in 
the  course  of  translation  in  Berlin.  Such  success  is  very  gratifying 
to  the  author,  and  is  pleasant  to  the  national  pride  of  all  of  us.  In 
the  proper  place  is  an  advertisement  embracing  the  favorable  criticisms 
of  English  and  French  journals. 

Blanchard  d:  Lea*$  Illustrated  Catalogue. — We  spoke  of  this  cata- 
ogue  last  month,  but  by  some  oversight  omitted  to  give  the  publishing 
house. 


Medical  Schools. — Some  of  the  colleges  of  the  countiy  continue  to 
give  a  Spring  course  of  instruction.  The  announcements  of  two 
fichools  will  be  found  in  the  proper  department.  We  call  attention  to 
the  announcement  of  the  Long  Island  College  Hospital.  In  its  pres- 
ent organization  it  embraces  some  of  the  most  prominent  teachers  'of 
this  country. 

Berkshire  Medical  College  Commencement.  —  The  Annual  Com- 
mencement of  Berkshire  Medical  College  occurred  on  Tuesday,  the 
24th  of  November,  and  was  an  occasion  of  much  interest.  The  fol- 
lowing gentlemen  received  the  degree  of  Doctor  of  Medicine,  and  read 
the  theses,  the  titles  of  which  are  printed  opposite  their  names. 

Kirk  H.  Bancroft,  Lowell,  **  Pneumonia." 

Maurice  K.  Bennett,  Burlington,  Ct.,  **  Gonorrha*a." 

Charles  F.  Couch,  Pittsfield,  "  Etiology." 

A.  P.  Folsora,  Oldtown,  Me.,  "Exercise." 

V.  H.  Gaskill,  Pancoast-borough,  Ohio,  **  Physiology  of  Circnla- 
t>n." 

Wm.  H.  Graves,  New  Milford,  Ct.,  **  Death." 

Wm.  H.  Gray,  Acton,  **  Scorbutus." 

E.  W.  Loveland,  South  Hartford,  N.  Y.,  ''Importance  of  a  Correct 
Diagnosis." 

J.  F.  Niver,  Cedar  Hill,  N.  Y..  "  Fractures." 

C.  A.  Osborn,  Oneida  Lake,  N.  Y.,  **  Puerperal  Fever." 

Ralph  Sherwood,  Fairfield,  Vt.,  "Intra  Capsular  Fracture  of 
Cervix  Femoris." 

David  Stephens,  Addison,  N.  Y.,  **  Shock." 

R.  S.  Turner,  Morristown,  N.  Y.,  "The  Human-Skin." 

Frank  Whitman,  Bernardston,  "Coxalgia." 

J.  J.  Woodbury,  North  Dana,  "  Dyspepsia." 

J.  K.  Draper,  U.S.A.,  "  Quinia." 

The  venerable  H.  H.  Childs,  President  of  the  Institution,  addressed 

the  graduating  class  with  much  feeling,  complimenting  them  highly 

npon  their  proficiency.     The  usual  Commencement  address  was  made 

by  Dr.  Pliny  Earle,  Professor  of  Materia  Medica,  Hygiene  and  Pay- 

hological  Medicine.     At  the  close  of  the  public  exercises,  the  usual 


IWi]  SdUor's  Table.  53 

annoil  dinner  was  given  to  the  graduating  class  and  invited  guests  at 
tbe  Berkshire  Hotel,  and  was  an  occasion  of  much  social  enjoyment. 
The  following  is  a  list  of  the  Faculy  of  the  Institution  as  at  present 
constituted  : — Henry  H.  Childs,  M.D.,  President ;  William  Warren 
Grrene,  M.D..  Dean ;  Henry  H.  Childs,  M.D.,  Emeritus  Professor  of 
the  Theory  and  Practice  of  Medicine  ;  Timothy  Childs,  M.D.,  Prof, 
of  Military  Surgery  ;  Corydon  L.  Ford,  M.D.,  Prof,  of  Anatomy  and 
Physiology ;  William  P.  Seymour,  M.D.,  Prof,  of  Obstetrics  and 
Diseases  of  Women  and  Children  ;  Wm.  Warren  Greene,  M.D., 
Prof,  of  Principles  and  Practice  of  Surgery  and  Clinical  Surgery  ; 
Panl  A.  Obadbourne,  M.D.,  Prof,  of  Chemistry  and  Natural  History  ; 
Alonxo  H.  Pakner,  M.D.,  Prof,  of  Pathology  and  Practice  of  Medi- 
cine; Pliny  Earle,  M.D.,  Prof,  of  Materia  Medica,  Hygiene  and  Psy- 
chological Medicine;  E.  B.  Lyon,  M.D.,  Demonstrator  of  Anatomy 
and  Prosector  of  Surgery  ;  A.  J.  Bigelow,  Prosector  to  the  Prof,  of 
Military  Surgery  ;  Edward  H.  Sexton,  A.M.,  Clerk  of  Clinique. 


Hujdey  versus  Owen, — The  following  burlesque,  first  published  in 
the  London  Times,  respecting  the  ethnological  controversy  which  is  at 
present  attracting  so  much  of  the  attention  of  the  scientific  men  of 
Europe,  and  of  which  we  have  spoken  m  former  numbers,  is  so  very 
tnosing  that  we  copy  it  for  the  entertainment  of  those  who  may  not 
have  already  seen  it. 

A  Sad  Case— Mansion  Uouse^ April  23,  l^^Z— {Before  the  Lord 
Mayor). 

1'.  H.  Huxley,  well  known  about  the  town  in  connection  with 
monkeys,  and  Richard  Owen,  in  the  old  bone  and  bird-stufl5ng  line, 
were  charged  by  policeman  X.  with  causing  a  disturbance  in  the 
•treeu. 

The  prisoners  exchanged  glances  of  such  a  character  that  it  was 
thought  prudent  to  keep  them  separated  In  the  dock. 

Pfdioeman  X.,  being  sworn,  stated  as  follows  : — My  attention  was 
eailed  to  the  prisoners  by  a  crowd  of  persons,  who  seemed  much  ex- 
cited— they  appeared  to  take  sides,  and  some  were  for  Owen  and  some 
iyf  Uaxley.  On  coming  near  I  saw  Huxley  snapping  his  fingers  at 
Uwen,  and  telling  him  he  was  only  a  little  better  than  an  ape  ;  ho 
Meoied  very  angry,  and  would  have  done  Owen  some  bodily  harm  if 
1  had  not  been  near.  He  told  Owen  he  had  quite  as  much  brains  as 
he  had,  and  he  called  him  some  awful  names.  Must  I  repeat  the  bad 
vordfi,  Toor  worship  ? 

L-jfd  Mayor — Certainly.    Yon  must  state  what  he  said. 

Puliceman  X. — Well,  your  worship,  Huxley  called  Owen  a  lying 
Ortbognathns  Brachyceplialic  bimanous  Pithecus  ;  and  Owen  told 
him  he  was  nothing  else  but  a  thorough  Archencephalic  Primate. 

Lord  Mayor — Are  you  sure  you  heard  this  awful  language  ? 

PcilMBaa  X. — Ye^»  your  worship,  and  some  more  1  could  not  ex- 
actly sadcutaaL 

Lofd  Mayor— Did  you  see  any  violence  used  ? 


54  £diior'8  Table.  [Jannaiy, 

Policeman  X. — Yes,  your  worship.  Huxley  had  got  a  beast  of  a 
monkey,  and  he  tried  to  make  it  tread  on  Owen's  heels — and  said  'twaa 
his  grandfather — and  like  hini — and  just  the  same  breed  and  all  that ; 
and  some  gentleman  cheered  and  said  **  Bravo." 

Lord  Mayor — Did  you  see  the  man  Huxley  actually  put  the  monkey 
on  the  other  prisoner — was  there  no  interval  between  them  ? 

Policeman  X. — He  put  the  beast  so  near  as  ever  he  could  ;  he  tried 
to  make  him  go  quite  close,  but  he  could  not,  and  he  kept  singing  oat, 
••  Look  at  'cm,  a' n't  they  like  as  peas  ?  " 

Lord  Mayor — Did  Owen  appear  much  annoyed  by  this  outrage  ? 

Policeman  X. — He  behaved  uncommon  plucky,  though  his  heart 
seemed  broke.  He  tried  to  give  Huxley  as  good  as  he  gave,  but  he 
could  not,  and  some  people  cried  **  Shame,"  and  **  He*8  had  enough," 
and  80  on.  Never  saw  a  man  so  mauled  before.  'Twas  the  monkej 
that  worritted  him,  and  Huxley's  crying  out,  *•  There  they  are — bone 
for  bone,  tooth  for  tooth,  foot  for  foot,  and  their  brains  one  as  good 
as  t'other." 

Lord  Mayor — That  was  certainly  a  great  insult. 

Huxley — So  they  are,  my  lord,  1  can  show — 

Here  a  scene  of  indescribable  confusion  occurred.  Owen  loudly 
contradicted  Hnxloy  ;  the  lie  was  given  from  one  to  the  other ;  each 
tried  to  talk  the  other  down  ;  the  order  "  Silence  I "  was  uuheeded  ; 
and  for  a  time  nothing  could  be  heard  bat  intemperate  language,  min- 
gled with  shouts  of  •*  Posterior  Cornu,"  **  Hippocampns,"  "  Third 
Lobe,"  etc.,  etc.  When  order  was  restored,  the  Lord  Mayor  stated 
that,  in  all  his  experience,  he  had  never  witnessed  snch  virulent  ani- 
mosity amoui;;  costermongers. 

The  Lord  Mayor  hero  asked  whether  either  party  were  known  to 
the  police. 

Policeman  X. — Huxley,  your  worship,  I  take  to  be  a  yonng  hand, 
but  very  vicious  ;  but  Otven  I  have  seen  before.  He  got  into  trouble 
with  an  old  bone  man,  called  Mantell,  who  never  could  be  off  com- 
plaining as  Owen  prigged  his  bones.  People  did  say  that  the  old  man 
never  got  over  it,  and  Owen  worritted  him  to  death  ;  but  I  don't  think 
it  was  so  bad  as  that.  Hears  as  Owen  takes  the  chair  at  a  crib  in 
Bloomsbury.  I  don't  think  it  be  a  harmonic  meeting  altogether. 
And  Huxley  hangs  out  in  Jermyn  street. 

Lord  Mayor — Do  you  know  any  of  their  associates  ? 

Policeman  X. — 1  have  heard  that  Hooker,  who  travels  in  the  green 
and  vegetable  line,  pats  Huxley  on  the  back  a  good  deal ;  and  Lyeli, 
the  resurrectionist,  and  some  others  who  keep  dark  at  present,  are  p^li 
of  Huxley's.  / 

Lord  Mayor — Lyell,  Lyell ;  surely  I  have  heard  that  name  before. 

Policeman  X. — Very  like  you  may,  your  worship  ;  there's  a  fight 
getting  up  between  him  an'  Falconer,  the  old  bone  man,  with  Prest* 
witch,  the  gravel  sifter,  for  backer. 

Owen — He's  as  bad  as  any  of  'em,  my  lord.  I  thought  he  was  a 
friend  of  mine,  but  he's  been  saying  things  of  me  as  I  don't  like  ;  bat 
1 11  be  even  wiih  him  some  day. 


im,]  Mitor'8  Table.  55 

Lord  Major — Silence  !  Have  you  seen  the  prisoners  in  the  company 
of  any  ticket-of- leave  men  ? 

Policeman  X. — No,  your  worship  ;  hnt  from  information  I  have 
received,  I  believe  Huxley  is  one  of  the  same  set  with  John  William 
Nittl,  or  some  such  a  name,  for  he  is  one  of  those  chaps  as  has  got  a 
lot  of  aliases,  who  has  lately  returned  from  abroad.  John's  been 
kicking  np  a  pretty  row,  he  has. 

Lord  Mayor — I  desire  yon  to  bring  him  before  me  if  you  detect  him 
io  fretting  any  disturbances. 

Policeman  X. — Oh  !  your  worship,  there's  plenty  trying  to  catch 
kioi,  bol  he's  so  artful  they  can't  trap  him  no  how.  They  wanted  to 
tike  his  ticket  from  him,  but  they  could  not ;  then  they  tried  to  coax 
kim  to  give  it  np,  but  he  would  not ;  not  he.  You  see  when  he  was 
icrovs  the  water,  he  took  to  the  bush  and  got  in  with  the  savages,  and 
tntX  to  come  over  them,  but  one  of  the  Kaffirs  gave  him  such  a  topper 
tkit  he's  never  been  the  same  man  since. 
Lord  Mayor — You  have  not  seen  thein  together  ? 
Policeman  X. — No,  your  worship ;  but  I  believe  they  are  both 
tarred  with  the  same  brush. 

As  there  appeareil  to  be  no  case  against  Owon,  he  was  allowed  to 
ke  »wom.  Hereupon  Huxley  deninndcd  be  to  sworn  likewise,  but 
Oveo  objecte<l,  declaring  it  impossible  to  swear  a  man  who  did  not 
believe  in  anything,  and  Huxley  declared  it  was  equally  impossible  to 
•wear  Owen.  Owen,  however,  was  directed  to  take  the  book  in  his 
hand,  wherenpon  Huxley  vociferated,  **  Ho  does  not  know  a  hand  from 
a  fooL"  An  angry  altercation  ensued  between  the  parties,  amidst  the 
dia  of  which  the  words  **  peronnus  longns,"  **  movable  toe," 
"ihomb/*  *'  abtragalus,"  and  '*  short  flexor,"  could  be  distinguished. 
The  Lord  Mayor  addressed  both  parties,  and  declared  such  violent 
ODB^inct  was  scarcely  human,  at  which  Huxley  laughed  and  Owen 
looked  gra%'e.     He  then  gave  his  evidence  as  follows  : 

1  knew  the  prisoner  in  former  years.  We  were  both,  in  the  same 
ho/kioess,  and  I  looked  upon  him  as  a  quiet,  well-meaning  man.  lint 
mre  he  has  risen  in  the  world,  he  has  become  highly  dangerous,  so 
s«(  h  so,  that  I  am  willing  to  believe  his  conduct  proceeds  from  dis- 
caiie^l  brain. 

[Here  tho  Mavor  called  upon  Dick  Owen  to  come  to  the  point.] 
Owen  proceeded — For  the  last  two  years  my  life  has  been  a  burden 
t»  me.  That  fellow  Huxley  has  got  new  pals,  Charlie  Darwin,  the 
yigvozi- fancier,  and  Rollstone,  and  others  of  that  awful  lot ;  and  he 
vajlava  me  io  public,  and  throws  dirt  at  me.  Indeed,  he  has  hit  me 
very  moch  abont  the  head,  very  hard  indeed  ;  and  he  tries  to  make 
Uieve  that  I  don't  know  my  trade  ;  and  that  he  can  teach  mo ;  and 
he  tries  to  make  me  ridiculous  in  the  eyes  of  the  public,  and  I  can't 
bear  it.  And  lately  I  went  down  to  Cambridge,  and  who  should  I 
■•  thm  hoi  that  Tom  Haxley  and  his  low  set,  and  they  all  attacked 

[Here  tbe  Ifayor  directed  the  witness  to  keep  to  the  point.] 
'    UwcB  eooHniied — ^I  could  live  well  enough,  if  yoi^  could  only  keep . 
dbac  hinrty  monkey  away  from  me,  and  make  Huxley  hold  hia  U>ngu^ 


5G  £(iitor*8  Table.  [Janaary, 

about  comparing  onr  brains.  Indeed,  continued  Owen,  how  would 
you  like  to  be  told  in  public  that  physically,  morally  and  intellectual- 
ly you  wore  only  a  little  better  than  a  gorilla  ? 

Huxley  was  now  called  upon,  and  said  as  follows ; — 

Me  and  Dick  is  in  tlie  same  line — old  bones,  bird-skins,  offal,  and 
what  not. 

**  Do  you  mean  the  marine  store  line  ?  " 

Huxley — No,  your  worship;  that's  Bowerband  and  Woodward's 
business.  Well,  as  I  was  saying,  we  was  in  the  same  line,  and  com- 
fortable as  long  as  Dick  Owen  was  top-sawyer,  and  could  keep  over 
my  head,  and  throw  his  dust  down  in  my  eyes.  There  was  only  two 
or  three  in  our  trade,  and  it  was  not  very  profitable  ;  but  that  was  no 
reason  why  I  should  be  called  a  liar  by  an  improved  gorilla,  like  that 
fellow. 

[Here  the  Mayor  cautioned  the  prisoner.] 

Well,  iu  my  business  I  put  up  monkeys,  and  the  last  monkey  I  pnt 
up  was  Dick  Owen's 

[Hero  the  Mayor  declared,  on  the  repetition  of  such  language,  ho 
would  at  once  commie  Huxley. J 

Well,  as  I  was  saying,  Owen  and  me  is  in  the  same  trade  ;  and  we 
both  cuts  up  monkeys,  and  I  finds  something  in  the  brains  of  'em. 
Hallo  !  says  I,  here's  a  hippocampus.  No,  there  ain't,  says  Owen. 
Look  here,  says  I.  I  can'c  see  it,  says  he  ;  and  he  sets  to  worritting 
and  haggling  about  it,  and  goes  and  tells  everybody  as  what  I  finds 
ain't  there,  and  what  he  finds  is,  and  that's  what  no  tradesman  will 
stand.  So  when  we  meets  we  has  words.  He  will  stick  to  his  story, 
your  worship,  he  won't  be  right  himself,  nor  let  any  body  else  be 
right.  As  to  this  here  monkey  business,  I  can't  help  th^ brutes  tread- 
ing on  his  heels.  If  he  was  to  go  forward  more,  why  you  see  he'd  bo 
further  ofT  from  the  beast ;  but  he*s  one  of  these  here  standstill  Tories, 
what  they  call  the  orthodox  lot,  as  never  moves  forward.  If  he'll 
keep  his  tongue  in  his  head,  why  I'll  keep  mine ;  but  he  shan't  have 
the  last  word,  or  my  name's  not  Tom  Huxley. 

[The  Lord  Mayor  having  tendered  advice  to  the  disputants,  they 
were  liberated  ] 

The  N'obility  of  Medicine. — It  is  told  of  Abernethy  that,  years  since, 
fulfilling  the  functions  which  Mr.  Paget  so  eloquently  discharged  when 
he  stood  as  the  orator  inaugurating  the  medical  session  at  St.  Bar*. 
tUolomew's  Medical  School,  he  looked  round,  as  he  entered,  on  the 
clustered  heads,  and  noticing  the  young,  eager  and  expectant  faces 
that  crowded  the  amphitheatre,  began  his  address  with  the  words— 
**  God  help  you  all  ?  what  will  become  of  you  ?  "  A  recent  medical 
author  —  Mr.  Edwin  Canton — admirably  illustrates  Abernethy 'a 
thought  by  quoting  a  striking  passage  from  the  writings  of  Dr.  John* 
son.  In  the  course  of  his  life  of  Akenside,  that  great  moralist  writes  : 
**  A  physician  in  a  great  city  seems  to  be  the  mere  plaything  of  For-, 
tune.  His  degree  of  repntation  is  for  the  most  part  totally  casnal : 
they  that  employ  him  know  not  his  excellence  ;  they  that  reject  him 
know  not  his  deficiency,"    By  an  acute  observer  who  had  looked  on 


1864.]  jBdiior*i  Table.  67 

the  timnsiictioBS  of  the  medical  world  for  half  a  centary,  a  very  cnriooa 
book  might  be  written  '*  on  the  fortunes  of  a  phyaician."  Mr.  Paget 
took  a  more  hopeful  view  ;  and  thoagh  he,  as  well  as  every  man  who 
haa  opportunities  of  watching  the  way  of  the  world  and  observing 
"good  Bociety,"  must  know  how  much  of  bitter  truth  this  sentence 
holds,  yet  he  chose  rightly,  as  we  think,  to  show  rather  the  silver 
lining  to  the  cloud.  Work,  ha  told  them,  was  the  first  thing  and  the 
second ;  and  ho  maintained  that  if  we  may  reckon  as  work  all  that 
which  honestly  makes  us  able  to  prolong  and  comfort  human  life, 
then  there  is  no  calling  in  life  in  which  the  true  success  is,  on  the 
whole,  more  fairly  proportioned  to  the  true  work  than  it  is  in  ours. 
He  bade  them  not  confound  apparent  success — the  success  of  the 
quack,  of  the  money-grubber,  of  the  fa<)hionable  impostor — with  the 
•olid  sncce5.s  which  consists  in  a  "  competency  of  living,  the  society 
ef  e<lacated  men,  blessings  from  the  poor,  recompense  with  gratitude 
from  the  rich,  boundless  fields  for  intellectual  exercise,  access  to  the 
rk-he>t  stores  of  knowledge  for  '  the  glory  of  tho  Creator  and  the  relief 
of  nan's  estate,'  and  daily  inducements  to  the  exercise  of  the  highest 
Christian  Tirtoes."  Herein  Mr.  Paget  spoke  loftily  and  well,  and 
placed  lieforc  his  hearers  those  considerations  on  which  the  incentives 
la  enter  on  the  aaedical  vocation  chiefiy  rest.  It  is  some  evidence  of 
the  sufficiency  of  the  medical  profession  to  occupy  and  delight  the 
highest  class  of  mind  that  a  man  like  Mr.  Paget,  gifted  with  an  intel- 
tect  so  refined  and  comprehensive,  can  find  in  it  enough  to  exercise  his 
great  power  and  satisfy  his  mental  and  moral  activity,  and,  after  years 
of  labor  and  in  the  prime  of  a  life  already  rich  in  experience,  can 
eoamciid  his  craft  in  language  so  eloquent,  manly,  and  sincere  to  the 
riaing  joath  of  England.  A  distinguished  surgeon,  ripe  pathologist, 
aad  siDgolarly  thoughtful  author  and  eloquent  speaker,  Mr.  Paget  by. 
word  and  deed,  offers  an  example  which  all  mny  be  proud  to  keep 
htfore  their  eyes,  and  is  one  of  those  illuKtrations  of  our  profession 
wiio  dignify  it  in  the  eyes  of  the  world. — London  Lancet, 

The  Britith  Treaiment  of  Prvso^ere, — ^To  the  Editor  of  the  Ameri- 
nvm  Jiedical  'I%met: — In  severll  late  numbers  of  the  Medical  Timee 
Jim  have  noticed  the  condition  of  tho  Feiieral  prisoners  at  Richmond. 
▲a  the  London  Laneei  has  complacently  thanked  God  that  Englibh 
man  have  never  been  marked  by  any  of  the  barbarities  reported  in 
Cbia  ooaotry,  I  dksire  to  call  its  attention  to  the  following  from 
*'  Loaaiog'a  Field  Book  of  the  Revolution."  These  extracts  are 
aliost  a  repetition  of  the  reports  from  the  Southern  Prison  House. 
Tlw  scene  of  these  barbarities  is  New  York,  and  the  actors  the  Biicish 
Bilitary  anthortties  in  the  time  of  the  revolution. 

*'  TIm  '  New  Jair  was  made  a  provost  prison,  whore  American 
and  the  roost  eminent  Whigs,  who  fell  into  the  hands  of  the 
Brhiih,  were  confined.  Here  was  the  theatre  of  Cunningham's 
(proTOit-niarifaal)  brntal  conduct  toward  the  victims  of  his  spite. 
n«  priaonera  were  formally  introduced  to  him,  and  their  name,  age, 
nad  ffmk  were  recorded.  They  were  then  confined  to  the  g?oomy 
or  lo  Ike  oqiudly  loathsome  upper  chamber,  where  the  higheat 


58  EdUorM  TahU.'  [Januity, 

officials  in  captivity  were  bO  closely  crowded  together  that  when,  at 
night,  they  lay  down  to  sleep  npon  the  hard  plank  floor,  they  could 
change  position  only  hy  all  turning  at  once,  at  the  words  righi — left. 
Their  food  was  scanty,  and  of  the  poorest  kind,  often  that  which 
Cunningham  had  exchanged  at  a  profit  for  better  food  received  from 
their  fribnds  or  the  Commissaries.  Little  delicacies  brought  by  frienia 
of  the  captives  seldom  reached  them,  and  the  brutal  CunninghaM 
would  sometimes  devour  or  destroy  such  offerings  of  affection,  in  the 
presence  of  his  victims,  to  gratify  his  cruel  propensities.  Thus  for 
many  months,  gentlemen  of  fortune  and  education,  who  had  lived  in 
the  enjoyment  of  the  luxuries  and  the  refined  pleasures  of  elegant 
social  life,. were  doomed  to  a  miserable  existence,  embittered  by  thd 
coarse  insuTts  of  an  ignorant,  drunken  Irish  master,  or  to  a  speed/ 
death  cauRe<i  by  such  treatment,  the  want  of  food  and  fresh  air.  .  .  . 
Still  greater  cruelties  were  practised  upon  the  less  conspicuous  prison- 
ers, and  many  were  hanged  in  the  gloom  of  night  without  trial  ox 
known  cause  for  the  foul  murder." 

''  Next  to  the  provost  prison,  the  sugar-house  in  Liberty  street  was 

most  noted  for  the  sufferings  of  captive  patriots Within  this 

gloomy  jail  the  healthy  and  the  sick,  white  and  black,  were  india^ 
criminately  thrust ;  and  there,  dunng  the  summer  of  1777,  many  died, 
for  want  of  exercise,  cleanliness,  and  fresh  air.  '  In  the  suffocating 
heat  of  summer,'  says  Dnnlap,  '  I  saw  every  aperture  of  those  strong^ 
walls  filled  with  human  heads,  face  above  face,  seeking  a  portion  of 
the  external  air.'  At  length,  in  July.  1777,  a  jail  fever  was  created, 
and  great  numbers  died.  During  its  prevalence  the  prisoners  were 
marched  out  in  companies  of  twenty  to  breathe  the  fresh  air  for  half 
an  hour,  while  those  within  divided  themselves  into  parties  of  six 
each,  and  then  alternately  enjoyed  the  privilege  of  standing  ten  min- 
utes at  the  windows.  They  had  no  seats,  and  their  beds  of  straw  were 
filled  with  vermin.  ...  In  messes  of  six  they  received  their  daily 
food  every  morning,  which  generally  consisted  of  mouldy  biscuit  filled 
with  worms,  damaged  peas,  condemned  pork,  sour  fiour  and  meal, 
rancid  butter,  sometimes  a  little  filthy  suet,  but  never  any  vegetables.*' 

The  condition  of  the  prisoners  on  board  the  Jersey  prison  ship  is 
thus  described  :  •*  Every  morning  the  prisoners  brought  up  their  bed- 
ding to  be  aired,  and,  after  washing  the  decks,  they  were  allowed  to 
remain  above  till  sunset,  when  they  were  ordered  below  with  imprecn- 
tions,  and  the  savage  cry  *  Down,  rebels,  down  ! '  Tlie  hatches  were 
then  closed,  and  in  serried  ranks  they  lay  down  to  sleep,  if  possiblop 
in  the  putrid  air  and  stifling  heat,  amid  the  sighs  of  the  Acutely  dis* 
tressed  and  the  groans  of  the  dying.  Each  morning  the  harsh  order 
came  below,  'Rebels,  turn  out  your  dead.'  " — t.  d.  in  Amer,  Med. 
Times. 


A  Desirable  Localion  for  Sale. — We  desire  to  call  attention  to  the 
following  notice :  A  phytfician  desires  to  retire  from  practice  the  pres- 
ent spring,  and  wishes  to  dispose  of  his  property  at  a  low  fignre  to 
some  trustworthy  practitioner.    The  practice  is  woiih  92.000  a  yeeiv 


18M.J  EiKior*s  Table.  59 

the  locAtioQ  18  p1e&8aDt,  and  the  property  to  be  disposed  of  is  in  good 
condiuoa.     For  terms  or  other  particulars,  address 

Dr.  8.  C.  McCuLLODOH, 

Kirkville,  Wapello  Co.,  Iowa. 

like  Unutual  Delay  in  the  issne  of  this  number  has  been  owing  in 
part  to  the  confusion  incident  to  a  change  of  proprietorship  in  our 
printiog  office,  and  in  part  to  the  extreme  cold  setting  in  about  the 
usaal  time  of  working  off  the  number  which  made  press  work  almost 
a  maiter  of  impossibiiitj. 


tm  • 


Army  Medical  Intelligeaoe. 

Sorgeon  Daniel  Meeker,  U.S.V.,  recently  released  as  prisoner  of 
war  froiq  Richmond,  Va.,  will  report  in  person  to  Assistant  Surgeon-   • 
General  W«ood  at  Lonisville,  Kv.,  for  assignment  to  duty.     Pcrniis- 
aioB  to  delay  reporting  for  twenty  days  is  hereby  granted  him.    (Dec. 
%.  1833.) 

Sorgeon  Charles  E.  Swasey,  U.S.Y.,  now  on  duty  as  Attending- 
Snrgeon  to  sick  and  wounded  officers  at  Frederick,  Md.»  will  report  in 
penon  without  delay,  for  duty,  to  the  Commanding-General  of  the 
Department  of  the  Missouri,  ami  by  letter  to  Assist.  Surgeon -General 
R.  C.  Wood.  U.8.V  ,  at  Louisville.  Ky. 

Ajifristaiit-Snrgeon  W.  H.  Park,  49ili  Ohio  Vols.,  is  hereby  granted 
an  extension  of  ten  days  to  the  time  heretofore  allowed  him  by  Special 
Ordeit  No.  528,  Nov.  28,  1863,  from  the  War  Department. 

Aanistant-Soi^on  C.  O.  Wright.  85ih  Ohio  Vols.,  and  Acting 
Aaabtant- Surgeon  W.  S.  Hosack,  78th  Pennsylvania  VoIr.,  recently 
released  as  prisoners  of  war  from  Richmond,  Va.,  will  join  their 
legiment^.  Permission  to  delay  reporting  tor  twenty  days  is  hereby 
gfaaled  them. 

Tl»  Secretary  of  War  has  decided,  on  (he  recommendation  of  Col. 
E.  D.  Townsend,  approved  by  Major-General  Hullcck,  that  Hospital 
fiiewarda  are  entitled  to  the  same  bounty  (6402)  as  other  recruits  for 
cW  Reguliv'  Army. 

Bm'geon  John  Q.  F.  Holston,  U.8.V.,  has  been  assigned  to  duty 
m  Mediekl  Inspector  of  Hospitals  at  Memphis,  Tenn. 

Sargeon  Henry  8.  Hew  it,  U.S.V.,  is  on  uuigical  duty  in  the  hospi- 
tals at  Chattanooga,  Tenn. 

Sergeon  8.  fi.  Davis,  U.S.V.,  ban  been  relieved  fiom  General 
Hoipiul,  Leavenworth  city,  Kansas,  and  oMsigncd  to  duty  as  Medical 
Director  8.  W.  Miasouri,  at  Springfield,  Mo. 


60  Editorial  Abstradt  and  Selectiont.         [December* 


(Sflltorial  ^hittntts  anA  SftUtHttut. 


PRACTICAL    MEDICINE. 

1.  Treatment  of  Delirium  Tremens, — Will  yon  allow  me,  bj  meant 
cf  yonr  widely  circulating  journal,  to  draw  attention  to  a  pIaq  of 
treating  delirium  tremens,  which  I  have  long  employed  and  think 
deserves  to  be  better  known? 

As  far  as  I  have  observed,  the  natural  duration  of  an  acnte  attack, 
under  favorable  circumstances  and  ordinary  treatment,  is  about  three 
days,  during  which  time  the  system  seems  quite  insensible  to  lai;go 
doses  of  opium,  either  swallowed  or  injected;  but  directly  digitalis  is 
combined  with  the  opium,  sleep  is  procured.  May  we  not  therefore 
regard  it  as  a  specific?  Such,  I  believe,  extended  experience  will 
prove  it  to  be. 

In  the  summer  of  1836,  being  called,  in  the  absence  of  my  prinoi- 
pal,  to  attend  a  master  mariner,  on  the  Suffolk  coast,  quite  unmanage- 
able from  delirium  ti-emens,  and  failing  to  procure  sleep  by  opium,  I 
was  first  induced  to  try  the  effect  of  adding  digitalis  in  very  fall 
doses.  The  second  dose  was  followed  by  thirty-six  hours'  sleep  and 
perfect  restoration.  In  two  days  ho  continued  his  voyage.  Many 
months  afterwards  the  same  medicine  was  sent  for  from  a  distance, 
where  he  was  suffering  another  attack,  which  baffled  treatment.  He 
was  again  speedily  relieved.  After  that  he  got  an  attack  at  aea, 
when  quite  unprovided  with  medical  aid,  and  died. 

Of  late  years,  a  plan  of  treatment  by  half-ounce  doses  of  tincture  of 
digitalis  has  been  commended,  and  has  sometimes  succeeded;  but  I 
Rtill  prefer  a  smaller  quantity  combined  with  opium,  as  in  the  follow- 
ing recent  cases,  where  the  plan  was  early  adopted,  without  giriog 
time  for  the  disease  to  exhaust  itself: 

O.  D ,  a  retailer  of  beer  and  wine,  fell  from  steps  whilst  clean* 

ing  his  window,  and,  being  a  very  heavy  man,  severely  injured  his 
right  ankle.  Erysipelatous  inflamation  followed,  with  great  swelling 
up  to  the  knee,  and  constitutional  disturbance  of  a  gouty  character. 
He  then  got  delirium  tremens,  and,  leaving  his  bed  partially  dresaed, 
escaped  from  the  house  and  attendants,  pounding  his  unfortunate  limb 
at  every  step.  We  got  him  back  to  bed,  gave  him  half  a  drachm  of 
Battley's  sedative  solution  and  the  same  quantity  of  tincture  of 
digitalis  directly,  and  repeated  it  in  two  hours,  when  he  fell  asleep  : 
all  symptoms  of  delirium  vanished,  and  he  required  no  further  treat- 
ment than  that  applied  to  the  injured  limb. 

K.  F ,  a  clerk,  working  over  hours,  and  living  by  suction,  was 

brought  home  in  what  was  called  a  fit.     I  found  him  with  symptoma 
of  delirium  tremens,  and  treated  him  with  smaller  doses  of  the  combi- 
nation spoken  of,  with  advantage.     Next  day  he  got  np  and  went  o 
against  orders,  but  was  incoherent,  apprehensive,  and  excited,  witk 
mnacolar  tremors,  and  illnsiona  optical  and  auditory.    I  directed  Ua 


1R64.]  Editorial  AUtracls  and  Saedioni.   \  61 

to  be  walked  abont,  and  carefnlly  watched  for  some  hours;  then  got  to 
bed,  and  given  a  draught  containing  tinctnre  of  digitalis  one  drachm, 
Battler's  solotion  one  drachm.  This  procured  sleep  and  restored  the 
nental  equilibrium.  It  remained  to  treat  him  for  haBmatemesis,  and 
oth^r  haemorrhagic  tendencies,  and  he  soon  returned  to  business. 

Hoping  the  plan  now  indicated  may  prove  equally  effective  in  the 
bandii  of  my  medical  brethren,  and  that  they  will  kindly  inform  mo  of 
the  results  in  their  practice— J.  W.  Robinson,  M.R.C.S.  in  London 


2.  Treatment  of  Rheumatic  Fever, — In  an  able  paper  on  rheumatic 
fever  by  Dr.  Wade,  ho  alludes  to  the  infrequency  of  delirium  in  that 
dmrder  and  the  propriety  of  treating  it  with  stimuli.  As  any  addi- 
tional evidence  on  this  subject  may  be  valuable,  I  beg  to  offer  a  re- 
mark or  two  in  testimony  of  tho  cflicacy  of  such  treatment.  I  tind  by 
referring  to  my  note-book  particulars  of  a  case  of  rheumatic  fever 
which  was  under  ray  care  in  1854,  and  where  symptoms  of  noisy  de- 
lirium, with  much  nocturnal  excitement,  supervened.  I  prescribed 
ralphnric  either  in  doses  of  fifteen  minims  every  six  hours,  with  most 
remarkable  benefit.  The  note  states: — ''Delirium,  with  frequent 
starting  in  Mecp;  pulse  soft  and  weak.  The  day  following:  pulse 
110,  full  and  soft.  Slept  better  and  was  less  noisy.  An  endocardial 
marmar  load  at  apex;  the  'to-and-fro'  sound  audible,  though  not  so 
lood/' 

At  that  period  I  had  adopted  the  plan,  which  I  have  ever  since  fol- 
lowetl,  of  treating  rheumatic  fever  with  potash  salts;  prescribing  the 
aitraie  and  bicarbonate  alone  in  camphor  mixture.  In*  nearly  every 
ease  1  commenced  with  calomel  and  jalap,  and  gave  Dover's  powder* 
IB  ten  or  fifteen  grain  doses,  occasionally  at  bed -time. 

The  above  case  terminated  favorably,  though  for  a  little  while  he 
was  fsnbject  to  startin^s  in  sleep,  and  had  a  diiistolic,  aortic,  and  a 
pjat'klic  mitral  murmur  at  tho  period  of  convalescence.  The  special 
treatment  of  the  heart  affection  I  need  not  dwell  upon.  He  was  a 
■Irong  laboring  man,  and  had  previously  suffered  from  a  similar  at- 
tAck,  when  his  heart  was  likewise  implicated.  In  all  cases  of  de- 
liriam  from  irritability  of  the  nervous  system  stimuli  are  indicated; 
the  proportions  and  particular  kind  should  be  regulated  by  tho 
patient's  previous  habits  and  constitution. 

Ilhenmatic  fever,  with  its  too  frequent  accompaniment,  heart  disease, 
has  been  a  favorite  subject  of  study  with  myself  as  with  Dr.  Wade. 
Bet  I  must  curtail  my  letter.  No  treatment  is  so  reliable  as  by  the 
potash  salts:  but  as  he  alludes  to  the  ''distressing"  action  of  colchicum, 
let  me  mention  that  this  can  be  corrected  by  prescribing  carbonate  of 
ma!;ne»ia  in  combination,  as  I  witnessed  in  Dr.  Dm  rows'  hospital 
practice  twelve  years  ago.  I  have  also  seen  the  lemon -juice  treat- 
ment carried  ont  steadily  and  perseveringly  to  the  patient's  death.  The 
physician  who  acted  thus  has  been  some  time  dead.  Quinine  I  have 
irieii.  but  without  any  benefit  in  the  acute  stage;  it  seems,  however, 
fo  promote  recovery  when  employed  in  ai)proachin^  convulcsccucc. 
Dr.  Wade  justly  remarks,  '*It  is  de:}iniblc  to  simplify  and  uol  V> 


62  Editorial  AbairaeU  and  SeUdioM.  [Janoaty, 

complicate  treatment  or  mnltiplj  drugs,  else  it  becomes  diflBcnlt  to 
difltingainh  their  effects."  Nevertheless,  we  find  a  little  farther  on 
that  he  prescribes  this  medicine  (quinine)  while  giving  the  potasill 
mixture  also.  From  which  of  these  two  does  he  consider  he  deriyes 
advantage? — J.  Hawkes,  M.D.  in  London  Lancet. 

3.  Treatment  of  Spasmodic  Asthma. — Will  some  of  your  numer- 
ous readers  inform  me  what  is  the  best  treatment  for  spasmodic  asth- 
ma? I  am  a  young  medical  man,  and  in  the  discbarge  of  my  pro- 
fessional dutica  I  unfortunately  got  an  attack  of  acute  bronchitis, 
which  left  an  emphysematous  condition  of  both  lungs,  the  result  of 
which  is  I  am  a  martyr  to  asthma.  1  have  an  attack  about  twice  a 
week;  in  fact,  I  am  no  sooner  rid  of  one  than  another  begins,  so  that 
my  life  is  a  source  of  misery  to  me.  I  have  tiied  all  kinds  of  medi- 
cines, with  but  little  relief.  I  have  visited  nearly  every  part  of  Great 
Britain,  but  with  no  benefit.  I  have  been  advised  lo  go  abroad;  but 
as  the  only  difference  1  find  between  warm  and  cold  weather  is  that 
the  attacks  are  a  little  shorter,  I  do  not  anticipate  much  benefit  from 
this  step. 

Can  it  bo  bossible  that  medicine,  which  has  done  so  much  for  other 
diseases,  can  do  nothing  for  one  of  the  most  distressing  complaints 
that  man  is  heir  to? — London  Lancet, 

4.  Infantile  RendtUnt  Fever, — Henry  Oliver,  M.  D.,  in  a  letter  to 
the  editor  of  the  Medical  Surgical  Beporter,  says  :  What  really  is 
this  misnamed  infantile  remittent  fever  with  its  white  furred  and  dot- 
ted tongue,  (strawberry  tongue  as  some  writers  call  it)?  Nothing,  I 
am  convinced,  but  a  scarlatina  sine  eruptions,  the  undeveloped  poison 
of  this  producing  the  distress,  gastric  or  otherwise,  for  which  infantile 
remittent  is  so  distinguished.  In  the  epidemic  of  infantile  remittent 
prevailing  hero  this  summer  and  spring,  the  characteristic  strawberry 
tongue  of  scarlatina  was  presented  in  eveiy  case.  The  general  symp- 
toms and  aspect  of  the  patients  were  the  same ;  tlie  only  perceptible 
ilifference  lay  into  an  internal  localization  of  pain  in  the  case  of  tha 
infantile  remittent.  Sometimes  the  pain  was  referred  to  the  head  ; 
sometimes  to  the  stomach  or  sides,  viz.  right  hypochondriac  region, 
more  frequently,  In  these  cases  of  infantile  remittent,  the  thi-oat  was 
flushed,  erythematous  and  yellowish  mucous  was  visible  gurgling  up 
into  it ;  the  nasal  membrane  was  even  plainly  inflamed. 

I  attended  throe  children  in  one  family  affected  with  infantile  remit- 
tent, and  a  fourth  with  precisely  the  same  general  symptoms  and  in 
the  same  condition  ;  but  in  this  latter  case  a  rash  was  superadded. 

Surely  we  must  admit  convertibility  or  transmutation  here,  and  must 
not,  cannot,  affirm  coincidence  of  distant  disorders.  From  the  fact 
that  adults  take  this  infantile  remittent,  and  that  I  have  seen  it  assume 
in  them  a  typhoid  character,  requiring  the  same  treatment  and  rebel- 
lious to  the  same  remedies,  I  am  persuaded  that  a  fuilher  transmuta- 
tion does  occur  than  would  be  at  the  present  hour  of  investigation 
credited  ;  in  other  words  I  believe  that  the  poison  of  typhoid  is  analo- 
gous, if  not  identical  with  that  of  infantile  remittent  and  scarlet 
rever. 


1S64.]  £diiariml  AMracU  and  Sei$cti(mi.  63 

That  diptheria  is  evidently  a  diaease  doe  to  the  same  poison  as 
acarlatiaa  nobody  would  doubt  who  saw  the  complication  of  paralysis 
(a  diptheria  symptom)  in  these  cases  of  infantile  remittent.  The  old 
theory  of  modification,  according  to  impression  of  epidemic  constita- 
tioo,  will  not  do  any  longer.  The  true  solation  is  transmutatipp. 
Ootncidence  is  not  tenable.        j^ 

5.  7%e  Compound  Cathartic  PUh, — This  is  one  of  the  most  im- 
portant formn^las  in  the  U.  S.  Pharmacopeia  and,  like  all  others 
fthoald  be  strictly  adhered  to.  It  is  a  most  excellent  antibilious  pur- 
gative, never  griping  the  patient ;  but  is  perfectly  easy  in  its  action. 
As  a  precedent  to  other  remedies  where  an  antibilious  cathartic  is 
indicated,  it  is  employed  by  physicians  more  than  any  other  remedy 
known  to-^s.  For  mildness  and  efficiency  it  is  unsurpassed.  They 
are,  howf  ve^,  from  the  nature  of  the  ingredients  (principally  extracts) 
very  liable  to  lose  their  shape  and,  to  prevent  this,  they  are  too  often 
iua«le  from  false  formulas,  pewders  bein^  substituted  for  extracts  of  the 
tame  substances,  and  which,  if  the  pills  be  of  the  same  strength,  are 
increaaed  in  bulk,  which  it  is  always  desirable  to  avoid  ;  or,  upon  the 
other  hand,  they  are  more  frequently  made  of  the  ordinary  size, 
which  not  only  weakens  the  power,  but  at  the  same  time  causes  the 
physician  to  prescribe  blindly  ;  for  he  finds  the  medicine  varies  at  the 
dtfierent  apothecaries  ;  consequently  he  is  just  as  likely  to  prescribe  too 
small  a  quantity,  as  well  as  an  overdose,  the  action  of  the  medicine 
depending  solely  upon  where  his  patient  purchases.  This  should  not 
be.  and,  af^er  sufficient  experiment,  1  have  adopted  for  some  months 
pvt  the  following  plan,  by  which  the  objections  mentioned  are  obvi- 
atetl ;  and  suggest  it  as  worthy  of  a  trial  ; — Reduce  the  extracts  (if 
too  hard)  to  the  proper  consistency,  by  heatiog  them  in  a  water-bath  ; 
then  mix  all  the  ingredients  thoroughly  together  and  add  a  small  quan- 
tity of  magneiia  calc,  or  a  q.  ».  to  make  a  maus,  and  to  make  into  pills 
%M  quick  as  possible  (as  the  mass  hardens  rnpidly).  The  magnesia 
being  a  light,  dry,  and  spongy  powder,  abrorbs  the  moisture  of  the 
extracts,  andsolidiHes  the  mass,  and,  being  itself  a  laxative,  docs  not 
weaken  the  power  of  preparation.  This  is  the  only  reliable  method 
bnovn  to  me  (except  coating)  by  which  wo  can  retain  the  original 
form  and  size  of  the 7////,  without  impairing  its  quality. — Amer.  Cir. 
«W  Ckcm.  Gazette, 

6.  The  ^ect9  of  Ipecacuanha  in  Dysentery. — I  will  preface  my 
fttatement  by  remarking  that  we  have  few,  if  any,  of  asthenic  dys- 
entery, whether  endemic  or  otherwise;  our  mountainous  regions, 
b^akhy  invigorating  air,  and  rugged  habits,  conduce  in  the  absence  of 
miiamatic  influences  to  produce  this  result,  I  presume  in  every  case, 
withoal  regard  to  temperament,  ago.  or  sex.  1  invariably  rely 
vpoo  ipecacuanha,  in  doses  appropriate  to  the  age  only.  There  is 
aoeb  aaaroeness  in  the  result  in  my  hands  that  I  am  surpiiscd  at  the 
di*erepaiicies  in  the  statements  of  others  of  the  profession  in  its  use. 
The  moat  noticeable  advantages  are  :  1st.  The  preservation  of  tone  in 
tke  ayaleBi  ;  2d.  An  almost  invariable  cutting-short  of  the  disease  ; 

U.  Bapid  convalescence ;  and  as  a  sequence  the  eas>y  manage- 


64  Ediiorial  Absirads  and  SeUethnt.         [December* 

roent  of  a  relapse.  All  of  which  are  so  difficult  on  the  old  plan,  i.  0., 
•  hyd.  chlor.  mite,  terebinthina,  etc.  My  plan  of  procednre  is  as  fol- 
lows: Immediately  upon  being  warned,  or  made  aware  of  the 
condition  of  my  patient,  I  administer  a  pretty  fiill  dose  of  snlphate  of 
magnenia,  followed  as  soon  os  it  has  operated  by  from  20  to  60  graina 
of  ipecac,  nsing  every  exertion  to  have  it  retained  as  long  as  possible  ; 
it  is  expelled  however  generally  in  from  three  to  seven  minutes  after 
its  administration.  From  this  time  on  I  have  seldom' failed  to  find  a 
convalescence  established,  the  febrile  symptoms  abate,  the  tongue 
moistens  and  cleans,  the  stool  assumes  a  natural  fecal  appearace,  etc.» 
etc.  To  trace  the  manner  of  its  beneficial  action  we  must  keep  in 
view  the  characteristics  of  the  disease,  and  at  the  same  time  the  pre- 
sumed properties  of  this  agent.  In  dysentery  we  have  congestion  of 
the  bowels,  mucous  or  bloody  discharges,  impaired  secretions,  tenes- 
mus, etc.  The  properties  claimed  for  ipecac,  are  briefly  tonic, 
emetic  and  sudorific;  it  appears  4o  me  that  its  virtues  rest  mostly  upon 
Ist.  The  powerful  impression  the  heroic  use  of  it  makes  upon  the. 
nervous  system  ;  2d.  Its  anti- peristaltic  action  ;  and  lastly.  Its  ab- 
sorbent and  astringent  properties  which  are  not  inconsiderable.  I 
may  hereafter  give  a  few  cases  in  point  to  illustrate  my  modus  ope- 
randi,— Z. W.  Thomas,  M.  D.,  in  Med.  and  Surg.  Reporter. 

7,  Rheumatoid   Arthritis.  —  Mary  Anne  B ,  aged  thirty,  was 

shown  to  John  C.  Thorowgood,  M.D.,  at  the  dispensary,  June  30th. 
For  the  last  eighth  months  she  has  felt  and  heard  a  peculiar  creaking, 
almost  grating,  noise  in  the  right-kneer  joint,  both  on  flexion  and  ex- 
tension of  the  limb.  The  sound  is  loudest  on  extreme  flexion,  and 
comes  from  under  the  ligamentiim  patallas.  On  comparing  the  two 
knees  there  is  no  marked  difierence  in  shape  or  feci  between  them. 
No  other  joint  is,  or  has  been,  affected  with  a  like  creaking.  General 
health  feeble ;  no  history  of  rheumatism.  Blisters  have  been  tried, 
iodine  in  various  shapes  and  forms,  also  mercurials,  but  no  benefit  has 
resulted.  Her  general  health  has  improved  much.  Citrate  of  iron 
and  quinine  was  ordered,  but  the  knee  is  noted  on  July  23d  as  being 
in  no  way  improved. 

About  four  years  ago  I  saw  a  man  about  forty  years  of  age  who  had 
a  most  unpleasant  grating  noise  in  both  shoulders ;  he  had  this 
for  two  years,  and  it  seemed  connected  with  syphilis.  The  syrup  of 
iodide  of  iron,  in  largo  doses,  for  two  months  seemed  of  some  value  in 
this  case. 

80  far  as  my  judgment  goes  there  does  not  seem  a  better  name  for 
these  joint  affections  than  that  of  rheumatoid  arthritis.  Like  rheuma- 
tism and  general  rheumatic  affections  they  most  certainly  are,  and  that 
they  origiuate  in  chronic  or  subacute  inflammatory  action  in  or  about 
the  joint  is,  I  think,  tolerably  certain. — London  Lancet. 

8.  Trial  of  Woorara  in  Tetanus. — Dr.  Schuh,  of  Vienna,  had  recent- 
ly under  his  care  a  man  of  twenty-six,  whose  hand  had  been  shattered 
by  the  bursting  of  a  gun.  The  lacerated  wound  gave  rise  to  tetanus, 
and  this  serious  complication  was  combated  by  subcutaneous  injec- 
tions with  a  solution  of  one  grain  of  woorara  in  one  hundred  and  forty 


18M.]  JUiiorial  Abstracts  and  Silec^tms.  65 

drops  of  spirit^  the  qnantitj  of  the  injected  flaid  being  gradnally  in- 
rreniod.  Some  aNeviation  was  obtained  after  aboat  three  grains  had 
bem  nted,  bat  the  patient  died  ten  days  after  the  accident. — Boston 
Mtd.  end  Surg,  Journal. 

SURGICAL. 

9.  Ofifrations  far  Sirangulatsd  Jlemia  in  very  Aged  Patients. — 
Having  read  io  the  Land,  Lancet.,  that  Mr.  Smith  of  King's  College 
Hoikpital,  has  operated  on  a  patient  aged  eighty-three,  and  that  Mr. 
Partridge  operatc<l  on  another  aged  eighty.  N.  J.  Mackintosh,  M.  D., 
forwards  tho  following  case,  to  show  that  the  operation  ran  be  per- 
formed with  Kacccas  on  patients  close  on  ninety.  Mr.  Smith  stated — 
*'  I  believe  that  cases  have  been  recorded  where  patients  older  than 
eighty-three  have  lived  after  tho  operation,  but  I  cannot  recollect  any 
inch." 

On  the  5tb  of  Jnly  last  I  was  called  to  see  Sarah  M ,  residing 

in  tbia  town,  as  she  was  suffering  severely  from  pain  in  the  left  groin, 
and  vomiting  occasionally.  I  attended  her  previously,  and  knew  she 
bad  a  hernia  for  nine  yeara.  I  found  the  hernia  about  the  size  of  a 
large  ben's  egg,  extremely  hard  and  painful  to  the  touch.  I  attcmpte 
to  reduce  it  carefully,  but  could  not  produce  the  slightest  effect.  I 
recommended  fomentations,  and  gave  some  medicine.  I  saw  her 
again  in  the  evening,  and  there  was  no  improvement.  Called  again 
aext  morning,  and  found  tlie  symptoms  of  the  worst  aspect;  stercora- 
reons  vomiting,  chills,  pulse  very  quick  and  weak,  and  she  said  she 
knew  ebe  was  dying.  1  made  another  attempt  at  reducing  the  herina, 
and  adopted  various  means,  but  to  no  avail.  The  symptoms  being  so 
argent,  I  called  upon  my  friend>^Mr.  G.  Wales,  to  assist  me.  He  in- 
itantly  applie<l  the  taxis,  but  without  any  effect.  We  then  agreed  to 
icnd  for  his  father,  whose  judgement  and  extensive  experience  are  al- 
ways of  the  greatest  value.  lie  monipulntpd  with  it  for  some  time, 
and  failed  likewise.  Consequently,  the  only  alternative  had  was  to 
operate  immediately.  We  could  not  venture  to  administer  chloro- 
form, from  her  exhausted  condition.  After  drinking  a  little  brandy- 
and- water  she  was  taken  to  the  end  of  the  bed,  when  I  made  a  pretty 
ftee  incision  about  two  and  a  half  inches  long.  After  dissecting  the 
different  layers  of  muscles  carefully,  I  arrived  at  the  hernial  pac. 
That  was  opened,  and  one  inte?»tine,  twisted  upon  itself,  livid,  but  not 
devoid  of  its  organic  vitality.  Inst$*ad  of  employing  a  groovecj  di- 
rector I  used  the  little  finger  of  my  left  hand,  and  after  a  good  deal  of 
troable,  got  it  introduced  between  the  intestine  and  abdominal  ring. 
The  faria  was  stretched  as  hard  and  tight  as  possible.  I  slipped  the 
thekn:f«>  down  to  it,  with  its  back  to  my  finger,  and  got  it  divided  at 
oare.  The  intestine  was  easily  returned  afterwards.  She  recovered 
from  the  operation  without  a  single  bad  simptom,  and  now  she  is  able 
to  walk  about  the  honse,  with  no  appearance  of  hernia.  She  never 
wore  a  tmsa,  and  is  now  in  her  eighty-ninth  voar. 

T.  M.  Kendall.  F.  U.  C.  S..  Senior  Sin geoi  of  West  Norfolk   and 
Ljma  Hospital,  also  contributes  the  following :     Ann  C »  OLg^di 


66  JSdiiorial  AbitraeU  and  Sdectiom.  IJ^nmrj, 

eigbty-two,  sent  for  me  three  miles  to  see  her.  I  foand  ehe  had 
strangulated  inguinal  hernia,  which  had  existed  for  three  days.  She 
had  never  worn  a  tniss.  Stercoraceous  vomiting,  much  pain  on 
pressure  and  anxiety.  This  was  on  the  let  of  December,  1855.  At 
seven  in  the  evening,  by  candle-light  in  a  cottage,  I  operated.  The 
bowels  acted  on  the  I2th  naturally,  and  she  recovered  without  a  bad 
symptom.  She  died  of  old  age  on  the  24th  of  June,  1863.  I  give 
you  merely  a  rough  outline  of  the  case,  as  Mr.  Smith  remarks  he  had 
never  before  operated  or  seen  an  operation  on  a  patient  over  seventy 
jaam  of  age. 

10.  Use  of  AnoBstheticn. — Man,  aged  thirty.  In  this  case  not  only 
the  ankle  joint  proper  is  the  seat  of  disease  but  also  the  tarsal  bonea» 
the  limb  is  also  enclosed  by  a  broad  cicatrix  which  interferes  with  the 
recuperative  process;  the  veins  are  varicose.  This  dinease  has  been 
going  on  for  about  30  years.  Our  purpose  to  day  is  to  amputate  this 
man's  leg  at  the  junction  of  the  middle  with  the  lower  t]^ird.  If  yon 
saw  any  way  of  curing  this  disease,  even  at  the  expense  of  anchylosis 
of  the  ankle  joint,  the  opemtion  would  not  be  expedient;  but  that  is  im- 
possible. I  shall  perform  the  double  flap  operation,  cutting  from 
without  inward.  I  generally  prefer  the  circular  operation  as  I  think  it 
makes  a  better  stump.  The  tourniquet  should  be  applied  loosely  until 
everything  is  ready,  and  then  screwed  up  promptly,  otherwise  the 
limb  bbcomcs  engorged  with  venous  blood  which  gushes  out  at  the 
first  incitiion.  This  patient  will  not  have  the  operation  performed 
without  chloroform,  which  I  regret,  as  I  never  use  that  agent  when 
the  patient  will  do  without  it.  I  entertain  the  opinion  that  chloro- 
form has  done  a  thousand  times  more  harm  than  good,  and  I  have 
regretted  that  it  was  ever  invented  as  an  anaesthetic  agent.  There  is 
only  one  thing  that  can  be  said  in  favor  of  it,  that  is,  that  it  relieves 
pain.  In  all  other  respects  it  is  injurious.  It  subdues  the  circulation 
and  we  have  to  wait  a  good  while  for  reaction ;  produces  rigidity 
of  the  muscles  unless  we  use  it  to  a  dangerous  extent.  It  tends  to 
produce  phlebitis,  and  in  a  great  many  cases  it  is  a  powerful  poison. 
A.11  anaesthetics  are  alike,  as  ether,  etc.  Chloroform  is  a  better  agent 
than  ether,  and  its  unpleasant  cifects  are  less.  It  is  used  to  enable  the 
patient  to  undergo  the  operation  without  pain,  but  the  great  thing  is  to 
cure  the  patient  and  I  think  it  contributes  to  a  fatal  result.  The  wound 
was  closed  with  the  interruprcd  suture  and  adhesive  strips,  and  a  ban- 
d  ige  applied. 

Nov.  28. — Our  patient  whose  leg  we  amputated  perished  from  phle- 
bitis ;  he  did  not  die  from  the  immediate  ieffects  of  chloroform,  but  I 
have  no  doubt  that  the  impression  made  by  it  on  his  enfeebled  system 
contributed  to  the  fatal  result. —  Clinic  of  Prof  ,  Nathan  Smithy  (^  Bal- 
timore,— Medical  and  Surgical  Reporter, 

m 

11.  Fissure  of  the  Anus  and  Rectum,  twice  treated  by  Caustics^  twice 
by  Operation. — G.  B.,  a  thin,  delicate-looking  man,  aged  twenty-five, 
first  came  under  Mr.  Tcevan's  care  at  St.  George's 'and  St.  James's 
DiKpensaiy  in  March,  1862.  He  then  stated  that  he  worked  in  a 
pianoforte  manufactory,  and  had  ehjoyed  moderately  good  health  till 


1864.]  Editorial  AhttracU  and  Sdectiimf.  67 

aboat  a  year  Mt^,  when  he  noticed  occasional  pains  in  the  lower  part 
of  the  bowel  after  defecation.  These  pains  gradnally  increased  in  fre- 
qaencj  and  Kereritj  till  he  was  forced  to  give  up  work,  and  became  an 
in-patient  at  one  of  the  metropolitan  hospitals.  He  was  there  told 
that  be  was  suffering  from  a  fissure  in  the  anus,  and  was  treated  with 
an  application  of  the  nitric  acid,  followed  by  the  occasional  use  of  the 
nitrate  of  silver.  After  a  residence  of  two  months  in  the  hospital,  he 
was  dibcharged  cured.  He  now  resnmed  his  occupation  and  remained 
tree  from  pain  for  about  two  months,  when  he  again  began  to  suffer 
from  tbe  lomer  symptoms,  and  applied  to  Mr.  Teevan  for  advice.  He 
tben  stated  that  be  suffsred  from  the  pain  nearly  every  day  for  about 
iix  or  eigbt  hours  ;  that  it  sometimes  came  on  shortly  after  defecation; 
bat  at  other  times  about  evening,  keeping  him  awake  most  of  the 
aighL  His  sensation  of  pain  was  "as  if  some  one  was  boring  a  hole 
through  the  lower  part  of  his  backbone/'  and  he  always  described  it 
ai  *'on  tbe  bone."  He  also  stated  that  he  never  suffei-ed  pain  during 
the  act  of  defecation,  and  that  he  had  not  observed  anything  particu- 
lar about  his  faeces,  except  that  they  were  sometimes  small,  and 
ttreaked  with  blood.  Thei-e  was  no  ascertainable  evidences  of  phthisis 
or  cancer  either  in  himself  or  family.  The  introduction  of  the  finger 
into  the  rectum  caused  great  pain,  but  this  ceased  when  the  finger  was 
held  free  and  motionless  in  the  gut.  On  pressing  the  rectum  circu- 
iaily,  no  pain  was  felt  till  the  coccyx  was  pressed,  when  he  flinched 
and  cried  out  through  the  pain,  and  it  was  hero  that  the  finger  dete'*ted 
a  soft  farrow,  bounded  on  either  side  by  an  indurated  edge.  The  in- 
trodoction  of  the  specnlum  caused  even  greater  pain,  and  exhibited  a 
dark  granular  slit  at  the  upper  and  posterior  part  of  the  anus,  and 
mDiiing  into  tbe  rectum.  This  fissure  was  about  two  inches  long  by 
half  ao  inch  wide,  with  white  cord-like  edges.  He  was  treated  by  the 
application  of  nitric  acid  freely  to  the  part,  and  by  the  occasional  use 
of  tbe  nitiate  of  silver,  together  with  a  liberal  supply-of  tonics,  porter, 
and  M>ap.  Under  this  treatment  he  groatly  improved  his  health,  lost 
hi5  f*ain,  and  in  about  two  months  discontinued  his  attendance. 

In  Oi-tobor  his  pain  gradually  returned,  and  caused  him  again  to 
seek  Silvice.  He  was  then  transferred  to  the  West  Loudon  Hospital, 
aad  on  November  IDth,  Mr.  Teevan  introduced  a  bistoury  into  the 
rectam.  and  divided  the  diseased  structures  longitudinally  to  the  depth 
of  about  a  quarter  of  an  inch.  This  gave  instant  and  perfect  relief 
for  three  weekiT,  when  the  pain  again  returned. 

On  December  20th  another  incision  was  made  through  the  strnc- 
tam«  and  the  sphincter  ani  divided.  This  operation  seemed  to  be 
qaiie  successful ;  for  he  lost  all  pain,  felt  quite  well,  and  returned  to 
work. 

Two  months  later  he  returned,  saying  that  the  pain  had  come  on 
]un  as  bad  as  ever.  Mr.  Quain  now  kindly  examined  him  for  Mr. 
Tcrvan,  and  ailviited  him  to  be  troateil  medically  rather  than  surgically, 
as  he  coQi^idered  there  was  incipient  mrlignant  disease  in  the  part. 
Aftrr  a  trial  of  many  kinds  of  suppositories  of  opium,  alone  and  in 
rbabination  w^ith  other  remedies,  it  wan  found  tiiat  the  only  supposi- 
tory which  gare  him  perfect  relief  was  one  composed  of  two  gTaitiBol 


08  Editorial  Abstracts  and  Selections,  [January, 

opium  and  ten  grains  of  the  extract  of  henbane.     By  using  one  of 
these  whenever  the  pain  comes  on,  he  is  enabled  lo  continue  at  hia 
work  with  perfect  case   to  himself.     lie  states  that  he  can  rarely  go 
longer  than  two  days  without  using  a  suppository. 

It  is  worthy  to  remark  that  one  grain  of  the  extract  of  belladonna, 
given  per  rectum,  sufficed  in  this  man  to  produce  all  the  well-known 
symptoms  of  a  largo  dose  of  the  drug. — London  Lancet, 

OPIITHALMOLOGICAL. 

12.  Cases  of  Retinal  and  Choroidal  Disease  of  the  Eye,  Demonstral* 
ed  by  the  Ophthalmoscope. — On  Saturday  last,  in  the  course  of  an  oph- 
thalmoscopic demonstration  to  the  pupils  of  the  means  of  diagnosing 
**  obscure  diseases  of  the  eye,"  Mr.  Ernest  Hart,  of  St.  Mary's  Hos- 
pital, took  the  opportunity  of  showing  how  much  such  examinations 
could  now  1)0  fncilitatcd  by  the  respective  use  of  atropine  and  the  ex- 
tract of  the  Calabar  bean,  carefully  adjusted.  The  cases  submitted 
to  examination,  and  demonstrated  to  those  around  by  the  aid  of  a 
stand  ophthalmoscope,  included  several  which  until  lately  must  have 
been  massed  together  under  the  conventional  and  uninstructivc  title  of 
amaurosis. 

One  case  was  that  of  a  laborer,  sent  for  operation,  as  being  believed 
to  be  the  subject  of  cataract  of  the  right  eye.  The  left  eye  had  been 
injured  by  an  accident,  and  sight  lost,  fourteen  years  previously.  On 
dilating  the  right  pupil  with  atropine  pap^r,  and  making  ophthalmo- 
scopic examination,  it  was  seen  that  operation  would  be  hopeless. 
The  lens  was  very  slightly  opaque,  though  much  discolored.  Threads 
of  cellular  tissue  floated  about  in  the  vitreous  humor,  which  Was  par- 
tially disorganized.  There  waCs  extensive  and  excessive  staphyloma 
posteriorly,  with  atrophy  of  the  nervous  and  vascular  tissues  of  the 
eye.  The  optic  nerve  was  greatly  degenerated,  and  its  vessels  fila- 
mentous. Mr.  Hart  observed  that  in  such  a  case  no  improvement 
could  be  expected  from  any  operation  or  any  form  of  treatment ;  bui 
had  the  patient  applied  in  a  much  earlier  stage  of  the  disease,  its  pro- 
gress might  have  been  arrested. 

In  another  case  of  a  patient,  aged  forty-two,  a  male,  in  whom  tba 
perception  of  even  the  largest  objects  was  abolished,  and  who  could 
only  just  discern  the  difH^rence  between  light  and  darkness,  requiring 
to  be  led  about,  although  the  eyes  were  to  all  external  appearances 
healthy  and  bright,  the  ophthalmoscope  showed  an  extreme  degree  of 
cupping  of  the  optic  nerve,  with  some  degree  of  atrophy.  This  was 
a  case  of  chronic  glaucoma,  with  atrophy  in  an  advancing  stage.  The 
patient,  being  put  in  full  possession  of  the  character  of  the  diseasSp 
desired  to  take  advantaoro  of  the  faint  chance  of  retaining  the  remnants 
of  vision  afforded  in  such  a  condition  by  the  operation  of  iridectomy. 
Here  also  Mr.  Hart  said  that  it  was  to  be  regretted  that  the  disease 
had  not  been  recognized,  and  that  iridectomy  had  not  been  performed 
at  an  earlier  stage,  so  as  to  relieve  th^  intrn-ocular  pressure  before  it 
had  induced  the  present  almost  hopeless  condition. 

Among   the   other   cases   following    were   one   of   true  lenticular 


1864.]  EdUoriaL  Absiracia  and  Seledhm.  60 

eiUract,  reserred  for  extraction  on  the  ensuing  Wednesday  ;  a  strong- 
iT-marked  case  of  conicity  of  the  cornea,  also  reserved  for  operation 
by  iriddesis  ;  and  one  of  acnte  glaucoma. 

In  the  cases  in  which  it  was  desired  to  examine  ophthalmoscopically 
is  Urge  a  field  as  possible  of  the  retina  and  choroid,  Mr.  Hart  applied 
10  the  inner  surface  of  the  lower  lid  a  small  particle  offpaper  imbued 
with  atropine  ;  the  paper,  prepared  according  to  the  suggestion  of 
Bfr.  Streatficld,  being  so  made  that  a  little  morsel  one-fifth  of  an  inch 
iqoare  contains  as  much  of  the  sulphate  of  atropine  as  a  drop  of  the 
folullon  of  two  grains  to  an  ounce  of  water  commonly  used.     With 
one  of  these  morsels,  or  a  part  of  one,  the  pupil  may  be  fully  dilated 
in  the  coarse  of  a  few  minutes.     Mr.  Sqnii-e  has  now  prepared  paper, 
by  soaking  it  in  the  tincture  of  the  Calabar  bean,  so  as  perfectly  to 
eonnteract  this  effect.     Mr.  Hart  remarked  that  if  the  pupil  bo  left 
dilated  and  the  accommodation  effected  by  atropine,  as  has  hitherto 
been  inevitably  the  case  after  its  employment  for  ophthalmoscopic 
pvrposea,  the  patient  suffers  considerable  inconvenience  for  a  time  from 
the  inequality  of  the  visual  powers  of  the  two  eyes.     Hence,  too,  he 
is  often  led  to  believe  that  the  surgeon  has  inflicted  some  actual  injury, 
and  permanently  damaged  his  sight,  by  the  harmless  process  of  dilata- 
tion ;  rand   many   a   patient  suffering   from  progressive  amblyopia, 
absurdly  enough,  yet  from  a  comprehensible  error,  ascribes  the  date 
of  TJaiole  progress  of  his  disease  to  the  date  of  this  temporary  dilata- 
urn  of    (he  pupil,  with  its  attendant  obvious  inconvcnieuces.     It  was 
ietirmble  to  avoid  misconceptions  in  practice,  and  especially  in  hospi- 
lal  practice,  where  the  patients  were  commonly  not  sufficiently  intclli- 
fnt  to  understand  long  explanations,  nor  had  the  surgeon  time  to  ex- 
pkin  to  each  the  theory  of  accommodation  and  the  harmless  nature  of 
Ike  temporary  dilatation  of  the  pupil  by  a  drop  of  a  weak  solution  of 
ttropine.     In  private  practice,  also,  it  wa^  desirable  to  avoid  subject- 
ng  patients  to  this  inconvenience.     Mr.   Hart  observed  that,  by  the 
wm  of  a  blue  glass  screen,  through  which  the  rays  of  light  were  made 
to  pa^,  it  was  often  possible  in  a  number  of  cases  to  dispense  with 
dEatalion  for  tlie  purpose  of  ophthalmoscopy  ;  but,  on  the  other  hand, 
A  UHjfcagh  and  satisfactory  examination  of  the  retina  and  choroid, 
nch  ai>  was  oHen  needed  for  a  proper  knowledge  and  conscientious 
tmtment  ofJdiKeases  of  the  internal  tissues  and  humors  of  the  eye- 
ball, could  not  be  effected  without  dilating  the  pupil,  so  as  to  increase 
tbe  number  of  rays  which  entered  and  illuminated  the  eyeball,  and  to 
cilarge  the  field  of  observation.     It  had  very  early  been  obvious  that 
tbe  Calabar  bean  might  probably  furnish  an  active  principle  which 
might  be  safely  and  innocently  employed  to  counteract  the  dilatation 
•ni&cially   induced    by   atropine.     The   first  beans  which  came  to 
LootSoo  were  placed  in  his  hands,  and  he  employed  them  experiment- 
dlly  for  this  purpose.     It  was  at  once  obvious  from  the  first  series  of 
eMerralioDS  that  the  bean  fully  possessed  the  power  ascribed  to  it ; 
kot  tbe  beU  mode  of  employing  it,  the  means  of  adjusting  its  appli- 
citkm  so  M  not  to  carry  the  effects  too  far,  could  not  at  once  be  de* 
He  had  employed  the  bean  in  extract,  and  a  solution  of  the 
ia  water  and  in  glycerine  ;  Messrs.  Bell  &  Co.  supplying  al 
■oggfttioa  a  sort  of  standard   solatha  in  glycerine,  one   drof 


70  EdUofial  Abstracts  and  SeUcthn$.  [Jannftrj, 

answering  to  four  grains' of  the  bean.  The  mobt  canvenicQt'mcihody 
however,  for  ordinary  purposes,  was  bj  saturating  with  the  extract 
thin  paper,  so  adjusting  the  strength  of  the  solntion  that  equal  portioot 
of  the  Calabar  bean  paper  and  atropine  paper  noight  be  made  to  nea- 
traliza  each  other,  and  leave  the  eye,  after  ophthalmoscopic  examina- 
tion, as  nearly  as  possible  in  statu  quo.  The  nearest  approach  to  this 
object  was  attained  by  some  paper  which  had  been  prepared  by  Mr« 
Squire.  It  is  prepared  according  to  the  following  formula  :  one  ounce 
of  the  white  portion  of  the  bean  is  exhausted  by  two  ounces  of  recti- 
fied spirit ;  the  solution  is  now  evaporated  to  one-eighth  of  its  balk» 
and  then  the  paper  is  soaked  in  it  and  dried. — London  Lancet. 

13.  Three  Cases  of  Amaurosis  Produced  by  Tobacco, — By  J.  C. 
Wordsworth,  Esq.,  F.R.C.S.,  Surgeon  to  the  Royal  London  Ophthal- 
mic Hospital. —  Case  1. — W.  A.,  aged  twenty-one,  a  clerk,  residing  at 
Liverpool,  came  to  the  lloyal  London  Ophthalmic  Hospital  in  186 U 
on  account  of  partial  loss  of  sight  in  both  eyes.  He  is  a  strongs 
healthy -looking,  rather  little  man.  Has  always  had  excellent  health, 
and  never  suffered  from  syphilis.  His  employment  is  principally  m 
the  open  air,  as  he  is  engaged  in  clearing  vessels  at  the  Custom  HonaOr 
etc.  For  some  years  he  has  smoked,  having  gradually  increased  from 
two  to  three  pipes  per  day,  until  he  has  reached  the  enormaus  amount 
of  a  pound  to  a  pound  and  a  half  of  strong  tobacco  in  the  week  ;  and 
for  some  time  has  rarely  been  without  his  pipe  half  an  hour  in  the  day. 
For  a  long  period  his  sight  has  gradually  failed,  till  he  can  only  see  to 
read,  for  a  short  time,  characters  of  one-third  of  an  inch.  Though  ho 
has  had  misgivings  that  his  ailment  proceeded  from  tobacco-smoking, 
ho  has  continued  the  habit  to  the  present  time,  and  is  now  daily  be- 
coming more  blind. 

Both  pupils  are  rather  large,  but  the  motions  of  the  iridos  are  active. 
By  means  of  the  ophthalmoscope,  both  optic  nerves  appear  of  brilliaot 
white  color,  their  areas  being  enlarged,  and  their  outlines  irregularly 
defined. 

Case  2. — J.  M.,  aged  thirty-six.  a  railway  servant,  came  to  the  Oph- 
thalmic Hospital,  on  account  of  dimness  of  sight  in  both  eyes,  about 
June,  18G2.  Ho  is  a  tall,  muscular,  lather  pale  man,  and  says  he  hat 
always  had  good  health.  He  is  employed  as  a  signal-man,  and  hat 
been  accustomed  to  beguile  his  time  by  smoking  all  day  long.  For 
an  uncertain  time  ho  has  noticed  his  sight  to  be  gradually  failing,  and 
attributed  the  defect  to  the  use  of  tobacco.  He  has  still  continued  to 
smoke  to  the  present  time,  and  his  sight  has  now  become  so  imperfect 
that  he  is  unable  to  attend  to  his  business.  Ho  has  never  had  vene* 
real  disease  of  any  kind,  nor  has  he  used  his  eyes  much  for  cloao 
vision. 

The  pupils  are  considerably  dilated,  and  not  mnch  influenced  by 
light.  The  fundus  of  each  eye  seems  quite  normal,  with  the  exception 
of  the  optic  discs,  which  appear  too  large,  and  irregularly  circular,  tha 
tissue  being  quite  of  tendinous  whiteness. 

Case  3. — G.  A.,  aged  twenty-eight,  a  butcher,  residing  in  Essex, 
applied  at  the  Royal  London  Ophthalmic  Hospital,  March  25th,  I86S9 


1864.]  EdUwrial  Absirads  and  Selections.  71 

on  acconnt  of  failing  Bight  in  both  eyes.     He  is  a  stont,  strong,  tnid- 
dle-stzed  man.  having  every  appearance  of  health,  and  says  he  has  had 
excellent  health  all  his  life.     He  began  to  smoke  eight  or  nine  years 
ago,  moderately,  but,  gradually  increasing,  has  now  for  some  time 
lieen  in  (he  habit  of  smoking  half  an  ounce  of  strong  tobacco  every 
day,  apparently  without  any  ill-effect.     About  nine  months  since  his 
fright  began  gradually  (o  fail,  and  has  continued  to  get  worse  to  the 
p^e^ent  lime.     He  has  always  been  temperate  as  to  the  quantity  of 
V«er,  etc.,  which  he  has  taken,  and  has  never  drunk  spirit  habitually. 
He  in  a  married  man.  and  has  three  healthy  children.     Has  never  suf- 
fered from  ftyphilis,  nor  has  he  used  his  eyes  much  at  any  trying  occu- 
patton«    With  the  exception  of  both  pupils  being  rather  large,  and 
the  motions  of  the  irides  sluggii^h,  he  has  no  external  appearance  of 
any  ailment  of  the  eyes.     He  can  only  see  to  read  No.  18  test-type 
(canon)  with  his  left  eye,  and  with  the  right  No.  16  (two-line  great 
piimer),  wonl  by  word  ;  and  distant  objects  are  equally  indistinct. 

The  ophthalmoscope  demonstrates  an  atrophic  condition  of  both  optic 
aerres,  the  inner,  (appaa'nt)  half  of  each,  been  in  the  reversed  image, 
Wing  quite  white  and  non- vascular  ;  the  outer  part  being  redder,  and 
ore  vascular  than  normal. 

Within  the  last  three  years  I  have  seen  a  considerable  number  of 
of  amaurosis,  apparently  produced  by  the  influence  of  tobacco. 
I  admit  (I  need  scarci'Iy  say)  how  difficult  it  is  to  reduce  the  etiology, 
of  this  obscure  affection  to  a  demonstration.  For,  in  the  first  place, 
iaanroais  is  attributed  to  a  vast  variety  of  causes,  many  of  which  are 
alvaysmore  or  less  in  operation  ;  then,  again,  the  discaKO  is  dependent 
on  a  Mroilar  variety  of  pathological  condition  ;  and,  lastly,  our  knowl- 
edge of  the  physiology  as  well  as  of  the  pathology  of  the  retina  and 
r-rain  is  so  limited  that  we  can  ill  appreciate  or  dcHne  the  influence  of 
pbvMologiral  agents  on  their  structures  and  functions. 

No  one  can  doubt  that  tobacco  possesses  properties  that  are  capable 
of  proilacing  great  effects  on  the  nervous  system  at  large  nor  that  the  « 
iulitnal  nse  of  it  has  much  influence,  of  an  indirect  nature,  on  the 
'>ical  remrtibns.  Our  only  wonder  is  that  the  almost  universal  eniplo\  - 
ant  of  ihia  powerful  agent  does  not  leave  vestiges  of  its  influence 
:hai  are  better  known  and  recognized  as  signs  of  disease.  This  may 
M  accoQUled  for  to  some  extent  by  the  rapid  cadaveiic  changes  that 
•ecnr  in  the  nervous  elements,  thus  obscuring  or  effacing  diseased 
lAaten  before  we  have  the  opportunity  of  recognizing  them. 

AM  the  claf«ic  writers  attribute  its  full  share  of  causation  to  tobacco 
u  a  »oorce  of  amaurosis  ;  yet  I  have  not  met  many  that  are  willing, 
inJiridnally,  to  allow  that  they  have  traced  its  influence.     Bat  it  has 
'>fteB  happened  that  the  causes  of  disease  are  long  unrecognized  by 
ibaay,  after  as  full  a  proof  has  been  made  of  their  reality  as  possible. 
F^'f  instance,  it  is  recorded  of  one  of  the  causes  of  iritis  (that  every 
c»»  n.jw  allows.)  that  fur  many  yoars  it  was  not  admitted  by  men  of 
vast  experience  that  any  closer  relation  than  that  of  coincidence  exist- 
ed between  it  and  syphilis  ;  yet  so  great  has  been  the  revulsion  of 
''pinioa  tbat  »ome  eminent  men  now  seem  to  think  it  never  occurs  ex.* 
IB  ooBDScltun  with  thai  contamination. 


V2  Editorial  Absiraeia  €md  Seledicnt. 

I  have  Felcctcd  the  cases  above  sketched  to  illustrate  this  subject* 
bccAUse  they  seem  to  be  as  free  from  the  unavoidable  fallacies  that  en- 
circle thiH  sulijecl  an  possible.  Many  have  come  under  my  notice  ia 
which  I  could  not  find  any  other  cause  to  account  for  the  conditions ; 
but  few  so  typical  of  the  atrophy  of  the  optic  nerve,  or  so  advanced. 
It  is  obviously  desirable  to  cite  well-marked  cases.  Many  of  those 
obticrved  gimlually  merged  into  less  definite  conditions,  and  were  only 
corrobomtive,  rather  than  conclusive.  Again,  many  were  so  fettered 
with  other  complications  that  I  consider  them  inapposite  for  my  pres- 
ent purpose.  All  the  cases  that  liave  come  under  my  observation  nave 
(as  might  probably  be  expected)  been  in  males.  It  will  be  noticed 
that  only  one  pathological  condition  was  seen  in  these  three  C|tses — 
namely,  that  of  white  atrophy  of  the  optic  nervos.  I  am  not  prepar- 
ed to  assert  that  tobacco  produces  blindness  In  this  way  only  ;  bnt  in 
all  my  cases  I  have  recognized  this  condition  in  a  gi^at  or  small 
degree. 

I  may  anticipate  that  I  shall  be  asked,  IIow  can  it  be  that  of  the 
hundreds  of  thousands  of  smokers,  only  so  small  a  proportion  are  af- 
fected by  amaurosis  ?  I  should  reply,  first,  that  few  probably  smoke 
to  such  excess  the  strongest  tobacco  ;  in  the  second  place,  we  are  not 
yet  in  a  position  to  recognize  the  smaller  degrees  of  tobacco-disease  ; 
and  thirdly,  as  Dr.  Mackenzie  has  aptly  obscrvetl,  only  one  of  five 
hundi'ed  shall  become  amaurotic,  in  whom  a  stronger  pi'edisposition 
to  the  disease  had  existed.  .  ^ 

Secondary  syphilis  aflects  the  retina,  and  leads  to  amaurosis  ;  but 
of  the  thousands  afleeted  how  few  become  blind  I 

Thou  it  has  been  suggested  that  I  ought  to  show  that  amanosis  is 
most  common  where  smoking  is  most  general.  To  this  I  reply,  it  ia 
impossible  so  to  estimate  and  proportion  the  other  recognised  causes 
of  amaurosis  so  as  to  enable  us  to  compare  them  with  the  efTecta 
of  tobacco,  and  thence  reduce  any  relation.  But  so  far  as  probability 
warrants,  I  think  thci-e  may  be  some  conclusion  to  this  purpose  de- 
'diiced  from  the  greater  frequency  of  atrophy  of  the  optic  nerves  in 
men  than  in  women,  (of  which  I  suspect  there  is  little  doubt),  though 
the  other  causes  of  amaurosis  are  more  likely  to  affect  the  latter — for 
instance,  needlework,  etc. 

Dr.  Mackenzie,  in  his  great  work  on  Ophthalmology,  expresses  hii 
belief  that  tobacco  is  a  frequent  cause  of  amaurosis,  and  adds  that 
"  one  of  the  best  proofs  of  tobacco  being  a  cause  of  amaurosis  is  ia 
the  great  improvement  in  vision — ^sometimes  complete  restoration — 
which  ensues  on  giving  up  the  use  of  this  poison,"  and  cites  a  very 
striking  case  in  illustration.  With  him  1  agree  also  in  the  conviction 
that  tobacco  is  a  common  cause  of  the  cases  of  partial  loss  of  sight 
that  are  daily  to  be  found  at  our  hospitals. — London  Lane§L 


xcmmii  imd  it  (ibsfrbcr. 


KUITRD  BV 

'8.  STEVKvs,  \(,ii.  .  .  .mm  \.  iiuHi'iiv,  n.v. 


^dlXUINK  V  I 


THWffiK  MtflABKH  WRVT  *tr  TMB  01.lt  RTAND. 


New  Central  Office, 


Opened  April,  189 


a    FBAN£    PALMER. 


imuvoa  lo  tl.1-  STONE  EDIFIiTE. 
Mo.   1IK)1I  Cboatuul  Eti-ee 


evuty  J." 
•IV  I'. 


'iiintn  ilic  New  Rules  tbr  Air putn linns,  ami  full  In .. 
Lion  for  pri'ijif  iii  mini  of  Umbs,  edit  lico  •        -..miiie,  bj  mnll  orolher 
'Hia  Bttcntlou  of  Surgcaiu.  Phr'i  i      ,  and  nil  [icruins  liitr-r*li 

A  I  former  nnrtncirliips  Iiave  expired  b}  llmilalloD.     Addreta 

E.  FRANK.  PALHRR, 
No.  1009  ChMDUt  Stfvot.  rUltUt* 

n.  N.  UARSII,  CORLISR  &  CO.,  AgtnU,  rauciBMti. 


WILLIAM    Z.     REUS, 

TKUS8,  BRACE   AND   BANDAGE   INSTITUl 


CKOIttAl.   AMI  nr.nTAI.  iKItTIIITMKKVk.  AttTirie 

(.EBH.  Annff,  nAUBs,  An*  itimE)t( 
NO    71  W.  SIXTH  ST.  OIMCI^BNATI.  OHIO. 


''     .'  '  ./ 


I  • 


*1»  - 
''■"^•''"  THE 

:DfCmNATI  LANCET   AND  OBSERVEU. 

coxnrcTED  iiY 

E  B.  STEVENS,  M.D..  AND  J.  A.  MURniY,  M.D. 


'OLVII.  FEBBUABy,   1804.  No.  2. 


0rlginnl  CTommunifaticrnis. 


ARin  i.r.   I. 

A  Glance  at  the  History  of  Bloodletting, 

UJ.-n  the  ladUanpxIii  Mi"1i  al  A«  vociati'tp.  lunl  oriK>red  to  he  strut  to  ths /.AUi-ft  it.fl 

0'.*trtvr  f."»r  inil-Iicilinii.] 


DT    WILLIAM    r..    I'LKTI-IIKS,    M.D. 


t 


III  the  interestini^  paper  upon  pmuinonia  road  bofoic  this  Associa- 
At  the  last  meeting,  I  was  Puq)riscHl  at  tlio  vjpws  of  tlio  aiilli"r 
■d  of  all  the  members,  except  two,  upon  thijisiibjeet  of  Lloodlottinijf  in 
CBtc  inflAmmntion.s  ;  for  with  on*.'  voice  it  was  eoiiilemnedas  a  usel'^^-t 
■d  ftliacdoncd  practice.  I  lhcrefi>rc  delorriiined  to  in(]uire  into  tic.' 
of  the  change  of  o]iinii»u  on  this  subject,  wliich  has  evidently 
np>^n  thn  jirofession  in  the  last  ijuartrr  of  a  eenluiy  ;  ami  1  ven- 
Bt  to  iTive  a  brief  review  of  my  ip-o-ireh  t<»  tbiN  A^-rx-ijitinu  to-ni^bf « 
lere  w.th  a  view  t'»  'Irawing  out  liirther  di>ens>i«Mi  tlian  to  preMMitim; 
IT  new  idnas  of  niv  i»wm. 

Thft  vtffV  fir"»t  re«r>rd  of  bloutUottiiig  tak<'s  ns  back  t«>  the  j)riniitivo 
nod  in  ihc  w.ii].l*>  hi>(oiv,  or  about  three  tbou.saml  vcars  aL<«i,  win  n 

ii  written,  •'  Pubilirius.  -on  of  E^eulapii:s,  being  cast  away  upon 
I  ialmod,  wa>  for.ud  by  a  .^hrplierl,  who,  barning  tliat  ]Ni(I;ilirii:< 
ai  a  j''hr?»i«:i;in,  '.•■•ndu<tel  him  t«>  the  kin^,  wbosi*  daiiirliter  bad  I'.ilbMi 
BB  a  Lou*L-top  and  wa«  lying  insen-^ible.  >njpo>e«l  by  her  a(ten«!aiits 

lie  dead.  I'udaliriii^  bl.fd  her  from  i/Otli  arms  aud  she  lecovenMl.' 
feao«urd'-  Iliai'iry  of  Mediiine.)  Fri»m  tbi*  firfi;<'iii;^  it  is  n-a^on- 
Jt  to  it:ppo*e  that  bluodl'^tting  was  lesouc-d  to  in  roiig<»»*ti«ins,  nnd 
fhapa  mo-^t  di-^ea-^e-*  even  in  that  early  periii  1,  but  it  i.:>  >•»  early  iwA 
motl  XDVntlcal.  that  we  got  n«i  further  iraa'  of  this  niitipliloi:i>tii' 
Bedj,  until  about  ii\c  hun-licd  yvars  before  the  Christian  era,  or  the 

TU.— 1. 


74  Original  Communications,  [Febroaij. 

philosophic  period,  when  medicine  was  studied  by  old  Hippocimtep* 
who  wrote  so  truly  and  so  well  upon  many  subjects,  that  to  this  daj 
we  have  scarcely  added  or  improved. 

Sqmc  have  doubted  the  ability  of  the  old  physicians  to  correctlj 
diagnose  internal  inflammations.  It  is  true  Hippocrates  had  not  tht 
stethoscope  or  pleximeter,  but  he  gives  minute  and  accurate  descrip* 
tions  of  disease  from  commencement  to  termination,  and  shows  knowl- 
edge of  objective  and  subjective  symptoms,  and  records  the  whole  in  a 
manner  so  clear  and  simple,  that  it  would  do  honor  to  any  modem  ob* 
server  of  medical  phenomenon,  but  as  to  his  treatment  of  pneumonia 
and  pleurisy,  he  is  as  rational  as  any  one  could  wish.  We  .have  a 
general  impression  that  the  old-time  physicians  were  very  ignorant^ 
and  killed  the  majority  of  their  patients  by  drawing  off  the  vital  fluid* 
Hippocrates  writes  of  pneumonia  as  follows  :  **  If  the  fever  be  acute; 
if  there  is  pain  on  one  or  both  sides  of  the  chest ;  if  the  patient  sufiiMr 
during  expiration,  if  he  coughs  and  the  expectoraiiqn  is  rusty  and 
livid,  or  thin  and  frothy,  or  blood  red  ;  the  pain  extending  above  and 
toward  the  clavicle  or  toward  the  arm,  the  internal  vein  on  that  aida 
should  be  opened.  The  qnantity  of  blood  drawn  should  be  proper" 
tional  to  the  constitution  of  the  body,  the  season  of  the  year,  the  age 
and  color  of  the  patient ;  and  if  the  pain  be  acute,  the  bleeding  shou|d 
be  boldly  pushed  to  syncope."  (Renouard's  History  of  Medicine.) 
The  first  stage  of  pneumonia  is  the  only  one  in  which  he  recommenda 
the  use  of  the  lancet.  His  directions  for  the  patient  during  convalee- 
cence  are  given  with  characteristic  minuteness,  and  much  to  the  aame- 
purpose,  as  would  be  pursued  by  our  best  practitioners  of  our  own  time. 

After  this  truly  great  man  and  good  physician,  little  was  added  to 
medical  knowledge,  except  an  occasional  discovery  in  anatomy,  ov 
surgery  until  the  time  of  Galen — or  a  period  of  about  six  hundred 
years — during  which  time  the  practice  of  Hippocrates  was  the  plan 
adopted  by  all  who  wrote  or  taught  the  science. 

Galen  drew  to  himself  all  the  medical  knowledge  of  IIippocratea» 
added  largely  to  the  anatomical  branch,  and  rewrote  all  that  waa 
written  of  medicine,  and  he  left  the  treatment  of  acute  inflammation 
just  as  he  found  it.  In  fact,  little  was  added  to  the  treatment  of  die- 
ease  from  the  time  of  Galen,  although  the  science  passed  into  Egypt, 
and  into  the  hands  of  the  Arabs,  yet  we  find  it  in  the  beginning  of  the 
fourteenth  century,  just  stiiiggling  for  memory  and  life  in  the  dawn  of 
European  civilization.  And  now  began  that  steady  healthy  growth 
of  knowledge,  which  has  been  gradually  increasing  to  the  present 
day.     But  to  return  to  bloodletting.    After  medicine  fell  into  the 


S64.]  Fletcher — BiHory  of  Bloodletting.  75 

binds  of  the  Arabs,  the  practice  of  Hippocrates  and  Galen,  of  bleed- 
ing Itr^ly  from  the  arm,  fell  into  disrepute,  and  was  gradually  aban  - 
doneJ,  and  inbtead  they  prescribed  pricking  slightly  the  vein  of  tbo 
foot,  to  let  the  blood  flow  drop  by  drop,  and  this  method  prevailed 
nntil  about  the  year  1520.  Whou  a  pleuritic  epidemic  ])rovaiIed  in 
Paris  a  physician  named  Pierre  Bissot,  6ick  of  Keeing  iiis  patients  die,' 
and  eoconraged  by  reading  the  Greek  authors,  dared  revive  the  prac- 
tice. The  snooess  astonished  him,  and  he  declared  boldly  the  superi- 
'>rity  of  Hippucnites*  method.  And  now  followed  a  dispute  between 
ibe  Arabii^os  and  those  who  practiced  this  ancient  heroic  and  plilogis- 
ti:  T-Lui,  but  at  length  experience  taught  the  latter  plan  was  the  best, 
tni  for  a  hundred  years  bloodletting  is  the  great  "  stand-by"  of  the 
Ilvctor  in  comk'iting  acute  inHammation. 

About  une  hundi-e<l  years  from  the  time  that  Pierre  Bissot  revived 
c-ioo'iletting,  one  Ji»lm  Baptist  von  Heluiont^  who  was  educated  for 
tWf'hnrcb,  but  abandoned  it  for  the  study  of  medicine,  declared  that 
•IJ  lleeding  was  butchery.  Although  he  was  a  learned  chemist  and 
boanist,  he  gives  no  reason  for  not  bleeding.  Nevertheless,  blood- 
kciDg  becomes  unpopular,  and  is  for  a  time  abandoned,  but  soon  was 
lutofvd  to  its  place  among  remedial  agents,  for  this  was  a  time  when 
Kvntific  men  M*ere  not  so  easily  robbed  of  their  experience  by  bright 
•nr  tLe<»ries. 

Harrer  miikes  his  disco verv  in  1G19,  and  in  1G03  Boerhaave,  who 
wii  one  of  the  greatest,  the  brightest  and  the  best  of  men — whose 
viiciogs  I  reread  with  renewed  interest  for  the  fresh,  spring-like  truth- 
fidlaes»  and  simplicity  of  expression-  In  his  aeadcniieal  Iciturcs,  in 
vpeakinz  of  "phlebotomy,"  (Dr.  Hoerhaave's  Academical  Lectures, 
vol.  Tj.  p.  420)  as  he  calls  it,  he  gives  the  most  common-sense  and 
Mcooable  view  uf  the  subjects  which  I  have  found  in  any  author, 
aker  an.'ient  or  nmdern. 

hk.  He  gives  the  elfects  of  *'  bloodletting  within  bounds"  ;  l2d. 
When  the  ''discharge  is  indicated  to  be  necessary"  ;  od.  How  it  is 
^  madf .  etc. 

II*;  lays  :  •'  Bk'f.*ding  is  forbid"  l.st.  In  most  chronical  diseases,  in 
VLicb  many  of  the  ves!»els  are  obstructed,  and  very  little  lluid  blood 
imarM  in  th'*  vessels  ;  2d.  From  oM  a,Lr«',  or  weakness  of  the  patient ; 
M.  Ff'.-m  the  patient's  temperature  and  habit  ;  4th.  From  the  known 
Utira  t'f  the  disease,  whether  epidemical  or  endemical  ;  oth.  From 
■ctrril?  or  ••mall  proportion  of  red  color  in  the  blood  with  a  weakness 
d  al]  the  powers  from  thence  proceeding  ,*  6th.  From  a  woman's 
Win^  Uidy  lain  in. 


76  Original  Communicaiions.  [Febrnaiyy 

"  From  what  has  been  said,  it  is  evident  how  much  benefit  and  bow 
miich  damage  may  be  offered  to  mankind  from  never  having  reconne 
to  the  use  of  this  remedy,  or  else  by  applying  it  indifferently  in  all 
cases,  nccording  to  Helmont  and  Botallus." 

Boerhaavc  remarks  in  a  note  that  "  Ilolmont  exclaims  that  all  bleed- 
ing  is  butchery.  Botallus,  on  the  contrary,  erics  it  up  in  every  disease, 
and  even  in  dropsy  ;  but  one  will  he  safer  who  takes  the  middle  way, 
since  these  extremes  arc  both  equally  extravagant." 

Thus  we  see  bloodletting  revived  from  the  Arabs,  and  rescued  from 
Ilelmont's  banishment,  is  once  more  practiced  and  taught  by  the  most 
learned  in  Europe  ;  but  let  us  see  in  this  age  of  progress,  when  Jenner 
is  confirniing  his  discovery,  and  the  Hunters  are  turning  to  light  the 
secrets  of  anatomy,  physiology  and  pathology,  and  Wm.  Cnllen  is 
improving  his  Institutes  and  Materia  Medica,  let  us  see  if  with  all 
this  advance  in  knowledge,  any  thing  is  discovered  to  cause  an  over- 
throw of  the  great  antiphlogistic,  for  about  this  time  (1750)  it  had  its 
third  decline,  and  as  far  as  advance  in  science  goes,  it  does  not 
account  for  it ;  hut  happily  Ilistory  does,  and  it  tells  us  that  it  was  one 
John  Brown,  and  trnly  his  soul  is  marching  on.  While  the  names  of 
Jenner,  Ciilleu  and  the  Hunters'  live,  why  should  that  of  their  cotem- 
porary  be  lost  forever. 

John  Brown  was  bom  in  Berwickshire,  Scotland,  of  poor  parents 
was  educated  for  the  Church,  but  left  it  to  study  medicine.  He  sup- 
ported himself  by  giving  instruction  in  Latin  to  medical  students,  and 
soon  I'crame  known  to  the  Professors.  Tliis  was  in  Edinburg.  (New 
American  Cyclopedia  in  Brown.)  Dr.  Wm.  Cullen  employed  him 
as  a  private  tutor  in^iis  family,  and  gave  Brown  many  advantages. 
But  Cullen  opposed  his  nomination  to  a  professorship,  and  Brown  left 
his  friend  and  patron  in  anger,  and  soon  began  to  attack  Dr.  Cnllcn's 
medical  views,  and  took  a  decidedly  opposite  course  in  every  thing, 
lie  soon  hccnme  a  leader  of  a  party  of  medical  students  wtio  were 
called  Brownites  in  distinction  from  (/ullcnites.  Brown  went  to 
London,  and  taught  some  time,  and  his  theoiy  spread  over  Germany, 
Italy  and  France.  Brown  became  a  victim  of  his  own  plan  of  treat- 
ment ;  he  over- stimulated.  His  theory  was,  stimulus  is  life,  the  lack 
of  it,  death. 

Tlius  from  a  domestic  quaiTel  came  division  of  opinion  in  the  prac- 
tice of  medicine,  anil  an  excess  of  stimulation  was  iirged  to  bpite  an 
alleged  excess  of  depiction.  Through  the  present  century  the  practice 
of  bloodletting  again  came  into  general  favor  until  about  twelve  years, 
ago  it  began  to  be  contested  in  Europe.     Some  contested  that  disease 


1SG4.]  Fletcher — BUtory  of  Bloodletting,  77 

hA<l  changed  its  type,  and  that  bloodletting  was  not  as  ncccssarj  as  of 
old.  (Effects  of  bloodletting  during  the  last  four  years.  By  l*rof. 
AlisoQ.  Edinbarg  Medical  Journal,  March,  185G.)  ^Yhile  Dr.  Ben- 
nett contended  thai  new  patholog}'  proved  clearly  that  bloodletting  in 
icuto  in ri animation  was  now  and  ever  had  been  a  irroat  error.  Dr. 
Bennett  maintains  thai  the  older  writers  could  not  know  much  of  in- 
ternal inflammations,  and  therefore  were  not  authority  on  that  point ; 
that  you  can  not  cut  short  inliammatory  action,  that  bloodletting  does 
EOt  'liminiAb  the  amount  of  blood  in  an  inflamed  part,  and  that  it  is 
l-td  practice  to  diminish  the  How  of  blood  to  the  part.  (Edinburg 
Maiical  Journal,  March,  1857.    Also  Bennett's  Practice  of  Medicine.) 

Iir.  Bennett  trios  to  prove  his  theory  by  his  success  in  treatment, 
bnt  I  mn>t  ?ay  after  comparing  the  results  of  many  physicians,  blood 
kfiers  and  stimulators  and  narcotizers,  I  am  at  a  loss  to  know  which 
hi8  J  rove<l  his  theory  by  practice.  None  of  the  tables  give  exactly 
ike  important  information  which  is  necessary  to  form  correct  conclu- 
f»D«.  snch  as  the  age,  Fex,  color,  climate  and  constitution  of  the 
|at:ent,  nor  the  time  when  ti-eatment  began. 

And  now  we  are  brought  down  to  our  own  day.  Let  us  review,  and 
we  will  !^G  thai  bloodletting  for  three  thousand  years  has  been  used 
ia  a^-ute  inflammations,  that  at  seveial  periods  it  has  become  unpopular 
ni  fallen  into  disrepute,  and  has  again  revived  in  full  forco  ;  really, 
10  far  as  I  can  .see,  without  the  slightest  physiological  or  pathological 
rea*or.f.  Ist.  Abandoneil  by  the  Arabs  ;  2d.  Kijoi'ted  by  llelmont ; 
3J.  OpjiOffcd  by  Brown,  to  spile  Cullen  ;  4th.  Declared  wrong  b}'  J. 
Ho.'h-.-s  Dennett,  M.D.,  F.U.S.,  on  pathological  grounds,  scon  very 
ckariv  i-r  himself,  but  rather  dimly  by  the  rest  of  the  world.     Tlieso 

foTir  r*:riodH  •.»!  a  huiidrctl  years  each  has  certainly  had  no  tendcufv  to 

I  «  •  w 

leule  the  ijr.estion,  and  here  we  muKt  leave  it,  giving  only  as  example 
U  ihe  opici-jns  of  a  few  ootemporaries.  M.  Boullaud  bleeds  in  puou- 
m:-<iLi  •'•d  an  average,  four  or  tive  pounds,  and  goes  as  high  as  ten  ;  and 
UT*  Li's  *'  patients  recover  with  strength  and  vigor  in  a  remarkably 
ikon  time.  (Medico-Cliirurgical  Review,  p.  4.  July,  1858.)  While 
br.  B>.'aneti  contends  in  a  great  many  words  that  the  whole  thing  is 
vT'.-ikg  :  yot  the  same  Dr.  Bennett  did  in  1845,  bleed,  cup  and  give 
a&tin-.'-^ny,  'ipium  and  calumel  to  ptyalism  in  a  qhhq  of  pneumonia, 
alUivogh  there  was  little  pain  and  fever,  and  almost  no  dyspmra. 
(BiemarLs  fiQ  Dr.  Bennett's  paper  on  bloodletting,  etc.,  by  W.  T. 
Gardner,  M.D.  Edinburg  Journal,  June,  1>^57.)  Query:  Did  such 
fiUH  help  him  to  his  "advanced  diagnosis  and  pathology.''  **The 
luce;  Li  a  weapon  which  slays  annually  more  than  the  sword,"  say.s 


78  Original  Communications.  [Februaiy, 

Dr.  Tullcy.  "  It  is  probable  tbat  opium  and  its  preparations  have 
done  seven  times  the  injury  they  Lave  rendered  benefit,  on  the  great 
scale  of  the  world,"  says  Dr.  Gallup.  (Border  Lines,  by  O.  W. 
Holmes. )  **  What  is  the  meaning  of  this  perpetual  change,"  asks  Dr. 
Holmes,  who  then  answers  with  his  usual  fine  sense,  "  Simply  Ibis* 
all  methods  of  treatment  end  in  disappointment  of  those  extravagant 
expectations  which  men  are  wont  to  entertain  of  medical  art.  I  bave 
no  doubt  that  the  bills  of  mortality  are  moit;  obviously  effected  by 
drainage  than  by  this  or  that  method  of  practice.  The  Insurance 
Companies  do  not  charge  a  different  percentage  on  the  lives  of  this 
or  that  physician.  In  the  course  of  a  generation,  more  or  less  physi- 
cians themselves,  are  liable  to  get  tired  of  a  practice  which  has  solif^le 
effect  upon  vital  decomposition." 

**  Then  ihey  are  ready  for  a  change,  even  if  it  were  back  again  to  a 
method  which  has  been  tried  and  found  wanting." 

Thus  we  have  seen  that  bloodletting,  like  most  of  our  remedial 

agents,  has  had  its  rise  and  fall  at  various  times.   Also  that  it  has  not 

been  carried  to  the  mad  extreme  by  the  old  fathers  in  medicine  as  is 

commonly  s^ppoi^ed  ;   and  that  the  best  medical  men  of  onr  own 

period  are  those  who  take  neither  extreme,  as  may  be  seen  by  the 

practice  and  writings  of  Watson,  Todd,  Turner,  and  many  of  our  own 

country. 

~  ■  •  »  ■  » 11 

AET.  II. 

A  Report  of  Operations  after  the  Battle  of  Chicamauga  in  Field  Hospital. 


UY    W.   H.    MATCUKTT,   i^SSIBTA^IT-SUBGEON    FORriKTO  O.Y.I. 


Camp  of  the  40th  O.  V.  I.,     )       - 
Shell  Movsd,  Tcnn.,  Dec.  18th,  1868.) 

I  herewith  send  a  report  of  operations  that  came  under  my  obber- 
vation,  while  on  duty  in  the  field  hospital,  after  the  battle  of  Chicft- 
man«^a,  Ga.,  in  September  last,  which  I  submit  to  your  disposal. 

The  wounded  after  this  great  disaster  were  sent  back  to  Chattanoo- 
ga, and  after  filling  all  houses  suitable  for  hospitals  in  the  city,  it  was 
determined  to  establish  a  field  hospital. 

As  an  instance  of  the  many  unavoidable  inconveniences  that  armj 
surgeons  meet  with,  I  will  state  that  the  first  thing  furnished  for  this 
groat  undertaking,  was  about  seven  thousand  wounded  men.  There 
were  at  hand  but  fifty  iiospital  tents  proper,  intended  for  a  field  hos- 
pital, and  no  surgical  appliances  or  medicines.  h>o  we  were  com- 
pelled to  make  shift  the  best  we  could,  and  sent  to  the  regiments  and 


^  - 


1SG4.J  XATCBBTT — Operations  in  Field  BospilaL  79 

got  their  tents,  tent  flie«r tarpaulin,  ''dorg-tentB*'  and  medical  stores, 
thftt  we  might  pat  the  wounded  under  shelter.  Even  these,  i^  the 
reseire  coTps,  were  "  few  and  far  hetweeu,"  for  we  were  ordered  up 
from  Bridgeport  iindcr  light  inarching  trim  ;  hence  all  haggnge  that 
could  be  dispensed  with  was  left  hehind,  the  men  having  nothing  with 
them  bat  a  gum  blanket  to  protect  from  rain. 

Fat  by  a  degree  of  i)erseveranco  and  creative  ingenuity  that  can 
maki^ '*  something  out  of  nothing,"  certainly  commendable  on  tho 
part  of  our  corps  snrgeons,  and  especially  our  division  and  brigade 
Fvrgeons,  Messrs.  McPhecters  and  Beach,  we  had  at  the  end  of  two 
dAr».  a  fiair  degree  of  accommodation  for  tho  unfortunate. 

There  were  received  in  that  portion  of  tho  Held  hospital,  assigned  to 
ibe  reserve  corps,  under  charge  of  Surgeon  J.  G.  McPhecters,  33rd 
IikiiAna  Medical  Director,  Ist  Division,  K.  C,  about  seven  hundred 
patients.  Tliere  were  twenty-two  02)erations  perfonned,  eleven  of 
which  died  during  the  first  six  weeks.  The  whole  number  of  deaths 
daring  the  same  time  was  sixty-eight,  or  about  ten  per  cent. 

From  the  above-stated  want  of  hospital  accommodation  and  surg* 
icil  appliances,  it  is  evident  these  operations  were  perfoimed  under 
verj  unfavorable  circumstances,  and  should  not  be  classed  as  strictly 
primary  operations.  Again  :  many  of  the  wounded  of  the  K.  C.  were 
kft  on  the  field  of  battle,  and  fell  into  tho  enemy's  hands,  were  not 
parolled  and  sent  in  to  hospital  for  from  four  to  ten  days  after  tho 
httde.  It  may  be  asked,  why  not  defer,  for  a  secondary  operation  ? 
It  was  the  understanding  of  all  surgeons  there,  that  that  was  but  a 
temporary  ho5pit«il  to  keep  an«l  prepare  the  wounded  for  transportation 
t '  ho>pital  in  the  rear ;  and  from  the  precarious  couditions  of  our  po- 
Mii-m  about  Cliattanoogri  at  th.it  time,  it  was  uncertain  how  soon  we 
woald  ht compelled  to  "light  out;"  and  as  it  was  impossible  for  these 
poor  fellows  to  stand  transportation  in  wagons  and  ambulances  over 
the  rough  mountain  road  between  Chattanooga  and  l(ri<]g^port  with 
tLeir  mangled  extremities  dangling  about  them,  an  operation  at  tho 
earliest  opportunity  was  inv|)crative.     [But  see  report  on  next  page. J 

In  addition  to  the  above  were  many  w(»unds  of  the  joints — as  knee, 
■akle  and  foot,  which  wore  treated  by  simple  dressing,  but  tho  result 
vas  not  as  favorable  as  could  be  wishiHl. 

All  woanda,  fracturing  the  long  bones,  but  without  much  commi- 
iDtion  or  extensive  fissaring,  involving  the  joints,  were  treated  by 
liaple  dressing,  with  fair  prospect  of  favorable  result. 

There  were  three  cases  of  ganga'ue  following  operations  ;  notwith- 
■anding  the  bromine  was  freely  used,  they  all  proved  fatal. 


80 


Original  Communicatums, 


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1864.]  Matchett — Operations  in  Field  Bospital,  81 

Erysipelas  occnrred  in  six  cases — no  deaths.  This  was  controlled 
by  the  topical  and  internal  use  of  muriate  tincture  of  iron. 

There  appears  to  be  a  sort  of  mania  among  army  surgeons  to  per- 
form  exsections,  it  being  somelhinc^  new,  and  many  simple  operations, 
snch  as  removing  the  rough  and  fissured  extremities  of  fractured  fibu- 
las, or  either  one  of  the  bones  of  the  fore  arm,  which  is  frequently 
done  by  enlarging  the  track  of  the  ball  and  using  the  bone  forceps  or 
chain  saw  ;  properly  a  reaeciion  of  simple  nature,  amounting  only  to 
A  dressing,  is  bften  reported  as  an  exseciion  of  great  magnitude. 

In  the  table  of  cases,  are  reported  five  operations  of  this  nature  ; 
ibar  got  well  or  are  doing  well. 

But  what,  in  my  judgment,  should  be  called  exsections,  indeed  do 
not  result  well,  performed  in  the  field  or  in  hospitals  where  they  are 
likely  to  be  moved  soon  to  other  hospitals.  Of  this  class  there  ^e 
four  cases  reported  ;  two  died,  and  the  other  two  are  so  much  reduced 
by  suppuration  and  long  suffering  that  the  result  is  yet  somewhat 
doubtful.  While  in  amputations  in  cases  of  similar  injuries,  (as 
Mitchell  to  Bivins,  and  MclMahon  to  Ruggles/'Aai/^  got  well  and  gone 
home, 

I  am  impressed  with  the  idea  of  leaving  gun-shot  wounds  freely 
open  for  the  first  ten  or  fifteen  dayjs,  or  even  longer ;  and  where  it  is 
practicable,  to  lay  open  by  free  incision  the  track  of  the  ball  in  the 
flesh,  then  use  simple  water  dressing,  that  a  free  exit  of  matter  may 
be  had.  This  cannot  be  where  pledgets  of  lint  and  tight  bandages  are 
applied  and  continue«l.  This  must  result,  more  or  less,  in  absorption 
of  matter  and  pyemia. 

Since  I  left  the  field  hospiLil  (Nov.  1st)  the  wounded  have  nearly 
all  been  transported  by  steamboat  to  Bridgeport,  and  the  field  hospital 
ba:s  been  removed  from  its  temporary  position,  three  miles  north  of 
the  river  and  city  to  a  permanent  position  on  a  beautiful  plateau  or 
elevation  one  mile  south  of  the  city  on  the  road  to  Lookout  Mountain, 
tod  filled  up  again  with  wounded  soldiers  who  made  such  a  glorious 
charge  on  Lookout  Mountain  and  Mission  Ridge,  on  the  24th  and  25th 
Xovcmber. 

While  on  this  thought  of  Lookout  Mountain,  I  wish  to  correct  a 
fal*€  impression  which  does  great  injustice  to  the  surgeons  of  General 
Geary's  command,  and  especially  General  Whitaker's  brigade  which 
made  the  charge  on  Lookout  on  that  memorable  day. 

A  correspondent  of  the  Cincinnati  Daily  Gazette  in  second  of 
December  number  says  :  "  Far  upon  the  mountain  toward  the  city  is  a 
white  fnmie  house,  a  prominent  and  noted  object.     To  this,  after  the 


82  Original  Communications.  f  Febnurj 

8trngg1e  of  Tuesday  and  Tuesday  night,  our  wounded  were  oonveyedy" 
**  InU  there  were  no  surgeons  to  wait  upon  them.**  **  Colonel  Scribner 
heard  of  their  condition."  "  His  noble  nature  was  moved."  "  The 
toils  of  the  day  were  disregarded."  "  He  entered  the  hospital,  and 
with  a  faithful  few  to  assist,  he  labored  until  far  into  the  small  hours 
of  the  night,  like  an  angel  of  mercy,  in  soothing  the  pains  of  the 
sufferer,  and  alleviating,  as  far  as  it  was  possible,  their  agony,  and 
binding  their  bleeding  wounds."     (The  italics  are  my  own.) 

Now  I  happened  to  be  placed  in  position  to  Arnouhihat  this  is  all 
bosh,  a  mistake  entirely.  In  the  first  place,  this  white  house  was  not 
a  hospital.  N9  sensible  surgeon  would  think  of  making  a  hospital  of 
a  house  that  was  in  possession  of  the  enemy  until  near  the  close  of  the 
day,  and  at  all  times  during  the  afternoon  and  night  while  in  our  pos- 
session, exposed  to  the  enemies'  fire. 

The  fads  are,  that  before  the  charge  on  the  mountain,. at  early  morn- 
ing, the  brigade. surgeons  selected  a  house  at  the  foot  of  the  mountain, 
west,  where  the  assault  was  made,  and  selected  the  corps  of  surgeons 
to  remain,  with  directions  to  follow  up  as  the  army  advanced,  and  they 
could  get  a  suitable  house.  Tiiey  also  selected  the  field  surgeons.  I 
was  one  of  the  latter,  and  with  Surgeon  J.  N.  Beach,  40th  O.  V.  I., 
brigade  surgeon  of  the  2nd  brigade  4th  A.  C,  followed  the  regiment 
«n  that  ever  memorable  day  in  their  **  battle  among  the  clouds" — 
dressed  tin  wounded  as  they  occurred,  and  sent  them  to  the  hospital  at 
the  foot  of  the  mountain.  We  were  as  much  exposed  to  the  rebel 
sharp-shooters  as  any  on  the  mount.  We  were  with  the  brigade 
when  the  charge  was  made  on  said  white  house,  when  it,  together  with 
the  breast- works  and  cannon  near  said  house,  were  captured  by  the 
40th.  I  cannot  forget  this,  for  the  sharp  crack  of  the  rifle,  the  pinge 
and  zip  of  the  bullet  around  my  head  that  day  has  indcUibly  impressed 
it  on  my  memory.  There  we  saw  our  noble  Major  Acton,  of  the  40th, 
fall,  shot  through  the  lungs.  This  was  about  two  o'clock  P.  M. — 
After  this,  Surgeon  Beach  established  the  depot  for  dressing  the 
wounded  behind  the  breast-works,  near  the  white  house,  but  not  in  it. 
Our  advanced  line  was  next  formed  at  a  stone  fence  not  more  than 
one  hundred  yards  to  the  east  of  the  house  where  it  remained  until  one 
o'clock  at  night  when  the  conflict  ceased. 

Surgeon  Beach  and  myself  remained  at  this  post  until  evening, 
when  our  brigade  was  relieved  from  active  duty  by  fresh  troops,  and 
ordered  to  take  and  hold  a  position  for  the  night,  on  a  ridge  about 
three  hundred  yards  to  the  west  of  the  house.  After  we  had  learned 
the  position  of  the  brigade  for  the  night,  we  i-eturned  to  the  house 


18M.]  Matchstt — Operattans  in  Held  Hospital.  83 

agaio,  where  we  remained  on  duty  all  night,  not  heing  absent  but  a 
short  time  at  midnight,  and  then  only  to  learn  the  position  of  onr 
regiment.  We  were  assisted  in  oar  labor  of  the  night  by  an  assistant 
Borgeon  of  au  Iowa  regiment,  and  before  daylight  we  had  all  the 
wonnded  safely  conveyed  to  the  hospitals  at  the  foot  of  the  mountain, 
for  it  was  the  impression  of  all  that  the  battle  would  be  renewed 
around  said  honse  in  the  mining  ;  bnt  in  this  wo  were  mistaken,  for 
the  rebs  had  enough  of  Yankee  daring,  and  had  left  the  mountain  in 
tiie  after  part  of  the  night ;  and  at  morning  dawn,  instead  of  the  sharp 
crack  of  the  rifle  startling  us,  our  ears  were  deafened  by  the  shouk  of 
the  cold,  bhi%'ering  heroes,  whose  eyes  overflowed  at  the  sight  of 
Wbitaker's  battle-flag  and  the  Stars  and  Stripes  boldly  planteil  on  the 
top  and  floating  in  the  breeze  of  Lookout  point. 

If  there  were  any  manifestations  of  **  mercy''  in  that  house  by  any 
C*oloDel,  more  than  by  many  other  officers  and  assistants,  it  is  straftge 
I  did  not  sec  it,  for  I  know  we  were  in  every  room  in  that  house  where 
woonded  were  taken,  many  times  that  night,  notwithstanding  the  cor- 
respondent's declaration,  **  there  were  no  surgeons  to  wait  upon  them,** 

I  cannot  tell  why  it  is  that  ncwsi>aper  men  who  follow  the  army, 
arc  so  often  making  such  "  digb"  at  the  surgeons,  unless  it  is  beoanse 
the  '*  powers  that  be"  have  orderc<l  the  surgeon  to  take  charge  of  the 
whiskey,  and  let  those  only  have  it  whom  ho  thinks  requires  it.  This< 
makes  it  frequently  necessary  to  refuse  the  application  of  *'  Stoton 
bottles,*'  or  deny  having  any  of  the  **  critter"  at  hand. 

Now  li)«>k  at  this  piiture  at  the  battle  of  Chicamauga.  Tlie  Union 
force  ih  e>tiniated  at  forty  thousand — perhaps  one  hundred  ri'ginients  ; 
then  allow  to  each  regiment  its  full  quota  of  surgeons,  (throe — which 
is  not  likely  to  be  the  case,)  and  we  have  one  hundred  and  fifty  sur- 
geons, one  half  of  whom  were  field  sui-geons,  (another  large  estimate,) 
and  notwithstanding  newspapermen  inquire  into  the  character,  bravery 
and  pat^i^Jti^nl  oi  surgeons,  the  statistics  of  Libby  prison  show  fifty- 
three  surgeons  captured  and  now  prisoners  of  war,  a  greater  propor- 
tion tlian  of  any  other  officers  of  similar  rank  in  the  army.  They 
might  have  escaped,  but  rather  than  neglect  the  wounded,  were  cap- 
tured with  them. 


84  Original  Communications.  [Febroaiy. 


ARTICLX  III. 

Case  of  Constitutional  Hemorrhage,  or  ''  Hemorrhagio  Diathesis." 


BT   JAMES   W.  HUGHES,   M.  D.,   BERLIN,   OHIO. 


Editor  op  the  "Lancet  and  Journal" — 

Sir :  Having  read  with  deep  interesf  the  able  article  of  Dr.  Gans 
on  the  **  Hemorrhagic  Diathesis,"  which  appeared  in  the  November 
number  of  the  Journal,  I  have  thought  a  brief  history  of  a  case  of 
th^t  formidable  but  fortunately  rare  affection,  existing  in  my  own 
family,  might  not  be  devoid  of  interest  to  my  professional  brethren. 

My  youngest  son,  James  B.  Hughes,  will  be  eighteen  years  old  on 
the  5th  day  of  January,  1864.  He  is  five  feet  ten  inches  in  heij^bt ; 
weighs  one  hundred  and  forty-two  pounds  ;  was,  until  articular  inflam- 
mation of  the  knee  interfered  with  its  mobility,  very  brisk  and  agile. 
His  hair  is  dark  and  rather  stiff;  his  eyes  are  dark  blue,  and  his  skin 
rather  fair ;  his  pulse  is,  at  the  time  of  writing  this,  jnst  eig]^ty ;  his 
temperament  I  would  call  nervo-sangnine ;  his  mental  faculties  are 
well  developed  ;  quick  to  2)erceive  ;  prompt  to  act ;  an  ardent  friend, 
and  a  social  companion.     He  is  a  favorite  among  his  associates. 

With  James,  the  hemorrhagic  diathesis  was  without  doubt  con- 
genital. My  attention  was  first  arrested  by  the  long  continued  trick- 
ling of  blood  which  followed  the  slightest  scratch  of  a  pin  when  he 
was  but  a  few  weeks  old,  frequently  oozing  away  for  hours.  When 
three  or  four  months  old,  his  nose  commenced  bleeding  fi'om  both 
nostrils  without  apparent  cause,  and  continued  slowly  to  bleed  «for 
several  days,  finally  yielding  to  the  pressure  made  by  pushing  dossils 
of  lint  up  the  nostrils.  As  he  grew  older,  the  sources  of  danger  mul- 
tiplied. A  slight  fall ;  a  wound  from  the  first  sharp  incisors ;  the 
scratch  of  a  kitten  ;  anything  that  caused  the  slightest  abrasion  of  the 
cuticle,  or  the  least  solution  of  continuity,  would  be  followed  by  con- 
tinuous hemorrhage.  Slight  bruises,  a  pinch,  a  blow  from  a  bal]>  or 
other  trifling  injury  were  followed  by  extensive  ecchymosis,  feeling  as 
if  some  hard,  round  or  oval  substance  were  embedded  beneath  the 
skin.  These  thromboses  were  very  slowly  absorbed.  Though  subject 
at  all  times  to  troublesome  or  protracted  bleeding  from  slight  wounds, 
the  tendency  to  spontaneous  hemorrhage  is  more  marked  at  irregular 
intervals,  varying  from  one  or  two,  to  six  or  eight  weeks.  Those 
periods  of  increased  tendency  to  bleeding  are  generally  preceded  by 
deeper  and  more  diffused  redness  of  the  cheeks,  an  increase  of  tem- 
perature, more  frequent  and  harder  pulse,  with  other  symptoms  of 


1864.]  HuQHES — Constitutional  Bemorrhaffe.  85 

increased  arterial  excitement.     The  shedding  of  the  first  teeth  was  a 
process  attended  with  con&tant  peril.     As  one  after  another  loosened, 
almost  any  moving  of  them  would  cause  them  to  bleed  ;  frequently 
half  a  dozen  teeth  would  be  bleeding  at  once,  or  rather  the  gums 
around  them  ;  some  in   the  upper  and  some  in  the  lower  jaw,  and 
nothing  but  continued  pi-essure  on  and  around  them  all,  was  of  any 
avail  in  arresting  the  discharge.     Fine  lint  applied  dry,  and  kept  in 
place  by  the  thumb,  and  one  or  more  fingers  continuously  applied, 
some  times  for  hours,  sometimes  for  days,  controlled  it  when  every 
other  remedy  failed.     Night  i^ter  night,  his  mother  and  myself  have 
alternately  held  him,  with  finger  and  thumb  applied,  through  the  long 
and  tedious  hours,  only  removing*  them  for  a  moment,  when  the  lint 
became  saturated,  to  apply  fresh  dry  pledgets  on  what  was  already 
there,  or  to  remove  the  saturated  mass,  and  supply  its  place  with  fresh 
dry  lint.     When  the  teeth  became  so  loose  as  to  adhere  only  at  one 
or  two  points  slightly,  I  usually  removed  them  quickly  with  forceps, 
while  his  mother  stood  ready  with  a  compress  of  dry  lint,  to  press  it 
instantly  on  the  bleeding  surface,  having  foand  by  experiencejjthat  the 
sooner  the  means  used  for  arresting  Ihe  bleeding  were  applied  the  more 
promptly  they  succeeded.     Frequently  the  discharge,  when  long  con- 
tinued or  profuse,  is  followed  by  numerous  irregularly-shaped  petechia?; 
some  large,  some  small ;  some  confluent,  some  distinct ;  some  of  a 
pinkish  hue,  and  some  purple.  The  trank  and  limbs  becoming  bloated 
and  dropsical  ;  the  heart's  action  being  at  the  same  time  irregular, 
excited  and  tremulous  ;  as  is  generally  the  case  in  extreme  anemia. 
He  is  peculiarly  subject  to  inflammatory  affections,  having  had  two  or 
three  severe  attacks  of  tonsilitis  ;  also  several  severe  attacks  of  neu- 
ralgic rheumatism  ;  usually.  I  believe,  invariably  attacking  the  right 
thigh  and  leg  ;  the  limb  being  swollen,  colorless  and  shining,  and 
excruciatingly  painful  ;  the  pain  being  often  intermittent  or  paroxys- 
aal.     Those  rheumatic  attacks  have  usually  been  alleviated  and,  I 
think,  materially  abridged  by  the  internal  use  of   large   doses   of 
dovers  powder,  or  sulph.  morphia?,   combined  with  colchicum,  and 
the  external  application  to  the  limb  of  a  liniment  composed  of  tincture 
iconite  two  parts,  tincture  iodine  one  part.     When  he  has  been  very 
anemic,  or  the  intermissions  well  marked,  the  addition  of  quinine  and 
iron  ha«  proved  beneficial.     Spontaneous  hemorrhage  from  the  mucous 
lurfaces,  has  so  far  been  confined  to  the  nose  and  mouth.     Though 
eqoallj  subject  with  others  to  colds  and  cough,  he  has  never  had  hem- 
optiiis  hematemesis  or  hematuria.     If  the  observation  of  others  coin- 
cides with  my  owu,  the  fact  above  noted  may  aid  in  the  difTercntial 


86  Original  Communications.  [Febmaiy, 

diagnoses,  between  idiopathic  constitutional  hemorrliago,  and  the 
acquired  or  symptomatic  purpura  hemorrhagica.  So  far  as  ray  expe- 
rience with  the  latter  affection  extends,  hemorrhage  takes  place  from 
all  the  mucous  surfaces,  interchangeably  or  simultaneously.  It  may 
commence  from  the  gums  or  nostrils,  but  sooner  or  later  all  the  mucous 
surfaces  participate  in  the  abnormal  action.  Another  difference  of 
diagnostic  value  is  found  in  the  color  of  the  blood.  In  the  idiopathic 
hemorrhagic  diathesis,  the  blood  discharged  is  of  a  bright  arterial  red, 
in  purpura  it  is  dark  and  venous.  Constitutional,  hemorrhagic  dia- 
thesis is  generally  considered  hereditary,  probably  is  so.  Purpura 
hemorrhagica  is  perhaps  always  accidental  or  acquired.  The  former 
makes  its  appearance  in  early  childhood,  remains  active  to  adult  age, 
and  the  diathesis  continues  through  life,  modified  it  may  be,  but  prob- 
ably never  entirely  disappearing.  The  latter  I  have  never  seen  appear 
under  twenty-five  or  thirty  years  of  age.  It  usually  follows  some  pro- 
tracted and  debilitating  affection,  in  which  the  organs  of  assimilation 
and  nutrition  have  failed  to  elaborate  a  sufficient  supply  of  healthy 
blood  ;  it  usually  ends  in  a  few  weeks  in  recovery  or  death. 

Treatment, — I  proceed  to  give  a  brief  sketch  of  the  treatment  that 
has  in  my  hands  been  most  satisfactory.  Locally,  I  have  exhausted 
the  list  of  styptics  and  astringents  :  alum,  sulpli.  cupri,  tannin,  kino, 
catechu  have  been  applied  to  the  bleeding  surface,  in  powder,  tincture 
and  solution.  Tincture  ferri  mur.,  creosote,  nit.,  arg.,  ice,  agaric 
have  all  been  alike  useless.  Pledgets  of  finely  scraped,  dry,  linen 
lint,  applied  to  the  bleeding  surface  and  kept  in  place  by  firm  press- 
ure with  the  thumb  and  finger,  or  both,  perseveringly  used,  has  so  far, 
always  suppressed  the  hemorrhage  at  last.  Sometimes  it  has  required 
many  days  to  arrest  it  entfrely,  but  even  under  the  most  diccouraging 
and  alarming  circumstances,  it  has  restrained  and  kept  the  hemorrhage 
within  bounds  compatible  with  life  until  it  gradually  ceased.  Other 
remedies  may  be  locally  applied,  but  pressure  with  fine  dry  lint,  per- 
scvcringly  used  is  the  sheet  anchor. 

Internally  I  have  administered  sugar  of  lead,  tannin,  iron  in  varions 
forms,  gallic  acid,  turpentine,  creosote,  &c.,  with  little  or  no  benefit. 
Some  five  of  six  years  since,  I  saw  an  article  in  Braithwaite's  Retro- 
spect highly  recommending  glaubers  salts  in  large  dozes.  I  had  seen 
it  recommen<led  before,  by  Liston  <fe  Mutter,  perhaps  others.  I  con- 
cluded to  give  it  a  trial.  I  had  not  the  sulphate  of  soda  by  me,  but 
the  sulphate  of  magnesia  was  on  hands.  I  had  no  doubt  the  benefit, 
if  any,  resulted  from  the  copious  serous  discharges,  and  not  from  any 
specific  virtue  in  the  particular  salts.      My  son   was  very  low  at  the 


1964.]  Treatment  of  Trachoma.  87 

tpie.  The  bemorrhage  persisted,  his  pnlse  was  feeble  and  unsteady, 
be  was  anemic  and  anasarcous,  and  his  body  maculated  with  petechia. 
Baffled,  foiled,  almost  despairing,  I  gave  him  a  full  dose  of  epsom 
salts  ;  copious  watery  stools  were  induced  ;  prompt  and  decided 
improvement  followed,  attended  with  an  abatement  of  all  the  threat- 
ening symptom^.  After  an  interval  of  thiily-six  hours  during  which 
he  took  the  tinct.  ferri  mur.  in  doses  of  twenty-five  drops  every  eighth 
hour,  another  full  dose  of  epsom  salts  was  given,  followed  like  the 
first  by  free  catharsis  and  a  still  farther  improvement.  Since  then  he 
has  bad  many  threatening  attacks  of  hemorrhage,  but  free  purgation 
with  saline  purgatives,  and  iron  during  the  intervals,  has  rcnclered  the 
attacks  less  frequent  and  unmanageable.  He  continues  the  use  of  the 
fitlts  followed  by  iron,  whenever  there  are  indications  of  an  increased 
tendency  to  bleed.  By  pursuing  the  above  prophylactic  course,  with 
out-of-door  exercise,  and  the  avoidance  of  whatever  would  be  likely  to 
encourage  a  tendency  to  hemorrhage,  he  has  escaped  any  very  alarm- 
ing attacks,  although  he  is  admonished  by  slighter  hemorrhage  from 
the  nose  or  gums,  every  week  or  two,  that  the  diathesis  still  exists. 


*•  ^  • 


ARTICLE   IT. 

Treatment  of  Trachoma. 

I A  Paper  read  before  the  Clncliinati  Academy  of  Medicine.] 


BT    B.    WILLIAMS,    M.D.,    CINCINNATI. 
[Contiiiufd  fn»m  December.] 

I  come  now  to  the  most  important  part  of  ray  essay,  the  treatment 
ff  trachoma.  In  doing  so,  I  shall  confine  myself  mainly  to  those  reg- 
ulations an«l  remedies  which,  in  my  own  experience,  I  have  found 
most  efficacious.  First,  as  to  general  treatment,  a  great  many  plans 
tad  modifications  of  plans,  have  had  their  day  of  triumph  and  their 
turn  of  reproach,  running  from  one  extreme  of  rigid  antiphlogistics 
tnd  rice-water  regimen,  to  that  of  stall-feeding  and  stimulation. 
Among  intelligent  specialists,  the  reign  of  modern  views  of  inflam- 
mation has  caused  general  bleeding,  blisters  by  the  yard,  unmiiigated 
fnrgation,  the  unconstitutional  use  of  mcrcnry  for  its  constitutional 
fff'rcls,  and  starvation  ad  libitum,  to  be  abandoned  or  nearly  so,  in  the 
treatment  of  trachoma.  In  the  early  stages  of  acute  conjunctivitis, 
e'p^.'cially  in  robust  subjects,  moderate  purging,  some  restriction  of 
diet,  leeches  and  temporary  confinement  to  a  moderately  darkened, 
lot  wel]-yenti]at3d  room,  arc  often  beneficial.  Bnt  the  persistence  in 
this  com^e  for  more  than  a   few  dnys,  debilitates  the  constitution. 


88  Original  Communicaiions.  [Febmarji 

favors  local  congestions,  impairs  healthy  nutrition  and  tends  to  perp0* 
tuatc  the  very  trouble  it  is  intended  to  remedy.  I  therefore  advise  my 
patients  in  all  cases  of  ohronic  trachoma,  and  also  in  acate  cases  as 
soon  as  the  violence  of  the  symptoms  has  somewhat  abated,  to  nse 
nourishing,  digestible  diet  and  to  take  moderate  exercise  in  the  fresh 
air  every  day,  regulating  their  clothing,  of  course,  to  suit  the  character 
of  the  weather.  Very  many  cases  that  come  under  my  observation 
are  already  much  reduced  in  health  and  flesh  by  the  severe  general 
treatment  to  which  they  have  been  subjected,  and  the  anxiety  they 
have  suffered  about  the  condition  of  their  eyes.  All  such  are  benefit* 
ed  by  generous  diet,  tonics,  stimulants  oven,  fresh  air,  cheerful  society 
and  all  that  invigorates  both  physically  and  morally.  If  the  bowels 
are  habitually  constipated,  they  should  be  regulated  by  laxatives  com- 
bined with  tonics.  The  general  tonics  which  I  use  almost  exclusively 
are  quinine  and  iron  combined  or  not  with  nux  vomica,  gentian  and 
other  simple  bitter  substances. 

The  administration  of  mercury  with  a  view  to  its  effect  in  cutting 
short  the  inflammatory  process  or  causing  the  absorption  of  the  gran- 
ulations, i.s  but  to  bring  it  into  disreputet  and  do  your  patient  injury 
and  nothing  but  injury.  Of  course,  I  must  be  undei*stood  as  speaking 
of  its  use  in  uncomplicated  trachoma.  In  case  of  the  occurrence  of 
iritis  in  the  course  of  granulations,  it  may  be  necessary,  or  at  least 
excusable,  to  resort  to  very  mild  ptyalism  ;  but  even  then  the  ener- 
getic local  use  of  atropine  and  leeches  if  necessary,  are  vastly  superior 
to  every  lljing  else.  In  abscess  or  ulceration  of  the  cornea,  a  compli- 
cation of  granulations,  so  frequent  and  so  disastrous,  I  never  use  mor* 
cury,  but  depend  on  atropine,  paracentesis  cornea,  and,  in  the  failure 
of  those,  iridectomy. 

The  treatment,  whether  general  or  local,  of  trachoma,  must  be 
directed  first  to  the  mitigation  and  reduction  as  far  as  possible,  of  the 
inflammation  ^hich  precedes  the  development  of  the  granulations  and 
accompanies  them  throughout  the  whole  period  of  their  obstinate  ex- 
istence ;  and,  secondly,  to  the  removal  of  the  granulations  themselves. 
The  well-established  fact  that  the  tendency  in  trachoma  is  to  sponta- 
neous absorption  of  the  granulations,  and  that  this  process  may  be 
much  facilitated  by  controlling  the  inflammatory  element  of  the  dis- 
ease, or  retarded  by  aggravating  the  inflammation  with  injudicious 
remedies,  should  always  be  remembei-ed  in  the  management  of  this  af- 
fection. It  is  from  losing  sight  of  this  leading  truth,  and  firing  im- 
mediately and  continuously  on  the  granulations  themselves,  with  the 
heaviest  artillery,  without  regard  to  the  stage  of  the  disease,  the  degree 


1864.1  WiLUA^s—TreatmerU  of  Trachoma.  89 

of  inflammation  present  or  any  of  the  nnmerons  complications  that 
may  arise^  that  we  see  so  much  disaster  to  vision  in  the  treatment  or 
maltreatment  of  this  affection  by  inexperienced  or  reckless  persons ; 
and  so  ranch  hesitation  on  the  part  of  the  commnuity  in  employing  a 
liocior  for  sore  eyes.  If  people  would  only  give  up  the  insane  habit 
of  resorting  to  nostmma  and  quacks  and  old  women,  from  the  same 
motive  that  deters  them  often  from  employing  a  physician,  the  effect 
in  many  instances  would  be  salutary.  But,  unfortunately,  they  fly 
from  the  doctor  to  some  or  all  of  those  diabolical  substitutes,  and  if 
ibe  n#  medicairix  triumphs  over  them  all  and  brings  the  patient 
throflgh  even  "seeing  darkly  as  through  a  glass,"  the  last  obstruction 
tbri^wn  in  the  way  receives  the  palm  of  victoiy  !  One  patient  not 
loD^  since  informed  me  with  an  air  of  the  greatest  surprise  and  of  the 
moiit  stolid  simplicity,  that  he  had  tried  every  thing  that  every  body 
had  told  him  and  still  his  eyes  would  not  get  well  ! ! 

But  I  must  return  to  the  means,  general  and  topical,  best  suited  to 
the  relief  of  the  inflammation  which  precedes  and  attends  the  grann- 
laiions.    The  general  treatment  most  likely  to  contribute  to  this  object 
kas  already  been  given  in  substance.     In  addition,  I  would  say,  when 
there  ia  mach  annoyance  from  the  feeling  of  sand  in  the  eyes,  soreness 
to  the  touch,  and  especially  tenderness  to  the  light,  full  doses  of  ano- 
dynes, particularly  opiates,  at  night  or  even  through  the  day,  are  often 
very  asefnl  in  allaying  irritation,  promoting  sleep  and  thus  redacing 
i&ft«mmation.     The  patient  should,  as  far  as  possible,  avoid  all  sour- 
ces of  irritation  to  the  eyes,  such  as  dust,  smoke,  cinders,  sharp  winds, 
bri;rht  lights,  etc.,  antl  refrain  absolutely  from  all  attempts  to  read, 
vriie  or  use  the  eyes  in  any  work  that  requires  accurate  vision.     After 
the  amite  symptoms  of  the  first  stage  of  trachoma,  or  of  the  relapses, 
«f  aore  or  less  severe  inflammation  that  so  often  occur  during  the 
vhele  progress  of  the  disease,  have  abated,  and  it  is  thought  advisable 
that  the  patient  should  have  moderate  exercise  and  fresh  air,  the  use 
of  »ome  kind  of  shades  will  be  beneficial  as  well  as  very  giateful  to 
the  eje«.     A  hat  with  a  broad  brim,  or  a  pasteboard  sha  le,  or  what 
i*  better  tlian  all,  a  pair  of  lar^e,  hollow  glasses  of  a  light  smoked  or 
Uuisk  eelor,  in  spectacle  frames,  as  they  are  now  sold  by  almost  all 
"{xicians.     These  shade  sufficiently,  soften  the  light,  allow  of  fresh 
vrt)  the  eyes,  while  they  break  off  the  wind  and  dust,  and  obstruct 
the  Tisi4.»A  Imi  very  little.     All  goggles  are  objectionable,  and  green 
T'^ki  absolutely  horrible. 

kk  to  topical  treatment  pnrely  for  its  efiect  in  allaying  inflammation, 
I  wedd  enphatically  refrain  from  all  irritating  9r  stimulating  appli- 


90  Original  CommutueaiianB,  [Febroarjr, 

cations  used  either  as  collyria  or  applied  in  any  other  way,  daring  thi 
early  period  of  the  disease,  or  at  any  time  when  there  is  severe  inflam- 
mation and  particularly  pain»  photophobia,  lachrymation,  with  decided 
'  injection  of  the  anterior  ciliary  vessels  forming  a  pinkish  zone  aronnd 
the  cornea,  and  indicating  actual  or  threatened  corneitis,  or  it  may  bi 
iritis.  Under  such  circumstances,  to  use  local  astringents  at  all,  anii 
particularly  to  apply  them  in  a  concentrated  form,  is  but  to  add  fne 
to  the  fire.  It  is  the  inconsiderate  use  of  sulphate  of  copper  in  snb' 
stance  or  of  the  nitrate  of  silver  in  strong  solution,  when  there  is  Ux 
much  local  inflammation  with  more  or  less  ciliary  neurosis,  that  bai 
brought  those  and  other  valuable  remedies  into  disrepute.  There  ii 
vastly  more  danger  of  being  too  heroic  and  doing  too  much  in  the  earl] 
period  of  trachoma,  than  of  erring  on  the  side  of  expectancy.  It  h 
wiser  to  wait,  patiently  under  the  use  of  the  general  treatment  men 
tioned  above,  till  the  local  symptoms  will  admit  of  the  safe,  but  a 
first,  very  cautious  trial  of  local  astringents.  In  the  employment  oi 
them  we  muBt/eel  our  way  as  it  were  by  using  them  at  first  very  weal 
and  carefully  watching  the  effects.  In  simple  uncomplicated  conjnnc 
tivitis,  mineral  astringents  in  weak  solutions  used  as  collyria,  are  oftei 
very  beneficial  ;  but  when  granulations  have  appeared,  I  place  bn 
little  reliance  on  their  action,  and  when  there  is  much  irritability  o 
the  eyes,  they  may  be  decidedly  pernicious. 

Therefore,  in  the  local  treatment  of  the  inflammatory  element  o 
trachoma,  particularly  in  the  earlier  stages  of  the  disease,  I  depenc 
almost  exclusively  on  soothing  collyria,  such  as  aqueous  solutions  o 
opium,  or  what  is  better,  sulphate  of  morphia  dissolved  in  water,  o 
mucilage  in  the  proportion  of  from  two  to  six  grains  to  the  onnce 
dropped  well  into  the  eyes  three  or  four  times  a  day.  If  the  conditioi 
of  the  eyes  will  tolerate  astringents,  they  may  be  added  to  the  solatioi 
of  morphia  in  the  proportion  of  half  a  grain  or  a  grain  of  sulphate  o 
zinc  or  sulphate  of  copper  to  the  ounce.  Whenever  abrasions  of  tb 
cornea,  ulcerations  or  opacities  with  decided  intolerance  of  light  an< 
lachrymation  occur,  I  abandon  all  local  irritanlR,  and  confine  myael 
to  the  general  medication  already  described,  with  topical  anodynes 
sulphate  of  morphia  in  mild  cases  and  sulphate  of  atropia  when  thar 
is  more  severe  implication  of  the  cornea  with  a  high  degree  of  photo 
phobia.  Where  dangerous  ulceration  of  the  cornea  supervenes,  sal 
phate  of  atropia  in  solution — two  to  four  grains  to  the  ounce  of  water- 
is  the  only  coilyrium  which  is  admissible.  The  same  is  true  of  iriti 
deep  seated  inflammations  that  arc  liable  to  arise  as  complications  c 
trachoma. 


1864.]  Treatment  of  Trachoma.  91 

Cold  water  applications  are  sometimes  beneficial  in  acute  trachoma, 
bot  frequently  they  are  disagreeable  to  the  patient,  and  by  giving  rise 
to  corysa  they  may  even  increase  the  inflammation.  In  the  later 
•tages  of  the  disease,  when  the  granulations  come  up,  to  complicate 
and  perpetuate  the  inflammation,  cold  water  is  generally  not  well 
borne. 

A«  has  been  said  before,  inflammation  in  a  greater  or  less  degree, 
precedes,  accompanies,  and  often,  unfortunately,  continues  long  afler 
die  granalaiions  have  disappeared.  The  careful  management,  therefore, 
of  this  element  of  trachoma  is  the  most  important  point  in  the  treat- 
ment of  that  disease.  What  I  have  said  of  the  general  and  local 
agents  to  be  employed  to  keep  it  in  subordination,  is  applicable  to  all 
the  stages  of  this  affection.  But  there  is  one  fact  of  great  practical 
importance  which  should  always  be  borne  in  mind,  and  that  is,  that 
local  irritants  in  the  early  periods  of  the  disease,  especially  within  the 
first  few  weeks  during  the  acute  inflammation  attending  the  formative 
stage  of  the  granulations,  are  very  apt  to  aggravate  the  inflammatory 
action  end  increase  the  tendency  to  dangerous  corncitifl  or  iritis  ;  while 
ia  the  later  periods  when  the  affection  has  become  more  chronic  and 
the  eyes  tougher  and  more  tolerant,  even  the  very  concentrated  use  of 
utringeots  and  caustics  may  act  as  antiphlogistics.  But  the  relapses 
of  acute  inflammation  so  frequent  and  characteristic  of  granulations, 
daring  the  entire  time  of  their  existence,  revive  to  a  greater  or  less 
degree,  this  early  intolerance  to  local  irritants,  and  we  have  to  suspend 
their  nite  and  fall  back  upon  the  soothing  treatment  till  the  acute 
cymptoms  have  begun  to  subside. 

I  cone  now  to  the  ti-eatment  to  be  directed  to  the  granulations  them- 
selves. By  their  mechanical  action,  as  well  as  by  the  inflammation 
which  constantly  attends  them,  they  are  a  continual  source  of  danger 
to  the  integrity  of  the  eye,  and  should  be  gotten  rid  of  by  the  most 
apedkious  means  that  are  compatible  with  safety  and  the  permanent  re- 
etoratiom  of  the  conjunctiva  to  its  normal  condition. 

In  the  outset  I  will  state  that  this  object  is  accomplished  most  effec- 
taally.  not  by  destroying  tbe  granulations  either  with  mechanical  con- 
triTaneee  or  chemical  substances,  but  by  inducing  their  absorption. 
FaitbenDore,  in  exciting  their  absorption  we  should,  as  a  general  rule, 
strive  to  attain  our  object  by  the  use  of  those  applications  which  pro- 
doee  tbe  itast  inflammatory  reaction.  The  tendency  to  spontaneous 
diaappeerance  of  granulations,  when  the  patient  is  placed  in  favorable 
drcnmsiuicee  aa  to  diet,  exercise,  fresh  air  and  suitable  clothing ;  and 
ii  wemed  to  avoid  reading,  writing,  winds,  dust,  smoke,  brilliant 


92  Original   Communications,  [Febmary, 

lights  and  all  causes  internal  and  external,  that  aggravate  the  inflam- 
mation of  the  eye.s,  should  always  serve  us  as  a  guide  in  the  treat- 
ment, and  keep  us  from  using  too  violent  remedies.  No  douht  gran- 
ulations can  be  destroyed  by  the  action  of  powerful  caustics,  such  as 
nitric  acid,  chloride  of  zinc,  solid  nitrate  of  silver,  etc.,  very  rapidly. 
But  then  their  use  in  this  way,  exposes  the  patient,  in  the  first  place* 
to  an  intense  reaction  which  may  destroy  the  eyes  in  short  order ;  and 
in  the  second  place  the  conjunctival  mucous  membrane  is  destroyed 
at  the  same  time,  so  that  rough,  incurable  cicatrices  follow,  the  secret- 
ing power  of  the  conjunctiva  is  annulled  and  the  eye  placed  in  a  con- 
dition vastly  worse  than  that  caused  by  the  granulations.  The  disor- 
ganization of  the  ]conjunctiv;i  produced  by  the  deposit  of  granula- 
tions, especially  in  severe  cases,  is  bad  enough  without  being  aided  by 
destructive  treatment.  All  ophthalmologists  of  the  present  day,  are 
therefore  agreed  in  the  following  recommendation — stimulate  the  ab- 
sorption of  granulations  by  medicines  which  neither  cause  dangerons 
reaction,  nor  impair  the  integrity  of  the  conjunctiva. 

Of  the  numerous  agents  recommended  at  different  times  and  by  dif- 
ferent authors,  in  the  treatment  of  granulations,  but  few  according  to 
my  experience,  are  of  any  great  value.  And  here  I  must  say  that,  the 
beneficial  effect  of  any  article,  depends  as  much  upon  how  and  when  it 
is  aj)2)liedf  s  it  does  upon  the  substance  used.  Nitrate  of  silver,  for 
instance,  is  always  nitrate  of  silver,  but  the  effect  of  a  solution  of  three 
or  RvQ  grains  to  the  ounce  brushed  on  the  everted  lids  and  washed  off 
with  water  before  letting  them  return,  is  very  different  from  the  insane 
use  of  the  solid  substance  let  down  without  washing.  In  the  immense 
majority  of  cases,  all  that  can  be  accomplished  with  any  substance^ 
can  be  achieved  by  the  skillful  employment  of  nitrate  of  silver  or  sul- 
phate of  copper,  the  frequency  and  the  manner  of  the  applicationB 
being  adapted  as  far  as  possible  to  the  individual  peculiarities  of  each 
separate  case.  I  do  not  at  all  moan  to  assert  by  this,  that  other 
agents,  such  as  tannin  in  mucilage,  neutral  acetate  of  lead,  chloride  of 
zinc  and  a  few  others,  possess  no  efficacy  ;  but  that  nitrate  of  silver 
and  sulphate  of  copper  varied,  as  they  can  be,  to  suit  the  stage  and 
the  complications  of  the  disease,  produce  more  certain  and  better 
results.  The  objection  to  the  tannin  mucilage,  so  highly  recommend- 
ed by  M.  Hairion,  of  Belgium,  is  that  it  acts  too  slowly.  The  acetate 
of  lead,  in  all  diseases  of  the  eye  where  abrasion  or  ulceration  of  the 
cornea  exists  or  is  liable  to  occur  at  any  time,  is  decidedly  objectiona- 
ble on  account  of  the  risk  of  indelible  precipitates  in  that  membrane. 


ISM.]  Treatment  of  Trachoma.  93 

I  nerer  ase  it  in  the  treatment  of  granulations,  and  very  seldom  in 
simple  conjanctivitis,  in  consequence  of  that  risk. 

In  commencing  the  treatment  of  granulations  by  topical  means,  it 
is  always  wise  to  begin  cautiously  and /eel  your  way.  Let  the  applica- 
tion be  light  and  watch  carefully  the  effect  before  it  is  repeated.  If 
even  a  slight  touching  causes  increased  irritation  for  several  hours,  and 
the  eyes  are  not  as  well  the  following  day,  it  is  better  to  return  to  the 
soothing  and  expectant  treatment  for  a  while  longer  and  then  try  local 
stimulants  again.  It  is  very  difficult  sometimes  to  decide  when  the 
acnte  symptoms  have  sufficiently  abated  to  allow  of  the  safe  use  of 
astringent  applications  to  the  granulations,  and  it  is  only  by  careful 
teotatives  that  we  can  ascertain.  In  making  these  trials,  and  in  all 
tonchings  of  the  granulations,  so  long  as  the  cornea  is  not  involved, 
it  is  very  dcbirable  to  confine  the  action  of  the  medicine  to  the  granulations 
themselves.  The  less  you  irritate  the  cornea  and  the  conjunctiva  of  the 
Mrlerotic,  the  less  likely  you  are  to  excite  corneitis  with  abrasions  of 
the  epithelium,  ulceration,  opacity,  vascularity,  etc.,  and  a  state  of 
things  that  sets  you  back  in  the  treatment  for  weeks  or  months  and 
makes  the  final  result  much  more  precarious. 

The  indications  for  the  preference  of  nitrate  of  silver  over  sulphate 
of  copper,  or  vice  versa,  in  any  given  case  of  trachoma,  can  not,  I 
think,  be  very  categorically  laid  down,  in  the  present  uncertain  state 
of  onr  knowledge  on  that  subject.  Contributions  to  the  healing  art, 
in  the  form  of  careful,  unbiased,  long-continued  observations  of  the 
acti'jtt  of  remeilies  already  in  general  use,  so  as  to  establish  more  pre- 
cipe indications  for  their  employment,  are  more  needed,  in  my  judg- 
Bent,  than  pilgrimages  to  all  the  kingdoms  of  nature,  in  search  of 
•omediing  new  to  add  to  our  already  immensely  superfluous  stock  of 
vn-;*^rtain  therapeutic  agents.  In  the  department  of  ophthalmology, 
this  effort  at  precision  in  thc.indications  fur  the  use  of  a  comparatively 
few  reaic«lies,  long  since  recommended  on  more  or  less  vague  claims, 
has  been  crowned  with  encouraging  success  within  the  last  few  years. 
While  we  do  not  discard  new  remedies  because  they  arc  new,  neither 
do  we  adopt  old  ones,  simply  because  they  are  old.  All  are  subjected 
to  the  rigid  test  of  scientific  empiricism,  every  source  of  error  being, 
as  far  as  possible,  excluded. 

The  well'e»tablished  beneficial  action  of  solutions  of  nitrace  of  silver 
iiS  arresting  the  violent  inflammation  and  suppuration  of  purulent  con- 
jcnctivitia,  has  led  to  its  employment  in  those  cases  of  granulations 
when^  thera  is  considerable  purulent  secretion,  in  preference  to  sulphate 
of  copper ;  bat  even  in  these  the  result  is  often  attained  quite  as  well 


94  Original  CommunieaHont,  [Febraarj 

by  the  nse  of  the  latter  article.  Where  the  graanlations  are  large  and 
callous,  with  no  very  high  degree  of  irritation,  the  nitrate  of  silver 
acts  more  powerfully  in  exciting  that  degree  of  swelling  and  softening 
necessary  to  facilitate  their  absorption.  Also  in  chronic  trachoma 
complicated  with  obstinate  panniform  inflammation  of  the  cornea  and 
marlAsd  intolerance  of  light  with  profuse  lachrymation,  I  have  gener- 
ally found  the  nitrate  to  act  better  than  any  other  substance  in  allaying 
the  irritation.  My  manner  of  using  it  under  such  circumstances,  I 
shall  mention  hereafter.  With  these  exceptions,  I  do  not  think  that 
either  one  of  these  valuable  substances  is  greatly  superior  to  the  other. 
As  a  general  rule,  I  p^-efer  the  sulphate  of  copper  because  the  reaction 
caused  by  its  use  is  not  so  prolonged,  and  no  indelible  staining  of  the 
conjunctiva,  as  it  is  very  liable  to  occur  from  the  long-continued  use 
of  nitrate  of  silver,  ever  takes  place.  I  alternate  them,  however  very 
often,  in  the  treatment  of  the  same  case,  and  that  with  good  results. 
In  trachoma  I  never  apply  nitrate  of  silver  in  substance,  and  very 
seldom  in  solutions  stronger  than  that  of  ten  grains  to  the  onnoe. 
For  several  years  past  I  have  been  in  the  habit  of  using  almost  ezclu* 
sively  the  compound  nitrate  of  silver  as  recommended  by  Desmarres 
in  preference  to  the  pure  article.  It  is  made  by  fusing  together  equal 
parts  of  nitrate  of  silver  and  nitrate  of  potassa,  and  running  them 
into  a  stick.  The  action  of  the  caustic  is,  in  this  way,  very  mucji 
mitigated  and  much  safer.  Of  this  compound  stick  I  use  generally 
three  strengths — six,  ten  and  twenty  grains  to  the  ounce  of  water,  ac- 
cording to  the  degree  of  toleration  in  each  case,  going  nearly  always 
cautiously  from  the  weaker  to  the  stronger.  Where  the  granulations 
are  large  and  callous,  and  a  higher  degree  of  reaction  is  desired,  I 
apply  the  compound  stick  in  substance,  rapidly  passed  over  them  and 
then  washed  off  with  water  before  the  lid  is  let  down.  Sometimes  it 
does  better  to  use  the  powder,  formed  by  -shaving  it  down  on  a  piece 
of  glass  with  a  sharp  knife,  and  applying  it  with  a  moistened  brush. 
These  touchings,  however;  should  not  generally  be  repeated  more  than 
once  a  week,  and  that  only  for  a  limited  time,  the  weaker  preparations 
being  applied  in  the  intervals  once  a  day.  In  the  treatment  of  gran- 
ulations by  topical  applications,  they  should  seldom  be  made  more 
than  once  a  day,  even  the  weakest.  Is  the  cornea  still  intact ;  is  its 
invasion  threatened,  as  indicated  by  injection  of  the  anterior  ciliary 
vessels  with  ciliary  neurosis  ;  or  is  it  actually  attacked  by  panniform 
inflammation  in  its  early  period  ;  then  I  avoid  any  contact  of  the 
medicine  with  that  membrane,  with  the  greatest  care.  The  best  way 
of  shielding  the  cornea  and  confining  the  medication  to  the  region  o 


1864.]  Trealmeni  of  TraehonuL.  95 

the  grsDolaiioiiB,  is  to  direct  the  patient  to  close  tbo  eyes  and  keep  them 
allot,  after  one  has  everted  the  lids  and  holds  them  secure  with  the 
thomb  and  index  finger  of  the  left  hand,  sitting  in  front  of  the  patient. 
Id  this  manner  the  contraction  of  the  orbicularis  approximates  the 
back  edges  of  the  tarsal  cartilages  and  covers  the  eye  from  view.  A 
earners  hair  brush,  dipped  in  the  solution,  is  passed  two  or  three  times 
over  the  everted  surfaces,  washed  off  with  simple  water  after  a  few 
seconds,  and  the  lids  allowed  to  assume  their  normal  position. 

When  the  pannns  is  of  longer  standing,  more  extensive  and  the  eye 
■lore  tolerant,  the  passage  of  the  medicine  over  the  cornea  may  con- 
tribate  to  the  absorption  of  the  deposits  and  the  removal  of  the  vas- 
cnlarily.  In  such  cases  washing  off  may  be  omitted.  Even  then, 
bowever,  the  veil  usually  clears  away  from  the  cornea  in  proportion  as 
tbe  granulations  subside,  without  any  medicine  coming  directly  upon 
it.  Henee,  as  long  as  I  see  any  decided  improvement  in  tbe  vision,  I 
continue  the  cautious  method  of  treatment,  reserving  the  direct  medi- 
cation of  the  cornea  for  the  contingency  of  no  further  advancement. 

In  adopting  local  applications,  I  begin  with  the  mild  and  advance 
if  need  be,  step  by  step,  to  the  more  energetic.  If  mild  treatment  will 
accompliih  the  removal  of  tbe  granulations  in  any  reasonable  time,  it 
ia  useleM,  and  sometimes  very  unsafe,  to  resort  to  violent  measures. 
Slow  and  9ure  is  my  maxim  in  combatting  trachoma.  A  restless 
de»ire  to  make  greater  speed,  has  caused  many  a  terrible  railroad  dis- 
aster ;  and  the  ftame  spirit  has  run  bushels  of  sore  eyes  <^the  tracks 
producing  inexcusable  delay,  and  often  irreparable  injury.  In  the 
adoption  of  the  compound  btick,  it  is  only  to  overcome  obstinate  re- 
aistance  to  the  weaker  solutions,  that  a  forty-grain  solution  or  even 
the  powder,  may  be  resorted  to  at  intervals  of  a  week  or  more,  daily 
lighter  touchings  being  kept  up  in  the  meantime.  In  concentrated 
solutions  and  especially  in  substance,  it  produces  a  very  sharp  burning 
sensation,  but  if  kept  from  the  ball  and  well  washed  off,  the  severe 
reaction  does  not  last  more  than  a  few  hours.  If  it  does,  harm  rather 
than  good  is  likely  to  follow.  The  very  pungent  feeling,  caused  by 
the  nitrate  of  poCassa,  induces  sudden,  free  lachrymation  which  assists 
in  curtailing  the  period  of  excitement. 

The  iulpkal^  tf  copper  in  substance  or  solution — varying  from  ten 
to  forty  grains  to  the  ounce — should  be  used  with  the  same  precautions 
above  recommended.  I  am  in  the  habit  of  using  a  solution  of  twenty 
grains  to  the  ounce,  rather  than  the  crystal,  because  it  enters  into  the 
folds  and  fissures  more  promptly  and  thoroughly.  But  it  is  best  to 
try  it  in  different  ways  and  adopt  that  which  seems  to  act  best  in  each 


96  Original  CammunieatUmt  [Febrntrj, 

individual  case.  In  chronic  cases,  especially  wiih  pannos  of  some 
weeks  or  months  duration,  this  suhstance  need  not  be  washed  off  at 
all.  Indeed  in  obstinate  pannos,  I  have  often  found  that  even  the  eom- 
pound  stick,  in  strong  solution  or  in  powder,  may  be  brushed  on  the 
lids  and  let  quickly  down  without  washing,  or  touched  directly  on  the 
upper  part  of  the  cornea,  with  rapid  improvement.  The  powder  how- 
ever should  not  be  applied  often,  on  account  of  its  escharotio  effect  and 
the  anatomical  lesions  induced  by  it. 

As  a  vehicle  for  the  convenient  application  of  the  snlphate  of  copper 
and  other  articles,  to  the  conjunctiva,  when  there  is  no  necessity  of 
-shielding  the  cornea  ;  I  have  been  in  the  habit  for  several  years,  of 
using  the  amylum.  glycerine  paste.     It  is  called  Simon's  Paste  or 
salve,  from  the  Berlin  apothecary  who  first  successfully  combined  these 
two  substances  in  a  perfect  amalgam,  and  published  an  account  of  it 
in  1859.     As  a  menstruum  for  the  local  wee  to  the  eyes,  of  various 
medicines,  such  as  morphia,  atropine,  sulphate  and  chloride  of  zinc, 
red  precipitate,  and  especially  sulphate  of  copper,  it  can  not  be  ex- 
celled.    The  first  specimens  of  this  paste  were  made  for  me  some 
years  ago,  by  Mr.  A.  Fennel,  an  intelligent  German  apothecary  of 
this  city.    More  recently  Prof.  E.  L.  Wayne,  chemist  and  apothecary 
in  the  large  drug  stora  of  Suire,  Eckstein  &  Co.,  has  modified  the 
original  method  of  preparing  it  so  as  to  produce  a  much  nicer  sub- 
stance.    It  is  homogeneous,  semitransparent,  free  from  lumps   and 
odor,  and  little  liable  to  alter  by  keeping.     At  my  solicitation,  he  has 
furnished  the  following  directions  for  its  preparation,  which  I  give  in 
his  own  words.      "I  take:  R.  Glycerine  (Price's)  3j.  ;  Bermuda 
arrow-root.  gr.  xl. ;  Aquae  q.  s.     I  place  the  arrow-root  in  a  mortar 
and  triturate  it  well ;  then  add  to  it  as  much  water  as  the  arrow-root 
will  absorb  without  becoming  pasty.     The  glycerine  is  then  placed  in 
a  dish  and  heated  up  to  about  two  hundred  and  twenty-five  degrees 
Fahrenheit  and  the  arrow-root  then  stirred  in.     The  combination  is 
at  once  effected  and  a  smooth  uniform  mass  the  result.    I  prefer  arrow- 
root, as  it  is  a  starch  having  less  odor  than  that  from  any  other  sub- 
stance.     Ordinary  starch  always  makes  a  rank-smelling  amylum. 
glycerine."     In  the  treatment  of  granulated  lids,  I  use  a  solution  of 
sulphate  of  copper  in  this  paste,  in  different  strengths,  from  half  a 
grain  to  two  grains  to  each  drachm  of  the  amylum.  glyceriue.     With 
li  probe  or  small  spatula  a  good  drop  of  this  is  applied  once  a  day  to 
the  everted  upper  lid  and  let  down  upon  the  eye.     It  smarts  quite 
sharply  for  a  few  seconds,  but  the  irritation,  where  it  is  well  borne, 
passes  off  in  fifteen  or  twenty  minutes.     For  the  past  year  or  so  I 


1864.]  Treatmeni  of  Trachoma.  97 

bire  generally  combined  one  or  two  grains  of  snipbale'of  morphia  to 

etcb  drschm  of  tbe  cnprnm  paste,  and  find  that  it  shortens  the  period 

of  reaction  produced  by  the  copper.     Indeed,  I  combine  morphia  in 

unable  qnantitioj?,  with   most  astringent  collyria  for  the   different 

forms  of  conjunctivitis  and  for  opacities  of  the  cornea.     Trachoma  is 

a  disease  of  long  duration,  and  patients  from  a  distance,  even  when 

not  «t  back  every  few  weeks  by  a  relapse,  can  seldom  remain  with  the 

physician  till  tbey  arc  well.     As  a  prescription  to  be  used  at  home  by 

the  patient  himself,  there  is  nothing  equal  to  the  cuprum  and  morphine 

paste. 

As  adjuvants  that  may  be  use<i  in  the  treatment  of  trachoma  to 
soothe  the  eyes,  but  especially  to  obviate  the  annoyance  caused  hy  a 
glntination  of  the  eyelids  during  sleep,  unguents  are  very  beneficial. 
In  the  acute  at^ge,  I  prescribe  one  or  two  grains  of  sulphate  of  mor- 
phia rubbed  up  with  a  drachm  of  lard  and  a  few  drops  of  glycerine, 
to  be  applied  to  the  lids  at  bed  time.  In  the  chronic  forms,  I  use  the 
broum  citrine  oinfmeni  for  this  purpose.  It  melts  almost  instantly  when 
applied  to  the  eyes,  is  tenacious  and  produces  very  little  irritation. 
This  salve  is  valuable  in  trachoma,  but  it  is  particularly  in  phlyctenular 
camjmneiivitis  and  keratitis  as  they  occur  in  children  and  strumous  sub- 
jects, and  in  blepharitis  marginalis,  that  I  have  found  it  lo  act  so  like 
a  charm  that  I  have  abandoned  all  other  mercurial  preparations  in  its 
favor,  in  eruptions  of  the  nose,  face,  ears  and  scalp,  so  common  in 
the  same  class  of  rases  it  is  equally  cfRcacious.  I  have  it  applied 
every  night  by  rubbing  it  on  ;  and  in  phlyctenular  affections  of  the  eye, 
by  patting  a  portion  of  it,  of  the  size  of  a  grain  of  wheat,  from  the 
end  of  a  probe  or  knitting-needle,  on  the  inside  of  the  lower  lid.  It 
melts  almost  as  soon  as  it  touches  the  eye,  and  by  pulling  the  lids 
apart  a  time  or  two,  it  is  spread  over  the  entire  cornea.  The  prepara- 
tion is  not  officinal  and  I  have  never  seen  any  account  of  its  use,  ex- 
cept in  the  book  ot  Mr.  Wilde  on  the  ear,  where  he  gives  in  a  note, 
the  formula  for  making  it,  and  recommends  its  use  in  the  ear  in 
chronic  inflammation  of  the  dermoid  lining  of  the  meatus  anditorius. 
I  firvt  tried  it  for  that,  and  finding  how  ([uickly  it  dissolved  by  the 
Latnral  beat  of  the  body,  I  was  led  to  try  it  in  the  above  affections  of 
the  eye,  and  it  has  more  than  justified  my  expectations.  I  have  con- 
fttanily  prescribed  it  and  carefully  watched  its  effects  for  four  or  five 
year«,  in  different  forms  of  disease  of  the  eye,  and  in  the  class  of 
ca^es  abore  mentioned  I  deem  it  almost  a  specific.  The  formula  is 
the  <ame  as  that  of  the  U.  6.  Pharmacopo^a  for  making  common 
citrine  ointment,  except  that  twelve  ounces  of  cod  liver  oil  are  substi- 


98  Original  CommunieaUiOtu.  [Febmaiy, 

tuted  for  the  nine  ounces  of  neat's  foot  oil  mnd  the  three  onnces  of 
lard.  After  cooling,  Mr.  Wayne  directs  that  it  be  heaUd  again,  and 
then  stirred  till  it  is  cold.  That  makes  it  softer,  tougher  and  more 
homogeneous.  It  is  of  a  dark  brown  color,  has  theySfAy  smell  and 
keeps  a  long  time  when  well  made,  without  decomposition. 

In  obstinate  cases  of  trachoma  where  no  topical  application  to  ex- 
cite absorption,  is  tolerated,  Dr.  A.  von  Graefe  recommends  the  use, 
for  a  few  days,  of  warm  water  compresses  and  warm  pouldces  to  the 
eyes.  In  this  way  the  granulations  seem  to  be  favorably  affected  by 
the  hyperaemia  and  swelling  of  the  conjunctiva,  with  increased 
mucous  secretion,  induced  by  the  warmth  and  moisture.  Toleration  to 
topical  medication  of  the  granulations  is  sometimes  sicnred  by  this 
course,  but  it  must  not  be  kept  up  too  long.  The  same  author  recom- 
mends division  of  the  eyelids  for  half  an  inch,  at  the  external  canthua, 
to  relieve  pressure  upon  the  eye  caused  by  the  granulations,  thickening 
of  the  lids  and  spasmodic  action  of  the  orbicularis.  In  some  cases  I 
have  resorted  to  this  elongation  of  the  palpebral  commissure  with  da* 
cided  benefit — in  others  it  did  no  good,  and  I  had  to  wait  for  the  toler- 
ation to  be  established  by  natui-e,  or  resort  to  inoculation.  The 
remarks  of  Dr.  Graefe  on  the  use  of  warm  poultices,  to  induce  tolera- 
tion, and  the  excision  of  a  horizontal  fold  of  skin  from  the  upper  lid 
as  well  as  the  division  of  the  lid  commissure  mav  be  consulted  with 
much  advantage  in  the  Archiv,  fur  Ophthalmologie  for  1860. 


Euthtuiattic  Farewell  to  an  Army  Surgeon, — A  very  graphic  and 
spirited  account  is  given  in  the  Delhi  Gazette  of  one  of  the  most  grat- 
ifying occnrreuces  that  has  lately  taken  place  respecting  a  member  of 
our  profession  in  India.  It  records  the  departure  of  Dr.  Chambers 
from  the  Thirty-Fifth  Regiment,  to  which  he  had  been  attached  for 
sixteen  years.  On  the  2d  of  June,  a  dinner  was  given  to  him  by  the 
officers,  when  bia  health  was  drunk  with  the  most  marked  demonstra- 
tions of  respect,  the  cheers  being  reechoed  by  nearly  the  whole  of  the 
men  of  the  regiment,  who  had  assembled  outside  the  mess- house. 
His  health  was  then  drunk  by  the  non-commissioned  officers,  who 
were  called  in,  as  well  as  by  the  soldiers,  one  from  each  companj 
'  being  present.  On  the  4th,  after  a  farewell  dinner  with  the  colonel » 
Dr.  Chambers  left  the  cantonment,  his  carriage  being  drawn  by  a 
large  party  of  soldiers  ;  and  when  he  got  into  his  "  palky"  he  was 
borne  by  as  many  of  the  officers  as  could  find  room  under  the  poles. 
An  escort  was  also  formed  of  the  officers,  civilians,  and  ladies. 


1M4.]  Proceeding t  of  Societiei.  09 


Proceedings  of  the  Cincinnati  Academy  of  Medicine. 

B«port«d  by  W.  T.  Bbown,  M.D.,  SeCrttuj. 


Hall  of  Academy  of  Medicine,  November  23,  1863. 

Dr.  Richardson  reported  the  following  case  : 

Diphtheria, — ^Half  past  eight  o'clock  Sunday  morning,  Nov.  1st, 
called  to  see  a  bov  of  Mr.  F.'s  on  Eighth  Street,  about  five  years 
old,  nervo-bilions  temperament,  of  good  constitution,  usually  enjoying 
good  health.  He  was  breathing  with  considerable  difficulty,  the  sound 
of  both  inspiration  and  expiration  being  decidedly  croupy.  On  inquiry, 
I  learned  that  he  had  not  been  well  for  some  eight  or  ten  days,  as 
•ridanced  by  loss  of  appetite,  evening  recurrence  of  fever,  occasional 
coagh,  and  nocturnal  restlessness.  Friday  evening,  (thirty- six  hours 
anterior  to  my  first  visit,)  the  cough  became  croupous,  and  during  the 
■ight  respiration  also  became  so,  with  several  paroxysms  of  suffocative 
eoogh.  During  the  forenoon  of  the  following  day  (Saturday)  there 
waa  mitigation  of  symptoms,  although  the  cough  and  respiratory 
toand  continued  croupous.  During  the  night,  however,  the  condition 
of  the  previous  night  recurred  with  increased  severity,  two  or  three 
times  threatening  sufTocation.  On  examination,  I  found  the  throat 
reddened,  with  slight  exudation  on  posterior  part  of  fauces,  which  did 
not  cover  the  tonsils,  the  latter  being  but  little  enlarged.  The  tongue 
waa  coated,  but  in  no  degree  furred.  Aphonia  had  supervened,  and 
wben  speaking  was  attempted,  an  indistinguishable  whisper  was 
forced.  Pulse  feeble,  heart's  action  labored,  and  but  little  above  nor- 
mal frequency.  There  was  doubt  aa  to  the  correct  diagnosis.  Was 
ii  croup  or  was  it  diphtheria  ?  The  prodromic  manifestations  inclined 
nnto  the  latter  opinion.  The  invasion  of  croup  is  usually  more  ab- 
mptp  and  its  progress  more  rapid  than  in  this  case  ;  and  although 
naarlj  five  years  old,  he  had  never  had  an  attack  of  croup.  On  the 
odier  hand,  from  what  I  could  learn,  there  had  been  much  more  cough 
than  usually  characterizes  the  developing  period  of  diphtheria  ;  for  it 
if  usually  so  slight  as  not  to  attract  attention.  The  appearance  of  the 
fauces  was  not  such  as  is  generally  found  in  an  undoubted  case  of 
diphtheria  thus  far  advanced.  Under  either  diagnosis  or  by  any  plan 
of  treatment  I  viewed  the  case  as  unmanageable,  and  so  expressed 
myself  to  the  parents.  Viewed  and  treated  as  croup,  however,  the 
chance  for  a  favorable  event  of  the  case  was  better,  never  having 


100  Proceedinf^B  of  Societies.  [FebniAij« 

known  of  recovery  under  diphtheritic  attack,  where  continnoas»  cronpy 
breathing  liad  been  fully  established.     I  therefore  determined  upon 
the  following  course  of  treatment :  Pr.  Hydrarg.  chlo.  mit.,  grs.  Vj. ; 
piilv.  ipecac,  grs  iij. ;    pulv.  Doveri,  grs.    j.  ;  M.  ft.  pulv.  No.  8. 
The  first  two  an  hour  apart,  the  balance  every  two  hours. 

Saw  him  again  at  5  o'clock  p.  m.  No  appreciable  change  in  respi- 
ratory movcmcnls  or  croupous  sound.  Pnlse  more  feeble  and  expres- 
sion of  face  dull.  Had  vomited  two  or  three  times  ;  bowels  freely 
evacuated.  Had  taken  all  the  powders.  Same  prescription  renewed^ 
omitting  the  Dover's  powder.  One  to  be  given  every  two  hours,  with 
teaspoonfull  doses  of  the  following  mixture  intermediately.  ^.  Chlo- 
rate potassa,  3j. ;  syrup  rhubarb  and  aqua  menth.  pipu  aa.  3^^* 

Monday,  8^  o'clock  a.  m. — Found  him  lying  down,  lips  and  faoo 
puffy  and  pale,  free  secretion  of  mucous  in  the  mouth,  tongue  more 
coated,  stupid  expression,  pulse  more  feeble  and  frequent,  croupous 
sound  the  same  with  increased  mechanical  difficulty  in  respiratory 
movement.  Had  vomited  two  or  three  times  during  night,  bowels  fine- 
ly moved.  As  he  was  evidently  worse  in  every  particular,  and  a  con« 
tinuance  of  like  treatment  could  result  in  nothing  but  injury,  I  de- 
termined upon  a  reversal  of  it.  I  therefore  prescribed  the  following : 
ft.  Tinct.  ferri  chlorid.  Jss.  ;  quinia  sulph.  grs.  viij. ;  syrup  simplex 
3j.  Mix.  A  teaspoonfnl  every  two  hours,  which  by  misunderstanding 
of  the  mother,  was  given  every  hour. 

5  o'clock  p.  M. — Had  taken  all  the  medicine,  was  sitting  up.  Mark- 
ed improvement  both  in  sound  and  character  of  respiration.  Coun- 
tenance better,  pulse  slower  and  fuller.  Same  prescription  renewed, 
and  ordered  eveiy  two  hours,  with  the  following  to  be  given  in  like 
doses,  a  teaspoonfull  on  the  intermediate  hours  :  ft.  Chlorate  of  po- 
tassa,  3i. ;'  Syrup  rhei.  and  water  aa.  Jss.     Mix. 

Tuesday  morning,  8^  o'clock. — Had  passed  a  good  night.  No  suf- 
focative cough.  Breathing  scarcely  to  be  heard.  But  little  labor  in 
respiratory  movement.  Croupous  cough,  however,  and  aphonia  still 
persist.  Tongue  cleaning,  and  pulse  improving  in  tone  and  frequen- 
cy, bowels  open.  No  exudation  in  the  throat.  Same  treatment  to  be 
continued;  the  period  being  for  each  four  hours  instead  of  two,  making 
a  dose  alternating  every  two  hours. 

5  o'clock  p.  31. — Continued  improvement  in  every  respect.  Appe- 
tite returning.  Eespiration  and  pulse  natural.  Cough  somewhat 
muffled,  but  not  markedly  croupy.  Tongue  still  coated  on  posterior 
half,  bowels  open.  Treatment  continued,  to  be  given  at  intervals  of 
six  hours  each,  a  dose  every  three  hours.     Saw  him  next  morning. 


1864]  Proceedings  of  Societies,  101 

Wednesday,  still  improving,  voice  returning,  cough  slightly  rough, 
bot  not  croupy.  Appetite  very  good,  sleeps  well.  The  treatment 
WIS  continued,  lessening  the  doses  of  each  one  half,  time  same.  Bavr 
him  next  day,  Thursday,  doing  well,  stopped  quinine  mixture.  Con- 
tinued chlorate  of  potassa  mixture  three  times  a  day. 

Monday,  November  9th. — Apparently  well  in  every  respect,  but 
posterior  third  of  tongue  heavily  coated,  appetite  not  so  good.  Gave 
kirn  one  drachm  of  aromatic  sulphuric  acid  in  two  ounces  of  syrup,  a 
taa^oonfall  three  times  a  day.  Saw  him  November  17th.  Tongue 
clean,  appetite  good,  well  in  every  respect. 

Dr.   Bramble  said  he  was  called  yesterday  to  visit  a  woman  who 
had  been  delivered  by  a  midwife  one  week  ago  last  Thursday.     The 
patient  preyious  to  her  confinement  had  often  expressed  herself  fearful 
as  to  the  results.    There  was  a  moderate  lochial  discharge,  also  a  good 
fecretion  of  milk.     Tliere  had  been  no  operation  from  her  bowels  for 
era!  days.     Friday  she  became  delirious.     She  had  not  slept  for  a 
k,  and  her  throat  became  sore.     When  he  saw   her  on   Sunday 
Boming,  hhe  was  talking  all  the  while,  pulse  SO,  no  natural  heat  of 
fkin.  throat  covered  with  a  white  exudation.     He  prescribed  chlorate 
of  potassA  and  a  Dover's  powder  to  make  her  rest  ;  the  latter  she  re- 
jecttHJ.     In  the  evening,  there  being  no  heat  of  skin,  he  prescribed 
morphia  in  half  grain  doses  every  two  hours,  until  she  slept.     This 
Boming  the  white  exudation  was  removed,  leaving  only  a  smiill   de- 
poi^it  on  each  side  of  the  throat.     Continued  chlorate  of  potassa  and 
morfhii,  also  applied  cantbaridal  collodion  behind  her  ears,  and  mus- 
tard cataplafems  to  her  extremities.     This  evening  pulse  100,  j[rave  her 
oiU  after  it  operates  directed  that  the  morphia  bo  continued.     Tlio 
Doctor  said  he  reported  this  case  to  get  some  lighten  its  management. 
Dr.   Davis  reported  the  following:  On  Friday  morning,  Nov.  13th, 
Mr.  H.  called  at  my  office,  and  asked  me  to  go  as  soon  as  possible  to 
■ee  his  child,  aged  six  months  who,  he  said,  was  seized  with  a  severe 
attack  of  croup,  and  he  was  fearful  it  would  suflbcate.      I  went  as 
de!>>ired,  and  as  I  approached  the  room  in  which  the  child  was,  heard 
tin*  sonorons  inspiration,  difficult  breathing,  and  the  rough,  brassy 
congh  of  cynanche  trachealis.     I  found  the  child  in  its  mother's  arms, 
wi:h  a  flushefl  countenance,  and  a  rapid,  thready,  but  compressable 
pn!9e.     The  soft  palate,  velum,  and  tonsils  were  slightly  inilamed,  but 
tfcfre  wa«  no  exudation  visible*     Having  recently  treated  a  number  of 
ea*ec  of  laryngeal  diphtheria,  and  having  attended  the  same  child  a 
nonth  pievions,  through  an  attack  of  diphtheria,  I  concluded  that 
the  pretent  attack  was  not  croup,  but  laryngeal  diphtheria^     Accord- 


102  PfoceedingB  qf  SoeietUs.  {Febnutj, 

ingly,  I  ordered  the  following  :  Br.  Potass,  chlorat.  5j. ;  Tinot.  ferri 
miiriat.  3j. ;  Syrap  scillae.  3ij.  ;  Syrup  ipecac  Jij,  Mix.  Sig.  A 
tcaspoonful  every  hour,  also  a  tablespoonful  of  castor  oil. 

Galled  on  the  14th,  and  found  the  febrile  symptoms  somewhat  abmt- 
cd,  but  the  cough  still  distessing  and  croupy,  and  the  breathing  diffi* 
cult.     I  continued  the  same  treatment. 

Called  on  the  15th,  and  finding  the  breathing  still  obstructed,  and 
the  cough  frequent  and  sharp,  I  ordered  :  Br.  Argent,  nit.  Bj. ;  Aq. 
distil.  3j.  Mix.  Directed  the  parents  to  swab  its  throat  every  three 
hours.  I  continued  the  first  prescription,  and  directed  brandy  to  be 
freely  given  it  in  a  solution  of  gum  Arabic. 

Galled  on  the  IGth,  and  found  the  child  much  better,  its  breathing 
was  easy  and  natural,  and  the  cough  loose  and  less  frequent.  Upon 
an  examination  of  the  throat,  1  observed  for  the  first  time,  the  charac- 
teristic  exudation  upon  the  soft  palate.     Continued  treatment. 

Called  on  the  17th  and  found  it  still  improving.  '  The  cough  baving 
subsided  and  the  exudation  disappeared,  I  omitted  the  nitrate  of  silver, 
and  gave  the  first  prescription  but  three  times  per  day.  I  now  put  it 
on  the  following  :  B-  Ferri  citratis.  3ss.  ;  Vin  Maderi.  Jiss. ;  Simple 
syrup  Sss.  Mix.  S. — A  teaspoonful  three  times  per  day  ;  and  saw 
it  every  two  or  thi-ee  days  until  the  30th,  when  I  dismissed  it  as  well. 

On  November  30th,  by  request  of  Dr.  John  Davis,  saw  a  patient 
of  his  residing  on  Mt.  Auburn,  wife  of  Rev.  E.  IT.,  aged  thirty-five 
years.  She  was  seized  on  the  27th  inst.  with  great  prostration  of  tbe 
entire  system,  severe  pain  in  the  left  side  of  throat,  accompanied  with 
a  sense  of  rawness,  difficulty  of  breathing,  a  sharp,  short,  gruff  cougb, 
and  entire  loss  of  voice.  Severe  diarrhoea  and  vomiting  also  attended 
the  attack.  An  examination  of  the  throat  revealed  nothing  but  a  slight 
redness  of  the  tonsils  and  the  neighboring  parts.  No  exudation  was 
visible.  Dr.  John  Davis  diagnosed  the  case  as  laryngeal  diphtheria 
with  ulceration  on  left  side  of  larynx.  Ho  gave  morphine,  chlorate  of 
potash,  compound  tincture  of  cinchona  and  biandy,  the  latter  very 
freely,  and  swabbed  the  throat  as  near  into  the  larynx  as  he  could  reach, 
with  a  strong  solution  of  nitrate  of  silver.  Immediately  after  the  first 
swabbing  she  vomited,  and  threw  up  false  membranes  mingled  with 
blood.  She  improved  from  the  first  application  of  the  nitrate  of  silver, 
so  that  when  I  saw  her  on  the  30th,  she  was  convalescent. 

I  have  found  dianhoca  and  dysentery  attending  all  the  cases  of 
diphtheria  I  have  treated  this  winter.  Often  they  are  very  obstinate,  baf- 
fling every  remedy.  Last  Fall  we  had  diarrhoea  and  dysentery  prevail- 
ing throughout  our  city,  which  proved  the  precursor  of  typhoid  fevexs 


1864.]  Correspondence.  103 


($onrei8po»dienrie. 


Letter  from  Boston. 


Boston,  Mass.,  Jannarj  9,  1864. 

Mkssrs.  Editohs  : — On  a  former  occauion,  I  alluded  to  physical 
trainiDg,  or  gymnastic  exercise,  in  our  public  schools.  The  rules  of 
oar  School  Board  require  that  the  pupils  shall  have  some  kind  of  phy-. 
«icm]  or  gymnastic  exercise  twice  a  day,  forenoon  and  afternoon.  This 
Tegnlation  is  pretty  generally  carried  out,  in  our  High  and  Griimmar 
Departments,  and  in  many  of  the  Primary  Schools.  The  subject  of 
inlrodacing  military  gymnastics  and  drill  into  schools  for  boys  is  now 
cndar  coosideration,  and  will  be  tested  in  some  of  the  schools  by  a 
thorough  military  instructor.  The  teachers  are  to  be  instructed,  so 
thai  hereafter  they  may  bo  competent  to  drill  their  pupils  according  to 
the  beet  system  of  military  tactics.  If  this  method  of  training  pupils 
should  become  universal  in  our  commonwealth,  we  shall  have  regi- 
Benta  and  brigades,  and  I  might  nay,  an  army  of  boys,  thoroughly 
diaciplined  ia  all  the  requirements  necessary  for  a  good  soldier. 

I  believe  it  is  a  well  settled  fact  with  educators  that  the  children  of 
oar  public  schools,  especially  in  our  larger  cities,  need  to  bo  more 
tkorooghly  developed  in  their  phyoical  natures,  and  that  the  training 
of  the  mind  and  body,  should  go  on,  hand  in  hand,  if  we  would  raise 
op  a  generation  of  healthy  and  robust  men  and  women.  In  this  com- 
mnnicaton,  one  important  question  arises  ;  and  that  is,  the  liability 
of  taxing  the  physical  energies  too  much,  aside  from  the  mental. 
We  believe  that  this  in  often  done  when  the  exorcises  are  out  of  pro- 
portion to  the  natural  strength  of  the  child,  who  rather  loses  in  ner- 
vous and  muscular  force,  than  gains  in  development  and  strength,  so 
will  too  violent  and  ill-timed  gymnastic  exorcise  so  exhaust  the  motive 
power  of  the  body,  that  the  mental  faculties  suffer  as  well  as  the  vital 
forces. 

Hence  the  necessity  of  a  just  discrimination  in  the  adaptation  of  such 
exercises  of  gymnastics  to  the  various  classes  of  pupils  as  their  pecu- 
liar wants  demand.  As  many  physicians  in  cities  and  towns  are 
largely  intereste<l  in  the  education  of  the  youth  of  our  country,  by 
being  selected  as  the  proper  persons  to  serve  as  committees  and  super- 
visors of  the  public  schools,  it  becomes  them  to  8(;o  that  a  wise  and 
jadicious  system  of  physical  instruction  be  adopted  ;  one  that  will 
best  promote  the  health  of  the  pupils,  thereby  indirectly  increasing 
the  inCdlectoal  capacity.     Cliildren  of  f^le  constitutions  are  often 


104  Correspondence.  [Fcbraanr, 

greatly  benefitted  l»y  a  proper  course  of  calisthcnic  training.  But  this 
class  should  be  subjected  to  a  milder  form  of  gymnastics  tban  tho 
robust  «ind  vigorous.  It  appears  that  in  the  recent  pugilistic  en- 
counter between  Hecnon  and  King,  the  former  had  been  overtasked  by 
too  Kevero  physical  training.  The  physiological  observations  mado 
by  Dr.  Clark  and  others,  as  i*eported  in  the  London  Lancet,  seem  to 
confirm  this  view  of  the  case.  The  following  is  the  sabstance  of  tbe^ 
article  in  tho  Lancet : 

m 

''  Four  or  live  hours  after  the  termination  of  the  li^bt  on  the  10th 
inst.,  Heenan  arrived  at  a  friend's  house  in  London.  Mr.  J.  P.  Clarke 
saw  him  immediatoly.  Ho  was  then  suffering  from  great  exhaustion. 
His  face  was  considerably  disfigured,  and  thci-e  was  a  cut  on  the  right 
sidp  of  tho  upper  lip  abouc  half  an  inch  in  length,  which  required 
a  siitch.  There  were  no  bruises  of  any  consequence  about  the  body, 
but  there  were  a  few  sciatches  on  tho  chest.  The  action  of  the  heart 
was  very  feeble,  and  the  pulse  scarcely  perceptible.  Suitable  medi- 
cines were  resorted  to,  under  tiie  influence  of  which  he  gradaally  im- 
provoti  until  the  13th.  On  the  evening  of  that  day  he  had  a  fainting 
lit.  On  the  14th  Dr.  Tanner  saw  him  in  consnltation  with  Mr. 
Clarke.  He  was  then  weak  ;  his  nights  had  been  restless,  and  there 
was  considerable  uneasiness  on  taking  a  deep  respiration. 

**  On  examining  him,  all  marks  about  tho  chost  had  nearly  disap- 
peared, while  the  bruises  on  the  face  weie  quickly  fading.  Tho  cut 
in  his  upper  lip  had  healed.  The  right  nasal  bone  was  loosened  from 
its  articul.'itiuns  ;  but  there  was  no  fracture.  On  carefully  practicing 
auscultation,  the  heart's  action  was  found  to  be  feeble,  though  there 
was  no  bruit,  the  valves  acting  efHciently.  The  pulse  was  weak,  very 
compreshible,  and  rather  abovo  100.  The  left  lung  was  healthy  ;  but 
over  tho  apex  of  the  right  there  was  dullness,  with  evident  signs  of 
congestion.  On  either  side  at  the  back  of  the  neck  there  was  consid- 
eral'le  stitfnesN,  which  was  ascertained  to  exist  chieliy  in  tho  tendinons 
attac'liuKMits  ui'  tlic  trapezius  muscle  to  the  occipital  bone,  ligamentum 
nuchtc,  tlorsal  vertebrae,  and  spine  of  the  scapula. 

**  The  immense  development  of  the  muscles  about  the  shoulders  and 
chest  was  very  remarkable.  They  stood  out  prominently,  and  as  little 
encumbered  with  fat  as  if  they  had  been  cleaned  by  the  scalpel.  In 
firmness  they  resembled  cartilage.  The  same  conditions  were  albo  ap- 
parent in  the  recti  muscles  of  the  abdominal  wall,  the  tendinous  inter- 
sections (lineae  transversa?)  of  which  were  strongly  marked.  But  with 
all  this  splendid  development  it  was  evident  that  Heenan  had  i-eceived 
a  shock  from  which  his  system  was  only  slowly  recovering ;  though 
whether  the  loss  of  power  was  due  to  the  punishment  received  in  the 
fight  or  to  the  hard  training  which  he  had  previously  undergone,  may 
be  a  disputed  point, 

'*  As  physiologists,  it  may  seem  to  us  highly  probable  that  his 
training  had  been  too  prolonged  and  too  severe.  When  Heenan  went 
into  training,  on  Wednesday,  the  23d  of  {September — just  eleven 
weeks  before  the  match— Ais  weight  was  158t.  7Ib.     As  he  stepped 


1864.]  CarftipcmdtncB,  105 

into  tbe  ring  on  the  10th  inst.  he  was  exactly  148t  At  the  same  time 
King  weighed  ISst.,  thoagh  he  was  three-quarters  of  an  inch  taller 
than  Heenan,  whose  height  is  6  feet  1^  inch.  Those  who  know  what 
■evcTB  training  means  will,  perhaps,  ag^ree  with  ns  that  Heenan  was 
probably  in  better  condition  five  weeks  l)efore  meeting  his  antagonist 
than  on  the  morning  of  his  4^feat,  although,  when  he  stripped  for 
fighting,  the  lookers-on  all  agreed  that  he  seemed  to  promise  himself 
mn  easy  victory,  while  exulting  in  his  fine  proportions  and  splendid 
mnscnUr  development. 

"  It  is  now  clearly  proved  that  Heenan  went  into  the  contest  with 
much  more  muscular  than  vital  power.  Long  before  he  had  met  with 
any  severe  punishment — indeed,  as  he  states,  at  the  close  of  the  third 
ronnd^he  felt  faint,  breathed  with  mnch  difficulty,  and  as  he  describ- 
ed it,  his  respiration  was  'roaring.'  He  declares  that  he  received 
KOFK  severe  treatment  at  the  hands  of  Bayers  than  he  did  from  King ; 
ycc  at  the  termination  of  the  former  fight,  which  lasted  over  two  hours, 
hs  was  so  fresh  as  to  lesp  over  two  or  three  hurdles,  and  distance  many 
of  his  friends  in  the  race.  It  was  noticed  on  the  present  occasion  that 
kxa  phjftiqu€  had  deteriorated,  and  that  he  looked  much  older  than  at 
his  last  appearance  in  the  ring. 

"  Without  offering  any  opinion  as  to  the  merits  of  the  combatants, 

it  is  certain  that  Heenan  was  in  a  state  of  very  deterioiated  health 

when  he  faced  his  opponent,  and  it  is  fair  to  conclude  that  deterioration 

was  doe  in  a  great  measure  to  the  severity  of  the  training  which  he 

W  undergone.     As  with  the  mind,  so  with  the  body,  undue  and  pro- 

oaged  exertion  must  end  in  depression  of  power.  .  In  the  process  of 

he  phvaical  education  of  the  young,  in  the  training  of  our  recruits, 

r  in  tke  sports  of  the  athlete,  the  case  of  Heenan  suggests  a  striking 

entary  of  great  interest  in  a  physiological  point  of  view.    While 

.  properly  so  called,  tends  to  development  and  health,  ezces- 

e  exertion  produces  debility  and  decay.     In  these  times  of  over- 

ritement  and  over-competition  in  the  race  of  life,  the  case  we  now 

OA  record  may  be  studied  with  advantage." 

do  not  qnote  the  above  as  an  approval  of  the  use  of  man's  powers 
adnrance,  in  such  a  barbarous  way  ;  but  as  having  an  important 
!•(  on  the  subject  of  physical  culture,  which  is  receiving  much 
lioa  from  our  public  educators.  b. 


Quinine  in  Puerperal  Convulsions. 

lA  jon  would  ask  the  readers  of  the  journal  in  what  way  sul- 

of  quinia  arrests  the  paroxysms  in  puerperal  convulsions.     I 

wd  it  in  several  cases  within  thejast  four  years,  with  very  sat- 

f  remits  in  each  cafio.     I^was  led  to  use  it  first  by  observing 

zysms  occurring  periodically  ;  once  every  thirty -five  or  forty 


■ 

106  Spedd  SelicHons.  [FebroiiT, 

minutes.  I  had  previously  to  using  the  sulphate  of  quinine  ahstraoted 
blood  very  freely  ;  gave  chloroform,  chloroform  and  ether,  and  erexy 
thing  else  that  would  naturally  suggest  itself  to  my  mindp  and  par- 
haps  some  things  that  had  no  natural  common  sense  connected  with  it, 
probably  not  very  unlike  a  certain  Eclectic  who  called  upoa  a  Regular 
in  this  County,  and  wished  him  to  visit  a  patient  of  his.  It  was  avezy 
strange  case.  He  had  given  her  lobelia.  May  apple,  boneset,  Culrttr'a 
root,  rattle  root,  but  all  to  no  purpose.  Finally,  he  '*  gave  her  a  — »- 
of  a  dose  of  Materia  Medica,"  but  the  disease  hadn't  yielded  and  he  be- 
came alarmed.  Very  respectfully,  S.  Dat. 
HarrisonvUle,  Ateigs  Co.,  0.,  Jan,,  1864. 


■  •» »  ■ 


On  the  Injurious  EfTeota  of  Chloroform  During  Labor, 

Br  Robert  Johjcs,  M.B.,  F.R.C.S.I.,  Chairman  ot  the  Midwifery  Court,  and  Ex- 
aminer in  diBeaiea  of  Women  and  Children,  Bojal  College  of  Burgeona ,  Ire- 
land, kc. 

As,  at  the  present,  the  subject  of  chloroform  inhalation  is  again  «ic& 
judiee,  I  feel  it  incumbent  upon  me  to  raise  my  voice  against  its  em- 
ployment in  midwifery,  and  to  lay  before  my  professional  brethren 
my  reasons  for  the  adoption  of  such  a  course,  which  I  sincerely  tnut 
shall  have  some  weight  with  the  unprejudiced,  and  which  may,  per- 
chance, call  the  more  serious  attention  of  some,  if  not  of  all,  of  thoae 
now  too  deeply  wedded  to  its  use,  to  the  dangerous,  and  too  often  fa- 
tal results  consequent  thereon ;  in  which,  if  I  but  even  partially  bqc- 
ceed,  I  shall  consider  myself  well  repaid. 

From  experience,  repeated  observation,  and  the  published,  abo 
the  othsrwise  expressed  opinions  of  those  who  agree,  as  well  aa  of 
those  who  disagree  with  me  upon  the  subject,  I  am  firmlv  convinced 
that  choloroform,  when  inhaled  during  labor,  very  fruitrally  predis- 
poses to  hasmorrhage,  puerperal  infiamation,  chest  afiections,  and  to 
other  diseases  detrimental  to  health  and  life,  which  it  aggravate  if 
given  during  their  presence.  It  also  lays  the  foundation  ofdiscaeea  to 
arise  at  a  more  distant  period,  and  thus  increases  the  mortally  in 
childbed,  and  subsequent  thereto.  I  have  known  puerperal  inflamma- 
tion frequently  to  have  followed  its  inhalation,  and  too  oflen  with  a 
fatal  result ;  in  fact,  some  years  since,  when  it  was  more  fashionable. 
and  was  given  with  a  more  lavish  hand,  a  great  mortality  obtained 
amongst  the  patients  of  some  few  men  who  administered  it — so  much 
so  that  a  popular  outcry  was  raised  against  its  employment.  In  the 
majority  of  those  cases,  puerperal  fever  was  the  cause  of  death,  which  ' 
when  thus  raised,  being,  as  I  firmly  believe,  always  infectious  or  oth- 
erwise communicable,  became  epidemicizcd,  after  which  even  thoee 
who  wisely  refused  the  drug,  "  charmed  it  never  so  sweetly, "  ware 
thus  inadvertently,  and,  in  some  instances,  hopelessly  poisoned. 


1864.]  SpeeUd  Selections.  107 

In  Bopport  of  these  positions,  I  shall  first  refer  to  the  several  pub- 
lished Ileports  of  the  Dublin  Lying'n  Hospital.  We  find,  on  refer- 
eiiO0  thereto,  during  the  masterships  of  Drs.  Collins  and  Johnson, 
when  chloroform  was  not  inhaled,  that  the  mortality  was  much  less 
than  dnriog  that  of  Dr.  Shekleton,  when  this  pernicious  drug  was  used 
— ■•  thus  : — In  the  first  report  are  recorded  out  of  16,414  deliveries 
but  164  deaths,  or  1  in  100  ;  in  the  second,  out  of  6,634  deliveries  but 
65  deathB,'or  1  in  102  ;  whereas  in  the  third,  13,748  deliveries  are 
given,  and  163  deaths,  or  1  in  84  ! !  But  of  these  last  cases  13,406 
of  them  were  not  chloroformed,  of  which  only  183  died,  or  1  in  100, 
bnt  of  the  remaining  342,  who  took  the  drug,  30  died,  or  1  in  11 ! ! ! 
If.  again,  we  examine  the  reported  cases  of  chloroform  administration 
bj  Bimpeon  and  Denham,  we  shall  find  that  of  245  cases  mentioned 
by  the  former,  5  died,  or  1  in  49  ;  and  of  56  by  the  latter,  5  died,  or 
in  11 ! !  And,  by  adding  all  these  recorded  cases  together,  we  have  a 
mortality  on  the  whole  of  1  in  16  !  I !  By  again  consulting  those  re* 
porta,  we  perceive  that  in  Dr.  Collins'  mastership  there  occurred  79 
cneee  of  post  partum  inflammation,  or  1  in  169  ;  m  Dr.  Johnson's,  62 
cues,  or  1  in  107 ;  but  in  Dr.  Shekleton's,  150  cases,  or  1  in  91.  Of 
thoee  150  cases,  20  followed  upon  chloroform  inhalation,  or  1  in  17  111 
and  in  the  remaining  130  cases,  in  which  it  was  not  employed,  the  av- 
era^  mortality  was  only  1  in  103.  In  Denham's  report  we  find  4 
fiift,  or  1  in  14  ;  which,  with  all  the  recorded  cases,  strikes  an  aver- 
age of  1  death  for  every  16^  persons  who  took  chloroform  1 1 1 

We  also  find  that  during  Dr.  Collins'  mastership,  puerperal  convul* 
none  proved  fatal  in  the  proportion  of  1  in  6 ;  whereas  in  that  of  Dr. 
Bfaekmon,  when  under  chloroform,  it  amounted  to  1  in  3  1 1  and  in 
Denham'i  cases  to  2  in  3 1 1 !  or,  on  the  whole,  to  1  in  2|  1 1! 

It  appears  that,  during  Dr.  Hhekleton's  tenure  of  office,  post  partum 
hvmorrbage  occnied  but  once  in  every  257  cases  when  chloroform 
waa  noi  used  ;  yet  after  its  inhalation  this  complication  was  present  in 
1  of  every  49  cases.  In  Dr.  Denham's  report  it  was  present  in  1  of 
19  cases ;  making,  on  the  whole  an  average  occurrence  of  1  case  of 
flooding  in  every  39  4-5  cases  that  had  uken  chloroform. 

With  respect  to  the  mortality  after  perforation,  the  report  of  Drs. 
Hardy  and  M'Clintock  shows  1  fatal  case  in  every  6,  and  that  of  Drs. 
Sindair  and  Johnston  1  in  every  5 ;  but  if  we  go  a  little  below  the 
snrCioe  in  the  latter  report,  and  examine  into  99  cases  of  perforation, 
an  of  equal  severity  and  danger,  we  shall  discover  that  of  the  29  cases 
ia  wUcn  chloroform  was  inhaled  9  died,  or  1  in  3^  ;  puerperal  inflam- 
■aHow  occorred  10  times,  or  1  in  every  3  cases  ;  and  haemorrhage  fol- 
lewed  in  8  cases,  or  I  in  every  10 ;  whereas,  of  the  70  cases  in  which 
this  drag  was  not  employed,  only  6  women  died,  or  1  in  every  12 ; 
patiperal  inflammation  arose  only  in  3  cases,  or  1  in  every  23 ; 
sad  im  no  case  did  hsemorrhage  occur. 

Many  have  teitifled  to  the  fact  that  uterine  action  has  been  lessened, 
sad  wnm  eaued  to  cease,  by  ansssthetics  ;  as  also  that  their  effect  on 
SMM  le  not  coaunensnrate  with  the  quantity  of  the  drug  employed — 
tea  :  a  very  large  amount  not  having  any  effect  upon  some,  whereaa 
the  inhalation  of  a  very  small  dose,  even  of  a  few  drops,  has  produ'^- 


108  Special  SeUdioM.  [Fedniftiy 

ed  almost  deep  coma  in  otbers.  Dr.  Denham  says  : — ''  In  some,  if 
left  to  nature,  the  labor  would  probably  have  been  completed  in  a 
somewhat  shorter  space  of  time.  The  advantages  to  be  gained  bj 
chloroform  in  some  cases  will  not  be  found  an  adequate  compensation 
for  the  loss  of  power  sustained  in  the  muscles  of  animal  and  oiganic 
life  ;  and,  were  we  to  continue  its  use,  I  do  believe  that  the  patients 
would  remain  undelivered  for  hours,  or  even  days.  The  cases  that 
apparently  require  it  most — tedious  and  difficult  labors — are  those 
where  it  often  appears  to  be  injurious,  by  weakening  the  pains  or  re- 
laxing the  muscles  of  animal  life. "  Rigby  says  : — "  We  meet  with 
cases,  every  now  and  then,  where  chloroform  undoubtedly  retards  la- 
bor, and  in  some  cases  Hkely  to  call  for  the  use  of  the  forceps. " 

Dr.  Robert  Lee  mentions  cases  iA  which  "  uterine  contractions  were 
arrested,  requiring  the  use  of  the  forceps,  and  the  destruction  of  the 
child  by  the  perforator.  " 
Tyler  Smith  **  has  seen  chloroform  stop  labor  midway.  " 
In  some  of  the  cases  recorded  by  Sinclair  and  Johnston,  uterine  ac- 
tion was  impaired. 

My  friend  Dr.  Young,  of  Monaghan,  says,  in  a  letter  to  me : — **  I 
believe  chloroform  in  many  instances  to  delay  the  labor,  by  causing 
the  pains  to  come  at  longer  intervals,  and  rendering  the  expulsive  ef- 
forts of  the  patient  less  efficient,  owing  to  her  insensibility  to  suffer- 
ing. " 

Merriman  has  mentioned  a  case  in  which'  the  uterus  was  so  paraly- 
ed  that  it  failed  to  act  afterwards. 

Snow  says  : — ''It  is  true  that  a  full  dose  wonld,  at  any  time  suspend 
uterine  action  for  a  few  minutes,  or  as  long  as  it  might  be  kept  up.  ** 

On  looking  into  Drs.  Sinclair  and  Johston's  report,  we  find  "  two 
cases  in  which  version  was  verv  difficult ;  and  two  others,  in  whieh 
that  operation  was  impossible,  where  chloroform  had  been  inhaled.  ** 

Murphy  thus  speaks  : — '*  In  a  case  of  version,  I  never  experiened 
so  much  difficulty,  in  consequence  of  the  strong  contractions  of  the 
uterine  fibres  about  the  child.  '* 

Barnes  remarks  : — ''  In  many  cases  it  does  not  facilitate  the  oper- 
tion  of  version,  the  uterus  resisting  the  introduction  of  the  hand.  '* 

Puerperal,  hysterical,  and  epileptic  convulsions,  mania,  paralysis, 
and  insanity  have  followed  on  its  use.  Cases  are  recorded  by  Mont- 
gomery, Sinclair,  and  Denham,  in  which  puerperal  convulsions  occur- 
red after  its  employment,  Sinclair  gives  two  cases  of  hysterical  convnl- 
sioDS,  in  one  of  which  violent  muscular  action  was  induced  and  rest- 
lessness continued  for  a  considerable  time  after  the  inhaler  was  re- 
moved. 

Murphy  states  that,  "  in  dentistry,  hysterical  women  have  been 
seized  with  fits  when  under  its  influence." 

Snow  asserts  that  '*  hysterical  patients,  as  soon  as  they  lose  their 
consciousness  from  the  effects  of  the  vapor,  are  sometimes  attacked 
with  a  paroxysm  of  hysteria.  ** 

Dr.  K.  Lee  says  :— **  Epilepsy  has  been  so  induced.  " 

Sinclair  records  one  case  of  epilepsy. 


1864.J  Special  Saedhm.  109 

Snow  And  M.  Fix  have  stated  ''  that  persons  subject  to  epilepsy  are 
likelj  to  have  a  fit  brought  on  bj  inhaling  chloroform. " 

Ramtbotham  "  saw  three  cases  of  puerperal  mania  so  caused.  A 
friend  of  his  also  saw  ono  similar  case.  " 

Bntherland  "  met  three  other  cases  similarly  produced.  " 

^ler  Smith  stated  "  that  he  had  seen  mania  from  its  use.  " 

Piirlu  relates  the  case  of  a  lady  who  had  chloroform  in  her  third  la- 
bor. "  She,  after  delivery,  complained  of  violent  pain  in  the  head, 
became  delirious,  tore  the  Curse's  gown  and  the  bedclothes  into  pieces, 
and  was  perfectly  maniacal.  " 

Mr.  Banner  thus  speaks  : — "  A  patient  became  delirious,  and  con- 
tinued ao  during  the  day  and  greater  part  of  the  night,  after  its  use.  ** 

Haartman  "  saw  a  case  of  headache  terminating  in  paralysis,  caua- 
ed  by  this  drug. " 

In  one  of  Dubois'  published  cases,  numbness  of  the  fingers,  and  in 
another  the  same  condition  of  the  legs,  supervened,  and  had  not  sub- 
sided at  the  end  of  twenty-four  hour. 

In  Denham's  report  I  find  one  case  of  coma  after  chloroformio  in- 
halation. 

Dr.  R.  Lee  says  "  that  insanity  has  followed  on  its  employment ; 
that  dangerous  and  fatal  peritonitis  and  phlebitis  have  been  caused  by 
Hf  inhalation.  '* 

Two  or  three  of  Denham  s  cases  were  seized  with  rigors  ;  and  Lee 
aentions  others  with  dangerous  fits  of  syncope ;  and  in  this  he  is 
borne  out  by  the  following,  which  I  find  recorded  amongst  Denham's 
cases  :— "  While  inhaling,  the  pulse  became  very  weak,  and  she  gave 
BO  signs  of  consciousness  ;  and  immediately  on  the  birth  of  the  child 
tlie  respiration  of  the  patient  ceased,  and  the  pulse  became  impercepti- 
ble ;  the  application  of  cold  water  to  the  face  soon  revived  her,  and  she 
went  on  favorably  for  some  days  ;  but  diarrhoea,  with  extensive  in- 
lansmation  of  the  mucous  membrane  of  the  ileum  set  in,  and  she  died 
OB  tbe  fourteenth  day.  " 

SiBclair  and  Johnston  record  nearly  a  similar  case,  as  thus :— "The 
poise  suddenly  became  imperceptible,  and  respiration  appeared  to  have 
ossssd.  She  subsequently  died  of  phlebitis.  "  And  they  give  anoth- 
os  IB  which  cf llapse  occurred,  and  she  also  died  with  symptoms  of 
phlebitis. 

Dr.  Barnes  stated — "  That  he  had  himself  given  chloroform  to  fa* 
cQiCste  the  extraction  of  an  adherent  placenta,  and  had  witnessed  such 
•xeesding  prostration  for  eight  hours  afterward,  as  to  make  him,  and 
BBOther  practitioner  who  assisted  him,  apprehensive  of  the  instant 
of  the  patient " 

Msoy  aro  of  the  opinion  that  the  inhalation  of  chloroform  predis- 
to  laceration  of  the  perineum  ;  indeed,  some  of  the  published 
would  tend  to  favor  this  idea.  In  Sinclair  and  Johnston's  re- 
port we  find  that,  in  the  recorded  cases,  it  occurred  once  in  27  cases  ; 
mad  when  not  employed,  the  accident  happened  only  once  in  93  cases. 
la  tlis  asBis  work  we  find  three  cases  of  chest  afifection  aggravated  by 
tUs  BiesBS,  two  of  which  succumbed. 

Dr.  BiBgland  in  reply  to  a  letter  from  me,  writes : — "I  have  se  b 


no  Sp$cial  StUcAmt.  [F«bnuiiy, 

chloroform  froquently  used  in  puerperal  convolsions,  and  have  vaed  it 
myself  in  connection  with  the  practice  of  the  Goombe  Lyi^gin  Hoapi- 
tal ;  and  the  conclusion  I  have  come  to  is,  that  I  will  never  again  use 
ity  or  sanction  its  use,  in  puerperal  convnlsiona.  I  have  observed  that, 
however  satisfactory  its  employment  mav  appear  at  the  time,  it  has 
been  almost  invanably  followed  by  bronchitis  within  about  48  hours, 
and  that  the  patients  liave  sunk  rapidly  under  the  latter  affection.  I 
have  seen  this  so  frequently  that  I  cannot  but  look  on  chloroform  and 
bronchitis,  under  the  circumatanoes  I  have  named,  as  cause  and  efiaot; 
and  the  mortality  from  the  subsequent  bronchitis,  as  the  actual  reanlt 
of  the  employment  of  chloroform.  " 

Bamsbotham  relates  the  case  of  "  a  lady  who  was  seized  with  dys- 
pnoea, with  excessive  lividity  of  the  face,  and  all  the  signs  of  engoige- 
ment  of  the  lungs  and  heart,  and  died  in  convulsions  six  hours  after/' 
Murphy  has  published  a  case  nearly  aimilar ;  he  also  admits  *'  that 
vomiting,  nausea  and  headache  aometimes  follow  on  its  use. ''  Nau- 
sea  and  vomiting  were  also  present  in  one  ofDenham's  cases. 

Rigby  states,  **  that  intense  headache,  and  even  vomiting,  are  oon- 
sequences  of  its  use.  " 

Parks  gives  the  case  of  a  lady,  in  whom,  after  chloform  inhalation, 
flooding  came  on  to  a  fearful  extent,  and  incessant  sickuess.  He  man- 
aged to  extract  the  placenta ;  and,  owing  to  the  feeble  contractions  of 
thefuterus  (and  this  latter  condition,  he  is  confident,  it  often  produ- 
ces), he  has  kept  grasping  it  for  four  or  five  hours  ;  the  vomiting 
continued  for  eight  hours  without  intermission ;  the  headache  remain- 
ed for  weeks. 

Tyler  Smith  **  believed  that  post  partum  hemorrhage  and  retention 
of  the  placenta  occurred  more  frequently  after  its  use  than  without  it.'' 
Montgomery  was  of  opinion  *'  that  it  predisposes  to  retained  placen- 
ta and  hemorrhage.  " 

My  friend  Dr.  Young,  before  alluded  to,  says  : — "I  have  blamed  it 
for  causing  a  longer  detention  of  the  placenta,  and  for  occasional  afiter- 
hemorrhage,  owing  to  the  lazy  and  inefficient  contraction  of  the  uterus. 
After  its  use  opiates  have  very  little  effect ;  even  verv  decided  doses  > 
in  any  form,  have  not  been  followed  by  that  tranquility  I  have  hoped 
for,  in  that  violent  pain  which  I  have  so  often  found  to  follow  opera* 
tions  when  chloroform  had  been  used.  " 

Murphy  speaks  of  being  obliged  to  press  upon  the  uterus  to  ezpel 
the  placenta,  in  two  cases,  after  chloroform. 

Borne  of  the  loudest  advocates  for  chloroform  inhalation  in  labor 
have,  in  order  to  counteract  its  deleterious  effects  upon  uterine  actioBi 
recommended  the  co-administration  of  ergot  of  rye;  which  praotioe 
reminds  me  of  the  astute  physician  who,  to  be  sure  to  hit  his  patient's 
disease,  prescribed  for  him  the  combination  of  a  stimulant  with  a  se- 
dative. 

Cusack  and  others  have  also  testified  to  the  deleterious  effiacts  of  this 
drug  upon  the  cerebro-spinal  system  of  that  infant. 

Dr.  Aveling  speaks  of  ''  a  lady  who  had  chloroform  in  three  labors, 
all  of  whose  children,  when  unwell,  had  for  years  afterwards  the  umM 
distinctly  off  their  breaths.    This  lady  would  never  take  it  again. " 


1864.]  JBjptdal  Sdtcticm.  Ill 

I 

Dr.  J«ckBon  (an  American)  thas  writes  npon  the  subject : — '*Wlien 
dilorofonn  is  inhaled  into  the  Inngs,  the  oxygen  is  abstracted  from  the 
blood,  and,  combining  with  the  formyle,  makes  formic  acid,  while  the 
eUorine  oombines  with  the  blooa  as  a  substitute  for  ozjgen. 
Ural  a  portion  of  the  blood  becomes  chemically  changed,  disorgania- 
ed»  and  rendered  unfit  for  its  vital  functions. 

Denham  says : — "There  ara  cases  in  which  chloroform  appeared  to 
be  not  only  useless,  but,  when  persevered  in,  positively  injurious. " 
And  again  : — "  In  giving  chloroform  we  incur  a  certain  amount  of 
pment  danger,  and  perchance  of  remote  ill  effects. " 

Dr.  Robert  Lee,  in  reply  to  a  letter  from  me,  says  : — "  I  could  £^ve 
yon  a  great  number  of  cases  in  which  chloroform  was  not  only  injuri- 
one,  bnt  fatal. " 

Dr.  Gream  said : — ''He  agreed  with  Dr. -Lee  in  saying  that  we 
ware  unacquainted  with  one-tenth  of  the  evil  effects  which  had  resulted 
from  the  use  of  chloroform,  particularly  in  Scotland.  '* 

Dr.  Duncan,  in  a  letter  to  Dr.  Lee,  thus  writes  : — «  Your  case  of 
chloroform  death  in  midwifery  is,  to  the  best  of  my  belief,  not  the  on- 
ly one  in  Scotland.  I  was  called,  too  late,  to  a  case  which  died  sud- 
denly while  taking  it  in  itnaU  quantity,  " 

Dr.  Campbell,  of  Ayrshire,  records  another  case  of  death  in  labor  from 
ito  nae.  lu.  Carter  says  "  that  in  two  cases  its  effects  would  appear 
to  kaTe  been  pernicious.  " 

Prof.  Faye,  of  Christiana,  has  also  recorded  a  fatal  case  of  labor  af- 
tar  ita  use. 

Dr.  Rogers  said  **  ho  knew  of  a  case  where  death  took  place  appar- 
flBllj  in  consequence  of  its  use  in  midwifery. " 

Dr.  Baniei  says : — «'  In  ordinary  forceps  oases  chloroform  certainly 
ia  not  raquiied,  either  to  facilitate  the  operation  or  to  allay  pain.  In<- 
deed  by  its  use  in  such  cases  we  lose  one  very  valuable  indication  in 
the  loaa  of  our  patient's  sense  of  feeling. 

Dr.  Chas.  Kidd  does  not  consider  its  use  devoid  of  danflrer,as  he  advises 
the  physician  who  administers  it  "  alwayt  to  carry  in  his  pocket  a  por- 
table galvanic  chain  or  battery. 

Drs.  Kidd  and  Richardson  are  reported  as  having  seen  many  deaths 
after  ita  employment ;  and  the  former  gentleman  "  to  have  seen  about 
800  cases  restored  to  life  or  rescued  after  they  had  been  pronounced 


I  would  ask,  in  the  name  of  common  sense,  is  it  within  the  bounds 
nf  reason  to  believe  that  a  medicine  can  be  employed  innocuously  with 
tka  pregnant  female,  when  confessedly  its  use  has  often  been  followed, 
not  only  by  dangerous,  but  even  fa^al  results  under  other  circumstan- 
«a,  as  testified  to  by  Drs.  Kidd  and  Richardson,  amongst  many  oth- 
en,  aa  nlao  by  almost  every  periodical  we  take  up. 

We  have  been  told  that  across  the  Tweed  death  has  not,  in  any  in* 
followed  upon  the  inhalation  of  chloroform  in  labor,  whereas 
have  been  since  recorded  ;  and  not  very  long  ago  I  was  inform- 
ed, by  more  than  one  physician  practising  in  Scotland,  that  many 
ao  oecnired  there,  but  not  made  public,  yet  well  known  to  the 


112  jRmnem  and  NoAm.  [  [Febnuiy, 

It  is  also  a  fact  tliat  some  who  have  written  faTorablj  on  ita  nso 
have  since  changed  their  opinions,  hnt  have  not  said  so  publicly.  Some 
give  it  only  in  name,  or  as  has  been  styled  a  la  Reine,  making  their 
patients  believe  that  they  are  saved  from  a  vast  amount  of  pain,  when 
m  reality  they  have  scarcely  inhaled  a  single  breath  of  it. 

We  very  frequently  see  better  and  safer  recoveries  after  tedious  and 

Cinfal  than  after  rapid  and  painless  labors,  and  the  latter  are  not  th^ 
8  likely  to  be  seriously  complicated  :  indeed  in  former  days,  when, 
happy  for  the  pertarient  female,  chloroform  was  unknown,  and  when 
meddlesome  midwifery  was  strongly  reprobated,  such  an  opinion  was 
entertained. 

Even  though  it  were  possible  to  divest  chloroform  of  its  dangers,  it 
does  not,  as  has  been  already  shown,  always  produce  the  advantages 
expected  from  its  use,  as  in  version  ;  for  indeed  not  a  few  instances 
have  been  recorded  of  its  having  been  an  impediment  to  this  opera- 
ticn,  which  in  some  cases  could  not  be  overcome.  I  cannot  see  any  ad- 
vantage derivable  from  the  inhalation  of  this  poisonous  drug  in  casea 
of  retained  placenta,  as  generally  snch  a  complication  is  caused  by  in- 
action of  the  uterus ;  and  our  object,  therfore,  surely  not  further  to 
paralyze  it. 

Every  practical  man  hails  after-pains  as  salutary,  especially  after 
quick  and  painless  labors,  and  would  not  dream  of  interfering  with 
their  wholesome  action,  unless  very  severe,  for  some  hours  after  ddiv- 
erv  ;  yet  those  misguided  chloroformists  think  nothing  of  interfering 
with  that  safe  action  at  times  when  the  advent  of  hemorrhage  would 
complicate  matters  more  seriously.  The  other  objectiojas  to  its  use  at 
other  times,  under  certain  circumstances,  are  equally  admissible  here. 
I  think  I  have  now  demonstrated  not  only  by  my  own  experience  but 
also  by  some  of  the  highest  obstetrical  authorities  in  the  land,  that 
chloroform  inhalation  is  far  from  being  a  safe  remedy  in  childbed,  and 
should  not  then  be  employed. — Dublin  Quarterly  Journal  qf  Medical 
Science, 


■  •»» » 


On  Atthma :  Its  Pathologj  and  Treatment.  Bj  Henrt  Htdk  Salter,  M.D., 
F.R.S.,  Fellow  of  the  Royal  College  of  Physicians,  etc.,  eto.,  etc.  Philadel- 
phia: Bianchard  &  Lea.    1864. 

The  present  handsome  volume  of  260  pages  has  been  publishing  in 
the  Medical  JVews  and  Library  during  the  past  year,  and  the  readers  of 
that  publication  have  been  thus  made  already  familiar  with  the  excel- 
lence of  this  reprint. 

In  his  prefatory  remarks  Dr.  Salter  says,  "  For  many  years  past 
my  attention  has  been  specially  directed  to  the  subject  of  asthma,  and 
from  an  enforced  and  very  close  observation  of  it,  I  have  become  ao- 
quainted  with  many  facts,  both  with  r^ard  to  its  clinical  history  and 


1881]  Bm0w$  and  SaAeu.  118 

« 

tiwifiiant,  far  snj  BOiioe  of  which  I  hftve  yainly  searched  the  litera- 
ture of  the  enhject.  To  communicate  these  facts  to  others  has  been 
Um  principal  motive  that  has  induced  me  to  commit  the  following 
pages  to  the  press." 

^Hie  book  divided  into  fifteen  chapters,  treats  of  the  theories  of 
Mthma,  its  pathology,  its  clinical  history,  varieties,  etiology,  conse- 
qiianoes,  etc.,  etc.  Five  chapters  are  devoted  to  a  consideration  of  the 
vmrions  treatment  of  asthma.  .Finally,  we  have  chapters  on  the  ther- 
apeatical  influence  of  locality,  hygienic  treatment  of  asthma,  its 
piognoais. 

In  the  appendix  the  interest  and  value  of  the  book  is  increased  by 
the  Bairative  of  a  number  of  cases  under  the  observation  of  the  author. 
Scattered  indeed  throughout  the  work  are  fragmentary  cases,  partial 
hisloriae  only.  This  appendix  gives  the  careful  history,  and  each  will 
be  found  readable. 

The  book  of  Dr.  Baiter  is  an  important  addition  to  our  literature 
of  aathma,  and  will  be  sought  after  by  the  profession,  to  whom  we 
chcsrfolly  commend  it. 

For  sale  by  Bickey  <k  Carroll.    Price  92.00. 


At  Mtdkml  FonmUtry:  Being  a  oolleetion  of  prescript  ions,  derived  from  the 
wricings  and  praotieo  of  many  of  the  most  eminent  physicians  in  Amerioa 
aad  Barope,  etc.,  eto^  etc.  By  Bevjami!!  Ellis,  M.D.,  late  Professor  of 
Materia  Mediea  and  Pharmacy  in  the  Philadelphia  College  of  Pharmaoy. 
Eleventh  edition,  carefully  roTised  and  much  extended.  By  Bobirt  P. 
Thomas,  lfJ>.,  Professor  of  Materia  Mediea  in  the  Philadelphia  College  of 
Fharmaey.  **Morbos  autem,  non  eleqnentia  sed  remedis  cnrari." — Cels. 
De  Med.  Lib.  1.    Philadelphia :  Blanchard  &  Lea.    18G4. 

The  style  and  appearance  of  the  prescriptions  of  a  large  number  of 
the  medical  men  of  the  present  day»  are  a  reproach  upon  us  as  a  pro- 
fession, claiming  to  be  one  of  learning  and  culture.  With  some  there 
is  at  onoe  evidence  of  familiarity  with  the  value  and  proper  therapeu- 
tic use  of  remedies,  while  at  the  same  time  there  is  exhibited  a  disre- 
gard for  neatness  and  exactness,  that  is  repulsive  to  the  eye  of  taste. 
Others  manifest  in  their  mode  of  prescribing  both' their  ignorance  of 
ivmedies  and  their  lack  of  oulture.  An  elegant  prescription  is  grale- 
fkl  to  the  cultivated  physician  as  an  evidence  of  the  character  of  his 
bnocher  physician,  and  becomes  elegant  precisely  and  simply  in  propor- 
tien  to  its  exactness,  its  correctness. 

Unfortunately  the  art  of  prescribing  is  not  made  prominent  in  the 
employments  of  the  student.  It  is  regarded  as  one  of  those  minor 
points  whtdi  may  be  safely  postponed  until  the  young  physician  shall 
hftva  eatevsd  upon  the  real  practical  duties  of  his  profession.    And 


114  JBemmfi  mtd  XMcu.  [V4btmatf, 

tlien  it  18  that  the  young  doctor  realises  the  embamaaineiit  of  making 
up  a  jndicions  prescription. 

It  is  to  obviate  in  some  degree,  the  inconTeniMioe  which  (he  grada- 
ate  first  experiences,  that  the  volume  before  ns  was  first  nndertalosn 
and  executed.  That  it  has  so  long  sustained  itself  in  the  pnblio  de* 
mand  as  to  run  through  ten  editions — having  now  passed  to  this  the 
eleventh — ^is  very  good  evidence  of  the  success  of  the  undertakiiig 
proposed. 

''  It  contains  in  a  condensed  form,  and  we  think  advantagecmsly 
arranged,  many  of  the  most  important  prescriptions  employed  in 
modem  practice.'' 

'*  The  application  of  remedies  to  diseases  has  been  genendly  left  to 
the  judgment  of  the  practitioner,  and  therapeutical  detail  as  mudh«s 
possible  avoided,  as  it  would  have  been  inconsistent  with  the  natme 
and  design  of  the  work.*' 

The  whole  book  is  arranged  after  a  regular  systematic  order.  Chap- 
man's old  classification  being  used  as  the  basis ;  so  that  we  not  only 
have  instructions  and  models  for  the  elegant  and  judicious  formulas 
furnished  to  us,  but  these  models  presented  in  groups  or  classes  which 
are  of  themselves  a  sort  of  suggestive  system  of  materia  medica. 

The  introductory  chapters  contain  much  valuable  matter  for  the  in- 
experienced practitioner  and  prescriber ;  a  table  of  drops,  of  abbrevi* 
ations,  doses  for  children,  table  of  doses  of  medicines,  tabular  view  of 
,  the  doses  of  the  principal  articles  of  the  materia  medica. 

The  body  of  the  volume  however  is  made  up  of  a  vast  oolle<^ou  of 
prescriptions,  arranged  under  the  subdivisions  of  emetics,  cathartics, 
expectorants,  narcotics,  etc.,  of  caustics,  injections,  gargles,  ointments, 
lotions,  etc.  We  also  have  several  pages  devoted  to  dietetic  prepara- 
tions for  the  sick ;  and  a  chapter  on  poisons,  with  the  proper  antidotes 
mnd  mode  of  treatment.  Finally,  in  the  form  of  two  appendices,  we 
have  a  chapter  on  the  endemic  use  and  application  of  medicines,  and  a 
•chapter  on  the  use  of  ether  and  chloroform. 

We  have  thus  hastily  given  an  outline  of  the  plan  of  Ellis'  For- 
mulary. It  has  been  a  long  time  known  to  the  profession,  and  a  more 
minute  notice  would  scarcely  be  proper.  We  endorse  the  favorable 
opinion  which  the  book  has  so  long  established  far  itself,  and  take 
this  occasion  to  commend  it  to  our  readers,  as  one  of  the  convenient 
handbooks  of  the  office  and  library. 

For  sale  by  Bobert  Gkurke  d^  Go.    Price  $2.25. 


18M.]  IMUar'i  Tmits.  115 


€tfit0V'«    SXllIf* 


Deatli  of  Leonidas  M.  Lawton,  M.D. 

It  is  our  sad  doty  once  more  to  record  the  decease  of  one  of  onr 
prominent  professional  brothers.  Dr.  L.  M.  Lawson — ^late  Prof. 
of  Um  llieorj  and  Practice  of  Medicine  in  tbe  Medical  College  of 
Okio— died  at  his  residence  in  this  city  at  one  o'clock  on  Thursday 
morning,  January  2l8t,  at  the  early  age  of  fifty-one. 

Dr.  Lawson  was  throughout  his  professional  life  identified  with  the 
iatooita  of  the  profession  of  Cincinnati  and  medical  teaching  in  onr 
city,  nerertheless  he  had  occupied  yariocs  positions  of  honor  in  neigh- 
boring cities  at  difierent  periods  of  time.  Very  early  in  his  career  he 
was  elected  to  a  proiessorship  in  the  medical  department  of  Transyl- 
Taaia  UniTeraity  at  Lexington,  Ky.  Subsequently  lie  held  a  profes- 
Mcahip  in  LonisTille  for  two  or  three  winters,  and  for  a  single  winter, 
(1869-60),  he  was  Prof,  of  Clinical  Medicine  in  the  University  of 
Tioniaiana  at  New  Orleans.  Btill  with  these  honorable  appointments 
wo  find  his  heart  regularly  returning  its  best  afiections  to  this  city  of 
his  early  adoption.  Here  he  has  done  his  best  work ;  here  he  has 
dooed  his  labors. 

In  the  spring  of  the  year  1842,  Dr.  Lawson  established  the  WuUm 
Lamed,  and  continued  at  its  head,  with  various  associates,  until  the 
winter  of  1854-55,  when  his  absence  in  Louisville  made  it  necessary 
ibr  liim  to  withdraw  from  his  editorial  duties  here.  The  subsequent 
of  the  Medical  Obsgrver  with  the  Lancet  as  Lancet  and  Ob- 
of  course  renders  this  the  regular  successor  of  Dr.  Lawson*s 
fouiding  in  1842.  A  present  tribute  of  respect,  therefore,  comes  from 
BO  one  with  more  propriety,  certainly  with  no  greater  sincerity  and  es- 
ibr  hia  professional  industry  and  scholarship,  and  for  his  many 
and  domestic  virtues,  than  from  us. 
Immediately  after  returning  from  New  Orleans,  Dr.  Lawson  brought 
his  work  on  Phthisis  Pulmonalis,  the  labor  of  his  life.  We  quote 
the  following  closing  paragraph  of  the  criiique  of  the  BritUh  and 
Fmfifm  Mtdko'Chwrnrgko  Bevicw  in  its  notioe  of  Dr.  Lawson's  book, 
April,  1863. 

"  For  acntoneas  of  observation,  for  sober  discrimination  and  sound 
jmigmmntj  and  fair  criticism  of  the  writings  of  others,  and  especially 
oC  eoCompoimrieif  and  for  the  wide  knowledge  which  it  displays  of 


116  JBdUor*$  Table.  [Februiyf 

the  literature  of  his  sabject,  we  know  few  books  superior  to  it.  We 
bestow  our  praise  the  more  readily,  our  author  beings  an  Americtn,  of 
Anglo- Saxon  race,  as  his  name  implies,  and  one  who,  we  trnst,  wiU» 
witn  all  his  right-minded  countrymen,  still  cherish  a  love  of  the  old 
stock  from  which  he  sprang,  abhorrent  of  the  vulgar  clamor  sadlj 
now  prevailing  against  England,  as  if  the  American  States,  whether 
united  or  separated.  Federal  or  Confederate,  had  not,  with  our  coun- 
try, a  common  interest,  apart  from  the  community  of  blood — that  of 
language,  of  literature,  and  of  laws." 

Dr.  Lawson  continued  in  the  regular  performance  of  his  profession- 
al and  college  duties  up  to  the  time  of  the  Christmas  holidftys, 
though  it  was  well  known  that  his  health  was  feeble  and  that  study 
and  close  attention  to  duty  was  telling  upon  him.  He  then  went  to 
the  country  for  a  brief  relaxation,  but  returned  after  a  few  daya  to 
take  his  sick  conch,  from  which  he  was  destined  never  more  to  return 
to  the  labors  of  eai-tli. 

Dr.  W.  H.  Taylor,  who  conducted  the  post-mortem  ezaminatioD^ 

has  handed  us  the  following  notes,  which  will  be  read  with  interest. 

Examination  Thirty-Six  Hours  after  Death, — ^Body  emaciated,  ane- 
mic, slight  post-mortem  rigidity.  Extensive  adhesions  of  the  plenim 
were  found,  which  in  the  upper  part  of  the  thorax  were  very  firm,  in 
the  lower  lateral  portions  of  left  were  indications  of  recent  inflamma- 
tion. The  lungs  presented  extensive  vesicular  emphysema  predomi- 
nating in  the  right.  In  the  apex  of  right  lung  were  several  tubercular 
cavities  each  about  the  size  of  a  hazel  nut.  Throughout  the  entire 
parenchyma  of  both  lungs  were  small  yellow  tubercles  in  all  stagef, 
some  hard,  some  softening,  some  cretified.  The  surrounding  lung 
Btruoture  was  engorged  and  in  some  portions  hepatized.  The  peri- 
cardium was  healthy.  It  contained  rather  more  than  the  usual  amount 
of  fluid  which  was  tinged  with  blood.  The  walls  of  the  heart  were 
not  more  than  half  their  usual  thickness^  and  were  so  soft  as  to  be 
easily  penetrated  by  the  flnger.  The  small  intestines  were  healthy. 
In  the  head  of  the  colon  were  numerous  small  oval  and  round  ulcers 
penetrating  the  mucus  and  muscular  coats.  The  mucus  membrane 
surrounding  the  ulcers  was  of  a  dark  color.  Several  patches  of  chronic 
engorgement  were  found  in  the  mucus  membrane  of  the  rectum.  The 
liver  was  so  soft  as  to  tear  by  its  own  weight  when  but  partially 
raised.  The  spleen  was  twice  its  usual  size  and  very  soft.  The 
kidneys  were  about  normal  size,  dark  colored,  very  flabby,  and  the 
fascia  propria  easily  detracted.  On  section  the  junction  of  the  coni- 
cal and  medullary  portions  was  scarcely  distinguishable.  A  consider- 
able quantity  of  thin  dark  fluid  with  oil  globules  flowed  from  the  cut 
surface.  The  calicos  were  lined  by  a  yellow  deposit  of  cheesy  con- 
sistence about  a  line  in  thickness,  and  contained  a  milky  fluid. 

The  following  is  the  tribute  of  the  profession  on  this  occasion  : 

In  Mbmoriam. — At  a  meeting  of  the  Regular  Medical  Profession* 
held  at  the  Medical  Collie  of  Ohio,  on  Saturday,  28d  inst.,  the  fd- 


1864.]  Editor's  Table.  117 


^  resolutions  were,  after  appropriate   remarks,  unanimously 
adopted.  t  j.  L.  Vattier,  M.Q.,  President. 

jr.  P.  Walkxb,  M.D.,  Secretary. 

"  Wkereoi,  It  has  pleased  Qod,  in  his  good  providence,  to  remove 
from  oar  midst  our  professional  brother,  Dr.  L.  M.  Lawson,  late  Pro* 
fe«or  of  Theory  and  Practice  in  the  Medical  College  of  Ohio  ;  there- 
Cdto  be  it 

'*  B^Mclvtd,  That  in  the  death  of  Dr.  Lawson,  the  profession  of  this 
eitj  and  whole  country,  has  lost  an  accomplished  member,  and  one 
wholly  devoted  to  scientific  pursuits. 

**  Besdved,  further ^  That  in  his  death  the  profession  has  lost  a 
member  whose  labors  in  behalf  of  medical  science  have  given  addi- 
tiooal  luster  to  the  American  profession  of  medicine  at  home  and 
abroad. 

*'  Besoived,  That  in  him  we  lose  the  well-bred  gentleman,  of  amiable 
manners,  wholly  directed  during  his  entire  life,  to  the  advancement  of 
bis  profession,  and  the  welfare  of  its  members. 

**  Beeolved,  That  a  copy  of  these  resolutions  be  sent  to  the  family 
of  tbe  deceased,  and  published  in  the  daily  papers,  and  in  the  Cincin- 
wifti  Lamceiand  Obeerver." 

Tbe  funeral  took  place  from  the  First  Presbyterian  Church  of  this 

city,  tbe  discourse  being  delivered  by  the  Bev.  Mr.  Worrall,  of  Cov- 

ingion,  and  the  remains  were  followed  to  the  cemetery  by  the  Free- 

maaona,  of  which  body  he  was  a  Knight  Templar,  by  the  Profession, 

aad  tbe  students  of  the  Medical  College  of  Ohio.    His  memory  and 

toacbings  will  long  remain  with  the  profession  of  this  Great  Valley  . 

His  body  rests  in  the  tomb  'till  the  beauty  of  the  Resurrection  mom. 


ion  of  tSea- Sickness, — ^Mr.  Ashe,  of  Birkenhead,  has  taken 
ovt  a  patent  for  a  conch,  which,  by  means  of  a  ball  and  socket,  and 
other  apparatus,  is  constantly  suspended  in  the  same  position  whatever 
maj  be  the  motion  of  the  vessel.  It  is  said  that  a  patient  reclining 
vpOB  tbis  will  be  free  from  sickness. — London  Lancet, 


iRrw  American  Pkarwuicopana. — The  January  number  of  the  London 
Lameei  contains  a  very  appreciative  review  of  the  last  edition  of  our 
Fhannacopcsia.  The  notice  concludes  with  the  following  paragraph : 
**  Upon  tbe  whole,  we  consider  the  New  United  States  Pharmacopoeia 
a  work  highly  creditable  to  its  compilers  and  the  profession.  It  bears 
tbe  impress  of  an  honest  and  earnest  endeavor  to  advance  the  science 
aad  aii  of  healing,  to  render  available  to  all  the  experience  and  infor- 
matkm  obtainable  from  every  quarter,  and  without  favor  or  prejudice 
to  adopt  whatever  may  be  practically  useful  from  any  source." 


118  3Hiw^i  TiOU.  [Februaty, 

Gov,  Tod, — It  is  not  often  that  we  feel  s  regret  at  the  retirement  of 
a  public  officer,  txscnpying  the  first  office  in  the  State.    We  hettrtilj 
regret  that  Gov.  Tod  has  retired  to  private  life.    In  onr  knowledge  be 
is  one  of  the  few  men  who  entertains  a  high  respect  and  regard  for  the 
regular  profession  and  its  members.    It  is  to  him  that  the  profession 
owes  the  appointment  of  a  State  Medical  Board  for  the  examination 
of  all  applicants  for  Surgeon  and  Assistant-Surgeon  of  the  Tarionfl 
regiments  raised  in  the  State.  His  predecessor  appointed  the  Suigeons 
of  the  regiments  in  the  same  way  he  appointed  the  staff  officers — on 
his  own  judgment,  influenced  of  course  by  political  consideratioha. 
This  Gov.  Tod  refused  to  do.     He  sent  all  applicants  before  the 
Medical  Board,  and  if  they  were  successful  in  their  examination,  he 
appointed  them.   On  assuming  the  duties  of  his  office,  he  streng^then- 
ed  himself  by  the  appointment  of  a  hi|rhly  accomplished  gentleman 
as  Surgeon-General — Dr.  Gustav  C.  E.  Weber.    In  everjr  thing  con- 
cerning the  welfare  of  the  soldiers  in  the  field,  he  consulted  Dr. 
Weber.     His  opposition  to  quacks  and  quackery  of  all  kinds  was  so 
decided  that  he  refused  to  listen  to  them  for  one  moment. 

As  a  result  of  all  this  the  medical  men  appointed  from  Ohio  oconpj 
a  high  place  in  the  army.  They  compare  favorably  with  those  ap* 
pointed  from  other  States. 

In  some  of  the  States,  as  for  instance  Indiana,  the  Governors  have 
appointed  any  and  everybody.  Gov.  Morton  has  said  we  are  inform- 
ed, that  a  physician  is  better  known  in  his  own  neighborhood  than  in 
any  other  place,  and  that  if  he  has  letters  from  the  people  with  whom 
he  has  practiced,  they  are  sufficient  to  entitle  him  to  an  appointment. 
In  carrying  out  this  view,  Gov.  Morton  has  commissioned  several 
notorious  quacks. 

Governor  Tod  maintained  that  as  the  soldier  in  the  field  has  no 
choice  of  Surgeons,  he  was  determined  that  he  would  send  none  but 
the  best.  He  has  demonstrated  to  the  Legislature  and  the  people  of 
the  State,  the  necessity  and  importance  of  a  State  Medical  Board. 

On  account  of  the  decided  course  of  Gk>vemor  Tod  against  appoint* 
iug  quacks,  the  Legislature  attempted  to  cripple  him  and  force  him  in- 
to recognizing  quack  physicians.  It  met  however  with  a  signal  fiiil- 
ure,  and  now  for  the  first  time  in  many  years,  the  regular  medical  pro- 
fession holds  a  strong  place  in  the  public  estimation.  The  variona 
quack  systems  and  their  blatant  advocates  have  received  from  Govern- 
or ^od's  course,  a  blow  more  severe  than  could  have  been  given  fHMn 
any  other  source. 

The  profession,  we  repeat,  lose  in  Governor  Tod  a  warm  friend. 


1804*1  JEtf Aor^«  2Ult.  119 

Ha  liM  in  aTery  raspact  provad  himself  to  ba  ona  of  iha  bast  Gtovara^ 
oif  ihm  Suta  hM  avar  had. 

Loyal  and  daTotad  above  all  party  prejudices,  to  the  interests  of  onr 
baloTad  bni  distracted  country,  generous  and  kind  to  the  soldier  and 
officer*  ha  haa  provad  himself  to  be  ona  of  the  few  men  who  honor  tha 
placa  from  iriiich  ha  retiree. 

Wa  hope  that  the  members  of  the  regular  profession  will  not  forget 
his  good  offieee  in  their  behalf.  We  sincerely  hope  that  tha  people 
not  permit  so  good  a  man  to  remain  long  out  of  public  service. 


Apologue. — ^We  regretted  very  much  the  necessity  of  sending  out 
oar  Janoaty  number  so  lata,  which  was  unavoidable ;  and  also  for 
sfading  oxA  an  untrimmed  number,  which  was  owing  to  an  accident 
in  tha  bindery  juat  as  we  were  issuing.  Press  of  work  in  every  de- 
paitmant  of  printing  renders  it  very  difficult  to  be  as  prompt  «s  we 
ooold  daairoy  and  wa  must  ask  our  friends  to  exercise  as  much  patience 
ia  diaaa  matsera  as  poaaible. 

Ptncmal. — Dr.  W.  H.  Mussey  has  resigned  his  position  as  Medical 
laapaetor  in  the  United'  States  Army,  and  returned  to  the  practice  of 
Us  pfoiaaaion  in  this  city.  His  friends  will  greet  him  amongst  us 
with  a  great  deal  of  very  sincere  pleasure. 


BrmUkwaiUTt  JUdroiped-^V^xi  XLVIII— January,  1864.— Mr.  W. 
A*  Towiiaand,  of  New  York,  continues  the  regular  issue  of  this  in- 
▼alnabla  renmie  of  Practical  Medicine  and  Surgery.  The  number 
before  ua  completes  twenty-four  annual  volumes,  its  publication  having 
eommanoad  in  the  year  1840.  The  present  part  fully  sustains  the 
wdl  known  and  established  reputation  of  the  Retrospect^  as  a  mirror 
of  the  progreaa  of  medical  acience.  The  price  is  $1.25  each  Part,  or 
94.(M>  a  year  for  Braithwaite  with  Lancet  and  Observer. 


Siergeom  Oeneral  W.  A,  Bammond,  U.S.A. — Although  we  did 
Approve  of  the  mode  in  which  Suig.  Gen.  Hammond  secured  the 
t  to  his  present  responsible  position,  we  were  nevertheless 
of  those  who  desired  his  success,  and  expressed  ourselves  decidedly  in 
his  behalf.  We  knew  that  he  possessed  more  than  ordinary  scientific 
sdiolarahip  and  energy  of  character ;  he  entered  upon  the  duties  of 
his  new  office  at  a  critical  time  in  the  affairs  of  our  nation.  It  was  ev- 
kiaatly  no  time  to  dwell  upon  personal  preferances»  it  certainly  was  a 
time  to  stand  by  every  man  who  manifested  earnestness  of  purpose 
and  hmrtinaaa  in  tha  execution  of  any  public  trust.    When  it  became 


120  BdUor'9  liOU.  [Febnmiy, 

efident,  as  we  bolieyed,  that  Sarg.  General  Hammond  waanot  endow- 
ed with  those  elemeDts  of  character,  and  jnst  appreciation  of  the  honor 
of  his  profession,  that  fit  him  for  so  exalted  a  place,  at  our  readen 
very  well  know,  we  reluctantly  took  grounds  against  him— we  did  lo 
under  a  full  conviction  of  public  duty — we  did  so  fully  and  frankly— 
if  perhaps  harshly,  we  certainly  intended  no  diacourieBy.     For  aeveral 
months  past  wo  have  not  introduced  the  subject  in  our  columns,  from 
the  fact  that  ii  was  understood  that  his  official  conduct  was  undeigo- 
ing  an  examination,  which,  as  we  thought,  made  it  improper  in  na  to 
attempt  any  forestalling  of  professional  opinion.     So  much  has  of  late 
however,  been  remarked  in  the  newspapers  of  the  day,  conoeming  tbe 
Surgeon  Greneral,    that  it  is  perhaps  proper  to  make  the  following 
statement.     Several  months  ago  Surgeon  General  Hammond  was  tem- 
porarily relieved  from  the  duties  of  his  office  in  Washington — Buigaon 
Joseph  K.  Barnes,  U.S.A.  being  ordered  on  duty  as  acting  Suigeon 
General — while  Dr.  Hammond   was  ordered  on  varioua  toun  of  in- 
spection, down  the  coast  to  New  Orleans,  Nashville,  Chattanooga,  d^c 
d^c.     In  the  meantime  a  special  commission  was  appointed  to  examine 
the  papers  and  records  of  the  office  ;    and  by  way  of  parenthesis,  it  ia 
perhaps  right  that  we  express  our  very  serious  doubts  of  the  propriety 
of  this  system  of  espoinage  of  official  papers  and  documents  in  the 
constrained  absence  of  an  officer  under  suspicion,  we  think  Dr.  Ham- 
mond should  have  been  present  throughout  this  entire  preliminary  in- 
vestigation.    The  result  of  this  commission,  however,  has  been  tlie 
preferment,  if  we  are  to  regard  newspaper  reports,  of  most  grave  and 
serious  charges  against  the  administration  of  the  Surgeon  General, 
and  as  we  write   (Jan.  25th.)  a  court  martial  has  commenced  ita  sit- 
tings in  the  city  of  Washington,  which  will  doubtless  carefully  and 
thoroughly  investigate  those  charges.     It  is  improper  that  we  make 
any  leflections  or  anticipations ;  perhaps  quite  as  soon  as  this  number 
of  our  Journal  reaches  our  readers,  the  verdict  will  be  given  to  the 
world  in  the  newspapers,  and  with  that  verdict  we  shall  doubtless  luiv» 
given  to  us  sufficient  of  the  evidence  to  enable  us  to  form  for  ourselves 
a  fair  opinion  of  ita.  righteousness. 

In  the  meantime  Dr.  Hammond  has  met  with*  a  serious  accident 
which  will  probably  in  any  event  unfit  him  for  any  active  service  for  a 
long  time  under  the  most  favorable  circumstances.  "  In  stepping  in- 
to hi^  carriage  at  Nashville,  Tenn.,  on  the  point  of  departing -thence  to 
Knoxville,  he  slipped  on  the  steps  and  fell,  severely  injuring  his  spine. 
He  was  confined  to  his  bed  when  last  heard  from,  his  lower  limbs  be- 
ing partially  paralyzed. " 


1864.]  BdUar's  Table.  121 

ne  imv  Ambfdance  BUI. — Senator  Wilson,  of  Massachnsetts,  baa 
More  Congress  a  very  important  bill  providing  for  a  complete  reor- 
guixalion  of  the  ambulance  system  of  our  army.  There  is  perhaps 
nothing  in  onr  army  more  fanlty  than  the  ambolance  system  as  it  has 
been  carried  ont  hitherto.  In  onr  most  hardly  foHght  battles,  ambn- 
laneet  havo  been  sadly  and  terribly  deficient  in  the  performance  of 
their  legitimate  dnties.  This  matter  has  elicited  the  attention  of  Snr- 
geoBS  in  and  out  of  the  army,  all  over  the  country,  and  at  length  as  we 
hope  with  a  fair  prospect  of  reform  ;  we  clip  a  paragraph  from  a  tele- 
gimphic  message  in  a  recent  daily  : — "Mr.  Wilson's  bill  provides  that 
the  number  of  iwo-horse  ambnlances  attached  to  army  corps  shall  be 
thrse  to  an  infantry  regiment  of  ^^9^  hundred  ;  two  to  a  regiment  of 
twoJimdred  ;  one  to  a  regiment  of  one  hundred  or  more ;  two  to  a 
etralry  regiment  of  five  hundred  ;  one  to  a  regiment  of  less  number ; 
one  to  a  battery  of  artilery.  All  persons  are  prohibited  from  using 
sabaUnoes  for  other  purposes  than  the  care  of  the  sick  and  wounded." 


A  ani  Editcrial  Arrangement — Hereafter  Dr.  Wm.  B.  Fletcher, 
oflndiADopolis,  will  have  charge  of  the  entire  department  of  "Edito- 
rial abstracts  and  selections  "  and  arrange  and  condense  them  for  this 
Joomal.  Old  readers  of  the  Lancei  and  Obeerver  will  remember  the 
attiactiTa  character  of  this  department  while  under  the  control  of  the 
hnealtd  Hartmann ;  and  our  friends  in  Indiana  who  know  Dr. 
Fletcker,  will  congratulate  us  in  securing  so  worthy  a  successor.  Ez- 
changea  will  do  us  a  favor,  and  at  the  same  time  secure  for  themselves 
.fgnlar  notice  and  prominence,  by  forwarding  to  Dr.  Fletcher  a  du- 
plksic,  for  which  courtesy  we  shall  always  be  happy  to  reciprocate. 


'New  mode  €f  Preparing  Beef  Tea. — A  Medical  friend  had 
oecaaioB  not  long  since  to  order  "  beef  tea  "  for  a  patient,  and  at  a 
■bwqnent  visit  happened  to  inquire  of  the  nurse  if  she  understood  the 
srt  of  mnking  beef  tea  correctly  :  Oh  yes  she  replied — but  for  fear 
ike  might  be  mistaken  she  had  consulted  another  lady  friend  learned 
ia  the  doties  of  the  sick  room  ;  and  between  us,  said  she,  we  succeed- 
ed bcnatiliilly.  I  took  a 'nice  piece  of  beef — cut  it  in  very  fine  pieces 
~pot  them  in  a  bottle,  corked  it  carefully,  and  then  put  it  in  a  kettle 
•f  water  aiid  boiled  for  two  hours  :  we  then  took  out  the  bottle  and 
U  the  patient  a  spoonful  of  the  water  from  the  kettle  every  two  hours! 

light  feift  Bomeapaikic  Olobules. — And  while  we  are  in  the  way  of 
it  bare  is  another  humorouf  item  that  will  bear  repeating.  Every  body 


122  JUitar'9  Table.  [Fabrnaiy, 

in  the  Miuni  valley  knows  Rev.  Bam.  Clayton.  Ho  if  a  genial,  mn- 
ny  felIow»  and  a  worthy  member  of  the  Methodist  traveling  connee^ 
tion ;  and  furthermore,  he  is  not  one  of  your  Methodist  clergymen 
who  is  to  bo  trapped  or  seduced  into  any  endorsement  of  qnaoka-^ 
"  mellifloons  "  or  otherwisop  simply  becanse  they  treat  him  oonrteone- 
ly  or  send  him  a  box  of  pills  via  the  Book  Concern.  Clayton  happen- 
ed "  once  on  a  time  '*  to  be  enjoying  the  hospitalities  of  a  homeopathio 
doctor,  and  it  also  happened  that  he  was  somewhat  unwell :  of  coniae 
the  host  was  anxious  to  do  all  in  his  power  to  make  his  guest  com* 
fortable,  and  bringing  a  few  globules  in  his  hand  was  very  certain 
they  would  relieve  his  ailments ;  *'  very  well,  says  Sam,  all  right,  on- 
ly hold  on  a  little  my  good  brother,  while  I  go  out  and  catch  a  hand- 
ful of  lightning  bugs  to  show  them  little  pills  the  right  way— t^^y'll 
never  find  the  track  themselves.  " 

The  Trumpei'Eat, — ^Bnckland,  in  his  OyrioniieM  qf  Nafwroi  JBitUnf, 
gives  the  following  account  of  a  lawsuit  in  France  about  a  rat : 

Pliny,  Bnffon  and  Lacepede  have  made  ns  acquainted  with  the  racee 
of  animals  which  inhabit  the  two  hemispheres,  but  none  of  these 
savants,  any  moi-e  than  the  naturalists,  their  successors,  have  made 
mention  of  the  **  trumpet-rat,''  and  a  search  for  it  among  the  antedi- 
luvian animals  discovered  by  science  will  be  equally  nnsuooesefiil. 
The  "  trumpet-rat"  is  modern ;  its  existence  dates  from  the  time  the 
Zouaves  were  in  Africa.  The  action  at  law  brought  by  M.  Trignsl 
against  Girome,  a  retired  Zouave,  makes  us  believe  that  this  is  the 
animal  in  question. 

The  Plaintiff. — "  Gentlemen,  this  individual  has  cheated  me  oat  e( 
a  hundred  francs  (820),  and  has,  at  the  same  time,  wilfully  abased 
my  confidence.  He  knows  that  I  am  much  interested  in  geology,  an- 
tiquities, natural  sciences.  I  have  collections  of  fossils,  of  medals,  of 
rare  animals,  of  curious  plants.  One  day  he  called  upon  me,  and 
said  :  '  Sir,  I  have  a  kind  of  animal  which  has  never  been  mentioned 
by  any  naturalist.'  '  What  is  it,  sir  ? '  '  It  is  a  trumpet-nt.' 
'  What  do  you  call  the  trumpet-rat  ?  '  '  Sir,  as  the  name  indicates,  ifc 
is  a  rat  which  has  a  trumpet.'  '  Where  is  it  ? '  'On  his  nose  lil»  a 
rhinoceros.'  *  And  you  nave  it  alive?'  'Alive  and  well;  if  yon 
wish  to  see  it,  you  have  only  to  come  to  my  house.'  '  Directly  ;  come 
along.' 

"  I  was  very  anxions  to  see  this  strange  animal.  We  arrived  at 
his  house,  and  he  shows  me  in  a  cage  an  enormous  rat,  very  lively  and 
in  a  good  condition,  and-  which  really  had  on  its  nose  a  sort  of  slender 
excrescence  about  two  centimetres  long  (two* thirds  of  an  inch),  eov* 
-ered  with  hair  like  the  body  of  the  animal,  with  vertobrsB  in  it,  and,  n 
imost  extraordinary  thing,  larger  at  the  summit  than  at  the  bast,  the 


1864.]  EiUw't  TtMe.  '    123 

• 

contrary  to  what  it  ought  to  be  in  the  nsaal  coarse  of  thingR.  I  ask 
to  examine  this  phenomenon ;  he  puts  it  in  my  band,  and  hold  its 
pava  and  head  that  I  might  examine  at  my  ease  this  extraordiuary 
tmmpel.  I  ^k  him  if  it  were  not  a  dnpe,  and  mystification,  and  to 
convince  myself  I  take  a  pin  and  force  it  into  the  trumpet.  The  ani- 
mal cried  out,  winced,  and  a  drop  of  blood  came  from  the  prick.  The 
experiment  was  conclusive — il  was  really  a  trumpet  terming  a  part  of 
the  imL 

"  I  wonder.  I  ask  this  man  if  he  would  sell  his  rat.  He  answers 
in  the  affirmative.  I  ask  his  price.  Fifty  francs.  I  pay  it  without 
any  bargaining,  and  I  bring  the  animal  home.  I  invite  my  friends 
and  senranta  to  see  it ;  the  cry  of  admiration  was  universal — I  was 
enchanted. 

"  Some  one  says  to  me,  "  You  ought  to  procure  a  female  (this  was 
a  male).'  I  had  thought  of  that,  but  lAving  seen  but  one  rat  at  the 
house  of  the  person  who  sold  it  to  me,  I  concluded  that  he  had  no 
more.  I  determined,  therefore,  to  go  directly  to  see,  and  I  ask  him 
if  it  were  possible  to  get  a  female.  '  Nothing  easier,'  he  answered 
me ; '  I  have  written  to  Africa,  and  they  have  sent  me  many  tnimpet- 
raCa,  of  which  I  have  two  females.'  With  these  words,  he  brings 
ont  a  cage  full  of  rats  like  that  which  he  had  sold  me.  He  chooses 
me  a  female,  for  which  I  pay  him  fitly  francs  (810.)  I  carry  it  off 
mora  enchanted  than  ever.  Some  months  afterward  the  female  has 
yonng ;  I  look  at  them,  they  had  not  trumpets.  I  say  to  myself, 
*  Witboot  doubt  they  will  sprout  hereafter  like  elephants'  tusks.'  I 
wait  one  month,  two  months,  six  months  ;  every  day  I  look  at  the 
nose  of  my  rats,  but  the  trumpet  never  appeared. 

"  In  a  house  where  I  go  frequently  I  make  the  acquaintance  of  an 
oScer  who  had  served  a  long  time  in  Africa.  'Tel!  me,'  I  Kays  to 
him  one  day — '  you  have  been  in  Africa — do  you  know  the  trumpet- 
mta  ?  *  '  Perfectly,'  he  auHwers  me.  '  Ah  1  then  you  can  inform 
ma.'  I  than  tell  him  my  story.  Then  this  gentleman  began  to  laugh, 
aa  though  his  sides  would  Rplit.  1  say  to  myself,  '  Certainly  then  I 
have  been  doped.'  When  he  was  calm  I  beg  him  to  explain  the  mo- 
tive of  hia  hilarity.  Then  he  tells  me  what  follows :  '  fho  trumpet- 
mi.  he  lells  me,  is  not  a  sn{>ernatural  thing — it  is  an  invention  due  to 
Ike  kianre  moments  of  the  Zouaves.  This  is  how  they  make  them  : 
JOB  taike  two  rats,  you  tie  their  paws  firmly  on  a  board,  the  nose  of 
close  to  the  end  of  the  tail  of  the  other ;  with  a  pen-knife  or  a 
yon  make  an  incision  into  the  nose  of  the  rat  which  is  hinder- 
and  yon  graft  the  tail  of  the  first  into  the  nose ;  you  tie  firmly 
the  moxxle  to  the  tail,  and  you  leave  the  two  rats  in  this  position  for 
|(>rtT -eight  hours.  At  the  end  of  the  time  the  union  has  taken  place, 
and' the  two  parts  have  grown  together  ;  then  you  cut  off  the  tail  of 
the  rat  which  is  ip  front  to  the  required  length,  and  let  him  go,  but 
adn  keep  the  other  tied  to  the  board,  but  with  his  head  loose,  and  you 
fiTo  him  aomething  to  eat.  At  the  end  of  a  month  or  more  the 
vonnd  ia  perfectly  healed,  and  the  eyes  of  the  most  curious  spectators 
woald  not  see  a  trace  of  the  grafting.  This  is  what  these  Zouaves  do ; 


124  EdUor's  Table.  [Febnuirj, 

the  rats  have  no  trumpet — you  have  been  deceived  (les  rats  n*ont  paa 
de  trompo  ;  vous  avez  eto  trompe). 

"  On  the  part  of  the  defendant,  it  was  urged  that  he  had  certainly 
made  up  the  rats  as,  has  been  stated,  but  he  affirms  that  he  had  not 
sold  them  to  the  plaintiff  as  rats  '  bom'  with  a  trumpet. 

The  President—" '  Is  this  true,  M.  Triguel  ?' 

M.  Triguel — "  *  You  understand,  sir,  after  the  experiment  wbich  I 
made  with  the  prick  of  the  pin,  which  bled  and  made  the  animal  cry, 
I  ought  to  believe  that  the  trumpet  was  natural.' 

The  President — "  *  Then  the  defendant  told  you  that  it  was  a  par- 
ticular kind  of  rat  ?  '  v 

The  Plaintiff—"  '  Yes,  without  doubt.' 

The  Defendant — "  '  In  fact,  it  is  a  particular  kind  of  rat.'  " 

Verdict  for  the  Zouave*— the  trumpet-rat  maker. 


A  Medical  Reformer  in  Spain  — Tlic  Spanish  medical  journals,  one 
and  all,  announce  with  profound  regret  the  death  of  Dr.  Asensio,  one 
of  the  warmest  supporters  of  medical  Beform.  The  deceased  always 
defended  with  great  energy  the  rights  of  medical  men,  and  was  con- 
spicuous for  his  activity  on  behalf  of  the  welfare  of  his  medical 
brethren. — London  LanceL 


Two  Niew  Cases  of  Syphilis  Conveyed  by  Vaccination, — Besides  the 
case  of  M.  Devcrgie,  lately  mentioned,  we  have  now  one  alluded  to 
by  M.  Chassaignac  before  the  Surgical  Society  of  Paris ;  and  another 
observed  by  M.  Hcrard,  and  brought  before  the  Medical  Society  of 
Hospitals.  The  parents,  in  both  cases,  have  not  suffered  from  syphilisi 
and  the  specific  ulcers  became  apparent  in  the  children  at  the  spot 
where  vaccination  had  been  performed.  The  symptoms  of  syphilis 
were  verified  by  the  members  of  both  the  above-mentioned  Societies. 
— London  Lancet. 


Nyctanopia, — Prof.  Hind,  of  Toronto,  has  published  some  curioas 
details  concerning  the  nyctalopia,  or  night-blindness,  prevalent  among 
the  !Montagnais  or  Nashquapee  Indians.  The  sufferers  from  this 
affliction  can  see  perfectly  as  long  as  the  sun  is  up,  but  become  nearly 
or  wholly  sightless  from  sunset  until  dawn.  No  artificial  light  is  of 
the  least  sei  vice.— Zomf on  Lancet. 


The  Medical  Staff  of  England. — From  the  last  census  it  appears 
that  there  are,  in  England  and  Wales,  one  surgeon  or  general  practi- 
tioner to  about  1712  of  the  population,  one  physicisn  to  5552»  and 
one  dentist  to  3505. — London  Lancet. 


1864.]  BdUar's  TM0.  125 


PriiiM  Current. — A  correspondent  wishes  to  know  why  we 
do  not  insert  Drcggist  circnlars  in  oar  Journal ;  complaining  that 
dealers  in  the  country  impose  a  heavy  advance  on  their  former  charges, 
and  they  desire  a  guide  as  to  proper  rates.  We  reply  that  Mr.  W.  J. 
M.  Gordon  d;  Brother,  and  other  advertisers  in  our  Journal  haveheen 
in  the  habit  of  famishing  such  a  Price  Carrent  to  our  subscribers,  but 
they  have  for  a  while  delayed  the  usual  issue  of  such  a  circular  on  ac- 
count of  the  unusual  advances  and  great  changes  which  have  been  con- 
Uantly  taking  place,  so  that  such  Price  Current  of  to-day  might,  in 
many  prominent  articles,  be  materially  changed  before  it  would  reach 
our  subscribers.  We  presume  however  the  circular  of  Messrs.  Gor- 
don will  appear  with  this  number  of  the  Lancet  and  Observer^  and  an- 
iwer  as  an  approximate  guide. 


LiTKRARY  ExcHAKGEs. — Barpev's  Magazine  for  February,  1864,  is 
already  on  our  table.  It  is  for  sale  by  all  book  and  periodical  dealers 
at  twenty-five  cents  a  number.  Harper  sustains  in  the  numbers  thus 
br  of  the  current  year  the  well-earned  reputation  so  well  established 
as  one  of  the  best  family  magazines  extant. 

Oodey^i  Lad%f*e  Book. — ^We  have  neglected  to  notice  this  old  favor- 
ite of  the  ladies  until  reminded  by  the  appearance  of  the  February 
number  which  is  before  us,  filled  to  repletion  with  its  usual  melange  of 
engravings,  model  cottages,  patterns,  and  fashions  and  furbelows,  with 
a  letter-press  of  pleasant  and  safe  light  reading.  Godey  is  now  pass- 
ing into  its  thirty'/uurlh  year  of  publication,  which  is  perhaps  as  good 
%  testimonial  of  its  character,  stability  and  excellence  as  any  words 
of  oars.  Price  $3.00  for  single  copy.  Address  L.  A.  Godey,  Phil.  , 
or  the  Zfcncet  and   Obeervcr  and    Qodey  sent  one  year  for  $4.50. 

Atlamik  Monthly  for  February,  1864.  The  contribators  for  the 
Bomber  before  us  present  the  following  brilliant  array  of  names  : 
Oliver  W.  Holmes,  Harriet  Beecber  Stowe,  Robt.  Dale  Owen,  Trow- 
bridge, Uilliard,  Alice  Carey,  Louis  Agassiz,  Mrs.  Waterston,  Hale, 
Cabot,  Akers  and  Wesson.  The  regular  readers  of  the  Atlantic  will 
ngBrd  oar  repeated  assertion  that  the  Atlantic  is  the  ablest  conducted 
periodicml  in  this  country  as  entirely  within  bounds.  It  is  furnished 
by  the  publishers,  Ticknor  k  Fields,  Boston,  and  by  all  news  dealers 
at  $3.00  a  year.  We  send  the  Lancet  and  Obscever  and  Atlantic  for 
$Ai»0  a  year. 

&.  Louis  Medical  and  SurgicalJoumal : — This  old  and  valued  ex- 
diaBge,  yielded  to  the  pressure  of  the  times  three  years  ago,  and  sus- 
pended its  issue.    We  are  pleased  to  learn  by  a  prospectus  which  has 


126  EdUor*8  TaMe.  [Febnunyt 

just  reached  ns  that  the  Journal  will  at  once  resume  it  puUioation,  to* 
be  under  the  Editorial  charge  of  its  former  able  and  well  known  chief 
Prof.  M.  L.  Linton,  of  the  St.  Louis  Medical  College,  and  Prof.  Frank 
M.  White,  of  the  same  Institution.  We  wish  our  old  eo/^frtr$  pros- 
perity and  success.  The  Journal  in  its  new  series  will  be  issued  every 
alternate  month,  with  ninety-six  pages,  at  92  a  year,  invariably  in  ad- 
vance. 


Pamphlets  Received — To  Know,  Us  Source,  iii  Mode,  and  Um 
Power. — An  Introductory  Address,  Delivered  at  the  St.  Louis  Hedica^ 
College,  November  2nd,  1863,  by  Prank  M.  White,  A.M.,M.D.,  Pro- 
fessor of  Materia  Medica,  and  Therapeutics. 

Transactions  of  the  Illinois  State  Medical  Society. — Eleventh  Annu&I 
meeting,  for  the  years  1861-2-3,  held  at  Jacksonville,  May  5th,  1863. 

Medical  Logic, — An  Introductory  Lecture  to  the  Medical  Depart- 
ment of  the  University  Michigan,  session  of  1863-4,  by  S.  G*.  Armor 
M.D.,  Prof,  of  Institutes  of  Medicine  and  Materia  Medica. 

The  Vascular  Connection  between  the  Mother  and  FaUtii  in  VUrc--^ 
By  John  O'Reilly,  M.D.,  F.R.C.S.I.,  etc.,  New  York. 

We  have  not  had  time  to  read  or  notice  these  pamphlets  as  we  could 
wish,  we  hope  to  do  so,  and  place  them  in  our  pigeon  hole  for  that 
reservation. 


Authority  of  Military  Commanders  over  General  Bospitals, — The< 
of  Assistant- Snrgeon  Waflen  Webster,  U.S.A.,  tried  for  disobedience 
and  conduct  prejudicial  to  military  discipline,  embraces  the  following 
facts  :  Gen.  Canby,  commanding  the  city  and  harbor  of  New  York, 
ordered  Gen.  Brown,  commanding  the  post  at  Fort  Schuyler,  to  arrert 
and  send  to  Governor's  Island  a  soldier  represented  to  be  at  that  post. 
The  man  being  not  at  the  post,  but  in  the  McDougall  General  Hospi- 
tal, General  Brown  ordered  Dr.  Webster,  of  the  regular  service,  in 
charge  of  hospital,  to  arrest  the  soldier  and  send  him  as  before  men- 
tioned. The  man  was  at  the  time  confined  to  his  ward  by  the  resnlts 
ot  a  severe  surgical  operation  just  performed,  and  could  not  be  remov- 
ed with  safety.  The  surgeon- in-charge  reported  to  Gen.  Brown  that 
since  General  Hospitals  were  under  the  control  of  the  Surgeon-General 
he  considered  it  his  duty  to  remove  patients  only  when  orders  came 
through  the  Medical  Director ;  and  for  this  repoit  he  was  put  on  trial. 

Orders  heretofore  given  had  been  through  the  Medical  Director  or 
the  Surgeon-General.  The  court-martial  found  Surgeon  Webster 
guilty,  and  sentenced  him  to  "  be  confined  to  the  limits  of  his  post 


1864.]  JSUik^'i  Tbble.  127 

Joft  mx  Bumtlui,  and  to  be  reprimanded  in  (General  Orders  by  tbe  Gkn- 
•nl  eommmnding  tbe  Department."  Qen.  Dix  modified  the  sentence, 
eanfiBhig  him  to  his  post  for  sixty  days.  This  case  raises  some  nice 
points  affecting  the  position  of  surgeons  in  charge  of  hospitals.  We 
shall  notice  them  more  at  length  at  some  future  day. — Amer.  Medical 


Ths  Value  of  Lutuitie  Life,  —  Some  time  ago  a  lunatic  named 
Ashmore,  confined  in  the  Richmond  Asylum,  was  killed  in  the  night 
by  another  patient,  not  previously  supposed  to  be  dangerous.  His 
widow  brought  an  action  against  'Dr.  Lalor,  the  superintendent,  which, 
after  a  two  days'  tria|,  was  decided  in  his  favor,  the  jury  not  consid- 
ering that  she  sustained  any  damage  by  losing  an  insane  husband.— 


7%e  Diew9erer  of  the  Circulaiion. — It  is  universally  believed  that 
Harrey,  the  eminent  physician  of  Charles  I.,  was  the  first  who  made 
ttat  great  physiological  discovery — viz.,  the  circulation  of  the  blood. 
On  tko  oilier  hand,  it  is  maintained  by  some — and  Dr.  Woden,  in  a 
work  written  and  published  som(»  two  hundred  years  ago  declares—- 
&at  Michael  Servetus,  the  French  physician  and  victim  of  Calvinistic 
iaiolerance,  who  was  burnt  at  Geneva  in  the  year  1553,  was  the  first 
discoverer  of  the  distribution  and  circulation  of  the  blood  through  the 
hsmaa  frmme. — Md. 


TV^p/ite. — ^The  wife  of  a  medical  man  a|pFuentemajor  (Spain),  has 
JMi  been  delivered  of  three  girls,  all  strong  and  healthy.  The  mother 
ii  fofty-three  years  of  age,  and  this  is  the  thirteenth  time  she  has  been 
coafioed  of  triplets.  It  would  be  interesting  to  learn  how  many  of 
these  thirty-nine  children  our  professional  brother  is  now  blessed  with. 
(Wa  extnu^t  this  paragraph  from  the  Gazette  Medicate  de  Lyon^  with 
aD  doe  reserve.  )^iW. 

The  AttUm  </  Oxygen  on  Wine, — At  the  last  meeting  of  the  Acad- 
eay  of  Sciences  M.  Berthelot  showed  that  ten  cubic  centimetres  of 
mre  raffieient  to  destroy  the  bouquet  of  a  litre  of  wine  in  a  few 
istea.  Hence  the  importance  of  corking  bottles  carefully.  Yet  a 
quantity  of  oxygen  in  a  diluted  state,  as  in  atmospheric  air, 
not  seem  to  spoil  the  bouquet,  owing  to  the  presence  of  carbonio 
ia  wine.  The  eaose  of  the  loss  of  bouquet  in  wine  afler  long 
¥ii|iin|t  appears  to  be  the  gradual  absorption  of  oxygen,  which  affects 
it  as  woold  the  addition  of  a  mineral  water,  such  as  that  of  Vichy. — 


128  BdUor'i  ToNt.  [Febiii«y. 

Munificeni  JBequett, — ^The  late  James  H.  EooseTelt  has  beqoeadiML 
about  $900,000  for  the  establishment  and  endowment  of  a  hoepiUd  in 
New  York.  The  testator  gives  this  fond  in  trust  to  certain  designat- 
ed persons.  No  restrictions  are  placed  upon  the  trustees  in  regard  to 
the  locality  or  character  of  the  hospital.  A  fine  opportunity  is  thus 
afforded,  of  which  we  trust  advantage  will  be  taken,  to  erect  a  modal 
hospital,  one  which  will  fulfil  all  the  requirements  of  the  science  of  the 
day. — Med.  Netos  and  Library. 

Surgeon-  General  Hammond. — We  are  glad  to  learn  that  the  severe 
injury  which  this  gentleman  received  by  a  fall  at  Nashville,  is  not 
likely  to  produce  permanent  ill  efifects.  At  first  he  was  deprived  of 
the  use  of  his  lower  limbs,  but  the  most  serious  symptom  has  in  some 
measure  disappeared.  It  is  now  confidently  anticipated  that  his  re- 
covery will  finally  be  complete. — Amer.  Med.  Times. 

American  Medical  Association. — ^Tbere  are  abundant  indications  that 
the  next  meeting  to  be  held  in  New  York,  in  June,  will  be  one  of  ths 
largest  ever  held.  From  all  parts  of  the  country  we  hear  the  note  of 
preparation.  The  profession  of  New  York  have  for  some  time  been 
making  arrangements  to  render  the  meeting  in  the  highest  degree  a  ^ 
success.  Societies  throughout  the  country  should  appoint  delegates 
at  an  early  day,  to  give  ample  time  for  preparation. — Ibid. 

Died,  in  Baltimore,  Dec.  25,  1868,  of  pneumonia,  Samuel  Ohsw, 
M.D.,  Professor  of  the  Principles  and  Practice  of  Medicine  in  the 
University  of  Maryland.  ^ 

Died,  in  Boston,  on  the  8th  of  January,  from  rupture  of  left  kidney 
caused  by  a  fall  on  the  ice,  John  C.  Dalton,  aged  68  years. 


Army  Medical  Intelligence. 

Special  Orders,  No.  24. 

Was  Dxpaktmbht,  Adjutaitt-Gbrbkal's  Omei,  l 
Wasbirqton,  D.  C^  Jan.  16,  1864.     / 

19.  By  direction  of  the  President,  a  General  Court-Martial  is  hereby 
appointed  to  meet  in  this  city  at  12  o'clock  m .  on  the  19th  day  of  Jan- 
uary, 1864,  or  as  soon  thereafter  as  practicable,  for  the  trial  of  Brig.- 
Gen,  W.  A.  Hammond,  Surgeon-General  U.S.A.,  and  such  other 
prisoners  as  may  be  brought  before  it. 

Detail/or  the  Court. — Major  Gen.  Rr  J.  Oglesby,  U.S.V. ;  Bng.- 
Gen.  W.  S.  Haniey,  U.S.A.  ;  Brig.-Gen.  W.  S.  Ketchum.  U.S.V. ; 
Brig.-Gen.  G.  S.  Green,  U.S.V. ;  Brevet  Brig.-Gen.  W.  W.  Morris, 


18M.J  Bdiiar*i  TM0.  129 

Gohmel  2d.  U.  B.  Artillery ;  Brig.-Gen.  A.  P.  Howe,  U.8.V. ;  Brig.- 
Qm.  J.  P.  SloDgh,  U.8.V. ;  Brig.-Gen.  H.  E.  Paine.  U.S.V. ;  BriR.- 
Otn.  J.  G.  Starkweather,  U.S.V. ;  Major  John  A.  Bingham,  Judge 
Advocate  of  the  Court. 

No  other  officers  than  those  named  can  be  assembled  without  mani- 
fat  iDJory  to  the  service. 

Bj  order  of  the  Secretary  of  War : 

E.  D.  TowssEND,  A86ist.-Adjt.-G«n. 

Gtneral  OrderB,  No.  2. 

War  Dkpartxknt,  Adjvtaiit-Gknbral's  0»ick,  1 
Washinoton,  D.  C,  Jan.  2, 1864.     / 

The  percentage  of  men  allowed  to  be  absent  at  one  time  nnder  the 
atthoritj  given  in  (General  Orders,  No.  391,  of  1863,  to  grant  for- 
loQghi  to  enlisted  men  in  hospitals,  is  changed  from  five  to  twenty  per 
cont. 

By  order  of  the  Secretary  of  War : 

E.  D.  TowKSEND,  Assist.-Adjt.-Gen. 

Omenl  Order$,  No.  9. 

War  DxPARTMKirT,  Adjctamt-Qeneral's  Opfick,  1 
Washington,  D.  C,  Jan.  4,  1864.     j 

The  Hospital  and  Ambalance  Flags  of  the  Army  are  established  ks 
foDows  :  For  General  Hospitals,  yellow  bunting  9  by  5  feet,  with  the 
letter  H,  24  inches  long,  of  green  bunting,  i|i  centre. 

For  Post  and  Field  Hospitals,  yellow  bunting  6  by  4  feet,  with 
letter  H,  24  inches  long,  of  green  bunting,  in  centre. 

For  ambulances  and  guidons  to  mark  the  way  to  field  hospitals, 
yellow  bunting  14  by  28  inches,  with  a  border,  one  inch  deep,  of  green. 

By  order  of  the  Secretary  of  War  : 

E.  D.  TowvsEND,  Assist. -Adjt. -Gen. 

Cum/or  Letter. 

Surokon-Gkneral's  OFricB,  1 

Wasuinoton,  D.  Cf  Jan.  14,  1864.     / 

The  Board  of  Medical  Officers,  assembled  al  the  city  of  Philadel- 
phia, for  the  pnrpose  of  examining  the  different  models  submitted  to 
them  for  an  artificial  arm,  liaviug  reported  in  favor  of  Selpho's  Model 
for  cases  of  amputation  below,  and  the  Lincoln  Model  above  the  elbow 
joint,  yon  are  authorized  to  order  artificial  arms,  from  these  manufac- 
turers, for  soldiers  who  may  be  entitled  to  receive  them,  under  the  same 
instnictions  as  heretofore  published  for  artificial  limbs,  the  price  not 
to  exceed  fifty  dollars  (•50.) 

In  compliance  with  the  recommendation  of  the  Board,  when  a  sol- 
dier may  desire  to  purchase  "  the  more  elegant  and  expensive  arm  of 
Pafaotr/'  fifty  dollars  will  be  allowed  toward  payment  for  the  same, 
vpon  a  written  application  to  that  effect  to  a  Medical  Director,  who  shall 
salieff  himself  that  the  transaction  has  been  carried  out  in  good  fsith. 

By  ordar  of  the  Acting  Surgeon- General. 

G.  H.  Crake,  Surgeon  U.S.A. 


180  EdMior*9  TohU.  [F6bnu»7» 

The  resignation  of  Lient-GoL  Wm.  H.  Masaey,  Medical  Inspoetor 
U.S.A.,  has  been  accepted  bj  the  President,  to  take  effect  Jan.  1«  1884. 

Snrgeon  L.  H.  Holden,  U  S.A.,  has  been  ordered  to  proceed  withoat 
delay  to  Wilmington,  Del.,  and  report  in  person  for  examination  to 
Major-General  McDowell,  President  of  the  Kotiring  Board,  convenad 
by  Special  Orders  No.  807,  Jnlj  11, 1863,  from  the  War  Department. 

Medical  Inspector  R.  H.  Coolidge,  U.S.A.,  will  at  once  repair  to 
Knoxville,  Tenn.,  and  examine  into  and  report  npon  the  sanitary  con- 
dition of  the  United  States  troops,  at  or  near  Knoxville.  Upon  tha 
completion  of  this  dnty,  Medical  Inspector  Coolidge  will  at  once  return 
to  New  York,  and  report  in  person  to  the  Suig.-Gen.  of  the  Army. 

So  much  of  Special  Orders,  No.  664,  current  series,  from  the  War 
Department,  as  discharged  Sargeon  John  J.  Marks,  I8th  Pennsylvania 
Cavalry,  for  physical  disability  and  absence  without  leave,  is  so 
amended  as  to  omit  the  charge  of  absence  without  leave. 

Sargeon  Henry  A.  Martin,  U.S.V.,  is  relieved  from  duty  at  Pilot 
Knob,  Mo.,  and  will  proceed  without  delay  to  Fort  Monroe,  Va.,  and 
report  in  person  for  dnty  to  Major-General  Butler,  U.8.V.,  command- 
ing Department  of  Virginia  and  North  Carolina. 

Upon  the  recommendation  of  a  Board  of  Officers,  convened  by 
Special  Orders  No.  285,  June  27, 1863,  from  the  War  Department 
Acting  Assist. -Surgeon  Alexander  B.  Tadlock,  4th  Tennessee  Vola^ 
is  honorably  discharged  the  service  of  the  United  States,  on  account 
of  physical  disability. 

In  addition  to  his  duties  as  Health  Officer,  Surgeon  H.  J.  Church- 
man, U.S.y.,  has  been  assigned  to  duty  as  Post-Surgeon  at  Vicks* 
burg.  Mo.  V 

Assistant-Surgeon  Samuel  Hart,  U.S.V.,  has  been  relieved  from 
duty  with  the  16th  U.  S.  Infantry ,  and  placed  in  charge  of  the  11th 
Division,  General  Hospital,  Murfreesboro',  Tenn. 

Surgeon  Howard  Culbertson,  U.S.Y.,  has  assumed  charge  of  the 
Harvey  General  Hospital  at  Madison,  Wis.,  Assistant- Surgeon  Fran- 
cis L.  Town,  U.S.A.,  recently  in  charge,  has  been  ordered  to  report 
in  person  at  the  Office  of  the  Assistant  Surgeon-General,  at  Louis* 
ville.  Ky. 

Surgeon  F.  N.  Burke,  U.S.Y.,  has  been  transferred  from  Jefferson 
Hospital  to  Gayoso  Hospital  at  Memphi?,  Tenn. 

Surgeon  Enoch  Pearce,  U.S.Y,,  absent  on  sick  leave,  has  been  or- 
dered before  the  Board  in  session  at  Cincinnati,  Ohio,  for  the  examina- 
tion of  sick  officers. 

A.  P.  Esselhom,  of  Cincinnati,  Ohio,  and  Charles  E.  Sanborn,  of 
Boston.  Mass.,  have  been  appointed  Medical  Cadets,  U.S.A. 

Surgeon  Georse  S.  Courtright,  U.S.Y.,  has  been  assigned  to  dnty 
at  Fort  Sumner,  N.  M. 

Surgeon  D.  W.  Hartshorn,  U.S.Y.,  has  been  ordered  to  report  to 
the  Medical  Director  at  Louisville,  Ky.,  for  temporary  duty  while 
awaiting  acceptance  of  his  resignation. 


1864.]  BiUorial  AhttraeU  and  SilecHoM.  181 

Smnon  A.  C.  Scbwarzwelder,  IT.S.y.9  has  been  directed  to  report 
to  the  lledical  Director,  Lomsville,  Ky. 

Somon  D.  G.  Brinton,  U.S.Y.,  has  been  assigned  to  duty  as  Med- 
ical Director.  11th  Armj  Corps,  Army  of  thp  Gomberland. 

Sorgeoa  L.  0.  Bice,  U.8.V.,  has  been  ordered  to  report  to  the 
Aeriatant  Sorgeon-Gteneral  at  Lonisville,  Ky. 

Burgeon  Thomas  McHillin,  U.S.A..  will  report  in  person  without 
ddaj  to  the  Oommanding  General,  Army  of  tne  Potomac. 


^"^nm^^-^- 


%AiUtin\  %%%Xtiit\$  xntf  S^tXuiUv^t, 


PRACTICAL    MEDICINE. 

I 

1.  Fatal  Oai€  of  Pwmmng  hf  Oil  of  Biiier  Almonds. — Edward 
EIllis»  M.D.  was  called  abont  a  quarter  to  eleven  on  Monday  evening, 
Angnst  Sd,  to  a  person  "  who,  it  was  feared  was  in  a  fit ;  only  there 
was  a  strong  smell  of  the  oil  of  bitter  almonds  in  the  room."  In 
leaa  than  ten  minntes  he  was  at  the  house,  takioff  with  him  some 
ftronaCic  spirit  of  ammonia,  etc.,  in  case  he  should  find  the  suspicion 
^  bittar-almond-oil  poisoning  to  be  true.  He  found  the  patient,  a  lady 
aged  thirty-six,  lying  on  the  bed,  motionless  and  insensible.  Her 
friends  stated  that  they  had  found  her  lying  on  the  floor,  and  had  lifted 
ker  npoQ  the  bed ;  and  that  she  had  not  spoken  or  shown  any  token 
of  consciousness.  This  must  have  been  about  four  minutes  after  tak- 
ing the  poison.  When  Dr.  Ellis  saw  her,  about  fourteen  minutes 
bad  elapsed.  Her  breathing  was  then  stertorous  and  at  long  inter- 
Tals ;  her  mouth  was  open  ;  the  breath  smelling  most  powerfully  of 
oil  of  bitter  almonds,  as  also  the  air  of  the  room  ;  her  lips  wore  pale 
and  bluish ;  the  surface  cold  and  clammy.  There  was  no  distortion 
of  the  features  or  convulsion  up  to  the  time  she  died.  Her  pnlse  was 
alow  and  flickering,  and  the  heart's  beat  correspondingly  feeble,  some- 
times intermittent.  The  eyes  were  fixed  and  glassy  ;  the.  pupils  mod- 
erately dilated  and  quite  insensible  to  light.  In  seven  minutes  after 
Dr.  E.  first  saw  her  she  was  dead. 

He  had  the  windows  thrown  open  and  her  chest  bared,  and  kept  up 
artificial  respiration,  moistening  the  lips  with  ammonia ;  but  it  was 
erident  from  the  outset  that  all  efforts  would  be  unavailing. 

At  the  post-mortem  examination  made  forty-four  hours  after  death' 
the  weather  being  warm)  there  was  no  notable  smell  of  bitter  almonds 
at  the  month ;  the  discoloration  of  the  surface,  especially  of  the  more 
depending  parts  of  the  body,  was  very  marked  ;  there  was  no  draw- 
ing or  distortion  of  the  features  ;  the  color  of  the  muscles  was  not 
Basch  changed,  but  on  the  whole  rather  darker  than  natural.  On 
Ciieniag  the  chest  an  intense  odor  of  bitter  almonds  became  percepti- 
ble. *&»  Inngs  were  goiged  with  black  blood,  and  smelt  strongly  on 
aeetiofi.  The  heart  was  nearly  empty  ;  the  left  ventricle  firmly  con- 
tracted.   The  liver  was  slightly  congested  ;  the  spleen  and  kidneys 


182  Edilorlal  AbatracU  and  SdectUmi.  [FebiiiaTj» 

healthy.  The  stomach  was  removed  in  a  pot  for  after-examinaiioD^ 
he  examined  it  on  the  following  day.  It  was  opened  along  the  lesser 
curvature,  and  the  contents  were  found  to  be  about  foar  ounces,  con- 
sisting mainly  of  nndigesting  food,  smelling  intensely  of  the  oil,  and« 
on  being  tested,  giving  abundant  evidence  of  the  presence  of  pmssic 
acid.  The  mucous  membrane  was  black  and  softened,  with  one  or 
two  red  patches  of  inflammation  toward  the  cardiac  end. 

At  the  inquest  it  appeared  that  the  deceased  had  purchased  a  shil- 
ling's worth  of  the  essential  oil  of  bitter  almonds  at  a  chemist's  in  the 
neighborhood,  and  that  his  assistant  had  sold  her  two  drachms. 

I  should  add  that  at  the  time  of  the  occurrence  she  had  been»  owing 
to  improved  health,  for  about  a  month  out  of  Bethlehem  Hospital ; 
and  dnring  that  time  her  friends  declare  that  she  acted  quite  ration- 
ally, and  exhibited  no  tendency  to  insanity,  for  which  she  had  been 
jifBviously  placed  under  restraint — London  Lancet. 

MATERIA  MEDICA. 

2.  Perchloride  of  Iron  as  a  Bamostaiie.  — -  The  Antwerp  Journal 
states  that  perchloride  of  iron  combined  with  collodion  is  a  good  h«* 
mostatic  in  the  case  of  wounds,  the  bites  of  leeches,  etc.  To  prepare 
it,  one  part  of  crystallized  perchloride  of  iron  is  mixed  with  six  parts 
of  collodion.  The  perchloride  of  iron  should  be  added  gradually  and 
with  care,  otherwise  such  a  quantity  of  heat  will  be  generated  as  to 
cause  the  collodion  to  boil.  The  composition  when  well  made  is  of  a 
yellowish  red  color,  perfectly  limpid,  and  produces  on  the  skin  a  yellow 
pellicle,  which  retains  great  elacticitj. — London  Lancet. 

8.  On  the  Preparation  of  Aconiime. — By  MM.  Liegcois  and  Hot- 
tot. — ^The  process  for  preparing  the  valuable  alkaloid  aconitine,  given 
by  the  authors  above  named,  is,  we  believe,  of  English  origin,  and 
will,  with  a  slight  difference,  be  incorporated  in  the  forthcoming  Bri- 
tish Pharmacopoeia  :  'we  therefore  extract  it : — 

"  The  bruised  root  of  the  Aconiium  napellue  is  digested  for  eight 
days  in  alcohol  slightly  acidulated  with  sulphuric  acid.  The  alcohol 
solution  is  then  pressed  out,  and  the  alcohol  distilled  off.  A  small 
quantity  of  green  oil  and  an  aqueous  extract  are  thus  obtained.  The 
green  oil  is  separated,  and  the  extract  further  evaporated  to  the  consis- 
tence of  a  syrup.  It  is  now  dissolved  in  water  and  neutralized  with 
magnesia,  and  then  shaken  up  with  ether.  The  etberial  solution  on 
evaporation  yields  the  rough  aconitine.  This  is  again  dissolved  in 
water  acidulated  with  sulphuric  acid,  and  decolorised  by  means  of  ani- 
mal charcoal.  Ammonia  is  then  added  to  precipitate  the  aconitine, 
and  the  mixture  boiled,  after  which  the  alkaloid  U  collected  on  a  filter 
and  dried.  This  part  of  the  process  is  repeated  once,  or  twice  if  nec- 
essary, in  order  to  obtain  the  alkaloid  with  as  little  color  as  possible. 
It  is  eventually  precipitated  with  a  very  slight  excess  of  ammonia,  and 
dried  at  a  low  temperature.  " 

Aconitine  so  obtained  is  of  course  completely  soluble  in  ether,  and 
possesses  remarkable  activity.    The  alkaloid  received  from  the  Con- 


1864.]  Editorial  AhttracU  and  SelecUom.  188 

tinent,  and  commonly  sold  in  England,  is,  as  was  recenllj  shown  bj 
a  ooirespondent  of  this  Jonraal,  of  very  inferior  qnality.  Our  cor- 
respondent administered  three  grains  to  a  dog  without  producing  the 
smallest  discomfort  to  the  animal.  Two  millig;amme8,  or  little  more 
than  three  hnndredths  of  a  grain,  prepared  by  MM.  Liegeois  and  Hot- 
tot  by  the  above  process,  killed  a  frog  in  four  minutes,  while  it  requir- 
ed a  grain  and  a  half  of  the  most  active  they  could  find  in  commerce 
to  produce  the  same  effect. 

\Vhat  foreign  aconitine  is  we  have  no  means  of  knowing.  It  may 
be^aftM.  Barreswill  supposes  (jSep^WotVtf  de  Chimie  Appiiquee,  Sep- 
tember, 1863,  p.  853),  *'  some  peculiar  principle,  such  as  asparagine, 
or  perhaps,  in  some  instances,  for  the  most  part,  sulphate  of  lime. " 
The  latter  was  not  the  case  with  two  samples  wo  have  examined,  which 
possessed  no  more  activity  than  that  mentioned  by  our  correspondent. 

The  British  Pharmacopoeia,  we  have  been  informed,  makes  consid- 
erable use  of  alkaloids,  and  as,  in  consequence  of  their  greater  cheap- 
ness, most  of  these  will  be  imported  from  abroad,  it  will  be  incumbent 
on  pharmaceutists  to  test  their  activity  by  oxpenments  on  living  ani- 
nuus,  or  procure  the  alkaloids  from  reliable  English  sources. — Chem. 
yinn,  London,  Oct.  24, 1863,  from  Joum.  de  Pharmacie,  August  1868. 

4.   Oh  Phloridzint  and  its  Use. — By  Dr.  Dc.  Bicci.-Phloridzine  is  a 
neutral  principle  existing  in  considerable  quantities  in  the  bark  of  the 
root  of  the  apple,  plum,  and  cherry  trees,  but  principally  in  the  root 
of  the  apple  tree.     It  appears  in  the  market  in  the  form  of  a  dirty- whi- 
tish powder,  consisting  of  broken-up,  silky  needles,  somewhat  resem- 
bling quinine  which  has  not  been  well  bleached,  and  when  rubbed  be- 
tween the  fingers  it  has  a  soft,  velvety  feci,  very  like  that  of  French 
chalk.     When  crystallized  by  slow  cooling  from  a  diluto  solution, 
previously  treated  with  freshly  prepared  animal  charcoal,  phloridzine 
may  be  obtained  perfectly  white,  and  in  the  form  of  long  silk  needles. 
Its  taste   is  peculiar,  being  bitter  at  first,  but  afterwards  somewhat 
sweetish,  with  a  flavor  og  apples.     Phloridzine  ditiers  from  quinine 
by  containing  no  nitrogine  in  it  schemical  composition,  but  in  this  re- 
spect it  resembles  salicine,  to  which  it  is  much  allied.     Like  salicine, 
it  does  not  combine  with  acids,  to  form  salts,  is  very  soluble  in  alco- 
hol, ether,  or  boiling  water,  but  requires  one  thousand  parts  of  cold 
water  for  solution. 

The  cases  in  which  Dr.  De  Ricci  has  employed  phloridzine   with 
most  SQCcess  have  been  certain  forms  of  atonic  dyspepsia  occurring  in 
delicate  females,  to  whom  it  was  impossible  to  administer  either  bark, 
qninioe,  or  salicine  in  any  shape,  without  bringing  on  serious  nervous 
excitement.    He  has  also  found  it  extremely  well  adapted  for  the  treat- 
ment of  yonng  children  of  delicate  constitutional  habit,  or  when  re- 
covering from  whooping-cough,  infantine  fever,  or  any  other  disease. 
TLs  doses  he  has  employed  are  five  grains  three  or  four  times  a  day 
for  adults,  and  proportionately  smaller  doses  for  young  children.    In 
pietcribing  phloridzine  it  must  bo  borne  in  mind  that  it  is  almost  in- 
aolmble  in  cold  water,  but  the  addition  of  a  very  small  quanity  of  am- 
monia instantly  dissolves  it ;   thus,  by  adding  to  an  eight  ounce  mix- 


134  Editorial  Abstraeti  and  Sdectians.  [Febmary, 

tare,  containing  a  drachm  of  phloridxine,  a  fow  drachms  of  aromatic 
spirit  of  ammonia,  the  fluid  which  was  previooslj  milky  becomes 
perfectly  clear,  and  the  addition  of  the  aromatic  spirit  rather  improves 
the  mixture  than  otherwise,  Dr.  De  Ricci  relates  the  case  of  a  young 
lady  of  a  strumous  constitution,  suJOfering  from  chlorosis,  in  which  the 
effects  of  phloridzino  were  manifestly  favorable.  The  patient  was  on* 
able  to  take  iron  in  any  shape,  and  both  quinine  and  salicine  eqoally 
disagreed  with  her  ;  but  phloridzine  agreed  perfectly  well,  and  her 
canstitution  improved  so  much  under  its  use  that  she  was  subsequent- 
ly able  to  take  citrate  of  iron  and  strychnia  in  grain  doses,  which  ulti- 
mately effected  a  perfect  cure.  Dr.  De  Ricci  thus  recapitnlates  the  ad- 
vantages of  this  drug  ;  it  is  tolerated  in  cases  where  neither  qninine,. 
nor  salicine,  nor  bark,  can  be  administered  with  impunity  ;  it  is  par- 
^Vcularly  adapted  to  young  children,  it  is  not  expensive,  and  it  is  abun- 
dantly supplied  in  Great  Britain,  thus  rendering  ns  independent  of  the 
rapidly  diminishing  cinchona  forests  of  South  America.-2>iiMiii  Quar. 
Jour,  of  Medical  Science,  August,  1863. 

5.  Piconitrate  of  Potash  as  a  Virmi/uffe'^^Some  months  ago  Dr. 
Friedrich,  of  Heidelberg,  described,  in  Virchow's  Arckiv,  the  benefi- 
cial effects  of  piconitrate  of  potash  in  cases  of  trichnia.  The  remedy 
has  also  been  employed  in  taenia.  Dr.  Walter,  of  Offenbach,  relates 
the  case  of  a  woman  aged  30,  who  had  toenia  sofium  for  several  years. 
During  fifteen  months  he  had  employed  all  known  remedies  for  tape- 
worm, including  the  bark  of  the  root  of  the  pomegranate,  considered 
by  some  as  infallible.  On  November  15,  1862,  he  gave  the  patient 
five  pills,  each  containing  ^ve  centigrammes  of  piconitrate  of  potash. 
On  the  20th,  an  entire  worm  was  expellad  with  the  head.  Four  days 
after  taking  the  medicine,  the  pttient  presented  a  jaundiced  appearanc. 
— DuUin  Med,  Prsss,  may  27,  1863,  from  Archiv/ur  Pathii,  AnaL 
und  Phys. 

6.  Note  on  Formosa  Camphor,  —  (By  Robert  Swinhoe,  F.G.8. 
etc.,  II.  M.  Consul  at  Talwin.) — The  manufacture  of  this  article  has 
for  some  years  been  monopolized  by  the  taotai  (or  head  Mandarin)  of 
the  inland,  and  its  sale  farmed  out  to  wealthy  natives.  In  former 
years,  a  good  deal  of  the  dnig  was  clandestinely  produced,  and  smug- 
gled across  to  China,  where  it  was  largely  brought  np  by  foreign  spec- 
ulators, and  carried  to  Hongkong  for  shipment  to  Calcutta,  at  which 
place  it  finds  the  resdiest  market,  being  used  by  the  natives  of  Hin- 
dostan  for  lubricating  the  body  and  other  domestic  purposes.  Bat 
now  its  monopoly  is  so  closely  watched  that  almost  the  entire  trade 
in  it  falls  to  the  lucky  individual  whose  Chinese  agents  can  secure  the 
monopoly.  This  bad  system  has  occasioned  the  price  of  the  article  in 
Hongkong  to  increase  considerably  in  value,  and  to  make  the  profits 
accruing  to  the  fortunate  monopulist  almost  fabulous.  The  cost  of 
the  drug,  I  learn,  amounts  to  only  six  dollars  at  its  place  of  manufac- 
ture. The  monopolist  buys  it  from  the  Madarin  at  16  dollars  the  pe- 
cul,  and  sells  it  in  Hongkong  at  28  dollars.  The  gigantic  laurel 
{Liiurus  camphora)  that  yields  the  camphor,  covers  the  whole  line  of 
high  mountains  extending  north  and  south  throughont  Formosa.    But 


1864.]  EdiiorUa  Abtirads  and  SeUaUmt.  -        135 

as  the  greater  part  of  this  range  is  in  the  hands  of  the  ahorigines,  the 
Chinese  are  ahle  to  gain  access  only  to  those  parts  of  the  mountains  con- 
tigaooi  to  their  own  territories  that  are  possessed  by  the  more  docile 
tnbet.  The  "trees,  as  they  are  required,  are  selected  for  the  abnn- 
daoee  of  their  sap,  as  many  are  too  dry  to  repay  the  labor  and  troable 
of  the  undertaking.  A  present  is  then  made  to  the  chief  of  the  tribe 
to  gain  permission  to  cut  down  the  selected  trees.  The  best  part  of 
the  tree  is  secured  for  timber,  and  the  refuse  cut  up  into  chips.  The 
cbipa  are  boiled  in  iron  pots,  one  inverted  on  another,  and  the  snbli- 
maied  vapor  is  the  desin^  result.  The  camphor  is  then  conveyed 
down  in  carts  of  rude  construction,  and  stowed  in  large  vats,  with 
eacape-holes  at  the  bottom,  whence  exudes  an  oil,  know  as  camphor- 
cU,  and  ufed  by  Chinese  practitioners  for  its  medicinal  properties  in 
rheumatic  diseases.  Samples  of  this  oil  have  been  sent  home,  and  ic 
may  eventually  become  a  desideratum  in  Europe.  From  the  vats  the 
cmmphor  is  stowed  in  bags  to  contain  about  a  pecul  each,  and  is  thns 
exported.  The  Chmese  government  has  empowered  the  Formosan 
anthorities  to  claim  on  its  account  all  the  timber  produced  by  the  is- 
land for  ship-building  purposes  ;  and  it  is  on  this  plea  the  Taotai  ap- 
propriatei  the  prescriptive  right  of  dealing  in  camphor.  About  6000 
pecnls  of  the  drug  are  annually  produced  in  the  neighborhood  of  Tam- 
•ay . — Am,  Jour,  of  Pharmacy,  from  London  Pharmaceutical  Journal, 
Dec.  1863,  Eiiraeted  from  paper  read  before  the  BritUh  Asaociation  at 
JTtweaetle, 


OPHTHALMOLOGICAL. 

7.     On   the  Use  of  Tannin  in  Inflammatory  Affections  of  the  Con* 
jmm€ii9a.—Bj    G.   K.   Sheraton,  I.R.C.H.E.,  M.R.G.S.— In   conse- 
quence of  the  great  discrepancy  of  opinion  that  seems  to  exist  rcs})ect- 
ing  the  relative  value  of  local  and  general  treatment  of  ophthalmia, 
each  of  which  has  been  extolled  and  variously  estimated  from  time  to 
time,  I  submit  for  the  consitieration  of  my  profcshional  brethren  the 
leanU  of  my  experience  in  this  class  of  disorders,  in  which  I  shall  st- 
tenpt  to  show  the  vast  superiority  of  the  local  over  the  antiphlogistic 
treatment,  of  the  value  of  astringents  generally,  and  of  tannin  in  pan- 
ticola*^.     But  in  the  treatment  of  this,  as  in   that  of  other  disoases, 
there  must  necessarily  be  considerable  modification  made  dependent 
vpon  its  cause,  for  if  arising  from  constitutional  causes,  that  stale  of 
constitution   must  be  remedied,  whilst  the  local  treatment  is  merely 
palliative  and  of  secondary  import ;  but  local  affections  dependent  up- 
on local  cansos  obviously  require  local  treatment.     Inflammatory  af- 
fections of  the  "  conjunctiva  "  usually  belong  to  the  latter  class.   "  No- 
where do  we  find  the  inflammatory-  process  so  admirably  shown,  or  the 
eflcct  of  remedies   so  easily  and  accurately  observetl ;    the  slightest 
change  in  the  congested  membrane  towards  resolution,  or  increased 
cottgeation,  the  most  casual  observer  cannot  fail  to  i>erceive. 

How   frequently  have  we  seen  the  antiphlogistic  treatment  perse- 

Tered  in  till  the  system  has  been  drained  of  its  blood,  without  prodnc- 

Bg'the  kast  beneficial  efiect,  otherwise  than  relieving  the  co-existing 


136  Editorial  Abitroeis  ami  StlfcHont.  [Febmu^ 

tj-mjitomntui  fbver,  with  a  attcceiifioii  uf  biihlcrt  enlf  lu  Jucioauq  tlie 
vcxaiinti  auil i]iuipi>oifitm«ut.  If  we  link  o\nt  tlia  liat  dHoimI  reiiie- 
ditt.  tliAl  liavu  liecu  aui^oextifullv  emplnjred  iii  the  ti-cktmi^nt  of  lito  op- 
thtttmia  wo^'illfiiid  tli«m  to  lie  tiitriiiffanU,  u  plamli.  »c«L,  u-yMt, 
nit.,  xiui'i  Kulpfa.,  iio.,  and  lliut  ihttk  brntifidal  riMultH  uo  in  pioi>or- 
tion  to  till!  umuiiiit  uf  iLHiriii^eucy  wbiuli  Ibuy  sonata, 

Axtriiijjenta  ttiv  itleo  iodiualed  on  disuivtieal  giouiitU,  ibe  rMubit 
oprratK^t  of  whidi  npon  tbe  living  tiiuiiieB  is  to  •  caQtiilonlila  estont 
mocbMnLnl by  cuiiCniclinx  tlu  fibi'<!a  and  cajiillary  vma^U  aribu  pait 
to  whiuti  liiey  nru  upplieii,  by  wbicli  }esa  fluid  la  aJmlU<.il  loin  tlieqt. 
But  ibu  HstriiigcnU  arJinarily  in  uite,  aud  derived  (totii  Ilia  m[im»I 
kingdam,  mv  ioaduiliuable  duriuj;  the  kouU  niages,  iu  ctfunequuiui  of 
ifae  vioJcTtt  tiiiuiiuD  ibey  pruduoe  if  itn^lied  directly  ro  ilie  uiaalimnq, 
except  in  a  very  ttwlTcciuul  ilegree  of  dilotiifii. 

l)n  tbcM  gruuodti,  Ciicii,  I  liave  bees  l«d  lo  umploy  Uuojd,  wblcfala 
probably  una  of  tbe  moat  powerful  aalriugeots,  wbilo  it»  corajiamivfl 
irMdom  li-um  irriintion  rendt-i'S  it  mmfa  and  effettiial  mn^ily  fkir  tbo 
claxH  ciFca!bL«  ivbidi  I  bave  prupoHt^.  Tile  maniieiiu  wbii'b  [ctuploy 
it  is  ia  Ibu  fui'ui  uf  eolation  «f  taaaiu.  3  i. — 3  ']■  t»  ep-  diui).  3  L 

A  Hiuiill  portiou  tif  tbi^  ia  dropped  into  ifae  eyo,  wliii-li  ■!  firtt 
vtimai  Ik  Amailiui;  Bensaiimn.  with  a  gu§h  of  tears,  ami  ivLii-b  ti  aiu- 
ueeded  by  dryiieiu)  aud  a  r««Iiri£  of  cumfort.  'tbU  is  lo  be  repaatud 
thne,  four,  or  a  doacn  tiiuce  a  day  as  ^itcumstaDoea  rnntu/e.  Tlq 
eSect  prodni'cd  ia  boou  made  appaicat ;  tbe  ilistentled  capiUariefl  aaOB 
to  becuniH  unloaded  of  their  stagiiuii  eontenla.  incitascJ  bcbiyntsUDn 
nnd  nuivi'piirnlent  dini^bargfl,  if  prusent,  i»  obeokcd,  the  orE-an  be- 
comes mwo  fined  tu  pi-rfuim  its  oiUnu,  and  tb«  dependent  <:ou*Ula- 
lifriutl  xympioutN  are  luitigatdd  aud  diMppi'ar.  I  bavo  nuw  Irealed  a 
mat  niinihor  of  caaes  uiont  nutiitfaeturily  m  M»  ciunDur,  wtLbcitil  vrnr 
bavin^  bud  oivaaron  to  doviittJ.'  from  ibut  aoitrcciti  tlie  Bliglilnat  ile^ron 
vbmt  ilie  riMtilt  of  cxtoiEal  caitMa  aud  uiicuuiit^cted  ivitU  I^(TtutitlltLon-_ 
wi  dialbtwi*  ;  thotigb  c)i«miMs,  whcu  prasttiit,  aMm  lo  relaiil  tlie  pro* 
gntn  Komnwhat,  probably  m  uonartiunriue  of  (be  HfTased  Quid  for  a  limtt 
pret-«min^  it*  fitti  coiiiitriutiva  iattunnie  upou  tbe  vapilUiy  vaaakU, 
twiner  I  liave  bun  tliurnugbly  uotivin'xd  of  ibc  utility  of  taiiDin  am  m 
remndiHlngenlin  thU  clana  ofca<4ie.  i  havi<  modified  tba  moil^  nf  ap- 
plinition  to  NuU  tbe  pxlgcndu*  of  iba  variuiia  auan,  e.  g..  by  its  cam- 
bination  with  aoiui.'  aqumua  Rxtracit  of  a  sedative  drnff,  ai  itoliiiiiin  of 
morpbia,  belladouua,  opium,  &e.,  to  ii<lievQ  tbe  diHtroeiiitif;  paiu.  beat 
and  eniaiUiig  tkal  always  to  a  ^rwter  or  Iom  extent  awotupany  thta 
d*i(order.  1  b»V6  alao  found  U  to  be  cxCrcmely  nasful  darla^  the  Muita 
aiago  of  Btriiraons,  pblysIuDuUr  corneiiio,  rcmoviop  ibo  vatoularibr 
more  eJtpfditely  ihan  any  olber  remedy  tliat  I  bav«  bilbntu  rinpluyaa, 
and  probably  lending  to  contraction  of  tbe  re^uUia^  alrer,  aud  bjr  lift 
combinntioQ  with  the  nqoeoun  solution  of  belladonna,  rW.,  aaotbe* 
and  relicveii  tfau  intolerance  of  lip:bL  ;  though  it  buH  uatially  hooo  mj 
pratilica  to  employ  the  ptimulaliuf;  mode  of  treatmcut  ax  aoou  at  tha 
faadculi  of  vossola  had  disap[i6ftred,  I  have  ako  beeu  careful  to  ae- 
<^ro  a  suitable  togimoii,  aud  a  doao  uf  apoii«iil  uiedicine  wbcn  sucb  waa 
deemed  neceasary. — Jirdieal  Timet  ami  Oste'U. 


1 


Wbala  Vouuoe,  XXV I  li- 


rtr  Iiincet  ^  ibscrber. 


?KNS.  M.I).   .   .    iiiHV  A.  Ml  lirilV.  M.li. 


rt 


m 


OOKTOTS  KOU  MA  It"  M     l>*fil 


Aw  I.— Lwiiiir«  un  itiia.l.ul  Wcwi.Ik.    Bj  B.  U-*,m\,  M.I' 

AIT.  II.— Hcmoti'liiglc  Duilioih    BjV.  Wngacr.M.D. 

Art  TM— ^Ttif  nrr'wiiiiTti  lt*ni»rH<nelnt.     Uj  J.  Bomiun.  M.U., 


napollB  Mtdlinl  .\BiiciutiuU'  < 


AntKiliHta  .ii  riiloi'ifufm .-.IlkVlB] 


r.i]{Ui  in  Jlvdrlnslii  i  .M<ri)UmeLi  lo  l>r.  l.iiln)ili 11 

Ltnliim  oil  i>nliu|iwnlic  Surgwy  I  TmiMaolIoiw  at  Ihe  IlllliO!*  Sulf 
Medical  ^cict;  :  i'lucrwllup  of  Sbs  AmPilcwi  i1niniui<,'«ur>'»I  Amu 
OMtlaii  at  111  BlfTriiili  Annual  M*MlBff  :  r>nl*ii'*  Fmediwl  TlinNM- 

as lUH-l 

■DITUn  TAaUL 

"HvmieliaallfScftllng"  GinuhH  WuomU  of  ihvlTliMi;  TttL*Mn>>' 
pamieiiUi  I  Nutlet*  ul  Publicatioiu  i  Arms  HriiMi  lnt*lli$cut«  i 
Arm;  Old  tn. ■ 

SPCCUL  JiKI-K.  I'litM. 

Ctrolini-Hfiiiiiil  M«uiiiK>(la..-.-  » 

EtMTOMu.  AmnAcn  txu  SuacnoH* 


I 


THE 

CINCINNATI  LANCET   AND  OBSERVER 

CONDUCTED  DT 

E.  B.  STEVENS.  M.D.,  AND  J.  A.  MUBPIir.  3I.D. 


▼el.  VII.  UABCH,    1864.  No.  3. 


Original  (^omiunoUations. 


ARTICLE    I. 

Lecture  on  Gunshot  Wounds.* 

BT  B.  BOWABD,  M.D.,  AI8I8TANT>8UBGB0«,  U.S.A.' 

'Ae  invitation  to  meet  jon,  geutlemcn,  having  been  received  at  mv 
hotel  only  a  few  honrs  ago,  I  can  not  pretend  to  treat  the  subject  under 
eoDuderation  at  all  exbaostively,  but  will  proceed  to  speak  to  you  in  a 
informal  manner  on  the  treatment  of  gunbhot  wounds  of  the 
in  general,  directing  your  attention  more  particularly  to  a  spe- 
cial mode  of  treatment  recently  pursued,  that,  viz.,  by  hermetically 
Mftling. 

*  If  Ton  have  consulted  the  authors  on  this  subject  to  any  extent, 
jon  bave  probably" observed  that  they  treat  very  [fully  on  ordinary 
penetrating  and  incised  wounds,  but  on  coming  to  gunshot  wounds, 
tkej  leave  ns  on  the  very  threshold  of  inquiry,  stating  evasively,  that 
at  these  wounds  differ  so  much  in  their  nature  from  simple  pcnctrat- 
iag,  or  incised  wounds,  all  that  has  boon  said  rcspci-ting  the  furmcr  is 
ippHcablc,  of  course,  in  the  local  treatment  of  the  latter.  They 
lunally  proceed  to  recommend  that  the  wound  be  covered  up  with 
a  sinple  dressing,  and  that  otherwise  the  general  indications  be  care- 
fally  met  as  they  may  arise. 

Bj  the  sketch  upon  the  Blackboard  you  will  perceive  that  the  lung 
ia  raspendcd  in  a  closed  chamber,  of  which  the  ribs  and  soft  parts  form 
■espcctively  the  lath  and  plaster.  This  red  line  represents  a  Fcrous 
membrane  called  the  pleura,  which  ceils  the  entire  wall*  On  reaching 
tht  not  of  the  Inng,  it  is  continued  by  reflection  uninterruptedly,  ju8t 


I  vH  deUtvrfd  at  rt<saMt  of  Prpf.  Dl^kmaa  to  the  cIam  of  the  M«(llcftl  CoUfge 
▼IL — 1. 


138  Original  CommutUcationi.  *  f March, 

as  I  am  continuing  this  red  line  over  the  entire  snrface  of  ihe  hmg ; 
that  part  lining  the  ribs  is  called  the  pleora-costalis — that  coTering  tbt 
surface  of  the  lung,  plcnra-pulmonalis.  It  is  thus  you  see,  we  have 
in  the  chest,  an  elastic  air-tight  chamber. 

The  air,  being  excluded  from  this  chamber,  it  follows,  that  motion 
of  the  ribs  upwards  and  outwards,  by  enlarging  it,  tends  to  produce 
a  vacuum  ;  this  necessitates  a  rush  of  air  down  the  trachea,  juet  as 
raising  the  side  of  a  pair  of  bellows  causes  a  current  of  air  to  rush  in 
through  its  valve.  The  air  thus  entering  entirely  inflates  the  elastic 
lung,  causing  an  expansion  corresponding  to  the  increased  size  of  the 
chamber.  This  is  breathing.  When  a  ball  passes  through  the  lang, 
it  breaks  through  the  chest  wall,  integument,  soft  parts  of  rib  perhaps ; 
tears  through  the  pleura-costalis ;  pleura-pulmonalis ;  the  lung  sub- 
stance, consisting  as  I  have  shown  you,  of  air-tubes  and  cells,  arte- 
ries, veins,  ner^^es,  connective  tissue,  etc. ;  and  continuing,  passes  on 
through  pleura-pnlmonalis,  costalis,  and  out  again  through  the  chest 
wall  at  the  opposite  side. 

The  most  alarming  symptoms  in  a  patient  thus  wounded,  are  as  we 
might  suppose,  dyspnoea  and  hsemorrhage.  The  patient  breathes 
hard,  for  there  is  a  rent  in  the  side  of  the  bellows ;  and  the  air  which 
should  be  expanding  the  lung  and  decarbonizing  the  blood,  is  audibly 
whistled  through  this  hole  out  into  space.  Tliis  air-tight  chamber, 
the  pleural  cavity,  being  now  open,  the  whole  surface  of  the  lung  it 
subjected  to  an  atmospheric  pressure  of  nearly  fifteen  pounds  to  the 
square  inch..  The  lung  is  compressed  against  the  posterior  wall  of  the 
cavity,  the  organ  is  laid  up,  its  ability  to  perform  its  functions  having 
temporarily  been  nearly  overcome  or  destroyed. 

The  mediastinum  is  more  or  less  subject  to  the  pressure  also  which 
diminishes  the  capacity  of  the  sound  side.  Bleeding  is  apt  to  be  very 
profuse  ;  for  as  we  have  seen,  this  organ  is  exceedingly  vascular,  as  it 
is  the  depot  where  all  the  blood  in  the  body  comes  to  obtain  its  supply 
of  oxygen.  The  hemorrhage,  together  with  the  dyspnoea,  induces  a 
leaden  pallor  of  countenance  ;  there  is  labored  respiration  ;  the  patient 
with  dilated  nostril  gasps  for  bi'eath,  and  he  wears  an  appealing, 
anxious,  apprehensive  expression,  looking  as  if  he  had  lost  something 
which  might  perhaps  never  be  recovered. 

The  treatment  urged  by  most  authors  for  these  local  difiiculties  are 
constitutional  in  their  nature.  For  the  hsemorrhage,  bleeding  to  syn- 
cope, use  of  opium,  etc.  For  the  dyspnoea,  nothing  that  I  know  of 
except  position,  which  indeed  the  patient  will  always  best  attend  to 
himself.     I  am  happy  to  say,  that  during  the  war  I  have  seen  neither 


Row AAD^OutiMhoi  Waufuh.  189 

phlebotomj  nor  opiam  resorted  to,  for  by  the  time  the  surgeon  sees 
tlie  pfttient,  he  has  osnally  lost  more  blood  than  a  wounded  man  can 
convenientlj  spare,  and  the  toxaemia  resulting  from  insufficient  respi- 
ration it  verj  manifest.  The  treatment  as  practised  in  our  army,  has 
been  Co  leaTe  entirely  alone,  covering  up  the  wound  with  a  rag  wet 
with  cold  water,  as  if  to  hide  our  shame  from  view,  and  endeavoring 
to  meet  subsequent  constitutional  indications  as  they  might  present 
themeelves.  Until  recently,  no  attempt  whatever  has  been  successful- 
ly made  to  arrest  the  chief  cause  of  trouble ;  which  is  first,  local ; 
afterwards  both  local  and  constitutional. 

The  wound  being  left  open,  the  full  force  of  atmospheric  pressure 
mpon  the  lung  is  constantly  kept  up.    The  blood  springing  from  its 
ieuree,  wells  upward,  and  passes  outward  by  overflow.     A  current  is 
thoa  kept  up,  which  is  exceedingly  favorable  to  the  continuance  of 
hemorrhage.     Should  it  be  arrested  by  formation  of  clot,  it  is  likely 
to  become  loosened,  and  the  bleeding  may  recur  at  any  moment. 
The  air  in  the  pleural  cavity  is  a  loreign  body,  which  acts  not  only 
ieally,  but  chemically.    The  clotted  blood  becomes  diffluent^ 
by  the  oxygen  of  renewed  currents  of  atmospheric  air  passiog 
kft  and  through  it,  is  soon  reduced  to  a  state  of  putrescence  ;  so 
that  this  also  in  addition  to  its  action  as  a  foreign  body,  has  its  chem* 
ied  character  so  changed  as  to  make  it  a  distinct  cause  of  vital  depres- 
sion.   TIm  pleura  too,  from  similar  exposure  to  air,  becomes  univer- 
sdly  inflamed,  and  with  extensive  pneumonia,  there  is  also  profuse 
sapperation  of  the  pleura  of  the  most  foetid  description,  sometimes 
■aking  an  entire  ward  intolerable.     While  all  these  evils  may  be 
cuaed  and  kept  up  by  keeping  the  wound  open,  the  only  advantage 
fnm  it  ever  auggested,  that  I  know  of,  is,  that  it  affords  an  outlet  for 
thseoHeding  fluids.    This,  however,  is  rarely  the  case  except  to  s 
■ttU  extent,  aa  it  only  occasionally  happens  that  the  wound  is  low 
ttoogh  to  afford  good  drainage,  but  simply  to  allow  of  overflow  of 
te  which  would  otherwise  rise  above  the  level  of  the  wonnd. 

Bo  loog  aa  the  wound  remains  open,  the  chief  cauae  of  the  original 
iTVptoBs,  dyspncea  and  haemorrhage  remain,  and  new  ones  are  com- 
?HidiBg, accumulating,  and  strengthening  for  a  reduction  of  the  con- 
■^MMMi  by  further  means.  Suppuration,  toxaemia,  hectic,  death, 
*^  oeenrring  soon  after  reception  of  the  wound,  is  usually  from  one 
^  both  of  the  former  superadded  to  shock.  When  it  takes  place 
*Acr  a  eonaiderable  period,  it  is  more  generally  the  result  of  one  or 
*Mt  ef  Urn  latter  causes. 
I^e  it  another  mode  of  treatment,  one  which  I  have  recently  in- 


140  Ori(final  Camnutnicaiiont.  [Marehy 

troduced  into  practice,  and  which  may  perhaps  more  readily  commend 

itself  to  yonr  judgment.    It  consists  in  reducing  the  gunshot  wound 

to  a  simple  incised  wound,  and  securing  healing  by  first  intention. 

It  is  conducted  thns  :  Introduce  the  point  of  a  sharp-pointed  biatomj 

perpendicularly  to  the  surface,  about  a  quarter  of  an  inch  abore  the 

wound,  and  with  a  sawing  motion,  pare  away  all  the  contused  mai]^, 

converting  the  wound  into  one  of  an  elliptical  shape,  then  dissect 

away  all  the  injured  portion  down  to  the  ribs.    Remove  all  foreign 

bodies,  speculie  of  bone,  eitc.,  make  the  wound  perfectly  clean,  and 

bring  the  edges  together  with  silver  sutures  deeply  inserted,  and  made 

secure  by  twisting.    Cut  them  off  short  and  turn  down  the  enda  out 

of  the  way.    Now  dry  the  surface  carefully,  and  apply  a  free  coating 

of  collodion  over  the  wound.    This  may  be  repeated  several  times  at 

discretion. 

In  order  to  increase  the  security  of  the  dressing  during  transporta- 
tion, arrange  shreds  of  charpie  crosswise,  in  addition,  over  the  wound, 
and  saturate  it  with  collodion.  By  repeating  this  a  few  times*  a  Tery 
firm  hard  dressing  is  obtained.  Cold  water  dressing  may  be  applied 
oyer  it,  and  if  deemed  desirable,  to  prevent  tension  on  the  sntuces,  a 
body  bandage,  also  a  many-tailed  one  of  adhesive  plaster  will  be  best 
if  convenient. 

Wo  have  now  restored  the  par(s  as  nearly  as  possible  to  their  nor- 
mal condition.  The  lung  is  again  in  an  air-tight  cavity,  an  integu* 
ment  of  collodion  having  sealed  the  wound  hermetically,  and  thus  en* 
tirely  removed  the  atmospheric  pressure  from  the  surface  of  this  organ. 
This  disposes  of  the  primary  cause  of  dyspnoea.  The  outflowing  cur- 
rent of  blood  has  been  stopped.  Thus  dammed  up,  only  a  little  mora 
can  possibly  be  poured  forth  from  the  bleeding  vessels.  This  soon 
stagnates,  and  forms  a  clot  whose  elastic  pressure  is  the  best  poesible 
styptic  to  the  open  vessels  of  the  yielding  lung.  We  have  thus  pro- 
vided against  death  from  hcemorrhage. 

You  will  now  perhaps  enquire,  what  becomes  of  the  clotted  blood 
enclosed  in  the  pleural  cacity  ?  Being  free  from  any  liability  to  de- 
composition, it  may  become  absorbed.  The  same  may  be  said  respect- 
ing pus,  should  it  happen  that  notwithstanding  our  preventive  mea- 
sure8  some  degree  of  suppuration  takes  place.  It  can  not  be  absorbed 
as  pus  however,  but  only  by  a  previous  transposition  of  its  component 
parts.  Should  fluid  be  present  so  as  to  occasion  inconvenience,  it 
should  be  immediately  removed  by  introducing  the  trochar  at  the  most 
dependent  point,  so  as  to  afford  complete  drainage ;  taking  special 
care  to  avoid  the  admission  of  air  during  the  operation. 


1864.]  Howard— &mimAo^  Wownds.  141 

RaspeetiDg  the  track  of  the  ball  through  the  lung.  Yoa  remember 
that  a  dot  has  already  formed  in  it,  all  the  wounded  vessels  opening 
into  It  have  become  securely  plugged,  and  thus  you  see  the  parts  are 
in  a  Terr  favorable  condition  for  the  formation  of  a  cicatrix. 

In  reply  to  the  question  of  Prof.  Blackman  I  would  state  that  I 
hmrm  Bot  seen  more  than  four  or  five  cases  of  hernia  of  the  lung.  This 
mode  of  treatment  is  certainly  the  best  preventive  of  such  a  compli* 
catioB,  aad  after  it  has  occurred,  I  can  say  from  experience  that  it  is 
certainly  the  most  effective  and  satisfactory,  placing  its  recurrence  en- 
tirely onl  of  question.  When  satisfied  that  union  is  complete,  remove 
ihe  antnres.  I  have  been  able  to  do  this  on  the  fourth  and  fifth  days, 
though  It  is  safer  to  wait  a  longer  period.  The  proper  time  for  this 
operation  is  before  any  suppuration  has  taken  place.  I  have  operated 
on  more  than  thirty  cases  within  the  first  forty-eight  hours  after  the 
reception  of  the  wound  ;  the  result  being  uniformly  all  I  could  antici* 
pate,  and  in  some  cases  tfhly  marvellous.  As  in  tlie  most  settled 
method  of  treatment  of  any  disease,  so  also  in  this,  will  modiGcation 
be  indicated  as  a  matter  of  course  by  exceptional  and  varying  condi- 
tions. 

It  is  interesting  on  looking  back,  to  note  how  many  years  this 
treatment  has  appeared  to  be  just  about  to  dawn.  Successive  authors 
have  recommended  the  closing  of  all  incised  and  penetrating,  but  have 
directed  exactly  the  opposite  course  in  gunshot  wounds  of  the  chest. 
Kow  the  conditions  are  pit)cise1y  the  same  in  each  case  except  as  re- 
gards the  nature  of  the  wound,  which  has  always  precluded  the  idea 
ef  poraning  in  gunshot  wounds  the  indications  common  to  both.     By 

loring  the  difference  in  the  conditions,  the  fatal  obstacle  is  over- 

aad  we  are  enabled  to  pursue  the  indications  alike  in  both  cases. 

T%ia  mode  of  treatment,  gentlemen,  is  not  to  be  considered  in  con- 

ti«at  with  some  other  method.     It  is  simply  a  question  between  this 

ami  nothing  ...  of  leaving  the  patient  to^die  if  he  must ;  to  recover 

if  he  can  ;  or,  the  adoption  of  a  course  which  promises  promptly  to 

kove  the  chief  cause  of  danger,  and  avert  the  tendencies  to  death. 


Jtmrria^s  of  Consanffuinify, — M.  De  Cinq  Cassaux,  with  a  view 
to  rdale  the  argnments  lately  brought  forward  to  prove  the  danger  of 
marriagea  amongst  relations,  quoted,  at  the  last  sitting  of  the  Acade- 
my of  Sdencea,  the  example  of  the  ancient  kings,  who,  since  the  time 
eC  CamhjaWt  had  been  in  the  habit  of  marrying  their  sisters,  and 
even  thsir  daughters,  and  yet  produced  a  very  fine  race. — Lancet, 


142  Original  Cammunicatiom,  [Hafcb, 


AET.  II. 

H»morrhagio  Diathesis. 

BT  F.   WAONEE,  M.D^  KELSO^  IND. 


Editobs  Lancet  ahd  Observer  : — After  reading  Dr.  Gans'  article 
in  the  November  number  of  the  Lancet  and  Observer^  on  the  hemor- 
rhagic diathesis,  which  by  the  way,  is  a  very  excellent  prodoctioo,  I 
am  convinced  that  a  great  apathy  has  held  in  the  profession  regarding 
the  statistics,  or  reporting  of  cases,  of  this  disorder.  I  am  certain 
that  twenty-one  families  or  fifty-eight  iDdividuals  afflicted  with  hnmo- 
phily  could  be  found  in  almost  any  one  of  the  larger  States  of  the 
Union#  leaving  the  British  Provinces  out  of  the  question.  In  m  very 
limited  field  of  observation,  and  in  the  course  of  but  a  few  years,  I 
became  cognizant  of  three  haemophilic  families  with  five  members 
affected,  in  my  immediate  neighborhood.  One,  a  young  lady  of  sev- 
enteen years,  otherwise  healthy,  bleeds  from  the  nose  as  often  as  four 
l)r  five  times  in  the  course  of  the  year,  generally  after  periods  of  ex- 
citement, produced  by  fast  walking  or  running  up  stairs  in  a  hany« 
Menstruation  regular  as  to  time  and  rather  profuse  in  quantity.  Hors 
than  once,  I  found  her  with  a  large  wash-basin  full  of  pure  blood 
before  her,  pallid,  cold,  faint  and  almost  pulseless,  the  blood  still  flow- 
ing,  almost  colorless  from  the  nose.  Plugging  had  never  done  much 
good,  the  bleeding  generally  recommencing  when  the  plugs  were 
withdrawn,  so  I  never  had  recourse  to  it  myself.  I  generally  succeed- 
ed in  arresting  the  flow  in  a  veiy  short  time,  by  giving  her  half 
drachm  doses  of  gallic  or  tannic  acid,  frequently  repeated,  and  inject- 
ing up  the  nostrils  a  strong  solution  of  acetate  of  lead,  very  cold,  or 
diluted  tincture  of  chloride  of  iron,  once  or  twice  I  had  to  nse  the 
perchloride,  which  preparation  I  do  not  fancy,  and  never  used  it,  if  I 
could  get  along  without  it,  on  account  of  the  unsightly  plug  it  pro- 
duces with  coagulated  blood,  and  which  generally  remains  in  the  nos- 
trils several  days,  compelling  the  patient  to  breathe  through  the  mouth. 
This  is  the  only  well  developed  case  in  that  family,  consisting  of  five 
children,  though  even  the  others  have  trouble  with  slight  cuts  and 
scratches. 

In  another  family  of  three  sons  and  four  daughters,  two  of  the  boys 
are  affected,  one  of  them,  being  on  a  visit  about  four  miles  from  home. 
picked  his  teeth  after  dinner  with  a  pin  and  slightly  wounded  his 
gums.  Profuse  bleeding  followed.  Domestic  remedies  were  used  by 
his  relations,  such  as  salt,  alum,  etc.,  but  to  no  purpose.     After  two 


1864.J  WAQVER—ffafmoffhapie  DiatkeMis.  148 

boon  bleeding  and  endeavors  to  stop  it,  be  bad  to  be  hanled  home  in 
a  apring-wagon,  being  unable,  from  faintness,  to  ride  his  horse.  I 
fonnd  but  a  rery  slight  scratch,  not  more  than  a  half  line  in  length, 
jet  several  applications  of  perch! oride  of  iron  were  necessary  to  arrest 
tba  haemorrhage.  This  young  man's  brother  was  known  by  me  to  be 
bsDmophilic,  yet  I  was  not  prepared  for  the  exhibition  he  made  of  it 
last  anmmer.  Being  accidentally  thrown  out  of  a  wagon,  he  struck 
tba  calf  of  bis  led  leg  against  the  wheel,  and  the  small  of  his  back 
against  a  fence  rail  on  the  ground.  Ho  felt  but  little  soreness,  and 
was  able  to  walk  to  the  house  without  difficulty.  But  in  a  short  time, 
extenaire  ecchymosis  came  on,  with  but  slight  swelling  in  the  spots 
where  he  was  struck.  In  the  corirse  of  three  hours,  ecchymosis  ex- 
tended from  the  eighth  rib  on  each  side,  and  the  whole  breadth  of  the 
posterior  surface  of  his  body  down  to  his  heels.  This  alarmed  the 
fiamilj  and  I  was  sent  for ;  ice  applications  were  made,  and  the  spread- 
ing of  *tbe  discoloration  arrested,  yet  it  took  several  weeks  to  get  rid 
of  it,  by  the  use  of  discutients,  and  stimulating  liniments  afterwards. 

Two  brothers  of  another  family  have  to  send  for  a  physician  every 
time  one  receives  a  slight  wound,  before  they  can  get  the  haemorrhage 
aCopped«  which  will  generally  recommence  if  the  dressing  is  removed 
in  leas  than  a  week's  time. 

While  I  have  the  pen  in  hand  I  wish  to  infoim  you  of  an  instance 
where  symptoms  of  narcotic  poisoning  came  on  after  minute  doses  of 
creoeote.  The  case  was  one  of  vomiting  dependent  on  pteg^ancy,  and 
almost  all  the  ordinary  remedies  had  been  employed  without  benefit, 
when  I  determined  to  try  creosote  as  recommended  by  a  distinguished 
gentleman  about  two  years  ago,  (the  formula  was  published  in  the 
Lameeiand  Ob$erver)  creosote  m.  ij.,  water  ft.  Jij-  Ten  drops  to  be 
giTen  at  shor^  intervals.  I  directed  it  to  be  given  every  hour.  After 
taking  the  first  dose,  her  husband  informed  me  next  day,  her  feet  and 
banda  got  cold  and  clammy,  while  the  head  and  face  were  hot.  She 
delirions,  "  complaining  of  anawful  headache."  These  symp- 
passed  off  in  about  half  an  hour.  Her  husband;  thinking  that 
tbcy  were  merely  accidental,  administered  the  next  dose  when  the 
lone  came.  The  same  symptoms  were  repeated,  excepting  that  she 
did  not  become  delirious,  but  in  place  of  it  was  affected  with  roaring 
in  the  ears,  dizziness  and  vertigo.  Her  husband,  a  tall  stout  man, 
standing  alongside  of  her  bed,  she  believed  to  be  half  a  mile  off,  and 
"  not  bigger  than  a  baby,"  while  her  children  in  the  room  appeared 
m  bar  not  larger  than  "  good-sized  rats."  It  was  more  than  an  hour 
beiBie  abe  got  better.    On  being  informed  of  these  circumstances  next 


fl 

144  Ofiginul  CdimmmaxtUmt.  [Ihrdi 

day,  I  was  astonished  and  doubted  considerabl j  the  eorreotness  of  tl 
report,  bnt  the  husband  of  the  lady  was  very  willing  to  xepeat  the  ei 
periment ;  which,  however,  I  prevented  him  from  doing,  notwithstand 
ing  my  own  curiosity.  After  using  a  variety  of  remedies,  she  finall 
got  well  on  pills  made  from  very  hard  opium,  and  a  diet  of  lime  wat( 
and  milk,  excluding  every  thing  else. 

Last  spring  I  had  a  somewhat  rare  case.  A  discharged  soldier,  ei 
gaged  in  hauling  wood  to  Indianapolis,  got  thoroughly  wet  eomin 
home.  Next  day  he  had  a  severe  chill,  and  when  the  fever  came  U] 
was  taken  with  pain  in  his  bowels.  This  passed  off  with  the  fever  i 
an  hour  aflor  it  had  begun.  The  day  following,  the  chill  came  c 
again,  afterwards  the  fever  and  pain,  the  latter  much  more  severe,  an 
it  did  not  subside  with  the  fever,  but  lasted  till  the  next  paroxysi 
came  on,  on  the  third  day«  when  it  became  agonising.  Being  sent  fo 
I  found  the  patient  in  bed,  with  an  anxious  countenance,  coated  tongU' 
quick,  sharp  pulse,  124  per  minute,  hurried  breathing,  knees  dran 
up,  abdomen  very  tender,  abdominal  muscles  contracted  and  stiff  as 
board,  with  numerous  knots,  the  size  of  a  walnut,  dispersed  throng 
them.  He  was  groaning  with  pain,  and  the  perspiration  was  pourii 
through  every  pore.  He  was  put  upon  quinine  and  opium,  two  grail 
of  each,  every  two  hours,  with  hop  fomentations  to  the  abdome 
Next  day  I  found  him  sitting  up,  and  but  slight  soreness  remaino 
A  cathartic  and  a  few  more  doses  of  quinine  with  small  portions 
morphia  completed  the  cure.  He  has  had  no  relapse  of  ague  or  per 
tonitis  to  the  present  time. 


AETICLB  nf. 

Case  of  Purpura  Hamorrhsgiea :  Treatment  followed  with  Radical  Cm 

BT   J.  BOWMAN,  M.D.,   8I8TBEYILLE,   WEST   VAI 

Was  called  on  July  2d,  1863,  to  visit  Mrs.* Harriet  Williamao 
aged  about  twenty-seven  years,  had  borne  three  children,  the  youn 
est  being  about  twenty  months  old.  She  was  covered  with  purf 
spots,  irregularly  scattered  over  the  thighs,  arms  and  trunk  ;  was  i 
dieted  with  haemorrhage  from  the  mouth,  particularly  in  the  roof,  lar 
blisters  forming.  After  being  ruptured,  the  blood  would  ooze  c 
freely,  attended  with  yellow  skin  and  great  loss  of  flesh. 

I  gave  at  first  a  mild  cathartic  of  rhei.  grs.  xii. ;  hydrarg.  sub.  mi 
grs.  viii. ;  followed  it  in  ten  hours  with  castor  oil  and  turpentii 
While  for  the  local  application  to  the  mouth  gave  pulv.  borax,  ale 


18M.J  BowMAx — Pwrpura  BaMU>rrkaffiea.  145 

tad  loaf  sugar,  alternating  with  a  wash  of  acetate  of  lead,  enlphate  of 
siaeaiid  water. 

July  4th. — Gould  not  discover  mnch  change.  Gave  twenty  drops 
linctare  ferri  chlor.  every  five  hours,  advised  as  a,  local  application  in 
place  of  the  acetate  of  lead  wash,  solution  of  sulphate  of  iron,  twenty 
graine  to  the  fluid  ounce  of  water. 

Jaly  10th. — Patient  still  bleeding  from  mouth,  and  occasionally 
from  noee,  and  failing  very  fast.  Gave :  Qr.  Quinine  sulph  ;  ferri 
lolph.  aa.  grs.  xij. ;  M.  ft.  pulv.  iv. ;  S.  Give  one  every  four  hours. 
July  15th. — ^Found  patient  laboring  under  great  depression  of  spir- 
iu»  loss  of  appetite,  and  unable  to  sit  up.  There  was  considerable 
kamorrhage  from  the  viscera.  The  urine  was  about  one-fourth  blood, 
attended  with  painful  micturation.  Gave  Qr.  Uva  ursi.  and  buchu,  aa. 
Ji  hot  water  O  ;  steep  three  hours,  strain  and  add  nitrate  potassa  3iii ; 
take  fl.  3  every  tbree  hours  ;  gallic  acid  grs.  iij. ;  acetate  of  lead  grs.  i. 
tad  opium  gr.  ^  evory  three  hours. 

July  16th. — Found  patient  bleeding  so  profusely  from  os  uteri  and 
Tsgina,  that  I  became  alarmed.  Upon  examination  with  the  speculum 
fbond  the  whole  surface  of  the  vaginal  walls  was  oozing  out  blood, 
ibo  profuse  hsemorrhage  from  the  region  of  the  os.  Ordered  an  in* 
jsetion  of  alum  and  tannic  acid  every  two  hours,  to  be  alternated  with 
•  strong  solution  of  sulphate  of  iron.  The  strength  failing  so  fast  I 
•dviaed  free  use  of  best  rye  liquor  and  brandy. 

From  the  fact  that  in  thirteen  years  practice  I  had  met  with  but  two 
esses  of  purpura  htemorrhagica,  I  requested  a  consultation.  During 
the  day  of  the  17th,  the  patient  sinking  very  fast,  I  added  to  treat- 
ment :  Qr.  Camphor  pulv.  grs.  xii. ;  ammonia,  carb.  grs.  viii.  ;  sulpb. 
qainine  vi. ;  M.  ft.  chart,  iv.  ;  8.  One  every  two  hours.  Also  ad- 
fluaiatered  of  the  best  alcoholic  stimulants,  all  that  she  in  her  weak- 
ened state  could  bear.  The  haemorrhage  from  the  bladder,  uterus  and 
Tigina  ceased  during  the  day  gradually. 

Dr.  Boyce,  after  a  very  careful  examination,  said  that  in  seventeen 
yean  practice  he  had  never  met  with  so  ssrious  a  case,  and  but  three 
ef  a  like  nature.  Said  he  could  add  but  little,  if  any  thing  to  the 
trMtment.  Spoke  of  native  wine,  and  encouraged  me  to  persevere  in 
■y  plan  of  remedies.  He  told  the  patient's  husband  that  there  was 
a  hope  for  her  recovery.  In  a  few  hours  after  the  Doctor  left 
korrhage  commenced  in  the  alimentary  canal  attended  with  severe 
and  great  prostration.  I  should  state  here,  that  up  to  this  period 
cha  bowela  had  been  in  a  favorable  condition. 

patient  during  the  night  of  17th  July  frequently  informed^me 


146  ProcMdimgB  ef  SocMn.  [HuA, 

that  she  coald  sensiblj  feel  the  blood  trickle  down  the  bowels.  I  now 
resorted  to  wine  of  ergot  fS. ;  morphia  salph.  gr.  \  everj  three  hoan, 
alternating  with  increased  doses  of  tincture  ferri  chlor.  and  injections* 
both  per  rectnm  and  vagina,  of  infusion  of  the  seeale  comntnm»  made 
very  strong,  calculating  if  I  did  not  succeed  with  these  to  use  the 
tampon.  Bat  to  my  relief,  I  did  succeed  with  these  agents  in  check- 
ing the  hsemorrha^e  in  a  few  hours. 

During  the  18th  and  19th  she  became  much  more  feeble,  with  some 
little  bleeding  from  parts  before  mentioned.  Was  obliged  to  freqnent" 
ly  fill  the  nose  with  powdered  alum  and  x)erchloride  of  iron,  to  stop 
bleeding.  From  this  time  she  began  to  slowly  improve.  Continued 
most  of  treatment  to  28d,  when  I  gradually  changed  to  vegetable 
tonics,  and  increasing  the  diet,  keeping  bowels  regulated  during  the 
time  with  castor  oil  and  turpentine.  The  purple  spots  continued  foi 
fifteen  or  twenty  days.  I  am  happy  to  record  that  Mrs.  Williamsoxi 
has  been  since  convalescence  much  more  hearty  than  she  had  been  foi 
many,  many  years  previous  to  the  attack  of  this  truly  alarming  disease. 

Permit  me  to  say  in  conclusion,  that  as  a  member  of  the  Medical 
Profession  I  am  thankful  that  this  fearful  disease  is  of  so  rare  oooar- 
rence.  I  have  given  this  case  at  some  length  with  its  treatment,  in 
the  hope  that  it  may  aid  some  one  who  like  myself,  is  unacquainted 
with  the  disease  ;  for  I  very  often  meet  with  cases  in  the  Lancet  and 
Observer  that  truly  aid  me  along  the  rugged  path. 


■  ^  »  »  > 


^xnttt&\xi^%  0f  S^t^tUWn. 


Abstract  of  the  Proceedings  of  the  Indianapolis  IMedlcal  Associatfon. 

Boported  by  W.  B.  Flktcbkr,  M .D.,  Seoretarj. 

Monday  Evening,  Jan.  4th,  1864. 

Dr.  Jas.  S.  Athon,  President,  called  the  Association  to  order. 

The  ordinary  business  being  transacted,  Dr.  Clippinger  reported  i 
case  of  gunshot  wound  occurring  at  the  battle  of  Greenbrier,  Westen 
Virginia.  It  was  caused  by  a  six  pound  spherical  case  striking  neai 
the  outer  condyle  of  the  femur,  and  passing  upward  became  imbeddec 
in  the  glntei  muscles,  near  the  left  ischium.  The  ball  was  removec 
by  Dr.  C.  ten  hours  after  the  accident,  the  patient  being  in  a  state  oi 
collapse,  from  which  he  did  not  rally,  but  died  at  9  o'clock  next  mom 
ing.     Dr.  Clippinger  presented  the  ball  to  the  Association. 


18U.]  Froe$$dinp8  qf  SoeieHes.  147 

Dr.  Oall  read  an  ioteresling  and  very  complete  dissertation  npon  the 
lae  of  emetics,  in  which  he  sketched  their  history,  modes  of  action, 
their  efiects  local  and  general,  the  circumstances  modifying  their  efifect, 
the  conditions  of  the  system  favorahle  or  nnfavorahle  and  their  nses, 
rales  ohserred  in  their  administration,  and  their  applications  in  various 
diseases. 

Dr.  Athon  said  he  agreed  with  the  paper  just  read  in  regarding 
emetice  as  most  valuahle  agents  in  the  treatment  of  insanity.  Among 
the  Eastern  physicians  who  have  charge  of  such  cases,  there  was  not 
much  reliance  placed  upon  emetics,  but  the  experience  of  Western 
physicians  was  quite  different. 

Dr.  Wilky  finds  emetics  give  relief  to  and  cut  short  our  autumnal 
fevers,  and  always  gives  them  in  preference  to  purgatives.  Thinks 
tartrate  of  antimony  too  irritating,  and  uses  ipecacuanha. 

Dr.  Gbaton  nses  emetics  with  caution,  finding  great  difference  in  the 
ability  of  persons  to  tolerate  them,  uses  salt,  mustard  and  water  as  a 
ample  evacuant  of  the  stomach,  and  finds  it  to  act  without  much  sub- 
•eqiMnt  nausea  or  depression.  Finds  emetics  decidedly  beneficial  in 
icierotic  inflammations  when  given  daily. 

Dr.  Harvey  said  that  from  personal  experience  he  could  testify  to 
the  good  effects  of  emetics  in  sick  headache,  with  which  he  was  some- 
times troubled ;  found  nothing  would  remove  it  so  quickly.  He  gives 
emetics  in  diphtheria  and  croup,  following  it  up  with  quinine  and 
stimolants,  almost  always  airesting  the  disease.  He  uses  emetics  in 
fevers ;  thinks  they  do  good  not  only  by  evacuating  the  stomach,  but 
by  their  remote  effect  upon  the  brain  ;  therefore  their  action  should  be 
clocely  watched. 

Dr.  Smelser  uses  emetics  in  diphtheria,  followed  by  purgatives,  qui- 
nine and  chlorate  of  potash.  In  intermittents  they  are  good  ;  in  croup, 
in  first  stages,  good  ;  but  doubts  their  effects  being  beneficial  in  the 
later  stages,  as  with  great  difficulty  you  get  them  to  act,  because  the 
nervous  influence  between  the  brain  and  stomach  is  impeded  or  lost. 

Dr.  CHpping^r  is  partial  to  the  use  of  the  agents  spoken  of  in  the 
paper,  and  it  so  thoroughly  covered  the  subject  it  left  nothing  to  be 
added.  He  would  only  refer  to  the  use  of  mustard  as  a  simple,  ever 
ready  and  efficient  emetic.  In  a  cR8e  where  a  young  man  had  taken 
tax  ounces  of  tincture  of  opium,  and  the  stomach  would  not  respond 
to  any  of  the  means  used,  he  then  poured  down  large  quantities  of 
warm  water  and  mustard  which  caused  the  patient  to  vomit  freely,  and 


Dr.  Bams  thought  the  paper  the  best  one  read  before  the  Associa- 


148  Pro€$iding$  qf  SocUtie$.  \mMnii, 


tion,  thinks  emetics  tbe  most  reliable  agents  in  disease.  His  maaner 
of  giving  emetics  was :  ipecacnanha  grs.  xv. ;  tartrate  antimon j,  gtSt 
iij. ;  in  a  teacapful  of  warm  water.  He  tben  gave  the  patient  half  this 
quantity,  and  if  it  did  not  produce  emesis,  filled  the  cnp  and  gave  the 
second  portion »  and  so  with  the  third  if  the  second  did  not  act. 


Monday  Evbnivo,  Jan.  18th. 

Dn  Clippinger  reported  tbe  following  case : 

FiUulous  Communication  of  the  Neck  of  the  Bladder  with  the  Beehm^ 
— On  tbe  5tb  inst.  Henrj  Carles,  late  a  private  of  Co.  G.  Sixtj-eightli 
Begiment,  Ind.  Vols.,  presented  himself  for  an  examination  with  tlie 
view  of  obtaining  a  pension.  He  was  twenty-five  years  old,  had  never 
had  venereal  disease,  nor  any  urethral  trouble.  Six  months  ago,  at 
Hoover's  Gap  in  Tennessee,  was  engaged  two  days  heavily  in  driving 
tbe  enemy  out  of  that  position,  and  at  tbe  close  of  the  engagement 
found  some  difficulty  in  urinating.  Next  day  discharged  urine  frotn 
the  rectum  and  has  never  since  voided  his  bladder  in  any  other  way. 
He  at  this  date  suffers  excruciating  pain  in  tbe  scrotum  and  testea, 
while  the  penis  is  much  contracted  and  shrivelled.  The  perineum  is 
so  tender,  though  without  much  tumefaction  or  any  abscesses,  as  not 
to  allow  tbe  slightest  pressure  without  exciting  an  agony  of  pain  and 
spasms  in  tbe  surrounding  parts.  The  patient  said  that  at  times  tbe 
pain  excited  spasms  in  all  the  adjacent  muscles,  requiring  him  to  flex 
tbe  body  and  limbs  to  their  utmost  capacity.  He  voided  his  urine 
about  four  times  each  twenty-four  hours,  and  was  not  troubled  by 
dribbling,  or  its  involuntary  escape.  Though  cathartics  were  repeat- 
edly passed  into  tbe  bladder,  no  urine  had  since  tbe  date  of  the  fiatn* 
lous  opening  been  evacuated  througliHbem.  The  patient  retained  his 
flesh,  could  eat  sufficiently,  but  tbe  constant  pain  so  long  endured 
added  to  sleepless  nifrbts,  bad  given  his  features  an  expression  of 
sharpness  and  anxiety.  He  remarked  that  death  would  be  preferable 
to  his  tben  condition. 

Dr.  Gaston  read  a  paper  upon  rbenraatism,  in  which  he  reviewed 
the  principal  modes  of  treatment,  and  related  cases  in  which  be  had 
used  propylamin  with  success,  using  it  in  doses  of  from  two  to  six 
drops  every  two  hours. 

Dr.  Harvey  had  used  propylamin,  thinks  it  is  only  a  concentrated 
alkali,  and  no  better  than  the  alkaline  treatment.  Would  like  to  ask 
why  it  is  that  rheumatio  inflammation  attacks  first  tbe  joints  most 
used,  as  the  walking  pian*s  knees,  tbe  wood  chopper's  wrist  and  back 
and  the  excited  heart,  etc. 


1S6«J 


Proc€$imff$  of  SocieUes.  140 


Dr.  PeftiBon  bat  used  most  of  the  remodies  spoken  of  in  the  paper, 
md  Chinks  the  alkaline  preferable. 

Dr.  Willey  finds  the  use  of  chloroform  locally,  and  the  acetate  and 
iodide  of  potassa  internally,  about  the  best  treatment  in  his  experience, 
bot  finds  all  of  them  deficient  in  some  cases. 

Dr.  Smelser  says  he  has  not  had  mnch  experience  in  this  disease, 
but  looks  upon  it  as  neuropathic  in  character,  and  gives  opium,  qui- 
nine, etc. 

Dr.  Clippinger  used  to  think  nitrate  of  potash  the  best  remedy,  but 
was  deceived .  Next  the  iodide  was  a  favorite,  but  had  to  give  that 
«p^  Has  nsed  propylamin  in  two  cases  with  good  results.  His  at- 
tention had  been  caired  to  the  use  of  the  poke  root  (phytolacea  deetnt" 
iru,)  in  rheumatie  conjunctivitis,  and  nsed  it,  thought  it  a  good  agent. 
He  Qfes  opinm  in  the  fibrous,  and  colchicnm  in  the  synovial  forms  of 
tlie  disease,  but  thinks  there  is  no  specific. 

Dr.  Parvin  has  nsed  the  phytolacea,  but  does  not  think  much  of  its 
pewtra  in  combatting  rheumatic  inflammation,  uses  alkalies  and  thinks 
it  the  beat  treatment. 

Dr.  Todd  thinks  the  acetate  of  potassa  the  best  remedy  in  this  dts- 
esse.  While  in  Missouri  he  saw  a  great  number  of  cases  under  this 
tmatment.  It  produced  a  marked  effect  upon  the  urine.  He  gave 
Isrge  dotes  of  Dover's  powder  at  night  to  produce  rest. 

Dr,  Bams  asked  what  efiidct  it  produced  on  the  duration  of  the 
diseaae. 

Dr.  Todd  thought  it  was  about  its  usual  time. 

Dr.  Clippinger  wanted,  to  know  what  quantity  was  given. 

Dr.  Todd  gives  a  tablcspoonful  of  the  acetate  of  potassa  in  a  tum- 
Usrfol  of  water,  and  gave  it  three  times  a  day.  It  was  usually  w:^ll 
telenHed. 


Monday  Evening,  Feb.  Ist,  1864. 

The  usual  business  having  been  transacted,  Dr.  Smelser  rekd  the 
following  case : 

Scr^^ulfmM  Adenitis, — ^Dr.  J.  H.  Moore,  aged  thirty,  of  a  sanguine- 
Bwous  temperament ;  was  a  man  that  was  not  possessed  of  any 
kaown  habits  that  would  particularly  jeopardize  the  laws  of  health. 
la  the  spring  of  1858  he  dii*ected  my  attention  to  a  tumor  in  the  left 
iaguioal  region,  which,  upon  examination,  appeared  to  be  hypertrophy 
of  the  inguinal  gland,  and  without  discoloration  of  the  cuticle,  and 
itlsiided  with  little  or  no  pain  at  any  time.  Some  two  or  three  months, 
•aheoqueBtly,  he  began  to  complain  with  a  slight  pain  on  the  outside 


160  Proeeedinps  i/ Sodetiei.  [M«idi» 

of  the  fibnla  of  the  right  leg,  near  the  iiiBertion  of  the  biceps  miif de. 
The  pain  continued  more  or  less  until  the  middle  of  Augnst,  when  it 
became  severe  and  assumed  a  periodical  type,  coming  on  regularly 
every  morning,  continuing  from  two  to  four  hours,  and  then  ceasing. 
In  the  meantime,  the  foot  and  leg  had  become  edematous.     No  discol- 
oration of  the  Bkin  at  any  point  except  at  the  seat  of  the  pain,  which 
for  a  short  time  was  inflamed.     Subsequently  suppurated  and  discharg- 
ed pus  for  thirty-six  or  forty  hours,  after  which  the  ulcer  healed  kindly. 
The  pain  still  continued,  but  at  longer  intermissions,  having  only  a 
paroxysm  every  four  or  six  hours,  and  even  longer.     By  this  time  ha 
had  almost  lost  the  use  of  his  leg.     The  edema  had  subsided ;  no 
swelling  at  any  point  except  at  the  seat  of  the  pain,  which  was  not 
only  swelled,  but  indurated.    A  short  time  after  this  he  was  taken 
with  a  pain  in  the  umbilical  region,  which  was  severe  and  lacerating, 
and  continued  about  thirty  hours,  not  yielding  to  any  remedies  used, 
until  he  vomited  ;  after  which  he  became  entirely  easy,  having  no  pain 
either  in  bowels  or  leg.     About  ten  days  afterward  he  was  again  at- 
tacked with  pain  in  his  bowels.     I  was  called,  and  found  him  suflfor- 
ing  intensely.    The  pain  seemed  to  be  located  directly  posterior  to 
the  umbilicus,  and  occupied  apparently  a  space  of  two  or  three  inches 
in  diameter.     When  I  arrived  lie  said  he  was  sufiering  intolerable 
pain.     His  extremities  were  cold  and  bathed  in  a  clammy  perspira- 
tion, no  pulse  perceptible  at  the  wrist.     I  ordered  friction  and  hot  ap- 
plications to  the  surface,  and  used  morphia  and  diffusible  stimulants 
internally,  after  which  reaction  came  up,  and  he  became  tranquil. 
After  this  he  had  occasionally  a  slight  paroxysm  of  pain  in  the  bowels, 
not  retarning  oftencr  than  every  eight  or  ton  days.     About  this  time 
he  had  occasional  attacks  of  pain  in  the  thorax  below  the  region  of 
the  heart,  but  not  of  so  severe  a  character  as  was  in  the  bowels. 
Also  about  the  time  that  he  had  the  first  paroxysm  of  pain  in  his 
bowels  a  number  of  tumors   made  their  appearance,  being  seated  in 
the  celfular  tissue  and  located  upon  the  sternum,  intercostal  spaces, 
arms,  legs,  etc.,  no  discoloration  of  the  skin  over  any  of  them  until 
•  week  before  dissolution.     Some  of  them  were  lobulated,  others  not ; 
a  few  of  them  passed  away  by  absorption.     By  this  time  our  patient 
had  become  very  much  emaciated,  and  the  log  above  spoken  of  had 
at  the  joint  where  the  pain  formerly  was  a  circumscribed  tnmor  which- 
was  supposed  to  be  of  the  same  nature  as  those  that  had  recently  ap- 
peared upon  the  breast,  etc.  Patient  had  no  cough  at  any  time,  except 
about  two  weeks,  which  yielded  readily  to  medicinal  agents.     The  di- 
gestive apparatus  was  generally  good ;  appetite  voracious,  except  when 


1864.]  PfiKeedmfft  qf  SocieHei.  151 

be  had  a  pftroxysm  of  pain  ;  tongne  natural ;  poise  nsaally  aboat  100 

to  1 10  ;  nrine  noitnal  in  appearance,  no  lateritious  sediment ;  bowels 

TCgolar,  bnt  maratmns  still  continued ;  and,  finally,  some  five  or  six 

weeks  before  death,  he  had  occasional  chills  and  hectic  fever  with  col- 

liqnetiTe  sweats  ;  no  pains  now  complained  of,  until  about  one  week 

before  dissolution,  when  he  had  i»ome  pains  in  the  bowels,  also  a  con- 

Tiilsion,  which  I  was  informed  lasted  two  or  three  minutes ;  and, 

lastly,  he  was  taken  with  convulsions  which  lasted  six  or  seven  hours, 

vben  he  departed.     With  regard  to  treatment,  he  at  first  used  quinine 

and  other  antiperiodics,  but  all  to  no  effect.     After  I  was  called  to 

us  bim,  my  treatment  during  the  paroxysms  was  only  palliative. 

Between  them  I  recommended  and  had  used  cod  liver  oil,  the  ferri 

topics,  colchicum,  stimulants  and  nourishing  diet,  none  of  which 

Ntmed  to  have  any  influence.     In  the  meantime,  Drs.  Fish  back.  Day 

iDd  Green,  of  Shelby  villc,  visited  him  and  gave  their  counsel,  bnt  all 

to  ao  avail.     In  short,  none  of  us  could  satisfactorily  diagnose  the 


A  poet-mortem  examination  was  made  eight  hours  after  death  by 
Drt.  Leavitt,  Green  and  myself.  We  examined  first  some  of  the 
taaora  above  described,  which  were  bedded  in  the  cellular  tissue. 
Sone  of  them  had  a  nucleus  of  pus  in  the  centre,  others  had  none. 
8oBe  bad  tubercles  studded  through  them,  others  not.  One  or  more 
ksd  sopparated,  and  burrowed  through  the  walls  of  the  chest.  These 
tamon  when  dissected  and  where  they  contained  no  pus  were  opaque 
aad  cheesy,  did  not  have  the  appeal ance  of  a  perfect  organization. 
Oae  of  them  which  was  situated  upon  the  anterior  superior  half  of  the 
sUrnom  had  produced  complete  absorption  of  the  ossific  tissue,  so  that 
Om  bone  was  found  upon  its  removal  to  be  in  two  distinct  pieces. 
Upon  opening  the  chest,  the  left  lung  was  sound.  The  right  lung  had 
tsberclca  npon  both  lobes  and  some  adhesion  posteriorly.  In  break- 
lag  up  the  adhesions,  some  pus  was  found.  The  pericardium  was 
rtadded  with  small  tumors  from  base  to  apex ;  the  valves  of  the  heart 
aonsal.  The  heart  proper  was  atrophied,  weight  five  ounces.  The 
tOBon  opon  the  pericardium  were  the  same  in  appearance  and  char- 
acter as  those  situated  in  the  cellular  tissue.  Diaphragm  healthy. 
Upon  examining  the  abdominal  region,  the  mesentery  was  completely 
eovered  with  tumors  of  the  size  of  a  hazel  nut  and  less,  and  of  the 
seae  character.  Many  of  them  had  tubercles,  some  of  which  were 
■oftBaedy  others  not.  Liver  healthy  except  at  the  anterior  inferior 
put  of  the  great  lobe  was  situated  a  large  tumor.  There  was  also  oue 
krge  lobolated  tumor,  immediately  posterior  to  the  umbilicus,  it  was 


152  Proeeedinfft  of  SaeUUii.  [Hftreli, 

adhered  to  the  iliam  bad  a  number  of  tubercles  in  it,  some  of  which 
were  softened.  Also  a  large  tumor  of  the  same  character  ocoupjing 
the  place  of  the  renal  capsule  being  adhered  to  the  liver  above  and  to 
the  kidney  below.  The  inguinal  gland  was  next  examined*  which 
was  found  to  have  been  converted  into  the  same  morbid  stmetare  ; 
and  lastly,  the  tumor  over  the  head  of  the  fistula  was  examined  and 
was  found  to  be  a  solid  mass  containing  neither  tubercle  nor  pus,  but 
there  was  a  complele  absorption  of  about  three  inches  of  that  bene. 
After  making  this  examination,  our  conclusion  was  that  the  constito- 
tional  vice  was  scrofula,  and  the  tumors  occupied  perhaps  a  middle 
place  between  benign  and  malignant  formations,  and  the  peculiar  de* 
posite  was  of  a  tubercular  nature,  being  at  first  perhaps  interstitial,  hot 
subsequently  accumulating  by  apposition  in  mass. 

Dr.  Athon  had  seen  two  cases  like  the  one  reported  by  Dr.  Bmelser. 
He  looked  upon  them  as  syphilitic. 

Dr.  Clippinger  related  thi-ee  cases  of  what  he  was  inclined  to  iUnk 
was  paralysis  of  the  bowels.  In  the  first  case  there  was  great  distm* 
tion  from  eating  beans  ;  the  second  from  eating  raspberries.  In 
neither  case  coald  ho  produce  an  action  upon  the  bowels,  and  both 
cases  were  fatal.  In  a  third  case,  that  of  a  young  man,  there  was 
total  paralysis  of  the  sphincter  and  perineum.  A  catheter  pushed  up* 
into  the  bowels  was  not  retained.  The  case  proved  fatal.  In  another 
case  where  the  same  conditions  existed,  ho  used  the  electric  current, 
passing  one  electrode  into  the  rectum,  the  other  over  the  abdomen. 
This  was  followed  by  a  free  evacuation,  and  the  patient  recovered. 

Dr.  Parvin  thinks  paralysis  of  the  bowels  not  unusual.  Often  meets 
with  cases  where  persons  go  from  four  to  fourteen  days  without  an 
evacuation,  and  has  cured  such  by  combining  extract  nux  vomica  with 
Lady  Webster's  pills. 

Dr.  Ware  said  he  had  a  case  of  obstinate  constipation,  on  accocmt 
of  which  it  was  feared  the  patient  would  not  recover.  Ho  gave  him 
a  pill  composed  of  rhubarb,  podophylliu  and  leptandrin.  He  took 
this  for  two  weeks,  and  recovered  entirely. 

Dr.  Athon  said  he  had  known  persons  who  frequently  go  six  weeks 
without  a  passage  from  the  bowels.  He  thinks  nnx  vomica  the  best 
remedy  in  such  canes.  Insane  persons  suffer  with  prolapsus  of  the 
bowels  ;  in  melancholia  frequently  found  the  colon  fallen.  Such  cases 
were  always  benefitted  by  the  use  of  strychnia.  He  is  of  fhe 
opinion  that  constipation  depends,  in  the  more  obstinate  forms,  upon 
a  prolftpse  or  crowding  together  of  the  bowels.  This  was  particnlarlj 
the  case  in  epileptics. 


JBdUoriai  IrantlalioM,  168 

Dr.  Fktober  said  be  had  jnst  retanied  from  West  Newton  where  he 
had  been  to  see  a  patient  in  consultation  with  Dr.  Allen,  and  while 
there  he  visited  eleven  other  cases,  all  having  the  same  form,  and 
there  known  as  spotted  fever.  Dr.  Allen  informed  him  that  about 
sixty  caoea  had  occurred  in  that  township.  Three  or  four  only  proved 
fatal,  and  those  were  very  sudden ;  from  the  outset  to  the  termination 
not  more  than  twelve  to  thirty-six  hourR  elapsed. 

Tho  symptoms  were : 

1st  Stage. — Rigors,  lasting  from  one  to  four  hours,  nausea,  pain  in 
head,  stinging  pains  in  the  ears,  or  throat,  pulse  from  40  to  90. 

2nd  Stage. — Swelling  of  the  neck  or  some  part  of  the  face,  pain 
incraaaes  in  back  of  the  neck,  pupils  dilated,  countenance  anxious,  de- 
lirinm,  and  death. 

Moat  of  the  cases  had  a  slight  eruption  like  that  of  typhoid  fever. 
In  others,  there  seemed  diphtheritic  exudations  ;   the  bowels  were 

ily  controlled.  After  the  first  thirty-six  hours  had  passed,  the 
seemed  perfectly  exhausted  and  recovered  slowly.  They  had 
a  pale  ansemic  look«  and  in  several  cases  there  was  a  distinct  ansemic 
mnnnnr  heard  over  the  heart. 

From  what  he  had  seea  of  the  disease  ho  was  not  prepared  to  give 
it  n  name.  It  resembled  a  mixed  condition  of  typhoid,  diphtheria, 
and  eerebro-spinal  meningitis.  Drs.  Allen  and  Mendenhall,  of  West 
Newton,  have  promised  to  furnish  statistics  in  full,  when  it  is  hoped 
tha  snhject  will  be  more  fully  discussed  before  the  Association. 


■erlew  tf  Breascd  DtocaMS  la  CeBaecdoa  witk  a  Case  Beported  bf  M. 
FsBTcC,  er  Crattaactaeflc;  ky  M.  Jacfaed. 

Among  the  diflcrent  pathological  conditions  which  may  coincide 
vish  a  black,  persistent  pigmentation  of  the  external  tegument,  Melan- 
emia  and  Addison's  disease  hold  the  first  rank,  and  the  interest  which 
attadMS  itself  to  these  two  morbid  states,  as  much  from  a  clinical 
point  of  view  as  from  a  physiological  aspect,  is  sufficiently  shown  by 
the  nnmerons  works  they  have  inspired. 

T  For  this  reason  I  can  not  pass  unnoticed  the  remarkable  history  that 
M.  Fanvei  has  jnst  published  in  the  OazeUe  Medicale  D'  Orient,  after 
having  read  it  before  the  Imperial  Medical  Society  of  Constantinople. 
observation  in  itself  is  worthy  of  serious  attention,  and  itac- 


154  BdUwial  TVanriaHaiu, 

quires  more  value  still,  thanks  to  the  judicious  remarks  with  which 
the  skillful  professor  has  followed  it.  From  this  motive  alone^  the 
fact  merits  notice,  and  it  offers  us  beside  an  ezcellent  opportunity  to 
examine  slig^btlj  our  position  touching  the  cutaneous  melanopathiee. 
Let  us  recall  in  the  first  place,  in  a  few  words,  the  fundamental  char- 
acteristics of  Melanemia  and  Addison's  disease,  and  we  shall  thus  be 
able  more  easily  to  appreciate  in  its  true  light,  the  obserratien  of  M. 
Fauvet.  Melanemia  is  formed  by  the  presence  of  pigmentary  corpus- 
cules  in  the  blood  in  considerable  proportion,  whose  focus  of  formation 
is  in  the  spleen  ;  exceptionally  in  the  liver.  As  long  as  these  produc- 
tions circulate  without  obstruction  in  the  capillary  vessels,  no  anoma- 
lous phenomena  happens  to  awaken  attention,  unless  it  is  a  coloration 
of  grayish-brown,  which  occupies  tbe  external  tegument.  This  color- 
ation is  60  characteristic,  that  it  is  sufficient  in  itself  alone,  according 
to  Frerichs,  to  suggest  the  existence  of  Melanemia.  If  later,  the  pig- 
mentary granulations,  arrested  in  their  free  course,  should  reunite  in 
collections  more  or  less  considerable,  we  see  serious  troubles  arise  in 
the  general  nutrition,  and  in  the  functions  of  those  organs  directly 
concerned.  Thus,  tbe  modifications  undergone  by  the  liver  may  ex- 
tend even  to  atrophy  ;  the  injury  of  the  kidneys,  extending  under  the 
tubuli,  and  the  accumulation  of  corpuscles  in  the  small  vessels  of  the 
brain  may  lead  to  their  rupture,  and  may  be  the  point  of  commence- 
ment of  a  persistent  albuminuria. 

But  I  lay  aside  this  order  of  symptoms.  It  offers  but  a  secondary 
interest  in  the  question  that  occupies  me.  The  black  coloration  dne 
to  Melanemia  is  general  and  uniform,  without  spots  or  stains.  It 
coincides  constantly  with  the  presence  of  pigmentary  corpuscles  in  the 
blood,  which  the  microscope  renders  easily  discernible.  This  morbid 
state  is  characterized,  in  almost  the  total  number  of  cases,  by  a  tumor 
of  the  spleen,  and  it  appears  in  individuals  attackeil  with  paludal 
cachexia.  And  in  our  opinion,  these  points  are  the  most  usefnl  to 
notice.  As  for  the  disease  of  Addison,  it  presents  also  its  pathologi- 
cal triad,  and  the  author  whose  name  it  bears  has  thus  classed  the 
three  elements  which  compose  it,  according  to  the  rank  of  their  rela- 
tive importance,  viz. :  profound  asthenia,  alteration  of  the  soprarenal 
capsules,  a  bronzed  coloring  of  the  skin.  This  color  is  always  mora 
intense  in  the  same  points  of  the  tegument  which  have  in  the  normal 
state  the  deepest  tint.  Contrary  to  a  too  general  opinion,  this  color  n 
not  characteristic.  When  it  assumes  the  form  of  isolated  spots,  it 
should  be  uniformly  spread  over  all  the  exterior  surface  of  the  body ' 
and  then,  to  employ  the  comparison  of  which  Addison  makes  use,  the 


IBM.]  JUtidrial  Shzntlaiioni.  155 

paiient  resembles  completely  s  mulatto,  often  OTen  to  sn  individual  ot 
the  black  race.  In  a  more  recent  work  on  this  subject,  Wilks  has 
pMiieiilarlj  and  correctly  insisted  on  this  fact,  for  the  error  has  often 
eommittad,  and  some  have  very  wrongfully  recorded,  under  the 
le  of  the  disease  of  Addison,  the  account  of  patients  in  whom  the 
broDzad  or  black  color  presented  itself,  under  the  form  of  stains  or 
iliiwmiinsh^  spots  on  some  particular  parts  only  of  the  externa!  tegu- 
ment. These  being  the  facts,  let  us  examine  now  the  observation  of 
M.  Favret 

Tlie  patient  was  an  Armenian,  aged  about  twenty-eight  years,  who 
wotked.  by  turns,  at  husbandry  in  his  own  country  and  at  brick- 
Bekiag  et  Constantinople.  This  man,  who  had  never  been  seriously 
iD  up  to  1861,  was  then  taken  with  a  daily  intermittent  fever,  which 
disappeared,  without  treatment,  at  the  end  of  two  months.  A  month 
kler,  the  lever  reappeared,  without  regularity,  and  again  lasted  two 
Moaths,  after  which  the  paroxysms  ceased  spontaneously.  Dating  from 
tbie  moment,  the  patient  commenced  to  experience  a  pain  in  the  left 
kjpoehondrinm.  This  pain,  which  grew  worse  after  eating,  and 
wkilsl  walking,  continned.  The  fever  had  ceased  during  three  months 
it  reappeared  Vgain,  without  regular  type.  At  the  end  of  a 
which  is  not  exactly  stated,  these  febrile  paroxysms  were  accom- 
pBDisd  by  a  real  jaundice,  which  disappeared  at  the  end  of  five  days, 
the  fever  itself.  Our  Armenian  considered  himself  cured  in  a  fort- 
rhen  at  the  beginning  of  March,  1862,  after  a  day's  work  in 
the  fields,  he  noticed  that  his  shin  took  a  blackish  color,  that  it  had 
bad  nntil  then.  This  color  appeared  first  on  the  face  and  limbs, 
in  the  coarse  of  two  or  three  weeks,  it  spread  over  the  whole 
bo^»  without  assuming  the  form  of  spots  or  stains.  From  that  time 
the  liver  baa  not  returned,  the  left  hypochondrium  is  large  and  pain- 
M,  bai  OB  the  whole,  aside  from  painful  digestion,  want  of  appetite, 
I,  there  has  been  no  considerable  trouble  in  the  health  of 
In  the  meantime,  he  came  to  Oonstantinople,  to  work  in 
brick  yard,  but  at  the  end  of  two  weeks,  he  was  forced  to  quit 
and  aome  days  after,  presented  himself  at  the  Climque  de  Vetoie^ 
H  was  admitted  the  18th  of  July,  1868.  The  black  color  has 
over  all  his  body,  but  in  different  shades.  In  the  face,  neck 
I,  also  in  the  genital  parts,  it  attained  its  maximum  of  inten- 
rfly.  Upon  the  body,  it  is  less  intense,  and  presents  a  yellow  tinge  as 
ia— latfoee.  For  the  rest,  the  coloring  does  not  vary  suddenly.  It 
ia  Bol  jjiy?*^  in  spots,  but  passes  from  one  shade  to  another  by  in- 
anaible  gradations.    At  a  certain  distance,  the  black  color  seems  o  f 


166  Ediioriai  TrahahfoM.  fUardi, 

uniform  intenBity  as  upon  the  healthy  skin  of  a  negro.  On  closer  in- 
spection, TfQ  see  that  it  is  not  so  everywhere.  The  skin  is  mors  or 
less  reddish,  and  we  ohscrvo  npon  it,  hero  and  there,  some  spots  of 
very  deep  black,  some  of  which  present  in  the  centre,  a  point  almost 
white,  which  corresponds  to  the  cicatrices,  more  or  less  superficial,  of 
pustules,  furuncles  and  excoriations.  Moreover,  there  are  parts  when 
upon  the  yellow  background,  there  exists  a  black  speck  without  any 
appreciable  injury  of  the  epidermis.  These  little  spots  vary  from  the 
size  of  a  largo  pin  head  to  an  almost  imperceptible  point.  It  is  in  the 
face  especially,  that  they  are  found  in  the  greatest  nnmber.  Aronad 
the  eyes,  there  are  little  intervals  where  the  white  tissue  of  the  skin  is 
visible.  This  arrangement  of  the  pigment  gives  to  the  face,  seen  at  a 
little  distance,  the  appearance  it  would  have  if  the  individual  had  been 
daubed  with  imperfectly  powdered  charcoal.  This  exists  to  such  a 
degree  that  it  would  seem  that  in  rubbing  the  skin,  the  black  color 
would  detach  itself  from  it.  This  is  not  the  case,  however.  'Neither 
friction  nor  soap  suds  has  brought  away  any  of  the  coloring, 
nor  does  the  perspiration  take  away  any  black  particles.  On  the 
outside,  the  lips  are  unifoimly  black  as  those  of  negroes.  On  (he 
inside,  presents  blackish  spots,  formed  as  by  a  very  fine  stick. 
Upon  all  the  internal  part  of  the  cheeks,  the  black  color  is  general  and 
uniform.  There  are  some  spots  on  the  outside  of  the  gums  where  the 
teeth  are  wanting ;  some  black  exist  in  the  arch  of  the  palate,  espe- 
cially in  the  anterior  part.  Except  some  light  violet  spots  on  its  lateral 
parts,  the  tongue  is  pale,  its  upper  surface  is  covered  with  a  thin, 
whitish  coating.  The  ocular  conjunctiva  presents,  in  the  part 
which  corresponds  to  the  separation  of  the  eyelids,  some  brown, 
vascular  arborisations,  and  some  little  spots  of  a  yellow  color  in  the 
neighborhood  of  the  cornea.  Every  where  else,  the  coloring  of  the 
conjunctiva  is  natural.  In  the  eyelids  it  is  a  pale  rose.  The  interior 
of  the  eyes  offers  no  alteration  ;  vision  is  not  troubled.  The  hair  is 
of  a  deep  black,  and  dull  as  if  dyed.  It  is  straight,  stiff,  and  has  not 
a  woolly  appearance.  The  skin  at  the  root  of  the  beard  has  a  tinge 
much  less  than  the  face.  As  for  the  limbs,  we  remark  that  the  color- 
ing of  the  skin  is  much  clearer  here  than  elsewhere.  It  is  the  same 
at  the  ankles.  The  rest  of  the  limbs  have  a  black  and  almost  uniform 
tinge,  except  the  spots  owing  to  excoriation.  The  finger-nails  have 
an  almost  natural  color,  unless  on  the  outside,  where  they  are  colored 
brown.  The  spleen,  hard  and  very  large,  extends  beyond  the  ribs  to 
the  width  of  a  hand,  and  obliquely  towards  the  median  line 
almost  to  the  umbilioui.      Pretoure  was  painful.     The  liver  was 


1864]  jBdiiarial  TramlaiUms.  157 

ftot  senaitif  e  to  pretsnre.  Its  free  edge  extended  beyond  the  ribs  to 
the  width  of  a  finger.  It  was  hard  to  the  toacb.  The  impulse  of  the 
liaart  ia  scarcely  sensible  ;  the  sounds  are  feeble  ;  the  first  muffled  and 
a  little  ploughed.  There  is  a  light  souffle  at  the  right  in  the  vcsseln 
<tf  (he  neck.  Aside  from  the  general  weakness,  no  symptom  attracts 
paiticolar  attention.  The  chest  is  healthy  ;  the  abdomen  presents 
neither  flatulency  nor  dropsy.  The  urine  limpid,  and- of  a  citron  color, 
precipitates  neither  by  acids  nor  by  heat ;  but  it  contuns  much  urea 
aad  phosphates,  and  a  large  proportion  of  coloring  matter.  Three 
dmym  after  his  entrance  into  the  hospital,  the  patient  was  submitted  to 
Ihe  qoioine  treatment,  and  took,  up  to  the  25th  of  July,  160  grains 
of  aolphate  of  quinine.  On  the  2Lst  of  July,  after  100  grains  of 
qoioine  had  been  administered,  it  could  be  stated  that  the  spleen  de- 
oeeoded  less  than  formerly  by  the  width  of  a  finger.  But  from  that 
dme.  there  was  no  more  perceptible  diminution.  At  the  same  time 
thai  the  ose  of  sulphate  of  quinia  was  begun,  a  blister  was  applied  in 
the  region  of  the  spleen.  In  the  morning,  the  skin  being  raised, 
ahowed  a  red  surface,  scarcely  marbled  with  some  small  brown  spots, 
then  little  by  little,  in  proportion  as  dessication  took  place,  these  spots 
ahowed  themselves  more,  and  new  ones  were  formed.  Starting  from 
ihe  15th  of  July,  the  dessication  being  complete,  the  pigmentary 
■ecrodon  generalized  itself  rapidly,  so  much  so  that  on  the  first  of 
Aogoti,  the  surface  of  the  blister  had  become  of  an  as  intense  black 
no  ihe  adjoining  parts. 

The  patient  was  photographed  on  the  23d  of  July.  Already,  at 
thia  iime,  it  seemed  to  those  who  observed  him  each  day  that  the  gen- 
onl  tinge  of  the  skin  was  a  shade  more  clear.  This  appreciation  was 
MOro  folly  confirmed  in  the  following  days.  Then  it  appeared  that 
the  coloring  remained  stationary,  after  having  experienced,  on  the 
whole,  a  very  slight  modification,  which  might  even  be  only  the  result 
of  tho  onaccustomed  sojourn  of  the  patient,  from  exposure  to  the  sun. 
Ai  tho  end  of  some  time,  under  the  influence  of  substantial  diet, 
gIfOBgth  reiumed.  llie  appetite  was  good,  the  digestive  functions 
ootorol.  and  the  patient  feeling  himself  strong  enough  to  recommence 
work,  left  the  service  on  the  8th  of  August,  in  a  much  more  satisfac- 
aoij  condition  than  at  his  entrance  ;  but  the  coloring  of  his  skin  pre- 
ionled  no  other  change  than  that  already  indicated  above. 

IL  Faovet  had  the  opportunity  of  seeing  this  man  again  on  the  3d, 
15ch  and  18th  of  September.  His  general  condition  was  good.  On 
the  15th  of  September,  the  spleen  descended  less  by  the  width  of  three 
finfm,  than  at  the  time  of  leaving  the  hospital.    The  liver  had  ako 


158  Bdiiarial  Ihtnaatumi.  \UmA^ 

become  smaller.  Its  hard  and  free  edge  was  no  longer  felt  extending 
beyond  the  false  ribs.  On  the  18th  of  September,  M.  Faavet  had  kit 
Armenian  photographed  anew,  and  it  seemed  to  him,  as  alap  to  all 
those  persons  who  had  seen  the  patient  daring  his  stay  at  the  ClinJq[Bab 
that  the  black  color  had  considerably  cleared,  in  a  general  way,  espe- 
cially upon  the  body,  and  that  the  blackish  spots  of  the  bucal  caTity 
had  b^nn  to  die  oat. 

In  the  commentary  fall  of  interest,  which  follows  this  obeervEtiimi 
M.  Fanvet  has  sought  to  what  known  form  of  black  pigmentation  he 
should  attach  the  history  of  his  patient.  The  antecedentc,  the  tumor 
of  the  spleen,  the  aniemic  state,  suggested  the  idea  of  Melanemia.  In 
the  latter  case,  however,  the  coloring  is  never  so  deep  as  it  was  in  tl« 
Armenian ;  and,  moreover,  the  examination  of  the  blood  has  shown 
one  time  more,  the  danger  of  a  diagnosis  a  priori.  The  pigmentuy 
corpuscles  were  absolutely  deficient.  The  microscopic  examination  of 
the  blood  was  made  at  three  different  times  :  the  2Sd  of  July,  the  5di 
and  15th  of  July.  On  the  last  day,  M.  Fan  vet,  desirons  of  having 
his  own  observations  confirmed  by  a  not  less  competent  person,  desired 
Dr.  Muling  to  examine  the  blood  of  the  Armenian  himself,  and  eaeh 
time  the  results  were  perfectly  negative.  It  was  not  a  question  of  • 
case  of  Melanemia. 

Melanemia  being  thus  well  and  duly  set  aside,  it'is  a  question  of 
considering  this  morbid  state  under  the  name  of  Addison's  disease. 
But  for  reasons  I  am  going  to  make  known,  M.  Faavet  has  not  believ- 
ed himself  authorized  in  assimilating  his  case  to  those  which  have 
been  published  under  this  head ;  and  he  has  concluded  by  reserving 
this  fact  as  exceptional.  It  is  upon  this  point  that  I  am  not  entirely 
of  his  opinion.  Before  arriving  at  this  conclusion,  the  author  has 
taken  pains  to  compile  a  certain  number  of  observations,  and  it  is 
after  having  compared  them  to  his  own,  that  he  has  rejected  the  sim- 
ilarity ;  but  I  believe  that  if  he  had  had  at  his  disposal  the  woriu  on 
the  subject  which  we  have  at  our  disposal,  he  would  have  attached 
a  less  absolute  value  to  the  different  characteristics  that  he  has  noted. 
The  engorgement  of  the  spleen  and  liver,  the  previous  paludal  pois- 
oning, the  absence  of  leucocytes  in  the  blood,  and  lastly,  the  gradual 
amelioration  which  comes  over  the  patient,  are  the  reasons  whioh  hsvis 
prevented  M.  Faavet  from  seeing  in  his  observation,  an  example  of 
Addison's  disease,  and  because  that  these  facts,  according  to  him, 
have  not  been  noted  among  known  fiicts  at  the  present  time.  But  the 
engorgement  of  the  spleen  and  liver,  without  being  the  rule,  ave  fiir 
frem  being  rare  in  Addison's  disease.    Thus,  among  the  observations 


1884.]  JBdilorud  l^andaUant.  150 

pablished  from  1857  to  1860  inclasive,  (and  I  cite  only  those  which 
hM!f9  beea  accompaniad  by  affirmative  autopsies,)  I  find  fourteen  casep, 
is  which  the  liver  has  been  found  more  or  less  tumefied.  In  the  case 
of  Bakowell,  it  was  large  and  hai-d ;  in  that  of  Thompsouv  it  was 
larg«  and  painfnl  to  pressare.  The  same  thing  in  the  patients  of 
Caieaave,  Taylor.  Cotton,  Ball,  Bnhl  and  also  of  others.  The  tume- 
faction of  the  spleen  is  not  exceptional.  In  the  same  period,  I 
find  ten  obvervations,  in  which  a  tumor  of  the  spleen  more  or  less 
▼oloniBoos,  has  been  formed,  either  during  life  or  during  the  autopsy. 
Sevend  of  those  (acts,  it  is  conceded,  are  the  same  which  have  offered 
ns  a  proof  of  the  intumescence  of  the  liver.  However,  that  of  Troos- 
Man,  of  Mettenheimer,  of  Hochgosandt,  form  no  part  of  the  first  group 
cited.  The  paludal  poisoning,  antecedent  or  present,  is  much  less  fre- 
qnent,  ii  is  true,  yet  it  does  not  suffice  to  imprint  upon  an  obseraation 
sn  exceptional  character,  for  it  has  been  positively  noticed  in  the  cases 
of  Taylor,  of  Gromier,  of  Schmidt  (of  Rotterdam).  The  latter  finds 
even,  a  great  analogy  between  cachcxie  bronzed  and  cachezie  mias* 
aalae.  The  patients  of  Frcsne  and  Perroton  ha^  not  had  intermit- 
tent fevers,  but  they  had  lived  a  long  time  in  a  country  of  fevers. 
ITie  increase  of  white  globules  in  the  blood  of  individuals  attacked 
with  Addison's  disease,  is  not  a  general  fact,  (M.  Fauvet  has  taken 
cara  to  say  so  himself,)  and  if  this  phenomena  has  not  been  present 
in  hia  patient  as  in  one  of  those  observed  by  Hartly,  although  the 
spleen  was  equally  large,  there  is  nothing  in  that  which  should  sur- 
prisa  OS.  As  to  the  amelioration,  which  came  over  the  patient  of  M. 
FaoTet,  it  does  not  seem  to  me  that  it  is  of  a  nature  to  make  us  hesi- 
tate in  the  interpretation  of  the  fact.  On  the  one  hand,  it  may  be  that 
this  amelioration  was  only  temporary,  and  on  the  other,  cases  of  cure 
have  been  cited  by  observers,  whose  names  are  sufficient  guarantee  of 
ibe  truth  of  the  diagnosis.  The  patients  of  Thompson  and  Litz 
were  completely  cured  ;  that  of  Chevandier  experienced  such  an  ame- 
lioration, that  it  was  almost  e([uivalcnt  to  a  cure.  Let  us  add  that  the 
lattar  also  justifies  the  comparison  with  a  negro,  and  that  in  the 
patient  of  Litz,  the  cure  was  not  contradicted  at  the  end  of  three  3'ears. 
Tbitf  rapid  glance  is  sufficient,  I  think,  to  show  that  the  case  of  M. 
Fanret  is  not  altogether  exceptional.  For  myself,  at  least,  I  can  not 
partaka  of  the  reservations  of  the  learned  author  of  the  observation, 
aad  I  see  in  hia  patient,  a  remarkable  example  of  that  state,  which  is 
daacrftad  since  1855,  nnder  the  name  of  diseases  of  Addison  or 
beoDiiad  akin.  Does  it  follow  from  this,  that  in  this  individual  the 
•vpmreDal  capsules  should  waste  away  ? 


160  Editorial  TranslaHonM.  [Msroh 

Tho  numerous  facts  which  have  heen  published*  under  the  name  of 
the  bronzed  disease,  or  maladj  of  Addison,  (troublesome  synonym  in 
all  respects, )  far  from  being  similar,  are  not  even  at  all  comparable. 
One  single  phenomenon  approximates  them,  an  nsthenia  more  or  leu 
profound.  It  is  found  in  all  the  observations.  But  as  for  what  there 
is  of  black  coloring,  and  of  injury  to  the  suprarenal  capsules,  it  is  an- 
other thing.  And  the  facts  known  in  this  respect  are  classed  under 
three  heads,  viz. :  simultaneous  existence  of  black  coloring  and  supra- 
renal injury  ;  coloring  without  lesion,  even  microscopic  ;  suprarenal 
lesion,  without  coloring.  Are  data  desired  ?  In  1857,  Virchow  noted 
in  his  report  on  the  bronzed  skin,  nine  cases  of  black  coloring, 
without  lesion  of  the  capsules  ;  and  fourteen  of  lesion,  without  pig- 
mentation. In  1858,  the  same  author  found  eight  facts  pertaining  to 
the  first  of  these  groups,  and  fourteen  bearing  on  the  second.  In 
1848,  Harley  and  Parked  made  known  a  case  of  black  coloring,  and 
found  no  lesion  of  the  capsules,  carefully  examined  under  the  micro- 
scope. The  same  year.  Professors  Monerct  and  Davey  each  obaerred 
a  case  of  complete  wasting  of  the  capsules  without  unnatural  pigmen- 
tation. And  in  1860,  Buhl  uniting  fourteen  new  facts  to  those  already 
compiled  by  Virchow,  for  his  reports  of  1857  and  1858,  arrived  at 
this  result,  viz.  :  coincidence  of  the  black  coloring  and  of  the  lesion 
forty  times  ;  coloring  without  lesion,  ten  times  ;  lesion  without  color- 
ing, twenty-four  times  ;  which  amounts  to  saying,  that  in  seventy-four 
cases,  tho  relation  noticed  by  Addison  has  failed  thirty-four  times. 
Let  us  admit,  now,  with  Wilks,  (1.)  who  has  devoted  two  disserta- 
tions to  the  defense  of  this  idea,  that  many  observations  have  been 
accredited  to  the  charge  of  Addison,  which  do  not  answer  to  his  de- 
scription, and  for  which  he  can  not  be  I'csponBible.  Let  us  recollect, 
in  the  second  place,  that  profound  sesthenia  holds  the  first  place  in  the 
morbid  slate  he  has  noted,  and  that  the  black  should  be  imputed  to 
this  state,  only  when  it  is  general  and  uniform.  Let  us  strictly  ad- 
mit that  a  special  lesion  is  necessary  {^scrofulous  material)  and  not  any 
lesion  whatever  of  the  capsules  to  constitute  the  disease  of  Addison 
Yet  admitting  all  this,  making  all  these  concessions,  we  should  have 
still  some  refractory  casas,  when  there  would  be  only  one  of  Addison 


,  Virchow  (CoiisUtra  Yearly  Report  for  1H57  and  1SS8.)  Harley  and  Parkea,  brwuad  akte 
ao<l  healthy  Buprarenal  rapaales.  (Medical  Times  and  Gaxette,  NoTember  and  Dtaember, 
1858.)  Monner<»t,  Stndy  on  the  Complex  Waatlofl:  of  the  Spleen,  )rnion  Medicale,  1851.) 
Xorrls  DaTey,  OompleU  DIaorgaolxationof  Both  Snprareual  Capsnlea  withoat  Diacolontkm  of 
the  Skin,  (Medical  Time«  and  Gasette,  iai9.)  Compare,  Lebert,  SsaentUl  Anicminle  (W«lB«r 
Medicinal  Weekly.  1858,)  Charoatand  Velpean,  Bronze  Colurlnff  of  tho  Skin,  Patty  Dborgaa* 
laitlon  of  the  Suprarenal  Oapinleet  (Hedic»l  Oasette  of  Pari*,  1858.) 


1861.]  BdUorial  TranslaHofu.  161 

bimflelf,  one  of  tba  facU  of  the  second  diBsertation  of  Wilks,  and  one 
which  has  been  ao  recently  pnblibhed  in  the  English  Lancet,  Here  a 
lesion  existed ;  the  trae  lesion  closed  up,  and  nevertheless,  the  color- 
ing was  totally  wanting.  Finally,  for  these  rebellions  cases,  and  to 
save  the  theory  in  peril,  Wilks  has  devised  this  explanation,  viz. :  the 
ksion  of  the  capsules  was  produced  so  quickly,  and  the  development 
of  the  disease  so  rapid,  that  the  black  coloring  had  not  time  to  appear. 

Thns,  then,  after  all  our  concessions,  we  iind  ourselves  brought 
back  to  the  conclusion,  that  in  a  certain  number  of  cases,  the  lesion  of 
Addison,  in  the  suprarenal  capsules  is  observed  in  connection  with 
profonnd  lesthenia  and  a  general  coloring.  This,  in  my  judgment,  is 
the  only  possible  conclusion  ;  but  at  least,  in  those  typical  cases, 
which  shall  represent,  if  so  desired,  the  disease  of  Addison,  properly 
called,  separated  by  pathological  anatomy,  from  the  vague  group  of 
bronied  diseases  in  these  cases,  I  ask,  does  there  exist  between  the 
phenomena  the  relation  that  the  English  physician  wished  to  estab- 
lish? Is  it  then,  necessary,  to  confine  ourselves  to  the  lesion  of  the 
iiiprarenal  capsules,  to  sDSthenia,  to  the  cutaneous  pigmentation  ?  I 
esn  not  consent  to  it,  for  I  see  nothing  which  justifies  this  pathogenic 
interpretation.  And  firstly,  in  the  most  of  coses  where  the  lesion  of 
the  suprarenal  capsules  has  been  found  with  Melanodcrmic  coloring, 
(this  is  a  very  happy  expression  of  M.  Fanvet,)  the  patients  were 
labercnloQS  or  cancerous.  They  had  arrived  at  the  cachetic  period  of 
tkeir  disease,  and  1  confess  that  in  all  the  cases  of  this  nature  it  seemed 
to  me  the  lesion  of  the  suprarenal  capsules  ought  to  be  attributed  to 
the  last.  It  is  only  a  very  small  corner  of  the  pathological  table,  and 
I  attribnte  the  wasting  of  the  pigmentary  secretion  to  the  terminal 
esdiezie  of  the  diathesis.  In  the  last  stage  of  the  disease,  this  secre- 
tioB  as  all  others,  is  deranged  and  nothing  more.  I  should  say  that  this 
epinion,  with  which  I  entirely  agree,  is  not  my  own.  It  was  put  forth 
in  the  early  parts  of  this  account  by  Gubler  and  Bonchut,  at  least,  for 
phthisis  ;  and  very  recently  it  was  reproduced  by  Demme,  in  regard 
to  the  patient  of  Hirzel.  This  way  of  viewing  is  applicable  to  a 
hfge  nomber  of  cases.  In  fact,  by  adding  to  the  eleven  primitive 
esses  of  Addison,  sixty-four  facts  borrowed  from  various  authors,  I 
arrive  at  a  total  of  seventy-five  cases  (with  autopsy)  among  which  I 
Ind  seventeen  tuberculous  and  eight  cancerous.  The  proportion  as  is 
ssen,  is  very  respectable. 

Bot,  finally,  it  will  be  said  there  remains  a  certain  number  of  facts 
well  TOQched  for  and  very  clear,  in  which  in  the  absence  of  all  tuber- 
fnlixatkm,  in  the  absence  of  cancer,  the  principal  lesion  was  seated  in 


162  JBdUorial  TramUitiot^.  [Mftiok. 

the  capsales.  And  among  these  facia,  there  are  some  even  (Addison^ 
Wilks,)  whioh  have  shown  the  capsules  very  much  altered,  and  all 
the  other  organs  healthy.  Should  we  not,  at  least,  for  each  Gaaea, 
accept  the  relation  noticed  hy  Addison,  between  the  leaion  and  the 
symptoms  ?  Very  well  1  Even  here  I  would  not  go  so  far  ;  nor  pan 
can!  see  any  coincidence.  The  following  are  the  reasons  for  my  re- 
servations  : 

In  the  great  majority  of  facts  related,  no  mention  is  made  of  the 
condition  of  the  intestinal  glands,  and  of  the  abdominal  lymphatic 
ganglions  ;  on  the  other  hand,  in  those  cases,  of  whioh  the  autopsy 
has  been  completed,  and  accompanied  by  a  satisbctoxy  micro- 
scopical examination,  those  organs  were  found  altered.  Without 
speaking  of  the  tubercles  and  the  cancer  which  had  been  formed  whan 
the  patients  were  phthisical  or  cancerous,  I  would  call  to  mind  that 
Page  and  Hochgesand  have  noticed  a  tumefaction  and  a  general  infil- 
tration of  the  isolated  and  agminated  follicles  of  the  intestines,  with  a 
seeming  alteration  in  the  mesenteric  glands.  Schmidt  (of  Botterdam) 
has  made  the  same  observation.  Vogel  found  in  a  tuberculous  person 
all  the  intestinal  glands  attacked  with  a  considerable  pigmentary  infil- 
tration. Lesions  of  the  same  kind  were  seen  in  the  mesenteric  gia« 
glions  by  Buhl,  Bacon,  McKenzie  and  Sanderson.  It  is  not  then 
proven  to  me  that  the  disorganization  of  the  suprarenal  oapsules  was 
really  singular  in  the  cases  where  it  was  reported  as  such  ;  and  then 
in  those  very  cases,  the  intestinal  glands  and  mesenteric  ganglions 
have  not  sustained  a  satisfactory  examination.  This  entirely  legiti- 
mate doubt  from  my  point  of  view,  strikes  the  foregoing  observation! 
with  nullity  ;  as  for  those  where  the  lesions  of  the  glands  and  of  the 
ganglions  have  coexisted  with  alterations  of  the  capsules,  I  seek 
vainly  in  what  way  they  could  prove  the  pathogenic  influenco  of  these 
latter  organs.  The  principal  thing  here  is  not  in  fact  the  lesion  of  the 
suprarenals,  but  alteration  of  a  whole  series  of  hsematopoietio  glands, 
an  alteration  which  reacts  in  the  first  place,  upon  the  blood,  then  upon 
the  secretions,  in  a  word,  upon  the  general  nutrition.  I  should  have 
noticed,  beside,  that  the  relation  propos^  by  Addison  is  founded  on 
a  physiological  error.  He  assumes  that  the  suprarenal  capsules  take 
part  in  the  formation  of  the  pigment  and  that  they  assist  by  proper 
action  in  the  regular  accomplishment  of  the  functions  of  nntritioa. 
Experiment  shows  that  these  propositions  are  so  many  hypotheaiit 
and  that  two  functions  can  not  be  attributed  to  an  organ  in  a  morbid 
state,  which  do  not  belong  to  it  in  a  healthy  condition. 

There  is  one  last  fact  which  I  can  not  pass  oyer  in  silence,  for  if 


.]  BiUofki  IVanilaiumi.  168 

is  wmating  to  develop  my  argament,  I  wish  at  least  to  state  tbem. 

before  thinking  of  the  lesion  of  the  snpr^renal  capsnles  and  of 
ifluenee  it  may  exert,  there  is  an  alteration  very  differently  signifi- 
which  we  must  consider.  It  is  the  atrophy  of  the  abdominal , 
•thetic  nerve.    It  has  been  fonnd  only  twice,  it  is  tme  ;  bat  how 

times  has  it  been  looked  for  ?  Strange  to  say,  the  first  obser- 
n  was  reported  by  Addison  himself.  The  microscopic  examina- 
iras  made  by  Qnecket,  who  established  the  atrophy  of  the  semi- 

gsnglion,  and  of  the  branches  of  the  solar  plexns.  The  second 
Mongs  to  Schmidt  (of  Rotterdam.)  It  was  the  case  of  a  yonng 
aged  sixteen,  who  died  of  profoand  SBsthenia,  with  almost  gen- 
pigmentation,  and  in  whom  the  capsales  were  infiltrated  with 
;les.  Booganl  who  made  the  microscopic  examination,  found  a 
lersble  atrophy  of  the  sympathetic  aronnd  the  abdominal  aorta. 
rom  being  decided,  the  question  is  re-examined  anew  from  this 
of  view,  and  this  argument,  were  it  the  only  one,  seems  to  me 
nflScient  to  combat  the  interpretation  of  Addison. 
sam  np,  I  see  clearly  that  under  the  name  of  Addison's  disease 
bave  been  described,  which  do  not  agree  with  symptoms  presented 
Idtson,  and  I  agree  that  they  must  be  laid  aside  and  not  accred- 
>  its  charge.  But  I  see  also,  that  the  individuality  of  the  symp- 
established  by  the  English  physician,  can  not  yet  be  admitted. 
that  in  the  complete  and  typical  cases,  nothing  absolutely  nothing 
B  a  pathogenic  relation  between  the  condition  of  suprarenal  cap- 
and  the  symptoms  observed.  I  see,  finally,  that  before  any  con- 
)0,  researches  should  be  recommenced  from  the  point  of  view,  of 
lion  of  the  haematopoietic  glands,  and  of  the  alteration  of  the 

sympathetic.  We  must  then  wait.  But  is  it  not  a  progress  to 
DCS  a  false  assumption,  and  to  establish  our  ignorance.  For 
ff  had  I  to  seek  in  the  present  state  of  science,  a  classification 
»  different  morbid  states  characterized  by  a  deposition  of  black 
lat,  I  would  begin  by  renouncing  the  word  disease  which  is  not 
istificd  and  I  would  unite  in  a  large  class  all  the  melanopatbics. 
*1ass  would  admit,  naturally,  two  kinds  :  the  visceral  melanopa- 
with  which  I  do  not  concern  myself,  and  the  cutaneous  melan- 
its  or  melanodermics.  Here  we  should  find  some  kinds  well 
1.  I  would  commence  by  them,  and  I  should  thus  have  the 
physiological  melanodermy  of  the  fat ;  that  which  is  produced 
islroke  ;  by  exposure  to  a  centre  of  heat  (ephelis  ignealis)  ;  that 

aocompanies  dermotoses  (pytyriasis  for  example)  ;  finally,  that 

follows  absorption  of  salts  of  silver,  etc.,  etc. 


164  EdUorial  TramkUumt.  [Maidi, 

After  having  divided  these  various  forms  of  pigmentation  which  an 
of  importance  onlj  in  a  diagnostic  point  of  view,  I  would  write  in 
mj  table,  first  melanemia,  then  melanodermy,  (tuberoulea — canoer) 
and  lastly,  I  would  admit  nnder  the  name  of  SBSthenio  melanodormj, 
(a  fully  established  qualification  and  one  which  prejudges  nothing),  a 
last  group  whore  should  be  ranged  provisionally  all  those  facts  which 
do  not  enter  into  the  preceding  classes,  that  is  to  say,  all  those  caaei 
of  pretended  suprarenal  melasma.  This  last  group  will  he  modified. 
It  is  possible  that  it  will  disappear  when  we  shall  be  more  enlightened 
on  the  lesions  of  the  sympathetic  and  of  the  organs  engaged  in  Mood- 
making.  But  it  seems  to  me  difficult  at  this  time,  to  go  further,  and 
I  do  not  see  that  we  gain  by  introducing  into  terms,  a  precision  which 
does  not  yet  exist  in  the  facts.  In  the  condition  they  are  in  I  do  not 
see  that  we  can  do  better  than  associate  ourselves  in  the  wish  present- 
ed on  the  3d  of  November  last  before  the  Pathological  Society  of 
London,  by  Dr.  Crisp,  who  demanded  the  creation  of  a  new  commit- 
tee to  judge  and  examine  the  so-called  Addison's  disease.  I  wish 
that  this  demand  may  be  taken  into  consideration  ;  bnt  until  the  whole 
matter  may  be  decided  without  appeal,  I  hold  without  any  reserre  to 
the  opinion  put  forth  by  Schmidt  (of  Rotterdam)  in  1859.  The 
morbid  condition  known  under  the  name  of  Addison's  disease,  is  in 
all  cases  the  lesult  of  an  affection  of  the  sympathetic  abdominal 
nerve.  Here  is  the  principal,  the  primitive  faut.  As  to  the  lesion  of 
the  supraronals,  it  is  secondary.  It  may  be  wanting  without  that  the 
symptoms  shall  be  otherwise  modified.  It  is  only  an  accessory  question. 


■  •  ■  ■ 


New  Mode  of  Retaining  the  Anastliesia  of  Chloroform. 

The  Medicinal  H*U  of  Vienoft  contalas  the  following  importont  notice  of  ft  new  mod*  of 
rcUInlDg  for  aevenil  hours  the  Anouthoeia  of  Chloroform  through  hypodermatic  appUeatfoB  of 
narcotics. 


TKAXSLATEI)  Sr  DE.  BOMBURO,  (CIKClStXATI.) 

The  following  observations  of  Professor  Nupbaum,  of  Munich,  are 
likely  to  prove  of  vast  importance  not  only  in  chirnrgical,  bnt  also  for 
internal  medical  treatment,  for  instance,  in  refeience  to  the  therapy  of 
the* tetanus,  various  neuroses,  etc.,  yea,  even  in  experimental  physiol* 
ogy.  Since  it  appears  to  us  desirable  that  the  valuable  experiments 
in  question  should  be  confirmed  by  other  surgeons  and  physicians 
so  that  experiments  may  be  had  in  the  most  varied  manner,  we  hasten 
to  communiiate  them  briefly,  even  without  waiting  for  a  greater 
number  of  cases  bearing  thereon. 


1864.]  BdUorht  H-oMlaiUms.  165 

Professor  Napbanm  remoTed  about  three  weeks  ago  from  a  patient 
aged  forty,  a  miller,  residing  in  Foelz,  a  great  sarcomatons  tnmor  on 
tbe  neck,  using  chloroform  in  the  nsnal  manner.  To  silence  pains 
aiker  the  operation,  which  required  a  complete  preparation  of  plexus 
oerriealis,  he  injected  beneath  his  skin,  while  still  under  the  influence 
of  choloroform,  one  grain  of  acetate  of  morphine.  The  person  oper- 
ated upon  did  not  snbseqnentlj  as  usual  awaken  from  his  narcotism, 
but  slept  on,  breathing  re^^larlj  and  calmly,  uninterruptedly,  for 
twelve  hours.  He  endured  during  this  sleep  the  deepest  stitches  of 
the  needle,  incisions  into  the  skin,  and  the  application  of  red  hot  iron, 
ete.,  without  even  the  slightest  reaction  against  the  same.  Finally,  he 
awoke  from  deep  slumber  exactly,  as  if  he  had  just  passed  through  a 
eUoroform  narcotism. 

A  few  days  later.  Prof.  Nupbaum  most  pleasingly  surprised  at  this 
exbibition,  and  the  effect  just  stated  of  subcutaneous  application  of 
morphine  on  a  second  patient,  a  Mr.  M.  in  Swabia,  upon  whom,  in 
conaequenee  of  a  cancer,  he  had  just  executed  the  resection  of  the 
upper  maxillary  bone  without  removing  the  alveolar  process  during 
the  chloroform  nercolism,  and  had  finally  on  account  of  cancerous 
irritation  in  the  facial  skin,  undertaken  a  transplantation  in  the 
neighborhood  of  the  temples  and  forehead  by  closing  the  wound. 
Tliia  patient  too  slept  with  complete  absence  of  all  feeling  during 
eight  hours  amid8t  the  most  quiet  breathing.  His  pulse  remained  in 
rhythm  and  number  perfectly  regular.  The  effect  of  the  narcotic 
appears  the  more  surprising  in  this  case,  because  the  same  dose  of 
acetate  of  morphine  had  a  few  days  previous  been  injected  hypoder- 
metically  witliout  producing  Bleep  and  still  less  aniesthesia. 

Two  other  cases  embrace  a  woman  fifty  years  old  and  a  seven  year 
old  boy,  upon  both  of  whom  only  about  half  a  grain  of  morphine  had 
been  subcutaneously  injected  ;  and  both  slept  from  five  to  six  hours 
the  same  quiet  sleep  and  enjoyed  an  equal  anacothctic  condition. 
Another  case,  in  which  the  experiment  in  question  failed  has  up  to 
now  not  beep  observed  by  Professor  Nupbaum. 

From  the  preceding  observations  appears  to  anse  a  physiological 
experimental  point,  that  must  on  further  use  tend  doubtlessly  to  most 
gratifying  results.  Obviously  it  appears  as  if  the  hypodermetic  ap- 
plication of  morphine,  and  perhaps  of  other  narcotics,  for  instance,  of 
atropia,  might  during  the  chloroform  narcose  preserve  for  several  (six 
to  twelve)  hours,  that  peculiar  condition  of  the  central  nervous  system, 
of  which  we  know  it  is  to  be  lamented,  as  yet  so  little,  and  which  is 
temporarily  produced  by  the  effect  of  inhaled  chloroform,  and  to  do 


166  Correspondenee.  [MnJkg 

this  by  greater  or  lesser  doses  of  morphine ;  as  long  at  least  ma  the 
effect  of  morphiae  is  maintained  ;  and  of  coarse  also  (ho  anrnoothasj 
which  to  produce  throagh  the  inhalation  of  chloroform  is^  as  well 
known,  one  of  the  most  beneficent  inventions  in  aid  of  soieriBg 

humanity. 


•  m 


Ergot  In  Mydriasis, 

Miss  M.,  aged  eighteen  years,  had  diphtheria  early  in  September 
last.  Under  the  nsnal  treatment,  the  inflammation  anbsidad  in  the 
course  of  eight  or  ten  days.  Two  or  three  weeks  afterward,  in  at^ 
tempting  to  nse  her  hymn>book  at  church,  she  discovered  some  debet 
of  vision.  She  could  not  distinguish  words  or  letters  of  ordinary 
sized  type.  The  next  day  she  conld  not  sew,  every  thing  appaaiing 
blurred  and  indistinct.  This  imperfection  of  vision  continoed  aboot 
two  weeks,  when  I  was  called.  The  pnpils  were  dilated  and  slags^sb. 
It  was  with  difficulty  that  she  could  read  characters  of  a  quarter  of 
inch.  But  by  means  of  a  card  perforated  with  a  pin  hole,  or  a 
nifying  glsRS  of  three  and  a  quarter  inches  focal  distance,  she  conU 
read  ordinary  print  readily. 

Having  read  the  report  of  a  similar  case  (Cincinnati  Laneeiand 
Observer  for  September,  1868,  page  548,)  treated  by  Dr.  Williams 
with  ergot,  I  determined  to  try  it  in  this  case.  She  was  accordiogly 
put  upon  the  following  :  1^  Pulv.  ergot,  grs.  iij. ;  Qninia  sniph.  gr.  i. 
M.  ter  die.    Also  :  1^.  W.  fer.  mur.,  grs.  z.  bis  d%$. 

On  the  fifth  day  after  commencing  this  treatment,  she  conld  read 
and  write  as  well  as  ever  without  the  aid  of  glasses.  Treatment  was 
then  discontinued.  There  was  considerable  hoarseness  left  by  the 
diphtheritic  inflammation,  and  this  disappeared  almost  as  rapidly  and 
completely  as  the  ophthalmic  trouble. 

The  dose  of  the  ergot  in  this  case  was  much  smaller,  in  proportion 
to  the  age  of  the  patient,  than  in  Dr.  Williams*  case,  yet  the  reenlt 
was  fnlly  as  satiftfactory.  '  J.  O.  HinsH,  M.D. 

Bantam,  Ohio,  Feb.,  1868. 


■  ^a»  i 


Monument  to  Dr.  Lawson. 

Editors  Lancet  and  Observer  : — Permit  me  through  the  Lancet,  to 
call  the  attention  of  its  readers  to  a  matter  that  has  suggested  itself 
to  my  mind. 


18M.]  Oorreipond^nct.  167 

Ib  the  death  of  Prof.  J.  M.  Lawson,  wo  have  lost  one  of  the  bright- 
eit  omameDti  of  the  profession  west  of  the  mountains.  I  suppose  I 
speak  bat  the  sentiment  of  a  nnited  profession,  when  I  say  that  in  his 
dflpBftment  Prof.  Lawson  had  no  superior  in  this  country,  if  in  any 
country. 

Lawaon  on  *'  Phthisis  Pulmonalis,"  I  doubt  not  is  the  most  com- 
plete work  that  has  been  published  from  the  West.  It  has  command- 
ed the  attention  of  the  men  best  qualified  to  judge  it,  not  only  in  this 
country,  but  in  Europe.  But  this  is  not  all  that  he  accomplished.  In 
1842,  he  projected  and  edited  the  journal  now  so  ably  conducted  by 
his  suooessors.  Those  of  us  who  began  with  the  first  number  remem- 
ber hia  article  upon  "  Phlogoeis  of  the  Mucous  Membrane"  with  plea- 
sura.  I  suppose  he  was  among  the  first  that  pointed  out  the  nature 
of  that  affection  and  the  correct  method  of  medication. 

But  be  is  gone  !  6ball  the  Profession  in  no  way  bear  testimony  to 
his  worth  ?  I  propose  that  the  readers  of  the  Lancet  and  Obeerver 
(and  all  others  favorable,)  manifest  their  appreciation  of  Prof.  Law- 
Bon'a  worth,  by  contributing  one  dollar  (and  upward)  to  be  appropri- 
iled  to  the  erection  of  a  monument  to  his  memory.  Let  a  committee 
of  medical  gentlemen  be  appointed  by  the  Academy,  who  will  take 
thia  thing  in  charge,  and  see  to  it  that  a  suitable  monument  be  erected. 
I  do  not  doubt  that  each  reader  of  the  Lancet  and  Observer  will  at 
onoe  forward  a  small  sum  for  an  object  so  noble.  Let  the  many  young 
Ben  scattered  over  the  West  and  South  have  an  opportunity  of  mani- 
issdng  their  grateful  remembrance  of  his  worth  as  a  teacher.  Let  the 
many  who  have  been  instructed  by  his  immortal  work,  have  an  oppor- 
tmiity  of  manifesting  their  appreciation  of  his  worth  as  an  author. 
Let  the  profeasion  abroad  see  that  Western  talent  is  appreciated  by 
Woitem  men.  In  short,  let  a  monument  be  erected  to  the  memory  of 
Prof.  L.  M.  Lawson.  By  this  medical  brethren  will  do  honor  to 
tkcmselves,  and  perpetuate  the  memory  of  one  ever  regarded  as  a 
Christian  gentleman,  a  medical  scholar  and  philanthropist. 

I  am,  sir  yours  W.  H.  Scobky. 

BamUiam,  Feb.  10th,  1864. 

[It  if  proper  enough  perhaps,  to  say  that  the  suggestion  of  Dr. 
Scobcj  has  already  been  acted  upon.  It  is  proposed  to  erect  a  suitable 
monoment  to  the  memory  of  Dr.  Lawson,  and  many  of  the  Profession 
of  thia  city  have  entered  with  liberal  generosity  into  the  movement. — 
Em.  L.  *  0.] 


168  Rtvlem  and  Kclictt.  [M  >reh 

Jj  rturet  on  Orthopoedie  Surgery :  Delivered  at  tho  Brooklyn  Medioal  and  Bar- 
gical  Institute.  V^ith  numeroas  illustrations.  By  Locia  BAUim,  ll.D., 
M.R.C.S.,  Kng.,  Professor  of  Anatomy  ond  Clinioal  Surgery,  ete.,  etc.,  eCo. 
(Iteprintcd  from  the  Philadelphia  Medical  and  Surgical  JleporUr.)  Philadel- 
phia: Lindsay  &  Biakiston.     186-i. 

Tho  aathor  of  tlic  little  volume  before  us  is  not  altogether  nnknown 
to  the  readers  of  the  Lancet  and  Observer,  As  one  of  our  occAsional 
and  very  acceptable  contributors  Dr.  Louis  Bauer  has  in  times  past 
materially  added  to  tho  value  of  our  pages.  This  volume  of  collected 
lectures  on  orthopedic  surgery  first  appeared  in  various  consecutive 
numbers  of  the  Philadelphia  Reporter  is  now  given  to  the  public  in  e 
handsome  volume  of  a  hundred  pages  or  more,  well  illustrated. 

Orthopaedic  surgery  is  comparatively  a  new  field  of  professional 
enterprise  in  this  country,  though  cultivated  with  success  as  a  special- 
ty in  Europe  for  many  years.  Oar  author  very  pleasantly  tracei»  in 
his  Introductory  Lecture,  the  history  of  this  favorite  branch  of  sur^ 
gery,  showing  how  Andry  of  Paris,  and  Yenel  of  Switzerland,  fint 
gathered  up  its  scattered  fragments  into  something  like  definite  system 
a  hundred  years  ago  ;  and  how  Scarpa,  and  Soemmering  and  Delpedi 
and  finally  Stromeyer,  each  in  turn  contributed  their  part  to  the  pres- 
ent proportions  of  the  stately  edifice. 

In  the  United  States  manv  circumstances  have  tended  to  embarrass 
the  progress  of  orthopaedic  surgery.  Dr.  Bauer  very  candidly  alludes 
to  these  particularly  growing  out  of  the  professional  feeling  against 
all  specialties.  He  says  :  "  The  obj()c;tions  of  the  profession  to  spe- 
cialties arc  based  partly  on  wrong  pi-emises,  partly  on  mere  notions. 
Tho  country  abounds  with  quacks  and  pretenders,  who  victimize  and 
fleece  the  community  at  a  fearful  rate.  They  gather  around  themselves 
siiiTerers  by  the  hundi-cd,  and  are  inexhaustible  in  their  promises  and 
schemed  to  delude  the  ignorant  and  credulous  portion  of  the  people. 
What  medical  art  is  impotent  to  achieve  the  quacks  arrogantly  claim 
as  their  divine  secret.'*  Still  Dr.  Bauer  argues  that  all  this  infamous 
business  proves  nothing  against  the  scientific  and  legitimate  pursuit 
of  specialties.  That  specialties  legitimately  established  in  Europe 
especially,  and  to  a  degree  even  in  this  country,  have  not  degenerated 
in  quackery,  Indeed,  on  general  principles  it  would  appear  that 
meilical  science  and  art  during  the  present  century  owes  much  of  its 
rapid  advancement  to  tho  division  of  labor,  as  exhibited  in  the  results 
of  the  investigations  of  Laennec  and  Scoda  in  diseases  of  the  chest 


1864:]  R€vkw  and  SoHcei.  169 

at  Orftmer  in  the  hearing  appanitas  ;  of  Von  Graefe  in  ophihalmolor 
g7  ;  and  Marion  Sims  in  surgical  diseases  of  women. 

Our  author  brings  up  these  historical  reminiscences  in  very  gracefnl 
atjk.  and  concludes  by  a  tribute  to  the  labors  of  Mott  and  a  recogni- 
ttoa  of  a  full  course  of  instruction  in  this  department  now  given  in 
the  Belief oe  Medical  School  by  Prof.  Sayre. 

The  topics  embraced  in  the  present  series  of  lectures  are  convenient- 
ly grouped  under  the  following  heads :  I.  Deformities  of  the  feet ; 
IL  Deforttities  of  the  knee-joint ;  III.  Deformities  of  the  hip-joint ; 
IV.  Deformities  of  the  spine  ;  V.  Deformities  of  the  neck. 

A  very  large  space  is  occupied  in  the  consideration  of  the  nature 
and  treatment  of  club  foot  in  its  various  forms,  in  the  course  of  which 
c2it  noceasary  apparatus  is  fully  illustrate,  embracing  several  things 
introduced  and  modified  by  Dr.  Bauer  himself,  as  for  instance  his 
"dorsal  actew'*  and  his  "orthopoedio  shoe." 

Under  the  third  head  we  have  the  views  of  Dr.  Bauer  as  to  the 
maaa^MBent  of  that  very  important  disease,  morbus  coxarius  or  hip 
joint  disease.  The  most  important  element  of  therapeutics  according- 
ly is  rest — "absolute  rest  of  the  implieated  artictdation,"  For  this 
pvpoae  Dr.  Bauer  uses  his  wire  splints  of  peculiar  construction — the 
model  resembling  after  a  fashion  **  wire  breeches."  He  has  consid- 
mble  to  say  of  the  mechanism  of  the  Davis,  Sayre  and  Veddel 
ipliBto,  and  points  out  the  particular  value  and  indication  of  each. 

We  ean  not  at  this  time  follow  out  the  details  of  the  book  before 
us.  It  is  full  of  practical  teachings  upon  a  most  important  series  of 
■oAid  conditions,  heretofore  in  great  part  poorly  understood  or  ne- 
glected by  practitioners.  We  therefore  can  best  advise  our  readers  to 
gH  this  interesting  book  and  read  it  carefully. 


ofth4  lUtnait  State  Mfedieal  Society  far  18G8. 

The  eleventh  annual  meeting  of  the  Illinois  State  Medical  Society 
iru  held  in  Jacksonville,  May  5th  and  6th,  1863.  The  volume  of 
TViaaactions  is  before  us,  and  presents  a  valuable  contribution  to  the 
ransnt  periodical  literature  of  the  profession.  The  papers  published 
consist  of  a  Report  on  Typhoid  Fever  by  Dr.  Noble,  of  Heyworth  ; 
«a  Diseases  of  the  Eye  by  Dr.  Holmes ;  Minor  Mental  Maladies  by 
Dr.  McFarlane ;  Report  on  Surgery  by  Prof.  Andrews ;  Treatment 
4  delayed  onion  of  Fractures  by  Dr.  Prince. 

The  Report  on  Snrgery  by  Prof.  Andrews  contains  much  that  will 
'(€  read  with  general  interest ;  for  example,  the  Report  places  on  per- 


«Tf. 


170  JReviewi  and  yioiiea.  [Iftr^ 

manent  record  the  history  of  the  admission  of  suigeons  and  aaaiatanl 
to  appointments  in  Illinois  regiments.  It  appears,  on  the  firat  call  fii 
troops,  Drs.  N.  8.  Davis,  0.  Ryan,  O.  W.  Stipp,  Wm.  Chamben 
and  Dr.  Carpenter  constituted  the  Board  of  Medical  Ezaminan — 
fair  voucher  that  applicants  would  be  subjected  to  a  full  test  of  thai 
qualifications.  At  a  subsequent  call,  a  new  Board  was  appointed,  an 
as  several  changes  have  occurred,  we  find  the  following  gentlaoM 
have  from  time  to  time  served :  Prof.  Johnson,  Dr.  H.  W.  Davii 
Prof.  Wing,  Dr.  Bryan,  Dr.  Boskotten,  Prof.  Brainard,  Dr.  Oraa 
Prof.  McArthur. 

Up  to  Jan.  1st,  1863,  five  hundred  and  ninety-five  candidatea  ha 
been  examined  by  the  Board.  .  Of  these,  two  hundred  and  fifty-nin 
were  recommended  for  surgeons  and  two  hundred  and  siz^-aiz  h 
assistant-surgeons ;  and  seventy  were  rejected. 

The  report  also  embraces  considerable  military  surgery  drawn  froi 
the  personal  experienee  of  Prof.  Andrew  while  in  the  field. 

The  Society  adjourned  to  meet  in  Chicago  on  the  first  Tneaday  i 
May,  1864. 


Proceeding*  qf  the  Amerieam  Pharmac^eal  Attoeiathn  at  iU  JSUvemtk  Amm 
Xttivng :  Held  in  Baltimore,  Mftryland,  September,  1868. 

The  Transactions  of  the  American  Pharmaceutical  Association  to 
1863,  which  have  just  reached  us,  makes  a  handsome  volume  of  abov 
three  hundred  pages,  containing  a  large  amount  of  valuable  matter  i: 
the  shape  of  regular  reports  and  special  essays.  Of  these,  the  repoi 
en  the  Progress  of  Pharmacy  occupies  a  large  space,  and  is  from  IVoi 
Ferd.  F.  Mayer,  of  the  New  York  College  of  Pharmacy.  It  is  pn 
pared  with  a  great  deal  of  evident  care  and  labor.  Of  the  speoii 
essays,  W.  Proctor,  Jr.,  contributes  three,  one  on  Aconite  Boot,  o%  i 
Still  for  Apothecaries,  (illustrated)  on  Fluid  Extracts.  J.  M.  Maiae 
•ontributes  two  articles,  on  Solutions  of  Tartaric  Acid,  on  Contamina 
tlon  of  Sulphuric  Acid  with  Arsenic.  Edward  Parrish  givea  tw 
essays.  Other  contributions  are  by  Geo.  C.  Close,  Thoa  Wi^mnd 
P.  W.  Bedford,  II.  P.  Thomas,  F.  F.  Mayer,  G.  J.  Scattergood 
and  F.  Steams.  It  will  thus  be  seen  that  the  members  take  a  livel 
interest  in  their  Association,  afibrding  a  large  amount  of  earnest  labg 
to  promote  its  progress  and  the  success  of  its  meetings.  The  resul 
is  easy  enough  to  foresee.  The  position  of  the  American  pharmacea 
iist  is  steadily  advancing  in  honor,  and  worthy  sharers  in  the  honor 
of  the  great  temple  of  medicine. 

As  further  evidence  of  the  spirit  of  the  Association,  prizes  are  oiBR 


1864.]  Reviewt  and  NcUcM.  171 


•d  for  esMja  upon  the  two  following  snbjects  :  On  Cimicifagft  Race- 

BOta  in  its  chemical  and  pharmaceutical  relations  and  medicinal  uses. 

An  ataay  based  on  a  practical  and  successful  experiment  on  the  oul- 

tm  and  pivparation  of  elaterium  in  the  United  States,  accompanied 

\f  a  spseimea  of  the  product  of  not  less  than  one  hundred  and  twentj 


!Ehs  Association  adjonmed  to  meet  in  Cincinnati  on  the  afternoon 
ef  the  lloid  Wednesday  of  September*  1864. 


AvrwA't  iVstfiosI  P%mrmaejf :  Desirned  as  a  Text-Book  fbr  th«  Stadent,  and 
as  a  Gaide  f»r  tlia  Pbysieian  and  Pharmaeeotist.  With  manj  FormaUs  and 
FieseiipUoiis.  Third  edition,  sreaily  iinpro?«d.  In  one  handsome  oeta?o 
?•!«■«•  ef  nearly  860  pages,  with  se?eral  hundred  illastrations.    Extra 

This  work  is  so  well  known  by  all  who  have  to  do  with  medicine 
whether  he  be  pharmaceutist,  student  or  physician,  that  it  scarcely 
assds  further  mention.  The  simple  annonncement  that  Edward 
Pkrrish  hss  oome  ont  in  a  new  edition  being  sufficient  to  draw  large 
wdsis  from  booksellers,  and  an  immediate  demand  from  those  who 
voold  be  wM  informed  upon  the  latest  and  best  improvements  in  this 
Itpartment  of  science. 

Tlwre  is  no  work  upon  this  subject  so  readable  or  instructive.  The 
lylhbvSv  in  the  scientific  portion  of  the  work,  Parts  III.  and  IV.,  has 
km  extended,  and  furnishes  the  most  compact  method  of  displaying 
tki  eomposition,  doses,  and  other  important  facts  in  regard  to  the  in- 
Si|BBie  diemical  products  and  the  proximate  principles  'of  organic 
•aksiaiioes  used  in  medicine. 

Ts  the  conntiy  physician  who  is  obliged  to  dispense  his  own  medi- 
this  work  is  invaluable,  for  it  tolls  exactly  how  eveiy  thing 
ht  done,  from  preparing  the  most  difficult  medical,  chemical  or 
fhsffMsoantical  compounds  to  tying  a  package  or  pasting  a  label. 

appendix  to  this  work  gives  a  most  valuable  chapter  upon  the  - 
It  of  a  Sick  Chamber,"  which  we  recommend  to  the 
cucfU  perasal  and  practice  of  both  doctors  and  nurses. 

A  list  of  articles  of  diet  and  irode  of  preparation  for  the  sick  and 
esnvalascent,  is  as  necessary  as  tne  medical  formulas,  and  physicians 
win  do  mil  to  become  as  familiar  with  it. 

After  this  comes  a  diapter  of  '*  Becipes  for  some  of  the  more  Im- 
portnat  amd  Popular  Medicines.*'  All  of  which  is  followed  by  a  most 
eomplsCs  Index,  which  saves  many  valuable  moments  in  referring  to 
IS  larys  n  book.  w.  b.  f. 


172  Editor's  TaSle.  [Hardi, 

■    ■ 


*' JTermeticalfy  Sealing"  Ounahct  Wounds  qf  ihe  CAeif.  — In  tht 
original  department  of  this  nomber  we  print  a  Lectare  by  Dr.  Howard 
on  this  important  subject.  Our  readers  will  be  glad  to  read  in  this 
connection  the  following  criticism  on  the  suggestions  of  Dr.  Howard 
by  Dr.  Longmore,  being  part  of  a  Lecture  on  this  subject  before  the 
Army  Medical  School,  delivered  last  December  : 

"  A  plan  of  treating  chest  wounds  has  been  lately  brought  to  notice 
in  the  American  Medical  Times  by  Dr.  B.  Howard,  of  the  United 
States  Army,  which  is  called  by  its  author  the  '  treatment  by  hermet- 
ically sealing  /  and  the  editor  states  it  to  be  understood  that  at  the 
next  engagement  of  the  Army  of  the  Potomac  a  hospital  is  to  be 
organized,  under  charge  of  Dr.  Howard,  for  the  sole  putpose  of  tnat^ 
ing  gunshot  wounds  of  the  chest  by  the  sealing  process.  Dr.  Howard 
advocates  the  propriety  of  this  treatment  for  all  penetrating  wonnds 
of  the  chest  by  gunshot.  He  also  describes  it  to  be  applicable  to  pen- 
etrating wounds  of  the  abdomen,  whether  made  by  gunshot  or  atab- 
bing  instruments. 

"  The  following  is  a  description,  in  Dr.  Howard's  own  words,  of 
the  manner  in  which  the  operation  of  hermetically  sealing  is  to  be 
practised : 

" '  All  accessible  foreign  bodies  having  been  removed,  introduce  the 
point  of  a  sharp-pointed  bistoury  perpendicularly  to  the  surface  jnst 
beyond  the  contused  portion,  and,  with  a  sawing  motion,  paro  the  en- 
tire circumference  of  the  wound,  converting  it  into  a  simple  incised 
wound  of  an  elliptical  form.  Dissect  away  all  the  injured  parts  down . 
to  the  ribs,  then  bring  the  edges  of  the  wound  together  with  silver 
sutures,  deeply  inserted,  at  not  more  than  a  quarter  of  an  inch  apart ; 
.  secure  them  by  twisting  the  ends,  which  are  then  cut  off  short  and 
turned  down  out  of  the  way.  Carefully  dry  the  surface,  and  with  a 
camel's  hair  pencil  apply  a  free  coating  of  collodion  over  the  wound  ; 
let  it  dry,  and  repeat  it  at  discretion. 

"  'For  greater  security,  shreds  of  charpie  may  now  be  arranged 
crosswise  over  the  wound,  after  the  manner  of  warp  and  woof ;  satu- 
rate it  with  collodion,  and  when  dry  repeat  the  process,  until  the 
wound  is  securely  cemented  over.  As  a  still  greater  protection,  a 
dossil  of  lint  may  then  be  placed  over  the  part  and  retained  with  ad- 
hesive straps. 

"  *  If  there  be  a  tendency  to  undue  heat  in  the  part,  it  may  be  kept 


•  «  « 


1 864. 1  Mditar's  Table.  178 

lown  with  cold  afiusion ;  should  uny  loosening  of  the  dressing  occnr» 
tu  additional  coating  of  collodion  may  be  applied.  The  sutures  must 
Do4  hm  removed  until  healing  by  first  intention  is  complete. 

Should  suppuration  occnr,  so  as  to  occasion  distressing  dyspnoea, 
to  treat  it  in  all  respects  as  a  case  of  empyema,  introducing 
\hm  trocar  at  the  most  dependent  point,  and  taking  special  care  to 
avoid  the  admission  of  air/  " 

**  Dr.  Howard  describes  particularly  three  advantages  which  are 
gaisad  by  this  perfect  closure  of  the  wound.  Ist.  HsBmorrhage  is 
eoBlrolled.  At  the  wo^t,  he  says,  the  amount  of  blood  lost  after  the 
opOTEtioa  can  not  be  more  than  would  suffice  to  -fill  up  the  unoccupied 
space  remaining  in  the  pleural  cavity  ;  the  elastic  clot  resulting  fur- 
aishing  a  styptic  par  exc€Uene$  for  the  wounded  vessels  of  the  yielding 
Img.  2d.  Dyspnoea  is  immediately  relieved  upon  removal  of  tl^  at- 
Boepheric  pressure.  3d.  Suppuration,  if  not  prevented,  is  greatly 
duainiihed  by  shutting  out  the  constantly  renewed  currents  of  atmo- 
spheric air,  and  its  character  is  very  favorably  modified.  '  Indeed,  if 
the  wound  were  closed  soon  enough,'  says  Dr.  Howard,  '  I  deem  it 
poenble  that  the  slough  of  the  track  through  the  lung,  with  the  limit- 
ed amoant  of  attendant  pus,  might  be  entirely  disposed  of  by  absorp- 
tioB  aqd  expectoration.' 

''  As  a  proof  of  the  successful  results  of  the  sealing  plan  of  treat* 
I,  Dr.  Howard  mentions  that  some  cases  upon  which  he  operated 
■ix  days  in  the  ambulances  before  reaching  a  General  Hospital, 
paii  of  the  road  travelled  over  being  of  the  worst  description  ;  on  the 
Ifth  day  all  but  one  of  these  so  treated  were  able  to  walk  comfortably. 

"  la  considering  the  proposed  treatment,  what  first  attracts  notice 
is  the  abeence  of  any  limitations  in  its  application,  and  the  assumption 
tkat  healing  of  the  wound  by  the  first  intention  can  be  secured  in  all 
sa.  It  is  the  unqualified  manner  in  which  this  plan  of  treat- 
it  u  put  forth  that  makes  me  think  it  important  to  notice  it ;  for 
if  pot  into  practice  as  described,  I  feel  certain  it  must  lead  not  only  to 
Mch  disappointment,  but  occasionally  do  considerable  harm.  The 
voaads  of  the  ohest  to  ivhich  it  is  to  be  applied  are  simply  designated 
'feaetimling  wounds,'  but  it  is  obvious  from  Dr.  Howard's  remarks 
All  he  iadndes  perforating  wounds,  and  indeed  all  wounds  in  which 
thi  cavity  of  the  chest  is  opened  by  gunshot,  with  or  without  wound 
tf  the  long.  As  I  have  already  explained,  the  variations  which  are 
eeeaUntiy  found  in  the  accompanying  circumstances  of  a  number  of 
vooads  of  the  chest  by  grunshot  involve  corresponding  variations  in 
tksir  degrees  of  gravity  and  probable  issues.     The  difference  between 


174  JBdiiar's  TaUe.  [Hmh, 

an  ordinary  penetrating  wonnd  by  gnnshot,  and  a  perforating  one,  ii 
immense ;  in  the  one  case  the  projectile  is  probably  lodged ;  in  tin 
other  it  has  passed  out.  Again,  in  either  a  penetrating  or  a  perforat- 
ing wonnd,  most  important  differences  arise  in  the  nature  of  the  fagur} 
and  the  efiects  of  the  treatment,  according  as  the  lung  is  penetrated  m 
not ;  and  serions  differences  also  depend  upon  the  part  of  the  Imif 
penetrated  or  trayersed  by  the  ball.  All  these  circumstances  ahouU 
be  noted  and  taken  into  account  in  estimating  the  value  of  a  spooia 
plan  of  treatment  in  a  given  number  of  cases.  If  a  ball  paasei 
through  or  near  the  root  of  the  lung,  it  is  scarcely  possible  to  prerem 
a  fatal  result  by  any  plan  of  treatment ;  if  the  track  of  the  ball  hai 
been  limited  to  the  periphery  of  the  lung,  and  the  constitution  of  thi 
patient  and  opportunities  of  treatment  be  favorable,  we  have  a  righ! 
to  expect  a  favorable  cure  in  a  considerable  proportion  of  cases  nndei 
the  mode  of  treatment  which  has  hitherto  been  in  ordinary  use  of  lati 
years,  and  which  I  have  already  described  to  you. 

**  The  surgeon's  efforts  to  secure  healing  by  the  first  intention  ii 
the  way  named  in  gnnshot  wounds  will,  I  think,  be  attended  witl 
success  in  only  a  very  small  proportion  of  exceptional  cases.  It  i 
the  rule  of  practice  among  army'  surgeons  to  close  completelyt  b] 
sutures,  compresses,  adhesive  plasters,  and  bandages,  all  wounds  o 
the  chest — such  as  incised  and  stabbing  wounds — ^in  which  there  i 
thought  to  be  a  probabiliiy  of  union  by  the  first  intention  being  ob 
tained.  Not  only  the  relief  to  the  breathing  by  rendering  more  com 
plete  inflation  of  the  lungs  practicable — which  is  the  immediate  e&c 
of  this  operation  in  an  incised  wound  of  the  soft  parietes  of  the  ches 
and  periphery  of  the  lung — but  the  arrest  of  the  hnmorrhage  (if  thL 
complication  exist,)  together  with  the  prevention  of  subsequent  ax- 
tended  pleuritis  and  pleuro-pnenmonia,  are  sought  to  be  obtained  bj 
these  means.  And  as  in  many  cases  the  urgent  symptoms  have  grad 
ually  abated  under  this  treatment,  and  eventually  respiration  in  tb 
wounded  lung  being  re-established,  it  has  been  rendered  evident  tha 
the  wounds  had  become  closed  by  the  adhesive  process.  Yon  wil 
find  such  cases  fully  recorded  in  the  works  of  Guthrie,  Larrey,  Hen 
nen,  and  others.  But  in  treating  cases  of  incised  wounds  we  can  no 
rely  upon  obtaining  healing  by  adhesion  even  of  the  external  orlfioe 
although  this  may  be  uncomplicated  with  injury  or  cartilage ;  and  wt 
should  be  prepared  to  meet  these  abortive  attempts  by  other  definit 
plans  of  treatment.  The  restlessness  of  the  patient,  the  natural  move 
meuts  of  the  chest  in  respiration,  inflammatory  action,  cough,  weak 
ened  health,  habits  of  life,  and  special  conditions  of  the  tissues,  ma; 


1884]  Sdiiar^s  TabU.  175 

tbwmii  oar  attempta  to  effect  this  object.  When  to  these  soarces  of 
fiulore  w%  add  oontinued  hemorrhage  at  the  eeat  of  injury  in  the 
pariatea,  and  torn  oartilage  or  divided  ribs — such  frequent  concomi- 
laata  of  theaa  injuries, — the  difficulty  of  obtaining  healing  by  the 
£nt  iaiantion  ia  still  further  increased. 

**  When  we  leave  incised  wounds  and  approach  those  of  penetrating 
gaaahot  wounds — at  least  those  inflicted  by  projectiles  as  large  as  or- 
Aiiiary  musket-balls, — the  probability  of  obtaining  healing  by  the  first 
iataatioQ  seems  to  be  altogether  absent.  Here  not  only  all  the  ordi- 
nary aotnees  of  prevention  of  this  desired  result  which  I  have  just 
aaniionad  azist  in  an  aggravated  degree,  but,  in  addition,  a  rib,  wheu 
itruck,  ia  not  aimply  divided  as  by  a  sword,  but  is  contused  and 
^liBlared,  and  the  soft  parts  around  the  opening  made  by  the  ball,  for 
a  'diatanco  varying  according  to  the  size  and  shape  of  the  projectile, 
sad  ita  amount  of  ^momentum,  are  bruised,  and  their  vitality  and  re- 
paraCiva  tendency  proportionately  diminished.  To  remove  this  spha- 
eslalad  anrface  and  surrounding  bruised  structures  by  incision,  and 
then  to  force  the  edgea  of  this  enlarged  opening  together  by  sutures 
(for  it  ia  to  be  remembered,  even  in  cases  where  ribs  and  their  carti- 
Isgea  have  escaped,  the  intercostal  muscular  tissues  and  pleura — not 
■srsly  the  integument — are  contused  and  torn,)  appears  to  involve 
the  — caasity  of  such  a  strain  as  would  prevent  all  probability  of  cohe- 
by  first  intention,  even  if  such  further  impediments  as  costal 
ints,  sudden  impulses  by  coughing,  and  symptoms  of  inflam- 
ioB  ariaing,  were  not  in  existence.  Experience  has  hitherto  taught 
that  ia  these  injuries  provision  must  be  allowed  for  the  escape  of 
;^s  £zd  suppurative  discharges  from  the  parietal  wounds — not  to 
other  circumstances  ;  and  that  to  pen  them  np  by  close  com- 
ia  to  thwart  nature's  plan  of  attempting  cure,  and  to  aggravate 
tta  evila  which  have  been  already  inflicted.  Hence  the  rule  has  arisen 
fa  all  caaea  of  imeUed  wounds  of  the  chest,  whether  haemorrhage  be 
paisaat  or  not,  to  close  the  wound  by  suture  and  compress  as  early  as 
poasibla,  aad  to  seek  for  union  by  adhesion  ;  but  in  gunshot  wounds, 
to  doaa  by  suture,  and  only  to  make  accurate  closure  a  matter  of 
dty  where  they  are  accompanied  by  active  hemorrhage. 
*'  Baron  Larrey,  in  his  memoirs  of  the  Egyptian  campaign,  (Mb' 
ra  ds  CkirwrgU  HUUaire^  tome  ii.  p.  155.  Paris,  1812,)  has  given 
sacxoelleat  explanation  of  the  manner  in  which  the  urgent  symptoms 
af  aa  iaeiaad  wound  of  the  lung  with  hmmorrhage,  when  the  hssmor- 
ihaga  ariaaa  wholly  from  the  pulmonary  vessels,  are  frequently  caused 
lo  caaaa,  if  tha  wound  in  the  chest  be^accumtely  closed.    While  the 


176  JSMfar's  Taite.  [Hirch, 

wound  is  open,  tlie  inspired  air,  finding  a  readjr  way  of  exit  ij  dM 
opening  in  the  Iung»  constantly  opposes  the  cohesion  of  the  maigins 
of  this  opening,  at  the  same  time  that  its  escape  in  this  way  preveata 
the  distension  of  the  air-cells  of  the  eurronnding  lung-straotare,  wtMtk 
would  lessen  the  arterial  flow,  and  accelerate  the  retnm  of  the  blood 
hy  the  pulmonic  veins.  When  the  wound  in  the  chest  haa  been  acca- 
rately  closed,  after  allowing  the  blood  already  effused  in  the  plenrm  to 
escape  through  the  opening  by  fayorable  position,  the  air  introdoeed 
into  the  Icng  by  breathing,  not  finding  the  same  way  of  isaaOv  fiDs 
more  completely  the  small  bronchial  tubes  and  air-cells,  facilitates  the 
return  of  blood  to  the  heart,  causes  the  divided  lung  ■nr£acea  to  ap- 
proach  each  other,  favors  the  contraction  oi  the  orifices  of  the  wound- 
ed veffsels,  and  assists  by  these  means,  as  a  consequence,  the  adhesive- 
process.  But  in  the  case  of  a  contused  and  ragged  canal  being  opened 
through  the  lung  by  a  projectile  passing  into  or  through  it,  all  the  cir- 
cumstances are  manifestly  changed  *  if  bleeding  is  going  on  from  its 
surface,  neither  the  passage  of  the  air  through  the  wound  in  the  chest- 
wall  nor  its  restraint  can  exert  influence  upon  it,  for  the  track  of  the 
ball  will  remain  patulous  under  all  circumstances,  so  far  as  the  act  of 
respiration  is  concerned. 

''  Let  me  briefly  consider  the  three  advantages  which  Dr.  Howard 
advocates  for  the  hermetically  sealing  treatment  in  gunshot  wounds. 
Dr.  Howard  states  the  causes  of  fatality  in  gunshot  wounds  of  the 
lungs  to  be  hsemorrhage,  dyspnoea,  and  suppuration  ;  and  that  these 
may  be  restrained  and  modified,  if  not  prevented  or  removed,  by  the 
simple  operation  already  described. 

"  Bcemorrhape,  Dr.  Howard  rightly  places  first  amongst  the  cansei 
of  fatality.  It  is  the  symptom  which  of  all  others  alarm&  the  surgeon ; 
for  he  can  not  but  feel  how  much  the  power  of  nature  to  arrest  the 
flow  of  blood,  and  how  much  the  result  of  his  own  endeavors  to  aid 
nature  in  her  efforts,  must  depend  upon  accidental  circumstances  con- 
nected with  the  course  of  the  projectile  and  the  injuries  it  has  inflicted, 
which  is  entirely  out  of  his  power  to  control.  The  track  of  the  bullet 
is  out  of  sight ;  the  injury  it  has  done  to  the  lung  is  out  of  reach.  It 
may  be  judged  that  vessels  of  the  largest  size  have  not  been  divided 
as  it  traversed  the  viscus,  or  death  would  have  been  nearly  instanta- 
neous :  a  surmise  may  even  be  made  of  the  part  of  the  lung  wounded 
by  the  situation  of  the  aperture  of  entrance,  or,  if  two  openings  exist, 
by  a  supposed  line  connecting  them.  But  such  surmises  are  often 
proved  to  be  erroneous  by  post-mortem  inspection  ;  even  the  source  of 
the  haemorrhage,  whether  it  be  wholly  pulmonic  or  wholly  parietal,  or 


1884]  Sdiicr*$  Tabh.  "    177 

tli0  two  combined,  can  not  be  diagnosed  with  certainty  in  these  com- 
plicated wonads.  It  is  not  to  be  wondered  at  then,  that  under  anch 
cireamttances  oif  doubt  and  consciousness  of  helplessness,  surgeons, 
tliongh  recognizing  the  differences  between  a  gunshot  and  an  incised 
woand  of  a  lung,  should,  nevertheless,  almost  instinctively,  stop  the 
gap  through  which  the  life-blood  of  the  patient  is  seen  to  be  flowing. 
Although  the  surfaces  of  the  wound  in  the  lung  can  not  be  brought 
into  contact  and  coaptation,  there  is  still  the  hope  that  as  the  blood 
aocamulates  within  the  pleura,  it  may  exert  such  a  pressure  upon  the 
wounded  lung,  and,  perhaps,  so  plug  up  the  mouths  of  the  open  res- 
•da,  as  to  stay  the  flow  of  blood,  and  procure  time  for  the  saving  pro- 
oesaea  of  nature  and  the  application  of  remedial  measures  on  the  part 
of  the  smgeon  that  may  lead  to  the  recovery  of  the  patient  And  the 
moat  experienced  army  surgeons  have  long  recommended  this  course 
under  circumstances  of  gunshot  wounds  with  profuse  haemorrhage* 
'  Hermetically  sealing,'  thus  applied,  is  only  a  new  term  :  the  practice 
is  not  new.  Immediate  closure  of  the  wound  is,  at  the  present  day, 
the  geaeral  practice  of  all  surgeons  in  such  cases.  The  difference  in 
the  treatment  between  the  practice  of  closure  and  hermetically  sealing 
ia»  that  in  the  one  no  attempt  is  made  to  obtain  healing  of  the  wound 
by  the  first  intention,  which  it  is  not  expected  can  be  obtained  in  open* 
iags  made  by  gunshot;  and,  secondly,  that  the  continuation  of  the 
doaare  is  made  subject  to  other  contingincies  which  are  not  unlikely 
to  Ibllow  the  injury.  It  frequently  happens  in  such  cases  that  the 
flow  of  blood,  after  the  closure  is  not  arrested  until  the  accumulation 
on  the  wounded  side  is  so  great  that  the  pressure  exerted  upon  the 
heart  and  eonnd  lung  is  strong  enough  to  threaten  death  from  asphyxia. 
It  is  manifest  under  such  circumstances  that  the  wound  can  not  be 
kept  hermetically  seated  ;  it  must  bo  reopened,  some  of  the  effused 
Upod  allowed  to  escape,  and  there  still  remains  the  hope  that  the 
state  of  the  circulation,  and  the  usual  condition  consequent 

loss  of  much  blood,  with  tlie  aid  of  proper  lemedial  measures,  may 
fkwor  ths  prevention  of  further  haemorrhage.  If  we  persist,  under 
these  eircnmstances,  in  maintaining  the  hermetically  sealing  of  the 
chest, — if  Dr.  Howard's  injunction  that  the  sutures  are  not  to  be  re- 
Bored  until  healing  by  the  first  intention  is  complete,  is  attempted  to 
be  carried  out, — I  fear  the  risk  will  be  run  of  causing  the  death  of  the 
patient  by  soffocation. 

**  DffMpmtm  is  a  symptom  which  may  depend  on  several  causes.  I^ 
nay  be  indoced  by  the  very  circumstance  I  have  just  described,  after 
closure  of  the  wound — viz.,  continued  bsemorrhage  and  accumulation 


178  JSdUar's  TaUe.  piarah, 

of  blood  in  the  cavity  of  the  chest,  and  sealing  will  not  then  afford 
relief :  if  it  depend  upon  the  interference  with  natural  respiration  snek 
as  has  been  described  to  exist  in  incised  wounds  of  the  Inng,  hermet- 
ically sealing  might  afford  relief  if  there  were  no  complication*  and 
the  sealing  conld  be  maintained  long  enongh.  This  continued  sealing, 
however,  it  is  believed,  the  circumstances  connected  with  the  dischargee, 
and  other  consequences  of  gunshot  wonnds,  will  not  admit  of.  Bat 
supposing  that  for  the  relief  of  this  symptom  the  chest  has  been  her- 
metically sealed,  an  irregnlarly  torn  lung,  or  a  lung  with  the  open 
track  of  a  ball  through  it,  will  almost  certainly  give  rise  to  pneumo- 
thorax, and  the  continued  escape  of  air  into  the  cavity  will  cause  subh 
compresttion  on  all  the  contents  of  the  chest  as  to  aggravate  the  dysp- 
noea extremely,  and  cause  imminent  danger  to  life  from  suffocation. 
In  such  a  case,  again,  the  wound  must  be  reopened,  or  another  open- 
ing practised  by  the  trocar,  to  afford  relief. 

"  Lastly,  Dr.  Howard  advances  that  suppuration  is  greatly  dimin- 
ished, if  not  prevented,  by  shutting  out  external  air.  This  is  dovbt- 
less  the  case  with  incised  wounds,  but  can  we  expect  it  to  be  with 
penetrating  gunshot  wonnds  ?  An  uncomplicated  wound  of  this  kind, 
without  hemorrhage,  without  lodgment  of  foreign  bodies,  is  unfortu- 
nately rare  indeed,  and  such  complications  can  scarcely  fail  but  lead  to 
pleuritic  effusion  and  empyema.  If  the  haemorrhage  be  slight,  the 
blood  may  be  absorbed ;  but  if  it  be  in  its  usual  quantity,  and  not 
evacuated,  it  will  irritate  the  serous  sac,  and  produce  the  same  efiects 
as  other  foreign  bodies.  Mr.  Gnthrie*s  experience  in  the  Peuinsnlar 
War  led  him  to  state,  that  in  cases  in  which  there  was  not  a  free  com- 
munication between  the  wound  in  the  parietes  and  the  cavity  of  the 
chest,  pleuritic  effasion  was  the  principal  danger  to  be  feared.  '  When 
the  external  wound,'  Mr.  Quthrie  says,  '  has  been  closed,  or  is  so  par- 
tially closed  as  not  to  allow  the  escape  of  the  effused  fluid,  it  is  com- 
monly the  immediate  cause  of  the  death  of  the  patient.  Its  secretion 
and  early  evacuation  are,  therefore,  the  most  important  points  to  be 
attended  to  in  wounds  of  the  chest.'  (  CommetUaries  on'  Surgery^  5th 
edition,  p.  382.) 

"  I  have  thought  it  right  to  consider  this  subject  at  some  length  be- 
cause I  fear,  if  penetrating  gunshot  wounds  of  the  chest  are  treated  in- 
discriminately by  hermetically  sealing  the  external  wonnd  or  wonnds, 
a  fatal  termination  will  be  induced  in  some  cases  which  might  termi- 
nate otherwise  under  the  more  ordinary  methods  of  treatment  '  But 
if  my  fears  in  this  respect  should  be  proved  to  be  groundless,  and 
practice  shall  bring  to  light  an  improved  method  of  treating  these 


1864.)  JBdUar't  IMe.  Vfi 

•erioos  injnriet,  miliUry  surgefj  will  be  greatly  indebted  to  its  Aoihor' 
fer  it  is  midoiibtedly  unhappily  moat  trne  that  hitherto,  in  all  cam- 
paigna»  the  proportion  of  fatality  in  really  penetrating  and  perforating 
wonnda  of  the  chest  has  always  been  excessively  large.    I  believe  the 
proportion  of  fatality  would  even  appear  greater  than  it  does  in  some 
taUea  if  the  diagnosis  were  more  accarately  made  in  the  various  ho8« 
pitab  from  the  combined  retqms  of  which  such  tables  have  been  com- 
posed;    Easy  as  one  might  at  first  suppose  to  be  the  diagnosis  of  a 
mnsket-ball  wound  of  the  chest,  whether  penetrating  or  non-penetrat- 
ing, dperience  shows  that  it  is  not  so.    Partial  circuits  of  balls  be- 
aenth  the  integuments  and  the  muscles  of  this  region,  beneaih  the  sca- 
pula, perhaps  complicated  with  great  bruising,  fracture,  hiemorrhagei 
and  attended  with  dyspnoea,  haemoptysis,  and  faintness,  deceive  the 
mwary  at  once  into  the  belief  that  the  chest  must  have  been  opened 
and  traversed  by  the  ball  when  the  pleura  has  escaped  entire.    The 
eirennastances  of  field  hospitals  for  some  time  after  a 'battle  too  often 
add  to  tbe  chances  of  inaccurate  diagnosis  of  particular  wounds,  and 
errors,  onoe  made,  are  not  likely  to  be  changed  in  the  tabular  returns* 
although  the  nature  of  each  case  may  be  more  truly  arrived  at  in  the 
seeondaiy  or  general  hospitals,  through  which  the  patients  subsequent- 
ly pass.   I  hftve  repeatedly  seen  cases  returned  as  penetrating  wounds, 
IB  wliich  I  have  been  able  to  demonstrate  satisfactorily  that  the  cavity 
of  tlie  chest  has  not  been  exposed  at  all.    You  will  find  several  such 
cases  described  by  me  in  the  last  volume  of  Army  Medical  Repori$» 
nder  Wounds  of  the  Chest.     If,  as  has  been  stated,  a  field  hospital 
ihonld  be  established  in  America  for  the  reception  of  gunshot  wounds 
of  the  chest,  and  the  cases  be  submitted  to  the  treatment  I  have  been 
commenting  upon,  it  is  especially  to  be  hoped  that  the  diagnosis  in 
oich  case  shall  be  in  the  first  instance  established  and  defined  as  accu- 
lately  as  possible,  so  that  the  value  of  the  observations  made  on  the 
sSKta  of  this  treatment,  and  of  the  tabular  deductions  as  to  its  fina^ 
nsnltSp  mav  not  be  impaired  by  any  doubts  as  to  the  nature  of  the 
Mries  of  casew  which  have  been  subjected  to  it. 

**  No  pains  appear  to  be  spared  by  the  authorities  in  America  to  en- 
eoorage  professional  investigations  of  this  nature  ;  and  under  the  able 
firectioa  of  the  energetic  Surgeon -General,  Dr.  Hammond,  and  from 
fte  observations  of  the  hundreds  of  medical  officers  who  are  laboring 
m  the  immense  field  of  campaigpiing  practice  which  is  now  afibrded  in 
tkai  comitry,  we  have  every  right  to  expect  that  great  advances  will 
he  made  there  in  the  science  of  military  surgery. 


180  BdUoi's  Tabu,  [Mmh, 

To  C0BRE8PONDXNT8. —  Our  GrmMing  FrUnd  will  baf^ad  to  know 
tliat  his  strictureB  are  accepted ;  and  we  hope  he  will  not  hereafter 
have  occasion  to  repeat  them.  The  fault  compkined  of,  howererg  was 
not  altogether  our  own. 

Vaccine  Virus. — Many  of  onr  correspondents  write  to  ns  to  send 
them  vaccine  matter,  We  comply  with  the  request  when  we  are  able 
to  do  so,  but  just  now  the  demand  is  so  great  that  it  is  very  difiEioQlt 
to  do  so.  We  take  this  occasion  consequently  to  say  that  Mr.  Gordon, 
comer  Eighth  and  Central  Avenue,  generally  keeps  a  supply  of  fresh 
on  hand  at  81.00  a  scab. 

Union  Washing  Machine. — To  save  replying  individually  to  quite 
a  number  of  our  friends  who  have  written  to  us  for  our  opinion  of 
this  washing  machine,  (advertised  on  onr  cover  sheet),  we  state  that 
the  machine  has  been  in  weekly  use  in  our  family  for  several  montha, 
and  fully  meets  the  promise  made  by  the  proprietors.  The  work  is 
done  in  half  the  time,  with  less  expense  of  labor,  less  soap,  and  the 
work  is  more  thoroughly  done,  better  done.  This  is  the  verdict  of  onr 
women  folks,  and  that  corresponds  to  the  experience  of  a  large  number 
of  families^using  this  machine  in  our  city. 

Acceptable  Articles  are  on  file  from  Dr.  A,  McMahon,  Suigeon 
Sixty- fourth  O.V.I.,  on  duty  at  Chattanooga,  and  frofti  Dr.  William 
Commons,  Assistant- Burgeon,  U.S.N. ,  on  duty  on  Flag  Ship  Hart- 
ford, Farragut's  Fleet  o£f  New  Orleans,  and  from  Dr.  Boynton, 
Secretary  of  Trippler  Military  Medical  Society,  Knoxville,  Tenn. 

Many  Correspondents  write  to  us  on  items  of  business  occurring 
incidentally.  We  attend  to  these  with  pleasure  when  we  can  do  so 
and  as  promptly  as  we  can  ;  bnt  we  are  often  requested  to  do  so  by 
"  return  mail/'  and  perhaps  to  write  a  letter  relative  thereto.  We 
must  ask  our  friends  to  be  patient  with  us,  and  as  a  general  thing,  not 
expect  a  response  by  mail,  unless  in  special  cases  or  where  there  is  a 
special  necessity.  Onr  correspondence  is  necessarily  already  quite  as 
extended  as  we  can  do  justice  to. 


Sydenfiam  Association.  —  The  physicians  of  Oldham,  Henry  and 
Shelby  Counties,  Ky.,  have  oi^anized  a  Medical  Association  with  the 
foregoing  title,  for  mutual  improvement  and  the  advancement  of  the 
interests  of  the  profession  in  that  region.  We  have  received  a  copy 
of  the  Bill  of  Prices  adopted  by  the  Sydenham  Society  and  which  the 
members  pledge  themselves  to  observe  and  carry  out.  The  rates 
agreed  -upon  arc  certainly  very  moderate,  considering  the  times,  and 
surely  aflford  no  temptation  to  any  member  to  undercharge.     Thus, 


1884.]  Edk^'8  ntU,  161 

for  TiflU  in  village,  91.00,  50  cents  each  additional  mile  ont  of  townj 
office  piescriptions,  91.00 ;  vaccination,  50  cents  to  91.00 ;  Aerticei 
in  attendance  on  variola,  double  rates  ;•  obstetrical  attendance,  exclu- 
sive of  visits,  98.00  ;  placental  delivery,  95.00  ;  reducing  simple  f^ac- 
toie,  96.00-10.00 ;  compound  fracture  and  first  dressing.  910.00- 
20.00  ;  ampuUtions,  95.00-10.00,  etc.,  etc. 

We  think  there  is  a  disposition  in  the  profession  more  generally  to 
cultivate  social  relations.  Vigorous  associations  are  springing  up» 
and  we  feel  confident  they  will  bear  abundant  and  pleasant  fruiL 
Our  present  issue  contains  the  abstract  of  Proceedings  of  the  Indiana- 
polis Association.  It  will  be  seen  that  our  friends  there  have  entered 
npoB  the  duties  of  their  Society  with  an  energy  that  is  refreshing. 
Thej  will  not  be  sorry  if  they  persevere  in  their  present  excellent  re? 
latkms. 


Sew  York  Academy  t^f  Medicine, — ^The  annual  oration  before  the 
Academy  of  Medicine  was  delivered  on  Thursday  evening,  December 
10th,  at  the  hall  of  the  University  College,  by  l*rof.  John  W. 
Draper.  The  subject  was  the  Influence  of  History  upon  the  Medical 
Profession,  and  it  was  treated  by  the  distinguished  orator  with  the 
most  consummate  ability.  His  studies  of  history  enabled  him  to  il- 
lustrate his  subject  with  many  exquisite  sketches,  and  enrich  it  with 
«any  philosophical  deductions.  The  audience  was  large  and  select, 
and  received  the  address  with  great  favor. — Medical  Times, 

Wbmen^i  Hospital,  yew  York, — At  the  late  annual  meeting,  Dr. 
Thomas  Addis  Emmett  reported  that '110  patients  have  been  under 
tiestment  in  the  institution  during  the  past  year.  Eighty-five  surgi- 
od  operations  have  been  performed  during  the  year,  mostly  of  a  severe 
disracter.  The  number  of  out-patients  was  610,  all  of  whom  could 
bare  been  l)ettcr  treated  in  the  hospital,  had  there  been  room  for  them. 
The  receipts  during  the  year  were  97,619. — Boston  Med,  and  Sur^. 
JcumaL 


Medical  Goxxenorxbxts. — Bush  Medical  College  Ki  Chicago,  held 
its  twenty-first  annnal  commencement  on  the  evening  of  the  27th  of 
Jtaiiary,on  which  occasion  seventy-nine  gentlemen  received  diplomas. 
Ptot  Brainard,  President  of  the  Faculty,  delivered  the  diplomas  and 
proBOimced  the  valedictory. 

The  Sam  Francisco  Medical  Press, — Prof,  L.  C.  Lane  who  has  so 
ably  conducted  this  journal  since  the  decease  of  the  late  Prof.  Cooper, 


182  .Salter**  !Mk.  [Uiie^ 

withdraws  from  the  editorial  maoageiiMot  and  it  anooa^hjL  bj  Dn. 


Nsw  Works. — Prof.  Austin  Flint  is  engaged  ia  the  piepaiation  of 
a  new  treatise  on  the  Principles  and  Practioe  of  MA<^^^■M^^  whkii  oaa- 
not  fail  to  be  an  important  contribution  to  Medical  litoraton* 

Prof.  W.  H.  By  ford,  of  Ohicago  has»  as  we  are  pleased  to  lean,  a 
new  work  in  course  of  preparation  and  will  soon  be  issued  oft 
"  Chronic  Diseases  and  Displacements  of  the  Uterus.'* 


A  State  Board  for  the  ExamimUionrf  Candidakifwr  thmiuaiiamn^^ 

The  University  of  Buffalo  Medioal  Department  has  taken  a  step  in 
the  right  direction  in  this  matter.  We  observe  that  at  the  recent 
meeting  of  the  New  York  State  Society  at  Albany,  the  following  eom- 
munication  was  presented  and  on  motion  adopted  : 

"Umivkr^^itt  of  Buffalo,  Medioal  Dspartmevt. 

"  On  motion  of  Prof.  Chas.  A.  Lee,  seconded  by  Prof.  James  P. 
White,  it  was 

'<  Resolved,  That  the  New  York  Sute  Medical  Society  be  requested 
to  appoint  a  committee  to  consider  the  expediency  of  and  to  report  a 
plan  for  the  appointment  of  a  State  Board  of  Examiners  for  the  degrte 
of  Doctor  of  Medicine,  and  to  report  at  the  next  meeting  of  the 
Society. 

**  Beeolved,  That  the  same  committee  bo  instructed  to  bring  the 
subject  before  the  next  meeting  of  the  American  Medical  Association* 
and  that  the  delegates  of  this  Society  be  instructed  to  urge  the  ffeneral 
adoption  of  the  same  plan  in  other  States  of  the  Union.  Carried 
nnauimously."  i       Thos.  F.  Rochester,  Chairman. 

Sanford  Eastman,  Dean  of  the  Faculty. 

Buffalo,  Feb.  2d,  1864. 

In  commenting  upon  this  action  of  the  Buffalo  School,  and  the  New 
York  State  Society,  the  Buffalo  Medical  Journal  makes  the  following 
remark  that  has  a  terrible  significance  and  we  fear  too  much  truth  : 
*'  There  is  no  doubt  that  an  impartial  Botu'd  of  Examiners  would  re- 
ject, as  unprepared  for  the  duties  of  the  medical  profession,  from  one- 
quarter  to  one-third  of  the  young  men  who,  under  the  present  system 
of  graduation,  are  yeftrly  admitted  to  the  practice  of  medicine.'* 


Marsh,  Corliss  dt  G9.  —  By  some  oversight,  the  card  of  this  old 
eetablishment  at  No.  8  West  Fourth  St.,  was  omitted  from  our  adver- 
tising department  Our  friends  will  find  this  the  same  reliable  place 
for  procuring  trusses,  and  apparatus  for  deformities,  and  all  gCMS  in 
this  department. 


1864;]  E^Oor^B  TMt.  188 

A.  LomU  MkUeal  and  Surgical  Journal, — We  have  reoeived  No.  1 
of  the  iww  series  of  this  Journal.  It  is  gotten  np  with  great  care 
and  excellence  in  every  department,  exhibiting  an  anueual  amount  of 
painstaking,  editorial  labor.  The  paper  is  good  and  the  printing  well 
tssented.  It  oontains  ninety-six  pages  published  every  alternate 
moath»  at  98.00  a  year.  It  deserves  the^  patronage  which  we  doubt 
mot  it  will  receive  from  the  physicians  of  the  West,  especially  the 
Yalkj  of  the  Missouri. 

Marrud,  at  the  residence  of  the  bride^s  father  in  this  city,  on  the 
t^antfif  of  February  11th,  by  Rev.  Dr.  M.  L.P.  Thompson,  Chas.  P. 
WiLsov,  M.I>.,  and  Miss  Marie  F.  Cofpik. 

Long  life,  happiness  and  prosperity  attend  our  esteemed  young 
fritad  in  his  new  relation. 

Oo9.  Ted. — Prof,  Blackman,  —  The  following  communication  is 
vseeived  from  Prof.  Blackman  just  as  we  are  going  to  press,  and  too 
jsto  to  find  a  place  in  the  usual  department  of  Correspondence.     We 
tjhereforo  give  place  to  his  strictures  in  our  Editorial  Table : 

Cincinnati,  Feb.  27th,  1864. 
Editobs  Lanobt  and  Observer  : — Your  number  for  February  con- 
tuns  a  complimentary  notice  of  Gov.  Tod,  in  which  I  find  the  follow- 
ing extraordinary  statement.     "  It  is  to  him  that  the  profession  owes 
As  appointinent  of  a  State  Medical  Board His  predecessor  ap- 

P'nted  the  surgeons  ...  on  his  own  judgment,  influenced  of  course 
political  considerations.  This  Oov.  Tod  refused  to  do.  He  sent 
S&  applicants  before  the  Medical  Board,  and  if  successful  in  their  ex- 
SBiination,  he  appointed  them.'*  Again,  ''  As  k  result  of  all  this  the 
Bsdical  men  appointed  from  Ohio  occupy  a  high  place  in  the  army. 
.  .  .  On  acconnt  of  the  decided  course  of  Governor  Tod  against  ap  • 
pointing  quacki,  the  Legislature  attempted  to  cripple  him  and  force 
um  into  recognising  quack  physicians." 

**  Without  calling  in  qnestion  this  last  statement,  let  ns  look  for  a 
sement  at  the  real  facts  of  the  case.  Some  months  before  the  ezpi- 
lation  of  Governor  Den ni son's  term,  the  Legislature  passed  a  bill  re- 

r'ng  the  Governor  to  appoint  a  State  Medical  Board  for  the  army. 
Wlliting,  of  Canton,  Ohio,  Prof.  Hamilton,  of  Columbus  and 
■yself  were  appointed.  Governor  Dennison  told  us  to  fix  our  own 
sUBdnrd  of  qualifications,  and  assured  us  no  one  should  be  commis- 
steed  who  had  not  been  examined  and  recommended  by  us.  For  two 
tessioBS,  during  which  I  was  on  the  Board,  the  applicants  were  snb- 

e tad  to  a  severe  examination,  so  severe  that  a  large  number  had  to 
nJBCtad.  No  irregular  practitioner  was  admitted  to  an  examina- 
taoB.  *  One  of  these  carried  the  matter  before  the  Legislature,  and 
evtain  prominent  members  were  unsparing  in  their  denunciation  of 
tte  BoBfdf  and  used  every  effort  to  compel  us  to  examine  irregular 


184  MdUor's  Tttitf^  [Mtn^ 

practitioners,  but  I  have  yet  to  learn  of  ihe  first  ioBtancv,  diter  the  or- 
ganization of  the  Board,  in  which  Gk>yernor  Dennieon  commisaioned 
an  irregnlar  practitioner.  For  my  own  part,  I  am  not  willing  siMntly: 
to  submit  to  the  injustice  of  your  reflections  on  the  State  Medical 
Board  first  organized  after  the  passage  of  th«  bill  through  the  L^gta- 
latnre,  and  it  is  due  to  Governor  Dennison  and  the  members  of  thaf 
Board,  that  the  misstatements  contained  in  your  last  number  shoaU 
bo  corrected. 

Respectfully  yours,  Geo.  C.  Blaokxak. 

Surgeon-  GeneraVs  ybtice. — We  call  attention  to  the  following  notice 
issued  by  Dr.  Barr,  Surgeon-General  of  Ohio,  for  a  meeting  of  the 

State  Board  of  Medical  Examiners  convene  Tuesday,  March  15. 

Officis  Surgeox-Gkneral  ov  Ohio^  1 
Columbus,  Feb.  4, 1864.     / 

A  meeting  of  the  State  Board  of  Medical  Examiners  will  be  held 
in  the  city  of  Columbus,  on  Tuesday,  the  15th  day  of  March,  com- 
mencing at  10  o'clock  A.  M. 

Boquisitc  qualifications  :  Graduation  in  a  regular  Medical  Collega, 
cuidenced  by  diploma,  and  certificates  of  good  moral  standing. 

'      B.  N.  Barr,  Surgeon  General  of  Ohio. 


m  • 


Army  Medical  Intelligence. 

Assistant'Surgoon  Samuel  Adams,  U.S.A.,  has  been  relieved  from 
duty  with  Snrgeon-Goneral  William  A.  Hammond,  U.S.A.,  and  will 
report  in  person  to  the  Acting  Surgeon-General,  Washington,  D.  C. 

Surgeon  Burkitt  Cloak,  U.S.V.,  id  relieved  from  duty  at  Camp 
Dennison,  Cincinnati,  Ghio,  and  will  report  in  person  without  delay 
to  Assistant  SurgoonGonoral  Woo<l,  U.S.A.,  at  Louisville,  Ky.,  for 
assignment  to  duty. 

AssisUint-SnrgGon  Henry  Kvcrsmau,  U.S.V.,  is  on  duty  in  the 
Office  of  the  Medical  Director,  Louisville,  Ky. 

Surgeon  K.  B.  Dalton,  U.S  V.,  has  returned  from  leave  of  abseneo, 
and  resumed  his  duties  as  Surgion-iu-chargc,  Balfour  Hospital,  Porta^ 
month,  Va. 

General  Hospital  Xo.  5,  Nashville,  Tenn.,  has  been  closed.    In  con- 
sequence of  iho  want;  of  fuel  at  Nashville,  all  the  patients  whose  con- 
dition  warranted  it,  have  beun  sent  North  for  the  winter. 

Surgeon  S.  A.  Hoi  man,  U.S.V.,  has  relieved  Huigeon  Charles 
O'Leary,  U.S.V.,  as  Medical  Director,  6th  Army  Corps,  Anny  of  the 
Potomac. 

.  General  Hospitals  Nos.  1,  2,  and  3,  New  Albany,  Indiana,  Branch 
12  of  Goueral  Hospital  No.  1,  and  Branch  10  of  General  Hospital 
No.  2,  at  Louisville,  Ky.,  have  been  closed. 

Surgeon  Thomas  A.  Worrall,  U.S.V.,  now  on  duty  at  Depot  for 


1864.J  Edkor*9  TciU.]  lft& 

Drmfted  Hen,  Rikcr's  Island,  New  York,  to  report  to  Assistant  Sar-~ 
geon-Qeneral  R.  0.  Wood,  U.S.A.,  at  Louisville,  Ky.,  for  assign- 
ment to  daty. 

8nT}^n  Alexander  H.  HofT,  U.S.Y.,  now  on  daty  in  charge  of 
Hospital  Steamer  Charles  McDongall,  at  Louisvillo,  Ky.,  to  report  to 
the  Commanding-General,  Department  of  the  East,  for  assignment  to 
daty,  as  soon  as  his  presence  before  a  Court  Martial  now  in  session  in 
New  York  can  be  dispensed  with. 

Several  of  the  largo  General  Hospitals  at  Memphis,  Tenn.,  are  being 
evacuated. 

A  new  General  Hospital  has  been  established  at  Pulaski,  Tenn. 

SuTgteon  Levi  H.  Holden,  U.S.A.,  will  at  once  resume  his  duties  in 
the  Department  of  the  Monon/i'ahela. 

Surgeon  William  Estep,  1 26th  Ohio  Yols.,  has  been  honorably 
discharged  the  service  of  the  United  States  on  account  of  physical  dis- 
ability, with  condition  that  he  shall  receive  no  final  payments  until 
he  has  satisfied  the  Pay  Department  tha  t  he  is  not  indebted  to  the 
Government. 

Assistant-Surgeon  Oeorge  S.  Rose,  U.S.Y.,  has  been  assigned  to 
duty  as  Attending  Surgeon  at  Fort  Bascom,  N.  M. 

Sargeon  Geor^  S.  Courtright,  U.S.Y.,  has  been  assigned  to  duty 
St  Fort  Sumner,  3^.  M.  This  post  is  situated  on  the  Fecos  River, 
and  is  generally  known  as  the  **  Basque  Rcdondo." 

Assistant-Surgeon  G.  M.  Sternberg,  U.S.A.,  Assistant  Medical 
Director,  Department  of  the  Oulf,  has  received  a  leave  of  absence  for 
twenty  days. 

Snrgeoa  D.  B.  Stuigeon,  U.S.Y.,  has  been  assigned  to  duty  at  Fort 
Ciaig,  N.  M. 

Sargeon  F.  H.  Gross,  U.S.Y.,  Medical  Director,  14th  Corps,  on 
lick  leave  at  Pittsburg,  Pa.,  has  been  ordered  before  the  Board  for  the 
oiaination  of  sick  officers,  at  Cincinnati,  Ohio. 

Snrgeon  George  F.  Woodward,  13th  New  York  Cavalry,  having 
teodered  his  resignation,  is  honorably  discharged  the  service  of  the 
Coited  States,  with  condition  that  he  shall  receive  no  final  payments 
VDtil  he  has  satisfied  the  Pay  Department  that  ho  is  not  indebted  to 
the  Government. 

Sorgeon  E.  W.  Thurm,  U.S.Y. ,  has  been  transferred  as  Sur^^n- 
m-Chief  from  the  1st  to  the  Sd  Brigade,  3d  Division,  11th  Corps, 
Anny  of  the  Cumberland. 

Assi«tant-Surgeon  William  Carroll,  U.S.Y.,  lias  reported  for  duty 
St  tlie  Headquarters  Army  of  the  Potomac,  and  has  been  assigned  to 
doty  with  Artillery  Brigade,  2d  Army  Corps. 

Snrgeon  D.  P.  Smith,  U.S.Y.,  has  returned  from  leave  of  absence, 
and  resnmed  charge  of  the  General  Hospital,  Fairfax  Seminary,  Ya. 

Assiftunt-Snrgeon  R.  W.  Pease,  U.S.Y.,  has  reported  for  duty  at 
Resdqaarters,  Army  of  the  Potomac,  and  is  assigned  as  Medical 
Director,  Cavalry  Corps. 


186  MdUtn^i  TahU.  [MuA, 

Circular,  No.  2. 

SuBOBOir-OnrBBAL's  Omoa,        ) 
WASHiiiaTOii,  D.  C,  Janaary  19, 1864.  / 

The  attention  of  Medical  Officers  in  cbarge  of  IT.  S.  Hospitalf  ii 
called  to  the  imperative  necessity  for  more  strict  complianoe  with 
Paragraph  1286,  Revised  Army  Regulations,  1868,  regarding  Descrip- 
tive Lists  of  soldiers  leaving  hospitals.  Whether  a  soldier  be  trans- 
ferred  from  one  hospital  to  another,  to  his  regiment,  or  to  any  other 
point,  his  complete  and  certified  descriptive  list  moat  be  at  once  trans- 
mitted to  the  proper  officer. 

Hereafter,  failure  to  comply  with  this  regulation  will  be  considered 
disobedience  of  orders,  and  as  such  reported  to  the  Secretanr  of  War 
for  his  action.  Jos.  K.  Babhbs,  Acting  Snigeon-General. 

Duty  qf  Medical  Impedor^, 

Medical  Inspectors  are  authorized  to  inspect,  condemn,  and  reeom- 
mend  for  final  disposition,  such  articles  of  medical  and  hospital  prop- 
erty as  may  be  regarded  as  useless  and  unfit  for  issue.  They  era  the 
"  Authorized  Inspectors"  for  such  property,  under  Paragraphs  1022 
and  1023,  (General  Regulations  for  the  Army. 

By  order  of  the  Secretary  of  War : 

Circular  in  Menard  to  Hiwdid  Scldicrt* 

All  invalid  soldiers  mustered  on  invalid  transfer  rolls  by  anrgeona 
in  charge  of  hospitals,  and  all  men  of  the  2d  battalion  companies  who 
can  be  spared  from  the  hospital,  and  who  have  so  far  recovered  from 
their  wounds  or  disease  as  to  be  thought  fit  for  duty  in  the  Ist  battalion, 
will  be  sent  to  the  invalid  camp  or  depot  nearest  to  the  hospital ;  and 
they  will  be  there  examined  by  a  board,  consisting  of  a  field  officer  of 
the  Invalid  Corps  and  a  medical  officer  of  the  regular  or  volunteer 
service,  who  shall  have  power  to  confirm  their  transfer  to  the  corps, 
and  to  decide  to  which  battalion  they  shall  be  assigned  ;  to  send  those 
judged  fit  for  field  duty  to  their  regiments,  and  to  dischaige  thoee 
whose  infirmities  unfit  them  for  any  duty. 

By  order  of  the  Secretary  of  War. 

Circular  in  Regard  io  Ice, 

Ice  provided  from  the  appropriation  for  the  Medical  Department,  is 
exclusively  for  the  use  of  the  sick  in  Qeneral  and  Post  Hospitals,  and 
will  not  under  any  circumstances  be  issued,  or  otherwise  disposed  of, 
to  officers  or  soldiers  not  actually  under  treatment  in  them.  The 
most  rigid  econoniy  must  be  observed  in  the  issue  and  use  of  ice  so 
supplied.  Issues  to  hospitals  will  be  made  upon  the  estimate  of  one 
pound  daily,  per  patient,  at  Washington  and  points  south  of  it ;  half 
a  pound  daily,  per  patient,  at  all  points  north  of  Washington,  which, 
with  proper  care,  will  be  found  an  ample  allowance.  Medical  Dirsct- 
ors  will  give  such  orders  as  will  insure  compliance  with  these  inatmc- 
tions. 

By  order  of  the  Acting  Surgeon-General. 


18M.J  Special  Sd$€tUms.  187 


Sfpttinl  S^tltttittti. 

Cerebro-Spinal  Meningitis. 

I>«tt»r  fHMB  A  Oomtpondent— Cllnlcml  Benutrki  In  Beply  ;  Being  the  SnbtUnce  of  a  Lcetart 
MtiN  OliMtiB  tk«  ChioHO  lUdieU  OoUh** 

Bt  H.  8.  Datxi ,  M.D.,  Prof,  of  Practleftl  and  Clinical  Medidno. 

By  cerebro-spinal  meningitis,  we  mean  an  inflammation  of  the 
membranes  and  snrface  of  the  base  of  the  brain,  medulla  oblongata, 
and  npper  part  of  the  spina]  cord.  Ordinary  inflammation  of  this 
portion  of  the  nervous  system  is  not  of  frequent  occurrence  in  general 
practice^  although  occasionally  met  with,  both  in  adults  and  children. 
nhen  it  does  ocour  it  is  always  dangerous,  and  often  speedily  fatal  to 
tbe  patient.  This  arises  from  the  direct  connection  of  this  portion  of 
tbe  nervous  centres^  with  the  most  important  functions  of  animal  life, 
such  as  respimtion,  circulation,  and  deglutition.  An  attack  is  gen- 
erally ushered  in  by  chilliness,  followed  by  general  febrile  reaction  ; 
|Miin  in  the  occipital  region,  often  extending  to  the  back  of  the  neck 
and  shoulders ;  stifl'ness  or  rigidity  of  the  muscles  of  the  neck  and 
jaws  ;  sometimes  cramps  in  the  muscles  of  the  arms,  with  difficulty 
of  d^lutition  ;  a  conlracted,  frequent,  and  variable  pulse ;  hurried 
mpiration ,  and,  as  the  diKease  advances,  delirium  ending  in  coma. 
While  sporadic  cases  of  this  inflammation  are  not  of  frequent  occur- 
icnce,  a  modified  form  of  it  has  often  occurred  as  an  epidemic,  in  cir- 
camscribed  localities.  When  thus  occurring  epidemically,  it  has  been 
band  to  have  been  either  closely  associated  with  the  prevalence  of 
ctyupelas,  or  connected  with  the  same  circumstances  that  usually  orig- 
inate typhus  and  pyemia,  namely,  close  and  ill-veutilated  rooms, 
over-crowded  and  uncleanly  camps,  etc. 

We  are  occasionally  informed  of  its  occurrence  and  alarming  fatal- 
ity in  very  limited  country  districts. 

Close  inquiry,  in  most  of  such  cases,  will  reveal  the  fact  that  those 
attacked  have  been  sleeping  in  very  small,  or  altogether  over-crowded 
rooms,  without  any  ventilation  whatever.  Such  was  found  to  be  the 
case  with  some  families  in  a  neighborhood  near  Valparaiso,  Indiana, 
in  which  the  disease  appeared  and  proved  rapidly  fatal,  soon  after  the 
iatense  cold  weather  that  ushered  in  the  present  month. 

Only  two  days  since,  I  received  the  following  letter  from  a  medical 
friend  at  Bfanckport,  Harrison  County,  Indiana  : 

''Pnor.  N.  8.  Davis, 

"Demr  Sir  : — Knowing  that  you  have  the  opportunity  to  inform 
yonrself  oonceming  all  forms  of  disease,  I  drop  yon  a  letter  to  ask 
]roaT  Tiews  in  regard  to  a  disease  that  is  prevailing  in  this  county,  to 
sn  alanning  extent.  So  far  as  my  knowledge  extends,  every  case  that 
has  occnrred,  up  to  tbe  present  time,  has  proved  fatal.  The  person 
attacked,  complains  of  a  slight  cold  for  about  twenty-four  hours,  when 
a  moderate  chill  occurs,  lasting  from  one  to  two  hours. 

**This  is  immediately  followed  by  pain  in  the  back  of  the  neck. 


188  :fyectal  S^lecHont.  [Maitih, 

8pine  and  limbs  ;  stiffness  or  rigidity  of  the  muscles  of  the  neck  And 
jaws  ;  and  soreness  or  morbid  sensibility  of  the  surface,  even  to  the 
ends  of  the  fingers  and  toes. 

**  In  half  an  hour  the  jaws  become  closed,  with  loss  of  speech,  fol- 
lowed in  a  short  time  more,  by  complete  unconsciousness.  Death 
usually  follows  the  coma,  in  from  two  to  three  hours.  Please  give  me 
some  information  concerning  this  disease,  if  your  time  will  permit, 
and  greatly  oblige.  Yours  truly,  H.  K.  Dish." 

The  description  here  given,  though  brief,  is  sufficient  to  identify  the 
disease  as  a  cerebro-spinal  meningitis. 

The  pain  extending  from  the  occipital  region  down  the  spine,  with 
rigidity  of  the  muscles  of  the  neck  and  jaws,  morbid  sensibility  or 
soreness  of  the  flesh,  especially  cf  the  extremities  ;  followed  ho  spieed- 
ily  by  unconsciousness  and  death,  point  unmistakably  to  the  cerebro- 
spinal axis  as  the  seat  of  the  disease.  The  rapidity  with  which  the 
disease  progresses  to  its  final  termination,  is  one  of  its  most  striking 
features.  Thus  the  distinct  chill  or  chilliness  that  marks  the  onset  i^ 
severe  symptoms  is  often  followed  by  death  in  from  six  to  twelve 
hours.  But  the  poat-m/ortem  examinations  made  by  Dr.  Upham  and 
others,  reveal  not  only  the  appearances  of  inflammation  in  the  mem- 
branes enveloping  the  medulla  and  base  of  the  brain,  but  more  or  leea 
purulent  or  sero-purulent  effusion.  The  rapid  progress  of  the  disease ; 
the  exceedingly  brief  period  in  which  the  suppurative  process  is  estab- 
lished ;  with  the  sudden  and  generally  fatal  exhaustion  of  the  patient ; 
all  indicate  that  the  inflammation  is  of  a  strongly  asthenic  or  septic 
character.  This  view  of  its  nature  is  further  indicated  by  the  fact 
that  the  disease  has  often  been  associated  with  epidemic  emipelas ; 
with  the  foul  air  of  crowded  military  camps  ;  and  with  small,  un ven- 
tilated lodging  rooms  in  country  districts. 

If  this  view  of  the  special  character  of  the  inflammation  in  epidemic 
cerebro-spinal  meningitis  is  correct,  it  enables  us  readily  to  understand 
why  the  treatment  by  antiphlogistic  and  sedative  measures  on  the  one 
hand,  or  by  simple  stimulants  and  tonics,  on  the  other,  very  generally 
fails  to  exert  an  appreciable  control  over  the  progress  of  the  disease. 
It  is  well  known  tnat  bleeding,  general  and  local,  cathartics  ;  and  se- 
datives, have  been  used  without  any  apparent  benefit. 

When  the  disease  has  occurred  in  districts  naturally  malarious,  qui- 
nine and  stimulants  have  been  freely  used  ;  and  if  I  remember  correct- 
ly, both  were  used  in  most  of  the  cases  reported  by  Dr.  Upham,  bnt 
with  no  apparent  influence  over  the  progress  of  the  disease.  Calomel 
has  also  been  used,  both  in  cathartic  and  alterative  doses  ;  bnt  with 
no  more  success.  Indeed  the  rapid  progress  of  the  disease  affords  not 
Buflicient  time  to  gain  any  important  alterative  influence  from  the  mer- 
curial preparations.  And  if  the  special  character  of  the  inflammation 
in  these  cases  is  asthenic  or  allied  in  nature  to  pyaemia,  as  I  have 
already  suggested,  mercurialization  as  well  as  depletion,  is  directly 
contra-indicated.  The  clear  indications  for  treatment  in  such  a  grade 
of  inflammation,  aro  to  increase  the  contraction  of  the  capillaries  of 
he  inflamed  part  for  the  purpose  of  retarding  the  accumulation  of 


1864.J  S^teiat  Sekeiiaiu.  189 

blood  in  them ;  and  to  change  the  aplastic  or  septic  condition  of  the 
blood,  tbefeby  preTondng  if  possible,  the  rapid  development  of  the 
suppnratiTe  process  with  effusion.  Being  satisfied,  from  mach  clini- 
oal  observation,  that  the  views  of  Brown  Seqnard,  in  relation  to  the 
aeilon  of  belladonna  on  the  cerebro- spinal  centre,  are  correct ;  we 
ahonld  regard  that  agent  as  one  of  the  most  efficient  for  accomplishing 
Ibe  first  indication  named ;  while  to  meet  the  second  indication  we 
BQsi  rely  on  those  remedies  fonnd  most  efficient  in  erysipelatons  and 
pyemic  inflammations,  such  as  the  tincture  of  the  chloride  of  iron 
aiid  the  solphites  of  soda  and  lime. 

During  the  last  six  months,  five  cases  of  cerebro-spinal  meningitis 
have  eome  under  my  care.  The  first  was  a  boy,  about  twelve  years  of 
age.  He  bad  complained  of  headache  and  weakness  for  one  or  two 
days  ;  bot  the  severe  characteristic  symptoms  did  not  commence  until 
Saturday  evening,  and  he  died  the  following  day  in  the  afternoon.  I 
law  bim  first,  late  on  Batnrday  evening.  I  directed  ice  to  his  occipi- 
tal and  cervical  regions  ;  opened  the  bowels  freely  by  a  mercurial 
parge,  and  followed  it  with  iodide  of  potassa.  The  next  morning,  be 
was  visited  by  my  colleagues.  Professors  Andrews  and  Johnson,  who 
advised  the  use  of  quinine.  The  loss  of  consciousness  and  difficulty 
af  deglatition^  however,  prevented,  the  exhibition  of  more  than  a  single 


The  aocond  case  was  an  adult,  female,  and  the  mother  of  several 
children.  After  having  felt  some  lassitude  and  indisposition  for  one 
or  two  days,  she  had  a  moderate  chill,  followed  by  some  febrile  reac* 
tioo  ;  Mvere  pain  in  the  back  of  the  head,  neck,  and  shoulders  ;  with 
aome  convulsive  movements  and  rigidity  of  the  extremities.  Alarm- 
ed at  theae  symptoms,  I  was  sent  for  in  great  baste,  but  did  not  reach 
the  patient  until  about  three  bonrs  had  elapsed.  I  found  her  with 
■oderale  heat  of  the  skin  ;  an  anxious  expression  of  countenance  ;  a 
snail  and  frequent  pulse ;  rigidly  contracted  condition  of  the  muscles 
ea  the  posterior  part  of  the  neck,  causing  the  head  to  be  drawn  a  little 
back,  the  jaws  stiff,  and  deglutition  difficult.  The  muscles  of  the  arras 
were  in  a  similar  state  of  rigid  contraction.  All  attempts  to  move  the 
had  and  shoulders  greatly  aggravated  the  sufferings  of  the  patient. 
The  death  of  the  boy,  only  a  few  days  previously,  had  caused  me  to 
reflect  much  on  the  nature  of  the  supposed  inflammation  in  these 
esses,  and  I  determined  to  put  this  patient  directly  on  the  use  of  the 
mipkiUi  with  belladonna.  I  accordingly  directed  fifteen  drops  ot  the 
tiaetnre  of  belladonna  and  half  a  drachm  of  sulphite  of  lime  to  be 
given  at  once,  and  repeated  in  half  an  hour,  alter  which  they  were  to 
be  taken  every  hour,  until  the  muscular  rigidity  ceased,  or  the  specific 
f5ec(B  of  the  belladonna  were  visible  on  the  pupils  of  the  eyes  ;  after 
which  the  interval  was  to  be  extended  to  four  hours.  Ice  was  applied 
lo  the  neck  and  occiput. 

Under  tbi^  treatment  the  muscular  rigidity,  pain  and  fever  soon  be- 
gui  to  abate,  and  in  twenty- four  hours  all  the  severe  symptoms  were 
itliaved,  except  stiffness  of  the  neck  and  giddiness,  with  some  pain 
whaaavar  attempts  were  made  to  move  the  head.  Under  the  moderate 
isa  of  the  aame  remedies,  she  continued  to  improve ;  and  in  four  or 


190  Special  SdectwnM.  [IfArdi', 

five  dajs  was  able  to  sit  up.  Her  limbs,  bowcver,  remained  weak, 
and  she  was  troubled  witb  some  unsteadiness  in  walking  for  ten  or 
twelve  days. 

llie  third  case  was  a  boy,  only  two  years  old,  in  the  same  neighbor- 
hood with  the  second  case,  and  was  under  treatment  at  the  same  time. 
The  symptoms  of  coi-ebro-spinal  inflammation  were  well  marked,  and 
the  treatment  the  same  as  in  the  preceding  case,  only  adapting  the 
doses  to  the  age  of  the  patient.  The  relief  was  prompt  and  perma- 
nent, the  child  recovering  fully  in  a  week. 

The  fourth  case  war  an  adult,  male,  naturally  athletic  and  healthy. 
Ho  had  been  employed  for  some  time  as  tender  of  a  bridge,  over  the 
North  Branch  of  the  Chicago  River  :  and  that  stream  was  at  the  time 
in  a  very  foul  and  offensive  condition.  Ho  was  attacked  in  the  night 
with  a  well-marked  chill,  followed  by  pain  in  the  back  of  the  hMd; 
neck,  and  shoulders  ;  stiffness  of  the  muscles  of  the  neck,  and  frequent 
severe  cramps  in  the  muscles  of  the  legs  and  forearms.  When  I  was 
called  to  see  him  in  the  morning,  his  expression  of  countenance  was 
haggard  and  anxious ;  his  pulse  small,  frequent,  and  compressible ; 
tongue  moist ;  skin  covered  with  moisture  ;  mind  depressed  and  taci- 
turn ;  with  considerable  pain  and  stiffness  in  the  neck,  but,  at  that 
time,  no  cramps  in  the  extremities.  Learning  that  the  patiettt  had  had 
a  well -marked  chill,  followed  by  fever  and  pain,  while  he  was  then 
perspiring,  I  too  hastily  inferred  that  the  case  was  one  of  irregular  and 
severe  malarious  fever  ;  an  inference  which  would  have  been  corrected 
readily  had  I  given  due  attention  to  the  locality  of  the  pains  and  th6 
condition  of  the  muscles  of  the  neck  and  extremities.  As  it  was, 
however,  I  ordered  the  patient  six  powders,  each  containing  sulphate 
of  quinine,  8  grs.,  sulphate  of  morphia,  ^  gr.,  and  calomel,  2  gra.^ 
one  to  be  given  every  three  hours. 

Before  they  were  all  taken,  he  became  so  furiously  delirious  that  no 
treatment  could  be  continued,  and  he  died  in  little  more  than  forty- 
eight  hours  after  the  commencement  of  the  attack. 

The  fifth  case  occurred  about  two  weeks  since.  The  patient  was  a 
well-known  citizen,  aged  about  fifty  years.  On  going  out  to  his  baa- 
incRS  in  the  morning,  he  felt  some  stiffness  of  the  back  of  his  neck, 
with  an  approach  to  vertigo  or  a  slight  sense  of  unsteadiness  in  walk- 
ing. Tlicse  symptoms  were  too  slight  to  attract  much  attention  du- 
ring the  day.  About  5  o*clock  P.  M.,  he  stepped  into  the  office  of  a 
friend,  when  he  suddenly  became  so  affected  with  a  sense  of  vertigo  and 
exhaustion,  that  he  came  near  falling.  He  recovered  his  steadiness  in 
a  few  minutes,  and,  accompanied  by  his  friend,  returned  to  his  resi- 
dence. Duriqg  the  evening  he  was  chilly,  and  complained  of  severe 
pain  in  the  back  of  his  head,  neck,  and  shoulders,  with  constant  rig- 
idity of  the  muscles  of  the  neck. 

These  symptoms  so  rapidly  increased  in  seventy,  that  at  8  o'clock 
in  the  morning  I  was  called  out  of  bed  to  visit  him.  I  found  him 
with  a  countenance  expressive  of  extreme  anxiety  and  suffering  ;  skin 
hot,  but  covered  with  perspiration ;  pulse  small,  frequent,  and  firm 
under  pressure  ;  tongue  slightly  coated  ;  head  drawn  back  and  fixed 
firmly  in  its  position  by  a  rigid  contraction  of  the  muscles  of  the  neck 


and  jaws*  He  complained  of  inteiuie  pain  in  the  back  of  the  bead  and 
neck,  extending  in  sharp  paroxysms  to  the  shoalders  and  right  side  of 
bia  chest.  Erery  attempt  to  move  the  head  or  shoulders  so  agg^vated 
these  paroxysms  of  pain  as  to  literally  terrify  the  patient. 

The  skin  being  covered  with  perspiration,  caused,  as  the  patient 
allied,  by  the  seventy  of  his  pains,  I  did  not  deem  it  pmdent  to  ap- 
ply ice  to  the  neck  and  occiput ;  but  on  the  contrary  ordered  the  ap- 
eication  of  cloths,  kept  constantly  wet  in  a  tepid  infusion  of  aconite 
ives.  Internally,  I  directed  20  grs.  of  sulphite  of  soda,  dissolved  in 
a  dessert  spoonful  of  mint  water,  with  12  drops  of  the  tincture  of  bel- 
tadonna,  every  half-hour,  until  three  doses  were  taken,  and  then  once 
aft  boor,  antil  my  next  visit.  I  also  directed  a  powder  containing  S 
gim.  of  calomel  and  6  grs.  of  Dover's  powder,  to  be  given  every  three 
hours.  I  visited  the  patient  again  in  five  hours.  All  my  directions 
bad  been  faithfully  executed. 

The  second  dose  of  calomel  and  Dover's  powder  caused  slight  vom- 
iting, by  which  a  part  of  it  was  rejected.  On  this  account  no  more  of 
them  were  given. 

The  only  important  changes  in  the  condition  of  the  patient  were,  a 
•lower  pulse ;  a  more  cheerful  state  of  mind ;  and  a  subsidence  of 
those  severe  paroxysms  of  pain  through  the  shoulders  and  chest.  The 
head  waa  still  firmly  retracted,  with  pain  in  the  neck,  greatly  aggra- 
Tated  by  the  slightest  motion.  I  directed  the  sulphite  of  soda  and 
bdladonna  to  be  continued  every  hour  and  a-half,  and  also,  the  narcotic 
fomeotations  to  the  neck.  The  patient  continued  to  improve  gradu- 
ally through  the  day  ;  and  at  night  I  directed  the  interval  between 
tiM  doees  of  the  snlphite  of  soda  and  belladonna  to  be  increased  to  two 
honrs  ;  and  ^ve  three  compound  cathartic  pills  to  move  the  bowels. 
On  the  folowing  morning,  I  found  the  patient  cheerfnl  ;  the  skin 
BAtnrml ;  pulse  85  per  minute  and  soft :  no  pain  while  entirely  still ; 
or  when  slowly  and  cautioubly  rotating  the  head ;  but  still  inability 
to  bring  the  head  forward,  or  to  indulge  in  any  active  movements 
without  snflering.  The  pupils  were  moderately  dilated  by  the  bella- 
donna, but  there  had  been  no  movement  of  the  bowels.  I  ordered  a 
bottle  of  liquid  citrate  of  magnesia  to  be  taken  in  divided  doses  until 
k  ahoold  operate,  while  the  sulphite  of  soda  and  belladonna  were  con- 
Kioned  every  three  hours.  During  the  succeeding  twenty-four  hours, 
the  bowels  moved  freely  three  times,  and  the  patient  continued  steadi- 
ly to  improve  ;  though  he  complained  of  much  lassitude  and  general 


I  oontinned  the  sulphite  of  soda  and  belladonna  every  six  honrs  for 
two  days  longer,  with  nourishment ;  at  which  time  the  patient  was 
able  to  leave  nis  bed,  though  still  feeling  difficulty  in  bending  the 
kcad  forward,  and  some  unsteadiness  in  walking. 

I  then  directed  a  prescription  consisting  of  bromide  of  ammonium, 
dissolved  in  syrup  of  wild  cherry  bark,  to  be  taken  three  times  a  day  : 
ftftd  the  recovery  has  since  been  complete.  It  must  be  remembered 
that  during  the  time  that  these  cases  were  occurring,  erysipelas  was 
nananally  prevalent  in  the  city ;  and  the  general  sanitary  condition  ot 
the  whole  city  bad.    The  treatment  of  those  few  cases  is  not  sufficient 


192  JSdiiorial  AltiraeU  and  Sdeetiom.  [KMnh, 

to  toBt  the  valao  of  any  of  the  remedies  nsed.  Bat  if  the  inflamoiatioB, 
ia  these  epidemic  and  rapidly  fatal  eases  of  of  cerebro-spinal  mening- 
itis, is  of  that  specific  character,  which  renders  it  analogous  to  erysip- 
elas or  pyemia,  as  we  have  already  suggested,  then  certainly,  we  nnsl 
look  for  remedies  chiefly  to  such  articles  as  will  connteract  the  septic 
or  Buppnrative  tendency,  with  sach  narcotics  as  diminish  the  morbid 
sensibility,  by  contracting  the  cerebro -spinal  capillaries.  Of  the  fiiat 
class  of  articles,  wo  know  of  none  more  reliable,  or  capable  of  being 
more  rapidly  introduced  into  the  system  than  the  tincture  of  chloridia 
of  iron,  and  the  sulphites  of  soda  and  lime,  and  the  chlorates.  Of 
the  latter  class,  the  preparations  of  belladonna  and  strammonium  are 
doubtless  most  efficient.  But  for  any  class  of  remedies  to  be  effioiea^ 
in  a  disease  so  rapid  in  its  progress  as  cerebro-spinal  meningitis,  tbej 
must  be  administered  early  and  efficiently. 


■  •» 


nUPAMED  BT  WK.  B.  rLETCHISt  M .D<,  UDLUIAPObU,  UTOlAVA. 

PRACTICAL    MBDICINB. 

1.  Oold  Applicaiiona  in  Croup. — ^The  editor  of  the  CanadfiL  Zaneei, 
aroused  we  suppose,  by  the  newspaper  paragraphs  which  declared  the 
application  of  cold  was  "  a  new  and  French  remedy,"  says  he  is  "  re- 
minded of  the  truth  of  the  remark,  that  our  profession  are  constantly 
bringing  forward  old  forms  of  treatment,  and  that  our  knowledge  of 
them  is  increased  by  the  attention."  He  then  gives  the  history  of 
the  use  of  cold  applications  in  this  disease.  Dr.  Harden,  of  St. 
Petersburg,  in  1822  commenced  the  use  of  il  upon  his  own  child . 
(when  everything  else  had  failed)  with  success,  and  introduced  it  into 
general  practice,  and  from  that  time  to  the  present  it  has  never  fiillen 
entirely  into  disuse.  He  has  rarely  omitted  their  employment  for 
years  past,  and  thinks  he  has  never  witnessed  a  single  instance  where 
they  have  not  produced  a  marked  good  effect  upon  the  breathing. 

2.  Dr.  M.  E.  Taylor,  of  Iowa,  writes  upon  the  same  subject  as 
follows:  "The  mode  with  which  I  have  oeen  most  favorably  im- 
pressed, after  some  five  years  trial,  is  that  of  external  application  to 
the  throat.  I  have  used  it  in  both  inflammatory  and  spasmodic  croup, 
in  diphtheria,  tonsilitis,  laryngitis,  and  oedema  of  the  glottis,  and  I 
assure  you  of  my  belief  that  we  possess  no  remedy  so  effective,  and 
at  the  same  time  so  manageable,  as  the  external  applications  of  ioe  to 
the  larynx,  or  parts  higher  up,  when  thus  inflamed.  Its  powerful 
sedative  impression  is  observed  in  a  very  short  time,  directly  upon  the 
morbid  process  ;  while  there  is  a  general  sedation,  seen  in  the  dimin-. 
ished  action  of  the  heart,  and  loss  of  temperature,  with  a  correspond- 
ing modification  of  febrile  excitement,  upon  the  continuance  of  the 
application  of  the  remedy. 

«  In  infants,  I  have  seen  it  control  the  croupy  respiration  in  a  very 


1884.]  MUarial  AhUradt  and  Sdectiom.  19S 

km  nimitaSy  and  tbat  too  when  time  is  of  the  utmost  importance,  aa 
IB  the  aeTere  fonns  of  the  spasmodic  variety.  In  diphtheria,  it 
doea  not  always  arrest  the  exudation  of  false  memhrane,  but  the  ice 
will  diminish  ihe  amount  thrown  out«  and  assuage  the  local  pain  and 
•walling  Tery  much.  In  the  earlier  stage  of  tonsilitis  it  will  often 
amat  the  disease,  always  modifies  and  lessens  the  inflammatory  ao- 
tioii»  and  prsTents,  to  a  very  considerable  extent,  the  suppnrative  pro- 
cess. In  some  cases,  however,  when  repeated  suppnrative  inflamma- 
tions have  occurred  in  the  tonsils  before,  it  has  not  always  arrested  the 
formation  of  an  abscess — perhaps  it  might  have  done  so  had  it  been 
applied  ia  an  earlier  stag^  of  the  disease. 

*'  My  mode  has  been  to  secure  a  piece  of  ice,  the  size  of  a  hen's 
^gg,  so  shapen  as  to  adapt  itself  to  the  form  of  the  neck,  upon  each 
aide  of  the  larynx,  or  as  near  the  seat  of  inflammation  as  practicable  ; 
and  for  tonsilitis,  immediately  to  the  submaxillary  region,  upon  one  or 
both  sides,  as  the  case  might  require.  I  have  generally  adjusted  the 
ice  by  enveloping  it  in  a  single  thickness  of  oiled  silk  so  that  it  could 
not  slip  from  its  proper  place,  then  placing  it  saddle  wise  over  the 
larynx,  I  next  envelop  the  whole  neck  with  several  thicknesses  of 
flannel,  with  the  view  of  preventing  the  temperature  of  the  surround- 
ing air  from  contributing  to  ai^r  extent  in  dissolving  it.  When  the 
ice  seems  to  be  no  longer  required,  the  moderate  application  of  cold 
water  will  prevent  too  great  reaction,  and  the  lighting  up  anew  of  the 

irbid  action. 

'*  It  does  not,  or  at  least  I  have  not  relied  upon  it  solely  with  that 
,  do  away  with  the  necessity  of  other  treatment ;  but  I  have  gen- 
erally employed  such  medication  as  the  circumstances  seemed  to  de- 
■Mod  fur  the  arrest  of  the  disease,  with  only  this  precaution ;  that 
aatimony  and  veratrum  be  administered  sparingly,  lest  too  great  de- 
prcaaton  be  obtained. 

"  It  will  be  recollected  tbat  the  ice  lies  closely  upon  the  larger 
veteela  of  the  neck,  and  that  the  greater  part  of  all  the  blood  sent  to 
aad  feinming  from  the  brain,  comes  more  or  less  under  its  influence;^ 
and  thai  the  sedative  effect  of  the  small  quantities  thus  employed  i 
■mdi  more  marked  than  when  a  considerably  lar^rer  quantity  is  applied 
to  tbe  whole  cerebrum. 

"  I  have  not  employed  it  in  those  an^inose  aflections  of  the  throat 
conarcied  with  scarlatina,  lest  it  might  interfere  with  the  appearance 
of  the  eniption ;  though  in  a  desperate  case,  when  other  remedies  had 
kiled,  I  should  do  so,  and  seek  to  counteract  any  unpleasant  effect  by 
friclion  to  the  surface,  and  artificial  heat  to  the  remote  parts.  I  have 
•em  ao  unpleasant  effects  from  its  use,  though  I  can  readily  conceive 
that  on  yoang  infants,  without  proper  care,  its  action  might  be  car- 
ried tfoo  far. — Canada  Lancet, 

3.  EtmmUum  o/  Tape  Worm. — Mrs. ,  married  lady,  age  22 

fsars,  haa  been  troubled  with  tape  worm  since  Sept.,  1862.     Her 
aeHicel  attendant  prsacribed  turpentine  and  castor  oil  aa.  3  j'-i  non 
if  the  wernu  followed ;  subsequently  Sanative  pills  w^re  taken ;  sam 
iciiib.    A  few  months  afterward  bhe  took  an  ounce  of  turpent   in 


194  JSdiiorial  AbsiraeU  and  Sdectumi.  [Mardi, 

without  any  material  effect.  She  then  took  pumpkin  seeda,  but  no 
worms  followed  their  use.  ^  In  Nov.  1863,  she  again  took  pumpkin 
seeds  as  follows  :  Saturday  morning,  fasting,  took  three  tablespoon- 
fnlls  of  seeds  preyiously  dried,  peeled  and  pulverized,  and  mixed  with 
sngar ;  half  an  hour  af^r  took  castor  oil,  3  js. ;  on  Monday  repeated 
the  dose  of  seeds  and  oil.  On  Monday  evening  she  passed  at  one 
stool  the  entire  worm,  measuring  eighteen  foat  nine  inches.  She  took 
in  all  six  tea  spoonful  Is  of  seeds,  five  ounces  of  castor  oil,  and  fasted 
fifty  hours  — Amer.  Med.  Tirrut. 

4.  Urine  in  Typhoid  Fever, — ^M.  Primavera,  of  Naples,  has  for 
some  time  been  observing  the  constituents  of  the  urine  in  various  dia- 
eases,  and  in  reference  to  typhoid  fever,  makes  the  following  state- 
ments : 

a.  The  complete  absence  of  the  chlorides  from  the  urine,  is  a  path- 
ognomonic diagnastic  sign  of  typhoid  fever.  This  valuable  eign  will 
serve  to  distinguish  this  fever  from  a  simple  and  benignant  fever,  con- 
tinuous or  intermittent,  in  which  the  urine  always  contains  an  appre- 
ciable quantity  of  salts  of  this  nature. 

b.  Urine  passed  during  the  ascending  period,  or  even  during  the 
whole  course  of  typhoid  fever,  when  this  has  a  fatal  issue,  shows  not 
only  an  entire  absence  of  the  chlorides,  but  even  a  very  considorabh 
diminution  of  the  phosphates  and  urates. 

c.  The  first  step  towards  convalescencd  is  indicated,  better  than  by 
any  other  sign,  by  a  rapid  and  very  sensible  increase  of  the  phosphites. 

d.  The  second  phase  of  amelioration  is  shown  by  an  analogous  in- 
crease of  the  urates. 

e.  Finally,  the  re-appcarance  of  the  chlorides  in  the  urine,  however 
tanly,  definitely  indicates  the  recovery  of  the  patient. 

Ocular  inspection  is  not  always  enough  to  calculate  the  quantity  of 
the  urates ;  although  when  in  eTicess,  reveal  their  presence  by  making 
the  urine  turbid,  or  by  throwing  down  a  brickdust  deposit.  It  very 
often  happens,  also,  that  Chey  remain  in  solution,  owing  to  the  pres- 
ence of  an  alkaline  bibasio  phosphate  which  accompanies  them.  In 
this  case  it  is  sufiicient,  after  cooling,  to  pour  a  few  drops  of  acid  into 
the  urine,  to  see  a  large  quantity  of  this  liquid  rendered  turbid  and 
thick  from  a  copious  precipitate  of  urates.  Now  us  this  precipitate 
resembles  very  much  that  which  nitric  acid  produces  in  albuminons 
wine.  M.  Primavera  advises  in  this  case  to  employ  acetic  acid  and  not 
nitric,  which  precipitates  both  urates  albumen.  It  is  also  very  prob- 
able, he  adds,  that  the  albumen  often  found  in  the  urine  of  typhoid 
patients  by  certain  practicioncrs  who  use  nitric  acid  to  the  exclusion 
of  all  other  re-agents,  is  in  reality  nothing  but  urates. — Lancei. 

5.  Internal  administration  of  Belladohna  in  case  of  Severe  Bum,^^ 
Experimental  physiologists  have  recommended  belladonna  for  use  in 
the  treatment  of  burns,  in  the  belief  that  it  diminishes  that  state  of 
the  nervous  functions  under  which  reflex  inflammations  are  likely  to 
be  originated.  They  assert,  on  the  one  hand,  that  of  all  remediea 
opium  is  the  one  most  powerful  in  increasing  this  peculiar  state,  and 
^hat  it  ought  consequently  to  be  avoided.     In  clinical  practice,  how- 


1864]  BdUoriai  AMraeti  and  Seiedhnt.  195 

ever,  we  believe  that  this  opinion  is  wholly  disregarded,  and  that  opi* 
nm  18  the  form  of  anodyne  most  commonly  resorted  to  in  these  cases. 
Yet  it  is  generally  suspected  that  the  canses  of  death  after  bnrns  arc,  in 
a  majority  of  instances,  connected  with  reflex  inflammations,  e.  ^, 
nicere  of  the  intestines,  pneumonia,  &c.  In  a  series  of  cases  nnder 
Mr.  Hutchinson's  care  in  the  London  Hospital  during  the  lant  six 
months,  the  belladona  treatment  has  been  tried.  In  some  remarks  at 
the  bedside  of  a  patient  the  other  day,  Mr.  Hutchinson  stated  thai  he 
considered  the  general  results  to  hav.e  been  fairly  satisfactory.  He 
adverted  to  the  extreme  difliculty  of  forming  a  trustworthy  conclusion 
on  auch  a  matter,  since  these  cases  are,  in  their  nature,  never  station- 
ary, but  always  tend  cither  to  improvement  or  the  reverse,  and  often 
with  great  rapidity.  If,  therefore,  the  remedy  were  commenced  when 
the  patient  was  very  ill,  it  might  chance  to  be  just  at  the  time  when 
the  improvement  was  abont  to  sot  in  ;  and  if,  on  the  other  hand,  the 
patient  got  worse,  it  might  fairly  be  alleged  that  the  remedy  was  used 
too  late.  If,  on  the  other  hand,  we  should  give  it  in  cases  in  which, 
as  yet,  no  serious  symptoms  had  appeared,  wo  might  again  be  much 
led  aatrav,  since  a  great  majority  of  bum  oases  do  well  without  any  ^ 
ipecial  plan  of  medieation.  Mr.  Hutchinson  stated  that  the  cases  if 
which  the  remedy  had  seemed  to  be  most  useful,  were  those  of  children 
io  whom  general  febrile  symptoms,  attended  with  restlcsness,  loss  on 
appetite,  cc.,  had  set  in  without  any  local  complications.  In  several 
of  these,  there  could  be  no  mistake  that  the  feverish  state  had  passed 
away  qaickly  and  very  satisfactorily  under  the  use  of  belladonna.  In 
no  cases  had  he  witnessed  any  ill  results.  If  the  burn  itself  was  very 
pninfal*  and  the  patient  unable  to  get  sleep  on  account  of  the  pain, 
then  the  belladonna  seemed  comparatively  ineflicacious  to  procure  ease, 
and  morphia  was  far  more  cflicient.  As  a  rule,  no  opium  ha<]  been 
given  to  the  cases  treated  by  belUdona  ;  but  in  a  few,  and  those  chiefly 
in  adulta,  it  had  been  found  requisite  to  give  an  occasional  night  dose. 
Possibly  more  benefit  might  have  been  obtaiued  had  the  administra- 
tion of  the  belladonna  been  pushed  to  larger  doses.  The  usual  dose 
given  had  been  a  third  of  a  grain  three  times  a  day.  In  speaking  of 
xte  Jesa  frequent  results  of  burns,  Mr.  Hutchinson  mentioned  a  recent 
caae  in  which  acute  intlammation  of  one  hip-joint,  followed  rapidly  by 
diaiocntion,  had  occurred  in  a  child  who  had  been  severely  burnt  on 
the  arm  and  chest.  He  was  in  doubt  whether  to  regard  it  as  a  reflex 
iaflammation,  or  as  a  consequence  of  pyaemia. — lied,  Ihmesand  Oax., 
/fls.  2,  1964. 


SURGICAL. 

4.  OunMhci  wound  of  Intestines  and  Bladder. — Private  W.  E  ,  be- 
longiDfC  to  the  oth  Mass.  Battery,  was  admitted  into  the  Hospital 
Jnlv  13,  1^63.  Patient  states  that  on  July  2,  1863,  at  the  battle  of 
Getcyahnn;.  he  was  wounde<l,  and  was  obliged  to  remain  on  the  field 
igmal  hours  without  attention.  When  received  here,  his  wants  were 
prmerlj  attended  to,  and  his  wounds  thoroughly  examineil.  It  was 
"  that  a  musket  ball  (probably  conioal)  had  penetrated  the 


196  JSdUorial  AbsiraeU  and  Sdediont.  [March* 

soft  parts  of  the  right  glateal  region,  at  a  point  that  was  midway  be- 
tween the  right  great  trochaater  and  the  corresponding  sacro-iliae 
symphysis.  Its  course  was  then  upward  and  across^  making  its  exit 
jost  above  Pouparts  ligament,  and  near  the  external  abdominal  ring 
on  the  left  side. 

The  abdomen  was  found  greatly  distended,  tympanitic,  and  tender 
to  the  touch.  His  knees  were  drawn  up,  and  his  breathing  diflSonlt^ 
and  mostly  carried  on  by  the  muscles  of  the  chest,  and  not  in  the  least 
was  it  aided  by  the  diaphragm.  Gentle  pressure  over  the  abdomen 
caused  gas  and  fascos  to  escape  freely  out  of  the  anterior  wound,  show- 
ing that  the  ball  had  perforated  the  intestines.  A  catheter  was  intro- 
duced into  the  bladder,  when  a  slight  quantity  of  very  o^ensive  urine 
oozed  out,  mingled  with  liquidated  feces.  The  pressure  of  the  instru- 
ment caused  intense  pain  and  irritation,  and  on  removing  it  the  canal  waa 
found  charged  with  the  faeces,  thereby  proving  the  bladder  was  alao  com- 
plicated in  the  injury.  The  patient  was  fast  reaching  a  typhoid  condi- 
tion, had  a  quick  wiry  pulse,  ranging  at  about  100,  while  his  expreasion 
was  anxious,  and  his  teeth  and  gums  were  commencing  to  be  covered  with 
Bordes.  Altogether  his  case  was  thought  to  be  hopeless,  and  I  so  in- 
formed him,  as  I  thought  peritonitis  of  an  aggravated  form  had  set  in. 

The  treatment  consisted  in  applying  emollient  poultices  to  the  ab- 
domen, injecting  small  quantities  of  flax  seed  tea  into  the  bladder,  al- 
lowing him  the  same  to  drink,  administering  enemas  as  they  wore  re- 
quired, and  giving  him  full  doses  of  opium  until  he  was  well  under 
its  influence,  when  it  was  lessened  in  quantity  and  kept  up  at  regular 
intervals. 

The  patient  was  ordered  for  his  diet,  concentrated  beef- tea  and  mut- 
ton broth,  and  afterwards,  as  he  improved,  a  more  mixed  diet.  Ho 
was  kept  very  quiet,  and  most  faithfully  nursed.  At  first,  the  oontenta 
of  the  bowels  escaped  from  time  to  time  through  the  artificial  anna, 
and  were  received  by  the  dressings  which  were  changed  frequently.  It 
was  under  the  above  system  of  treatment,  with  the  precaution  of  por- 
sisting  in  keeping  the  patient  in  a  recumbent  position  for  a  long  timo 
after  his  bad  symptoms  had  left  him,  that  his  wounds  were  closed,  and 
the  functions  of  the  intestines  and  bladder  were  completely  reatored. 
He  was  allowed  a  furlough  to  visit  his  homo,  8ept.  18,  1863,  and  was 
by  us  then  considered  almost  a  well  man.  Since  that  date,  nothing 
has  been  heard  of  his  condition,  and  it  is  presumed  he  is  still  recover- 
ing from  his  severe  injury. — Amer,  Med.  7\me9. 

7.  Wound  of  the  InteatineB. — ^The  following  case  is  one  of  some  in- 
terest, showing  what  nature  will  do  towards  prolonging  life  : 

August  5th,  was  sent  for  in  haste  to  go  eight  miles  into  the  country 
to  see  Christopher  Howard,  who  had  been  stabbed  in  an  afiray  with  a 
neighbor. 

I  arrived  three  hours  after  the  injury,  and  found  a  wound  on  the 
left  side,  commencing  a  half  inch  from  the  median  line  of  abdomen, 
and  one  and  a  half  above  Poupart's  ligament,  running  upwards  and 
outwards  four  and  a-half  inches,  and  penetrating  completely  through, 
so  that  the  bowels  protruded  when  he  was  carried  to  the  house.     The 


1864.]  BdUorial  Abstracts  and  Seledims.  197 

intestines  were  replaced,  however,  Lefore  my  arriyal.  From  personal 
examination,  and  report  of  those  who  assisted  in  replacing  the  bowels, 
I  condaded  the  intestines  could  not  have  been  wounded,  thongh  the 
omentnm  was  dark  and  congested,  and  had  been  slightly  cnt  or  torn. 
I  brought  the  wound  together  with  several  interrupted  sutures  and 
adhesive  plaster,  and  applied  cold  water  as  a  dressing.  Thinking  it 
not  desirable  to  disturb  the  bowels  with  a  cathartic,  1  put  him  under 
the  inflnence  of  opium,  snfiScient  to  keep  the  bowels  quiet,  and  relieve 
him  from  all  restlesness,  and  kept  him  on  beef-tea,  or  fluids,  exclu" 
alvely.  Everything  progressed  favorably  up  to  the  ninth  day,  no 
constitntional  disturbance  indicating  there  was  extravasation  of  fncu- 
lent  matter,  or  inflammation  of  peritoneum.  The  external  wound  had 
hemled  by  first  intention*  except  the  outer  angle  for  half  an  inch. 

On  the  morning  of  the  ninth  day,  very  unexpectedly,  fieces  began 
to  pass  from  the  small  opening,  portions  of  indigested  corn  and  black- 
berry seeds,  eaten  the  uay  of  the  injury,  now  came  away  with  other 
material.  As  the  bowels  had  not  been  moved  since  the  injury,  I  now 
thought  it  advisable  to  unload  the  lower  portion  and  give  room  for 
that  above  to  pass  down,  if  so  inclined.  I  ordered  an  enema,  and 
iQperintended  its  administration,  and  before  half  a  pint  had  been 
thrown  up  it  began  to  ][)our  out  of  the  opening  above,  thus  showing 
the  descending  colon  to  bo  wounded. 

With  this  state  of  affairs,  there  were  no  constitutional  symptoms 
inJicaiing  infiltration  into  the  peritoneum. 

Still,  I  thought  it  best  to  keep  him  fully  under  the  influence  of  opi- 
■m,  so  as  to  perfectly  control  the  bowels,  giving  nothing  but  fluids  for 
aonrishment,  and  trust  to  nature.  In  three  weeks  the  external  wound 
healed  by  granulation,  and  without  an  unfavorable  constitntional 
sjmptom  from  the  beginning. 

The  wound  was  inflit-ted  with  a  largo  jack-knife,  of  not  very  sharp 
pointed  blade.  1  think  the  outer  coats  of  the  colon  must  have  been 
oivided  at  the  time  of  the  injury,  and  the  mucous  coat  must  hsvo  given 
way  afterwards,  allowing  the  contents  to  pass  out ;  but  during  the 
sine  days,  nature  had  prei>ared  the  part.*i  I'V  adhesion,  so  that  no  extra- 
▼aaation  into  the  peritorium  took  place,  thus  saring  life. — Ainer,  Med.  > 


A.  Simpie  dressing  for  Recent  Burns, — Dr.  John  II.  Packard,  of 
Philadelphia,  in  speaking  of  dressings  for  recent  burns,  gives  his  de- 
cided preference  to  fresh  lard,  as  the  one  most  easily  obtained,  and 
cvca  tne  best  under  all  circumstances. 

1.  It  can  bo  had  at  short  notice  in  any  quantity. 

2.  It  is  easily  applied,  witnout  paining  the  patient. 

3.  It  protects  the  parts  from  all  irritation  ;  it  is  sofl,  nnirritatiiig, 
air-proof. 

If  the  lard  be  salted,  it  is  easily  washed  in  pure  water,  and  then 
applied  thickly  upon  old  linen,  and  nicely  adapted  to  the  surface. 

Id  very  wann  weather  it  is  sometimes  deficient  in  body,  and  may 
ikcB  require  a  small  portion  of  simple  cerate,  one  part  of  cerate  to 
ftmr  of  lard  .^Jm#r.  Msd,  Times  — Canada  Lancet, 


198  ^Uorial  Abiiraets  and  SeUetiom.  [Mu- 

9.  Piuraeenteiia  Tkorwu, — kA  there  is  consideimble  differeDca 
opinion  in  regard  to  the  influence  of  admission  of  air  into  the  plea 
cavity  ;  the  following  cases  will  show  that  it  is  not  as  injanoaa 
has  usually  been  supposed.     Dr.  £.  P.  Bennet,  of  Danberry,  Coa 
says :  "  I  punctured  the  chest  in  a  boy  about  eight  years  old,  who  1: 
suflfered  from  pleuro-pnenmonia,  and  about  two  pints  of  pas  was  d 
cbaged.    No  precantions  were  taken  to  prevent  the  admission  of 
into  the  cavity»  and  it  entered  fully."     A  second  puncture  was  maA' 
week  later,  and  another  pint  of  pus  was  drawn  off.    The  opeaiog 
mained,  and  for  several  di^ys  the  air  passed  freely  out  and  in  at  ea 
inspiration  or  expiration,  and  no  evil  consequenccfollowed,  thepati^ 
making  a  good  recovery. 

The  second,  a  child  eighteen  months  old  ;  the  case  a  severe  one. 
punctured  the  chest,  and  discharged  a  pint  of  thick  pus.  The  pan 
ture  did  not  close,  and  the  air  passed  fully  out  and  in  for  several  dft^ 
The  child  immediately  improved,  and  finally  recovei^,  to  the  ntl 
astonishment  of  many  who  saw  him.  I  have  often  ponctared  C 
chest,  and  have  always  found  when  the  air  was  admitted  freely  is 
the  pleural  cavity  the  patient  did  best.  Hence  I  am  led  to  believe  t 
fears  of  the  profession  upon  this  subject  are  groundless,  and  insur 
ments  for  withdrawing  the  fluid  without  admitting  the  air,  superflnoi 
— Amtr.  Med,  Timee, 

10.  Superiority  of  Vulcanized  Caoutchouc  over  any  other  Sniita9 
for  the  Fabrication  of  Bougies. — ProfeHsor  Nelaton  has  recently  sho^ 

the  superiority  of  vulcanized  india  rubber  for  catheters  and  bong' 
over  the  instruments  in  common  use  made  of  tissue  coated  with  < 
mixed  with  litharge.  The  latter  arc  rigid,  liable  to  give  rise  to  fal 
passages,  cause  pain,  and  when  permanently  left  in  the  urethra,  exi 
oise  a  degree  of  pressure  which  may  induce  mortification  and  perfoi 
tion.  In  a  few  days,  moreover,  they  are  deteriorated  by  humidii 
Vulcanized  india-rubber  sounds,  on  the  contrary,  are  perfectly  flexit 
and  unchangeable.  They  are  inserted  with  greater  case,  and  cause 
little  distress,  that  they  may  be  preserved  in  the  urethra  during  a  jot 
ney  without  inconvenience.  They  are  not  afTected  by  moisture,  ai 
one  of  these  instruments  which  remained  in  the  urethra  twelve  daj 
in  one  of  M.  Nelaton's  cases,  when  withdrawn  picsented  no  sign 
outward  injury,  and  was  as  smooth  as  before  its  introduction. — Jn 
de  Med,  et  Chir,— Dublin  Med.  Preee,  June  24,  1863,  p.  627. 

11.  On  Xitrate  of  Silver  to  Prevent  the  Pitting  of  Small- Pcg,^] 
John  lligginbottom,  Esq.,  Nottingham.  —  Having  observed  ma' 
years  ago,  that  the  nitrate  of  silver  had  been  used  on  the  Con  tine 
by  MM.  Velpeau,  Breton nean,  and  Serres  for  the  purpose  of  prevei 
ing  pits  and  scars  consequent  on  small-pox,  I  was  induced  to  ftpply 
as  they  directed,  by  puncturing  the  centre  of  each  vesicle  with 
needle,  and  then  applying  the  solid  stick  of  the  nitrate  of  silver, 
found  it  effectual  in  preventing  any  further  progi'ess  of  the  pox. 

The  next  patient  on  whom  I  used  the  nitrate  of  silver  was  a  a troi 
healthy  young  man,  about  twenty  years  of  age.  with  confluent  smi 


18M.]  JEditorial  Al$tract9  and  SiieciioM.  199 

poi.    I  ]Hinctitred  a  few  of  the  veeicles  on  the  face,  bat  these  being 

▼ery  nnmeroos,  I  satisfied  myself  with  applying  the  concentrated  soln- 

iion  o^er  the  whole  surface  of  the  face,  where  they  were  moRt  confla- 

entywithoai  making  any  pnnctnres.    The  solution  answered  as  well  as 

where  the  pnnctnres  had  been  made  in  arresting  the  progress  of  the 

eruption.     The  next  case  of  conflaent  small-pox  was  one  where  no 

punctures  were  made, — Mr.  P.,  a  yonng  man,  nineteen  years  of  age, 

and  of  delicate  constitution.     From  the  confluent  state  of  the  pox  I 

ihoald  have  expected  deep  pits  and  scars  on  his  face.     I  applied  the 

eoncentrated  solution  on  the  whole  of  the  face  and  the  ears  in  the  same 

manoer  as  recommended  in  erysipelas. 

The  vesicles  of  the  pox  were  immediately  arrested  in  their  progress, 
ind  in  four  days  presented  small  hardened  eschars,  free  from  inflam- 
Bstion,  whilst  the  pustules  on  the  body  were  gradually  proceeding  to 
•nppuration.  In  about  nine  days  tlie  eschar  had  come  away  from  the 
boc  without  leaving  pits.  In  this  case  the  nitrate  of  silver  not  only 
preTsnted  the  pits,  but  the  inflammation,  irritation,  and  offensive  sup- 
pQntioQ  which  are  so  distressing  to  the  patient.  If  thought  necessary, 
tk  nitrate  of  silver  might  be  applied  all  over  the  scalp,  as  in  erysipe- 
hs,  to  prevent  cerebral  inflammation.  It  might  be  applied  on  and 
vithm  the  cavity  of  the  ear  to  prevent  otitis,  and  on  the  conjunctiva 
to  prevent  ophthalmia.  I  have  used  as  a  gargle  to  the  throat  in  small- 
pox, with  great  benefit,  a  solution  of  a  scruple  of  nitrate  of  silver  in 
thne  ounces  of  distilled  water. 

For  the  remedy  to  be  successful  in  preventing  pitting,  it  should  be 
ipplied  on  the  fourth  or  fifth  day  of  the  eruption.  The  concentrated 
MlatioB  being  used,  composed  of  the  old  stick  nitrate  of  silver,  four 
Knplet,  to  four  drachms  of  distilled  water. — Hed.  Times  and  OazeUet 
Aiy  11,  1863,  p.  54. 


OPHTHALMOLOGICAL. 

12.  Prt^,  James  Syme  on  Jridectomtf. — Sir — As  you  ask  my  opin- 
ion on  iridectomy,  I  have  no  hesitation  in  saying  that  it  has  always 
Nemed  to  me  an  entire  delusion  accepted  for  the  cure  of  blindncsR,  on 
tk  came  principle  which  loads  drowning  men  to  catch  at  straws. 
Olaocuna  has  been  regarded  as  so  hopeless  a  disease,  that  it  was  pe- 
ctliarly  well  suited  for  tho  proposal  of  an  operation  which  promised 
■erely  to  afTord  some  chance  of  relief.     Such  being  its  modest  profes* 
noQ,  the  deatractiva  inflammation,  lenticular  opacity,  and  collapse  of 
the  eye-ball,  which  loo  frequently  result  from  opening  the  cornea  and 
catling  oat  a  portion  of  the  iris,  were  not  held  to  counterbalance  the 
hcBcfit  claimed  by  patients  who  had  been  so  fortunate  as  to  escape 
thsM  dangers.     But  this  alleged  benefit,  from  what  has  come  under 
■y  observation,  does  not  appear  to  be  at  all  different  from  that  which 
every  one  labouring  under  incurable  deafness  may  believe  for  a  time 
he  has  received  from  the  use  of  remedial  means,  wHktever  they  may 
have  been.     The  truth  is,  that  any  man  who  has  paid  money,  and 
•o&red  pain,  does  not  like  to  cunlobs  that  his  object  in^doing  so  has 


200 


Sp€citd  SelecUonB. 


[Uarob* 


not  been  accomplished ;  while  his  attention  and  imagination  being  at 
the  same  time  excited,  he  is  apt  to  regard  the  feeblest  glimmer  of  lights 
or  the  faintest  perception  of  sound,  as  a  favorable  symptom  of  improv- 
ment.  Iridectomy  will,  therefore,  I  trusft,  soon  disappear,  not  only 
from  surgical  practice,  but  from  surgical  language. — Btii.  Mid.  Jomr., 
Oct,  24.  1863. 


MATERIA   MEDICA. 

13.  Sarracenia  Purpura. — ^The  Committee  on  Intelligenco  of  the 
New  York  County  Medical  Society,  after  giving  the  history  of  tbia 
plant,  examine  its  virtues  as  a  remedial  agent  in  small  pox,  for  which 
disease  it  has  been  highly  lauded  by  some  foreign  physicians.  They 
sum  up  their  labors  in  the  following  report : 

*'  Ist,  That  the  analysis  already  made  of  the  plant  do  not  giva  any 
active  principle  or  element  which  would  indicate  any  great  medicinal 
potency  ;  2d,  That  the  discovererH  and  advocates  of  the  specific  remo- 
diol  power  of  the  sarracenia  purpura  over  variola  have  given  too  great 
credit  to  the  post  hoc  circumstances,  as  hoiug propter  hoe  influenoaa. 
one  reason  for  this  latter  inference  being  suggested  by  the  loose, 'unaci- 
entific  and  eulogistic  style  of  the  communications  ;  and  3d,  That  the 
reliable  recorded  experience  thus  far  appears  to  preponderate  againat 
the  remedial  efficiency  of  this  plant  in  those  forms  of  the  disease  which 
do  not  generally  recover  under  the  administration  of  ordinary  remC'; 
dies." — Amer.  Med.  Timee. 

14.  Iodide  of  Lime  a  Substitute  for  Iodide  of  Potassium.  —  The 
'*  iodide  of  lime"  is  rapidly  gaining  favor  among  English  practition- 
ers, as  a  remedy  of  great  value.  It  is  used  in  those  cases  where  iodide 
of  potossiuni  is  indicated,  with  more  marked  effects  than  nanally^ 
attend  the  use  of  that  salt.  The  lime  and  iodine  are  held  together  by 
a  very  feeble  affinity,  and  the  salt  will  not  admit  of  exposure  without 
evolving  free  iodine.  The  solution  is  a  colorless,  and  almost  tasteleas 
liquid,  and  remains  permanent,  although  long  kept  and  exposd  to  the 
air. 

Each  drachm  of  the  salt  contains  eight  and  a  half  grains  of  iodine  ; 
each  fluid  ounce  of  the  solution  cuntaiuK  half  a  grain  of  iodine. 

The  iodide  of  lime  is  superior  to  the  iodide  of  potassium  in  several 
particulars  :  Ist.  Smallness  of  the  dose ;  2d.  In  not  passing  off  so 
quickly  by  the  kidneys ;  3d.  In  its  ready  combination  with  the  blood 
and  tissues,  manifesU'd  liy  its  alterative  effects  ;  4th.  Its  being  nearly 
tasteless,  therefore  readily  taken  by  children  ;  5th.  It  is  less  expen- 
sive ;  6th.  In  not  producing  gastro-enteritis,  or  vesical  irritation. 

Iodide  of  potassium  is  ten  times  as  expensive  as  the  iodide  of  lime. 

Dose  :  About  one-fourth  of  a  grain  in  solution  two  or  three  times  a 
day.  The  solution  should  always  be  used  in  preferance  to  the  salt. — 
Buffalo  Med.  and  Surg.  Journal. 


vmote  VohiDM,  XXI  X 


APKIL.  IB64. 
THE 


tannaii  faucet  i  ^bseriier. 


sDiTBo  oy 
EVENS,  M.D.  .  .  JOHN  A.  MWPHV.  hr.a 


\ 


CINCINNATI: 


OOSTENTS  POn  AIMUI.,  11^6*. 


ilRiatKAL  lOUUtrXICATKIXf 

Avt.  I. — Obiiriiciton  nrFtowcli.      Sy  U'llt.  ('nmtniini,  M.Di  . 
Am-.  11.— ReporU  «[  CoDCt  ui  Jtlliturjr  tiurgcry.       By  K.  Wit 
AtT.  III.— Ei*r«iitc;  li*  rlij^slotogr,  I'lUlly  »ii  n  mooni  b(  lltnlUl,] 
unU  toTlueiicc  luCiiuitlfTiiCtlnfi:  PiilmonniJ'  Tuli«rouIii»l«,  j 
By  ,1. 1'.  IluWlier,  IW.U.,  uf  Kimn  Vullirj,  IVi 
AsT.  I\'— On  Ihu  AnDperlmlic   )'ro|<«rtieii  uf  ihv  lUrk  of  PrnuBiU  J 
Nijjni,  lit  Swiuni.  Aril.    By  D.  W  ■  C.  Uemiy,  M.  »■.. 

l-ROCEKIIl.VCrit  iir  EOCIKTIKS. 

I'l'DOonUogBof  Trlppt^  Mllllarr  blvdiual  Siiciai; i^^i 

I'roc«edln^»f  Uio  QliiciniiatI  Acmlemy  uf  McdiCili*'  -  ■ 

ri>B«K!<rii\D(:\rK. 

I.*«cr  ftiim   BorUiu 

On  Hi*  Employment  of  AtHmibiHic*  In  UUloirlo  WolWiir  Md  » 

Lpcliirtii  on  Mmlifnl  BiluakiloTi  ;  TrariMOtioni  of  Uto Mollcal  » 
liiuHtHtrnl'Kirw  Yorkj   Treaiiae  on   lluuinii  PlinluUigj  ;  1 
<t  Aoiiiml  nrpiirt  orttitiMMMgonarthciliau  I.tinaiicAtjhini 


New  York   . 


I'lipalJ  SiiltRcripiinn*  i    Clild^u  Mtdlnl  Juunwl  i  Trijijilcr  Milltai 
•Mwl.  Bocieiy  i  Hrourt-Plnlti*  of  Armor  i  "  SpotloJ  Vcrtx-  -.•'  "  ' 
biiit;  Kith  nUii'i'  J'-urnnla  i   Depiutnienl  ol'tlia  Nnrtti :  A  tt»m  ftu 
ily  furDnllii.  rlc;   Q<uck  Medical   t.ilnnitMru  in  Reli^uul  Nsfl 
pem  ;  T>k3  Joiimab  Wtnlifil  I    Tlie  AmeriwD  Mediot]   / 
McilicB]  CullfiiM ;    Armr    Mallcnl    Intcl1[j(Eiice...... 

E[i1TI>*l>L  AllDKurO  t 


THE 

CINCINNATI  LANCET   AND  OBSERVER 

CONDL'CTED  BT 

E.  B.  STEVENS.  M.D.,  AND  J.  A.  MURPHY.  M.D. 


▼el.  VII.  AFBIIi.    1864.  ISorA. 


Original  (SommnnUnUens, 


ABTICLB    f. 

Obstruction  of  Bowels. 


BT   WILL.   C0MM02CS,    M.D.,  ASS18TAKT-8UaQ£ON|  U.8.N. 


William  Doverenx,  soamcn,  aged   twenty-two,  native  of  Boston, 

Was  called  to  see  bim  at  one  o'clock  a.  m.,  Jan.  12th,  1864. 

Found  him  suflvring  severely  with  pain  in  abdomen,  referred  to  region 

bdow  the  umbilicus,  and  mostly  to  the  left  side  ;  abdomen  flat,  hard, 

■0C  Ijmpanitic,  and  upon  percussion,  emitted  a  sonnd  of  high  pitch  ; 

aaval  retracted  and  recti  muscles  so  contracted  as  to  render  it  impossi- 

Ub  for  him  to  assume  an  erect  position  ;  pain  slightly  increased  by 

;  pulse  70  per  minute  ;  tongue  natural  and  skin  moist ;  occa- 

atteropts  at  vomiting,  without  being  able  to  eject  anything ; 

itenance  pale  and  anxious  ;  bowels  moved  yesterday.     Examined 

earefully,  but  could  detect  no  hernia.     Thinking  I  had  a  case  of 

"*  ipAimodic  colic"  to  deal  with,  I  gave  morph.  sulph.  grs.  ss.  and  in 

tmoktj  minntes  the  dose  was  repeated,  which  seemed  to  relievo  the 

,  and  he  was  left  until  morning. 

Jan.  12,  9  a.  m. — Not  any  better  condition,  about  the  same  as  when 

n.   I  now  learned  thai  he  had,  by  diioction  of  Surgeon  Gibson, 

four  compound  cathartic  pills  in  the  afternoon  of  yesterday,  but 

oiion  of  the  bowels  had  followed.     As  yet  there  were  no  indica- 

of  inflammation.     Gave  him  mag.  sulph.  Sj.f  AQd  left  him,  with 

that  ho  should  bo  re|K>rted  to  me  in  a  short  time,  if  not  better. 

4  p.  M. — Was  called  to  him  again,  and  found  him  worse.     Pain 

jfiranmlj  extending  from  left  side,  along  the  track  of  the  colon,  to 

i%ht  hypochondriac  region  ;  pulse  increased  in  frequency,  small  and 
VII.— 13. 

[ 


202  Originai  CimmumeaAom.  [A 

quick  ;  frequent  and  violent  attempts  at  yomiting ;  connUmanoe 
and  pinched  and  expressive  of  great  suffering ;  abdomen  some' 
distended,  but  not  tympanitic— on  the  contrary,  percussion  was 
and  the  colon  could  be  felt  as  if  filled  with  fecal  matter ;  pain  inen 
by  pressure,  more  over  the  course  of  the  colon.  Salts  had  prod 
no  operation.  I  now  suspected  that  it  was  a  case  of  obstrnctic 
the  bowels.  Directed  injections  of  sea  water.  Saw  him  an 
afterward.  Three  injections  had  been  given,  which  came  away  a] 
immediately,  but  brought  no  fecal  matten  Batching  continosd, 
pain  so  great  as  to  imperatively  demand  anodynes.  Ghive  snlphi 
morphia  in  half  grain  doses,  and  as  there  were  indications  of  ain] 
each  dose  was  given  in  half  an  ounce  of  whisky.  Used  warm  fo 
tations  to  abdomen,  and  continued  injections,  but  without  be 
By  10  p.  M.  he  had  swallowed  grs.  v.  of  morphia,  and  as  many 
ces  of  whisky.  Pain  continued,  and  in  every  way  he  had  g 
worse.  My  principal.  Dr.  Gibson,  now  saw  him,  and  directed 
Bulph.  Sj*>  Ai>d  injections,  anodynes  and  stimulants  were  contii 
At  midnight  gave  croton  oil  gtts.  ii.,  at  one  o'clock  gave  gtts.  iii. 
injected  infusion  of  tobacco.  He  grew  rapidly  worse,  and  di 
8.80  A.  M.  January  15.  Daring  the  last  four  hourt  he  complain 
no  pain. 

PaH' Mortem  Appearanee. — Abdomen  greatly  distended ;  pent 
sac  contained  about  a  pint  of  dark,  red,  serous  fluid.  The  whc 
Che  intestines  were  of  a  rich  purple  color,  deepened  on  the  colon 
color  almost  black.  The  small  intestines  were  moderately  filled 
fluid  matter.  The  large  bowel  was  very  tense,  and  filled  with 
ibcal  matter  and  gas.  In  lower  portion  of  descending  colon, 
above  the  sigmoid  flexure,  was  a  dense,  fibrous  band,  encircling 
completely  obstructing  the  bowel.    No  other  lesion  discovered. 

The  above  case  is  not  devoid  of  interest,  and  upon  the  wholes  I 
deemed  it  worthy  of  being  reported.  I  make  no  comment  o 
course  pursued  in  the  treatment  The  violence  and  rapidity  o 
symptoms  were  not  in  my  opinion,  altegether  in  keeping  with  tlu 
vious  good  health  of  the  patient  He  said  he  had  sufiered  wil 
attack  of  eoUc/our  yeart  ago,  which  was  quickly  relieved,  and  % 
could  not  possibly  have  any  connection  with  his  last  sickness.  I 
then  he  had  been  uniformly  healthy.  By  the  most  rigid  inqi] 
could  learn  nothing  that  gave  me  reason  to  believe  that  he  had 
sufiered  from  peritonitis,  or  any  disease  of  the  bowels.  Neithei 
he  been  troubled  with  constipation.'  He  assured  me  that  he  had 
quite  well  until  the  afternoon  of  Monday,  Jan.  11th,  and  when  ] 


■.  861]  MoMabov— Gstet  m  MSUarf  Surgery.  908 

n  Wm  lie  wu  **  on  watch/'  doing  the  duty  of  a  aeaman.    He  pass- 

ipidly  from  had  to  worse,  until  reliered  hy  death,  fifteen  honn 

tfie  appearance  of  the  first  symptoms,  and  the  autapiff  revealed  an 

ipassahle  strictnre  of  colon,  doubtless  of  inflammatory  origin.    The 

iMnrd  seemed  to  be  twisted  once  upon  itself,  and  above  the  strictnre  it 

w«  of  natoral  siie,  and  distended  almost  to  bursting,  but  at  the  seat 

€f  strictnre  it  was  contracted  and  scarcely  Uiger  than  the  qnill  with 

whiA  I  am  writing.    Granting  that  the  motion  from  his  bowels  on 

Vsiday  was  only  matter  contained  in  the  bowel  Mow  the  stricture, 

Ant  is  still  a  wonder  that  he  should  have  experienced  so  litde  difficnl- 

tx  mil  within  so  short  a  time  of  his  death. 

tU^Sk^  **  Bartfwr^'  f^f  R^  Wui,  Jm.  16, 1864. 


ABT.  U. 

Reports  of  Oases  In  Military  Sarf  ery. 

BT  A.  M*MAB0X,  MJ>., 
8wt«os  SUtyVouib  n»glMtat,  O.VX,  on  d«tj  at  Ch«tteMMS*> 


Cisi  V-^UigaiUm  €f  Prtmiikfe  and  JSxiemtd  Oaroiid$/ar  Oim$koi 
^hmdif  Fq/u  \  iZseovtffy.— Daniel  Oox,  aged  twenty-five,  private  in 
Os.  F.  Fifteenth  Ind.  Vols.,  wounded  November  25th,  at  the  storming 
<f  IGssion  Ridge.  Ball  entsred  anterior  to  angle  of  left  lower  maxilla 
htliring  the  bone,  making  a  ragged  opening  neariy  one  inch  long, 
downwards  under  the  tongue,  cutting  the  floor  of  the  month, 
out  on  opposite  side  to  the  right  and  a  little  below  the  great 
of  hyoid  bone. 
Oa  the  evening  of  November  29th,  I  was  called  by  the  Assistant- 
SiigBon  Thirty-Fourth  Dlinois  to  see  this  man,  as  he  was  bleeding 
piliMly  from  wounds.  The  distance  was  about  one  square  to  the 
hBdiagin  which  he  was  lying.  On  arriving,  I  found  him  bleeding 
the  right  side,  the  blood  rushing  from  his  mouth  and  the  point  of 
of  escape  of  ball  in  neck  in  a  continuous  stream,  which  was 
1^^  aiterial.  and  as  was  supposed,  coming  from  the  sublingual 
Mwy.  At  this  time  he  had  lost  at  least  between  thrse  and  four  pints 
sf  llood,  as  the  hsmorrhage  had  continued  without  any  intermission 
Ibt  etfural  minutes,  and  without  any  attempt  having  been  made^to 
smstit. 

Urn  patient  was  placed  in  the  semi-rsoumbeut  position,  his  bade 
wsD  anppoftsd  by  one  of  the  nurses,  and  it  was  at  once  decided  to 
Ai  oommon  carotid  of  right  side.    It  was  utteriy  impossible 


204  Original  CammuniMHons, 

for  him  to  lio  down  ;  as  it  was,  the  hlood  flowed  into  his  month  wi 
such  rapidity  as  almost  to  cause  strangulation.     The  administrati 
of  chloroform  could  not  be  entertained,  and  with  the  assistance 
Surgeon   Lytic,  Thirty-Sixth    Illinois,  an  incision  was  made  fi 
point  of  exit  of  ball  down  the  neck  on  inside  of  stemo  mastoid,  divii 
ing  the  superficial  structures  and  deep  fascia,  working  with  handle    ^^^ 
scalpel  succeeded  in  exposing  the  sheath  of  the  vessels  with  decendetf" 
noni  nerve,  opened  \he  sheath,  passed  the  artery  needle  armed  wifcB 
ligature  from  without  inwards  and  secured  the  vessel  just  above  tb# 
ormo-hyoid  muscle.     As  soon  as  the  ligature  was  brought  home,  all 
hsemorrhage  instantly  ceased. 

If  I  had  seen  the  patient  sooner,  the  proper  course  to  have  pursued 
would  have  been  the  ligature  of  the  external  carotid,  but  in  finding 
this  vessel  so  muAi  time  would  have  been  consumed  thajt  it  wonld 
have  been  unnecessary  to  have  applied  the  ligature  after  the  vessel 
was  found.  Under  the  circumstances,  no  other  course  was  left  me,  as 
the  danger  of  his  dying  was  imminent,  but  ligate  at  the  most  available 
point,  at  the  position  that  would  soonest  arrest  the  hiemorrhage,  where 
I  could  do  so  with  the  possibility  of  saving  the  man's  life,  even  at  the 
risk  of  violating  one  of  the  established  rules  of  Surgery,  viz. :  **  In 
wounds  of  its  (the  external  carotid)  deep  seated  branches,  ligate  the 
external  carotid." 

In  dividing  the  tissues  not  a  single  arterial  or  venous  branch  was 
cut  which  would  have  rendered  the  operation  very  simple  were  it  not 
for  the  continual  flow  of  blood  through  the  wound  completely  delug- 
ing and  o'bscuring  the  parts,  but  this  was  remedied  to  a  considerable 
extent  by  the  judicious  use  of  the  sponge  by  my  assistant.  The  Cime 
consumed  was  extremely  short,  as  the  operation  to  be  at  all  saccessfiil 
had  to  be  expeditious  to  save  life.  The  pressure  applied  to  carotid 
in  the  neck  preparatory  to  the  operation  had  very  little  eflfect  on  the 
haemorrhage,  as  the  difficulty  of  breathing  was  very  great  at  best, 
without  compressing  the  parts  about  the  trachea.  During  the  opera- 
tion,  an  assistant  had  to  introduce  his  finger  into  the  man's  mouth  to 
free  it  from  the  clots  of  blood  which  interfered  with  respiration.  In 
tightening  the  ligature,  I  watched  the  patient's  face  to  see  if  any  effect 
would  be  produced,  but  none  was  visible  except  an  expression  of  relief 
from  the  pain  incidental  to  the  operation. 

This  upon  the  whole,  has  been  the  most  frightful  case  it  has  been 
my  province  to  witness.  The  blanched  appearance  of  the  face,  the 
anxious  expression  of  his  eyes,  the  almost  absence  of  pulse  at  the 
wrist,  the  stream  of  blood  from  wound  arching  out  as  if  being  driven 


1 864.]  McMahok — Cans  in  Military  Surgery.  205 

l>j  a  force  pump,  bis  shirt  and  bed  clothing  saturated  with  blood  ren- 
tlered  it  a  eight  to  appal  the  6(rongeRt  nerve.     He  stood  the  operation 
^^rell,  never  complained  till  it  was  over.    Whisky  and  water  were  free- 
ly administered,  and  to  be  continued  dnring  the  night  with  beef  tea. 
lie  rallied  pretty  well,  considering  the  vast  quantity  of  blood  he  had 
lost;  pnlse  small  and  rapid,  complained  of  being  very  weak.     We 
were  fearful  htemorrhage  might  occur  from  opposite  side,  and  he  was 
closely  watched  during  the  night. 

Nov.  80th. — No  further  return  of  hemorrhage  during  the  night ; 
lid  rested  tolerably  well ;  pulse  still  rapid  and  weak  ;  very  much 
prostrated.  Stimulants  to  be  continued  during  the  day ;  takes  quite 
large  quantities  of  beef  tea,  of  which  he  is  very  fond. 

Evening. — No  hemorrhage  ;  more  cheerful ;  has  taken  a  good  deal 
of  nourishment  to-day ;  pulse  small,  but  has  a  little  more  volume  and 
about  100  ;  general  appearance  improved. 

Dec.  1st. — Slight  haemorrhage  occurred  from  wound  on  left  side 
doring  night,  controlled  by  liq.  fcrri  per  sulphatis. 

Dec.  .2d. — Haemorrhage  occurred  again  this  morning  from  left  side, 
appeared  to  come  up  out  of  lower  maxilla  between  the  ends  of  frac- 
tored  bone  as  if  coming  from  inferior  dental  artery.  Plugs  of  lint 
tatarated  with  liq.  fcrri  per  sulphatis  were  inserted  with  temporary 
relief  from  haemorrhage. 

Evening. — Haemorrhage  again  occurred  from  wound,  the  patient 
IcMtog  scarcely  any  blood  during  this  or  previous  haemorrhages  from 
this  side,  as  he  was  continually  under  the  supervision  of  a  medical 
officer.  This  was  again  controlled  by  the  iron.  Finally,  it  was  re- 
solved that  the  only  course  to  be  pursued  in  the  event  of  the  recurrence 
of  bemorrbage  during  the  night  to  any  alarming  extent  would  be 
ligation  of  the  external  carotid. 

•  Dec.  8d. — Last  night  about  12  m.  haemorrhage  occurred  again  with 
considerable  force,  which  necessitated  the  ligation  of  the  external 
carotid  of  left  side  without  any  further  return  of  haemorrhage. 

Dec.  4th. — ^Patient  very  weak;  pulse  100,  small  and  weak  ;  appe- 
tite not  good,  can  not  take  any  solid  food,  has  to  live  on  fluids,  beef 
tea,  farina,  (hin  gruel,  coffee,  tea  and  whisky  toddy.  Milk  punch  he 
can  not  bear. 

Dec.  6th. — General  condition  somewhat  improved  ;  more  cheerful  ; 
appetite  better  ;  inclined  to  doze  a  good  deal ;  rather  drowsy  ;  mnsco} 
Tolitantes  floating  in  the  field  of  vision  ;  can  not  sit  up  in  bed  with- 
OQt  causing  a  feeling  of  fftintness  and  dizziness.  Pulsation  cau  be 
lelt  on  supra-orbital  ridge  of  left  side,  more  in  right.     Face  blanched. 


206  Orimbud  Commumeationt.  [ApA, 

Dec.  9th. — ^Doing  well ;  pulse  90,  tolerably  etrong,  wiUi  eonnder- 
ftble  volame  ;  appetite  good.    Expresses  himself  as  doing  well. 

Dec.  11th. — ^Patient  improving  rapidly  ;  pulse  84,  with  eonaidfln- 
ble  force ;  appetite  good,  still  takes  a  large  quantltj  of  berf  tea  dafly ; 
thinks  he  will  soon  be  able  to  go  home.  The  ligature  from  eztenial 
carotid  separated  on  yesterday;  that  from  primitive  to-day.  That 
condition*  of  drowsiness  has  almost  left ;  wounds  in  neck  granulating 
kindly,  dischaiging  healthy  pus. 

Dec.  16th. — Face  still  blanched ;  appetite  not  good  ;  complaina  of 
a  great  deal  of  pain  and  soreness  in  neck  ;  pulse  full,  but  somawhat 
gaseous  ;  no  return  of  drowsiness ;  stimulants  with  general  diet  ooa- 
tinned. 

Dec.  20th. — General  condition  improved ;  pulse  90,  pretty  fidl. 
Fluids  pass  out  from  mouth  through  wounds  in  n^ck.  He  is  qnila 
lively  and  cheerful.  The  ends  of  fractured  bone  are  still  quite  visible* 
no  evidence  of  any  attempt  having  been  by  nature  to  repair  the  injmy. 

Dec.  24th. — Hsemorrhage  from  small  vessel  on  right  nde  lying 
quite  superficial,  controlled  by  iron,  without  any  recurrence. 

Jan.  22,  '64. — ^Patient  says  he  feels  as  well  and  strong  as  ev«r  ; 
no  muscie  volitantes  in  field  of  vision.  He  walks  about  the  oi^ 
every  day  when  the  weather  is  fine.  Union  has  not  taken  place  in  tlie 
fractured  maxilla.  Through  a  small  external  opening  the  ends  of  tbe 
bone  can  be  seen  perfectly  white  and  bare,  no  callus  whatever  viaible. 

Jan.  28th. — ^This  man  left  Chattanooga  on  furlough  for  his  home  in 
Indiana,  to  all  appearance  as  well  as  ever,  except  the  inconvenienoe 
of  being  unable  to  masticate  his  food. 


Cass  II. — Ligation  qf  Brachial  Artery  for  Bbemarrhage  from  Omm- 
ihot  Wounds  \  Recovery. — Robert  Hebker,  aged  twenty-five,  private  in 
Co.  G.,  Sixty-Fifth  Regiment,  O.V.I.,  wounded  November  28,  at  the 
taking  of  Orchard  Knob  in  front  of  Misdion  Ridge.  Ball  paaaed 
through  upper  third  of  left  arm  immediately  under  brachial  artery,  not 
touching  the  bone.  I  examined  the  wound  shortly  after  its  reception, 
and  felt  the  vessel  pulsating  distinctly,  as  if  its  sheath  was  out.  The 
prognosis  made  at  the  time  was  that  secondary  hsBmorrhage  Wonld 
most  likely  occur  in  ten  or  twelve  days  from  ulceration  into  ita  coata 
and  recommended  he  be  closely  watched. 

Dec.  6th. — ^The  prognosis  was  verified  by  a  sudden  and  copious 
hsmorrbage  which  occurred  to-day,  which  was  arrested  by  compres- 
sion after  the  loss  of  at  least  one  quart  of  arterial  blood.  The  artery 
being  compressed  by  the  fingers  of  an  assistant,  I  enlarged  the  point 


166i»]  McMahov — CuHi  in  Military  Surgery.  207 

of  exit  of  boll,  cot  down  to  the  yessel  and  fonnd  a  ragged  opening  in 
bimfllikl  artery  and  tied  the  Teesel  at  ita  dbtal  and  proximal  sides. 
Coaaiderabb  difficolty  was  experienced  in  detaching  the  yesael  from 
the  anrronnding  atmctnres  on  aocoant  of  the  matting  together  of  the 
pMta  bj  the  fibro-albnminons  deposit,  the  result  of  the  previous  in- 
flammation. The  ligatures  were  applied  from  the  opening  in  vessel 
About  one  and  one-half  inches  on  each  side,  thus  securing  healthy 
pMta  of  vessel  for  the  ligatures.  Between  these  two  points  the  supe- 
rior profunda  artery  gave  off.  The  brachial  artery  was  divided  over 
dia  aaat  of  injury  by  the  knife.  The  median  nerve  was  also  imbedded 
ia  thia  matted  mass  from  which  I  freed  it^by  some  dissection  and 
uaiag  die  handle  of  scalpel.  Before  closing  the  wonnd  a  slight  hsemor- 
fhago  waa  observed  from  bottom  of  wound  caused  by  the  anastomosis 
•f  profunda.  This  vessel  was  at  once  ligated  just  where  it  was  given 
off  firom  main  vessel  without  any  further  evidence  of  hemorrhage. 
During  the  operation  no  chloroform  was  administered  as  I  was  fearful 
iapry  might  be  produced  owing  to  the  extreme  weakness  of  the  circu- 
IfttioB.  He  bore  the  operation  well.  Stimulants  with  a  little  morphine 
mre  given,  which  enable  him  to  have  considerable  rest  during  the 

Dec.  7th. — Quite  cheerful ;  pulse  small  and  frequent ;  appetite  good ; 
■e  fletum  of  hssmorrfaage ;  sensation  in  arm  a  good  deal  better  than 
peayioua  to  operation,  the  numbness  of  which  he  had  complained  in 
kia  hand  and  fingers,  except  little  finger,  has  almost  disappeared. 
This  ia  no  doubt  owing  to  the  freeing  of  the  median  nerve  from  the 
around  the  seat  of  injury.  Heat  of  arm  good  ;  bandages  at 
of  wound  applied  very  loosely  ;  no  oedema  or  swelling  of  the  arm 
kidieatife  of  sluggishness  in  the  venous  circulation. 

Dec.  8th«— Pulsation  distinctly  felt  at  radial  of  left  wrist,  also  in  a 
II  Tesael  passing  over  the  external  condyloid  ridge.  The  pulsation 
ia  more  easily  distinguished  than  at  wrist.  It  is  short,  forcible 
aad  quick  aa  if  the  vessel's  calibre  was  too  small  for  the  quantity  of 
forced  through  it.  General  condition  of  patient  good,  better 
could  have  been  expected  after  the  quantity  of  blood  lost 
Dec.  16th.— Ligatures  separated  from  vessels  to-day ;  wound  gran« 
ulating  kindly  ;  fore-arm  and  hand  somewhat  shrivelled ;  the  skim 
dry  aod  scaly  ;  pulsation  not  increased ;  temperature  good  ;  sensation 
good.     Sits  up  a  little  daily. 

Dec  29th.^^omplains  of  severe  pain  in  hand  during  the  night  and 
every  other  day.  Condition  otherwise  good«  Ordered  quinine  and 
iRMi  gra.  T.  three  times  daily« 


208  Original  Communieationt.  [ApriBi 


Jan.  22,  '64. — ^In  spite  of  all  treatment  both  local  and  generaU 
pain  in  hand  and  arm  would  recur  periodically,  giving  rise  to  inteiii^ 
suffering,  causing  him  to  wear  a  very  haggard  expression  of  coanten-^  - 
ance.  n 

Jan.  28th. — Sent  North  to  his  home,  without  any  relief  from  pai] 


'm  » 


ASTICLB  III. 

Exercise:  Its  Physiology,  Utility  as  a  Means  of  Health,  and  Influamw 

in  Counteracting  Pulmonary  Tuberculosis. 

BT  A.  P.  DUTCHEE,  M.D.,   OF  EN05   VALLET,    LAWRENCE  CO.,  PEW. 


I. — Pkyilology  of  EzerclBe. 

To  rightly  understand  and  appreciate  the  importance  of  exercise  as 
a  means  of  health,  it  will  be  necessary  to  take  a  brief  glance  at  its 
physiology.  All  the  motions  of  the  human  body  are  accomplished  l^ 
muscles,  they  are  very  numerous  embracing  several  hundred  pairs,  and 
constitute  more  than  one-half  of  the  bulk  of  the  body,  and  00080** 
qnently  a  very  large  portion  of  the  whole  quantity  of  the  blood  ii 
devoted  to  supply  them  with  nourishment.  By  continued  exertions, 
their  energy  and  materials  become  rapidly  impaired  and  reduced,  and 
can  only  be  restored  by  an  increased  activity  in  the  circulation.  The 
manner  in  which  tliis  is  accomplished  will  be  readily  understood  by 
examining  the  movements  of  the  blood  vessels  of  any  of  the  limbs. 
Take  for  example  the  arm. 

By  inspecting  the  arm,  you  will  see  that  its  blood  vessels  are  cover* 
ed  and  protected  throughout  their  whole  course  by  the  adjacent  musdes* 
which  they  furnish  with  blood  by  their  numerous  branches.  In  con- 
sequence of  this  position,  the  muscles  can  not  contract  without  at  the 
same  time  compressing  the  blood  vessels  and  propelling  thoir  contents 
forward.  The  assistance  afforded  to  the  blood  by  this  arrangement  is 
very  great,  and  may  be  familiarly  exemplified  in  the  simple  operation 
of  bleeding.  Thus  when  the  blood  stops  or  flows  slowly,  it  is  custom- 
ary to  put  a  hard  body  in  the  band  of  the  patient,  and  desire  him  to 
squeeze  it  by  opening  and  shutting  his  hand  rapidly.  The  success  of 
this  action  depends  on  the  muscles  of  the  aim  compressing  the  blood 
vessels  and  forcing  onward  the  current  of  the  blood  by  their  succes- 
sive contractions. 

The  increased  activity  of  the  circulation,  thus  induced  by  general 
muscular  action,  is  not  confined  to  the  circulation  of  the  blood  vessels 
of  the  muscular  system,  but  the  whole  frame  partakes,  and  every 
organ  and  texture  feels  its  good  influence.     Not  only  is  the  circulation 


1864.]  DuTCHER — ExercUe,  Us  PhynAogy,  etc.  209 

invigorated,  but  a  greater  quantity  of  blood  is  required  to  supply  the 
demand.  It  passes  through  the  lungs  more  rapidly  and  in  larger 
quantities,  which  urg^  the  respiratory  organs  to  more  active  operations 
m  order  to  purify  the  blood  with  sufficient  rapidity  ;  while  to  supply 
the  demand  for  quantity  of  blood,  the  appetite  is  excited,  more  food 
is  eaten,  and  the  digestive  organs  partake^  of  the  excitement.  Thus, 
directly  or  indirectly,  almost  every  function  is  impelled  to  increased 
activity  and  the  whole  system  receives  a  healthy  impulse. 

niostrations  of  these  facts  as  well  as  the  reverse,  may  be  daily  met 

with,  especially  in  our  large  towns  and  cities.     We  find  that  those 

who  lead  active  and  even  laborious  lives  are,  generally,  in  possession 

of  good,  vigorous  constitutions,  healthy  looks,  and  frames  that  will 

iBdare  an  almost  incredible  amount  of  labor ;  while  we  see  others 

equally  well  prepared  in  early  life  for  a  state  of  body  so  very  desira- 

Ills,  but  who,  by  a  course  of  sedentary  and  inactive  pursuits,  are  thin, 

ptle,  without  muscular  strength,  and  subject  to  a  variety  of  diseases. 

Tbe  difference  between  these  two  opposite  conditions  is  jnntly  attrib- 

stable  mainly  to  the  non-employment,  in  one  case,  of  the  muscular 

ijitem,  and  its  regular  and  continued  exercise  in  the  other. 

It  is  a  well-established  fact  that  moderate  and  uniform  exercise  of 
individual  muscles,  will  greatly  increase  their  size  and  strength. 
Tkii  is  exemplified  in  the  case  of  various  artisans  who  have  occasion 
to  employ  different  sets  of  muscles.  With  the  blacksmith,  who  is 
^y  in  the  habit  of  striking  with  a  heavy  hammer  or  in  lifting  mas- 
sive bars  of  iron,  we  shall  find  the  muscles  of  the  arms  so  lars^e  as  to 
appear  almost  deformed  from  their  size,  and  possessing  proportionate 
■tRBgth  and  hardness,  while  the  muscles  of  the  lower  limbs,  used  for 
^  little  else  than  to  keep  him  in  an  erect  posture,  present  nothing 
"BBarkable.  On  the  contrary,  we  find  the  muscles  of  the  legs  of  the 
dificing  master,  which  are  used  to  throw  his  body  into  a  thousand 
liferent  attitudes,  and  with  great  force  and  rapidity,  large  and  firm, 
vide  the  moscles  of  his  arm,  having  but  little  to  do,  are  small  and 

To  increase  the  size  and  strength  of  a  muscle,  therefore,  to  its  greatest 
^cgiee,  its  exercise  must  be  uniform  and  not  excessive.  The  intervals 
of  iilaxationfl  from  labor  should  be  frequent,  in  order  to  give  the 
Wades  and  the  nerves  opportunity  to  recruit  their  powers.  It  is 
*try  easy  to  propel  the  action  of  a  set  of  muscles  beyond  their 
■trnigth,  a  circumstance  which  every  individual  has  made  known  to 
kio,  when  it  occurs,  by  the  production  of  painful  sensations  in  the 
<*pUM,  cnllad  fatigue  ;  and  if  this  occurrence  is  not  regarded,  and  the 


210  OUgitud  CammtmeaUont.  [April, 

mosdes  are  still  continnad  in  action  without  lert,  their  energies  mi^ 
at  last  become  so  far  ezhaasted  as  to  cause  unpleasant  results,  requir- 
ing  at  least  a  long  period  of  inaction  to  recover  them,  and  their  con- 
tractile power  may  become  permanently  impaired.  For  nearly  tha 
same  reason,  a  muscle  should  never  be  exerted  to  exoesa.  A  atienn* 
ons  effort,  especially  of  a  muscle  unaccustomed  to  work,  will  ofiUa- 
times  exhaust  it  completely. 

Exercise  of  the  muscular  system,  to  be  beneficial,  ought,  in  the 
Jirii  place,  always  to  be  proportionate  to  the  strength  of  the  oonstita* 
tion,  and  not  carried  beyond  the  point,  easily  discemaUe  by  experienee^ 
at  which  waste  begins  to  succeed  nutrition,  and  exhanstion  to  take  Ae 
place  of  strength.  And  seeondfy,  that  it  ought  to  be  regnlarly  reenlft- 
ed  after  a  sufficient  interval  of  rest,  in  order  to  insure  the  permanenea 
of  healthy  impulse  given  to  the  vital  powers  of  the  muscular  systam ; 
and  in  the  lait  place,  that  it  is  of  the  utmost  consequence  to  join  with 
it  a  mental  or  nervous  stimulant. 

Exercise  is  the  natural  food  of  the  muscles,  upon  it  they  will  in- 
crease and  streugthen ;  they  will  be  piore  able  to  do  their  reqniied 
work ;  the  spinal  column  will  then  be  kept  straight ;  an  upright 
figure  and  a  graceful  carriage,  but,  above  all,  a  free  and  easily  dilated 
ohest,  and  an  exemption  from  many  pulmonary  disorders,  and  other 
complaints,  will  insure  to  the  individual  a  happier  and  longer  life. 

"  Exercise  is  life!  'tis  the  still  water  fftileth  ; 
Idleness  ever  deepaireth,  bewaileth  ; 
Keep  the  watch  woaod,  for  the  dark  mst  assaileth ; 

Flowers  droop  and  die  in  the  stillness  of  noon. 
Exercise  is  glorious  I  the  flying  cloud  lightens ; 
Only  the  waving  wing  changes  and  brightens; 
Idle  hearts  only  the  dark  future  frightens ;    - 

Play  the  sweet  keys  would  you  keep  them  In  tune." 

II.— WaIUbs. 

There  are  two  modes  of  exercise  which  contribute^  very  materiallj 
to  the  health  and  strength  of  the  body,  namely,  walking  and  riding ; 
but  they  will  not  produce  these  happy  efiects  unless  they  are  properly 
employed.  Walking  is  an  exercise  in  which  all  must  to  a  certain  ex- 
tent engage,  it  is  therefore  a  matter  of  considerable  importance  that 
the  circumstances  connected  with  it  are  such  as  not  to  render  it  a 
burden  or  an  inconvenience.  The  wants  of  the  system  compel  ua  to 
exercise  all  our  limbs,  and  the  laws  of  health  imperiously  demand 
that  we  perform  locomotion.  To  take  pleasure  in  this  mode  of  exer- 
cise, it  is  necessary  that  the  body  should  be  free  and  unrestrained  in 
all  its  motions,  that  the  respiration  be  not  impeded  by  a  tight  dreaa. 


M4.]  DuTOHKE— Aerofi,  iis  Phenology,  etc.  211 

Ihmi  tibe  aimt  be  at  liberty,  And  that  the  feet  m  not  confined  by  tight 


We  know  from  experience  that  jnst  in  proportion  to  the  activity  of 
•xftroiae  the  circulation  of  the  blood  and  respiration  are  increased  in 
■an  and  all  inferior  animals,  and  in  proportion  as  the  motions  of  the 
dieel  are  restrained  will  be  the  difficulty  of  breathing.  We  see  these 
(acta  exemplified  in  the  horse  daily.  Who  has  not  noticed  his  per- 
^nrfttion  and  panting  after  a  fast  drive  ?  and  who  that  has  been  much 
m  the  habit  of  riding  on  horseback,  has  not  more  than  once  seen  the 
saddle  girth  broken  by  the  violent  expansion  of  the  chest  in  a  deep 
iupiration  f  Nature  thus  makes  known  her  wants  by  her  great  efibrta 
to  sopply  them.  Besides  the  great  obstacle  that  a  tight  dress  opposes 
to  rapttation,  it  hinders  the  action  of  the  muscles  in  walking.  The 
■naelea  which  keep  the  body  erect  and  move  the  limbs  forward  are 
eoaliiied  and  compressed  by  the  corset,  so  that  their  function  is  not 
half  performed,  and  hence  the  unsteady,  vacillating  movements  of 
who  little  deem  that  they  display  any  other  than  a  graceful  form, 
equally  graceful  gifts. 

In  walking  nothing  is  so  uncomfortable  as  a  tight  boot  or  shoe. 
ne  best  arUde  in  our  judgment  for  this  purpose,  is  a  light  gaiter 
koot»  made  of  elastic  materials,  and  laced  so  that  it  shall  exactly  fit 
the  foot  and  ankle,  without  being  tight ;  the  sole  should  be  juat 
•o  tliick  as  to  prevent  injury  to  the  foot  from  irregularities  in  the 
ground  on  which  we  walk.  The  best  material  used  in  the  manufao- 
lore  of  the  gaiter  is  buckskin,  which  in  all  oases,  notwithstanding  a 
dwre  to  show  a  small  foot,  should  be  so  large  as  not  to  confine  the 
aatnral  and  necessary  action  of  the  foot  and  toes.  In  all  ancient 
paintings  and  statues  we  look  in  vain  for  a  modem,  foot,  the  toes  in 
Omuk  are  spread  so  that  each  one  presses  the  ball  upon  the  ground ; 
hot  in  three  feet  out  of  four  of  those  of  the  present  generation,  we 
sImU  find  one  or  two  toes  squeezed  in  such  a  manner  as  to  be  riding 
■poB  the  othefs.  But  this  malposition  is  not  the  only  evil,  for  who 
ie  there  who  is  not  sufferiug  from  corns,  or  growing  of  the  nails  into 
ihi  fleah,  or  both  f  And  when  an  inquiry  is  made  as  to  the  cause  of 
painful  affections,  you  never  hear  any  other  answer  than  tight 
or  tifki  Mkoes. 


III^BIdlBg. 

Bot  of  all  the  various  modes  of  exercise,  riding  is  the  most  condu- 
cive to  health  and  to  vigor  of  constitution  ;  but  as  a  good  thing  may 
ke  impropeily  need,  so  riding  sometimes  produces  an  effect  contrary 


212  Original  CommunicaHom,  [Aprils 

to  what  18  intended.  Those  who  are  not  accustomed  [to  riding  aie 
most  apt  to  snfTer,  the  pleasure  and  exhilaration  being  so  great  that 
fatigue  or  exhaustion  are  induced  when  thej  are  least  expected.  In 
cold  weather,  people  unused  to  carriage  exercise  are  apt  to  think  that 
the  same  quantity  of  clothing  uecessaiy  in  walking,  will  be  an  ade- 
quate protection  when  riding.  Often,  a  person  will  not  experience  a 
sensation  of  cold,  ho  will  not  be  aware  that  his  body  is  becoming 
chilled,  till  he  alights  from  his  carriage,  or  till  he  approaches  the  fire^ 
when  he  becomes  fully  sensible  that  his  ride  has  been  too  protracted. 
Those  who  are  in  good  health  do  not  often  experience  any  thing  more 
than  a  temporary  inconvenience  from  this  cause,  but  in  the  delicate  it 
is  sufficient  to  be  followed  by  seriono  illness.  When  this  form  of  ex- 
ercise, therefore,  is  selected  as  a  means  of  health,  the  individual  should 
be  very  careful  to  put  on  clothing  sufficient  to  defend  himself  from  the 
cold  ;  if  this  be  neglected,  injury  instead  of  benefit  will  be  the  legiti- 
mate consequences.  I  have  known  several  individuals  to  suffer  from 
pneumonia  and  bronchitis,  produced  by  riding  in  a  carriage  in  a  damp 
and  chilly  air,  with  a  thin  dress  that  afforded  but  little  protection 
from  the  cold. 

Riding  on  horseback,  is  quite  a  different  exercise  from  the  preced- 
ing ;  and  fast  nding  is  not  only  active  exercise,  bujt  severe  labor. 
This  is  one  of  the  most  noble,  manly,  and  healthful  exercises  that  can 
be  imagined ;  and  as  it  formed  a  part  of  the  education  of  the  Spartan 
youth,  80  ought  it  to  be  made  a  part  of  the  education  of  the  young,  of 
both  sexes,  in  our  own  country.     Riding  on  horseback  exercisdfe  every 
muscle  and  every  organ  in  the  body  ;  and  it  causes  the  blood  to  cir- 
culate so  freely  that  in  cold  weather  this  is  one  of  the  most  comfort- 
able ways  in  which  a  person  can  travel,  provided  he  can  bear  the 
exercise  without  fatigue.     This  may  seem  strange  to  those  who  have 
never  made  the  experiment ;    but  the  evidence   of  those  who  have 
tested    it    for   several   successive  years,  in  all  weathers  and  at  all 
seasons,  have  established  the  fact  to  their  satisfaction,  that,  at  a  speed 
of  seven  or  eight  miles  an  hour,  no  person  would  feel  the  cold  in  un- 
usually severe  winter  weather.      During  my  medical  experience,  I- 
have  frequently  arose  from  my  bed  at  midnight,  when  the  thermometer 
was  some  degrees  below  zero,  mounted  my  horse,  and  rode  five  or  six 
miles  in  forty  minutes,  and  at  the  end  of  the  ride,  I  have  been  much 
warmer  than  at  the  commencement.     The  stimulating  influence  of  the 
keen  sharp  air,  the  rapid  motion  of  the  horse,  and  the  active  labor  of 
riding,  will  send  the  blood  bounding  through  all  parts  of  the  body, 
and  produce  an  extra  amount  of  animal  heat,  for  the  especial  amer- 


1864.]  DuTCHER — Exercise,  iie  Phyndogy,  etc,  218 

gencj,  which  will  preserve  the   normal  temperatare  of  the   hody. 
When  I  commeneed  the  practice  of  medicine  I  was  in  very  feeble 
liealth,  having  threatening  symptoms  of  phthisis.     I  have  for  several 
years  enjoyed  most  excellent  health,  which  I  attribute   mainly  to 
horseback  exercise.     This  at  times  is  very  extensive,  amounting  to  as 
many  as  thirty  and  forty  miles  a  day,  in  a  sickly  season,  for  days  in 
SDOoetsion.     And  I  have  long  observed  that  those  physicians  who  do 
the  most  of  their  riding  on  horseback,  usually,  enjoy  the  best  health. 
When  we  recommend  horseback  exercise  to  an  individual,  in  ill 
health  who  is  not  accustomed  to  it,  he  frequently  desists  before  making 
a  fair  trial  to  ascertain  whether  or  not  he  will  receive  benefit  by  the 
exercise  :  the  reason  for  not  persevering  is  that  he  becomes  fatigued 
and  disconraged.     In  riding  on  horseback,  a  new  set  of  muscles  are 
called  into  action,  or  they  are  required  to  perform  a  service  which  they 
are  nnnsed  to ;  too  much  is  demanded  of  them  at  first,  and  hence  the 
consequent  soreness  and  lameness  of  the  limbs  and  back.     Besides, 
the  exercise  is  pushed  too  far  at  the  commencement,  induces  a  free  per- 
spiraiion,  which  is  generally  suddenly  checked  when  the  exercise  is 
discontinued.     If  an  organ  has  been  suffering  from  an  afiection,  its 
derangement  is  most  certainly  aggravated,  and  the  person  believes  tliat 
the  remedy  is  not  suited  to  his  case.     One  who  is  unaccustomed  to 
this  exercise  should  ride  at  first  but  a  short  distance,  and  make  him- 
lelf  at  the  outset  acquainted  with  the  gait  and  disposition  of  his 
horse,  and  habituate  himself  to  his  seat  in  the  saddle  ;  the  next  day 
the  ride  may  be  extended,  and  thus  gradually  the  distance  may  be 
prolonged,  until  an  individual  may  bo  able  to  ride  forty  and  fifty 
miles  in  a  day  without  sufifcring  very  much  fatigue. 

IV.— Swimming.  * 

But  there  are  other  modes  of  exercise  besides  walking  and  ridiog» 
that  are  useful  means  of  health,  such  as  sailing,  rowing,  swimming 
and  gymnastics.  Swimming  is  a  very  healthy  exercise.  What  is 
more  delightful  on  a  beautiful  summer  evening  than  a  plunge  and  a 
twim  in  the  pure  and  running  stream.  Few  know  its  pleasures  or 
comprehend  ita^physiology.  In  swimming  we  have  the  combined 
advantages  of  bathing  and  exercise.  There  is  no  exercise,  excepting 
riding  on  horseback,  that  calls  into  action  a  greater  number  of  muscles 
than  thii,  and  there  is  none  that  fatigues  and  exhausts  the  vital  powers 
move  rapidly.  There  are  very  few  men,  although  they  may  be  expert 
iwimm^,  who  have  the  physical  endurance  to  swim  a  mile  without 
It  18,  therefore,  an  exercise  ill  adapted  to  those  in  feobb 


214  Orig^hud  Cammumeaikmi. 

health,  and  those  whoee  constitational  powers  are  weakened  hj  diaeaeo; 
Even  those  in  robust  health  and  with  strong  physical  powers,  may 
carry  it  too  far  and  greatly  injure  themselves  thereby.  In  our  dimaCls 
swimming  can  only  be  practised  in  the  summer  season.  It  is  not  aafo 
to  indulge  in  it  at  any  other.  Although  uncivilized  men,  in  the  ex- 
treme North,  may  without  injury,  at  every  season  of  the  year,  plnngs 
into  the  coldest  stream,  yet  the  health,  if  not  the  life  of  an  individual, 
reared  in  civilized  society,  would  be  endangered  were  he  to  attempt  a 
similar  course.  Some  caution  is,  therefore,  necessary  in  selecting  the 
time  best  adapted  for  this  exercise.  The  best  time  for  swimming  is 
about  two  hours  before  sunset.  We  select  this  period  becauss  the 
water  is  then  much  warmer  than  at  any  other  Ume  during  the  day,  and 
the  individuaPs  stomach  will  not  be  apt  to  be  burdened  with  the 
digestion  of  food ;  it  is  an  important  law  of  health  that  no  person 
should  engage  in  very  active  exercise  immediately  after  eating,  and  ib 
this  case  it  should  be  imperative. 


The  gymnasium  was  the  war  school  of  the  ancient  Oreeks  and 
Romans.  It  was  in  them  that  their  youth  were  trained  to  feats  of 
activity  and  strength*;  and  hence  they  were  also  considered  schools  of 
health.  In  these  establishments,  there  were  five  principal  exercises 
practised,  running,  wrestling,  boxing,  leaping,  and  throwing  the  quoit. 
By  these  means,  not  only  were  the  muscular  powers  increased  in  flex* 
ibility  and  strength,  but  the  senses  were  also  rendered  more  acute,  and 
the  facility  for  acquiring  knowledge  through  them  greatly  increased. 
The  connection  between  the  efforts  of  the  mind,  and  feats  of  bodily 
strength  and  agility,  was  formally  acknowledged,  not  only  in  the  prae- 
tices  of  many  of  the  most  distinguished  statesmen  and  philosophers 
of  antiquity,  but  also  in  the  fact  of  prizes  being  disputed,  as  well  for 
the  exercises  already  mentioned.  Consequently,  some  modem  author 
has  defined  gymnastics  to  be  "  the  art  of  regulating  the  movements 
of  the  body,  in  order  to  develop  its  strength,  to  improve  its  agility,  its 
pliancy,  and  its  powers  ;  to  preserve  or  re-establish  health  ;  it  is  ia- 
^  tended,  in  fact,  to  enlarge  the  moral  and  physical  faculties."  That 
gymnastic  exercises  will  produce  all  these  eflbcts,  when  properly  regn- 
lated,  can  not  be  doubted  by  any  one  who  has  been  in  the  habit  of  en- 
gaging in  them.  I  have  seen  in  several  instances,  the  most  benefieU 
effidcts  produced  by  the  dumb-bell  $xereiie.  This  alone  is  a  very  healthy 
exercise,  particularly  when  varied  according  to  the  plan  recommended 
by  Dr.  Lewis,  in  his  **  New  Gymnastics ;  "  a  book  that  should  be 


1804.1  DuTCBUt— JSrmtM,  in  Pkfiiohpy,  §le.  215 

•HvAiIlj  studied  by  every  pbytician  and  teacher.  Indeed,  every  in- 
dividoal  who  wants  health  and  strength  should  read  it.  The  author 
is  a  practical  physiologist,  who  has  faithfully  studied  the  adaptation  of 
es^reise  to  the  human  frame,  and  has  in  his  book  exposed  many  of 
Um  errors  of  the  old  system  In  our  judgment,  he  has  devised  a  series 
of  gymnastic  exercises.,  which  if  properly  attended  to,  can  not  fail  to 
itmgth^  and  invigorate  every  oigan  of  the  human  body. 

VL— lawciM  In  Phthitlt. 

Individuals  predisposed  to  pulmonary  tuberculosis,  can  not  pay  too 
■«ch  attention  to  the  subject  of  exercise.    In  addition  to  general  ex- 
ffcise,  they  should  adopt  such  local  exercise  of  the  cheat  and  subsidi- 
ary organs,  as  is  calculated  to  expand  the  lungs,  and  increase  the 
strength  and  power  of  the  muscles  of  respiration.    The  following  we 
consider  a  very  good  plan  to  accomplish  this  end.   While  the  individ- 
ual is  standing,  let  him  throw  his  arms  and  shoulders  back.    Whila 
in  this  position  let  him  inhale  slowly  as  much  air  as  he  can,  and  repeat 
this  exercise  at  shorter  intervals  several  times  in  succession.     This 
eieroise  should  be  adopted  daily  by  all  young  persons  whose  chests 
an  narrow  or  deformed,  and  should  be  slowly  and  gradually  increased. 
Persona  whose  lungs  are  naturally  weak,  will  derive  great  benefit  from 
Ihia  exercise,  after  a  veiy  short  trial.  Marked  changes  soon  take  place 
ia  the  external  appearance  of  the  chest ;  for  not  only  are  the  lungs 
themselves  expanded  by  means  of  the  dilation  of  their  cells,  formerly 
esmpressed,  but  the  ribs  become  elevated,  and  the  muscles  concerned 
h  respiration  acquire  a  greater  degree  of  power  and  volume  by  this 
JMrsased  action  of  their  parts.     If  pulmonary  tuberculosis  be  the  result 
ef  drftttive  re$pinUion,  as  maintained  by  some  writers,  the  local  exer- 
ciaa  of  the  muscles  of  the  chest  can  not  be  too  highly  recommended  to 
who  have  a  proclivity  to  this  disease. 
When  phthisis  becomes  fully  established  in  an  individual  who  has 
in  the  habit  of  leading  a  sedentary  life,  if  he  desires  to  live  long, 
•fweome  his  disorder,  and  enjoy  health,  he  must  sxxaciss.    If  ne 
Aaea  not  change  his  habits,  all  medication  will  be  in  vain.    Those 
who  sit  down  and  nurse  their  disease  will  fall  a  sure  prey  to  it.    I  ^ 
shrayi  despair  of  a  listless,  inactive  patient.     It  is  emphatically  true 
m  this  case  that  adum  U  life  and  r^pote  is  dsath.    The  records  of 
malieiBe  abound  "with  instances  of  recovery  from  this  malady,  under 
Iha  infloeBce  of  active  vigorous  exertion.   And  thousands  more  would 
ha  added  to  the  list,  if  physicians  would  be  mors  positive  in  their 
OB  this  subject.    There  should  be  no  timidity  here.     If  tha 


216  Original  Communications.  [April, 

individual  is  able  to  walk  or  ride  at  all,  he  slioald  take  daily  eiereue. 
"  Nor  should  the  weather  be  scrupulously  studied.  Though  I  would 
not  advise  the  consumptive  patient  to  expose  himself  recklessly  to  tha 
severest  inclemencies  of  the  weather,  I  would,  nevertheless,  warn  him 
against  allowing  the  dread  of  taking  cold  to  confine  him  on  every 
occasion  when  the  temperature  may  be  low  0|^  the  skies  overcast.  I 
may  bo  told  that  the  patient  is  often  too  feeble  to  be  able  ta  bear  ex* 
ertion ;  but  except  in  the  last  stage,  when  every  remedy  must  prove 
unavailing,  I  believe  there  are  few  who  can  not  use  exercise  oat  of 
doors  ;  and  it  sometimes  happens  that  those  who  are  exceedingly  de- 
bilitated find,  npon  making  the  trial,  that  their  strength  is  increased 
by  the  efifort,  and  that  the  more  they  exert  themselves  the  better  able 
they  are  to  support  the  exertion." — Richardson's  Hygienic  Treaimeni 
of  Pulmonary  Consumption,  p.  52. 


m   • 


▲KTICLS  IT. 

On   the   Antiperiodio   Properties  of  the  Bark  of  Fraxinut  Nigra,  or 

Swamp  Ash. 

BY   D.   W.  C.   DENNY,  M.D.,  ALBION,  IND. 


As  no  notice  of  the  medicinal  properties  of  this  bark  have  ever  been 
publicly  given  to  the  profession,  allow  me,  through  the  medium  of 
your  invaluable  journal,  to  call  attention  thereto. 

The  tree  on  which  the  bark  is  found,  grows  abundantly  throughont 
Canada  and  the  northern  and  middle  States  of  the  Union,  in  low  moist 
grounds,  as  well  as  swamps,  from  which  it  derives  the  popular  name 
of  Swamp  Ask.  The  wood  is  used  for  making  hoops  and  bottoms  for 
chairs  of  domestic  manufacture.  In  the  spring  of  1854,  I  accident- 
ally chewed  a  small  piece  of  the  bark,  which  I  found  possessed  ma 
intense  bitter, — allied  to  that  of  sulphate  of  magnesia, — also  leaving 
an  astringent  or  styptic  feeling  of  the  mouth  for  several  minutes  after 
chewing  it.  I  immediately  deteimined  to  try  a  strong  decoction  in  the 
treatment  of  some  cases  of  simple  intermittents  I  then  had  on  hand. 

The  bark  was  first  divested  of  its  outer  covering,  then  stripped  from 
^the  tree,  and  cut  into  small  pieces,  which  were  placed  in  a  small  iron 
kettle,  until  nearly  full,  to  which  was  added  rain  water  sufficient  to 
cover.  The  bottle  was  then  placed  over  a  good  fice,  and  allowed  to 
boil  until  half  evaporated.  The  liquor  was  then  strained  through  a 
coarse  clolh,  returned  to  ihe  vessel  and  allowed  to  slowly  evaporate  to 
the  consistence  of  molassec.     I  commenced  ten  hours  previous  to  the 


J  864.]  Proceedings  of  Societies.  217 

•ffeetad  paroxysm,  and  administered  a  tablespoonfol  every  boar  ODtil 
Bine  had  been  given,  always  adding  a  fnll  dose  of  opium  or  morpbia 
to  the  last  dose. 

Ever  since  1854,  all  my  cases  of  intermittents — which  have  been 
nnmeroos — have  been  thus  treated,  and  I  candidly  aver  has  never  fail- 
ed to  arrest  the  disease.  Now,  I  believe  from  years  of  experience, 
and  also  from  the  testimony  of  several  highly  respectable  practitioners 
of  my  acqnaintance — whom  I  induced  to  try  it — that  it  may  be  profit- 
ably and  satisfactorily  substituted  for  quinine,  in  all  simple  and  un- 
eomplicated  intermittents.  It  is  certainly  superior  to  quinine  in  this, 
that  the  paroxysms  are  not  nearly  so  apt  to  return.  I  can  confident- 
ly assure  those  who  may  desire  to  try  it,  that  they  need  not  fear  being 
disappointed  as  to  its  resnlts. 


Prooae^ingt  of  Trippler  Military  Medical  Soolety. 

Bepoited  bj  DaiiUi  T.  Botnton,  M.D.»  Secretary, 
of  Memben  of  the  M«dlo«I  StofT  of  the  Department  of  the  Ohio,  KnoxrIUe,  Tcnn. 

At  the  reqvest  of  the  Medical  Director  of  the  Department  of  the 
Ohio,  members  of  the  Medical  Staff  in  and  about  this  city  assembled 
at  Masonic  Hall  at  7  o'clock  p.  m.,  on  the  13th  inst.  (Feb.) 

Surgeon  L.  D.  Griswold,  of  the  One  Hundred  and  Third  Regiment, 
O.V.I. ,  was  called  to  the  chair,  and  Daniel  T.  Boynton,  Assistant- 
Surgeon  One  Hundred  and  Fourth  Regiment,  O.V.I.,  requested  to 
act  as  Secretary. 

Sorgeon  Hunt  then  being  called  upon,  stated  that  the  effect  he  had 
ta  view  in  appointing  the  meeting  was  to  elicit  from  the  Staff  an  ex- 
pression of  opinion  in  regard  to  the  policy  of  organising  a  Military 
Medical  Association,  the  chief  aim  of  which  should  bo  the  elevation 
of  science^  and  the  maintenance  of  the  dignity  and  honor  of  the 
Medical  Profession.  After  stating  in  a  clear  and  concise  manner  the 
idfantages  which  in  his  belief  would  accrue  from  such  an  organiza- 
tion, be  concluded  by  expressing  the  hope  that  he  might  hear  from 
other  geatlemen  present  upon  tho  subject. 

L.  D.  Griswold,  Surgeon  One  Hundred  and  Third  Regiment, 
O.V.I,  Edward  Shippen,  U.8.V.,  Post  Medical  Director,  J.  G.  Hat- 
ohec  U.aV.,  Medical  Diiector  Twenty-Third  A.  C.  and  other  gentle- 
fellowody  all  heartily  endorsing  the  views  of  Surgeon  Hewit.. 

TO.— 14 


2 1 8  ProcHdingi  ^  Societies.  [  AprT^ 

On  motion  of  Surgeon  Hatdiet,  a  Committee  was  appointed  with 
instructions  to  draft  a  constitntion  under  which  to  form  a  pemumeiit 
organization  and  report  at  a  future  meeting. 

There  beiug  no  further  business,  the  meeting  adjourned  to  meet 
<igain  at  7  o'clock,  p.  m.,  Wednesday  the  17th  inst. 

Wkdksbdat,  Feb.  17ch,  1864. 

The  meeting  of  the  Medical  Staff  assembled  this  evening  parsoant 
to  adjournment,  and  was  called  to  order  by  the  Chairman.  The 
minutes  of  the  last  meeting  were  then  read  and  adopted.  The  report 
of  the  Committee  being  next  in  order,  the  following  Constitntion  was 
read  and  submitted  by  the  Chairman  of  the  Committee. 

CONSTITUTION. 

**We  the  undersigned  medical  officera  of  the  army  on  duty  in  this 
place  and  Department,  hereby  associate  ourselves  int  o  a  Medical  and 
Surgical  Society  nnder  the  following  Constitution  and  By-Laws,  and 
pledge  ourselves  each  according  to  his  ability,  to  promote  and  carry 
out  the  interests  and  objects  of  this  Association. 

<'  1st.  This  Society  shall  be  called  the  Triplor  Military  Medical 
Society,  in  honor  of  Surgeon  Chas.  S.  Tripler  of  the  U.  S.  Army. 

''  2d.  Its  object  shall  be  mutual  improvement  in  scientific  attain- 
ments ;  the  collection  and  preservation  of  facts  and  comparison  of  ex- 
perience with  reference  to  their  bearing  on  professional  duty  in  the 
field  and  hospital ;  the  advancement  of  the  honor  and  interests  of  the 
Profession ;  contributing  to  the  historical  records  of  the  war  and  en- 
riching the  National  Museum  of  Pathology. 

"  3d.  Its  officers  shall  be  a  President,  Secretary,  and  Executive 
Committee,  consisting  of  three. 

"  The  President  and  Secretaiy  shall  be  chosen  by  ballot ;  the  Ex- 
ecutive Committee  shall  be  appointed  by  the  President;  the  President 
shall  be  chosen  from  the  Surgeons  of  hospitals  or  regiments ;  the 
Secretary  shall  be  an  Assistant- Surgeon  or  Acting  Assistant- Snigeon* 
The  term  of  office  shall  be  three  months. 

**  4th.  The  duty  of  the  Executive  Committee  shall  be  to  prepare 
and  present  subjects  of  discussion,  and  to. propose  by-laws  and  amend- 
ments  to  by-laws.  The  President  may  call  a  special  meeting  whenever 
it  may  be  his  pleasure,  by  and  with  consent  of  two.  of  the  Executive 
Committee.  One  Assistant-Surgeon  or  Acting  A^sistant-Snigeoa  at 
least,  shall  be  a  member  of  this  Committee.  It  shall  alsa  be  arbiter 
in  all  questions  of  ethics. 


1864.J  Proceeimgsli^  Sociedsi.  219 

''5th.  The  t thics  of  this  Society  shall  be  the  ethics  of  the  American 
Midical  Association. 

"  6th.  All  Medical  Officers  of  the  Army  and  Contract  Physicians, 
senring  in  the  Department,  are  members  of  this  Society.  All  physi- 
ctans  of  the  community  and  those  engaged  in  a  semi-official  capacity 
are  eligible  as  hoDorary  members  and  are  respectfully  invited  to  attend 
the  scientific  meetings.  Hospital  Stewards  who  are  bonajide  students 
of  medicine  are  invited  to  be  present  at  the  meetings,  but  will  be  ex* 
pected  to  retire  at  the  commencement  of  the  Executive  Session.  The 
Medical  Director  may  at  anytime  request  the  President  to  adjourn  the 
nieeiiBg  for  the  purpose  of  calling  an  official  meeting  of  the  Sta£f  for 
military  purposes. 

"  7th.  The  records  and  papers  of  this  Society  shall  be  carefully  pre- 
ttnred  by  the  Secretary,  handed  over  to  his  successor,  and  in  its  expi* 
latioa  become  the  property  of  the  Surgeon  General's  office.  The 
veeUj  reports  of  the  meetings  shall  be  sent  to  the  American  Medical 
limea  for  publication.  This  Constitution  and  By-Laws  shall  be 
pnUished  in  two  medical  periodicals,  one  western  and  one  eastern. 

''8ih.  The  Medical  Officers  of  the  different  Army  Corps  in  the 
Departmont,  when  separated  from  the  headquarters  of  the  Department, 
ire  xecommended  to  form  sub-societies  in  correspondence  with  this 
body,  and  to  forward  their  records  for  incorporation  and  final  trans - 
■iaaal  to  the  Medical  Bureau  of  the  Army.  Meetings  shall  be  weekly 
or  more  frequent,  as  the  Society  may  direct.  All  official  papers  re- 
feived  from  Headquarters  of  the  Army,  Surgeon- General  and  Assist- 
aat  Burgeon-General,  affecting  the  common  duty  and  interests,  will  be 
read  at  each  meeting.*' 

On  motion  of  Surgeon  Ashman  of  the  Ninety-Third  Begimcnt, 
t^VX,  in  chaTge  of  General  Hospital  No.  2,  the  Constitution  was 
xcepted  and  adopted  by  sections. 

On  motion  of  Surgoon  Wolff,  Acting  Assistant- Surgeon,  U.S.A., 
ibt  Cooatitntion  and  preamble  were  then  adopted  as  a  whole  and  the 
Committee  discharged. 

The  names  of  the  following  gentlemen  were  then  enrolled  as  mem- 
l«r8  of  the  Society  : 

AnytcMtf.— Geo.  W.  McMillen,  Fifth  East  Tennessee  ;  L.  D.  Gris- 
woU,  One  Hundred  and  Third  Ohio ;  Geo.. P.  Ashman,  Xinety-Third 
^Vo ;  Alfred  Nash,  Ninth  Michigan  Cavalry ;  John  Wright,  One 
Hndied  and  Seventh  Illinois ;  John  Mills,  Sixth  East  Tennessee  ; 
r.  H.  B^ilhacbe,  Fourteenth  Illinois  Cavalry ;  C.  W.  McMUIin,  Firet 
last  Tenoeewe ;  Geo.  A.  Collamore,  One  Hundredth  Ohio ;  Hamil- 


220  ProeeedingM  qf  Soeieiiei.  [Apiil< 

ton  E.  Smith,  Twenty- Seventh  Michigan  ;  Edward  Bhippen,  U.B.Y 
and  Post  Medical  Director  ;  James  G.  Hatchet,  U.S.Y.  and  Hadiea; 
Director  Twenty-Third  A.  C. ;  A.  M.  Wilder,  U.S.V. ;  A.  J.  Phelps 
U.S.V. ;  A.  L.  Carrick,  Second  East  Tennessee  Cavalry. 

Assistant' Surpedns. — Henry  L.  U.  Barritt,  U.S.V. ;  David  Markay 
Seventy-Ninth  New  York  ;  W.  W.  Moss,  Twenty- Fourth  Kentucky 
R.  McGowan,  U.S.V. ;  W.  R.  Welman,  Eightieth  Indiana. 

Acting  Assistant' Surgeons. —  B.  Wolff,  U.S.A.;  B.  Darling  Jr. 
U.S.A. ;  Ralph  W.  Cummings,  Twenty-Third  Michigan ;  S.  E.  Sbel 
don.  One  Hundred  and  Fourth  Ohio  ;  C.  S.  Frink,  U.S.V. 

Surgeon. — H.  S.  Hewit,  U.S.V.  and  Medical  Director  of  the  De* 
partment. 

Assistarit' Surgeons. — Daniel  T.  Boynton,  One  Hundred  and  Foortl 
Ohio ;  John  J.  Wilkins,  Fourteenth  Illinois  Cavalry  ;  G.  A.  Wilson, 
Fourteenth  Illinois  Cavalry  ;  M.  L.  Lick,  Ninth  Michigan  Cazalry 
Wm.  W.  Wythers,  U.S.V ;  W.  McMillah,  Ninth  Ohio  Cavalry 
Edwin  Truman,  U.S.V. ;  C.  M.  Chalfant,  One  Hundred  and  Elevent): 
Ohio ;  A.  J.  Larey,  Second  East  Tennessee. 

The  election  of  officers  resulted  as  follows,  viz. :  L.  D.  Griswold, 
Surgeon  One  Hundred  and  Third  Regiment,  O.V.I.,  President ;  DanI 
I.  Boynton,  Assistant-Surgeon  One  Hundred  and  Fourth  Regiment, 
O.V.I.,  Secretary. 

The  President  then  briefly  addressed  the  Society,  thanking  the  gen- 
tlemen  for  the  high  honor  they  had  been  pleased  to  confer  upon  him. 
And  while  he  felt  that  a  more  competent  person  might  have  been  se- 
lected,  yet  he  yielded  to  none  in  point  of  proportionate  zeal  and  ii 
the  eamestnesa  of  •  his  desire  4o  promote'  ttie  in(!lerests  and  carry  oal 
the  aims  of  the  Association.  ^tt^ 

The  appointing  of  the  Executive  Committee  ^ing  next  in  order, 
at  the  request  of  the  President  it  was  agreed  that  he  have  until  thi 
next  meeting  to  make  the  selections. 

On  motion  of  Sunken  Hewitt,  the  President  was  instructed  to  re- 
quest the  Secretary  to  address  a  letter  to  Surgeon  Charles  S.  Tripkr, 
informing  him  that  he  has  been  made  an  honorary  member  of  this 
Society. 

There  being  as  yet  no  Executive  Committee,  the  President  was  re- 
quested to  announce  some  subjects  for  discussion  at  the  next  meeting. 
Exseetion  resection  or  excision,  was  the  subject  proposed,  and  Baigeon 
Shippen  invited  to  open  the  discussion. 

After  the  reading  of  official  papers  from  headquarters  of  the  Army 
and  conversation  npon  various  topics  pertaining  to  the  Medical  Depart- 


1861]  Proeeedinpt  qf  Soct^iet.  221 

aentiOB  motion  of  Snrgeon  Asbman,  Ninety -Third  RdgimentO.Y. I. 
SitordAT  OTening  was  fixed  upon  as  the  time  for  the  weekly  q^eeting, 
of  the  Society,  and  the  meetiqg  adjourned  to  meet  again  Saturday  at  . 
7  o'clock,  p.  M.,  on  the  20th  inst.         L.  D.  GaiswoLn/Tresident. 
Daxibl  T.  Botnton,  Secretary. 


•   mmm  • 


Prooootfingt  of  the  Cincinnati  Academy  of  Medicine. 


Baportad  bj  W.  T.  Bmowir,  M .B.,  Sdontaiy. 


Hall  or  Academy  of  Medicine,  December  7,  1868. 
AlertMiing  Patholoyieal   Specimens. — J)r.   Taylor    said  he  had  a 
pstbological  specimen  to  exhibit  to  the  academy  ;  and  as  Dr.  Thomas, 
of  CoTington,  was  present  he  would  like  him  to  give  a  history  of 

tiM  case. 

Dr.  TkamoM — Said  he  had  only  seen  the  patient  in  consultation  a 
ihort  time  previous  to  his  deaths  and  was  unable  to  give  a  complete 
Urtory  of  the  case. 

Dr.  Fries — Said  he  saw  the  case  six  or  eight  weeks  ago.  The 
pitieDt  complained  for  many  months  of  pain  in  the  region  of  the  kid- 
ICTS»  running  down  to  the  scrotum^  1 1 1 1  nl  1 1 1  li  liiMr llf Jtt  f  fitj fTTt  Pf  the 
latter  muscles.  There.BCiMitfi^HHinnERalionr,^or4oitQ^tM 
il  amount  of  uruMMp^HHPIHPpass^il^Sin^  Jiormal  in  appNOy^r- 
k.  He  ha<^|^^^Kual  symptoms  o^^renal  calcnlus.  They  had 
\am  copped  o^^^^Jbiob  of  the  kidneys,  and  gave  him  opiates, 
dimedcs  and  laxativST  otnA-.^dljtpipiana^haughl  tii«sa4>vi9xysms  of 
pain  doe  to  an  excess  of  lilhic  acid.  The  man  was  able  to  walk 
iboot  the  house  until  a  short  time  before  his  death,  which  took  place 
doing  one  of  his  violent  paroxysms  of  pain. 

Dr.  Taylor  then  reported  the  autopsy,  as  follows : 

Mr.  G.,  aged  51 ;  autopsy  thirty-six  hours  after  death.  Slight 
pott  mortem  rigidity.    Moderate  degree  of  emaciation. 

Upoo  opening  the  abdomen  the  small  intestines  were  found  in  a 
hmlthj  condition.  The  external  surface  of  the  stomach  was  dark 
colond ;  the  mucous  sur£ftce  was  of  a  deep  slate  color,  and  in  the 
vicinity  of  the  pylorus  some  portions  were  black. 

Tha  descending  colon  at  the  sigmoid  flexure  turned  at  an  acute 
iDgis.  and  passed  obliquely  upwards  nearly  to  the  umbilicus,  from 
okidi  point  it  descended  in  a  direct  line  to  the  anus. 

Ike  liver  auQspleen  were  healthy.     The  kidneys  were  Urger  and 


; 


222  Proceedings  of  Societies.  [4l^ 

Rofter  than  natural,  with  an  nnnsnal  amount  of  fat  surrounding  tbern. 
The  pelris  of  the  right  kidney  was  engorged,  and  contained  a  great 
nnmher  of  oil  globules,  a  lesser  amount  of  oil  was  found  in  the  pelvia 
of  the  left.  Both  ureters  were  dilated  ;  within  the  walls  of  the  right 
one  for  a  distance  of  about  three  inches  from  the  kidney  was  an  ex- 
travasation of  blood. 

Beneath  the  peritoneum,  and  extending  from  the  spinal  column  to 
the  middle  of  the  left  side,  and  from  the  diaphragm  to  the  pelvis*  was 
an  extravasation  of  blood,  the  coagulation  of  which  was,  in  some  por- 
tions, an  inch  in  thickness.  Within  the  layers  of  the  descending  meso 
colon,  throughout  its  entire  length,  was  extravasated  blood  also. 

Upon  removing  the  intestinos,  a  tumor,  about  two  and  a  half  inches 
in  diameter,  and  about  one  inch  in  depth,  was  found  lying  upon  the 
aorta,  over  the  upper  lumbar  vertebras.  The  tumor  consisted  of  very 
firm,  white  fibrin  and  coagulated  blood.  Upon  removing  the  mass*  a 
rupture  of  the  aorta  was  found,  commencing  an  inch  above  the  bifur- 
cation into  the  iliacs,  and  extending  upwards  seven-eighths  of  an  indi, 
involving  two-thirds  of  the  circumference  of  the  vessel.  On  inspee- 
tion  of  the  adjacent  portions  of  the  vesbol,  atheromatous  deposits  were 
found.  The  left  side  of  one  of  the  lumbar  vertebric  was  entirely  de- 
nuded and  carious. 

Dr.  Fries — Said  in  r^rd  to  the  diagnosis  of  this  case,  be  had 
never  seen  a  case  of  renal  calculi  when^iJl  the  symptoms  were  better 
marked.  What  produced  ibese  paroxisTmT'af  pain  he  could  not  tell. 
Possibly  the  abnormal  condition  of  the  urine^  tKtf()||xce88  of  lithic 
acid.  Yet  it  is  difficult  to  imagine  how  this  ooidabe  <he  cause.  Hie 
presumption  would  be,  that  the  paroxysms  would  occur  oftener,  and 
last  longer.  How  the  conditions  presented  by  the  autopsy  could  cause 
the  paroxysms  of  pain,  it  is  difficult  to  imagine. 

Dr.  Thomas — Said  the  urine  was  thoroughly  acid.  With  the  mi- 
croscope you  could  see  the  lythic  acid  crystals.  There  was  no  pus  or 
blood  globules.  Purpurin  gave  the  urine  its  dark  color.  The  patient 
could  take  but  very  little  food,  everything  turned  acid. 

There  seemed  a  periodicity  about  the  recurrence  of  the  pains.  Opi- 
um would  not  relieve  him,  he  gave  him  chloroform ;  after  coming  from 
under  its  influence  he  would  be  easy  for  a  while.  In  1000  parts  of 
his  urine,  there  was  one  grain  and  fifty-nine  thousandths  more  lithic 
ncid  than  was  normal. 

Case  of  Cataract. — Dr.  WUliams  reported  the  following : — ^The  pa- 
tient was  an  old  man,  sixty-three  years  of  age,  and  had  had  paralysis 
sgitans  for  years.    Five  weeks  ago.  Dr.  W.  made  an  iridectomy  of 


1864.]  Proaedmgs  qf  Societies.  223 

the  hft  eye,  and  on  last  Thnrsday  he  operated  by  extriKstion.  Having 
plaeed  the  patient  under  the  influence  of  chloroform,  ho  made  a  lower 
flap.  The  eyes  being  very  deep-seated,  rendered  the  operation  more 
difficult.  Immediately  after  making  the  flap  the  cornea  fell  into 
vriakles.  In  healthy  eyes  the  cornea  does  not  fall  in  or  wrinkle,  after 
inch  an  operation.  He  looked  npon  this  as  an  nnfavorable  indication, 
blinking  it  showed  that  the  cornea  did  not  possess  sufficient  vitality. 
Yaeterday  he  found  some  mucus  and  pus  in  the  inner  angle  of  the  eye  ; 
aid  to  day,  on  removing  the  dressings,  he  found  the  anterior  chamber 
faSi  of  pus.  The  eye  will  shrink.  If  he  goes  blind  in  the  other  eye, 
the  only  safe  operation  will  be  couching. 

Bmrwal  InflammaUan. — Dr.  Woodward  said  that  inasmuch  as  his 
liiend  on  the  left.  Dr.  Bruin,  had  recently  been  afflicted  in  an  unusual 
way,  he  would  be  pleased  to  hear  the  Doctor  report  his  case  to  the 
Socbtj. 

J>r.  Bruin — Said  he  had- suffered  occasionally  for  a  number  of  years 
Vodi  pain  in  the  left  foot,  at  the  junction  of  the  great  toe  with  the 
■atafaroil  bone,  at  the  place  called  the  bunion.  Two  months  since, 
in  the  evening,  after  having  walked  considerably  during  the  day,  he 
attacked  with  great  pain  in  the  foot ;  so  great  was  the  pain  as  to 
ipel  him  to  remain  in  bed  for  24  hours.  The  skin  being  very  much 
tUdrened  at  this  place,  he  pulled  off,  with  his  knife,  a  thin  lamella 
whao  a  thick,  glairy  fluid  escaped,  and  continued  discharging  until 
it  amonnled  to  two  ounces.  Then  a  severe  inflammation  set  in,  which 
waa  subdued  by  cold  applications.  A  month  afterward  he  had  anoth- 
fr  similar  attack :  he  made  use  of  the  cold  applications  all  night ;  in 
the  morning  there  was  much  swelling,  and  the  tumor  being  very  elas- 
tic, he  punctured.  A  small  quantity  of  thin,  glairy  fluid  was  dis- 
charged, when  severe  pain  and  inflammation  again  commenced. 

He  sent  for  Prof.  Blackman,  but  before  he  arrived,  he  was  seized 
with  aevexe  spasms  of  the  voluntary  muscles  of  the  neck  and  jaws, 
thty  becoming  stiff  and  rigid. 

He  was  in  so  much  pain,  that  he  took  three  grains  of  morphine  and 
two  ounces  of  McMunn's  Elixir  of  Opium  within  24  hours.  Warm 
estaplaama  were  also  employed. 

The  Doctor  said  he  had  asked  Prof.  Blackman  what  was  the  cause 
of  hia  sodden  seizure.  Whether  he  had  opened  a  mucous  bursa,  or 
whether  there  had  been  a  direct  communication  between  the  atmos- 
and  the  synovial  membrane  of  the  joint.  Prof.  B.  said  he  was 
to  give  a  cause,  he  had  never  had  a  case  of  this  kind  before, 
aad  had  only  read  of  one,  reported  by  Mr.  Skey,  of  London.    Dr. 


224,  ProceedmgM  qf  Socidies,  [^l*^! 

Bruin  said,  tbe  books  teach  ns  to  open  inflamed  buna,  but  tbe  oaoM 
of  his  affection  was  to  him  inexplicable.  He  did  not  think  there  w«s 
direct  communication  between  the  atmosphere  and  sjoovial  membraae* 

J)r,  Woodward — Said  his  own  treatment  of  inflamed  bursa,  was  to 
use  iodine  and  pressure ;  never  to  open  them.  A  ladj,  some  time 
since,  whom  he  had  been  in  the  habit  of  attending,  had  a  large  num- 
ber of  them.  She  became  dissatisfied  with  his  treatment,  and  sent 
for  a  surgeon,  who  opened  one  of  them,  thereby  inducing  a  great  de- 
gree of  inflammation,  which  came  near  destroying  her  life.  The  Dr. 
said  he  would  like  to  hear  the  opinion  of  Dr.  Taylor,  as  he  had  devo* 
ted  considerable  time  to  pathological  anatomy,  as  to  whether  Dr. 
Bruin's  case  was  connected  with  the  joint,  or  whetber  it  was  an  in- 
flamed bursa. 

J)r,  Taylor — Said  he  looked  upon  it  as  occasioned  by  pressure  on 
the  foot,  and  reported  the  following  case  in  illustration  of  this  view. 
A  man  came  to  him  who,  two  weeks  previously,  had  been  injured  by 
a  bank  of  earth  falling  in,  and  burying  him  to  the  waist.  Some  two 
days  afterwards,  he  noticed  a  slight  swelling  on  the  right  hip.  When 
the  patient  came  to  him,  there  was  a  large,  fluctuating  tnmor  extend* 
ing  downwards  from  the  trochanter  seven  inches,  and  three  inches 
across,  apparently  containing  a  watery  fluid.  Upon  consultation 
with  Dr.  Wood,  he  opened  it,  making  a  free  incision.  It  dischaiged 
over  a  pint  of  thin,  glairy  fluid.  He  then  closed  the  opening  and  ap- 
plied pressure.  This  case  he  looked  upon  as  having  been  produced 
by  the  contusion,  and  not  connected  with  the  joint. 

Epidemic  Diarrhcea. — Dr.  Woodtoard  suggested  the  inquiry  whether 
the  diorrhoea  and  dysentery  now  prevailing,  was  produced  by  the  nse 
of  the  water.  There  is  a  repoit  prevalent  that  the  water  of  the  Ohio 
has  been  poisoned  by  the  fllth  poured  in  at  Deer  Creek. 

Dr,  J.  F,  While — Said  there  was  no  doubt  about  the  people  having 
this  idea.  He  had  seen  a  good  many  cases  of  diarrhoea  and  dysentery, 
but  we  had  the  same  thing  last  year.  Then  the  people  thought  it  was 
due  to  the  condition  of  the  reservoir.  He  could  not  see  any  legiti- 
mate connection  between  the  waters  of  Deer  Creek  and  the  Ohio 
river.  He  had  no  faith  in  the  water  being  the  cause  of  the  disease. 
These  diarrhoeas,  though  sudden  and  severe,  yield  readily  to  treatment 
and  to  very  simple  remedies. 

Hiram  Smith — Said  he  was  of  the  opinion,  inasmuch  as  we  have 
this  diaiThoca  every  year,  that  it  was  due  more  to  the  change  in  diet, 
people  using  more  pork  which  is  not  very  well  salted,  than  to  the 
water. 


18M]  Proeeedmfft  of  Soeieiiis,  225 

Dr.  Carrol — Was  also  of  the  same  opinion  that  the  diarrhoea  and 
djtentery  now  prevailing,  was  due,  not  to  the  water,  hut  more  to  the 
ckange  in  diet,  and  to  the  poisons  following  Scarlatina  and  Diphthe- 
ria. The  Doctor  said  he  had  vaccinated,  during  the  fall  and  winter, 
nine  or  ten  children  after  the  small  pox  had  broken  out,  and  therehy 
saved  them  all.  One  child  had  an  eruption  out  for  ten  days  when  ha 
vat  called.  There  was  an  in&nt  in  the  family  that  had  not  been  vac* 
doated.  He  vaccinated  the  child,  and  it  took,  but  varioloid  appeared 
OB  the  seventh  day,  very  much  modified.  The  vacinnation  went  on 
and  was  perfectly  developed.  He  mentioned  these  cases  to  show  the 
importance  of  vaccinating,  no  matter  how  late. 

2V.  CorfOA — Said  he  had  a  great  deal  of  this  diarrhcea  in  his  prac* 
tioe  last  winter — it  was  easily  treated,  but  often  recurred.  This  winter 
the  same  disease  prevails.  There  has  been  no  satisfactory  cause 
anigned.  It  is  not  surprising  that  the  cause  is  referred  to  the  water. 
He  had  seen  livers,  small  pigs  and  the  like,  floating  near  the  entrance 
of  the  main  water  tube.  It  is  the  popular  belief  that  the  water  is 
Aa  caiMe,  though  he  did  not  thus  attribute  it.  He  hoped  that  a  com- 
mittee  wonld  be  appointed  to  investigate  this  whole  subject. 

Ih.  B.  Smiik — Thought  it  right  to  investigate  this  whole  subject, 
tad  Co  get  a  chemist  to  analyse  the  water. 

Dr*  Corf  on— Moved  that  a  committee  be  appointed  to  investigate 
tha  cause  of  the  dianhoea  and  dysentery  now  prevailing^  in  the  city. 

Dr.  Woodward — ^ililoved  that  Dr.  Carson  be  appointed  as  that 
eommittee.      Carried. 

Dr,  Carton — Suggested  that  two  be  added  to  that  committee. 
The  Chair  appointed  Drs.  White  and  H.  Smith. 

REPORTS  OF  COMMITTERS. 

At  a  subsequent  meeting  of  the  Academy,  Jan.  11,  1864,  Dr. 
Canon,  Chairman  of  the  committee  appointed  to  investigate  and  re* 
port  upon  the  cause  of  the  diarrha^a  and  dysentery  now  prevalent  in 

the  city,  presented  the  following  report : 

AhMirad  of  Report  on  Diarrhoea  and  Dysentery  : — 

The  great  prevalence  of  diarrhoea  and  dysentery  in  winter,  in  all 
parta  of  the  city,  and  among  all  classes,  ages  and  sexes  is,  in  its  eti- 
ob^cal,  pathological  and  practical  relations,  an  important  subject  of 
investigation  for  the  Academy. 

That  it  18  so  prevalent,  is  proven  by  the  reports  of  practicioners. 


5  Proceedings  qf  Societies,  L^/^'*-* 

d  die  examination  of  Druggists'  prescription  files  in  tbe  diflhrent 

»rts  of  the  city. 

The  symptoms  are,  in  most  cases,  those  of  simple  diarrhoea,  with 'a 
3ndency,  in  the  severer  cases,  to  dysentery. 

In  the  middle  cases,  there  is  no  constitutional  or  unasnal  derange- 
ment of  secretions,  as  evidenced  by  tbe  tongue.  The  severer  attacks 
arq  attended,  in  many  instances,  wiib  unusual  prostration,  and  obsti- 
nacy to  treatment.  A  frequent  symptom  in  the  latter  cases,  is  the 
light  colored  discharge,  indicating  the  absence  of  proper  secretion 
from  the  liver. 

The  treatment  seems  to  vary  ;  some  practicioners  relieving  the  mu- 
cous membrane  of  the  bowels  by  gentle  laxatives,  combined,  in  many 
cases,  with  a  mercurial,  and  then  administering  opiates  and  astrin- 
gents.    Others  preferring  to  beg^n  wiih  opiates. 

This  point  would  be  an  interesting  practical  matter  for  discnssiM 
before  the  Academy. 

In  defining  the  etiological  character  of  this  disease,  the  prevalence  of 
other  diseases  should  be  taken  into  consideration.  We  have  had,  last 
winter  and  this,  a  great  deal  of  typhoid  fever,  erysipelas,  measles,  scar- 
latina, diphtheritic,  and  other  sore  throats,  jaundice,  and  skin  diseases. 
A  glance  at  these  will  show  a  class  of  diseases  in  which  there  is  an 
unusual  tendency  to  affections  of  the  mucous  membranes.  It  is  prob- 
able that  there  is  a  point  of  connection. 

A  comparison  of  the  above  list  of  diseases  with  those  prevalent  in 
the  army,  will  show  a  close  correspondence.  The  type  of  disease 
smongst  us  is  the  army  type.  The  camp  diarrha^oa  has  been  princip- 
ally a  summer  disease,  differing  in  that  respect  from  that  which  we 
are  discussing.  How,  and  to  what  extent  the  diseases  prevailing  in 
civil  practice,  have  been  affected  by  the  causes  in  operation  in  the 
army,  is  another  interesting  relation  of  the  subject. 

The  most  prominent  local  cause  that  has  been  suggested  ia  the 
water  supply.  That  we  are  using  an  impure  water,  is  undoubtedly 
true.  The  sources  of  contamination  are  obvious  to  any  one.  The 
amount  of  impurity  has  been  shown  by  Mr.  Wayne's  analysis,  proving 
that  of  the  solids  of  a  gillon  of  water,  a  little  over  fifty  per  cent,  is 
organic  matter.  This  is  an  enormous  amount  of  impurity,  and  sudi 
impurity  as  is  likely  to  develop  severe  and  extensive  diarrhoea,  in 
systems  already  made  sunceptible  by  what  are  commonly  considered 
atmosphoric  causes  of  disease. 

To  ascertain  how  far  this  cause  is  operative,  requires  an  investigation 
of  our  whole  city  and  vicinity. 


18M.]'  PrcceedlngM   ofSoeieHes.  227 

Communications  from  physicians  in  Colombia,  Pendleton,  Newport 
tod  Walnnt  Hills  report  none  of  this  diarrhcea.  Dr.  Mount,  of 
Comminsvile,  more  than  usual  in  his  range,  reaching  College  Hill. 
Dr.  D.  Jodkins  reports  being  consulted  bj  persons  living  on  Mount* 
Auburn  for  treatment.  No  report  could  be  obtained  from  Covington. 
Partial  examination  of  districts  within  the  city  limits,  where  the  city 
water  supply  does  not  reach,  produced  the  impression  that  the  disease 
is  aggravated  when  the  reservoir  water  is  used. 

There  are  striking  instances  of  the  effects  produced  by  the  use  of 
impure  water.  Most  of  .them  are  to  be  found  in  English  literature. 
Diarrhoea  and  typhoid  fever  are  considered  by  English  sanitarians  as 
the  beet  tests  of  the  sanitary  condition  of  any  locality.  A  series  of 
extensive  inquiries  into  the  unusual  prevalence  of  diarrhoea  in  six 
towns  in  England,  by  Dr.  Oreenhow,  indicates,  besides  a  general 
influence,  two  important  local  cases,  atmospheric  contamination,  by 
expoeure  of  large  amounts  of  decomposing  animal  matter,  and  the  use 
of  an  impure  water. 

The  well*  known  neligencc  in  proper  street  cleaning  and  sewerage, 
may  also  be  supposed  to  have  an  infloeuce  with  tis. 

On  referring  to  the  Meteorology  of  the  winter  months  of  1861-'62 
and  '68,  nothing  unusual  is  discovered.  We  are  indebted  to  ^Ir. 
Harper  of  Woodward  High  School,  for  a  complete  record  of  the 
weather.    It  is  ap|>cnded  to  this  report  for  reference. 

We  hope  to  be  able  to  develop  this  subject  more  fully  hereafter. 

(Signed) 

Prof.  Wayne — Also  very  kindly  presented  to  the  Academy  an 
analysis  of  the  water  with  which  the  city  is  supplied,  showing  at  the 
preeent  season,  a  much  greater  amount  of  organic  matter  than  is 
contained  in  pure  water. 

n§  Chairman — of  the  committee  stated  that  their  time  had  been 
eomewhat  limited,  and  in  order  to  make  a  complete  report,  the  sur- 
rounding  country  should  be  canvassed  to  ascertain  the  nature  of  the 
prevailing  diseases. 


228  Correspondence.  \KfiAp 


Letter  from  Boston. 

Boston,  Mass.,  March  12tb,  1864. 

Messrs.  Editors  : — ^The  annual  commeiicoment  of  the  Harvard 
Medical  School  took  place  on  Wednesday  last,  at  the  Medical  College 
in  North  Grovo  Street.  The  exercises  were  witnessed  by  a  largo 
number  of  medical  gentlemen  and  laymen  ;  and  gave  general  satiafiMS- 
tion.  President  Hill  presided,  and  opened  the  exercises  with  prayer. 
Selections  from  the  following  Dissertations  were  read  by  members  of 
the  graduating  class  :  B  rights'  Disease,  Gangrene  of  the  Lnn'gs,  An* 
atomical  Symmetry,  Criticism  on  the  Nature  of  Tiibnde  as  treated  of 
in  "Wood's  Theory  and  Practice  of  Medicine,"  and  "  Jones' and 
Sieveking's  Pathological  Anatomy,"  Peritonitis,  Our  Native  Ma- 
teria. These  productions  of  the  young  gentlemen  evinced  considera- 
ble research  on  their  part,  and  gave  evidence  that  they  had  been  jndi- 
ciously  trained  in  the  preliminary  branches  of  study. 

!f^resident  Hill  conferred  the  degrees  on  forty-one  gentlemen  ;  be- 
side this  number,  eleven  received  their  degrees  in  July.  His  Excel- 
lency, Gov.  Andrew,  conducted  the  exercises  by  an  address.  After 
some  feliciting  remarks  to  the  graduating  class,  upon  the  strength 
and  honor  they  would  add  to  the  State,  he  announced  as  his  theme, 
<'  The  Physician  regarded  as  Citizen  in  a  free  commonwealth*"  The 
address  was  mostly  devoted  to  the  consideration  of  the  subject  as  de- 
veloped by  the  wants  of  the  present  war.  The  Governor  said  that 
Massachusetts  had  sent  into  the  medical  service  103  surgeons  and  200 
assistant  surgeons ;  "  comprising  men  of  eminent  merit,  noble  patriot- 
ism, and  distinguished  professional  acquirements  unsurpassed  else- 
where by  a  similar  number  in  any  army."  He  paid  a  high  and  noble 
tribute  to  Surgeon  General  Dale,  for  his  administration  of  the  medi- 
cal affairs  of  the  State.  The  merited  compliment  was  well  deserved, 
for  Surgeon  Dale  has  been  indefatigable  in  the  performance  of  his  da- 
ties  ;  always  acccssable,  courteous  to  strangers,  obliging  to  friends, 
and  prompt  in  the  execution  of  all  business  transactions.  He  deserves 
much  credit  for  his  efforts  in  sustaining  the  regular  profession  amid 
the  influence  brought  to  bear  to  secure  the  appointment  of  irregular 
practitioners  in  the  army.  The  Governor  also  spoke  of  the  services  of 
the  surgeons  from  this  state,  in  the  different  departments,  and  especi- 
ally of  Dr.  L.  v.  Bell.  He  said  that  thirteen  had  laid  down  their  lives 
during  the  last  three  years,  giving  to  their  country  and  mankind  the 


1864.]  Correspondence.  22^ 

highest  pleilge  of  patriotism,  valor,  and  conscientioas  devotion  to  the 
behests  of  duty.  The  patriotic  and  glowing  words  of  the  Governor 
were  frequently  applauded. 

The  annual  report  of  the  Trostees  of  tho  Massachusetts  General 
HoHpitAl  has  hecn  received.  The  past  year  has  been  one  of  marked 
interest  in  the  annals  of  the  institution.  The  change  in  many  depart- 
ments from  resignations,  deaths,  and  transfer  of  duties  have  been  more 
immerous  than  usual.  The  increased  prices  of  everything  needed  for 
the  hospital,  without  a  corresponding  increase  of  the  receipts,  and  a 
more  than  usual  demand  upon  its  resources,  have  caused  some  anxiety. 

From  Dr.  Shaw's  report,  the  resident  physician,  it  appears  that  there 
were  admitted  to  the  hospital  during  the  year  1868  1648  persons  ;  of 
whom  648  were  Americans,  and  1000  foreigners.  The  whole  number 
tneted  during  the  year  was  1798.  The  admissions  exceed  those  of  any 
year  except  18G2  by  282,  and  that  year  hj  87.  No  applicant  has 
been  refused  admission  for  inability  to  pay  boanl. 

Dr.  Abbott,  tho  physician  to  out  patients,  reports  that  the  whole 
number  of  applicints  has  been  5214,  all  of  whom  were  treated  except 
227,  while  1590  prescriptions  wera  famished  without  charge.  All  the 
private  rooms  in  the  hospital  were  in  constant  use,  and  many  moro 
would  be  sought  for,  if  the  hospital  contained  them. 

Dr.  Tjrl^t  c>^  ^^^  McLean  Asylum  in  Somerville,  reports  that  94 
patients  were  received  dnring  the  year,  and  that  the  whole  number 
under  treatment  was  270.  69  patients  were  discharged  during  the 
jear  ;  of  whom  86  were  considered  rccovei^ed,  6  were  much  improved, 
9  were  improved,  5  were  not  improved,  and  18  died.  A  new  building 
for  the  accommodation  of  the  more  excited  and  hopeless  class  of  male 
patients  is  in  tho  process  of  construction.  Tho  sum  of  810,000  have 
beea  received  from  bequests  and  donations. 

The  expenditures  for  the  hospital  and  aoylum  last  year  amounted 
to  9116,722,  while  the  income  was  8102,877,  leaving  a  deficiency  of 
•18,845. 

There  is  much  other  interesting  matter  in  these  reportn,  but  I  will 
not  trespass  on  your  space.  Our  new  Free  City  Hospital  lias  not  yet 
gomm  into  operation.  The  homeopaths  are  still  persisting  in  their 
eftifta  to  be  represented  in  the  medical  and  surgi:al  corps.  b. 


230  Special  SeUaUm.  [April* 


On   the  Employment  of  An«8thetiot  in   Obstetrlo  MadloiiM  and 

Surgery. 

BY    nORATIO  B.  8T0REB,  H.  D.,  OF  BOSTON,  SURGEON  TO  TUB  PLSASJUIT  tTERT 

HOSPITAL  rOE  WOMEN. 

[  The  Employment  of  Ancutketie  Medioine  and  Surgery',  In  a  former  nnmber  we 
pablisheil  an  article  on  this  subject  from  Dr.  Johns,  taken  fh>m  the  IhMm 
QaarUrly  Journal  of  Mescal  Science  \  as  an  additional  eontributioB  to  Uils 
department  of  literature  we  print  a  paper  from  Dr.  Storer,  setUng  forth, 
howcTer,  somewhat  different  yiews. — Eds.  Lancet  and  Oheervtr.l 

Ix  ordinary  surgical  practice  it  woald  be  viewed  as  cruel,  if  not  de- 
ciiiedly  wrong,  to  perforin  an  operation  without  the  previoue  induction 
of  auacsthesia.  This,  however,  is  as  yet  often  considered  uneafiB*  nn* 
necessary  or  unadvisable  in  obstetric  practice,  and  in  midwiferr  espe- 
cially its  aid  is  In  this  region,  as  a  general  thing,  still  withheld.  In 
behalf,  therefore,  of  those  whose  sufferings  in  the  imperfect  or  abnor- 
mal performance  of  their  peculiar  function  are  doubtless  far  more  ex* 
qiiisite  and  agonizing  than  we  as  men  can  possibly* realize,  I  would 
claim  precisely  the  same  propriety  and  the  same  necessity  for  the  oae 
of  ana&sthetics  in  obstetrics  as  is  now  acknowledged  in  other  and  gen- 
eral practice. 

The  sabject  is  one  with  which  I  happen  to  have  been  brought  into 
peculiarly  close  relations  ;  for  the  past  eight  years,  and  by  a  large  cir- 
cle of  medical  fridnds,  I  have  been  often  importuned  to  state  my  con* 
viclions  regarding  it.  I  am  satisfied  that  there  exist  several  impor- 
tant and  very  prevalent  errors,  and  in  speakiug  decidedly  it  will  bo 
from  extended  personal  experience. 

Various  objections  have  been  brought  against  the  employment  of 
anesthetics,  bnt  it  will  be  found  that  their  use  has  been  advanced  by 
the  very  arguments  relied  upon  by  their  opponents.  Many  of  these 
being  upon  their  very  (ace  absurd,  I  shall  notice  only  those  that  aro 
in  any  degree  plausible. 

It  has  been  asseited — 

1. — ^That  ancethetics  are  hazardous  to  life  ; 

ti. — Tliat  they  have  a  tendency  to  develop  immortalities,  alike  in 
operator  and  patient ; 

3. — That  it  is  unnecessary  to  abrogate  pain,  a  natural  phenomenon. 

4. — That  their  use  is  to  produce  subsequent  ill  effects  upon  the  im- 
mediate or  remote  health  of  the  patient. 

C)f  these  objections,  two  apply  to  the  general  use  of  ansethesiap  and 
the  last  three  more  especially  to  its  employment  in  midwifery  ;  though 
the  last  of  them  all,  that  involving  a  subsequent  delcrious  influence, 
to  a  certain  extent  has  a  general  bearing.  As  to  the  first  of  them, 
which,  with  the  exception  of  the  last,  is  really  the  only  pno  deserv- 
ing serious  consideration,  it  will  bo  noticed  that  the  argument  applies 
with  different  force  to  ether  and  chloroform,  the  two  anaesthetics  gen- 
erally employed ;  and  to  these  again,  with  still  other  degree,  as  they 


1864.  Special  Sai€&mi.  281 

may  be  resorted  to  in  midwifery  or  for  the  other  purposes  of  obstetric 
medicine  or  saigerj. 

I  shall  return  1o  these  points,  and  now  merely  state  in  answer  to, 
lirat^  the  general  objection  that  anaesthesia  are  hazardons  to  life  ; 

a  — That  ansstlMsia  is  no  more  hasardous  thsn  other  measures  ac- 
knowledged by  the  profession  to  be  not  merely  justifiable,  but  abso- 
lotely  necessary ;  and 

h, — ^That  its  use  is  often  less  hazardous  than  its  absence. 

To  the  second  objection  no  more  weight  attaches  than  as  regards 
the  nae  of  any  narcotic  or  stimulant. 

To  the  third,  which  covers  the  use  of  anesthetics  in  labor,  we  reply 
that  pain  is  of  itself  an  evil,  and  of  itself  depresses  the  vital  powers  ; 
thai  delays  are  here  always  dangerous  to  the  life  of  either  mother  or 
I'hfld ;  that  a  naturally  painless  labor  is  almost  never  seen,  and  that 
to  shorten  the  average  duration  of  labor  is  to  annually  save  tens  of 
thoonods  of  lives  now  sacrificed. 

The  fourth  objection  applies  equally  to  the  whole  practice  of  obste- 
tric medicine  and  surgery,  and  therefore  though  it  could  be  logically 
disproved,  it  needs  no  fnrtber  reply. 

The  last  objection  to  which  we  have  referred,  is  based  upon  a  belief 
that  the  use  of  an  anssthetic  renders  the  patient,  in  general  practice, 
more  liable  to  affections  of  tbe  circulation  or  nervous  system,  and  in 
labor  predisposes  her  to  post-partum  hemorrhage,  ect.  There  is  no 
doubt  of  this  liability  when  the  agent  is  an  improper  one  or  unskil- 
fally  administered,  and  it  is  to  the  frequency  of  such  instances  that 
wo  may  fairly  attribute  tbe  prevalent  opinion.  On  the  other  hand,  I 
«lo  BOt'hesitate  to  assert  that,  under  other  circumstances,  no  such  fear 
need  be  entertained.  As  far  as  regards  the  possible  sequels  of  child- 
bed, it  will  be  seen  that  anesthetics,  when  properly  exhibited,  increase 
tlie  force  of  the  uterine  contractions,  and  probably,  also,  the  very 
uterine  contractility,  so  that  in  such  cases  liability  to  post-partum 
hemorrhage,  for  instance,  would  be  decidedly  lessened  ;  and  in  abnor- 
mal labor,  where  the  uterus  itself,  for  operative  measures,  is  purposely 
I  •at  to  sleep,  rapid  delivery  would  be  hardly  likely  to  occur,  unless  by 
•iesign,  allowing  the  uterus,  therefore,  sufficient  time  to  awaken  again, 
a*  it  would  be  sure  to  do.  Should,  however,  hemorrhage  take  place 
under  these  circumstances,  it  would  probably  have  occurred  without 
ilie  aaiesthetic — for  this  agent  does  not  separate  the  placenta  from  the 
uterine  wall,  any  more  than  it  produces,  as  has  been  gravely  asserted 
nf  it  in  more  than  one  instance,  an  hydroceplialic  or  an  cneephalous 
f^etoa. 

Od  the  other  hand,  the  obstetric  advantages  of  anesthesia  are  de- 
t-idad — giving  the  patient  relief  from  pain  and  saving  of  her  vital 
l»owors — and  to  the  operator  increased  facilities  for  action  from  mus- 
cular relaxation,  and  absence  of  disturbing  elements,  emotional  and 
inteUectnal. 

The  indications  for  its  use  in  obstetrics  are — general  and  special. 

1. — ^It  is  useful  for  purposes  of  diagnosis — ^both  in  cases  puerperal 
aad  non-piDerpera].  It  stops  spasmodic  and  reflex  muscular  action,  as 
in  the  rarions  forms  of  hysteria,  subduing  general  convulsive  disturb- 


^32  Special  Seiedhns.  [April. 

ances,  quieting  tbe  abnonnal  mnscles  where  their  moremeiit,  r^ukr 
or  irregular,  would  soggest  those  of  a  footus  in  Qtero,  flattening  tbe 
snrfacc  in  so-called  spurious  pregnancy,  straightening  joints  supgosod 
anchylosed  or  otherwise  diseased,  checking  the  extreme  tenesmus  of 
vagina  or  rectum,  by  which  prolapsus  uteri,  cystocele  or  rectocele  are 
at  times  etimnlated  ;  and  in  other  cases  it  prevents  (he  involnntary 
shrinking  from  pain,  and  consequent  almost  involuntary  muscular  ac- 
tion, during  a  sevoi'6  examination.  ^ 

2. — It  relieves  pain,  anxiety  and  restlessness  during  disease,  as 
dysmenorrhoea,  carcinoma,  etc. ;  operations,  non-puerperal  and  puer- 
peral ;  and  especially  during  labor — thereby  shortening  it  and  lessen- 
ing its  mortality  and  dangers,  to  mother  and  child. 

3. — It  is  indicated  in  labor,  not  merely  because 

a.  it  relieves  pain,  anxiety  and  restlessness,  and  so  saves  the  vital 
powers,  as  already  said  ;  but  because 

6.  it  dilates  the  os  and  vaginal  passage — often  relieving  rigidity 
where  such  exists  ; 

c.  it  relaxes  the  voluntary  muscles,  prcternaturally  excited  by  reflex 
action,  preventing  their  interference  and  undue  effect ; 

d.  it  excites  the  uterine  fibres,  producing  greater  uterine  contrac- 
tion and  thereby  preventing  inertia  and  hemorrhnge  ; 

e.  it  prevents  puerperal  convulsions  where  threatened,  and  where 
they  are  present  it  abates  them  ; 

/.  it  facilitates  manaal  or  instrumental  assistance  where  sncb  is  re- 
quired. 

As  to  the  relative  value  of  the  two  anaesthetics  for  obstetric  purposes  : 

Between  ether  and  chloroform,  putting  aside  all  local  prejudices, 
which  both  in  Europe  and  America  have  been  allowed  altogether  too 
much  weight,  there  are  certain  differences  noticed,  worthy  of  grave 
consideration.  That  I  may  not  be  misunderstood,  I  shall  express  my- 
self very  plainly,  and  in  view  of  the  circumstances  under  which  I 
have  experimented  with  each  of  these  agents.*  I  trust  the  profession 
will  feel  inclined  to  look  fairly  at  my  views  of  the  subject,  even  if  in 
some  respects  they  run  counter  to  the  generally  received  opinion. 

I  think  I  may  state  the  following  as  rules  for  practice  : 

1. —  Kther  alone,  and  never  chloroform,  should  be  used  for  pnrposes 
of  diagnosis  and  in  all  cases  of  operative  surger}',  capital  or  minort 
general  or  obstetric,  except  those  immediately  pertaining  to  labor. 

2.  Chloroform  alone  should  bo  used  in  midwifery,  to  the  entire  ex- 
clusion of  ether. 

That  deaths  have  taken  place  in  general  practice  from  the  use  of 
chloroform,  I  freely  admit.     It  is  remarkable,  however,  that  many  of 


«■  Hy  finit  tmprcMlons  an«l  eatlmat*  of  eth«r  were  formed  In  Boston,  fW>m  direct 
anceof  ttNeff«>cc«fn  thekandsof  thote  who  flrat  applied  It  to  practice,  and  who  have  ever 
since  kept  lu  best  Interests  In  view.  I  refbr  to  these  sources  In  connecUon  with  my  own  pri* 
vato  experience  with  the  agent,  now  by  no  means  Inconsiderable,  Inasmnch  as  they  hava  all 
led  me  to  a  single  conclasiun.  My  first  Impressions  md  estimate  of  chloroform,  aieainst  which 
I  had  been  decidodly  pm)udiced.  were  formed  from  dally,  I  might  sa^  hourly,  familiarity  with 
It  daring  my  sojonm  In  Edlnbareh  with  Prof.  Slmpstm,  who,  while  he  was  tha  first  ever  (o 
use  other  in  midwifery,  was  only  lei  to  diaeover  the  aosBsthetIc  properties  of  chloroldm.  at 
deliberate  and  repeated  risk  to  hii  own  lifip,  by  experience  of  the  dlsadrantagta  of  ether  tn  tht 
pwpoaciOfUbor. 


1864.  SfBcial  S$leciian8.  \  288 

these  ouBes  have  been  of  the  simplest  operations,  as  in  dentistry,  and 
that  often  occurred  before  tbe  operation  had  commenced,  the  agent 
hariag  been  ezbibited  not  to  lessen  bnt  to  prevent  pain,  the  nervous 
sjatem  being  in  a  quiescent  condition. 

For  the  ordinaiy  purposes  of  surgery,  therefore,  it  is  plain  that  as 
]ess  risk  in  such  cases  does  not  pertain  to  etber,  it  should  be  used  in 

S reference  to  chloroform.  With  regard  to  the  practice  of  midwifery, 
oweTer  it  is  far  different.  To  the  present  date,  so  far  as  I  am  aware, 
there  does  not  exist  on  record,  from  the  thousands  of  obstetric  cases 
ia  which  chloroform  has  been  used,  a  sing^le  instance  where  death  can 
be  legitimately  attributed  to  its  influence.  With  certain  allegations 
to  the  contrary  I  am  of  course  familiar,  but  in  the  caftes  upon  which 
these  are  based,  the  fatal  result  seems  in  every  instance  to  have  been 
directly  dependent,  not  upon  chloroform,  but  upon  one  or  other  of  the 
following  causes : 

The  agent  was  impure,  or  was  administered  by  an  incompetent  at- 
tendant, whether  physician  or  nurse ;  the  patient  without  other  care 
or  snpervision,  herself  induced  the  anaesthesia,  either  during  the  labor 
or  aahtequently — or  there  existed  some  previous  disease  or  unavoid- 
able complication,  that  of  itself  must  necessarily  have  produced  death. 
Sach  being  the  fact,  the  objection  falls.  It  cannot  be  said  that  if 
Dot  on  record*  unfortunate  cases,  directly  depending  upon  chloroform, 
must  yet  have  occurred ;  for  there  are  too  many  opponents  of  anss- 
thetia,  who  would  at  once  seize  upon  and  publish  them  did  they  ex- 
let. 

If  such  immunity  in  child-bed  be  granted  to  chlorofbrm,  as  I  con- 
oeive  must  be  done,  upon  what  grounds  can  it  be  explained  ?  Upon 
•ererml. 

Firatly :  labor,  though  so  often  treated  and  spoken  of  to  the  contra- 
ry, ia  essentially  a  normal  and  strictly  physiological  action — the  great 
«nd  for  which,  sexually  and  anatomically  speaking  women  are  formed. 
The  ahock,  therefore,  to  the  system  which  she  undergoes  during  child- 
bed, though  in  the  simplest  cases  so  tremendous,  is  one  of  which,  to  a 
great  extent,  provision  has  already  been  made.     There  is  at  that  time 
a  greater  tolerance  of  nervous  shock,  for  want  of  a  better  expression, 
than  we  find  in  ordinary  surgical  cases  of  apparently  much  less  pro- 
portionate severity,  especially  if  these  be  in  disease  of  long  standing, 
or  afler  ee^'ere  accident,  where  the  vital  powers  have  been  in  conse- 
«{Denoe  undermined,  or  an  important  organ  has  been  structurally  dis- 
organiaed.     It  these  cases  the  vitality  of  the  patient  may  bo  consider- 
ed u  below  par ;  in  labor,  on  the  contrary,  it  is  decidedly  exalted,  and 
Above  par. 

Upon  this  point,  the  obstetric  tolerance  of  chloroform,  other  ele- 
i&ents  leem  to  bear,  as 

becondly  :  tbe  excitability  of  the  reflex  system  in  the  female  is  no- 
torioQi ;  and  that  this  is  enhanced  not  merely  by  abnormal  processes. 
M  of  various  uterine  or  ovarian  disease,  but  even  by  the  perfectly 
Wtltby  perfennaace  of  natural  functions,  as  of  menstruation,  copula- 
tioB  aad  eonoeption.  This  influence  is  very  evident  during  the  whole 
fttn  of  geslatioUy  and  it  is  undoubtedly  as  powerful  during  labor.    If 


234  Special  Seleetiom.  [April, 

it  wero  granted  that  the  1iat)i1ity  to  fatal  depression  or  collapBC  from 
the  use  of  chloroform  existed  daring  partarition  to  so  great  a  degree 
as  at  other  limes,  against  which,  however,  we  have  other  reasoning 
and  direct  negative  evidence  besides,  it  is  probable  that  in  tho  very 
exaltation  of  the  whole  reflex  system  to  which  I  refer,  we  bare  a  suffi- 
cient safeguard  and  cure. 
But  Mill  farther: 

Thirdly  :  It  is  now  ^nerally  believed  that  in  the  female,  daring 
the  period  of  menstraation,  a  large  elimination  of  carbon  from  the 
Hanguinous  system  takes  place  through  tho  medium  of  the  uterus,  and 
that  at  these  times,  accordingly,  the  lungs  are  relieved  of  a  portion  of 
their  nsual  work.  If  this  be  true,  and  there  is  certainly  strong  evi- 
dence in  its  favor,  then  it  follows,  normal  labor  taking  place  almost 
precisely  at  the  time  of  the  periodical  menstrual  molimen,*  that  a  cer- 
tain amount  of  adverse  impression  might  bo  produced  at  this  time 
upon  tho  general  system  through  tho  lungs,  which  conid  not  safely  be 
induced  by  the  same  channel  at  another. 

By  the  three  theories  I  have  propounded,  namely  (1)  the  gradnal 
preparation  of  the  system  for  the  shock  of  parturition,    (2)  the  exists 
once  of  an  unusal,  and  for  the  time  tonic,    stimulus    to   the  nervons 
system,  by  which  cardiac  paralysis  may  be  averted,  and  (3)  an  una* 
sua),  and  fur  the  time  tonic,  depumtion  and  decarbonization  of  the 
blood  through  the  uterine  sinuses,  by  which  the  onlinary  tendency  to 
asphyxia  from  the  use  of  chloroform    may   be   prevcnted^-do  we  not 
have  a  satisfactory  explanation  of  the  immunity   from  accident  that 
has  been  observed  in  the  exhibition  of  this  agent  dunng  childbirth  ?* 
I   have  dwelt   at  length   upon  this  point  in  my   brief  summary, 
the  inimuuity  of  chloroform  during  labor,  because  its   appai-ent  inex- 
plicability  has  be&n  to  many  a  safHcient  reason  to  decide  them  at  once 
against  its  use.     "  We  grant  that  a  death  may  never  yet  have  occurred 
from  chloroform  in  childbed,"  has  more  than   once  been   said   to  me 
by  friends  of  high  authority,  **but  you  may  possibly  lose  your  next 
patient,  and  are  therefore  not  justified  in   such   hazard."     I  confess 
that  early  in  practice  I  shared  these  fears,  but  since  the  arguments 
now  urged  have  suggested  themselves,  such   bcruples  have  gone,  and 
of  late  I  have  not  hesitated  to  administer  chloroform  to  parturient 
patients  far  gone  in  cardiac  and  pulmonary  disease. 

The  argnments  above  advanced  have  not,  I  think,  been  hitherto  as 
distinctly  presented  by  any  writer  or  teacher,  though  in  part  they  may 
have  been  foreshadowed. f  Do  they  not  explain  certain  other  intricate 
obsteric  problems  ?  As,  for  instance,  the  alledged  improvement  of 
phlhiriical  women  daring  pregnancy  ;  the  apparent  relief  to  pulmonary 
disease  sometimes  seen,  when  complicated  with  amenorrhee,   during 

*Thlii  mulimcn  nndoabtrdlj  occur*  to  a  certain  ezttnt,  thovRh  parbaptalmcwt  luipeimitiMyi 
at  its  roKular  interral  tlironghoiit  gestation,  rendering  the  patient  mach  more  liable  to  aMrtat 
iODie  timoe  then  othert  npon  illght  provocation. 

*  It  might  be  thongbt  that  the  last  of  the  theoriea  propesed  wonld  Bpplj  with  eoval  fttve  to 
the  case  of  purely  Tunoos  hoaorrhage  from  any  ordinary  soaree.  I  conoeive,  howenr.  that 
even  were  we  to  allow  a  certain  amouot  of  Influence  In  such  cases,  which  baTo  not  as  yet  in 
this  connection  been  at  all  ioTcstigated.  It  is  the  bet  of  the  occurrences  as  a  regnlar  aoo  ner» 
mal  physiological  phenomenon  during  labor,  no  matter  how  small  in  estent,  that  fiimlshoi  tho 
key  10  the  whelo  queetion. 


1864.  Special  SeiecHani.  235 

vicarioas  menstraation ;  and  also  the  rapid  decline  in  consumptive 
|MUienta,  oocasionally  occurring  after  parturition.  I  would  call  the 
attention  of  thoracista  to  these  several  points. 

To  retnm — 

The  use  of  chloroform  in  midwifery,  granting,  as  I  have  claimed, 
its  safety  for  this  purpose,  has  (wrtain  positive  advantages  over  ether  ; 
sufficient,  I  consider,  to  entitle  it  to  decided  prefereuce.| 

1. — ^l*he  vapor  of  chloroform  is  much  more  agreeable  to  the  patient 
and  to  the  physician. 

2. — It  is  less  Irkeiy  to  occasion  any  unpleasant  or  depressing  con- 
comitant, as  nausea,  vomiting,  etc. 

3. — Being  more  powerful  than  ether,  it  induces  ansBsthesi-a  with 
mnch  more  rapidity — a  matter  of  great  importance  in  labor,  where  it 
is  always  necessary,  except  where  operative  interference  is  required, 
that  the  affect  of  the  anaesthetic  should  be  confined  to  the  pains,  and 
DoC  pass  over  into  the  interval. 

4. — Its  effects  are  much  more  transient  than  those  of  ether,  a  char- 
aeteriatic  of  equal  value  with  the  last,  and  for  precisely  the  same 
lOMon,  namely,  that 

5. — It  does  not,  as  is  frequently  the  case,  with  ether,*  prevent  the 
iQcnrrence  of  the  pains,  and  so  stop  the   progress  of  the  labor. 

6. — It  is  more  efficacious  than  ether  for  restraining  or  preventing 
puerperal  convulsions  and  puerperal  mania. 

It  has  been  suggested  to  me  by  a  close  observer,  Dr.  Mclntire,  now 
of  Concord,  N.  U.,  whose  use  of  chloroform  in  childbed  has  been  very 
estensive  and  dates  from  its  first  suggestion  to  the  profession,  that 
vhea  rasortcil  to  there  is  much  less  daugcr  of  pHer|)eral  fever,  if  the 
pntient,  as  is  often  the  case,  has  been  directly  exposed  to  contagion  or 
any  other  exciting  cause.  From  the  facts  communi(*ated  to  me  by  Dr. 
Xelntire,  I  am  iucline<l  to  think  there  are  good  grounds  for  his  opin- 
ion. There  is  no  doubt,  at  any  rate,  of  the  efficacy  of  chloroform  in 
preventing    exhaustion,   nervous    irritation   and  other  predisposing 

As  to  the  time  of  its  administration,  a  point  upon  which  there  has 
much  difference  of  opinion  : 

Generally,  its  use  is  hardly  required  till  the  completion  of  the  fii*8t 
itage  of  labor,  when  the  os  uteri  has  become  fairly  dilated.  Should 
tkere  exist,  however,  sufficient  suffering  at  an  earlier  period,  the  agent 
ihoiild  certainly  then  be  resorted  to.  it  should  be  given  only  during 
ik  pains,  except  a  complication  exist  requiring  manual  or  instrumen- 

tlfkmaklj  Ackoowlcdse  that  my  attention  waa  first  riveted  upuii  thii  quettl<m  lOine  thirteen 
!««•  af*  kf  mj  fHand  Dr.  Walter  Channlng,  to  whoae  phlhwoplilcal  remarks  upon  the  asbject 
khto  asccUtai  tmtiae  upon  Xtherlaation  in  ChildMrth .  I  wuuld  refer  inj  reMeri. 


upon 

[T»  ihcta  I  calted  tha  attention  of  the  profusion  levi^ral  years  since,  at  a  meeting  of  the  Saf- 
tXadicalSoclctT,  at  which  It  had  been  prup<Hi«d  that  the  physlrlans  of  this  city 
i»r«Uataap  their  emphatic  and  genvral  condemnation  upon  the  inhalation  af 
I  tkta  Glafmcd  that  whatcTer  ul^Uuns  miaht  ba  nri^ed  against  the  drug  for 
practiM,  an  czcaptlon  must  be  made  in  its  favor  for  casas  of  mIdwUery.  promising  that 
n  •  9mmm  4^r  I  vmdd  rcrart  to  the  subject.    I  accordingly  new  radaam  this  pladga. 


*TW  aiWHy  of  athar  In  this  rrspect  Is  notoriona.    For  a  alngla  admlmion  to  tha  point,  and 
ia|^ur«k«l  Blii^t^aMBcad,  IwUl  rvfcr  to  editorial  artlclaa  in  th«  BotUmMM.mmd 
Ifcr  A«gvt*f  the  present  year,  (pp.  63  and  t7,)  pnblUhad  ^fi9r  tke  »bOTa  paper 


236  Special  Seledians.  [April, 

tal  interference,  when  its  nse'sbonld  be  continued  tbroa(|;h  tbe  interval; 
and  in  this  lies  one  oi  the  chief  advantages  of  chloroform  in  midwifeij, 
that  whereas  given  during  the  pains  alone,  and  properly,  it .  not  only 
docs  not  interfere  with  the  uterine  contractions  but  regulates  if  incon- 
stant, and  enhances  them,  on  the  other  hand,  if  a  cessation  of  that 
action  be  required  to  enable  us  safely  to  pursue  any  measures  within 
the  cavity  of  the  uterus,  as  for  turning  or  applying  forceps  above  the 
brim,  we  can  obtain  it  by  extending  the  use  of  the  agent  through  the 
interval.  In  a  large  proportion  of  cases  it  will  not  be  necessary,  at 
any  time  during  the  labor,  to  induce  complete  insensibility  ;  a  sreiy 
few  breaths  of  chloroform,  sometimes  indeed  a  single  one,  sufficing  to 
annul  the  sensation  of  pain. 

The  ubsolute  amount  given  is  usually  too  small  and  with  too 
sparing  a  hand.  Somewhat  like  opinion,  we  get  from  minut!e  doses  a 
period  of  excitement  and  perhaps  of  delirium  that  is  escaped  by  mon 
decided  application.  The  great  secret  is  to  produce  the  narcotism  as 
rapidly  as  possible,  and  yet  gradually  obtain  our  mastery  over  the  re* 
spiratory  organs.  This  remark  applies  with  equal  force  to  the  admin- 
istration of  ether  in  ordinary  surgical  practice,  though  its  importance 
is  too  often  lost  sight  of  or  not  fully  appreciated.  ^ 

At  first,  and  throughout,  atmospheiic  air  should  bo  freely  admitted 
with  the  vapor  applied  ;  and  therefore  I  would  condemn  any  form  of 
artificial  inhaler,  however  constructed.  The  simplest  form  is  the  best, 
and  a  mere  handkerchief  or  napkin  will  answer  every  indication  if  it 
be  only  borne  in  mind  that  the  vapor  of  chloroform  is  much  heavier 
than  air,  and  if  properly  applied  will  descend  about  tlie  face  of  its  own 
weight.*  Attention  to  this  fact  will  also  prevent  the  possibility  of 
vesicating  or  unduly  irritating  the  mucous  or  cutaneous  surfaces. 
The  patient  should  bo  told  from  the  outset  to  inspire  very  deeply ;  the 
motion  soon  becomes  automatic,  and  the  vapor,  by  penetrating  every 
pulmonaiy  vesicle,  produces  a  much  more  profound  and  instantaneous 
oiToct.  Throughout  the  inhalation  and  as  a  matter  of  course,  due  at- 
tention should  be  given  to  the  pulse,  and  more  especially  to  the  res- 
piration of  the  patient. 

I  have  referred  to  the  necessity  of  the  agent  being  perfectly  pure 
and  reliable.  In  this  matter  ])erhaps  I  may  be  overcautious ;  but 
upon  personally  inhaling  many  specimens  of  chloroform;  procured 
from  different  sources,  there  has  apparently  been  evident  a  diversity  of 
effect,  and  I  therefore  still  confine  myself  to  what  from  long  experience 
I  have  every  reason  to  be  satisfied  with — the  manufacture  of  Messrs. 
Duncan  ^  Flockhart,  of  l^dinburgh  procuiing  it  cither  through 
friends  or  responsible  parties  in  the  trade.* 

<"  A  suicguiion  bu  bef>n  nindo  to  me  by  Dr.  SuthorUud,  the  well-known  Professor  of  Cbem- 
i.Htry  At  MoDtrcal.  that  maj  prore  of  extreme  vulae  iD?|)rc\«'ntlnK  the  occnrreDoe  of  fttun  accJ- 
(lent  from  chloroform  in  ordinary  sarfical  practice.  It  i«  that  the  ftice  and  bndy  of  tho  pattrnt 
•luring  inhalAtion  «»boiiId  be  turned  more  to  one  side  than  is  generaHy  th«  case.  The  weigfit 
i)f  the  vapor  being  such  as  after  a  few  inspirations  to  fill  and  almost  hermetically  seal  the 
lunfpi  by  its  more  gravity,  the  position  X  have-lndicatod  wonid  eTidently  allow  more  perfect  *];• 
l>1ration  and  a  much  more  complete  entrance'and  admlxtureof  atmospheric  air  than  ii  other- 
wise posbible. 

^Measrt.  Metcalf  A  Co.  and  Leopold  Babo,  of  Boston,  are  prepared,  I  beliere,  to  tanlah 
chloroform  directly  from  Messrs.  Duncan  A  Vlockbart. 
The  above  mlet  one  woald  suppose  to  be  simple  enough.    With  reference  to  the  ol^ectlea 


Special  SekcHans.  287 

iloric  ether  I  have  had  mach  less  experience  than  of  sulphuric 
d  chloroform ;  knowing  no  reason  to  prefer  it  to  either  of  these 
vhile  there  are  several  decided  objections  to  its  use,  I  omit  its 
mention. 

sometimes  asked,  if  a  patient  should  be  urged  to  the  use  of  an 
»tic,  when  timid  or  prejudiced  against  it.  This  is  a  question 
rsonally,  I  have  no  hesitation  in  answering  affirmatively. — 
ears,  as  already  said,  are  perfectly  groundless,  when  the  agent 
irly  given  and  its  use  duly  restricted.  The  risk  to  life  in 
s  rather  in  the  absence  of  an  anaesthetic  than  in  its  adminis- 
and  60  does  the  liability  to  a  tedious  recovery.  Few,  if  any 
I,  and  this  remark  applies  also  to  cases  of  general  surgery,  but 
ij  bear  an  aniesthetic,  and  come  kindly  under  its  influence, 
t  be  properly  exhibited  ;  and  every  additional  example  of  this 
may  be  able  to  present  in  practice,  is  so  far  a  refutation  of  the 
» the  contrary  that  so  generally  obtains.  For  this  reason  I 
ftdvise  its  use  under  the  circumstances  we  are  now  considering, 
for  this  alone.  Since  entering  obstetrical  practice,  it  has  been 
I  a  matter  of  conscience,  this  abolishing  the  last  and  most  ex- 
igony  of  all,  save  dissolution,  to  which,  in  one  respect,  the 
:  asunder  of  two  distinct  natures  during  childbirth,  it  bears  no 
Memblance. 

recall  not  one  single  case  of  labor  among  several  hundred 
have  given  chloroform,  in  which,  however  simple  or  compli- 
t  case,  I  have  noticed  the  slightest  ill  effect  from  the  anses- 
in  all,  I  am  satisfied,  its  use  was  attended  with  benefit  to  the 
1  refer  to  this  personal  experience  for  the  same  reason  that 
trolled  ray  practice — that  I  believe  that  in  the  advancement  of 

e,  individual  influence  but  bepim  with  the  cases,   be  they  few 

f,  under  a  physician's  care.  It  is  the  example  and  the  em- 
Lliought  that  avail. 

■  thtoJcmrnal  for  October  IMh,  page  838  that  Ignonoce  of  th«te  plain  and  reUablo 
8  to  the  admlntirtration  of  cblorofonn.  because,  common,  ii  infflclent  argoment  againtt 
hna,  k  applies  t^nallj  to  erery  drugof  auy  power  need  bj  medical  men.  Becaaae 
hftve  happened,  in  the  hands  of  the  Ignorant,  from  their  exhibition  in  sorgery.  the 
>t  l«  be  blamed  or  lightly  thrown  aside;  that  accldenta  have  happened  from  their 
•  la  the  hands  of  the  wise  and  iklllftil,  who  were  yet  on  an  important  point  or  points 
I  or  furgctful,  sboald  no  m  ore  be  laid  to  the  agent's  discredit. 


238  Reviews  and  Notices.  [April, 


Lectures  on  Medical  Education^  or  on  tho  Proper  Method  of  Stndying  Medidne* 
By  Samubl  Chkw,  M  D^  Professor  of  the  Practice  and  Principles  of  Medi- 
cine, and  of  Clinicnl  Medicine  in  the  UnlTcrsily  of  Maryland.  Fhiladet 
phia:  Lindsay  &  Blakiston.    18G4. 

The  preface  to  the  interesting  little  volume  before  us  begins  with  i 
resume  of  the  queries  'whicb  naturally  arise  in  tbe  mind  of  the  medi- 
cal  student  just  entering  upon  bis  labors.  Thus  be  inquires  of  books 
— of  time  to  be  devoted  to  study — and  the  manner — of  the  order  of 
medical  studies — of  tbe  taking  of  notes — of  clinical  instrtfbtioii— 
dissections — auscultation — medical  schools.  Upon  all  these  topics  s 
variety  of  questions  are  naturally  suggested,  and  form  the  basis,  the 
necessity  for  this  little  volume  of  lectures. 

Dr.  Chew  was  an  eminent  member  of,  the  medical  profession,  and  a 
well  known  teacher  of  medicine  in  the  University  of  Maryland  ;  be 
was  therefore  well  fitted  for  the  judicious  performance  of  the  task  thus 
self  allotted,  and  i^po^  which  ho  entered  with  interest  and  pleasure, 
lie  had  devoted  his  leisure  time  during  the  past  summer  and  aalomn 
to  the  preparation  of  this  volume,  wi(h  tho  expectation  of  having  it 
ready  for  the  use  of  students  during  tho  winter  sessions  of  our  medical 
colleges  just  closed.  Alas  for  the  uncertainty  of  all  human  purposes 
and  expectations  1  "  On  tho  morning  of  the  25th  of  December,  1863, 
shortly  after  the  last  proof  sheets  of  tho  w^ork  had  been  received  from 
the  publishers,  he  was  removed  from  this  world,  after  an  illness  of 
one  week  with  pneumonia." 

The  topics  discussed  in  the  Five  Lectures  of  this  book  are  mnch  ia 
the  character  and  order  of  the  querrics  already  noted  above  as  sugges- 
tive of  the  undertaking,  it  will  therefore  bo  scarcely  necessary  to  re- 
peat them  at  length. 

Lecture  Fourth  is  mainly  occupied  in  tbe  consideration  of  the  im- 
portance of  clinical  experience  and  instruction.  Well  and  Jrnly 
does  Dr.  Chew  appreciate  and  enforce  the  importance  of  chemical  in- 
struction and  hospital  advantages  as  a  necessary  part  of  the  apparatus 
of  medical  instruction  ;  "  a  part  so  necessary  that  without  it  no  school 
of  medicine  can  be  even  moderately  well  qualified  to  do  justice  to  its 
pupils."  Says  Dr.  Chew,  "  There  are  many  things  in  the  natural 
histoiy  of  diseases  which  you  can  learn  more  easily  and  more  perfectly 
by  seeing  them  than  by  any  other  means.  No  verbal  description, 
however  accurate  and  faithful,  of  the  symptoms  of  typhus  and  typhoid 
fever,  of  the  agitated  muscles  of  delirium  tremens  or  chorea,  or  the  fine 


1864.]  £evi€w$  and  NoUcei.  289 

erepiUtion  of  pnenmonia,  or  the  bellows-murmer  of  endocarditis,  can 
give  yon  so  correct  an  idea  of  those  symptoms  as  you  can  obtain  in  a 
few  moments  from  observing  them  as  you  stand  by  the  bedside.  "  The 
knowledge  of  things  *'  says  Julias  Scaliger,  "  cometh  fr6m  things 
Ibemselves — renun  ipsamm  cognUia  vera  a  rebus  ipeia  est. 

Lecture  V.  discusses  the  great  field  of  medical  schools — what 
neoeisity  there  may  be  for  reforms — what  reforms  arc  needed — the 
cooiparative  superiority  of  European  and  American  schools ;  these 
together  with  the  usual  suggestive  complaints  against  the  schools  of 
ibis  country,  are  well  and  pleasantly  considered. 

Take  it  in  all,  it  is  a  well  timed  book,  and  will  serve  as  %  most  ex- 
cellent manual  for  the  student,  as  well  as  refreshing  and  suggestive  to 
Uie  old  practitioners  of  our  time  honored  art. 

For  sale  by  Robt.  Clarke  k  Co.     Price  81.00. 


^on$  of  the  Medical  Society  of  the  State  qf  Xew  Tork^  for  the  year  1863. 

The  New  York  State  Medical  Society  met  persuant  to  statute  in 
the  city  of  Albany  on  Tuesday,  Febuliry  3d,  1863,  and  was  called  to 
order  by  the  President,  Dr.  Thomas  Hun. 

The  book  before  us  is  the  result  of  the  deliberations  of  the  society 
with  its  papers  and  conti-ibutions,  making  a  volume  of  over  400 
pages— certainly  a  large  amount  of  valuable  matter  to  be  compressed 
within  the  limits  of  a  three  days'  session. 

Not  having  time  to  do  better  we  must  content  ourselves  with  the  brief- 
cat  notice  of  the  contributions  (o  the  trarisactions  ;  and  first  we  have  the 
itnal  annual  address  by  the  President,  Dr.  Hun — *'  Influence  of  Prog- 
ress of  Medical  Science  over  Medical  Art."  Next  in  order  a  very  inter- 
CRtiog  and  timely  paper  by  Dr.  Charles  A.  Lcc  on  '*  Hospital  Const  ruc- 
tion. Notices  of  Foreign  Military  Hospitals."  •  Dr.  Lee's  paper  is  chiefly 
the  roault  of  his  observations  during  an  European  visit  during  the 
year  1862,  and  is  illustrated  with  ground  plans  of  several  European 
hospitals,  as  that  of  L' Hospital  Dc.  Lariboisiere,  at  Paris — arranged 
for  612  beds ;  tlie  Military  Hospital  at  Yincenncs,  for  637  beds  ; 
the  Xaval  Hospital,  Yarmouth,  for  310  beds ;  the  Herbert  Hospital 
it  Woolwich,  intended  for  650  beds ;  etc.,  etc.  The  Mechanical  Treat- 
sent  of  Pott's  Disease  of  the  Spine,  is  the  subject  of  a  paper  by  Dr. 
C.  P.  Taylor — A  remarkable  case  of  Deception,  a  woman  professing 
to  secrete  nothing  but  charcoal  and  stone,  the  natural  functions  being 
ancited,  by  Dr.  Lewis  A.  Sayre^^togethcr  with  a  large  number  of  other 
pipen  by  distinguished  members  of  the  Society  in  all  making  nearly 
forty  eaaaya  and  reports.    Toward  the  conclusion  of  the  volume  we 


240  Reviews  and  JfUtcee.  [April, 

notice  an  important  report  compiled  hj  the  secretary,  Dr.  8.  D.  Wil- 
lard,  embracing  a  list  of  all  the  medical  officers  of  all  the  New  Yoik 
regiments — their  age — place  and  year  of  graduation — what  senrioe 
since  graduation — to  what  regiment  appointed — and  the  changes — snch 
as  dismissioDS,  resignations,  transfers  and  promotions.  This  al- 
though necessarily  somewhat  imperfect,  is  prepared  with  ^  great  deal 
of  care,  and  will  be  a  valuable  table  of  statistical  reference  in  the  futnre 
for  materials  in  the  history  of  the  great  rebellion.  We  should  he 
glad  to  see  every  State  Medical  Society  carefully  treasuring  in^  its 
archives  a  like  record. 

The  officers  for  the  ensuing  year,  now  closed,  were  Dr.  Daniel  P. 
BisscU,  of  Utica,  for  President ;  Dr.  Joel  Foster,  of  New  York,  Vice 
President ;  Dr.  Sylvester  D.  Willard,  of  Albany,  Secretary  ;  and  Dn 
J.  V.  P.  Quackenbush,  of  Albany,  Treasurer.  The  Society  ia  cer- 
tainly undci  great  obligations  to  its  Secretary,  Dr.  Willard,  for  the 
self-imposed  labor  performed  by  that  officer,  whereby  much  of  the 
great  usefulness  and  success  of  the  Society  is  secured. 

Treatise  on  Human  Physiology :  Designed  for  the  use  of  Students  and  Praeti- 
titioners  of  Medicine.  By  John  C.  Dalton,  Jr.,  M.D.  Prof,  of  Physiology  and 
Microscopic  Anatomy  in  the  College  of  Physicians  and  Surgeons,  New  York, 
etc.,  etc.  Third  Edition  Revisetii  and  Enlarged,  with  two  hundred  and 
soTeniy-three  illustrations.    Philadelphia :  Blanchard  &  Lea. 

It  is  wholly  unnecessary  for  us  to  say  one  word  as  to  the  merits  of 
this  third  edition  of  Dalton's physiology.  In  the  preface  the  author 
tells  us  that  ho  has  introduced  into  the  *'  text  certain  new  facts  and 
discoveries,  relating  mainly  to  details  which  have  made  their  appear- 
ance within  the  last  three  years.  Such  are  the  experiments  of  the 
author  with  regard  to  the  secretion  and  properties  of  the  parotid  sal- 
iva in  the  human  subject,  and  the  quantitative  analysis  of  this  fluid 
by  Mr.  Perkins ;  the  valuable  observations  of  Prof.  Austin  Flint,  Jr., 
on  stercorine,  cholestrin,  and  the  effects  of  permanent  biliary  fistula, 
and  those  of  Prof.  Jeffries  Wyman  on  Fissureof  Hare-lips  in  the  me- 
diam  line,  from  arrest  of  development. 

The  work  is  certainly  the  best  for  the  every  day  practitioner  and 
student.     For  sale  by  llobt.  Clarke  &  Co. 


Twenty  First  Annual  Report  of  the  Managers  of  the  State  Lunatio  Asylam  of 
New  York  for  the  year  1863. 

The  report  of  the  lunatic  asylum  at  Utica,  New  York,  for  the  last 
year,  exhibits  a  very  satisfactory  condition  of  Its  affairs  and  working 
in  every  respect    There  were  514  patients  in  the  asylum  on  the  18th 


18M.]  EdUf^*$  Table.  241 

of  Daeember,  1862  ;  287  were  admitted  dnring  the  year,  ending  No- 
irember  81,  1863  ;  the  whole  number  nnder  treatment,  therefore,  dnr- 
mg  the  year  was  801 ;  80  were  discharged  recovered,  38  improved, 
101  unimproved,  6  not  insane,.  42  died,  leaving  534  patients  in  the 
aajlam  at  the  end  of  the  year.  The  daily  average  number  nnder 
treatment  has  been  528,  which  is  staled  to  exceed  the  average  of  any 
former  year. 

According  to  the  Treasurers'  Report  the  total  expenditures  during 
tlie  year  were  8116,506.51 — with  a  balance  in  the  treasury  to  start 
upon  the  current  outlays  of  the  new  year  of  817,442.41. 

The  institution  is  under  the  charge  of  Dr.  John  P.  Gray,  assisted 
by  Dra.  Cleveland,  Kellogg  and  Shantz,  and  the  report  of  the  super- 
intendant  incorporated  in  the  annual  report  before  us  is  a  suggestive 
and  sensible  contribution  to  the  literature  of  insanity  and  its  best  man- 
agement. 

Tomrtk  Annual  Report  of  the  Board  of  Director  and  Officers  of  Loog  View  Asy 
loB,  to  the  Oorernor  of  the  Bute  of  Ohio,  for  the  year  1863. 

Smih  Anmtal  Report  of  the  Northern  Ohio  Lunatic  Atylum  for  the  year  1863. 
Smik  Annual  Report  qf  the  Southern  Ohio  Lunatic  Asylum  for  the  jear  1863. 

We  have  not  received  the  report  of  the  Central  Asylum.  The  re* 
porta  of  the  above  named  institutions,  show  that  they  are  in  a  flonr- 
iahing  condition.  The  management  seems  to  be  working  out  an  in- 
creased number  of  cures  each  year.  The  usual  tables  of  statistics  are 
gireOy  to  which  wo  refer  our  readers. 


Stfitov  jS  Baltic. 


Unpaid  Subscriptions. — By  reference  to  our  Prospectus  and  Terms 
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avafled  themselves  of  the  terms,  and  all  payments  made  during  this 
OMNkth  will  be  accepted  at  these  rates.  We  shall  make  out  bills  early 
in  the  year  and  forward  in  the  Journal,  when  in  all  cases  the  accounts 
will  be' for  83. 

The  price  of  materials  and  labor  concerned  in  printing  books  and 
magazines  being  still  on  the  advance,  it  is  possible  we  may  be  obliged 
at  aa  early  day  to  make  a  small  temporary  advance  on  these  rates,  to 
ebrtete  loes — if  so  we  doubt  not  our  friends  will  divide  the  burden 
with  «a  cfacerfnily  for  the  common  good. 


242  Ediior't  TahU.  [April. 

Chicago  Medical  Journal, — ^The  editorial  control  of  this,  old  niedieal 
monthly  has  been  transferred  to  Drs.  Do  Laskie  Miller  and  Epriam  In- 
gals,  Drs.  Brainard  and  Allen  retiring.  We  wish  oar  new  compeen 
every  success,  and  welcome  them  to  the  ranks  of  the  fraternity. 

Messrs.  Balliere,  Publishers  of  the  American  Medical  Ttmew^  tiaye 
removed  from  440  Broadway,  to  520  Broadway,  N.  Y.,  np  stain. 

Dr,  L,  C  Lane,  late  editor  of  the  San  Francisco  Med.^  Presto 
having  retired  from  editorial  life,  writes  to  place  himself  on  the  re^- 
lar  subscription  list  of  this  journal ;  but  wo  do  not  dare  to  repeat  the 
clever  things  he  says  of  the  Lancet  and  Observer,  nevertheless,  he 
has  our  hearty  acknowledgment  of  the  compliment ;  many  other  cor* 
respondents  take  occasion  to  give  us  hearty  greetings — to  all  of  whom 
we  must  simply  content  ourselves  with  saying  we  shall  try  to  make 
the  journal  worthy  of  such  good  cheer  and  kind  regards. 

'^Trippler  Military  Med.  Society.^* — In  the  transactions  of  medical 
societies,  wo  give  the  organization  of  what  promises  to  be  an  efficient 
association,  amongst  the  surgeons  on  duty  in  and  near  Knoxville» 
Tenn.  We  observe  the  **  organic  law,"  provides  for  the  publication 
of  its  transactions  in  the  Amer.  Med,  Times.  We  do  not  wiah  to 
iucite  any  infractions  of  established  law,  but  as  a  large  proportion  of 
the  gentlemen  acting  in  this  society  are  western  men — and  many  of 
them  surgeons  of  Ohio  regiments,  we  respectfully  suggest  the  propri- 
ety of  so  far  waiving^that  rule,  as  to  give  a  fair  proportion  of  the  dis- 
cussions and  papers  of  the  Trippler  Military  Med.  Society  to  the 
Lancet jand  Observer,  especially  as  wo  dwell,  just  now,  in  the  imme- 
diate neighborhood  of  the  patron  of  the  society,  Surgeon  Trippler 
himself. 

Breast-Plates  of  armor — Promotive  of  Cowardice .-^In  ihe  course 
of  a  recent  lecture  on  gun-shot  injuries  of  the  chest.  Prof.  Hamilton, 
of  New  York,  made  the  following  remarks  concerning  those  ingenios 
pieces  of  mechanism  which  have  been  devised  as  protectors  for  the 
chest,  to  be  worn  in  time  of  battle 

In  connection  with  this  subject,  gentlemen,  I  think  it  proper  to 
speak  of  those  metalic  corselets  or  breastplates,  and  complete  cuirass- 
es, which  have  been  furnished  occasionally  to  the  army  by  ingenious 
and  humane  artisans,  and  of  which  I  am  happy  to  say,  but  few  have 
ever  been  worm  by  either  officers  or  men — at  least  so  far  as  my  expe- 
rience goes.  Some  have  been  made  of  wire,  I  believe,  and  are  com- 
posed of  links,  resembling  the  linked  or  chain  armor  worn  bjr  the 
knights  and  soldiers  of  olden  time,  before  powder  and  guns  were  in- 
vented.    These  I  have  never  seen  in  use.     I  show  yon,  however,  two. 


1864.]  BdUor's  TMe.  243 

made  of  plates  of  iron,  hinged  and  bolted,  which  were  worn  in  battle 
by  officers  during  the  present  war  ;  and,  so  far  as  I  know,  these  are 
all  that  have  ever  been  worn  by  persons  of  my  acquaintance.  One  of 
them  never  felt  a  bullet  until  it  was  tried  by  me  as  a  target*  after  the 
owner  had  thrown  it  aside.  The  other  was  worn  by  a  captain,  and  he 
was  killed  in  the  first  severe  action  in  which  he  was  engaged.  The 
ball — a  conical  ball — entered  the  breastplate,  near  its  upper  and  ante- 
rior margin,  and  perforating  it,  passed  through  the  chest,  severing 
some  of  the  larger  vessels.  He  was  found  upon  the  field  dead.  In 
this  instance  the  ball  having  struck  the  armor  at  a  right  angle  with 
the  surface,  and  at  a  short  range,  no  protection  was  afforded. 

Surgeon  David  Prince,  the  able  and  indefatigable  Medical  Director 
of  Couch's  Division  of  the  4th  Corps,  Army  of  the  Potomac,  reported 
to  me,  after  the  battle  of  Fair  Oaks,  that  *'  in  several  instances  bullets 
were  arrested  by  breaftplates.*'  In  one  case  a  breastplate  was  pene- 
trated by  a  minie-rifie  ball,  but  its  force  was  so  nearly  expended  after 
pcforating  the  metalic  plate,  that  it  merely  entered  beneath  the  skin ; 
and  then,  passing  along  superficially  over  the  muscular  walls  of  the 
abdomen,  it  was  found  lying  beneath  the  integument  upon  the  oppo- 
site side.     This  was  on  the  person  of  Capt. ,  1st  Long  Island 

Vols. 

Ko  doubt,  these  plates  have  firmness  enough  to  turn  aside  missiles 
whose  force  is  partially  arrested,  or  which  strike  obliquely ;  but 
some  of  them  protect  nothing  but  the  chest  and  a  small  portion  of  the 
abdomen,  leaving  many  vital  parts  wholly  exposed  and  their  little 
▼aloe,  therefore,  as  a  means  of  defence,  is  more  than  counterbalanced 
by  their  weight,  which  is  not  less  than  eight  or  ten  pounds  ;  and  so 
long  as  swiftness  of  movement  is  the  prime  element  of  successful  tac- 
tics and  strategy,  such  cumbrous  and  imperfect  armor  can  have  nothing 
to  recommend  it  to  soldiers — certainly  not  to  infantry. 

Further  than  this,  I  am  of  opinion  that  it  demoralizes  a  soldier  very 
much  in  the  same  way  that  too  much  fighting  under  cover  of  breast- 
works is  known  to  do.  Troops  accustomed  for  a  long  while  to  lie 
behind  raised  lines  of  defence,  do  not  stand  or  charge  well  upon  an 
open  field.  They  exaggerate  the  danger  ;  and  an  officer  or  soldier, 
one  portion  of  whose  body  is  securely  protected,  must  be  constantly 
remindcil  of  those  parts  which  are  not  at  all  covered.  He  will  say  to 
himself,  "  My  brc:ist  is  safe,  but  alas !  my  poor  head,  and  my  poor 
belly.'^  Ho  never  can  acquire  in  battle  that  enthusiasm  and  perfect 
9Umdon  which  characterize  the  true  soldier,  and  inspire  courage  and 
confidence  into  all  about  him.  In  short,  I  think,  it  will  make  him  a 
eoward,  if  he  was  not  one  before. 

"  Spotted  Fever V — Concerning  this  epidemic  Dr.  Cleland,  of  Ful- 
ton Co.,  Indiana,  writes :  "  The  prevailing  diseases  in  this  part  of 
Indiana  during  the  month  of  January,  February,  and  so  far  in  March, 
(ITtb)  are  billions  pneumonia  and  what  many  of  our  practitioners  call 
spotted  /ewer,  but  which  I  think  is  malignant  typhus  fever  of  our 
gtandard  aothors.     It  has  been  very  fatal  in  some  locations  many  dy- 


244  EdUor*s  TaUe.  [Aprfl, 

ing  in  the  cold  stage,  or  the  chill  which  precedes  the  fever.  I  witli 
some  of  your  correspondents  who  have  had  experience  in  the  treataient 
of  this  fever  woald  publish  some  medical  intelligence  for  the  general 
benefit  of  the  profession." 

Clubbing  with  other  Journals, —  We  have  again  and  again  g^ven 
notice  that  we  have  no  account  current  with  snch  publications  as  we 
offer  to  club  with  ;  we  send  the  cash  for  every  copy  ordered  for  our 
subscribers  as  ordered  ;  hence  the  request  of  some  forty  or  fifty  of  oar 
patrons  to  send  on  to  their  address  one  or  more  of  those  publications, 
with  the  assurance  that  thev  will  speedily  remit  the  amount  to  as  is 
exceedingly  unreasonable.  All  such  friends  failing  to  receive  their 
reiucsted  club  journal  will  understand  the  reason  why — ^we  can  not 
spare  the  money. 

DepattmerU  of  the  North — Army  Medical  Changes, — The  State  of 
Ohio  is  detatched  from  the  Department  of  the  Ohio  ;  and  the  States  of 
Ohio,  Indiana,  Illinois,  and  Iowa  are  constituted  in  a  new  department 
known  as  the  Department  of  the  North,  and  is  under  the  command  of 
GFen.  Heintzlman,  with  head  quarters  at  Columbus.  Surgeon  Charles 
8.  Trippler,  U.S.A.,  at  the  request  of  Gen.  Heintzlman  is  made  Medical 
Director  of  the  Department.  Surgeon  Hewitt,  U.S.Y.,  is  made  Medi- 
cal Director  of  the  Department  of  the  Ohio,  with  headquarters,  at  pres- 
ent, at  Knoxville.  Surgeon  W.  S.  King,  U.S.A.,  late  Medical  Director 
Department  of  the  Ohio,  becomes  Superintendent  of  Hospitals  at  Cin- 
cinnati, and  President  of  the  Army  Medical  Board  in  this  city  ;  Sur- 
geon John  T.  Carpenter,  U.S.V.,  being  relieved  by  Surgeon  King,  is 
ordered  to  report  to  the  Assistant  Surgeon  General,  at  Louisville,  Ky., 
and  is  assigned  to  duty  as  Inspector  of  Hospitals  for  the  Western  Dept. 

A  New  Remedy  for  Boils,  etc, — Dr.  Hoffman  states  that  in  the 
San  Francisco  Medical  Press,  that  the  tincture  of  iodine,  double 
strength,  of  the  formula  given  in  the  United  States  Dispensary,  ap- 
plied thoroughly  to  boils,  bunions,  and  carbuncles,  will  cut  s]iort  the 
supcrative  stages  more  than  one-half,  as  well  'as  relieve  the  patient  of 
all  pain.  All  of  the  feverish  systems,  with  alternate  agues,  chills, 
and  unpleasant  feelings  in  the  same,  that  are  met  with  in  delicate 
females  and  other  persons,  are  relieved  almost  entirely  by  the  first 
application.  The  quantity  of  matter  is  also  much  smaller  when  this 
remedy  is  used  than  under  other  treatment. 

Quack  Medical  Literature  in  Religious  Family  Newspapers, — We 
have  heretofore  entered  our  protest  against  the  iniquity  of  a  large  por- 
tion of  the  religious  press  of  the  day,  in   advertising  quack  nostrums. 


1864.1  EdUor's  Table.  245 

Without  farther  comment  at  present  we  quote  a  very  appropriate  and 
truthful  article  which  we  find  in  the  Round  Table  of  a  recent  date : 

A  Short  word  with  the  Religious  Press. — It  is  not  a  matter 
of  especial  wonder  when  a  traveler  writes  that  he  saw  emblazoned,  in 
huge  letters,  upon  some  of  the  old  ruins  of  Greece,  the  advertising 
cards  of  quack  medicines.  As  Americans  we  are  pretty  thoroughly 
educated  to  a  point  of  resignation,  and  indifference,  when  we  find 
huge  bulletins  despoiling  monuments  of  art  and  beauty,  and  even 
when  they  stare  us  in  the  face  on  rocks  and  hillsides  during  our  sum- 
mer tours  of  respite  and  recreation.  Nor  does  it  disturb  the  exquisite 
as  it  once  did  to  be  obliged  to  read  a  daily  mixture  of  criminal  news 
and  the  disgusting  advertisements  of  the  medicine  venders.  All  this 
we  are  becoming  inured  to  as  a  people.  But  there  is  one  medium  of 
publicity  where  we  look  for  something  higher,  purer,  better.  There 
is  one  source  of  power  whence  we  look  to  see  only  healthful  streams 
departing.  If  the  religious  press  of  the  country  fails  to  stem  the  tide, 
how  can  we  hope  to  see  any  effort  at  restraint  in  other  quarters.  If 
the  Christian  editors  and  publishers  of  the  land  are  false  to  their  high 
calling  and  duty,  what  shall  prevent  the  lifting  up  of  the  flood-gates, 
and  the  outpouring  of  a  deluge  of  filth  and  pollution  ? 

The  facth  of  the  case  are  apparent  to  every  pure -minded  man  who 
reads  the  weekly  religious  press.  Before  us  are  recent  issues  of  two 
leading  religious  journals,  the  Independent  and  the  Observer,  We 
find  in  each  broad  columns  staring  us  in  the  face,  full-freighted  with 
the  disgusting  details  of  the  properties  of  certain  medicines.  "Helm- 
bold*8  Bnchu,"  *« Constitution  Water/'  and  "Cherokee  Injections" 
are  instances  of  the  most  revolting.  And  these  are  spread  out  through 
long  columns,  and  sent  forth  under  the  name  and  with  the  sanction 
and  influence  of  the  religious  press.  They  go  into  the  best  families 
of  the  land,  to  be  read  in  the  pure  atmosphere  of  the  family  circle  and 
about  peaceful  and.  wholesome  Christian  firesides.  They  carry  dis- 
gust to  the  modest,  and  tend  to  aggravate  and  increase  vice  and 
crime. 

We  piotes  against  these  growing  indecencies  of  our  religious  jour- 
nalism. And  m  doing  this  it  is  but  simple  justice  to  say  that  all  the 
weekly  religious  papers  do  not  thus  prostitute  their  columns.  There 
are  several  worthy  exceptions.  But  it  is  a  matter  of  regret  that  any 
journals  which  have  attained  to  a  great  circulation  and  influence 
should  go  forth  from  week  to  week,  professedly  the  religious  ex- 
pounders of  the  hour,  but  practically  mere  money-making  sheets, 
laden  with  purchased  puffs  and  shameless  advertisements.  Perhaps  if 
lata  attention  was  paid  to  financial  successess  and  more  to  the  possi- 
ble good  to  be  done  in  the  way  of  a  stronger  and  healthier  Christian 
literature,  they  ^might  find  quite  as  many  friends,  and  surely  more 
nearly  accomplish  the  supposed  object  of  their  existence. 

This  we  say  with  a  heart  in  sympathy  with  every  effort  that  may 
ttnd  to  make  men  better,  purer,  happier.  We  say  it  not  merely  in- 
spired by  disgust  at  the  presentation  of  such  indecent  advertisemenis 
at  our  own  counter,  making  us  doubly  ashamed  when  assured  that  cer- 


246  Edtor'B  Table,  [April. 

taiii  religious  papers  made  no  objection  to  tbeir  pnblication,  but  rather 
actuntc'l  by  a  dosire  to  see  these  great  mediums  of  power  and  inflnence 
working  from  a  higher  motive  than  mere  money  success,  and  looking 
to  a  grander  end  to  be  accomplished  than  the  pleasing  and  tickling 
and  puffing  of  men.  Christianity  can  need  no  help  bought  with  the 
profits  of  such  indecency.  The  cause  of  humanity  demands  a  litera- 
ture which  shall  inspire  a  truer,  purer  life. 

Old  Journals  Wanted, — ^To  complete  our  file  of  the  Western  Lancdf 
we  desire  to  obtain  the  following  back  volumes :  for  1848-'44— '45 
«»46-»47-'48-'49. 

A  medical  friend  also  desii-es  to  complete  broken  setts  of  varions 
Western  medical  periodicals,  and  has  made  out  the  following  list. 
Any  person  having  any  of  tlie.se  volumes  or  parts  of  volumes,  who 
will  dispose  af  them,  will  confer  a  favor  by  communicating  with  Dr. 
E.  B.  Stevens,  at  this  office. 

**  Western  Quarterly  Medical  Reporter.  "  Edited  by  Dr.  John  D, 
Godman  :  Cincinnati,  1822—2  Vols. 

"  Ohio  Medical  Repository."  Di-s.  Guy  W.  Wright  and  James 
M.  Mason,  Editors :  Cincinnati,  1826 — 1  Vol. 

*'  Western  Medical  and  Physical  Journal."  Drs.  Guy  W.  Wright 
and  Daniel  Drake,  Editors  :  Cincinnati,  1827 — 1  Vol.  Continued, 
as  **  Western  Journal  of  Medical  Sciences  by  Dr.  Drake,  till  1839. 

**  Louisville  Journal  of  Medicine  and  Surgery,"  by  Profs.  Miller, 
Yandell  and  Bell :  2  numbers  issued. 

**  Semi-Monthly  Medical  News,"  Louisville  Ky.  Want  Vol.  1, 
No  8. 

"Louisville  Medical  Gazette."  Want  Vol.  No  1,  6,  7,  8,  9,  10, 
11,  and  12. 

•'  Nashville  Monthly  Record."  Want,  Vol.  1,  No.  8  ;  Vol.  2,  No. 
1,  3,  5,  6,  9,  10,  12  ;  Vol.  3,  all  after  No.  3. 

'•  The  Western  Medical  Gazette."  Edited  by  Drs.  Eberle,  Mitchel, 
Smith  and  Gross.     Cincinnati,  1832-35—2  Vols. 

*•  Ohio  Medical  Repository,"  (second  of  the  name.)  Cincinnati, 
1835—1  Vol. 

"Western  Lancet."  Dr,  L.  M.  Lawson.  Cincinnati,  1842.  Want 
Vol.  1,  Nos.  1,  2,  3,  11,  12,  or  whole  volume  ;  Vol.  2,  Nos.  10,  12, 
or  whole  volume;  Vol.  11,  No.  1 ;  Vol.  15,  No.  1;  Vol.  17,  No.  11. 

"  Transylvania  Journal  of  Medicine  and  the  associate  Sciences." 
Edited  by  Drs.  John  E.  ^Gooke  and  Charles  W.  Short.  Lexington, 
Ey.,  1828.  Want  Vols.  1,6,  7,  8,  9,  11  and  12  entire,  or  the  entire 
Bet. 


1864]  Editor'9  TMt.  247 

The  American  Medical  Aasociaiion. — We  have  received  the  follow- 
iog  announcement  of  the  forthcoming  meeting  of  the  National  Asso- 
ciation in  New  York  city,  to  which  we  urge  the  special  attention  of 
tbe  profession,  and  all  bodies  and  associations  desiring  representation. 
We  also  trnst  that  the  several  special  and  standing  committees  will  be 
reminded  hereby  to  mature  their  reports  in  good  time  : 

The  15th  Annual  Meeting  of  the  "  American  Medical  Association," 
will  be  held  in  the  city  of  New  York,  commencing,  Tuesday,  June  7, 
1S64,  at  10  o'clock  A.  M.  Proprietors  of  Medical  Journals  through- 
ont  the  United  States  and  their  Territories  are  respectfully  requested 
to  insert  tho  above  notice  in  their  issnes 

GuiDo  FuRMAK,  M.  D.  Secretary. 

New  York  City,  March,  1864. 

We  also  append  the  following  extract  from  the  constitution;  show- 
ing the  proportion  of  representation  to  which  various  medical  organi- 
zations are  entitled.  Lists  of  delegates,  pix>perly  authenticated,  should 
be  forwarded  to  the  Secretary  at  New  York  as  early  as  possible,  to 
enable  him  to  make  duo  arrangments : 

Every  permanently  organized  Society,  College,  Hospital,  Lunatic 
Asylom,  and  other  medical  institutions  of  good  standing  in  the  United 
States,  and  from  the  American  Medical  Society  of  Paris,  have  tho 
privilege  of  sending  delegates  to  the  Asbociation,  as  follows  :  Every 
local  society,  one  delegate  for  every  ten  of  its  regular  resident  mem- 
bers ;  one  for  every  additional  fraction  of  more  than  half  this  number. 
The  faculty  of  every  regular  constituted  college  or  chartered  school 
of  medicine,  two  delegates.  The  medical  staff  of  any  municipal{hos- 
pital,  containing  one  hundred  inmates  or  more,  two  delegates  ;  and 
any  other  permanently  organized  medical  institution  of  good  standing, 
one  delegate." 

**  The  Chiefs  of  the  Army  and  Navy  Bureau  of  the  United  States, 
tmek/ottr  delegates,  to  represent  the  medical  staff  of  their  respective 
departments." 

And  in  this  connection  we  give  the  following  card  from  the  Treas- 
urer, Dr.  Wistar  of  Philadelphia  : 

Philadelphia,  March  1,  1864. 

DsAR  Sir  : — The  Transactions  of  the  American  Medical  Association, 
Vol,  XIV.,  arc  published,  and  now  ready  for  delivety. 

Should  yon  desire  a  copy,  please  remit  three  dollars  to  my  address. 
As  there  are  varions  methods  by  which  the  volume  may  be  sent, 
inforn  we  which  you  prefer.     If  by  mail,  please  forward  thirty -two 
cents  in  post-office  stamps^  that  your  postage  may  be  prepaid. 

Very  KespectfuUy, 

CASPAR  WISTER, 

Treasurer  American  Med,  Aaaoeiatiany 

No.  1808  Areh  StiMt. 


2^S  I  Editor's  TaUe.  [April, 

The  following  volumes  arofor  sale:— 

Proceedings  of  tlio  Meeting  of  Organization,  50  cents.  (Volt.  I., 
II.,  III.,  IV.,  and  VI.  are  oat  of  print.)  Vols.  V.,  VIL,  VUL.  and 
IX,  if  taken  collectively,  85  the  set ;  if  singly,  82  apiece  ;  Vol.  X.  at 
82  ;  Vol.  XI.  82  ;  Vol.  XII.  82  ;  Vol.  Xlll.  83  ;  Vol.  XIV.  88. 


•  mmm  ■  I 


MEDICAL  COLLEGES. 

The  Medical  College  of  Ohio  held  its  Annual  Commencement  in 
the  Ampithcatrc  of  the  college  on  Tuesday  evening  March  let  ult. 
The  valedictory  address  in  behalf  of  the  Faculty  was  delivered  by  Dr. 
M.  B.  Wright,  and  Flamcn  Ball  Esq.,  President  of  the  Board  of  Trua- 
toes  conferred  the  degree  of  Doctor  iu  Medicine  upon  the  following 
gentlemen,  thirty-one  in  nnmber  :  Abram  W.  Blackburn,  Oliver  L. 
Gaines,  Albert  P.  Esselborn,  Benj.  H.  Fisher,  Wm.  II.  Salcy,  Pat- 
rick T,  Gillanc,  James  E.  Finley,  Theodore  D.  Brooks,  G^eorge  W. 
('hinie,  George  P.  Daly,  Albert  G.  Brown,  Stephen  C.  Ayres, 
(rcorgc  A.  Hais,  Phillip  Kennedy,  Johnson  Lofland,  John  L.  Middle- 
ton,  John  C.  Miller,  Harrison  Phillips,  Daniel  W.  Humphreyville, 
Albert  H.  Hoy,  Solomon  B.  Hiner,  John  W,  Reed,  Alfred  L.  ViTood 
Joseph  Shugant,  Royal  Stuble,  Charles  P.  Simons,  Wm.  R.  Hamil- 
ton, Oliver  P.  Briuker,  R,  J.  Curtiss,  Wm.  H.  Barker,  Massillon 
<  )assatt. 

The  Starling  Medical  College  at  Columbus,  held  its  Commenoe- 
iiient  on  the  evening  of  March  1 8th.  The  graduating  class  numbered 
thirtv-two. 

m 

TJie  Commencement  Exercises  of  the  Buffalo  Medical  College  are 
represented  as  being  of  an  unusually  interesting  character.  It  was 
}u?ld  on  the  evening  of  February  23d,  the  graduating  class  numbering 
lorfy-one.  A  valedictory  on  behalf  of  the  class  was  delivered  by  Ed- 
win B.  Tefft ;  and  the  charge  to  the  graduates  by  Prof.  Chas.  A.  Lee. 
A  supper  at  the  American  Hotel,  with  speeches,  sentiment  and  good 
«'lieer  closed  what  is  claimed  as  one  of  the  most  prosperous  sessions 
the  Buffalo  school  has  heretofore  known. 

The  Massachusetts  Medical  College  held  its  commencement  on  the 
Dth  of  March,  thirty-eight  graduates  receiving  the  degree.  In  connec- 
tion with  the  exercises  of  the  occasion  Governor  Andrew  delivered  an 
address  to  the  class  which  is  spoken  of  as  abounding  in  eloquence 
:ind  happy  allusiona  appropriate  to  the  occasion.     ^ 


1864]  JSdUor'M  Table.  249 

Ccmmenameni  of  the  Bellemte  BospUal  Medical  College. — ^The 
third  AnnDAl  Commencement  of  the  Bellevae  Hospital  Medical  Col- 
lege was  held  March  3d,  at  the  Academy  of  Mnsic.  The  interest 
wbtch  the  public  take  in  this  institution  was  evinced  by  an  nnusuallj 
crowded  hoase.  Prayer  was  offered  by  the  Rev.  Dr.  Beach.  The 
Prenideat  of  the  Facalty,  Prof.  Isaao  E.  Taylor,  conferred  the  degi^ee 
of  Doctor  of  Medicine  upon  the  members  of  the  graduating  class.  The 
Hippocratic  oath,  containing  the  nsnal  injunctions  of  professional 
ethics  and  etiquette,  was  first  administered,  after  which  the  students 
who  were  to  receive  the  grade  pas8ed  upon  the  stage,  applause  greet- 
ing the  representatives  of  the  various  States  as  their  names  were  an- 
nounced. 

Two  members  of  the  class,  Engcne  0.  Rowe,  N.  Y.,  and  Chas.  E. 

Harris,  N.  S.,  deceased,  having  passed  examinations  and  amply  earm- 

ed  the  honor,  received  the  degree  as  a  ^stimonial  of  respect,  in  a  verjr 

inpressive  ceremony,  in  which  Dr,  Taylor  made  a  most  honorable 

and  touching  allusion  to  their  worth  and  merit.     The  addresses  to  the 

gnduates  were  delivered  by  Prof.  Flint,  who  reminded  the  gentlemen 

jvtt  presented  with  the  evidence  of  their  acquisitions  in  the  lecture 

room,  of  the  several  aims  which  should  actuate  them  in  the  profession 

of  vhich  they  had  now  become  members.     They  should  use  the  proper 

■eaos  for  securing  favor  ;  they  should  keep  pace  with  the  advance- 

Aeot  of  medical  knowledge  ;  they  should  even  aspire  to  contribute 

tbemselTes  to  that  advancement ;  and  above  all,  should  remember  that 

sot  talent  so  much  as  attention  and  timely  adoption  of  proper  methods 

sad  habits  is  the  most  essential  conaition  of  success.     Wm.  T.  Lusk, 

of  the  Graduating  Class,  delivered  an  eloquent  valedictory,  in  which 

hi  held  up  Jenner  as  the  model  physician.     Addresses  were  delivered 

hjr  the  Hon.  Simeon  Draper,  President  of  Commissioners  of  Public 

Charities  and  Correction,  and  of  the  Board  of  Trustees ;  and  Qeorge 

F.  Tallman,  Esq.,  of  the  Board  of  Trustees. 

CcmumemeemejU  of  the   UniversUy  Medical  College, — The   Annual 
Commencement  of  the  Medical  Department  of  the  New  Vork  Univer- 
nty  was  held  March  4th,  in  the  chapel  of  the  University  Building,-  in 
the  presence  of  a  large  assemblage.    The  members  of  the  Faculty^. 
among  whom  were  Dr.  Valentine  Mott  and  Dr.  Paine,  occapied  the 
platfiorm.     The  venerabb  Chancellor  Ferris  presided,  and  opene<l  ths 
czereites  with  a  selection  from  the  Scriplur^  and  prayer,  after  which 
ht  cooferred  the  degree  of  M.D.  upon  the  members  of  the  graduating 
class,  numbering  59. 
The  following  prizes  were  then  awarded ;  Prof,  tf  ott's  bronse  medalt 


250  JEd»ior'$  Tobk.  T^^pnlf 


to  Dr.  Charles  M.  MoLaurie ;  Prof.  Medcalfs  lat  prise«  a  pocket 
of  instruments,  to  Dr.  James  Moore ;  2d  prise,  a  case  of  inetr&inaRli 
for  post-mortem  examinations,  to  Mr.  Wm.  H.  B.  Post.  An  ezoal' 
tent  address  was  delivered  by  Dr.  Charles  A.  Badd,  and  ihe  ezeioiaaf 
Tvere  closed  with  a  benediction. 

Dr.  HoHBR  0.  HiTOHcocK,  of  Kalamasoo.  Mich.,  is  preparing  s 
paper  on  the  Entrance  of  Air  into  the  Uterine  Veins  in  forced  Abor- 
tion, to  be  read  at  the  meeting  of  the  American  Medical  AsaociatioB. 

Dr.  Eoberi  P.  Thomas,  Prof,  of  Materia  Medica.  in  the  Philadel- 
phia College  of  Pharmanj,  died  on  the  8d  of  Febrnary,  1884,  aged 
4B  years. 

Dr.  Thomas  has  been  generally  recognize  as  one  of  the  moat  leal- 
ous  pharmaceutists  in  this  country.  *'  He  was  elected  to  the  chair  of 
Materia  Medica  in  the  year  18^.  His  abilities  as  a  teacher  of  that 
branch  have  been  constantly  in  the  ascendant,  and  at  the  period  of 
his  decease  he  was  undoubtedly  one  of  the  ablest  lecturers  on  Mate- 
ria Medica  in  the  United  States." — Am,  Jour,  of  Phar, 


Army  Medioal  Intelligenoe. 

CiRcrLAR  No.  5. — Surgeons  in  charge  of  General  Hospitals  are 
hereby  positively  instructed  that  when  a  soldier  is  discharged  from 
service  on  account  of  wounds  received  in  action,  that  fact  will  be  en- 
tered both  on  the  Discharge  and  Final  Statement  of  the  soldier. 

By  order  of  the  Acting  Surgeon-General. 

Surgeon  William  Clendenin,  U.S.V.,  has  been  relieved  from  dot j 
AS  Acting  Medical  Inspector,  and  is  assigned  to  the  position  of  As- 
sistant Medical  Director,  Department  of  the  Cumberland,  at  Nash- 
ville, Tenn.,  relieving  Surgeon  A.  H.  Thnraton,  U.S.Y.,  who  has  re- 
lieved Surgeon  John  McNulty,  as  Medical  Director,  12th  Army  Gorpe. 

Surgeon  McNulty  is  at  Tullahoma,  Tenn.,  slowly  con valescing  from 
his  severe  injury  (concussion  of  the  brain,  caused  by  a  fall  from  his 
horse  while  on  duty)  ;  is  able  to  sit  up  and  walk  around  hia  room, 
and  expects  t<f  be  fit  for  hospital  duty  in  six  weeks. 

Assistant-Surgeon  Charles"J.  Kipp,  U.S.Y.,  has  been  relieved  frooi 
duty  at  Nashville,  Tenn.,  and  assigned  to  the  Military  Prison  Hospi- 
tal, Camp  Morton,  Ind. 

Surgeon  S.  J.  W.  Mintzer,  U  S.V.,  has  been  relieved  from  do^ 
At  General  Hospital,  McMinnville,  Tenn.,  and  assigned  to  the  2d  Di- 
vision, 14th  Army  Corps?  Army  of  the  Cumberland. 

Surgeon  William  Grinste^,  U.S.Y.,  in  addition  to  his  duties  aa 
Recorder  of  the  Army  Medical  Board,  now  in  session  at  Cincinnati, 


ISM]  JSdiior's  TabU.  m 

Ohio,  for  ibe  cgcAmination  of  Assistant-Surgeons  of  Yolnnteers,  will 
nlWve  Sorgeon  F.  M.  Heister,  U.S.V.,  as  a  member  of  the  Boards 
also  in  scission  in  the  same  city,  for  the  organisation  of  the  Invalid 
Corpa.  On  being  relieved  Sargeon  Heister  will  proceed  without  de- 
lay to  Louisville,  Ky.,  and  report  in  person  to  Assistant  Surgeon- 
Qeoeral  Wood,  U.S.A.,  for  assignment  to  duty. 

Aasistant- Surgeon  Harvey  E.  Brown,  U.S.A.,  is  relieved  from  duty 
at  Fori  Columbus,  New  York  harbor,  and  will  report  in  person  with- 
out delay  for  duty  to  the  commanding  Creneral,  Department  of  Hew 
Mexico. 

Appointments  confirmed. — ^Tbe  Senate  has  confirmed  the  appoint- 
ment of  Bledical  Inspector  Joseph  K.  Barnes,  U.S.A.,  to  be  Medical 
laapector  General,  U.S.A.,  with  the  rank  of  Colonel. 

The  journey  from  Washington,  D.  C,  to  Louisville,  Ky.,  and 
hack  in  order  to  turn  over  his  property  at  the  latter  place,  made  by 
tejgeon  A.  U.  Uoff,  U.S.Y.,  is  authorized ;  he  having  reported  in 
ihia  city  in  obedience  to  a  summons  from  a  Judge- Advocate  of  a 
Giiieral  Court-Martial  as  a  witness,  and  bis  station  having  been 
Mantime  changed  from  Louisville,  Ky.,  to  the  Department  of  the 
East. 

Burgeon  L.  H.  Ilolden,  U.S.A.,  is  relieved  from  duty  in  the  De-* 
piitment  of  the  Monongahela,  and  will  proceed  without  delay  to  Chi- 
cago, III.,  and  relieve  Surgeon  J.  B.  Porter,  U.S.A.  (retired),  in  his 
dttiai  at  that  place. 

ne  order  of  Brigadier-Oeneral  Slemmer,  U.S.V.,  President  of  the 
Examining  Board  at  Cincinnati,  Ohio,  daied  February  4,  1864,  di* 
retting  Surgeon  F.  H  Oross,  U.S.V.,  to  join  his  command  without 
Way,  and  paragraph  37,  Special  Orders  No.  64,  from  thee  War  De- 
^ment,  confirming  the  above,  is  i-evoked.  Surgeon  Gross  will 
WBply  with  the  requirements  of  Special  Orders  No.  62,  February  8, 
1864.  directing  him  to  report  to  the  commandi ug  General,  Middle 
l>epartment,  for  duty  at  Camp  Parole,  Annapolis,  Md. 

■ 

Sui^peon  Ealward  Sbippen,  U.S.V.,  is  stationed  at  Knoxville,  Tenn., 
•s  Medical  Director  of  The  Poet. 

IIbadquarters  Department  op  the  Ohio, 
Knoxville,  Tennessee,  March  9,  1864. 

Circular  jVo.  7. — Upon  the  recommendation  of  the  Medical 
Director,  the  following  ambulance  system  will  be  adopted  in  the  Army 
of  the  Ohio,  in  the  Field  : 

Ambulances  will  be  allowed,  one  for  each  Regiment,  or  battery,  or 
DeCached  Battalion,  one  to  each  Division  at  Corps  Headquarters,  and 
oee  to  the  Medical  Director  of  the  Department 

The  ambulances  of  each  Division  will  park  by  themselves. 

All  Regimental  ambulances,  will,  as  one  train,  march  in  the  rear  of 
die  eofamn,  and  will  be  accompanied  by  a  Medical  Officer,  detailed 
Jmtlj  for  that  dntjf  who  shall  permit  men  to  ride  who  are  nnabl^  to 


262  JSdUorial  Abitrada  and  SebdUmi.  [April, 

march.  No  man  will  be  allowed  to  ride,  anlees  autliorfaed  to  fall  oat 
of  rankB  for  that  purpose,  by  written  order  of  one  of  his  R^mratal 
Medical  Officers  The  Regimental  ambulances  will  carry  the  medi- 
cine  chest  and  instruments  of  the  Regiment,  and  no  other  baggage 
whatever.  They  will  report  for  these  articles  at  the  hour  of  movingp 
and  deliver  them  at  night.  AH  ambulances  are  subject  to  be  rcqnired, 
when  necessity  arises  for.  conveying  sick  or  wounded  men»  and  wOl 
be  cheerfully  yielded  on  application  of  the  Medical  Direotor  oraolhor* 
ised  officer. 

Two  stretchers  will  be  carried  by  each  ambulance  at  all  times. 

The  ambulance  boxes  will  be  kept  filled  with  extract  of  beef,  ex* 
tract  of  coffee,  tea  and  sugar.  They  will  carry  in  addition,  two  tia 
cups,  two  tin  plates,  two  knives  and  forks,  two  spoons,  a  water  backet 
and  a  small  camp  kettle.  Attendants  and  bearers  will  be  detailed  in 
proportion  of  one  Sergeant,  one  Corporal  and  ten  men  to  every  fve 
ambulances.  They  will  be  marked  on  the  field  by  a  white  fellet  on 
the  left  arm,  and  no  others  will  be  allowed  to  handle  or  remove 
wounded  men.  They  will  be  inquired  to  report  at  the  station  of  the 
ambulances  of  their  respective  Divisions,  whenever  the  troops  go  into 
action  or  are  drawn  up  in  line  of  battle.  A  Military  Officer  moantad, 
to  be  designated  by  the  General  Commanding,  will  be  assigned  lo 
daty  as  Chief  of  the  Ambulances.  This  officer  will  be  responaible 
for  the  eare  and  condition  of  vehicles,  horses  and  harness,  and  for  the 
presence  and  discipline  of  the  drivers  and  attendants.  He  will  report 
daily,  in  person,  to  the  Medical  Director  for  orders  and  instmctioos. 
He  shall  be  allowed  additional  officers  when  required,  for  separate 
trains,  running  to  and  from  depots  of  wounded  on  the  field  of  batlkp 
or  proceeding  to  distant  points. 

No  military  stores  shall  ever,  or  under  any  circumstances,  be  plac- 
ed in  or  carried  by  the  ambulances,  set  apart  for  the  sick  and  wounded. 

Bt  command  of  Major  Oenebal  Schofibld  : 

J.  A.  CAMPBELL, 

Assistant  Adjutant  (Jeneral. 

Official:  Hbnrt  Cqrtiss, 

Assistant  Adjutant  Gkneral* 


I*  • 


PUSPAftSD  BT  W.  B.'FUTOIUB,  M.  D.,  IllDIAIfArOLII. 

PRACTICAL    MEDICINB. 

1'  On  the  Bjfpodermical  Treatment  of  DUetue. — ^In  1858-59  papers 
were  oommunicatedto  some  of  the  Medical  Journals  by  Charles  Hun- 
ter, Esq.,  M.  R.  0.  B.,  establishing  the  application  of  "the  puncture** 
to  the  treatment  of  diseases  affecting  the  organism  generally,  or  at 
points  far  remote  from  the  point  of  Medicinal  introduction. 

This  meihod  has  special  valoe  in  subduing  cerebral  and 
ezeiteiDent. 


1864.]  BdiUmal  Abatraeis  and  SelecHoM.  268 

The  alkaloids  of  belladonna,  aconite,  drc.»  were  first  employed  hj- 
podennicaDy  by  Mr,  Hunter,  althongh  the  balk  of  his  obsenrationa 
relative  to  the  the  action  of  morphia. 

Though  the  value  of  this  mode  of  treatment  is  most  marked  in 
ions  of  the  nervous  system,  from  the  rapid  way  in  which  it  wiQ 
prodooe  sleep,  and  lull,  or  cure  pain,  still  there  are  many  other  affeo- 
tioiui — blood  diseases — which  show  the  superiority  this  method  has 
over  others,  in  checking  disease. 

Four  or  five  grains  of  quinine  injected  beneath  the  skin,  are  equal 
to  five  or  six  times  that  quantity  taken  by  the  stomach.  Bmall  doses 
of  morphine,  given  in  this  way,  will  procure  sleep  in  delirium  tremens, 
when  large  stomachic  doses  fail. 

The  solutions  used  are  the  most  concentrated  that  can  be  produced. 
The  lesA  the  bulk  of  the  fluid  injected,  the  better.  Thi-ee  mivima 
duowD  in  at  one  place,  produces  no  pain.  • 

The  punctures  should  not  be  made  close  together,  or  acute  inflam- 
MSlion  of  the  cellular  tissue  will' result. 

The  fluid  employed  should  be  as  near  neutral  as  possible.  * 

The  mode  of  action  of  our  narcotics  and  sedatives,  is  so  little  known 
or  thought  about,  that  practicioners  are  often  in  doubt  as  to  which 
■geat  to  employ  in  such  and  such  a  case.  The  special  parts  of  the 
■onrona  system  upon  which  the  various  alkaloids  act,  are  not  suffi- 
dently  considered.  • 

By  tlie  hypodermical  administration  of  the  medicines,  these  difier* 
eat  effixsta  are  better  seen,  than  when  given  by  the  stomach. 

When  a  dose  is  given  by  the  mouth,  it  has  to  pass  into  the  intee* 
Ciaal  tract  and  through  the  portal  circulation  before  it  reaches  the 
and  its  systematic  effects  are  more  slowly  developed.  But 
inlrodnoed  into  the  cellolar  tissue,  the  absorbent  vessels  carry  it 
■a  once  to  the  fountain  head  of  arterial  supply,  its  effects  are  more 
powerful,  and  better  observed. 

The  effects  of  morphia  and  atropine  on  the  same  subject,  are  thus 
described  : 

John  A ,  with  sciatica  of  some  years  standing,  was  injected  in 

tho  arm  with  half  grain  of  morphia.  The  pulse  at  the  time  was  80, 
^[miei  and  small ;  in  one  minute  it  was  76,  fuller  and  stronger  in  qual- 
ity ;  in  twelve  minutes,  the  quality  remained  full,  but  in  rate  dtmin- 
islied  to  66  ;  the  brain  circulation  was  influenced,  he  was  drowsy ;  he 
aiopt  better  that  night  than  for  months  before. 

K  his  pulse  is  light,  and  the  patient  ejKited,  the  action  of,  the  heart 
in  diminished  in  proportion  to  the  dose  injected.  Thus  in  mania,  it 
m  rtduoed  from  120  to  80,  in  four  minutes,  and  the  respirations  di- 
■uniahed  accordingly,  at  the  same  time    the    cntaneous    action    is 


The  effecta  of  injected  morphia,  are : 

lot.  Upon  the  heart,  and  its  arteries. 

2nd.  Upon  the  lungs. 

And  aleep  ia  brought  about  by  diminished  action  of  the  heart,  by 
dteiniahed  rate  of  reapiration,  consequently,  slower  circulation  in 
tho  brain,  diminished  oxygenation  in  the  blood.    This  first  lowerinf^ 


254  Ediiorial  AUtracU  and  Selectiont.  [April, 

effect  upon  the  circulation  is  a  point  of  practical  importance  in  faneat- 
ment  of  inflammations. 

The  acute  pain  that  accompanies  the  earlj  stages  of  inflammation 
of  the  cje,  the  pleura,  and  the  peritoneum,  are  cases  when  a  single  ia- 
jection  will  do  more  good  than  doses  of  calomel  and  opinm  repeatad 
at  intervals  hj  the  mouth. 

The  same  patient,  at  another  time  had  [an  attack  of  sciatica.  Fall 
doses  of  atropine,  (his  pulse  at  the  time  being  88,)  in  three  minutes  it 
was  96,  in  six  minutes  108,  in  ten  minutes  96  —  twelve  hoars  66. 
The  patient  felt  a  glow  all  over  him  three  minutes  after  the  injection ; 
pupils  dilated  in  five  minutes. 

In  the  several  examples  given  of  the  use  of  these  two  alkaloids,  the 
following  results  have  been  obtained  : 

BearVi  Action  ;  n)orphia»  the  heart's  action  diminished — ^beatii^ 
slower  after  the  injection.     Atropine,  heart's  action  stimulated,  pnlse 
growing  more  rapid ;  heart  beating  more  powerfully. 
•  MespiratUm  ;  morphia,  rate  of  respiiation  diminished.     Atropine, 
respiration  short  and  hurried. 

Atropine  is  not  a  cerebral  narcotic,  it  is  a  stimulant  at  the  -oataet, 
then  a  sedative,  and  sleep  is  not  produced  as  bj  morphia,  bat  it  be- 
nnmbs  sensibility,  pain  is  relicvea,  and  sleep  follows.  Sleep  begina 
with  the  eyes  open, ;  respiration  deep,  irregular^  but  not  sterterons, 
and  the  pulse  quicker  by  20  beats  than  usual. 

The  chief  nerves  affected  by  atropine,  are  the  sciatic  and  pnenmo- 
gastric. — Lancet 

2.  Digiialis  in  the  treatmenlof  Epilipsy. — A  nursing  child,  not  quite 
two  years  old,  was  brought  to  Prof.  Clark's  clinic,  to  be  treated  for 
"fits,"  from  which  it  had  suffered  for  the  last  twelve  months,  occnr- 
ring  every  three  or  four  weeks,  limited  to  one  a  day,  thongb  on  one 
day  it  had  seven. 

The  character  of  the  disease  was  evidently  epiliptic,  and  Professor 
Clark  determined  to  give  the  digitalis  a  trial.  The  child  was  accord- 
ingly put  upon  one  drop  of  the  tincture  three  times  a  day,  with  direc- 
tions to  increase  the  dose  gradually  as  circumstances  might  indicate. 
No  attack  occurred,  however,  since  commencing  with  the  tincture,  one 
drop  of  which  had  been  taken  regularly,  three  times  a  day,  until  foor 
months  had  elapsed,  when  the  child  was  last  seen  at  the  clinia 

Prof.  Van  dcr  Kock  has  had  some  snccess  in  the  treatment  of  epil- 
epsy, by  applying  cupping  glasses,  with  scarification,  or  leeches,  to  the 
back  of  the  neck,  followed  by  seton,  or  issue,  with  a  view  to  moder- 
ate the  exalted  sensibility  of  the  medulla  oblongata,  and  proscribing 
internally  the  infusion  of  digitalis,  with  small  doses  of  tartar  emetic. 
if  the  patient  can  bear  them  without  nausea,  to  moderate  still  fnrtlier 
the  excited  vascular  action  ;  but  he  says  he  never  succeeded  in  curing 
a  case  with  digitalis  .alone,  though  he  believes  it  contributes  much  to- 
wards promoting  the  cure. 

3.  Treatment  of  Whooping  Cough  by  Belladonna  and  Sulphate  qfZinc. 
E.  Garraway,  writing  of  whooping  congh  says  : — ^The  prcpunderalice 
of  opinion  is  in  favor  of  its  being  a  nervous  disorder ;  and  Appears  to 


1864.]  XHiorwi  AhitraeU  and  Sehdbm.  255 

kare  s«  macli  claim  to  be  so  considered  as  asthma,  chorea,  epilepsy^ 
or  other  convnlsive  disorders  which  it  has  been  impossible  to  localize 


The  treatment  by  belladonna  and  snlpbate  of  zinc,  in  some  fiflj  o^ 
siztj  cases  was  eotirelj  successful :  it  was  g^ven  in  extract,  eithei* 
diffused  in  water  with  the  zinc,  with  sufficient  syrap  to  make  it  agree* 
able  to  children,  or,  to  those  whe  were  old  enough,  in  pills ; — the  dos^ 
being  from  one  sixth  to  one  fourth  of  a  grain,  of  extract  of  belladonnat 
and  half  a  grain  of  zinc,  three  or  four  times  a  day,  steadily  increasing 
the  amount  till,  at  4he  end  of  three  weeks,  children  would  be  taking 
ffom  four  to  six  grains  of  belladonna,  and  twice  that  quantity  of  sul- 
phate of  zinc,  daily. 

80  far  as  investigations  went,  it  would  appear  that  both  the  toler- 
ance of  the  remedy  and  the  speedy  subsidence  of  the  disorder,  were  in 
inverse  proportion  to  the  age  of  the  subject — a  child  eight  or  ten 
months  old  bearing  much  larger  proportionate  doses,  than  one  from 
eight  to  ten  years. 

When  the  pupils  have  become  dilated,  the  doso  was  diminished  for 
a  few  days. — Lancet. 

4  On  ike  Treatmeni  of  AethmaHe  paroxysme  by  full  doeee  <^  Alcohol, 
— ^Hjde  Salter,  M.  D.,  who  has  recently  written  a  work  upon  Asihma. 
itataa  that  he  has  reason  to  change  his  views  upon  the  use  of  alcohol 
bj  asthmatic  patients : 

He  has  latelv  had  three  cases,  in  which  nitre  paper,  ether,  stramo- 
Bicai»  eoflfee,  lobelia,  chloroform,  emetics  and  everything  else  was 
fovDd  useless,  when  the  asthmatic  paroxysms  instantly  gave  way  upon 
the  patients  imbibing  freely  hot  Scotch  whisky,  gin  or  brandy. 

In  carrying  out  this  treatment,  he  gives  the  following  rules  : 

The  alcohol  must  not  be  given  as  a  diet — that  is,  not  sipped 
padaally. 

It  must  be  given  in  quantities  sufficient  to  produce  the  physiological 
eflbcta  of  the  drug. 

The  most  concentrated  forms  of  alcohol  are  the  best — ^brandy,  grin, 
whiaky  : — the  weaker  being  inoperative  in  proportion  to  its  dilution. 

It  is  best  given  koi. 

Its  continued  use  requires  increase  of  quantity. 

Raniember  the  use  of  alcohol  is  more  easily  begun  than  left  off,  and 
o«ly  when  every  other  remedy  fails,  can   it  b^  justifiably  used. — 


5.  Aniidoiee  for  Siryehna, — Professor  R.  Bellini,  after  eonductii^ 
a  long  series  of  experiments  on  poisoning  by  strychnia  and  its  salts, 
arrives  at  the  opmion,  that  the  best  antidotes  are  tannic  acid  and 
teamin,  chlorine  and  the  tinctures  of  iodine  and  bromine.  Chlorine, 
he  maintains,  attacks  the  strychnia  even  when  it  is  diffused  through  the 

rrm,  for  he  found  that  in  rabbits  poisoned  with  the  sulphate  of  the 
oid,  on  being  made  to  inhale  chlorine  gas  in  quantity,  such  as 
was  not  sufficient  in  itself  to  kill,  the  convulsions  were  retarded,  and 
were  milder  whed  they  occurred  ;  death  also  was  less  rapid.  The 
aalhor  further  observed,  that  when  strychnia  was  exhibited  with  pyro- 
gallic  acid,  the  convulsion  was  retai-ded  for  the  space  of  half  an  no^oix^ 


256  JEdiiorial  AbttraeU  and  S^gdiom.  [Apri 

by  comparison  with  other  experiments  in  which  the  alkaloid  waagivaa 
by  itself.  Professor  Bellini  believes  that  this  arrest  in  symptomt  it 
not  dependent  on  the  ncid  acting  chemically  on  the  strychnia,  bnt 
only  through  the  astringent  effects  produced  by  the  acid  on  the  mncons 
membrane  of  the  stomach,  whereby  the  absorption  of  the  poison  is 
tendered  difficult.  The  same  author,  dwelling  on  the  frog-teat  for 
8tychnia»  asi^rts  t|}at  this  test  is  not  to  be  trusted,  inasmuch  aa  other 
poisons  proauce  the  tetanic  symtoms,  although  in  a  lesser  degree. — 
British  Mediccd  Journal. 

Compound  Santonin  LazengtB, — ^The  following  receipe  has  Veen 
furnisihed  us  for  publication,  as  thai  used  by  Mr.  Fougera,  of  New 
York,  in  making  his  '*  Dragees  de  Bantonine  Uomposeea  "  used  as  a 
Vermifuge. 

Grammes. 
{I.  Santonin,  25  00 

Jaiapin,  10.00 

Polv.  Gum  Arabic,  80.00 

Chocolate,  pure,  60.00 

White  Sugar,  160.00 

Water,  q.  s.  about,  15.00 

Make  a  pilular  mass,  divide  into  one  thousand  pills,  and  coat  with 
sugar.  Laterally,  Jaiapin  hos  been  replaced  by  the  resin  of  gamboge* 
owing  to  the  scarcity  of  the  former. 

The  origin  of  Cow  Pox  and  the  nature  of  Vaccine  Virus, — Investiga- 
tion on  this  subject  in  the  Paris  Academy  of  Medicine,  has  led  to  the 
following  conclusions: 

1st,  That  vaccine  virus,  (as  a  thing  separate  and  apart,)  has  no 
existence. 

2d,  That  the  pretended  vaccine  virus,  which  we  consider  as  antag- 
nistic  to,  and  neutralizing  the  variolus  virus  itself. 

3d,  That  the  equine  and  bovine  species  are  subject  to  an  eruptive 
malady  which  is  identical  as  regards  its  nature,  with  variola  of  the 
human  species. 

4th,  It  is  demonstrated  that  the  same  is  the  fact  as  regards  several 
other  species  of  animals,  pigs,  sheep,  dog.^,  goats,  apes,  etc. 

5th,  The  local  and  general  phenomena  with  animals  is  the  same  as 
those  observed  in  man.  The  only  difference  as  regards  the  pustules 
are  those  which  depend  on  the  structure  of  the  skin  and  the  number 
of  the  hairs. 

6th,  As  in  the  human  species,  so  in  the  equine  and  bovine,  variola 
may  appear  sporadically  or  epidemically. 

7th,  From  the  horse  we  may  '  inoculate  the  cow.  and  reciprocally. 

8th,  From  the  cow  we  may  inoculate,  without  difficulty,  individu- 
als of  the  human  species,  provided  they  have  not  had  spontaneous  or 
inoculated  variola. 

9th,  The  cow,  the  horse,  and  several  other  species  may  be  inoca- 
lated  with  variolus  matter  from  the  human  species. 

10th,  When  a  variolus  epidemic  occurs  among  men,  it  often  ex- 
tends itself,  by  contagion,  to  other  animals. 


1864]  Editorial  Abstracts  and  Selection.  257 

11th.  An  epidemic  of  varioia  may  commence  among  animals,  and 
extend  to  man. 

12th,  Inoculated  variola  prodnccs  a  much  less  degree  of  general 
reaction,  than  does  variola  developed  by  contagion.  This  is  true  in 
both  man  and. lower  animals. 

ISih  The  pustules  which  result  from  inoculated  variola,  are  often 
limited  to  the  points  inoculated. 

14th,  When  a  secondary  eruption  is  produced,  it  is  almost  always 
insignificant,  and  composed  of  a  small  number  of  pustules. 

15th,  In  a  general  manner  we  may  say  that  the  variola  of  animals 
la  more  discrete,  and  less  severe,  than  that  of  the  human  species. 

16th,  That  the  dangers  of  inoculation  of  variola  in  man  have  been 
mnch  exaggerated.  Tne  unprejudiced  study  of  what  has  been  written 
CD  this  subject  will  convince  of  this. 

17th,  It  is  probable  that  animals,  as  man,  are  subject  to  aphthous 
emptions. 

18th,  But  the  maladie  aphiheuse,  as  it  is  described  by  writers  on 
veterinary  medicine,  is  nothing  else  than  variola. — Medico  ChirurgUal 
Rmew, 


SimGICAL. 

7.  Hemoval  of  a  broken  Catheter  from  the  Bladder. — Assistant  Sur- 
geon Brett,  2l8t  Wis.  Vol.  Inf.,  gives  in  the  American  Medical  Tim^s 
for  October  17th,  1863,  the  following  account  of  an  ingenious  and 
successful  operation  in  an  accident  of  this  kind,  by  Dr.  C.  8.  Mnscroft, 
of  Cincinnati,  then  Medical  Director,  3rd  Division,  14th  Army  Corps: 

Jacob  Sheets,  a  corporal  of  Company  I,  lOlst  Ohio  Vol.  Inf.,  was 
admitted  into  one  of  the  hospital  depots  of  the  3d  (Maj.  Qen.  Rose- 
crans)  Division,  14ih  Army  Corps,  in  the  Department  of  the  Cumber- 
land, on  the  Ist  day  of  January,  1863,  having  been  wounded  on  the 
day  previous  by  a  ball  (supposed  to  be  a  minie)  at  the  battle  of  Stone 
River. 

The  ball  entered  from  behind  at  the  inferior  border  of  the  gluteus 
maximus  muscle  an  inch  and  a  half  to  the  right  of  the  mesian  line, 
and  passe<i  obliquely  forward  and  upwards,  wounding  the  nre(hra  in 
the  posterior  third  of  its  spongy  portion  ;  then  making  its  exit  at  the 
aoperior  portion  of  the  scrotum  half  an  inch  to  the  left  of  the  raphe,  it 
having  passed  through  the  superior  third  of  the  left  testis.  When  the 
pattentwas  fi  rst  admitted,  his  penis  and  scrotum  were  enormously 
eedemtons,  with  ecchymosis  extending  above,  over  nearly  the  whole 
of  the  hypogastric  and  iliac  regions.  When  he  attempted  to  urinate 
the  water  flowed  freely  from  the  wound  anteriorly  ;  consequently  he 
had  volantarily  retained  his  urine  for  twenty  .four  hours.  A  silver 
catheter  was  now  introduced,  and  the  contents  of  the  bladder  evacuated 
aflter  which  a  gum  elastic  catheter  was  substituted,  and  left  in  th 
onrthra,  being  confined  there  by  suitable  dressings.    The  catheter  w a 


258  EdUorial  Absiradi  and  Selection*.  \A.^\t\. 

«o  arranged  as  to  condact  the  urine  into  a  fflass  bottle.     Comprassei 
wet  with  cold  water  were  applied  to  the  inflamed  parts. 

January  3d. — The  scrotum  appeared  nearly  the  same  as  on  the  fint» 
except  that  it  was  softer  and  flnctnating.  The  penis  was  still  swollen, 
discolored,  and  oedcmatous.  Two  incisions  were  mad|3  throv^h  tlie 
coTering  of  the  testes  into  the  sac  of  the  tnnica  vaginalis.  The  dis- 
charge of  pus  and  fcetid  urine  was  abundant. 

January!  5th. — ^The  ecchymosis  in  and  about  the  penis  was  much 
tliminiKhed,  but  a  portion  of  the  scrotum  was  evidently  gangrenooi. 
A  line  of  deraarkation  had  formed  on  the  seventh,  and  on  the  tenih 
had  separated,  leaving  the  testes  bare  to  the  extent  of  nearly  the  whole 
of  their  anterior  surface. 

Adhesive  straps  were  then  applied  to  the  removing  integument  of  th* 
scrotum,  drawing  the  edges  together  as  near  as  possible,  to  form  an 
anterior  covering. 

About  this  time  the  urine  became  loaded  with  sediment,  leaving  a 
light  colored  gritty  deposit  on  the  end  of  the  catheter  which  protruded 
into  the  bladder,  also  filling  the  whole  of  the  length  of  its  tube,  pre- 
venting the  passage  of  urine. 

This  was  removed,  and  another  introduced.  In  three  days,  it  be- 
came filled  with  deposit  in  like  manner  to  the  former  one,  and  another 
of  smaller  size  (which  was  the  only  one  at  hand  at  the  time)  was  in- 
troduced. 

On  the  following  morning  (the  25th)  I  was  called  to  see  the  patient, 
and  found  that  the  catheter  had  been  broken  off  about  midway  ;  the 
distal  end,  which  was  the  longest,  having  fallen  out  of  the  urehra,  the 
other  remaining  in,  the  outer  end  of  which  could  be  distinctly  felt  with 
a  probe.  In  this  emergency  I  called  upon  Surgeon  C.  S.  Muscroft, 
the  Medical  Director  of  the  8d  Division,  who  readily  responded,  bring- 
ing with  him  a  long,  straight,  narrow  bullet  forceps,  which  was  the 
only  instrument  in  his  possession  that  promised  any  success  in  the  te- 
traction  of  the  remnant  of  the  catheter.  The  patient  was  put  under 
the  effects  of  chloroform,  when  it  was  found  on  examination,  that  the 
remaining  end  had  receded  behind  the  symphysis  pubis  into  the  mem- 
branous portion  of  the  urethra,  and  could  not  be  reached  with  the 
straight  forceps.  Here  Dr.  Muscroft  ingeniously  improvised  a  curved 
forceps  by  heating  those  he  had  in  the  stove,  and  bending  them  to 
the  proper  curvature  over  the.  window-sill.  The  patient  being  still 
under  the  influence  of  chloroform,  the  forveps  were  again  introduced, 
and  after  persevering  efforts,  the  broken  piece  of  catheter  was  nicely 
and  firmly  grasped,  and  extracted. 

The  catheter  was  not  again  introduced,  but  compresses  and  adhesive 
straps  were  made  around  the  urethra  with  a  view  to  re-establish  the 
natural  urinary  channel  and  obliterate  the  fistulous  opening. 

This  was  successfully  accomplished.     The  urine  was  avoided  freely  ' 
from  the  meatus  externns,  none  escaping  at  the  wound. 

On  the  27th,  the  patient  had  a  heavy  chill,  and  on  the  following 
day  complained  of  great  pain  in  the  perineum  at  the  right  and  lower 
portion ;  a  slight  degree  of  redness  and  swelling  was  perceptible. 
On  the  fifth  day  following,  an  abscess  had  formed,  which  was  punc- 


1884.  Editorial  Seledions  and  Ahdraeti.  HSM 

tared,  and  discharged  a  large  quantity  of  pns.  From  tbis  time  for- 
ward the  patient  steadily  improved,  and  was  discharged  from  the  hoe- 
pHal  cared. 

8.  JUdO' Vesical  LHhomy  in  the  Male.-The  Paris  correspondent  of  the 
London  Lancet  wiitcs  as  follows  : — **  Yon  published  last  year  a  paper 
bj  Mr,  James  Lane  '  On  Lithotomy  in  the  Female  Bladder/  in  favor 
of  the  vesico-vaginal  incision.  Dr.  Marion  Sims,  of  New  York,  now 
practising  in  Paris,  considers  that  the  facility  and  invariable  success 
with  which  a  cut  in  the  vesico-vaginal  septum  may  now  be  closed 
soggest  this  as  '  the  only  justifiable  operation  for  stone  in  the  female 
Uadder.'  He  performed  this  operation  first  in  1850.  It  has  since 
bean  repeatedly  performed  in  America  by  Dr.  Emmett,  of  the  Women's 
Hoitpital  of  New  York,  and  by  Dr.  Bennett,  of  Connecticut.  Thesim- 
plidiy,  safety,  and  unfailing  success  of  the  operation  are  spoken  of  in 
warm  terms. 

**  The  application  of  this  to  the  parallel  method  of  recto-vesical 
lUkUomy  in  the  male  is  a  subject  worthy  of  careful  consideration. 
Recto-vesical  lithotomy  in  the  adult  is  a  proceeding  which  was  used 
loog  before  the  introduction  of  metallic  sutures,  and  was  followed  with 
modifications  by  Mr.  Lloyd,  of  St.  Bartholomew's.  Without  these 
eotnres  it  was  liable  to  a  serious  objection — the  occasional  persistence 
of  recto-vesical  fistula.  The  silver- wire  sutures,  however,  promise  to 
obviAte  this  inconvenience.  Dr.  Sims  has  mentioned  to  me  a  case  in 
which  Dr.  Bauer,  of  New  York,  operated  bv  tbis  plan  in  1859,  Dr. 
Siint  putting  in  the  sutures.  He  says  : — '  The  patient  was  placed  on 
tlie  left  side,  and  my  speculum  was  introduced  into  the  recium,  ex- 
posing the  anterior  wall  of  the  rectum,  just  as  it  would  the  vagina  in 
tbe  femflie.  A  sound  was  passed  into  the  bladder.  The  Doctor  en- 
ttrod  the  blade  of  a  bistoury  in  the  triangular  space  bounded  by  the 

Soatrate,  the  vesiculro  seminales,  and  the  peritoneal  reduplication, 
e  passed  the  finger  through  this  opening,  felt  the  stone,  and  re- 
moved it  with  the  forceps  without  the  least  trouble.  The  operation 
wna  done  as  quickly  and  as  easily  as  it  would  have  been  in  the  female 
throngh  the  vaginal  septum.  After  the  removal  of  the  stone.  Dr. 
Baaer  kindly  a^ked  me  to  close  the  wound  with  silver  sutures,  which 
I  did,  introducing  some  five  or  six  wires  with  the  same  facility  as  in 
tbe  ragina.  There  was  no  leakage  of  urine.  The  patient  recovered 
without  the  least  trouble  of  any  sort.  The  wires  were  removed  on  the 
eii^bth  day,  and  on  the  ninth  day  the  patient  rode  in  a  carriage  with 
Dr.  Bauer  a  distance  of  four  or  five  miles  to  call  on  and  report  himself 
lo  oar  distinguished  countryman,  Dr.  Mott.  The  facility  and  safety 
of  execnting  recto-vaginal  lithotomy  (except  in  children,  for  anatom- 
ical reasons.)  and  the  success  of  closing  at  once  the  cut  by  the  intro- 
duction of  metallic  sutures  ought  to  make  this  the  operation  in  the 
lie." — Boston  Medical  Journal. 

9.  Operative  Perforation  of  the  Membrana  Timpani  in  a  ease  of  deaf' 
. — M.  Philipcaux,  ot'  Lyons,  had  lately  under  his  care  a  gentle- 
aged  twenty- five,  who  was  deaf  on  both   sides,  but  ea^ee\i\V) 


^0  Editorial  AbUracU  and  SeJerti'am.  [AprU, 

the  right.  On  this  side  he  conld  not  hear  the  tickling  of  a  watch  ap* 
plied  close  to  the  ear.  No  complicalion  existed  in  the  mouth,  and 
the  complaint  was  traced  to  a  sndden  inflamation  of  the  mcmbruia 
tympani.  M.  Pbilipeaux  resolved  to  perforate  the  membrona,  wUeh 
he  did  with  a  small  trocar,  favored  by  a  strong  light. 

The  opening  was  dilated  im-mediatelj  by  moving  the  instrament  in 
various  direction,  and  snbsequentlj  with  an  elastic  bougie.  The' im- 
provement was  immediate  ;  and  so  great  a  few  days  afterwards  that' 
the  patient  could  distinctly  hear  the  watch  when  held  ten  inches  from 
the  ear,  and  carry  on  a  conversation  even  in  a  low  tone  of  voice. 

10.  Glycerine  and  its  application  to  Medical  and  Surgical  Treaimeni,"^ 
This  substance  has  been  used  internally  as  a  laxative,  but  its  aperieDt 
effects  are  more  evident  when  employed  as  an  enema,  in  proportion  of 
two  ounces  of  glycerine  to  sixteen  of  water.  Fetid  and  gangrenooi 
ulcers  are  modiHcd  by  glycerine,  and  rapidly  assnme^a  healthy  aspectt  ' 
if  the  dressings  are  changed  two  or  three  times  a  day. 

It  forms  a  good  dressing;  for  malignant  carbuncles,  and  in  cases  of 
burns  it  imparts  to  the  injured  surfaces  a  permanent  sensation  of 
coolness,  due  to  its  hygrometric  properties. 

It  is  also  a  useful  adjunct  in  the  treatment  of  scorbutic,  scrofulooft 
and  syphilitic  ulcers,  and  a  valuable  palliative  in  cancer. 

It  possesses  the  property  of  dissolving  iodine,  and  an  injection  of 
an  ounce  of  iodino,  and  three  and  a  half  of  glycerine,  has  been  found 
very  efficacious  in  cases  of  very  deep-seated  abscess,  sinuses,  scrofu- 
lous wounds,  syphilitic  buho,  etc.  In  disear^s  of  the  skin,  glycerine 
is  often  more  successful  than  poramades,  as,  for  instance,  in  vilbnlas 
hypercestbesia  ;  in  pityriasis  capitis,  a  combination  of  hydrochlorate 
of  ammonia,  glycerine  and  rose  water  is  very  efficacious  for  scalds, 
and  sulpber  pomade  made  with  glycerine  instead  of  lard,*  possess 
the  advantage  of  being  inoderous,  and  of  not  staining  the  linen. — Brit, 
and  Foreign  Med.*'  Chir,  Rev, 


MATERIA  MEDICA. 

11.  Tlie  Properties  and  Uses  of  the  Calubar  Bean — Those  of  our  pro- 
fession who  treat  diseases  of  the  eye,  have  been  made  to  rejoice  in  the 
discovery  of  an  agent,  having  well  marked  physiological  properties, 
which  have  never  been  observed  in  any  known  substances,  and  offer- 
ing a  new  hoiizon  to  therapeutics  by  filling  a  void  which  has  long 
been  deplored. 

Whilst  we  possessed  infallible  means  for  dilatation  of  the  pupil, 
the  power  of  contracting  the  pupil  did  not  belong  to  any  known  pro- 
duct, until  the  discovery  of  this  Calabar  bean  :  which  comes  from  the 
kingdom  of  old  Calabar — and  there  used  as  an  ordeal  for  accused  per- 
sons. 

The  bean  weighs  from  thirty-six  to  fifty  grains  ;  it  has  a  hard, 
brittle,  and  ligneous  tegument,  of  a  brownish  color ;  they  arc  not 
like  other  leguminous  seeds  in  taste. 


1864.  Sdltorial  AlttracU  and  Siledimu.  271 

The  Calabar  acts  on  the  sphincter  of  the  iris  by  irritation,  by 
CMuing  spa^roodic  action  of  ihe  third  pair,  as  an  antagonist  of  atropia, 
which  acts  by  irritation  on  the  radiating  fibres  of  the  iris  and  the 
Itoaor  choroid®,  through  the  sympathetic. 

Like  atropine,  caUbarine  acts  only  on  the  eye  to  which  it  has  been 
applied  and  like  it,  acts  by  penetrating  to  the  anterior  chamber.  It 
•fen  acts  on  eyes  where  the  cornea  has  been  perforated,  an  important 
fact  as  regards  therapeutics. 

12.  ^inine  and  its  SttbsiUvtes, — In  the  London  Lancet  r  practitioner 
largely  experienced  in  the  treatment  of  agues  and  intermittent  fever, 
taatifies  to  the  valne  of  cinchonine  as  an  antiperi  odic,  subtitnting  the 
Qie  of  quinine.     Tlie  culture  of  quinine  is  by  no  means  yet  fully  es- 
tablished on  so  large  a  basis  as  to  promise  a  continued  supply  in  the 
tnormoas  quantities  in  which  it  is  now  demanded  all  over  tiie  world. 
Into  l|ii8  conntry  bark  found  its  way  for  the  first  time  late  in  the 
wrenteenth  century  ;  and  in  France  it  won  its  entrance  into  the  phar- 
uacopoea  by  curing  Louis  XIV,  being  used  then  for  him  ns  a  secret 
renedy,  aiid  on  the  following  conditions :  48,000  livers,  2,000  as  a 
potion,  and  the  title  of  Chevalier.     The   sources  of  quinine  are, 
Mwever,  gradually  failing  under  the  pressure  of    the  enormous  de- 
■aod ;  and  although  the  experiments  of  the  British  Government  in 
fanning  plantations  of  cinchona  trees  in  India,  have  met  with  suocesa 
in  in  important  degree,  yet  the  best  kind  of  quinine  bearing  trees  are 
laid  not  to  have  succeeded  so  well  as  the  others.     If  conchoninc  really 
poiKst  the  antiperiodic  properties  which  have  been  ascribed  to  it,  it 
H  in  all  respects  a  most  interesting  circumstance,  of  which  physicians 
nd  practitioners  should  take  note.     It  is  very  cheap  and  abundant, 
itd  the  fnturc  promises  an  abundant  snpply. 

13.  Chloroform. — Dr.  Edw.  Ellis,  in  a  letter  to  the  London  Lanjei^ 
murks  that  in  order  that  **  the  public  may  have  due  confidence  in  its 
idainistration,  chloroform  should  never  be  given  but  by  a  second 
pvion,  who  may  devote  his  energies  entirely  to  watching  its  effects, 
lid  10  leave  the  surgeon  free  from  any  sense  of  anxiety,  to  operate 
hinrely  and  with  discretion."  Wo  have  had  occasion  more  than 
Oitt  to  insist  upon  this  necessity.  Where  chloroform  is  given,  the 
nk  attention  of  a  skilled  assistant  to  its  administration  may  be  pro- 
HQiced  as  indispensable  in  cases  of  surgicfil  operation.  It  behovev 
tki  iQthorities  of  hospitals  to  be  especially  careful  in  looking  to  this 
WUr ;  and  we  note  with  satisfaction  the  recent  adoption  by  the 
Wird  of  St.  Mary's  Hospital  on  the  recommendation  of  the  medical 
CQttmittee  of  the  following  resolution,  moved  j>y  Dr.  Cnredell  Juler, 
ttdieeonded  by  Mr.  George  Bird,— «  That  Mr.  D.  O.  Edwards,  who 
^1  administered  cliloroform  in  the  hospital  for  the  past  nine  yearn, 
■i  licognized  in  the  next  annual  report,  as  chloroformist  of  the  hos- 
P^"  Ghloroformists  are  now  appointed  at  most  of  the  hospitals, 
lb  is  really  a  very  useful  step,  as  formalizing  the  reco^ition  of  the 
fvriees  of  an  officer  who  mnst  henceforth  be  considered  indispensable 
^  all  hoepitals,  and  as  to  whom  it  will  be  a  general  benefit  if  the 
freittsioD  come  more  clearly  to  understand  that  such  eerricea  ikT% 


272    '  Edllwlal  Selections  and  Al^tnueU.  [Aprils 

C88cntial  to  the  eafo  generalization  of  the  processes  for  prodacing 

anaesthesia. 

14.  Use  and  abuse  of  Stimulants  in  Fever —  Occasional  aniiphlogkbe 
treatment, — A  few  days  ago  we  saw  at  Guy's  Severn  1  patients  conm- 
lescent  from  fever.  In  reference  to  them,  Dr.^Wilks  remarked  on 
the  treatment  of  fever  by  stimulants.  A  young  man,  who  bad  bad 
typhus  fever,  and  who  had  been  covered  with  the  ordinary  mnlbanj 
rasli,  had  recovered  without  any.  As  there  appeared  no  need  to  gift 
any,  Dr.  Wilks  wished  to  prove  to  his  class  that  alcohol  was  not 
always  necessary  in  fever,  and  that  ho  did  not  by  any  mean8|con8idir 
alcohol  as  an  antidote  to  fever,  for  he  found  the  disease  always  ran  its 
ronrso  under  every  form  of  treatment.  He  considered  the  rule  laid 
down  by  many  of  the  older  phy^cians  to  bo  the  correct  one  with  rs- 
^ard  to  the  treatment  of  all  fever's ;  that  in  very  many  cases  snper- 
vision  Wcas  alone  required,  and  that  in  others  a  stimulant  plan  vm 
necessary  ;  the  only  question  being  the  quantity  of  alcohol  rcqnired 
and  the  time  when  it  was  needed.  Ho  thought,  therefore,  that  thosa 
who  spoke  of  their  success  by  the  universal  treatment  by  alcohol  in 
all  cases  of  fever,  were  adopting  (to  say  the  least)  a  very  unscientifio 
method,  which  was,  in  reality,  one  founded  on  such  a  reasoning  as 
this  :  That  severe  cases  of  fever  are  benefitted  by  alcohol,  and  mild 
ones  are  not  killed  by  it,  and,  therefore,  it  is  safes  to  give  it  to  all. 
Tlie  same  may  be  said  of  those  who  declare  carbonate  of  ammonm  to 
be  the  remedy  for  all  cases  of  scarlatina.  It  is,  no  doubt,  of  great 
value  in  severe  cases,  and  in  mild  ones  it  certainly  will  not  kill  the 
patient.  Dr.  ^Vijks  would  not  say,  however,  that  wine  and  spirits 
did  no  harm,  for  in  some  cases  ho  believed  they  weie  decidedly  in* 
jnrious,  especially  in  young  persons  with  typhus  fever  and  violent  de* 
lirium.  lie  had  such  a  case  under  his  caro,  in  which  he  ordered 
cupping  to  the  back  of  the  neck,  and  which  was  followed  by  qniet  end 
sleep.  He  wos  a  total  disbeliever  in  the  change  Of  type  theory ;  for 
such  a  rase  as  this,  and  two  others  which  he  lind  seen  bled,  and  jet 
did  well,  entirely  refuted  such  an  opinion.  Although  he  believed  the 
present  plan  of  treatment  by  support  J^aved  moie  lives,  he  was  quite 
8nre,  that  if  no  stimulants  were  given,  and  tlmt  if  the  patients  were 
bled,  that  the  gr cater  number  would  recovci-  as  heretofore. — JM, 
Times  d-  Oaz.Jan,  23,  1864. 

15.  Purpura  Ihzmorrhagica. — We  notice  in  a  late  number  of  the 
London  Medical  llnies,  an  article  from  the  pen  of  Dr.  Grant  of  Ottawa, 
on  the  prevalence  of  an  agravated  form  of  purpura  among  thelumher- 
men  in  liis  part  of  the  country,  styled  by  them  **  black  leg."  He  at- 
tiibutes  it  in  a  great  measure  to  the  excessive  use  of  nitrate  of  potash 
in  the  preservation  of  the  meat  on  which  they  subsist.  And  says 
that  the  same  effeut  was  produced  some  twentry-five  or  thirty  years 
iiince  from  the  same  cause,  and  that  it  ceased  on  a  more  moderate 
employment  of  this  salt ;  and  that  a  long  series?  of  years  has  correctljT 
established  the  truth  of  this  observation.  We  quote  the  following 
description  of  it  from  his  article : 


1894]  Editorial  Abstracts  and  Seledwm.  373 

In  one  sliantj  twenty- five  men  out  of  thirty-six  were  attacked  with 
this  same  disease,  and,  from  ascertained  facts,  the  great  proportion  of 
the  cases  were  developed  as  follows  : 

Slight  pains  in  the  extremities,  particnlarly  about  the  ankle  joints 
and  posterior  parts  of  the  legs.     After  a  few  days  in  severe  cases,  the 
pain  18  liable  to  extend  to  the  arms  and  shoulder-joints.     The  intega- 
nmt  of  the  legs  is  first  ob8er\'ed  to  change  color,  passing  from  a 
KOnewhat  yellow  to  a  deep  venous  hue,  in  large    atchcs,  almost  ap- 
proaching to  a  black  (hence  the  term).     The  legs  and  the  arms  are 
liable  to   swell,  particularly  the  former.     Frequently,  two  or  three 
weeks  before  any  constant  pain  is  complained  of,  or  change  of  color 
takes  place,  the  limbs  move  sluggishly  in  response  to  the  will,  and 
coBsiaerable  soreness  is  experienced  on  pressure.     Abrasion  of  the 
integnment  is  followed  by  a  sero-sanguinolent  discharge ;  and,  if  much 
irritated,  is  liable  to  inflammation,  partaking  of  the  asthenic  character. 
The  limbs  are  said  to  be  almost  free  from  pain  when  immersed  in 
wtter,  during  the  spring  season,  rifting  ;  but  aflerwards  they  become 
kird,  painful   and    stiff.     The  gums  are  frequently  observed  to  be 
iwolleD  and  spongy  for  some  weeks  before  the  limbs  become  painful. 
"nw  bowels  are  usually  regular,  and  the  mine  voided  is  normal  in 
quatity.     But  the  sleep  is  restless,  an^  many  of  the  men  are  subject 
toWdache,  giddiness,  loss  of  appetite,  and  swelling  of  the  eye-lids  ; 
ibo  at  times,  to  a  peculiar  sensation,  as  if  the  head  attained  enormous 
^itttnsions. 

Daring  the  month  of  April  the  great  proportion  of  these  cases  be- 
nme  most  marked,  and  under  judicious  treatment,  rarely  extended 
^>w  a  period  of  four  weeks  before  convalescence  was  established.  It 
vai  oot  an  unfrequcnt  circumstance  to  observe,  amongst  those  who 
van  exposed  to  the  same  dietary  influence,  attacks  of  accute  rhcuma- 
ti«a,  u  well  as  nyctalopia  (obscurity  of  vision  during  daylight),  both 
'^  which  readily  yielded  to  rest  and  regimen,  in  conjunction  with 
aiU  medicinal  agents. 

Whenever  nyctalopia  is  detected  l»y  the  experienced  lumberer,  fresh 
ailk  is  administered  largely,  when  attainable,  which  has  a  most 
•pcedj  and  salutary  influence,  tie  retina  recovering  its  tone  in  the 
*pice  of  a  few  days. 

W.  Treatment  of  Diarrhoea  and  Dysentery — By  Prof.  Skoda, — Be- 

joiid  everything  stands  a  strict  regulation  of  the  diet.    When  the  intes- 

naal canal  is  in  a  diseased  state  almost  any  subject  introduced  into  the 

itoaach  acta  mischievously,  and  it  ih  not  unfrequcntly  necessary  to 

•upend  all  food  until  the  intestine  is  in  a  condition  to  Lear  it.     Every 

•olid  article  eo  ipso  is  Ithen  mischievous,  but  even  fluids,  by  reason  of 

tbcir  temperature,  may  act  as  prejudioiously.     In  most  cases  taking 

s  finr  spoonfuls  of  warm  soup,  or  drinking  a  mouthful  of  cold  water 

will  inmediAtcly  be  followed  by  severe  colics,  and  soon  afterward  by 

trasnatiens.     Wo  must  only  allow  lukewarm  soups  or  other  drinka, 

sad  that  only  by  a  spoonful  at  a  time.     Of  course  these  stringent  rules 

ssly  apply  to  a  very  obstinate  diarrhoea,  and  especially  dystcntcry,  for 

there  are  many  cases  of  temporary  diarrhcca  in  which  the  patients  con- 

lAoe  to  eat  fraits  and  the  like,  and  still  soon  get  well.    8nch  cases 


274  Editorial  Abttradt  and  Seltelloni.  [April, 

miiBt,  however,  not  bo  taken  into  acconnt,  and  it  is  aliriys  mosl  pni- 
(lent  nt  lliu  commencement  or  «  diarroca  to  cut  oft  the  supply  o(  fooJ  na 
far  RH  poEHible,  and  si  all  evenM  to  prohibit  all  articles  likely  to  aug- 
ment tlie  aficctioa. 

Opinni  is  the  most  valiiable  medicine  in  Diarrhoea,  for  it  kecpa  the 
Bphincier  in  a  state  of  permanent  contraciioD,  a  contraotioa  wliicli  ia 
often  propagated  to  the  inrge  intestine,  and  tho  small  intestine  is  un> 
able  to  propel  its  contents  far  enough  to  indnce  the  irritation  vhich 
cansca  tWir  expnUion.  'When,  by  reason  of  this  coiitraclion,  thsM 
contents  are  retained,  their  amount  ma^  becomo  considtriU)!/  dimin- 
ished b;  the  absorbtion  of  the  fluid.  Frequently,  hoirev«r,  tbero  is  no 
Fpot  of  the  canal  which  is  not  so  diseatuid  aa  lo  prevent  aucti  ftbitaili- 
tion  taking  place,  and  then  the  diarrh<na  will  coiilinne  in  spite  of  the 
opium  ami  of  the  contraction  of  the  spincters.  It  appears,  moWoTMi 
that  opium,  besides  its  action  on  the  muscniar  portion  of  the  canal. 
exerts  by  contact  a  soothin<;  effoct  npon  the  mmons  membrane.  In 
conscqnenco  of  the  diminution  of  the  irritation  of  this  membrane,  tt< 
secretion  is  probably  lessenetl,  as  arc  possibly  those  of  the  liver  nod 
pancreas.  However  this  may  bo,  opinm  acts  very  favorubly  in  pro- 
fuKo  secretion  from  the  intesiinnl  mucous  membrane.  From  half  • 
grain  lo  three  grains  may  be  given  in  the  twentyfoar  hours,  the  beet 
preparation  being  the  exC  opii  aguoxum. 

If  opium  or  morphia  do  not  HiifTico,  it  must  be  aided  by  aslriagoit 
TcniihlieK,  by  far  the  best  of  vTbich,  and  the  most  easily  siipportoJ,  it 
tho  snlphas  ainci.  One  would  have  supposed  that  tannin  in  its  separ- 
ate state  would  have  proved  more  UNcful  than  the  zinc,  but  tbiit  ii.  nut 
the  case,  and  it  is  much  less  easily  borne.  It  acts  much  builcr  and 
more  energetically  when  employed  as  a  household  reined/  ( ,e  g.,  as  s 
decoction  of  sloe  of  wild  pear  tive)  ihnn  in  its  separate  form  ;  Ami  ia 
then  of  great  service  in  priictice  among  tho  poor.  Alum  is  of  no  nae 
whatavor  in  diarrhijea.  Lead  approachea  zinc  in  efficacy,  bnt  still  it  ia 
less  certain  than  it.  'llie  dose  shoiiM  not  be  greater  than  a  qnurter  of 
a  grain',  and  this  may  be  repeated  every  two  or  three  hours,  and  at 
moat  every  hour.  If  these  means  do  not  anflice,  we  must  have  ra> 
source  to  cnumata  of  salep  or  starch  (with  which  may  be  combined 
one  grain  of  opium  or  half  a  gi-ain  of  Eino)  not  throwing  up  nioio  than 
two  ounces  nt  a  time.  If  the  clyster  does  not  cause  pain  in  the  rec- 
tum, and  tlie  dise.i!;e  continues  obstinate,  the  dose  of  the  zinc  may  be 
increased  to  two  grains.  Tiinnin  may  bo  added  to  the  enema,  but  the 
zinc  is  far  more  serviceable.  In  the  most  obstinate  cases  we  must 
have  recourse  to  cauterization  ;  but  this  is  only  the  caee  when  them 
is  a  disoued  condition  of  the  lower  part  of  the  rectum.  Very  obatt- 
nnto  cases  of  blennorrhcea  confined  to  tho  anns  may  be  completeljp 
cured  by  the  application  of  nitrate  of  silrer  in  substance  as  high  sa  it  i 
can  be  passed.  The  injection  of  m  strong  solution  of  this  snbttancs 
does  not  usually  attain  the  same  end. — Med.  3iWf  arid  Oat,,  StpL 
12,  18a3,/n>m  Wim  Alls/em.    Med.  Ztit.    No.  48.— ^tn.  Mtd.  Jmr. 


OOSTENTS  FOB  >IAV.  18IH. 


f  tllUauiAI.  (»lltfl:MiJkTli'V«. 

AfiT-  I.— <ip  ibE  t'*r  of  fvrri  ]>rr  ffuljiliu  la  ITwwiin^ 
n*,..<><.  ..<   (■..»,      lly  (k«.  n.  r«n»rlxhl,  >j 

Anr  1'       >-^    ■    -       f     ri,n».  C,  fluilUi,^.-. ^ 

-Ai'  ■,,     By  J,  B,  Bl»cl,  -...,— J 


BWTOIUAI,  TBANSI.ATl. 


^Phe  Merhaniral  Treatment-  of  Angulnr  Can 

OR  POn'3  DISEASE  07  TttE  SPim. 

HY  cnAIlM'-S  FWKTrE  TAVLOK,  Ml*, 


mk;3tn 


/ 

I 


THE 

INCINNATI  LANCET   AND  OBSERVER 

CONDOCTED  BT 

E.  B.  STEVENS,  H.D..  AND  J.  A.  MUBFHT.  MJ). 


O.'VIZ.  MAT.   1864.  Ko.  S 


•rtgisxl  0ommttsUati0tt5. 


ASnOLB    I. 

UMOf  Ferri>er  Sylpliat  in  Stemorriioidt,  with  Reports  of  Cases. 


BT  OM.  f.  COCKTKIQBT,  AMIflTAXT  Sl'BOIOX,  V.  ■.  T.,  FOKT  fUaVIB,nW  HBXICO. 


Iti, — Major ,  U.  S.  A.,  of  full  habit  has  been  the  subject 

d^ht  Hemorrhoids  for  several  years.  For  the  last  twelve  months» 
■  bsen  obliged  to  travel  a  great  part  of  the  time  in  a  rough  vehicle. 
iplied  to  ma  December  5th,  1863.  On  examination  found  a  small 
•or.  external  to  the  sphincter,  about  the  size  of  a  large  pea,  when 
■lool  it  would  protrude  to  the  size  of  a  small  walnut,  and  would 
l!h  difficulty  be  returned. 

g^wftaml— lead  water  freely  applied  to  the  part,  and  Qr  Ferri  per 
IpluM  3m.,  Cerate  Simplex  Si-  ^ub  well  together  and  apply  on  re- 
ii^  at  night.  The  e£fect  of  the  Per  Sulphas,  was  almost  immediate, 
Ivriog  pain  and  cauterizing  the  part. 

[  would  state ;  that  he  had  previously  used  ointment  of  Galls,  Tan- 
ip  Opium,  etc.,  with  only  a  temporary  relief.  The  effect  of  the 
r  Salphas  is  permanent  and  in  the  above  case,  he  was  able  to  ride 
koffMbttck,  or  take  active  exerci^,  within  two  weeks  afler  com- 
■eiag  the  use  of  the  Iron,  without  the  least  inconvenience.  It  is 
w  two  months  since  he  first  commenced  the  use  of  it  and  has  not 
I  AS  J  return  since. 

tStftf  2md. — A  private,  detailed  as  carpenter.  Has  been  the  subject 
Bniorrhoids  at  times  for  several  yeajs.  After  severe  lifting,  and 
vm  ozertion  at  his  trade,  they  became  very  severe,  so  as  to  confine 
B  to  hia  quarters.  They  protruded  to  the  size  of  a  large  hazle  nut. 
flito,  at  this  time,  had  an  attack  of  diarrhoHi. 
Vol.  Tii.— 257. 


258  Original  Communieaihns,  [M0 

In  this  case  I  prescribed  the  Ferri  per  Sulphas,  as  described  abo 
and  in  ^ve  days,  he  was  able  to  return  to.  his  occupation.  Two  men  i 
has  elapsed  and  he  has  not  had  any  t^tnm  of  the  trouble,  for  the  difl 
rhcBa  he  took  small  doses  of  astnngents. 

Case  Srd — Private  Elias  B ,  detailed  as  teamster  in  Q.  2 

Department,  is  six  feet  four  inches  high,  ot  an  anaemic  constltutio 
This  case  has  been  the  subject  of  Haemorrhoids,  at  intervals  for  & 
years.  Tbcy  protnided  to  the  size  of  a  small  walnut  and  very  pa£ 
fnl.  Appliciation  of  cold  water  was  ordered  to  be  used  frequently,  a  1 
strict  quietade  enjoined,  and  the  ointment  to  be  applied  freely  at  n^gf 
This  case  improved  rapidly  under  the  use  of  tonics,  and  was  soon  ab 
to  resume  his  duties.     He  has  not  had  any  rerum  of  the  disease  sine 

Case  4th. — Henry  C ,  employed  as  clerk.    This  case  is  01 

of  some  years  standing,  of  obstinate  constipation  and  Haemorrhmd 
Tbe  latter  caused  to  a  great  extent  by  the  constipation.  In  thib  caae 
gave  a  pill,  R.  ol.  tig.  gtt.  i.  extract  Nux  Vomica  gr.  s;.  extract  ec 
acyntb,  co,  grs.v.;  one  pill  to  be  taken  once  or  twice  a  day  as  neede 
to  procure  a  free  passage  from  the  bowels.  Was  obliged  to  use  em 
mas  to  remove  impacted  faces  under  the  use  of  the  pill,  and  attentic 
to  diet ;  the  bowels  regained  their  natural  tone,  and  the  Haemorrhoic 
became  less  severe.  In  this  case  the  same  application  was  used,  as 
relieved  the  pain  and  reduced  the  irritability  of  the  protruded  part.  E 
states  that  he  has  previously  used  oint.  of  opii.  tannin,  etc.,  b: 
not  with  the  same  satisfactory  result  as  with  the  Ferri  per  Sulphas. 

Case  bih. — Wm.  K. ;  Private.     Has  been  in  the  service  tir 

and  one-half  years.  Shoemaker  by  trade.  This  case  was  complicatci 
with  ulcerated  internal  Hemorrhoids.  The  external,  almost  resemble 
prolapsus  ani.  Great  relief  was  afforded  in  this  case  when  it  (tL 
ointment)  was  made  with  R.  Ferri  per  Sulphas,  3i ;  to  Cerate  Sim] 
3i ;  being  just  twice  the  strength  of  tbe  former  piescnptiun.  This  cac 
was  not  entirely  cured  by  its  use,  but  his  condition  is  so  much  in 
proved  that  he  has  been  doing  regular  company  duty  for  six  week 
and  does  not  suffer  from  the  haemorrhoids,  except  when  he  is  attacke 
with  diarrhoea,  when  he  resorts  to  the  use  of  the  ointment,  with  speed 
relief  to  his  sufferings. 

I  have  also  used  the  Per  Sulphas  in  other  cases,  but  these  are  tl 
most  important. 

In  the  above  cases  of  privates,  there  was  great  objections  by  tl 
patients  to  having  any  surgical  operation  performed. 

I  do  not  bring  forward  the  use  of  the  per  Sulphate  of  iron  in  Haen 
orrhoids,  to  be  used  in  all  cases  in  place  of  surgical  interference ;  h\ 


864.]  SuiTH-- Aphonia.  259 

3   mild  casesi  or  in  Ihoso  whore  there  are  great  objections  to  any  sur- 

ioal  operation,  being  performed,  I  deem  it  one  of  the  best  remedies  in 

ae  Materii  Medica. 

Ht  is  especially   beneficial   in  ulcerated   haemorrhoids  ;  or  in  those 

rli  ose  constitutions  are  debilitated  from  Diarrhoea,  long  marches,  and 

scessive  fatigue  of  any  kind. 

Xt  is  nnnecessary  to  make  any  remarks  as  to  its  modus  operandi, 

iS   it  is  now  well  known,  being  one  of  our  most  important  Styptics, 

bmviog  been  used  in  all  kinds  of  Haemorrhages  from  mucous  as  well 

as  cataneons  surfaces.  Diarrhoea  Ac, 

Since  writing  the  above,  I  have  seen  another  officer  stationed  at  a 

p<»t  it  some  distance,  for  whom  I  prescribed  the   Ferri  per  Sulphas 
for  (Miinful  Haemorrhoids,  some  time  since. 

This  officer  states  that  he  has  been  the  subject  of  Haemorrhoids  for 

Mvenl  years,  and  has  nsed  all  the  various   astringent  ointments  with 

only  partial  relief.     He  sriys  :     "  The  ointment  you  gave  me  me  has 

cured  me."     He  is  now  able  to  ride  on  horseback  and    endure   ex- 

cenive  fatigue  without  feeling  the  least  annoyance. 


•^m^ 


Abticls  II. 

Aphonia. 

Casu  Retobtkd  bt  Tbob.  C.  Smith,  Ass't  Scbobon  116  0.  Y.  L 


Vote  1. — Benj.  Coffield,  Comp.  C.  Admitted  to  Hospital  Jan  23, 
1884.  Aet  21 :  Disease:  Aphonia  of  5  months  standing.  Cause: 
Kvere  catarrh  :  general  health  good.  Upon  examination  of  the  throat 
foand  the  mucus  membrane  much  congested,  and  apparently  thick- 
•»ri.  Had  some  cough,  arising  from  the  chronic  irritation,  whicli 
Fodoced  a  continual  tickling  sensation ;  expectoration  slight,  no 
Mmd  could  be  pro<luced  above  a  whisper  ;  physical  diagnosis  proved 
^  tbsenoe  of  pulmonary  disease 

TrtmtmerU, — Jan.  23,   Hydr.  mass,  grs.  xii.  repeated  every  twelve 
koors,  and   Potass  Iodide  3  i.   Aq.     DisL  5  i.     Dose,  a  3  every  2 
iours,  also,  Tincl.  Iodine,  applietl  every  four  hours  to  the  throat  ex- 
ternally.    Jan.  24,  Treatment  continued.  Jan.  25,  treatment  conlin- 
oed  with  the  addition  of— Argenti  Nit.,  grs.  xv,  aq.,  Dist.  3i,  which 
was  applied  to  the  Rima   GloUis  and  Larynx,  by  means  of  a  small 
ipongc    probang     Up  to  this  time  no  perceivable  improvement  had 
occurred,  but  in  a  few  minutes  after  giving  evidence  of  the  caustic  so- 
lation  having  entered  the  larynx,  the  patient  counted  the  first  three 


260  Original  Commumcatums,  [JAtj 

nnmerals  quite  distinctlj.  Jan.  26,  Potass  lodidoi  and  Tinot.  lodin 
continued,  doubling  the  length  of  the  interval :  articulation  greatli 
improved  but  still  low  and  muffled.  Jan.  27,  treatment  continned 
voice  rapidly  improving  in  clearness,  which  continned  up  to  the  SOth 
at  which  time  he  was  returned  to  duty,  with  his  voice  as  clear  am 
distinct  as  normally. 

Case  2.— William  Wheaton,  admitted  Jan  28,  1864.  Act  80 
Disease  :  aphonia  of  12  months  standing.  Cause :  rubeola.  Oenen 
health  good.  No  pulmonary  disease  discoverable.  Symptoms  var 
similar  to  those  of  case  1,  only  being  more  aggravated. 

Treatment  — Jan.  28,  Hydr.  mass,  grs  xii,  repeated  every  twelv 
hours,  and  Potass  Iodine,  3  i.  Aq.  dist,  S  i*  Dose,  a  3  every  twi 
hours,  through  the  day,  also  Tinct.  Iodine  applied  to  the  throat  ex 
temally,  every  four  hours.  Jan,  29,  treatment  continned.  Jan  SO 
treatment  continned,  with  the  addition  of  Argenti  Nit.,  grs.  zv.  Aq 
dist,  3  i,  applied  as  in  the  first  case.  Patient  through  the  day  conU 
make  a  few  indistinct,  articulate  sounds.  Jan.  81,  treatment  contin 
ned.  Up  to  this  time  (8  A.  M.,)  no  words  had  been  distinctly  apo 
ken  by  the  patient,  but  at  12  M.,  he  could  articulate  with  considerabh 
degree  of  distinctness.  Feb.  1,  to  3,  Potass  Iodide  and  Tinct.  lodiii 
continued,  the  length  of  the  interval  doubled,  during  which  time  th 
voice  continued  to  increase  in  strength  and  clearness.  Feb.  4,  treat 
mcnt  discontinued.  Feb.  8,  voice  completely  restored  and  patient  re 
tnrned  to  duty. 

Caes  3. — Wm.  Yeager,  Comp.  O,  admitted  Jan.  3l8t.  1864.  Aet 
18.  Disease  :  aphonia,  of  14  months  standing.  Cause  :  mbeola 
Patient  much  stooped,  round  shouldered,  and  chest  undeveloped 
coughs  severely  when  freely  exorcised ;  expectoration  very  slight 
appetite  tolerable ;  bowels  regular ;  pulse  above  normal ;  tongue  far 
red  ;  much  congestion  of  the  investing  membrane  of  the  throat. 

Treatment. — Hydr.  mass,  Potass  Iodine,  and  Tinct.  Iodine,  nsod  a^ 
in  cases  1  and  2,  from  Jan.  31  to  Feb.  2.  Feb.  3  to  5,  treatmen 
continued,  with  solution  of  Argenti  Nit.  added  as  in  the  above  cases 
On  tho  4th,  slight  improvement  was  observable.*  During  the  5th,  h 
became  able  to  articulate  indistinctly. ;  6th  to  10th,  treatment,  Potasi 
Iodine  and  Tinct.  Iodine  continued  at  intervals  of  double  forme: 
length  :  voice  gradually  improving.  11th,  Treatment  discontinued 
20th,  patient  -gradually  improving,  and  now  speaks  quite  distinctly 
The  application  of  the  caustic  solution  produced  considerable  genera] 
irritation  and  increase  of  cough  for  several  days. 

Case  4. — Ghirrison  Miracle,  Comp.  F,  adniitted  Feb.  11»  1864 


18€4.]  Rurm^Aphonim.  261 


A<^29.  Disease:  aplionia  of  10  months  standing.  Canse:  severe 
eaaiftarrh*  contracted  soon  after  recovering  from  typhoid  ;  general  health 
good ;  no  pulmonary  disease  perceived.  Symptoms  and  treatment 
gmsiie  as  case  2nd,  with  exactly  the  same  result.  Feb.  20ih  returned 
to  daty,  voice  completely  recovered. 

Other  similar  cases  might  be  reported,  bat  we  presume  the  forego- 
ing; number  is  sufficient,  as  no  case  presented  for  treatment  that  fail- 
ed, to  recover  the  U'  j  of  his  voice,  and  cases  Ist,  2nd  and  4lh,  are  all 
ible  to  articulate  #s  distinctly  and  easily,  as  befere  the  difficulty  oc- 
carred.    Case  8d,  being  by  far  the  most  aggravated,  is  gradually 
improving.     It  may  be  asked,  if  the  caustic  solution  was  confined  to 
th«  larynx,  or  was  it  also  applied  to  the  pharynx  ?    The  object  of 
iim  in  each  case,  was  to  make  the  application  directly  to  the  jRtma- 
OUtdi,  and  to  the  mucus  membrane  of  the  larynx  itsey,  if  possible, 
Mbg  assured  this  would  produce  the  usnal  therapeutic  eflect  of  Ar- 
giBti  Nit.  thus  applied,  viz.,  contraction  of  the  membrane,  and  thns 
iicretse  the  patient's  chances  for  articulation. 

Being  aware  of  the  difficulty  in  the  way  of  entering  the  larynx,  or 
^  Curly  touching  the  Rima-Qlottis,  even  with  a  very  small  sponge 
pvebang,  we  were,  therefore,  not  prepared  to  rclinguish  the  operation 
*fttr  a  few  nnsnccessful  attempts,  but  persevered  until  satisfactory 
^Hdence  of  success  was  given.    Nor  were  we  ignorant  of  the  danger 
of  thus  entering  the  larynx  with  a  remedy  so  severe,  but  we  were  wil- 
ing to  take  the  risks  for  the  sake  of  the  result  to  be  attained.     Wo 
M  positive,  when  we  assert  that  the  probang  sponge  passed  beneath 
the  epiglottis  to  the  Rima,  or  in  some  instances,  even  into  the  larynx 
imtf.  notwithstanding  the  opinions  of  many  of  the  most  learned  and 
ikHlfnl  anthers  and  professors  in  this  and  other  countries ,  that  such 
ii  impofftible.      *.. 

la  eome  of  the  cases,  the  ep'glottis  was  distinctly  seen  to  rise,  and 
ihs  sponge  to  pass  beneath,  and  the  immediate  supervention  of  symp- 
tOBit,  not  of  a  pharinyeal^  but  of  the  far  more  severe  and  protracted 
Uryngeal  character.  This  direct  application  once  attained,  in  a  few 
hoora  tabaequent  the  patient  would  begin  to  utter  indistinct  articulate 
•oandit  from  which  he  would  prog^ross  to  complete  recovery  and  con- 
trol of  his  voice. 

We  know  that  many  methods  of  treatment  in  this  disease  have  been 
lucd  by  as  many  of  the  most  skilled  army  surgeons,  but  as  yet  have 
iMftrd  of  DO  ancoeeses,  prior  to  the  adoption  of  the  above  related  plan. 
Wa  pretend  to  nothing  but  what  we  believe  to  be  simple,  plain  truths 
Mid  ut  only  led  to  give  the  foregoing  statement  for  what  \t  mv^  ^ 


262  Original.  CommunteaiUms.  C^J* 

worth  to  the  nolde  profestian  we  represent,  and  to  those  onforianate 
soldiers,  who,  from  various  causes,  have  lost  their  power  of  speech. 

Any  one  doubting  the  verity  of  this  statement,  can,  by  presenting 
himself  at  this  i-egiment,  be  show  at  least  six  cases,  none  of  whom, 
previous  to  treatment,  could  utter  a  syllable  louder  than  a  /oreedwhU' 
per,  but  who  are  now  able  loudly  to  speak  for  themselves  in  accents 
unmistakable,  that  "  he  that  was  dumb  now  speaketh." 

Martinsburg,  Va.,  Feb.  1864. 


^^ 


ARTICLK  IIT. 

Camp  Diarrhcsa. 

^  BT   J.  R.  BLACK,  M.D^  NEWARK,  OHIO. 

Among  army  surgeons  a  difference  of  opinion  exists  as  to  whether 
the  diarrhoea  of  camp  life  differs  at  all  from  that  observed  in  civil 
practice.  The  majority  however,  so  fares  my  knowledge  obtain8»are 
of  opinion  that  in  most  of  its  features  there  exists  decided  difibienees 
from  ordinary  civic  cases.  That  there  are  peculiar  circumstances, 
and  conditions  appertaining  to  the  production  of  the  disease, — that  it 
is  remarkably  obstinate  to  treatment,  and  that  the  pathclogical  condi- 
tions and  modes  of  death  are  in  some  respects  peculiar,  mostsargeons 
of  experience  will  cordially  admit.  That  these  differences  are  suffi- 
cient to  entitle  the  disease  to  be  considered  a  distinct  variety,  is,  I 
think,  fully  warranted  by  the  facts  in  the  case. 

There  can,  I  think,  no  harm  ensue,  but  on  the  contrary  good  result 
from  so  considering  it.  The  newly  installed  surgeon,  impressed  with 
the  idea  of  perfect  identity,  feels  very  certain  that  he  can  manage  this 
pest  of  camp  life,  from  the  results  of  home  experience.  He  enters 
upon  his  duties,  and  at  morning  call  is  surrounded  by  the  usual  cor- 
don of  diarrhoea  patients.  He  resorts  to  his  usual  remedies  for  that 
disease,  only  to  find  himself  completely  baffled  in  successful  treatment. 
He  thinks  that  certainly  the  patients  do  not  take  the  medicine,  or  that 
they  are  malingering.  But  the  frequency  of  his  failures,  and  the  pro- 
gressive emaciation  of  the  patients,  negatives  the  idea.  It  is  true  that 
a  few  are  quickly  amenable  to  treatment,  but  in  the  majority»  6ven 
with  the  rare  opportunities  for  medication  the  results  are  in  the  high- 
est degree  unsatisfactory. 

The  disease  usually  is  not  violent  at  the  onset.  One  or  two  evacu- 
ations during  the  night,  often  none  during  the  day,  to  become  again 
repeated  at  night  with  renewed  activity.    Soon  the  patient  has  to  go 


.]  BhkCR—Can^  Dkcrrhm.  283 

to'  stool  every  diree  or  foar  hours,  and  in  some  insUQcea  much  oftener. 
A  few  are  taken  more  violently  with  considerable  constitntional  dis- 
tarljance,  and  dejections  every  half  hour,  with  some  nausea  and  now 
aad  then  vomiting.  The  debility  and  emaciation  are  in  these  cases 
marked  and  extreme,  but  the  violence  of  the  action  soon  subsides 
lending  the  patient  exceedingly  weak  and  with  stools  thin  and  less 
{re<^Qent. 

The  character  of  the  stools  present  considerable  nn^'formity.     The 
color  is  usually  a  grayish  brown,  with  variations  now  and  then  to  a 
dark  green.     Their  consistence  is  much  like  that  of  well  boiled  bean 
soup.     The  detris  of  a  former  meal  are  often  observed  almost  wholly 
unaltered.     Beans  the  size  of  life,  and  fragments  of  unfermonted  bread 
that  surprise  the  eye.    After  the  disease  has  continued  sometime  jelly 
looking  stools  are  not  nnfreqnent,  often  small,  and  accompanied  with 
coQiiderable  tenesmus.     Bloody  stools  arc  comparatively  rare.     The 
odor  is  not  I  think  at  all  remarkable.     I  should  rather  think  that  the 
ncent  stool  has  not  even  the  full  disagreeable  odor  of  health.    In  oi- 
(linary  instances  the  debility  and  emaciation  are  gradual  and  progress- 
ive, though  in  some  of  the  more  violent  cases  it  is  proportionally  sud- 
den.   The  wastiug  of  the  body  contiuues  despite  a  good  or  even  an 
excellent  appetite  till  the  patient  looks  like  a  skin-covered  skeleton. 
The  eyes  are  dull  and  suuken,  the  skin  hATsh,  dark,  and  dry.     The 
ribs  are  painfully  distinct,  the  abdomen  flat,  the  vertebral  column  be- 
ing easily  felt  through  its  parietes.     Comparatively  little  pain  attends 
thia  disease  although  exceptions  occur  in  which  there  is  violent  tcne- 
mus.     On  heavy  pressure  a  slight  tenderness  is  usually  experienced  in 
the  epigastrium,  as  well  as  in  the  umbilical  region.     The  tongue  is 
covered  with  a  very  thin  fur,  dry  in  the  center,  and  the  whole  mouth 
haft  a  dry,  flat,  and  si icky  sensation.     Thirst  is  proportional  to  the 
uaount  of  constitutional  disturbance.     When  fever  is  slight  or  absent 
the  appetite  is  good,  often  craving  and  insatiable.    Persons  with  this 
disease  will  report  morning  after  aiorning,  running  into  weeks,  and 
nonths,  getting  weaker  and  thinner,  day  by  day,  and  yet  eating  much 
more  freely  than  their  healthy  comrades.    This  is  so  common  and  its 
reanlis  so  harassing  to  the  surgeon,  who  wishes  to  keep  his  reports 
dear  of  a  long  list  of  incapables,  that  the  field  hospital  is  often  used 
as  a  place  where  to  keep  the  patient,  and  cure  him  ;  where  strict  ser- 
veilanoe,  quiet,  and  rigid  dictatory  rules,  can  be  enforced.     But  even 
mder  these  circnmstaoccs  if  the  tents  are  too  crowded  many  have  to 
be  discharged  ere  ihey  are  fully  restored,  and  the  result  commonly  is, 
A  speedy  relapse.    The  pulse  shows  increased  frequency,  more  full  and 


264  Oriffkuii  Chmmunkaikmi.  ,  [ilayt 

hmrd.  Occftsionally,  especially  in  ohronic  caaee,  it  is  intermittent. 
Ansoultation  according  to  my  experience  &il8  to  rereal  any  mmaoal 
ionnd  when  in  the  systole  or  diastole. 

The  progress  of  the  disease  is  slow.  It  b  seldom  that  a  padent 
dies  of  uncomplicated  diarrhcea  nnder  a  month,  and  in  many  instanees 
it  has  been  mnning  for  two,  three  or  six  months. 

The  mode  of  death  is  in  some  cases  peculiar ;  in  others  anch  as 
might  be  expected,  a  low  and  decided  irritative  fever  seta  in,  that 
soon  licks  np  the  remaining  vitality.  This  is  by  fiir  the  mo^t  oovn- 
mon.  In  the  other  form,  after  a  sense  of  prolonged  attack,  the  disaase 
would  seem  to  have  spent  itself.  The  patient  thongh  greatly  weaken- 
ed, and  a  mere  shadow  in  flesh,fyet  goes  abont.  Remedies  seem  to 
have  a  more  controlling  influence,  the  appetite  is  good,  the  stools  less 
frequent,  the  patients  more  lively  and  hopeful,  which  taken  together 
would  seem  to  indicate  that  the  patient  is  in  a  fair  way  to  recover. 
He  may  even  not  have  occasion  to  get  up  for  a  night  or  two,  on  an- 
other night  he  may,  rises,  walks  a  few  steps,  and  drops  dead.  My 
observations  on  the  pathological  appearances  are  confined  to  examina- 
tions made  of  the  contents  of  thorax  and  abdomen. 

No  morbid  appearance  of  the  lungs,  specially  associated  with  the 
disease.  The  heart  externally  appears  n(yinal,  but  on  making  section 
of  five  that  I  examined,  four  had  considerable  deposits  of  fibrin  in  the 
cavities,  two  in  left  ventricle,  two  in  the  right,  and  one  in  both  right 
and  left.  In  one,  it  was  however,]very  inconsiderable,  not  more  than 
thirty  grains.  These  deposits,  or  emboli,  were  in  some  instanoes 
adherent  to  the  walls  of  the  heart,  more  commonly  however  taking 
their  origins  from  the  columnae  carneas  or  chordie  tendinesB.  The 
depositos  varied  in  length  from  two  to  six  inches.  It  is  not  uncom- 
mon for  them  to  extend  two  or  three  inches  into  the  aorta.  They  are 
larger  at  the  base  than  at  the  fore  extremity,  and  a  number  of  fibrille 
often  form  all  one  elongated  mass,  rounded  at  the  fore  extremity,  and 
looking  as  if  worn  by  attrition.  Their  appearance  struck  me  as  re* 
sembling  the  stringy  deposits  of  fibrine  in  coagulated  blood,  washed 
of  its  coloring  matter,  ^nd  worn  smooth  by  a  current  passing  over  it. 
The  endocardium  only  in  one  instance  gave  evidence  of  inflammation, 
and  that  of  a  very  limited  degree,  nor  was  the  muscular  fiber  of  the 
heart  softened  or  degenerated.  Surgeon  W.  Varian,  U.S.V.,  inform- 
ed me  that  in  a  large  number  that  he  examined  whdi  died  with  the  dis- 
ease, but  few  were  found  without  it.  In  fact  he  looked  upon  them 
as  one  of  the  determined  pathological  states  of  chronic  diarrhoea  of 
camp  life. 


\ 


1864.1  Black — Camp  Diarrkma.  '  985 

# 

I  nerer  had  opportnnity  to  examine  one  who  died  with  sarprising 
iftddenneM  but  there  is  little  doubt  but  that  the  death  is  owing  to  the 
gudden  detachment  of  these  emboli. 

Tlie  liver  contrary  to  what  might  be  expected  was  nsnally  found 

healthy,  as  was  also  the  spleen  and  pancreas.    The  stomach  is  only 

sffaded  in  exceptional  cases»  a  slight  tnrgescence  or  redish  blush  in 

spots,  which  it  is  di£BcnU  to  say  might,  or  might  not  be  post  mortem. 

Bilk,  deep  redness  of  the  ileum  and  colon  was  observed  more  or  less 

ia  all,  with  softening  of  the  mucus  coat.     I  did  not  observe  any 

patches  of  ulceration,  and  this  agrees  well  with  the  remarkable  ab- 

*  MM  of  sanguineous  flow  with  the  discharges  in  this  affection.     The 

onntum  almost  destitute  of  fat,  shrunken  and  its  vessels  abnormally 

^   tskrged.    The  mesenteric  glands  seemed  to  partake  of  the  irritation, 

sal  were  in  a  state  of  hyperemia,  yet  apparently  smaller  than  ordi- 

Cavsks. — Almost  as   many  theories  as  observers.    Hard,   soft, 

iptiiig,  well,  and  running  water  each  have  to  bear  the  onset  of  cans- 

iig  this  complaint.    That  impure  water  injudiciously  partaken  of  will 

ttOM  the  disease  there  can  be  but  little  room  for  doubt.    But  as  a 

gwsttf  rule,  I  am  convinced  that  it  has  but  little  to  do  with  it.     For 

Ottiple  while  the  Beservd  Corps,  Army  of  the  Cumberland,  were 

Ijiig  in  camp  at  Franklin,  Tenn.,  diarrahcea  became  epidemic,  and 

Vis  of  unusual  severity.     Good  spring  water  from  the  limestone 

>oeb,  was  easy  of  access,  and  abundant.     Some  surgeons  deemed  the 

As^ga  or  kind  of  water  as  the  cause  of  the  complaint.     But  this  idea 

vai  eompletely  overthrown  by  the  fact  that  some  sixty  or  eighty  in- 

%neouB  negroes  employed  on  the  fortifications  suffered  fully  as  much 

IS  tlM  white  soldier,  several  of  whom  finally  died  of  it. 

AmoDg  the  most  influential  causes  may  be  reckoned  the  quality 
ofditfood  consumed  by  the  soldier.  The  hard  unfermented  bread 
tiMjpnm  with  very  many  persons  in  ordinary  civil  life.  But  few  take 
tiaa  to  perfectly  masticate  it,  and  when  softened  in  the  favorite  mode 
by  atawing  it  with  the  gravy  from  the  frying  pan,  it  is  then  gulped 
lowii  with  as  much  facility  as  its  consistence  will  allow.  Not  only 
la  hat  the  quantity  that  each  one  consumes  is  something  enormous. 
Aa  Inead  not  being  porous,  but  extremely  hard  and  close  in  texture, 
s  krge  qnantfty  is  taken  into  the  stomach  to  make  the  requisite  bulk 
sad  bring  on  satiety,  very  much  in  excess  of  that  ordinary  ingested  of 
a  fanented  article.  In  fact  one-half  of  the  same  weight  of  the  latter 
prapatalion  would  satisfy  as  soon  as  that  of  the  former.  Then  it  is 
pit  borridly  into  the  atomach,  mixed  with  a  large  quantity  o(  \a,^ 


266  Original  Communicaiiom,  flftj, 

cooked  In  the  worst  way.     Coffee  is  used  at  all  the  meals,  inlensdj 
strong,  and  saturated  with  sugar.     When  heans  arc  used  it  is  difficult 
to  get  the  soldier  to  cook  them  properly,  and  few  thoroughly  masti- 
cate them.     A  great  many  eat  their  fat  pork  raw,  and  in  defiance  of 
frequent  lectures  as  to  the  hest  mode  of  cooking,  will  stealthily  frj  it 
half  the  time.     Again  many  seem  to  regard  the  ration  as  an  appor- 
tioned duty,  to  be  religiously  devoured  and  measure  their  capacity  a^ 
cordingly.     It  is  really  no  wonder  that  these  failings  exist,  for  eating 
is  almost  the  only  pleasure,  of  an  animal  kind,  in  which  they  have 
unrestricted  freedom,  and  the  enfeebled  convalescent  has  no  otlm 
mode  of  whiling  away  the  tedious  hours.     Amid  this  profusion  of  in*  • 
gestion  there  is  little  call,  either  mentally  or  physically,  to  repair  tbfl 
waste  from  action  and  continual  exertion.     After  placing  their  tents, 
and  on  favorable  days  one  or  two  hours  drill,  constitutes  the  sum  of 
general  duties.     Fighting,  and  fitful,  or  fatiguing  marches,  are  excep- 
tional.    Take  in  addition  to  the  fact  that  nearly  all  of  our  troops  an 
in  a  hot  and  oppressive  climate,  where  the  hydro-carbonaceons  com- 
pounds are  needed  only  in  a  very  limited   degree  to  sustain  animal 
heat,  and  the  rule  obtains  of  listless  easy  indolence  requiring  but  small 
expenditure  of  azotized  material,  and  yet  further  the  vigorous  digest- 
ive system  of  the  young  sturdy  men  that  make  the  file  of  our  ranks, 
and  no  surprise  need  arise  that  the  oiganism  would  soon  be  survhaig- 
ed  with  an  overflow  of  elaborated  pabulum,  or  complete  disturbance 
between  the  nice  balance  of  waste  and  supply  necessary  to  health,  and 
that  a  process  would  be  set  up  by  nature  to  get  rid  of  this  superfluity 
in  the  way  of  diarrhoea. 

Practically  an  exemplification  of  the  truth  of  this  view  is  known  to 
every  surgeon  of  experience.  When  an  order  to  march  is  received 
after  a  long  period  of  inactivity,  cases  of  men,  whom  we  know  to  be 
suffering  from  the  disease,  will  present  themselves  to  the  surgeon,  and 
claim  that  Uicy  are  wholly  unfit  for  the  task.  Reluctant  to  decimate 
the  regiment  at  every  order  to  march,  and  send  the  sufferers  to  the 
General  Hospital,  from  whence  nine-tenths  never  see  the  regiment 
again,  encouragement,  cajolery,  and  even  peremptory  ordering  to  their 
companies,  with  the  promise  of  giving  them  occasional  assistance  in 
the  ambulance,  carries  them  into  the  line  for  the  front.  At  the  end 
of  two  or  three  days,  persons  who  have  been  sick  for  months  wjll  find 
themselves  completely  cured,  without  the  aid  of  further  medication. 

Connected  with  this  are  what  are  termed  the  moral  influences  as 
causing  the  disease.  In  the  majority  of  cases  the  wonted  life  and 
animation  of  the  soldier  is  gone.     Ho  is  moody  and  taciturn.     The 


1884.]  Black — Camp  JHarrhixa.  1^67 

objects  and  associations  aronnd  him  are  void  of  interest,  from  them 
Im  cannot  draw  the  least  excitement ;  in  short  the  patient  is  also  a 
Tictim  of  nostalgia.  Under  these  circnmstanccs  a  fnrlough  for  thirty 
dajs  will  act  like  a  charm,  and  snrgeons  deserve  credit  for  devising 
and  applying  the  remedy  appropriate  for  the  case. 

Lying  npon  the  ground  and  causing  a  sudden  or  severe  retrocession 
of  the  cutaneous  secretion,  undoubtedly  plays  a  part  in  superinducing 
the  diaease.  The  prevalence  of  damp  foggy  weather  seems  to  have  a 
like  effect,  more  especially  when  the  soldier  is  off  duty. 

The  treatment  among  army  surgeons  is  varied  and  conflicting. 
8alines»  mercurials,  whisky,  quinia,  opium,  bismuth,  lead  and  fowlers 
solution,  each  have  had  trial,  and  their  advocates.  Treatment  ordina- 
rily ia  alow  and  unsatisfactory,  no  matter  what  class  or  doses  of 
leatedies  are  administered. 

A  favorite  and  in  a  majority  of  instances  proper  mode  is  to  open 

« 

treatment  by  the  administration  of  an  emetic.  Aside  from  the  gen- 
eral therapeutical  effect,  the  gall  bladder  is  emptied,  and  the  excited 
persiataliic  action  of  the  stomach  and  duodenum  for  a  time  arrested 
or  reversed.  I  learned  from  a  surgeon  of  repute,  whoso  name  is  un- 
foftnnately  not  remembered,  that  he  relied  almost  exclusively  upon 
the  nae  of  ipecac  in  large  doses.  He  repeated  it  daily  until  the  disease 
was  arrested,  which  he  said  had  been  much  more  prompt  than  under 
any  other  course  of  procedure. 

When  cathartics  are  indicated  I  know  of  no  class'  that  exerts  so 
kind  and  happy  an  influence  ever  the  dibeased  intestines  as  that  of 
the  salines.  They  do  not  seem  so  much  to  cure,  as  to  moderate  the 
vioienoe  of  the  symptoms,  and  modify  the  character  of  the  dejections. 
bnlph.  Magnesia  in  small  and  repeated  doses  is  the  one  usually  pre- 

ferrd. 

Great  difference  of  opinion  exists  as  to  the  use  of  mercurials  in  this 

aflection,  although  the  majority  of  them  use  them  in  some  shape  dur- 
ing the  progress  of  the  case.  Calomel  given  in  very  small  doses  from 
one-fourth  to  one-sixth  of  a  grain,  every  three  or  four  hours  with  one- 
foarth  of  a  grain  of  morphine,  I  can  speak  with  the  most  unequivocal 
poaitiveness  of  its  admirable  effects.  No  other  course  after  due  initia- 
tory treatment  gives  results  so  permanent  and  satisfactory.  It  seems 
to  be  that  the  prejudice  in  the  minds  of  many  has  arisen  from  the  too 
free  employment  of  the  agent  in  question.  The  axiom  of  the  older 
writes  that  "  chronic  diseases  require  chronic  treatment"  cannot  be 
too  deeply  impressed  upon  the  mind  of  him  who  treats  camp  diarrhoea. 
Given  in  these  doses,  it  slowly  and  steadily  overcomes  irritation,  and 


268  Ori^nal  Communieaiiont.  [Sbj, 

inflammation ;  and  ronders  the  stools  lass  freqaent  and  more  consistent 
As  the  disease  abates,  the  treatment  should  bo  correspondingly  lessen- 
ed.   Administered  in  this  way  I  have  never  seen  any  unpleasant  ef- 
fects, snch  as  ptyalism,  or  constitntional  cachexia.     Surgeon  Wil- 
liams, 12 1st  O.V.I.,  I  was  pleased  to  find,  entertains  the  same  bi^ 
estimate  of  this  remedy  administered  in  minute  doses.    Another  con- 
sideration might  have  weight,  in  favorably  regarding  the  benefieid 
.effects  of  this  treatment.    The  tendency  to  an  abnormal  developmetft 
of  fibrin  in  the  blood,  and  its  adhesion  to  the  theoa  of  the  hesrti 
thereby  giving  rise  to  unpleasant  and  dangerous  complications,  oooU 
not  be  better  obviated  by  any  other  treatment.    It  would  seem  as  U 
the  chyle  in  passing  through  the  lacteals  and  mesenteric  glands  i* 
impressed  in  its  elaboration  by  the  hypersemia  or  inflamed  state  of 
these  tissues,  transmiting  elements  in  undue  proportion  into  fibrin* 
and  thus  bringing  about  its  excessive  preponderence  in  the  blood* 
With  this  view  it  may  be  conceived  how  the  simple  rush  of  blood  &f0C 
the  salient  points  of  the  heart  may  by  aggregation  and  excessive  plas' 
ticity  accumulated  in  considerable  quantities.     Fowlers  solntion  id 
some  old  and  obstinate  cases  acted  extremely  well.    Those  having 
small  and  frequent  stools  were  the  most  benefited  by  it.    Doae  fif0 
drops  three  times  a  day.    A  form  of  what  may  be  termed  heroic  I 
have  seen  used  in  a  large  number  of  cases.     I  allude  to  the  ase  of 
whisky  and  quinine.     For  a  time  the  symptoms  in  some  seemed  sub- 
dued, but  the  disease  was  only  in  abeyance,  gathering  strength,  for  a 
fresh  inroad  on  vitality.    Doubtless  in  a  few,  in  whom  inflammation 
was  removed,  and  in  whom  debility  and  relaxation  were  the  main  in- 
dications for  removal,  these  and  kindred  remedies  had  a  salutary  effect 
But  while  their  employment  has  done  good  my  observation  leads  me 
to  infer  that  they  have  injured,  if  not  hastened  to  a  final  and  fatal 
issue,  more  than  enough  to  counterbalance  twice  over  their  good  eflects. 
In  some  instances  where  they  have  got  well — no,  not  well — ^but  man- 
aged to  live  through  this  heroic  ordeal,  an  inexpressibly  dirty  tint  of 
skin,  puffy  state  of  the  tissues,  bloated  abdomen,  depraved  appetite, 
and  morbid  condition  of  the  bowels  ha^  remained  for  months,  sye, 
for  years  after  their  use  has  been  abandoned.     Liet  enthusiasts  go  into 
rhapsodies  over  the  revivication  of  the  doctrines  of  Brown,  and  call 
them  new,  or  progression,  or  discovery,  or  an  improvement  of  the 
age,  the  foct  will  remain  patent  to  every  observing  mind,  that  their 
sweeping  employment  of  stimulants  and  tonics  is  carried  to  a  ridicu- 
lous excess,  and  fraught  with  evil  to  the  afflicted,  that  it  is  an  old 
dogma  untenable  and  unpliilosophical. 


1864.]  Proceiding9  <f  SodeiUi.  269 


^totttAlntii  ttt  9ctitHtn. 


ProoMdingt  of  the  Cinoinntti  Academy  of  Medioilie, 

B^Miitd  hj  W.  T.  Bbowk,  K.D.,  Secretary. 

Monday  Eveninq,  January  28,  1864. 
AcET.  or  Lead  in  Hemorrhage. — Dr»  Carroll — Said,  that  he  oh- 
senred  from  the  readings  of  the  minutes  of  the  last  meeting,  that  in 
tlieease  of  uterine  hemorrhage  reported  by  Dr.  Hiram  Smith,  ergot  and 
iogar  of  lead,  had  been  prescribed.  He  regarded  the  use  of  sugar  of 
ktd,  as  a  remedial  agent,  to  be  very  injurious.  That  it  interfered 
with  the  proper  action  of  the  stomach  and  destroyed  its  power.  He 
tlu>Bf(ht  more  good  was  accomplished,  in  cases  of  hemorrhage,  by 
ngilftting  the  secretions  and  by  hygienic  measures  than  by  the  use  of 
ngtr  of  lead  and  ergot. 

Ih,  Baker — remarked  tlybt  his  friend,  Dr.  Carroll,  was  opposed  to 
theoseof  sugpar  of  lead  because  it  produced  nausea  and  vomiting. 
Hiii  was  probably  dne  to  the  heroic  doses  which  he  administered.  In 
Ut  own  practice  ho  had  found  it  very  valuable. 

Dr.  H.  Smith — said  in  the  case  reported,  as  soon  as  the  action  of 
dw  medicine  could  be  effected,  the  flooding  ceased.     Now  its  arrest 
>iS8t  be  ascribed  to  one  of  the  three  remedies,  or  to  all  of  them.     He 
coold  not  rely  on  lead  alone,  because  the  uterus  must  contract,  and  lead 
bti  not  much  power  over  the  muscular  contractility  of  that  organ,  it 
icted  as  an  astringent  only,  through  absorbtion.     He  gave  ergot  for  a 
specific  purpose,  and  it  acted  promptly.     Shall  we  say  it  had  no  effect  ? 
Dr,  Carroll — How  do  you  know  it  caused  contraction  ? 
Dr.  Smith — I  discontinued  its  use  and  the  hemorrhage  returned  ; 
and  Dpon  giving  the  same  prescription  again  the  hemorrhsge  ;ivas  ar- 
retted, the  womb  contracted  flrmly,  thus  proving  the  power  of  ergot 
over  its  muscular  fibras. 

/>r.  B.  S.  Lawton — inquired  of  Dr.  Carroll  if  he  ignored  the  use  of 
acetate  of  lead  in  all  cases  ? 

Dr.  Carroll — I  do  ;  it  is  a  miserable  humbug. 
Dr.  Law9on — It  is  strange  that  the  medical  profession  should  bo 
be  humbugged  so  long.  That  sugar  of  lead  does  produce  sickness  of 
the  stomach  we  all  know,  but  it  is  as  manageable  as  any  article  in  use. 
I  have  been  disappoinled  in  almost  every  article  of  medicine  at  some 
time  or  other.  I  do  not  believe  sugar  of  lead  ever  did  or  could  pro- 
duce lead  colic. 


270  ProceedingM   of  Societies.  fMaj, 

Lead  is  not  only  a  valuable  agent  as  an  astringent,  but  alao,  oftra 
subduing  inflammatory  action,  as  in  dysentary,  it  is  valuable ;  it 
changes  the  morbid  action  of  the  mucus  membrane  from  an  unhealthy 
to  a  healthy  action.  Jn  hemorrhages,  no  nmtter  when  used,  it  is  one 
of  the  most  valuable  medicines. 

J)r,   Carroll — Said,  lead  is  never  given  alone,  it  is  usually  pn-     ' 
scribed  with  opium  and  ipecac.     After  using  it  for  ten  [jrears  and  see- 
ing its  efiects,  I  have  abandoned  it,  and  have  been  more  successful 
since.     The  proper  way  to  test  the  value  of  an  article  is  to  prescribe 
it  alone. 

Dr.  Lawson — There  are  always  other  symptoms  with  hemorrhage 
requiring  additional  remedial  agents. 

Dr.  Stevens — I  am  glad  this  discussion  has  occurred.  I  have  had 
good  effects  from  the  use  of  sugar  of  lead  and  opium,  also  from  ergot; 
but  in  chronic  cases  I  have  not  observed  the  same  good  results.  I 
consider  it  important  to  disciiminate  your  cases,  in  the  selection  of 
your  remedies.  In  such  a  case  as  reported  by  Dr.  H.  Smith  I  would 
use  the  Electro  Magnetic  Battery. 

Dr.  Johnson — Said,  I  cannot  coroborate  what  Dr.  Lawson  has  said 
about  the  use  of  sugar  of  lead,  or  agree  with  Dr.  Carroll,  but  I  must 
say  that  I  have  been  more  disappointed  in  its  use  than  in  that  of  any 
other  article.  My  experience  would  not  allow  me  to  believe  that  it 
would  change  the  condition  of  the  bowel  from  an  abnormal  to  a  healthy 
condition.  On  the  contrary  I  think  it  the  worst  remedy  we  can  em- 
ploy in  diarrhoea  and  dysentery. 

Monday  Evening,  February  1,  18G4. 

Dr,  Bruin — Made  the  following  lemaiks  in  regard  to  the  use  of 
the  acetate  of  lead.  Heretofore  he  had  refrained  from  speaking,  on 
account  of  the  great  ability  and  experience  brought  to  bear  on  the 
subject,  yet  he  considered  it  the  duty  of  every  member  of  the  Acad* 
emy,  to  give  his  opinion  in  reference  to  this  article  of  medicine.  Ee 
referred  to  the  views  expressed  at  the  last  meeting  by  Drs.  Carroll 
and  Lawson. 

Acetate  of  lead  has  an  afinity  for  the  liquid  parts  of  the  body  with 
which  it  enters  into  combination,  and  in^eye  diseases  it  has  been  dis- 
carded by  the  best  aculists,  on  account  of  the  bad  results  oocurring 
from  its  indiscriminate  use,  a  milky  hue  of  the  cornea  being  oaused 
by  the  chemical  combination  of  lead  with  the  albumen  of  the  eye 
forming  albuminate  of  lead.  European  writers  state  that  acetate  of 
lead,  when  used  externally,  will  enter  into  combination  with  the 
proting  compounds  of  the  body,  and  be  absorbed. 

Internally  it  will  act  as  a  caustic  upon  the  coats  of  the  stomach. 


1884.]  Academy  of  Itedieine.  271 

and  tbis  is  tbe  reason  we  bave  vomiting  following  iU  administration, 
because  it  acts  as  an  irritant  to  tbe  parts,  and  tbns  sets  np  an  inflam- 
niation. 

When  the  lead  .is  combined  witb  albumen,  it  becomes  redissolved 
bj  tbe  gastric  juice,  and  is  carried  to  all  parts  of  tbe  body  by  tbe 
Mood.  It  bas  been  fonnd  in  (be  liver,  in  tbe  gall  bladder,  in  tbe 
urine,  and  in  tbe  brain,  not  as  sngar  of  lead  but  in  some  combine - 
tton.  Not  only  in  tbe  soluble  state  is  it  absorbed,  bdt  even  in  tbe 
inaolnblo.  Blcn  working  in  lead  mines  become  affected  by  its  absorp- 
tion. Ho  bad  seen  lead  colic  in  New  Orleans,  occasioned  by  the 
use  of  wine,  containing  sngar  of  lead  and  logwood. 

He  bad  seen  lead  used  alone  in  pbtbisis,  when  tbe  patients  were 
baTiog  watery  alvine  dejections,  and  it  pi  educed  lead  colic.  Nearly 
all  tbe  salts  of  lead  are  soluble  by  tbe  floids  of  tbe  stomach,  except 
tbe  muriate  of  lead;  tbis  will  pass  through  tbe  body  unebangcd. 
Acetate  of  lead,  no  matter  bow  small  tbe  dose,  will  accumulate  and 
produce  its  deleterious  affects.  All  tbe  good  resulting  from  tbe  com- 
Uoation  of  lead  and  opium,  is  due  to  tbe  latter. 

Dr.  Williami — Reported  the  following  cases  in  eye  surgery.  Dis- 
location of  tbe  lens 'under  the  conjunctiva  : 

Pat  Begley  aged  56,  a  day  laborer  bas  bad  imperfect  vision  of  tbe 
rigfbt  eye  since  childhood,  produced  by  a  central  opacity  of  the  cornea. 
On  tbe  2l8t  of  January  last,  while  splitting  wood  a  piece  flew  and 
struck  him  in  this  eye,  causing  immediate  loss  of  sight.  A  few  hours 
after  the  accident  he  came  to  see  me,  when  I  fonnd  tbe  following  con- 
dition :  Eye  and  eye-lids  blood  shotten,  anterior  chamber  nearly  filled 
with  blood,  and  eye  very  soft  to  the  touch.  On  raising  the  lid  care- 
fiiUy  1  disco verod  a  lump  about  tbe  size  of  a  large  pea,  just  back  of 

tbe  upper  and  inner  edge  of  the  cornea,  over  which  the  conjunctiva 
was  entire.     The  central  part  of  the  protrusion  was  most  prominent, 

tad  it  presented  the  appearance  of  the  lens  under  tbe  conjunctiva  both 

IB  its  shape  and  in  the  slightly  amber  colored  reflexion  seen  through 

tbe  semi-transparent  cornea.     By  the  touch  I  also  ascertained  that  it 

was  harder  than  the  surrounding  parts,  and  had  a  convex  surface. 

1  diagnosed  laceration  o(  the  sclerotic  just  back  of  the  cornea  and 
escape  of  the  lens  through  the  rent  under  the  conjunctival  membrane 
which  was  not  ruptured. 

On  tbe  following  day  I  made  an  incission  through  the  conjunctival 
bag  and  removeil  the  entire  lens  which  was  of  a  yellowish  amber  color 
nd  quite  bard.  The  wound  healed,  the  eye  filled  up  and  became 
firm,  but  the  pupil  is  drawn  upward,  and  there  is  some  deformity  at 


272  Ptoeeedinfft  qf  SocUtm.  [Ibf i 

the  seat  of  rupture,  which  was  about  a  third  of  an  inch  long,  and 
some  two  lines  from,  and  parallel  with  the  margin  of  the  cornea. 

I  trealed  the  case  with  a  compa3S  and  bandage  kept  wet  with  eold 
water. 

The  size  and  shape  of  the  organ,  (except  the  lead  colored  staphj- 
loma  at  the  seat  of  ruptare,)  have  been  preserved,  bat  the  patient 
has  no  perception  of  light. 

Second  Case  Reported  by  Dr.  WUlianu — Spontaneous  laxation  and 
subsequent  absorption  of  the  lens  in  both  eyes. 

Mrs.  Helen  A.  Davis,  of  Athens  County,  Ohio,  aged  27  and  ap- 
parently in  good  health,  consulted  me  on  the  80th  of  December.  I86S9 
on  account  of  her  little  daughter,  who  she  supposed  was  very  near- 
sighted. On  examining  the  eyes  of  the  mother,  I  discovered  that  she 
had  no  lenses.  The  anterior  chambers  we)re  much  deeper  than  natur- 
al, the  iridcs  plain  and  undulating  with  every  motion  of  the  eyes,  but 
one  image  present  by  the  katoptric  test,  an  erect  image  of  the  retina^ 
as  seen  by  the  ophthalmoscope  without  the  aid  of  any  kind  of  glass. 

8be  says  she  has  been  warned  by  several  physicians  against  the 
use  of  strong  magnifying  glasses,  but  she  had  used  them  much  to  the 
aid  of  her  vision  which  has  been  imperfect,  and  she  has  been  short- 
sighted since  childhood.  On  trial  I  found  that  with  convex  glasses 
No.  3  she  could  read  small  print  fluently,  and  also  see  well  in  the  dis- 
tance— that  she  was,  in  short  in  the  condition  of  a  person  who  has 
been  successfully  operated  upon  for  cataract.  I  therefore  ordered 
her  a  pair  of  cataract  glasses  for  constant  use,  of  the  strength  inlicat- 
ed  above. 

The  daughter,  four  years  old,  was  apparently  very  near-sighted,  as 
she  held  objects  almost  touching  her  nose  when  she  wanted  to  see 
them  accurately.  On  such  occasions  she  constantly  used  only  one 
eye,  holding  the  book  or  other  object  always  close  to  the  face,  and  to 
the  right  or  in  a  corresponding  direction  to  the  left. 

The  aqueous  chambers  were  a  little  deeper  than  usual,  and  slight 
undulations  of  the  iridcs  were  noticeable  npon  close  inspection.  The 
pupils  were  circular  and  active,  and  the  eyes  in  other  respects  appear- 
ed natural. 

By  the  ophthalmoscope  the  erect  view  of  the  retina  was  readily  ob- 
tained without  the  aid  of  any  lens,  indicating  a  decided  deficiency  in 
the  refracting  power  of  the  eyes.  With  convex  glasses  No.  6,  she 
could  see  much  hotter  in  the  distance.  On  dilating  her  pupils  and  re- 
examining with  the  ophthalmoscope  I  saw  that  the  crystalline  lens  in 
each  eye  was  luxated,  the  left  distinctly  outward  leaving  a  red  crescent 


18S4.]  Academy  of  Medicine.  273 

Vetwecn  its  inner  margin  and  the  edge  of  the  dilated  papil ;  and  the 
light  downward  and  outward  to  ahont  the  same  distance  leaving  the 
tame  red  crescent  between  its  edge  and  the  pupilary  margin,  when  the 
fandas  of  the  eye  was  illuminated  by  the  instrument. 

When  the  pupils  were  of  normal  size  she  saw  through  the  inner 
edge  of  the  lenses  by  looking  obliquely  as  I  mentioned  before  was  her 
habit. 

There  was  in  her  case  partial  dislocation  of  the  lenses  from  sponfan- 
eoQs  yielding  of  the  suspensory  ligament  of  the  upper  and  inner  part. 
There  ia  every  probability  that  the  mother  had  been  affected  in  the  be- 
ginning in  the  same  manner,  and  that  finally  the  lenses  disappeared  by 
ipontaneous  absorption »  as  may  also  occur  in  the  child,  in  the  course 
of  years,  if  she  lives. 

When  she  is  a  few  years  older,  of  the  displacement  of  the  lenses 
deea  not  increase,  and  they  remain  transparent,  it  would  be  advisable 
to  dislocate  the  pupils  in  the  same  direction  by  the  method  of  Critchell, 
of  London,  so  as  to  make  them  correspond  with  the  center  of  the 


MONDAY  EvKxiNG,  March  7,  1864. 

Preaident  Dr.  Robert  R.  Mcll value  called  the  Academy  to  order 
•t  the  nanal  hour. 

After  the  reading  and  the  approval  of  the  minutes  of  the  last  meet- 
ing, the  Academy  proceeded  to  the  election  of  officers  for  the  ensuing 
year  with  the  following  result : 

President,  Dr.  S.  0.  Almy  ;  First  Vice  President,  Thos.  Carroll ; 
8oeoiid  Vice  President,  Wm.  B.  Davis  ;  Recording  Secretary,  Chas. 
P.  Wilson  ;  Corresponding  Secretary,  E.  B.  Stevens ;  Treasurer, 
Wm.  H.  Taylor  ;  Librarian,  E.  II.  Johnson. 

Y  Dr.  McIIvainc,  upon  retiring  from   the  chair,  made  a  few  remarks 

after  which  Dr.  Almy  was  duly  inducted  into  office. 
Dr.  Heigh  way  proposed  the  name  of  Dr.  J.  P.  Walkor  for  mem- 

lewhip.  Dr.  Gerwe  proposed  the  name  of  Dr.  Hetliok,  Dr.  McRey- 

•^da  proposed  the  name  of  Dr.  Cossat,  Dr.  Comegys  proposed  the 

■tme  of  Dr.  Iloeltgc.     Referred  to  the  Committee  on  Admisaioas. 


274  Proceedlnga   of  SocMet.  \Mv> 

Indianapolit  Medical  AMOciation. 


Reported  by  De.  W.  B.  Vbltchbs,  Secratary. 

Monday  Evenino,  March  lat.,  1864, 

As  the  essayist  for  the  evening.  Dr.  Parr,  was  not  prepared,  Dr. 
Parvin  reported  a  case  of  cancer  of  the  uterus. 

On  the  first  of  last  month  I  was  called  to  see  Mrs. thirty-eigbt 

years  old,  the  mother  of  three  living  children,  the  youngest  twelve 
years  of  age  ;  the  patient  was  suffering  from  uterine  hemorrhage. 
This  hemorrhage  had  been  of  occasional  occurrence  since  the  preced- 
ing August,  but  had  been  almost  constant  since  the  middle  of  Decem- 
ber, compelling  ber  to  remain  lying  down  nearly  the  whole  time — 
never  suffering  any  pain,  and  looking  upon  the  discharges  as  simply 
an  excessive  menstrual  flow,  she  songht,  through  her  husband,  pre- 
scriptions for  the  relief  of  this  symptom  from  two  or  three  pbyhiciani, 
but  was  averse  to  a  personal  consultation  with  any.  The  medicines 
which  she  had  taken  were  muriated  tincture  of  iron,  wine  of  ergot  and 
quinine;  all,  however,  without  benefit.  At  the  time  that  I  visited 
her  she  had  had  a  more  exhausting  flow  of  blood  than  ever,  \n»\^  very 
pale  and  almost  pulseless.  A  hasty  vaginal  examination  revealed  ex- 
tensive disease  of  the  neck  of  the  womb.  It  was  three  or  four  times 
its  normal  size,  with  smooth  but  hardened  and  irregular  prominence, 
and  the  entire  organ  was  much  less  mobile  than  natural. 

The  character  of  the  growth,  the  hemorrhages,  and  the  evidences  in 
the  complexion  and  general  appearance  of  the  patient  permitted  me 
no  doubt  as  to  the  malignant  nature  of  the  disease.  I  contented 
myself  with  controlling  the  hemorrhage  with  tannin  and  the  tampon, 
and  continued  the  administration  of  quinine  and  iron  for  a  few  days 
until  Dr.  Blackman  visited  her. 

Dr.  Blachnan — directed  in  addition  to  the  iron,  cod  liver  oil,  and 
as  local  applications,  the  iodide  of  [ammonium  dissolved  iu  glycerine 
and  water,  and  a  saturated  solution  of  the  pcrchloride  of  iron,  the  for- 
mer to  be  applied  daily  to  the  lower  part  of  the  abdomen  and  along 
the  lymphatics  of  each  groin,  and  the  latter  to  be  used  with  a  brush 
twice  a  day  to  the  diseased  cervix. 

About  a  month  has  elapsed  since  this  treatment  was  instituted  and 
the  results  thus  far  have  been  very  satisfactory.  The  hemorrhage, 
which  was  fast  draining  away  the  poor  patieut's  life,  had  been  entire- 
ly arrested  ;  she  had  gained  in  flesh  and  strength,  her  pulse  was  one 
hundred  and  twenty,  it  is  now  eighty,  she  is  able  to  walk  about  her 
room,  and  her  complexion  has  less  of  the  cancerous  hue  ;  the  disease 


1864. J  Indianapolis  Medical  Association.  275 

growth  has  sensibly  diminished.  While  I  do  not  believe  this  or  any 
other  ti-eatrocnt  will  cure,  no  one  can  'doubt  that  it  has  prolonged 
her  life ;  and  had  it  been  sooner  instituted  even  the  former  result 
might  have  been  attained,  that  is  supposing  the  first  deposition  of 
cancer  cells  occurred,  as  it  generally  does,  in  the  neck  rather  than  in 
the  body  of  the  womb.  Now,  however,  the  body  being  diseased,  nay, 
some  of  the  surrounding  structures  themselves  being  involved,  no  one 
can  be  sanguine  enough  to  believe  even  in  the  possibility  of  ultimate 

recovery- 

I  believe  that  the  results  attained  in  this  case,  surprising  me  not  a 
little*  present  some  encouragement  to  us  in  the  treatment  of  what  are 
nsnally  termed  malignant  growths. 

Let  us  look  for  a  moment  at  the  ^statement  of  authors,  as  to  the 
fatality  of  cancer,  and  then  endeavor  to  ascertain  whether  there  are  not 
some  principles,  empirical  or  theorelicai  or  both,  to  guide  us  in  the 
choice  of  remedial  means. 

Mr.  Charles  H.  Moore,  surgeon  to  the  Middlesex  Hospital,  in  the 
article  entitled  **  Cancer  "  in  *•  Holmes  System  of  Surgery  "  uses  this 
language  :  "  The  subject  of  cancer  is  one  in  which  there  is  the  strong- 
eat  disproportion  between  the  amount  and  the  practical  value  of  onr 

knowledge :  True  cancer  retains  not  the  less  its  claim  to 

the  epithet  incurable."  If  we  consult,  especially  upon  the  subject  of 
the  uterine  cancer,  writers  upon  diseases  of  women,  we  find  in  general 
but  little  to  encourage  us  in  the  use  of  local  or  constitutional  means. 
Churchill — "There  is  no  hope  ot  cure,  and  but  little,  if  any,  decideil 
mitigation  of  the  agonizing  suffering  entailed  by  the  complaint." 
Clarke  &  Dewves  believe  that  they  have  succeeded  in  curing  a  few 
caaes  in  their  incipient  state.  Prof.  Bedford  (page  69,  "  Diseases  of 
Women  and  Children,")  says  *'  Whatever  may  be  the  hopes  of  relief 
in  the  incipient  state  of  carcinoma  uteri,  there  are  none,  except  through 
aa  exception  to  an  almost  universal  rule,  when  the  disease  has  passed 
to  the  stage  of  deep  ulceration."  All  are  familiar  with  the  delineation 
bj  Dr.  Charles  West  of  the  cancerous  cachexia,  and  the  utter  hope- 
lessness of  the  unfortunate  patient  afflicted  with  uterine  cancer.  Dr. 
Meigs  gives  this  testimony  :  "  I  have  certainly  met  in  the  course  of 
fifty  jears,  with  several  cases  of  diseased  uterus,  which  I  had  the 
greatest  r^aiton  to  believe  was  cancerous,  but  which  yielded  to  ^er&e* 
variog  treatment,  and  ended  in  the  perfect  recovery  to  health." 

But  I  desire  especially  to  call  the  attention  of  my  professional 
brethren  to  the  statement  of  Prof.  Simpson  in  his  "  Lectures  Upon 
Diieaaes  of  Women."     He  adduces  two  cases  of  unequivocal  nterinj 


276  Proeeedingi  of  Sodttkf.  [^7> 

cancer  that  were  snocessfollj  treated,  the  one  by  himself,  the  local 
agents  being  first  the  diied  sulphate  of  zinc,  and  then  the  mnriated 
tincture  of  iron,  the  other  nnder  the  care  of  a  professional  friend,  and 
the  muriated  tincture  of  iron  the  local  application.  Both  of  their 
patients  were  still  living  some  years  after  the  treatment,  without  any 
return  of  the  disease,  and  one  had  given  birth  to  a  child.  Now  such 
facts  cannot  be  disputed  ;  it  cannot  be  asserted  in  regard  to  these 
cures,  as  it  has  been  in  regard  to  some  of  Lisfranc's  suocessfnl  cases 
of  excision  of  the  neck  of  the  womb,  that  the  diseases  for  which  the 
operation  was  done  was  not  malignant  at  all,  now  that  we  must  admit 
by  the  most  recent  evidences  that  local  applications  have  removed  not 
merely  for  a  short  time,  but  permanently  cancerons  disease  of  the  neck 
of  the  woumb,  and  this  even  after  the  positive  manifestation  of  the 
eanoerous  cachexia.  Professor  Simpson,  in  refering  to  the  beneficial 
results  arrising  in  one  of  the  cases  from  the  use  of  the  sesquiohloride' 
suggests  that  "  perhaps  a  saturated  solution  of  the  per-chloride  would 
act  still  more  efiectnally."  It  will  be  observed  that  in  the  case  whieh 
I  have  reported,  the  remedy  was  resorted  to,  and  the  results  decided- 
ly endorse  its  use. 

While  it  is  true  we  may  expect  a  fatal  issue,  sooner  or  later,  in  the 
vast  majority  of  cases  of  cancerous  disease,  yet  the  occasional  excep- 
tions furnish  us  with  hope  that  this  small  number  may  be  increased, 
and  that  our  therapeutical  power  will  ultimately  correspond  with  our 
pathological  knowledge.  Doubtless,  if  we  will  eliminate  from  our 
minds  the  idea  that  the  disease  is  consequent  upon  a  contamination  of 
the  blood,  they  will  be  in  a  more  favorable  condition  to  devise  and 
pursue  suitable  treatment.  **  Just  the  very  forms  in  which  medical 
men  are  the  most  apt  to  console  themselves,  especially  for  the  short- 
comings of  the  therapeutic  results,  with  the  reflection  that  they  have 
to  do  with  a  deeply-rooted  and  incurable  chronic  dysuria,  just  these 
forms,  depend  I  imagine  least  of  all  upon  an  original  change  of  the 
blood."  (.Virchow's  Cellular  Pathology,"  p.  217).  If,  therefore, 
we  look  upon  the  cancerous  formation  as  primary,  and  the  condition 
-of  the  blood  as  secondary,  we  will  be  more  encouraged  while  remedy- 
ing the  latter  to  attempt  the  removal  of  the  former. 

Iron  is  generally  regarded  as  the  most  valuable  among  constita- 
lional  remedies.  Mr.  Carmicheal,  of  Dublin,  thought  it  important  to 
keep  the  patient's  system  saturated  with  it  to  prevent  the  progress  of 
the  disease ;  and  Mr.  Moore,  to  whom  reference  was  made  in  a  previous 
portion  of  this  paper,  states,  ''  In  common  with  many  other  surgeons, 
both  of  the  pnesent  and  past  century,  I  have  found  advantages  from 


18ft4.]  Indianapolis  Ifedieal  AsMciation.  277 

the  use  of  iron  ;  but  it  is  more  particularly  when  united  with  chlorine 
that  it  has  appeared  to  me  to  be  beneficial  in  cancer."  . 

Do  the  structaral  characters  of  cancer  furnish  any  hints  as  to  the 
best  agents  to  destroy  it,  or  to  retard  its  growth  ?  Quoting  again  the 
eminent  pathologist,  Vichow,  **  cancer  is  not  malignant  because  it 
contains  heterologous  cells,  nor  cancroid  benignant  because  its  cells 
are  hemologous,  they  are  both  malignant,  and  their  malignity  only 
differs  in  degree.  The  forms  which  yield  dry,  juicelesd  masses,  are 
relatively  benignant.  Those  which  produce  succulent  tissues  have 
always  more  or  less  a  malignant  character."  Should  we  not  endeav- 
or,  therefore,  to  convert  the  malignant  into  the  benignant  by  lessening 
the  amount  of  fluid  ?  The  more  we  reduce  **  the  parenchymatous 
jnices  "  of  the  diseased  mass,  the  greater  the  probability  of  the  sur- 
sonndiog  structures  remaining  free  from  contamination.  Hence  theo- 
retically, cold,  desiccating  agents,  cutting  off  the  supply  of  blood,  and 
astringents  should  be  beneficial  in  the  local  treatment  of  cancer ;  prac* 
Cically  too,  none  of  these  means  have  been  proved  useful.  Possibly, 
moreover,  in  view  of  the  beneficial  effects  of  iron  administered  inter- 
nally, especially,  as  snggested  by  Mr.  Moore,  when  combined  with 
diloriBe,  there  is  an  antagonism  between  iron  and  chlorine,  and  the 
caacer  cell,  an  antagonjsm  but  partially  and  feebly  manifested  when 
they  aro  directly  applied  to  the  diseased  mass.  Hence,  it  may  be  that 
sesqoi-chloride,  or  the  perchloride  of  iron  is  beneficial  as  a  local  appli- 
cation in  cancer,  not  merely  as  a  caustic,  or  as  an  astringent,  but  from 
aoae  specific  influence  upon  the  cancer  cell. 

Vers. — The  patient  whose  case  I  have  reported  is  bow  ia  the  eight  week  of 
tkt  treat  Bent  detailed  above.  Ker  general  health  is  better  than  it  has  been 
far  at  least  f  ve  moalhs.  While  I  aia  without  hope  of  her  recofery,  jet  there 
eaa  h%  bo  question  that  the  course  pursued,  especially  the  local  application, 
retard  tbe  progress  of  the  disease  and  greatly  promote  her  eomforu  As  an 
'inent  i  omitted  the  application  of  the  per-chloride  for  thirty-six  hoars, 
tbe  emission  was  followed  by  hemorrhage,  pain  and  great  discomfort . 
mow,  ahhoogh  it  is  impossible  to  iatrodace  the  speculum  without  oauiing 
•me  fafferiag,  in  consequence  of  the  caacerous  deposition  ia  the  vaginal 
wall,  yet  she  cheerf ally  endures  this  suffering  for  the  relief  furnished  by  the 
tkorough  pencilling  of  the  cancercai  growth  with  the  iron. — Ivdianapolis, 
29. 


278  Editwial  TransIaiioM.]  [M«y, 


ASnCLK  IT. 

Specificity. 


A  Olfnical  T4ectarp,h7  Prof.  Troaswan,  translated  firom  the  CTinl^pie  MeihaU  IhVMcM  IMm 
^HfU  PariMi  Bt  J.  II.  BouoLAM,  M.D.,  Nkw  York  Citt. 

Erown  and  Bronssais  were  forced  to  admit  the  diversity  introdnced, 
in  the  manifestations  of  vital  force,  by  the  special  anatomical  proper- 
ties of  the  tisHuc  and  of  the  organs,  of  solids  and  of  liquids,  as  well 
as  the  functional  differences  which  are  connected  with  them  ;  but  they 
considered  them  of  no  consequence.  The  fundamental  idea  of  their 
doctrine  is  identical  ;  and  Brousasis  admitted  this  by  taking  the  sym- 
pathetical  proposition  of  Brown  as  the  text  of  his  own  ;  but  by  the 
interpretation  which  he  gave  totlie  forces  of  reaction,  he  diverged  com- 
pletely from  the  path  followed  by  his  predecessor,  and  arrived  at  these 
practical  conclusions  totally  opposed  to  those  of  the  disciple  of  CuUen. 

Brown  affirmed  that  all  the  facts  of  the  human  economy  are  en- 
dowed with  a  peculiar  property,  a  special  aptitude  which  he  calls  ind- 
ilhUiiy,  It  shows  itself  by  incitation,  and  this  incitation  can  only  re- 
sult from  the  action  of  an  inciting  power ;  but  this  aptitude  is  limit- 
ed ;  being  exhausted  by  the  very  act  of  being  set  in  motion,  it  requires 
to  be  incessantly  renewed  either  by  its  quantity  being  augmented  by 
means  of  alimentation,  or  by  the  accumulation  of  the  necessary  quanti- 
ty while  the  organism  remains  in  repose.  As  for  example  the  mus- 
cles :  their  incitability  is  exhausted  by  movement,  and  when  the  mus- 
cular action  has  been  exaggerated,  or  inordinarily  prolonged,  the  in- 
dividual, having  jeached  the  last  point  of  fatigue,  loses  the  faculty  of 
motion.  You  will  see  gentlemen  in  what  manner  the  pathological 
and  therapeutical  doctrine  of  Brown  is  derived  in  its  entirety  from 
this  primordial  fact. 

Every  disease,  in  his  opinion,  springs  either  from  a  diminution  of 
incitability,  the  effect  of  an  excessive  incitation,  or  from  an  excess  of 
incitability,  the  effect  of  a  diminished  incitation.  In  the  one  case,  as 
in  the  other,  the  final  result  is  debility,  and  the  part  of  the  physician 
is  therefore  limited  in  all  cases,  to  lencwing  the  strength  of  the  pa- 
tient ;  in  the  first  case  by  stimulating  agents  of  moderate  strength  ;  in 
the  second  by  the  aid  of  remedies  capable  of  augmenting  his  incita- 
bility. 

Bronsasis,  taking  into  consideration  the  irritability  in  the  tissues 
attacked  exclusively,  insisted  that  all  diseases  proceeded  from  the  un- 
timely or  exaggerated  action  of  agents  calculated  to  produce  sncb  ac- 


1864.]  Specificity.  279 

lion.  Irritants  are  therefore  the  only  morbific  causes,  and  their  effect 
is  to  produce  irritation.  And  therefore,  in  his  opinion  the  very  re- 
verse of  that  claimed  by  Brown,  we  must  in  order  to  restore  the  func- 
tions to  their  phyt^iological  condition,  seek  to  calm,  to  dispel  this  ir- 
ritation. 

Whether  the  pathological  condition  consists,  according  -to  the 
Edinburgh  doctrine,  in  a  greater  or  less  incitability,  or  whether  in- 
deed, according  to  the  Val-de-grace  theory,  it  consists  in  an  exaggerat- 
ed irritability,  or  more  rarely  in  diminished  irritability.  In  both 
these  dichotamous  systems  which  are  essentially  opposed,  thongh 
springing  from  the  very  same  principle,  the  quantity  of  the  morbific 
cause  is  above  considered  ;  and  its  quality  is  deemed  of  no  account 
whatever.  The  therapeutics  based  on  such  systems  as  these  must 
necessarily  be  extremely  simple.  And  ^wo  indeed  they  were  limited 
by  Brown  to  the  class  of  excitant  remedies,  and  in  some  very  rare 
cases  to  antisthenics,  if  I  may  be  allowed  that  term,  while  Broussais 
resorted  to  antiphlogistic  medication  alone,  and  only  in  very  exception- 
al circumstances,  advised  excitant  remedies. 

It  cannot  be  disputed  that  a  certain  class  of  slight  phlegmasia  may 
be  brought  strictly  within  the  limits  of  Broussais'  system  ;  for  that 
which  renders  the  phlegmasia  more  or  less  severe,  is  on  the  one  hand 
the  g^reater  or  less  intensity  of  the  cause  under  the  influence  of  which 
ii  ia  developed  ;  and  on  the  other  hand  the  difference  of  the  organiza- 
tions affected  by  it.  Thcra  is,  however,  another  class  of  diseases 
which  do  not  come  within  this  dichotomy,  namely,  the  class  of  spe- 
cial diseases.  But  it  is  of  little  moment  to  Brown  that  variola  is  a 
epecial  disease  ;  to  know  whether  it  is  a  sthenic  or  asthenic  disease  is 
the  only  thing  that  concerns  him,  in  order  to  formulate  the  indication 
to  Himulate  or  to  weaken.  It  is  a  matter  of  little  consequence  to 
Broussais  that  cholera  differs  in  form  from  dothinenteritis  ;  he  sees 
In  these  two  cases  an  irritation  of  the  digestive  tube,  causing  different 
sympathies,  and  this  irritation  is  the  dominant  fact  wherever  springs 
the  necessity  of  an  antiphlogistic  treatment. 

This  was  making  as  clear  a  sweep  as  possible  of  all  nosology  and 
mil  materia  meilica.  Matters  were  at  this  point  at  the  beginning  of 
this  century,  and  this  doctrine,  so  seductive  at  the  first  glance,  by 
reason  of  its  simplicity,  had  gained  many  adherents,  when  Laennec 
mnd  H.  Bretonneau,  each  in  his  turn,  struck  it  a  blow,  whose  gravity 
Broussais  sought  in  vain  to  conceal.  Lacnnic,  under  the  modest  title 
of  a  semiological  discovery  and  seemingly  limiting  his  observation  to 
tbe  study  of  diseases  of  the  respiratory  apparatus,  wrote  a  marvelous 


280  Editorial  Tramlaiions.  [Hay, 

chapter  of  nosology.  While  in  his  Traiie  des  if^awimationM  Mpeekdu 
du  tistu  mugueuz  M.  Brctonneau  accomplished  ia  respect  to  acute 
diseases  the  same  restoration  which  Laennec  had  brought  aboat  in  tbe 
history  of  chronic  diseases. 

Galling  attention  to  this  primordial  fact,  that  the  difference  in  the 
the  nature  of  the  cause  introduce  into  diseases  far  greater  differences 
than  the  greater  or  less  intensity  of  this  cause,  and  then  the  Tariety  of 
organization,  the  illustrious  physician  of  Tones  overturned  from  top 
to  bottom,  the  grand  edifice  o(  phydolopism  and  pretende<i  raiionalism 
in  therapeutics,  and  on  its  ruins  reared  the  doctrine  of  the  specificity  of 
diseases. 

In  physiology  he  gives  to  the  special  prpperties  of  the  different  tis- 
sues and  of  the  different  organs  a  far  greater  importance  than  that 
which  he  accords  to  the  modifiers  of  the  organism  in  pathology.  He 
admits  that  a  great  number  of  diseases  have  an  element  in  common 
which  may  be  called  irritation  or  inflammation  ;  but  this  common 
element  has  not  the  importance  assigned  to  it  by  Broussois.  Doubt- 
less the  carbuncle  and  the  malignant  fustula,  the  syphilitic  chancre 
and  Iierpes  praq>uticUis,  gastric  disturbance  and  dothinenteritis  have 
as  an  element  in  common,  inflammation  characterized  by  fluxion  and 
by  redness,  appreciable  when  the  inflammation  attacks  tissues  access- 
ible to  sight,  by  pain  and  by  an  elevation  of  the  temperature  of  the 
body  ;  but  besides  this  common  element  there  are  other  very  consid- 
erable characteristics  which  distinguished  these  different  affections* 
and  these  latter  have  a  far  greater  importance. 

The  natural  history  of  diseases  has  a  remarkable  analogy  with  the 
natural  history  of  animals  and  of  plants,  and  Sydenhram  a  long  time 
ago,  promulgated  this  truth,  when  in  the  second  section  of  his  medi- 
cal observation  he  says,  speaking  of  the  pestilential  fever  and  pla§^e 
in  1665-66  :  **  TJnaqueque,  morborum  non  minus  quam  animalium, 
aut  vegetabilinn  species,  affectiones  sibi  proprias  pcrpetuas  ac  paritar 
univocos  ab  essentia  sua  promanantes,  sortita  est."  Examples  taken 
from  botany  and  zoology  will  enable  you  the  better  to  understand  the 
subject  which  I  am  now  considering. 

The  different  vegetable  species,  for  example,  present  to  our  view 
characteristics  in  common  which  caused  them  to  be  classed  in  the 
same  natural  families,  and  these  common  characteristics  are  also  found 
in  neighboring  families  ;  but  in  the  form  of  the  flower,  in  that  of  the 
fruit,  in  the  juices  secreted  by  the  plant,  there  are  differences  which 
do  not  permit  us  to  confound  not  merely  the  different  families*  but  not 
even  the  species  most  nearly  allied.     Thus,  night  shade,  and  datur 


3864.]  SpecificUv.  281 

•Irftmoninm,  celandine  anil  the  poppy,  sweetbrier  and  the  cherry  laurel^ 
hmv^cbaracteri sties  in  common,  but  they  have  also  specific  character* 
istic6»  which  the  botanist  will  not  fail  to  recognize. 

When  yon  study  two  examples  of  the  class  of  reptiles  and  of  the 
order  of  ophidiacie  an  adder  and  viper,  yon  note  resemblances  in  their 
external  forms  and  in  their  anatomical  organizations,  but  you  pay  very 
great  attention  to  their  specific  characteristics.  The  presence  or  ab- 
•euce  of  scales  or  plates  on  the  head  of  the  animal,  the  presence  or 
absence  of  venomous  fangs,  establish  in  your  judgement  capital  dif- 
ferences between  these  two  individuals  so  similar  in  appearance,  and 
DO  one  would  be  disposed  to  regard  the  viper  as  a  variety  of  the  adder. 

Well,  gentlemen,  diseases  which  seem  to  resemble  one  another  most 
nearly,  have  specific  characteristics  by  which  they  are  discriminated 
in  the  same  manner  as  the  different  species  of  the  same  natural  family, 
vegetable  or  animal,  are  distinguished  from  one  another.  This  is 
what  Brousasis  would  not  admit.  The  inflammatory  element,  whos« 
existence  we  do  not  at  all  dispute,  was  even  in  his  opinion  the  capital 
and  only  controlling  fact.  Although  in  some  cases,  I  repeat,  this  is 
so  ;  though  in  slight  phlegmasiae,  the  quantity  of  the  morbific  causs 
is  the  g^at  point ;  the  difference  of  organs  and  the  variety  of  organ- 
isation being  taken  into  consideration,  yet  most  generally,  in  phlegm 
aasiae  soch  as  pyrexias,  such  as  the  great  majority  of  diseases,  it  is 
leas  the  quantity  than  the  quality  of  this  morbific  conrse  which  must 
be  eonsidcrdd. 

Let  as  take,  if  you  please,  examples  from  most  clearly  marked  and 
cooseqnenily  least  disputed  cases. 

Sorely  a  small  vesicle  which  appears  at  the  base  of  the  gland  subse- 
quent to  an  impure  coition  is  in  appearance  a  very  slight  thing,  and 
if  we  jadge  by  appearances  only,  it  is  an  afiection  of  less  importance 
than  the  group  of  vesicles  or  herpes  praeptUialtM  which  may  make 
their  appearance  under  the  same  condition.  It  is  true  that  if  we  only 
take  into  consideration  the  inflammatory  characteristic,  the  latter  affec- 
tion is  far  more  serious  than  the  former ;  but  what  differences  outside 
of  this  common  element !  While  the  vesicle  of  herpes,  left  to  itself, 
will  become  filled  with  pus,  and  will  dry  up,  and  after  the  scab  which 
will  be  formed  shall  have  fallen  off,  will  leave  in  its  place  only  a  small 
nnd  insignificant  cicatrix,  the  syphilitic  vesicle  will  pass  rapidly 
through  its  period  ;  but  in  the  place  where  it  appeared,  there  will 
•npenrene  an  induration  of  the  subjacent  cellular  tissue,  and  already 
yoQ  will  perceive  between  this  inflammatory  affection  and  the  former, 
m  difference  to  which  you  will  attach  the  greatest  importance.     And 


282  Indianapdii  Medical  Asiociation.  V^V» 

cbaracteristics  must  not  be  confounded  with  those  which  determine  the 
varieties  ;  in  nosology  as  in  natural  history  we  must  discriminate  be- 
tween them. 

To  continue  my  comparisons  :  between  the  lap  dog  of  our  ladies 
and  the  mastiff  of  the  Pyrenies  the  difTcrence  is  gi'eat,  and  yet  they 
are  not  diiferent  species,  bat  only  varieties  of  one  and  the  same  spe- 
cies of  the  germ  Canis.  Both  will  have  the  same  instincts,  the  same 
anatomical  and  physiological  characteristics,  which  you  will  fiud  in- 
variably in  each.  Although  ingenious  breeders  have  been  able  by 
intelligent  cross  breeding  to  rear  animals  very  different  from  the  primi- 
tive stock,  and  to  create  races  in  which  they  have  caused  the  wool,  the 
fat,  or  the  muscles  to  predominate,  according  to  the  purpose  for  which 
the  animal  was  destined.  Yet  those  races  are  only  varieties  of  a  type 
which  preserves  all  the  specific  characteristic?.  The  same  thing  is 
true  in  respect  to  plants  ;  you  know  how  readily  we  can  multiply  the 
varieties  of  a  vegetable  species,  and  can  create,-«o  to  speak,  monstrosi- 
ties. Thus  from  the  most  simple  violet,  the  skilful  horticulturalist, 
will  make  innumerable  varieties,  and  from  the  wild  sweetbrier  be  will 
obtain  those  beautiful  roses,  the  ornaments  of  our  gardens. 

But  whether  in  the  vegetable  kingdom  or  in  the  animal  kingdom* 
these  are  only  varieties,  di^erent  modes  of  existence  of  the  species* 
and  it  is  impossible  for  us  to  change  them  completely,  still  less  to 
create  new  Fpecies.  A  long  time  ago,  the  horse  was  crossed  with  the 
ass,  and  yet  whether  we  put  a  stallion  to  an  ass,  or  a  jack  to  a  mare, 
we  can  never  get  anything  but  mules,  that  is  to  say  varieties  belonging 
to  either  one  or  the  other  species  of  the  germs  Equus,  but  accidental 
varieties  which  are  not  reproduced  nor  perpetuated  by  themselves. 

Neither  in  nosology  nor  in  natural  history,  should  the  varieties  of 
a  type  be  mistaken  for  different  species.  Thus,  varioloid  is  not  a  spe- 
cies difTerent  from  variola  ;  it  is  only  a  modification  of  it,  a  variety, 
while  varicella  is  an  entirely  distinct  species. 

I  insist  on  this  point,  gentlemen,  because  some  have  looked  upon 
this  subject  of  specificity  as  merely  a  matter  of  degree,  greater  or  leas, 
while  in  reality  there  is  an  absolute  difference  as  well  between  the  dif- 
erent  nosological  species  as  between  different  botanical  or  zoological 
pecies.  Never,  whatever  we  may  do,  will  roseola  becon^e  measles 
nor  will  varicella  become  variola,  nor  will  simple  bronchial  catarrh 
become  hooping-cough.  These  diseases  all  have  their  specific  charac- 
teristics, absolute  and  invariable,  which  distinguished  them  clearly 
from  on »  another,  whatever  may  be  in  other  respects  the  severity  of 
these  different  mala^lies ;  and  their  indisputable  specific  character  is  so 


1864.]  •  Spectficify.  ^88 

of  bnt  little  importance ;  the  qnantity  was  nothing  the  qnalitj  every- 
thing. 

The  characteristics  which  impress  upon  specific  maladies  their  pecu- 
liar stamp  are  tinequi vocal  and  are  always  enconntered  whatever  may 
be  the  degree  of  the  common  element  with  which  they  are  connected. 
Thus  variola,  whether  it  be  discrete  or  confluent,  mild  or  malignant, 
normal  or  modified  will  always  be  recognized  by  its  pustules,  but  by 
pustules  of  a  special  nature,  which  are  the  peculiar  work  of  it,  as  in- 
variably and  as  specific  as  can  be  the  peculiar  characteristics  of  the 
vegetable  or  animal  species. 

That  which  is  true  in  human  pathology  is  also  true  for  the  same 
reason  in  comparative  pathology.  Thus  you  will  see  the  rot,  that 
eruptive  disease  prevalent  among  sheep  of  which  I  spoke  to  you  in  a 
former  lecture  when  comparing  it  with  variola  in  man,  manifei^ting 
itself  by  an  eruption  having  perfectly  clear  and  unmistakable  charac- 
teristics which  unable  us  to  distinguish  it  from  all  other  eruptive  dis- 
eases met  with  among  sheep. 

In  their  pathological  disorders,  plants  themselves,  whose  organiza- 
tion is  80  inferior,  testify  to  the  influence  of  the  quality  of  the  cause 
by  the  power  of  the  disease.  The  insects  which  sting  their  leaves  or 
their  sUilks  cause,  at  the  point  of  contact,  morbid  exuberances,  the 
significant  characteristic  of  which  points  to  their  cause.  Thus  the 
iting  of  such  an  insect  is  succeeded  by  such  a  sort  of  excrescence,  and 
•o  invariably,  that  the  practised  naturalist  can  always  determine  from 
the  form,  the  color  and  the  size  of  the  excrcsence  what  the  insect  is 
whose  larva  is  therein  contained. 

Whether  we  have  to  deal  with  a  phlemasia  developing  itself  exter- 
nally, or  with  an  internal  phlegmasia,  the  theory  is  the  same.  Thus, 
in  dothinentcrilis,  you  will  find,  independently  of  the  general  charac- 
teristic, common  to  every  intestinal  phlegmasia,  a  phlegmasia  occupy- 
isg  a  circumscribed  point,  limited,  fixed  and  always  the  same;  yon 
will  find  the  furunculus  eruption  of  the  agmenatedand  isolated  glands, 
mad  aa  the  furunculous  eruption  is  invariably  forme<l  in  putrid  fever, 
JOQ  will  very  properly  fix  upon  it  as  the  specific  characteristic,  the 
special  anatomical  manifestion  of  the  disease. 

In  dysentery,  which  is  in  fact  only  a  colitis,  yon  also  note  peculiar 
cbaracteriAtics  either  in  the  intestinal  secretion,  or  in  the  symptoms, 
or  in  the  anatomical  lesions,  which  enable  you  to  distinguish  the  in- 
flammation of  the  large    intestine  from  other  kinds  of  colitis,  and  to 
establish  the  specific  character  of  the  disease. 

I  must  call  your  attention  to  the  fact,  gentlemen,  that  these  specific 


284  EdUorial  Trantlations.  jMay, 

truly  you  will  be  right ;  for  after  the  herpes  is  cured,  you  will  htn 
no  cause  for  alarm  as  to  the  health  of  the  individual  ;  the  local  malidy 
having  disappeared,  the  cure  will  be  radical.     Will  this  be  the  case 
after  the  cicatrization  of  the  chancre  ?     No  ;  for  two  or  three  months 
later,  and  sometimes  after  a  still  longer  time,  certain  accidents  of  the 
skin  or  mucous  membranes,  will  make  their  appearance  which  yoQ 
will  connect  with  the  existence  of  that  little  vesicle  so  insignificant  in 
appearance.     There  will  be   a  peculiar  eruption,  ulcerations  of  the 
throat,  and  if  the  physician  does  not  then  intervene  energetically  to 
combat  the  disease,  other  affections  which  are  all  however  connected 
with  the  first,  will  successfully  be  developed  ;  affections  of  the  cellu- 
lar tissue,  tubercles,  gums  etc.,  affections  of  the  osseous  system,  osteo- 
copic  pains,  caries  and  necrosis,  which  if  their  progress  be  not  stayed 
will  introduce  frightful  disorders.     In  addition  therefore  to  the  charac- 
teristics which  it  offered  in  common  with  herpes,  the  chancre  had  also 
specific  characteristics  which  merited  great  consideration.     If  the  in* 
fiammation  had  been  the  capital  fact,  we  would  have  succeeded  in  one 
case  as  in  the  other,  according  as  Broussais  pretended. 

Analogous  examples  appear  in  throngs  in  the  clinical  study  of  dis- 
eases ;  what  we  have  said  concerning  syphilitic  chancre,  wo  might  re- 
peat in  respect  to  a  multitude  of  other  affections. 

A  little  pimple  makes  its  appearance  on  the  hand  of  a  butcher  who 

has  skinned  a  sheep  that  died  of  ?     It  merely  occa^^ioned  a 

disagreeable  sensation  of  itching,  and  compared  with  a  boil  which  is 
often  so  painful,  it  will  seem  to  you  an  afiiection  scarcely  worthy  of 
attention.  But  wait,  and  this  insignificant  affection,  apparently  so 
benignant  in  its  character,  will  begin  to  increase  ;  a  little  eschar  will 
appear  in  its  place  ;  an  erysipelato-oedematous  swelling  developed  in 
the  region  affected  will  gradually  advance  until  the  whole  limb  is  in- 
volved ;  the  epitiochlian  and  axillary  ganglions  will  become  swollen  ; 
at  the  same  time  fever  will  manifest  its3lf  and  increase  in  violence  each 
day,  the  delirium  will  supervene,  and  the  patient  will  fall  with  greater 
or  less  rapidity  into  a  condition  of  excessive  weakness  attended  by 
formidable  typhoid  accident.  This  little  pimple  was  a  malignant  pus- 
tule. 

And  yet  the  boil  which  caused  in  the  very  commencement  such 
violent  pain,  this  affection  whose  inflammatory  element  was  carried  to 
a  far  higher  degree  than  in  the  other  case,  this  boil  will  get  well  o^ 
itself,  and  he  who  suffered  so  much  from  it,  will  have  nothing  to  fear 
on  account  of  it.     The  inflammatory  element,  therefore,  proved  a  fact 


1864.]  Speeifick^.  285 

eompletelj  iDScribed  upon  them,  that  there  is  no  seed,  in  order  to  re- 
eognize  a  nosological  species,  to  have  all  its  symptoms  together  ;  and 
then  as  we  have  seen  in  the  case  of  masked  scarlatina — a  single 
word  will  often  suffice  to  enable  us  to  construct  the  entire  patbologi* 
cal  phrase,  in  like  manner  as  Cuvier  restored  to  life,  so  to  speak,  lost 
animal  species,  by  studying  a  few  portions  of  antedilnvian  skeletons. 

That  which  gives  to  specific  diseases,  their  invariable  characteristics 
is  not  the  quanlily  but  the  quality  of  the  morbific  cause,  in  its  very 
satore  invariable,  under  the  influence  of  which  they  are  developed. 

Judging  merely  from  the  examples  which  I  am  about  to  cite  to  you, 
you  will  reailily  comprehend  that  the  class  of  special  affections  is  so 
extensive  that  it  fills  the  greater  part  of  the  n'osological  system.  If 
we  study  the  different  causes  of  diseases,  whether  these  causes  are  irri- 
taliag  agents,  or  agents  of  any  other  nature,  we  shall  see  them  pro- 
duce effects  so  peculiar  and  characterized  by  forms  so  invariably  the 
tame  according  to  the  nature  of  these  causes,  that  ijt  will  be  impossi- 
Ue  noi  to  recognize  their  specificity  at  every  step  we  take  in  the  ob- 
lervatioB  of  diseaRe. 

Buppose  a  blister  appears  on  the  skin  nnder  the  influence  of  an  ap« 
plieatioo  of  cantbarides,  or  that  it  has  been  prodoccil  by  heat  aided 
by  light,  in  what  is  called  snn  stroke,  or  has  made  its  appearance  in 
erysipelas,  or  is  the  result  of  cauterisation  with  ammonia  ;  the  affection 
will  be  different  in  all  these  cases.  You  know  how  sharp  the  pain  is 
in  fiii»-atroke,  yet  ft  is  not  the  same  as  that  occasioned  by  a  blister  of 
caolharides  or  ammonia ;  tlie  latter  has  not  the  same  pungency  and 
continues  during  a  much  shorter  period  than  the  former  ;  and  yet  the 
mtaneoas  phlegmasia  causeil  by  the  blister  is  much  more  intense  than 
that  earned  by  the  sun-stroke,  but  each  canse  has  its  special  effect. 

Let  un  take  still  more  himplc  facts,  and  see  what  takes  place  in  r,?* 
tpoct  to  the  chemrcal  agents  whose  effects  are  the  R>ost  easily  noted. 
Applied  to  the  human  bo<ly,  they  have  each  a  peculiar  and  very  dif- 
ferent effect,  in  accordance  with  the  nature  of  each.  The  pain  occas- 
ioned by  bnrniag  with  hydrochloric  acid  passes  away  far  more  speedi- 
ly than  that  caused  by  nitric  acid  ;  and  this  latter,  even  wlien  ft  pro- 
duces mortification  of  the  parts  involved,  causes  a  less  profoimd  and 
leas  persistent  sense  of  pain  than  thai  produced  by  cauterisation  with 
sulphuric  acid,  although  m  this  latter  case  the  destruction  of  the  tis' 
roes  ma  J  be  less  extensive  than  in  the  former.  Tliere  is  not  a  student 
who  does  not  know  that  the  application  of  Vienna  caustic  and  of  al^ 
kftline  caustics  is  much  less  painful  than  the  application  of  the  chlor- 
ide of  zinc,  of  butter  ef  ant inaony,  or  arsenical  preparations.    In  a  word. 


286  Editorial  Translations.  l^Jm 

the  (lifTerent  chemical  agents  produce  •n  the  skin  an  action  so  rerjr 
different  that  with  a  little  skill  we  may  determine  the  substance  which, 
has  acted  in  a  manner  peculiar  to  itself,  as  well  as  tlie  form  of  the  n- 
action  which  has  succeeded  its  application.    Evidently  we  cannot  argaa 
in  this  case  from  the  quantity  of  the  cause,  for  experience  shows  that 
we  can  never  do  with  potash  what  we  can  do  wiih  butter  of  aniimony* 
whatever  may  be  the  duses  which  we  use.     That  this  is  attributable 
to  the  chemical  qualities  of  the   two  agents  and  to  the  manner  in 
which  they  combine  with  the  tissues  we  do  not  dispute,  but  we  do 
contend  it  shows  that  there  is  an  inavoidablc  diQerence. 

If  now  we  examine  the  question  of  poisons  we  shall  see  that  each 
one  acts  in  its  own  way,  and  to  such  an  extent  in  its  own  way  that 
the  very  slightest  examination  will  almost  always  suffice  to  enable  oi 
to  distinguish  the  nature  of  the  poison.  Certaiuly  there  is  no  toxi- 
cologist  of  even  a  moderate  degree  of  skill  who  cannot  distinguish  the 
intoxication  from  the  use  of  opium,  from  that  which  succeeds  the  in- 
gestion of  stramonium,  veratrum  or  strychnine  ;  or  who  wiil  not  nolo 
the  diversity  of  accidents  which  follow  after  the  absorption  of  the 
venom  of  the  rattlesnake,  the  viper,  tlie  scorpion,  the  tarantula,  the 
bee,  the  mad  dog,  etc. 

Each  special  morbific  cause  produces  on  the  human  organization 
effects  which  have  their  own  specific  character. 

An  individual  enters  a  hospital  suffering  from  paralysis  of  the  ei 
tensor  muscles ;  his  gums  at  the  point  of  attachment  to  the  teeth 
present  a  bluish  line,  the  skin  has  a  subictcric  line,  tlie  patient  com- 
plains  of  a  violent  colic,  and  of  darting  pains  along  the  course  of  the 
nerves  of  the  limbs.  You  will  not  need  u  long  cxamiuation  in  order 
to  diagnostigato  lead  poisoning.  The  fact  is  so  clear,  that  it  seems  to 
you  there  caunot  be  a  doubt  of  it.     The  disease  has  characteristics  so 

• 

very  specific,  that  at  the  very  first  glance,  you  recognized  it,  just  as 
at  the  fiist  glance  you  know  a  tree  by  its  leaves  and  its  general  ap- 
pearance. You  have  at  once  remarked  the  differences  which  distin- 
guish saturnine  intoxication  from  coffee-poisoning,  just  as  yon  are 
struck  instantaneously  by  the  differences  which  separate  the  different 
vegetable  or  animal  species  from  one  another. 

Another  individual  comes  affected  by  general  tiembling,  his  gums 
arc  ulcerated  and  bleeding,  teeth  loose  in  their  sockets,  his  intelligence 
is  weak  etc.  The  first  question  you  ask  him  is  whether  or  not  he  is 
a  silvercr  of  mirrors,  a  gilder  of  metals  or  whether  he  does  not  follow 
some  other  avocation  in  w^hich  mercury  is  employed  ;  without  hesita- 
tion, you  have  suspected  mercurial  into.xicutiou — the  accidents  by  which 


Specificity.  287 

ml  was  affected  were  so  clearly  characteristic,  that  yon  coold 
istaken  in  respect  to  them. 

now.  gentlemen,  what  are  the  symptoms  of  the  disease  pro* 
'  the  inhalation  of  the  sulphur  of  carbon  among  operatives 
k  at  the  fabricaiion  of  vulcanized  india-rnbber ;  the  interest- 
tigations  of  my  colleague,  Mr.  Delpech,  into  this  subject  have 
ailed  our  attention  to  this  point. 

:ing  into  consideration  the  specificity  of  certain  phenomena 
I  had  noticed  in  a  worker  in  caoutchouc  phemomena  which 
'elation  to  any  known  disease,  this  sagacious  observer  has 
I  to  C8talj]ish  the  existence  of  this  new  malady,  a  certain  nam- 
scs  (if  which  he  has  since  met  with,  presenting  in  every  in- 
8  same  characteristic  symptoms  ;  disturbance  of  the  intelli- 
id  especially  loss  of  memory  ;  cephalalgia  more  or  less  acute, 
?s  very  intense  ;  violent  vertigo,  pains  in  the  limbs  and  a 
rceping  i«onsation,  coincident  with  ovalgesia,  and  rarely  with 
s  hyieiscthe.sia,  enfceblcment  of  the  senses  and  of  the  genera- 
tions ;  observation  of  motive  power,  cramps  at  first  then  con- 
;  finally  muscular  weakness  at  first  in  the  lower  extremities 
-wards  in  the  arms  ;  anorexia,  vomiting.  Under  the  infiuences 
disturbances  of  the  system,  the  inilividual  lapses  into  a  con- 
cadiexia  mure  or  less  profound.  An  important  characteria- 
s  di^('asc  is  the  immediate  amelioration  of  the  symptoms,  and 
•ases  complete  euro  consequent  upon  a  sufliciently  prolonged 
»n  from  their  exciting  cause. 

g  thf*  twenty  years   past  in  which   chemical  have 

e  place  of  the  old  sulphur  matches,  physicians  have  only  too 
opportimiiies  to  study  the  affection  produced  by  phosphorus 
the  workmen  employed  in  their  manufacture  ;  affections 
low  themselves  in  necrosis  and  caries  of  the  bones,  and  which 
B  peculiarity,  that  passing  by  other  portions  of  the  osseoos 
they  invarial.ly  locate  themselves  in  these  very  same  bones. 
>a«e,  the  result  of  phosphoric  intoxication,  has  therefore  its 
L-ific  marks  and  characteristics. 

(•men,  in  thc.-e  specific  diseases  produced  by  the  physical  or 
1  agents  whioh  we  have  just  been  considering,  we  can  grasp 
:he  m'>rhitic  cause  ;  we  can  also  grasp  it,  so  to  speak,  althiugh 
be  impossible  for  us  to  isolate  it,  in  virulent  or  venomous 
We  know  tliat  it  exists  in  the  liquids  thrown  off  by  the 
ivi«Iu&l,  as  the  \  irus  in  the  saliva  of  a  rabid  dog,  the  variol- 
6  in  the  ptis  of  a  pustule,  although  these  liquids  may  be  idea- 


238  Editorial  7rantla(ions.  V^V 

tical  in  appearanco  with  those  which  do  not  prodace  any  specific  ef<* 
feet.  Wc  know  that  this  cause  exists  in  the  secretions  pecnlisr  to 
certain  animals  and  to  certain  plants  ;  in  the  venom  secreted  bj  the 
gland  place.1  at  the  base  of  the  rattlesnake's  fang  as  also  in  the  joios 
secreted  in  the  prickly  nettle,  but  even  though  in  the  greatest  number 
of  cases  we  can  no  longer  clearly  see  the  morbific  cause,  yet  we  do  m 
in  natural  history,  by  admitting  its  existence,  suppose,  in  fact,  thift 
having  found  for  the  first  time,  in  a  certain  country,  a  plant  which  op 
to  that  time,  was  unknown  there,  we  should  afrerward  discovAr  in  the 
same  rcgiou  a  large  number  of  them  presenting  all  the  characteristict 
of  the  first  plant,  invariably  the  same,  would  we  not  be  right  in  af- 
firming that  all  these  plants  were  derived  from  one  and  the  same  germ, 
although  we  may  not  have  seen  the  seed  from  which  they  oristnally 
sprang.  In  my  opinion  a  better  compariHon  could  not  be  chosen,  and 
an  analogy  has  been  justly  established  between  nosological  species 
and  vegetable  species.  The  living  organism  has  been  likened  to  a 
spot  of  ground  in  which,  under  ceiiain  conditions  inherent  in  the  na* 
ture  of  this  organism,  the  seeds  of  disease  could  germinate,  and  spring 
up  with  their  specific  characteristics,  just  as  the  seed  of  a  plant  con* 
fides  to  suitable  soil,  springs  up,  reproducing  the  same  species  which 
furnished  the  germ.  Although  this  comparison  may  be  more  appli* 
cable  to  contagious,  inoculable  diseases  than  to  others,  for  of  these  we 
may  truly  say  that  their  seeds  are  sown,  and  that  therefore  they  nec- 
essarily retain  the  quality  of  the  germ,  yet  this  comparison  is  appliea-^ 
blc  not  only  to  contagious  diseases  which  are  not  inoculable,  but  also 
to  another  order  of  diseases  characterized  by  phenomena  in  every  in- 
stance identical,  we  are  led  to  recognize  the  existence  of  special  causes 
which  are  followed  by  special  effects  although  these  causes  may  com- 
pletely  escape  our  notice  ;  just  as  in  respect  to  the  plants  of  which  we 
have  just  spoken,  we  were  compelled  to  admit  that  they  all  spring 
from  the  very  same  germ. 

And  so  gentlemen  we  all  admit  the  existence  of  what  we  call  mias- 
ma, though  wc  judge  them  only  by  their  effects  ;  we  admit  that  there 
are  several  sorts,  because  certain  peculiar,  special  phenomena,  wbicb 
are  invariable,  characterize  different  diseases  which  we  suppose  to  be 
produced  by  them.  Who  of  you  would  fail  to  recognize  marsh  fever, 
which  manifests  itself  most  frequently  by  intermittant  attacks  vary- 
ing in  type,  but  in  some  cases  by  neuralgic  symptoms  ?  who  of  yoa 
^ould  not  conclude  that  the  person  affected  by  it  had  been  exposed  iq 
miasmatic  emanations  ? 

But  here  again,  though  we  fail  to  discover  the   morbific  cause,  w 


1864.]  Specifieify.  289 

know  At  least  the  conditions  of  its  development.  In  «  great  nnmber 
of  ctTcumstanoes,  these  conditions  themselves  are  completely  unknown 
lo  Q8,  and  yet  we  cannot  deny  the  eiislence  of  a  canse,  special  in  its 
ttalnre,  which  mast  give  rise  to  the  special  eflfect  we  have  noted. 

We  are  ignorant  of  the  meteorological  or  tellaric  conditions  under 
Che  inflnence  of  which  cholera  morbus  makes  its  appearance  ;  we  are 
still  more  ignorant  of  its  cause,  and  yet  no  one  can  deny  its  specificity, 
when  he  sees  the  disease  ever  manifesting  itself  by  symptoms  which  are 
invariably  the  same.  We  do  not  know  the  cause  of  dothinenteritis  ; 
but  there  is  no  physician  who  will  not  admit  that  it  is  special  in  its 
natnre»  when  he  sees  the  disease  constantly  characterized  by  special 
symptoms  and  by  special  anatomical  alterations  ;  and  these  specific 
characteristics  are  so  clearly  marked,  so  predominent,  that  all  confus- 

ioQ  is  impossible.     Every  one  can  distinguish dothinenteritio 

enteritis  from  simple  enteritis,  when  he  shall  be  pi^rmitted  to  observe 
OB  the  autopsy,  the  anr.tomical  lesions,  just  as  during  the  life  of  the 
pelieBt  the  difference  of  the  symptoms  enable  him  to  form  his  diag- 

To  sum  pp,  gentlemen,  what  I  have  just  set  forth  before  yon,  we 
BQst  eonsider  in  every  disease  a  common  element,  which  may  he 
called  the  physiological  element,  irritation,  inflammalion,  etc.  ;  an 
dement  also  which  may  be  called  the  nosological  element,  impressing 
opon  the  former,  and  upon  the  whole  disease,  a  peculiar  stamp,  assign- 
iiif  to  it  a  unique  origin,  a  special  principle,  a  nature  more  or  less 
dcArly  determined,  constituting  in  a  word,  the  morbid  species. 

The  common  element  predominates  in  diseases  which  may  be  re- 
garded as  accidental  perturbation  of  our  economy  ;  ^  a  simple  burn 
wonld  be  an  absolute  type  of  these.  In  this  instance,  the  quantity  of 
the  morbific  canse  is  everything,  and  we  have  only  to  take  into  con- 
sideration the  diflference  of  the  organs,  and  the  variety  of  organiza- 
ttoiia.  But  in  a  .great  number  of  diseases,  in  which  the  aosological 
•lenent  controls  the  common  element,  it  would  doubtless  be  as  absurd 
to  ezdttde  the  quantity  of  the  morbific  cause  from  all  participation  in 
tlie  production  of  effect,  as  it  would  be  not  to  take  into  consideration 
the  diflerence  of  organs  aud  the  variety  of  organizations ;  but  the 
qoaatity  of  the  cause,  the  difii^nce  of  organs,  the  variety  of  organi- 
aatioiiii  are,  in  these  instances,  controlled  by  the  quality  of  the  cause, 
mnd  it  is  this  and  its  nature  which  must  above  all  be  considered. 

la  certain  cases,  we  can  grasp  this  cause,  and  produce  almost  at 
will  the  effects  which  belong  to  it.  Such  is  the  case  in  respect  to  the 
specul  phlegmasia  excited  by  special  physical  or  chemical  agents,  in 


290  Special  SiUeHant.  [Ibj* 


respect  to  vinilent  and  venomoiui  diseases  and  poisoniDgs ;  aoek  if 
also  the  case  in  respect  to  diseases  whose  canse  itself  we  do  not  knoWt 
Bat  we  so  know  the  conditions  of  iU  action,  as  for  instance  mank 
fever.  In  these  cases  the  specificity  b  indispntablo  ;  it  is  none  As 
less  so  in  other  diseases  whose  causes  and  whose  conditions  of  actioa 
are  themselves  unknown  to  us  ;  becanse  in  these  cases,  the  speoifidtf 
is  as  clearly  determined  by  the  invariability  of  the  symptoms  and  sf 
the  forms  of  the  afifection,  as  if  we  had  known  at  the  same  time  bott 
eflfects  and  causes  ;  for  it  is  philosophical  to  argne  from  the  conftaMjf 
of  one,  the  constancy  of  the  other. 

SfifttlJil  Sftlttti9Ut. 

Defective  and  Impaired  Vision,  with  the  Clinical  use  of  the  OphthalMt- 

soope  in  their  Diagnosis  and  Treatment 

By  Laubbnci  Tubmbull  M.D.,  Sorgvon  to  Howard  HotptUl.  Ac. 


Mv  attention  has  recently  been  directed  to  the  subject  of  defeetifs 
and  impaired  vision,  having  been  appointed  examining  snrgeoif  Vf 
the  Govenor  to  examine  men  who  were  drafted  and  who  desired  ex- 
emption. The  proportion  of  cases  of  short  sight,  or  myopia,  was 
fifty  in  the  thousand,  while  the  cases  of  weak  sight  or  AmblyopSt 
cataract,  amaurosis,  astigmatismus,  granular  disease,  etc.,  was  only 
twenty-five  in  one  thousand  cases.  I  have  therefore  come  to  the  coo- 
elusion  that  a&  the  fifty  cases  of  myopia  had  been  so  since  boyhood  or 
girlhood,  and  in  a  few  of  the  instances  only  was  the  defect  hereditaiji 
there  was  a  neglect  on  the  part  of  parent  or  guardian  in  not  prevent* 
ing  so  bad  a  habit.  There  is  also  a  good  deal  of  the  blame  to  be  tt- 
tached  to  the  family  physician,  who,  when  his  attention  is  called  to 
the  weak  eyes  of  the  near-sighted  child,  neglects  to  place  it  on  a 
proper  course  of  treatment  so  as  to  improve  the  general  health  and 
eyes  at  the  same  time. 

I  therefore  thought  some  practical  observations  upon  this  and  kin- 
dred subject,  in  a  series  of  articles,  would  be  acceptable  to  the  mem- 
bers of  the  profession  whose  attention  is  perhaps  only  called  to  a  case 
once  in  six  months  or  a  year,  and  who  has  not  the  opportunities  which 
our  city  physicians  have  of  calling  in  consultation  one  of  their  brethren 
who  devotes  much  of  his  time  and  talents  to  this  one  subject,  and  who 
is  posted  on  all  the  improvements  which  the  last  ten  years  has  pro- 
duced. 

The  Ophthalmoscope. — And  first  of  the  ophthalmoscope  or  specu- 
lum oculi,  for  without  the  use  of  this  important  aid  in  diagnom;  we 
will  often  make  most  serious  mistakes.  Its  employment  requiies  a 
little  more  ingenuity  and  about  the  same  amount  of  time  and  attention 
which  is  necessary  to  become  expert  with  the  stethoscope  ;  and  cer- 
tainly no  right-minded  and  conscientious  physician  should  be  satisfied 


1864.]  Spuial  Sel^cthm.  291 

la  daciiliog  on  Qxe  existence  of  amaurosis  in  anj  case  without  a  prior 
SAmioation  with  the  ophthalmoscope.  With  just  as  much  certainty 
:oald  we  consider  a  patient  to  be  laboring  under  phthisis,  without  a 
iihyaical  examination,  because  he  has  purulent  expectoration  and 
'ever.  It  will  also  bo  found  that  there  are  numerous  cases  of  defect- 
ive and  diseased  eyes,  which  formerly  would  have  been  pronounced 
lopelesss  but  which  upon  a  careful  examination  by  this  admirable  in- 
rention  of  Helmholtz'e,  are  ascertained  to  be  carable,  and  the  reverse 
irill  equally  hold  good,  thus  preventing  a  long  and  tedious  course  of 
livatment,  often  to  the  detriment  of  the  patient's  general  health  and 
Hir  own  discomforture.  Those  who  use  the  ophthalmoscope  claim 
for  it  that  it  enables  them  to  decide  promptly  and  almost  with  cer- 
tainty as  to  the  disease  and  its  nature,  if  situated  in  the  crystalline 
lens,  its  capsule,  the  vitreous  humor,  the  retina,  choroid,  and  even  the 
PDtrauce  of  the  optic  nerve. 

Bat  as  it  is  nsually  the  case  with  every  innovation  upon  old  ideas, 
there  is  always  found  a  certain  number  who  stand  opposed  to  its  em- 
ployment, and,  as  would  naturally  bo  anticipated,  it  comes  from  the 
iame  class  of  men  who  opposed  the  introduction  of  vaccination,  anaes- 
iheaia,  and  other  equally  valuable  adjuncts  to  our  profession,  and  who 
■re  equally  well  represented  outside  of  our  profession  by  the  opponents 
to  the  introduction  of  steam,  gas,  the  electric  telegraph,  etc.  Being 
OBwilling  to  learn  its  use  by  the  sacrifice  of  time  and  labor,  they  en- 
deavor to  produce  its  condemnation  by  a  variety  of  objections,  among 
which  may  be  mentioned  the  charge  that  it  has  injured  the  eye  by  the 
bright  light  which  has  to  be  emploved  in  tbe  examination,  or  that 
daiger  may  result  from  the  use  of  the  solution  of  atropia.  These,  I 
am  confident,  have  bat  slight  existence,  as  in  the  numerous  ex- 
aaunations  which  I  have  made  with  the  valuable  instrument  both  in 
hoapital  and  private  practice,  since  May,  1853,  it  has  rarely  been  my 
lot  to  hear  a  complaint  from  my  patients,  or  to  see  any  injurious  con- 
seqMQi'cs  result  from  its  use.  When  in  London,  in  1859,  on  a  visit 
to  the  Ruyal  Ophthalmic  Hospital,  Moorficld,  I  made  the  inquiry  of 
Dr.  Dixon,  one  of  the  surgeons,  if  he  had  ever  seen  any  injurious  re- 
Milta  follow  the  use  of  the  ophthalmoscdpc,  when  he  stated  that  only 
in  one  case  in  thousands  had  he  remarked  any  detrimental  results, 
and  in  this  case  was  a  lady  who  subsequently  died  of  apoplexy.  He 
notice<l  that  after  such  examination  there  was  an  increased  effusion 
of  Uood  upon  the  retina.  This  single  instance  of  injury  would  be  but 
a  poor  excuse  for  our  rejection  of  so  valuable  an  aid  to  diagnosis, 
vnich,  according  to  II.  Ilavnes  Walton,  has  revolutionized  ophthal- 
mic nosology,  and  rendered  obsolete  nearly  everything  that  has  been 
written  or  taught  on  the  deep-seated  diseases  of  the  eye.* 

Diagnosis  is  the  all-important  scci-et  of  the  physician,  without 
which  our  therapeutics  are  but  an  agency  of  evil,  destroying  what  we 
vant  to  cure,  and  from  this  consideration  alone  every  physician  and 
Mirgeon  ahonld  gladly  avail  himself  of  all  the  auxiliaries  within  his 
r— ch. 


•  ▲  >mMw  oa  tb«  SvglMl  Wumm  of  Vm  St*,  p.  664«  Moond  HHton,  London,  18GI. 


292  £^)MwI  StlmlioiU.  [Hif , 

In  184G,  Gnmining*,  of  London,  first  determined  tlwt  b;  s  cetteii 
arrBii(!cment  of  a  gas  light  and  a  lens  the  fnndns  of  tin  hnmui  &jt 
conlil  bo  Been.  He  did  not  see  the  optic  nerre  nor  the  retina  TCMela. 
"  His  Bimplo  process  of  examination  was  this  ;  let  the  person  ondK 
examination  ( with  the  dilated  pnpil )  eit  or  stand  eight  or  ten  feet  fnm 
a  gas  light  looking  a  little  to  the  side  ;  standing  near  the  gaa  ligkt 
we  have  only  to  approach  as  near  as  possible  to  the  direct  line  bt- 
tweon  it  and  the  eye  to  be  viewed,  at  once  to  see  the  reflection.  Oria 
a  dark  room,  a  candle  being  placed  four  or  five  feet  from  the  eye,  if 
we  approach  the  direct  line  between  them  we  shall  he  able  at  one*  t» 
see  it  in  m.iny  cafies.  If  solar  light  be  admitted  throngh  ■  newly 
closed  shatter  into  a  dark  room  the  luminosity  may  be  seen  when  tit 
pupil  is  tolerably  dilated,  the  patient  standing  five  or  six  feat  froB 
the  apcrtnre  and  the  observer  occnpying  the  position  before  i&dicat 
ed."  "  In  persons  of  fair  complexion  and  blue  or  gray  iridee,  it  ii 
genernlly  more  brilliant  and  more  readily  seen  than  in  those  of  dark 
skin  and  iii'Ies.     In  the  mulatto  it  is  also  dusky." 

To  Dr  Mackenzie  is  due  a  pait  of  the  credit  of  applying  the  fitit 
rudimentary  ophthalmoscope  to  the  investigation  of  deep-seated  db- 
eases  of  the  eye.  His  method  consisted  in  directing  the  light  of  a 
gas  jet  through  the  dilated  pnpil  with  a  lens,  so  as  to  disco^'er  "  what 
he  considered  the  effects  of  byaloiditie,  or  inflammation  of  the  hyalnd 
membrane.*'!  But  the  credit  of  the  invention  is  dne  to  Helmbdlti, 
professor  of  Physiology  at  Konigsburg,  Prussia,  who  made  and  de« 
crilwil  the  first  cpbtbalmoscopc,  and  published  it  to  the  worldii 
18&1.^  Ho  first  employed  a  single  slip  of  glass  brightly  polished, 
and  witli  this  he  was  able  to  sec  the  surface  of  the  retina  but  Tcry 
faintly,  not  dilating  the  pupil  in  his  first  examinations.  Findingtlnt 
the  illuminating  power  of  a  single  slip  of  polished  glass  was  too  hinl 
to  view  the  minute  details  of  the  fondus,  Helmholtz  increased  ita  in- 
tensity by  constructing  a  compound  reflector  of 
several  slips,  Buperimposed  in  such  ■  manner 
that  the  reflections  from  their  several  anrfacea 
cover  each  other,  and  coalesce  in  a  single  image. 
For  greater  convenience  ho  fixed  this  reflector 
upon  one  end  of  a  short  tube,  in  the  opposite 
eitremily  of  which  he  placed  a  concave  lena. 
In  Fig.  1  is  a  horizontal  sectional  view  of 
Helmholtz's  instroment.  Fig.  1,  oa  is  asboit 
blackened  metal  tube  closed  at  and  end  by  a 
plate  bb,  centrally  perforated,  which  snppoits 
a  hollow  triangular  prismatic  metal  box  tee. 
The  base  of  this  prism  is  connected  with  the 
■  plate  by  the  short  open  cylinder  d,  in  snch  a 
manner  as  lo  nilow  the  rotation  of  the  prism  on  the  axis  of  the  tube 
aa.     The  long  side  of  the  prism  contains  the  reflector,  composed  of 

•  Htdlra-I'lilnirgicil  TnniutlaDi,  ISU. 

t  Hnckpnile  on  DlMin  of  the  E  j«,  p.  itU.  Am.  Ed. 

X  BaulirFilinn::  (loei  Aii(*nipitgtli  inr  UatenDcbnog  diT  Kcdliut  Im  lib«ud*B  Aigr, 


1884.]  Special  Selections.  293 

three  plane  polished  slips  of  glass,  inclined  at  an  angle  of  56^  to  the 

axis  of  the  tabe,  the  other  end  of  which  contains  the  concave  lens  /, 

which  is  held  in  posilion  by  the  friction  tnbe/.     When  we  examine 

the  baalthy  eye  of  a  yonng  per&on  the  pnpil  appears  dark,  as  if  the 

bottom  of  the  eye  was  black.     This  is  not  because  any  of  the  tissues 

are  black  that  we  look  through,  but  it  arises  from  the  reflective 

power  of  the  cornea  and  lens.     Helmholtz,  by  overcoming  the  re- 

1  motion  of  the  cornea  and  lens  by  his  ophthalmoscope,  reflected  the 

iBjs  of  light  from  the  retina  and  made  them  come  to  a  focus  and 

prodaca  an  image  on  the  retina  of  the  experimenter's  eye.      It  is 

rtaCod  that  an  accident  suggested  the  invention  to  Helmholtz,  but 

this  is  doubtful,  as  *'  Gummings'  "  experiments  were  published  and 

mnt  all  over  the  world,  still  we  give  it  as  stated.     His  friend  Von 

Erlach,  who  wore  spectacles,  observed  one  day  whilst  conversing 

with  an  acquaintance,  that  the  eye  of  the  latter  became  illuminated 

when  the  rays  of  the  light  from  a  neighboring  window  were  reflected 

by  his  glasses  into   this   person's  eye — ^hence  it  is  also  stated   the 

prohable  reason  of    Helmholtz   using  plate  glass  as  the  reflector  in 

his  ophthalmoscope.    There  is  no  doubt  that  the  immortal  honor  of 

the  invention  of  the  eye  speculum,  or  ophthalmoscope,  belongs  to 

blmholtz,    although   many  others   may  have  contributed  to  it,  he 

«ado  it  tnily  practical  and  with  it  he  was  able  to  distinguish  the  optic 

Mnre  and  the  vessel  emerging  from  it.     In  1852,  Ruete*  invented  an 

ophthalmoscope  on  a  diSierent  principle  from  that  of  Helmholtz.  light 

being  thrown  into  the  patient's  eye  by  meaps  of  a  concave  mirror, 

thioogh  a  hole  in  the  centre  of  which  the  observer  looked  directly 

ipoB  the  illuminated  retina.     The  objection  to  this  ophthalmoscope 

ii^  tbat  it  is  fixed  upon  a  stand  and  therefore  not  well  adapted  to  ob- 

servo  an  organ  so  constantly  in  motion  as  the  eye.     Coceiusf  avoided 

this  inconvenience  by  constructing  a  small  perforated  mirror  to  be 

hiM  in  the  hand,  and  this  instrument  has  been  still  further  nfodified 

by  Anagnoetakis,^  whose  ophthalmoscope,  from  its  extreme  simplici- 

tjt  Appears  to  many  to  be  the  most  useful  that  has  been  invented.     It 

eoosiata  of  a  circular  mirror,  about  an  inch  and  three  quarters  in  di- 

Matter,  slightly  concave,  and  perforated  in  the  center  with  a  round 

kola,  the  tenth  of  an  inch  wide.     The  amalgram  of  the  mirror  is  pro- 

teefeed  bj  a  bi-ass  plate  perforated  at  a  spot  corresponding  to  the  hole 

ia  the'  glass.     The  inside  of  this  perforation  should  be  brushed  over 

with  a  non*rcflecting  black  coating  so  as  to  prevent  the  mctalic  edge 

from  producing  small  rays  of  light,  which  are  very  confusing  to  the 

abeerver.     The  mirror  is  set  in  a  metal  frame  to  which  a  handle  is 

ixed. 

Ib  a  recent  work  by  Zander  §  he  divides  them  |^into  [three  classes, 
via: 

1.  Ophthalmoscopes  in  which   the  reflector  consists  of  slips  of 

*  IWr  Aag*ospicc*l  oimI  img  OptoiD«t«r«  CkMUngeii. 

t  Vtfttr  dl«  Aawcndang  de*  AocenspltgeU,  Leipsls,  1863. 

;  l0»l  av  risplonUioa  do  UReiine  it  des  MIUo«z  d«  PQEU  tor  U  VlTuit,  Paris,  1859. 

I  Itmiwt,  A.,  Bar  Avgeaipiefil,  SeiiM  ForaaB  «o4  8«ia  G«brMiek.  Leipslg,  1SK). 


294  [Special  Selections.  [Mtj^ 

highly  polished  glass,  with  plane  parallel  surfaces,  as  Helmholtz's. 

2  Homo-centric  ophthalmoscopes,  concave  mirrors  of  silvered  gh^s 
or  metal,  as  Rente's  and  Liehreich's. 

3.  Hetero-centric  ophthalmoscopes,  plane  or  convex  specola  in  eom- 
hination  with  a  convex  lens,  as  Coccins'  and  Zehender's. 

For  several  years  we  have  employed  the  ophthalmoscope  of  Co^ 
cius,  as  modified  by  Anagnostakis,  but  more  recently  that  oi  Liebreieh. 
It  is  a  small,  slightly  circular  concave  metallic  mirror  monnted  on  t 
handle,  and  pierced  centrally  with  a  much  smaller  hole  than  that  g«- 
erally  made  in  the  glass  mirrors.  Being  of  metal,  an  accidental  ftli 
does  not  break  it,  and  the  smallness  of  the  hole  diminishes  to  a  mini- 
mum  the  amount  of  central  shadow  in  the  illumination,  that  resnlli 
from  the  absence  of  the  reflecting  surface  from  the  centre  of  the  mirror. 
A  Klip  for  holding  a  small  convex  or  concave  lens  is  hinged  to  tin 
frame  of  the  mirror  and  folds  against  its  back.  To  larger  convex 
lenses  of  two  and  two  and  a  half  inches  focal  lengths,  are  usnaOj' 
supplied  with  this  ophthalmoscope,  and  the  whole  is  packed  in  i 
strong  portable  case,  and  all  made  by  Mr.  Kolbe  of  this  city. 

In  u.'ing  any  of  the  forms  of  the  ophthalmoscope  the  room  shonid 
be  darkendcd,  and  we  can  only  employ  artificial  light;  a  candle 
produces  too  faint  an  illumination* 

A  steady  lamp  flame,  like  that  used  for  the  microscope,  is  required 
for  viewing  the  interior  of  the  eye  ;  I  employ  a  gas  lamp  with  a  Ood- 
dard  burner,  with  a  hVht  blue  chimney,  made  by  Cornelius  dr  Co. 
The  best  arrangement  Siat  I  have  seen  for  illumination  is  that  at  the 
**  Royal  London  Ophthalmic  Hospital,"  Moorefields.     It  is  anAr- 
gand  burner  with  veiy  fine  apertures,  and  has  a  piece  of  fine  wire  gauze 
fitted  to  the  bottom,  which  subdivides  the  draught  into  a  great  nnmber 
of  small  currents,  which  makes  it  very  uniform.     A  short  glass  chim- 
ney, tinted  blue,  is  preferable  ;  a  tall  one  produces  too  rapid  a  draught. 
The  burner  is  fitted  to  a  double  jointed  arm  which  can  be  raised  or 
lowered  and  moved  from  side  to  side.    The  eye  of  the  patient  must  be 
screened  from  the  direct  rays  by  a  small  blackened  tin  shield  fixed  to 
the  burner. 

If  the  pupil  of  the  patient  is  dilated  or  very  dilatable,  no  artificial 
means  need  be  employed  to  produce  it,  but  if  a  very  thorough  exami- 
nation is  required  and  the  patient  is  past  middle  age,  more  especially 
if  the  examination  is  behind  the  iris,  oelladonna  or  its  salts  must  be 
resorted  to  by  placing  a  small  quantity  of  the  soft  extract  around  the 
brow  the  night  previous,  or  placing  within  the  eyelids  a  few  drops  of 
a  solution  :  T)e,  Atropia  sulphatis,  gr.^ — j.  Aquae  distil.  f.J.  H. 
M.  ft  solut. 

This  is  to  be  nsed  a  few  minutes  before  the  examination.  No  be- 
ginner should  attempt  to  examine  the  eye  even  in  health,  without  the 
use  of  the  ntropia.  It  will  be  well  to  state  to  the  patient  that  after 
the  examination  the  vision  will  be  impaired  for  one  or  two  days ; 
state  that  this  is  not  owing  to  the  exannnation,  or  use  of  the  ophthal- 
moscope, which  they  are  apt  to  think  is  the  cause.  In  some  it  pro- 
duces much  disturbance  to  the  patient's  vision,  a  solution  of  opium  in 
the  form  of  the  watery  extract,  dropped  into  the  eye  will  soon  cause 


1884]  Special  SOeetUmt.  295 

eontrmeiioD,  or  an  opiDm  plaster  applied  to  the  temple  will  relieve  it. 

From  recent  and  oarefnl  ezpenmenta  of  Dr.  Hayden,*  he  proves 
die  following  facts :  that  belladonna  dilates  the  pnpil  by  inducing  a 
■late  of  active  contraction  of  its  dilator  mascles  through  the  sympa- 
thetic, and  that  opium  causes  its  contraction  by  stimulating  its  con- 
strictor ronscle  through  the  tWird  or  motor  oculi  nerve. 

''The  force  which  presides  over  active  accommodation  is  derived 
from  the  oerebro-spinal  system  :  the  other,  which  holds  under  its  con- 
trol the  tensor  of  the  circular  fibres,  is  the  ganglionic  system,  on 
which  opinm  and  belladonna  act  with  opposite  effects,  the  former 
paralysing  them  and  the  latter  exciting  them.  We  mnst  not  lose  sight 
of  the  fact  that  the  contraction  of  the  radiated  fibres  corresponds  to 
leUxation  of  accommodation  as  paralysis  does  to  the  maximum  con- 
▼ezity  of  the  lens. 

"  The  tensor  muscle  of  the  choroid,  like  the  iris,  is  composed  of  a 
crown  of  radiated  fibres,  implanted  by  their  internal  extremity  upon 
e  circle  formed  of  circular  fibres  in  the  manner  of  sphincters.  The 
radiated  fibres  placed  under  the  influence  of  the  sympathetic,  contract 
in  both  organs  under  the  reflex  action  of  the  sympathetic  or  by  the 
action  of  belladonna.  Opium,  on  the  contrary,  paralyzes  them  as 
does  the  division  of  the  superior  fillet  of  the  cervoid  ganglion,  thus 
evincing  the  action  of  sphincters." 

The  experiments  of  Orfila  have  shown  that  persons  who  have  died 
from  the  effects  of  belladonna,  the  cerebro-spinal  centre  and  its  invest- 
ing membranes  are  in  a  state  of  extreme  vascular  congestion.  But 
«e  know  now  that  belladonna  may  act  as  an  excito-motor  stimulant 
when  applied  to  the  eye,  without  at  all  giving  rise  to  congestion  of  the 
ocnlar  vessels.  It  would  appear  that  whether  applied  to  the  perior- 
hilal  and  palpebral  intcgumenLs,  or  on  the  conjunctiva,  it  acts  invari- 
ably upon  the  sympathetic  supplied  to  the  radiating  muscular  fibres  of 
the  iris,  through  the  branches  of  the  fifth  pair  of  nerves  distributed  on 
thone  surfaces  as  its  incident  medium. 

Thb  Calabab  Bean. — Next  in  importance  to  the  use  of  opium  in 
piodncing  effects  exactly  opposite  to  those  induced  by  belladonna  or 
atropia,  is  the  Calabar  beau  or  its  alkaloid.  The  first  notice  of  its 
iftcta  was  by  Dr.  Robertson, f  of  Edinburgh,  who  states  that  his 
frieod  Dr.  Frazer  informed  him  that  he  had  seen  contractions  of  the 
pnpil  result  from  the  local  application  of  an  extract  of  the  ordeal  lean 
4f  Calabar.  He  resolved  to  investigate  the  action  of  the  substance 
npon  himself,  and  with  some  difficulty  obtained  the  bean  from  which 
ha  made  an  alcoholic  extract  of  various  strengths ;  the  stron^st  was 
anch  that  one  minim  of  it  corresponded  to  four  grains  of  the  bean. 
The  results  obtained  from  his  first  experiments  were,  that  the  Calabar 
bean  acted  first  on  the  accommodation  of  the  eye,  causing  indistinct 
viaion  of  distant  objects  beyond  eight  inches  from  the  eye,  appeared 
and  indistinct,  but  was  relieved  by  the  use   of  concave  glasses. 


•  DmkUm  Qmrnrtm-lm  JoonMl,  Aagaat,  1SQ3— p.  S1^54.  H^jrden  on  Poitonlng  with  AtropU 
BeUaauikBa  aad  on  the  motto  of  acUon  of  Belladonna,  aocorJing  to  Grnefo.  OpkUudmie  Jcmrmi, 
Jfnl«  ISGB,  p.  SOS. 

t  mHabmnl^  ibdkml  J^tnml  and  BotCoa  Mtdiemt  «mK  flvfiesl  /MnMl,  April  S,  1800,  p.  178. 


206  Spmal  SehdUmt.  [May, 

The  next  marked  effect  produced  was  conlractioii  of  the  pupil,  ita 
diameter  being  reduced  from  two  lines  to  half  a  line.  He  further 
proved  by  a  second  series  of  experiments*  that  it  possesses  the  pomr 
of  counteracting  the  effects  of  atropia,  resembling  opium  in  this  par^ 
ticular.  He  thinks  the  most  feasible  explanation  of  the  action  of  tha 
Calabar  bean  on  the  eye  is. to  regard  iu  as  a  stimulant  to  the  ciliaiy 
nerves.  It  is  applicable  in  all  instances  where  atropia  is  used  to  ran* 
der  the  examination  of  th^  eye  more  perfect  or  more  simple.  This 
includes  two  classes  of  cases  ;  those  in  which  dilatation  of  the  pupl 
is  either  necessary  or  desirable  to  aid  ophthalmoscopic  examinatioil» 
and  those  in  which  paralysis  of  the  ciliary  muscle  is  necessary,  io  order 
to  ascertain  the  state  of  the  accommodation  of  the  eye.  He  also  ad- 
vises its  use  in  cases  of  retinitis  with  photophobia,  ulceration  of  the 
margin  of  the  cornea  leading  to  perforation,  or  even  when  prolapaus 
of  the  iris  has  just  occurred,  as  well  as  in  the  cases  where  the  iris  has 
a  tendency  to  protrude  through  a  corneal  wound,  T)nt  as  yet  he  had 
but  little  opportunity  to' test  it  practically,  which  was  soon  done  by 
Mr.  Thomas  Nunneley,*  of  Leeds,  who  obtained  a  supply  of  the  ex- 
tract dissolved  in  glycerine  and  at  once  availed  himself  of  ita  power 
over  the  concentric  fibi-es  of  the  iris,  by  which  he  observes  the  pupO 
nay  be  lednced  in  size  to  a  mei«  speck,  and  the  whole  surface  of  ue 
iris  put  upon  the  stretch  ;  the  direction  of  the  force  being  from  the 
circumference  toward  the  centre  of  the  membrane.  The  meet  import 
tant  application  was  to  wounds  of  the  cornea  and  sclerotic  with  pro- 
lapsing iris,  either  the  result  of  injury  or  in  operations  by  the  surgeon. 
Many  plans  have  been  suggested  for  disengaging  the  prolapsed  iiis, 
which,  though  occasionally  successful,  far  more  commonly  fail.  It 
occurred  to  Mr.  Nunneley  that  if  the  iris  could  be  kept  for  some  hoon 
on  the  full  stretch,  by  the  almost  entire  contraction  of  the  pupil,  it 
would  not  prolapse,  and  thus  the  corneal  wound  might  heal  by  tha 
first  intention.  The  result  of  two  cases  in  which  he  employed  the 
bean  is  most  satisfactory,  and  would  quite  justify  the  belief  that  if  the 
case  is  seen  immediately  after  the  infliction  of  the  injury,  before  pro- 
lapsus has  taken  place  or  even  though  this  has  happened,  before  ad- 
hesion has  occurred,  the  iris  may  be  kept  out  of  the  wound  and  this 
will  then  heal  as  after  a  surgical  wound.  The  two  cases  reported 
were  as  favorable  as  possible,  and  the  results  have  been  far  better  thaa 
he  could  have  anticipated. 

«  Lancet  and  Dublin  MeduxU  Prm,  Jalj  20, 1863,  p.  111. 


1864.]  Btpmn  and  Notiee$.  297 


TwtBiy-Fifkh  ADDnal  Report  of  the  Board  of  Tmstees  and  OiBoers  of  the 
CcBtral  Oliio  Lanatic  Asylum,  to  the  Governor  of  the  State  of  Ohio,  for  the 
jear  1863. 

This  is  also  the  eighth  year  under  the  administration  of  Dr.  Hills^* 
who  has  managed  the  affairs  of  this  our  eldest  State  Institution  for 
the  insane — with  judgment  and  excellent  success. 

We  have,  in  the  Superintendent's  Report,  the  usual  statistical 
tables — from  which  we  glean  as  follows  : 

In  the  Asylum,  Nov.  1st,  1862, 
Admitted   during  the   year. 
Total  under  treatment, 
Discharged, 

Remaining,  Nov.  Ist,  1863,  126  126        252 

The  per  cent,  of  recoveries  on  the  numher  discharged,  was  64. |. 

Daring  the  year  the  Central  Asylum  met  with  a  sad  loss,  in  the 
death  ot  Dr.  D.  L.  Ely,  who  had  heen  connected  with  the  Institution 
ae  Assistant  Physician,  for  more  than  seven  years,  and  was  an  ac- 
coBipIished  physician  and  courteous  gentleman. 

Dr.  Hills  makes  a  number  of  valuable  hints  and  suggestions  in  the 
coune  of  bis  report — for  which,  however,  we  must  refer  the  reader  to 
tbe  report  itself. 


Halo. 

Femalf*. 

Total. 

140 

120 

260 

69 

79 

148 

209 

199 

408 

83 

78 

156 

Tke  Trannactions  of  the  American  Medical  Aisociation— Inatitated    1847. 
ToL  XIV.    Philadelphia:  1864. 

Once  more  we  have  the  welcome  sight  of  a  volume  of  Transactions 
of  the  American  Medical  Association.  From  1860,  when  tbe  Asso- 
eittion  convened  in  tbe  quiet  and  classical  city  of  New  Haven,  to 
1863,  when  it  again  assembled  in  tbe  growing,  bustling  city  of  the 
great  North  West — is  a  sad  blank  in  tbe  history  of  American  Medi- 
tiae  as  marked  in  the  Annual  contributions  of  our  National  Associa- 
tion. No  Transactions  for  1861-G2  !  We  trust  in  all  the  years  to 
come,  no  more  such  silent  waymarks  may  rise  up  before  us  ;  but 
Jiar  after  year  we  shall  rather  hope  that  our  brethren  may  henceforth 
issemble  lo  the  spirit  of  fraternity  and  union — the  entire  American 
Xedical  profession  comin<;  up  to  this  Annual  Jubilee,  with  gifts  for 
die  common  Altar  of  Medical  Science. 

Under  the  peculiar  circumstances  of  tbe  occasion,  and  the  condition 
oToor  country,  it  becomes  interesting  to  look  over  the  roll  of  names 


298  Beviewi  and  NotictB.  [^T* 

answering  to  the  Secretary's  call»  in  whioh  we  see  a  goodly  list  in 
attendance,  many  of  them  well  known  all  overlhe  country,  while  wt  no- 
tice eighteen  states  and  one  territory  reprebonted  by  their  regidar 
delegates — with  abont  twenty-five  regular  associations,  hosjpitals  and 
colleges,  besides  the  large  assemblage  of  permanent  members.  , 

The  volume  before  us  representing  the  labors  and  traaaactions  of 
the  Association  for  1863,  is  perhaps  the  smallest  in  size  ever  issued ; 
owing  in  part^«we  presume,  to  the  suggestion  of  the  Treasurer,  ad- 
monishing the  Society  that  with  the  heavy  advance  in  everything  eoa- 
nected  with  book  making,  it  behooved  them  to  refer  only  strictly  vsl- 
uable  papers  to  the  Committee  on  Publication,  and  in  every  way,  so 
far  as  consistent,  to  condense  the  volume. 

Following  the  usual  record  of  the  minutes  proper,  and  the  usual  bus- 
iness reports,  we  find  in  regular  order  the  following  papers,  several  of 
them  very  valuable,  and  worthy  of  the  early  days  of  the  AasociatioD. 

The  annual  address  of  the  retiring  Piesident,  is  by  the  acting 
President,  Dr.  Wilson  Jewell,  of  Pennsylvania.  The  Presideiit 
elect  at  New  Haven,  the  venerable  Dr.  Eli  Jones,  having  in  the  ii- 
terim  been  gathered  to  his  fathers,  full  of  years  and  full  of  honors. . 
Dr.  Jewell  gives  a  neat  and  rapid  note  of  the  retirements  of  the  vari- 
ous Presidents  of  the  Association,  from  the  illostrions  Chapmto, 
down  to  that  most  excellent  and  worthy  gentleman,  Dr.  Lindsley. 
President  elect  at  the  session  of  1859,  at  Washington  :  having  paid 
this  graceful  tribute,  ho  proceeds  to  discuss  the  subject  of  Hygiene. 

Report  of  the  Committee  on  Medical  Education.     By  C.  C.  Cox> 
Surgeon  U.  S.  Vols.,  of  Maryland. 

Report  on  Medical  Literature.     By  Dr.  0.  A.  Lee. 

Diatheses — their    Surgical  Relations  and    Effects.     By  Prof.  £ 
Andrews,  of  Chicago. 

The  American  Method  of  treating:  Joint  Diseases  and  Deformities. 
By  Dr.  H.  G.  Davis,  of  New  York. 

Cases  of  Diarrhoea  Adiposa.  By  Dr.  J.  H.  Qriscom,  of  New 
York. 

American  Nrecology.     By  C.  C.  Cox,  Surg.  U.  S.  V.  Md. 

An  Inquiry  into  the  Physiological  and  Medical  Properties  of  the 
Veratrum  Viride  :  Together  with  some  Physiological  and  Chem^ 
ical  observations  upon  the  Alkaloid  Veratria  obtained  from  this 
and  other  species.  Being  the  Prize  Essay  to  which  the  American 
Medical  Association  awarded  the  Prize  Medal  for  1863.  By  Samuel 
R.  Percy,  M.  D.,  of  New  York  city. 


1864.]  SdUor*s  IhbU.  29^ 

^  LaryDgiscopal  Therapy,  or  the  Medication  of  the  Larynx  under 
sight.     By  Dr.  Lonis  Elsberg.  of  New  York  city. 

Some  of  these  papers  ,  as  we  have  jnst  said,  are  of  permanent  valae 
^ftnd  some  treat  of  matters  of  general  interest  to  o6r  readers ;  we 
ahall,  therefore,  at  onr  leasure,  rccar  to  their  consideration,  and  present 
tome  of  the  more  important  views  of  their  authors. 

Such  of  our  readers  as  desire  to  secure  the  Transactions  for  the  cnr- 
rentyear,  should  address  the  Treasurer,  Dr.  Caspar  Wistar  of  Phila- 
delphia. 


[ — 

iSlf.  John's  Hoid  for  Invalids. — For  sometime  past  the  friends  of 
this  Institution  have  had  it  in  contemplation  to  either  rehuild  their 
hospital  or  build  anew  on  some  more  suitable  site ;  thus  enabling  the 
Suters  who  have  this  Charity  under  their  control  the  more  successfally 
to  carry  out  their  plans,  and  accommodate  the  press  of  patients  over- 
erowding  their  wards.  •  This  enterprise  has  recently  taken  a  fresh 
impulse,  and  as  we  understand  the  subscriptions  are  of  so  liberal  a 
ehsracter,  as  to  render  the  early  erection  of  a  new  hospital  a  matter 
of  certainty.     At  a  public  meeting  a  few  weeks  since  of  friends  inter- 
atted  in  Si.  John's  Hotel  a  large  business  committee  was  appointed  to 
mature  plans  and  present  a  systematic  appeal  to  the  friends  for  their 
aid  ;  this  committee  is  composed  of  C.  T.  Jones,  Esq.,  Jos.  C.  Butler, 
R.  R.  Springer,  W.  W.  Scarborough,  L.  C.  Hopkins,  J.  C.  Baum,  S. 
8.  L'Hommedieu,  W.  H.   Clement,   Judge  Mallon,  etc.,  etc.     This 
committee  is  now  organized  by  the  election  of  C.  T.  Jones,  President ; 
J.  J.  Rickey,  SecreUry  ;  and  Jos.  C.  Butler,  Treasurer.     We  presume 
we  shall  h^ve  the  new  St.  Johns  as  amongst  the  handsome  edifices 
adorning  our  city  at  an  early  day.  and  shedding  in  its  unostentatious 
way  blessings  and  health  upon  the  community.  '."  ' 

We  hope  to  be  able  soon  to  announce  that  earnest  steps  are  in  prog- 
ittt  for  the  erection  of  a  building  to  take  the  place  of  the  old  Com- 
mercial Hospital  which  has  so  long  disgraced  the  Queen  City  of  the 
West, 


Dr.  TumbuU  on  Defective  and  Impaired  Vision. — Some  months  ago 
we  gave  a  wood  cut  illustrative  of  the  ophthalmoscope  together  with 
some  account  of  its  application.     Dr.  Tumbull,  of  Philadelphia,  is 


800  IUitor'$  naie.  [Mty, 

publishing  a  series  of  articles  in  the  Reporter  on  the  ophthalmosoope 
and  its  uses  in  impaired  vision,  and  through  the  courtesy  of  the  editor 
of  that  well  *  known  Journal  we  shall  re-publish  those  papers  whieh 
have  special  coference  to  the  ophthalmoscope  together  with  the  ilios- 
trations,  commencing  as  our  readers  will  observe  in  the  present  nam* 
bar,  under  the  head  of  Special  Selections.  We  think  the»6  papers  will 
interest  and  profit  our  readers. 


Annual  Medical  Regiater, — We  notice  in  the  Philadelphia  Bepoftir 
an  extract  from  the  prospectus  of  Dr.  Furman,  of  New  York  City, 
who  proposes  to  issue  a  Medical  Register  for  the  city  of  New  York. 
It  will  contain  a  good  deal  of  useful  information  and  be  a  very  con- 
venient pocket  manual  for  the  physicians  of  that  city.  "  It  is  intend- 
ed to  contain — the  name,  residence,  and  office  hours  of  every  nsouLAB 
pRACTiciNo  PHYSICIAN  iu  this  city,  as  far  as  they  can  be  ascertained ; 
an.  account  of  the  various  hospitals,  dispensaries,  infirmaries,  medieal 
colleges  and  societies,  with  especial  reference  to  physicians ;  a  brief 
account  of  the  laws  of  this  State,  relating  to  coronor's  inquests,  and 
the  disposal  of  insane  persons  ;  a  calendar,  indicating  the  days  of 
meeting  of  the  different  Medical  Societies;  Medical  Necrology  (or 
1862-3,  etc.,  etc.  It  is  further  designed  to  issue  a  revised  edition  of 
this  work  about  the  first  of  June  of  each  year ;  the  price  not  to  ex- 
ceed one  dollar  a  copy." 

Has  not  the  time  nearly  arrived  when  such  an  annual  Medical  Beg- 
ister  would  prove  a  most  agreeable  visitor  to  the  tables  of  Cincinnati 
physicians  ? 


Increase  of  Pri'^e  of  Medical  Journals, — We  remarked  in  oirr  last 
number  the  probable  approaching  absolute  necessity  oi'  an  increase  in  the 
subscription  price  of  this  Journal.  Since  that  issue  we  see  ihe  PhU- 
adclphia  Reporter  announces  that  from  and  after  the  1st  of  May  that 
publication  will  be  enlarged  and  the  price  will  be  advanced  to  $5,  a 
year.  We  have  not  decided  on  an  advance  as  yet,  but  with  the  steady 
advance  in  the  cost  of  everything  in  the  country,  material,  labor,  food, 
everything,  we  forsee  that  we  must  prepare  for  such  a  change  in  our 
terms,  much  as  we  regret  the  necessity. 


Old  Journals  Wanted. — To  complete  our  file  of  the  Western  Lancet, 
we  desire  to  obtain  the  following  back  volumes  :  for  I843-'44-'45 
«'46-'  47-'48'-.'49. 

A  medical  friend  also  desires  to  complete  broken  setts  of  various 


1864.]  JSdUar'8  TabU.  801 

Western  medical  periodicals,  and  has  made  oat  the  following  list. 

Any  person  having  any  of  these  volumes  or  parts  of  volames,  who 

wOl  dispose  of  them,  will  confer  a  favor  hy  communicating  with  Dr. 

B.  B.  8teven9,  at  this  office. 

•*  Western  Quarterly  Medical  Reporter."     Edited  by  Dr.  John  D. 

Oodman :  Cincinnati,  1822^2  Vols. 

••  Ohio  Medical  Repository."     Dr.  Guy  W.  Wright  and  James 
M.  Mason,  Editors  :  Cincinnati,  1826—1  Vol. 

••  Western  Medical  and  Physical  Journal."     Drs.  Guy  W.  Wright 

lad  Daniel  Drake,  Editors  :  Cincinnati,  1827 — 1  Vol,     Continued, 

at  ••  Western  Journal  of  Medical  Sciences,"  by  Dr.  Drake,  till  1839. 

•*  Louisville  Journal  of  Medicine  and  Surgery,"  by  Profs.  Miller, 
Yandell  and  Bell.*  2  numbers  issued. 

•- Semi-Monthly  Medical  News,"  Louisville,  Ky.     Want  Vol.  1, 

No.  8. 

"  Lonisvillo  Medical  Gazette."  Want  Vol.  No.  1,  6,  7,  8,  9,  10, 
11.  ami  12. 

••  NMhville  Monthly  Record."  Want,  Vol.  1,  No.  8;  Vol.  2,  No. 
1,  S,  5,  6,  9,  10,  12 ;  Vol.  3.  all  after  No.  3. 

••  The  Western  Medical  Gazette."  Edited  by  Drs.  Eberle,  Mitchel, 
Smith  and  Cross.     Cincinnati,  1832-35—2  Vols. 

•«  Ohio  Me^lical  Repository,"  (second  of  tEe  name.)     Cincinnati, 

ins^i  Vol. 

••Western  Ijancet."  Dr.  L.  M.  Lawson.  Cincinnati,  1842.  Want 
Vol.  1,  Nos.  1,  2.  3,  11,  12.  or  whole  volume;  Vol.  2,  Nos.  10,  12, 
or  whole  volume  ;  Vol.  11,  No.  1 ;  Vol.  15,  No.  1 ;  Vol.  17,  No.  11. 

••Transylvania  Journal  of  Medicine  and  the  Associate  Sciences." 
Edited  by  Drs.  John  E.  Cooke  and  Charles  W.  Short.  Lexington, 
Ky.,  1828.     Want  Vols.  1,  6,  7,  8,  9, 11  and  12  entire,  or  the  entire 


71#  AwhtTican  Medical  Association, — We  hare  received  the  follow- 
ng  annoimct^raent  of  the  forthcoming  meeting  of  the  National  Asso- 
datioD  in  New  York  City,  to  which  we  urge  the  special  attention  of 
the  profession,  and  all  bodies  and  associations  desiring  representation. 
We  aUo  tmst  that  tlie  several  special  and  standing  committiees  will  bo 
fcminded  hereby  to  mature  their  reports  in  good  tinie  : 

The  15th  Annual  Meeting  of  the  *'  American  Medical  Association," 
will  ho  held  in  the  city  of  New  York,  commencing,  Tursday,  Juno 
7,  1864,  at  10  o'chx'k  am.  Proprietors  iff  Medical  Journals  through- 
out the  United  States  and  their  Territories  are  respectfully  reqnested 
to  insert  the  above  notice  in  their  issues.  • 

GuiDo  FuRMAN,  M.D  ,  Secretary, 

Xew  York  City,  March,  18G4. 


302  Editor's  Table. '  [Hay, 

We  also  append  the  following  extract  from  the  conBtitntion,  show- 
ing the  proportion  of  representation  to  which  varions  medical  organ- 
izations are  entitled.  Li8ts  of  delegates,  properly  aDthenticaied,  BhooU 
he  forwarded  to  the  Secretary  at  New  York  as  early  as  possible,  to 
enahle  him  to  make  dne  arrangements  : 

Every  permanently  organized  Society,  College,  Hospital,  Lnnatie 
Asylum,  and  other  medical  institutions  of  good  standing  in  the  United 
States,  and  from  the  American  Medical  Society  of  Paris,  have  the 
privilege  of  sending  delegates  to  the  Association  as  follows  :  Every 
local  society,  one  delegate  for  every  ten  of  its  regular  resident  mem- 
hers  ;  one  for  every  additional  fraction  of  more  than  half  this  nnmber. 
The  faculty  of  every  regnlar  constitnted  college  or  chartei-cd  school  of 
medicine,  two  delegates.  The  medical  staff  of  any  mnnicipal  hospitid, 
containing  one  hundred  inmates  or  more,  two  delegates  ;  and  any  other 
permanently  organized  medical  institution  of  good  standing,  one  del- 
egate " 

«*  Tbe  Chiefs  of  the  Army  and  Navy  Bureau  of  the  United  States, 
each  four  delegjites,  to  represent  the  medical  staff  of  their  respective 
departments." 


yew  York  Medical  Independent. — We  have  received  the  first  nnm- 
her  of  a  new  weekly  journal  with  the  title  of  Xew  York  Medical  Inde' 
pendent  and  Pharmaceutical  Reporter,  and  as  we  infer  from  the  first 
number  it  will  be  devoted  to  the  general  interests  alike  of  Medicine 
and  Pharmacy.  It  is  printed  on  good  paper,  and  presents  a  credit- 
able appearance.  We  place  it  on  our  cxelmngo  list  with  pleasure.  No 
editorial  name  is  given,  we  must  therefore  extend  our  greetings  to  the 
Independent.  The  price  is  82.  a  year.  Address  No.  447  Broome  St, 
New  York. 


Annual  Report  of  the  Surgeon  General  of  Ohio,  for  the  Year  1863. 
— This  Interesting  and  truly  valuable  State  paper  is  before  us,  and 
the  late  Surgeon  General,  Dr.  Smith  has  our  thanks  for  the  large 
amount  of  information  thus  placed  in  permanent  shape.  The  Report 
is  arranged  under  the  following  topics  «is  special  heads : 

1.  State  Volunteer  Medical  and  Surgical  Service.  2.  Kxaminalions 
of  Medical  Officers.  S.  Appointments  and  Uesignations  of  Medical 
Ofiicers.  4.  Deaths.  5.  Miscellaneous.  In  the  tabular  list  of  the 
Medical  appointments  for  the  year  we  find  that  one  hundred  and  fifty- 
five  appointments  have  b^iu  made,  the  oHicers  being  destributed 
throughout  the  entire  list  of  regiments  on  our  State  Holl.  The  neces- 
sity for  so  large  a  nnmber  of  appointments  is  occasioned  by  varions 
causes ;  new  regiments  have  been  organized,  many  medical  officers 


186iJ  ;  Miior*8  TaUi.  808 

have  resigned*  and  a  nnmbcr  have  been  traosferred  to  tbe  U.S.  Vol- 
nateer  Service.  One  hundred  and  nineteen  resignations  were  aooepted, 
a  large  portion  of  these  being  tendered  on  account  of  failing  health. 

Pemuyhania  HotpUal.-^'Dx,  Jos.  Pancoast  has  resigned  his  situ- 
ation as  one  of  the  surgeons  of  this  institution,  and  Dr.  Thomas  Geo. 
Morton  has  been  selected  in  his  place, — Med.  Newn, 


A  BowpxiaXfor  Consumptives. — We  laid  aside  the  following  article 
froitti  the  Boston  Medical  and  Surgical  Journal^  some  weeks  ago,  in- 
tending to  revamp  it  for  adaptation  to  the  wants  of  our  own  city ; 
bnt  on  re-reading  it  we  find  it  so  well  said,  and  the  ground  so  com- 
pletely occupied  that  wc  reprint  it  entire,  and  commend  the  matter  to 
ihe  suggestions  of  our  readers  : 

Need  of  a  Special  Hospital  for  Consumptive  Patients. — It  is 
somewhat  remarkable  that  in  the  wide  circle  of  the  numerous  and  va- 
rioos  charitable  institutions  of  New  England  there  still  remains  an 
unfilled  gap,  which  any  reflecting  person  knowing  the  peculiarities  of 
,onr  climate,  and  the  pathological  predisposition  of  so  large  a  number 
of  onr  people,  would  have  expected  to  have  seen  filled  long  since ;  we 
mean  the  need  of  an  asylum  or  sanitarium  for  the  victims  of  consump- 
tiofi.  No  other  disease  in  onr  latitude  counts  so  many  victims,  and 
in  the  larger  cities  no  other  disease  so  taxes  the  resources  and  calls 
forth  the  sympathies  of  private  charity  as  does  this  ;  and  yet  the  result 
of  all  charitable  effort  in  this  direction,  for  the  want  of  the  special  com- 
forts which  a  hospital  expressly  designed  for  this  class  of  patients 
would  afford,  is  most  discouraging  and  unsatisfactory. 

Tbe  need  of  some  such  provision  is  so  obvious  that  it  seems  almost 
huperfluous  to  mention  it.     Doomed  as  tbe  sufferers  from  this  fatal 
disorder  are,  in  so  many  instances,  to  many  weeks  and  months  of  in- 
validism, we  cannot  harshly  question  the  judgment  of  those  who  con- 
trol onr  various  general  hospitals,  if  they  object  most  seriously  to 
receiving  them,  as  a  general  rule,  within  their  walls.     The  protracted 
natnre  of  their  complaints  makes  them,  if  admitted,  so  long  depend- 
ent on  the  bounty  and  care  of  these  institutions,  that  a  number  of  pa- 
tients, suffering  from   curable,  acute  affections,  might  in  succession 
have  occupied  the  place  filled  by  one  such  incurable  one  ;  and  several 
lives  might  have  been  saved  to  the  community  where  one  poor  victim 
has  had  his  pathway  to  the  grave  only  made  smoother  and  easier. 
Any  one  conversant  with  existing  hospitals  must  have  often  felt  with 
poienant  regret  the  necessity  for  excluding  the  majority  of  applicants 
of  tnis  class  for  this  reason.     How  frequently  is  the  exclamation,  there 
oaght  to  be  a  hospital  for  patients  with  consumption  !     A  single  fact 
illnstrates  this  truth  most  forcibly.     During  the  year  1863,  among  the 
out-patients  of  the  Massachusetts  General  Hospital  there  were  between 
two  and  three  hundred  cases  of  phthisis  in  its  various  stages.     The 
very  fact  of  their  application  there  indicates  their  great  want  of  the  first 


304  JSdUor's  Table.  [Mgy, 

requisites  to  ensure  their  comfort.  No  person  poor  enough  to  solicit 
gratuitous  aid  from  a  public  charity  can  ponsibly  be  in  the  way  of  ob- 
taining tho  comforts  and  luxuries  which  are  absolutely  essential  inlUi 
disoAse-  A  large  number  of  these  patients,  it  is  true,  apply  at  this  in* 
Btitution.for  a  positive  diagnosis  and  prognosis  of  their  coaiplaints, 
and  after  one  or  two  visits  disappear  and  no  more  ia  known  of  them. 
What  mockery  is  it  to  prescribe  a  long  course  of  expensive  atimulanti 
or  touicH,  with  nutritious  diet,  to  thcne  poor  victims,  whose  only  re- 
source  for  their  daily  .bread  is  cut  off  by  their  inability  to  work! 
Hundreds  of  poor  people  in  this  community  are  thus  at  this  very  mo- 
ment langnishing  away  under  the  withering  hand  of  this  destroyer, 
who  from  first  to  last  must  depend  on  the  uncertain  dole  of  private 
charity,  or  the  hard-spared  earnings  of  their  immediate  friends,  and 
must,  therefore,  inevitably  lack  many  things  which  would  have  great- 
ly alleviated  their  sufferings. 

But  it  is  not  of  the  hopelessly  consnraptive  alone  that  we  wouM 
speak — objects  of  the  deepest  sympathy  as  they  are.  There  are  others 
— we  cannot  say  how  many — whom  the  want  of  a  public  institution 
for  their  special  treatment  deprives  of  tho  only  hope  of  improvement 
or  recovery.  What  chance  can  a  young  sowing  ffirl  with  incipient 
phthisis  havOf  for  instance,  bending  all  day  over  her  work,  shnt  oj^ 
from  morning  to  night  in  a  hot  room  with  a  crowd  of  others,  nnlesii 
she  eun  be  released  from  such  drudgery  and  breathe  a  purer  air  ? 
Many  such  there  are  who  present  themselves  for  examination,  for 
whom  there  is  a  reasonable  chance  for  greatly  improved  health,  if  not 
ultimate  recovery,  could  they  have  the  opportunity  of  coming  under 
proper  hygienic  influences.  As  it  is,  they  struggle  on,  subject  to  the 
very  causes  which  have  developed  their  fatal  disease,  compelled  to 
labor  to  keep  body  and  soul  together  until  the  last  moment  of  their 
failing  strength,  without  hope  of  ever  being  any  better,  and  only  toq 
happy  if  their  sufferings  are  not  greatly  prolonged  after  their  capacity 
for  work  has  ceased.  For  this  class  there  is  a  most  urgen  need  of  an 
asylum,  where  temporary  relief  might  recruit  their  exhausted  energies, 
allowing  them  to  return  perhaps  for  a  time  to  their  wonted  occupations, 
possibly  arresting  entirely  the  advance  of  their  destructive  malady,  and 
at  any  rate  holding  out  to  them  the  prospect  of  a  haven  of  rest  and 
comparative  comfort  when  the  inevitable  doom  has  set  its  soal  upon 
them. 

There  is  still  another  aspect  in  which  tho  establishment  of  a  chari- 
table institution  for  the  treatment  of  consumption  is  of  very  great  im- 
portancre,  namely,  the  opportunity  which  it  would  afford  for  the  study 
and  scientific  treatment  of  this  disease  here.  Of  late  years,  as  we  all 
know,  there  have  been  very  great  changes  in  tho  methods  of  treating, 
and  new  theories  have  come  in  vogue  of  the  special  causes  originating 
it.  The  climate  and  atmospheric  influences  of  New  England  are  pe- 
culiar, and  require  to  be  studied  with  special  reference  to  this  disor- 
der. Our  plans  of  treatment  and  theories  of  origin  have  hei-etofore 
been  mainly  borrowed  from  European  authorities,  whose  researches 
have  hL"v.*n  conducted  under  very  diftorent  conditions.  Dr.  Bowditch 
has  only  quite  recently  demonstrated  the  extreme  probability  that  hu- 


18M.]  BdUor'M  TaUe.  805 

Midity  of  the  soil  is  the  excitiag  cause  of  consamptioa  ia  many  parts 
of  New  England.  How  important,  then,  that  a  healdiy  residence 
•hmild  be  secured  for  those  attacked  by  this  disease,  whose  means  do 
not  admit  of  their  choosing  a  home  best  calculated  for  their  recovery  I 
TImio  are  many  methods  of  treatment,  also,  where  the  poor  are  the 
aalfjaets  of  it,  which  can  only  be  satisfactorily^  tried  in  a  hospiul ; 
•ODM  of  them  are  such  as  can  hardly  be  used  in  any  case  except  in 
audi  an  institution.  We  are  fully  persuaded  that  we  are  far  from 
haviag  learned  all  that  can  be  learned  of  this  scourge  of  New  England, 
SMid  the  opportunities  which  a  special  hospital  would  afford  would 
gifo  the  best  chance  for  discoveries  which  would  be  of  the  greatest 
Snefit  to  the  whole  community.  Let  us  hope,  therefore,  that  this 
gap  ia  the  circle  of  our  public  charities  may  not  remain  unfilled  much 
longer. 


Society  of  Indiana — ^Will  hold  its  Fourteenth  Annual 
meeting  at  Indianapolis,  beginning  on  the  third  Tuesday,  (17th  inst.) 
of  this  month,  under  the  presidency  of  Dr.  Sloan,  of  New  Albany. 

We  are  not  advised  as  to  the  prospects  of  a  good  meeting,  but  we 
do  know  that  our  professional  friends  throughout  the  State  should  sus- 
tain the  society  by  their  presence.  An  attendance  for  several  years 
kaa  amply  demonstrated  to  us  there  is  both  pleasure  and  profit  in  be- 
ing present  at  its  sittings. 

A  committee  was  appointed  last  year  to  present  to  this  meeting  a 
leviasd  Constitution  and  By-Laws,  and  the  following  are  the  special 
committees  expected  to  report : 

Cerebro- spinal  Meningites,  Dr.  Bracken  ;  Entozoa  of  Man,  Dr. 
Fletcher  ;  Chronic  Diarrhoea,  Dr.  Spencer  ; .  Pneumonia,  Dr.  Hard- 
tag  ;  Intermittant  Fever,  Dr.  Day ;  Scariet  Fever,  Dr.  Woodworth  ; 
Chaage  of  Type  of  Disease,  Dr.  Eitt ;  Rheumatism,  Dr.  Collings ; 
laflaence  of  Mind  on  Disease,  Dr.  Wishard. 

The  delegates  from  the  Ohio  State  Society  to  that  of  Indiana  for 
the  preeent  year  are  Drs.  H.  S.  Conklin  and  J.  A.  Murphy. 

We  have  also  heard  it  hinted  that  tlie  Indianapolis  Medical  Asso- 
ciation have  some  arrangments  on  hand  not  announced  in  the  above 
programme  which  promise  to  add  to  the  social  attractions  of  the  meet. 
lag  and  will  make  it  agreeable  for  the  fraternity  at  large  to  be  present. 

We  also  venture  the  suggestion  that  members  throughout  the  State 
brief  notice  of  those  meetings  in  their  respective  county  papers* 


Cimemnaii  iJoUege  qf  Medicine  and  Surgery. — ^The  commencement 
exercises  in  this  institution  were  held  on  Wednesday  evening,  the 
17th  of  February,  1864,  in  Bible  Chapel  on  Longworth  Street  between 
Central-Avenue  and  John  Street. 


806  NiUn^M  TaNe.  [Hij, 

The  Degree  of  Doctor  of  Medicine  was  conferred  by  Jacob  Graft 
Esq.,  President  of  the  board  of  tmsteeti,  on  the  following  named  ga* 
tleman,  being  thirty  in  number ;  ae  follows :  John  J.  Albers,  Edward 
M.  Anderson,  George  A.  E.  Gaiey,  Stephen  W.  Brown,  Qeoiga  ft 
Chitwood,  Jr.,  John  E.  Obitwood,  David  H.  Daniel,  Issao  W.  DMf* 
las,  Richard  Edwards,  Edward  G.  Farsbee,  William  J.  Fain,  Joha 
B.  Grayer,  Joseph  T.  Harper,  Levi  Hess,  Uriah  A.  Y.  Hester,  Has- 
derson  Hine,  Thomas  F.  Holiday,  Calvin  B.  Holoomb,  Francis  X* 
Howard,  Edward  Kitzmiller,  Philip  H.  Livingston,  Joseph  B.Liicai» 
Prentis  Mede,  William  C.  O.  Rear,  John  M.  Pickett,  Timothy  F. 
Risk,  John  M.  Ross,  James  M.  Runyan,  A.  B.  Tadlock  and  GhariH 
Wyman. 

After  which  a  valedictory  address  to  the]  graduating  class  was  de- 
livered by  Prof.  T.  A.  Pinkney. 


The  Ohio  State  Medical  Society^WxVL  meet  at  White  Snlphar 
Springs  on  Tuesday,  the  21st  of  June.  We  call  attention  thus  early, 
that  members  and  committees  alike  may  be  reminded  of  the  time  and 
make  their  arrangements.  The  meetings  of  the  Society  for  seteral 
years  past  have  been  held  at  the  White  Sulphur  Springs,  and  have 
been  occasions  of  a  great  deal  of  gratification  to  the  members  both 
professionally  and  socially.  We  anticipate  a  full  and  interesting 
gathering  the  present  year.  We  also  take  this  occasion  to  announce 
the  special  committees  as  follows  : 

Surgery,  N.  Dalton ;  Diseases  of  the  Eye,  A.  Metz ;  Obstetrical 
Surgery,  M.  B.  Wright ;  Practice  of  Medicine,  J.  A.  Murphy  ;  Obit- 
uaries, M.  Dawson ;  Insanity,  R.  Gundry ;  New  Remedies,  E.  B. 
Stevens ;  Asthma,  T.  A.  Reamy ;  Pancreatic  Disease,  J.  P.  Gruwell ; 
Diptbtheria,  P.  Beeman  ;  Uterine  Diseases,  G.  W.  Boerstler. 

Dr.  M.  Dawson  is  chairman  of  the  Executive  Committee,  and  what- 
ever arrangements  he  may  make  of  interest  to  members  intending  to 
visit  White  Sulphur  Springs  at  that  time,  will  doubtless  be  commu- 
nicated in  time  for  our  next  number. 

RoU.  Carroll  d  Co-^Succeuors  to  Rickey  A  Carroll, — ^Mr.  Rickey, 
of  the  well  known  book  publishing  house  in  this  city  heretofore  known 
as  Rickey  <k  Carroll,  having  withdrawn  from  the  firm,  the  house  will 
be  known  by  the  title  of  Robt.  Carroll  h  Co.,  and  will  remain  in  the 
old  room  in  the  Opera  House  building  on  Fourth  Street. 


OBITUARIES, 


Dmik  nf  Dr.  Fleming, ^kt  a  meeimg  of  die  BflgoUr  Medical  Pro- 
fciimi  of  Shelbyville,  held  at  the  office  of  Dr.  Forbeiv  on  the  evening  of 
Kaidi  22d,  1864»  for  the  purpose  of  conaidering  the  death  of  Dr.  Flem- 
iig^  Dr.  Day  was  called  to  the  Chair^  and  Dr.  Oreen  appointed  Secre- 
taiy.  Drs.  Qreen,  Kennedy,  and  Forbesjwere  i^ppointed  a  committee, 
»ko  reported  the  following  preamble  and  resolutions,  which  were  nnan- 
laontly  adopted: 

WnnsAS,  It  has  pleased  an  All-wise  Providence  to  remove  from 
Btr  midst  by  death,  our  friend  and  co-laborer  in  the  Profession,  there- 
f<Me» 

S€$ol99d,  That  in  the  death  of  Dr.  O.  W.  Fleming,  the  Profession 
iss  loKt  an  honorable  and  useful  member,  the  community  a  good  and 
ind  physician  and  public  spirited  citisen,  the  poor  a  generous  and 
litkful  iriend,  and  his  wife  and  children  an  aflfoctionate  husband  and 
ither. 

.  JBetolv^d^  That  as  further  testimony  of  respect  for  our  deceased 
Irother,  we  will  attend  his  funeral  in  a  body. 

Sgfohed,  That  a  copy  of  these  resolutions  be  presented  to  the  fam- 
ly  of  the  deceased,  and  published  in  the  county  papers,  and  that  Dr. 
i.  A.  Kennedy  be  requested  to  write  an  obituary  for  the  Cincinnati 
jaaeet  4  Observer.  S.  D.  Day,  Pres't. 

W.  F.  Orbbh,  Sec'y. 

Died,  in  Shelbyville,  Indiana,  at  noon,  on  the  21st  day  of  March, 
[884,  of  Erysipelas  gangrenosus.  Dr.  G.  W.  Fleming,  in  the  68d 
fcnr  of  his  age. 

Until  night  of  the  12th  of  Mardi,  he  had  been  in  his  usual  good 
leaMh.  In  the  morning  of  that  day  he  accidentally  scratched  his  left 
laad  with  a  pin,  and  in  a  few  hours  afker  rode  to  the  country  and 
tressed,  for  one  of  his  patients,  a  large  chronic  abscess.  In  the  night 
le  was  suddenly  seised  with  violent  darting  pains,  commencing  in  the 
iajuied  hand,  and  extending  to  the  shoulder.  Upon  examination,  the 
kand  and  lymphatics  of  the  axilla  were  found  slightly  swollen ;  in  a 
riKMt  time  the  hand  and  forearm  were  covered  with  blains,  containing 
limpid,  reddish  serum,  and  with  their  appearance  constitutional  symp- 
toma  came  on,  which  led  him  to  believe  that  in  cleansing  and  cauter- 
iaiBg  his  pattents  wonnd  (the  day  previous),  septic  poison  was  com- 
mnnicated  to  him  through  the  abrasion  on  his  hand.  On  Sunday, 
Dr.  Day  visited  and  concurred  with  him  in  that  opinion. 

In  the  course  of  a  few  days,  the  cuticle  and  cellular  tissue  of  the 
entire,  arm  and  shoulder  wore  in  a  state  of  sphacelus.  His  constitu- 
tioB,  otherwise  good,  succumbed  to  the  terrible  shock,  notwilhstaad- 


808  JWfor*#  3iM0.  [Majr, 

ing  the  ezUbifeioii  of  all  m^Miff  tluit  Lora  snd  Sdeiioe  oooU  toggail, 
and  thus  be  fell  a  victim  to  the  destrojiQ^  angel,  whom  Iw  Ind  io 
often  and  snccessfdiy  eoMMad.  I^r  o^ers. 

Dr.  Fleming  was  bom  in  WuUaffiin^omij.  Pa.  |LI|fir«d^ 
age  be  entered  Washington  Oollege»  and  eoaipi6i*ilAii0iiii.  mmm 
in  1822.  He  then  commenced  the  study  of  medie^  In  Idtliaim 
town,  with  Dr.  James.Strans,  an  eminent phjsMan  of  thit  jlkkm.  On 
account  of  a  certain  degree  of  deafness  oeonrrii^  soon  after  As  ooii* 
pletion  of  bis  medical  pupilage,  be  did  not  engage  in  tte  ptaetiee  of 
his  profession,  until  he  emigrated  to  this  State,  in  1880*  Aftsr  two 
years  sojourn  here,  he  became  dissatisfied,  and  went  to  WastttMMaad 
County,  Pa.,  where  be  remained  until  1849,  when  he  again  came  to 
this  Gounty,  the  field  of  his  early  professional  labors. 

Dr.  John  Bedmon  Coxe — died  in  Philadelphia,  March  28d,  nit. 
in  the  91st  year  of  his  age.  He  was  the  oldest  graduate  of  the  Ksd- 
ical  department  of  the  University  of  Pennsylvania, — and  was  wAm* 
quently  and  for  many  years  a  Professor  in  that  Institution,  filling  Ibrst 
the  Chair  of  Chemistry,  afterwards  that  of  Materia  Medioa,  leUimg 
from  the  school  in  the  year  1835.  He  was  one  of  the  first  to  tnt^ 
dnce  vaccination  into  the  United  States.  He  was  also  the  inventor 
of  the  old  preparation — Syrupus  Scilice  Camposihu,  CT.&P.,— better 
known  for  the  past  quarter  of  a  century  as  Voxels  jBive  Syf^.  For 
many  years  he  has  been  leading  a  quiet  and  retired  life. 

Dr.  Franklin  Baehe-^M  March  19th  ult.,  in  the  city  of  Phila- 
delphia. Dr.  Bache  is  well  known  as  one  of  the  authors  and  editois 
of  the  United  States  Dispensatory.  He  bad  filled  many  honorable 
stations,  and  at  the  time  of  his  decease  was  Professor  of  Chemistry 
in  the  Jefierson  Medical  College. 


■  ••  » ■ 


Army  Medical  Intelligence. 

Surgeon  Josiah  Curtis,  U.S.Y.,  has  been  ordered  to  Knoxville, 
Tenn.,  for  duty  in  the  field. 

Surgeon  Charles  O'Leary,  U.S.V.,  has  been  relieved  from  the  chaige 
of  Christian  Street  Hospiul,  Philadelphia,  Pa. 

Surgeon  Charles  O'Leary,  U.S.V.,  now  at  Philadelphia,  Pa.,  will 
report  by  letter  to  the  Provost  Marshal -Oeneral,  U.S.A.,  for  duty  as 
member  of  a  Board  to  be  convened  in  that  city,  for  the  examination  of 
applicants  for  commissions  and  commissioned  Officers  already  in  the 
U.S.  Invalid  Corps. 

Assistant  Surgeon  Franklin  Grube,  U.S.V.,  has  been  assigned  to 
the  charge  of  the  Marine  General  Hospital,  Cincinnati,  Ohio. 


1664.]  Bdkan'al  AbdncU  aMt  S^tdiont.  809 

Surgson  Suiford  B.  Hunt,  U.S.  V.  is  ivIieTed  fttiiD  daty  tt  Uw  Rea- 
dearoas  of  Diitnbation,  near  Alexaadria,  Vk.,  tni  will  proceed  with- 
out d«U7  to  Loaiaville,  Ky.,  aod  report  in  ptireon  to  Asaiatant  Bar- 
gwn-Genenl  R.  C.  Wood,  U.8.A.,  for  tueignroent'to  duty. 

Sa^^n  J.  S.  Bobbs,  TT.S.V.,  now  on  duty  &t  IndUnapolis,  Ind., 
will  report  bj  letter  to  the  Provost  H&rshal-Qeneral,  U.S.A.,  for  duty 
■•  member  of «  Board  to  be  convened  in  that  city,  for  the  examina- 
tioo  of  applicants  for  commissions  and  commissioned  Officers  already 
in  the  Invalid  Corps. 

Bnrgeon  Alexander  J.  Mnllen,  36th  Indiana  Vols.,  having  tendered 
bis  leaignaiion,  is  honorably  discharged  the  service  of  the  United 
Stales,  with  condition  that  he  shall  recoive  no  final  payments  until  he 
has  satisfied  the  Pay  Department  that  he  is  not  indebted  to  the  Gov- 
ernment. 

In  addition  to  his  daties  as  attending  Surgeon,  Battery  £,  2d  U.S. 
Artillery.  Assistant- 8 nrmon  E.  Freeman,  U.S.V.,  has  been  assigned 
to  the  Franklin  House  Hospilal,  Knoxville,  Tenn. 

Sargeon  J.  W.  Lawton,  0.8. T.,  has  been  assigned  to  duty  in 
charge  of  Convalescent  Camp,  Nashville,  Tenn.,  Qeneral  Hospital 
Mo.  12,  of  which  be  was  lately  in  charge,  having  beea  closed. 

Avietant- Sargeon  Samuel  Hart.  U.S.V.,  has  been  placed  inchaige 
of  Qeneral  Hospital  No.  4,  Mnrfreesbnro,  Tenn. 

Snrgeoo  S.  B.  Davis,  U.S.A.,  has  reported  to  Major-Qeneral  Cur- 
tis, U.S.V.,  at  Fort  Leavenworth,  Kansas. 

Surgeon  Henry  A.  Martin,  U.S.V.,  has  been  relieved  from  dnty  as 
Chief  Medical  Officer,  cities  of  Norfolk  and  Portsmonih,  Vs.,  and  will 
proceed  to  Newborn,  N.  C,  and  report  to  Sutgeon  D.  W.  Hand,  U. 
8.  v.,  for  duty  in  the  District  of  North  Carolina. 

Surgeon  H.  B.  Buck,  I'.S.V.,  has  l^w-n  relieved  from  the  charge  of 
the  Military  Prison  Ho^'pilal.  Uamp  Morton,  Iml.,  >n'l  SMignpd  to 
dnty  as  Superintendent  of  HoBpitatii.  Camp  Iliiilcr,  III. 

Surgeon  William  Watson.  U.S.V.,  having  closed  the  Jack-siiii  I 
piul  at  Memphis,  Tenn.,  is.  by  order  of  Ansistant  Suq)        ~ 
Wood,  assigned  to  the  Ccitlenden  Hospital,  Louisville,  | 

Surgeon  E.  L.  Slanfonl,  U.S.V. .  has  been  nalieri 
•nt  of  Uospiuls  at  Knoxville,  Tenn.,  and  has  i 
Sargeon -Oeneral  Wood,  st  Louisville,  Ky.,  for 


Snrgeon  John  F.  Head,  U.S.A..  will  nli«T« 
U.S. v.,  in  his  duties  at  Cindnnati.  Ohio.  Sar, 
port  in  person  lo  A(si«tant  Surgeon  Oeneral  R. 
Loaiaville,  Ky.,  for  assignmetit  lo  doty. 


810  BdUarial  AitinuU  oM  SiUeiiom.  fibj, 

SargeoQ  Gideon  8.  Palm«r,  U.S.Y.,  lus  been  relbyad  firon  d«|gf  it 
St.  Loois,  Mo.»  aiulirill  report  to  Aieista&t  SuigeoBLHjkfteittl  WW 
for  duty.  ,~     . . 

Snrgeon  A.  H.  Hoff;  XT.S.T.,  iiMl$eibnwip^  to  datr  ttRjHUbd 
Director  of  Transportation  in  New  York  0llfg^lKii0^'WtagB^  I 
C.  Dalton,  U.S.V. 

Burgeon  John  H.  Phillips,  U.S.Y.,  to  the  let  Diviidon,  Oinker- 
land  Hospital,  Nashyilk,  Tenn. 

Assistaut-Suigeon  Edwin  Freeman,  U.S.Y.*  to  Golnmlnnf  Oluo^ 
attending  sick  and  wounded  officers  and  examining  recmits. 

Assistant-Surgeon,  W.W.  Wjthes*  U.S.Y.,  has  arrived  at  Knoi* 
ville,  Tenn.,  and  been  assigned  to  duty  at  General  Hospital- Ho.  4. 

Surgeon  S.  W.  Gross,  U.S.Y.,  to  Jacksonville,  Fla. 

Surgeon  John  T.  Carpenter,  U.S.Y.,  has  been  relieved  from  datf 
at  Cincinnati,  Ohio,  and  ordered  to  report  to  Assistant  Sovgeon-Gen- 
oral  Wood,  at  Louisville,  Ky. 

Surgeon  William  S.  King,  U.S.A.,  has  been  relieved  from  dnfyei 
Medical  Director,  Department  of  the  Ohio,  and  ordered  io  report  to 
the  Medical  Director,  Northern  Department,  for  duty  as  Supennlaa^- 
ent  of  Hospitals  at  Cincinnati,  Ohio. 


•  ••»  » 


PftKPAKBB  BT  W.  B.  Flitohse,  M.  D.,  Imviakavolu . 

SURGICAL. 

Bursce. — Frederic  C.  Skey,  Snrgeon  to  Dr.  Bartholomew's  Hos- 
pital, in  his  Reports  of  Cases,  says  that  the  Tincture  of  Iodine,  aad 
blisters,  are  both  ineffectual  in  the  treatment  of  Bursas,  and  in  a  laige 
number  of  cases  he  has  used  the  thread,  which  destroys  the  trarstt, 
whether  composed  of  solid  walls  or  fluid  contents. 

A  moderately  thick  silk  thread  is  passed  through  the  bursty,  and 
the  formation  of  an  abscess  follows.  The  period  required  for  this 
conversion  is  from  three  to  ten  days. 

The  presence  or  the  immediate  advent  of  matter  is  indicated  by  pain 
in  the  swelling  and  by  the  existence  of  a  red  halo  around  the  opening 
made  by  the  needle.  When  this  sighn  is  fuUy  established,  the 
thread  may  be  withdrawn.  The  bursas  is  now  forever  obliterated, 
and  we  have  an  abscess  in  its  place,  identical  with  and  ammenable  to 
the  same  treatment  as  an  abscess  in  any  other  place. 

The  more  chronic  and  solid  varieties  pass  slowly  into  suppuration ; 
the  more  acute  cases,  when  accompanied  by  redness  and  pain,  require 
watching,  and  are  early  removed  by  the  thread. 

Adventitious  burs ,  called  gangUons^  presenting  on  the  baok  of  the 
waist  or  foot,  are  successfully  treated  by  eniirely  evacuating  the  oon- 


JSUUorial  AbUradi  and  SeUUiom.  811 

the  oppoeite  walls  beings  mainUined  in  absolate  contaott  by  a 
»,  will  effect  a  care  in  from  twelve  to  Iqciy-^ight  boars.-* 
Lancet. 

«. — ^The  best  tieatmeni  of  barns  and  scalds  is  that  introdnoed 

Kentisht  of  Bristol,  abont  half  a  oentarj  ago»  and  consists  in 

of  stimalating  applications  to  the  injnred  sarfisoe.! 

ikey  has  folly  tested  this  treatment  for  a  nnmber  of  yean,  in  a 

amber  of  cases,  and  feels  conTinced  after  nsing  all  other  meth- 

liich  are  supposed  to  soothe,  allay,  or  calm  the  pain,  and  be- 

lat  any  one  fally  trying  the  two  plans,  will  adopt  the  stimalat- 

.tment.    As  an  instance,  he  gives  the  following : 

were  bronght  into  the  Hospital  at  one  time,  severely  bamt  by 

losion  of  gas.    One  died   immediately,  the  remaining  fonr 

dly  burnt  about  the  face,  chest,  and  arms. 

aoe  and  chest  of  each  man  was  washed  with  a  eolation  of  ten 

)f  Nitrate  of  Silver.    To  the  arms  was  applied  the  celebrated 

.  or  boiled  oil. 

ity-four  hours  elapsed,  and  on  inquiry  whether  the  patients 

ffbring  any  pain,  each  made  the  same  reply,  ''I  am  easy  every- 

Bzccpt  in  the  hands  and  arms." 

oil  was  removed,  the  solution  was  applied,  and  relief  followed 

atcly.     The  solution  may  be  applied  at  any  time,  so  long  as 

I  remains.    Ten  to  fifteen  grains  to  an  ounce  of  water  for  an 

five  to  seven  for  a  child,  is  the  strength  employed. — Ibid. 

nie  VlcevB. — Dr.  Skey  says,  "  I  have  treated  a  large  nnmber 
t  affections,  and  with  success.  The  more  chronio  the  nicer,  the 
ts  size,  the  more  aged  the  snbject,  the  more  remarkable  is  the 
»  of  opium  in  effecting  its  cure.  Let  a  case  be  selected  for 
lent,  of  some  twenty  years  duration,  which  has  exhausted  the 
3  of  various  medical  attendants,  as  well  as  the  remedies  em- 
by  them  for  cure. 

\  such  a  cose  of  chronio  nicer,  of  the  laigest  size,  having  a 
it,  bloody  base,  a  high  mound  lymped  around  it,  covered  by 
integument,  the  sore  pouring  out  large  quantities  of  watery 
laturating  every  covering.  Select  such  a  case  occurring  in 
:  give  such  a  person  ten  to  fifteen  drops  of  tinetnre  of  opiam 
ad  morning,  leave  the  bowels  alone,  and  observe  the  base  of 
)  in  five  or  six  days  :  it  will  exhibit  a  number  of  minnte  red 
which,  daily  increasing  in  nnmber,  will  rise  up  in  the  form  and 
'  of  healthy  granulationo,  and  cover  the  entire  surface  of  the 
'  and  at  the  same  time  the  base  is  becoming  elevated,  the  mar- 
omes  depressed,  and  the  process  of  cicatrization  is  o6mmenced. 
injury  to  the  constitution  attaches  to  the  use  of  this  remedy, 
itary  action  upon  the  ulcer  is  obtained  solely  through  the 
influence  it  exercises  upon  the  constitution. — IM. 

)ure  of  the  Subclavian  Artery — Dr.  Millard  Parker  has  given 
w  York  Pathological  Society  an  account  of  his  ligating  the 
ibdavian  inside  the  scalenus  musolep  together  with  common 


812  JgiUmal  AiUraeii  Md  MedStm.  fibj, 

•  ■  •  •       •  • 

carotid  and  Terlebral  arteries,  for  sttbolayian  iaemrbm*  Hjmhw* 
rhage  from  the  distal  end  of  the  subclavian,  resnlllDg  i4  daatk  on  tli 
42nd  day. 

The  operation  for  ligatove  of  tha  ilA^^iaBJ|^»  been  perfMnl'ia 
all  tweWe  times,  by  the  following  Bnigeoili'!*>  M-  .lOW^  <■  ^^^ 
death  occnrrijig  fr(»n  hieniorriiaga  on  thefbiifih  day;  &mL  Hott^ 
in  1833,  death  from  h»monrhageoa  tbe.eigbteenth  daj;  UL  Bmj* 
den,  in  1885,  death  from  iMsmonrhage  on  the  twelnk  dav ;  w. 
O'Bmlly,  in  1886,  death  by  hamofrhag^  on  the  twenty-thud  day ; 
5th.  Partridge,  in  1841,  death  from  pericarditis  and  plwiritiB  o»  m 
fourth  day  ;  6th  and  7th,  Liston,  in  two  oases — in  the  flisl»  1837, 
death  ooournd  from  h»morrhage  On  the  thirteenth  day»  nod  in  tibe 
second,  1839,  death  from  the  sameoanse  on  the  thir^-sixdi  d«y ; 
8th  and  9th,  Anverte,  in  two  cases ;  in  both  death  was  the  itsnlt  ef 
hfBmorrhaffe,  in  the  first,  on  the  twenty-second,  and  in  the  seooiid  on 
the  cleTenth  days ;  10th.  Rodgers,  in  1845,  death  from  ha»monfasga 
on  the  fifteenth  day ;  llih.  Cavellier,  in  1860,  death  from  h»mor- 
rhage  on  the  tenth  day— carotid  and  sobclavian  of  right  side  ligatniid. 
12th.  Paaker,  in  1862,  case  already  referred  to. 

Injection  of  IrritanU  uUo  Tumors,  eU. — Dr.  Lnton,  of  Rheims,  adr 
Tocates  the  injection  of  irritaiKs  in  the  parenchym  of  diseased  tissoee 
This  injection  produces  an  artificial  morbid  action  which  may  nUf' 
mately  bring  about  a  perfect  cure.  It  has  been  usefully  employed  A 
neuralgia  and  local  pains,  white  tumofs,  periostitis,  caries,  Pott^ 
disease,  strumous  swelliDfirg  of  the  glands,  tumors  of  diffiBrmt 
natures,  either  acute  or  chronic,  as  for  example,  boils,  anthrax, 
phlegmonous  tumors,  inflammation  of  the  parotids. 

Injections  of  tincture  of  iodine  have  been  made  in  goitres.  Hus 
mode  of  treatment  is  attended  with  no  danger  whateyer. 

Topical  JnjecHons  of  Strychnine  in  cases  of  paralysis  of  the  facial 
i^erve,  have  been  recommended  by  a  French  Surgeou. 

A  few  drops  (from  eight  to  sixteen)  were  injected  along  the  course 
of  the  facial  nerve,  between  the  stylo-mastoid  foramen  and  the  neck 
of  the  lower  maxilla, — the  strength  varying  from  one  in  a  hundred  to 
one  in  seventy.  The  injection  was  repeated  every  second  or  third 
day.  All  the  muscles  of  the  face  recovered  the  faculty  of  movement 
after  from  three  to  six  injections,  in  about  ten  days  or  a  fortnight. 

The  author  states  that  no  relapses  have  taken  place  in  these 
—^Lancet. 


PRACTICAL    MEDICINJB. 

OK  THE  PRESENT  STATS  OP  THERAPBUTIOS, 

From  a  Lecture  hy  J.  Bughee  Sennei. 

I }  The  Influence  which  the  Mind  exerts  over  the  Body, — Although  such 
influence  has  been  recognized  for  a  longtime,  it  has  been  proved  far 
greater  than  was  formerly  supposed.    JSistory,  from  remotest  time. 


1864]  JUiiorial  AiUr^uH  mid  S^Uciimi.  818 

pratantt  examplet  where  individoals,  ringlj  aod  in  maltUadM,  M 
away  bj  predomiDani  idaaa,  have  performed  aeti  thooght  miraen- 
lona,  and  suffered  no  pains  nor  injuiieSv  whioh,  nnder  ordinarj  eir- 
ooneUnces  would  ha^e  proineed  the  greatest  agony. 

Thvs,  the  extaoiee  of  the  Pythian*  and  other  priestossea ;  the 
stoieism  of  the  Indian  warriors  st  die  suke,  and  insensibility  of 
men  excited  in  battle  by  strong  religions  enthusiasm ;  the  dancing 

E*lemio»  of  St.  Vitus  or  of  toerantism,  in  the  aiiddle  ages;  the 
nomena  induced  by  magioi  incantations,  and  the  evil  eye;  the 
ueinations  of  the  conTuIsionarfes  at  the  tomb  of  St.  Medard  in 
Paris  ;  the  seTcral  delusions  described  in  the  Journal  of  Mr.  Wes« 
ley,  in  the  religious  camp-meetings  of  America,  and  among  our  re- 
Yiraliats  in  recent  times ;  the  results  of  mesmerismi  table-turning 
and  spirit  rappings,  produced  in  the  present  day,  are  all  of  «  similar 
eharneter,  and  indicate  the  remarkable  influence  which  the  mind 
poeaeeses  over  the  sensationSi  emotion,  volition,  and  even  the  animal 
fiinetions. 

Thni  power  has  always  been  seised  upon  by  certain  individuals  as 
a  means  of  cure ;  hence  the  power  of  charms,  amulete,  etc.,  have 
been  known  to  remove  all  kinda  of  pain,  and  produce  wonderful 
enrss  ;  and  the  same  thing  has  resulted  from  intense  religious,  po- 
lilaoal,  and  mental  excitement.  So  far  from  the  alleged  cures  having 
been  improbable,  does  not  all  that  we  know  of  the  e£GMst  of  confident 
mpomises  on  the  one  hand,  and  implicit  belief  on  Uie  other,  render  it 
likely  that  they  actually  occurred  ?  If  so,  this  power  must  be  taken 
into  account  in  every  true  system  of  therapeutics ;  its  influence  must 
be  recognised,  and  we  ought  to  endeavor  to  make  it  amenable  to 
scientific  rule. 

The  late  Sir  Braid  Manchester  did  much  to  give  effect  to  the  the- 
therapeutic  exercise  of  the  mind  upon  the  lM>dy.  By  suggesting 
thoughts  to  his  patients  in  varions  ways,  or  diverting  them  to  cer- 
tain anbjects,  or  by  definite  physical  iirpressions,  he  fixed  certain 
ideas  in  their  minds.  These  ideas  he  found  to  act  as  stimulants  or 
sedatives,  according  to  their  purport  and  the  current  of  thought  di- 
rected to,  or  withdrawn  from  particular  organs  or  functions.  In- 
deed, there  can  be  no  question  that  the  beneficial  effects  of  many 
drugs  and  systems  of  treatment,  which  are  really  inert  or  uncertain 
in  Uieir  action,  and  which  are  supposed  to  operate  through  the  blood 
on  the  glands,  muscles,  or  nerves,  truly  act  by  exciting  expectan^ 
ideas,  and  through  such  ideas,  indirectly  on  the  parte  disordered 
This  constitutes  one  of  the  great  therapeutic  advancements  of  modem* 
times,  coring  maladies,  and  explaining  innumerable  recoveriee,  here- 
tofore neglected  by  the  profession. 

Dr.  Bennett  proceeds  to  unfold  the  change  of  opinion  which  has 
oecuned  in  modem  times.  For  example, ''  it  was  n>rmerly  supposed 
that  acute  inflammations  had,  for  the  most  part,  a  destractive  ten- 
dency ;  if  inflammations  visited  the  skin,  the  mucous  or  serous 
membranes,  or  internal  organs,  the  great  object  was  to  prevent  its 
spreading  by  the  use  of  the  most  violent  means,  as  blood  letting, 
pnrging,  antimony  and  low  diet,  which  seemed  the  name  of  anti- 


814  Bddiwrlal  AMrwsU  mnd  StkMuu.  \}bf, 

pblogistios.    Oa  the  other  hand*  toberotilar  disease  was  eiqppeisl 
to  be  uniformly  fataJL^nd  altogether  beyond  the  reaoh  of  art. 

Now  these  cooolasiona^lafa  emioiieoiis.  .  We  have  seen  that  as  JJ* 
lopathio  treatment  onres  tnbemHtaa^iW^ease,  while  the  ag||^Uo* 


gistic  treatment  is  a  moetfktal  pr^^ctioe.  T^^^^Mht,   jf^>«^ 

JiCalignant  growths  were  supposed  to  be  seiieft  m  lie  bload ;  u 
idea  whioh  rendered  operatins^  useless,;  but  in  this  also.a  gresi 
change  of  opinion  has  been  effected ;  so  that  eanoers  and  the  othtf 
growths  are  now  successfully  extirpatod." 

He  speaks  of  the  impossibility  of  knowing  the  effect  of  a  maedj* 
without  first  knowing  the  natural  course  and  terminaUoa  of  the 
disease. 

Of  the  efficacy  of  the  tincture  of  muriate  of  iron  in  erysipelas,  he 
has  some  doubts  ;  he  says  :  '*  In  the  Royal  Infirmary  I  hate  ate 
many  severe  cases  of  erysipelas.  I  have  never  given  tne  muriate  of 
iron,  or  any  thing  but  good  diet,  with  lotions  of  acetate  of  lead, 
fiour  or  oil  locally  to  alleviate  irritation,  and  I  have  not  had  *  fatal 
case.  Any  remedy  might  easily  obtain  a  great  reputation  if  glfea 
in  diseases  that  almost  always  get  well  of  themselves.'* 

In  rheumatism,  he  alludes  to  the  numerous  and  ooutiadietory 
remedies  which  have  been  used,  and  gives  his  opinion,  that  *'al- 
thoagh  many  of  these  remedies  may  retard  oonvaleseenee,  it  hss 
yet  to  be  proved  which,  if  any,  shorten  its  duration  even  one  hoar." 

'*  Tbe  knowledge  derived  from  an  improved  diagnosis  and  path- 
ology, perhaps  more  than  anything  else,  has  tended  to  alter  oar 
appreciation  of  drugs.  Instead  of  gaessing  at  what  was  probably 
the  matter,  we  now  often  determine  with  certainty  what  exists." 
Z.  Of  veratrum  yiride,  Dr.  Bennett  expresses  himself  as  follows  :— 
"  It  is  maintained  that  this  drug  posseoses  the  power  of  diminsihing 
the  force  of  the  pulse,  and  on  that  acconnt  it  is  a  most  valuable 
medicine  in  fevers,  inflammations,  and  other  diseases  where  the 
pulse  is  excited.  Bat  pathology  indicates  that  so  far  from  lowering 
the  pulse  in  these  disorders,  what  is  required  in  troth  Is  to  support 
it.  I  cannot  conceive  any  circumstances  in  which  such  a  remedy 
with  its  ascribed  properties,  can  be  useful.** 

Antidotes  far  Strychnia. — Prof.  Ranini  Bellini,  after  having  made 
a  great  number  of  experiments  on  poisoning  by  strychnia  and  its 
salts,  believes  that  tannic  acid  and  tannin,  chlorine,  tincture  of  iodine 
and  bromine,  are  the  best  antidotes.  "  Chlorine,**  he  says,  "  jnen* 
tralizes  strychnia  even  after  it  has  been  absorbed.**  M.  Ballini  has 
also  observed  that  when  strychnia  is  mixed  with  hydrogallic  acid, 
the  convulsions  do  not  appear  for  half  an  honr  later  than  usual;  but 
he  attribntes  this  effect  to  the  action  of  the  acid  on  the  mucous  mem- 
brane of  the  stomach,  by  which  action  the  absorption  of  the  poison 
is  rendered  more  difficult. — Amer.  Mtd,  Txmen. 

Simple  dreuing  for  Burns. — Dr.  Squibb  highly  recommends  as  an 
application  in  these  cases  the  creosote  water,  made  according  to  the 
new  U.  S.  P.,  as  follows  :  Take  of  creosote,  a  fluid  drachm  ;  distilled 


1864.]  JUHorial  AbUntdg  atkd  SUhcUom.  815 

water,  a  pint.    Mix  them  and  agitote  the  mixtart.iiiiil  Umi  eraoaota 
ia  diaaoWad. — Ibid.  •  <  ^  ^ 

liq^e  WomL^^Df.  P.  J.  F^fiii«woi1li^cir  fijoaa,  Iowa,  baa  gtran  a 
boy  pomkin  seod  taa,  wbioli  bad  tba  effaot  of  bringing  away,  by 
roogb  maaagre«aili  iw$he  yardi  of  tape  worm. — Ibid. 


MATERIA  MEDICA. 

AnastheUe  Campoundt  qf  Carbon. — ^Modern  chemistry  baa  plaoad 
at  the  command  of  medical  art  no  more  yaloable  aids  than  the  volatile 
compoanda  at  present  employed  for  prodocinff  nnconsciousness,  an^a- 
tbeaia,  in  the  minor  as  well  as  greater  sai^icai  operations ;  and  though 
ancsthesiation  by  some  other  means  appears  to  have  been  known  to 
the  ancients,  yet  with  the  exception  of  narcotics  of  a  different  kind, 
no  substance  was  known  twenty  years  ago  as  being  resorted  to  for 
this  purpose,  although  most  of  those  at  present  used,  were  even  then 
largely  employed  by  chemists.  It  appears  scarcely  creditable  that  the 
obvious  eflfect  of  ether  in  producing  inaenaibility  when  inhaled  should 
not  have  been  known  to  any  of  the  great  surgeons  of  the  last  800 
3rean  and  made  use  of  for  some  purpose.  Fairy  talea  and  novel  writ- 
ers of  all  ages  and  countries  introdnce  the  magic  charm  of  sleep  or 
miconsciousness,  wherever  it  seems  needful  that  some  such  Deu9  «9 
wiaekina  should  appear,  and  the  great  anthor  of  the  "Tale  of  Two 
Citiea'*  uses  the  conceit  with  considerable  effect,  placing  into  the 
hand  of  one  of  his  heroes  an  anissthetic  at  a  time  whiohfpreceded  but  a 
few  years  the  first  published  suggestion  from  a  scientifio  man  that  anch 
an  agent  was  really  at  our  command. 

There  appears  to  be  no  reason  to  doubt  that  Sir  Humphrey  Davy 
waa  the  first  to  observe  the  property  of  nitrous  oxyd  gas  of  producing 
insensibility ;  a  note  dated  either  in  1799  or  in  1818,  and  contained  in 
hta  "  Researches  on  Nitrons  Oxyd  Oas,"  suggests  its  trial  in  surgic- 
al operations,  inasmuch  as  it  appears  capable  of  destroying  physical 
pain.  Sir  H.  having  himself  used  it  to  relieve  violent  attacks  of  tooth- 
ache. •  The  experiments  of  Thenard  agree  with  those  of  Davj ;  it 
waa,  however,  an  American  dentist,  Horace  Wells,  who  applied  it 
practically. 

The  use  of  this  gas,  as  somewhat  cumbersome  in  its  preparation, 
waa  aoon  superseded  by  that  of  ether.  This  volatile  compound  had 
long  enjoyed  a  reputation  as  an  alleviant  in  asthma,  and  was  for  that 
purpose  employed  at  least  as  early  as  1795  by  Pearaon.  Its  introdno- 
tion  aa  an  anaesthetic  in  surgery,  whether  due  to  Morton,  Wells,  or 
Jadtton,  dates  from  about  the  time  when  Morton  employed  the  nit- 
rosa  oxyd,  but  the  name  of  the  agent  used,  iqppears  to  have  first  been 
■Mde  known  by  Dr.  Bigelow,  in  1856.  Then  followed  in  rapid  auo- 
eanon,  the  discovery  of  the  anissthetic  action  of  chloroform,  of  chlo- 
fide  of  ethyl,  or  light  chloric  ether,  of  the  so-called  chloride  of  hydro- 
eklerie  ether  (  Wiggers'  cUker  anmitkeiieui)  of  chloride  of  ethyline  or 
eUfa  (Dotdi  liquid),  of  proto-chloride  of  carbon,  aeaqni-cbloride  of 


816  ^BiUorial  AhMraeii  and  SOtuUmm.  f]|br* 

carbon,  amdyDe,  hydride  of  amjl,  chloride  of  anjl*  and  aUdb;j4e»  to 
which  mnst  be  added  benzole  and  keroselene,  and  carbonie  ozyd  tad 
carbonic  acid  among  the  gawui. 

In  order  to  clear  op  the  freqneiit  %ai«^^  which  ftriee^fepai  tte 
similanty  in  the  names  of  many  of  ihe  ccn|[|ili|di  |Me<l:  JHm»  m 
give  below  a  table  of  synonyms  and  the  dtemml  tMmmM  ^  wUek 
each  compoand  is  represented. 

./Ether.  Ether.  U.  S.Ph.  (sulphuric  ether,  cx^  qf  etk^l)=C4  H5 
O. 

./Ether  Muriaiieu8.  (light  hydrochloric  ether,  chloride  of  €<iyl}=C4 
H5  CI. 

JEUur  AfUBithetieua,  ( Wiggers'  anesthetic  ether,)  [Arans*  Hej- 
felder's,]  chloride  of  hydrochloric  ether,  chloride  of  Dutch  liqiior»  • 

rC4  H  C15: 
a  mixture  o£=  < 

(C5  H2  cm; 

JSlaytt  Chlortdum  (liquor  Hollandicus,  Dutch  liquor,  oil  of  the 
Dutch  Chemists,  oil  of  defiant  gas,  chloride  of  olefiant  gas.  chlorida 
of  hydrocarbon,  hydrobicarburet  of  chlorine,  chlorhifdraie  qf  chloridt 
qf  acetyl,  chloride  ofelayl,  chloride  of  cethylene)=G4  ^4  012. 

Carbonei  Protochloridum=:Ci  014. 

Carbonei  Perchtoridum  (perchloride  of  carbon,  terchloride  of  carbon, 
eeequkhloride  of  carbon,  perchloride  of  chloride  of  ethylene)=C4  CM- 

Aldehydinum  (aldehyde,  hydride  of  acetyl,  aldehydic  aeid)=C4 
H4  02. 

Acetonum  (pyro-acetio  spirit,  oenylic  alcohol,  methyl-acetyl)=C6 
H6  02, 

Alcohol  MUhylicum  (pyro-xylic  spirit,  pyro-ligueous  spirit,  wood- 
naphtha,  hydrate  of  methyl,  hydrated  oxyd  of  methyl,  methylic  alcokiX) 

(02  H8  o; 

=02  H4  02=  \ 

I    HO 
Amylenum  (amylene,  paramylene,  valerene,)=O10  H10« 
AmyUe  Hydridum  (hydride  of  amyl)=O10  HI 2. 
AmylU  Chlortdum  (chloride  of  amyl)=:010  HI  I  01. 
Chloroformum  (chloroform,   chloride  of  formyl,  chloride  of  bichloro 

methyr)-G2  H  CIS. — Amer.  Drug,  Circular  and  Chem.  Gazette. 

Glycerine, — Glycerine  should  be  absolutely  without  smell  or  color, 
with  a  saccharine  taste,  and  of  the  consistency  of  syrup.  Its  chemical 
formula  is  06  H7  07,  H  O.  With  a  spejiiic  gravity,  at  60°  P.,  of 
1-24,  it  contains  94  per  cent,  of  anhydrous  glycerine.  It  can  be  con- 
centrated to  1*26,  when  it  contains  98  per  cent.  It  is  soluble  in  ail 
proportions  in  water  and  alcohol,  but  insoluble  in  ether.  It  should 
show  no  reaction  with  litmus  paper,  and  yield  no  precipitate  with  any 
reagent. 

Unlike  oils  and  fat,  it  does  not  absorb  oxygen,  and  therefore  never 
becomes  rancid,  or  decomposes  substances  dissolved  in  it.  It  is  prob- 
ably mainly  by  virtue  of  this  property  that  it  acts  as  an  antiseptic. 
Applied  alone,  it  soothes  the  irritation  of  most  skin  diseases,  and  ml- 


I  EdUarial  Ah$traH$  and  SdicUmt.  817 

le  pain  of  ioflamed  parte*  With  the  exoeptioa  of  A*  formula 
)  use  of  starch  to  render  it  semi-solid,  a»  given  bj  Dr.  Tilt,  we 

advantage  in  copying  the  varioQt  lormulss  which  have  been 
(bed.    Every  one  can  deacribe  the  remedy  be  aelecto  according 

known  propertiee,  if  the  quantity  soluble  in  the  fflyoerine  b 

I.    Hence  we  conceive  the  following  tables  will  be  found  Tory 

• 

A.    Inorganic  ntbtiane^. 

parte  of  pure  glycerine  dissolve — 

or                                    0*1  Cyanide  of  mercury  270 

horns                               0*3  Arsenic  acid  20*0 

\                                     1*0  Arsenious  acid  20*0 

ne                (all  proportions^  Boracic  acid  10*0 

tulpharet  of  potessiom    (all  Chlorate  of  potash  8*5 

proportions)  Arseniate  of   "  50.0 

"        of  sodium        "                  '*            soda  50-0 

of  lime             "          Carbonate  of    '*  98*0 

phuret  of  potassium      25  0  Bicarbonate  of  '*  .  8*0 

I  of  sulphur                      1*6  Borate  600 

potassium                 400  Carbonate  of  ammonia  20  g 

zinc                          40  0  Hvdrochlorate  of    ''  20*0 

lide  of  mercury                 0*3  Alum  400 

de  of  potassium              250  Sulphate  of  iron  25*0 

of  iron       (all  proportions)           "       zinc  86  0 

de  of  sodium                  20*0          "        copper  80*0 

barium  10*0  Nitrate  of  silver  (all  proportions) 

zmc                       50*0  Tannic  acid  50*0 

iron  (all  proportions^  Oxalic     "  15*0 

»ride  of  mercury                7*0  Benzonic  acid  10*Q 

de  of  potassium  82*0 

th  the  sulphuric,  nitric,  phosphoric,  hydrochloric,  acetic,  citric, 
rteric  acids,  glycerine  unites  in  all  proportions  ;  and  the  same 
he  caustic  alkalies  and  some  salte,  aa  the  hypochlorites  of  soda 
>Cass.  Most  of  the  metelic  salte  soluble  in  water  are  to  about 
ne  degree  soluble  in  glycerine  ;  some,  however,  are  decomposed, 
bichromate  and  permanganate  of  potess. 

B.  Organic  aubstanccM,  alkalaid$,  dx, 

parte  of  glycerine  dissolve — 

lia  0*45  Quinine  0*5 

te  of  morphia  20*0  Sulphote  of  quinine  2*75 

ine  3*0  Cinchonine  1*5 

ate  of  atropine  33*0  Yeratrine  1*0 

mine  0*25  Brucine  2*25 

ate  of  strychnine  22*5  Codeine        (all  proportions) 
e  of  strychnine                 4*0 

tery  extractions  of  vegeteblea  are  very  soluble  in  glycerine ; 
;  gums,  resins,  essential  oils,  ethereal  exiracte»  camphor,  bal- 


818  EdUoridl  AbHraeU  and  Sdictwni.  [May, 

gams,  fatty  aoids,  are  either  wholly  inaolable  or  sparingly  lolable.^ 
Laned. 

Terha  de  Flecha — a  curious  pltmL — ^An  English  paper,  the  Wedihf 
yews,  informs  us  that  a  gentleman  of  Ban  Fnuicisco  lately  ieeeiv«d 
from  Mexico  some  seeds,  which  exhibit  the  most  extnofdinaty  pbe- 
nomena.  They  are  of  a  tree  called  Yerba  de  flecha,  or  arrow  tree. 
When  placed  on  the  ground  or  on  a  sheet  of  paper,  they  move  aboot, 
at  first  slowly,  then  mora  rapidly,  till  at  last  they  jump  aboot  like  lo 
many  peas  on  a  hot  iron.  The  tree  itself  is  Very  cnnoua  ;  the  jaiee 
from  its  leaves  is  a  powerful  poison,  much*  used  by  the  Indians  to 
steep  the  points  of  their  arrows  in,  from  which  a  wound  is  mortal. 
When  first  wounded,  convulsions  of  a  most  extraordinary  kind  tab 
place  :  the  victim  jumps  and  bonnds  about  as  if  under  galvanic  influ- 
ence, and  dies  in  a  sort  of  *'  perfect  cure ''  fashion  in  about  an  hour 
after  the  injury  is  inflicted.  The  wonderful  way  in  which  the  seed 
hops  about  is  explained  by  the  supposition  that  there  exists  in  them  a 
great  amount  of  electric  fluid,  and  that  placing  them  in  contact  with 
certain  things  occasions  their  movement.  This  is  quite  a  nut  to  crack 
for  the  scientific.  Might  not  the  seed  be  used  for  curing  paralysis  aod 
those  diseases  in  which  there  is  loss  or  diminution  of  the  nerrou 
power. — Amer.  Drug,  Circular, 

Dr.  McMunrCi  Mtxir  of  Opium, — The  following  receipt  for  making 
this  preparation  has  lately  been  discovered  among  the  papers  of  a  cel- 
ebrated chemist  of  the  city  of  New  York  : 

1.  "  Take  ^Ye  pounds  of  Turkey  opium,  cut  in  small  pieces  and 
dried,  and  put  it  into  a  large,  strong  glass  jar  with  a  wide  mouth,  and 
pour  on  it  sulphuric  ether  enough  to  a  little  more  than  cover  it ;  thea 
stop  the  jar  tight  with  a  glass  stopple  to  prevent  its  evaporation  ;  set 
it  away  in  a  cool  place,  and  stir  it  daily  with  a  stick  so  that  all  the 
lumps  may  be  broken.     At  the  end  of  a  week  drain  off  the  ether,  and 
again  pour  on  as  much  more,  and  repeat  stimng  it  every  day  for  a 
week  longer,  when  it  may  be  drained  off  as  before.     Then   atop  the 
jar  tight,  and  lay  it  down  on  its  side,  so  that  all  the  ether  that  accu- 
mulates near  its  mouth  may  be  drained  off,  and  repeat  doing  so  until 
the  opium  is  all  dry.     Then  expose  it  to  the  open  air  for  a  few  days. 

**  The  sulphuric  ether  extracts  from  the  opium  the  narcoitne,  which 
is  its  most  deleterious  principle,  and  also  deprives  it  of  its  peculiar 
noxious  odor,  so  that  tlie  elixir  will  not  smell  of  it  thereafter. 

**2.  Now  to  free  the  opium  of  the  smell  of  the  ether,  and  to  extract 
its  valuable  medicinal  principles,  boil  it  in  water,  as  follows  :  Pour 
into  a  tin  boiler  four  gallons  of  pure  soft  water,  and  when  hot  (but  not 
boiling)  put  in  the  opium,  when  a  great  ebullition  will  take  place, 
which  is  owing  to  the  evaporation  of  the  ether.  Then  let  it  boil  ten 
or  twelve  minutes,  occasionally  stirring  it  so  that  the  lumps  of  opium 
may  be  all  broken  and  dissolved.  Then  set  it  away  till  the  next  day, 
when  it  should  oe  strained  through  a  cloth  strainer,  and  if  there  be 
not  four  gallons  of  the  solution,  pour  on  the  leeched  opium,  boiling 
water  enough  to  make  that  quantity  when  it  is  strained  and  clear. 

*'  When  in  the  state  of  watery  solution,  it  is  better  to  be  kept  in 


1864.]  BdiUmdL  Abttracts  and  Sdtetwm.  819 

stooe  crocks  that  will  hold  aboat  two  or  three  gallons  each,  and  in  a 
cool  place,  as  a  cellar  ;  after  standing  five  or  six  days,  the  clear  solu- 
tion sboold  be  carefully  dipped  off  ^into  a  large  tin  can.  The  skim- 
mings and  dregs  should  be  alrained,  and  when  clear,  pnt  with  the 
other. 

"  8.  To  this  fear  gallons  of  watery  solution,  add  one  and  a  half 
gallons  of  alcohol,  and  stir  the  mixture  thoroughly ;  then  cover  the 
can  tight,  so  as  to  prevent  evaporation.  After  standing  a  few  days, 
the  clear  elixir  may  he  carefully  dipped  off  into  another  can,  and  the 
dregs  at  the  bottom  strained,  aud  when  clear  poured  into  the  other. 

*'  Now,  after  standing  undisturbed  lor  a  few  weeks,  it  will  be  fit 
to  use.  It  will  be  equivalent  to  laudanum,  both  in  its  strength  and  the 
size  of  its  dose." — Med.  and  Surg.  Heparter. 

Renudiei  for  ChUhlaim. — [Selected  formnlie  that  have  been  recom- 
mended by  distinguished  physicians.] 

HuBiATic  ACID  LOTION  (Foy). — ^Muriatic  acid,  1  part;  water,  16 
parts.     To  be  used  occasionally  as  a  wash. 

Sulphuric  acid  linimxnt  (Foy). — 9r.  Sulphuric  acid,  2  drachms  , 
olive  oil,  2^  ounces  ;  oil  of  turpentine,  1  ounce.  Mix.  Applied  with 
gentle  friction  where  the  skin  is  not  broken. 

Linimxnt  op  balsam  of  pbbu. — 9r.  Balsam  of  Peru,  \  drachm  ; 
Muriatic  ether,  2  drachms  j  Laudanum,  2  drachms.  Mix.  To  be 
used  as  a  friction. 

TuftFBNTiNX  LOTION  (Gaussicourt). — 9r.  Oil  of  turpentine,  4  parts ; 
fiolphuric  acid,  1  part ;  Olive  oil,  10  parts.  Mix.  To  be  applied  to 
the  aflfected  parts  night  and  morning. 

Pktroleum  embrocation  (Saunders). — Qr.  Petroleum,  ^  ounce ; 
Alcohol,  ^  ounce.     Mix. 

Camphor  ointmsnt  (Radius). — Qr.  Lard,  suet,  oil  of  bayberries, 
wax,  of  each  \  ounce.     Melt  together  and  add  camphor,  1  drachm. 

CoMP.  ointment  op  creosote. — 9r.  Creasote,  10  drops  ;  Solution 
of  snbacetate  of  lead,  10  drops  ;  Ext.  of  opium,  1^  grains  ;  Lard  1 
ounce.     Mix. 

As  chilblain  is  only  another  name  for  a  languid  circulation  in  the 
ymxi  aeffcted,  indicated  by  a  congested  skin,  or  a  low  form  of  inflam- 
mation, the  value  of  most  of  the  foregoing  receipts  will  be  apparent 
when  ii  is  noticed  that  they  are  all  calculated  to  act  as  stimulants  of 
the  blood  vessels,  and  thus  promote  tlie  motion  of  the  partially  stag- 
BAUt  blood  which  gives  rise  to  the  heat  and  itching  that  are  so  dis- 
tressing. 

•  For  Coughs. — Troncuim's  cough  syrup. — ^Qr.  Powdered  gum  ara- 
ble, 8  ouDces  ;  Precipitated  hulphurct  of  antimony,  4  scruples  ;  An- 
ise, 4  scruples  ;  Extract  of  liquorice,  2  ounces ;  Extract  of  opium,  12 
grains  ;  W  hite  Fugar,  2  pounds.  Mix,  and  form  lozenges  of  six 
grains,  one  of  which  b  to  be  taken  occasionally  iu  catarrh  and  bron- 
clual  aflcctioub. 


sso 


JUHorivt  Abttradi  and  SetK&mt. 


Snop  WITH  KKBHBB  MiiiKBAL — R.    Kermes  mineral.  2  graina ;. 
Qam  Arabic,  1  dnuihiii ;  Byrop,  5  ounces.     Mix.     A  &paonfnI  occm>'^ 
ioiullj  when  expectoration  la  difltcult. — (Pierqtiin.) — Amer.  Ijhvg. 
Oiratfar. 

^imham't  Zaudanvm. — ^.  Opium,  2  ounces  ;  SklTron,  1  gtmea ; 
BruiMd  cinnamon,  bruised  cloves,  each  1  drachm  ;  Sherry  wiae.  om 
pint.  Hix  and  macerate  for  fifteen  liiiyB  nnd  filler.  Twenty  dmp* 
are  equal  to  one  grain  of  opinm. — Amer.  Drvff.   Circular. 

IhtrU  Afnara,  a  Kew  Pvrgaiive. — We   observed   Dr.  Wilim   use  a 

Sorgative  which  wu  new  to  n>,  tlic  Iberit  amara,  or  crandy  lull-«««<)- 
[e  had  been  recommended  to  ita  nae  by  Mr.  Slellwell,  of  Epsom,  whv 
said  that  it  had  been  a  favorite  purgntivo  medicine  with  hiro  darng^  J 
the  whole  of  a  Ions  practice,  given  cither  alone  or  combined  with  jalap  f 
powder.     Tbe  seeds  when  broiaed  are    oily  and    acriil,  and,    wbaR  | 
made  into  a    pill   of  fonr  or  five  grains,  act  as  a  good  put-go.     Dr. 
Wilka  aaid  he  had  fonnd  it  answer  iCH  intended  purpose  ;  but  aa  thaM  1 
was  no  want   of  aperient  medicines  in  the  Pharmacopfcia,  he  aaw  no  I 
reason  to  adopt  it  in  preference  to  those  in  ordinary  nee.     A  atroii(  1 
Irishman  took  three  fcrains  with  no  efToct.  bnt  ten  grnina  piii'g«d  bin  1 
two  or  three  times.     A  man  who  \va,j^  habitually  i:on»tipated,  and  wIm  | 
had  heen  taking  magnesia  mixture  daily  with  only  slight  efiectt  V 
ordered  three  grains  three  times  a-day  ;  he  took  five  pills,  and  « 
purged  violently  eeveral  times.     A  Ud  with  cardiac  dropsy  took  fin 
grains,  and  in  a  few  honrs  it  acted  twice.     In  some  cases  it    produced 
Bicbnesa.     In  the  case  of  a  man    with  rcnnl  dropiiy  ten  grains  were 
given.     In  two  hours  he  was  siclt,  and  in  seven  hours  lie   was   well 
panged.     It  was  repeated,  but  without   llie    sickness.     In  all  abont 
twenty  cases  were  treated,  and  ita  purgative  action  well  te.sLed. — Jiid. 

Saracana\Purjivrea.—T)T.  James  Watson  has  e:fpenment«d  In 
eight  cases  of  small  pox,  in  the  Roysl  Infirmary,  with  this  newlf 
vannted  Canadian  remedy  for  small  pox.  and  found  it  absolutely  inert. 
Sd.  Med.  Joum..  Jan.,  1864.) 

lurpentine  at  a  Styptic, — Dr.Wilkes  believes  that  tnrpeatino  doM 
not  hold  the  place  among  styptics  which  its  merits  deserve.  Ua  has 
long  been  in  the  habit  of  giving  it,  and  often  found  it  arreat  bwmop- 
tysis,  when  other  ordinary  remedies  had  failed  :  he  hnd  also  seen  it 
verj  beneficial  in  one  or  two  canes  of  purpura  hemorrhagica. 


(.'ONTENTH  FOR  .ilNH,  iMi. 


I  Alt.  I.— C«»M  uf  Hu»(jl'*l  Uaugreii- 

Aar.  II.— Tlia  Cans*  nf  raiiip  tiinrrlj<i 

'  Ait.  III.^L'tikkcD-rDO  in  A<liil<>.     I., 

^BOCXKDlXf^  OF  «.i,IKTtK* 

I'laciialmp  of  tUi  Cincirtiisli  ^'lulDiiif  uf  UrJioiiw 
plUTTOUIAL  TKAXSLATli'Vs 
'    ^leciaeirr.    J,  II.  Doiigln'- 

DefeaUte  and  Iinp^trrit  Vulon,  wiih  ilie  I'llnlonlm 
ll.tlmnieatM!  lu  ili«lt  t»ii>;iK*Uan<l  TrMlniMii.      Bjr  1| 
Tuniiul!,  M,D. _ 

IVIBW!*  AMP  XOTICW 

lifniTOK'.*  TAHI.K  ,. ., 

XMmtiiit.  AuTKitcn  4vni'LLL<.ii 


THE 

CINCINNATI  LANCET   AND  OBSERVER 

CONDUCTED  BT 

E.  B.  STEVENS.  M.D.,  AND  J.  A.  MURPHY.  M.D. 


Tel.  VIX.  JUNJI,  1864.  ITo.  O 


ABTICLK    I. 

Catet  of  Hotpital  Gangrene. 


By  A.  B.  SrcraiM,  M.  D.,  Svg.  fith  Rcfft.  O.  T.  Ii,  Ao  .  Mod,  Direct.  3d  DIr.  4th  Oopn. 

Near  CleveUnd,  Tenn. 


Mmnj  young  physicians  are  too  proncto  give  credence  to  the  puh- 
lished  reports  of  remarkaUe  cures,  and  are  thus  led  involuntarily  to 
the  conclusion  that  every  disease  has  its  specific^  and  that  all  the  good 
doctor  has  to  learn,  to  bid  defiance  to  all  **  the  ills  that  human  flesh  is 
lieir  to,"  is  the  diagnosis  of  disease,  and  then  to  look  up  its  specific 
and  go  forth  to  conquer.  But  alas,  they  too  often  find  by  bitter 
experience,  that  even  after  administering  their  most  valued  specifics, 
the  patient  cannot  '*  rise  up  from  his  bed  of  pain  to  bless  them/'  and 
from  thia  aad  disappointment  they  are  very  apt  to  fall  to  doubting  the 
Tirtnee  of  their  specifics,  and  fre([ucnt1y  to  look  upon  the  whole  sys- 
tem of  medicine  as  fallaciousb 

And  aa  very  many  extravagant  statements  have  of  late  been  made 
and  published,  in  military  as  well  as  civil  practice,  in  regard  to  the 
use  of  bromine  in  the  cure  of  hospital  gangrene,  I  beg  leave  to  present 
for  the  consideration  of  your  young  re  iders,  three  cases  of  hospital 
gangrene  from  my  case  book  of  Ward  No.  2,  General  Hospital  No  4, 
Chattanoog^a. 

Case  1. — Mich.  Murphy,  5th  Ky.  Rcgt.,  wounded  on  Nov.  25th|  ad- 
mitted tame  day  ;  contused  and  lacerated  shell  wound  of  left  thigh. 
Wound  improved  for  three  weeks,  when  it  took  on- a  gangrenous  ap* 
pearance.  Pure  bromine  was  applied  to  the  wound.  On- the  15th  of 
Jan.,  although  the  gangrene  had  not  spread  to  any  great  extent,  yet 
it  had  tin  dirty  gray  floUgh  tiud/oeior  which  characterize  that  disease, 
and  covered  the  apex  of  Scarpas  triangle.  The  patient  was  placed 
wider  the  infloencc  of  chloroform,  and  with  scissors  and  knife,  all 


822  Original  Communicaiians,  [Jime^ 

dead  and  gaDgrenons  matter  removed  down  to  the  healihy  and  Uead— 
iog  structures,  and  the  pure  undiluted  bromine  spread  over  the  entw 
surface  by  means  of  a  glass  pp.  syringe,  and  after  five  minates  a  tur- 
seed  poultice  was  laid  over  the  wound,  with  orders  to  change  it  evoy 
six  hours.     On  the  16th,  the  sore  was  covered  with  the  yellow  tiigi 
of  bromine,  which  could  not  be  detached  from  the  structure  benetdi. 
A  cloth  was  wet  with  'the  alcoholic  solution  of  bromine,  and  bpt 
over  the  wound.    At  this  time  there  appeared  to  be  but  little  distob- 
ance  of  the  general  system.     On  the  18th,  the  slough  presented  all  the 
appearance  of  gangrene,  and  was  loose  from  the  entire  oircumfereott 
of  the  wound,  and  the  space  filled  with  a  soft,  light,  pulpy  substance, 
from  which  the  gangrenous  odor  steamed  unpleasantly.    I  injected 
around  the  entire  circumference  of  the  wound,  the  alcoholic  eola- 
tion of  bromine,  and  the  flaxseed  poultice  was  replaced.     On  the  19di, 
the  general  system  began  to  fail ;  the  pulse  was  more  weak  ;  the  tongoe 
slightly  dry,  and  the  appetite  not  so  good.     I  had  the  patient  removed 
from  the  main  building  to  a  tent  isolated  from  all  other  patients,  and 
after  the  administration  of  chloroform,  cut  away  with  the  knife  and 
scissors,  all  the  slough  with  the  pulpy  mass  underneath,  and  by  ^ 
aid  of  the  forceps  drew  out  and  cut  off  all  the  cellular  structnie  be- 
tween the  muscles  and  underneath  the  skin,  that  appeared  at  all  dis- 
eased, until  a  clean  and  healthful  surface  was  exposed.     Then  tbe 
pure  bromine  was  again  applied  as  before,  and  the  surface  covered 
with  a  poultice,  while  the  patient  was  ordered  to  have  quinine  and 
iron,  with  ale  and  whisky,  and  as  much  nourishing  fqg^  as  he  desiredy 
of  which  extract  of  beef  was  urged  as  a  matter  of  importance.    On 
the  2l8t,  the  same  dirty,  gray,  slough,  nearly  half  an  inch  thick,  fill' 
ed  the  cup  of  the  wound,  while  the  soft,  yellowish,  pulpy  mass  coold 
be  seen  oozing  up  from  beneath  when  pressure  was  applied.    23d. 
Tonics,  nourishment,  and  stimulants  were  urged  as  of  vital  import- 
ance, and  the  bromine  applied  for  the  third  time  after  renewing  the 
slough.     On  the  24th,  the  profunda  femoris  gave  way  beneath  the 
gangrenous  slough,  and  was  ligated  with  the  loss  of  not  more  than 
five  ounces  of  blood.     We  now  kept  the  wound  wet  with  the  solution 
of  bromine,  trusting  to  general  treatment.    The  pulse  was  weak  ;  the 
tongue  tremulous,  and  the  patient  sinking.     On  the  26th,  the  femoral 
artery  gave  way  just  beneath  Poupart's  ligament,  and  required  a  liga- 
ture above  and  below  the  opening.    From  this  he  lost  considerable 
blood,  and  died  at  0  o'clock,  P.M. 

0 ABB  2~Thos.  Bosley,  68th  Regt  Indiana  Vol.  Infantry.    Wounded 
on  the  25th  day  of  November,  1863.    Flesh  wound  of  right  leg.  The 


Btephbns — Caseiof  HospUal  Oan^rene.  828 

out  out  of  the  gastrocnemii,  and  the  wound  looked  well  until 
of  January,  when  gangrene  made  its  appearance,  where  the 
been  cut  out,  although  the  general  health  appeared  perfect. 
1  was  immediately  removed  to  a  tent  isolated  from  the  main 
,  and  when  he  was  completely  **  off,"  I  removed  with  scissors 
e,  all  gangrenous  matter  down  to  the  healthy  structure,  and  then 
lass  syringe  spread  over  the  entire  wound,  bromine,  pure  and 
d,  and  afterwards  covered  it  with  a  flaxseed  poultice.  On  the 
»  wound  was  filled  with  the  same  gangrenous  slough,  which 
I  a  quarter  of  an  inch  around  its  borders.  After  administer- 
roform.  the  wound  was  completely  cleaned  with  knife  and  scis- 
all  diseased  structures  down  to  the  healthy  parts,  and  bromine 
plied  over  the  surface,  while  lint  wet  with  the  solution  of  bro- 
18  kept  constantly  on  the  parts,  and  tonics  and  stimulants 
temally.  On  the  18th,  the  gangrenous  slough  again  covered 
le  aspect  of  the  wound,  and  was  again  cut  away  and  the  bro* 
plied  to  the  healthy  structure  beneath,  and  injected  by  glass 
nto  the  cellular  tissue  between  the  muscles  and  the  skin,  while 
Jmulants,  and  nourishments,  were  freely  administered.  But 
}th,  the  sore  presented  the  same  gangrenous  appearance  it  first 
no  check  whatever  could  be  perceived  to  the  advance  of  the 
Then  the  wound  was  thoroughly  cleansed,  and  nitras  argenti 
freely  rubbed  over  the  face  and  a  quarter  of  an  inch  beyond 
I  of  the  sore,  and  then  covered  with  a  flaxseed  poultice.  On 
after  washing  off*  the  loose  matter  filling  the  wound,  a  few 
^nulations  were  seen,  and  the  stick  nitras  argenti  was  rub- 
them  as  before.  On  the  22nd,  the  wound  was  completely 
,h  healthy  granulations ;  and  while  tonics  and  stimulants  were 
3,  the  sore  was  kept  wet  with  a  solution  of  argenti  nitras  [grs. 
a  Jv].  On  the  28d,  the  wound  was  rapidly  cicatrising,  and 
mt  on  the  26th,  was  sent  to  Field  Hospital  with  the  wound 
is  closed. 

\. — John  Messer  87th  Alabama,  (Confederate)  wounded  lit 
Mountain,  Nov.  24th,  gunshot  wound  of  left  fore-arm,  frac- 
oth  bones  and  opening  elbow  joint.  The  loose  fragpnents 
removed,  and  the  rough  and  uneven  ends  of  the  bones  sawed 
•moved  with  bone  forceps,  leaving  a  clean,  nice  wound  with 
\  i^nry  to  important  vessels  or  nerves.  The  arm  was  kept 
ler  position  with  pillows  and  pads,  and  by  means  of  an  irri- 
)t  constantly  cool.  The  wound  granulated  well  until  the 
Dec.,  when  the  brachial  artery  gave  way  and  a  copious  hem* 


324  Original  Uammunicaiions.  [Jane, 

orrhage  ensued.  After  consultation  the  arm  was  amputated  two  inches 
above  the  condyles.  On  the  17th,  gangrene  appeared  on  the  flaps  of 
the  stumps.  The  patient  was  immediately  rem9Ted  from  the  ward  in 
General  Hospital  to  a  tent  twenty  yards  distant.  After  administer- 
ing chloroform  the  diseased  structures  were  completely  cut  away  and 
bromine,  undiluted,  applied  over  the  entire  wound,  ^d  the  patient  at 
once  placed  on  a  full  diet,  of  which  the  essence  of  beef  waa  to  compose 
a  portion,  with  tonics  of  quinine,  and  iron,  and  whisky,  or  ale  four 
times  a  day.  On  the  18th  the  wound  was  covered  with  the  yellow 
eschar  of  the  bromine,  but  no  fetor  or  appearance  of  gangrene  was 
present.  On  the  19th  the  slough  came  away  and  healthy  granulations 
covered  the  stump.  The  wound  was  kept  wet  with  the  alcoholic  so- 
lution of  bromine,  until  the  23d,  when  gangrene  again  appeared  in 
the  stump.  While  the  patient  was  under  the  influence  of  chloroform 
all  diseased  parts  were  removed  with  instruments  and  the  pure  bro- 
mine applied  as  before.  On  the  24th  no  check  could  be  observed  to 
the  disease  and  chloroform  was  again  administered,  the  parts  cut 
away  down  to  the  healthy  structures,  and  bromine  again  applied  and 
injected  by  syringe  into  the  cellular  spaces.  On  the  25th,  the  whole 
wound  was  covered  with  the  same,  dirty,  gray  slough,  from  beneath 
which  oozed  on  pressure  the  yellow,  pulpy,  stinking  matter  charac- 
teristic of  this  disease.  Again  were  the  parts  cut  away  and  the  bro- 
mine applied,  but  still  the  disease  went  on  as  if  nothing  had  been  done. 
On  the  27th,  after  thoroughly  cleasing  the  wound  down  to  the  healthy 
structures,  nitras  argenti  in  stick  was  well  and  treely  rubbed  over  the 
entire  wound,  and  a  little  beyond  the  borders,  after  which  it  was  cov- 
ered with  a  cloth  wet  with  a  weak  solution  oi  the  nitrate  and  the  pa- 
tient left.  On  the  29th,  after  washing  away  the  black  and  loosened 
eschar  the  wound  was  found  covered  with  good,  healthy  granulations 
and  not  a  sign  of  the  fell  gangrene  left.  The  stump  was  kept  wet 
with  a  solution  of  the  nitrate  of  silver  until  the  middle  of  Jiyiuary 
when  the  patient  was  able  to  get  out  for  exercise,  and  was  sent  to  the 
field  hospital  with  the  wound  almost  completely  closed. 


1864.]  Camp  Diarrhcta.  825 

TIm  Cauta  of  Camp  Diarrtoa. 

(BMd  belbra  th«  KuBllton  (Batter  Co.,  O.,)  Ifodicti  Socitty.] 
BT  I.  A«  COONS,  ILD.,  MIDDLXTOWV,  O. 

There  is  perhaps  no  disease  prevailing  in  our  army  that  has  yielded 
so  stubbornly  to  treatment,  or  that  has  so  completely  baffled  the  skill 
of  the  surgeon  as  camp  diairhoea.  At  least  this  is  my  experience  af- 
ter a  connection  with  the  army  of  more  than  two  years  ;  and  from  its 
extensive  prevalence  in  camp  barracks  and  hospitals,  extending 
through  the  different  degrees  of  latitude,  from  the  city  of  Washington 
to  the  southern  coast  of  Florida,  its  prevention  and  successful  treat- 
ment are  more  important  to  the  surgeon,  soldier  and  Government, 
than  of  any  other  disease  known  to  military  practice.  The  special 
agent,  recently  sent  from  Ohio  for  the  purpose  of  inspecting  western 
hospitals,  and  looking  after  the  interest  of  soldiers  from  this  State, 
Fays  in  his  report  to  the  Governor  that  a  very  large  majority  of  the 
inmates  of  the  institutions  he  visited,  were  ttffected  with  camp  diar« 
rhoea.  Surgeons  of  regiments  and  hospitals  are  required  to  make 
weekly  and  monthly  reports,  in  which  they  state  what  disease  is  the 
most  prevalent  in  their  commands.  And  being  in  a  position  where  U 
large  number  of  these  reports  passed  through  my  hands,  I  found 
that  diarrhoea  was  almost  universally  marked  aa  the  prevailing  dis- 
ease, and  that  too  independent  of  the  variety  of  latitude,  from  Virginia 
to  Mississippi — low  lands,  or  mountains,  wet  lands  or  dry,  kind  of 
water,  or  the  season  of  the  year  at  which  the  report  was  made.  While 
it  is  true  that  hot  weather  of  summer  has  an  effect  in  aggravating  the 
disease,  the  cold  of  winter  is  not  a  prophylactic.  No  disease  has 
diffused  itself  so  extensively  throughout  the  whole  army,  and*  none 
have  disabled  and  kept  more  soldiers  from  active  service.  Seven  out 
of  every  ten  cases  prescribed  for  in  the  army  are  cases  of  camp  diar- 
rhoea ;  and  while  it  completely  disables  thousands,  very  many  more 
are  only  able  for  partial  duty  ;  and  from  the  great  emaciation, 
shfirpness  of  features  and  present  pallor,  they  do  not  seem  to  be  more 
than  half  alive.  Camp  diarrhoea  seems  to  be  rather  a  symptom  of 
another  disease  than  a  disease  itself.  As  it  prevails  among  our  troops 
it  f^eems  to  depend  upon  a  scorbutic  state  of  the  system,  which  state 
amounts  to  scurvy.  In  many  cases  of  this  disease  there  are  other 
^^vmptoms  of  scurvy  aside  from  the  discharge  from  the  bowels,  such  as 
sbrasions  of  the  mucus  membrane  of  the  mouth  and  throat — ^resisting 


326  Original  Communications.  |  June, 

local  treatment— pallor  of  coantenance,  sharpness  of  features,  and  in 
cases  of  wounds  a  disposition  not  to  heal.  My  attention  wac  forciblj 
called  to  this  want  of  disposition  to  heal  in  this  class  of  cases  among 
the  wounded  at  the  battle  of  Murfreesboro.  Those  affected  with  chii 
disease  seem  to  possess  an  insufficient  amount  of  healthj  blood  ai 
well  as  vigor  and  ability  of  reaction  of  the  neryous  system.  Thflj 
were  more  readily  attacked  with  gangrene  and  rallied  from  the  shodc 
badly.  It  is  generally  sspposed  that  there  must  be  an  inflamed  and 
spongy  state  of  the  gums  in  every  case  of  scurvy,  but  the  history  of 
this  disease  as  connected  with  military  practice,  shows  that  diarrhcsa 
is  almost  universally  given  as  a  system  while  inflammation  of  the 
gams  are  frequently  not  present.  Larrey  says  diarrhoea  was  a  promi- 
nent symptom  of  scurvy  in  the  army  in  Egypt.  It  is  also  spoken  of 
in  connection  with  dysenterv,  as  an  important  symptom  of  this  dis- 
ease in  the  Crimean  war.  Dr.  Pincoffs  speaks  of  typhus  and  diseases 
other  ihan  diarrhoea  being  produced  by  scurvy.  It  was  frequently 
masked  by  other  diseases  in  the  Crimean  campaign,  so  as  not  usually 
to  be  discernible  by  the  ordinary  signs,  among  which  diseases  diar- 
rhoea was  prominently  mentioned.  Dr.  Marlow  says  although  there 
were  no  pure  scurvy  cases  nearly  every  admission  into  hospitals  ex- 
hibited unequivocal  signs  of  scorbutic  taint.  My  attention  has  been 
particularly  called  to  this  same  condition  of  patients  admitted  into 
hospital  during  the  present  war.  In  the  army  in  New  Mexico  a  few 
years  ago  diarrhoea  and  dysentery  were  mentioned  as  leading  symp- 
toms of  scurvy,  and  often  almost  the  only  evidence  of  the  scorbutic 
state.  As  the  etiology  of  disease  properly  understood,  is  the  key  to 
its  prevention  and  successful  treatment,  it  is  especially  important  in 
an  affection  so  wide  spread  in  its  attacks,  unyielding  in  its  course  and 
destruQtive  in  its  results,  both  to  life  and  the  best  interests  of  the  Oot- 
ernment,  to  discover  if  possible  the  cause  of  its  production.  While 
climate,  bad  policing,  filthy  water  and  miasm  may  sometimes  produce 
a  diarrhcea  and  very  much  modify  this  disease,  as  it  exists  in  the 
army,  none  of  these,  nor  a  combination  of  them  is  capable  of  produc- 
ing true  camp  diarrhoea.  The  cause  of  camp  diarrhoea  must  be  as 
universal  as  the  prevalence  of  the  disease.  No  local  cause  could  pro- 
duce the  general  and  wide  spread  symptoms,  similar  wherever  found 
in  the  vast  and  varied  territory  occupied  by  the,United  States  troops. 
It  cannot  be  climate,  or  miasm,  for  these  are  both  local  and  the  dis- 
ease prevails  independent  of  them  in  the  northern  as  well  as  southern 
latitudes ;  in  the  pure  and  mountainous  regions  of  Tennessee  and  Vir- 
ginia, where  good  spring  water  is  abundant,  as  well  as  in  the  low 


1864.]  Coons-*  (7amp  Diarrhaa.  827 

lands  of  Louitiana  and  Mississippi,  where  the  troops  are  exposed  to 
ezeeseiTe  heat,  compelled  to  drinic  from  filthj  swails  and  stagnant 
pools,  and  breathe  the  contaminated  atmosphexe  of  extensive  masmatio 
districts  of  country.  It  cannot  be  produced  by  bad  policing^  for  this 
ia  local  also.  Take  the  army  as  a  whole  we  will  find  but  few  camps 
where  the  sanitary  condition  is  neglected,  while  camp  diarrhcea  if 
present  in  all.  If  miasm,  water,  temperature,  or  filth  were  the  causea 
there  is  no  good  reason  why  some  camps  and  locations  should  not  be 
free  from  this  scourge.  Nor  is  there  any  reason  why  oitisens  in  the 
immediate  neighborhood  of  infected  troops  should  not  also  be  attacked. 
They  breathe  the  same  air,  drink  the  same  water,  exposed  to  the  same 
temperature  and  where  camps  are  in  or  near  towns,  they  are  liable  to 
be  affected  by  imperfect  sanitary  regulations  ;  but  I  have  never  notic- 
ed this  disease  prevailing  among  those  living  in  the  vicinity  of  infect- 
ed camps.  When  we  examine  the  difimnce  in  diet,  we  find  the  citi- 
aeo  has  variety,  especially  of  vegetables ;  while  the  soldier  is  coa« 
fined  almoet  exclusively  to  the  same  articles  from  month  to  months 
with  but  few  or  no  vegetables.  The  cause  of  camp  diarrhcsa  seems 
to  me  to  be  the  tameneu  of  food,  together  with  its  deficiency  in  qualUjf 
and  qmamUbf.  This  lack  of  variety  in  the  soldiers'  food  is  aa  wide 
spread  and  general  as  the  diseshc,  being  alike  in  all  parts  of  the  army 
and  in  all  localities. 

As  a  rule  the  food  furnished  the  army  is  in  good  condition,  but 
what  I  mean  by  quality  is,  that  army  rations  lack  that  peculiar  acid 
or  principle  without  the  acid  of  which  the  nutritious  part  of  the  rations 
are  not  properly  digested,  or  taken  into  the  blood  and  assimilated. 
By  deficiency  in  quantity  I  mean  the  food  is  in  to  small  a  bulk,  too 
much  concentrated.  It  contains  sufficient  nutriment,  but  it  is  a  well 
known  fact,  that  in  order  to  keep  the  stomach  and  bowels  inanactive» 
healthy  condition  you  must  have  bulk  to  your  diet  as  well  as  nutrition* 
The  lower  animals  will  eat  rotten  wood,  day  and  other  substances  con« 
taining  no  nutriment  whatever,  in  order  to  meet  this  want  of  quantity. 
The  clay-eaters  of  the  south,  kept  upon  the  scantiest  (are,  and  the  In- 
dians who  mix  saw-dust  with  their  honey  are  both  but  illustrations  of 
the  principle  that  nature  craves  and  demands  bulk  when  food  is  taken 
into  the  stomach  in  a  concentrated  form.  Lata  experiments  to  reduce 
the  bulk  of  feed  for  army  horses  has  proved  a  £rilure  and  has  been 
abandoned.  In  proportion  as  a  soldier  is  of  more  in^Kirtance  than  a 
horsn,  and  his  life  of  more  value  than  that  of  many  such  animals,  the 
effort  should  be  made  to  increase  the  bulk,  variety  and  peculiar  quali^ 
of  his  rations.    In  my  opinion  upon  this  concentration  of  diet,  wani 


828  Oriffmdt  Communieaiiani.  ^        [June, 

of  variety  and  lack  of  tome  particolar  add,  or  quality*  hot  only  de- 
penda  camp  diarrhoea  bat  ako  aoiinry  and  a  boat  of  other  diaaaaee 
wbicb  together  are  destroying  more  lives  than  all  the  balla  aad  bay- 
onets of  the  enemy. 

Gamp  diarrhoea  is  rather  a  symptom  of  aeorvy  than  a  diaeaaa  of 
itself*  and  nothing  would  be  «o  apt  to  produce  this  acorbuiio  taint  aa 
sameness  in  diet,  especially  if  that  diet  be  composed  moady  of  salt 
meats.  Bnt  the  strongest  evidence  that  camp  diarrhoea  ia  but  the  re- 
sult of  an  impoverished  state  of  the  blood,  produoad  by  •  want  at 
variety  in  diet,  is  the  success  attending  a  course  of  treatment,  in  which 
the  diet  is  changed  to  fresh  vegetables,  auch  as  oniona,  lemons,  cab- 
bage, potatoes,  etc.,  and  as  a  rule  the  entire  failure  of  all  remedies  to 
favorably  affect  the  system  until  this  change  in  diet  has  been  made 
I  have  seen  many  soldiers  so  far  reduosd  with  this  affsotion  as  to  be 
unable  to  walk  without  assistance,  on  being  sent  home  from  high  and 
healthy  locations  in  Tennessee  and  other  States,  to  low,  damp  and 
malarious  parts  of  Ohio,  Indiana,  and  Illinois,  commence  improving 
from  the  Xime  they  reached  civilisation  and  were  able  to  procoie  cili- 
sens  food  and  continued  steadily  on  independent  of  their  unhealthy 
locations  at  home.  Widiout  a  change  in  diet,  medicines  seem  to  have 
but  little  effect  and  no  course  of  medication  is  attended  with  success 
so  long  as  the  patient  is  confined  to  army  rations.  The  treatment  of 
this  disease  differs  as  mucb  from  the  treatment  of  diarrhcsa  in  dvil 
practice  as  the  causes  which  produce  the  affection  are  diffisrent.  One 
is  a  disease  of  over-feeding,  the  other  a  disease  of  starvation.  In  the 
fall  season  when  the  troops  in  some  localities  had  all  the  gre«i  com 
they  could  eat,  the  symptoms  of  camp  diarrhoea  would  be  aggravated 
at  first  by  the  enormous  quantities  taken  into  the  stomach,  but  after 
the  first  few  days  when  a  less  amount  seemed  to  satisfy  the  appetite, 
and  the  com  commenced  producing  its  constitutional  effects  there  wss 
a  marked  benefit  derived  from  its  use.  The  same  good  efifects  were 
produced  by  potatoes  and  other  vegetables,  especially  onions,  but  as 
com  growing  in  the  field  could  sometimes  be  had  in  abundance,  and 
other  fresh  vegetables  were  procured  only  in  limited  quantities,  and  at 
long  intervals,  my  attention  was  particularly  called  to  the  good  effects 
of  the  com.  I  have  twice  cured  myself  of  this  affection  by  eating 
large  amounts  of  vegetables,  without  the  use  of  any  medicines  what- 
ever, and  I  have  seen  hundreds  cured  by  this  same  course  of  diet  after 
a  great  variety  of  remedies  had  been  used  with  but  little  effect.  Of 
all  the  articles  of  diet  furnished  the  army  none  produce  so  good  an  ef- 
fect in  arresting  this  disease  as  raw  onions.    Hundreds  and  thousanda 


1864.J  CoovB— Camp  Diarrkma.  829 

of  soldian  wlio  are  being  slowly  bat  surely  consomed  in  the  Tarioos 
hospitals  and  camps  of  our  army  with  this  disease,  might  be  saved  to 
to  themsdves,  their  friends  and  their  country,  if  the  Gtovemment 
woold  canse  to  be  issned  regularly  in  snfficient  quantities  as  rations, 
onionSp  pickles,  cabbage,  and  tomatoes,  cront,  mustard,  etc.;  the 
grave  would  be  robbed  of  thousands,  and  millions  of  doUars'would  be 
saved  to  the  Government  ere  the  closing  of  this  rebellion.  And  in 
addition  to  this  sanitary  regulation  nothing  would  conduce  more  to 
the  moral  and  physical  health  of  both  officers  and  men,  the  modifica- 
tion of  thia  disease  and  the  general  good  of  the  service  than  an  order 
expelling  sutlers  from  the  army.  Much  qf  their  beer  is  made  bitter 
by  aloes,  their  wines,  whisky  and  bmndy — ^large  amounts  of  which 
they  keep  in  direct  violation  of  orders — are  villainous  compounds,  not 
only  producing  di£forent  diseases  besides  delirium  tremens,  but  also 
aggravating  camp  diarrhoea  as  well  as  many  other  afleetions.  If  the 
Oovemment  would  keep  such  notions  and  necessary  articles  as  the 
soldiers  require,  with  the  commissary  stores  of  the  army,  and  sell  them 
U>  soldiera  at  cost,  the  health  of  the  army  would  be  much  better  and 
many  a  poor  soldier  whose  morbid  appetite'  compells  him  to  buy  un- 
wholesome articles  of  food,  or  drink,  would  be  able  to  send  something 
to  the  needy  ones  at  home  instead  of  spending  almost  his  entire  income 
at  the  tables  of  these  extortioners.  Soldiers  appetite  for  food  become  as 
morbid  and  as  uncontrollable  by  being  kept  upon  the  same  aiUcles  of 
diet  for  months  as  drunkards  do  from  the  use  of  strong  drink ;  and  he 
is  but  little  more  accountable  for  his  conduct  than  the  man  who  is  ad- 
mitted in  the  asylum  for  the  cure  of  inebriates.  I  have  often  seen  a 
soldier  buy  a  pound  of  cheese  and  eat  it  all  in  less  than  five  minutes, 
so  also  with  large  quantities  of  nuts,  raisins  and  other  injurious  arti- 
cles. Burgeons  are  often  compelled  to  have  such  patients  guarded  as 
are  able  to  walk  about,  to  keep  them  from  theee  sinks  of  iniquity  cal- 
culated more  as  traveling  saloons,  affording  good  drinking  fiKdlities 
for  officers,  than  for  any  good  the  troops  may  derive  from  them.  It 
is  easy  for  those  in  civil  life  to  talk  about  governing  appetite,  they  have 
had  abundsnce  to  eat  all  their  lives  of  the  greatest  variety,  and  per- 
haps have  never  missed  a  supper,  tint  no  ones'  opinion  is  worth  any* 
thing  on  this  subject  who  has  not  been  kept  for  six  months  almost  ex- 
dnsively  on  salt  bacon  and  hard  crackers,  and  been  obliged  for  days 
at  a  time  to  subsist  on  limited  quantities  of  parched  com.  Although 
there  are  few  sober  Burgeons  in  the  army  but  consider  iutler  shops 
greatly  injurious  to  the  service,  and  would  gladly  see  them  abolished, 
there  is  but  little  hope  of  purging  the  army  of  this  monstrous  evil, 


880  OrigimU  Cammnmealiami.  [JoM» 

80  long  as  many  of  those  high  in  military  anthority  oontiaiM  to  **hHik 
upon  the  wine  when  it  is  red  in  the  enp,*'  regsrcUesa  of  tha  aolemn 
warning  that  *'  at  last  it  biteth  like  a  serpent  attd  e^iogeth  lib  an  ad* 
der." 

ijmcLi  in. 

CMoken-Pox  la  Adults. 


By  Obo.  B.  Ooubtsioht  Bmtg.  U.  8.  Tolt.  Tt  Stntatr,  Htm  X«dieot 

Case  1.— Henry  H .    Aet.  26.    Fnll  habit    PriTate.  Wss 

attacked  with  alight  rigors  and  feyer.  Three  days  after  aa  eniptioa 
made  its  appearance  on  the  head,  then  on  the  neok  and  shmdders,  but 
few  Tesicles  on  the  face.  Says  he  has  been  yaccinatad  eeveral  times 
without  any  effect.  Jan.  11th,  '64.  Five  dajra  after  admission  un 
sick  report,  performed  vaccination.  Seven  days  after  had  a  large 
scab  on  the  arm,  with  some  constitntional  disturbance.  Jan.  28. 
Scab  ready  to  fall  off. 

In  this  case  there  was  some  difficulty  in  oonvincing  the  patient  that 
the  eruption  was  not  small-pox. 

Case  2.— Amos  R .    Aet.  20.    Private.     Was  first  attacked 

with  well  marked  chills  and  fever, — as  he  expressed  it,  **  dumb  ague.**^ 
Jan.  24th,  '64.     Was  admitted  on  sick  report.     Has  some  fever  of  an 
intermittent  type,  accompanied  with  slight  pain  in  lumbar  region. 
Says  he  was  vaccinated  several  times  when  a  child,  withont  any  re- 
sult, and  that  he  attended  his  brother  who  had  the  small-poz,  eigh- 
teen months  since.    Jan.  28d,  '64.    Has  an  eruption  on  scalp,  which 
he  first  discovered  when  combing  his  hair  ;  also  a  slight  eruption  *o& 
the  neck,  and  a  few  vesicles  on  the  forehead  ;  has  some  fever.     Jan. 
26th.     Now  has  a  well  marked  eruption  on  the  scalp,  face,  chest  and 
back,  vesicular  in  character.    Presents  the  appearance  of  pouring  hot 
water  on  the  body — and  each  drop  producing  a  vesicle,  clear  and 
slightly  red  at  base.     Some  of  the  vesicles  on  forehead  are  dry,  and 
others  are  appearing.     No  tever  or  pain  in  any  part  of  the  body : 
sleeps  well ;   tongue  slightly  coated  ;  bowels    regular.     To-day   per- 
formed  vaccination.     Was  admitted  into  Hospital.    Jan.  27th.  A  few 
new  vesicles  appearing, — old  ones,  scab  small  and  gummy,  dry  quick- 
ly and  drop  off. 

In  this  case  vaccination  was  not  successful :  the  patient  made  a 
rapid  convalescence. 

The  treatment  was  mild.    During  the  stage  of  fever — diaphoretics, 
with  pulv.  doveri  at  night  to  secure  sleep. 


1864.}  Cincinnati  Academy  <f  Medicine.  881 

The  onlj  point  of  interest  in  the  above  caM8»  Is  the  age  of  the  pa- 
UentSp  and  in  cane  2nd,  the  profnsion  of  the  ernption. 

1  haire  had  a  great  man  j  cases  among  the  Indians  at  this  place,  and 
was  surprised  to  see  so  many  cases  in  adults,  and  bnt  few  in  children. 
And  among  them  it  is  the  rule  in  the  former  and  not  the  exception. 
They  all  recovered  rapidly. 

Ft.  Sumner,  N.  M.,  March  2,  '64. 


••••- 


^tttttAlnqs  ft  SfttittUt. 


Procedings  of  the  Cincinnati  Aoademy  of  |f edieine. 

Bnport^d  }tf  0.  P.  WiLMir,  ■•D.,  SMnUry. 

Hall  op  Acadimt  op  Hedioiitb,  Aprfl  4, 1864. 

Cen^'Spimd  Menin^ide, —  Dr.  Mussey  stated  that  as  his  re- 
marks at  a  former  meeting  as  to  tho  difference  between  diphtheria  and 
cerebro-spinal  meningitis,  had  been  disputed,  he  would  give  the  fol- 
lowing ease : 

He  was  called  a  week  ago,  to  see  a  patient  who  had  been  in  the 
hands  of  a  homeopath  for  several  days,  th'>ngh  first  prescribed  for  by 
Dr.  J.  B.  Smith,  who  found  the  man  first  in  a  convulsion  then  deliri- 
ous, talking  violently,  and  very  unmanageable,  with  the  head  thrown 
hack,  neck  arched,  insensible  and  evincing  a  diseased  condition  of  the 
meninges. 

Dr.  Smith  first  gave  a  strong  carthartic,  then  sedatives,  and  a  di- 
aphoretic, but  after  his  second  visit  he  was  discharged  by  an  attend- 
ant of  the  patient,  and  a  homeopath  employed  for  four  or  ^ve  days, 
when  Dr.  Mussey  was  called ;  he  found  the  man  delirious,  exceed- 
ingly restless,  neck  much  arched,  and  his  pupils  dilated,  which  Dr. 
Mussey  thought  was  produced  by  belladonna  or  aconite,  a  prepara- 
tion of  one  of  which  he  found  in  the  room. 

The  Dr.  ordered  broken  ice,  contained  in  a  bladder  and  that  rolled 
in  a  towel,  to  be  placed  on  the  top  of  the  man's  neck,  extending  from 
the  occiput  over  cervical  vortebrss ;  this  controled  his  movements  and 
quieted  him.  He  also  ordered  a  mercuriali  cathartio  as  the  man  had 
had  no  operation  since  Dr.  Smith's  attendance,  also  a  diaphoretio 
mixture  of  tartar-emetic,  and  acetate  of  potash.  He  persisted  in  this 
treatment  for  several  days,  the  man  improving  rapidly.    From  some 


882  ProeeedingM  qf  Societiei.  June,] 

cause  the  ice  was  left  off  for  twenty-four  hours  when  tha  man  again 
became  very  restless ;  but  immediately  on  the  reapplieation,  grew 
better. 

Testerday  Dr.  Mussey  ordered  a  discontinuance  of  the  icep  but  wis 
obliged  to  repeat  it  again  this '  morning.  This  evening  die  man  is 
better,  and  is  now  taking  iodide  of  potash,  squills  and  ipicac  to  pro* 
duce  free  diuresis.  ^ 

In  this  case  there  was  no  diphtheritic  exudation,  nor  any  symptoms 
of  typhoid. 

7\fphu8. — Dr.  Yattier  related  the  following  cases  :— 
About  the  middle  of  January  an  emigrant  family  of  seven  persons 
arrived  in  this  city  from  Europe  ;  they  were  quartered  here  upon  a 
family  of  four,  all  living  in  two  rooms,  so  that  they  were  much  crowd- 
ed. Ue  was  called  to  see  the  son  on  the  10th  of  February ;  found  him 
laboring  with  tjrphus  fever.  Over  the  surface  of  the  whole  body  there 
was  an  exteni^ive  crop  of  spots  like  the  bite  of  a  gnat ;  they  were  de- 
veloped to  a  great  extent,  the  boy  was  feverish,  had  great  pain  in  the 
back  of  the  neck,  and  was  laboring  under  great  depression  of  gpirits. 
At  this  stage  the  Dr.  thought  it  was  a  case  of  small-pox,  and  pre- 
scribed accordingly.  On  the  next  day  there  was  a  retrooesaion  of 
the  spots  and  they  were  of  a  darker  hue ;  the  patient  was  delirious 
for  three  or  four  days,  slept  none,  and  the  symptoms  became  much 
more  aggravated. 

Succeeding  this  case,  on  the  6th  of  March,  twenty  days  after,  an* 
other  of  the  eleven,  a  girl  twenty  years  old,  and  bom  in  this  country, 
was  taken  sick  in  the  same  way ;  spots  on  the  body,  pains  in  the 
back  of  the  neck,  which  was  deeply  arched.  She  was  sick  until  the 
24th  of  March  but  is  now  well.  On  the  same  day  another,  a  boy, 
broke  out  with  measles,  of  which  he  was  well  in  four  days. 

On  the  the  10th  of  March  another  was  affected  with  this  typhus 
fever.  March  12th  he  was  sent  to  St.  John's  Hospital  and  died  March 
18th. 

March  11th  a  little  girl  six  years  old  was  seised  with  measles,  from 
which  she  recovered  in  four  days.  March  15th  she  had  this  fever  with 
the  symptoms  much  more  aggravated  and  intense  than  in  any  of  the 
others  ;  she  is  now  well.  March  11th  one  of  the  boys,  16  years  old, 
broke  out  with  the  same  fever,  was  sent  to  St.  John's  and  has  now 
recovered.  March  12th  a  nephew,  aged  21  years  was  afiected  similar- 
ly, sent  to  St.  John's  Hospital  and  was  well  on  the  18th.  March 
Idth  a  girl,  bom  here,  was  taken  jn  the  same  way,  with  but  slight 


1 864.  J  Cinfinnati  Academy  of  Medicine,  338 

eruption,  and  was  convalescent  in  four  or  five  days.  On  the  10th  of 
March  one  of  the  boys  bom  here  was  taken  the  same  as  in  the  above ; 
the  eruption  in  his  case  was  slight.  He  was  sick  till  the  24th,  then 
convalesced,  and  now  is  well.  On  the  24th  the  mother  of  the  emi- 
grant family  was  similarly  affected,  but  the  symptoms  were  not  so 
aggravated  as  in  the  other  cases,  though  they  were  severe.  She  con- 
valesced in  fonr  or  five  days. 

April  3d  the  first  boy  who  was  attacked,  died  just  fifty-four  days 
after  he  was  taken  sick. 

On  the  11th  of  March  Dr.  Yattier  had  the  same  symptoms,  which 
in  four  or  five  days  ended  in  colliquative  diarrhoea,  showing  a  blood 
poifion  in  his  system  as  well  as  in  theirs.  One  of  the  number  that 
remained  under  his  hands  died,  and  one  of  the  three  sent  to  the  hos- 
pital died. 

This  family  came  over  on  a  clean  ship,  one  man  only  on  board  was 
sick,  and  he  died  during  the  passage,  from  homesickness,  as  they  said. 

Dr.  Yattier  said  he  considered  the  above  cases  to  be  typhus  fever, 
and  in  answer  to  a  question  by  Dr.  Mussey  said  they  all  occupied  two 
rooms.  Dr.  Mussey  thought  that  enough,  with  ill  ventilation,  to 
account  for  all  the  trouble. 

Dr.  Yattier  said  he  kept  the  rooms  well  ventilated  and  used  a  dis- 
infectant. In  the  child  six  years  old  there  was  a  slight  diptheritic 
exudation,  but  it  readily  yielded  to  proper  treatment ;  the  pain  in  the 
back  of  the  neck  lasted  longest  and  was  the  most  difiScult  symptom 
to  relieve.  In  the  beginning  the  treatment  consisted  of  slight  doses 
of  calomel ;  afterwards,  stimulating  diaphoretics,  and  then  tonics. 
The  eruptions  in  these  cases  appeared  at  the  second  or  third  days, 
an<l  receded  on  the  fourth  or  fifth. 

I  Dr.  Woodward  thought  tliese  cases  even  more  of  a  typhus  than  a 
typhoid  nature,  and  recalled  a  case  which  he  attended  with  Dr.  Smed- 
ly,  of  Carthage. 

The  patient,  a  girl,  on  her  return  from  school  had  a  violent  chill 
followed  by  fever.  She  was  then  semi-conscious  but  soon  became 
altogether  unconscious,  and  remained  in  a  muttering  delirium  until 
she  died.  The  eruption  which  presented  itself  resembled  purpura 
somewhat,  but  was  more  diffused. 

Dr.  W.  said  he  thought  there  were  several  gradations  in  purpura, 
and  this  eruption  resembled  one  of  the  fainter  varieties.  The  girl 
remained  insensible  for  several  days,  with  great  congestion  of  the 
eerebro-spinal  system  and  then  died.  Chlorate  of  potash^  moriated 
tincture  of  iron,  quinine  and  stimulants  were  administered. 


834  Ptoceedingi  qf  Sodeiiei.  [  Jant, 

This  had  been  the  only  case  seen  hj  Dr.  Woodward,  and  was  not 
similbr  to  typhoid,  in  which  there  are  no  petechiiB  over  the  abdamen, 
showing  a  complete  broken  down  condition  of  the  Tasciilar. system, 
and  how  easily  the  serom  of  the  blood  will  exude  through  the  eoatsof 
the  vessels. - 

Dr.  Mussey  thought  the  cases  of  Dr.  Yattier  suggested  a  query, 
whether  considering  the  length  of  the  voyage,  the  food  and  ill  ventili- 
tion  of  the  ship,  they  were  n^t  cases  of  scurvy,  as  he  had  seen  some  cases 
of  scorbutus  in  this  city  in  persons  who  had  been  living  on  pork  alone. 
He  also  thought  there  was  considerable  analogy  between  his  cases 
and  Dr.  Yattier's,  owing  to  the  high  price  of  food  and  to  the  fact  that 
emigrants  who  carry  their  food  for  the  whole  voyage,  were  as  a  gen- 
end  thing  stinted  for  means,  so  that  they  could  not  have  much  of  a 
a  variety.  He  thought  their  disease  was  induced  by  their  voyage, 
remotely,  and  immediately,  by  the  crowded  and  ill  ventilated  condi- 
tion of  their  rooms. 

Dr.  Graham  said  as  far  as  he  could  determine,  the  discussion  was 
the  difference  in  the  diagnosis  between  typhus  and  typhoid  fevers ; 
he  had  seen  three  cases  in  his  practice,  of  typhus  fever — two  came  up 
the  river  on  a  boat,  and  the  other  was  a  nurse  in  the  hospitaL  All 
three  died.  The  symptoms  in  these  cases  were  so  well  marked,  that 
they  could  clearly  be  diagnosed  typhus,  in  which  fever  the  eruption 
appeared  earlier,  the  lesions  of  innervation  were  more  profound,  and 
the  disease  runs  its  course  more  rapidly. 

In  typhoid  the  eruption  and  lesion  of  innervation  appeared  later. 
Another  distinctive  character  in  typhoid  was  the  lax  condition  of  the 
bowels,  the  stools  were  marked  by  quantity  and  liquidity  but  not  by 
any  particular  pain  or  stench  ;  in  typhus  there  is  no  tendency  to  di- 
arrhoea, but  rather  to  constipation,  and  the  stools  were  very  offensive, 
we  also  have  pulmonary  lesions  in  typhoid,  but  not  in  typhus,  and 
the  fatality  was  very  great  in  the  latter  disease. 

Dr.  Graham  then  proceeded  to  say  that  he  thought  the  suggestions 
of  Dr.  Mussey  of  no  weight,  and  that  one  met  with  oases  of  scorbutus 
in  persons  who  came  from  abroad,  and  also  with  some  living  in  our 
midst ;  but  that  in  scurvy  there  was  no  lesion  of  innervation,  and  the 
eruption  so  on  becomes  dusky  and  does  not  disappear  on  pressure  as 
in  typhoid,  in  which  the  spots  were  circumscribed,  and  lenticular, 
and  in  the  other  appeared  more  like  ecchymoses. 

Dr.  Mcllvaine  remarked  that  typhus  fever  never  originated  in  this 
latitude,  but  was  found  in  London.  Typhoid  prevailed  in  Paris.  In 
typhus  delirum  appeared  earlier,  but  in  typhoid  late,  and  often  not  at 


18e4.]  Editorial  Translations.  885 

all,  80  that  the  patient  would  die  with  his  head  clear.  In  typhoifl  the 
supra-diaphragmatic  regions  were  always  affected  ;  and  thought  the 
caaes  reported  here  might  he  grave  forms  of  typhoid.  He  also  said  that 
in  1845  or  '46  a  disease  called  the  hlack  tongoe  prevailed  extensively 
with  anologons  symptoms  to  the  cases  of  typhns  reported  to-night. 


d^bitorial  Cranshtions. 


Speoitloity. 

A  Cliatcml  L^ctsr*,  br  Prof.  Troiwpeas,  trantUted  from  the  CIMqmt  MtiiemU  Ih  VHoM  Dim 
db  iW<* :  Bj  J.  U.  I>oi;oi.AM,  M.D.,  Mbw  York  Crt. 

[(Mmehtdtdjirom  pag0  290.] 

It  may  perhaps  seem  to  some  of  you,  gentlemen,  that  I  have  dwelt 
too  much  at  length  upon  this  subject  of  specificity,  which  in  your  judg- 
ment would  be  more  suitably  considered  in  a  course  of  lectures  on  gen* 
ami  pathology,  than  in  these  clinical  conferences.  I  have  not  feared 
to  discourse  upon  it  as  I  have  done,  because,  although  the  important 
Bobject  does  really  belong  to  the  domain  of  pathology,  yet  practically 
it  will  be  found  of  greater  importance  at  the  bed-side  than  elsewhere, 
because  as  I  have  said  before,  it  controls  all  practical  medicine.  Its 
clinical  importance  seems  to  me  so  grei^,  that  I  shall  still  dwell  upon 
it  in  order  to  show  you  the  utility  and  necessity  of  this  idea  of  speci- 
ficity in  respect  to  the  diagnosis,  progress  and  treatment  of  diseases. 
And  in  these  new  details,  I  will  show  you  that  it  is  the  key  of  med- 
icine, and  that  without  it,  it  is  impossible  for  us  to  go  forward  with 
any  certainty  in  the  practice  of  our  art  In  regard  to  diagnosis,  if  we 
deny  thai  there  is  a  nosological  species,  in  other  wo|^b,  if  we  do  not 
take  into  consideration  the  quality  of  the  morbific  cause,  and  only  con- 
sider its  quantity,  and  thus  subordinate  the  nosological  element  to  the 
pbyrfological  element,  do  we  not  recognize  the  uaeleasness  of  any  oth- 
er differential  diagnosis  than  that  which  is  limited  to  determining 
what  organ  is  diseased  and  the  extent  of  the  affection,  since  the  nature 
of  the  malady,  varying  only  in  degree  and  not  in  kind,  ia  necessarily 
known? 

If  we  push  the  argument  to  its  final  consequences,  what  is  the  use  of 
tedung  to  distinguish  variola  from  measles,  if  the  pustulous  erup- 
tioQ  which  c^racterizes  the  former  is  only  a  more  advanced  stage  of 
inftimmati<m  of  the  skin,  while  the  exanthemata  which  characteriiea 


836  SpecyUUy.  [Juae, 

tli(Matter  in  a  less  advanced  stage  ?  The  partiitaiis  of  the  diehotom- 
ous  schools,  if  there  are  anj  now-a-dajs*  would  reCasa  to  go  ao  iu 
as  that.  When  treating  diseases  which  show  themsalToa  in  eotaae- 
oas  eruptions,  they  are  very  eager  to  find  oat  whether  thejr  have  to 
deal  with  variola,  roseola,  measles,  or  scarlatina,  in  spite  of  them- 
selves they  admit  the  notion  of  specificity,  since  it  is  npon  the  speeifie 
characteristic  of  the  eruption  that  they  hase  their  diagnosis. 

The  fact  heing  necessarily  admitted  hy  all  in  respect  to  disesiM 
whose  anatomical  manifestations  occur  upon  the  skin,  the  question hu 
heen  asked  why  it  has  required  so  great  effort  on  the  part  of  M.  Bn- 
tonneac  and  his  ptipils,  physicians,  and  surgeons,  to  procure  a  gener- 
al application  of  this  principle  of  specificity  to  other  diseases ;  whj 
it  is  that  in  different  phlegmasias,  as  for  example,  in  thoseof  the  mu- 
cous membrane,  their  opponents  have  persisted  in  seeing  only  inflam- 
mation identical  as  to  their  nature,  variftle  merely  ^  iBspeot  to  their 
locality  and  their  degree. 

Then,  in  the  system  we  are  attacking,  dothinenteritis  and  dya^tery 
are  ententes  of  the  same  class  as  intestinal  catarrh,  oolites  and  oiher 
inflammations  of  the  intestines,  produced  either  by  sulphuric  acid,  or 
by  arsenic,  or  by  croton  oil,  or  by  any  other  toxical,  or  irritatiog 
agent.  They  will  not  see  that,  considering  only  the  anatomical  char- 
acteristics of  those  diseases,  these  characteristics  are  essentially  differ- 
ent ;  that  whatever  we  may  do,  we  can  never  produce  with  sulphuric 
acid  the  lesions  caused  by  afsenical  acid  or  by  croton  oil,  and  for  a 
still  stronger  reason  that  by  the  aid  of  these  substances,  we  can  never 
succeed  in  producii^  the  lesions  of  dothinenteritis.  In  respect  to  other 
characteristics,  specificity  stands  out  still  more  prominently.  Though 
between  dysenteiy  and  oolites,  there  is  a  certain  similitude,  though 
each  one  is  an  ulcerative  infiammation  of  the  large  intestine,  yet  they 
are  distinguisMd  from  one  another  by  characteristics  impossible  to  be 
mistaken.  I  shall  have  occasion  to  point  them  out  to  you  in  the 
course  of  these  lectures.  ^ 

The  same  thing  is  true  in  respect  to  diseases  of  the  respiratory  ap- 
paratus ;  in  the  most  simple  cold,  in  hooping-cough,  in  asthma,  they 
will  see  only  a  phlegmasia  of  the  bronchi,  without  stopping  to  con- 
sider the  peculiar  characteristics  which  determinate  them.  When  we 
come  to  speak  of  these  different  di<»eases,  I  will  carefully  show  you 
what  these  characteristics  are  ;  but  for  the  present,  you  understand  of 
what  importance  it  is  to  know  them,  in  order  not  to  confound  simple 
enteritic  with  the  folliculous  enteritis  of  putrid  fever;  or  hooping 
cough,  or  asthma  with  a  purely  inflammatory  bronchial  catarrh,  etc. 


1864.]  Editorial  Dranslaiions.  887 

This  is  a  matter  of  the  highest  importance  in  respect  to  prognosis 
and  treatment.  I  have  already  called  your  iittention  to  the  fact  in 
regard  to  dothinenteritiswhen  speaking  of  the  intestinal  catarrh  which 
is  one  of  its  elements.  I  then  told  you  that  these  maladies  had  fatally 
distinct  features,  that  the  simple  enteritis  which  we  were  considering 
did  not  progress  in  like  manner  as  dothinenteritis,  and  that  if  we. did 
not  know  the  steps  of  this  natural  progress  peculiar  to  each  species, 
it  would  he  impk>s8ible  to  establish  our  prognosis.  Take,  if  yon  please, 
another  example.  An  individual  comes  to  yon,  suffering  from  sore 
throat ;  he  was  seized  with  it  the  previous  day  after  a  chill,  lassitude, 
loss  of  appetite  and  fever.  The  next  day  ho  complains  of  difficulty  of 
deglutition,  and  the  submaxillary  ganglia  are  only  slightly  swollen. 
On  examining  the  pharynx  you  perceive  enlargement  of  the  tonsils, 
redness  of  the  pillars  and  veil  of  the  palate,  and  •  upon  the  diseased 
surfaces,  you  see  secretions  havii  g  all  the  appearance  of  false  mem- 
branes. Suppose  that  at  the  same  time  you  have  been  sent  for  to  visit 
another  patient  affected  in  like  manner  with  membranous  angina ; 
but  in  this  ease  the  affection  has  assumed  a  difierent  form  of  develop- 
ment. Without  any  appreciable  cause,  he  has  had  for  several  days  a 
cense  of  restlessness  unaccompanied  by  fever,  and  his  sorj  throat  was 
much  less  painful  than  in  the  former  case. 

If  you  take  into  consideration  only  the  anatomical  element  common 
to  the  two  affections,  they  are  in  all  points  similar.  The  scalpel,  the 
microscope,  chemical  analysis,  will  show  you  that  in  the  two  cases 
the  false  membranes  are  identically  the  same,  and  judging  from  ap- 
pearances, yonr  second  patient  will  appear  less  sick  than  the  first. 
Bot  if  yon  leave  these  two  cases  to  themselves,  you  will  see  the  one 
which  announced  its  presence  by  the  more  violent  symptoms,  by  a 
more  violent  pain,  by  the  febrile  reaction  which  was  lacking  in  the 
second  case,  you  will  see  this  angina,  I  say,  rapidly  and  spontaneously 
getting  well,  and  leaving  no  trace  of  its  occurrence ;  while  the  other 
may  kill  the  patient,  who  w/il  yield  his  life  either  to  a  general  poison- 
ing, or  to  attacks  of  suffocation  induced  by  the  development  of  psondo- 
membranous  laryngitis  or  croup.  In  both  these  cases,  however,  you 
had  to  deal  with  a  membranous  angina,  but  with  this  difference,  that 
oae  was  the  common  membranous  angina  herpes  of  the  pharynx  which 
tn  ordinarily  unimportant,  while  the  other  was  malignant  membranous 
angina,  diphlkerittc  angina,  which  is  on  the  contrary  habitually  severe « 

It  was  important,  as  you  see,  gentlemen,  to  understand  the  specific 
character  of  these  two  affections,  so  similar  in  appearance ;  for,  in 
ona  caae*  yoo  might  regard  an  affection  naturally  of  bnt  slight  im- 
portance*  as  a  severe  disease,  while  in  the  other  you  m\g\vt  ^xo^TkOsCv 


888  ^^MctjCdAy.  [JoM^ 

cate  ft  mild  affection,  when  yon  teftUy  had  to  deal  with  •  diitftae  eapa- 
ble  of  terminating  in  death,  or  at  the  beet  of  prodnoing  a  rnnTakincfe 
prolonged  bj  serioos  sjmptome,  snoh  as  paralyeif  more  or  lees  geoM^ 
al,  and  more  or  lees  persistent. 

It  is  useless  to  multiply  cases  at  this  point,  for  we  shall  hnva  oelljr 
too  fireqoent  occasion  to  retnm  to  this  subject,  sinee  this  matter  of 
8|)ecificity  will  repeatedly  come  before  ns^t  the  dinic  I  now  ton 
to  the  subject  of  treatment. 

OenUemeu,  to  heal  the  sick,  or  at  least  to  afford  them  relief^  ia  (b 
aim  of  medicine.  Its  name,  derived  from  mtderi  (to  care  for,  to  ofibr 
a  remedy,  to  cure),  clearly  tells  us  that'sueh  is  its  mission.  Therapes- 
tics,  in  which  is  included  the  study  of  the  means  fay  which  we  msf 
hope  to  obtain  this  end,  forms  therefore  the  most  important  part  of 
our  art ;  but  you  are  also  aware  how  difiScient  a  part  it  is.  Subordi- 
nate to  the  experienee,  the  genias,  the  inspiration  of  ihe  physician ;  it 
is  also  subject  in  a  still  greater  degree  to  the  nature  of  the  comphust 
which  is  sought  to  be  cured,  to  special  conditions,  to  the  oigaiiiaatioB 
of  the  patient  and  to  a  host  of  circumstancee  which  are  too  often  ua- 
known  to  us.  While  it  is  necessarily  based  upon  a  knowledge  of  thi 
symptoms  of  diseases,  it  rests  also  especially  upon  an  aeqoaintanee 
with  their  causes,  and  with  their  natural  progress,  and  for  this  rsasos 
the  notion  of  specificity  plays  an  important  part. 

How,  indeed,  can  we  judge  of  the  value  of  a  medication,  of  the  ef« 
facacy  of  a  remedy  if  we  pay  no  attention  to  what  the  ancients  called 
the  operations  of  nature,  operations  Vhioh  vary  in  the  different  species 
of  diseases.  By  confounding  these  with  one  another,  do  we  not  run  the 
risk  of  attributing  great  virtues  to  medicaments,  which  in  reality  have 
none  at  all,  while  we  deny  all  therapeutical  properties  to  others  whoee 
usefulness  is  incontestable  when  they  are  properly  administered. 

Thus,  as  I  told  you  when  speaking  of  dothinenteritis,  some  have 
highly  praised  pretended  substitutes  for  cinchona,  while  others  charge 
this  remedy  with  having  changed  intemitient  fevera  into  severe  ty- 
phoid fevers.  Because,  in  the  first  place,  they  had  to  deal  with  sim- 
ple synocha  which  would  have  got  well  of  themselves,  and  which  at 
the  banning  had  assumed  the  intermittent  type ;  while  in  the  second 
instance,  it  was  a  question  not  of  marah  fever,  but  of  dothinenteritis 
jutermittent  in  its  type,  whose  fatal  progrees  cinchona  could  not  arrsst. 

In  the  same  way  if  we  confound,  as  I  see  done  every  day,  a  simple 
colitis  accompanied  by  bloody  stools  with  dysentery,  we  shall  fall  into 
grave  tberapenU'cal  errors.  We  shall  believe  that  by  the  aid  of  a  few 
t  o-.^ies  and  some  emollient  lavements,  we  rapidly  cored  the  eeoosd  of 


1864.]  BdUorud  JVanMUUhm.  889 

Umm  difeaaea  becanse  tbe  bloody  aacretion  waa  abandant,  tbe  atoola 
freqiwnt,  the  teneamos  considerablo  and  ibe  fever  higb,  when  in  leal- 
itj  we  haTe  treated  an  aSeetion  which  will  disappear  of  itself  in  a  few 
daja.  And  then  when  confounded  with  troe  dysentery,  and  deairing 
to  apply  the  medication  which  seemed  to  have  succeeded  so  manrel- 
oaaly  in  the  former  instance,  we  are  anrprised  at  onr  lack  of  soecesa. 
Yon  are  sent  for  to  visit  a  patient  suffering  from  great  difficulty  of 
breathing.  His  respiration  ia  accompanied  by  a  laryngeal  sifllant 
sound,  which  at  once  attracts  your  attention ;  on  carrying  your  finger 
bdiind  the  base  of  the  tongue,  yon  detect  an  enlargement  of  the  ep!g* 
lotUa  and  of  the  ary  tens-epiglottic  ligaments ;  on  pressing  the  neck  in  the 
region  of  the  larynx,  you  cause  the  patient  pain.  Yon  are  told  that 
the  patient  began  to  lose  his  voioe  about  two  or  three  months  before, 
and  thai  since  that  time  his  voice  had  gradually  become  weaker,  end- 
ing in  complete  aphonia.  His  inspiration,  at  first  aiffiant  only  during 
•leepi  or  when  the  patient  had  walked  a  little  too  fast  or  was  aaoend- 
iof  a  ataircase,  because  so  continuously  even  when  in  a  state  of  re- 
poee ;  the  difficulty  of  breathing  made  rapid  progreas,  and  at  the  mo- 
■WBt  when  you  are  sent  for,  tracheotomy  seems  to  yon  to  be  the  only 
meana  of  preventing  death.  However  you  learn  that  this  cedema  of 
the  glottia  resulting  from  important  lesions  of  the  larynx,  whose  car- 
tilegea  are  perhaps  necrosed,  or  the  mucoos  membrane  of  which  ia  at 
best  ulcerated,  you  learn,  I  fay  that,  the  laryngeal  affection  was  pre* 
ceded,  aometime  before  by  symptoms  seated  elsewhere.  The  patient 
haa  bad  a  chronic  coryza,  characterised  by  a  disagreeable  dischaige  ; 
ke  haa  thrown  off  scabby  secretions  and  the  nasal  fossie  emitted  a  fetid 
odor ;  in  addition  he  haa  sufiered  from  bony  tumors.  Without  fur- 
ther examination,  you  diagnoetigate  a  syphilitic  disease,  and  you  at 
once  inatitute  a  aystem  of  treatment  under  the  influence  of  which  the 
patient  gradually  recovers.  If  the  attacks  of  suffocation  were  such  aa 
to  put  the  life  of  the  patient  in  imminent  peril,  you  perform  tracheo- 
tomy, but  you  know  that  your  operation,  by  retarding  death,  will  give 
yoo  ground  to  hope  for  a  complete  return  to  health.  By  one  of  those 
liagolar  diaina  of  circumstances  which  often  occur  in  practice  you  are 
at  the  aaae  time  consulted  in  behalf  of  another  individual  also  attack- 
id  with  csdema  of  the  glottis ;  bat  in  this  caae,  the  laiyngeal  affection 
ia  eoBDeoted  with  a  tuberculona  diathesis.  If,  now,  taking  into  con- 
sidanftioB  only  the  affection  of  tbe  laiynx  and  paying  no  attention 
whatever  to  the  specific  character  of  the  disease  from  which  it  springs, 
fOtt  siMNild  atrive  to  attun  the  aame  resnlta  by  the  aame  meana,  yon 
wmU  iMviCsbly  fiiO. 


840  Sp^^ftdl^.  [Jone, 

m 

In  the  same  ward  in  the  hospitalf  you  find  three  patientii  affected 
by  neuralgia  of  the  fifth  pair  of  nenree  ;  in  one  case,  the  paroxyemt 
retnm  every  day,  marked  by  terrible  pain  which  lasts  six  and  even 
ten  honrs  accompanied  by  weeping,  coryza,  and  saliTation ;  in  the 
second  case,  the  neuralgia  retnrns  four  t>r  five  times  during  the  twenty* 
fonr  hours,  accompanied  by  the  same  phenomena  as  in  the  first  case 
continuing  however  during  a  period  of  two  hours  only ;  in  the  third 
case  the  paroxysms  are  repeated  every  two  or  three  hoais  moro  or  less, 
and  continue  one  minute  at  most,  bnt  causing  terrific  pain  and  a  con- 
vulsive movement  of  the  face/  Of  these  a£Bsction8,  so  similar  in  ap- 
pearance nnd  located  in  the  same  organ,  the  first  will  yield  to  bark,  it 
being  an  intermittent  fever  the  second  may  be  advantageously  oppot 
ed  by  martial  preparations,  because  it  is  connected  with  the  chlorosis 
with  which  the  patient  is  affect^ ;  sometimes  by  veratmm,  by  oolchi- 
cum  or  applications  of  belladonna ;  this  is  neuralgia  subsequent  to  a 
chill,  or  rheumatic  neuralgia ;  the  third  will  resist  all  the  medication 
which  you  may  employ  against  it,  this  is  tic  douloureux,  or  epilepti- 
form neuralgia. 

You  understand  from  these  facts,  which  may  be  indefinitely  mul- 
tiplied, how  absolutely  necessary  in  the  treatment  of  diseases  is  the 
notion  of  their  specificity.  I  must  say  however  that  in  certain  cases, 
this  theory  is  of  but  little  use.  In  eruptive  fevers,  for  instance,  when 
they  progress  in  a  regular  manner,  the  differential  diagnosis  is  of  but 
little  importance  in  respect  to  treatment,  since,  in  those  cases,  the  in- 
tervention of  art  is  completely  ineffeciual. 

Thus  far  we  have  spoken  only  of  the  specificity  of  diseas  c >  t 
us  say  few  words  concerning  specificity  of  remedies.  This  subject 
would  I  ke  up  but  little  of  our  time,  if  by  it,  wo  mean  specific  reme- 
dies, tha  is  to  say  those  which  according  to  the  definition  of  Parr 
such  as  q  nine  in  marsh  fevers  or  mercury  in  syphilis,  produce  infal- 
libly and  I  ^3n  all  diseases  certain  given  salutary  efiects  by  acting  upon 
the  disease  by  means  of  an  unknown  power,  going  straight  forward  to 
attack  it  in  its  very  principle,  without  regard  to  the  form  of  the  symp- 
tom. On  the  one  hand  the  list  of  specific  remedies  would  very  soon 
be  exhausted  for  the  specificity  of  diseases  does  not  imply  the  exist- 
ence of  a  specific  remedy  for  each  one  of  them ;  and  on  the  other 
hand,  the  efficacy  of  these  remedies  is  not  such  as  always  to  produce 
the  effect  expected  of  them.  There  are  cases,  in  fact,  in  which  the 
medicaments,  justly  extolled  as  eminently  specific,  not  only  fiiil  to 
cure,  bnt  even  aggravate  the  disease  Mrhich  they  ought  to  cure.  In 
such  cases,  we  must  abandon  these  remedies  and  resort  to  medicm- 


1864.]  BdUorial  TtamlatUm.  841 

m^\A  styled  rational,  that  is  to  say,  to  thote  wbich  are  indicated  by 
the  symptoms,  ^he  proposition  is  supported  by  the  cases  of  two 
women,  who  after  an  interval  of  some  months,  succeeded  one  another 
in  the  same  bed  in  the  Saint  Bernard  ward.  They  were  suffering  from 
syphilis ;  mercury  given  metbi^ically,  and  with  very  great  prudence 
had  arrested  the  symptoms,  when  it  became  necessary  to  suspend  its 
administration.  The  patients  had  fallen  into  a  condition  of  profoand 
chlorotic  cachexia  which  necessitated  a  resort  to  martial  preparations 
under  the  inflaence  of  which  they  recovered  quite  rapidly.  In  other 
cases,  you  will  see  mere  serious  symptoms  supervene :  the  ulceration, 
which  the  mercurial  treatment  should  cause  to  heal  over,  will  spread ; 
the  digestive  tube  will  become  irritated,  fever  will  be  excited,  and  a 
pseudo  syphilis  will  make  its  appearance,  which  will  complicate  and 
change  the  nature  of  the  true,  without  curing  it. 

Finally,  gentlemeu,  the  mode  of  action  of  these  specific  remedies 
does  not  differ  essentially  from  that  of  the  medicaments  called  rational 
In  the  one  case  as  in  the  other,  the  curative  effect  is  preceded  by  a 
vital  action  excited  by  these  medicaments,  and  which  maybe  called  the 
immediate  or  physiological  effect.  The  difference  between  them  is 
this,  that  the  specific  remedies,  having  a  special,  direct  influence  upon 
the  pathological  action  which  they  modify,  their  immediate  effects  are 
confounded  with  their  ultimate  or  curative  effects :  while  in  respect  to 
the  remedies  called  rational,  these  two  orders  of  effect  are  clearly  dis- 
tinguished from  each  other. 

Without  dwelling  further  on  this  scholastic  difference,  medicaments 
which  are  the  modifiers  of  the  organism  as  to  its  pathological  condi- 
tion, just  as  hygienic  agents  are  the  modifiers  of  the  organism  in  its 
healthy  condition,  medicaments,  I  say,  have  properties  common  to  a 
whole  class,  which  produce  in  the  human  economy  certain  commoji  or 
.general  effects,  such  as  to  stimulate  or  to  weaken,  to  excite  or  to  calm, 
etc.  But  in  adilition  to  these  are  also  othen  peculiar  to  each  species, 
which  are  productive  of  special  effects ;  and  theea  kinds  of  properties 
also,  existing  in  very  variable  proportions,  and  manifesting  themselves 
very  diversely  according  to  the  individual  predisposition  of  the  sub- 
ject to  whom  thciie  medicaments  are  administered.  This  is  what  I  mean 
bj  specificity  of  medicaments.  To  develop  the  subject  which  com- 
prises the  whole  domain  of  therapeutics,  would  carry  me  much  beyond 
the  point  I  proposed  to  reach,  for  I  would  be  compelled  to  pass  in  re- 
view if  not  indeed  every  medicament,  at  least  every  kind  of  medica- 
tion. I  will  therefore  merely  refer  to  the  TWoA^  on  Tkerapeuiie$ 
p«i\>lished  by  myself  in  collaboration  with  my  colleague  and  learned 


842  ^  iS;p#ej|l%.  [JmSb 

friend,  Dr.  Pidoax,  and  partioalarljr  to  that  portion  of  it  which  traaU 
of  8ub8tUuiive  medication,  which  is  hased  entirely  upon  this  idea  of 
speciality  jnet  referred  to :  ^  ■  « 

It' controls  all  medicine — Dichotomons  doctrines  of  Brown  and 
BroQssais — Diseases  have  characteristics  in  conHnon*  in  additkNi  to 
which  they  manifest  pecnliar  specific  characteristics — Specificity  of  Che 
canse — Specificity  of  symptoms-^Application  to  diagnosis  and  to 
prognosis,  and  to  therapentics. 

Oentlemen  as  ernptive  fevers  have  already  afibrded  vs  the  hest 
marked  type  of  specific  diseases,  I  desire,  before  proceeding  fiirtber  with 
the  study  of  the  facts  which  we  are  observing  together,  to  dwell  for  a 
moment  upon  this  subject  of  specificity.  This  important  anhjactp  as 
I  hope  to  demonstrate  to  yon,  exercises  a  controling  inflnence  over  all 
pathology,  all  therapeutics  ;  in  a  word  over  the  whole  field  of  medi- 
cine ;  and  already  in  the  course  of  the  preceding  lectures,  I  have  had 
occasion  to  speak  to  you  of  it.  It  will  meet  yon  face  to  face  at  eveiy 
step  yon  take  in  the  practice  of  our  art,  and  as  not  a  day  will  pass 
in  which  you  will  not  find  me  bringing  it  forward  at  the  bedaidei  I 
feel  it  to  be  my  duty  to  give  you  as  full  an  idea  as  possible  of  what  is 
meant  by  specificity  in  diseases. 

Although  we  pretend  to  have  shaken  off  the  yoke  of  the  doctrines  of 
Brown  and  Broussais,  we  are  still  to-day  subject  to  their  influence ; 
our  medical  ideas,  our  very  language  itself  are  still  tinctured  with 
them,  however  much  we  may  deprecate  it.  It  is  therefore  necessary  to 
speak  of  them  at  this  time,  in  order  to  show  what  is  erroneous  in 
those  doctrines.  However  much  opposed  they  may  be  to  one  another 
they  rest  upon  a  common  foundation,  and  Broussais,  while  he  is  the 
greatest  antagonist  of  Brown,  has  none  the  less  drawn  the  principles 
of  his physiolcgitm  from  the  pathological  system  of  the  Scotch  reform- 
er, whose  iricitability  differs  only  by  its  abstraction,  from  the  brautaii- 
tan  irritability. 

Life,  says  Brown,  is  only  sustained  by  excitants  ;  life,  says  Brou- 
ssais, is  kept  up  only  by  stimulants.  Their  physiological  theory  is 
established  upon  this  basis,  upon  which  they  have  also  founded  their 
pathological  theory.  In  their  judgment,  in  fine,  there  is  but  one  mor- 
bific cause,  the  excessive  or  improper  application  of  excitants^  or  of 
stinudants  to  the  human  body.  The  difference  of  intensity  of  the 
cause,  the  difference  in  the  mode  of  reaction  of  the  economy,  are  the 
sources  of  innumerable  differences  in  the  forms  of  diseases.  This  Is 
the  starting  point ;  it  is  the  very  same,  for  excitants  and  stimulants 
are  tjvo  words  in  this  case  entirely  synonimous. 


1864.]  CvnmpmdmM.  848 

Brown  Mid  m  Bidumis  haa  repaatad  in  otbir  tarma,  thai  light  waa 
iha  natKral  mcitanty  or»  whidi  ia  tha  sama  thiag,  iha  atimiiiaiit  of  dia 
cgra^  whoaa  ineitation  lasnltad  in  Tision ;  that  food  waa  tha  natnial 
incitaat  of  tha  stomach,  whota  incitalion  raraltad  in  digaation ;  that 
tha  aarimilatad  matter,  the  nutritive  floids  were  tha  natural  incitanta 
of  tha  diflfiMrant  organs,  whence  natrition ;  that  the  hlood  waa  the  nat- 
wal  incitant  of  the  secretory  apparatoa,  whence  the  urinary  secretion 
when  the  incitability  of  the  kidneys  was  set  in  motion  ;  whence  tl|e 
apatmatic  secretion,  when  the  seminal  glands  were  incited.  But  while 
admitting  the  constant  identity  of  the  cause,  which  Taried  only  in  ita 
quantity  they  could  not  refuse  to  reoogniae  a  varfety  in  the  quality 
of  the  aupport  of  the  stimnlua,  and  modification  in  t}ie  contexture  of 
tha  oigan,  in  Tirtue  of  which  the  eieets  of  the  stimulation  were  diflbr- 
ant.  To  say  that  CTerything  depended  upon  tha  quantity  of  the  atim- 
ulna  by  auppbaing  the  organic  condition  identical  in  all  individuala 
waa  to  refuse  to  believe  evidence.  For  how  could  they  explain  the 
diveraity  of  efiects,  the  diversity  of  functions  t  Did  they  not  expoee 
thamaalvea  to  fall  into  prodigioua  abswditiasy  aa  for  instance  to  pre- 
tend, as  in  (act  did  Pecanniaa,  a  man  however  of  incontestable  talent, 
thai  by  exalting  the  excitability  of  the  nerves  of  the  finger,  or  of  the 
epigsatric  region  to  the  degree  of  the  incibility  of  the  retina,  we  might 
by  adapting  to  theee  parts  an  optical  apparatni  analogoua  to  that  of 
the  aye,  aee  with  the  finger  or  wit^  the  atomaoh. 


Oarebro-Spinal  Meningitis, 

Daxvillb,  Kt.,  April  26, 1864. 

Ifissna.  Editors. — We  have  had  in  thia  village  and  vicinity,  for 
tha  paat  two  months  a  number  of  casaa,  of  unusual  diseaae,  attended 
with  great  fatality.  It  could  hardly  be  called  an  epidemic,  yet  the 
tasns  were  sufficiently  numerous  to  create  alarm  in  the  community. 
I  thonght  a  ehort  description  of  the  diseaae  aa  it  appeared  among  ua, 
■li^  intereat,  if  it  did  not  subserve  any  more  useful  purpoae. 

Physicians  have  given  different  namea  to  the  diseaae,  oerebro-spinal 
asaningitis,  spotted  fever,  malignant  erysipelas,  malignant  scarlatina, 

ale. 
AH  tha  caaas  have  not  presented  the  same  aymptoma  ;  in  fact  there 
been  considerable  diveraity  in  thia  rsspeet,  yet  there  was  a  family 


844  Corrupimdmee.  [Jimtf 

likeness,  (so  to  speak,)  and  every  case  tliat  oama  under  mj  obaem- 
tion  had  some  marks  common  to  all.  The  attack  ia  aadden*  and  mi- 
formlj  ushered  in  with  a  chill,  not  verj  serere,  lasting  from  one  to 
three  hours.  lYomiting  generally  attends  the  chill,  and  contiaiifls  in 
some  cases  to  near  the  fatal  termination.  The  matters  ejeotod  fioa 
the  stomach  consist  usually  of  green  and  yellow  bilCf  mixad  with  nn- 
cous,  and  are  acid  to  the  smell.  The  chill  ia  followed  by  modeiate 
fever,  lasting  in  most  cases  from  six  to  ten  honrs,  and  then  awestiaf 
comes  on.  The  fever  has  not  usually  been  intense,  or  the  aweatiag 
profuse.  Soon  after  the  subsidence  of  the  chill,  delirium  with  gnat 
dullness  of  perception,  comes  on ;  the  dullness  gradually  increaaing 
until  it  ends  in  coma.  In  every  case  there  has  been  dilitatioa  of  the 
pupils ;  in  a  majority  convulsions  and  opisthotonos.  In  one  case, 
that  terminated  fatally  on  the  third  day,  there  was  diUtation  of  the  ' 
pupil  of  the  right,  and  contraction  of  the  pupil  of  the  left  eye.  In  this 
case  there  was  opisthotonos,  the  left  lower  limb  was  in  continual  mo- 
tion, (drawing  it  up,  extending  it,  and  turning  it  from  side  to  aide.) 
while  the  right  lower  limb,  together  with  the  arms  were  kept  atill. 
In  nearly  every  case  an  eruption  (if  I  may  call  it  such)  nude  ita  ap* 
pearanoe  in  about  twenty-four  hours  from  the  time  of  attack.  It  con* 
sisted  of  red  spots,  from  the  size  of  a  pin-head  to  that  of  a  ten  cent 
piece,  scattered  over  the  limbs  and  body  generally.  They  had  no 
definate  shape,  pressure  did  not  alter  or  modify  them,  there  was  no 
elevation  or  roughness  of  the  skin,  in  short  the  spots  had  the  appear- 
ance of  ecchymosis.  The  impression  made  on  my  mind,  from  their 
appearance  was  that  they  were  produced  by  an  effusion  of  blood  from 
the  capillaries  beneath  the  skin.  In  most  cases  there  was  some  inflam- 
mation of  the  throat,  though  not  severe  or  attended  with  any  exter- 
nal swelling.  The  bowels  were  usually  in  a  normal  condition.  The 
tongue  was  moist,  covered  with  a  tight  velvety  coat  of  a  buff  color. 
The  pulse  was  usually  small,  without  force,  and  from  110  to  160  per 
minute.  One  of  the  most  constant  and  troublesome  symptoms,  as 
long  as  consciousness  continued,  was  severe  pain,  shifting  its  seat  from 
place  to  place ;  one  time  in  the  stomach,  then  the  bowels,  then  either 
side,  the  shoulders,  arms,  legs,  etc.,  remaining  in  no  one  place  long  at 
a  time,  but  when  it  shifted,  prone  to  return  to  the  spot  it  had  left  a 
few  hours  before.  The  urine  was  natural  in  quantity  and  appearance  » 
it  was  not  tested. 

The  symptoms  that  were  uniformly  present  were  the  chill  followed 
by  fever,  the  delirium,  the  dilitation  of  the  pupils,  and  the  erratic  pains- 
Those  generally  present,  were  the  eruption,  the  weak  rapid  pulae,  and 


S4.]  Correfpandenee.  845 

iTuUions,  somewhat  less  frequently  was  tbe  opisthotonos.    In  two 
three  cases  there  was*  violent  vomiting  and  purging ;  they  were 
nounced  at  the  time  cases  of  acute  gastro  enteritis,  and  all  of  them 
Bi  down  rapidly  ;  still  they  had  the  deltrinm,  the  wandering  palns» 
I  one  of  them  died  in  a  convulsion.    After  death,  -(I  was  so  inform- 
by  ladies  who  dressed  them,  they  were  young  ladies,)  they  had  a 
nber  of  those  hruised  looking  spots  on  them, 
V.  large  majority  of  the  cases  occurred  in  young  girls,  a  few  in  hoys 
[  adalts.     Our  population  is  very  nearly  equally  divided  hetween 
ck  and  white,  hut  in  some  fifteen  cases  that  came  under  my  obser- 
ton  there  was  only  one  black.     As  to  treatment,  I  will  say  that 
hing  seemed  to  be  of  any  service.    About  four  cases  oat  of  five 
ninatel  fatally,  and  generally  in  from  thirty-six  to  seventy-two 
trs.    The  means  principally  relied  on,  were  quinin^,  opium,  carb, 
nonia,  brandy,  blisters,  sinapisms,  etc.    Other  remedies  were  used 
r§  naia.    No  post  mortem  examination  was  had  in  'any  case, 
'ha  disease  now  seems  to  have  abated,  but  the  ordinary  diseases  of 
country,  common  at  this  season  of  the  year,  such  as  pneumonia, 
schitis,  etc.,  are  more  intractable  than  usual.    Is  it  not  owing  to 
fact  that  the  constitution  of  every  body,  is  more  or  less  under  the 
Hence  of  the  poison,  whatever  it  be  ?    We  have  r^arded  it  here 
.  blood  disease,  and  from  what  little  we  can  find  in  the  journals  on 
anbject,  or  perhaps  for  want  of  a  better  name,  have  called  it  spot- 
fever. 

could  add  more  to  this  desultory  communication  but  find  I  have 
ady  exceeded  my  limits. 

I  am  very  respectfully,  A.  R.  MoKn,  M.D. 


>€reiro  Spinal  MemnffiUs. — Dr.  Denny  of  Albion,  Noble  Co.,  Iiidi« 
»  writes  as  follows  : 

he  prevailing  disease  with  us  daring  the  months  of  Janoary, 
roary.  March,  and  up  to  the  present  writing  (April  2Sth)  have 
i  scarlet  fever,  pneumonia,  and  "  «;pottii /#Mr/'  which  we  (my 
oer  and  myself)  term  malignant  spinal  menimpiiit.  This  disease 
been  and  is  now  prevailing  as  an  epidemic  throoghout  this  (  Noble) 
nty,  and  has  uniformly  proved  fatal  in  most  localities. 
7e  have  however  been  unifoHbly  successfol  since  adopting  the  fol« 
Ag  plan  of  treatment,  which  I  give  in  aeoordance  with  Dr.  Cla- 
ra request  in  your  April  nomber : 


846  BiHorial  JTcUi.  [J 

During  the  cold  stage,  or  ohill  which  preoedesthie  fevwr^  tha  pttieot 
is  placed  in  a  Ao^  batiks  and  as  soon  as  lemoTed  imphmn  mo  applisd 
to  the  stomach,  legs,  and  the  lower  part  of  the  spine  ;  the  back  of  the 
head  is  shaved  and  a  hlister  pnt  therebn,  which  is  extended  dowa  to 
the  sixth  dorsal  vertebra ;  quifdne  and  viiir.  tmei.  nf  vtfm  an  fteslj 
given  every  two  hoars,  until  the  violence  of  the  qriBptooiaabata»  whsB 
the  iron  is  omitted,  and  brandy  and  qninine  coniiniied  until  .convaks- 
oence  is  established. 

[In  this  connection  we  condense  such  items  as  we  find  in  receat 
exchanges  as  seem  to  have  any  practical  bearing  on  tiUs  epidemic  se 
terribly  fatal  in  same  localities. — ^Ed.  Laxo.  h  Obs.] 

JDr.  Btavtr, — Cwdnn^Spmoi  MtwmgiiU  has  prevailed  in  aome  parts 
of  Pennsylvania  with  great  malignancy.  Dr.  David  Beaver  gives  ia 
his  thesis  for  the  degree  of  M.D.,  at  the  University  of  Peansylvaais 
last  March,  some  personal  experience  in  the  vicinity  of  Norrisiown, 
Pa.  The  Thesis  is  published  entire  in  the  PkOmielpkm  B^mUr  for 
March  26. 

In  regard  to  ireaimeni  we  quote  the  following :  **  I  would  state  ia 
regard  to  the  treatment  of  spotted  fever,  that  purgatives  ba^re  beea 
found  to  be  productive  of  more  harm  than  good,  and  that  thoee  cases 
did  best  where  even  mild  laxations  >rere  not  used  for  several  days. 
When  first  called  to  a  case  we  generally  administered  brandy,  or  car- 
bonate of  ammonia,  applied  blisters  to  the  temples  and  back  of  the 
ears,  and  Granville's  lotion  along  the  spine  and  also  to  the  stonuush. 
The  last  named  article  we  found  to  be  of  great  value,  as  it  acted  much 
more  promptly  than  the  blisters.  Oar  principal  reliance,  I  am  s^- 
fied,  is  to  be  placed  in  stimulants,  counter  irritants,  and  tonics.  In 
the  after  treatment  of  cases  much  must  necessarily  depend  upon  the 
judgment  of  the  practitioner  in  applying  such  remedies  as  are  indicat* 
ed,  by  the  symptoms  that  present  themselves." 

Dr.  Foran. — In  the  same  issue  of  the  Reporter  we  find  several  com- 
munications on  this  subject,  but  for  the  most  part  wanting  in  any 
practical  suggestion.  Dr.  Foran  of  Syracuse,  N.  Y.,  writes  :  *'The 
epidemic,  for  so  it  may  be  called,  prevailed  in  this  country  in '  1854- 
1856,  more  extensively  in  the  latter  year.  The  mortality  was  very 
general  and  in  many  cases  very  sudden,  so  that  all  treatment  was 
abandoned  as  useless.  In  other  cases  the  treatment  although  varied, 
pro  re  nata  was  generally  unsuccessful.  Quinine  and  opium  seemed 
to  have  the  best  efiect  combined  with  wine  (^^^i^  '^^■7  freely,  ^e 
qninine  must  be  g^ven  in  full  doses  dissolved  in  aromatic  sulphurie 
acid  and  wine  vehicle— ^iata  %e yomr  $heei  anchor.    If  the  case  admit- 


864.]  Ed:torial  Xcta.  847 

sd,  a  full  dose  of  calomel  with  opiam  and  carbonate  of  soda  in  the 
arlj  stage  in  a  bilions  diathesis,  would  be  advantageous ;  the  system 
DStained  by  suitable  agents. 

[Most  reliable  authority  both  in  past  and  present  epideuiics  of 
erebro-spinal  meningitis,  differ  very  much,  and  some  abioItUeiy  rejed 
U purgatives  fufataly  depressing  in  their  effect — Ed.  Lanc.  h  Obs.] 

The  post  mortem  revealed  a  complete  degeneration  or  softening  of 
be  cerebellum,  a  perfect  illustration  of  the  iyphun  crisis,  and  of  the 
yemic  species,  so  accurately  described  by  Rokitanski,  the  genuine 
srebro-spinal  meningitis  as  you  have  diagnosed.  But  the  question 
atnrally  arises  here,  What  is  cerebro-spinal  meningitis  ?  Is  it  pri- 
lary  or  secondary,  is  it  a  lesion  of  the  blood,  is  it  tn/act  a  blood  die- 
wMef 

Dr,  A,  P.  Woodward,  of  Brandon,  Yt.,  reports  some  cases  in  the 
Imertcan  Medical  Times,  He  thinks  the  epidemic  is  not  necessarily 
cerebro-spinal  meningitis,  that  being  only  one  of  the  forms  of  the 
iaease.  He  regards  it  as  "  a  nervous  affection  sui  generis  ;  "  pain  be- 
ig  perhaps  the  only  constant  system.  The  spots  not  alivays  making 
seir  appearance,  but  when  showing  themselves,  being  of  the  charac- 
sr  of  the  eruption  in  enteric  and  typhus  fever.  He  advises  a  varied 
vatment,  materially  governed  by  the  peculiarities  of  the  case.  One 
lae  he  reports  a  favorable  <^nvalescent  under  the  use  of  diffusible  and 
(rebral  stimulants  ;  in  another  the  favorable  change  occurred  after 
ipioue  cathartics.  He  says,  "  cases  will  doubtless  arise  when  blood- 
"tting  will  be  the  only  available  means  with  which  we  can  combat  it 
ith  the  beit  prospect  of  success.  I  think  when  blood-letting  is  likely 
»  prove  serviceable,  in  order  to  get  the  full  benefit  of  the  remedy,  we 
loald  resort  to  it  at  an  early  period  of  the  disease.  When  the  pa- 
ent  is  unconscious,  unless  he  gets  to  the  urinal  himself,  the  bladder 
x>n]d  by  no  means  be  neglected.'' 

Sew  York  Academy  of  Medicine. — We  make  the  following  extracts 
<mi  recent  discussions  in  the  Academy  of  Medicine  ; 

Discussion  on  Spoiled  Fever, — Dr.  W.  H.  Draper  concluded  the 
sadiDg  of  his  paper  on  cerebro-spinal  meningitis.  His  observations 
f  the  disease  were  fonnded  principally  upon  the  laige  number  of  cases 
hieli  have  recently  occurred  at  Carbondale,  Pa.  In  the  majority  of 
m  cases  the  meninges  ot  the  brain  and  spinal  cord  were  intensely  in- 
kmed,  while  in  others  the  pericardium,  pleura,  and  even  the  lungs 
lilered.  Tlie  discolored  patches  or  spots  irom  which  the  present  epi- 
■mic  seems  to  have  derived  its  name,  were  not  always  present.  Opis- 
lotonos  was  a  pretty  constant  symptom.  The  liver  and  kidneys  in 
mie  instances  were  found  to  be  the  seat  of  fatty  degeneration.     The 


348  JSdUarial  XoUs.  [Jum, 

diseaso  was  generally  of  short  diiratioii»  and  vmj  fatal.  Ha  waa  a- 
dined  to  the  belief  that  it  was  iafectioiu.  The  oondnaion  of  hia  ftsm 
was  occupied  by  Arguments  to  prove  the  identity  of  the  diaeaae  with 
typhus  fever.  The  paper  was  a  very  elaborate  and  finiahed  ono^  aad 
we  regret  that  we  are  unable  to  publish  it  in  full. 

Dr.  Scriven  stated  that  he  had  met  with  a  few  cases  of  cerebro-apiaal 
meningitis  since  the  last  meeting.  The  symptoms  were  in  Am  nuoa 
similar  to  those  described  at  the  last  meeting.  He  referred  to,thiii 
cases  in  particular.  The  first  was  that  of  an  old  man,  aged  71.  who 
was  seized  at  first  with  rheumatic  pains,  followed  by  vomiting.  Whea 
Dr.  S.  first  saw  him  he  was  suffering  from  spasms  of  the  posterior  ear- 
vical  muscles.  The  pulse  was  full  and  strong.  The  features  seeBwi 
relaxed  ;  "  his  whole  face  seemed  to  hang.'*  Hia  mind  was  {ndiaed 
to  wander,  though  at  times  he  was  able  to  give  some  account  of  him- 
self. He  complained  of  burning  pain  in  the  head  and  down  the  bai^ 
The  patient  was  bled  to  faintness,  and  the  pulse  ooming.up  after  he 
was  laid  down,  he  was  bled  again.  Hiq  symptoms  were  all  reliered, 
and  the  patient  at  last  accounts  was  doing  well.  The  blood  showed 
a  bufify  coat,  and  was  cupped  after  standing.    ■ 

The  second  case  whicn  Dr.  S.  referred  to  was  that  of  a  boy,  eigiht 
years  old,  whom. he  only  saw  in  a  state  of  collapse.  Caps  were  ap- 
plied to  the  mastoid  process,  but  little  or  no  blood  was  drawn  ;  they 
were  also  applied  to  the  back  of  the  neck  With  the  same  reaali.  At 
the  suggestion  of  Dr.  Sayre,  who  saw  the  case,  the  jugular  vein  wu 
opened,  but  it  was  some  three  or  four  minutes  before  the  blood  was 
made  to  fiow,  it  being  necetisary  to  free  the  orifice  of  the  opened  vessel 
by  scraping  away  the  partial  coagular  which  existed  there.  The  symp- 
toms were  alleviated,  but  the  child  was  already  too  far  gone  to  rally. 

The  third  case  was  interesting  in  respect  to  an  abcess  which  devel- 
oped itself  in  the  lumbar  region,  and  seemed  to  extend  into  the  spinal 
canal. 

Dr.  Clark  did  not  think  there  had  been  sufficient  opportunities  to 
study  the  disease  in  and  around  New  York,  inasmuch  as  there  had 
been,  to  the  best  of  his  knowledge,  not  more  than  a  dozen  oases  under 
observation,  and  out  of  this  number  there  had  been  opportunities  af- 
forded for  but  two  or  three  autopsies. 

He  had  met  with  but  one  case.  This  was  in  the  practice  of  Dr. 
King,  and  in  the  person  of  a  young  mechanic.  He  was  seized  on  Sun- 
day, three  weeks  ago,  with  a  feeling  of  malaise,  attended  with  vomit* 
ing  and  headache.  These  symptoms  continued  until  evening,  when 
he  retired  at  the  usual  time.  During  the  night  he  became  dellrions, 
and  partially  paralysed.  Dr.  King  saw  him  the  following  morning, 
and  found  him  pretty  profoundly  comatose ;  the  pulse  was  exceeding- 
ly small  and  rapid,  the  face  livid,  and  there  were  noticed  blotches 
upon  the  neck.  At  twelve  o'clock,  the  time  of  the  consultatfon  visit, 
stimulants  in  the  meantinie  having  been  given,  the  pulse  was  more 
appi*eciable,  and  had  increased  somewhat  in  force,  but  was  still  very 
rapid.  He  was  then  very  restless.  He  refused  to  speak,  probably  on 
account  of  an  inability  to  move  his  jaws,  which  were  firmly  contract- 
he  pupils  were  neither  dilated  nor  contracted.    The  respiration 


18C4.]  Editorial  Nates.  349 

wfts  Bufficicnt  to  aerate  bis  blood  fairly,  and  presented  no  remarkable 
feature  as  to  character  or  frequency.  Tbe  olotcbes  varied  in  size ; 
some  were  so  small  as  to  be  completely  covered  by  a  pin's  head, 
while  others  conld  not  be  covered  by  the  end  of  the  finger.  The  more 
recent  and  smaller  ones  were  ecchymotic  in  character.  The  larger  ones 
were  dark  in  their  centres,  and  of  a  light  red  along  their  margins. 
Their  form  was  exceedingly  irregular,  no  two  resembling  each  other ; 
tbej  were  notched  and  irregular  in  outline,  and  either  angular  or  near- 
ly ronnded,  none  having  any  definite  oval  form.  The  eruption  ap- 
peared on  the  neck  three  hours  before  it  did  upon  the  feet.  There  was- 
then  (12  m)  no  opisthotonos.  The  patient  was  doing  pretty  well  at 
last  accounts. 

Dr.  Clark  was  inclined  to  doubt  as  to  whether  the  right  name  had 
been  found  for  the  disease ;  in  some  cases  the  brain  and  spinal  cord 
were  involved  in  the  inflammation,  and  so  far 'the  term  cerebro-spinal 
meningitis  was  correct  enough  ;  but  in  other  cases  the  inflammation 
was  limited  to  the  brain,  while  in  still  other  cases  the  brain  and  cord 
escaped  altogether,  and  the  inflammation  had  spent  its  force  upon  the 
pericardium,  the  pleura,  and  even  upon  the  lungs.  That  being  the 
case,  the  ditiease,  in  his  opinion,  was  due  to  a  condition  of  the  system 
in  which  there  is  a  tendency  to  inflammation,  and  that  that  inflamma- 
tion might  show  itself  in  one  part  of  the  body  or  the  other,  dependent 
upon  circumstances  which  we  cannot  at  flrst  appreciate. 

He  was  not  able  to  agree  with  I)r.  Draper  as  to  any  identity  which 
existed  between  thiq  disease  and  typhus  fever.  In  typhus  fever  the 
eruption  rarely  or  never  appears  before  the  seventh  day  from  the  time 
tbe  headache  and  chilly  feeling  commences ;  the  rate  too  at  which 
this  eruption  travels  over  the  body  occupies  a  more  considerable  space 
of  time ;  and  then  again  the  inflammation  of  the  brain,  which  some- 
times complicates  typhus,  does  not  show  itself  until  after  the  end  of 
the  first  week,  and  more  generally  in  the  course  of  the  second  or  third 
week.  The  rapidity  with  which  spotted  fever  runs  its  course,  and  the 
fymptoraa  attending  its  fatal  termination,  were  very  different  from 
those  of  typhus.  As  to  the  fatty  degeneration  of  the  liver  and  kid- 
neys, it  was  most  allied  to  yellow  fever;  though  the  investigations  of 
Dr.  Thomas  have  lately  tended  to  show  that  this  same  condition  of 
things  may  be  met  with  in  typhus  fever.  Why  might  not  this  lesion 
exist  in  spotted  fever  independent  of  an^  analogy  that  might  exist  be- 
tween it  and  typhus?  Taking  everything  into  consideration,  he  was 
inclined  to  look  upon  the  two  diseases  as  entirely  distinct. 

l^T.  Griscom  related  a  case  that  had  come  under  his  observation 
in  New  York  Hospital,  and  which  was  still  under  treatment.  The 
patient,  after  genera]  malaise,  was  flrst  attacked  with  severe  pain  in 
the  hend,  and  when  Dr.  G.  saw  him  he  was  suffering  from  the  syfnp- 
tomi  of  cerebral  inflammation.  His  pupils  were  contracted  but  were 
dilmtnble.  Uis  face  was  the  seat  of  a  most  intense  congestion  ;  cups 
were  applied,  followed  by  venesection,  when  almost  all  the  urgent 
•ymptoms  were  alleviated.  The  following  day  the  patient  suffered 
from  an  attack  of  catalepsy,  which  lasted  for  twelve  hours.  He  had 
BO  command  over  his  sphincter,  and,  having  an  attack  of  diarrhoea 


350  MdUarial  IfcUt:  [Ji 


discharged  the  contents  of  his  howels  in  his  hed  ind^rer  the  floor. 
There  was  no  opisthotonos  present  For  some  time  he  had  been  ds- 
lirons,  would  spit  at  every  one  with  a  seeming  maIieioasness»  whib 
at  odd  times  he  wonld  exercise  a  mnsical  talent,  which  he  seemed  to 
possess,  hy  whistling  vociferonslr.  Taking  the  symptooM  oollect- 
ively,  Dr.  G.  was  disposed  to  think  at  the  time  of  repoitiaig  the  esse, 
that  the  patient  was  sniFering  from  acnte  mania. 
X  Dr.  La  Roche,  of  Pbiladslphiay  made  some  remarks  eonoenung  the 
general  characters  of  the  disease  as  he  had  met  with  it  amnd  Phila* 
delphia,  which  corrohorated  the  views  of  Dr.  Clark. 

Dr.  Horsefield  referred  to  a  case  that  occurred  in  Jentif  City»  whidi 
proved  fatal.    The  tonic  and  stimulant  treatment  was  resortod  to. 

Dr.  Draper  instanced  some  examples  of  the  contagjonsnass  of  tlw 
disease,  which  tended  to  corroborate  the  statements  concMrmiag  that 
point  referred  to  in  his  paper. 

Dr.  Dutdap,  qf  Springfield,  Ohio. — The  disease  has  also  mads  iti 
appearance  in  and  about  the  city  of  Springfield.  In  a  recieni  eonrer- 
sation  with  Dr.  Dunlap  of  that' place,  he  related  to  usliis  experience, 
and  his  views.  Nearly  dvery  case  as  it  first  appeared  proved  iatsl. 
Blisters,  counter  irritants,  belladonna  and  lime  on  the  plan  of  Prof. 
Davis,  and  various  treatment  gave  the  same  fatal  result.  In  this  des- 
perate state  of  things.  Dr.  Dunlap  arrived  at  the  following  vi^ws : 

The  epidemic  is  not  a  disease  of  inflammation,  it  is  a  blood  disetse, 
just  as  malignant  scarlatina  is,  belongs  to  the  same  class  of  diseases; 
the  brain  and  nervous  system  becomes  involved  by  virtue  of  a  vidotis 
supply  of  blood.  Ozone  is  the  ready  antidote  to  this  state  of  the  sys- 
tem ;  and  that  plan  of  treatment  which  affords  ozone  most  readily  will 
prove  the  most  successful.  In  support  of  these  views  in  part,  he  refers 
to  the  views  presented  by  Dr.  Jackson  in  an  article  in  the  AmericoM 
Journal  of  Medical  Sciences  for  January  last.  Dr.  Dunlap  sdected 
the  permanganate  of  potash  as  his  remedy,  and  gives  it  in  doses  of  ^-^ 
grains,  frequently  repeated ;  it  is  administered  in  solution.  After 
adopting  this  simple  plan  of  treatment  he  had  a  favorable  result  in 
nearly  every  case.  He  thinks  quinine  and  iron  come  in  as  proper 
remedies  in  the  later  stages  of  the  disease  if  the  recovery  beoomea  pro- 
tracted. Dr.  Dunlap  makes  a  wide  application  of  these  views  and  this 
rjmedy,  believing  that  the  same  principles  and  treaiment  are  applica- 
b?e  'n  erysipelas,  hospitAl  gangrene,  typhus,  etc. 

We  make  no  apology  for  devoting  so  much  space  to  this  topic,  be- 
lieving we  could  not  afford  matter  more  acceptable  to  most  of  our 
readere. 


1804.]  Spedat  Seltrlioiu. 


IMkellvt  and  Impalrn]  VUlon,  with  tlis  Cllnloal  uw  of  the  Opk  Ihftlmo- 
■oop«  In  th«Ir  Dlagnoili  and  Tnatmaat 


Before  commencing  with  direcliona  for  its  maDagement,  I  ought  to 
mention  that  tha  ophthalmoscopo,  nhon  employed  alone,  gives  the  up- 
right pictnra  of  the  interior  of  the  eye,  but  when  wo  use  the  lona  wa 
■M  an  "  inverted  picture,"  so  that  what  appears  to  be  placed  upward 
or  iaward,  is  in  reality  situated  downward  and  outward,  and  Tica 
vens,  the  great  advantage  derived  from  the  use  of  the  double  convex 
leaa  is,  that  by  it  we  obtain  a  larger  picture  ;  bat  should  we  desire  to 
r«dnce  it,  we  then  nso  a  doable  concave  lena.  The  aimple  mirror  of 
Anagnoitakis,  used  in  combinslion  with  a  convex  glass  in  the  manner 
I  MB  about  to  describe,  certainly  allows  of  our  seeing  in  their  nal 
position  parts  which  do  not  fall  within  the  focus  of  the  patient's  crya* 
talline  mis.  Thus  a  morbid  growth— an  encephaloid mass,  for  in- 
stanctt — which  might  be  seen  on  the  floor  of  the  vitreons  chamhar, 
woald  be  found  really  to  occnpy  that  position  when  the  globe  has  been 
extirpated.  But  the  optic  nerve  and  retina,  lying  within  4he  focna  of 
tbe  patient's  lens,  are  seen  reversed  ;  so  that  the  axis  of  vision,  which 
ia  raslly  plaoed  on  tbe  temporal  side,  appears  to  lie  on  the  nasal  side 
of  tfae  nerre,  and  an  extravasation  of  blood,  or  patch  of  pigment,  be- 
low tbo  iMrva,  woald  appear  to  be  above  it.* 

Having  daifaned  tha  room,  tbe  patient  should  be  seated  by  a  amall 


Hoftt*  SrtiP.TTI-t.-^ 


«!■••'  Stii|W7,  >«L  U.  L 


352  Spedtd  SeUdlons.  .  [Joiie, 

steady  table,  the  lamp  having  been  lighted  and  placed  dose  to  the  aide 
of  the  head,  the  flame  on  a  level  with  the  eye,  so  that  the  face  receives 
no  direct  rays  by  means  of  the  side  shade. 

The  surgeon  sitting  on  a  high  stool  or  standing  in  front  of  the  pa- 
tient, at  about  eighteen  inches  distance,  for  the  indirect  inethod,  with 
the  ophthalmoscope  applied  to  his  own  eye,  as  seen  iiitiie  cot*  (Fig.  2) 
receives  the  rays  from  the  flame,  and  by  a  slight  oblique  isotion  re- 
flects them  upon  the  patient's  eye,  whose  pupil  is  in  a  tboit  tine  illn- 
minated  with  a  bright  red  glow,  that  changes  to  ailveij.  vl^  when 
the  eye  is  turned  slightly  inward  toward  the  middle  line,  ^(md  hold- 
ing the  double  convex  lens  bv  the  bundle  as  in  the  picture,  or  between 
the  thumb  and  forefinger  of  his  left  hand,  he  placet  it  at  (be  distance 
of  about  one  inch  in  front  of  the  patient's  eye,  stea^ng  it  by  lightly 
toucl^ing  the  orbital  region  with  his  little  finger  between  thia  ead  and 
the  speculum,  and  then  by  a  slight  to  and  fro  movamentof  bie  b«id, 
ho  tries  to  catch  the  distance  at  which  the  inverted  iouffe  of  the  pa- 
tient's fundus  is  visible  to  him  :  when  he  has  this,  he  then  begins  to 
see  the  disc  of  the  optic  nerve  and  the  vessels  of  the  retina.  Yon  must 
not  expect  to  see  too  much  at  first  examinatiob,  as  it  requires  some 
practice  to  properly  illnminate  even  the  fundus  of  the  eye  and  pkcJb 
the  convex  glass  in  pro^  position.  It  is  well  to  make  experiments 
on  some  of  the  lower  animals,  especially  the  white  rabbit,  which 
makes  a  most  admirable  subject.  To  be  able  to  see  the  optic  nerve 
well,  the  patient  must  be  directed  to  turn  the  eye  a  little  toward  the 
nose,  and  by  turning  slowly  in  various  directions  the  whole  of  the 
fundus  mhy  bo  explored. 

"  For  the  examination  by  the  direct  method,  the  pupil  should  be 
fully  dilated,  and  the  accommodation  paralyzed  with  atropine ;  the 
patient  and  lamp  should  occupy  the  same  relative  positions  as  they  do 
in  the  direct  method,  but  the  surgeon  must  bring  his  eye  within  a 
much  shorter  distance  ot  the  patient's  eye  ;  an  ioch  and  a-half  or  two 
inches.  In  approaching  so  closely  to  the  patient's  eye,  if  a  concave 
speculum,  as  Liebreich's,  is  used,  much  light  is  cut  off  the  outer  mar- 
gin of  his  orbit,  and  the  illumination  of  the  fundus  is  proportionately 
dim  ;  but  at  these  short  distances,  Zehender's  ophthalmoscope  still 
illuminates  brightly,  and  for  this  reason  its  employment  is  preferable 
in  the  direct  examination." 

Zehxinder's  OpHTHALMoscpPE. — "Unlike  those  which  have  been 
described,  this  consits  of  a  convex  metal  speculum,  in  combination 
with  a  biconvex  lens  which  is  of  shorter  focal  length  than  the  nega- 
tive focal  length  of  the  speculum.  The  clip  which  holds  this  lens, 
is  mounted  on  a  jointed  bracket,  which  turns  right  and  left  on  the 
short  handle  of  the  speculum.  A  clip  for  an  ocular  lens  is  hinged  to 
the  side  of  the  frame  just  as  in  Liebreich's  small  ophthalmoacope ;  it 
is,  however,  less  easy  to  manage.*" 

The  eye  may  be  illuminated  in  still  another  method  indirectly  al- 
luded  to  before,  namely,  the  "  oblique  illumination,"  but  which  cannot 
be  earned  with  entira  satisfaction  beyond  the  capsule  of  tlielena. 
' — ■ — -^— — ^— ^— — — ^_— _— — ___^_ii-^________— __^_______^ 


I 


Sp$cial  3$U9U€m* 


tit 


oniutf  in  placing  the  light  at  the  side  of  the  eye  lo  be  examitttd. 
e  eni^^eon  will  find  it  most  oonTenient  to  aland  behind  and  above 
itient  intpected,  so  aa  to  get  the  light  reflected  from  the  eiyalal- 
Mu.  A  double  convex  lens  is  so  inserted  between  the  eje  aaad 
^ht  that  its  focus  falls  upon  the  penrta  to  be  examined.  If  we  da- 
•  examine  the  superficial  reflecting  medium  of  the  eye,  aa  oornea* 
>tc.9  the  raya  of  light  should  be  mtde  to  paaa  through  near  the 
of  the  glass ;  but  should  we  find  it  deairaUe  toexemine  tot  eat* 
NT  adheaions  of  the  iris  to  the  capsule  of  the  lena,  the  neeier  to 
per  margin  of  the  lens  should  the  raja  be  lebaeted.  No  exam- 
1,  however,  can  be  complete  for  cataract  or  deep*eeated  leaiona  of 
e,  without  the  use  of  the  ophthalmoacope.  Besides  the  ophthal* 
pes  we  have  already  noticed,  there  aie  Prof.  Jaqger'st  of  Vianon» 
rof.  Desmarre'^s,  of  Paris.  Both  are  metallic  mirrora,  and  only 
ilightly  in  form.  That  of  Prof.  Bau,  of  Beme^  is  a  cooeeve  adr- 
glass,  lined  with  mercury,  and  ita  focua  ia  foortesn  indhea. 


Fig.  8. 

mieh'a  larse  ophthalmoscope  is  seen  in  Ffff.  8 ;  ft  eonaiala  of 
ibea,  one  aUding  within  the  other  by  a  nek  i»d  pinion.  The 
NKt  tbs  observer,  on  the  right,  oonlaiBi  <he  qmBolmn  vUdi 
I  irsHieally  on  tmnniona  levolvfaig  in  ellpa  in  mA  n  wnr  Omi 
be  eamly  Tcmoved  and  leplaeed.    ApeideBcrfUetdieii^iit 


S64  iS^tdal  SHtdimi.  [Jaw, 

K^Kj  ID  order  to  admit  li^ht  to  th«  apaenlDin,  beliind  wliieli  ttian  u 
ft  DMTOW  nlit  for  ft  eonT«z  l«tu  of  low  power.  Th«  tnbo  on  tlw  hit, 
next  the  patient,  oontaias  *  oonrex  lens  of  ftbont  two  IncbM  fonl 
IsQ^li,  swung  ID  Uie  lame  manner  u  lb*  specnlam.  Thii  tube  k 
encircled  bj  %  itoDt  collar,  wbich  alides  on  the  vertieal  rod,  lo  flat  the 
wbole  can  be  fixed  at  any  convenient  heigbt  Tba  lower  and  of  tta 
rod  bna  ft  damp  for  fizina;  to  a  steid;  table.  Abort  tba  oollar  bfin 
agradnafed  horiEontal  eliding  rod  ending  in  an  oval  plata^  agiUnt 
wbich  the  patient  etsadicB  hia  forehead  in  the  manner  ropraMntad  ii 
tbe  figure.  Additional  steadinesa  ii  gained  by  a  cbafn  raft.  Aamall 
braes  ball  monnted  on  a  jointed  brftcket  fonna  a  convenient  olgaet 
for  the  patient  to  fix  bie  eye  npon.  A  conple  of  amall  blftokenad  b 
sbades,  not  shown  in  the  figure,  cnt  off  tbe  direot  t«^  of  the  kmp 
frtfm  the  patient  and  enrgeon's  ejes.  This  inatrnment  !■  Totj  aati*- 
factory  when  the  focus  is  obtained,  but  it  reqnirea  an  expariencad  ob- 
servei  to  make  tbe  arraogement,  then  anj  nomber  of  student*  can  ii 
tnm  observe  tbe  appearances.  It  is  also  useful  to  a  teacher  in  maUag 
drawings.  The  neceasily  for  Tarying  the  poei^n  of  the  eye,  consti- 
tntes  a  great  objection  to  each  complicated  opbtbalrooaeopea,  and  aoss 
oyea  are  so  unsteady  and  ao  little  ander  the  patient's  control,  that  tbt 
obserrer'ia  obliged  to  follow  their  movements  by  slight  chaises  in  the 
position  of  tbe  opbthalmoicope,  which  can  be  best  efiacled  wlwn  Ibe  ia- 
strnment  is  held  in  the  hand.  Tbe  simple  inatramant,  when  ODce 
learned,  is  eoongb  for  oar  purpose. 

Tbk  ATFaARANOE  or  thx  Retina. — When  we  examine  tba  ^e  of  a 
healthy  indiiidnal  we  do  not  find  tbe  retina  always  presenting  OM 
nnifom  tint ;  it  T&ries  from  pale  red  through  abades  of  red  mixed 
witli  orange,  even  to  buff.  In  plethoric  persons  of  a  ruddy  counten- 
ance, the  retina  is  natttrally  redder  in  appearance  than  in  tbat  of  a  per- 
son with  a  pale  complexion.  The  color  of  the  retina  depends  on  its 
own  capillary  network,  and  also  to  the  extremely  vascular  chornd  be- 
hind it.  The  diagram  (Fig.  4.)  is  a  magnified  view  of  the  fundus  of 
tbe  eye,  and  gives  an  idea  of  the  optic  disc  and  the  central  artatyaDd 
"'■*■  vein  ;  and  by  directing  the  patient  to  tart 

the  eye  a  little  toward  tbe  median  plane, 
the  observer  will  be  able  to  trace  thaas 
vessels  to  ibeir  parent  tmnlca.  It  Teqoina 
V  a  good  deal  of  practice  to  diatingnidb  be- 
Itween  the  retinal  srteriea  and  veins,  lla 
I  only  difference  in  color  is  tbat  the  vein* 
I  are  brigbUr  red  color ;  tbia  is  owing  tothe 
f  coats  of  tbe  veins  which  are  so  tbin  that 
it  allows  the  blood  to  sbine  tbrougb  them. 
Even  this  distinction  between  tbe  Teiai 
,^^^^  and  arteries  of  the  retina  becomes  lea 

marked  in  persona  advanced  in  yeani.  If  wo  wish  to  prodnce  pulia- 
tioo  in  Ibe  retinal  veasela,  wo  muat  presa  on  the  globe  of  tbe  eye  bj 
tbe  finger  while  we  ate  examiuing  it.  Two  natoral  pulses,  •  vgnoU 
and  an  arterial,  are  atoted  to  bavo  been  Moi  by  Van  Trigfat  *|and 

•f>BM|kt7ft7dq  dl^iMbwBll,<»1WW«.     DH««l,lMa. 


1864.]  [Special  Selectiom.  365 

3r.  Ed.  Jaeger.  A  visible  poise  in  the  relinal  vessels  is  a  sign  of 
excessive  intro-ocular  pressure,  and  the  arterial  indicates  a  ^igher 
)re8i(nre. 

Optic  rebyb  eutrance. — From  the  wood  cat  yon  wonld  suppose 
he  optic  papella  or  nerve  entrance  was  white,  bat  this  is  not  th^  case, 
us  it  is  a  grayish  pink  disc,  its  color  depending  on  the  amount  of 
>1ood  circvlating  in  it.  The  recognition  of  the  minute  structure  of  the 
lerve  requires  great  proficiency  in  the  use  of  the  ophthalmoscope  and 
I  verr  brilliant  light.  According  to  Dr.  Dixon,  no  structure  seen 
rith  the  ophthalmoscope,  presents  a  greater  variety  of  appearance  than 
he  optic  nerve,  even  in  patients  who  enjoy  good  fight. 

PuKCTUM  CsNTRALE  Retinjs,  OR  Yellow  Spot. — This  18  situated 
n  the  axis  of  the  eye,  and  is  one-tenth  of  an  inch  external  to  the  ea- 
rance  of  the  optic  nerve.  To  see  it  with  the  ophthalmoscope  requires 
i  higher  power.  It  is  of  a  circular  or  oval  figure,  and  is  distinguished 
rom  the  surrounding  parts  by  the  dullness  of  its  image  and  by  the 
plater  richness  of  the  choroid  in  pigment.  It  is  the  one  twenty- 
oni-th  of  an  inch  in  size,  and  is  surrounded  by  a  broad  yellow  margin 
Thich  gradually  shades  off  into  nearly  colorless  retina. 

Thk  Ghoboid. — The  choroid  is  the  dark  tissue  interposed  between 
he  delicate  sentient  retina,  but  when  lit  up  by  the  mirror  of  the  oph* 
halmoscope  the  color  seen  is  chiefly  due  to  the  proportions  of  blood 
kod  pigment.  If  blood  is  in  excess,  the  fundus  is  ^f  a  bright  red 
rolor,  but  if  pigment  preponderates,  the  tinge  is  more  of  the  orange, 
rhe  distinctnoKs  with  which  it  is  seen  depends  also  upon  the  degree  of 
ransparency  of  the  retina.  In  young  persons  it  looks  as  if  overspread 
rith  a  film,  bnt  in  elderly  persons  they  are  plainly  seen  and  of  a 
)rowni.sh  tinge.  In  persons  of  swarthy  complexion  the  veins  map  out 
he  choroid  in  small  spaces  which  are  deep  brown  with  a  violet  tinge; 
his  color  ia  also  found  in  the  eye  of  the  negro.  In  the  albino  the  re- 
leciion  produced  by  the  vascular  choroid  is  the  most  brilliant  and 
ightest  in  tint. 

Ov  THE  CBoiCBOP  AN  OPHTHALMOSCOPE. — Accordiug  to  Sicliel,*  the 
ophthalmoscope,  in  its  greatest  ^implicity,  consists  of  a  reflecting 
nirror,  designed  to  receive  and  bring  to  a  focus  on  its  surface  the  rays 
>f  light,  and  to  return  them  according  to  the  angle  of  incidence  on  the 
iorface  of  the  pupil,  in  such  a  manner  as  to  illuminate  the  internal 
larts  ef  the  eye  and  render  visible  the  phenomena  which  are  passing 
n  the  refracting  medium  and  in  the  internal  membranes. 

The  number  of  ophthalmoscopes  has  ronltfplied  so  rapidly,  thi^t 
tractitioners  who  arc  not  acquainted  with  all  the  modifications  to 
vhich  the  instrument  has  been  subjected,  wonld  find  difficulty  in  fix- 
og  their  choice.  I  have  tried  nearly  all  the  ophthalmoscopes  which 
iBTe  been  described  until  now.  A  frequent  use  of  this  instrument  has 
soght  DC,  that  the  most  convenient  ophthalmoscope,  the  easiest  to 
naiiage,  and  the  most  perfect  in  its  results,  is  that  of  M.  E.  Jager, 
PI.  Ixix.,  fig.  14,)  and  that  of  M.  Coccius,  modified  in  a  very  impor- 
aat  and  indispensable  manner,  by  M.  A.  Qraefe,  which  has  adapted 


856  Special  SeUetkmf.  [J 

to  it  a  series  of  eancave  lenses  sliding  into  *  frame.  Thb  last  opV 
thalmoscope  having  been  abandoned  by  M.  de  Q.,  and  adopted  1^  im 
I  call  it  at  present  mine.  It  wonld  be  nselesa  to  describe  mors  st 
.  length  than  has  been  done  in  the  description  of  the  plate.  ^Hbass  ia- 
stmments,  which  are  at  present  in  the  hands  of  every- body,  mad  whidi 
are  to  be  proenred  in  Paris  at  MM.  Charrier  k  Lxiar,  iaatmilieiii  ma- 
kers, and  at  M  Nachet's,  optician.  Let  ns,  however^  remark,  that  it  ii 
the  concave  and  convex  mirrors  that  give  the  instroment  its  troe  vahs. 
All  ophthalmoscopes  formed  with  a  simple  reflector,  that  ia  to  saj,  a 
simple  concave  or  convex  mirror  to  project  the  light  to  the  depth  o( 
the  ocnlar  globe,  are  imperfect  instmments,  which  rarelv  permit,  es- 
necially  to  myopic  eyes,  seeing  with  entire  clearness  the  vesseli  of 
tne  retina  and  the  other  fine  details,  normal  or  abnormal.  These  sim- 
ple ophthalmoscopes,  as  for  example,  that  of  M.  Anagnoatakis,  stb 
only  sufficient  for  the  study  pf  diseases  of  the  crystallise  apparatai  m 
the  vitreous  body,  and  those  which  are  seated  between  the  retina  and 
the  choroid.  In  di8ea8ei3  of  the  retina  and  of  the  choroid,  not  aeeom- 
panied  with  deposit  between  the  membranes,  the  simple  ophthalmos- 
cope is  entirely  insnflicient,  above  all  for  a  myopic  obeerratf on ;  bat 
with  the  use  of  convex  or  concave  mirrors  to  a  certain  lesnlta  leavbg 
nothing  to  desire. 

To  all  those.specially  occupied  with  the  study  of  ocular  diseaaes,  I 
would  connsel  to^rocnre  for  themselves  one  of  the  two  composite  oph- 
thalmoscopes of  which  we  have  spoken.  I  give  the  preference  to  tiiat 
of  M.  Jager,  above  all  to  the  large  model,  bnt  the  small  model  also  is 
excellent,  above  all  when  it  is  furnished  with  a  second  mirror,  with  a 
feeble  reflector,  that  is  to  say,  an  unpolished  glass. 

On  thb  Morbid  Appearakcxs  of  thb  Rktika,  Optio  Ncbtb  avd 
Ghoroid. — It  was  well  observed  by  William  Bowman,  the  distin- 
guished physiologist  and  surgeon  of  the  London  Ophthalmic  Hospital, 
**  We  have  fallen  on  a  time  that  will  be  forever  memorable  in  the  his- 
tory of  ophthalmic  science — the  epoch  of  the  invention  (and  applica- 
tion) of  the  ophthalmoscope." 

"  What  would  be  thought  by  physicians  if  they  were  prosented  with 
an  instrument  enabling  them  to  see  the  membranes,  the  cavitiea,  the 
course  of  the  fibres,  the  configuration  of  the  brain,  with  the  vessels 
pulsating,  the  veins  varying  in  emptiness  or  repletion,  and  every  pro- 
duct and  physical  condition  of  disease  exposed  to  view  ?  Or  if  the 
great  organs  of  the  chest  or  belly,  with  all  their  complicated  connec- 
tions and  mov<^ments  in  a  healthy  or  unhealthy  state,  were  disdosed  ? 
They  would  be  transported  with  deliffht  at  the  facilitiea  given  for  the 
exf^Kst  detection  of  disease ;  and  doubtless  a  harvest  of  great  lesilts 
wbuld  instantly  be  reaped  in  the  field  of  practical  medicine.  What  I 
have  imagined  for  the  great  cavities  of  tbs  body,  came  to  paas  for  the 
delicate  structures  of  the  eye  about  eleven  years  ago.  We  may  be  all 
elavn^oyanie  now  for  this  hollow  oi^n,  into  whidi  we  can  penetrate 
by  the  aid  of  the  reflector,  and  discern  (in  eXl  where  the  media  lemain 
transparent)  the  physical  conditions  of  the  internal  coats,  widi  the 
c:iquisite  course  and  aspect  of  the  vessels,  and  firinteet  morbid  altsra- 


1864.]  Sjpedal  SeUaiom.  357 

tions  of  structnre,  as  clearly  and  bnlliantlj  as  if  Ibey  were  opened  up 
bj  tbe  anatomist,  or  placed  under  a  leus  on  the  table  before  us.  And 
wberc  the  media  are  themselves  fanlty,  tbe  faults  can  be  detected  in 
their  earliest  and  slightest  forms  by  the  same  means.  So  long  as 
there  are  human  eyes  to  suffer  damage  from  disease,  or  cultivators  of 
the  divine  art  of  healing,  so  long  will  the  ophthalmscope  be  in  uni- 
versal use,  and  the  name  of  Helmnoltz  be  Iield  in  honor  among  man- 
kind. No  less  than  a  total  revolution  in  ophthalmic  practice  has  been 
already  effected  by  this  instrument,  and  constant  further  advances  may 
be  conOdently  anticipated  in  our  knowledge,  not  only  of  the  disease  of 
the  eye  itself,  but  collaterally  of  various  cognate  affections  of  other 
organs,  especially  of  the  brain."*  ^ 

Hyfbrjcxa  and  Ikflaxatiok  of  thx  JtsTiNA. — "  Capillary  conges- 
lion  of  the  retina  first  shows  itself  as  a  minute  pink  strippling  limited 
to  a  segment,  or  overrunning  the  whole  of  the  optic  disc.  As  the 
distention  of  the  vessels  proceeds,  the  minute  dots  and  streaks  blend 
io  a  uniform  blush,  which  invades  the  centre  of  the  disc  last.  As 
the  redness  of  the  disc  increases,  its  contrast  with  the  adjacent  fundus 
diminishes,  and  its  outline  becomes  inconspicuous,  or  lost  to  view,  in 
which  case  the  confluence  of  the  large  retinal  vessels  alone  maiks  its 
situation.  These  vessels  seem  to  end  abruptly  at  the  surface  of  the 
optic  disc,  the  redness  and  the  opacity  of  the  nerve  tissue  concealing 
their  deeper  vertical  portions  from  view.  Tbe  retina,  unlike  the  op- 
tic nerve,  is  not  reddened  by  simple  capillary  congestion,  the  reason 
being  the  largeness  of  the  meshes  of  its  capillary  net. 

'*  Ita  arteries  are  but  little  prone  to  enlargement  or  varicosity,  and 
they  readily  elude  notice  ;  but  its  veins  become  very  swollen  and  tor- 
tuous, and  as  they  lie  at  different  parts  of  their  course,  and  are,  there- 
fore, overlaid  by  a  greater  or  levs  thickness  of  retinal  tissue,  they  ap- 

>fa 


in  different  degrees  of  distinctness.  Thus  the  convex  bend  ol 
vein,  which  comes  close  to  the  inner  surface  of  the'  retina,  is  plainly 
Tistble ;  whilst  the  continuous  portions  of  the  same  vessel,  as  they 
dip  away  from  the  surface  toward  the  middle  retinal  strata,  becomes 
indistinct  and  tapering,  or  wholly  hidden,  and  thus  gives  the  veins  tbe 
appearance  of  being  interrupted. 

"  The  saturation  of  the  retina  with  serum  by  reducing  its  tranppar- 
eacjr,  produces  these  appearances,  and  the  presence  of  more  opaque 
intlammatory  products  still  further  intensifies  them.  The  degree  of 
concealment  of  the  deeper  portions  of  the  veins  is  a  measure  of  the 
extent  in  which  the  transparency  of  the  retina  is  diminished,  and  in 
this  way  \%  a  clue  to  the  quantity  and  nature  of  the  inflamn^atory  ef- 
fusion. But  we  possess  another  gauge  in  the  degree  in  which  the  cho- 
roidal coloration  of  the  fundus  is  damped,  because  the  view  of  the 
cfaorod  is  obscured  in  proportion  to  the  opacity  of  the  retina.  A  lit- 
tle aemm  which  only  produces  a  faint  haziness  of  the  retina,  but  slight- 
ly flattens  the  brightness  of  the  choroid  ;  whilst  dense  inflammatory 
prodncta  so  cloud  the  retina  that  the  choroid  but  dimly  ^limmeis 
throagh  it,  or  is  wholly  lost  to  view.     In  this  case  the  retina  has  a 

Jo«nwl  of  OpbtliAlBogy,  Vol.  1,  ao.  3.  pp.  104, 10& 


358  [Special  Sd^diont.  [Joae, 

dull  gray  or  stone  color,  blotched  with  mfitj  pfttcbea  wfaera  capillary 
hemorrhage  has  taken  place.  These  changes  m  the  retina  are  aocom- 
panied  with  a  cloudiness  of  the  vitreous  honior,  which  is  greats  in 
the  parts  bordering  on  the  retina,  and  decreases  toward  the  center  of 
the  humor. 

"  Tlie  following  forms  are  distinguished  : 

1.  Eetinitis  characterized  by  intense  redness  of  the  optic  disc,  great 
venous  congestion,  oedema  and  capillary  hemorrhage,  little  tenmicy 
to  deposition  of  lymph,  and  little  loss  of  transparency  of  the  niintl 
tissues  or  of  the  vitreous  humor.  Bet  simplex,  ret  apoplectica.  Ca- 
pillary apoplexy  of  the  retina. 

2.  Retinitis  with  less  vascular  turgescence,  bnt  with  free  infiltration 
of  the  i«tina  and  adjacent  vitreous  humor  with  lymph  and  corrospoiid- 
ing  great  opacity.    As  the  syphilitic  and  atrumona  retinitis. 

8.  Suppuration  of  the  retina. 

**  Retinitis  ends  in  resolution  and  recovery,  or  in  atrophy.  Where 
the  former  occurs,  the  distention  of  the  swollen  reins  sabaidet,  the 
spots  of  capillary  hemorrhage  disappear,  fading  from  the  edges  toward 
the  centre  ;  the  inflammatory  products  are  removed,  the  tranaparency 
of  the  letina  returns,  and  the  details  of  the  choroid  are  again  aharply 
seen.  The  redness  of  the  opiic  nerve  is  often  last  to  diaappear.  The 
veins  frequently  retain  their  tortuosity,  and  with  this  exception  the 
fundus  |)re8erve8  no  traces  of  the  previous  inflammation.  This  for- 
tunate termination  commonly  occurs  only  in  the  first  of  the  above 
three  forms  of  retinitis.  In  the  second  form,  complete  recovery  oc- 
curs only  where  the  exudation  has  been  in  limited  quantity,  and  tbe 
inflammstion  has  been  arrested  befoi-e  the  retinal  tissues  have  aufiined 
much.  In  a  very  large  proportion  of  cases  of  this  form,  atrophy  en- 
sues, and  when  the  vitreous  humor  has  become  6u£Bciently  clear  to 
allow  the  optic  nerve  to  be  seen,  this  is  found  shrunken,  oval,  or  other- 
wise distorted,  with  a  ragged,  jagged  border  ;  it  is  no  longer  distin- 
guishable. Branches  of  tbe  large  retinal  vessels  are  observed  to  be 
obliterated,  traces  of  them  remaining  in  the  form  of  thread-like  lines ; 
other  branches  have  wholly  disappeared.  The  fundus  is  blurred,  the 
choroid  is  confused  or  wholly  hidden  by  patches  of  retina  of  a  pecu- 
liar opalescent  yellowish- white  color,  in  a  state  of  fatty  disint^ration. 

The  third  form  of  retinitis,  the  suppurative,  always  ends  in  deatruc- 
tion  of  the  eyeball," — Bulks  on  the  Ophthalmoscope,  p.  41-48. 

Retinal  Hemorrhaob. — ^This  is  not  an  unfi*equent  canse  of  sudden 
loss  of  vision,  it  may  be  complete,  or  more  generally  a  portion  of 
the  retina  is  involved,  so  that  it  may  still  perform  its  funciiona  imper- 
fectly. There  is  usually  a  strong  red  glare  before  the  eye  if  aeen  early, 
and  often  deep-seated  pain.  The  iris  is  motionless  or  sluggish  if  di- 
lated, with,  no  improvement  in  vision.  A  patient  now  under  my  care 
has  passed  the  first  stage,  and  on  examination  a  deep-seated  greenish 
reflection  was  seen  in  the  eye,  and  on  an  ophthalmoscopic  examination 
effusion  was  found  upon  the  retina  covering  the  entrance  to  the  optic 
nerve.  8uch  a  case  may  be  improved,  but  from  a  severe  blow  and 
the  age  of  the  patient,  perfect  vision  will  not  be  restored. 


1864]  Spmol  BdedUm.  8S» 

A  jonng  boy  raoeiTod  «  blow  in  Ibe  eye  Realising  blindneit)  with 
a  8now  ball»  wbich  cansed  dilatatioa  of  papil  iris  slaggiab  aod  pink 
effusion  upon  the  retina.  Treatment,— Leeching  with  diaxetio8»  he 
entirely  recovered;  it  required  some  two  months*  treatment.  The 
blood  in  elderly  persons  is  changed  to  lymph  and  thus  causing  a 
whititfh  or  dark  cloud  before  the  eye.         / 

If  the  hemorrhage  is  not  produced  by  mechanical  violence,  as  in 
the  instance  before  mentionea,  it  proceeds,  according  to  **  Hnlke  "* 
from  the  capillary  vessels,  and  apoplexies  are  more  numerous  behind 
than  in  front  of  the  equator  ;  they  are  scattered  or  crowded,  in  which 
case  neicrhboring  ones  run  together  into  patches  of  considerable  siae. 
Fresh  blood-spots  have  a  rich  crimson  color,  deepest  at  the  centre  and 
falling  off  toward  the  edge  ;  older  ones  are  blacker  or  browniah  red, 
rusty  or  buff.  '*  The  effused  blood  is  either  completely  removed*  leav- 
ing no  trace  of  its  former  presence,  or,  what  is  much  more  frequent, 
in  the  sites  of  former  apoplexies  the  fundus  retains  a  confused,  patfohy 
appearance." 

Apoplexy  of  the  Betina.  This  is  occasionally  a  foremnner  of  an  at- 
tack of  apoplexy  in  the  brain.  An  interesting  case  of  this  kind  was 
related  to  me  by  Dr.  Dixon.  In  such  cases,  pain  is  felt  on  the  exam- 
ination. In  another  case  which  I  examined,  there  was  no  pain  on 
the  loss  of  vision,  nor  any  on  the  ophthalmoscopic  examination. 

R.  B.  A  countrymen,  a?ed  40  years,  diiited  pupil  with  no  per- 
eqpiion  of  light,  attack  sudden,  no  cause.  Directed  to  place  in  the 
eye  a  few  drops  of  solution  of  the  sulphate  of  atropia,  two  grains  to 
the  ounce  of  distilled  water,  it  dilated  the  pupil  well. 

Ophlhalmoicqph  Slgnn,  The  retina  was  found  covered  with  diSus* 
ed  patches  of  extravasated  blood.  It  required  some  four  or  five 
months  before  he  was  able  to  read  largo  sized  type,  and  the  retina  was 
left  opaque  and  mottled.  When  blood  escapes  from  the  rotina  into 
the  vitreous,  it  appears  by  reflected  light,  black,  and  is  very  slowly 
absorbed  ;  in  one  instance  it  required  six  or  seven  months. 

Comb, — A.  H.,  a  farm  servant,  set.  21,  who  said  his  health  had  al- 
ways been  good,  had  a  sudden  obscuration  of  the  right  eye  whilst  at 
work.  The  mist  which  was  at  first  not  dense,  increased,  so  that  per- 
ception of  objects  was  quite  loitt.  Six  months  after  this  he  came  to 
the  Royal  London  Ophthalmic  Hospital.  The  pupil  was  active.  The 
outward  appearance  of  the  eye  was  good. 

Opkikalmotcopie  Ayns.  The  retina  and  choroid  could  not  be  seen. 
The  upper  hemisphere  of  the  vitreous  humor  oontains  a  gray»  cloudy, 
floating  film,  witirsmall  brown  flocculi  below  it.  Whibt  still  lower 
than  this,  between  the  equator  and  ora  serrata,  there  was  a  large  dark 
mass,  which,  when  obliquely  illuminated,  had  a  deep  crimson  color, 
and  was  evidently  a  large  blood  clot. 

Otui€. — E.  M.,  flst.,  21,  a  gardener,  was  admitted  to  the  Royal  Lon- 
don Ophthalmic  Hospital.  Three  months  previously,  whilst  stooping 
to  clip  a  boxrow,  his  right  eye  was  obscured  to  such  a  degree  that  he 

•■«Uki  oa  tat  OpataalflMMopt,    p.  43. 


860  Beviem  €mi  N6Ht$$.  [Jtou^ 

oonld  not  discern  objeots.  I  conid  not  discover  aajtliing  wrong  In  the 
ezternsl  appearsnce  of  the  eye.  The  retina  wlw  jnst  sensitive  to  lig^ 
OpkihmM9copic  8ign9,  Extensive  retinal  apofdexiea  hiding  the 
entrance  of  the  optic  nerve,  and  large  clots  in  toe  viteona  hnmor.'' 
— Medical  and  Surgical  lUpoHer. 


!•    ■ 


%tvum  xitf  9«ti»$. 


The  Diseases  of  the  Ear,  Their  Diagnosis  ani^  Treatment.  A  text  iMok  of 
Aural  Bargery  in  the  form  of  Academical  Lectures.  Bj  Da.  Axrov  Vsi 
TmoaTscB,  Anral  Burgeon  and  Lecturer  In  the  University,  In  Wnrsburg,  Ba- 
varia. Translated  firom  the  German,  and  Edited  by  D.  A.  8t  John  Booia, 
M.D.,  A8S*t  Surgeon  to  the  New  Tork  Eje  Infirmary.  lUnstrated  wilh 
Wood  Engravings.  From  the  second  and  last  German  Edition.  New  Tork: 
Wm.  Wood  &  Co.,  1864. 

We  have  read  this  little  work  on  Anral  Surgery  and  Hedicins, 
with  more  than  usual  care  and  interest.  It  treats  of  a  field  of  profes- 
sional  labor  which  is  very  much  neglected  by  the  general  praotitioaery 
and  sadly  given  over  to  the  tender  mercies  of  unprincipled  quacks 
and  impostors.  The  genepal  introduction  of  this  little  book  of  Dr. 
Von  Troltsch  amongst  practitioners,  will  tend  greatly  to  do  away 
with  the  disrelish  for  this  department  of  surgery,  and  lead  us  to  real- 
ize that  we  may  do  a  great  deal  towards  relieving  many  of  the  afiec« 
tions  of  the  ear  heretofore  regarded  as  out  of  the  reach  of  treatment 

The  book  is  arranged  on  the  basis  of  a  series  of  lectures,  treating 
seriatim  of  all  the  important  diseases  of  the  auditory  apparatna,  com- 
mencing with  the  external  structures — the  meatus — ^the  internal  ear-^ 
the  nervous  supply-— the  eustachian  tube — together  with  those  various 
affections  of  the  nose  and  throat  which  indirectly  affect  the  condition 
of  the  mouth  of  the  tube,  and  therefore  of  the  ear  itself. 

The  mode  of  examining  the  ear — the  most  important  inatnaaents 
needed  by  the  aural  surgeon — are  carefully  detailed  in  their  proper 
order. 

In  the  treatment  of -diseases  of  the  ear,  it  occurred  to  us,  not  deeply 
experienced  in  this  branch  of  surgery,  that  a  very  prominent  place 
was  given  to  the  use  of  catheterization  of  the  eustachian  tube — the  air 
bath  by  means  of  the  catheter,  drc,  in  the  management  of  a  large  pro- 
portion of  the  cases  under  consideratien :  We  have  no  criticism  to  of- 
fer, only  it  seemed  to  us  that  the  remedy  seemed  of  most  too  univer- 


1864.]  JUvism  and  NeHca.  861 

sal  applicttion  to  feel  that  we  had  as  yet  readied  accuracy  in  our 
knowledge  of  the  subject. 

We  do  not  wish  to  be  captious,  but  there  is  a  fault  in  the  style  of 
the  book  that  is  objectionable  ;  we  found  too  many  places  for  comfort^ 
sadly  obscure  in  the  use  of  words  or  their  arrangement.  For  the 
most  part  we  can  arrive  at  the  meaning  of  our  author  by  the  conn^* 
tiouy  or  by  some  little  study,  but  the  meaning  is  often  too  muddy  for 
good  English  ;  as  illustration  take  this  paragraph  on  page  139 — ^the 
text  is  speaking  of  the  bad  effects  sometimes  occurring  from  the  sud- 
den reports  of  artillery,  the  blast  of  a  trumpet,  etc.  It  says—-"  Either 
a  laceration  of  the  membrana  tympani,  of  the  fenestra  rotunda,  a  push- 
ing  of  the  stapes  into  the  Testibule,  or  a  separation  of  the  extremely 
delicate  articulation  between  the  incus  and  stapes,  or  any  other,  ac- 
cord ing  to  the  kind,  force,  and  structure  of  the  powerful  movement  of 
the  air."  We  could  quote  a  great  many  similar  passages,  so  obscure 
as  to  render  it  exceedingly  difficult  to  determine  what  is  intended. 
Whether  the  fault  is  in  the  author  or  the  translator,  we  are  unable  to 
say,  though  these  passages  read  to  us  as  if  written  originally  in  Eng^ 
liah  by  a  person  slightly  familiar  with  our  language. 

Still  there  is  much  that  is  very  excellent  in  this  book ;  it  is  brief; 
for  the  most  part  the  instructions  are  to  the  point ;  and  physiciaoa 
will  pick  it  up  during  the  leisure  of  a  few  odd  days,  and  peruse  the 
whole  of  it.  We  can  recommend  it  to  our  readers  as  worthy  of  their 
attention. 

For  sale  by  R.  W.  Carroll  &  Go. 


Ike  AmerieaB  Journal  of  Ophthalmologj.    (Quarterly.) 

The  initial  number  of  this  valuable  Journal,  for  1864,  is  before  ua, 
being  Number  one  of  Volume  No.  two.  Dr.  Hombeiger,  the  Editor 
and  Proprietor,  is  doing  a  good  work,  and  we  hope  the  friends  of  Eye 
Snrgery  in  this  country,  will  afford  him  a  helping  hand,  both  in  sub- 
scriptions and  contributions.  The  present  number,  in  its  general  de- 
partment, is  largely  made  up  of  contributions  by  the  Editor  :  Arta- 
clee  on  Epilepsy  of  the  Retina  :  On  a  New'^ode  of  Performing  Iri- 
dectomy ;  Practical  Hints  on  the  Use  of  the  Ophthalmoscope  ;  A 
New  Mode  of  Applying  Atropine,  etc.,  etc.  A  case  of  "gouging" 
of  the  Eyes,  with  consequences,  and  A  Case  of  Pyramidal  Cataract, 
are  reported  by  Dr.  £.  L.  Holmes,  of  Chicago. 

Under  the  head  of  Journalistic  Reports,  the  Editor  has  condensed 
the  most  important  material  contributing  to  his  speciality  in  the  Joor- 


882  JStfadr't  IUU$.  -  [Jwm, 

nal  literattire  of  the  daj.  Especially  wa  obsenre  that  he  hita  had  ae* 
cess  to  the  Qerman  Journals,  and  made  fi-ee  use  from  them. 

The  Journal  is  well  printed,  the  paper  excellent,  with  aaYend  wood 
cut  illustrations  of  new  instruments  ;  and  aceompanying  this  mmkr 
is  a  beautiful  chromotype  view  of  "  The  eye-gronnd  of  a  light  haiied 
Bthject.** 

The  American  Journal  of  Ophthalmology,  heretofore  puUiihsd 
every  alternate  month,  now  appears  as  a  quarterly ;  and  is  pilUnhad 
by  Dr.  Julius  Hombeiger,  24  West  12th  Stiecft,  New  York,  attt  i 
year  in  advance. 


SAitav'K  tisihlt. 


Independent  Jimnudum. — ^This  is  a  common  phrase,  both  amongst 
Medical  and  Secular  Editors,  i  If  it  has  any  meaning,  we  aappoae  it 
is  that  persons  now  and  then  in  the  control  of  Jonmala,  are  ao  snr- 
rounded  by  circumstances,  oriso  constituted  mentally  or  phyaieally, 
that  they  can  speak  frankly  and  fully  the  honest  truth,  both  as  to  iacts 
and  criticism.  It  is  unquestionably  true,  that  in  the  history  of  Amer* 
ican  Medical  Journalism  publications  have  been  continually  projected, 
with  simply  a  purpose  to  subserve  ;  very  many  Medical  Journals  rep- 
resent Medical  Schools,  aud  are  desigued  mainly  to^promote  the  inter- 
ests of  those  connected  with  the  college.  Large  Publishes  have  from 
time  to  time  been  so  deeply  interested  in  the  pecuniary  affairs  of  Jour- 
nals, as  materially  to  influence  the  spint  of  its  criticisms  and  reviews. 
Various  other  interests  control  various  Journals.  And  yet,  despite 
these  circunstances,  we  believe  American  Journalism  is  quite  as  urn- 
tramelled  as  in  other  countries— H^uite  as  independent— indeed,  we 
have  sometimes  thought,  in  some  respects,  rather  much  ao.  It  is, 
however,  quite  the  fashion  for  men  not  connected  with  the  editorial 
management  of  a  Journal,  to  express  their  anxiety  for  that  happy  time, 
when  we  shall  reach  an  independent  press  : — all  new  editors  and  the 
projectors  of  new  Journals,  always  announce  this  as  their  grand 
purpofe,  the  establishing  of  an  independent  criticism.  An  editorial  ex- 
rience  of  near  ten  years  will,  we  suppose,  not  render  it  preaumptnons 
or  offensive  in  us,  if  we  say  this  cant  is  very  largely  "  bosh.*'-  Hon- 
esty is  desirable — ^frankness  is  desirable, — an  independence  based  on 
knowledge  and  culture  is  desirable ;  and  yet  we  have  met  with  a  great 


1804.]  £dkor*s  HtbU.  863 

deal  of  editorial  iodependence  in  our  day,  tbai  was  very  questionable 
in  its  propriety,  usefulness,  aod  even  tmth. 

The  judicious  editor  of  a  Medical  Journal,  should  keep  an  eye  out  for 
all  tbe  wide  spread  and  numerous  interests  of  the  profeesion — and  we 
hare  no  hesitation  in  saying  that  for  their  promotion,  we  are  often  re- 
quired to  exercise  a  great  deal  of  prudent  reflection,  that  to  the  unini- 
tiated, might  savor  of  dependence — when  it  is  only  a  proper  caution. 

"We  are  in  the  receipt  of  a  very  spicy,  and  in  all  respects  thus  far. 
unexceptionable  exchange — which  assumes,  both  in  its  title  and  edito- 
rial remarks,  to  be  par  excellence, — The  iMUptndetU  Medical  Journal 
of  this  country :  we  note  the  same  cant  to  which  we  have  just  alluded. 
It  announces  that  it  has  a  large  corps  of  editors,  some  ten  or  a  dozen. 
Its  editorial  Bta£f  are  as  yet  unannounced  to  the  public.  These  two 
circumstances  are  supposed  to  avoid  the  probabilities  of  outside  press- 
ure. We  cannot  for  the  life  of  us  see  how  either  circumstance  is  guar- 
antee for  any  particular  indepeudence.  So  far  as  the  strength  of  the 
editorial  corps  is  concerned,  we  fancy  a  little  experience  will  demon- 
strate this  as  its  fimt  element  of  weakness ;  and  how  their  names  be- 
ing unannounced  will  promote  their  independence,  we  are  too  dull  to 
understand — indeed,  so  far  as  the  general  reader  is  concerned,  we  sup- 
pose he  will,  from  the  very  first,  lack  the  most  desirable  assurance 
that  the  frankness  and  veracity  of  the  publication  is  to  be  implicitly 
relied  upon.  The  mere  formal  declaration  of  the  editors,  that  inde- 
pendence is  their  right — that  they  will  thereby  abide— that  they  will 
*'hold  fast  to  their  indep^dence  at  any  price,"  is  simply  the  old  re- 
hash of  new  editors ;  we  have  some  faint  remembrance  of  writing 
afker  a  like  fashion  ourselves  some  years  ago. 

We  do  not  say  these  things  out  of  any  111  nature,  or  any  lack  of 
ikiih  in  humanity,  fur  we  happen  to  know  something  of  the  ''inner 
asan  "  we  are  just  now  criticising — which  to  us  individually  is  a 
guarantee  for  good  faith — but  we  protest  against  the  implied  idea  that 
American  Journalism  is  prostrated  to  venal  purposes  and  objects — 
and  that  there  is  so  great  and  crying  a  necessity  for  an  independent 
medical  press.  It  may  exist  as  a  local  want — ^perhaps  in  New  York 
perhaps  in  Cincinnati — we  do  not  believe  th^ general  interests  of  the 
profession,  however,  are  so  dependent. 


Tk4  Medical  CcUtge  ^  OiUo.— The  death  of  Prof.  Lawson  last  win- 
•sr,  has  rendered  it  necessary  to  reorganiae  to  some  extent,  the  Faculty 
of  this  venerable  Institution.  We  have  no  official  information  concern* 
lag  the  nutter,  but  we  learn  by  common  mmori  that  some  changes 


864  iMift>r't3Ub.  [JoM^ 

have  taken  place,  looking  to  the  permanent  organittikm  of  iha  tchool 
for  fature  operations.  We  hear  that  Prof.  Qraham  ie  tranaferred 
from  the  Chair  of  Materia  Hedica/to  the  vacant  Chair  of  Theory  aod 
Practice :  Dr.  Comegye  retnms  to  hie  old  Chair  of  Pbyeiology  and 
Pathology  ;  and  Dr.  Theophiloe  Parvin,  of  Indianapolia,  la  eleoUdto 
the  Chair  of  Materia  Medica,  vacant  by  the  transfer  of  Dr.  Grahaa* 
We  do  not  understand  any  other  changes  have  been  made :  the  <mly 
new  man,  therefore,  is  Dr.  Parvin,  who  is  in  all  respects  a  high«ti»sd 
gentleman  and  an  accomplished  scholar,  as  well  in  general  letters  as  in 
the  strict  literature  of  his  profession.  He  has  already  depaited  for 
Europe,  and  will  spend  the  summer  abroad,  retaming  in  time  for  the 
Winter  Course  of  Lectures.  We  shall  gladly  welcome  Dr.  Parvia 
amongst  us,  and  doubt  not  he  will  make  a  valuable  and  aoceptaUe 
teacher  of  medicine. 

Thus  much  we  have  given  as  a  current  item  of  news  ;  when  the  ar- 
rangements of  the  Ohio  College  are  complete  and  duly  annoaneed,  it 
will  be  time  enough  for  us  to  say  whether  they  come  up  to  the  present 
demands  of  the  profession,  and  meet  its  just  expectation,  as  being  the 
oldest  medical  school  in  this  great  valley. 


ApcHogetie  Again. — We  have  been  obliged  so  frequently  to  aak  the 
indulgence  of  our  subscribers  during  the  present  year  to  our  short- 
comings, that  we  feel  mortified  to  speak  of  the  matter,  and  feel  almost 
tempted  simply  to  do  the  best  we  can  under  the  circumstances,  and 
make  no  comment.    The  fact  is  all  the  prinling  establishments  of  this 
city  are  overworked,  and  short  of  hands.     We  have  had  one  or  two 
"  strikes,"  each  time  materially  advancing  the  price  of  work,  and  all 
the  time  publishers  have  been  at  the  mercy  of  the  printers  both  as  to 
price  and  time.    The  delay  of  the  present  number,  however,  has  been 
in  great  part  owing  to  another  cause — ^paper  was  ordered  in  good  time 
for  our  issue,  but  that  too  is  one  of  the  **  fancy  stocks  "  of  the  mlirket 
and  is  not  subject  to  dictation — our  supply  at  this  date,  (80th  of  the 
month)  has  ju»t  come  to  hand.    These  embarrassments  are  quite  as 
vexatious  to  us  as  to  our  friends.     We  look  forward  to  the  time  when 
a  more  settled  state  of  the  country  will  permit  us  to  return  to  peaceful 
employments  and  regular  habits.     In  the  mean  time  we  return  our  ac- 
knowledgements to  our  well  tried  friends,  for  so  much  patience  and 
indulgence  ;  especially  manifested  in  the  fact  that  now  in  the  middle 
of  this  volume  for  1864  we  have  fully  reached  the  highest  circulation 
this  publication  has  ever  known,  having  fully  recovered  the  circula- 
tion lost  by  the  efiects  of  the  rebellion,  and  to  appearances  we  are  now 


1864]  Edkar's  TM4.  865 

steadily  on  a  growth  which  would  he  ahniidantly  satisfactory  were  it 
not  for  the  heavy  growth  in  expenditure^ 


Ohio  State  JMical  Society, — We  are  glad  to  learn  that  Andraw 
Wilson,  Esq  ,  will  he  in  readiness  to  take  care  of  the  State  Society  at 
its  annual  gathering  at  the  Ohio  White  Sdpher  Springs  on  the  2lBt 
inst.  What  would  the  Springs  he  without  the  genial  faoe  of  "  mine 
host,"  Andy  Wilson  ?  and  how  could  the  Society  meet  without  his 
thoughtful  foresight  ?  Dr.  Dawson  is  completing  arrangements  with 
the  various  railroads  for  a  half-fare  trip,  so  that  we  presume  all  mem- 
bers having  paid  full  fare  going,  will  be  returned  free  on  the  usual 
certificate  of  the  Secretary. 

We  expect  to  see  another  large  gatheriog  of  the  doctors  and  their 
families  at  this  meeting :  we  owe  it  to  ourselves  to  take  this-  much 
recreation ;  physicians  are  the  variest  slaves  in  the  world,  and  it  is 
alike  a  matter  of  health,  and  recuperation  of  mind  and  body,  to  lay 
aside  the  harness  once  a  year,  and  enjoy  a  holiday  and  the  social  in* 
terconrse  of  brethren.    Come  up  to  the  State  Society. 


Dr,  Thtopkilus  Parvln,  the  newly  elect  Prof,  of  Materia  Medica  in 
the  Medical  College  of  Ohio,  has  left  for  Europe  ;  as  we  understand 
he  will  devote  the  greater  part  of  the  summer  in  the  city  of  Edinburgh 
as  pupil  to  Simpson.  We  are  promised  regular  letters  foi  the  Lan- 
cet and  Observer  during  his  stay  abroad. 

The  Indiana  State  Medical  Socieit/  convened  at  College  Hall  in  the 
city  of  Indianapolis  on  Wednesday,  the  17th  of  May.  In  the  ab- 
sence of  the  President,  Dr.  Moffat,  of  Rnshville,  presided,  and  deliv- 
ered the  annual  address  in  the  evening.  The  address  was  spoken  of 
as  able  and  appropriate.  « 

During  the  second  day  papers  were  read  by  Dr.  Booker,  of  Castle- 
ton,  and  one  by  Dr.  Lockhart,  contributed  by  Dr.  Hutchinson,  of 
Iowa,  formerly  a  member  of  the  Indiana  State  Society.  The  paper  of 
Dr.  Booker  was  upon  the  prevailing  epidemic,  "  spotted  fever,"  and 
elicited  considerable  discussion. 

Dr.  Brower,  of  Lawrenoeburg,  pronounced  an  extemporaneous  but 
excellent  tribute  to  the  memory  of  four  deceased  members  of  the  As- 
•ociation,  r\z,:  Drs.  Ballard,  of  Indianapolis,  West,  of  Hagerstown, 
Elliot,  of  Thomtown,  and  Wilson,  of  Browmstown.'  And  at  his  in- 
ttaiiee  suitable  resolutions  were  adopted,  expressive  of  the  feelings  of 
be  Society. 


866  MHorU  TaUe.  [Jim, 

Dr.  S.  M.  LiDton,  of  Colnmbns,  was  elected  Pretidentfer  the  en* 
suing  year  ;  Dr.  W.  Lockhart,  Vice  President ;  D.  W.  M.,  Hamy, 
Secretary  ;  Dr.  W.fP.  Parr,  Assistant  Secretary  ;  R.  N.  Todd»  Cor- 
responding Secretary  ;  and  J.  H.  Woodbxirn,  Treasurer. 

On  motion,  the  Society  will  hold  its  next  session  May  1865,  at  tlie 
city  of  Richmond,  Wayne  Co.  ' 

On  tho  evening  of  the  second  day,  the  Indianapolis  Medical  Asso- 
ciation, gave  the  State  Society  a  fine  entertainment,  where,  betide^ 
ample  provision  for  the  comfort  of  the  inner  man,  sentiments  and 
speeches  were  the  order  of  the  occasion.  Dr.  Brown  responded  to 
'*  the  founders  of  the  Indiana  State  Medical  Society.*'  Bev.  Dr.  Nntt 
to  the  "  Literaiy  Institutions  of  Indiana.'*  Brief  speeches  were  also 
made  by  Drs.  Newland,  Parvin,  Moffitt,  Athon,  and  Tarioos  other 
gentlemen. 

We  have  to  regret  onr  great  personal  disappointment  in  not  being 
able  to  be  present  with  our  friends  at  this  meeting. 

New  Books. — Da  Coatas  Medical  Diagnosis  is  just  pnplished  by  J. 
B.  lipincott  <&  Co.  Blanchard  <&  Lea  have  just  issued  a  new  ^edition 
of  Bumstead  on  Venereal  Diseases  ;  and  the  long  promised  Ohsikria 
of  Hodge,  These  books  will  dout>tless  reach  us  in  time  for  a  notice 
next  month. 


Confederate  Medical  and  Surgical  Journal. — So  far  as  we  know  all 
the  old  medical  journals  of  the  rebellious  States  suspended  with  the 
beginning  of  the  war.  We  notice,  however,  a  paragraph  f^om  the 
London  Lancet  to  the  effect  that  a  Southern  medical  journal  with  the 
above  title  is  being  published,  but  at  what  point  in  the  Confederacy 
we  are  not  advised. 

Specialties, — ^There  is  still  a  question  amongst  onr  best  men  as  to  how 
far  the  practice  of  specialities  in  medicine  and  surgery  are  or  ought  to 
be  encouraged  as  legitimate  in  the  profession.  The  present  feeling  in 
this  country  undoubtediy  favors  the  practice  to  very  considerable  de- 
gree. The  danger,  however,  and  the  constant  tendency  is  to  modes  of 
advertising  and  announcing  direct  and  indirect  that  shall  savor  of  the 
arts  of  quackery  ;  inasmuch  as  legitinuOe  specialties  are  laigely  depend- 
end  on  the  influence  and  good  will  of  the  legitimate  profession  for  suc- 
cess, it  behooves  prectitionera  to  be  on  their  guard.  A  recent  number 
of  the  London  Lancet  alludes  to  this  aubject,  and  reviews  the  tenden- 


864.]  Bdiior*s  lUU.  867 

lies  of  specialities  in  America  with  some  sarcaim,  and  its  inferences 
ire  worthy  of  onr  careful  reflection. 


TravelUng  Agerdi. — H.  P.  Throop  and  J.  Bowk  Smith  are  anther- 
zed  agents  for  subscriptions  and  collections  on  this  Journal.  Mr. 
rhroop  will  travel  extensively  thronghont  Indiana,  and  Mr.  Smith 
irill  canvass  Ohio  during  the  present  Feason. 


Waniedj  at  this  office.  May,  1858  of  the  Lanedand  Observer ;  also 
Fannary,  February,  October  and  November,  1868.  For  a  copy  of  these 
lumbers,  either  or  all,  we  will  pay  25  cents  each  to  complete  a  set. 

The  yew  Baepitai. — By  the  invitation  of  the  Trustees  and  Medical 
^taff,  the  physicians  of  the  city  and  vicinity  had  an  opportunity  on 
Saturday  last  of  visiting  the  City  Hospital  of  Boston  before  its  pub- 
ic opening.  A  large  number  of  gentlemen  met  to  satisfy  a  curiosity 
IS  to  the  form  in  which  this  long  considered,  vexeil,  and  much  desired 
project  had  at  last  been  realized.  They  were  received  by  Alderman 
Norcross  and  others  of  the  Trustees,  and  were  conducted  over  the 
establishment  by  the  Superintendent.  We  think  that  not  one  of  thore 
irho  were  then  there  for  the  first  time,  had  any  previous  conception  of 
irhat  modem  skill  in  internal  architectural  appliances  and  apparently 
tinlimited  resources  might  accomplish  in  the  construction  of  a  hospital. 
To  those  who  had  spent  a  portion  of  their  student  life  in  European 
mediaeval  hospitals,  such  as  the  vast  lazarettos  of  Italy,  once  filled 
irith  plague-stricken  inmates,  or  the  monastic  and  sombre  institutions 
)f  Grermany,  or  the  old  halls  of  the  Hotel  Dieu  of  Paris,  all  simple 
itmctures  of  plainest  stone  and  wood  and  plaster,  but  .with  steps  worn 
by  feet  of  many  ganerations  of  stndents  and  famous  teachers  of  onr 
sTt,  it  seems  hardly  possible  that  all  this  magnificence  was  also  a  hos- 
pital, unless  designed  for  some  exalted  class  of  patients.  Certainly 
there  b  none  like  it  in  the  world,  was  a  frequent  exclamation.  And 
fet  with  all  the  splendor  of  marble  floors,  rich  carpets,  electric  clocks, 
lofty  dome  and  corridors  and  pavilions,  and  the  beautiful  systems  of 
machinery  for  heating  and  ventilating  the  building,  for  washing  and 
wringing  and  ironing  the  linen,  and  for  the  comfort  of  all  its  inmates, 
whidi  it  may  gratify  the  pride  of  a  wealthy  dty  to  have  founded,  it  is 
lo  be  remembered  that  its  success  as  an  institution  after  all  rests  al- 
most wholly  with  the  members  of  our  profession,  to  whom  it  is  so 
ioaa  to  be  given  in  charge,  and  it  is  to  them  that  the  pubUo  will  look 


868  JBHior'i  2Ufe.  {Jwm, 

to-see  tbat  the  large  aoioimt  of  money  thse  expoided  is  propedy  de- 
voted to  its  divinest  parpoBe. 

In  a  future  number  we  hope  to  be  able  to  give  onr  readers  a  full 
description  of  the  internal  arrangements  and  novelties  in  eonstmekbn 
of  a  hospital,  which  in  all  points  but  sise  most  rank  ampogths  most 
perfect  yet  built.  In  some  of  its  details  it  is  indeed  open  to  eritidsBi, 
but  these  defects  are  such  as  can  be  easily  remedied.  Two  wings  aie 
now  completed  and  furnished  for  the  receptfon  of  patients,  afibrding 
present  accommodation  for  one  hundred  and  fifty  patients,  medical  and 
surgical,  in  addition  to  the  elegant  private  wards  in  tte  eentral 
building.  It  is  to  be  open  to  the  sick  npon  the  first  of  Jame*  We 
are  sorry  to  hear,  however,  that  the  Trustees  have  deoidsd  te  azeMs 
from  its  walls  just  the  class  of  patients  for  which  alone  there  was  any 
imperative  need  of  hospital  accommodation,  namely,  lying*in>waaieD, 
and  those  affeoted  with  venereal  and  contagions  diseases.  Ift  saemi 
to  be  the  design  to  make  it  another  Massadinsetts  Gwieral  Hospital, 
a  plan  which  could  not  he  too  highly  praised  were  two  ineiitQiioas  of 
that  character  needed  at  pnsent  in  this  city  ;  bat  it  appean  to'vs  dist» 
if  this  exclusive  system  is  allowed  to  prevail,  the  petition  of  the  phy- 
sicians of  Boston  has  not,  been  answered,  and  that  we  still  have  si 
great  need  of  a  aiy  hospital  as  before. — Boston  Med.  and  Sur^.  Jom. 

List  of  Graduates,  Ac—Ai  the  annual  commencement  of  the  Med- 
ical Dapartment  of  the  University  of  the  Pacific,  held  at  Piatt's  Hall, 
San  Francisco,  March  18,  1864,  the  degree  of  Doctor  of  Medicine  was 
conferred  on  the  following  gentlemen,  by  Bev^M.  Bannhster,  Presi- 
dent of  the  University  : 

M.  A.  Cochot,  San  Francisco.    Subject  of  Thesis,  Delirium  Trepiens. 

D.  S.  Deal,  Marysville.  "  •'  Rhenmatism. 
W.  T.  Garwood,  San  Francisco.  •'  ««  Hydnigeo. 
J.fr.  Harrison,  Amador  County.    «                **          Puerperal  Fever. 

E.  B.  Robertson,  Mokelumne  Hill.*'  "  Primary  Syphilis. 
Owen  H.  O'Neil,  San  Francisco.  "  «•  Erysipelas. 
P.  S.  Stirling,  San  Francisco.        "                «'          Ovarian  Dropsy. 

The  charge  to  the  graduates  was  given  by  Prof.  Lane,  an  oration  in 

Latin  was  delivered  by  Prof.  Barstow,  and  the  exercises  closed  by  an 

appropriate  address  from  John  T.  Doyle,  Esq. — San  Frandseo  Med, 
Press. 


The  Illinois  State  Medical  Soaeiy  held  its  12th  annual  session  in 
Chicago,  commencing  on  the  12th  inst.,  and  continuing  three  days. 
Among  the  papers  read  were  J[two  on  cerebro-spinal  meningitis — by 
Dr.  J.  Adams  Allen  and  Dr.  R.  E.  McVey.    Dr.  J.  S.  Whitiftoia 


1864.]  JSdUor'i  HMe.  '   869 

also  reported  verbally  three  cases  of  ibe  same  disease  in  bis  practice. 
A  resolution  was  adopted  to  the  efipect  that  the  present  pay  and  rank 
of  surgeons  and  assistant  surgeons  in  tbe^army  are  disproportionate  to 
tbe  service  performed,  and  that  proper  exertions  should  be  used  for 
relief  by  national  legislation  on  the  subject. 

Old  Journals  Wanted, — To  complete  our  file  of  tbe  Western  Lancft, 
we  desire  to  obtain  the  following  back  volumes :  for  185^*44-'45 

A  medical  friend  also  desires  to  compUte  broken  setts  of  varioas 
Western  medical  periodicals,  and  has  made  out  the  following  list. 
Any  person  having  any  of  these  volumes  or  parts  of  volumes,  who 
will  dispose  of  them,  will  confer  a  favor  by  communicating  with  Dr. 
E.  B.  Stevens,  at  this  office. 

"  Western  Quarterly  Medical  Reporter."     Edited  by  Dr.  John  D. 

Godman :  Cincinnati,  1822—2  Vols. 

"  Ohio  Medical  Repository."  Dr.  Gny  W.  Wright  and  James 
M.  Mason,  Editors  :  Cincinnati,  1826—1  Vol. 

••  Western  Medical  and  Physical  Journal."     Drs.  Gay  W.  Wright 

and  Daniel  Drake,  Editors  :  Cincinnati,  1827 — 1  Vol.     Continued, 

AS  **  W^estera  Journal  of  Medical  Sciences,"  by  Dr.  Drake,  til!  1839. 

"  Louisville  Journal  of  Medicine  and  Suigery,"  by  Profs.  Miller, 
Yandell  and  Bell :  2  numbers  issued. 

*' Semi-Monthly  Medical  News,"  Louisville,  Ky.     Want  Vol.  1, 

No.  8. 

••  Louisville  Medical  Gazette."  Want  Vol.  No.  1,  6,  7,  8,  9,  10, 
11,  and  12. 

-  Nashville  Monthly  Record."     Want,  Vol.  1,  No.  8;  Vol.  2,  No. 

1,  3,  5,  6,  9,  10,  12 ;  Vol.  3,  all  after  No.  3. 

V  The  Western  Medical  Gazette."  Edited  by  Drs.  Eberle,  Mitchcl, 
Smith  and  Cross.     Cincinnati,  1832-35—2  Vols. 

'*  Ohio  Medical  Repository,"  (second  of  the  name.)  Cincinnati, 
1885—1  Vol. 

«*  Western  Lancet."  Dr.  L.  M.  Lawson.  Cincinnati*  1842.  Want 
Vol.  1,  Nos.  1,  2,  8,  11,  12,  or  whole  volnme;  Voh  2,  Nos.  10,  12, 
or  whole  volume  ;  Vol.  11,  No.  1 ;  Vol.  15,  No.  1 ;  Vol.  17,  No.  11 

"Transylvania  Journal  of  Medicine  and  the  Associate  Sciences." 
Edited  by  Drs.  John  E.  Cooke  and  Charles  W.  Short.  Lexington, 
Ky..  1828.  Want  Vols.  1,  B,  7,  8,  9«  11  and  12  epiire,  or  the>ntiro 
seL 


870  JSfitar'*  2Uf«.  [Jum, 

ArwKf  IMImI  hiMllQtMt. 

Surgeon  A.  C.  Schwaiswelder,  lTj9.y.,  as  Snigeon-iiMhaig^  Erqjh 
live  Fever  Hospital,  LouiavilerKj. 

Sargeon  William  Orinstead,  U.B.Y.,  as  Sui]gttOfi-iB-ChH  M  Di- 
vision, 11th  Army  Corps,  Department  of  the  pamberland. 

Surgeon  Wm.  Threlkeld,  U.S.y.»  to  NathTille,  Tenn, 

Surgeon  W.  Thidkeld,  U.S.V.,  as  Sorgeoii-in*bhaigi^  GvMnl 

Hospital,  Tullahoma,  Tenn, 

Surgeon  O.  S.  Palmer,  U.S.V.,  as  Medical  Dinolor,  11th  Armj 

Corps,  Department  of  the  Cnmberland. 

Surgeon  E.  S.  Fuller,  U.S.Y.,  as  Attending  Surgwm,  Sick  Bah- 

gees  at  Nashville,  Tenn.> 

Surgeon  J.  W.  Lawton,  U.S.Y.,  to  the  Department  of  the  Ohio. 

Surgeon  J.  A.  Philips,  U.S.N.,  as  Sui^geon-in-Ohief,  8d  DiTiaioii, 

14ih  Army  Corps,  Department  of  the  Cnmberland. 

Assistant- Snrgeon  W.  B.  Troll,  to  Loniaville,  Ey. 

Hospital  Steward  E.  J.  Doe,  U.S.A.,  to  Office  of  Medical  Director, 
Northern  Department,  Columbus,  Ohio. 

Hospital  Steward  C.  Nail,  U.S.A.,  to  Fort  Wayne,  Mich. 

Surgeon  C.  McMillin,  U.S.Y.,  to  special  duty,  ezaming  recmits  at 
New  York  City. 

Assistant-Surgeon  S.  H.  Horner,  U.S.A.,  as  Medical  Panrcjor, 

Department  of  the  Ohio,  Knoxville,  Tenn. 

Surgeon  S.  D.  Carpenter,  U.S.Y.,  as  Medical  Director,  District  of 

St.  Louis,  Mo. 

Assistant- Surgeon  R.  McOowan,  U.S.Y.,  to  the  Beserve  Artillery, 

Knoxville,  Tenn. 

Surgeon  F.  N.  Barke,  U.S.Y.,  as  Health  Officer  at  Memphis,  Tenn. 

So  much  of  Special  Orders  No.  107,  of  March  5th,  1864,  from  the 
War  Department,  as  relates  to  Surgeon  John  F.  Head,  U.S.  Y.,  is  re- 
'voked,  and  Surgeon  John  F.  Head,  U.S.Y,  in  addition  to  his  prssent 
duties  as  a  member  of  the  Board  now  in  session  at  Cincinnati,  Ohio, 
for  the  examination  of  sick  officers,  is  assigned  to  duty  as  member  of 
liie  Board  now  in  session  in  that  city  for  the  examination  of  Assist- 
ant-Surgeons of  Yolunteers. 

There  are  a  large  number  of  vacancies  existing  in  the  Corps  of  Sur- 
geons and  Assistant-Surgeons  of  Yolunteers,  and  in  the  Colored  Reg- 
iments the  need  of  Assistant- Surgeons  is  urgent. 

Surgeon  W.  M.  Chambers,  U.S.Y.,  has  returned  from  leave,  and 
resumed  his  duties  as  Surgeon-in-charge,  General  Hospital  No.  15, 
Nashville,  Tenn. 


1864.]  SdUarUTaih.  871 

Ckneral  Hospital  No.  1,  at  Padacah,  Ky.,  was  destroyed  by  order 
of  Colonel  Hicks,  oommandin^,  as  it  afforded  shelter  to  the  sharp- 
shooters of  the  rebel  Gkneral  Forrest's  cofkimaod,  in  the  late  attack  on 
that  place,  whence  they  killed  our  gnnners  in  the  fort.  The  patients 
were  all  safely  removed.  Oeneral  Hospitals  No.  2,  3,  and  4  suffered 
no  damage. 

The  Assistant  \  Surgeon-General  at  Louisyille,  Ky.,  has  directed 
Surgeon  Thomas  W.  Fry,  U.S.V^,  Superintendent  of  Hospitals  at 
New  Albany,  Ind.,  to  select  a  suitable  building  at  the  latter  place, 
and  fit  it  up  in  first-class  style  for  the  reception  of  sick  and  wounded 
soldiers  of  African  descent. 

Acting  Assistant-Suigeon  Charles  A.  MoQuestion,  n.&. A«,  to  Fort 
Wingate,  N.  M.,  as  Post  Surgeon. 

Assistant- Surgeon  J.  H.  Shout,  1st  Cavalry^  N.  M.  Vols.,  to  Fort 
Union,  N.  M.  as  Post  Surgeon. 

Sargeon  £.  J.  Whitney,  U.S.Y.,  as  Chief  Sufgeon  Expedition 
against  Northern  Apaches^  N.  M. 

Sargeon  S.  S.  Schultz,  U.S.V.,  to  special  doty  with  the  Provost- 
Marshal- General  of  Ohio. 

Sargeon  Frederick  Seymour,  U.S.Y.,  dismissed  by  sentence  of  Gen- 
eral Court-Marshal,  Special  Orders  No.  31,  current  series.  Depart- 
ment of  the  Cumberland. 

Large  Depots- and  Field  Hospitals  for  the  wounded  have  been  es« 
tablished  at  Belle  Plain  and  Fredericksburg,  Ya.  Thote  at  Freder- 
icksburg are  in  charge  of  Surijreon  E.  B.  Dalton,  U.S.V.,  and  at  Belle 
Plain  in  charge  of  Lieutenant-Colonel  J.  M.  Cuyler,  Medical  Inspector, 
U.S.A.  Previous  to,  and  awaiting  the  battle,  extensive  preparations 
were  nude  for  the  reception,  care,  and  comfort  of  the  wounded,  so 
that  in  Washington,  Baltimore,  Philadelphia,  and  New  York,  a  va- 
cnnt  bed  is  ready  for  every  wounded  man.  Of  course  a  large  number 
of  strere  cases  must  remain  in  Yirginia  until  they  are  able  to  travel. 
They  are  arriving  at  Washington  rapidly.  All  skulkers  are  sent  to 
the  front.  Immediately  upon  receipt  of  intelligenoe  of  the  locality  of 
the  wounded,  immense  supplies  were  forwarded,  with  a  large  number 
of  Army  Surgeons,  Cooks  and  Nurses.  lu  addition  to  these  Acting 
Sufgeon-Gkneral  J.  K.  Barnes  has  idso  granted,  up  to  noon.  May  14th, 
paiiei  to  71  Tolunteer  citizen-physicians  who  offered  their  senrioeB, 
and  to  378  nnrses,  also  volunteers. 


MARRIED. 


At  Mulberry  Orove,  on  the  22  inst.,  by  the  Ber.  Dr.  Jas.  HoppIe» 
Hob.  W.  p.  Kincaid,  M.  D.,  of  Neville,  0.,  to  Miss  Mollie  R.»  daogh- 
ter  of  Hon*  John  P.  Blair,  late  of  Clermont  Co.,  0.,  dec'd. 


872  Bditorial  JtHraeli  oncf  Selectum. '  f  Jane, 


.  Pnputd  bf  W.  B.  funcsiB,  M.  D.»  ladlaAifolik 


[   BUBGIOAL. 

1.  Acupresiure. — Dr.  Simpson,  in  one  of  hi8  clinical  kefliMS,  draws 
the  following  comparison  between  the  ligatnre  and  aevpreesave : 

ThB   LiOATUBB  AcUFRXSSUBa. 

1.  Requires  isolation,  and  con-      Beqaires  none, 
sequently  some  detachment  of  the 

end  of  thciYesseU 

2.  Prodnces  laceration  of   the      Prodnces  none. 

two  internal  coats  of  the  artery.  '  .  ' 

'8.  Prodnces  strangnlatioh  of  the      Prodnces  none, 
external  coat. 

4.  Leads  on    to  ulceration  or      Produces  none, 
mol^nlar   destruction  of  the  ex- 
ternal coat  of  the  constricted  part. 

5.  Causes  mortification  of  the      Produces  none, 
artery  at  the  tied  point,  and  usual- 
ly also  below  it. 

6.  Produces,    consequentlyi^    a      Prodnces  none, 
dead,  decomposing  slough  of  each 

part  ligatured. 

7.  If  organic,  it  imbibes  animal  Bequires  only  metalic  needles  or 
flnids,  which  speedily  decompose  threads,  which  are  incapable  of 
and  irritate.  imbibing  animal  flnids. 

8.  Bequires  to  produce  *the  Bequires  to  produce  inflamma- 
highest  stages  of  inflammation  at  tion  up  to  the^  stage  of  adhesion 
each  ligatured  end,  Tiz  :    uloera-  only. 

tion,  suppuration,  and  mortifica- 
tion. 

9.  Is  not  remoyable  except  by      Is  removable  in  an  hour,  a  day, 
the  slow  ulceration  and  sloughing  etc.,  at  the  will  of  the  operator, 
of  the  ligatured  vessel,  which  re- 
quires a  period  of  from  four  or  five 

to  twenty  days  and  more. 

10.  Generally  req^uires  two  per-  Bequires  only  one  person, 
sons  for  its  application. 

11.  Is  sometimes  followed  by  Is  seldom  followed  by  this  form 
secondary  hnmonliage,  as  an  ef-  of  secondary  hemorrhage,  as  there 
feet  of  ulceration  and  sloughing.  is  no  ulceration  or  sloughing. 

12.  Sometimes  faila  altogether  Has  succeeded  under  anSi  cir- 


4 
1864.]  Editorial  AhUradt  and  Seltetioni.  878 

in  cmses  of  recorring  secondary  cnmstances  when  the  ligatnre  has 
hfemorrhage.  failed. 

13.  Sometimes  cannot  be  ap-  Does  not  necessarily  reqnire  the 
plied  till  the  snrgeon  first  exposes  exposure  of  the  vessel,  and,  there* 
the  bleeding  vessels  by  the  knife,  fore,  has  sometimes  prevented  the 

necessity  of  using  the  knife. 

14.  Prevents,  as  a  foreign  body.  Is  early  withdrawn,  and  is 
adhesion  by  first  intention  along  hence  far  less  opposed  to  primary 
M  track  as  long  as  it  remains.         nnion. 

15.  Stops  only  the  artery  tied.      Stops  generally  both  artery  and 

^  vein. 

16.  Stops  only  one  artery.  May  close  two  or  more  smaller 

arteries,   by    means  of  a  single 
needle. 

17.  Is  not  unfreqnently  followed  Is  much  less  likely  to  be  f oV 
by  surgical  fever,  from  leading  to  lowed  by  surgical  fever ;  because 
the  formation,  and  allowing  ah-  it  does  not  lead  to  the  formation 
sorption  of  septic  matters.  of  septic  matter,  and   closes  the 

veins  as  well  as  arteries. 

18.  For  these  various  reasons.       Primary  union  more  frequent, 
primary  union  rare,  healing  slow,  healing  quicker,  and  septio  or  sur* 
and  septic  or  surgical  fever  not  gical  fever  less  common, 
uncommon. 

— Amer,  Med.  Times. 

2.  Enchondromaie  Tumor, — Dr.  H.  J.  Bigelow  has  reported  to  the 
Boston  Society  for  Medical  Improvement,  a  case  of  enchondromatus 
tumor  of  the  scapula,  which  gave  the  following  measurements :  Cir* 
cumference  of  base,  45  inches ;  antero-posterior  circumference  of  trans- 
verse and  vertical  diameters,  each  14  inches  : 

This  tumor  was  of  ten  years'  growth,  but  up  to  three  years  ago  it 
had  attained  only  the  size  of  a'  new  bom  babe's  head.  In  the  last 
year  it  doubled  in  size,  and  finally  produced  death  of  the  patient.  Af- 
ter death  it  was  removed  and  weighed  81  pounds. 

Another  case  reported  by  the  same  gentlemap  was  a  fibro-cellular 
tumor  growing  from  the  skin.  The  patient  was  a  young  woman  25 
years  of  age  ;  the  tarn  or  made  its  appearance  six  years  ago,  situated 
upon  the  left  buttock.  It  was  removed  and  weighed  18|>  pounds. 
The  wound  after  excision  measured  about  18  by  17  inches,  and  the 
patient  after  having  be^n  much  prostrated  recovered. — Boston  Medical 
and  Surjienl  Journal. 

o.  On  the  Therapeutical  Applications  qfthe  Solution  ofPermangoMiaU 
of  Potash  and  Ozone. — By  Samuel  Jackson,  M.D. — In  looking  over 
U&t  spring,  Bouchardat's  Annuaire  da  Therapentique»  eto.,  for  1868, 
1  met  with  the  statement  "  that  the  ozonized  water  of  the  English  is 
a  solution  of  the  permanganate  of  potassa,  in  the  proportion  of  two 
parts  to  one  thousand  of  water." 

Pincus  and  others  had  already  established  the  disinfecting  and  de- 
odorizing properties  of  the  solution  of  this  salt  These  iioUQ«a  va^- 
gested  to  me  the  thought  oi  teaiing  its  therapeutic  aci\oui  voii  ^xu^v 


% 

874  JUitorial  AUiradi  mU  SiUeUtm.  [Jqib, 

cal  applieatioo.    Mj  obaenratiooa  eommeiietd  ia- April,  bit  eonfined 

to  my  office,  my  investigations  were  of  coorse  limited. 

Having  prepared  the  aolntion  aocordingfto  the  ai>ov#  farmuli*  I 
proceeded  to  ascertain  its  soisible  properties  on  nyaelf.  It  liad  no 
proper  taste,  but  gave  a  sensation  of  coolness  in  the  mcMSth.  leaviag 
behind  a  slight  styptic  feeling  .and  dryness,  which  contioned  an  boor 
or  more.  Taken  in  the  dose  of  a  tea-spoonfh),  sligbtlr  dilata4»  tluee 
times  a  day,  it  produced  no  prominent  symptoms.  It  oaveed  no  in- 
convenience ;  there  was  some  increase  'Of  apjietite^  whifh«  boweiver, 
was  good,  and  an  easier  digestion.  A  diureuo  action  was  c^mos ; 
there  was  no  general  excitement,  increase  of  temperatnvs,  or  freqaeacy 
of  pulse.  A  few  days  after  I  prescribed  the  solution  in  a  oaea  of  dys- 
pepsia, attended  with  loss  of  appetite,  disordered  digestion,  and  ex- 
treme lassitude.  A  teaspoonfid  in  half  a  wine-glass  of  water  was 
directed  to  be  taken  four  times  a  day.  In  a  few  days  tha  patient  call- 
ed to  report  a  complete  recovery^ 

Four  cases  of  a  similar  character  were  treated  in  the  same  manner, 
with  a  prompt  and  successful  result.  In  only  one  slight  aoigieal  eass 
have  I  been  able  to  test  its  efifoets.  It  was  a  foul  ulcer  of  modMate 
size  on  the  leg,  the  veins  being  varicose.  The  solution  was  given  in- 
ternally, and  directed  to  be  used  as  a  wash  several  times  a  day»  walk- 
ing to  be  avoided  as  much  as  possible,  and  the  leg  to  be  h&pL  np.  In 
a  week  the  patient  presented  nimself,  the  ulcer  healthy,  ra[ndlT  cica- 
trizing, and  his  appetite  and  digestion  restored  with  improved  health. 

But  the  most  remarkable  and  almost  marvelous  effects  are  its  prompt 
in  most  cases,  its  immediate  action  in  the  treatment  of  gangrenous 
wounds  in  the  Campbell  Hospital  in  Washington,  and  in  dieiTnited 
States  Jarvis  Hospital,  Baltimore. 

On  the  19th  of  May  my  young  friend.  Dr.  Hinkle,  of  Marietta*  Pa., 
called  on  me  in  passing  through  the  city.  He  informed  me  be  was 
Aoting  Assisting  Burgeon,  U.S.A.,  and  was  then  stationed  at  Camp- 
bell Hospital,  Washington.  In  the  course  of  conversation  on  lus 
medical  and  surgical  experience,  he  mentioned  the  number  of  cases  of 
gangrenous  wounds,  particularly  in  the  wounded  at  the  battle  of  Fed- 
ericksburg ;  the  difficulty  of  treating  them,  and  the  ill  snooess  of  the 
treatment  persned.  I  informed  him  at  once  of  the  observations  I  had 
been  making  with  the  solution  of  the  permanganate  of  potassa,  and 
proposed  to  him  to  give  it  a  trial.  Having  a  conviction  that  ozone 
existed  in  the  solution,  I  was  strongly  impressed  with  the  belief  that 
it  would  be  found  adapted  to  such  cases.  The  Dr.  at  once  acceded  to 
my  proposition,  and  obtained  the  salt  at  Mr.  Blair's  on  leaving  my 
office. 

On  the  2bth  of  May  I  received  a  letter  from  him  of  date  24tb,  in 
which  he  informs  me  that  '*  in  reference  to  the  treatment  of  hospitil 
gangrenous  wounds  and  gangrene,  it  has  already  proved  beyond  all 
d^oription  efficacious  ;  in  the  action  of  the  remedy  yon  proposed  I 
find  more  than  I  expected,  and  almost  all  that  I  could  wish.  I  now 
give  you  a  prominent  case  as  an  illustration  of  its  valuable  effi^ts, 
and  the  instant  change  produced  by  its  local  application,  and  its  inter- 
nal administration  upon  tiha  gi^ets^  ODi».tMA»t  ^^bA  whole 


1864.]  EdiUmd  AbUradi  and  Sehdums.  875 

'  **  A  soldier  bad  received  on  extensive  gunshot  flesh  woand  at  the 
apper  fourth  of  the  tibia  and  fibula  of  the  right  leg.  The  integu- 
ments for  the  space  of  four  inches  in  length  and  three  in  breath  had 
sloughed  from  gangrene,  leaving  at  this  date,  Maj  23,  the  tibia  expos- 
ed for  three  inches.  The  whole  of  the  leg  and  up  to  the  middle  half 
of  the  thigh  is  infiltrated  with  a  putrid  ^anious  liquid  and  pus.  The 
dischafge  is  nearly  a  quart  per  diem. 

*'The  left  leg  had  been  penetrated  hj  a  minie  ball  at  the*commence- 
ment  of  the  popliteal  space.  A  considerable  amount  of  fluid  had  gravi- 
tated back  of  the  knee  joint,  which  was%  source  of  great  suffering. 
This  was  relieved  by  a  counter-opening  giving  a  free  discharge  of  the 
fluid.  The  treatment  was  commenced  ^y  23,  7  a  m.,  at  which  time 
the  situation  of  the  patient  was  very  critical.  Pulse  was  thread-like 
and  96.  Face  palid  with  anxious  expression  ;  head  covered  with  cool 
sweat.  The  general  temperature  below  the  natural  standard  ;  had 
slept  five  hours  in  the  hst  twenty-four.  The  gangrenous  surface  look- 
ed badly,  had  a  dark  g^reen  aspect  and  flabby,  exuding  a  sanious  liquid 
mixed  with  debris  of  dead  tissues.  The  odor  was  pungent  and  hiffhly 
oflfensive.  The  whole  leg  and  thigh  appeared  as  tnongh  melting  into 
this  fluid. 

*'  The  following  treatment  was  adopted  according  to  your  sugges- 
tion : — 9r. — Per  mang.  potassa  3j,  acid,  sulph.  gtt.  xx,  aq.  comm. 
Oij, — ^M.  A  teaspoonful  was  given  every  three  hours  in  a  wineglass 
of  water.  The  gangrenous  parts  were  washed  with  the  solution  ex- 
ternally and  internally,  and  charpie  soaked  in  it  was  kept  continually 
applied,  being  changed  as  often  as  the  dressing  became  saturated  with 
the  discharge,  or,  when  that  was  checked,  when  it  became  dry. 

"  The  effects  on  the  gangrenous  tissues  were  instant.  The  flabby, 
sloughing  and  indolent  surface  immediately  dried  up,  and  in  a  few 
minntes  presented  the  appearance  of  a  wound  to  which  a  solution  of 
nitrate  of  silver  has  been  applied  ;  or  that  of  a  delicate  eschar  from  a 
slight  bum,  yet  it  gave  no  sensation  of  pain.  In  three  hours  the  odor 
wms  greatly  lessened,  and  in  less  than  twenty -four  hours  it  was  barely 
to  be  perceived. 

*'  In  at  least  fifteen  other  cases  of  gangrene,  such  as  of  stumps  of 
limbs,  etc.,  its  action  was  no  less  efficacious.'* 

TIm  Doctor  concludes  :  "I  am  already  assured  that  it  (the  solu- 
tion of  permang.  potass)  is  of  the  greatest  value  in  cases  as  above 
mentioned." 

I  received  from  the  Doctor  a  communication  inclosing  the  history 
of  ten  cases  of  gangrenous  wounds  treated  in  Jarvis  United  States 
Hospital,  Baltimore,  with  the  solution,  and  in  all  the  gangrene  was 
promptly  arrested.  He  also  describes  the  mode  of  application  which 
he  has  found  the  most  UHcful  from  his  extended  experience. 

He  also  informs  me  that  he  in  making  out  a  report  to  the  Surgeon - 
Creneral  on  the  permanganate  of  potassa  and  its  uses.  In  this  he  will 
give  the  history  of  the  numerous  cases — I  believe  now  nearly  one 
handred— of  different  affections  in  which  he  has  employed  it.  A  du- 
plicate, he  states,  will  most  probably  be  pnbliaVied  \n  lVi«  Med\ca\ 
TSme0,  Co  which  I  refyr  for  a  full  confirmation  of  \r\iaV.  \  ^t^\^^) 


• 

from  my  limited  experience  reepeoting  the  tifaienkpeatio  totion  of  the  eo- 
Intioa  of  the  permanganate  of  potaeh.  I  huve  a  etiong  eonviction  that 
science  has  acquired  in  thia  agent  a  remedj  of  aetiva  powert*  of  nr 
tensive  application,  easily  procured  at  a  smalloost*  and  whidi  can  be 
used  without  apprehension  of  risks  to  be  incurred. 

Prof.  Jackson  then  goes  on  to  relate  his  escperimeats  to  aeeertain 
the  active  principle  of  the  permanganate  of  potash,  whieh  he  diacoT- 
ered  to  be  ozone,  and  that  the  solution  of  bromine  and  ohlorino  i^e 
their  medicinal  virtues  to  the  same  principle  as  the.permaiigmBate  of 
potash. — American  Journal  Hedicai  Seiene§$.  « 

4.  Treatment  of  DiarrhoMi.'^'DT.  Davis,  late  Suigeon  of  (he  84th 
Iowa,  writes  to  the  American  Medical  limee,  that  he  has  had  no 
tronble  in  the  treatment  of  diarrhcea  so  prevalent  in  the  army.  He 
uses  the  following  prescription :  Vs.  Spts.  nit.  dulc  jyj. ;  tr  opii 
3j. ;  stricbnine  gr.j.  To  be  given  in  dose  from  thirty  to  forty 
drops  four  times  a  day.  A  majority  of  the  cases  yielded  in  lorty-eight 
hours. 

Dr.  Lyman,  of  Chicago,  writing  to  the  same  journal  advocates  the 
use  of  castor  oil  as  a  most  useful  remedy  for  the  cUre  of  chronic  dis- 
ease  of  the  intestines,  and  gives  an  instance  of  a  soldier,  who  had 
been  sick  a  long  time,  resolved  to  try  the  eflect  of  a  **  thorough  greas- 
''  ing  inside,"  whereupon  he  swallowed  a  tumbler  full  of  castor  oil. 
No  purgative  effect  followed  this  draught  only  a  portion  of  the  oil  was 
voided  unchanged  next  morning. 

This  application  was  repeated  every  day ,;  recovery  commenced  im- 
mediately, and  in  a  few  weeks  was  complete,  and  has  never  been  fol- 
lowed by  any  return  of  the  disease. 

5.  A  New  Made  of  Applying  some  External  Agen^e  to  ike  JS^, — 
Since  1862  paper  has  been  used  as  a  medium  for  the  application  of 
sulphate  of  atropine  and  various  other  soluble  salts  to  the  eye*  but  is 
objectionable  on  account  of  its  stiffness,  and  difficulty  of  removing  it. 

It  is  now  found  that  gelatine  rolled  out  in  thin  sheets,  the  thick- 
ness of  thin  writing  paper,  and  imbued  with  any  salt  requirecL  this 
overcomes  all  the  objections  to  the  use  of  paper,  and  has  the  advan- 
tage of  not  requiring  to  be  removed  from  the  eye,  as  it  is  aoon  dissolv- 
ed and  acts  in  every  way  well. — BrU.  and  Foreign  Med.  Cki*  Bemew. 

6.  Coif  odium  for  the  Sting  of  Wasps. — Dr.  Munde  gives  his  ex|^ 
rience  with  collodium,  for  the  sting  of  wasps,  bees,  etc.  He  aays 
"  I  was  stung  by  a  wasp  in  the  first  joint  of  my  right  index  a  little 
below  the  nail.  The  pain  was  intense  and  inflammation  set  in  im- 
mediately. 1  seized  a  vial  containing  collodium,  and  covered  the  in* 
jured  place  all  over,  when  to  my  surprise,  the  pain  left  immediately, 
the  swelling  subsided  and  I  had  no  unusual  feeling  a  minute  after- 
ward than  would  be  caused  by  the  contraction  of  the  dry  collodium. — 
Lancet. 

7.  Atmospheric  Cure, — A  report  was  read  lately  at  a  sitting  of  the 
Societe  Medicale  d'Emulation,  on  a  curious  paper  by  Dr.  Foley,  in 
wbiob  be  reeommends  a  h\gh  aliaoHf\i^t\Q  ^\««iraxtt  aa  a  cure  for  vari- 


1864.]  lUitarial  AUtraeU  and  Sdedbnu.  877 

OQs  diseatas.  He  lemarks  that  fish  can  bear  the  greatest  possible 
barometrical  variations  hj  means  of  their  air-bladder,  whidi,  by 
swelling  up,  can  moderate,  and  eren  momentarilj  suspend  the  circu- 
lation of  the  blood.  The  permanence  of  viscero-mnscalar  paesanre  in 
fish  prbventa  the  formation  of  a  Vacuum.  The  air-Uadder  presses 
upon  the  vena  cava*  and  the  aorta,  and  thus  prevents  the  shook  of  the 
vital  fluid  on  its  return.  In  birds  there  are  air-bladders  all  around 
the  viscera,  and  nearly  resembling  the  lungs.  The  higher  a  bird  can 
soar,  the  larger  are  the  reservoirs  for  air,  covered  with  contractile  or- 
gans. The  very  bones  and  feathers  are  pierced  for  air,  and  in  the 
more  powerful  species  air-bags  are  provided  even  under  the  skin. 
The  ostrich,  the  casoar,  and  other  swift  runners,  have  their  laigest 
air-bags  nnder  the  muscles  of  the  thigh ;  the  condor^  swallow,  and 
others,  whose  power  nf  flight  is  great,  have  these  bags  under  the  mus- 
cles of  the  wing.  By  this  organisation,  all  these  creatures  can  bear 
any  amount  of  atmospheric  pressure  or  rareCsction  within  reasonable 
limits,  for  the  immentic  depths  of  the  ocean,  measuring  thousands  of 
fathoms,  for  instance,  are  unfit  for  animal  life,  and  &A  that  by  way 
of  experiment,  have  been  let  down  to  such  depths,  have  beeq  broqght 
up  again  dead.  The  effects  of  the  pressure  or  the  atmosphere,  though 
tolerablv  well  known  before,  have  been  quite  recently  tested  in  Eng- 
land, where  it  has  been  found  that  bottles  filled  with  liquids,  and  then 
well  corked,  but  so  as  to  leave  a  small  empty  epace  between  the  liquid 
and  the  cork,  would,  if  kept  for  an  hour  under  the  pressure  of  a  col- 
umn of  water  two  thousand  fathoms  high  (which  may  be  done  by  a 
hydraulic  press)  have  their  cork  pressed  down  to  the  very  surface  of 
the  liquid.  An  empty  bottle  had  its  cork  driven  in,  and  was  brought 
up  again  filled  with  water.  '  Applying  all  these  facts  to  therapeutics. 
Dr.  Foley  remarks  that  mountaineers  are  obliged  to  breathe  more 
quickly  than  men  inhabiting  the  plains,  because  the  air  is  more  rare- 
fied on  the  mountains  than  the  plains,  and  therefore  affords  less  oxy* 
gin  at  a  breath  than  the  denser  air.  Conversely,  therefore,  if  a  pa- 
tient be  in  want  of  more  oxygen  than  he  can  get  under  the  ordinary 
pressure,  let  him  be  exposed  to  an  atmosphere  rendered  artificially 
denser.  This  can  be  done  by  constructing  a  small  chamber  commu- 
micatittg  with  a  forcing-pomp,  and  provided  with  an  atr-gnige  and  a 
safety-valve.  A  patient  confined  in  such  a  chamber  may  be  subjected 
without  inconvenience  to  the  pressure  of  abont  two  atmospheres  and  a 
half.  By  this  treatment,  catarrh »  asthma,  and  other  complaints  of  the 
respiratory  organs,  may  be  removed.  In  croup  the  compressed  air 
will  flatten  down  the  adventitioas  membranes ;  and  in  disorders  aris- 
ing from  weakness  compressed  air  will  arterialize  the  blood,  and  in- 
creaea  the  vital  powers  of  the  patient. — Medical  and  Sofffuai  Beparier. 

8.  Fin4  Clay  a$  a  DretHng  to  SortM. — ^Dr.  Sohreber,  of  Leipiic, 
recommends  the  use  of  clay  as  the  most  "  energetic,  the  moot  innocent, 
the  moat  simple,  and  the  most  economical  of  palliative  applications  to 
iSufaoea  yielding  foul  and  moist  dischargee."  He  moreover  considers 
that  ift  haa  a  specific  action  in  accelerating  the  curs.  Clay  aofteuad 
down  in  water^  and  treed  from  all  gritty  pattidea,  la  \aA&t\i:jt(t  V{ 


878  JBiiitnM  AbtirM€i9  mU  StlittimiB.  ^        [Jane, 

layer,  OTer  the  affected  part  to  the  thiokneBi  of  atMwt  a  Hne.  If  it 
become  dry  and  fall  off,  fresh  layera  are  applied  to  the  eleaoaed  aor- 
face.  The  irritating  secretion  is  rapidly  abaorbed  bjr  tiie  day,  and 
the  contact  of  air  prevented.  The  enre  thns  goes  on  rapidly.  This  olay 
ointment  has  a  decisive  action  in'  oases  of  fcetid  penpiration  <rf  the 
feet  or  armpits.  A  single  layer  applied  in  the  morning  will  deatroy 
all  odor  in  the  day.  It  remains  a  long  time  snpple»  and  tlie  pieces 
which  fall  off  in  fine  powder  produce  no  ineonyenienoe.^£rWiA  JM. 
Journal,  April  11,  1868,  p.  881. 

[We  can  qnite  corroborate  Dr.,Schreber's  observalionst  having  used 
the  fine  clay  poultices  for  several  years-— chiefly,  however,  in  cases  of 
local  inflammation  requiring  the  application  of  cold.  Bags  wet  in 
water,  or  goulard  water,  so  rapidly  oecome  drr  and  hot  that  the  ben- 
^  efit  from  the  cold  application  is  completely  lost  There  ia  no  dirt 
when  the  clay  is  enveloped  in  a  piece  of  fine  linen,  and  ia  not  too  floid 
ia  consistence.— ^roiMiMMfo.] 

9.  Sore  NlppUs, — [The  plan  of  treatment  recommended  by  Dr. 
Castle,  of  Fortsmooth,  is  one  very  likely  to  prove  sooceasfQL  In  a 
very  obstinate  case  related  by  him  he  says :  J 

The  nipples  and  their  areol»  being  fissured,  bleeding  on  the  slisht- 
est  touch,  and  so  painful  that  the  application  of  the  child  was  dreaded, 
on  account  of  the  torture  to  which  the  mother  was  subjected,  1  employ- 
ed R  slight  coating  of  the  tinctura  of  benzoin,  co.  to  arrest  all  bleeding, 
and  having  carefiuly  dried  the  parts  with  a  soft  muslin  handkerchief, 
I  applied  a  solution  of  gotta  percha,  so  as  to  completely  surround  the 
nipple,  and  cover  all  abrasions,  giving  it  three  or  four  coatings,  allow 
^  ing  each  to  dry  thoroughly  before  repeating  the  application.  During 
the  act  of  suction  (only)  a  boxwood  shield,  with  calfs  teat,  was  used, 
and  in  the  course  of  a  few  days  all  was  well. 

I  make  the  solution  thus :  Outta  percha  tissue,  3j. ;  choloroform, 
Jiij. ;  first  place  the  tissue  in  a  bottle,  add  the  chloroform,  shake,  and 
it  wiU  soon  dissolve. 

The  film  rapidly  formed  by  the  evaporation  of  the  chloroform  is  firm, 
elastic,  and  harmless,  and  should  it  rub  off,  is  very  easily  replaced. 
The  almost  painless  nature  of  the  treatment,  the  effioctual  protectioa 
'  from  the  contact  of  the  air  and  irritation  of  tne  infant's  mouth,  re- 
commend it  strongly  to  general  use.  I  have  also  used  this  solution 
with  great  benefit  in  several  minor  cases  of  surgery  instead  of  collo- 
dion.—iftfc^.  TifM9  and  Gaz^U,  Ou.  10,  1868, /i.  886.— ^rotMiNuVf 
Betroyi€ct. 

10.  JVew  Application  qf  Chloroform. — M.  Graw,  a  French  physician, 
proposes  to  destroy  the  taste  of  intensely  bitter  medicines  by  mixing 
chloroform  with  them  in  certain  proportions.  He  claims  that  the  taste 
and  odor  even  of  assafoBtida  can  be  annihilated.    • 

11.  Deafness, — Dr.  Tobert  de  Lsmballe  gives  a  report  on  a  high- 
ly important  paper  from  Dr.  Phillppean,  on  deafness.  The  aouor 
describes  aome  new  experiments  on  the  perforation  of  the  drum  or 
tjrmpBn  of  the  ear.    In  order  to  aaofiitUitk  wV^^vViat  a  i^tient,  laboring 


1864.]  JBdidmai  AbHratti  and  SOidkmi.  879 

under  deafness*  can  hope  to  recover  bis  hearing,  or  not.  Dr.  Phillip- 
pean  applies  a  common  watch  to  his  temples,  and  if  he  hears  the  tick- 
ing his  core  may  be  considered  certain. 

12.  Otnerotion^ff  Oxygen  — Mr.  Robins,  the  analytical  chemist,  has 
jast  discovered  an  easy  way  of  obtaining  oxygen.  It  simply  consists 
in  heating  chromate  of  potash  and  peroxide  of  banum  with  diluted 
solphnric  acid.  The  operation  is  performed  in  a  common  glass  re- 
tort, at  the  ordinary  temperature.  Now  that  oxygen  is  becoming  a 
valuable  therapeutic  agent,  this  method  of  obtaining  it  will  be  fonnd 
far  more  preferable  to  the  old  one,  which  consists  in  healing  peroxide 
of  manganese  in  iron  retorts. 

13.  Bcematurea  of  the  Cape  of  Qood  Hope, — Whilst  we  are  dealing 
with  entoxoa,  we  must  refer  to  a  paper  read  by  Dr.  Harley  before  the 
Royal  Medical  and  Surgical  Society,  upon  hnmaturea  as  it  occurs 
epidemically  upon  the  Cape.  The  singularity  of  the  epidemic  led  Dr. 
Harley  to  investigate  its  cause,  and  in  examining  various  specimens  of 
urine  sent  to  him,  he  invariably  found  the  egg  of  an  entozoon  ;  and  in 
one  case  a  perfect  embryo  under  the  form  of  a  minute  ciliated  animal- 
cule, which  from  its  anatomical  character  he  places  among  the  trema- 
tode  class  of  worms,  and  to  the  family  Distomum.  It  is  called  the 
DUtoma  koemaiobium.  It  is  well  known  in  Egypt  and  other  parts  of 
Africa,  and  has  been  discovered  in  the  portal  blood  of  the  African 
monkey.  Both  man  and  monkey  are  supposed  to  get  this  parasite 
from  eating  small  mollusks,  or  drinking  the  unfiltered  waters  of  Afri- 
can rivers. 

In  the  cases  reported  by  Dr.  Harley,  the  urine  was  not  is  reality 
bloody,  bul^  after  micturation  a  little  blood,  never  exceeding  a  teas- 
poonful  appeared  with  the  last  half  ounce  ;  there  was  some  pain  oc- 
casionally in  the  loins. — London  Zoncei, 

14.  Tap4  Worm. — The  physician  to  the  Queen's  Hospital  has  been 
looking  aAer  tape  worni^  statistics,  and  finds  in  one  hundred  cases, 
thirty  were  males,  seventy  were  females,  all  middle  age,  all  cured  by 
oil  of  male-fern.     Longest  worm,  fifteen  yards. — BriL  Mtd,  Joumai, 


t 


OBSTERICAL. 


15.  Incision  of  the  0$  Uteri  at  a  Cure  for  £Sfm/fly — Dr.  Spencer 
Wells,  an  eminent  London  surgeon,  has  lately  endeavored  to  throw 
some  light  upon  the  mysterious  subject  of  sterility.  Admitting  that 
it  m-as  produced,  in  many  cases,  by  a  contraction  of  the  uterine  orifice, 
be  proposes  to  incise  this  orifice,  on  two  sides,  with  the  hysterotome 
of  Dr.  Simpson ;  an  instrument  analogous  to  the  ordinary  tenotome 
eaehs.  This  operation  may  be  performed  without  exposing  the  patient, 
the  fore  finger  serving  as  a  guide,  and  the  incision  being  enlarged  as 
the  instrument  is  withdrawn,  so  that  the  oa  tincce  be  divided  to  ita 
raginal  insertion.  Hardly  any  pain  or  hemorrhage  aceom\MLuie«  th^ 
operation.     However;  for  prudential  motives,  it  \a  n^W  V>  ^^%^^i^ 


880  JSd:toriaJ  AhUradt  and  Stl^eUmt.  f  June, 

t 

Tagina,  and  in  case  of  serious  hemorrbage,  to  applj  pledgets  of  lint 

saturated  with  a  solution  of  the  perchloride  of  iron.  SuDseqiie&tly 
repeated  cauterizations  with  the  nitrate  of  silver  will  .pTBYont  the  ra- 
union  of  the  small  flaps,  and  the  parts  will  present  the  appeanmce  of 
a  maternal  neck.  ^ 

More  fortunate  than  Mr.  Simpson,  the  surgeon  of  the  Samaritan 
Hospital  claims  to  have  observed  no  conseontive  attendants.  One  or 
two  days  of  rest  have  only  been  necessary  for  the  cure.  Sevonl  wo* 
men»  who  had  undergone  this  opeiation,  have  aabseqoently  beoome 
mothers.  In  other  cases,  he  has  thus  suoceeded  in  earing  painful 
cases  of  dysmenorrhoBa.  But  it  is  necessary,  in  order  to  obtain  this 
result » that  the  incision  includes  the  whole  ^length  of  the  nack^  and 
even  the  internal  orifice. — Bt.  LouU  Med,  and  Surgical  Jourmd. 

16.  Two  Canes  rf  Inversion  of  the  Uterus, — ^This  Tory  seiioaa  ac- 
cident is  said  by  the  books  to  be  of  rare  occorrenoe,  and  ia  nanally 
caused  by  hardships  and  force  used  by  the  accoucheur  in  removing  the 
placenta.  In  the  two  cases  reported  by  Dr.  Smithy  of  Peterabnrgh, 
N.  H.,  there  had  been  nothing  unnsual  abont  the  labor;  one  woman 
giving  birth  to  her  second,  the  other  her  seventh  child. . 

In  the  first  case  the  fundus  and  body  of  the  ntema  descended  through 
the  08,  and  lay  inverted  :n  the  vagina.  This  patient  was  in  a  col* 
lapsed  state,  by  pressure  with  the  fingers  persistent,  and  for  some  min- 
utes the  uterus  was  replaced.  The  patient  died  in  an  hour  after.  In 
this  case  the  inversion  is  supposed  to  have  followed  the  expnlaion  of 
the  placenta,  but  was  not  discovered  for  two  hours  afterward  while 
making  examination  to  arrest  the  continued  although  not  alanning 
hemorrhage. 

In  the  second  case  the  woman  had  some  flooding,  btit  this  soon 
ceased,  and  in  twelve  hours  her  physician  found  her  quite  comfort- 
able. Eighteen  hours  after  her  aocouchment,  whilst  sitting  upon  a 
vessel  to  evacuate  the  bladder  she  cried  out  that  "  something  had  come 
from  her,"  and  was  in  great  disti-ess  ;  and  the  doctor  found,  z  few 
hours  after,  the  inverted  uterus  and  vagina  1}etween  the  thighs.  He 
gave  stimulants,  ^warmed  the  prolapsed  organs,  and  returned  them. 
The  patient  died  in  four  hours. 

1^7.  Effects  qf  Suppressed  Action  rf  Skin. — Edenhuitzen  has  per- 
formed some  experiments  on  rabbits,  sheep,  a  dog,  sHid  other  animals, 
for  the  purpose  of  ascertaining  what  changes  take  -place  in  the  organ- 
ism, vv  hen  the  action  of  the  skin  is  suppressed.  When  one-eighth  to 
one  sixth  of  the  skin  of  an  animal  was  covered  with  glue,  oil-colors, 
varnish,  gum,  tar,  eto.,  it  was  sure  to  die  of  the  effects. 

Edenhuitzen  infers  from  his  researches,  that  in  the  healthy  state,  a 
small  quantity  of  nitrogen,  in  a  gaseous  form,  is  given  off  by  the  skin, 
and  that  this  function  being  suppressed,  the  nitrogen  is  retained  in  the 
blood  in  the  form  of  ammonia,  which  is  then  deposited  as  triple  phos- 
phate, in  the  subcutaneous  areolar  tissue,  and  in  the  peritoneum. 
The  nitrogenous  compound  retained  in  the  blood,  acts  as  an  irritant 
to  the  nervous  system,  producing  rigoi-s,  palsies,  cramps,  and  tetanic 
Mttacks. — Annual  of  Sdent'fio  Ditcovery. 


1864  ]  EdUorial  Abstradi  and  Seleettom.  881 

18.  Secretion  of  Urea  and  Chloride  of  Sodium, — Dr.  Etnil  Beeoher, 
Assistant  Surgeon,  Army  Medical  Staff,  took  advantage  of  a  voyage 
to  China,  to  make  a  series  of  observations  on  the  relation  between  air 
temperatare  and  the  secretions  above  mentioned,  as  carried  on  in  his 
own  person.  He  fonnd  a  constant  increase  of  the. secretions  with  the 
rising  of  the  temperature  from  50^  to  70^,  and  an  equally  constant 
falling  off,  with  the  further  rise  of  temperature  from  70^  to  90^. 

19.  Remarkable  Chemical  Terms, — ^The  production  of  numerous  new 
organic  bodies  in  chemical  research,  which  are  the  derivatives  of  sev- 
eral prior  derivatives,  have  led  chemists  to  the  coining  of  terras, 
which,  although  expressive,  are  in  some  instances,  absurdly  complica- 
ted and  unpronounceable.  Thus,  Messrs.  Pcrkin  h  Church,  English 
Chemists,  who  are  devoting  tdemselve^  to  the  preparation  and  prac- 
tical application  of  the  various  dyes,  and  other  derivatives  of  coal  tar, 
announce  in  a  recent  communication  to  the  London  Chemical  Society, 
that  they  have  discovered  a  new  organic  base,  to  which  they  have  ap- 
plied the  name  of  *'  Azodinapihyldiamine,*'  and  to  a  derivative  of  the 
base,  a  new  organic  acid,  they  give  the  still  more  remarkable  name  of 
' '  Axodinapthyldiciiraonanaic. *  * 

20.  Xew  Source  of  Orygenfor  the  Animal  Orpanijtm. — ^At  a  recent 
meeting  of  the  Munich  Academy  of  Sciences,  Baron  Liebig  announced 
what  he  considered  as  a  very  important  discovery.  The  atmospheric 
air  has  hitherto  been  regarded  as  the  chief  or  only  source  of  the  oxy- 
gen employed  in  the  process  of  nutrition  and  metamorphosis  firithin 
the  animal  organism.  By  the  aid  of  an  apparatus,  lor  which  the 
King  of  Bavaria  provided  7,000  florins  from  nib  private  purse,  it  has 
DOW  been  shown  that  within  the  bodies  of  camivora,  a  very  consider- 
able amount  of  oxygen  is  produced  from  water  ;  and  that,  under  given 
circumstances,  a  powerful  process  of  decomposition  is  set  up,  resolving 
the  water  into  its  constituent  parts,  its  oxygen  serving  for  the  forma- 
tion of  carbonic  acid,  and  the  hydrogen  f  which  often  exceeds  the  vol- 
ume of  the  animal  in  quantity),  being  discharged  by  expiration, 

21 .  Causes  of  Coagulation  of  the  Blood, — Prof.  Lister  observes 
that,  "  the  coagulation  of  the  blood  is  in  no  way  connected  with  the 
influence  of  oxygen  or  of  rest.  The  real  cause  of  the  coagulation  of 
the  blooil,  when  shed  from  the  body,  is  the  influence  exerted  upon  it 
by  ordinary  matter,  the  contact  of  which  for  a  very  brief  period  effects 
a  change  in  the  blood,  inducing  a  mutual  reaction  between  its  solid 
and  fluid  constituents,  in  which  the  corpuscles  impart  to  the  liquor 
sanguinis  a  disposition  to  coagulate. — Annual  of  Scientific  Discovery, 

22.  The  Efect  of  Petroleum  upon  Health  has  lately  been  made  the 
subject  of  investigation.  A  memorial  was  aent  to  the  Liverpool 
Health  Committee,  signed  by  several  hundred  citizens,  and  complain- 
ing of  the  storage  of  petroleum  in  their  neighborhood  as  "  a  nuisance 
and  prejndicial  to  health."  The  question  waa  referred  to  Dr.  French, 
the  medical  oflicer  of  the  Board  of  health,  and  after  a  very  thorough 
pcraonal  examination  of  the  case,  he  reported  that,  while  he  had  no 
Deaitmtion  in  pronouncing  it  a  nuisaoce  on  account  of  its  strong,  of- 


882  BiiioHal  AhttrueU  oM  8d§cUoik$  [Jm^ 

fensive  sinell,  hit  investigation  mlitfied  Mn  tbst  petroleum  wai  not 
prejadicial  to  health.  In  order  to  make  a  foil  inveetigatioft,  he  viait- 
ed  153  honrs  in  the  vicinitj  of  the  oil  atoiea,  and  fimnd  no  eaaea  of 
sickness  arising  from  the  pretrolenm.  Ibid. 

28.  New  SuhiiiMe/or  Alb^i^en. — ^In  conseqoenoa  of  a  priae  llaTiig 
been  offered  in  France  for  the  invention  of  a  snbstitnte  ror  albamM 
prepared  from  hen's  eggs,  an  albnmen  eapml  in  onali^  and  anidk 
cheaper  has  been  discovered,  which  is  made  from  fisa  roe. 

24.  Mieroictpie  Vse  <^  J^agenia  J)ye» — Magenta  dje  can  bo  amployad 
in  microscopio  research  to  great  advantage*  to  tinge  tbaUobd  i^bolea 
or  animal  cells.  It  causes  nndear  stmotiires  to  be  diattodly  displajed. 
— Annual  of  8deni>fie  DUeowry. 

25.  PaUtmnff  6y  NUro-Bentol^, — ^By  a  paper  commmkalad  to  Ae 
Boyal  Society  (O.  B.)  by  Dr.  Leterby,  it  appears  that  if  a  dote  oi  ni- 
tro  benzole  lie  not  too  large,  its  poisonous  action  will  not  be  imn«di* 
ately  apparent,  bnt  it  "  may  destroy  life  by  a  lingerinff  illneaay  whleh 
shall  not  only  defy  the  skill  of  the  physician,  bat  shall  also  baffle  the 
researches  of  he  jurist.''  After  death,  the  blood  of  animals  ao  kfllad 
is  black  and  turbid,  and  the  largans  congested,  and  no  niCfO-bauiola 
can  be  discovered,  if  sufficient  time  has  elapsed,  as  it  will  thtn  b^ 
converted  into  amiline*  Such  facts  show  the  necessity  of  having  qaed* 
ical  men  well  trained  in  chemistry.  The  conversion  of  the  latter  into 
the  former  takes  place  in  a  dead  stomach  or  by  contaot  with  putied 
flesh  for  several  hours. — Annuai  nf  Seniifie  Ditcovery. 


!•♦     •■ 


PRACTF.CAL  MEDICINE. 

TrichiniaM. — We  published  in  our  last  number  an  extract  from  a 
foreigpn  journal  relating  to  the  wholesale  poisoning  of  a  laige  aaaembly 
at  Hettstadt,  Gkrmany.    The  fatal  agent  used  was  Trichina  spiralis, 
served  in  hog's  flesh  at  a  feast.     Disregarding  the  injunction  in  Le- 
viticus concerning  swine,  *'  Of  their  flesh  ye  shall  not  eat,  and  their 
carcass  shall  ye  not  touch :  they  are  unclean  to  you,"  eightydiree 
persons  ate  and  died,  and  there  can  be  no  doubt  that  many  instaneee 
of  death  attributed  to  poison  or  mysterious  disease  are  doe  to  the 
same  cause.    It  would  really  seem  as  if  the  hog  were  created  to  serve 
as  a  foul  nursery  for  the  mo:it  loathsome  parasites  which  infest  man, 
and  our  aversion  to  him,  which  long  ago  amounted  to  complete  ab- 
stinence from  pork  in  any  form,  is  now  increased  tenfold  by  the  recent 
information  that  the  encysted  Trichinss,  which  are  occasionally  fonnd 
in  the  muscles  of  man  on  dissection  and  which  we  knew  were  derived 
from  the  muscles  of  swine,  instead  of  being  the  harmlesa  parasites  we 
have  hitherto  considered  them,  form  one  of  the  most  deadly  diaeaset 
known.    Untortunately  there  are  no  symptoms  of  triohiniaaia  in  the 
pig,  after  the  encysted  stage,  and  the  presence  of  the  capsules  wfaioli 
contain  the  worms  will  hardly  be  noticed  in  its  flesh  on  aoeooat  of 
their  near  resemblanoe  in  color  and  the  amount  of  fat  with  which  the 
latter  ia  infiltrated.    The  disease  haa  never  been  met  with  inany  herb* 


1864.]  lUdUorial  AbtAradt  and  Sel^eiUmi.  8S8 

ivoua  animaly  and  according  to  Langenback  trichinaB  have  been  fonnd 
in  great  nambers  in  earth-worms  (as  many  as  500  or  600  in  a  single 
worm); which  form  part  of  the  food  of  swine  when  at  liberty.  A 
committee,  consisting  of  Yirchow,  Remak,  Gnrlt  and  others,  has  been 
appointed  by  the  Berlin  Medical  Society  to  investigate  the  whole  sub- 
ject. We  add  for  the  further  information  of  our  readers  an  interest- 
ing account  by  M.  Davaine  of  the  symptoms  produced  in  man  by  this 
disease,  for  which  we  are  indebted  to  the  Apni  number  of  Tke  Amer- 
icon  Journal  of  the  Medical  Sdeneee : 

"  When  triehinie  exist  in  great  numbers,  their  presence  in  the  mus- 
cles or  intestines  produces  severe  and  sometimes  fatal  symptoms. 
These  symptoms  may  in  animals  experimented  on»  present  three  suo- 
cessive,  more  or  less  distinct  phases. 

**  The  first  phase  is  characterized  by  intestinal  disorder,  produced 
by  the  development  of  the  larvn  in  large  numbers  and  their  adhesion 
to  the  mucous  membrane  of  the  intestine.  In  this  stage,  M.  Davaine 
baa  seen  rabbits  die  with  intense  diarrhoea  ;  one  of  two  cats  which  he 
fed  with  trichinized  meat  had  diarrhoea  for  at  least  a  fortnight,  but 
survif ed.  Of  five  or  six  rats  fed  on  a  similar  diet,  one  only,  which 
was  pregnant,  died  of  diarrhoea,  after  abortion  on  the  eigth  day.  Ac- 
cording to  M.  Lenckart,  the  passage  of  the  embryos  of  the  trichina 
throng^  the  intestinal  walls  sometimes  produces  peritonitis.  This  in- 
testinal phase  often  becomes  blended  with  the  next ;  it  may  be  reliev- 
ed by  tb«  expulsion  of  the  worms  by  means  of  the  diarrhoea ;  or  may 
oease  with  the  natural  death  of  the  worms. 

"  The  second  stage  presents  general  symptoms — muscular  pains,  etc. 
These  phenomena  are  dependent  on  the  introduction  of  the  triehinie 
into  the  muscles  ;  they  rapidly  acquire  their  maximifm  intensity,  and 
have  not  a  long  duration.  The  appearance  and  duration  of  this  stage 
are  in  complete  relation  with  the  development  and  length  of  sojourn 
of  the  trichinae  in  the  intestines  ;  in  fact,  in  this  entozoon  oviposition  is 
not  slow  and  of  long  dnration  as  in  many  nematoid  worms :  the  genital 
tube  is  rapidly  formed,  and  the  ova  in  its  whole  length  are  developed 
almost  simultanconsly,  so  that  the  embryos,  arriving  soon  at  maturi- 
ty, are  at  once  thrown  out  in  large  numbers  into  the  intestine,  and  the 
mother  trichinae  dies  exhausted.  If  it  be  remembered  that  the  embryos 
do  not  escape  before  the  eighth  day,  that  a  certain  number  of  days  are 
required  for  their  arrival  in  the  muscles,  and  that  new  ones  are  not 
produced  after  six  or  seven  weeks,  it  will  be  understood  that  the  first 
syptoms  of  this  stage  can  scarcely  appear  until  the  end  of  a  fortnight 
after  isgesiion  of  the  diseased  food,  that  they  mast  continue  four  or 
five  weeks  and  that  after  this  they  may  disappear.  This  coarse  of 
events  is  observed  in  animals  ;  and  in  man  the  symptoms  of  this  stage 
bave  shown  themselves  and  become  aggravated  from  the  third  to  the 
sixth  week  after  infection.  Most  animals  die  during  this  stage ;  rab- 
bits rardy  survive  ;  rats,  on  the  contrary,  generally  resist  it. 

"  If  the  animals  do  not  die  of  the  general  symptoms  or  local  dis- 
turbaooes  proper  to  these  two  stages,  the  inflammatory  symptoms 
oease,  respiration  becomes  natural,  and  order  is  re-established.  But» 
in  some  cases,  the  number  of  cysts  formed  in  the  muscles  are  sufficient. 


884  ^itorial  Ahttraela  and  StUdlau, 

It  great  to  impede  the  proper  exerciie  of  their  fuactionsi  oncl  b«t)ce 
arise  generftt  dibility,  a  kind  of  consumption  whicb  persists  or  becomes 
aggravated,  and  the  animal  diea  of  raarasmue.  )1.  Davaino  has  no- 
liceil  this  in  rabbits,  bnt  especially  in  a  rat. 

"  Recovery  from  these  phases  of  triohinal  infection  may  he  appar- 
ently perfect.  A  rabbit,  which  M.  Davaine  kept  during  fiv«  luuntlu, 
became  largo  and  fat,  althoagh  it  had  a  large  ntmiber  of  tricbinx  ia 
'  its  muscles  ;  a  rat  which  had  had  these  entosoa  in  considerable  nnm- 
bere  during  tiiz  monLhs  was  to  all  appearance  in  good  h»lUi.  Ueoct 
ho  concluilea  that  the  trichinte  produce  symptoms  only  when  they  an 
in  the^ntCNtinal  canal  and  when  they  are  enteringthe  mnscles.  Rar- 
ing become  lodged  in  their  cysts  among  the  maHuInrtibrcs,  th»T  may  . 
remain  hormlesa  for  an  indefinite  time.  In  every  case  except  «>ii«^ 
down  to  1859,  trichioK  have  been  fonad  in  the  bodies  of  persons  who 
have  died  of  disease  (generally  chronic)  or  by  accident,  or  in  the  di«- 
sacting  room  in  bodies  regarding  which  the  previous  history  could  not 
be  obtained.  In  most  cases,  the  cysts  contained  a  cretaceous  or  fatty 
deposit,  showing  that  they  had  probably  existed  for  several  years. 

"  The  observations  which  .have  been  made  en  tbc  htima^  anb- 
ject  in  regard  to  the  symptoms  caused  by  trichinit  show  that  tbey  be- 
long, as  in  animnls,  to  the  intial  period  of  infection.  They  conMstin 
intestinal  and  muscular  lesions  ;  the  latter  coincide  with  the  entrance 
of  the  parasite  into  the  muscles,  and  are  tmelylranniatic.  In  Zen  Iter's 
case,  the  intestinal  symptoms  present  mere  swelling  and  pain  ;  ina 
case  descrilied  by  Friedrich,  diarrhoea  was  prosect.  In  all  eaeei,  the 
most  remarkable  symptoms  were  violent  rheunaloid  pains  in  the 
muscles,  not  in  the  joints,  which  were  considerably  aggravated  hy 
attempts  to  extend  the  lialf-bent  limbs.  The  other  i>ymptoins  hate 
been  variable,  but  have  had  a  strong  resemblance  to  ihose  of  typhoid 
fever.  In  novcral  cases  there  has  been  abundant  iwenting,  and  in  one 
there  was  a  very  remarkable  miliary  and  fnnincular  eruption.  The 
animal  heat  was  diminished  in  Fricdrich's  esse  ;  and  in  thos«  ob- 
served iu  Voigtland  by  F'reytag,  the  tomperalure  never  exceeded  102* 
Fah. 

"  The  progress,  duration,  and  severity  of  the  discnse  in  mHR  are  In 
relation  to  the  number  of  trichinae  taken  into  the  digestive  canal.  Of 
sixteen  patients  observed  at  Plaucn  by  Drs.  Bcehler  and  Kwntgadisf- 
fer,  eight,  who  were  moderately  aSected,  reoovend  in  a  month  ;  four, 
more  severely  diseased,  were  ill  two  months  ;  of  fonr  others,  one  died 
with  ascites  and  colliqnative  diarrhoea  at  the  end  or  two  months,  and 
three  recovered  slowly  at  the  end  of  [hroe'or  fonr  months.  Recovery 
does  not  imply  the  death  of  the  trichiaa) ;  it  follows  their  ioclosure  in 
cysts.  '  ' 

"The  diagnosis  of  trichinal  infection  haa  several  tim<?s  been  made  J 
in  the  living  human  subject  by  removing  a  portion  of  mnaols.  IC. 
Davaine  thinks  it  probable  that,  during  the  first  six  or  eight  wseka  of 
the  disease,  the  diagnosis  may  bo  confirmed  by  searohing  for  adnli 
trichinie  in  the  alvine  evacuations,  prodneed  naturally  or  bj  meaai  of 
a  purgative." — Botton  Medieal  artd SuryiealJouniaU 


Wlwtit  Toluae,  XXX- 


1                jiTi.r,    lae*. 

^.,..-  ' 

^^B 

imafi  faucet  ^  #bserto. 

^^f         mrriiD 

IsIKVKNS,  M.D.  •  1  JOHN  S.  MURKHV.  M.D. 
l_                  ^                                     _L 

CiapiSMATl: 


^m^m 

1 

COMTKNTb  KUK  JUI.V,  18».             ^H 

1 

j| 

1 

B 

1 

^^^^H 

.^^H 

1 

^^^^H 

F 

Dr.  Robort  Bartholow,          ^M 

(L«tn  A,»,U,M  S»rs»»H  V.  .S.  A.)            ^| 

Having  rotiKiiCfl  liii  lyiuiinlMbii)  to  llio  \mj  tiUtr  «  ■ciHm  ilT Mi^H 

lm«  pi>:nto<i  Into  pri raio pnciIciT-                                                           ^^H 

OFFICF  AND  IfHStPKyrK.                ^H 

i 

No.  Ml  Duo-  Stitfi,  ti<*fi!  Nixtl..                   ^H 

ciscis/Mri.  »fi^H 

^^^^^^^^^^          ^^B 

THE 

CINCINNATI  LANCET   AND  OBSERVER 

COKDDCTED  BT 

E.  B.  STEVENS.  H.D.,  AND  J.  A.  MURPHT.  ILD. 


▼oLTII.  JUIiT.  18e«.  No.  7 


0riflina(  (StrnvannUnUotis, 

ABTICLB    t. 

Empyema. 

Bvportod  by  Jamu  I.  Booku*  M.D.,  CMtlatoD,  ladJuiA. 

I  WM  called  to  see  John  W.  Wadswortb,  aged  47  years,  March  7th» 
1864.  I  was  informed  that  about  forty  days  previous  he  was  attack- 
ad  with  m  chill  followed  by  a  severe  pain  in  the  left  side,  and  consid- 
arrnUe  febrile  excitement,  supposed  to  be  the  result  of  cold  contracted 
while  traveling  on  the  care  at  night  from  the  western  part  of  Illinois 
Co  Indimna,on  a  visit  to  his  Uncle.  I  learned  that  his  previous  health 
had  been  excellent,  no  predisposition  to  hereditary  disease.  He  was  a 
farmer  by  occupation,  and  when  in  health  his  weight  was  about  two 
handled  pounds.  The  physician  who  had  been  in  attendance  previ- 
o«e  to  my  seeing  him,  had  supposed  the  case  to  be  pneumonia  with 
•olidification  of  the  left  lung,  and  had  been  treating  the  case  on  this 
hrpothesis  for  forty-two  dayn, 

I  fbnnd  him  with  pulse  122  per  minute,  respiration  24,  anxious 
appearanoe,  propped  up  in  bed,  was  not  able  to  drink  more  than  a 
vpoonfal  of  water  at  a  time,  as  he  said  it  "  worried  him  so,"  hands 
and  ieei  cold,  no  appetite,  has  had  frequent  shivering  followed  by  a 
low  continued  fever,  very  sore  mouth  the  result  of  previous  ptyalism. 
f  Ob  making  further  examination  I  found  the  inner  costal  spaces  of  the 
kft  side  filled  up,  in  short  an  edematous  condition  of  the  entire  left 
ude  extending  down  to  the  foot.  By  auscutation  I  detected  the  heart 
tartiag  on  (he  left  side  two  inches  to  the  right  of  the  sternum,  dia- 
phragm presaed  down.  By  percussion  I  detected  dullness  over  the 
vn.— 7. 


386  Original  Communieatians.  [July, 

entire  left  side.  I  was  fally  convinced  that  I  had  to  treat  a  cam  of 
hydrothorax,  or  empyema.  Conclading  that  my  patient  was  too  weak 
to  stand  an  operation,  I  resolved  to  pnt  him  on  a  stimulating  and  tonic 
course  of  treatment.  Two  days  after  this  I  found  him  moch  wone» 
nothing  that  I  had  given  him  had  had  any  effect  for  the  hetter,  bis 
pulse  was  much  more  frequent,  breathing  more  laborons,  I  did  not 
think  my  patient  in  bis  present  condition  could  survive  twelve  honn, 
and  resolved  on  resorting  to  an  operation.  I  first  introduced  an  ex* 
ploring  needle  between  the  seventh  and  eighth  ribs,  which  was  foiloir- 
ed  by  an  expulsion  of  a  few  drops  of  pus.  A  messenger  was  dispatch- 
ed for  Dr.  Buddell,  of  Allisonville,  who  brought  a  large  sixed  trochir 
which  was  introduced  in  place  of  the  exploring  needle,  which  wts 
followed  by  pure  pus,  that  came  out  with  such  violence  as  to  strike 
the  wall  some  four  feet  from  where  my  patient  lay.  One  palian  osi 
a  h§Jfio(u  taken  away  at  this  tapping.  It  was  all  carefully  meunred. 
In  the  place  of  our  patient  becoming  weaker,  his  pulse  became  sloirer, 
bis  breathing  less  frequent.  We  introduced  a  tent  extemporised  bj 
Dr.  Bnddell  out  of  a  piece  of  elm  bark,  held  to  its  place  by  a  bandige* 
Oa  the  following  day  the  tent  was  removed  and  a  female  catheter  in* 
trodnced,  when  we  drew  off  three  qnarts  more.  We  found  consider- 
able difficulty  to-day  in  drawing  it  off,  owing  to  the  instrument  be* 
coming  filled  with  lymph  ;  after  this  the  cathether  was  introduced 
every  day»  and  we  drew  off  in  the  first  six  days  four  gallons  of  sero 
purulent  matter. 

Drs.  Bnddell  ,  Bowles,  and  Conklin  saw  the  case  with  me ;  Dr. 
Buddeil  attendeil  in  consultation  every  day  for  the  first  three  weeks. 
After  the  first  six  days  I  injected  into  the  pleural  cavity  warm  water 
at  first ;  sometimes  as  much  as  three  quarts,  or  one  gallon.  After 
this  as  an  injection  we  used  strong  soap  sAds,  made  of  castile  soap* 
The  catheter  was  introduced  and  after  the  pus  was  drawn  off  injactioas 
of  soap  suds  was  used  every  day  for  eight  weeks.  He  was  put  on  the 
use  of  ale,  and  cod-liver  oil,  etc.  Our  patient  improved  gradnally. 
In  about  six  weeks  from  the  time  I  operated  he  was  able  to  get  up 
and  dress  himself,  and  take  his  regular  meals  in  the  dining  room.  I 
discharged  him  May  13th,  almost  well.  He  started  for  home  May 
14th,  some  four  hundred  miles,  in  good  spirits. 

BsMABKs. — The  afiove  case  is  an  interepting  one  from  several  con- 
siderations. First,  cases  of  this  character  ai'e,  I  believe,  generally 
fatal,  and  it  is  therefore  interesting  for  statistic  1  purposes.  Second, 
how  absolutely  essential  is  it  for  the  general  practitioner  to  be  well 
versed  on  the  subject  of  auscultation  and  percussion.    Had  a  correct 


18ft4]  Uhdirwood — Purpura  H0tmorrhapica.  887 

diagnosis  been  made  in  this  case,  it  might  never  have  terminated  as  it 
did.  Third,  as  to  treatment  the  orifice  in  this  case  was  kept  open  all 
the  time,  and  injections  thrown  into  the  cavity  once  every  day,  for 
two  months  ;  in  this  case  I  nsod  strong  soap  suds,  and  in  this  con- 
nection I  will  say,  that  at  times  the  discharge  was  very  oflfensive,  and 
I  woald  then  add  with  the  soap  snds,  common  salt  As  is  common 
in  cafes  of  this  character  there  was  a  sinking  in  of  the  ribs  on  the  dis- 
eased side,  and  I,  do  not  suppose  that  the  left  Inng  will  ever  be  of 
much  use  to  him.  The  patient  also  indines  to  bend  over  to  the  left 
aide  in  walking. 


^*«  AETIOLB  If. 

Purpara  HamorrhafiM.  ^ 

Ed.  Lakcet  and  Observer  : 

I  do  not  propose  to  enter  the  list  of  contributors  to  yonr  valuable 
Jonmal  as  an  essayist,  but  for  the  benefit  of  the  profession  give  my 
experience  in  the  treatment  of  some  diseases  of  rare  occurrence  in  this 
section  of  the  country,  and  the  result  of  that  treatment. 

Purpura  hseroorrhagica.  the  most  complicated  of  any  of  that  class 
of  diseases  that  come  under  the  nosological  arrangement  of  "  cachexia  " 
of  authors — scorbutic  cachexia,  "  caciiexia  scrofulous,"  etc. 

On  the  24tk  of  February  last  I  was  called  to  see  a  little  girl  aged  20 
months,  and  from  the  parents  I  learned  that  about  the  25th  of  Decem- 
ber she  was  attacke<l  with  pertussis.  The  disease  progressed  in  a 
cnild  form  until  the  middle  of  January ;  Ibeat  this  time  she  had  an 
attack  of  pneumonia  of  the  right  lobe  of  the  lungs,  which  terminated 
Csvorably,  and  about  the  5th  of  February  was  dismissed  by  her  attend- 
lug  physician  as  convalescent.  Nothing  occurring  to  alarm  or  create 
Qoeafciaese  in  the  minds  of  the  parents  uattl  three  er  four  days  before  I 
•nw  her.  Her  parents  are  healthy  persens,  and  appear  to  be  entirely 
clenr  of  all  cacbectto  taint,  and  natives  oi  the  State  of  New  Jersey. 
The  little  girl  has  light  blue  eyes,  light  hair,  fair  skin,  of  a  nervous 
«noguine  temperament,  and  very  intelligent.  Present  condition,  irri- 
table, restless,  pulse  quick,  fn^quent  and  rather  feeble,  general  surface 
covered  with  petecheal  spots  from  the  size  of  a  pin  head  to  the  size 
oC  a  quarter  of  a  dollar,  mucous  membrane  of  the  mouth  and  nostrils 
and  at  many  points  tnmorfied,  blood  was  constantly  ooaing 


388  OiigintU  Communications,  [Joly, 

from  the  gums,  noee,  and  greater  labia  wbich  were  mncli  awollen 
and  abraded,  one-balf  the  evacuations  from  the  bowels  and  bladder 
appeared  to  be  dark  grumoas  blood,  some  appetite  for  milk  bat  for 
nothing  else. 

Treatment :  ^  sulph.  mag.  Ji. ;  aqua  para  (vi.  acid  aulpk  f  3iii. 
M.  S.  teaspoonfal  every  four  hours  for  twenty-foor  hoars. 

February  25th — Patient  same,  continued  same  treatment. 

February  26th — Hemorrhage  subsiding,  ordered  the  mbOTe  pre- 
scription to  be  given  every  six  hours  and 

]^  iodide  patassa  grs.  xxx. ;  iodide  ferri  grs.  v. ;  aqua  para  iiu 

M.  8.  Twenty  drops  to  be  given  every  six  hours  alternating  with 
the  other. 

Conti.:\  ^d  this  treatment  up  to  the  4th  of  March,  recommending  ts 
nouribhn  cut  suculent  vegetables  and  fresh  soups. 

March  4th — Hemorrhage  entirely  stopped,  tumofaction  gone,  pur- 
ple spots  changing  to  a  light  greenish  yellow.  Ordered  the  above 
treatment  continued  at  Jonger  intervals. 

March  16th — Patient  quite  convalescent,  good  appetite  for  food  of 
Any  kind,  sleeps  well,  is  cheerful  and  happy.  Patient  discharged 
well. 


*  ^•^ 


ASTICLK  III. 


Post-Partum  Hemorrhage. 


BT  F.  WAQNER,  M.D.,  KIL80,  IVD. 


It  has  been  so  generally  believed  that  the  introduction  of  the  hand 
into  the  uterus  would  always  bring  about'  speedy  contraction  of  that 
organ,  and  therefore  arrest  the  hemorrhige,  provided  the  hemorrhage 
depended  on  inaction  or  rather  noncontraction  of  the  womb,  that  I 
venture  to  send  you  the  following  account  of  a  case,  which  has  re- 
ccn'iy  occurred  to  me,  and  which  goes  far  to  shake  my  faith  in  that 
r^.octrine. 

On  «he  28th  of  April  last,  I  was  called  at  one  o'clock  a.m.,  to  at- 
tend Mary a  single  woman,  in  labor  with  her  first  child.     She 

had  been  in  labor  since  4  o'clock  p.m.  the  day  before.  At  the  time  I 
was  called  the  old  woman  in  attendance  declared  that  something  was 
.  WTon^,  and  wanted  a  physician  sent  for.  I  was  informed  that  the 
**  waters  had  broke  an  hour  ago,  and  that  she  flooded  the  bed."  On 
making  an  eaamfnation  however,  I  found  (he  ammiotic  sac  entire, 


1864.  VfAQ^u-^Poit'Porium  BmMrt\ege.  889 

and  the  breech  presenting,  (sacram  resting  npon  the  pnbis  of  the  moth- 
er. I  waited  for  sometime^  so  as  to  have  the  membranes  almost  pre- 
senting externally  before  rupturing  them.  Progress  was  very  slow, 
pains  came  on  bnt  once  every  half  honr  or  three  quarters  of  an  hour, 
and  were  then  very  ineflfcctoal,  so  that  it  was  nearly  nine  o'clock  a.m. 
before  the  child  was  born.  This  was  very  lai^ge,  the  largest  I  have 
ever  seen.  While  preparing  to  lay  on  the  bandage,  (the  placenta  had 
come  away  naturally)  I  noticed  that  the  patient  all  at  once  became 
deadly  pale,  at  the  same  time  I  heard  a  slight  gurgling  sound,  which 
caused  me  to  drop  every  thing  and  introduce  my  hand  into  the  womb, 
with  the  least  possible  delay,  encountering  on  the  way  a  perfect  stream 
of  blood.  Less  than  a  minute  before,  I  had  my  hand  on  the  uterus 
externally,  and  was  mentally  congratulating  myself,  how  nicely  it 
WAS  contracting  and^on  its  small  size,  after  such  a  protracted  labor. 
When  my  hand  arrived  in  the  cavity  of  the  uterus,  I  found  that  the 
anterior  wall  had  contracted  into  a  ball  (hollow)  the  fist  just  finding 
room  within  it.  I  did  not  know  what  to  make  of  it  at  first,  as  I  had 
a  right  to  think  that  from  such  a  uterus  no  such  gushes  of  blood  could 
issue.  With  drawing  my  hand  a  little  I  found  a*  other  entrance,  and 
such  a  state  of  things  as  made  the  hemorrhage  easy  enough  to  explain. 
The  posterior  wall  was  perfectly  flabby,  taking  parts  between  my  fin- 
gers and  pinching  them  had  no  effect  whatever.  At  length  the  ante- 
rior contraction  ga^e  way  to  some  extent,  when  a  slight  contraction 
took  place  throughout  the  organ,  and  I  could  feel  that  the  hemorrhage 
had  ceased.  It  must  be  recollected  that  up  to  this  time,  I  made  my 
wrist  act  as  a  plug,  and  no  blood  could  excape  externally.  The  whole 
operation  had  lasted  about  fifteen  minutes.  I  incautiously  withdrew 
my  hand  a  little  too  soon.  Preparing  to  give  her  some  ergot  I  heard 
her  shriek,  "  Doctor  its  commencing  again,"  I  instantly  re-introduoed 
my  hand,  and  fonnd  the  vessel  from  which  the  blood  flowed.  Hem- 
orrhage had  been  more  free  the  second  than  the  first  time,  but  by 
compression,  which  wsk  easily  effected,  it  was  promptly  arrested.  But . 
the  uterus  would  not  contract  in  spite  of  my  hand.  I  worked  and 
kneaded  externally  but  there  was  the  firmly  contracted  anterior  wall. 
I  made  her  take  ergot  and  whisky  punch,  ordered  the  attendants  to 
dash  cold  water  upon  her  abdomen  from  a  height,  but  they  were  so 
proTokingly  slow  and  clumsy  as  almost  to  drive  me  to  desperation  ; 
of  the  water  I  received  more  than  half  over  my  head  and  neck.  In 
this  position,  my  hand  in  the  uterus,  and  trying  every  possible  expe- 
dient and  experiment,  I  had  to  remain  forty-five  minutes  before  the 
long  hoped  for  contractions  began  to  take  place  ;  I  had  to  wait  ^CUkq^ 


890  Onpimi  Ccmmunication9.  [J^f 

minntes  longer  before  tHe  womb  embrtced  mj  fist  mnd  expelled  H.  I 
noticed  that  before  every  coDtraction  of  thtf  flaooid  part  of  the  woaib» 
the  contracted  portion  relaxed  aomewfaat  and  then  both  acted  together. 
After  having  applied  a  bandage  and  oompreas,  I  left  die  patient  to 
look  after  her  again  in  the  evening.  She  was  comfortable  and  ralliad 
considerable  under  the  influence  of  opium  and  diffusible  atimnlanta. 

The  old  lady  wi^h  whom  this  girl  made  her  home  is  very  inexperi- 
enced in  such  matters  and  allowed  her  to  walk  out  in  the  garden  on 
the  third  day  after  her  confinement,  and  to  help  plant  flowenip  ete. 
Although  the  weather  was  cool  no  harm  came  from  \i'.  Another  j^nt 
of  interest  in  this  case  is,  that  she  never  had  a  drop  of  milk  in  her 
breast,  which  remained  flabby  and  loose,  nor  was  there  any  l<tchial 
discharge  after  the  first  hemorrhage  was  over  sufficient  to  atain  a 
white  cloth.  The  girl  has  recovered  perfectly  and  remains  well  to  the 
present  time. 


AmcuB  IV. 

Case  of  Large  Gravel  Extracted  ft*om  the  Male  Urethra. 


Stported  bj  B.T.  McKbsbaii,  1C,D.,  CUrlubarg,  T*. 

E.  S.  aged  56  residing  in  Harrison  Co.,  West  Virginia,  liad  been 
suffering  with  gravel  for  the  past  year.  About  the  5th  of  January, 
1864,  happening  in  his  neighborhood,  he  sent  a  request  for  me  to  call 
and  see  him.  On  examining  his  case  I  found  upon  sounding  the 
urethra  with  a  female  catheter  that  a  gravel  was  lodged  in  the  bulbous 
portion.  It  entirely  filled  up  the  passage  so  that  micturition  waa  im* 
posible.  The  patient  however  could  pi^ss  a  catheter  and  thus  evacu- 
ate his  bladder.  His  spirits  were  very  much  depressed  as  he  had 
consulted  with  several  physicians  and  had  been  told  that  he  must  un- 
dergo a  cutting  operation  for  its  removal.  He  had  a  great  dread  of 
that  kind  of  operative  proceedings  and  hence  his  depression  of  spirits. 
I  encouraged  him  with  the  assurance  that  I  thought  it  could  be  ex- 
tracted with  the  urethra  forceps  and  having  none  with  me  I  promised 
to  procure  one  and  return  and  attempt  to  extract  the  gravel.  In  a 
few  days  I  returned  to  try  the  operation.  The  patient  waa  placed  on 
a  lounge  in  a  recumbent  posture.  The  penis  was  held  vertically  by 
an  assistant,  and  seating  myself  by  his  side,  I  began  slowly  to  intro- 
duce the  forceps  previously  well  oiled.  When  it  reached  the  bulbous 
portion  of  the  urethra  I  could  hear  and  feel  it  grate  upon  the  gravel. 
The  bladeB  of  the  instruments  were  now  gradually  opened  by  means 


1864.]  McKeihav — Cote  <^  Larff$  Oravd.  891 

of  the  screw  at  its  outer  extremity  and  it  was  oantiooslj  pushed  for- 
ward until  by  screwing  down  the  gravel  was  found  to  be  fastened  in 
its  grasp.  Having  secured  it  as  well  a«  I  could,  I  b^gan  slowly  to 
extract.  The  instrument  slippped  twice  before  I  succeeded  in  secur- 
ing a  firm  hold  on  the  gravel  notwithstanding  all  the  carer  I  took  to 
prevent  it.  These  manifestations  were  in  no  degree  painful  to  the 
patient  so  I  took  my  own  time  and  worked  patiently  until  my  object 
was  accomplished.  The  gravel  being  at  last  firmly  seized  I  steadly 
exerted  the  extracting  force  resting  occasionally  when  the  pain  becaiie 
too  great  for'the  patient,  until  finally  I  had  the  gratification  of  seeing 
the  gravel  emerging  fr9m  the  urethral  orifice.  It  proved  to  be  of  the 
phosphatic  variety  composed  most  probably  of  phosphate  of  ammonia 
and  magnesia.  It  was  cylindrical  in  shape  seven-eighth  of  an  inch  in 
diameter.  It  is  doubtless  one  of  the  largest  that  has  ever  been  ex- 
tracted throogh  the  male  urethra.  Certainly  it  is  the  largest  that  can 
be  extracted  from  this  gentleman's  urethra. 

As  early  as  last  April  this  patient  had  felt  symptoms  of  gravel. 
He  had  observed  that  the  urine  was  paler  and  more  abundant  than 
usual  and  ou  standing  was  covered  with  an  iridescent  pellicle  of  suf- 
ficient cohesion  to  be  raised  on  a  stick.    He  felt  pain  and  weakness 
in  the  lumbar  region  and  an  uneasy  sensation  in  the  glans  penis ;  the 
urine  also  deposited  some  transparent  mucus  on  standing.     When 
a  drop  fell  on  some  hard,  smooth  surface  it  left  a  brownish  spot  hav- 
ing a  glazed  appearance.     In  October  last  the  patient  passed  a  snuller 
sized  gravel,  and  in  November  two  more,  making  four  in  all.     One  of 
these  was  very  white,  smooth  and  polished,  and  about  the  size  of  the 
common  white  bean.     The  patient  does  not  now  feel  any  symptoms 
of  stone  in  the  bladder  excepting  that  micturition  is  still  too  frequent, 
and  the  symptoms  indicating  the  phosphatic  diathesis  are  also  passing 
off,  so  that  it  is  to  be  hoped  that  he  is  rid  of  his  unpleasant  malady. 
He  is  using  tonics  and  acids  to  correct  the  phosphatic  trouble  in  the 
future. 


392  Orifinal  Cammunicat'ont.  \Jvij, 


4BTICLIT. 

Cerebro-Splnal  Menlngltft,  or  Spotted  Fever. 


BT  mOBBBT  BAETBOLOir,  AM  ,  X  J>^ 
L»U  AMJtUat  SsrftPBt  U.8.  Amy,  GiadBBall. 


Epidemics  of  a  new  form  of  disease,  the  onus  of  which  is  heme 
hy  the  cerebro-spinal  nervoas  system,  have,  lately,  awakened  very  gen- 
eral interest.  The  question  is  discabsed  with  much  enei^y  whether 
this  disease  is  a  new  one  to  the  nosology,  or  an  old  one  with  new  and 
unexpected  modifications,  or,  whether  it  is  a  simple  inflammation  of 
the  meninges  of  the  brain  and  spinal  cord.  Its  etiology  and  pathology 
are  alike  involved  in  doubt;  the  first  in  conseqnence  of  imperfect 
knowledge  of  its  history  and  the  objective  and  subjective  circumstan- 
ces attending  its  development,  and  the  second,  in  consequence  of  the 
absence,  or  incompleteness  of  the  autopsies  performed  in  each  case. 
The  questions  which  arise  in  the  consideration  of  this  subject  axe.  It 
it  a  new  disease  ?  Is  it  a  known  form  of  disease  with  some  new  in- 
cidents in  its  course  and  progress  ?  Is  it  cerebro-spinal  meningitis  ? 
Is  it  a  form  of  typhus  or  low  typhoid,  in  which  the  force  of  the  mor- 
bid poison  is  expended  upon  the  nervous  system  ? 
^i  The  discussion  of  these  questions  will  enable  me  to  present  my 
views  of  the  nature  of  this  disease,  founded  upon  clinical  observations 
and  the  study  of  its  pathology  in  the  dead  house. 

By  giving  an  outline  of  the  disease,  as  narrated  by  various  observ- 
ers, and  the  lesions  reporteil  by  them,  its  analogy  or  dissimilarity  to 
known  maladies  may  be  traced.  Under  the  names  of  spotted  fever, 
cerebro-spinal  meningitis,  congestive  fever,  etc.,  its  clinical  history 
has  been  discussed  recently  in  the  New  York  Academy  of  Medicine,  in 
the  Academy  of  Medicine  in  this  city,  and  in  the  various  medical 
journals  of  the  countiy.  One  of  the  mo^t  elaborate  accounts  which 
has  fallen  under  my  observation  is  that  of  Surgeon  Upham,*  who 
witnessed  au  epidemic  at  Newborn,  North  Carolina. 

The  majority  of  observers  agree  in  describing  certain  symptoms 
doe  to  meningeal  inflammation— delirium,  exalted  sensibility  (hypei- 
mesthesia)  in  certain  parts  of  the  body,  diminished  sensibility,  (anaes- 
thesia) in  other  parts,  rigidity  of  the  posterior  cervical  and  spinal  mus- 
cles, (opisthotonos)  convulsive  seizures  (epileptiform)  coma,  vomit- 
ing and  sometimes  a  state  of  typhosis.    Thus  far  their  accounts  agree 

*  HofplUI  NotM  and  MemonncU,  Boiton  18G3. 


1864.]  Bartbolow-- (kr^O'Spinai  MtmngitU.  898 

wiih  the  facts  observed  by  all  those  who  have  seen  cases  of  cerebro- 
spinal meningitis*  and  with  the  description  of  systematic  writers.  But 
some  new  symptoms  aie  found  in  the  cases  recently  reported.  A  pe- 
culiar eruption  is  said  to  characterize  this  new  form  of  meningitis, 
but  the  descriptions  of  it  do  not  agree.  One  observer,  (Upham)  says 
"  petechiie  very  similar  to  the  true  typhus  eruption/'  and  '*  purpureal 
spots  of  large  size  and  abundant "  were  often  present  and  in  some 
cases  none.  Another  observer*  describes  the  **  spots  as  not  unlike 
the  spots  seen  in  enteric  and  typhus  fevers,  often  altogether  wanting, 
but  when  present,  presenting  in  few  cases  all  grades  from  the  rose 
colored  rash  to  the  deep  and  permanent  (under  pressure)  petechia." 
These  spots  were  similarly  described  by  Dr.  Draper  and  others,  in  a 
discussion  on  the  subject  before  the  New  York  Academy.f  All  agree 
that  the  eruption  is  frequently  absent. 

The  views  expressed  as  to  the  pathology  of  the  disease- are  most 
diverse  and  conflicting  ;  scarcely  two  accounts  agree  as  to  the  organs 
implicated.  The  lesions  do  not  seem  to  have  been'  confined  in  a 
single  instance  to  the  meninges  of  the  brain  and  cord,  although  they 
were  usually  involved  ;  but  other  organs,  the  lungs,  liver  and  spleen, 
were  more  or  less  affected.  Dr.  Upham  observed  "  passive  engorge- 
ment of  the  lungs  in  their  depending  portions,  occasional  presence  of 
lymph  in  the  pericardium  and  ventricles  of  the  heart  and  sometimes 
enlargement  of  the  liver  and  spleen."  Dr.  Woodward  says  *  **  from 
observation  and  inquiries,  I  am  persuaded  that  the  viscera  of  the  ab- 
domen are  occasionally  involved Of  the  viscera  of  Ithe 

thorax  I  believe  the  lungs  and  pericardium  are  the  only  organs  that 
have  been  known  to  become  involved."  And  again  in  the  same  article 
'*....  In  fact  the  cerebro-spinal  meningitis  is  only  one  of  the  many 
forms  which  the  disease  assumes.  .  .  .  Other  organs  are  oHen,  per- 
haps not  quite  as  liable  to  be  attacked  with  inflammation  as  the  mem- 
branes of  the  brain  and  cord."  In  the  New  York  cases  varipus  or- 
gans beside  the  meninges  were  the  seats  of  morbid  alterations  e.  ^. 
fatty  degeneration  of  the  liver  and  kidneys. 

To  acquire  correct  views  of  the  pathology  of  a  new  disease,  it  is 
necessary  to  study  the  morbid  appearances  after  death,  comparing 
them  with  the  pymploms  observed  during  life.  Unfortunately,  this 
had  been  done  in  very  few  instances.  The  editor  of  the  American  Ifed- 
ical  Ttwui  in  commenting  upon  the  discussion  of  "  spotted  fever  "  at. 

•  Wood w«,  AmgrifMU  Mtdicml  Timf,  Maj  M,  1SC4, 
tbM. 


804  Original  Camuuimeatiom.  \f^7» 

the  New  York  Academy,  allndes  with  some  eererity  to  the  crude  no- 
tions which  prevailed  amongst  the  members,  and  to  the  great  danger 
of  committing  errors  of  diagnosis  "  when  the  knowledge  of  the  eass 
is  derived  entirely  from  the  signs  and  symptoms/*  *'  It  most  havi 
astonished  the  paiMoffiMii  of  the  Academy ''  eto.,  he  piocaeda  to  say 
farther.  I  ne^  not  attempt  to  illnstrate  by  farther  quotatioAa  .ths 
discrepant  yiews  of  more  or  loss  well-qnalified  obserrers. 

Jsit  a  new  dmast  f  Bnrgeon  Upham  considers  it  a  form  of  typhis ; 
so  does  Dr.  Draper ;  bnt  Dr.  Clark,  of  New  York,  deniea  this  idea- 
tity  and  assnmes  that  it  is  a  disease  9i$\g$nm$.  Cerebro-apiiial  nsa- 
ingitis,  snrely  is  not  a  new  disease,  neither  is  an  epidemic  fonn  of  its 
new  manifiMtation.  There  are  few  Sonthern  physicians  who  an  not 
familiar  with  epidemic  or  sporadic  cases,  and  tiie  medical  joonab 
have  contained  notices  of  snch,  especially  amongst ^tbe  colorad  peopk^ 
for  many  years  past.  ' 

IsUa  knovmfarm  cfdinanvUk  8cm$nemineid€ni$imii9camr$$md 
progrein  ?  The  association  of  a  peculiar  ernption  with  the  ehaxaetsr- 
istics  of  the  epidemics,  has  confused  the  diagnosis.  All  obeerfsn 
agree  in  this,  that  the  eruption  is  neither  constantly  prestnt  nor  uni- 
form in  appearance ;  it  cannot  therefore  be  considered  diagnoatie. 
Petechias  and  purpareal  spots  occur  in  so  many  blood  diseases  that 
they  have  no  specific  value.  The  latter  were  seen  in  that  great  pes- 
tilence of  the  fourteenth  century,  the  "  black  death  **  black  or  bhM 
spots  came  oat  on  the  arms  or  thighs,  or  other  parts  of  the  body,  eith- 
er single  and  large,  or  small  and  thickly  studded."*  Sydenhtm 
speaks  of  such  appearances  as  witnessed  in  the  febrile  epidemics  of  hii 
time— appellatainea  ante  m  qubut  d%gno9€untur,  abintigni  aUqua  oftfrs- 
tive  9anguin$  impressa  vel  evidetUiari  aympiomaie  mmiuari :  kae  raiiom 

PUTRIDJB    DICULTUR,  MALIOKJE,  PETECHIALBS,  CtO.f      Such   petechia  Of 

vibices  are  seen  now  in  the  most  various  forms  of  disease— -in  scorbu- 
tufl,  purpura,  typhus,  typhoid,  and  in  the  exanthematsd— -diseasei 
which  have  a  similar  origin  in  some  occult  alteration  of  the  blood. 

In  fevers,  leaving  out  or  considefation  the  lesions  whicb  may  be  con- 
sidered specific,  the  po:son  is  expended  nponvarious  pigans,  end  apon 
none  more  frequently  than  the  brain  and  spinal  cord.|  This  fiact  is 
especially  true  of  typhus,  to  which  fever,  the  so-called  spotted  fever  is 
moat  closely  assimilated.    There  seems  to  be  therefore  no  ground  for 


*  Hecker,  Epidemics  of  tiM  Middl*  Arm,  p.  IS. 

t  Sydenham  Opgrm  OmnUt  O^Mrvatimmum  MtiUeormm.  I.  S. 

t  Tweed!*,  Art.  VtTer  in  OTolopedi*  of  Practical  Medicine. 


1854.]  Bartholow — Cerebrospinal  Memngitis,  895 

assuming  that  (he  lesions  fonnd  to  exist  in  the  spotted  fever  are  new 
incidents  ocenrring  in  a  known  form  of  disease. 

1$  ii  cerebro-apinal  meningitU  f — Ls  it  typhu$  or  a  low  form  of  ty- 
phoid  in  which  the  poison  is  dhiefly  expended  tipon  the  nervoua  system  ? 
Apparentlj  these  two  varieties  of  diseased  action  have  been  confound- 
ed under  one  designation.  The  grounds  of  this  opinion  are  these : 
First,  cases  of  cerebro  spinal  meningitis  followed  to  a  conclusion  and 
%'erified  bj  post-mortem  examination  presented  the  signs,  symptoms 
and  morbid  appearances  characteristic  of  that  disease  ;  and  second, 
that  the  so-called  spotted  fever,  presents  no  signs,  symptoms,  nor  post- 
mortem appearances  which  have  not  been  witnessed  in  cases  of  ty- 
phus or  typhoid.  Lot  me  snbmit  some  cases  in  illustration  of  the 
first,  and  draw  from  the  Hterataro  of  fevers,  observations  of  various 
accurate  observers  to  prove  the  second  :    . 

Case  I. — Cerebro- Spinal  Jieninyltu;  Recovery  after  an  lUneis  of 
Three  i/oji/A*.— Reported  by  Act.  Asst.  Surgeon  J.  W.  Digly,  U.S. 
A. — HiMiory, — Philip  Beaufort,  Sergeant  Major,  Thirty-l}iird  New  Jer- 
•ey  Volunteers,  was  admitted  into  General  Field  Hospital,  Ohattanoo- 
ga,  under  charge  of  Asst.  Surgeon  R.  Bartholow,  U.S.A.,  December 
18,  I8d3.  He  had  participated  in  the  battle  of  Mission  Ridge,  and  was 
afterward  ordered  to  Knnzvilie.  When  upon  the  march  he  was  taken 
with  a  chill,  followed  by  fever,  obstinate  constipation,  headache  and 
inability  to  sleep. 

Symptoms  on  Admission. — Complains  of  severe  pain  in  lower  part 
of  spine  and  great  tenderness  on  pressure  or  percussion,  and  of  shoot- 
ing pains  down  the  thighs  ;  he  is  obstinately  constipated,  has  head- 
ache, is  delirious  at  times  and  is  unable  to  sleep. 

Progrsis  of  the  case. — These  symptoms  soon  increased  in  severity. 
He  suffered  from  a  sense  of  constriction  about  the  abdomen,  had  vio- 
lent spasms  of  the  muscles  of  the  neck  and  back,  so  that  the  body  was 
drawn  np  and  the  head  thrown  back,  (opisthotonos)  and  had  great 
difficulty  in  urinating.  Beside  these  symptoms,  his  respiration  was 
embarrassed,  he  had  dilated  pupils,  frequent  rigors  and  was  usually 
delirious.  He  gradually  lost  the  use  of  his  left  arm  and  both  lower 
extremities ;  sensation  ceased  in  these  parts,  but  he  had  acute  sensi- 
bility (hyperaesthesia)  of  the  anterior  walls  of  the  chest  and  abdomen. 
This  exalted  sensibility  was  accompanied  by  wheal  (urticaria?)  of 
large  size  and  confined  to  the  sensitive  surface.  He  continued  in  this 
state  nearly  two  weeks  wheif  the  symptoms  began  to  subside,  pain 
grew  less,  bead  symptoms  disappeared  and  spasms  lessened  in  fre- 
queDcy.    The  paralysis  of  lower  extremities  continued  sometime  afUt 


396  Original  Communicationi,  [Jalji 

the  difficulty  of  mictmition  and  the  obstiDate  constipation  bftdoeasad. 
Sensation  returned  by  degrees,  and  afterwants,  motion.     Bacovend. 

The  treatment  consisteil  of  counter  irritants  to  spine,  paigatiFet, 
cilomcl  and  extract  of  coninm  and  last,  iodide  of  potassiom  and  ion- 
ics, and  the  local  application  of  iodine. 

Case  II. — Cerebro- Spinal MerUnffUU ;  Death  tn  Seven  Days;  Antiaf- 

sy. — Reported  by  Act,  AeU,  Surgeon U.S.A. — liUtory. — Lient  B. 

D.  Edwards  (rebel)  was  admitted  into  General  Field  Hospital,  Chat- 
tanooga, in  charge  of  Asst.  Surgeon  R  Bartholow,  U.S.A.,  February 
Ist,  1864.  Previous  history  unknown,  except  that  he  had  had  aflcdi 
wound  of  the  thigh,  which  at  the  time  of  admission  was  healed. 

Symptoms  on  Admiesion, — Ho  complained  of  severe  pain  through 
forehead,  left  eye,  and  left  side  of  his  face.  Left  eyelids  purple,  and 
much  swollen  ;  pupil  not  sensitive  to  light.  He  was  quite  deaf.  Hd 
had  pain  in  and  contraction  t>f  cervical  muscles  posteriorly,  and  some 
stiffness  and  pain  of  the  muscles  of  the  back  ;  great  tenderness  wai 
evinced  upon  pressure  being  made  upon  last  cervical  and  first  dorsal 
vertelbrie  ;  sensation  somewhat  lessened  in  the  extremities  of  leftside, 
and  motive  power  greatly  impaired.  He  suffered  from  thirst,  and 
was  constipated  ;  pulse  115  and  strong.  He  was  delirious,  of  the  low 
muttering  character  rather,  but  when  aroused  answered  rationally. 

ProgresK  of  the  cnee. — The  paralysis  gradually  increased,  extending 
to  extremities  of  right  side  ;  delirium  incre^ised  with  paralysis.  For 
the  four  days  previous  to  his  death  he  was  in  an  almost  helpless  con- 
dition and  complained  greatly  when  moved.  He  became  quite  deif, 
and  returned  irrational  answers  when  spoken  to.  During  the  whole 
progress  of  his  case  he  was  drowsy  and  stupid  ;  never  complained 
save  when  moved.  Death  occurred  on  the  7th  of  February,  one  week 
from  the  date  of  admission. 

Autopsy  : — February  8th,  1864. — The  record  was  entered  in  this 
case  by  Medical  Cadet  Bradley  at  my  dictation. 

Hei<^ht  5  feet  6  inches,  eyes  brown,  hair  black,  complexion  dark  : 
bronze  hue  of  face  and  upper  extremities,  some  i-eddish  spots  on  limbis, 
and  considerable  suggillation  posteriorly,  rigor  mortis  not  well  marked 

Topograplcal. — Upon  laying  open  thorscic  and  abdominal  cavities 
find  the  lungs  filling  the  thorax,  the  left  maintained  in  its  place  by 
some  old  adhesions  to  the  pericardium  ;  apices  of  lungs  approach 
within  one  and  a  half  inches  of  each  other,  equi  distant  from  the  me- 
dian line  ;  base  of  heart  opposite  intercostal  space  between  second 
and  third  ribs,  and  extends  one  and  a  half  inches  to  the  right ;  apex 
points  to  intercostal  space  between  fourth  and  fifth  ribs^  three  anil  • 


L864.]  Bartholow — ^erehro- Spinat  Mefdngitlt.  897 

lalf  iocbes  from  median  line.  Small  part  of  liver  and  no  part  of 
tomach  in  vievr ;  large  intestine  mnch  distended^  lies  in  front  of 
»tomach  ;  bladder  enormoosly  distended. 

Brain, — Upon  removing  calvarium,  find  one  onnce  of  reddieb  ser- 
ial at  bane  of  brain,  and  a  quantity  of  jellowisb  exudation  diffluent 
Lod  pus-like  surrounding  left  lobe  of  cerebellam  and  adbering  to  ten- 
oriom ;  veins  of  pia-water  filled  witb  blood ;  tbin  semi-transparent 
•xudation  on  tbe  surface  of  botb  bemispberes ;  n^embranes  easily  de- 
acbed  from  convolutions.  Upon  rem  )v:n j^  bemispberes  blood  flows 
ireely  from  divided  vessels,  and  tbere  are  numerous  bloody  points 
brongb  tbe  wbite  substance;  rigbt  and.lefk  lateral  ventricle^  filled 
ritb  fluid,  vessels  of  choroid  plexus  not  injected,  pineal  gland  broken 
lown  into  a  tbin  yellowish  fluid  adherent  to  the  velum  interpositum  ; 
ome  yellowish  white  exudation  about  tbe  conmissnre  of  tbe  optic 
lerve.     Weight  of  brain  3  lbs  2  oz.' 

Heart. — Upon  dividing  great  vessels  blood  partly  coagulatei  flows 
»ot.  A  yellow  fibrinous  clot  in  right  cavity,  mnscniar  walls  of  which 
\x%  thin  and  have  an  entire  pubstitntion  of  fat  along  inner  border  and 
arg«  masses  of  fat  attached  to  base  of  rigbt  auricle ;  a  smaller  fibrii- 
ma  clot  in  left  ventricle  ;  muscular  fibr^  of  deep  red  color  and  pretty 
inn  ;  valves  healthy  ;  weight  of  heart  11  oz. 

Lan^, — Superior  lobe  of  rigbt  Inng  of  blni»b  pink  color  anteriorly' 
larker,  posteriorly.  The  lung  substance  on  division  of  a  reddish  pink,' 
■ootains  an  abundance  of  reddish  serum,  crepitates  and  floats  in  watei*. 
inisrior  lobe  of  darker  color,  externally  and  internally  ;  veins  engorg- 
kI,  non-crepitant  and  sinks  in  water.  Superior  lobe  of  left  lung 
leftlibj  ;  inferior  lobe  of  dark  blue  posteriorly  containing  patches  of 
■oodeoaed  pnlmonary  tissue. 

L:9er, — Gall  bladder  contains  half  an  ounce  of  reddiah  brown  bile. 
[Jrer  II  inches  bv  7^,  and  3  inches  in  thickness.  Brownish  fawn  color 
DoCtled  (nutmeg)  internally  and  externally  ;  capsule  easily  detached  ; 
lubttance  soft,  breaking  up  readily  and  perceptibly  g^reaay  ;  weight  of 
irer  3  lbs  and  4  os. 

Spleen, — 5  inches  by  3.}  inches,  of  a  bluish-green  color  on  anterior 
■uriace,  posteriorly  reddish ;  much  softer  than  nsual ;  malphigian 
i>odiea  enlarged  and  distinct ;  the  substance  of  tbe  organ  breaks  down 
••aily  into  a  diffluent  mass  and  is  washed  away  by  a  stream  of  water. 
VV«igbt  bi  oz. 

Kidneys. — Except  a  sli<rht  degree  of  hyperaemia  healthy. 
InUtdnal  Canal. — Stomach  small  and  contracted;  rugae  distinct 


898  Original  CanununieiUknu.  (.Joly, 

and  of  a  grayish  aah  oolor';  small  patches  of  injection,  the  mncoot 
membrano  softened  in  several  places  and  easily  detadied,  especially 
about  the  cardiac  orifice.  Large  portions  of  iliam  colorad  Uoe ;  intes- 
tinal walls  tbin,  the  solitary  glands  Tisiblet  large  oblong  pateheaof 
Lieberkahn's  follicles  seen  opposite  the  attaehinent  of  the  meeestery,  at 
which  places  tha  epithelial  layer  is  soft  and  readily  detached  from  the 
basement  membrane.  Mesentery  healthy ;  mnoons  membnme  of  large 
intestine  healthy^  hnt  the  open  months  of  the  soliiaiy  glands  appear 
qnite  distinct. 

Spine. — ^Upon  laying  open  the  spinal  column  find  b^  os.  of  bloody 
serum,  some  blood  dot  and  an  exudation  assuming  a  membimnosi 
form  one  line  in  thickness,  extending  frpm  last  cervical  to  tenth  donil 
vertebra.  The  membranes  being  opened  and  turned  aaide  with  can 
the  cord  is  seen  bathed  with  a  yellowish,  creamy  flnid»  end  the  cord 
itself  is  soft,  and  semi-flnid  at  the  point  at  which  tfae  blse  Inembmw 
terminates.  Gray  substance  of  the  cord  scarcely  distingaiahable  from 
the  white. 

I  need  not  extend  this  communication,  already  growii  beyond  a 
suitable  length,  by  recapitulation  of  similar  cases.    The  two  ptessated 
may  be  considered  typical  cases,  showing  the  signs  symptoms,  sad 
morbid  anatomy  of  cerebro-spinal  meningitis.    They  appear  to  me 
to  present  few  points  in  common  with  the  cases  of  the  so-caUed  spot*, 
ted  fever,  but  are  similar  to  if  not  identical  with  the  leoorded  caaes 
of  cerobro-spinal  meningitis. 
'  *    The  term  spotted  fever  is  one  of  the  designations  applied  to  typhost 
derived  from  the  characteristic  pctechisd  and  vibicea  of  that  disesae. 
In  those  great  epidemics  of  typhus  which  devastated  Irebind  during 
\the  famine  periods,  these  purpnreal  spots  and  ecchymoses  were  aoi* 
versal,  and  such  was'  the  profound  alteration  of  the  blood  that  these 
spots  in  many  cases,  went  on  rapidly  into  gangrene.*     "  They  are 
permanent  stains,  of  a  deep  purplish*blue  tint,  and  da  wot  duojppear  o» 
pressure  /  .  •  .  .  they  are  sometimes  present  in  extraordinary  aban- 
dance,  thickly  strewn  upon  the  face,  neck,  trunk,  and  npper  and  loirer 
extremities,  upon  the  anterior  as  well  as  posterior  surface  "f    These 
spots  are  quite  distinct  from  the  true  maculce  or  petechise  of  typlios 
Lyons,  who  has  probably  seen  more  cases  of  this  diseeue  than  snj 
physician  of  the  present  day,  and  has  studied  its  pathology  more  pro- 
foundly, ennumerates  the  following  as  the 


*  Lyons*  TrMtlte  on  Feftn. 
t  Ibid,  p.  106. 


1864.]  Daugbkbtt — Amenorrkwi.  8d9 

8BCONDABT  LBBI0N8  OF  TTPHUS. 

"  These  secondary  lesions  *'  he  proceeds  to  say»  **  implicate  almost 
all  organs  in  the  body.  Ist.  Secondary  lesions  of  the  cerebral  organs. 
2d.  Secondary  lesions  of  ^the  circnlating  apparatus.  8d.  Secondary 
lesions  of  the  lungs  and  pleurse.  5th.  Se(iondary  lesions  of  the  intes- 
tines. 5th.  Secondary  lesions  of  the  liver,  spleen  and  kidneys.  6th. 
Secondary  legions  of  the  Icutaneons  system.'^ 

The  foregoing  includes  all  the  lesions  said  to  belong  to  the  cases 
of  the  so-called  spotted  fever.  They  consist  of  congestion  of  and 
exudation  upon  meninges,  hypostatic  congestion  of  lungs  and  inflam- 
mation of  pleurie,  softening  of  muscular  tissued  of  heart,  softening 
of  spleen  and  alterations  of  live/  and  kidneys,  (mainly  fatty  meta- 
morphosis )  etc.  By  comparing  these  with  the  lesions  found  by  Dr. 
Draper  in  the  epidemic  of  "spotted  fever,'*  at  Carbondale,  by  Dr. 
Woodward  at  Brandon,  Yt.,  and  by  the  New  York  Commission  at 
LiODg  Branch,  a  remarkable  similarity  will  be  observed,  sufficient,  I 
think,  to  justify  ihe  conclusion  that  they  are  cognate  or  identical  dis- 
ettcea.  The  etiology  of  typhus  is  too  obscure  a  subject  to  found  a 
tbeory  of  the  origin  of  the  disease  upon.  If  it  has  occurred  under 
some  new  conditions  in  this  country,  it  is  because  the  nature  and 
diaracter  of  the  morbid  poison,  have  not  been  thoroughly  understood. 

ConelMMioni.T-The  forgoing  observations  seem  to  justify  me  in  as- 
•nmiog  that  cerebro-spinal  meningitis  is  a  disease  quite  distinct  from 
spotted  fever,  and  that  the  lesions  of  the  meninges  found  in  the  latter 
are  some  of  the  incidents  characteristic  of  it.  I  think  1  am  justified 
in  assuming  further  that  these  two  forms  of  disease  have  been  com- 
foonded  together,  and  that  typhus  or  a  low  form  of  typhoid  has  been 
observed  rather  than  cerebro-spinal  meningitis. 


■  ■ 


▲aricu  n. 


A»Miorrhcia  Treated  with  Arsenio  and  Preoip.  Car^.  Ferri. 

W.  H.  DAVOHnTT,  ]|.0.,  LttCU  Ii«k,  Ky. 


I  was  called  ab6nt  the  first  of  April,  1863,  to  see  Miss  Julia  O 
an  interesting  girl  aged  nineteen  years,  who  had  been  laboring  under 
amenorrhesa  for  thirteen  months.  She  was  weak  and  greatly  emaci- 
ated, pulse  weak,  about  sixty- four  beats  per  minute,  skin  pale,  appe- 
tite and  degeation  depraved,  oppressed  respiration,  i^as  listless  and 
melanckolj,  giddiness  on  rising  to  her  feet,  auscultation  and  purcut- 


400  Original  Communieaiiimi,  [Jolj* 

sion  reveAled  no  actaal  lesion  of  the  langi ;  •  bellows  tcnnd  wm  de- 
tected over  the  heart  and  large  arteriee . 

At  the  onset  of  the  disease  she  was  trsated  by  her  frmilj  phjaidaQ, 
a  riegalar  physidan  of  some  eminonoe ;  after  a  few  months  Ids  Tisits 
were  discontinaed  and  her  case  considered  beyond  the  rsfudi  of  medi- 
cine.   She  then  followed  the  advice  of  the  knowing  Mladie$  in  the 
vicinity,  and  her  great  desire  to  get  well  caused  her  to  take  ersTythiDg 
prescribed.  ^Madder,  indigo,  me,  aloest^nrpentine,  tansy  bitters,  etc., 
were  all  tried  in  vain,  after  which  she  was  given  np  to  die,  and  in 
this  condition  I  fbnml  her.    I  placed  her  at  onoe  npon  the  fetlowing 
treatment  which  had  met  my  expectations  in  previons  menstmal  de- 
rangements.    I  gave  her  Fowler's^  solution  of  arsenio,  commenced 
with  gtt.  iv.  three  times  a  day,  increasing  the  dose  one  drop  overj  day 
till  gtt  i.  has  been  taken  at  a  dose ;  then  decreased  the  dose  in  the 
same  ratio  back  to  gtt.  iv. ;  stopped  its  nse  five  daya  and  began  in  like 
manner.    Simultaneous  with  the  arsenic  I  gave  her  B  i.  predp.  carh. 
ferri  per  day.    This  treatment  was  persevered  in,  and  on  the  19th  of 
June  following  she  menstnrated  and  has  been  very  regular  e?er  since, 
and  is  at  this  writing,  (March  20ch,  1864,)  a  stout,  beMiy,  healthy 
girl. 


■  •  ^m^  • 


^KoatAlnqi  of  SfotUtin* 


Prooe^dings  of  the  01nolnn*ti  Aoadamy  of  Medlolna. 

Beported  bj  0.  P.  WiiaoH,  lC.n.,  StcrttMy. 

Hall  of  Academy  of  Medicine,  March,  21,  1864. 

Tapeworm, — Dr,  Mitsaey  presented  for  the  inspection  of  the  mem- 
bers of  the  Academy  a  specimen  of  tape  worm,  twenty -four  feet  long, 

which  was  discharged  from  Mrs.  A on  the  evening  of  the  5th  of 

March,  following  the  administration  of  granulated  tin. 

He  directed  3iv  to  be  prepared  and  divided  into  three  parts  ;  one 
part  was  taken  Fi-iday  evening,  one  Saturtay  morniiig,  and  the  third 
Saturday  evening.    On  Sunday  morning  he  gave  her  3  ij-  of  castor  oil. 

Three  hours  after  the  oU  was  taken,  the  worm  waib  discharged  in 
one  piece.  He  stated  that  he  had  been  unable  to  detect  the  presence 
of  the  head  and  was  not  sure  but  that  it  was  detached  ;  but  the  mi- 
nuteness of  the  joints  at  one  extremity  of  the  worm  lead  to  the  belief 


1864.]  ProceedlngB  of  Soeieiiet.  401 

that  nearly  all  was  discharged.  The  Dr.  proposed  to  repeat  the  med- 
icine in  a  ehort  time,  hut  found  his  patient  tired  and  exhausted  on 
Saturday,  with  a  child  at  the  hrcast,  and  doing  her  own  work,  so  he 
thought  hest  to  defer  the  administration  for  a  while. 

In  the  Western  Lancet  may  be  found  the  report  of  the  treatment  and 
radical  cure  of  three  cases  by  the  use  of  granulated  tin  ;  two  of  these 
cases  were  treated  by  the  late  Dr.  Raymond  and  one  by  himself. 

The  subject  of  the  treatment  at  that  time  brought  to  him  the  patient 
whose  case  is  now  presented.  The  first  case  had  not  had  any  signs  of 
the  disease  since  the  date  of  the  Dr.'s  treatment.  The  history  of  the 
present  case  is,  thr^e  years  ago  joints  of  tapeworm  were  noticed  and 
treatment  commenced  ;  two  years  since  large  doses  of  nauseating  rem- 
edies were  administered  by  a  German  Homeopath  without  avail. 
About  six  weeks  later  eight  feet  of  worm  were. passed  ;  since  that  time 
isolated  joints  have  been  occasionally  discharged.  The  patient  is  a 
Jewess  and  says  she  has  never  tasted  pork,  bO  measly  pork  cannot  be 
held  accountable  for  the  worm. 

The  first  patient  however  admits  his  having  transgressed  the  Law 
of  Moses.  The  same  person  had  been  treated  in  London  and  other 
places  without  success,  and  finally  came  here  in  1850,  where  he  was 
cured  by  the  tin  at  the  suggestion  of  Dr.  Raymond. 

Dr.  Mussey,  8r.,  had  used  the  pumpkin  seeds  with  success,  as  he 
thought  but  the  disease  returned  in  two  or  three  years.  For  this  case 
the  Dr.  said  he  had  not  had  the  opportunity  of  trying  the  tin. 

Dr.  Smith — Wished  to  know  of  Dr.  Mussey  if  there  were  any  par- 
ticular symptoms  in  his  case  to  distinguish  between  tapeworm  and 
the  other  varieties  of  worm. 

Dr.  Mu9sey — Said  ho  had  ocular  proof  a^  his  patient  brought  him 
several  joints. 

Puerperal  Fever. — Dr.  Tate  remarked  that  after  his  entrance  on  time 
of  service  at  the  hospital,  he  found  puerperal  fever  to  prevail  there ;  ho 
had  seven  cases  in  the  hospital  and  one  ouU^ide.  The  treatment  of  all 
was  the  »ame  :  gr.  j.  of  calomel  an<l  one-sixth  gr.  morphine  every  three 
hours.  Tlie  house  physician  applied  a  small  blister  in  one  case  and  dve 
leeches  in  another,  because  of  certain  symptoms  which  seemed  to  indi- 
cmte  their  need.  With  these  exceptions  the  rest  were  treated  as  above. 
All  recovered,  lie  tried  to  arrest  the  fever  from  spreading  by  giving 
moriated  tincture  of  iron  before  confinement,  but  without  success ; 
then  he  ordered  one  of  the  rooms  to  be  well  ventilated  and  fumigated, 
the  house-physician  to  change  his  dress,  and  he  procured  a  oew  nurse, 
tinea  that  time  there  have  been  no  new  cases. 


402  Proeeedinfft  of  Societies.  {J^J, 

In  one  case  wbere  the  poultice  on  the  abdomen  had  given  no  relief, 
he  tried  cold  applications  ;  the  patient  had  passed  no  nrine  for  twdre 
honrs  so  the  Dr.  ordered  flannels  dipped  in  hot  whisky,  altematelj 
with  sadden  applications  of  cold,  which  gave  great  relief,  the  patient 
passing  freely.    None  were  salivated. 

While  pnerperal  fever  existed  in  the  female  wards  efysipelas  pre- 
vailed in  the  children's  wards.    Inione  child  it  first  mada  its  appear- 
ance on  the  labia-majora  and  rapidly  spread  over  the  whole  body.    In 
'  another  it  appeared  on  the  hand  extending  only  over  the  arm. 

In  both  cases  it  soon  dipped  down  apd  involved  the  areolar  stmctnre. 
In  the  first  case  the  labia  sloughed  and' the  child  died  ;  on  the  last  an 
ulcer  formed  on  the  hand  and  the  child  recovered. 

2.**'.  Tate — Said  it  was  remarkable  that'  the  mothers  of  these  dul- 
dren  escaped  puerperal  fever.^ 

Ii|  erysipelas  he  used  iron  internally ,  locally  iodine  in  one  case,  and 
niti't  e  of  silver  in  the  other. 

Dr.  iftr^My— -Asked  Dr.  T.  if  he  believed  in  the  transmission  of 
the  fever  by  the  accoucher,  and  whether  the  case  outside  was  in  the 
neighborhood. 

Dr.  Tate — Said  he  was  a  firm  believer  in  the  contagiousness  of  the 
disease.  He  also  thoaght  that  lying-in-hospitals  should  be  separate 
from  the  rest  of  the  general  hospitals.  He  said  ^the  question  was  now 
being  agitated  in  Europe,  whether  there  should  be  any  lying-in-hos- 
pitals at  all. 

Encephaloid  Tumor, — Dr,  Taylor  exhibited  a  specimen  of  encepha- 
loid  disease  of  the  liver.  The  patient  was  'under  treatment,  three 
months,  was  fifty-five  years  old.  his  skin  of  a  citron  tint,  and  he  was 
much  emaciated.  The  liver  was  much  enlarged,  extending  below  the 
umbilicus,  nodulated,  mottled,  and  so  soft  that  it  tore  by  its  own 
weight  on  raising  it ;  the  neighboring  lymphatics  were  all  enlarged. 

Dr.  Murphy — Was  called  to  see  a  little  boy  at  the  O.BI.R.B.,  who 
had  swallowed  a  bean  three  days  before.  When  he  arrived  he  found 
the  child  in  a  convulsiou. 

Z^K^^  Blackman  and  Mussey  had  been  sent  for. 

Dr.  Cook  had  just  gone  from^Dr.  Blackman's  who  had  been  sent 
for  a  second  time. 

Dr.  Cook — Asked  Dr.  M.  if  the^boy  had  any  cough,  the  Dr.  replied 

in  the  negative.     He  said  the  reason  he  asked  the  question  was  that, 

he  had  a  similar  case  some  years  ago  in  his  own  &mily ;  a  little  son 

of  twenty  months  had  swallowed  a  cedAr  branch  one  and  one-fourth  of 

an  inch  long ;  it  passed  into  0;i«  i\^V.  V^xon^hi^  he  had  no  cough.  *  At 


1864.]  Proeeedingi  of  SodetUt.  403 

the  end  of  nine  days  inflammation  ensued  which  continued  for  thirteen 
weeks,  when  he  died  from  an  abeess  forming,  and  pointing  between 
the  sixth  and  seventh  ribs,  attachments  onlj  skin  deep.  The  right 
arm  was  elevated  from  the  time  inflammation  began  ;  bnt  there  was 
no  pain,  only  an  effort  to  swallow,  and  he  had  no  congh. 

MoKDAT  EvKHiNO,  March  28,  1864. 

Dr,   Wittiams — ^Presented  the  following  ease  for  the  inspection  of 
the  Academy. 

Wro.  A.  Sittle,  aged  25  years,  of  a  stont  and  healthy  condition,  re- 
ceived a  blow  on  the  right  side  of  the  face  in  1850,  which  caused  a 
slight  fracture  of  the  orbit  at  the  upper  and  outer  part,  m  is  indicated 
by  a  slight  scar  and  projecting  spiculum  of  bone. 

In  the  spring  of  1863  he  was  struck  in  the  eye  by  some  saw-dust 
which  caused  a  good  deal  of  pain  and  inflammation  for  a  week  or  two. 
About  a  month  after  the  accident  an  unnatural  prominence  of  the  eye- 
ball was  noticed,  which  increased  until  Ddoember  1st,  1863.  At  that 
time  the  eye -ball  protruded  downward  and  forward  half  an  inch ;  move- 
ments were  free  in  all  directions  except  some  limitations  upwaid 
The  upper  part  of  the  globe  behind  the  equator  was  flattened,  but  other- 
wise the  eye  seemed  natural.  The  lids  closed  with  difficulty  and  there 
was  slight  conjunctivitis.  By  deep  pressure  between  the  globe  and 
upper  and  outer  part  of  the  orbit,  a  fluctuating  tumor  could  be  felt, 
whi^h  was  supposed  to  be  a  serous  cyst.  An  exploring  trochar  was 
introduced  through  the  bottom  of  the  upper  cul.  de.  sac  of  the  con- 
junctiva about  one  and  one-half  inches  in  the  direction  of  the  tumor, 
about  an  ounce  of  yellowish  serous  fluid  escaped.  The  eye  at  onoe 
sank  back  so  that  the  exophthalmus  was  very  much  diminishe'd  and 
the  vision  improved. 

In  a  week  the  eye  began  again  to  protrude,  and  in  four  weeks  the 
patient  returned  with  the  exophtfiialmus  as  marked  as  ever.  A  sec- 
ond puncture  was  made  with  the  same  result  as  before.  The  patient 
returned  March  22d,  1864,  with  the  eye  more  prominent  than  ever, 
and  the  fluctuation  could  be  moreextensively  Mt  than  before.  An  in- 
rinion  was  made  by  Dr.  Williams  with  a  bistoury,  about  one  and  a 
half  inches  long,  within  the  upper  and  outer  edge  of  the  orbit,  and 
parallel  with  it.  The  cyst  ihus  explored  extensively  was  laid  open, 
and  an  ounce  of  fluid  escaped.  The  sac  was  of  a  bluish  white  color 
and  easily  torn,  and  was  removed  with  a  pair  of  scissors  as  far  as  pos- 
sible. An  injection  of  water  into  the  cavity  which  extended  to  the 
apex  of  the  orbit,  brought  out  two  long  rolls  of  toogh,  gelatinous  lo^k> 
leg  matter  of  a  dirtj  jettow  color,  and  mnknng  a  maaa  ol  ^ikiA  %>b^  ^^^ 


404  FtoeeedMffi  of  Sodetiea.  U^J* 

the  middle  finger.  The  carity  was  explored  with^  the  fioger  and 
foand  to  be  free ;  the  inner  two'thirde  o(  the  ineieioa  was  cloned  wiih 
twisted  satores,  and  united  by  first  intention^  while  the  pater  part  was 
kept  open  by  a  tent,  which  was  removed  twiee  a  day  and  the  matter 
pressed  out.  It  suppurated  freely,  and  when  the  patient  left  for  home 
on  the  28th — six  days  after  the  operation — the  cavity  was  diminished 
more  than  two-thirds,  and  the  globe  was  gradually  retreating  in  the 
orbit. 

Dr.  Williams  directed  a  continuance  of  the  tent  for  ten  days,  when 
the  patient  is  to.j^urn  an^  enable  the  Dr.  to  give  the  final  reAlt. 

JDr.  Blachman — Said  there  were  some  very  important  points  of  imr 
terest  In  the 'case  related  by  Dr.  Williams  ;  one,  the  obscnri^  in^the 
diagnosis  of  tumors  about  the  orbit,  of  which  there  were  nnoiiBioni 
varieties  and  mai^  of  which  were  malignant. 

Dr.  Gibson,  in  the  case  of  the  lamented  Crawford  who  died  at  Home 
from  malignant  disease  of  the  orbit,  used  the  exploring  needle,  as 
Dr.  Williams  and  all  good  physicians  would  do,  to  ascertain  the  troe 
character  of  the  disease ;  but  so  much  abuse  was  heaped  upon  Gibson 
that  he  was  obliged  tp  call  upon  ihe  physicians  of  the  whol^  world  to 
defend  and  uphold  him,  in  what  he  had  done.  Many  persons  asying 
the  disease  was  hastened  by  the  use  of  the  needle. 

All  surgeons  used,  the  exploring  needle,  and  all  were  benefited  by 
its  use,  provided  they  were  judicious  in  selecting  one  of  the  right  cal- 
ibre. 

Dr.  Blackmau  noticed  Dr.  Williams  regretted  he  had  not  collected 
some  of  the  finid,  and  would  here  call  the  attention  of  Dr.  W.  as  well 
as  thcT  other  members  of  the  Academy  to  a  new  and  useful  instrument, 
ft  was  an  exploring  needle  with  a  bulbous  end  for  collecting  the  fluid 
from  a  tumor. 

Dr.  Blackman  operated  in  a  similar  case  several  years  ago  ;  the  tu- 
mor was  over  the  orbit,  of  great  length.  He  made  almost  the  same 
•incision  as  Dr.  Williams  did,  and  with  the  blunt  point  of  &.scoop 
scooped  and  tore  the  cyst  until  the  whole  of  it  was  removed.  He  had 
removed  in  the  same  way  cysts  over  the  jugular- veins  with  perfect  suo- 
cess. 

Oiteo  Sarcoma. — Dr.  Blackman  presented  to  the  Academy  an  ex- 
traordinary specimen  of  osteo  sarcoma  or  enchondromatoua  tumor  of 
the  femur,  measuring/oicr  /set  in  circumference,  and  weighing  sixty- 
five  pounds.  It  is  one  of  the  largest  known,  there  being  but  three  on 
reoord  of  a  larger  size.  The  patient  from  whom  this  specimen  was  ob- 
t^io$d,  by  a  post-moTieni|  Tea\dai  u^  Iha  river.    A  few  months  i^ 


1864.]  [ProeeMngn  of  Sodetim.  405 

Dr.  B.  was  sent  for  to  ampntate  at  the  hip  joiot,  hat  he  found  the  man's 
condition  snch — pulse  165,  week  and  feehle — that  he  declined  to  op- 
erate. He  amputated  at  the  hip  joint  several  years  ago  for  a  similar 
tumor,  when  the  patient  lived  eighteen  months.  The  moitalitj  of  hip 
joint  ampntation  was  very  great,  heing  65  per  cent. 

Lngol  exhibited  one  in  Paris  which  measured  six  feet  in  circumfer- 
ence and  on  bursting  discharged  sixty  pints  of  serum.  Nelaton  also 
reconled  one  six  feet  in  circumference.  In  both  these  cases  the  tu- 
mors burst,  dischargriug  serum  very  freely,  after  which  putrid  infec- 
tion set  in  and  the  patients  died. 

*  In  Dublin  there  was  one  measuring  six  feet  three  inche8,''where  the 
patient  lived  three  years  after  the  tumor  was  first  noticed.  This  va- 
riety of  tumor  was  considered  benign  and  consisted  of  cartilaginous 
degeneration  of  bone. 

Dr.  Blaekman — Said  he  would  not  speak  at  length  on  the  subject 
now,  as  he  expected  to  present  another  similar  specimen,  probably  at 
the  next  meeting,  from  a  patient  now  in  the  city.  In  this  case  the  tu- 
mor involved  the  humerous,  measuring  thirty-six  inches.  It  hurst 
discharging  serum  copiously.  Symptoms  of  pyemia  had  appeared  and 
the  patient  would  not  long  survive. 

Foreign  Body  in  TVac^ea.— In  the  case  reported  at  the  last  meeting 
of  foreign  body  in  the  trachea.  Dr.  Blaekman  said  that  when  sent  for 
he  was  out  of  town,  but  on  his  return  he  visited  the  boy,  a  beautiful 
child,  the  son  of  an  army  surgeon,  and  found  him  in  convulsions, 
with  pupils  widely  dilated  and  other  cerehral  symptoms  ;  there  had 
been  nosofTocation,  was  no  cough,  but  he  had  croupy  symptoms  in  the 
morning.  Six  months  before  ho  had  had  cerebral  difficulty,  over  both 
Inngs  rales  could  be  distinctly  heard  and  dullness  over  the  bifurcation 
of  the  trachea,  but  no  flapping  could  he  noticed  as  in  other  similar 
cases. 

The  history  of  this  case  was  simply  this,  two  little  boys  were  play- 
ing together  when  one  came  running  in  the  house  saying  his  playmate 
had  swallowed  a  bean. 

Dr.  Blaekman — Said  it  was  a  rule  of  all  physicians  to  open  the 
trachea  if  they  were  confident  a  foreign  body  was  lodged  there,  but  in 
this  case,  after  a  careful  examination,  finding  no  indication  of  a  for- 
eign body,  he  refused  to  operate,  considering  it  more  a  medical  than  a 
surgical  case,  and  that  it  should  be  treated  as  snch ;  advising  that  the 
family  physician  proceed  with  it.  On  leaving.  Dr.  B.  r«(^«%\«4  ^%X. 
if  the  child  showed  any  signs  of  suffocation,  they  a\i<yn\^  vnnA  ^otVxsbl. 
II0  bsd  not  been  borne  an  bour  before  a  mesaenget  eauke  lox  \ivai%  «:^ 


406  PnKHiing$  ^  SaektSa.  [ Jaljr» 

before  he  coald  retch  the  hooee  the  obild  waa  deed.    Fire  minittee 
before  death  the  patieat  preeented  the  only  aTmptoms  doriog  his  whole 

sickness  of  a  foreign  body  in  the  trachea. 

The  post-mortem  revealed  a  large  bean  much  swoUeDt  whieh  had 
been  ei^lled  from  the  right  long  and  lodged  in  the  traohea  just  be* 
yond  the  junction  of  the  right  bronchi,  oanaiiig  anffocation.  Tha  in- 
ferior thyroid  artery  was  of  lai^  size  and  lying  directly  acvoaa  the 
trachea  and  it  wonld  oertainly  have  been  divided  in^an  operaiiDait  M  it 
lay  directly  in  the  line  of  incision  the  Dr.  wonld  have  made.  The  vrfna 
were  also  large  and  full,  effusion  had  already  manifested  ilself  iaii^t 
brain  so  that  the  Dr.  rejoiced  that  he  had  not  operated,  for  tha  dHlf 
>ould  notwithstanding  have  died,  and  an  operation  would  oaly  liasi 
added  to  the  sufferings  and  hastened  death.  In  the  right  Inagww 
found  ulceration,  and  suppuration  had  commenced,  in  such  oases  it 
was  best  not  to  operate  but  Dr.  Blackman  thought  he  would  deviate 
from  this  rule  in  certain  exceptions,  for  a  cavity  in  the  lung  was  not 
necessarily  fatal,  as  is  shown  by  tubercular  patients  who  live  maay 
years  after  cavities  are  formed. 

Dr.  Muuey — Said  that  several  years  ago  a  child  from  Indiana  was 
sent  to  his  father  and  himself  to  operate  on  for  foreign  boby  in  the 
trachea ;  they  could  not  determine  whether  there  was  a  foreign  body 
present,  but  kept  the  child  here  treating  it  for  some  little  difficulty 
which  it  had,  the  child  rapidly  improved.  The  mother  waited  some 
time  for  a  paroxysm  to  come  on,  but  getting  tiied,  at  last  she  went 
home  taking  her  child. 

The  Drs.  Mussey  not  being  satisfied  wrote  to^the  family  physician, 
who  had  sent  the  case,  that  they  could  not  discover  a  foreign  body, 
but  advised  hip  to  be  on  the  alert,  and  ready  to  operate,  for  the  case 
might  yet  require  an  operation.  Some  time  after  this  physician  sent 
to  Dr.  M.  a  locust  bean,  which  he  had  found  in  the  trachea  of  the 
child  on  a  post-mortem,  writing  also  that  he  might  have  saved  the 
child  had  he. had  the  courage  to  have  operated,  and  wishing  to  Gk)d 
that  be  had. 

Dr,  Musaey — Said  he  would  use  extraordinary  means  in  such  cases 
to  bring  on  paroxysms  of  couching  to  thus  dislodge  the  foreign  body. 
Also  that  if  he  had  the  testimony  of  some  reputable  physician  or  re- 
sponsible person  that  the  child  had  swallowed  anvthing,  he  wonld  use 
some  means,  as  suspending  by  the  heels,  shaking,  spanking  or  bump- 
jug  it  to  bring  on  a  paroxysm.  Also  that  he  felt  guilty  because  of 
th9  cMse  above  related,  and  w\a\i^  \a  ^i\\  Iha  attention  of  country 
/>r«ch'tiooers  and  phjeirianta  \n  gei&«i«\  Vo  >X»  \Ttt\twx^tL%  ^V  Vma^ 


1864.]  Proceedings  oj  SaddUi.  407 

nwake  and  prompt  in  using  energetic  means  in  all  such  cases. 

Dr.  Blackman — Said  his  patient  bad  no  congh,  and  that  the  famil  j 
physician  who  examined  the  child  shortly  after  the  accident  conld  dis- 
cover no  signs  of  a  foreign  body,  then  went  on  to  say  that  attempt 
to  lemove  bodies  by  suRpension  had  been  tried  but  without  sncoess» 
as  in  the  case  of  the  celel^rated  engineer  Bmiyl,  where  Benj  Brodie 
tried  in  vain  to  dislodge  the  piece  of  silver  by  suspension,  and  afUr 
many  efforts  in  which  he  almost  killed  his  patient,  was  obliged  to 
make  an  opening  in  the  trachea,  when  again  suspending  him  the  piece 
dropped  out  of  the  opening. 

On  Seventh  Street  Dr.  Blackman  operated  afler  a  bean  had  been 
swallowed  eight  days.  He  opened  the  trachea,  suspended  and  thump- 
ed the  child  till  he  nearly  killed  it,  without  any  good  result,  and  sev- 
eral days  after  the  bean  passed  through  the  opening  in  the  trachea. 

Dr,  Blackman — Thought  it  was  difficult  to  make  a  diagnosis,  and 
in  support  gave  the  case  of  a  child  where  he  operated  and  removed  a 
grain  of  coffee  ;  the  child  died  some  weeks  afterwards,  when  the  left 
lung  was  found  ulcerated  from  another  grain  of  coffee  which  had  re- 
mained.   The  child  swallowed  two  grains  at  once. 


»•»  ^i 


Proceedings  of  the  Fifteenth  Annuai  Meetfnti  of  tlie  Afnarioan  Medica 

Association. 

[neld  at  New  Ycrk,  JajM  Tth,  Stb,  Stb,  1B64.] 

Tuesday,  June  7th,  Morhiho  Sbssioh. 

Tlie  Association  met  pursuant  to  regulations  ai  11  o'clock,  Tuesday 
morning,  Jone  7th,  1864,  at  Irving  Hall,  New  York,  and  was  called 
to  order  by  the  retiring  President,  Alden  March,  H.D.,  of  Albany 
supported  by  retiring  Vice-Presidents,  Dr.  John  Cooper,  of  Delaware ; 
Dr.  David  Prince,  of  Illinois;  Dr.  C.  0.  Cox,  Surg.  U.S.V.  The 
Secretaries,  Drs.  H.  A.  Johnson  of  Illinois,  and  Guido  Fnrman  of 
New  York,  were  also  present. 

Prayer  was  offered  by  the  Rev.  Dr.  De  Witt,  of  New  York,  after 
which  Dr.  James  Anderson,  of  New  York,  Chairman  of  the  Commit- 
tee of  Arrangements,  welcomed  the  delegates  and  memt>ers,  and  made 
the  following  report : 

Mr.  Prbsident  and  Dblkoatrs  to  thb  Axxricah  Mbdioal  Asso- 
ciATioK — Gkntlkiien  : — In  the  discharge  of  the  duty  devolved  upon 
me  as  Chairman  of  your  Committee  of  Arrangements^  it  aft<(std!^  \&<^ 
great  pleasure  on  this,  the  fifteenth  anniveraary  ot  iVie  AAl«(lc^a!C\Ql^>  v^ 
hehmlf  of f  oar  committee  as  well  as  the  profeaaion  m  gwk«t%\»   ^ 


408  Proc$$ding$  qfSoditiss,  [Jnlj. 

tend  to  yoa  a  cordial  welcome.  This  organisation,  whose  genn  was 
first  developed  in  the  Medical  Society  of  the  State  of  New  Totli,  was 
perfected  on  the  7th  of  May,  1847,  hy  the  election  of  the  venerable 
Dr.  Nathaniel  Chapman,  of  Philadelphia,  as  its  first  President,  since 
which  time  its  meetings  have  heen  held  in  nearly  all  the  prominent 
cities  of  nur  country.  Its  sole  object  has  ever  been  the  devation  of 
the  dignity  and  usefulness  of  the  profession,  in  the  endeavor  to  ob- 
tain which  it  becomes  us  individually  as  well  as  collectively,  by  onr 
advice  and  example,  to  stimulate  each  other  to  higher  attainmenta,- 
and  by  our  condijct  to  command  respect.  It  is  now  eleven  yeafliaiace 
your  last  meeting  in  thiii\*ity,  around  which  occasion  cluster  many 
pleasant  i-emioiscences,  saddened, only  by  the  absence  of  some  of  the 
brightest  names  among  your  ranks,  who  have  passed  to  their  silent. 
resting-place — names  which  gave  dignity  to  your  body,  and  wisdom 
to  your  counsels.  Tour  Committee  of  Arrangements,  in  due  time 
after  their  appointment  in  Chicago,  organised  and  invited  a  represen- 
tation from  the  hospitals,  colleges,  and  medical  societies  of  this  city 
and  Brooklyn,  for  the  purpose  of  eliciting  a  united  expression  and 
procuring  a  more  extensive  and  general  welcome  to  this  national  re- 
union, and  have  matured  such  plans  as  it  is  hoped  will  render  your 
stay  both  instructive  and  interesting.  Guide-books  will  be  furnished 
to  each  delegate,  wiih  a  programme  comprising  a  variety  of  intellect- 
ual as  well  as  social  amusements.  Among  the  institutions  which 
have  sprung  up  since  your  former  visit  may  be  noticed  St.  Luke's 
Hospital,  on  the  Fifth  Avenue,  with  a  full  and  efficient  medical  staif ; 
also  a  medical  college  under  the  auspices  of  the  Commissioners  of 
Charities  and  Corrections,  and  in  connexion  with  the  Bellevne  Hos- 
pital and  Alms  House ;  and  in  time,  through  the  liberal  bequest  of 
the  late  Mr.  Roosevcflt,  a  third  hospital  will  be  added  to  the  list 
There  is  a  feature,  Mr.  President,  in  your  present  assembling,  of  deep 
interest  and  solemn  regi-et.  I  allude  to  that  profound  silence  of  sev- 
eral, and  the  diminished  response  of  other  States,  which  will  appear 
upon  the  calling  of  the  roll.  It  would  not  be  proper  on  this  occasion, 
nor  becoming  the  circumstances  under  which  I  appear  before  yon,  to 
allude  to  its  cause.  Let  us  trust,  however,  that,  through  the  interpo- 
sition of  an  all-wise  and  overruling  Providence,  the  time  is  not  far 
distant  when  we  may  again  ofier  to  our  alienated  brethren  the  hand  of 
professional  fellowship  which  it  is  our  privilege  to  extend  to  yon  this 
day.    I  again  welcome  you  all  to  this  metropolis. 

On  motion,  the  report  was  read  and  adopted. 

Dr.  Anderson,  on  behalf  of  the  Committee,  suggested  that  the  Aaso- 


1864.]  Pioeeedinpt  of  SocietUi.  409 

ciation  hold  two  daily  sessions  during  Tuesday,  Wednesday,  and 
Thursday — one  in  th^  morning,  from  ten  to  half  past  one  o'clock  p. 
M.  ;  and  one  in  the  afternoon,  from  three  o'clock  until  such  time  as 
was  the  pleasare  of  the  hody  to  adjourn.  On  motion  this  snggestioif 
was  ordered  to  he  embodied  in  the  report. 

Surg.  C.  C.  Cox,  U.S.V.,  moved  that  Surg.  Charles  S.  Tripler,  U. 
S.A.,  be  invited  to  a  seat  on  the  platform.' 

It  was  then  moved  that  the  Association  should  take  a  recess  of  ten 
minutes  for  the  purpose  of  afifoiding  an  opportunity  to  the  delegates 
lo  select  the  Nominating  Committee,  which  was  carried.  xVfter  the 
lapse  of  the  specified  time,  the  Committee  elected  reported  the  follow- 
ing names  : 

J.  C.  Weston,  Maine  ;  Thos.  D.  Marshall,  N.  II. ;  J.  N.  Stiles, 
Vt. ;  Horatio  R.  Storer,  Mass.  ;  Johnson  Qard:ner,  Rhode  Island  ;  £. 
H.  Catlin,  Conn. ;  Jas.  P.  White,  N.  Y.  ;  L.  A.  Smith,  N.  J. ;  A. 
Nebinger,  Penn. ;  F.  E.  B.  Hintze,  Md.  ;  Henry  F.  Askew,  Del. ; 
B.  B.  Leonard,  Ohio  ;  Jas.  F.  Hibbard,  Ind. ;  Wm.  H.  Byford,  111. ; 
R.  G.  Armor,  Mich. ;  J.  H.  Bartlett,  Wis. ;  A.  E.  McCurdy,  Iowa ; 
Geo.  W.  Phelps,  Mo.  ;  Noble  Young,  D.  C. ;  Thos.  Antisell,  U.S. 
A. ;  and  Thos.  L.  Smith,  U.S.N. 

Retiring  President* 9  Address. —  Dr.  Alden  March  was  next  re- 
quested to  read  his  retiring  addi-ess  as  President  of  the  Association. 
His  subject  had  reference  to  the  elevation  of  the  standard  of  the  pro- 
fession by  a  thorough  and  proper  medical  education.  After  a  few 
general  and  preliminary  remarks,  and  the  rehearsal  of  many  of  those 
who  bad  devoted  considerable  time  and  attention  to  tlie  theme,  be  set 
foith  his  ckims  npon  the  consideration  of  the  Association  as  a  body, 
and  urged  the  importance,  in  the  first  place,  of  a  fitting  preliminary 
education,  as  the  grand  foundation-stone  npon  which  to  rear  the  su- 
perstmctare,  and  contended  that  every  candidate  for  the  honorary  de* 
gree  of  Doctor  of  Medicine  should  be  required  to  attend  three  fnll 
coorses  of  lectares,  instead  of  the  two  usually  prescribed.  If  this 
plan  were  carried  out,  he  had  no  doubt  hot  that  the  time  of  stndy  thus 
increased  would  afford  the  student  an  opportunity  to  digest  more  fully 
the  great  principles  of  onr  art  as  given  to  him  in  the  leetnre-room. 
Too  many  of  our  young  men,  in  his  opinion,  were  allowed  to  gradu- 
ate, who,  for  want  of  these  very  opportunities,  sufifored  from  a  mental 
indigestion  which  troubled  them  more  or  less  through  their  whole  pro- 
feMiooal  career,  and  prevented  them  from  applying  the  g^reat  truths  of 
science  to  every-day  practice  with  that  degree  of  satisfaction  which 
was  the  only  sure  forerunner  of  advancement  and  success.     If  sack 


410  Proeudlngi  of  SacUtie9.  [Jolyt 

coarse  6houId  only  compriae  a  period  of  foar  montbt,  be  ihoi^tthat 
the  entire  time  of  attending  lectnres,  extending,  as  it  aboold,  orer  a 
period  of  three  yeftis,  wonld  be  more  than  equivalent,  in  point  of  ac- 
tual benefit  to  the  student,  to  the  ordinary  two  full  courses  of  six 
months  each.  « 

Dr.  Wilson  Jewell,  of  Pa.,  moved  that  a  vote  of  tbanks  be  tender- 
ed  to  Dr.  March  for  his  noble  and  interesting  address*  and  tbat  be  be 
requested  to  famish  a  copy  for  publication. 

The  Association  then  adjourned  till  3  p.m. 

Tuesday — ArrsBHOov  Ssssiov. 

The  Association  was  called  to  order  by  the  President,  afkar  which 
the  minutes  of  the  prerions  session  were  read  by  the  Secretary.  The 
names  of  registered  members  were  next  read. 

OfficerifoT  the  Ensuing  Year, — ^The  Nominating  CommiUaa  thea 
made  the  following  partial  report :  N.  S.  Davis,  of  111.,  President; 
W.  H.  Massey,  of  Ohio,  Worthington  Hooker,  of  Conn,  William 
Wheelan,  of  D.  0.,  and  F.  E.  B.  Heintae,  of  Md^  Vioe-Presidents ; 
Guide  Farman,  of  N.  Y.,  Secretary ;  Casper  Wistar,  of  Pa.,  Treasurer. 

The  Committee  recommended  Boston,  Mass,  as  the  place  for  hold- 
ing the  next  annual  meeting. 

Dr  Griscom,  New  York.,  moved  that  the  report  of  the  Committee 

be  laid   upon  the  table  in   order   to  discuss  the  following  propoted 

amendments  to  the  plan  of  organization  : — 

Ist.Providing  for  the  appointmeotof  one  permanent  Secretary.  2d. 
That  the  President  and  Vice-Presidents  of  this  Association  elected 
each  year  shall  assume  the  functions  of  their  respective  offioes  at  the 
beginning  of  the  meeting  of  the  year  next  succeeding  their  election. 

This  motion,  however,  was,  after  much  discussion  finally  lotU 

Dr.  Raphael,  of  New  York,  then  moved  that  the  report  of  the  Nom- 
inating Committee  be  reoommitted,  with  instructions  that  two  Presi- 
dents  be  nominated  instead  of  one,  and  that  the  one  who  abould  re- 
ceive the  piajority  of  the  number  of  votes  should  be  declared  elected. 

A  lengthy  discussion  then  ensued  as  to  the  propriety  of  tho  mea- 
sure, and  it  was  eventually  voted  down. 

The  question  for  the  adoption  of  the  report  of  the  Committee  was 
next  put  and  carried* 

On  motion  of  Dr.  Griscom  of  New  York,  the  President  and  Vice* 
Presidents  were  duly  Obcorted  to  their  chairs. 

Dr.  N.  S.  Davis,ou  assuming  his  duties  as  President  of  the  Auoci- 
atiou,  tendered  his  sincere  tbanks  for  the  honor  conferred  upon  him, 
and  asked  of  the  members  tbeu  kind  co-operation  in  in  his  endeavors- 
to  perform  the  duties  ot  Yua  o^oia* 


64.]  ProeemiingM  ^  SoeUOeg.  41 1 

The  Chainntn  of  the  Committee  of  Arangemente  stated  that  invita- 
>ii8  were  extended  to  the  members  to  visit  the  following  places : — 
.  8.  NavT  Yard,  Brooklyn  ;  Collegiate  and  Polytechnic  Institute  ; 
>ng  Island  College  Hospital ;  U.  8.  Naval  Hospital,  Brooklyn ;  U. 

Soldiers'  Depot,  New  York. 

The  following  gentlemen  were  announced  as  members  by  invita- 
•n  ; — ^Drs.  Ed.  M.  ^^tein,  O.  R.  Brush,  P.  H.  Barton,  D.  McSweeny, 

H.  Gregory,  Elisha  Harris,  and  B.  Dewitt,  Bradford  Co.,  Pa. 
The  President  appointed  the  following  Committee  to  examine  all 
luntary  communications  : — Drs.  A.  B.  Palmer,  H.  F.   Askew,  8. 

Hubbard. 
Dr.  C.  Ramsay,  N.  Y.,  moved  that  the  regular  order  of  businees  be 
ipended,  and  that  the  proposed  amendment  of  the  Constitution  be 
ken  up  ;    which  was  carried,  and  the  following  amendment  intro- 
seed : — 

Amendment  of  the  ConetUntUm  m  Relation  to  Permnneni  Secretary. 
U  is  here  ordained  that  Article  4,  Sec  1,  of  the  Constitution  be 
tended  as  follows : — From  the  2d  line  strike  out  the  words  "  two 
eretaries,"  and  insert  "  one  Permanent  and  one  Assistant  Secie- 
j"  and  in  the  5th  line  after  word  "  ofiBcer,"  insert  the  words 
xcept  the  Permunent  Secretary  ,*  also  add  to  the  same  section, 
)  following ;  "  the  Permanent  Secretary  shall  hold  his  appointment 

ten  years,  unles  sooner  removed  by  death,  resignation,  or  a  vote 

two-thirds  of  the  members  present  at  a  regular  annual  meeting." 

\Qd  be  it  further  ordained  that  Section  5  of  tlie  same  article  be 

fcken  out,  and  the  following  substituted  in  its  place,  yiz., :  "  The 

rmancnt  Secretary  shall  record  the  minutes  and   authenticate  the 

Kcedings,  give  due  notice  of  the  time  and  place  of  each  ensuing 

laal  meeting ;  notify  all  members  of  Committees  of  their  appoint- 

nt  and  of  the  duties  assigned  to  them ;  hold  correspondence  with 

er  permanently  organized   Medical  Societies  both  domestic  and 

sign ;  serve  as  a  member  of  ^he  Committee  on  publication ;  see 

1  the  published  transactions  are  promptly   distributed  to  all  the 

mbers  who  have  paid  their  annual  assessment,  and  carefully  pre- 

ve  the  Archives  and  unpublished  Transactions  of  the  Association, 
rbe  Assistant  Secretary  shAlJ  aid  the  permanent  Secretary  in  re- 
ding and  authenticating  the  proceedings  of  the  Aesoeiation ;  serve 
1  member  of  the  Committee  of  Arrangements,  and  perform  all  the 
iea  of  permanent  Secretary  temporarily  whenever  that  o£Bce  shall 
vacant  either  by  death,  resignation  or  removal, 
ind  be  it  further  ordained,  that  Article  6,  Section  "  fee<md*'  ^ 
leti  after  the  word  "  meeting,"  in  the  second  Vine,  t\i«  to\\o^\ii^, 
. :  '*  \uc]udwg  the  necesssry  expenses  of  i\m  perman^iiV  &%i&\«U.r5 


412  Procudtngi  qfSoeUiM.  JoljJ 

in  maintaining  the  correspondence  of  the  Association." 

After  reading  the  amendments,  Dr.  Jewell  of  PeifnsyWania  mOTed 
to  strike  ont  from  the  last  clause,  "  attending  the  regular  meetings." 
Which  motion  was  adopted. 

Dr.  Nebinger,  Pa.,  moved  to  strike  out  the  word  **  ten  "  in  the 
second  paragraph,  and  substitute  "  five.'*    Which  was  lost. 

Dr.  Griscom  proposed  to  strike  out  all  that  related  to  a  apodfied 
term  of  years. 

Tlie  previous  question  being  called  for  and  suatainedy  the  amend- 
ment of  Dr.  Griscom  was  carried. 

The  question  recurring  on  the  adoption  of  the  proposed  amend- 
ments as  amended,  it  was  finally  carridl  in  tho  afiSrmativ^e. 

The  Association  then  adjourned  until  ten  a.  m.  of  the  wkj  follow- 
ing, June  8. 

During  the  evening  the  members  were^  handsomely  entertained  at 
the  residences  of  Drs.  Jos.  M.  Smith,  C  A.  Bodd,  Isaac  E.  Taylor, 
Gurdon  Buck,  and  Mayor  Ounther. 

Wednesday,  June  8th. — Mobnivo  Skssiov. 

The  Association  was  called  to  order  by  the  President,  N.  S.  Davis, 
at  10  A.  u. 

The  minutes  of  the  previous  session  were  then  read  by  the  Secretary, 
Dr.  Furman,  and  adopted. 

The  following  gentlemen  were  elected  members  by  invitation,  and 
were  requested  to  take  seats  on  the  platform  : — Drs.  G.  W.  Steams, 
N.  Y. ;  G.  C.  Knight,  New  Haven  ;  S.  H.  Gasey,  Gneonta  ;  W.  B. 
Southard,  Mich. ;  Philander  White,  Gswego  Co.,  N.  Y. ;  F.  L.  Liv- 
ingston, BdiTct,  Mass ;  J  no.  Green,  Worcester,  Mass. ;  Noycs, 
Norfolk,  Conn.  ;  Thorn  is  Cock,  N.  Y. 

Gn  motion,  the  following  gentlemen  were  elected  permauent  mem- 
bers : — Drs.  Brown -Seqnard,  Boston,  Mass. ;  Jno.  P..  Gray,  Stats 
Lunatic  Anylum,  Utica,  N.  Y. 

The  reports  of  the  Standing  Committee  were  next  called  for  in  re- 
gular order  and  referred  to  their  appropriate  sections. 

7reasHrer*s  Report, — The  Report  of  the  Treasurer,  Dr.  C.  Wistar, 
showed  a  balance  on  hand  of  8^49.02.  Gnly  about  120  copies  of 
Volume  xiv.  have  been  sold  during  the  past  year. 

Report  on  Compuhary  Vadnation, — Dr.  Jas.   F.  Hibbard,  Chai^ 
man  of  the  Committee  on  Compnlsary  Vacination,   read  a  report  in 
which  it  was   contended  that  the  adoption  of  the  measure  was  im- 
f  racticable,  inasmncb  asil^aa  necessary  for  the  people  to  bo  convinc- 
ed of  its  utility  and  liarmWaiiftw  Xi^lox^  ^1  ^o^^  vo^mit.    They 


1S64.]  Proceedings  of  SocieUiS,  413 

could  be  properly  edacated  ia  this  matter  by  the  medical  profession, 
who  should  act  as  a  unit  in  reccommendiog  it  under  all  circumstances. 
The  Committee  also  reoommended  that  the  daily  papers  thronghout 
the  Union  should  be  requested  to  ventilate  the  matter,  and  use  every 
precaution  in  their  power  to  bring  the  public  to  a  proper  understand- 
ing of  the  power  of  vaccination  in  preventing  the  spread  ol  small  pox. 
The  report  concluded  with  the  following  resolutions  :  — 

Hesohed^ThtLi  a  Committee  of — be  appointed  to  sapervisoand  con- 
trol under  the  direction  of  this  Association,  all  matters  pertaining  to 

general  vaccination. 

Resolved,  That  a  Committo  of  —  be  appointed  in  each  State  to  su- 
perintend the  measnre  in  its  State,  which  Commit  oe  shall  be  suboi- 
dinate,  auxiliary,  and  advisory  to  the  Central  Committee. 

«         Signed,  J  as.  F.  Hibbard,  Chairman, 

Wilson  Jvyell. 
Jko.  H.  Griscom. 
Adopted,  and  referred  to  the  section  on  public  health. 
Dr.  H.  H.  Childs,  of  Mass.,  was  invited  to  take  a  seat  on  the  plat- 
form . 

Medicines  and  Surg>cal  Apparaius  for  the  Wounded  and  Suffering 
in  ike  Sovth. — Dr.  A.  K.  Gardener  ofi'ercd  the  following : 

Whereas,  It  is  the  duty  and  great  distinction  of4I!hnstian  nations, 
and  in  conformity  with  the  highest  instincts  of  humanity,  to  assnage 
the  f^ufferings  and  mitigate  the  horrors  of  war  in  every  possible  man- 
ner, in  which  attempt  the  medical  profession  has  ever  been  eminently 
conspicuous  ;  and 

Whereas,  The  stringency  of  our  blockade  of  the  Southern  coast 
has  to  a  great  extent  deprive  the  sick  and  wounded,  the  feeble  babe, 
the  helpless  woman,  the  aged  man,  as  well  as  the  suflerers  by  wonnds 
and  disease  in  the  ranks  of  our  enemies,  of  needful  appliances  to  re- 
lieve pain  and  to  save  lift ;  and 

Whereas,  From  the  same  cause  thousands  and  tens  of  thousands 
ryf  onr  own  brave  sons  and  brothers,  fighting  for  the  holy  cause  of  our 
Union,  and  left  wounded  on  the  battle-field  in  the  hands  of  the  enemy, 
have  been  compelled  to  have  operations  performed  without  the  relief 
and  benefit  which  chloroform  would  bring,  and  have  lain  in  Buffering 
unto  death  in  the  hospitals  of  the  South  from  the  absolute  destitution 
of  the  country  of  many  needful  medicines  and  instruments  of  surgery  ; 
and 

WuKREAt,  These  articles  are  in  no  respect  to  be  considered  as 
among  the  **  sinews  of  war,"  and,  as  has  been  seen,  Are  not  material 
to  a  vigorous  persecution  of  rebellons  warfare  ;  and 

Whereas;  This  Association,  nnmbering among  its  lawful  members 
the  medical  men  of  the  entire  thirty- four  States  of  the  Union,  we 
deem  it  eminently  fitting  that  we  should  nrge  npon  the  QovemmAfk^ 
ftiid  the  people  of  the  United  States  tv  remember  the 


1 


414  Proceedinfft  of  SoeielUi .  \  Jolj, 

hood  of  man  and  the  undying  atttibates  of  bmnftaitjr ;  it  ie  iharafora 
nnanimonsly 

Resolved,  That  the  Association  request  the  President  of  the  United 
Htates  to  take  such  action  as  shall  caose  all  medieinet  and  medieil 
and  sargical  instruments  and  appliances  to  be  exoloded  from  tha  list 
of  articles  called  "  contraband  pf  war/'  and  diat  such  articles  in  any 
quantity  may  be  purchased  by  any  person  in  any  State  of  the  Union, 
and  may  be  jsonveyed  beyond  oar  lines  under  a  flag  of  trace,  after 
a  proper  inspection,  so  as  to  give  every  necessary  comfort  to  mliert 
any  human  suffering,  whether  of  our  own  soldiers  or  that  of  the  enemy. 

Resolvedt  That  a  copy  of  the  above  Preamble  and  Reaolation  be 
sent  to  the  President  and  Heads  of  Departments,  and  to  eaeh  and  everj 
member  of  the  United  States  Senate,  and  attested  by  tha  officers  of  Ail 
^  dissociation ;  and  that  every  member  be  requested  to  nee  all  the  infls* 
ence  in  his  power  i^  stripping  this  fratricidal  war  of  aome  of  its  ua* 
necessary  horrors,  and  thereby  to  inaugurate  the  re-astablishment  oi 
more  kindly  feelings,  and  to  smooths  away  some  of  the  obstmctions 
to  the  reconciliation  of  our  misguided  brethren. 

Resolved,  That  a  Committee,  representing  every  State  of  the  Unioa 
here  present,  be  appointed  to  present  these  Besolntions  to  the  Presi- 
dent. 

On  motion,  the  consideration  of  the  resolutions  was  indefinitely  post- 
poned. 

Increase  of  Rank  and  Pay  ofJSIedkal  St^ffof  Army  and  NavyjS^r 
C.  C.  Cox  offered  a  resolution  to  increase  the  rank  and  pay  of  medi- 
cal officers  of  the  army  and, navy. 

Dr.  Frank  H.  Hamilton  urged  the  passage  of  the  resolution  by 
some  well  timed  and  appropriate  remarks,  after  which  the  question 
was  put  and  carried  unanimously. 

The  Chair  appointed  a  Committee,  composed  of  the  following  gen- 
tlemen, to  report  upon  the  same,  and  prepare  a  memorial  for  the  ae- 
tion  of  Congress  :  Drs.  McOugin,  Iowa  ;  Antisell,  Waahington,  D. 
C. ;  F.  H.  Hamilton,  N;  Y. :  and  Askew,  of  Delaware. 

The  Association  then  adjourned  until  10  a.m.  of  Thuradmy,  Jane  9. 

The  afternoon  was  occupied  in  the  meeting  of  the  different  sections. 

The  entertainments  for  the  evening  were  given  by  Drs.  WiUard 
Parker,  James  Anderson,  Alonzo  Clark,  and  Jared  Linsley. 

Thuksdat— MoRinNo  Session,  Juhs  9. 

The  Association  was  called  to  order  by  the  President  shortly  after 
10  A.M.  Thd  Secretary  then  read  the  minutes  of  the  previous  aossioo, 
which  were,  on  n^otion  adopted. 

Surg.  C.  C.  Cox,  the  Chairman  of.  the  Committee  appointed  to 
memoralize  the  President  of  the  United  States  in  reference  to  the  ia- 
( reace  of  rank  and  pay  o!  mo^xcsX  ofn^^T^  csf  ih«  army  and  navy,  mov- 


1864.J  I  ProceedingM  of  Sodetiti.  415 

ed  that  Dr.  Charles  S.  Tripler  be  added  to  that  Committee,  and  be 
appointed  the  Chairman  of  the  same.     Carried. 

Dr.  Morgan,  B.  I.,  called  the  attention  of  the  Association  to  the 
prixes  offered  by  the  Bhode  Island  Medical  Society,  and  stated  that 
they  were  two  in  nomber,  100  dolUrs  each,  and  were  open  to  the 
competition  of  all. 

I'inu  of  Next  Meeting, — On  motion  of  Dr.  Askew,  of  Delaware,  it 
was  agreed  that  the  time  of  the  next  meeting  of  the  Association  shonld 
be  on  the  first  Tuesday  of  June,  1865. 

Report  of  Standing  Committees, — The  reports  of  the  Standing  Coii\- 
mittees  were  again  called  for,  with  the  following  results : 

Committee  on  Insanity, — Dr.  R.  Hills,  of  Ohio,  the  Chairman  of  the 
Committee  addressed  a  note  to  the  Association,  reported  progress  and 
asked  for  further  time,  promising  an  elaborate  report  if  such  a  privi- 
lege were  granted. 

It  was  then  carried  that  the  time  should  be  extended  ;  and  on  mo- 
tion of  Dr.  (^riscom.  Dr.  E.  H.  Van  Dusen,  the  Medical  Superintend- 
ent of  the  State  Lnnatic  Asylnm,  Kalamazoo,  Mich.,  was  added  to 
the  Committee. 

Committee  on  Prize  £lsiays.^The  Chairman  of  the  Committee  not 
being  present,  the  calling  for  the  report  was  deferred. 

Beporti  of  Sediom.'^Dr,  S.  W.  Butler,  of  Philadelphia,  the  Chair- 
man of  the  Section  on  Medical  Topography  and  Epidemic  Diseases, 
presented  a  report,  which  was  adopted  in  full ;  and  the  following  gen* 
tlemen  wei^e  appointed  as  members  of  the  Committee  to  carry  out  the 
spirit  of  the  resolutions  appended  to  report  of  the  Committee  on  Com- 
pnUory  Vaccination  :  Drs.  A.  N.  Bell,  of  Brooklyn  ;  J.  P.  Loines, 
and  H.  D.  Bulkley,  N.  Y.  ;  A.  Nebinger,  Philadelphia ;  and  J.  F. 
Hibbatd,  Ind. 

The  Section  on  Surgery  and  on  Practical  Medicine  and  Obstetrica 
'  made  no  report  at  this  period  of  the  proceedings. ' 

Report  on  the  Practical  Workinge  qf  the  U.S.  Law  relating  to  the 
Imfpaetion  of  Drvge  and  liedicinei. — Dr.  Squibb,  the  Chairman  of  the 
Committee  on  the  Practical  Workings  of  the  U.S.  Drug  Law,  made 
a  atatement  to  the  effect  that  the  gentlemen  who  composed  that  Com- 
mittee coold  not  agree  upon  the  report  prepared  for  their  action  ;  and, 
inaamnch  as  at  the  time  it  was  presented  for  their  consideration  there 
waa  not  opportunity  for  an  exchange  of  views  npon  the  anbject,  they 
reapacifolly  requested  that,  as  a  Committee,  they  should  be  discharged. 

On  motion  of  Dr.  Gardner,  the  report  of  the  CommiUUeia  ^«a  «a- 
cepied  and  tke  Committee  discbaiged.  ^  ^^^^ 


416  Proeeedingt  of  SodetUi.  [Jul J* 

Dr.  Sqnibb  tbea  proceeded,  by  invitation,  to  present  bi)  views  npon 
tbe  subject,  in  tbe  form  of  a  volnntarj  commanicatioD.  He  contend- 
ed tbat  the  practical  working  of  tbe  law  was  to  all  intents  and  por- 
poses  a  dead  letter,  and  that  the  Secretarj  of  the  Treasary  had  not  act- 
ed npon  tbe  earnest  solicitations  of  the  Committees  from  the  different 
Societies  and  Colleges  in  New  York  who  had  been  appointed  to  me* 
monilize  him  npon  the  subject,  bat  had  made  an  appointment  withoa 
qualifications,  which  could  be  ascertained  at  the  time*  or  which  hare 
since  been  manifested  in  the  daties  of  tha  of&se,  sioca  drogs  of  veiy 
inferior  quality  wore  constantly  passed  through  the  Custom  How. 
As  an  example  he  instanced  several  articles,  among  which  wers  tboie 
of  jalap  and  scammony,  which  were,  on  examination,  foand  to  contain 
a  very  small  per  cent,  of  active  principles — much  below  that  which  the 
law  prescribed.  He  threw  out  the  suggestion  that,  considering  tbe 
facts  of  tbe  appointment  of  the  present  inspector,  it  woald  be  of  Httl« 
use  to  make  any  further  requests  to  the  appointing  power. 

In  conclusion  ho  stated  that  he  alone  was  responsible  for  the  state- 
ments contained  in  the  paper,  nud  that  Dr.  Bowditch,  one  of  the  Com- 
mittee, declined  to  sign  a  report  which  \%  considered  of  a  partivaii 
character,  reflecting  upon  tbe  officers  of  the  Genera  IGoTemment  at 
the  present  time.  Dr.  Carson  the  other  member  of  the  Committee, 
did  not  wish,  as  a  matter  of  principle,  to  sign  a  paper  until  he  was 
satisHeii,  from  personal  observation,  tbat  all  the  statements  therein 
contained  were  correct. 

After  some  discussion,  the  report  (^  Dr.  Squibb  was  accepted,  after 
which 

Dr.  S.  R.  Percy*  of  New  York,  remarked  that  Dr.  Squibb  had  U- 
bored  under  a  false  impression  in  making  the  statements  contained  in 
tbe  paper  ;  and  further  stated  that  the  appointment  of  Drug  Inspector 
was  made  by  Secretary  Chase  in  perfect  good  faith,  and  with  the  con- 
viction that  it  would  meet  tbe  end  for  which  snch  an  appointment  was 
designed.  That  gentleman  had  made  diligent  search  for  the  right 
man,  and,  as  the  result  uf  very  numerous  recommendations  from  re- 
liable men  of  tbe  profession,  had  selected  the  present  incumbent.  Con- 
cerning tbe  honesty  of  the  present  Inspector,  Dr.  Percy  was  prepared 
to  vouch,  from  a  personal  knowledge  of  that  gentleman's  character, 
and  he  could  confidently  assert  that  every  endeavor  had  been  made  to 
discharge  the  duties  of  the  responsible  office  with  fidelity.  Everj 
specimen  that  it  was  possible  to  examine  was  carefnlly  examined 
before  it  was  allowed  to  pass,  and  he  could  not  conceive  upoi^what 
foundation  Dr.  Squibb  had  made  his  assertions.    In  conclusion,  be 


1861.]  Froaedingi  of  SoeM$i.  417 

did  not  think  it  came  within  the  province  of  the  Association  to  en- 
dorse any  stigmas  made  against  any  one  ;  and  as  a  friend  to  the  In- 
spector, he  felt  that* it  was  his  dnty  pnhlicly  to  defend  him. 

Dr.  Squihh  remarked  that  he  was  not  acquainted  with  the  Inspector, 
and  did  not  allude  to  anyone  hy  name,  bat  merely  had  presented  facts 
which  had  come  to  his  knowledge,  leaving  the  members  to  draw  their 
own  inferences.  He  only  referred  to  the  two  articles,  scammony  and 
senna,  stating  that  he  had  examined  specimens  of  the  former  article 
which  contained  as  low  as  15  per  cent,  of  active  principle,  instead  of 
70  ;  and  of  the  latter  article,  which  contained  from  10  to  55  per  cent, 
of  sticks  and  stones,  and  which  in  that  condition  had  passed  the  C as- 
tern Houfee. 

A  motion  was  made  to  refer  the  paper  to  the  Committee  on  Publi- 
cation, with  discretionary  power,  which  was  lost. 

Dr.  Curry  of  Westchester  Co.,  spoke  at  some  length  against  the 
general  practice  of  referring  papers  to  the  Publishing  Committee, 
uijgiQg  ^  ^^  argnment  against  it  that  many  communications  would 
find  their  way  into  the  volume  which  would  not  be  entitled  to  it,  and 
thought  that  the  Committee  should  have  ample  discretionary  power 
in  the  matter.  He  did  not  wish  it  to  be  understood  that  his  remarks 
referred  to  Dr.  8quibb's  paper,  but  only  wished  the  principle  of  the 
thing  to  be  discussed. 

The  President  stated  that  the  discretionary  power  belonged  to  the 
section  to  which  any  paper  might  be  referred,  and  suggested  the  pio- 
priety  of  referring  Dr.  Squibb's  paper  to  the  Section  on  Chemistry. 

Dr.  McFarland,  of  New  York,  thereupon  made  a  motion  to  refer  it 
to  that  section,  which  was  carried. 

Heport  (^  Section  on  Practical  Medicine  and  Obitetria. — Dr.  Storcr, 
of  Boston,  read  a  report  of  the  meeting  of  the  Section  held  the  after- 
noon before,  and  concluded  the  same  by  presenting  the  following  res- 
olutions, which  were  appended  to  his  paper,  and  which  we  have  al- 
i«uly  alluded  to : 

JU$of9ed,  That  in  the  opinion  of  the  American  Medical  Association 
it  is  txpe<lient  that  there  should  be  attached  to  every  public  hospital 
for  the  insane,  one  or  more  consulting  physicians,  whose  appointment 
shonld  be  honorary,  and  who  may  be  consulted  al  the  discretion  of 
the  soperiniendent,  such  measures  being  alike  for  the  interest  of  the 
hoepital,  iu  medical  officers,  and  its  patients. 

Besoiwd,  That  a  copy  of  the  above  Resolutions  te  transmitted  to 
the  Board  of  Trustees  of  each  of  our  public  hospitals  for  the  insane, 
and  also  to  the  Secretary  of  the  Association  of  American  Superin- 
tendenU  for  the  Insane,  and  request  that  ii  may  h%  tudoiis&^l  v>a%X 


418  Pronidkifii  i^  ihtkUu.  [Jdy, 

body,  the  action  pro{M>s#d  bting  upon  tbo  rttpeeUvo  boards  witli  wbjdi 
it8  members  are  officiaUy  cqnaectad. 

Dr.  Griscom  contended  tbat  tbe  AeeoeUtion,  hf  pasaiqg  Iheaa  tm- 
olotions,  would  prevent  any  medical  man  wbo  ahonld  be  so  a]ip<HBled 
from  receiving  any  remuneration.  He  tbougbt  tbe  pbyeician  •hoild 
be  paid  for  bis  aervicee*  if  be  cbose  to  make  an  anmngemimt  to  tiiat 
efifect  witb  tbe  managers  of  tbe  institution ;  but  if  he  was  dispoaoj  to 
accept  It  as  an  bonorary  position,  tbe  matter  was  of  course  onlj  %  per- 
sonal one.  Tbese  being  bis  views,  be  moved  tbat  the  clauao^  *'  ^whose 
appointment  should  be  bondrary,"  be  stricken  out. 

Bemarks  were  made  endorsing  Dr.  Griseom  by  Drs.  Qardaar^  of 
New  York,  McCarthy,  Dl.,  and  others. 

The  amendment  was  then  carried,  after  which  the  resohitioM  were 
passed  upon  as  a  whole. 

Ths  Campietian  of  tie  Report  itf  ih$  Nommatiom  Cfmmittm.  Mbe- 
</a  Permammt  Secretary — Before  tbe  readii^of  the  report  of  the 
Nominating  Committee,  Dr.  Griscom  obtained  permisaioa  to  make  a 
few  remarks  upon  the  dutiea  which  should  be  required  of  tha  PSanu- 
nent  Secretary.  He  considered  tbat  it  was  of  tba  utmoat  impoitaaos 
that  tbe  right  man  should  be  selected  for  tbe  performv^ce  of  duties 
which  involved  so  great  responsibilities.  He  contended  that,  audi  an 
officer  of  tbe  society  should  bold  regalar  correspondence  with  all  the 
members  and  with  all  tbe  different  societies  throughout  the  oountry ; 
tbat  be  should  attend  every  meeting ;  should  procure  a  systematie  re- 
duction of  fare  over  the  different  railroad  lines  communicating  with  the 
city  in  which  the  meeting  is  held  ;  tbat  he  should  give  his  peraoaal 
attention  to  tbe  sale  of  the  Transactions,  and  use  every  endeavor  to 
advsnce  the  interests  of  the  Association.  Such  a  man,  in  his  opinion, 
could  only  be  obtained  by  proper  remuneration,  and  be  thereforo 
moved  the  adoption  of  a  resdution  to  the  following  effect : 

Beiolved,  That  tbe  Permanent  Secretary  shall  be  entitled  to  the 
cont^ensation  of  dollars  per  annnm,  payable  out  of  any  sniplns 

funds  of  tbe  Association  after  all  other  claims  for  each  current  year 
shall  be  paid. 

Considerable  discussion  bare  followed  as  to  tbe  propriety  of  adopt- 
ing tbe  resolution  and  the  amount  of  remuneration  to  be  ofieiedt  when 
it  was  finally  agreed  to  lay  the  matter  on  the  table. 

Completion  of  Report  of  Committee  on  yommaium$.-^Th%  Commit- 

e  on  Nominations  then  presented  the  completion  of  their  report,  as 
follows : 

QmmitteeonExiedMtnandiU  Conmexiom  wik  Comerwtitm  fiwyvyy 
(^enlarged).— Drs.  Sayte.oi  15.X.»Qc.^  .^w^a,^%.,, G.  C.  Black- 


1864.]  PrateMiffi  </  So^UiUi.  419 

nun,  O.,  S.  H.  Tewksbnry,  Me.,  E.  Anditm,  Ill.»  Oeo.  B.  Twitehdl, 
N.  H„  J.  0.  Hughes,  Iow*t  a.  Glymer,  U^.,  J.  R«  W.  Doabar, 
Md.,  R.  H.  Gilbert,  U.S.A. 

On  Drainage  and  Sewerage  of  Large  CKiieM  and  tkair  Infimemm  on 
PMic  BeaUh.—Dn.  W.  J.  0.  Dobamel,  D.  0.,  E,  C.  Baldwin^  Md. 
Cjroe  Ramsey,  N.  Y. 

On  Alcohol  and  iU  BeltUiani  to  Kan.— Dr.  O.  E.  Moiyen 

On  Jiieroicopic  Obeervaiiom  in  GsiMfr*  CVBt^-— Leonard  J.  Baaftid, 
Conn. 

On  Quarantine  (ooniinoed). 

On  Medical  Ethice, — Die.  J.  A.  Morphj,  Ohio,  M.  L.  Linion,  lio., 

B.  F.  Schenck,  Pa.,  Swain  Wiokersham,  Dl.,  A.  J.  Fnller,  Me. 
On  ike  Jliaroeeope. — Dr.  Jae.  M.  Corse,  Pa. 

On  BeUUione  which  EUdricOy  tuetame-io  the  Oaueee  of  JHeeaie.^^Dr 
S.  Little,  Pa. 

On  the  Morbid  and  I%erapeuitc  ^ede  qf  Mental  and  Moral  ii|ffa- 
enee9. — Dr.  A.  B.  Palmer,  Mich. 

On  the  Came  of  Extinction  of  thi  Abonginal  Bacee  o/Awurica  (con- 
tinned). 

On  the  Caueee  and  Treatnuni  of  Un-united  IVaeturee.—Dr.  F.  JS. 
Hamilton,  N.  Y. 

On  D'pth$ria.—DT.  Lndns  Clark,  III. 

On  the  Ueee  ondAbueei  of  Peeeariei.^Dr.  Jae.  B.  White,  N.  Y. 

On  Iniemaii&nal  and  Medical  Ethice. — Dre.  J.  Baxter,  Upham, 
Mass.,  G.  C.  £.  Weber,  Ohio. 

On  Climatologg  and  Epidemic  Dieeaeee.^Dn.  C.  W.  Parsons,  B 
I.,  P.  A.  Staekpole,  N.  H.,  T.  M.  Logan,  Gal.,  R.  0.  Hamill,  HI.,  J 

C.  Weston,  Me.,  B.  H.  Catlin,  Cono.,  C.  L.  Allen,  Vt.,  T.  Antieell 
Waahington,  D.  C,  J.  W.  H.  Baker,  Iowa,  Abraham  Sager,  Mieh 
O.  a  Mahon,  Md.,  J.  W.  Rassell,  O.,  D.  F.  Condie,  Pa.,  H.  Tawn 
sesM,  ff.  Y. 

On  Antcpeiee  in  Belittion  to  Medical  Juricpmdence. — Dr.  T.  C . 
Finnell,  N.  Y. 

On  eo-caUed  Spotted  Fever.^Dr.  J.  J.  Levick,  Pa. 

Onthc  Introduction  qf  Dieeaee  ly  Commerce  and  the  Meane  for  ite 
Frewention.-^Dr.  A.  N.  Bell,  N.  Y. 

DB.  WV.  B.  ATKIirsOV,   OF  PHIIJLDBLPBIA,    PKBKAVBVT  8BCBBTABT. 

Permaneni  Seeretarg  American  Medical  JssoMfNm.— Dr.  William 
B.  Atkinson,  of  Philadelphia. 
AeeieUmi  Secretary.— Dr.  H.  B.  Storer»  Boeton. 


420  •     Proee^n^  of  Soeiit^.  fJnly, 

On  Paieni  BigkU  and  JMieal  JAfi.-*Dnu  DaTid  Piiim,  ID.,  Hot. 

Antisell,  D.  0.»  and  Stephen  Sttith,  N.  Y. 

The  report*  after  mach  dUenssion  in  relation  to  (ke  eleotimof  Ae 
Secretary,  was  finally  adopted. 

It  was  moTed  that  a  Oommittee  be  appointed  to  lepoit  «t  tlie  next 
meeting  on  the  Ligature  of  the  SabotaTian  Artery,  *  Adopted,  and 
the  following  gendemsn  selected  as  that  Oommittee :— 'J>n.  Wilfand 
Parkefi  N.  Y.,  Armeby,  Albany,  Norrie,  Philad.,  and  Mnaey,  (^ 
cinnati,  0. 

Report  of  Prize  CommUee. — The  prize  was  awarded  to  Br.  S.  Flset 
Spier,  for  an  Essay  on  the  Pathology  of  Janndioe. 

The  Association  then  adjonmed  nntil  4  p.  m. 

Th»r$day,  June  9. — AFTntvooir  Sneiov. 

The  Assoeiation  was  duly  called  to  order  by  th4  President 

The  Chairman  of  Arrangements  announced  the  following  mem* 

hers  by  invitation  ; — Drs.  Barsnt  Staats,  AJbatty  Medical  S6eis^ ; 

E.  M.  Hant,  State  Medical  Society,  New  Jersey;  H.  O.  Qndj, 

Indiana. 
Dr.  C.  C.  Cox  submitted  the  following  resolutions  :--r- 

Beeolved,  That  a  Committee  of  three,  consisting  of  Dr.  V.  L.  Smitli. 
of  New  York,  Dr.  Wilson  Jewell  of  Peansjlvania,  and  Dr.  B.  F. 
Bache,  U.  S.  N.,  be  appointed  to  memorialise  Congress  upon  the  sub- 
ject or  the  attempted  wrong  to  the  Medical  Corps  of  the  Navy,  as  in- 
dicated by  a  widely  circulated  protest  ef  the  line  officers  of  the  serrice 
against  the  very  moderate  increase  of  rank  given  to  medical  offietn 
by  a  General  order  of  the  Department  of  the  18th  March,  1868.  whidi 
increase  in  rank  by  no  means  corresponds  in  extent  to  the  advance- 
ment in  rank  of  the  officers  of  the  line  thus  protesting. 

The  following  resolutions  were  also  offered  and  adopted.     By  Dr. 

Raphael,  N.  Y. : 

Reeotvedt  To  amend  the  four^  article  of  the  Constitution  so  as  to 
insert  after  the  word  "  ticket  (fifth  line)  the  words  '*  except  in  ease 
of  the  President,  who  shall  be  nominatea  and  elected  by  ballot  in  open 
session  of  the  Society,  the  member  receiving  a  majority  of  all  the 
votes  cast  to  be  declared  electe  > 

By  Dr.  Dnhamel,  Washington,  D.  0. : 

Beeolved,  That  the  Members  of  the  American  Medical  Association 
tender  their  thanks  to  the  gentlemen  of  the  medical  profession  of  the 
city  of  New  York,  for  the  Hospitality  and  civilities  extended  to  Uiem 
during  their  stay  here. 

Betolved,  That  we  also  tender  our  thanks  to  Mayor  Gunther  and 
the  gentlemen  of  the  public  Institutions,  who  have  extended  to  the 
members  of  the  Associalion  much  kindness  and  attention.^ 

Bj  Dr.  McQugin,Iows^j: 


1864.]    •  Prmidm^i  <^  8oei€ti$9.  421 

Besoivtd,  Thtt  the  Committee  appoiiited  for  the  purpose  of  drafting 
a  suitable  bill  to  be  presented  to«  Congress  for  its  ooosideration  and 
adoption  on  the  relative  rank  of  the  medical  officers  of  the  Army  be, 
and  they  are  hereby  instracted  to  embrace  in  its  prorisions  a  farther 
seperationof  the  Medical  Department  from  the  commanding  officers 
of  the  line,  in  order  to  have  a  more  perfect  and  unrestrained  control  of 
its  interests  and  greater  efficacy  in  tnat  branch  of  the  service. 

Also  by  J)r.  McGagin  : 

Betdved,  That  each  member  of  the  Association  is  hereby  earnestly 
requested  to  famish  to  the  Chairman  or  any  member  of  the  Standing 
Committees  appointed  to  report  upon  the  subject  assigned  themv  at 
the  next  annnal  meeting,  all  facts  m  his  posseasion,  and  his  experi- 
ence touching  the  subject  matters  upon  which  said  Committee  are  re- 
quired to  report. 

Dr.  Palmer,  Mich. :  ]  y 

Retdvtd,  That,  as  the  representatives  of  the  profession  of  the 
country,  meeting  at  the  moment  when  the  greatest  military  colliaion  of 
modern  time  is  at  its  acme,  producing  almost  unprecedented  numbers 
of  wounded  and  suffering  men,  calling  for  the  greatest  skill  and  devo- 
tion, imposing  the  deepest  responsibilities,  the  most  intense  labors, 
and  the  most  patient  and  painful  endurance  on  the  part  of  the  mili- 
tary surgeons,  we  cannot  separate  without  a  formal  and  heartfelt  re- 
cognition of  the  services  of  our  brethem  in  the  field  and  hospitals, 
who  have  been  and  are  at  this  moment  so  nobly  responding  to  all 
these  demsnds — and  while  cheriKhiog  their  immense  and  invaluable 
services  as  an  honor  to  our  professian,  we  commend  these  mon  and 
the  memory  of  their  deeds  in  the  cause  of  sa#iicf  and  patriotism,  of 
Union,  of  liberty,  of  humanity,  to  the  gratitude  of  the  country,  whoso 
life  as  well  as  that  of  their  heroic  patients  they  are  laboring  to 
preserve. 

The  Subject  of  Speciaiit'ei. — Dr.  Homberger,  N,  T.  offered  a  reso- 
lution for  adoption,  which  had  reference  to  defining  the  relations 
which  should  exist  between  specialists  and  general  practitfoners  of 
Bodicine,  and  moved  that  the  Association,  in  order  properly  to  con- 
sider the  matter,  should  resolve  itself  into  a  Committee  of  the  whole. 

The  resolution  was  favored  by  Drs.  Elsberg  and  Gardner,  M.  T., 
Storer  of  Boston,  and  others ;  but  was  lost,  and  a  motion  prevailed 
to  lay  it  on  the  table  and  have  a  special  Committee  of  five  appoint- 
ed to  report  at  the  next  meeting. 

The  usual  resolntions  of  thanks  to  the  President*  Seoretaiy.  Com- 
mittee of  Arrangements,  and  others,  were  paased  without  comment. 

Concerning  Dr.  Morton  ike  alleged  DiSC09ererqf  Etk^r.-^Dr.  Henry 
D.  Noyes,  delegate  from  the  New  York  Eye  Infirmary,  offered  the 
following  resolution :— • 

AVbkrkas,  There  is  now  pending  in  Congma  %ik  %\i^T^m»)ivQiti 
donating  to  Dr.  T.  G.  Morton,  of  Boston*  the  aum  ot  vSiM^^^  ^^^ 


482  Pr9mtU^9  of  SmMm.  i[Jriy, 

bis  terrioM  in  conneeliaii  with  the  introdnetioa  of  fldpbmie  tlhar  m 
an  anaesthelio  agent, ;  and 

Wbarsas,  The  eaid  Dr.  Morton,  bj  antta  againat  ehiiltkble  meiieal 
inatitntiona  for  an  infringenient  of  an  alk«d  patent  eorering  not 
only  anlpbnric  ether,  bat  file  atato  of  anieathaia  however  prodnoel, 
baa  placed  himself  beyond  the  j[Nile  of  an  honorable  profeaaion  mnd  of 
trae  laborers  in  the  cause  of  science  and  btimanitjr ; 

Beiolved,  That  the  American  Medical  Asaooiation  enter  flisir  ^- 
test  againat  anj  appropriation  to  the  aaid  Br.  Horlan,  ■^■■■— t  of 
'bis  nnworthj  oondaot,  alao  beoanae  of  Ui  onwarauitaiUo  aniwntiffli 
of  a«patentable  right  to  ansMtbesia,  and  farther,  bocanaa  privnta  imk 
eficence  in  Boeton,  New  Yqrk,  and  Philadelphia,  and  other  plaaaa, 
have  aafficentlj  rewarded  him  for  any  olaima  which  ha  maf  Jn^j 
nrge. 

Miolved,  That  a  copy  of  these  resolutions  be  sent  to  iba  Cbairaaa 
of  the  Oommittee  of  Ways  and  Means  in  the  Hooae  of  Bapraaants* 
tives  at  Washington. 

Adopted. 

Dr.  Baphael,  of  New  York,  betiered  (hat  Dr  Morton  waa  jgaaeally 
conceded  to  be  the  inventor  ofansstbeaia,  And  aa  aiidi  abodd  Bacsiva 
a  due  amotfnt  of  credit  and.  emolument.  If  Oongresa  tfionght  k  beat 
to  vote  that  amount  of  money  to  the  Dr.  it  had  a  perfect  right  to  do 
ao,  and  it  was  no  business  of  the  AssociatioQ  to  interfere.  He  lioped 
that  the  resolution  would  not  pass. 

(Load  calls  for  question  I  question!) 

Dr.  Moran,  of  B.  I.  moved  the  adoption  of  the  resolution,  which 
motion  was  carried  with  but  two  or  three  dissenting  voices.  / 

The  reports  of  the  several  Sections  were  on  motion  adopted. 

Some  unfinished  business  of  minor  importance  was  then  diapoasd 
of,  after  which  the  Association  adjourned  to  meet  in  Boston  the  first 
Tuesday  in  Jnne,  1865. 

On  Thursday  evening  the  members  visited  the  homae  and  labora- 
tory of  Dr.  Squibb,  in  Brooklyn,  and  were  elegantly  entertained. 
Notwithstanding  the  inclemency  of  the  weather  a  large  number  were 
present. 

On  Friday,  those  of  the  delegates  who  remained  in  town  accepted 
the  invitation  of  the  Commissioners  of  OhaHty  to  visit  the  dififorent 
institutions  under  their  charge,  and  on  Saturday  the  invitation  of 
Dr.  McDougal,  Medical  Director,  Department  of  the  East,  was  ac- 
cepted to  visit  the  Military  HospiUls  at  David's  Island,  N.  Y. 


1864.]  ProakKn^i  ^  SoeUiin.  42t 


NiMteenth  Annual  8M«iofi  of  the  Ohio  State  Madloal  Sooiety. 


■•ported  by  I.  B.  anrnn,  ka  SeerrUry,  Ohio  White  Solplmr  Sprinci,,  Jut  Slit  1864. 


MoRiriKO  SisBiov. 

The  Ohio  State  Medical  Societj  was  called  to  order  at  10  o'clock, 
A.  M.,  the  Presideot  Dr.  W.  P.  KiQcaid  in  the  chair ;  Yioe-Pretident» 
Dr.  M.  DawBon  on  the  stand ;  Dr.  E.  B.  StereoB,  Secretarjc. 

In  taking  his  seat  Dr.  Kincaid  made  a  brief  address  to  the  Societj 
— fiting  the  occasion,  and  as  to  the  mode  in  which  he  shonld  act  as  a 
presiding  officer  ;  after  which  he  proceeded  to  call  the  several  Stand* 
ing  Committees. 

Dr.  M.  Dawson,  Chairman  of  the  Executive  Committee  reported 
that  all  necessary  arrangements  have  been  made  with  Mr.  Wilson  for 
the  accommodation  of  the  State  Medical  Society ,  and  with  most  of  the 
railroads  for  retnm  of  members,  free,  on  certificate  of  the  Secretary. 
On  motion  the  report  was  accepted. 

The  President  appointed  Drs.  Specs,  Bnssell,  and  Barr,  to  fill  ra- 
cancies  on  the  Committee  on  Finance : 

Drs.  Dnnlap,  Brown  of  Bellefontaine,  and  Monnt  to  fill  up  the 
Committee  On  Ethics  :  and. 

Dr.  Weber  to  fill  vacancy  in  Committee  on  Medical  Societies. 

The  several  Committees  appointed  to  be  present  at  the  examinations 
of  the  various  Medical  Colleges,  in  Ohio  reported,  that  having  re- 
ceived no  notice  from  the  proper  officer  of  thoee  Institutions  of  the 
time  at  whidi  the  Examinations  were  to  be  held,  they  failed  10  at- 
tend from  feelings  of  delicacy. 

The  Commit^  on  Finance  made  the  following  report : 

The  Committee  on  Finance  beg  leave  to  report  that  an  assesament 

of  $1  is  made  for  the  cnrrent  expenses  of  the  coming  year. 

R.  L.  SwxanBT, 

A.  Carby, 

S.  P.  Spbes,  ^  Faumoi  OommiiUt. 

J.  W.  RUSSBL, 

R.  N.  Barb,  J 

Report  received  and  adopted. 

The  Committee  on  Publication  made  the  following  report : 
Year  Committee  beg  leave  to  report  that  250  copies  of  the  Tran- 
sjtctions  were  pnblished  at  a  cost  of  894 ;  and  500  copies  of  the  Con- 
stitution and  By-Laws,  for  836,  ToUl,  $180.  Owing  to  \!d%  \iicx%aaA^ 
expense  in  printing,  ms  well  bs  the  abridged  aise  ot  Oua  igaiixxi\^^^^&^^% 


424  Pm€90dbip9  ^  SoekHn.  ^iOf, 

Tonr  Committee  decided  to  issue  tbe  Transactions  with  onlf  p^per 
covers.  -  BimAw  B.  SxBfwn.  HBMmmi^. 

Report  accepted. 

Special  Committee'^  called : 

^r.  Mete,  on  Diseases  of  the  Eye ;  Dr.  Stevens  on  New  BesMdiss ; 
Dr.  Beeman,  on  Diptberia,  and  Dr.  Beamy  an  Asthmat  wg^fH^i^* 
pers  to  be  read  at  the  pleasure  of  tbe  Societyt      , 

Dr.«M.  Dawson,  Committee  on  Obituaries,  reported  tbat.  lie-^had 
not  beeo  able  to  collect  materials  for  proper  notice  of  pur  deoeased 
members,  although  he  had  exercised  unusual  diligence.  He  l|i4  •PC- 
ceeded  in  procuring  an  incomplete  memoir  of  tbe  late  Prof.  I^waon, 
which  he  asked  to  retain  for  revision.  Dr.  M.  Dawson  was  eoiitin- 
ued  on  the  Committee  for  another  y^ar.  Dr.  ](yle  announced  9^  volan- 
teer  paper  on  a  case  Gun^^sbot  wound,  to  be  read  at  the  pleaaove  of 
the  Society. 

Dr.  Stevens,  from  Committee  on  Diploma  Plate,  reported  ttmisiace 
the  death  of  Dr.  Gans,  the  Chairman  of  that  conimitt«»  he 
bad  endeavored  to  find  some  trace  of  the  plate,  but  thus  far  in  vain  ; 
old  members  of  the  Society  suppose  the  plate  to  have  been  engnved 
in  Cincinnati,  but  he  bad  made  inquiries,  at  tbe  various  engravers 
and  plate  printers  of  that  city  thus  far  without  success.  The  estimat- 
ed cost  of  a  new  plate  would  be  from  $75,  to  1150,  according  to  tbe 
size,  style  of  work  etc. 

On  motion,  tbe  Committee  wag  continued.  Dr.  Stevens  was  made 
Chairman,  and  Dr.  Spees,  of  Highland  County,  added  to  take  tbe 
place  of  Dr.  Gans  deceased. 

Tbe  Treasurer  made  his  Annual  repoii,  which  was  referred  to  the 
Committee  on  Finance. 

The  Treasurer  also  presented  a  list  of  150  mem'Ders  who  are  in 
debt,  fi-om  |8,  to  812.  On  motion,  this  list  was  referred  to  a  special 
committee  of  three  to  report  this  afternoon.  Drs.  Kyle,  Kirtland,  and 
Thompson  appointed  that  committee. 

On  motion  of  Dr.  Weber,  the  Surgeon-General  was  requested  to 
furnish  to  this  Society,  an  entire  list  of  the  medical  men  in  Ohio, 
who  have  died  in  tbe  service.     Adopted. 

Pending,  the  adoption  of  this  resolution  remarks  were  madeby^Dr». 
Weber,  Barr,  Kyle,  Kirtland,  Dunlap,  Spees,  Metz,  Sinnett,  and  oth- 
ers. Dr.  Kyle  offered  to  amend,  so  that  the  report  shall  be  made  to 
a  special  committee,  who  shall  prepare  brief  notices  of  each.  Lost. 
Dr.  Weber  proposed  tbal  l\k^  ^wt^^on-Cx^u^tal  make  his  report  at  our 
next  annual  meeting.    AAopt^i  ^ 


1964.  J  Proc0edbiff9  if  8oaiti4i.  425 

Dr.  Banr*  SurgeoD-General  of  Ohio,  annoonoed  to  tbe  Society,  that 
the  Board  of  Examiners  woald  hold  seesiono  daring  Uia  interima  of 
eostions  of  tbe  Society  for  the  examination  of  candidates  fortthe  posi- 
tion of  Assistant-Surgeon  to  Ohio  Regimenta. 

Dr.  Kiriland  called  attention  to  errors  in  names  of  honorary  and 
regular  members  of  tbe  Society  as  published  in  tbe  Transactions, 
which  on  motion  were  ordered  to  be  corrected  in  future  reprints. 

Dr.  Mets  paper  made  tbe  order  for  2  o'clock  this  afternoon. 

On  motion,  the  election  of  officers  made  the  order  for  to-morrow 
morning  at  9  o*clock. 

Recess  till  2  p.m. 

Aftkrhoov  Sassioar. 

The  President  Dr.  Kincaid  in  the  chair. 

Dr.  Metz,  of  Massillon,  read  his  teport  on  Diseases  of  tbe  Eye ; 

Presenting  a  very  able  and  complete  review  of  the  present  patholo- 
gy and  therapeutics  of  the  most  important  topics  of  opthalmology. 

Dr.  Weber,  of  Cleveland,  made  interesting  remarks  6n  some  of  the 
points  of  Dr.  Metz's  pajper.  He  especially  desired  that  Dr.  Hetz 
would  give  tbe  Society  his  experience  and  mode  of  operating  in  Iritis 
by  Paracentesib  ocnli. 

Dr.  Ifetz  detailed  with  some  minutes  bis  mode  of  practice. 

Dr.  Weber  made  some  further  remarks  relating  to  the  peculiar  dis- 
coloration of  the  iris,  which  has  been  observed  in  iritis  ;  did  not  think 
this  discoloration  was  always  owing  to  an  actual  ebanga  of  color  as 
same  ocul  ii^ts  have  supposed  ;  but  related  a  case  to  show  that  this 
waa  sometimes  owing  to  tbe  changed  color  of  the  aqueous  humor, 
which  was  possibly  the  result  of  tbe  inflamatory  process* 

On  motion  tbe  paper  of  Dr.  Mets  waa  referred  to  tbe  Committee  on 
Publication  with  instructions  to  print. 

The  Committee  on  Finance  made  the  following  report ; 

We  have  examined  tbe  books  and  papers  of  the  Treasurer,  and  End 
tbe  same  correct ;  as  follows  :  BaUnCe  in  tbe  Treasury,  June  16, 1868, 
833,11.  Initiation  Fees  and  Assesments,  9888.  Postage  stamps 
and  envelopes  on  band  94,  52.  Amount  expended,  $270,  88.  Balance 
in  Treasury  June  20, 1864,  909,  88. 


R.  L.  Swamir,  ^ 

A.  CARlTr  J 

S.  J.  Spsxs,        }  Fii 


Finance  Committee. 
J.  W.  Roaaau., ') 
R.  N.  Barr,       J 

Report  accepted. 

Dr.  BeemMD,  ofSUnej,  re^d  bia  report  on  Dip\il\Mt^  \ 


426  Pro!e€$din^4qf  Soekiiif.  U^f 

Ou  motion  referred  to  the  Committee  on  Pnblicaiioa  with  iiwtnw- 
tions  to  print. 

The  Special  Committee  to  whom  was  tef^rred  the  listof  detlttquent 
members,  reported  in  favor  of  striking  their  names  from  the  rolls  of 
the  Society,  and  placing  their  aecounts  in  the  hands  of  a  coHeetor  tot 
settlement.  The  resolutions  led  to  a  lengthy  debate,  iu  whieh  Dts. 
Kirtland,  Kincaid,  Weber,  Kyle,  Halt»  Brown,  Thompson*  Garerf»  ttd 
others  participated.  Qaite  a  variety  of  snggestioos  were  inade  as 
to  the  mode  of  disposing  of  these  cases,  which  shonld  be  for  die  hmtt 
interests  of  the  Society.  Finally,  on  motion  of  Dr.  SanciUd^  liie 
whole  matter  was  referred  back  to  the  original  Committee  for  jfiiHher 
consideration. 

Adjonmed  till  9  o'clock  tomorrow. 

Sbcovd  Bat.  «^0  o'elock  ▲  Jt. 

Dr.  Kincaid  in  the  chair. 

The  Society  proceeded  to  the  annual  election  of  officer^  and  In  no* 
cordance  with  the  resolutions  of  last  year,  nominationMRP^ere  snade  in 
open  Society,  and  the  balloting  resulted  as  follows : 

Prftufen/.— Onstav  0.  E.  Weber,  of  Cleveland. 

Vice  PresidenU. — J.  G.  Kyle,  of  Xenia ;  A.  Metz,  of  HaseiDon  ; 
Robert  Rogers,  of  Springfield  ;  A.  Carey,  of  Sal^m. 

Secretariei. — Edward  B.  Stevens,  of  Cincinnati ;  W.  C.  Ball,  of 
Payetteville. 

Treasurer. — John  B.  Thompson,  of  Colnmbus. ' 

VommUtee  on  Admissions — S.  J.  Spees,  ft.  L.  Sweney,  P.  Boeman, 
K.  G.  Thomas,  A.  S.  Williams. 

The  President  appointed  Drs.  Rogers,  of  New  Richmond,  and  Bus- 
sell  of  Mount  Vernon  to  wait  upon  the  President-EIect.  and  conduct 
him  to  the  chair.  In  taking  bis  scat  Dr.  Weber  gracefully  ackaowl- 
eged  the  high  compliment  which  the  Society  had  bestowed  «pon 
him. 

The  Special  Committee  on  Delinquent  list  made  the  following 

report: 

^  The  Special  Committee  on  the  Delinquent  List  begs  to  offisr  th^ 

following  resolutions  as  their  report. 

Resolved,  That  the  accounts  of  all  members  of  this  Society  who  a;s 
in  arrears  to  the  amount  of  eight  dollars,  or  more,  shall  be  made  out 
and  put  into  the  hands  of  Dr.  E.  B.  Stevens  for  collection. 

Besohed,  That  the  Treasurer  at  an  early  day  after  the  adjournment 
of  the  present  Session,  shall  cause  a   copy  of  the  report  of  this  Com- 
mittee, with  their  account,  loVy«  Ixaiv^mlaed  to  each  one  of  the  deUn- 
qaentB  of  the  class  lefote  xa<enl\OTiQ^« 


1864.]  .  Proei0<^4  qf  SockUsi.  427 

All  of  which  18  xespectfally  submitted. 

John  O.  Kyle,     "j 

J.  B.  Thompson,    V  Committ«e. 

J.  P.  KlRTLAKD.      J 

Hesolvedt  That  at  any  time  any  such  delinqtient  member  may 
dbooM  to  pay  all  daea,  he  may,  and  will  be  without  prejudice,  rein- 
etaled  as  a  member  of  this  Society. 

Bepoit  accepted  and  adopted. 

Dr.  Beeman  aa  Chairman  of  .the  committee  on  Medical  Societies 
made  a  verbal  report  on  the  condition  of  local  societies  throughout 
the  State  ;  and  presented  the  application  of  Union  Medical  Society  of 
Alliance  as  auxiliary  to  the  State  Society,  accompanied  with  the  Con- 
stitution, By-Laws,  and  List  of  Membership  of  the  Society. 

On  motion,  report  accepted,  and  Union  Medical  Society  constituted 
auxiliary  to  State  Society. 

The  credentials  of  Drs.  K.  O.  Thomas,  and  R.  A.  Johnson  were 
then  presented  as  delegates  from  the  Union  Medical  Society,  and  on 
modon  they  were  received,  and  took  their  seats. 

Dr.  J.  G.  Kyle,  of  Zenia,  read  a  paper  entitled  "  A  History  of  a 
Case  of  Gunshot  Wound,"  with  remarks.  The  specimen  vas  ex- 
hibited. 

On  motion  the  paper  was  referred  to  the  Committee  on  Publication 
with  instructions  to  print — Dr.  Kyle  having  privilege  to  write  out  in 
foil. 

Dr.  Stevens  read  his  paper  on  "  New  Ilemedies." 

On  motion  of  Dr.  Russell  the  paper  was  referred  to  the  Committee 
on  Publication,  with  instructions  to  print,  and  Dr.  Stevens  continued 
for  another  year  by  vote  of  the  Socisty. 

Dr.  Weber  offered  the  foUowiog  : 

Resolved,  That  a  committee  of  three  be  appointed  to  confer  with 
the  ciMnmittee  appointed  by  the  American  Medical  Association  at  its 
late  iieasion  in  New  York,  for  the  purpose  of  memorializing  Congress  * 
and  the  President  of  the  United  States,  on  the  subject  of  increase  of  pay 
mod  rank  of  Medical  officers  in  the  army. 

Reiolved,  That  this  committee  assure  the  committee  of  the  Na- 
tional Association  that  the  Ohio  State  Medical  Society  heartily  ap- 
proves and  endorses  all  efforts  of  the  Association  to  obtain  legislation 
for  the  increase  of  rank  and  pay  of  our  medical  brethren  in  the  mili- 
tary service. 

Jieeolved,  That  this  oommittee  be  instructed  if  desired  to  sign  on 
bebalf  of  this  Society,  any  memorial  of  the  National  Association 
which  may  be  sent  to  the  General  (Government  on  the  subject  in  <^«^- 

turn. 


428  Proe—dtmgi  qf  Saei^m.  [Joly 

The  President  appointed  .Dn.  Weber»  Barr»  and  Horpbj  the  com- 
mittee of  conference  on  the  above  resolutions  of  Dr.  Weber. 

Dr.  Russell,  of  Mt.  Yemon,  called  up  the  matter  of  his  resolatiou 
of  last  year  pertaining  to  the  establishment  of  an  Inebriate  Asylum  is 
this  State.  Dr.  Bn^sell  said  he  had  secured  9646.  vibscriptions  from 
members  of  the  Knox  Co..  Medical  Society,  and  he  desired  to  meet  st 
noon  any  gentlemen  present  who  were  interested  or  moving  in  this 
matter.  Dr.  Russell  also  proceeded  to  make  some  general  xemarb 
pertinent  to  the  subject. 

The  address  of  the  retiring  President  was  made  the  order  for  2 
o'clock  p.  M.,  and  the  ladies  were  invited  to  be  present. 

Recess  till  afternoon. 

Arrnurooir  Bsssiov- 

President  Weber  in  the  chair.  Retiring  prefcfdent  Kineidd  pro- 
ceeded to  deliver  the  annual  address,  which  was  able  and  eloquent, 
suited  to  the  occasion. 

On  motion  of  Dr.  J.  B.  Thompson  the  address  was  rebrred  to  the 
Committee  on  Publication  with  instructions  to  print 

Dr.  Weber  offered  the  following  resolution  which  was  adopted 
amidst  tremendous  applause : 

Resolved,  That  the  thanks  of  this  Society,  as  well  as  the  good 
wishes  of  all  the  good  citizens  in  the  land  are  eminently  due  to  our 
venerable  fellow  member  J.  0.  Rogers,  M.D.,  of  New  Richmond.  Ohio, 
for  the  skilful  manner  in  which  on  the  morning  of  the  22nd  of  April, 
1822,  he  assisted  into  this  world  Ultssbs  Simpson  Obakt,  the  Com- 
mander of  the  American  Armies — the  hero  of  Vicksburg,  and  the  pre- 
destined destroyer  of  the  great  rebellion. 

Dr.  T.  A.  Reamy,  of  Zanesville,  read  his  report  on  "Asthma." 

On  motion,  referred  to  Committee  on  Publication  with  instructions 
to  print.  An  interesting  discussion  followed  in  which  Drs.  Russell, 
Reamy,  Kincaid,  Reed,  Weber  and  others  participated,  as  to  the  na- 
ture and  treatment  of  asthma. 

The  committee  on  Ethics  made  the  following  report  in  the  case  o^ 
complaints  against  Dr.  J.  P.  Gruwell,  of  Damsscoville ; 

The  committee  on  Ethics  beg  leave  to  report  that  they  have  exam- 
ined carefully  the  charges  preferod  against  Dr.  J.  P.  Gruwell,  of  Col- 
umbiana County,  and  find  that  he  has  been  guilty  of  a  violation  of 
the  code  of  ethics  by  examining  the  patient  of  another  physician,  in 
the  absence  of  the  latter,  expressing  his  opinion  freely  to  the  patient 
ani  family  difiering  from  the  attending  physician.  He  acknowledges 
that  he  knew  this  was  a  violation  of  the  code  of  ethics.  He  is  also 
charge  1    with  unprofessional  conduct :  in  evidence  of  which  it  Is  of- 


1864.]  Proceedinsii  of  SockUii.  429 

fered  m  proof  that  whilst  a  memVier  of  the  "  AUianco  Medical  Union 

Society  "  he  assailed  snch  society,  and  some  of  the  members  thereof 

by  an  anonymoos  commanication  in  a  newspaper.     This  charge  he 

also  confesses  to  be  true. 

The  committee  deem  it  their  duty  to  recommend  that  Dr.  Gmwell 

be  expelled  from  the  Society. 

A.  Mrrz,  ^ 

H.  8.  CoNKLiN,    I 

A.  DuNLAP,  V  Committee. 
W.  C.  Hall,        I 

B.  8.  Bbowk,       J 

On  motion  the  report  was  accepted,  and  upon  a  motion  to  adopt. 
Dr.  Oruwell  proceeded  to  address  the  Society  at  some  length— setting 
forth  circnmstAUces  connected  with  his  violations  of  the  code,  which 
he  desired  should  be  admitted  in  extenuation  ;  and  claiming  that  his 
wish  and  intention  was  not  to  trespass  on  the  rights  of  his  .brethren, 
but  so  to  act  as  to  honor  the  profession  he  loved  above  all  earthly 
things. 

On  motion  of  Dr.  Thompson,  the  resolution  was  amended  by  strik- 
ing out  the  word  "expelled/*  and  inserting  "reprimanded.** 

The  resolution  thus  amended  was  adopted,  and  on  motion,  Pr. 
Tliompson  proceeded  to  administer  the  reprimand, — which  was  done 
with  kindness  but  firmness,  and  to  the  point. 
On  motion  of  Dr.  W.  C.  Hall 

JUidved,  That  the  thanks  of^this  society  are  hereby  extended  to 
the  retiring  officers,  for  the  efficient,  able,  and  satisfactory  manner 
which  they  have  severally  discharged  their  duties. 

On  motion  of  Dr.  T.  A.  Reamy 

Retclvedf  That  the  thanks  of  the  society  arc  due  to  Mr.  Wilson  for 
the  many  courtesies  received  at  his  hands,  and  the  attention  to  our 
eonfort  and  convenience. 

Also  by  Dr.  Reamy 

XfMclred,  That  this  society,  when  it  adjourn,  adjourn  to  meet  at 
White  Sulphur  Springs  on  the  3d  Tuesday  of  June*  1865 :  but  if 
from  any  circumstances  the  society  cannot  be  accommodated*  the  Ex- 
ecQtive  Committee  are  empowered  to  make  arrangements  for  Yellow 
Springs. 

On  motion  of  Dr.  J.  P.  Bing,  of  Pomeroy, 

RnoUttd  That  the  Ohio  State  Medical  Society  sympathize  with  our 
profasstonal  brethren  In  their  arduous  labors  and  sell  sacrifice  in  the 
bocpital  and  field ;  and  that  we  hereby  re-affirm  onr  onconditional  de- 
fooon  to  the  good  old  flag.    Adopted  with  applause. 

Al  diffcreat  sMiiona  of  the  society,  the  Committee  on  AdmiiaiotL 


430  /VocMtOvf  y  iRnMm.  [Mf. 

reports  th«  following  namw  at  snitabh  parsoiis  to  beoome  meaibiifl 
of  the  Ohio  State  Medical  Society  ;  who  wereibereiipoQ  dnlj  elected: 

Drs.  Wm.  H.  Banc^*  Oberlin  ;  Joeeph  Tmwj,  Nevada ;  AIM 
Follett,  Granville ;  J.  L.  Kennedy,  Batavia ;  D.  H.  Salatoa,  MMiw- 
barg ;  T.  H.  Armetrong,  Armstrong^e  Willi ;  C.  B.  Reed,  Middbport ; 
W.  J.  Bellinger,  Pleasant  Valley  ;  J.  Cntter,  Belle  P(»«l ;  D:  N. 
Kinsman,  Giroleville  ;  J.  W.  Yandew'ort,  Harreyabivg ;  O.  W.  Pol- 
len, Logan  ;  W.  F.  Paige,  Johnstown ;  R.  A.  Johnson,  Wdlsrille  ; 
W.  B.  Loller,  Nashville. 

The  President  annonncf  d  the  following  committees  for  the  •nsaiDg 
year  : 

STANDIirO  COMMITTixs. 

''  Executive :— J.  G.  Kyle,'  E.  Hyatt,  J.  B.  Thompson,  H.  8.  Conk- 
lin,  8.  J.  Spees.  * 

Finance: — R.  L.  Sweney,  A.  Carey,  S.  J.  Spees,  C.  P.  Landoa» 
B.  N.  Barr. 

Publication :—E.  B.  Stevens,  W.  C.  Hall,  J.B.Thompson,  M. 
Dawson,  W.  W.  Dawson . 

Medical  Ethics :— J.  A^  BInrphy,  A  Metz,  H.  S.  Conklin,  W.  C. 
Hall,  A.  Danlap. 

Medical  Societies : — P.  Beeman,  J.  G.  Rogers,  W.  D.  Scnrff,  J.  C. 
Bi-own,  E.  Sinnett. 

SPXCIAL  COMMITTEBS. 

Surgery : — N.  Dalton,  Military  Surgery  ;  R.  N.  Barr.  Micros- 
cope, with  its  applications  to  Praclttcal  Medicine ;  D.  N.  Kinsman. 
Diseases  of  the  Eye ;  A.  Metz.  Obituaries  :  M.  Dawson.  AmpoU- 
tions  in  Military  Service — Primary  and  Secondary ;  J.  G.  K)Ie. 
New  Remedies  .  £.  B.  Stevens.  Uterine  Diseases  ;  G.  W.  Boeist- 
ler.  Puerperal  Convulsions;  W.  C.  Hall.  Obstetrics;  Thad.  A 
Reamy.  Cerebro- Spinal  Meningitis;  R.  L.  Sweney;  Antisepties 
in  MiliUry  Surgery  ;  K.  G.  Thomas. 

Delegates  to  Indiana  State  Medical  Sodeiy :— J.  C .  Reeve,  P.  Bee- 
man,  U.  G.  Carey. 

DeJepaUi  to  American  Med,  Aeeoeiation : — J.  G.  Kyle,  Xania ;  M. 
L.  Brooks,  J.  A.  Semple,  H.  K.  Cnshing,  Cleveland ;  Alex  McBridsb 
Berea  ;  S.  0.  Almy,  J.  A.  Murphy,  R.  R.  McHvaine,  G.  C.  Black- 
man,  J.  L.  Yattier,  C.  G.  Comegys,  Geo.  Mendenhall,  W.  H.  Mot* 
sey,  Cincinnati ;  R.  N.  Barr,  J.  B.  Thompson,  J.  W.  Hamfltoe, 
John  Dawson,  S.  M.  Smith,  Columbus ;  A.  Beach,  BellsTille ;  P. 
Beeman,  H.  8.  ConkUn,  &\4n%3  \ I.P.  B\n^^  Pomeroy ;  B.  8.  Brova. 
BellefonUine ;  KM,  BneVLvni^aam^  l^«T>'Bt^a^^^^^cAvic%«%^Rl■c- 


1864.]  Pfoceedingi  of  Sodedet,  431 

field  ;  A.  C«rey,  Salem  ;  N.  Dalton,  Toledo  ;  M,  Dawson,  Bojralton  ; 
C.  Falconer,  Hamilton;  L.Firestone,  Wooster;  R.  Onndrj,  J.  Da* 
via*  Dayton  ;  G.  C.  Hildretb,  T.  A.  Reamy,  Zanesville;  E.  Hyatt, 
Delaware ;  A.  Metz,  Massillon  ;  W.  Moant,  Cnmminsville ;  D.  N. 
Kinsman,  Circleville  ;  J.  G.  Rogers,  New  Richmond  ;  J.  W.  Russell, 
Mi.  Vemoa  ;  8.  8.  ScoTille,  Lebanon ;  S.  J.  Spees,  Lynchburg ;  R. 
L.  Sweney,  Marion ;  K.  G.  Thomas,  Alliance. 

Adjourned  to  meet  at  White  8olphar  Springs,  the  8d  Tuesday  in 
•Tone,  1865. 

E.  B.   Stevens,)     c...«^.^«^«         Gustat  C.  E.  Wkbbr, 
W.  C.   Hall,       f    «>ocreUnes,  President, 


•  ^•i 


(£nxtt$vtuttuxt. 


Letter  from  Boston. 

BosTOH,  Mtss.y  May  7, 1864. 

MsasEs.  Editors  : — Two  new  bnildings  have  jnst  been. dedicated  in 
our  puritanical  city— the  Museum  of  the  Society  of  Natural  Hislory, 
and  the  New  City  Hospital.  These  structures  are  real  monuments  of 
architectural  taste  and  genius  ;  and  ^  ill  not  only  be  objects  of  pride 
among  our  own  citizens,  but  attractions  to  strangers.^ 

The  Natural  History  Society  was  organized  on  the  8th  of  April, 
M  years  ago,  by  three  or  four  gentlemen,  and  has  now  grown  to  its 
present  proportions,  with  the  erection  of  a  most  spacious  and  orna- 
mental edifice,  for  the  disposal  of  its  rare  collection  of  specimens  in 
natnral  science,  which  are  qnite  numerous,  and  will  soon  be  enriched 
by  some  beautiful  private  collections  of  some  of  its  earlier  benefactors. 
Dr.  Cnarles  T.  Jackson  has  donated  his  private  collection  of  minerals, 
rained  at  more  than  1 10,000.  Others  will  feel  the  impulse,  and  add 
to  the  riches  of  the  museum.  At  the  dedication  last  week,  Dr.  Jef- 
frka  Wyman,  President  of  the  Society,  oecnpied  the  Chair.  Ad. 
dreaaes  were  made  by  several  gentlemen,  in  the  presence  of  a  large 
aadience  of  both  sexes.  The  building  will  be  open  to  the  public  two 
or  three  times  a  week,  giving  to  the  children  of  our  sehooky  and  oth- 
era,  an  opportunity  to  study  comparative  anatomy,  botany,  geology, 
and  other  kindred  sciences.  Among  the  mnny  aictW%  m«i8\)«ft  nil 
thia  aocset/,  mre  wmdj  phjaicuLW,  as  well  as  laymcm. 


432  Carre^xmdene^.  U^t* 

Active  measures  are  being  taken  foe  the  erection  of  a  eoperb  shiKt- 
ure  near  hj,  for  the  use  of  the  Technological  societj.  Thus  motes 
the'*  Hub." 

The  New  City  Hospital  was  dedicated*  May  '24,  and  wm  opeaed 
for  the  reception  of  patients,  Jane  1.    The  Inaugoration  oertmoiues 
consisted  of  prayer,  masic  by  a  select  choir,  addresses  by  hit  Honor 
the  Mayor,  the  Chairman  of  the  Building  Committee,  and  BoMd  of 
Trustees ;  and  the   dedicatory  address.    I  should  trespass  oia  yoor 
pages,  did  I  attempt  to  give  you  a  description  of  the  external  and  in- 
ternal arrangementr  of  this  new  edifice,  which  for  neatness  and  ele- 
gance of  structure,  and  richness  and  beanty  of  the  internal  i^plianess. 
stands  unsurpassed.    But  a  brief  outline  will  suffice.    The  Hospital 
grounds  cover  an  area  of  about  seven  acres.    The  original  design  of 
the  buildings,  embraced  six  pavillions  or  wings,  grouped  aromid  t 
center  structure  intended  for  officers,  operating  roonn,  and  apartments 
for  the  residence  of  the  superintendent  and  other  officers.     Beside  the 
construction  of  this  centre  building,  with  its  lofty  dome,  only  two 
pavilions  are  now  completed.    Each  of  them  are  connected  to  tlie 
main  bnilging  by  three  ciroalar  corridors  or  walks.    There  are  alto, 
aside  from  these  structures,  washing  departments,  engine  house,  doct 
house,  porter's  lodge,  sheds,  etc.     The  building  is  heated  by  steam ; 
and  washing,  wringing,  ironing,  and  cooking,  are  done  by  the  same 
power.     The  ventilation  is  considered  quite  perfect.     Hot  and  cold 
air  is  made  to  circulate  at  will.     For  the  lat^r,  a  large  fan  is  pro- 
pelled by  steam,  driving  a  constant  current  of  air  through  the  vari- 
ous departments,  as  it  may  be  desired.    The  carpets  and  furniture  are 
elegant  in  the  central  building,,  and  reminds  one  that  he  is  in  a  prir* 
ate  palace,  rather  than  in  a  hospital.    The  two  pavilions  will  accom- 
modate only  150  patients.     So^e  select  patients  will  be  admitted  to 
the  roome  in  the  central  building. 

This  is  a  small  number  for  the  actual  cost  thus  far  of  this  stmctare, 
which  is,  including  land,  over  9500,000.  In  due  time,  other  pavilions 
will  be  added  as  circumstances  dictate.  The  Trustees  have  decided.  I 
understand,  to  make  it  in  part,  a  paying  hospital.  This  was  not  the 
design  of  the  originators,  which  was  to  have  a  /ree  hospital.  Since 
that  v>ani  will  still  exist,  and  will  call  for  further  benevolence  on  ths 
part  of  our  opulent  citizens  and  city  fathers. 

The  Annual  meeting  of  our  State  Medical  Society,  was  held  the  Uit 
Wednesday  in  May,  in  this  city.    The  meeting  was  largely  attended 
by  the  profession  from  all  parts  of  the  Commonwealth,  and  by  dele- 
gates fix)m  other  Statsa*    TW^  \9^  t^qV.  \nxx^  qI  xi^dkal  interest  be- 


1864.]  Cormpond^na.  488 

fore  the  Societj.  Dr.  John  Greon»  of  Boston,  read  a  paper  on  the^ 
snbstitation  of  straw  for  splints  in  cases  of  fracture,  more  especially 
of  the  leg  and  thigh.  Dr.  Bowditch  read  a  short  enlogj  on  the  late 
Dr.  John  Ware.  Tho  Annual  Address  was  bj  Dr.  J.  Mason  Warren. 
His  subject  was.  Surgery  as  practiced  during  the  last  thirty  years, 
The  address  contained  much  of  practical  interest  to  the  profession,  as 
the  Doctor  spoke  from  experience  as  well  as  from  observation.  It 
will  be  a  valuable  contribution  to  8Ui:gical  literature.  The  exercises 
closed  with  a  collation  at  the  Rdvere  House.  The  Anniversary  chair  • 
man.  Dr.  Henry  J.  Bigelow,  welcomed  the  Fellows  to  the  festive 
board,  in  a  spirited  and  patriotic  speech.  He  was  followed  by  Gov. 
Andrews.  After  the  palatable  entertainment  was  concluded,  Dr.  0. 
W.  Holmes  recited  a  poem  on  Dr.  John  Ware,  and  his  son.  Dr. 
Robert  Ware,  who  died  in  the  Department  of  the  South.  He  was 
Surgeon  of  one  of  tho  regiments  of  Massachusetts  Volunteers. 

Dr.  John  Odranaux,  a  delegate  from  New  York,  addressed  the  So- 
ciety in  A  very  felicitous  manner.  He  spoke  of  the  profession  of  the 
city  of  New  York ;  of  the  Medical  Schools  and  Hospitals,  and  of  tbe 
services  of  those  physicians  who  had  fallen  in  our  national  struggle. 
He  also  spoke  of  the  necessi^  of  some  provisions  being  made  by  the 
Government  for  the  support  and  care  of  disabled  soldiers  which  this 
war  will  leave  after  its  termination. 

By  the  report  of  the  Treasurer  of  the  Society,  it  appears  that  during 
the  year,  the  amount  received  was  814,673.69,  and  the  amount  paid^ 
out  was  814,232,37,  leaving  a  balance  in  his  hands  of  8441.82.     The 
debt  of  the  Society  amounts  to  82,207.40,  and  the  value  of  the  prop- 
erty owned,  including  cash  in  hand,  is  831,180.49. 

Although  our  State  Society  is  among  the  oldest,  if  not  the  oldest, 
in  this  country,  still  it  does  not  accomplish  as  mnch  as  many  now  in 
early  manhood.  Wo  Lave  talent  enough ;  but  want  a  little  more 
energy.  As  it  now  is,  the  members  meet  more  for  a  social  hour  than 
for  intellectual  labor.  At  the  Annual  meeting  of  tho  councillors,  the 
Kabject  of  having  an  Annual  Meeting  of  the  State  Society  for  two  or 
three  days,  for  tho  consideration  of  medical  topics,  was  referred  to  a 
( *ommittee  to  develop .  some  similar  plan  to  those  adopted  in  other 
States.  We  trust  ero  long  this  ancient  and  venerable  society  may  be- 
rome  rjuvenated,  and  its  life-blood  vitalized,  so  that  its  literary 
froits  may  bo  more  abundant,  and  its  influence  for  good  more  ex- 
tended. '  B. 


448  Bmem  and  J/btke9.  {ttify, 


^tvUm  x«A  StftUei* 


The  Pathologj  and  Treatment  of  Venareal  Diseases  t^taeliidiBg  ike  fisatli  af 
reeent  inTestigations  upon  the  snbJeoL  B7  Freenaa  J.  IwiMStead,  M3,i 
Leetarer  on  Venereal  Diseaees  at  the  College  of  Plijsieiaas  and  fhirfessi. 
New  York;  etc^  eto.    A  new   and  reyised  BdUum,  with  Illtistntliii. 

Philadelphia:  Blanehard  &  Lea^  1M4. 

In  the  fall  of  1861  we  had  the  pletsnre  of  gifing  a  brief  iwriew  o( 
Dr.  Bumstead'e  new  work  on  Yenereal  Diseases,  in  this  Jonmnl :  Ifa 
author  ventured  modestly,  yefe  with  good  taste  and  oleaniess,  to  ar* 
range  in  the  form  of  a  special  treati6e»  oertain  new  views  «pe«  dw 
very  important  topics  discussed.  We  expra^ed  ourselves  deeidedly 
pleased  with  the  work  then,  and  commended  it  cheerfully  and  ooidially 
to  the  favor  of  our  readers. 

The  present  is  the  second  edition  of  the  book,  and  will  tbeiefore 
need  but  a  brief  notice  at  this  time.  Time  has  served  co  estaUidi  and 
mature  the  views  of  our  author  as  originally  set  forth  in  the  fiisl  edi- 
tion, and  we  have  in  like  manner  been  confirmed  in  oar  opinion  of 
their  correctness. 

In  a  former  notice  of  this  work  we  pointed  out  some  of  the  more 
prominent  waymarks  in  the  present  status  of  venereal  pathology.  Tbe 
following  extract  from  the  author's  preface  to  the  present  edition,  will 
indicate  the  progress  which  has  been  going  on  in  the  author's  views 
during  two  years  : 

"From  a  certain  deference  to  the  opinions  at  that  time  generally le- 
ceived,  the  chancroid  and  its  complications  were  in  the  first  editioB, 
discussed  in  connection  with  syphilis  ;  they  have  now  been  assigned, 
as  is  their  due,  to  separate  portions  of  the  work.  This  change  hw 
necessitated  a  complete  reconstruction  of  the  second  part  of  the  first 
edition,  and  its  division  into  two — a  change  which  it  is  hoped,  will 
impress  still  more  strongly  upon  the  mind  of  the  student,  the  distinct 
nature  of  the  two  diseases  referred  to.  The  same  object  has  been  had 
in  view  in  abandoning  the  terms  "soft,"  "hard,"  '* simple,"  and 
**  infecting  chancre,"  and  in  applying,  in  accordance  with  logical  ac- 
curacy, the  term  chancre  exclusively  to  the  initial  lesions  of  ayphilis, 
and  that  of  chancroid  to  the  contagious  ulcer  of  the  genitals.  The 
practical  portion  of  the  work  has  also  unde]*gone  important  alterations 
on  various  topics,  among  which  may  be  mentioned  the  treatmaat  of 
striciare  by  the  "  immediate  planl"  of  Dr.  Holt ;  the  abandonment  of 
ipacial  remedies  in  moat  ca%ea  ol  ^^x^^^A»^.^»^A.^^      ayphilis ;  tht 


1864.]  Htwkm  and  NMm.  4S5 

preferenoe  giren  to  the  eztoniml  ntlier  tbaii  the  mteniAl  om  of  mer- 
Cory  ia  tacondarj  and  tertiaiy  syphilis;  and  the  neoaatity  of  trQiting 
to  natore,  aided  by  hygienic  inflQeneea,  and  not  to  treatment*  iadefi- 
nttely  prolonged  after  the  disappearance  of  all  syphilitic  manifesta- 
^ione,  to  eliminate  the  vims  from  the  system/'        , 

It  may  be  acceptable  to  some  of  onr  readers,  to  briefly  enumerate 
eome  of  the  most  prominent  accepted  dootrinea  of  tenereal  disease*  as 
now  nn^rstood  by  the  best  syphilographers. 

Venereal  disease  is  a  common  phrase  or  term  ezpreasive  of  all  Aose 
diseases  which  resnlt  from  impure  seznal  interconrae.  Of  thaae  we 
hnve  Sfonorrhcsa,  ckanaroid,  and  $^hilii. 

Ootwrrkcki  chiefly  affects  the  snrfooe  ;  that  ia  to  say,  primarily  the 
mncons  surface  of  the  urethra,  or  the  perpnce ;  rarely  producing  an 
ulcer ;  its  complications,  inrolving  parte  connec  ted  with  the  original 
seat  of  disease — as  the  bladder,  prostrate  gland,  and  testicle ;  the  poi- 
son gf  gonorrhosa  may  arise  spontaneously ;  its  Tehide  is  pus  ;  it 
does  not  become  a  constitutional  disease. 

iJkanermd  is  a  contagious  ulcer  of  the  genitals,  butia  distinguished 
from  the  syphilitic  chancre ;  it  does  not  become  a  constitutional  dis- 
ease, in  this  respect  resembling  gonorrhcBa ;  its  primary  attaA  mqr 
iavolre  the  whole  thickness  of  the  mucous  membrane ;  while  its  com- 
plications follow  the  course  of  the  ab§orbeni  Tessela  and  ganglia;  its 
Tobicle  is  also  pus. 

The  yehicle  then  of^  both  these  affiMtiona  [is  alike  in  the  pua«gIo- 
bnle ;  and  it  has  been  shown  that  if  a  pnrulent  gonorrhcsa  or  chan* 
croid  discharge  be  deprived  of  its  pus-globule,  the  remaining  fluid  is 
ittDOCcuous.  Furthermore,  these  poisons  never  reach  the  general  cip> 
eolation ;  if  the  purulent  matter  of  a  chancroid  enters  an  absorbent 
▼easel  causing  the  formation  of  a  bubo,  it  goes  no  further,  the  pof- 
som  does  not  proceed  to  travel  in  the  absorbent  veaael  beyond  this 
point— its  progress  is  arrested. 

One  attack  of  either  gonorrhoM  or  chancroid  ia  no  protection 
against  subsequent  attacks. 

SjfpkUit  is  capable  of  infecting  the  system  at  laige ;  and  ao  too  ita 
preaence,  affords  immunity  against  subsequent  attacks.  Its  first  lesion 
ia  ao  ulcer — the  ckanert :  (we  cannot  now  go  into  minute  distinctions, 
for  theee  we  refer  the  reader  to  the  text)  Its  poison  is  not  confined 
to  pnsy  it  exists  in  the  blood,  in  the  fluid  of  aeoondary  lesions,  in  the 
u  perhaps  in  all  the  secretions.  The  presence  of  virus  ia  the  se- 
ia  proven  by  the  occurrence  of  hereditary  ay^\k\V\a  Vn.  \9ibio  tji^ 
•priqg,  wbao  Ihsikhar  aioiis  was  iofedad. 


4S6  Mmimm  and  JfcHeu.  [July. 

7'hese  three  paiione  mof  ea-exiei  in  (he  eeuM  peretm  ;  which  explains 
many  mysterious  phmiomeiia ;  a  peraoa  wmj  have  gOBorrhoM»  chan- 
croid, and  Bome  form  of  ajphiiitio  lesion,  iiU  at  the^aama  timeu 

In  aooordance  with  these  general  prineiples^  onr  author  haa  difided 
his  work  into  three  parts,  devoted  to  the  sepacaUi  eonaideratioii  of 
these.threedistinot  poisons  and  their  oomplicatiooa. 

Once  more  we  commend  this  book  to  idl  phjaieiaaa  who  have  euj 
care  of  venereal  patients,  as  the  beat  work  with  which  mp  are  ae- 
qoainted,  and  the  most  oonvenimit  handbook  for  the  boay  praotitioner. 

For  sale  bj  Rob't  Clarke  (k  Go.    Price  •4.60. 

Ov  RsKUMATnii,  RnioMAno  Gotrr  A]n>  BonnoA;  their  Patholegy,  Qjnaptons 
and  TreatmenL  Bj  Hkhet  Wiluax  Fulxjeb,  M.  I>.  Canta£  FeUov  of  Uie 
Royal  College  of  Physicians,  London,  &o.,  &o.  From  the  late  London  £di« 
lion.    Philadelphia ;  Lindsat  &  Blakibtoit.    1804. 

The  views  of  Dr.  Fuller,  as  to  the  nature  and  treatment  of  Bhenms- 
tism  are  famfliar  to  the  profession  of  this  country,  and  indeed  may  be 
said  to  have  very  materially  given  character  to  the  opiniona  and  prM- 
tice  of^  American  physicians  fn  the  management  of  this  disease.  The 
present  is  simply  a  new  edition  of  the  well  known  treatise  which  ap- 
peared a  number  of  years  ago. 

As  is  well  known  Fuller  gives  prominence  to  the  use  of  alkalies  and 
neutral  salts,  as  the  great  remedies — given  freely— given  in  large  and 
prompt  doses.  He  now  comes  to  us  in  the  maturity  of  his  experienee 
and  reaffirms  the  views  and  statements  heretofore  made  as  to  the  singa- 
lar  efficacy  of  this  plan  of  treatment ;  the  alkaline  method  of  treatment, 
indeed  may  be  said  to  be  the  Fuller  treatment,  and  may  still  further 
be  said  to  be  the  especial  point  of  the  author's  book. 

To  such  of  our  readers,  however,  as  are  hot  familiar  with  Dr.  Ful- 
ler's work,  we  may  say  that  it  is  a  comprehensive  treatise  on  die  en- 
tire subject.  Obapter  I  is  introdactory,  and  treats  of  the  nature  and 
origin  of  Rheamatism ;  Fuller  believes  it  to  be  dependent  upon  the 
presence  of  a  peculiar  poison  in  the  blood,  a  product  perhaps  of  msl* 
assimilation — and  probably  this  poison,  lactic ^acid.  Then  follow 
chapters  upon  the  Rheumatic  diathesis — the  seat  of  the  disease— and 
the  classification  of  its  varieties ;  then  a  consideration  of  Rheumatic 
fever,  or  acute  Rheumatism.  Chapter  Y  is  devoted  to  the  therapeu- 
tics of  Rheumatism,  embracing  a  view  of  all  the  prominent  agents 
which  from  time  to  time  have  been  regarded  as  valuable  remedies ; 
embracing  of  course  the  detailed  view  of  the  Author's  "  Method  of 
treatment,  with  its  rationale.*'  Considerable  space  is  given  to  ihso- 
matic  disease  of  the  heail)  toeeiOost  mVk  1^a^.\t^&na  tUVsMi  disease  to 


1864.]  jRevUw  ^nd  Xoiicei:  437 

connection  with  rbeamaiism.  i^mongst  the  condading  chapters  we 
have  one  on  chronic  rheumatism^  bnt  we  regret  to  repeat  the  anthors 
candid  acknowledgment  that  in  this  field  of  inqotry  we  hare  still 
much  to  learn. 

We  know  of  no  book  that  we  so  sincerely  advise  onr  readers  to 
procnre  and  stndy  as  this  book  of  Dr.  Fuller's.  For  sale  by  Robert 
Clark  (fe  Co.     Price-83,00, 

Tna  PaivciPLKs  ahd  PaAcnoK  or  OBSTSTBioi:  illustrated  with  One  Hondred 
and  Fiftj-Dine  Lithographic  Figures  from  Original  Photographs,  and  with 
Original  Wood  Cuts.  By  Hugh  L.  Hodgb,  M-D.,  Emeritus,  Prof,  of  Obste- 
iries  and  Diseases  of  Women  and  Children  in  the  UoiTeraity  of  PenniylTa* 
nia,  ete.  etc.    Philadelphia :  Blanchard  and  Lea.  1865. 

The  large  quarto  volume  before  us,  is  in  all  that  pertains  to  the 
publishers  art  certainly  the  most  thoroughly  gotten  up  book  on  ob- 
stetrics which  has  Ahus  far  ever  appeared  from  an  American  press, 
and  its  well  known  author  having  occupied  the  post  of  public  teacher 
on  that  subject  in  the  oldest  medical  college  of  the  country  for  more 
than  a  quarter  of  a  century,  we  may  well  presume  this  to  be  the  result 
of  a  life-time  of  observation  and  experience,  the  last  mature  labor  of 
a  ripe  old  age  in  obstetrical  practice  and  teaching.  The  professional  - 
public  of  America  will  therefore  look  to  this  new  book  with  a  great 
deal  of  interest  and  confidence. 

The  first  feature  in  the  book  especially  noticeable  is  the  illustra- 
tions.  These  consist  of  one  hundred  and  fifty-nine  lithographic  en- 
gravings, from  original  photographic  views.  The  photographs  are 
especially  of  the  cranium  of  the  foetus — the  cavity  of  the  pelvia— 
etc.,  thus  serving  to  illustrate  and  elucidate  with  exactness,  points 
which  hitherto  have  been  regarded  as  obscure.  The  lithographic  pho- 
tographs also  serve  to  illustrate  with  great  satisfaction  the  mechanism 
of  labor,  and  the  position  occupied  by  instruments  under  the  various 
presentation  of  the  infant.  In  addition  to  these  lithographs  we  have 
a  large  number  of  very  excellent  wood-cut  illustrations,  upon  all 
matters  of  interest  throughout  the  volume,  to  the  extent  of  more  than 
one  hundred. 

In  the  arrangement  of  the  text  there  is'but  little  that  seems  of  such 
peculiarity  or  novelty  as  to  require  notice  in  so  brief  a  review  as  the 
present ;  our  author  however  has  very  properly  recognized  the  im- 
portance of  the  knowledge  of  the  "  mechanism  of  labor, "as  being  at 
the  foundation  of  all  obstetric  science,  and  has  accordingly  devoted^ 
good  deal  of  space  to  its  consideration.     Other  ilxaii  l\i\«w«\iax«o\i\:3 
to  say  that  JDr.  Hodge  htLS  given  us  in  hia  text  a  cmietuX  uiii  %3iX«v^* 


438  Bmriemi  and  Nf^tkm.  [J«l j, 

atie  treatise  on  obstetrics  proper ;  embod jiog  m  we  may  natoian j 
suppose  nmoh  of  the  lesutts  of  bis  own  large  experienoey  acenmnlating 
for  so  many  years.  He  accords  howeter  to  his  oompeeM  all  dne  ered- 
it,  and  claims  to  have  presented  "  not  simply*his  own  opinions*  bnl 
also  those  of  the  most  disUngnished  anthorittes  in  the  profesaiott ;  so 
that  bis  book  may  be  considered  as  a  digest  of  the  dieofy  and  pimetios 
of  obstetrics  at  the  present  period/* 

The  preface  contains  a  very  interesting  resume  of  the  histoiy  of 
obstetrics,  especii^lly  the  American  contribntions  to  the  teieads  end 
art ;  going  back  to  the  early  daye  of  American  midwifiMy»  wh^lhe 
practice  was  almost  ezclasirely  in  the  hands  rffanalee,  and  iMMuig 
with  a  graceful  expression  the  laborl  of  Shippen,  Ohatining,  Frisneis» 
Delafield,  James,  Dewees,  and  many  others  of  onr  earlier  teachers. 
Dr.  Samuel  Bard,  of  New  York,  receires  the  credit  of  preparhg  the 
first  American  treatise  on  midwifery ;  this  was  \n  1808,  and  wss 
chiefly  intended  as  a  mannel  for  the  instmotioi^  of  midwivee — a  dass 
at  that  time  deplorably  ignorant  in  this  country.  tn.l825  Dr.  Dew- 
ees  published  his  rery  mature  and  scientific  treatise  on  obstetrics,  fol- 
lowed by  other  works  in  his  department  of  teaching,  "  On  Dbeases 
of  Women,"  "Diseases  of  Children*'  etc. :  Dr.  C.  D.  Meigs  issued 
his  work  on  obstetrics  in  1838 ;  Dr.  Miller's  book  came  out  in  1858 ; 
and  Dr.  Bedford's  valuable  work  is  fresh  before  our  readers. 

We  should  be  glad  if  we  had  space  to  give  a  fuller  synopsis  of  the 
historical  and  biographical  sketches  condensed  in  this  TOiy  loadable 
preface ;  but  for  the  present  we  must  bring  our  entire  notice  to  a  dose. 

We  need  not  advise  our  readers  to  buy  the  book ;  thousands  of 
practitions  of  medicine  and  obstetrics  throughout  the  United  States 
have  listened  to  the  teachings  of  Professor  Hodge,  and  will  ghdly 
avail  themselves  of  the  opportunity  of  securing  these  teachings  in  a 
permanent  shape  for  constant  reference.  For  sale  by  Bobt  Clarke  dr 
Co.    Price  $13. 


1864.]  Sator'a  lUb.  4t9 


ZAiitt'i  Ssftlf. 


2  he  Ohio  SkUe  Medical  Society. — As  will  be  seen  by  the  pablished 
proceedings  in  anotber  part  of  tbie  namber,  tbe  State  Medical  Sooietj 
beld  ite  annual  meeting  at  Wbite  Snlpbur  Springs  on  the  2l8t  and 
22Qd  of  Jane,  according  to  adjoummeiit.  The  attendance  was  larger 
than  was  anticipated — many  of  the  old  and  faithfnl  members  beSng 
promptly  on  hand.  The  new  plan  of  postponing  the  election  of  offi* 
cera  until  an  advanced  period  of  tbe  sessions  worked  well.  The  Pres* 
ident  elect  of  last  year  entered  npon  his  position  promptly  and  the 
machinery  of  tbe  society  moved  along  without  a  jar.  Weber,  of  Oleve*. 
land,  is  tbe  President  elect  for  the  ensuing  year.  The  scientific  pa- 
pers and  discussions,  added  perhaps  about  tbe  average  value  and  in- 
lerset  to  the  occasion.  The  papers  read  beside  the  President's  ad- 
dress  were  by  Drs.  Mets,  on  Eye  Surgery  ;  Beeman,  on  Diphtheria  ; 
Kyle,  a  report  of  a  Gunshot  Wound ;  Seamy,  on  Asthma ;  and 
Stevens,  on  New  Remedies. 

The  special  committees  for  next  year  are  numerous,  as  will  be  seen 
by  the  minutes,  and  give  promise  of  more  than  ordinary  attraetion. 
We  trust  valuable  volunteer  essays  not  in  this  announcement  will  be 
forthcoming. 

An  effort  to  change  the  place  of  meeting  was  made  by  some  of  the 
members,  who  find  the  location  inconvenient  of  access  ;  but  the  local 
attractions  of  tbe  Springs,  the  social  feature  for  the  families  of  physi- 
cians in  attendance,  and  the  total  absence  of  all  distracting  influences, 
still  serve  to  overbalance  the  objections  which  exist,  and  the  express- 
ion  of  the  Society  was  largely  in  favor  of  the  same  place  of  meeting 
for  another  year. 

NonoB. — ^The  present  Secretary  of  the  Ohio  State  Hedieal  Society 
desires^to  perfect  its  early  records  in  several  respects,  and  to  this  end 
reqnests  tbe  co-operation  of  the  members.  Any  one  having  depKcate 
copies  of  the  Early  Transktions,  from  the  organisation  down  to  tbe 
year  1852  will  confer  a  favor  on  the  Secretary  by  forwarding  such  du- 
plicate to  bis  address  ;  or  if  members  have  not  duplicates  of  tlieee 
early  years  to  spare,  will  be  kind  enough  to  allow  the  temporary  use 
of  them  they  will  be  taken  care  of  and  duly  returned.  The  Secretary 
will  also  take  it  as  a  g^reat  favor  if  members  generally  will  commnai- 
cale  all  facts  respecting  the  membership,  deaths,  aaui  t&M^ewc  <A  ^AnSda. 
if  potsibfc^  from  ibo  miiteBi  names  on  the  Teeoida ;  tsftfwA^ 


4  40  AttoK*  9Mb.  [ Jdj, 

where  to ;  present  status  in  tbe  Profossion  and  all  sqicli  matters  of 
statistical  information. 

Address  Dr.  £.  B.  Stevens,  Bec'y:,  Ohio  State  Hed.  Society,  Cin- 
cinnati. 


Brown  Sequard,  the  celebrated  Physiolog^t,  has  removed  to 
coantry,  and  will  ^ake  his  future  permanent  residence  in  Boston. 
The  Corporation  of  Harvard  University  Medical  College  have  estab- 
lished the  new  chair  of  Physiobgy  and  pathology  of  the  nervooa  sys- 
tem, to  which  he  is  appointed.  By  the  way  this  school  is  beoomiiig^ 
in  its  organization  and  plans  one  of  the  most  useftd,  as  it  will  of 
course  at  the  same  time  prove  one  of  the  best  attended  medical  c<fl- 
leges  in  our  country. 

MoiULGhuB^tf  General  JSoepUal.'^'Dr,  Bowditch,  for  many  yeaie 
one  of  the  iHsiitng  physicians  of  this  hospital,  has  resigned  Ids  posi^ 
tion,  and  is  succeeded  by  Dr.  Oalvin  Ellis,  Adjunct  ProL  of  Theory' 
and  Practice  of  Medicine  in  Boston  Medical  fiohool.  Dc«  Brown  Se- 
quard is  also  appointed  one  of  the  Consulting  Board. 

American  Ophihalmological  Auociation, — An  organization  taking 
this  title  was  effected  by  gentlemen  specially  devoted  to  ophthalmologi- 
cal  science  and  practice,  during  the  meeting  of  the  American  Medical 
Association  at  New  York.  Dr.  Delafield,  of  New  York  presided,  and 
delegates  were  present  from  various  parts  of  the  United  States.  It 
was  voted  to  hold  the  first  annual  meeting  in  the  ci^  of  New  York 
on  the  second  Tuesday  of  June,  1865. 

American  Medical  Association. — For  a  full  report  of  the  proceedings 
of  the  Association  at  New  York,  we  are  indebted'  to  the  I^ew  York 
Independent,  Its  editors  will  please  accept  our  thanks  for  the  cour- 
tesy ;  we  have  however  chiefly  availed  ourselves  of  the  report  in  the 
Am.  Med.  Times.  Dr.  N.  S.  Davis,  of  GMcago,  was  elected  Presi- 
dent, and  Dr.  W.  H.  Mussey,  of  Otnoinnati,  one  of  the  Vice  Presi- 
dents. By  reading  the  minutes  it  will  be  seen  the  meeting  was  spir- 
ited, and  several  topics  of  importance  were  under  consideration ;  one 
of  the  most  importa  nt  for  its  bearing  upon  the  interests  of  the  Abso- 
ciation  was  the  election  of  Dr.  Atkinson,  of  Philadelphia,  as  Perma- 
nent Secretary. 

As  usual  the  social  feature  of  the  gathering  was  prominent— the 
pTofeeaion  of  New  York,  together  with  some  of  the  prominent  citisens 
doing  themselves  great  CT«d\t  Vn  ^^tiAvc  mvo&l^XA.^^^^  ^1  hospitality*' 


[]  JMitar'i  TaNe.  411 

rtainments  were  provided  at  the  residences  of  Drs,  J.  M.  Smith, 
L.  Budd;  I.  E.  Taylor,  Gordan  Back,  Willard  Parker,  Alonzo 
k,  James  Anderson,  Jared  Linslej,  and  His  Honor  Mayor  Gnn- 
The  next  meeting  of  the  Association  will  be  held  in  the  city  of 
on  on  the  1st  Tuesday  in  Jnne,  1865. 

The  Social  EvU,** — A  correspondent  of  the  Pkiladefphia  JRepor- 
loses  a  communication  on  this  subject  with  the  following  pro- 
ions  for  its  abatement.  They  arQ  terse,  and  if  not  entirely  prac- 
le  are  certainly  vigorous  : 

Ist.  Females  guilty  of  illicit  habits  should  be  sent  to  venereal 
ims  for  life  ;  there  so  treated  and  employed  as  to  improve  their 
i\  and  physical  condition.  Such  institutions  might  be  made  self* 
orting.  or  nearly  so.  2nd.  The  procuress  and  keepers  of  brothels 
Id  suffer  death.    Sd.  All  males  frequenting  brothels  should  be  eas- 

ir 

le  Editor  of  the  Canada  Laneei  will  please  accept  our  thanks  for 
•s  of  BrilUk  Medical  Journal. 


tnonal — Surg,  J,  T»  Carpenter, — The  many  friends  of  Dr.  Carpen- 
rho  was  for  a  long  time  superintendent  of  U.S.  Hospitals  for  Cin- 
iti,  will  learn  with  regret  that  his  health  is  such  as  to  render  it  nec- 
y  for  him  to  resign  his  commission  as  a  surgeon  of  United  States 
itecrs.  He  reiums  to  his  home  in  Pensylvania  where  we  under- 
I  he  will  resume  the  ptactice  of  his  profession. 

•aiikwaiies  Retrotpect, — ^The  publishers  of  this  old  and  valuable 
It  have  found  it  necessary  on  account  of  the  eontinued  advaaoe  in 
9st  of  printing  and  material  to  make  an  advance  on  the  price 
•1.25  for  each  semi-annual  Part  to  91.50.  We  shall  therefore 
'liged  to  make  a  coiTcsponding  advance  on  the  commutation  rate 
this  journal ;  hereafter  the  price  of  the  LoMcei  and  OlMemr  and 
'hwaUe,  until  further  notice,  will  be  $4.50  per  annom. . 

e  American  Medical  Times,  of  New  York,  has  advanced  its  terms 
).00  per  annum  from  and  after  the  Ist  of  July. 

?eral  Sew  Books  await  a  time  when  we  can  spare  space  for  their 
V  "  DaCosta's  Medical  Diagnosis,''  ''  Tanner's  Practice  of 
sine,''  and   "  Byford  on  the  Uterus/*  are  amongst  these, 

B  transacti(7ii5  o£  Societies,  State  and  National,  OQCwp^  SiSi  ^asBmmi 


442  JBdUm^i  nU$.  fJfJtf. 

amount  of  spaca  m  tlie  preaent  numbery  and  naoasaariljr  crowd  out  a 
portion  j>f  oar  variety,  aapeciallj  oar  aammarj  of  aj^trac;(s  from  Dr. 

Pletclier. 

LiTBBART  ExoHANQBs. — ^Notwithstanding  the  heavy  expenae  of  pab- 
lishing  monthly  magazines  our  leading  American  literary  exdungei 
are  still  issned  with  prompt  regularity,  and  without  change  of  pries. 
This  speaks  well  for  the  good  taste  and  reading  habita  of  our  peoflt 
that  they  should  thus  largely  patronize  publications  of  taate  and  lettsn 
amidst  the  exciting  season  of  protracted  civil  war. 

The  Atlantic  IfaiMfy  continues  to  hold  rank  MB  oertainlj  the  abkst 
literary  magazine  ever  established  in  this  country,  and  so  lar  as  we 
are  familiar  with  English  magazines,  they  furnish  no  superior.  <  Hm 
Single  series  of  "  House  and  Home  Papers  "  whidi  have  been  paasbg 
through  the  numbers  of  the  current  year,  by  Mrs.  Btowe,  a»  wdl 
worth  all  the  subscription  price  of  the  AtlatUie.  The  contribnlieas 
are  of  the  highest  character  for  excellent  literary  taste  and  ooHfton, 
while  those  readers  having  a  taste  for  politics,  criticism  and  aeieoeears 
fully  gratified,  and  the  writers  are  amongst  the  most  aceompliahed  of 
the  country.  Published  monthly  by  Ticknor  &  Fields,  Boston :  but 
furnished  by  booksellers  everywhere  at  25  cents  a  number. 

Harper's  Monthly  Magazine  is  also  one  of  the  peculiar  institntioDS 
of  this  country,  which  has  become  a  household  word  and  neceasity. 
The  July  number  continues  the  interesting  papers  on  the  War  of  1813. 
Purther  chapters  from  Thackery's  last  novel  —  Dickens'  '*Hataal 
Friend"— together  with  the  usual  variety  of  readable  miscellany  and 
profuse  illustrations.     For  sale  everywhere  at  25  cents  a  number. 

Oadey^e  Lady*%  Book  has  a  characteristic  engraving  for  July— 
''  Yankee  Doodle  " ;  and  in  all  matters  of  interest  to  our  fair  friends, 
it  still  leads  the  way.  A  standing  feature  of  Godey  for  many  yean 
has  been  its  designs  for  model  cottages,  which  we  have  no  doubt  have 
had  a  good  influence  in  bringing  up  the  taste  of  our  people  for  pleas- 
ant and  convenient  bouses.  The  present  number  contains  a  beautiful 
model  cottage,  together  with  sixty  other  engravings.  Its  reading  mat- 
ter  is  healthy  in  its  tone  and  safe  for  introduction  to  the  &mily  circle. 
Price  93.00  a  year ;  two  copies  85.00 ;  Lancet  and  OhserHr  and 
Oodey  one  year  91.50. 

Physical  Culture. — We  learn  that  Dr.  Dio  Lewis  continues  his 
Normal  Institute  for  Physical  Culture.  From  the  circular  we  make 
the  following  extract; 


SiUar'i  TM$.  44S 

[onnal  Institate  for  PhjrsicAl  Edaeation/*  ineorponted  in 

under  the  management  of  Dr.  Dio  Lewii,  will  opea  iU 
ession  on  the  5th  of  Jaly,  1864. 

aand  for  teachers  of  the  New  Ojmnastics  has  hecome  such, 
ist  two  classes  of  Graduates,  consisting  of  ahont  ninety  la- 
^ntlcmen,  were  at  once  engaged,  and  hundreds  more  might 
able  employment 

down  medical  men  assist  in  preparing  the  pupils  to  act  as 
Physical  Oolture. 

lepartment  of  Gymnastics,  Dn  Lewis  personally  trains  OTary 
for  the  New  Profession. 

eader  would  know  more  of  this  pioneer  institution  in  a  new 
profession,  let  him  or  her  send  for  a  full  circular  to  Dr.  Dio 
>ston. 

r.  Dio  Lfcwis,  than  to  any  other  man,  is  the  country  indebt- 
present  deep,  practical  interest  in  physical  onlture.  He  has 
ble  work." — Mass.  Teacher. 

)ok  upon  Dr.  Lewis  as  one  of  the  benefactors  of  his  race." 
Treentcood, 

ss  to  Dr.  Lewis'  Gymnasium.  No  better  institution  exists.'* 
cker. 

icwis'  book  is  the  most  practical,  sensible  work  on  this  snb- 
t  in  any  language." — Vontineniai  Mtmthltf.     , 

ewis  has  g^ven  us  far  the  best  and  most  practical  of  all  pnb- 
»n  the  subject  of  Physical  Culture." — N,  Y.  Itui$p€nd$iU, 

:  JB.  CampbeU:'— The  New  York  Medical  Independent  oc- 
eral  pages  in  one  of  its  recent  numbers  in  an  expo$4  of  a  dis- 
amphlet  on  maternity — a  new  theory  of  conception,  and  an 
''  prevention  " —  etc.  The  whole  subject  is  filthy  as  well 
hor ;  and  we  fancy  if  the  Independent  could  see  the  greasy 
in  question,  he  would  not  feel  Tery  proud  of  the  space  daTOt* 
consideration.  In  this  city,  where  he  is  supposed  to  reside 
cely  known,  and  his  importance  is  so  very  limited  that  he 
exceedingly  thankful  to  us  were  we  to  copy  the  Independents 
1  entire.  Wo  have  certain  "  Rapheals  "  and  *'  Bcandina- 
>rs,"and  "  fortune  tellers"  of  quite  as  much  general  and 
lal  interest,  and  quite  as  worthy  of  space. 

I  State  Medical  Society.— The  Transactions  of  the  Suta  Had- 
ty  for  its  session  in  May,  is  promply  on  our  taUe,  throogh 
sy  of  Dr.  Fletcher.  It  contains  the  Presidential  Address  of 
t,  of  Rushville — Reports  of  Gases  by  Dr.  Lockbart»  of  Dan- 
.  Hutchinson's  paper  on  the  Ferersof  IndiaiA— I>t.^¥(/qic^«^% 
Cnmp  DinrrbcBB.    There  is  also  appaikdiad  Om  t«!^T\  A^^ 


444  SdU^i  TM$.  fJidjr, 

Committee  on  a  Beviaioii  of  the  Ooiuiiitation,  aiid  the  code  of  tithia 
of  the  American  Medical  AssociatiOQ.  The  TransaetioiiB  for  the  piee- 
ent  year  are  qaite  moderate  in  hnlk»  but  small  as  it  is  wo  ha?o  net 
had  leisure  to  pemse  the  papers  as  }ret ;  we  therefore  mutt  bo  con- 
tented with  this  brief  aoknowledgment. 

Cincinnati  Medioal  HofpUaU, — Dr^  W.  H.  Gobroeht,  8aig.  tkS.T^ 
has  been  relieved  from  the  charge  of  West  B^d  Hospital,  luid  placid 
in  charge  of  a  new  hospital  to  be  known  as  Officers'  Hospital  eo 
Fairmonnt  in  ^e  suburbs  of  the  city,  Occupying  the  building  orif|i* 
nally  erected  by  the  Baptist  Education  Society  as  a  Theological  Sen* 
inary. 

Dr.  RoWts  Bartholow,  late  Surg.  U.S.Y.,  now  resident  of  this 
city,  succeeds  Dr.  Gh>brecht  in  charge  of  West  End* 

Bach  numbert  </  J864  already  exhatuted. — Although  we  materially 
increased  our  issue  with  the  beginning  of  the  present  year,  wears 
obliged  to  announce  that  back  numbers  for  the  first  half  of  the  TdnN 
are  so  far  exhausted  that  we  are  unable  to  supply  them  to  new  sub- 
scribers. This  will  explain  to  a  number  of  new  subscriben  why  ibtj 
have  not  until  now  received  the  jonmal.  Hereafter  we  commence  all 
new  subscriptions  from  July,  having  again  increased  our  edition. 

New  Fee  Bills, — Some  medical  friend  has  sent  us  the  Denver  Gitj 
Colorado  Commonwealth,  of  Jane  10th  in  which  we  find  a  new  fee  bill 
adopted  by  the  Medical  Society  of  that  city.  It  is  well  up  to  the  ad- 
vanced rates  of  living,  but  not  too  much  so.  It  runs  somewhat  after 
the  following  rates:  For  a  single  visit  $3. ;  for  each  subsequent 
mile  in  the  country,  $2.50  ;  ordinary  obstetrical  attendance  925. ;  de- 
tention per  honr  $2.50 ;  consultation  visit  810.  etc. 

In  this  connection  we  notice  the  Boston  Medical  Association  has 
recently  made  a  thorough  revision  of  the  fee  bill  of  that  Society.  The 
following  will  give  an  idea  of  the  advance  the  Bostonians  have  thougbt 
necesary  to  make  in  their  charges  :  For  a  first  visit  in  any  case  83. 
to  85. ;  visits  in  regular  attendance,  (medical,  surgical  or  obstetrical) 
83. ;  extraordinary  service,  detention,  or  unusual  responsibility  the 
fee  to  be  proportionally  increased  ;  consultation  visit  85.  to  810. ; 
visits  between  9  p.m.  and  8  ▲  h.  85.  to  810. ;  for  attendance  oat  of 
the  city,  mileage  to  be  charged  for  short  distances,  91.  to  82. ;  and 
on  railroad  Itnd  long  distfinces  according  to  time  and  inconvenienos 
to  the  physician,  from  half  a  dollar  to  one  dollar ;  office  advice,  88.  to 
820. ;  letters  of  advica  %1Q  V^  V2i^.\  l^x  ^'^\\)^.^'Q&Ssik^^VTvn^  qoestiooi 


1864.]  JSdifor'i  TiihU.  445 

at  law  in  wbicb  the  physician  may  be  snbpooaed,  $50. ;  for  detention 
in  court  as  an  expert  in  matters  involving  a  professional  opinion,  $50. 
a  day  :  certificate  of  health  S5.  ;  obstetrical  attendance  $24  to  $30., 
with  proper  extra  charges  for  detention,  consultations,  obstetric  op- 
erations, etc.  ^ 

It  will  be  observed  that  these  charges  are  in  some  respects  in  ad- 
vance of  the  fee  bill  in  operation  in  Cincinnati,  in  other  respects  rath- 
er below  ;  it  is  however  on  the  whole  a  very  jadicioas  scale,  and  with 
the  present  exorbitant  rates  of  living  the  fees  are  not  high.  With  all 
expenses  of  living  doubled  in  many  items  of  the  necessaries  of  life  two 
or  three  times  over,  it  is  simply  absurd  to  attempt  to^get  along  on 
any  thing  like  the  old  rates. 

Private  Instruction, — Dr.  Bartholow,  late  Asst.  Surg.  U.8.A.,  pro- 
poses to  engage  in  private  instruction  of  niedical  students,  or  young 
men,  desiring  to  enter  army  and  navy.  His  course  of  instruction  will 
embraces  the  curriculum  of  the  Medical  Colleges  and  the  usual  subjects 
of  the  examination  of  the  army  and  navy  Boards.  Office  844,  Race 
Street,  Cincinnati,  0. 


Traveling  Agents. — J.  Ro^e  Smith  and  H.  P.  Throop  are  author- 
ized agents  for  subscriptions  and  collections  on  this  Journal.  Mr. 
Smith  will  canvass  Ohio  during  the  present  season,  and  Mr.  Throop 
is  traveling  through  Indiana. 

Old  Journals  Wanted. — To  complete  our  file  of  the  Wsstsrn  Lancet, 
we  desire  to  obtain  the  following  back  volumes  :  for  1853-*44-'45 
-45-'47-48'-49. 

A  medical  friend  also  desires  to  complete  broken  setts  of  various 
Western  medical  periodicals,  and  lias  made  out  the  following  list. 
Any  person  having  any  of  these  volumes  or  parts  of  volumes,  who 
will  dispose  of  them,  will  confer  a  favor  by  communicating  with  Dr. 
E.  B.  Stevens,  at  this  office. 

••  Western  Quarterly  Medical  Reporter."     Edited  by  Dr.  John  D. 

Godman:  Cincinnati,  1822— 2  Vols. 

"  Ohio  Medical  Repository."  Dr.  Guy  W.  Wright  and  James 
BI.  Mason,  Editors  :  Cincinnati,  1826—1  Vol. 

"  Western  Medical  an<l  Physical  Journal."     Drs.  Guy  W.  Wright 

and  Daniel  Drake,  Editors :  Cincinnati,  1827 — ^1  Vol.    Continued, 

as  "  Western  Journal  of  Medical  Sciences,"  by  Dr.  Drake,  till  1889. 

"  Louisville  Joamal  of  Medicine  and  Surgery/'  by  Profa.  MUki^ 
YandeU  and  Bell :  2  numbers  issued. 


446  MHor'i  TaN$.  [Jdj, 

"  Semi-Monthly  Modiod  Newi/'  LodsTiDe,  Kj.    Want  YoL  1, 

No.  8. 

<'  LonisviUe  Medioal  Gasette."    Want  Vol.  No.  1,  6,  7»  8,  0, 10, 

11,  and  12. 

•'  Nashville  Monthly  Record.**    Want,  Vol.  1,  No-  8 ;  Vol.  2,  No. 

1,  3,  5,  6,  9,  10,  12 ;  Vol.  8,  all  after  No.  8. 

'<  The  Western  Medical  Gazette."  Ediced  by  Drs.  Eborle,  MitcM, 
Smith  and  Gross.    Oincinnati,  1882-85 — 2  Vols. 

*'  Ohio  Medical  Repository,"  (second  of  the  name.)  CineuiBatiy 
1835—1  Vol. 

'<  Western  Lancet."  9t,  L.  M.  Lairson.  Cincinnati,  1842.  Want 
Vol.  1,  Nos.  1,  2,  8, 11, 12,  or  whole  Tolnme;  Vol.  2,  No*.  10, 12, 
or  whole  volume  ;  Vol.  11,  No.  1 ;  Vol.  15,  No.  1 ;  Vol.17,  No.  11 

"Transylvania  Journal  of  Medicine  and  the  Asaociata  Scleneet." 
Edited  by  Drs.  John  E.  Cooke  and  Charles  W.  Short.  Lexingtoo, 
Ky.,  1828.  Want  Vols.  1,  6,  7,  8,  9, 11  and  12  eniire,  or  the  entire 
set. 


•  mm* 


Army  Medical  Intelllgenoe. 

Surgeon  Henry  Eversman,  U.S.V..  as  Chief  Medical  Officer  st 
Johnson's  Island,  Ohio. 

Surgeons  C.  S.  Tripler  and  H.  R.  Wirtz.  U.S.A.,  and  Snrgeoiii 
Thos.  Antisell  and  C.  0.  Cox,  U.S.V,,  are  detailed  to  represent  the 
Medical  Department  of  the  U.S.  Army,  at  the  meeting  of  the  Ameri- 
can Medical  Association  in  New  York  City,  June  7th,  1864. 

The  following  Officers,  unconditionally  released  by  the  rebel  anther- 
ities,  will  proceed  without  delay  to  rejoin  their  respective  commands : 
Surgeon  N.  F.  Graham,  12th  Ohio  Vols.,  Assistant- Surgeon  W.  S. 
Newton,  Olst  Ohio  Vols.,  Surgeon  N.  D.  Furgnson,  8th  New  York 
Cavalry,  Assistant -Surgeon  D.  W.  Richards,  145th  Pennsylvanii 
Vols.,  Surgeon  W.  S.  Welsh,  15th  West  Virginia  Vols.,  Assistant- 
Snrgaon  J.  T.  Johnson,  same  regiment.  Surgeon  C.  H.  Thatcher,  IMl 
Woit  Virginia  Vols.,  and  Chaplain  John  L.  Irwin,  same  regiment. 

Surgeon  J.  J.  DeLamater,  U.S.V.,  has  reported  for  duty  at  Fort 
Monroe,  Va. 

Surgeon  C.  G.  A.  Campbell,  U.S.N.,  is  sick  at  hia  home  in  Phila- 
delphia, Pa. 

The  U.S.  Barracks  at  Augusta,  Me.,  have  been  turned  over  to  Med- 
ical Department  for  a  hospital. 

Surgeon  G.  H.  Hubbard,  U.S.  V.,  has  been  ordered  to  resume  hit 
datiea  as  Medical  D\rQQloT,l>\iVtV^oixVi%  Frontier,  Fort  Smith,  Ark. 


1864.]  Editor's  TabU.  447 

The  following  named  medical  officers  are  relieved  from  duty  at 
tbeir  present  stations,  and  will  report  in  person  without  delaj  to  As- 
Riston  Surgeon- General  R.  C.  Wood,  U.  S.  A.,  at  Louisville,  Ky.  : 
Surgeons  J.  H.  Grove.  N.  F.  Marsh,  and  John  G.  Hatchitt,  U.  S.  Y. 

Surgeon  Ebcnezer  Swift,  U.S.A.,  is  relieved  from  duty  in  the  De- 
partment of  the  South,  and  will  report  to  the  Commanding  General, 
Department  of  the  North-West,  to  relieve  Surgeon  Thomas  M.  Getty, 
U.S.A.,  as  Medical  Director. 

Surgeon  Getty  on  being  relieved  will  report  to  the  Commanding 
General,  Department  of  the  Fast,  for  assignment  to  duty. 

Surgeon  G.  M.  Kellogg,  U.S.V.,  as  Medical  Director,  General 
Crooks'  command.  Department  of  West  Virginia. 

Surgeon  W.  D.  Stewart,  U.  S.  V.,  as  Medical  Director,  General 
Sigel's  command.  Department  West  Virginia. 


MARRIED. 

Married,  at  Asbury  Chapel,  Tuesday  morning,  June  7th,  by  Rev. 
Adam  Poe,  A.  J.  Milks,  M.D.,  of  London,  O.,  to  Miss  Mart  F. 
Stxarns,  of  Cincinnati,  O. 


OBITUARIES. 

Cineinnaii  Colege  of  Medicine  and  Surgery,  June\2lh,  1864. — At 
a  called  meeting  of  the  faculty  and  students  to  take  action  in  regard 
to  the  death  of  Daniel  B.  Spahr,  a  student  of  the  College,  Prof.  A.  H. 
Baker  was  called  to  the  chair,  and  A.  H.  Underwood  was  appointed 
Secretary. 

On  motion,  the  following  gentlemen  were  chosen  a  committee  to 
draft  resolutions  expressive  of  the  sentiments  of  the  College  in  regard 
to  the  deceased :  Prof.  J.  A.  Thacker,  W.  H.  Smith,  S.  A.  Hinton, 
W.  P.  Foster,  and  H.  G.  Nelson. 

The  Committee  after  retiring  reported  the  following  resolutioni , 
which  was  unanimously  adopted  : 

Wbsrkas,  It  has  pleased  God  in  his  Divine  Providence  to  take 
from  oar  midst  Daninl  A.  Spahr,  a  student  of  college,  whom  we  all 
loved  and  esteemed 

ReMotvedj  That  it  is  with  great  pain,  that  we  bear  the  separation 
from  our  beloved  friend  and  fellow  student,  temporary  thongh  it  may 
be,  but  we  hope  that  our  loss  is  his  gain  ;  and  the  belief  that  he  has 
gone  to  the  enjoyment  of  the  bliss  of  the  better  land,  tends  much  to 
make  his  severance  from  us  reconcilable. 

Resolved,  That  m  the  deceased  were  all  the  qualities  that  are  em- 
braced in  the  character  of  the  true  gentleman,  the  intelligent  axAVcv- 
dusliioas  itudent,  and  a  consistent  Christian ;  and  ^\i\c\k  «ndoKc^ 


418 


Biitar'i  Tail: 


liin  to  UB  all.  HiS'lut  words,  when  inquired  of  as  to  whettm  ha 
w«4  ready  to  dia,  asliibitad  bii  goaaino  piatf ,  viz. :  "  I  am  rradj  waA 
iTtUing."  Indeed  all  ^nalitiea  Delosgine  to  him  give  prooTof  fuiun 
eminenoe  in  his  profesaion  and  great  naalUnen. 

Setohtd,  That  we  tender  our  aympatfaie*  and  coqJo)cuo«  to  bit 
bereaved  family ;  hoping  they  will  besr  hie  lota  tvith  due  reaignatloi. 
"We  farther  as  a  token  of  reapect  to  the  deoeoscil  will  suepeod  oat 
regular  collegiate  exercises  on  the  morrow. 

On  motion,  the  minntes  and  reaolatiuna  were  directed  to  be  pn]c 
lisbed  In  the  Cincinnati  LaruH  and  OSmtM*.  the  Chicago  iffiHad 
Journai,  and  the  Conoty  paper  of  the  deoeaied— nnd  further,  a  C<m- 
mittee  of  eight  stadents  were  appointed  to  act  W  pnll-bcarerN  in  oonvef- 
ing  the  body  of  the  deceased  from  hia  rooma  to  iha  cats  in  ita  (»o«t 

Adjourned.  A.  H.  UKDEnwooD,  Sxc'r. 

Deatk  of  Dr.  N.  S.  Artmtrot^. — Below  wiU  be  found  the  aciion  of 
the  ProfeBsion  of  thia  city  in  the  ceae  of  the  deiLth  of  Dr.  ArmsUODg. 
Dr.  Armstrong  baa  been  in  failing  health  for  Mvernl  years,  and  ecarM- 
ly  able  for  profeBsional  duty  at  any  time  ;  his  decease  was  thvrafera 
anticipated  ty  his  friendsi  and  took  place  on  Saturday,  July  thU. 
Ha  was  a  quiet,  nnostentatioua  Christian  gentleman,  and  his  d«aik 
will  be  sincerely  lamented  by  a  large  circle  of  fcicoda  in  and  out  of 
the  Profession  ; 

At  a  meeting  of  the  regular  Aledical  Profession  of  this  city,  heUij'' 
the  Obio  Medical  College  on  the  morning  of  July  3d,  to  take  actfcS' 
in  refetence  to  the  death  of  N.  S.  Armstrong,  Dr.  J.  L.  Vattiorwai 
called  to  tbe  chair,  and  Dr.  G.  S.  Mnscroft  was  dected  Secretary. 

A  committee  couGisting  of  Drs.  D.  D.  Bramble,  J.  H.  Jttickacr  and 
C,  8.  MiiRcroft  was  appointed,  who  presented  liiG  following  prtamUt 
and  resolutions: 

Whereas,  It  has  pleased  Divine  Providence  ta  take  from  onr 
midst  Dr.  F,  8.  Armstrong,  who  departed  tbiii  life  July  2nd,  IEV4, 
therefore  be  it 

SesotveJ,  Tliat  in  the  death  of  Dr.  Armatroug,  the  Medical  Prv 
fession  has  loRt  a  steadfast  and  devoted  member,  and  the  commutitty 
a  worthy,  highly  esteemed  and  respected  citizen.  As  a  phyftieiao, 
be  wts  faithful  and  true,  always  prompt  to  obey  iho  callii  of  BufTeiiiw 
humanity.  As  a  citizen  he  was  noted  for  his  unassuming  worth  iM 
honesty  of  purpose. 

Seiolved,  That  the  Slodical  Profession  attend  bia  fancral  in  a 

Retolved,  Also,  that  a  copy  of  these  proceedings  be  sent  In 
family  of  the  deceased  and  published  in  the  daily  p^wn^  and  ^ 
Cincinnati  Linctiand  Obftrttr, 

J.  Ij.  Yavbtm,  Pru'u 
C.  B-MiracBorr,  Sat.     . 


«r-fea  ••  WoU  VtL—So.  8- 


WlMl«  VuliuBe,  XXX 


AlVirHT,     1  B« 


Jrucinuati  ilancct  tc  iBhtxkx. 


KlIlTlit' ill  '  ^^ 

"sTEVlirf-*;  M.l).   .   .  JulLN  A.  JJlllJ'UV.  M.U.  , 


«!>•■   INSATl: 


COJiTEjrrS  FOR  AfUUST,  180*. 


Aur   III 
|piuicei:i'i^i--  "<  "n  mi*.- 

SGi'olhii^s  of  ilin  Cinclopatl  Anulcmj  wF Htdkitiil- ■ 

Al'lcotoribB  H  ... 

I'BGTIEWS  AXH^'.  .1 

I  EwMUU.  Aaannr.!.  m.  ^Jll_;...-[i.l^.l 


Medical  I  olleffeof  Ohio.CinciDnalfl 

|rpiii   I 


Dr.  Robert  Bartiiolcw. 

Sa.  341  Race  Smet,  nbovc  }{inU> 

VINCIX\.\T1.  OHIO  j 


THE 

CINCmNATI  LANCET   AND  OBSERVER 

CONDOCTKD  BT 

E.  B.  STEVENS.  M.D.,  AND  J.  A.  MURPHY.  M.D. 


Vol.  VII.  AUOUBT.  1864.  K  o. 


(Drigittjtt  ^amvuunltntiam. 


AETICLB    I. 


A  Report  on  New  Remedies. 


ptrad  Uefore  the  Ohio  SUt«  Medical  Society,  WhlU  Salphnr  SpHogt,  June  tl.22,  18r4.i 

BT  KDWARD    B.    ITCVKNa    M.   D.,    CIMCINMATI. 


The  present  report  of  yoar  committee  on  new  remedies  will  be 
mainly  %  continuation  of  the  report  of  last  year,  and  therefore  will 
be  devoted  to  the  notice  of  such  remedies  and  preparations  as  have  re- 
cently been  presented  for  favorable  consideration  :  nevertheless  some 
general  remarks  in  connection  will  not  be  entirely  out  of  place.         ^ 

In  an  editorial  in  the  Buffalo  Medical  Journal  by  Dr.  Miner,  we 
find  some  remarks  on  Drugs  and  their  use  in  the  treatment  of  disease 
that  are  corrollary  to  views  expressed  iu  a  former  report  of  your  com- 
mittee, showing  especially  that  the  tendency  of  scientific  medicine 
ID  its  stcA<iy  progress  is  toward  the  treatment  of  diseaHo  with  less 
drug  medication — their  proper  use  being  rather  for  the  assistance  of 
tbe  vital  lon*e  in  its  instinctive  resistance  of  pathological  changen, 
nild  their  conduct  to  safe  terminations.  We  quote  a  brief  paragraph 
or  two  expressive  of  these  ideas. 

"  Disease  is  almost  everywhere  over  treated,  and  nothing  can  be 
more  plain  or  more  easily  demonstrated  than  this  propotfiiion.  If  wo 
did  not  kuow  it  was  true  we  should  be  glad  to  speak  otherwise.  It 
did  appear  at  a  time  that  the  vagaries  of  Uahnnsman  were  to  be  adopt- 
ed iu  a  degree  to  prevent  somewhat  the  injurious  abuse  of  medicine,  but 
eren  the  belief  that  Homeopathic  remedies  would  at  least  do  no  harm 
has  long  since  been  diiisipated  with  the  knowledge  that  even  the  disci- 
ples of  tkia  monstrous  delusion  are  drugged  more  extAVi%\^^\N  «xi\\ik»v^ 


450  Original  Conununieaiians.  (^ August, 

dangeronsly  than  any  other  :  they  are  literally  fed  on  drags,  in  doses 
which  would  do  honor  to  the  chivalrous  days  of  'heroic  practice/ 

"  The  progress  of  true  medical  science  has  greatly  qualified  our  esti- 
mate of  the  value  of  mere  medicine  in  the  treatment  of  disease.  The 
sore  that  used  to  be  treated  with  an  unguent  composed  of  twenty  in- 
gredients, heals  under  moist  lint  when  placed  in  proper  position,  or 
supported  by  the  stimulus  of  gentle  pressure.  The  Pneumonia  that 
used  to  be  attacked  with  heroic  remedies — bleeding,  antimony  and 
calomel — now  gets  well  with  horizontal  position  and  small  doses  of 
Do  vers'  powders.  Inflammation  even  of  the  serous  membranes,  which 
formerly  received  most  active  medication  is  now  observed  to  termin* 
ate  favorably,  if  pain  is  -abated  and  sleep  obtained  by  a  full  anodyne. 
The  more  painless  or  even  pleasant  a  physician  can  make  his  treat- 
ment, the  more  he  can  divest  it  of  irritating  and  disturbing  charac- 
ters, the  better  is  it,  and  the  greater  and  more  acceptable  is  he.  The 
chief  characteristic  of  advancing  therapeutics,  is  to  watch  the  natural 
course  of  disease,  to  regard  pathological  processes  ouly  as  modifica- 
tions of  physiological  ^nes,  with  a  natural  tendency  to  terminate  in 
harmonious  and  healthy  action  when  the  obstacles  are  overcome  which 
the  pathological  processes  themselves  were  put  in  action  to  remove. 
We  often  see  in  the  worst  forms  of  disease  "  an  effort  of  nature  to 
throw  off  the  morbific  matter,  and  thus  cure  the  patient.  "  All  this  is 
done  without  any  detraction  from  the  dignity  and  importance  of  the 
physician  :  he  is  indeed  much  more  worthy  of  public  admiration  and 
confidence  than  he  who  would  attain  the  same  result  by  the  most  ac- 
tive medical  warfare. 

**  Physicians  never  talked  so  modestly  about  "curing  "  disease  as 
now,  and  those  who  excel  in  this  modesty  do  most  toward  the  further- 
ance of  the  object.'* 

U.  S.  Fharmacopicea. — During  the  past  year  the  regular  decennial  re. 
vision  of  the  United  States  Pharmacopoeia  has  been  issued,  by  authori- 
ty ol  the  national  convention  for  revising  the  Pharmacopoeia  held  in  the 
City  of  Washington  in  the  year  1860.  It  is  of  course  to  be  expect- 
ed that  with  the  completion  of  each  decennial  interval,  the  progress  of 
medical  science  will  bring  with  it  many  modifications  in  the  opinion 
of  practitioners  as  to  the  value  of  remedial  agents  :  and  this  last  revis- 
ion while  it  is  another  evidence  that  our  science  has  not  reached  a 
state  of  perfection — is  also  an  evidence  of  the  steady  and  painstaking 
progress  we  are  making  in  this  department  of  our  profession. 

^BaAIo  Medical  a&d  SurglQaiJoTmil,  Kot.,  1863. 


1864]  BfavMSB—Neu  Bemidml  461 

V 

A  Pharmacopoeia  of  the  United  States  is  not  merely  a  series  of  for* 
mnlffi  for  the  best  moile  of  presenting  uniform  preparations — ^bnt  it  is 
for  the  time  a  declaration  of  what  the  experience  of  the  profession  has 
decided  shall  be  considered  its  standard  officinal  preparations. 

As  some  evidence  of  the  change  which  experience  has  brought  in  the 
views  of  practitioners — we  remark  that  in  the  list  of  the  IfaUria 
Medica  proper — twenty -six  articles  have  been  dismissed  as  useless  or 
so  inferior  as  to  be  unworthy  of  *a  regular  place  as  officinal  articles  : 
and  from  the  list  of  officinal  preparations^twenty-seven  have  been  in 
like  manner  dismissed  : — On  the  other  hand»  fifty-five  articles  have 
been  considered  of  sufficient  ^alue  to  be  added  to  the  Materia  Med" 
tea — and  one  hundred  and  eleven  preparations.  These  are  not  how- 
ever to  be  strictly  regarded  as  new  remedies — they  are  the  new  remedies 
which  the  experience  ot  ten  years  has  approved — and  a  large  propor- 
tion are  already  in  general  use  before  the  mere  declaration  of  the  Phar- 
macopoeria  had  made  them  officinal. 

Of  course  we  shall  have  next  in  order — and  at  an  early  date— a 
fresh  edition  of  the  United  States  Dispensatory  conforming  to  this 
modified  Pharmacopcsia,  which  will  be  looked  for  with  interest  by  the 
professsion. 

In  this  connection  it  is  but  fitting  that  we  acknowledge  the  eminent 
services  of  that  dilligent  '^  hand  maid  "  Pharmacy :  In  this  country 
the  plodding  compounder  of  drugs  has  within  comparatively  a  recent 
period,  risen  rapidly  to  the  dignity  of  an  independent  and  worthy 
profession  :  in  this  we  should  sincerely  rejoice — for  t}ie  elevation  of 
Pharmacy  represents  in  an  important  degree  the  progress  of  medical 
science.  While  we  should  systematically  frown  upon  that  villainous 
nondescript  which  continues  in  a  large  degree  to  infest  our  cities  and 
larger  villages — who  is  half  druggist  half  doctor  ; — bleeds,  pulls  teeth 
and  treats  gonorrhoea  ; — who  fawns  on  the  members  of  the  profession 
for  their  prescription  patronage,  and  sneers  at  them  to  their  patients ; 
who  resorts  to  all  scurvy  tricks  for  a  consideration ;  nevertheless  we 
say  all  honor  to  the  true  Pharmaceutist — let  us  strive  to  draw  the  dis- 
tinction in  our  esteem — and  so  far  as  may  be  draw  the  distinction  in 
our  patronage. 

During  the  past  year  or  two,  the  London  Lancet  has  published  a 
series  of  articles  on  what  the  contributor  is  pleased  to  style  new  mM- 
diei.  Some  carefulness  in  the  reading  of  these  articles  incline  nt  to 
the  opinion  that  a  large  amount  of  trash  has  been  gathered  up,  with  a 
few  really  valuable  contributions ;  quite  a  number  of  Te;tnftA\«^  ix^Vs^- 
ken  at  second  hand  from  the  representationa  oi  E\«c^o  ixA  ^^Xkc^ 


I 

452  Original  Cimmume€diUm$.  [August 

practitioners  of  tliis  country,  who  are  by  no  means  regarded  with  a 
prophet's  honor  at  home.  Others  are  treated  of  as  new  which  haVe 
been  long  known  in  this  conntry  and  nsed  by  all  classes  of  practition* 
era — as  for  example  the  PhUolqcea  deeandra,  (poke  root. )  The  sever 
ral  individnal  articles  that  we  propose  to  notice  are  too  disoonnectsd  to 
suggest  any  systematic  order,  we  therefore  take  np  first —  ^ 

Substitutes /or  Quinia ;  Cinehanine.  In  the  series  of  articles  we  al- 
Inde  to,  we  have  cinehonim  presented  as  a  reliable  an ti -periodic,  in  all 
respects  equally  efficacious  as  a  remedy,  though  in  doses  one  third  lar- 
ger than  quinine.  The  cinchonine  has  the  advantage  of  being  less  bit- 
ter in  taste,"  and  much  cheaper.  The  cinchonine  is  especially  commen- 
ded in  a  communication  from  Dr.  McPherson,  who  has  had  a  lengthy 
and  extended  opportunity  for  observation  in  the  fevers  of  the  East 
Indies.  Inasmuch  as  the  sources  of  supply  of  quinine  are  becoming  ev- 
ery year  more  limite  d,  it  becomes  a  very  important  inquiry  to  test  a 
reliable  substitnte — or  even  a  substitute  which  shall  be  reliable  for 
many  purposes.  It  is  stated  that  the  supplv  of  cinchonia  is  both 
cheap  and  abundent.  The  Swamp  Athor  Fraxinus  NUgra^  \b\  oflbied 
as  another  substitute  for  the  sulphate  of  quinine..  In  an  article  in  the 
Oineinnati  Lancet  and  Observer  for  VApril  1864,  Dr  Denny  of  Albion, 
Indiana,  reports  an  experience  of  ten  years  in  the  use  of  the  swamp 
ash.  He  administers  the  remedy  in  the  form  of  a  synipy  decoction  or 
fluid  extract  of  the  inner  bark^  in  do<'es  of  a  table  spoonfull,  frequent 
ly  repeated  during  the  state  of  apyrexia,  adding  a  full  dose  of  opium 
to  the  last  dose  of  swamp  ash  in  anticipation  of  the  expected  parox* 
ysm.  He  says'" ever  since  1854  all  my  cases  of  intermittents  hav^ 
been  thus  treated,  and  I  candidly  aver  has  never  failed  to  arres' 
disease."  He  further  expresses  the  opinion,"  from  his  observation 
hat  relapses  of  ague  thus  treated  are  less  apt  to  i*ctum. 

Pkloridzxne,  is  another  remedy  which  has  some  claims  to  profes- 
sional regard,  as  in  some  degree  a  subsitnte  for  quinia.  As  long  ago 
as  the  year  1856  some  favorable  notices  of  phloridzine  appeared  in 
the  medical  journals.  We  find  in  the  Medical  Observer  of  Cincinna- 
ti some  account  of  its  use  by  phyciads  of  that  city  in  the.  treatment  of 
intermittent  diseases.  Dr.  De  Ricci  revives  attention  to  this  remedy 
in  a  recent  article  in  the  Dublin  Quarterly  Journal  of  Medieal  Scienee, 
August  1864,  as  follows  : 

"  Phloridzine  is  a  neutral  principle  existing  in  considerable  quan- 
tities in  the  bark  of  the  root  of  the  apple,  plum,  and  cherry  trees,  but 
pilncipally  in  the  apple  tree.    It  appears  in  the  market  in  the  form 
^f  a  dirty  whitish  powder,  conttv^lVu^of  broken  up  silky  needles,  some- 


1864.]  Stbvenb — New  Remedies.  453 

what  resembliug  quinine  which  has  not  been  well  bleached,  and  when 
rabbed  between  the  fingers  it  has  a  soft  velvety  feel»  very  like  that  of 
frcnch*chalk.  When  chrystalized  bj  slow  cooling  from  a  dilute  sola- 
tion,  previously  treated  with  fresh  prepared  animal  charcoaj,  phlorid 
sine  way  be  obtained  perfectly  white,  and  in  the  form  of  long  silk 
needles,  its  taste  is  peculiar,  being  bitter  at  first,  but  afterwards 
somewhat  sweetish,  with  a  flavor  of  apples.  Phloridzino  differs 
from  quinine  by  containing  no  nitrogen  in  its  chemical  composition 
bnt  in  this  respect  it  resembles  salacine,  to  which  i«;  is  much  allied. 
Like  salicine  it  does  not  combine  with  acids  to  orm  salts,  is  very 
i^oluable  in  alcohol,  ether,  or  boiling  water,  but  requires  one  thousand 
parts  of  cold  water  for  solution. 

"  The  cases  in  which  Dr.  De  Ricci  has  employed  phloridzine  with 
most  success  have  been  certain  forms  of  atonic  dyspepsia  occurring 
in  delicate  females,  to  whom  it  was  impossible  to  administer  either 
bark,  quinine,  or  salicine  in  any  shape,  without  bringi  g  on  serious 
nervous  excitement.  lie  has  also  found  it  extremely  well  adapted  for 
the  treatment  of  young  children  of  delicate  constitutional  habit,  or 
when  recoveriug  from  the  whooping  cough»  infantile  fever  or  any 
other  disease.  The  doses  he  has  employed  are  five  grains  three  or 
four  times  a  day  for  adults,  and  proportionally  small  for  children. 
In  prescribing  phloridziuv.*  it  must  be  borne  in  mind  that  it  is  almost 
insoluable  in  cold  water,  but  the  addition  of  a  very  small  quantity  of 
ammonia  instantly  dissolves  it,  thus  by  adding  to  an  eight  ounce 
mixture  containing  a  drachm  of  phloridzine  a  few  drachms  of  aromat- 
ic spirit  of  ammonia  the  fluid  which  was  previously  milky  becomes 
perfectly  clear,  and  the  addition  of  the  aromatic  spirit  rather  im- 
proves the  mixture  than  otherwise.  Dr.  De  Bicci  relates  the  case  of 
A  young  lady  of  a  strumous  constiturion,  suffering  from  chlorosis,  in 
which  the  effects  of  phloridzine  were  manifestly  favorable.  The  pa- 
tient was  unable  to  take  iron  in  any  shape,  and  both  quinine  and  sala- 
cine equally  disagreed  with  her ;  but  phloridzine  agreed  per- 
fectly well,  and  her  constitution  improved  so  much  under  its  use,  that 
►he  was  subsequently  able  to  take  citrate  of  iron  and  strychnia  in 
grain  doses,  which  ultimately  effected  a  perfect  cure.  Dr.  De  Bicci 
thus  recapitulates  the  advantages  of  this  drag: 

"  It  is  tolerated  in  cases  where  neither  quinine,  nor  salicine,  nor 
bark  can  be  administered  with  impunity. : 

"  It  is  particularly  adapted  to  young  children  : 

**  It  is  not  expensive — thus  rendering  us  indepetid«\i\.  ol  Cka  w^vSk^ 
(liminishiD^  cincboDS  forcata  ot  Sonth  America.** 


454  OHgmal  CommumefOioni.  [Anput* 


£rffoi  qf  Wheat  a  tuhtUMe  for  JE^ol  i^  i^.— Phjsidsas  who  an 
m  the  habit  of  using  the  ergot  of  rye,  have  always  experienced  oeitain 
inconveniencies  which  tend  to  deteriorate  its  actual  efBcacj  and  render 
its  action  constantly  uncertain :  these  are  particularly — ^the  amonnt  of 
poisonous  resin  which  is  contained,  and  the  action  of  time  and  damp 
in  rendering  it  absolutely  inert.  These  objections  are  sought  to  ha 
avoided  by  the  substitution  of  the  eigot  of  ^tiheai  for  the  rye  hereto- 
fore so  well  known.  We  find  the  following  parsgraph  in  the  Ifm 
York  Independent  for  June  8lA  InU. : 

«<  The  ergot  of  wheat  is  proposed  by  M.  Leperdriel  of  Montpdier, 
It  is  much  rarer  than  the  ergot  of  rye  but  can  be  found  in  snffident 
quantity.  Its  color  is  much  the  same  as  that  of  lye,  buT  diflfars  in 
shape.  Whilst  the  ergot  of  rye  is  fusiform,  generally  curved  like  the 
spur  of  a  cock,  and  fbrrowed  longitudinally  with  striae  of  equal  lengthy 
ihe  ergot  of  wheat  preserves  the  form  of  the  grain  which  it  repIaceo» 
is  deeply  deft,  and  is  often  even  divided  into  two,  and  sometimes  into 
three  at  its  upper  extremity.  It  has  the  remarkable  physical  proper^ 
ty  of  resisting  decay/ and  hence  of  preserving  for  a  length  of  time  its 
medical  virtues.  It  can  thus  be  kept  many  years  without  undeiftoing 
any  alteration.  It  moreover  contains  15  per  oent.  less  of  the  poison- 
ous principle  of  ergots,  and  yield  20  per  cent  more  of  the  e£Scacious 
principle.  Such  are  the  reasons  which  lead  Mr.  Leperdriel  to  pre- 
fer ergot  of  wheat  to  that  of  rye. 

Caulophyllum  Thalactroidee  as  a  parturient. — ^In  the  series  of  arti* 
ties  to  which  we  have  already  referred  in  the  London  Lancet,  it  is  sta- 
ted that  the  caulophyllum  thalactroidee  which  we  believe  belongs  to 
the  cohosh  family;  and  therefore  may  probably  resemble  the  cimifuga 
racemosa,  is  a  parturient  of  more  decided  reliabile  efiScacy  than  the 
eigot.  Its  mode  of  administration  and  dose  is  not  given,  but  wo 
suppose  should  be  given  as  an  infusioh^-or  what  would  be  better^— 
as  a  fluid  extract,  of  which  388  to  3j  would  be  a  proper  dose. 

Liquor  Biemiuihi :  Most  practitioners,  agree  in  opinion  as  to  the 
special  value  of  bismuth  in  painful  affections  of  the  stomach,  however 
much  they  may  differ  as  to  the  nature  of  the  pathological  conditions 
giving  rise  to  these  very  common  painful  states  of  the  or^n.  We 
have  hitherto  been  confined  to  two  preparations — ^the  tris  nitrate  and 
carbonate.  Both  these  are  insoluble  powders,  bulky  and  inconveni- 
ent, inasmuch  as  a  single  dose  cannot  be  made  into  one  or  two  pills. 

The  Lancet  for  Sept.  1868,  states  that  Mr.  Schacht  of  Clifton,  has 

succeeded  in  preparing  a  solution  of  Bismuth,  which  is  uniform  in 

composition,  stable,  misc\b\e  vr\l\i  iv^Axst  ox  other  fiuids  without  pro- 


1864]  Bfnman^N^m  MmtOm.  ^  466 

dpiUdon,  and  if  efficient  in  amalt  doeet^  Thie  tofaitimi  It  qnite 
tmnspeientt  with  a  slight  alkaline  reaotiont  and  althoogh  it  contains 
only  eight  gprains  of  oxide  of  bismnth  in  an  onnoe,  a  fluid  drachm  for  a 
dose  is  found  to  be  equivalent  to  a  fell  doae— fifteen  or  twenty  grains 
—of  the  insoluble  tris  nitrate. 

A  Tcry  excellent  chemist  and  pharmaceutist— Mr.  Wayne — at  the 
store  of  Snire^  Eckstein  db  Co.,  in  Cincinnati,  has  been  for  some 
time  preparing  the  liquor  bismuth,  and  several  physieians  of  that  city 
have  tested  its  efficacy  and  report  very  satisfaotary  results. 

Me  Mmmm'i  EUxw  qf  Opimm. — ^For  near  a  quarter  of  a  century  the 
seorst  nostrum  known  as  McMunn's  Elizii  of  Ojnum  has  been  a  favor, 
ite  remedy  with  many  physicians  who  have  patronised  il  and  praitsd 
it  to  the  great  delight  of  the  proprietor,  and  the  degmdation  of  the  ' 
profession. 

The  special  excelknce  originally  claimed  for  McMann's  ISlizir  was 
that  the  opium  was  denareciiM$dt  but  it  has  long  siaee  been  very  well 
established  that  narcoHm  posseesss  no  narcotic  principle.  It  is  at  least 
harmless,  if  not  a  safe  anti-periodic.  Bacent  articles  in  ths  PlUfmid* 
pkim  Bepariir  and  the  If.  T.  AdepimUni  give  the  entire  rafipnab  of 
the  pieparation,  from  which  we  learn  in  brief  the  following  slepa  in 
theprocsss. 

1st,  The  opium  is  subjected  to  sulphuric  ether,  which  ie  suppossd 
to  remove  the  narootine,  as  also  its  peculiar  noxioua  odor. 

Snd,  A  process  of  boiling  follows  to  remove  the  sulphuric  ether. 

8d,  A  watery  solution  is  made  and  the  opium  is  macerated  for  six 
days,  after  which 

4th,  Alcohol  is  added  in  certain  proportions,  afker^pAaading  un- 
disturbed a  fow  weeks  it  is  the  elixir,  and  is  fit  for  use. 

Beliable  chemical  analysis  proves  that  the  pi^aration  thus  made  ts 
for  efficiency  oa/jr  a  ioltUum  qf  Morphia  that  the  process  leaves  the 
morphia,  ntrcine  and  extractive  matters  only  depriving  the  opinm  of  its 
peeudo  morphia,  oordeira,  narootina,  tbebana,  meconine,  fatty  mat* 
ter  and  resin.  The  narcine  and  extractive  matters  contained  are  so 
neariy  inert  that  after  the  precipitation  of  the  morphia,  the  liquid  might 
be  taken  in  doses  of  an  ounce  without  injury.  It  seeme  then  demon* 
atrated  that  the  so  long  vaunted  Blixir  of  MeMunn  is  nothing  more 
than  a  aolution  of  impure  morphia. 

JSmrac€nia  Pmrfmrw. — ^Perhapa  no  new  remedy  has  attraeted  more 
general  professional  interest  and  attention  than  the  American  pitdier 
plant,  for  the  treatment  of  variola ;  and  the  importance  of  ila  tAa\m]^ 
be  sufficiiht  apology  for  oecupyiag  wwKm  VMsnsiL  ugsa>  Vn.  ^te 


456  OHffinml  OotmmmMtiHmi.  [AngiOi 

notice.  The  sanoenia  parporea,  or  Amerioan  pitcher  plant,  grows 
abundantly  in  various  parts  of  the  United  States,  and  firat  eama  into 
notice  about  four  years  ago,  as  the  "  Indian  Remedy ''  for  small^poz, 
and  was  introduced  to  professional  notice  by  Britiah  army  anrgwms 
on  duty  in  Nova  Scotia.  They  claim  for  it  that  it  not  only  raliera^ 
but  aotn  'lly  exiinguhkes  the  disease ;  renders  the  Tariolona  poison 
effete ;  that  its  special  manifestation  is  first  to  encourage  the  appear- 
ance of  the  eruption,  then  to  abort  it*  i.  e.  that  ver^  speedily  the  er^ 
lion  dcRsiccates,  and  scales  off  without  rendering  the  patient  liable  to 
pitting  or  any  of  the  terrible  train  of  this  loathsome  disease  in  its 
usual  progress.  It  was  in  addition  claimed  that  the  &araeema  is  a 
most  reliable  and  efficient  remedy  for  inveterate  entameofos  aflbdioBi 
as  psora  lepra,  etc.  etc. 

As  used  by  the  Indians,  and  as  introduced  by  Drs.  Miles  and  Mor- 
ris, the  decoction  of  the  root  was  alone  recommended,  the  old  originil 
squaw  claiming  that  the  root  alone  possessed  anti-variolooa  properties. 
Other  writers  however  report  the  use  of  the  entire  plant  indiseriisi- 
nately  ;  for  instance  Dr.  McDowell,  Act.  Asst.  Surg.,  n.S.A.,  at  Tren- 
ton, Mo.,  in  an  article  in  the  Am.  Med.  Times,  of  Sept.  btht  186S, 
used  the  leaves  as  he  was  unable  to  procure  the  root,  and  administer- 
ed  the  decotion  of  the  leaves  in  the  strength  of  1^  3  to  a  quart  of  boil* 
ing  water,  a  wine  glassful  of  this  strength  being  administered  every 
6  hours.  He  reports  43  cases  treated  with  this  remedy  in  the  U.  8. 
General  Hospital,  at  Trenton,  and  the  results  fully  or  mainly  confirm- 
ing the  claims  originally  set  up  by  Miles  and  Morris ;  that  is  to  ssy 
that  the  patients  treated  with  saracenia  had  less  secondary  fever,  the 
eruption  speedily  aborted,  little  or  no  pitting  followed. 

On  the  other  hand,  several  very  careful  observers  have  reported 
their  experience  as  having  no  appreciable  result  confirming  the  good 
effects  of  the  remedy. 

Dr.  Noah  C.  Levings,  of  New  York,  reports  his  experience  in  sev- 
eral cases,  in  which  he  had  "  obtained  the  contused  root  of  the  sara- 
cenia purpuria  direct  from  Maj.  Lane,  of  Halifax,  the  putative  father 
of  the  specific.*'  In  the  observations  of  the  group  of  cases  pat  to  tins 
test.  Dr.  Levings  called  in  Dr.  Jacobi,  a  wf^ll  known  New  York  prac- 
titioner-and  teacher,  to  watch  the  progress  of  the  coses,  ao  thatwf 
have  every  reason  to  regard  the  experiments  as  made  carefully  and 
without  prejudice  for  or  against  the  success  of  the  remedy.  His  re- 
port is  that  there  was  no  increase  of  urine,  no  flattening  of  the  erup- 
tion, but  that  in  every  respect  these  cases  passed  consecutively  through 
the  regular  and  cuBtomary  eVa^  ^l  N%riQ\^\  thA  remedy  in  no  re- 


1864. 1  BnyiRVB—A\m  Bem§dm.  457 

epect  nutnifestiDg  any  appreoiable  effects  open  the  eWftoter  or  dora* 
:ion  of  the  several  oases. 

Dr.  Goyd^r  reports  in  the  ZoiiAm  Zaneei,  a  siDgle  case  treated  with 
.he  root  infasion  according  to  the  direetions  of  Dr.  Miles ;  A  child 
iged  8  years  came  under  treatment  Oct  28th— eruption  already  pap- 
liar  and  tending  to  confluence  ;  gave  the  saracenia  in  table  spoonful 
loses;  Ocb.  81— vesicles  becoming  pnstular ;  Nov.  1 — the  eruption 
vherever  not  abraded  by  the  rnbbing  of  the  patient,  are  much  flatter 
han  nsnal,  and  he  supposed  the  remedy  was  beginning  to  manifest  itP 
■apposed  virtues  especially  as  neutralising  the  vitality  of  the  pustule, 
ind  the  variolous  poison  ;  that  night  however  the  patient  died« 

It  has  80  happened  that  I  have  had  an  opportunity  during  the  past 
•rear  to  test  the  remedy  to  some  extent,  as  physician  to  the  Cincinnati 
i'e;it  house.  108  ca^es  of  small-pox  were  under  my  care  during  the 
seven  months  following  July  )st,  1868.  Of  these  108  esses,  nearly 
%l\  were  subjected  to  the  free  use  of  the  decoction  of  the  leavti  of  the 
•aracenia  purpurea — not  being  able  to  procure  the  root^-the  decoction 
vas  prepared  of  the  strength  of  Ij;  3  of  leaves  to  the  quart  ol  infos* 
on,  and  was  administered  freely  as  a  drink,  from  6  to  8  3  of  this 
nfosion  being  given  during  the  day.  Some  of  these  cases  had  meas- 
ireably  run  their  course  previous  to  admission.  8ome  were  mild  cases, 
isaentially  but  simple  varioloid  ;  of  course  these  were  no  test  of  tjit 

iffeet  of  the  remedy.  About  75  cases  were  fairly  submitted  to  the  in* 
laence  of  the  remedy.  In  a  few  of  the  cases  I  thought  there  was  an 
ibridgment  of  the  duration  of  the  cases,  and  that  the  pustules  dried  up 
nore  speedily  and  scaled  off  more  promptly  than  is  usual.  But  in 
he  great  majority  of  these  c  ises  I  saw  no  difierenco  in  the  progress 
>f  the  disease  from  that  usual  in  cases  of  like  malignancy.  The  mild 
rases  run  a  mild  and  manageable  course  as  is  usual ;  the  well  marked 
ind  confluent  cases  run  a  course  unabated  in  any  respect  from  its  usn* 
il  Timlence  snd  completeness.  The  pustulation  was  as  full,  the  heavy 
lakes  of  scales  as  large,  and  the  condition  of  the  patient  in  every 
iray  quite  as  offensive.  In  the  well  marked  cases  there  was  the  same 
proportion  of  pitting,  and  in  no  case  did  I  observe  that  the  seerstion 
^f  urine  was  affected  either  in  character  or  quantity. 

In  the  trestment  of  these  108  cases,  the  remedy  was  administered 
Q  every  stage  of  the  disease,  administered  freely  and  with  a  desirs  for 
ts  saecess.  My  oonviction  was  that  no  more  imprssaion  was  made 
ipon  the  disease  tHan  would  be  by  any  other  herb  tea.  I  am  therefore 
nelined  to  aeoept  as  oorreot  the  conelusiona  of  the  committee  o^ 
[ntelligeuee  of  the  N.  Y.  Coon^  Medtoal  Bodaly.     \iX.TViaX^QM^ 


468  Of^inei  ComsmfiiiMitfoiur.  •    [Apgitt. 

tiuilysis  already  made  of  tlie  plaat  do  not  giva  any  aotlYe  priBdpli 
or  element  which  would  indicate  any  great  medleinal  potaBoy.  iad. 
That  the  discoverers  and  adyocatee  of  the  ipeeifio  remedial  poMr  of 
the  saracenia  purpurea  over  rariola  baTO  gi^sn  too  great  eradit  to  ths 
pa$i  hoc  circumstances,  as  being  prcpier  Jkoeinflueaoee.  8,  TluA  Aa 
reliable  recorded  experience  thus  &r  appears  to  prqpoiKlarala  agriast 
the  medicinal  efficiency  of  this  plant  in  those  forms  of  diaaaai 
do  not  generally  reooTor  under  the  admiustratioa  of  ordinaij 
dies." 

The  (Mohair  Boon, — TSo  new  remedy  has  periiapa  attracted 
interest  of  late  than  the  calabar  bean,  especially  amoogsl  praelltioasw 
deroted  laigely  or  speoially  to  eye  suigery.  We  are  indabtad  fa  Dr. 
Obristison  for  bringing  the  peculiar  properties  of  this  drug  to  ao* 
tice.  In  his  personal  experience  he  found  that  It  gra.  of  tha  pawte- 
ed  bean  produced  serious  and  dangerous  eymptoms  of  poiaonii^  ae- 
companied  with  remarkable  contraetion  of  the  pupO.  It  ia  now 
that  a  solution  of  the  extract,  or  a  tincture,  if  applied  in  amaU 
tities  to  the  eye  produces  this  contraction  of  the  pupil  in  a  aiagaiai^ 
marked  degree.  In  fact  in  this  respect  its  therapeutical  aotiaa  bsi^f 
exactly  the  rcTerse  or  the  antagonist  of  the  belladona  ;  and  if  atropiae 
be  applied  to  one  eye  and  a  tincture  of  the  otlabar  bean  to  the  otksr, 
the  two  extremes  of  therapeutic  efifoct  are  most  remarkabla.  One  cf 
the  most  readily  oocurring  uses  of  this  remedy  would  suggaat  Itsslf  ai 
oounteracting  the  use  of  atropine  for  its  usual  purposes  in  eja  snigeiy ; 
but  undoubtedly  its  application  in  eye  surgery  alone  will  proTemuch 
more  extended  than  this,  even  though  its  efiects  as  a  peculiar  poiaoa 
ehould  not  render  it  available  for  other  purposes. 

Per  Mdnganaie  of  PolosA.—- Another  new  mnedy  b  attracting  aeais 
attention,  not  particularly  as  a  new  salt,  but  from  the  fact  that  aev 
properties  and  applications  of  it  are  proposed.    Dr.  Samuel  Jaekaoa. 
of  Philadelphia,  haa  contributed  for  the  American  Journal  ^  JftAW 
Sdencet  for  January,  an  article  on  ihe  permanganate  of  potaah,  as  a 
rapid  developer  of  osone  in  the  human  system ;  and  hence  aa  likely  ts 
become  an  important  remedy  in  the  treatment  of  low  forma  of  dissssi; 
especially  those  forms  of  diseaae  dependent  on  a  depraved  condition  «f 
the  blood,  or  a  condition  of  the  blood  faulty  aa  to  ita  oxygenation ;  ss 
for  instance  :  erysiplas,  hospital  gangrene,  typhus  fever,  and  the  like. 
As  bearing  somewhat  on  thia  remedy  we  quote  a  paragraph  out  from 
one  of  the  papers  of  the  day : 

Osone  water  is  now  used  for  drinking  and  the  toilette.     It  is  sd- 
Fortised  in  London  in  ftia  to\!loV\ii%  «^i\%  \  '*  Ita  use  is  attended  by  » 


1864.]  STEYKSS—New  JtemdUt.  459 

ftensatlon  wbicb  has  been  aptly  described  as  the  '  perfume  of  purity/ 
Being  perfectly  inoxious  and  tasteless,  a  few  drops  make  a  most  re- 
freshing and  invigorating  addition  to  the  tumbler  of  plain  drinking  or 
soda  water,  from  which  they  remove  all  trace  of  soluble  organic  mat- 
ter— a  fact  of  infinite  importance  to  the  royager  or  the  invalid.  When 
employed  for  the  toilet,  bath,  etc.,  it  temoves  from  the  mouth  all  im- 
pure and  foreign  tastes  and  odors,  whether  arising  from  natural  or  ar- 
tificial causes,  such  as  the  practice  of  smoking,  and  counteracts  the 
irritation  and  morbid  effect  of  carious  teeth.  It  purifies  and  softens 
the  akin,  and  tends  to  promote  a  healthy  state  of  the  whole  body,  by 
removing  all  secretion,  and  restoring  a  wholsome  condition." 

Now  Dr.  Jackson  states  that  this  ozonized  water  of  the  English  is  a 
solution  of  the  permanganate  of  potash  and  water  in  the  proportions 
of  2  parts  to  1000.  In  dyspeptic  conditions  of  the  stomach  he  found 
this  simple  ozonized  water  had  a  decidedly  tonic  effect  in  do^s  of  a 
teaspoonful  three  or  four  times  a  day.  As  a  local  application  to  ul* 
cers  it  stimulated  to  a  process  of  healthy  action  and  cicitrization.  In 
bospital  gangrene  it  was  given  internally  and  applied  locally  ;  inter* 
nally  it  was  used  afiter  the  following  formula :  Qr — permanganate  of 
potaah  3  ;  acid  sulph,  gtt.  zx  ;  aqua  font,  oij.  which  is  about  2  gr.  to 
the  oz.  Of  this  one  teasgoonful  was  directed  every  three  hours  in  a 
wine  glassful  of  water.  Its  good  effiscts  when  applied  loeally  were 
almost  immediate. 

Acting  upon  the  hints  in  this  paper  of  Dr.  Jackson's  we  learn  that 
our  fellow  member,  Dr.  Dunlap,  of  Springfield  has  experienced  most 
gratifying  effects  from  the  use  of  the  permanganate  of  potash  in  the 
treatment  of  "  spotted  fever,"  as  it  appeared  recently  in  and  about 
that  city.  He  gave  it  in  the  form  just  noted  ;  and  in  the  more  ma- 
lignant cases  increasing  the  dose  from  ^  to  ^  gr.  frequently  repeated. 
His  theory  being  that  in  epidemic  spotted  fever  we  have  a  depraved 
condition  of  the  blood  resembling  that  of  malignant  8carlatina»  or  ery- 
siplas. 

Thus  we  might  proceed,  and  still  to  considerable  extent  swell  the 
matter  of  this  report.  We  feel,  however,  that  the  patience  of  the  So- 
ciety has  been  sufficiently  trespassed  upon,  and  leave  for  future  more 
careful  gleaners  to  bring  up  the  changing  and  improving  progress 
which  this  department  of  medicine  is  making  in  its  annual  march. 


460  .  Orlfwal  Communications.  [Angutt. 


Phlyotenulsr  Ophthalmia. 


""  BT  DE.  a.  WILLI4M8. 

Phlyctcnatar  iDflammatiQa  of  the  eyes  is  not  only  essentially  a  dis- 
ease of  children,  but  of  a  particular  class  of  children.  It  oocon  far 
most  ffpqaently  in  those  of  a  delicate  organization,  long-eye^laakas, 
and  precociouN^ntellect,  generally  designated  as  struP*ou»  or  MonfkumM* 
Hence  the  connnqn  designation  of  scmfulow  ophthalmia^  applied  ee 
pecially  to  this  disease.  Some  anthers  descrihe  it  as  herpes  cornea 
and  herpes  conjunctivas,  as  the  vesicles  may  he  situated  on  the  oomea 
or  on  the  conjunctiva  scleroticae.  Others  have  taken  their  nomincla- 
turo  from  the  exanthemata,  which  it  frequently  accompanies  or  fol- 
lows. I  prefer  the  name  ahove  given,  premising  that  ophthalmia  is 
nsed  for  the  sake  of  brevity,  phyctenular  conjunctivilis  and  keralitis, 
according  to  the  seat  of  the  herpetic  deposits,  heing  the  strictly  anat- 
omical appellations.  It  is  not  only  a  disease  of  early  life,  bnt  em- 
phatically the  disease  of  t(ie  class  of  subjects  which  I  have  mentioned. 
The  ages  between  which  it  almost  exclusively  appears  for  thefint  time, 
are  1  and  15  years,  being  most  frequent  from  3  to  10  years  of  age.  I 
have  seldom  seen  it  in  adults  except  in  those  who  have  sofiered  from 
it  as  children. 

Phlyctenular  Ophthalmia  is  a  disease  so  peculiar  both  in  its  ob- 
jective and  subjective  symptoms,  that  it  needs  to  be  seen  bnt  a  very 
few  times  to  be  readily  recognized.  The  characteristic  objective  symp- 
tom is  the  small  circumscribed  inflammatory  deposit  in  the  form  of  a 
speck,  vesicle,  or  pimple,  which  is  seen  either  on  the  sclerotic  coa- 
junctiva  or  on  the  cornea.  The  most  common  scat  of  these  phlycten- 
ulse,  which  may  be  single  or  multiple,  is  the  narrow  zone  6f  conjunc- 
tiva immediately  surrounding  the  corned  and  the  cornea  itself.  Thej 
very  often  are  seated  upon  the  conjunction  of  the  sclerotic  and  cornea 
in  the  region  of  the  limbus  conjunctivae.  They  vary  in  size  from  the 
smallest  noticeable  speck  to  that  of  large  pin's  head,  assuming  larger 
diminsions  usually  on  the  junctiva  scleroticss  than  when  they  ap- 
pear on  the  cornea.  On  the  limbus  conjunctivse  they  are  aometimet 
so  near  together  as  to  become  confluent,  taking  on,  in  that  case,  an 
elongated  form  and  usually  extending  parallel  with  the  margin  of  tbe 
cornea.  In  some  few  cases  I  have  observed  them  to  occupy  continn- 
ously  the  whole  limbus  conjectivse,  and  resembling  very  much  the  ap- 
pearance of  epircsleriiis  or  inflammation  of  the  subjunctival  cellular  tis* 
sue  and  sclerotic  immed\a.\.«\7  «.xittQuxA\XL^\hft  cornea. 


1864.]  Willi A^n^Pklffcienuiur  Ophthalmia.  461     ^ 

Tho  phlycteDula  is  nsnally  circular  in  shape,  slightly  elevated,  and** 
contains  a  semi-fluid  grayish  or  dirty  whitish  substance,  which  be- 
comes more  opaqne  and  even  purulent  as  the  disease  advances.     This 
vesicle  or  pimple  generally  niptures  or  ulcerates  and  gives  rise  to  a 
superficial,  ragged  abrasion  or  actual  ulceration,  the  bottom  of  which 
is  yellowish  or  whitish,  if  situated  on  the  sclerotic,  but  bluihh  white 
or  even  transparent,  if  on  the  cornea.     These  little  ulcers  are  usually 
superficial,  but  sometimes  they  go  on  destroying  layer  after  layer, 
until  they  reach  the  surface  of  the'  sclerotic,  or  perforate  the  cornea. 
Perforation  of  the  cornea,  however,  from  phlyctenular  ulcers  is  a  rare 
occurrence  except  from  great  neglect  of  the  patient  or  maltreatmenti 
In  some  cases  where  tho  ulcer  is  large  and  threatens  perforation,  hy- 
popinro  is  developed,  and  increases  till  the  tension  of  the  eye  is  re- 
lieved  by  spontaneous   perforation  or  a  paracentes  corneae.     Phly-. 
ctenulie  however  do  not  always  terminate  in  ulceration,  but  are  ac- 
caaionuUy  absorbed  as  the  infiamroation  subsides  without  even  the 
destruction  of  the  epithelium. 

Unnatural  vacularily  is  another  objective  symptom.     The  congest- 
ed blood  vessels  of  the  coujective  usually  assume  a  peculiar  triangnlar 
form,  the  base  of  tho  triangle  corresponding  to  tho  cul  de  sac  and  the 
apex  to  the  phlyctenular  to  which  the  vessels  converge.    If  the  vesicle 
is  seated  in  the  coinen  tho  vessels  converge  to  the  corresponding  point 
of  its  margin,  and  if  the  inflammation  lasts  long  or  is  severe,  a  fas- 
ciculus of  bh)od  vessels  is  seen  to  advance  from  the  apex  of  the  tri- 
angle at  tho  margin  of  tho  cornea,  to  the  seat  of  the  speck.     Fre- 
quently, lymph  is  exuded  along  the  course  of  this   fasciculus  causing 
a  streak  of  opacity  of  a  ribband  i>hape  that  moy  remain  long  after  the 
diaeaNO  Kuhbides.     If  there  are  but  one  or  two  phlycteuulie  these  tri- 
angular patches  of  injected  conjunctiva  contrast  strongly  with  the  sur- 
soanding  healthy  portions — but  if  many  exist  at  the  same  time,  the 
whole  ball  becomes  red,  as  in  general  conjunctivis.     Should  the  ves- 
icles on  the  cornea  be  numerous  and  the  inflammation  intense  the  dif- 
ferent fascicul  of  blood  vessels  may  run  together  and  give  rise  to  pan- 
nus  or  the  appearance  of  keratis  vasculosa. 

With  the  striking  objective  phenomena  above  described,  mhfectivt 
gywiplomM,  quite  as  peculiar,  are  associated,  particularly  where  the 
cornea  is  the  seat  of  the  deposit.  The  first  of  these  in  order,  and  the 
moat  distressing,  is  the  extreme  intolerance  of  light.  Children  will 
cover  their  eyes  with  a  handkerchief,  cloih,  or  any  thing  that  will 
exclude  light ;  press  their  hands  constantly  upon  them  ;  bury  their 
face  in  •  pillow  ;  or  lie  for  hours  and  days  and  weeka  \u  \\i«  ^%t\»iX 


462  Oriffmal  OmmmmietAmi.  [AvgoA 

^corner  they  can  find,  seeking  thns  to  exclude  eveiy  poteiblo  my  of 
light  from  the  retina.  The  photophobia  is  generally,  bat  not  always, 
in  proportion  to  the  number  of  the  phlyctennl«  and  the  intensity  of 
the  inflammation  which  prodnoes  and  aeoompanies  them.     One  of  the 

# 

pecnliarities  of  this  disease,  howerer,  is  that  the  aensitiTeiieBS  to  I%fct 
is  ont  of  proportion  to  the  local  symptoms,  so  that  in  a  child  Aat  hss 
not  opened  its  eyes  for  weeks,  yon  will  often  find  by  forciblo  ezamiaa* 
tion,  bat  one  or  two  small  specks  or  nloers  of  the  cornea,  the  net  of 
that  organ  being  perfectly  transparent  As  a  necessary  oonaeqnenes 
of  this  intense  photophobia,  we  have  always  profaselachiymation  and 
spasmodic  action  of  the  orbicnlar  mnacle.  It  is  imposaible  to  inspect 
the  eyes  of  snch  patients  without  using  chloroform,  plunging  their 
faces  in  ice  water  or  holding  the  head  between  the  knees  and  forcibly 
opening  the  lids  with  the  fingers  or  the  elevators.  It  is  astonishiag 
with  what  force  and  persistence,  such  a  6h>ld  can  squeexe  the  lids  to* 
gether  to  prevent  exposure  to  the  light.  The  difficulty  in  examiaiic 
the  cornea  in  a  fair  light,  and  the  frequently  very  small  and  aaperfidsl 
npecks  or  ulcerations  of  its  surface,  even  where  the  sensitiTeness  to 
light  is  most  extreme,  have  caufied  some  to  overlook  them,  and  eon* 
elude  that  the  cornea  is  intact.  Whenever  a  child  is  brought  to  ne 
with  marked  photophobia  and  the  other  symptoms  which  neoessarOj 
go  with  it,  I  am  sufe,  even  before  inspecting  the  eyes,  that  it  his 
phlyctenular  keratitis.  Still  one  should  never  neglect  the  direct  and 
thorough  examination  of  that  structuFe  to  ascertain  the  number,  size» 
and  extent  of  the  specks  or  ulcers,  so  as  to  give  a  more  correct  prog- 
nosis. The  symptoms  of  this  affection  are  so  severe  that  the  parents 
usually  feel  great  apprehension  as  to  the  recovery.  Nothing  but  tlie 
assurance  based  on  a  thorough  examination  of  the  eyes,  will  enable 
one  to  pacify  them.  Besides  this  if  you  do  not  detect  the  phlycten- 
ulas  and  tell  the  friends  that  specks  will  be  seen  on  the  eyes  after  the 
child  is  able  to  open  them,  they  will  often  blame  you  for  having  pro- 
duced them  by  your  treatment  Hence  I  always  insist  upon  a  satis- 
factory examination  of  the  eyes,  however  cruel  the  means  adopted  maj 
appear.  Hold  the  head  between  the  knees  with  the  face  up  to  a  good 
light,  and  open  the  lids  by  force,  but  without  everting  them.  If  the 
cornea  turns  up  so  as  to  be  out  of  sight  even  then,  hold  the  lids  opes 
for  a  few  seconds  or  moments,  and  it  will  roll  down  into  view. 

In  addition  to  the  characteristic  symptoms  above  mentioned,  I 
may  add  that  the  intolerance  of  light  and  spasmodic  action  of  the  lids, 
is  generally  worse  in  the  morning,  moderating  toward  evening  so  thst 
the  little  sufferera  wVU  lYion  o^\i  \]M\t  e^ea  and  become  more  playfil* 


1864.]  V^ iLU AUB—Pki^€t€mUar  OpkAalnUa.  488 

Excoriations  of  tbe  skin  of  the  eye  lids,  raw  places  at  the  ezternsl 
canthns,  pimples  and  crasts  along  the  edges  of  the  lids,  incrustations 
in  and  around  the  nose,  with  ernptiona  an  the  cheek,  face,  and  behind 
the  ears,  as  well  as  sometimes  on  the  scalp,  complete  the  beantifal 
picture  of  this  disease.  Add  to  this  that  repeated  crops  of  phlycten* 
nlsB  at  intervals  of  one  two  or  three  weeks,  with  corresponding  ag- 
gravation of  the  subjective  symptoms  are  likely  to  occnr  and  protract 
the  sufferings  for  months  if  not  years,  and  you  have  the  perspective  or 
rather  prospective  of  the  picture.  In  aggravated  and  protracted  cases, 
the  patienttt  are  usually  fretful,  irritable  and  ungovernable,  often  ag* 
gravating  and  protracting  the  cure  by  crying  by  the  hour  on  the  least 
provocation. 

The  duration  of  the  disease  varies  from  a  few  days  to  as  many 
months  or  even  years,  if  the  patient  is  of  an  unhealthy  condition,  and 
especially  if  it  cannot  be  placed  under  proper  moral  and  hygienic  con- 
trol. As  a  general  rule  however  phlyctenular  ophthalmia  terminates 
in  resolution  in  the  course  of  three  or  four  weeks,  leaving  specks  of 
opacity  upon  the  cornea  which  will  eventually  be  absorbed.  If  per- 
foration of  cornea  with  synechia  anterior  has  occarred,  or  if  the  al- 
bugo is  very  large  or  thick,  it  will  be  indellible,  and  becomes  gener- 
ally the  exciting  cause  of  ikabumui  and  amblyopia  from  dima  of  the 
•ye. 

In  speaking  of  the  treatment  of  phlyctenular  ophthalmia,  I  shall 
not  attempt  to  go  over  the  lengthy  category  of  remedies  that  have 
been  reccommended  from  time  to  time,  but  confine  myself  to  what 
my  own  experience  has  led  me  to  adopt  in  these  cases.  Cleanliness, 
promoted  by  frequently  bathiog  with  tepid  water  and  putting  on 
fmh  linen,  regular  exercise,  nolens  volens,  evenings  and  mornings 
when  the  weather  will  permit,  flannel  and  other  warm  clothing  in 
winter,  free  ventillation  of  apartments,  plain  nourishing  diet  compos- 
ed of  a  nroper  combination  of  animal  and  vegetable  food  taken  at  reg- 
ular inllrvals,  and  no  stuffing  with  cake,  candy,  or  anything  else  be  •* 
tween  meals  and  abioiui$  negation  of  crying  and  fretting,  constitnfta 
the  most  important  hygienic  treatment.  By  all  means  the  patient 
shonld  not  be  allowed  to  bury  its  face  in  the  pillow,  the  mother's 
bosom,  in  its  hands  or  anything  else  that  confines  the  heat  and  per- 
speration  of  the  face  and  ejtM.  It  should  be  made  to  sleep  on  a  hard 
mattress  with  a  hair  pillow,  and  forced  to  lie  on  tho  side  rather  than 
the  face.  Early  rising  should  be  enforced  at  all  hasards,  instead  of 
ktliog  the  little  nnfortnnalea  folk>w  their  own  inclinationi  in  lybg 
till  9or  10  o'dock  in  a  dark  room  with  tbe  bm  bnm^ Vn. tibit^^aaadA 


464  Orip^  d.,,m>«,ica^,m.         '     '  [A.g..t. 

and  pillow  and  soaking  with  penpiration.  Force  thtoi  ont  into  tbe 
light  and  fifesh  air,  but  a  soitable  shade  over  the  eyes  and  command 
**  hands  off,"  even  if  they  mnst  be  tied  behind  the  baek.  If  tock 
children  are  shut  up  in  a  dark  room  and  left  to  barrow  all  daj  in  the 
darkest  comer,  they  are  sure  to  become  worse  and  worse. 

As  to  constitntioDal  medication  I  consider  it  eztremly  important, 
not  80  much  in  effecting  the  immediate  relief  of  the  infltmation,  as  in 
maintaining  the  cure  accomplished  by  topical  treatment.  I  asnallr 
commence  with  one  or  ^wo  mild  purgatives  at  intervals  of  a  day  or 
two  and  follow  this  immediately  with  the  free  administration  of  qain- 
ine  and  iron.  Quinine  is  almost  a  pecific  for  the  extreme  photopho- 
bia which  constitutes  the  most  troublesonie  feature  in  the  treatmeiit. 
To  a  child  two  or  three  years  old  I  give  generally  2  grains  three  times 
a  day  ;  to  one  younger,  from  1  to  2  grains  ;  and  if  older,  larger  doses 
in  proportion.  If  diarrhoea  is  present  it  is  well  to  combine  a  few 
grains  of  dover  powder,  or  a  quarter  or  eighth  of  a  grain  of  opiom 
with  each  dose  of  qninine  for  a  short  time.  As  the  intoleianee  of 
light  abates  and  the  other  symptoms  improve  I  either  leave  off  the 
quinine  for  some  preparation  of  iron,  or  combine  the  two  substances. 
As  a  rule  I  use  the  quinine  freely  for  two  or  three  weeks,  and  then 
prescribe  tbe  syrup  of  iodide  of  iron,  or  some  other  preparation  of  that 
metal,  in  moderate  doses,  to  be  kept  up  for  several  months  till  the 
patient  is  entirely  well  and  the  general  health  satisfactory.  With  tbe 
jadiciouH,  and  for  the  quinine,  heroic  and  persevering  use  of  these 
articles  I  seldom  fail  to  effect  very  gratifying  results,  and  therefore 
do  not  resort  to  any  other  internal  treatment. 

The  only  topical  application  that  will  be  tolerated  in  the  acute  and 
early  stages,  is  the  sulphate  of  atropia.  For  tbe  acute  inflammation 
with  specks  or  ulcers  upon  the  cornea  attended  by  groat  photobit, 
lachrymation  and  spasm  of  the  eyelids,  there  is  nothing  to  compare 
to  it.  It  is  astonishing  often  to  see  the  rapid  improvement  of  a^  these 
distressing  symptoms  under  the  instillation  of  snlph  of  atropnia  into 
the  eyes.  I  employ  a  solution  of  from  ^  to  2  grains  of  the  salt  to  an 
ounce  of  water,  according  to  the  age  of  the  subject,  and  have  it  drop- 
ped into  the  eyes  thoroughly  three  or  four  times  a  day.  The  more  in- 
tense the  photobia  the  stronger  the  solution  should  be  and  the  oftener 
applied.  I  seldom  prescribe  it  however  stronger  than  2  grains  to  tbe 
ounce  for  children  under  ten  years  of  age,  and  as  the  acute  symptoms 
yield  I  diminish  the  strength  or  the  frequency  of  application,  so  ss 
not  to  produce  any  serious  constitutional  effects.  ^  For  children  under 
two  years  oi  tge,l  me  otdVnMUY  a  solntion  of  from  a  ^  to  1  grain  to 


1864.]  VriLUAUB^PkfyeUmdar  i^MmlnUa.  486 

the  ounce.    This  should  be  kept  up  as  long  m  Uiere  is  any  decided  red- 
ness of  the  sderotio  and  intolerance  of  light.    There  is  more  danger 
of  abandoning  its  use  too  soon,  than  of  eontinning  it  loo  long.     Not- 
withstanding the  large  dilatation  of  the  pupils  and  the  consequent 
greater  admission  of  light,  the  soothing  and  antiphlogistic  effects  of 
this  substance  will  show  itself  as  the  child  opens  his  eyes  better  to  the»> 
light,  the  redness  disappearsi  and  it  becomes  eheerful  and  happy. 
When  the  redness  of  the  sderotio  conjunctivss  and  the  dread  of  light 
has  nearly  disappeared,  so  that  the  child  opens  its  eyes  and  plays 
about  more  cheerfully,  I  commence  the  local  application  once  a  day 
of  the  brawn  ciVrint  eiiil^iitfii/,  which  I  write  generally  w^u^tU.  citrm 
wmb.  to  distinguish  it  from  the  ordinary  citrine  salve.    For  the  history 
and  method  of  preparation,  I  refer  the  reader  to  a  paragraph  found  on 
page  97  of  the  February  number  of  this  journal.    As  stated  there  I 
have  for  years  used  this  substance,  and  find  it  far  preferable  to  all 
other  mercurial  preparations  in  the  treatment  of  blepharitis  maiginalis 
and  phlyctenular  ophthalmia.    It  also  acts  like  magic  in  relieving 
the  scabby  eruptions  about  the  nose,  &oe,  ears,  and  head  of  the  same 
class  of  subjects.  •  Nothing  contributes  more  surely  to  permanent  re- 
covery from  phlyctenular  ophthalmia  than  the  cure  of  the  sors  nose 
mud  (ace  which  so  often  complicates,  aggravates,  and  perpetuates  it ; 
mnd  nothing  relieves  that  so  quickly  and  certainly  as  the  brown  salve. 
I  insist  upon  the  thorough  removal  of  the  scabs  from  about  and  with- 
in the  no8e  by  softening  them  with  tepid  water  and  rubbing  them  off, 
and  of  the  crusts  from  the  roots  of  the  eye  lashes,  or  from  the  head 
«nd  then  have  the  salve  rubbed  freely  on  the  parts  twice  a  day/  but 
most  liberally  at  night.     In  phlyctenular  ophthalmia  I  direct  a  large 
drop  or  mass  of  the  size  of  a  grain  of  wheat  to  be  put  from  the  end  of 
m  probe  or  knitting  needle,  between  the  lower  lid  and  eye  ball  every 
night.     It  dissolves  almost  instantly  by  the  natuml  warmth  of  tlHft 
parts,  and  by  pulling  the  lids  open  a  time  or  two,  is  spread  thoroqgh- 
Ij  over  the  cornea.     The  prompt  improvement  under  its  use  is  almost 
always  highly  appreciated  by  the  parents  or  friends  of  the  little  pa- 
tients, and  they  ace  sure  to  ask  for  more  of  the  brown  salve  when  it 
in  out.    When  the  phlyctennlae  are  seated  on  the  conjunctiva  sclerati- 
cae,  with  but  little  intolerance  of  light*  the  salve  may  be  applied  to 
the  eye  in  the  earliest  stages  with  decided  advantage.     I  once  thought 
calomel  dusted  into  the  eye  in  such  cases,  acted  delightfully,  as  it 
really  does,  but  the  brown  ointment  is  decidedly  better.    It  produces 
bat  little  irritation,  adheres  for  sometime  to  the  eye  and  lida^  %tA\QL 
all  respects  is  the  best  of  the  mercurial  prepafalloni  tot  \!ha  VwiX 


466  Oriffinal  Cammumeaiums.  [Augatt, 

treatment  of  the  cases  I  have  described.  I  hare  prescribed  it  widi 
good  effect'  ia  other  eruptions  on  the  snrface  of  the  body,  and  partic- 
ularly those  which  occur  on  the  arms  sometimes,  after  or  daring  vac- 
cinnation  and  prove  so  difficult  to  heal.  I  do  not  wish  to  exaggerate 
the  importance  of  this  substance,  but  feel  it  my  duty  to  reccommend 
it  to  the  profession  as  a  very  valuable  preparation,  that  all  druggists 
should  learn  to  prepare  properly  and  keep  it  on  hand.  Its  nse  in 
hlyctenular  ophthalmia  should  be  continued  for  two  or  tliree  months 
after  all  the  inflammatory  symptoms  have  passed  away,  so  as  to  stim- 
ulate the  absorbtion  of  the  remaining  opacities  of  the  cornea,  and  pre- 
vent a  relapse  of  the  disease.  Toward  the  last,  oof  or  two  applica- 
tions a  week  will  suffice.  As  I  said  before  the  alropia  may  be  left 
off  as  soon  as  the  eye  tolerates  the  salve  well,  but  should  be  resumed 
in  case  of  relapse. 

To  sum  up  the  treatment  which  I  usually  adopt  for  phlyctenuhir 
ophthalmia,  I  will  say  atropia  and  quinine  during  the  acute  stage 
with  photophobia;  and  brown  citrine  ointment  and  iron  to  follow  up 
and  perpetuate  the  cure.  At  some  future  time  I  hope  to  be  able  to 
contribute  another  article  on  some  points  connected  with  tbis  disease, 
that  I  cannot  now  elaborate. 


*  > 


ARTICLE  III. 


Two  Cases  of  Femoral  Hernia  in  Pregnant  Women-^Miscarriage  in  Both 

Cases  Ten  Days  After  the  Operation. 

BT  WM.  B.  FLETCHER,  M.D.,  IMDIANAPOUB,  INO. 

Case  I. — April  2nd,  1863. — I  was  sent  for  by  Dr.  J.  Brown,  of 
Bethel,  to  onerate  in  a  case  of  strangulated  hernia.  After  a  ride  of 
twelve  miles  through  mud  and  darkness,  we  arrived  at  the  house  of 
the  patient,  at  one  o'clock  a.m. 

Mrs.  M.,  who  is  the  sufferer,  is  about  38  years  old  ;  muscular,  and 
plethoric.  She  has  "  had  rupture  for  two  years  ;  it  was  caught  once 
before  and  has  now  been  down  five  days  "  (since  Sunday,  29th  of 
March.)  "  I  have  been  vomiting,  but  not  mqch,  and  great  pain  in  my 
lower  bowels."     Such  was  the  short  but  sad  history,  hastily  given 

by  the  patient. 

Dr.  Brown  informed  me  that  every  means  for  reduction  had  been 

fully  trietl.'   Herniotomy  was  therefore  the  only  resort.     The  patient 

was  placed  upon  a  table,  under  the  influence  of  chloroform  and  the 

taxis  once  more  aiiemple4,Aio^\T3i^  V!si^  t^wAsi^  effect  of  the  chloro- 


1864.]  FL^TOBm^Fimorat  B$ri§ia.  467 

form  might  assist  in  replftcing  the  strangulated  got,  bat  this  proved  a 
waste  of  time.  Upon  oncovering  the  patient  there  appeared  a  large 
oblong  tumor,  situated  under  ponparts,  ligament ;  it  was  dark  and 
puffy,  showing  marks  of  great  pressure  and  violence  used  in  trying  to 
reduce  it.  By  the  light  of  two  or  threq  tallow  candles  the  operation 
was  performed  by  making  an  incision  along  pouparts  ligament  and 
then  a  cut  from  near  the  inner  third  of  this  line  outward.  Carefully 
dissecting  up  the  tissues  we  came  down  upon  the  sack  ;  it  was  irregu* 
lar,  kidney-shaped,  extending  from  the  ring  outward  and  upward, 
adherent  throughout.  When  opened  a  quantity  of  redish  colored  fluid 
escaped  which  contained  some  yellow  flocoulent  masses.  The  intes- 
tine was  now  exposed  aad  appeared  of  a  dark  purple  color,  with  some 
fibrous  exudation,  a  few  perfectly  black  specks,  about  as  large  as  bird- 
shot  were  observed,  which  were  bounded  by  a  yellow  margin.  Pass- 
ing the  little  finger  down  to  the  stricture  it  conld  be  felt  hard  and 
corded,  as  if  the  finger  was  pressing  upon  a  small  button  hole.  Pass- 
ing a  probe  pointed  bistoury  flat  along  the  intestine  through  the  ring, 
and  then  turning  the  edge  upward,  it  gave  way  with  a  snapping 
sound  and  the  strangulated  portion  returned  with  a  gurgling  sound. 

A  T  bandage  and  water  dressings  were  applied  and  some  mor- 
phene  given. 

Dr.  Brown,  who  gave  the  subsequent  attention,  writes  that  Mrs.  H. 
had  a  comfortable  sleep  and  took  some  nourishment  the  day  following 
the  operation.  On  the  ^eond  day  the  inflammation  of  the  bowels 
which  had  been  slight,  became  violent ;  but  after  a  dose  of  oil  and 
turpentine,  both  internally  and  externally,  this  condition  subsided  and 
the  evacuation  became  natural,  and  a  week  after  she  was  able  to  sit 
up,  and  continued  doing  well  till  the  tenth  day,  when  she  miscarried 
in  the  fourth  month,  and  this  destroying  fire  of  inflammation  which 
had  almosi  subsided  was  re-kindled  and  Mrs.  M.  died  of  peritonitis  on 
the  14th  day  after  herniotomy. 

Casb  II. — March  80th. — Was  called  to  consult  with  the  same 
physician  in  a  case  similar  and  quite  near  the  place  of  the  first  op- 
eration. 

Mrs.  K.,  the  patient,  was  a  strong  (German  woman,  40  years  of  age, 
and  was  at  this  time  pregnant  four  months.  She  gave  the  following 
history  of  her  case  :  A  year  ago  when  in  a  tedious  labor  with  her 
eighth  child  she  felt  a  sharp  pain  in  the  left  groin  and  found  a  small 
tumor,  which  her  doctor  said  was  abrupture  and  advised  her  to  wear  a 
truss.  About  six  mouths  after  its  03onrrenoe  it  bscame  ver^  ^v^^x^. 
and  '*  broke,"  discharging  large  quantlliea  oi  msAtasc  vn&.  iIXmkvl  ^^ 


4<t8  Qf^Ml  Cmnmimicaikim,  [Atgns!, 

well,  giving  her  no  titrable  till  ksl  Monidaj  morfdng  wheii  ibo  gofe  op 
to  make  a  fire,  and  while  stooping  down  Mi  someihiiiK  give  way  with 
a  sharp  pain ;  leinrning  to  her  bed  she  endeavored  to  redoee  the  ta- 
mer bat  withoat  saooees.  Yarione  remedies  were  tried  for  two  days. 
Emetics,  handfols  ctf  cathartio  piils,  pbnltioee,  etc.*  but  each  failed  to 
give  relief.  On  the  third  day  of  strangalation  m  physician  was  called 
and  gave  An  opiate.  On  th^  fourth  day  she  was  modi  prostrated*  by 
constant  vomiting ;  the  bowels  became  intensely  painfnl  and  swoUra. 
On  the  fifth  day  Dr.  Brown  was  called,  who  at  once  recognised  the 
necessities  of  the  case,  and  npen  a  short  ciMisultation  we  determin- 
ed to  operate.  Dr.  B.  pnt  the  patient  folly  ander  the  inflaenoeof 
chlorofohn,  and  the  exposed  tamor ;  it  was  Jttnated  ou  the  left  side 
and  was  not  laiger  than  a  qniil'a  ^gg.  An  inelsion  *was  made  over 
the  tamor,  as  onewoald  cat  throttgh  a  boil,  directly  down  to  the  sack, 
which  by  another  incision  was  opened  and  a  small  quantity  oi  flnid 
escaped.  The  strangnlated  portion  of  the  intestine  was  dark  and  pre- 
sented some  black  and  yellow  specks.  After  drawing  it  oat  by  slight 
pressure  with  the  bistoory,  the  ring  gave  way  and  the  heraia  was  re- 
tamed. 

Mrs.  K.  was  left  under  the  care  of  Dr.  B.  who  gave  her  opiates 
through  the  following  day.  Twenty-four  honrs  after  the  operation 
we  saw  the  patient  and  found  her  still  vomiting  stercoraceous  matter ; 
the  bezels  more  swollen  and  tender  than  before,  and  apparently  worse 
than  if  the  strangulation  still  existed.  The  incision  through  the  skin 
had  united.  The  pulse  140,  countenance  anxious.  By  slight  press- 
ure with  the  finger  upon  the  edges  of  the  wound  it  opened  and  some 
bloody  serum  escaped  along  with  a  'quantity  of  pus  ;  passing  the  little 
finger  into  the  opening  it  entered  through  the  crural  ring  into  the 
oavity  of  the  pelvis,  and  the  intestine  could  be  felt  puffy  and  rough 
from  exudation,  and  the  whole  mass  seemed  almost  burning.  A 
catheter  was  passed  into  the  abdomen  through  the  wound,  and  near 
three  pints  of  bloody  serum  drawn  off.  This  fluid  had  a  most  intense 
heat,  after  it  was  drawn  off.  She  felt  some  relief,  but  vomiting  con- 
tinued. Oil  was  administered  and  rejected  ;  calomel  was  not  heavy 
enough  to  stay  down ;  injections  were  tried  of  every  description,  and 
we  left  the  patient  expecting  she  would  die,  but  reccommending  in- 
jections of  cool  water  every  hour,  throwing  in  as  much  as  possible. 
These  directions  were  carried  out,  although  many  articles  were  given 
internally  by  a  German  midwife  who  succeeded  us  in  this  treatment 
of  a  case  which  we  had  hastily  pronounced  incurable.  On  the 
morniog  ot  the  third  day  l&xa.'S..  >a.^  ^  ^^^ui^e  from  the  bowels 


V 


1864.]  ProeudlngM  of  SoeUHei.  469 

which  gave  her  much  relief,  and  to  the  tenth  day  did  well ;  then  she 
began  having  pain  in  the  back  and  miscarried. 

From  the  new  trouble  she  recovered  rapidly,  and  now  (July  20th) 
does  a  man's  work  in  the  harvest  field.  The  hernia  is  radically  cured, 
and  the  midwife  gets  the  credit  of  curing  the  patient. 

Remarks. — Upon  the  subject  of  hernia,  enough  is  said  in  our  col- 
leges and  written  in  our  books,  unless  it' be  on  one  point,  i.  e.  the 
necessity  of  operating  prom^iU^,  After  trying  to  reduce  under  chlo- 
roform, and  trying  cold,  (all  of  which  might  be  thoroughly  tried  in  a 
few  hours'  time)  why  not  proceed  with  the  knife  and  save  the  patient  ? 

Several  cases  have  come  to  my  knowledge  within  the  past  two  years, 
in  which  patients  had  their  lives  worried  out  of  them  by  the  oft  re- 
peated attempts  at  taxis.  Others  died  because  the  hernial  tumor  was 
mistaken  for  a  carbuncle,  and  judiciously  poulticed  with  the  assurance 
that  when  it  broke  of  course  it  would  get  well. 

Hernia  is  the  bug-bear  of  medical  students,  and  the  acare-crow  of 
the  green  room,  and  perhaps  that  in  some  way  accounts  for  the  great 
timidity  of  taking  hold  promptly  in  such  cases. 


y 

Proossdingt  of  the  Cincinnati  Academy  of  Medlolne. 


RcporUd  hj  C.  P.  Wiuo  >,  M.  D.,  ••ertUrj. 


j  Hall  of  Academy  of  HsDicnn, 
( Monday  Evening,  Apr.  11,  1864. 

In  the  absence  of  the  President,  Vice  President  Carroll  took  the 
chair;  there  being  no  regular  paper,  reports  of  cases  was  in  order. 

Sandy  deposit  in  fecal  diickatgei — Dr,  Carroll  exhibited  to  the 
Academy  some  sand  which  came  from  the  bowels  of  a  lady,  who 
thought  bhe  had  passed  at  least  *a  quart  in  three  weeks.  Hydatids 
were  also  passed  at  the  same  time.  Some  of  the  sand  appeared  as 
if  minute  shells  with  thin  sharp  broken  edges,  they  appearing  to  have 
been  broken  in  the  passage.  In  one  stool  which  Br.  Carroll  himself 
saw  there  was  an  ounce  of  sand.  The  patient  was  large  and  fleshy, 
and  had  been  nnwell  for  some  time.  Her  liver  did  not  appear  to  be 
much  affected,  and  this  material  could  not  have  coma  Ctc^i^  >}dl^  ^jb^ 
bladder,  for  the  lai^gpsr  particles  of  it  were  noV  i>xig^\mx»\^^i^>i^3^Kt^  ^^- 


470  Proaedings  qfSoeietiei.  [  Aogost, 

ed  as  already  said.    In  three  weeks  the  quantity  diminished  much, 
and  has  now  altogether  disappeared,  hut  still  the  woman  complains. 

In  answer  to  Dr.  Taylor  as  to  the  consistence  of  the  stools,^  and  if 
the  sand  was  intermingled,  Dr.  GarroU  states  that  the  stools  are  thin» 
and  that  the  material  was  intimately  mixed  with  them,  that  the  nrine 
was  normal,  and  that  he  had  no  donht  the  sand  came  from  the  bow- 
els, and  he  thought  from  use  of  the  water.  No  analvsis  had  yet  been 
made  of  the  sand,  but  he  intended  to  h|ve  one  made  soon. 

jRheumaiUm. — Dr.  Murphy  said  he  wished  to  report  two  cases  of 
rheumatism,  in  one  of  which  there  was  both  endo  and  pericarditis. 
The  first  case  occurred  last  Friday.  The  patient  was  a  large  Irish 
woman  aged  thirty  seven  ;  her  occupation,  bar  keeper  and  shop  tend- 
er, found  her  in  bed  groaning  and  complaining  with  general  rnenma- 
tism  of  the  whole  body  ;  every  joint  afiected  and  stiff,  pulse  120  ;  face 
flushed  and  skiu  dry  and  hot ;  ordered  a  teaspoon  full  of  rochelle  salts 
everty  two  hours  until  she  was  well  purged,  tp  be  followed  in  two 
hours  after^purgation  with  a  mixed  alkaline,  treatment  of  bicarb,  of 
potash  3li;  nitrate  and  acetatate.of  potash  each  3i,  with  liquor  ammo- 
nia acetas  3vi ;  give  a  table  spoon  full  every  throe  hours,  ^  a  gi'ain  of 
morphine  at  bed  time,  and  the  affected  parts  wrapped  in  cotton. 
Her  urine  was  scanty,  lithic  acid  plentiful,  and  brick  dust  sediment. 
She  slept  all  friday  night.  On  Saturday  morning  had  less  pain,  the 
urine  also  being  more  copious  and  not  so  much  acid.  Sunday  much 
better,  and  this  morning  her  pulse  was  87,  urine  natural  and  copi- 
ous, and  she  is  now  convalescent. 

The  second  case  occurred  three  weeks  ago  in  a  woman  who  had 
been  confined  three  weeks  previously.  The  rheumatism  appeared  in 
every  joint  in  her  body,  even  in  the  temporo-maxillary  articulation. 
The  doctor  found  her  in  bed  a  perfect  cripple,  could  not  move  either 
hand  or  foot,  with  active  fever,  breathing  tumultuous,  and  a  pale  or 
rather  dirty  expression  to  her  face,  as  though  some  cardiac  trouble 
was  present,  but  no  rubbing  or  blowing  sound  could  be  heard.  The 
mixed  alkaline  treatment,  with  full  doses  of  opiates  was  commen- 
ced. She  began  to  improve  and  so  continued  until  last  friday  eve- 
ning he  found  her  sitting  up  in  bed  in  great  anguish  with  distressing 
symptoms  of  sinking.  On  auscultation  the  ruubing  and  bellows 
murmur  could  be  distinctly  heard,  her  pulse  was  128,  her  hands  and  . 
knees  fixed  and  could  not  be  movefl  without  a  great  deal  of  pain.  The 
Doctor  said  the  question  occurred  to  him  whether  he  ought  not  to  tie 
up  the  arm  and  bleed,  but  on  turning  down  the  lip  and  seeing  its 
pallid  and  blanched   condilVon,  \l^  ^oxkOixjA^  \.^V[^  twelve  leeches. 


1864  ]  ProeeedingM  </  8ocM$i.  471 

six  just  below  the  mamnui,  over  the  base  of  the  heart,  and  six  over 
the  apex,  in  addition  ordered  a  pill  containing  ^  grain  of  calomel 
and  tartar  emetic  each,  and  a  ^  gr.  of  opium  every  two  hours,  also 
continued  the  alkaline  mixture  with  three  drops  of  veratrum  viride  in 
each  dose  every  two  hours  altemtfting  the  pills.  Next  morning  the 
patient  was  easier,  better,  and  could  lie  down.  He  continued  the 
calomel  for  twenty-four  hours,  when  he  left  it  o£f  for  fear  of  saliva- 
tion, and  continued  the  alkalies.  The  friction  sound  and  bellows 
murmur  diminished,  she  went  od  comfortably  for  four  days,  when  her 
trouble  returned,  and  on  the  fifth  day  the  rubbing  and  bellows  sound 
were  again  perceptible.  He  then  pushed  the  veratum,  gave  calomel 
till  the  gums  were  soft  and  tender,  and  the  alkalies  until  bloody  stools 
were  produced — all  with  no  effect,  then  gave  opiates  in  full  doses  and 
beef  tea.  This  morning  gave  quinine  and  sub  carbonate  of  iron ; 
what  next  to  do  he  koew  not. 

Again,  three  weeks  ago  he  saw  a  patient  of  Dr.  J.  Judkin's  who 
was  rheumatic  fiomhead  to  foot,  and  had  the  bellows  murmur  clear 
and  distinct.  Dr  Judkins  had  ordered  if  the  man  b*d  any  cardiao 
trouble,  that  he  be  cupped.  Br.  Murphy  purged^im  freely,  put  him 
on  the  alkaline  treatment,  and  in  ten  days  the  man  was  well,  the  bel- 
lows murmur  entirely  disappearing.  Now  it  was  a  question  with 
him  whether  the  murmur  was  not  owing  to  anemia. 

Dr,  Jfusietf  said  he  would  like  to  know  what  was  a  proper  dose  of 
veratrum  viride,  saying  he  asked  for  information,  for  after  the  bat- 
tle of  Pittsburg  Landing  he  was  asked  to  see  a  Greneral  who  had 
been  badly  wounded  ;  the  man's  wife  had  been  ordered  to  give  vera- 
trum, 7  drops  every  two  hours.  After  giving  six  doses  she  discon- 
tinued it  and  gave  him  brandy.  On  asking  his  approval.  Dr.  M.  h^ 
told  her  she  acted  right,  and  advised  her. to  continue  the  brandy. 
The  man  died  in  a  few  days  from  traumatic  fever  following  the 
wound. 

Dr.  Murphy  said  no  regular  dose  of  veratrum  could  be  laid  down, 
if  he  found  a  patient  sweating,  pale,  prostrated  and  nauseated,  he 
would  at  once  discontinue  the  remedy. 

Dr.  MasMty  related  in  this  connection,  that  he  was  called  to  Mt. 
Auburn  several  years  ago  to  see  a  woman  that  was  said  to  be  dying. 
He  found  her  much  prostrated,  pulse  weak  and  feeble,  and  a  Homm^ 
path  giving  hor  brandy,  and  applying  hot  cloths  wrung  out  of  boil- 
ing water  to  hor  feet  and  legs,  which  were  parboiled  from  the  hot 
applications.  Dr.  Mussey  at  once  administered  carb.  ammonia,  with 
injections  of  the  same,  and  ordered  the  feet  to  \>«  iit%^^«^  vol^vc^sl 


479  PMaU^iga  <^  SoAlUt.  iJ^Vft^ 

dry  cloths.  Tho  Homeopalii  snid  he  had  given  her  a  ^  gr.  of  Tcn- 
tri*  by  a  guess,  and  admiit«d  her  piostration  w&&  the  eFFect  of  ihU 
dose.  Ha  hud  loft  her  ten  similar  powders  and  ibis  wae  tbe  effect 
oftho  first.  The  patient  rct^overecli  but  it  was  sometime  before  she 
was  able  to  walk,  on  account  of  the  tenible  blistering  of  her  feet. 

J)r.  iSWenisaid  no  rule  as  to  quantity  can  be  given  with  uafetj  ks 
to  the  (lose  of  veratnim  viride,  bis  enperience  was  that  each  individa- 
nl  cnso  where  tbia  remedy  is  administered  must  be  watched  with  care. 
Said  that  some  years  ago  he  hnd  umier  bis  care  a  case  of  general 
dropsy  dflpendentnpon  some  eavdiao  trouble,  and  acting  en  the  adrice 
of  consultation,  four  drops  of  Norwood's  tincture  was  ordered,  to  b« 
repeated  at  certain  intervals,  but  thfl  first  dose  produced  such  alarm- 
ing symptoms  of  proalratiOD,  pulselessnesa.  and  collapse  that  erery 
effort  was  necessary  in  the  administration  of  brandy,  carb,  ammonia 
and  bpnt  to  undo  tbe  mischief  of  this  single  moderate  dose.  Subse- 
qucntlya  single  drop  of  the  tincture  repented  tbe  same  distressing 
Eymptoms  to  a  marked  degree.  So  that  as  be  bad  already  said,  the 
action  of  this  agent  is  not  uniform,  and  it  ia  so  liable  to  pvocuce  un- 
expected violent  results  that  nntil  the  effect  is  lealod  npon  each  partic- 
ular case,  the  physician  must  watch  its  action  with  circumspectness, 
aai  determine  the  doM  accordingly. 

Jir.  B.  S.  LawtoH  said  it  was  impossible  to  prescribe  veratraiu«itbet 
in  reference  to  its  quantity  or  qnalitj ;  he  generally  gave  8 — 8  drops 
ereiy  three  honrs,  antil  tbe  effect  was  obtained,  either  watching  for 
himeelf  or  leaving  gome  one  tnutworthy  to  watcli  over  the  patient, 
bringing  down  the  pulse  to  a  certain  point  and  tben  stopping.  He 
thonght  the  prostration  of  veratram  was  easily  overcome  by  stimD- 
'  ladts,  and  its  sedative  effects  more  easily  oonqnered  than  thoM  of 
tartar  emetic.  He  generally  combined  opium  in  its  administration, 
and  considered  it  the  best  sedative  we  have,  and  bad  no  more  fear 
of  it  than  he  bad  of  tartar  emetic.  , 

Hali.  ot  the  Agadxht  or  I^dioinx,  April  18. 

President  Atmy  in  the  chair. 

SheumalUm — Dr.  Carroll  said  he  had  now  two  cases  of  rheuma- 
tism under  his  care  in  the  Commercial  Hospital ;  tbsy  were  old  cases 
wbich  had  been  treated  by  yonng  physic.  Tbe  1st  was  a  woman 
aged  35,  in  whom  the  bnrsn  about  tbe  joints  were  mnch  enlarged,  one 
of  which  bad  suppurated  and  was  dischargiDg  freely.  The  patient 
had  been  pnt  under  treatment  of  iodide  of  potassinm  by  tbe  house 
physician  and  was  now  slowly  recovering.  He  supposed  at  first  it 
WMS  K  CM6  of  ioflsmmKtory.T'hQamB.Xwm.  'vi^ilcb  had  besn  treated  by 


1864.]  Proceedinpi  of  SocUiki.  478 

gentleman  of  this  city  who  did  not  believe  in  the  nae  of  medicine,  and 
tkiuks  that  in  a  few  years  all  diseases  can  be  cured  without  it.  The 
case  had  run  on  week  after  week,  and  at  last  getting  no  better  was 
sent  into  the  hospital. 

The  second  case  was  a  similar  one.  Dr.  Carroll  thought  if  the  pa* 
tient  of  the  first  case  had  been  bled,  leeched,  purged  an  1  mercurial- 
ized, she  would  never  have  gone  to  the  hospital.  Dr.  Carroll  allu- 
ded to  the  cases  of  rheumatism  reported  at  our  last  meeting,  in  which 
he  thought  the  treatment  was  much  different  from  that  published  bj 
the  same  physician  a  year  ago.  Now  he  puts  on  twelve  leeches.  Dr. 
Stokes  would  have  put  on  thirty  or  forty,  and  in  several  hours  thirty 
more,  and  would  have  purged  freely,  and  he  thought  in  the  case  re« 
ported  if  instead  of  applying  a  dozen  leeches  the  Doctor  bad  put  ou 
forty,  he  would  have  (fured  her.  In  his  mind  there  was  no  question 
but  that  nearly  all  chronic  cases  were  brought  on  by  this  dilly-dally 
mode  of  treatment,  and  if  they  are  treated  at  first  with  decision  and 
vigor  there  would  be  no  chronic  cases.  Over  thirty  years  ago  he  tried 
the  sbw  treatment,  when  the  patients  laid  weeks  and  weeks  in  bed^ 
with  the  veins  much  enlarged,  even  the  effected  joints.  He  then  be- 
gan tb  bleed  freely  and  found  th9  patients  rapidly  recover. 

Twenty  years  ago  the  doctors  of  this  city  treated  rheumatism  with 
lemon  juice,  giving  it  in  enormous  quantities,  and  saying  they  per- 
formed cures  with  it.  A  few  years  after  the  believers  in  blood  poi- 
soning introduced  the  alkaline  treatment,  but  he  thought  it  had  lit- 
tle effect. 

You  must  deplete  generally  and  locally,  salivate  and  give  colchi- 
cum,  it  is  best  in  the  first  three  or  four  days  to  keep  the  patient  as 
near  death's  door  as  possible,  then  give  opiates,  in  one  .  week  the  pa- 
tient will  be  easy,  and  in  ten  days  well.  Dr.  C.  then  related  the 
following  case  in  support  of  his  views  : 

A  young  gentleman  came  to  this  city  a  short  time  ago  with  his 
ancles  much  swollen,  and  very  lame  in  both  his  knees  ;  he  had  been 
sick  a  week.  Dr.  C.  had  him  put  his  foot  in  hot  water,  opened  a 
vein  over  the  ancle,  and  bled  him  till  he  fainted  twice,  then  purged 
him  with  calomel  and  jalap,  and  gave  opiates  at  night.  On  the  4th 
day  the  man  was  walking  about,  and  on  the  5th  went  home  well. 
Dr.  C.  was  satisfied  gentlemen  would  be  deceived  if  they  expected  to 
core  rheumatism  by  alkalies,  which  would  protract  the  case  for  two  or 
three  weeks,  and  by  this  time  the  heart  w6uld  become  affected.  '  All 
this  he  thought  to  be  prevented  by  depletion,  and  this  belief  was  sus- 
tained by  Dr.  Hope  in  hih  work  on  the  heart. 


474  Prtmiinst  ofSotitlm.  {k^fo/L 

Dr.  Marphy  said  in  regAnl  to  the  cane  of  rheamtitisin  repoiled  by 
himself  st  the  laat  meeting  nnd  reFcrretl  to  this  evaniog  by  Dr.  Car- 
Oarroll,  fit  11  o'clock  to  day  when  he  saw  the  patient  she  nai)  eaf:y 
and  doing  well,  the  bellows  murmur  and  friL'tiun  sound  had  entirety 
diKappeared,  ber  pulse  100,  nppeiito  good,  slia  sleeps  well,  and  her 
BDiious  expression  n-as  nearly  gone  ;  since  the  last  meetiug  she  had 
take  viii  grs.  of  sub.  carb.  of  iron,  one  gr.  of  quinine,  and  a  ^  gr. 
of  opium  three  titnea  a  day  with  liberal  diet,  and  a  full  dose  of  opiate 
at  bsd  time  if  she  was  in  much  pain.  The  Doctor  proceeded  to  say 
that  those  persons  whom  we  look  un  its  quacks  do  succeed  in  curing 
these  ciLses  sometimes,  not  from  any  skill  of  their  own,  but  bccnuac 
'  the  diseases  got  well  of  themsielves.  He  thought  llie  present 
practice  of  medicine  depended  for  its  foundation  in  pathology  and 
physiology — in  the  cell  doctrine ;  that  our  diagnosis,  the  sulisfying 
ourselves  of  the  lesions  and  ihe  complications  of  cases  was  only  to 
be  approximated  by  largo  reading  and  eslendeil  observation  ;  that  the 
inAnnunntionof  rheumatism  was  not  one  particle  different  from  that 
of  pneumonia  when  you  come  down  to  the  ceil  doclrino.  Those  per- 
sons who  pursue  other  than  the  antiphlogistic  treatment  do  not  say 
that  some  cases  of  rheuraalism  are  not  benefitted  by  bleeding,-  they 
grant  that  often  bleeding  does  relieve,  in  many  other  CAsea,  bowenr, 
doing  no  good,  (he  diseaso  marching  right  on  to  get  well  of  itaelf. 
Dr.  Carroll,  he  said  would  have  every  patient  bled,  purged,  and  treat- 
ad  with  antimony,  without  regai'd  to  the  general  condition  of  the 
man,  whether  he  was  a  strong  robust  van,  a  fit  subject  for  depletion, 
or  B  weak  and  feeble  persoti  needing  atimulants.  Dr:  AI,  said  h«  did 
not  treat  infiammation,  cardrtia  or  any  similar  trouble  like  Dr. 
Hope  did,  for.bleediijg  does  not  stop  either  endo  or  pericaditis,  ae  is 
well  shown  by  Dr.  Clarkson  in  hia  lectures.  In  the  one  be  hod  re- 
ported last  week,  the  woman  hod  only  been  out  of  ber  bed  six  weoks, 
and  her  confinement  had  not  made  ber  blood  plentiful  and  rich  in  red 
corpuscles,  but  had  produced  the  opposite  condition.  Six  weeks  af- 
ter, while  mending,  she  was  taken  sick.  She  waa  not  in  a  oondilion 
to  bear  blood-letting,  so  be  purged  her  lightly,  and  when  the  cardiac 
trouble  appeared  leeched  ber.  if  he  had  bled  ber  be  thought  she 
wonld  have  been  in  her  grave  by  this  time.  There  are  many  coses 
of  rbenmntism  that  noremediea  will  have  any  effect  upon.  Tbe  most 
Bucoesafnl  treatment  as  he  thought  was  tbe  alkaline,  it  does  for  tbe 
blood  what  blood  letting  does,  namely :  It  cuts  down  the  fibrin 
without  weakening  tbe  patient  by  the  loss  of  blood  consequent  oo  the 


1864.]  Proceedingt  ^  Sotitlm.  475 

use  of  the  lancet,  the  alkalies  also  carry  otf  certain  ^injarious  salts  bj 
the  urine. 

Dr,  Orakam  thought  our  own  observations  were  of  more  valae  to 
us  than  theories ;  that  it  would  be  easy  for  him  to  raise  a  controTcr- 
sj  with  Doctor  Murphy  about  the  cell  doctrine,  or  with  Dr.  Smith 
about  his  views  of  rheumatism  being  a  disease  of  anaemia ;  or  with 
Dr.  Carroll  in  regard  to  the  treatment  of  rhenmatism,  bnt  he  prefer- 
red rather  to  give  his  own  observations.  When  he  commenced  the 
practice  he  bled  freely  in  rheumatism,  but  soon  became  satisfied  that 
the  treatment  was  often  injudicious,  and  he  was  amongst  the  first  to 
adopt  \he  alkaline^mode  of  treatment  after  its  introduction  here,  which 
he  had  pursued  ever  since  with  certain  modifications.  He  could  not 
claim  that  the  alkaline  treatment  had  any  superiority  as  regards 
brevitv,  but  be  was  sure  it  was  the  most  successful.  It  is  recorded 
by  the  English  and  French,  that  in  45  per  cent,  there  was  scarcely  a 
cardiac  complication  after  treatment  by  alkalies,  and  he  had  never 
seen  cardiac  trouble  in  more  than  three  cases  where  this  plan  of  treat- 
ment had  been  pursued  for  twenty-four  or  forty-eight  hours.  In  acute 
forms  as  yon  establish  the  alkalinity  of  the  urine  and  saliva,  the  pain 
and  trouble  diminish ;  this  he  had  tried  to  his  satisfaction,  by  leaving 
o£F  the  remedies  in  some  cases,  and  as  the  blood  became  acid  the  pain 
returned.  It  is  asserted  by  some  that  in  rheumatism  there  is  a  su- 
per fibrination  in  the  blood  with  a  deposit  of  fibrin  on  the  valves  of 
the  heart,  and  this  must  be  diminished;  alkalies  will  diminish  the  acid- 
ity  of  the  blood  and  superfibri nation.  He  thought  the  too  rigid  ad- 
vocacy of  certain  doctrines  and  certain  remedies  had  led  men  into  er- 
ror ;  that  he  would  never  permit  himself  to  overlook  the  advantages 
derived  from  colcbicum  where  the  small  joints  were  affected,  and  from 
iron  and  quinine  in  weak  and  feeble  persons,  and  from  bleeding  in  the 
acute  form  in  strong  and  robust  persons. 


Letter  from  Dr.  Parvin. 

London,  Jnna  29th,  18ft4. 

Mr  Dear  Doctor  : — Did  yon  ever  go  to  aea  ?  I  know  you  hive 
be«n  to  see  yoar  wife  whether  the  prayers  of  ibe  church  wore  desired 
or  not — the  point  whereof  is  that  there  ia  no  point — bat  have  yoB 
been  on  the  ocean  ?  If  yon  ha?o,  and  if,  the  rational  coneeqaence 
thereof,  you  were  seii  eick,  doubtless  you  agreednith  Horace  as  to 
the  impiety  of  ocean  navigation,  and  wiflhed  yonrself  oncemore  on 
Urrafirma,  oa  terra  in-Mfftiila  even  or  on  almosE-any  other  hind  of 
terra,  including  terra  eotla,  cerlainly  such  wbk  my  espoiience  in  my 
recent  passage  across  the  Atlantic,  most  nnexpectedly  too,  for  this 
WM  my  third  voyagi?,  and  in  neither  of  the  others  had  I  known  what 
8e«-BicItnes5  was.  It  is  needless  to  speculate  on  the  malady  now — 
A  better  speculation  would  be  to  provide  some  remedy  for  it— bat  it 
wema  to  me  to  indicate  a  profound  sympathy  between  the  stomach  asd 
the  water,  the  distarbanee  and  restlessness  of  the  one  being  directly 
ptoportioTiata  to  thit  of  theothar,  the  ona  heaest  and ao  does  the  other, 
and  the  libations  thns  poared  oat  conetitnts  the  devotion  paid  to  Kii% 
Keptane,  an  emelie  oHering,  wberein  it  differs  from  the  prayers  to  the 
gods  in  general,  for  Proclus  carionely  advised  a  "  eatkarlie  prayer  for 
averting  diseases  'originating  from  pestilence  and  other  cobtagioai 
distempers. " 

However,  let  me  write  of  the  land.  I  have  no  very  pleasant  mem- 
ories of  at  least  one  half  of  the  twelve  days  spent  npon  the  water,  wd 
I  will  write  too  of  professional,  rather  than  of  personal  matters. 

Glasgow,  where  I  spent  a  week  npon  first  landiqg,  is  a  place  ofcotl: 
siderable  interest  to  the  pbysiciao.  The  medical  department  of  OIaa> 
gow  University,  and  the  Rt>gsl  Infirmary,  of  course  all  know  of;  the 
buildings  of  the  latter  occupies  three  sides  of  a  square,  one  devoted  to 
the  surgical,  another  to  the  medical  wards,  and  the  third  is  a  fever 
hospital.  Among  the  physicians  probably  the  most  well  known  by 
US,  ffom  his  being  an  aathor,  is  Dr.  Gairdoer,  be  also  occupies  the 
chair  of  practice  in  the  medical  schools.  He  is  very  thorough  in  hii 
hospital  investigations,  and  makes  an  excellent  lecturer.  -Dr.  Fraser 
another  physician  of  the  infirmaryjs  deservedly  one  of  the  most  prom- 
inent of  ths  profession  in  Glasgow  his  kindness  to  me  lean  never  for- 
get-     Hy  the  way  be  niVata^  \a  \aR  '^%  ItiW^viw^  (circumstance  which 


1864.]  Corrupwkimet.  4T! 

has  never  been  in  print,  and  jet  is  worthy  of  being  recorded,  illnstm- 
ting  tbe][oontinnaQce  of  the  poison  of  small  poz.  Borne  two  or  thrse 
years  since,  in  the  discharge  of  his  official  daties»  he  is  Health  officer 
of  the  port,  of  Glasgow,  he  sent  on  shore  from  a  ship  jast  starting  to 
Australia  with  a  large  nnmber  of  emigrants,  a  family,  one  child  of 
which  was  recovering  from  the  small  poz — ^he  directed  the  room  occii* 
pied  by  this  family  to  be  boarded  «ip,  and  disinfectants  made  use  of, 
and  his  directions  were  complied  with.  Bat  after  the  ship  was  at 
sea  a  month  it  was  regarded  as  safe  to  have  the  room  occupied,  and 
accordingly  a  family  went  into  it,  and  within  two  weeks  they  were  at* 
tacked  with  small  pox.  This  case  is  worthy  of  particular  attention 
JQst  now  with  us,  as  there  has  been  such  an  unusual  prevalence  of 
small  pox  dunng  the  past  winter  and  spring,  for  the  purpose  of  cau- 
sing proper  precautions  to  be  taken  lest  the  disease  spread  anow  from 
the  houses  or  rooms  which  patients  with  the  disease  occupied. 

Among  the  surgeons  of  Glasgow,  I  suppose  most  of  us  know  best 
of  Mr.  Lister,  he  is  an  Englbhmauv  and  the  son  in  law  of  Mr.  Byrne 
of  Edinburgh.  1  did  not  expect  to  see  a  man  with  as  much  reputa* 
tion,  so  youthful ;  he  has  resided  in  Glasgow  but  a  short  time,  and 
there  is  a  rumor — it  comes  to  me  through  a  non-professional  channel- 
that  he  will  be  called  to  succeed  the  recently  deceased  Prof.  Miller,  of 
Edinburgh. 

I  aaw  an  operation  for  vtttVo  va^iudJlHulm,  performed  very  hand- 
Komely  by  Dr.  Lyon— >he,  Dr.  Morton,  and  Mr.  Lister  are  the  surgeons 
of  the  Infirmary.  It  was  the  fourth  time  the  patient  had  been  opera- 
ted upon,  this  may  account  for  her, bearing  it  so  well,  she  had  got 
used  to  it,  for  no  anaesthetic  was  used  and  yet  she  scarcely  g^roaned. 
Each  of  the  previous  operations'  had  accomplished  something,  but 
still  there  was  a  grievous  rent  to  be  closed  up  by  this  final  one.  The 
simple  iron  wire  was  used,  the  ends  twisted* and  then  left  pro* 
jecting  from  the  vagina. 

Dr.  Lyon  informed  me  that  Dr.  Boseman^  of  the  United  Statea 
was  the  first  to  do  the  operation  in  Glasgow.  Isn't  there  some« 
thing  really  noble,  something  that  takes  one  back  to  the  days  of  chiv- 
alry in  the  copduct  of  these  knights  of  silver  ligatures  and  button 
sutures  ?  From  land  to  land,  from  city  to  city  have  they  gone  to  re- 
lieve the  unfortunate  victims  of  this  sad  mishap. 

Last  Saturday  I  was  at  Prof.  Ferguson's  surgical  ciinique  at  King's 
hospital  in  this  city.     The  most  important  of  the  operations  perform- 
ed by  this  eminent  surgeon,  was  the  removal  of  a  very  lar^g^  ^V^t^^osa 
tumor,  some  fourteen  years  in  growth,  from  \mmed\i.Vft\:i  V^vw  ^Siua 


478  Oorre^Muidme:  f  Aagwt, 

anglaofthe  lower  jaw,  -  the  removal  was  rapidly  oEFacteJ  mainly, 
iifier  the  first  incision  in  the  skin,  by  the  fingers  and  by  the  handle 
of  the  sualpel,  a  procoeilure  which  Mr.  F.  in  hia  remarks,  insitited  op- 
on  as  being  mucli  preferable  to  the  plan  resorted  to  by  ididy  surgeuDs 
of  diBSecliD^  out  the  sac,  the  latter  plan  taking  away  more  than 
was  nec«8sary,  consnming  so  maoh  time,  and  causing  so  much  hem- 
orrhage. 

I  ought  to  mention,  in  addition,  the  mo  of  Ihc  litholrite. 
in  the  case  of  a  patient  npon  whom  some  months  before,  Mr.  F.  had 
operated  forstone  a  small  fragment  bad  'begun  to  give  the  patient  troD- 
ble,  hut  it  was  seized  nith  the  ioslrnment  and  In  a  lttU«  while  crash- 
ed, 

Mr.  Fergnnon  is  a  much  younger  man  in  appearance  th&a  tod 
would  imagine  him  to  he  ;  looks  as  if  he  were  good  (or  twenty  years 
more  of  active  professional  life.  He  is  in  aorao  sort  a  king  amongst 
surgeons,  and  is    well  worthy    of  such  kingly    crown. 

After  these  cases,  and  removal  ofa  tumor  from  the  breast,  two  or  three 
coses  adult  females  and  an  operation  for  anastomotic  Hnenribm  in  a  child 
Mr.  Bmilh  operalod  npon  a  case  of  urethral  stricture  by 
Holts'  insilrument.  It  was  the  second  time  the  patient  had  been  ope- 
rated upon,  and  paralyiis  of  tli4  bladder,  which  oecnried  when  the 
stiiclure  first  formed  and  was  removed  by  the  operation,  had  retnni- 
cd  with  the  retam  of  the  striotars,  a  difGcnlty  which  ths  operator 
confidedtly  predicted  would  be  again  removed,  « 

At  St.  Bartholomew's  hospital  Mr.  Lawrence,  his  hair  as  white  ai 
snow,  and  his  step  somewhat  tottering,  is  still  in  aolire  service. 
Here,  too,  on  the  surgical  staff,  are  Mr.  Paget,  Mr.  Savory,  Mr.  Qal- 
lender,  and  not  last  in  any  regard,  Mr.  CooteJ  as  good  a  teacher  and 
as  kind  a  gentleman  as  one  would  meet  in  many  a  day.  But  I  miss 
in  the  medical  staff  one  whom  I  had  hoped  to  sea  and  hear.  Dr.  Uhas. 
West — be  is  not  now  connected  with  the  hospital.  Indeed  the  three 
men  of  London  whom  my  past  reading  in  diseases  of  females  made 
me  most  anxious  to  see,  Drs.  West,  Tilt  and  Bennett,  are  not  now 
connected,  or  at  lea«t  only  nominally,  with  any  public  charity.  Bat 
enough  for  this  lime. 

T.  P. 


1864.]  CorreipmuUnc€.  479 


Trichina  Spiralis  and  Epidemic  Diarrhoea. 


^  San  Dieqo,  Gal.,  June  9tb,  1$64. 

Editors  Lancet  and  Obseryeb  : — In  a  report  published  in  yoar 
April  No.  of  A  discussion  on  epidemic  diarrhoea,  I  notice  that  Dr.  Hi- 
ram Smith,  thinks  it  "due  more  to  a  change  in  diet,  pedPo  using 
more  pork  which  is  not  well  salted,  than  to  the  water.''  If  this  is  the 
case,  would  it  not  be  better  to  examine,  or  prospect,  the  muscles  of 
patients  suffering  with  these  diseases,  for  trichina  spiralis,.  Accor- 
ding to  Dr.  W.  Muller  of  Hamburg,  Prussia,  diarrhoea  is  one  of  the 
Bjmptoms,  without  exception,  when  this  parasite  is  winding  in  the 
muscles  of  the  human  body. 

The  operation  is  easily  performed,  and  without  much  pain,  with 
Middeldorpfs  harpoon.  The  muscles  found  in  the  calves  of  the  legs 
are  the  best  to  operate  on.  Also  the  pork  should  be  examined.  A 
piece  of  muscle  ta^en  from  either  leg  of  a  hog  dead  or  alive,  if  they 
are  present,  will  discover  them  readily  in|a  good  microscope.  In  pork 
that  has  been  salted  and  smoked,  if  found  at  all,  they  will  be  found  in- 
corporated in  a  chalky  nebulum. 

This  may  be  the  cause  of  your  yearly  epidemic.  I  would  suggest 
that  your  committee  in  their  examinations  look  into  the  matter. 

Very  respectfully  yours,  Ac, 

D.  B.  Heftman, 
Asst.  Surg.  4th  Infty  Cal'.  Vols. 


^-^^^^^ 


Letter  From  Ft.  Halieck,  Idaho  Territory. 


Thinkiko  that  a  few  lines  from  this  far  off  region  would  be  accepta- 
ble to  the  readers  of  the  "Lancet  and  Observer,  "  I  propose  to  men- 
tion briefly  the  diseases  we  are  called  upon  to  treat. 

Alibongh  we  are  "  $even  thousand  Jeet  above  ^he  gulf  of  mexico,  " 
we  are  not  free  from  miasmatic  diseases.  As  well  marked  <;ase8  of 
"malarial  fevers  "  occur  as  yon  can  find  in  Ohio,  and  qninia  is  just 
as  useful  here  as  in  the  Wabash  valley. 

Pneumonia  is  unusually  fatal.  Can  the  aliitmde  *and  consequent 
rarity  of  the  atmosphere  have  any  influence  ? 

For  persons  suffering  from  Pulmonary  difficulties  the  climate  is 
admirable.  Several  of  our  command  hive  entirely  recovered  from. 
'  haemoptysis  "  and  "  bronchitis,  "  and  a  few  ikiat  ax^^^  ^oiAum.^* 


480  (hrreipandence.  [Augoat, 

tive  "  have  beon  greatly  benefitted  |by  the  trip  aeross  the  plains  and 
residence  in  the  country. 

Daring  the  months  of  January  and  February  "acunry  "  made  its 
appearance  amongst  the  troops  stationed  at  ih\gi  post,  as  well  as  at  al- 
most every  garrison  throughout  the  west.  I  have  not  noticed  any- 
thing uuisnal  in  its-  mode  uf  attack,  symptoms,  or  course  from  that 
laid  down  by  our  best  writers  upon  the  subject. 

Every  case  was  complicated  with  "laryngitis  "—some  with  "  rheo- 
matism  " — a  feW  with  **  palpitation, "  and  two  with  *'  night  blind 
ness." 

The  causes  I  think  are  attributable  to  a  want  of  fresh  vegetables, 
a  long  cold  winter,  iDSufficient  exercise,  aud  illy  ventilated  quarters. 
As  soon  as  possible  after  the  appearance  of  the  disease  a  small  sup- 
ply of  potatoes  onions  and  canned  fruits  were  procured  for  the  sick, 
salt  and  salt  meats  were  almost  entirely  prohibited,  the  well  men 
were  required  to  take  more  exercise,  citric  acid,  tincture  of  iron,  and 
colohicum  were  used  freely,  and  under  this  course  an  almost  instanta- 
neous improvement  took  place. 

About  fifty  cases  occurred  in  our  command  of  eight  full  companies, 
only  one  died,  and  at  this  time  all  but  two  have  been  returned  to  du- 
ty, and  they  are  nearly  well.  I  think  that  the  "tinct.  ferri  chlor" 
aided  greatly,  and  in  those  cases  where  the  patient  had  beon  addicted 
to  the  use  of  stimulants,  small  quantities  of  whisky  and  wine  were  of 
advantage. 

Tinct.  of  myrrh,  creosote  and  tannin  were  used  as  a  wash  for  the 
gums.  I  found  tincture  of  iodine — diluted — an  excellent  agent  in  the 
the  throat  complications,  one  or  two  applications — with  a  pencil  or 
used  as  a  gargle — always  gave  relief. 

Our  surgical  operations  have  been  limited  to  aiding  nature  in  re- 
moving a  few  frozen  fingers  and  toes.  J.  W.  Finfrock, 

Asst.  Surg.  11th  O.  V.  C. 
Fort  Halleck,  Idaho  Territory,  June  12th,  1864. 


Ourcubits  Pepo  In  Taenia. 


Mrs. ,  aged  35  years,  native  of  Pennsylvania,  now  living  near 

Hanover,  Indiana,  has  had  tape  worm  for  nearly  three  years.    During 

this  time  she  has  been  under  treatment  of  several  good  practitioners, 

without  any  relief ;  nine  months   ago   she   voided   three   feet  of  the 

worm.    Came  uudot  my  cai^  k^T\\  >i)ti^\^v\i.    Health  very  much  im- 


1864.]  Special  SdeeiioHi.  481 

proved.  The  most  strangely  marked  STmptoint  were  nerrons  tenia- 
tioDS  in  the  epigastrium,  nausea,  and  voracions  appetite,  headache, 
yertigf  great  emaciation  On  the  10th  gave  her  3ii  of  pulverized 
pnmp  1  seeds,  mixing  honey  snfiScient  to  make  a  paste  ;  gave  it  in 
the  r  ing  with  a  dose  of  castor  oil.  In  two  hours  after  taking  the 
oil,  a  worm  twenty-five  feet  long  was  voided.  Has  now  entirely  re- 
covered ;  has  gained  in  flesh  ;  has  no  symptoms  of  Taenia. 

R.  W.  8iw. 


J^ptfUI  SftlttHtnt. 

A  ^  Plea  for  tha  Handmaidaii. 

BT  anwAmD  PAaana: 

We  often  hear  Pharmacy  represented  as  the  handmaid  qf  medtcinif 
and  acting  on  this  idea  some  of  our  titled  colleagues  of  the  Medical 
Profession,  par  exceJUneet  would  exclade  the  Pharmaceutist  from  the 
great  temple  of  medicine,  or  if  they  would  vouchsafe  him  an  entrance 
at  all,  would  shut  him  out  in  the  servant's  hall  or  the  scullery.  Ot 
what  grounds  this  superiority  of  the  Doctors  is  founded,  we  man 
perhaps  profitably  inquire ;  if  we  go  to  the  past  we  shall  find  that  thy 
I'harmaceutists  of  to-day,  equally  with  the  Physicmns,  represent  the 
ancient  votaries  of  iEsculapius.  If  it  be  true,  as  we  are  told,  thae 
Hippocrates  and  OaleD,  with  not  a  few  of  their  eminent  disciples  and 
followers,  dispensed  their  compounds  many  of  them  keeping  open 
shops,  while  all  were  perhaps  more  concerned  with  Materia  Mediea 
and  Pharmacy  than  with  either  anatomy,  physiology,  pathology,  or 
surgery,  albeit  th&  latter  pertained  chiefly  to  the  hairier^  who  still 
represents  by  his  trade  insignia  the  ancient  blood-letting  propensities 
of  the  craft,  may  we  not  claim  at  least  as  ancient  and  honorable  an 
origin  as  any  branch  of  the  healing  art?  Measured  by  the  standard 
of  ihtpruent^  we  must  indeed  own  to  being  occupied  with  the  ignoble 
pursuits  of  business ;  we  soil  our  hands  with  labor,  and  even  demean 
ourselves  with  the  insignia  of  self-seeking  trade;  yet  we  do  produce 
something  wherewith  to  benefit  mankind,  and  is  not  the  producer,  at 
last,  the  true  hero  of  this  nineteenth  century  ?  Whal  would  medical 
art  be  now,  but  for  the  Scientific  Pharmacy  which  evolved  Morphia 
and  Quinia,  Ferrum  redactnm,  and  the  Valerianates,  and  which  has 
added  to  our  new  Pharmacoposa,  despite  tha  conservatism  which  con- 
trolled its  authors,  one  hundred  and  eleven  new  preparations,  for  the 
amelioration  of  suffering  and  the  cure  of  disease  7 

These  reflections  have  passed  through  my  mind  in  coming  over 
some  of  the  flagrant  abuses  which  distinguish  the  conduct  of  phyai- 
eians  in  our  large  cities  towards  their  co-laborers,  the  PhannaA(Si^\\«Xm« 
It  is  a  common  obeervation,  that  those  practiilonttia  iiViO  'Ao^^  Vik 


482  Spteial  Seltdiont.  [Angiut, 

whnt  are  called  "  aristocratic  circles,"  ami  who  pander  to  the  follieft 
of  tbe  fashionable  lite,  are  most  addicted  to  disregarding  the  recog- 
nized ameoitioa  of  profesaiooal  interoourse,  eapeciallj'  where  their 
humble  compeers,  the  Pharmacentiats,  are  concerned.  Inflated  with 
ideas  of  tbeir  influence  and  power,  and  fortified  by  the  greatnesa  of 
their  feca,  these  professional  nabobn  delight  in  patronizing  some  one 
renegade  Pharmacetitiat,  who,  by  the  well  applied  arts  of  the  courtier, 
iiiiuisters  to  their  vanity,  nliile  a  delicately  admiatstered  douceur  oc- 
ca^sionally  testifies  a  grateful  appreciation  of  the  patronage  bestowed. 
Some,  more  honest  than  the  rest  perhaps,  habitaally  resort  to  a  sin- 
gle dispensing  establishment,  because  they  really  are  persnaded  that 
ihoir  prescriptions  are  better  dispensed  than  at  (he  numerous  shops  of 
respectable  graduates  in  Pharmacy,  who  stand  unimpenched,  either  in 
the  matter  of  honesty  or  skill,  dne  of  the  greatest  defects  in  the  ed- 
ucation of  prosessional  men  is,  that  for  want  of  that  contact  with  men 
which  a  business  education  in  early  life  affords,  they  so  often  do  not 
know  how  to  estimate  the  pretentions  of  those  who  lay  claim  lo  su- 
perior knowledge  or  skill— to  use  a  common  phrase,  they  are  guUiUe. 
This  trait  ia  conspicuous  in  certain  clergymen,  who  are  ready,  on  the 
strength  of  a  single  apparent  cure,  to  give  their  inSuence  in  favor  of 
the  pretentions  of  some  nnprincipled  quack,  whose  groundless  assump* 
tions  would  at  once  vanish  into  thin  air  before  the  steady  light  of 
common  sense.  In  these  physicians  it  ia  observable  in  the  willing 
credence  they  give  to  to  the  extraordinary  assertion  of  the  pharma- 
ceutical cicerone,  lo  whoso  gaidnnce  (liey  have  willingly  lent  them- 
Bfllvee  in  their  dabioni  course  through  the  labarintha  of  UatorU  Med- 
ica ;  meanwhile,  the  knowing  ones  mdnlge  a  fwling  betveeD  isdig- 
nation  and  contempt  for  the  practitioner  who  is  so  easily  l»d  by  the 
nose,  and  pity  for  the  patients  who  are  the  victims  of  his  iafatoUioni. 
When  we  are  "  hectored  "  by  oni  medical  friends  becanse  some  anf- 
ferer  hoa  boen  relieved  of  a  cold  or  a  colio  by  a  timely  doae  admin- 
ed  "  over  the  counter,"  withoat  having  paid  a  fee  to  soma  one  entitled 
to  exact  it,  we  may  point  him  to  the  nnmerons  graduates  of  medicine, 
who  have  an  office  adjoiDiDg  some  corner  shop  belonging  to  them, 
where  their  prescriptiona  are  compounded  by  a  so-called  apprentic*  or 
clerk,  who  ia  paid,  perhaps  less  than  a  stevedore  on  the  wharf,  and 
whose  iDStrnctions  are,  to  add  the  doctor's  fee  to  the  cost  of  the  nnd< 
dicine,  whenever  practical.  Or  we  may  direct  the  attention  of  on 
medical  compUiners  to  more  prominent  physicians,  who  Bead  their 
prescriptions  to  a  certain  store  in  the  neighborhood,  the  depository  of 
their  private  receipts,  and  recommended  by  no  single  merit  over  near 
and  more  respectable  dispensing  stores. 

If  a  poor  sufferer  oomes  into  my  shop  asking  relief  from  tlie  pangs 
of  tooth-ache  I  feel  no  hesitation  in  relieving  him  if  I  can,  and  in- 
deed  few  acta  of  my  daily  rontine  give  me  more  aatisfaotion.  For 
this  I  was  never  assailed  by  the  nearest  dentist  with  the  charge  of 
having  interfered  with  his  perogative.  Neither,  on  the  same  groonda, 
do  I  hold  myself  accoantable  to  the  medical  focolty  for  azeroiauv  •<> 
much  homani^  andcomtnon  sense  as  will  help  out  a  inffering  feQow 


1864.]  Beviewt  and  Noticet.  483 

mortal,  withoat  resort  to  the  complexities  of  his  diagnosis  prognosis 
and  other  technicalities. 

Lot  me  not  be  charged  with  hostility  to  the  medical  profession. 
My  earliest  recollections  and  life-long  associations  have  tanght  me  to 
love  and  honor  the  high-minded  physician  who,  with  zeal  for  both 
science  and  humanity,  devotes  his  life  to  the  most  laborions  and  re- 
sponsible of  puTSQits  ;  bnt  this  very  respect  for  the  Physician  as  he 
shayld  be,  indaoea  me  to  place  a  proper  estimate  npon  the  Physician 
as  he  too  often  u,  and  to  protest,  in  the  name  of  common  honesty 
and  fair  dealing,  against  the  unprofessional  fiivoritism  to  which  I  have 
alluded  as  being  notorious,  especially  in  our  large  cities.  And  now, 
on  entering  the  second  decade  iii  the  history  as  this  Araociation,  let 
me  assert  for  American  Pharftiacy  the  claim,  founded  on  a  eommon 
origin  and  kindred  objects,  to  an  equal  and  independent  place,  no 
longer  as  a  handmaideni  but  as  a  modeat  and  docile  sister,  beside  the 
more  numerous  and  distinguished  branch  of  the  medical  family.  May 
we  all  strive  to  deserve  such  a  position. — From  Proceedings  of  the 
American  PharmaceuHcai  Asiociatian. 


%tvltvit  fttid  ^tttUti. 

A  TrtatUe  on  th$  Cknmie  In/Ummmtion  and  Diqthteement  nf  iks  fttjTurnalirf 
UuntM.  By  Wm.  H.  Bjford,  A.M.,  M.  B.,  Prof,  of  Obsietries,  etc.,  Chioaga 
Medioml  Coll«g«,  Med.  DepATtment,  land  University.  Fhiladelphia  ;  Lind- 
say h,  BUkiston.    1864.    pp.  215. 

We  have  received  this  little  volume,  sometime  anticipated,  from  our 
old  classmate  with  a  great  deal  of  pleasure  and  satisflustion.  Its  title 
perhaps  sufficiently  indicates  the  general  scope  of  the  work,  and  at 
the  onset  we  might  simply  expect  to  find  a  treatise  on  the  topics  sug- 
gested, modified  by  the  peculiar  views,  theories,  and  personal  experi- 
ence of  the  author.  In  some  good  degree  such  is  the  character  of 
Prof.  Byford's  work,  but  it  is  something  more  besides. 

There  are  two  parties  who  hold  somewhat  opposite  and  extreme 
views  in  uterine  pathology.  One  party  holds  that  the  uterus  hae  very 
little  sympathetic  influence  in  the  system ;  that  the  diseases  of  the 
uterus  are  quite  as  often  dependent  upon  affeetions*of  the  other  organs 
as  of  independent  origin.  Of  course  this  class  of  pathologists  believe 
that  these  general  symptoms  are  to  be  relieved  withoot  particular  at- 
tention to  the  lacal  condition  or  treatment  of  the  uterous  itself.  This 
is  one  extreme. 

The  other  party  holds  "  that  the  sexual  system  of  the  female,  in  a 
stflte  of  disease,  exercises  a  very  morbid  influence  over  nearly  the 
whole  organization.    That  this  morbid  influenoe*is  parttenlvd^  «uiX- 


484  JBtfiriftM  and  Nolkit.  [Augast, 


I. 


ed  over  tVe  spintl  and  oerebnil  nervons  sjstems^.i^d  Aft  the  <ni1j 
snra  ftnd  psnidanent  reU#f  i«  fbtmd  km,  tbb  ciixe  of  tbe  diioidered  eon- 

dition  of  file  nteroi*.'* 
Then'w^  iSiid  ibtill  fnrt>|6r  tbat  there  Are  •  riiriety  of  enbdiTiikmi 

ia  ihese.  parti^um  gvoop^  i  tbiui  we  bi^te  «  otaai  of  nteritte  peliiblo- 

piefo  wbd  iMUiive  that  all  these  a^mpaliheiio  dieturbamoee  grow  <mt  of 

yariouB  ddgreee  of  iaflamitDatioii  and  tilecvaUon ;  inoCher  dass  of  eqpial* 

I7  respedtible  auihoTitl0$  bold  tb^ttbe  oanse  of  these  matiiftistatioiis 

wili  almost  alwjiys  be  found  |ii  fome  form  or  de^e  of  dteplaoement, 

aad  these  maintain  tbatt  the  inflammation  fi^id  oloeration  are  of  bnt 

slight  importance. 

I)r.  BTford  is  ox^e  of  those  Who  iliot  only  believe  ib  the  great  i^m- 
patibetic  infloehoe  9f  tbe'atei^s;  bnt  be  is  amongst  those  who  especial- 
ly believe  "  that  inflammation  and  its  aocomj^anying  effbcte  ^*  are  the 
conditions  upon  which  its  sympathetic  energies  depend. 

These  explanations  prepare  the  reader  to  anticipate  in  this  litHe 
volume  a  vigorous  exponent  of  the  practice  of  local  treatment  as  the 
important  consideretton  in  the  management  Of  utedne  amotions.  In 
his  introductory  and  general  observations  our  author  pursues  the  ar* 
gument  to  some  length,  but  we  presume  our  readers  will  scarcely  care 
for  their  synopsis.  Perhaps  howe^r  the  most  interesting  and  forci- 
ble point  made  is  the  parallel  which  he  draws  between  the  symptoms 
neually  attendant;  on  uterine  disease  and  spermatorrhora ;  be  gives  a 
peiftUel  tabular  statement,  and  the  dmilarity  is  certainly  remarkable, 
and  as  Dr.  Byford  remarks,  "affords  an  aigument  in  favor  of  the  ef- 
ficacy of  local  causes  in  producing  uterine  inflammation,  and  of  the 
powerful  and  general  sympathetic  influence  of  them  when  once  ori- 
nated." 

We  cannot  attempt  a  general  review  of  the  contents  of  this  book, 
we.  only  aim  to  convey  an  idea  of  itsiscope  and  tendency.  One  of 
the  special  exqellencies  of  the  book  is  its  individuality.  It  gives  very 
fairly  a  systematic  account  of  the  nature,  causes,  and  plans  of  treat- 
ment of  the  diseases  embraced  in  his  field  of  observation,  but  he  does 
not  merely  give  them  %/i  an  editor,,  be  does  not  re- vamp  and  re-bash 
the  prominent  authorities;  indeed  yoaare  at  o^ioe  impressed  with  the 
idea  that  authorities  are J^ept  out  of  sight,  and  the  persotal  experience 
of  the  author  is  for  the  most  part  presented  to  ypu.  There  is  of  course 
a  freshness  in  this,  style  of  book  making  that  is  always  acceptable  to 
the  practitioner.  Ther^is  nothing  in  medical  literature  so  greedily 
Aoqgjit  afteiTy  and  read  with  so  moch  gratification  as  the  personal  ex- 
periences and  observatiouB  ol  i«%i^\aI\Aa  VAMbata  ;  hence  the  rapidi- 


1864.]  EdUar't  TMt.  485 

ty  with  which  works  of  clinical  medicine,  obttetrioi,  and  snigery 
find  a  sale. 

Dr.  Byford's  book  closes  with  a  few  illnstrative  oases,  showing  the 
results  of  strictly  local  treatment  in  cases  of  aggrarated  disease ;  they 
are  only  valuable  however  in  connection  with  the  detailed  views  em- 
braced in  the  body  of  the  book. 

For  sale  by  Robert  Clarke  it  Oo.    Price  92.00. 


Medical  Officert  Warded  in  the  Service.  There  is  a  laige  and  nrgent 
demand  for  medical  officers  in  the  service.  These  are  for  the  most 
part  wanted  for  duty  South  and  with  the  colored  troops.  Graduates 
of  respectable  medical  colleges  who  wish  to  engage  in  this  service 
should  apply  at  once  to  Surg.  W.  8.  King,  U.S.A.,  Superintendant  of 
Hospitals  in  Cincinnati.  If  applicants  desire  contracts  as  Act.  Asst. 
Surgeon  they  will  be  referred  at  once  to  report  to  Asst.  Surg.  Qen. 
Wood.^at  Louisville.  If  they  prefer  a  commission  as  Surgeon  or  As- 
sistant Surgeon  of  colored  troops  they  will  be  subjected  to  a  proper 
examination  by  Surgeon  King  and  assigned  to  duty  immediately. 

Braithwaite*$  JRetrapect,  Part  XLIX,  from  January  to  July,  1864 
.is  at  band,  from  the  publisher,  Mr.  W.  A.  Townsend,  New  York 
On  account  of  the  great  increase  in  the  price  of  material,  the  publish- 
er has  advanced  the  price  of  BraiikwaiU  to  $1.50  each  for  Half  Yearly 
Parts.  The  Lancet  and  Obeerver  and  BraithwaiU  are  furnished  at  94.50 
per  annum.  Our  readers  are  familiar  with  this  old  and  well  known 
publication — of  its  kind  nothing  compares  with  it. 

Univereiiy  of  Michigan,  We  have  received  the  annual  catalogue  of 
students  in  the  various  departments  of  this  Institution,  and  the  an- 
nouncement of  the  Medical  Department  for  the  ensuing  course  of  lec- 
tures which  will  commenoa  on  the  1st  of  October  and  continue  for  six 
months. 

UniUd  StaUi  Stamp  JhOiee.    Messrs.  Robert  Clarke  &  Co.,  of  this 
city,  have  published  on  card  paper  the  rates  of  U.B.  aVMn^  ^^M>Ma«\^ 
very  conveniast  form  for  office  reference.    Pnce  oiAf  \^  cXsk. 


486  I  JBUhr'i  lable.  F^ugwt, 


!■ 


The  Wealthy  Phftidanf  of  Parte.— The  practioe  of  M.  lUcorcU  tk 
distinguUhed  torgaon  of  the  Hospital  du  Midi  (hospital  for  yeiiireftl 
disordsrs)  at  Paris,  is^now  the  largest  in  Franos — ^perhaps  ia  the 
world ;  it  is  worth  800,000  francs  (960,000)  pet  year,  and  he  wears 
decorations  from  eyeiy  principal  monaroh  in  Europe.  Aflfcer  M.  Bi- 
cord,  the  largest  practice  is  that  of  M.  Nelaton,  snigeon,  which  leaehes 
beyond  200,000  franos.  N.  Nelaton,  who  was  rich  bj  birth  and  by 
marriage,  claims  to  be  the  richest  surgeon  in  the  world.  After  IL 
Nelaton  come  nearly  in  the  same  rank,  Messrs.  Trousseau,  9oger 
Andral  and  Yelpeau. 

Annual  Annauneemewt  and  Cvrcviar  of  the  BeOmnme  Boepkal  MeH' 
eal  College  of  New  Turk, — This  new  medical  college,  based  upon 
clinical  teaching  in  Belleview  Hospital,  has  apparently  made  a  most 
complete  success  ;  itTannovnces  a  class  for  the  session  of  1868-64  of 
807  matriculants.  '  The  annual  session  of  1864-66  will  commence  on 
Wednesday,  October  .12th,  with  a  preliminary  term  of  four  weeks. 
The  fees  are  $105,  for  the  regular  tickets  ;  Matriculation  ticket  t5 ; 
Demonstrators  ticket  95  ;  and  Graduating  Fee  $80.    { 

P  The  Miami  Drake  Medical  Society. — Nothing  indicates  so  clearly 
the  correct  ethical  condition  and  energy  of  a  professional  community 
as  its  interest  in  the  support  of  local  medical  societies  ;  and  corroUary 
to  this  is  the  degree  of  character  medical  organizations  reflect  upon 
the  membership.  When  doctors  live  isolated  from  their  brethren 
they  are  apt  to  grow  to  a  degree  suspicious  of  each  other,  they  magni" 
iy  personal  offences  and  trangressions  of  professional  propriety,  and 
are  tempted  to  retaliation:  This  all  tends  to  a  State  of  barbarism  in 
the'profession  that  degrades  us  in  our  own  self-esteem  and  in  the  es- 
teem of  all  sensible  people ;  pecuniarily  it  is  only  a  curse  ;  we  are  al< 
ways  gratified  therefore  to  note  new  organizations,  and  obserre  the 
healthy  condition' of  old  ones."^  The  Miami  Drake  Medical  Society — one 
term  of  the  title  elpressire  of  the  locality  in  the  heart  of  the  wealthyy 
teeming,  growing  Miami  Valley,  the  other  a  tribute  to  the  memory  o 
thej  great  Drake— Was  organized  in  Middletown,  Butler  Co.,  Ohio, 
May  5tb,  1864.  Dr.  I.  A.  Coons,  of  Middletown,  was  elected  as 
President ;  Dr.  R.  P.  Evans,  of  Franklin,  Vice  President ;  Dr.  O. 
Evens,  Jr.,  of  Franklin,  Secretary  ;  Dr.  John  Corson,  of  Middletown 
Treasurer ;  Drs.  'Dyche,  McAroy,  and  Wampler  a  Board  of  Censors^ 
Wo  have  received  a  copy  ot  ^^  CQtL%V.\\.'atvon^  code  ot  ethics,  and 
roll  of  membership,  togetW  w\tti  ^"^  "^^  ^l^^%  V5  %^^^\«A.  Oie 


1864.]  Bditar'M  TaN$.  "      487 

Society.  The  fees  are  properly  up  to  the  state  of  the  times,  and  right- 
fully indicate  a  disposition  on  the  part  of  the  Society  to  he  fairly  re- 
nnmerated  for  professional  services. 

Dayton,  July  16, 1864. 

Db.  Stevens. — Dear  Sir: — In  your  report  of  the  meeting  of  the 
Chip  State  Medical  Society  you  say,  "  The  several  committees  ap- 
pointed to  he  present  at  the  examinations  of  the  various  medical  col- 
leges in  Ohio  reported  that  having  received  no  notice  from  the  proper 
officers  of  those  institutions,  etc.,  etc." 

I  was  on  the  committee  to  visit  the  Cleveland  Medical  College,  and 
I  helieve  I  was  the  committee  ;  the  &culty  gave  me  due  notice  of  the 
time  of  the  examinations  and  very  cordially  invited  me  to  he  present 
at  them.  Circumstances  did  not  permit  me  to  accept  the  invitation 
and  fulfill  my  duties  to  the  Society.  J  did  not  unite  in  the  Report 
made  hy  the  State  Society  hecause  I  had  nothing  to  report.  Bat  to 
allow  this  to  go  uncorrected  would  be  manifest  injustice  to  the  Col- 
lege concerned.  Will  you  therefore  be  so  kind  as  to  make  a  note  of 
this  in  your  journal,  next  number,  and  thus  set  matters  right  ? 

I  am  truly  yours  J.  C.  Reeve. 

We  insert  the  above  note  from  Dr.  Reeve  which  explains  itself ; 
we  only  add  that  so  far  as  any  report  was  made  to  the  State  Society, 
the  record  of  the  Secretary  was  correct.  Qentlemen  of  those  various 
committees  made  verbal  reports  to  the  State  Society,  as  stated.  No 
report  was  offered  from  any  one  appointed  to  visit  Cleveland,  hence 
the  error.  Prof.  Kirtland  from  the  Cleveland  Medical  College,  ex- 
pressed the  opinion  that  the  proper  officer, had  given  due  information 
to  the  committee,  but  as  he  did  not  make  any  authorative  statement 
the  Secretary  made  a  general  record  without  exception. 

'  Homaopathy  Mathematics, — The  following  calculation  was  originally 
published  in  the  London  Medical  Circular,  It  is  hard  to  conceive 
how  medicines  are  prepared,  having  such  extreme  attenuations  as 
bome  homoeopathists  profess  to  use.  Mr.  Wharton,  an  able  Professor 
of  mathematics  and  astronomy,  has  had  the  kindness  to  answer  the 
difficult  questions  proposed  below  : 

Q.  \i  Homoeopathists  give  as  they  profess  to  do»  the  decillionth  of 
a  grain  of  medicine  for  a  dose,  and  which  decillionth  can  only  be  ob- 
tained by  dissolving  the  grain  of  medicine  in  a  decillion  drops  of  some 
liquid — say  alcohol — how  long  would  the  grain  of  medicine  last,  if 
the  population  of  the  world  were  a  thousand  milUotL%^  viA  \\  ^^mr^ 
were  a  thousand  mWVionB  of  such  worlds,  and  \t  «ilcYi  \TAcki\A\»Xi\.\v«^^ 


488  JBkKtar'iTabUi  fAiigiiat, 

for  a  thousand  jears,  and  if  they"  each  took  a  dote  per  second  daring 
their  whole  existenise  ?  And  what  mnst  he  the  dimensions  of  the  yeceel 
that  would  juBt  hold  the  decillion  drops  Of  alcohol. 

A.  The  number  of  generations  each  subsisting  a  thousand  years, 
that  the  grain  of  medicine  would  supply  with  the  homoeopathic  dose 
to  each  individual  per  second,  each  generation  consisting  of  the  1,000»- 
000,000  inhabitants  of  the  1,000,000,900  worlds^,  is  81,987,5S5,M%- 
882,425,8il,012,l&6,738,473 ;  and  the  wliole  number  of  yean  tbs 
grain  of  medicine  would  last  the  inhabitants  of  those  wbrlds,  ia  Sl»* 
687,535,943,38M25^811,01I456,888,474X  1,000,  equal  to  thir^- 
one  thoQsand  six  hundred  and  eighty-seven  qtiintillions,  fi^e  hundred 
and  thirty-five  thousand  nine  hundred  and  fbrty-three  quadrillions, 
three  hundred  and  eighty-two  thousand  four  hundred  and  twenty-five 
trillions,  eight  hundred  and  eleven  thousand  and  twelve  billions,  one 
hundred  and  fifty-six  thouisand,  seven  hundred  and  thirty-eight  mil- 
lions, four  hundred,  and  seventy-fonr  thousand  years  !  1 1 

The  time  it  would  talce  the  trillion  inhabitants  of  the  thousand 
million  worlds/each  containing  500  years  per  minute,  without  inter- 
mission, to  count  the  number  of  years  the  medicine  would  last,  is 
120.494,090  years. 

The  vessel  that  would  just  hold  the  decillion  drops  of  alcohol  must 
have  its  length,  breadth,  and  depth,  each  229,995,079,096,540  miles. 

Light. traveling  192,500  miles  in  a  second,  would  require  378  years 
to  travel  the  length  of  one  of  the  sides  of  the  cubical  vessel  that  would 
just  hold  the  decillion  homoeopathic  doses  of  medicine. 

The  spherical  space  which  contains  the  solar  system  would  hold  only 
a  very  small  part  of  the  decillion  drops. 

The  length  of  the  major  axis  of  Neptune's  orbit,  and  consequently 
the  diameter  of  the  sphere,  is  5,706,893,200  miles,  which  light  would 
travel  over  in  eight  and  a  quarter  hours. 

If  the  spherical  space  which  bounds  the  solar  system,  vast  as  it  is, 

was  increased  so  as  to  have  its  diameter  40,300  times  greater,  it 

would  be  equal  in  length  to  a  side  of  the  cubical  vessel,  but  would 
not,  of  course,  hold  the  decillion  drops,  for  if  the  sphere  was  put  into 

the  vessel,  it  would  touch  it  only  at  five  points,  or  six,  if  covered  and 

the  angular  spaces  would  be  empty. — Medical  and  Surgical  JSeportn, 


A  Physician  Punished  and  Fined  for  DwvJiging  a  Paiienfs 

— A  Paris  physician  has  been  sentenced  to  imprisonment  for  one  year, 

fined  five  hundred  francs,  and  placed  under  the  surveillance  of  tho 

police  for  five  years,  fox  laavVuf^  ^\v^\^<^6l  Usa  nature  of  a  patient's 


1864.1  JEdUar'i  Tahh.  489 

»    disease,  and  tbas  injared  his  character.     He  was  also  condeomed-to 
ptj  one  thousand  francs  damage  to  his  patient. 

A  Female  M.D.  in  England. — We  find  the  following  in  the  Med, 

and  Surg,  Reporter ,  which  is  taken  from  a  London  paper,  April  8th  • 

For  the  first  time,  a  ladj  has  this  week  passed  ihe  necessary  exam- 
ination as  a  medical  practitioner.  After  five  years'  stndy  and  sereral 
repulses  in  London  and  Edinburgh,  Miss  Elizabeth  Garrett  has 
found  a  reward  for  her  indomitable  perssTeranoe  by  her  name  appear- 
ing in  the  list  of  successful  candidates  at  Apothecary's  Hal).  Another 
examination  has  yet  to  be  gone  through,  which  if  Miss  QabRett, 
passes,  she  will  be  a  duly  qualified  medical  practitioner. 

Large  Brains. — Three  of  the  largest  brains  in  modern  times  were 
those  of  Drs.  Chalicers,  and  Ambergombie,  and  Mr.  Thackeray  ;  all 
of  whom  died  suddenly  and  alone,  in  bed. — Med.  and  Surg.  Beporier. 


Production  of  Ozone. — M.  Saint  Pierre  lately  communicated  to  the 
Academy  of  Science  a  paper  on  the  production  of  ozone  by  the  me- 
chanical action  of  apparatuses  of  ventilation.  Ozone  as  yon  know  is, 
according  to  most  chemists,  electrified  oxygen,  and  its  teat  is  iodized 
starch.  M.  Saint  Pierre,  having  plaoed  several  strips  of  paper  coated 
with  this  test,  into  the  eduction  pipe  of  a  blowing-machine  intended 
Weed  a  furnace  of  an  iron  foundery,  and  placed  other  strips  of  the 
same  kind  in  the  adjoining  chambers  and  outside,  set  the  blowiog- 
machine  a  going,  and  found  that  in  the  course  of  ten  minutes,  the 
strips  exposed  to  the  action  of  the  machine  became  tinged  with  violet, 
which  deepened  by  immersion  in  water  t  while  the  other  strips  in  the 
open  air  underwent  no  change  whatever,  thou£^  exposed  for  several 
hours.  The  weather  was  fine,  there  was  no  tempest  brewing,  the  air 
in  the  workshop  was  equally  free  from  oxone,  and  the  ventilator  was 
fed  with  non-ozonized  air  taken  from  both  within  and  without. 
Hence  the  only  explanation  possible  of  this  phenomenon  is,  that  the 
oxygen  of  the  atmosphere  is  transformed  into  ozone  by  the  compress- 
ion to  which  the  air  of  the  ventilator  was  subjected.  The  experiment 
repeated  in  various  ways,  always  led  to  the  same  zesnlts.— JIM.  wad 
Surg.  ReporUr, 

Armg  Medical  Museum. — Without  by  any  means  endorsing  the  in- 
direct but  manifest  fawning  of  the  Medieat  Times  on  the  late  Burgeon 

Gen.  Hammond,  or  its  view  of  an  Army  Medical  School^  both  of 

which  as  is  well  known,  are  decided      angonistic  to  onx  own.«^tXVk& 


490  EdUor*t  TabU.  [Angatli 

notice  of  the  Arm  jMedical  Masemn  is  iimel/  and  we  Uke  great  pleu- 
nre  in  bringing  the  matter  before  onr  readers. 

Army  Medical  Mu$eum. — Sir  Henrj  HoUand  reoend j  remarked  to 
a  prominent  member  of  Government,  that  nothing  had  interested  hia 
80  much  in  his  present  visit  te  this  country  as  the  Arm  j  Medical  Mi- 
seum  at  Washington.  No  one  who  carefallv  reviews  this  magnificsitf 
collection  of  specimens,  illnstrative  of  the  improvements  in  the  mis- 
siles of  war  and  their  destructive  effects,  and  also  the  pathology  of  dis- 
eases incident  to  annies  in  the  field  and  in  camp,  can  fail  to  fens  s 
high  estimate  of  the  value  of  this  national  museum.  And  yet  it  ii 
stated  that  the  remark  of  the  distinguished  foreigner  saved  the  eoDse- 
tion  from  destruction.  We  would  lain  doubt  if  there  can  be  eo  diglit 
an  appreciation  of  this  great  National  Museum  as  this  statement  wooU 
imply  on  the  part  of  any  member  of  the  Government.  Of  this,  how- 
ever, we  are  certain,  that  the  profession  are  not  su£Sciently  infor  med 
of  the  value  of  this  collection  of  morbid  anatomy  and  of  illostratloBS 
of  military  surgery.  Few  medioal  men  have  any  knowledge  of  its  ex- 
tent and  completeness,  for  little  has  been  published  in  regard  to  it^and 
it  is  seldom  visited  by  physicians.  We  earnestly  desire  to  awaken 
such  an  interest  in  the  medical  profession  in  regard  to  this  institution 
as  shall  not  only  prevent  its  being  sacrificed,  but  lead  to  its  beiac 
more  vigorously  susUined  by  Government. 

The  plan  of  the  Museum  originated  with  Surge on-Oeneral  Ham- 
mond, and  may  be  regarded  as  one  of  the  fruits  of  that  effort  which 
placed  at  the  head  of  the  Medical  Department  a  thoroughly  ecientifie 
man  as  well  as  an  accomplished  medical  officer.  The  scheme  was  re- 
garded by  many  as  visionary,  bat  the  majority  of  the  army  surgeons 
have  given  it  their  unvarying  support.  The  temptation  is  very  grest 
to  retain  those  specimens  which  fall  to  each  surgeon  in  his  practice  for 
future  study  and  as  trophies  of  his  skill ;  but  the  medical  staff,  witk 
their  accustomed  generosity,  have  contributed  without  reserve  everj* 
thing  of  value  to  the  Museum.  The  original  projector  of  GTen.  Ham- 
mond was  to  establish  an  Army  School  in  connection  with  the  Hn- 
seum,  at  which  a  coarse  of  special  lectures  were  to  be  given  on  mili- 
tary surgery  and  hygiene,  and  on  anatomy,  materia  medica,  jurispru- 
dence, etc.,  to  those  who  were  about  to  enter  the  service.  In  this  pait 
of  his  undertaking  he  followed  the  English  and  French  plana  of  ft 
government  school  in  which  the  future  army  surgeon  was  to  receive 
special  training  for  his  subsequent  duties.  A  corps  of  competent 
teachers  were  engaged,  and  the  commencement  of  the  course  of  lec- 
tures had  been  fixed.  But  with  the  removal  of  the  Sorgeon-G^nenl 
from  active  duties  at  the  head  of  the  bureau,  the  school  was  abss- 
doned.  The  failure  to  organize  a  school  in  immediate  connectioo 
with  the  Museum  will  prove  a  great  misfortune  to  the  future  medical 
staff.  No  ordinary  school  can  thoroughly  prepare  its  graduates  for 
all  the  duties  of  an  army  surgeon.  Much  of  the  institution  must  be  of 
a  special  character,  with  means  of  illustration,  such  as  this  MuseoiD 
and  the  neighboring  hospitals  present.  We  hope  yet  to  see  the  plan 
of  an  Army  Med.  Sc\vooV  in\\^  <i«^xi\a\  q^V.  «i  the  seat  of  Government. 


1864.]  ^itor't  TalU.  491 

The  Museam  is  divided  into  the  Medical  and  Surgical  portions,  the 
specimens  being  arranged  npon  either  side  of  a  gallerj.  The|8nTgi- 
cal  Division  is  in  charge  of  Frederick  Schafhirt,  late  Onrator  of  Uie 
University  of  Penn.,  and  formerly  aaaociated  with  Langenbeck,  a  most 
skilful  artist  in  the  preparation  of  morbid  specimens.  Nothing,  in- 
deed, can  exceed  the  delicacy  of  touch  manifest  in  the  preparation  and 
moonting  of  the  specimens  in  this  division.  Each  preparation  is  so 
arranged  as  to  admit  of  the  most  accurate  study,  without  disturbing 
its  position  and  relations. 

The  surgical  specimens,  taken  as  a  series,  illustrate  forciblv  a  vast 
number  of  disputed  points  in  military  surgery,  and  afford  aonndant 
food  for  reflection  to  the  thoughtful  surgeon.  Here  he  may  learn  that 
trephining  is  not  to  be  discaided  in  gunshot  wounds  of  the  cranium  ; 
that  balls  lodged  should  be  early  removed,  even  if  an  extended  search 
is  necessary,  and  especially  when  in  contact  with  bone  ;  that  delay  in 
the  union  of  compound  fractures  is  often  due  to  the  interposition  of 
foreign  bodies,  as  balls,  necrosed  bones  ;  that  resections  of  the  knee- 
joints  after  gunshot  woands  are,  for  the  most  part,  failures.  We  can- 
not estimate  the  value  of  such  a  collection,  when  complete  in  all  de^ 
partments  of  surgical  practice,  on  the  progress  of  American  military 
aurgery.  The  number  of  specimens  now  mounted  exceeds  1200,  and 
there  is  a  large  and  rapidly  accumulating  collection  awaiting  prepa- 
ration. 

The  Medical  Division  is  in  charge  of  A.  J.  Schafhirt,  son  of  the 
Curator  of  the  surgical  portion,  who  exhibits  the  same  rare  abilities 
in  the  mounting  of  specimens.  In  this  division  the  preparations 
are  for  the  most  part  wet,  and  for  the  first  time  we  here  find  specimens 
so  dbplayed  that  wo  can  study  them  with  the  utmost  ease,  and  to  the 
tame  advantage  as  the  dry  specimens  upon  the  opposite  side  of  the 
g^lery.  Though  the  number  of  specimens  in  the  medical  is  much 
more  limited  than  in  the  surgical,  yet  we  find  here  series  of  the  great* 
est  importance  illustrating  the  pathology  of  the  diseases  of  the  camp 
and  the  field.  The  first  series  represent  those  diseases  of  the  larynx 
lescribed  by  Dr.  R.  K.  Browne,  who  presented  them  as  "gangrene 
>f  the  larynx."  They  are  regarded  by  Dr. Woodward,  however,  as 
icorbutic  ulcerations — a  very  common  complication,  in  his  opinion,  of 
nany  diseases.  A  second  series  beautifully  illustrates  the  lessons  in 
aimp-fever,  typhoid,  or  typho-malarial.  A  third  exhibita  tubercular 
ilceratioos  of  the  intestines  at  several  different  points  in  the  same  sub- 
let. Bnt  we  cannot  specify  the  many  subjects  for  study  which  these 
>eantifnlly  prepared  specimens  suggest.  An  accurate  descriptive  cat- 
Jogue  is  kept,  in  which  is  entcroid  the  history  of|each  specimen,  as 
riven  by  the  surgeon  who  presents  it,  and  a  minute  account  of  the  crit- 
eal  examination  to  which  it  is  subjected  before  it  ia  finally  placed  up- 
m  the  shelves. 

The  Museum   fund  is  limited,  consisting  of  a  small  appropriation 
Dade  by  Congress,  but  the  very  best  use  is  made  of  the  means  at 
is  disposal.     Great  economy  is  practiced  in  the  purchase  of  materi- 
da,  and  by  the  re<listillation  of  alcohol,  a  supply  ia  obUintd.  lto\EL^^\. 
vhich  is  rejected  for  other  purpoaeB,  or  is  conlraband. 


492  Editar't  TaNe.  [Am«A 


7h$  Relatlw  of  ike  Medical  Frqfetdan  to  ScUne0^im  ike  tidt  of 
an  address  delivered  before  the  graduating  dais  of  tha  Hedieal  Dt- 
partment  of  the  Univerfifity  of  Michigan,  by  Ber.  O.  E.  Hayen,  Piw- 
ideat  of  the  University.  We  have  read  the  addresa  with  iotemi; 
and  a  aense  of  pleasant,  grateful  feelmg  to  the  anther  for  tlia  higl 
tribute  he  has  seen  fit  to  bestow  upon  the  seienee  of  medicine.  Tib 
the  following  paragraph  as  indicative  of  the  spirit  of  the  addiHs: 

"  Remove  from  the  natural  science  of  to-day  all  that  baa  beenooi- 
tributed  to  it  by  men  of  your  profession,  and  the  world  wonld  li 
thrown  into  great  oonfosion,  and  much  of  thsi  daikneBS  of  the  iHk 
ages  would  settle  down  again  upon  us/' 

Trichina  Spiralis. — ^Deaths  from  the  presence  of  this  paiasitib  sa 
beginning  to  excite  considerable  attention  in  this  eonntrj.  Sam 
cases  were  reported  as  having  occurred  in  New  York  Citj  last  wialff 
from  eating  la  ham,  and  an  examination  of  portions  of  the  ham  nUb- 
ited  an  abundant  presence  of  trichine.  These  cases  were  repoilBl  it 
the  Med.  7%mei  for  February.  Several  deaths  oeoored  in  May  W 
in  the  vicinity  of  Buffalo,  N.  Y.,  and  considerable  space  is  oceopiidift 
the  Med.  and  Surg.  Journal  with  their  report.  The  aymptoBS  d 
these  cases  were  such  as  in  the  first  place  to  lead  the  attending  physi* 
cian  to  suppose  he  had  "  acute  muscular  rheumatism  "  to  deal  witb ; 
there  was  "  stiffness  of  the  limbs  and  the  whole  body,  bloating  of  tha 
face»  with  a  slight  oedema  of  the  eyelids  ;  soon  after  there  fdlowed 
distinct  pains  in  all  the  limbs  and  body,  so  that  they  could  not  Utr 
even  the  slightest  touch.  By  and  by  the  paiqs  diminished ;  thea  nt 
in  very  labored  respiration  and  great  prostration  combined  with  pro- 
fuse sweats.  In  the  commencement  of  the  illness  they  both  had  hid 
slight  diarrhea  for  a  few  days,  and  during  the  whole  conrse  of  tb 
sickness  they  suffered  greatly  from  sleeplessness  and  unquenchable 
thirst."  In  the  post  mortem  a  great  abundance  of  trichinss  were  fomd 
in  the  shreds  of  sausage  of  which  the  patients  had  eaten,  and  in  mof- 
cular  fibre  taken  from  the  thorax,  abdomen  and  thigh  of  the  patient 
The  micropical  examinations  were  made  by  l)rs.  Hadley  and  Lothrop. 
of  Bualo,  and  are  perfdctly  reliable. 

Dr.  Alfred  jSSri7/#— formerly  Prof,  of  Theory  and  Practice  of  Msdi- 
eine  in  the  Pennsylvania  Medical  College,  has  been  elected  to  the  ssae 
chair,  to  succeed  Prof.  Pepper  in  the  University  of  Pennsylvania. 

Dr.  B.  H.  ^and — ^has  been  elected  to  the  chair  of  chemistry  ii  At 
Jefferson  Medical  OoWeg^*  \a  «.^<^q«^  'CioC.  Bache. 


1864.]  IkiUor't  7\M0.  498 

The  Univerniy  of  Edinburgh  Ims  reoenilj  met  with  a  Berere  loss  In 
the  death  of  Prof.  Miller,  who  has  oocapied  so  high  and  sncoessfal 
a  position  as  a  teacher  of  snrgery.  He  was  well  known  in  this  conn- 
try  through  his  works  on  the  Principles  and  Practice  of  Surgery. 
His  age  was  fifty-two. 

Papers  Received, — ^Too  late  for  insertion  in  the  present  number  we 
have  received  an  article  fromJ3r.  Bartholow  on  the  "Ohlorides  in 
Pneumonia."  Also  we  have  on  hand  an  acceptable  paper  by  Dr. 
Rooker  on  ''Spotted  Fever.'*  There  will  also  appear  next  month 
fhrther  correspondence  from  Dr.  Parvin,  from  London. 

The  American  Pharmaceutical  Aseociatian  will  convene  the  present 
year  in  the  city  of  Ginoinnati.  The  session  commencing  Wednesday 
the  21st  of  September. 

Philadelphia  Med,  and  Surg,  Beporier. — This  weekly  ootemporary 
enters  upon  its  twelfth  volume  since  the  oommencement  of  its  weekly 
saries,  with  the  1st  of  July.  It  appears  with  a  new  and  titsty  cover- 
page»  embracing  the  familiar  face  of  Rush.     It  is  announced  to  ap- 

Csr  hereafter  simultaneously  at  Philadelphia  and  New  York.    Price 
.00  a  year. 

The  Boston  Medical  and  Surgical  Journal  has  advanced  its  price 
from  the  beginning  of  a  new  volume  to  $4.00  a  year. 

Pr<if.  Langetdnuk  has  beeen  appointed  Surgeon  Qeneral  of  the 
Army. 


■  •) 


Army  Medical  Intelligence* 

Surgeon  W.  Threlkeld,  UJS.V.,  as  Snrgeon-in-eharge»  Barracks 
9oapital»  Nashville,  Tenn.' 

Assistant-Surgeon  Gerhard  Saal,  U.S.Y.y  as  8aigeoii-in*charge, 
{•minary  Hospital,  Columbus,  Ohio. 

Lieutenant-Colonel  John  Wilson,  Medical  inspector,  U.S.A.,  will 
nake  a  special  inspection  of  the  hospitals  in  the  Northern  Depart- 
nent,  and  will  report  the  result  of  such  inspection  lo  the  Snigeon- 
30iieral,  U.S.A. 

Surgeon  Charles  O'Leary.U.S.V.,  relieved  from  the  operation  of  all 
nrders  requiring  him  to  perform  duty  in  connection  witk  the  Provoet 
Harabal  Genend's  Burean,  and  ordered  at  once  to  resume  his  former 
loties  in  charge  of  General  Hospital  at  Philadelphiai  Pa. 


494  Eiii&r^$  JMU.  L^ngiMt, 

Sargeon  Eugene  B.  HArriaon,  68tli  OhioYoISy  and  Assistant- Sor- 
geon  Jasper  M.  Groye»  7th  Indiana  Gavalrj,  honoiablj  discharged  on 
acoonnt  of  pb3r8ical  disability  on  the  report  of  a  Board  of  Officers. 

Assistant-Snrgeon  Corwin  B.  Fraser,  A.  B.  Prescott,  and  Jobs 
Fitzer,  U.S.V.,  ordered  to  report  to  Assistant  Sorgeon-General  B.  0. 
Wood,  U.S.A.,  at  Louisville,  Ky. 

Assistant-Snrgeon  Henry  W.  Dayis»  n.S.y.»  relieved  from  doty  in 
the  Department  of  Arkansas,  and  ordered  to  report  to  Assistant  onr^ 
geon-Oeneral  R.  C.  Wood,  I7.S.A:»  at  Lonisvilie,  Ky« 

Assistant-SuTgeon  Elliott  Qones,  U.SJL^y  as  Post-Smgeon,  Foft 
Whipple,  Arizona* 

Acting  Assistant-Surgeon  John  W.  Beers,  U  S.A.,  to  Fort  Qood- 
win.  New  Mexico. 

Sargeon  H.  P%  Steams,  U.S.Y.,  to  report  to  Assistant-Smgeoi- 
General  Wood  at  Louisville,  Ky. 

'  Surgeon  H.  P.  Steams,  U.S.V.,  as  burgeon-in-chargo,  Joe  Holt 
General  Hospital,  Jeflfersonville,  Ind. 

Surgeon  David  Stanton,  n.S.y.,  as  Assistant  Medical  Bivselor, 

Northern  Department; 

Surgeon  W.  H.  Oobrecht,  U.S.Y.,  as  Surgeon-in-oharge,  OlBceit' 
Hospital,  Fairmonnt,  near  Cincinnati,  O. 

Assistant- Surgeon  W.  W.  Wyihfia*  U.S.V.,  as  Executive  OfEoer, 
Asylum  Hospital,  Knoxville,  Tenn. 

Surgeon  A.  L.  Cox.  U.S.V.,  as  Sargeon-in-charge,  General  Kdd 
Hospital,  Kingston,  Ga. 

Assistant- Surgeon  M.  0.  Wood  worth,  XT.  S.  V.,  as  Sorgeon-iD- 
charge.  General  Field  Hospital,  Resaca,  Ga. 

Surgeon  George  F.  French,  TT.S.V.,  to  duty  establishing  *Genenl 
Hospitals,  Home,  Ga. 

The  Treasury  Department  has  decided  that  the  law  increasing  the 
pay  of  Cadets  at  the  Military  Academy,  West  Pointy  N.  Y.,  does  not 
increase  the  pay  of  Medical  Cadets  of  the  XJ.  S.  Army. 

The  War  Department  has  decided  that  under  the  law  of  April  9, 
1864,  Chaplains  cannot  receive  commutation  of  fnel  and  qoarters. 

Plans  and  estimates  are  being  prepared  for  the  erection  of  an  Eje 
and  Ear  Infirmary  at  Chicago  for  the  use  of  the  United  States  Armj 
Medical  Department. 

Since  the  commencement  of  General  Grant's  campaign  1,000  8a^ 
geons  and  Nurses  have  been  sent  to  the  Army  of  the  Potomac,  ef 
whom  194  were  private  physicians  of  the  Volunteer  Aid  Corps,  4S 
Contract  or  Acting  Assistant  Surgeons,  9  Regular  SnrgeonSy  aod 
775  Nnrses. 


1864.]  BdUorial  AbKroeU  ami  StUetioiu.  495 

dtfitovUI  ^itttMttS  9ViH9tltttl»U$, 

PRACTICAL  MEDICINE. 

Frtpu«d  by  W.  B.  Vutcna,  X.  ]>.,  ladbuuipolli. 

1.  Case  of  J?<7«tnea— Reported  by  John  A.  Spencer  P.  B.  C.  8  J. 
(Sargeon  69th  N.  Y.  Regiment. 

Peter  Brennan,  aged  46,  of  intemperate  habits,  a  private  in  Com- 
pany K.»  69th  Regiment,  was  admitted  into  hospital  on  March  28d, 
1864. 

Symptoms  on  Admission, — ^Pain  referred  to  the  lower  ribs  on  the 
left  side,  weakness,  mascnlar  trembling,  costireness,  pnlse  75,  fair ; 
ongae  moist  and  clean,  temperature  of  skin  normal ;  respiratory 
marmnr  and  rhythm  of  heart  natnral.    Qr  magnes.  sniph.  Si. 

Bifiory  qfthe  Case. — On  the  15th  inst.  Brennan  came  to  me  with 
the  statement  that  he  was  detailed  to  attend  to  officer's  horse,  but  for 
the  past  few  days  he  had  not  felt  able  to  do  his  daty.  Nothing  ab- 
normal could  be  detected  on  examination,  and  there  were  no  data 
upon  which  to  act,  save  the  man's  own  story,  that  he  did  not  feel 
well,  and  had  a  pain  in  his  side.  The  question  then  arose,  as  to 
whether  he  was  malingering,  or  suffering  mm  pleurodynia.  Finally 
it  was  decided  to  give  him  the  benefit  of  the  doubt,  and  accordingly 
he  was  relieved  from  duty  for  a  few  days  and  orders  to  report  occas- 
ionally,  the  following  being  prescribed :  Qr  ext.  colch.  fl.  10  min., 
every  two  hours  till  it  operates  ;  Dt  morphiae  sulph.gr.  ss.  each  night 
at  bed  time.  On  the  18th  he  came  again,  saying  that  he  still  felt  un- 
well, though  the  pain  was  partly  relieved  ;  on  this  occasion  a  blister 
was  applied  to  the  affected  part.  His  next  visit  was  on  the  20th,  his 
complaint  the  same :  9;  qnin.  sulph.  gr.  v.  ter  in  die.  The  coldri- 
cum  to  be  discontinued.  On  the  23d  he  was  sent  to  hospital  by  Dr. 
Nealis  the  Assistant  Surgeon,  who  saw  him  in  camp  ;  ne  had  to  be 
carried  thither  on  a  stretcher. 

Daily  Reports, — March  24th.  He  lies  sunk  down  in  the  bed,  on 
Lis  back  with  the  knees  drawn  up ;  pulse  80,  weaker  than  yesterday ; 
tongue  shows  some  disposition  to  dryness  about  the  center;  does  not 
answer  at  once  when  addressed ;  speaks  of  having  great  thirst ;  trsm- 
blea  like  one  in  an  ague  fit ;  has  had  no  rigor,  as  far  as  can  be  as- 
certained. Ordered  the  "  imperial  **  drink  to  be  given  him  at  inter- 
▼als  ;  a  pint  of  beef  tea  for  dmner.  Qr.  liq.  ammon,  aoetas.^  a  table- 
apoonful  every  third  hour. 

March  25th. — There  is  a  duskr  redhue  about  the  nose  and  forehead, 
pidae  88,  weak  and  compressable  ;  tongue  brown  and  dry  in  centre; 
red  at  edges  aud  tip ;  bowels  acted  freely  last  night,  motion  healdby. 
Uq.  ammon.  acetas.  to  be  discontinued.  Qr.  sp.  frnmenti  3ii.,  qmn 
aaljph.  gr.  v.,  four  times  a  day ;  body  to  be  sponged  with  tepid  water, 
hair  to  be  cut  close  to  the  head. 


496  SdUarUd  Ahttraels  tmi  StleMmu.  [Aiignsf, 

March  26th«-Per8pir9d  profasely  jetterdAy  eTening ;  tlie  trembling 
persistent ;  pulse  80,  not  eo  weak  as  before,  tongue  brown  and  dry, 
there  are  three  nnhealthy  looking  pnainlee  noticed  on  the  face,  one  at 
the  root  of  the  nose,  between  the  eyebrows  almost  large  enough  to  fill 
this  space,  another  on  the  forhead,  and  a  third  on  the  upper  lip  below 
the  left  nostril.  These  three  are  precisely  alike. in  appearmnce,  and 
are  each  surrounded  by  a  broad  dark  livid  margin.  The  attendant 
reports  that  the  patient  "  wandered  "  during  the  night.  Whisky  and 
qninine  as  before. 

March  27th. — ^Last  night  he  passed  the  fooes  inroluntarily  antwen 
incoherently  when  spoken  to,  pulse  90,  irregular  and  thread  like..  The 
pnstulee  noti(^  on  the  face  yesterday  have  broken  and  discharged  a 
thin,  reddish  sanious  fluid.  The  integument  of  the  back  is  of  a  livid 
color,  and  thece  are  patches  of  a  si^iilar  hue  on  the  lower  limbe*  which 
are  also  covered  with  pustules  of  about  the  size  of  those  in  sniall-pox  ; 
the  scalp  .too  is  studded,  with  these  pustules.  On  the  upper  and  low- 
er anterior  part. of  jthe  left  thigh  is  a  tumor  &om  one  and  a  half  to  two 
inches  in  diameter  ;  it  is  moderately  hard,  and  if  touched,  the  patisnt 
semirconscious,  cries  out.  8  p.m.,  pulse  120,  intermittent :  his  foeces 
pass  from,  him  so  frequently  that  it  is  necessary  to.  have  an  India- 
rubber,  lilanket  kept  under  him  and  changed  constantly ;  it  is  remark- 
ed that  these  disdgi^ijges  are  very  •offensive.^  Directed  a  reliable  man 
to  remain  up  i^rith,  hun  through  the  night  and  to  give  him  aa  oonce 
of  whisky  each  hour  as  long  as  he  conld  swallow. 

March  28th,  a.m. — Gould  with  difficulty  swallow  the  stimulant. 
10^  A.M.,  died  comatose.  No  autopsy.  The  following  points  con- 
nected with  the  case  may  perhaps  be  considered  worthy  of  attention  ; 

1st.  The  absence  of  any  marked  febrile  disturbance  up  to  an  ad- 
vanced period  of  the  disease.  2nd.  The  earlier  symptoms  simulating 
rheumatism.  3.  The  true  nature  pf  the  afifectioa  being  so  completely 
masked  till  the  pustules,  etc.,  made  their  appearance.  4th.  The  ab- 
sence of  the  more  aggravated  symptoms  of  tbe  disease  in  consequence, 
I  think,  of  the  poison  acting  upon  the  brain,  and  destroying  life  bj 
that  or^an  before  the  more  horrible  details  of  ^*  glanders  "  had  as  it 
were,  time  to  be  developed. 

Before  closing  it  is  necessary  to  state  that  the  horse  Brennan  had 
attended  was,  beyond  all  doubt,  glandered,  though  ina  snb-acute  form. 
The  animal,  which  I  examined*  had  a  persistent  purulent  discharge 
from  the  nostrils,  small  chancrous  ulcers  on  the  mucous  lining  mem- 
brane of  those  cavities,  pustules  on  the  skin,  and  the  glands  under  the 
jaw  were  swollen,  tender  and  adherent. — Am.  Mid,  Tunes. 

2.  Some  Practical  Observations  on  Small-pox  and  Vhmnnatifm  at 
Sock  Island  Prison  Barracks,  Bock  Island,  lu, — ^The  following  is  aa 
extract  from  an  article  in  the  Am,  Med  Times,  by  B.  M.  Lackey,  M. 
D.,  A. A.  Surg.  U.S.A.,  under  the  above  heading: 

^*  There  are  few  subjects  in  the  medical  world  that  have  claimed 
the  attentioti  and  study  of  physicians  more  than  small-poxl  Every 
medical  wHter  for  centuries  past  has  treated  of  it;  some  devoting 
themselves  excluBively  U>  Us  study « the  most  raluable  results  attend- 


1864.]  Sdilortal  AlOroHs  and  SeUd^onn.  497 

io^  their  labors.  It  is  however*  a  soaroe  of  regret  that  nearly  three- 
qn^irters  of  a  century  after  the  aehievementfl  of  Jenner,  small -pox 
should  still  prevail,  notwithstanding  we  have  daily  evidence  of  the 
power  of  vaccinnation,  when  properly  employed,  to  arrest  the  ravages 
of  this  loathsome  disease.  From  its  earliest  recorded  history  small- 
pox seems  to  have  prevailed  extensively  in  large  armies,  the  presence 
of  which  in  this  country  during  the  past  three  years,  I  think  may  be 
reganlod  as  the  exciting  eanse  of  its  general  prevalence,  the  contagion 
bo  !oming  more  powerful  by  concentration,  the  predisposiQg  cause  be- 
ing negligence  in  regard  to  vaccinnation,  and  the  large  nnmber  of 
persons  who  are  consequently  unprotected. 

The  appearance  of  the  disease  here  was  almost  simultaneous  with 
the  first  arrival  of  troops  for  garrison  duty,  but  it  did  not  begin  to 
spread  to  an  alarming  extent  until  a  fortnight  or  more  after  the  arri- 
val of  the  first  lot  of  prisoners,  which  was  about  the  5tli  of  December, 
1863.  From  January  1st,  1864,  and  almost  entirely  amongst  the 
prisoners,  some  days  as  many  as  forty  new  cases  occurred.  As  there 
had  been  no  buildings  erected  for  hospital  purposes  outside  the  prison 
yard,  some  old  dwelling  houses  on  the  Island  were  used  as  a  post-hos- 
pital, an  I  men  sick  with  small-pox  were  crowded  into  those,  where 
they  suffered  from  exposure  of  insufficient  ventilation  nntil  better  ac- 
commodations were  provided.  Although  there  are  few  who  have 
never  been  vaccinated,  yet  the  number  of  bad  cases  that  occur  is  large. 
Thus  out  of  558  cases  admitted  there  were  but  44  that  had  never  been 
vacfinate<i ;  yet  out  of  this  nnmber  166  had  confluent  small*pox. 
This  may  be  accounted  for  by  the  fact  that,  of  the  514  that  had  been 
vaccinated,  there  were  107  on  whom  the  vaccination  bad  not  taken 
efleol,  and  59  in  whom  the  matter  used  was  evidently  bad.  as  is  shown 
by  the  character  of  the  scars  ;  and  in  88  cases  the  variola  and  vac- 
cine disease  occurred  simultaneously,  making  in  all  204  that  were 
wholly  unprotected.  Th**  whole  nnmber  admitted  to  small-pox  hos- 
pitals to  this  dale  is  1165  ;  of  these  335  have  dieii,  or  one  in  8.17. 
Of  confluent  cases  the  deaths  have  been  about  75  per  cent.  This 
would  show  a  heavy  mortality  but  for  the  condition  of  these  men 
when  attacke<l.  Many  of  them  are  almost  exhausted  by  other  dis- 
eases, and  a  large  number  die  during  the  first  week  of  the  eruption. 

In  the  treutment  of  small-pox  several  plans  and  remedies  have  been 
employed  and  pronounced  by  some  to  have  the  power  of  aborting  the 
disease.  The  sarracenia  purpurea,  so  highly  recommended  by  Dr. 
Morris  of  Halifax,  N.  S..  and  others,  has  been  used  here  to  some  ex- 
tent, but  its  employment  has  not  been  followed  by  the  marvelous  of- 
fecLs  claimed  for  it  As  soon  however  as  another  supply  can  be  pro- 
eurcvl.  we  propose  giving  it  a  further  trial,  and  hope  to  be  able  to  re- 
port more  favorably. 

It  has  boon  asserted  by  some  that  vaccination,  even  after  the  vario- 
lous eruption  has  appeared,  modifies  the  disease  and  this  course  has 
been  recommended;  but  observations  here  have  not  confirmel  the 
trnth  of  this  statement.  I  have  carefully  obeorved  thirty-eight  cases 
io  which  the  vaccine  disease  and  small -pox  ooourred  avtOLXiU^u<^<^>&!iXl  * 
and  there  was  not  a  case  in  which  the  vMcmii^lVim  «Mm«\  \io  V«  o*^ 


498  JtfjtorM  AMm^  mud  SdMimm.  \  [Aogaii, 

anj  benefit ;  bat  i&  eome'  eaeee  ike  rarioloiil  modified  the  TAceme 
poison,  making  tbe  Tesiole  eniAUer  (haa  naotl*  and  in  others  the  vae* 
oine  venole  became  oontandnated  with  the  iranolons  poison,  and  ran 
the  same  course  of  tbe  smalirpox  postnles.  £  see  no  objeet  therefov^ 
in  vaccinating  after  the  ▼arklonsQ^  appeared. 

The  treatment  whioh  seems  to  be  attended  with  the  best  ^esnlts 
here  is,  to  open  the  bowels  freely  at  the  onset  ^f  the  disease,  and  if 
there  be  much  nansea,  an  emetic  may  be  advisable  to  assist  in  frsdy 
unloading  the  stomach.  Some  of  the  saline  laxatives  ace  given  to 
keep  the  bowels  soluble  during  the  coarse  of  the  disease.  For  rest- 
lessness  and  wakefulness  dover's  powder  in  10  grain  dpsea  at  bed* 
time.  After  the  secondary  fever  has  subsided  it  is  neeessanr  to  oss 
all  the  supporting  means  at  our  disposal — quinine,  iron,  wine,  egg^ 
nogg,  and  nourishing  diet.  For  the  diroat  affection  that  so  freqnenl- 
ly  occurs  from  about  the  sixth  to  the  eighth  day,  we  have  been  using 
bromine  by  inhalation,  and  with  very  decidedly  beneficial  reaolts. 
Frequently  the  tongue  and  throat  swell  enormovsly  in  a  few  hours,  so 
that  the  patient  can  neither  speak  nor  swallow,  and  suflBlcation  seems 
imminent.  In  these  cases  we  have  seen  the  swelling  diminish  as 
rapidly  as  it  came  from  the  use  of  this  remedy.  An  inhiling  appara- 
tus may  be  extemporised  by  two  tubed  placed  in  the  oork-stopper  of 
a  wide-mouthed  bottle.  From  the  fourteenth  to  the  twenty-first  day 
pneumonia  is  most  to  be  feared ;  and  nearly  all  the  oasee  in  whtdi  it 
occurs  prove  fatal.  Treatment  is  of  but  littie  avail,  except  to  paUiats 
as  far  as  possible  the  suffenngs  until  death  relieves  the  Tictim.  Ery- 
sipelas is  very  prevalent ;  nearly  25  per  cent,  of  the  whole  number  of 
patients  are  in  the  erysipelas  ward.  For  this  we  find  the  local  and 
constitutional  use  of  iodine  and  bromine,  with  prompt  support,  the 
best  treatment.  Abscesses  and  sloughing  are  very  common  among 
anaesmic  subjects.  I  have  seen  the  scrotum  and  penis  nearly  iS 
slough  away  before  death  took  place.  For  the  abscesses,  when  diey 
become  extensive  and  tbe  parts  gangrenous,  we  have  found  the  injec- 
tion of  a  weak  solution  of  iodine,  after  the  pus  is  evacuated,  very 
beneficial.  We  have  made  use  of  a  variety  of  external  local  applica- 
tions, mainly  for  their  soothing  effects  during  the  stages  of  matnra- 
tiott  and  decline.  A  very  excellent  soothing  application  is  olive  oil 
and  creasote,  from  ten  to  twenty  drops  of  the  latter  to  the  ounce  of 
oil  softens  the  surface,  and  the  creasote  allays  the  itching,  and  besides 
its  antiseptic  properties  are  of  some  value.  Another  local  remedy  that 
we  have  used  with  gpreat  advantage,  especially  for  the  eyes,  is  glycer- 
ine. We  usually  take  equal  quantities  of  glycerine  and  water,  and 
for  the  eyes  the  addition  of  a  few  grains  of  tannin  to  the  ounce  is 
beneficial.  Where  there  are  extreme  dryness  and  sorsnesss  of  the 
mouth  the  glycerine  mixtare  is  an  excellent  application,  not  only  la 
small-pox,  but  in  other  diseases. 

Of  the  558  oases  of  which  I  have  taken  notes,  those  between  16 
and  20  bear  the  di8ea3e  best ;  no  bad  cases  occurring  in  those  over 
40  years  of  age  recovered  ;  and  no  deaths  have  occurrsd  in  those  who 
have  a  good  vaccine  mark.  Yaocinnation  is  the  great  disanner  of 
this  great  distroyer  of  human  life  ^  and  the  eeal  manifested  by  some 


1864.]  Editorial  AhstraeU  and  SeUdunu.  499 

physicians  in  extending  its  blessings  soon  after  its  discovery  is  well 
worthy  of  imitation."     ♦     ♦     ♦ 

3.  Spotted  Fever, — The  following  synopsis  of  a  discussion  on  MnotUd 
fever  at  a  meeting  of  the  New  York  Aoadbxt   or  Mxdxoivb,  is  re- 
ported in  the  American  Medical  Tinut : 

"  Dr.  W.  H.  Draper  concloded  the  reading  of  his  paper  on  cerebro 
spinal  meningitis.  His  observations  of  the  disease  were  founded 
principally  upon  the  large  number  of  cases  which  have  recently  occur- 
red at  Carbondale,  Pa.  In  the  majority  of  the  cases  the  meninges  of 
the  brain  and  spinal  cord  were  intensely  inflamed,  while  in  others 
the  pericardium,  pleura,  and  even  the  lungs  suffered.  The  discolored 
patches  or  spots  from  which  the  present  epidemic  seems  to  have  de- 
rived its  name,  were  not  always  present.  Opisthotonos  was  a  pretty 
constant  symptom.  The  liver  and  kidneys  in  some  instances  were 
found  to  be  the  seat  of  fatty  degeneration.  The  disease  was  general- 
ly of  short  duration,  and  very  fatal.  He  was  inclined  to  the  belief 
that  it  was  very  infection!.  The  conclosion  of  his  paper  was  occu- 
pied by  argnments  to  prove  the  identity  of  this  disease  with  typhus 
fever.  The  paper  was  a  very  elaborate  and  finished  one,  and  we  re- 
gret that  we  are  unable  to  publish  it  in  full. 

Dr.  Scriven  stated  that  he  had  met  with  a  few  cases  of  cerebro- 
spinal miningitis  since  the  last  meeting.  He  referred  to  three  cases 
in  particular.  The  first  was  that  of  an  old  man  aged  71,  who  was 
seized  at  first  with  rheumatic  pains,  followed  by  vomiting.  When 
Pr.  8.  first  saw  him  he  was  suffering  from  spasm  of  the  posterior 
cervical  muscles.  The  pulse  was  full  and  strong.  The  features 
seamed  relaxed ;  **  his  whole  face  seemed  to  hang.  His  mind  was 
inclined  to  wander,  though  at  times  he  was  able  to  give  some  ac- 
count of  himself.  He  complained  of  burning  pain  in  the  head  and 
down  the  back.  The  patient  was  bled  to  faintnees,  and  the  pulse 
coming  up  after  he  was  laid  down,  he  was  bled  again.  The  symp- 
toms werej  all  relieved,  and  the  patient  at  last  accounts  was  doing 
well.  The  blood  showed  a  huffy  coat,  and  was  capped  after  stand- 
ing. 

The  second  ease  which  Dr.  S.  referred  to,  nas  that  of  a  boy  eight 
years  old,  whom  he  only  saw  in  a  state  of  collapse.  Cups  were 
applie  I  to  the  mastoid  process,  but  little  or  no  blood  was  drawn  ; 
they  were  also  applied  to  the  back  of  the  neck  with  the  same  result. 
At  the  suggestion  of  Dr.  Sayre,  who  saw  the  case,  the  jngnlar  vein 
was  opened,  but  it  was  some  three  or  four  minutes  before  the  blood 
was  made  to  flow,  it  being  necessary  to  free  the  orifice  of  the  opened 
vessel  by  scraping  away  the  partial  coagula  which  existed  there.  The 
symptoms  were  alleviated,  but  the  child  was  already  too  far  gone  to 
rally. 

The  third  case  was  interesting  in  respect  to  an  abscess  which  de- 
veloped itself  in  the  lumbar  region,  and  seemed  to  extend  into  the 
spinal  canal. 

Dr.  dark  did  not  think  that  there  had  been  saffieient  opportnnities  to 
study  the  disease  in  and  around  New  York,  inasmnco  as  there  had 


500  Editorial  Ahstradi  and  Seltdiant,  [August, 

been  to  tbe  best  of  bis  knowledge,  not  more  tban  a  dozen  cases  nn- 
der  observation,  and  ont  of  tbis  nnmber  tbere  had  been  opportunities 
afforded  for  bat  two  or  three  autopsies. 

He  had  met  with  bnt  one  ca^e.  This  was  in  the  praotioe  of  Dr.* 
King,  and  in  the  person  of  a  ypung  mecbanio.  He  was  seized  on 
Sunday  three  weeks  ago  with  a  feeling  of  malaise,  attended  with 
vomiting  and  headache.  These  symptoms  continued  until  evening, 
when  he  retired  at  the  usual  time.  During  the  night  he  became  delir- 
ious, and  partially  paralysed.  Dr.  King  saw  him  the  following 
morning,  and  found  him  pretty  profoundly  comatose ;  the  pulse  was 
exceedingly  small  and  rapid,  the  face  livid,  and  there  were  noticed 
blotches  upon  the  neck.  At  twelve  o'clock,  the  time  of  the  consul- 
tation viisit,  stimulants  in  the  meantime  having  been  given,  the  pulse 
was  more  appreciable,  and  had  increased  somewhat  in  force,  bnt 
was  still  very  lapid.  He  was  then  very  restless.  He  refused  to 
speak,  probably  on  account  of  an  inability  to  move  his  jaws,  which 
were  firmly  contracted.  The  pupils  were  neithei  dilated  nor  contract- 
ed. The  respiration  was  sufficient  to  aerate  his  blood  fairly,  and 
presented  no  remarkable  feature  as  to  character  or  frequency.  Tbe 
blotches  varied  in  size ;  some  were  so  small  as  to  be  completely  cov- 
ered by  a  pin's  bead,  while  others  could  not  be  covered  by  the  end  of 
the  finger.  The  more  recent  and  smaller  ones  disappeared  on  press- 
ure, while  the  larger  ones  were  ecohymotic  in  character.  The  lar- 
ger ones  were  dark  in  their  center,  and  of  a  light  red  along  their 
ma^'gin.  Their  form  was  exceedingly  irregular,  no  two  resembling 
each  other  ;  they  were  notched  and  irregular  in  outline,  and  either  an- 
gular or  very  rounded,  none  having  any  definite  oval  form.  The 
eruption  appeared  upon  the  neck  three  hours  before  it  did  upon  the 
feet.  There  was  then  (12  m.)  no  opisthotonos.  The  patient  was  do- 
ing pretty  well  at  last  accounts. 

Dr,  Clark  was  inclined  to  doubt  as  to  whether  tbe  right  name  had 
been  found  for  the  disease.  In  some  cases  the  brain  and  spinal  col- 
umn were  involved  in  the  inflammation,  and  so  far  the  term  ccrebro 
spinal  meningitis  was  correct  enough  ;  but  in  other  cases  the  inflam- 
mation was  limited  to  the  brain,  and  the  cord  escaped  altogether,  and 
the  inflammation  had  spent  its  force  upon  the  pericardium,  the  pleura, 
and  even  upon  the  lungs.  That  being  the  case,  the  disease  in  his 
opinion  was  due  to  a  condition  of  the  system  in  which  there  is  a  ten- 
dency to  inflammation,  and  that  inflammation  might  show  itself  in 
one  part  of  the  body  or  the  other,  dependent  upon  circumstances 
which  we  cannot  at  first  appreciate.  He  was  not  able  to  agree  with 
Dr.  Draper  as  to  any  identity  which  existed  between  this  disease  and 
typhus  fever.  In  typhus  fever  the  eruption  rarely  or  never  appears 
before  the  seventh  day  from  the  time  the  headache  and  chilly  feelings 
commences  ;  the  rate  too  at  which  the  eruption  travels  over  the  body 
occupies  a  more  considerable  space  of  time,  and  then  again  the  in- 
flammation of  the  brain,  which  sometimes  complicates  typhus,  does 
not  show  itself  until  after  the  end  of  the  first  week,  and  more.gener- 
Ally  in  ^h^  second  or  third  week.  The  rapidity  with  which  spotted 
ibver  runs  its  course,  and  \\i«  ^^m^WccA  «X.\ATi.d\n^  its  fatal  tennina- 


1834.]  EdUonial  Ah^racU  and  SaicUaus.  501 

^oD,  were  very  different  from  those  of  tjphas.  As  to  the  fatty  de- 
generation of  the  liver  and  kidneys,  it  was  most  allied  to  yellow  fever; 
thoagh  the  investigations  of  Dr.  Thomas  have  lately  tended  to  show 
that  this  same  condition  of  things  may  he  met^  with  in  typhus  fever. 
Why  might  not  this  lesion  exist  in  spotted  fever  iDdependent  of  any 
analogy  that  might  exist  between  this  and  typhns.  Taking  every 
thing  into  consideration,  he  was  inclined  to  look  upon  the  two  dis- 
eases as  entirely  distinct. 

Dr,  Oriscom  related  a  case  that  had  come  tinder  his  observation 
in  New  York  Hospital,  and  which  was  still  under  treatment.  The 
patient,  after  general  malaise,  was  first  attacked  with  severe  pain  in 
the  head,  and  when  Dr.  G.  saw  him  he  was  suffering  from  the  symp- 
toms of  cerebral  inflammation.  His  pupils  were  contracted  but  were 
dilatable.  His  face  was  the  seat  of  a  most  intense  congestion  ;  cups 
were  applied,  followed  by  venesection,  when  almost  all  the  urgent 
symptoms  were  alleviated.  The  following  day  the  patient  suffered 
from  an  attack  of  catalepsy,  which  lasted  for  twelve  hours.  He  had 
no  command  over  his  sphincter,  and  having  an  attack  of  diarrhoea, 
discharged  the  contents  of  his  bowels  in  his  bed.  and  over  the  floor. 
There  was  no  opisthotonos  present.  For  some  time  he  had  been  de* 
lirious,  would  spit  at  every  one  with  a  seeming  maliciousness,  while 
at  odd  times  he  would  exercise  a  musical  talent  which  he  seemed  to 
possess,  by  whistling  vociferously.  Dr.  G.  was  disposed  to  think  at 
the  time  of  reporting  the  case,  that  the  patient  was  suffering  from  an 
attack  of  acute  mania. 

Dr,  La  Roche  of  Philadelphia,  made  some  remarks  concerning  the 
geneml  characters  of  the  disease  as  he  had  met  with  it  around  Phila- 
delphia, which  corroborated  the  views  of  Dr.  Clark. 

Dr.  Horsefield  referred  to  a  case  that  occurred  in  Jemej  City, 
which  proved  fatal.  The  tonic  and  stimulant  treatment  was  resorted 
to. 

Dr,  Draper  instanced  some  Examples  of  the  contagiousness  of  the 
disease,  wh^ch  tended  to  corroborate  the  statements  concerning  that 
point  referred  to  in  his  paper. 

4.  **  Spotted**  or  Petechial  Fever. — ^The  peculiar  affeotion popu- 
larly termed  "  spotted  fever,"  which  has  been  so  prevalent  in  adja- 
cent portions  of  the  country  the  past  year  has  attracted  much  atten- 
tion in  consequence  of  the  fatality  attending  it.  Too  little  has  been 
underfitood  concerning  its  pathology  and  treatment  Now,  however, 
considerable  light  has  been  thrown  upon  both  by  means  of  communi- 
cations published  through  our  columns. 

This  maladv  first  appeared  in  the  United  States  in  the  town  of 
Midficld,  ia  Massachusetts,  in  1806.  In  1812  an  epidemic  occurred 
among  the  soldiers  of  the  United  States  army  at  Greenbush. 

During  the  winter  and  spring  of  1818  it  was  prevalent  and  was  ex- 
tremely fatal  in  the  State  of  Vermont,   also  in  the  northern   part  of 
the  State  of  New  York,  where  it  has  occurred  at  intervals  of  tea  ot 
twelve  years,  and  was  termed   by  some    cerebro-a^Vci^X   tasiiX'^^^- 
The  disease  is  hriefiy  described  by  WaUoii»  and  a\ao  \)i  N^cirA^'Q^- 


502  Editorial  AhstracU  and  SeTedlom.  f  Angost, 

der  this  latter  title.  The  statistics  sbow  that  it  chiefly  attacks 
children  and  young  persons,  especially  boys.  An  epidemic  occurred 
during  the  winter  and  spring  (which  would  seem  to  be  its  favorite 
season,)  of  1857,  in  the  village  of  Elmira  and  Horseheads,  and  to  some 
extent  in  other  parts  of  Chemung  County,  New  York 

Although  this  disease  has  prevailed  since  the  time  of  Sydenham, 
in  every  epidemic  owing  to  its  fatality  it  is  aliVays  spoken  of  as  a  new 
disease,  and  yet  the  symptoms  are  almost  constant  and  harmonious 
which  are  **  a  chill,  headache,  vomiting,  prostration,  morbid  sensi- 
tiveness of  the  skin,  jactitation,  coldness  of  the  surface,  wildness  of 
expression,  dilated  pupils,  irregular  breathing,  paralysed  deglutition, 
wry-neck,  retraction  of  the  head,  dullness  or  abolition  of  the  senses, 
pulse  but  little  effected,  bowels  quiescent,  petechia,  delirium,  convul- 
sions, coma;  these  are  impressive  symptoms,  and  many  or  all  of 
them  attend  each  case. 

It  would  seem  that  this  fever  appeared  in  New  Jersey  in  1836,  and 
then  crossed  the  river  attacking  the  inhabitants  of  Philadelphia,  and 
passing  through  the  State  qi  Pennsylvania.  The  late  Dr.  Joseph 
Parish  gained  great  credit  by  avoiding  bleeding  and  depending  upon 
stimulation,  which  has  been  the  most  successful  treatment  in  all  the 
epidemics  which  have  occurred.  Dr.  Parish  had  studied  with  care 
Dr.  North's     treatise  on  this  disease. 

It  is  somewhat  remarkable  that  in  the  epidemic  of  1864  in  Phila- 
delphia, the  authorities  do  the  same  thing  which  was  done  by  those 
of  London  during  the  plajjue,  two  centuries  ago,  namely,  1664,  for  in 
the  mortuary  bill  of  April  4th,  this  disease  is  termed  spotted  fever, 
malignant  typhus,  and  for  the  first  time,  cerebro-spinal  meningitis.  In 
the  early  days  of  the  plague  it  was  put  dowu  on  the  list  as  spotted 
fever,  not  to  alarm  the  public.  The  mortality  so  far  in  our  epi- 
demic, is  equal  to  that  of  all  the  others,  namely  :  one  half  die  ;  and  so 
also  of  the  pathological  lesion,  the  only  one  as  a  constant  condition  is 
entire  change  in  the  blood,  almost  a  separation  of  it  into  its  original 
elements.  This  epidemic  exhibits  also  the  remarkable  characteristic 
of  counterfeiting  other  disorders,  and  the  physician  is  not  unfrequent- 
ly  surprised  at  the  sudden  approach  of  death  in  instances  where  the 
patient  was  actually  about  his  room,  or  walking  about  the  day  previ- 
ous, as  was  the  case  with  a  distinguished  physician  of  this  city,  and 
also  was  seen  in  one  of  our  public  institutions  for  boys,  where  there 
were  four  fatal  cases  out  of  some  ten  or  twelve  attacked- 

The  predisposing  course  of  this  fever  seems  as  yet  to  have  eluded 
investigation.  That  it  is  not  contagious  is  universally  agreed.  The 
suggestion  in  a  report  recently  published  in  regard  to  ergot  (spnrred 
rye)  or  any  other  grain  as  having  produced  it,  is  not  corroborated  by 
sufficient  evidence.  The  true  cause,  as  in  all  other  epidemics,  de- 
pends upon  a  peculiar  state  of  the  atmosphere.  The  exciting  causes 
are  eating  improper  food,  stale  or  diseased  meat ;  the  meat  of  the 
young  calf,  pig,  or  sheep.  Indeed  a  very  large  amount  of  meat  sold 
in  many  of  our  street  markets  is  entirely  unfit  for  food,  exposed  to  cold 
or  damp,  great  fatigue,  anxiety  of  mind,  fearing  the  name  of  the  dis- 
ease, sometimes  indacing  a  morbid  condition  of  the  mind  making  the 


1864.]  Bdiiorial  Ahitradi  amd  Sebetiom  603 

system  favorable  to  its  infloenoe.  The  humaoo  and  pnideiii  physi- 
cian will  therefore,  do  all  io  his  power  to  divest  the  disease  of  its 
alarming  name,  calling  it  *'  nervous  *'  fever  or  cerebro-spinal  menin- 
gitis, which  is  considered  by  some  as  being  more  appropriate,  as  hot 
a  small  proportion  of  the  cases  are  marked  with  petechia. 

Squire  Transactions  of  Medical  Society  of  State  of  New  York, 
1858.  p.  133. 

The  reader  may  consult  Dr.  N.  E.  North  on  spotted  fever  ;  com- 
munications to  the  Mass.  Med.  Soc.,  Vol.  ii«  New  England  Med. 
Jour.;  Amer.  Med.  and  Philosophical  Register,  and  Med.  fUw^ster  of 
New  York.  Gullup  on  Epidemics ;  Sketches  by  James  l£tnn,  M. 
D.,  and  treatise  on  Typhus  Syncopalis,  by  Thomas  Miner,  M.  D. ; 
and  American  Modem  Practice,  by  James  Thatcher,  1826. 

5.  Cerehro  Spinal  MeningUiiOM  it  appeared  among  ^  troops  etation' 
ed  at  Benton  Barracks,  Jio.,  ly  Ira  BuestU,  Swrg.  U.  S.  V,,  and  Poet 
Surg, — During  the  winter,  Benton  Barracks  have  been  a  rendezvous 
for  colored  troops,  and  a  temporary  stopping  place  for  white  regi- 
ments going  home  on,  and  returning  from  furlough.  Benton  Bar- 
racks are  situated  just  outside  of  the  limits  of  the  city  of  St.  Louis, 
and  in  rather  an  unhealthy  or  malarious  locality.  The  diseases  most 
prevalent  among  the  troops  have  been  measles,  some  cases  of  typhoid 
ortypho  malarial  fever,  a  large  number  of  cases  of  pleuro-pneumo- 
nia,  together  with  many  of  cerebro  spinal  meningitis.  The  latter  dis- 
ease appeared  first  among  the  colored  troops.  Not  less  than  fifty  ca- 
ses occurred  among  them  during  the  months  of  January  and  Februa- 
ry, more  than  half  of  which  proved  fatal.  Latterly  quite  a  number 
of  cases  have  occurred  among  the  white  troops,  the  symptoms  and 
progress  of  the  disease  not  differing  materially  from  that  among  the 
negroes.  ♦♦♦♦♦♦♦ 

6.  General  Oheervatione. — There  has  been  a  good  opportonity  to  ob- 
serve the  symptoms  and  progress  of  this  fatal  malady,  as  it  has  hap- 
pened at  this  post,  and  I  have  watched  it  with  a  good  deal  of  interest 
and  considerable  care.  In  what  respect, ijf  any,  it  di&rs  from  the 
same  disease  in  other  localities,  I  am  unable  to  state,  having  never 
seen  or  treated  any  ca^es  of  it  elsewhere.  It  is  my  opinion  that  local 
miasmatic  influences,  if  not  its  sole  originating  cause,  have  had  much 
to  do  in  producing  it.  It  is  unquestionably,  I  think,  of  an  aesthenic 
typo,  and  I  believe  that  the  same  opinion  is  entertained  by  the  sur- 
geons on  duty  at  this  post  who  have  had  the  most  experience  in  treat- 
ing it.  At  first,  surgeons  were  inclined  to  adopt  active  antiphlogis- 
tic remedies,  and  to  depend  upon  stimulants,  tonics,  iodide  of  potas- 
sium and  opium,  together  with  cups,  sinipisms  and  blisters 
to  the  spine.  Opium  has  certainly  exerted  a  good  influence  in  con- 
trolling delirium.  I  have  been  led  to  believe  that  the  administration 
of  quinine,  freely  given  in  the  early  suges  of  the  disease,  prior  to  the 
period  of  collapse,  will  in  very  many  instances  arrest  it.  Whether 
quinine  exerts  a  specific  influence  over  the  disease,  or  merely  removes 
one  of  its  predisponing  causes — viz  :  malaria.  I  am  unable  to  deter- 
mine, as  my  experience  in  treating  it  has  been  oonfinod  to  cases  oc- 


504  Sdiion^  AbUrac^  ami  iSUfc^JoM.     •  [Angiulf 

earring  in  this  localitj,  in  whioh  nu^Urii^  aboamL—^jBoflcHi  JUedietA 
and  Surgical  Journal. 

7.  On  Albumenuric  Aphonia,  ly  Gtorgt  D.  Qititm,  MM.^  A99mttud 
Physician  to  the  WestmntterBiMpiiud'^AihumentirUiUAmMmfmUtic^ 
of  the  renal  di»ea86  now  known  as  Bright's,  and  gives  ris«  occasion* 
ally,  thoagh  rarely,  to  laryngeal  symptoms  which  rssnlt  in  aphonia* 
to  which  Dr.  Charles  Fauvel,  of  rans,  has  recently  given,  tte  name 
of  **  aphonia  albnminnriqae."  This  loss  ot  voice  occurs  also  in  the 
renal  dropsy  following  scarlatina.  It  must  be  in  the  ezp6rienee4>f 
most  hospital -physicians  to  have  witnessed  oases  of  esctensive  anasar- 
ca resulting  from  Bright's  disease,  and  as  a  secret  to  scarlet  fever,  In* 
volving  the  submucous  areolar  tissue  ot  the  larynx,  and  producing 
hoarseness,  stridor,  and  aphonia.  Although  this  cannot  be  an  ex- 
tremely rare  complication  for  several  example*  have  oome  under  my 
own  notice  in  the  larger  wards  of  the  hosphals  of  London,  yet  scarce* 
ly  a  writer  that  I  am  acquainted  with  ever  mentions  such  an  oociLr* 
rence. 

It  was  but  the  other  day  (Jan.  29th,)  chat  a  male  child*  two  yeaxs 
and  a  half  old  was  brought  to  me  amongst  the  out-patients  at  West- 
minster Hospital  with  Bnght's  disease  of  recent  date,  associated  with 
general  dropsy.  The  child  had  been  much  exposed  to  cold,  was 
blanched,  puffy  about  the  eyelids,  had  bled  at  the  mouth,  and  the 
voice  was  completely  gone.  The  urine  was  scanty  and  albuminous, 
which  was  from  the  disease  mentioned,  as  it  had  not  had  scarlatina. 
With  assistance  I  was  enabled  to  see  in  the  laryngeal  mirror  supra- 
glottic  oedema  of  the  larynx,  of  a  very  pale,  indeed  almost  white  col- 
or. Here  was  an  instance  of  albuminuric  aphonia  in  a  young 
child.  The  laryngeal  dropsy  was  purely  passive,  yet  the  dispnoea 
was  urgent.  , 

It  is  well  known  that  one  of  the  causes  of  death  in  dropsy  is  effu- 
sion beneath  the  mucous  membrane  of  the  air  passages,  and  the  lar- 
ynx is  liable  to  become  involved,  and  add  much  to  the  patients  suf- 
fering. I  am  indebted  to  Dr.  Charles  Fanvel  for  a  copy  of  his  orig- 
inal essay  on  albuminuria,  and  the  following  is  a  summary  of  his  ob- 
servations : 

The  laryngeal  mirror  only  can  discover  the  affection,  whicli  is  a 
white  oedema,  either  chroaic  or  intermittent,  of  the  vestibule  of  the 
larynx  and  vocal  cords,  preceding  or  following  albumenuria,  and 
more  often  without  any  external  manifestation  to  afford  even  the  sus- 
picion of  the  existence  of  Bright's  disease.  This  oedema  at  one  time 
abruptly  manifests  its  presence,  and  at  another  slowlv,  by  complete 
aphonia,  or  slight  dysphoma.  The  first  symptom  wnich  appears  is 
hoarseness ;  the  patient  neither  coughs  nor  expectorates  ;  has  no  feel- 
ing of  a  foreign  body ;  he  complains  only  of  slight  uneasiness  of 
breathing  and  a  little  oppression  at  the  chest.  Very  soon  he  is  com- 
pelled to  make  great  efforts  at  inspiration,  and  after  spme  days  the 
voice  is  weak  and  obscure,  sometimes  altogether  lost,  and  a  whisper 
occurs  only  with  the  lips. 

No  cause  can  be  made  out  in  the  patient's  history  to  explain  the 


1864.]  ^^^     JMUorial  Ab^racU  and  StlitiUm.  606 

condition  of  the  larynx.  If,  boweTer,  it  is  recognized  either  bj  a 
direct  examination  of  the  larynx,  or  by  the  appearance  of  an  oedema- 
tou9  sweliing  of  the  iaoe,  or  swelling  of  the  eyelids,  or  general  ana- 
aarcn,  the  proper  treatn^nt  for  albumennria  will  arrest  the  progresa 
of  the  laryngeal  affection.  If  the  disease  bo  not  diagnosed,  it  will 
nevertheless  disappear  in  a  few  days»  becaose  it  will  have  been  the 
conseqoeuoe  of  an  intermittent  albumennria.  On  the  other  hand,  when 
the  intermission  disappears,  and  the  disease  returns  in  an  aggravated 
form,  the  obstruction  becomes  so  great  that  tracheotomy  must  be  per- 
formed. Dr.  Fanvel  cites  the  particulars  of  two  or  three  well  mark- 
ed examples,  and  has  seen  many  patients  attacked  with  aphonia  or 
dyi^phonia  in  the  best  of  health,  without  any  other  explanation  to  ac- 
count for  the  swelling  in  the  larynx  than  albuminuria,  very  sensible 
ti  aces  of  albumen  being  discovered  in  the  urine  by  the  application  of 
nitric  acid. 

If  supra-glottic  oedema  of  the  larynx  suddenly  arise  as  a  foreran-  < 
ner  or  primary  symptnm  of  Bright's  disease,  its  early  diagnosis  is  of 
gi«at  importance,  and  the  profession  cannot  be  too  soon  made  aware 
of  it. — London  Lancet. 

8.  Ouy't  HoipUal— Bright  $  DUeait,  OiouitUand  (kdema  CHoUld€9. 
— We  publish  the  following  oases  for  the  purpose  of  illnstrating  the 
occasional  coexistence  of  laryngeal  mischief  with  diseases  of  the  kid- 
ney : 

Joseph  B ,  aged  forty-eight,  was  admitted  into  Lazarns  ward 

on  the  evening  of  the  16th  of  Aui^ust,  1863,  suffering  from  glossitis, 
hi.H  tongue  protruding  from  his  mouth  and  filling  it.  There  appeared 
no  immediate  danger  of  suffocation,  but  word  was  left  withtbe  nurse 
to  call  the  surgeon  on  any  increasetl  effort  in  breathing.  He  was 
found  dead  in  the  morning;  Autospy  eight  hours  afterwards.  The 
hotXy  presented  no  remarkable  appearances.  The  tongne  was  enor- 
mously swollen,  and  filled  the  mouth.  The  paUite  was  oedematoos ; 
the  glottis  in  continuation  with  the  palate  was  much  swollen  with  oe- 
dema beneath  the  mncoas  membrane.  The  oedema  of  the  glottis  ap- 
peared snffident  to  blose  the  chink.  The  kidneys  were  very  much  dis- 
eased, small,  granular  and  covered  with  cysts.  All  the  other  viscera 
were  healthy. — London ^Lan^t, 

9.  OnUf  Bypodermk  Treatmtni  of  Ut$rin$  PaU^  fy  J.  Henry  Bm- 
neii^  M,  2>.,  LtUi  Pkyddan  Aecoucher  to  the  Royal  rrei  Bospiial. — ^I 
9Ji\  not  aware  to  what  extent  the  hypodermic  injection  of  sedatives 
lias  been  resorted  to  for  the  treatment  of  uterine  pain  since  it  was 
iv as  first  introduced  to  the  profession,  but  I  am  desirous,  of  giving 
toy  testimony  to  its  extraordinary  efficacy  in  ca>»es  presenting  that 
sy'niptom.  I  may  add  that  my  attention  was  first  forcibly  directed 
to  this  mode  of  treatment  by  the  valuable  papers  of  Mr.  Charles 
Hunter  in  The  Lancet. 

During  the  past  winter  I  have  used,  with  prompt  and  marked 
ftu^ce^,  the  hypodermic  injection  in  several  cases  of  severe  dysmen- 
fM-rbcea,  with  or  without  hysterical  complications,  and  in  several  oth- 
Cra  of  aterine  and  ovarian  neuralgia,  and  at  facial  neuralgia  havioga 


506  JUUarlal  AhOraeU  and  Sd&dhiu*  [ Angiiit, 

uteriDe  origin.  The  lelief  has  bdenobUmed  in  from  fifteen  to  thirty 
minates ,  withotit  being  attended  or  followed  bj  the  headache*  lost 
of  appetite  or  naasea,  which  are  so  frequently  the  result  of  the  use  of 
opiates  in  any  other  way.  ^ 

This  latter  mode  of  administering  opiates  has  hitherto  been  my 
slieet  anchor  in  the  treatment  of  uterine  spasms  and  pain»  and  is  eer- 
tainly  most,  efficacious;  but  it  is  not  unfitequently  att«[ided  by  all 
the  abore  mentioned  drawbacka»  from  which  the  nypodermio  injee* 
tion  appears  to  be  singularly  free.  In  nearly  all  tne  instanoss  is 
which  I  have  tried  this  mode  of  introducing  opiatee  intp  the  system, 
the  sedative  result  alone  has  been  produced ;  there  has  been  no  sub- 
sequent bad  effect  whatever. 

In  one  case  of  severe  uterine  tormina  and  pain*  the  resnlt  of  arrest- 
ed men8truatix>n  from  cold,  I  injected  thirty  minims  of~  the  aolutioi 
of  morphia.  In  half  an  hour  the  pains,  which  had  been  agontaiag 
for  the  past  twenty- four  hour!,  were  calmed.  A  good  night's  tmi 
followed,  and  the  next  morning  the  menses  had  resumed  their  coorseb 
and  my  patient  was  all  but  well.  In  another  similar  case  the  nteriae 
pain  was  accompanied  by  severe  hysterical  symptoms.  The  injec- 
tion was  followed  by  the  same  favorable  result : — ease,  sleepi  and 
rapid  disappearance  of  all  morbid  symptoms. 

Owing  to  the  complete  control  over  the  element  of  pain  which  the 
hypodermic  injection  of  opiates  appears  to  give,  I  have  been  able  to 
carry  on  the  necessary  treatment,  in  an  interesting  case  of  uterine 
disease,  which  I  would  otherwise  have  been  obliged  to  treat  under 
chloroform,  or  at  a  great  disadvantage.  The  patient,  a  young  Ger- 
man lady  of  twenty- four,  came  to  Mentone  last  autumn,  by  direction 
to  her  medical  attendants,  with  the  view  of  spending  the  winter  in 
the  south.  She  was  considered  to  be  suffering  from  neuralgia,  ficisl 
and  general,  and  from  nervous  irritability  of  the  system  in  general. 
She  had  been  traveling  with  her  husband  from  place  to  place,  from 
bath  to  bath,  in  search  for  health,  for  more  than  two  years.  On  be- 
ing consulted,  I  recognized  the  existence  of  a  host  of  uterine  symp- 
tons,  and  found  that  the  neuralgia  and  nervous  illness  had  manifested 
itself  after  a  severe  confinement,  which  had  occurred  about' three  years 
ago.  The  discovery  of  inflammatory  ulceration  of  the  neck  of  the 
womb  gave  the  key  to  the  state  of  ill  health.  Singularly  enough, 
none  of  her  previous  medical  attendants  had  suspected  the  uterine  ori- 
gin of  the  neuralgia.  Such  cases  are  always  very  difficult  to  treat; 
interference  with  the  uterfne  lesion  all  but  invariably  rouaing^he  nea- 
ralgia.  I  have  repeatedly  had  cases  of  the  kind  that  I  could  only  ex- 
amine and  treat  locally  by  giving  chloroform  to  the  full  surgical  ex- 
tent on  each  occasion,  and  this  I  have  had  to  do  twenty  or  more  times 
in  the  same  patient. 

With  the  patient  in  question  the  surgical  treatment  of  the  ulcera- 
tion was  borne  tolerably  well  at  first,  but  as  the  diseased  surface  be- 
came more  healthy,  and  consequently  more  sensitive,  endurance  di- 
minished. Every  time  the  sore  was  touched,  severe  neuralg^  fol- 
lowed, and  the  general  health  began  to  flag.  In  former  days  I  should 
have  suspended  all  treatment,  and  have  sent  the  patient  to  the  countiy 


^864;]  EdiUmal  AhOrocU  and  SeUditrnt.  607 


a  couple  of  tnonths  to  allow  the  nerroas  syBtem  to  calm  down, 
to  let  natare  do  her  best.       In  this   instance  snch  a  conree  was 
t  desirable,  my  patient  being  yery  anxious  to  continue  the  necessa- 
^^  treatment  so  as   to  be  locally    cured  before  we  separated  in  the 
ring.     I  thought,  therefore,  of  the  hypodermic  treatment,  and  tried 
injection  of  thirty  minims  of  the  solution  of  morphia  immediately  i 
r  each  uterine  dressing.     This  cour&e  was  attended  with  complete 
ss  ;  no  neuralgia  ensued,  and  I  have  been  able  to  continue  nn- 
rruptedly  the  treatment  now  all  bat  brought  to  a  successfal  is- 
On  ono  occasion  I  omitted  the  precaution,  and  was  sent  for  at 
o'clock  at  night.     I  found  the  patient  a  prey  to  the  most  distress- 
attack  of  facial  neuralgia,  which  had  come  on  an  hour  before.    She 
s  positively  convulsed   and  shrieking  with  agony.       Cblorodyne, 
phuric  ether,  &c.  had  been  taken,  with   no  relief.     1  injected   the 
irty  minims  of  morphia  solution,  and  in  twenty  minutes   she  wa 
~m  and  free  from  pain.     It  was  repeated  next  day,  and  the  facial 
ralgia  has  not  i-eturned.       This  lady  will  no  doubt  gradually  re- 
ver  her  health  and  get  rid  of  the  neuralgia   when  the  uterine  dis- 

is  thoroughly  cured. 
In  a  case  of  pure  neuralgia,  attacking  first  one  and  then  another 
^lart  of  the  body,  I  have  injected  from  twenty  to  thirty  minims  of  the 
acetate  of  morphia  solution  forty-two  days  in  succession,  without 
Mmj  unfavorable  result.  The  neuralgia,  which  was  very  severe,  was 
entirely  subdued  by  it  for  about  eighteen  or  twenty  hours,  when  it  re- 
appeared, gradually  increasing  in  intensity  until  the  injection  again 
'Upslieved  it.  At  the  end  of  that  long  period  the  pains  gave  way,  the 
treatment  having  been  either  cnrative,  or  having  allowed  the  neural- 

S'c  attack  to  wear  itself  out.  During  the  entire  period  of  treatment, 
e  patient,  a  very  delicate  lady,  slept  better  than  usual,  ate  as  well, 
<(her  appetite  being  usually  bad,  and  the  digestive  powers  weak),  and 
"was  able  to  take  part  socially  in  all  that  was  going  on  aronnd  her. 
}7o  one,  indeed,  was  aware,  except  her  family,  that  she  was  suffering 
from  so  painful  a  malady.  To  my  surprise,  I  was  able  to  suspend 
the  morphia  suddenly,  without  any  of  the  distress  and  discomfort 
^rhich  is  habituallv  observed  when  opiates  have  been  long  used  and 
are  abruptly  abandoned. 

From  what  I  have  seen  of  the  hypodermic  system,  I  believe  that 
its  use  is  capable  of  great  extension  m  the  treatment  of  pain  general- 
Ij.  1  consider  that  the  injection  of  a  solution  of  morphia  after  any 
operation  would  deaden  pain,  and  produce  a  general  calm  of  the  sys- 
tem both  soothing  and  beneficial  to  the  patient.  I  think  also  that 
this  result  might  be  obtained  in  most  cases  without  the  usual  draw- 
back of  opiates  taken  internally. 

Some  years  ago  I  recommended  in  this  journal  the  injection  of  opi- 
um^into  the  rectum  as  a  means  of  modifying  and  even  arresting  obsti- 
BAie  sea-sickness.  Since  then  various  additional  cases  have  come  un- 
der^my  notice,  illustrating  its  efficacy.  The  great  difficulty  to  all  edi- 
fication in  sea-sickness  is  the  fact  that  the  stomach  ftbsorbs  finids  with 
diflfisruUy.  By  injecting  subcutajieously,  this  difficulty  is  got  over, 
moreover,  a  subcutaneous  injection  would  be  managed  easier  on  shi^i 


508.  JBdUwral  AhitracU  and  SeUdkm.  [AogiA 

board  than  the  rectal  injection,  lo  which  moat  people  bere  a  rerj  ait* 
nral  antipathy. 

I  have  used  all  bat  exclusively  a  aolotion  of  acetate  of  morphia  ii 
diBtillcd  water.  Nine  grains  dissolved  in  two  onncea  of  water  aim 
a  strength  abont  equivalent  to  that  of  landanam.  The  liqoor  Mm*- 
phiae  of  the  phaimacopoea  contains  spirit,  and  I  have  found  thaik 
constantly  occasions  small  patches  of  painfol  inflammatioii,  withoiK 
the  spirit  on  the  contrary,  it  appears  to  be  qaite  ianocaoiia.  j^  *Md' 
erate  bized  steel  needle  or  canula  I  find  preferable  to  the  aniall  gell 
one.  The  steel  canula  is  sharper,  and  passes  easier  through  tk 
skin.  Ny  pinching  firmly  the  fold  of  skin  that  has  to  be  piaroed  be- 
tween the  finger  and  thumb,  its  sensibility  to  the  pancture  is  neck 
diminished.  It  does  not  seem  to  matter  much,  as  regards  leselti^ 
in  which  region  of  the  body  the  injection  takes  place-  I  hayepria- 
I  cipally  chosen  the  praecordial  region  for  aterine  and  general  paia,  ui. 
for  local  neuralgia  a  spot  as  near  to  the  region  affected  as  pomiUi- 
— London  Lancet.  — _ 

MATERIA  MEDICA.  - 

10.  Oxygen  at  a  Therapeutic  Agent ^-J)tb,  Demn^afguarj  and 
Leconte  publish  their  observations  on  properties  of  the  ozygeasi 
a  therapeutic  agent.  If,  at  the  commencement  of  this  ceataiTt 
when  it  was  first  studied  by  physicians,  it  had  been  applied  to  tat 
proper  cases,  its  uses,  onr  authors  observe,  would  not  have  hen 
so  easily  abandoned.  One  of  the  cases  in  which  oxygen  would  be  de- 
^cidedly  hurtful,  is  that  in  the  existence  of  inner  sores,  or  focuses  of 
inflammation;  oxygon  in  such  cases  revives  a  sensation  of  pain  is 
the  inflamed  regions,  within  a  few  days.  Still,  the  physician  mtj 
even  derive  some  advantage  from  the  exciting  property  of  oxygen,  is 
order  to  change  the  nature  of  the  inflammation.      Oxygen  has  alsot 

i)owerful  effect  on  the  heart,  because  it  generally  renders  the  circala- 
ation  more  active.  Hence,  it  should  not  be  administered  to  old  men, 
in  whom  a  disturbed  circulation  is  found  to  exist.  Persons  predis- 
posed to  hemorrhagia  should  not  breathe  oxygen  ;  nor  those  who  ire 
in  a  feverish  state.  But  as  to  the  cases  in  which  the  inhilation  of  ox- 
ygen  should  be  had  reoonse  to,  there  is  scarcely  any  limit  to  them; 
for  so  long  as  a  man  can  breathe  it,  this  agent  can  be  adminiHtered ; 
while.  On  the  other  hand,  the  power  of  absorption  of  the  stomack, 
the  organ  to  which  recourse  is  always  had,  is  limits.  Oxygen 
ought  to  be  inhaled  in  cases  of  anaemia,  chloro -anaemia,  diptheria, 
and,  generally,  in  all  those  cases  in  which  it  is  necessary  to  afford 
strength  to  the  patient.  Under  the  influence  of  oxygen,  and  in  a  very 
short  time,  if  age  and  the  general  state  of  health  permit  it,  the  pa- 
tient regains  his  vigor  and  appetite  to  such  an  exteut  that  patients 
have  been  heard  to  call  for  something  to  eat  during  the  night ;  th« 
lips  soon  become  red  again,  a  greater  vitality  becomes  apparant,  and 
many  nervous  symytoms  disappear  under  the  influence  oi  this  agent 
On  the  other  hand,  sores  become  more  inflamed.  In  a  cose  of  cronp* 
in  which  the  patient^  a  child,  had  undergone  the  operation  of  traohae- 
otomy,  a  large  blister,  covered  with  diptheric  membranes^  was  cleans- 


1864.]  JSdUorial  AbsiracU  and  SeUciloiu.  500 

ed  by  the  action  cf  oxygen  ;  bnt  a  week  later  this  agent  had  to  be  dis- 
continacii*  the  blister  having  become  inflamed.  The  child  recovered. 
Our  authors  state  that  the  action  of  oxygen  is  rapid,  that  they  have 
never  admiuistered  longer  than  for  thirty  or  fortv  days  at  a  time,  and 
that  in  most  cases  it  was  discontinued  at  the  end  of  fiflteen  or  twenty 
days,  to  be  resumed  in  the  course  of  a  feif  days. — Med.  and  Sur^i" 
cal  Reporter, 

11.  Oeneration  of  Oxygen, — Mr.  Robins,  the  analytical  chemist  has 
JQst  discovered  an  easy  way  of  obtaining  oxygen.  It  simply  consist 
in  heating  chomate  of  potash  and  peroxide  of  barium  with  dilute  sul- 
phuric acid.  The  operation  is  performed  in  a  common  glass  retort, 
at  the  ordinary  temperature.  Now,  that  ozygen  is  becoming  a  valu- 
able therapeutic  agent,  this  method  of  obtaining  it  will  be  found  far 
preferable  to  the  old  one,  which  consists  in  heating  peroxyde  of  man- 
ganese in  iron  retorts. — Med,  and  Surgical  Reporter, 

12.  nerapetUicnl  Application  of  Electro-  Oalvaniam. — The  therapeu- 
tic application  of  electro-galvanism  is  albo  attracting  considerable  at- 
tention. In  applying  a  current  of  electricity  to  the  human  frame, 
the  object  is  to  act  upon  the  static  electricity  in  the  body.  By  the  ap- 
plication, for  instance  of  tne  positive  pole,  the  corresponding  electrici- 
ty contained  in  the  body  is  set  free  and  circulates  in  larger  quantities 
in  the  nerves,  the  combination  of  the  positive  current  from  the  apar- 
atns  with  the  negatives  in  the  body  forming  a  neutral  cpmpound. 
An  opposite  result,  of  course,  follows  the  application  of  the  negative 
pole. 

The  normal  current  circnlatin;]^  in  the  nerves  should  be  increased 
when  there  is  a  deficiency  of  electricity  in  the  system,  and  decreased 
when  there  is  an  excess.  In  health  there  exists  a  certain  quantity 
of  electrical  fluid  in  the  nerves,  which  is  increased  or  diminished  by 
disease.  In  those  cases  which  require  an  increase  of  electric  activity 
to  supply  the  deficiency  of  the  current  in  the  nerves ;  the  negative 
electrode  must  be  placed  cither  on  the  spinal  column,  the  forehead' 
the  temples,  or  nape  of  the  jiapo  of  the  neck ;  and  the  positive  ap- 
plied to  the  hands,  feet  or  abdomen,  according  to  the  part  aflected, 
which  it  is  to  bring  as  much  as  possible  under  the  direct  influence  of 
the  electric  fluid.  In  those  cases  which  require  the  quantity  of  elec- 
ricity  circulating  in  the  nerves  to  bo  diminished,  the  positive  pole 
must  be  place<l  on  the  back,  the  negative  on  the  part  eflected.  Chron- 
ic affections  of  long  standing,  reqniro  persevercnce  in  the  continued 
aae  of  the  remedy  ;  and  there  arc  few  onses  but  which,  if  they  do  not 
absolutely  yield  to  its  influence,  at  least  derive  some  benefit  from  it. 
In  general  debility,  the  employment  of  the  electric  current  is  invari- 
ably beneficial.  It  must  be  applied  chiefly  to  the  back  when  the  de- 
bility is  general,  and  to  or  as  near  as  possible  to  the  part  aflected, 
when  it  is  more  local. 

Dr.  Froriep  has  met  with  ffreat  success  in  treating  incontinence  of 
nrine  with  electricity.  His  plans  consists  in  introducting  the  electric 
fluid  by  one  pole  into  the  bladder,  whilst  the  other  is  applied  over 
the  pubis.  Electro  galvanic  currents  have  been  successfully  applied 
to  tne  bladder,  where,  from  orer  distinction  during  labor,  it  has  lota 


510  JSdiUmal  Ahitradi  and  Sd0eiUm$*  f^^gvlt 

tho  power  of  expelling  its  contents,  requiring  the  daily  use  of  tht 
catheter.  The  electric  current  speedily  restores  the  organ  to  the  dt- 
minion  of  the  will.  ♦  ♦  W.  H. 

— JHfed.  and  Surg.  lUporter* 


SURGICAL.  ' 

lb.  JVeaiment  of  Permanent  Stricture  cf  the  Urethra  2y  SmdimlKb' 
tion. — The  following  communication  from  the  Chicago  JUmiKcal  Jmf 
nal,  hv  Dr.  Wm.  B.  Slavter,  of  Chicago,  will  be  read  with  mneli  ii- 
terest  by  the  profession,  as  the  treatment  by  **  sudden  dilation/'  sr 
more  properly  speaking,  forcible  rupture  of  strictures  by  instmmsili 
with  expanding  blades,  has  not  met  with  general  favor  in  this  eon- 
try  or  in  Europe',  on  account  of  the  danger,  or  unpleasant  consaqusMM 
to  be  apprehended  from  such  a  yiolent  mode  of  treatment.  Sneh  «p" 
prehensions  are  in  a  ffreat  measure  groundless.  We  are  taught  vii 
experience  that  in  gradual  dilation,  the  attempt  to  advance  too  speedi- 
ly produces  pain,  constitutional  irritation,  and  frequently  inflskBise* 
tion,  followed  by  additional  depositions  of  plastic  deposit,  inciessiig 
the  contraction,  yet  we  aro  inclined  to  the  opinion,  that  these  nnforti-. 
nate  complications  result  from  the  misapplication  of  the  maohsniflil 
dilating  power.  In  the  use  of  Mr.  Holt's  instrument  the  dihtiig 
force  acts  at  right  angles  with  the  urethra,  and  with  just  foree  enoap 
to  accomplish  the  desired  object,  dispensing  with  the  additiosai 
tbrasting  force  required  when  t^e  dilating  power  is  applied  in  thi 
direction  of  the  axis  of  the  urinary  passage.     He  remarks  : 

*^  Of  all  diseases  of  the  urinary  organs  which  fall  to  the  lot  of  tb 
snrgcon,  permanent  stricture  of  the  urethra,  perhaps,  is  the  most  st- 
noying  and  tedious  to  the  patient  and  most  troublesome  to  the  medi- 
cal attendant,  and  it  is  for  this  reason  that  I  feel  called  upon  to  bring 
before  the  profession  of  this  city  a  mode  of  treatment  which  has  bees 
sanctioned  and  adopted  by  many  of  the  principal  surgeons  of  Greet 
Britain,  among  whom  may  be  mentioned  Professor  Fergnsson  of 
King^s  College  Hospital,  London,  Mr.  Skey  of  St.  Bartholomew'it 
Mr.  Cutter,  and  numerous  others  of  world-wide  reputation. 

"  This  treatment  consists  in  a  forcible  and  sudden  dilation  of  tk 
stricture  by  means  of  an  instrument  invented  by  Mr.  Holt  of  the  the 
Westminister  Hospital,  and  with  which  in  the  space  of  a  few  tecondi 
the  largest  size  catheter  may  be  passed  into  the  bladder  without  the 
slightest^difficulty. 

"  Strange  to  say,  this  treatment  has  received  very  little  attention  is 
America,  and,  with  the  exception  of  one  or  two  Surgeons  in  New 
York — 80  far  as  I  know — has  not  been  alluded  to  by  any  Ameriesa 
writer.  The  instrnment  itself  consists  •  of  two  portions :  first,  two 
solid  silver  branches  of  the  shape  of  an  ordinary  bougie,  grooved  in- 
ternally, and  firmly  attached  to  each  other  at  the  point ;  at  the  handb 
is  at  screw  by  which  they  are  compressed  together  to  the  siae  of  a  Ne. 
8  catheter,  and  between  the  two  is  a  silver  wire  which  serves  se  s 
gnide  for  the  statight  hollow  dilator  with  which  the  stricture  is  bunt 


JSdUoriQl  Abtiracts  and  SelecHont.  511 

ing  to  the  size  of  the  instrnment  it  ia  impossihle  to  use  it  tiiitil 
reoD  has  succeeded  in  passing  a  No.  3  catheter  through  the 
i,  and  then  it  may  he  omplojed  in  the  great  majority  of  cases 
the  least  fear  or  hesitation.  In  some  cases  this  treatment  has 
}pted  when  only  a  No.  1  catheter  could  he  passed,  hut  the  in- 
t  used  has  heen  of  smaller  dimensions  than  the  ordinary  one. 
I  following,  then,  is  the  mode  of  procedure,  after  the  snrgeon 
needed  in  passing  a  No.  3  catheter  :  The  branches  being  tight- 
ed  together  are  passed  through  the  stricture  into  the  bladder  ; 
I  then  unscrewed,  and  the  largest  size  dilator,  No.  10  or  11,  is 
pushed  down  through  the  stricture  on  the  silver  guide.  The 
ent  is  immediately  withdrawn,  a  No.  10  or  11  catheter  passed 
urine  drawn  off.  The  patient  is  directed  to  take  quinine  gr. 
Opii.  m.  X.,  three  times  a  day  for  the  first  twenty-four  hours, 
purpose  of  preventing  any  stricture  fever  coming  on ;  he  is 
)wed  to  empty  his  bladder  withont  the  aid  of  a  catheter  for 
two  days.  A  No.  11  catheter  is  again  passed  on  the  second 
7  alternate  day  for  a  week  or  fortnight,  when  the  patient,  first 
night,  is  directed  to  pass  an  instrument  himself  occasionally. 
!  modus  operandi  of  the  instrument  has,  I  think,  been  concla- 
roved  by  the  following  experiment,  which  Mr.  Holt  quotes  in 
k  on  stricture  :  A  man  died  in  hospital,  I  believe,  from  dis- 
thc  chest,  and  at  the  time  of  his  death  was  the  subject  of  a 
ht  strictare.  At  the  post  mortem  examination  Mr.  Holt  in- 
1  the  dilator  mto  the  bladder,  split  the  stricture,  and  removed 
s.  The  fibrine  forming  the  strictnre  was  found  to  be  com- 
burst  open,  but  the  mucous  membrane  lining  the  urethra  re- 
quite  uninjured.  The  hemorrhage  after  this  operation  is  very 
;  in  the  majority  of  cases  amounting  to  half  a  dozen  drops, 
rery  rare  instances  to  a  teaspoonfol. 

f  great  advantages  of  this  over  the  ordinary  mode  of  treatment 
ual  dilation  are  :     Ist.  The  rapidity  with  which  a  stricture  is 
2nd.  It  is  less  liable  to  return  after  this  treatment.     3rd.  Its 
freedom  from  danger. 

The  rapidity  with  which  a  strictnre  is  cured.  As  I  have  he- 
ed,  any  ordinary  permanent  structure,  provided  a  No.  3  cathe- 
be  passed,  may  be  cured  in  a  fortnight ;  whoreas  by  the  ordi- 
ithod  it  very  often  takes  months  before  a  patient  can  dispense 
)  doctor.  This  saving  of  time  is  certainly  an  immense  ad- 
,  especially  in  cases  where  fistulse,  abcess,  irritation  or  chronio 
lation  of  the  bladder  are  threatened,  or  where  the  complioa- 
e  already  present.  For  by  removing  the  stricture,  these  dis-. 
pidly  get  well. 

-Stricture  is  less  liable  to  return  after  this  treatment^  Stric- 
»wever  treated,  is  liable  to  return,  but  it  has  been  proven  most 
A>n\y  that  it  is  less  likely  to  do  so  after  the  fibnne  has  been 
pen  than  when  gradually  dilated.  In  the  very  few  cases  in 
he  stricture  has  returned,  it  has  been  cleirly  traced  either  to 
ents  neglect  in  not  passing  the  catheter  occasionally,  or  to  his 
)old,  or  too  free  indulgence  in  drink  or  other  excesses.    I  have 


512  Sditorial Aiitraett  and  Sdecliotu.  [Angiut, 

Sean  very  many  cases,  two  and  three  yosn  after  they  Invo  been  op«- 
atoil  npon,  Bn<f  they  have  never  had  the  ali^hleBt  ratiini  of  Ilie  coin* 
plaini  or  experienced  any  diffically  from, it  whatOTer. 

Srrt — Its  perfect  freedom  from  danger.  Wboa  this  treatmeat  _ 
apt  brought  (o  the  notice  oF  the  profcstioR,  all  eartu  of  imajfinar^ 
dangers  atul  difficulties  arising  from  it  ircre  conjoctnreil.  In  iht  find 
place  it  was  said  lliat  (he  pain  of  the  operatioa  woultl  bo  too  painful 
for  most  poople  to  put  up  with.  Mr.  Holt  at  firat  aiminiNtered  chl<»- 
Toforin  ;  lint  Hftor  the  first  few  cases  the  pain  of  thu  opersiioa  «at 
found  to  be  do  very  slight  that  it  was  dincontiaaed,  and  dot,  except 
in  very  rare  instances,  i(  is  never  given:  The  next  objection  waa  that 
it  woidd  necessitate  the  rerirement  of  the  patient  ft'om  his  orditair 
hnsinit^s  foe  some  time  ;  bat  experience  haa  ibown  ihnt  Ibroo  or  foor 
hourM  qniot  after  the  operation  is  all  that  is  neceasary. 

"Some  imagined  that  itiia  apparently  rongh  treatment  might  pre- 
dnce  abcoss  of  ihe  urethra,  eztravasatioo  of  nrlne,  and  even  death. 
Mr.  II>lt  has  operated  on  upward  of  two  hundred  cnse*.  many  of 
which  1  have  watched,  when  House  Surgeon  at  the  Wc^tmioiiiur 
Hospital,  I  also  operated  on  npward  of  fifty  casts,  and  Ihe  onlr 
bad  symptonH  that  have  ever  been  noticed  have  been  a  few  rignr^,  tai 
these  in  a  very  few  cases  ;  and  in  not  a  ai'n^f  iiulanct  has  abcesi  oc 
Other  serious  complication  arisen. 

In  conctnsion,  I  wouKl  say,  after  having  had  a  large  experience  in 
all  kinds  of  troatmcnt  of  strioture,  that  I  batievs  this,  in  the  maiorilr 
of  cases,  to  ,be  the  very  best ;  and  I  am  aatiaSed  that  any  surgMB 
who  gives  it  a  fair  trial  will  be  very  soon  convinced  of  its  juporiority 
and  will  never  have  cause  to  regret  hiving  n«d  it." 

14.  Siillvaiy   Oa'eu'tu. — Dr.    Papin  preseifted  to  di?  Soci«y  __ 
interesting  specimen  of  salivary  calculus,  which  he  hail  removed  ftmn 
the  right  side  of  the  soft  pnlale  of  a  patient  lately  nndor  h'n  e*i«. 
The  pntiont,  a  lady  of  sixty-five  yours  of  ago,  had  anibn.'d  from  slight, 
but  very  oimoying  soro  throat,  fur  two  yoara.     She  had  ooniu'    ' 
physiti-ms  here,  but  being  informed  that  it  wis  nflihing  serious, 
the  treatincut  giving  no  relief,  she  went  to  Now  YorL  und  Phila. 
phia,  nod  ihs  surgeons  whom  she  consulted  there  assured  h^r  tbst  i 
was  only  laboring'  nnder  a  slight  sore  throat — she  wmld  soon  gel  wi 
She  relurned  borne  and  consulted  two  physicians  before   I  ttw  h 
When  Bont  for,  I  found   tlie  patient  very  nerrons,  and  aomewi 
dibilitateJ.     On  eramining  the  throat,  I  found  the  soft  palate  on  i 
right  sido  slightly  red  and  tumid,  and  in  the  central  position  I  noiti 
an  tilcur  with  dark  centre  ;  oa  touching  the  dark  spot,  I  felt  conC- 
thing  bard,  like  bone,  and  substituting  the  dressing  forcepi.  1  ex- 
tracted a  salivary  stono,  whioh  I  now  show  you:     These  seeui  to  Wj 
Tsiy  rare.    I  have  only  heard  of  two  being  m«t  with  in  8l  Lmi 
one  by  Dr.  Pope  and  one  by  Dr.  Phillipa. 


tttnn 


<  •'  - 

/V^''  t-'i^^ 

» 

Wbilltt  Volain».XXX 

b 

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1 

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piuct  A'  (Dbscrbcr. 

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nsv" 

iiIlN  A.  JII1BH11',«.71. 

Hedical  CoUeg^eof  Ohio,  Cincinnati 


tt*L  of  Ifce  Prj . 


P«r  luHbtrltilOmiK 


EYE    STJl 

A'o.  04  &*niM    *MW,  Ar/.-. 

ctyciyxATJ.  oiijo. 


Dr.  Robert  Baxtholcnv, 

(  ImIi  Afi*lant  Sirymn  V.  6'.  A. ) 

Bminfl^dpiWl  liifaiOiii.U.l'-f,  U  lU  Arm.  ..ft^. -,vtft 

'  hM  mi«c*i  into  )>ri^U"  f>"<" ' 
No.  341  ; 


THE 

CINCINNATI  LANCET   AND  OBSERVER 

CONDUCTED  BT 

E.  B.  STEVENS,  H.D..  AND  J.  A.  KURPHT.  H.D. 


Vol.  TII.  BBPTBICBBB.      1804.  ITo.  9, 


<9rii)inBt  0a»»Kttic«Uottf. 


"  The  Chloridet"  in  PiMumonla. 

BT  mOBKET  BAETBOLOW  M.l>.  CIVCIBBATI,  OHIO, 

Source  of  the  CMurides  in  the  Urine, — ^The  chloride  of  podium,  the 
principal  chloride  of  the  nrine,  is  contained  in  conaiderahle  quantitj 
in  various  articles  of  food,  hoth  animal  and  Tegetabla,  but  the  chief 
•onrce  of  it  is  the  table  salt,  which  the  artificial  tastes  of  mankind  have 
exalted  into  a  necessity.     It  does  not  seem  to  be  of  very  great  mo* 
ment  bow  much  of  this  condiment  may  be  consumed  with  the  food, 
for  the  kidneys  easily  and  quickly  excrete  it,  and  it  passes  off  also 
with  the  excrementitious  matters  and  the  intestinal  mucous  eurface, 
Nererthelcss  death  has  been  produced  by  the  ingestion  of  large  qnan* 
titles  of  common  salt  with  all  the  symptoms  of  irritant  poisoning.* 
On  the  other  hand  it  is  quite  possible  to  maintain  the  body  In  per- 
ftct  health  without  the  use  of  this  condiment.  ,  Many  Indian  tribes 
cf  this  continent  have  no  knowledge  of  its  use,  and  white  men  domi- 
ciled amongst  them  have  lost  all  relish  for  it. 

QuaiiUitive  determination  ef  the  ehlaridee.^^!  allude  to  this  very  aim- 
pile  chemical  subject,  lest  some  of  the  readers  of  the  Lcmeet  and  06- 
eereet  may  not  be  familiar  with  the  method  of  detecting  the  chlo 
rUee.  The  urine  to  be  examined  should  be  acidulated  with  colorless 
nitric  acid,  and  then  a  solution  of  nitrate  of  silver  added  drop  by 
drop.     If  the  chlorides  be  present,  a  more  or  less  dense  white  prccip- 

•  V^flor  OD  |»ol0OBt,  p.  19l 


514  Ori^nal  Cammunieatiom.  j^Septambert 

itate  of  silver  is  prcwlaoed.    Th^  reaction  may  be  represented  by  (be 
following  equation : 

Na  Cl+Ag  0  NO  —  Ag  Cl+N  0  NO 

5  5 

The  nitric  acid  used  must,  of  course,  be  free  from  bydro-cbloric . 
this  may  be  ascertained  by  testing  it  with  the  nitrate  of  silver  solation; 
If  the  nitrate  of  silver  test  be  applied  withont  previously  acidulating 
the  urine,  a  precipitate  of  earthy  phosphates  might  confuse  the  reac- 
tion. 

VicarioM  Excretion  of  the  Chlorides. — Heller,  and  afterwards  Si- 
mon and  Redtenbacher  demonstrated  the  disappearance  of  the  chlo- 
rides from  the  urine  in  pneumonia.*  Bealf  of  London  and  Bennet^ 
of  Edinburgh,  by  numerous  clinical  observations,  have  added  to  the 
knowledge  of  this  remarkable  incident  in  the  progress  of  that  disease. 
This  fact  has  now  become  the  common  property  of  the  profession, 
and  the  clinical  history  of  a  case  of  pneumonis  is  incomplete  unless 
reference  is  made  to  the  presence  or  absence  of  the  chlorides. 

The  proposition  may  be  thus  stated :  During  the  progress  of  a 
pneumonia  the  chlorides  (chiefly  chloride  of  sodium)  which  are  nor- 
mal constituents  of  the  urine,  disappear  from  that  secretion  and  are 
found  in  the  sputa,  and  the  return  of  the  chlorides  to  the^urine  is  an 
indication  of  the  resolution  of  the  inflammation.  Why  should  this 
vicarious  excretion  of  the  chlorides  take  place  in  pneumonia  ?  *ihis 
id  a  question  not  to  be  answered  in  the  present  state  of  our  knowl- 
edge. Is  it  confined  to  pneumonia  ?  Or  are  other  inflammations,  or 
injuries  or  diseases  in  the  course  of  which  this  phenomenon  occurs  ? 
Heller  supposed  the  chlorides  to  be  absent  in  other  considerable  in- 
flammations. According  to  Lehman  the  chlorides  disappear  in  acute 
rheumatism,  capillary  bronchitis  and  typhus,  frequently  although  not 
constantly.  Bennett  found  them  absent  in  one  case  of  peritonitis 
and  in  all  the  cases  of  variola  examined.  With  the  view  of  deter- 
mining how  far  the  diagnostic  and  prognostic  indication  of  the  presence 
or  absence  of  the  chlorides  may  be  depended  upon  in  pneumonia,  I 
submitted  to  examination  from  day  to  day  the  urine  of  the  patients  in 
the  West  End  Military  Hospital.  The  cases  consisted  of  typho-ma- 
larial  fever,  erysipelas,  hospital  gangrene,  gunshot  wounds,  acute  and 
chronic  rheumatism,  dyspepsia,  chronic  diarrhoea,  and  chronic  dys- 
entery, and  pneumonia.  A  large  number  of  observations,  independ- 
ent and  comparative  were  made.     The  vicarious  excretion   of  the 

«  Lohman,  Ph/siologlcal  Ghemlstry*  TnnaUt«d  by  Day.    Vol.  11,  p.  ISS. 
t  Tidoioa,  of  M«d.  CUo.  Socitty,  for  1852.    t  Clinical  M«dlelne,  p.  S43. 


1864.]  Bartholow— d/ori!cfe«  in  Pmmroimo.  fjlS 

chlorides  was  not  found  in  %nj  of  the  oftses  except  pDemnonU.  '  This 
is  coQtrary  to  the  opiDioii  of  Heller,  who,  m  before  mentioned,  be- 
lieved the  chlorides  to  be  absent  in  considerable  inflammattona.  It 
is  also  opposed  to  the  assertion  of  Lehman  that  the  chlorides  are  fre- 
quently absent  in  acute  rheumatism.  There  seems  to  be,  therefore, 
good  reason^for  assuming  that  the  discrepances  in  the  observations 
made  on  this  subject,  may  be  due  to  the  unsuspeeted  development  of 
an  intercurrent  pneumonia  in  the  diseases  in  which  it  ie  said,  the 
chlorides  disappdar.  I  have  elsewhere*  shown  the  chlorides  to  be 
absent  in  the  capillary  bronchitis,  accompanied  by  atelektasia  or  lob- 
ular pneumonia,  in  cases  of  camp  measles  ;  but  their  disappearance 
has  been  coincident  with  the  intercurrent  disease  of  the  pulmonary  tis- 
sue. It  may  therefore  be  expressed  in  general  terms  that  the  vicari- 
ous excretion  of  the  chlorides  is  produced  only  in  pneumonia.  If 
there  be  exceptions,  they  are  too  unfrequent  to  seriously  impair  the 
value  of  the  indications  afforded  by  this  sigpi  of  the  state  of  the  pul- 
monary tissue.  ^The  importance  of  this  fact  in  diagnosis  is  obvious. 
In  obscure  cases,  when  the  physical  signs  fail  to  indicate  the  chsrac- 
ter  of  the  diseased  action  clearly,  the  applicition  of  a  very  simple 
chemical  test  may  resolve  the  doubts.  Its  prognostic  value  is  scarce- 
ly less  impoiiant.  By  means  of  it,  I  was  enabled  a  few  days  ago,  to 
discover  the  earliest  period  of  commencing  resolution  in  a  case  of 
pneumonia  of  the  left  lung,  when  the  most  careful  physical  explora- 
tion failed  to  detect  any  change  in  the  lung  tissue— the  general  signs 
being,  also,  most  unfavorable.  The  return  of  the  chlorides  to  the 
urine  is  in  the  nature  of  a  critical  phenomenon.  This  leads  ice  to  the 
question, 

1$  there  a  "  eriih  "  in  pneumonia  f — I  am  qnite^  satisfied  from  my 
own  observation  that  there  is  a  period  in  this  disease  when  a  critical 
evacuation  announces  the  commencement  of  the  return  to  health. 
The  return  of  the  chlorides  to  the  urine  is  usually  marked  by  an  in- 
crease in  the  quantity  of  that  secretion  discharged  and  by  a  diminu- 
tion in  its  specific  gravity.  Concurrent  eriticai  phenemena  are  fre- 
quently observed,  increased  di  (phoresis,  considerable  diarrhcea,  or 
more  abundsnt  expectoration.  In  an  uncomplicated  case  these  criti- 
al  evacuations  occur  at  a  psnod  ranging  from  the  sixth  to  the  twelfth, 
day. 

The  prei^nt  belief  in  the  occasional  occurrence  of  critical  dischargee 
is  a  revival  in  a  modified  form  of  the  Asdepiadan  doctrine  of  Goctiov. 

_  —        — — ^ 


518  Original  eammunicatiom.  .  [September, 

eoeta  non  ervda  9unt  medieanda.  Celsus*  gave  in  his  adhesion  to  thi« 
doctrine,  m  later  times/Sydenhani.f  also.  AAer  falling  into  discredit 
it  reviTed  again,  bat  the  modern  doctrine  does  not  inclade  the  Pytha- 
gorean dogma  of  critical  days  represented  by  certain  numerals  and 
mnltiples  of  these.  Crises  occar  at  yariable  periods  evei^  in  the  same 
disease,  but  the  phenomena  manifested  in  many  instances,  are  in  strict 
harmony  with  the  Hippdcratic  idea  of  present  humors  ripened  for  dis- 
charge. Now  the  reappearance  in  the  nrine  of  the  chlorides,  although 
they  are  not  cocta,  signals — so  to  speak — the  elaboration  and  dis- 
charge of  morbific  matters.  Every  practical  physician  should  there- 
fore daily  test  the  urine  of  his  cases  of  pneumonia,  not  only  for  the 
valuable  diagnostic  and  prognostic  indications  thereby  afforded,  but 
also,  to  learn  the  time  for  critical  evacuations  which  he  may  hasten, 
encourage  or  imitate. 


i»  • 


imTISLS  II. 


Rvpture  of  the  Anterior  Portion  of  the  Fundus  Uteri  in  Parturition. 

BT  6TEPBSH  BOHKIR  M.D.,    CIHOIKVATI. 


On  the  evening  of  the  28th  of  July,  ult.,  I  was  summoned  to  at- 
tend Mrs.  W.,  aged  24  years,  a  stout,  rather,  robust  woman,  in  her 
first  labor.  I  found  her  with  very  active  and  efficient  expulsive  pains, 
with  the  OS  dilated  to  its  utmost.  Membranes  tense  and  strongly  press- 
ing against  the  perineum.  With  a  view  to  facilitate  the  labor,  I  rup- 
tured the  membranes,  when  the  head  decended  and  fairly  occupying 
the  inferior  strait,  promised  a  speedy  termination  of  the  case.  At 
this  stage  of  her  labor ,  and  whilst  having  a  very  hard  pain,  she  was 
suddenly  seized  with  what,  from  her  interrupted  respiration,  seemed 
to  be  a  spasm  of  the  diaphram,  and  she  immediately  placed  her  hand 
over  the  epigastric  region,  and  complained  of  pain  in  that  part.  Hav- 
ing my  fears  that  some  accident  had  occurred,  I  passed  my  hand 
over  the  abdomen ,  and  when  on  the  part  indicated,  to  my  consterna- 
tion, I  came  in  contact  with  a  foot  of  the  child,  which  had  jnst  es- 
caped through  the  fundus  uteri.  On  making  this  discovery,  I  imme* 
diately  dispatched  a  messenger  for  my  instruments,  telling  my  patient 
that  I  should  have  to  deliver  her  as  soon  as  possible.  Meanwhile  I 
occupied  my  hands  over  the  fundus,  making  firm  pressure  laterly  and 

«  Celaw  De  Medicin*  Lib.  III. 
t    dohedvU  MoBiton. 


1864.]  HoomiSpcUsd  Fe9$r.  ,  617 

downward,  so  as,  if  possiblo,  to  prevent  a  further  widening  af  the 
rapture,  in  which  effort  I  think  I  was  saccessfnl.  The  instruments 
having  arrivad,  and  owing  to  the  favorable  position  of  the  head,  Ca- 
voring  a  reailj  and  easy  application  of  the  forceps,  I  had  the  good 
fortune  to  deliver  a  fine,  healthy  boy,  weighing  10  ft,  in  probably 
less  than  half  an  honr  after  the  accident  took  place.  The  pla^ienta 
being  brought  away  by  traction  on  ihe  cord,  a  firm  contraction  of 
the  uterus  followed.  A  bandage  carefully  appplied,  and  anodyne  ad- 
ministerad,  and  our  patient  made  as  comfortable  as  possible,  I  left 
her  for  the  night. 

In  this  case  it  was  most  fortunate  that  the  rupture  was  so  aoon  dis- 
covered, and  her  delivery  so  speedily  acc/)mplished.     I  also  consider 
it  fortunate  that  the  membranes  had  been   ruptured  and  the  liquor 
amni  allowed  to  escape,  else  a  portion  of  it  might  have  found  its  way 
into  the  cavity  of  the  abdomen  ;  the  result  of  which,   pritonnl  infla* 
niatiou,  would,  no  doubt,  in  a  short  time,  have    terminated  in  death* 
lliis  is  the  fifth  case  of  rupturo  of  the  uterus  which  came  under  my 
notice  during  an  extensive  obstetrical  practice  of  32  years*  and  the 
only  one  that  recovcretl — two  occurring  in  the  hands  of  midwives, 
and  three  whilst  in   attendance  myself.     It  is  now  one  month  since 
my  patient  was  delivered,  and  at  this  time  she  is  in  the  enjoyment  of 
perfect  liealth,  no  unpleasant  symptoms  remaining  as  the  reaaltof 
the  accident. 


4anctB  III. 


Cerebro-S^iiinl  Meningltfs,  or  S^otlei  T^fmr. 

ST  JA1CK8  L  BOOKia,   MJ>.,  CASTLROH,  IHD. 

Cerebro- spinal  Meningitis,  or  spotted  fever,  as  so  ealted,  it,  at 
present,  prevailing  to  an  alarming  extent  in  the  rural  districts  of  the 
United  States.     Particularly  is  this  the  case  in  portions  of  Indiann. 

It  has  been  my  unfortunate  .duty  to  have  to  treat  quite  a  number 
of  patients  suffering  with  this  disease — but  with  very  little  success. 

I  think  the  disease  first  made  its  appearance  in  my  vicinity  in  the 
spring  of  1862,  attacking  indiscriminately  all  ages  and  sexes.  Dyphtha- 
ria  was  also  prevailing  as  an  epidemic  at  the  same  time,  and  in  this 
connection  I  will  8ay  that,  in  many  respects,  they  are  similar,  and  no 
doubt  but  many  cases  that  were  recorded  as  dyphtheria,  were  spotted 
fever.  Cerebo-Kpinal  meningitis,  or  spotted  fever,  is  generally  ushered 
in  withont  premonitory    symptoms.     Tbe  patient  is  smxiA^L  VwVi  ^ 


418  Original  Commumcatitms.  [Seitember* 

chill,  pa!n  in  the  head,  stiffness  of  the  innscles  of  the  neck,  a  tendency 
to  opisthotonos,  vomiting,  palse  quick  and  smal! — freqnently  140  per 
minnte, — constipated  howels,  urine  scanty,  high-colored  and  an  ex- 
cess of  the  phosphates,  hreathing  lahorions — breath  fetid,  almost  in- 
tolerable, the  patient  tosses  abont  in  bed,  and  requires  assibtance  to 
keep  under  the  coyer — cries  out  with  a  severe  pain  in  the  foot,  which 
changes  to  the  hand,  is  seized  with  tonic  spasms  of  the  muscles  of 
the  leg.  In  many  cases  there  will  be  loss  of  voice — the  patient  be- 
comes delirious,  thinks  he  is  flying  or  falling  from  some  high  moun- 
tain, calls  piteonsly  for  help, — at  times  perspires  copiously,  and  as 
(he  fetor  of  the  breath  is  intolerable,  by  a  careful  examination  of  the 
extremities,  you  will  detect,  t>ver  those  mupcles  which  have  sufiR^red 
the  most  from  spasms,  spots  of  a  purplish  hue,  about  the  size  of  a 
split  pea,  which  cannot  be  obliterated  upon  pressure  ;  but  this  is  not 
always  the  case,  sometimes  the  spots  are  larger,  and  assume  more  of 
the  character  of  purpurea,  the  longue  ^becomes  dry,  sordes  on  the  teeth 
and  lips,  pain  and  spasms  subside  coma  and  death.  The  patient  may, 
as  I  have  seen,  pass  though  all  these  symptoms  and  die  in  the  abort 
space  of  six  hours.  No  two  patients  are  affected  alike;  the  bowels 
of  one  are  constipated  and  cannot  be  operated  upon ;  while  in  the 
second,  jou  will  find  a  copious  diarrhoea.  One  patient  may  be  seized 
with  loss  of  voice,  hearing  and  sight,  with  almost  complete  opisthot- 
onos. The  case  may  terminate  in  six  hours  or  ten  weeks.  The  symp- 
toms are  so  diverse  ihat  it  is  not  my  intention  to  enter  into  a  minute 
description  of  them,  but  rather  to  content  myself  with  what  I  consid- 
er to  be  ihe  cause  of  this  malady.  About  the  time  this  disease  made 
its  appearance,  there  was  an  epidemic  broke  out  among  the  swine, 
which  has  received  the  appellation  of  ''Hog  Cholera."  A  farmer  with, 
apparently,  a  fine  lot  of  hogs,  will  notice  one  or  many  of  them  at- 
tacked with  "  fits/'  in  some  cases  vomiting,  diarrhoea,  in  short,  all 
the  syraptoms  I  have  enumerated  above  as  in  spotted  fever ;  and, 
probably,  in  the  short  space  of  one  week  he  looses  fitly  out  of  his  hun- 
dred head  of  hogs.  Shortly  aAer  hog  cholera  made  its  appearance 
in  my  neighborhood  (Dec.  25,  '62)  I  was  called  to  a  boy  three  years 
of  age,  of  a  wealthy  family,  who  had  been  in  excellent  health  up  to 
the  day  I  was  called  to  see  him,  I  saw  the  little  patient  in  two  short 
hours  after  he  was  first  attacked,  found  him  vomiting  frequently,  and 
offensive  discharges  from  his  bowels, — pulse  140  per  minute,  pupils 
dilated,  opisthotonos,  which  partly  subsided  at  times,  perspiring  copi- 
ously, body  covered  with  purplish  eruptions  not  to  be  obliterated 
upon  pressure.    The  Bytu^Vom^  %^w^  \sfcft^>Eae  worse,  my  little  sufferer 


1864.]  Ro6nnt— 6H^  ^'Inwr.  7119 

parsed  into  a  comatose  condition  and  died  in  twdve  bonn  after  the 
first  attack.  A  feir  days  previous  to  seeing  this  ease  I  had  lost  some 
hogs  with  the  new  disease,  and  was  at  once  struck  with  the  similarity 
of  the  diseases.  On  making  enquiries,  I  learned  that  the  farmer  with 
whom  my  patient  resided  was,  at  that  time,  loosing  many  of  his  hogs 
from  hog  cholera.  After  this,  I  lost  some  thirteen  of  my  hogs  from 
the  same  disease,  and  I  resolred  on  making  some  post  mortem  exam- 
inations. The  first  was  a  large,  fine  sow,  which  was  attacked  with 
the  nsoal  symptoms  and  died  in  twelve  bourse  On  examining  the 
cutaneous  surface  I  rsadily  detected  an  eruption  identical  to  that  I  had 
seen  in  spotted  fever.  I  first  took  out  the  stomach  and  intestines, 
found  the  mucous  coat  rather  conjested,  hut  in  other  respects  quits 
healthy  ;  but  on  examining  the  A>i^in  aud  spinal  cord,  I  found  an  in- 
flammatory condition  of  the  membrane  of  the  brain,  with  a  serous  ef- 
fusion into  the  ventricles,  the  inflammatory  condition  oi  the  membrane 
extending  the  entire  length  of  the  medulla  oblongata.  I  found  all  the 
rest  of  the  organs  in  a  healthy  condition,  except  the  liver,  which  was 
gorged  with  blood  ;  the  gall  bladder  was  empty.  I  afterwards  exam- 
ined some  five  or  six  cases  in  the  same  way,  and  in  all  found  the  same 
condition.  In  localities  where  "  hog  cholera  "  prevailed,  there,  and 
there  only  have  I  found  spotted  fever.  It  is  a  disease  peculiar  to  the 
rural  districts.  The  physicians  of  cities  have  seen  but  few  eases  of  it. 
I  think  the  disease  is  communicated  from  the  swine  in  two  ways  :  1st, 
by  inhaling  tlie  atmosphere  of  hogs  suffering  from  the  disease,  2nd, 
by  eating  the  meat.  Many  farmers  will  kill  and  eat  the  remainder  of 
their  hogs  that  have  been  spared  from  "  hog  cholera." 

Treaiment  — As  to  treatment,  I  have  but  little  to  say.  Out  of  about 
twenty  cases  1  have  been  directly  and  indirectly  associated  with,  I 
have  tried  the  stimulating  and  tonic  course,  have  known  the  antiphol- 
gistic  treatment  adopted,  dec.  I  believe  the  disease  produced  by  a 
poisoned  condition  of  the  blood,  a  constitutional  disease  and  the  in- 
flamatory  condition  set  up  in  membranes  of  the  brain,  is  only  i^  local 
manifestaton  of  a  constitutional  disease,  as  ulceration  of  Peyer's  glands 
in  typhoid  fever,  and  the  most  rational  mode  of  treatment  is  to  neutral- 
ize and  eliminate  this  poison  from  the  system.  I  also  think  it  of  an 
asthenic  type,  and  would  reccommend  stimulents  and  tonics  from  the 
start.  If  the  patient  is  vomiting  and  suffering  severely  from  pain  and 
spasms,  1  have  found  nothing  so  good  as  to  give  chloroform  by  inhala- 
tion, and  also,  frequent  and  small  doses  internally.  Turpentine  emul- 
aion,  sweet  spirits  of  nitre,  hot  baths,  drc,  Ac;  support  with  beef  tea> 
milk  punch,  and,  after  this  is  done,  in  nine  cases  onl  ol  X^tk^^oi^x  \%>* 


420  Or^tfl  Hmmuirieaiiai^.  [Septemb«r^ 

tient  will  die.  K  mj  hj'pothesis  should  i^ove  oorreoi,  we  m>y  pi»- 
Tent  the  spread  of  this  droadful  mslsdy  by  stopping'  th^  use  of  eo 
much  pork.  It  may  he  that  there  is  i^  similarity  of  hog  cholera  in 
this  country  and  a  like  disease  that  has  prevailed  in  the  Old  World 
among  the  swine.  It  is  well  known  that  persons  who  eat  aanaages 
made  from  pork  containing  the  fle^h-worm,  will  l^e  attacked  with 
tjphus  symptoms  and  generally  die.  Dr.  Muller,  of  Hambai|^ht  in 
the  April  nnmber  of  the  London  Lancet,  for  the  year  1864,  in  describ- 
ing the  disease  of  the  human  family  produced  by  eating  pork  con- 
taining flesh- worms  says,  '*  The  only  important  symptoms  of  typhns 
absent  in  the  disease  is  the  enlargement  of  the  spleen,  and  it  is  very 
probable  that  some  of  the  so-called  epedimies  of  typhus  fever  -of 
former  days  were  caused  by  the  eating  of  pork  containing  flesh*  worms 
in  the  human  body.*'  I  have  not  been  able  to  use  the  microscope  in 
the  examination  of  my  cases,  but  probably  we  might  find  flesh- 
worms  as  the  cause  of  the  disease. 

Since  writing  the  above,  X  have  been  informed,  by  Dr.  Kimberkiji, 
of  Hamilton  county,  that  he  was  called  to  treat  a  case  of  -spotted 
fever,  in  a  tanner  who  cut  his  hand  with  a  knife,  while  dressii^  the 
skin  of  a  hog  which  hud  died  from  hog  cholera.  The  symptoms  in 
his  case  were  well  marked.  The  fetor  of  the  breath  was  almost  intol- 
orable,  and  it  was  the  general  remark  of  the  farmers  who  called  to 
see  him,  that  the  smell  was  identical  with  hog  cholera.  This  patient 
made  a  slow  recovery  in  about  ten  weeks. 


•  »i 


▲mnoLi  ir. 


Strangulated  Hernia— Operation — Intestine  Found  to  have  Peirforatad 
the  Peritoneum  and  Transversalls  Fasola-^Reoovery, 

By  A.  H.  Smith,  Ant.  Surg.  U.S.A.  Lm  Oroeet,  K«w  Mntlco. 


Mr.  S  ,  an  American  ageil  28,  of  robust  constitution  and  temper- 
ate habits,  states  that  shortly  after  a  somewhat  difficult  stool  on  the 
morning  of  December  31st,  he  was  seized  with  a  pain  in  the  groin  of 
snch  severity  that  he  applied  to  me  at  once. 

On  examination  an  elastic  tumor  about  an  inch  and  a  half  in  diam- 
eter wsH  found  occupying  the  situation  of  the  external  ring,  while  a 
continuation  of  the  same  could  be  traced  to  the  internal  ring,  de- 
scending the  inguinal  canal.     The  tumor  was  very  sensitive,  and  the 


1864.]  SuxTB^Strangulafed  Esmia.  421 

taxis  exceedingly  painful.  Patient  iosiitts  that  be  had  had  no  tumor 
in  the  groin  previous  to  this  time. 

An  attempt  was  made  at  once  to  reduce  the  hernia  in  the  asoal 
way,  which  proving  unsuccessful  hot  and  cold  applications  were  ap- 
plied ;  the  first  with  hope  of, relaxing  the  parts  sufficiently  to  permit 
reduction,  whi<^  Taiira^^^eeild  «ppljca(jon8  were  tried  with  the  view  of 
diminishing  the  bulk  of  the  extended  mass.  This  proving  also  of  no 
avail,  the  patient  was  placed  fully  und«r  the  influence  of  chloroformp 
and  the  taxis  again  employed.  This  was  still  unsuccessful,  nor  could 
1  by  any  force  which  I  deemed  it  prudent  to  exert  diminish  in  the  leatt 
the  volume  of  the  tumor.  Previous  to  the  administration  of  the  chloro- 
form vomiting  had  occurred  repcateilly,  but  was  not  of  a  atercoraccous 
character.  The  pain  was  so  atrocious  that  the  patient  begged  mo  to 
proceed  at  once  to  the  operation,  stating  that  death  itself  would  be 
preferable  to  a  prolongation  of  his  suflerings. 

It  being  evident  that  the  only  hope  for  the  patient  lay  in  an  opera- 
tion, a  messenger  was  dispatched  to  Mesilla,  three  miles  distant,  for 
Snrg.  Oliver,  U.8.V.,  who  arrived  within  an  hour.  Chloroform  was 
again  administered  and  the  taxis  employed  by  Dr.  O.,  but  without 
success.  As  night  was  approaching  it  was  decided  to  proceed  to  the 
operation  at  once.  An  incision  was  made  in  the  usual  manner,  and 
the  subcutaneous  fascia  was  divided  with  the  greatest  care.  To  my 
astonishment  tlie  loop  of  iuteatine  waa  found  immediately  beneath  the 
facia  superficial  is  communis,  between  it  and  the  tendon  of  the  exter- 
nal oblique  muscle.  Tkert  toas  not  a  9€Siipi  ^  the  Miual  envolapei  or 
hernial  sack,  nothipg  but  the  faked  gut.  The  intestine  was  found  in- 
tensely congested,  but  its  vitality  seemed  at  yet  unimpaired.  The 
border  of  the  external  ring,  hard  and  tendinous,  formed  a  very  firm 
constriction  about  the  loop  of  intestine,  compressing  it  ao  closely  that 
until  some  of  the  external  fibres  of  the  tendon  had  been  divided  with 
a  scalpel  it  was  impossible  to  introduce  even  the  tip  of  the  little  fin- 
ger as  a  guide  to  the  hernia- knife.  This  first  stricture  having  been 
divided  the  finger  was  passed  along  the  inguinal  canal  to  the  internal 
ring,  where  another  stricture  equally  firm  and  unyielding  waa  en- 
countered. This  having  been  divided,  I  attempted  to  retnru  the  pro- 
truding intestine  into  the  abdomen  but  waa  unsuccessful.  The  exter- 
nal wound  was  then  enlarged  until  the  finger  ceuld  be  passed  through 
and  beyond  the  intestinal  ring,  and  the  nature  of  the  obstruction  dia- 
covered.  It  was  then  apparent  that  the  intestine  had  forced  its  way 
through  the  peritoneum  and  fascia  trausversalis,  and  waa  constricted 
by  the  margin  of  the  hutton-hoU  iVt,  which  it  had  made.    A^  vWt\ 


422  Proceedings  of  Sodettee.  [September, 

application  of  the  hernia-knife  released  the  gat  completely,  and  it  pass- 
ed readily  into  the  abdomen  with  the  chantcterietic  gnrgling  sound. 
The  external  woand  was  now  closed  with  sntares  and  cold  water 
dressings  applied  oyer  which  was  placed  a  bag  of  sand,  making  pres- 
sure over  both  rings  and  along  the  canal.  Opiam  was  given  in  quan- 
tities sufficient  to  keep  the  patient  in  a  state  of  partial  narcotism. 
The  stomach  becoming  exceasiyely  irritable,  the  opium  as  well  as  all 
the  nourishment  taken  by  the  patient  for  the  first  three  days  was  ad- 
ministered by  the  rectum.  During  the  two  days  succeeding  the  op- 
eration the  pulse  ranged  from  120  to  140,  but  there  was  no  tympani- 
tis and  no  tenderness  except  at  the  seat  of  the  wound. 

On  the  seventh  day  the  bowels  were  moved  for  the  first  time  by  the 
use  of  a  cathartic,  assisted  by  an  enema.  The  wound  healed  by  first 
intention,  and  in  three  weeks  that  patient  was  discharged  cared. 

It  seems  almost  incredible  that  a  hernia  of  this  kind  could  have 
been  produced  by  so  insignificant  a  cause,  but  I  have  no  reason  te 
doubt  the  truth  of  ths  patient's  statement. 


■  •■»  » 


'^X9tttfik\XLt^$  0f  9t^t\t\\t%. 


Proceedings  of  the  St.  Louis  Medioal  Society. 

Beported  by  Tbm.  Kkhvaid,  M.D. 

Therapeutical  Action  of  Verairum  Viride. — Dr.  Coons  said  be  de- 
sired to  call  the  attention  of  the  members  of  the  Society  to  the  bene- 
ficial effects  of  the  tincture  of  veratrum  viride,  as  it  still  seems  a  ques- 
tion with  some  physicians  as  to  the  favorable  action  of  this  remedy. 
Dr.  John  Hughes  Bennet,  the  eminent  professor  of  Edinbnrg,  in  a 
communication  to  the  London  Lancet^  states  that  he  has  no  confidence 
whatever  in  its  remedical  effects;  that  it  is  no  antiphlogistic,  as  claim- 
ed, but  injurious  to  the  system.  Dr.  Coons  suid  he  had  used  the  rem- 
edy, for  twelve  or  fifteen  years,  quite  extensively  ;  both  before  Dr. 
Norwood's  paper  upon  the  subject  appeared,  and  more  extensively 
since  ;  and  never,  in  a  single  case,  had  he  been  disappointed  with  it 
It  was  true,  that  in  some  cases  it  had  not  accomplished  all  he  defli^ 
ed,  but  in  every  instance  it  had  been  beneficial.  It  was  undoubtedly 
a  powerful  sedative,  capable  of  reducing  the  pulse  very  rapidly.  Ib 
cases  where  ihero  wa&  ^v^^V  n^t^ous  irritability,  the  pulse  very  irreg* 


1 864]  Procndingi  ^  Stme^.  428 

niar  and  excitable,  at  in  some  cases  of  chronic  pnlmonary  disease,  he 
ha'l  need  it  with  happy  effects  in  the  following  prescription  :  V^  tinct. 
veratnim  viride  m  60,  tinct.  aconiti  radicis  3J8s  JT,  give  with  a  small 
qnantity  of  brandy,  from  three  to  five  times  in  twenty-fonr  hours,  in 
doses  containing  one  minim  of  the  yeratram  viride,  and  continuing 
the  remedy  three  or  four  days,  when  it  calms  the  system  very  much. 
He  had  lately  employed  the  remedy  in  tlie  treatment  of  chordee,  with 
the  very  best  effect.  Ho  combined  it  with  a  small  quantity  of  syrup 
of  ipicao,  and  gave  three  minims  at  bed-time,  repeating  the  dose  if 
necessary.  The  patient  generally  slept  without  trouble.  He  was 
induccil  to  employ  this  for  chordee  in  the  case  of  a  stout  negro  boy, 
18  years  old,  who  had  a  yery  obstinate  gonorrhoea,  and  he  thought 
the  discharge  was  partly  kept  up  by  the  uncontrollable  chordee,  tbe 
erections  having  de6ed  treatment  for  some  time  and  continued  per- 
haps for  as  long  as  two  months.  In  one  night  I  overcame  it  by  this 
remeily,  and  on  continuing  its  use  for  several  nights,  both  the  chor- 
dee ar.d  gonorrhoea  were  cured.  In  another  case  I  cured  violent  gon- 
orrhoea with  this  remedy  alone,  using  it  until  it  produced  nausea. 
The  same  patient  was  recently  cured  a  second  time,  by  this  remedy 
alone,  in  ten  days.  I  have  never  heard  of  veratrum  viride  being  used 
for  this  purpose  before,  and  would  recommend  its  further  trial. 

Dr.  Wm  Johnson  said  he  had  useti  this  remedy  for  several  years* 
and  was  much  pleased  with  its  action  ;  he  had  given  it  often  in  pneu- 
monia when  everything  else  had  failed,  and  with  the  very  best  effect ; 
he  had  given  aj  much  as  four  minums  every  two  hours,  watching 
the  pulse  until  it  was  reduced  to  70  beats  per  minute,  and  never  san^ 
any  injurious  effects  from  it.  He  had  used  it  during  the  past  winter 
in  the  second  stage  of  pneumonia,  complicated  wiJi  delirium  tremens, 
and  obtained  relief  from  delirium  in  one  night.  He  knew  that  Ben* 
net  said  it  was  very  deleterious,  producing  dangerous  depression,  etc.. 
but  he  thought,  though  Bennet  was  a* very  learned  man,  he  was  a  bet- 
ter pathologist  than  practitioner,  and  relied  more  on  nature  than  rem 
adiea  in  every  case. 

Dr.  R.  E.  Bland  said  :  I  have  bad  conMiderable  experience  with 
this  remedy,  have  nsetl  it  for  twelve  years  or  more,  and  fully  endorse 
the  views  atlvanccd  by  Drs.  Coous  and  Johnson.  There  is  one  dis- 
ease* however,  of  a  most  appalling  nature,  in  which  I  have  made  extan- 
sive  ase  of  the  tincture  of  veratmrn  viride,  and  with  the  happiest  ef- 
fects— namely,  puerperal  fever.  We  alt.know  that  if  the  lancet  failed 
to  relieve  bad  cases  of  this  disease  in  its  early  stages,  following  the 
treatment  of  former  days,  death  was  the  almost  inavxlaVA^  iea\!\Xi  vl 


424  Proceedings  of  SocietUi*  [September, 

every  case.  Now,  during  the.past  ten  years,  I  have  employed  liactare 
of  viratrum  viride  in  every. case  which  has  come  ooder  my  treatment, 
and,  witlioQt  q^  single  exccptioiu  with  the  most  charminjg  effect.  Ker- 
cr,  in  a  single  instance,  have  I  failed  to  see  the  disease    yield  to  fcba 

I'm''  '  ^ 

remedy  befoi-o  I  had  reached  the  dose  of  fifteen  drops.  I  commenee 
with  five  drops,  repeating  the  dose  every  three  hours,  and  increasing 
one  drop  every  tiraj  until  it  reaches  fifteen,  unless  vomiting  or  pniy* 
ing  ensues  in  the  m3antimo,  when  it  should  always  be  omitted  tor  a 
while.  I  have  seen  the  pulse  lowered  from  130,  or  evei^  160,  to  165, 
in  the  course  of  twenty-four  hours,  and  with  the  lowering  of  the  pnlis 
all  traces  of  disease  disappears.  I  have  used  it  in  pneumonia  with 
the  veiy  happiest  effects.  Only  a  few  days  since  I  treated  a  case  of 
this  disease  with  it,  giving  fonr  drops  every  three  hours  until  the  dose 
was  increased  to  ten  drops,  and  then  all  fever  and  trouble  in  respin- 
tion  disappeared,  and  in  three  days  the  patient  was  perfectly  well.  I 
don't  pretend  to  explain  the  modus  operandi  of  cure,  but  I  merely 
give  facts  as  that  is  what  wo  want,  and  I  earnestly  entreat  my  pro- 
fessional brethren  to  give  it  a  fnir  trial  in  puerperal  fever,  and  I  assnie 
them  they  will  not  be  disappointed.  Don't  be  afraid  of  it ;  but  if  the 
injurious  effects  manifest  themselves,  use  its  antidotes,  morphine  and 
brandy.  I  have  not  bled  a  case  of  this  kind  for  tcii  years,  and  con- 
sider it  unsafe  and  unnecessary,  now  that  we  have  a  better  remedy  in 
the  tincture  of  veratrum  viride. 

Dr.  Newman  agreed  with  Dr.  Bland,  that  experience  alone  deter- 
mined the  beneficial  effiict  of  a  remedy,  and  thought  the  thera|)entiesl 
value  of  veratrum  viride  had  been  well  established.  It  certainly  acti 
as  an  arterial  sedative,  and  if  we  control  the  action  of  the  heart  wft  j 
accomplish  a  great  deal  in  many  cases.  Dr.  Norwood  reecommeodi 
U9  to  begin  with  eight  drops  for  a  dose,  but  I  consider  this  too  much. 
I  also  think  brandy  acts  as  an  antidote,  counteracts  the  effect  of  thii 
remedy,  which  I  mention  because  Dr.  Coons  lias  used  the  remedy  ia 
combination  with  it  in  certain  cases,  which,  it  seems  to  me,  could  do 
no  good,  but  prevent  the  veratrum  from  acting  at  all. 

Interesting  Fihious  Tumor  of  the  Uterus. — Reported  by  Dr.  0. 
Hurt.  In  the  month  of  October,  1868,  I  attended  the  accouchemed^ 
of  an  unmarried  female.  After  a  labor  of  about  eight  hours,  witb-l 
out  complication,  or  difficulty,  except  such  as  are  usual  to  primipar^tM 
she  was  delivered  of  a  healthy  female  chifd.  After  delivery  tfaiiil 
was  delay  of  the  placenta,  which  induced  me  to  resort  to  frictions  on 
the  abdomen  to  excile  mI^tiii^  eowtr&ction,  and  in  passing  my  hsnl 
over  the  region  ol  t\ie\ilera%»l^\*^o^^t^^^V%\.  ^\.  ^x^v'^u^gested  to 


14]  TrdeeeXnpi  of  S6eiitt€i.  425 

the  idea  of  tlie  head  of  a  wecond  JcUutf  bnt  there  being  no  other 
^ence  of  twins  I  dismissed  that  impressioii,  and  questioned  the  pa- 
It  as  to  her  Rymptoms  prior  to  pregnancy,  which,  if  there  had  been 
'  at  all,  they  were  so  slight  as  to  have  failed  to  attract  her  atten- 
1. 

rhcdelny  of  the  placenta  having  continued  for  more  than  an 
tr,  and  having  administered  ergot  in  large  doses  without  indncing 
rine  contraction,  and,  fearing  some  accident  on  further  delay,  I  pro- 
led  to  remove  the  placentia  by  force.  After  detatching  it,  and 
ile  my  hand  was  yet  in  the  womb,  I  had  no  difficulty  in  grasping 
imor.  which  I  found  attached  to  that  portion  of  the  uterine  wall 
senting  to  the  right  iacro  iliac  Hymphjsis,  of  about  the  sice  of  a 
a^  ornngc,  firm  in  texture,  and  aparently  quite  devoid  of  sen^ibili- 
I  feel  no  hesitancy  in  prononnciog  the  tumor  fibroud,  thougji'  so 
Q  in  texture  as  to  suggest  the  idea  of  fib ro- cartilage. 
[  did  not  operate  for  the  removal  of  this  tnmor,  but  reported  the 
»o  as  one  suitable  for  operation  either  by  ligature  or  the  ecrasseur, 
1  of  the  two  I  took  occasion  to  express  my  preference  for  the  for- 
r,  as  in  my  judgement,  being  the  more  simple,  at  the  same  time 
*nr\g  equal  certainty  of  success  and  less  ribk  of  accidental  injury 
manipulation. 

The  tumor  was  sufTicicntly  pedunculated  to  have  rendered  the  ad- 
tment  of  a  ligature  entirely  practicable,  and  my  only  excuse  for  not 
v\x\g  operateil  is  not  in  being  provided  with  the  necessary  instru- 
>nts.  through  those,  I  think,  could  liave  been  easily  improvised  on 
«  spot,  as  a  bit  of  stout  twine  and  a  piece  of  steel  out  of  an  nm- 
?1I»  frame  would  have  been  all  sufficient  in  the  hands  of  a  practical 
rgeon. 

Case  t/ threatened  Abortion  treatel  with  Chhmftrm, — Dr.  Shumanl 
id  that  sometime  ago  he  was  calleil  to  see  a  lady,  two  and  a  half 
inths  advanced  in  pregnancy,  who  was  sufTering  from  severe  pains 
tho  bn^-k,  accompanied  by  hemorrhage  evidently  uterine.  He  pre- 
ribe<i  opium  and  sugar  of  lead  to  check  the  bleeding,  which,  bow- 
er, hail  no  effect.  T*he  pains  becoming  much  worse,  he  gave  her 
loroform  by  inhalation,  and  very  soon  all  pain  and  hemoiThage 
ased.  t^n  the  next  morning  she  was  somewhat  debililnted,  but  had 
\  retnrn  of  tho  pain.  This  was  six  weeks  ago,  and  there  has  been 
>  tn»ublc  since.  The  lady  has  miscarried  three  or  four  times  before, 
K>nt  the  same  period. 

Placenta  Pracia. — Dr.  Bland  said  thai  a  case  of  nnroidable  hem- 
thage  from  placenta  prsvia,  which  occnrred  in  bis  practice  %o\!&% 


426  Proceedinfft  of  SoeUllu.  [Septamber, 

years  ago,  was  treate4  bj  the  method  since  recoommended  by  Dr. 
Simpson.     Previons  to  the  occnrrence  of  this  ease,  I  noticed  in  sonie 
journal  tlie  suggestion  that  the  hemorrhage  in  these  cases  was  pro- 
duced by  pailial  separation  of  the  placenta,  and  that  the  bleeding  came 
from  the  placenta.     The  idea  suggested  was,  in  these  cases,  to  male 
a  dean  iweep,  completely  detach  the  after-birth  from  the  neck  of  the 
womb,  and  thus  stop  the  bleeding  ;  this  method  seemed  justifiable  to 
me.     I  had  had  these  cases  to  contend  with  before,  and  found,  as  I 
thought,  turning  to  be  inappropriate  in  cases  of  profuse  hemorrhage, 
which  plan  is,  however,  I  believe,  still  pnrs*icd  by  most  obstetricians. 
I  was  called  to  the  wife  of  Mr.  B.,  whom  I  found  lying  in  bed,  very 
much  exhausted  from  sudden  and  profuse  uterine  hemorrhage ;  her 
pulse  was  very  small  and  frequent,  and  she  was  in  imminent  danger. 
She  had  not  suffered  any  pain,  but  was  sitting  on  a  chamber^  whoi  a 
Bttdifen  gu^h  occurred,  which  she  at  first  thought  was  water,  bat  to 
her  horror  and  surpriMS,  fonuil  it  to  bo  blool.     I  immediately  intro- 
duce I  my  han  1,  an  I  foun  1  th)  placeata  detachad  from  the  right  side 
of  the  neck  of  the  womb,  and  irregularly  detached  from  other  por-  4 
tions,  but  extending  over  the  left  portion  of  the  cervix.     I  first  in- 
tended to  turn  and  deliver,  but   remembering  the  suggestion,  I  com- 
pletely detached  the  placenta,  made  a  clean  sweep  of  it,  and  it  imme- 
diately fell  intj  my  hand,  when  I  feared  I  had  committed  a  rash  act 
I  said  to  myself,  I  have  saved  the  life  of  my  patient,  but  the  child 
will  be  dead.     I  had  taken  the  precaution  to  give  large  (loses  of  ergot, 
previous  to  detaching  the  placenta,  and  immediately  after  its  removal 
uterine  pains  came  on  rapidly  ;  the  hemorrhage  ceased,  and  fortunate- 
ly the  child  was  born  alive  and  lived  to  be  ten  years  of  age. 

Since  that  case  happened  to  mc,  I  have  had  several  others,  and  never 
hesitated  to  completely  detach  and  remove  the  placenta,  when  satis- 
fied that  it  was  partly  detahed,  and  thus  would  prevent  or  prodocc 
irregular  contractions  and  h3nce  fail  to  stop  hdmorrhngrt.  I  do  it  ia 
order  the  more  surely  to  save  tho  life  of  the  mother,  even  at  the  ri^k 
of  the  life  of  the  child. 

Dr.  Boislinere  remarked  that  he  must  protest  against  this  method 
of  managing  cases  of  placenta  prcevia,  for  he  believed  that  a  fortuoaie 
result  in  these  cases  is  the  exception,  and  not  by  any  me^ns  the  rnle; 
the  child  must  certainly  perish  unless  born  very  rapidly  after  com- 
plete detachment  of  the  afterbirth,  and  we  know  that  generally  the 
uterus,  after  profuse  hemorrhage  has  occurred,  is  in  a  state  of  inertist 
and  not  likely  to  contract.  Dr.  Bland  was,  1  believe,  snccessfol  is 
his  case  because  the  ergot  which  he  had  previously  given  acted  prompt- 


V 


1 864.]  Proc$ed:nff$  qf  Sod^iiei.  427 

ly,  produced  contractions  of  the  womb,  and  thos  stopped  the  hemor- 
rhage which  conld  not  be  stopped  without  the  uterine  contractions ; 
and  I  believe  in  his  case  the  flow  would  have  been  checked  without 
the  removal  of  the  placenta,  as  soon  as  the  head  was  forced  down 
against  it,  and  the  open  bleeding  vessels  thus  stopped.     I  must  then 
protest  against  this  metkod  of  Professor  Simpson,  as  useless  in  the 
only  cases  in  which  it  can  be  practiced,  as  being  almost  necessarily 
fatal  to  the  child,  and  more  dangerous  than  turning  to  the  mother. 
In  most  of  these  rases  we  had  better  follow  the  old  plan  of  delivery, 
by  turning  ;  which  operation  can  bo  very  quickly  performed,  in  most 
cases,  by  any  one  possessing  an  ordinary  amount  of  skill.     In  all 
cross  presentations,  of  course  turning  is  the  only  method  to  pursue. 
If  there  be  only  a  moderate  hemorrhage,  and  the  head  is  presenting, 
I  generally  rupture  the  membranes,  either  by  hand  or  by  means  of  a 
catheter  and  also  gpve  ergot,  which  produces  pains,  brings  down  the 
h«ad  against  the  placenta,  and  helps  to  check  the  bleeding ;  in  such 
cases,  when  there  is  inertia  of  the  uterus,  I  have  used  galvanism  with 
good  effect.      This  does  in  ordinary  cases,  and  generally  both  the 
mother  and  child  will  be  saved.     The  catheter  is  used  to  rupture  the 
membranes  when  the  placenta  is  completely  over  the  mouth  of  the 
womb.    When  the  hemorrhage  is  excessive,  alarming,  we  have  no  time 
to  wait,  and  had  better  tnm  and  deliver  at  once.     Now,  in  cases 
where  the  bleeding  is  small  and  the  os  uteri  undilated,  but  the  head 
presenting,  we  may  try  the  tampon  ;  but  in  any  other  than  a  vertex 
presentation,  wo  can  not  employ  the  tampon,  but  must  dilate  the 
mouth  of  the  womb,  either  by  insinuating  the  hand  into  it,  or  by 
making  multiple  incisions  of  the  os,  ten  or  twelve  incisions,  which 
will  make  an. opening  for  the  hand;  we  most  then  turn  and  deliver 
ma  quick  as  possible.     The  incision  of  the  os  is  very  safe  in  these  cases, 
and  also  where  there  are  fibrinous  bands  extending  across  the  upper 
part  of  the  vagina,  which  sometimes  occurs,  and  is  very  dangerous. 
Pr.  Bland,  in  reply  to  the  above  criticisms,  said  :  If  I  was  called  to 
a  case  of  unavoidable  hemorrhage,  when  the  os  was  undilated,  I  would 
not  for  a  moment  think  of  trying  to  detach  the  placenta  ;  for  so  long 
as  there  is  a  rigid  and  undilated  os  tincss,  there  is  no  danger  of  death  ; 
but  in  cases  of  exhausting  hemorrhage  and  extreme  danger,  I  recom- 
mend the  complete  detachment  of  the  placenta,  instead  of  turning, 
wli«cli  I  think  is  too  slow.     It  is  in  those  cases  where,  from  partial 
detachment  of  the  placenta,  the  contractions  of  the  womb  are  slow 
and  irregular,  that  I  make  a  dean  twttp  of  it,  for  the  purpose  of  pro- 
ducing regular  contractions.    I  have  had  a  numb?r  of  these  cases,  aad 


428  Proceedings  of  SoeUtUt.  [September, 

never  saw  the  detachment  of  the  pUcenta  fail  to  checlc  the  hemorrhage. 
I  have  of  course  lost  some. 

Dr.  Papin  being  called  npon,  said  ho  had  onlj  had  -three  of  theia 
cases  to  contend  with,  and  in  all  he  delivered  bj  tnming.  The  chil- 
dren were  born  dead,  bnt  the  mothers  did  well.  In  two  cases  the  ofl 
was  fully  dilated  and  the  hemorrhage  excessive ;  in  the  other  the  os 
was  rigid  and  contracted,  and  here  I  made  incisioos,  as  reccommended 
by  Dr.  Boislinere,  I  believe  we  should  give  these  new  methods  a  fair 
trial,  as  they  have  been  recommended  by  reliable  and  very  able  men. 

Dr.  William  Johnston  observed  that  he  must  agree  with  Dr.  Boit- 
linere,  that  unless  the  womb  is  contracting,  we  had  best  turn  and  de- 
liver, for  he  could  not  see  how  removing  the  placenta,  or  aoj  thing 
else  but  uterine  contractions,  could  stop  the  hemorrhage. 

Dr.  Kennard  said  that  one  might  suppose,  from  the  diacassion  we 
have  listene  I  to  upon  this  subject,  that  this  trouble  was   quite  fre- 
quent ;  bnt  fortunately  for  the  human  race,  placenta  pr«via  very  sel- 
dom occurs,  and  except  with  accoucheurs  enjoying  a  very  large  city  or 
hospital  practice,  it  is  indeed  very  rarely  met  with.     According  to 
statistics  I  believe  it  occurs  once  in  every  twelve  or  fifteen  hnmlred 
cases ;  so  that  a  physician  in  private  practice  mast  either  attend  a 
very  lar<^c  number  of  obstetrical  cases,  or  be  an  ill-fated  man,  to  meet 
with  this  accident  many  times  in  his  life.    Dr.  Robert  Lee,  of  London, 
who  I  presume  enjoyed  as  large  a  private  and  consultation  practice 
in  midwifery  as  any  man  that  ever  lived,  reports  in  delai!  the  treat- 
ment of  sixty-three  cases,  which  he  met  with  in  twenty  o^ld  years*  full 
practice  in  the  metropolis,  and  I  suppose  no  one  man  ever  met  with 
more.     Perhaps  not  one-half  the  members  of  this  Society  ever  had  a 
single  case  to  manage,  bnt  this  does  not  detract  from  the  interest  of 
the  subject,  or  the  importance  of  our  remembering  how  we  should 
manage  a  case  when  met  with..    Like  everything  else,   it  must  be 
treated  according  to  the  nature  of  the  case,  and  not  by  any  one  mcthotl 
for  all  cases  ;  for  no  one  plan  is  suitable  for  all.     A  want  of  appre- 
ciation of  this  palpable  fact,  a  lack  of  common  discretion,  is  a  cauf»c 
of  much  disappointment  in  practice.     Being  then  convinced  by  the 
history  of  the  cat^e,  that  the  hemorrhage  is  the  consequence  of  placenta 
prflcvia  that  the  after-birth,  instead  of  being  attached  to  the  uterus 
in  a  normal  way,  is  either  placed  center  for  center  over  the  mouth  of 
the  womb,  or  attached  to  some  portion  of  the  cervix,  and  that  gesta- 
ion  having  proceeded  to  the  sixth  or  seventh  month,  wheix  the  neck 
of  the  womb,  commencing  to  shorten  (as  it  does)  from  the  uterine 
extremity,  as  a  matter  of  necessity,  in  most  cases,  will  begin  to  tear 


( 


1864.]  Proceed^ngn  cf  89eidi$i.  629 

away  the  placenta  from  the  neck  of  the  womb,  and  thns  leaving  the 
ntero- placental  Tessels  open,  will  produce  nnavoidable  hemorrhage. 
Now  if  this  bleeding  happens  between  the  sixth  and  eighth  month, 
and  is  not  very  profuse,*  wo  should  place  the  patient  flat  on  her  back 
on  a  hfird  bad,  in  a  cool  room,  give  her  cooling  drinks  as  lemonade, 
or  lee  her  take  a  few  drops  of  dilute  sulphuric  acid,  in  a  tumbler  of 
ice  water,  or  fifteen  drops  of  the  sulphate  of  the  peroxyde  of  iron  three 
times  a  day  ;  keep  her  bowels  opened  with  small  doses  of  epsom  salts, 
and  never  allow  her  to  rise  from  the  bed,  but  to  avoid  all  causes  of 
disturbance,  physical  and  mental.  If  this  does  not  check  the  bleeding 
and  the  head  presents,  use  the  tampon,  which  in  this  stage,  with  an 
nndilated  os  and  a  vertex  presentation,  cannot  prodnce  internal  hem- 
orrhage or  do  any  harm,  but  may  cause  a  coagulum  of  blood,  be- 
tween the  bleeding  vessels  of  the  cervix  and  the  tampon,  and  thus 
check  the  flow.  If  in  spite  of  these  remedies,  the  blood  continues  to 
flow,  we  must  examine  whether  the  womb  be  dilated  or  not,  and  also 
what  is  the  condition  of  the  placenta.  It  may  happen  that  the  con- 
tractions of  the  womb  have  been  forcible  enough  to  spontaneously  de- 
tach the  placenta,  or  even  extrude  it  from  the  mouth  of  the  womb, 
and  then  of  course  it  ought  to  be  at  once  removed,  and  if  the  head  of 
the  child  i.s  not  immediately  forced  down  against  the  mouth  of  the 
womb,  80  as  to  press  upon  the  bleeding  utero-placental  vesselH,  we 
ought  as  soon  as  possible  to  turn  and  deliver.  If  the  head  below 
down  we  may  deliver  with  the  forceps ;  but  in  every  cross  or  malpo- 
sition, tnming  is  the  remedy.  As  the  hemorrhage  comes  not  from 
the  surface  of  the  detached  placenta,  but  from  the  utero-placental  ves- 
sels, it  would  seem  that  complete  detachment  of  the  placenta,  as  re- 
commended by  Professor  Simpson,  of  Edinburgh,  or  partial  detach- 
ment, as  practiced  by  Dr.  Barnes,  would  only  increase  the  bleeding 
and  make  matters  worse,  unless  the  womb  thereupon  immediately 
contracted  so  as  to  close  these  open  bleeding  vessels.  Ergot  may  be 
used  in  some  cases  of  vertex  presentation,  where  the  mouth  of  the 
womb  is  open  and  the  tampon  has  failed  to  check  the  flow ;  but  if 
there  be  any  mal presentation,  or  the  hemorrh tge  is  profuse,  we  must 
turn  and  deliver,  and  not  wait  for  anything  else.  Dr.  Bedford,  my 
former  Professor  and  one  of  our  most  reliable  and  eloquent  writers, 
aays,  in  esse  the  palliative  treatment  does  not  succeed,  and  hemorr- 
hage is  profuse,  we  must  at  once  turn  and  deliver,  for  time  is  every- 
thing, and  the  sooner  the  womb  is  emptied  the  better  the  chance  of 
saving  both  the  mother  and  the  child.  He  also  recommends  (in 
case  the  placenta  is  placed  center  for  center  ov«t  iVk^  tiiq^>^  ^"l  ^^ 


580  Proaedingi  </  Soeietki.  [SeptamlNr, 

womb»  and  no  deUchment  can  be  discovered),  to  plunge  the  hand  im- 
mediately tbroagh  it  and  bring  down  tbe  cbild ;  to  pay  no  attention 
to  the  placenta  ;  bring  down  the  feet,  deliver  the^hild,  and  then^  if 
the  expulsion  of  the  pUcenta  should  not  promptly  follow,  oarry  up  the 
hand  and  bring  it  away.  Now  it  seems  to  me  if  the  partial  detach- 
ment  was  useful  in  any  case,  it  would  be  in  these ;  for  we  might  not 
only  thus  keep  up  the  connection  between  placenta  and  fostus,  bat  at 
the  same  time  make  room  to  introduce  tlie  hand  and  tarn.  So  it 
seems  to  me,  from  the  teachings  of  experience,  we  most  adapt  the 
means  to  the  nature  of  the  case  under  treatment  Sometimes  pallia- 
tive ti-eatment  will  answer ;  sometimes  the  placenta  becomes  spontan- 
eously detached,  and  this  checks  the  hemorrhage ;  but  in  most  cases 
we  will  act  wisely  to  turn  and  deliver. 

C<ue  of  Placenta  Prcsvia,  vnth  remarkt  by  Dr,  M.  D.  Senier. — ^Bfr. 
President :  I  desire  to  present  a  case  of  placenta  prievia  which  came 
under  my  observation,  belonging  to  that  class  in  which  the  placenta 
is  centrally  attached  to  the  cervical  outlet.  In  the  treatment  of  this 
class  of  cases,  I  fully  sustain  the  position  taken  by  my  friend  Dr. 
Bland,  and  will  add  a  few  observations  to  the  case  detailed  below,  to 
substantiate  my  views.  Mrs.  P.,  an  Irish  woman,  about  28  years  of 
age,  medium  size,  aniemic  appearance,  red  hair,  of  a  nervous  tempera- 
ment, was  taken  in  labor,  and  soon  after  commenced  flooding.  A  mes- 
senger was  dispatched  at  once  for  me,  at  a  distance  of  three  and  a 
half  miles ;  he  stated  that  she  was  flooding  when  he  left.  Upon  my 
arrival,  I  found  her  delirious  from  loss  of  blood,  alternately  laughing, 
singing  and  weeping.  The  pains  were  not  very  frequent  or  strong, 
but  a  gush  of  blood  followed  each,  saturating  the  bed,  and  forming  a 
pool  underneath. 

On  examination  the  os  uteri  was  found  partially  dilated,  perhaps 
two  inches  in  diameter,  disclosing  what  I  had  already  suspected,  the 
placenta,  from  the  center  of  which  the  cervix  had  by  its  expansion 
become  detached,  the  detachment  extending  beyond  the  circumference 
of  the  cervical  opening. 

The  mother's  life  was  in  danger  and  no  time  to  be  lost,  ergot  was 
administered,  and  upon  the  pains  becoming  active,  the  still  attached 
border  of  the  placenta  was  at  once  separated,  and  allowed  to  remain 
till  spontaneously  expelled,  thereby  fulfilling  two  indications  :  1st. 
By  separation,  the  free  expansion  of  the  cervix  was  unobstructed. 
2nd.  By  allowing  it  to  remain,  its  shape  and  position  acts  as  a  wedge, 
facilitating  the  same  object.    The  labor  terminated  favorably,  although 


1864  ]  Proeetduv  of  Soeiitki.  681 

the  patient  was  so  prostrated  that  the  loss  of  a  few  more  omices  of 
blood  would  have  proved  fatal. 

In  this  class  of  cases  (that  is  where  the  plaoenta  is  centrallj  attach- 
ed within  the  lower  or  cervical  Eone)»  I  am  now  more  than  ever  con- 
vinced, that  the  safety  of  the  patient  consists  in  advancing  the  labor 
to  the  commencement  of  the  second  stage  as  speedily  as  possible. 
Here  the  cavity  of  the  n terns  and  the  dilated  vagina  form  one  contin- 
uous canal,  the  cervix  being  mechanically  stretched  or  expanded  by 
the  festal  head,  till  it  forms  a  mere^and  of  circular  fibers  spread  out 
in  the  direction  of  the  canal. 

At  this  stage  the  danger  from  hemorrhige  is  at  an  end,  not  from 
the  pressure  of  the  head  upon  the  open  mouths  of  the  utero-placental 
vessels,  for  they  do  not  exist  as  such,  but  from  a  change  in  the  rela- 
tive condition  of  the  parts.  The  disturbance  of  the  relation  of  the 
tissues  from  the  passive,  mechanical  expansion  of  the  cervix^  being  of 
such  a  nature,  that  the  blood  vesseb  can  no  longer  traverse  its  sub- 
stance as  cylindrical  vessels  capable  of  conveying  blood. 

In  conclusion,  it  may  not  be  uninteresting  to  state,  that  I  after- 
ward delivered  the  same  patient  of  triplets,  and  after  that  still  was 
obliged  to  resort  to  evisceration  and  turning  in  a  shoulder  presenta- 
tion. 

C(ue  of  Rupture  of  the  UUru$.  Reported  by  B.  E.  Bland,  M.D.— 
This  case  happened  several  years  ago,  in  the  country,  about  fifteen 
miles  from  St.  Louis.  In  the  month  of  September,  about  six  a.m.,  I 
was  called  to  the  patient,  a  very  large  woman,  who  had  been  in  labor 
some  time,  but  the  pains  were  not  very  violent,  and  there  seemed  to 
be  no  great  necessity  for  haste.  I  was  warming  my  hands  by  the  fire 
when  the  lady  turned  over  from  her  right  side  to  her  left,  and  in  do- 
ing so  seemed  to  hurt  herself,  as  she  exclaimed,  **  Oh  I  what  a  pain  I  " 
but  as  I  saw  nothing  out  of  the  way,  and  the  pains  not  being  very 
violent,  I  accepted  an  invitation  to  breakfast.  On  my  return  to  the 
patient's  room,  I  noticed  she  had  undergone  a  great  change ;  her 
countenance  was  haggard,  and  she  was  vomiting.  Apprehending 
some  disaster  to  the  uterus,  I  as  soon  as  possible  made  an  examina- 
tion. The  08  was  dilated  somewhat,  and  yielded  easily  to  the  hand, 
but  no  child  could  be  felt.  On  introducing  my  hand  into  the  womb, 
and  passing  it  to  the  right  side,  I  found  a  large  rent,  and  through 
this  opening  I  felt  the  child  in  the  cavity  of  the  abdomen,  into  which 
it  had  escaped  through  the  ruptured  womb.  Following  the  advice  of 
Dewces,  and  having  felt  the  child  also  through  the  abdominal  wall, 
I  attempted  to  deliver  through  the  rent  in  the  uterus ;  but  thft  b^^^% 


582  Proceedings  of  SocteHee.  [Septemler* 

came  in  front  of  the  foetus,  protruded  tbrougb  thld  opening,  and  lo  ob- 
strnctod  it  that  I  could  not  succeed.  I  then  sent  for  my  friend  Dr. 
Morris,  but  be  not  being  borne,  tbe  messenger  brongbt  another  physi- 
cian, who,  on  first  examinatian,  said  be  did  not  discover  the  mptnv ; 
but  I  explained  where  it  was,  and  passing  my  band  again  tbrongti 
tbe  opening,  be  acknowledged  that  be  felt  my  fingers  throagh  tbe 
abdominal  wall.  On  making  a  re-examination,  tbe  doctor  said  be  fUt 
the  placenta  loose  in  tbe  womb,  which  be  would  remove.  I  warned 
him  not  to  do  it,  that  be  was  probably  mistaken  ;  but  he  again  need 
traction,  and  the  substance  came  away  with  his  band,  when  he  said 
he  did  not  think  anything  else  could  be  done,  and  boon  left.  After 
be  was  gone,  I  examined  this,  and  Dr.  Morris  also  saw  it,  and  we 
found  it  to  be  about  eighteen  inches  of  tbe  bowel.  I  do  not  tliink, 
however,  the  amount  of  traction  which  be  employed  would  have  bees- 
sufficient  for  so  disastrous  a  result,  unless  there  had  been  softening 
of  the  bowel.  The  patient  lived  about  two  days  and  a  half  after  the 
rupture  of  tbe  womb  occurred. 

Dr.  Philips  said  be  bad  seen  two  cases  of  rupture  of  the  womb,  in 
both  of  which  Caesarean  section  was  performed.  In  one  case  tbe 
mother  lived ;  in  tbe  other  tbe  mother  died  on  tbe  eleventh  day  after 
operation.  I  believe  it  has  been  stated  that  no  woman  ever  survived 
the  operation  after  ruptured  womb. — St,  Louis  Med,  and  Sury.  Joar, 


■  •»•  ■ 


Royal  Medical  and  Chlrurglcsl  Society. 


A  case  of  prognmlTo  atrophy  of  th«  tongue  and  mnaelet  of  ipMch :  ■Qh«eqaeat  loas  of  pav- 
er :  great  general  airophy :  poit<inortemi  appcarancea.    Bj  Idoae  Baesbb,  Jvx.,  M.R.C.S. 


Since  the  publication  in  the  Medico  Chirurgical  Transactions  in 
1851,  by  Dr.  E.  Meryon,  no  other  case  of  this  description  bad  been 
brought  before  tbe  notice  of  the  Society.  The  subject  was  a  gentle- 
man, aged  fifty-one,  who  bad  enjoyed  excellent  health  till  May,  1856, 
when  a  slight  difficulty  of  speech,  accompanied  by  general  failure  of 
benltb  and  strength,  induced  him  to  seek  medical  advice.  These 
symptoms,  without  any  apparent  cause,  with  the  addition  of  impair- 
ment of  deglutition,  continued  to  increase,  and  on  tbe  following  Sep- 
tember, after  some  months'  residenC'O  at  tbe  sea- side,  tbe  tongue  had 
assumed  the  following  remarkable  appearance :  small  and  shrunken, 
it  lay  low  in  the  floor  of  tbe  mouth,  and  over  its  whole  surface  was 
noticed  an  unceasing  tremuktion  of  tbe  fibrils  of  its  muscular  struc- 
ture ;  it  bad  lost  its  bright  healthy  hue,  and  was  of  a  pale-yellow 


1864]  Proct$dingi  ^  SoeUta.  6SS 

color.  Uis  faoe  bad  also  lost  its  ordinary  expression  ;  the  cheeks  and 
lips  w«re  flaccid,  and  hnng  down.  Saliva  frequently  dribbled  from 
the  mo  (lib.  No  symptom  whatever  of  irritation  of  brain  or  spinal 
cord  was  ever  present,  but  the  muscular  tissue  in  di£ferent  parts  con- 
tinued to  waste  and  degenerate  with  unrelenting  pertinacity.  Grad- 
ually articnlation  became  unintelligible,  and  deglutition  impossible. 
The  fibrillary  tremors  so  noticeable  during  the  wasting  of  the  muscles, 
ceased  with  their  destruction.  From  the  tongue  to  the  muscles  of 
deglutition,  thence  to  those  of  the  upper  and  from  these  to  the  lower 
extremities,  the  disease  extended.  At  length  the  imtercostals  were 
a£fected  ;  and  the  breath  consequently  at  times  became  much  labored, 
as  each  morning  brought  increasing  difficulty  in  the  necessary  expul- 
sion of  mucous  collected  in  the  bronchial  tubes  during  the  previous 
night.  Great  exhaustion  followed  these  attacks,  and  on  the  morning 
of  the  15th  of  October,  1861,  he  gradually  sank. 

Various  remedies  had  been  for  many  weeks  together  tried,  but  none 
seemed  in  any  way  to  arrest  the  steady  outward  progress  of  the  dis- 
ease. Cod-liver  oil,  quinine,  iron  in  various  forms,  sine,  strychnia, 
and  the  constant  use  of  galvanism,  were  the  principal  agents  employed. 

The  post-mortem  examination  of  the  tongue  went  to  prove  that  in 
its  entire  extent  it  had  been  converted  into  a  soft,  pale-yellow  mass  of 
fatty  tissue  The  papillie  were  shrunken,  and  most  of  its  muscular 
fibres  were  replaced  by  oil-globules,  amidst  which  granular  and  fat- 
laden  Gbrcs  were  here  and  there  scattered  ;  and  of  the  muscles  attach- 
ed to  the  tongue,  only  the  genio-hyoglossi  and  stylo-hyoglossi  retain- 
ed any  manifest  traces  of  their  form  and  structure,  llie  nerves  of  the 
tongue,  so  far  as  traceable,  were  natural ;  no  apparent  softening  or 
atrophy  of  them  could  be  detected  ;  muscular  fibre  in  the  arches  of 
the  palato  and  in  the  uvula  were  chiefly  natural,  save  here  and  there. 
The  same  granular  appearance  was  noticed  in  the  pectoralis  major  and 
in  a  portion  of  the  left  ventricle  of  the  heart  and  in  the  left  side  of  the 
diaphragm.  In  all,  the  muscular  fibre  was  in  great  part  natural, 
thou|^h  in  each  specimen  in  an  equal  degree  contained  stray  fibres, 
which  were  losing  the  clearness  of  their  transverse  markings,  and  be- 
coming granular  with  fatty  deposit.  The  ezaminadon,  worked  out 
with  the  gp^atcst  care  and  by  accurate  observers,  failed  to  bring  satis- 
factory evidence  of  any  change  in  the  nervous  tissue  supplying  the 
affected  muscles,  either  in  their  centre  or  peripheric  extremities  ;  but, 
on  the  contrary,  the  examination  tended  to  strengthen  the  ^tMKoX. 
prevailing  opinion  that  the  disease  is  esientlaWj  \iL\\i<b  m^QAC3^»x  CwiKa^ 
itaelC  sod  must  yet  be  looked  upoa  as  ik\ik\to  IViaX  qo\AVa»ilVc»- 


584  Proceedinffi  of  SoeUHei,  [Beptamber, 

quently  met  with  in  the  left  yentricle  of  the  heart,  and  known  as  fattj 
degeneration. 

In  answer  to  a  question,  Mr.  Callender  said  that  the  examination 
was  made  chiefly  hj  Mr.  Paget  and  Dr.  Brown- Seqnard,  bat  he  oonld 
not  say  that  there  was  any  microscopical  examination  of  the  spinal 
cord. 

Dr.  Meryon  said  that  in  a  similar  case  to  that  related  the  spinal 
cord  and  the  nerves  connected  with  it  had  been  examined,  bat  not  the 
slightest  disease  conld  be  detected.  Cmveilhier  had  recorded  three 
cases  of  the  disease,  in  two  of  which  the  spinal  cord  was  not  afiiBcted, 
though  it  was  in  the  third  case.  In  this  patient  there  was  the  same 
tremnlons  action  of  the  muscles.  The  origin  of  the  disease  had  been 
attributed  to  exposure  to  night  air.  Since  his,  (Dr.  Meryon's)  case 
had  been  related  two  brothers  of  the  patient  had  died,  the  last  one 
about  three  years  since.  Dr.  Meryon  then  referred  to  several  cases  of 
the  affection,  iu  none  of  which  had  he  seen  the  tremor  of  the  muscles, 
except  after  the  use  of  electricity.  He  attributed  the  disease  simply 
to  a  breaking  down  of  the  muscular  structures  of  the  part,  and  thought 
it  unconnected  with  nervous  changes.  Medicines  in  these  cases  had 
exerted  little  or  no  influence.  In  one  case,  however,  he  had  giren 
liquor  arsenicalis  for  six  months,  and  the  disease  had  not  progressed. 

Dr.  Gnll  said  that  the  cases  referred  to  by  Dr.  Meryon,  and  the  one 
under  consideration  were  not  at  all  similar.     Dr.  Meryon's  was  a  cla^ 
occurring  among  young  people,  and  the  muscular  degeneration  was 
somewhat  analogous  to  the  rickets  in  bones.     The  case  of  Mr.  Barker 
was  of  another  kind  ;  and  considering  that  no  microscopical  examina- 
tion had  been  made  of  the  7th  and  lingual  nerves,  it  was  valueless  in 
respect  to  the  cause  of  the  disease.     He  entered  his  protest  against 
the  assumption  that  it  was  primarily  dependent  on  muscular  degen- 
eration.    How  did  it  commence  ?     Now,  looking  at  the  fact  that  one 
of  the  olivary  bodies  was  fattened  and  the  anterior  pyramid  altered  in 
form — the  very  eye,  as  it  were,  of  the  nervous  centres, — and  taking 
into  account  the  symptoms,  it  would  appear  that  the  disease  had  its 
origin  in  the  nervous  system.     He  had  shown  in  some  lectares  at  the 
College  of  Physicians  that  paralysis  might  begin  in  any  of  the  struc- 
tures of  the  body. 

Dr.  Fuller  had  seen  a  case  in  every  way  similar  to  that  of  Mr. 

Barker,  except  that  it  was  not  fatal.     The  disease  began  in  the  tongue, 

but  the  upper  and  lower  extremities  became  aflfected ;  the  patient  could 

not  walk,  and  could  scaxceV^  W^V.  \v\%  \x«i.TA  \a  \i\%  Ai^nd.    He  was  not 

of  a  strumous  habit,  \>nl  'waa  ^xeVvyajA'S  Ktl  ^o^AV^i^Csi,  v\A^\.t\s^V 


1868']  Pfoatrm^  ^  Bocklim.  585 

ed  the  diseMd  to  great  mental  and  bodily  exiiaaation  oonseqnent  upon 
exertion.  The  symmetry  of  the  diseaae  in  theae  caaea  waa  in  favor  of 
the  opinion  ezpresaed  by  Dr.  OalI»  aa  were  alao  the  eramp  and  some 
other  symptoms  present.  He  (Dr.  Fuller)  had  aeen  another  case 
which  had  likewise  been  attributed  to  great  mental  and  bodily  ex- 
haustion ;  this  case  proved  lataL 

Mr.  W.  Adams  referred  to  a  case  which  had  come  under  his  ob- 
servation in  most  respects  similar  to  that  of  Hr.  Barker,  and  in  which 
the  disease  was  attributed  to  great  mental  distress. 

Mr.  Callender  said  that  some  disease  of  the  nervona  ayatem  was 
expected  to  be  found  in  Mr.  Barker'a  case.  There  waa  certainly  some 
change  in  the  olivary  and  pymmidal  bodiea*  which  were  dightly 
atrophied ;  but  on  careful  microscopical  examination  no  change  of 
structure  could  be  discovered.  Mr.  Barker,  he  believed,  had  brought 
forward  his  case  as  a  clinical  memior  chiefly.  With  respect  to  the 
symmetrical  character  of  the  disease  being  indicative  of  its  nervous 
origin,  he  did  not  think  it  of  so  much  weight.  One  muscle  became 
affected  ;  and  even  in  nervous  affections  the  muscles  on  one  side  were 
often  alone  involved. 


On   tb«  tr«atm«Bt  of  ttrletuv  of  tW  mrtlbn  W  lolMsfauMvt  SlfliloB*    Bj  EC;  4ir 
Dkk,  M.I>. 


[C«miiiinleato4  bj  Wiuiui  Avahi,  Xi^| 

In  1858  Dr.  Dick  published  hie  first  case,  and  in  1855  he  aent  a 
memoir  to  the  Academic  de  Medicine  de  France,  in  which  two  other 
auccessfnl  cases  are  related.  Since  that  time  Dr.  W.  Adams  and  Or. 
Dick's  colleague  at  the  National  Orthopsdio  Hoapilal — Mr.  Alling- 
bam — have  operated  after  the  same  method  with  the  beat  resolt.  Dr. 
Dick  divides  strictures  into  two  classes,  after  their  physical  proper- 
ties — namely,  into  dilatable  and  non-dilatable.  Stricture  asay  occur 
at  any  spot  of  the  urethra ;  but  the  most  frequent  is  the  bulb.  They 
are  less  frequent  at  the  fossa  navicnlaris  and  the  membranoos  por- 
tion. Stricture  is  the  result  of  inflammation,  a  new  tiaaqe  being 
formed  at  the  strictured  spot,  which  is  of  a  ftbrous  nature.  The 
greatest  number  of  strictures  take  the  form  of  atrophy ;  bnt  a  few  are 
met  with  of  the  hypertropic  form.  In  drawing  attention  to  the  shape 
of  the  stricture.  Dr.  Dick  points  out  that  every  portion  of  the  strio- 
tnre  must  be  divided,  because  if  only  the  narrowest  part  ia  divided 
symptoms  of  stricture  will  return.    He  further  aUn4%a  \a  ^MrntCvi^  ^V 


536  Proceedingi  of  SocMei.  IBrptHaJm, 

the  urethra  in  Btriciures,  believing  that  ihe  back  opening  fit  the  atna- 
ture  does  not  correspond  with  the  front  opening.  He  aajs  thai  those 
pathological  changes  are  the  result  of  post-inflammatory  vetractioB. 
Dr.  Dick  passes  in  review  the  different  treatment  of  strietare.  He 
believes  dilitation  by  the  graduated  metalic  bongiea  is  the  safest ;  bat 
there  are  cases  where  dilitation  will  not  give  modi  relief  to  the  pafkit, 
or  sometimes  social  exigencies  urge  the  patient  to  get  radically  cnrad. 
The  different  methods  employed  he  divides  into  three :  1st,  caateria- 
tion  ;  2nd,  splitting  or  tearing ;  3rd.  cutting  strictnres.  And  thi 
cutting  he  subdivides  into  three  kinds — the  internal,  the  extema!,  and 
the  subcutaneous  methods.  He  thinks  cauterisation  the  most  objse- 
tionable,  having  regard  to  the  pathological  anatomy  of  strietum. 
Splitting  he  only  admits  in  a  few  exceptional  cases — ^where  divisioa 
by  the  knife  cannot  be  practiced  with  safety,  where  a  namber  of  stric- 
tures are  closely  following  each  other,  or  where  a  large  part  of  the 
urethra  is  strictures ;  but  even  in  these  there  is  no  certainty  if  the 
stricture  has  been  really  torn  or  forcibly  dilated.  He  cites  two  eases 
of  sudden  death  occurring  after  splitting.  His  other  objection  te 
splitting  is  that  the  pain  is  so  violent  that  resource  must  be  had  to 
chloroform.  Besides  it  is  a  principle  in  surgery  never  to  tear  parti 
when  they  can  be  cut  with  safety.  Dr.  Dick  thinks  that  the  internal 
incision  is  the  most  logical,  having  regard  to  the  pathological  anat- 
omy of  strictures  ;  but  its  execution  has  great  drawbacks.  Heal* 
ludes  to  the  difficulty  of  making  the  cut  at  the  right  spot  with  the  in- 
struments. Incisions  with  those  cutting  machines  are  very  difficult 
to  execute,  as  very  often  the  knife  acts  as  dilator  instead  of  a  cntting 
instrument  when  the  part  is  not  tensely  dilated.  He  objects  to  the 
external  incision  as  being  almost  as  hazardous  an  operation  aa  onttiag 
for  stone.  The  suppuration  afterwards  is  also  long,  consequently 
pyssmia  is  much  to  be  apprehended  ;  besides  the  long  suppuration  is 
yery  likely  to  occasion  great  retraction,  some  cases  of  which  have 
come  under  his  own  observation.  He  comes  now  to  the  snbcutaneeos 
division,  which  he  believes  fulfils  the  indications  of  the  pathological 
anatomy.  The  surgeon  can  attack  directly  with  the  kniie  the  con- 
tracted spots.  He  is  at  liberty  to  make  his  subcntaneous  cut  as  long 
and  as  deep  as  he  thinks  most  suitable  for  the  occasion.  The  exter- 
nal puncture  heals  in  the  first  twenty-four  hours.  The  operation  has 
further  the  advantage  that  chloroform  is  not  require,  the  pain  being 
yery  trifling,  the  hemorrhage,  too,  is  insignificant.  The  snbcutaiieons 
method  is  indicated  not  only  in  severe  strictures  where  dilatation  can* 
not  be  practiced,  but  a\ao,  \Ti  \i\a  ^^Y^xsAWi/vsv  n!siq«a  elastic  strictnies 


865]  Proc$edm^  ^  SSmiMm.  U7 

'hicb  return  after  diliUtion.  He  then  deeeribes  the  mbde  of  opeim- 
on.  Dilatation  mnet  first  be  practiced  to  a  small  extent,  to  enable 
le  operator  to  pass  a  small-grooved  conductor  tbrongb  tbe  strictore. 
To  cbloroform  is  U8ed.  Tbe  patient's  regimen  is  not  cbanged.  In 
'inter  he  confines  bis  patient  to  bis  room  for  eigbt  days  ;  in  summer 
nly  for  three  days.  For  tbe  operation  tbe  patient  is  placed  in  tbe 
OS  it  ion  for  lithotomy.  Tbe  instmments  need  are  a  grooved  condno- 
>r,  which  was  shown  to  tbe  Society  ;  an  ordinary  tendon  knife,  whicb 
»r  strictures  in  the  membranoas  portion  should  have  rather  a  long 
eck,  and  be  a  tenotome  cache  ;  a  good  sized  catheter  in  proportion 
>  tbe  orifice  of  tbe  urethra ;  a  T-shaped  bandage,  an  ordinary  ban- 
age,  sticking  plaster  and  lint.  No  bandages  are  required  for  strio- 
ires  in  tbe  membranous  portion ;  for  tbe  latter  oases  a  large  metallic 
Dugie  is  left  in  the  urethra  after  tbe  operation.  Tbe  patient  placed 
I  position,  tbe  conducting  catheter  is  introdnoed  until  the  two  knobs 
;op  before  tbe  stricture  ;  then  tbe  surgeon  by  skillful  manipulation, 
ides  out  tbe  small  grooved  conductor  (which  was  concealed  in  the 
>nducting  catheter)  through  tbe  strictare.  Tbe  oondacting  inatm* 
lent  being  then  in  position,  tbe  surgeon  delivers  it  into  tbe  band  of 
is  assistant,  telling  him  to  keep  it  gently  but  steadily  against  the 
;ricture.  He  then  feels  outside  tbe  urethra  for  the  two  small  knobs, 
rasps  with  bis  left  band  the  penis  with  tbe  instrument,  and  places 
m  thumb  just  before  tbe  knobs,  having  bis  index  and  middle  fingers 
:  tbe  back  of  tbe  penis ;  be  then  takes  tbe  tenotome  in  his  right  band, 
id  thrusts  it  between  the  two  knobs,  pnsbiug  it  resolutely  through 
le  stricture,  and  divides  it  in  that  tawing  manner  in  which  usually 
mdons  and  fibrous  tissues  are  divided.  He  thinks  tbe  cni  should 
ways  be  from  three-quarters  of  an  inch  to  an  inch  long ;  also  that 
le  knife  should  not  be  withdrawn  until  the  surgeon  !s  quite  eonvinc- 
i  that  tbe  stricture  is  completely  divided.  The  condnoting  catheter 
then  withdrawn,  and  tbe  lint  and  aticking-plaster  placed  on  the 
Kternal  woand,  and  tbe  whole  kept  in  position  by  a  T-abaped  ban- 
ftge,  a  common  roller,  and  a  few  pins.  Tbe  patient  is  then  pat  to 
ed,  and  bis  urine  drawn  off  twice  or  thrice  a  day  when  required  with 
large  catheter.  Dr.  Dick  strongly  objects  to  leaving  a  catheter  in 
le  urethra  after  tbe  operation.  He  now  quotes  four  cases  of  his  own 
id  two  of  Mr.  Allingham's,  all  of  which  were  attended  with  the 
lost  successful  results.  In  them  he  relates  as  a  remarkable  fact  that 
livering  always  took  place,  but  no  bad  results  followed.  The  only 
bse  in  which  shivering  did  not  occur  W4a  that  atV«t  Viiftiavtsium^^ 


588  Special  SeUdkm.  [Septinte, 

fossa  n&vicnlaris.  Another  point  of  importaaoe  on  which  ht  direUi 
is,  that  dilation  with  a  large  metallic  bongie  should  be  practiced  om 
a  week  for  six  months  after  the  operation.— Zondlbii  LatKei^  Aitg.  186L 


»^tt\lk\  »tUt\\%%%. 


An  Artifloial  Vtlum. 

We  have  been  very  much  interested  in  the  appliance  for  oonecting 
the  evils  of  Congenital  Cleft  Palate,  recently  brought  to  the  notice  of 
the  profession  by  Dr.   N.  W.  Kingsley,  dentiat  of  this  city.    Fof 
many  years  the  only  hope,  presenting  itself  to  the  mind  of  the  Wr 
geon,  of  benefitting  this  nnfortunate  class  of  patients  has  been  dN 
operation  of  staphyloraphy,  bnt  it  must  be  confessed  that  the  nemte 
of  cases  in  which  a  good  union  was  obtained,  ercn  in   the  handi  oC 
the  most  skillful  surgeon,  was  so  exceedingly  limited   as   to  harcilf 
justify  the  operation.     Besides,  experience  has  proven  that  bnt  little 
material  benefit  was  derived  from  the  most  successful  operation.    Ui- 
der  these  circumstances,  surgeons  hail  with  gratitude  the  inveatioa  A 
an  apph'ance  which  supersedes  the  operation,  and  prodoces  far  mof« 
desirable  results. 

At  a  meetins;  of  the  Medico-Chirurgical  College,  June  23rd,  Dr. 
Kingsley  was  invited  to  exhibit  his  invention  and  explain  its  applica- 
tion. His  remarks  were  forcible  and  concise,  and  showed  a  thoroagli 
comprehension  of  his  subject,  and  one  of  his  patients  who  had  woo 
an  artificial  velum  but  a  few  months,  proved  by  the  distinctness  of 
his  articulation  to  what  perfection  this  invention  had  been  carried. 
We  here  reproduce  his  remarks  on  that  occasion,  as  the  best  explant- 
tion  of  his  theory  and  application  that  we  have  seen. 

At  a  recent  meeting  of  the  American  Medical  Aasociation,  Dr. 
Kingsley  read  a  paper  on  this  subject,  which  was  ordered  for  publica- 
tion in  their  transactions.     His  remarks,  which  we  give  to  our  read- 
ers, cover  the  ground  of  that  paper.     He  said,  in  snbatance  : 
*         *         ♦         *  I  presume  the  following  positions :    Irt. 

The  only  necessity  of  operating  at  all  is  with  a  view  of  improving  the 
articulation.  2nd.  Th^j  operation  of  staphyloraphy  in  all  decided  fif- 
snros  of  tho  velum  is  without  material  results  in  benefitting  the  speech. 
3rd.  The  only  treatment  now  known  which  can  produce  this  reaalt, 
is  the  filling  of  the  fissure  with  an  elastic  mechanical  appliance. 

In  all  the  cases  lYial  Vivr^  ^om<^  xxuder  my  observation,  I  have  never 
fonnd  a  patient  w\io  e'x\)^Tve\!L<i^^  w^^wxsX  ^\^^Vj  vn  deglution  to 


W.]  Special  8d€€Am$.  639 

Btify  anjr  painfal  or  tediout  operation  for  iU  iiiiprof^iiMnt.  Daring 
e  earlier  periods  of  infancy,  while  the  child  ia  dependant  apon  flnida 
r  nourishment,  serious  difficultiea  do  certainly  exist,  but  long  before 
e  child  has  arrived  at  a  proper  age  for  an  operation  these  difficnltiea 
tve  been  nearly  or  entirely  overcome,  and  I  hare  nerer  conversed 
th  a  patient  who  was  troubled  with  a  regurgitation  of  food,  either 
ii<l  or  solid,  unless  tlie  head  was  inclined  considerably  forward.  I 
)  not  therefore  regard  this  as  so  serious  a  difficnlty  as  to  demand 
remedy  for  the  comfort  of  the  patient.  In  fact  the  physical  com- 
It  of  an  adult  patient  with  congenital  fissure  of  the  palate  is  in  no 
ly  impaired. 

I  consider,  therefore,  that  the  only  difficulty  worthy  of  notice  from 
is  abnormal  development  is  its  effMts  upon  Uie  individuars  artionla* 
»n.  The  voice  is  not  effected  by  it,  but  all  those  elementary  sounds 
articulate  language  which  are  modified  to  a  greater  or  less  degree 
the  velum,  are  more  or  less  defective,  depend  to  some  extent  upon 
)  size  of  the  fissure.  I  conceive,  therefore,  that  the  only  necessity 
*  operating  at  all  is  with  a  view  of  improving  the  speech. 
The  operation  of  staphyloraphy  as  the  true  remedy  for  these  defeetSp 
nld  most  naturally  suggest  itself  to  any  one  but  paKially  acquaint* 
with  the  results,  but  I  believe  it  to  be  universally  conceded  now  by 
"geons  that  the  operation,  while  compelling  the  patient  to  undergo 
evere  and  painful  trial,  is  rarely  successful  in  securing  either  a par- 
l  or  entire  union  of  the  parts,  and  in  all  cases,  be  the  sides  or  the 
lores  ever  so  skillfully  brought  together  by  suture,  it  is  subject  to 
many  accidents  which  cannot  be  provided  ag^inat,  that  it  comes  to 
regarded  as  one  of  the  most  unreliable  operations  the  surgeon  is 
led  upon  to  perform.  Furthermore,  the  only  object  which  justifies 
operation  is  rarely  if  ever,  attained.  When  we  come  to  carefully 
imine  the  mechanical  action  of  tho  parts  involved,  reason  as  well 
the  facts  will  bear  out  this  conclusion. 

The  office  of  the  velum  in  acting  as  a  valve  to  direct  the  voice 
ough  the  oral  cavity,  through  the  nasal  passages,  or  permit  it  to 
s  throngli  both,  must  be  of  that  elastic  nature  and  under  sock  eon« 
1  of  tho  muscles  that  it  must  perform  these  functions  perfisctly,  or 
ny  of  the  sounds  which  form  our  language  will  necessarily  be  de* 
ive. 

n  case  of  cleft  palate,  when  the  parts  have  been  onited  by  sotore, 
las  been  found  necessary,  in  almost  every  instance,  to  sever  cne  or 
re  of  the  muscles  on  each  side  before  the  edges  could  be  brought 
rontact,  and  the  result  is,  even  in  the  most  favorable  case  of  union* 
t  the  septum  thus  formed  is  unnaturally  rigid  and  its  flexibility 
mobility  very  much  impaired  or  totally  wanting.     It  cannot  be 
troMed  as  the  natural  velum,  and  cannot  serve  the  porpoae  of  a 
re  to  diiect  the  voice  one  way  or  another.  Lot  serves  rather  as  s 
:ition  to  divide  the  column  of  sound  as  it  issoes  from  the  glottis, 
uany  instances  rendering  the  articulation  more  defective  than  be* 
the  operation,  as  more  of  the  voice  escapes  through  the  oaTsa,  %sA 
of  it  is  brought  under  the  control  of  tns  Vmf[;«b,\v(i^««o^^a^^«c 
ins. 


510  Spedal  SeUdfimi.  [SeptoAv, 

I  cannot  therefore  come  to  any  other  conolnsion  than  thai  thaop^ 
Rtion  of  staphylorophy  is  uncalled  for  to  improre  deglutition,  and  ii£ 
failure  in  its  results  upon  articulation. 

The  treatment  proposed  to  be  resorted  to  is  the  subttitntioii  of  a 
mechanical  appliance  to  close  up  the  fissure.  All  metallic  obtraaton 
or  other  non-elastic  instruments  adapted  to  the  posterior  narea  aieiM- 
fess ;  tney  can  only  serve  to  plug  the  nares,  and  might  in  aome  lait 
cases,  prevent  the  regurgitation  of  fluids,  but  can  be  of  no  manner  d 
benefit  to  articulation.  It  is  physically  impossible  for  the  speech  to 
be  materially  improved  by  their  use.  The  only  appliance  now  koovi 
which  can  produce  this  result  is  an  elastic  artificial  velum,  filling iki 
fissure  throughout  its  entire  length,  restoring  as  nearly  as  possible  ii 
form  the  natural  dome  of  the  palate,  embracing  the  aides  of  the  fimif 
and  sufiiciently  long  to  reach  during  certain  mnsoular  movements  to 
the  posterior  wall  of  the  pharynx,  at  the  same  time  leaving  abuadanM 
of  room  behind  it  when  in  its  normal  position  for  respiration  and  thi 
passage  of  nasal  sounds. 

Such  an  instrument  as  that  described  has  been  brought  to  sack  s 
state  of  perfection  that  I  have  no  hesitation  in  saying  that  ifc  can  bt 
adapted  to  any  case  of  congenital  finsure  of  the  velum  that  is  nsosOf 
seen,  whether  complioaied  with  a  fissure  of  the  mazillse  or  not  U 
can  be  mtde  so  as  to  be  retained  in  situ,  without  danger  of  misplaei- 
ment ;  can  be  worn  all  the  time  from  the  first  hour  without  disooa* 
fort ;  is  capable  of  being  raised,  and  depressed,  and  contracted  npoa 
itself  by  the  muscles  embracing  it,  and  is  so  simple  that  a  child  cai- 
not  disarrange  it  to  its  detriment.  Such  an  appliance  renders  it  pe^ 
fectly  possible  for  the  patient  to  learn  to  speak  well. 

Lest  these  remarks  lead  to  an  unwarrantable  inference,  let  it  be 
distinctly  remembered  that  speech  is  a  mechanical  function  and  lean- 
ed by  imitation,  and  be  the  natural  organs  of  articulation  ever  so  per- 
fect, their  use  for  that  purpose  is  au  acquirement.  So  with  tneis 
caKes  ;  let  the  restoration  of  the  defective  organs  be  ever  so  remark- 
able,  the  full  benefits  to  be  derived  from  their  use  is  the  result  of  ptr- 
severance  and  time.  The  application  of  this  instrument  to  nearly  a 
dozen  patients  during  the  past  five  years,  and  the  uniform  general  re* 
suit,  justify  me  in  stating  it  as  above. 

The  physical  and  mechanical  difficulties  to  bo  overcome  in  the 
adaptation  of  this  artificial  velum,  are  a  serious  obstacle  to  the  oper- 
ator for,  on  the  nice  adjustment  of  the  instrument  to  all  the  parts  sur- 
rounding the  fissure,  depends  entirely  the  comfort  with  which  the 
patient  wears  it,  and  the  consequent  use  they  will  make  of  it.  It  is 
essential  that  it  should  be  accurately  adapted  to  the  superior  or  hid- 
den part  of  the  cavity,  as  well  as  to  the  inferior  or  more  exposed. 
To  secure  this  adjustment,  impressions  of  the  whole  cavity  are  taken 
in  plaster  of  Paris  ;  these  impressions  reveal  the  conformation  of  all 
those  parts  hidden  fi*om  the  eye,  including  the  floor  of  the  nares.  ths 
inferior  turbinated  bones,  the  vomer,  the  chamber,  and  the  walls  of 
the  pharynx  as  far  down  as  the  fauces.  From  these  impressioDi 
plaster  and  modeVs  ate  mtk^^  \\i  \2tA  ^>kqaI  manneri  to  which  modda 
the  artificial  velum.  \s   a^^ipVi^. 


Special  Sihctians.  641 

material  of  whicb  the  Telam  is  made,  is  elastic  vulcanized 
,  prepared  with  special  reference  to  this  object,  and  possebsee 
lU  flexibility  to  be  carried  by  the  mnscles  in  any  direction  they 
m  it ;  alfK>  anfficient  elasticity  to  regain,  and  firmness  to  keep, 
rinal  position  when  the  muscles  are  relaxed*  It  is  so  delicate  in 
iciurc  that  I  have  never  known  a  single  instance  of  irritation  or 
nation  of  the  tissue  in  contact  which  it,  when  properly  adapted, 
material  is  molded  into  form  and  vnlcanized  in  metallic  moulds, 
roes  f:  om  the  mould  comparatively  finished,  ready  for  use.  llio 
c  mould  is  preserved,  and  the  number  of  vela  for  that  particu- 
e  can  be  multiplied  indefinitely. 

supported  in  $iiu  by  resting  on  the  superior  snrfaoe  of  the  pla- 
maxillary  bone  in  the  vicinity  of  the  apex  of  the  fissure.  It 
ined  by  a  very  simple  attachment  of  gold  connected  with  it 
B  apex,  and  reaching  to  one  or  two  of  the  teeth,  with  sufficient 
round  the  teeth  to  prevent  its  slipping  off.  But  even  the  pres- 
'  natural  teeth  is  not  essential  to  retain  it  firmly  and  properly 
)08ition,  as  in  one  case  which  I  had  under  treatment  the  patient 
•t  a  natural  tooth  in  her  mouth,  and  an  entire  upper  and  under 
irtificial  teeth  was  adspted,  and  to  the  upper  set  of  teeth  wae 
k1  the  artificial  palate,  which  was  worn  with  as  much  saiisfac- 
i  any  case  that  has  come  under  my  observation. 

difliculty  of  obtaining  a  correct  impression  of  those  delicate 
ires  in  their  relaxed  and  quiet  state,  was  a  most  serious  obstacle 
?ess  in  my  earlier  efforts,  and  at  that  time  it  was  my  practice  to 
e  parts  under  a  limited  course  of  training  uotii  they  would  bear 
ng  Homewhat  without  involuntary  motion.  Binee  then  I  am 
kI  that  this  course  was  rendered  necessary  only  by  my  fear  of 
9,  rather  than  from  any  uua?coQnta*>le  irritability  of  the  mucous 
rane.  Wliile  formerly  I  allowed  several  days  to  elapse  before 
)ting  to  get  an  impression,  in  all  my  later  experience  I  have 
the  impression  of  the  whole  cavity  and  its  immediate  surround- 
iictnies  at  one  sitting,  and  rarely  is  any  effort  made  to  swallow 
he  plaster  is  hardened  sufficiently  to  resist  disarrangement, 
re  are  many  points  of  physiological  importance  developed  by 
cperienrep  which  would  be  mosti  nteresting  to  dwell  upon,  did 
nitcd  time  prevent  my  presenting  them  lu  full.  To  some  of 
however,  I  must  briefly  recur. 

t  intelb*ctual  capacity  of  the  patient  exerciaes  a  greater  control 
he  rapi«lity  and  amount  of  progress  in  improvement,  than  tlie 
sr  physical  conformation  of  the  defect.  A  musical  ear,  eulli- 
to  a  niro  distinction  of  sonnds,  is  of  material  benefit  in  making 
ost  of  this  appliance.  The  age  should  also  be  taken  into  con- 
tion,  and  as  early  an  ag^  as  the  patient  would  take  an  interest 
eloping  its  benefit  wuuld  undoubtedly  be  preferable.  The  im« 
r  position  in  which  some  of  the  organs  of  speech  are  placed  in 
orts  of  the  patient  to  articulate  distinctly,  becomes  so  habitual 
30  almost  impossible  to  overcome,  and  manifestly  the  earlier  the 
.  which  this  is  attempted  before  these  habits  become  firmly  ^x^ 
iter.    I  have,  however,  in  one  instance,  adikpW\»xk\T»Vi:^inffci>% 


512  Special  Sdedumt.  [SeptemWr, 

for  A  patient  over  thirty  years  of  age,  and  in  anotliM'  for  <ma  orer 
forty  years  of  age,  both  of  whom  deriyed  very  marked  benefit  from 
use  within  a  very  few  months. 

Again  the  sensitiveness  of  the  Individual  to  the  defect,  the  mortifi- 
cation experienced  in  the  exposure  by  their  speech  of  this  deformkj, 
will  prove  a  powerfal  incentive  to  their  practice  and  the  oonseqosit 
rapidity  of  their  improvement. 

It  is  astonishing  with  what  entire  freedom  from  disoomfort  or  u- 
noyance  the  velum  is  worn  immediately  on  its  introdaction.  I  haw 
never  had  a  patient  where  there  was  any  irritation  or  inflammaliei 
in  consequence  of  wearing  it,  and  only  in  rare  cases  have  they  erv 
experienced  a  lameness  of  the  surrounding  mnscles. 

The  experience  of  persons  wearing  this  velum  is  most  interesting; 
especially  in  the  earlier  stages.  Time  will  not  permit  me  to  give  i 
detailed  report  of  cases.  I  can  only  briefly  state  those  points  wtii 
seem  common  to  them  all.  Its  immediate  efforts  upon  articniatioa  ii 
such — as  a  general  rule — that  the  friends  do  not  understand  thsa  u 
well  as  before.  In  fact  they  seem  for  a  few  days  to  apesk  bitts 
without  than  with  it ;  this  period  gradually  passes  into  the  saeood 
stage,  when  they  can  speak  better  with  it,  than  formerly  without  it 
At  this  point  it  is  noticeable  to  those  who  have  watched  these  dsfd- 
opments,  that  while  the  individual  most  certainly  articulates  iar  ttOR 
distinctly  with  it  then  thej  formerly  did  without  it,  they  also  aitiei- 
late  much  more  distinct  without  it  than  they  formerly  did  withoot,  lo 
that  at  this  second  stage,  as  I  term*it,  it  is  also  impossible  to  shov 
to  a  stranger  any  decided  contrast  of  the  speech  with  it  in  and  with- 
out. But  great  encouragement  is  derived  from  the  fact  that  maniiest- 
ly  to  all,  the  articulation  is,  on  the  whole,  more  distinct  than  fo^ 
mcrly.  In  a  few  months  this  gradually  emerges  into  the  third  stage, 
when  the  patient  has  acquired  far  more  control  of  the  muscles,  ttd 
the  former  mis-use  of  the  organs  is  somewhat  overcome,  the  improve- 
ment is  most  decided  when  the  velum  is  in  situ.  But  when  oot  the 
power  of  articulation  seems  almost  lost. 

Its  efTects  on  deglutition  are  not  remarkable.  Ordinarily  it  pro- 
duces no  annoyance  in  eating  or  swallowing  ;  it  is  tolerated  withont 
inconvenience.  The  patient  never  having  experienced  any  difficoltr 
of  deglution,  cannot  of  course  realize  in  that  direction  any  improve- 
ment. In  some  cases,  however,  the  first  impression  is  that  fluids 
cannot  be  swallowed  as  readily  as  formerly.  This  earlier  experience  I 
soon  passes  into  that  where  they  feel  far  more  comfortable  in  everr 
respect,  with  it  in  than  without  it. — ^.  V.  Med.  Independemi. 


\ 


18C4.]  Special  StUaUm.  548 

Tanioide  PropertiM  •f  Pepo :  Witk  RepopI  oft  Cat«  in  wfcioli  it  wm 

8uoo«Mftilly  llfim 

BT  1.  IXQALf,  ]|J>, 


Pepo,  made  of&cioal  by  the  PharmaeopoBia  of  1860,  has  been  known 
now  for  more  than  a  century,  to  poeaess  properties  destructive  to  the 
Ape  worm.    The  influence  of  the  doctrine  of  sigoatures  is  said  to  have 
first  suggested  its  use  for  this  purpose.     Inasmudi  as  there  was  ob- 
lerved  to  be  a  degree  of  resemblance  between  the  pumpkin  seed  and 
the  joints  of  which  the  body  of  the  worm  was  made  up,  it  was  snr- 
tnised  that  it  would  be  the  proper  remedy  to  be  used  widi  a  view  of 
ridding  the  system  of  this  troublesome  parasite— and  as  fortune  would 
have  it,  a  doctrine  that  has  its  foundation  only  in  ignorailbo  ftod  sn- 
perstitution,  was  in  this  instance  the  parent  of  truth.     But  though 
the  pumpkin  seed  has  been  so  long  known  as  a  remedy  for  tapeworm, 
l^ei  it  has  never  been  extensively  employed  for  this  purpose,  espe- 
eially  in  this  country.     Its  use  was  introduoed  into  the  United  States 
by  Dr.  J.  A.  Smith,  of  Boston,  m  1850. 

Since  that  time  a  considerable  number  of  cases  of  its  suooessful 

employment  have  been  reported  in  our  medical  journals  ;  such  reports, 

coming  mostly  from  physicians  practicing  in  the  Eastern  portion  of 

the  Republic,  and  we  have  reason  to  thiuk  that  the  remedy  has  been 

vsed  there  more  than  at  the  West  or  South.    The  seeds  contain  a 

fixed  oil,  which  may  be  obtained  from  them  by  impression,  and  to 

this  is  said  to  be  due  their  medicinal  virtue.     Some  cases  of  tape 

worm  have  been  successfully  treated  by  the  administration  of  this  oil, 

a  fluid  ounce  being  given  at  one  dose,  to  be  followed  in  two  hours  bj 

some  active  cathartic ;  but  the  oil  is  not  known  to  possess  any  ad- 

vmntages  over  the  seeds  in  substance. 

The  case  in  which  we  used  this  remedy  occurred  in  a  healthy  boy, 
eleven  years  old,  who,  for  two  months  before  his  parents  brought  him 
to  me,  had  been  voiding  a  number  of  the  joints  of  the  worm  daily, 
and  his  previous  symptoms,  as  related  to  me,  justify  the  conclusion 
that  he  had  been  afiSicted  with  it  more  than  a  year,  though  no  treat- 
ment had  been  resorted  to,  as  they  did  not  suspect  the  nature  of  the 
malady.    The  health  of  the  patient  did  not  sum*,  except  that  he  was 
troubled  somewhat  at  night  by  a  cough  of  a  spasmodic  natnre,  and 
the  parents  noticed  that  this  was  always  much  worse  when  the  child 
took  milk  for  his  supper,  and  likewise'that  prompt  relief  was  sure  to 
follow  the  taking  of  some  bitter  substance.     I  directed  that  Sj  of  the 
pumpkin  oeeds  should  be  freed  from  their  shells,  and  then  with  S  ^j 
of  water,  to  be  made  into  an  emulsion,  and  of  this  one-third  was  to 
be  taken  every  hour,  after  fasting  from  supper  until  morning,  and  in 
one  hour  after  the  last  dose  5  ss  of  castor  oil.    As  this  fisiled  to  act 
on  the  bowels,  three  hours  after,  5  j  more  of  the  oil  was  given,  which 
produced  only  a  mild  laxative  effect,  and  this  not  nntil  three  hours 
slier  it  was  taken,  bringing  away  only  about  thirty  segments  of  the 
worm.    This  was  on  Sunday,  and  not  wishing  to  keep  the  boy  from 
his  school,  I  postponed  farther  treatment  nntil  the(o\\oiivn.^%%Xnx^M 


544  Special  Sdeetiom  [Saptcnbo; 


when  I  ordered  the  tame  amoant  of  emnlsion  as  before, 
that  one-half  of  it  he  given  in  the  morning,  fasting,  the  remainder  ii 
half  an  hour ;  and  one  hour  thereafter,  3  xij  of  the  liqaor  magneHi 
citi-atis.  In  a  little  more  than  two  honrs  this  occasioned  actireo- 
tharsis  ;  the  first  three  dejections  containing  only  disjointed  segiMH 
of  the  worm,  bnt  the  next  brought  the  entire  paraaite, « tflsaiaMlinif 
twenty-two  feet  in  length,  but  not  dead. 

I  have  reported  this  caRS,  not  as  anything  new,  bnt  boping  it  wf 
have  some  influence  to  induce  others  to  test  the  rirtnea  of  this  ankk 
To  obtain  a  medicine  that  shall  be  efficient  for  the  cure  of  diseiic;^ 
the  same  time  that  it  is  absolutely  innocuous  to  the  patient,  isi 
desiderzitum  greatly  to  be  desired,  but  not  always  found.  Of  tkii 
remedy  it  is  known  that  its  use  is  neither  unpleasant  nor  injarieHi 
and  it  retrains  only  to  demonstrate  its  effioaoy,  and  it  is  not  naliWf 
that  experience  may  prove  it  to  be  the  best  remedy  for  tapewora,iii 
things  considered  that  we  possess. 

The  following  are  some  of  the  advantages  that  the  pepo  may  pr 
haps  jnstly  claim  over  other  tienifago  remedies  in  common  o«,tf 
the  nialo  fern,  the  bark  of  the  pomegranate  root,  konsao,  oil  of  tor 
pentine,  etc.,  Ist.  To  the  patient  it  is  entirely  harmless,  and  kvi 
unpleasant  to  take.  2d.  In  this  country  it  may  always  be  easily  o^ 
tained,  and  of  a  quality  known  to  be  good.  8d.  To  ua  it  is  indigci- 
ons,  and  other)  things  being  equal,  such  remedies  sboald  be  pi^ 
ferred  before  those  which  are  imported,  especially  in  times  like  iW 
present,  when  the  whole  nation  should  husband  every  resource,  hon- 
ever  trifling,  for  martial  purposes. 

Some  recommend  that  the  remedy  be  given  in  large  qnantitiei,  sol 
during  a  number  of  days,  and  without  the  adjuvant  of  a  cathartic,  f^-: 
the  emuUion  itself  when  thus  administered  acts  as  a  laxative  ;  bi: 
we  think  an  active  cathartic  should  never  bo  omitted,  for  its  open- 
tion  is  capable  of  expelling  a  worm  enfeebled  by  the  effects  of  I'a^ 
medicine,  but  not  to  a  degree  to  ensure  its  death  if  left  in  the  alimeQ* 
tary  canal.  It  maybe  proper  to  say,  that  among  the  people  who 
have  experience  with  domestic  remedies,  there  is  an  opinion  some- 
what prevalent,  that  the  pumpkin  seed  is  an  efficient  remedy  for  tk 
destruction  of  the  ascaridea  lumbricoides,  but  I  am  not  aware  tbit 
this  has  been  confirmed  by  the  observation  of  the  profession. — Chica^ 
Med,  Journal, 


■      •! 


TiichincB  in  Meat — Ii  is  stated  in  the  London  Laneei  that  a  thor- 
ough boiling  or  roasting,  as  also  perhaps  intense  salting  and  smoking, 
will  kill  the  trichinte  ;  bnt  an  imperfect  preparation  by  these  methois 
will  not  effect  the  parasites,  at  least  not  those  in  the  interior  of  tba 
meat.  Even  putrefaction  to  a  certain  extent  will  leave  the  trichia* 
intact. 


1864]  Corrapondenee  545 


LMw  From  Dr.  Parviii* 


LoHDOv,  July  Sib,  1864. 

DiAR  Doctor  : — In  a  former  letter  I  spoke  of  Dr.  Chas.  West  as 
not  now  being  connected  with  anj  pablic  charitj.  I  was  mistaken, 
for  although  he  has  retired  from  St.  Bartholomew's  Hofipital  he  is  still 
one  of  the  physicians  to  the  hospital  for  sick  children.  Great  Osmond 
Bt  Two  visits  made  to  this  institution,  in  Tiew  of  which  I  spent 
an  hour  or  two,  both  in  the  wards  and  in  the  room  where  out-patients 
are  prescribed  for,  impressed  me  with  the  great  value  of  this  charity, 
and  the  advantage  afiforded  by  it  for  acquiring  professional  knowi- 
edge  in  the  treatment  of  diseases  of  children.  The  rooms  are  large, 
well  ventilated,  and  have  numerous  engravings  and  pictures  hanging 
upon  the  walls.  The  wards  are  not  crowded,  and  the  little  patients 
are  abundantly  supplied  with  books  and  toys,  so  that  you  might  al- 
most imagine  yourself  in  some  nursery  of  the  favored  children  of  for- 
tune. There  is  a  pleasant  garden  attached  to  the  building  where  the 
inmates  when  the  weather  and  their  condition  permit  may  spend  an 
hour,  enjoying  the  flowers,  the  green  grass  and  the  pleasant  sunshine. 
Besides,  the  Hospital  has  a  "  Home  "in  the  country  where  the  con- 
Talescents  are  sent  to  confirm  their  recovery,  before  they  again  go 
back  to  their  own  homes. 

The  inmates  during  the  last  year,  (the  Hospital  has  been  in  exist- 
ence twelve  years)  were  five  hundred  and  seventy-one,  and  the  out- 
patients eleven  thousand  two  hundred  and  twenty-four ;  and  the  con- 
tributions for  its  support  were  nearly  four  thousand  seven  hundred 
pounds  sterling.  The  most  liberal  contributor  for  the  past  year  was 
the  queen,  giving  one  hundred  pounds,  and  among  the  many  pictures, 
toysT  etc.,  for  the  pleasure  and  instruction,  or  the  comfort  of  these 
sufferers,  the  queen  again  is  foremost  in  her  contributions ;  nor  have 
her  sons,  the  Prince  of  Wales,  and  prince  Alfred  been  negligent  in 
this  regard,  and  the  Princess  Helena  has  famished,  the  work  of  her 
own  hands,  many  a  pair  of  socks  for  these  little  ones.  While  I  trust 
the  day  is  far  distant  when  we  shall  have  king  or  queen,  lord,  duke, 
or  earl  in  our  own  land — have  any  hereditary  ranks  or  title,  but  still 
preserve  our  republican  institutions,  yet  let  us  remember  that  among 
those  who  contribute  most  largely  to  support,  by  labor  and  by  bene- 
faction, the  many  munificent  charities  of  this  great  city,  are  to  be  reck- 
oned not  a  few  of  those  who  have  title  an&  TanV  ;  ^oia  %t%  >^^\xtw^ 


546  Can€9pimimc9.  [SeplnAii; 

nobility,  who  feel  themselves  but  stewards,  their  position  and  wesltk 
conferriDg  no  immanity  from  laboring  to  relieve  the  sick  and  deid- 
tate,  but  the  greater  responsibility. 

Bat  let  ns  return  to  the  hospital ;  and  yet  why  shoold  I  speak  of  it» 
save  from  a  strictly  professional  point  of  view,  telling  some  eases  I 
saw  and  the  treatment  pursued  ;  for  does  not  every  reader  of  Dickea*! 
**  Household  Words  **  know  of  this  noble  institution  ?  Charles  Did- 
ens  has  indeed  made  by  his  pen,  with  its  rare  touches  of  beauty  aai 
tenderness,  the  Hospital  for  sick  children.  Great  Osmond  St,  a  pieeiooi 
household  word  wherever  his  recent  writings  have  gone.  Bead,  if 
yon  have  not,  his  "  Drooping  Buds  **  and  **  Between  the  Cradle  aai 
the  Grave, "  and  you  will  not  need  lo  know  more  in  regard  to  th 
completeness  of  this  establishment,  and  the  immense  amount  of  good 
it  is  effecting. 

Among  the  cases  of  interest  I  have  seen  there  are  seven  of  cKores, 
the  most  of  them,  I  believe,  under  the  strychnia  treatment,  in  addi- 
tion  they  are  "put  through,''  a  regular  course  of  gymnastio  move- 
ments, in  which  the  various  muscles  are  in  succession  called  into  ex- 
ercise. Dr.  West,  whom  it  was  my  good  fortune  to  accompany  this 
morning  in  his  semi-weekly  visit,  stated  one  source  of  embarrassment 
in  administering  this  drug  to  sick  patients,  there  were  no  premonitoij 
symptoms  of  the  constitutional  affection,  and  evidently  there  might 
be  severe  tetanic  convulsions  ;  indeed  I  saw  a  little  patient  in  whom 
this  accident  occurred  yesterday,  and  death  was  quite  imqiinent  until 
the  house  surgeon  administered  chloroform  by  inhalation,  and  then 
the  convulsion  ceased.  A  case,  that  of  a  little  boy  upon  whom  lith- 
otomy had  been  performed  a  few  days  ,before,  looked  very  unpromis- 
ing, for  rigors  had  occurred,  followed  by  some  fever  and  irregular 
sweating  and  then  severe  pain  in  the  knee,  together  pointing  almost 
with  absolute  certainty  to  pyaemia,  and  I  need  not  say  that  this  dis- 
ease, pus  in  the  Mood,  as  it  is  very  unphysiologically  called,  in  the 
vast  majority  of  cases  is  fatal.  Another  patient,  one  in  whom  Mr. 
Holmes  three  weeks  ago  had  exsected  the  head  of  the  thigh  bone,  wai 
doing  well,  and  everything  promised  a  good  recovery.  Two  litde 
patients,  one  male  the  other  female,  have  had  tracheotomy  performed 
upon  them,  one  for  diphtheria,  the  other  for  spasms  connected  with  the 
chime  of  the  glottis  ;  the  operation  in  each  case  was  done  some  months 
ago,  but  in  one  there  is  contractions  of  the  trachea  above  the  wound, 
and  the  patient  cannot  breathe  without  the  tube ;  of  course  efforts  are 
being  made  to  dilate  the  trachea ;  but  in  the  other  case  there  is 
trouble  higher  up,  the  patient  can  expire  very  well  by  the  natural  pas- 


1864.]  Oorrw^wkhmi.  BiT 

sage,  but  not  intpirt.  This  morniDg  tfib  ktt  pfttieBt  Wm  pdt  ndtr 
the  infiuenoe  of  chloroforniv  it  looked  odd  to  pni  a  child  to  sleep  if 
holding  a  piece  of  lint  a  coDple  of  inches  eqaare,  npon  whiph  a  kiw 
drops  of  the  ansesthetio  had  been  poured,  jost  before  the  throat ;  and 
then  the  solid  oanstio  was  freel j  applied  to  the  upper  anterior  portion 
of  the  larynx. 

Yesterday  at  St.  (}eorge*s  I  saw  Mr.  Holmes,  we  know  him  in  our 
country  from  *'  Holmes'  System  of  Surgery/'  the  fourth  Tohime  of 
which  by  the  way  will  be  issued  in  the  fall-^perform  orariotomy. 
The  ease  attracted  mnoh  interest,  the  amphitheatre  was  crowded  with 
students,  and  there  were  many  eminent  physicisns  and  euigeons  pres- 
ent, and  among  them  one  of  our  own  oonntry*men,  who  seems  as  well 
and  as  favoiably  known  on  this  side  of  the  Atlantic  as  on  that.  Dr. 
J.  Marion  Sims.  Mr.  Holmes  was  sssisted  on  either  side  by  Henry 
Lee  and  Mr.  Polock,  the  last  of  whom,  in  which  he  agrees  with  bst- 
oral  with  whom  I  have  met.  has  a  Tery  pleasant  reooUeetion  of  the 
visits  of  one  of  your  Oincinnati  suigeons.  The  ovarian  eyst,  which 
had  been  punctured  some  two  weeks  before,  was  quite  large,  con- 
tained fully  hslf  a  large  bucket  of  dark  grumons  fluid,  was  multivlo- 
cular  and  bed  nnmerons  attachments ;  but  patiently  and  skillfully  these 
were  broken  up,  a  damp  spplied  to  the  pedicle,  and  the  mis-shapen 
mass  severed  from  its  connection  in  a  little  while  with  silk  sutures 
needles,  adhesiro  strips,  cotton,  and  the  flannel  bandage  were  spplied, 
and  the  patient  conveyed  from,  as  she  was  brought  into  the  operating 
room  entirely  nnconscious.  Mr.  Holmes  speaks  fatorably  of  the  prob- 
able result — the  patient  was  young,  only  twenty -nine,  none  of  the 
contents  of  the  sac  had  entered  the  cavity  of  the  peritoneum,  the 
previous  wound  had  healed  kindly  and  quicUy,  and  her  general  health 
was  good.  He  mentioned  as  a  reason  for  prefering  silk  to  silver 
sutures,  that  in  a  recent  fatal  oase  Mr.  Wells  in  making  a  jMtf  mar* 
tern  found  after  ho  had  cut  the  wire,  (Mr.  W.  had  used  silver  wire  in 
his  operation)  and  while  pulling  it  out  the  peritoneal  adhesion  was 
broken  up  and  a  drop  of  pus  followed  the  wits  and  passed  into  the 
gap  between  the  peritoneal  edges,  and  this  could  not  occur  with  the 
vegetable  ligature. 

So  far  as  I  have  had  an  opportunity  of  obeerving  Ijondon  HoepiCal 
physicians,  I  am  atruck  with  their  practice  resting  upon  physiological 
principles  rather  than  on  empirieal  rules  ;  esperially  is  4his  impressed 
upon  me  by  what  I  see  of  Dr.  Beale's  course  in  his  wards  at  King's 
College  Hospital.  I  need  not  tell  the  readers  of  the  Lamei  rnnd  M- 
Miner  that  Dr.  B.  is  one  of  foremost  physUogista  saDd  vteMi«nQi^«*a.>BSk 


648  Gmrupotidince.  [Septemhr, 

tlM  world,  and  hie  loientifio  atUinmentii  add  all  the  move  to  lua  ikill 
aad  success  as  a  practitioner ;  nor  can  I  forbear  mj  teetimoBy  to  Ui 
manly  worth,  mj  gratitode  to  him  for  his  kindness.  He  ezpeots  to 
visit  our  conntrj  by.  and  bye,  and  I  know  the  same  gvnerone  spirit 
he  manifests  to  others  will  be  shown  him  there  by  the  members  cf 
the  American  profession  whom  he  may  chance  to  meet. 

A  death  occurred  at  the  Middlesex  Hospital  on  Wedneedaj  last,  to 
a  patient  during  an  operation.  The  operation  was  the  lemoval  of  s 
large  tumor  from  the  nose  ;  the  hemorrhage  was  oopiooa,  and  it  wm 
supposed  that  blood  clotting  in  the  larynx,  rather  than  dilorofonn 
was  the  cause  of  death. 

I  think  British  suigeons  are  more  cautious  than  onr  own  in  the  ad- 
ministration of  chloroform  ;  inhalers  that  secure  a  dne  ndmiztwe  of 
atmospheric  air,  are  generally  used,  the  quantity  of  the  ansMthstis^ 
which  is  small  at  one  time,  carefully  measured,  and  the  ansasthesii 
more  giadually  produced. 

Next  month  I  go  to  Paris,  and  then  back  here  agun,  and  henee  to 
Edinburgh  and  Dublin.  t.  p. 


Letter  ft*om  an  Army  Surgeon. 


An  intelligent  medical  officer  in  the  army  writes  us  as  follows  : 
I  have  often  wished  to  write  a  communication  for  the  Lanat  ami 
Observer,  but  the  fact  is,  a  regimental  surgeon  has  no  opportunity  of 
learning  any  thing  worth  publishing  under  the  present  system  in  the 
army  except  in  rare  cases.  As  you  may  be  in  some  degree  unfamiliar 
with  all  the  details  of  the  present  oiganisation  of  the  medical  depart- 
ment of  the  army,  I  will  devote  this  letter  to  a  sketch  of  it ;  for  of 
the  military  operations  in  progress,  I  of  course  know  much  leas  than 
the  newspaper  correspondents  do. 

More  than  three  years  of  bitter  experience  in  this  war  has  taught 
us  many  things ;  and  based  npon  that  experience  many  improvements 
have  been  made  in  the  different  departments  of  the  army.  But  three 
score  years  of  war  would  hardly  suffice  to  bring  the  medical  depart- 
ment up  to  a  rational  degree  of  efficiency  and  system,  at  the  rate  at 
which  it  has  been  progressing.  For  though  changes  have  been  nu- 
merous enough,  from  the  erasure  of  calomel  and  tartar  emetio  from  the 
supply  table,  to  the  institution  of  U.S.Vols.,  yet  improvements  have 
been  lamentably  few.  And  at  the  present  day,  the  system  upon  which 
the  medical  affidrs  of  the  army  are  conducted  is  full  of  inconsiatenciea 


18M.]  C&rr§ipoui§n^.  549 

and  abiorditiea ;  coMequentlf  tlie  important  Aiaidm  expected  of  the 
mrmj  BurgtonB  are  leM  offioientlj  performed  tban  tboy  thovld  and 
might  be.  The  management  of  the  sick  and  wounded  in  the  diriaion 
to  which  I  belong  ia,  I  presnme  in  moat  partieaUra.  similar  in  all 
other  dirisionB  thronghont  the  army.  It  ia  thia ;  A  diriaion  hospital 
ia  eatablished  at  a  safe  distance  in  the  rear,  to  whioh  all  wounded  and 
aick  men  who  cannot  be  txeated  in  their  irgimenta  are  transferred. 
Aa  no  change  of  diet  can  be  obtained  in  the  ngiment,  and  the  only 
quarters  are  the  little  **  pup"  tents,  of  oonrae  no  really  aiok  man  can 
be  treated  there.  Neither  can  any  of  the  wounded,  except  thoae  whose 
injuries  are  of  the  most  trivial  character,  be  kept  with  their  eompa- 
nies  for  tranaportation,  for  even  a  aingle  tin  waah  basin  is  not  allowed. 
The  only  medicine  which  can  be  kept  on  hand  oonatantly  are  eight  ot 
nine  small  bottles  of  opium,  chbroform,  quinine,  oachaftic  pilb,  etc^ 
which  together  with  a  lew  rollen,  a  piece  of  plaster  and  a  oouple  of 
sponges,  are  carried  in  a  field  case  by  the  hospital  steward.  A  medi* 
cine  cheat  or  pannier  is  also  allowed  to  eaeh  regiment ;  but  is  seen 
only  occasionally,  as  it  is  generaUy  carried  in  the  ambulance  train« 
It  becomes  therefore  necessary  to  transfer  all  aick  men  to  the  diTision 
hospital.  Oat  of  some  forty*four  medical  offioen  present  with  thia 
division,  five  are  detailed  to  do  all  tho  work  at  the  hospital— «  sur* 
gton-in-charge,  and  four  aasistant  snigeona  to  attend  to  the  detaila« 
When  an  action  comes  off,  the  medical  director,  I  believoi  rides  to  the 
front  with  the  rest  of  the  staff,  for  the  purpose  of  taking  care  of  the 
General  commanding  the  corps  ;  the  chief  anigeon  of  division  taksa 
care  of  his  (General ;  and  the  brigade  anigeon  doea  the  aame  kind  of* 
fice  for  the  brigadier.  Perhaps  they  alao  wish  to  prove  that  the  doo« 
ton  are  no  less  bravo  than  othera,  although  they  are  non-combatants. 
As  the  wounded  are  brought  back  to  the  boapital  they  are  placed  on 
tbe  tablea  and  operated  on  when  auch  a  proceeding  ia  necessary,  and 
aometimea  when  it  ia  not  But  I  am  aatisfied  more  orron  are  made 
on  the  aido  of  convalescent,  ao-calUd  ;  and  that  many  a  life  is  saeri 
fioed  in  the  attempt  to  aave  a  limb.  Especially  do  I  think  that  re 
aections  of  tbe  bones  and  joints  are  operationa  vaiy  rarely  admisaUe 
in  the  field.  The  idea  of  removing  tha  heel  and  three,  foar,  or  fivn 
indiea  of  the  bunseroa,  in  view  of  the  after  trsatmsnt,  the  caae  ia  to* 
receive,  is  perfectly  preposterous.  Such  operetiona  are  not  at  all  on- 
frequent ;  but  would  soon  become  mudi  more  so,  I  am  aatisfied,  if 
the  operetore  only  knew  something  of  tha  rasnlta.  But  as  in  a  ftw 
hoare,  or  daya  at  farthest,  the  wonndod  are  eiinL\ia«3L\o  ^SbsMuHaA^ 
ga  or  aoDtf  oiker  poitA  on  the  milroad,  iba  o^snioi  MfiMt  ima  ^n»a 


650  \  Chrf99pomdtmee.  [8eptenlNr» 

bears  anything  more  of  them,  and  is  of  oonno  at  libertj  to  fanej  Ai 
most  favorable  result  he  oonld  desire.  We  however  hear  same  ftaifld 
sromors  of  ampntations  at  Chattanooga  following  the  fancj  reseetioas 
at  the  front ;  and  of  still  other  oases  of  resection  going  the  waj  of  sD 
flesh  without  any  farther  aid  from  the  opemtors.  What  I  conoeive  to 
be  a  great  mistfko,  is  the  custom  of  keeping  the  wounded  at  the  front 
for  days  after  being  operated  on,  or  until  inflammatory  action  aid 
suppuration  is  established,  instead  of  immediately  transtering  them  to 
the  permanent  hospitals  at  the  rear,  thus  subjecting  the  unfortunate 
men  to  the  exhausting  and  painful  journey  when  the  system  is  anfilBr- 
ing  from  irritation  and  debility,  and  the  parts  wounded  have  become 
highly  sensitive.  Sometimes  the  early  advance  of  the  army  after  aa 
action,  necessitates  the  immediate  removal  of  the  wounded,  but  I  do 
not  think  I  ever  saw  such  a  prooeeding  carried  out  aa  a  matter  of 
choice.  The  operators  at  the  division  hospitals  are  usually  designat- 
ed but  it  sometimes  happens  from  disinclination  on  the  part  of  indi- 
vidnals  and  other  causes,  that  after  a  time  it  becomes  a  matter  of 
doubt  who  is  to  perform  the  operation,  when  a  case  is  presented  re- 
quiring any  such  interference.  When  an  action  accurs,  some  of  the 
regimental  medical  officers  seek  the  hospital  in  the  rear,  while  othen 
remain  with  the  troops  or  at  the  primary  depots  in  close  proximity  to 
the  line  of  battle.  And  this  selection  of  posts  of  duty  seems  to  be  in 
great  part  optional-with  individuals ;  nnless  in  the  cases  of  those  who 
consider  themselves  the  regularly  detailed  operators.  Others,  again- 
seem  to  feel  at  liberty  to  retnm  to  the  hospital  only  when  men  belong, 
ing  to  their  regiments  are  wounded  and  sent  there.  This  circum- 
stance they  consider  sufficient  authority,  or  excuse,  if  you  will 
for  appearing  at  the  hospital  themeelves.  At  some  of  the  hospitals, 
gentlemen,  ambitions  to  distinguish  themselves  as  operators,  "  go 
in  "'indiscriminately  at  the  tables  of  other  brigades  as  well  as  their 
own  though  I  must  state  that  the  rage  for  surgery  seems  to  be  at  a 
rather  low  ebb  in  this  army  at  present,  and  I  suppose  there  are  good 
reasons  why  it  is  so.  As  a  contrast  to  this  looseness  of  arrangement 
or  organization,  I  will  give  you  a  specimen  of  the  system  that  pre- 
vails. On  last  evening  the  brigade  chief  surgeons  received  an  order 
to  ascertain  and  report  the  number  of  men  in  their  respective  brigades 
who  would  be  **  unfit  for  duty  for  three  weeks  '**  but  unaccompanied 
by  anything  explanatory  of  any  action  contemplated.  One  brigade 
reported  twenty,  and  another  twenty-five  men  who  would  probably 
lemain  unfit  for  duly  tot  \^<&  ^\\icA  v^\&<^.  The  consolidated  es- 
timate was  foTwardeito  \\ie  \ntt^\wi\  ^vtvsX««  V|  ^^^\^  vax^^Mmof 


1864.]  Oarreqtonim^ci,  651 

ihe  division,  who  io  retarn  receired  %xk  order  next  morning  to  inttmct 
the  brigade  sorgeons  to  select  fire  of  the  worst  cases  in  each  brigade 
and  transfer  them  to  hospital.  Further  more,  they  had  to  examine  the 
cases  personally  ;  being  of  conrse  better  qualified  to  jndge  of  their  fit- 
ness or  unfitness  for  admission  to  hospital  than  the  officers  who  had 
had  immediate  charge  of  them,  and  consequently  constant  observation 
of  their  natnre,  tendencies  and  progress.  When  it  is  considered  that 
each  brigade  contains  eight  or  nine  regiments,  the  order  limiting  the 
number  of  sick  to  five,  will  appear  sufficiently  ridiculous  ;  and  the  ab- 
surdity of  such  dictation  is  not  diminished  by  the  fact  that  the  func- 
tionary who  issues  his  mandates  from  corps  headquarters,  three  or 
four  miles  off,  is  not  seen  in  the  camps  from  one  end  of  the  month  to 
the  other. 

Such  is  an  outline  of  the  working  of  the  medical  department  in  the 
army  of  the  Cumberland.  And  I  presume  it  is  quite  sufficient  to 
satisfy  you  that  a  regimental  surgeon  just  now  is  a  very  insignificant 
individual ;  very  suggestive  to  my  mind  of  a  fifth  wheel  to  a  wagon. 

In  fact  his  duties  at  present  are  less  importan  t  than  t'uose  of  a  hos- 
pital steward  used  to  be  a  couple  of  years  ago.  And  that  seems  to  be 
the  view  taken  of  them  by  the  commanding  officers  in  the  army.  I 
sometimes  think  their  actions  show  a  studied  determination  to  belittle 
and  degrade  the  officers  of  the  medical  department  as  much  as  their 
positions  give  them  power  to  do.  As  an  example :  About  a  month 
ago  Oeneral  Stanley  commanding  the  1st  Division  of  the  4th  Corps, 
issued  an  order  requiring  the  return  to  their  companies  of  a  large 
number  of  the  men  detailed  in  the  several  departments  of  the  army. 
Admitting  the  fact  that  many  men  were  held  on  merely  norminal  duty, 
who  should  have  been  in  the  ranks,  I  yet  pronounce  the  vigor  with 
which  the  order  was  enforced  in  the  cases  of  surgeons,  as  nothing 
l»B  than  an  outrage  and  insult  to  that  class  of  officers.  For  no  de- 
tailed man  at  all  was  allowed,  unless  in  cases  where  packmules  were 
used  for  the  transportation  of  the  medicine  pann>ers.  In  other  cases 
4i6  hospital  stewanl  was  required  to  carry  the  field  medical  case,  be- 
sides his  blankets,  clothing*  rations,  etc.,  and  the  surgeons  could  car- 
ry his  amputating  case  as  he  pleased.  What  a  dignified  appearance 
a  surgeon  must  present  with  a  great  clumsy  box  of  clumsy  knives 
under  his  arm !  And  he  is  said  to  rank  as  major,  and  wear  two  rows 
of  buttons  on  his  coat !  Is  it  any  wonder  that  many  a  good  man  in 
the  medical  staff  of  the  army  is  tired  of  his  position,  and  anxious  to 
give  it  up  ?  I  am  much  inclined  to  ascribe  the  unfa^OTsXA^  «^>xm.«\A 
at  which  wrgBoas  $eem  to  be  held  now»  io  two  cSkUMA  OdaAi« 


552  Corregi>ondenei^  [BepteBlNri 

to  a  deterioration  in  the  quality  of  the  article  Bopplied  to  the  anaj 
latferlj  ;  and  secondly,  to  the  character  of  the  men  who  are  umgati 
to  staff  appointments,  and  who  instead  of  being  gnardians  and  cham- 
pions of  the  dignity  and  honor,  and  rights  of  their  profeaaional  broth- 
ers of  the  army,  are  the  supple  weak-kneed  attendants  on  some  npstaiC 
miserable  creatures,  who  either  by  chance  or  ahaxp  practice  have  been 
dubbed  generals 

I  did  intend  saying  som thing  about  the  maUrial  of  the  medical  staK 
and  my  opinion  of  the  qualifications  of  those  who  aspire  to  the  rtpo- 
tion  of  being  known  as  ''brilliant  operators  *' etc.,  but  I  haTenow 
written  a  much  longer  letter  than  I  had  intended ;  and  no  doubt  foUj 
as  much  as  you  will  care  to  read  at  any  one  time.  Give  my  Iots  to 
all  the  brethren  who  may  yet  remember  me  ;  and  though  far  off  oi 
the  so-called  plains  of  Atlanta,  accept  the  assurances  of  mj  na&disg 
regard. 


■   mmm  ■ 


^Embalming. 

B7  W.  H.  XviBT,  Ut«  Medical  lofpector,  U.S.A. 


The  charges  for  embalming  bodies  in  the  army  are  so  exorbitant 
compared  with  the  actual  cost  of  the  process,  that  I  am  induced  to 
present  to  the  profession  the  following  note  upon  the  subject : 

Whilst  in  North  Carolina  last  year  an  old  friend  whom  I  found 
there  died.  He  was  a  chaplain.  His  family  being  in  moderate  dr- 
cumstances,  I  thought  to  save  the  expense  of  embalming  I  would  do 
it  myself,  and  took,  chloride  of  zinc,  1  oz  ;  arsenious  acid,  2  drachms  S 
warm  water,  1  gallon.  The  chloride  of  sine  was  dissolved  in  water, 
the  arsenic  in  alcohol  in  a  mortar  and  the  articles  mixed  in  the  warm 
water,  and  injected  into  the  femoral  artery  by  means  of  an  ordinary 
elastic  gum  syringe,  the  compression  of  the  ball  affording  sufficient 
force,  and  a  continuous  stream  was  thrown  upward  till  about  one  pin^ 
Remained,  when  the  nozzel  of  the  syringe  was  turned,  and  the  limb 
^njected. 

The  result  was  that  when  the  body  was  interred  in  Massachusetts 
the  features  were  exposed,  they  were  perfectly  natural,  with  a  blush 
upon  the  cheeks.     The  sooner  after  death  that  the  injection  is  made 
the  more  perfect  will  be  the  state  of  preserration.    A  medical  student 
or  a  hospital  eteward  w\l\i  W\.  \\V(\^  vDk^\x^^\\^u^Quld  soon  beoome 


^1864.]  Bevlim  ami  Nidk$$.  568 

•!9zperi  in  the  process.  The  aotiul  cost  of  the  materitl  ii  not  more 
etthan  fiftj  cents.  The  charges  for  embalming  from  twenty -five  to  two 
ihnndred  dolUrs. 

t:  Clabksbubo»  Ya.,  Aug.  8d«  1864. 

I  Deas  Sir  : — In  the  "  case  of  large  grarel  extracted  from  the  male 
urethra/'  reported  by  me  and  published  in  the  Jaljr  number  of  your 

.  joamal,  the  printer  makes  me  tell  a  very  large  untruth.  I  am  made 
to  lay  that  the  gravel  was  seven-eights  of  an  inch  in  diameter.  It 
should  have  been  seven*eight8  of  an  inch  in  length  and  very  nearly 
lialf  an  inch  in  diameter.  This  is  quite  large  enough,  and  I  presume 
it  18  seldom  that  one  of  such  size  is  extracted  in  that  way.  You  will 
please  correct  the  error  as  it  seriously  e£kcts  the  truth  of  my  report. 
Were  it  not  for  that  I  would  not  trouble  you  with  any  reference  to  the 
subject  Yery  Respectfully,    B.  F.  McKsxhah. 


ItVteWjS  B8fl  %9\Ut%. 


W—k  Lmgt  and  ffaw  to  Make  2%cM  Sinn^ :  or  Disoasts  of  the  Organs  of  the 
ChMt,  with  iii«ir  home  irtaimeni  bj  the  moTemeai  oort.  By  Die  LawiSi 
M J>^  etc,  tto^  etc.  Profoielj  illoitrated.   Boston :  Tiokaor  &,  FUldt,  1861. 

We  have  before  us  a  small  volume  by  a  very  well  known  writer ; 
containing  a  great  many  very  good,  clever  and  correct  ideas — mixed  ' 
up  with  a  great  deal  that  is  very  foolish — and  some  things  decidedly 
cliarlatanish.  Dr.  Dio  commences  with  a  preface  that  sounds  a  good 
deal  after  the  fashion  of  the  "  Sands  of  Life"— or  <'  The  Retired  Cler- 
gyman" :  "  Nearly  twenty  years  ago  there  came  under  my  profess- 
ional care  a  consumptive  for  whose  recovery  I  felt  the  deepest  solicit- 
nde.  Since  then  I  have  treated  many  invalids,  of  tha  same  class,  for 
whom  my  tenderest  sympathies  have  been  awakened.  Twelve  years 
ainca  my  wife^s  health  failed.  Obviously  it  was  a  oase  of  consump- 
tion. Two  sisters  had  died  of  the  malady.  In  the  persons  of  my 
dearest  friends  I  have  felt  the  mo^t  intense  interest  in  pulmonary 
consumption." 

Very  clearly  Dr.  Dio  has  got  hold  of  a  very  huge  hobby,  and  he 
can  see  nothing  else ,  indeed  he  seems  to  think  he  and  his  hobby  are 
all  that  there  is. 

The  introductory  sections  on  the  symptoms  of  consumption  are  in 
accordance  with  the  views  and  teachings  of  our  best  authoritiea^  asA 
our  author  very  properly  dwells  upon  the  caxiaaa  ot  Vo&MiteciL^M&&  «k  A 


554  jBevtVwa  and  Ifoiieei,  [Septeaki; 

qnite  as  mnch  importance  as  tbe  rational  treatment  of  developed  tt 
ease.  Indeed  we  think  this  part  of  his  book  of  quite  as  much  iap» 
tance  as  anj,  though  some  of  its  suggestions  are  certain! j  of  thkc- 
trayagant  and  ultra  character  one  expects  from  a  hobbj-  rider.  Itii 
however  difficult  to  say  too  much  on  the  vitiated  air  so  onifemlii 
the  sick  room — in  theatres,  legislative  and  concert  halls,  and  ilhr 
rooms  for  public  assemblage — and  we  have  no  doubt  mueh  of  tb 
scrofulous  disease  of  the  world  may  be  referred  dirootly  to  the  ddbct- 
ive  ventilation  of  our  homes  and  consequent  impure  air  inbakd  If 
our  people ;  and  add  to  this  damp  cellars,  and  cellars  foul  with  b- 
caying  vegetable  matter,  it  is  not  difficult  to  trace  disease  and  hd 
epidemics  to  their  sources. 

Dr.  Lewis  thinks  the  common  belief  that  a  dry  atmosphere  is  mik 
favorable  to  the  consumptive  is  an  error.  **  In  the  British  Isles,  ui 
in  France,  outside  the  cities  and  manufactories,  the  mortality  bm 
pulmonary  diseases  is  much  less  than  among  the  agricultural  cLmni 
of  this  country  ;  and  on  the  western  shores  of  this  continent,  coasn^ 
tion  is  comparatively  unknown."  He  claims  that  a  watery  vapor  se- 
tually  relieves  the  irritability  of  the  lungs ;  and  that  experience  jftom 
that  the  humid  atmosphere  of  wet  weather  affords  comfort  to  the  eos- 
sumptive.  Hence  he  argues  that  there  is  no  possible  weather  cao  ex* 
cuse  the  consumptive  for  keeping  in  doors,  "  Give  him  sufficicst 
clothing,  protect  bis  feet  carefully,  and  he  may  go  out  freely  in  rtia, 
sleet,  snow  and  wind." 

Decided  objection  is  made  to  the  use  of  furnaces  and  stoves  ;  thfj 
cause  a  carbonized  state  of  the  particles  floating  in  the  atmospben 
poisonous  to  the  lungs  ;  while  "  an  open  fire  is  number  one  among 
house  blessings."  Our  author  in  this  connection  combats  another 
popular  idea — in  which  we  are  glad  to  agree  with  him-*he  believes  it 
better  to  warm  the  sleeping  apartment  with  fire.  With  a  fire  he 
iii'ges,  you  may  keep  your  window  open,  thus  improving  the  ventila- 
tion, and  you  will  be  able  to  dispense  with  a  portion  of  the  otherwise 
required  bedding,  a  large  number  of  blankets  not  only  interfering  with 
circulation  and  respiration,  but  prevents  the  escape  of  the  gases  which 
the  skin  is  constantly  smiting. 

Of  course  in  a  book  of  this  character  there  is  a  good  deal  to  be 
said  about  diet ;  and  first  of  all  we  eat  too  much  ;  as  a  people  we  are 
inclined  to  gluttony,  so  thinks  Dr.  Dio.  He  quotes  the  old  table  for 
quantity  so  many  ounces  each  of  bread  butter  and  tea  for  breakfact. 
so  many  ounces  of  meat,  vegetables,  bread,  malt -liquor  and  water  for 
dinner,  etc.,  but  on  the  whole  wisely  concludes  that  we  can  arrive  at 


IM4.]  JUwmm  and  Nbthmi^  M 

i  nffieientlj  imtional  diet  without  this  philoiophicAl  exaetnest.  To* 
baaeo  and  spirits  oome  under  tin  bm  of  oar  mnthor,  and  even  oat 
IsYorite  beyerages  of  tea  and  cofiee,  are  deelared  most  i)eniic]oas. 
Bvofa  of  oar  readers  as  are  familiar  with  the  old  teachings  of  the 
Mer  Mossej*  will  at  onoe  recognise  the  riews  of  oar  aathor  on  dreas 
— OTon  the  old  cnts  and  illostrations,  that  Tonerable  man  used  to  re- 
jolee  in  are  roTamped  and  brought  to  life 

With  Dr.  Dio— medicine— drags  is  nothing,  worse  than  nothing 
Iq^ene,  diet,  dress,  the  **  moToments"  are  the  grand  idea.  Bathing 
ikoold  be  resorted  to  frequently,  espedallj  in  the  winter.  He  brors 
1m  hot  air  bath,  and  describes  its  mode  of  use  and  eflhots  on  the  sja- 
t&m  ;  bat  as  a  regalar  bath  he  adtises  the  use  of  cold  water  on  ac- 
MMint  of  its  tonic  reaction. 

Bat  we  cannot  follow  Dr.  Lewis  through  the  details  of  this  little 
>ook*;  the  prominent  feature  following  the  sections  we  have  thus  hasti- 
f  and  imperfectly  ran  through,  is  devoted  to  hia  apecial  gymnastic 
HBweises,  of  which  he  arranges  a  complete  and  systematic  outline  eal- 
nlated  to  employ  the  patient  regularly  through  a  series  of  weeks, 
rhis  plan  of  exercise  is  profusely  illustrated  in  all  its  minutia,  and 
XNBstitutes  Dr.  Dio  Lewis*  great  hobby,  what  he  styles,  *«  The  More- 
neat  Cure." 

As  we  have  said  all  through  this  book,  there  are  many  good  things, 
pood  and  useful  hints  and  suggestions ;  but  like  all  hobby  riders.  Dr. 
>io  Lewis  sees  outside  of  the  "  movement  cure"  nothing  worth  con- 
idering,  suggesting  or  thinking  about.  He  has  got  it  all,  all  that  is 
»f  any  value.  Again  Dr.  Dio  Lewis  has  gotten  up  a  book  calculated 
imply  as  a  huge  puff  of  Dr.  Lewis  and  his  pet  Institutions.  Pa- 
tents arc  to  come  to  his  school,  send  for  his  spirometer,  correspond 
rith  Dr.  Dio  and  be  healed,  etc.,  etc. 

Early  in  the  body  of  the  book  the  reader  is  incidently  informed 
hat  a  school  designed  to  carry  out  particular  views  will  be  opened  in 
Boston  at  such  a  date,  and  for  names  of  teachers,  general  features  of 
ha  institution,  etc.,  send  for  a  circular  to  Dr.  Dio  Lewis,  Box  12, 
Boston,  etc.  Ten  or  a  dosen  pages  further  on  another  hint  is  thrown 
>ut  respecting  his  school  for  "  Physical,  Mental  aud  Moral  Training 
>f  Girls  and  Boys,"  etc.  Still  a  little  further  on  Dr.  Dio  describes 
ind  advertises  at  some  length  (four  pages)  his  Pangymnastikon,  '*  the 
rhole  is  boxed  for  shipment  at  this  office  for  ten  dollars.  Address 
)ox  12."  etc.,  etc. 

Quite  early  in  the  book  he  advertises  the  book  his  wife  is  going  to 
mblish  by  and  by ;  and  in  the  latter  part  of  the  book  he  advertises  the 


$56  lUvUm  and  yaiiui.  [SaptMftta 

book  ho  did  himBolf  publUh  heretofore.  Finally  the  laei  two  or  Aai 
pages  are  advertisement  direct.  Dr.  Dio  says  to  all  persoas  wA 
weak  chests,  I  ahall  be  happy  to  advise  with  yon.  Of  oonne  heiA 
He  gives  yoa  his  ofiSce  honrs^  and  if  yo«  oannot  Tieit  Boalim.  yeiM 
correspond  and  he  gives  yoa  the  pointa  to  write  about.  Mestflk 
lanthropic  and  nnsophisticated  Doctor  Dio  Lewis  I 

Once  more,  that  school  for  training  in  ventSatad,  for  wbick  lb 
once  more  all  interested  parties  are  requested — Box  12,  et^.  etc.  Oi. 
Dio  also  announces  that  he  has  a  Mrist  of  books  in  preparation  difilri 
to  the  "  movement  cure.*'  The  titles  are  given,  bat  anffident  for  Al 
day  is  the  evil  thereof*  and  we  considerately  refrain.  la  die  ndf 
disgusted  with  the  quack  feature  of  this  handsome  little  book  ?  Wi 
certainly  think  the  author  ought  to  be  disgusted  with  himaetf. 


Tk$  Phyneimt^ Dow  and Si^mpiom  Both:  ooBtaiuiDg  the  doeee  and  uswtfil 
the  prinoipal  artiolaeof  the  Materia  Mtdioa  aad  ofieloal  pnrepanlka%flli 
etc.    By  Joseph  Wtthib,  A.M.,  M.D.,  author  of  **  The  Miorosoope.  "ela,  ^ 

•    FooTlh  edition.    Philadelphia:  Lindsay  ft  BlaUston,  18S4. 

The  title  page  of  this  little  hand  book  so  fally  explains  its  digeet 
and  character  as  to  leave  but  little  additional  to  say  respecting  it 
Besides,  this  little  book  has  for  a  long  time  been  familiar  to  the  pie- 
fession,  and  favorably  received.  We  have  no  very  great  partislil} 
for  this  sort  of  little  books  which  aim  to  compress  a  great  deal  witUi 
a  very  small  space  ;  but  many  others  do  not  agree  with  us  and  fini 
such  a  volume  a  very  convenient  book  of  reference.  The  tabhi 
which  the  author  has  arranged  are  neat  and  convenient. 

For  sale  by  Robt.  Clarke  &  Co.    Price  68  cents. 


1864r  3IUaF'$  JM$.  557 

JPrlce  Advanad. — Hereafter  the  nnifona  price  of  ihe  LamcH  and 
Oiarver  will  be  $8.00  per  annam:  We  eappoee  oar  subtcriben 
liftTe  anticipated  this  adrance  for  some  time.  For  two  yten  we  hate 
assumed  the  heavy  adyance  in  the  cost  of  printing  materiaU  hoping  it 
wonld  be  hot  ten^porary  ;  we  have  at  length  determined  to  ask  oar 
friends  to  share  with  us  thli  burdeiu  We  donbt  not  they  will  do  so 
diaerfally.  There  will  of  coarse  be  a  proportionate  advance  in  the 
price  of  sach  publications  as  are  sent  oot  with  this  journal  at  com* 
mutation  rates.  A  number  of  our  subscribers  hare  already  paid  to  a 
time  in  advance  of  this  announcement ;  some  new  subscribers  com- 
mencing with  the  middle  of  this  volume  have  paid  up  to  the  middle 
of  the  next  volume.  Of  course  all  such  payments  have  been  doly 
credited*  and  will  be  observed  in  good  faith.  But  all  new  subscribers, 
and  all  payments  on  running  account  will  from  this  date  be  charged 
at  the  uniform  rate  of  Thbxi  Dollabs  per  annum. 

Ofiari*  Hoipital  at  CineitmatL — For  sometime  past  Dr.  Oobrecht, 
late  in  charge  of  West  End  Hospital  in  this  city,  has  been  fitting  up 
the  Baptist  Seminary  building  on  Fairmount — in  the  western  suburbs 
of  this  city —  as  an  Officers*  HosptUl.  On  Friday*  Angust  5th,  this 
new  hospital  was  formally  opened,  by  a  regular  inspection  by  Surgeon 
C.  8.  Tripler,  Medical  Director  of  the  Northern  Department ;  Qen. 
Heintzleman,  together  with  many  medical  officers  on  duty  in  this  de- 
partment, officers  of  the  pay  department,  quartermaster's  department, 
etc.,  were  present. 

The  hospital  is  fitted  up  with  every  necessary  convenience,  and  is 
intended  to  accommodate  seventy-five  patients.  In  the  basement  are 
store  rooms,  kitchen,  laundry,  etc.  In  the  upper  stories  are  dining- 
rooms,  offices,  drug-room,  together  with  the  apartments  for  the  pa- 
tients, so  arranged  that  only  one  or  two  will  be  placed  in  each  room. 
The  building  occupies  one  of  the  finest  situations  iu  the  suburbs  of  the 
city,  and  for  beauty  of  prospect  and  healthy  atmosphere  cannot  be 
surpassed  in  this  vicinity. 

After  the  formal  inspection  was  over.  Dr.  Gk)bfecht  conducted  his 
guests  into  the  old  library  room,  where  was  spread  a  fine  collation. 
Toasts  were  given  in  honor  of  Surgeon  Tripler,  Gen.  Helntselman,  Dr. 


5§8  JBdUor^B  TMs.  [Septemto, 

Qobreht,  and  various  other  officers  present,  wbo  duly  responded  after 
a  neat  and  appropriate  fashion.  The  whole  affair  was  well  conceiyed- 
and  passed  off  pleasantly,  ^ 

Dr.  Gobrecht  has  already  proven  himself  an  efficient  medical  offiosr, 
and  will  doubtless  conduct  the  affairs  of  the  OJkeri*  Sottpiidl  with 
doe  regard  to  the  interests  of  all  concerned. 

Independent  Journalism. — ^We  are  very  sare  our  friends  of  the  Mei- 
ad  Independent  will  not  deem  us  actuated  by  any  personal  feelings  if 
we  briefly  say  that  we  have  just  received  an  illnstrafion  of  the  correct- 
ness of  certain  views  expressed  by  ns  some  time  since  on  independent 
journalism,  and  which  our  neighbors  saw  fit  to  criticise  at  sonae  lengdu 
We  have  received  one  or  two  numbers  of  the  UkivertUy  Jfedicml  mi 
Surgical  Journal^  published  monthly  in  Philadelphia  ;  at  first  glaaca 
one  naturally  infers  that  the  old  University  has  rejuvenated  its  en- 
ergies and  come  into  the  field  with  an  organ,  but  on  looking  over 
number  one  we  observe  that  it  is  the  representative  of  the  Pennsylvr 
nia  Medical  University,  Woman's  College  of  Philadelphia ;  teaekisg 
no  sectarian  system  or  path,  but  being  truly  eclectic  in  its  aim  I  Tb 
publishers  state  that  "  A  free  and  independent  medical  journal  ii  a 
desideratum  long  needed  by  the  more  liberal  portion  of  the  medical 
commuuity  " —  it  "  is  designed  to  differ  from  other  medical  joomals 
in  its  freedom  from  sectarian  trammels,  and  the  independent  course  the 
publishers  have  marked  out  for  it ;  it  will  recognize  no  sex  in  science, 
nor  make  any  distinction  between  its  devotees  on  that  account,  hot 
afford  encouragement  to  mimf  when  inclined  in  that  direction,  without 
regard  to  the  sex  that  may  be  represented  by  individuals/'  Well  os 
a  careful  examination  of  the  specimen  numbers  received  we  think  we 
have  no  use  for  this  ind'^pendent  candidate  for  public  favor. 


The  Case  of  Surgeon  General  Hammond, — Some  time  since  we  an- 
nounced that  Dr.  Hammond  was  on  trial  before  a  duly  constituteJ 
military  commission  at  Washington,  and  although  that  trial  has  been 
the  subject  of  a  great  many  newspaper  comments  and  dispatches,  we 
have  forborne  any  remarks  on  the  subject,  prefering  to  await  the 
slow  process  and  decision  of  the  authorities,  which  after  ao  longs 
time  has  been  made  public.  The  following  report  of  the  Judge  Ad- 
vocate gives  the  charges  and  specifications,  with  the  findings  of  the 
court  and  the  approval  of  the  President.  We  publish  the  entire  re- 
port for  the  information  of  our  readers.  In  addition  we  see  it  stated 
in  the  newspapers  \.\i9Ll  \ri  the  order  of  the  Secretary  of  War,  Ur- 


1  Bdilw*9  TabU.  669 

tor  Whiting  is  directed  to  proeeonte  Ez-8argeon  Gen.  Ham- 

,  I^Iessrs  Wythe  dr  Brothers,   and  Wm.  A.  Stephens,  for  the 

ery  of  8450,000  said  to  he  the  amount  of  which  Government 

efraoded  by  the  contracts  specified  in  the  charges^helow. 

3  Court  was  composed  as  follows : 

jor-General  R.  J.  Oglesby,  U.S. Y.,  President ;  Brigadier^Gener* 
.  S.  Uarney,  U.S.A.;  Brigadier- General, W.  J  .Eetcham,  U.S. 
irigadier-General  G.  S.  Green,  U.S.V. ;  Brevet  Brigadier-Gren- 
V.  W.Morris,  Colonel  2d  U.  S.  Ariilleiy;  Brigadier- General 
'.  Howe,  U.S.y'.;  Brigadier- General  J.  P.  Slongh,  U.S.V.; 
(licr-General  H.  E.  Paine,  U.S.V.  ;  Brigadier-General  J.  C. 
weather,  U.S.V. ;  Major  John  A.  Bingham,  Judge  Advocate. 

JvDOB  Adtooats  Ounuii*a  Omci,  Xaj  IT,  ISM 

the  Honorable  Secretary  qf  War  : 

gadicr  General  William  A.  Hammond,  Snrgeon-General  United 
R  Army,  was  tried  upon  charges  of  "  disorders  and  neglects,  to 
;  prejudice  of  good  order  and  military  discipline,"  "  condoct  nn- 
ing  an  officer  and  a  gentleman/'  and  "  conduct  prejudicial  to 
order  and  military  discipline." 

e  specifications  which  set  forth  the  statement  of  facts  alleged, 
ound  by  the  court  to  constitute  these  offences,  are  as  follows . 
AROE  IsT. — *<  Disorders  and  neglects,  to  the  prejudice  of  good 
and  military  discipline." 

ecifications  Ist.  '*  In  this  :  that  he,  Brigadier- General  William 
[Inmrnond,  Surgeon- General  United  States  Army,  wrongfully 
unlawfully  contracted  for,  and  ordere<i  Christopher  C.  Cox,  as 
^  purveyor  in  Baltimore,  to  receive  blankets  of  one  William 
tephens,  of  New  York.  This  done  at  Washington  City,  on  the 
tcenth  day  of  July,  in  the  year  of  our  Lord  one  thousand  eight 
red  and  sixty-two." 

ecifieation  2d.  '*  In  this  :  that  he  Brigadier-General  William 
amroond.  Surgeon -General  as  aforesaid,  did,  on  the  thirtieth  day 
ty,  in  the  year  of  our  Lord  one  thousand  eight  hundred  and  sixty- 
,  at  Washington  City,  wrongfully  and  unlawfully  prohibit  Chris- 
!r  C.  Cox,  as  medical  purveyor  for  the  United  States  in  Baltt- 
,  from  purchasing  drugs  for  the  army  in  said  city  of  Baltimore." 
teclfication  3d.  "In  this :  that  he,  the  said  Brigadier-General 
iam  A.  Hammond,  Surgeon -General  United  States  Army,  did 
vfully  order  and  cause  one  George  Cooper,  then  medicsJ  pnr« 
r  for  the  United  States,  in  the  city  of  Philadelphia,  to  buy  ofone 
iam  A.  Stephens,  blankets,  for  the  use  of  the  Government  ser- 
of  inferior  quality  :  he,  the  said  Brigadier- Greneral  William  A. 
mond,  then  well  knowing  that  the  blankets  so  ordered  by  him  to 
irchased  as  aforesaid  were  Inferior  in  quality,  and  that  said  pnr- 
r  Cooper  had  refused  to  hny  the  same  of  said  Stephens.  This 
'  at  Philadelphia,  in  the  State  of  Pennsylvania,  on  the  twenty- 
th  dsy  of  May,  in  the  year  of  our  Lord  one  thousand  eight  huu- 
and  sixty-two." 


560  JBdiiar'i  Tahh.  \SBpUmheT, 

Specifieation  4t1i.  "  In  this  :  that  he,  the  said  Brigadier-Genorml 
William  A.  Hammond,  fini^on-G^nenl  as  aforeBaid»  on  tlie  fonr- 
taenth  day  of.  Jaoe»  in  the  year  of  onr  Lord  one  thoneand  eiffbt  hnn* 
dred  and  sixty-two,  at  the  city  of  Washington,  in  the  District  of 
Golambia,  unlawfnlly,  and  with  intent  to  aid  one  William  A.  Steph- 
ens to  defrand  the  Government  of  the  United  States,  did,  in  writing, 
instruct  G^rge  E.  Oooper,  then  medical  purveyor  at  Philadelphia,  in 
substance  as  follows : 

^*  <  Sir  . — Ton  will  please  purchase  of  Mr.  W.  A.  Stephens  eight 
thousand  pairs  of  blauKets,  of  which  the  inclosed^ card  is  a  sample* 
Mr.  Stephens'  address  is  box  2,500,  New  York.  The  blankets  are 
five  dollars  per  pair/  " 

Specification  5th.  ''In  this:  that  he,  the  said  Brigadier-General 
William  A.  Hammond,  Surgeon-General  United  States  Army,  on 
the  sixteenth  day  of  June,  in  the  year  of  our  Lord  one  thonsand  eight 
hundred  and  sixty-two,  at  the  city  of  Washington,  did  cormptly,  and 
with  intent  to  aid  one  Willliam  A.  Stephens  to  defraud  the  Govern- 
ment of  the  United  States,  give  to  the  said  William  A.  Stephens  an 
order  in  writing,  in  substance  as  follows:  'Turn  over  to  George 
Cooper,  medical  purveyor  at  Philadelphia,  eight  thousand  pairs  of 
blankets  ; '  by  means  whereof  the  said  Stephens  induced  said  Cooper, 
on  Government  account,  and  at  an  exhorbitant  price,  to  receive  of 
said  blankets,  which  he  had  before  refused  to  buy,  seventy- six  hun- 
dred and  seventy-seven  pairs,  and  for  which  the  said  Stephens  re- 
ceived payment  at  Washington  in  the  sum  of  about  thirty-five  thons- 
and three  hundred  and  fourteen  dollars  and  twenty  oents." 

Specification  6th.  ''  In  this  :  that  he,  the  said  Brigadier-General 
William  A.  Hammond,  Surgeon- General  United  States  Army,  on 
the  thirty-first  day  of  July,  in  the  year  of  onr  Lord  eighteen  hun- 
dred and  sixty-two,  at  the  city  of  Philadelphia,  in  the  State  of  Penn- 
sylvania, well  knowing  that  John  Wyeth  ^  Brother  had  before  that 
furnished  medical  supplies  to  the  medical  purveyor  at  Philadelphia, 
which  were  inferior  in  quality,  deficient  in  quantity,  and  excessive  in 
price,  did  corruptly,  unlawfully,  and  with  intent  to  aid  the  said  John 
Wyeth  ^  Brother  to  furnish  additional  large  supplies  to  the  Govern- 
ment of  the  United  States,  and  thereby  fraudulently  to  realize  large 
gains  thereon,  and  then  and  there  give  to  George  Cooper,  modical  pur- 
veyor at  Philadelphia,  an  order,  in  writing,  in  substance  aa  follows : 

**  *  You  will  at  once  fill  up  your  store-houses,  so  as  to  have  con- 
stantly on  hand  hospital  supplies  of  all  kinds  for  two  hundred  thous- 
and men  for  six  months.  Ibis  supply  I  desire  that  you  will  not  use 
without  orders  from  me.' 

"And  then  and  their  direct  said  purveyor  to  purchase  a  large 
amount  thereof,  to  the  value  of  about  one  hundred  and  seventy-three 
thousand  dollars,  of  said  John  Wyeth  k  Brother*' 

Specificatum  7th.  "In  this,  that  he,  the  said  Brigadier- GenenJ 
William  A.  Ilammond,  Surgeon-General  United  States  Army,  about 
the  eighth  day  of  October,  in  the  year  of  our  Lord  eighteen  hundred 
and  sixty -two,  at^a^YAn^VoTLOlty,  in  contempt  of,  ar.d  contrary  to 
the  ptovisiona  oi  l\iQ  ac\.  ^nVViXft^  *  k\L  %r\.  \.^  ^kk^^iic  and  increase 


1864.]  £d:tor'i  I\Me.  661 

the  efficiency  of  the  medical  departmcni  of  the  army,'  approved  April 
16,  1862,  did  unlawfally  direct  Wyeth  dr  Brother,  of  Philadelphia, 
to  send  foity  thouHand  cans  of  their  'extract  of  beef  to  various 
places,  to  wit :  to  Cincinnati,  St.  Louis,  Cairo,  New  York,  and  Bal- 
timore, and  send  the  account  to  the  8argeon-6cnerarK  office  for  pay- 
ment." 

Charge  2d.     "  Condnct  unbecoming  an  officer  and  a  gentleman." 

Specification  Int.  **  In  this,  that  he,  Brigadier-General,  William 
A.  Hammond,  Surgeon- General,  United  State  Army,  on  the  thirteenth 
day  of  October,  in  the  year  of  onr  Lonl  eighteen  hundred  and  sixty- 
two,  at  Washington  City,  in  a  letter  by  him  then  and  there  addressed 
to  Dr.  George  E.  Cooper,  declared  in  substance  that  the  f:aiil  Cooper 
had  been  relieved  as  medical  purveyor  in  Philidelphia.  because, 
among  other  reasons,  'Halleck,'  meaning  Mnjor-Generol  Henry  W. 
Halleck,  Gen'^ral- in-Chief,  re(|nesteJ  as  a  particular  favor  that  Murray 
might  be  orlere  1  to  PhilaiJelphia ;  which  declaration  so  ma  le  by  htm. 
the  STiid  Brigadier-G'Mieral  William  A.  Uammond,  S a r^Mu- General 
as  aforesaid,  was  false." 

An  additional  charge  and  specifications  preferred  against  Brigadier- 
Gener.il  William  A.  Hammond,  Surgeon -General  United  Stales  array  : 

CiiARsE  oD.  **  Condnct  to  the  prejudice  of  good  order  and  milita- 
ry dihcipline." 

Spec  fie  tiioti  1st.  "In  this,  that  he,  the  said  Brigadier- Gisneral 
William  A.  Hammond,  Surgeon-General  United  Stales  Army,  on 
the  eighth  d«y  of  Noven]l>er.  in  the  year  of  our  Lonl  eighteen  hundred 
and  hixty-two,  at  Washington  City,  did  unlawfully  order  Henry 
Johnson,  then  miHlical  storekeeper  and  acting  purveyor  at  Washing- 
ton City,  to  purchase  three  thousand  blankets  of  one  J.  P.  Fisher,  at 
the^rice  of  85  90  per  pair,  and  to  l>e  delivered  to  Surgeon  G.  E. 
^'oopor,  U.S.A..  medical  purveyor  at  Philadelphia. 

A  plea  of  not  guilty  was  entered  upon  each  of  the  charges  and 
spoi'ifications.  and  after  a  full  hearing  of  the  testimony  for  the  Gov- 
ernment and  the  defence,  and  the  oxaminatinn  of  a  large  amount  of 
documentary  evidence,  together  with  the  consideration  of  tlie  elabor- 
ate argtiment»4  of  both  sides,  the  court  rendered  a  Huding  of  guilty  on 
all  the  charges,  and  sentenced  the  accused  to  be  di!<misse<l  theservice, 
and  to  bo  forever  disqualified  from  holding  any  office  of  honor,  profit, 
or  trust,  under  the  Government  of  the  United  StaUfS. 

In  reporting  upon  this  case,  the  second  charge^-condnct  unbecom- 
ing an  nffiorr  and  a  gentleman — will  be  first  considered. 

Under  this  charge  it  was  allegeil  that  accused  made  a  falsa  declara- 
tion, in  w riling,  that  Dr.  Cooper  had  lM*cn  relieved  from  his  position 
a^  medical  purveyor  at  Philadelphia,  because  among  other  reasons. 
General  Halleck  had  requested  as  a  speinal  favor,  that  Dr.  Murray 
miKht  be  onlered  to  duty  in  that  city. 

it  appears  from  the  evidence  that,  on  the  8th  of  October,  accused 
reque**tetl  of  the  Adjutant -General  that  Dr.  Cooper  be  relieved  froai 
duty  as  medical  purveyor,  at  Philadelphia,  by  Dr.  Smith.  On  the 
13ih  ho  wrote  a  letter  to  Dr.  Cooper,  as  follows : 

'*  Mr  Dbar  Doctok.— I  have  just  receitel  yotft  «ti^    TV^a  ^Aeuu\ 


662  XiUor'i  Table.  [Saptember, 

for  your  relieval  from  diiij  went  to  the  Adjntant-Oeneral  a  lew  dayi 
sinoe.  I  told  Smith  to  tell  jon  of  it.  It  was  with  great  reloetance* 
even  with  pain,  that  I  made  the  detail.  I  am  entirely  satiafied  with 
your  energy,  faithfulness,  and  acquaintance  with  your  datT  ;  but  I 
fonnd  great  complaints  made  in  regard  to  yonr  manners,  which  wen 
constantly  reiterated  from  medical  officers  and  citizens  of  standing.  I 
believe  the  change  would  have  been  made  over  my  head  had  I  not 
not  made  it  myself.  I  was  forced  to  come  to  the  conolnsion  that  it 
was  necessary  to  be  done.  Once  before  the  detail  was  made,  but  I 
would  not  f>ign  it,  and  this  time  it  lay  on  my  table  aeTeral  days. 
This  is  one  reason.  The  second  is  even  more  imperatiTe.  Halleek 
requested,  as  a  particular  favor,  that  Murray  might  be  ordered  to 
Philadelphia:  There  was  nothing  for  Murray  to  do  there  but  to  take 
your  place,  King's,  or  Smith's.  The  latter  have  both  been  ia  active 
service,  and  I  thought  it  best  to  relieve  you  on  that  aocoant. 

"  As  A.  E.  Smith  is,  in  my  opinion,  better  suited  to  perform  the 
duties  of  purveyor  than  Murray,  I  decided  to  make  him  purveyor,  and 
Murray  medical  director  of  transportation. 

"  I  assure  you  that  so  far  as  your  official  action  is  concemed,  I  have 
not  the  least  fault  to  find.  Yours  sincerely, 

"  W.  A.  HAlOfOVD. 

Oeneral  Halleck  testified,  substantially  that  **  to  the  best  of  his 
recollection,"  he  never  made  any  request  of  the  accused  to  order  Dr. 
Murray  to  Philadelphia ;  the  only  communication  he  ever  made  to 
him  on  the  subject  being  a  letter  on  the  first  of  October,  stating  that 
Dr.  Mnrray  had  served  long  and  faithfully  in  the  field,  with  the  army 
in  the  West,  and  would  like  to  be  transferred  to  Eastern  hospital  duty, 
and  asking  the  consideration  of  his  case. 

On  the  part  of  the  defence,  a  letter  from  Dr.  Murray  to  Qehenl 
Halleck,  dated  Louisville,  September  27th  was  submitted,  in  which 
Dr.  Murray  stated  to  General  Halleck,  that  if  he  would  request  the 
Surgeon-General  to  order  him  to  Philadelphia,  it  would  •*  be  done  at 
once."  And  it  was  claimed  by  the  accused — but  not  shown — that 
Oeneral  Halleck,  besides  writing  the  letter  of  October  Ist,  in  whidi 
he  asked  that  Dr.  Murray's  desire  to  be  ordered  East  on  **  hospital 
duty  "  might  be  considered,  also,  in  some  personal  interview,  made 
a  verbal  request  that  he  be  assigned  to  that  duty  in  Philadelphia. 

The  argument  of  the  Judge  Advocate  on  this  charge  may  be  found 
on  pages  57  to  59  of  his  '*;Ileply,"  and  that  of  the  counsel  foi  the 
accused  on  pages  51  to  58  of  the  "Defense." 

The  findings  upon  the  first  and  third  charges  involve  questions  of 
law  as  well  as  of  fiict. 

It  was  contended  by  the  accused  (see  pages  9  to  16  of  the  '*  De- 
fence ")  that  the  Suigeon- General  had  the  power  to  control  all  pur- 
chases of  stores  for  his  department ;  to  order  purveyors  when,  at 
what  places,  of  whom,  and  at  what  prices  they  should  procura  them; 
and  further,  that  he  might  purchase  them  himself. 

It  was  submitted  by  the  Judge  Advocate  (see  pages  4  to  7  of  hit 
"  Reply  "  )  that  the  acta  of  Congress  of  April  16,  and  July  17, 1862. 
limited  the  auUiotity  ot*\!^<^  &^T^sM]Ri*%«u«t%.l  Vi  the  direction  when  to 


1864.]  Bditar'i  ToAh.]  "       568 

porchase,  and  the  kind  and  qaantitr  to  be  proeared ;  that  haying 
giren  this  direction,  hie  lawful  aathofitj  was  determined,  loaring  to 
medical  parvejors,  nnder  bonds  for  the  proper  dischaige  of  their  re- 
sponsibiiitiee,  the  whole  dntj  of  selecting  in  snch  markets,  and  of 
buying  from  snch-  persons,  and  npon  saoh  terms  as  their  judgment 
dictated. 

The  former  of  these  enactments  provides  ''  that  medical  purvejora 
shall  bo  charged,  nnder  the  direction  of  the  Surgeon-General,  with 
the  selection  and  purchase  of  all  medical  supplies,  including  hospital 
stores,"  etc.,  etc. 

The  latter  makes  prorision  that  medical^iurveyors  shall  give  bond, 
with  approved  security,  in  such  sums  as  the  Secretary  ot  War  shall 
require,  for  the  faithful  performance  of  their  duties. 

It  would  seem,  from  the  express  language  as  well  as  from  the 
reason  of  the  law,  that  the  position  taken  by  the  Judge  Advocate  was 
correct,  and  the  decision  of  the  court  upon  this  issue  was  warranted. 
But  it  is  deemed  unnecessary  to  bestow  further  consideration  npon  this 
question.  The  findings  of  the  court,  that  the  accused  ordered  the 
purveyors  to  purch  ise  supplies  of  inferior  quality,  well  knowing  them 
to  be  such,  and  to  purchase  articles  at  exorbitant  prices,  with  corrupt 
intent  to  aid  in  defrauding  the  Government,  and  that  he  ordered  the 
purchase  of  "additional  large  supplies,"  "corruptly,"  and  "with 
mtcnt  to  aid"  certain  persons  "  fraudantly  to  realise  largo  gains 
thereon,"  impute  much  more  than  a  more  tochnical  over-stepping  of 
the  limits  of  tho  enactment  of  April  16,  1862.  They  convict  him  of 
official  corruption,  abuse  of  power,  «nd  a  gross  breach  of  public  trust. 

The  proof  upon  which  these  findings  are  based  was  oflered  in  sup- 
port of  the  3d,  4th,  5th,  6th,  and  7th  specifications  to  the  first  charge. 
It  is  not  requisite  in  this  report  to  collate  and  comment  upon  it.  The 
fall  presentation  of  the  whole  case  by  the  Judge  Advocate  relieves 
thib  office  of  the  necessity  of  entering  into  that  detailed  discussion  of 
the  facts  and  legal  questions  involved  which,  under  different  circum- 
stances, would  have  been  proper. 

In  his  "  Reply,"  and  the  "  Defence"  of  the  counsel  for  the  accus- 
ed, both  of  which  are  printed  and  attached  to  the  record,  the  impor- 
tant portions  of  the  evidence  and  all  the  prominent  features  of  the 
proceedings,  are  presented  as  concisely  as  the  voluminous  character 
of  the  testimony  would  admit. 

That  the  natural  and  necessary  result  of  the  acts  of  the  aooused  as 
established  by  the  record,  involved  a  criminal  spoliation  of  the  (Gov- 
ernment treasury,  which  would  alone  have  called  for  hia  dismiasal 
from  the  service,  cannot  be  denied ;  but  when  it  is  remembered,  as 
shown  by  the  proof,  that  this  spoliation  was  in  part  accomplished  by 
the  purchase  of  inferior  medical  supplies  and  stores — thus  comprom- 
ising the  health  and  comfort,  jeopardising  the  lives  of  the  side  mad 
wounded  soldien  in  the  hospitals  and  apon  the  battle-fields  oi  the 
oonntry — soldien  aolemnly  oomaiittad  to  the  shelter  and  aymp'tbiea 
of  the  office  held  by  the  accused,  by  the  ymj  law  and  purpose  of  its 
creation — it  most  be  admitted  that  this  fisaruiny  augments  the  meaa- 
ore  of  his  crhainality. 


561  EdUor*9  ToUe.  [September, 

The  trial,  which  lasted  nearly  four  months,  was  one  of  the  most 
patient  and  thorough  that  has  ever  occurred  in  our  military  bistorj  ; 
and  the  accused  had  throughout  the  assistance  of  eminent  and  able 
counsel  in  conducting  his  defence.  The  court,  which  was  composed 
of  nine  general  officers,  at  the  close  of  this  prolonged  investigation, 
declared  him  guilty  of  the  charges  preferred,  and  awarded  the  pun- 
ishment which,  in  their  judgement,  was  in  accordance  with  the  na- 
ture and  degree  of  the  offences  committed  ;  and  a  careful  examination 
of  the  record  leaves  no  room  for  doubt  as  to  the  validity  of  the  pro- 
ceedings, or  the  justness  of  the  findings  and  sentence. 

J.  Holt,  Judge  Advocate  General. 

The  following  is  the  President's  order  confirming  the  sentence  in 
this  case : 

**  The  record,  proceedings,  findings,  and  sentence  of  the  court  in 
the  foregoinff  case  are  approved ;  and  it  is  ordered  that  Brigadier- 
Qeneral  William  A.  Hammond,  Surgeon-General  of  the  United  States 
Army,  be  dismissed  the  service,  and  be  for  ever  disqualified  from 
holding  any  office  of  honor,  profit,  or  trust  under  the  Government  of 
the  United  States.  A.  Lincolv. 

;^*'^tt^t«n8,  1864." 

Medical  Communicationt,  with  the  Proceedings  of  the  Seventy-see- 
ond  Annual  Convention  of  the  Connecticut  Medical  Society,  Held 
at  New  Haven,  May  25th  and  26th,  1864. 

This  interesting  volume  of  Transactions  opens  with  the  annual 
address  of  the  President,  Dr.  E.  K.  Hunt,  of  Hartford  —  wherein  he 
combats  with  much  force  tho  idea  of  **  Inert  Practice  in  Disease," 
showing  very  clearly  that  while  nature  is  abundantly  able  in  mauj 
cases  to  counteract  disease  —  yet  that  diseased  conditions  are  positive 
in  their  character,  and  medicines  definite  in  their  effects ;  hence  the 
physician  should  learn  to  estimate  justly  the  relative  power  of  nature 
and  art,  in  the  management  of  disease. 

Following  the  President's  address,  we  have  a  dissertation  on  Scar- 
latina, by  Dr.  P.  M.  Hastings  :  It  is  a  careful  and  thoughtful  review 
of  the  pathology  and  treatment  of  this  disease  on  rational  principles ; 
while  immediately  following  is  another  article,  enthusiastically  advo- 
cating the  Water  treatment  of  Scarlatina,  especially  by  the  wet  sheet 
pack ;  This  essay  is  by  Dr.  R.  W.  Matthewson.  Articles  on  En- 
largement of  the  Prostrate  Gland,  by  Dr.  Eussell ;  Sulphuric  Ether 
in  Surgical  operations  ;  Schirrus  of  the  Testes,  &c.  Biographical 
sketches  of  several  deceased  members.  Proceedings  of  the  Conven- 
tion —  Officers  —  Members  —  and  other  business  matters  close  the 
volume.  The  next  annual  meeting  of  the  State  Society  will  be  field 
at  Hartford,  May  25,  1865. 

L(mg  Lland  College  HotpUol. — ^^^  «aTiual  CMnmeacement  of  lUf 


1864]  fJMitor*$ny$.  696 

Medical  School  took  place  on  the  evening  of  July  1st.  The  degree 
of  M.  D.  was  conferred  on  thirty  -  seven  Gmdnates.  The  address  on 
behalf  of  the  Faculty  was  made  by  Prof.  Hntchinson.  An  elegant 
gold  chain  was  presented,  in  behalf  of  the  class,  to  Prof.  E.  N. 
Chapman ;  and  complimentary  re^oiutions  to  the  Professor  of  Materia 
Medica  and  Therapeutics. 

Commutations,  —  Notwithstanding  frequent  explanation  of  the 
matter,  our  sabsoribers  do  not  appear  to  understand  our  arrangements 
for  commutation.  First  of  all,  the  whole  system  of  deductions  for 
commutation  with  other  Journals  is  of  no  advantage  to  us  —  we  turn 
over  all  the  deduction  to  our  subscribers  as  an  inducement  to  them  to 
remit  promptly,  and  to  encourage  their  disposition  to  increase  the 
number  of  their  Journals.  Again :  All  such  subscriptions  are  at 
onco  remitted  to  the  several  Journals  called  for;  for  instance,  a 
subscriber  sends  us  the  money  for  the  Lancet  and  Observer,  and  at 
the  same  time  for  the  London  Lancet  and  Braithwaite*s  Betroepect : 
we  at  once  remit  to  London  Lancet  the  name  and  cash  for  one  sub- 
scriber, which  goes  on  their  hookn,  not  ours  ;  and  that  copy  of  London 
Lancet  is  thence  regularly  mailed  from  the  New  York  ofifice,  noi  from 
here  :  so  in  the  same  way  Braithwaite  —  Atlantic  Monthly,  &c.  Now 
when  a  subscriber  fails  to  receive  a  particular  number  of  one  of  these 
Journals,  he  should  immediately  address  the  publisher  of  that  Jour- 
nal —  not  us  —  for  if  we  are  addressed,  we  are  obliged  to  write  a 
reply  to  our  subscriber,  and  a  note  of  inquiry  to  Braithwaite,  London 
Lancet,  or  whatever  it  may  be  —  thus  causing  the  necessity  for  three 
letters,  and  a  delay  of  time,  when  one  letter  direct  wonid  have  been 
more  to  the  purpose. 

The  Canada  Medical  Journal,  and  monthly  reeord  of  medical  and 
surgical  science.  Edited  by  Drti.  Fenwick  and  Campbell,  Montreal. 
Wc  have  received  No.  2  of  this  new  Journal,  and  take  great  pleaanre 
in  placing  it  on  our  exchange  list.  It  is  handsomely  published,  and 
conducted  with  energy.  We  hope  our  Canada  brethren  will  give  this 
new  Journal  a  generous  support 

Please  send  us  Number  One. 

Medical  Schools  :  There  seems  to  be  a  tendency  to  revive  medical 
Journalism  and  medical  teaching.    By  reference  to  our  advertising 
department  it  will  be  seen  that  a  new  school  is  organized  in  Cleve- 
land, under  the  head  of  Prof.  Weber,  to  be  known  aa  l\i^  CKarUi 
Hospital  Medical  CoU^pe  :  it  is  to  be  condnctfii  mt\u\^  <iti  ^<^  ^%.^ 
of  the  BelJevue  Hospital  Cbll^ge  of  New  YoA,  c\\u\ci\  vniXr^t^^o^ 


666  Bi'Un^9  TM§.  [SifUmbtt, 

fonning  a  prominent  featnre  of  the  oonrie  of  teaching.  We  do  net 
know  wbat  may  be  tbe  neeeMity  for  a  lecond  school  at  Cleveland — 
but  the  plan  of  this  new  College  is  in  accordance  witli  the  demaadi 
of  the  profession.  Tbe  final  organization  of  the  Medical  College  of 
Ohio,  appears  in  onr  adyerdsing  department,  arranged  and  annonwvd 
just  as  we  are  going  to  press.  Quite  a  number  of  other  College  Ai- 
nonncements  are  found  in  this  number  of  the  Joamal  —  and  our 
readers  will  note  them  at  their  leisure. 

9^  New  Booki  : — Lindsaj  &  Blakiston  hare  issued  a  new  edition  ef 
Dr.  Durkee's  Treatise  on  Otmorrkea  and  SypkUd  ;  W.  A.  Townseod 
has  also  just  published  a  new  book  —  Man  and  HU  IMaiion$.  dtc^ 
bj  Dr.  8.  B.  Brittan.  We  shall  notice  these  books,  and  others  on 
our  table  heretofore  acknowledged,  at  an  earlj  date. 

lo  Correspondents :  —  The  continued  ill  health  of  the  Ptabliskr 
of  this  Journal  has  prevented  individual  replies  to  manjr  of  our  cor- 
respondents ;  communications  are  received,  and  on  file,  from  Dr. 
Wallace  of  Nashville — Dr.  Cleland  of  Indiana — Dr.  Hajmoodof 
Monticello,  Ind.  —  and  Dr.  Charles  Cochran  of  Toledo,  who  will 
please  accept  our  thanks. 

7^  Amenean  Journal  of  Opthalmotogy  for  April,  being  No.  2 
Vol.  I,  is  just  at  hand.  Although  late  in  making  its  appearance,  it 
is  an  excellent  number.  Tbe  opening  article  is  by  the  £ditor,  Pr, 
Homberger,  and  is  a  review  of  "  the  standard  operations  forcatarsct, 
and  particularly  the  methods  proposed  by  Mooren  and  Jacobson. " 
In  the  course  of  this  article  Dr.  H.  gives  his  own  personal  experience 
in  these  operations.  This  article  is  followed  by  several  carefully  pre- 
pared communications  —  together  with  the  usual  selected  variety  and 
editorial  notes.  We  sincerely  hope  this  effort  to  establish  an  Amer- 
Joumal  devoted  to  this  specialty  will  be  entirely  successful. 

B.  Frank  Palmer^  Esq.  —  This  gentleman  so  well  known  as  the 
inventor  of  the  Palmer  Leg  —  and  Palmer  Arm  —  has  recently  been 
called  to  pass  through  grevious  trials :  Tbe  Western  University  of 
Pennsylvania  has  conferred  upon  him  the  degree  of  Doctor  of  Laws 
—  and,  as  if  to  test  endurance  to  its  utmost,  he  has  about  the  saoe 
time  taken  to  himself  a  wife  ;  so  that  our  old  friend  is  L.L.D.  and  t 
Beoedict. 

Personal,  —  Dr.  E.  Williams,  Eye  Surgeon,  has  ramovad  to  his 
new  residence  and  office.  No.  64  Seventh  st.,  near  Vine. 

Dr.  John  A.  Murphy  has  removed  also  to  his  new  residence 

and  office*  No.  21%  ^\|^\\i  %^.>  n^^ax  'ScXi^. 

Surgeon  QsmtaL  qf  the  Ut^^ted  BlaUa.— '^LK^Swei^  \\kK^^Ktor  Dr. 


1864.]  JSdiiar'i  TabU.  567 

Josepli  K.  Barnes,  wbo,  sinoe  the  arrest  of  Dr.  Hammond,  has  been 
Acting  Sargeon  General,  has  received  his  commission  as  Sargeon 
Qeneral,  to  date  from  Augast  22nd. 

American  PhmrmaceuUeal  Asioeiation  :  —  We  have  heretofore  no- 
ticed the  meeting  of  this  Society,  to  be  held  in  this  city  on  the  21st 
inst. ;  we  learn  that  the  meeting  will  be  held  in  Mozart  Hall,  in  the 
Catholic  Institute  building  —  and  that  the  arrangements  promise  an 
interesting  meeting  of  the  Association. 


*•»  ■ 


Army  Medical  Intelligenot. 

In  accordance  with  orders  from  Headquarters  Military  Division  of 
the  West  Mississippi,  no  resignations  of  Medical  Officers  serving 
within  the  limits  of  this  Department  will  be  accepted  except  by  reason 
of  incompetency  or  disability  from  sickness,  and  in  these  cases  only 
after  an  examination  and  recommendation  has  been  made  by  a  Board 
of  Medical  officers. 

By  Command  of  Maior-Oeneral  Banks : 

OxoBOi  B.  Drakb,  As9iit.  At^uiwU-Oenirat, 

Surgeon  J.  H.  Grove,  U.S.Y.,  as  Surgeon  in-charge.  General  Field 
Hospital,  Army  of  Tennessee,  Rome,  Georgia. 

Assistant  Surgeon  B.  O.  Brown,  26th  Kentucky  Vols,  as  Snrgeon- 
in-charge,  Military  Prison,  Louisville,  Ey. 

Permisiion  to  remain  in  Washington,  D.O.,  under  medical  treat- 
ment, has  been  granted  Assistant-Surgeon  John  S.  Billings,  U.S.A. 


•  •»  • 


CSditarial  ^luttuttt  nn&Sftltttlnnt. 


PRACTICAL    MEDICINE. 

1.  Pneumonia. — ^There  are  many  cases  of  this  affection  treated  dur- 
ing the  year  at  Bellevue,  ami  consequently  the  disease  is  familiar  to 
us  all.  Of  the  diagnosis  we  no  not  propose  to  speak.  A  few  words 
aa  to  treatment.  It  is  now  generally  aamitted  that  pneumonia  is  a 
disease  which  tends  to  debility,  and  therefore  requires  aaaleptie  treat- 
ment. The  oldeu  metho«i8  of  sangpninsous  depletion  with  antinu>niali 
have  been  swept  away  by  the  advance  of  medical  science,  rather  than 
by  a  change  in  the  type  of  the  disease  ;  indeed  we  seldem  meet  with 
a  case  of  pneumonia  so  sthenic  as  to  require  or  even  tolerate  a  plan  of 
treatment  which  is  eseentisll y  depressing.  A  simple  case  of  pneumo* 
nia  will  get  well  of  itself  without  any  medical  assistance  v^^a^iviw^ 
provided  the  system  possess  vitality  anfimeni  \o  taxn  ^^  ^^^a^tsox 


568.  JESdUorial  AbMruOt  and  Sdectiota.  [September, 

tbrongh  the  disease  ;  and  the  chief  indication  which  the  physician  is 
called  to  meet,  is  to  sastain  the  vital  forces  when  they  begin  to  flag. 
Antiphlogistics  are  only  admissablo  as  paliativeu,  or  checks  to  cer- 
tain symptoms,  and  exercise  no  control  over  the  real  disease.  These 
are  the  principles  which  govern  our  practice  :  For  a  temperate  and 
healthy  man,  in  whom  the  disease  is  confined  to  one  lobe,  and  the 
pleuritic  pain  inconsiderable,  we  ficquently  do  nothing  further  than 
Keep  him  comfortable  in  bed,  with  diet  nutritions  and  easy  of  digei- 
tion,  suflicient  to  meet  the  demands  of  the  appetite.  Such  a  man  has 
within  himself  the  elements  of  recovery.  Should  this  patient  anfier 
from  active  febrile  symptoms,  with  acute  pain  during  the  first  stage, 
dry  cups  to  the  chest,  and  a  moderate  diaphoresis  by  means  of  an  oil* 
ed  muslin  jacket  and  a  dover's  powder,  will  relieve  the  symptoms. 
If  the  pneumonia  be  more  extensive,  we  expect  a  greater  degree  of 
subsequent  asthenia,  and  modify  the  treatment  accordingly  ;  as  sooa 
therefore,  as  any  active  symptoms  have  been  allayed  as  above,  we 
begin  with  the  more  liberal  use  of  food,  as  strong  beef- tea,  eggs,  etc., 
reserving  tonics  and  stimulants  for  the  flagging  pulse.  Dr.  Loomis, 
however  gives  quinine  from  the  commencement  of  consoliiiation,  with 
a  view  to  support  the  nervous  system  till  convalescence  is  establish- 
ed, and  thinks  the  patient  under  this  treatment  recovers  more  rapidly. 
Pneumonia  in  old  persons  and  in  children,  or  in  persons  debilitated 
from  any  cause  whatever,  is  very  apt  to  assume  the  asthenic  type,  and 
requires^  besides  the  above,  for  its  successful  issue,  the  administration 
of  stimulants,  graduated  to  the  symptoms  in  the  case  ;  for  instance,  a 
boy  aged  twelve  years  was  very  ill  last  winter  with  a  pneumonia  con* 
fined  to  the  lower  lobe  of  the  right  lung  ;  his  pulse  had  risen  to  120, 
and  was  very  weak  ;  for  several  days  he  took  with  marked  benefit 
sixteen  ounces  of  whisky  per  diem  with  eggs,  beefsteaks,  milk,  etc., 
and  finally  recovered.  Most  of  our  patients  sick  with  pneumonia,  get 
more  or  less  whisky  during  their  illness,  and  all  are  allowed  extra 
diet.  The  oiled  muslin  jacket  is  used  in  nearly  every  case,  the  prac- 
tice being  to  put  it  over  a  flannel  shirt,  and  the  two  keep  the  skin  in 
a  continual  moisture.  We  do  not  expect  to  lose  any  patients  with  a 
simple  pneumonia,  unless  it  be  confirmed  drunkards  ;  and  it  is  as- 
tonishing to  observe  how  this  class  of  patients  succumb  to  this  dis- 
ease. Thev  demand  stimulante  ad  libitum.  We  have  examined  the 
urine  for  chlorides  in  many  cases,  and  do  not  find  them  absent  nor 
diminished  near  so  frequently  as  some  would  have  us  suppose. — Am, 
Med,  Times, 

2.  Creosote  and  Arsenic  in  ike  Treatment  of  Sinn  Diseases, — From 
the  well-known  prevalence  and  obstinate  character  of  some  of  the 
cntaneous  diseases  of  the  North-Western  States,  frequently  resisting 
alike  the  efforts  of  well-directed  medical  skill,  the  never-failing  nngn- 
ents,  lotions,  and  alterative  secretion  regulating  secret  remedies  of  the 
presumptuous  charlatan,  and  much-lauded  specific  nostrums  of  the 
patent  medicine  vender,  I  desire,  through  the  medium  of  your  widely 
circulating  journal,  to  commend  to  the  consideration  of  the  profess- 
on,  after  an  experience  ol  ^lleeti  "^^ax^^^^^  i\y^^^  %tt\cleB  in  the  tieat- 
xnent  of  cutaneous  diseaaea. 


hi.]  Edlityr^al  Abstracts  and  Selections,  569 

IftTing  kept  no  record  of  cases  T  have  no  data  but  memory  from 
ich  to  write.     I  shall,  there'ore,  make  a  brief  general  statement  of 

manner  in  which  I  have  been  in  the  habit  of  Ubing  the  above  arti- 
^  and  if  the  statements  which  I  may  make  should  prove  of  benefit 
my  one  of  the  profession,  or  any  of  the  afflicted,  my  end  will  have 
n  attaine<l. 

have,  during  tbo  time  specified,  treated  many  cases  of  these  die* 
es,  of  various  grades,  and  have  found  more  good  rcsnUing  from  the 

of  creosote  than  from  any  other  article  which  I  have  used.  The 
?ase3  in  which  I  have  found  it  more  particularly  useful,  are  im- 
igo  and  porrigo,  and  more  especially  of  these,  porrigo  larvalis  of 
lun  and  Bateman,  or  inpetigo  larvalis  of  the  French  writers  ;  this 
iety  affecting  young  children  during  the  period  of  dentition,  is  a 
rce  of  mnoh  annoyanL*o  both  to  nurses  an  I  doctors,  to  say  nothing 
he  more  serious  consequences  ^vhich  may  occasionally  result  from 
long  continuance,  where  it  seems  to  baffle  all  the  skill  of  practi- 
ler  and  nurse. 

'his  varit'ty  (for  a  description  see  Wood's  Prac.  of  Med.,)  some- 
es  discharges  fluid  so  copiously  that  scabs  cannot  form  ;  it  is  in 
[i  cases  that  I  have  found  the  creosote  to  act  most  advantsgeoubly, 

alho  in  the  particular  oases  of  eruption  of  the  scilp.  I  have  been 
;h  gratified  with  its  results,  indeed,  it  has  given  entire  satisfaction 
ilmost  every  cskc  where  I  have  been  able  to  fairly  test  its  virtues. 
I  manner  in  which  I  have  found  it  to  act  most  beneficially  is  in 
n  of  an  ointment,  made  according  to  the  following  formula  : 
Kr.  AdcpK  preparata,  3  j  ;  creosote,  gtt.  xxv.  Mix  on  a  clean  tile 
)late  tmtil  the  two  are  thoroughly  incorporated.  Apply  the  oint- 
It  with  a  camel's  hair  pencil  or  the  tip  of  the  finger  to  the  parts 
irted,  twice  a  day,  cleansing  it  well  with  fine  soap  and  ram  water 
?  a  day.  If  the  ointment  in  this  proportion  should  be  too  strong 
the  particular  case  to  which  it  is  applied,  the  inflammation  will  be 
eased  ;  this  should  be  an  indication  for  a  lessening  of  tlie  creosote  ; 
a  the  contrary  it  is  too  weak,  the  eruption  will  heal  very  slowly 
lot  at  all,  which  is  an  indication  for  greater  strength.  The  con- 
itional  symptoms,  if  any  are  present,  and  it  frequently  so  occurs, 
iild  be  met  with  appropriate  remedies,  and  it  is  here  that  I  have 
id  arsenic  in  the  form  of  Fowler's  Solution,  more  valuable  than 
the  other  alteratives  and  entropies  which  I  have  used, 
'his  may  be  very  safely  adminidtered  to  small  children  if  the  nurses 
sufficiently  warned  of  the  care  necessary  to  be  taken,  to  give  only 
prescribed  dose.  The  manner  in  which  I  have  usually  given  it 
B  follows  :  To  a  child  from  2  to  6  months  old,  git.sj  ;  from  6  to 
gtt.  iss  ;  from  IS  to  24  months,  gtt.  ij  ;  two  or  three  times  in  24 
rs,  increasing  with  the  age.  I  have  been  in  the  habit  of  oontina- 
the  use  of  the  solution  for  a  length  of  time  varying  from  two  to 
months,  which  practice  would  aeem  to  suggest  itself  as  beicg 
ificial  on  account  of  tlie  well-known  properties  of  areenic  in  pro* 
ing  nutrition.  J.  Ellks  Ltovb»  M.U. 

fmnthffion,  Ind. 


570  .JSdUorud  AhsiraeU  and  Sdiditm»*  [Septembir, 


3.  Imianiansoua  Trtatmeni  of  &h  2y  Oil 
ed  from  the  Journal  Medeeine  de  Bord^ux  for  Jane,  1864»  for  the  An- 
ton Medical  and  Surgical  JoumeiZ.— Dr.  Hanfre,  the  venorable  Qliaictl 
professor  ia  the  UniTersity  of  Naples,  has  published*  ia  »  Bomai 
political  newspaper  many  articles  on  the  rapid  core  of  itch.  The  bert 
remedy,  which  he  says  he  has  thas  far  tried  with  complete  Buoeess  ia 
his  clinical  service,  is,  according  to  M.  Manfre,  the  oil  of  beigaaot, 
which  cares  instantly,  or  at  most  in  two  minates,  evea  where  (he 
eruption  is  general. 

According  to  him,  this  remedy,  more  economical,  lese  irritatiog, 
more  prompt  in  its  insecticide  effects  than  Helmerioh'e  ointment  or 
snlphar,  makes  the  wards  appropriated  for  patients  with  this  diseiat 
in  hospitals  superfluous  ;  for  a  single  friction  over  the  whole  effected 
surface  is  sufficient  to  effect  a  perfect  cure.  The  petient  nuij  return 
home  immediately  after  this  application,  the  precaution  being  takei 
of  making  him  cnange  his  clothing,  or  of  thoroughly  purifying  Uist 
which  he  has  worn.  An  ounce  or  two  of  oil  of  bergamot  ie  enoogb 
to  complete  the  cnre. 

According  to  M.  Manfre,  the  same  remedy  may  be  adventageonslj 
substituted  for  all  those  employed  for  the  destruction  of  Ampedieahu 
pubis. 

For  a  long  time  physicians  hare  known  the  insecticide  power  of 
the  essential  oils,  and  there  may  be  found  in  some  formularies  manj 
receits  of  M.  Aube  for  the  cure  of  itch  in  two  minutes.  The  essentia 
oil  of  turpentine,  mixed  with  eHsence  of  lemon,  is  the  basis  of  ths 
treatment  recommended  by  this  author.  Before  him,  AL  Gras  had 
recommended  the  essential  oil  of  lavender,  which  is  quite  enalogoos 
to  that  of  bergamot,  and  has  the  additional  advantage  of  not  costing 
more  than  a  quarter  or  half  as  much. 

OPHTHALMOLOGICAL. 

4.  Lumtnous  Eyes, — By  Prof.  K.  Stellwag  Von  Carion. — (Trans- 
lated from  the  Wiener  iiedxcal  Wochenschrfft,  1864,  pp.  145,  161. 
177.) — ^The  fundus  ocnll  reflects  light  both  in  a  regular  and  irregnlar 
manner.  Of  the  former  wo  have  an  example  in  the  peculiar  shining 
of  the  eye  in  dogs  or  cats  ;  of  the  latter,  in  the  light  reflected  back  to 
the  observer  with  the  ophthalmoscope.  After  describing  the  structure 
of  the  tapetnm,  to  whicn  the  lu8tre  of  an  animal's  eye  ia  priocipally 
due,  the  author  passed  to  the  similar  phenomenon  in  the  human  eve. 
So  far  as  he  is  aware,  Fermin,  who  saw  it  in  1795  in  an  albino,  was 
the  flrst  to  mention  it,  and  J.  Beer  the  first  to  pay  any  particular  at- 
tention to  it.  The  latter  considers  it  to  be  immediately  owing  to  a 
pathological  disappearance  of  the  choridal  pigment  (ca:s*-eye  amaa- 
rosis).  This  appearance  soon  came  to  be  considered  a  symptom  of 
medullary  cancer  of  the  retina.  The  assertion  is  quite  correct,  that 
such  a  disease  at  an  early  period  frequently  produces  exactly  similar 
reflections  to  those  described  by  Beer  ;  for  cancer  is  wont  to  occar  *» 
an  infiltration,  w\v\cVv  distends  a  greater  or  less  part  of  the  retina  into 
a  thick  layer.    Sow,  a^  \ki^  \«i\.\,«t  ^iw^x^  ^^  "^v^S^^Q^ent-layer  of  the 


1864.]  Xdilmtd  AbHradB  cmf  StheUm^.  571 

ehoroid,  and  owing  to  iU  litUe  trmtpareiicy  and  ligbt  oolor,  diflfosei 
and  refleetB  a  largo  amount  of  the  inoident  light,  the  fundus  heoomes 
illuminated  and  appears  red,  whitish-red,  or  whitish,  according  to 
the  yascularitj  of  the  new  formation.  Moreover,  as  the  tumor  gp-ows, 
it  passes  more  and  more  within  the  focus  of  the  media,  and  therefore 
is  seen  in  an  erect  and  magnified  image— the  Teasels,  little  elevations* 
etc.»  becoming  distinctly  visible.  Finallj,  light  is  regularly  reflected 
by  the  surface  of  the  tumor ;  the  eye  becoming  lominous  when  to- 
ward dusk  it  is  placed  in  a  certain  position  with  reference  to  the  light 
and  to  the  observer,  the  morbid  product  taking  the  place  of  the  tape- 
tum  in  an  animal's  eye. 

The  observations  of  Travers,  Ammon,  and  others,  showed  that 
sometimes  after  this  symptom  had  been  observed  the  eyeball  gp-adual- 
ly  become  softer  and  atropic.  This  was  at  first  explained  by  the  sup- 
position that  the  supposed  concer  had  undergone  a  retrograde  meta- 
morphosis— a  supposition  which  was,  however,  proved  to  be  incorrect 
by  Chelius.  Now-a-days,  it  is  known  that  in  such  cases  the  tumors 
are  of  inflammatory  origin,  that  they  are  formed  of  connective  tissues, 
and  that  they  usually  proceed  from  the  choroid,  although  in  excep- 
tional instances  they  may  be  primarily  developed  in  the  retina.  Such 
tumors  constantly  end  by  suppuration  or  atrophy ;  they,  of  conrse 
destroy  the  eye,  but  do  not,  uke  cancer,  destroy  the  patient.  They 
now  pass  under  the  title  of  sarcomatous  tamors. 

It  must  not  be  imagined  that  the  lustre  is  a  constant  symptom, 
either  of  cancer  or  sitrooma  ;  its  occurrence  depends  on  certain  condi- 
tions. In  the  first  place,  the  service  of  the  tumor  must  be  of  a  light 
color,  and  not  too  rough.  In  sarcomatous  tumors  of  the  choroid, 
which  contain  a  large  quantity  of  pigment,  or  which  are  covered  by 
the  unaltered  pigment-layer  of  the  choroid,  and  intra-ocular  melano- 
sis, no  lustre  is  observed.  Stellwag  also  believes  that  there  is  no 
lustre  in  cases  of  sarcoma  or  cancer  where  the  surface  projecting 
into  the  vitreous  body  is  very  irregular  and  vascular.  For  choroids 
tumors  to  regularly  reflected  light  there  is  another  oondition  :  the  re- 
tina must  have  either  been  ruptured,  or  be  stretched  as  a  tense  and 
even  membrane.  This  phenomenon  is  not  found  in  cases  of  separa- 
tion of  the  retina  from  the  surface  of  the  tumor  by  serous  fluid,  or, 
indeed,  in  the  ordinary  cases  of  retinal  separation,  for  the  membrane 
Is  too  transparent  to  act  efficiently  as  a  mirror,  and  yet  too  opaque  to 
allow  sufficient  light  to  pass  to  the  surface  of  any  subjacent  tumor. 

This  phenomenon  seems  to  be  specially  promoted  by  a  light-colored 
choroidal  tnmor  prss^ing  the  retina  forwaitl,  so  as  to  apply  it  exactly 
to  the  posterior  surface  of  the  lens.  The  author  has  scarcely  ever 
■aen  it  so  beautifully  as  in  an  albino,  two  and  a  half  years  old.  whose 
right  eye  was  afiected  in  the  mauner  just  mentioned.  Even  in  a  well- 
lighted  room  there  was  a  w%rr  markM  mother-of-pearl  Instre,  but  in 
aemi-darkness  the  eye  emitted  truly  brilliant  bluish  and  yellowish  re- 
flections whilst  the  left  eye  sparkled  of  a  ruby- red.  In  the  right  eye 
the  cornea  was  perfectly  transparent— the  ins  reduced  to  an  extremely 
narrow,  brownish-black,  immovable  border ;  tbft  ^ViftW  \«cl%  "«%.% 
in  contact  with  the  comeM,  and  ita  poatariot  inttiea  wa»  c»va'^^^l 


572  EdUorM  AhHraeU  and  8d$dwM.  [SeptomUr, 

covered  by  the  retina.  The  latter  was  Terj  opaqoe,  and  of  a  grer- 
irih-yellow  color  ;  here  and  there  were  blnieh-white  stripes,  aad  spoti 
containing  masses  of  cholesterine.  A  light-colored  inmor  sitaatsd 
behind  it  appeared  as  if  covered  with  a  thick  reil.  The  eje  was  al- 
ready atrophying. 

A  separated  retina  may  cause  such  a  peculiar  reflection  nnder  less 
favorable  oircnmstanccs,  provided  it  is  thickened  and  transformed  into 
a  dense,  tendinous  mass ;  an  example  of  this  has  been  furnished  bj 
Alfred  Grafe  (  Ophth,  Review,  i.,  p.  160). 

There  has  been  some  doubt  as  to  the  nature  of  the  affection  describ- 
ed by  Beer  as  ''  cats' -eye  amaurosis/'  Himly  refers  it  to  absorptioa 
of  the  choroidal  pigment,  and  supports  his  view  by  the  light  color  of 
the  fundus  oculi  and  the  lastre  observed  in  albinos.  It  is  true  that 
some  observers  have  not  notice<l  the  latter  appearance,  probaUj 
owing  to  their  neglect  to  the  conditions  under  which  it  can  be  seen. 
If  an  albino  is  placed  in  a  partially  darkened  room  opposite  a  mod- 
erately distant  window  or  lamp,  a  properly  placed  obsenrer  will 
scarcely  ever  fail  to  perceive  the  lustre— only,  indeed,  when  the  popil 
cannot  dilate.  The  author  considers  rapidly  advancing  myopia  to 
have  been  the  essential  lesion  in  Beer's  cases  ;  the  extreme  atrophj 
of  the  choroid  and  consequent  exposure  of  the  sclerotic  very  much  con- 
duce to  the  production  of  the  lustre ;  and  the  author  can  from  hit 
own  experience,  affirm  that  it  may  always  bo  seen  in  the  most  brilliant 
manner  in  such  cases,  provided  the  eitternal  conditions  of  the  phe- 
nomenon are  fulfilled.  Even  if  there  is  only  a  posterior  staphyloma, 
or  if  the  surrounding  choroid  is  but  little  atrophied,  the  phenomenon 
can  always  be  perceived,  provided  the  pupil  is  well  dilated  and  the 
eye  properly  directed  with  reference  to  the  lamp. 

As  this  lustre  could  be  perceived  where  the  staphyloma  was  but 
small,  it  appeared  probable  that  it  might  also  be  seen  in  cases  of 
fibrous  degeneration  of  the  optic  disc.  This  supposition  was  confirm- 
ed by  the  examination  of  a  number  of  such  cases  ;  indeed,  the  lustre 
was  very  marked.  The  ophthalmoscope  showed  in  the  mass  of  these 
cases  that  the  choroid  was  quite  normal,  the  atrophy  of  the  optic  nerve 
being  a  consequence  of  simple  neuritis  optica,  or  depending  on  cerebral 
amaurosis.  In  one  case  there  was  an  old  and  very  characteristic 
glaucomatous  excavation. 

The  same  lustre  may  be  seen  in  normal  eyes  ;  it  is  very  difficult  to 
render  it  apparent  so  long  as  the  pupil  is  contracted,  but  if  full  dilita- 
tion  is  effected  by  the  use  of  atropine,  there  is  not  much  trouble.  For 
the  same  reason,  it  is  a  constant  symptom  where  there  is  a  congeni- 
tal absence  of  the  iris. 

From  what  has  been  said,  thore  can  be  no  great  difficulty  in  deter- 
mining what  is  the  part  that  takes  the  place  of  a  mirror.  If  the  cho- 
roidal pigment  is  entire,  the  room  must  be  darkened,  the  lamp  placed 
at  a  distance  of  several  feet  from  the  eye  to  be  examined,  and  the  ob- 
server must  place  a  screen  between  himself  and  the  flame,  so  that  he 
may  look  almost  exactly  in  the  same  direction  ;  at  the  same  time,  the 
eye  observed  must  \>e  d\t«c\j^^  ^QtoA'nViat  inward.  This  is  the  only 
position  in  whicii  lYie  IxlsVt^  \a  oVi^^xx^^.  ^\«  «iL^\vGfiASQX\i&  much  fa- 
cili  tated  by  full  d\\aia\.\oTi  ol  \}!afc  ^tx^^.   \\.\^\vKw»i  «Nf\\«Q^^^caX'^«(^ 


1864,]  Edliwrial  Ahsiradt  and  Sel^dum.  678 

18  in  the  normally-pigmented  fundua,  no  considerable  surface  which 
can  act  as  a  specalum  ;  the  opinion  that  the  optic  disc  is  the  reflector 
appears  to  be  confirmed  br  the  fact  already  mentioned,  that  the  Instre 
is  more  readily  obeerred  when  the  nerve  has  undergone  fibrous  degen- 
eration. 

Where,  from  any  morbid  process,  the  choroidal  pigment  has  been 
extensively  destroyed,  ihe  exposed  sclerotic  takes  the  place  of  the 
tapetum.  For  exactly  analogous  reasons,  the  lustre  is  very  marked, 
and  very  readily  perceived  in  albinos. 

Eeliual  cancers,  light-colored  choroidal  tumors,  fibrous  degenera- 
tions of  the  separated  retina,  very  closely  resemble  the  tapetum  in 
their  physical  qualities. —  Ophihalmk  Bev'iw, 

SURGICAL. 

5.  Punctured  Wound  of  the  Thorax — Pneumothorax — Recovery, — J. 
B.  aged  23,  was  stabbed  on  the  night  of  February  20th,  between  the 
vertebral  column  and  the  anterior  angle  of  the  left  scapula.  He  stat- 
ed that  the  stab  was  immediately  succeeded  by  an  oppressive  dys- 
pnoea and  great  phyHical  prostration.  In  this  condition  he  was  ad- 
mitted into  the  hoKpital,  (Bellevne).  He  was  expectorating  small 
nnantities  of  bloody  mucous,  and  his  face  was  pallid  and  anxious. 
The  percussion  note  upon  the  right  side  was  normal,  but  over  the  left 
thorax  a  highly  typanitic  resonance  was  elicited.  Auscultation  re- 
vealed cavernous  breathing  over  the  upper  portion  of  the  left  scapula, 
with  absence  of  all  respiratory  sounds  over  the  remaining  portion  of 
the  left  cavity.  The  external  wound  was  sealed,  and  the  patient 
placed  in  a  recumbent  posture,  after  which  his  bieathing  became  easy. 

Feb.  28. — He  has  continued  to  expectorate  a  bloody  froth  since 
admission,  but  has  been  very  free  from  dyspnoea,  and  reports  himself 
comfortable.  Auscultation  reveals  distinct  metallic  tinkles  more  dis- 
tinctly in  the  Rubclavicular  region  ;  there  is  but  little  fluid  in  the  thora- 
cic cavity,  which  throughout  the  greater  portion  of  its  extent  yield 
the  same  abnormal  resonance. 

Fob.  28ih. — Improving  ;  no  dyspnoea  ;  no  metallic  tinkling,  and 
much  loss  of  the  tympanitic;  resonance.  Itcspiration  can  now  be  heard 
extensively  over  the  posterior  aspect  of  the  left  side.  From  this  time 
the  condition  of  the  patient  steadily  improved,  until  March  12i\i, 
when  he  was  difchargcd  estirely  well. 

Thi8  case  is  interesting  on  account  of  the  rapidity  of  the  recovery 
which  he  made  from  so  grave  an  accident,  there  being  but  three  weeks 
from  the  date  of  the  injury  to  that  of  his  discharge.  The  svmptoms 
indicating  a  wound  of  the  lung,  with  a  complete  collapse  of  this  organ 
were  so  well  defined  that  an  error  in  diagnosis  cannot  be  admitted. 
This  man  had  none  of  the  usual  sequelae  of  the  accident,  such  as 
pleurisy,  pneumonia,  or  empyemia,  and  to  this  must  be  attributed  his 
early  recovery  .^-4fn.  Med,  Timei, 

2.  Bloody  Ttmore  Beneath  ihe  Scalp.— Uturj  R ,  aged  29, 

admitted  February  Tib,  18(>4,  waa  foond  npon  the  street  in  a  state  oC 
intoxication.    She  had  a  stone  in  her  band  with  \iVi\q\i  AiA>^9^^me<Q^ 


574  Editorial  AbiiracU  and  SeUeliam.  l^&fka^m^ 

beating  her  own  bead.  On  admiesion  a  large,  flnctnaUng  tumor,  oor- 
vering  the  wbole  top  of  her  head,  waa  found,  and  diagnoaticated  if  a 
large  extravaration  of  blood  prodnoed  by  the  rapture  of  some  blood- 
vessels against  which  the  stone  had  impinged.  8he  waa  placed  in  bed 
and  measures  taken  to  prevent  her  from  inflicting  farther  TiokDei 
upon  hei^self.  The  bowels  were  kept  soluble,  and  nothing  waa  dona 
locally  for  the  tumor.  In  two  days  ahe  had  recovered  fully  from  dw 
debauch,  and  wished  to  go  home  with  her  friends.  The  awelling  bad 
diminished  in  size  somewhat  more  than  one  half,  and  the  contained 
blood  was  still  uncoagulated.  These  bloody  tumors  between  the 
muscular  aponeurotic  layer  and  the  perecraninm  are  of  rare  ocGurrenos^ 
and  are  apt  to  be  extensively  diffused,  owing  to  the  loose  connexioi 
which  obtains  between  these  coverings.  The  diagnosis  is  easy,  es- 
pecially when  the  history  of  the  case  oan  be  obtained,  as  in  the  pm* 
ent  instance.     The  prognosis  depends  upon  the  aui^on. 

The  invariable  rule  of  treatment]  among  our  moat  intelligent  and 
experienced  surgeons  is  to  abjure  the  knife,  leaving  the  blood  to  bi 
absorbed,  which  is  usually  accomplished  in  a  few  days,  more  or  hsit 
according  to  the  amount  effused  ;  if  any  assistance  is  needed  it  will 
be  a  gentle  stimulation  of  the  scalp  in  order  to  promote  this  prooeis. 
Gases  that  have  been  cut  into  have  resulted  in  a  diffused  erysipelatou 
inflammation,  gangrene,  and  sloughing,  denuding  the  skull  of  its  per^ 
icranium,  and  ultimately  terminating  in  the  death  of  the  paticfli 
The  difference  between  one  of  these  tumors,  before  and  after  being 
oponcd,  is  strictly  comparable  to  that  of  a  simple  and  compound  frae* 
ture. — Am.  Med,  Times. 

6.  BurM  and  Scalds.  From  Reports  of  BeUevue  SjMpital  in  Am, 
Med.  limes. — Under  this  head  is  included  a  class  of  accidents,  rang- 
ing from  the  most  trivial  to  the  most  grave  and  dangerous  with  which 
the  surgeon  is  called  to  deal.  We  are  constantly  receiving  patients 
suffering  from  every  variety  of  bnms  and  scalds,  many  of  whom  die 
soon  after  admission,  from  collapse  occasioned  by  either  the  extent  or 
severity  of  the  injury,  the  former  being  the  most  frequent  cause  of 
early  death. 

The  treatment  of  those  cases  in  which  the  skin  is  simply  reddened 
consists  in  the  application  of  a  rag  wet  with  cold  water,  which  is  some- 
times condusive  to  the  comfort  of  the  patient,  but  perhaps  is  oftener 
a  placebo,  as  in  these  cases  the  pain  is  slight,  and  it  matters  but  lit- 
tie  what  remedies  are  employed,  provided  they  do  no  harm.  In  those 
cases  where  the  derma  is  burned  to  a  greater  or  less  depth,  the  pain 
and  general  symptoms  are  proportionally  aggravated.  If  the  injuiy 
is  very  extensive  the  patient  will  be  in  a  state  of  collapse,  requiring 
diffusible  stimulants  and  artificial  warmth  ;  if  less  extensive  the  pain, 
which  is  often  of  the  most  exquisite  character,  demands  the  immedi- 
ate exhibition  of  opiates,  and  in  both  cases  the  surface  of  the  bam 
should  be  protected  as  soon  as  possible  from  the  atmosphere  and  other 
external  resources  of  irritation.  This  we  effectually  accomplish  \>j 
the  following  mixture,  which  is  used  for  nearly  every  burn  in  this 
hospital,  as  well  aa  \^7  omt  \i«v^^D\^T%  «t  the  New  York  Hospital :— 


B64.]  Editorial  AhitracU  and  SdacUom  675 

r.  Gam  arabio  3j. ;  gum  tragct]itb»  tyr.  Aisdi»  aa  sSj. ;  aqua  bal- 
entiB  Oj. ;  M.  When  cool  applj  in  a  tbin  coating.  Experience  bas 
mgbt  us  to  trust  to  tbie  mixture  in  preference  to  any  otber  remedy, 
'bis  is  applied  till  suppuration  is  tborougUy  eetablisbed,  and  tbe  snr- 
ice  studded  witb  granulations,  after  wbicb  tbe  injury  is  treated  as  a 
imple  healing  ulcer.  Simple  cerate  spread  upon  sheet  lint  or  tbin 
luslin,  is  now  a  very  good  dressing.  Should  tbe  granulations  be- 
Dmc  pale  and  flabby,  tbe  dressing  may  be  changed  by  combining  equal 
arts  of  simple  cerate  and  balsam  Peru,  which  makes  a  moderately 
timulating  and  pleasant  application.  These  cloths  are  changed  once 
r  twice  daily,  according  to  tbe  profusion  of  tbe  discbarge ;  it  is  bet- 
sr,  however,  to  change  them  seldom  than  to  be  too  officious  in  pre- 
erving  cleanliness.  Of  course  the  propriety  of  analeptics  during  tbe 
upnration  of  an  extensive  bum  commends  itself  io  the  minds  of  all. 

Dr.  Packard  of  Philadelphia,  bas  recently  published  in  tbe  Ameri- 
an  Journal  of  Medical  Science,  bis  succesa  in  immediately  alleviating 
be  pains  of  burns  and  scalds  by  tbe  application  of  fresh  lard  ;  while 
Ir.  Skey  of  London,  thinks  the  best  remedy  for  tbe  early  periods  of  a 
»urn  is  a  solution  of  nitrate  of  silver,  grs.  x  to  xt  to  the  ounce  of 
irater. 

Soon  after  seeing  Mr.  Skey's  report  of  this  plan  of  treatment,  we 
.dmitted  a  patient  with  an  extenaire  bum  upon  tbe  thorax  and  upper 
xtremities.  She  was  in  a  condition  approaching  to  agony  of  pain. 
Vs  soon  as  tbe  solution  was  applied  she  said,  '*  1  feel  free  from  pain," 
.nd  soon  fell  into  a  quiet  sleep  ;  this  application  was  continued  until 
be  surface  began  to  heal  on  the  edges.  We  learned,  however,  not  to 
ipply  the  cotton  wool  recommended  by  Mr.  Skey,  in  conjunetion  witb 
he  solution,  as  it  sticks  to  tbe  surface  and  irritates  rather  than  soothes. 

7.  To  Prevent  the  PiUlng  of  Small' Pox, — According  to  the  experi- 
ence of  the  following  gentlemen,  we  have  a  simple  and  effectual  plan 
o  prevent  the  striking  disfigurement  produced  by  small  pox.  Dr.  F. 
3owen  in  the  Medical  Tim«e  and  OoMette,  states  that  in  1850  be  was 
lirected  by  tbe  senior  surgeon  of  tbe  Marine  and  Emigrant  Hospital 
n  Quebec : 

''  To  puncture  the  vesicles  on  tbe  face  and  neck  of  one  of  the  bospi- 
al  patients  then  suffering  from  small-pox,  with  a  needle  dipped  in  a 
tolntion  of  the  nitrate  of  silver.  I  felt  skeptical  as  to  tbe  succesa  of 
,he  treatment,  and  secretely  determined  to  apply  tbe  needle  and  aoln- 
ion  to  the  vesicles  on  one  side  of  the  face  and  neck  only,  and  watch 
ihe  result.  I  did  so.  Tbe  patient  recovered  ;  but  the  disfigurement 
wa^  really  frightful,  for  wbUe  one-half  of  bis  faoe  was  deepy  pitted, 
Jie  otber  half  was  smooth  and  free  from  spots  as  before  tne  attack. 
Fha  superintending  medical  officer  waa  not  ioelined  to  disoharffe  this 
patient,  but  over  and  anon  produced  him  before  tlia  daas  in  w  lee* 
:are  room,  when  he,  poor  fellow,  waa  laoghed  at^  while  I  waa  twitted. 


CHARITY  HOSPITAL  MED.  COlLEGf." 

CLEVELAND,     OHIO. 


FACULTY. 


JAHES  DASCOMB.HD., 

Pioreuor  of  Cbeuittc?  uid  Toxicolcgj. 

A.  P.  DtJTCHER,  M.D., 

Profeawrof  PriadplciaiMl  I'imUm  of  Hc£cia«. 

L.  FIRESTONE,  M.D., 

ProfeMOTof  ObBte'ric««nf  Dur&aiof  WumaiatidCUtdr.ti. 

J.  H.  SALISBURY,  M-D., 

ProfeuoT  of  E'Mologj,  Phjuology,  Puholofloil  Auauimr. 

R.  A.  BARR,  M  J) , 

Proh'Mr  of  Anil  nj. 

OOSTAV  E.  WEBER,  M.D., 

FAifomr  of  C)*JI  uid  Mililirj  Snriaf . 

H.  S.  CASTLE,  E«i., 

Pr  if«Beor  of  Leg'l  Mcdhine. 

W.  J.  aCOTT,  M.D., 
ProfcBaor  bf  Materia  M.di.a. 

A.  METZ,  M.  D  , 

Frofvssor  of  Opthilmn'ogr. 

S.  U.  SARGENT,  M.D  , 

Frofci  or  of  Ihc  Dis  »aei  of  the  Urinu;  Org  as. 

J.  C.  SHENCK,  MJ}., 

Demo  iStrntor  of  Anatom?. 

GU3TAV  C  E  WEBER,  M.D  ,  Dfas, 
3.  H.  SALISBURY,  MD.,  Sacwwuir. 
Thii  Inalitution  u  CBUbliaheil  on  the  same  plan  m  tfac   Belltfioa  CoU*;* 
of  Meir  Vo  k      C  in'cal  Iiutruction  conatkatei  a  pronin  ut  featacff^n  thll 
plan  of  BducatioD. 

Tbe  tecturoswiU  ootnineDee  on  th«  SGth  day  of  October  ind  continiM   IT 
vMka. 

Prafciioni'  tickeU,  S6D,  Mit  icula'inn  fo',  $i,  Oradoalion  fea  $90,  Den- 
onBtnitor'd  ticket, $u.  Hoaplal^oket,  ffi. 

PenooB  desiring  fbrlher  infonnation  can  addt«n  the  Dean  or' SvcNtBT  il  ' 
CleTcUBd,  Ohio.  GDSTAV.  C.  E.  WEBER,  M.D., 

D:u9f  th«  Faed^.    ' 


lUvlog  t««igii4il  tiU  omimiuluu  Id  lb*  Araiy  oAa  a  Mntce  lif  • 
lui  enioc«il  intu  privalf  insetic*. 

So.  344.Bao«  Strvni.  nlntti  Xliiil> 


THE 

CINCINNATI  LANCET   AND  OBSERVER 

CONDUCTED   BY 

E.  B.  STEVENS.  M.D.,  AND  J.  A.  MUHPHY.  M.D. 


fiB 


Vol.  VII.  OOTOB  EB,      1864.  No.  10, 


Original  ^ommunirations. 


AETICLK    I. 

Scarlatina. 

[B«A(I  t>«ror«  the  Toledo  Medical  Aisociation,  ao<1  puhUeUeil  hj  request  of  the  Soctotj.] 


BT  CBA8.  COCUR43I,  M.D. 


Scarlatina  has  prcvailcil  among  \in,  to  some  cxtont,  during  tlio 
past  few  months.  I  havo  8e-3n  bat  little  of  it,  and  have  had  but  little 
experience  in  its  treatment.  For  that  reason  I  f*;el  reluctant  to  enter 
upon  its  discussion,  and  I  do  so,  as  a  source  of  profit  to  myself  rather 
than  with  the  expectation  of  imparting  to  the  members  of  the  asso- 
ciation, any  new  ideas  upon  a  subject  which,  from  its  importance, 
Las  received  the  attention  of  the  be>t  minds  of  the  profession  in  ovary 
age  I  shall  not  examine  the  aetiology  pathology,  or  therapeutics  of 
tlie  disease.  These  can  be  found  in  the  books,  and  have  doubtless 
been  pernsed  more  frequently  and  have  be^'n  more  thoroughly  dig  ;btod 
by  the  members  of  the  Society  than  by  myself. 

Three  varijti^is  are  d  js/rib^^  1,  simple,  anginosc,  and  malignant.  It 
•cems  to  ma  more  natural  to  divide  it  into  himple  and  complicated. 
The  first  would  comprise  all  the  mill  cases  requiring  little  or  no  med- 
ication, and  the  lattor  all  the  H)voro  cases  in  which  complications  of 
aaj  kind  may  arise  during  the  progress  of  the  disease.  Such  com- 
plicatioos  too  frequently  arise  and  they  call  for  the  exercise  of  all  the 
akill  and  energy  that  can  be  brought  to  hear  upon  the  case. 

^o  one  can  read  the  standard  authors  in  medicine  without  notiv'ing 
the  discordant  views  of  the  nature  of  scarlet  fever,  and  the  diiTercnt 
methods  of  treating  the  dissasd.     If  one  reads  with  the  intAUt^^-v  <^1 


578  Original  CommunieaHans.  [October, 

yielding  to  the  weight  of  authority,  and  thoB  gnidisg  hit  practice,  he 
may  adopt  the  most  opposite  theories  of  its  nature,  and  pnreue  the 
most  opposite  methods  of  treatment.  Yet  no  one  can  read  these  aa- 
thors  without  foaling  that  they  wrote  under  the  influence  of  mature 
judgment,  and  each  recommended  a  course  of  treatment,  adapted  to 
meet  indications  as  they  presented  themselves  to  him. 

These  different  theories,  and  the  corresponding  diflforent  practice, 
can  only  he  explained  hy  assuming  that  the  disease  has  at  different 
periods  presented  types  essentially  different,  and  consequently  required 
treatment  to  be  varied  to  meet  the  type  which  then  prevailed.  This 
brings  up  the  subject  of  epidemic  constitution,  or  prevailing  diathesis, 
a  subject  of  vast  importance,  which  has  received  much  less  attention 
than  it  deserves.  The  many  years  of  experience  of  our  worthy  pret* 
ident,  has  no  doubt  shown  him  the  disease  at  sometimes  with  charac- 
teristics in  striking  contrast  with  thoae  which  it  exhibited  in  other 
epidemics',  and  even  the  fifteen  or  twenty  years  that  some  of  the  rest 
of  us  have  been  in  the  profession,  have  shown  us  the  disease  of  a 
much  higher  grade  of  inflammation,  at  some  times  than  have  pre- 
vailed at  other  times  or  than  now  prevails: 

This  epidemic  constitution,  or  prevailing  diathasis,  alone,  can  ex- 
plain the  diversified  phases  which,  in  books,  the  disease  has  been 
made  to  wear,  and  explain  why  methods  of  treatment  so  opposite  to 
dach  other,  have  at  different  times  been  attended  with  success  so  nearly 
uniform  in  cheir  results. 

With  these  introductory  remarks  I  shall  call  your  attention  to  scar- 
latina as  it  prevailed  in  Sandusky  during  the  winters  of  1851  and  '52. 

The  first  case  with  which  I  met,  occurred  on  the  28ih  of  December, 
and  the  last  on  the  25th  of  March  following.  Between  these  two  dates 
I  treated  nineteen  cases  ;  ten  of  which  presented  the  ordinary  symp- 
toms of  the  simple  form  of  the  disease,  and  were  treated  with  tepid 
spongings  of  the  body,  gentle  laxatives  when  necessary,  fresh  air, 
and  mild  unirritating  diet,  with  the  result  of  perfect  recovery.  Some 
of  the  other  cases  I  shall  describe  in  the  order  of  their  occurrence  and 
give  the  peculiarity  and  treatment  of  each  as  fully  as  brief  notes  taken 
at  the  time  will  permit. 

Case  I.  Dec.  28th,  1851. — E.  B ,  little  girl  aged  four  years, 

was  attacked  with  vomiting  about  6  o'clock,  a.m.,  for  which  I  was 
called  at  10^  o'clock  the  same  morning.  She  complained  of  pain  in 
the  head,  had  some  fever,  tongue  covered  with  dirty  white  coat,  vom- 
its frequently,  complains  of  sore  throat ;  the  glands  about  the  neck 
are  enlarged,  the  fauces  ate  inflamed  and  the  tonsils  swollen.     At  this 


1864.]  CooHRAV— iS^rlfl/tiMtf  579 

time  there  liad  been,  to  far  as  I  knew,  no  eases  of  searlet  feter  in  tlie  * 
citj.  I  stw  no  rash  and  looked  for  none.  I  supposed  it  a  case  of 
fever  attended  by  irritabilitj  of  the  stomach,  and  haviag  accidental 
local  inflammations.  I  prescribed  an  emetic  of  ipecao,  to  be  followed 
bj  ten  grs.  calomel,  and  a  dose  of  castor  oil  six  honrs  afterwards,  all 
of  which  operated  well. 

Next  day  worse,  more  fever,  throat  more'  swollen  externally,  aod 
fanoes  more  inflamed,  dirty  white  spots  on  both  tonsils.  I  applied 
solution  of  nitrate  of  silver  40  grs.  to  the  Jj.  water,  to  the  tonsils, 
volatile  liniment  to  be  applied  externally.  Prescribed  calomel  2  grs: 
pnlv.  ipecac  half  grain  every  two  hoars.  Next  day  she  was  abbnt 
the  same  ;  had  been  slightly  delirioas  daring  the  night ;  the  throat  is 
very  sore,  the  spots  on  the  tonsils  are  now  of  a  dark  ash  color,  the 
whole  mncoas  membrane  of  the  month  is  inflamed,  and  there  is  the 
peculiar  strawberry  appearance  of  the  tongae.  I  discovered  scattered 
patches  of  scarlet  rash  on  the  surface.  The  inflammation  of  the  fau- 
ces extends  to  the  nares,  from  which  a  dirty  fluid  is  discharged.  She 
has  ear  ache,  and  though  she  answers  correctly  when  spoken  to  she  is 
inclined  to  be  delirious.  I  ordered  a  gai^le  of  salt,  capsioum,  and 
vinegar,  alternated  with  chlorinated  soda ;  sponged  the  throat  with  the 
solution  of  nitrate  of  silver,  and  continued  the  powders  of  calomel 
and  ipecac  every  four  hours.  From  this  date  the  case  continued 
with  symptoms  slightly  varied  from  day  to  day  ;  but  on  the  whole 
rather  improving  under  a  treatment  of  spirits  of  nitre,  small  doses  of 
ipecac,  occasionally  a  small  dover  powder  with  a  grain  or  two  of  cal- 
omel, a  laxative  when  needed,  and  tonics  daily,  after  the  first  three 
days,  till  the  23d  of  January,  when  she  was  discharged  cured,  having 
been  sick  twenty-six  days.  She  however  regained  her  strength  slowly, 
and  was  quite  deaf,  which  unfortunately  proved  to  be  a  permanent 
trouble. 

Casb  V.^-J.  p.,  a  little  boy  three  years  old,  was  attacked  with 
slight  fever,  for  which  I  was  called  January  20th.  Found  him  suf- 
fering from  sore  throat  and  the  ordinary  symptoms  of  fever,  for  which 
I  administered  a  dose  of  calomel  to  be  followed  next  morning  by  castor 
oil.  Soap  liniment  to  be  applied  to  the  throat  externally.  Next  day 
ha  was  more  comfortable  ;  the  scarlet  eruption  was  just  making  its 
appearance.  I  left  a  mixture  of  pulv.  ipecac  and  water  to  be  given  if 
the  fever  increased.  He  continued  apparently  doing  well  till  the  night 
of  the  third  day.  During  this  day  he  had  been  playing  with  the  other 
chfldren  about  the  room  ;  had  been  put  to  bed  early  in  the  evening 
apparently  as  w^ll  as  usual  and  went  quietly  to  aVus^.     KXxVii^XM^* 


580  Ordinal  Cammunieaiiant.  [October, 

fore  midnight,  when  I  arrived  ho  was  sufferiag  from  all  the  symptomi 
of  a  severe  case  of  croup.  I  had  him  as  soon  as  possible  in  a  warn 
bath,  administered  emetic  tartar  and  ipecac  which  operated  freelj  as 
an  emetic  with  partial  relief.  I  gave  10  grs.  calomel  and  directed  as 
follows :  9r  calomel,  8  grs. ;  pnlv.  ipecac,  4  grs. ;  m.  ft  chartalas 
No  4,  of  which  give  one  every  two  hoars.  I  also  left  a  mixture  of 
emetic  tartar,  ipecac  and  water,  of  which  a  spoonful  at  a  dose  was  to 
be  given,  and  repeated  if  the  breathing  shoald  become  impeded.  After 
an  hoar  or  two  the  croapy  symptoms  became  more  aggravated  and  in 
less  than  six  hours  my  patient  died. 

Case  VI. — A  brother  of  the  last,  five  years  old,  was  taken  sick 
January  25th  with  the  ordinary  symptoms  of  simple  scarlet  fever. 
The  rash  made  its  appearance  on  the  third  day,  pursued  it«  usatl 
course,  and  the  patient  was  considered  convalescent  in  about  a  week. 
On  the  11th  of  February,  seventeen  days  after  the  attack,  I  was  again 
called.  He  had  not  been  quite  so  well  for  a  few  days  ;  his  counten- 
ance was  rather  pale,  there  was  a  puffiness  about  the  eyes  and  fullness 
of  the  face ;  and  further  examination  revealed  general  anasarca.  The 
pulse  was  excited,  and  a  little  wiry.  I  prescribed  six  grs.  each  of 
calomel  and  jalap,  to  be  followed  in  six  hours  by  a  drachm  each  of 
sulph.  magnesia  and  cream  tartar,  which  operated  freely.  A  pill  of 
calomel,  jalap  and  rheubarb  each  one  grain,  was  given  every  night  for 
about  ten  days,  and  a  solution  of  nitrate  of  potash  freely  given  through 
the  day,  under  the  operation  of  which  he  recovered. 

Case  XII. — F.  P.,  a  little  boy  4  years  of  age,  was  attacked  widi 
pretty  severe  fever  February  7th.  He  vomits  freely,  glands  of  the 
neck  considerably  swollen,  complains  of  sore  throat,  much  inflamma- 
tion about  the  fauces  and  tonsils.  I  administered  an  emetic  of  ipecac  ,* 
prescribed  6  grs.  calomel,  to  be  followed  in  six  hours  by  3j»  castor 
oil ;  all  of  which  operated  well.  The  rash  appeared  the  next  day. 
The  case  continued  about  eighteen  days.  The  inflammation  of  the 
throat  extended  to  the  nose  and  aural  passages,  from  which  there 
was  a  dirty  watery  fluid  discharged,  which  at  times  was  bloody.  He 
was  treated  by  gentle  laxatives,  and  diaphoretics.  Gargles  of  salt, 
capsicum,  and  vinegar,  alternated  with  chlorinated  soda,  were  freely 
used.     Ho  perfectly  recovered. 

Case  XIV. — Feb.  29th  was  called  to  see  J.  M.,  about  two  years 
old.  The  mother  thought  the  child  had  not  been  quite  well  for  two 
or  three  days.  Its  countenance  was  pale  ;  temperature  of  snrface  less 
than  natural,  except  over  the  abdomen  ;  the  extremities  were  decided* 
]y  cold ;  pulse  amiVl,  io^bU  aud  much  less  frequent  than  natural ; 


1864.]  CooEBAV—Searlatind.  581 

vomits  freely  ;  between  vomitings  is  inclined  to  6inp6r ;  glands  aboat 
tbe  neck  swollen.  He  refufles  noarishment ;  sometimes  cries  for 
drink,  bnt  when  it  is  offered,  after  an  ineffectaal  effort  to  drink,  pnsbes 
the  vessel  awaj.  His  lips  are  parched  ;  tip  of  his  tongne  dirty  red  ; 
papulae  prominent.  He  would  not  permit  me  to  examine  the  fauces 
or  throat.  I  directed  a  warm  bath,  followed  by  mnstard  paste  to  the 
extremities ;  gave^  8  grs.  calomel  in  hot  sling,  and  directed  an  Sj* 
castor  oil  in  four  hours.  Two  hours  after  the  oil  was  given,  there 
having  been  no  effect,  a  stimulating  enema  was  given,  and  repeated 
once  or  twice  without  effect  In  the  evening  the  carlomel  and  oil  was 
repeated  in  hot  whisky  toddy,  and  directions  given  to  repeat  the  ene- 
mata.  'ihe  medications  operated  freely  during  the  night  without  af- 
fording any  relief.  The  patient  becann  comatose*,  was  unable  to 
swallow,  and  died  the  following  night. 

Case  XV. — Brother  of  the  last,  4  years  of  age.  The  same  day  I 
was  called  to  see  the  last  case,  I  was  told  their  boy  had  been  sick  all 
nigbt.  Ho  was  then  able  to  be  running  aSout  the  hoase  though  some- 
what feverish  and  had  sore  throat.  He  had  castor  oil  and  was  to 
have  volatile  liniment  to  the  throat.  Tbe  nejtt  day  there  was  a  dis- 
tinct scarlet  rash  with  moderate  fever,  which  was  treated  with  gentle 
laxatives  and  diaphoretics.  The  disease  progressed  as  is  usnal  with 
cases  of  simple  scarlet  fever  till  the  fifth  day,  when  there  was  swelling 
of  the  parotid  and  cervical  glands  of  one  side.  This  swelling  inoreas- 
ed  very  fast,  and  in  three  or  four  days  appeared  to  be  pointing. 
Poultices  of  linseed  meal  were  applied  and  in  two  days  an  abscess,  on 
being  lanced,  discharged  a  thin,  saneons  fluid.  The  patient  gradually 
lost  strength.  Quinine,  Huxham's  tinct.,  muriated  tinct.  iron,  wine, 
And  brandy,  with  nutricions  diet,  were  perseveringly  given,  notwith- 
standing all  which,  he  gradually  failed  till  the  twentieth  day  of  the 
disease  when  he  died. 

Remarks.  —  Of  the  nineteen  cases  treated,  three  died.  There  was 
quite  a  difference  in  the  severity  of  the  cases  of  simple  scarlet  fever. 
Some  were  much  more  severe  than  others  ;  the  recovery  more  slow, 
And  the  patient  much  more  prostrated.  I  am  not  certain  but  the  in- 
creased severity*  in  some  cases,  was  due  to  the  medication  employed. 
I  am  inclined  to  think  that  cases  of  simple  scarlet  fever  should  receive 
bnt  very  little  medicine.  Tepid  sponging  of  the  surface,  small  doses 
of  pulv.  ipecac,  or  nitrate  potash,  once  in  three  or  four  hours,  the 
mildest  laxatives,  whan  the  bowels  are  slow ;  or,  what  is  perhaps  still 
better,  mildly  stimulating  enemata,  is  all  that  such  caMia^vQA>^^ 
require.    The  physician  can  not  cut  abort  tbe  diMAiia  ;  \ia  t^cf^^^s^l 


582  Original  Ommuni^tions.  [October* 

attempt  to  Rnbdae  severe  symptoms  as  they  arise,  and  thns  pilot  Ms 
patient  through  the  dangers  that  threaten  his  path.  I  suspect  that 
the  success  that  has  attended  the  inunction  of  acarlet  ferer  patients 
with  oil  and  rinds  of  bacon,  is  largely  due  to  the  fact  that  while  this 
is  being  done,  the  patient  is  unharmed  by  medicine.  I  think  I  bate 
repeatedly  seen  cases  mild  in  their  commencement,  and  which  proba* 
bly  would  have  continued  so,  had  they  been  left  to  themselves,  ren- 
dered more  severe,  under  the  operation  of  a  severe  oatbartic.  By 
this  remark,  I  do  not  question  the  wisdom  of  those  who  have  adv  ised 
the  administration  of  the  most  active  purgatives.  I  have  already 
accounted  for  the  difference  by  alluding  to  the  prevailing  diathesis  of 
the  disease,  which,  at  the  time,  may  have  rendered  such  treatment 
appropriate.  To  show  the  extent  to  which  cathartics  have  sometimes 
been  used,  you  will  allow  me  to  allude  to  an  account  of  scarlet  fever 
reported  by  Dr.  Judkins,  who,  in  1832,  at  Steubenville,  treated 
scarlet  fever  with  large  doses  of  calomel,  followed  in  a  few  hours  by 
a  full  dose  of  croton  oil.  During  the  whole  progress  of  the  disease, 
one  of  his  favorite  prescriptions  was,  Qr  calomel  20  grs,  croton  oil  8 
drops,  simple  syrup  Sj  •  n^ix  :  of  which  give  3j  every  two  or  three 
hours.  This  treatment  might  bave  been  good  at  that  time,  in  that 
epidemic,  but  the  man  who,  at  this  time,  with  our  diathesis,  should 
recommend  a  drop  of  croton  oil  eveiy  two  or  three  hours,  during  the 
progress  of  any  variety  of  scarlet  fe\rer,  would  be  considered  extremely 
heroic. 

Taking  the  position,  as  I  do,  that  simple  scarlet  fever  should  receive 
little  or  no  medicine,  I  am  far  from  thinking  that  it  is  wise,  or  even 
safe,  to  dispense  with  the  regular  attendance  of  a  physician  during 
the  progress  of  simple  scarlet  fever.  The  most  severe  cases  frequent- 
ly commence  with  symptoms  the  most  mild ;  and  these  symptoms, 
mild  though  they  may  be,  should  be  carefully  watched,  and  the  first 
indication  of  complication  should  be  promptly  met  by  the  appropriate 
remedy.  Just  here  lies  a  field  for  the  exercise  of  the  clearest  discern- 
ment, the  nicest  discrimination,  and  the  soundest  judgment.  It  is  one 
of  the  nicest  points  in  the  practice  of  medicine,  to  make  our  remedies 
exactly  adequate  to  subdue  prominent  symptoms  as  they  arise.  In 
simple  scarlatina  we  may  be  too  officious,  but  the  vital  forces  will 
usnally  remedy  our  interferance ;  not  so,  however,  the  complicated 
cases.  Ho  who  fails  to  meet  severe  complications,  with  boldness  and 
promptitude,  sufficient  to  give  him  command  of  the  symptoms,  loses 
the  golden  opporlumly,  aud  thereafter  generally  struggles  in  vain  to 
regain  what  was  \ost\iy  \\m\^\\.^  wx\  \\v\<8«vsvwi.    1  a^^eak  feelingly 


1865.]  OocanAM—SearlaUma.  688 

on  this  point,  and  yon  cau«  perhaps,  apprtciate  ihesa  feelings,  when 
yon  recar  to  oases  five  and  fonrteen,  detailed  in  the  preceding  pages. 

The  former  was  apparently  a  case  of  simple  scarlet  fever,  and  was 
treated  as  snch  with  every  evidence  of  snccess,  till  the  night  of  the 
third  day,  when  I  found  him  suffering  from  all  the  symptoms  of  se- 
vere croup.  Here  was  a  severe  complication.  If  I  had  met  the 
Mune  symptons,  unconuected  with  an  attack  of  scarlatina,  I  probahly 
would  have  had  no  hesitation  in  bleeding  the  patient ;  but  the  books 
say  that  in  scarlatina,  great  caution  should  be  exercised  in  resorting 
to  this  agency,  in  consequence  of  its  prostrating  effect,  and  I  was  not 
heroic  enough  to  meet  the  case  as  its  urgency  demanded.  Should  I 
again  meet  a  similar  complication,  I  would  bleed  freely,  and  then 
pursue  about  the  same  treatment  that  was  adopted  at  the  time.  If  I 
lost  the  patient,  I  would  at  least  have  the  consolation  of  having  met 
a  grave  disease  with  an  efficiency  somewhat  commensurate  with  its 
severity. 

Let  us  recur  to  case  fourteen,  and  review  the  symptoms  as  I  found 
them  on  the  29th  of  February,  1852.  The  countenance  was  pale  ; 
temperature  of  surface  less  than  natural,  except  over  the  abdomen  ; 
the  extremities  decidedly  cold  ;  pulse  feeble,  and  less  frequent  than 
natural ;  vomited  occasionally,  and  after  vomiting,  was  inclined  to 
doze.  What  is  indicated  by  this  group  of  symptoms  ?  The  pale* 
ness  and  deficient  animal  heat  indicated  the  absence  of  the  nsual  force 
of  circulation  through  the  superficial  vessels.  The  feeble,  slow  pulse 
indicate  a  want  of  energy  in  the  heart's  action.  The  drowsiness  and 
vomiting  that  the  brain  and  stomach  are  implicated.  There  is  evi- 
dently a  deficiency  of  vital  force,  and  unless  the  case  is  immediately 
relieved,  it  must  terminate  fatally.  I  did  not  meet  the  case  as  its 
urgency  demanded,  and  I  lost  the  patient.  I  may  lose  other  similar 
cases,  but  I  did  not  fail  in  the  following  year,  when  I  met  a  case  so 
precisely  similar  to  this,  that  its  description  will  be  but  a  repetition 
of  this  case.  With  this  group  of  symptoms,  I  thought  the  prostra- 
tion only  apparent,  not  real  —  that  the  heart,  lungs  and  brain  did  not 
perform  their  appropriate  functions,  because  the  blood  was  concen- 
trated upon  them  with  such  overpowering  force  that  they  conld  not 
act.  I  concluded  that  I  had  a  case  of  severe  congestion,  and  my  first 
effort  was  to  relieve  the  congestion.  The  patient  was  immediately 
placed  in  a  warm  mustard  bath,  and  while  in  the  bath,  I  bled  the  pa- 
tient. The  blood  flowed  at  first  slowly,  but  with  increasingjfreedom. 
1  carefully  watched  the  pulse,  and  found  it  increasing  in  volume  and 
frequency.    The  bleeding  was  large,  thongli  I  d\d  uo^  ^i^Sx\AvV^ 


584  Ordinal  OommutUeationt.  [Octolmv 

cope.  Upon  coming  out  of  the  bath»  the  surface  was  mbbed  drj 
with  flannel,  and  ten  grains  of  calomel  at  once  given,  and  five  graiu 
of  the  8a me  was  administered  every  hour,  till  foar  doses  more  were 
given.  As  the  stomach  was  irritable,  the  calomel  was  thrown  drj 
upon  the  tongue,  and  washed  down  with  cold  water.  After  the  fifth 
dose  of  calomel  had  been  given,  a  large  enema  of  salt  and  water  was 
given,  and  repeated  several  times,  which  produced  free  billions  stools.' 
All  this  time  the  animal  heat  had  been  gradually  returning,  and  there 
WAS  a  warm,  pleasant,  general  perspiration.  The  next  day  the  scarlet 
rash  appeared.  But  little  further  medication  was  necessary,  and 
there  was  a  speedy  recovery. 

It  13  freely  conceded  that  scarlatina  is  a  depressing  disease,  and 
that  the  vital  forces  should  be  carefully  preserved  ;  but  in  cases  com- 
plicated as  was  this,  the  question  is  not,  how  can  we  best  save  the 
strength  of  the  patient  —  how  best  enable  him  to  pass  through  coQ" 
valescencc,  tedious  enough  at  best  —  but  how  shall  we  most  promptly 
relieve  the  vital  organs,  so  as  to  enable  them  to  act  at  all  ?  How 
shall  we  most  effectually  rescue  them  from  the  deluge  that,  gathered 
from  the  superficial  organs,  from  all  parts  of  the  body,  seems  to  be 
hurled  upon  tbe  internal  organs  with  overwhelming  force  ?  I  would 
eed.  I  would  thus  turn,  if  p  )s.siblj,  the  current  in  the  opposite  di- 
rection ;  and,  hiving  relieved  the  internal  organs,  I  would  afterwards, 
if  necessary,  repair  losses  by  the  exhibition  of  tonics  and  stimulants. 
Indeed  I  think  we  often  fail  of  success  in  our  treatment  of  scarlatina 
for  the  want  of  appropriate  tonics  and  stimulants  at  the  proper  time. 

There  are  cases  of  scarlet  fever  malignant  from  their  commence- 
ment. Possibly  even  some  of  these  cases  have  a  period  in  their  his- 
tory, short  it  may  be,  when  heroic  treatment  might  be  appropriately 
resorted  to,  and  thus  prevent  the  prostration  that  too  often  proves 
fatal.  Frequently  the  physician  is  not  called  till  that  period  is  past. 
Sometimes  when  called  early,  he  lets  slip  the  golden  opportunity,  and 
is  thus  compelled  to  combat  the  disease  in  its  lowest,  worst  type.  I 
have  met  such  cases,  and  have  uniformly  lost  them.  I  presume  you 
have  all  traveled  the  same  road  often  enough  to  render  it  unnecessary 
for  me  to  raise  finger  -  boards  to  point  the  way  ;  especially  as  I  have 
discovered  no  new  methods  of  treatment,  by  which  a  more  fortunate 
result  can  be  attained. 

In  some  of  the  cases  detailed,  I  have  described  sequelae  which  fre- 
quently  follow   tho   disease.     They  are  numerous,  and  of  but  little 
less  importance  than  the  disea&e  itself.     They  may,  with  little  impro- 
priety, be  consuUtc^  jia^^\il\t\  -^wKa  cil  VX^a  disease,  and  can  not  be 


1864.]  CuBLAVD— jeimi^yMia.  685 

overlooked  in  the  treatment.     It  would  be  singoUr,  if  its  occurrence 
were  :iot  so  frequent  that  the  milder  form  of  the  disease  should  so 
frequently   have  severe   sequelw.     In   looking  over  the  more   than 
twenty  years  of  my  professional  life,  I  can  not  recall  an  instance  of 
severe  sequel ab  in  a  case  severe  in  its  onset.     They  are  to  be  looked 
for  in  the  serous  and  mucous  membranes,  and  in  the  parenchymatous 
system,  and  are  g^erally  of  an  inflammatory  character  —  and  may 
terminate  as  do   inflammations  of  those  iissues   arising  from  other 
causes.     1  do  not  recollect,  in  my  own  practice,  meeting  with  cases  of 
abscess  of  the  large  joints  ;  but  it  is  not  difficult  to  conceive  of  their 
occurrence.     I  have  frequently  met  with  abscess  of  the  glands  about 
the  throat.     They  are  doubtless  more  frequent  in  the  cervical  glands 
and  cellular  tissue  than  in  the  parotid  glands,  though  these  often  sup- 
purate.    When  pus  forms,  it  is  important  that  it  be  early  evacuated, 
lest  pyemia  be  added  to  the  train  of  ills  that  beset  the  patient.     I  have 
treated  theie  glandular  swellings  with  liniments,  tinct.  iodine,  fomen- 
tations and  poultices,  and  I  can  not  say  which  was  more  appropriate  ; 
or  indeed,  that  either  has  exercised  much  control  over  them. 

The  most  frequent  sequelso  is  serous  eflfusion  of  the  lung^,  of  the 
pericardium,  of  the  brain,  or  more  frequently  general  anasarca.  These 
aerous  effusions,  wherever  found,  are  generally  of  a  sthenic  character^ 
and  are  best  treated  by  active  catharsis,  and  the  free  use  of  mercu- 
rials. I  have  rarely  failed  with  calomel  so  combined  as  to  obtain 
copious  watery  stools.  It  should  be  continued  for  several  days,  of 
course  avoiding  ptyalism. 


>  •<■  ■ 


ABTICLB  II. 

Empyema  of  the  Left  Lung. 


By  M.  T.  CLtLAHD,  M.D.,  Kewasft,  Fulton  Co.,  lod. 

I  was  called  to  see  Lieut.  Ilenry  H.  Carter  of  Co.  A.,  26th  Begt 
Ind.  Vol.  Infantry  on  the  30th  day  of  July,  1864,  who  had  an  at- 
tack of  acute  inflammation  of  the  pleura  while  on  his  return  home 
from  New  Orleans  the  last  of  March,  and  on  arriving  at  the  city  of 
Indianopolis  on  the  first  day  of  April  sent  for  medical  aid.  He  was 
treated  by  two  physicans  for  disease  of  the  heart,  they  at  that  time 
overlooking  the  acute  disease  affecting  the  left  lung  and  plura.  Ue 
remained  under  their  treatment  for  several  weeks,  until  the  affection 
of  the  left  lung  assumeil  a  chronic  form  ;  he  wm  lVieii\iTO^^\.\iOTSA^ 


586  Orffftrnd  Ctwrnwafwrfioiif.  [Ootahr, 


%  distance  of  one  handred  mi]mp  and  snppoMDg  his 
eeacluded  to  die  a  nataitml  death  and  take  no  mom  medims. 

When  I  saw  him  he  had  an  exercerbation  of  f«f%r  Bwmj 
pnlse  120 ;  respiration  laborions  ;  aaxiou  appeuvnoe ;  propped  ipii 
bed ;  and  perfect  solidification  of  the  left  Inag  with  ooonlmuuMe  ftk^ 
jet  possessing  energy  and  an  anxioos  desire  to  reoover 
his  regiment ;  he  had  no  disease  of  the  heart ;  the 
cold,  and  at  times  there  was  an  edematooi  ooaditioii  of  die  left  die 
and  extremities,  and  no  appetite.  Left  him  morph.  ^  gr«,  aoda  S  pu^ 
port  wine  a  tablespoonfal  every  three  hoanu  On  the  Slat  of  Jaly  I 
Tisited  him  again.  His  general  condition  aboat  the  same.  By  sw 
cnltation  I  detected  the  heart  resting  three  iachee  to  the  right  from  in 
proper  position  ;  diaphragm  pressed  down,  and  by  perentaioB  I  de- 
tected a  dullness  thronghoat  the  entire  left  side»  which  was  swollea; 
and  all  the  intercostal  spaces  filled  up.  I  did  not  hesitate  to  resort 
at  once  to  an  operation  to  relieve  the  patient,  who  was  saffaring  ssren 
pain ;  the  action  of  the  heart  being  so  violent  as  to  shake  his  body» 
and  the  bed  npon  which  the  patient  was  lying.  I  iatrodaoed  betwesa 
the  sixth  and  seyentfa  ribs  a  sharp  pointed  bistaoty  to  the*depch  of 
three  inches  which  was  followed  by  a  copions  dischaige  of  sere  ps- 
rnlent  matter.  One  gallon  was  taken  at  this  tapping,  which  imoMdi- 
atcly  redaced  the  heart's  action  to  its  natural  pulsation,  aad  in  plsM 
of  che  patient  becoming  weaker  his  pulse  became  slower,  and  respirs- 
tion  natural ;  the  discharge  continued  until  the  4th  day  of  Aogmt, 
and  on  the  5th  day  I  m:t  in  consultation  Dr.  Bobbins  of  Rochester, 
Ind.  There  was  at  that  time  an  abscess  forming  between  the  third 
and  fourth  ribs,  and  much  nearer  the  surface  than  before,  occasioned 
from  the  position  our  patient  had  to  lie  in  bed.  We  determined  ob 
a  second  operation  to  relieve  the  same  symptoms  which  were  as  seven 
as  at  the  first  operation.  An  abscess  lancet  was  then  introdnced  aad 
Ji&e  gallons  of  pure  pus  discharged.  I  then  introduced  a  tent,  and  st 
this  date  it  is  still  discharging.  The  amount  of  pus  discharged  sines 
the  second  operation  cannot  be  less  than  four  gallons.  Onr  patient 
was  put  upon  a  treatment  of  quinine  and  iron  with  ale  and  port  wine. 
At  pleasure  he  has  since  been  able  to  ride  oot  in  a  boggy ;  ie  mnek 
stronger,  his  appetite  very  good,  and  in  fact  he  cannot  eatenoagh  food 
to  satisfy  his  appetite. 

Lieut.  Carter  has  been  in  the  service  three  years,  is  an  efficient  aad 
brave  officer,  has  been  most  of  the  time  in  the  South  and  has  lived  to 
see  his  regiment,  which  was  full  when  they  left  Fulton  Go.^  Iiidiaas» 


\  1864.]                   WALLACjA^Jf^ikwineBoifiitali.                        587 

J  ledaoed  to  bat  two  GompaQies.    Ho  is  now  improying  and  shoold 

.  his  case  termiaate  favorably  I  will  report  for  pablieation. 

^  Bbmarks. — The  character  of  the  abore  case  is  iateresting.  first,  from 

I  Ills  being  treated  for  heart  disease  whea  that  organ  was  only  sympa- 

I  tibetic  from  disease  of  the  long.     He  has  been  visited  since  his  return 

r  home  to  his  father's  by  several  prominent  physicians,  and  no  disease 

,  of  the  heart  can  be  detected.    Second,  it  is  absolntely  essential  to  keep 

,  the  orifice  open  that  the  matter  may  discharge  freely,  and  to  support 

.  the  drain  upon  the  system  by  a  tonic  treatment. 


•^■^i 


4mcu  III. 

United  States  Hospitals  at  Nashville. 


BT  a.  WALLACB,  A.M.  V.D. 

U  pftix  Im  mifluito  anterreot  I«ara  |Mu«nto,  Dmi«  Us  goam  1«  fwraiU  eatemnt 
•aCuta.  ** 


Mbssrs:  Editors. —  Supposing  that  a  letter  from  me  wonld  be 
•omewhat  interesting  to  you,  and  not  unprofitable  to  your  readers,  I 
now  proceed  to  give,  briefly,  an  outline  of  the  medieal  department  of 
this  great  military  post. 

Nashville  is  by  railroad  three  hundred  and  twenty-two  miles  from 
Cincinnati,  one  hundred  and  fifty-one  miles  from  Chattanooga,  and 
two  hnndred  and  eighty-five  miles  from  Atlanta,  Georgia.  This  is 
the  central  depot  of  military  supplies,  and  the  great  central  medical 
depot  of  the  army  of  the  Cumberland,  for  the  receiving  of  the  sick 
ar.d  wounded  for  medical  and  surgical  treatment.  The  United  States 
Army  entered  this  place  the  27th  day  of  February,  1862.  And  al- 
thoogh  this  has  been  the  centre  of  our  hospitals  for  this  army,  most 
of  the  time  since  coming  here,  during  the  last  three  months  we  have 
received  a  greater  number  of  patients  than  we  did  all  the  time  previ- 
DOS.  Were  you  to  take  your  seat  by  the  Nashville  and  Louisville 
depot  and  observe  the  number  of  soldiers  coming  from  the  North,  and 
the  number  of  patientu,  prisoners  of  war,  refugees,  and  deserters  sent 
north  yon  would  be  astoniiihad.  During  the  last  two  months  the 
Assistant  Provost  Marshal  sent  north  6,807  men»  mostly  prisoners, 
with  some  deserters  from  the  rebel  army,  and  refugees.  During  the 
same  time  the  medical  director  transferred  north  6,375  patients,  sick 
and  wounded.    Usually  our  order  is  to  send  anch  m^ii  xiot^  iant^ 


588  Original  Communicaiioni.  [OdAu, 

not  be  fit  for  duty  for  forty  days,  and  such  as  will  not  be  injured  by 
the  journey.  A  great  number  of  these  men  do  not  become  fit  for  6cld 
daty  for  a  long  time,  and  many  of  them  never. 

The  hospitals  of  Nashville  at  this  time  number  eleven.  At  ok 
time  we  had  twenty-three  ;  (then  this  was  No.  19).  These  hospitib 
are  commanded  by  the  Assistant  Meiical  Director  of  the  Departnotf 
of  the  Cumberland,  (Sargeon  W.  Clendenin)  who  is  assisied  byioM 
one  hundred  assistant  surgeons  and  several  medical  cadets.  Dr.  Cles- 
dcnin  has  been  in  this  office  since  the  7th  of  January,  1864.  Wc 
think  he  is  the  best  Medical  Director  in  the  army,  certainly  the  belt 
we  ever  had  at  this  post.  I  never  heard  a  medical  or  m i I itarj  officer 
speak  of  him,  as  an  officer  or  a  man,  but  he  used  language  like  this: 
"He  is  a  perfect  gentleman,  a  splendid  medical  director/'  etc 

Something  **  new  under  the  sun."  We  have  a  Hospital  for  Proe- 
titutes,  also  a  Syphilitic  Hospital.  The  object  of  the  former  is  to 
diminish  the  number  of  patients  in  the  latter.  At  this  time  there  tie 
in  this  city  460  licensed  prostitutes,  who  do  business  according  t« 
"  law,"  that  is  their  vocation  is  legalized.  This  is  the  first  timeiad 
place  that  any  thing  of  this  kind  has  been  in  our  country.  TW 
licensed  order  went  into  effect  the  17th  of  August,  1863.  Whetlier 
it  is  worth  anything  as  a  prophylactic  measure  or  not,  I  am  not  nov 
prepared  to  say  ;  but  I  do  know  that  not  long  since  the  Syphilitic 
Hospital  WAS  80  full  that  the  other  hospitals  had  to  retain  that  cIass 
of  patients  instead  of  transfering  them.  The  history  of  the  Hospitil 
for  Prostitutes  is  this,  about  one  year  ago  the  General  commandiBg 
the  post  ordered  the  prostitutes  out  of  Nashville.  They  went  awtj 
on  a  Government  transport,  (to  the  very  great  grief  of  the  army)  bat 
were  very  justly  sent  back,  as  the  removing  of  an  evil  or  nuisance  fron 
one  point  to  another  would  do  no  good.  After  their  return,  in  onkr 
to  protect  the  army,  the  General  commanding  ordered  that  every  pros- 
titute should  bo  licensed,  examined,  and  diagnosed  every  ten  days* 
for  which  she  pays  one  dollar.  This  money  goes  to  the  support  of 
the  hospital.  If  she  is  found  ''clean  "  she  receives  a  certificate  of 
"  clearance,"  if  unclean  she  is  sent  to  the  hospital  for  treatment,  from 
which,  in  the  language  of  the  surgeon  in  charge,  she  receives  medical 
treatment  and  is  **  returned  to  d^uty  "  as  soon  as  possible. 

At  the  close  of  last  month  we  had  remaining  in  the  hospitals  7,37^ 
patients.  The  proportion  of  sick,  was  4400  ;  wounded,  2963.  Whit 
a  splendid  field  for  clinical  observation  and  practical  experience.  ^^ 
medical  man  at  any  time  or  place  ever  had  a  better  opportunity  u> 
perfect  \\\m%c\l  m  E^\&x«\\k\%.\ic^\i^%  c>{  the  profession. 


1864.]  Wallaci— iVaMv<7^  ffoipUals.  589 

Greneral  Hospital  No.  19  contains  700  beds.    It  is  one  of  the  finest 
:   bnildings  in  the  city.     The  building  is  212  bj  56  feet,  fonr  stories 
;   high.     We  have  all  the  windows  oot  and  the  skylight  off.     Beside 
this  building  we  have  a  branch  which  holds  ^ne  hundred  and  thirty 
,   patients.     Last  month  we  transferred  north  561  patients,  and  lost  by 
,  death  52.     We  have  now  remaining  250  sick,  and  341  wounded, 
j  Since  our  army  came  here  we  have  lost  by  death  9135  men  ;  at  Mur- 
^  freesboro  about  4000  men.     These  do  not  include  any  lost  on  the  bat- 
tle field. 
4      This  afternoon  I  visited  the  small -pox  hospital,  which  is  abotut  one 
.  mile  from  the  city.     The  patients  are  in  tents  which  hold  from  twelve 
^  to  fifteen  men.      We  hivo  been  having  an  epidemic  of  small-pox, 
which  commenced  about  the  Ist  of  February.     Very  few  cases  at  this 
time  occurring.      I  obtained  the  following  very  interesting  statistics 
from  the  Surgeon  in  charge,  (Dr.  France)  who  took  charge  in  March  : 
Cases  treated  in  March,  number  35  small -pox  ;  could  not  aacertaiu 
whether  vaccinated  or  not,  10  of  which  died.     11  cases  of  varioloid 
_  treateil ;  not  known  to  have  been  vaccinated  ;  3  deaths.     344  cases 
.  of  small-pox  not  vaccinated  ;  result  153  deaths.     13  cases  of  vario- 
.  loid  not  vaccinated  ;  of  which  5  died.    121  cases  of  small-pox  known 
.  to  have  been  vaccinated  ;  of  which  97  died.     559  cases  of  varioloid 
known  to  have  been  vaccinated  once  ;  of  which  29  died  ;  of  these,  8 
^  cases  of  varioloid  were  vaccinatoi  successfully. 

April — 33  cases  of  small-pox  not  known  whether  vaccinated  or  not ; 
8  died.  493  cases  of  smill-pox  not  vaccinated ;  4  deaths.  177  cases 
•mall-pox  who  were  vaccinated  ;  66  deaths.  685  casea  of  varioloid 
who  were  vaccinated  ;  23  deaths. 

May — 12  cases  of  small-pox  not  known  to  have  been  vaccinated  ;  9 
deaths.  4  cases  varioloid  not  known  to  have  beon  vaccinated  ;  4 
deaths.  357  cases  of  small  pox  not  vaccinated  ;  72  deaths.  41  vari- 
oloid not  vaccinated  ;  6  deaths.  181  small-pox  who  were  vaccinated  ; 
58  deaths.     541  varioloid  who  were  vaccinated  ;  26  deaths. 

Jane — 4  cases  small -pox  not  known  to  have  been  vaccinated  ;  no 
deaths.  1  case  varioloid  not  known  to  hive  been  vaccinated  ;  1  death. 
170  cases  small-pox  not  vaccinated  ;  29  deaths.  29  varialoid  not 
Taccinated  ;  4  deaths.  120  small -pox  who  were  vaccinated  :  80 
deaths.     292  varioloid  who  were  vaccinated  ;  12  deaths. 

July — 5  cases  small-pox  not  known  to  have  been  vaccinated  ;  1 
death.  2  cases  varioloid  not  known  to  have  bean  vaccinated  ;  no 
deaths.    69>small-pox  not  vaccinated  ;  12  deaths.     16  cases  rario- 


590  Original  CommunieaiwM.  [Octokr, 

loid  not  vaccinated;  1  death.      56  cases  small-pox  ▼■ocinftted;8 

deathfl.     11^  varioloid  vaccinated  ;  6  deaths. 

Of  course  a  number  of  the  patients  remained  from  thtt  first  mosll 
to  the  second,  and  so  on.  The  number  treated  in  the  lant  three  monda 
white  soldiers.  615  ;  returned  to  duty,  480  ;  transferred^  21 ;  and  81 
died.  Colored  soldiers  treated,  110  ;  returned  to  doty,  SO ;  and  9 
died.  Citizens,  contrabands,  and  refugees  treated,  749  cases ;  411 
got  well ;  and  187  died.  Nothing  new  concerning  the  tremtneii 
The  doctor  remarked  that,  during  wet  weather  the  namber  of  eusi 
increased,  and  also  the  mortality. 

Well  grounded  objections  to  the  hospitals  of  this  place  are  as  fel- 
lows :  lat.  Having  them  in  the  city  with  such  a  crowded  popalatioi, 
with  so  much  noise  and  dirt ;  notwithstanding  all  the  sanitary  piecai- 
tions.     2nd.  Most  of  the  buildings  are  unsuitable,  especially  with  it- 
gard  to  height.    Some  of  them  are  five  and  six  storin,  each  story  veiy 
high.     Going  up  and  down  is  very  exhausting  on  well  men  when  tin 
thermometer  is  100^,  and  much  more  so  on  convalescents.     At  om 
time  we  used  nearly  all  the  churches  ;  now  they  are  nearly  all  toned 
over  to  the  congregations.     A  good  military  hospital  should  not  be  ii 
a  city,  and  should  be  only  one  stoiy  high.     Sick  and  woanded  mci 
from  the  field  do  not  like  to  be  taken  up  into  the  "  third  heaTee," 
neither  is  it  good  for  them.     In  the  management  of  the  hospitals,  oae 
great  obstacle  in  the  way  is,  the  number  of  times   cooks,  clerks,  and 
nurses  are  changed.    About  the  time  a  cook  or  nurse  is  well  trained, 
an  order  comes  to  send  him  '•  front  *'  to  his  regiment.     It  takes  some 
time  and  a  great  deal  of  training  to  produce  good  cooks  and  nurses. 
Indeed  it  is  just  as   necessary  to  have  good  cooks  and  nurses  is 
order  to    insure  success,   as  to  have  *goo.l  surgeons,     especially  for 
wounded  men.     Without  good  food  properly  prepared,  hospital  gan- 
grene cannot  bo  successfully  treated.     With  good  food,  and  rigid  hy- 
gienic measures  there  is  good  success  even  in  extremely  bad  casei. 
Most  of  the  cases  of  gangrene  which  occurred  in  the  hospitals  daring 
the  last  eighteen  months  depended  on  constitutional  causes  ;  such  as 
entire  prostration  of  the  nervous  system  during  the  marches  and  the 
battle,  or  the  bad  condition  of  blood,  induced  by  poor  and  insufilcient 
food.     There  is  not  much  difference  with  what  you  cut  or  burn  cot 
gangrenous  tissue,  or  how  you  remove  it ;  just  as  often  as  removed,  co 
often  will  it  return,  while  the  system  is  in  that   broken  down  condi- 
tion.    But  on  the  contrary,  get  the  system  of  the  patient  in  a  healtbr 
condition  ;  feed  well,  give  a  judicious  supply  of  tonics,  and  a  libcrti 
supply  of  stimulants,  and  you  will  find  it  of  small  conequcnce  br 


1864.]  WALjJicm—yathwaie  Bo9pUaU.  691 

which  of  many  ways,  or  what  agent  yon  use  to  remove  the  gangrene. 
Indeed,  gangrene  will  not  often  appear  if  this  course  is  commenced 
i&  time,  and  persisted  in.  No  donbt  gangrene  generally  is  a  consti- 
tntional  taint,  manifesting  itself  locally  at  the  weakest  point;  al- 
thongh  it  may  be  introduced  locally,  which  when  done  operates  very 
•lowly,  and  is  not  so  difficnlt  to  eradicate.  No  donbt  exists  in  my 
nind  but  that  it  has  often  been  produced  in  wounds  by  the  injudicious 
use  of  cold  water.  After  patients  get  hpre  I  used  tepid  water  in  al- 
most every  case.  I  have  not  had  over  five  cases  in  eighteen  months, 
in  cases  where  the  above  course  was  pursued.  Some  soldiers,  while 
with  the  regiment  as  patients,  are  treated  by  two  or  three  surgeons  in 
as  many  months  ;  then  by  transfer  from  hospital  to  hospital  arrive 
ti  this  city,  without  either  diagnosis  or  medical  descriptive  list.  It 
cannot  always  be  furnished,  surgeons  have  so  much  to  do.  I  find 
such  patients  do  best  by  discontinuing  all  medicines. 

Sach  patience,  such  heroism,  as  is  manifested  by  the  wounded  sol* 
diers  is  beyond  belief.  To  believe  that  men  could  suffer  so  much, 
endure  it  so  long,  it  must  be  seen.  It  is  amazing  the  number  of  ex* 
tiemely  bad  cases  that  get  well  under  not  very  favorable  circumstances. 
Each  wounded  man  seems  to  think  some  one  else,  perhaps  the  next 
man  to  him,  worse  than  himself;  sometimes  even  seems  to  cease  to 
tkink  about  himself.  Verily  **  There  is  a  time  to  be  bom  and  a  time 
lo  die."  One  man  comes  into  the  hospital  so  badly  wounded  and 
diMAsed  that  it  would  seem  impossible  for  hina  to  recover  ;  another 
one  very  slightly  wounded  is  received.  The  former  often  recovers,  the 
biter  sometimes  dies.  After  the  battle  of  Chickamanga  I  received  a 
•oldier  in  Hospital  No.  3,  with  a  gun-shot  wound  of  a  finger,  requii- 
ifig  amputation.  The  amputation  was  performed  ;  from  that  mo- 
ment a  severe  pain  en&ued  in  the  stump  and  hand ;  pysBmia  followed 
and  death  relieved  the  sufferer.  Indeed,  the  finger  was  nearly  ampu- 
tated by  the  g^n-shot,  and  no  difficulty  of  any  kind  was  experienced 
by  the  patienL  Now  take  a  grave  case  :  On  the  30th  of  March  the 
orderly  of  Col.  R.  D.  Mussey  was  admitted  into  No.  19 ;  accidently 
•hot  through  the  superior  portion  of  the  left  lung ;  the  patient  also 
had  secondary  syphilis,  acd  m  less  than  a  month  he  was  well  enough 
fo  be  furloughed  ;  went  to  Pennsylvania  and  came  back  well.  Case 
Srd.  Sargent  Q.  Haywood,  Co.  I.  24th  Wisconsin  Infantry,  was  ad- 
mitted to  Hospital  No.  i,  May  4th,  1863.  Had  nervous  tempera- 
ment, and  a  delicate  constitution,  supposed  to  be  consumptive.  Aftor 
remaining  some  weeks,  although  not  fn  good  health,  at  his  own  re- 
quest he  was  returned  to  duty.     In  the  battle  of  Chiokamauga,  on 


1864.]  Boipital  BtpoHt.  fi98 


osj^ital  lltports. 


Clloleal  Reports  fh>m  WMt  Bod  U.S.  Ocaeral  Hoipital,  Olneiooatl.    Dt.  Robt.  BAimoboir 
Act.  Afst.  8urg..  U.S.A.  In-ch«rg«.    Reported  by  Loutf  MmTB  Act.  Med.  Cadet, 


Bospifal  Gangrene. — Several  cases  of  Hospital  Gangrene  have  been 
received  in  this  hospital  from  Louisville  recently.  They  famished  oc- 
casionfor  some  observations  by  Dr.  Bartholow,  8ai*geon-in-charge, 
on  the  pathology  and  and  treatment  of  this  affection. 

Hospital  gangrene  exists  in  two  forms  in  the  army.  First  a  trna 
hospital  gangrene,  transmissable  (>y  contagion  from  wound  to  woand ; 
and  a  second  a  psendo-hospital-gangrene.  In  the  fir^t  form,  which  is 
much  less  frequently  observed,  the  application  of  a  morbific  agent, 
either  through  the  medium  of  the  atmosphere  or  by  actual  contact, 
induces  a  rapidly  destructive  inflammation  and  death  of  the  ttssnes. 
It  is  a  peculiarity  of  this  inflamm'itton,  that  it  has  no  boundaries  and 
■preads  with  great  rapidity  through  all  the  tissues,  hot  especially 
through  the  connective  tissue  ;  the  contact  of  the  decomposing  sloughs 
being  sufficient  to  keep  up  the  morbid  action.  In  this  form  of  gan- 
grene the  local  losion  precedes  those  grave  constitutional  complica- 
tions^'' the  typhoid  state."  In  the  other  form  the  locil  disease,  the 
sloughing,  the  pseudo  gangrene,  appear  at  a  period  subsequent  to  con- 
stitntional  infection.  Soldiers  in  the  field  are  subjected  to  various  in- 
fluences, which  lower  vitality  ;  their  blood  is  impovished  by  insuffi- 
cient diet,  fat  igue,  and  exposure  to  vicissitudes  of  temperature  and  to 
malaria.  These  influences  impair  the  secondary  assimilation,  and 
consequently  low  er  the  reparative  process  in  injuries.  In  a  soldier 
whose  vital  powers  are  thus  weakened,  a  gunshot-wound  or  injurv  is 
very  apt  to  assume  the  sloughing  or  gangrenous  character  ;  and  the 
variety  or  extent  of  the  local  action  will  depend  upon  the  degree  in 
which  scorbutus  and  malaria  have  vitiated  the  blood. 

How  shall  these  two  forms  of  hospital  gangrene  be  discriminated  ? 
How  arc  the  points,  if  any,  in  the  different  diagnosis  ?  The  history 
of  the  case,  and  the  character  of  the  locil  lesion  are  the  only  meant  of 
determining  this  interesting  question.  If  the  constitutional  have  pre- 
ceded the  local  symptoms,  and  evidences  of  the  scorbntio  taint  and 
malarial  each  )xy  have  existed,  it  may  be  presumed  that  we  have  to 
deal  with  t^i3  p9*alo  gin^rrena.  This  pronmption  will  be  converted 
Qto  certainty,  if  thera  be  present  ny  soarjes  of  infection  and  the 


694  MiHpiki  JbfMrferw  [OtM*p 

■loiighing  presents  the  characters  pecalur  to  the  pseodo  gragraMi 
What  are  these  charactors  ?  In  the  psendo  gangrene  the  aloiigha  aie 
neTcr  so  extensive  as  in  tme  gangrene,  the  honndaries  between 
healthy  and  diseased  teztores  more  dearlj  marked  and  the  inflamma- 
tory  zone  snrronnding  the  sloaghing  tissaes  lees  rivid.  In  the  paeodo 
gangrene  there  is  less  rapid  extension  of  the  disease,  and  rarely  these 
large  and  sndden  detachments  of  aaasses  of  skin  and  connective  tissue ; 
hnt  the  gangrene  spreads  more  slowly  and  equally,  like  soond  atrae- 
tnres  presenting  pretty  well  defined  healthy  margins.  How  ehall  we 
treat  the  varieties  of  hospital  gangrene  ?  It  is  obvionsly  impoHail 
to  recognize  whether  it  is  a  local  disease  followed  by  seooodary  con* 
stitntional  complications,  or  a  constitutional  diserasy  prodndng  see- 
ondary  local  phenomena.  In  the  first  form,  or  the  true  hoapital  gan- 
grene, we  may  rely  on  topical  applications,  escharotics,  acinml  canCeiy, 
etc.,  since  the  destmction  of  the  local  morbid  proeess  prerenta  consti- 
tntional  or  systemic  infection  and  enables  the  reparative  process  to 
assume  its  normal  direction.  In  the  second  form  or  peeado-hospitaK 
gangrene,  topical  medication  is  of  secondary  importance ;  the  dis- 
erasy must  be  corrected,  the  secondary  assimilation  lestored  to  its 
healthy  state,  by  vegetable  food,  animal  nutriments,  porter,  ale,  etc 
and  the  local  morbid  process  changed  by  suitable  dresaing^s. 

Bromine  has  aoqaired  its  reputation  in  the  cure  of  hospital  gnngrrae, 
by  its  general  use  in  this  form.     To  ensure  a  successful  application  of 
the  bromine,  it  is  necessary  to  apply  it  to  the  structures  not  yet  in- 
vaded by  the  gangrene,  and  hence  the  slonghs  must  be  carefully  dissect- 
ed off.    This  is  a  tedious  process,  and  the  app  lication  of  the  bromine 
to  the  sound    tissnes  is  acutely  painfnl.     Moreover,  bromine  itself 
thus  applied,  produces  a  slough  which  may  be,  and  is  not  unfreqnent- 
ly,  mistaken  for  an  extension  of  the  gangrene,  requiring  renewed  ap- 
plications of  the  escharotio.     These  are  strong  objections  to  the  use  of 
this  agent.    There  can  be  no  doubt  that  thus  applied  it  is  quite  effect- 
ual* but  not  more  so  than  nitric  acid,  permanganate  of  potassa,  chlo- 
ride of  zinc  and  other  agents  of  this  class.     Indeed  a  reviewer  of  Dr. 
Gk>ldaraiths  monogram  on  bromine  in  hospital  gangrene,  asserts  that, 
a  saturated  solution  of  sugar  is  equally  efficatious  if  applied  in  the 
same  way  1     So  great  is  the  trouble  ami  pain  attending  the  removal  of 
the  sphacelated  tbsue  from  the  application  of  the  escharotio,  that  it  is 
very  desirable  to  secure  an  agent,  which  will  dissolve  out  the  sloogke 
and  change  the  action  of  the  tissnes.     We  have  such  an  agent  in  the 
OIL  OF  TURPKNTiNB.     Wc  havc  sceu  the  application  of  turpentine  in 
several  quite  formidable  cases  of  sloughing  wounds,  followed  by  the 


1864.]  Sospiial  FeporU.  595 

speedy  solution  of  the  gangreooas  tissue  and  a  change  at  once  quick 
and  decided  in  the  surroanding  stractnres.  Let  me  submit  some 
cases  to  illustrate  these  principles  : 

Case  I. — Wm.  Ambrosher,  private  Co.  C.  49th  Eegiment  O.V.I., 
aged  25  years,  was  wounded  on  the  27th  of  May,  1864  near  Dallas, 
Ga.,  with  a  musket  ball  in  lumbar  region,  posteriorly,  right  over  spinal 
column.  Admitted  July  1st,  1864.  Patient  in  a  scorbutic  and  very 
anaemic  condition,  has  bed-sores  over  nearly  every  bone,  that  comes 
in  contact  with  the  bed,  as  over  the  crests  of  ilia  and  trochanters  of 
femurs.  The  wound  made  by  the  ball  is  surrounded  by  considerable 
inflammation.  Three  days  after  admittance,  some  necrosed  bone  of 
the  spinous  processes  of  the  vertebra,  which  had  been  touched  by  the 
ball,  were  renewed  and  two  days  after  this  the  patient  had  much  fever, 
parts  around  the  wound  became  much  more  inflamed  and  consider- 
able swelling  took  place,  an  abscess  formed,  the  contents  of  which 
made  their  exit  through  a  fissure,  nmningfrom  the  abscess  to  the  pos- 
terior surface  of  left  thigh.  A  large  sloughing  ulcer  of  four  inchea  in 
diAmoter  took  the  place  of  the  abscesn  and  wound,  at  the  same  time 
sloughing  also  commenced  in  the  bed-sores 

I]y  order  of  Dr.  Bartholow,  poultices  of  yeast  and  charcoal  were 
applied  to  the  inflamed  surface  and  to  the  ulccis,  the  oil  of  turpentine 
twice  per  day,  by  means  of  a  piece  of  lint  bhaped  exactly  like  the  sur- 
face of  the  ulcers,  and  saturated  with  turpentine  ;  the  borders  of  ulcers 
were  protected  with  sweet  oil.  The  turpentine  arrested  the  sloughing, 
appeai'ed  to  di^isolved  the  slough  and  detach  it  from  the  healthy  tis- 
sue. After  the  fourth  application  granulations  were  seen  on  the  whole 
surface  of  ulcers,  turpentine  was  then  discontinued  and  equal  parts  of 
alcohol  and  water  sub^tituted  as  a  dressing.  The  fissure  was  injected 
with  a  solution  of  permanganate  of  potassa,  this  soon  healed  it ;  ex- 
cessive granulation  was  coniroled  with  a  solution  of  nitrate  of  stiver, 
(40  grs.  to  Ji-  of  water,)  quinine,  a  g<Kxl  diet  and  a  bottle  of  porter 
every  day  were  given.     Patient  is  nearly  well  now. 

('ahe  II.— a  Henderson,  Sergeant  Co.  G  ,  39th  Kegiment  O.V.I., 
Aged  30  years,  was  woundeil  on  the  4th  of  July  18(>4,  with  a  mu»ket 
ball  in  Georgia,  in  posterior  part  of  left  lower  leg  at  about  its  middle. 
A<imitte<l  September  9th,  1864.  Patient  is  suffering  from  an«mia 
and  scorbutus,  but  not  in  the  same  degree  as  the  preceding  cas«).  The 
wound  was  in  a  very  goo<l  condition  and  healed  nntil  the  6th  of  Sep- 
tember, when  parts  around  the  wound  inflamed  and  swelled  consider- 
able.    When  admitted  wound  and  parts  around  it  were  in  a  slough- 


596  EoipUal  RtporU.  [Oetobar, 

ing  condition,  a  large  nicer  extended  soon  over  the  whole  lateal  and 
poeterter  sorfaces  of  left  leg,  exposing  all  the  mnsdes  of  thmt  part  and 
small  spaces  of  the  tibia.  Parts  below  the  nicer  were  of  a  tallowish 
appearance  and  pitted  on  pressure.  Poultices  of  yeast  and  charooal 
were  used  on  the  inflamed  parts  and  five  applications  of  tarpentine  to 
the  nicer  were  sufficient  to  arrest  the  sloughing ;  after  this  the  aleohol 
and  water  dressing  was  used.  Good  diet,  porter  and  10  grs.  of  quia- 
ine,  given  as  an  enema  once  per  day,  were  ordered.  Patient  is  in* 
proving  rapidly. 

Cask  III— 0.  B.  Wilcox,  private,  Go.  F.,  66th Begiment O.VJ^ 
aged  23  yetrs,  admitted  July  Ist.,  1864.  Was  wounded  on  the  26th 
of  May,  in  Georgia,  with  a  musket  ball  in  the  plantar  surfaoe  of  right 
foot  Patient  also  is  in  an  an»mic  and  soorbutic  condition ;  parts 
around  wound  are  inflamed  and  slightly  swollen.  Five  days  after 
admission  inflammation  and  swelling  increased  much,  and  the  wound 
commenced  to  slough,  and  soon  a  large  and  deep  ulcer  took  its  plaee. 
His  treatment  did  not  difler  from  that  of  the  two  preoeding 
The  same  good  eflfects  were  produced. 


Cases  of  Gunshot  Wounds,     Case  L     Gunshot  tffousid  ; 
of  internal  iliac  vein  and  small  intestine.     Death  on  the  second  day 
aftST  receipt  of  wound. 

John  Dud  fey.  (  Colored  soldier. )  Age  82  years.  Admitted 
August  30th,  1864,  at  9  o'clock,  A.M.  Was  wounded  on  the  29th 
of  August,  1864,  by  gnerrillas  in  Kentucky,  with  a  pistol  ball. 

On  examination,  found  a  wound  on  the  right  hip,  which  was  sup- 
posed to  be  the  orifice  of  entrance  of  the  ball.  Another  wound  an- 
teriorly in  the  right  iliac  region,  supposed  to  be  the  orifice  of  exit. 

Patient  was  very  weak ;  pulse  rapid  ;  respiration  also  rapid ;  skin 
cold  and  dry.  The  abdominal  muscles  are  firmly  contracted*  and  the 
lower  extremities  drawn  up.  He  evinced  great  suffering  when  pressed 
upon  abdomen.  Patient  vomited  frequently.  At  2  o'clock,  P.M., 
hemorrhage  took  place  from  the  anterior  wound,  but  was  soon  arrest- 
ed,  by  placing  the  patient  on  his  back ;  commenced,  however,  again, 
when  patient  was  lying  on  his  right  side.  There  was  also  great  irri- 
tability of  bladder ;  but  no  urine  passed,  when  catheter  was  intro- 
duced. 

Morphia  and  one  oz.  of  whiskey  given  every  four  hours  ;  also, 
applications  of  warm  water  were  made  over  his  abdomen.  Patient 
was  unable  to  take  food. 


1864.]  BotpUal  BeporU.  607 

Autopsy  —  sixteen  hours  after  death,  made  by  Dr.  Bartholow. 
There  is  considerable  suggillation  posteriorly  and  abont  the  neck,  and 
swelling  of  the  neck  anteriorly.  Upon  laying  open  the  cavity  of  the 
abdomen,  find  blood  clots  effused  on  the  anterior  surface  of  the  intes- 
tines ;  and,  entangled  in  it,  the  skin  of  a  grape.  The  peritoneam  is 
red  and  injected,  but  there  is  no  exudation  of  false  membrane.  The 
cavity  of  abdomen  is  filled  with  blood.  Upon  removing  the  intestines 
and  tracing  the  course  of  the  ball,  find  that  it  entered  through  the 
ischiatic  notch,  divided  the  internal  iliac  vein,  impinged  upon  the 
right  lateral  portion  of  the  bladder,  and  made  its  exit  in  the  right 
iliac  region.  The  ball  also  passed  throagh  the  lower  portion  of  the 
ileum,  about  twelve  inches  from  ileo  cffical  valve. 

Case  II.  —  Gunshot  wound,  involving  left  lung,  diaphragm,  sple$n, 
stomach  and  liver ;  another  ball  entering  spinal  canal ;  a  third  ball 
loJging  m  muscles  of  hip.  Death  on  the  third  day  nfter  rtcep'ion  of 
injuries, 

James  Watkins,  (  Colored  soldier.  )  Age  80  years.  Admitted 
August  31st,  1864,  at  10  o'clock,  A.M.  Was  wounded  on  the  same 
occasion  as  the  preceding  case,  with  pistol  bftlls. 

On  examination,  find  one  wound  in  middle  dorsal  region  po:>u- ;• 
orly  ;  two  wounds  in  right  lateral  lumbar  region  ;  one  in  epigastric 
region,  one  inch  below  zyphoid  cartilage,  directly  in  the  median  line. 
Patient  is  in  a  prostrated  condition  ;  pulse  and  respir.-ition  ai^  rapid  ; 
the  bkin  is  cold  and  moibt ;  the  abdomen  distended,  and  yields  a  flat- 
ulent sound  on  percussion.  He  regurgitates  some  yellowish  fluid. 
HivS  legs,  bladder,  and  nphincter  ani  muscles  are  paralyzed  ;  he  con- 
sequentl /suffers  from  rutuutiou  of  urine,  and  has  involuntary  alvine 
dejections. 

An  enema  of  one  grain  of  opium  with  starch  and  water  was  given 
every  four  hours  on  the  first  day  ;  but  on  the  second  d?iy  he  rejected 
the  injections.  The  treatment  was  then  changed  to  one  halt  of  a  grain 
of  opium  given  per  mouth  in  pill  form,  every  four  hours.  Warm 
water  applications  were  made  over  his  abdomen.  A  catheter  was 
introduced  to  relieve  the  distension  of  the  bladder.  Absolute  rest 
was  enjoined,  ami  small  quantities  of  milk  and  watsr  Qt^ 
diet.     Died  on  the  day  after  admission. 

Aui'psy  —  twelve   hours   after  death,   ouido 
Height  4  feet  If  inches.     Upon  reflecting  tlie  pftrim 
abdomen,  and  removing  the  sternum,  find  tho  ri§lM 


698  Ho^piial  JUparii.  [Octobti^ 

thoracic  carity  of  right  side,  and  adraacLDg  half  an  inch  to  Che  Itft 
of  median  line,  the  snperior  lobe  of  left  long  onlj  appearing  in  view 
an  inch  and  a  quarter  from  the  median  line.    The  superior  border  of 
lefl  lobe  of  liver  extends  to  a  line  opposite  the  lower  border  of  the  Sch 
rib,  and  contains  a  perforation  one  inch  from  the  median  line  to  the 
right,  and  one  inch  below  the  inferior  surface  of  diaphragm.    At 
least  a  quart  of  bloody  serum  in  left  thoracic  caTity.     One  opeaing 
is  found  in  intercostal  space  between  the  7th  and  8th  riba,  8^  inolMS 
from  spinal  column.     The  inferior  lobe  of  left  lung  is  oarnifiedt  does 
not  crepitate  on  pressure,  sinks  in  water.     A  small  circular  openii^ 
opposite  wound  in  wall  of  thorax,  is  found  about  half  an  inch  firaa 
its  inferior  margin.     The  superior  lobe  of  left  lung  is  much  redoced 
in  size,  of  a  dark,  blueisb  gray  color,  externally,  still  crepitates  and 
floats  in  water,  though  its  substance  is  somewhat  condensed.     The 
whole  external  surface  is  covered  with  abundant  reddish  granular  ex- 
udation, assuming  a  membranous  form  ;  this  exudation  is  more  abna- 
dant  and  better  organized  on  the  surface  of  pericardium.    The  supe- 
rior and  middle  lobes  of  right  lung  still  contain  air,  and  crepitate  ea 
pressure  ;  the  inferior  lobe  of  same  lung  is  of  a  deep  black  color  ex- 
ternally ;  internally,  textare  soft,  and  breaks  up  easily,  assuming  the 
character  of  soft,   vcnons  coagulam.     Heart  is  firmly  contracted; 
right  auricle  contains  small,  fibrinous  clot ;  right  ventricle  empty ; 
mnscnlar  tissue  is  firm  and  healthy  ;  walls  of  right  ventricle  ^  inch 
in  thickness  ;  left  ventricle  }  inch  in  thicknes.     Weight  9  oz. ;  valves 
healthy.     Liver  12x9  —  3^  inches  thick  ;  weight  4^Ibs.     An  oblique 
opening  is  found  in  the  left  lobe  of  liver,  at  about  its  middle  portion, 
which  was  made  by  the  ball,  in  a  line  with  the  opening  in  the  left 
lung  and  intercostal  space  ;  organ  otherwise  healthy.     The  peritone- 
um of  the  under  surface  of  liver  covered  with  a  yellowish  grannlar 
exudation.     A  similar  exudation  occupies  the  lesser  curvature  and 
anterior  wall  of  the  stomach.     Adhesions  between  the  stomach  and 
the  liver  form  the  boundaries  of  a  cavity,  filled  with   broken  down 
exudation  of  a  yellowish  granular  character. 

Diaphragm  penetrated  by  the  ball  in  its  passage.  An  opening  ex- 
isted (  track  of  the  ball,  )  in  the  spleen  at  its  inferior  margin,  extend- 
ing obliquely  throuj^i^h  its  substance  ;  the  tissue  about  this  opening  is 
very  firm  ;  the  rest  of  the  organ  is  healthy.  The  under  sur&ce  of 
the  spleen  forms  part  of  the  wall  of  the  abscess  between  the  liver  and 
stomach.     Kidneys  are  healthy,  weighing  6|  oz. 

That  part  of  peritoneum  near  the  track  of  the  ball  is  deeply  inject- 
ed, and  covered  for  the  most  part  with  a  yellowish  exudation.     Upon 


1864.]  Froeeedm^M  cf  Sociiik9.  5M 

continniDg  the  ezAnination,  find,  the  ball  passed  through  the  stomach 
an  inch  and  a  half  from  the  cardaic  orifice  and  from  the  lesser  ourr* 
ature.  The  whole  superior  and  anterior  surface  of  the  stomach  is 
covered  with  a  firm,  yellowish,  membranous  exudation,  and  the  mu- 
cous membrane  around  orifices  of  ball  is  injected  ;  but  other  parts  of 
it  are  healthy. 

The  intestines  are  healthy,  except  some  prominence  of  the  follicles 
of  Lieberkuhn.  8ome  port  wine  injections  of  the  mucous  membrane 
and  three  ulcers,  confined  to  the  epithelial  coat  -in  the  ilium  near  the 
ileo  csecal  valve. 

There  is  another  opening  posteriorly  in  the  right  lumbar  re^on, 
two  inches  from  the  spinal  column,  between  the  11th  and  12th  dor- 
bal  vertebrae.     The  larger  portion  of  the  ball  entered  the  spioal  caual 
and  lodged  against  the  cord.   The  cord  is  not  softened.   On  the  outer 
surface  of  the  duramater,  there  is  considerable  exudation  ;  on  exam- 
ining the  other  opening  in  the  right  lumbar  region,  find,  the  ball 
lodged  in  the  glutei  muscles. 

The  peculiar  interest  in  this  case  is  derived  from  the  extensive  in- 
jury ot  organs  by  one  ball,  which  penetrated  the  left  thoracic  cavity, 
passed  through  the  inferior  border  of  left  lung,  through  the  diaphragm, 
spleen,  stomach   and   liver.     It   is   not    difficult  to  understand  this, 
when  it  is  remembered  that  the  injury  was  received  qfter  a  full  meal. 
Another  point  of  interest  is  the  extensive  exudation  occurring  so  soon 
after  the  reception  of  the  injury.     The  paralysis  was  obviously  due 
to  the  lodgement  of  the  ball  in  the  spinal  canal.     But  here  the  inflam- 
matory changes  were  much  less  marked,  than  in  pleura  and  peritona- 
am  —  the  cord  was  not  even  softened. 


Proof  ediags  of  the  Cineiimati  Academy  of  Medioina. 

K«pwte4  hjO,  p.  Wiuoii,  M.  D.,  ••cNtorjr. 

Hall  of  Acadbmtov  MsMciini,) 
Monday  Evening,  8ept  12,  1864) 

la  the  absence  of  the  President,  Dr.  Almy,  Viee  President^ OarroU 
cook  the  chair. 

Typhoid  Fever. — ^There  was  no  disertation  presented  to  the  Societj^ 
and  the  members  considered  in  an  informal  way  the  subject  of  ferar 
fts  it  had  prevailed  in  this  city  during  the  past  year. 

Jh,  Carroll — from  the  chair  remarked  tliat  o  had 


600  Pfoe^mg$  ff  8oeie6$i.  [OctolNrt 

preyailed  in  this  community  bot  yory  little  true  typhoid  tetwrnr  dnriag 

the  epidemic  of  the  last  season. 

Dr.  JHuacrqft—S^id  a  new  word  bad  been  suggested  by  90010  leeettl 
writers — viz. ;  i^hic  — to  indicate  a  t]rpe  of  fever  with  m  tendeney  to 
a  low  grade.  He  also  proceeded  to  detail  tbe  nanal  characleria& 
features  of  the  typhoid  fever  as  we  are  taught  to  understand  tbat  dis- 
ease ;  but  he  also  argrees  with  the  President  that  in  bia  obwrratiM 
there  had  been  but  very  little  typhoid  fever  in  the  proper  sense  of  tbst 
term. 

Dr.  Stevens — ^Remarked  that  it  was  a  source  of  a  good  deal  ef 
gratification  to  him  to  hear  his  elder  professional  brethren  agreeing  in 
the  opinion  that  the  recent  epidemic  of  fever  in  this  city  was  not,  as 
it  was  the  habit  to  style  it,  true  typhoid  fever.  He  thought  it  nnlbr- 
tnnate  that  we  were  frequently  so  loose  in  our  mode  of  expression—* 
in  announcing  the  character  or  type  of  diseases.  In  common  with 
other  medical  gentlemen  of  this  city,  he  had  treated  a  ImrgB  number 
of  cases  of  continaed  fever  of  a  peculiar  type  daring  the  past  eight  or 
ten  months ;  but  so  far  as  these  cases  had  come  under  his  observation 
they  very  rarely  possessed  the  distinctive  characteristics  of  typhoid 
fever.  There  was  in  the  onset  general  febrile  symptoms,  without 
peculiar  character,  a  white  furred  tongue,  sometimes  headache  of  a 
persistent  character,  but  rarely  disturbed  intellect,  rarely  red  diy 
tongue,  or  tympanitis  or  diarrhoea,  or  rose  colored  spots  ;  there  was 
gi'eat  prostration,  a  very  tedious  duration  of  illness  ;  and  some  occas- 
ional cases  appeared  to  be  well  marked  typhoid  fever,  but  be  certainly 
could  not  think,  judging  from  the  cases  that  he  had  observed,  that 
typhoid  fcvor  was  a  frequent   disease  in  this  community. 

Dr.  Tate — Said  he  de  sired  to  express  some  views  on  this  question 

of  fever  as  it  had  prevailed  in  our  midst.     Befo  re  doing  so  however, 

he  wished  to  relate  the  history  of  a  case  of  dislocation  of  tbe  femur, 

on  the  dorsum  of  the  ilium  of  the  right  side,  m  a  lad  of  only  four  or 

five  years  of  age.     The  accident  was  the  result  of  a  fall,  and  he  had 

been  summoned  very  promptly  to  the  case.     He  procured  the  redne- 

tion  by  manipulation,  on  a  modification  of  Reid's  Method,    with 

prompt  and  entire  success.     Dr.  Tate  remarked  his  special  i  nterest  in 

|he  case,  arose  partly  from  the  ease  with  which  the  reduction  was  ac- 

coTTtplished,  and  partly  from  the  youth  of  the  subject  in  which  tbe 
dislocation  had  occurred. 

He  said  that  having  just  entered  he  had  not  heard  the  remarks  of 

other  gentlemen,  but  understood  the  subject  before  the  Academy  to  bt 

the  pi*e vailing  fevers.     He  would  therefore  make  use  of  the  oecasioa 


1865]  ProcHdingu  q^  J^iHm.  601 

to  say  something  of  the  CAses  which  he  had  ohserved  daring  the  past 
winter  and  summer. 

These  fevers  he  regarded  as  cUfferent  from  any  forms  of  fever  which 
he  had  ever  known  to  prevail  here.  They  were  neither  cases  of  typhus 
nor  typhoid  fever,  properly  so  called,  but  were  in  many  respects  more 
like  the  relapsing  fevers  of  Scotland  than  any  other  he  had  seen  de- 
scribed ;  though  it  differed  from  these  in  that  it  had  no  petechial  spots, 
and  showed  no  especial  tendency  to  terminate  in  a  sweat  at  the  end 
of  the  first  week,  and  then  relapse  again.  It  begun  with  a  chill, 
which  in  two  children  he  had  seen  attended  by  strong  convnUions. 
To  this  chill  succeeded  pain  in  the  back  of  the  head,  with  stiffness, 
and  contraction  of  the* muscles  of  the  neck,  and  tenderness  vp  and  down 
the  spinal  coltann,  with  general  soreness  over  the  body,  so  that  some 
patients  will  be  very  reluctant  to  move  in  bed.  There  is  great  exal* 
tation  of  the  sensibility  of  the  superficial  nerves ;  in  some  the  least 
pressure  over  the  surface,  and  particularly  over  the  epigastric  region 
would  cause  the  person  to  cry  out  with  pain  ;  several  of  the  patients 
said  pressure  there  went  like  a  knife  through  the  back.  These  symp- 
toms would  soon  be  followed  by  more  or  less  febrile  excitement.  I 
have  8cen  the  pulse  run  up  to  120,  though  it  rarely  exceeded  100,  and 
this  was  attended  by  considerable  beat  of  the  surface.  In  one  case 
however,  where  the  neck  was  stiff,  and  the  patient  delirious  for  several 
nights,  and  suffeiing  a  horrible  sense  of  oppression  across  his  chest, 
the  pulse  was  below  sixty.  There  was  often  a  sense  of  numbness  of 
the  extremities,  sometimes  accompanied  with  pain  ;  some  complained 
of  pricking  sometimes,  others  of  cramps  in  the  extremities,  and  I  ob- 
served that  the  left  arm  rather  thui  any  other  part  seemed  to  be  more 
frequently  the  sufferer.  In  a  yonng  woman  who  complained  most 
bitterly  of  pain  in  her  left  arm,  and  who  in  her  delirium  thought  it 
had  been  fractured,  I  noticed  at  times  that  there  the  temperature  seem- 
ed several  degrees  hotter  than  that  of  the  opposite  extremities.  The 
tongue  was  in  most  cases  slightly  coated  white,  unlike  the  bilious 
tongue,  and  without  the  red  tip  and  e«lges  of  typhoid  fever.  In  some 
few  cases  there  was  vomiting.  The  bowels  seemed  to  suffer  no  spe- 
cijd  derangement. 

The  disease  seems  to  have  no  definite  term  of  duration  ;  aome  caiea 
terminate  in  a  few  day^,  others  running  on  to  three  or  four  weeki 
nor  did  I  observe  any  teudency  to  terminate  by  any  apeciftl  ed 
sweat  or  other  evacuation.     I  have  seen  but  two  deaths  ;  one  • 
three  years  old,  which  never  recovered  from  the  first  coAToleies 
which  he  was  seized;  the  other  that  of  a  jOQBg  mut  wkftJ 


602  ProoBetBa^  if  JShoHm.  [OcCobv, 

giok  ten  days.  Daring  tho  last  four  ho  was  deliriom  at  afglit ;  ki 
woald  have  canons  apells,  in  which  his  eyes  woald  beeome  ftzed«  U$ 
limbs  tremalons»  and  palse  interrapted ;  finally  withoal  beoowm 
oottatose  he  passed  away  in  a  sort  of  eonvalsion.  One  of  the  peea* 
liaraties  of  the  disease  is  the  large  namber  of  young  children  whe 
are  attacked  by  it,  at  least  three-foarths  of  all  the  onaas  I  hava  mm 
have  occurred  in  children  from  three  to  ten*  years  of  ago. 

The  patients  were  treated  by  the  tincture  of  belladonna*  hy  dbe 
liquor  ammonia  aoetatis,  by  the  iodide  of  potaeh,  by  the  aalph.  ef 
qainine  in  eolation,  by  the  chlorate  of  potaeh,  wine  whaj.  wine 
water  etc.,  etc  I  did  not  observe  that  any  of  theea  remadias 
to  arrest,  or  sensibly  control  the  disease.  T%e  qaimna  aaamed  di- 
oidedly  injnrioas,  and  stimulants  in  general  eonld  only  ba  naed  whsa 
the  malady  was  pretty  well  worn  oat.  Stimnlatione,  ambroei^tioai^ 
and  dry  caps  were  applied  to  the  spine,  and  email  bliatera  behind  tki 
ears. 

I  noticed  in  one  ease  a  remarkable  instance  of  the  axarcisa  of  a 
oontroling  inflaenoe  on  the  part  of  th:8  endemic  over  tha  prepress  ef 
another  disease.  A  yonng  woman  who  was  seised  with  all  the  symp- 
toms of  this  disease,  on  the  third  day  broke  oat  with  varioloid,  whiek 
afterwards  ran  its  regnlar  coarse. 

From  the  symptoms,  course,  and  tendoncies  of  this  disease,  it  seems 
to  m3  clear  that  the  chief  seit  of  this  disorder  is  in  the  cerebro-spiaal 
axis  ;  whether  this  is  occasioned  by  thd  circulation  of  impure  blood 
there,  or  whether  it  be  a  conjestioa  tending  to  effasion,  I  have  not  had 
the  means  to  determine. 

Monday  Evening,  Sept.  I9th,  1864. 
Dr.  Carroll  in  the  chair. 

Urinary  Calculus. — Dr,  Taie — Related  the  following  case:  He 
presented  to  the  Academy  a  small  calculus,  one  of  three,  ihis  being 
the  smallest,  which  were  removed  from  the  genital  fisaare,  (not  the 
urethra)  of  a  femile  child  aged  three  months.  He  supposed  withont 
having  made  any  carefal  examination  or  analysis  that  the  calcnlns  was 
urate  of  ammonia  and  magnesia.  The  child  very  early  manifested 
derangement  of  the  health,  chiefly  as  it  regarded  the  condition  of  ths 
bowels  ;  the  evacuations  being  green  and  watery,  with  vomiting ;  it 
lost  flesh  and  became  much  emaciated.  After  the  calculi  passed  it 
regained  its  health  and  flesh,  an  I  subseqaently  there  were  no  sandy 
deposits,  and  nothing  peculiar  in  tha  appoaraace  of  the  urine.  !%• 
mother  assured  him  the  largest  calcu  i  of  ths  three  was  about  the  siss 
of  an  ordinary  pea.    This  age  was  very  early  for  tha  passage  of  a  eal- 


1863  ]  Proceedings  ^  SocUtiei.  608 

calus.  Of  couFBe  it  was  niQoh  easier  to  pa  ss  away  in  a  female  than 
a  male  child  ;  and  while  it  had  beea  supposed  that  calculi  were  some- 
times  formed  even  before  birth,  he  thought  there  were  no  very  well  an* 
theuticate  I  cases.  Qtoss  states  that  calculus  may  be  fjund  at  almost 
any  age,  but  Dr.  Tite  thought  the  sjAtement  indefinite  and  unsupport- 
ed by  cases. 

Dr.  Carroll — Said  that  two  years  was  the  earliest  a  ge  in  which  he 
had  known  calculi  to  be  found. 

Dr.  Goode  reported  the  following  case  as  of    interest  in  connection 
with  the  case  of  Dr.  Tate  . 

Dr,  Goode — Reported  the  case  of  a  bay  twenty  monthi  of  aga. 
There  was  no  particular  history  of  the  case ;  the    mother  had  noticed 
a  diffi'3alty  iu  the  child  pa*<sin^  his  water  for  three    weeks  ;  the  urine 
would  bei^iii  to  flow  an  I  then  soon  cease.     This  continued  for  three 
weeks,  when  his  mother  became  alarmed,  not  so    much  by  the  diffi- 
culty in  passing  water  as  by  thj  enlargement  of  the  scrotum  ;  the  left 
testiolc  was  pushii  well  up,  and  th3  T\\r\\i  one  down  by  a  tumor  which 
filled  the  whole  anterior  part  of  the  scrotum.     Such  was  the  condition 
of  the  pirts  when  the  Dr.  made  his  first  visit.     Finding  the  tumor 
hot,  glazed,  fiuctuating  to   the  touch,  and  evidently  containing  fiuid  ; 
the  child  h;id   not  passed  water  during  th3  night.     On  taking  hold  of 
the  glans  penis  he  founl  the   meatus  urinarius  blocked  up  by  a  hard, 
gritty  substance,  biulln^  his  prob;.     Tii}  Dr.  tried  to  rem)ve  it  but 
itslippel  I)  ick  out  of  rvja.'h,  vvli.»reup3u  th^  child   passe  I  its  water. 
In  the  evening  the  Dr.  suooej  led  in  rorn>/in>c  this   substance,  which 
be  found  to  bo  calculus,  composed  of  wha-i  he  could  not  definitely  say. 
On  opening  the  tumor  in  the  scrotum  fully  two  ounces  of  urine  and 
pus  were  discharged,  and  a  fistulous  opening  communicating  with  the 
bladder  was  founi.     The  treitment  lasted  four  or  five  weeks,  consist- 
ing merely  of  keeping  a  catheter  in  the  penis,  removing  it  every  three 
>r  four  days  to  cleanse  it.     The  fistulous  opening    was  quite  laige  and 
I  great  part  of  the  urethra  destroyed,  but  the  wound  granulated  nicely 
imd  is  now  healed. 

Canerum  Orie. — The  same  gentleman  also  leported  the  case  of  a  litde 
prl  eight  years  old,  who  Lad  been  under  the  treatmentof  Dr.  Fiahbum  np 
;o  two  weeks  previous,  she  being  then  convalescing  from  typhoid  fever. 
Dr.  Finhbum  being  ill  Dr.  Goode  was  called  and  found  a  black  gan- 
pienous  maKt,  two  inches  in  diameter  in  the  right  cheek  ;  on  opening 
the  month  the  same  condition  was  found  on  the  inside  of  the  cheek,  and 
ivery  tooth  in  the  upper  jaw  had  dropped  out  but  one  which  was  easi- 
ly removed  by  the  fingers.     The  gums  and  soft  palate  had  sloughed 


604  Proc€ed%ng$  of  Soeidki,  [OctoWt 

the  tongae  looked  well  and  clean,  better  tban  could  be  expected  ia  a 
case  of  this  kind.  The  gums  and  teeth  of  the  lower  jaw  were  aonnd. 
This  trouble  did  not  result  from  ptjalism,  as  no  mercariala  had  beet 
given  ;  but  it  was  constitutional,  independent  of  any  remedies  admm- 
istered.  Dr.  G-.  said  he  considered  the  case  hopeless,  but  gave  tiacL 
of  iron,  beef  essence,  and  brandy  ;  he  appl  ied  warm  flaxseed  pooltieei 
over  the  surface  of  the  cheek  and  touched  the^gnms  and  inner  sorftce 
with  a  solution  of  nitrate  of  silver.  The  child  lived  ten  dayn,  (tt 
which  time  the  difficulty  involved  the  whole  face,  extending  even  be- 
low the  lower  jaw)  at  last  dying,  not  from  the  disease  which  wu 
cancrum  oris,  but  from  hemorrhage  which  came  from  the  mouth  The 
child  lived  in  the  first  story  of  a  frame  house  built  on  a  side  hill,  the 
back  rooms  of  the  house  resting  against  the  bluff  bank  and  beiag 
nothing  more  than  damp  dark  cellars. 

Dr,  Carroll — Said  he  had  this  year  one  fatal  case  of  cancmm  orii 
ollowino;  measles. 

Dr.  MuBcrofi — Reported  he  had  had  but  two  cases  in  his  practiee 
of  cancrum  oris,  both  fatal  ;  one  following  typhoid  lever,  the  other, 
independent  of  any  disease,  appearing  first  by  an  ash-colored  spotoi 
the  angle  of  the  jaw  at  the  root  of  the  teeth. 

Dr,  Carroll — Thought  it  a  curious  disease  ;  when  a  number  of  jean 
ago  he  was  physician  of  the  Cincinnati  Orphan  Asylum,  there  were 
twenty-eight  inmates  of  the  house,  of  which  number  fourteen  died  io 
one  year  of  cancrum  oris.  That  it  depends  on  confinement  and  the 
state  of  the  atmosphere.  All  the  cases  he  had  published  followed 
measles. 

Dr.  Muscroft  once  saw  on  the  upper  lip  of  a  child  an  ash-colored 
spot  much  swollen  and  glazed.      He  thought  it  a  case  of  cancrum  ori>, 
and  that  the  child  would  die.     He  used  locally  tinct  iron,  and  inter- 
nally the  same  remedy  and  iodide  of  potash.     The  child  recovered 
under  this  treatment. 

Dr.  Tate — Had  teen  cases  of  cancrum  oris,  following  mea^iles, 
which  had  recovered.  Also  referred  to  a  specimen  of  maxillary  bo« 
which  he  had  already  presented  to  the  Society,  which  came  from  t 
child  after  measles.  In  this  case  the  child  lived  in  a  healthy  localitr. 
took  the  measles  like  other  children  but  after  recovering  from  tbetn 
the  fetid  condition  of  the  breath  was  noticed,  and  on  examination  it 
WHS  found  that  the  destructive  process  of  the  gums  had  commenced. 
He  applied  the  stick  of  (he  nitrate  of  silver  and  gave  Huxham's  tinct 
nternally ,  a  verv  valuable  remedy  he  thought  in  all  such  cases.    Dr- 


1864.]  Proeud'»ng9  of  SocietUs.  605 

T.  also  said  he  had  seen  two  such  cases  of  cancram  oris,  independen 
of  deterioration  of  the  blood,  from  eruptive  disease,  bnt  they  were  in  an 
unhealthy  atmosphere,  occurring  several  years  ago,  in  two  old  houses 
on  Race  Street  near  the  river,  where  from  the  situation  the  cellars 
wete  always  damp.  Also  another  fatal  case  within  the  last  three  years 
which  he  had  treated  with  iron.  He  thought  the  disease  lasted  two  or 
three  weeks,  and  that  it  was  surprising  how  long  children  affected  with 
it  wonld  live. 

Dr.  Carroll — Remarked  that  ten  years  ago  or  more  his  grandchild, 
m  delicate  girl,  became  afiocted  with  purpura.     Ecchymoses  appeared 
along  the  sides  of  the  fejt,  one  eye  soon  closed  then  the  other  was  af- 
fected similarly.     She  was  blind  for  three  days ,  then  the  first  eye 
opene  1  and  soon  the  other.     By  this  time  the  inferior  extremities  were 
mnch  swollen,  likewise  the  abdomen,  by  an  eff}i»ion  of  at  least  six 
qnarts  of  fluid  between  the  layers  of  the  peritoneum.     The   Dr.  gave 
squills,  digitalis,  and  calomel   for  a  slight  purgative  effect ;  at  the 
game  time  constantly  administering   iodide  of  potash.     After  all  her 
firiends  had  given  her  up.  she  passed  a  gallon  of  water  in  one  night  and 
then  recovered      Now  ecchymosed  spots  appeared  on  the  gums  around 
tbe  base  of  the  teeth  ;  and  wherever  these  spots  appeared  the  disease 
dipped  down  to  the  alveolar  process  removing  the  periosteum.     The 
first  set  of  teeth  were  thus  destroyed,  but  a  new  set  appeared  and 
tbe  child  is  now  a  stout,  healthy  girl.     At  the  latter  stage  of  the  dis- 
ease mild  tonics,  quinine  and  wino  were  giveu,  but  the  Dr.'s  main 
reliance  was  in  iodide  of  potash  till  the  free  discharge  of  urine,  referred 
to  above,  took  place.     At  the  heighth  of  the  disease  she  passed  small 
quantities  of  urine  which  contained  albumen.     Dr.  Carroll  could  not 
account  satisfactorily  for  the  disease,  but  thought  she  had  been  consti- 
pated for  some  time,  and  had  voided  but  little  urine  till  the  ecchy- 
moses came  on.     He  was  also  inclined  to  believe  that  the  profession 
did  not  give  iodide  of  potash  as  freely  as  they  ought  in  dropsy. 

Dr.  Muicro/i — Asked  Dr.  C.  if  it  was  not  a  case  of  scorbutus,  say- 
iBg  he  had  seen  cases  like  the  one  described  in  which  the  gums  were 
ppongy  and  wonld  bleed  ;  ecchymoses  and  purple  spots  were  apparent, 
and  the  teeth  lost,  and  he  ha<i  never  seen  the  same  condition  in  any 
other  disease  than  scurvy. 

Laryngitd  —  Dr,  TaU — Gave  the  following  case  of  cronp  :  A  week 
ago  yesterday  he  was  called  to  see  a  young  lad,  six  years  of  age,  who  put- 
ting on  a  heavy  suit  of  clothes  walked  into  the  country  for  a  mile  or 
two,  and  returning  heated  from  walking,  went  into  a  cold,  damp  parlor, 
consequently  taking  cold.     On  Sunday  evening,  he  complained  of  his 


606  PrtK9eXng9  of  SocUimm.  [Odbbv. 

throat.  A  wet  towel  wm  wrapped  aponiid  it  tlie  next  morning,  aad 
throngh  the  day  he  was  quite  comfoftahle»  hut  at  night  n  ahrill,  ropy 
congh  made  its  appearance  with  great  dyspnoea  and  fever,  m%  indiot* 
ed  by  the  pulse,  skin,  and  desire  to  drink.  The  boy  wnevomited  hf 
wine  of  ipecac,  wine  of  antimony,  and  sqnilU.  and  a  wet  towel  agiia 
wrapped  aronnd  the  throat.  There  was  no  improvement  in  the  case, 
so  at  8  A.M.  he  was  again  vomited,  and  a  sponge  wrang  ont  of  boC 
water  applied  to  the  throat  for  half  hour  at  a  time.  He  Kmained  ia 
the  same  condition  till  morning  when  he  was  a  little  better ;  calonel 
and  ipecac  were  now  given  every  two  hoars,  which  nauseated  but  did 
not  vomit  him.  The  shrill  congh  still  continuing,  he  was  again  vom- 
ited by  sulphate  of  copper,  grs.  x\j.  to  the  oa.  of  water,  applied  by 
means  of  a  probang  at  the  back  of  the  throat,  and  a  hot  flaxseed  poah 
tice  was  kept  over  th?  throat  diirinor  tha  day.  On  this,  ihe  third  night, 
the  fever  was  almost  gone,  and  from  this  time  the  child  began  to  im- 
prove. There  still  being  some  croupy  symptoms  be  was  again  vom* 
ited  by  a  eolation  of  copper  with  alum,  and  the  poultice  continved ;  oa 
the  third  day  he  was  much  better  and  is  now  almost  welL 

Dr.  Tate  then  went  on  to  say  that  the  above  was  a  case  of  aeiti 
laryngitis  in  a  boy  six  years  of  age,  treated  without  depletion  or  aoj 
remedies  to  reduce  him  much  ;  also  thought  it  an   important  poiat 
not  to  reduce  the  vital  energies  of  the  child  with   cronp,  which  will 
not  kill  by  clogging  up  the  wiud  pipe  unless  there  is  so  great  pros- 
tration of  the  vital  sources  that  the  niucons  cannot  be  raised.    He 
thonglit  too  that  the  reducing  treatment  was  a  poor  one,  and  he  had 
seen  such  cases  after  the  use  of  leeches  and  tartar  emetic  where  diar- 
rhoea was  the  result  and  life  lost  by  these  reducing  remedies  ;  and 
other  cases  where  the  child  recoverd  though  the  contrary  result  was 
certainly  expected.     Almost  at  the  same  time  as  the  above  case.  Dr. 
Tate  was  called  to  see  an  unhealthy  looking  child  evidently  redoced 
by  a  several  days'  illness.     Its  mother  said  it  had  coughed  for  severs! 
days,  and  the  Dr.  on  an  examination  found  the  pharynx  covered  br 
true  diphtheritic  exudation,  accompanied  by  a  hard  croupy  coogh. 
Here  he  supposed  the  proper  treatment  would  have  been  to  have  torn 
off  the  exudation,  cauterizing  the  surface  exposed  with  nitrate  of  silver, 
and  internally  giving  brandy  and  iron  ;  such  would  have  been  his 
treatment,  but  before  h^'s  second  visit  the  child  died.    The  Dr.  thoogbt 
^hat  the  above  two  cases  were  entirely  diflferent  diseases ;  in  one  then 
was  a  deposit  from  a  true  inflammatory  condition  of  the  part,  io  tbe 
other  a  deposit  from  the  corrupt  condition  6f  the  blood ;  that  thas^ 
two  Gondii ons  were  analgous  to  two  affections  of  the  peritonenm — petr- 


1864]  Chrre$pandeme$.  M7 

litis  and  puerperal  feyer  ;  the  former  a  highly  inflammatorj  affection, 
and  the  other  the  result  of  the  depraved  coodition  of  the  hlood. 
There  heing  no  further  business,  on  motioDy  the  Academy  adjourned. 


■  *•  » ■ 


etvttfivotiAtntt. 


Letter  From  Dr.  Parvin, 


London,  August  2nd,  1864. 
Dear  Doctor  :  —  My  recollection  of  the  letters  already  sent  you, 
If  that  ibey  were  miscellaneous  in  character  and  contents.  If  correct 
in  this,  then  the  present  letter  will  be  quite  in  keeping  with  its  prede- 
ceasors  ;  if  mistaken,  then  it  may  be  redeemed  from  reprOach  by  con- 
trast with  them.  The  problca.  presented  me  for  solution,  when  I  sit 
down  to  write,  is  with  an  almost  infinity  of  topics,  and  a  brief  time 
to  digest  them  in,  how  to  make  a  readable  letter  ;  and,  of  consequence, 
many  things  will  be  hurried  together  without  reference  to  proper 
juxtaposition. 

One  is  struck,  in  walking  the  medical  rounds  of  the  London  Hos- 
pitals, with  the  great  prevalence  of  renal  and  of  hepatic  diseases  in- 
duced by  dram  -  drinking.  The  use  of  spirits  is  frightfully  common 
among  the  London  laboring  classes  ;  gin  they  often  make  a  substitute 
for  bread  and  meat.  Here  is  a  solicitor's  clerk  brought  into  King's 
with  cunsiilerable  emaciation,  impoverished  blood,  and  enormous  ab- 
dominal distension  ;  and  the  secret  of  his  condition  is  eirrhozed  liver, 
and  the  secret  of  this  is.  for  eight  years  he  has  been  daily  drinking  a 
pint  of  gin.  Poor  fellow,  paracetUesis  was  performed,  and  he  imme- 
diately sunk.  In  the  female  wards,  yon  will  see  a  woman  less  than 
thirty,  a  wife  and  a  mother,  sufferinor  with  slight  anasarca,  urine 
albuminous,  from  nephritis  ;  she  has  been  drinking  six  ounces  of  gin 
daily  for  three  or  four  years  past.  These  two  cases  are  sufficient  — 
let  them  stand  for  hundreds  of  others  one  may  see  here. 

I  think  that  the  London  practitioners  are  more  given  than  we  at 
home,  to  the  use  of  hydrogogue  cathartics  in  the  treatment  of 
dropsies.  As  a  diuretic  they  frequently  use  the  hraom  ;  as  a  tonic, 
the  favorite  prescription  seems  infusion  of  quassia  with  the  muriated 
tincture  of  iron. 

Oar  surgeons  are  dcubtless  all  familiar  with  Mr.  Wood's  operation 
for  the  radical  cure  of  hernia,  and  therefore  though  witnessing  him 


608  Chmfpandenm.    "  [Oebh 

operate  the  other  day,  I  iieel  not  waste  time  with  a  deaeriptiiM :  1 

me,  however,  give  hie  preHoainary  8tatenie|nt  —  he  had  operated  m 
one  handred  times,  and  the  resalt  in  upwards  of  eevmitj  oaaet  m 
complete  eaccess,  while  of  those  not  absolntolj  cured  eereral  we 
mnch  relie9ed.  Mr.  Wood  is  not  an  enthasiast,  and  hii  aasertioi 
may  ba  taken  as  absolately  true.  If  this  operation  is  not  already  ei 
tablished  at  home,  it  certainly  is  worthy  of  being. 

L3t  me  not  fail  to  mintion  among  the  able  man  of  '*  1^iQ,:(*8,  "  Mi 
F^rgnsson's  colleague,  Mr.  Partridge,  who  looki  as  jolly  and  good 
natured  and  "  chaffs  "  his  patients  as  if  he  did  n't  care  that  Nelato 
foand  a  ball  in  Giribaldi's  foot  which  he  said  was  Q*t  there  I 

Ouy's  Hospital  is  moro  remarkable  for  its  mnsoam  than  for  it 
men  ;  no  one  should  fail  to  visit  it  for  tho  former.  Gay's  and  Bar 
tholomew's  soem  to  have  the  greatest  nnmber  of  stndonte. 

St  Thomas'  —  where  on  last  Saturday  I  saw  Mr.  Solly  perfon 
lithotomy — -even  with  such  famous  men  as  Solly  and  Simon,  does  a* 
count  over  sixty  students.  .  Tbis  is  one  of  the  wealthiest  hospitals  ii 
London,  its  annual  inooma  now  thirty  •  five  thousand  pounds •  and  U 
be  increased  to  seventy  thonsand,  and  having  a  bnilding  fond  of  three 
hundred  thonsand.  By  -  the  -  way,  there  was  an  interesting  diseai* 
sion  tho  otlier  day  at  the  ra39ting  of  the  Governors.  a»  to  tha  qnantit] 
of  coal  ami  porter  the  druggist  of  this  Qo^ipital  was  receiving  — la- 
nually  twf^nry  -  four  ton^  of  coal,  and  a  pint  of  porter  daily  foretcb 
member  of  bis  family  from  himself  dowa  to  his  last  baby  in:ln'5ire! 
Really,  one  would  think  tbis  quite  enough  coal  and  porter  to  kecphio 
and  bis,  warm  and  well  -  toned 

St.  Thomas'  temporarily  occupies  the  oil  Surrey  Gardens,  oncei< 
famous,  possibly  the  word  should  be  infamous,  as  the  Cremoine  Gtr- 
dens  arc  now  ;  but  previous  to  this  being  converted  to  this  benevoleoi 
nse,  the  Music  H.ill,  wbi-^b  is  the  main  hospital  now,  was  occupied  bj 
the  ffimoiis  Spurgeon,  who  s'ill  continues  in  the  imm3nse  tabemade 
erected  for  him  a  few  srjuares  off.  a  building  with  capacity  for  soin« 
six  thousand,  to  attract  immense  crowds. 

In  a  year  the  uew  hospital,  which  will  adjoin  Lambeth  Palace  os 
the  Thames,  will  be  comm'^nccd.  and  doubtless  it  will  be  one  of  tlie 
finest  and  most  complete  in  the  world. 

Some  days  ago  I  saw  a  London  surgeon,  whom  we  know  qaite 
well  on  our  bide  of  the  wjter.  remove  a  ncnut,  the  size  of  a  smaS 
orange,  from  the  scapula  of  a  child  two  or  three  years  old,  by  the  tf" 
dions  and  confessedly  dangerous  process  of  dissection,  in  preferenei 
to  the  ligature,  "  it  w'iufd  be  such  a  fine  specimen  for  the  mtueacii/" 


1864.]  Correspondence.  609 

Let  me  mention  another  operation,  thoagh  with  diflbrent  intent.  A 
surgeon  removed  a  tumor,  the  size  of  a  large  hen's  egg,  from  near 
the  angle  of  the  jaw  —  a  part  of  it  orerlaid  by  the  parotid,  and  the 
base  almost  resting  npon  the  deep  vessels  of  the  neck ;  the  sac  was 
carefullv  dissected  out,  after  evacuation  of  its  contents,  atheromatous 
in  character,  and  the  class  told  of  the  difficulties  and  dangers  of  the 
exploit.  Early  last  spring  I  saw  Dr.  Fletcher,  of  ludianapolis,  do  a 
precisely  similar  operation  ;  the  tumor  similar  in  size  and  in  situation  t 
without  half  so  much  facial  contortion  and  perspiration,  with  quite  as 
much  dexterity,  and  with  more  celerity. 

It  amuses  one  not  a  little  to  observe  how  our  British  brethren  tnis- 
locate  some  of  our  American  physicians  and  surgeons,  not  merely  in 
oral,  (  or  it  might  be  overlooked,  )  but  in  printed  words.  One  of  the 
staff  of  Middlesex  Hospital  writes  of  "  Dr.  Carnochan  of  Philadel- 
phia ;  "  at  a  recent  meeting  of  the  Royal  Medical  and  Chirurgical 
Society  Dr.  Harley  spoke  of  Dr.  Jackson  of  New  York ;  elsewhere 
Dr.  Hayward  w  attributed  to  Philadelphia  ;  and,  as  if  Boston  should 
be  compensated  for  having  Hayward  and  Jackson  taken  from  her. 
Baker  Brown,  in  his  '*  Surgical  Diseases  of  Females,  "  refers  to  "  Dr. 
Marion  Simi  of  Boston  ;  "  of  course  Dr.  Sims  does  n't  belong  to 
Boston  ;  New  York  is  the  theatre  of  his  most  suooessfnl  labor,  and 
of  his  greatest  fame. 

We  have  one,  though,  among  our  physicians,  who  is  often  referred 
to,  and  never  mis  -  placed,  Dr.  George  B.  Wood.  His  "  Theory  and 
Practice  "  is  a  standard  work  here  ;  a  Wlan  would  n't  venture  to  go  up 
for  examination  in  the  University  of  London  without  thoroughly  pre- 
paring himself  in  this  ;  and  no  one.  at  least  I  judge  from  all  that  I 
have  heard,  in  the  United  States  has  a  higher  fame  among  physicians 
here  than  he  :  all  of  which  of  course  is  very  gratifying  to  every 
American,  and  especially  to  a  graduate  of  the  University  of  Penn- 
sylvania. 

At  the  Women's  Hospital,  Soho  Square,  (  this  is  the  institution 
with  which  the  eminent  name  of  Dr.  Prothewe  Smith  is  connected  — 
he  was  mainly  instrumental  in  its  establishment,  and  he  is  still  con- 
nected with  it,  )  I  find  another  Philadelphia  production  held  in  great 
repute,  I  mean  Ho<ige'd  pessary.  My  own  faith  and  practice  have 
1)6en  resolutely  tenacious  of  the  horse  -  shoe  ;  they  will  be  confirmed 
by  the  experience  and  judgment  of  those  who  have  been  working  so 
long  and  in  so  large  a  school  as  this.  Three  or  four  hours  twice  a 
week  it  has  been  my  privilege  to  spend  here.  The  number  of  patients 
varies  each  of  these  two  days,  Wednesday  and  Friday,  from  sixty  to 


1864.]  Beriewf  and  Sbdef.  611 


agiinst  MalarioQfl  Dipeases,  by  Dr.  Van  Boran ;  Yaecination  in 
Annies,  by  Dn.  F.  G-.  Bmitb  and  Alfred  Stilli ;  Rnles  for  the  Pre- 
serving the  Health  of  the  Soldiers,  by  Dr.  Van  Bnren  ;  Scnrvy,  by 
Dr.  Wm.  A.  Hammond ;  Miasmatic  Fevers,  by  Dr.  John  T.  Metcalf ; 
Continued  Fevers,  by  Dr.  J.  B.  Upham  ;  Yellow  Fever,  by  Dr.  Met- 
calf ;  Pnenmonia,  by  Dr.  Anstin  Flint ;  Dysentery,  by  Dr.  Alfred 
8tille  ;  Pain  and  Anaesthetics,  by  Dr.  Valentine  Mott ;  Hemorrhage 
from  Wounds  and  the  Best  Means  of  Arresting  it,  by  Dr.  Mott ; 
Treatment  of  Fractnres  in  Military  Baigery,  by  Dr.  J.  H.  Packard  ; 
Amputations,  by  Dr.  Stephen  Smith ;  The  excision  of  Joints  for 
Traumatic  Cause,  by  Dr.  R.  M.  Hodges ;  Venereal  Diseases,  by  Dr. 
Freeman  J.  Bumstead. 

It  will  be  observed  that  the  original  order  of  publication  of  these 
essays  has  not  been  observed  in  the  present  volnmo ;  but  the  editor  has 
arranged  them  in  groups  according  to  general  topic  ;  thus  those  which 
relate  to  the  prevention  of  diseases  come  first,  those  on  medical  snb- 
ects  next,  lastly  those  pertaining  to  suigical  matters.  When  written 
these  essays  were  very  timely  ;  they  are  "  simple  practical  memoirs, 
written  without  any  attempt  at  a  display  of  learning."  They  are 
condensed  outlines  of  the  various  medical  and  surgical  topics,  and  are 
well  suited  to  the  hurry  and  bnstle  of  the  field.  Many  will  be  glad 
to  have  them  collected  together  in  this  permanent  form ;  and  as  these 
constitute  but  a  small  part  of  the  medical  and  sargical  essays  issued 
by  the  Commission  since  the  war  commenced,  we  presume  we  may 
anticipate  a  further  series  in  dne  time. 

In  most  respects  the  publishers  have  done  their  usnal  good  part, 
having  furnished  good  tinted  paper,  with  clear  letter  press;  but  we 
must  certainly  express  our  surprise  at  the  singular  display  of  taste  in 
t  he  excesbive  amount  of  red  which  envelopes  the  Tolnme ;  it  is  alto- 
gether too  gaudy. 

For  sale  by  Kobt.  W.  Carroll  k  Co.    Price  9b. 

A  Treatise  <m  Oonorrhoeu  and  S^philU,  By  Silas  Doekeb,  II.  D.,  CoBsaUinc 
Sargeon  of  the  Boston  Citj  Hospital,  ete ,  etc.  Seeond  Edltloa  Revised  aad 
EnUrged;  with  Eight  Colored  lUastrAiions.  PhtUdelphia:  Lindsay  k 
BUkiBtoD,  1bG4. 

It  is  now  five  years  since  we  have  had  the  pleaaure  of  reviewing  the 

first  edition  of  Dr.  Durkee's  excellent  Treatise  on  (Gonorrhea  and 

Syphilis,  which  we  commended  to  the  favorable  regards  of  our  readers 

We  are  very  glad  to  find  that  our  judgment  of  the  book  then  has  been. 

so  far  Confirmed  by  the  favor  of  the  profession  as  to  call  for  this  new 

edition  now  before  us. 


1864.]  Revxeum  and  Ifcitcei.  613 

ment  cure/'  we  will  therefore  content  onrselves  with  a  very  hasty  out- 
line of  the  contents.  The  opening  chapter  is  devoted  to  a  considera- 
tion of  the  Natritive  Process,  especially  discussing  the  office  of  muscu- 
lar motion  as  a  promoter  of  tissue  formation,  as  also  the  condition 
of  the  circulation — both  endosmotic  and  capillary — as  influenced  by 
muscular  action.  A  very  little  reflection  will  show  how  important 
for  tho  general  propositions  of  this  system,  these  elementary  or  fun- 
damental principles  become.  Then  we  have  chapters  on  muscular 
contraction  and  the  philosophy  of  general  exercise. 

Next  we  have  in  regular  order  chapters  treating  of  Curvature  of  the 
Spine,  Paralysis,  the  Circulation,  Constipation,  Chronic  Diarrhcea, 
Dyspepsia,  Phthisis,  Deformities  of  the  Limbs,  Chronic  Injuries  of 
the  Foot  or  Ankle,  Diseases  Incident  to  Women,  Derangement  of  the 
Nervous  System.  In  all  these  diseased  conditions  the  author  en- 
deavors to  point  out  tho  practical  applications  of  localized  move- 
ments as  a  valuable  therapeutic  measure. 

We  find  independent  of  the  immediate  views  of  the  author,  that  he 
has  interwoven  throughout  this  little  book  many  suggestions  worthy 
of  cai-eful  attention,  and  has  given  a  great  many  facts  and  cases  in 
illustration  of  his  doctrines  that  are  exceedingly  interestmg.  We 
think  our  readers  will  find  Dr.  Taylor's  book  entertaining,  and  wor- 
thy of  a  place  in  the  library. 

For  sale  by  Robt.  Clarke  &  Co.     Price  •1.50. 


Physician's  Visiting  List  for  1865. — The  present  price  of  this  in- 
valuable pocket  companion  is  75  cents  to  91.50,  according  to  style  of 
binding  and  number  of  patients.  The  usual  size  for  25  patients, 
leather  and  tucks  is  81.25.  Wo  have  received  a  Visiting  List  for 
1865  from  the  publishers,  Messrs.  Lindsay  &  BUkiston,  and  are  of 
the  opinion  that  its  getting  up  is  rather  unusually  good.  As  to  the 
general  character  of  this  style  of  memorandum  it  is  too  long  and  well 
known  to  require  comment. 


Memoranda  on  Poitont.  Bj  Thomas  Hawses  TAHXsa,  M.D.,  F.L.S.,  etc.,  etc., 
etc.  From  Uie  iMt  London  Edition.  Philadelphia:  Lindsaj  &  BUkiston, 
1804. 

This  convenient  little  manual  is  prepared  by  the  author  of  the  very 
excellent  little  book  on  the  Practice  of  Medicine  ;  and  is  intended  as  a 
remembrancer  in  cases  of  emergency  ;  intended  to  show  almost  at  a 
glance  the  treatment  to  be  adopted  in  each  particular  case  of  poisonir*'* 
to  which  a  medical  man  may  be  summoned.    The  book  is  oow 


1864.]  JRitor*«  2Ub.  615 

—  men  made  like  oarmlvee^  mth  the  same  hopee  end  fean*  with  tlie 
same  style  of  stomach  and  nenroos  apparatns,  with  brothers  and  sis- 
ters, and  fathers  and  mothers,  and  may  be  wiTes  and  babies,  like 
other  hnman  beings  —  is  a  question  to  appal  the  stontest  heart.  And 
then,  to  consider  the  infinite  extent  of  simple  credulity  and  child-like 
gullibility  which  must  exist  in  a  community,  where  reasoning  crea- 
ture will  swallow  anything,  with  a  nicely  printed  label  surmounted 
by  a  quack's  head  with  '*M.D.''  under  it — this,  too,  is  amazing. 
The  "  age  of  Faith  "  has  certainly  not  passed  away.  Every  apoth- 
ecary's shop  is  witness  to  its  existing  and  flourishing,  at  least  among 
onrselres.  We  are  a  believing  people,  if  we  are  only  well  hum- 
bngged. 

The  taste,  however,  appears  to  be  on  the  increase  ;  and  there  U  one 
cause  for  this  which  we  have  never  seen  noticed,  but  which  is  oer* 
tainly  suggefitive.  We  write  to  ask,  what  is  the  precise  connection 
between  Sectarianism  and  Quackery  ?  Where  is  the  nexus  between 
dissenting  sermons  and  sngarHwated  pills  ?  Where  is  the  link  con- 
necting Sectarian  Divinity  and  Patent  Doctoring  ? 

There  is  not  a  new  nostmm,  cooked  for  the  stomachs  of  the  drug- 
eating  public,  that  has  not  the  vouchers  of  half  a  dozen  *'  Reverends," 
of  as  many  of  the  **  Bvangelic  Denominations.*'  No  "  medical  al- 
manac "  is  complete  without  a  list  of  wonderful  cures,  certified  by 
•<  the  Rev.  Qullible  Gnhbias,  Presiding  Elder,  etc.,**  or  by  *'  Elder 
W.  Gudgeon,  of  the  First  Church,  etc.  '*  No  wonderful  column  of 
•*  Testimonials  "  to  the  "  great,  all-curing  Life  Bvrup  and  Pain  Kill* 
ing  Elixer,  warranted  to  cure  or  the  money  refunded  **  is  without  the 
namp  of  the  "  Rev.  Oander  Gray,  the  eloquent  pastor'*  of  some  sim- 
ple flock  of  one  of  the  "  persusHions.  "  Even  the  moat  clumsy  hair 
dye  —  some  villianous  compound  of  nitrate  of  silver,  red  lead  and 
alcohol  —  will  parade  its  list  of  sectarian  ^'  Reverends  "  and  "  Doctors 
of  Divinity,  "  whose  red  locks  it  has  changed  to  purple,  and  whose 
gray  whiskers  it  has  convcitcd  to  a  lovely  blue-black  I 

The  thing  can  not  be  too  gross  or  too  worthless,  the  humbug  can 
not  be  too  vile,  to  find  "  fiteverends  "  certifying  to  its  excellence. 
The  extent  to  which  the  clergy  of  '*  tlie  varions  denominations  "  have 
gou%  into  this  business  of  puffing  quackery  is  astonishing  to  any  one 
who  has  not  kept  track  of  it. 

It  is  very  curious,  at  firet  sight.  But  there  must  be  a  reason  for 
this  close  communion  between  the  Denominational  pulpit  and  the 
Qnack's  laboratory,  and  it  may  not  be  far  to  seek.  Quack  Medicine 
and  Quack  Divinity,  Quackery  for  body  cure.  Quackery  for  soul  cure 
—  ttivy  are  not  antagonistic.  The  mixture  of  distrust  and  credulity 
which  leads  to  faith  in  some  well-puffed  nostrum,  is  jnst  the  mixture 
which  exists  in  a  Divinity  that  despises  the  ordinary  means  of  Grace, 
distrusts  the  sober  teachings  of  antiquity,  and  g^s  greedily  gaping 
after  new  gospels  and  miraculous  means  of  sal  ration. 

The  merchant  is  brought  down  to  precision  daily,  the  lawyer  ia 
required  to  be  clear  under  penalty,  the  carpenter  and  the  blacksmith 
must  know  the  jealities  of  their  business  ;  but  the  "  Preacher  "  is  a 
ialker.    He  has  no  definite  Theology.    He  has  only  a  vague  mats  of 


1864.]  Iklitor^i  TtMe.  61T 

nostrums  and  qnack  remedies — even  if  called  npon  as  merchants  to 
wll  them  —  knowing  them  to  be  worthless  and  often  pernicious  he 
exhorted  them  to  a  carefalregard  for  duty  and  morality.  The  cor- 
duility  with  which  his  remarks  were  received  spoke  well  for  the  integ- 
ritj  of  the  gentlemen  present  at  any  rate.  Mr.  W.  J.  M.  Gordon,  of 
Cincinnati,  was  cflected  President ;  H.N.  Riitenhonae,  of  Philadelphia^ 
(mt  present  U.S.  Medical  Purveyor  at  this  city)  Recording  Secretary. 
The  Society  adjourned  to  meet  in  Boston,  Sept.,  1865. 


Pharmaceutieal  Humor,  —  One  of  the  queries  propounded  by  the 
American  Pharmaceutical  Association  for  the  recent  meeting  of  the 
Association  was  as  follows :  "  Does  the  aqueous  extract  prepared 
From  Jalap  that  has  been  previously  exhausted  by  alcohol  possess  any 
medicinal  properties,  or  does  the  alcoholic  extract  of  Jalap  fully  rep* 
resent  its  virtues."  Mr.  Alfred  B.  Taylor  of  Philadelphia,  in  reply 
itated  that  he  had  made  the  experiment  npon  himself,  taking  in  the 
^nrsc  of  one  day  240  grs.  of  a  carefully  prepared  aqueous  extract !  that 
Jie  morning  afterward  he  had  one  single  natural  stool,  just  as  usual ; 
■nd  twenty-four  hours  thereafter  again  a  single  stool,  just  as  usual. 
ELie  inference  was,  that  the  preparation  was  entirely  devoid  of  medi- 
"inal  viitues.  A  member  suggested  to  Mr.  Taylor  that  perhaps  the 
ifiect  of  the  extract  was  partly  dependent  on  the  present  high  price  of 
Falap»  rendering  the  drug  costive. 


Medical  Department  of  the  University  of  yashville. — We  are  happy 
o  learn  that  amid  the  wreck  of  educational  institutions  in  the  South- 
am  States,  the  Medical  Department  of  the  University  of  Nashville 
iMB  escaped  entire  ruin.  If  we  are  correctly  informed,  its  course  of 
bstruction  was  suspended  but  for  a  single  session,  that  of  1862-3,  a 
i4irtial  course  of  lectures  having  been  given  during  the  past  winter,  to 
\piie  a  respectable  class  of  young  men.  The  life  and  soul  of  the  institu- 
ion,  its  projector,  and  the  man  to  whom  more  than  to  all  others  it  owed 
^B  magnificent  success.  Dr.  W.  K.  Bowling,  still  remains,  and  if  he 
ft  spared,  we  predict  that  it  will  not  be  long  ere  this  school  will  take 
Xm  place  in  the  very  front  rank  of  educational  institutions  of  its  kind 
^  the  land. — Med.  and  Surg.  Reporter. 

2  he  American  Medical  Times. — We  regret  to  announce  the  temper- 
ty  suspension  of  this  most  excellent,  and  so  far  as  tone  and  ability 
*e  concerned,  remarkably  successfull  weekly  cotemporary.  The 
Oapenaion  is  announced  by  the  publishers  with  the  following  remarka : 


X864.]  Ediior*9  TaUe.  619 

ii  J)eath  of  J,  Bawe  Smith, — We  regret  to  itnnoance  the  death  of  Mr. 
i|>  Smith — lately  engaged  in  convassing  and  collecting  for  thia  Journal. 
u  Bis  enccess  in  procuring  new  suhscribers  had  been  nnnsnally  good  and 
1.1  we  hoped  he  would  very  materily  add  to  onr  list  in  Ohio  before  the 
»  eonnmencement  of  a  new  volume.  With  his  death  we  have  now  no 
if^fikveling  agent  in  this  State,  and  we  respectfully  solicit  the  aid  of  onr 
ififriends  in  working  for  our  increased  circulation  ;  and  those  in  arrears 
0HriIl  now  be  pleased  to  remit  at  once  without  waiting  for  a  collector 
^^to  visit  them. 

^'  Personal. — Onr  friend  Dr.  Mcllvaine  in  a  recent  visit  to  New  Tokr 
had  pleasant  interviews  with  Prof.  Parker,  formerly  of  this  city, 
^''Prof.  G.  S.  Bedford  and  Prof.  Stephen  Smith  of  the  Bellevne  Hospi- 
"^^Hal  College.  Dr.  M.  speaks  of  these  men  as  earnest  energetic  workers 
^lii  the  profession,  and  withal  pleasantly  interested  in  men  and  things 
^^pertaining  to  Cincinnati. 


Obituary  Notices — Died,  in  Philadelphia,  Dr.  Robt.  M.  Huston 
.^aged  70  years.  Dr.  H.  was  formerly  Professor  of  Obstetrics,  and  the 
^iAiseases  of  Women  and  Children  in  the  Jefferson  Medical  College, 
.^Ukd  for  some  time  editor  of  the  Medical  Examiner, 

J  Died,  in  Boston,  April  29,  1864,  aged  68  years,  John  Ware,  M.D., 
formerly  Prof,  of  Theory  and  Practice  of  Medicine  in  the  Medical 
Department,  of  Harvard  College,  and  one  of  the  most  eminent  and 
highly  respecteti  physicians  of  Boston. 

^    Died. — Dr.  Frank  Morris,  of  Hamilton,  O.,  died  at  his  residence  on 
^Friday  morning,  Sept.  23d.    He  was  late  Surgeon  of  the 35th  O.V.L, 
a  worthy  gentleman,  and  a  physician  of  character  and  promise. 


^  Army  Medical  Inttfligenca. 

^  Wa  publish  the  following  card  which  Dr.  Hammond  has  issoad 
*ri&c«  his  sentence  as  a  matter  of  simple  justice  to  him,  while  at  the 

same  time  we  must  express  our  sense  of  the  bad  taste  of  the  fling  he 
'aaes  fit  to  throw  out  against  the  present  administration,  wherein  he 

apparently  seeks  to  make  a  little  petty'personal  capital  by  raising  a 

=folitical  issue : 

"     A  Card. — ^The  undersigned  has  read  in  the  Sunday  Morning  Ckron- 
irff  of  this  city,  the  remarks  of  Judge  Advocate  General  Holt  on  the 
ffoceedings  of  the  Court-martial  in  his  case. 
He  learns  from  this  review  and  from  the  order  of  the  President  ap* 


.]  SdiUmal  AbiiraeU  and  SOectUmi.  621 

S.  MtfaUie  Mercury  Jound  in  Banes. — Professor  Hyrtl,  %  celebrated 
ist  in  Germanj,  has  found  in  three  cases  metallic  mercury  in 
The  first  time,  about  twenty-five  years  ago,  whilst  demon- 
or  of  anatomy  at  Vienna,  having  found  in  the  bottom  of  a  cellar 
irhich  skeleions  had  been  macerated,  a  certain  quantity  of  mercury, 
Examined  separately,  each  one  of  the  bones  and  found  out  that  those 
l^lbich  contained  mercury,  belonged  to  a  man  about  whom  no  in  forma 
could  be  procured.     The  quantity  of  metal  he  gathered  on  shak- 
the  bones  might  have  been  equal  to  a  spoonful.    Three  of  his  con- 
iples  gathered  also  a  few  drops.     Last  year  Professor  Hyrtl  again 
id  metallic  mercury  in  the  skeleton  of  a  man  of  about  thirty  years 
age.  and  which  bore  traces  of  periostitis  at  the  inferior  extremity  of 
left  radius.     About  half  an  uunce  was  gathered,  but  it  was  im- 
lible  to  find  out  the  quantity  lo&t  throuch  the   maceration  and 
'oration  of  the  bones.     Lastly  Professor  Hyrtl  mentions  a  skull  of 
llalaysian  belonging  to  a  collection  of  skulls  sent  from  India,  and 
Mtnrated  with  mercury  that  the  metal  would  ooze  out  drop  by 
^p  on  the  least  motion  given  to  the  skull.     It  is  evident  that  the 
rcury  thus  deposited  in  bones  must  have  penetrated  in  them  by 
ftna  of  the  blood  vessels,  and  came  fiom  mercurial  frictions  made 
the  integument.     Persons  still  disposed  to  deny  this  will  be  forced 
yield  to  evidence,  for  Prof.  Hyrtl,  is  well  known  to  be  an  intelli- 
1  observer  whose  words  merit  full  confidence. 


8.  Case  {^Poisoning  hy  Atropia  Cured  by  Opium, — At  Children's 
sjlum,  Philadelphia  Hospital,  May,  27,  1864,  a  two  ounce  solution 
^>f  mtropia  of  the  strength  of  one  grain  of  the  sulphate  to  an  ounce  of 
"prater  was  prepared  and  ordered  to  be  dropped  fromitime  to  time  into 
"^be  eye  of  a  certain  patient. 

The  attendant  nurse  after  using  as  was  directed  placed  ihe  bottle 
Vpon  the  table,  when  her  son,  aged  "Ik  years,  seized  and  drank  about 
Imlf  an  ounce  of  the  liquid.     No  bad  symptoms  at  the  time  were  man- 
ife^ted,  and  the  mother  thought  he  had  not  taken  a  suflicicnt  quantity 
^o  fear  any  serious  consequences.     However,  in  about  half  an  hour 
afterward  the  child  became  restless  and  cross.    When  the  mother  be- 
cmme  alarmed  and  medical  aid  was  called.     The  child  now  complain- 
ed of  pain  in  the  region  of  the  stomach  which  was  very  hard  and 
tense.     His  pupils  were  largely  dilated,  immovable  and  iuseuKible  to 
the  brightcht  light  (as  was  evinced  by  a  double  convex  lens  which 
oon<*entrated  the  rays  of  a  gas  light  and  made  it  intensely  bright. 
His  vi>ion  was  impaired  ;  slUo  his  hearing,  as  he  seemed  to  notice 
nothing,  and  was  insensible  to  sound  when  spoken  to  in  the  loudest 
tone.     An  orange  was  placed  before  him  and  he  was  told  to  take  it, 
bat  regarded   it  not.     llis  tongue  and  lips  were  very  dry.     All  the 
Tnuscles  of  the  bwly  contracted  npasmodically — those  of  the  face  work- 
ed irregularly.     His  hands  and  feet  moved  like  a  patient  sufiering 
from  a  bad  attack  of  chorea.     He  would  throw  himself  backward  in 
his  nurse's  arms,  then  forward  crying  all  the  time.     He  couM  not 
etmn<l ;  his  limbs  were  powerless  and  quite  cold.     His  puUe  was  quite 
feeble.    His  body  was  coverefi  with  an  eruption  resembling  scarlatina. 


632  JMItoHW  AUtfftmofaBJMkm.  [Oetdier, 

An  emetio  ofsiiiei  ndph.  snd  poW.  ipeqii^  esMh  fp,  t.  wm  rnkm- 
istered.  This  very  soon  had  the  defliir^  oflfoet,  far  Ms  ■tdmseh  wm 
wdl  emptied.  An  asMfceiids  onekna  was  abo  ordered  ;  and  half  a 
hour  after  the  emetic,  half  a  grain  of  opium  was  given  by  the  moiitL 
The  opiam  was  ordered  to  he  repeated  in  quarter-grain  doaes  ererf 
half  hour,  its  efibets  carefally  watched.  Aftor  several  doaea  had  beea 
administered  the  eruption  hegan  to  fade,  the  pupil  to  contFact  to  its 
normal  condition. 

After  this  the  child  was  left  alone  to  enjoy  its  slumber  from  which, 
when  it  awakened,  it  appeared  perfectly  well,  and  as  his  aabeeqoeat 
condition  has  proved,  experienced  no  persistent  bad  eSe'bts  fkum  the 
dose.  D.  F.  Woods,  M.D. 

4.  A  Singular  Ca»€  of  Afuuarca — ^The  progress  of  anaaarcat  in  • 
case  reported  hy  Dr.  Bariy,  is  very  singular.  The  osdama  of  the  ei- 
tremities  which  had  existed  from  the  honing  disappeared  prsttj 
rapidly,  and  was  replaced  by  an  abundant  collection  in  the  pentooo- 
nm.  This  latter  showed  itself  some  days  before  when  I>r.  Barry  wti 
notified  that  the  patient,  a  child  aged  thirteen  years,  was  in  a  dyiog 
state.  He  found  her  in  convulsions,  without  consciousness,  snd  widis 
slow  and  hard  pulse,  'ihe  bed  was  wet,  and  the  collection  hadentireij 
disappeared.  Dr.  Barry  did  not  at  first  make  out  what  had  taksa 
place,  the  patient  having  been  found  in  this  state  after  being  left  alone 
for  some  time.  He  thinks  that  the  liquid  reabsorbed  must  have  bets 
eliminated  by  the  natural  vicr,  and  it  is  difiicuU,  in  fiact,  to  ims^^M 
another  explanation.  The  comatose  state.  Dr.  Barry  attributes  to  the 
production  of  a  serous  collection  in  the  interior  of  the  skull.  He 
caused  ico  to  be  applied  to  tbo  head,  the  inferior  extremities  to  be 
kept  warm,  and  prescribed  mercurial  unctions  in  the  internal  side  of 
the  thighs  and  under  the  arms.  The  child  came  to  itself  at  the  end  of 
forty  hours,  and  after  another  convulsive  attack  of  half  an  hour.  The 
convalescence  was  long,  but  health  completely  returned. 

On  the  Hypodermic  Injection  of  Sedatives,  —  To  the  Editor  of  tke 
American  Medical  I^mes  —  Sir  :  —  In  the  American  Medical  limit 
for  July  30,  1864,  there  is  an  article  on  the  "  Hypodermic  Treatment 
of  Uterine  Pain,"  by  J.  Henry  Bennct,  extracted  from  the  London 
Lancet.  The  reprint  of  that  article  shows  your  belief  that  inform*- 
tion  on  that  topic  will  be  gladly  received  by  the  profession,  while  Dr. 
Bennett  does  not  seem  to  think  that  such  a  practice  as  be  advocates  is 
at  all  general. 

My  experience  with  this  method  of  treatment  goes  back  to  the 

month  of  Augnst,  1857,  just  seven  years  ago,  and  in  the  New  Jarl 

Journal  of  Medicine  for  Nov.  1858,  pp.  340-341,  will  be  found  the 

/iret  two  cases  of  hypodermic  injection  that  were  ever  published  in  thit 

country. 

1  then  stated  that  among  the  various  uses  to  which  I  applied  this 
method  of  treatment  were  "  for  infra  -  mammary  and  ovarian  paios 
with^  temporary  relief ;  for  insupportable  neuralgia  of  uterine  and 
ovarian  origin  with  similar  results,  &c."  Such  are  exactly  the  class 
of  uses  to  which  Dr.  Bennet  now  calls  attention.    The  first  instm- 


JStNkmta  AUiraeU  mkd  Seledlcm.  62ft 

■de  in  this  conntry  was  made  for  me  by  Mr.  Tlemann,  from 
el  brought  to  this  country  by  my  friend  Dr.  Barker,  and  the 
bber  syringe  then  first  used  is  a  great  improvement  over  the 
le.     The  canula  was  also  made  of  steel.     At  that  time  I  used 
>n  of  the  acetate  of  morphia  grs.  yiij.  ad  Sj.>  though  now  I 
use  Magendie's  Solution  made  without  acid, 
meeting  of  the  Medical  and  Surgical  Society  at  Dr.  Metcalfe's 
after,  I  showed  this  syringe,  and  expressed  my  conviction 
vould  soon  bo  the  pocket  companion  of  all  physicians.     And 
sir,  I  thought  that  our  public  use  of  it  in  Bellevue  Hospitil 
lany  years,  and  the  reiterated  expressions  of  approval   by  so 
f  our  profession  in  this  city,  had  removed  the  need  for  calling 
attention  here  to  the  plan  of  treatment, 
heartily  endorse  all  that  Dr.  Bennett  says  in  regard  to  the 
ness  and  efficacy  of  these  injections.     It  has  often  occurred  to 
)e  called  to  cases  of  dysmenorrhea  and  to  relieve  the  patient 
he  syringe  has  been  thoroughly  cleansed  and  replaced  in  the 
nd  1  have  very  often  thus  quieted  those  teasing  falpe  pains 
so  agitato  and  weary  patients  on  the  eve  of  confinement.     I 
ijccted   everywhere   over  the  surface  of  the  body  except  the 
lect,  genitals,  eye-lids,  ears,  and  scalp. 

some  years  back  I  have  ceased  to  endeavor,  as  a  rule,  to  inject 
rphine  in  the  neighborhooil  of  the  painful  part,  pieferring  to 
over  the  gluteal  mnscles  just  behind  the  crest  of  the  ilium, 
ic  tloating  ribs,  or  over  the  deltoid  in  the  order  named.  It  is 
desirable  to  so  inject  the  fluid  that  gravitation  will  assist  in 
ng  it,  as  some  drops  may  run  out  unless  yon  use  this  prccan- 
By  using  Magendie's  Solution  of  Morphine  (gr  xvj.  ad  Sj») 
rithont  acid,  the  amount  lequire^l  to  produce  an  eflfecl  is  much 
r  than  Dr.  Bennet  needs  ;  and  diminution  in  bulk  is  a  great 
ngi*,  and  diminiKhes  risk  of  subsequent  inflammation.  In  cases 
ccr,  or  other  hopeless  cases  where  we  can  do  nothing  but  pro- 
nthanasia,  I  instruct  some  nurse  or  member  of  the  family  in 
*  of  the  instrument,  and  make  them  procure  one  for  thcm^«elve8 

0  be  independent  of  me.     A  patient  of  Dr.  Van  Buren's,  whom 

1  saw,  had  morphine  injected  hypodcrmically  daily  for  about  a 
^hich  was  the  most  prolonged  use  tnat  I  have  known.     Some 
u^cated  by  it,  and  are  reluctant  to  return  to  the  remedy.     All 
ected  vcr}"  promptly.     It  is  desirable  to  be  careful  in  its  use 
the  kidneys  are  discaseil.     I  once  injected  fifteen  drops  (T  Ma* 
I'h  Solution  in  the  arm  of  a  gentleman  with  cardiac  hypertrophy, 
albuminuria  and  casts,  and  he  slept  all  that  night,  and  until 
^xt  evcTiing,  although  he  awoke  in  the  morning  after  the  injec- 
nite  rational,  and  could  be  awakened  readily  at  any  time  during 
y.     Still  his  susceptibility  showed  anotlicr  illustration  of  the 
of  the  law  that  opium  should  be  cautiously  used  in  these  cases, 
have  used  it  in  pregnant  women  who  were  the  subjects  of  albu- 
la.     Indeed,  it  has  never  caused  any  other  trouble  in  my  hands 
occasional  nausea  and  boils.     When  long  u.sed  over  the  ribs  the 
>ecome8  hard  and  drawn,  like  that  over  the  prize-fighter's  (Jaoe, 


624  JBdiiorial  AhtiracU  and  Seleetimu.  [October, 

from  condensation  of  the  areolar  tissne.  I  have  used  it  in  peritonitis, 
pneumonia,  plenrisy,  acute  rheumatism,  gout,  passage  of  renal  and 
biliary  calculi,  cystitis,  neuralgia,  restlessness,  and  insomniA  ;  or- 
ganic and  functional  diseases  of  the  heart,  lungs,  liver,  stomach, 
uterus,  and  ovaries  ;  delirium  tremens,  puerperal  mania,  and  convul- 
sions, as  well  as  in  other  cases  which  I  do  not  at  this  moment  recall. 
I  have  used  it  after  obstetric  operations  and  where  an  anodyne  was 
indicated,  while  there  was  also  much  nausea.  It  is  no  part  of  my 
purpose  to  write  an  elaborate  article  on  this  subject,  but  simply  to  aid 
in  calling  attention  to  a  method  of  practice  with  which  very  many  of 
us  are  familiar  ;  but  I  shouM  regret  to  leave  the  impression  that  my 
extended  use  of  the  hypodermic  syringe  makes  me  unmindfal  of  other 
modes  of  using  anodynes.  On  the  contrary,  not  a  day  of  my  life 
passes  without  my  being  called  on  to  prescribe  vaginal  or  rectal  sup- 
positories of  the  watery  extract  of  opium  or  morphine,  made  with  the 
butter  of  cocoa ;  or  to  give  Internally  morphine,  McMunn's  Elixir, 
Dover's  or  Tully's  Powder,  opium,  codeine,  or  chlorodyne. 

Indeed,  it  is  from  the  conviction  that  the  practice  of  medicine 
would  be  utterly  unsupportable  without  the  power  of  relieving  pain, 
that  I  have  again  recorded  my  testimony  in  favor  of  this  prompt, 
mild,  and  most  efficacious  plan  of  administering  anodynes,  and  para- 
mountly  morphine.  Yours,  Gso.  T.  £lliot,  Jr.,  M.D. 

5.  A  Case  of  Varicella  in  Advanced  Age.  By  Ghas.  H.  Hughes, 
Surgeon  1st  Inf.,  M.S.M.  All  medical  writers,  whom  the  profession 
accept  as  authorities,  are  agreed  as  to  the  period  of  life  when  individ- 
uals are  peculiarly  inimical  to  varicella.  Wood  speaks  of  it  as  being 
"  con6ned  almost  exclusively  to  children,  but  not  entirely  so,  **  and 
alludes  to  the  fact  that  •*  cases  have  been  observed  in  persons  of 
midddle  age.  *'  Watson  says,  **it  is  a  disorder  almost  peculiar  to 
infants  and  children  of  tender  years  ;  "  but  speaks  of  **  Millan  hav- 
ing described  one  unambiguous  example  of  It  in  a  gentleman  thirty 
years  old  ;  "  and  of  another  **  genuine  instance  "  seen  by  Dr.  Greg- 
ory at  the  small  pox  hospital,  (  London  ),  in  the  person  of  *•  an  adult 
female ;*'  but  I  have  met  with  no  allusion,  among  the  many  author- 
ities whom  I  have  consulted,  to  the  occurrence  of  this  disease  in  those 
advanced  beyond  the  period  of  middle  life.  The  case  I  have  to  record 
is  of  the  latter  kind. 

I  was    summoned  February  20th.   1858,  to  see  Mrs.  ,  living 

near  the  Big  Mound,  for  what  a  physician  (  who  had  previously  vis- 
ited her  and  declined  giving  her  farther  attention  ),  pronounced  a  case 
of  variola.     The  patient  yra^  fifty  -  nine  years  of  age,  of  Irish  extrac- 
tion, and  had  evidently  been,  as  she  stated,  well  inoculated  with  small 
pox  in  the  "  old  country.  '*     When  I  saw  her,  the  eruption  was  at  i\& 
height,  and,  what  is  m  )Mt  unusual  in  varicella,  more  copious  on  the 
face  than  elsewhere,  although  the  body  and  extremities  were  by  no 
means  free  from  it.     By  a  process    of  rubbing    the    vesicles   with  & 
piece  of  rough  flannel,  saturated  in  vinegar,  to  which  the  patient  re- 
sorted, **  for  the  purpose  of  relieving  the  itching,  '*  she  had  succeeded 
in  converting  many  of  the  vesicles    into  vusiulea  ;    it  is  not  strange, 


1864.J  JSdiiarial  AbstracU  and  Sd$dUmi.  625 

tbereibre,  that  tha  physiciiin  who  preceded  me,  io  the  examination  of 
the  case,  should  have  pronoimced  it  one  of  small  pox.  It  was  one  of 
those  cases  in  which  John  Thompson*  and  those  who  preceded  him 
in  the  assertion  that  ^*  varicella  is  only  a  modified  form  of  small  pox/' 
would  have  heen  justified  in  pronouncing  ii  variola  or  varioloid. 

I  am  free  to  confess,  myself,  that  had  I  made  only  a  cursory  exam- 
ination of  the  case,  and  had  not  learned  that  she  had  been  once  inoc- 
ulated, and  that  no  small  pox  epidemic  was  then  prevailing  in  the 
city,  I  should  have  fallen  into  the  same  error  in  diagnosis.  Not  only 
were  the  vesicles  converted  into  pustules,  but  some  of  them  were  um- 
bilicated.  The  fever  came  on  with  a  chill,  and  the  eruption  was  more 
than  a  week  in  disappearing.  There  was  also  great  headache,  slight 
vomiting,  constipation,  foul  tongue,  suffusion  of  the  eyes,  soreness 
of  the  throat  and  swelling  of  the  face.  The  patient  kept  her  bed  the 
greater  part  of  two  days,  «nd  was  irritated  and  feverish  from  the 
eruption. 

The  eruption  was  ceilainly  copious  enoufirh  to  entitle  it  to  be  called 
variola,  if  it  had  been  of  that  nature  at  all.  Thompson  would  not 
have  hesitated  to  pronounce  it  small  pox,  but  I  saw  the  case  through, 
and  its  sequelae  and  the  treatment  establish  it  as  simply  varicella, 
aggravated  by  friction  of  the  vesicles. 

Against  the  gantric  irritability,  array  the  fact  that  lumbar  pain  was 
entirely  absent ;  against  the  presence  of  umbilicaled  vesicles,  array  the 
fact  that  the  globular  and  conoidal  predominated  ;  consider  the  short 
duration  of  the  disease,  and  the  previous  inoculation  of  the  patient, 
and  it  would  be  difficult  to  call  it  variola  or  varioloid  ;  and  if  wo  take 
into  consideration  the  other  facts,  namely,  that  the  peculiar  odor  of 
small  pox  patients  was  absent,  that  no  small  pox  epidemic  was  ex- 
isting at  the  time  in  the  neighborhood  or  city,  that  none  of  the  many 
(  vaccinated  and  unprotected  ),  who  had  access  to  the  patient,  con- 
tracted either  modifie<l  or  unmodified  small  pox,  while  several  cases 
of  chicken  pox  in  children  of  the  neighborhood  could  be  traced  to  no 
other  source  of  contagion,  we  are  compelled  to  conclude  that  it  was 
only  an  anomalous  case  of  varicella.  The  treatment  confirms  ttie 
conclusion,  for  only  aromatic  sulphuric  acid  and  epsom  salts  were 
given  internally,  while  the  face  was  smeared  only  with  lard  until  the 
case  got  well. 

6.  Cases  showing  (he  Efficacy  of  the  Perchloride  qf  Iron  in  Croup. 
Case  I.  Komajou's  daughter,  aged  six  yeai^,  taken  with  croup.  A 
blihter  ib  applied  to  the  neck  and  between  the  shoulders  ;  frequent 
doses  of  tartar  emetic  administered  ;  at  first  with  benefit,  when,  on 
the  fouith  day,  the  voice  becomes  more  croupal  than  ever  ;  the  emetic 
gradually  loses  its  efficacy.  A  mixture  of  the  perchloride  of  iron  is 
then  begun,  in  the  proportion  of  fifteen  drops  to  four  ounces  of  water  ; 
this  to  be  administered  internally,  in  tablespoontul  doses,  every  fivo 
or  ten  minntes. 

At  the  time  the  little  patient  began  this  remedy,  the  disease  had 
reached  its  height,  and  there  was  threatened  asphyxia.  Afler  a  few 
tablespoonsfoly  the  symptoms  had  amended ;  attacks  of  soffocationy 


626  EdUorial  AhttracU  and  SdeeHoiu  [October, 

however,  return  occasionally.  The  mixtore  is  continued,  when,  on 
the  next  day,  the  child  is  seized  with  a  convnlsire  congh,  and  expec- 
torates a  piece  of  false  membrane  presenting  a  perfect  monld  of  the 
larynx  ;  it  is  very  dense  and  thick.  From  this  moment,  the  child 
recovered  rapidly,  and  is  to-day  in  perfect  health. 

Case  II.  A  little  child  of  A.  Charpentier.  Oronpal  voice  ;  dysp- 
noea, aphonia  ;  not  mach  fever  ;  no  psendo  exudations  detected  on  the 
tonsils.  An  emetic  and  vesication  of  the  nape  of  the  neck  ordered 
—  the  emetic  to  be  repeated  occasionally.  Towards  night,  the  child 
much  better,  and  continues  so  until  the  fourth  day,  when  the  voice 
becomes  strongly  cronpal,  the  tartar  emetic,  although  frequently  re- 
peated, having  lost  its  vomitive  power  —  an  event  very  frequent  in 
croup.  A  dose  of  the  perchloride  of  iron  mixture  ordered ;  but  the 
young  patient  has  a  great  aversion  to  the  remedy,  which  is  adminis- 
tered only  in  a  few-drop  doses  by  weak  ^parents.  The  cough  and 
dyspnoea  are  extreme  ;  death  occurs  on  the  following  day. 

Cask  III.  Greorge  Gkllier,  aged  5  years.  Unwell  for  a  few  days  ; 
presents  the  croupal  voice  and  diphtheric  patches  on  each  tonsil. 
Sundry  gargles  had  been  tried  without  benefit ;  cauterization  ;  an 
emetic  of  ipecac ;  the  child  vomits,  but  the  pseudo  -  membranous 
patches  are  reproduced.  On  the  next  day,  a  solution  of  tartar  emetic 
is  given,  also  insufflation  of  powdered  alum  on  the  tonsils,  and  a 
chlorate  of  potash  mixture ;  cauterization.  The  day  following,  every 
symptom  has  become  aggravated ;  cough,  dyspnoea,  aphonia,  expec- 
toration of  false  membranes. 

In  presence  of  this  array  of  formidable  symptoms,  and  considering 
the  inefficiency  of  the  treatment  hitherto  instituted,  the  perchloride 
of  iron  in  the  above  formula  is  tried.  The  next  day,  the  voice  is 
clearer,  the  pharyngeal  false  membranes  gradually  disappear,  and  the 
remedy  being  persevered  in  four  or  five  days  longer,  the  cure  is  com- 
plete. The  remedy  is,  however,  continued  at  lengthened  intervals, 
for  a  few  days. 

Case  IV.  Newton  D,.  a  young  boy.  Sick  twenty  four  hours  with 
severe  croup.  From  the  street  the  sibilous  voice  could  be  heard. 
The  perchloride  of  iron  is  immediately  given.  In  two  hours,  symp- 
toms better,  expulses  shreds  of  false  membranes,  but  soon  the  symp- 
toms become  worse  again,  and  in  the  evening  he  dies  in  a  fit  of  suffo- 
cation. 

Case  Y.  Felix  Lambert,  a^ed  ten  years.  Hoarse  for  one  or  two 
days ;  presents  heat  of  skin,  fever,  pearly  false  membranes  on  both 
tonsils,  and  strongly  marked  croupal  cough.  Mixture  of  perchloride 
of  iron  ordered,  in  tablespoonful  doses,  every  five  minutes.  The  next 
day,  the  voice  and  cough  of  a  better  character  ;  the  latter  \f  softer 
and  easier,  as  if  the  false  membranes  had  softened  and  changed  their 
positions.  In  order  to  facilitate  their  expulsion,  an  emetic  of  ipecac 
is  ordered.  Child  vomits,  but  does  not  throw  up  any  false  membrane. 
The  perchloride  is  resumed  every  five  minutes.  On  the  tnird  day,  in 
a  fit  of  coughing,  the  child  expectorates  several  shreds  of  false  mem- 
brane, of  a  rosy  white,  elastic,  and  in  the  shape  of  a  ribbon,  fringed 
at  the  edges.     One  of  these  shreds  was  one  inch  long,  and  one  -  third 


1864.]  Editorial  Abairacti  and  StbcUotu.  627 

of  an  inch  broad.  After  thiH,  the  child  gradnallv  began  to  recover, 
although  for  four  or  five  days  he  continued  to  expel  fragments  of  false 
membranes,  thirty  or  more  in  all.  The  remedy  was  continued  at 
more  distant  intervals  for  several  days  afterwards.  The  recovery  was 
complete. 

Casb  Vr.  Barbnd,  age  eight  years.  Parents  for  a  few  days  think 
he  has  taken  a  slight  cold,  and  a  physician  is  sent  for  when  the  dis- 
ease had  already  made  considerable  progress.  The  above  treatment 
tried,  bnt  patient  suffocated  in  his  bed  that  very  evening. 

Casf  VII.  Barbnd,  a  brother  of  the  above,  and  aged  thirteen 
years,  taken  subsequently.  This  time,  the  parents,  taught  by  expe- 
rience, send  for  tbe  physician  as  soon  as  they  notice  the  hoarseness 
and  croupal  cough.  The  child  presents  also  diphtheric  patches  on 
the  tonsils.  The  above  treatment,  in  the  same  doses,  is  begun.  The 
intervals  are  lengthened,  (every  ten  minutes).  The  disease  then 
grows  worse.  The  doses  at  intervals  of  hve  minutes  are  again  begun. 
False  membra^  es,  well  organized  and  in  shreds,  are  expelled  for  a 
week.  This  patient  took  in  all  900  drops  of  the  liquid  perchloride 
of  iron,  diluted  as  above  stated,"-  (  15  drops  to  4  oz.  ),  and  recovered 
entirely. 

Case  YIII.  A  third  child  of  the  same  family,  aged  four  years, 
during  the  illness  of  her  brother,  is  taken  with  croup,  and  for  three 
days,  presents  all  the  symptoms  characteristic  of  the  disease.  She 
was  very  reluctaut  in  taking  the  remetly,  and  the  termination  was 
fatal. 

Cask  IX.  Barthey,  aged  twenty  months,  and  very  well  constitut- 
ed. Another  child  of  the  same  family  had  already  dieil  of  croup. 
The  same  treatment  begun  and  continued  with  good  results,  until 
night,  when,  from  some  misunderstanding,  the  mixture  run  out  and 
was  not  renewed.  The  child  died  in  tho  night.  Although  the  per- 
chloride of  iron  acts  quickly,  it  is  a  modifier  of  the  blood,  and  some 
time  must  be  allowed  tor  its  action  on  the  economy. 

In  order  to  obtain  success  by  the  above  medication,  it  should  be 
persevered  in  with  regularity,  and  according  to  the  doses  and  inter- 
vals above  mentioned.  The  solution  of  perchloride  of  iron  used  in 
the  above  cases,  was  the  concentrated  solution  introduced  by  Dr. 
Pravaz.  The  medicine  thus  administered  proiluced  no  bad  effects  on 
the  stomach :  it  caused  an  increase  of  of  appetite.  Black  stools  were 
proiiuced,  but  no  intestinal  irritation. 

To  the  above  cases,  related  by  Dr.  G.  Dsx,  may  be  added  another, 
reported  by  Dr.  Dandon,  who,  in  addition  to  the  internal  administra- 
tion of  the  above  solution,  swabbed  very  freely  the  false  membranes 
with  a  probang  soaked  in  the  pure  solution  of  the  perchloride  of  iron. 
This  was  the  case  of  a  child  five  years  old,  with  marked  pseudo- 
membraneous  croup.  He  made  a  good  recovery.  —  Revue  de  TKera- 
peuttque  Med,  Chirurg.  —  St.  Louie  Med,  and  Surg,  Journal, 

7.  Two  Caeee  qf  S^philie,  showing  prohnged  Incubation  period  and 
communication  of  the  disease  by  Secondary  contagion.  By  Berkely 
Hill,  Esq.,  F.R.C.S.,  Assistant  Surgeon  to  University  College  Hos* 


628  JUHaria  AhttroeU  and  Sdeetioim.  [Octobw, 

pital.  On  the  5th  of  March,  1864,  John  J-~— ,  aged  diirty'thnep 
oetler,  applied,  among  my  ont  •  patients,  for  relief  for  a  painfnl  afieo- 
tion  of  the  right  eye.  He  said  that  aboat  fourteen  days  before  Christ- 
mas last,  while  fighting,  he  reeeived  a  blow  on  the  right  eye  and  cheek* 
which  drew  blood  ;  his  antagonist  sncked  the  wonnds  for  him,  after 
which  they  quickly  healed,  and.  as  far  as  he  knew,  the  marks  also 
disappeared.  He  experienced  no  further  inconvenience  until  the  lat- 
ter end  of  January,  when  he  observed  some  pimples  appearing  where 
he  had  been  hit,  and  presently  some  scabs  fell  off,  leaving  a  reddish 
pimple  beneath  each ;  but  there  was  no  ulcer,  nor  any  discharge  from 
these  pimples.  His  eye  next  became  troublesome,  growing  red  and 
bloodshot,  and  smarting  occasionally  ;  and  on  Feb.  1st  he  applied  for 
some  eye- water,  with  which  he  bathed  his  eye,  bnt  without  improve* 
ment.  Finding  the  eye- water  of  no  service,  on  the  5th  of  March  be 
came  to  me,  anxioas  for  other  treatment.  1  examined  him,  and  found 
the  following  state  of  things :  At  the  outer  comer  of  the  right  eye 
was  an  oval,  coppery  patch,  slightly  elevated  from  the  skin  around 
it,  especially  so  at  the  edges  ;  it  was  smooth  and  dry.  There  was  also 
about  the  middle  of  the  margin  of  the  lower  eye-lid  another  smaller 
patch,  which  desquamated  freely,  andwhenee  the  eye  lashes  had  drop- 
ped out.  Two  more  similar  patches  existed  on  the  cheek,  over  the 
malar  bone.  All  these  tubercles  were  indurated,  and  surrounded  by 
an  areola  of  coppery  tint.  The  conjunctival  membrane  of  the  right 
eye  was  congested  and  the  palpebral  part  thickened  ;  whence  the  dis- 
comfort for  which  relief  was  sought.  The  lymphatic  glands  beneath 
the  jaw  and  in  the  neck  on  that  side  were  severally  enlarged,  but  pain- 
less. A  coppeiy,  roseolous  rash  extended  over  the  forehead  and  trunk. 
The  penis  was  quite  free  from  sores  or  cicatrices  of  any  kind,  and 
there  was  no  history  of  any.  The  inguinal  lymphatic  glands  were 
also  quite  normal  ;  likewise  those  of  the  body  generally,  with  the 
above-mentioned  exception  of  the  sub-maxillary  ones.  Though  he 
complained  of  sore  throat  when  questioned,  the  soft  palate  and  uvula 
were  only  somewhat  congested.  He  was  ordere<l  to  take  four  grains 
of  blue  pill  with  a  little  opium  twice  daily,  and  to  attend  frequently 
at  the  hospital. 

On  the  i2th  of  Harch  I  saw  him  again.  He  was  then  under  the 
influence  of  mercury.  His  gums  were  swollen,  his  breath  was  fetid, 
and  he  had  a  bad  tante  in  his  mouth.  His  throat  was  not  sore.  The 
areolae  round  the  hardened  tubercles  less  spread  and  paler  ;  the  roseola 
much  fainter ;  more  of  his  eye  lashes  had  fallen.  To  continue  his 
pill. 

March  19th.  —  Induration  of  the  tubercles  less  defined,  and  the 
glands  under  the  jaw  smaller,  lie  looked  paler,  and  felt  weaker  than 
before  —  probably  from  the  combined  effects  of  scanty  diet  witli  mer- 
curial ization,  as  he  had  been  out  of  work  that  week.  I  ordei-ed  him 
to  take  a  little  quininc-and-iron.  and  to  take  his  pill  once  a  day  only. 

30th.  —  The  glands  under  the  neck  were  less  enlarged,  the  coppery 
tint  of  the  patches  oa  the  face  much  fainter,  and  the  induration  with- 
ering. The  throat  still  not  sore ;  and  no  other  ernpUon  visible  on  the 
body. 


1864.]  Ediiarial  AhUracU  mnd  SiUdkmt.     I  629 

April  20th.  —  The  coppery  discoloration  remained  in  two  places 
only,  and  waft  of  very  small  extent.  The  induration  of  the  tubercles 
was  perceptible  in  one  cicatrix  only.  The  eye  was  quite  well,  except 
that  the  lashes  had  not  grown  again.  The  lymphatic  glands  were  of 
their  usual  size,  and  the  man  felt  quite  well.  Having  found  work  in 
the  country,  he  had  been  nnable  to  show  himself  at  the  hospital,  and 
had  not  taken  medicine  for  a  fortnight.  He  wao  ordered  to  continue 
his  pill  once  every  other  day  for  a  little  time  longer. 

On  the  26lh  of  March  the  patient  led  in  his  late  antagonist  for  ex- 
amination, of  whose  condition  I  took  the  following  note  :  F  M , 

aged  thirty-one,  a  wheelwright,  of  intemperate  habits.     He  stated 

that  when  he  sucked  John  J 's  eye  he  bad  a  sore  at  the  corner  of 

his  mouth,  (  where  there  is  one  still  ),  and  that  he  had  some  sores  on 
his  penis  at  that  time,  which  had  existed  for  six  weeks  or  two  months 

beforv  the  time  at  which  he  gave  the  blow  to  John  J ;  but  they 

did  not  trouble  him  much.  However,  he  recollects  that  the  lumps 
■ow  in  his  groin  were  there  then,  and  that  they  were  rather  tender. 
He  has  never  observed  any  rash  on  his  skin  or  NoreuesH  in  his  throat, 
and  has  felt  very  well  ever  since.  On  examination,  the  sore  proves 
to  be  a  fissure  at  the  left  angle  of  the  mouth,  wiih  one  or  two  enlarg- 
ed papillae  round  it,  which  are  nioint  and  scaling,  not  possessing  any 
induration,  however.  There  is  no  ulceration  <>u  the  muconn  surfaces 
of  the  mouth  and  fauces  ;  the  lymphatic  glands  are  not  enlarged  un- 
der the  jaw,  or  at  the  back  of  the  neck  The  body  is  free  from  erup- 
tion of  any  kind,  save  that  one  or  two  acne  spots  on  his  shouUler 
hsve  a  coppery  tint.  On  the  penis,  behind  the  corona  glandis,  are 
two  scars,  with  well  marked  induration  —  the  sites,  the  patient  says, 
of  the  sores  he  had  last  December.  The  lymphatic  glands  in  both 
eroins  are  plainly  enlarged,  but  not  at  all  tender,  and  the  skin  cover- 
ing them  is  of  its  usual  color.  He  has  never  taken  any  medicine  for 
his  disease  ;  and  the  only  inconvenience  of  which  he  has  ben  con- 
scious is  the  persistent  sore  on  the  month.  I  orderei  him  a  small 
quantity  of  bichloride  of  mercury,  with  iodide  of  potassium.  This 
treatment  has  been  pursued  during  the  month  of  April,  and  the  sore 
on  his  mouth  has  healed.  The  induration  has  much  diminished  on 
the  |>enis,  and  the  patient  has  preserved  his  good  health. 

These  cases  show  very  clearly  :  Piist.  That  there  exists  an  incuba- 
tion period  in  syphilis  between  the  moment  of  inoculation  and  the 
manife^tatioa  of  its  effects,  whi<.'h  has  a  duration  not  very  exactly 
known.  In  the  cases  of  V.  Barensprnng,  where  inoculation  was 
purpo8<>ly  practised,  the  incubation  laste  1  twenty-eight  and  twenty- 
oine  days  ;  Sigmund  and  Rollet  both  estimated  it  at  about  three 
weeks,  with  extremes  of  fourteen  and  forty-two  days;  Hnnter  relates 
itn  instance  of  two  months  intervening  between  the  time  of  contagion 
And  the  appearance  of  the  disease  ;  and  Aime  Martin,  in  his  thesis 
for  1802,  iiientiona  the  case  of  a  girl  incarcerated  in  the  fit.  Laeare 
Pri>on.  in  close  confinement  on  the  15th  July,  !561,  on  whose  labium 
m  syphilitic  sore  made  its  appearance  on  the  25th  September  following 
—  a  peri<xi  of  seclusion  of  seventy  -  two  days.  The  case  I  am  reUi- 
iiig»  had  a  long  period  of  incobation,  about  five  weeks  or  rathsr  moce, 


680  Md&orUt  AhUradi  and  Selmsfymi.  [October, 

as  nearly  as  can  be  estimated,  bnt  not  of  an  extreme  length  if  com- 
pared with  those  related  bj  other  observers.  Secondly.  The  kind  of 
primary  lesion  produced  by  the  disease  when  other  disturbing  causes 
are  absent  is  here  well  shown.  The  indurated  tnbercles  grew  at  the 
point  of  inoculation,  and  never  ulcerated,  perhaps  because  they  were 
free  from  irritation,  resulting  from  the  moistening  by  secretions,  urine, 
Ac. ;  though  I  do  not  mean  that  such  irritation  is  in  all  cases  the 
cause  of  ulceration  in  primary  syphilitic  affections,  but  that  these  are 
probable  causes  of  it  in  many  instances.  These  papules  or  tubercles 
—  for  some  resembled  one  and  some  the  other  —  had  been  slowly  de- 
veloping  themselves  for  six  or  seven  weeks,  and  had  become  indurated 
to  such  an  extent  that  one  was  as  large  as  a  sixpence  ;  yet  their  aur- 
fftce  was  unbroken  in  all  that  time.  In  this  case  at  least  the  primary 
affection  bore  no  resemblance  to  a  Hnnterian  chancre.  Thirdly.  The 
disease  was  communicated  by  contagion  with  secondary  secretions  — 
namely,  the  fluid  exuding  from  the  sore  at  the  angle  of  the  second 
patient's  mouth  was  inoculated  into  the  open  wounds  of  the  cheek  of 
the  first  patient ;  and  that  this  sore  was  a  secondary  affection  is  shown 
by  the  pre-existence  of  the  primary  disease  in  another  part  of  the 
man's  body,  which,  since  we  can  not  produce  a  primary  lesion  of 
syphilis  on  a  person  already  subject  to  the  disease,  prevents  the  pos- 
sibility of  the  sore  at  the  mouth  being  one. 

I  have  brought  forward  these  cases  for  the  readers  of  Th$  Lanuit 
because  they  are  examples  of  an  usual  mode  of  communicating  the 
disease  —  namely,  by  suction  of  open  wounds,  though  a  precisely 
similar  means  of  contamination  takes  place  when  nurses  are  inoculat- 
ed by  their  foster  children,  in  which  cases  the  primary  lesion  is  a 
chancre  on  the  breast. — London  Lancft, 

8.  Podophyllin  in  Comtipation. — In  the  Medical  TiTnes  and  Gazette 
we  find  the  following  observations  by.  Dr.  Clark  in  reflference  to  this 
resinoid.  He  first  attempts  to  induce  regularity  of  the  bowels  by  suf- 
ficient use  of  fluids,  daily  exercise,  kneading  and  friction  of  the  abdo- 
men, and  due  solicitation  of  nature  at  stated  intervals.  When  all 
these  have  proved  insufficient,  resorcc  must  be  had  to  drugs.  He 
say:^  :  '*  The  drug  best  fitted  for  the  purpose  is  that  which  will  act 
without  irritation,  slowly,  moderately,  and  by  the  production  of  a 
formed  8tool,  after  the  manner  of  nature.  Tbe  <»l»jections  to  ordinary 
laxatives  are  almost  innumerable ;  sometimes  they  act  too  freely  to 
permit  of  subsequent  spontaneous  regularity  fi>r  some  time,  distension 
being  required  to  excite  the  contractility  of  the  bowels  ;  and  at  other 
times  the  bowels  are  teased  by  frequent  ineffective  actions,  and  rau- 
cous discharges  are  induced.  In  some  cases  the  muscular  contrac- 
tility is  exhausted,  and  the  patient  is  afHicted  with  flatulent  disten- 
sions of  the  bowels.  In  other  cases  the  head  is  distracted  with  un- 
easy sensations  or  there  is  a  general  nervous  restle^sne8s,  for  relief 
from  which  the  patient  flies  to  larger  doses  of  more  purgatives,  till  at 
last  life  befjomes  little  less  than  a  continuous  suflfering,  complaint  and 
misery.  Now  there  is  in  my  experience  no  single  remedy  for  constipa- 
tion so  free  from  these  objections  as  podophyllin.     It  is  not  a  specific 


1864.]  JBdUari^l  AbftracU  and  SeUdum.  631 

for  constipation,  and  it  is  not  in  all  cases  free  from  these  objections  at- 
tached to  other  remedies  But  in  the  great  majority  of  cases  of  sim- 
ple constipation,  it  fulfills  the  condition  required  of  a  safe  and  effecta- 
al  remedy,  by  operating  slowly,  easily,  and  after  the  manner  of  nature. 
"Podophylliu  is  an  amorphous,  rosinoid  powder,  obtained  by  evap- 
oration from  an  alcoholic  solution  of  the  May  apple  (Podophyllin pel- 
tatum.)  In  America  it  is  used  in  ten  ^rain  doses  as  a  cathartic,  of 
similar  character  to  the  resin  of  jalap  ;  but  for  use  as  a  natural  laxa- 
tive, the  maximum  dose  is  one  grain.  If  more  than  this  is  given  it 
produces  griping  and  loose  stools.  For  most  persons  a  grain  is  too 
large  a  dose.  It  is  better  to  begin  with  half-grain  doses,  made  into 
pills  with  extract  of  taraxacum,  which  must  be  taken  during  break- 
fast, that  it  may  operate  next  morning  after  tliat  meal.  For  the  first 
few  days,  the  operation  may  be  accompanied  by  a  little  griping  and 
by  uniform  stooU.  Should  these  continue  to  the  fourth  day,  admin- 
ister only  quarter  grain  doses,  and  combine  them  with  an  equal  quan- 
tity of  ipecacuanha.  If  after  the  drug  does  not  operate  in  the  manner 
described,  it  is  not  likely  to  prove  successful,  and  had  better  be  re- 
linquished. When  the  right  dose  is  determined  \t&  use  m>ty  be  con- 
tinued without  fear  of  injurious  consequences  ;  and  instead  of  requir- 
ing to  be  increased,  may  after  a  time  be  diminished  without  effecting 
the  success  of  its  operation." — Mei.  and  Surg,  Reporter, 

9.  Evidence  against  the  InUrnal  use  of  Mercury  in  Syphilis  and  other 
Diseases. — In  a  paper  read  at  the  Uarveian  Society  of  London,  Dr. 
Drysdule  has  collected  a  great  mass  of  evidence  against  the  internal 
administration  of  mercury,  and  his  statintics  and  conclusions  are 
brought  forward  to  support  the  assertion  that  this  metal  does  more 
barm  than  good  to  the  patients  for  whom  it  is  prescribed.  By  quo- 
tations from  Skey,  Desruelles,  Copeland,  and  others,  he  shows  that 
mercury  possesses  the  physiogical  property,  when  given  to  dogs,  of 
producing  caries  of  bones  and  complete  degradation  of  the  animal 
frame.  Dr.  Drysdalc  contends  that  the  only  property  which  mercury 
is  proved  to  posses  is  its  power  as  a  purge,  but  that  it  is  a  bad  purge  ; 
and  although  it  is  called  a  cholagogue,  recent  experiments  have 
Hhowii  that  it  actually  diminishes  the  secretion  of  bile.  In  iritis, 
mercury  has  biH?n  shown  to  be  ukcIcss  and  probably  injurious  by  Car- 
miohacl.  Dr.  Hughes  Bennett,  and  others.  Dr.  11.  Bennett  also  con- 
demns the  use  of  mercury  in  infia-r^matory  disea^ies  of  the  lungs,  and 
Dr.  WaKhe  entertains  the  same  views.  With  regard  to  syphilis,  in 
which  mercury  has  long  been  considered  a  6|)ecific,  Dr.  Drysdale 
qnotcs  Dr.  Fergusson,  who  showed  in  his  experience  from  1812  to 
1846,  how  many  thousands  of  the  British  army  had  recovered  from 
primary  and  secondary  syphilis  without  a  particle  of  mercury  ;  aud  on 
the  other  hand,  how  the  British  army  suffered  in  the  Peninsula  from 
the  mercurial  treatment.  Mr.  Guthrie  had  declaied  that  all  sores  on 
the  penis,  whether  indurated  or  not,  will  recover  perfectly  under  rest, 
diet,  and  cleanliness,  without  mercury.  Out  of  407  cases  treated  by 
Hennen,  iritis  occurred  only  in  one ;  in  1818,  Dr.  John  Thomson  had 
treated  a  largo  number  of  troops  in  Edinburgh  for  venereal  dieeaee 


1864.]  Bikonmt  AhstraOi  mtd  Sdmikm.  688 

12.  Is  Ovariotomi^  Justifiable  f — Ih  the  JSefiior  of  the  American  Medical 
T^mes  :  —  Sir  —  Tbe  reasons  oflfered  by  Professor  Peaslee,  in  a  recerAt 
nnmbcr  of  yo^r  journal,  in  regard  to  the  question,  "  whether  ovariot- 
omy  ofigbt  to  be  recognised  as  a  legitimate  surgical  operation,  *'  do 
not»  as  it  seens  to  me,  cover  the  whole  gronnd.  The  question  is  by 
no  means  wholly  a  etattttical  one,  as  be  seems  to  take  for  granted.  It 
18  one  in  which  the  heart  and  comscience  are  as  much,  if  not  more, 
inteieeted  than  the  head. 

We  all  know  that  onr  great  master  in  surgery,  Mott,  has  never 
performed  ovariotomy.  Have  tbe  advocates  for  this  operation  ever 
inqnired  why  he  has  not  ?  Does  any  one  suppose  he  is  ignorant  of 
ovarian  statistics  ?  Or  that  Professors  Meigs,  Mutter.  Liston, 
Donean,  the  French  Academy  of  Medicine,  as  well  as  nearly  all  the 
great  surgeons  of  the  age  in  all  countries,  are  also  ignorant  on  this 
point,  and  bence  have  regarded  ovariotomy  as  unjustifiable  ?  Did 
statistics  show  even  more  favorable  results  than  they  do,  there  is  no 
reason  to  bupposo  that  they  would  regard  the  operation  in  any  differ- 
ent light.  Onr  surgeons  do  not  decline  thin  operation  because  it  is 
diflicult,  or  requires  any  particular  skjU  or  anatomical  knowledge;  on 
tbe  contrary,  it  is  one  of  the  simplest  in  all  surgery*  But  they  are 
unwilling  to  be  instrumental  in  shortening  human  life,  when  there 
seems  to  be  no  evident  necessity  of  taking  such  a  risk ;  they  will  not 
endanger  their  peace  of  conscience  by  undertaking  a  surgical  experi- 
ment where  a  fatal  result  is  as  one  in  three  ;  when,  without  such 
experiments,  the  patient  may  perhaps  live  for  years  in  comparative 
comfort,  and  possibly  recover.  They  do  not  think  it  right  to  frighten 
females  afflicted  with  ovarian  disease  by  predicting  a  fatal  result  with- 
out an  operation,  and  that  at  no  distant  period  ;  and  then  try  to  quiet 
their  own  consciences  by  leaving  it  entirely  to  said  females  to  decide 
for  iberaselves  whether  they  will  submit  to  an  operation  or  not.  I 
have  never  had  the  hardihood  to  perform   ovariotomy  ;    and  I  shall 

always  have  a  higher  opinion  of  the  late  Professor  ,  who,  after 

o|>«fuing  the  abdomen  of  a  female  afflicted  with  an  ovarian  tumor, 
immediately  closed  it  without  an  attempt  to  finish  the  operation,  pre- 
viouhly  saying  to  those  present  that,  if  there  was  any  surgeon  in  the 
room  who  would  like  to  finish  the  operation,  he  would  be  glad  to 
cotieent  to  his  doing  so.  This  female  lived  fifteen  years  after  in  the 
eDJoyment  of  very  comfortable  health.  But  the  professor  never  made 
another  attempt  at  the  same  operation,  and  always  condemned  it  m 
bis  lectnies. 

I  may  further  urge  in  my  own  behalf,  as  well  as  that  of  my  surgi- 
cal brethren  generally :  —  1st.  That  the  diagnosis  in  a  majority  of 
cm^es  of  ovanan  disease  is  very  obscure,  and  that  the  prognosis  is  to 
the  same  extent  doubtful,  if  not  unfavorable.  2d.  That  many  females 
Carry  these  tnmors  throngh  a  long  life  with  comparatively  little  incon- 
venienoe  ;  that  in  many  cases  they  actually  diminish  in  size,  while 
llie  inconveniences  attending  them  of\en  nearly  disappear.  Sd.  That 
the  moat  favorable  statistics  show  that  nothing  is  gained  on  the  whole 
ms  regarda  the  prolongation  of  life  by  the  operation  ;  for  it  is  found 
thsty  taking  an  equal  number  of  females  affected  with  ovarian  tumova 


684  BtOmta  Ahs^raeU  and  StUcUomi.  [October. 

of  equal  ages,  and  under  as  nearly  as  possible  similar  oireomstanoat, 
the  average  duration  oj  lift  wiil  he  greater  in  thoee  an  whom  tke  cpere- 
tion  has  not  been  performed  than  in  those  who  haee  en^mitted  lo  d.  80 
that  statistics^  in  fact,  condemn  the  operation  as  nnjosiifiable.  4tL 
In  all  the  other  great  operations  the  sorgeon  has  no  misgivings ;  k 
is  laid,  as  it  were,  under  duress,  as  Jb'rofessor  Meigs  wonld  saj,  to 
operate  if  circomstances  required^  and  he  has  no  severe  qualms  d 
conscience  should  the  case  prove  afterwards  fatal.  6.  Far  ochsrwisB, 
however,  must  it  be  with  every  properly  oonstitnted  mind  when  t 
fatal  result  attends  an  operation  regarded  as  wholly  unjustifiable  bj 
the  highest  authorities  in  surgery,  and  by  nine-tenUis  of  the  profsf* 
sion  generally.  6th.  From*  what  has  been  ofiered,  it  may  safely  sod 
justly  be  inferred,  that  otr  principal  surgeons  do  not  envy  the  profei- 
sional  reputation  acquired  by  the  operation  in  queation ;  Uiey  do 
theiDsolves  honor  by  showing  that  they  nave  studied  ethics  in  a  wisff 
school,  and  that  they  prefer  peace  of  mind  and  a  g^ood  conscienoe  to 
transient  notoriety  and  pecuniary  rewards.  P. 

13.  At  a  recent  meeting  of  the  Chicago  Medical  Society,  Dr.  Bartlett 
presented  a  means  of  using  chloroform,  when  its  application  mast  of 
necessity  be  frequent  or  immediate,  as  in  convulsionSp  hooping  coogli, 
neuralgia,  labor,  etc.  He  recommended  it  also  as  a  matter  of  econo* 
my.  By  its  use  the  chamber  of  the  patient  is  kept  comparatively  btb 
from  odor  of  chloroform,  to  many  disagreeable  or  sickening. 

Into  a  fonr-onnce  gallipot,  Dr.  B.  fits  a  cup- shaped  sponge,  retaiB- 
ing  it  in  place  by  a  transverse  stay  of  wood.  The  anesthetic  being 
poured  upon  the  sponge,  the  pot  is  placed  inverted  in  a  saucer  cootsin* 
ing  a  little  water  (or  mercury).  The  tention  of  chloroform  vapor  not 
being  great  and  it  being  spaiingly  solnble  in  water,  but  litile  is  lost. 
The  sponge  may  be  successfully  used  hours  after  the  pouring  on  of 
the  anaesthetic. 


OPHTHALMOLOGICAL, 


1 4.  Unusual  form  of  Albinism. — {KUn  MonaisU.f  Augenh.,  1. 516). 
—  A  lady  of  45  consulted  Dr.  Liebreich  for  an  affection  of  theeyo: 
he  was  siruck  with  the  intensly  red  glow  of  the  pupils  when  she  en- 
tered the  room.  When  the  eye  was  illuminated  by  the  ophthalmo- 
scope, at  the  first  glance  the  pupils  only  appeared  to  be  red  ;  further 
examination,  however,  proved  that  the  iris  also  was  transparent,  as  io 
an  ordinary  albino  ,*  though  owing  to  its  being  seen  by  both  reflected 
and  transmitted  light,  the  red  from  the  fundus  admingled  with  tbe 
brown  hue  of  the  anterior  surface.  The  degree  of  transparency  oi  the 
iris  may  be  best  recognized  by  using  only  transmitted  light ;  thus  br 
throwing  the  rays  converging  from  a  convex  lens  on  the  outer  part  01 
the  sclerotic,  while  the  eye  is  turned  a  little  inward.  Thus  in  the 
present  case,  just  as  in  ordinary  albinos,  not  only  the  pupil  bat  the 
whole  of  the  cornea  appeared  of  a  brilliant  red  ;  by  throwing  the  apex 


1864.]  Sdltorial  Absiraeit  and  SeUdUmi.  685 

of  tbe  iDminons  cone  alternate! j  on  to  the  anterior  snrface  of  the  iris 
and  on  to  the  sclera,  and  thns  examining  only  by  reflected  or  only  by 
transmitted  light,  it  became  clear  that  the  posterior  pigment-layer,  the 
epithelium  of  the  iris  contained  no  pigment,  whilst  the  stroma  con- 
tained an  approximately  normal  amount.  In  the  latter  respect  the 
present  case  diflfers  from  the  ordinary  albino,  where  the  stroma  of  the 
iris  is  also  free  from  pigment,  and  hence  appears  white  by  reflected 
light.  The  epithelium  ^f  the  choroid  contained  no  pigment,  and  the 
stroma  very  little,  so  that  the  choroidal  vessels  could  be  seen  with 
great  clearness ;  had  there  not  been  slight  nystagmus,  it  would  cer- 
tainly have  been  possible  to  see  the  choriocapillaris. —  Ophthalmic  He* 
visw. 

15.  Calabar  Bean  \n  Ocular  Therapeutics, — Dr.  E.  Martin,  of  Mar- 
seilles, records  {Revue  de  Therap.  Med.  Chirg.)  two  cases,  one  of  par- 
alysis of  the  iris,  and  the  other  a  hernia  of  iris  through  a  wound  of 
the  cornea,  both  successfully  treated  by  the  application  of  the  calabar 
bean. — Am,  Jour,  Med,  Sciences, 


OBSTETRICS. 

16.   On  a  Case  of  Sudden  Delivery.  By  Thomas  Langston.  M  R.C. 

8.,  Ac.     M.  C ,  aged  twenty-three,  single,  wassnddenly  delivered 

of  a  full  grown  male  child,  at  half-past  Ave  A.M.,  on  the  5th  of  Jan- 
uary last,  under  the  following  circumstances  :  She  stated  that  between 
foor  and  five  o'clock  on  that  morning,  she  felt  *•  griping  pains  "  in  the 
abdomen,  and  that,  knowing  her  condition,  she  suspected  the  pains 
indicated  labor,  and  therefore  left  her  residence,  intending  to  go  to  a 
friend's  house  to  be  confined,  the  distance  being  about  six  hundred 
jardrt.  When  she  had  proceeded  half  way  she  was  suddenly  deliver- 
ed while  in  the  erect  position,  and  her  child  fell  upon  the  pavement. 
The  funis  was  ruptured,  and  shortly  afterwards  the  placenta  waR  ex- 
pelled ;  and  she  walked  on  to  the  place  where  she  intended  to'  have 
been  confined,  carrying  her  child,  which  she  had  wrapped  in  a  petti- 
coat. 

At  ten  minutes  to  six  I  was  called,  by  a  person  passing  in  the 
neighborhood,  to  visit  this  woman  ;  and  on  my  arrival  I  found  her  in 
bed,  looking  perfectly  well,  free  from  pain,  and  merely  complain  ng  of 
cold,  as  the  morning  was  very  severe.  This  was  her  first  child  :  it 
was  well  nourished  and  healthy  looking  ;  but  on  the  left  parietal  bone, 
at  tbe  junction  of  the  coronal  suture,  was  a  8oft  cushion-like  tumor, 
between  two  and  three  inches  in  its  transverse  diameter,  which  was 
nligbtly  ccchymosed.  The  funis  I  found  had  been  lacerated  trans- 
versely four  inches  from  the  umbilicus.  Both  mother  and  child  pro- 
l^essed  favorably ;  and  tbe  tumor  had  entirely  disappeared  at  the  end 
of  three  weeks. 

Jiemarks,  —  Here  was  a  case  of  sudden  delivery,  and  that  of  a  first 
child,  occurring  in  an  unmarried  woman,  the  infant  possessing  marks 
of  violence,  solely,  according  to  the  mother's  statement,  (  which  there 
was  no  reason  to  doubt ),  through  the  circumstances  of  delivery.  Had 


eS6  JSHimM  Ahiiraeii  mi  iSUMMt.  [Odokr, 

fatal  results  followed  to  the  child,  prima  fach  the  motker  might  have 
been  accused  either  of  mansUaghter  or  miirder,  especiAlly  ae  ahewM 
unmarried,  and  the  delivery  oecnrred  in  the  stxeet  ao  early  ii  tbi 
moining.  Certainly  it  might  have  been  urged  in  her  favor  Aal  tk 
lacerated  condition  of  the  cord  would  verify  the  aeooan^  of  the  nodi 
in  which  she  was  delivered. 

The  funis  had  been  rudely  tied  after  her  arrival  at  the  hooee.  No 
doubt  the  intense  cold  had  caused  oontractftn  of  the  veaedat  *nd  lo 
prevented  fatal  hsemorrhage  both  to  the  child  and  hta  mother. 

I  have  reported  this  case  from  the  obvious  interest  of  iU  mtdico- 
legal  bearings. 

17.  To  Cause  a  flow  of  Milk  in  the  Female  Breast — ^In  Vol.  T.  of 
the  "  Obstetrical  Transactions  "  may  be  found  some  intereating  npt- 
riments  by  Dr.  Skinner,  in  reference  to  the  effects  of  faridisation  ai  i 
gallactogogue.  The  ordinary  machines  will  not  answer  the  pnrpoii» 
not  even  the  portable  chain  battery  Pulvermacfaer,  conaistiBg  of  50  or 
120  elements,  excited  by  vinegar.  The  positive  pole  may  he  desflf 
pressed  into  the  axilla,  while  the  negative  is  lightly  applied  ro  tk 
nippb  and  areoia.  The  current  should  be  of  an  intensity  onlyM 
agreeable  to  the  patient.  It  will  not  answer  the  purpose  if  the  cnrreit 
is  passed  through  distant  parts  or  with  the  poles  far  asunder,  bet  tb 
galvanic  cuirent  must  be  localized  in  the  breast.  After  the  poles  an 
properly  adjusted,  the  current  mast  be  steadily  passed  through  the 
parts  for  two  or  three  minutes,  then  raised  and  imbedded  in  anotWr 
part  surrounding  the  nipple  until  their  whole  circumference  lias  beei 
travoi'heil.  The  upper  surface  of  the  breast  should  receive  particnltf 
attention.  This  process  may  daily  be  repeated  in  both  breasts.  !■ 
many  cases  which  were  consi  lered  apparently  hopeless,  the  judicioat 
perKOveronco  in  this  application  was  followed  by  a  plentiful  sei^retioi 
of  milk. — Med,  and  Surp,  Reporter, 

1 8.  Placenta  Prcevia  ;  A  rrest  ff  Bammorrkaffe  ;  Child  bum  ci/irf ,— 1» 
the  Dublin  Quar,  Jour.  Med.  Sciences  is  recorded  an  interesting  ctK 
reported  befoi*e  the  Dublin  Obstetrical  Society,  where  the  cause  w»$ 
suspected  from  the  severe  gushes  of  blood  with  the  pains  of  the  pstient 
She  w«8  much  exhausted  from  loss  of  blood,  the  os  uteri  dilated  to  the 
size  of  a  crown  piece,  with  the  placenta  to  be  readily  felt.  Tbe  fii* 
gers  were  readily  insinuated  between  the  placenta,  and  upon  sweeping 
them  round  it  was  detached  from  the  uterus.  The  Bcemmorrhage  ti 
once  ceased.  The  foRtus  was  then  turned  which  occupied  ten  oriiftetf 
minutes,  and  when  born  the  heart  was  acting  and  respiration  wis 
gradually  established.     Both  mother  and  cliild  progressed  favoraUj' 


864.]  SdMarUl  Abstract  and  SdtditmB.  687 

PHYSIOLOGICAL. 


19.  A  Cast  of  Bermarphrodism, — M.  B.  H.,  aged  21.  This  patient 
rmB  examined  at  Denniaon  U.S.A.  Hospital,  B.  Cloak,  M.D.,  Surg. 
J.8.  Vols.,  in-charge,  with  a  view  of  returning  him  to  dnty. 

The  discovery  of  malformation  of  the  organs  of  generation,  induced 
tie  to  retain  the  case  for  further  examination. 

The  following  history  was  elicited  from  the  patient.  Was  bom  in 
^ortage  County,  Ohio,  on  the  15th  of  April,  1842.  Has  one  brother, 
.  larged  sized-man,  and  three  sisters,  the  youngest  of  whom  very 
nach  resembles  himself. 

His  occupation  prior  to  entering  the  service,  was  a  farmer.  When 
kbout  fifteen  years  of  age  he  commenced  beinsr  troubled  with  bloody 
liacharges  from  the  urethra,  as  he  supposed,  following  each  mictura- 
ioD,  and  lasting  from  two  to  ^ve  days.  Thin  occurred  with  rare  ex- 
leptions,  every  month,  occasionally  it  only  came  on  once  in  two  months. 
i  was  always  preceded  and  accompanied  with  more  or  less  pain  in 
be  back,  dizziness  in  the  head,  and  pain  and  swelling  in  the  left  groin, 
rheae  distressing  symptoms  were  mitigated  when  discharge  was  fully 
elablished.  If  he  takes  cold  at  the  time  of  these  periodical  discharges, 
t  edds  yerj  much  to  his  sufferings.  States  that  he  never  hid  an 
section,  (may  have  had  something  like  an  erection  once  or  twice,)  or 
lie  least  sexual  desire ;  thinks  lie  once  had  a  seminal  emission  oc- 
snring  while  he  was  asleep.  Enjoys  the  society  of  ladies  better  than 
iiet  of  men,  but  never  formed  any  particular  attachment  for  them  ; 
^ee  little  or  no  beard,  occasionally  shaves  for  the  fashion  of  it,  but  not 
t^eceuse  it  is  necessary.  Has  a  mixed  voice  ;  can  sing  good  soprano^ 
bat  usually  sings  bass. 

He  entered  the  service  October  15,  1861,  was  admitted  to  ihe  hos- 
pital July  20,  1^^,  disease  said  to  bo  intermittent  fever.  Is  now 
well,  with  exception  of  these  monthly  bloody  dischargen,  and  occas- 
ional pains  in  the  left  breast ;  was  very  anxious  to  be  cured  of  his 
disease  ;  never  had  submitted  to  an  examination  before,  or  told  any 
oae  of  his  difiiculties. 

Physical  Examination. —  Form    round  and    plump.      Pelvis  and 
■lioulders%)mewhat  broad  ;  height  four  feet  eleven  and  a  half  inches  ; 
weight  one  huudre<i  and  ten  pounds  ;  complexion  somewhat  bnmzed 
Irhd  exposure,  otherwise  fair  and  ruddy.     Mamraie  more  largely  de- 
veloped than  in  the  male,  perhaps  less  than  an  average  in  unmarried 
fneaiee,   with  well-formeil  nipple,  though  not  large ;    and  distinct 
eieola  surrounding  it.     The  general  appearance  of  the  external  organs 
ef  generation  was  more  allied  to  that  of  the  female  than  male,  the  labia 
■MJora  and  mons  veneris  were  both  well  developeil,  and  surmounted 
with  the  usual  growth  of  hair.     At  the  Nile  of  the  commissnra  f^npe- 
rior  of  the  vulva  protected  a  penis  about  an  inch  in  length,  or  an  inch 
end  a  half  on  the  superior  surface,  with  the  meatus  urinarius  tied 
down    by  the  frienum  preputii  to  within  half  an  inch  of  the  fissure 
between  the  labia.     The  penis  has  a  well-developed  glans  penis,  co* 
lena  glandia,  and  prepuce.     But  the  meatus  urinarius  in  it,  upon 


688  MUorial  JUtracU  and  Sdidhm.  [October. 

closer  examination  proved  only  a  fissure  abont  one-fonrth  of  an  iaek 
deep  extending  posteriorally,  and  dividing  the  frasnnm  prepntii  into 
two  sections.  Immediately  posterior  and  below  tbe  false  meatnB.and 
in  tbe  same  elongated  fisanre  dividing  tbe  fmnnm»  a  small  openfog 
was  found  into  whieb  a  probe  could  be  passed  abont  balf  an  incL 
Tbis  proved  to  be  only  a  cul-de-sac.  A  balf  incb  below  this  opeDing 
was  another  small  passage,  discovered  by  Dr.  Oarpenter,  in  bi«  ex- 
amination  of  tbe  case,  wbich  would  admit  of  a  medium-siied  catheter. 
which  could  be  passed  downward  and  backward,  tbe  distance  of  four 
inches.  A  male  catheter  could  be  passed  in,  turning  under  tbe  arok 
of  the  pubis,  a  distance  of  six  inches,  without  entering  the  bladder. 
When  it  was  withdrawn  a.  quantity  of  thick  tenacious  colorless  floid, 
adhered  to  the  end  of  the  instrument.  There  is  no  scrotum  and  no 
testicle  on  the  right  side.  In  the  left  groin,  extending  in  &ct,  into  tin 
left  labia  is  a  substance  about  tiie  size  of  a  bean,  which  may  be  t 
rudimentary  gland.  It  is  somewhat  tender  to  the  touch,  and  becomei 
swollen  and  painful  at  each  period  of  his  bloody  discharges. 

Rim  ARK  8. — In  this  case  there  seems  to  be  an  equal  blending  of  thi 
male  and  female  natures.  He  has  always  passed  with  bis  assoeialoi 
as  a  male,  with  the  occasional  remark,  (as  he  says),  that  he  hadt 
full  breast  for  a  man.  I  am  very  much  inclined  to  the  opinion,  how- 
ever,  that  there  is  a  preponderance  of  woman  in  his  composition.  Bii 
general  conformation,  is  certainly  nearer  that  of  tbe  female  than  tkit 
of  the  male.  The  statement,  if  true,  that  he  has  no  sexual  desire,  ii 
another  evidence  of  this  supposition.  In  the  generative  organs,  the 
female  organism  certainly  preponderates  over  that  of  the  male.  The 
penis  has  no  urethra.  The  meatus  urinarius  evidently  empties  intotht 
opening  described  above,  as  the  one  into  which  the  catheter  was  pass- 
ed, and  this  pa8sa<re  is  no  doubt  a  rudimentary  vagina.  The  bloodj 
discharges  arc  most  certainly  a  menstruation.  The  external  opening 
is  sufficiently  close  to  prevent  tbe  menstrua  from  passing  off  ad  libi- 
tum, but  it  is  forced  when  the  passage  is  opened  by  the  act  of  miotn- 
rition.  Could  this  passage  be  enlarged  by  dilitation,  or  an  operation, 
I  doubt  not  that  a  womb  would  be  found  in  its  proper  positioo.— 
Afed,  and  Surg,  Reporter, 


i»  1 


20.  foreign  Intelligence,  —  In  a  letter  from  Paris  appearing  in  the 
Wlen  Med,  Woch.,  ii  is  stated  that  there  are  about  twenty  Germani 
practising  in  Paris,  some  of  them  enjoying  a  first  rat^  celebrity.  Tbe 
liberality  with  which  all  obstacles  have  been  foregone  by  the  French 
Government  and  Faculty  is  in  striking  contrast  to  what  prevails  in 
Vienna,  where  even  the  diplomas  of  diiferent  Universities  of  the  sadm 
empire  are  not  acknowledged  as  giving  a  right  to  practise.  Among 
the  German  practitioners  in  Paris,  the  names  of  Gruby,  Liebreich, 
Mandl,  Meding,  Sichel,  and  others  arc  widely  known.  Gruby  wsss 
poor  student  at  Vienna,  who  labored  diligently  under  Hyrtl,  lioki* 
tansky,  and  other  able  professors,  and  he  would  probably  havesetded 
in  his  place  of  education,  but  being  a  Jew^  all  posts  were  denied  him 


1864.]  EJtiorial  Abstracts  and  Seledhns.  639 

bv  AuRtrian  intolerance.  He  therefore  went  to  Paris,  where  he  has 
acquired  fame  both  as  a  teacher  and  practitioner.  In  the  latter  capac- 
ity his  views  are  narrow  enough,  ignoring  the  maxims  of  medical 
science,  and  professing  to  treat  disease  solely-  by  regimen.  Still  he 
is  in  enormous  repute,  his  consultation  room  being  crowded  all  day, 
chiefly  with  hysterical  women,  who  often  send  their  servants  before 
hand  to  secure  their  turns.  Gruby  is  a  very  different  man  among  his 
anatomical  and  chemical  preparations  at  his  laboratory  at  Montmatre, 
and  his  hospitality  to  foreign  visitors  is  boundless.  Liebreich,  the 
formor  assistant  of  Yon  Graefe,  at  Berlin,  has  advanced  far  more 
rapidly  than  most  practitioners  at  Paris.  He  has  established  an  oph- 
thalmic clinic,  with  sixteen  beds  and  ^  Dispensary,  in  the  Quartier 
Latin  ;  and  here  he  not  only  sees  the  poor  gratuitously,  but  gives  the 
five- franc  consultations  to  those  of  slender  means  in  an  adjoining 
room.  This  clinic  is  amply  supplied  with  patients,  and  foreign  phy- 
sicians from  all  parts  of  the  world  flock  to  his  lectures.  His  ophtbal- 
moKcopic  demonstrations  are  skillfully  performed,  and  he  is  always 
ready  to  enter  into  explanations.  In  the  afternoon,  the  richly  decon 
ated  waiting-room  of  his  residence  in  the  Champs  Elysces  is  frequent- 
ed by  rich  and  fashionable  patients ;  for,  combining  most  polished 
manners  with  profound  knowledge  of  his  speciality,  he  has  acquired 
a  large  practice  in  a  remarkably  short  time.  Mandl  also  enjoys  a 
good  leputation  both  as  teacher  and  practitioner,  the  laryngoscope 
especially  of  late  occupying  his  attention.  With  a  good  consultation 
practice,  and  his  Dispensary  in  the  Quartier  Jjatin,  he  yet  flnds  time 
for  the  scientiflc  pursuits  which  have  given  him  an  European  reputa- 
tion. Besides  Liebreich,  there  are  three  other  pupils  of  Von  Graefe 
who  are  making  their  way  in  Paris  as  oculists,  and  Von  Graefe  him- 
self always  passes  a  month  every  year  in  that  capital,  during  which 
he  of  course  sees  many  patients.  A  Dr.  Lowenberg,  a  pupil  of  the 
celebrated  Poltzer,  has  also  established  himself  as  an  aurist  in  Paris, 
and  founded  a  clinic  for  diseases  of  the  ear. 

Professor  Langenbeck  has  been  elevated  to  the  rank  of  the  nobility 
for  his  services  in  the  late  Schleswig-Holstein  war. 

A  severe  case  of  strychnia-poisoning  is  reported  to  have  been  cured 
by  the  use  of  worara  in  Konigsberg. 

At  the  last  meeting  of  the  Academic  des  Sciences,  M.  Wohlcr,  of 
Goitingen,  was  elected  foreign  associate  in  place  of  the  late  Professor 
Mitscherlich.  The  other  candidates  were  De  la  Rive,  Geneva  ;  Agas- 
sis, Boston  ;  Airy,  Greenwich  ;  Bunsen,  Heidelberg  ;  Hamilton,  Ed- 
inburg  ;  Martins,  Munich ;  Murchison,  London ;  and  Struve,  Pul- 
tATa.  —  Afed.  T^mes  and  Gazette. 


CHARITY  HOSPITAL  MED.  COLLEGE 

CLETELAND.     OHIO, 


FACULTY. 


JAHBS  DABOOHB.MJIh 

ProftMOT  of  ChwBlMcj  and  Todrndatj. 

A.  P.  DDTOHBR,  M .D., 

l^oftwBtof  Frindplea  ud  PneUn  nt  Ksdiein*. 

L.  FIRESTONE,  MJ}., 

Pnttmor  of  Obat«ti1oB  mi  Diinut*  of  Womn  huiI  Cbililrm. 

J.  H.  8AU9BURT,  BUL, 

Profwsar  of  Hb^Iog;,  PhjdDlogj,  PtthdsginI  Aduobij. 

R.  A.  BARS,  H J>, 

PivfeiMH  of  AoaMBf ; 

OtrSTAV  B.  WEBER,  MJ)^ 

pKrfkMOrof  CItU  uid  HU)tu7  Sorga?. 

M.  S.  OASTLE,  En., 

ProfBBor  of  LcgU  Uediriiw. 

W.  J.  SCOTT.M.D., 
Profeuor  of  SUlerik  Midki. 

A.  METZ,  U.  D., 

ProfeaMT  of  Optlulmologj. 

S.  H.  SARGENT,  MJ>., 

TnteM^OT  of  ths  DIhimm  of  ttie  Urian;  Oi^iiw. 

J.  C.  SHENCK,  HJ}., 

DemoiiHtrator  of  AdbIoiiv. 

GUBTAV  C  E,  WEBER,  M,D  ,  Bus. 
J.  H.  SALISBURY,  11  D..  Secht.st. 
Thia  InetinUoD  is  CBtsblished  on  the  uma  plu  u  tlie   Bellcvu«  Colbg 
«f  Mew  Vo'k      Cilnicsl  InBtnictian  conititotet  %  pronlu'Ql  fcatiu«  iatU 
pUn  of  «diie«tioti. 
Tbe  leetana  will  mmmeuie  on  the  a6th  d*;  of  Ootober  ind  coficaiiia  i7<<| 

Profeaaon' ticfceta,  $60,  MatricuIfttloD  fa>,S5,  Ond.ntioa  f<M!  $30,  Davl 
onitntor'a  ticket,!!).  Hoaptal  ticket,  ?S.  I 

PeisonB  desiring  further  infornutian  can  addrcaa  the  Dein  or  Secretur  at  I 

CleTeland,  Ohio.  SU8TAV.  0.  E.  WEBER,  MJ)^        J 

Deon  of  the  Pacii%     ' 


iicumaii  f niKct  t^'  ibserbtr. 


i,,ll\    1    MlllM'IIV.  »,1^ 


OONTKNl'S  KOIl   SuVKJlBEIl. 


Dr.  Robnt  Bartholovr, 


^  cnlareJ  Into  |i 


ctscjtrKATi-nmii 


THE 

CINCINNATI  LANCET   AND  OBSERVER 

CONDUCTED  BT 

E.  B.  STEVENS.  ED.,  AND  J.  A.  MURPHY.  M.D. 

▼0I.VXI.  SrOVllMBDB.  1864.  No.  11. 


(^viginat  tfammttnicationj. 


ABTICUB    I. 


Diphtheria. 


A  p«ptr  rtftd  bftfore  the  White  Ooantj  If •dlcal  SocUt j,  JvXj  18th,  IBM,  bf  W.  8.  Hat«oii»> 
[.D.I  of  Montkcllo,  IndlAoa. 


I  bare  chosen  for  the  snbject  of  my  essay  the  disease  which  is  now 
everywhere,  by  the  uniTernal  consent  of  the  medical  profession,  dc- 
denomioateil  diphihiria,  or  diphlheritU — a  term  meaning  an  "  cxuda- 
lioD  in  patches."  It  is  applied  to  a  disorder  attcndetl  with  a  peculiar 
form  of  sore  throat,  and  certain  constitutional  symptoms,  which  en- 
title it  to  be  considered  as  distinct  from  all  other  affections  ;  but  it  has 
throagh  ignorance  of  its  nature  been  blended  or  associated  in  some 
nanner  with  nearly  every  malignant  disease  of  the  throat,  and  conse- 
quently has  been  generally  treateil  as  a  local  affection.  It  is  no  new 
dieeaae  although  it  is  mainly  to  modern  pathologi8ts  that  we  are  in- 
debted for  its  differential  diagnosis,  or  the  characteristic  difTcrcnces 
which  denote  its  peculiarities,  and  have  assigned  to  it  an  independent 
poaitioD  in  the  catalogue  of  diseases.  Diphtheria  was  not  entirely 
nnknown  to  the  ancients ;  it  was  recognised  by  Hippocrates,  and 
ny  of  ita  prominent  symptoms  described  by  Artacns.  From  that 
1y  period  it  remained  in  neglect  until  sometime  daring  the  last 
tury^  when  it  arrested  the  attention  of  Cullen,  Huxham,  Fother- 
^n,  and  others,  who  pronounced  it  "  a  new  and  aeparate  disorder." 
The  notice  giren  it  by  these  celebrated  observers  was  not  safficient, 
however,  to  hold  the  attedHon  of  the  profession  any  lengCh  of  time  to 


642  Oriffkmt  Oommmmealion$.  {TSotmtAm, 

tbe  views  thej  had  promalgfttad*  std  it  ag*iii  rsUpaad  into  obliTion, 
where  it  slambered  until  brotight  to  light  bj  the  invostigationt  of 
difltingnithod  obsonrem.  of  the  pvaoent  centnry.  It  may  ba  aaid  with- 
out exaggeration  that  all  Aat  was  1cno#n  brIrritiUfn  abont  the  disor- 
der prior  to  the  last  quarter  of  a  centoij  is  of  bot  liule  raloe  eooi- 
pared  with  the  more  enlightened  opinions  of  pathologists  stnoe  tbat 
time. 

How  confnsed  mnst  have  been  the  minils  of  physicians,  and  nn* 
satisfaetorj  their  treatment,  when  they  eonlbonded  the  diaoase  with 
nearly  eveiy  variety  of  thi^oat  disease;  tirbii  simple  angina  to  vlal^ 
nant  eronp ;  when  the  lancet  and  the  antiphlogistic  regimen  wen 
carried  to  the  ulterior  extent  to  subdue  inflammation,  and  to  redaoe 
vital  action,  and  depress  the  powers  of  the  system  in  order  to  stb- 
jugate  the  disease. 

Diphtheria  existed  as  it  now  dtfiBs  from  time  immemorial,  for  the 
same  causes  have  always  been  in  operation  to  produce  it.    It  hts 
been  called  at  different  times  by  varioua  names  ;  such  as,  maglignsat 
sore  throat,  putrid  sore  throat,  angina  maligna,  membranous  angina, 
eynandie  maligna,  psendo  membranous  pharyngitis,   angina  gan- 
grenosa, croup,  snftocative  angina,  scarlatina  anginosa,  and  a  hcit 
of  other  appellations,  little  expressive  of  the  peculiar  nature  of  thA 
disorder  because  of  their  equal  applicability  to  all  the  serious  forms 
of  sore  throat  under  the  shadows  of  their  imperfect  nosology.     Dipb- 
theria  has  been  blended  during  centuries  with  diseases  similar  to  it 
only  in  local  appearances,  while  its  distinct  character  as  a  genend 
disorder  has  been  but  little  understood.     How  successfully  diphtheris 
was  treated  by  our  progenitors  in  the  profession  can  only  be  guessed 
at  by  the  universal  rule,  viz. ;  when  the  physician  is  ignorant  of  tlie 
true  nature  of  any  disorder,  and  prescribes  medicine,  he  is  almost  is 
likely  to  do  harm  as  effect  good.     Medicine  is  a  progressive  sciencSf 
and  the  investigations  of  many  more  years  must  be  added  to  the  prse- 
ent  stock  of  knowledge  before  it  can  be  fully  developed  and  arrive  at 
anything  like  perfection.    It  has  only  been  a  comparatively  short 
period  since  the  same  uncertainty  and  confusion  existed  with  regard 
to  fevers.    Thus,  typhus,  typhoid,  and  billious  remittent  fevers,  wen 
blended  together  and  embraced  under  the  name  of  continued  fever, 
and  treated  as  a  single  disorder,  though  sometimes  admitted  to  poi- 
sess  widely  difierent  symptoms.    But  the  physician  of  the  present  daj» 
who  is  uninformed  of  the  characteristic  features  that  distinguish  eaek 
kind,  and  is  not  enlightened  by  the  adnnoed  pathology  of  fevers, 
would  be  regarded  as  an  empiric. 


1864.J  UATUom—DipkAeri^  643 

The  term  diplitheria  was  applied  in  the  year  1826  to  a  class  of  dis- 
orders ia  which  there  existed  a  characteristic  tendency  to  the  formation 
of  false  membranes  upon  the  skin  and  mncous  surfaces.     Since  that 
time  it  has  been  oniv^ersally  applied  to  the  disease  under  considera- 
tion, which  is  distinguished  by  symptoms  peculiar  to  itself,  and  prom- 
inent among  them,  this  characteristic  exudation,  which  attaches  itself 
in  the  shape  of  false  membranes,  to  the  mucous  surfaces  of  the  throat 
and  air  passi^ges.     The  initial  stage  of  diphtheria  is  often  deceptive, 
and  its  progress  insidious.     Very  often  no  symptoms  are  so  well 
marked  as  to  attract  the  attention  of  parents  or  friends  to  the  victim 
of  this  terrible  disorder  until  it  has  made  fatal  progress.    The  diph- 
theritic poison  has  accumulated  insidiously,  the  patient  scarcely  mak- 
ing any  complaint,  to  burst  forth  suddenly  wiih  alarming  symptoms. 
Such  cases  are  unattended  with  psrceptible  fever,  with  a  cough  that 
scarcely  excites  attention,  and  a  slight  soreness  of  the  throat  about 
which  little  or  no  complaint  is  made,  until  the  tonsils  have  become 
hypertrophicd  to  such  a  degree  as  to  approximate  closely  to  each  oth- 
er* and  have  become  glazed  over  with  patches  of  tenacious  membrane, 
which  nuy  have  even  extended  downward  to  the  rim  of  the  glottis  and 
invaded  the  larynx.     Suddenly  the  countenance  of  the  patient  becomes 
8uffu!>ed  and  dusky,  on  account  of  diminished  supply  of  oxygen,  or 
vital  air ;  difficulty  of  breathing  becomes  apparent  and  increases  every 
moment,  until  perhaps  a  croupal  sound  is  emitted,  and  the  sufferer  is 
discovered  to  be  in  peril  from  immediate  suffocation.     Diphtheria 
often  pursues  this  insidious  course,  and  when  it  has  made  extensive 
progress  before  it  is  discovered,  it  is  often  too  late  to  avert  the  danger. 
Wherever  diphtheria  is  known  to  prevail,  or  where  the  least  suspicion 
exists  with  regard  to  its  presence,  the  first  and  slightest  uneasiness  of 
the  patient  should  be  sufficient  to  attract  attention  to  him.     An  oc- 
caeional  dry  cough,  slight  fever,  uneasiness  about  the  throat  and  chil- 
ly sensations,  are  symptoms  that  should  not  be  neglected,  but  a  care- 
•Ul  examination  of  the  throat  should  be  immediately  made,  in  order 
that  danger  may  be  met  at  the  threshold,  and  averted  by  the  appro- 
priate remedies.     I  have  seen  several  cases  of  this  type,  and  regarded 
them  as  being  highly  dangerous.     First,  because  the  disease  in  this 
form  is  of  the  asthenic  character  ;  indicating  diminished  vital  action. 
Second,  because  it  is  likely  on  account  of  its  insidious  character  to 
progress  to  a  (atal  extent  before  the  physician  is  consulted.     In  such 
oases  we  may  say  the  disease  has  progressed  in  a  masked  form.     In 
other  cases,  however,  it  manifests  itself  In  a  very  different  manner — 
openly  and  with  well  marked  sthenic  action.    Generally  from  the  in- 


644  Onffin^i  CommmnUiMomi.  [Noremfcer, 

cipiencj  of  the  disorder  the  patieiit  eomiflains  of  son  tbfOAt,  hemdaehe^ 
chilly  sensations,  mote  or  less  serere,  and  is  freqaendj  dal1»  feverisk 
and  petnlent.    Bat  the  disease  is  often  nshered  in  wiUi  a  violent  chill, 
which  is  soon  followed  with  high  fever,  eztensiTe  awelling  at  the 
throat,  both  internally  and  externally,  with  rapid  formation  of  ftlss 
membranes  upon  the  tonsils,'  fauces,  etc.    These  paita  exhibit  a  high- 
ly congested  condition,  and  have  a  deep  red  velvety  appearance,  cot- 
trasting  strangely  with  the  parasitical  ash  oolovsd  depoeits.     No  csss 
of  sore  throat  should  be  pronounced  diphtheria  until  the  Iklee  msm* 
branes  can  be  detected ;  and  of  these  there  is  generally  ocular  evidenes 
in  a  phort  time  after  disease  has  appeared.    No  case  of  diphtheria 
can  occur  without  this  peculiar  exudation,  which  is  a  pathognomonie 
symptom,  unless  in  certain  instances  where  death  ii  speedily  produc- 
ed by  the  overwhelming  force  of  the  poison  upon  the  nervous  center, 
accompanied  with  powcHul  internal  congestions.    But  we  sometimsi 
bear  of  some  very  lucky  doctor  or  quack  reporting  througli  the  coon- 
try  his  wonderful  success  in  the  treatment  of  this  disorder.     He  hsi 
treated  a  hundred  or  more  cases  and  cured  them  all  1    Or  if  he  hss 
accidently  met  with  one  case  of  diphtheria  and  the  patient  died  hs 
would  still  claim  great  success,  having  only  lost  one  ease  ou^of  so 
large  a  number.    He  has  found,  perhaps,  numerous  cases  of  catarrhsl 
disease  of  the  throat,  such  as  qninfy,  a  simple  inflammation  of  the 
fauces,  and  has  called  them  all  diphtheria.     Nothing  can  so  complete- 
ly degrade  a  medical  man  in  the  eyes  of  scientific  and  honest  physi- 
cians as  this  species  of  charlatinism,  which  must  explode  sooner  or 
later,  like  a  magazine  placed  beneath  his  feet,  tearing  his  flimsy  prs- 
tentions  to  tatters  in  the  very  community  he  has  deceived. 

In  diphtheria  we  will  generally  find  a  white  coat  upon  the  tongue, 
not  differing  materially  from  that  observed  in  other  diseased  condi- 
tions. The  cough  in  diphtheria  is  peculiar,  and  not  likely  to  be 
mistaken  for  that  belonging  to  phthisis  pulmonalis  or  bronchitis  It 
is  loose  and  rough,  but  generally  without  expectoration  ;  it  is  often 
the  first  symptom  that  attracts  attention  to  the  disorder,  and  may  be 
frequently  detected  before  the  patient  has  made  any  complaint.  In 
some  cases  the  cough  rapidly  assumes  the  oroupal  character,  which  is 
usually  an  unfavorable  omen,  as  it  indicates  the  extension  of  the  psea- 
do  membranous  formation  to  the  larynx.  The  false  membranes  are 
loosely  attached  to  the  subjacent  mucous  surfaces,  and  have  well  de- 
fined smooth  margins.  The  pnlse  is  often  deceptions.  In  sthenic 
cases  with  high  arterial  action  it  is  usually  hard  and  frequent ;  but 
in  cases  of  the  insidious  type  it  is  as  uncertain  and  variable  as  the 


1864.]  HATxoHD-*Z>t>A/WMi.  645 

symptoms  are  steady  and  treacherous.  These  are  the  most  promineat 
symptoms  noticed  In  the  early  stages  of  the  disease,  hut  they  are  sas- 
oeptable  of  a  great  variety  of  modifications,  owing  to  the  "  different 
physical  conditions  of  the  subject  affected."  Some  writer  has  well 
stated  that  there  are  not  two  cases  having  a  perfect  resemblance  either 
in  the  grouping  of  the  symptoms  in  their  order  of  succession,  or  in 
the  degree  of  their  individual  symptoms. 

Diphtheria  is  not  a  local  affection,  not  a  simple  disease  in  which 
the  throat  only  is  affected,  but  a  general  disorder  affecting  the  whole 
system,  in  which  every  drop  of  the  life  sustaining  blood  is  charged 
with  the  malignant  poison,  and  carries  disease  with  it  to  all  parts  of 
tJbe  body.  Diphtheria  sometimes  is  inflammatory,  and  has  both  types, 
sthenic  and  asthenic,  well  marked  at  the  onset  of  different  cases. 
But  there  exists  a  well  marked  tendency  in  all  cases  to  pass  into  the 
asthenic  condition.  This  usually  occurs  early  ;  but  in  some  cases  the 
sthenic  is  not  superseded  by  the  asthenic  condition  for  several  days. 
Diphtheria  has  also  the  character  of  acute  and  chronic.  Many  cases 
will  run  their  course  to  convalescence  in  a  few  days,  whilst  others 
will  continue  for  weeks  and  months.  I  have  known  cases  that  had 
not  entirely  recovered  in  four  or  five  months.  Diphtheria  expends  its 
whole  force  upon  the  whole  system.  No  organ  can  claim  exemption 
from  its  assaults,  and  no  function  remain  secure  from  its  action.  It 
operates  locally  and  generally,  openly  and  insiduously.  The  charac- 
teristic membrane  may  assail  every  surface  of  the  body,  mucous,  se- 
rous acd  cutaneous.  It  is  found  on  the  tonsils,  on  the  velum,  in  the 
glottiH,  trachea,  bronchia,  eustachian  tube,  schneiderian  membranes, 
in  the  anus,  on  blistered  surfaces,  about  the  margins  of  wounds,  in 
the  cavities  of  the  heart,  and  perhaps  in  the  ventricles  of  the  brain. 
Diphtheria  belongs  to  the  zymotic  class  oi  disorders,  in  which  the 
tmaitriet  morbi  is  contained  in  the  blood  producing  contamination  of 
its  elements,  through  which  the  whole  system  is  affected.  With  this 
constitutional  condition,  there  are  always  associated  certain  charac- 
teristic local  disturbanees,  directed  chiefly  to  the  throat  and  the  glands 
of  the  neck.  This  is  shown  by  extensive  swelling  and  redness  of  the 
tonsils,  fauces,  etc.,  inflammation  of  the  lymphatic  glands  of  the  neck, 
and  the  pellicular  deposit  of  lymph  upon  the  internal  surfaces  in  the 
form  of  the  inorganic  false  membrane.  It  is  chiefly  on  account  of 
these  serious  local  manifestations  that  alarm  is  first  excited  and  the 
greatest  danger  to  life  apprehended. 

Diphtheria  extends  its  ravages  to  all  ages  and  sex  ;  but  to  child- 
hood and  youth  its  visitations  are  the  most  frequent  and  the  most  to 


e4[6  Or^fUii  t%Ml««&Mfefi«.  NoTttnto, 

be  dreaded,    tt  appears  sometimes  to  depei&d  vp&n  certain  ooadii 
tions  of  the  atmospliere  by  wttifSi  ft  is^id  to  ^reVait  epidemically. 
I  have  not  witnessed  tbe  disorder  so  prevalent  in  Af  season  as  to 
merit  tbe  title  of  an  epidemic ;  bnt  if  we  accept  the  e^ettoe  of  many 
writers  we  mnst  conclnde  that  it  occasionally  ea^tinids  over  limited 
sections  of  the  oonntry,  affecting  a  coiisiderahle  linm1)er  of  persons  at 
one  visitation.    Bnt  so  far  as  m^  observation  gods  IC  has  oecntrri 
only  as  an  epidemic,  attacking  a  falnily  if  ttiated  here  And  there,  or 
widely  isolated,  and  without  the  least  appearance'  of  epidemic  influ- 
ence.   Is  the  disease  contagions  ?    Ifhis  is  a  question  that  still  ptnste 
all  onr  contemporaries.    Some  hold  positive  opinions  iik  the  affirma- 
tive; others  dfeny  its  contagions  character  Altogether.    I  hnve  as  pit 
seen  no  evidences  addnced  from  my  6ihi  obsetVations  leading  to  ebsr 
proof  of  contsgion.    But  if  we  snfibr  ourselves  to  be  oontroHed  on  this 
subject  by  the  majority  rule  we  will  find  the  opinion  of  the  profession 
preponderating  in  favor  of  the  doctrine  of  contagion.    Bot  We  aie 
perhaps  safe  in  asserting  that  nnder  peculiar  cifciimstancfts  the  diseaitf 
is  infections.    The  same  may  be  said  with  regard  to  typhoid  fever  and 
some  other  disorders,  which  are  believed  not  to  possess  any  geneiil 
contagious  character.     Dr.  Hanmann  in  his  able  article  published  is 
the  Lancet  and  Observer  a  few  years  ago,  states  that,  "  Cases  hats 
been  adduced  where  matter  ejected  from  the  mouths  of  patients  labor 
ing  under  diphtheria  and  cast  into  the  the  nostrils  of  the  attending 
physician  have  produced  the  disease,^'  with  the  formation  of  the  ca- 
coplastic  deposit  on  the  scheiderian  membranes  and  its  extensitin  to 
other  parts,  accompanied  with  the  usual  constitutional  symptoms. 
The  same  is  stated  with  reference  to  *•  particles  of  morbid  matter,'* 
when  applied  to  the  abrased  or  wounded  skin.     In  these  cases  the 
peculiar  membrane  first  appears  upon  "  the  spots  aflfected,"  and  from 
it  exerts  a  poisonous  influence  to  the  whole  system  through  the  sction 
of  some  zymotic  power.    It  is  also  said  to  have  been  conthicted  by 
inhaling  the  breath  of  those  afiected,  and  endermically  by  the  use  of 
the  same  water  for  a  bath,  which  had  been  used  by  them  allected  with 
the  cutaneous  variety.     If  examples  of  this  kind  are  to  be  taken  as 
facts,  it  must  be  admitted  they  are  of  rare  occurrence.     In  a  countiy 
practice  seasons  often  roll  round  without  a  single  case  coming  nnder 
the  notice  of  the  physician  ;  but  when  it  does  occur  it  will  often  be 
limited  to  a  single  family  in  a  neighborhood,  or  section  of  country 
embracing  several  square  miles  in  extent.    In  the  beginning  tne  dis- 
ease may  attack  only  one  child  and  subsequently  aflect  others  ;  bnt  in 
some  instances  two  or  three  are  attacked  simultaneously,  or  at  lesst 


1864-3  Haymokd— iH/jA/iUrMu  549 

leaving  too  short  an  interral  for  one  to  have  contracted  |t  from  aii 
other.  In  these  isolated  examples  the  disease  seldom  extends  beyond 
the  environs  of  the  building  where  it  appeared,  though  numerous  per- 
sons in  the  neighboring  vicinity  of  all  ages  have  been  in  daily  attend- 
ance on  an  afflicted  &mily,  and  have  exposed  ihemselves  in  every  pos- 
sible way.  The  qnestion  arises,  why  should  the  disorder  happen  in 
this  isolated  manner,  hurling  its  shafts  of  terror  and  death  among  the 
members  of  a  single  family,  while  for  a  radius  of  twcniy  miles  around, 
for  months  and  even  years  preceding  or  following  that  time,  no  other 
case  of  the  disease  had  occurred  ?  We  can  scarcely  account  for  this 
on  the  presumption  that  some  poisonous  element  contained  in  the 
atmosphere  was  accidentally  wafted  to  this  solitary  spot  from  abroad, 
and  fortuitously  caught  up  and  absorbed  by  the  unfuitunate  family. 
Neither  can  we  admit  in  this  age  of  reason  it  was  sent  to  them  in  the 
form  of  a  special  judgment  an  account  of  their  evil  deeds.  I  imagine 
we  have  a  proneness  in  our  medical  theories  to  look  too  far  off  for 
exciting  agencies  and  causes.  Wc  ara  too  fond  of  spinning  out  high 
flown  theories,  based  upon  problematic  ideas  to  allow  ourselves  to 
observe  simple  truths  and  collect  facts  and  informal  ion  that  properly 
lie  within  our  reach. 

Diphtheiia  is  a  disorder  that  seldom,  or  never  affected  any  peri>on 
living  or  sleeping  in  the  open  air,  or  who  has  strictly  observed  na- 
ture's simple  hygienic  laws,  i.  e.,  to  breath  at  all  times,  awake  or 
sleeping,  all  the  oxygen  in  the  form  of  pure  atmospheric  air  that  the 
organs  of  respiration  will  admit ;  to  observe  cleanliness  of  person, 
and  exercise  care  in  the  removal  of  all  caubes  that  can  give  rise  to  the 
generation  of  noxious  vaporb  and  exhalatii  ns  about  dwelling  houses, 
sleeping  apartments,  and  out-buiMings  as  well  an  foul  drains  and 
cetss  poolri  of  filth  that  generally  remain  neglected,  in  the  neighbor- 
hood ;  to  eat  and  drink  tlmt  alone  whiih  is  pure  and  healthful,  and  to 
take  daily  exercise  huflicicnt  to  invigorate  the  whole  system  and  stim- 
ulate the  functions  of  every  organ  io  healthy  action.  Diphtheria  is 
not  sent  through  the  land  as  a  hpecial  bcourge,  but  it  occurs  rather  as 
a  punishment  for  ignorance,  or  neglect  and  dibiegard  for  the  laws  of 
health.  It  is  one  of  natuie's  penaltiis  for  tbohe  who  trample  upon 
the  precepts  of  her  wise  code.  Diphtheria  does  not  arise  like  croup 
and  other  foimKof  bore  ihtoat  from  expohure  to  cold  or  nieie  changes 
of  weather,  but  is  a  couhtitutioiiul  affection  engendeied  by  bome  pecu- 
liar poison  which  conteminaces  the  blooil,  and  through  it  the  whole 
system. 

Si  me  writers  have  regaided  diphtheria  and  croup  as  identical ;  lut 


r 


JcmiMKmceiiim.  [NoTonber, 

^reen  them  M  Bhown  b j  the  ooiietitiitioii«I 
.  iU  invariabk  tendency  to  asilietiiA,  and  by 
.  chiiraoteristio  deposit  with  its  cmpacitj  to  ez- 
id  surfaoes.    Gronp  is  simply  a  highly  irritated 
Aon  of  the   laryngeal  or  tracheo-laryngeal  mem* 
bra>.  X  general  in  character,  having  no  constitutional  tea- 

dencieb  a  mere  sympathy  with  the  local  inflammation.    It  gives 

rise  soroeti.  jes  to  a  psendo  plasma,  but  this  is  entirely  distinct  firom 
the  inorganic  membrane  of  diphtheria.  Swdling  of  tba  lymphatie 
glands  of  the  neck  is  said  to  occur  in  all  cases  of  diphtberia,  and  to 
be  always  wanting  in  croup.  These  diognosiic  fbatures  snAciently 
distinguish  the  separate  character  of  the  two  disMses  ;  biit  in  the  se- 
qnelsB  of  chronic  cases  of  diphtheria,  we  meet  with  a  vast  chain  of 
symptoms  and  constitutional  derangemtote,  that  will  serve  more  dear- 
ly to  widen  the  distinction  between  it  and  cronp. 

There  is  b^t  one  other  disease  that  can  be  mistaken  for  diphtheria, 
and  that  is  scarlatina.  It  has  been  a  mooted  question  for  a  loag  time 
whether  the  two  diseases  are  identical  in  character,  though  occurring 
under  different  typical  forms.  Scarlet  fever  is  characterised  by  a  pe- 
culiar eruption,  and  is  often  attended  with  ulceration  and  sloughing 
of  the  throat.  The  eruption  of  scarlatina  is  a  common  and  pntkog- 
nomonic  8ymj)tom,  and  is  only  found  wanting  in  a  few  exceptional 
cases  of  the  grave  variety,  as  where  death  is  suddenly  produced  by 
the  overwhelming  force  of  the  poison.  Diphtheria  is  generally  un- 
attended with  any  cutaneous  rash,  though  in  a  few  exceptional  casei 
a  certain  kind  of  efflorescence  has  been  noticed  on  the  skin.  This  ev- 
idently arises  from  functional  disturbances,  and  is  accidental  rather 
than  characteristic.  The  opinion  advanced  by  some,  that  a  rash  sim- 
ilar to  scarlatina  is  produced  in  diphtheria  by  the  administration  of 
belladonna  is  not  entitled  to  much  weight  as  evidence  in  favor  of  the 
identity  of  the  disorder ;  for  it  is  claimed  the  ding  is  capable  of  pro- 
ducing efflorescence  on  the  skin  of  a  person  not  afflicted  with  any  dis- 
ease. We  may  conclude  then  that  the  rash  in  one  disease  is  pecuiiar 
and  eharaderistic,  in  the  other  undefined  and  of  rare  occurrence.  In 
attem  pting  to  establish  the  identity  of  these  disorders  from  the  erup- 
tion, we  are  forced  to  assume  as  a  basis  fiom  which  to  draw  general 
conchisionp,  a  mere  negative  exception.  We  might  for  a  similar 
reason  pronounce  a  case  of  typhoid  fever  rubeola,  because  the  petech- 
ial eruption  or  rose  colored  spots  of  the  former  are  slightly  analo- 
gous in  appearance  to  the  pathognomonic  measles.  Every  disease 
is  endowed  with  certain  specific  features,  or  characteristic  symptoms, 


1864]  BAnto}Kih^J)iplMeria.  M9 

and  tbeae  are  almost  always  present.  Eaob  disease  is  (ben  to  be 
recognized  and  introduced  by  tbese  prominent  signs,  not  by  some  ao- 
cidental  or  analogous  symptom  nnnsnal  to  it.  Scarlatina  can  be  read 
by  its  cbaracteristic  emption,  and  otber  peculiar  symptoms  ;  sucb  as 
the  loosening  of  the  epidermis  from  the  integnment  and  its  easy  de* 
tachmenty  etc. 

It  is  highly  probable  that  scarlatina,  diphtheria,  erysipelas,  and 
typhas  fever  aro  frequently  engendered  by  causes  of  the  same  nature 
in  the  form  of  certain  toxic  elements  ;  but  in  the  complex  relation  of 
chemical  actions  and  affinities,  a  distinct  poison  has  been  generated, 
capable  of  exhibiting  a  specific  influence  upon  the  blood  in  each  class 
of  dibordcrs.  Typhus  fever,  typhoid,  etc,  were  formerly  couHidered 
as  one  discsfe,  yet  they  are  as  diKtiuct  from  each  other  as  the  difierent 
types  of  the  exanthemata.  Typhus  fever  for  instance,  is  as  distinct 
from  bilh'ous  remittent  fever,  as  rubeola  is  from  vaiiola  ;  and  diph- 
theria and  scarlatina  are  separated  from  each  other  by  distinctions 
equally  wide. 

If  we  take  the  example  of  the  fevers  and  exanthematous  diseaaeSy 
we  will  dis(*over  thai  all  medical  history  and  experience  point  in  one 
direction,  viz  :  ihat  simplification  and  separation  is  the  rule  — that 
disorders  exhibiting  only  accidental  or  analagous  symptoms,  bnt  dis- 
tinct in  prominent  characteristics  hhould  not  be  grouped  or  classified 
under  a  common  name,  bnt  are  entitled  to  a  place  as  seimrate  and 
distinct  diseases.     As  medical  science  advances  we  discover  disorders, 
pos^eshing  separate   characteristics,  that  have  long  been  associated 
with  other  afifections,  and  treated  as  such.     The  tendency,  then,  in 
the  progress  of  knowledge,  is  to  the  multiplication  of  diseases,  as 
each  afiiection  is  dependent  upon  some  specific  cause  for  its  production. 
Koihing  satisfactory  has  yet  been  advanced  to  show  what  peculiar 
agencies   originate  diphtlieria,   or  the  nature  of  the  maitriei  morH 
that  contaminates  the  blood,  and  its  modus  operandi  upon  the  sytitem. 
Very  few  have  taken  pains  to  collect  a  sufficient  array  of  facts  upon 
which  to  base  any  plausible  theory.     But  some  have  originated  fan- 
ciful theories,  without  facts  or  reason  to  support  them.     Others  have 
attempted  no  more  than  conjecture  :  thus  Dr.  Dyas  conjectured  that 
the    principal   feature   of  diphtheria   depended   upon  some  morbid 
imprertfiion  upon  the  par  vsgum  ;  but  nothing  has  been  produced  in 
corroboration  of  his  opinion.     Some   have  attempted  to  prove  that 
the  disease  arises  from  chlorosis ;  that  it  can  only  occur  in  chloroiio 
persons,  or  those  in   whom  there  is  supposecl  to  be  an  altered  state  of 
the  blood,  in  which  the  fibrin  is  in  excess,  and  the  red  globules  defi- 


MO  Origmti  flp»iwi»ii>ff<feyy^  [Novmbv, 

eient.  According  id  thia  tkeorj,  tliend  is  no  sach  diacMo  u  diphtbt- 
rift ;  cliloroAiais  the  disMM,  vMle  Uie  peculiar  exiuUtiion,  (di|}litlM- 
fidc,  )  iaoaly  a  iymptom.  la  anpport  of  tbu  doctrioa*.  Acj  hold 
Aat  dilorosia  !«  a  disoMO  ehaneteriiMl  by  a  low  ^rade  of  inflamm*- 
tory  action^  pvodnoiBi^  byptrtmphy  of  tba  anciia  aurOusaa,  and  the 
effosion  of  lymph.  They  maintain  ako,  that  there  ie  aa  enfeebled 
energy  of  4m  whole  eyetem — an  adyaamio  eDndition  which  is 
idiopathUi  and  oongenital ;  and  that  thie  ie  oharaytRriind  by  enfeebled 
ciroolation  of  the  blood»  .with  the  want  of  energy  ia  the  vital  fonoi 
of  aeeimilatioii.  Zheee  derangementB»  thiq^  .effirmv  give  riae  to  the 
andation  of  the  lifekear  inocgaaio  neiabian0  o<f  diphtheria,  by  pie- 
dneing  eome  depiaTcd  condition  of  the  plaenuu 

This  theory,  howoTer,  ia  nnenstained  by  facte.    If  it  were  trae» 
ehlorotio  pereone  wonld  constantly  ba  subject  t<>  eoro  throat  beeeme 
the  enrplus  fibrin  woald  always  be  struggling  to  app^er  oa  the  mocni 
surfaces.    The  emdation  of  false  membrane  wonU  he  a  chacactenstie 
symptom,  having  a  constant  tendency  to  occur  in  those  afllicted  vith 
that  disorder.    But  this  ie  untnie»  as  thousands  of  oblorotic  psrsesi 
Ii?e  months  and  years,'  and  many  die  after  protract  illnnnos,  witboot 
affording  the  least  evidence  of  suoh  local  disturbance.     According  te 
Dr.  Wood,  chlorosis  usually  appears  in  girls  between  the  periods  of 
puberty  and  maturity ;  and  it  is  a  disorder  chieHy   confined  to  the 
female  sex.     Diphtheria  is  not  characterized  by  any  exudal  paniali- 
ties,  but  attacks  indiscriminately  males  and  females  —  the  sanguine 
and  athletic,  and  those  who  have  inherited  the  most  vigorous  constita- 
tions.     Again  :  chlorosis,   ( though  an  artificial  dietinotion  may  be 
drawn  between  it  and  anaomia^  )  is  not  necessarily  a  constitntional  or 
hereditary  disease,  but  may  be  produced  by  many  causes.     Amoog 
these  Dr.  Wood  mentions,  *'  such  as  want  of  nutritious  food  ;  abuse 
of  coffee  and  tobacco ;  habitual  exposure  to  cold  and  dampness ;  sed- 
entary habits ;  depressing  emotions,  &c. ;  with  also  certain  oiganie 
diseases  of  the  stomach,  liver  and  bowels. "     None  of  these  caasei 
have  ever  been  known  to  produce  diphtheria,  and  are  as  unlikely  to 
engender  it  as  they  are  to  create  small  pox  or  rheumatism     There 
never  has  been  the  slightest  evidence  adduced  to  show  that  fibrin  is 
eliminated  from  the  blood  in  the  form  of  diphtheritic  exudation,  os 
account  of  a  reduction  or  deficiency  of  the  red  corpuscles.     If  from 
any  cause  the  red  corpuscles  of  the  blood  be  reduced,  by  which  means 
an  excess  of  fibrin  is  retained  in  the  blood  above  the  usual  proponios 
of  that  ingredient,  but  not  increased  beyond  the  standard  quantitjof 
fibrin  proper  to  the  blood,  by  what  principle  of  viul  action,  or  for 


1864.]  HikTMovD  —  JDipkOerim.  661 

what  pbysiolog^cal  purpose,  is  tbe.  fibrin  also  to  be  eliminated  from 
tbe  circvlaiing  flnid  ?  Is  it  to  establipb  an  eqnflibriam  bj  a  still 
farther  reduction  of  tbe  flnid  pabnlnm  ?  Nature  never  attempted 
such  a  freak  in  chlorosis  ;  and  the  physician  who  would  attempt  to 
cure  chlorosis  by  first  reducing  tbe  amount  of  fibrin,  in  order  to  bring 
the  quantity  down  to  the  low  standard  of  the  diminished  red  cprpns- 
eles,  would  be  guilty  of  reducing  tbe  already  enfeebled  powers  of 
life,  to  a  still  lower  ebb.  His  duty  is  to  restore  lost  ingredients  ;  not 
to  disturb  those  remaining.  Diphtheria,  then,  can  not  be  caused  by 
chlorosis  ;  but  it  has  an  origin  of  its  own,  gprowing  out  of  the  action 
of  some  specific  poison  received  in  the  blood,  and  it  is  dearly  entitled 
to  a  separate  consideration  as  a  disease,  net  p0neri$» 

Of  the  exact  nature  of  the  diphtheritic  poison  and  its  MO(lirt(>p#- 
randi  we  know  no  more  than  we  do  of  the  nature  of  miasms  in  gen* 
oral.  As  the  result  of  personal  observatfons  as  well  as  reflection,  I 
■n  persuaded  tbia  disease  derives  its  origin  from  local  causes ;  such 
as  noxious  emanations  from  the  decomposition  of  animal  and  vegeta- 
ble matter  ;  uncleanliness  ;  want  of  proper  arterialisation  of  the  blood 
from  deficiency  of  oxygen  in  respiration,  having  its  place  supplied  by 
the  poisonous  elements  of  aeote,  and  carbonic  acid  gas.  These  gene- 
rating causes  do  not  always  act  with  the  same  energy,  but  are  modi- 
ified  or  called  into  action  through  certain  atmospheric  influences. 
Typhus  fever  and  erysipelas  generally  arise  from  similar  causes, 
which  are  likewise  subject  to  the  modifying  inflaences  of  the  atmos- 
phere.  Erichsen  states,  in  his  work  on  surgery,  that  "  the  occurrence 
of  erysipelas  is  best  gnarded  against  by  attention  to  hygienic  meas- 
nree,  more  particnlarly  to  proper  ventilation,  with  pure  air  and  the 
aroidance  of  over-crowding  of  patients.  In  hospitals  eryyipclas  may 
be  produced  at  will  by  want  of  attention  in  these  respects,  and  it  will 
usually  be  found  that  the  pestilence  of  er}'8ipclas  in  certain  wards,  or 
even  its  repeated  appearances  in  certain  beds  is  owing  to  some  local 
cause,  such  as  emanations  from  a  drain,  on  the  removal  of  which  the 
disease  will  cease.  '* 

Dr.  Geddings,  of  South  Carolina,  in  bis  monograph  on  diphtheria, 
conjectures  that  the  diteare  "  depends  on  an  epidemic  constitution  of 
the  atmopphere,  '*  but  admits  '*  that  under  particular  circumstam-es,  as 
where  many  persons  are  crowded  together,  where  ventilation  is  im« 
perfect,  and  cleanliness  neglected,  there  can  be  no  doubt  of  the  gene- 
ration of  a  contagious  influence  capable  of  transmitting  the  disease 
from  one  person  to  another. " 

That  the  atmosphere  may,  at  certain  times,  exhibit  conditions  more 


66S  Orffkml  QgwwimfeffipMf?  INovnkr, 

fiivorablo  to  the. proftig^iixm of^ietMi thABftt otbor tisti, eunadait 
of  no  donbt.  Cfrtftin  bafomotrictl*  ttienBonetrical*-  IhygmatttrioiL 
and  electriQ*!  eondittoM  of  tbe  itmjMiflbm%»  Mdosbtadly  mw§!km  At 
mstion  of  locrii  cMnai  to  the  deygiopwmt  of  iiifeotioaivifawHM.  Poif 
0D0U8  elemtntAy  local  and  imrroniidiiig  nu,  (bat  under  etdineiy  w- 
(Bumatanees  lie  donnant  or  inmt,  may  aoddenly  be  oalled  into  adioa, 
and  produce  delelerioiia  effacta  upon  heaHh,  from  tlia  iaflneiieeeiKiiidl 
npon  tbem  by  aome  pecnliar  condition  of  tbe  atmoepberet  eledrial 
or  otherwiee.  We  bave  been  in  the  babit  of  aliribfit&q^  too  mmk 
credit  to  tbe  atmoephere  ae  a  primary  eanee  of  dieeaee.  In  moit 
eaiee  tbe  infeotiona  devnente  are  loea1»  jand  m^  be  foBBd  barboiel 
around  ue  on  all  nidet*  ready  to  ^ng  into  notion,  whendiatmbadky 
any  exciting  in^nenoe,  Wben  tbe.  tone  miaaai  ia  genemted  t«y 
freely,  or  wbere  it  is  retained  in  dote  plaoea  on  acconnt  of  inperfKl 
Tentilation,  or  wbere  a  email  space  ia  enrebarged  with  it»  k  genentH' 
disease  in  tbe  endemic  form«  J3nt  wben  it  baa  been  called  into  gmmal 
action  by  atmospberic  inflnenoee^  the  nnmher  of  caaee  ie.  Iargsl|y  ia- 
creased,  and  tbe  dieorder  is  denominated  an  ^^Mmik.  Thia  epidsiii 
constitution  of  the  atmoephere  r- or  peculiar  exciting  iafeeneS'^ 
arises  probably  from  some  union  or  combination  of  tbe  electrical  aid 
other  conditions  that  bave  been  named.  Since  this  peculiar  unioa  of 
conditions  is  regulated  by  no  known  laws  of  periodicity,  we  are  Isft 
without  the  knowledge  to  determine  beforehand,  the  exact  season  it 
which  any  epidemic  will  occur.  In  order,  therefore,  to  guard  agaioit 
danger  from  such  causes  —  to  pre?ent  them  from  springing  euddealy 
into  action  —  we  should  constantly  put  in  force  all  the  rules  of  hygi- 
ene. We  should  be  careful  to  disarm  the  explosive  magaaineschsif* 
ed  with  the  elements  of  destructiou^  that  eucompass  us  on  all  sidsi, 

and  lie  hidden  around  uk, 

"  Thick  M  sutamnal  lesTes. " 

Diphtheria  is  one  of  those  terrible  maladies  that  is  engendered  by 
causes  that  often  lie  in  our  power  to  control.  Those  who  are  its 
victims,  generally  live  in  open  violation  of  the  simple  laws  of  hygi- 
ene. They  live  deprived  of  the  necessary  quantity  of  one  of  heaven's 
most  bounteous  gifts,  oxygen,  that  vital  air  that  imparts  life  to  the 
blood,  and  makes  it  bound  through  its  countless  channelsi  beetowiog 
heslth  and  energy  to  the  whole  system.  Instead  of  receiving  sa 
abundant  supply  of  this  vitalizing  element,  they  breathe  noxious  ex- 
halations and  deleterious  -gases.  Ill  ventilated  and  over-crowded 
sleeping  apartments  or  dormitories,  are  prolific  nurseriee  of  diphthe- 
ria.   We  will  often  find  more  than  half  a  doaea  persmia  liviag  and 


L  864.]  Hatmohd  —  DiphUkeria.  658 

ileeplng  in  a  itnall,  cramped  np,  air  tight  room,  that  doea  not  oontkin 
Dore  oxygen  than  two  persons  would  oonsnme  in  one  night.  The 
kmily  live  on,  regardless  of  danger,  breathing  carbonic  acid  gas, 
Misonous  azote,  and  the  efflnvia  of  their  own  exhalations.  Some- 
imes  there  is  only  one  small  window  to  the  chamber,  and  that  is 
ipeneraliy  closed,  with  a  blind  or  cnrtain  stretched  across  it,  to  the 
izclnsion  of  light  as  well  as  air.  Sitnated  thus,  they  are  prone  to 
Irowsiness,  and  early  yield  to  the  slnmbers  of  night,  and  while  in 
iiis  negative  condition,  the  treacherons  elements  which  increase  as  the 
>xygen  diminishes,  besiege  the  citadel  of  life,  and  plant  the  seeds  of 
lieease  in  every  fibre  and  cell.  The  maledictions  of  heaven  can  not 
!mll  npon  any  more  befitting  object  than  much  of  the  architecture  of 
,his  country. 

In  order  to  appreciate  the  immediate  and  dire  effects  resulting  from 
I  deficient  snpply  of  air,  no  better  example  can  be  furnished  than 
'  the  black  hole  of  Oalcntta. "  In  this  dungeon  of  eighteen  feet 
(qnare,  with  only  one  small  grated  window,  one  hundred  and  forty- 
pz  persons  were  confined  by  the  nabob  of  Bengal.  As  no  accessions 
)f  frefih  air  could  enter,  great  difficulty  of  breathing  came  on  within 
>ne  hour,  producing  violent  delirinm,  which  filled  the  place  "  with 
incoherent  raving^,  and  cries  for  water.  *'  But  water  failed  in  the 
ilighiest  degree  to  allay  their  thirst.  In  four  hours  many  of  them 
bad  died  from  "  snflbcation  and  in  violent  delirium.  *'  One  hour 
later  nearly  all  the  sufferers  were  "  frantic  and  outrageous  "  —  and 
the  most  of  them  insensible.  Within  the  next  four  hours  all  had 
lied  except  twenty-three,  and  these  were  said  to  be  in  a  "  highly 
pntrid  condition,  "  but  recovered  under  the  influence  of  fresh  air. 

This  example  illustrates,  in  the  most  Ntriking  manner,  the  impor- 
tance of  free  ventilation,  and  a  bountiful  snpply  of  pure  air.  Ac- 
conling  to  Bir  Humphrey  Davy  and  Lavoisier,  the  quantity  of  oxy- 
gen consumed  by  one  person  in  a  minute  is  81-6  cubic  inches,  or 
45,564  cubic  inches  in  24  hours.  This  will  amount  to  about  25 
cubic  feet  per  day,  and  will  render  five  times  that  qnantitj  of  air  un- 
fit for  respiration  and  combustion.  But  this  is  not  all,  for  the  oxygen 
which  disappears  is  replaced  by  about  an  equal  quantity  of  carbonic 
acid,  which  is  wh  Ily  unfit  for  respiration.  This,  when  inhaled  in 
large  quantities,  is  capable  of  destroying  life  with  great  rapidity,  and 
when  continued  for  a  long  time  in  smaller  qnsntities,  it  must  effect 
changes  in  the  blood,  that  will  give  rise  to  serious  disorders.  Fresh 
air  is  always  needed,  because  respiration  is  arrested  before  all  the 
ozTgen  of  the  air  is  exhausted.    This  ottrurs  not  only  on  account  of 


654  Orjifmti  (kmmMni€^4i^9*  [HovepWr, 

ike  cftrboiiic  A^dgiv^.oC  but  «Uo  hecftow  of  tba  rosidnftij  amI^ 
which  it  poisonoiui  in  tJbt  ttacombiiiid  BUUe».ai»d  unfitfor  nffiimtioi. 
Theae  toxic  eleoM^its  an  genecated  hy  o«r8ely«f«  ^and  liiiger  ^lOBiid  m 
$1  til  times.  When  we  au£br  tfae^  io  msoamnlate  in  Qjodne  qoMti- 
tieB,  we  must  tnfier  (he  oonseqaegea^  This  is  ajMBflij  that  asy 
extend  from  sl^ht  indbposition  to  the  most  serious  di/|ordir.  Tb 
Atmosphere,  that  pure  element  adapted  to  tha  natuos  4d  man,  seUkm 
carries  with  it  any  deleterions  sahstaaea*  diffqsad  iwd  nndihisi 
Though  noxious  gases,  arising  from  cess  po^ls  of  filth  aqld  thedsooa- 
position  of  matter,  may  localise  themselves  for  ashorttima  in  limilsd 
portions  of  atmosphere,  near  the  immediate  spot  where  ihej  are  gm- 
erated.  Oarbonio  acid  is  e^ery wbeoe  fop^d  vg^.  the  atmoapheie;  kit 
equally  diffused  through  all  its  parU.  Only  about  1-IOOQ  or  1-1400 
piurt  of  the  atmosphere  is  carboDic  acid*  ba^  t)us  amall  proportisB  of 
the  life  giving  element,  is  inpapable  of.  acting  injarioualf. 

Having  alluded:to  the  fatal  effects  produced' suddenly  by  defidssiy 
of  oxygen,  and  the  liberation  of  deleterious  gsses,  itjnemaiiia  toaotioe 
the  slower  operations  of  the  sai^e  cause  in  the  g^neratioii  of  disessw 
This  applies  not  only  to  man,  but  also  to  the  injbrlor  ^yim^u^  n^i 
crowded  too  closely  together.  In  the  hoi^e  it  is  said  to  j»codssi 
glanders ;  in  fowls  certain  diseases  ;  and  in  sheep  a  peculiar  disoxdv 
from  which  they  die  sometimes  in  great  numbers.  Jail  fevers,  skip 
fevers,  camp  fevers,  &c.,  generally  originate  from  the  same  oause.  Ii 
large  cities  it  exercises  a  pestilential  sway  in  a  thousand  difibitat 
forms,  and  is  the  most  fruitful  source  of  cachexia.  This  evil  infls* 
ence  falls  with  the  greatest  force  upon  the  young,  as  shown  by  tfe 
statistics  of  large  cities ;  and  this  is  particularly  so  with  rsgard  to 
diphtheria.  In  London  the  annual  propoxtion  of  deaths  junder  ^f^ 
years  of  age,  is  not  less  than  40  per  cent,  of  the  whole  number  of 
deaths  ;  and  in  Paris  the  proportion  is  25  per  cenU  of  those  under 
two  years  of  iige.  Diphtheria  attacks  chiefly  those  confined  closelj 
to  uncleanly  and  ill  ventilated  places  -^  to  jLhe  ^lmates  of  ovar-crowd- 
ed  nurseries,  and  bed  rooma  —  while  adults  and  those  who  spend  the 
greater  portion  of  their  time  out  of  doors,  exercising  in  the  open  siTi 
are  seldom  the  victims  of  this  disease.  To  such  local  causes,  embrac- 
ing everything  connected  with  imperfect  hygiene,  I  am  firmly  p^' 
suaded,  diphtheria  owes  its  origin.  I  am. aware,  however,  tbit 
some  writers  attribnte  the  cause  wholly  to  atmospheirio  inflaeeo^- 
What  that  influence  is  —  how  it  operates  «-  they  have  not  attemptK^ 
to  explain.  It  can  not  depend  upon  mare  condUia$u  of  the  atmof* 
phere,  as  they  are  not  capable  jper  m  of  ^generating  any  specific  poisoo. 


1864.]  Emom^  l>ipIMeria.  856 

If  it  ariMB  from  certafn  adventitions  poisons  sbsoriMd  bj  the  atmos- 
phere, it  is  evident  that  these  mnst  have  proceeded  from  loeal  causes, 
such  as  may  be  prodnced  from  chemical  changes,  emanations  from  tbs 
decomposition  of  animal  and  vegetable  matter,  fto. ;  and  if  so,  npon 
what  principle  of  philosophy,  or  reason,  are  we  led  to  oondnde  that 
they  act  with  more  vigor  in  the  generation  of  diseases,  when  diflfased 
throngh  the  atmosphere  in  a  dilated  state,  than  when  local,  enoiroling 
the  focus  of  their  origin,  and  in  a  form  of  greater  density  ? 

Diphtheria  presents  many  points  about  which  there  still  exists  the 
greatest  discrepancy  of  opinion.  Some  regard  "  the  false  membranes 
layers  of  coagulated  mucus  mixed  with  epithelial  scales,  and  gradu- 
ally concreting  and  solidifying  into  tubes  and  casts  "  ;  whilst  others 
consider  them  as  proceeding  from  granulation  or  exudation  cells,  and 
the  results  of  inflammation  of  a  low  and  aplastic  character,  which 
depend  upon  some  cachexia  of  the  system,  or  broken  down  condition 
of  the  constitution.  But  this  theory  is  negatived  from  the  fact  tbat 
diphtheria  is  not  confined  in  its  action  to  persons  of  depraved  consti- 
tntions.  Before  the  peculiar  exudation  takes  place,  there  is  no  change 
in  the  relative  proportion  of  the  blood  ingredients,  no  excess  of  fibrin 
or  deficiency  of  red  corpuscles.  Bnt  after  the  disease  has  made  some 
progress,  the  blood  appears  to  undergo  rapid  deterioration  in  all  its 
Titalizing  properties,  and  the  whole  system  sympathises  in  a  remark- 
able manner  with  thene  changes.  According  to  recent  physiological 
investigations,  the  opinion  is  maintained,  that  the  oxygen  taken  by 
the  air  into  the  lungs  is  carried  to  the  distant  capillaries,  where  com- 
bustion alone  takes  place,  and  by  its  assistance  secretion  and  all  the 
fanctions  of  animal  life  are  carried  on.  From  this  it  would  follow, 
that  when  the  supply  of  oxygen  is  greatly  deficient,  and  the  blood 
surcharged  with  carbonic  acid,  asote,  and  other  poisonous  matter  in 
the  form  of  noxious  exhalations,  that  healthy  secretion  mnst  be 
arrested  from  the  want  of  vitalising  power,  and  in  its  place  abnor- 
mal, amorphous  or  inorganic  formations  be  substituted. 

There  is  no  disease  about  which  a  greater  amount  of  discrepancy 
exists,  in  the  etiology,  pathology  and  treatment,  than  diphtheria. 
Hiose  who  have  witnessed  it  in  all  its  forms  and  phases,  with  its  long 
a9d  inexplicable  train  of  constitutional  symptoms,  embracing  all  the 
•eqneic  of  chronic  malignant  cases,  will  be  apt  to  regard  it  not  only 
as  a  disorder  of  the  most  troublesome  and  aerioos  character,  bnt  one 
diabolical  in  its  nature.  . 

The  prognosis  of  diphtheria  is  grave.  Mild  oases  may  terminate 
in  convaleaoenoe  in  a  few  days  with  but  Kttle  treatment,  and  often  in 


VMlPittPf  'QiHMIIIHIipppM*  £JrafniMi!ff 


ginniDg,  or  of  the  kiakliotts  kiad,  will  peijbk  nndmr  Uie  mpol  prompt 
wad  boat  dirMod  ireoiiiiool.    JBit  irhea.dM  g^xmiJi  ojinptosis  Mt  ift 
w4di  soTority,  with  grpoi  «w0lUqg  ahoo^  ib»,^R)fttr  ii^enud  and  ci- 
toniaU  eztonoiveiexQdatioii  of  ^^^  membroiM^  and  crovpal  coiigii« 
ti)6  danger 'i«  alwayi  imtniacAk  -  It^  iadicaCet.  Iba  axtonaioii  of  the 
false  mottbrnaes.  to  Ihe  larynx  vaod  .U»oheai:  and  tliat  thara  is  daagar 
of  a  fatal  result  fron  aephyxi^.    l^oy  (Mia  wih  iapiOTe  andcr 
treatmeiii  mtiil  •the  local  ay  mpiOBia*  bave  abalad  or  eQtirely  disappttr- 
ed,  and  con^aleacanae  aeema  to,  ba  fully  aetabUelwd»  when  anddenly, 
and  without,  pivmoaicion,  a  new  ttaia  mf  ayinpioma  of  a  daagerou 
and  perplexing  natare  will  ariee*  and  the  anfferer  will  aither  die  juj 
anddenly,   or  linger  weeka^  or  mofitba,  einili  to  the  loweet  ebb  of 
TitaHty,  before  doaih  will  oloee  the  aceae*  or  recovery  take  piece. 
Vrom  oertaiv' inexplicable  caoeeet  aew  pathologieal  aymptoms  aie 
«!eprodacedy  and  iheee  are  generally  fur  more  aeriona  and  tronbkeoBM 
llian   the  -first  symptoms.    .  Among  iheee  eeqnelsi  I  have  notioai 
spasms  ;  choking  or  saffocatjng  sensations^  as.  if  aome  fomgn  body 
were  impacted  in  the  air  passages*,  beyond  the  atrength  of  the  pstieet 
to  dislodge,  hy  efforts  of  congbipg »   wonderful-  depraaaion  in  tbe 
epigaBtric  region ;  frequent  faintings  ;  exMraordinary  foeblenees  of  the 
pulse,  or  lifeless  circulation  of  the  blood;  incessant  nauaea,  accompA- 
nied  with  frequent  vomiting,  and  the  vejection  of  all  kinds  of  food 
and  medicines  ;  rapid  emaciation  ;  pallor  ;  extreme  muscular  help- 
lessness ;  pains  in  the  joints*  sides  and  bowels  ;  fugitive  pains  in  all 
parts  of  the  body  ;  cold  extremities ;  diminished  sensations ;  psralj- 
sis  of  the  limbs  ;  feebleness  of  the  voice  ;  functional  disturbances  of 
Tision,  such  as  presbyopia*  dilated  pupils*  and  amaurosis.     All  tbsM 
symptoms  I  have  known  to  occur  in  convalescent  pati^its*  after  all 
the  local  trouble  had  disappeared,  and  too*  when  they  were  taking 
iron,  quinine,  and  nutritions  food  in  abundance*  and  had  been  kept 
on  such  treatment  from  the  beginning.    The  muscular  debility  is  ho 
great  in  some  cases  that  the  legs  will  not  support  the  body,  or  inter- 
pose the  slightest  resistance  to  prevent  :the  patient  from  falling,  if 
placed  upon  his  feet;  the  arms  will  hang  to  the  sides   like  useless 
incumbrances  ;  breathing  and  swallowing  will  become  almost  impos- 
sible, and  the  former  sometime  imperceptible ;  yet  amidst  all  of  this, 
with  the  frequent  faintings  and  spsema^  reason  flashes  out  at  intervals 
and  seems  "  to  illuminate  the  countenance  of  death*.  *' 

About  the  15th  day  of  last  MasehX  w|m  called  to  visit  a  boy  1^ 
years  of  age,  who  was  attacked  with  di|phth|sria»    The  disorder  com- 


1864.]  Hatmovd— i>tpMAma.  657 

menoed  with  a  ohill  of  oonsidarabl^  seventy,  followed  with  fever, 
•welliog  about  the  glands  of  the  neck,  with  some  hypertrophy  of  the 
tonsils,  and  the  Uhnal  exndation  of  false  membrane.  In  this  case  the 
false  membranes  extended  throngh  both  nostrils,  and  appeared  to  be 
the  caoee  of  a  tronblesome  eruption  on  the  upper  lip,  around  the  an- 
terior nares.  With  very  little  and  simple  treatment  this  patient  be- 
came convalescent  in  a  few  days,  and  was  able  to  go  out  and  do 
light  work.  He  seemed  to  be  annoyed,  however,  for  some  time  after- 
wards, with  the  false  membranes  retained  in  the  nostrils,  which  kept 
him  continually  blowing  and  picking  at  his  nose.  In  the  meantime 
other  members  of  the  family  were  attacked  with  the  disease,  and  it 
continued  to  previil  among  them  without  intermission  for  a  period  of 
nearly  four  months  In  a  month  after  the  patient  alluded  to  was  at- 
tacked, he  was  suddenly  taken  down  with  the  disease  again.  The 
second  attack  was  even  more  violent  than  the  first,  and  was  charac- 
terized by  a  similar  train  of  symptoms,  except  the  pseudo-membran- 
ous formation  in  the  nostrils.  He  recoveied  rapidly  from  thn  second 
attack,  and  went  about  as  usual  A  few  weeks  later  he  became  afflict- 
ed with  the  disorder  the  third  time,  but  suffered  less  than  in  either  of 
the  preceding  attacks.  There  was  nothing  remarkable  about  this  case 
except  the  repeated  recurrence  of  the  disorder,  after  lengthy  intervals 
of  convalescence.  The  qnestion  arises  in  this  case,  did  a  portion  of 
the  toxic  element  remain  in  the  blood  as  a  nucleus  for  the  regenera- 
tion of  the  disorder,  or  was  the  disease  reproduced  by  the  same  excit- 
ing causes  that  gave  origin  to  the  first  attack  ?  In  about  a  week 
after  this  patient  was  first  attacked,  two  other  members  of  the  family, 
m  boy  aged  14  years,  and  a  girl  of  10,  were  attacked  simultaneously 
with  diphtheria,  in  a  malignant  form.  The  disease,  in  both  cases,  set 
in  with  chill  and  fever,  and  was  characteriaed  by  well  marked  sthenic 
action.  The  external  swelling  about  the  throat  and  neck  was  very 
great :  the  tonsils  were  greatly  swollen,  and  covered  with  thick,  ten- 
acioua  membranes.  In  the  boy  the  tonsil  ^  were  so  extremely  byper- 
tropliied  as  to  crowd  upon  each  other,  and  the  whole  neck  on  both 
aidea  from  the  ears  to  the  clavicles  were  enormously  swollen,  and  the 
tonails  velum  and  fauces  covered  with  false  membranes  which  would 
reform  upon  the  same  surfaces,  as  rspidly  as  portions  were  removed. 
The  cough  soon  became  croupal,  with  extension  of  the  false  mem- 
branea  to  the  larynx  and  trachea,  producing  great  difficulty  of  breath- 
ing, and  death  ham  asphyxia  in  about  a  week.  In  this  case  the  falsa 
membranes  were  thick  and  heavy,  and  it  was  impossible  to  detach 
them  from  the  larynx,  or  if  any  escaped,  others  soon  formed  in  their 


658    .  (Mgimd^  -Ci^timummiHmiki  f Novembeit 

place.  Th^  l^t  denisaiitr^tiiioiiti  ooattiftiilioMil  and  locd,  Mled  to 
effect  any  good.  In  die  esse,  of  the  gtri^  the  fever  was  of  a  less 
sthepic  grade,  aiidj  was  alieadedi  with  less  swelltng  aad  faTpertrophy  ; 
but  the  tendency  to  the  £;MmQtation  of  false  memfairafaes  was  «zoeediiig1y 
active,  and  continued  ahooti three  weeks*  Th(»  aKtemai  swelling  be- 
hind the  angles  of  the  jaws  waai very  hard,  and  reioamed  so  a  long 
time^  but  gradaslly  declined*,  and  disappeared  under  frequent  appli* 
cations  of  the  tiaoturorof  iodine«  Convsteeenoe  appeared  (to  be  fully 
established  at  thjB  ead  of  three  weeka«T^  false  mainbraaeB  disappeared 

—  swelling  entirely  subsided —r  and  the  patient  .running  aboat  the 
house,  and  able  tp  take  her  meals  at  the  table.  Suddenly*  and  with- 
out any   premonitory  disturbances,  a  train  of  the  most  alarming 

,  symptoms  set  in ;  scich  as  complete  prostration  of  the  whole  system 

—  muscular  helplessness  -r-^incesssnt  vomiting  -^spasms  -^  choking 
sensations  —  cold  extremities  —  feeble  circulation  of  ^e  blood. 
To  meet  these  iiidicatioas  I  resorted  to  tonics,  stimulants^  supporting 
nourishment,  4^.  But  iuia  short  time,  tiie  stomach  utteriy  refused 
to  tolerate  either  medioine  or  food  ;  and  it  was  with  the  greatest  ^diffi- 
culty that  a  sufficient  quantity  of  nourishment  was  retained  to  support 
life.  By  this  time  the  disease  hadtextended  to  all  the  rematniag  chil- 
dren, viz  :  an  infant,  and  two  girls,  one  aged  &,  and  the  other  16 
years.  There  was  no  constitutional  cachexia  of  any  kind  belonging 
to  the  family,  and  the  afflicted  ones  had  previously  evinced  all  the 
characteristics  of  good  health  and  sound  constitutions.  But  they  had 
all  been  kept  pent  up  in  an  almost  air-tight  room,  where  the  whole 
family,  eight  in  number,  had 'slept  during  the  rough  and  changeable 
weather  of  March.  The  room  was  kept  continually  heated  to  a  high 
temperature,  and  every  aperture  to  ventilation  closed,  in  order,  as 
they  conceived,  to  prevent  "taking  cold  ''  ;  for  every  change  for  the 
worse  in  those  afflicted,  was  charged  to  the  admission  of  a  little  fresh 
air.  Finding  it  impossible  to  effect  the  changes  in  ventilation  neces- 
sary to  preserve  the  life  of  the  second  patient,  I  had  her  moved  to  a 
neighboring  house,  where  there  was  an  abundant  supply  of  pure  air. 
This  chaoge  produced  a  salutary  effect  immediatety^  and  she  continu- 
ed to  improve  for  several  days;  until  she  was  brought  home  on  a 
visit,  and  allowed  to  sleep  one  night,  in  the  same  room  where  the  otb- 
ers  were  confiiied,  aod  breathe  its  contaminated  air.  This  caused  an 
immediate  relapse^  which  was  worse  in  all  reepeots  than  the  preced- 
ing. She  became  palUdii  pulseless,  skin  as  cold  as  death  .^^deglntiticm 
nearly  impossible;  bre^ng  scarcely  percq>tible;^a8m  followed 
spasm  until  it  ^eem^.  there  waa  not  enough  vitali^  remaining  to  en- 


1S64.]  KkYUom^^  Diphtheria.  659 

dare  another;  yet  amidst  all  these  disturbances  there  was  an  occa- 
aienal  flash  from  the  eje  that  seemed  to  bid  defiance  to  death. 
Strangely,  she  continued  to  live,  though  unable  for  days  to  take,  on 
an  average,  half  a  dozen  tea-spoonfuls  of  nourishment.  After  suffer- 
ing a  lingering  illness  of  nearly  four  months,  and  struggling  through 
a  succession  of  varied  constitutional  nymptoms,  she  entirely  recover- 
ed. In  the  other  three  cases,  the  same  prostration  occurred,  attended 
with  a  similar  train  of  consfitational  symptoms,  af\er  the  subsidence 
of  the  local  trouble.  These  cases  were  very  annoying  to  me,  though 
the  symptoms  were  not  so  serious  as  in  the  former  case.  In  the  old- 
est girl  the  disease  was  asthenic  from  the  commencement.  The  ten- 
dency of  the  pseudo-membranous  formation  was  principally  to  the 
bronchial  mucus  membranes.  In  this  case  there  was  considerable 
functional  disturbance  of  vision,  amounting  to  complete  inability  to 
read  print  of  ordinary  size.  In  the  six  cases  all  recovered  except  one. 
The  greatest  discrepancy  continues  to  exist  with  regard  to  the 
treatment  of  diphtheria.  The  whole  field  of  the  materia  medica  has 
been  ransacked  for  remedies,  and  many  of  them  have  been  thought 
to  possess  specific  virtues.  So  many  conflicting  plans  of  treatment 
have  been  recommended,  that  the  subject  is  enveloped  in  confusion. 
Nothing  proves  more  clearly  than  this  that  there  is  no  specific  remedy 
for  diphtheria,  or  at  least  none  has  yet  been  discovered.  But,  not- 
withstanding this,  we  are  in  possession  of  many  facts  and  much 
knowledge  that  will  serve  to  g^ide  us  in  our  course.  With  a  correct 
knowledge  of  the  constitutional  nature  of  the  disease,  and  its  general 
tendency  to  asthenia,  tho  practitioner  will  not  be  likely  to  commit 
serious  mistakes,  by  the  improper  use  of  -antiphlogistics,  and  such 
remedies  as  tend  to  reduce  vital  action.  As  there  is  no  specific 
treatment  for  diphtheria,  we  must  be  governed  in  some  measure  by 
general  principles,  and  call  into  action  whatever  agents  or  forces  that 
may  be  reqoiced  to  meet  its  indications.  Where  there  is  sthenic  ac- 
tion, witk  high  grade  of  fever,  cathartics,  diuretics,  sedatives,  diapho- 
retics, and  anodynes  may  be  used,  and  should  in  such  cases  always 
precede  the  administration  of  tonics  and  ferruginous  preparations. 
Through  the  emanctories  of  the  liver,  skin,  bowels  and  kidneys,  we 
cnn  accomplish  much  in  the  elimination  of  the  toxic  element  from  the 
system ;  eflfecting,  in  many  cases,  all  that  is  required  in  the  way  of 
treatment.  In  a  robnst  patient,  with  high  arterial  excitement,  a  brisk 
purge  thonld  be  administered  at  the  commencement,  and  this  should 
consist  of  calomel,  cembined  with  rhubarb,  jalap,  or  the  powdered 
extract  of  colocynth.    So  more  mercnry  should  be  given  in  the  case 


660  OipMo/  CommMnkUuma.  [KoTcmlwr, 

unless  (bere  U  maDifest  disonler  of  the  hepatic  runctiona.  The  bow- 
els shoiilU  be  kept  nell  opened,  bat  active  purgation  ahoiitd  uot  be 
resorted  to  afterwards.  In  astbenic  cases,  active  purgation  BhonM 
be  cerefnlly  avoided  from  ibe  beginning,  and  only  mild  cathanics  or 
laxatives  given  to  keep  open  the  bowels.  We  should  next  seek  for 
some  reniedj  calculated  to  act  upon  the  morbid  influence  in  the  blood. 
It  haa  been  disputed  by  many  vrnters  whether  eoch  a  remedy  has  yet 
been  discoveied.  But  it  is  a  pnpnlar  opinion  among  physicisns  both 
in  this  country  and  in  Europe,  tbat  we  poseeas  such  an  agent  in  chlo- 
rine and  its  salts ;  and  the  one  specially  selected  is  (he  chlorate  of 
polassa.  How  it  acts  upon  the  morbid  matter  in  the  blood  has  not 
been  satisfactorily  expluined.  It  probably  exerts  its  beneficial  iiifln- 
anceby  virtue  of  its  antiseptic  properties  —  by  some  anti-fernieDling 
power  that  is  capdble  of  preventing  one  morbid  atom  from  developing 
others.  Perhaps  tbe  chlorides  of  soda,  lime  aod  potassa,  would 
prove  equally  beneficial.  The  chlorato  of  potassa  should  be  admin- 
iltcrcd  in  large  doses  in  all  malignant  cases,  and  at  abort  intervale. 
As  much  aa  from  8  to  20  grains  bhould  be  given  every  two  or  three 
hours,  according  to  the  grade  of  the  disorder,  and  the  age  of  the 
patient.  No  better  formula  can  be  eelecled  for  its  administiation 
than  that  furnished  by  Dr.  LambJen.  H'.r  forninls  is  chlor.  Potass. 
3jj  ;  Hydrochloric  acid  3j  ;  water  f.  J  viij.  Dose  of  this  miztnre 
from  half  an  ounce  to  an  ounce.  In  a  great  many  cases  no  other 
oonstitutional  treatment  will  be  required  ;  and  even  thisis  not  always 
needed.  Bat  whenever  eigne  of  debility  appear,  such  as  a  feeble 
pulse,  moist  or  clammy  skin,  &c.,  quinine  should  be  given  in  suffi- 
oienl  quantitiesto  meet  these  indications.  I  prefer  it  should  be  ad- 
ministered in  small  doses,  frequently  repeated,  eo  as  to  eustain  a  mod- 
erate stimulation  of  the  nervous  system.  The  best  form  for  its  admin- 
istration is  in  solution  with  hydrochloiic  acid  and  water.  By  this  we 
obtain  in  addition  to  the  quinine,  tbe  tonic  and  antiseptio  virtues  of 
the  mineral  acid.  Along  at  tbe  same  time  the  quinine  is  given,  or 
afterwards  it  may  be  necessary  to  prescribe  iron  in  some  form.  This 
is  not  required  in  all  cases,  bat  ehonld  be  administered  whenever  dn- 
terioration  of  the  red  capsules  of  the  blood  becomes  manifest.  Oth- 
erwise it  can  not  possibly  do  any  good.  Tbe  administration  of  qut- 
■ine  and  iron  indiscriminately  in  all  cases,  as  is  tbe  cnbtom  of  manj 
prftctitionere,  simply  because  the  disease  is  dipbtheria,  can  not  be  too 
■trongly  condemned.  The  great  majority  of  cases  will  recover  with- 
oat  either.  It  is  sufficient  always  to  prescribe  a  remedy  when  the 
prop«r  indications  viviz  \  ot.^etrwise  it  most  do  barm  ratber  than  good. 


1864]  TlAYUom^DiplUkiria.  661 

Iron  will  generally  be  required  in  the  seqnelaB  of  chronic  cases,  and 
iu  use  often  indispensable.  Among  the  preparations  given,  prefer- 
ence has  generally  been  given  to  the  tincture  of  the  chloride.  It  is 
preferable  to  the  dry  preparations  of  iron,  on  account  of  the  hydro- 
chloric acid  which  it  contains,  and  also  because  it  is  absorbed  more 
readily  into  the  circulation.  8ome  enthusiasts  have  gone  so  far  as  to 
claim  specific  virtues  for  the  tincture  of  the  chloride  of  iron  in  diph- 
theria. This  opinion  is  incori-ect.  Iron  is  no  more  a  specific  in 
diphtheria  than  any  other  drug,  but  is  given  merely  to  meet  an  indi- 
cation that  arises  frequently  in  the  disorder ;  vis :  to  increase  the 
hematosin  of  the  blood.  It  should  be  given  in  doses  suited  to  the 
age  of  the  patient,  and  the  necessities  of  the  case.  The  soluble  citrate 
of  iron  is  an  excellent  preparation,  especially  for  small  children,  and 
may  be  combined  with  other  ingredients,  rendering  it  more  agreeable 
to  the  taste  than  the  tincture. 

It  must  not  be  forgotten  in  diphtheria,  that  an  abundance  of  pure 
air,  and  free  ventilation,  are  tndUpensabie.  A  change  from  the 
vitiated  atmosphere  of  the  cloi^ely  confined  sick  room,  to  a  well  ven- 
tilated chamber,  or  the  open  air  in  pleasant  weather,  will  often  pro- 
duce the  most  salutary  effects  ;  and  if  made  early,  will  generally  pre- 
vent the  disease  from  assuming  the  chronic  form,  and  avert  an  evil 
train  of  scquelse.  Among  the  therapeutical  agents  that  have  been 
mentioned,  I  would  strongly  recommend  that  a  lair  trial  be  made  of 
the  chloridcR,  especially  the  chloride  of  potassa.  The  chloridcH  have 
been  tried  with  the  most  gratifying  results  in  several  infectious  blood 
diheases  of  animals,  and  it  is  highly  probable  they  would  prove  ben- 
eficial to  the  contaminated  blood  in  diphtheria. 

In  treating  the  chronic  sequelae  of  diphtheria,  we  must  in  a  great 
measure  be  governed  by  general  principles,  and  treat  each  symptom  or 
condition  as  it  arises.  Tonics,  stimulants,  and  a  generous  diet,  will  be 
required.  Among  the  tonics  iron  is  the  chUf,  and  it  is  specially  in- 
dicated in  these  cases.  The  simple  vegetable  tonics,  bark  and  the 
mineral  acids,  may  be  used  often  with  advantage.  Among  the  slim- 
ulantK,  wine,  brandy  or  whisky,  of  the  alcoholic  kind,  and  other 
forms,  such  as  carb.  ammonia,  turpentine,  ether,  dec,  will  be 
often  required,  to  sustain  the  patient  in  thin  low  condition.  When 
the  powers  of  assimilation  are  loo  weak  to  tolerate  food  and  medi- 
cine taken  into  the  stomach,  we  most  attempt  to  introduce  them  into 
the  system  through  other  channels.  Tlie  endermic  application  of  cod 
liver  oil,  wine,  brandy,  and  milk,  will  sou\eV\isv««  \>^  ^<^\sw%^^^^>  v^ 
desperate  esses.     Frequent  bathing,  and  IncXiv^n*  on^t  >\>ft  >iVv\^%^ 


663  Oriffiaal  ConmmmealioiM.  {Vanmibu 

'■  face  of  the  body,  witib  BtloitilaHng  mbrMttioM,  will  bo  fobiM  Itae- 

fieial.  Wlipn  ihcre  ia  paralywis  of  tbe  limbs,  bcnefil  may  be  derind 
frum  email  doses  of  gtiycbnin,  ivbich  lORy  be  adminislered  la  itilote 
Bcetiu  acid,  w»ier  and  aimple  syrup.  If  this  Bhooli!  fail,  our  next 
tesorl  would  be  oJeftrictty.  Funftional  derangement  of  vision,  will 
generally  yield  to  the  ii)Baeni»  of  tonii-H,  or  what  eer  meana  will 
tend  to  the  invigoratioii  of  tbe  whole  syBtera.  In  one  «»se  I  dertred 
good  results  from  the  iodide  of  potasRa.  Bnt  the  most  important 
remedy,  in  all  these  adynamic  oonditionR  of  diphtheria  is  oxygeo. 
It  IB  only  recently  'that  oxygen  has  attracted  much  Btteotioii  as  a 
therapeutic  agent  of  great  v^iiue;  and  there  is  no  disease  in  which 
it  exerts  a  more  benefieial  effect  than  in  diphtheria.  The  blood,  ia 
this  disorder,  iindorgoes  degunerution  through  tbe  want  of  some  vital- 
izing power  ;  and  there  ia  no  agent  that  can  so  rapidly  supply  this 
deficiency  as  oiygen.  To  conclude  with  the  geaerai  treatment  of 
these  perplexing  and  desperate  c^a^es  of  dipbiheria,  it  ia  only  necessa- 
ry to  say  that  we  will  often  have  to  depend  upon  our  ingenuity,  and 
mnst  invoke  all  the  dynamic  forces  of  the  medical  art,  in  search  of 
means  to  snatch  our  patients  from  tbe  clutches  of  death. 

There  exists  among  physicians  a  great  deni  of  discrepancy  wiib 
regard  to  the  local  UGaiment  of  diphtheria.  Whilst  eomc!  denounce 
local  means  altogether,  others  have  placed  great  dependence  npon 
their  efficacy,  and  have  brought  forward  and  recommended  a  great 
variety  of  articles  belonging  lo  their  class.  Out  of  this  mass  of  rnb* 
bish  we  may  select  enough  for  our  purpose,  that  ia  reliable,  and  let 
the  rest  slide.  In  our  choice  we  should  select  those  most  reliable,  aad 
the  least  annoying  to  our  patients.  The  ose  of  Misters  is  a  pernicious 
practice,  and  should  never  he  countenanced.  They  add  greatly  to  the 
distress  of  the  patient,  withont  mitigating  in  the  least  d^ree  the 
internal  symptomx,  or  arresting  the  formation  of  tbe  false  membranes 
within.  The  same  may  be  said  with  regard  to  sinapisms,  or  any 
thing  calculated  to  impair  tbe  integrity  ot  the  skin.  But  mild  coun- 
ter-irritation with  volatile  liniment,  or  the  same,  with  the  addition  of 
camphor  and  turpentine,  will  perhaps  accomplish  all  the  good  that 
can  be  derived  from  this  class  oi  remedies.  This  shonld  be  used  in 
the  early  st^es  of  the  swelling,  while  it  is  soft,  and  yields  readily 
under  pressure.  The  bacon  skin,  or  slip  of  iat  bacon  applied  about 
the  throat,  has  many  advocates  who  attribute  lo  it  beneficial  rasults. 
It  acts  as  an  emollient,  softening  tbe  parts,  and  diminishing  their 
eobefioQ.  Some  have  recommended  rubbing  the  throat  with  cod 
lirer  oil,  or  olhei  oleaginous  substance ;  but  this  is  less  convenient, 


1864.]  ..UjmiOMik^^J)ipkik9Ha.  663 

and  perhaps  not  more  efficacious.  The  external  nse  of  cold  water  has 
been  recommended  by  lof  nj.  «  My^ -^perience  wonld  not  lead  me, 
however,  to  conclude  that  it  efiects  any  beneficial  inflnence.  But  after 
the  external  sw^ling  has  become  hard  and  unyielding  to  pressure, 
then  it  is  that  we  will  find  iodine  prodneing  happy  dflfbcts.  Either 
the  tincture  .or  the  ointment  should  be  applied  as  ofteniae  four  to  six 
times. per  day. 

Witb  rsgard  to  the  internal  ioFpieal  treiitment,  there  are  wide  diflfer- 
enoes  of  opinion  inibe  profession^  ^Specially  with  respect  to  caustics. 
But  it  appears  to  me  thai  the  advooates  and  opponents  of  cliusttcs, 
have  not  undentood  eaeh  other  with  reference  to  the  eondttioas  Utfder 
which  they,  eheuld;  be  employed  or  rejeeted.  This  ie  a  subject  tba^ 
requires  great  discrimination^  and  of  which  I  have  dome  to  the  fol- 
lowing oondnsioBS :  When  there  is  excessive  hypertrophy  of  the 
tonsils,  with  thick  and  heavy  Jalse  membranesii  and  threatenSng  dan- 
ger to  the  larynx,  the  solid  nitrate  of  silver,  era  very  strong  solution 
of  the  same,  if  more  convenient,  should  be  applied  so  as  to^  (cauterize 
all  the  inflamed  parts  within  reach.  This,  if  efieotuaHy  applied, 
should  not  be  repeated  oftener  than  once  a  day,  and  only  during  the 
period  of  great  danger.  Sometimes  two  or  three  applications  will 
accomplish  all  that  is  required.  Caustics  do  not  destroy  the  false 
membranes*  bat  seem  to  produce  some  healthy  change  of  the  hyper- 
trophied  surface.  In  these  serious  cases,' weak  solutions  of  "nitrate  of 
silver  can  not  be  depended  npon  ;  but  where  the  internal  inflammation 
is  not  great  and  threatening,  with  light  and  thin  false  membrante, 
only  weak  solutions  of  the  canstie  should  be  employed.  In  such 
cases  I  seldom  use  a  stronger  solution  than  ten  or  fifteen  g^its  to  the 
fluid  oz.  of  water*  which  is  carefully  applied  to  the  throat  twice  a 
day,  with  a  fine  sponge  probang.  At  short  intervals  between  the  ap- 
plications of  caostic  mild  gargles  may  be  used.  They  oAen  aftord 
relief  to  the  distressing  feelings  about  the  throat,  and  assist  in  detach- 
ing and  bringing  away  portions  of  the  constantly  forming  membranes. 
A  host  of  gargles  have  been  recommended  and  tried  ;  but  perhaps  a 
few  of  the  simplest  kind  are  the  most  efficient.  1  have  found  nothing 
to  answer  bettor  than  the  following :  ]k  chlorate  potaasa  3j  ;  chloride 
of  sodiam  3ij  ;  water  f.  S^ii}*  This  is  beat  adapts  to  the  early 
stages  of  the  disorder.  After  the  disesee  hae  become  somewhat 
ehronic,  with  hypertrophy  of  the  tonsils,  the  iodide  of  sine  in  weak 
solution  may  he  substiuited  for  the  above,  and  may  be  relied  upon  ak 
a  valuable  adjuvant  in  the  tvaatasnt. 


664  Xh^^bM  OanmwnedHaiu.  LNoremWr, 

ABTIOLI  n. 

Ruptured  T7l«rii$. 

BT  S.  I.  J0MK8)  M  D.,  W^PSLLO,  IOWA. 

I  was  called  on  the  ibrenoon  of  the  20tli  of  August  last,  to  see  Mrs. 

E ,  in  her  fifth  aeconohment.    She  had  heen  in  labor  for  two  dajs, 

and  wa«  attended  by  a  woman  who  pretends  to  be  a  hydropathic  ph  jf - 
ieian.  Upon  my  arrival  I  found  the  patient  in  an  extreme  state  of 
prostration,  pnlse  so  rapid  and  indistinot  as  not  to  be  counted  at  the 
wrist,  extremities  cold,  countenance  anxioos,  pains  rery  severe,  hot 
accomplishing  nothing  toward  d^iv^ry.  An  examination  revealed 
the  head  of  the  child  far  np ;  the  amnionic  liquid  having  been  dis- 
charged several  hours  before,  the  uterus  was  irregularly  contracted. 
The  vagina  was  dry,  and  the  soft  parts  very  much  swollen,  and  ex- 
tremely tender  to  the  touch,  propably  owing  greatly  to  too  much 
manipulation  on  the  part  of  the  woman  in  attendance. 

As  the  patient  seemed  to  have  suffered  already  about  aa  much  a> 
her  system  was  capable  of  enduring,  my  first  thought  was  to  turn  and 
deliver  the  child  as  speedily  as  possible,  out  in  this  attempt  I  failed  ; 
not  being  able  to  introduce  my  hand,  though  well  oiled,  on  account 
of  the  swelling  and  soreness  of  the  parts  with  which  it  came  in  con- 
tact. I  then  gave  her  a  small  portion  of  brandy,  repeating  ic  every 
fifteen  minutes.  At  the  end  of  an  hour  the  evidences  of  prostration 
had  very  much  disappeared,  the  pulse  was  fuller  and  less  frequent 
pains  of  an  expulsive  character  returned,  the  case  progressed  favora- 
bly for  about  an  hour,  and  I  was  congratulating  myself,  and  encour- 
aging the  friends  with  the  prospect  of  a  speedy  favorable  termination 
of  the  case,  when  after  a  few  moments  absence  from  the  room,  I  found 
her  vomiting  incessantly.  Labor  pains  had  ceased  entirely  with  evi- 
dences of  rapid  prostration.  On  examination  I  fonnd  the  head  had 
receded  almost  beyond  the  reach  of  the  finger.  I  now  placed  my 
hand  upon  the  abdomen  and,  to  my  dismay,  distinctly  perceived,  not 
the  feet  only  but  also  the  body  of  the  child  in  the  mother's  abdomen 
above  the  womb,  whither  it  had  escaped  through  what  was  after- 
wards found  to  be  a  large  transverse  rupture  of  the  fundus  uteri. 

I  at  once  informed  the  lady's  husband  of  the  nature  of  the  case,  and 
asked  for  assistance,  when  Dr.  Bums  was  immediately  called.  We 
decided  to  put  the  patient  under  the  influence  of  chloroform  and  at- 
tempt the  delivery  by  version  through  the  rent  in  the  uterus,  which 
was  accomplished  \n  Wt  Uale  more  than  half  an  hour  after  the  oc- 
currence of  t\\e  acc\d^xxX, 


1864.]    "  Jon^^JUqOured  UUru$.  665 

Th«  woman  was  made  as  comfortable  as  possible  in  ber  bed,  and 
lar^  portions  of  morphine  4}rected»  with  bnt  little  effect  however  of 
relieving  ber  suffering.  Sbe  died  aboat  four  o'clock  of  tbe  following 
morning,  abont  seventeen  boars  after  tbe  mptnre. 

This  is  one  of  these  extremely  tinfoHnnate  vcases,  upon  which  tbe 
physician,  after  doing  all  tbatjie  can,  reflects  with  sadness.  Had  we 
tbe  means  ef  forseemg  these  accidents,  we  might  be  able  to  avert  them, 
bnt  nnfbrtanately  tbe  first  intimation  of  their  oscnrrence  is  the  reve- 
lation of  the  accident  itself. 

The  patient  in  this  case,  bad  fiillen  npon  tbe  floor  eight  days  before 
ber  confinement,  which  had  probably  cansed  the  death  of  ber  child, 
altbongh  she  thought  sbe  bad  perceived  its  movements  afterwards, 
bnt  of  which  sbe  was  not  certain.  The  evidences  of  decomposition 
in  the  child  were  sncb  as  led  to  tbe  conviction  that  it  bad  been  dead 
for  several  days,  and  no  donbt  from  tbe  fall  referred  to  above.  Al- 
tbongh there  was  no  post  mortem  examination  in  this  case,  I  am  cer- 
tain there  was  softening  of  ibe  oterns,  both  from  its  appearance  to  tbe 
tench  at  tbe  rent,  nd  also  from  the  fact  that  tbe  pains  were  not  suf- 
ficiently strong  to  cause  tbe  accident  without  some  obstruction  to  tbe 
passage  of  tbe  child. 

The  lesson  which  this  case  enforces  upon  my  mind,  is  the  impor- 
tance of  gaarding  against  |tbat  extreme  prostration  of  system,  which, 
although  a  young  practitioner,  I  have  met  with  in  several  cases  ;  and 
when  that  condition  is  unavoidable,  the  importance  of  spee#ly  delivery. 
If  labor  is  prolonged  for  a  consideral  time  after  tbe  discharge  of  tbe 
liquor  amnionic,  tbere  will  be  irregular  contraction  of  the  uterns  about 
the  body  of  tbe  child,  a  condition  which  will  very  mnch  hinder  its 
expulsion  power,  and  induce  a  greater  degree  of  prostration  on  ac- 
count of  tbe  delay  which  it  occasions  ;  and  tbe  difficnlty  of  delivery 
by  artificial  means  will  increase  with  every  hour  which  elapses  after 
this  condition  aapervenes. 

If  the  woman  in  attendance  bad  turned  and  delivered  the  child  upon 
the  first  evidence  of  prostration,  or  bad  tbe  forcepts  been  used,  there 
might  have  been  a  safe  termination  of  this  case.  Believing  the  child 
to  be  dead,  I  would  probably  have  performed  craniotomy  when  I  found 
it  impractable  to  turn,  bad  I  been  in  possession  of  instruments ;  but 
there  were  none  within  twelve  miles  so  I  trusted  to  nature  to  do  the 
work,  which  she  was  unable  to  perform. 


666  BomM  lU^arU.  {TSow^ 


iotfitil-Stfirdt. 


Marine  U.S.  OeMral  Hotpltel,  OlaelBiiatl.    Bot^  J.  0.  Wamaiuk  VJ^f.  im-ek«iti 
ported  by  F.  0.  Plv«kbtt,M.». 


Empyamia. 

Bistary.—EnLBiXLB  W.  Baley,  Co.  F.»  Hitb  O.Y.O..  aged  18  jean, 
was  transferred  id  this,  from  General  Hospital  at  Lexington,  Kj-.tad 
reached  hete  Sept.  ]:6tli,  1864.     Fohr  months  ago  be  had  plevkf 

'  and  had  heen'  ih  hospital  ever  since.  When  adittitted  lie  was  so  ht 
ble  as  to  be  entirely  helpless ;  his  body  and  upper  extremities  wen 
emaciated,  and  his  fset  and  legs  swollen  to  their  utmost  extent;  ki 
bad  some  congh,  some  dyspnosa,  was  totally  unable  to  lie  down,  aad 

'  boald  only  rest  by  Stipportini^  his  head  upon  something  placed  befon 
him  while  sitting  in  his  chair  ;  he  had  chronic  diarrhoea  with  hemon- 
hage  from  the  bowels,  and  occasional  hsBmatisis  and  epistaxis,  and 
expectorated  small  quantities  of  highly  offensive  sangnineo-pnrnlent 
mucus,  which  formed  sordes  on  the  teeth  and  lips  ;  breath  exceed- 
ingly offensive.  The  infraclavicular  thoracic  walls  were  somewhsk 
depressed  and  apparently  motionless  on  inspiration,  and  the  lower 
intercostal  spaces  on  the  right  side  preternaturalfy  full.  On  percos- 
sion  there  was  dullness  over  the  entire  chest  with  the  exception  of  ft 
small  portion  of  the  apex  of  both  lungs.  The  resonance  on  the  right 
side  was  exceedingly  faint  and  circumscribed  ;  the  respiratory  mQ^ 
mur  was  confined  to  the  left  upper  lobe,  was  very  prolonged  and  al- 
most obscured  by  mucous  crepitations  with  occasional  gurgling.  He 
was  unable  to  take  either  stimulant  or  nourishing  diet,  and  the  entire 
body  gave  off  an  (tensive  cadavaric  odor." 

The  case  being  entirely  hopeless,  palliative  remedies  only  were  used, 
and  he  died  in  ninety  honrs  after  admission. 

Sectio  CcLcLaverU — ^twenty  two  hoars  after  death,  revealed  an  empj- 
lemic  cavity  of  the  right  pleura  containing  eleven  pints  of  dirty,  foetid, 
pnrnlent  fluid.  The  pleural  surfaces  were  thickly  covered  with  dirtj 
looking  lymph.     The  Inng  was  adherent  to  the   nvediastinal  pleura. 

and  was  enliieVy  caiTiV&Q\  tjAVui^xxoL^^bU  to  air  except  a  very  small 


X864.]  ffotpiiat  RepwrU.  667 

■    "-■.     .»    ■    .  ■  '■■ ' 

liortioii  of  the  apex.    The  left  pleura  contained  about  three  pints  of 

serous  floid  containing  flocnla  of  lymph.  The  long  was  compressed 
npon  and  closely  adherent  to  the  posterior  and  lateral  costal  plenra, 
bj  firm  chronic  adhesions.  The  lower  lobe  and  part  of  the  upper 
pwas  hepatizedy  with  occasional  emphysematoas  patches  npon  its  sur- 
Iftce  resembling  small,  blasters.  The  permeable  portion  of  the  Inng 
contained  frothy  mncoos  commiBglei  with  pnnileot  flnid  similar  to 
Jiat  found  in  the  right  pleural  carity.  Both  lungs  were  infiltrated 
■with  tuberculous  matter  in  rarious  stages  of  softening,  but  contained 
^o  cavities.  The  pericardial  sac  was  normal  ;  the  right  side  of  the 
^emrt  was  enlaiged  and  the  vena  caxa  and  pulmonary  artery  dis- 
i«nded.  The  entire  portal  system  was  highly  engoijged  but  presented 
^o  evidences  of  inflammatory  action.  The  liver  was  abnormally  Urge 
Mid  firm,  of  an  olive  green  color,  mottled  with  brown  and  highly  con- 
^»t»  d.  The  gall  bladder  was  empty  ;  the  spleen  and  pancreas  were 
su^rmal  ;  the  kidneys  were  somewhat  enlarged  and  congested  ;  their 
i«ction  presented  numerous  hemorrhagic  spots  and  a  highly  congest- 
a«l  condition  of  the  tubular  cones.  Their  entire  structure  contained 
toineral  concretions ;  some  of  which  were  of  considerable  size  ;  the 
^xeters  and  bladder  wer  enormal.  The  mucous  coat  of  the  alimentary 
Manal  presented  no  evidences  of  uloeration,  but  was  extremely  congest- 
ed A  preserved  portion  of  the  mesentary  and  ileum  presents  the 
tppearance  of  a  carefully  prepared  arterial  and  venous  injection  of 
Ihe  parts  ;  the  mesenteric  glands  were  enlarged  and  contained  tuberou- 
^ns  deposit. 

The  congestion  of  the  venous  and  portal  system  and  distension  of 
\kti  right  side  of  the  heart  and  its  appendages  were  evidently  conse- 
|vent  to  the  obstructed  pulmonary  circulation  ;  and  the  oedema  and 
Maasarcous  extremities  a  natural  sequence  of  their  dependent  position 
^  the  relaxed  and  debilitated  condition  of  the  physical  organization. 

It  is  remarkable  that  In  his  diseased  condition  he  was  enable  to  en- 
lure  the  fatiguing  journey  from  Lexington  to  this  place.  For  sever- 
a.]  days  prior  to  his  death  the  respiration  function  must  have  been 
Performed  by  a  portion  of  the  lung  not  exceeding  one-eighth  its  ordi- 
bulk. 


I 


668  Proceedings  of  SoelttUi.  [Soreii 

"     irorreatngis  ot  ^ntUntt. 

Royal  Medical  and  Chlrurgioal  Sociaty. 

Od  Hid  OondlliLin  atlUr  SlDmnrli  ud  Inri'iclan  Id  SrarlaHniu    Bj  Sikdh  lirm 

The  object  of  this  paper  is  to  prove  tbe  following  proposiiioas 
Ist.  That  ihe  mucoiig  membrane  of  the  resopliBgas,  stotnvii. 
intostineB  is  inflamed  i:i  scaiUtiaa. 

Sod.  That  desquamation  of  the  epithelium  of  these  parts  tikes pl« 

3rd.  That  iiotnithBlanding  the  Rnalomii^*]  changes  in  l!i?  icnnii 

membrane  of  the  stomach,  the  formalion  of  pepsine  is  not  preTfiid 

4Ui.  That  the  condition  of  the  sitin  is  similar  to  the  coaiiiiiosi 

tbe  mucous  membrane  in  scarlatina. 

In  support  of  the  firat  propo.silioTi,  the  microacopic  exatniaatiw 
the  mucons  membrane  of  the  cesopliagus,  stomaob,  and 
detailed  in  ten  cases  of  death  from  scarlolina  during  the  first  nwli 
illness,  anil  in  six  phsos  who  died  in  the  second   or  third  week  u(  t 
fever.      The  fiist  effecla   of  the   Hnarlalina   poison   upon   ihe  moM 
membrane  of  the  stomach  were  shown  to  be   the  conge^ilon  of  £ 
blood-vessels  and  the  stripping  the  epithelium  from  the  tubfi'  mill 
surface  of  tlie  organ,  nnd  nliio  the  xofiening  of  the  tissues      Tklil 
are  greatly  distended  by  grjnnUr  and  fatly  matters,  or  by  small  cJ 
intermixed  vrith  granules,  and  in  some  canes  they  are  lined  by 
formed  membrane.     Sometimes  no  normal  cells  can  be  didiingni-'M 
in  other  eases  they  are  present,  but  are  acatterej  irregularly. 
the  second  or  third  week  the  tubes  are  fonnd  less  distendoil  thsn 
earlier  period,  and  whilnt  their  closed  ends  are  slill  li>ad»d  wiih  p* 
nlar  matters,  which  greotty  obscure  the  gastric   cell.     These  b«« 
more  evident  totvard  the  surface  of  the  mucous  membrane.     Th^ 
at  (his  period  are  sometimes  very  large,  sometimes  loaded  with  Tii 
coHted  with  grannies,  and  seem  to    have  but  little  adhesi-^  .. 
basement  membrane,  as  they  readily  separate  from  the  tubes,  biH"1 
here  closely  to  each  other.     Tlie  elFects  of  the  inHamaiaiion  upoaw 
intealine.i  seem,  in  slighter  cases,  to  consist  in  the  efTusion  otgrwoK 
and  fatly  matters  into  Ihe  mucous  membrane  ;  but  in  more  s*«i< 
cases  the  lubea  of  Lieberkuhn  are  obstruftcd  by  epithelial  cells,  ''^^ 
extra vKsaiions  of  k>\o(td  take  place  iu  the  villi,  and   these,  with  ih 
rest  ot  iVie  macoTia  laeitfti'ct.Tie,  *■»  V«i<&.W\^  wcaHI  cells  and  p»>' 


k]  Procmdin^t  qf  Soeieiiei.  669 

»  In  one  case  the  macoas  membrane  was  entirely  stripped  of  villi, 
jgi  a  few  fragments  which  still  remained,  and  the  enlarged  and 
ainent  openings  of  the  follicles  of  Lieberkuhn  gave  its  surfuse 
appearance  of  a  sieve.  In  some  instances  in  which  the  pancreas 
been  examined,  evidences  of  disease  presented  themselves. 
3e  second  proposition  was  stated  to  be  more  difficult  of  proof,  in- 
ach  as  vomiting  nsnallj  occurs  only  in  the  first  stage  and  the  an- 

had  no  opportunity  of  examining  the  vomited  matters  at  this  pe- 

of  the  disease.  In  one  case,  in  which  vomiting  took  place  in  the 
■  week,  fibrinons  casts  of  the  stomach  tubes  were  discovered,  and 
mmation  of  the  mucous  membrane  was  proved  to  have  existed  by 
-mortem  examination.  The  chief  reason  upon  which  the  opinion 
^desquamation  of  the  epithelium  occurs  was  founded,  was  from  the 
ioacopic  examination  of  the  contents  of  the  stomachs  of  those  who 
died  of  this  disease.  The  contents  in  recent  cases  consisted  of 
■•  of  fine  membrane,  of  cells,  and  of  granules  and  shreds  of  mem- 
m.  The  membranes  were  of  the  shape  and  size  of  the  tubes  of 
stomach,  and  were  covered  with  granules  and  fat.  The  cells  va- 
flrom  1.1200th  to  1.2200th  of  an  inch,  and  were  usually  fringed 

fine  pieces  of  membrane.  In  cases  of  long  duration  the  mem- 
IBS  were  covered  with  cells,  and  were  also  of  the  size  and  shape  of 
ttlomach  tubes.  In  order  to  ascertain  if  these  appearances  were 
^vorthy  as  evidences  of  inflammation,  the  contents  of  the  stem- 

of  forty-five  subjects  were  examined  at  the  Middlesex  Hospital^ 
Mmdition  of  the  mucous  membrane  being  at  the  same  time  noted. 
Uriy  one  were  there  any  fibrinous  casts,  and  it  was  in  a  case  of 
H  gastritis.  In  eighteen  there  were  only  separate  cells,  chiefly  of 
Ndnmnar  form,  and  in  none  of  these  was  there  any  inflammatory 
^.  In  eight  cases  casts  of  the  upper  parts  of  the  tubes  were  plea- 
».  eomposed  only  of  healthy  conical  cells,  and  in  all  the  mncoas 
w^%rmne  was  in  a  natural  condition.  In  eighteen  there  were  either 
^  formed  of  cells  and  granules  from  the  secreting  parts  of  the 
H^  or  the  casts  of  conical  cells  were  overlaid  with  granular  matters, 
&]i  all  of  these  the  stomach  was  more  or  less  inflamed.  Two  cases 
tetritis,  unconnected  with  scarlatina,  were  also  quoted  as  exam- 
"fpf  the  forms  in  which  casts  of  the  stomach  tubes  appearsd  in 
did  matter  during  life,  and  the  author  stated  he  had  detected  casta 
!•  aionsach  tubes  in  matters  vomited  by  persons  affected  with  gaa- 
fe  connected  with  diseased  kidneys,  with  inflammatory  dyspepsifti 
Mber  forma  of  inflammation  of  the  gastric  mnoons  membrane. 
M  urged  thai  if  caata  of  the  gastric  tubes  can  be  diaoovered  dnr- 


670  Proeeedingt  of  SoeUties*^      .    .       [NpTanlM, 

ing  life  io  cm68  of  gMlritis,  and  if  in  tcarlatfna  this  conditki 
exists,  and  casts  have  been  found  in  the  stomach  after  dtetb,  theiv  ii 
every  probability  that  the  desqnamatton  of  the  epitheliam  takes  pki 
in  this  organ,  as  it  does  in  the  skin  and  kidneys. 

In  support  of  the  third  pToposition,  the  tesnlts  of  the  folloiriag  ei* 
periments  were  giren  in  three  caseil  of  scarlatina:  Ten  grsioirf 
hard  boiled  white  of  egg  were  digested  at  a  temperatnre  of  90*  for 
twelve  hours  in  an  infusion  of  the  tnncote  membi'ane,  to  whidi  Ham 

m 

per  cent,  of  hydroohloric  acid'  had  been  previouiily  added.  The  ar«^ 
age  loss  of  albumen  was  three  grains  tod  twe-thirda.  Similar  expi- 
riments  performed  with  the  stomachs  of  eleven  males  who  died  of 
various  diseases  at  the  same  hospital  gave  an  average  loss  of  fotr 
grains ;  so  that  there  had  been  scarcely  any  diminution  of  pqwsi 
produced  by  the  fever.  As  a  contrast' to  this  were  the  results  of  iib- 
ilar  experiments  upon  four  cases  who  died  of  typhus  fever.  In  tM 
of  these  the  albumen  had  gained  three  grains  of  weight  by  imbiUdoi^ 
and  was  not  at  all  softened  ;  whilst  in  the  other  two  it  was  softeisi 
and  had  lost  only  half  a  grain,  the  other  one  grain  and  a  kilf  it 
weight.  But  as  the  activity  of  the  digestion  must  dop^Q^  ^^  ^ 
upon  the  relative  amount  of  pepsins,  but  also  upon  the  bulk  of  thi 
mucous  membrane,  this  was  also  attempted  to  be  estimated.  T^ 
average  weight  of  the  mucous  membrane  of  the  Htomachs  of  ten  miki 
dying  of  various  diseases  at  the  Middlesex  Hospital  was  eigbtcd 
drachms,  the  weight  of  two  recent  cases  of  scarlatina  was  eighteen  an! 
sixteen  drachms,  (the  latter  being  in  a  boy,)  whilst  it  only  amonntd 
to  fifteen  drachms  in  one  who  died  in  the  third  week  of  illness.  Ii 
four  cases  of  typhoid  fever  the  average  weight  of  the  mucous  meoi- 
brane  only  reached  eleven  drachms. 

Under  the  fourth  proposition  it  was  stated  that  the  skin  had  onlf 
been  examined  microscopically  in  three  cases.  In  the  first,  in  vrhkl 
the  patient  died  after  a  few  days'  illness,  the  only  morbid  appearaaoi 
in  the  cutis  was  an  occasional  minnte  extravasation  of  blood  in  tk 
neighborhood  of  the  sudoriferous  ducts.  The  rete  mucosum  was  grcii- 
ly  thickened,  and  numerous  round  cells  with  large  nuclei  were  eveif 
where  visible,  intermixed  with  the  natural  cells.  The  basement  mta* 
brane  of  the  sweat-glands  were  thickened,  and  thei  apithelium  lioiof 
them  was  so  much  increased  that  in  most  cases  ft .  obstructed  their 
channels.  In  some  of  the  sweat-glands  the  coils  of  which  they  vci* 
composed  were  loaded  with  ooagulated  blood,  and  were  greatly  aid 
irregularly  distended,  in  the  other  recent  case  the  appearances  wei« 
similar,  exceplVng  i\iaX.  VJtift  ^x\j«raA\.Vv|«ca  of  the  cuticle  were  stainad 


PrwMJ^M  if  doa$He$.  671 

1  in  minute  patches,  ancf  tbe  sweat *dnct8  were  also  reddened; 
were  no  extravasations  of  blooct  either  in  ihe  glands  or  cutis. 
*f  the  dncts  the  epithelium  was  detached  from  the  basement 
$8.  In  the  case  of  a  man  who  died  dnring  the  tfiird  week 
iferons  tnbes  were  still  chohed  ap,  bnt  in  the  glands  the 
I  seemed  in  many  placefi  to  be  torn  away,  leaving  the  base- 
abranes  bare,  or  only  covered  by  ragged  particles.  The  cn- 
a  natural  condition. 

thor  stated  that  although  he  had,  in  accordance  with  the 
om,  described  the  appearance  of' the  skin  and  mucous  mem: 
the  results  of  inflammation,  yet  that  certain  conditions  sug- 
idea  that  the  term  when  so  used  was  periiaps  misapplied. 
ina,  we  find  that  in  each  part  the  morbid  condition  is  most* 
i,  in  the  first  instance^  to  the  basement  membranes,  and  con- 
le  formation  of  layers  of  new  cells,  which  in  the  skin  are 
ed  into  cuticle  of  natural  appearance,  and  in  the  stomach 
spsine.  If  future  researches  should  prove  that  a  similar  con* 
urs  in  the  kidneys  and  other  parts,  it  will  be  necessaiy  to 
1  the  structural  changes  produced  as  resulting  from  increased 
ical  rather  than  from  pathological  action  ;  and  that  the  pri- 
;t  of  the  scarlatina  poison  is  suddenly  and  violently  to  stim- 
latural  cell-growth  of  the  v\rious  secreting  organs, 
ilson  Fox  said  that  he  had  listened  with  much  pleasure  to 
ick*s  very  able  pape^.  It  had  possessed  an  especial  inter- 
na, inasmuch  as  Dr.  Fenwick's  observations  on  scarlatina 
those  which  he  himself  had  communicated  to  the  Society  in 
the  condition  of  the  stomach  in  a  vapety  of  acute  diseases, 
variola,  typhoid  and  puerperal  fevers,  pneumonia,  peri-  and 
tis,  cholera,  and  many  others,  in  which  he  had  found  the 
n  a  condition  very  closely  resembling  that  described  by  Dr. 
and  which,  after  Professor  Virchow,  he  had  designated  as 
ite  catarrh,  the  mucous  membrane  being  hypersmic,  swollen 
y-looking,  and  covered  with  tenacious  mucus.  This  condi- 
Dr.  Fox)  had  always  found  associated  with  a  granular  con- 
Jie  epithelial  cells,  which  were  shed  with  great  facility  both 
surface  of  the  membrane  and  from  the  interior  of  the  tubes  ; 
found  in  great  numbers,  and  often  enlarged  and  presenting 
inclei,  in  the  tough  mucus  covering  the  surface.  Since  he 
these  observations  he  had  been  in  the  habit  of  rsgarding  the 
idition  of  the  tongue  in  acuta  diseases  at  au  index  of  the  same 
production  of  epithelium  through  the  gastric  intestinal  tract. 


672  Proeeedinffi  </  SoeMsi.  [Nofember, 

He  bad  also  at  the  same  time  been  able  to  point  ont»  on  annatomical 
gronnds,  that  chronic  affections  of  the  stomach  were  frequently  asso- 
ciated with  chronic  affections  of  other  organs.  On  some  points  of 
detail  Dr.  Fox  said  that  his  observations  differed  from  those  of  Dr. 
Fenwick.  He  (Dr.  Fox)  had  not  examined  with  the  macroecopt 
stomachs  of  patients  dying  from  scarlatina,  but  the  appearances  whid 
these  presented  to  the  naked  eye  corresponded  so  cloeelj  with  tboft 
to  which  he  had  alluded  that  he  spoke  on  them  with  more  confidence 
than  he  should  otherwise  feel  inclined  to  do.  He  atill  thonght,  as  bt 
had  pointed  out  in  his  original -paper,  that  the  granular  matter  which 
Dr.  Fenwick  described  as  occurring  free  in  the  tubes,  was  really  con- 
tained in  the  interior  of  epithelial  cells,  and  that  it  was  only  in  the 
severest  cases  of  acute  gastritis,  in  which  the  cells  became  at  ones 
broken  down,  that  the  granular  matter  was  found  free.  With  regard 
to  the  casts  of  tubes  described  by  Dr.  Fenwick,  he  (Dr.  Fox)  not 
having  examined  the  stomachs  of  scarlatina  patients,  could  not  mak« 
any  positive  observations,  but  he  had  never  found  any  in  the  cases  of 
other  diseases  which  he  had  mentioned.  He  had,  however,  often  ob- 
served appearances  in  the  mucus  having  a  most  deceptive  resemblance 
to  casts,  from  the  manner  in  which  the  epithelial  cells  were  aggluti- 
nated by  the  tough  mucus.  He  did  not  think  that  these  casts,  if  thej 
did  not  occur  in  the  stomach,  could  be  of  a  fibrinous  nature,  any  more 
than  the  first  epithelial  desquamations  from  the  kidney  in  the  earlf 
stages  of  Bi  ighi's  disease  possessed  that  character  ;  nor  was  he  of 
opiDiou  that  the  membrane  limitans  of  the  gland  separated  with  the 
epithelium.  He  believed  that  when  the  membraua  limitans  (when  it 
existed)  was  destroyed  or  injured  the  power  of  reproducing  epithelium 
was  impaired  or  lost.  Epithelium  often  separated  in  continuous 
masses  from  mucous  surfaces  and  fiom  the  interior  glands.*  Such 
desquamuiinn  was  not  only  exceedingly  common  nnder  conditions  of 
irritation,  but  was  also,  under  some  circumstances,  a  physiological 
act.  It  had  been  noted  long  ago  by  Mr.  Goodsir  during  digestion, 
and  many  recent  observations  on  this  subject  were  contained  in  Vir- 
chow*8  Archiv.  He  (Dr.  Fox)  was  of  opinion  that  Dr.  Fenwick's 
observation,  though  very  valuable  as  evidencing  the  participation  of  the 
stomach  and  intestines  in  the  consequences  of  the  scarlatina  poisou, 
did  not  show  anything  specific  in  that  organ,  or  peculiar  to  the  dis- 
eases in  question. 

♦Dr.  F'»x  rpqa^Rts  ns  to  append  to  his  remarks  a  fact  which  he  omitted  to  mratloa  tolht 
Sooietjr,  that  he  hua  notct  of  a  eaee  of  acuta  inflAmmatory  dlarrhcea  which  came  anJer  his  ob> 
•erration  «  .me  jroarw  affo,  Mod  of  which  he  has  presenred  drawinn  of  casts  of  crrpts  of  Lis- 
herkohn  fouud  in  the  Intestinal  maont. 


1804]  JVMMtffi^ ^  AeMiM.  678 

Dr.  Webster  htA  listened  with  greet  gretificetion  to  the  paper,  es- 
pecially as  it  oonfirmed  what  he  had  obaerved  as  to  the  employment 
of  remedies  in  scarlet  ferer.  It  gave  a  great  additional  value  to  the 
minnte  researches  of  the  author  that  they  had  a  practical  bearing  in 
treatment.  Dr.  Webster  then  related  instances  in  which  the  internal 
administration  of  irritating  remedies,  especially  purgatives,  did  harm. 
He  referred  also  to  the  bad  effect  of  diet  which  was  administered  to  some 
children  in  scarlet  fever  to  tempt  the  appetite ;  and  lastly,  alluded  to 
the  good  effirate  of  sponging  the  skin  with  tepid  vinegar  and  water. 

Dr.  Mnrcfaison  said  Uiat  he  had  examined  the  stomach  in  twenty 
oaeee  of  scarlet  fever,  and  fonnd  an  the  whole,  similar  appearances  to 
those  described  by  the  author ;  but  he  agreed  with  Dr.  Fox  that  the 
grannies  were  in  the  interior  of  the  epithelial  cells.  He  had  not  seen 
any  easts.  He  thought,  however,  that  the  author  had  called  atten- 
tion to  an  important  complication ;  but  he  (Dr.  Murchison)  could  not 
agree  that  it  was  of  univenal  oconrrence,  as  he  had  examined  the 
stomach  in  several  case  of  scariet  fever,  and  bad  found  it  quite  healthy ; 
and,  en  the  other  hand,  he  had  found  changes  like  those  in  scarlet  fever 
in  the  stomach  of  those  who  had  died  of  oi^er  diseases. 

Dr.  Fenwick  said  the  question  was  one  of  experience,  and  oontinc 
ed  examination  would  no  doubt  settle  the  question.  In  every  case 
that  he  had  examined  during  four  years  he  had  found  the  changes  he 
had  described.  In  some  cases  cf  scarlet  fever  the  skin  was  not  affect* 
ed,  and  yet.  it  was  still  called  scarlet  fever,  and  just  so  in  a  few  the 
stomach  might  escape.  BtiU  we  should  in  a  large  number  find  evi- 
dence of  inflammation  of  the  stomach.  The  paper  was  chiefly  to 
draw  attention  to  the  subject.  In  reply  to  Dr.  Pox,  he  said  that  he 
had  made  the  sections  vertical  with  a  donble-bladed  knife,  and  exam- 
ined  them  with  a  low  power  and  by  help  of  parabolic  condenser.  He 
had  found  casts  best  in  children  who  had  died  a  few  days  after  the 
disease  began  ;  but  in  other  cases  he  had  not  found  them,  and  some- 
times he  had  found  only  plug^  as  described  by  Dr.  Fox.  These 
plqgs,  he  had  no  doubt,  were  the  result  of  inflamnutory  action. 


W*  ■ .  \  .fiBafmp^f4m9$.    ••  [No 


I  • 


•  It  ^  '■■  .I'Uli 

PcBMii,  AvgQit  27tb,  1864. 

Dkab  Dootoe. — A  .witty  \tngliafaiiuiQ  dm4^  Iih  epoi^iyflMia  into 
l^hose  who  have  been  to  Pnrifp  and-  th^  who  intond  t^  go.  Pkjii- 
ciana  might  be  similarly  dmjed ;  M  in  •Bin'Oirson'n  oUaaifieation  of 
men,  bene-fhctoTU  and  jiM&-factore,  the  la^  far  €^t*nnmber  the  fonner. 
So  of  medical  gentleman,  iho^  who  intend  going  to  Par^  far  ont-nnm- 
bec  those  who  have  been»  Heaven  forbifl  that  the  analogy  ahonid  be 
pushed  an  iota  &rth6r ! 

But  in  reference  to  this  Paris^passion, ,  so  genantlly  .  poaseaaed  by 
my  professional  brethen,  let  meanggest — and  I  do  it  with  baaitation 
for  my  own  stay  in  the  French  capital  waa  brief— >that  there  ia  danger 
of  forgetting  the  very  great  opportanittea  for  .pro^Msiqiial  .knowledge 
ofiered  by  the  large  cities  of  England,  SooUa^d  ai^d  Ii;jriand  Take, 
for  example,  this  city  of  Doblin,  of  which  ;tha  Irish- Siie  jnsUy  so 
prood,  a  city  of  less  than  three  hundred  thousand  inhabitants  and  yet 
with  fifteen  or  twenty  important  hospitals — some  of  them  as  coqaplete 
in  all  their  endowments  and  arrangements  as  any  I  have  chanced  to 
see  at  home  or  abroad.  The  American  too  will  find  more  cordiality, 
more  kindness  on  the  part  of  the  profession  here  than  he  will  in  Lon- 
don at  least ;  indeed  we  have  more  in  common  with  the  Irish  than 
with  the  English.  I  am  .snre  too,  he  will  recognise  in  Ireland  more 
sincerity  and  truthfulness  than  in  France.  One  cannot  help  think- 
ing that  mnch  of  French  life,  very  beautiful,  and  superficially  pleas- 
ant, is  like  Paris  itself,  where  he  walks  along  magnificent  streets,  be- 
holds beautiful  gardens  and  fountains,  palaces  and  pictures,  but  yet 
walks  above  sewers  and  catacombs,  all  hollow.    And  if  the  choice 

were  now  given  me  between  a  year  in  Dublin  or  in  Paris  I  would  lea  re 
the  decision  to  the  toss  of  a  penny. 

Of  such  men  as  Carmichael,  Cusack,  Crampton,  Graves,  Sir 
Henry  Marsh,  Montgomeiy,  and  others  who  have  passed  away,  and 
whose  fame  is  connected  with  this  city,  I  shall  not  speak ;  of  the 
living  men  actively  engaged  in  professional  labors,  and  many  of  them 
teaching,  and  whose  names  are  familiar  to  us,  it  would  seem  invidi- 
ous as  it  is  difficnlt,  to  select  from  a  list  of  such  celebrities  :  and  yet 
there  are  some  whom  I  cannot  forbear  mentioning.  Drs.  Stokes  and 
Oorrigan,  probably  stand  at  the  head,  then  Drs.  Hudson,  Banks, 


1864]  OMmtpmUhmm.  676 

• 

und  Lyons  ranks  next  as  Medical  practitioners ;  in  obstetrics  and  dis- 
eases of  women,  Dr.  Ohnrcbill  stands  foremost,  and  then  Drs.  Den- 
bam,  Sinclair,  M'Glintook,  and  Hardy  :  of  specialists  Dr.  Jacob  is 
still  in  active  work,  and  Sir  Wm.  Wilde,  to  wbose  generous  kind- 
ncKs  I  acknowledge  myself  a  debtor,  is  probably  tbe  first  of  living 
anrists,  as  well  as  one  of  tbe  best  operators  in  ophthalmic  surgery  to 
be  found  anv  where. 

* 

Dr.  Churchill  has  rscently  resigned  his  chair,  and  has  been  sno- 
cee<led  by  Dr.  Sinclair.  The  reason  of  this  resignation  is  the  demand 
made  by  private  practice  ;  for  though  it  may  seem  strange  at  home^ 
yet  nevertheless  it  is  true  that  Dr.  Churchill,  no#  about  fifty-six 
years  old,  has  but  within  a  year  or  two  past  attained  to  full  practice. 
When  Dr  Montgomery  passed  away,  he,  by  the  law  of  succession,  be- 
comes the  leading  man  in  his  department.  It  is  slow,  slow  work  in 
these  countries  for  a  man  who  seeks  the  foremost  place  in  bis  profsHs- 
sion — twenty  or  thirty  years,  sometimes  even  more — of  waiting  and 
working  before  the  cherished  prise  can  be  grasped,  and  then  it  can 
be  held  but  a  little  while  ere  inexorable  death  relaxes  the  grasp,  and 
transfers  the  cherished  object  to  the  next  in  the  eager  pursuit .  Here, 
however,  men  last  longer  than  with  us.  Take  Dr.  Corrigan,  for  ex- 
ample, who  by  the  way  is  one  of  the  pleasantest  gentlemen  it  has 
been  my  fortune  to  meet,  he  has  a  remarkably  large  brain,  and  a  heart 
(speaking  figuratively)  quite  in  proportion,  possesHSS  much  true  Irish 
humor ;  and  in  regard  of  diseane,  as  he  goes  through  the  hospital 
wards,  his  conclusions  seem  quick  almost  as  intnitionSy  physically 
and  intellectually  active :  and  yet  this  man  so  busy  in  hospital  and 
private  practice,  is  well  on  the  shady  side  of  sixty.  Dr.  Stokes  who 
is  on  the  staff  of  the  Meath  Hospital  is  also  quite  advanoed  in  life. 

The  Meath  is  not  a  large  establishment,  only  about  one  hundred 
Mid  thirty  beds.  An  additional  ward,  which  will  be  decidedly  the 
handsomest  part  of  the  building,  is  now  in  process  of  construotioa  ; 
it  is  to  be  devoted  to  diseases  of  children. 

Dnblin  has  probably,  I  will  not  be  positive  as  to  the  number,  half 
a  dosen  medical  schools.  As  a  general  thing  yon  will  find  in  thaae 
countries  medical  schools  mors  numerous  in  proportion  to  the  nna- 
ber  of  students,  and  of  course  the  proportion  of  the  latter  allotted  to 
each  school,  less  than  with  as.  On  the  other  hand  the  licensing 
bodies  are  fewer,  and  these  bodies,  coiwequently  are  not  the  same, 
though  some  members  thereof  may  teach ;  and  thns  an  important 
divorce,  much  to  be  desired  in  our  own  country,  ia  effeoted. 

Hers  hi  me  correct  an  error  made  by  me  b  a  pf«ri»af  laUarp  oim- 


676  OarNipmi$mt^  J[TSonakhm 

AmniliDg  tb0  nni¥«nhj  of  Lottdoa— wUek  ii  timplj  *  ttnpoimte  »• 
utitation  for  Um  examinatioii  of  dl  itftindmlt  ht  M  D^— witli  At 
Univomity  Hospital  and  Seliool ;  the  two  ave  eatin1(f  diithMt.  TUa 
itereasea  too  the  pmiae  b^eMWrt  ii^ioii  our  emmiil  oovBttymaa'a 
«« Thieory  and  Pmoti6e/'  Aad*  by  the  wajf ,  I  have  foaad  Dr.  Wood 
held  in  mndi  llhe  eiime  high  ealeem  in  GHaiBgow  and  in  Dahlia  aa  in 
London.  The  Dablin  physicians  feel  very  gratefiil  to  Dr.  W.  for  pre*- 
aeniing  to  their  Oollege  last  sioanBier,  a  wJlaetio&t^f  iitm  Anorieaa 
Ifateria  Medica  emhiaoing»  I  think»  one  hnndred  and  thirty  apocnoMDa. 
]L  have  before  me  a  pamphlet  presented  me  by  the  anchor.  Dr.  H. 
Kennedy,  of  Dublin*  il^herein  one  of  the  Ohio  phyairiana*  Dr.  J.  Sal- 
iabnry,  of  Hewark,  is  Tery  handaomely  apoken  of  in  oonnootion  with 
artides  pnblifihed  by  him  in  the  Am§rieMm  Journal  Jnlg^  and  Ootobetv 
1862. 

Ooe  of  the  most  ralnable  fielda  oi  tnatmetian  in  whidi  thia  dty 
abounds,  is  that  afforded  by  the  Rotunda  Lying-in  Hoapital :  heie 
fourteen  hnndred  women  are  ddivered  OTeiy  year,  and  throe  hundred 
oases,  surgical  and  medical,  of  female  diaeaaea  are  treaiad ;  making 
in  an  seventeen  hundred  in-door  padenta,  and  the  out-door  pationti 
run  up  to  two  thcroaand.  The  gentleman  who  haa  ohaigo  of  it  is 
termed  the  Master,  and  holds  his  appointment  for  seven  years  ,  hs 
has  two  assistants,  graduates,  and  here  under  graduatea  are  practi- 
cally instmoted  in  all  the  duties  pertaining  to  the  accoucheur.  Be- 
sides instruction  is  given  to  nurses,  of  whom  I  should  think  then 
were  eight  or  ten  now  being  qualified,  and  among  the  number  a  sooty 
maiden  from  Malabar,  who  is  quite  at  home  with  her  white  stttera, 
and  promises  to  be  an  iexcellettit  nurse. 

Among  those  who  have  held, the  position  of  Master  aro  aeveral— 
some  living  and  others  dead,  for  the  hospital  has  been  in  operation 
■for  a  century — who  have  been  among  the  moat  celebrated  contrite- 
tors  to  obstetrical  science  afnd  art.  The  present  Maater  is  Dr.  Den- 
ham  ;  and  I  am  sure  the  physician  who  visits  the  Hoapital  and  makes 
his^cquaintanoe,  will  be  treated  with  the  utmost  Idndnesa,  and  every 
facility  afforded  for  the  acquisition  of  knowledge.  Here  one  may  see 
every  day  cases  of  labor  in  progrese,  sometimes  instrumental  detiveriea, 
now  and  then  important  surgical  operations,  and  every  day  the  vari- 
^tls  local  applications  to  diseased  eervia  vim. 

it  seems  strange  to  an  American  physician,  at  least  it  did  to  me^ 
^If  shamfully  ignorant  I  confess  it)  to  find  that  the  non-identity  of 
typhus  and  typhoid^fover  was  still  a  matter  of  dispuie  in  DnUin*; 
iQr*eiasii|^l«»  yon  wiM  findaone  nwinent  men  who  oontend  for  Ibsir 


1864.]  Ommgandmet.  tlT 

identity ;  uaong  then  too,  to  I  wm  informed  to  day  el  the  Meetk 
Honpit*!,  ie  Dr.  Btokee ;  on  the  other  hand  Dr.  Oorrignn  and  Dr. 
Banks  belieTe  in  their  n(Hi-identity»  while  Dr.  Kennedy  believes  thai 
the  two  types  offerer  oan,  in  the  great  majority  of  instances*  be  dis- 
tingnished  from  each  other»  yet  it  is  essential  that  they  should  be  ooa* 
sidered  the  lesnks  of  a  oommon  poison. 

Last  Thursday  I  spent  a  few  pleasant  hoora  witnessing  the  ananal 
Feie  given  at  the  Richmond  Lonatio  Asylum.  There  were  foot-raeaB« 
aack-races,  etc.,  the  winners  receiviag  pipes  and  tobaooo  as  priaes ; 
dances  on  the  green  mound,  performanoes  of  *'  Punch  and  Judy/'  ale, 
observed  or  participated  in  by  the  lunatics  with  as  mneh  aest  jind  joy 
as  any  sane  people  could  manifest.  The  grounds  of  the  Richmond 
embrace  between  fifty  and  sixty  acres,  right  in  the  city  of  Dublin* 
inclosed  by  a  high  stone  wall ;  the  buildings  are  not  in  one  masa, 
hot  detached — here  a  hospital,  there  a  female  ward»  here  a  Roman 
Catholic  Chapel,  there  a  Protestant  Ohapd,  and  so  on.  Aa  a  general 
thing,  too,  these  stroctorss  exhibit  more  th  an  ordinary  arohitectoral 
beaaty  and  taste,  and  thus  scattered  over  the  green  slopes  of  the  en-» 
dosure  present  a  very  attractive  appearance.  However,  I  have  men* 
tioned  this  imititution  to  oall  attention  to  a  novelty  which  has  been 
introduced  into  it,  and  which  is  found  very  useful.  I  refer  to  the  in- 
struction of  the  inmates.  These,  numbering  some  seven  hundred,  hafe 
their  teachers  and  regolar  school  hours.  The  poor  patients  enjoy  this 
teaching  wonderfully,  and  at  the  same  time  it  is  thought,  in  many 
instances,  to  have  a  permanently  beneficial  influence  in  reference  to 
their  insanity.  Dr.  Salor  is  the  gentlemanly  and  efficient  medical  of- 
ficer— ^work  enough,  care  enoqgh  for  one  man  in  all  conscience,  one 
would  say,  to  have  chaige  of  seven  hundred  lunatics. 

But  I  must  close  this  illy  digested,  hastily  written  letter.       t.  p. 


Latter  From  Boeloa* 


Rostov.  Mass.,  Oct.  11th,  1864. 

Messrs.  Eorroas  : — In  June  last.  **  Letters  Patent  "  were  granted 
to  Dr.  John  A.  Cummings,  of  this  city,  for  *'  valuable  improvements 
in  "  AfH^UM  Oum  ami  PqUU$9^**  aqd  for  the  ••.Sole  right  of  insert* 
ing  Artificial  Teeth  in  a  base  of  Vulcanite  or  hard  rubber.'* 

Bubeequently  a  eorporation  was  established  in  aocordance  with  the 
laws  of  the  State,  under  the  name  of  the  *'  Dental  Ynkanite  Compa- 
V»"  with  a  capital  of  tMO^OOO,  ibr  the  puipaue  of  earyiug  into  •^ 


878  Cfmrwrnprndrnti.  [Ho 

fret  the  right  granttd  by  Htm  Ltttmrt  Patanl.  TUi  compuy.  im  Aa- 
gnat,  iMued  •  cirealar  to  the  dmtittk  of  the  United  BtftAes,  aad  all 
others  intereeted,  celling  their  Attention  io  the  ikei  of  this  pofeent,  and 
ofiering  to  grant  them  lioenses  for  using  it  *'  npon  the  BMMt  liberal 
terms/'  These  licenees  are  to  be  need  for  sneh  time  na  mnj  be  do- 
sired  ;  and  all  persons  are  emotioned  againet  infringing  opon  this 
patent,  or  using  the  invention  without  the  propet  libenee  from  the 
company. 

As  I  understand*  imlcaniaed  robber  has  been  used  by  dentiats  in  this 
country  and  in  Europe  for  sometime  as  the  base  lb»  artificial  teeth ; 
and  that  the  article  has  been  patented  heretofore.  Bnt  Dr.  Com- 
mangs  claims  that  after  many  years  of  patient  etndy  and  experiment* 
he  is  entitled  to  his  patent ;  and  that  it  securss  to  him,  or  his  associ- 
ates, the  '*  sole  "  right  to  use  the  material  for  the  purpoees  designated. 

From  the  high  price  of  gold  for  the  last  two  years*  this  vnlcanits 
material  has  bean  eztenaiyely  used  by  dentists,  and  will  continue  to 
be.  Some  dentists  have  procured  their  licenses  from  the  .company, 
others  are  doubting  the  Talidity  of  the  patent.  The  Bfaaencbueetts 
Dental  Association  hsTe  the  subject  under  consideration,  and  from 
what  I  can  learn,  I  thiuluthere  is  a  strong  feeling  to  test  the  validity 
of  Dr.  Cummings'  patent  in  the  court.  At  a  recent  meeting  the  fol- 
lowing preamble  and  resolutions  were  passed  : 

Whereoit  John  A.  Cummings,  of  this  city,  has  taken  out  letters 
patent,  thereby  vesting  :n  himself  the  exclusive  right  to  U£e  India 
Rubber  for  artificial  plates  and  palates,  for  the  base  of  artificial  teeth, 
therefore, 

Heaolved,  That  the  Massachusetts  Dental  Association  solicits  the 
co-operation  of  all  dental  associations  and  others  interested  in  testing 
the  validity  of  said  letters  patent  in  snch  form  or  manner  as  the  exi- 
gencies of  the  case  demand. 

Resolved^  That  all  associations  and  sooietids  and  others  who  may 
take  action  in  the  premises,  are  requested  to  report  the  result  thereof 
to  Dr.  S.  C.  Rolfe,  the  Corresponding  Secretary  of  this  Association. 

Reaolvedt  That  a  committee  of  three  be  appointed  from  the  Asso- 
ciation, that  they  be  and  hereby  are  instructed  to  obtain  from  »neh 
evidence  as  may  be  had,  a  legal  opinion  on  the  validity  of  said  letters 
patent,  and  report  at  the  next  meeting. 

This  is  a  subject  of  much  importance  to  dentists,  and  if  the  patent 
is  valid  they  will  submit  to  it,  and  if  not,  or  if  there  is  a  doubt  they 
will,  by  their  united  action,  take  the  benefit  of  that  doubt. 

It  may  not  be  uninteresting,  even  at  this  late  day,  to  give  aome  of 
the  more  important  facts  in  the  excellent  Annual  Report  of  the  Ci^ 
Register,  for  1:868.    In  no  city  of  this  oonntry,  of  the  same  sine,  ars  ty 


1964.]  0cm9pfmdinc$.  679 

records  fonnd  so  complete  and  ftccorate  as  those  belonging  to  Boston. 

Births. — The  nnmber  of  children  bom  daring  the  year  1868  was 
5,255,  a  decrease  of  three  from  the  previons  year  ;  males.  2,700  ; 
females,  2,555.  The  first  quarter  of  the  year  was  the  most  frnitfal 
and  the  last  the  least  so.  The  larg^est  nnmber  of  births  was  in  March, 
and  the  fewest  in  Febmary.  In  six  wards  the  percentage  of  deaths 
was  greater  than  that  of  the  births  in  the  locality.  In  one  ward  the 
births  exceed  the  deaths  by  more  than  fonr  per  cent.  Only  1/207 
children  bom  had  parents  who  were  native  bom  ;  or  only  28.40  per 
cent,  of  the  children  had  parents  born  in  the  United  States  ;  45.19 
percent,  were  of  nnmixed  Irish  parentage ;  and  the  German  element 
only  8.50  per  cent.  As  an  offset  to  this  the  deaths  among  the  same 
classes  bear  a  similar  relation,  so  that  the  alarm  of  some  about  the 
preponderance  of  the  foreign  element  is  not  well  gronnded.  There 
were  62  colored  children  bom,  an  increase  of  17  over  the  preceding 
year.  For  the  last  nine  years  there  were  566  colored  children  born, 
and  the  same  nnmber  of  colored  marriages,  while  the  deaths  amount- 
ed to  611,  nearly  doable  the  nnmber  of  births.  In  1863  there  were 
111  deaths,  or  about  twice  as  many  as  births.  This  does  not  look 
like  having  the  Northem  States  overflown  with  the  colored  race. 
There  were  49  instances  of  twin  births  (one  of  them  being  colored)' 
and  one  case  of  triplets.  In  this  last  case  they  were  all  females.  In 
twelve  instances  both  children  were  males  ;  in  11  both  were  females  ; 
and  in  25  one  of  each  sex.  In  the  previous  year,  there  were  47  twin 
births. 

Marrtaobs. — The  whole  nnmber  was  2,822,  an  increase  of  228 
over  the  number  reported  in  1862.  This  seems  a  small  nnmber  ac- 
cording to  the  population  of  the  city.  The  largest  nnmber  of  mar- 
riages  occurred  in  the  last  quarter  of  the  year ;  more  solemnized  in 
November  than  any  other  month,  and  the  fewest  in  March.  Only 
280  of  the  gnx>ms.  or  a  little  more  than  12  percent,  of  the  whole  num- 
ber were  born  in  Boston  ;  and  only  125  of  these  married  Boston  born 
females.  27.04  percent,  of  the  grooms  were  bom  in  the  State,  and 
nearly  51  percent  were  native  born  ;  deducting  those  who  married 
foreign-bora  females  and  we  have  41.50  percent,  in  which  both  par- 
ties were  native  born.  Ireland  as  usual  contains  the  largest  percent, 
of  foreign  grooms,  (30.66.)  Of  the  brides  1,098  (47.28  percent.) 
were  born  in  the  New  England  States ;  18.80  percent,  in  Boston  ; 
11.88  percent,  in  other  parts  of  the  States  ;  10.66  percent,  in  Maine  ; 
and  1 .27  percent,  in  other  States.  The  number  of  Irish  bora  brides 
waa  little  over  83  percent,  of  the  whole  number.    88.80  percent  o 


the  whole  nnmbor  of  nmlM  loiurriad  b«tv«ill  I&a  9gm  tf  25  «id  tt 
years.  The  oezi  bvored  period  wm  belweeft  21  Mi^  26^  darii^  wUeh 
706  or  80.86  peroent  were  iii«rried»  nudmg  644^  pMttenU  oC  the  wndm 
merryiDg  between  21  and  ^0  67  of  the  oulee  wen  miiioevi  and  m  ift* 
ereese  of  18  from  1862.  There  wee  w  pnorpMe  of  il  heiwwvi  Ihl 
ages  of  80  end  40 ;  and  of  16  beiw«m4Q  aad&Q.  Oilj  10.  60  pn 
eent.  of  the  males  were  ahove  40;. 

Some  sinking  ezaqoiplea  are  given  showiag  the  diaeiepttad^  olep 
hetween  the  partiea.  24  minors  oa(  of  67  married  hiidea  voder  W; 
while  12  selected  brides  between  26  and  80 ;  etiU  others  took  thoeeef 
riper  age.  On  the  other  band,  4  between  the .  agee  40  and  60  fiwrnd 
fiivor  in  the  eyes  of  bridee  of  less  than  SO. ;  while  some  TenemUe  mm 
of  80  were  led  oaptive  by  the  channa  of  80  ifommem* 

The  largest  number  of  females  nu^iy  between  ihe  agee  of  80  end 
26  ;  while  81  groome  had  passed  their  60th  year,  only  16  femalea  had 
been  so  fortunate.  One  boy  of  18  was  unitad  to  a  bride  of  21^;  while 
one  of  20  dierishad  the  oharms  of  ^a  partner  of  80.  The  youngest 
female  married  was  14  years  old,  her  husband  bed  the  matori^  ef 
88.  There  were  60  colored  groomi^*  40  of  whpm  were  mnrried  te 
persons  of  the  same  oolor»  while  8  chose  white  oompaniont. 

Of  the  males  over  87  per  cent,  were  first  marriages*  an  inoieaae  of 
nearly  one  per  cent. ;  and  18.95  per  cent,  second  marriagea.  In  44 
instances  the  grooms  had  been  twice  widowed.  Of  the  femalea  1^048 
(or  87.98  per  cent.)  were  first  marriages,  824  feoond,  and  10  third 
marriages. 

Deaths. — ^The  number  of  deaths  in  Boston  during  the  year  was 
4,699,  an  increase  of  579  over  the  mortality  of  1862.  When  it  ia 
remembered  that  there  was  a  decrease  in  births*  the  increaae  of  mer- 
tality  is  a  large  one  —  estimating  tbejpopulation  at  182,000*  whicd- 
gives  a  ratio  of  1  in  88.78*  a  result  seldom  seen  in  the  reoord  of  mor* 
tality  in  this  city.  The  ratio  in  1862  was  1  in  44.17.  Compare4 
with  New  York*  Philadelphia,  Baltimore*  and  Providence^  Boat<m 
stands  in  an  unfavorable  light.  628  deaths  oecnrred  in  the  month  ef 
August,  or  18.16  per  cent,  of  all  the  deaths — an  increaae  of  302  ovei 
the  same  month  the  previous  year.  There  were  only  272  deaths  ia 
June  ;  42  less  than  in  1862.  The  montha  of  July*|Auguet»  and  B^ 
tember  were  as  usual  fatal  among  children  ;  8|287  of  thoee  who  died 
were  bom  in  the  United  States*  1,787  of  these»  however,  wwe  ef 
foreign  parentage,  which  deducted  will  leave  only  81.92  per  eent  c( 
the  deaths  among  the  native  bom,  and  68.07  per  cent  among  the  fer^ 
eign  bom.    The  mortality  amoRg  theee,  of.  New  Wnglend  paraat^pb 


IML]  9mi0m  md  JMm.  681 

made  28^  per  q^nt  of  ftb#  whole.  The  pievioiMi  yeer  it  wm  26  per 
eeai.  Those  of  MafSMhi^eette  peienti^  meka  only  14.02  per  oeal 
or  a  reduction  of  1.48  per  cent  from  1862.  The  nnmber  of  pereoae 
whoee  deaths  were  ah^ie  20*  wae  2»247»  or  aearly  48  per  cent. ;  of 
theee  50.41  per  cent  were  foreign  bom.  Of  these  Ust  no  leBS<thae 
79.10  were  bom  in  Ireland.  Of  the  994  who  died  under  one  year  of 
9ge  60.22  per  cent,  were  of  foreign  parentage;  7.34  p(ur  cent,  died  oa 
the  day  of  their  birth.  The  same  ratio  of  deaths  among  those  of  fcNPt 
pga  parentage  exists  from  year  to  year.  One  centenarian,  a  woinan« 
died  at  the  mature  age  of  104.  Of  the  deaths  2^481  were  make,  and 
2^268  females. 

Did  space  permit,  it  would  be  interesting  to  persue  this  report  more 
minutely  in  its  deductions  ;  and  to  give  the  causes  of  the  deaths  in  i^ 
dassified  form  ;  also  the  occupations  of  those  who  died,  with  many 
other  statistics  from  the  numerous  tables.  But  I  must  not  weary 
yonr  paiienoa.  n. 


%tVtttlt  Xtlfl  §9iUtt. 


A  Qtmprehmmve  KtHeal  DietUmary:  Containtng  the  Pronaneiation  etc.,  ef 
Ike  ttrme  made  mse  ofia  Medioal  Soieaaes,  etc.,  ela,  ete.  By  J.  Thoma%  M, 
P.    PbiUdslpUa:  J.aLifpiaoott&Co.    1864. 

Dr.  Thomas  and  the  publishers  have  performed  their  work  well  it 
fsoparing  this  most  capital  Medical  Dictionary  for  professional  use. 
The  large  work  of  Dr.  Donglison  is  of  its  kind  all  that  can  be  wished 
er  expected,  but  for  oonveoient  reference  and  the  use  of  the  student, 
m  abridged  dictionary,  more  convenient  in  siie  has  been  a  desidem* 
Ipm,  which  as  we  say  is  oertainly  aSbrded  very  satisfactorily  in  tho 
vdume  before  us. 

Wo  ane  greatly  struck  with  the  style  of  type  used  by  the  publieh- 
fia,  the  contrast  between  the  terms  and  their  definition  being  marked 
nd  agreeable  to  the  eyo.  An  appendix  is  given  in  addiuon  to  the 
dietionary  proper  with  the  following  contents,  which  sufficiently  ox- 
plaia  their  use  to  the  practitioner : 

A  TM$  i/  Maiirim  JMkm.-^Thu  is  an  entfro  Uble  based  upon  tbf 
WoU  known  classification  of  Dr.  Wood.  A  Chtfkr  Estplaining  all 
Ihe  mmel  Letia  tsrms,  phrases,  etc.  WriUmg  Fr§$eripHin$ — a  ehap* 
^  of  oxcelieDt  instraotions  on  this  much  neglected,  and  importani 
Bitjsrf  A  TMe  qf  DoMm — the  substances  amnged  alphabetically^ 
A  liOU  ^  CkmUal  3§miol$.    A  ntk^JKtp^M  Pt 


682  Memewi  and  Ifotie^i.  [NoTember, 

— with  the  principal  anthorities  in  faror  of  eaob.  A  (^tunfieaiitm  9f 
Disease* — according  to  Cnllen's  Nosology.  A  doMs^ation  </  2>«h 
eases — according  to  Good's  Nosology. 

Some  of  these  appended  matters  appear  rather  irreleymt  to  the  book, 
yet  M  are  nsefal  and  conveniently  arranged  for  office  table  refersnea 

In  these  days  of  expensiye  material,  we  are  sorry  to  perceive  tbi 
necessity  for  employing  cloth  binding  on  a  book  of  such  eonstui 
handling  as  a  dictionary.  In  all  other  respects  the  work  of  the  pob- 
lisher  is  satisfactory  and  creditable ;  and  #e  take  great  pleasnie  a 
commending  the  book. 

For  sale  by  Robt.  Clarke  &  Go.     Price  $8.50. 


Alcohol:    Its  Place  and  Power.    By  Jambs  MtLLsa. 

The  UetandAbiue  of  Tobacco,    Bj  JoRH  Liz  ass.    Philadelphia:  landitj  t 
Blakiston.    1864. 

The  little  books  whose  titles  are  given  above,  have  been  heretofbn 
noticed  in  this  journal ;  they  are  really  bat  little  more  in  extent  this 
elaborate  tracts — and  being  upon  topics  of  a  kindred  character  snd 
interest  in  social  i-eformatory  movements  have  now  been  issoed  ii 
one  connected  volume. 

The  first  is  by  the  late  Professor  Miller,  of  lEdinbnrgh,  and  wu 
prepared  at  the  instance  of  the  Directors  of  the  Scotland  Temperasoe 
League,  who  were  **  anxious  to  have  a  work  of  high  anthority  on  tli 
medical  view  of  the  temperance  qnestion."  This  treatise — the  resoU 
of  this  application  to  Prof.  Miller — is  evidently  prepared  with  a  gt&d 
deal  of  care — and  embraces  a  review  of  the  whole  subject. 

The  Place  of  alcohol — as  a  poison,  as  a  medicine,  as  food,  and  ii 
a  luxury.  The  Power  of  alcohol,  not  only  as  a  poison,  a  medicine, 
etc.,  but  in  a  great  variety  of  aspects  mainly  from  a  scientific  aspect, 
partly  in  its  social  considerations. 

The  treatise  on  tobacco  considers  the  subject  in  a  historical,  pbjd- 
ological,  and  social  aspect;  the  general  scope  of  the  book,  howenr* 
and  purpose  of  the  author  will  be  best  exhibited  by  the  following  fret 
extract  from  the  preface. 

"  It  is  difficult  to  estimate  either  the  pernicious  consequences  pro- 
duced by  habitual  smoking,  or  the  number  of  its  victims,  amon^  sD 
classes,  old  or  young.  The  enormous  consumption  of  tobacco  can  be 
ascertained  from  yearly  returns  made  by  the  Gt>vGrnment  Castoa 
House;  but  its  physical,  moral,  and  mental  deteriorations,  admit  of 
no  such  tangible  analysis.  These,  although  certain,  are  slow  atid  in- 
perceptible  in  their  development,  and  it  it  therefore  impossible  to  ae* 


L884.  J  Xiwi$^  omI  JKsftav^ 

Mrtain  the  extent  of  the  injnry  which  the  poieoBons  weed  inflicts  npon 
die  pnblic  health,  or  the  alteration  it  most  neoeesarilj  efiect  npon  the 
Siaracter  of  its  inhabitants.  The  eonsamption  of  tobacco  is  stated  to 
bmp  in  1853,  29,737,561  ponnds,  thns  showing  an  allowance  of  con* 
liderably  more  than  a  pound,  on  an  average,  to  every  man,  woman, 
mod  child  in  the  united  kingdom  of  Great  Britain  and  Ireland.  The 
prevalence  of  smoking  has  been  greatly  on. the  increase,  and  the  use 
af  the  narcotic  commences  with  the  young  from  mere  childhood. 
Bnch  a  habit  cannot  be  more  lamented  than  reprobated.  The  injnry 
3one  to  the  constitution  of  the  young  may  not  immediately  appear, 
bat  cannot  fail  ultimately  to  become  a  great  national  calamity." 

Notwithstanding  these  conditions,  the  use  of  tobacco  in  its  various 
ESorms  will  do^lless  continue  a  widely  spread  and  prevailing  habit 
■ritli  people  all  over  the  world  ;  and  *the  extent  of  its  injury  on  the 
bnman  economy  a  matter  of  very  wide  dispute. 

Foraale  by  Robt.  Clarke  dk  Co.     Price  $1.00. 


Pyi99ophif  ^  Martuigt:  in  its  social,  moral  and  physical  relations,  with 
the  physiology  of  generation  in  the  vegetable  and  animal  kingdom.  By 
If  ice  A  SI.  Rtax,  M.D.,  Member  of  the  Royal  College  of  Phjsioians  and  8ar« 

Koas  la  Londoe.    From  the  last  London  edition.    Philadelphia  :  Lindsay  h 
akistoa,  1 864. 

We  have  examined  the  little  book  before  us  with  a  good  deal  <tf 
»  and  have  been  decidedly  impressed  with  the  idea  that  its  pub- 
LJeAtion  could  have  been  very  well  dispensed  with.  It  is  supposed 
Bmn  its  title  pMige  to  be  devoted  to  the  philosophy  of  marriage.  It 
doold  quite  as  properly  havo  been  styled  a  treatise  on  animal  and  veg* 
Mable  generation.  A  small  part  of  the  book  has  a  brief  consideration 
fef  aome  of  the  aspects  of  marriage — and  yet  even  these  chapters  have 
M  MMUtant  itching  to  branch  off  oi^  the  prurient  suggestions  of  the 
iepio.  Thus  we  have  in  the  Introductory  Chapter,  "Popn1ation» 
HArriage  and  Bastardy  Laws,  Reproduction  of  the  Human  Species  " 
mixed  together.  Chapter  Two  is  a  proper  and  fit  discussion  of 
nstttation  and  object  of  marriage  ;  while  Chapter  Three  mixes  op 
physiology  and  hygieology  of  marriage,  with  the  premature  and 
fekoaive  exercise  of  the  genital  function.  The  body  of  the  book  how 
aa  we  have  said  is  devoted  to  the  physiology  of  procreation  in  all 
•apeeta  for  wbieh  our  author  seesss  to  have  a  peculiar  taste  ;  th# 
lading  chapters  singularly  enough — perhaps  eonsistently  enough 
deyotod  to  the  pathology  of  the  generative  organs,  ehiefly  their 
aieolaons. 
Take  the  book  for  all,  we  scarcely  coneeive  its  vtilily ;  as  a  popviaf 


w 


^MtTUrf.    PnW 

The  Medical  Society  of  the  State  of  Pennayh 
AsDnal  Session  in  the  city  of  Philadelphia  on  t 
June,  1864. 

Dr.  Wilson  Jevell,  the  President  of  last  jnar  i 
appropriate  Taledictory  address.  He  allnded  to  i 
— the  new  Medical  Hall  of  the  Colle^  of  PhyBii 
— and  hereby  was  snggested  to  the  speaker  a  gr< 
pleauint  suggestions.  Gircnmetancea  connected 
of  the  PennsylvaDla  Hospital,  the  Univeraitj  < 
the  College  of  Phyeiciaua — "  noble  ins^ationi 
lenco,  science,  and  Itleratare,"  and  hr  the  eel 
Dr.  Jewell  claims  honor  especially  to  the  medio 
nia  and  his  own  native  Philadelphia.  This  tboi 
acter  to  the  bnrden  of  hie  theme,  he  proposes  t 
threshold,  as  it  were,  of  this  chaste  hall,  in  whi 
for  the  first  time,  and  in  retrospection  three  qnai 
•mine  the  foot  prints  of  time, 

Tka  lormM  that  oMt  hkn  b«H/' 

V»  then  proceeds  to  aotioe  briefly  of  coone  bnt 
and  Bedman,  John  Jones,  James  Hutshinson,  I 
fiache  anil  Thomas.  Notices  of  these  illastrioui 
ootemporary  evente  of  their  day,  «nable  the  ap 
chief  historic  events  conoacted  with  the  three 
whose  names  tre  have  ariven.     The  address  is  at 


m*.]  Jtflto»''«  fkMk  686 


tiitvr'if  IxlUv 


''HhKidm  in  OineiiimaH, — For  more  than  fortj  yean  the  city  •( 
tMiniuiti  hm  in  some  sort  been  a  leading  medical  centre  in  the  heatt 
f  this  ^reat  valley  of  central  and  western  American  States.  Dnring 
B  theee  years,  a  worthy  list  of  great  names  have  from  time  to  time 
•SB  engaged  in  the  public  teaching  and  pnblic  and  private  practioe» 
f  medicine  in  all  its  departments  of  snrgery,  practice,  and  obstetriosb 
1^  Ae  early  pioneer  days  of  onr  Queen  City  the  foresight  and  ambi- 
itm  of  the  great  Drake,  secured  the  establishment  of  the  Medical 
Mlege  of  Ohio,  and  as  its  strong  right  arm  and  collateral,  the  Oom- 
moial  Hospital ;  and  from  that  time  to  the  present,  notwithstaad- 

E  bickerings  of  professional  jealonsy,  these  two  to  a  fair  degree 
MM  hand  in  hand  in  the  labor  of  medical  education  ;  so  that 
cAahn  for  ^e  medical  instructions  of  Cincinnati  a  well  devised 
|ril  SKeellent  linical  character  long  before  that  impwtant  feature 
e  so  justly  prominent  in  the  requirements  of  professional  edu^ 


cr 


'i^kuieuding  Drake,  and  associated  with  hfm,  from  time  to  time,  in 
mk  oHy,  have  been  some  of  the  very  greatest  medical  lights  of  Amer^ 
iil  teadicine  and  suigery.  There  was  Godman  so  early  cut  off  in 
P  bright  promise,  and  the  lamented  Staughton  ;  Parker  and  Gross ; 
Mtlie  and  Mitchell ;  John  Locke,  John  Bell  and  Reuben  D.  Mussey. 
^kmt  A  long  Kst  we  might  record,  some  of  them  lo^g  since  gone  to 
t^  reward—- some  actually  driven  from  our  ranks  by  petty  piques, 
^  give  dignity  and  honor  to  other  cities  and  other  schools  of 
^Aicine. 

^«t  with  these  advantages  of  centrality,  established  institutions, 
^^dwNitioBal  and  hospital  purposes  and  great  teachers,  what  a  poor 
iKriftg  have  we  to  record  after  i^l  these  forty  years  !  What  im- 
nsolts  have  we  aecumulated,  to  mark  the  toil  of  btain  and 

ef  vifiscle  1  all  through  ^is  great  teeming  valley  of  the  Missis- 
!^  mn  Aa  hmdredi  of  usefoA  practioners  of  our  art,  who  exhibit 
^  pagehment  of  this  (Hty;  we  thank  God  at  least  we  can  point  to 
^  worthy  momment.  But  where  is  our  strong,  overshadowing 
kool  af  iiie4ieHia-*-w6  ovght  to  have  it.  Where  is  our  Hospital 
v^ttara,  oonmeBsorate  with  the  wants  of  so  great  a  City,  and  in 

iny  with  tlM  present  plans  and  hygieiiio  improvements  ?  Where 
Pathologioal  Museum  ?    The  surgical  and  medical  practice 


prob«. 

Itwoald  be  vain  ftnd  invidioiu  to  record  the  ci 
tor  us  oar  peculiar  medical  hiatoiy  ;  faesidea  tt 
DR  alone  ;  college  warfareB,  profeasional  jealoui 
prises,  failnros  and  trimpH  sadly  blended,  belong 
we  bave  any  knowledge,  and  with  some  the  r 
in  every  reRpcct  than  onr  own.  Borne  of  tl 
univcntiticB  abroad  hold  momben  of  their  Fac 
holding  a  world  wide  celebrity — hold  each  o 

With  na,  as  eleewheie,  the  medical  college  ha 
extent — at  least  given  ehape  to  oar  profesaiona 
tion  to  individual  ambition  and  effort ;  and  ai 
standing  the  diatingnished  gentlemen,  who  h 
adorned  our  ranka,  the  building  np  of  a  great  n 
details,  haa  too  generally  been  a  secondary  c< 
Bcboola  andhoapital  amphitbeatrea  have  been  m 
promotion  of  pcraonal  advancement  and  privi 
evil  has  neceaaarily  involved  aeveral  others,  ant 
changnx,  with  no  permanent  harmonious  co-ope 

Individuala  have  been  connected  with  the  scl 
frequent  revolutions  and  re -organizations  haa  be 
leas  to  say  how  theae  commotions  have  origin 
have  resulted  trom  shameful  internal  dtssensioiL 
side  until  the  explosion  occurred  ; — perhaps  < 
have  had  iU  ahnrc  of  influence.     Still  this  cry 


L]  Em^'i  T4M$.    '  687 

\  raised  the  warning  crj,  "beware — Uiai  is  one  of  Drake's  schemes" 
if  certain  men  made  any  effort  for  personal  or  professional  im* 
rement,  he  would  hear  the  same  admonition,  "  look  out  for  him — 
a  Drake  man."  But  Dral&  is  dead,  and  now  we  do  him  rever- 
L  Since  that  spirit  is  laid,  the  ghost  of  those  terrible  Miamis 
come  among  us  to  terrify  the  timid  old  ladies  of  our  craft.  They 
9  a  vast  amount  of  sin  to  account  for,  and  we  fear  the  memory  of 
r  energy  and  harmony  as  a  vigorous  school  will  long  trouble  us, 
?a8t  till  some  new  shadow  darkens  and  haunts  our  pathway, 
^ne  great  mistake  in  the  history  of  our  medical  politics  has  been 
perpetual  disposition  in  certain  quarters  to  import  material  for  pro. 
orships  from  abroad,  under  various  fanciful  ideas  of  supposed  pe- 
ar availability.  It  is  scarcely  in  human  nature  to  anticipate  the 
r  cordial  co-operation  of  a  home  profession,  with  an  instituiion  by 
ch  it  is  thus  systematically  ignored.  Hence  a  large  proporticm  of 
le  appointments  have  sadly  disappointed  both  the  school  and  the 
[>inteeR. 

ousistent  with  the  same  policy,  has  been  that  other  disposition  to 
ourage  the  efforts  of  home  talent  for  special  professional  improve - 
it ;  especially  almost  every  attempt  at  private  teaching,  which 
ly  has  a  tendency  to  foster  and  strengthen  the  schools,  lias  been 
thered,  and  embarrassed  in  every  conceivable  mode,  apparently 
er  the  impression  that  personal  or  school  rivals  might  possibly  grow 
of  these  individual  enterprises.  In  other  cities  these  private 
)ols  and  individual  courses  of  instruction  form  very  strong  addi- 
lal  attractions,  gathering  in  the  aggregate  crowd  of  patronizing 
ients. 

ITe  fear  we  arc  trespassing  on  the  patience  of  some  of  our  readers 
>  may  fancy  our  remarks  invidious,  and  for  the  present  we  close 
criticisms;  what  we  have  said  is  well  known  here  to  be  true,  while 
oad  our  troubles  are  known  without  their  philosophy  ;  still  we 
old  not  at  this  time,  have  rehearsed  these  difficulties  and  unfor- 
ate  mistakes,  were  it  not  that  we  believe  we  have  good  reason  to 
e  that  we  are  now  entering  npon  radical  changes  in  our  policy  that 
11  aet  up  a  new  order  of  things. 

1  Ntw  FtQtun.-^WQ  commence  with  this  number  a  new  feature  of 
journal,  which  will  add  to  its  value  and  aoceptability  with  the  pro- 
ion;  we  shall  have  hereafter  a  regular  Optkalwiolo^Ual  DeparHneni, 
)6  edited  by  the  well  known  oculist  of  this  city.  Dr.  E.  Williams, 
this  new  department.  Dr.  Williams  will  present  whatever  he  may 


1864.]  JBdUor'i  Ihbh.  689' 

the  college,  affording  %  Imrge  amoiintof  practical  medicine  ortheobeer- 
▼ation  of  the  stadent.  We  regard  this  as  one  of  the  n^ost  valaable  fea- 
tures of  the  school ;  and  additionally  we  think  it  safe  to  say  that  the  hos- 
pitals of  this  city  afford  quite  as  abundant  opportunity  for  studying 
disease  as  the  student  can  avail  himself  of,  with  bis  oth<>r  urgent  duties. 

We  took  a  general  survey  of  the  old  college  edifice  a  few  days  since, 
and  are  glad  to  say  that  we  have  never  seen  it  in  such  attractive  con- 
dition ;  the  whole  establishment  has  been  everywhere  thoroughly 
renovated,  painted  and  cleaned.  The  dissecting  rooms  are  in  most 
capital  order,  and  wholesome  cleanliness  ;  they  are  nnder  the  charge 
of  onr  friend  Dr.  Seely  who  we  are  sure  will  make  an  accomplished 
and  popular  Demonstrator  of  Anatomy. 

The  regular  course  of  lectures  was  inagurated  on  Monday  evenings 
October  31st,  by  a  lecture  "  On  the  Blood,"  by  Prof.  Parvin.  o' 
which  at  present  we  have  only  space  to  say  it  quite  met  the  expecta- 
tions of  his  friends. 

Ihe  Case  of  Surg,    Cftn,  Hammond, — Having  printed  in  full  the 
charges  and  specifications  upon  which  Dr.  W.  A.  Hammond,  late  Surg- 
geoQ  Oeneral  of  the  United  States  Army  was  convicted  and  sentenced, 
it  is  but  justice  to  make  some  additional  remarks.     And  first  in  refer- 
ence to  the  late  protracted  trial,  we  have  no  reason  to  doubt  but  that 
every  reasonable  opportunity  was  afforded  the  accused  to  defend  him- 
self against  the  serious  charges  presented  ;    there  was  no  haste ;  we 
have  no  reason  to  believe  the  court  was  prejudiced ;  the  case  was  cer- 
tainly not  sprung  unadvisedly  on  the  President.     Dr.  Hammond, 
however,  has  published  a  lengthy  defence   in  pamphlet  form,  which 
consists  in  an  ingenious  interweaving  of  hii  own   laborious  achieve- 
ments, with  the  personal  difficulties  and  animosities  between  himsel 
and  the  Secretary  of  War.     He  claims  that  from  the  very  beginning 
of  his  entering  upon  the  duties  of  Surg.  Gen.,  Secretary  Stanton  had 
A  settled  personal  dislike  toward  himself  that  grew  and  'festered  and 
finally  culminated  in  this  prosecution.     That  all  the  appliances  were 
resorted  to  for  months  to  make  and  force  a  case  ;  important  papet 
were  abstracted  from  his  office,  as  is  hinted,  through  the  connivance  o 
the  Secretary  of  War.     Personal  enemies  determined  on  his  dcdtruo- 
4ion  were  placed  on  the  commission  to  examine  the  conduct  of  hia  of- 
fice ;  tbeae  with  a  varietv  of  special  pleadings  make  up  the  pamphlet 
of  Dr.  W.  A.  Hammond  as  his  defence.     We  have  only  to  say  that 
the  charges  of  official  and  personal  animosity  on  the  part  of  Secretaiy 
Scsnton  appear  very  forced  and  not  supported  by  either  reasonable 


«90  JMitor*»  .flUb.  rNof«ndwr» 

faots  or  probabiKty-aiidfr  all  the  cirdmnrtaaoar,;  aad  that  tli#OMa  had 
a  tedions,  and  so  far  as  we  om  iearu,  a  fair  trial  bjttha  oompet^t 
court.  We  shall  be  only  too  happy  if  a  ciTil  -tribiiiial  shall  hereaf- 
ter demonBtrate  the  iaaooenoe  of  Dr.  Ha  mmoiid,  and  no  one  will  be 
more  ready  to  aanotuioe  auoh  a  dooiaion.  In  the  meantiiiie  it  may  be 
well  to  remind  oar  readers  that  the  oppoiition  lOf  thia  jonmal  hereto- 
fore against  the  late  Snrgeen  Oeaeral  did  not  oonsiat  in  any  sus- 
pioion  of  his  personal  honesty^  Wa  oharged  on  him  in  common 
with  a  large  and  honorable  part,  of  the  profession,  that  he  had  dis- 
honestly violated  his  faith  to  his  piofeeaion ;  that  his  iamons  order 
proscribing^  calomel  and  tartar  emetic  conveyed  a  reflection  against 
his  brethren  as  to  capacity  that  was  nigast ;  and  the  facts  he  attemp- 
ed  then  and  snbseijaently  to  urge  in  his  jostification  were  both  ialss 
and  absurd.  This  was  our  complaint  against  the  late  Soigeon  Qen- 
end — and  for  which  we  held  that  he  manifested  traits  of  character  un- 
fitting him  for  his  high  position.  In  this  grave  chaige  made  by  hie 
superior  officers,  of  fraud  and  peculation,  we  take  no  part  beyond  the 
mere  record  of  passing  events. ' 

« .••■•■• 

A  New  MHhod  of  Tteoiiwf  9t^Uktu  qf  th%  F^mw  m  Childrm^ 
— Dr.  G.  D,  Beebe,  late  8urg.-in-0hief  of  the  14th  army  corps,  US 
A.,  proposes  a  new  plan  of  treating  fractures  of  this  description  which 
has  some  novelty  and  appears  so  plausible  that  we  give  at  length  his 
plan  of  proceedare.  After  noting  the  usual  embarrassments  and  ob- 
stacles to  a  successful  maintainance  of  apposition  of  fragments,  be 
says: 

While  seeking  for  some  principle  which  would  apply  to  these 
cases  in  common,  it  occurred  to  me,  that  if  two  lines.  A,  and  B,  be 
drawn  as  in  Fig.  1  and  fixed  in  their  relative  positions,  then  the  in- 
tervening space  C,  would  also  have  to  remain  unchanged. 

Let  then  the  trnnk  be  represented  by  the  line,  A,  and  the  shaft  of 
the  tibia  by  the  line,  B,  the  space  C,  must  then  represent  the  femur. 

[That  is  to  say  the  figure  of  the  splint  will  represent  the  thi«;:h 
slightly  flexed  on  the  body  and  the  leg  flexed  on  the  thigh  at  about  s 
right  angle.] 

When  called  to  a  fracture  at  any  point  in  the  space,  C,  the  surgeon 
would  proceed  to  take  the  measure  of  the  line,  A,  from  near  the  axilla 
to  the  trochanter  major,  and  of  the  line,  B,  from  the  tibio-femoral  ar- 
ticnlation  on  the  sound  side  would  give  the  space,  C.  He  would  then 
rapiUy  sketch  upon  paper  a  diagram  embracing  these  measurements, 
with  a  projecting  flap,  corresponding  to  the  calf  of  the  leg. 

A  tinner  would  from  this  pattern  cat  a  splint  from  heavy  tin  which 
could  readily  be  hollowed  to  fit  the  form  from  the  axilla  to  the  ankle, 
with  perforations  for  the  admission  of  air  in  the  part  overlying  the 


1864. J  BdUar'i  TabU.  691 

femnr,  the  flap  being  carried  underneath  and  hollowed  to  receive  the 
calf  of  the  leg,  bnt  extending  only  so  far  as  to  cover  the  posterior  snr- 
fare.  This  splint  being  padded,  shonld  then  be  embraced  by  a  roller 
extending  from  the  toes  to  the  knee.  An  assistant  now  makes  cou-, 
ter  extension  by  fixing  the  pelvis  ;  another  makes  extension  by  grasp 
ing  the  knee,  the  thigh  being  flexed  at  the  angle  indicated  by  the  splint 
while  the  surgeon  with  bis  tape  measure  first  ascertains  that  a  sufli- 
cient  degree  of  extention  was  made,  and  then  applies  around  the  body 
a  broad  stout  band,  with  a  pocket  made  to  receive  the  axillary  portion 
of  the  splint,  which  may  be  snugly  pinned  or  laced,  and  if  need  be, 
supplied  with  a  few  vertical  strips  of  whalebone,  after  the  manner  of 
a  corset,  to  prevent  its  gatliering  its  folds.  It  is  hardly  necessary  to 
say,  that  this  band  can  be  prepared  by  the  child's  mother  or  nurse, 
while  the  splint  is  being  made.  The  axillary  portion  of  the  splint 
having  thus  been  secured,  the  surgeon  now  continues  the  roller  from 
the  knee  upward  applying  such  compresses  and  lateral  supporting 
splints  as  the  case  requires. 

In  children,  fracture  of  the  shaft  of  the  femur  is  generally  transverse, 
and  hence  forcible  extension  and  counter-extension  is  not  required  to 
that  ejttcnt  usually  necessary  in  the  ailnlt.  It  may  be  asked,  why  the 
nece^  iiy  of  flexing  the  thigh  ?  The  natural  position  of  the  infant  is 
wi  f6  the  thighs  flexed,  and  the  restraint  imposed  in  extension  on  a  line 
y\ifh  the  trunk  is  a  source  of  great  irritation  and  discomfort,  and  much 
less  //kely  to  secure  the  desired  result. 

Dr.  Beebe  relates  a  number  of  cases  treated  on  this  plan  which  ap- 
pear to  justify  the  confidence  of  the  author  in  the  value  of  his  mode  of 
treatment. 


yew  Books. — From  Blanchard  &  Lea,  we  have  received  '*  Stille's 
Therapeutics  and  Sfateria  Medica ;  *'  from  J.  B.  Lippincott  4  Co., 
''  Hammond  on  Venereal  Disea^'^,*'  and  "  Mitchell,  Morehouse,  and 
Keen  on  Gunshot  Wound,  etc  "  ;  from  Bailliere  Bros.,  "  Macleod's 
Surgical  Diagnosis."  These  works  will  receive  attention  and  notice 
in  due  time. 

It  is  also  stated  by  the  PkUadslphia  Reporter  that  J,  B.  Lippincott 
A  Co.  have  in  press  a  new  edition  of  the  U.  8.  Dispensatory,  by  Wood 
&  Bache.  The  publication  of  a  recent  eilition  of  this  important  work 
has  boon  for  some  time  deferred  in  order  that  the  editors  might  avail 
themselves,  in  its  revision,  of  the  new  edition^of  the  British  Phar  - 
maco[»oea,  and  other  works  and  means  of  information  heretofore  in- 
accessable.  The  recent  appearance  of  the  former,  however,  now  en- 
ables them  to  go  rapidly  forward  with  the  revision  of  the  Dispensato- 
ry, and  it  will  be  issued  as  speedily  as  a  due  rsgmrd  todta  mechanical 
execution  will  permit. 


692  SdUot^i  tatte.  [Novmnber, 

Si,  Mark's  ffoapiial,  Oap$  Palmoi,  Africa. — ^The  foiind«tion  Btone 
of  this  hospiul  was  Uid  four  years  ago.  A  snbstanti'il  stone  building 
has  since  been  erected  at  a  cost  of  about  $5,500.  The  building  is 
represented  as  beautifully  situated,  and  the  ward  rdOms  clean  and 
comfortable.  It  is  now  open  to  the  sick  among  the  seamen,  colonists 
and  natives.  It  is  under  the  management  of  the  U.  8.  Protestant 
Bpisoopal  Missionaries,  and  is  supported  bj  voluntary  contributions. 
'^Boston  Med,  and  Surg,  Javr, 


The  London  Lancet, — Many  of  our  readers  are  familiar  with  this 
Taluable  reprint.  We  learn  with  pleasure  that  Mr.  Herald,  the  New 
York  publisher,  will  hereafter  continue  the  publication  of  the  Laned 
at  the  old  rates  of  $5.00  per  annum.  Such  of  our  subscribers  as  pre- 
fer to  take  the  two  journals  together  will  receive  the  Lancet  and  Ob- 
ierver  and  London  Lnncet  for  97.00,  thus  saving  91.00  per  year  by 
the  arrangement.  The  London  Lancet  is  one  of  the  moat  valuable 
practical  joui-nals  of  Medicine  and  Surgery  extant,  being  a  faithful 
mirror  of  London  hospitals  and  lectures. 


A  Monkey  Surgeon, — We  vouch  for  nothing  of  the  following  from 

Cassars  Popular  Natural  History,  except  the  story,  which  is  a  pretty 

good  one  : 

"The  small-pox  having  spread  fearfully  amongst  the  monkeys  of 
South  America,  Dr.  Pinkard,  Secretary  of  the  Bloomsbury-Street 
Vaccination  Society,  was  struck  by  the  idea  of  arresting  its  farther 
progreHS.  Vaccination  was  of  course  to  be  the  means  of  staying  the 
plague,  and  his  scheme  for  its  introduction  was  entirely  ingenious. 
He  bound  two  or  three  boys  hand  and  foot  and  then  vaccinated  them 
in  the  presence  of  an  old  monkey,  who  was  observed  to  be  closely  at- 
tentive to  the  prooeedings.  He  then  left  him  alone  with  a  young 
monkey,  with  some  of  the  matter  ou  the  table,  and  beside  it  a  lancet, 
guarded,  that  it  might  not  cut  too  deep,  by  a  projecting  piece  of  steel. 
The  Doctor  witnessed  the  result  from  a  neighboring  room  ;  the  old 
monkey  threw  the  young  one  down,  bound  him  without  delay,  and 
vaccinated  him  with  all  the  skill  of  a  professor. 

Surg,  Gen,  of  Pennsylvania, — Dr.  James  Kino,  the  late  able  Surg  • 
Oen.  of  the  State  of  Pennsylvania,  has  resigned  his  position  and  is 
succeeded  by  Dr.  Joseph  A.  Phillips,  who  acted  as  Asst.  Surg.  C^n* 
during  the  service  of  Dr.  King. 


What  has  become  of  our  yeighbours  f — It  is  now  nearly  a  year  sine® 
we  heard  any  tidings  of  the  Ohio  Medical  and  Surgical  Journal,  We 


1864.]  JBiliar^t  IWe.  693 

suppose  it  has  suspended  ;  and  we  have  our  fears  for  the  New  York 
Medical  Independent — has  it  too,  yielded  to  the  pressure  ?  We  have 
missed  it  from  our  table  for  several  weeks. 


Dr.  Brawn  Seguard. — We  regret  to  notice  by  the  Boston  Med.  and 
Sur^.  Jour,  that  this  distinguishetl  gentlemen  will  be  prevented  by  ill 
health  from  delivering  his  course  of  lectures  contemplated  in  connec- 
tion with  the  course  of  the  Boston  Medical  College  this  winter. 


Dhivertiiy  of  EdMurgh, — Mr.  Spencer  has  been  elected  to  the  Pro- 
fesRorship  of  Surgery  in  this  school,  lately  made  vacant  by  the  death 
of  Professor  Millar. 


Promoiion. — Surgeon  Bichard  S.  Satterlee,  Medical  Purveyor  UJS . 
A.,  has  been  promoted  to  the  rank  of  Brigadier  (General  *'  for  diligent 
care  and  attention  in  procuring  proper  army  supplies,  as  medical  pur- 
veyor, and  for  economy  and  fidelity  in  the  disbursement  of  large  sams 
of  money." 


Business  ybiiees, — We  call  special  attention  to  our  Prospectus  for 
1865.  We  advance  our  own  rates  to  $3.  a  year  ;  and  it  will  be  no- 
ticed the  terms  of  most  other  publications  being  advanced,  we  have 
also  been  obliged  to  modify  our  terms  for  commutation.  Our  friends 
will  take  note  of  these  changes,  and  forward  their  remittances  and  new 
Bubscribers  as  fast  as  they  pleaite  and  accept  our  continued  thanka. 

Dr.  Bedford — J.  B.  Lipincfttt  Jt  Co, —  Our  readers  will  see  the  ad- 
vertisement of  "  Dr.  Bedford's  Obstetrics  " — the  new  edition  of  this 
great  work  ;  and  a  new  book  from  Lipincotts'  publishing  house. 

Location  for  a  Physician. — See  the  card  in  its  proper  place. 

John  Keshan*s — well  known  drugstore — aflforda  a  new  card  this 
month,  to  which  we  direct  attention. 

Eye  Surgery. — Dr.  Waldo's  card  appears  in  our  advertising  de* 
partment. 

Cutaneous  Diseases. —  We  have  heretofore  noticed  Dr.  Bmen's 
Specialty. 


694  SiitorU   TabU.  [Noyember 


[Tor  the  CiBciniMtl  Lancet  And  Ote^rrar.] 

OBITUARIES. 


Died. — In  the  U.  8.  serrice,  at.  Huntsville,  Ala.,  Febmaiy  20th, 
1864,  of  hepatic  abscees.  Dr.  G.  8.  Guthbie,  of  Poineroy,  O.,  aged  51 
years. 

Dr.  Gathrie  was  a  native  of  Pennsylvania,  but  was  edacated  in 
Ohio.  He  gradnated  at  the  Mo'lical  College  of  Ohio  many  years  ago* 
and  subsequently  received  a  degree  from  one  of  the  Philadelphia  Med- 
ical Colleges — the  Jefferson  1  think.  He  located  in  Pomeroy  about 
the  year  1844,  since  which  time  he  has  maintained  an  honorable 
standing  as  a  practicing  physician,  living  fully  up  to  the  honor  of  the 
profession,  and  the  **  code  of  ethics."  He  possessed  fair  natural  tal- 
ents and  respectable  literary  and  professional  attainments.  He  was 
an  influential  elder  in  the  Presbyterian  Church,  unassuming  in  man- 
ner, an  ardent  patriot,  and  in  the  highest  sense  a  Christian  gentleman. 
He  accepted  the  commission  of  Asst.  Surgeon  of  the  82nd  R^U,  O. 
V.I.  dated  June  20th,  1863.  The  labors  of  the  field  proved  too  onor- 
ous  for  his  declining  constitution,  and  he  has  gone  to  his  reward. 
In  his  death  the  community  have  sustained  a  loss.  Long  should  he 
live  ill  the  greatfnl  memory  of  those  whom  he  has  so  conscientiously 
and  faithfully  served.  J.^.  Binq. 


In  Memoriam. — At  a  meeting  of  the  Physicians  of  Hamilton,  on 
the  occasion  of  the  death  of  F.  D.  Morris,  M.D.,  Dr.  J.  Hittle  was 
called  to  the  chair,  and  W.  H.  Scobey  appointed  Secretary. 

By  request,  Dr.  McNeely  gave  a  brief  hihtory  of  the  disease  of 
which  the  Dr.  died. 

On  motion,  Drs.  W.  H.  Scobey,  McNeely  and  Caldwell  be  a  com- 
mittee to  r*»port  suqh  action  as  may  be  proper  for  the  profession  to 
take  on  such  occasion. 

The  committee  reported  as  follows  : 

Whereas,  it  has  pleased  our  Heavenly  Father  to  remove  from  our 
midst,  F.  D.  Morris,  M.D.,  Surgeon  of  the  35th  Reg.t.,  O.V.I. ; 
Therefore, 

Beaolvt'dy  That  in  the  death  of  Dr.  Morris,  the  Profession  has  lost 
a  devoted  member ;  the  country  a  firm  and  tried  friend  and  an  eflfi- 
cient  medical-  officer — the  Church  and  community  a  highly  respected 
and  worthy  member. 

Reaohed,  That  we  attend  his  funeral  in  a  body. 

Resolved^  That  a  copy  of  these  proceedings  be  sent  to  the  family  of 
ceased,  with  out  Bmc^te  coxi^c^^TiCft  m  xViAa^  their  time  of  a£Sic- 


1864.J  Bdkor'8  7M$.  696 

tioD  and  bereavement,  and  that  thej  ^  published  in  the  Hamilton  pa- 
pers, Cincinnati  OazeUe,  Commercial,  Lanc$i  and  Obierwr,  9knd  Jjeb%' 
non  Star, 


Obituary  Record. — It  ia.  with  profound  regret  that  we  have  to  i-e- 
cord  the  death  of  Professor  Jonathan  Rnioht,  of  New  Havcu,  which 
sad  event  occurred  on  the  25th  of  August  last,  in  the  7^th  year  of  his 
age. 

Dr.  Knight  for  many  years  filled,  witfi  signal  ability,  the  chair  of 
Surgery  at  Yale  Medical  Institution.  He  was  the  President  of  the 
Convention  which  organized  the  American  Medical  Associatioa^  and 
it  was  In  no  small  degree  owing  to  hia  firmoeiiSt  and  knowledge  of 
preliminary  rules,  that  the  convention  w«m  saved  from  disruption  with- 
out accomplishing  any  thing.  On  the  organization  of  the  Associa- 
tion he  was  elected  Vice  President  and  subsequently  (1853-4)  Presi- 
dent. Indeed,  in  all  cases  of  diffculty,  he  was  looked  for  to  preside, 
bis  exalted  character,  pre-eminent  urbanity,  and  knowledge  of  legis- 
lative rules  always  commanding  respect  and  acquiescence  in  his  decis- 
ions. 

Dr.  K.'s  great  skill  as  a  surgeon  was  second  only  to  his  lofty  moral 
character ,  and  as  a  physician,  and  as  a  man,  he  presents  a  model 
worthy  of  all  to  emulate,  but  which  few  can  hope  to  equal. 


Died,  in  Lancaster,  Pa.,  July  12th,  Dr.  P.  OA^fliDT.  Dr.  Cassidy 
was  a  prominent  Practitioner  and  Surgeon  of  the  Board  of  Enroll- 
ment of  the  9th  Military  District. 


Army  Medical  kitelUgenca. 

WASHINGTON  ARMY  MEDICAL  DIRECTORY. 

Brigadier-General  J.  K.  Barnes,  Surgeon  General — Office  comer 
15th  street  and  Pennsylvania  Avenue. 

Lieutenant-Colonel  John  M.  Cuyler,  Act'g  Medical  Inspector  Gen- 
eral. U.  8.  A.— Office,  No.  302  H  street,  comer  of  17th  street,  first 
floor. 

Lieutenant  Colonel  John  Wilson,  Medical  Inspector  U.  8.  A.  In- 
spector of  the  Army  of  the  Potomac — Office  at  Rev.  Dr.  Ransom's, 
Cohiml)ian  College.  Washington,  D.  C. 

Lieutenant-Colonel  A.  C.  Hamblin,  Medical  Inspector  Department 
of  Washington — Office,  303  I  street,  north. 

Surgeon  R.  O.  Abbott,  Medical  Director,  Department  of  Washing- 
ton— 132  Pennsylvania  Avenue. 


1864.J  Slrieture  <^  At  Jfatcil  Duet.  697 


Xdltod  by  B.  WnxtAm,  M.D.,  GmoiinrATi. 


Stricture  of  the  Natal  Duot 


But  few  years  ago  there  prevailed  among  surgeons  a  general  dis- 
satisfaction bordering  on  disgust,  witb  all  the  then  known  methods  of 
treating  dacryocystitis  with  stricture  of  the  nasal  duct.  It  was  at 
this  period  that  Desmarres  revived  and  popularized  the  ancient  meth- 
od of  obliteration.  His  results  and  those  of  others  after  him,  were 
brilliant  compared  with  the  almost  uniform  failures  of  the  numberless 
devices  of  his  predecessors,  for  the  restoration  of  the  natural  passages. 

In  the  first  few  years  of  my  practice  I  was  a  eealous  advocate  for 
occlusion  of  the  sac,  using  at  first  Desmarres  actual  cautery  and  after- 
ward more  frequently  nitrate  of  silver  and  chloride  of  zinc.  During 
those  days  I  was  sorry  to  be  consulted  by  patients  with  mild  cases  of 
blenorrhoRa  of  the  sack.  I  could  not  conscientiously  recommend  the 
hot  iron  for  so  trifling  an  ailment,  and  yet  I  had  no  confidence  in  any 
thing  else.  It  was  my  custom  to  send  such  patients  away  with  di- 
rections to  return  when  that  trouble  became  so  intensified  that  they 
were  willing  to  submit  to  the  operation  for  occlusion.  In  other  words 
I  let  them  ripen  for  the  roasi. 

In  the  midst  of  this  general  longing  for  something  better,  the  gen- 
ius of  Bowman  struck  out  a  new  path.  Still  imbued  with  the  idea 
of  mercy  rather  than  sacrifice  he  persisted  in  the  conservative  efforts 
to  remedy  and  restore  rather  than  destroy.  The  natural  and  happy 
idea  of  opening  the  sack  from  the  conjunctival  surface  instead  of 
through  the  skin,  suggested  itself  and  was  put  in  practice  by  slitting 
up  the  inferior  canaliculus  and  reaching  the  sack  through  it  as  a  guide. 
Through  the  opening  thus  so  easily  made,  he  practiced  injections  and 
dilatation  of  the  stricture.  His  plan  of  operating  and  series  of  stiles 
are  so  generally  known  that  I  need  not  detail  them  here.  Suffice  i^ 
to  say  that  it  opened  up  a  new  channel  and  formed  a  new  era  in  the 
history  of  the  diseases  of  the  lachrymal  passages. 

This  treatment  was  beneficial  in  most  cases,  but  relapses  were  not 
imfrequent  when  the  patients  were  observed  for  some  months  or  years 
after  the  use  of  the  stiles  was  left  off.  The  entire  failure  in  some 
\,  and  the  relapses  after  temporary  snocesi  in  others,  diminishec* 


1 864.]  SirUiure  of  ike  ITaMat  DmeL  699 

obtained  as  above,  he  enters  with  one  of  these,  passes  it  down  in  the 
direction  of  the  nasal  duct  and  ascertains  the  situation  and  character 
of  the  stricture.  If  the  stricture  is  membranous  and  elastic,  he  lays 
aside  the  silver  explorer  and  uses  the  smallest  elastic  bougies  such  as 
are  employed  for  the  urethra,  taking  care  that  they  be  somewhat  con- 
ical at  the  point.  After  a  few  days  a  larger  one  may  be  passed 
through  the  stricture,  aud  so  on  up  to  No.  9  or  No.  10  of  the  bou- 
gie scale,  finishing  the  treatment  with  wax  instruments  in  the  course 
of  three  or  four  weeks.  Should  he  find  the  stricture  narrow  and  cal- 
lous or  complete  atresia,  he  then,  after  injections  fur  a  few  days  with 
tepid  water,  forces  it  with  the  conical  silver  probe  and  dilates  it  to  the 
size  of  Bowman's  No.  6  at  once,  then  finishes  the  dilatation  with  the 
elastic  bougies  as  before.  He  thus  dilates  the  canal  to  the  utmost 
normal  capacity.  Although  Dr.  Weber  does  not  say  so,  I  infer  that 
he  introduces  the  bougies  for  a  short  time  every  day,  as  advised  by 
Bowman. 

As  topical  applications  to  the  diseased  mucous  membrane,  he  injects 
daily  a  solution  of  sulph.  zinc,  sulph.  cupri,  or  acetas  plumbi,  through 
the  same  opening.  In  cases  of  considerable  soreness  with  but  little 
secretion  he  uses  ^1  gr.  zinc,  or  10  grs.  of  the  lead  to  the  ounce  of 
water.  Where  there  is  a  more  abundant  purulent  secretion  he  resorts 
to  the  injection  of  from  10  to  20  grains  solution  of  sulph.  of  copper. 
For  further  particulars  of  Dr.  Weber's  treatment  I  must  refer  the 
reader  to  his  valuable  paper  above  cited. 

After  trying  pretty  faithfully,  fir^t  Bowman's  and  afterward  We- 
ber's method,  I  have  adopted  a  combination  of  the  two,  with  certain 
modifications  of  my  own.  My  results  for  the  past  two  years  have 
been  so  uniformly  successful  that  I  deem  it  a  duty  to  give  my  plan  o 
treatment  to  the  Profession  that  it  may  be  tested  by  others.  I  follow 
Weber  in  choosing  the  superior  canaliculus,  and  practice  the  opera- 
tion with  his  knife  and  essentially  as  he  directs.  After  the  sack  is 
sufficiently  opened  I  enter  with  one  of  his  conical  silver  explorers, 
search  for  the  stricture  and  pass  the  instrument  through,  if  I  can  do 
so  easily.  If  not  I  take  a  silver  stile,  of  the  size  of  Bowman's  No.  8, 
which  is  No.  5  in  the  bougie  scale,  as  nearly  as  may  be  one- sixteenth 
of  an  inch  in  diameter,  slightly  conical  at  the  end,  and  force  the  stric- 
ture according  to  Bowman.  If  I  find  that  the  stricture  yields  easily,  I 
withdraw  this  and  introduce  the  large  end  of  the  conical  explorer  and 
pass  it  down  so  as  to  dilate  the  stricture  almost  or  quite  to  the  full 
capacity  of  the  nasal  duct,  at  the  first  sitting.  Bleeding  from  the  nose 
after   its  withdrawal  always  occurs    and   soni  ^roCwoA. 


700  Ophlkalmekffieal.  [Noranber, 

Should  the  strictare  prove  to  be  firm  and  rigid,  I  eontent  mjielf  vith 
forcing  it  with  the  No.  5,  leave  it  in  a  few  minntae,  remoTe  it  tad 
have  the  patient  return  next  day,  when  it  is  passed  again  and  left  ii 
half  an  honr  or  more.  The  same  thing  is  repeated  each  snooesrin 
day  for  fonr  or  five  days,  when  the  stile  is  left  in  all  the  time.  For 
the  first  week,  about,  I  wash  out  the  sack  with  tepid  water  tad  t 
small  gutta-percha  syringe.  The  instrument  shonid  have  a  smtD 
point  bent  at  right  angles  for  convenience  and  be  in  perfect  order. 
The  syringing  is  done  once  a  day,  when  the  stile  is  taken  out,  Ai 
water  of  course  passing  freely  into  the  nose.  My  object  is  to  gst  tk 
patient  to  wearing  the  stile  day  and  night,  as  soon  as  it  ia  tolersted. 
Host  of  patients  will  be  able  to  do  so  in  from  four  days  to  a  wa^; 
while  a  few  very  irritable  subjects  have  to  be  eoaxti  along  for  tuo 
weeks  before  they  can  bear  it  more  than  a  few  minutes  daily.  Ef«s 
after  they  have  commenced  wearing  it  constantly  so  much  swelling 
may  occur  that  it  has  to  be  omitted  for  a  few  days  and  then  resnmad. 
This  is  however  rare.  For  wearing  I  have  had  a  series  of  five  silter 
stiles  made  by  Max  Wocher,  of  this  city.  The  smallest  with  which 
I  always  commence,  is  marked  No.  5,  in  size  equal  to  Bowman's  No. 
8.  I  have  them  marked  5,  6,  7,  8,  9,  and  they  correspond  in  sue  to 
the  same  numbers  of  the  bougie  scale  as  used  by  Mr.  Wocher.  No. 
5  has  a  diameter  of  one-sixteenth  of  an  inch,  and  No.  9  one-eigbtli  of 
an  inch.  Where  Bowman  leaves  cffthe  dilatation,  I  begin  and  go  np  to 
the  full  capacity  of  the  duct,  which  is  usually  about  No.  9.  In  cbil* 
dren  under  ten  years  of  age  No.  6  is  as  large  as  need  be  used.  The 
stiles  are  from  If  to  2  inches  long»  a  little  conical  at  one  end  and 
flattened  at  the  other,  and  slightly  curved.  They  are  long  enoagh  so 
that  when  passed  down  to  the  floor  of  the  nostril  the  flat  end  will  ex- 
tend about  one- fourth  of  an  inch  above  the  inner  canthus  and  rest  on 
the  skin  of  the  upper  lid.  The  upper  flattened  end  can  be  bent  for- 
ward a  little  or  in  any  other  direction  to  make  it  confortable.  The 
smaller  uumbe.s,  5,  6,  and  7,  especially  should  be  bent  forward  almost 
at  right  angles,  to  prevent  their  working  down  and  disappearing  in  tk 
sack,  which  has  happened  to  me  twice.  In  one  instance  I  had  to  in- 
cise the  sack  a  little  more  to  get  it  out  with  a  fine  pair  of  forceps.  In 
the  other  patient,  who  is  a  soldier  now  under  treatment  at  the  Marine 
Hospital,  I  introduced  No.  5  in  the  afternoon  and  told  him  to  wear  it 
till  next  day.  When  I  called  again  he  told  me  he  was  waked  in  the 
night  by  its  hurting  him,  and  he  found  it  was  gone,  and  believed  be 
swallowed  it.     As  it  could  neither  be  found  in  the  sack,  nor  in  the 


1864.]  Stricture  qf  the  Naeal  Duct.  701 

beH  I  concluded  be  was  right.     Foar  days  afterward  it  passed  bis 
bowels  by  a  little  obstetrical  assistance. 

After  letting  tbe  patient  wear  the  No.  5  a  few  days,  (generally  only 
two  or  three  days,)  it  becomes  easy  and  loose,  so  that  the  next  larger 
number  can  be  substituted,  and  so  on  op  to  No.  9,  which  is  usually 
Attainable  in  from  two  to  four  weeks.  During  the  whole  trentment 
the  stile  is  taken  out  daily  ,the  sack  washed  out  with  tepid  water  and 
then  injected  i^ith  a  solution  of  20  grains  of  sulph.  cupri,  after  which 
the  stile  is  reintroduced.  The  length  of  time  the  patient  is  made  to 
wear  the  No.  9  after  it  is  attained,  depends  upon  the  amount  of  secre- 
tion and  the  dilitation  of  the  sack.  As  long  as  there  is  any  percepti- 
ble discharge  of  mucous  from  the  sack,  the  stile  and  injection  should 
be  continued,  the*  latter  being  made  weaker  or  less  frequent  as  the 
case  improves.  It  is  astonishing  often  to  see  how  rapidly  the  blen- 
orrhosa  and  dilatation  of  the  sack  disappear  under  the  constant  use  of 
the  stile  and  injections. 

In  most  of  my  cases,  I  have  finished  the  treatment  and  abandoned 
the  htiles  in  about  six  weeks.  A  few  have  been  obliged  to  persevere 
longer,  and  some,  finding  so  much  relief  and  fearing  a  relapse,  insist 
on  wearing  the  stile  for  months.  One  lady,  the  wife  of  a  retired  phys- 
ician, who  had  a  fistula  on  each  side  with  profuse  suppuration  which 
had  tormented 'her  for  ysars,  has  been  wearing  two  stiles  since  last 
March.     She  will  not  give  them  up  although  she  has  long  since  been 

well. 

I  have  now  treated  a  large  number  of  cases  many  of  them  most 
aggravated,  with  such  success  that  I  scarcely  ever  find  it  necessary  to 
resort  to  obliteration.  The  chief  advantage  of  entering  the  sack  from 
the  superior  canaliculus  rather  than  the  inferior,  is  that  it  runs  more 
nearly  in  the  direction  of  the  sack  and  nasal  duct,  so  that  the  stile 
can  be  passed  down  without  changing  the  direction  but  very  little. 
If  passed  through  the  inferior  it  must  enter  horizontally  and  then  be 
raided  toward  the  glabella  to  the  perpendicular.  This  causes  more 
pain  and  the  point  is  liable  to  catch  in  the  folds  of  the  mucous  lining 
of  tbe  sack,  or  even  slip  out  as  the  hand  is  raised.  The  Hack  and  liga- 
mentum  mediale,  can  be  better  divided  from  above,  and  the  large 
opening  neccessary  for  the  higher  numbers  of  the  stiles,  shows  less. 
And  closes  more  satisfactorily  after  the  dilation  is  suspended.  It  con- 
trmcta  and  becomes  invisible  in  a  very  few  days,  although  often  the 
patient  can  blow  air  through  it  for  a  long  time.  I  have  not  observ- 
ed that  it  ever  closes  entirely  as  Dr.  Weber^says  he  has  seen  in  some 
of  his  cases.    Theoretically,  as  he  urges,  the  elastic  and  wax  baagja 


702  Opkikalmdcgiettl.  [Novmber 

ahoald  adapt  themselves  more  perfectly  to  to  tbe  shape  of  the  anal 
duct,  as  it  is  not  cilindrical  bat  flattened  from  without  inward.  Pne- 
tically  however  I  have  not  found  it  so,  and  the  silver  atile  ia  more  coi- 
venient  and  when  made  of  the  size  I  use  produoee  abundant  dilatt- 
tion.  By  wearing  them  constantly  the  care  in  effected  much  more 
rapidly  and  is  mnch  less  painful  than  the  daily  temporary  int^oda^ 
tion.  Besides  this  the  patient  very  soon  learns  to  take  it  oat  efe7 
day,  inject  the  sack  and  return  it  himself,  which  he  cannot  do  if  the 
stile  is  not  worn  constantly.  It  patients  live  at  a  distance  from  the 
city,  I  often  famish  them  with  the  20  grain  solution  of  anlphate  <^ 
copper,  a  suitable  syringe,  and  an  extra  atile  a  size  larger  than  tbe  one 
at  the  time  worn,  and  send  them  home  to  return  in  three  or  four  weeks. 
After  No.  7  or  even  No  6  is  reaohed  and  well  tolerated,  the  syringe 
enters  easily  and  the  patient  or  nuree,  or  any  physician  can  use  thea 
without  difficulty,  and  advance  to  the  higher  numbers  when  they  can 
be  readily  introduced. 

The  advantages  of  forcing  the  stricture  with  a  large  stile,  as  mj 
No.  5.  and  then,  if  practicable,  dilating  with  the  conical  instrament 
to  almost  or  quite  the  full  capacity  of  the  duct  immediately,  are  a  gnal 
gain  of  time,  quite  as  certain  a  result  and  less  danger  of  making! 
a  false  passage  than  with  a  small  stile  as  used  by  Bowman.  I  be- 
lieve that  every  case  where  the  nasal  duct  in  not  obliterated  bj  cal- 
lous or  bony  tiissue  in  its  entire  length,  whatever  other  complication 
may  exist,  is  curable  by  the  method  I  have  described. 


Dr.  A.  Von  Qraefe  on  Baaedowa  Diaeaae. 


In  the  Kltnische  MoncUaUaUer  fur  Augenheilkunde^  for  June,  1S64, 
is  a  Hynopsis  of  a  lecture  by  Dr.  Graefe,  before  the  Berlin  Medical 
Society,  on  the  exophthalmus,  hypertrjphy  of  the  thyroid  gland  and 
and  acceleration  of  the  action  of  the  heart,  called  Basedows  disease 
from  his  having  published  the  first  good  account  of  it  in  1840.  Ac- 
cording to  y.  Graefe  there  is  another  symptom  of  pathognomonie 
value,  especially  in  the  incipiency  and  in  slight  degrees  of  the  affec- 
tion where  the  diagnosis  is  uncertain.  It  is  the  loss  of  eonaenma  hi- 
ticeen  the  movemenis  of  the  eye  tide  and  (he  elevation  and  depree»m  of 
the  visual  plane. 

In  health  when  the  eyes  are  rotated  upwards  or  downwards  tbe 
upper  eye  lid  follows  in  a  corresponding  movement.  With  person^ 
suffering  from  Basedows  disease,  this  conaenianeaue  action  of  the  M 
is  aboliohed  or  very  much  reduced.     As  the  cornea,  for  example,  is 


L864.J  Basedawa  DUeate.  708 

lepressed  in  looking  down,  the  upper  lid  doea  not  follow  and  the  an- 
grier part  of  the  sclerotic  above  is  exposed  to  view  and  to  the  action 
>f  the  air.  That  this  is  no  direct  result  of  the  exophthalmus.  is 
proven  from  the  fact  that  in  tamors  of  the  orbit  and  other  caases  of 
protrusion,  the  symptom  is  wanting,  although  in  high  degrees  the  lids 
ire  moved  with  difficulty.  On  the  contrary  it  is  present  in  the  slight- 
est degrees  of  Basedows  disease.  Hence  its  diagnostic  importance. 
/Another  ^roof  that  this  phenomenon  does  not  depend  upon  the  ex- 
ophthalmus, is  that  it  may  disappear  while  the  protrusion  remains 
the  same.  Dr.  G.  has  seen  a  case  where  it  disappeared  suddenly  after 
an  injection  of  morphium  without  the  least  change  m  the  prominence 
of  the  eyes. 

It  results  therefore  evidently  from  a  lesion  of  innervation  of  the 
lid  muscles.  It  is  possible  that  the  symptom  is  caused  by  a  spasmod- 
ic contraction  of  that  portion  of  the  levator  palphlrae  supplied  by  the 
great  sympathetic  nerve,  and  which  was  discovered  by  the  lamented 
Heinrich  Muller.  It  is  perhaps  just  this  portion  which  regulates  the 
consentaneous  movements  of  the  lids  and  the  globe. 

In  a  practical  point  of  view  the  symptom  is  of  much  value  becaus^ 
it  ashists  in  the  diagnosis  of  slight  degrees  of  Basedows  disease  whicn 
is  not  very  uncommon  among  females,  and  in  the  earlier  stages  is  more 
amenable  to  treatment.  In  the  incipiency  of  the  affecttion,  the  en- 
largement of  the  thyroid  gland  is  often  absent  and  the  whole  difficulty 
then  consists  in  an  increaseil  frequency  of  the  heart's  action,  without 
change  in  its  volume  and  valves,  and  the  abolition  of  the  consensus, 
in  the  movements  above  mentioned,  with  or  without  slight  protrusion 
of  the  globe.  Temporary  improvements  in  the  feeling  of  the  eyes  of 
•nch  patients  are  often  solely  due  to  an  amelioratioti  of  this  symptom 

II.  Remak  first  demonHtrate<l  by  experiments,  that  by  irritating 
the  sympathetic  nerve  in  the  neck,  an  elevation  of  the  upper  eye  lid 
is  pro<luc^.  After  this  H.  Muller  demonstrated  the  existence  of  non- 
striated  muscular  fibies  in  connection  with  the  levator  palpebraa,  which 
are  endowed  with  filaments  from  the  great  sympathetic.  The  sim- 
ultaneous or  sncccDsive  implication  of  the  non-striated  muscular  fibres 
of  the  lid,  of  the  thyroid  t>ody  and  of  the  heart,  points  to  derange- 
ment of  the  sympathetic  in  the  neck,  as  the  connecting  pathological 
link.  Bezold  has  recently  proven  that  irritation  of  the  sympathetic 
in  the  cervical  region  increases  the  frequency  of  the  heart's  action. 
Remaks  therapeutic  experience  as  to  the  action  of  a  constant  current 
upon  the  sympathetic  in  the  neck  in  palpitation  of  the  heart,  corrob- 
rates  the  same  idea.     If  the  enlargement  of  the  thyroid,  as  Dr.  Graefe 


704  Ophthilmetogieal.  [\oveaib<r. 

oontendfl,  does  not  ocuar  till  afUr  the  eotUrattion  of  tha  uppof  «ft 
lid,  it  is  a  proof  thftt  the  bypertrophjr  ia  the  reenlt  of  liernngaraeal  o( 
the  Bympalhelic  nerve. 

The  above  in  the  siibstantre  of  the  interesting  paper  of  Von  Graefa 
and  tliu  aililitional  comments  upon  ic.  I  have  observed  the  loss  «f 
cr>Q§eu3U!j  between  the  movements  of  the  globe  and  npper  lid,  in  floni 
of  tha  numeroas  canes  of  Bstwdotva  disease  which  have  come  imdaf 
mj  o1)r!Crvftiion,  but  it  did  not  make  any  important  impressioa  na  mj 
mind,  in  the  absence  of  light  which  disooveries  have  ^ince  shed  opos 
(he  pUenomonon.  In  a  paper  pulilished  hj  me  in  this  jonrual,  <hn> 
yearri  airo,  detailing  the  histories  of  several  cases  and  the  factj>  in  re- 
gard to  this  curions  affection,  so  far  as  they  were  known  to  me  tbea. 
I  did  nut  Hpcnk  of  the  symptom  whiob  Dr.  Q.  derelops  in  ihc  sbon 
valuable  contribution.  I  am  therefore  very  glad  to  cotnp]<>(«  iht 
symptomalology  ol'  Basedows  disaase  by  calling  attention  to  tho  paper 
of  the  ingenuous  Oraefe,  whom  we  all  delight  to  honor. 


Treatment  of  ike  Bilet  of  Veitomou*  RtptUt*  and  Inarett,  i 
of  Pitnecli'in  Wounds. — Dr.  Julius  Lumaire  highly  estoU  the  I 
cBCy  uf  oaiuerization  with  pheiiic  acid  in  the  treatment  of  aII  poiaoi 
wounds.  He  states  also  that  moist  gKugrcuc  may  be  urrcsLcd  by  A 
same  uppli^'Ution.  Mr.  L.  claims  that  in  all  tliese  caaes  caiiteriaatidKl 
by  phciiii-  iicid  is  moiu  cftcctuiil  thrin  by  the  actual  cautery,  or  by  aaf  ■ 
other  I'liusCiu.  Two  or  three  drops  of  the  ai'id  applied  to  a  puDClnH^fl 
are  sutticiont  to  arrcitt  the  dangerous  effects  of  the  poison.  In  caHiT 
of  bites  or  wounds  the  acid  wbould  be  applied  to  the  whole  of  tb 
wounded  siirl'aue. — Le  Moniteur  Scient-fique  Aug.  1*1,  1864. 

Sttertin/ul  Ligation  of  the  InwitMoata. —  Dr.  D.  L.  Rodgcrs,  in  ■ 
loiter  to  I'rof.  V.  ^oti  {Med.  Times  and  Gat.,  Aug.  20,  18ti4).  an- 
municutcs  n  brit:f  notice  of  the  succe^hful  ligation  of  the  inuominala  I 
by  Dr.  A.  W.  Smith,  one  of  the  surgeons  of  the  Chariy  Uospilal 
>ew  OrlcfiQs. 

The  subject  was  a  mulatto  man,  aged  33  years,  with  a  largo  atiet- 
rism.  Un  tile  Idtb  uf  lust  May,  Dr.  S.  applied  a  ligature  to  tbeu-  ] 
teriainnoiiiiiiiita  and  to  the  right  carotid  about  one  inch  above  the  iB  I 
origin.  Hemorrhage  from  the  wound  recurring.  Dr.  ti.  on  the  19A  J 
of  July,  IJgato  I  the  vertebral  artery.  The  patient,  it  is  slated,  mwf  1 
eied. — Am.  Jour,  of  the  Mediiol  SeUnee: 


WbaW  VaUuaa.  1X1 


I 


Lnriiiiiati  faucet  i  (i^bstrbfr. 


•iiDinn  »v 

til  0.  *mirEN8,  M.I).  ,  .  JOHN  i,  uviem,  M.I^ 


r "^ 

(■o^■TE^-r3  ron  nKrnMcrrt,  i%n4.     ^H 

L, 

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IP 

ii^^^':          '^H 

.ckli  AouUmy  •rUi-llelw -..7..^^| 

Ciii;-' 

I 

or-1  ■ 

fl 

^H    THE 

CINCINNATI  LANCET  AND   OBsfl 

roE                          V 
wHoit:vat.  xxvL  ...                       fl 

1  i 

m 

\>f\ 

1 

^^^^^■^^H 

THE 

GINCINNATI  LANCE1S!!^^^VERV£H 

COHl 

&  B.  STEVENS.  K.D.,  AND  J.  A.  KDRPHY.  M.D. 


VohTII.  DKODMBBB.  1864.  Wo.  U. 


0ri0iiisl  ($om»ttiiirsti0itf. 


ABTICLB    I. 


Qattrotoroy,  flM*  the  removal  of  Non-Malignant  Tumors  from  the  Abdo- 
minal Cavity. 


BT  E.  VELfUVi  M.D^  HIW  TOEK. 


Having  reported  at  difierent  times  to  the  Medico-Ohimrgical  Socie- 
ty of  the  city  of  New  York,  cases  of  gastrotomj  for  the  removal  of 
ovarian  and  other  tumors  from  the  peritoneal  cavity,  I  was  requested 
by  several  members  to  write  and  read  a  paper  on  the  sabject,  foonded 
on  my  own  experiences,  irrespective  of  the  literatare  on  ovariotomy. 
At  last  I  complied  and  furnished  the  following  paper,  read,  Jaaaary, 
1864.  The  members  expressed  themselves  gratified  with  the  prodao- 
tion,  and  wished  that  it  should  be  published. 

I  have  frequently  been  called  on  for  a  copy,  and  was  specially  invit- 
•d  in  Siay  to  read  it  before  the  medical  section  onobstetrics  of  the  New 
York  Academy  of  Medicine.     I  complied  and  received  no  less  than 
fbur  snbsequeni  invitations  to  re-read  it.     On  all  of  these  accounts,  I 
■ow  publish  it. 

lam  well  aware  that  several  of  the  statements  made  cla^jh  with  re- 
oaivad  opinions — they  are,  nevertheless,  true,  and  important*  being 
fsQoded  on  facts  of  my  own  observation  ;  and,  I  am  fully  aware  that 
mj  remarks  on  the  mode  of  operating  may  be  considered  as  offsnsive 
to  operators  in  high  esteem,  and  deservedly  so ;  but  my  excuse  is^» 
tbe  interest  of  the  patient  before  that  of  the  operator. 

€hutroiQmjf  — ^The  operation  of  gastrotomy  may  be  needed  for  sev- 
parposes;  but  principally  for  the  removal  of  tnmors  sitnated 


706  OrigituU  Cammunkatiom,  [December, 

within  the  peritoneal  cavity.  There  are  three  kinds  of  tumors  thtt 
particularly  call  for  gastrotomy  ;  and  which,  withont  this  operation, 
always  ends  iardSith^;^  Ist.  Ovarian  tumors.  2nd.  Fibrous  out- 
growths from^be  uteniQ.  M.  A  fibro  adipose  mass  that  may  have 
its  origin  and  aeat  betwMtt  tSklayers  of  the  broad  ligament,  or  in  the 
parenchyma  of  the  o^iy  ;  or  m  the  annexes  of  these  organs. 

The  ovarian  tumor  most  fMqueiRly  met  with  is  the  muHiloadar, 
commonly  called  ovarian  dropsy.  It  occurs  between  the  ages  of  18 
to  25  years,  and  80  to  60  years  ;  that  is,  about  the  periods  of  nubil- 
ity and  its  cessation.  It  consists  of  a  general  hypertrophy  of  all  the 
tissues  that  constitute  the  ovary — its  internal  structure,  its  capsule  or 
external  coat,  and  the  peritoneum  that  covers  it.  All  these  enlarge, 
not  by  stretching,  but  by  growth.  Wiihin,  it  is  made  up  of  numer- 
ous cysts  that  vary  in  size  from  that  of  a  currant  to  an  orange,  ami 
some  of  them  even  to  a  sac  capable  of  containing  ten  to  fifteen  piotj 
of  fluid.  The  smallest  of  these  cysts  are  the  newest,  and  are  filled 
with  a  glutinous  transparent  fluid  ;  but  that  which  is  contained  in 
larger  and  older  cysts  is  thick,  ropy,  opaque,  and  colored  from  lighi 
bluish  to  dark  brown.  Each  cyst  is  lined  with  its  own  proper  mem- 
brane, of  a  quasi  mucous  character,  and  they  are  separated  from  cue 
another  by  intervening  septa  of  cellular  tissue,  which  tissue  gives 
passage  to  the  long,  slender  and  delicate  vessels  that  supply  the  cysts. 
Tncy  are  said  to  be  graafian  vesicles.  They  adhere  to  one  another, 
and  to  the  outward  envelop  when  next  to  it.  The  whole  mass  is  of 
rapid  growth,  enlarging  the  abdomen  in  the  space  of  a  year  or  so,  to 
the  size  of  a  full  pregnancy ;  and  when  after  i-cpeated  tapping  and 
refilling,  the  parieties  of  the  abdomen  yielding  with  more  and  more 
ease  to  the  distention  within,  the  tumor  may  attain  to  a  size  weigh- 
ing 70  lbs.  The  largest  cysts  lie  in  front,  and  by  paracentesis  will 
discharge  from  a  few  to  fifteen  or  twenty  pints  of  fluid.  This  opera- 
tion gives  all  the  other  cysts  an  opportunity  to  increase,  and  to  the 
lately  emptied  one  to  refill.  When  the  tapped  cyst  is  quite  emptied, 
the  trocar  is  compressed  by  the  adjoining  cyst  out  of  the  line  of  entry, 
and  made  to  lie  against  the  front  of  the  abdomen.  Some  operators 
have  taken  advantage  of  this  to  thrust  the  instrument  into  a  second 
cyst ;  but  not  without  danger,  for  an  intermediate  vessel  has  been  be- 
fore now  wounded,  and  has  bled  internally  into  the  sac.even  to  fill- 
ing it,  and  unto  the  death  of  the  patient ;  for  the  patient  is  generally 
much  reduced  at  this  time,  and  her  volume  of  blood  greatly  diminish- 
ed. Such  an  error  would  be  avoided  by  a  practitioner  acquainted 
with  the  structure  of  an  ovarian  dropsy,  and  the  distribution  of  the 


«       •* 


•  9 


^•*5 


18M|  Original   OmmunieaiitmM.  T07 

vessels  that  run  in  the  septa.  Another  error,  one  thut  has  mn  the 
rounds  of  the  jonrnals,  would  not  have  been  committed  and  cruelly 
repeated — that  of  emptying  one  cyst  and  injecting  ft  with  that  univer- 
sal panacea — iodine — had  the  operator  reflected  for  a  moment  that  he 
hirl  treated  only  one  cyst,  while  he  left  <m$  hundred  untouched  ;  to 
say  nothing  of  the  stupidity  of  supposing  thit  an  analogy  existed  be- 
tween hydrocele,  and  the  cysts  in  an  ovarian  dropsy — the  first  a  dis- 
ease in  a  serous  membrane  and  a  single  cavity,  attackable  in  its  whole 
extent,  and  capable  of  throwing  out  adhesive  matter  subject  to  or- 
ganization ;  while  the  second  consists  of  a  multitude  of  separate  and 
uncommunicatiiig  cysts,  each  lined  with  a  qnasi  mucous  membrane, 
iocapHble  of  throwing  out  plastic  (fibrinous)  matter,  and  becoming 
organized  into  an  adhesion  that  should  unite  the  parieties  of  the  sac, 
and  so  obliterate  the  cavity. 

The  growth  of  an  ovarian  tumor  is  rapid,  but  unaccompanied  \^\i\\ 
pain,  excepting  that  which  is  due  to  distention  of  the  parieties  of  the 
abdomen.  There  is  also  distiess,  when  large,  from  its  encroachment 
into  the  thorax,  pushing  the  diaphragm  as  high  as  to  the  fifth,  or  even 
the  fourth  rib,  producing  dyspnoea  ;  also,  by  pressure  on  the  stomach, 
leaving  to  that  viscus  little  capacity  for  the  reception  of  food.  In 
a  few  cases  it  will  cause  a  partial  ascites  by  its  pressure  on  the  larga 
visceral  veins  and  on  the  kidneys.  When  the  tumor  has  attained  to  a 
large  bize,  the  length  of  the  linea  alba  from  the  pubis  to  the  ensifurm 
cartilage  has  reached  the  extent  of  28  inches  in  two  of  my  cases. 

Fibrous  out  growths  from  the  uterus  into  the  peritoneal  cavity  gen- 
erally proceed  from  the  superior  part  of  the  uterus  ;  sometimes  from 
the  front,  or  back,  or  any  other  part  of  it,  and  is  immediately  covered 
by  peritoneum,  hence  called  suhperitoneal,  A  portion  of  the  tumor  is 
contained  in  the  walls  of  the  organ,  the  two  commingling  by  degrees 
that  render  it  difficult  to  say  where  one  structure  ceases  and  the  other 
begins.  When  the  tumor  is  largely  developeil,  between  it  and  its 
peritoneum,  nnmeious  broad  veins  are  seen  on  the  surface,  leading 
inexperienced  spectators  of  an  operation  to  exclaim,  *'  What  larg*'  va- 
ricose veins.''  These  veins  are  not  in  a  varicose  state,  not  having 
their  parietes  thickened  or  hypertrophied  ;  but  are  only  expanded 
laterally  ;  they  are  nearly  fiat,  and  their  parietes  are  thin  like  ordina- 
ry veins,  and  being  flat  contain  little  blood,  since  like  all  flattened 
tubes,  their  area  is  much  1*88  than  those  which  are  cyltndical,  a  form 
of  the  g^atest  capacity.  The  arteries  that  lead  into  the  tumor  are  few 
in  number;  but  within  the  new  stractore,  they  become  numerous, 
thongh  of  small  calibre  ;  .jet  their  nnkmi  areas  mach  exceed  that  of 


1864.]  Orpintd  Commumt^aioni.  709 

abdomen,  was  the  treatmeDt  pursued  nnavailingly.     At  last  the  ta- 

mor  presented  a  bi-Iateral  or  double  appearance,  the  larger  one  filling 
one  iliac  region  and  the  lesser  one  occupying  the  opposite  region  ; 
between  he  two,  under  the  linea  alba,  there  was  a  distinct  hiatus. 
She  was  now  told  that  she  had  enlargement  of  both  ovaries  ;  various 
medicines  were  persevered  in  unavailing) y  ;  and  she  at  last  gave  up 
"  doctoring."  All  this  time  she  enjoyed  perfect  health  except  the 
disturbance  occasioned  by  futile  medication.  Her  appearance  was 
.  attractive,  and  her  sexual  desires  great,  led  to  a  second  marriage » 
afler  she  had  honestly  made  her  case  known  to  her  suitor.  She  mar- 
ried. All  went  on  as  usual  for  two  years,  when,  without  perceptible 
cause,  the  "  two"  tumors  began  rapidly  to  increase  in  size.  I  now 
saw  her  for  the  first  time,  and  got  fi-om  her  the  foregoing  history. 
On  examination,  not  finding  fluctuation  nor  elasticity,  conditions  that 
belong  to  ovarian  'dropsy,  and  thinking  of  the  slow  progress  of  the 
case,  I  told  her  and  her  husband  that  there  was  no  disturbance  in  the 
ovaries  (her  catamenia  regular,  and  the  sexual  appetite  as  generous 
as  heretofore)  ;  but  that  the  resisting  nature,  and  the  hardness  of  the 
"  two  "  tumors  was  different  from  what  had  happened  in  ovarian  tu- 
mors. 

Ttey  requested  an  operation,  which  I  hesitated  to  undertake,  but 
at  last  consented  to  do  it.  She  went  home,  a  distance  of  a  hundred 
miles,  to  settle  household  affairs,  and  returned  in  eight  days.  In  this 
abort  period,  so  rapid  had  been  the  increase,  that  the  tumor  reached 
half  way  between  the  unbilicus  and  scrobicnlus,  and  she  had  become 
lean  and  looked  much  exhausted.  A  long  incision,  from  the  pubis  to 
near  the  pit  of  the  stomach  was  made,  exposing  the  tumor,  which 
was  a  single  one,  with  two  outgrowths  from  its  surface,  the  whole 
springing  from  the  greatly  enlarged  base  of  the  uterus.  It  was  cut 
crfT  and  removed,  she  made  a  good  recovery  in  four  weeks  and  contin- 
ued well  after.  The  tumor  was  covered  under  the  peritoneum  with 
broad  meandering  veins.  The  arteries  that  entered  the  pedicle  were 
small  where  it  was  divided,  and  eaHily  secured.  The  tumor  itself  was 
a  solid  homogenous  mass,  hard  and  reHisting,  and  divisable  into  large 
yellowish  slices,  showing  very  few  sections  of  vensels 

The  second  case  is  that  of  a  married  lady,  the  mother  of  two  chil- 
dren, the  youngest  approaching  puberty.  A  year  after  her  last  con- 
finement she  thought  there  was  something  unusual  going  on  in  the 
pelvis.  In  the  course  of  a  few  years,  a  round,  hard  tumor  gradunlly 
ascended  into  the  hypog^strium,  which  continued  to  grow  very  slowly 
wben  I  saw  her,  about  ten  or  twelve  vears  after  its  commencement. 


710  Original  Cammunieaiums.  [December, 

She  suffered  no  pain  or  inconvenience  from  it.  I  therefore  adviced 
her  to  do  nothing.  I  heard  of  her  a  few  years  after,  and  abe  was  in 
her  usual  health. 

A  third  case  I  may  as  well  mention.  A  married  woman  who  had 
borne  children,  presented  an  ahdomen  as  large  as  a  pregnant  one. 
She  had  had  it  some  years.  I  saw  her  about  a  month  before  she  died, 
in  considerable  suffering,  but  without  fever  of  any  kind.  It  grew  from 
a  much  enlarged  uteruf",  as  seen  on  dissection,  was  solid  throagbont, 
and  resembled  the  one  first  described. 

The  FibrO'Adiposif  Tumor  is  composed  of  large  fatty  masses  separ- 
ated from  each  other  by  tenacious  cellular  tissue  and  fibrons  bands, 
but  no  where  distinctly  separate.  These  masses  vary  in  size,  from 
that  of  a  fist  to  a  foetal  head.  The  whole  are  enclosed  in  a  fibrons 
envelope,  and  the  peritoneum  is  spread  in  front  above  and  over  til. 
One  that  was  removed  by  operation  weighed  thirty  pounds,  and  an- 
other forty.  They  seem  to  be  generated  within  the  broad  ligaments, 
at  least  this  was  the  case  in  both  instances  just  now  mentioned.  Hy- 
pertrophied  fibres  of  these  ligaments,  much  lengthened  and  more  oi 
less  separated  from  each  other,  inveloped  the  mass  all  round  and  ^ent 
bands  into  the  new  structure,  growing  with  the  growth  of  the  tumor. 
The  peritoneum  expands  before  it,  behind  and  all  rouiul,  excepting 
where  it  has  its  nttachnient,  which  is  very  extensive,  like  a  mesoco- 
lon, to  the  last  lumbar  vertebra,  promontory  and  hollow  of  the  sac- 
rum. In  the  few  cases  I  have  seen  it  had  extensive  adhesions  to  the 
whole  front  of  the  abdominal  parietes — some  few  to  a  lo<>p  or  two  of 
intestine.  Through  the  parieties  of  the  abdomen  the  tumor  gives  a 
a  softer  or  more  yielding  feeling  than  does  the  fibrons  outgrowth 
from  the  uterus  ;  and  on  palpitation  there  may  bejfelt  a  deceptive  seoise 
of  fluctuation,  which  is  due  to  the  quantity  of  the  fat,  of  a  very  soft 
nature,  in  them,  it  being  much  less  dense  than  that  which  is  met  with 
in  lipomas  under  the  common  integuments.  This  apparent  fluctua- 
tion I  have  known  to  deceive  a  surgeon.  These  tumors  and  their 
lobules  are  supplied  with  a  few  hut  not  large  arteries ;  and  abundant- 
ly with  expanded  veins,  some  of  them  resembling  sinuses.  These 
fatty  tumors  are  less  rapid  in  growth  than  are  the  ovarian,  but  more 
80  than  the  purely  fibrous  outgrowths  from  the  uterus. 

There  are  other  abdominal  turaois  occasionally  met  with  that  might 
possibly  be  relieved  in  some  cases  by  an  operation  ;  but  the  three 
kind^  I  have  mentioned  are  those  that  especially  call  for  gastroiomv, 
which  may  be  undertaken  with  hopes  of  success,  and  which  are  sure 
to  end  in  death  if  not  removed. 


1864.]  Orifi^l  CommumietaiMt.  711 

AdheMom. — All  these  tomors,  when  of  long  standing  and  grown 
large,  are  liable  to  become  adherent  to  the  anterior  parieties  of  the 
abdomen,  sometimes  even  to  the  liver,  which  they  crowd  np,  to  the 
diaphragm,  or  to  the  spleen  or  to  some  portion  of  the  omentum  ;  bat 
this  Ia.Ht,  in  most  cases  of  very  large  tumors  has  become  more  or  less 
absorbed  by  the  pressure  they  make  against  it.  Posteriorly  there  are 
few.  if  any  adhesions,  which  absence  is  due  to  the  almost  ceaseless 
peristaltic  movement  of  the  intestines,  and  their  alternate  distention 
and  collapse,  affording  no  time  for  anion  to  become  effected. 

These  adhesions  are  not  dne  to  inflammation,  effusion  of  lymph  and 
its  subsequent  organization  ;  for  in  all  the  cases  I  have  observed,  ex- 
cepting one,  has  at  no  time  suffered  from  any — the  slightest — symp- 
tom of  fever,  or  from  that  peritoneal  pain  that  invariably  accompa- 
nies inflammation.  The  adhesion  is  due,  simply  to  great  pressure  of 
the  tumor  against  the  tensely  stretched  abdomen.  In  the  early  stages  , 
this  tightness  does  not  exist,  and  tbe  lesser  size  of  the  tumor  admits 
of  its  sliding  to  some  extent  during  the  movements  of  tbe  patient 
while  getting  np,  lying  down  or  walking.  On  the  contrary,  when  the 
tnmor  has  attained  a  great  sise,  its  anterior  surface  presses  forcibly, 
and  conHanUy,  against  the  front  of  the  abdomen,  causing  the  cpithelii 
of  the  two  surfaces  to  disappear,  and  by  the  same  cause^its  great 
size — is  held  steadily  in  one  place,  immoveably.  The  two  peritonei 
having  come  into  immediate  contact  coalesce  into  a  single  membrane 
apparently,  in  those  places  where  the  pressure  is  greatest,  constant 
and  fixed  ;  but  in  other  parts  less  pressed  the  two  membranes  ad- 
here less  intimately,  and  can  be  easily  separated  by  the  fingers  of 
the  surgeon  pressing  between  them,  without  giving  escape  to  so  much 
as  a  tinge  of  blood,  because  no  vessels  exist. 

Having  heard  that  adhesion  of  separate  parts  cannot  take  plaoe 
without  the  intervention  of  inflammation,  and  its  office  of  throwing 
oot  fibrous  matter  to  become  organized  between  adjacent  surfaces  and 
thus  affecting  union  between  them  denied,  I  may  as  well  give  one  or 
two  examples,  out  of  many,  to  prove  that  an  intimate  union  of  nat- 
ural ly  separated  parts  can  take  place  without  the  intervention  of  the 
famous  adhetive  im/lammatian. 

Case  :  A  child  affected  with  intervertebral  softening,  ends  with 
distortion  of  the  spinal  column  which  draws  the  ribs  with  it.  The 
arches  of  the  ribs  on  the  convex  side  of  the  curvature  become  widely 
separated  from  each  other  ;  while  the  arches  of  the  ribs  on  the  lesser 
curvature  are  approximated.  The  intervening  intercostal  muscles  was 
by  preseuie  which  arrests  nutrition  and  permits  the  abeorptioA  of  the 
effete  nuterial  to  go  on,  and  when  the  upper  and  lower  edge  of  two 


712  Oris^fua  OoMnumeaH&m.  [Decemher, 

adjoining  ribs  approach  nearer  and  nearer,  until  at  last  the  perioateftm 
of  each  has  ceased  to  exist,  the  two  ribs  tonch,  unite,  and  in  that 
place  form  a  single,  broad  and  flat  rib.  All  this  goes  on  without  the 
slightest  complaint  of  pain  or  inflammation,  because  it  is  a  natnial 
process.  It  is  common  enough  to  get  such  a  skeleton  if  sought  for ; 
and  many  are  to  be  seen  in  museums,  where  not  only  but  two  bul 
three  ribs  are  united  into  a  single  one  on  the  conoaye  side  of  a  distort- 
ed trunk. 

Another  example  may  be  mentioned  :  A  man  had  bis  foot  badly 
crushed,  it  swelled  enormously  under  the  treatment,  and  sinuses  form- 
ed in  the  coarse  of  some  of  the  thec»  of  the  tendons.  When  consult- 
ed at  a  late  period,  I  advised  his  surgeon  to  put  a  thick  comprsis 
aboTC  and  below  the  phalanges  with  a  roller  over  all,  with  the  view 
of  diminishing  the  swelling  by  the  absorbent  effect  of  preeenre,  and 
to  keep  all  wet  with  water.  This  was  persevered  in  too  long,  the 
epidermis  between  the  second  and  third  toes  was  washed  away,  g^rsd- 
ually  admitting  the  leta  mucosa  of  each  to  come  into  immediate  prox- 
imity. When  1  saw  the  case  subsequently  the  two  toes  were  united, 
as  regards  the  soft  parts,  into  one.  All  this  occurred  in  the  complets 
absence  of  inflammation,  and  the  effusion  of  flbrin  to  become  organ* 
ized  subsequently.  In  this  way  toes  have  united,  little  by  little  from 
simple  entertigo,  they  being  maintained  in  contact  by  pressure.  In 
the  case  of  burns  it  is  different,  for  here  fibrin  in  a  thick  coat  is  qnick- 
ly  thrown  out,  and  if  not  peeled  off  will  snrely  organize,  and  in  the 
subsequent  stage,  long  afker  haviDg  healed,  the  fibrin  becoming  ab- 
sorbed, irremedial  contractions  gradaally  follow.  v 

Tumors  do  not  become  adherent  to  the  parieties  of  the  abdomen,  or 
viscera,  as  long  as  they  are  small  or  of  recent  growth  because  they 
exert  no  great  pressure  on  the. opposite  parts,  and  are  so  mobiloasnot 
to  stay  long  enough  in  contact  with  one  point  to  become  connected. 

Case. — A  girl  abont  twenty  years  of  age  had  ovarian  dropsy, 
which,  from  the  first  perception  of  it  to  when  I  removed  it  lasted  18 
months.  It  was  unadberent  although  nearly  30  pounds  in  weight. 
Other  patients  with  similar  tumors  of  abont  the  same  size  and  stand- 
ing, were  without  adhesions.  A  fibroid  outgrowth  from  the  uterus 
of  ten  years  standing,  had  reached  only  a  little  above  the  umbilicos, 
when  it  suddenly  took  to  rapid  growth  and  in  two  or  three  months 
after,  when  I  removed  it,  was  unadberent,  although  it  now  filled  both 
iliac  regions  and  reached  half  way  up  between  the  umbilicus  and 
scrobiculus  ;  but  then  for  a  long  time  it  was  small,  and  when  grown 
large  at  last  had  done  so  in  a  period  too  short  to  have  contracted 


1864.]  Oriffhutl  OmnmumieMmi.  718 

imioti  bf  presBnre  to  adjacent  parts.  It  is  qnite  different  in  large 
tumors  of  long  standing.  A  girl  twenty-nine  jears  of  age  had  a  very 
large  ovarian  tumor  of  over  iwo  years'  standing.  After  removal  it 
ireigbed  55  pounds.  It  then  adhered  to  the  whole  front  of  the  abdo- 
■aen  and  sides,  to  the  anterior  third  of  the  diaphragm,  to  a  portion  of 
kbe  spleen,  and  to  a  part  of  die  liver,  bat  no  where  to  the  intestines. 
The  anterior  adhesions  were  easily  severed  by  the  hand  and  outspread 
Sogers,  while  in  other  places  the  adhesions  tore  into  tongh  ribbons, 
and  a  few  had  to  be  cut  throngh.  No  blood  escaped.  She  qnickly 
recovered  notwithstanding  the  great  extent  of  the  adhesions  severed. 
No  peritoneal  inflammation  or  fever  followed,  doubtless,  because  no 
troe  peritoneum  remained  at  the  seat  of  -adhesions.  la  several  other 
eases  of  large  and  long  standing  tumors  adhesions  existed,  and  must 
be  expected.  They  will  be  found  strong,  according  to  the  length  of 
time  they  have  existed,  requiring  considerrble  force  to  tear  throngh 
them.  In  all  these  cases  thera  need  be  little  fear  of  hemorrhage  to 
occur  from  severing  them. 

Before  treating  of  the  operation  it  may  be  as  well  to  examine  the 
subject  of  inflammation  ;  for  this  is  the  ghost  that  haunts  many  sur- 
geons before  an  operation— especially  so  when  its  seat  is  in  a  serous 
membrane — bewilders  and  obfusticates  the  judgment,  induces  prepar- 
atory measures  that  always  add  to  the  disorder,  and  after  an  operation 
is  so  prolific  through  fear  of  it,  of  numerous  injurious  medications 
to  the  risk  of  the  patient. 

Injiitfnmation. — Many. practitioners  regard  wounds  of  the'peritoneum 
as  peculiarly  dangerous  from  the  inflammation  that  follows  them. 
Hence  has  arisen  a  dread  of  performing  operations  within  the  abdo- 
minal enclosure.  This  fear  has  so  greatly  influenced  the  judgment 
and  practice  of  some  surgeons  that  they  decided,  in  cases  of  hernia,  to 
divide  the  stricture  without  catting  into  the  sac,  and  in  this  way 
avoid  wounding  the  peritoneum,  and  not  expose  it  to  the  much  dread- 
ed malignancy  of  the  atmosphere.  We  have  all  seen  the  direful  con- 
•eqoences  of  this  innovation,  founded  on  the  mistaken  notion  of  re- 
garding all  peritoneal  inflammation  as  of  on$  kind  only,  while  there 
are  at  least  two,  diflfering  from  each  other  in  cause  and  course,  each  of 
which  is  subject  to  different  phrases  and  terminations  ;  which  I  shall 
now  examine,  and  endeavor  to  show  that  one  kind,  idiopathic  in  cer- 
tain seasons,  and  countries,  is  really  a  fearful  disease ;  and  the  other 
that  which  is  likely  to  follow  gastrotomy  is  less  to  be  feared  than  the 
first.  Although  what  follows  is  not  mentioned  in  books  or  in  lec- 
tures, let  it  be  borne  in  mind  as  an  axiom,  that  any  inflanunation  is 


714  Original  C<immunie4Miiat$s.  [December, 

merely  an  accident  to  many  diseases  which  differ  widely  from  etck 

other  ;  that  it  is  never  the  cause  of  the  malady  ;  bat  it  is  alwayx  iht 

effect  of  a  disturbance  elsewhere  situated — near  by,  or  far  off—tod 

sometimes  is  of  so  prominent  a  character  as  to  be  taken  by  some  pne- 

titioners  as  being  itself  the  whole  disease,  and  the  only  thing  to  bt 

combatted. 

1st.  Idiopathic  InH  tiwnation. — A  remarkable  exan^ple  of  the  erron- 
eous opinion  entertained  regarding  inflamnaatiou,  among  a  thoasami 

others  that  arose  and  lived  a  day^  was  that  of  the  celebrated  Broos- 

sais  and  his  disciples,  a  doctrine  that  overshadowed  all  "  Young  Eb* 

rope  "  for  a  few  years,  and  filled  so  many  untimely  graves.     He  tn<i 

they  denied  the  possibility  of  Idiopathic  or  Essential  fever,  as  tiie 

schools  call  it,  on  the  ground   that  they  always  found  in  every  fe«r 

some  one   or   other   organ    inflamed — true,  so  far ;  and  asaertetl  ihat 

the  inflammation  seen  was  the  cause  of  the  fever.     They  disreganied 

the  fact  that  the  fever  in  every  case  had  existed  several  days  befor 

the  local  disorder  (inflammation)  became  maniHest ;  passed  overlh« 

patent  fact  that,  in  the  same  fever,  during  the  same  ep'demic,  patiemi 

in  the  same  honse,  at  the  same   time,  might  have   the  local  disorder 

(inflammHlion)  as  in  typhus,  situated  in  a  different  organ  in  one  p*- 

ticnt,  it  might    be  muco-gastritis ;  in  another  an  enteiiiis,  in  a  third 

a  bronrliitis  ;  in  another  an  arachnitis,*  wliile  ihe  fever  (typhus)  was 

the  same  in  all. 

In  variola,  the  fever  (which  is  the  real  disease)  exists  wi  h  violence 
three  days  before  tlie  eruption  ;  six,  b<»fore  the  commencement  of  areo- 
lar inflainni>4tion.  In  iiliopathic  er}sipelas  the  fever  precedes  the  local 
disorder  at  least  twenty-four  hours  ;  and  so  on,  for  every  esaeuital 
fever  or  disorder. 

Id'opathic  peritonUis  and  enteritis  are  always  preceded  by  fever, 
more  or  less  marked  ;  but,  the  inflammation  once  become  manife^i. 
like  in  the  eruption  in  variola,  and  other  exanthemata,  the  inilam- 
mation  is  the  most  notable  condition  of  the  patient.  The  idiopathic 
peritonitis  is  a  specific  disease,  due  to  a  general  cause  ;  it  rapidly 
spreads  in  h'gh  latitudes,  over  the  whole  peritoneum — parietal  and 
visceral — throwing  out  a  thick  layer  of  fibrin,  and  there  too  often 
ends  ill  cleath  in  a  few  days  ;  so  also,  puerperal  peritonitis  ;  but  here, 
the  effn^iou  is  less  fibrous  or  solid  than  in  pure  peritonitis.  These 
inflammations  are  duo  to  occult  cause  hidden  in  the  system.  Tiio  phy-' 
sician  claims  the  attendance  on  these  cases  as  peculiarly  belonging  to 
his  branch  of  what  may  be  trnly  called  the  hack  art  of  the  prufe>sion 
— conjecture  bedaubed  with  speculative   imaginings  ;  claiming  that 


1864.]  Original  CammunicatHmi,  715 

the  physician  alone  is  competent  to  prescribe,  holding  the  knowledge 
of  the  snrgeon  in  contempt  as  compared  with  his  conceits. 

2d.  Traumatic  Inflammation, — As  the  name  implies,  is  always  due 
to  mechanical  injury,  and  varies  in  severity  according  to  the  nature 
of  the  lesion — bruising,  tearing,  or  simple  clean  cutting  It  in  a  very 
different  afiair  from  idiopathic  inflammation,  which  has  a  prescribed 
course  to  run,  and  which  is  merely  the  expression  of  a  disease  in  the 
whole  system.  The  traumatic  is  merely  the  sequel  of  a  local  injury. 
It  rarely  becomes  manifest  before  twenty-four  hours  after  the  acci- 
dcot  ;  and  in  four  or  ^^e  days  produces  pus,  a  natural  crisis,  the  gen- 
eration of  which  mitigates  all  the  inflammatory  symptoms,  unless  the 
lebioD  have  some  poison,  morbid  or  cht^mical,  addeil  to  it,  in  which 
cane  it  may  increase  even  after  the  generation  of  pus,  and  progress 
indefiuitely.  But  in  a  he^ihhy  person  .hould  the  lesion  consist  of  a 
clean  cut,  and  the  edges  be  brought  nicely  together,  union  will  take 
place  ^vithout  the  iutcrveution  of  inflammation,  even  of  that  slight 
degree  erroneously  called  *' adhesive.''  This  result  I  have  seen  in 
aevcral  cases  of  gastrotomy. 

There  is  a  ditference  in  the  amount  of  inflammation  that  follows 
wounds  in  different  parts  of  the  bo'ly,  or  when  the  patient  is  un- 
healthy at  the  time  of  being  wounded.  A  cut  into  the  abdominal 
cavity  of  persons  that  have  had  it  previously  much  difitcnde<l,  as  by 
pregnancy,  by  large  ovarian  or  other  large  tumors,  is  followed  by 
mach  less  inflammation  than  in  those  who  have  so  suffered  Every 
anrgeon  of  only  a  few  years'  practice  h:is  noticed  that  small  cuts,  like 
that  of  a  pen-knife  into  the  abdomen  of  a  man,  or  that  of  a  female 
who  has  never  been  stretched,  is  a  rather  serious  affair  ;  while  a  simi- 
lar stab  into  a  previously  distended  abdomen,  by  even  a  worse  instru- 
ment, a  trocar,  is  never  followed  by  peritoneal  inflammation. 

In  the  case  of  gastrotomy  for  the  removal  of  tumors,  the  cause  of 
this  difference  is  very  simple  and  of  easy  explanation.  In  th^slowly 
and  long  stretched  abdomen,  all  the  parts  that  conspire  to  form  its 
lateral  and  anterior  boundaries  have  been  gradually  expanded  in  both 
latitude  and  longitude,  but  not  in  thickness,  the  parts  did  not  grow, 
as  the  pregnant  uterus.  The  vessels  elongate,  but  scarcely  enlarge, 
they  rather  diminish  in  calibre,  for  instance,  the  epigastric  artery 
which,  in  the  natural  state  reaches  from  Poupart's  ligament  to  the 
tipper  section  of  the  rectus,  there  to  anastomose  with  branches  of  the 
aub^temal,  and  lower  iutercostals,  is  scarcely  9  inches  long,  while  in 
the  largely  distended  abdomen  from  pregnancy  or  tumors  it  is  drawn 
otit  to  24  or  26  inches,  according  to  the  degree  of  stretching  of  the 


716  Original  CfnmufiietBtums,  [Deoeinbci, 

abdomen,  which  I  have  known,  will  reach  28  inches  from  the  pabii 
to  the  ensiform  cartilage.  The  veins  will  correspond  in  elongation, 
hut  not  in  capacity  ;  thev  appear  to  snperficial  observers  mnch  larger 
than  natural,  while  in  reality  they  are  not  so ;  they,  like  all  the  otlter 
tissues,  are  merely  expanded  in  length  and  breadth,  bnt  not  in  ca- 
pacity, for  on  close  examination  they  will  be  found,  although  madi 
broader  than  usual,  to  have  no  more  or  less  capacity  than  usual,  bj 
reason  of  the  approach  of  their  anterior  and  posterior  sides.  Tendering 
them  into  flattened  tubes,  which  shape,  however  broad,  is  a  of  small 
capacity,  by  reason  of  their  diminished  area.  This  state  of  the  veiu, 
it  may  be  mentioned  here,  is  very  striking  in  appearance  on  the  sor 
fiftce  of  any  abdominal  tumor,  so  much  so,  that  I  have  heard  specti- 
tors  of  an  operation  exclaim,  "  how  varicose  the  veins  are/'  while 
no  varicose  state  exists. 

Once  more :  All  the  tissues  that  conspire  to  constitute  the  abdo- 
minal parieties  are  stretched  by  tumors  equally.  The  skin  so  mach 
so  as  to  suffer  long  lines  of  partial  rupture  of  its  chorion,  mptiuti 
that  are  never  recovered  from,  and  which  leave  those  marks  constant!/ 
seen  in  women  who  have  borne  children,  wrongly  called  vergitnras. 
The  muscles,  their  tendons  and  fascice  also  spread  out  greatly  botb  is 
length  and  breadth,  but  not  in  thickness,  for  there  is  no  growth. 
Each  rectus  instead  of  being  only  2^  inches  wide,  expands  to  4  or 
more  ;  its  sheath  increases  proportionally,  as  I  have  seen  when  a 
bungling  operator  deviating  from  the  medium  line,  has  laid  the  shettli 
open,  the  edges  of  the  muscle  not  reaching  its  breadth  and  filling  iu 
capacity.  The  length  of  the  rectus  with  its  intervening  tendons,  x^ 
extreme  cases,  has  been  28  inches,  instead  of  10  or  11,  the  usual 
length.  What  the  muscles  just  named  have  suffered,  all  accompany- 
ing tissues  with  their  nerves  and  vessels,  have  undergone  in  eqoal 
proportion.  The  consequence  of  this  expansion  is,  when  the  dis- 
tending force,  the  tumor,  is  removed,  the  parieties,  whose  contractili- 
ty has  been  greatly  overcome,  and  to  some  extent  lost,  recover  tbeir 
primitive  proportions  very  slowly,  but  never  completely.  This  re- 
covery is  not  wholly  due  to  contractility  that  interests  all  the  mole- 
cules of  the  parts,  it  is  partially  so,  but  is  mostly  effected  by  a  fold- 
ing of  the  fibers  one  against  another ;  in  this  corrugation  the  vessels 
and  nerves  participate,  bending  into  numerous  flexuosities,  a  condi- 
tion that  not  only  retards  but  obstructs  the  passage  of  blood  through 
them,  a  state  ill  adapted  to  furnish  that  supply  of  blood  which  is  ont 
of  the  essentials  of  acute  inflammation.  Hence  it  is,  that  gastrotomj, 
for  the  removal  of  large  tumors,  is  followed  by  very  trifling  inflam- 


1864.]  Original  Communicatumi.  717 

matioiiy  whan  the  operation  Las  been  well  performed,  and  the  case 
w«ll  managed  subsequently. 

On  the  other  hand»  an  abdomen  that  has  not  suffered  the  expansion 
mentioned  resembles  other  parts  of  the  body  as  regards  the  inflamma- 
tion that  follows  injuries,  since  the  tissues  are  actively  contractile  else- 
where ;  the  Teasels  are  short  and  round,  with  a  full  calibre  instead  of 
long,  and  in  the  case  of  the  veins  flat  without  capacity  and  contrac- 
tilitj  ;  the  nerves  also  have  been  stretched  and  proportionally  paral- 
jrsed. 

Having  hastily  noticed  the  difierence  ezisticg  between  idiopathic 
aod  traumatic  inflammation,  and  the  reasons  why  the  latter  is  less  to* 
to  ba  dreaded  than  the  former,  especially  in  gastrotomy  when  per- 
formed on  a  stretched  abdomen,  I  now  proceed  to  examine  the  ques- 
lion  of  the  iemperaiure  ^  ihe  apartmitU  in  which  the  operation  is  to 
be  performed.     Ihe  early  operators,  anxious  for  success,  but  having 
AO  facts  to  rely  on,  theorise  in  advance  as  to  what  might  interfere 
with,  or  favor,  the  result ;  and,  among  other  ideas,  imagine  that  in- 
aemnch  aa  the  temperature  of  the  viscera  was  constantly  near  100^ 
Fahr.,  the  room  in  which  the  operation  was  to  take  place  ought  to  be 
heetcd  to  that  degree,  lest  a  colder  atmosphere  should  provoke  great 
Initation  on  the  exposed  parts.     Had  these  practitioners  have  called 
to  mind  the  numerous  cases  of  wounds  through  wbich  the  bowels 
hftve  escaped,  been  exposed  for  some  length  of  time,  and  which  sab- 
Mqoently  did  well,  they  might  have  banished  the  fear  of  cool  air,  and 
hftve  saved  themselves  and  their  patient  from  the  oppression  of  a  tor- 
rid atmosphere.    The  length  of  time  necessary  to  complete  a  well 
eonducted  operation  is  so  short,  that  a  moderately  cool  air  (between 
BO  and  60  degrees)  has  not  time  to  act  injuriously,  while  the  heated 
room  will  prove  far  from  beneficial.     I  operated  on  a  patient  living 
m  a  temporary  house,  a  mere  shanty,  where  there  was  no  means  of 
heating  it»  on  a  dark,  rainy  day  in  the  month  of  December,  while  the 
temperature  was  so  low  as  46^  Fahr.,  so  low  that  our  breath  was 
fieible,  ae  was  the  steaming  hillatus  from  the  open  abdomen  of  the 
patient.    Not  one  anxious  symptom  followed,  the  patient  recovered 
perfectly  in  twenty  days,  and  has  since  become  the  mother  of  two  fine 
ihildrea. 

Another  patient  was  operated  on  in  a  room  opposite  a  large  win- 
low  wbich  was  kept  open  to  admit  light,  and  through  which  blew  a 
imart  breeie  at  60^  Fahr.     This  patient  did  well,  and  quite  recovered 
la  the  apace  of  three  weeks.    In  every  case  that  I  have  bad  since  these 
;be  operation  haa  been  performed  regardleaa  of  either  temperatoie,  for 


1864.]  Oriffinai  CimmunieaH<fH9,  719 


of  aon-adherent  ttunore.  When  (here  are  adhesicfns  a  sponge 
Biaj  (rarely)  be  needed  to  dip  away  the  little  blood  that  soroetimes 
obscarea  the  orifices  of  a  divided  arteriole,  in  order  to  eecnre  it  by 
fcoraion  or  ligature.  The  sponge  ought  never  to  be  rubbed  on  the  part 
for  by  doing  so,  the  part  becomes  irritated,  the  innervation  exalted, 
aod  the  living  ping  that  had  closed  the  vessel  drawn  out,  both  these 
■ffscts  setting  the  bleeding  agoing  actively  when  it  had  ceased.  A 
good  operator  rarely  employs  a  sponge,  and  when  he  does  he  is  care- 
fal  to  make  use  of  a  new  one,  and  not  one  that  has  been  contaminat- 
•d  by  use. 

Tk4  Lwg  and  Short  Ineisunu  Considered, — Early  operators  em- 
ployed the  *'  long  incisions  ; "  that  is,  long  enough  to  admit  of  the 
gscape  of  the  tumor,  and  to  afford  an  insight  to  what  thry  were  about, 
a  eat  from  fifteen  to  twenty-six  inches  long.  Secent  operators,  anx- 
iona,  both  for  improvement  und  perhaps  novelty,  deprecate  it  as  being 
dangerous  from  its  great  extent,  and  advocate  a  short  cut,  since,  by 
ponctoring  one  or  more  cysts,  the  contents  can  be  evacuated  and  so 
«iiich  reduced  iu  size,  that  the  sacks  may  be  drawn  through  a  cut  ol 
only  a  few  inches  long,  and  then  severed  outside  of  the  abdomen,  with- 
out exposing  the  viscera  to  the  air.  This  notion  has  largely  been  put 
im  practice  of  late  years  with  resnlts  far  from  favorable. 

A  abort  cut  is  less  painful  than  a  long  one.  This  is  its  only  merit, 
Mid  which  is  now  overcome  by  chloroform.  In  all  other  respects  it 
it  exceedingly  defective.  The  abort  cnt  is  utterly  useless  in  all  cases 
where  the  tumor  is  solid ;  also  in  cystic  tumors  that  are  adherent ;  for 
die  solid  tumor  cannot  be  reduced  in  size  since  its  contents  cannot  bo 
OTACuaied,  and  therefore  it  cannot  be  brought  through  a  small  open- 
kkg,  Should  the  tumor  consist  of  cysts  and  be  adheront,  the  adhes- 
ions most  be  severed  in  the  dark,  with  great  risk  to  the  parts  to 
which  it  adheres,  and  in  total  ignorance  of  any  hemorrhage  that  may 
ooenr.  It  is  only  ovarian  tumors  that  can  be  diminitthed  in  size  by 
•raeuaiing  the  cysts,  and  subsequent  dragging  the  flabby  portions 
ihrottgh  *  short  cut ;  a  slovenly  procedure  as  any  one  who  has  seen 
this  mode  of  operation  can  testily  ;  a  mode  that  favors  the  entry  of 
some  of  this  unnatural  fluid  into  the  abdo'uen,  there  to  set  up  irrita- 
tion and  that  inflammation  which  is  so  greatly  feared.  The  advo- 
cnlea  of  this  method  say  a  great  deal  about  the  advantages  it  gives 
of  fixing  the  '*  stump  "  in  the  cut,  and  outside  of  the  altdomen  by 
■Mans  of  a  clamp,  which  is  to  strangulaUs  the  peritoneum  and  tissuea 
within  its  grasp,  until  the  part  slonghs  off  outside ;  rather  than  leave 


720  Oriffmal  CcmmunwUiont.  [DeeembiTi 

it  within  the  abdominal  cavity,  th«reia  to  alongh,  to  poftrifj,  and  ea- 
poison  the  patient. 

All  this  surgical  complioation  is  doe  to  hypothetical  speeoklion  ii 
advance  of  what  is  expected  to  happen  ;  to  •  fear  of  hemorrhage ;  to 

a  fear  of  leaving  ligatures  in  the  abdominal  cavity  ;  to  a  fear  of  a 
posing  the  viscera  to  a  malignant  influence  of  the  atmoephere ;  all  rf 
them  imaginary  and  nnfoanded  fears,  completely  disproved  by  expt- 
rience ;  and  what  my  old  friend  Blnndell  woald  eall  "  meddleeoai 
snrgery." 

The  long  cat  admits  of  the  only  means  of  severing  adheaioBS  nttfi 
without  injury  to  adjoining  parts,  and  admits  of  meaas  to  arrest  lif 
hemorrhage  that,  possibly,  might  happen  from  a  divided  arterioli ; 
and  in  the  case  of  solid  tumors  is  absolutely  neoessary  to*  get  spaeotor 
it  to  pass  through  ;  enables  the  operator  to  see  what  he  is  abont,  ui 
to  get  at  the  few  small  vessels  going  to  it  that  may  require  ligatnnL 

Some  operators  advise  and  employ  a  thick  ligature— whip  cord,-' 
wiih  which  to  tie  the  whole  stump  in  a  single  noose.  Id  this  wajt 
large  ''  stump  **  will  no  doubt  be  left  to  putrify ;  a  disgraceful  pit* 
of  surgery,  when  it  is  so  easy  to  tie  the  few  arteries  that  enter  iatoi^ 
divide  it,  and  leave  no  stump  of  any  notable  siae,  behind.  Bat  to 
tie  these  vessels  neatly  and  efficiently,  it  is  requisite  to  have  rooa, 
which  the  short  cut  cannot  give ;  hence  the  lugging  out  of  the  stomp, 
and  strangulating  of  the  whole  in  a  clamp  ;  thus  carrying  sorgeij 
back  to  the  epoch  of  horse-gelders  and  sow-spayers,  who  know  no( 
how  to  arrest  hemorrhage  otherwise  than  clamps  and  searing  iroia. 

By  the  clamp  process  the  slump  is  forcibly  stretched  from  the  broi'i 
ligament,  or  the  spine,  according  to  the  attachment,  to  the  abdomintl 
surface,  like  the  yoke  about  the  goose's  neck.  The  viscera  have  to 
place  themselves  within  the  abdomen  as  best  they  can,  on  each  side, 
above  and  below,  like  about  a  post  set  up  among  them.  The  two 
edges  of  the  abdominal  incision  bear  on  the  left  and  right  sides  of  t^ 
hauled  out  stud,  and  must  contrive  to  unite  with  the  serous  surfaces 
of  the  stud  by  some  strange  process,  out  snrfaces  with  serous  surfacet 

There  need  exist  no  fear  of  hemorrhage  in  ovarian  cases,  since  onlj 
two  sets  of  vessels  travel  along  the  broad  ligament  to  the  tumor,  both 
of  which  can  be  rolled  under  the  peritoneum  and  collected  into  two 
groups  ;  one  the  spermatic  at  the  upper  edge ;  the  other,  some  eter 
ine  from  the  internal  iliac  at  the  lower  edge,  each  group  to  be  stna* 
gled  with  a  fine  ligature  into  a  compass  mei-ely  as  large  as  the  siie  oft 
crow  quill,  as  is  manifest  by  the  loop  of  several  ligatures  in  my  pos- 
session that  have  come  oflf  in  the  course  of  cure. 


1864.]  Original  Communications,  721 

The  fear  of  inflammatioD  from  leaving  two  or  more  ligatiircK  at- 
tached near  the  sacrum,  and  hanging  out  at  the  lower  end  of  the  cut 
over  the  pnhis  is  unfounded.  The  greatly  relaxed  parieties  in  thcHC 
cases  render  them  much  less  liable  to  inflame  than  do  parietics  that 
have  never  been  stretched  and  are  tenbe. 

Another  fear,  that  of  air  entering  by  the  side  or  track  of  the  liga- 
tures, is  also  unfounded  ;  since  during  the  first  few  days  after  the  op- 
eration the  peritoneal  liquor  oozes  constantly  out,  a  discharge  from 
within  being  opposed  to  an  entry  without  ;  and  this  discharge  ceases 
only  when  by  a  little  fibrinous  exudation  around  the  ligatures  in  tbeir 
whole  track  it  encloses  them  in  a  can  d  an  I  by  this  means  virtually 
excludes  them  from  the  abdominal  cavity. 

There  is  no  difference  in  the  length  of  time  requisite  to  heal  a  short 
and  a  long  cut  ;  since  the  agglutination  takes  place  throughout  the 
whole  length  of  each  at  the  same  moment,  and  not  progressively  from 
one  point  to  the  next  successively.  The  process  that  unites  one  atom 
of  the  cut  goes  on  in  all  at  one  and  the  same  time.  In  gastroiomy, 
in  caseH  of  a  previously  distended  abdomen,  when  properly  peiTorme«l 
and  judiciously  dressed,  I  have  found  union  to  take  place  without  any 
inflammation,  even  of  that  low  dei^ree  erroneously  called  adhesive,  and 
have  only  seen  a  little  of  it  with  a  harmless  suppuration  where  the 
ligatures  come  out  above  the  pubis. 

2he  Operation, — Any  medication  of  the  patient  previous  to  the  op- 
eration is  either  useless  or  hurtful,  as  fretting  the  economy  to  some 
extent.  All  that  need  be  done  is  to  give  a  dose  of  castor  oil  the  day 
preyionsly,  or  an  enema  in  the  morning  befoi*e  the  operation,  merely 
to  empty  the  bowels  ;  and  the  enema  should   be  tepid  water  simply. 

The  .patient  well  under  chloroform,  being  on  her  back,  should  the 
inmor  incline  to  one  side  more  than  to  the  other,  let  an  assistant  push 
it  so  mach  to  the  other  as  to  make  its  centre  of  convexity  lie  directly 
under  the  linca  alba.  The  0|>erator  now  commences  by  making  a 
ateady,  deliberate  cut  from  a  little  above  the  pubis  to  half  way  above 
the  mnbilicus,  or  higher  up  or  quite  to  the  scrobiculus,  according  to 
his  judgment  of  the  size  of  the  tumor.  Let  it  be  made  fearlessly 
throngh  the  skin  down  to  the  fascia  over  the  linea  alba.  Ko  blood, 
or  lef»8  than  a  spoonful  will  eMca|)e  if  it  be  made  exactly  in  the  median 
line.  Let  him  next  either  above  or  below  the  umbilicus,  exactlv  in 
the  centre  of  the  linea  alba,  neither  to  the  right  nor  to  the  Inft  of  it, 
ent  carefully  three  or  four  inches  long  until  he  comes  to  the  peritone- 
nm,  which  is  readily  distinguished  should  the  tumor  be  non-adherent 
in  the  oentre.    To  enter  the  abdomen  in  this  way  there  is  no  need 


7is2  Original  (Tommtciucffluf .  Deeeiober, 

of  probes,  directories,  forceps,  etc.,  and  that  scratching,  and  lamiot 
after  lamina  dissection  too  often  seen  done.  Having  entered  the  cav- 
ity of  the  peritoneum  he  will  insert  two  fingers  ;  on  one  or  hetween 
both,  place  the  back  of  the  knife,  the  edge  forward,  and  then  carry  it 
down  and  upward  in  the  direction  of  the  first  incision  to  the  extent 
needed,  and  thus  efifectnally  and  safely  open  the  abdomen.  This  mucb 
completed,  insert  the  hand,  palm  towards  the  tumor,  one  on  each 
side  of  it,  and  if  there  be  no  adhesions,  tnrn  the  mass  ont ;  but  care 
must  now  be  had  that  an  assistant  support  it  when  outside  of  the  ab- 
domen, lest  by  its  great  weight  it  draw  too  much  on  the  broad  liga- 
ment, tear  or  do  other  injury.  The  next  step  is  to  secure  the  vessels, 
which  is  easily  done  by  collecting  them  as  already  said,  into  two 
groups,  since  they  roll  freely  under  the  investing  folds  of  the  peri- 
toneum, one  set  at  the  upper  edge  of  the  broad  ligament,  the  other  set 
or  group  at  the  lower  edge,  dividing  the  space  between,  which  con- 
tains no  vessels.  A  careful  cut  must  be  made  through  the  peritone- 
um, which  lies  on  and  under  the  vessels  which  can  be  done  without 
the  slightest  risk  of  wounding  them,  in  which  cut  the  ligature  most 
be  buried,  in  this  way  the  peritoneum  will  suffer  less  than  when 
strangulated.  Let  the  ligature,  a  small  one,  be  drawn  quite  tight, 
and  the  same  done  to  the  other  group.  Leave  at  least  nine  inches 
long  of  the  ligature  to  hang  out  at  the  lower  end  of  the  incision  over 
the  pubis.  Next  cut  through  the  attachment  or  pedicle  of  the  tumor 
about  half  an  inch  from  the  ligatures  ;  in  this  way  no  fearful  "  stump" 
will  be  left  behind,  more  than  is  left  in  the  case  of  arteries  in  ampu- 
tations. The  tumorvis  now  extirpated.  Wait  a  few  minutes  and  see 
that  all  is  right,  there  need  be  no  hurry.  During  the  operation  the 
intestines  may  escape  when  the  tumor  is  small,  or  from  straining  of 
the  patient  when  the  chloroform  be  insufficient,  or  excite  vomiting ; 
but  the  escape  of  intestines  is  a  rare  occurrence  when  the  tumor  is 
large,  because  the  patient  has  not  had  capacity  sufficient  in  the  stom- 
ach to  take  in  enough  food  to  nourish  her  ;  she  is  lean  and  the  press- 
ure of  the  tumor  has  caused  the  absorption,  more  or  less  complete,  of 
the  mesenteric  and  omental  fat,  so  that  what  with  emptiness  and  ab- 
sence of  adeps,  I  have  seen  the  intestines  remain  in  the  cavity  of  the 
abdomen  resembling  flat  ribbons.  However,  should  the  intestines 
escape,  sufifer  no  meddling  with  them,  which  will  injui-e  them  more 
than  leaving  them  outside,  untouched  by  busy  hands,  until  it  is  time  to 
close  the  wound.  The  surgeon  ought  to  do  this  without  assistance, 
and  without  touching  them,  by  merely  taking  hold  of  each  side  of  the 
cut  as  he  would  the  open  mouth  of  a  bag,  and  lifting  the  loos   and 


1864.]  Origmal  OmmwudctUbm:  72S 

flabby  parieties  up,  the  intestiDes  will  natormllj  slip  in  of  tbeuselveo. 
Any  attempt  to  restrain  their  exit  daring  the  performance  of  the  op- 
eration will  be  to  braise  them,  and  embarrass  the  operator. 

The  next  step  in  the  operation  — the  enclosare  of  the  abdomen — i  s 
a  very  nice  one,  to  exactly  and  neatly  approximate  the  edges  of  the 
incision.  For  this  purpose  fonr  twisted  satare  pins  will  be  required 
to  transfix  and  maintain  the  edges  in  perfect  coaptation,  'ihese  pins 
mast  be  at  least  three  inches  long,  made  of  brass,  copper  or  iron  wire 
well  tinned— copper  is  the  best,  as  being  very  pliable  and  easily  bent 
after  insertion  to  sait  the  track  it  lies  in.  To  insert  them,  pass  the 
steel  needle  through  the  skin  an  inch  from  the  edge  of  the  wonnd  on 
one  side  of  it,  thrust  it  obliquely  inward  until  it  pierce  the  peritonenm 
half  a  line  from  its  cat  edge  within  the  abdomen,  again  pierce  the 
opposite  side  in  a  corresponding  way'to  come  out  at  the  same  distance 
as  the  first  entered.  Fit  the  cut  edges  exactly  and  neatly  together 
and  with  a  figure  of  8  ligature  secure  this  first  pin.  Do  the  same 
with  the  three  remaining  pins  at  equal  distances  from  each  other. 
Tliia  done  insert  at  suitable  intervals  a  sufficient  number  of  common 
interrupted  sutures  between  the  interffpaces  of  the  pins.  Add  long 
straps  of  adhesive  plaster,  and  place  over  the  line  of  cut  a  strip  of  old 
rag  moistened  with  a  little  blood  that  can  be  had  by  squeezing  out  the 
veins  of  the  removed  tumor.  This  blood  dressing  is  the  most  con- 
genial to  a  wound  ;  it  soon  dries,  and  retains  the  parts  like  as  plint, 
and  is  easily  removed  when  quite  dry.  Lastly,  lay  a  compress,  made 
of  one  or  two  folded  napkins  on  with  a  sufficiency  of  tow  to  fill  up  the 
empty  belly  to  the  level  of  the  ribs,  so  as  to  press  up  the  liver  and 
anpport  it  from  hanging  too  heavily  on  its  ligam  ents,  until  the  rib 
come  down.  Retain  this  thick  compress  by  a  many  tailed  bandage  ; 
the  only  kind  that  will  fit  snugly  and  not  roll  up  out  of  shape  and 
place  as  does  a  broad  napkin.  The  many  tailed  bandage  ought  to 
have  lis  slips  scarcely  four  inches  broad,  and  so  laid  on  each  other 
that  the  center  one  opposite  the  navel  will  be  the  first  one  lapped  on, 
and  the  next  one  above  and  below  to  shingle  over  each  other  alter- 
nately, to  reach  as  high  as  the  ribs  and  low  as  the  pubis  ;  the  last  slip 
to  be  passed  under  the  nates,  come  over  the  groins  up  in  front  of  the 
abdomen,  there  to  be  pinned,  or  tacked  with  stitches  to  those  that 
already  encircle  the  belly. 

Smhieguent  TreatmeiU. — ^The  operation  is  now  finished ;  the  patient 
in  bed,  and  soon  out  of  chloroform,  is  to  take  three  grains  of  solid 
opinn  (no  morphine  or  other  fancy  preparation).  After  this  she 
will  probably  sleep  six  or  eight  hours.     Aft^r  that  period  tome  slight 


724  Original  CommunicaiioM.  [December, 

pain  will  return,  and  is  to  be  met  with  another  dose  of  one  or  two 
grains  moie.  It  may  be  necessary  to  repeat  the  opium  in  two  grain 
doses  for  a  few  days  more,  morning  and  erening,  but  the  larger  dose 
should  be  given  in  the  evening,  as  that  is  both  the  time  of  exascerba- 
tion  and  the  natural  period  of  repose  when  opium  acts  most  kindlj. 
It  is  better  to  give  one  adequate  dose  that  will  last  several  hours,  than 
tease  the  system  with  repeated  small  doses.  After  a  full  dose  the 
system  may  be  allowed  time  to  recover  from  its  unnatural  state — the 
effect  of  opium  ;  biit  never  give  more,  nor  oftener  than  there  be  real 
need  for,  indicated  by  pain.  Where  there  is  pain  there  is  irritation, 
and  where  there  is  irntation  inflammation  is  likely  to  be  set  up— aM' 
dolor,  ihifluxus  tsL 

No  heed  need  be  taken  to  move  the  bowels,  a  routine  practice,  in- 
jurioa»4ificran  operation  that  requires  the  greatest  repose  of  the  body 
and  viscera ;  nothing  interferes  more  with  the  recovery  of  the  parts 
than  acting  on  the  bowels.  The  patient  may  well  go  five  or  six  days 
without  a  motion,  unless  flatulency  require  an  enema,  or  a  small  dose 
of  castor  oil  to  restore  peristaltic  action  of  the  intestines ;  as  the 
bowels  were  never  full  for  a  long  time  before  the  operation,  and  what 
little  remained  was  removed  by  the  enema,  and  nothing  since  accn- 
mnlated  within  them  during  the  low  diet.  But  the  diet  must  not  be 
too  low,  the  stomach  must  not  be  left  empty,  like  a  mill  without 
grist  to  grind  itself,  therefore  she  must  have  a  little  bread  and  toast 
water,  or  tea,  or  both,  according  to  her  previous  habit  of  living,  for  a 
few  days. 

The  dressing  need  not  be  changed  earlier  than  the  fifth  or  sixth 
day,  when  some  of  the  sutures  may  be  removed,  and  the  dressing  care- 
fully replaced. 

In  cases  where  there  has  been  no  adhesions  and  the  peritoneum  re- 
mained natural,  it  will  secrete  as  usual  a  small  quantity  of  liquor  ahdo- 
minnlis.  This  will  escape  at  the  exit  of  the  ligatures,  and  wet  the 
lower  portion  of  the  dressing  for  a  few  day  ;  a  little  later,  the  ligatures 
become  enclosed  in  a  sort  of  canal  made  by  a  slight  deposit  of  fibrin, 
and  becomes  shut  out,  as  it  were  of  the  abdominal  cavi  y,  and  now  no 
more  will  escape.  Care  must  be  taken  to  secure  the  outward  ends  of 
the  ligatures  under  adhesive  plaster  to  prevent  them  being  drawn  out 
before  the  vessels  they  constringed  become  completely  closed.  The 
ligatures,  left  to  themselves,  will  take  from  three  to  five  weeks  to 
come  away  of  themselves,  because  they  always  include  a  few  fibres  of 
the  fibrous  tissue  that  accompanies  the  vessels  in  the  broad  ligament. 


1864.]  Origintd  CommwnieoAmt.  725 

But  no  inoonvenienee  results  from  their  so  remaining,  since  the  patient 
can  go  about  as  in  health. 

The  forgoing  description  of  the  operation  of  gastrotomy  may  be 
taken  as  the  type  of  any  one  form  for  the  removal  of  tnmors  general- 
ly, from  the  abdominal  cavity.  Variations  may  be  needed  in  partic- 
ular cases,  as  when  adhesions  exist.  Also  when  the  case  turns  ont  to 
be  a  fibrpus  out-growth  from  the  uterus,  and  fibro -fatty  tumors. 

Gastrotomy  msy  be  availed  of  for  the  extirpation  of  tbe  uterns,  as 
suggested  by  Blundell  nearly  fifty  years  ago.  On  one  occasion  I  hes- 
itated between  extirpation  of  the  uterus,  or  excision  of  a  large  fibrous 
tumor  that  grew  from  its  base  and  ascended  mid-way,  between  the 
umbilicus  and  scrobicnlns,  filled  buth  iliac  regions  and  encroached  in 
the  hypochondrii,  its  pedicle,  if  pedicle  it  might  be  called,  was  over 
three  inches  in  diameter,  and  was  confonnded  with  the  substance  of 
the  enlarged  fnn'ius  of  the  uterus.  It  was  severed  close  to  the  uterus, 
the  patient  recovered  perfectly  in  three  weeks  time.  At  the  time  of 
the  operation  it  was  bard  to  say  which  of  tbe  two,  severance  from  the 
uterus,  or  extirpation  of  tbe  latter  with  the  tamor,  was  likely  to  be 
the  safer  operation.  Had  I  decided  on  tbe  removal  of  both,  I  should 
have  first  tied  the  two  internal  iliac  arteries,  a  simple  and  easy  op- 
eration in  the  then  open  abdomen,  where  the  vessels  lie  very  appar* 
ent.  In  snch  a  case  the  principal  difficnlty  will  be  to  sever  the  org^n 
from  the  urinary  bladder  in  front,  and  from  the  rectum  behind,  be- 
sides a  careful  regard  not  to  wound  the  uterus.  The  open  vagina  can 
be  closed  with  a  couple  of  sutures,  so  inserted  as  to  permit  the  ends  to 
come  through  the  vulva. 

Very  rarely  gastrotomy  may  be  needed  for  the  removal  of  a  foetus 
in  case  of  its  escape  into  the  abdomen  through  a  ruptured  uterus, 
and  for  the  removal  of  thn  remains  of  an  extra  uterine  conception. 
Snch  an  operation  is  very  simple  in  its  execution,  and  the  incinion 
will  be  of  verv  limited  extent. 

Caesarian  section  I  think  ought  never  to  be  performed.  There  are 
very  few  cases  of  natural  obstruction  so  complete  as  will  not  admit  of 
instruments  capable  of  extracting  the  fcetus,  piecemeal  at  least,  by 
the  natural  passage,  and  so  save  the  mother  in  preference  to  the  fcRius. 
I  have  seen  several  Caesarian  operations  performed  in  1832  and  1834, 
to  satiKfy  or  rather  gratify  a  bigoted  clerical  prejudice.  They  were 
all  unfortunate  and  cruel. 

A  Fbw  Miscellaneous  Remabks. — It  rs  not  wiihout  great  interest 
that  we  look  into  the  empty  abdomen  after  the  removHl  of  a  large  tu- 
mor, for  the  cavity  looks  empty.    The  stomach  will  be  found  very 


726  Orifhal  Commmni€iiittm$.  [DeoealMr, 

small  all  tbe  intestinea  nearly  emptj^  and  »o  lodncod  in  aiae  aa  to  n- 
aamble  flat  ribbons  ;  no  fat  anywhere,  in  long  tUading  cases,  eiw 
about  the  kidneys.  In  this  state  of  emptiness,  «nd  no  support  ontlie 
vessels,  we  cannot  help  smiling  at  the  caution  ao  seriously  inonkatsd 
in  cases  of  paracentesis  to  k3ep  np  great  pressure,  without  which  it  is 
supposed  that  syncope,  even  mortal  syncope,  may  occur. 

Whtpeord  as]  a  ligature  to  the  pedicle  is  too  large  to  be  i»pable  cf 
being  drawn  sufficiently  tight  to  compress  the  small  veasels  it  is  so 
disproportionately  applied  to.  It  wiU  btand  a  strain  of  nearly  s  hun- 
dred pounds  without  breaking,  a  force  much  greater  than  needed.  A 
single  thread  well  applied  ^  hare  found  adequate  to  every  fMirpose. 

Th$  Eenumrt  (cruriier)  a  novel  instrument  recentlj  introdneed  to 
sever  parts  without  the  risk  of  hemorrhage.  It  is  n  more  barbarens 
nstrument,  if  possible,  than  the  gilder's  clamp,  and  equally  disgrace- 
ul  to  the  pr(>gress  surgery  has  made.  Where  it  can  be  applied  with 
precihion,  and  bruise  its'  way  through  parts  a  knift  can  cut  with  ex- 
actitude, and  any  severed  vessels  tied,  should  the  surgeon  poasess  no 
more  than  limited  abilities. 

One  word  more  about  hemorrhage  in  the  case  of  extirpating  ova- 
rian tumors.  Here,  hemorrhage  can  come  from  two  sources  only— 
1  say  nothing  about  adhesions.  The  first  is  from  the  spermatic 
vessels  ;  these  cannot  give  trouble.  The  second  source  is  more  im- 
pel tun  t,  furnished  by  the  uterine  vessels,  deep  in  the  hollow  of  tbe 
sacrum,  where  in  a  few  cases,  difficulty  may  be  encountered  from  th« 
**  welling  up  "  of  blood.  But  this  can  be  easily  commanded  by  s 
good  assistant  compressing  the  internal  iliac  with  his  finger  against 
the  brim  of  the  pelvis,  alternately  pressing  and  relaxing,  to  enable 
the  operator  to  see  the  point  of  escape,  and  there  apply  a  ligature  with 
the  aid  of  a  forceps  or  tenaculum,  or  the  old  method  with  a  needle. 


■  •»  * 


▲KTIGLB  II. 


The  Exhausting  Alr^Treatment  of  Chronfo  Diseases. 


CasM  reported  by  J.  A.  roR»,  M.  D.,  Lexington,  Ky. 


Editobr  of  the  Lancet  ano  Obsbrveb  :  —  With  your  permission 
I  will  trespass  on  the  columns  of  your  Journal,  by  reporting  several 
cases  of  disease  cured  by  an  instrument  lately  introduced  to  tbe  pro- 
fession  by  A.  F.  Jones,  of  this  city.  The  instrument  of  which  I 
write,   is  an  Air  Exhauster,  with  a  pump  attached*  and  a  guage» 


1864.]  Original  OommunicationM.  727 

which  indicates  the  amonnt  of  air  exhausted.  The  patient  sits  in 
this  instrnment  —  which  is  made  air-tight  —  without  any  pain  or 
inconvenience,  the  breathing  organs  being  out,  so  that  he  can  breathe 
while  the  air  is  being  partially  exhan^ted  from  around  the  body,  (the 
exhaustion  being  regulated  by  its  effect  on  the  body,)  he  at  the  same 
time  breathing  the  natural,  heavy  air.  You  therefore  perceive  that 
the  patient  is  in  two  atmospheres,  a  heavy  and  a  light  one,  at  the 
same  moment. 

The  inventor  claims  that  this  instrument  acts  on  the  system  as  an 
alterative,  and  when  the  patient  is  under  its  influence,  induces  the 
blood  from  the  centre  to  the  periphery,  and  extremities  of  the  body, 
thereby  breaking  up  congestions,  and  equalizing  the  sanguineous  and 
nervous  flow.  The  inventor  also  claims  that  this  instrument  stimu- 
lates the  lymphatic  absorbents  to  take  up  and  throw  ofi*  morbid  secre- 
tions. 

This  .instrument  is  called  a  "  Restorator,"  which,  in  my  hands, 
has  made  many  cures.  The  history  of  several  of  these  cases,  I  now 
proceed  to  report  to  you.  In  my  next,  I  will  cite  you  to  other  very 
interesting  cases  cured,  if  you  will  allow  me  a  piacein  your  Journal. 
This  mode  of  curing  diseases  is  called  *^  The  Exhausting  Air  Treat- 
ment." 

Case  I.  Paralysis, — Lee  Talbott,  Esq.,  of  this  city,  aged  forty- 
seven  years,  commenced  treatment,  January  2d,  for  a  condition  of 
Paralysis,  of  over  twenty-two  months'  standing. 

Symptoms. —  Left  hide  of  the  body  paralysed  to   such    an   extent 
that  he  had  hardly  any  use  of  his  left  arm,  and  used  his  left  leg  with 
much  difiiculty,  with  the  aid  of  a  stick.     Both  limbs  were  considera- 
bly withered.     Bowels  ho  much  constipAte<l,  that   it   was   difficult  to 
move  them  with  the  most  powerful  purgatives,  often  going  as  long  as 
twelve  and  fifteen  days  without  an   operation.     Appetite  abnormal, 
eating  large  quantities  of  food    without    any   enjoyment,  as  nothing 
taKtefl  natural   to  him      Body   emaciated  ;  urinary   organs    partially 
paralyzed,   urinating  twenty    or  thirty    times   daily,   voiding  small 
quantities  of  water  at  each  time.      Commenced    improving  rapidly 
mftcr  the  first  application,  and  cured  in  seventeen  applications  of  6ve 
minutes  each,    without   any  pain  or  inconvenience,  and  without  any 
medicine  whatever.     Mr.  Talbott  remain^  in   a  good  state  of  health 
up  to  this  date,  and  has  a  perfect  use  of  his  limbs.     His  father  died 
of  paralysis,  aged  fifty-six  ^ears 

Case  IL     Spermatorrhea. — Samuel  F.  Gray,  aged  26  years,  com- 


728  Proceedings  of  Societies.  [[December, 

menced  treatment,  March  lOlh,  1864,  for  a  case  of  seminal  wfakness, 
of  over  6ve  years  standing. 

Symptoms. — Liver  torpid  ;  bowels  constipated  ;  appetite  bad;  sem- 
inal discbarges  frequent ;  was  reduced  in  flesh  from  one  hundred  and 
thirty-eight  pounds,  to  one  hundred  and  twenty-four  pounds. 

After  the  second  application  of  exhausted  air,  had  a  very  large  op- 
eration on  his  bowels,  which  have  been  in  a  healthy  and  natural  state 
ever  since.  After  the  seventh  application,  the  seminal  discharges 
entirely  ceased.  After  the  fifteenth  application,  was  restored  to  per- 
fect health  and  strength,  having  rapidly  improved  from  the  first  to  the 
fifteenth  application,  when  the  treatment  was  closed.  Each  applica- 
tion occupied  five  minutes  of  time,  and  was  not  attended  with  aaj 
pain  or  inconvenience  ;  neither  was  there  any  medicine  given.  Mr. 
Gray  remains  in  a  good  state  of  health  up  to  this  date. 

Cask  III.  Paralysis. — Sarah  Jane,  aged  seventeen  years,  one  of 
the  family  of  Randolph  Hailey,  Esq.,  applied  for  treatment  May  20tli, 
1864,  for  Paralysis  of  over  three  months  standing. 

Symptoms. — Both  legs  paralyzed  to  such  an  extent  that  she  walked 
with  much  difficulty,  with  the  aid  of  a  crutch,  and  the  assistance  of 
another  person.  Both  hands  wore  completely  paralyzed,  and  her 
arms  nearly  so.     General  health  bad.     Menses  suppressed. 

After  the  fourth  application,  did  fine  sewing,  and  could  walk  well^ 
without  any  assistance  whatever.     After    the    sixth   application,  was 
discharged,    entirely    cured,    and    has    remained  in  a  perfect  state  of 
health  ever  since. 


^rofcjefllcgis  of  J^ofiietleis. 


Proceedings  of  the  Cincinnati  Academy  of  Medicine. 

Roported  by  0.  P.  WiLao.^,  M.  D.,  Secretary. 

Hall  of  Academy  of  Medicine,) 
Monday  Evening,  Oct.  17,  1864.) 

Dr.  Almy  the  President  in  the  chair. 

Cutaneous  Disrates. — Dr.  Bruenn  wished  to  ask  h\<  medical  friends 
if  they  had  seen  of  late  many  cases  of  skin  diseases  amongst  children  ? 
Stating  that  he  had  been  called  hy  a  number  of  families  who  thought 
they  had  itch  amongst  them.  Even  the  children  at  school  suspected 
of  having  this  trouble  had  been  sent  home  by  the  principal.  A  great 
deal  of  prurigo  existed,  but  it  is  of  a  mixed  nature  ;  in  some  cases  the 
prurigo  with  Fome  pimples,  but  of  the  same  color   as   the  skin  others 


1864.]  Pioc€€dingi  of  SocUihi.  729 

complicated  with  lichen  or  erythema.  In  children  between  the  ages 
of  8  and  12,  of  a  sanguineous  temperament  there  is  no  lichen  or  ery- 
thema with  the  purigo,  but  in  younger  children  the  lichen  is  always 
present.  In  children  of  sangi;ineous  temperament  the  lichenocs 
eruption  goes  still  further  and  pustules  are  formed  by  which  not  only 
the  people  in  general  but  the  profession  had  been  deceived  and  called 
it  itch. 

He  was  called  in  the  country  to  a  family  where  their  family  physi- 
cinn  had  diagnosed  the  trouble  itch,  but  it  was  not  so  ;  in  a  great 
many  cases  sulphur  had  been  used,  but  it  was  improper  treatment,  for 
under  its  use  the  skin  becomes  more  irritated,  and  the  prurigo  more 
exaggerated.  The  treatment  pursued  by  Dr.  Bruenn  was  of  a  mixed 
nature  .  In  simple  prurigo  a  warm  bath  is  the  best  remedy  ;  but  in 
lichen  when  the  suppurative  state  has  begun  this  is  very  injurious. 
So  in  pure  pmrigo  he  ordered  the  alkaline  lath  daily,  of  1  lb  of  sal- 
erat^is  to  ordinary  bath  tub  of  water,  for  an  adult.  After  the  bath,  a 
towel  wet  with  as  cold  water  as  could  be  obtained  was  laid  over  the 
part,  and  then  rubbed  with  a  dry  towel.  Internally  he  gave  alkalies 
—the  host  he  thought  the  liquor  potassa — 10  to  15  drops  in  half  a 
tumbler  of  water,  two  or  three  times  a  day. 

The  urine  in  prurigo  always  reacted  acid,  and  therefore  he  used  the 
alkalies  ;  as  to  the  diet  he  gave  a  mild  but  bland  and  nourishing  one. 

In  lichen  when  the  pustules  are  formed,  the  baths  are  of  no  benefit 
anil  he  used  the  oxide  of  zinc  ointment  twice  a  day ;  confining  the 
hands  of  the  patients  to  ke^p  them  from  scratching.  When  the  pus- 
tules are  drying  and  the  skin  becoming  soft  and  smooth,  then  he  used 
the  warm  bath  and  not  before. 

The  Doctor  said  he  had  been  led  to  make  these  remarks  because 
he  had  heard  that  there  were  so  many  cases  of  scabies,  when  in  truth 
there  were  but  few.  These  cases  arose  during  the  hot  weather,  like 
the  tropical  lichen,  or  prickly  heat,  which  was  caused  by  perspiration, 
this  always  reacted  acid,  and  therefore  it  was  no  wonder  the  mouths 
of  the  follicles  became  irritated  ;  for  they  are  situated  near  the  mouths 
of  the  sudoriparous  follicles — and  here  is  where  the  trouble  oiiginates 
— caused  as  said  before  by  the  acidity  of  the  perspiration.  All  the 
Tariety  of  skin  diseases  spoken  of  belong  to  the  same  class  and  pro- 
ceed from  the  same  cause.  In  grown  persons  we  have  generally  pruri- 
go, bat  in  child i-en  the  lichen. 

Cas§  of  Tripleii.^Dr.  Quinn  reported  the  following  case  :  On  last 
Saturday  morning  he  was  called  to  see  a  large  robust  Irish  woman, 
the  wife  of  a  blacksmith.     He  learned  from  her  that  she  then  had  no 


730  ProeeedingM  qf  SociOUs.  [Deoembe 

pains  ;  she  had  been  in  labor  from  10  o'clock  at  night  with  grindm 
cutting  pains,  but  which  were  not  severe  enongh  to  indace  her  to  la 
for  a  physician.  At  6  o'clock  A  x.  the  bearing  down  pains  coi 
menced  when  she  sent  for  him.  Immediately  aflter  her  hnsband's  d 
parture  the  membranes  niptured  white  she  was  on  the  floor  ;  she  tb 
went  to  bed  and  found  a  foot  presenting,  at  which  abe  was  mn 
alarmed.  Dr.  Qninn  found  on  examination  a  foot  presenting inl 
vagina,  but  not  externally,  the  cord  wrapped  around  the  leg  of  i 
child  keeping  the  foot  up  ;  on  disengaging  the  leg,  the  foot  appeal 
externally,  and  in  five  minutes  from  the  time  he  entered  the  honse  ( 
child  was  bom.  On  examination  he  found  another  child ;  there  i 
capacity  enough  for  the  hand  to  be  well  introduced  into  the  nter 
In  three-quarters  of  an  hour,  the  pains  again  began,  by  which  the  s 
was  pushed  down  toward  the  pelvis  ;  the  second  pain  brought  it  it 
the  cavity  of  the  pelvis,  when  he  now  ruptured  the  membranes,  wbi 
was  followed  by  a  very  laige  gosh  of  the  waters,  and  another  paio  < 
livered  the  child,  head  presenting.  On  examination  he  found  the! 
of  another  child  high  up  in  the  fundus  of  the  uterus  ;  introducing  ( 
hand  he  grasped  the  sac  and  by  the  aid  of  the  uterus,  the  third  ck 
was  delivered  five  minutes  after  the  second.  By  gentle  traction 
the  cords,  and  by  giasping  the  uterus  externally  with  the  hand^,  i 
after-birth  was  soon  delivered  and  the  uterus  contracted  prompt! 
All  the  children  were  females  ;  the  first  and  second  each  weighed 
lbs,  and  the  third  weighed  a  little  over  7  lbs.  The  placenta  wasvo 
large,  and  a  single  one  without  any  septum  being  as  yet  discovcrei 
there  were  three  cords,  each  arising  from  different  points  on  the  pi 
cental  surface.  The  children  were  all  healthy  and  cried  lustily, 
was  computed  that  the  woman  must  have  carried  a  weight  of  30  \\ 
before  delivery.  The  first  sac  contained  bnt  little  liquor  amuii :  t 
second  a  large  amount,  and  the  third  an  onlinary  quantity.  T 
second  child  twenty  minutes  after  birth  had  a  ^asm,  attended  vri 
difficult  breathing,  and  obstructed  circulation,  which  was  ppeedily  i 
lieved  by  a  warm  bath.  Soon  after  it  had  another  spasm,  for  whi 
he  administered  a  little  warm  water  internally  ;  in  the  night  the  el<l< 
child  had  a  spasm,  for  which  he  was  summoned — when  he  also  fou: 
all  the  children  troubled  with  difficulty  of  breathing,  from  accnmnl 
tions  of  mucus  in  the  bronchial  passages.  Next  morning  he  foui 
mother  and  children  doing  well. 

Monday  Evenivo,  Oct.,  24ih. 

Vice  President  Dr.  Carroll  in  the  chair. 

Per  Chloride  of  Iron  in  Croup, — Dr.  J.  B.  Smith  related  the  f< 


1864]  Proceedings  qf  Societiee.  f&l 


ease  of  diphtheria,  with  reference  to  the  RQCcesii  of  a  certain 

piftn  of  treatment.     In  the  last  nnmher  of  the  Lancet  and  Observer  he 
nmd  noticed  an  article,  copied  from  some  London  joamal,  in  which 

ibe  treatment  of  cronp  hj  a  eolation  of  per  chloride  of  iron  was  re- 
•ommended.  On  last  Thnr«day  ho  was  called  to  see  a  little  girl  ten 
yeAfs  old.  The  mother  stated  the  child  had  some  tronhle  about  her 
throat  ;  on  examination  he  found  external  enlargement  of  the  glands, 
•ad  internal  swelling  of  the  fauces  and  tonsils  ;  pulse  120 ;  skin  cool ; 
M  i^astie  discharge  from  the  nostrils  ;  and  the  fauces  covered  with  diph- 
Aeritic  exudation.  Dr.  Smith  first  ordered  a  mixture  which  he  had 
h&em  in  the  habit  of  using  in  such  cases,  of  chlorate  of  potash,  muriat- 
mi  tincture  of  iron,  and  spirits  of  mindereri  ;  also  giving  beef  essence. 
la  three  or  four  hours  he  found  the  child  much  worse,  with  great  dif- 
fienhy  of  breathing,  the  discharge  from  the  nostrils  increased,  and  a 
Unish  condition  of  the  skin.  He  then  gave  the  following  solution  : 
to  drops  sol.  per  chloride  of  iron  in  8  ounces  water,  directing  a  table- 
ipoonful  every  half  hour.  When  she  first  took  it  most  of  it  passed 
back  through  the  nostrils.  In  the  evening  the  child  was  a  little  better, 
hb  ordered  the  solution  given  every  ten  minutes.  Next  morning  she 
wms  much  worse,  owing  to  the  fact  that  the  parents  had  neglected  to 
giTe  the  medicine  ;  the  medicine  was  then  directed  to  be  given  every 
Ave  minutes  ;  while  taking  the  solution  thus  often,  the  child  improved 
and  coughed  up  mucus,  blood  and  the  peculiar  diphtheritic  exuda- 
tion. He  continued  the  treatment  until  this  morning  when  there  was 
mo  appearance  of  the  exudation,  the  pulse  80,  and  the  patient  conval- 
escing nicely.  On  the  second  day  of  sickness,  the  child's  face  pre- 
sented a  peculiar  bluish  appearance,  resulting  from  the  impeded  cir- 
calation  of  the  capillaries,  with  great  dispnoca,  a  hoarse,  croupy  cough, 
and  it  appeared  to  the  Dr.  as  if  the  disease  was  extending  into  the 
brjnz  and  trachea ;  she  was  throwing  her  arms  wildly  about,  grasp- 
iag  everything,  in  fact  just  in  that  condition  when  death  might  be  ex- 
pected very  soon.  But  upon  the  more  frequent  administration  of  the 
■ladicine  there  was  immediately  a  decided  change  for  the  better.  In 
tlua  case,  either  nature  or  the  remetiy  effected  a  cure  ;  and  Dr.  Smith 
thought  that  some  portion  of  it  should  be  attributed  to  the  medicine- 
Judging  from  the  suci^ess  of  this  case,  and  if  all  that  ban  been 
elaimed  for  the  per  chloride  of  iron  in  croup  is  true,  the  Dr.  thought  it 
an  inTaluiible  remedy.  In  reply  to  a  question.  Dr.  Smith  stated  that 
tho  child  took  altogether  48  ounces  of  the  mixture  during  its  four  days 
of  sickness. 

A  Case  qf  Disiocaiion  qf  the  Shoulder — Mode  of  0'u§ing  Chiorifarm. 


732  CorT€9p<mdeno^. 

— Dr.  Tate,  reported  the  following  case  of  dislocation  of  the  &h(Mi 
to  illustrate,  as  he  thought,  the  hest  way  of  adEniaisteriiig  ehlorofi 
He  was  usually  able  to  reduce  di^locatioa  without  chloroform  bji 
pie  manipulation;  but  in  this  case  the  patient  being  a  stoot,  ro 
young  man  he  was  unable  to  effect  it.  The  dislocation  was  of  th 
humerus  into  the  axilla,  caused  by  the  patient  being  thrown  doi 
descending  from  a  car.  The  man  was  laid  down,  and  the  month 
nostrils  having  been  guarded  to  protect  the  skin,  chloroform  was( 
after  the  manner  of  Mohr  by  placing  a  very  thin  handkerchief 
the  mouth  and  nose,  and  a  very  few  drops  of  chloroform  prodnoe 
aesthesia  ;  the  quantity  used  in  this  case  was  not  more  than  a  thii 
full.  Immediately  after  the  dislocation  was  reduced  ;  the  man  a 
with  all  his  intellectual  faculties  good  ;  notwithstanding  his  fean 
the  auaesihetic  might  prove  dangerous  to  him. 


m   • 


(Sorvfisjiosafttr^ 


Letter  From  Dr.  Parvin. 


Dublin,  September  2d,  1S6J 
Dear  Doctor  :  —  In  my  last  letter,  I  spoke  of  Dr.  Chunl 
as  being  over  sixty  years  of  age,  and  thus  1  was  informed  by  od( 
the  profession  here.  It  was  a  mistake,  nevertheless  ;  Dr.  C.  is 
fifty-six,  and  hardly  looks  that  old.  He,  more  than  any  othertotl 
has  been  my  obstetrical  teacher  and  guide  ;  and  my  respect  for  1 
and  his  teachings,  thus  acquired,  has  been  increased  by  perso 
acquaintance.  Would  you  like  to  see  him?  Imagine  amansi 
two  or  three  inches  under  the  medium  height  —  erect,  but  sligli' 
form  ;  a  very  dark  eye  ;  an  unusually  heavy,  yet  black,  eye-brc 
a  head  not  at  all  bald,  but  wheron  the  silver  is  triumphing  over 
dark  hair  of  youth  and  manhood  —  a  head,  too,  remarkable  for 
round  and  full  appearance  ;  a  face  with  a  complexion  soraev 
dark,  but  beaming  with  benevolence  and  kindly  feeling  —  a  face, 
wheron  you  read  no  guile,  but  sincerity  of  purpose,  and  hone* 
expresfcion.  There  you  have  a  hurried  pen-sketch  of  Dr  Chur 
—  not  merely  as  he  seems,  but  as  he  w — for  seeming  and  being 
one  with  him.  lie  makes  you  feel  quite  at  home,  listens  pati« 
to  your  questions,  and  will  solve  your  difficulties  without  any  of 
air  of  haughty  condescension,  or  of  vexed  hurry,  which  I 
known  men  no  greater,  not  as  great,  indeed,  exhibit.     He  has  a 


Correspondence.  *    783 

ion  of  Dr.  Hodge's  pessary  —  indeed,  says  that  it  is  the 
e,  himself,  was  very  near  making  the  same  invention  some 
By  the  way,  what  a  massive  volume  the  ex-Professor  of 
sity  of  Pennsylvania   has   created  !     It  is  big  enough  to 
3ther  obstetrical  volumes  ;  and  to  most  book-cases  will  be 
?able  as  the  Vicar  of  Wakefield's  picture  was  to  his  home, 
f  the  book  here  —  theie  is  one  copy   on  sale  —  is  not  so 
lere  will  be  much  competitioti  to  obtain  possession  —  three 
bout  forty  dollars  in  greenbacks,  according  to  the  last  gold 
I  have  seen,)  will  drive  away  all  private  purchasers. 
Btnrn  :  Dr.  Chnrchill's  practice,  which  is  now  more  in  dis- 
nales  than  in  obstetrics,  of  course  is  quite  large  and  lucra- 
ike  some  otlier  Dublin  practitioners  of  note,  realizes  more 
lice  business,  than  from  visiting  patients.     In  practice,  he 
vativp  —  trusts  to  fiafe,  even  if  tedious  modes,  rather  than 
possibly,  reckless   ones  ;  **  be  assured  of  the  nature  of  the 
id  simply  go  on,  go  on,  in  the  treatment,  even  if  it  takes 
s."     The  operation  of  slitting  up  the  cervix,   introduced 
or  Simpson,  and  for  which  men  have  such  a  passion,  now 
>ften  done,  I  am  assured,  where  there  there  is  no  narrowing 
the  true  disease  is  entirely  overlooked,  meets  with  no  favor 
ds.     By  the  way,  referring  to  contracted  cervix  uteri,  let 
u,  that  an  admirable  material  for  producing  dilatation  has 
^n  found  in  the  Laminaria  Digitalia,  or  6ea*taiigle.     The 
^d,    of  course,  is  used,  and  it  will  expand  by   abhorbing 
rom  the  mucus  secretions  of  the  canal,  to  five  or  six  times 
len  introduced.     This  sea-tangle  may  be  nscd,  not  only  for 
be  08  and  cervix,  but  also  the  urethra ;  or  as  a  substitute 
in  surgical  practice.     The  discovery  is  so  recent,  that  but 
made  use  of  it.     Dr.  Churchill  told  me  that  he  had   not 
t,  but  he  intended  to,  the  fii-st  opportunity  ;  Dr.  Denham. 
iblin  Lying-in  Hospital,  has,  and  finds  it  of  great  value, 
singnlar  case  occurred  last  Sabbath,  at  the  Hospital  just 
1  :  A  woman  was  delivered,  at  the  full  term,  nothing  uou- 
ag  marked  her  pregnancy  — of  a  healthy,  perfectly  formed, 
d  after  the  birth,  a  hard,  jagged  body  having  been  felt,  at 
I  in  the  labor,   just  within  the  os.  Dr.  Denham  introduced 
,  and  removed  this  body,  which,  upon  inspection,  proved  to 
!«ier  part  of  a  superior  maxilla,  containing  a  molar  tooth, 
Hh,  had   one  found  tinder  other  circumstances,   he  would 
oDged  to  a  person  about  fourteen  jeAra  of  age. 


734  Corr$ip<mdenc».  December. 

I  find  that  cbloroform  is  very  little  need  here  ia  obstetrical  pr»e- 
tice,  save  in  instrumental  deliveries.  This  abstiaence  from  chloro- 
forming the  parturient,  is  mainly  caused  by  the  popular  dread  of 
the  agent ;  though  some  obstetrical  practitioners,  with  whom  I  haie 
conversed,  themselves  raise  an  objection  to  the  anaesthetic,  on  ibi 
ground  that  it  seriously  interferes  with  the  strength  and  the  frequency 
of  uterine  contractions. 

In  addition  to  the  Dublin  Lying-in  Hospital,  which  now  has  noit 
than  a  century  of  age  upon  it,  with  which  so  many  famoas  men  bate 
been  connected,  and  which  has  contributed  so  much  to  obstetrical 
science  —  there  is  a  similar  institution  here,  knowa  as  the  Coombe 
Lying-in  Hospital.  Of  this  institution,  at  which  I  spent  some  tims 
to-day,  with  Dr.  Kidd,  one  of  the  staff,  I  propose  speaking  in  a  fnUiR 
communication.  Dr.  K.  is  the  editor  of  the  Dublin  Quarterlif'^ 
which  is  now  one  of  the  exchanges  of  the  Lancet  and  Observir  — 
and  is  a  most  estimable  gentleman,  and  justly  occupies  a  promineti 
professional  position  in  Dublin. 

This  city,  I  need  not  tell  you,  is  an  excellent  place  to  see  typbai 
fever.  At  the  Meath,  at  the  Cork  Street  Fever  Hospital,  and  at  the 
Hardwicke  —  more  particularly  the  last,  I  have  had  an  opportunitj 
of  seeing  several  cases  of  genuine  typhus  ;  and  certainly  it  is  a  verj 
different  disease  from  the  typical  cases  of  enteric  fever  that  Dr.  Wood 
used  to  show  us  in  the  Peiin  Hospital.  Typhus,  of  course,  is  treated 
here  mainly  by  the  administration  of  stimulants,  wine  or  brandj, 
and  these  in  no  small  doses  :  recovery  generally  commences  in  froa 
fourteen  to  twenty-one  days,  and  this  commencement  —  as  Professor 
Banks  of  the  University  informs  me  —  is  marked,  not  by  any  critical 
discharge  —  indeed  free  perspiration,  for  example,  would  be  gener 
ally  a  fatal  omen  —  but  by  sleep. 

In  one  of  the  fever  hospitals,  I  confess  to  no  little  astonishment  at 
the  stethoscope  in  use  —  it  was  nearly  long  enough  for  a  cane  —  too 
long  for  the  most  adventurous  louse  to  crawl  from  patient  to  physi- 
cian ;  indeed,  even  a  flea  would  be  in  sad  want  of  sustenance,  wbo 
would  attempt  so  great  a  flight :  whether  the  fever  poison  is  equally 
discriminating,  is  doubtful. 

You  remember  Dr.  Wood  in  his  **  Practice,  "  refers  to  Dr.  Corn- 
gan,  and  his  instrument  for  ''  firing."  It  has  been  a  great  pleasnie 
to  me  to  become  acquainted  with  Dr.  C.  He  impresses  one  as  do 
common  man,  and  at  the  same  time  there  is  a  frank  heartiness  wbieb 
makes  you  quite  at  ease  with  him  ;  while  you  admire  the  clear, 
sharply  defined  views  he  presents,  no  matter  what  may  be  the  sab- 


1864.]  Corr€spwd€nee.  785 

ject  of  conversation  ;  it  bas  alf^o  been  a  pleaaure,  less  indeed  tban  tba 
former,  but  still  a  pleasure,  to  see  bis  instrument,  and  to  observe  tbe 
benefits  from  its  application,  in  many  cases  of  sciatica,  and  in  tbe 
severe  pain  in  tbe  back,  of  fever,  tbe  results  of  **  firing "  are  re- 
markable. Tbrougb  tbe  kindness  of  Dr.  Gordon,  a  very  able  col- 
league of  Dr.  Corrigan's  at  tbe  Wbitwortb  and  tbe  Hardwicke,  I 
have  witnessed  some  of  tbe  practical  uses  of  Dr.  Corrigan's  instrument. 
To-nigbt  I  start  for  Edinburgh,  wbence  I  bope  to  write  you  again. 

T.P. 


Letter   From  Boaton. 


Boston,  Mass.,  November  14,  1864. 

Hebsbs.  Editors — Tbe  Massacbusetts  Medical  College  was  for- 
mally opened,  on  tbe  2nd  inst.,  by  an  introductory  address  from 
Prof.  Clarke.  His  Subject  was  tbe  Materia  Medica  :  its  improvements 
«nd  progress  for  tbe  last  fifty  years.  It  was  an  able  exposition  of 
wbat  tbe  science  of  cbemistry,  and  a  more  tborougb  knowledge  of  tbe 
physiological  action  of  drugs,  bad  done  in  modem  times.  Tbe  ad- 
dress will  be  published,  and  will  be  a  valuable  addition  to  the  litera- 
ture of  tbis  branch  of  medicine.  Tbe  attendance  of  medical  gentle- 
men and  others  was  large.  I  learn  that  tbe  cl*se  numbers  some  three 
hundred  and  fifty. 

Dr.  Brown  Sequard  will  not  deliver  bis  course  of  lectures,  in  his 
special  branch,  owing  to  bis  impaired  health.  His  valuable  library 
was  sold  a  few  days  since,  as  he  was  about  Co  return  to  Europe. 

Dr.  John  £.  Tyler,  of  tbe  McLean  Asylum,  commenced  a  course 
of  lectures,  on  the  10th  inet,  at  the  Medical  College,  on  Mental  Dis- 
eases and  Insanity.  These  lectures  are  given  weekly,  and  open  to  all. 
.  You  may  recollect  the  atrocious  murder  of  young  Converse,  com- 
mitted last  December,  by  Edward  M.  Green,  in  the  Maiden  Bank. 
The  question  was  raised  as  to  tbe  state  of  mind  of  Green,  when  the 
deed  took  place.  The  prisoner  petitioned  for  a  commutation  of  his 
eenience  to  imprison ment  for  life,  on  the  grounds  of  insanity  and 
imbecility.  The  Committee  on  Pardons,  aAer  fnlly  considering  the 
matter,  refused  to  recommend  a  remission  of  his  sentence.  I  subjoin 
the  report  of  the  Medical  Commission  on  the  subject : 

lb  Ms  Emcelleney  John  A.  Andrew,  Oooemor  qf  the  CcmmmiwsaUk  : 
In  accordance   with  your  wishes,  we  have  endeavored  to  make  a 
carefb!  and  thorough  examination  of  the  mental  condition  of  Edward 
W.  Oreea,  now  confined  in  the  Middlesex  County  JaiL 


736  Correspondence,  Deceii 

We  Iwve  failed  to  discover  any  trace  of  insanity  in  him,  nor 
we  conpider  bim  **  an  imbecile.*'  But  be  is  a  man  of  inferior  cj 
ity,  liitle  education,  and  little  desire  for  it,  and  of  limited  gei 
iufovmation. 

His  aflfections  are  strong.  He  is  fond  of  children,  and  lovei 
wife  and  child. 

In  all  common  matters  of  social  life,  bin  moral  Bense  is  qnick 
correct.     He  by  no  m^^ans  confuses  rigbt  with  wrong.     He  had 
notiouH  of  personal  obligations   to  God,  but  of  religious  know 
and  experience  be  is  most  astoiiisbingly  ignorant. 

Until  bis  arrest  it  appears  that  lie  baa  led  an  idle,  frivolous,  se 
self-indulgent  Hie,  tbongb  not  given  to  tbe  excesses  fnost  comm< 
young  men,  caring  for  little  but  to  be  popular,  to  write  a  goo<l  1 
to  drive  a  fast  team,  to  eat,  and  to  have  a  good  time,  giving  \\^t 
though}  voluntarily  to  otber  things  than  ibe^e,  and  rarely  one  to 
religions  subjects. 

He  knowH  tbat  be  has  committed  a  great  crime,  and  that  he  dei 
punishment  for  it.  He  feels  in  a  measure  tbat  he  has  wronge 
parents  and  friends  of  Converse,  bis  own  wife  and  child,  an 
community  in  wbich  be  lived,  and  in  a  measure  be  lamented  this 
his  greatest  grief  seems  to  be  tbat  by  any  act  of  his  he  Hhould 
placed  bimseif  in  so  sad  a  po»>ition. 

We  can  not  consider  him  irresponsible.  He  came  to  bis  crii 
otber  men  have  come  to  great  crimes,  tbrougb  a  preparation  of  ] 
OUR  misdeeds,  and  by  permitting  tbe  object  of  his  desire  to  fi 
wbolc  field  of  view,  and  to  utterly  exclude  everything  else.  W 
lievc  tbat  be  was  les8  qnaliiied  to  resist  the  temptation  to  wron 
ing  tbnn  many  otber  men,  but  that  this  dinability  grew  rather  fr 
neglect  of  cultivating  bis  moral  powern^  than  from  any  cong 
absence  thereof. 

We  are  ready  to  give  a  more  detailed  account  of  the  examini 
and  our  reasons  for  tbe  above  opinion,  if  your  Excellency  si 
desire  it.  Your  obedient  servants, 

JOHN  E.  TYLER. 
CLEMENT  A.  WALKF 

Tbe  statistics  of  the  Boston  Dispensaiy  for  the  year  ending  Oc 
1st,  1864,  are  as  follows  :  Number   of  new   patients  treated  ai 

Central  Office  is  12,469.     Of  these  9.008  were  in  the  medical  de 

ment— men,  1,092  ;  women,  4,<i95;  children,  3,821.     In  tbe  S 

cal  there  wei*e  3,461  ;   men,   875  ;  women,    1,125  ;  children.  1 

In  tbe  District  there  were  9,701  ;  men,  1,630  ;  women,  3,743  ; 

dreu,  4,328;  making  a  total  of  22,170. 

There   were   treated    at   the  Central  Office,  old  and  new  pati 

Medical— 18,064  ;  Surgical— 5,114  ;  Total— 23,178.    Average 

attendance— 78^.     Births  in  District— 126.     Deaths  237. 


1864.]  Bmewi  ami  Nciie$$.  737 

Ltetmrm  on  Venereal  Dietatee.'—Bj  William  A.  HAMMOirB,  M.D.    Philadelphia : 
J.  B.  Lippinoott  &  Go.    1864. 

The  Tolume  before  us,  is  a  oomp«ct  and  veiy  satisfactory  synopsis 
of  the  doctrines  of  the  pathology  of  Tenereal  disease,  and  its  best  treat- 
ment, as  tanght  by  the  best  writers  of  the  present  time.  It  consists 
of  twenty  lectures  ;  the  firdt  five  of  which,  as  is  stated  by  the  author , 
were  deliTered  at  the  Baltimore  Infirmary  in  the  spring  of  1861,  and, 
as  delivered,  were  published  in  the  Xew  York  Medical  Timet  of  that 
year :  the  remaining  fifteen  were  prepared,  but  not  delivered,  owing  to 
the  author's  return  to  duty  in  the  army.  The  whole  series  are  now 
revised  and  presented  as  a  connected  outline  of  the  subject ;  though  in 
his  preface  Dr.  Hammond  modestly  disclaims  for  his  little  work  the 
excellence  or  completeness  of  such  recent  works  as  that  of  Dr.  Bum- 
atead.  to  which  as  we  think  he  Teiy  properly  gives  the  credit  of  cov- 
ering "  all  the  ground  a  work  of  the  kind  can  cover." 

Having  said  that  the  volume  embraces  in  brief  a  fair  outline  of  the 
recent  teachings  of  the  subject,  we  need  scarcely  enter  into  a  minute 
consideration  of  its  matter.  A  very  large  portion  of  the  book,  fifteen 
of  the  t^nty  lectures,  is  devoted  to  a  discntsion  of  syphilis.  The 
duality  of  the  poison ;  that  is  to  say,  the  distinct  natare  of  the  soft 
and  Hunfeerian  chancre,  is  very  fiilly  discnaed  in  the  introductory 
leetnres,  and  the  doctrine  of  duality  accepted.  Several  lectures  are 
occupied  with  a  consideration  of  the  lesions  of  secondary  and  tertiary 
syphilis ;  one  lecture  on  the  History  and  Claims  of  Syphilization  and 
one  lecture  on  the  Transmissibility  of  Syphilis  through  the  blood. 

The  condnding  chapters  are  taken  up  with  the  consideration  of 
€ronorrhoBa  and  its  complications.  Contrary  to  the  opinions  of  the 
best  8yphik)grapheri  of  the  present  day.  Dr.  Hammond  holds  to  the 
doctrine  that  gonorrhcsa  has  its  cri^n  in  the  matter  of  a  chancre. 
Further  that  we  have  two  distinct  forms  of  gonorrhoea,  just  as  we 
have  two  forms  of  chancre — the  pus  secreted  by  a  hard  or  Hunterian 
chancre  deposited  on  a  mucous  surface  giving  rise  to  one  form  of 
gonorrhoea — and  pus  in  like  manner  from  a  soft  chancre  (or  chan- 
croid) giving  rise  to  a  distinct  form  ;  cr'ginally  in  cbancrous  matter, 
but  once  developed  being  capable  of  reproducing  by  infection  the  <lis- 
ease  in  others.  We  have  not  time  to  proMUt  the  argiimentK  and 
observations  the  author  has  collected  in  support  of  these  views ;  at 
present  we  can  only  spare  space  to  present  the  peculiar  doctrines  of 
the  book. 


73S  BevUws  and  NoHeei^.  [December, 

The  publisher  has  as  nstial  done  bis  part  in  good  style  ;  the  paper 
being  good  and  tinted,  and  the  presswork  clear  and  satisfactory. 
For  sale  by  Robt.  Clarke  &  Co.     Price  $3.00. 


Diphtheria:  lu  Nature  and  Treatment :  With  an  ftcconnttof  the  Hi»tory  of  its 
PreTalance  in  various  countries,  ^y  Da>'I£L  D.  Slai>b,  M.D.  Being  a  see* 
ond  niKl  reyiped  edition  of  an  Essay  to  which  was  awarded  the  Fiske  Fund 
Prize  of  1860.     Philadelphia  :  Blanchard  &  Lea.     1864. 

Ar  stated  in  the  title  this  little  volume,  first  made  itR  appearance  in 

18G0,  being  the  Essay  to  which  was  awarded  the  Fiske  Fund  Prize 

for  that  year.     Upon  its  first  appearance  we  made  due  notice  of  its 

character,  in  this  journal.     The  author  remarks  in  a  brief  prefatory 

notice  to  the  present  edition,  that  he  is  thus  afforded  an  opportunity 

for  its  thorough  revision,  and  for  such  additions,  as  experience  and 

rvation  have  taught.     Dr.  81ade*d  treatise  has  very  generally  been 

.   ,;a8  one  of  the  best  on  the  subject,  and  as  a  resume,  at  Uriy 

te  (rt;the  subject,  may  be  consideredL^tbe  most  reliable  of  anything 

r*^-  to  which  we  can  readily  refer;  giving^  «  convenient  shape  and  com- 

~^^  pass  about  all  that  we  know  of  the  nature  and  treatment  of  this  terri- 

,*i#^"-^    bly  fatal  disease. 

For  sale  by  ]^>bt.  Clarke  d?  Co. 

/^  

V  ••>■ 

The  Army  Surgeon's  Mantutl:  For  the  use  of  Medical  Officers,  CiQIWb,  Chip- 
lain?,  and  Hospital  SrewAvds;  containing  the  regulations  of  the  Medical  D«^- 
purtment,  all  GeneriH  Orders  from  ibo  War  Department,  and  CirouUn 
ft  cm  the  2:>urgcon  QeneraVs  Office.  From  January  1st,  1661,  to  Julj  IsC 
I?^»»4.  By  William  Grace,  of  Washington,  D.  C.  Published. by  permission 
of  ihe  iSurgeon  General.    New  York :  Bailliere  Brpa.,  620  BroMwaj.    1664. 


We  have  not  in  a  long  time  seen  a  little  book  so  apropos  to  the 
times,  and  so  fully  yet  modestly  fulfilling  what  it  proposes  to  J'^. 
Its  somewhat  lengthy  title  page  very  well  expresses  the  character  of 
the  book,  though  as  sometimes  happens  we  have  a  somewhat  foimi'l- 
able  title  to  a  volume  of  moderate  dimensions.  Part  I.  contains  a 
list  of  the  medical  staff  of  the  U.  S.  Army,  up  to  July  1st,  1864.  pro- 
ceeding with  the  order  of  rank — Surgeon  General  lanking  as  Brig:i- 
dier ;  Asst.  Surg.  Gen.  ranking  as  Colonel ;  Medical  Inspector 
Gen.  ranking,  also  as  Colonel  ;  Medical  Inspectorii,  ranking  as  Litut. 
Colonel  ;  Surgeons  ranking  as  Major  ;  Asst.  Surgeons  ranking  a>  Cap- 
tain ;  Asst.  Surgeon  ranking  as  Fijst  Lieut.  Then  wo  have  in  the 
Volunteer  Service,  the  list  of  Surgeons,  ranking  as  Major,  an-.l  A^st. 
Surgeons,  ranking  as  First  Lieut.  Part  II.  gives  the  Regulations  of 
he  Medical  Depa\lmeii\,  a^i  V^V^\\^vq>tq.  Uie  revised  regulations  tor  th? 


1864.]  Beviemi  and  Nottcw.  739 

armj.  Part  III.  cm  braces  the  General  Orders  relative  to  the  Medi- 
cal departmcBt  from  March  1861,  to  July  4th,  1864.  Part  IV.  j^ives 
in  regular  order  the  Circulars  issued  from  the  Surgeon  General* h  Of- 
fice from  May  1862  to  July,  1864.  The  whole  concludes  with  a  co- 
pious index  enabling  the  reader  to  find  almost  any  order,  regulation, 
change,  appointment,  dismissal,  or  promotion,  since  the  berjinning 
of  the  war.  Every  oflifor  connected  with  the  Medical  Department  of 
the  army  will  appreciate  the  serrioe  which  is  thus  rendered  by  Mr. 
Grace.  The  publisher  will  plonse  accept  our  thanks  for  this  early 
copy  which  is  before  us. 

For  .sale  we  suppose  by  all  booksellers.     Price  81.50. 


Gunthoi  Wounds  ami  other  If^wie%  of  Nervf*:  Bv  S.  Wkir  Mitoiikll,  Ai.l)., 
GkioKOE  R.  MuREiiou»K.  M.li.,  iiiid  William  VV.  Kekn,  M.D  .  Act.  Asm  Siir- 
g*»oii»  U.9.A  ,  ID  charge  of  U.  S.  Army  Ward**,  foi  Dij«f»«>*ce  i>t  the  Nfrvoup 
tSTfftem,  TuTnfr'8  Ijiine  Huspital,  Philadelphia.  Phil'tilelphia :  J.  U.  L^p- 
piucott  &  Co.     1S04. 

The  little  v.  hmie  before  us  is  another  of  the  scientific  contributi  »nH 
which  has  been  called  out  in  the  progress  of  the  present  civil  w,ir: 

The  Authors  state  in  their  preface  that  *'  the  cases  up<m  which  this 
little  volume  it?  founded,  were  studied  during  about  fiftein  months^ 
U'ginning  in  Mny,  18(53." 

We  can  scarctdy  give  so  good  an  itle-i  of  the  st^ope  of  this  bonk  and 
the  proi'ess  by  which  it  has  been  made,  by  any  critical  analysis  of 
its  contents,  as  by  a  free  extract  from  the  introduction  chapter  itHclf : 

••  When  the  U.S.A.  Hospital  for  the  Diseases  of  the  Nervouj* 
System  was  organized  in  May,  1863,  it  was  at  first  pr^po^<•d  to 
limit  its  usefulness  so  that  only  those  cases  should  be  received.  It 
aoon  became  plain  that  it  would  be  advisable  to  include  also  wounds 
and  other  injuries  of  uervcs,  and  accordingly  an  order  to  that  eilcct 
was  issued. 

*•  No  sooner  did  this  class  of  patients  U»gin  to  fill  our  waids,  than 
we  peiceived  that  a  new  and  interesting  tifld  of  observation  was  heie 
op«.'ne»l  to  view.  Bff«»re  long,  ko  many  o:  these  cases  were  collected. 
that,  for  a  I«>ng  time,  they  formetl  the  majority  of  our  puii*.'uts. 
Aniong  them  were  representations  of  every  Qonceivuble  form  of  nerve 
iniuiv — from  shot  and  shell,  from  sabre  cuts,  conuisions,  and  di^lo 
cations.  .So  complete  was  the  field  of  study,  that  it  was  not  nricni  - 
mon  to  find  at  one  time  in  the  wanls  four  or  five  cases  of  guuNhut  in- 
uriete  of  any  single  large  n6r\e.     It  thus  happened  ll\%^.  ^Vv«tv(\\>\«\\% 


1864.]  Bepiewi  and  yoUea.  741 

ablj  tr»OM  tlia  oUnioal  study  and  observttions,  of  wbicb  they  are  the 
xepresentatiye. 

A  not  very  thorough  reading  of  thit  little  book,  will  permit  a  very 
&Torable  regard  for  the  many  points  of  interest  which  are  so  frequently 
presented.  Amoog  these  interesting  points,  we  notice  quite  a  num- 
ber of  interesting  pathological  reflections,  which  appear  to  have  come 
np  incidentally  in  the  record  of  individual  cases :  of  these  we  in- 
stance the  paragraphs  on — ^The  effect  of  wounds  on  the  nutrition  of 
the  skin  audits  appendages-— Muscular  HypersMthesia,  and  Anassthe* 
sia — Pain — with  many  of  like  interest. 

We  are  gratified  with  the  beautiful,  clear  type  which  the  publisher 
has  used  in  the  printing  of  this  volume,  but  can  not  bat  express  our 
surprise  that  a  little  book,  so  worthy  in  many  respects,  should  be  sent 
forth  to  the  world  in  paper  covers. 

For  sale  by  Robert  Clarke  <k  Co.    Price,  tl.OO. 


TVantaetians  of  the  liedical  Soeiei^  qf  ike  Staie  qf  New  York,  for 
the  year  1864.  The  Fifty-Seventh  Session  of  the  Medical  Society  of 
the  State  of  New  York,  met  in  the  city  of  Albany,  on  the  2nd  of 
February,  1864 ;  Dr.  T.  Bissell,  of  UHca,  Presiding,  and  Dr.  S.  D. 
Willard,  of  Albany,  Secretary.  The  deliberations  and  papers,  make 
A  large  and  valuable  volume  of  about  500  pages.  Many  of  the  con- 
tributions are  copiously  illustrated,  and  illustrate  some  of  the  most 
iasportant  topics  of  medical  science.  The  essay  to  which  was  a  ward - 
ad  the  Merrit  H.  Cash,  Prise,  was  by  Dr.  Bell,  of  Brooklyn,  and  die 
cusses  a  subject  which  is  interesting  a  large  portion  of  the  profession. 
The  completeness  of  the  protection  of  vaocinnation,  and  the  danger 
of  communicating  other  diseases  with  the  vaccine.  The  general  re- 
sults or  conclusions  of  the  essay  may  be  summed  up  in  brief — that 
small  pox  and  cow  pox  are  identical ;  that  the  protection  of  cow  pox 
is  immense,  and  may  be  regarded  as  complete,  when  a  repetition  of 
the  vaccinnation  does  not  again  take  efiect :  that  the  transmission  of 
other  diseases,  as  syphilis,  for  example,  with  vaccine  infection,  may 
be  perhaps  regarded  as  possible,  but  the  asserted  instances  doubtful, 
and  rarely  probable. 

Dr.  Taylor,  of  New  York,  contributes  a  paper  on  Spinal  Irritation, 
or  causes  of  back  ache  among  American  women  :  this  paper  is  pro- 
fusely illustrated  ;  as  is  also  a  paper  by  Dr.  Buck,  of  New  York  City, 
giving  the  History  of  a  case  in  which  a  scries  of  plastic  operations 
was  successfully  performed,  for  the  restoration  of  the  right  half  of 
the  upper  lip,  and  adjacent  portions  of  the  ohaek  and  nose. 


] 


742  EdUar'i  Table.  f  Dec«mb 

Perhaps  one  of  the  moRt  practicallj  nsefol  papers  in  the  volume, 
by  Dr.  Swinburne  of  Albany,  on  compound  and   comminuted  gi 
Hhot  fractures  of  the  thigh,  and  means  for   their  transportation  : 
Swinburne  has  given  a  great  deal  of  attention  to  the  surgery  of  fr 
turcH,  and  his  suggestions,  therefore,  are  to  be  received  wiih  mi 
respect.     It  is  not  easy  to  understand  his  plan  for    transportation 
these  cases,  without  the  accompanying  cut — but  it  is  devised  npo 
philosophy  of  the  treatment  of  fractures   much   dwelt    upon   by 
Doctor  in  past  contributions  on  this  subject — to  wit :  the  placing 
limb  so  completely   on  the  stretch,  as  to  compensate  for  the  losf 
extension  normally  afforded  by  the  sound  limb  :  he  proposes  a  stret 
er  for  this  purpose,  which  completely  extends  the  fracture,  and  gi 
it  relief,  even  while  the  patient  may  be  carried  off  the  field. 

Wo  can  not  further  notice  these  transactions — they  contain  m 
than  thirty  essays,  reports  and  memoirs,  and  reflect  great  credit  on  i 
profession  of  a  great  State. 


debitor's  Cable. 


r  JSnd  of  the  Yeur. — The  rapidly  changing  seasons,  has  brouj 
around  iiiiothor  dose  of  our  yearly  task  ;  and  yet  we  do  not  altogell 
so  regard  our  work,  else  it  had  closed  forever  long  ago.  The  lil 
of  editing  and  conducting  a  medical  periodical  in  America  has  ves 
tions  and  embarrassments,  but  it  has  its  pleasures  too,  and  we  stri 
to  banish  the  disagreeable  from  our  thoughts  and  dwell  upon  the  pie; 
ant.  The  prestnt  year  has  been  for  us  particularly  annoying  in  ma 
respects  ;  our  expenses  have  been  unusually  heavy  ;  and  with  the  \ 
creased  liabilities  we  have  not  yet  at  any  time  during  the  year  \<i 
able  to  present  our  journal  with  promptness  to  our  subscribers.  C 
arrangements  for  the  coming  year  ai*^  such  that  wo  hope  to  be  mc 
prompt,  and  with  a  new  dress,  and  other  features  and  promit^es. 
certainly  hope  to  meet  the  just  expectations  of  our  readers.  We  a 
desire  to  resume  the  custom  of  embellishing  our  vulume  with  the* 
giaving  of  some  distinguished  member  of  the  profession — we  sb 
therefore  accompany  an  early  issue  of  the  year  with  a  medical  p 
trait,  thou<^li  onr  present  purpose  is  to  furnish  the  portrait  onlv 
paying  subscrilters. 

Foi  any  shortcomings  of  the  year,  w^e  respectfully  solicit  tire  kirn; 
forbravance  (A  owt  \evv<\v^iv>..  If  we  have  inadvertently  wounde«l  t 
feelings  o^  ai\y  VTO^^>iW\oxvA  \ixc>\\vfc\>  v.N-t  \i>^  ^w^  <i^\\.^Tval  paragra] 


liirt^btWid  in-        M 


1864.]  SiOor't  Tabh. 

done  injoBtice,  we  utill  b^  ftbeoliilion  r<ir  ■k-: 
tent  etuUiously  aToi<led  «H  ench  purpo^^e. 

For  the  Tiiture  we  only  offer  the  rciMidr.  of  the  pW*.  and  ff»  eii 
honesty  of  purpose,  to  Isbox  still  ^■>r  llift  mlviinftillwil  "f  the  [irofvA- 
sinn  ;  we  t-hiA\  more  th^n  over,  worii  loh  li'  iumn-n  r.f  mnlk-ino  ind 
meilunl  tcftchiiig  in  thia  city  sn^  itnA  greai     <"  '; 

Fi'iendB,  we  «f)lf  yonr  hearty  ■.'o-0{-erai)':>ii  \i>rr<('i- 

fore;  Yonr  aid  in  cxtondiBg  oiir  uin-ulsiio"  i     >   <  i   mty  ail ; 

yonr  Tull,  mitnre  and  comtnt  rontdbuTiiiiiM     nil  ihr-^  \n  jUbrnry  \ 
to  bnild  np  a  prbcparoAfl  knd  Btfon^' juaroal. 


Snail  Pm-ProhiiUa  iy  Ptiilie  ^id.— The  Tillage  of  Kollesvilte. 
Indiaoa,  is  Avar;  olpv«r.yilIage,  •nd  they  have  therein  some  very  . 
clever  pnotieiilg  phj>ici«As  :  their  ooTporAtion  iegieUtoia,  however,  . 
have  eome  ^u^  notiona,  (^whit-h  the  followllig,  whicJi  we  may  re- 
garil  ae  a  sort  of  quarautiao  ragnlation,  is  a  spcdiucD  : 

"  NoTicg."Be  it  ordained  by  the  tawn  conncil  of  the  obrporation  of 
the  town  of  Nobleaville,  that  the  inarsball  of  said  ('orporation  iti  here- 
l>y  inGlrncted  to  notify  all  perxons  having  the  diseaise  commonly  call- 
e<i  the  iimall  pr)x,  that  at  every  where  tiny  person  has   the  sniall-poi   , 
a  pim'c  of  red  flannel  ahall  l>e  hung  out  for  a  aign  uf  the  small-pox. 

"  U>!  it  fnrtUer  unlaiued  that  aay  person  having  the  sraall-poi,  or 
expiwed  to  ilie  same,  itball  all  use  proper  means  to  keep  the  said  dis- 
ease fnim  sprcarling  through  rheluwii. 

"  Itt  it  further  bnlained  that  any  pemon  violating  «ftid  ordinance 
sIihII  tie  lined  lu  any  sum  not  lesx  tban  five  nor  more  thin  twenty 
dollat^. 

XMeaville.  Iwl.,  December  26th,  I?63.     Signed  by  the  Clerk," 

We  Ntispix't  that  in  thio  in-ie,  on  elsewhere, M>rjior4(ion  l^giKlnlors 
fanci''<i  they  hold  the  reliable  wiitdom,  nnd  were  not  vnlgar  enongU  to 
confolt  with  the  doctors.  ' 

Oar  Ybiinp  Folii. — \a  ilhiitraied  monttiiy  nagaEine  for  boyn  and 
ghU  to  le  e<li(ed  by  J.  T.  Tr..w1.ridgi-.  Coil  Hami]t..n.  an.f  Lucy 
I,^ii:<jm— iv.-!l  known  coiiiiiliuiorH  Ui  t]if  Jtlanlle  .V.i;((/(/y— will  bo 
ihMvl  ^lioitly  ity  Jlessrs.  Ti.-kn..r  .t  I-'id.i.  ..t  Bo-l.tii.     S..ru..  ..fibo 

aiiu'iiiiiiC'l  as  legiiliir  cuniribnior^  to  tli"  pMposcil  ni-w  ma^n/.ine. 
E»i'ii  tiUHi)  er  will  eiintuin  at  leuht  lit  jiigi '^<,  and  will  !«  ftilly  illus- 
tin-e.l.  Tb<'  pr'ie  will  be  9±  a  your,  wiili  a  gciieious  reduction  to 
club-.  Till-  Mcoess  of  the  pnl>li-]iiTs  in  iinnduiting  ibe  Mhinlk 
Moht/ily,  Hnivci'snlly  rc'Oi;iiiEt'iI  us  the  learling  literary  poriodii-iil  of 


Sdaor"*  TUb.  p)aoNib«r. 

ii  a  5ne   guarantee  of  the  forthooming-7  Omt   Tmaf 
lUtt»  I'tilks  will  eagerly  Mdoipsts  iti  a 


7%*  AmsrieoM  MtHcal  Ttme*.~Vfe  an  gntiSod  to  leua  from  1 
pHvaUsoutco,  th«i«  is  a  probability  thftt  thUexoaUentwMktjaudiei} 
w_    jiiUTtisI  will  resame  iu  publication  at  an  Mtly  dftte. 

NPrmM  iUSeal  JrutTVctlon- — By  nftrenoo  to  th«  adTntuong  if 
pitrtHritl  ol(|lua  jonmal.  it  will  be  Mea  tlut  Dra.  Pttrrin,  sad  Bu- 
tliol  Jir  liavA  entered  into  a  regular  sydematio  plan  of  prirata  medicil 
irix^^liiti^.  wbiub  will  coDsiat  of  Gxfxninations,  oeoarional  lactnroa  aad 
demonatratioBi.    For  paitunilan  mb  the  card  of  theae  genitaman. 

Quaek  Adttrtuinff. — SosM  frieikl  has  forwatded  to  our  addrsM  tbi 
vety  flaming  advertiMmaitt  of  a.  Dayton  qnaak  doctor ;  but  at  thm 
literary  effnatonB  are  very  similar  in  their  ityle  and  dtaiacler,  we  do 
not  see  that  we  would  benefit  soianoa  partienlarly  by  ventflating  the 
matter.  As  asnal  yarions  indiridnsls  of  that  oommnnity  have  had 
the  bad  taste  and  lack  of  good  sense,  to  famish  their  namea  to  gtvs 
chaiacter  to  this  "  doctor ;  "  bat  the  n  that's  so  old  a  hazaan  infirmi- 
ty that  we  scarce  care  to  be  troabled  about  it.  The  adTertiaement 
ctainiB  the  privilege  of  lefering  to  Commodore  Winslow  !  and  several 
prominent  snrgeons,  paymasters,  etc.,  etc.,  but  then  we  are  not  sn- 
tiiely  certain  that  this  is  by  permission  till  we  hear  otherwise. 

Medical  Colttfftt—ln  the- Medical  College  of  Ohio,  the  class  for  the 
present  session,  we  anderstand  is  sboat  one  handred  and  sixty. 

The  new  school  at  Cleveland  enters  on  its  first  session  with  very 
flsttering  proepeots,  the  class  numbering  sixty. 

We  learn  from  onr  Boston  correspondent  that  the  Medical  Depart- 
ment of  Harvard  College  has  a  class  of  S50.  We  have  heard  from  no 
other  schools  definitdy. 

£.  Frank  Palmer — Artytciai  Zdmit. — We  have  no  inlantion  of  en- 
tering the  list  in  the  discussion  of  merits  of  the  variooa  patent  arti- 
ficial legs  offered  to  those  who  have  lost  a  limb.  Some  of  these  aie 
manifestly  inferior  ;  others  require  a  knowledge  of  mechanics,  or  a 
personal  experience,  or  a  special  study  of  these  inventions  which  we 
are  ready  to  acknowledge  we  have  never  given.  We  have  for  many 
years,  however,  entertained  a  great  deal  of  regard  for  the  "Palmer 
Leg,"  as  we  have  frequently  expressed  ourselves  in  this  joarnal ;  and 
we  think  we  \i&va  ne^ftt  iiwiiiA'^'i^Ei\ti%  wi  «\.«^a.t  and  ingemoos  as  the 


1864.J  JUkar'w  Ia5fe.  745 

'*  Palmer  AitifieuJ  Ann/'  ms  we  obserred  it  sevenl  years  age.  These 
remarks  have  been  soggested  by  reading  a  pampUet  from  Palmer  re- 
newing his  connection  with  these  imrentions,  and  the  efforts  made 
b J  him  early  in  the  history  of  this  rebellion,  to  have  Gbyemment  as- 
inine in  behalf  of  the  maimed  soldier,  a  share  of  the  expense  of  a  new 
limb.  We  also  observe  that  Palmer  has  associated  with  him  in  the 
mann&ctare  of  artificial  limbs  several  gentlemen  who  have  oonstitnt- 
m1  themselves  into  a  body  corporate  under  the  name  and  title  of  the 
'*  American  Artificial  Limb  Company.'*  The  company  have  offices 
In  Philadelphia,  New  York,  and  Boston,  and  represent  their  facilities 
Tor  the  mannfactnre  commensurate  with  the  demand.  It  is  wonder- 
Fnl  how  the  importance  of  these  inventions  has  grown  with  the  prog- 
ress of  onr  civil  war ;  and  it  is  some  consolation  to  friends  that  onr 
pdlant  soldiers  can  have  a  substitute  for  a  lost  limb  (tf  such  elegance 
snd  wonderful  mechanical  completeness. 

Jneideni  in  Army  Pradke, — Case  of  twins— one  white  the  ether 
black. — ^A  correspondent  of  the  Boston  Mtdieal  and  Surgical  Journal 
relstes  the  case  of  a  colored  laundress,  confined  at  Post  Hospital,  New 
[beria.  La.,  December,  1868,  with  twins  ;  one  child  had  regular  fea- 
Unrea  and  was  white ;  the  other  was  purely  African  in  color,  features, 
md  form  ;  each  child  having  its  accompanying  placenta  and  envelope. 


TFoyne  Co.,  Indiana  Medical  Society. — Our  friends  at  Richmond, 
[nd.,  have  formed  a  medical  association  and  have  entered  upon  its 
profitable  enjoyment  in  a  vigorous  manner.  This  is  right ;  it  will 
soltivate  the  profession  of  that  vicinity,  and  do  away  with  a  large  de- 
cree of  the  petty  jealousy  incident  to  doctors  who  n^leot  or  refuse  to 
(mHivate  friendly  relations  and  intercourse.  The  secretary.  Dr.  War- 
ing, will  accept  our  acknowledgements  for  a  report  of  proceedings 
sad  discussions,  too  late  for  use  in  this  number  of  the  LancH  and  Oh- 


We  ars  also  pleased  to  learn  that  the  Indianapolb  Medical  Asso- 
eiation  has  harnessed  up  for  the  winter.  We  hope  to  hear  from  onr 
friends  there. 

Communicaiioni  are  also  received  from  Drs.  Fletcher,  Kipp,  Wells, 
Ftnfrock,  and  Langdon,  which  will  appear  in  regular  order ;  and  for 
which  the  authors  will  accept  our  thanks. 

Our  TkoMki  are  due  to  Dr.  Dauplatt  Bhf,  of  Bochester,  N.  Y.,  for 
a  copy  of  the  transactions  of  the  New  York  State  Medical  Society,  for 
llie  year  1864. 


746  J^^tor'iTabU.  [Decembs, 

Canada  Medical  Journal. — We  have  received  liJ'oB.  2  and  5  of  thu 
new  cotemporary  and  hope  our  neighbors  across  the  border  Will  supply 
ns  with  the  missing  numbers  and  accept  our  thanks  and  good  wikhei. 

obitTTary. 

[For  the  dnelnnatl  L*nc«t  andObtcrm.) 

Headquarters,  116th  O.V.I.,  Oct.,  Slst,  1864. 
It  is  with  regret  that  I  have  through  your  columns  to  announce  the 
sad  death  of  Thos.  I.  Shannon,  Surgeon  of  this  regiment,  fle  wti 
mortally  wounded  at  Middletown,  Va.,  in  the  engagement  of  the  19ik 
inst.,  and  died  on  the  20th  inst.,  at  Winchester,  Va.,.to  which  plice 
he  was  carried  after  receiving  his  wounds. 

Surgeon  Shannon  had  served  with  distinction  ever  since  he  entend 
the  army,  which  he  did  in  the  first  place  as  assistant,  being  after- 
wards promoted  to  the  position  of  Senior  Surgeon.  In  his  deoeaie 
the  regiment  and  command  at  large  ,have  lost  a  man  who  was  erer 
prompt  at  his  business,  being  always  at  his  post. 

Respectfully  your  Obt.  Servt., 

Thos.  Smith,  Asst.  Surg.,  116  O.V.I. 

We  find  the  following  account  of  a  most  ingenious  and  useful  in- 
vention in  a  recent  number  of  the  PhU  ideJpkia  Medical  and  Surgml 
Reporter^  from  which  we  copy  it  : 

Electricity  in  Household  Use.  —  Boston  claims  the  birth  of  th* 
philosopher  who  first  drew  elect noity  from  the  clouds  ;  ami  N^'w 
York,  the  residence  of  him  who  utilized  it  in  the  art  of  teleg»aphT: 
and  now  Philadelphia  demonstrates  her  right  to  the  great  brf)ther- 
hoo«l  of  practical  science,  by  a  new  and  beautiful  application  of  it  to 
an  important  domestic  purpose  The  name  of  Cornelius  is  soon  lo 
rank  with  those  of  Franklin  and  Morse. 

H<Miceforth  that  very  useful,  heretofore  indispensable,  generally 
disi»greeable,  and  oft  times  dangerous  little  article,  the  lucifer  matcb. 
may  be  dispensed  with.  Its  days  are  numbered,  and  it  may  be  said 
to  have  received  its  mortal  wound  by  a  stroke  of  lightning. 

The  improvement  which  elicits  those  remarks  is  called  ihe  E-t^- 
triad  Bracket,  and  consists  of.  an  ornamental  attachment  to  ih*^  orvli- 
nary  ga  burner,  by  which  the  gas  may  be  lighted  at  any  mom<*nt  bv 
the  instantaneous  production  of  a  spark  of  electricity.  Toe  niMr>  <^ 
accomplishing  this  is  as  simple  as  it  is  ingeoious,  and  so  easily  op- 
erated that  an  infant  cannot  make  a  mistake. 

The  application  of  electricity  to  the  ignition  of  the  current  of  ;44S 
issuing  from  an  ordinary  burner  is  not  a  new  thing.  Many  paliiV 
apartments,  as  the  Representatives*  Hall  at  Washington,  the  C'ooi»e: 
Institute  in  New  York,  and  others,  having  had  arrangements  lor  im 
simultawe^uft  V\g\vVY[v^  ol  \\vft  ^as  \ets  for  some  years  But  the  ajp*- 
ratus  iVierc  eTai^Xo-j^A.  \^  \)aft  w^\\v».\^  n<^\«\r.  W\.tftry  of  cups,  plates, 


1864.J  Edkor'M   TobU.  747 

acids,  etc.,  requiring  daily  and  carefnl  attention,  and  sometimes  fail- 
ing in  spite  of  the  best  super  vision. 

The  genins  of  Robert  Oomelins,  of  Philadelphia,  has  furnished  us 
with  an  arrangement  for  the  creation  of  the  electric  spark,  entirely 
different  and  avoiding  all  the  paraphernalia  of  the  old  method. 

The  means  he  employs  is  simple  friction  of  two  surfaces  of  suitable 
material,  by  a  movement  as  simple  and  easy  as  the  turning  of  a  key. 
The  apparatus  connists  of  a  brass  cup  of  about  the  size  and  shape  of 
an  apotnecary's  four  ounce  measuring  glass,  lined  inside  with  lamb*8 
wool  and  silk.  Into  this  cup  is  loosely  fitted  a  plug  of  hard  rubber, 
aod  these  furnish  the  surfaces  whose  friction  produces  the  electric 
spark.  The  cup,  supported  firmly  on  the  bracket,  is  connected  on  the 
gas  burner  by  a  fine  copper  wire  covered  with  silk,  and  terminating 
in  a  platinum  point  one-sixteenth  of  an  inch  from  the  aperture  of  the 
burner ;  merely  lifting  the  lubber  plug  from  its  bed  in  the  cup  suf- 
fices to  produce  a  spark,  which,  darting  from  the  platinum  point  to 
the  burners  ignites  the  escaping  gas.  This  little  appiiratus,  being 
without  any  tiuid  or  screws,  or  any  other  adjustnient  than  is  describ- 
ed above,  Oannot  get  out  of  order  by  ordinary  usage,  and  is  always 
ready  for  instantaneous  action.  To  render  it  infallible  at  all  seasons 
and  temperatures  has  been  the  inventor's  chief  anxiety,  by  the  use  of 
sach  materials  for  the  friction  surfaces  as  could  not  fail  to  produce  a 
spark  in  the  most  unfavorable  weather  ;  and  judging  from  the  daily 
observation  of  one  in  our  own  dwelling  during  the  present  summer, 
at  times  when  the  exceedingly  damp  atmosphere  would,  if  ever,  inter- 
rupt its  action,  we  are  convinced  that  the  present  arrangement  needs 
so  improvement. 

Til  is  elegant  addition  to  our  household  convenience,  when  placed 
before  the  public  (as  it  soon  will  be),  will  command  universal  atten- 
tion and  g  rati  filiation. 

The  same  principle  is  applied  by  the  inventor  in  other  forms.  We 
have  seen  five  burners  of  a  chandelier  simultaneously  ignited  by  one 
lorn  of  a  screw.  In  this  case  the  friction  surfaces  have  the  form  of 
fliit  dibcs  of  about  six  inches  in  diameter,  and  merely  raibingone  from 
the  other  with  a  slight  twisting  motion,  causes  a  spark  which  is  com- 
municated to  each  burner  by  a  separate  wire  conductor  at  the  same 
momt-nt. 

Auoiher  form  is  that  of  a  small  brass  tube  enclosing  a  movable  rod 
or  pihton,  which  slides  from  end  to  end  of  the  tube  as  the  latter  is  turn- 
ed in  the  hand.  The  fricti<m  caused  by  the  sliding  of  the  piston  ])ro- 
duces  (he  spark  which  is  romniunicated  to  the  burner  when  tue  tube 
iff  hi  ought  info  juxtaposition  with  it.  By  this  arrangement  any  gas 
jet  niHV  be  ignited  without  either  match  or  torch. 

This  is  one  of  the  neatest  invrn lions  it  has  ever  been  our  fortune  to 
witness  ;  ami  will  doubtless  br^ng  to  its  ingenious  and  philosophical 
contriver,  what  he  justly  deserves,  an  ample  pecuniary  return. 


TTAy  Animals  to  be  Eaten  must  be  Killed. — It  is  universally  under- 
stood that  animals  which  die  from  disease  are  not  &UAd.  lot  o^x  tsax- 


748  MUar'9  IWe.  [Deeembtr, 

kets.  It  is  also  nndentood  that  wlien  oattla  hsTe  been  oyardrifeB, 
their  meat  ia  notably  inferior  to  that  of  healthy  animala*  nnlew  thej 
are  permitted  to  recover  their  exhausted  eneigies  before  being  alaqgbt- 
ed.  Why  is  this  ?  The  first  and  most  natural  supposition  leqieet- 
ing  those  which  die  from  disease  is  that  their  flesh  is  tainted  ;  hot  it 
has  been  found  that  prolonged  agony  or  exhaustion  is  qaite  as  injuri- 
ous, though  in  these  cases  there  is  no  taint  of  dioeaoe  H.  Olaode 
Bernard  propounds  the  following  explanation  :  In  all  healthy  aai- 
mals.  no  matter  to  what  class  they  belong,  or  on  what  food  they  sub- 
sist, he  finds  a  peculiar  substance  analogous  to  Tegetable  starch,  ei* 
isting  in  their  tissues,  and  especially  in  tibeir  liver.  This  substaieib 
glycogene  or  liver-sugar^  is  abundant  in  proportion  to  the  vigor  sad 
youth  of  the  animal,  and  entirely  disappears  under  the  prolonged  ssf- 
fering  of  pain  or  disease.  This  disappearance  is  singolarly  rapid  ia 
fish,  and  is  always  observed,  in  the  spontaneous  death  of  animsia 
But  when  the  death  is  sudden,  none  of  it  disappears.  In  a  raUit, 
killed  after  suffering  pain  for  five  or  six  hours,  no  trace  was  found  of 
the  sugar-forming  principle,  and  its  flesh  has  a  marked  diffRence  ia 
flavor.  The  same  remark  applies  to  exhausted,  over-driven  animtb; 
their  muscles  are  nearly  deficient  in  glyeogene  and  yield  a  deddedlji 
larger  percentage  of  water  than  muscle  in  normal  condition.  M. 
Bernard  likewise  finds  that  animals  which  are  suffocated  lose  more  of 
this  sugar-forming  substance  than  similar  animals  killed  in  the 
slaughter-house.  To  this  let  us  add  the  fact,  that  the  blood  of  over 
driven  animals  will  not  coagulate,  or  coagulates  very  slowly  and  im- 
perfectly ;  and  we  shall  see  good  reason  for  exercising  some  circua- 
spection  over  the  practices  of  our  meat-markets. — Edhdmrgk  JMkal 
OfUrncU. 


Caution  to  Orities, — A  novel  action  was  lately  brought  in  Parii 
by  a  surgical  mechanician,  against  two  medical  officers.  The  latter, 
Drs.  Gonpil  and  Bernurts,  have  published  a  book  on  the  diseassb  of 
women,  and  therein  stated  that  a  peculiar  pessary,  invented  by  M. 
Grandcollot,  did  not,  as  far  as  they  had  seen,  answer  the  purpose. 
The  latter  thereapon  brought  the  action,  laying  the  damages  for  tbe 
injury  sustained  at  £1,000,  requesting,  besides,  an  apology  in  thirty 
newspapers,  and  also  a  rectification  to  be  inserted  in  the  above  meD- 
tioned  work.  He,  however,  lost  his  cause ;  the  verdict  was  for  the 
defendants,  and  the  plaintiff  was  saddled  with  the  coats — Lond  Zsa. 


14.]  Bgpepitm  XtrpaHiu.  749 


#{l(t(aImoIogtcaI  Stprtment.^ 


Mitod  bf  B.  WnubiAirt,  If  J>^  OnnnMATii. 


Hypopium-Karatitit. 

Prof.  Roser,  in  the  Archw  fur  OphthalmolqffU,  for  1856,  giTes<aii 
Ment  description  of  a  common  and  very  dangerous  form  of  comei- 

characterized  bj  a  central,  circumscribed,  well  defined  patch  of 
idation  ;  usually  in  the  deeper  layers  of  the  cornea  and  varying  in 
a  from  a  small  pin's  h^d  to  that  of  a  split  pea  or  eren  larger,  at- 
ded  very  generally  by  hypopium.     He  calls  it  kj^papwm  kerati" 

and  laments  the  inadequacy  of  the  then  known  means  of  treat- 
nt  for  its  control.  Since  then  Oraefe,  in  the  same  periodical  for 
60,  has  published  an  account  of  a  similar  affection  occuring  mostly 
children  under  eight  years  of  age.  His  description  is  given  under 
9  head  of  "  Tepid  and  Warm  Fomentations  in  Certain  Ophthal- 
a."  Among  other  affections,  he  says  that  these  have  a  most  happy 
)Ct  in  the  treatment  of  a  form  of  keratitis  which  he  calls,  for  want 
m  better  name,  reusloses  eiierififiltrat,  non  iraitable  infiltration  of  put. 
begins  as  a  yellow  speck  in  the  central  region  of  the  cornea,  which 
thin  a  day  or  two,  increases  to  the  siie  of  a  line  or  more.  At  this 
ige  there  is  an  absence  of  all  haainess  of  the  cornea  immediately 
rrounding  the  well  defined  spot,  little  or  no  injection  of  the  con- 
ictival  and  anterior  ciliary  vessels — the  eye  does  not  weep  and  is 
•ly  opened  in  a  bright  light  The  peculiarity  of  the  yellow  exu- 
tion,  extending  deep  into  the  substance  of  the  cornea  and  more  or 
16  ulcerated,  is  that  it  terminates  abruptly  in  the  perfectly  timnspar- 
i  cornea,  without  any  grayish,  slightly  elevated  line  or  sone  of  de- 
creation,  as  is  seen  in  ordinary  inflammatory  exudation  in  that 
nnbrane.  At  this  stage,  the  disease  may  come  to  a  stand  still,  and 
en  go  through  certain  stages  to  reeolution,  leaving  only  an  opacity 
the  cornea.  But  more  commonly,  the  purulent  yellow  infiltration, 
tends  more  and  more  laterally,  showing  little  tendency  to  perfora- 
m,  which  occurs  only  at  a  later  period.  As  the  exudation  extends 
eply  into  the  cornea,  the  epithelal  layer  of  the  membrane  of  Desce- 
Bt  participates  in  the  inflammation,  causing  a  diffused  yellowish  dis- 
loration  of  the  aqueous  humor,  without  however  terminating  in  by* 
»piam.  The  iris  now  b^ns  to  appear  of  a  yellowish  or  reddish- 
dlow  oolor,  becomes  infiltrated  and  swollen,  bnt  still  withom  %«^ 


750  OpMkalmotogical.  [Decembef 

teiior  synechia  or  exudation  upon  its  surface.     If  the  case  at  tliis  stage 

changes  for  the  better,  it  is  indicated  by  an  increase  of  the  ejmptonn 
of  irritation  with  the  formation  of  the  grayish  zone  of  demareaiion  m 
mediately  around  the  abscess  or  infiltrated  patch.  In  contrast  wit] 
common  keratitis  with  exudation,  it  shows  a  decidedly  destructif 
tendency.  The  former,  through  excesa  *of  inflammatory  reactioi 
leads  to  suppurative  destruction  of  the  part  involved,  showing  bi 
little  disposition  to  spread  laterally,  but  rather  to  extend  in  depth  ao 
lead  to  perforation.  The  latter  shows  exactly  the  reverse  tendencj 
It  spreads  laterally  and  destroys  an  extensive  portion  of  ibe  lameMi 
of  the  cornea.  The  process  of  snppei^tion  and  ulceration  advancf 
rapidly  in  width  and  slowly  in  depth,  till  a  large  portion  of  the  coi 
nea  is  destroyed,  perforation  takes  place,  with  synechia  anterior  tottli 
and  large  leucoma  or  staphyloma,  or  it  may  be  acophy  of  the  glob< 

Dr.  Graefe  thinks,  and  I  believe  justly,  that  there  is  not  enouj 
of  inflammatory  reaction  in  such  cases  to  egtaUiish  the  line  of  demax 
cation.  After  satisfying  himself  of  the  worthlessness  of  tSe  usual  ai 
tiphlogistics,  and  ihe  decidedly  pernicous  efifects  of  cold  application 
in  such  cases,  he  gradually  came  to  the  use  of  fomentations  wit 
warm  camomile  tea  at  a  temperature  of  from  26^  to  2s<^  Reanma 
He  found  this  to  establish  the  process  of  eHmination  so  favoralily  tbi 
he  Jibandoned  all  other  agents  except  atropine.  The  o^^casional  ir 
stillrttion  of  a  solution  of  atropine  and  the  warm  foraontaiion,  are  uso 
together  for  a  day  or  two  till  tho  reaction  is  sufficiently  e?*tablish<^l  t 
eliminate  the  ulcerated  and  necrossed  portion,  when  the  former  i 
continued  and  the  latter  left  off.  In  traumatic  absce.-ise.s  of  the  corno 
which  often  present  the  same  appearance  and  tendency,  be  uses  ih 
same  treatment,  and  in  cases  where  there  is  extensive  hypopinm  he  re 
sorts  to  repeated  paracenteses  and  even  iridectomy,  which  is  an  ex 
ceedingly  valuable  remedy  where  there  is  large  ulceration  and  irili:* 
with  abun<lance  of  pus  in  the  anterior  chamber. 

His  plan  of  using  the  warm  applications  is  to  apply  folded  cloth 
squeezed  out  of  the  warm  camomile  tea  and  laid  upon  the  eye  an 
changed  every  five  minutes,  with  intermissions  of  a  quarter  of  a 
hour  every  hour. 

Dr.  Adolph,  Weber  of  Darmstadt,  has  contributed  more  recently, 
very  valuable  paper  on  the  patbol«»gy  and  rherapeutics  of  this  snbjev 
— Archiv  fur  Ophthalmologie,  May,  1861.  lie  stylos  it,  nerrotic  ah 
sees  8  of  the  cornea,  aw^  insists  that  the  hypopium  results  nearly*! 
ways  from  perforation  or  opening  of  the  abscess  backwards  and  ih< 
escape  of  dae  pvia  \wV.o  Oci^  Wi\.«t\Qx  ^"axs^^x     Thu»  he  maintains  ii 


1864.]  Bypopinm  Keraiitts.  751 

(he  rule,  while  hypopium  from  irritation  of  the  membrane  of  Desce- 
met  and  from  iritis  in  8nch  cases,  is  the  exception — the  rcTerse  of  what 
is  advocated  by  Roser  and  others.     He  contends  that  the  disease  de- 
scribed  by  Qraefe  as  occurring  in  children,  and  sometimes  epidemical- 
ly, is  evidentially  the  same  as  inflammation  of  the  cornea  with  abscess, 
as  it  shows  itself  in  adnlts,  mostly  among  lalK>ring  men,  mechanics 
and  farmers,  and  generally  traceable  to  a  trumatlc  cause.     Contusion 
of  the  cornea  with  or  without  abrasion,  as  it  is  often  produced  by  a 
blow  from  the  twig  of  a  tree  ;  the  scratching  of  wheat  beards  ;  parti- 
cles of  stone,  coal,  wood,  steel  etc.,  flying  into  the  eye,  is  very  often 
followed  in  the  course  of  a  few  days,  by  circumscribed  central  abscess 
of  the  cornea  complicated  sooner  or  later  by  hypopiund.     This  result 
is  especially  liable  40  occur  from  such  accidents,  in   old  people.     A 
few  days  after  a  trauma  of  the  character  above  mentioned,  there  ap- 
pears a  well  defined  milky  white,  or  dirty  yellowish  white  sp<)t  on  the 
c<»mea,  usually  near  the  centre.     The  color  in  a  few  days,  becomes- 
more  saturated  and  yellower,  and   a  narrow  hazy  zone  immediately 
sorrounding  the  infiltrated  spot,  U  all  that  intervenes  between  it  and 
the  perfectly  transparent  cornea.     There  is  more  or  less  intense  injec- 
tion of  the  sclerotic  vessels,  with  moderate  tenderness  to  the  light  and 
epiphora.     From  this  time,  there  are  usually   severe  circnmscribed 
pains  which  are  more  intense  at   night.     In  old   people,  or  broken 
down  subjects  however,  the  pain   is  sometimes  entirely  absent,  and 
there  is  little  intolerance  of  light  from  the  coiumencement  to  the  end 
of  a  process  that  leads  to  complete  destnirtion  of  the  corne.i  and  ^-ub- 
leqnent  staphyloma  or  phthi^is  bulbi.     Tl  e  iiurfa«'C  of  the  infiltrated 
patch,  is  usually  slightly  elevated  above  that  of  the  surrounding  cor- 
nea ;  but  when  the  abscess  or  deposit  is   in  the  central   lamellu;  or 
nearer  the  posterior  surface,  there  is  a  bulging  backwards  into  the  an- 
terior chamber.     When   the  opacity  has  become  decidedly  saturated 
and  the  vascular  injection  and  subjective  symptoms  marked,  the  hy- 
popium  is  apt  to  show  itself.     A  slight  yellowihh  collection  in   the 
extirme   lower   part  of  the  anterior  clinnibcr,  is  first  seen,  which  in- 
crease's rapidly,  antl  in  bad  cases  may  mnuut  up  to  the  middle  of  the 
pDpil  or  even  fill   the    chamber.     Soun  the   surface  of  the  infiltrate<i 
spot  api»ear»   abraded    t»r  ulceriiled,  the  ne^TOiinil  tissue  in  gratlually 
elimioHttnl  and  perforation,  to  a  greater  or  less  extent,  takes  placi», 
Qsnally  with  prolapsus  of  the  iris  and  snb.-ei[uent   leucoma  adha^ren^ 
with  loss  of  vision. 

One  faral  peculiarity  about  this  afibction  is  its   tendency  to  spread 
latcittUy  by  yellowish  or  grayish  infiltration  of  its  edges  a.'wl  ^  %wx 


752  OpkMmolo^Ua^.  [DeoemlMr. 

of  undermining,  similar  to  that  of  a  pbagedenie nicer  of  the  skm.  It 
may  thns  by  eating  away  the  anterior  layers  of  the  cornea,  BprW 
nearly  or  quite  over  its  whole  surface,  producing  finally,  as  the  deeper 
lamellae  hte  broken  down  by  suppuration,  extensive  perforation  tad 
entire  destruction  of  the  eye.  In  ordinary  keratatis  with  ulceratioii, 
as  soon  as  spontaneous  perforation  takes  place,  or  the  tension  of  the 
eye  is  relieved  by  a  piraoentesis,  the  ulcer  ceases  to  spread  and  showi 
a  disposition  to  heal.  This  is  by  no  means  always  the  case  in  d» 
peculiar  form  under  consideration.  The  ulcer  both  before  and  afitf 
perforation,  shows  the  greatest  tendency  to  extend  downward,]  id 
consequence  of  the  gravitation  of  the  pus  between  the  layers  of  tbe 
cornea.  But  I  have  often  seen  it  extend  upward  and  to  the  sides  quits 
as  rapidly  as  in  the  natural  direction  of  gravitation. ,  A  light  grayiak 
zone  around  the  ulcer,  with  smooth  edges  is  a  favorable  symptom, 
but  ragged  edges  with  here  an-i  there  saturated,  yellowish,  or  grayish 
specks  extending  beyond  its  margins  indicate  farther  spreading. 
Dr.  Weber  maintains  that  these  are  all  cases  of  abscess  in  the  oonm 
and  subsequent  sinking  of  the  pus,  causing  the  progressive  destne- 
tion  already  described.  It  is  by  the  breaking  through  of  the  conteaU 
of  the  abscess  into  the  anterior  chamber  that  he  accounts  for  tiie  hj- 
popium,  and  its  perpetuation  or  frequent  reproduction  he  attri bates  to 
the  repeated  refilling  of  the  cavity  of  the  abscess  and  its  re-dischsrgi 
through  the  same  direct  or  sinuous  opening.  He  alleges  that  in  all 
cases,  careful  examination  by  oblique  focal  illumination,  reveals  tiie 
presence,  first  of  bulging  of  the  posterior  layers  into  the  anterior 
chamber,  and  afterwards  the  open  rupture  or  ulcer  with  more  or  less 
surrounding  infiltration.  Also  by  numerous  careful  examinatiooi 
after  the  discharge  of  the  abscess  into  the  aqueous  chamber,  and  after 
its  anterior  wall  also  had  given  way,  he  has  been  able  to  find  the  point 
of  perforation  with  a  small  Anels,  probe.  Sometimes  the  opening  is 
direct,  but  oftener  oblique  and  sinuous  so  as  to  be  of  a  valvular  char- 
acter and  require  that  the  probe  be  bent  to  find  it.  On  the  correct- 
ness of  these  views  of  the  pathology,  he  recommends  an  important 
modification  of  treatment  of  such  cases.  Instead  of  depending  on  the 
evacuation  of  the  abscess  by  simply  puncturing  its  anterior  wall  with 
a  needle  or  carteract  knife,  or  treating  the  case  by  repeated  {Paracen- 
tesis near  the  margin  of  the  cornea,  he  makes  an  oblique  puncture  or 
paracentesis  through  the  absciss.  He  uses  a  broad  paracentesis  needle 
(Dcsmares')  or  a  narrow  spear  knife,  enters  a  little  below  the  lower 
edge  of  the  abscess,  passes  obliquely  upwards  and  backwards  throngb 
\U  cavity  axid  «xi\Ai%  \)ci^  a.\!L\Ai\Qx  Q\\amber  at  its  upper  margin.    Ai 


.1864.]  Bypopium  HertatUis.  753 

tbe  needle  is  slowly  withdrawn,  tlie  external  opening  is  enlarged  if 
necessary,  so  as  to  afford  a  free  outlet  for  the  giavitatiag  pus  and  pre- 
vent its  subsequent  burrowing.  As  the  aqueous  humor  escapes, 
either  following  the  needle  or  after  the  wound  is  made  to  gape  by  slight 
pressure  with  the  end  of  a  small  probe,  it  enters  the  cavity  of  the  ab- 
scess and  washes  aui  the  pus  completely.  If  after  that  there  isopaqut' 
substance  in  the  cavity,  he  'enters  carefully  with  a  delicate  toothed 
forceps  and  removes  the  pyogenic  membrane  with  any  shreds  of  pdr- 
tially  broken  down  cornea]  tissue.  The  spot  then  at  once  becomes 
transparent  and  the  case  gets  well  like  magic 

All  this  looks  very  nice  on  paper  and  no  doubt  in  many  ca-es  hns 
been  actually  done  with  complete  success.  Of  his  method  of  making 
the  paracentesis  I  approve,  piovidel  it  is  done  carefully  and  early, 
before  spontaneous  perforation  of  the  curnea  is  about  to  take  place. 
If  the  weak  spot  is  about  teady  to  burst,  it  is  rather  hazardous  to  make 
a  paracentesis  through  the  ulcer,  and  I  prefer  to  do  it  through  the 
margin  of  the  cornea.  The  tension  of  the  eye  is  thus  relieved  and 
tbe  healing  of  the  ulcer  favored.  If  afterwards  the  pus  showh  a  ten- 
dency to  burrow,  the  cataract  knife  can  be  parsed  through  the  corneal 
layers  below  it,  so  as  to  allow  it  to  escape,  without  entering  the  an- 
terior chamber  ;  or  the  ra^ge  I  undermined  o<lgcs  of  the  ulcer  can  be 
shaved  off  or  scraped  off,  :is  I  have  several  times  done  with  good  ef- 
fects. In  a  case  of  ulceration  of  the  cornea  after  smail-pox,  in  the 
Commercial  Hospital  last  winter,  matter  burrowed  from  the  ragged 
tronghing  ulcer  at  the  superior  margin  down  through  the  c^entre  t(» 
the  lower  limbus,  making  an  opaque  grayish  yellow  strip  about  a 
line  wide.  I  made  several  paracentesis  through  the  outer  transpar- 
ent edge  of  the  cornea,  with  partial  relief,  but  the  gravitation  went  on 
till  I  incised  the  supeificial  lamclise  with  a  catoraot  knife  at  the  lower 
limbus  and  let  tbe  pus  escupo.  In  that  case  shreds  of  necrostMl  cor- 
neal tissue  appeared  in  the  wounds,  and  I  entered  with  a  small  forceps 
and  removed  quite  a  number  of  them  in  the'mauner  recommende<l  by 
Weber.  No  spontaneous  perforation  ever  occurred,  and  as  there  were 
no  marked  symptoms  of  iritis,  the  hypopium  which  was  present,  wat 
pas  sccrccted  no  doubt  from  the  irritate<l  membrane  of  Desc*eoiet  along 
the  coarse  of  the  gravitating  matter.  The  ca^e  recovered  and  very 
fair  vision  was  restored. 

In  two  cases  of  circumscribed  inflammation  of  the  cornea  with 
g^lyi^h  yellow  infiltration,  both  central,  occurring  in  middle  aged 
healthy  laboring  men,  and  attended  by  hypopium,  I  made  the  pai-a- 
centesis  through  the  abscess  as  revTommendcd  by  Webex»«LTi^N9\>^ck^Xl^ 


754  Ophihakioloffieal.  [December 


•f 


refialt  of  arresting  tbe  ulcers  and  saving  tbe  eyes^falthoiigh  in  both 
tbere  will  remain  a  central  opacity.  Tbey  both  ^ame  under  my  treat- 
ment last  week  and  on  tbe  same  day.  In  one  tbe  abscess  was  tiad- 
matic,  baving  been  caused  by  a  small  piece  of  wood  from  a  circolar 
saw  ;  wbile  in  tbe  otber  tbe  exciting  canse  conld  not  be  ascertained. 
In  tbe  former,  one  paracentesis  was  snfiScient,  in  tbe  latter  tbe  cornea 
was  punctnred  tbree  times  at  intervals  of  twenty-four  bours.  BoA 
were  at  tbe  same  time  treated  witb  a  strong  solution  of  atropin  and 
compression  witb  cotton  and  an  elastic  bandage  kept  on  day  and  nigbt 

I  am  disposed  to  tbink  that  Dr.  Weber  exaggerates  when  be  sayi 
tbat  nearly  all  cases  of  tbe  kind  described,  are  actually  abcesses  with 
perforation  backward  into  tbe  anterior  obamber.  Still  that  is  ua- 
donbtedly  tbe  explanation  of  a  large  portion  of  tbem,  and  the  method 
of  evacuating  tbe  abscess  and'  anterior  chamber  at  tbe  same  time  and 
in  the  way  be  recommends,  is  highly  philosophical  and  worthy  of  a 
faithful  trial.  There  is  no  species  of  inflammation  of  tbe  cornea  more 
dangerous  than  these  necrotic  abcesses  or  less  amenable  to  ordinary 
treatment.  I  have  long  since  abandoned  the  use  of  all  treatment  in 
snob  cases,  but  tbe  energetic  use  of  utropin,  repeated  paracentesis  and 
compression.  Where  the  ulcer  is  large  and  spreading,  witb  abund- 
ant hypopium,  I  have  several  times  performed  iridectomy  with  great 
advantage.  But  in  som^  cases  all  these  fail  and  the  eye  is  inevitablj 
destroyed.  Where  the  line  of  demarcation  does  not  show  itself  and 
tbe  symptoms  of  reaction  are  absent,  warm  fomentations  as  recom- 
mended by  Qraefe,  are  a  valuable  adjuvant  to  the  means  I  have  men- 
tioned. Paracentesis  performed  early  and  often,  through  the  abscras 
if  one  actually  exists  or  is  about  forming  ;  atropin  and  constant  well 
regulated  compression  are  the  means  which  have  rendered  best  service 
in  my  bands.  In  using  compression  to  the  eyes,  as  well  in  these 
cases  as  in  other  extensive  ulcerations  of  tbe  cornea,  also  after  extrac- 
tion of  cartaract  in  old  people,  especially  after  operations  for  staphy- 
loma, iridectomy,  etc  I  now  imploy  elastic  material  such  as  ladies 
use  for  garters,  only  wider.  I  take  a  piece  about  an  inch  #fde  and 
18  or  20  inches  long,  according  to  the  size  of  the  head  andtbe  degree 
of  pressure  I  wish  to  exert,  sew  the  ends  together  and  th^n  stretch  it 
over  tbe  head.  It  keeps  its  place  admirably,  makes  uniform  pressme 
and  is  readily  and  easily  applied. 

In  conclusion  I  will  remark  tbat  the  operation  of  paracentesis  ia 
hypopium  from  any  cause,  is  not  particularly  to  ep<zeu€U$  the  pus  but 
to  let  out  the  aqeuoue  humor  and  relieve  teneum.  When  that  is  ae- 
Complisheid  and  \\i^  \Ti^KmxoAX.<^T^  process  coutrolledy  the  matter  is 


1864.]  Fiuid  Catarmct.  755 

rapidly  absorbed  from  tbe  aqneoDB  cbamben  As  a  role  it  is  better 
to  panctnre  the  cornea  where  it  is  transparent,  and  generally  near  the 
outer  margin,  as  that  is  the  most  conyenient  place.  As  the  aqneons 
hamor  flows  ont  the  matter  mounts  np  toward  the  seat  of  the  pnno- 
tare  and  some  may  escape,  but  it  makes  little  difierepoe  whether  it  is 
discharged  or  not.  If  the  disease  which  develops  the  hypopinm  is 
checked  by  the  treatment,  the  pns  disappears  in  most  cases,  with  as- 
tonishing rapidity.  If  the  collection  is  large  and  the  nicer  extensive, 
it  is  better  to  nse  a  spear  knife  or  cartaract  knife  and  make  a  free 
incision  at  the  inferior  margin  of  the  cornea,  so  as  to  evacuate  the 
matter  with  the  humor.  It  in  decidedly  better  however  iq  such  oases, 
to  make  an  iridectomy,  outwards  or  inwards,  as  may  be  more  desir- 
able. The  tenacious  lymphy  pns  will  not  escape  by  a  small  punctnre, 
and  hence  it  is  better  in  using  the  needle,  to  enter  above  it  I  have 
abandoned  the  use  of  Desmares  paracentesis  needle  in  geaeiml,  pre- 
fering  a  sharp,  broad  needle  which  penetrates  much  easier.  -Qn  the 
other  end  of  the  same  handle  a  small  probe  can  be  fixed  for^fijti|ing 

# . 

FIvId  Catariot.  9 


the  wound.  <  <• 


^  ■> 


.J 


It  is  not  very  uncommon  to  meet  with  oases  of  cataract  wheie  the 
lens  has  become  perfectly  fiuid.  They  are  sometimes  congenital,  but 
oftener  a  termination  of  cataracts  that  date  from  early  life.  With 
the  gradual  liqnifaction  of  the  lens  substance,  there  is  spontaneous 
absorption,  and  diminution  of  volume.  Sometimes  the  entire  lens  is 
thus  absorbed,  and  a  spontaneous  resteration  ofjtfj^t.oiynr^  A  f<9w 
years  ago,  I  operated  on  one  eye  of  a  little  boy,  for  a  liquid  cataraot, 
whose  other  eye  had  been  restored  in  that  way,  the  only  obstructioa 
remaining,  being  a  slightly  opaque  capsnle. 

This  species  of  cataract  is  recognised  by  a  uniform,  milky-white 
color,  extending  quite  up  to  the  capsule,  and  interrupted  only  here 
and  there,  by  small,  whitish,  chalky  looking  speeks  on  the  inner  sur* 
fiaoe  of  the  capsule.  The  substance  is  very  opaque,  with  no  appear- 
ance whatever  of  a  nucleus.  In  addition  to  this,  there  are  the  usual 
signs  of  a  reduction  in  siae  of  the  lenticular  system — that  is,  increaa- 
ad  depth  of  the  anterior  chamber,  with  trembliag  of  the  iris,  whea 
the  eye  is  rotated.  The  age  at  which  tha  cataract  was  developed,  is 
not  of  much  diagnostic  importance,  for  only  a  small  portion  of  those 
occurring  in  childhood  become  liquid  with  advaneing  years ;  amd 
ocoasionally,  liqui&ction  resnlu  in  thoae  thai  davf^cv^  Va  %A.Ti^^a«  ^x 


I 


75C  Ophthalmol' f^lcal.  December, 

even  in  old  people.  I  have  seen  two  cases  of  this  latter  class,  lately 
— one  in  a  man  of  25,  the  other  of  50  years.  Tlie  first  had  a  liquid 
lens  in  one  eye,  which  I  removed  snciessfnlly  by  an  operation ;  and 
an  ordinary,  moderately  soft  caiaract  in  the  oilier,  that  still  exists. 
The  second  has  a  liquid  cataract  in  one  eye,  the  development  of  which 
I  have  followed  with  much  intere.4  for  3  years.  When  I  first  exam- 
ined him,  there  was  a  hard,  amher-coloied  ni.clens,  having  the  peifeci 
lomi  of  the  lens,  and  uvef  half  the  normal  diameter  of  thai  hodv. 
surrounded  by  a  white  liquid,  in  whi«h  it  floated  freely.  With  the 
pupil  of  medium  bize,  and  the  head  a  little  inclined  forwards,  its 
upper  round  margin  could  be  seen  in  the  loiver  part  of  the  pupil. 
When  the  pupil  was  largely  dilated  with  atropin,  and  the  patient  lay 
with  his  face  downwards,  the  entire  nucleus  could  be  seen,  resting  on 
ihe  anterior  capsule.  If  the  patient  assumed  a  supine  position,  it 
sank  back,  and  disappeared  in  the  white  fluid  part.  I  published  a 
description  of  it  at  the  time,  with  an  account  of  others,  observed  ly 
von  Qraefe.  Since  then,  once  or  twice  a  year,  I  have  examined  the 
eye,  and  saw  the  nucleus  gradually  melting  away,  until  at  present  no 
tVace  of  it  is  left,  and  tlie  cataract  is  perfectly  liquid  and  white. 

When  the  lens,  during  and  after  the  process  of  liquifaction,  disap- 
pears by  spontaneous  absorption,  there  is  presented  the  exact  ap- 
pearance of  a  secondary  cataract  —  an  opaque  capsule  with  whitish 
precipitates  on  its  internal  burfaee.  If  the  absorption  is  completoi 
at  an  early  period  of  life,  a  moderate  vision  may  be  restored,  as  in  the 
little  patient  mentioned  above.  Dr.  Graefe,  in  the  Archlv  fur  O/'h- 
thalmologief  for  1863,  gives  an  account  of  a  family  known  to  him,  in 
which  this  peculiar  form 'of  cataract  is  hereditary,  and  has  already 
appeared  in  severa!  generations.  The  aflected  individuals  have  an 
apparent,  very  thin,  secondary  cataract,  without  any  operation  ever 
having  been  perf(^rmed.  They  read  very  fine  print,  and  some  of  them 
even  without  glasses  whtn  held  extremely  near  the  eyes,  although  a 
degree  of  hyperopia  is  present,  corresponding  to  ophakia,  or  ab>euce 
of  the  lens.  Two  remarks  I  wish  to  make,  right  here.  The  rarity 
of  spontaneous  absorption,  will  not  justify  us  in  putting  off  an  op 
ration  in  expectation  of  that  event.  As  remarked  by  Dr.  Graefe,  this 
form  of  cataract,  when  congenital,  is,  in  a  very  few  years,  apt  to  be 
followed  by  amblyopia  or  amaurosis.  Hence  the  rule  that  in  all  ca>p'» 
of  cataract  occurring  congenitally,  or  in  early  life,  an  early  operation 
ought  to  be  performed,  is  particularly  applicable  to  the  liquid  variety. 
In  larasellar  cataract,  however,  where  the  opaque  disc  is  small,  ami 
the  edges  oi  l\ie  \^tv^  "^^\l^c\\^  Vt^Xi^^vt'SiwV.  \i  is  better  to  wait  and  we 


1864.]  Flu'd  Cattirad.  757 

if  the  ilisease  reniftins  stationarv.  If  so,  Critclieit's  operation  of 
I'ridesi^t  affonls  better  results  than  destmction  of  the  lens.  Duringr 
the  term  of  wailing,  however,  it  is  my  practice  to  keep  the  pupils  di- 
lated with  atropin  daily  applied,  so  as  to.  diminish  or  prevent  nystag- 
mus, and  effect,  for  the  time  being,  better  vision.  By  the  long  con- 
tinued use  of  this  substance,  the  eyes  become  usually  much  stronger 
tc»  the  light,  and  much  steadier. 

As  to  the  best  method  of  operating  for  fluid  cataract,  Dr.  Graefe, 
in  the  article  already  cited,  recommends  the  use  of  a  broad  solution 
ueedle,  which,  by  being  slightly  rotated  as  it  is  slowly  withdiawn, 
allows  the  fluid  lens  substance  to  escape  with  the  aqueous  humor,  so 
that  the  pupil  at  once  becomes  clear.  The  great  advantage  of  this 
over  the  ordinary  operation  of  solution,  is  that  no  particles  of  the 
lens  are  left  in  the  eye,  to  come  in  contact  with  the  iris,  or  the  mem- 
brane of  Descomot,  and  cause  dangerous  inflammation,  as  they  some- 
time*^ ilo.  There  is,  any  how,  in  these  cases,  a  predisposition  to  serous 
iiitirt,  with  precipitates  upon  ihc  capsule,  and  posterior  surface  of  the 
<  ornea.  Little  or  none  of  the  soft  substance  of  the  cataract  should  be 
loft  in  the  eye,  when  it  can  be  so  easily  let  out.  The  advantage  of 
the  broad  needle  over  the  old  methoil  of  extracting  the  fluid  lens  by  a 
linear  incision,  is  that  it  is  a  much  less  Kerious  operation,  and  there 
is  no  danger  of  prolapsus  of  the  iris,  cither  at  the  time  or  afterwards, 
l.y  th.e  iiuruliness  of  the  child.  Within  the  last  year,  I  perfonned  the 
t.])eration  on  both  eyes  of  a  child,  with  immediate  and  beautiful  suc- 
t?s.  A  few  weeks  ago,  I  was  couKulted  by  a  young  man  with  caia- 
ia«.t  in  both  eyes.  I  diagnosed  very  soft,  but  not  liquid  lenses.  The 
lii^ht  eve,  whi«h  had  been  blind  several  vears,  was  seleeted  for  the 
operation.  The  j)upil  being  dilated  with  atropin,  I  passed  a  fine  solu- 
tion needle  through  the  cornea,  and  no  sooner  had  I  punctuied  the 
«  apsulo,  than  the  liquid  lens  substance  flowed  out  like  oil  into  the  pie- 
viously  clear  aqueous  humor.  After  dividing  the  capsule  freely  as  1 
.  ouM.  I  withdrew  the  n  edle,  increased  the  puncture  with  a  wider 
one.  and  by  slight  pressure  on  the  posteiior  lip  oi  the  wound  with  a 
-mall  J. lobe,  th'  a<iu-ous  humor  with  the  turbid  lens  matter  escaped. 
As  a  tew  pariiclca  lemaineii  behind,  I  closed  the  eye  a  few  miDute^, 
to  l«?t  the  auuoou«  humor  re-form;  then,  hv  a  repetition  of  rhe  ma- 
iioMiv!t»  with  the  probe,  the  remainder  came  out,  and  in  1J4  hours, 
th«'  patient  wa>  w«»ll,  with  fair  vision.  The  reason  I  was  mistaken 
a-  to  the  consistence  of  the  lens,  was  that  it  was  more  of  a  blueish 
color  than  usual,  and  not  so  opaque.  I  could  see  c*'n$iderabl^  iuf^ 
./.*  subsiancf  by  oblique  illuminatioD,  which  U  nsually  wol\!bk^  ^"s^v^  v>x 


758  JBdUarial  AhtiracU  and  Selectkm.  [December, 

liqoid  cataract.  Had  I  known  the  consistence,  I  shonld  have  used  a 
broader  needle  at  fir^t,  and  the  extraction  wonld  have  been  still  mors 
simple.  My  success  in  the  nse  of  the  wide  solution  needle  in  the 
cases  under  consideration,  has  bepn  so  gratifying  that  I  can  add  ths 
weight  of  my  limited  experience  to  the  recommendation  of  Dr.  Graeft^ 
with  very  great  pleasure  and  confidence.  It  is  an  operation  almost 
entirely  withont  risk,  and  perfectly  and  immediately  sncoestfnl. 


dAlUtlMl  ^hittnttt  snxA9tlttU0Uf. 


Prep«r«d  by  W.  B.  Flstcbu,  X.D.,  Indlwupolla. 


PRACTICAL    MEDICINE. 

1 .  Notes  on  three  Pereone  Struck  hy  Liffhtmny.  One  Death  :  l\to 
Recoveries. ^Bj  Damxl  Mackintosh,  M.D. — On  the  evening  of  Fri* 
day,  the  20ih  of  May  last,  I  was  summoned  to  go  with  all  apeed,  ss 
the  messenger  would  have  it,  "  to  see  a  number  of  persons  who  wars 
all  killed,  or  nearly  so,  by  a  stroke  of  lightning."  On  my  way  to  ths 
place  of  accident  I  could  already  see  a  crowd  of  people  near  to  a  hogs 
stack  of  straw  to  which  latter  my  atteution  was  attracted  by  the  &ct 
that  it  was  enveloped  in  flames.  One  person  after  another  told  ms 
that  a  man  ajid  two  boys  had  resorted  thitherwards  for  shelter  ;  that 
the  thrte  were  struck  by  the  electric  fluid  ;  that  the  same  flash  tkst 
struck  them  set  the  stack  on  fire  ;  and  that  a  laboring  man,  who  also 
^as  rnnning  for  shelter  to  the  same  resort,  seeing  the  stack  on  fire, 
and  finding  that  it  ignited  from  the  very  spot  where  his  fated  fellow- 
laborers  were  in  shelter,  naturally  enough  hastened  to  their  reseos, 
ind  succeeded  in  removing  them  to  a  proper  distance  from  the  devour- 
ing element.  Here  I  found  my  patients,  about  twenty  minutes  after 
the  occurrence,  to  make  my  own  deductions  and  conclusions. 

Case  I. —  Edward  W ,  aged  ten,  was  now  able  to  walk  about, 

although  he  had  twenty  minutes  previously  to  be  carried  from  the 
source  of  danger.  On  questioning  this  little  boy  as  to  what  he  had 
seen  and  felt,  he  told  me  that  he  saw  the  stack  take  fire,  and  that  he 
immediately  said  to  his  father,  who  sat  beside  him,  '^  Father  let  ns 
run,  the  stack  is  on  fire."  But  his  far  her  not  answering  him  he  tried 
to  move  away  himself,  but  found  he  could  not,  and  he  then  cried  out 
for  help.  (Thib  statement  was  corroborated  by  the  man  who  carried 
him  away.)  On  asking  him  why  he  could  not  run  away,  seeing  that 
he  was  able  to  speak,  his  reply  was,  '*  I  felt  too  dizy  all  over,  and 
my  legs  would  not  carry  me  "  He  pointed  to  the  lower  part  of  the 
abdomen,  and  Kaid,  '*  It  is  here  it  hurts  me  "  On  nndoini^  his  clothes, 
a  peculiar  &\i\pbv\TO'Siuged  odor  was  perceptible,  and  I  conld  at  oaos 
see  several  \vte^\i\at  W\.  ^\«>\aw^\.t^\  %\x^'\V.^  of  about  a  finger's  brsatli 
rnnning  obV\c\ne\'j  ^owtkwa.x^  axiWA^ixx^  ^\i  ^\^^\  %\5»k  ^1  Uie  chest 


1864.]  BdfUmal  AbMiraUi  and  S$Ueikmt.  759 

to  the  middle  line  in  front  of  the  abdomen,  whence,  being  met  thej 
descended  over  the  linea  alb*,  pnia,  and  scrotnm,  and  were  lost  on 
the  perineum  ;  penis  being  of  a  orightar  tinge  of  red  than  the  conrae 
of  streaks  throughout,  owing,  no  doubt,  to  the  higher  degree  of  vaa- 
enlarity  of  those  parts.  Neither  hair  nor  clothes  were  sinewed  ;  metallie 
buttons  presented  no  appearance  of  fusion.  He  rapidly  recovered, 
and  is  now  attending  to  his  usual  calling.  The  red  streaks  graduallj 
disappeare4>  ^^d  could  hardlj  be  traced  four  days  after  the  injury. 

Case  II. — Jeremiah  W-  ,  aged  eleven  years,  lay  prostrate  and 
unconRcious,  with  an  expression  of  grim  terror  and  suffering  ;  frothed 
at  the  mouth,  and  moaned  pitiously ;  flung  his  legs  and  arms  about 
in  all  directions,  and  the  by-standers  expected  every  moment  to  be 
his  last.  The  respiration  was  deep,  slow  and  laborious  ;  heart  palpa* 
fating ;  pulse  weak,  and  very  irregular ;  pupils  dilated  and  ini»ensible. 
Several  red  streaks  converged  from  the  neck  and  shoulders  to  the 
middle  of  the  sternum,  and  passed  down,  aa  in  the  former  case,  over 
the  lines  alba,  and  were  lost  on  the  pubes.  From  a  point  over  Uie 
tuber  ischii  on  either  hip,  narrow  streaks  emenated,  which  passed  tm 
m  few  inches,  like  rays  from  a  centre,  in  different  directions,  and  diM 
were  lost ;  the  resemblance  aa  tn  the  course  these  stellated  raya  ibl* 
lowed,  or  to  the  figure  they  formed  on  either  hip,  being  so  remarka- 
bly striking,  that  an  impression  of  strict  obedience  to  prevailing  law 
eould  not  help  forcing  itself  on  the  mind  of  the  observer.  In  connec- 
tion with  this  fact  it  may  be  stated  that  the  patient  was  in  the  fitting 
posture  when  struck.  The  hair  on  the  back  of  the  head  and  necs 
was  singed,  and  the  peculiar  singed  odor  above  alluded  to  was  emit- 
ted  from  all  parts  ;  metallic  buttons  showed  no  trace  of  fusion  ;  clothes 
were  neither  burnt  nor  torn.  Stimulants,  cold  to  the  head,  blistering 
ftt  the  nape  of  the  neck,  mustard  poultices  to  the  feet,  and  cathartic 
■ledicines,  formed  the  staple  part  of  the  treatment.  He  rapidly  re- 
covered,  became  conscious  in  five  hours,  is  now  at  work,  and  suffers 
from  no  symptom  of  nervous  disorder.  The  red  streaks  gradually 
faded  away,  leaving  behind  them,  where  the  skin  was  more  deeply 
burnt,  streaks  of  a  scaly,  glistening,  white  appearance,  *whioh  in 
their  turn  also  gradually  vanished,  leaving  behind  no  trace  of  their 
aziatance. 

Oasb  III. — Thomss  W ,  aged  forty-six  years,  (father  of  the 

boy  Edward  W ,)  was  struck  dead  on  the  spot ;  he  was  not  ob- 

aerved  to  have  moved  hand  or  foot.  JELe,  like  the  other  two,  waa  m 
tlie  sitting  posture  when  struck.  Th6  mpression  of  countenance  waa 
SMDsrkably  placid  ;  the  pupils  were  ilidely  dilated.  The  electric 
fluid  entered  at  the  junction  of  the  occipital  with  the  parietiU  l^ohea. 
Inflicting  a  large  lacerated  wound  on  the  scalp,  but  not  fracturing  the 
bonea  of  the  skull.  It  then  aeemingly  divided  into  two  currents,  which 
phased  respectively  downward  between  the  soft  parts  and  the  cran* 
inni  on  either  side  of  ttm  head.  That  on  the  left  side  passed  down* 
ward  anteriorly  to  the  loft  ear,  and  terminated  on  the  side  of  the  neck» 
ropturing  bloodvessels  and  soft  parts,  which  gave  rise  to  swelling  and 
aztravsation  of  bloo  that  closely  resembled,  and  might  easily  ha^% 
been  mistaken  for  an  extensive  bruise  produced  b^  Tn!W^i%.TAca\  Vvc^ 


700  Editorial  Abatracis  and  Selections,  [Decemb 

leucc.     The  right- side  current  passed  directly  downward  to  the  8D|ii 

clavicular  region,  leaving  the  ear  and  soft  parts  on  its  way  IWid  ai 

swollen,   and  terminated,  in  that  region,  in  a  dark-bine,  mangle 

)  looking  patch  of  skin,  in  which  thtire  were  several-  free  commnnu 

I  tions  with  the  surface.     The  hair  on  the  back  of  the  head  waaslighl 

singed,  that  in  front  of  the  chest  was  singed  quite  close  to  the  ski 

,  •  The  hair  which  covered  the  wound  at  the  vertex  of  the  skull  was  a 

injured.     Metallic  buttons  as  in  th»^  former  c-ases,  presented  no  i 

pearnnce  of  fusion,  and  the  clothes  were  neither  torn  or  bunit ;  bat 

connection  with  this  it  is  perhaps  right  to  state  that  they  were  drenc 

;  od  wi(h  rain.     The  hat  was  burnt  in  the  straw-stack,  and  con{!>equei 

ly  exc.'ipcd  examination.     The  left  side  pocket  contained  several  Im 

fer-inaiches  and  a  tin  tobacco-box  apparently  untouched.     The  rig 

side  pocket  contained  a  knife,  which  acquired  and  still  retains,  stroi 

mairnet  polarity.     The  bo'lv  was  carried   to  a  warm   room.     Slroi 

cad.jvcrie  rigility  came  on  fouru»on  hours  after  death.     Posit  morrc 

examinaiion  not  allowed. 

j  These  cases  are  important,  inasmuch  as  they  tend  to  cast  rays 

•  light,  howcvt  r  feeble  and  glimmering,  on  a  subject  as  yet  but  iiupi 

fectly  known  to  the  scientific  world,  and  in  affording  proof  posili 

of  the  fact  that  parties  betaking  themselves,  during  a  thundersiun 

to  such  supjio>ed  places  of  protection  are  actually  throwing  tha 

•   '  solves  in  the  w  y  of  danger.     An«l,  again,  they  are  interesting  ioi 

I  much  as  they  <eive  to  bring  afp^sh,  to  our  rocolleciion  the  various  i 

'  focts  and  degro^s  of  intonsily  which  this  subile  «agent.  may  play  in  i 

]>as<age   through  the  animal   frame.     The    reader   will   obeerve  t 
strong  teu<leucy  the  electric  current  had,  in  these  particular  cases, 
unite  and  then  run  alunir  the  centre  of  the  bodv,  and  will  aUo  noli 
that  the  general  characters  of  tearing  and  burning  of  clothes  and  fusi< 
of  metallic  substances  about  the  perNon  were  not  met  with. 

T  would  only  add,  in  conclusion,  that  in  Case  1  a  citato  of  conscioi 
reason,  and  judgm*Mii  exists,  together  with  tcmpomry  suspension 
the  powers  uf  voluntary  motion,  in  Case  ^1  the  shock  given  to  I 
economy  all  but  overwhelms  the  powers  of  life  ;  the  brains  ami 
functions  are  ([uicscent  ;  volition  and  sensation  aio  equally  lost ;  \ 
lungs  but  sluggishly  obey  the  call  made  upon  them  ;  the  heart  a^ 
last  to  stop,  continues  to  battle  for  life,  and  by  its  continued  ihou 
irregular  action  the  dormant  system  is  enabled  to  resume  its  I'm 
tions.  Had  the  shock  been  a  shade  more  intense,  the  overpowei 
whnle  would  have  succumbed  under  it ;  vital  action  must,  as  in  Ci 
8,  have  been  at  once  and  completely  arR»sted. — London  Lancet, 


PHARMACEUTIC  GRANULES  AN:D  DRAGEES, 

—  Srr.AH.COATHD   riLLfl  — 

QAHNli'  '..          ■■■'  -i-  ;.  ;.-;uX  &  CO. 

^ 

^n,-..f;r.-.v,l.-                                                                    ■    ■■:,   V.-,n,j„-  ,n.t  Ir  tl.v 

V 

1 

^^^^H 

1 

^pola  A>;.                         :>'a.                 P.  A.  UUOHABD; 

1