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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 



. . - 12* 




t»& 


. .193, 316, 379, 400, 480, M3 




194 




673 




S82, 492, 632 




623 




617 




311 




824 




622 




198 


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TIIHKE Mtl'AHl^:^ WCKT OT THE OlwD K-rA:<ltl. 



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New Central Office, - - - - Opened April, Ml 

B. FBANK FAIiUER, 



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B. FRANK. PALURR. 

Ha. 1009 CliP'Inui t^ti-r«t nill».1clr>lJ 



WILLIAM Z. REES, 

SiiucetKirM Ucf, .N. <:. Ji^ 1) N. OiiiiiJ>, 

TRUSS, BRACK AND BANDAGE INSTITUl 



«l>ll«ilVAl. AHB UKNTAI. IKSTUtrillKniTlt. AMTird 
L£UH, Aims, BAMDH, AMD NUKC«. 

jso. 71 w. SIXTH ST . auscnasAtx. OBIO. 



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. 



To VmtT. J. V. Ktrtlanh: 

IIaI it n«^! l»*cn for yntir nqiio't thnf f wmiM wri»o out in full tlio views 
►o f«Ter wliieh I «rtnit» tiinc lM»ri»re p.i»'lir»l!y rxi'l:iino«l lo yfi»i. it iiri;r!ii h:ivo 
ft LiDj? tiinot'Oliirc I ^hr»llKl iiivu IkkI tlir> forritmlo to publish to tlio wotlil, 
full, m su^j'.-c: which. l]io<]<!h very (Ksir to myself, ini^lit not Ih! received in 

eoriial rmnricr hv nifinv ro:ii|oi'*. Hut when n in in i^f vniir I'xifMisivp re- 

■ ■ ■ 

^rrb aD>l T'tii'lor couM m^k Utr my vii"W!«, nml, n!*!or r<Tiiliii«r the:ii, ciM!fc?*s 
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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, 
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£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, 

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TKriLLIAM Z. RBBS, 

TUUSS, BIUCE AND BANDAGE INSTITUf 



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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 
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*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 oec nir e d 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. 



A pologue . — ^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 s e em 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. 

B ur geon 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 Corr es pondenee. [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. 

** Dff Mpm t m 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 »gl M tat, 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 a npp of t sd 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 l u ip ei mitiMyi 
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 
it will be noticoil that the price of the Lancet and Observer is 82.00 a 
year if payment be made in advance or before the^r«/ of April, other- 
wise the price is 83.00. A veiy large list of our subscribers have 
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 

g w sttf 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 W u mm 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 Bicarbonate of '* . 8*0 

I of sulphur 1*6 Borate 600 

potassium 400 Carbonate of ammonia 20 g 

zinc 40 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 

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 o'clock, P.M. 

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 p rocoie 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 Ame