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MEDICO - CHIRURGICAL 
TRANSACTIONS, 



PUBUSHED BY THE 



MEDICAL AND CHIRURGICAL SOCIETY. 




VOLUME THE THIRD. 



PRIMTED POR LONGMAN, HURST, SEES, ORME, AND BROWH, 
■ PATERNOSTER-ROW. 



G. WooDPALL, Printer, Angel-court^ Skinner-ftreet, London» 



^D VERTISEMENT. 



The President and Councilj convinced 

of the advantages resulting from the early pub^ 
lication of the Papers with which the Medicai 
and Chirurgical Society may he favored, and 
which may be deemed worthy of being laid 6e- 
fore the Public, have lost no time in editing 
this Third Volume of the Society s Transactions. 
The utility of the pian of early pub/ication, 
receives an important conjirmation from the 
experience of the Royal Society, and some other 
Scientific Bodies in this country ; and though 
the President and Council by no means wish to 
pledge themselves to the precise periods at which 
future volumes may appear, (which must ne- 
cessarily depend on the number, as well as the 
import ance of Communications made to the So- 
ciety,) yet they have every reason to expect, 
that they will be able to publish a pari of a 
Volume, if not a whole one, at the end of every 

season. 
8 



IV 



ADVERTISEMENT. 



Communications are received hy the Fresi- 
dent^ or Secretaries; or may he transmitted 
through any other Member of the Society. 



Medicai and Cbirurgìcal Society's House, 
3, Lincoln's Inn Fields. 

Decanber Ist, 1812* 



MEMBERS 



OFTHB 



MEDICAL AND CHIRURGICAL SOCIETY, 



ELECTED SINCE NOV. 1811. 



Adam BLACK, M.D. Pkysidan to tlie Ckelsea IHspcnsdiy, 

Sloane Street, 
Henry C- Boìsragon, M.D. Cheltenham. 
John Cheyne, M.D. Duhlin. 
Thomas Copeland, Esq. Amstant Surgean to the Westmimter 

General DUpensary, Golden Square, 
Hinchman Crowfoot^ Esq. Beccles, Suffolk, 
Philip de Bruyn, Esq. 
John EUiolson^ M.D. Clapham. 
George Goldie, M.D. Loìver Brook Street. 
Bx>bert Gooch^ M.D. Physician to the Westminster I^ing'in Hos- 
pital, Aldermanbury» 
Alexander Copeland Hulchinson^ M.D. Surgeon to the Royal 

Naval Hospital at Deal, 
Thomas Mac Whirter, M.D. Fenchurch Street, 
Benjamin Fonsisca Outram^ M.D. Hanover Square, 
Joseph Skey, M.D. Physician to tlte Forces, Great Russell Street, 

Bloomsbury, 
Robert Smith^ Esq. Sloane Street. 
Henry Herbert Southey, M.D. 2ueen Anne Street West. 
John Matthew Tiemey, M.D. Brighthelmstone. 
William WooUcombe, M.D. Plymouth. 
Thomas Young, M.D. F.R. and L.S. Physician to St, Georges 

Hospital, Welbeck Street. 



VI 



MEMBERS OF THE SOCIETY. 



FOREIGN MEMBERS. 



John Frederick Blumenbacb> M. D. F. R. S. Professor of 

Medicine in the University of Goettingen, 
Monsr. J. N. Corvisart, First Phi/sician io their Imperiai Ma- 

jesties, Sfc» Paris, 
Monsr. George Cuvier, F.R.S. Perpetuai Secretar^ to the National 

Instztute of France, Prqfessor in the College of France, and in 

the Museum of Naturai History, S^c. 
Louis Odier, M. D. Professor of Medicine in the University of 

Geneva, 
Benjamin Rush> M.D. Professo^ of Medicine in the University qf 

Pennsylvania, Philadelphia, 
Antonio Scarpa, F.R.S. Prqfessor qf Anatotmfin the University of 

Paris. 
S. Th. Soemmerring, M.D. Prqfessor ofAnatomy. 
G. Vieussieux, M.D. Geneva, 



OFFICERS AND COUNCIL 



OF THE 



MEDICAL AND CHIRURGICAL SOCIETY, 



ELECTED IN MARCH, 1812. 



PRESIDENT. 

SIR HENRY HALFORD, BART. M.D. F.R.S. 

JOHN ABERNETHY, ESQ. F. R. S. 

C. R. AIKIN, ESQ. SEC. 

MATTHEW BAILLIE, M.D. F.R.S. 

THOMAS BATEMAN, M.D. F.L.S. 

GEORGE BIRKBECK, M.D. 

ROBERT BREE, M.D. F.R.S. VlCErPRES. 

THOMAS CHEVALIER, ESQ. F.L.S. VICE-PRES. 

HENRY CLINE, ESQ. F.R.S. 

ASTLEY COOPER, ESQ. F.R.S. JOINT-TREAS. 

JAMES CURRY, M.D. F. A. S. 

SIR WALTER FARQUHAR, BART. M.D. 

SIR EVERARD HOME, BART. F. R. S. VICE-PRES. 

ALEX. MARCET, M. D. F. R. S. SEC. FOR. CORRESP. 

JOHN PEARSON, ESQ. F.R.S. 

C. R. PEMBERTON, M. D. F. R. S. 

P. M. ROGET, M.D. SEC. 

WM. SAUNDERS, M.D. F.R.S. 

JOHN SIMS, M.D. F.L.^. VICE-PRES. 

STEPHEN WINl'HROP, M.D. 

JOHN YELLOLY, M.D. JOINT-TREAS# 



y 



CONTENTS. 



I. Facts and Obsarations respecting Intermitteni Fevers, 
and the exhalations which occasìon tbem. By Sir Gil- 
bert Blane, Bart M.D. F.R.S. Pliysician in Ordinary 
to the Prince Regent ..... é 1 

Appendix> containing remarks onthe Comparative Health 
and Population of England and Wales, at different 
periods ....•..» 34 

IL History of a remarkable case of Ovarian Dropsy. By 
Thomas Chévali^r, Esq. F.L.S. Surgeon Extraordinary 
to the Prince Regent, and Surgeon to the Westminster 
General Dispensary . . . . . .41 

III. A Case of difficult parturition, occasioned by a Drop- 
sical Ovarium forming a Tumor in the lower part of 
the Pelvis. By Samuel Merriman, M.D. Physician 
Accoucheur to the Middlesex Hospital, and the West- 
minster General Dispensary . . . . .41 

lY . A Case of diseased Testicle, accompaaied with disease 
of the Lungs and Brain, and terminatifig fatally. By 
Henry Earle, Esq. Communicated by William Law- 
rence, Esq. To which is added a Note by Mr. Law- 
rence, containing some particulars of the histories and 
dissections of four cases , • • . . .59 

V. Description of an ìmproved method of tying diseased 

Tonsils. By Thomas Chevalier, Esq., F.L.S. Surgeon 
Extraordinary to the Prince Regent, and Surgeon to 
the Westminster General Dispensary . . .80 

VI. Cases of Cynanche Laryngea. By J. R. Farre, M.D." 84 

VCL. ni» b 



X CONTENTS. 

VII. History of a case of Aneesthesìa. By John YcUoly, 

M.D. Pbysician to the London Hospital . . • 90 

Vili. Account of a case of spontaneous Extravasation with- 
in the Theca Vertebralis, which soon terminateci &tally. 
By Thomas Chevalier^ Esq. F.L.S. Surgeon Extraor* 
dinary to the Prince Regent, and Surgeon tothe West- 
minster Greneral Dispiensary . ... • lOf 

IX. Observations on Diabetes Insipidus. By John Bostock^ 
M.D. of Liverpoel . . . . . .10^ 

X. Cases of premature Labour artifìcially induced in Wo- 

men with distorted Pelvis; to which are subjoined 
some observations on this method of practice. By 
Samuel Merriman, M.D. Physifcian-Accoucheur to 
the Middlesex Hospital, aud to the Weslminster Ge- 
neral Dispensary . • • '• • . 12S 

XI. Experiments on the Bark of the Coccoloba Uvifera. 

By John Bostock, M.D. of Liverpool . . .146 

XII. A Case of Splcnitis, with further remarks on that dis- 
ease. By Robert Bree, M.D. F.R.S. . . .155 

XIII. Account of the Muscles ef the Ureters, an4 their 
efiècts in the irrìtable states of the Bladdér. By Charles 
Bell, Esq. F.R.S. Ed., Teacher of Anatomy in Great 
Windmill-street. Communicated by Dr. Curry . 17 J 

XIV. History of a case in which a Calculus was voided 
from a Tumor in the Groin. By T. Copeland, Esq. 
Assistant Surgeon to the Westminster General Dis^ 
pensary ....... . 191 

XV. General Views of the Composition of Animai Fluids, 
By J. Berzelius, M.D. Professor of Chemistry in the 
College of Medicine, at Stockholm. Communicated by 
Dr. Marcet . . , , , . . 198 

XVI. A Case of Fungus Haematodes. By George Lang- 
staff, Esq. Surgeon, New Basingball-street Commu- 
nicated by William Lawrence, Esq. • . . 277 



/ 



COKTENTS. Mi 

XVII. Hifitory of a severe afiection of the Organs of Re- 
i^iration; ^ith the appear^nces on dissection, and re- 
marks. By A, P. Wilson Philip, M.D. Physician to 
the Infirmary at Worcester. Communicaled by Dr. 
Baillie 290 

XyiII. An Account of a new mode of treatment in Cbro- 
Die Rh^umatism^ and especially in Sciatica. Commu- 
nicated by Alexander Marcet, M.D. F.R.S. one of 
the Physicians to Guy's Hospital • . .319 

KIX. Appendix to the Paper on Cynanche Laryngea, 
cpntaining remarks on the distinction between that dis- 
ease and Cynanche Trachealis. By J. R. Farre, M.D. 323 

X^. Some Remarks on the Use of Nitrat of Silver, for 
the detection of minute portìons of Arsenic. By Alex- v 
ander Marcet, M.D. F.R.S. one of the Physicians to 
Gu/s Hospital , . 342 

XXI. History of a case of remitting Ophthalmia, and its 
successful treatment by Opiam« By Jaities Curry, 
M.D. F.A.S. &c. and Senior Physician to CJuy's Hos- 
pital 348 

List of Donations to the Society . # . 373 

Index 375 

Kxpl^nation of the Platet • * .381 



FACTS AKD ÒBSERVÀTIONS 



kÈSPkcTiNG 



INTEHMITTENT FEVERS^ 



AlÌD tHB 



ÈXHALATIÒNS WHICH OCCASION TtlEM, 

> . . . •• » 
By Sia GILBERT BLANE, Bart. M.D. F. R. S. 

^HYSICÌaR IK OKDÌNaEY tO THÈ PRWCS B£6£Mt. 



Éead March Sd, 1812. 



dtlÀVlNG been sent by the ijòvernmerìt of thi^ 
fcountry oti a special missloil tu the Island of Wàl- 
cheren; in thè aùtumh of the yèar 1 809, iti order 
to ascertain the nature and cailses òf the great sick- 
fiess and raortaKty preVaiKng in the Brìtisti army ìri 
Zealand, and to maké à xeport of my enqiliries i 
having been also sent by the Admiralty to Northfleet> 
ili thè autónin of 181Ò, ivi order tò investigate the 
nature aild situation of that spot in pfoint òf Health; 
with a view tò décide, whethef any òbjection in 
pdìnt òf unhealthfùlnéss would Anse tò thè formation' 
òf a projected dock-yard, and other navàl establish^^ 
inènts at that place, some ob'servations havè occuì*- 
rèd td me' iii execùtiiig thèse dùtìes, which àppéared 

* V 

VOL. Ili» B 



/ 
2 FACTS ÀND OBSERVATIONS 

to me sufficìently interesting to be laid befbre thiB 
Society. 

During my residence in Walcheren, I not ònly 
vìsited ali the hospitals, but inspèeted, with the 
permi^slon of the Cominander ià Chief, the whol? 
retums of the anny from the tìme of their disem- 
barkation, in order to adcertain the progress and ex- 
tent of the sdckness and mortality. The result of 
these enquiries ìè what I now propose to commu- 
nicate, and, in describing the nature, and detailing^ 
th^ ravagesf of the prevailing disorder, I shall bor- 
row the greàter part of what I bave to say, from my 
i^eial Communications. 

I arrived in the island on the SOth of September, 
and remaìned till the isth of October fi>llowing. 
During my stay I sta,ted to the govemment, th^t I 
fpu^i/d so g^^at a, propiortipn of the aicJc to consiat of 
those ^e^ted with the int^i:witting and remittii]^ 
fey^^apeculiar to m^irshy countries^ th^t there could 
b^ nQ dp}|bt tfeat the sic^cness of the army was ow* 
in^ tQ th^t c^juse. 

Ite fever cómmonly call^d typhujs,* with which 
annidi; in ordiiuiry cìrcumstaincq& are chiefly aifect* 
eil, h94 bQen rare, and dyaent^ry, which, in, the his- 
tory of fprmer ca,mpaigns* in 1;he Low Countrìes^^ 

*See Sir J. Pringle's Workoa the diseaeesof the anny, in wbicb 
there is a moBi accurate histoiy òf the diseases piciv^Iing in the 
Britbh annies in Zealand and otber pqrt^ of the hq^ Coufitiies. 



pioved SQ severe a soourge to our armies in the at^ 
tumnal moQths» bad been as jet but little &lt 

# 

Both these dìseases, however, had begun to sheir 
themselves at flushing, libere the accommcMlatiDm 
were at best fìur interior to those at Middiebuxgb ; 
but were then stili more so, in conseqa^ice of most 
of the buildings hayiiig been injured hy the shot 
and shells thrown into the town during the wgt« 
In the large and elegant city of Middleburgh, the 
accommodations were excellent, as we had not oixly 
the advantage of the hospitals formerly belonging 
to the Dtttch and French troops^ but the spacious 
and aìry warehouses of the Dutch £art India Com*- 
pany : this having been formerly the great empo* 
lium of Indtan commerce. Here I fbund no ty^ 
phua oor dysetitery, but the prevalente of Ihese 
two diaeases was very remarkable at flushixig, par« 
tieularly in one r^ment, of which ali the m^cal 
officers were eith^ absent or dead, and df whidi the 
sickofiftinaUy aJSectedwith the endemie disease were 
Wflèt^d» ftom tn>K«.«.d iy^U^, in «»». 
queoce of the want of cleanliness aa well aa of propei 
medicines, diet and attendance. This &ct afforda a 
proof of the necessity of general hospitals onactual 
tervice, a3 well to prevent the generation and ex- 
t^asion Qf infectìon» as to afibrd relief to the regi* 
mental establishments^ when the sick and wounded. 
accumulate beyond their means of accommodation. 
Itis evidentin the presentinstance, how necessary 
this is even in stationary service; but with regard to 
^e ordinary service of a campaign, where armies 

B 2 



4 f ACTS AKD OBSERVAtlONS 

tf e in motion, and where regimental surgeons and 
their adsistants itiust be present with the regiments^ 
general hospitàls may be regàrded as absolutely in^* 
dispeiisable* Theré ought also to be a liberal e$* 
tàblishinént of mi^cal officers attached to such 
hospitàls in case of eniergencies of service, and to 
fili up such casual vacancies as maj occur in regi** 
ments. 

1 foundmyself under the painM necessity, there- 
fere, of stating, that the sickness on this island did 
not diminish. It appeared from the latest general 
weekly retutn, that therfe were two thirds of the 
whole numerai strength òf the army incapable of 
duty* • The . mortality durii^ the last fofur weeks 
had been about 1000. Ali the battalìons Teiere afi 
fected nearly.in ari equal degree ; and it.does not 
appear^ that tbeir illness was connected with tbe nu^ 
lureof tliéir duty, or that it was owing to priva-» 
tions or nèglect of any kind ; for those were equal-^ 
ly sickly, who had enjoyed the utmost ease and 
comfort in cantonments, as those who hàd been^nr 
gagefd in thè siege of Flusbing. 



■ i . 



Nor was this great sickiiess imputableto any thing 
unfavourable in the weather at tliis seasoii^in cofm^ 
parison of former years. On the contrary^ the native 
inhabitants affirmed^ that thèy w^ete then lesssicMy 
than usuai at the same season of the yeàt, and théy 
accounted for this, from the uncommoti quantity of 
rain that had fàll^n the last two months : for tlirty 



ON THE WALCHEKEN FEVEB» 5 

^onsider it as fully establìshed by observalìon, that 
the most sìckly years are those, in which there had 
been great dfought ajid beat in the latter end of 
summer and the early part of autumn j owing, prò- 
bably, to the increased exhalatìbji, and the more 
concentrated foulness of the stagnant W9.ter prò» 
duced by these causes» 

I found upon enquiry, that a like degree of sick* 
ness prevailed among the French troops who occu- 
pìed Hushing during thelast seven yéarsj and that 
in former times, the Dutch troops, froin the horth* 
era parts of the United Provinces, suffèred equally. 
As the army had not sufFered either from the scan- 
tiness and bad quahty of provisions, nor from 
want of proper accommodation, nor from hardships 
and fatìgue, it admits of no doubt, that the unfor- 
tunate state of the army bere, was solely imputable 
to the contaminatibn of the air from a soil the most 
productive of deleterious exhaJations of any perhaps 
in Europe, producing an endemie fever which has at 
ali times been particularly severe upon strangers 
in the autumnal months» I find also upon enquiry, 
that though this is by far the most sickly season, the 
residents of this and the neighbouring islands do 
not ehjpy, at any season, the same degree of health, 
as the inhabitapts of the more salubrious parts of 
Europe, 

From this statement, it -will be clearly perceived, 
hpw much the caiis^ of sickness were Qut of th^ 



9 FACTS AUfD OBSERVATIOKS 

reach of human cofatrol. There were two fects, 
however, which afforded some encouragement fot 
the employment of artificial means, in còunteract- 
ing the overpowering influence of naturai causes. 
One was, that thosè belonging to the upper ordèrs 
of society in Walcheren were always less affected 
with its endemie fevers than the poorer inhabitants: 
the other, that the British officers suffered less in 
this campaign, thah the private men, as will be seen 
by an abstract of the retums. As this latter must 
be owing to tome circumstances òf superìor accom- 
modation and diet, there was encouragement to 
attempi some improvement in these respects, 
though the situation of the common soldier was as 
comfortable as belongs to his condition^ With this 
view I suggested the use of stoves in the barracks 
as well as the hospitals, in order to promote the dry- 
ness, warmth, and purity of the air. I alsO repre- 
sented» that considerable beixefit might arise from 
the men being suppUed with a hot breakfast. It 
may likewise be remarked, that those who i^lept in 
the upper stories of houses, were less Uable to the 
disease, and had it in a milder form, than those who 
slept on the ground floors. The testimony of the 
natives ìi in tzvor of Ihis obsérvation. We had a 
striking confirmation of it in the visit we paid to 
the party aceommodated at Fort Rammekins. Tò 
the obsérvation of General Monnet (the French 
general who commanded during the siege) with 
respect to the gobd eflfect of a small quantity rf ar- 
dent spirita in the moming, I may add a recoìti- 



OS THE WALCHEEEN FEVUR. t 

mendation of mixing pepper fteely with the brMh 
and other articles of food. 

There were, in the beginning of October^ wheii 
I arrived, considerably more than one half of the 
army sick, or convalescent in hospitals.. This 
amóunt tras not owing merely to the numbers aceru- 
ing from those who were dailytakenillj butwas swell- 
ed ib consequehce of the small number of dis« 
charges^ and the numbers of convàlescents waiting 
for a passage to England ; for under the inflaence <^ 
theendemial air, recov^rieswere slow andimperfecti 
and relapses very frequenta not only among the fex^ 
who were discharged^ but among the convalescents 
at the hospital, some of whom, when apparently in 
a &ir way of doidg well, would unaccountably drop 
down dead* This made me urge the conveyance 
pf such subjects to England, with as little deky as 
possiblf • There were then 6000 subjects proper 
for beirig transported to Englànd ; and I recom- 
mended, in conjunction with Dr. Macgregor, th« 
superintendant of the militàry hospitals^ that line 
of batile ships, with their lower deck guns taken 
out, should be sent from England for this purpose, 
therè being at Walcheren only the means of con* 
veyance for lOOOmen. This measurewas render- 
ed fhrther nec&ssary, by the rapid accumulation of 
«ck in &e hospitals, some of which were already 
over-crowded, and, if liot rdieved, must in them- 
selvès bave pròved a source of additional sicknes» 
and ifiifection. 



\ 



9 FACTS A)n> OBSERVATIOKS 

One of the most important'circumstances in thoi 
pperation of nqarsh miasma on the human body 
is the power of habit in mitigating its influence. 
The natives are not a robuat peoplé ; they are pf a 
very wan and sickly hue, and bave ali suffered 
more or less firom the bad air which they breathe. 
The children of both s^xes ar§ very subject to glan-» 
dular and abdominal coipplaints ; andtheadults, par-^ 
ticularly thòse of the lower orders, haye ali of them, 
some time or other in the course pf their lives, la- 
boured under the endemie intermitt^nt, They 
are, however, infinitely less subject to intermittent 
fevers than strangers, It was curìpus to repfiark, in 
conversing with the natives, èven, persons of educai 
tion, and medicai practitioners, that they would not 
admit their country to be more uiihealthy than any 
other ; and when they were asked to account fon 
the great sickness prevailing among our troops^ 
they n^entìoned some frivolous circumstance in diet 
and habits of life, but would allow nothing. to be 
ascrìbedto the insalubrity of the air. However 
unfounded this prejudice may be, it is strongly ex^ 
pressive pf the great difference in point of bealth 
between natives and strangers. These strangersi 
are also yarìously affected according to thè diatrict 
from which they come. It wa» found, that of the^ 
Brìtish troops, the natives of inountainous cóun- 
tries, and dry scila, were more frequently 9.ffibcted 
than the natives of fiat and moist . districts. It ì% 
also well ascertained, that strangers, if they si^ryiye 
the first attacks, become thereafter mucb l^ lia-i 



\ie io the endemia intenpittaitSt Tliiswàs wiU 
proved and ijlustoted in a JVfewaire which wasdis* 
covered in the hou^e pf the French general 
Monnet ff 

It.was there recQxnmended that tsoops should' 
jiQt he frequeiitly cbanged ; for when it was the 
custoin tQ send hattaUons from Bergen op Zoom» 
pvery fourth night, in successione to work on the 
lines of Flushing, these men never failed, on their 
i^eturn, to he takeQ iU in great numbevs* General 
Mpnnet therefbre advised» however displeasingit 
ipight be to Officerà) that a stationary garrìson 
should be retained in Walcheren, in order that it 
jmght be habituated to the air, (^accUmatéJ and 
jjie instanced a French regiment, which sqifered in 
the second year of its being stationed there only pne 
half the i^ckn^ss and mprtality which it sqffered the^ 
first year, ftnd hardly sufiei:ed at ali the thixd, 
There were some, othér iihportant remarks in the^ 
Memoire^ auch as, that when it might be nece^sary 
tQ rdinfojce the garrispn, this should be^ done eaily 
in wipter, i^ or^^r that the men might be habi* 
tuat^d to the <?]iii}ate bpfoye the return of the sicWy; 
mpnths, which he reckoned to he June., July, Au-^ 
gust and September. He also recommended, that 
xjien who mount guard or who are employed in any 

• 

* General Monnet was an ^ible map. sind bad.commanded at 
Flushing durìng the whole seven years in which the French had 
possession of that place. We may therefore admit the authofity 
ff hi^ j^<]g?n^t and eicperienc^. 



10 FÀCI'S AND OBSÉUVAriOSB 

other duty exposihg them to còld Aàmp or fatiguè^ 
should bave a doublé ratìon of spirìts (genievre,) 
and that that tììere Bbould be an additional allow^ 
ance of this, and also of vinegar durìng the fiickly 
months. Another remark of this General was very 
conschtoTy to us at this time, naìnely^ that the 
eddest inhabitant did not remember a jear, in which 
this endemie had not diisappeared before the end of 
Octoben 

The e^pedition to Zedand satled from the Downt 
oii the 28th of Jtdy^ and made good their knding òn 
Walcheren, and North and South Béveland^ óil die 
31st of July and the ist of August. The only m^ 
litary operation of consequence was the siege <si 
Mushing, which wasinvested on the lst<^ August, 
and capitulated on the 15th of the sàttie month. In 
the beginning of Septembei*, the islands of North 
and South fieveland were evacuated, and that part 
of the army which occupied them, tetutned to Eng- 
land} about 1 9000 beìng lefi to garrison Walcherem 
More than one half pf these died^ or were sent to 
£nglaiìd4cmaccountof sicknessin the course of the 
three fdllowing months ; and the island was finally 
«yacuated on the 2drd of December of that year. 

The following Tàbles exhibit a view of the course 
of the sickness and mortality. I was enabled to 
bring them down to the end of the oampaign, the 
Conunander in Chief havìng obligìi^ly allowed me 
to extract ^m the retums deposited at the War 



Oir THE WALCBEREN FÈVElt. 



11 



Office, what was wanting in tìie notes which I had 
taken in Zealand. 

I am also enabled to state, on the authority óf Dr. 
Bancroft*^, and Mr« Keate the sitrgeon-gonetal, 
that the whole number of sick sent to hospitals in 
Zealand, betweeii the 2lst of Augnst and the 18th 
of November, 1809, amounted to 26846, ìncluding 
relapses, and that the nutnbel: of sick, including a 
small number of wounded conveyed from thence to 
England, between the 2lst of Auguet and the. I6th 
of December, amounted to 12868 ; and that many 
ìnstauces occurred in those who returned to Eng- 
land apparently in health, in whom the endemial 
disease of Zealand appeared after the slighifatigue 
g£ a march. - 

Account qfthe Sìchness and MortalHy of the Army^ 
in the Islands qf Zealand^ ah&tracted from the 
Monthìy Retums, 25th Augusta 1809, and the 
three subseqtcent Months. 

HEAD QUARTERS, FORT BATHZ, SOUTH BEVELAND. 



1 ■■ 



DATE 

ofthe 

Monthly 

Return* 



» Aug. 1809 



TOTAL. 



KanR and 
File and 

Illoii-Coin- 

missioiiecl 

Office». 



4164S 



Coiti- 

sìoned 
Qfficers. 



Ì879 



SICK. 



In 
Quar- 
te». 



988 



In 

pi- 
U1& 



I 



To- 
tal. 



17132701 



DIED. 



Rank an4 1 



File and 

Nou-Com- 

missioned 

Office». 



Offi. 



1 114 h 7 



* EBsay on the Yellow Fever, page 303. 

t in this number 100 who Were kiUed and died crf wòmida are 
induded, so that pnly 14 died of diseaae. 

% Of these one was killed ajs above^ and 6 died of wounds, so 
that none died of disease. 



It 



. FACTS AKD OBSBRVATIOK^ 



HEAD QUARTERS, MIDDLEBURGH, IN W41.CHEREN. 





TOTAL. 


SICK. 


DIE1]U 


DATI^ 

of the 
Monthly 

Retums. 

• 


Rank and 

File and 

Non-Com- 

missiofied 

Ofiìcers. 


Com- 

ims- 

sioned 

Officei:s. 


In 

Quar- 

teK9. 


In' 
Hd«. 
pi- 
tals. 


(al. 

8829 
5878 
1093 


Rank and 

File and 

N"on-Com- 

missioued 

OiBcers. 


cer^ 


25 Sep. 1809. 
25 Oct. 
25 Nov. 

• • 


' 16931 

11921 

6297 


723 ^ 

611 

452 


3829 
9845 
! 469 


5000 

3027 

624 


883 
760 
196 


29' 
9 
3. 



Accotmt of the Sickness and MortaUfy in the Isbmd 
of Wahhereny ahstracted from the Weeldy Re- 
tums^ dated the lOth Septemher^ and the Pwehe 
subsequent Weeks, 



DATE 

of the 
Weekly Return. 



Rank and File 

and 

Non-Commissioned 

Officers. 



Ofiìcers. 



Total. 



10 September 

17 

24 

1 October 

8 
16 

SI 

7 Novemher 
14 
21 
2d- 



17870 
17410 
16409 
16156 
15276 

13017 
U747 

8868 
7926 
6361 



Sìck 



6931 
8141 
8754 
9127 
8969 

7145 

9228 

3799 
1226 
1158 



Died. 



Total. 



221 

277 

287 

254 

217 

Return 

l28 

121 

Return 

40 

36 

30 



770 
765 

782 
748 
719 

or\islajd 
655 
292 

mislaid 
559 
543 
383 



Sick. 



No ret. 
235 
191 
172 
168 

113 

80 



Died. 



4 

7 

2 



' 1 



45 
47 
30 j 



V 



The first circumstance which strikes the eye on 
ìnspecting these Tables, is the smallness of the ixior- 
tality in the first month pf sex-vice. It not only 



01* *HE WALCHEREN ¥EVfiR. ÌÌ 

pròves, that seyeral weeks are necessary fot tbèse" 
deleterious exhalations tò act tipon the system, sd 
às to produce disease, but that the rate of this mor-» 
tality is so much less than in ordinary cifcumstances, 
as to stagger one's beliefl According to the state-< 
ment hei*e exhìbited, only 14 dìed of disease itì 
41462 iti a càlendàr moiith, and not one officerà 
I at first distrusted my owìi acéuracy in making the 
abstract ; but repeatéd exaniinatiòn convìnced me 
that I i;eas correct. I next distrusted theaccuracy 
of the returns, but the adjutant-genend assured me 
that tbete wàs not the smaUest reason to siisp^ct 
ali erron Àecording to the poptilation retums of 
1801, tibe smallest degree of moitality in any of 
the counties of England and Walesj was in Pam-» 
brokeishìre ; and was 1 in 76. The greatest mor- 
tality was in London ; and was 1 in 31. But it is 
not feir to compare the mortality of an army, with 
that of the general populatión; for the lattar in- 
cludes ali ages, sexes, and constitutions, whereas 
the former consists of the robust part of the male 
sex, in theprìme of life. The computation being 
Iliade ori the like clafes, it would appear, that there 
is a éotisiderably smaller rate of mortality than in 
people óf the saine age in England; for according 
to Simpsòn's tables, the mortality heré in men and 
womén from 20 to 45 is at the rate of one in 50 
tómmUy; but the annua! rate of it in this army, if 
computed by the mqnth ending the 26th of August, 
would be only 1 in 248. 



14 PACTS AKD OQ9$]tyAT{ON9 

Jìd^ low rate of piortgjity wiU appear in ^ ^tUl 
«Qore stiiking point of view, when compared wit;lii 
that of fleets and sunniefii elsQwher&; for at Coxheatl^ 
in the year 1779*, the aanual mortality was at the 
rate of l in 109 } aad durìng the time in whix^h I 
kept records of the fleet in the West ladies, the 
lowest in any moa^, ^^ ^ 782, was equal to au 
annual mortality of l in 72} a?id the actual annual 
mortality about that tìme in the army was 1 in 4, 
and in some partìcular sqpots moxe than one half* 

Was this «maU rate of mortabty in Zealand at 
this perìodi owìng to the superior health »nd 
stx«[^^ of those men who compose an army aboy^ 
the persons f^ both aexes, (m whom the oalcul^tiQn 
19 made in civil fiK>ciety ? Or is it owing. to ^^^ 
that in the heginmng of m ei:peditio]i fnen's nmu^ 
are in that elated state, &Qfa the sanguine hbpea q( 
vìctory and success, which is £ivorable to health ? 
I have remarked else^^^diere t» that in flèets, im- 
pressiona q{ this kind have a striking eflfect on ^ 
health €^ men. Probabty both the abovemf ntìoned 
^rcqmstances hsid a sharo in keeping down the 
mortality at this period* This howeyer was of 
short dmration; &^ it witt be seen by the Tàblk^ 
thiit the sick had begun to in^rease raptd^ «t ^h>a 
tìme ; and that bef<»re the lOth of Sk^ijbraiibcr, tli^ 
mortality had bg^pme veiy great< Ab there is wt 

* Sec Blane's Observatiotis oti the Diseases bf Seaitieti^ page 
170. Third Editìon. 
t Ibid. page 77. 



a«*count In th^iEte' T^l^» of the nmqben takeo ili 
in die intemiedkte times, nor of tbose diachMged 
rateai nor my «ccDpate statement of the numb^ 
sent to l&igkod ^qm lime to tinie» we hs^ve oo^ 
i(^e of the ^e^reai^Qg sicJcHeps, ^ the aes^son 
c^aiiged; e^cept th# weekly diniinutioii of the xmmr 
ber of e£fectiye lì^gn. Tl\|is it wiU iippear by a c^- 
cuLation made. on Table 2nd, that in the week be* 
tween the I7th and 84th of September, the ^eqt- 
ive force was re(l^ced iro|n 9269 tq 7655, so that 
1 in 5.7 that ìs^ about 2 in 1 1, had in that time be? 
^me unfit ^ duty. It wiU appear by a Ul^e cai* 
e^tion, thi^t oh the 2Srd of October, the effectiv^ 
force was reduK^ to 5872; and that in the ^oojsse 
of the succeeding week^ it w£^ rednced to 5519; 
80 that 353 had in thàt time become unfit for duty^ 
that is^ 1 in 1,094, or abont l in 1 1. By thìs role^ 
ihf^ stckneas waa diminished by one half in the 
pourse of a few weeks, making i^llowance for the 
greater nymber that wiU be taken ili at the b^n- 
ning of a camppjgn: for the most sua^^tible will 
tteceèmily fir^l faU ili. Nq i^ jiju]gment can be 
i^prra^d fto{Bi tiie retiiirns c^ Novanber, for reii^orce* 
flieQtSj of the iapount of M^ch X am uiiinfonned» 
lunived ^pm ]gi^l|ind in ^e (fonfitst^ o£ ibfL% month 
t^ jiMpfll HI the evacuation of tiiie i4w^ FrOTpi ali 
^ «ndiOlice however, l could pjrocnre» the number 
<^ seiiiiipes c<mti«aed to diminiah as the winter adir 
Vianeed» cQnfonnably to what we had bee» tpld bjr 
the nAtivea^ 

I 



1 6 • l?ACt § AND OdSl&RVAtìOK0 

Thè Island of Walcheren is 13 miles long frcftft 
(eatót to west, and 9 liiilés from riorth to south. Thè 
icapitól of this iftland and of ali Zeàlatid is Middle^- 
burgh^ ah opcé town in the èentre of the island^ 
but comnluftkating with the sea by a bròad ànd 
deep canal, ■ continqed from a fiatural ìistvigable in*- 
lét, leading to >RammèkeHs, od the south-east quàr^ 
ter of the islànd. Flushirfg on thfe smith side of 
the island is the principal sea-port and arsèriàl, and 
the only: place bf stretìgth. The wholè island, witK 
the exception of sòme hills, o? ràther moùnds of 
sand- on thè western shòrè, is- a dead flati belo^ 
the lèvel of the sea at high Aiirater and preservéd 
froith muifdàtión by dykes* The sóil corisists of a 
fine white sand known in the éàstern ctìUntiés of 
England by the name of silt, ànd aboùt a tìiif d 
part of clày. It is divided into smàll squàre indo^ 
àùres, by dìtches, which serve as drains ; ano thesé 
^erè about two thirds filli of tttrbid Water whèì^ I 
was theré; T?hey etóit no smeli, that I còuld peri 
ceive; but I was serisible of a bad smeli proceeding 
from some ponds òf stagnàting water. Thè séfl 
seéms' to be a mass of aUùvial mattér likè the deltas 
of g4?eat rivers ; ciiid the whole islands of Zeàland 
seeiti -tó bave' beétf fo^pnied'by the detritus càrried 
down by thè Rhinte and Schéldt, anfd fòrming atji 
cumùlfttioris fbr a long sèries of ages. Thefe is^k 
poisdn in the exh^lationi^fròm«ach soils, the nature 
of whith fe euftìrèly tttikndwn: ' Itis liòt animai 
putrefaction ; for it is perfectly well abcertained^ 
that those whq are exposed to putrid vapors, such 



OK THE WALGH£B£H F£V£R. 1 7 

as anatomists and tanners, are not affectedby com- 
plaints of this kind; nor indeed by any complaifìt^ 
unless these vapors are very concentrated; and the 
'disease in that case ìs not an intermittent fever. 
Water in a state of stagnation, without any ascer- 
tainable principio of contamination, seems to gene- 
rate these exhalations* It is oniy from the absence of 
stagnation, that we can account for the Delta of the 
Nile not producihg the same disease as Zeaiand. 
This is so far from bdng the case, that Low« 
Egypt is one of the most healthfiil couhtries/in the 
world, and is not infested with endemie intermit- 
tente. This remark did not escape the geographer * 
Strabo; aad he assigns as the cause that the stagna'* 
tion of the water was prevented by tìae anQual in* 
undation of the Nile. It appears also, from a work 
i£ I>r. Maogregor, that intènmttent fevers, tfaough 
not unknown, are not endemie in Egyptt. On the 
other faaad we know from the medicai histoiy of 
MÌBorcal:, that, though l^is island consists <A a 
rocky bottom, and very thin soil, yet in conse- 
quence of some stagnant wat^ in channels and 
poois, severe intermittente are very common. I 
need harJly mentiim, that the pkgue ìb no excep- 
tion, this being a disease depeading on humum éfflu* 

* Vid. Strabon. Geogi^iplt lib. 17, pa^e 1143, Amsterdam, 
1707. 

t Vid. Medicai Sketches of the Expedition to .^f pt SK)m In- 
dia, by James Macgregor, M. D., page 99 and 163. London 
1804. 

X Vid. Cleghom on the Diseases of Minorca. 

VOL. in. C . • 



1 8 FACTSt AKD 0B5£RVATtQNS 

via, and eiitirely unconnected with the nature of. 
the soil. 

An intelligent general officer on the expedition 
to Egypt in the year 1 800, who had served in ali 
climates, assured me,Nthat he had nowhere seen so 
little sìckness and mortality from disease ; for sick- 
iiess, even including the pisane, was less destruc- 
tive than in any other country in which he had 
served; so that there was here an exception to a 
rule which holds everywhere else, that disease is 
more fatai thau the sword ; for more were killed, 
or died by wounds, thaii by sickness, including even 
those who died (^ the plague. Nor can it be al- 
legedy that humidity alone may bave the efFect of 
producing intermittent fevera ; for the vapor of 
pure ftesh water, when not in a state of long stag- 
nation, is fmmd to be free from any bad efFectl upon 
the greater.number of constitutions. It is remark- 
able, that though much greater quantities of rain 
fall in the western parts of England thim the east- 
ern, the average in some counties of the former 
being more than doublé of what it is in those of the 
latter, yet it does not appear that health is in the 
least affected by this circumstance ; and seamen, 
even in the thickest fogs on the banks of Newfound- 
land, for many days together, preserve their health 
perfectly. This poison, therefore, is some principle, 
with the natxure of which We are stili unacquainted. 
Thére are also certain species of decayed organiq 
matter, the exhalatipns from which are not at ali 



ON THE WALCHEREN PEVER. 1 9 

productivé of agues nor any òther dkorder. I al- 
lude to bogs or peat mosses. This is fully proved 
in Scotland, but stili more in Ireland, where there 
are immense tracts of this soil, without any hurtful 
influence upon health. It might naturally be ex* 
pected also, that the swamps round Venice would 
be productivé of endemie fevers. This is not the 
case i and it is probably owing to the water which 
forms them, being sea-water. 

The miasmata in Zealand, are more noxious than 
the like exhalations in England; the intermittents 
fn the former, being more violent, untractable, and 
fatai, than those which occur in the fenny coun- 
ties, in the eastern parts of our own country. I 
estimate this violence, by. the high degree òf febrile 
beat and delirium, by the excessive secretion of 
bile, the want of distinct intermissions, and the 
more frequent sweUings of the li ver and spleen, 
these taking place in the course of a very few weeks, 
which in England seldom occur but under a long 
continuance, or from frequent relapses of the dis- 
case. 

The exhalations of the soil in tropical climates, 
extend farther, and are stili more malignant than 
those of Zealand. Ships at the distance of dOOO 
feet from swampy shores, (a distance to which it 
did not extend in Zealand,) and even farther, were 
affected by the noxious exhalations, according to 
my own obscrvations and those of others in the 

c2 



l 



20 FACTS AND OBSERVATIONS 

West Indies ; and ì have been credibly informed of 
the like fact, with regard to the India ships in the 
channel which leads to Calcutta, This greater den- 
sity and malignity of the exhalations, might natu- 
rally be expected from the greater intensity of at- 
mospheric beat- 

A medicai gentleman belonging to the army in 
St. Lucia, one of the Caribbee Islands, in the year 
1 781, at which time I was Physician to the fleet on 
that station, fkvored me with the foUowing state- 
ment, which throws considerable light on the sub- 
ject bere treated of. 

" Tlie Fevers in general are of the low kind ter- 

4 

*' minating in intermittents. 

" Unhealthy situations are the causes of many 
" diseases bere, particularly the worst sort of fever 
" and intennittents. 

*' One regiment, viz. the 90th on the Mome 
" Fortunée lost 271 men ; the 91st on the side of 
" the bill 318 j the 89tb in Grand Gul de Sac at the 
" the bottom 486, 

" The bill or morne is above the level of the sea 
" 872 feet/' 



ON THE WALCHEREN FEVBR. 



21 



ai 

X 
H 



O 

Q 
< 

Xfl 

;z; 

•-^ 

o 



•sq^Faa l«ìox 



^ co GO G^ GO OQ Oi.»i^ p-( P-i ^ -^ 

>o Go o> »o-*o p-i co o ^ 00 ;o '^ 



co 



•Jiois IBJOX 



, _ _ _ W >^ o •-« « 



f-< -^ o »^ Go co 

^OCOOìOVCOOCO-^WC^tW©* 






•sq^Baa itm^uoiY 



COqC»OCf>0*<OiQ^(J>OCNCa 



•JI^IS jo Jaquin^ 



CO'?t<Qp^>OQOOiOC>OQGCO< 

SS 



G*5GÒ03;00^*ÒCO^GO 



*8asedsi0; Sai|icAaj j 



X . . . . 

3 O O O O 






co 

13 

OD 

o 






'i(sdoj(x 



;poo»ft(«0(yKyi'-<©<»-»-H 



•saxnjj 



eo co Oi t^ '-^ 

i-< ^ 00 0* ;o 
GO -* »o ^ o< 



5^ ^J4 ^^ ^J< ^rt4 ©5 ^N 
O) r-H CO O O O) Ì> 
1-^ (X 1-^ 1-^ f^ • 



*8«)nSv 



co co "^ e?* «^ 
iO ^ Q) O CO 



GO CO O O ^ O 00 

00 co t> t> co X co 



"SiaAdj 



•sqiBaa^-^iq^aopl 



^ aC a^ t^ 

co co O (>J 



O J> O i-H t^ t^ 01 

j> 00 co »o -^ t«- t» 



G0QCQD©i-4C0'^^O*'— •CM*'^ 
'^C0C0«*^O«^i>»^C0'^W'-« 



"VIS P iaqoTOK 



Oi-«0'^»'500GOO«-<OCOCO 



-S9SB3SIQ S01llBA9Jd 



l^l^à^^^^^ 



OR 
g 



•ifadcicr 



»C'^»-<aoo»0'^o«f-iGOGoo 



•88X11 li 



COG0»-<G0Cpl>'^O^Qj>OiW 
00'^»OOOOOt>CO'^COCO'rt«W 



•sanSy 



"^O>00OlOlOiaD00Q0pG5|p-j 



*&iaA8jl 



oi>cyi-'^G0i>»O'-<^-<'^'^0** 

tfs »ft -^ co GO Ol W G^ «H 1— I I— I 



•-'^^na So^'-HOOO>GOOXrHW2S^ 

joi nosiJUBO ni ua^ t-OOOXQOQOQOOi^SS 

•' P**l P^^ ^^^ ^^^ 



*sq^nopi ;ii8Jd0!P ^MX 






--^ 



«-• "O .o 






ce 



§ 

O) 



I 
I 
I 

3 

S 

III 



a; 



a; 



GO 



I 
I 
I 

3 

a 

«e 

O 



s 

.3 






»^t*G^O^G«JG0i-HCO 

o^GOi-iaoooooOQO 

0, p^ ^ ^ ,-, p^ ^ ^ 



% 



^<y> 



»ft »o 



«':^ 



•8 

e 

• 1-4 

Q 
••— » 

a 






e 

• •■4 

o 

a 
S 

US 



22 FACTS AND OBSERVÀTIONS 

It is evident that the severi ty of the symptoms, 
in the Zealand fever, added greatly to the difficul- 
ty of the cure ; and there could be no ópportunity 
of eitìploying Peruvian Bark or other specifìc reme- 
dies, till its violence had abated, and the redundant 
bile had been carried off. The treatment of this 
acute state, consisted chiefly in giving such reme- 
dies as purged freely; and in selecting them, the 
preferencewas due to those which acted most readily 
on the liver and the bile, such as calomel ; those 
which wére least heating, as the neutral salts; and 
such as were best borne by the stomach, which, in 
a great many cases, was extremely irritable. In the 
course of the general inspection, in which my duty 
consisted at this time, I had not myself an óppor- 
tunity of directing and wat^hing the practical de- 
tails of individuai cases ; but I had considerable 
experience in this way, in my atten dance on offi- 
cers in England, wha either brought the complaint 
with them, or were seized on the passage, or after 
their return to this country. • 

One of the medicai controversies respecting the 
cause of intermittents, is founded on the difference 
of opinion on the question, how far the excess of 
bile may be considered as the cause of them. It 
certainly cannot, in correct language, be called the 
cause ; otherwise every case of redundant bile, such 
as the cholera morbiùSj would be attended or fol- 
lowed by an ague.^ Certain it is, however, that 
epidemie intermittents not only occur exckisively 



ON the" WAECHERENT FSySB* 23 

in those seascms in which an excessivè-.secrelion of 
bile is most apt to arise, but every attack, whether 
originai or relapsed, which I bave secn, bore evi- 
dent marks of an excessive flow of this humor. The 
true statement of the fact perhaps is, that-that state 
of the body, in which there is the strongest ten- 
dency to a copious secretion of bile, either from 
the naturai constitution, or the season of the year, 
constitutes a predisposition favourable to the action 
of the poisonous exhalations*. There seems in this 
sondething analogous to other facts mentioned in à 
fbrmer paper respecting the Piagne and the Yellow 
Fever, namely, that the human body is not liable 
to be affected by them^ unless when predispòsed by 
a certain temperature of the atmosphere. If the 
attack of this disease depended merely on theqtian- 
tity of the exhalations, they would be most frequent 
in June and July, when the beat of the atmosphere 
is bighest But th^re is a stili more decisive proof 
of its depending.on that season, in which the secre- 
tion of bile is most copious, from this fact, that 
when those who bave imbibed the poison, are 
transported into countries where the air isin a state 
of greatest purity , it is in the autumnal months, that 
they are most conmionly attacked. There was" a 
very striking proof of this after the campaign of 
North HoUand in 1779. In the follo wing year some 
of the officers and men who had escaped the disease, 
were taken ili in the autumnal months; and none 
that I heard of, at any other season of the year. 



24 FACTS AKD OB^BltVATiaKS 

é 

The greateat difficulties which occurred in the 
cure òf thpse severe intermittents in their early 
stageSy proceeded firom the great irritability of 
^totnach, which rendered it very difficult to exhibit 
either purgatives with a view to procure intermis- 
sions, or bark in sufficient quantity after intermis- 
sions had been procured. The best means, I found, 
of obviating the first difficulty , was to purge with 
ealomely which, besides the advantage ahready men- 
tioned, is^ on account of its small bulk, swallowed 
without repugnance, and, by its weight, is not 
easily rejected after being swallowed; and in case 
the^ stomach rejetted neutral salts, to assist its ope- 
f aition by consideràble quantities of carbonated mag- 
nesia given in effervescence with lemon juice. It 
* , is sometìmes advisable to give mercury às an alter*- 
ative« Ramazim * relates^ that a person affect^ 
with aii obstinate ague wàs oired by mercurìal fric* 
tion administered for the lues venerea* The second 
difficulty was obyiated by substituting opium and 
àrsénic for bark. The stomachs of some patients 
were reconciled to the bark, by administering it with 
opiùm or magnesia ili effervescence, or both; to 
òthers it was so insùperably offensive, that it couid 
not be bome in any form, quantity, or eombination. 
In these cases, the cure was effected by opium and 
arsenic, along with such bitters and aromatics, as 
the stomach would bear, Where the periodica! 
paroxysms had not ceased, the tincture of opium 
was given from 30 to 50 drops, in the iatermission^ , 

* De morbis artifìcum. 



pN THE WALCHBIiJ&N FEVEE. S5 

a few hours before ih^ expected hour of seizure, 
accompanìe^ with as mueh liiubarb as would coun- 
teract its restringent effects. Sometimes the first 
administration of thìs stopped the paroxysm ^ bui 
more commonly only s^Ueviftted it, apd did not stop 
it till the second or third time. After the p^rpx* 
ysms were rtopped, it was continued in ^mailer dose^ 
ai the former perio^ds ; andeltber bark, or, if the 
stomach would not bear it, arsenici was given in 
the intervals, till it might r^asonably be supposed 
that the tendency to relapse had ceased. At this 
perìod, carbopate of iron wa^ also given with 9afety 
and advantage, and with stili more benefit at a more 
adyanced period, in prder to obviate debility ànd 
emaciatiòn, and to afibrd a stili greater sectirity 
against relapse, when there were no remains of fé? 
ver, nor suspicion of loc$l affection. I bave cured 
intermittent fevers in which bark had &iled both in 
the West Indiest, and in St. Thomas's Hospital, 
with the oxide of zinc ; but I bave made little use 
of Uiis remedy sìnce I became acquainte^ with the 
superior powers of opium and arsenic. 

The duratloQ of this tendency to relapse, wm 
yery indefinite. There is a ^ubtle, incomprehensit 
ble impression made on the liying human body by 
marshy exhalations, which, IlìQugh àttended with no 

* The dose was from six to twelve drops of the liquor arseni- 
calis of the London Pharmacopoeia, three times a day. 

t Sec Observations on the Diseases of Seamen^page 443. Third 
Edition. 



26 FACTS AND ÓBSBRVATIOKS 



immediate visible effect, so modify the constìtution, 
that tnany montbs afterwardsj though the persoti 
has been living ali the while in a pure air, an in- 
termittent fever arises sometimes, without any vi- 
sible exciting cause; but most frequently in conse- 
quence of cold, fatigue, watching, privatìon of 
some kind, or, as has been before mentioned, on 
the return of the autunm. This, as has been ai- 
ready remarked, was strik^ngly exemplifìed in the 
troops who had servèd in the campaign in North 
Holland in September and October, 1 799. Among 
these, was an officer who carne to town to put him- 
self under my care, in the month of August in the 
following year. He belonged to an encampment 
at Swinly near Windsor, a district not liable to such 
complaints; and he informed me, that not only 
himsclf, but others who had not been- affected in 
Holland, had been seized with intermittents, and 
that this disorder was confined to those who had 
been in the abovementioned campaign. I was in- 
formed in February, 1811, by a field officer, who 
came home from Portugal on account of bad health, 
that those men of his own regiment as well as of 
others, who had served before in Walcheren, were, 
upon the first exposure and fatigue, rendered unfit 
for duty, chiefly by remittent fevers, so as tó leave 
not more than a third part of them fit for service. 
Here there was a propòrtion of sick, far abòve that 
of the army^ in general. This tendency is stili 
strOnger, if the person had actually suffered from 
immediate exposure to these exhalations; a consi* 



ON TOB WAXCHEREN FEVER. 27 

deration which dbvìously suggests the necessity of 
continuìng.the remedies for a considerable time af- 
ter ali the symptmns of the complaint have subsi- 
ded, and also of avoiding the exciting causes above 
enumerated. ... 

% 

I had, in the course of this service, an opportu- 
nity of observing the extent to which the noxious 
exhalatìons extended, . which » was found to be less 
than is, I believe, generally known. Not only the 
crews of the ships in the road of Blushing were en- 
tìrely free from this endemie ; but also the guard- 
ships which were stationed in the nan'ow channel 
between this island and Beveland. The width of 
this channel is about 6CXX) feetj yet, though some 
of the ships lay «much nearer to one shore, than to 
the other, there was no instance of any of the men 
or officers being taken ili with the same disorder, 
as that with which the troops on shore were af- 
fected* 

I had an opportunity of farther proving and il- 
lustrating this ohservation, in the service I was 
sentHipon to Northfleet in the autumn òf the fol- 
lowing year. The spot upon which it i^ intended 
to erect the proposed dock-yard and arsenal, is a 
marsh of about 700 acres. On the banks of the 
river, both above and below it, there is soil of a 
similar description, but not immediately adjoining 
to it on either side ; for above is the village of 
Green Hithe, which stands on a chalky bottom, 



28 FACTS AND OBSBR^yATIONS 

rising to a few ìnches below the surface, and 
ìs a projecting point of the general chalky hills 
which compose the adjacent country, Below it, 
on the bank of the rìver, there. is a similar inter- 
vetition of the chalk, where the village of North- 
fleet stands. Both these are nearly on a level with 
the marsh ; yet the intermittent fevets are almost 
unknown at either of them, whereas they are ex- 
tremely prevaleti^t on the adjacent hiUs. I found 
this fact analogous to some others to which my en- 
quìries at this time led me. Dr. Maton infonned 
me, that in the neighbourhood of Weymouth, 
though there is stagndting water near the sea> pro- 
ducing intermittents, these disorders are not known 
in the dry districts on each side, on a level with 
the water, but prevail on the adjacent hills. A 
Cornish gentleman stated to me, that at St. Bla- 
zey, between St. Ausile and Lestwithiel, agues 
prevail much on a hill adjoining to a marsh conti- 
guous to the sea beach. And Major Rennel, the 
celebrated geographer, says, that in a district which 
he surveyed on the river Burrampooter, the waters 
pf which overflow, and, upon retiring, leave an oozy 
fiat, the agues prevail to the very summit of the 
adjoining hills. Lancisi mentions a hiU, on which 
the same sickness prevails, as in the marshy lands 
at the foot of it"^. An instance of the same fact in 
ìSt. Lucia, has been already mentioned. 



* Vid. Lancisi de Noxiis Paludum Effluviis, page 120, Roma 
1717. 



It is known to éveiy one, évei^ so little acquaìnt-^ 
ed with the operations of nature, aind indeed the 
conimon pheiiometià oP clouds and rain render it 
obvious to the inost ordihary observer, that water, 
recently exhaled from the surface of the earth, has 
a Ttendency to ascend, and being lifted over parts 
on thfe same ievel, impinges on the neighbouring 
heights, TTiere is reason to believe that impure 
and unwholesome particies in general are attracted 
by watery vapors, for it is remarkable, that, in case 
of fogs, oflfensive smells are perceived, which in a 
dry state of the air were fixed and quiescent. 
Though pure humidity, theiefore, is innocuòus, it 
may prove pemicious as a vehicle of unwholesome 
volatile matter. In like manner, ihe poiisonou 
principle of marshes, whatever it is, being engen- 
dered by moist soils, will naturally adhere to the 
watèry vapors, and ascend with fhem. 

There are facts to prove, that certaan artificial 
cfaanges tend greatly to improve the air of particu- 
lar spots. It is well ascertained^ by the records of 
physic, by the bills of mortality, and by civil* his- 
tory, that intermittent fevers were very prevalent 
in London, before the formation of common sewers 
and the adoption of other means, such as paving, 
conducive to cleanliness and dryness, to which, 
more perhaps than to the improved habits of lifè, 
in poìnt of diet, may be ascribed the unexampled 

* Kling James the First, and Oliver Cromwell, both died of agiie& 

Qontracted in London. 

/ 



90 FACTS AND OBSERVATIONS 

State of health in this great metropolis. There is 
a stili stronger proof and illustration of this in 
Portsmouth, which is buìlt upon a fiat, composing 
part of the marshy island of Portsea. I am assiìred 
by a medicai gentleman who practised there, but 
is now retired from practice, that when he first 
knevz that place, intermittent fevers were very pre- 
valent; but the town having been drained and paved 
in the year 1769, that disorder has since been un- 
known there*. Hilsea and other parts of the Island 
of Portsea bave retained the same aguish character j 
but this dìsease has greatly decreased there also, 
since a drainage which was madé in the year 1 79S, 
Numberless other examples might be addUeed in 
proof of this, derived from the general improved 
state of health in various parts of the kingdom, in 
consequence of the inclosure of commons for the 
purpose of. agricultural improvements, of which 
draining is (me of the prìncipal. This has been felt 
on the spot now in question, for I am assured by 
the Rev. Mn Crackhilt, who has resided in the pa- 
rish of Northfleet for 42 years, that there has been 

" , * » • • • • • - 

* It appears from the late Parliamentary Report, that Ports- 
mouth has had an accessìon to its population, during the last ten 
years^ of 8401 inhahitants; that the healthfuhiess of it has en- 
creased^ thè proportion of deaths in 1800 having heen oue in 98 ; 
in 1810^ one in 35 ; hoth computations'beingtakenon an average 
of three years. Plymouth in the same time has acquiredan addi- 
tional population of 12^866, and the mortality has varied but 
little, having been one in 27 in 1800, and not quìte one in 28 in 
1810. TTie population of Portsmouth, by the last Report, was 
40,567 ; that of Plymouth, 56,060. 



> 



/ 



ON THE WALCHEREN FEVER. SI 

in that time a progressiva amelìoration in point of 
health. 

It is mentioned by Bishop Burnet, in his History 
of the Reformation, that in the last year of Queen 
Mary's reign, " Intermitting fevers were so univer- 
sal and contagioùs, that they raged like a piagne;*' 
and we learn from Sydenham and Morton, that in- 
termittent fever was one of the most prevalent and 
fatai disorders in London from 1661 till 1665, and 
that for some years afterwards this cofnplaint was 
very rare. This was probably owing to the grea^ter 
dryness of the streets by draining, when the city 
was rebuilt after the great fire of 1666. We are 
told however by Sydenham, that intermittent fevers 
revived before the end of that century, and were 
epidemie from 1677 to 1685. They prevailed a 
good deal during the first part of the 18th century j 
and we learn from a work of Dr. Fothergill's, that 
they occiured as an annual epidemie in the spring 
and autumn, as late as the years 1751, 1753 and 
1754. For more than 30 years past, according to 
my own observation and the best ìnformation I can 
gather firom others, this disease has not been known 
as an epidemie in this metropolis. I was physician 
to St. Thomas's Hospital, from the year 1783 till 
1795, during which period, the whole number of 
intermittents that fell under my care, was 192. As 
there were three physicians, this may be reckoned 
the third part of the whole admiss^ons for twelve 
years in an hospital eontaining 400 patients. I 



32 f ACTS AND OBSERVATIONS 

bave aot noted in my journal, from what quarter 
they carne; but my memory perfectìy warrants me 
in aifirming, that the great majority of them were 
labourers from marshy districts, particularly Kent 
and Essex, and there is this internai proof of the 
greater part being strangers, that, of the number 
above specified, only SS were females. Had they 
belonged to the resident popuWion, the num- 
ber of each sex would bave been nearly equal. On 
referring to the notes, which I keep of my private 
practice, I find that in the course of 25 years, I 
bave met with 63 intermittents. Of these, 1 2 be- 
longed to the armies, that had served in Holland 
or Zealand, and of the number affected in Eng- 
land, more than one half came from the aguish 
counties. Several of the cases of those who be- 
longed to the resident population, were so slight 
and irregular, as to render it doubtfìd whether they 
werfe strictly referable to this gemcs of disease. 

One of the objects prescribed to me on my visit 
to Northfleet, was to ascertain how far the health 
of that spot might be affected by the exiialaticms 
from the Essex side of the river. What has been 
already said on the subject relating to Zealand, af. 
fords an ahswer to this question ; the width of the 
chànnel between Walcheren and Beveland being 
about sìx thousand feet, and the breadth of the 
ri vèr at Northfleet, aecording to a pian in the pos- 
session of Mr. Rennie the engineer, being three 
thousand feet. The distance of Essex from the 

6 



ON THE WALCHEREN FEVER. SS 

bank of the river at Northfleet, is therefore about 
the same as between the shipa riding in the middle 
of the channel, between the shores of Walchereft 
and Beveliind. I found, however, from the most 
accurate enquiry, that the endemie fever had not 
spread, either to the ships of war in the roads of 
Flushing, or to those stationed between the islands, 
though some of th^m were nearer the shore than 
the middle pf the channeK 

I was further informed by Mr, Rennie, that iq 
borìng the ground at Northfleet, he found tliat 
there were beds of chalk and gravel undemeath th^ 
clay, so that these materìals, when thro\m up in 
makìng thp e^f^cavatìons, would render the surfaCe 
dry and wholesome ; and that he had calculate4 
their quantity would be such^ as to raise the arti-» 
ficial suiface eighteen feet high^r than. the present 
naturai s^rfacQ, 

.Taking into consideration, therefore, the great 
changes which would take p]ace in the marshy spot 
on which it was proposed to erect the docks and ar.» 
senals, in consequence of the excavations, thQ 
draìnings, the pavings, buildings. and various other 
operatipns for forges and other machinery, I gave 
it as my opinion, that no solid objection, on the 
3Core of health, would arise to the pian proposed,. 



VOI*, in. D APPENDIX 



APPENDIX 



CONTAI NING 



Remarhs on the comparative Healtìi amd Pepuhtìck 
qf England and Wales ^ at dij^rent periods. 



SiNCE the preceding article was submitted tp tìie 
Society, the Speaker of the House of Gommons 
has done the author the honor of sendìng him a 
copy of the retums of the population and parìsh 
registers, made in pursuance of an Act of Fadia- 
ment past last year. From these, some interesting 
ànd authentic information may be gathered respect- 
ing the public health, particularly with regard to 
the disease, which is the sufojectc^ this article. 

It appears from these retums, that the mortalitgr 
in England and Wales in the year 1810, was ab<mt 
1 in 49, the whole population being 10,150,615, 
and the number of burials 208,184, that the births 
were in the proportion of 1 in 34, and iJiat every 

10 marriages produced on an average 42 childre©. 

■• • • 

The counties in which the mortaKty was abov« 
the average, were Middlesex, where it was 1 in »6; 
Kent, where it wias 1 in 41 ; Warwickshire, ^er« 
it was 1 in 42 ; Cambridgeshire, where it was 1 in 
44;' Essex, where it was also 1 in 44; Surrey, 
where it was one in 45 ; the East Riding of York* 
shire, where it was 1 in 47 ; Lancashire, where it 



ENOLAHD ÀKP WALES. 35 

was 1 in 48. 0£ the^e eight counties, four are sub*- 
ject io ague99 namely^ Kient, fissex, Caaibrìdge- 
shire) aiu} the £ast Bidiog of Yorkshire, comprìs- 
iiig aU the counties of that descrìption, except Lin- 
colnshire, in which the mortality is below the aver^ 
age, being 1 in 51. The ^mailer degree of lior* 
tality ii9i tìm last, is no doubt owing to the great 
proportion^ which the dry and upland part of it 
J>ears to the fenny districts. That there is a great 
diflEerence in the mortality in these, is proved by 
their respective return». Hie mortality in the 
town of Boston, for instapce, which is situated in 
the fens, is l in 97 } whereas that of Stamford, 
which is in the diy and upland division, is l in 50. 

And bere it may be proper to advert to an observ- 
ation grounded on a very satisfactory induction of 
&^ts, in a tract lately published, of which Dr. 
Wells is the authpr*, thàt Hithisis Pulmonalis is 
but little known in those districts which are infesta 
ed with the exhalations producing intermittent fe*- 
yer$. But as Phtbisis Pulmonalis forms one of the 
principal heads in the general mortality of England, 
so n)ucb the more is to be imputed to intermittents, 
in those districts in which they are endemie. 

It may be asked, whence arises the greater mor. 
tality of the other fibur counties, of which tlie rate is 

. * This tract k an article in Third Voi. of a work entitled, 
Transactions of a Society for the improveraent of Medicai a^wL 
Cbirurgrical Knowk(]j;e. London 1813. 

P 2 



^6 l»OPULATION OP 

above the average. With regard to Middlesex, it fe 
imputable no doubt to the varioùs circumstances ad- 
verse tohealth, peculiar tothe metropoli», such as 
the more intemperate habits of life, and perhaps 
stili more the unfàvorable influence^ of the air of 
thÉ great city, particularly on young childi-en. It 
is worthy of remark, howevèr, that London has of 
late years been improving in salubrity ; for it ap- 
pears by the bills of mortality , that the burials in- 
variably and considerably exceeded the christen- 
ings, till a few years before thè dose of thè last 
century : whereas since that time the christenings 
bave generally exceeded the burials. This may 
in part be ascribed to vaccination ; but it cannot 
be entirely owing to this cause, for the decrease of 
burials took place some years before that admirable 
discovery. The first year on the records of the bills 
of mortality, in which the births exceeded the bu- 
mls in this metropolis was 1790. The decrease in 
the deaihs of cliildren under two years of age, is 
the most striking point of difference in these 
tablep. In the beginning and middle of last cen- 
tury, their annual amount fluctuated from nine to 
ten thousand. Towards the end of last century, 
and duringthat partof the present which has elapsed, 
théy bave fluctuated from five to six thousand: and 
considering that the computed riumber of inhabit- 
antsiu 1700, was only 674,350, and in 1810, by 
the late enumeration it is 1,050,000: it is evid^nt 
that the relative mortality in this class, is little 
more than one third of what it was a hundredyear^ 



ENGLAND AND WALES. 8t 

ago. In farther probf of tìie improving health of 
London, it is. stateci in this Parliamentary Report, 
that the annual mortality in 1700, was one in 25 ; 
in 1750, one in 21 ; in 1«01, and the four prece- 
ding years, one in 35} and in 1810, one in 38. 
The increased mortality in the middle of last (!%n- 
tury, has been imputed to the great abuse of spi- 
rìtuous liquors, which was checked about that time 
by the imposition of high duties. The other causes 
of superior health, seem to consist in ageneì^al im- 
provement in the habits of life, particularly with 
regard to ventilation and cleanliness, greater abun- 
dance and better quali ty of food, the improved 
state pf medicine, ^nd thp better management of 
children» 

The high proportion of mortality in Surrey, is 
no doubt owing to its containing a portion of the 
metropolis consisting of a population of 170,000, 
which is more than one-half of the whole county. 

The high rate of mortality in Warwickshire, 
si^ems at first sight the most difficult to be ac- 
counted for, the air of this part of the kingdom 
I^eing very salubrious. It is no doubt owing to 
the town of Birmingham being situated bere, for 
it comprises two-fifths of the population ; and the 
qiortality on the average of the last ten years, i& 
one in 34. The mortality in this town is greater 
than in Manchester, Leeds, or Norwich, the ope- 



tatiótiÈ iti metaU, being probaMy mòte pemicioitar 
to health, than the operatians of weavi^g^. 

With regard to Lancashite,- where thè mdrtality 
ìs Somewhat above the average, the nitmber of large 
towns and extensive maniifkctures, affording a 
greater proportion of artisans, to niral inhabitants,^ 
than in any other county, except those in which 
the metropolis is situated, is certainly the cause of* 
this, for the air is very salubrious, and the great 
quantity and cheapnessof fuel, is extremely friend-. 
ìy to life, health, and comfort. The repott of 
Manchester, which is the second town in England 
in point of population, forms an exception to this 
remark, for the mortality there on the average of 
the last ten years, is one in 58, and in the year 1810, 
one in 74. But that of Liverpool, is one in 34 on 
the average of ten years, an<Ì one in SO, in the 
year 1810. In the former we have another pleas- 
ing pictur^ of the progressive improvement of 
health, for it is stated by the late Dr. Perei vai, 
that in the year 1757, the annual mortality of 
Manchester, was one in 25.7, and in 1770, one in 
28 ; although at the former period the populatioit 
was not quite one-fourth, and at the latter period, 
not one-half of its present amountt. This im- 
provement of health is greatly imputable to certain 
regulations of police, particularly with respect to 

'^ * See Ramazini de Morbis artìfìcum. 

t See the Works of Dr. Thomas Percival, Voi. II. Warring- 
tcn, 1789. 



ENGLAND AND WALES. S9 

ventilation^ recommeaded and introduced by the 
above mentìoned benevolent, enlìghtened, and ac» 
tive physician. 

The like progressive ameliòration of health, is 
deducible from these public documents with respect 
to the whole kingdom, as has been remarked lo- 
cally ; for it appears from the returns of 1800, 
that the mortality of alt England and Wales was 
fhen one in 45; but in 18 IO, it proves to be one 
in 49. 

Thìs statement of facts cotrpied tvith the general 
result of the population returns, from which it ap- 
pears, that this island has acquired an addition òf 
1,536,000* ìnhabitants in the last ten yearis, toge^^ 
ther with the aanual increase of wholéaendfte sub<* 
sistence from the rapid extension ef agricolture^ 
may befàirly deemed aproof i^tbe increasiiig hap- 
piness, power and prosperity of this country,, attd 
cannot fail to afford the most solid sati^tctipn; and 
delight, to every benevolent and patriotic lAznd*. 

* Aceording to the last veturn» the population ^ Great Britaii^. 
was 12^596 fiOS persons, of whom 6,334^087 were males^ apd 
6^262,716 were fèmales. It &rther appears^ that when classed 
aceording lo ihetr occupatioHs^ 895,998 femilies were cngaged in 
agriculture> 1,199,M^ were eng^ed in trade> manniaetutes; or 
handicrafls, and that the number of fankilies coni|HrÌ8ed in ockher 
of these classes was 519,168. 



HISTORY 

« 

REMARKABLE CASE 

OF 

OVARIAN DROPSY- 

By THOMAS CHEVALIER, Esq. F. L. S. 

kUBGEON EXTRAORDINARY TO THE PRINCB REGENT; AND 8CRGEOH 
TO THE WBSTMINSTER GENERAL OISPENSARY. 



Read December 24, 181 L 






On May 81, 1811, I was requested to vìsit 
Maria Grant, a young woman, 23 years of age, of 
a spare habit, who Was confined to the house by 
ovarian dropsy, which had enlarged the abdomen 
to a size very far exceedìng any thing of the kind 
I had e ver seen. The disease began about six 
years before, by a tumor in the left side, unaccom- 
panied by any derangement of her general health, 
which was even now very good, exceptmg only that 
she had not menstruated for two years past, and 
that the secretion of urine was scanty. Dr. Sim- 
mons hadfrom time to time prescribedfor her; but 
as medicine was not productive of any advantage, 
he wished me to see ben 

I found the abdomen to measure 6S inches and 
a half in circumference, and 38 inches firom the 



CASE OP OVARIAN DROPSYà %% 

point of the ensiform cartilage ta the top of thè 
pubìs. Thelegs were oedematous; the leftconsi* 
derably more so than the right ; and great part of 
the skiiì^of the left leg was in a state of complete 
ìchthyosis. The lower part of the belly was also 
oedematous, and the navel, when she sat, was on a 
line wìth the knee. 

The enormous qtiantity of fluid accumulated^ 
made it appear to me improper to think of evacua* 
ting tlie whole at once, and I judged it best that thp 
first evacuation should be made in a very graduai 
manner, lest a hasty diminution of the tension should 
produce syncope, and occasion too great a disturb- 
ance of the system. I called therefore on the fol* 
lowing day, June the first, accompanied by Dr. 
Merrìman and Mr. Copeland, and made an oblique 
puncture with a lancet at the most prominent part 
oftheabdomen, in the linea alba, six inches above 
the navel j and introducing a director, evacuated 
seven gallons and a half of very dark, coffee-co- 
loured fluid. When this quantity had beeh dis^ 
charged, she began to feel somewhat faint, and I 
immediately closed the puncture with adhesive 
plaster and graduated compresses. The abdomen 
was stili tense, and measured S5\ inches in cir- 
cumference, and 31^ from the ensiform cartilage 
to the pubis. 

She pàssed a good night, and on the foUowing 
^yappeared liàuch relieved. The bowels acted 

1 



"n 



48 CASfi or OVAHrAK DRó^sr. 

properly without any assistance firom medicine ; 
and she passed near twice as much urine in 24 
hourg, as she had been accu&tómed to do for severa! 
years before, and this increase in the secretion of 
urine contìnued. 

June the eìghth, the enlargement appeared to bé 
considerably more on the left side. The abdomen 
measured 54inches round, of which SO inches were 
from the spine to the middle of the linea alba, on 
the lefl side, and 24 inches on the right. From the 
point of the ensiform cartilage to the pubis weré 
80 inches, so that a diminution of an inch and an 
half in eadii direction had taken place in the inter-» 
vai between the operation, and this perioda I now 
xnade a second puncture in the most prominent 
part of the lefl side, and dìscharged four gallona 
and an half of straw-coloured, topy fluid. She 
then became languid, and the optning was dosed 
as before. The abdomen now measured 4S^ inches 
round, and 27 from the ensiform cartilage to the 
pubis: a bandage was applied. 

No disorder was occasioned by this puncture» 
The parietes of the belly gradually contracted »• 
as to render it less flaccid ; the quantity of urine she 
passed was as much as she had ever used to void 
before the disease commenced ; and the size of the 
belly contìnued to lessen, so that on the 27th of 
June the circumference was only 45 inches^ and 
the distance from the ensiform cartilage to the pu- 



CASE OF OVARIAN 0ROPST, ♦$ 

Bis only 24|. On this day I made a puncture with 
a trocar on the left side^ and a gallon and a haif 
of very ropy brownish coloured fluid was discharg- 
ed* The cantila then belarne obstructed by a very 
firm cyst pressing against it. It was therefore with* 
dtawn. The circumference was dimìmsbed 2f 
inches by this operation, the other measure remain- 
ìng the same« 

July the sixth. The circumference was 42 inches^ 
tfee dìstance from the ensiform cartilage to the pu* 
bis stili 2é^.. I introduced a trocar which enter- 
ed the abdomen, and evacuated a small qoantity of 
fluid» but was stopped by a cyst of uncotnitnon firm» 
ness which I could not penetrate till I withdrew 
the stilette, and introduced through the eanula the 
trocar used for pnnctwing the bladder through the 
rectum. This entered the cyst, and drew off 3 gri- 
lòns and an half of ropy bro^n fluid, and appeared 
completely to empty the abdomen j through the 
flaccid parietes of which, the encysted ovarium 
Could be distinctly felt. No syncope followed this, 
or either of the former operations. 

On the following day^ July the 7tb, ber putee 
was rather quickened, and her skin somewhat hot; 
but she w^s free frora pain or tenderness of the 
abdomen. July the lOth, the circumference wasr 
34 inches, and the distance from the ensiform car- 
tflage to the pubis 1 7^. Her skin $till cóntinued 
hot, and her puise frequenta She complained fre* 

1 



44 CASE OV OVARIAN DROPSY» 

qtiently of sickness, her strength failed ; she hàd 
no relish foa: food, and in a few days every thìng she 
took except gruél, was rejected, or followed by-a 
stool. Medicines gave only a temporary and imper- 
feci relief, for she Innguished in this state> with few 
material variations, till the sixth of September, 
which was the day of her death. The abdortien had 
fora time become enlarged during this.interval, but 
had greatly subsided again. Its circumference then 
,being only 34 inches, and the, space from the ensi- 
form cartilage to the pubis 17 inches. She had 
however become extrfemely emaciateci, 'l'he cir- 
cumference of the thorax immediately under the 
'axiilas was only 27 inches. 

On examining the body after death, the whole ca«* 
vity of the abdomen appeared to be occupied by 
two large cysts, formed in the lefl ovaiium, closely 
connected together, their coats being of a very 
firm texture, particularly the lowér one, which was 
much the largest and thickest. They both adhered 
anteriorly and laterally to the parietes of the abdo- 
men, so as to require considerable force, and some 
dissectioh, to detach them. The upper cyst con- 
fained about 2 quarts of a brown glairy fluid, like 
that which had been evacuated in the first opera- 
tion, with some loose flakes of coagulable lymph. 
The inferior cyst contained 3 gallons of .purulent 
fluid. Its inner surface was covered with coa^able 
lymph, having in it many large dark red spots. 
There were two very sraall cysts aJso formed in this 



CASE 0^ OVARIAN 0EOPST* 45 

t 

ovarìuHì, one contaìning about 4 ouhces of a soft 
gelatinons substance, and the other about half aa 
ounce. The right ovarium and the uterus were in 
a perfectly healthy state. 

The right kidney had entirely lost its naturai ap* 
pearance, and was converted into a sac, having two 
distinct cavities, fiUed with a. straw-coloured fluid, 
and having no opening into the ureter. The left 
kidney and the rest of the viscera were sound in 
their texture. But the liver ^as unusually sinalL 
The whole of the abdominal viscera were forced 
upward ; encroaching on the cavity of the thorax 
so much, that the summit of the diaphragpi was on 
a line with the upper edge of the thitd rib, 

This case appears to me to afford several Inter- 
estiiig particulars. A very obvious one, is the enor- 
mous quantity of fluid accumulated. For as the 
size of the abdomen diminished between each ope* 
ration, the secretion of urine being in the mean 
tirae increased, I am certainly warranted in as- 
suming, that at least a quantity equal to the whole 
which was drawn off in the four operations, had 
been coUected in the belly at first. This, it will be 
found, amounts to seventeen gallons ; a quantity, I 
believe,far exceeding that of any.otlier case on re- 
cord. And if any allowance is to he made for the 
diminution of size between the operatioijs, it would 
appear that the originai quantity must have been 
even considerably more than I have now stated. 



46 CASE OF OVARIAK DBOPSIT» 

It is also singular that so very large a cdlectioA 
€£ fluid sfaould be formed without any jdLerange*- 
aient of the general heakb, for the bowels had ali 
along continued their action as regularly as usuai* 
The breathing and pulse too were unaffected, not- 
witbstaading so great an encroachment on the ca- 
pacity of the thorax. In short almost the whol^ 
ìneonvenience ^e appeared to sustain fròm the dis- 
ease was the excessive weight she had to carry. 

Another cireumstance worthy of remark, is tlie 
progress of inflammation and suppuration in the 
larger and inferior cyst, to which ber death is to be 
escribed. That cyst, near a quarter of aa inch in 
thickness, and as compact in it^ texture as parch- 
tnent, was entirely insensible ; but it was most curi- 
ous to observe that the process of inflamxnatiou 
•sfaould be excited init, and go on to so large a col^ 
iection of pus, attended with a rapid decay of the 
gerieral healdi, and showing by that, the sympathy 
of the constitution with this adventitious substance, 
^tbout pain or tendemess being excited in it, or 
the neighbourìng parts ; for no mark of infiammai 
tian whatever was discoverable in the peritoneum, 
or in s^ny part exterior to this cyst ; and as I bave 
alrèady observed, during the whole interval be- 
tween the fourth (xperation and her dissolution, she 
bore tìie abdomen to be pressed by any degree of 
iEorce, without complaining of the smallest sensa-^ 
iion of tendernes^ or pain« 



^ C^SE 



OF 



DIFFICULT PARTURITION, 

OCCA8IONSD BT 

A DROPSICAL OVARIUM, 

FORMINO 

A TUMOn IN THE LOÌVER PART OF THE PELVJS. 
By SAMUEL MERRIMAN, M. D. 

PHY5IC1AN ACCOUCHEUR TO THE MIDDLESEX HOSPITAL, AK^ TH? 

WC3TMINSTER GENERAL DISPENSARY. 



Read January 7, 1812. 



In th^ Volume of the M^dico-Chinirgical Trans- 
^tions just published, I hav? read with much iq- 
t^rest, a paper by Mr. Park, of Liverpool, " pn 
Tuniors within the Pelvis occasfoning difficult Par- 
turitipii." The intelHgent author dpes not offer 
any explanation of the origin or nature of thes$ 
tumors, but contents himself with giving a veir 
^l^ar and precisa relation of the cìrcunistances at»^, 
t^nding each case. As the 9ubjeQt is deservin^ 
of Éurther investigatiou, I take the liberty of lay- 
jDg ìfQfgx^ the Spgiety, th« detail of a gase l at- 



48 DIFFICULT PARTURITION 

tended severa! years ago, which will, I think, throw 
some light on Mr. Park*s paper* 

December 20th, 1804, I was requested by my 
friend, Mr. Robertson, surgeon, then residìng in 
Half-Moon Street, Piccadilly, but now at Great 
Hindred in Berkshire, to see a poor woman in la* 
bour, to whose assistance he had been called the 
preceding evening. I learnt that she was about 
forty years of age, that she had been delivered of 
ber first child in the country, eight years before, 
since which she had never been pregnant till now, 
Her health was not very good, and she was very 
apprehensive respecting the result of her labour, for 
her fdrmer one had proved very long and difficult, 
though the child was extremely small. The child 
bowever was bom aJive, but died fn a fejv hours, 

Mr. Robertson informed me, that the Liquor 
Amnii had beeu evacuated before he was sent for, 
and that the labour had made very little progress 
during the last eight or ten hours, though the 
£ains had been very frequent and severe : he like» 
wìse told me that there was a tumor of an un- 
common nature in the vagina, on which account, 
principally, he wished me to see the patient, 

Having introduced my finger within tke vagina,^ 
I felt a soft elastic tumor, which seemed capable 
of containing four or five ounces of fluid : it was 
compressible, and did not give the sensation of 



FROM DROPSICAL OVARIUM. 49 

fluctuation under the finger, but rather felt as if it 
were a large pouch, formed by the coats of the 
rectum pretemati^ally distended. On passing my 
finger beyond this tumor, I felt the child's head 
within the os uteri, which was thick, rigid, and 
very little dilated. I was not unacquaìnted with 
the fact, of tìie ovaria in a diseased state having 
been occasionally found lyìng between the rectum 
and the vagina, and it occurred to me that this 
might be a case of that kind ; but I must confess, 
that I too readily abandoned this idea, being pre- 
possessed with the opinion, that the disease was 
situated in the coats of the rectum. 

From the state of the os uteri, it was apparent 
that nothing could be safely undertaken towards 
efiecting the delivery of the patient at present ; 
but as there was great reason to believe, that the 
bowels were much loaded, we determined to emp- 
1y them by castor oil and clysters, and afterwards 
to give a large dose of laudanum, in order to 
quiet the pains, which teazed the patient exces- 
Mvely, without producing any advantage. By 
tìiese means very copious evacuations from the 
bowelswere produced,and some sleepwas procured; 
but the OS uteri remained undilated, and the bulk 
of the child's head was stili shove the superior aper* 
ture of the pelvis. 

It will be unnecessary to state minutely ali the 
ciroimstances of this labour, whìle we were 

VOL. m. £ 



^ niFEICULT PARTUp-ITION 

ing for thè naturai diUtation of th^ os utaci, and 
more effectual uterine action, which, we felt a^ 
sured, wpuld overcomo aU the diflìculty of the ca^ 
without extraordinary assistance, for the tmnar 
did not se?m firm enough to afford much r^sistanc^ 
to the hìrth. It is sufficient; to say, that after a» 
iniorval <rf tìiirty-six hours, passed in much severe 
but in^flfectual pain, during which the poor wch 
nw»'si strength was muqh impaired» we judged ìt 
absolutely neces$airy to have reqourse to tl»e per- 
for^or* We faund; more difficulty tban we had 
expected in u«ng this instrume^t, and afterward» 
in loosening the parietal bones, in consequ^nce 
of the size of the vaginal tumor ; and after the 
head wa& diminished, a cqnsiderable space of time 
ejiapsed before the child eould be brought infeo tlwi 
wqrld. 

SoQijt after thi» child was bojcn, it wa9 ascer- 
tained ths^t there waa anotber in the uteru^^ 
whicb being smaller was expeUed by thie natura 
paini^ ; it ap$)(eared to have bee^i dead some hours» 
The placentae, carne away soon afterwards, and 
the woinai> was put to bed in a very exhausted , 
•tateijj ftom the length ajpid severity of her labowt . 

Oa the aad, the day after deKvery, she vm sq 
much better, that we began to hqpe she might^ 
well; but unfortunately, her . circumstances ad- 
mittod of but few of those comforts; which her si- 
tua^u rendered necesasry» and ber attembusMis,, 



FROK DRQOPSICAL OTARIITM. 51 

notwìthBtandìng ali; our ìnjunctions to tilie cdn- 
trary, were more dispcsed to indulge her with 
beer-caudle aad strong li(|uors, as a meams of sup« 
pcH*tàng hfr strength^ than to pursue the pian of 
treatment whìch ve had dìrected. Thìs ìmproper 
Indulgeisce^ added to the severity of her ìsboM, 
brou^t on perìtoneal infiammationy and on the 
ìSih due dbd» 

The body was opened the next day, and exhi- 
btted the urnsl appearancesi of perìtoneal ìnflamma- 
tioa. Tlie lesflr oTarìum ms in its proper pitua'^ 
^n» and of ite iwial si^e ; bnt tbe rìgbt ovmam 
was £>uQd lykig between the rectnm and the va« 
gina, and had formed the tumor whi<^ we felt 
during the laboixr. It wa^ aboizt the size of a smaQ 
tr$i^^ and in a very higii state of inflammation. 
It was diviided into serend cavities by membrana 
eoa fcpta^ which had a scirrhons &el, and wad 
somewbat mcxre tìda» half filled, wlth « fluid resemi 
bling, in eolour and cotasistence, hoi>ey and water 
mixed togetàeir : it ccaztaieed lìkewise a dot of 
blood, which nmst hare bèen* forced out of tìie 
^ v^essels by the pressure of the child in paésing, or 
by the vìolence of tìne painB* 

^ The pelvis wns narrow, the diameter from the 
aym^ysis pnbìs to the sacrum being bnt little 
more tha& three incdies ; this alone therefore would 
bave delayed the passage of the head tbrough the 
superior aperture. It is not improbable that the 

3$ 2 



52 DIFFICI7LT PAETURITION 

presence of twins in the uterus might likèwise 
prevenfe fhe full efFect of the pains ; but I imagine, 
that the position of the diseased ovariùm, more 
than any thing else, prevented the expùlsivè et 
forts of thè womb ; not becàuse it proved an ob- 
staclè to the birth of the child, (for the child did 
not come in contact with thè tumor till after the 
perforator had been used,) but by pajralysing, if I 
may so express it, ali regular uterine action. 

The fatai terniinatìon of this case made me re- 
solve, should another of the samé kind qccur in 
my practìce, that I would endeavour to evacuate 
the contents of the tumor, by puncturìng it 
through tìbe vagina, and I am well pleased to fìnd 
from Mr. Park's cases, that this may bè done with 
so great a probability of success. It must how- 
'ever be récoUecfed, that ovarìan tumors not con- 
taining a fluid, may sometimes be found in the 
pelvis. I bave in my póssession, a preparation 
consistìng of the ovarium enlarged, and filled 
with fatty matter intermixed with hair, which has 
formed to itself a bed, between the Vectum and 
the vagina. Had the woman from whom these 
parts were taken, become ìmpregnated, the ova- 
rium must of necessity bave been confined in this 
situation, and a tumor occupying a cònsiderable 
space, must in consequence bave been forméd in 
tlie pelvis, which would bave pròved a great ob- 
stacle to parturitìon. 



FROM DEOPSICAL OVARICM. 5& 

A case of this kìnd has lately occurred in one 
of the Lying-ìn-Hospitals of this city, as I was in- 

r 

formed by a surgeon, who was present at the dis- 
section. The birth of the child having been long 
delayed by a tumor in the vagina, it was deter- 
mined to lessen the child's head, and the won^tn 
was delivered, but did not long survive. After 
death it wais ascertained, that the tumor was oc» 
easioned by the ovarium filled with fatty matter 
intermixed with hair and teeth, lying between the 
vagina and the rectum. 

In Baudelo^que's " Art des Accouchemens/* 
5 196S, a similar, and, as he supposes, asolitary^ 
case of diseased ovarium in the pelvis, impeding 
the birth of the child, is recorded. It had been 
proposed by Lauveijat, and another accoucheur 
of Paris, tò perform the Cjaesarean operation, as. 
the only means of delivering the woman* Bau- 
delocque objected, and recommended delivery by 
the feet. After several ineffectual attempts on the 
part of the other accoucheurs to turn the child, by 
which the tumor was dislodged, and forced above 
f the brìm of the pelvis, Baudelocque succeeded in 
bringìng down the feet, but was obliged to bave 
recourse to the forceps, in ordex to accomplish 
the delivery of the head. The child was dead 
born, and the woman died in two days. On open- 
ing the body, the tumor was found to be occa* 
sioned by. the ovarium enlarged, and filled with 



hmg k^T f^ed well forandd teetb^ among VFhieh cmild 
be eaaily detected incison, oamne jt^eth $Qd mor 

It becomes a question whethe^ linda* ib» cir* 
cuiastances, ^ iiioisipD Bhould be ma^e inta tfaj^ 
tamffr wi^ the view of extx^^cting the l^iEàr, &c« 
4(S the(^ heterogeneous substances are usua^y cì;^'' 
taiued witbin a capsule, inìght it not be poi^il:^ 
to remove tbe whole mass by . an impision ì or 
might not the ovarìum ìtself be extirpated» throvgh 
the posterior part of the vagina ? Either of these 
operations might be practicable without ipuch ad* 
ditional hazard to the mother, and with a great 
prc^ability of preserving the child. * That estirpa* 
tion é|* the ovaria ìs not neoessarìly a iatal operai 
tion, has been proved by inany experiments upon 
brute animals ; and in Mr. Pott's Works, Voi. Ili, 
p. 352, a case is recorded of the extirpation of both 
the ovana ìp a womadp, v^ere they bad passed 
through the tendinous openìngs qf the oblique 
mnscles pn each side. The pal^ent recpvered, but 
lost the fuUness and fleshiness of the breasts, and 
never menstruated afterwards. Operations iode^d^ 
on any parts connected with the ttterus» ca^not be 
^therwis^ than dangeroys, duriqg pre^Htnoyi apd 
especially durii^ labour ) yet if the ovarian tumoir 
were so extensiye> as either to impede the desceut 
of the child's head by its bulk, or to preyeQt ih4 
aetion of the womb by i(s weight, or by its con* 



PROM BROPSICàI/ OVARiUlbf. S$ 

fined and imbedded position in the pelvis, th9 
safety of both motlier and child might be prG« 
moted by tlie operation, It must be considered» 
that the forceps or the lever can very farely ba 
eniployed with efFect, when the vagina is thus pro^. 
traded by a tumor behind it ; the only instruments 
that we can look forward to, are the perforator 
and hook ; the use of which presupposes the death 
of the child, if not its actual sacrifice, at the mo- 
ment of émploying theni. And with regard to 
the mother, theae instrutnents cannot be had re- 
course to in such cases, without exposing her life 
to great risk, as has been proved in several in- 
stances. Besìdes the two already mentioned, in 
both which the mothers died, a similar case is re- 
lated by Dr. Denman*, where the same fiital event 
followed the use of the perforator. 

Nor does it appear, that tuming the child, and 
delivering by the feet, is safer practìce, as is proved 
by Baudelocque's case, and likewise by one some-» 
what similar, attended by Doeverent, in both of 
^ich the mothers and children perished. Upon 
• the whole, therefore, I am disposed to believe, 
that where the tumor in the vagina occupies a 
large space, it would be a more warrantable prac- 
tice, to remove it by excision, if it consisted of a 

* Introduction to the Practice of Midwifery, 4to edit. p. 324, 
+ Doeveren Specimen Observationum Acad. cap. 13, Gm- 
ning», 176S. 



56 DIFFICULT PARTURITION, &C. 

solid substance*, and certainly to puncture it, if 
ìt contained a fluid, rather than to expose the 
child to certain death, and the mother to great 
hazard, by employìng the perforato!. 
Dee. 20th^ 1811. 

* Dr. Drew removed by excision during labour» a himor òf a 
" fat, grisly substance/' growing from the sacro-sciatic lìgaments, 
fourteen inches in circumference, and weighing two poundi 
eìght ounces ; which entirely prevented the bìrth of the child. 
The child was bom alive^ and the mother perfectly recovered. 

Edinburgh Medicai and SurgicalJoumal, Voi. L p. 20., 



C^SE 

or 

DÌSEASED 
APPENDIX VERMIFORMIS, 

By JOHN PARKINSON, Sorgeon. Esq. 

COUMVNICATED 

Bv JAMES PARKINSON, Esq. 



Read Januaiy 31, 1812. 



A PREPARATioK of dlseased appendix vermiformis 
in my possessione was removed &om a boy about 5 
years of age who died under the following circum- 
stances. 

He had been observed for some time, to decline 
in health) bui made no particular complaint, until 
two days before bis death, when he was suddenly 
seized wìth vomìting, and great prostration of 
' strength. The abdomen became very tumid and 
painfiil upon being pressed : bis countenance pale 
and sunken, and bis pulse hardly perceptible. 
Beath, preceded by extreme restlessness and deli- 
rium, took place within 24 hours. 

Upon examination, the whole surfàce of the pe« 
ritoneum was fbund inflaiped, and covered wìth a 



58 DISEASED APPENDIX VERMIFORMIS. 

thin coat of coagulable lymph ; and sHght adhe- 
sion had taken place between the peritoneum co- 
vering the viscera, and the parietes of the abdomen. 
The viscera, independent of the inflammatìon of 
their peritoneal covering, appeared in a perfectiy 
healthy state, excepting the appendix vermiformis 
of the coecum. Nò diseased appearance was seen 
in this part near to the coecum; but about an 
inch of its extremity was considerably enlarged 
and thickened, its internai surface ulcerated, and 
an opening from ulceratiqn, which would bave ad- 
mitted a crow quill, was found at the commence- 
ment of the diseased part^ about the middle of the 
appendix, through which it appeared, that a tìiin, 
dark coloured, and highly fetid fluid, had escaped 
into the cavity of tlie abdorawi. 

Upon opening the appendix, a piece of harden* 
ed foeces was found impacted in that part of it 
which lay between the opening, and that portion of 
the appendix, which wias not evidently marked by 
disease. 



A CASE 

or 

DISEASED TESTICLE, 

ACOOMPANIBD WiTH DÌSEASE 

Or THTE 

LUNGS AND BRAIN, 

ÀNB TSÌtMtHATlNC FATALLY« 

b'y henry EARLE, Es<i. 

COMMUNIOATED BY 

WILLIAM LAWRENCE, Esg- 

TO WHICH IS ADDED 

A NOTE, 
BY MR. LAWRENCE, . 

CONTAINING SOME FARTICULABS OF THE HISTORIES AND 
DISSECTIONS OF FOUR CASES. 

> I I! 1 "ni" Il II 1,11 irrii' imw e 
Read February Z, 1819. 



Thomas DEN1>IIE, aged one year and nine 
monthsy was brought to me on the lOth of June 
1811 9 fbr m^ opinion on a disease in bis left testi- 
eie. The fbUowìng is &e history which bis mother 
gave me of its origin and progress* Wh^n the 
child wt8 abottt a year old, he receìved a pinch 
from hi8 sister irìio viras nursing him ; he complained 
a good di^l at the time, but not mach attention 
naA paid to it Abont a fortnight from this time» 



60 FATAL DISEASE 

bis mother first perceived that^the lefl testicle was 
rather larger than the rìght From this period ìt 
gradually encreased until it attained the bulk which 
ìt exhìbited when she carne to consult me. She 
had applied to several siLrgeon$, who recommend- 
ed leeches, poultices, mercurìal ointment, &c. &c. 
without producing any visible amendment. The 
case had been twice mistaken fot a hydrocele, and 
thetesticle had been punctured wìth a trochar, but 
no fluid followed. Very little inflammation sue- 
ceeded the operations, and the disease did not ap- 
pear to bave been materially aggravated by them. 
At the time when I saw the child, bis testicle was 
rather larger than a goose-egg, and, when unsup* 
ported, reached tò the internai condyle of the femur. 
It was of an ovai figure, with a regular smooth sur- 
face, and when pressed had an elastic feei, so as to 
produce the sensatìon of a fluid contained in a cyst: 
so deceptive was the feel, that a gentleman, who 
has had most extensive practice in the treatment of 
hydrocele, pronounced it without hesitation to bc 
a case of that description. It was not, however, in 
the sÙghtest degree diaphanous ; and at the same 
time, was much heavier than a similar bulk of wai* 
ter. No testicle or epidid3rmis could be traced at 
the posterior or inferior part of the tumor. The 
child had a most unhealthy aspect; bis skin was of 
a greenish yellow colour, and bedewed with a clam- 
my moisture; bis muscles flaccid and diminished in 
sizej his head was large and prominent in front, 
bis eyes heavy, and pupil dilated, the iris being of 



i 



OF THE TESTICLE. 61 

suchaniinusuallydark colour, as to be with diffi- 
culty distinguished from the pupiL His respiration 
was rather anxioua; he was troubled with cough 
and had a frequent hard piilse. The abdomen was 
large and tense, and he was habitually costive. I 
ordered him Hydrargyri submurìatis gr. iìj. Jalapas 
gr. yj. omni alterna nocte, and a lotion consisting of 
liquQiis ammonite acetatis, aquas fontanae a a j^ iv. 
to be constantly applied to the part during the day, 
and a bread and water poultice at night. He con- 
tinued the use of these medicines foraweek, with- 
out any alteration in the state of the testicle, his 
cough was rather better and his abdomen was soft- 
er. As the disease had existed for nine montha, 
and had rèsisted ali applications, I did not think 
that any good would arìse from prosecuting these 
measures, and much evil might be expected from 
the delay which they would necessarily occasion. 
I therefore thought it my duty to propose an ope- 
ration, although from the unhealthy appearance of 
the child, and the unfortunate result of similar 
cases, I was not very sanguine of ultimate success ; 
stili Jhòwever I was led to entertain some hope from 
the cìrcumstance of being able to trace the sperma-* 
tic cord distinct and free from disease, for nearly 
an inch above tìie tumor, and from the inguinal 
glands being perfectly healthy and naturai. 

On the 22nd I performed the operation: after 
laying bare thè tumor in its whole extent, I passed 
a needle and ligature round the artery, dose to the 

7 



6fl FATAL SISEASE 

ring of the external oblique, and tben divided the 
cord, in whtch there was no disposition to refract«' 
The re9t of t^ operation was accomplisbed in the 
usurai manner. The tumor consisted of a pulpy 
greyiflh mass, kk -wfaieh no Testige of the originai 
stnK:t^re renmined^ after washìng it for some time, 
the water became turbid, in consequence of part of 
the mass, concisting of inatter reseiiiUiiig braiii io 
a ^ate of putrefactioiiv beiiig dissolved* The tvA 
sur&ee was uneven smà fibimis in appeanmce, £ke 
sloughs Of trregulariy deposited coagi^ble lytnph. 
The, disease dìd not eistend up €he eord; the arterjr 
wasvery krge, and the corpus pampyniforme madb 
encreased in sì^e. The nature cf the complainli 
was evidently the $ame «s has been described under 
^e several namefir <^ piilpy testide^ medultary sair« 
eoiBia» and fungus haamatodes^ Nothing wortl^y 
of remark oecurr^ durijag the after treatment, the 
wQ«nd graiìul^ted frod» its whole surface, and 
healed very slowly, fte^uently requiring to be stl- 
mulated with red precipitate or the nitrati of silv^r^ 
&c* In ax weeks it waa pertectly"cicatrized. Daw 
ring tbis tiine he took the foUo^&g medicine8« 
R I^iquoris Hydrargyri Oxymuriatìs | j. 

Tiiftcturas Cisebonas § j* 

Infusi Qaas8Ì9^ i^, M- &- naistura. 
Capiat qochlearia trìa majora bis quotidie: 
R Hydrargyri Submuriatis gr. ij. 

Riiei Palmati gr. X. 

Zi»f iberÌ9 gr. x« M. ft. pcd^s^ tertià quà^is noct^ 
i^meiodus* 



4 

/ 



or TH£ TKaxicuc. 63 

Under this pian af treatment the faealth graduai- 
., i^pr.™.. Hi» aUn w.s more n..u«l. ^ he 
liad even some colour jii his &ce; he yms mote 
Kvdly, his bowek aeted regularly, and his abdomen 
was 8iBaller and much mfter. Indeed he was so 
much better in every respect, that I hoped his core 
wcmld be permanent. About tiie 25th of August, 
l ceased to attend hìm, and recommended his be- 
ing s(ent into the country, I substituted the 
Hàustus Gontianse cum Seima Pbu S. Barb. for the 
mixtare contaìnìng the muriate of mercury ; and 
six grain9 of Hydrargyrus cum Creta fijir the cald^ 
jBiel, and enjoined a strìct attentton to his d^t. 

I saw nothing of the child from this time unti! 
the 12th of Novewiber, when hi^ mother again 
biought him to me. Sbe had not been able to 
send him into the country, and bad diseontinued 
the «se of the medicines soon after I eeased to at- 
tend him. Sh^ told me he had c^^ntinued well in 
every respect untìl the end of September, when, 
to use her expressìoii, ** he again began to fitli off.'* 
He wa^now mach M^orse ths^n when I first attended 
him, aU his^ bad i^ymptoms having returaed with 
aggravation. He vhbs very prone to ^teep, and pee- 
vifih ivheii Toused. He was coi^tantìy ^fesinms of 
resting his head, wbidi was evidently increased in 
9ÌM, althougb ali the sutureswere elosed, andfre- 
fjfut&^y carrìed bis hands there in his ^eep. Me 
made a Constant moaning queraloiis noise, and 
waa veify avei^ to being moved. His po{»ls wem 



/ 



64 ^ FATAL DISEASE 

dilated, but senable of the impressìon of a stxong 
light. His respiration I could not observe, as he 
always cried when I approached him. His pulse 
was frequent and ìrregular ; his abdomen full, and 
bowels constipated ; and he had disinclìnation for 
fopd. I immediately suspected that the sanie dis- 
eased action was begun in the brain, which had 
existed in the testicle, and foretold the unhappy 
termination of the case. I ordered him hydrar- 
gyri submuriatis gr. v. jalapae gr. x. This was re- 
peated twice before it operated, it then produced 
several copious fetid dark-coloured stools. The 
foUpwing day (the iSth) leeches were applied to 
his temples, and a seton was cut in the nape of his 
neck. Two grains of the submuriate of mercury, 
and six of extract of colocynth, were directed to 
be taken night and morning. On the 14th he was 
rather more lively ; the leeches and medicine were 
ordered to be repeated. 15th. He was not so well, 
was very prone to sleep, and had slight strabismus. 
I directed his mother to rub a drachm of mercurìal 
ointment into his body night and morning, and to 
continue his pills as before. The seton was poul- 
tìced, and was beginning to discharge. I did not 
see him again be&re the isth, when no material 
change had taken place. His mother had been ìU, 
and had not rubbed in the ointment above twice. 
I desired her to brìng him to the hospital the fi>l« 
lowing day, and promised to procure his admis- 
Sion, as I was yery anxious to watch the progress 
qf the case. She neglected to do this, and as she 



ÒP THE TESTICLEi 65 

i 

had changed bei* place of abòde I was nót able to 
ììiid ber out, and did not see him till the 28thé 
The disease had made rapid pj^ogress duiing the 
teti days. The head WàS mach enlarged^ and the 
veins of the scalp weré very turgid aiid incréased in 
size. Hìs pupils were dilated, and his counteniance 
expressive of great ànxiety. He was stili sensible, 
and the moment I éntered the room he cried and 
clung to his mòther, as he was woiìt to do èvèi* 
since the operation^ His lower extremities wei*e 
now. paralysed, and he passed hisexcrements in* 
vòluntariìy. His pulse was slow * and irregulat, 
with soime degree of fulness» His mothèr said that 
she had rubbed in the ointment eight titnes^ when 
his mouth bécame afFected \ that his bowels had 
acted regularly every day j that on the 25th he 
begaa to; lose the use of his legs, which sytnptom 
had gradlially incréased uiitil ali below the jielvis 
was palsied. He had passed a small calculus 
of lithic acid the day before* In this hopeless 
state it was useless to attempt any thing further. 
I saw him early the foUowing morning* He was 
then convulsed in the muscles of his face and eyes, 
which were in a stat^ of Constant tremulous mo- 
tion, and wide open. His upper extremities and 
ali the muscles of his trunk. were paralysed. His 
respiration was difficult, aiid much impeded by a 
collection of mucus in his throat* His pulse was 
too rapid to be numbered. At eight o*clock that 
night he died, and the foUowing moming I ex- 
amined his body. 

VOL. Ili* F 



86 ' FÀTAL DISÉÀ^ 

AppeArancès "Òri IXsseciion. 

' I 

On removing the calvarium^ nothifig partkiilàr 
prefsented itself in the appeatence of the duiba ma- 
ter. On slitting up the longitudinal sinus, the 
gkndulee Pacchioni were found di«eased, havxi^ 
ali appearance rfgramious blòod. After raiising 
the dura mater, the cotavolutioAs of the braiu Were 
so mufeh flattened a-s completely to obscurè the in- 
tervening snlci, and lo give the cerebrmn an uni- 
fòrm evetì surfacè. The vessels of the pia mater 
wère particulaiiy void of bloodw In the anteiiw 
lobe of thè right hemiq)here, a larga tumor pre- 
«etìted itself inìmediately betieaJth the arachnoid 
Brèmbrane ; its sutface Was a€ a dusky red colcmiTy 
ahd was rather ìrough. Two «:her tuinoi's WMe 
distinctly felt in thè Sùb$ta«tee <^ the braift, òtte 
in the posterior lobe of tìite right^ thè òther in tfeat 
of the left hemisphere, prèviòus to any sectk)n tim- 
ing made. On cutting through the substahce ton 
a level with the coipus calloeinm^ four mote to^ors 
.were exposed to view, and the tbnee fonfter wete 
divéded. The largest was of the site of an orango, 
the smallest as big as a chesnut. They were of a 
very firm consistence, of a dusky red xrolour, witìi 
ètreaks of "^liite interspersed thtough the substance. 
Onfe 5of them was of a darkfer colouron its ^xterior 
aurface^ bàving more the appearance 'of •a, fino 
coagulutn of veiiouè blood. * The smnx^unding oé- 
rebral substance was rématkàbiy soft and pu^» 
aitd had a pecuUar yellow tinge> which iras ii©t 



OF THE TESTICtE. 167 

destroyed by lettìng water run over it So iooàely 
wére these tumors connected witìi the stibstance bf 
the brain, that tìiey were with difficulty preserved 
in liieir situation. The ventrìcles were faéalthy^ 
and plexùs choroidés pale and void of bloìod* The 
cerdbellum was quìt^ free irom diséase, the me- 
dulia òblongata lemarkably firm, and ìts procésses 
v^ stroiigly m^ked* Dn opening the tiiohtx^ 
numerous large tubercks were &>und in the sub* 
stance of the lungs. In some places they occu- 
pied the whole thìdcaess fitim bue sur&ce to the 
èthfen When vìewed extemàlly through the serocb 
imémbrane of the lungs, they had a greyish white 
appearance, and were irregulariy radialb^ at their 
tdrctmifefènce. When pressed, they had a firm 
inelastìc feel. On being cut into, they exhibited a 
dd&e eveii textrae, very dissimilar to that of the 
tèi^^de ; when squeezed, a small quantity of a 
whitii^ fluid was prfessed oùt. On tearijig one of 
tìxeÀì^ ìt had a fibrous appearance like a fihn brain 
when torh òr dissected with the handle of a scal- 
pai. There was nothing ìike a capsule to any of 
(hèm^ they were contained in the substanoe of the 
iu^igs, and their edges tvei'e not well defined* The 
brom^hial glands had taken on tiie same diseased 
ftetton, and werè prodigìously enkrged, llieir in^ 
ternal «trilcture was very analc^us to the testicle^ 
Ihougli they were of a firmer texture, and were 
i^t elastic to the touch prevìous to being cut into» 
Not tmich disease was found in the abdomen^ 
The xneseriteric glands were enìarged, but when 

F 2 



6B / FATAL DISEASB 

cut into ' didl not exhibit any diseased structHre« 
A chain òf enlarged glands was traced on the side 
from whence the testicle had been extirpated, ruhi 
ning by the side of the aorta, and extendirig ùom 
the pelvis'to. the diaphragnié The intestines were 
much distended with flatus, but not unhealthy in 
their appearahce. The right kidney was enlarged^ 
and its ureter encreased in diameter, by the re^ 
cent passage of a calculus. 

I fear I shaii incur the charge of proKxity in 
the statement of the former part of this case^ a$ I 
am fully aware that a pulpy testicle ÌÉ by no itieans 
an unusual occurrence; It will, I trust, be ex* 
cusedj as the riecessary prelude to the interesting 
dissection which the termination of the case af* 
forded. Although this is not a very rare disease 
in the testis, it appears that its diagnostic symp* 
toms are not very well defined, nor its nature ge- 
nerally known, as many cases are on record where 
surgeons of great and deserved reputation hav^ 
inadvertently plunged their trochars into the 3tib- 
stance of the tumòr. Fortunately, no material in* 
jury is likely to accrue to the patient from such ari 
operation ; but the surgeon will be liàble to much 
censure for bis mistake. It is certainly difficult .to 
determine the nature of some cases ; but there are 
generally sufficient characteristic marks to enable 
a practitioner to form an accurate judgment. The 
regular ovai figure, the peculiar elastic feel, and 
total \vant of transparency ought certainly to raisé 



or THE TESTICLE. . 69 

mispicions in a person's mind, which shbuid t^i» 
der him cautious in giving bis ojnmon. Uhd^ar 
these circumstances no man shòuld attempt to' 
piwicture the tumor, without being fully prepared 
to follow up the operation, by removing the testi- 
eie in the event of there being no collection of • 
fluid ; but any one who has been in tlie habit of 
€omparin^ the two diseasés, will find rauch diffeiv 
encef'even in the serisation imparted to bis touch. 
To say «in what this diflference consists, I will not 
attempt,. as it is almOst imipossible to ^express in* 
woxds those njce powers of discrìmination which 
ean only be gained by experience. An altention 
to the. bistory of the case, ar^d to the state of 
health, which always suflfers more or less, will be 
of much assistance in forming an opinion. The 
term fungus hagmatodes has been applied to this 
disease, but upon what principle I ain at a loss to 
éetermine, as there does not appear to be any dis* 
position to the production of fungus, nor any 
oozing of blood whten it is wounded, What the 
naturai termination of th^ disease wpuld be, sup- 
posing it ta exkt alóne in the testicle, Jias npt, as 
iàr as I know, been yet cjetermined. It generally 
spreads to p^rts ess^ntial to life, and d^stroys be- 
fore the ulcers^tive ^tage has commenced. The 
term jnedullary sarcoma is perhaps equally ^xcep- 
^coìable, as it does not convey a correct id^a of the 
disease in differept parts of the body^. In the 
brain, for instance, where we bave the most fa- 
VQurable opportunity of making the comparìson, 
Ìt^;bears no ansi-Iogy to the surrounding meduUarv 



tOr TJLTAL DIlSfiASB 

matterà It is much easier to cbj^ect tban to amend» 
aztd it may he wrong to find &ult mth a tena when 
we biave nòt any better to o;&r ; but the fir$t 9tq)i 
tibr improvement is the exposltion of error* Any 
term fbunded on the appearance of this dìsease» 
in any one part, must necessarìly convey a wroDg 
ìmpressìon of ita nature in other parts» as ìt is cer*^ 
tainly much modified by its situatìon. I bave con» 
sidered this case as worthy of being recorded, as 
it ahows in a striking manner to what extent a dis. 
ease may reach in so important an organ ^s the 
brain^ without materially deranging its functions, 
provided its progress be graduai. This is the more 
to be wondered at, when wé consider that a total 
auspension pf its powers, and even death, will 
3ometimes ensue from so slight a derangement of 
ita structuxe, as ahnost to elude the investiga'tions 
pf the anatomista I had oc^asion to qiake this same 
remark about two ^ years since, in a case of hrge 
abscess in the brain, which was ^ot at ali suspect- 
ed during life. An account pf this case yrss pub^' 
lished in No. 132 of the Medicai and Pbysicat 
Journal. I consider the terminatìon c^ this case 
as a good illustration of the graduai loss of power 
in the brain, when labouring under the eflfects of 
disease. It is first incapable of transmitting its in-* 
fluence to tlie extreme parts of the body, as the 
disease advances it$ powers gradually diminisb, 
and the extent of its influence diminishes in pro- 
portion, those parts nearest th^ brain being last af- 
fected. It is probable fhat a less morbid state of 
brain may produce a numbness, or even palsy, of 



or THEr XESTI»D. 71 

the lower extremitie». This m^ÌQgy betWQ«p^ 
the cantre of the neivous and sanguifejroi^s 3y% 
tetns, haa not been sufficiently noticQd hy nosol^ 
gists, and may perhaps assisit in the explan^tipi^ Qf 
many phenomena in diseas^es. hitlìQTto ìnvolyed in 
obscurity. It has been a question, wh^th^r this 
disease spreads by absorption, or is constitutional. 
The prqsent instance strpngly faypurs the l^tter 
opinion. Its appearànce at snch» remote parfcs, 
wherethose intervening weye so sHghtly ^fiPect^d, 
prove» that it depends on the same peculiarity of 
constitution, and pievalex^ce of the same diseased 
action; Sinoe writing the above,' Mr. Hodgson/ 
who was preaent at the dissection, has favored me 
with a very accurate representation of the appear« 
ance of one of the tumors in the brain. Jigure 
I. reprosents a section of the tumor, shewing the 
looseness of its connection with the brain, and 
the bloody and mottled appearance of its structure. 
Figure IL represents the appearance of the tumor 
in the surfece of the brain covered by pia mater. 



Remarhs by Mr. Lawrence^ 

The occurrence of di&ease in severa! organs of 
tìie same individuai, is a point of so much impor- 
tance in pathology, and the combination of affec- 
tions of the internai parts with extemal disorders 
Ì9 of so much practical consequence, particularly 
in influendng our judgment conoerning the prg* 
priety of operations, and in leading to a just prò-» 



72 FATAL DISEASE 

gnosìs, that I take the liberty of oflFering to thq 
Society a few particulars of four cases, which 
have come under my observation within a veiy 
short time. They will forni a proper sequel 
to the preceding very interesting narrative of 
Mr. Earle, 

CASE I. — M. Lambertini, an Italiana about 
thirty-five years of age, perceived a hard tumor 
in the right breast about fifteen months hefore his> 
deat^i. When this had existed about twelve months^ 
it ulcerated, and a . fungus' shòt up. I saw hinx 
about three weeks before his. death, 'at which time. 
there was an ulcerated and fungous surf^ce of 
about two inches in circumference, on t^e right of 
the Tight nipple, which was sound. One consider- 
able protuberance in this surface was ulcerated, 
nearly smooth and florid: the rest wa,s irregular 
and tuberculated, and covered mostly wtli an un- 
healthy cuticle. The discharge was not consider-. 
able, and ra.ther offensive : sometimés it bied slight- 
ly. A hard mass occupied nearly the whole ante- 
rior part of the right half of the chest : the sim 
was hard and fixed, and small tubercles were feìt 
under it fox some distanpe round the fungouspart. 
The swelling and the hard state of the skin reach- 
ed into and filled the axilla; it extended up to the 
clavicle, as far as the middle of , the sternum, and 
below the edge' of ihe pectoralis major rauscle,. 
Hard tumors were felt above the claviclfiv and the, 
axillary glands on the opposite side of the-body 
vere enlarged. . The arm began to he oedematouSs^ 



DF THE TESTICLE. 7."* 

pid respiration was affected ; he was also remark-* 
ably hoarse. The pulse was not affected, the appe- 
tite very good, and little if any emaciation had oc^ 
Gurred. The oederaa and difficulty of breathing. 
gradually increased, debility carne on, and death 
took place without any particular change in the lo- 
cai disease, which had at na time been attendedwith. 
much pain. The carbonate of iron was used both 
^xtQrnally and internally : the discharge bec.amet 
less offensive, a^d the bow^ls very costive uijder 
its employment. 

A very considerale mass of exceedingly hard 

and tough substance covered the chest, reaching 

as high as the clavicle, and fìlling the axilla. It 

contained no cavity or celi, nor any part at ali sofì; 

, in its texture. The most striking character of this 

Gonsisted in its colour which was a bright yeUo^sh 

green. With this there was mixed more opless red> 

and a few portions nearly white. The axiUary 

glands fonned a part of the general mass, from 

which they could not be distinguished by their co- 

hur or any other circumstance. The skin over the 

swelling had its corion very much tluckened, and 

this change extended beyond the middle line of 

the chest. The tumor in most of its extcnt wa* 

distinct from the pegtoral muscle, but had extended 

through it apposite to the ulcerated portion, and 

seemed to bave converted the fibres completely in- 

to its own substance. The cellular tissue in both 

the pectoral muscles and in the intcrcostais, as weD 

p in ali parts about the region occupied by the tu-- 



74» FATAL DISCASE 

mor, had the same remarkable green colour as the 
swelKng itself. Thia colour eKtended along the 
subcutaneous stratum to the opposite side of the 
chest, and was observed in many points in the sub- 
stance of the left pectaralis major. A very iarge 
mass of substance entirely resembHng the originai 
tiunor was placed above the right clavicle, and ex* 
tended backwards to the spine, involving the axiU 
lary artery and vein, and plexus of nerves. The 
right pleura was greatly thickened, particular- 
ly where it covers the diaphragm, and converted 
into a tough green substance; its cavity contained 
more than two quarts of a very bright lemon-co- 
loured fluid. The lung was reduced to a very 
small size, and its covering of pleura was t^icken- 
ed ; but there was no disease in its substance. 

The peritoneum lining the right side of the dia- 
phragm was thickened and green ; and the mem* 
brane had undergone a similar change in two or 
three patches behind the abdominal muscles. 

' Two hard lumps, consisting of the substance ,Qf 
the gland indurated and turned green, were found 
in the pancreas ; and a very considerable number of 
masses of the peculiar green substance were dis* 
persed through both kidneys, the intermediate 
portìons of these orga^s being quite sound. 

A portion of cellular substance behind one of 
the vesiculae seminales was hardened, and exhibited 
the green colour. 



OF THE TESTICLE. 75 

The lymjAfttic gl^nds were very extensively dis- 
m^d : they w^re enlarge^ in various dqgreesj aii4 
their suhstance more or lesst extensively conyarted 
iutQ a bardiah homogeneaus ina$3 of the colour al* 
ready described. In siome instancea this depoaitioii 
occwpied the centre of the gland, and wds $ur-i 
rounded by a thicker or thmner stratum of ^^ 
jstance resembling the naturai structure of ^q 
part; in some this extemal layer had a deep red 
aod bloody appearanice ; other glands were convert- 
eà entirely into the green structure. The ceUular 
texture surrounding the glands was loose and natu^ 
ral. The axillary glands, on the diseaaed side» 
could not be distinguished from the originai tu- 
mor, and those above the clavicie formed a large 
swelling of exactly similar appearance. From 
this a chain of enjiarged' glands extended to the 
trachea, and along its right branch to the lung, 
ali the glands of which were affected. The axil- 
lary glande of the left side were very considerably 
enUrged* The right ìnguinal glands were shghtly 
diseased: thoee situated about the external and 
internai iliac vessels, the aorta, and vena cava, as 
high as the diaphragm, were greatly enlarged, and 
fermed one contiuuous chaia, The largest of these 
were equal in 9Ì2e to hen's eggs, and had ^e bloody 
appearance externally. Two or three glands in 
th^ mesentery, one on the stomach, one behind 
the ^ght rectus abdominis, and several in the pos- 
tQrior xnediastinum * were slightly enlarged, and 
partìally ponverted into the green ^ubstance. 



^6 FATAL DISBASE 

The largé lymphatic tranks passing between 
those abdominal glands, whioh exhibited the bloody 
colour in the most remarkable degree, were dis- 
tended with a reddish fluid. The thoracic duct 
contained a similar fluid, and was pervious through- 
eut. The tight absorbing trunk was pervious at 
its termination, Neither the loft arni nor the Iqwer 
lìmbs were at ali oedematous. 

r The lining of the pulmonary artery arid its 
branches, and of the aorta, together uvith its pri^ 
mary ramifications, was of a bright red colour>, 
but not thickened, 

" The mucous membrane of the trachea and its 
branches, presented a deep red colour, and the 

surface was crowded with small vessels, 

> ^ ». 

• No part of the brain shewed any trace of dis- 
èase ; and the right axillary nerves, which were 
involved in the diseased glands and the primary 
turaor, were equally free from ali morbid ap-r 
pearance. 

CASE II, — A woman, who had laboured for somo 
tirae under a' singular afiection of the arm, grew 
gradually worse, had a difficulty of breathing and 
general debility, and died. The subcutaneousi 
tissue of the arm, fròni the elbow upwards, wa» 
converted <m thè inner side, 'and over about one 
half of the limb, into a solid brawny mass of abonfj 

a 



OF THir TESTICLÉ, 7f 

« 

ah iiich in thickness, which eJevàted the integu^ 
ments into several small tuberclea. ^ >Two deep ul- 
cers^ with foul surface, irregular evertéd edgea, 
and uhhealthy discharge, had formed in thià dis- 
eased mass. The axillary glands, and those aboye 
the clàvicle^ were changed into a large tubef culated 
substance, resembling, in ita hardness and very 
light brown colour, the originai disease. Small 
depositions of a similar kind had taken place in 
the cellular substance of the biceps muscfe-; and 
sevèra! small portions, hardly producing any ete- 
vation of the surface, were found in the median 
nerve, for about two or three inches òf its coùrse, 
Very numerous* tuberei es were scattered over tbe . 
sur&ce 5 . and through the substance of tbe lung« : 
they possessed a whitish colour, and finn hpitìQ- 
geneous texture. They were most abundant on 
the surface, and varied in size from a millet sèed 
to that of the end of the finger, ; There was no 
appearance of suppuration in any of^them. The 
bronchial glands were enlarged. 

CASE III. — In a patient, who had been for some 
time under medicai treatment, on account of dis- 
ordered intestinal functions, and whose breathing 
was affected only a few days befóre . hÌ3 deatlx, a 
great number of very large and peculìar tubercles 
was found in the Jungs. They were very finn, of 
a white colour, and nearly unifonn in appearance 
throughout. Some were entirely icibedded in the 
substance of the lung, while otheis appeared p» 



/ 



7& TATAI. DISEAQE 

the sorface» They varied firom thife size of th« 
&t to that òf a nut. Nothing like suppuration 
appeared in any of tiiem ; but there wàis a slight 
blackish appearance in some, as if the substànce 
«f the liing had been imperfectly converted into 
the turftor. In the intervals of the tubercles the 
lung VFBS healthy. The foronchìal glands were con- 
siderably diseased. 

Fottf or fìve small tubercles were obfeeh^ed on 
the heart, under its serous membrane» 

A considerable lumor was ìbund ùa the upper 
siirface of the diaphragm, wìth the lung adbering 
to it ; and a similar one was seen under the thick 
edge of the livej. 

. Ève or six round and hard tubercles of different 
dizes appeared in the omentum ; and many smaller 
ones under the peritoneum in varìous parts òf the 
abdomen* " 

A white finn tubercle of the size of a nut, Was 
found in one of the kidnies. 

CASE rV. — In a woman,with whose history I am 
entirely unacquainted, the pelvis presented a most 
éestructive dìsease. The neck of the uterus was 
destroyed ; the remainder of that organ, the back 
of the bladder, and the front of thè rectum form^ 
ed the aides of a large cavity, with a rugged and 



OP THE TESTICLE. 79 

irregular surface covered by a horrìbly fetid dis- 
charge. The bladder communicated with this bj 
a large opening, and the larga intestine by two ul- 
cerated apertures, one in the rectum, and the 
other in the sigmoid flexure of tiie colon. The 
firndus of the uterus had its naturai appearance ; 
but the pa];t which contributed to the formation c£ 
tfae cavity, consisted of a white and softish mat- 
ten A similar substance surrounded the rectum^ 
and connected it firmly to l^e sacrum ; it extend- 
ed into the substance of that bone, which it had 
rendered so soft that it, could be cut with a knife* 
The^ inguiiud ^nds of the right side were con* 
verted into a tumor of similar appearance. On the 
sur&ce, and in the substance of the' liver, there 
were several depositions of a white soft niatter, of 
various sizes. The texture of die diseasé was very 
ffitmlar in ali these parts. Maceration softened It 
comsiderably, and pressure then reduced it to u 
pu!p, which would not bave been distinguished froùi 
the substance of the braìn. 



DESCRIPTION 



OF AN IMPROVED METHOD OF 



^TYING DISEASED TONSILa, 



By THOMAS CIIEVALIER, Esa. 

» - 

SURGEON EXTRAORDINARY TO THE PRINCE RECENT, ANO SÙRGEOiV 
TO THE WESTMINSTER GENERAL ©ÌSPENSARY. • 






Read Feìn^uary 18, 1812. 

Jl ASSING à iigature round a diseaaed:tonsii, 
has generali^ been found an operation of consider- 
able difficulty. The breadth of the tumor ski \\s 
base, and the extreme impatience of the fa^ices, 
concur very mux^h to embaryass the operatp;^ J 
ha ve lately been led to adopt a method, in.iiyliiqh 
the operation is,executed with great facilityj ^d 
which completely succeeds, without the necessity 
of -keepiiig an instrument in the mouth, after t^e 
Iigature is applied* 

r 

I use a doublé Iigature; ahd the ìmprovement 1 
atti about to describe, consists, first, in the mode of 
passing that Iigature; and secondly^ in the mode 
of securing it when passed. 

1, In order to pass the Iigature, I use a fiat, 
Bpear-pointed hook, fixed in a handle; the broadest 
part of wbich is about two lines. This hook i^ 



METHOD OF TYING WSEASED TONSILS. 81 

passed behìnd the diseased tonsìl, and ite point is 
tben pushed fbrwa3fd, so as tex perforate tiy fhrough 
the middle oi its base, It is thèn f o be wJthdyawrt. 
An eyed probe, very much carved, and àrmed 
with a lotóg doublé Kgatui'e, may tjien readrfy bc 
passed tfarough the pérforation!)^, and bromght otrtat 
the iriotitb, and the Hgature divid^d, tha^t one por^ 
tion may be tied round the uppét half of the tonsil, 
and the other Tound the lower. 

2. In order to effect this, I bave availed myself 

of a noose, mach in use among packèrs; which, 

» ♦ 

though it might r'èàdily he lóbséned, if à Aecharri- 
cal power were acting against ìt, remain^ under 
other circumstances pierfectly fastj and is fuHy sui- 
fideot fór the purpose in thi», and other anaiogouSi 
cases^ where a ligatusfe is re^uired. 

A single knot being first made upon one end of 
the thread, tììe end so knotted, is to be brought 
fotvrsofé upon the other, atid to màke a single noose 
upon itself including the other, and to be drawn 
tight ispòn it, dose to the first knot : the free end 
of the thread is then to be passed through the ring 
of the instrument, as in Rg. Ó. This end of the 
thread being then held firm, and the ring pushed 
forward upon the knot, the loop now formed, nlay 
be readily tightened, so as completely tò* strangu- 
late the diseasaì part; atid in the same manner it 
may be tightened from day to day, till the part ìs 
entìrely detached. 

VOL. III. G 



ss METHO0 OF tYlN» 

The kind of thread I prefer, is thin, strotlg lay* 
cord : common packthread is so quickly rotted by 
the offensive saliva^ which is afterward secreted, 
added to the wannth of the mouth, and the putres- 
cency of the strangulated part, that in one instance 
in which I have employed it, it gave way, beforé 
the tumor was completely separated : the tonsil, 
however, was ^ufficiently grooved to luake it readily 
included in a single ligature^ which was passed 
without difficulty. 

. Instead of a simple, fiat hook, I at first empio}*- 
ed one with an eye, carrying the. ligature ; which, 
being passed through the base of the tonsil, might 
be seized with a hook, and brought forward : but 
I found that the combined irritation from the punc- 
ture and the thread in the fauces, was so great, 
that the most determined courage was scarcely 
equal to withstand it, for a sufEcient length of time, 
to allow of the ligature being effectually laid hold 
on, and divided: and it was from being disappoìnt* 
ed in attempting to execute this part of the opera- 
tion in that manner, that I was first led to the more 
simple, and easy method of performing the opera- 
tion, which I have now descrìbed. 

A good deal of inflammation usually arises in 

* 

the mouth and fauces, and about the sublingual and 
&ubmaxillary glands, soon after the operation ; which 
ìs best soothed by small doses of laudanum and an- 
timonial wine. The mouth may be frequenti/ 



' DISEASÈI) TOKSILS» 83 

Washed with warrn water, and the poppy fomenta- 
tion employed extemally, if the pain should be 
considerable. This inflammatión begins to subside 
on the third day. I thìnk the tumor is generally 
detached on the fourth or fifth day, and the sore 
readily heals. 

The ligature shòuld of course be of sufficient 
length, to bang six or seven inches out of the 
mouth j and it will be an usefiil precautìon to cover 
the ends with a piece of adhesive plaster, which 
may be fixed on any convenient part of the neck or 
face, to keep them out of the way. 

Fig, 1. Represents the hook. 

Fig. 2. Represents the noose before; it is fasten- 
ed, with the instrument upon the long end of the 
ligature, by which it is to be secured, after the 
noose has been tightened. 



a 2 



C^SE 



or 



CYNANCHE LARYNGEA, 



By j. r. far^e, m. d. 



Ili 11 iji^t-yi 



Head Peb. ì»^ 1812- 



téttm^mm 



CASE I. 



ON Monday evening, the isth August, 1810, 
<— * Essex, aged S8, complained of sore throat. On 
the 14th at noon, bis. respiration was afifected, aisd 
in the evening it was loud and hoarse, and he was 
long in completing each inspìration. He could 
not sit stili for many moments, but walked about 
the room in the greatest distress, often struggling 
for breath. Unable to Uè down, he passed the en- 
suing night in the same restless and agitated state, 
with occasionai delirium^ On the 15th, the diffi- 
culty of bis breathing was in no respect diminish- 
cd. On the 16th, atfourinthe aftemoon, a me- 
dicai man observed the foUowing symptoms : res- 
piration perfonned with extreme difficulty ; pallid 
face, protruding eyes ; an anxiety difficult to be 



CYNANCHB LAEYNGEA. «5 

expressed ; the uvula large, oedematous, aUd speck- 
led^ as ìf about to ulcerate; tonsils not aifectedf 
pulse laborìous and frequenta The treatment bàd 
been hìtherto limited to the use of catbartics, and 
the application of blisters to the chest and throat. 
A momentary relief was now obtained by taking 
twenty-four ounces of blood from bis arm. At 
seven he was under the operation of a préparation 
of tartarized antimony and squills, wbich had ex- 
cited vomiting, and was tben acting on bis bowels. 
The blood wbich bad been drawn exhibited the ap- 
pearances wbich are usuai under àctìVe infiamma* 
tion. At liine o'clock, when sitting up, he expired. 

MorUd appearances 24 hours after death. 

Tlie velum palati, pharynx, and a portion of thè 
Oesophagus with the larynx, trachea and bronchia 
were carefuUy detach^d* The pharynx and ceso- 
phagus being slit down posteriorly, the mucous 
membrane investing the epiglottis, rima glottidis 
and the posterior part of the larynx, was found to 
be oedematous to so great a degree, as to make it 
evident that suflfocation had been prodttced by 
stricture of the glottis. Tlie tumefection ceased at 
the junction of the larynx and trachea. The in- 
ternai mucous membrane of the larynx was red 
and thickened. The traces of inflammation were 
less apparent in the trachea and bronchia, the 
membrane being irregularly reddened. No coagu^ 
lable lymph had been effused on any portion of 
tbis membrane j and eyen its muciis was not 



8ÌB CYNANCHE LÀRYNGÉA. 

changed. There was an appearance of slight cori" 
gestion in the lungs ; some adhesions of the right 
pleura existed, but these were not recent; the heart 
was naturai, and the liquor pericardii slightly in- 
creasqd. Excepting an enlarged spleen, there was 
no disease of the abdominal viscera. 

In this case the inflammation did not pass the 
stage of congestion in the mucous membrane of 
the trachea, and of sèrous effiision under the mu- 
cous membrane surrounding the glottis; but in tlie 
fbllowing, the inflammation went into the adhésive 
stage, and closed the glottis by the efiusion of 'co- 
agulable lymph. 

CASE II. — A poor, but industrious and tempe^ 
rate man, about 60 years old, on Sunday the Slst of 
March 181 1, was affected with a painful and difficuH 
deglutì tion. On the fbllowing momìng, Aprii Ist, 
alarmed at his inability to swallow fluid, which, on 
the attempt being made, returned by his uose, he 
sent for Mr. Weston who found the tonsils inflamed, 
and disposed to ulcerate. A brisk purge was order- 
ed. At ten o'clock, on the same evening, his respi- 
ration suddenly became diffìcult, when Mr. Weston 
immediately drew from his arm thirty-two ounces 
of blood, which proved to be very sizy. • In the 
course of an hour I attended, and observed the 
character of his disease at this stage. Although 
the tumefaction of the tonsils was mconsiderable, 
deglutitìon was extremely painful, and very diffìcult: 



CTNANCHE LARYNGEA. 87 

respiratìon was performed with convulsive and long 
continued èfForts : bis voice was nearly inaudible, 
and he could only whisper. He answered my in* 
quiry respectìng the seat of his suflfering, by put- 
ting his finger on the superior part of the thyroid 
cartilage. He feìt no pain in the chest. Ali the 
muscles of respiratìon were thrown into vìdient 
action, and he lay with his mouth widely opened, 
pupils dilated, face pale and sunken, skin covered 
with a clammy sweat, and his pulso at 133, and 
smaU. His powers were prostrate, and general 
bleeding could not be repeated* The anterior part 
of the throat was covered with leeches, but the dis- 
case never paused. At midnight, the op'eratìon of 
bronchotomy seemed to be the only resource ; and 
soon after one o'qlock^ I decided on its employment. 

About two o'clock, Mr. Astley Cooper attended, 
and as suffocatìon was instandy impending, the 
operatìon was immedifitely performed, by dividing, 
laterally, the ligament which connects the thyroid 
with the cricoid cartilage*. The dyspnoea was ' 

* The following note, made by Mr. Cooper on the moming af- 
ter the operatìon, he obligingly sent me with the drawìng. 

** I was csdled by Dr» Farve and Mr. Weston, at half past one 
A. M. on the Snd Aprii 1811, to a person aged more than 60, 
who had Angina Pharyngea. He was gasping for breath ; evcry 
muscle that could be brought into action to assist respiratìon was 
employed. He was seized with sore throat yesterday, and at ten 
o'clock to^night with dyspnoea, which has increased sorapidly that 
he appears to be dying, pulse quick, face ancl lips pale, pupils 
dUlated. 

*' I began 



' » 



88 QìmìA^Cfm LAB^NGEA.^ 

madti relieved by ihe operation. He now lay pas« 
sive, br^tliing by the naturai and ^rtlficial ap^^. 
tures, and the ìnordinate action of the muscleft of 
respiro^tion had ceased. He swallowed some nou-» 
jishment with a painful effort. In thig state he paas-^ 
ed tljp night, and the greater part of the foUoydng 
d»y. In the afternoon, the respir*lioq by the »a» 
turai passage entirely ceased, but W9.s continued 
by the artificial aperture. He was iiow evidently 
pinking, and expired at six in the evening, 

Aprii sd, eight p'clock A. M» Dis^eetìou by 
Mr. Astley Cooper. 

The right tonsil inflamed and vesicated. The 
epiglottis swoUen, its edges meeting behind, e& 
cepting just at the upper part. Pharynx inflamed, 
somewhat vesicated, covered with coagulable 
lymph about the epiglottis, but free from inflam«> 
ination near its tèrmin^tion in the oesophagus. The 
aperture which had been made between the carti-^ 
lages, appeared to he about half the size of the 
glottis. 

The mucous membrane of the larynx and tra- 
chea was pale. 

*' 1 began the operation by making a cut between the tbyro'id 
and cricoid cartilage, longitudinali y» and then transversely into 
the membrane which imited these cartilages. No vessai ^of the 
least importance was divided^ and he breathed through the open* 



I mg> «o as to be immediately relieved/^ 



CYNANCHE LARYNGEA. 89 

There was some accumulation of mucus in the 
cells of the lungs, and a slìght effiision of serum 
into their reticular texture. The left pleura par- 
tially adhered, and the cavities contained rather 
more fluid than is naturai to them. The abdom* 
inai viscera were not examined. 

I may be allowed to remark that Cullen's charac- 
ter of his 4th species of cynanche will not em- 
brace the cases which I bave above described. 

" Cynanche (Pharyngea) cum rubore in imis 
praesertim faucibus ; deglutitione maxime difficili, 
dolentissima, respiratione satis commodaj et febre 
synocha/* 

The anterior part of the pharynx was indeed 
the sèat of the inflammation ; but that portion of 
the membrane being also common to the larynx, it 
may, in a practical sense, be uséfiil to ternv the 
disease laryngea^ because it proves fatai by con- 
stricting or actually closing the glottis, and consti- 
tutes precisely that case which, in its ultimate de- 
gree, imperiously demands the operation of bron- 
chotomy. 



HISTORY 



or 



A CASE 



or 



A NiESTHES I A, 

By JOHN YELLOLY, M. D. 

PHYSICIAN TO THE LONDON HOSPITAL. 



Read March Sì, 1812. 



i HE foUowing case exhibits an example of the 
loss of sensation in the upper and Ipwer extremities, 
independent of paralySs; and as some pf the parti- 
culars are curious, and the occurrence of such a 
complaint is exceedingly rare, I have drawn up am 
account of ìt for the use of the Society. 

I. S. aged 58 years, a native of Scotland, residèd 
for many years in Jamaica as a pian ter; and with 
the exception of being now and then bilious (to use 
his own terni) he enjoyed, during the whole of this 
period, very good health. About three years ago, 
after being much heated and fatigued in his ai^ttend- 
ance, as one of the Grand Jury in Kingston, in 



CASE ÒF AN^STHESIA, 9l 

very sultry weather, he went to bed with the wìn- 
dow open, On awaking in the morning, he found 
liis feet and ancles perfectly numb, but without 
any sensation \)f pain, and without the muscular 
power beiijg at ali affected. Soon afterwards, he 
felt a numbness, with a tingKng pain in bis little 
finger, such as occurs in a part which is said to be 
asleep ; and, by degrees, finger after finger became 
affected, until the whole of both hands was in a 
considerable degree insensible. He never had any 
pain or giddiness in the head, nor was he ever af- 
fected with the dry colie, which so often gives rise 
to paralytic affections in the West Indies. 

A physician of eminence in Jamaica confidently 
assured him, that bis complaints originated from 
scurvy in some lurking forin or other; but it does 
Dot a;ppear that Mr. S. ever had the least appearance 
of cuticular afFection, till about 1 2 months after the 
occurrence of the numbness, when some red pim- 
ples shewed themselves in bis legs, on bis lying 
down on the ground, after being much heated by 
walking up a steep hilL ^ 

He arrived in this country on the 20th of July 
last; and from the time of my first seeing him, 
(which was on the 25th of Ofltober) till now, he 
had been as nearly as possibIe\in the same state, 
cxcept that bis appetite and digestive powers, 
which were then a good deal affected, bave been 
for some time past much improved. 



98 HISTORT OF A CASE 

The foUowing are the prìncipal circumstances 
i^hich I bave had occasion to observe relative to 
this case. 

The hands, up to the wrists, and the feety half 
tray up the leg, are perfectìy insensible to any spe- 
cies of injury, as cutting, pinching, scratching, or 
burning. The insensibility, however, does not sud- 
denly terminate ; but it exists to a certain degree, 
nearly up to the elbow, and for some distance above 
the knee. He accidentally put one of his feet, 
some time ago, into boiling water, but was no 
otherwdse aware of the high temperature, than by 
finding the whole surface a complete blister on re- 
moving it. Nq species of injury to a vesicated part, 
of either hands or feet, is felt by him. The extre- 
nfùties are insensible to electrical sparks takea in 
every variety of mode. The cubital nerve where 
it passes the elbow communicates the sensation prò* 
duced by pressure or a blow only half-way down 
the fore-arm*. He perspires much in the left side, 
just above the hip, but nowhere else« He is gene- 
rally rather chilly, and the extremities are coW, 

* I bave remarked in some cases of paralysis from Colica Pic- 
tOTuro, that this nerve has its sensibìlity very mach diminished; 
and in the case of a brìcklayer^ in whom there was a total loss of 
power, and in a considerfd)le degree of sensation in both of the 
fore-arms and hands, fr|(^ sudden exposure to cold, after working 
in a very hot furnace, the cubital nerve was totally insensible to 
àny degree of pressure or force applied to it. It is probaUe that 
a similar insensibility might have been fonnd to exist in other 
nerves, had they been accewible. 



OF AN^STHESIA. 93 

except when he is in a comfortable room ; and in 
this case they are crf the usuai temperature of thci 
body. The thermometer however rises to 101^ in 
the mouth. The hands are of somewhat a purple 
liue. If he wishes to ascertain the temperature of 
any body, he is under the necessity of putting it to 
his fece ór neck, or the upper part of his arm, His 
skin seems to be more than usually sensible to thè 
efiects of beat. On putting his band, at the desire 
€^ a friend, into a paìl of hot grains, which his 
fìiefid assured him were not too hot, and to con- 
vince him of this, previously thrust his band and 
arm into it, there was a very extensive vesication 
produced. His hands are never free from blisters, 
wtócb he gets by inadvertently putting them too 

m 

near the fire ; and he has met with* several severe 
bums, without being aware of it. No degree of 
pressure is felt by him ; but a blow produces a 
sHght degree of tingKng. He has a general uneasy 
sensation in the extremities, which warmth rather 
relieves. His skin, in general, heals very readily, 
after being bumt or scalded in the most severe way j 
and there is no fèver, nor is there, as far as he has 
been able to determine, any increased beat or 
throbbing during the process of healing. This 
seems to be also the case with some other parts of 
his body which are not altogether insensible; fora 
little tìme ago, he got bumt in the front of the pa- 
telkt, and though there was a consid^erable slough 
separated in consequence, he sufFei^d no pain, and 
little inconvenience during the cure. 

3 



9é ilISTORY ÒF A CA8É 

If the heat to whìch the insensible parts are ex* 
posed is moderate, vesicatìon is not immedìately 
produced. The part becomes red, and in a few 
tninutes, but sometimes not till the lapse of an hour 
or two, is bKstered, That a smaller than ordinary 
temperature produces vesication in this individuai, 
seems to be ascertained by the circumstance, that 
cxposure to the heat of a common fire gave rise to 
a blister in the knee, which was foUowed by the 
slough abovementioned, though the clothes which 
còvered the part, were not at ali injured. Immer- 
sion in water at 120"* produces no change in the 
affected parts; but exposure to the same 4:empera- 
ture at a common fire, speedily blisters, That de- 
gree of heat, is, as far as I can judge by myself, 
about the utmost which can be long borne by the 
hand, in ordinary circumstances, without pain* 

Cold water and warm water of every tempera-^ 
ture invariably appear lukewarm to him. Water at 
the freezing point produces no degree of sensation 
whatever; but when his hand is kept in it for some 
time, he feels a slight coldness at the end of the 
thumb. After his hand has been immersed in wa- 
ter of the common temperature, and was introduced 
into water of SS'', he had some sensation of warmth. 
The cold produced by means of a mixture of snow 
or ice, and salt, communicates no sensation except 
a slight chiUiness in the thumb, and when this 
freezing mixture foUows the use of water of the 
common temperature, it produces a slight degree 



OP ANi&STHESIAé 93 

of warmth. A soKd body produces no sensatjion, 
whatever its temperature may be* , . 

The power of motion exists in the muscles of 
both hands and feet. With the former he can 
grasp pretty firmly ; but in holding any thing he is 
apt to drop it, if his attentìon is at ali called away. 
There has been of late a slight loss of substance in 
the hands. 

He can lift a chair, but cannot raise himself from 
the ground, by taking hold of any thing placed 
àbove him. The susceptibility of impression, ge- 
nerally, as well as the muscular power, seem to be 
in this individuai in some degree diminished. 

/ 

The functions are naturai, and the pulse regular 
^nd moderate *. 

In the treatment of these symptoms, no advan- 
tage has been derived from any pian which I bave 
myself adopted, or which has been employed by 
others. The warm bath, electricity, galvanism, to- 
nics, the rhiis toxicodendron, and mercury, given 
both witli a view to its action on the bowels, and 
the system at large, bave been equally unavailing; 
though it must be owned, that the patient has ne- 
ver shewn a sufficient degree of perseverance, in 
the prosecution of any means which bave been 
adopted for his relief. 

* la Vcnerem minime habilis est 



9é ili ^ j CAS^ 






If the heat t ^tt0O^ power over the mus* 

posed is mod J ^^ which do not derive their 

produced. ^ ^ ^ :^ere sensibili ty commenced, 

minutes, b- ^ ^^xmipatible with a total loss of 

or two, is , 33toscles ; and it might therefore 

temperat ^ ^jjh some appearance of truth, 

seems t .^^iSility was confined to the integu- 

exposi . |}ie observatiotts which I bad fire- 

a blis ^^v j^pon this case, I had no doubt, hew* 

sloii ^v ìiisensibility extending to the muscles 

c^' v>; hut in order to ascertain this point ex- 

^^ ,a*«9y> ^ requested Mr. Travers, demonstra- 
' .tiK*toniy at Guy's Hospital, when exanrining 

^^ with me, to introduce a couching neediie 
j Jle fleshy part of the tìiumb ; having previously 
.,u the best surgical authority (with which Mr. 
:^vei's agreed) for believing, that such an injury 
^>M)Id he inflicted without dangeror material in- 
^•onvenience. A lancet-shaped couching nee'dle 
was accordingly thrust by him, to the depthof mne 
sixteenths of an inch, into the ball of the thumb, at 
the distance of an inch and quarter from the middle 
of the dorsura of the metacarpal bone. Il touched 
the bonejj and must bave passed thrbugli the mass 
of short flexors of the thumb. Not the least de- 
gree of pain, or even of sensation, was produced by 
this puncture. The part was desired to be poul- 
ticed, and the wound appears to bave healed by the 
first intention ; for the poultice was considered by 
the patient to be quite unnecessary after the 2nd 
day, aud he left London^, to embark for the West 



OF ANJESTHESU* ' 9? 

Indies, at Gravesend, in three or four days aft^r» 
wardsy without baving experienced the smallest 
inconvenience from it, I heard from hìs friends» 
before he left the river, where he remained g few 
days, that he was ia hi9 iisual h^alth, 

Most of the cases of anaesthesia which have been 
mentioned by authors, have occurred in paralysis ; 
in which complaint the degrees in which motion 
' and fiensation are lost» are very various, and do 
Dot bear any Constant or' regalar proportion to 
each othen Where the anaesthesia has been wholly, 
or nearly complete, it hasgenerally been described 
a& taking place in one side of the body, wfaile 
loss of the power of motion has occurred in the 
other, An interestiqg case of this kind, is given 
in the sepond volume of the Transactions of this 
Society *^ The principsJ circumstances relative to 
it, coQsisted in a wea}cness, and diminution of vo-» 
luntary power in the left side of the body, attendai 
ed wijli a slight degree of numbnéss in its upper 
extremity, and a total loss of sensibility in the left 
ùde of the head, and in the right side of the body, 
ftom the neck downwards. In this case, there 
were sp;pe of the perversions Qf s^nsation, which I 
have mcntipned as pccurring in the present, par? 
ticularly as to the feeling produced by cold water, 
which invariably appeared to be lukewarm, 

* History of a case of singular nervous afl^tion^ attended 
with anomalous morbid syinptoim. Medico-Cbirorglcftl Trans^ 
;ictions, Voi. IL p. 315. » 

VOI., Ili, B 



98 HISTORY OF A CASE 

I have met with two instances very iiearly re- 
sembling that which I have now laid béfore the 
Society*. The first occurs in the American Me- 
dicai Repoi^tory, and is communicated in a letter 
from Dr. Samuel Brown, of Le^^ington in Ken- 
tucky, to Dr. Miller, one of the editors. It is 
dated June so, 1799, and is as follo wst. 

" Mrs. M'L. of Baridstown, in Kentucky, aged 
about 40 years, has been deprived for more than 
two years, of the power òf sensatiòn in her hands 
and feet. She is quite insensible of the efFects of 
cutting ihstruments, or of buming coals applied to 
them. In one instance, when she was employed 
in s^iaping a pièce of woòd with a knife, she in- 
cautiously turned her eyes on some other object, 
and cut off the end of the thumb of héìr left band, 
without perceiving the smallest sense of pain. 
ISie cannot, from her sensations, discover the least 
difference between a hot and a cold iron, and has 
frequently burnt the skin and flèsh to a considera- 
ble depth, by mìstaking the one for the other. 
These wounds and burns heal without any uncòm- 
mon difficulty. Notwithstanding this total loss of 
sensibility, she retains the power of motion in foli 
perfection, and pursues her domestic employments 

''^ These cases I have met with s>ÌDce the paper was read to the 
Society. 

f Medicai Repository and Review of American Publications 
cu Medicine, Surgery» and the auxiiiary braaches of Philosophy, 
Voi. IV. p. 2^5. 



OF ANi»ST»E8IArf . 99 

without SLììy Tomarkàlde iiiconvenifeiKte. AlLher 
animai ànd vital' fiMctions are iu a naturai heaitb^ 
fili state, and hibr. spinitè ,aK iregular, nay even 
cheerfiil; She fedls no mconvenience irom faer 
complaifit^ except a sep^ a£ fulness in tìte veins, 
wfaidt she ^suscribés to the slow; oircmktìon of blood 
in tìie ^xtremities. As the sense of touch hoW- 
ever is éntirely Idst, i^ ftnds it diffifcult to retain 
substan^es in her hands witiiout lookìng àt thenl, 
as it li by sight, chiefly, that she regulates liie de- 
gree of muscular contraction necessary tò their re»- 
tention. On turfting her eyes aside, shè often 
drops glasse^, plates, &c which she Jioids in safe*- 
ty as long as she* iooks at them. A variety of re- 
liiedies had been tried without any effect. I was 
deidrous of witnessing the eftects of electricity. 
Although it produced very consideràbie contrae- 
tions in the muscles of her arms, down to her 
Wfists, the eflects of it on her hands ts^^e searcely 
perceptible. After two or three days hòwever, 
she imagined that she was sensible of some kind 
of sensation from strong shocks, and was there* 
fore advised to continue the application of it. 
Volatile liniment was prescribed, and rollers to 
fiupport the veins which appeared relaxed and dis- 
tended by their contents. Of the result of these 
experiments I bave not yet been informed, as my 
patient Kves more thàn 70 miles distant from Lex- 
ington/' 

The second case is given in a note in the Philo* 

H 2 



100 HISTORT OF A CASE 

$ophie Zoologique of Lamark. It is there men» 

tioned, on the authorìty of M. Hebreard, that a 

man of 50 years of age, had for 14 years the rìght 

arm completely ìnsensible. The lìmb, neverthe- 

less, preserved its activity, size^ and power. On 

the accidental occurrence of a phlegmon <up<a it» 

there ^ere heat, swelling, and redness produced 

in the part, but-no pain^even when it was pressed. 

During his work, the subject of this case happened 

to break the bones of his fóre-arm, at about a third 

of their length from the wrist. As he only felt a 

crash (craquement) he thought he had broken the 

shovel which he held in his band ; but it was sound, 

and he could only discover his accident by being. 

unable to continue his work. The following day» 

the arm, at the fractured part, was pufied up ; 

the temperature of the fore-arm and band was in- 

creased, but the patient experienced no degree of 

pain, even during the extension necessary to re* 

duce the fracture*. In this case, it is clear, that 

the muscles of the affected arm were equally in- 

sensible with those of L S. And it is probable 

that this was also the case with the person men- 

tioned by Dr. Brown, though the evidence is iiot 

so decisive ; as the injury done to the thumb might 

only bave affected the integuments. 

The existence of muscular power, and the fa- 
culty of directing its exercise by the will, where 

* Philosophie Zoologique, par J. B. P. A. Lamark, Tom. % 
p. ^62,^1 bave not been able to find the^ori^inal case. 



/ 



OP AN.SSTHESIA. 



101 



the n^res bave entirely lost that sensibiliiy which 
is always regarded as necessary to the conveyance 
of volition from the sensorium, are circumstances 
apparently irreconcfleable with any knowledge 
which we at present posseas, of the mechanism by 
which the will acts in the production of voluntary 
motìon» ^ ^ % 



ACCOUNT OF 

A CASE 

or 

SPONTANEOUS EXTRAVASATION 

WITHIN THE 

THECA VERTEBRALIS, 

WHICH SOOK 

TERMINATED FATÀLLY. 
By THOMAS CHEVALIER, Esq. 

SURGEON EXTRAORDINARY TO THE PRINCE ìtEGENT, AND SURGEON 
TO THE WESTMINSTER GENERAL DISFENSARY. 



ReadApiilU, 1812. 



JyllSS D- 5 aged 14, for several days felt 

pain in the head and back, which induced her, on 
the 26th of February, to apply for medicai assist- 
ànce. Blisters were applied behind the ears, and 
opening medicìnes were ordered, which operated 
the following day, and relieved the pain in the head ; 
but the pain in the back grew mach worse, and 
was aggravated and accompanied with a tendency 
to sickness, on sitting up* On the Srd of March 
the pain in the back ìncreased much, and on the 
following day ber mother thought she discovered 



THE THfiCA VERTEBRALIS. 103 

a little projection of the spinous processes of the 
lumbar^ vertebrae, in consequence of which I was 
desired to see her. I could not discover any thing 
in the appearance of the back that was nòt naturai, 
nor was any particular pain excited by pressure. 
The efFort to sit up distressed her much j but her 
countenance was clear and healthy. The tongué 
was rather white: she had a moderate, regular pulse 
at 1 20, Under these circumstances the pain did 
not excite any particular alarm in my mind : I di- 
rected some leeches to bé applied as nearly as pos- 
sible to the seat of the pain, and afierwards an opi* 
ate lotion : she was also ordered to take three grains 
of antimonial powder, with a saline draught every 
àx hours, and I left her in foli expectation of find- 
ing her relieved on the morrow, especially as, on 
strict enquiry, she could recollect no exertion or 
other vìolence by which the symptoms could bave 
been produced. 

On the foUowing morning, to my great surprise, 
I was informed that, on the evening after I had 
seen her, she complained of a sudden and violent 
increase of the pain, and immediately went into 
convulsions, in which she continùedbetweenfiveand 
six hours and then expired. On the 6th of March I 
examined the body in the presence of Mr. Johnston 
of Mortimer Street, who had attended her from 
nearly the commencement. There was not the 
leasfc appearance of disease in the brain or in any 
of the thoracic or abdominal viscera. The appear- 



104 EXTRAVASATION WItHiN tBÈ 

alice of the spine wad also perfectly naturai. I 
therefore proceeded io cut away the bodies of the 
]umbar vertebrae in order to expose the cavity of 
the spinai canal, dose to the seat of the pain. 1 
found it filled with extravasated blood, which froni 
its florid colour must certairily haVe beéft arterìal, 
and which covered the whole of the caudà equina. 
The cavity appeated to be filled much higher up ; 
but I did not prosecute the dissection as it did not 
appear to me of much consequence to ascertain the 
exact limits of the extravasation, and the violence 
that must bave beén committed in openitìg the ca- 
vity Éirther, would bave rendered it difficult, if 
not impoasible, to teli precisely from v?tlat vessel the 
blood had issued. The originai seat of the pain 
would naturally lead me to suppose that the rupture 
must bave taken place near the commenCement of 
the cauda equina, and it is prob&ble the efiusion 
of blood stopped within that part of the cavity in- 
closed by the dorsal vertebra?, as there was no ap- 
pearance of it at the foramen magnum occipitale 
when the brain was examined. 

The blood, thòiìgh tìorid, Was notali òf an equal 
tint, it was very imperfectly coagulated; itis there- 
fore probable that the vessel first gave way at the 
commencement of the illness, and again to a much 
greater extetit at the time the convulsions carne on. 

I apprehend cases exactly of thi^ descriptìon bave 
not been very commonly seen ; but that similar 
ìnischief should fiequently occur, in consequence of 



tHÉCA VERTEBRALIS^ lOj 

VÌoleht straìns, is naturally to be expected : and I 
believe the foundation of carióus spine, which isof- 
ten laid by sudi accidénts, is not unfréquently at- 
tendedby some such mischief, which, as it raay take 
place in variots degrees, would account for the great 
disproportion óne Sées in examining a multitude of 
Cases of this sort, between the degree of curvature 
in the spine, and diminution of power in the lower 
extremities^ 

A child of là months old, who had just reco- 
vered from thè operation for hair Hp, was carried 
cut by the nurse. On its return home, it seemed 
in mach pam, and appeared to bave lost the use of 
its lower extremitieS: it died in three days. Onopett- 
ing the body I found the spinai canal full of a bloody 
serum, which, I have no doubt, was occasioned by 
slight extravasatìon from a strain and subsequent 
Inflammatory effusion. And how destructive such 
extravasatìon, and inflammation combined raay be 
to the structure and office of the nerves, was illus- 
tratedby the case of a miller, who suddenly lost the 
use of his lower extremitiesj, by lifting a heavy sack 
of flour. He died on the 15th day after the acci* 
dent. On examining the vertebral canal, some ex- 
travasated blood was found mixed with a sanious 
matter, the theca vertebraJis was evidently inflamed, 
and the nerves of the cauda equina more complete» 
ly rotten, than I have found them after many weeks* 
ftiaceration in putrid water, after removal from the 
dead body* 



106 THE THECA VERTEBRAJLIS. 

These cases seem to bave a very dose resem- 
blance to apoplexy, and point out the propriety of 
bleeding as early as possible after their occurrence), 
in order to prevent an increase of extravasation be- 
fore constitutional debility takes pla^e, and shew 
also the importance of distinguishing betwixt that 
primary weakness of the lower extremities, which 
is the direct result of the locai ìnjury, and that sub- 
sequent weakness in which indeed they wiU partir 
cipate, but which is the effect of the shock the con- 
stitution has received, and which probably does 
not fully predominate till several days after ; the 
intermediate time being occupied by more or less 
of symptomatic fever, which requirej a moderate 
antiphlogistic pian of treatment. 



OBSERVATIONS 



ON 



DIABETÉS INSIPIDUS. 

By JOHN BOSTOCK, M. D. 

t 

OF LIVERPOOL. 



Read Aprila, 1812. 



DlABEigplS INSIPIDUS, when existing as an 
idiopathìc disease, is of such rare occurrence, that 
I presume! the following case, which appears to me 
to be entitled to this appellation, will not be un- 
interesting to the Society*. 

* The rariiy of the disease is very deciàedly proved by this 
circuiDstance, that since the tìme of Willis, who first pointed pu^ 
the sweetness of the urine^ scarcely any distinetly detailed case 
of diabetes insipidus is on record. Cullen, with that tlegree of 
scepticism which is so characteristic of a philosophic mind, he- 
sitates whether he should admit its existence^ yet he informs us 
that he had seen one case in which the urine was not saccharine''^. 
The two cases related in Dr. Rollo's work, in which a large quan*^ 
tity of watery urine was evacuated, were consequent to a locai 
injury of the kidney, and therefore do not belong to this classf. 
No^ do I regard the case in Dr. Duncan's annals, as entitled to 
the appellation of diabetes ; it was attended with profuse perspi- 
ration, and it may be inferred from the remarks, that the ap- 

* First linei, 4, S5. Synop. % 246. f p. 224, 5. 



108 OBSERVATIONS OS 

Mrs* — , aged 50, about four years ago 

was under my care for a violent and long continued 
attack of menorrhagia, by which she was much re- 
duced in lier strength, but which was finally re- 
moved, and was fbUowed by a total > cessation of 
the menstrual dìscharge. She considered herself 
well, although a great degree of weakness re- 
mained ; she complained of being much fatigued 
- after using the least èxercise, and remarked that 
although her appetite was good, yet that her food 
never appeared to give ber any sypport. The ge- 
neral weakness and the peculiar /state of the sto- 
mach increased upon her, and at length becam$ 
so marked, that I was again called upon to visit 
her. The symptoms which she described, imme- 

diately led me to suspect diabetes, and I found 

< 

petite was impaired*. The only reiference made by Cullen is to 
Lister ; but upon an examination of thìs autbor^ I think it will 
be foundj that he believed in the exbtence of diabetes insipidus, 
increly upon hypotheticai grounds. What a conttast does the 
prudent cauti on of CuUen, present to the hasty decision of Sauva- 
ges, who peremptorily declares, that ali the diabetic cases of the 
ancients were insipida becaiise they do not mention the sweetness 
of the.urine> while it is admitted, that ever since the time of . 
WiUis» ali the cases bave been saccbarinef. In referring to Lis- 
ter» it may be proper to observe, that the opinion which has been 
brougbt forwards with, a cert;ain air of novelty, of the stomach 
and not the kidney being the primary seat of the disease, was 
implicitly declared and defended by this author a century ago |. 



" f " r 



♦ Dimcan'8 Ana. 1801. 390. 1802. 361. f No* Meth. 2. 384, 

X Exerc. Med. p. 74. 



DIABETE8 INSIPIDUS. 109 

that the quàntity of urine passed was much grenler 
than naturai^ and that the calls in the night wero 
so frequent as raaterially to injure her rest. I 
leamed that for some weeks she had sufifered fì*pm 
an unusual dpgree of scurlfìness of. the head^ sa 
much so, that it appeared every moming as if the 
whole cutìcle were removed, and if the hair was 
not daily cleaned, thè part was affected with the 
most intolerable itching. The whole surface of 
the body felt dry, and particularly the palms of 
the hands, but I did not perceive any eruption, 
except on the hairy scalp, or its immediate vicinity, 
Although the skin was frequently hot, yet she a§- 
«ured me that she never perspired, 

> 
The average quantity of urine passed by this 
patient in 24 hours, was 5 quarts; an ounce 
measure ' of it, which I examined, weighed 492 
grains : therefore the whóle quantity evacuated 
would be ^xactly I05;lb3. Troy. It was pale and 
nearly transparent ; it had a faint odour ; it slight- 
ly reddened litmus ; and the specimen upon which 
the foUowing experiments wej^e made, had the 
specific gravity of 1,034. The residuiim, which 
was left by slow evaporation, in its physical proper- 
ties did not seem to differ from the extract of 
healthy urine. It appeated, by a simple calcala-» 
tion, that she was discharging between nine and 
ten ounces of s«Jid water in th%24 hours ; this 
may be estimated at about 8^ ounces more than. 
that evacuated in the healthy state, while th? e-v 



HO OBSERVATIONS ON 

eess of water above the naturai quantity woùld be 
about 7lbs. Trojr*. 

The constituetits of the urine were then more 
particularly examined. A quantity of the extract 
wàs digested in alcohol, and when ali was removed 
that the alcohol was capable of dìssolving, the 
fluid was evaporated. The part left by the evapo- 
ration of the alcohol, was to the part which the 
alcohol did not dissolve in the proportion of 17 to 4j 

* The weight of the entire urine in the healthy state, and the 
proportion of the sohd contents to the watery part, can only he 
obtained by an average estimate, and that subject to great uncer- 
tainty, in consequence of the numerous circumstances wiiich 
produce a variation both in the quantity and the quality of this 
excretion. Haller, witb his accustomed diiigence and accum'cy, 
Las coUected a great body of authorities witb respect to the quan- 
tity of the urine, froni which he fixes it at 49 ounces daily. But 
in forming this estimate, he hàs not exercised that judicious dis- 
crimination for which he is'generally so conspicuous ; after stat- 
ing the diflèrent quantitìes that are given by diffèrent wiiters» 
(which vary from 28 to.64 ounces) he takes the general averagCi 
regarding the number more than the weight of bis authorities'^. 
The observations which appear to me by much the most accurate, 
are those of Rye, who fixes the quantity at 40 ounces f. The 
proportions which bave been assigned for the water, and the soUd 
contents of the urine are as various as those rcspecting the entire 
quantity. Haller has coUected diffèrent estiinates, which make 
the water from |g to fg J. Mr. Cruickshanks informs us, that 
the extent varies from ^j to y^ in the healthy state § ; perhaps 
we shall not be far ffom the truth, if we take the average at 
about ^. 



* £1. Phys. 26. 4, 6. f App. to Rogers on £pid. Diseases. 

X El.Phy*. 26.3, 14. § Thomson's Fourcroy, 3. 315. 



DIABETES INSIPIDUS. Ili 

and as the former of these consisted principally 
of urea, it appeared to be in this case ratìaer 
more than four times the weight of the saline sub- 
stances. By refei^iflig to the quantities mentioned 
above, it will be found that this patient was dis- 
charging daily about 7^ ounces of urea, and nearly 
2 of different saline substances. I could not dis- 
cover any portion of sugar in the urea, nor did I 
observe any thing peculiar in the nature of the 
salts. 

With respect to the proportion which the animai 
matter in the urine bears tò its saline ingredients, 
the statements of different writers are completely 
at variance- MM. Fourcroy and Vauquelin say, 
that the sàlts form . only »% of the weight of the 
extract*, while Mr. Cruickshanks informs us, that 
they amount f o about ^ of it, or, more exactly, 
that they are to each other as 315 to 220t. It is 
not imppssible, or even iraprobable, that the urine 
may diiSfer from itself so much in different states 
of the body, as that both these aCcounts may be 
correct, as applying to extreme cases ; but grant- 
ing this to be the case, they stili give us no idea of 
the average condition of the fluid. The results of 
two experiments, which I made with a good deal 
of attention, were that, in the first, the salts were 
tothe urea as 13 to .69, and in the 2d, as 24 to 
79 ; the average of these is as 1 to 4, a proportion 
which is not very far from the medium between 

* Ann. Chim. 31. 68. f Rollo, p. 439. 



112 OBSEKVATIONS OK 

the estìiiiates of the French chemists and Mr. 
Cruickshanks. Supposing that the whole of the 
soUd contents iixJthe healthy state, amount to 600. 
grs. the urea will compose 450, and the salts 150 
grs. ; my patient was therefore discharging daily 
abov^ 6 ouuces of urea, and above 1^ of sisdts 
more than the naturai quantity. Such a waste of 
the system, may point out to us the final cause of 
tlie ìncreased appetite for food, and the excessive 
thirst, which form some of the raost characteristic 
symptoms of diabetes. 

In endeavourìng to detect the presence of sugar 
in this urine, I employed the action of nitric acid, 
and concluded that there was no sugar, because 
no oxalic acid was formed. In order to try how 
far this method of reasoning was correct, a quan*- 
tity of pure urea, prepared from healthy urine, 
had y\f of its weight of sugar added to it, and 
upon it was poured 6 times its weight of a mixture 
of equal parts of nitric acid and water, and heat 
was then applìed. When it had been boiled to the 
consistehce of a thick syrup, and was beginnìng 
to assume a^tlark colour, showing that the nitriq 
acid was separated, it was removed from the lump; 
in a few hours crystals w^ere formed, which, afler 
being dissolvéd in water and reorystalliised, seemed 
to consist of pure oxalic acid. 

* 

With respect to the treatment which was adopt^ 
ed in this c;ise^ I shall make only a ^ery few re» 



blABETES INSIPIDUS. 118 

tiiarks. As tìie urine was not saccharìne, animai 
diet was not prescribed, and those remedies only 
e^fij^oyed which wére snpposed to bave tìie power 
of strengthening the digestive organs, and repró- 
ducing a healthy state of the skin. For the for- 
mer purposé the preparations of iron were chiefly 
relied on, and for the latter the warm bath ; but I 
suspect tìiat the morbid symptoms were so far con- 
aected, thatwhatever tended to relieve the one, 
was likewise beneficiai to the otìier. The result 
was completely successfìilj the constitutional a£ 
fections disappeared, the urine was reduced to the 
nafìiral standard, and the sur&ce regained its 
h^thy action. The patient has remained well 
ibr above li months. 

To the case that has been now detailed, I con- 
ceive the appellation of diabetes is strictly appli- 
cable ; it possesses the three pathognomonic symp- 
toms of the disease, the increased appetite for 
fbod, the suppression of the cutaneous dischaiige, 
and especially, the evacuation from the urinary 
organs of a larger quantity than ordinary of ani- 
mal matter. This latter circumstance is essen- 
tially diiièrentfrom the mere increase in the quantity 
of water, a morbid state which has been often con- 
fouiided with diabetes, but from which I regard it 
as totally dissimilar. The quantity of matter dis- 
charged from the urinary organs, when the disease 
is fiilly formed, or exists in an aggravated state, 
is so considerable, as to increase the specific gra- 

voL. ni. I 



114 OBSERVATIONS ON 

vity of the fluid, iiotwithstanding the great increase 
in its quantity*. In thìs case it appeared, that 
the specimen upon which the experiments were 
made, which was obtained after the patìent had 
been for some time without evacuating the bladder, 
had its specific gravìty considerably increased, al- 
though the average specific gravity of the urine 
passed during the 24 hours, was not above the or- 
dinary standard. Although cases of diabetes in- 
sipidus bave been so seldom noticed, yet I am dis- 
posed to believe, that it is a more fi'equent occur- 
rence than is generally imagined. It is seldom 
that the attention is directed with so much mi- 
nuteness to the urinary discharge, as to enable the 
practitioner to ascertain the nature of its ingre- 
dients, and should the increase of its quantity be 
noticed, it is thought to be accounted for, by the 
increased quantity of fluids that are employed to 
allay the thirst. 

We are perhaps not able to decide with perfect 
certainty, whether this disease be the commence- 
ment of the diabetes mellitus, or has a tendency 
to terminate in this state. I conceive, however, 
that the opinion is in itself probable, and it ap^ 
pears to be strongly confirmed by a case which 
occurred to Dr. Lewin, of Liverpool, the parti- 
culars of which he communicated to me, and upon 
which, at bis request, I madé some experiments. 

* Henry in Medico-Chirurg. Trans. IL 119. 



J 



I DiABEfES INSIPIDUS. 115 



The patient was a hùddle aged female, and had a 
variety of complaints ìndicating general debility, 
and a decayed state of the digestive organs, which 
led him to suspect the existence of diabetes ; and 
upon inquiry^ he found that the urine was rather 
more copious than naturai» He sent me a quan-* 
tity for exatnination, the general results of which 
were as follows. It was somewhat opake, and of 
rather a browner colour than naturai ; by stand- 
ing, it deposited a sediment, and then became 
more transparent. The difFerent re-agents prò* 
duced nearly the usuftl effects, except that the 
scaly crystals, formed by adding nitric acid to the 
urea, were less distinctly visible than ordinary.^ I 
thought the odour of the urea was le^s urinous 
than naturai, but I was unable td procure from it 
any oxalic acid by heating it with nitric acid. 

Dr. Lewin afterwards sent me a second speci- 
men of urine, discharged by the same patient, the 
properties of which were, in sever^l respects, dif- 
ierent from what I had before examined. It wa3 
more opake, and deposited a greater quantity of 
sediment, its odour was sourish, and scarcely urj- 
nous* The extract produced by a slow evapora- 
tion, instead of being granulated, was of the con- 
sistence of a thick syrup, and when nitric acid 
was added, the scaly crystals were only imper- 
fectly formed, and mixed with a quantity of un- 
crystallized matter. This half crystallized mass 
had a fresh quantity of nitric acid paured upon it, 

l 2 



116 OBSERVATIONS ON 

and the beat of a lamp applied ; a brisk efferves* 
cence was excited, and a vapor disengaged, which 
had the odour of nitro-muriatic acid. The prò- 
cess was continued until the fluid was nearly eva- 
porated, and a mass was obtained, which, when 
cold, resembied candied honey. This was dis- 
solved in water and partly evaporated, and in 24 
hòurs some fine spicular crystals were formed, 
which produced a copious precipitate with lime 
water, and exhibited every property of oxalic acid. 
The result of this exaraination appeared to me so 
important, that I was desirous ot having it con- 
firmed by Dr. Henry, and I accordingly sent him 
a quantity of the solution of the honey-like sub- 
stance. He replies to me as foUows : " The small- 
er phial unquestionably contains oxalic acid, as I 
determined not merely by the fact of a precipita- 
tion, but by examining the precipitate, which, in 
ali its characters, answered to oxalate of lime.*' 

To Dr. Lewin's sagacity in detecting the nature 
of the disease in this early stage, we may consider 
ourselves as indebted for the important fact, that 
a small quantity of sugar can exist in mine along 
with a largè quantity of urea*. The case is almost 

. * The fact bere statcd is preciaely the cscmverse of that ad- 
v.anced by Dr. Henry ; he discovered that a small quantity of 
wrea can exist in urine with a large quantity of sugar, wliile I 
bave detected a small quantity of sugar united to a large quantity 
òf urea. These facts may bc considered as mutually illustrating 
each otber, and become more interesting by their contrast. 



BIABETES INSIPIDUS. 117 

eqiially decisive in favour of the conversioni of the 
insipida into the saccharine diabetes, and renders 
ìt probable that the two states alternate with each 
other, until, as the constitution becomes more and 
more impaired, the saccharine state of the urine 
predominates. 

I bave referred above to that morbid state of the 
urinary discharge, in which a large quantity of 
fluid is evacuated, but in which the animai matter 
exists in less proportion than naturai. Such cases 
bave generally been considered as diabetìc ; but I 
am disposed to doubt the propriety of the denomi- 
nation, and to regard them either as the sequel of 
proper diabetes, or afièctions of a totally difterent 
nature, perhaps orìginating in a disease of the kid- 
ney*. A remarkable instance of a large discharge 
of watery urine, lately occurred to Dr. M'Cartney, 
one of the physicians to the Liverpool Infirmary, 
who sent me some of the fluid for examination. 
Upon pouring it from the bottle in which it wa« 
contained, it seemed so very unlike urine, that I 
coQcluded there had been some mistake respecting 
it, and requésted that a fresh specimen might be 
procured. It appeared, howeverj that my suspi- 
cion was withojj^ foundation, for I received a se- 
cond quantity,^ ip^hich exhibited exactly the same 
properties with the first. 

* I gave an account of a case of this kind some years ago, 
wbich I called diabetes insipidus, but as I now conceive, incor- 
reetly.— Mera, of Lond. Med. Soc. VI. 258. 



118 OBSERVATIONS ON 

It was nearly without colour and smeli, slightly 
opake, neìthe;r acid nor alkalìne, and had a spe- 
cific gravity not much superior to that of water*. 
At the time when the patìent was discharging 4f^ 
quarts in the 24 hours, the sólid extract amounted 
to no more than ihs part of the weight of the fluid. 
The action of nitric acid upon the extract pro- 
duced a kind of spongy mass, in which the scaly 
crystals were scarcely, if at ali, perceptìble, nor 
was ^ny oxalic acid formed when an additional 
quantity of nitric acid was heated with it. The 
oxymuriate of mercury threw down a slight floccu- 
lent precipitate, which was rendered more dense 
by boiling, but no effect was produced by beat 
alone, por by the addìtion of tan. The other re- 
agents, commonly employed to detect the salts pf 
the urine, threw down precipitatesi which seemed 
to be in the usuai proportion to each other, but in 
smaller quantity than ordinary. Heated alcohol 
dissolved about 3- of the extract j the alcohol, upon 
being evaporated, left a brown substance, which 
in its extérnal appearance bore a resemblance to 
the urea, but which was found to diifer from it in 
b^ing reducible by a moderate beat to a dry state^ 
when it assumed a kind of crystalline appearance. 
JSTor did it produce any of the scaJy matter with 
nitric acid, Upon the addition o^ this substanccj^ 
there was a considerable efTervescence, and the ex- 
tract was converted into a spongy mass^. that ap-» 

* l)r. Henry, to whom I sent a. specimeaof tbii uiìqc^ ^i-* 
inated the specific gravity at 1,0058. 



DIABETES INSIMDUS, 119 

peared to be composed of very minute cubìcal 
crystals, of nearly a white colour. That part of* 
the extract, which was not soluble in alcohol, was 
chiefly dissplved by water ; but a portion was left, 
which when separated and dried, had the appear»- 
ance of a fine black carbonaceous powder : it com- 
posed about ^ of the mass which was not soluble in 
alcohoL The composition of the extract would 
therefore be nearly as foUows : 63 parts of a saline 
mass, which seemed to consist of the usuai muria-p 
tic and phosphoric salts, 26 parts of an animai 
matter, and 1 1 parts of the carbonaceous powder. 
The urine soon acquired a nauseous smeli, became 
slightly alkaline^ and deposited a small quantity of 
a flaky sediment j but it afterwards remained for 
severa! months exposed to the atmosphere, with-? 
out experìencing aìiy farther change. 

I relate this case rather as exhibiting a singular 
and curìous state of the urìnary discharge, tlian as 
directly leading to any physiological conclusions, 
One circumstance, however,is worthy of notice, that 
in this, as well as in the case of watery urine which 
I formerly published, the deficiency of the salts is 
not so considerable as of the animai matter. In this 
respect the urine seems to be analogous to the al- 
bmmnous fiuids of the body : for in the elaborate 
experìmeiits of Dr. Marcet» which bave been re- 
lated to the Society^ the salts were always found 
liearly in the same quantity, however various was 
^e proportion of the anìnial matter ; a circum« 



129 OBSERVATIONS OH 

stance which coìncìdes with my own experiments 
on these substances. 

Knotshole Bank, ncar Idverpool, 
Aprii 18, 1812. 



Eaperiments on ilie ]Ea:ttact Jrom Diabetjic tirine* 

The following train of facts, although not im- 
medìately connected with the subject q£ the abov« 
paper, I consider not undeservìng the notice of the 
Society, as tending to throw some light upon the na- 
ture of the extract procured from the urine of dia^ 
betes mellitus* 

About eight years ago, I procured some diabetic 
extract from urine, which was so highly saccharìne^ 
that by mere evaporation at a low temperature, 
the whole was converted into a dry substance, of 
a granulated and half crystallized texture, which 
in its appearance very nearly resembled fine brown 
sugar. It retnained for a long time without un- 
dergoing any alterations ; but having been placed 
in a damp room durìng the last winter, upon ex- 
amining it some weeks ago, I found its appearance 
entirely changed* The paper containing it, which 
consisted of several foids, was covered with a thick 
coating of mould, not uniike the mouid of cheese. 
The substance that remained within the paper- was 
much diminished in bulk, and had lost ali appear- 
ance of sug^r i it was of a viscid consistence, and 



looked like balf meked glue ; it was of à brown 
Golour and musty smelL It seemed io experìence 
no f^rther ehange by exposure to the atmosphere. 
Water, when boiled with it, was tinged of a light 
brown colour ; the substance seemed tó be rendered 
whiter, but it did npt appear to be soluble i^ thì$ 
fluid. Boiling alcohol rendered the substance 
harder and wjiiter, but no solution was efiected. 
Caustic potash, when assisted by beat, dissolved it 
in moderate quantity; the solution was brown, 
soapy in its consistence, and frothed much when 
boiled ; sulphurìc acid threw down a white flaky 
precipitate from the solution. Nitric acid, when 
diluted with an equal bulk of water, soon began 
to act upon this substance ; when heated to ebulli- 
tion the substance was dissolved, with the disen- 
gagement, first of nitric vapor, afterwards of ni- 
trous gas. The colour of the acid was much deep- 
ened, and its consistence was thickened; as it 
cooled, some flakes separated that resembled a • 
concrete oil : the acid had acquired that peculìar 
odour which attends the action of nitric acid upon 
the muscular fibre. When potash was added in 
excess, the nitric solution acquired a deep orange 
colour, a grey precipitate was thrown down, and 
the fluid was left nearly transparent. When am- 
monia was added to the nitric solution, there was 
a very copious emission of white fumes, and the 
same ehange of colour as with potash. 

These experìments were sufficient to show, that 



122 OBSEEVATIONS ON DIABETES INSIPIDUS* 

the saccharine extract had been converted into & 
substance very nearly resembling coagulated albu-. 
men. It is probable that the albumen must bave 
existed in the first instance, mixed with the sac- 
charine matter; but in what way the saccharine 
matter was decomposed, and the albumen coagu* 
lated, are points that I confess myself not able to 
detennine. 



CASES 

OF 

PREMATURE LABOTJR 

ARTiriCIALLY INDUCED, IN 

WOMEN WITir DISTORTED PELVIS; 

TO WHICH AR£ SUBJOINED 

SOME OBSERVATIONS 

ON THIS 

METHOD OF PRACTICE. 
By SAMUEL MERRIMAN, M. D. 

PHYSICIAN-ACCOUCHEUR TO THE MIDDLESEX HOSPITAL^ AND TO 
THE WESTMINSTER GENERAL DISPENSARY. 



==^ 



Read Mm/ 12, 1813. 



J\j[rS. pope, 21 years of age, had been many 
hours in labour of ber first cbild, under the care of 
a midwife, when my assistance was requested, oq 
account of the difficulty of the case. Whcn I ar- 
rived at the house, I was infbrmed that the difficulty 
arose, from the heads of two chìldren being in the 
pelvìs together; but upon an examination per. m-^ 
gimmj I diseovered, that the projection of the sa- 
crum had been mistaken by the midwife for the 
^ead of a second ^hìld* As the dìstortion of the 
pelvis was so great, it was evident, that the labour 
puld not be terminated safely to the mother, un- 



126 CASES OF LABOUR 

a fall, or some other accident, which threw her in* 
to premature labour. I was informed, that upon 
this occasion, her delivery was effected without 
difficulty, and thè child was bom, with so much of 
life, as to cry faintly once or twice, before it ex- 
pired. 

In November, 1 809, she fell into labour of her 
second child, at the full period of gestation. It 
was now for the first time discovered, that ber pel- 
vis was very much defòrmed, and that there was 
no possibility of the delivery beìng effected, with- 
out extraordinary assistance. The surgeon-accou- 
cheur in attendance therefore requested, that there 
should he a consultation upon the measures to be 
adopted; and two physician-accoucheurs being 
joined in consultation with him, it was judged ab- 
solutely necessary, to bave immediate resource to 
the perforator. Accordingly the contents of the 
cranium were evacuated, but it was not till after a 
V. very long, hard labour, that the child could be 

brought into the world. 

In her third pregnancy,^ she consulted with Dr. 
Denman, and myself, respecting the expediency 
of having premature labour brought on. As we 
both agreed in opinion, that this would give the 
only chance of her being delivered of a living 
child, it was detenriined to perform the operation» 
Having, as she believed, completed seven months 
and a fortnight of her pregnancy, and being in good 

S 



AftTIFlCIALLt INDUCED. 127 

health, I punctured the membranes, in the even- 
ing of Tuesday, Febraary 13, 1811. The pains of 
labour began, in the night of Thursday the 15th, 
and I was sent for the next moming, when I had 
the mortification of finding the child^s arm in the 
vagina. 

Having apprì^ed Dr. Denman of this untoward 
position of the child, he carne immediately to see 
the patient, and to afford his advice and assistance. 
The OS uteri appearìng to be dilateable, I cautious- 
ly endeavoured to introduce my band, for the pur- 
pose of tuming the child; but the irritation this 
produced, threw the uterus into such strong action, 
that we thought it more prudent to desist, and to 
allow some more hours to pass over, before another 
attempt should be made. We expected, that, in 
the meafi time, the parts would become more dilat- 
ed, and as the child was small, that the feet would 
be forced by the pains, nearer to the os uteri, by 
which the operation of turning would be much &- 
cilitated. 

At 8 o'clock in the evening, I made another at- 
tempt to tum the child, and accomplished it, with- 
out more difficulty than usually occurs in tuming, 
in a contracted uterus, after the liquor amnii has 
been so many hours evacuated. 

The feet, being brought into the vagina, were 
soon expelled by a pain, and almost immediately 



1 28 CASES OF LABOUR 

afterwards the hips protruded through the os e^t- 
temum« At thìs time^ the pulsation in the ftmis was 
strong, and the child vigorous; but when the head 
became wedged in the narrow part of the pelvis, 
the navel string was so much compressed, as soon 
to occasion the child's death. It was nearly half 
an hour before the head could be brought ìnto the 
world, though the action of the uterus continued 
very strong^ at ìntervals, during the whole time. 

Immediately after delivery, the mother was seized 
with a very violent shivering fit, of more than an 
hour's duration. This was fbllowed by so great a^ 
degree of fever and delirium, as to create consider- 
able alarm for her safety; and I was, in conse- 
quence, induced to order for her, an active cathar- 
tic, preceded by a dose of calomel, in a very few 
hours after deUvery. From these remedies, a co- 
pìous evacuation of very offensive dark coloured 
foeces was procured, which gave her great relief. In- 
deed it is probable, that the early exhibition of tliese 
purgatives saved her life, for her fever ran very 
high, and she continued in a very dangerous state, 
fbr seven or eight days. At length however she 
perfectly recovered. 

Mrs. Jenkins, 22 years of age, in labour of her 
first child, was attended by a veiTy experìenced ikiid- 
wife. Her labour began on the 1 5th of November, 
1 808. During the first twenty-four hours, the paìns 
were irequent but slìght, the liquor ammi was then 



ARTIFICIALLY nmCTCED. 189 

evacuated spontaneously, and the paiiìs become 
veiy strong and frequenta but the child's head 
made little progress, in descending into the pelvì^é 
My assistance was therefore requested on the 1 7th 
in the evening* This woman had been extremely 
ricketty when a child, and the pelvìs was in conse- 
quence very much deformèd. 

I believed it necessary to bave recourse to the 
perforator without delay, and having removed one^ 
parìetal bone, I left ber under the care of the mid- 
wife, that the pains might force the head, thus di* 
minished, lower into the pelvis. At the end of 
five or six hQurs, finding that no apparent progress 
was made in the labour, I endeavoured to extract 
the head, by the help of the blunt hook, but could % 
net finish the delivery without great difficulty. 

At the beginning of the présent year (1812), I 
leamt, that this poor woman was again pregnant \ 
and being convinced by anexamìnation, to which, at 
my rèquest, she iiow again submitted, that it would 
be impossible to deliver ber of a living child at the 
full period of utero-gestation, I determined with 
her ready consent on performing the operation for 
inducing premature labour. Accordingly on Wed- 
nesday, March 4, 1812, 1 punctured the membranes 
in the evening, giving her àfterwards a dose of tinct. 
opii. Labour pains carne on, Monday, March 9tb, 
and she was delivered of a live child on Tuesday, 
lOth, after about eighteen hours of very strong la- 

VOL. III. ^ K 



bcnif. Tlié ]^oJ€ictìk»Q> of the sacruaii oceupied. so 
tùuch s^Qe ìa the pelvia» asta pcoduce a very 
iBArk^ df I»re»sioBb of the rìght parìetal bone^ which 
cKd not recovej* it9 shape. far four or five days« 

Attila time the operation waa performed, Mrs» Jen- 
kìns reckoned that she had ad^anced about nine « 
ten day s beyond the seventh month of gestation ; so 
l^at the child» at it3. hirtìi, mast bave been ^ithìn a 
£>rtmght of eight months' grò wth. It is at preseat 
a thriving child ; and there is great i^éason ta be- 
lieve» that it will he reared to maturity* 



The praotìce of indudng prematura labour, in 
cases qf distorted pelvis, was first- adopted in Lon* 
don, as is well known, about the year 1756*; when 
fliere waa beld a consultation of the most eminent 
practitioners of midwiferyj ** to consider of tìie 
moral rectitude of, and the advantages that might 
bederìved from, the practice, v^hich met with tfaeir 
general approbationt;** 

The morality of the practice, though it has 

*The introductìonof this method of practice bas been errone* 
ouflly attributed to Mr. Barlow, of Blackbuniy in Lancashire^ 
wbo published severa! cases of the issue of this practice^ in 1800. 
It hàd'been mentìoned» by authors and lecturers on midwifery 
long befmrehis paper was published. 

t Dennum'ìB Introductkm to Midwifery^ 4ta p. 996. 



ARTIFICiALLr INDUCED. 131 

been irni^h questioned since this time, does not 
appear to have beèn doubted by these experienced 
practitiónefis. For the proposai was, that labour 
shouid be brought on at seven months, in Ijiose 
casea onlyj where it had been previously ascertaìn'- 
ed, that the pelvìs was too much contracted, to al* 
lòw a foli sìzed foetus to pass undiminished» By 
Ibis operation, therefore, it was proposed to give a 
chance to the mother of bearing a living child at 
seven months, which must of necessity be sacrificed 
to her safety at nine months. The idea was pro*- 
bably suggested, by the success which had occa^^ 
sionally attended the practicej recommended by 
Guillemeau and others, of rupturing the mem- 
branes at an early perìod, in cases of profuse ute- 
rine haemorrhage, during pregnancy. 

Objections to the morality of this practìce^^ are 
much more frequent in the writings df fbreign 
practitioners of midwiféry, than in those of this 
country. Sue» Baudelocque, and Gardieu, ali ac* 
coucheurs of great celebrity in France, decidedly 
òbject to it, not oiAy because they Ihink that the 
practice is contrary to the laws of iiàture, but be- 
cause they say it is not to be depended upon, ei- 
ther for lessening the sufferings of the mother, or 
for saving the life of the child*. M. Gardieu 

* n y a déjà long temps que M. Petit a conseillé et fait prt- 
fiquer Faccouchetnent premature daiis le cas de difK)rinité aux os 
dn bassin. IT a memè propose à ce sujet des moyens, dans le 
détail desquels ce n'egt* pas ici le lieu d'eiitrer^ avec d'autant plus 

K 2 de 



182 CASES OF LA30UR 

tells US, that it lays the fbundation for cancers and 
other dreadful diseases of the womb, and thinks 
that a woman had better run the risk of the Cesa- 
rean operation, or the divìsion of the symphysis 
pubis, than submit to this operation*. The pb- 
jections of these celebrated French accoucheurs, 
•are plainly the result of a theoretical investigatiori 
of this method, for they acknowledge that they 
bave had little or no experience of it. 

•è 

de raisoiìj qu'il faudroit d'abord que les casuistes et les théologiens 
éussent décide s'il est permis d^accélérer par art, une fonction à 
4aqueUe la nature a assigné un terme fìxe, et si on peut courìr les 
risques de la vie inceilaine de l'enfant, pour assurer celle de la 
mere. Sue, Essais hjstoriques sur TArt des Accouchemcns. T, il 
p. 606. • 

L'accouchement premature obtenu par de semblables moyens, 
est toujours si peu favorable à Tenfant, qu'il nous scroble qu'on 
ne devroit le permettre que dans ces cas d'hemorrhagies abon- 
dantes, qui ne laissènt d'espoir de salut pour la femme que dans 
$atlelivrance. 

li'accouchement premature, si on le sollicitoit constamment 
au méme terme, pourroit ètre aussi long, aussi laborieux, et tout 
^tissi infructueux, méme aussi ìmpossible en quelque cas, que si 
fon n'eut enterpris de délìvrer la lemme qu'au neuvieme mois. 

Baudelocque, Traité des Accòuchemens, T. 2, p. 344. 

* La lemme estatteinte d'une inflammation de la ma* 

trlce, qui est urie suite du travail contre nature, et des efibrts ne- 
cessaires pour ouvrir le col, qui ne se trouve pas disposa favorable- 
ment : si elle ne succombe pas aux accidens primitifs, elle est ex- 
posée par la suite aux squirres, aux ulceres, aux cancert de la ma- 
trice qui lui rende la vie à charge, et luì feroient préferer d'avoir 
respecté la grosse^se, au risque de s'etre exposée aux dangers qu'- 
auroienf pu lui faire courir l'urie des deux operations [L'opera- 
tion Céuarienne ou la section du pubis] qui deyient nécessaire pour 
•pcrer la delivrance dans ces rétrécissemens extrèmes. 

Gardieu, Traité d'accouchemens^ T. iii. p. IS. 



ARTIFICIAILY INBUOED* ISS 

The gcnerality <rf* writers admit the safety of 
,the practice, as far as it regards the mother : per- 
haps the safety of the practice has been too gene* 
rally adxnitted. Dr. Denman, in relating the par- 
ticulars of a case which he attended wlth the late 
Dr. Savage, says, " on the following day, (after 
the evacuation of the liquor amnii,) she had a ri- 
gor, succeeded by heat and other symptoms of fe- 
ver, which v^y much alarmed us for the event*^'V 
And a lady in the country upon whom thià method 
was trìed, was seized with severe shivering fits, 
foUowed by so much fòver, as maHe her relations 
and medicai attendants despair for some days of 
her recovery t. In the cases above related, one of 
the patients, Mts. North, was fqr several days in a 
state x)f great perii; It may.be aUeged that the 
danger which she ex]^erienced, arose rather ftom 
the mal-position of the child, requhing it to be 
tumed in utero, than from the premature excite* 
ment of labour ; bnt I am more indined to attri- 
buto the severe shivering fit, which attacked hèr, 
to the latter cause, because diiverìng seems to be 
no unusual consequence pi this operation, 

Whether the death of the mother has ever oc- 
ciirred firom ibis method of practice, I am uhable 
to state positively. I bave beard of three women 
who died in s^few days after delivery thus artifidally 

* Introduction to the Practice of Mìdwifery, 4to. p, 398, 
f Communicated to me hy the lady^n iisl^r* 



194 fiAflU ogp x^ou» 

ìaàwéd^ and tbeir dwthis wéce ^ttril>iited to the 
operajtion ; but ^heth^ justly or npt^ I mi 90t 
gutfficiently lu^quainted with ali the circuoastaooes 
to judge. At ali evento, the method in question, 
if careiully cooducted, cannot be more hasardom 
to the mother, perhi^s i$ mudi less so, tban .tibe 
oparatioo f<^ lessening the head of the foetus m 
utero, and it is ìncomparably iess perilous than the 
Geaarean operation,. or the division of the symj^y- 
Bbputtt9. 

Hie best de&nce of ^ practice, however, ìa 
derived £rom the .chance it affiurds of preserving 
dae Bfe of the ckM* In Iììb greater nuinber of 
instances. indeed, the child will eìther he dead 
bom, or will he horn ndth &o little li& as to expire 
in a few haucs ; but in naany cases the child has 
iièen preserved. 



* • 



... Dr..]Denman»in.his Introductìon to the Practice 
jdf iMidwi£ery, xeportis tmbm càses of this opera- 
tìon, and adds^ that the xùs^onty o£ the children 
were born ialive, but does not mention thè «ìcad; 

Mr. Barlow, a surgeon of great respectability 
and celeèrìty at Blackburn in Lancashire, publii^hed 
in the ath volume of the ^^ Medicai Facts and Ob*- 
servations,'* seventeen cases. Six of the children 
were dead born, mà^ve others, though born with 



ARTIIfCtAlcLT INOOGED. Ì89 



died ih a -fewhdurs; but ^W^re bom 
aad capaWe oFiàving*/ In the Mh Volume <tf 
tte ** Lottdoii Medicai Review and Magazine^' ^ 
1 800, #erte^ rqrarted ieh casès of this operation^ 
with which I became acquainted, from , their hav* 
ing occurred in thè practice of my un eie, Dy. 
Merriman* Four of these childreri wcre bórn liv- 
ing, atìd fikély to live. At the commencetnent of 
^6 paper,; I bave detailed' one succe^sful, and 
ikreq unsilocessful cases, and I bave fìirdier tò res* 
port, &òmlhé infonnation of my fdend, Mf. Mar# 
lAiatl, sui^ean; of Hàlf-'Moon Street, IHccadìUy^ 
Jòur o^&ìBT cases, one of M^iiehjwas comptetely 8uc> 
eeslsUd* Thus oiit oS forty^seoen instaneed of di^ 
iòrted pehjs, in which this opttation had hetìx 
fitactìsed, at least nmeteen diildren had been boni 
aliVe, and capabk of living. 

If it be considered, that ih ail these casea, the 
degree of distortion of the pelvis was so great, as 
it> preclùde the posfisibifity of a fbetus^at liine 

§ 

* Mr/Barkmr has descr^bed Ihefime vheQ the <»peration fiipuld 
be perfotmed^ rather inaccurately. He .says>. ** ny metbod coD- 
sists in exciting premature labour, .early in the seventh montk of 
pregnancy ; but he shouid haye sàiàearfy in theeightH month, that 
is after tJie qfier the sevtsnth móntH is -comphtei, 'Éariy 'm tl)^ se- 
^ Venth inomiVh^ itnplies ik ììtùt nbotì after the sixth inòfàh irMnpttied, 
ut wfaicb titoe tbexe is no^ancé of the chìld surrivingy-even ^MM||h 
jyt^hottld be bom a)ive. That Mr. Barlow meant f^^r the opeia- 
tion to be performed at seven. complete months, is apparent from 
bis afterwards saying« that " the chiM at geven mònih old has a 
sufficiedtthaface tif ^uirviving the birth/' 



136 CASES OF tAtoVK 

móhihs ùf gèst^tìùn passing alive, or undlìminìshed) 
there is^ I presume, sufiicient proof that the prac- 
tìce is not oàly adtnìssible, but Ihat it ought to be 
recòmmended in such deplòrable cases of distorted 
pelvis. 

* In móst of the unsuccessftd cases, the cau^ of 
the child's death was either not at ali adverted to, 
òr has not: been made known ; but this is a point 
that desèrves attention. In many instances thè 
death of the cbild sèems to bave tak^n place ìm- 
xnediately after the severe rigors and fever, already 
alluded to, whìch attacked the motbars within a 
<iay or two after the liqtior amnii was èvacuated« 
It is possible that by proper management after the 
operation, these nnfavorable symptoms may occa- 
sionally be averted. It appears likewìse, that a 
preteritural presentatìon rf the fcetus wa, . fte. 
c[ùent cause of the child's death. 

Dr^ Defnman does not take notice of any case 
of cross birth, among the twelve that he has re- 
corded, but amorig Mr. BarloVs cases, there are 
at least two of pretematural presentation : in two 
o£ the cases communicated to me by Mr. Marshall, 
and in jf5t(r of thosp which bave oc^urred within 
my own knowledge, the presentations were like- 
wise pretematural :— in ali these cases, the child- 
ren were dead bom, probably from this cai&e. 
The proportion of pretematural presentations, acr 
cording to this estimate, is about one in sdx* 



ARTIÈICIALLT INDUC£D« ISt 

li may be proper to enquìre» wbe&er pretenu^ 
turai presentations are equally firéquent, in laboui» 
which occur spontaneously before the proper pe^ 
riod ? But the detèrmìnation of this question ré- 
quìres more data than I at present possess. I ha^ 
however now before me, a list of seventtf^ght 
kbours occurrìng prematurely, eitlser from tàe 
spontaneous action of the womb, orfrom accident- 
al vìolence, and I iind that among them, d^ere 
were seventeen cases of preternaturàl presehtation> 
viz. 7 of the nates, ■ , 

5 of the feet, 

3 of the arm» . 

1 of both hands. 

1 of the funis, 
but I should suspect that this giyes a greater aver- 
age of preternatural presentations, than commonly 
happens in preJEuatwe labours occurrìng sponta- 
neously*. 

^ Authors are mach divided in opinion^ respeeting tbe proporr 
tionfr of preternatural presentations of the fbetiis^ at the full tiqoe 
of gestation. Smellie estimates the proportion at 1 in 100. PrcH 
.&s^pr Camper, of Ameterdami from the documenta af]R)tfded by 
Messrs. Titzing and Beckman, reckons them at not more than 1 
in 150; and Professor Jacobs^ in his *' Ecole pratique des- Ac* 
iDouchemens/' published at Ghent^ in I78d> states the average qt 
preternatural presentations at not mor^ than 1 in 160« On.vthe 
contrary, Dr. Blanda who has made the calculation with great ex* 
aclness^ from the registecs of the We&tminster General Dispen" 
eary, (Philos. Trans. VoL LXXI.) states the average of pretérna- 
tiiral presentations at 1 in 30 ; there having occurred in 1897 la- 
|[>ours^ ' 36 presentations of the nates^ 

18 ,.,.., of the feet, 

8 pre» 



^ \ 



■Ì4 



i^9 C44B9 <>F I^ÀBOUit i^ 

/.-ft Ims beeti iimb^eiA t^f mquiry, wbetber «o^er 
^rcumstanees, b^ides distoFtìon of the {^elvis, do 
not sometiines exìst durìlìg |>r€tgnaj[iey to make the 
iiiducément df ^vexoatìxre labour exp^dksiìt : ^as in 
c^aes of extreme iweakness, €»r iUness on tèe pìart 
idf tìiemodiet» Avhose recavery seómed to be im^ 
pMstble if bar gestatàtm wem sufferied to coBtiiiue ; 
m iùiaome ^' the more severe <:omplaiiìts peeuUar 
to f)r€^aney, whìch were tìnagiaed to pkce the 
Hftotberf^Ufe mirnvcmeot danger. An extenaioa 
of the practice to subch cases htis \feen strongly r&- 



8 presentations of the àrms, 
1 t óf %he fame. 

If the average given b^' Dt..!Bland> is What usually occurs^ 

other authors cannot hav6 been suffiQÌet^]y (accurate in their cal^ 

qulations : perhags tl^iey only mean to apeak of si^ch cases ^f pre- 

ternatural pres^tation as require extraordinary assistance. That 

ihèy bave òtnittedto enumerate many hates and feet presenta- 

-iàon», u reiideréd ^^ébabk from the feDowing hcti Messrs. TH>- 

zing and Beckman, state the number of arm presentatMHis iii 18 

years at 98, of the nates at 66, of the feet at 61. But it is well 

teo^Oj ^that nates and téet presentations are muGh more freqiient 

-tfaan thòse of the arm ; so fiiat it cannot he doùbfeed tj;>at fnany óf 

-ihe former «must have been overloòked. 

' t^ «goiotness of Dr. Bland's calculatsons faas been strongfy , 
«onfiirmed, by the retura c^ pretérnutttral presentatiOAs, vhidi oc- 
iscHTdL in the ^' Maison d'a^ouchem^is/' at Paris, during a pe* 
rioS of nearly tén years, to May 31st, 1809: From this it appearH, 
that upon an avera^ pretematural- presentations faappened tmee 
* fn 27f labours : of thesc 

396 were presentations of the nates, 

215 ...of the feet, 

«ndonly 60 -.../; of the superior extreuiities. 

The number of feb^ours from which the average is drawn, H& 
17,499. 



This gentleman says, ** The preservatìon of the 
étólé ìs Dbviously the ^ma^ <^ject j^r the hmkg" 
w^ on of ]^einature labo^^ in the distorted pelyìsi 
y^tìi the safety of the mother, under particuka: 
circumst^aices wUbout distortion, ^ould require 
iimihr means tp he employed» with safety to the 
chikl^ wcely no good rea^on can be assìgi>ed^ why 
thf^y ooght not tP be adopted/' 

ìf indeed it could be proved, that the safety df 
tbe motber required such a mode of practice^ an4 
&at the safety of the icbìld woald not be impUcated 
by the operatìon^ the argument mìght bave some 
weìgbt, but it seems hasty to assume that sucb .if^ 
Jhe fact. 

£ven in the case which the author adduces in 
support of this recommendation, it may be doubt* 
ed whether the safety of the mother required thÌ3 
^gaiethod of procedure* <Sh€ was indeed t^ased witb 
avery sev^e coi^h, and ber stojmach was^io irrita^ 
ble as to retain no food whatsoever, nor even opiut9 
in a solid form* . She had taken absorbents, stom^ 
chics, bitters, aromatics, and opiates without experi- 
encing any relief ; liniments, fòmentations, and 
blisters, had been externally applied without bene- 
fit, and she was tliought to be sìnking into ber 
grave» when it w^ i^Pposed, as alast resQurce, to 

6 



14Ù CASES OF LABOUR 

hdng on premature labour, six weeks befbre tìi« 
ifìill time, and the patient was delivered of a liv» 
ing child, and ultimately recovered. 

Men in extensive practice in midwifery must bc 
tware, tìiat the state ù£ irritabìlity of stomach bere 
described, occasianally takes place at ali stagès é£ 
pregnaney ; that however severe it, may be, the 
complaint frequéntly ceases before the termination 
of the prégnancy, and that very small quantitìes 
of simple diet, containìng but little riourishment, 
and nothing stimulating, will, under such circum- 
stances, support the mother for an inconceivably 
long space of time, without destroying, or injuring 
the foetus. It may likewise be remarked, that 
this state of irritabìlity of stomàch is generally 
connected with more or less of inflammatory acti- 
on, either in that viscus, or in some of the nei^-» 
bouring parts ; to relieve which, bleeding is per- 
haps, of ali others, the most appropriate rémedy : 
while cordials, and aromatics serve but to aggra- 
vate the complaint. Now as the patient in ques- 
4ion took remedies .of the latter class, while the 
former appears to bave been neglected, I think 
this case cannot be held up, as a proof of the ne* 
^essily of resorting to this expedient. 

Writers of the best authorìty bave remarked, 
&at in acute and dangerous diseases, thè spenta- 
neous occurrence of abortion or premature laboùr 
Swlds greatly to the danger of the patient. This is a 



ARTIFJCULLT INDUCED. 141 

strong reason against exciting premature labourby 
art^ during the continuance of such dìseases. And 
though the practice of ìnducing premature laboui: 
in cases of distorted pelvis has rarely been attended 
with alarming consequences^ yet I apprehend that 
I bave mentioned enough to shew, that there is no 
absolute freedom from hazard, even when the wo- 
man's health may be called good at the time of the 
operatlon, and how much the degree of hazard must 
be increased, when the patient is already in a state 
of great dariger, need not be insisted upon. 

As to the safety of the practice with regard to 
the child, that likewise seems to be assumèd upon 
no very substantial grounds ; at least if we may 
judge of the probability of saving the child, from 
what has happened in cases where distortion exist- 
ed, we shall not bave much encouragement, so £ir 
as the child is concemed, to extend the practice to 
such casès. If indeed the majority of the child- 
ren had been preserved, sometbing might be said in 
support of thè operation ; but it seems, that only 
Tiineteen children were born alive, and capable (^ 
Uvingy out ofJbrty'Seven instances of the experi» 
ment* 

These are indeed suflSicient to justify the prac- 
tice, when there is a moral certainty that the child's . 
life must be inevitably lost, unless this mode b^ 
adopted ; but there does not exist the same reason 
fpr resorting to it, when the child's lifè is not so 
cextainly exposed to danger» 



142 ' CASE» aF LABÒÙR 

Itpoìi the whole it appears to me, that tìie ad- 
vantage either fo mother or child from such an ex- 
tension of this practice is extremely problematìcal, 
wKile to admit of it wouid be opening a wlde door 
to a dreadful abuse of the opefation, by the igno- 
rante or the unprincipled. I must take leave there- 
fore to express my humble opinion, that the induce- 
ment of premature labour by art ought to be strictly 
confined to those melancholy cases of distorted 
pelvis only, for which it was originally recom- 
mended. 

In order to guard against any abuse of this me- 
thod of practice, itseems expedient, tbat somefixed 
rulés of conduct should be observed respecting its 
àdòption. What these rules ought to be, I do not 
presume to determine, but shall contpnt myself 
with subjoining such limitations and cautions as ap- 
pear to me to be indispensable. 

1. As the primary object is, to preserva the life 
of the child, the operati©» should never bé under- 
taken, till seven compiete montks of utero-gestation 
have elapsed, and if the pelvis of the mother be 
not too much contracted to allow of it, the delay 
of another fortnight, will give a greater chance to 
the child, of surviving the birth. 

2; Thè practice should never be adoptèd /^/e^-* 
perience has decideàly proved^ that the motìieris-in- 
capalìle of hearing a full-grown fiaettis àKve. v 



S. It is sometimes necessary to bave recowse'to 
tbe perfiiratór in a first labour^ though tfaerè majr 
he no considerable distortìon of the pelvis ^ th^e^' 
fere th^ use of thìs instrument in a fwmer labotxp 
ìa not alone to be considered, as a justification ctf 
the^practice *. 

4. The operalion ought not to be performedy 
wfaere the patient is^labouring under any dangerou» 
dtaeaae^ 

5. If upon examination, before the operation is 
performed it should be discovered^ that the present- 
ation is preternaturale it might be advisable^ to de^ 
fer it for a few days, ^s it is possible, that a spon- 
taneous alteration of the chiid's pòsition may take 
placet; particularly if the preaentation be of the 
superior extremities. 

*The pn^rìety of inducing premature khour io any dcfimneEk 
womaacaiLrarely^ if ever, be determined upon> before the ciotch- 
et blu been fbund indispensabiy mcessary, and actually.empioyed) 
ÌA a pcerious labour. lQdeed> uaks» the oontraction of tbe tube or 
canal of the pelvis be very conaiderabley and pietty aecucatsdy as« 
oertained,- it will scarcely be j^tifìable in any case to haye re»' 
course to this practice in ali the subsequent pregnances, until the 
woman has l^een ddiveied a secood or third tioie by the crotchet. 
For it.has happened in a very great number of instancea^ that & 
woman who has fafeen delirered of ber Imt child by the peiforator 
and-crotchet, has b^n afterwards deUvered [naturally] of one or 
more hving chìldren at the. full, time/' — Hall's Translation of 
Baiide)ocque's two Memoirs on the Cesarean section, p. 49. 

fSuch alterations in tlie paBÌti(«i of the foetui in utero bave 

been 



144 CASES OP ZJLBOJDR 

6> The utmost care should be taken» io guard 
against the attack of shiverìng and fever, which 
seems to be no unusual consequence of thi& at^ 
tempt to induce uterine action, and ha§ often 
proyed destructive to the child^ as well as alarming 
with regard to the mother. Tlie peculiar circum* 
stances under which the operation is performed, 
And the habitof body of the patientwill determinethe 
accpucheur either to adopt a strictly antiphlc^istic 
pian, or to exhibit opiates, or antispasmodics and 
tonics. 

7. In order to gìve every possible chance for 
preserving the life of the child, it wiU be prudent 

been known to happen. Dr. Denman bas known more than ooe 
instance of the presentation of the head being exchanged for the 
arm. Introd. to Midwifery, p. 450. Mr. Burns mentions a ca^ 
where theshoulderwas exchanged for the head, Princip. of Mìd- 
wifery, p. 218. ,Dr. Merrìman, senior, was about to puncture the 
membranes in a wooian who bad a distorted pdvìs, when he dìs- 
tÌQCtly felt the child's band through the membiianes, just witbìn the 
OS uteri ; he therefore deferred the operation, and at the end of 
three or four days, examined again, and discovered that the band 
vas retracted and that the head presented. He now performed 
tìie operation, which was completely successful. Silber tells of a 
case in which the elbow presented, but in tbirty-six hours, tbe 
head occupied its place. *' Pater meus explorans per vaginam Poe- 
minae adpariendum vicin», cubitum fcetus prdapsum, et per inte* 
gumenta caput in dextro matris latere invenit : nihilominus tamen 
post horas triginta sex, aquis effluxis caput situ naturali ingressum 
est/' — Silber de viribus naturae medicatricibus insitus foetuum ini-^ 
quos Tubingag 1799. 

Other such cases are to be met with in authon. 



ARTIFICIALLT INOUCEO* 



145 



to bave a wet-nurse in readiness, that the child may 
bave a plentifìil supply of breast milk firom the veiy 
hour of its brrth. 

Lastly, a regard to his &am character should de* 
termine tjie accoucheur^ not to perform this operation^ 
unless some other respectable pracHtioner has seen the 
patientj and has acknowledged thàt the operatàon is 
advisahk. ^ 



YOL. uu 



BXPERIMENTS 

• ■ - 

ON THE BARK OF THE 

COCCOLOBA UVIFERA. 

t 

f 

By JOHN BOSTOCK, M.D. 

Of LIVEHPOOL. 



Read May 13, 1813. 



ALTHOUGH kino has been, for a considerable 
lime, well known as an article of the materia me- 
dica, there stili remains, some uncertainty respect- 
ing its origin. It is indeed generally supposed, 
that there are three substances, somewhat dif&r- 
ent from each other, to which this name is applied. 
The one which has been the longest known, and is 
perhaps the most frequently met with, comes from 
Africa; but we are entirely ignorant from what 
plant it is derived. A second species is said to be 
extracted from the Eucalyptus resinifera of New 
South Wales; while a third variety, which isbrought 
from the West Indies, has by some writers been as- 
cribed to the coccoloba uvifera, and by otliers to 
the mahogany*. Having obtained a quanti ty of 
the bark of the coccoloba uvifera frp^p a friend in 

*Duncan's VaÌ. Disp. 292; Thomson's Lor.d. Disp. 213; 
Murrav's Mal. Med. 2. SOi; NicholsonV Journ. 6. 232. 



tfcV » 



COCCOLOBA UVIFERA». 147 

the West tndi^s, on whose accuracy I could impli- 
citlydepend, I embraced the opportunity of examin- 
ìng its properties, and comparìng the extract form- 
ed from it wìth the kino usually employed in medi» 
cine» 

The bark appeared to have béen taken from 
branches of from one to two inches in diameter» and 
was partially roUed up, much after the manner of 
the common Peruvian bark« No part of it was 
more than ^th of an inch in thickness, and some 
specimens considerably thinner. It was lined 
with a fine reddish brown cnticle, while the rei^t of 
the bark was of a L'ght yellowish brown coloun 
The extempl sur&ce was clean, and nearly firee from 
any protuberances^ but in many parts it was 
marked with slight longitudìnal fìirrows. When cut 
transversely, the extemal part of the bark, for about 
one quarter of its thickness, exhibited a coarser tex- 
ture than tb^ remainder, and could not he reduced 
to an equaUy fine powder, It had scarcely any 
smeli ; when chewed and kept for some time in 
the mouth, it produced a moderate degree of bit- 
temess and astringency, with a slight. mixture of 
an aromatic flavor. 

A portion of the bark reduced. to fine powder, 
from which a little of the coarser part had been 
separated, was mixed with 40 times its weight of 
water, atid kept for an hour at the beat of 200*. : 
A Ught brown fluid was formed,^ which was filtered 

L.2 



148 A^ALTSlè éF IHE 

while warm. ^ Athough at fìi*st it wàs only sKghtìiy 
opake, ìt became completely itìuddy apon cooling, 
wcìà remained so after bemg kepi -at rest for some 
days, but it was. renSei-ed héaHj^^lear by fatratìon* 
Fourteen successive infusions were made with' the 
same powder, when it appeared that ali the matter 
Wàs remdyed whida water was capablè of dissolving. 
The second infiision, like the first, was opake, but 
the IrSreHiaining infiisionswèrenearly, or quite trans- 
parent.' By the application of beat the opake in- 
fusions were i-endered transparent, but they be- 
cartié^ opajte àgain as they cooled. Tlie opacìty 
was equally prodiieed wK^ Aér they Wére exposed to 
the attóosphere, or entirely exeluded from it. At- 
ter being kept for some tkne, ali thè i»fiisions be- 
came mouldy^ the quiantìty of moùld bèing of 
course greater in the earlier ones. The water was 
found to bave dissolved *4*2 of the powder-; the 
residue was of a redder colour, and of a more 
spongy texture than bèfore the experiment. The 
iniusion seemed to retala ìtd transparency until ali 
the water was evàporàted ; the extract wias hard 
and brittle, and of a very deep reddish brown co- 
lour. It was softened by beat, and reduced to a 
half melted state. From what was observed during 
the evaporation of the infusion, it seems that wa- 
ter has the power of retaimng in solution almost an 
indefinite quantity of the extract, although when 
heated with the bark, it will' Hot originally take up 
mgre than ^^th of its weight of soluWe matter. 



COCCOLOBA UVIFERA. 149 

Wben thecoccobba hark was added to* water, 
.aad iK) h^eat applied, the effect was considerably 
lessj a tran&parent lightbrown fluid was pxQduced, 
«fter remaimBg severa! weeks in contact ; the prò- 
cess of moìààkìg seemed, however, to be more ra- 
pidin this, ihan in the ìnfìision made withheat. 

A pertion ef the powder was digested with 60 
tìmes its weight of alcohol: the fluid at first aasumed 
a duU olive coloux, and graduaUy bacarne more 
browA^ the brown colpur was increased by apply^ 
ìng a gentle beat, but it stili retained a considera 
able tinge ^ green. The fluid was then separated 
iro]|L the powdèr, and it graduaUy acquired a red- 
dish brewn ?olour, without any mixture of olive. 
The powder after being subjected to the action of 
the alcohol, wasfound tóhave lost exactly half its 
Veight ; the residue was not very different in its 
appearance from the entire powder, except that it 
was rather more dry and fibrous. 

The warm infuaion, after being flltered, andwhile 
it was stili recent, was subjected to the action òf 
different reagents, and by way of comparison, simi-s 
lar expefiments were performed on an infusion qf 
kino. The kino that I employed was the speoiea 
commonly used in medicine, and which appearéd 
to agree nearly with the description of the variety 
that is brought from Africa*. By being heated 
with water the gréatest part of it was dissolyed, but 

■ * Thomspn's I^ond. Disp. ?\3. 



150 



ANALTSIS OF THE 



after the addition of several successive portions of 
water, a littìe remained which was no longer capa^ 
ble of being acted on : thìs undissolved part was dark 
coloured, hard, and gritty. The infìision became 
opake as it cooled, but by filtration it was rendered 
nearly transparent, Its colour was very different 
from the infusion of the coccoloba, the latter being 
brown with a tinge of red, while the kìno was red 
with a sKght tinge of brown. The reagents em- 
ployed were, 1. jelly prepared from isinglass, 2* 
inuriate of tin, S. oxysulpliate of iron, 4, supera- 
cetate of lead, 5. tartarized antimony, 6. lime wa- 
ter, 7. sulphuric acid, and 8. subcarbonate of pof- 

ash : the saline bodies were ali in the state of satu- 

«... * 

rated solution. The results were as foHow : 



C0CC0L0B4. 

1. Copìóus, ligbt btùwn, floc- 
culent precipitate. 

2. Copious light brown precipi- 
tate. 

3. Copious black precipitate. 

4- Copious precipitata of a 
grayish colour. 

5. Copious gray precipitate. 

6. Consìderable gray precipi- 
tate. 

7. Copious whitish precipitate, 
g. Brown precipitate in moder- 
ate quantity. 



•t t 



mNO. 

Precipitate less copious, and of 

^areddish colour. 
Precipitate mucb less copious, 

andof a light buff colour. 
Copious precipitate of a dull 

olive colour. 
Precipitate less CQpjous. 

No ef&ct produced. 
Precipitate much less copious. 

Precipitate much less eppious» 
No precipitate; the red co- 

lour deepened and brighf- 

ened. 



cob€Oi:;<>BA uvifera. 151 

* The jiticture of tfie icoccoloba baiale was not afc 
fected hy the additìon of water. • Jelly and the 
oxysulpbate of iron threw down precipitates nearly 
similar to tliose ftomthe watery infusion, but the 
mnmte of titì had no -effect. A quantity of the 
tinctui^e was 6l<;iìwly evaporated, and a resàduum 
was òbtained which was brittle, and of a browneir 
colour than the extract from the ìnfbsion. It ap^* 
peared to be scarcely soluble in cold water, but in 
hot water the greatest part was dissolved ; the solu- 
tion became muddy asit cooled, ìt was rendered 
transparent by beat» and again grew opake when 
the beat wa» witìidrawn. It was then filtered, and 
an infusion was pbtained which was nearly trans* 
parent, and of a light brown colour. . The tincture 
of kino being treated in the same manner, a rci^ 
siduum was òbtained, which was of a deep rad co# 
lour, and of a mcHre .fiiable texture than the kino 
itself. This residuum was, for the niost part, rea- 
dily soluble in hot water, althòugb a small portion 
of a black substance remained undìssolved. Thia 
part was soluble in alcohol } and the solution was 
not precìpitated by water. Comparative experi- 
ments were then made upon these twoinfusions, by 
adding to each of them the same eight reagents as 
in the former instance; the efiècts were nearly simi« 
lar to those mentioned above. 

A portion of the residuum of the eoeccdoba, after 
the action of water upon it, was then digested in 
40 time^ its weight of alcohQl, and a light olive 



152 AKALTIIS OF TKS 

tincture was produeed, wfaich gradually acquired a 
ahade of brown. By thìs operatìon» the piMdet 
lost abcmt ^th of its weìgbt. Wlim the converse nf 
Ihis experimeot was tried, i* e. whea the residuuitt 
of the tincture was digested in water^ scarceiy any 
effect was produced, the ìnfiision was aligfatly ting<* 
ed by the oxysulphate of inm, and a very mìinite 
precipitate was produced by jelly» 

From the above experìm^its we may conclude, 
that the extract of coccoloba is a substance of the 
same nature wìth the kino used in medicine ; but 
ihat it diifers j&om it so fax as to show» that thejF 
are not derived from the same plant They are 
very similai* in their esternai appearauce ajad phy- 
sical properties ; but there is an obvious difierence 
in the colour» bofb of the infìision and tincture. 
The eiiect of the reagents is also difierent ; jelly 
producìng a brown precipitate with coccoloba, and 
a reddish one with kino ; iron a black precipitate 
wìth coccoloba^and an olive-coloiired one with kino* 
The efibcts of lime and sulphuric acid are much 
less with kino than with the coccoloba : there h 
no precipitate thrown down either by antimony or 
the subcarbonate of potash from kino, while the ei^ 
fect upon the coccoloba is very considerable. The 
soluble part of the coccoloba bark seemsr to consist 
principally of tan, which is in ali respects similar to 
the tm of the gali nut ; while thè tan of which 
kino is chiefly composed, resembles that of rhata- 
ny, and the substance which is artificially prò» 



COCCOLiHIA UVIFEBA. 15S 

curedìby Mr. Hatchetf s process» Hie tan of the 
cocodU>ba bark is accpiopankd, as is usuElly the 
case, with gallic acid^ and it likewise exhibits those 
propeitie^ which bave been ascrìbed to the presence 
of a spedfic vegetabk product called extractive ; 
btit the eKÌstence of this I thìnk has not been di^ 
tinctly proved*. The substance procured by èva- 
porating the watery infusion, is in.pàrtrenderedin- 
sohible by the process, and the same would appear 
to be the case with kino, as it is probable that kino 
is fbrmed by evaporation, from an infusion or de- 
coction. Its appearance indicates that it has un- 
dergone this kind of operation, and I am not ao 
quainted with any instance in which a substance, 
composed principally of tan, naturally exudes &om 
aplant. 

That part of the coccoloba which is soluble in 

ulcohol, and not soluble in water, was examined by 

evaporating the tincture formed from the aqueous 

residue of the bark. By the evaporation, a sub-^ 

stance was lefìt, the greatest part of which was of a 

greenish brown colour, and along with it a little 

reddish matter.. Its odour was fragrant, something 

like that of the balsam of tolu. Water that had 

been digested upon it produced only a slight efièct 

yiith isinglass, and the oxysulphate of iron. Neither 

the tincture of this substance nor of the entire 

extract of coccoloba were precipitated by water. 

The substance left, after digesting in water the re- 

*See Nicholson's Joura. 24. 315—223. 



15* ANALTSIS OF THE COCCOLOBA UVIFERA. 

■ 

sidue obtained by evaporating the tincture of the 
recent bark, was veiy similar,' in its colour, odour, 
znd consistence ta that procured above : it ap- 
proaches to the nature of the resinous balsam, but 
its solution in alcohol is not precipitated by water^ 
althòugh it is not itself soluble in that fluid» 

The Mowing may be regarded as an approxi- 
inatìon to the analysis of the bark óf the eoe- 
coloba : 

Woody matter - SO 
Tan . - . 41 

Balsanric substance 9 

. iòo ^ 



y' 



A CASE 



or 



SP LENITI S, 



/ 

WITH FURTHER 



REMARKS ON THAT DISEASE. 



JBy ROBERT BREE, M.D. F.R.S. 



Read May 2(5, 1812. 



jLlAyiNG laid before the Society a Case cf 
^* Painful and Tumid Spleen," which I ventured to 
pffer as a true description of the earliest and most 
simple state of spleniti», I beg leave to cali their 
attention to an example of that afFection in its more 
advanced stage. In this part of its progress the 
diseasie may be expeòted to bave assumed its in* 
flammatory chajacter, and to correspond with the 
account of writ^rs on splenitis. Even in this 
stage I believe that the treatment may be improved. 
It appears that the opinions of physicians are not 
settled respecting this disease j since the treatment 
of the foUowing case had been exceedingly various, 
and though it was directed by men of great intelli- 
gence and experience, the pian that was successful 
bad not made a part of their practice; and it must 



156 BEMARKS ON SPLENITIS. 

be inferred, that continued daily purgation had 
not been yet considered an effectual means of cure 
in splenìtìs. 

The subject of this case is a young lady about 
25 yéars of age, whose disease was finft noticed in 
the year 1 808, during a state of great uneasìness 
of mind. She had been sensible of debility and 
shortness of breath in the spring of this year, but 
in the summer she was free from complaint. In 
the month of September she began to complain of 
an uneasiness across the pit of the stomach, below 
the stemum, from the spurìous ribs of one side to 
those of the other side, and imder them. The 
right side was most affected, but she could not lie 
on either side. The pulse was not disturbed. Mr. 
Harcourt who attended the pat^ent observed, that 
it varied from 60 to 70, and only became quicker 
on the advance of thè diseiuse, in fits of pain and 
dyspnoea. In three weeks she began to saffer pain 
on pressure of the left side, and the right side be«^ 
carne more easy in proportion as this sensation in-» 
creased. She now had frequent nausea and puking, 
but an eager desire for food in the intervals of her 
sickness. 

The. first year passed in this mannen 

» 

In the coursè of tìie next year, 1809, tìie disease 
Jtiad inqreased greatly, and she wàs attended by 
inany of tlie most enunent nien i^ our professione 



EEMABKS ON SFLENITII^ 157 

In Aprii sbe Was àffected wìth cough, but there 
was no expectoration. 

In May and June she went tbrough the full trial 
of a course of mercury. 

* *• 

In the middle of sammer there was an abatement 
of severity in the symptoms for a short time. 

In Septembfer the disease had again ìncreased In 
vìolence. To tìie symptoms akeady enumerated 
there was added a new form of dyspnoea. It now 
carne on by spasmodic fits, and it also distressed 
ber in the intervals as before. 

In November she had some mitigation of her sui^ 
ferings, but there was no suspension of her com- 
plaìnt. On the attacks of spasm and pain the pulse 
roseto 120; at other tiìnes itwas seldom higher 
than «O in a minute. 

I was deaìred to visit this patìent first on ÌVf arch 
I7th, 1810. About two years from the beginning 
of her'complaint, which had new greàtiy increased 
in violence, and was attended by great depression 
of mind« The attacks of spasm were particularly 
distressing : fòr these she took large doses of anti- 
spasmodic and opiate medicines, which gaVe relief 
for short intervals only. Those a;ttacks consisted 
of difficulty of breathing, and sense of suffocation, 
accbmpanied with faintness and confiision of the 



158 REIMCARKS Oli SFLENITI8.: 

head. When the paroxysm abated^ extreme loW- 
iless succeeded; and the pain of the leftsidé greW 
insupportable^ Wìth more or less of these symptoms, 
she h^ been unable to lie down for séveral mónthsy 
and she had a heavy weightin the left ^e;. Upon 
examination of the side» it was found to be enlarged 
and painful : the eniargement was not promìnent 
at a point, but dìfiused from the margin of the 
£ilse ribs to the pìt of the stomach and backwards 
to the spine. The 8th rib, and the lòwer ribs ap- 
peared to be pushed forward. The least motion of 
tlie body aggravated the symptoms : the pulse had 
become as high as 90 between the attacks: the 
tongue was raoist, with a whitish siuface, the skin 
was naturai, the evacuations of stool and urine were 
naturai. 

. I prescrìbed pills composed of aloes with antìmo- 
nial powder and extract of coxìium to be taken 
every six hours, with a saline, draught* »She was: 
recommended to bear the attacks as ùlt as possìble 
without applyìng to opiates and antispasmodica. 

• * ' 

On my next visit I found that she was beginnìng 
to derive benefit from this pian. Tlje symptoms 
had abated gradually from the first purgative ope- 
ration of tìy medicines, which were contìnuéd with 
the efièct oi producing numerous( stoote every day 
till the 2 1 st of Aprii* 

Aprii 21. — The pube was les? frequenti the 



REM ARKS ON SFLENITIS. 1 39 

A. ... . 

* 

spasms were less distressing in^violqpee aod dara-> 
tion, and she had seldom taken the anodyne 
draught. The tension and soreness of the side were 
much less. She was directed to pursue the same 
medìcines. 

May 5* 19. — She had continued to have five or 
six stools dàily, and to discharge much urine, but 
neither of these evacuations had any remarkable 
appearance. The swelling of the side was more di- 
minishedv The spasms were not so frequent pr 
severe, and the dyspnoea and locai pain, tliough yet 
Constant, were become bearable. The pulse was 
96 only during theattacks. From the general 
amendnient, it was determined to attempt the use 
of a stom9.chic, combined with aperìents. An in-> 
fusion . of cascarilla was directed to be taken twice' 
in tì,e>y wIth soda and aloetìc wine: and . «din. 
draught was prescribed tp be taken at bed tim9«' 
with tartarized antimony, andgamphorated tincture. 
ofopium. 

June 16, SO. — After a short trial of the stomachic 
draughts, it had appeared that pain, general irrì* 
tation, and dyspno^ were increased, and that the 
bowels had not been so freely operated upon as by 
the fórmer medicines. She. was therefore directed. 
to resumé the aloetic antimonial pills, and to take 
a saline draught with sulphate of potash instead of 
that with infusion of cascarilla. 



160 BEMAKKS ON SPLEKltlS. 

Jtdy 14, 28.— This pian of medicine having been 
pursued through the month of July, ali her com- 
plaints were considerably lesseried by the end of the 
month. She lefl her room about this time. 

August 1 1 • — She stili persisted in the evacuant 
pian with continued good effect. The fulness or 
general swelling of the side was gone, but there 
was a perceptible thickness of the cartilaginòus ex- 
tremities of the false ribs, and of their integimients, 
with some tendemess on the pressure of these parts^ 
dose under the false ribs, and on their edge up to 
the scrobictilus cordis. By the absence of the 
swelling intemally, these extemal parts werè more 
distinctly noticed as the seat of complaint. The 
ade had been ipvariably more uneasy when the 
bowels were less purged. She had, however, been 
ttioved from four to six times every day. The pulse 
was stili quicker than naturai, but it generally was 
at 90 in a minute without much variation. It ap- 
peared proper to continue the pian of medicine, by 
taking pills of tartarized antimony and aloes every 
liight, and a saline draught every moming. 

s 

Septemher. — ^At the beginning of this month the 
tEermometer stood at 80, and in a few days after- 
wards at 55 and 60, but she felt no return of dis- 
ease, and could now lie very well ori either side. 
The pulse was 84, The pills and draught had prò- 
cured not less than four motions every day, which 
had no extraordinary appearance. She had a good 



appetite, a&d the power of ta}ang exercise vntk9Vit 
&tigue or dyspnoea. 

: As the disease had manìfested itself most in the 
qxring and autumn» I had looked to the advance of . 
the piesent season with anxiety, but firom the, fa- 
vorable state of the case at this peciod, I begau to 
expect that ìiie patient imght escape a relapse. 
Sbe was not, however, so &r confirined in faealth, 
or the disposition of the affected organ was not so 
£aut changed, as to realize my hope. 

"Por several days after the 20th oi September, a 
weight had been gradually increasing in the left 
side, attended with some uneasiness in lyììig on the 
rìght side* The head was confused and gìddy, and 
ishe had a short and panting respiration, with chil-* 
liness and beat at intervals. The pulse was 92. 
She had lately used a fuller diet and more exercise, 
and the menses were expected in a few days. I 
hoped that this change, with the efFect of active 
puFging, might reduce the action and fìihiess of 
the vessels, and remove the attack. I prescrìbed 
laiger doses of aloes united with calomel and a purg- 
ing saline draught every morning. She was to take 
a draught of camphorated mixture with camphorated 
tincture of opium after the operationeveiy night, and 
oftenerifnecessary. Thesemeansansweredverywell. 
Intwodaysthe menses appeared in great abundance, 
but with a naturai colour, and the patient was relieved 
òom this short attack by the end of the month. 

VOL. III. M 



162 REMARKS ON SPLENITIf. 

Oc/oder.*— After this she remained free from com*» 
plaint for several weeks» 

« 

November lé.^^ln the beginning of this month 
the disease retumed with some variatìon of symp- 
toms, in consequence of taking cold. It had as- 
sumed a more acute character, than I had observed 
since the formidable symptoms gave way in the 
spring; and it might have been mistaken for pleu- 
risy by a person unacquainted with the preceding 
circumstances. She had a severe cough, and a 
pain in the side, where the complaint had been he- 
fore felt. She had mach head-ache, sickness of the 
stomach and rigors. The pulse was 1 10. 

1 ordered a saline draught to be taken.every four 
hours, and jhUs of extract. coloc. compos. and gam- 
boge to be taken directly, and repeated according 
to circumstances once a day. Twelve ounces of 
blood were taken from the arm, which had the ap- 
pearance of healthy blood : there was no size, and 
the texture was good. The bleeding afibrded very 
little sense of relief from pain, which extended from 
side; to side^ but was felt acutely in the left side 
under the false ribs. There was no swelling per- 
ceptible extemally. In this state of things tlie 
menses appeared on the 2lst of November, and 
gave very speedy and almost pérfect relief. The 
cough wasgone: she had no head-ache or sickness: 
. the pulse was reduced to 85. She was directed to 
take piUs as before, of aloes and tarta^zedfintimony. 



R£MARKS ON SPLENITI». • 163 



y 



At the end of this moDth, she was free from com- 
plaint. The pulse was at • 80. She had a perspir- 
ing skin, and evacuated many stools every day. 
She was directed to continue the aperient pills. 

It appeared to me that the disease was stogped 
, in September by the evacuant medicines, and the 
appearance of the menses, and I consìdered it 
doubtfiil if the relapse would bave occurred in No- 
vember if she had not taken cold. The attack ìxi 
Noyember had 'the character of acute splenitis ii^ 
which the investing membranes were principally, if 
not whoUy, the seat of the disease. TKis acute 
state was favored by the increased irritability of 
the organ iti consequence of its long, suffering, 
and the continued appUcation of necessary treat- 
ment j but it seemed to be the harbinger of a con- 
fìrmed dispositìon to sound health in tlie part af- 
fected. 

Since the end of the yea,r 1810, this patient has 
remained well, with the slight exception of feehngs 
of uneasiness in the side on the approach of the 
menses, which menstruation has always removed. 
But she considers that the pills of aloes and tartariz- 
ed antimony bave been, by their effect on the bowels 
during the last year, a securityfor the confirm- 
ation of ber health. 



\ 



M 2 



164 «£MA&S:S 0^ SI^UÌNITIS. ^ 

Semarks on the preceding Case. 

1 bave considered this case as affordmg an ex- 
ampie of an advanced state of splenitis. It might 
be called the **Second Stage" when compared 
with that disease which I had the honor of de- 
scribing to the Society as a case of ** painful and 
turgid spleen** in its most simple state, in tìie 
earliest condition of this disorder tlie organ is sweD- 
fed from the passive state of its vesseis, which re- 
ceive a greater proportion of blood tìian they can 
return. No fever accompanied this stage, nor waS 
it the effect of fever, but an idiopathic afièction, 
leading to inflammation by tension and irritation of 
the membranes that invest the spleen. The means 
of cure were experienced to be active and daily 
evacuations, so persisted in as to become the prò- 
bable occasion of disease, if they had not been es- 
sential to the removal of it. A considerable iength 
of ti me is necessary to the cure of this affection, be- 
cause it is dependent on the weakness and passive 
condition of the vesselsof the spleen, and its duration 
must be in proportion as the return of their energy 
and contractilè power is slow. If the second stage 
of splenitis be made free from danger, it must re- 
quire stili longer time before it terminates in a cure 
than the first stage, as the disposition to a renewal 
of vascular sweliing will be more confirmed by 
time, and show itself periodicaJly. 

The more advanced stage of this disease has 
been often described, and too often furnished the 
anatomist with obsetvations after death. 



REMARK& ON SPL£^IS. 165 

In the second stage the pulsa becomes quicker^ 
and it is long, in convaleseence, befof e it is re- 
duced lo its naturai standard. The increased 
pulse is produced by painful irrìtation ait first» and 
next by the actual tension of the membranes, pro«^ 
ceeding to inflammation and adhesion- of adjoining 
"paxts. The quickncss. of the pulse will assist in. 
distinguishing the degree of progress of this dasease^ 
for it will be found, by reference to hisitories,, that in> 
a great proportion of cases,^ tbere was no waming 
c£ the growing mìschief in its earliest stage ; and 
fhat painful aifection of the lefl side existed in xm^ 
ny other casesv long before fever was ìndueed, 
though these ended fiitally. 

Ib the first stage the patient can lie upcm the 
left side, but not on the right side. In the second 
stage it is impossible to lie on the side afiècted. 
The spasmodic action of the (Maphragm is more 
likely to come on in the second stage, and may be 
much aggravated by stimulant treatment. Tbere 
is no emaciation in the first stage of a morbid kind, 
nor any qonsiderable emaciation in thè second 
stage» notwithstandiog the large and continued 
evacuations. But in the third and last stage of 
splenitis, emaciation is always an attending symp-^ 
tom, combined with hectie or slow fever, particu* 
larly in middle-aged aJad elderly people. In this 
third stage diarrhoea supervenes, as well as dysen» 
tery, and discharges of grumous and dark blood 
take place, by vomiting and by stools : these 



166 REMARKS ON SPLENITIS. 

charges give temporary relief in many cases, and 
óccur long before the énal event. 

Besides the two cases which I-have submitted* to 
the Society, it is right to observe, that I bave* seen 
the result of many others during the last three 
years, three of which occurred in young men and 
the majority in women. Ali these bave concurred 
to shew me in a satisfactory manner that drastic 
purging, long continued, is the proper mode of 
treatment. By this practice a young woman has 
been relieved of a swelling of the spleen and epi- 
lepticfits at the same time. The fits began with 
the first symptoms of disease in the leff side, and 
bave disappeared for the last year, during which 
time she was gradually recovered from the swelKng 
and pain. 

Compositions of aloes and antimony were prefer- 
red in the cases that bave been related, and gene- 
rally in others, but not exclusively adopted: large 
doses of neutral salts bave' however appeared 
exceptionable when exhibited daily, as they bave 
occasioned flatulence and depression. But aloes, 
extract of colocynth, and scammony withjalap, 
bave acted without this inconvenience, and calo- 
mei has been combined with these, at intervals, 
producing more efFectual discharges from the bow^ 
els : tartarized antimony in such minute doses, as 
not to puke, has always appeared to increase the 
beneficiai efFeCt of those combinations. 



REMARKS QN SPLENITI». 



167 



This idiopathic disease afiects femalés more than 
males, and they bave been alwayF relieved in a 
signal manner by the flow of the menses : this fact 
taay give rise to an idea somewhat speculative, but 
not wìthout supporta that a particular correspopd*» 
enee or sympathy of action, may exist between th© 
spleen and the uterus. Each of these vascular or* 
gans bave a structure which yields to extension and 
contraction with less disturbancB of the whoje ha» 
bit than happens from equal changes in otherorgans, 
and wherever splenitis is relieved by nature or art, 
the ìnferior vessels of the body receive more than 
their usuai quantity of blood, which passes from 
the uterus or the intestinés : a fact agreeing with 
the 48tb. Aphor. of Hippocrates, lib. 6. " Tot(ri trvM' 
^ùiìtn &c. Splenicis dysenteria superveniens saluta- 



ns. 



99 



The progressive efFects, and the cpmpUcations 
of this complaint may appear after death ; bùt it 
is obvious that no certain conclusions can be drawn 
from dissection^ respecting the two first stages of it, 
and particularly that the condition of the organ int 
the earliest and most simple state of its sufFering 
cannot be prpyed by anatomical examinatipn. 



Splenitis, complicated with extensive visceral 
obstructions, has been very frequently the effect 
of remittent and endemie fever; but a tumid spleen 
occasiòned by this cause, cannot afibrd any reason- 
ìng respecting the idiopathic disease, whicb in its 



1 6é àÈMARKS OK S^LENITII!^. 

progress wiB be distìhguisbed by a hectic fever, of a 
▼ery àiflferent cha^acter. The difference between 
Àuch Gomplicated affisctions and tbìs sìmple dìsease 
mll appeal^ mfficiently manifest io those who con- 
sult the historìés of Lieutaud and Morgagni, but 
particulariy the recent descriptions of Dr. Davis 
in his treatisé on the Walcheren fever. 

Arettóus Bàyè, that the disease is fatai to élderiy 
péople, but that it is not so dangerous to youth. Dr. 
Heberden's later observations confirm the assertion 
òf Arètaèus respecting the tendency of the disease in 
people advanced to middle age, in whom it is fatai 
in six months. 

It is very importànt at every period of lifc to dis- 
tinguish the disease in its early stages ; we are not 
to expect the presence of pyrexia, and extemal 
swelling to make the case obvious. Pain of the left 
side, and inability to He on the right side, are often 
the only i^gns, aiid if these two symptoms exist 
without fever, there cannot be much doubt respect- 
ìng the seat of the disease, fbr a painful disease of 
2^ny other organ of the left side would be accom- 
panied with fever, aftd other symptoiìis of consti- 
tutional sympathy and irritation. 

The spleen has been dei^crìbed very gènerally as 
» passive organ, and not readìly sensible, to inflam*^ 
matory irritation. (SeeDr. Pemberton.) Tliiscfaa* 
racter can occasìon little wonder, if the structure 



RBMARKS ON SPLENITE. 169 

and oeconomy of the spleen be well consìdered. 
(See Malpighi and Hakely &c.) The absence of 
pyrexia in the early part of splenitìs does not ap- 
peal so remarkaWe as it does in cases of the stran- 
gulated intestine, in which Dr. Baillie says, ** The 
pulse is sometimes not increased in frequency be» 
yond the stand^d of health, and yet the inflamma- 
tion of the bowels has been discovered afterwards 
by the operation to be very great/* 

It is impossible to say how far a continued ap- 
plication of purgatives might bave ahswered in ad- 
vanced cases, or in thè first stages of cases, which 
ended fatally, as ibis practice has not been follow- 
ed in any instance within my knowledge. In a 
case detailed. in the Edinburgh Journal, it was 
found that purging was the best means of relieving 
the patient, but it was only practised at intervals, 
and it was accompanied by the use of medicines 
which must bave acted upon an opposite principle 
to that of evacuation, possibly counteracting its in- 
fluence. Similar cases are to be found in Morgagni 
and lieutaud, and it must appear from the result, 
that it was a third stage of splenitis when the inge- 
nìous writer first saw the case, the distinguishing 
character of the early part of the disease having 
been lost. The patience and insensibility of the 
organ is so remarkable that changes that must bave 
been of long standing, bave been ohly discovered at 
the death of the patient. 



/ 



1 70 REMARKS OX SPLENITIS. 

A person met with sudden death from accident, 
and, as it is related in the ^* Acta Parisiensia/* bis 
spleen -was found stoney in its internai structure 
withouf any other mark of disease. 

Enlargements are recorded by writers to bave ex- 
isted without notice of the change, and fever, or 
severe pain only carne on to alarm the patients 
after a long period, thougb these diseases terminated 
in death, 

It is therefore true in the distinguishing of sple- 
nitis, that the disease may bave made great progress 
without observation. Pain may bave been felt 
without, swelling, and swelling without pain, and 
both may bave fexisted without the pulse having 
been disturbed for a long period in the first stage of 
splenitis; but on dissection, the spleen, after such 
previous circuinstapces, has been found iporbid, 
and the only diseased organ. 



ACCOUNT 



OF THE 



MUSCLES OF THE URETERS; 

AND 

THEIR EFFECTS 

JN THE IRRITABLFs STATES OF THE BLADDER, 
By CHARLES BELL, Esq. F. R. S. Ed. 

TEACHER OF ANATOMY IN GUEAT WINDMILL STREET. 

COMMUNICATED BY 

DR. CURRY. 



ReadJune23, 1812. 



JL AM about to describe a set of muscles whìch seem 
not to hav« been observed by former anatomists. 
They are attached to the orifices of the ureters, and 
are seated in the bladder. In health they are the 
Instruments of a very peculiar organic action, and 
in disease the cause of most distressing complaints, 

Before I proceed to describe the anatomy of this 
part of the bìadder, the subject seems to require, 
that I should give a short historical review of the 
opinions respecting it. 



1*72 ON THE MUSCLES 

Of the parts hilherto described as seated at tJie neck 
qf the bladder-^^La trigone de la vessie — La 
Luette — Uvula Vesicce — Corpora carnosa Mor^ 
gagnL — Third lobe qf the prostate^ S^c. 8^. 

In the plates of De Graaff there are represented 
certain folds extending forward from the orifices of 
the ureters, where tbey terminate in the cavìty of 
the bladdèr; and at the lower part of the orifice of 
the bladder, there is a tubercle fein-ily indicated. 
The same appearance is represented by Bidloù. In 
Santorini also the naturai appearance of these parts 
is accurately delineated. Morgagni expresses him- 
self to this purpose: " at the points where the ure- 
ters terminate in the bladder, there arises from each 
of them a thick round compact fleshy body, which 
takes a direction towards the orifice of the bladder. 
These two bodies having proceeded a little way, 
are united, and proceed forward, terminating in 
the Caput GaUinaceum*.'* 

^ Santorini t gives the same description of thése 
pai'ts as Morgagni has dehvered. 

Lieutaud describes these bodies under the term 
Zia trigone de la vessie. The learned Portai is in- 
correct in saying that Lieutaud was the first anato- 
mist who has given their description. 

* See Morg^agpi Adversarìa I. n. 9. Adversarìa UI^ Animad* 
ver. XLII. 

+ In the Observationes anatomicae^ cap. %• sec. xxi. 



OV TBE UB£T£lt£. 173 

Portai has tkus dcBcribed the Trig<me: at 
the lower part, the uiternal tunic of the bladder 
adberes to a triaagular body of a cartìiaginoue hard- 
ness, and tiiìs body is always prominent in the ca- 
vity of the bladder, especially in old meo* He 
proceeds to say, that, at the extremity of the trì- 
jxn^e, baclcwards, the orifices of the ureters open; 
and at their anterior extremity, there is an eminènce 
slightly protuberant, to whidi lieutaud has given 
the liame of Luette. 

This account leads me agaìn to refer to the plabe 
of the excellent anatomist Dominico SantorinL In 
his secoiìd table the Luette and Trigone are accu- 
rately represented. 

He h^as the fdlowing explan^tion on the letter L 
" Vesìcae urinai oscid^un cui prominulum corpus 
^* pr«6gitur quod in afièctis vesic» ac prominet ali- 
** quando ut urinai iter prorsus intercludat.*' This 
refers to the disease with which Mr. Hunter and 
Mr. Home bave made us familiar. 

The expression of Santorini recalls us again to 
the remark of Portai : he say s. ** I bave found in 
" old men who bave suffered retention of urine, 
" the Trigone de la Vessie so enlarged, especially 
" its tubercle, in the form of an Uvula (Luette) 
" that the orifice of the bladder was shut by it*/ 

* Portai, Cours d'Anatomie Med. T. v. p, 409, 



ce 
ce 
ce 



1 74 ON THE MUSCLES 

Sabatierfólìows his countryman in his. description 
of thìs part ofthe bladder, but adds; " The Tri- 
gone and Luette are the most sensible parts of the 
bladder; wHich is the cause why a stone lodging 
bere produces extreme irritation, while if it 
" lodges in any other part of the cavity of the blad- 
" der, it causes little inconvenience :" he adds, 
" The uvula (Luette^) which terminates thci ante- 
" rior angle is very subject to swell, and then it 
*' rises in the forni of a round tumor which fills the 
^' neck of the bladder, and opposes itself to the flow 
" of urine*." 

Desault^ speaking of the tumors which grow in 
the bladder, has this expression. " Le sommet de 
" ce viscere n'en est pas plus exempt que son bas- 
*' fond ; mais ce sont particulièrement ceux qui crois- 
" sent près de son col, et que quelques auteurs ont 
** pris pour un gonflement de la luette vesicale, qui 
" occasionnent la retentìon d*urine.** 

This sentence, which betrays the imperfect know- 
ledge which Desault had ofthe disease, isfollowed 
by other unequivqcal marks of unconfirmed prin- 
ciples and practice: and the whole chapter stands 
in reraarkable contras t with the publication of Mr. 
Home, in this country. 



^ See also Lieutaud« Hist. Anatomie, medica, tumores vesicae 
adnati. 



OF THE URETERS. 1 75 

m 

In Haller's Ekment. Physiolog*. we have a de- 
scription following that of Morgagni under the tidè 
Colliculi ab Uteribus in Urethram prodmiu ' 

m 

These authorities discussed, we come now to the 
more modem observation of Mr. Hunter. 



\ 



Mr* Hunter i has described a small portion of 
the prostate gland which lies behind the very be- 
ginning of the urethra; and this he describes as 
subject to swell out liké a point into the cavity of 
the bladder, where it acts like a valve on the mouth 
of the urethra. This can J^e seen even when the 
swellìng is not considerable, by looking upon the 
mouth of the urethra from the cavity of the bladder. 

It is ìmpossible to mistake this; the swelling he 
describes is the Uvula Veskce or Luette of Lieutaud. 
The observations of Mr. Hunter, then, go to inform 
US, th^t this tumor is of that part of the prostate 
gland which is below the urethra, and betwixt the 
lateral portions of the gland* 

This discovery carries us back to the great ana- 
tomists in whose works we find the elements of ali 
oui: present knowledge. Morgagni has very fiilly 
described the part of the prostate gland which Mr. 
Hunter mentions, and which he discovered to be 
the seat of this dangerous malady. Morgagni thus 
describes it : 

* T. V. p. 328. t P. J70. 



ce 

ce 



176 ON THE MUSCLES 

^^ Quod si vera ulla propago prostate addenda 
^ est, ea certe est subrotunda et renitens quasi 
^^ gianduia, quam cum soepe diligentissimus inci- 
^* sor noster in publicis dissectionibus animadvert- 
^^ isset inter vesicam, et seminaies capsulas qua 
sese mutuo h« jam contìngunt, proinìne»te« 
et nonnunquam ad angulum conveniendo, effici- 
^ unt, prostantem nos accurato instituto examine 
^^ nihil aliud esse comperìmus quam corporìs ip- 
^ sius prostatae particulam.*** 

In addìtion to the descrìption of Morgagni we 
bave the authority of Sabatier. *' Sometimes/* says 
he, ** only that part of the prostate is diseased to 
^ whidi they bave given the name of Lnette Vesu 
** cale. I bave seen several occasions (he con- 
tinues) in which the uvula forms a tumor with a 
narrow peduncle : this moving with a stream of 
urine, dosed the opening of the bladderf%. 



ce 
ce 



Anatomy of the Neck qfthe Bladder. 

I bave now to lay before the Society the anatomy 
of the neck of the bladder in man. 

On dissecting up the inner coat of the bladder, 
there are seen two strong fleshy columns, which 

■ 

* Morgagni, adversaria anat. IV. animad. XV, 
t Med. Operat. T, II. p. 72. 



OF THE URETERE 177 

deséend from the orifices of the ureters towards 
the orifice of the bladder : they unite and run to 
wards the prostate gland. On the surface, towards 
the cavity of the bladder, they are denser by the 
union of the inner coat of the bladder, but they 
are fibrous, and this fibrous structure is made mani» 
fest by dissection from be^ow. They are larger and 
firmer, but of the same colour and structure with 
the fleshy eolumns of the Detrusor urincv. The 
variety which we find in their length according 
with the degree of contraction of the bladder, 
proyes their muscularity. Whatever expites* the 
action of the bladder increases the size of these 
muscles in a remarkable degree, and they always 
acquire a great increase of power and size when 
the miiscular coat of the bladder, becomes more 
distinct and powerfuL In some of my specimens 
of^ diseased bladder, I find the cause of this to be 
stòné in the bladder ; in others, an ulcer ; in many, 
stricture ; but always irritation and the necessity 
of continuai action of the bladder are attended 
with an enlargement of the muscles of the ureters, 

When. contracted, the course of these columna 
is distinguishable ali the way from the mouths of 
the ureters to the beginning of the urethxa ; and 
there, at their union, they heave up the inner coat 
of the bladder producing the appearance of a tuber-. 
de at the lower part of the orifice of the bladder *r 

^ It ià this appearance presentéd bytbe muscles in a sfate fd con- 
traction, which has led so many of oiir best authorities to confour>4 
it with the disease of the third lobe of the prostate jìaud, 

VOJ-. ni. N 



17S ON THE IVIUSCLES 

It is stili the form of the inner coat whicli 
makes these fteshy columns appear to terminate for- 
ward in the caput gallinaceum ; which theydonot; 
they only take a firmer insertion. Where these co- 
lumns unite they are most fieshy, and their fibres 
are more intricate ; then, directing theu* eourse to- 
wards the lower and backmost part of the prostate, 
they degenerate into tendon, and are insertod into 
tlie portìon called the third lobe of the pròstate. ' 

Althougb I have described the course of these 
muscles as proceeding from the back part &rward, 
because it better corresponds with the first view we 
have of them, yet, I believe, it is more correct to 
consider their connection with the prostate gland 
as the fixed point, and their connection with the 
extremities of tliie ureters as their insertion. 

USE. — The use of these muscles is, to. assist in 
the contraction of the bladder, and at the same 
time to dose and support the mouths of the ureters. 
The surface of the bladder where it covérs their 
union on the inside, is endowed with an exquisìte 
sensibility, which is a prò vision of nature, fbr theii* 
ready and instantaneous action on the stimulus to 
|)ass the urine. It is bere that is seated that sensi- 
bility which produces the naturai cali to urine, and 
bere also is the seat of diseased irritations. 

It will be observed tliat the orifices of th^ ureters 
are not closed by the contraction of the musculftr 



QF THE URETERS. 179 

fibres around them. They are defended against 
the return of the urine by the obliquity of their pas- 
sage through the coats of the bladder. It is well 
known that the extremity of the ureter enters 
through the coats of the bladder obliquely, and 
that in consequenqe of this, there is a valvular 
action in the coats of the bladder which prevents 
the regurgitation of the urine into the ducts of 
the kidney. 

But if we look to the a^oining diagram, and 
consider thésubject, we shall find, that inpropor- 
tion as the bkdder contracts, this obliquity must 
be diminished j and further, if we reflect that the 
coat which contracts is òn the outside of the ob- 
lique passage of the uretei*, we shall conclude that 
without some counteradting power on the inside of 
the bladder to draw down the orifìce of the ureter, 
the obliquity of the passage would be lost. These 
muscles, which I bave now described, guard the ori- 
fiìces of the ureters by preseiTing the obliquity of 
the pas^e, and by pulUng down the extremities 
of the ureters according tp the degree of the con- 
traction of the bladder generali/. 



K 2 



OS THE MUSCLE» 




Èxplanaiion of the Diagram. 
Let A. Mprestnt the circle of the dilated bla<kler. 

B.^e Ureter or duct of the kìdney of eoteriog tfae cotta of 

the bladder. 
C. The extremitf of the duct opening on the inside of tìie 

bladder. 
B, C. mark the obhque course of the Ureter througb the 
coats of the btadder. 
Let D. Pepresent the contratted bladder, thickened at the samc 
time by its contractions. 
B. Tlie Ureter paasìng through the coats. 
The lines F. G. drawn from the centre of the circle will inter- 
sect coirespondJDg portìom of both circles, and demonstrate how 
the obhque passage of the Ureicr through the coats of the dilated 
bladder becomes moredirect in the contracted bladder. 

The mueclce dcKiribed act in the direction of the line H, and 



GF THE URETEUS. 181 

The membrane which covers these muscles, is 
the seat of that sense which calls the muscular 
coat of tfae bladder into action. Of this we may 
he sensible in passing the bouglé^ and stili more in 
passìng the uréthra sound. As the instriìmeht is 
passed down the uretfirà, there is a siqkéning sen- 
sation ; as it passes the caput gallinacèum, the na- 
ture of the pain is changedj and, lastly, in pass- 
ing it over the surface of the triangular elevation, 
produced by these muscles, there is experiénced 
thè familiar sensation of the cali to pass urine. If 
it were doubted that bere, in a particular manner, 
* is seated that sensibility, which calls the bladder 
into action, the efiect of a stone falling upon 
the part is sufficient proof. When a patient has a 
stone in the bladder, there is pain and excitement 
while it rests in this place, and relief when it 
lodges elsewhere. The reason why this part is 
possessed of such sensibility, I apprehend to be, 
that the muscles of the ureters may, as it were, te 
the fifst ^armed, in order to guard the mouth of 
the ureters, and preserve their obliquity during 
the action of the bladder* 

its operation is to draw down the orifice of the Ureter C. in pro- 
ppttion as the bladder coutracts^ by which, me^ins the pbliqviitT qÌ 
the passage is p^ ^sei:ve4. 



là2 GX THE S^X^LES 

Aftim in Disease. 

When the sensibility in the iusat of tìiese oms* 
cles ìs increased by disease, ànd the increased ien» 
«bility is accompanied vith a continuai actipn of 
the muscles, tifie prostate gland mmt fsmSkt xxsmxxA 
exciteinent. The naturai prominenee {wm^ by 
the piusclés being directly over the third lobe of 
the prostate, and theìr chief attachment being alsa 
to this third lobe, we may pecceive how it bappena 
that this part is sometimes enlarged without tìie 
body of the prostate gland partaking mui;;h in the 
disease, When there is an unusual fdm$ of the 
bladder, these muscles are the seat of it ; and as 
their united extremities are attached to the lower 
and middle portion of thè prostate gland, they 
must, I think, promote the growth of this portion 
in a direction toward^ the cavity of the bladder*^ 
This will produce the true tevula vemasj the pen-* 
dulous tumor in the neck pf the bladder resesi^ 
bling the uvula of the palate^ Thia tumor bangs 
into the cavity of the bladder, and falls like a vajve 
upon the orifice of the bladder, proving a most trou- 
blesome and dangerous obstruction to the urine. 

' But whilst I state this às an opinion, drawi^ 
from the consideration of the parts in their natu^^ 
ral state, I must also submit the naked facts. I 
have, in my coUectipn, two specimens of the dis- 
pase of the third Iqbe of the prestate, where these 
muscles are remarkably strong. I have, on the 



OlP TtìÈ URETERS. 183 

other band, soiAe specimens of diseased bladder, 
where thè muscles of the ureters are enlarged; 
aftd ótily in one of these ìs there a beginning en-- 
largement of the middle lobe of the prostate 
glaiìd. 

1 have many specimens of bone distorted by the 
action of the muscles ; and many, where, at the at- 
taehments of the tendons, the bones are dràwn out 
iftto l^pines atid tubercles. We may say, such ìs the 
eflbct óf the muscles ; but though the growth of 
Buch Spinès OF tubercles be the effect of thè action 
of the muscles directly, yet thése spines will not 
be formed, unless when the bones are at thè same 
tiiiìe sufiering from disebse. So in considering the 
action of the muscles of the ureters, as influencing 
the growth of the prostate in a particular direction, 
1 do not imagine that the muscles will do this 
merely by theif mechanical effect, There must b^ 
alsò a disposition to disease in the prostate ; and if 
disease be not present, the irritation of the bladder 
wiU continue even till the death of the patient, 
without afiecting the growth of the glande 

On the extremities of the ureters, in the dis^ 
easèd action of the bkdder, the contraction of 
ihèse muscles ìs converted from a salutary in« 
fluenc€, to one which aggravates disease, Thòy 
stili dose the mouths of the" ureters during' th^ 
action òf the bladder ; and the action continuing, 
they cause an accumuUtion in the ureters and pe^ 



184 ON THE MUSCLES 

vis of the kidney, and influence the kidney itsélf*: 
thus increasing the extent of the kx:al disorder, 
and consequently its influence on the constitutiòn» 

- Such consequénces as àrise froin the irritation \ 
and action of these muscles, are to be reKeved by j 
removing the cause ; by assuaging the sensibility 
of tlie surface of the tuberclc, and by drawing off" | 
the urine. When we know that this spot on the 
lower part of the orifice of the bladder, is the seat 
of that irritabiUty which is so distressing, we see 
that it is practicable to effect it by the use of the 
bougie. By the introduction of the catheter, the 
urine is let off without hindrance from the valve : 
the distressing excitement of the muscles is not 
perpetuated, and the prostate subsides from its ir- 
ritation* 

\ », 

This practice, though a direct deductiòn fix)m 
the examinatìon, I Jiave made, is no more than the 
advice given to us by the bést authors. 

Thus we see that a small tuhercle was painted 
by De GrafF, and described by others, but the na- 
ture and origin of the tuberete was miscoiicdvéd. 
Anatomists were calUngit uvula vesiccBy as if that 
naturai prominence was the same with the ttimar 
of this part of the bladder. We find that the dis- 
ease called , wrw/iz r?e5/c«?, is nootherthan that oc- 
casioned by the enlargement of the third lobe of 
the prostate gland. To Mr. Hunter and Mr. 



OF THE UEETEM* 185 

fiome, we are indebted for a full knowledge of 
the nature of this disease. It has been objected 
to Mr. Home, that he ìs in vain making that inr« 
portant, which the great anatomists of ali ages 
faave failed to discover, or* bave neglected to no- 
tice, I bave shewn that the thiid lobe of the 
prostate was known to Morgagni, and that it^was 
a subject of discussion in his day. We bave suffi- 
cient evidence (even on this very subject) of the 
difference of a fiict being noticed in the elaborate 
-Works of Morgagni, and of its being familiarlj 
and practicaUy known to surgeons. The third 
lobe of the prostate was qui te forgotten, the con- 
sequence was that we were igjQorant of the nature 
of the most fatai disease of the bladder. It would 
be disingenuously reserving the circumstance, 
which drew me to attend to this subject, were I 
to omìt the mentipn pf the late work of Mr. Home, 
or rather his originai paper on the anatomy of the 
prostate gland. I- acknowledge both the merit 
and the necessity of what he has written : for the 
observation of Morgagni, andthehint of Sabatier, 
were forgotten both bere and in France, until the 
subject was distinctly and practically brought fof- 
ward by Mr. Home. Even the latest French au* 
thor, Richerand*, stili ,speaks of the enlargement' 
of the anterior angle of the " trigone vesicale/* 
and the growth oi fungosities near the neck of the 
bladder, obstructing the course of the urine. 

** Nosographie Chimrgicalc, ii^ed. p.458. 



186 



ON THE liTUSCLES OF THE URETERS. 



It Stili remained to be explained^ why the small 
part of the prostate gland, the thìrd lobe of Mr. 
Home, shouid be so frequently eniarged, without 
the allection of the body generally being apparent, 
or why this pari shouid enlarge more rapidly thati 
the rest of the gland. It was in the prosecution 
of this inquiry, that I dìscovered the muscles of 
the ureters, and after ascertaining their nature, I 
iKaw through the obscurities of authors, in treating 
of the diseases of this part of the bladder ; so that 
in speaking of the enlargement of the anterior ex- 
tremity of a naturai tubercle, they were deceived, 
and that. in treating of the woulaj they were de« 
scribing éhe diseased prostate gland. 



EXPLANATION OF THE PLATES, 



, PLATE IV. 

A portìon of the inside of the bladder, with the 
prostate gland appended to it, by the attachment 
of the common tendon of the muscles of the ure- 
ters. 

A, The inside of a portìon of the bladder, 

RB. The mouths of the ureters opening into 
the bladder. 

ce. The muscles qf the ureters / to sKew which 
more distìnctly, the inner coat of the bladder* is 
dissected up, and a bristle is put under them. 

D. Th^e union of the two muscles j— a bristle is 
put under this part. 

» 

E. The tendon of the united muscles of the 

ureters inserted into the prostate gland. 

F. The middle lobe of the pròstate gland, into 
which the muscles of the ureters are inserted: ali 
other connection betwixt the bladder and the pros- 
tate gland is cut through, that the^land may bang 
and stretch out the muscle. 



188 EXPLANATION OF THK PLATES. 

G. The caput gallinaceum; and part of the 

urethra. 



PLATE V. 

The lower part and neck of the bladder, the ve- 
sìculae seminajes, the prostate gland, the mem- 
branous part pf the urethra, and (from the lower 
ade) the muscles of the ureters. 

< 

A. The spongy body of the urethra cut acrqss;» 

B. That part of the spongy body called the bulb, 

C. Cowper's gland* 

P. Membranous part of the urethra, 

E. The prostate gland» 

F. The extremity of the vasa deferentia, pass* 
ing through the prostate gland, to open on the ca- 
put gallinaceum, 

G*G. The vesiculae serainales. 

H.H. The vasa deferentia, where they are ne^r 
the ureters. 

LI. The ureters, or the ducts of the kidney 
leaduig to the bladder. 



EXPLANATION OF THE PLATES. 189 

K. The prostate gland, where it is betwixt the 
urethra and seminai vessels ; this is the third lobe. 

L. The outèr coat of muscular fibres cut across. 

M. The outer coat of muscular fibres of the 
Hbladder ; a portion of these fibres is cut across, to 
shew the niuscles of the ureters. 

N.N. The muscles of the ureters seen on the 
lower surface ; their fibrous structure is more evi- 
deut on this lower surfìice. 

O. The union of the muscles where their fibres 
are more intricate. 

P. The thin inner coat of the bladder^ with 
some few transverse fibres. 



PLATE Vt 



This piate represents the diseased prostate gland 
and part of the bladder. The third lobe of the 
prostate is enlarged, and the connection of the 
Aiuscles of the ureters with it is very distinct. 

A. A. The 'lateral portìons of the prostate 

GLAND. 

B. The capt^ galUnaceum. 



192 CALCUIUS VOIDED FftOM THE GftOW» 

some of the cases the gali bladder adheted to, and 
broke into, the colon ; in some abscess was formed 
extemally, which broke, discharged gali stones, 
and remained fistulous ; and in other cases they en- 
tirely healed. The symptoms which distinguish 
this speci es of tumor from others, are detailed 
with the singular sagacity which marks the writ- 
ings of that great sui^eon. 

Although in the following cases, the gali bladder 
was not immediately concerned, they seem so evi- 
dently allied to the subject of Mons. Petit's Essay, 
that it is impossible to avoid referring to ìt. 

* 

A lady, about fifty years of age, was afFected 
with great pain, which was described to be in the 
Stomacb, Constant sickness, and a costi ve state of 
the bowels, for which she took such medicines as 
were prescribed by ber physìcian. These symp- 
toms had continued for many wieeks, when a tu- 
mor, evidently contàining a fluid, presented itself 
just above the right groin, which I was desired to 
see. The preceding history, the want of surround- 
ing inflammation which shouid bave characterized 
a simple abscess, and the recoUection of Petit's* 
paper, induced me to decline opening the tumor. 

* It will he rcmarked by those who are not awareto how great 
a size the gali bladder will arri ve, that the situation of thè tumor 
dfstlnguislied it from such an affection. I may therefore ohsen-e, 
that there is in the coHection of St. Thomas's Hospital, a human 
g«B bladder« wbicb« I suppose, \iould contain at least three pinta 
of fluid. 1 



CALCULUS VOIDED FROM THE GEOIN. 19S 

I could not suppose it was a lumbar abscess, the 
oiìly other disease for which it could easìly be 
taken ; and even the propriety ,of opening such 
tumors is, I think, by no méans fully established. 
A poultice was therefore applied, and in aboutten 
days it broke, and discharged a consìderable quan- 
tity of discoloured matten The wound became 
cxceedingly irritable, the granulations were loose, 
indistinct, and dark-coloured, and the patient's 
health much impaired. She was àdvised to go into 
the country, and some time after her departure, I 
was informed that the complaìnt had assumed a 
difièrent charactér, that the discharge had become 
foetid, and that the caraway-seeds in some cakes 
she had eaten, Were occasionally seen with the dis- 
charge on the Knt covering her sore. Soon after 
this, she retiìmed to town, and another abscess 
formed and communicated with the preceding one, 
iand the discharge became manifestly faecal. Mean- 
while the functions óf the bowels were not mate- 
iially imjieded. She had an evacuation daily, with 
or without aperient medicine, but her health suf- 
fered much from the irritable state of the sores^ 
which was considerably increased by attempts at 
locomotion. 

At this period of her complaint, when I was 
examining the wound deeply with the probe, I felt 
it senslbly strike against a hard body, which, with 
some difficulty, I could move so as to ascertain to- 
lerably its situation and size. I then enlarged the 

VOL« III. o 



194 CALCULUS VOIDED FROM THE GUOIN* 

fistulous sore with the bistoury, and, with a pair of 
long forceps, succeeded in extracting a calculus of 
an ovai form, the long diameter of which wa3 more 
than half an indi. I did not think it necessary^ 
like Mons. Sajirau*, to remove the callous circum- 
ference of the sore, but the operation was painful 
and somewhat tedious, from the difficulty of seiz- 
ing the' stone with the forceps. No fever of con- 
sequence, or any other untoward circumstance fol- 
lowed, nor was the faecal discharge more copious 
from the enlarged wound, a circumstance which 
jsurprised me. About this time her health began 
to amend, and the discharge to abate. It was 
found necessary a short time 'afterwards, to divide 
the interval under which the two sores communi- 
cated, and which by its friction kept the parts in 
a state of irritation. The wound theh gradually 
contractted, assumed a more healthy appearance, 
and had nearly closed when she went into the 
country^ and her health was so much improved, 
that I bave no doubt, in a very short time her cure 
was perfectly accomplished. 

A woman, about twenty-five years of age, had 
for some time complained of pain and sicknes» 
in the stomach, occasionally more or Jess violent, 
and the functions of herbowels were so imperfectly 
performed, that for many months she had been 
constantly compelled to bave recourse to purga- 

* Acsulémie de Chirurg. Voi. I. p. 185. 



CALCtJLUS VOIDEB FROM THE GROIK. 195 

tive medicines : at last a tumor presented itself 
which I was requested to see, just above the right 
groin* It was evidently situated under the integu- 
ments and muscles of the abdomen, slightly move- 
able, and could almost be comprehended between 
the fingers and thumb. There was an inflamed 
line of above àn ìiìch. in diameter, extending ob- 
liquely upwards, and towards the linea alba. It 
was painful to the touch, and she had some fever. 

The first impression on- my mind, was that it 
might probably be an affection of the ovarium, 
But^ her age, the preceding history, and the very 
strong resemblance of the symptoms to the case I 
have described, induced me to suspect that, un- 
less it were prevented, it would have the same 
progress and issue; for it was clearly, I think, 
connected with the functions of the intéstinal ca- 
nal. I therefore directed her to apply leeches to 
the tumor, which was done four; or five times, 
and to be smartly purged every morning. With this 
treatment, tògether with rest, and a very low re- 
gimen, the tumor soon became less painful and 
smaUer, and in the course of ten days was so far 
reduced as to cease to be inconvenient to her; 
there was, however, stili a considerable indura- 
tibn, .which could be discovered by hard presaure 
on the abdomen. 

It would have been Éivourable to the analogyv 
which I yet presume wìll be acknowledged, of these 

02' 



196 CALCULUS VOIDED FROM THE GROIN. 

two cases, if a calculus, wherever it had been lodged, 
fiad been discovered in the faeces which passed 
ivhile the tumor was diminishing, But no such 
concretion was seen, nor perhapsvery accurately 
sought for, altl;iough I had said that very probably 
it would be found in the evacuations. 

^ ^ From the sìtuation and ali the circumstances of 
the first case, I thmk there can be no doubt that 
the calculus was the cause of the abscess, and that 
it was lodged in the coecum, where that portion of 
the canal is attached to the right side, and net, 
like Petit's cases, in the gali bladder. The faecal 
evacuations sufficiently distinguish the two diseases, 
and the fbetor of the discharge shews that it was 
not in the small intestines. 

Had the abscess been opened artificially, I have 
great doubt whether it would have terminated so 
favourably, for the differeilce between a spenta- 
neous wound, and one made by a cutting instru- 
ment, is often ^reater than a priori might have 
been suspected, more particularly ^ere a serous 
membrane is involved in the operatìon ; and the 
flow of fseces after the lancet, unlesis it had been 
distiYictly foreseen and foretold, would, at ali events, 
have been an embarrassing and unfavourable cir- 
cumstance to the surgeon. 

The fortunate issue of the second case, happily 
prevented niy having ocular evidence vf its jMredse 



m 
CALCULUS VOIDED FROM THE GROIN". 19? 

nature, but I cannot help supposing, from the 
dose resemblance of the symptoitts, that it was of 
a similar description. 

Golden Square, 
Augustlth, 1812. 

P.S. Dr. Marcetj having heen reqtiested to ex* 
mane the calculuSj found it to be of thefusìble kind^ 
and indestructible by Jire^ and having the general 
properties qfcakuli^ which consist of the miaedphos* 
phat qf Urne and ammoniaco^agnesian phosphat. 



<5ENERAL VIEWS ] 

or THB 

comÌposition 
ANIMAL FLUIDS 

By j' berzelius, m.d. 

PROFESSOR OF CHEMISTRY IN THE COLLEGE OF VEOICINE AT 

6T0CKH0LM. 

COMMUNXCATES BT 

DR. MARCET. 



Read Septembei^ 8, 1812. 

■ I / 

JlI AVING related to my friend Dr^ Marcet, some 
observations that I bave made on the subject of 
Animai Cbemistry; and being invited by him to 
communicate them to the Medicai and Chirurgical 
Society, I shall, in compliance with his wish, ven- 
ture to submit to the Society, some of the princi- 
pal results that I bave obtained at different periods, 
prior to my visit to this country, respecting the 
Huids of Animals. Most of these observations 
have been published in a more unconnected state 
in different works in the Swedish language*j but 

* In my " Fòrelasningar i Ejurkemien, 2 Voi. Stockh. 1808. 
And also in Afhandlingar i Fysik, Kemi ocb Mineralogie, 3 Voi. 
Stockh. 1810." / 



ÒF ANIMAL FLUIDS. 199 

as thcy have not been translated ìnto any other lan- 
guage, and as they have appeared to those who 
bave seen them, to contain some new views, I 
am induced to offer them to the Society, in the 
hope that they will be received isrith indulgence. 

I. Oftlie blood. 

In most of the analytical researches on blood, 
that of the bullock has been made the subject of ex- 
periment. I shall therefore begin with the analysis of 
the blood of that animai, and afterwards notice the 
essential points in whicb I have found it to differ 
from the human, 

A. Buttoclc's blood^ 

Blood may be regarded as a liquid holding a co- 
louring matter suspended in it, but not dissolved. 
The first step in the process of accurate analysis 
should therefore be to separate the suspended mat- 
tar by filtration. But this method succeeds only to 
a certain degree, and requires a time so considera 
able, that the blood undergoes spontaneous changea 
of composition before the separation can be com- 
pleted: for notwithstanding ali possible care, the 
colouring matter will either pass through with the 
fluid portion, or by adhering in masses, prevent ali 
further percolatìon, Another mode is that of allow» 
ing it to subside by rest: but this alsó goes on with 
extreme slowness: the clear supernatant liquor loses. 
its red colour but very gradually ; and the colour- 
less |>ortion is not capable of being coUected alone. 



200 CHEMICAL PHOPIiltTtES 

The usuai way of obtaining them separate is Ui 
take advantage of the coagulation of the blood, 
during which the fibrin enveloping the colouring 
substance, presses out the serum. This; method is^^ 
indeed but very ìmperfect, as a iarge partion of 
the serum stili remains attached to the red globules 
in the coagulum ; but it is the only one that we can 
employ. 

I shall first consider the crassamentum, and its 
two constituent parts, fibrin and colouring matter. 

The Chemical Properties qf Fibrin. 

Fibrin is insoluble in cold water. In boiling 
water it curls up, and, after the ebullitìon has con- 
tinued some hours, the water acquires a milky hue, 
but no gaseous product appears. By this operation 
fibrin undergoes a species of decomposition ; the 
water in which it is b'oiled affords, by the addition of 
tannin, a precipitate of white and distinct flocculi, 
which do not cohere together by the beat, as those 
produced by gelatìn. The evaporated liquid does 
not gelatinize to whatever degree it may be con-? 
centrated, and leaves a white, diy, hard and fri- 
able residue, which is soluble in cold water, and 
has an agreeable taste similar to fresh broth, and 
^otally unlike the salt and acrid flavour of the 
extrac t from muscles. fibrin, by Ipug boiling in 
water, loses its property of softeningand dissolvipg 
|n acetic acid* 



OP ANIMAL FLUIDS, 201 

2, In akohol of specific gravity 0.81 fibrin un* 
dergo^s a species of decomposition, and forms au 
^dipocirous matter, soluble in alqohol, aurJ pr^ci- 
pitatedby the addition of water } having often a very 
strong and unpleasant odour. The alcoholic soluti* 
tion leaves on evaporation a fat residue, which did 
not pre-exist in the fibrin, and which, as we shall 
find, is Kkewise formed by the action of al^ohol in 
the colouring matter and on the albumen. Fibrin 
heated in alcohol, retains' its property of softening 
and dissolving in acetic acid. 

S. By th? action of ether^ fibrin is converted in- 
to an adipocirous mass similar to the preceding, but 
in much greater abundance, and having a much 
«tronger and more disagreeable odour. We are on 
this account precluded from employing generally 
edther. alcohol or ether in analytical experiments on 
Itnimal substances» 

r 

■ « 

4. In concentrateci acetic acidy fibrin becomea 
immediatély soft, transparent, and with the assist- 
ance of beat is converted into a tremulous' jelly, 
By adding water and warming it, this jelly is com-» 
pletely dissolved^ with the evolution of a small quan* 
tity of azotic gas. The solution is colourless, of a 
mawkish and slightly acidtaste. During its evapora-, 
tion a transparent membrane appears on the surface, 
and after a certain degree of approximation , th e gel ati- 
nous substance is again re-produced; but this gela- 
, ^ne has no resemblance to that formed by paste. 



202 >CHEM1CAL PROPERtnCS 

When completely desiccated it ìs a transparent mass 
which reddens turnsol paper, but which without a 
fresh addition of acetic acid is insoluble both in cold 
and boiling water. The solution of fibrin in acetic 
acid added toprussiateof potassorof ammonia, gives 
awhite precipitate, without any separation of prussìc 
acid, This solution will also produce a precipitate by 
alkalies, but it is redissolved by a small excess of the 
latter. Sulphuric, nitric, and muriatic acids afibrd 
Kkewise a precipitate with this solution: and tìie 
precipitate is composed, as we shall presently see, 
of fibrin and the acid employed. If the precipitate 
be laid on a filter and washed, a certain quantity 
of this acid is carri ed off' by the water, and the re* 
maining substance is soluble in pure water. The 
sdiution contains a neutral combination of fibrine 
with the minerai acid employed, which is mucous, 
somewhat opaline, and of an acidalous taste. An 
addition of acid will again precipitate it, and itthus' 
often happens that an animai substance that has 
been treated with a minerai acid and washed on the 
filter, gives at length a clear liquor which becomes 
turbid on falling into the acid liquor that had first 
gone through. This phenomenon always indicates 
the presence of the abovementioqgd combination of 
a minerai acid with fibri», or with allfumen, which 
appears to possess tlie same chemical properties a^ 
fibrin*. 

* It may be oteervcd that the precipitate produced by nitric 
acid, assumes a yellow colour, but has in other respects the same 
pro^^erties as the two olhers. 



OV ANIM AL TLUIDS. SOS 

4. In weakmuriaticacid^ fibrìn shrihks and gìves 
out a small quantity of azotic gas ; but scarcely any 
portion is dissolved even by boiling: neither does 
the acid lìquor afFord any precipitate with ammo- 
nia, or with prussiate of potass. Evaporated to 
dryness a brownish residue is obtained, from which 
potash disengages a little amtnonia. Concentrated 
murìatic acid decomposes fibiìn by coction, and 
produces a red or violet-coloured solution^ 

The fihrin that has been digested with weak mu- 
rìatic acid is hard and shrìvelled. By washing re« 
peatedly with water, it is at length converted into 
a gelatinous mass, which is perfectly soluble in te^ 
pid water. The' solution powerfully reddens litmus 
paper, and yields a precipitate with acids as well as 
with alkalies. Fibrin has therefore the property of 
combining with muriatic acid in two proportions. 
The one gives a neutral combination soluble in wa- 
ter; the other, a combination with excess of acid 
which is insoluble, but which is reduced to the state 
of tlie soluble compound by the action oppure water. 

5. Concentrated suJphuric acid decomposes and 
carbonises fibrin.- The same acid diluted with six 
times its weigbt of water, and digested with fibrin, 
acquires a red colour, but dissolves scarcely any 
thing. The fibrin that is not dissolved is a combin- 
ation of it with an excess of sulphuric acid. By 
depriving it of this excess of acid, by means of pure 
water, a neutral combination is obtained which is 



204 CHEMICAL FROPEBTIDS 

soIuUe in water, and possesses thè same characters 
as the neutral muriate of fihrin. 

6. Nitric acid of the specìfic gravity 1.25 digest- 

ed with fibriQ, renders it yellow, and diminishes 

itscphesion. The fluid becomes yellaw, and the 

surface of the fibrin is covered with a small quantity 

of fat formed by the action pf the acid. During 

this operation elastic matter is disengaged, which is 

azotic gas alone, and in which I could not discover 

the smallest portion of nitrous gas. When the di- 

gestion has been continued twenty.four hours, the 

fibrin is converted into a pulverulent mass, of a 

pale citron colour, which is deposited at the bottom. 

of the Kquor. The latter ^>cing decanted off, and 

the undissolved matter placed on a filter and washed 

with a large quantity of water, the colour changes 

in proportion as the acid which was in excess is 

carried off, and the mass acquires a deep orange 

colour. Even vòen the affiision is continued J:ill 

the water gives no sign of acidity, the orange mass 

has not yet lost the property of reddening litmus. 

This yellow substance was discovered by Messrs. 
Fourcroy and Vauquelin, who obtained it in treating 
muscular flesh with nitric acid. They have de- 
scribéd it as a new acid formed by the action of 
nitric acid on the muscular fibre, and to which from 
its colour they have given the name of yellow acid. 
f Acide jaunej. This substance is dissolved in 
caustic alkali, to whigh it imparts aii orango colour. 



OF ANIMAL FLUIDS, $05 

and it is partìy soluble in acctate of potass and of 
soda. The French chemists found that if treated 
with a fresh quantity of nitrìc acid, it acquires the 
property of burning with the satne phenomena as a 
combustible body mixed with nitre. This fact iSù^^y 
consìdered as remarkable, since they could not de- 
tect any nitric acid in the yellow acid. But the 
latter, as will be presently shewn, is nothing more 
than a combination of fibrin with nitric acid, (oriu 
other cases, perhaps, with nitrous acid,) and also 
with another acid formed by the decomposition df 
a portion of the fibrin, a species of combination 
very analogous to the one already described. If 
the yellow substance be boiled with alcohol, a yel- 
low adipocirous matter is takeh up ; but it is depo- 
si ted when the liquor cools. This sebaceous matter 
has a great resemblance to that obtained by the 
action of alcohol on pure fibrin. If the yellow sub- 
stance, after being thus deprived of its adipocirous 
portion, be digested with water and carbonate of 
lime, it slowly decomposes the carbonate, disen- 
gages its acid in the form of gas, and produces a 
yellow solution. Having séparated this fluid fìrom 
the undissolved portion of the yellow substance, I 
concentrated it to the consistence of a sjrrup : and 
then poured in alcohol, which precipitated one 
part, retaining the other in solution. The precipi- 
tate had ali the characters of malate of lime. Dis« 
solved in water, and decomposed by a sufficient 
quantity of sulphuric acid, it yielded sulphate of 
Urne; and the acid liquor being filteréd and evapo- 



SÌOS ^ CHEMICAL PROFERTlES 

rated, gave a brownish and liighiy acid i^fup^ 
possessing aH the properties of malie acid. The 
portion dissolved in the alcohol was evidently a 
mixture of nitrate and nitrite of lime. The mixture 
consisting of undecoraposed carbonate of lime, and 
tlie insoluble part of the yellow substance, beìng 
decomposed by diluted muriatic acid, left a yellow 
mass perfectly sìmilar to the one which I had before 
decomposed, and possessing, like that substance, 
the property of reddening litmus paper. It appear- 
ed therefore that I had merely exchanged the ni- 
tric and malie, for tlie mmiatic acid. 

We thus find that fibrin enters into combination as 
readily with nitric acid, as with the other beforemetì- 
tioned acids, and that it is capable of forming two 
combinations, the one containing an excess of acid 
and having a pale yellow colour, the other neutral 
and of an orange bue. By digesting fibrin with 
nitric acid, it undergoes a species of decomposition 
by which malie acid is formed. This acid in con- 
junction with the nitric acid combines with the im- 
decomposed fibrin. The fibrin thus united with 
the two acids is certainly in some degree altered, 
for its neutral combination with nitric acid is inso- 
luble in Vater, and retains its insolubili ty and its 
yellow colour even when the nitric acid has been 
displaced by muriatic. On the other band, we 
bave seen that the precipitate thrown down by ni- 
tric acid firom a solution of fibrin in acetic acid, 
acquires a yellow tinge, but that watei^in depriving 



OF ANIMÀL FLUIDS. 207 

it of the excess of acid, renders ìt gelatinous and 
again soluble. It follows that the fibrin, which, in 
the yellow body, performs the office of a saline base 
to the nitrìc acid, must be modifìed in a difTerent 
manner from what it is in fibrin combined witli the 
acids in the soluble combinations. 

The nitric acid, in which the yellow substance 
has been formed, has a bright yellow colour : it 
holds in solution a portion of the yellow substance 
with a quantity of malie acid, Mixed with alkali 
in excess, it assumes a very dark yeUowish brown 
coloun 

7. In caustìc alkalij fibrin increases in bulk, be- 
comes transparent and gelatinous, and at length is 
completely dissolved. The solution is yellow with 
a shade of green. Acids occasion in it a precipitate 
which gradually becomes confluent. The solution 
of fibrin in caustic alkali is precipitated by alcohol^ 
which by means of the excess of alkali dissolves a 
portion of the neutral combination of fibrin with 
alkali. If the aqueous alkaline solution be evaporat- 
ed, a coagulum is formed towards tbe end of the 
process, probablyin proportion as the alkali becomes 
carbonated. The action of alkali upon fibriu pro- 

duces some alteration in its properties, fot th^ 

• 

precipitate thro\vn down by acetic acid does not 
dissolve by an additional quantity of acid. But 
whatever be the nature of this change induced oa 
fibrin by the alkalies, the former is by no paeanip 



aOS CHEMICAL PROPEftTttiS 

( 

9 

converted, as M. Fourcroy has alleged, into a fatty 
substance with which the alkali produces a sapona- 
ceous compound, nor has it even the least analogy 
to any species of soap. As far as I can perceive, 
tìiis effect of alkalies is confined to the epidennoid 
textures, and parts which by long arid continued 
boiling are converted into a simìlar substance. 

s 

Ofihe Colùuring Matter and its Chemical Properties. 

In order to separate, as much as possìble, the 
colourìng matter from the albumeft and the salts of 
serum, I cut the crassamentum irito very thin slices 
which I placed upon blotting paper, till it had 
taken up ali that it could absorb : after which they 
were dried. A portion of the crassamentum treat- 
cd in that manner, was triturated with water as 
long as it appeared capable of acting as a solvent. 
Tliis water acquired from the matter it had dissolv- 
ed, a brown colóur of so deep a shade that ìt did not 
exhibit the least transparency when contained in a 
glass tube of a quarter of an inch in diameter. 
The fluid had a faint odour of blood, and a mawkish, 
saline and highly nauseous taste. 

I coagulated the solution by raeans of beat in a 
pneumatic apparatus. The mass frothed consider- 
ably, but no elastic fluid was disengaged. While 
yet hot, it was placed on a Alter : the liquor had a 
tea colour which it lost by cooling, arid at the same 
lime deposited a small quantity of the colouring 
matter. I shall revert to this liquor in the sequel. 



OF ANIMAL FLUID9. 209 

The dark brown coagulated matter» after being 
tarefully washed, and subjected to a powerfìil press^ 
was drìed at a temperature of TO'" (centigrade ther* 
mometer.) It was but little contracted by the ex- 
siccatìoii, but had become black^ hard, difficultly 
palverisable. and shewed a vitrous fracture. Before 
the desiccation is complete, it is of a dark brown 
colour, faas little cohesion, and forms a granulated 
mass: drcumstances by which it may be distin. 
guished from both fibrin and albumen. 

1. The colourìng matter is acted upon by hoiling 
'water in nearly the same way as fibrin, becoming 
somewhat contracted by coction; and the solution 
contains soda, and an animai matter perfectly ana- . 
logous to that wliich k obtained from fibrin^ but 
rather less in quantity: for it would appear that a 

, portion of this sabstance begins to be fbrnìed from 
the comibencement of the process of coagulation. 
It retains its black colour, but loses the property 
of softening, and dissolvìng in acetic acid. 

2. Alcohol and etìher convert the colourìng mat- 
ter in part, into a &tty adipocirous mass, having a 
very disagreeable odour. 

3. In acetic aeìd^ the colourìng matter immedi» 
ately becomes soft, forming a black and tremulous 
jelly, which dissolves ia tepid water with the disen- 
gagement of a small quantity of azotic gas. The 
solution is reddish brown and only sémi-traixsparent» 

voL. in. p 



210 CUEMICAL PaOPJERTIES 

A small part of the coloUriog matter remains un- 
dis$olvedt aud forms with the acid a compound of 
very sparing solubility. 

A solution of the colouring matter mixed witl» 
^cetic acid does.not coagulate; hut when made to 
boil turns black and deposits a very small quantity 
of its insoluble compound, without however coagu- 
lating. . 

Tlie solution of the colouring matter in acetic 
acid is precipitated both by alkalies aud by alkaline 
prussiates. Ammonia produces a dark brown pre- 
cipitate, which when well washed and weighed, is 
found to be the colouring matter unaltered, and 
àgain soluble in acetic acid. The solution after 
precipitation by ammonia is. yellow, and deposits by 
evaporation a quantity of white matter, which ìi 
readily distinguished to be albumén, of whioh it is 
impossible entirely to deprive the crassamentum. 

Prussiate of ammonia precipitates from the acetic 
solution a mass of a blackish brown colour, resem- 
bling the precipitate by pure ammonia. Both ihese 
precipitates, employed as pigments, give the stme 
shade of a dirty brown. The prussic acid, therefore, 
appears to exert no action on the colouring matter 
of the blood; which should take place if the latter 
owed.its colour to a ferruginòus «alt. The solution 
of colouring matter in acetic acid is precipitated by 
the mineraL acids, and the precipitates have-pre* 



OF ANIMAL FLUIDS. 211 

cìsely the sarae characters, excepting the colour, 
which is brown, as those procured by the same me- 
thods fromfibrin. 

4. Concentrated muriatic acid does not dissolve 
the colouring matter, evén when aided by digestion : 
a small quantity of azotic gas is disengaged and the 
acid assumes a yellow tint : alkalies, however, prò-- 
duce in it hardly any precipitate. The undissolved 
portion is a compound with excess of acid which 
becomes soluble in proportion as the superabund- 
ant acid is carried oiR The neutra! solution of co- 
louring matter is brown, and has the sàme properties 
as that formed by acetic acid. The colouring mat«> 
ter boiled for a long time with muriatic acid, suffers 
a commencement of dacomposition ; some iron is 
taken up by the acid, and the undissolved portion 
is no longer soluble even by repeated washing, al-» 
though in this state it retains a portion of acid, of 
which the water cannot deprive it* 

5. The nitricacid produces the same effects in 
the colouring matter as on fibrin; the only dis- 
tinctìon being in the colour, which in the formey 
is invariably black, 

6. Catistìc Ammoma dissolves ^he colouring mat- 
ter assuming a very deep brown colour. A pre- 
cipitate is thrown down by acids, but not by the 
alkaline prussiates. The precipitate formed by 

?2 



212 CHEMICAL PROPERTIES 

acetic acid is again soluble, but only by an excess 
of acid. 

7. In solution of caustìc Jixed alkali the colour- 
ing matter is softened, forming a browni^ jeBy> 
which is dissolved by a sufficient quantity of water. 
During the evaporation it coagulate» in próportion 
as the alkali absorbs carbonic acid. The alkaline 
solution Ì3 precipitated by alcohol, which, however, 
acquìres a red tihge by dissolving a small quantity 
of the compound fbrmed of the colouring matter 
with the excess of alkali. The alkaline solution of 
colouring matter seen by day-light has a green 
colouF, buf appears red by candle-Ught. It was 
npon tbis appearance of gteen that Fourcroy con- 
ceived the idea that bile might be formed by boil- 
ing blood with a small quantity of water ; but thia 
green fluid, as we shall afterwards see, agrees with 
bile in no property excepting colour. 

8. If a solution of the colouring matter in water 
be exposed to a beat of 5(f (centigrade thermome- 
ter) in a saucer, it blackens aiid dries completely 
without coagulating. In this state it is again en- 
tirely soluble in cold water. 

These experiments prove that tìie colouring 
matter has the same chemical propwties, and con- 
sequently the same chemical compositicai as fibrin^ 
but that these two bodies are distinguiskable ironv 



OF ANIMAL FLUIDS. 21 S 

one another principally by a difference in colour; by 
the fibrin coagulating spontaneously in ali tempera- 
tures, while the colouring matter nmy be dried, 
without losing its solubility in water, and becomes 
insoluble only at a certain temperature : and lastly 
by the peculiar character of the latter when coagu- 
lated, such as its not being diminished in volume 
during the exsiccation, as happens with fibrin. 

Inquiry info the ÌTifltience of the iron containcd in the 
colouring matter^ in prdducing its colour. 

The greatest chemical difference that is found be- 
tweenfibrin, albumen, aridcolouring matter, consista 
in a quantity of oxide of iron being contained in the 
ashes of the colouring matter, while none, or at ' 
least an infinitely small portion is af&rded by the 
others. Parmentier and Deyeux, to whom we are 
indebted for an elaborate memoir on the blood, 
,have conjectured that the iron, contained in the 
blood, was dissolved in a way analogous to the al- 
kaline tincture of Stahl, an opinion which has since 
been controverted by Fourcroy and Vauquelin, 
who, on their side, bave endeavoured to prove 
that the colouring matter of the blood was a solu- 
tion of red subphosphate of iron in albumen. We 
shall find that neither of these theories can be true, 
and that the t^ode in which the iron is cambined 
with the colouring matter will probably long re* 
main ynknown. 



214 CHEMICAL PROPERTIÈS 

The colouring matter dried, and exposed to lire 
in an open crucìble, melts and swells up, and at 
last burns with flame. It leaves behind a poroiis 
coal, which cannot be incìnerated without the 
greatest difficulty* For this purpose it must be re- 
duced to a very fine powder, and exposed to the 
fire in very thin layers. Whìle the charcoal is con- 
suming, it continually exhales a smeli òf carbo- 
nate of ammonia, which proves that the constitu- 
ents of ammonia are not disengàged from the char- 
coal by heàt alone^ but that the influence of 0x7. 
gen is also required in ord^r to effect the separa- 
tion. The ashes remaining after the destruction of 
the carbon is yellow and pulverulent. 

The disetìgagement of ammonia from a mass of 
burning charcoal which has already been exposed 
for a long time to fire, is undoubtedly a very re- 
markable phenomenon; but another and a no less 
singular fact is presented by the same substancè. 
If the cl^rcoal which has already been long burti- 
ing, and whose surface is covered with yellow 
ashes, be pulverised and boiled in nitro-muriatic 
acid, the acid dissolves the ashes already fofmed, 
but does not deprive the remainder of the charcoal 
of the property of affording a fresh quantity of ashes 
on re-exposure to the fire. These observatipns 
seem to prove that the carbonaceou* matter of the 
colouring substancè which remains after the flame 
has ceased to appear, and after the whole mass has 



ÒF ANIMAL FltJlÙS. 215 

been subjected to a strong red beat, cannot be, as 
was before supposed, a mechanical mixture of char-, 
coal with the phosphates and carbonates of the 
earths and of iron. We must therefore consider it 
as a chemical compound of carbon, phjpsphonis, 
sulphur, with calcium, ammonium^ and iron ; and 
it appears that it is in a mode analogous to this com- 
bination that the iron as well as the calcium, phos- 
phorus &c. are united with the charcoal, and other 
constituents of the colouring matter ; for it is very 
evident that the mode in which combustible bodies 

* 

combine with one another, and with a small portion 
of oxygen in organic substances, is totally different 

fròm that which prevails among the inorgànic pro- 

ductiòns of naturet 

To return to the ashes of the colouring matter ; 
water extracts from ita very small quantity of soda 
roixed with muriate of soda. I bave great reason 
jto suspect that these two constituents are merely 
accidentale and that tliey appear in consequence of 
the impossibility bf freeing the crassamentum en- 
tirely from serum. If the alkaline liquor which is 
obtained from the ashes, be saturated by acetic 
acid, evaporat^d to dryness, and again dissolved, a 
precipitate will appear on the addition of lime-w^- 
ter, which is phosphate of lime, but in so minuta a 
. quantity as npt to be appreciable, 

I incinerated 20 graijimes (400 grains) of colour- 
ing matter, till the charcoa,! was completely 4estroy- 



216 CHBMICAL PftOFSRTIES 

ed, and obtained 0«25 grammeB (5 gràiiis) <ff 
ashes having a yellowish red colotin By^n ac* 
curate analysis, I found it composed of 

Oxide of iron - - 50-0 

Subphosphate of iron - 7.5 
Phosphate of Kme with a) 
small quantityof magnesia) 

Pure lime - • * 20.0 

Carbonio acid, and loss 16.5 



6.0 



100.0 



But this phosphate of iron was not, in ali proba- 
bility, contained in the colouring matter, not even 
in the ashes: it has evidently been a produet of the 
analytic process. It is produced in iike manner 
when oxide of iron and phosphate of lime are dis- 
solvedtogetber in an acid, and aflerwards precipitata 
^d with caustic ammonia. Part of the lime x^ 
mains in solution, and the iron seizes upon its phos- 
phoric acid. 

But as one mode of argument will hardly suffice 
to overtum a theory maintained by chemists of such 
pminence as Fourcroy and Vauqudin, and for 
the support of which they bave brougfat forward 
many positive facts, I bave made a number of ex- 
perimentsi with a view of throwing light on this 
subject, and bave not ^let with a single one, which 
^idnot appear in contradiotion to the opinion of 



these celebrateci analysts« Some of these experi- 
ments I shall now relate. 

(A.) The prussiates, as we have already secn, 
produce no effect on the colouring matter of the 
blood ; and yet they detect, after 24 hours, the 
least quantìty of any ferrugineous salt added te it^ 
bavìng the red oxide of iron for its basìs. 

(B.) A watery solution of colouring matter^ mixed 
with gallic acid^ acquires a beautiful red colour, 
but the acid produces no precipitate. By adding 
to the solution of colouring matter one or two drops 
of a dilute solution of tannin, the liquor becomes 
•of a beautiful red, without any precipitate appear- 
ing. But if on the contrary, tlie solution of tan- 
nin be concentrated^ it precipitates tlic colouring 
matter, and gives it a pale red colour. None of 
ihese effects seem to prove the presence of a salt 
,with tlie base of oxide of iron. 

(C.) The aqueous solution of colouring matter, 
mixed with solution of bary tes, is not precipitated : 
t^t the end of 24 hours a sinall quantityof phasphate 
of barytes is found at the bottom of the vessel, and 
the liquor has assumed a green colour by the action 
of the alkaline base. Lime water produces no 
change. 

(D.) A solution of gulphuret of potash produces 
QO change in the solution of colouring matter, ex- 



V 



SlS CHEMICAL PROPERTIES 

cept that the red colour is slowly converted ìnto 
green by the action of the alkali. A drop of ace- 
tic acid precipitates the sulphur of a white colour. 

(E.) It is well known that none of the minerai 
acids deprive the colouring matter of its colour, 
which ought to be the case if that colour had been 
owing to the presence of the subphosphate of 
iron* The phosphoric acid mixed with the co- 
louring matter blackens without precipitating it : 
whereas, if the opinion of the French cbemists 
were correct, it ought to produce a neutral and 
colourless phosphatCt 

(F.) A drop of a solution of acetate of lead ex- 
alts the colour of the colouring matter, and a larger 
quantity throws dowji a fine red precipitate, 

(G.) The nitrates of &ilver, of lead, and of mer- 
cury blacken the colouring matter, and wben addi- 
ed in larger quantity precipitate it, 

« 

These experiments prove that the iron in the co- 
louring matter is not contained in it in such a way 
as to admit of being detected by the best re-agents 
we possess, until the composition of the colouring 
matter is totally destroyed. 

But how can these facts be reconciled with the 
following, mentioned by Fourcroy in bis Systéìnedes 
Connoissances Cht/miques? " Vauquelin and I,'* says 

1 



ÒF ANIMAL TLtJIDS. 219 

he, " bave found that the subphosphate of oxide of 
iron is easily dissolved in albumen by a slight agita* 
tion and without the aid of beat, and that this so- 
lution possesses a bright red colour, similar to that 
of the blood. This colour becomes stili more vivid 
by adding a little caustic alkali, which fàcilitates 
stili mòre the solution of the subphosphate in albu- 
men." 

It was not till after having made and carefuUy re- 
peated many experiments, that I could venture to 
pronounce this opinion to be void of foundatiom 
I shall not seek to form any conjectxu'e with regard 
to the circumstances which may bave deceived 
thesG distinguishedchemists, but shall merely relate 
my own experiments on the subject* 

The subphosphate in question, newly prepared 
and stili moist, easily mixes with serum, giving it 
the colour of rust ; but it subsides in process of 
lime, and may be entirely separated from it by 
means of a fìlten The neutral phosphate of oxide 
of iron, mixed with serum also, does not dissolve^ 
and the addition of caustic- alkali instantly prò» 
duces the subphosphate ; but this last remains un- 
dissolved, and communicates to the liquor a colour 
of rust, which is quite dissimilar to that of the co- 
louring matter of blood. The serum deprived of 
subphosphate by filtration retains a pale yellowish 
colour, which is owing to a small quantity of oxide 
i>f iron hcld in solution. 



220 CHEMICAL PROFERTIES 

If serum is mixed with the sub^phosphate in 
question, and phosphoric acid is added, so as la 
dissolve the subphosphate, a clear rust-coloured 
liquor is formed, from which a small addition of 
caustic alkali precipitates a little albumen, which 
is again dissolved by a slight excess of the alkali ; 
and then the solution loses its rcd colour, and the 
subphosphate falls down, and may be coUected on 
thè fìlter. 

In ali these experiments the albumen dissolyes 
the oxide of iron, even in greater quantity than 
exists in the colourìng matter of the blood ; but 
this solution is yellowish, and has but little body 
of colour ; and the oxide of iron is shewn by the * 
usuai reagents* The albumen of serum wiU also 
dissolve many other metallic oxides, for instance, 
that of copper, as Vauquelin has long since proved; 
and it is doubtless the albumen which is the men- 
struum of the oxide of mercury, found dissolved in 
the blood during a course of this metal for the cure 
of syphilis. The oxidulum (or black oxide) dis- 
solves easily, and stili more copiously, in serum, 
forming a perfectly limpid sea-green liquor. The 
solution is readily obtained by adding to serum 
some salt c^ irOn, which has the black oxide for ita 
base, and neutralizing its acid by an alkali. When 
this green solution is exposed to the air, it ahsorbs 
oxygen, deposits red oxide of iron, and becomes 
yellow. The compounds of oxide of iron Imd aU 
bumen are dccomposed by the minerai acids, which 



OF ANIMAL FLUIDS. 221 

precipitate the albumen colourless, and retain the 
iron in solution. The prussiates alone do not dis- 
turb the solution of iron in albumen, because the 
metallie oxìde is not bere dissolved by any acid ; 
but if, àÀer mixing them, a little muriatic acid is 
added, an exquisitely beautiful azure blue precipi- 
tate appears, consisting of albumen and Prussian 
blue. If the acid phosphate of iron is dissolved 
in acetic acid, and afterwards serum be added, fol- 
lowed by a little caustic alkali, the albumen and 
subphosphate are precipitated together, of a rust- 
colour, which is not changed by drying, but has 
no resemblance to the colouring matter of blood. 
In a word, I have not been able to find any me- 
thod of combìning albumen with subphosphate of 
iron^ or with any other salt of this metal, so as to 
produce a compound identica! with the coloiuing 
matter of the blood. 

But firom the result of aU these experiments, 
what appears to be the difference betweeH venous 
and arterial blood ? This question I am unable to 
answer; nor can I explain the difierence between 
diese substances befbre and after coagulation. 

I have already mentioned that the liquid out of 
which the colouring matter has been coagulated by 
beat, has at first a tint of red, which it loses by 
cooling ; at which time it further deposita a small 
quantity ^f colouring matter. This liquid, whilst 
evaporating, becomes green, owing to the actiou 

2 



282 CHEMICAL phoperties 

of the uncombined alkali on the small portioti of 
colouring matter that it stili retains. This liqukl 
holds also in solution ali the salts, and the so- 
luble animai substances belonging to that portion 
of the semm which stili adheres to the coagulum, 
and cannot be entirely separated from it. The coa- 
gulum, I bave found by one analysis, Ito consist 
(exclusive of the saline and uncoagulable ingre- 
dients) of 64 parts of colouring matter, and 36 
parts of an insoluble mixture of fibrin and albumen. 

Ofthe Seruniy Albumen, and Salts ofthe Bhod. 

When serum is heated in a glass vessel, over a 
water-bath, it solidifies and forms a pearl-coloured 
jelly, transparent at the edges. If it is stirred the 
coagulation is more unijfbrm. It has been said to 
blacken any silver instrument employed to stir it ; 
but this only happens when the serum has begun 
to putrefy, or when the bottom of the coagialum 
has been bxumt. As this blackening of silvef is 
owing to sulphur, this substance has also been 
reckoned among the constituent parts of blood. 
But it would be equalìy proper to consider carbon 
and hydrogen as constituent parts, since these en. 
ter into the ccÉnposition of albumen, in the same 
way as sulphur does* 

jSIuriatic acid coagulates serum. ^lien heated, 
a small quanti ty of azotic gas is evolved. This 
coagulum has exactly the same propertiés as the 
qpmpound of fibrin and muriatic acid« 



OF ANIMAL FLUIDS. fi2S. 

The sulphuric and nitric acids also produce witìi 
the albumen of serum precisely the same com- 
pounds as with fibrin. 

Phosphorìc acid does not coagulate serum. 

The acetic acid does not coagulate serum, and 
when thìs acid is in sufficient quantity, it prevents 
the coagulation on heating. 

In short, the albumen of serum produces ex- 
actly the same compounds with. acids and alkalies 
as the fibrin does, and therefore to avoid repeti- 
tion, I shall refer the reader back to my observa- 
tions on this latter substance. Tlie action of al- 
cohol also is perfectly similar in both cases. 

There appears therefore to be very little differ- 
ance between fibrin and albumen ; and the latter 
seeips to be intermediate between fibrin and the co- 
louring matter. The only character of distinction 
between fibrin and albumen is, that albumen does 
not coagulate spontaneously, but requires a higher 
temperature for that purpose. Coagulated albu- 
men does indeed dissolve more slowly than fibrin 
or colouring matter in acetic acid and in ammonia, 
but probably this is owing to the influence of the 
heat employed for its coagulation. 

Ea^. 1. 1000 parts of serum evaporated to per- 
fect dryness, (that is tp say, so as easily to be r^^ 



S24f • CHEMICAL PROPERTIES 

duced to powder,) Icft ninety-fivé parts of a yel- 
lowish, semi-transparent mass, resembling amber, 
that split to pieces in drying, whicb, in curling up, 
carried with them thick scales of the porcelain 
glazing of the evaporating vesseL 

2. I digested ten grammes of the dried powder 
in cold waten The albuminous portion softened, 
and became gelatinous. I separatcd by the filter 
the liquid from the insolublc part, and washed the 
latter repeatedly with boiling water. The undis- 
solvcd albimien dried in the filter, werghed 6.47 
grammes, and did not give up its earthy phos- 
phatc, by subsequent digestion in muriatìc acid, 
as this acid remained clcar on saturation with an 
alkali. ' 

3. The solution which had passed the filter, was 
evaporated to dryness, during which thick membranes 
fbrmed at the surface, and the solution gelatinized 
befbre it was perfectly dry. I digested this residue 
:^n alcohol, whilst it was stili gelatinous ; the spirit 
a^ssumed a yellow colour, and on evaporation left 
an alkaline yellowish deliquescent mass, weighing 
0.92 grammes. This consisted of soda, holding 
albumeh in solution, of muriate of soda, and mu- 
riate" of potash, of lactate of soda*, and òf an 

* In raentioning the lactate of soda in this place^ I wish to 
makc some observatìons on the lactic acid, as one of the consti- 
tuent parts of ali animai fluida. It is well known that this acid 
Was discarercd by my iUustrious countryman, Scheele. Latterly, 

the 



OF ANIMAL FLUIDS. 225 

animai matter whìch always accompànies the 
lactate. 

The portion not dissolved by alcohol and di* 
gested with water^ left a fresh residue of albumen^ 
weighing 1.95 grammes, and possessing the same 
characters as that of exp. 2. The watery solution 

the French chemìstshave examined this acid ; and Fourcroy^ Vau- 
qudin^ Thenard, and Bouillon La Grange, have sought to prove 
that Scbeele was niistaken in the supposed peculiar nature of this 
acid, and thàt ìt is only a combination of acetous acid, with some 
animai matter. 

These cfaemists, howerer, have made no attempts to obtain this 
animai matter separate from the acid, and have never succeeded 
in producing the lactic acid by means of the acetic ; but this is 
the proof which they ^ve of Scbeele being in an error. Lactic 
acid ìs combined with an alkali, the resulting lactate ìs distilled 
with concentrated sulphuric acid, and in the recdver is obtained 
a mixttire of sulphureous, muriatic, and empyreumatic acetie 
acid, the latter of which is purified, and hence it is, that we are 
informed that the pretended lactic acid is only the acetous united 
with some animai matter. But it appears to me, that the French 
chemists have only cut the Gordìan knot ; for one of the proper- 
ties of the lactic acid, is to be incapable of volatilization, and it 
is a property of the sulphuric acid to change many organic sub* 
, stances with which it is distilled, into the empyreumatic ace* 
tous and sulphureous acids. By a parity of reasoning, almost 
every one of the freed vegeiable acids might be proved to be only 
acetic acid, combined with some matter which deprives it of ite 
volatility, without destroying its other acid properties; and in 
fact it is thus, that Bouillon La Grange has inferred that the malie 
and gallic acids are only varieties of the acetic. In an analysis 
of muscular flesh, which I made in the year 1806, I found that 
the humours of the muscles contained a free acid, which, by 
many experiments^ I discovered to have ali the properties which 
VOL. III. Q Schede 



•» 



226 CHEMICAL PROPERTIE» 

cotild not be made to gelatinizé, and did nòt hold 
the smallest quantity of gelatine* Besides the al^ 
kali, it contained an animai matter easily precipi- 
table by tannin and by muriate of mercury, and 
which appeàred to me to be extracted from the al- 

é 

I 

Schede attributes to the lactic àord. I oollected 9 qtiantity largtf 
énough for examination, and I succeeded by diffèrent methods, 
in obtaining it in greater piirity than Seheele had |)roCured bis. 
I examined a great number of its saline combìnations, with alka» 
liesj earths^ and metallic oxyds^ the particulars of which afe gìven 
at length in the second volume of my Treatise on Animai Cheniis* 
try, Stockholm, 1808. p. 430. 4* seq. If therefore it is allow- 
ed> that two acids that produce saUne compounds di^reat fìrom 
each otbery cannot be identi^eal in their nature^ the distination be^ 
tween the lactic and the acetic acids cannot be controverted. It 
i& since that time that I bave discovered the lactic addy free or 
combiiied^ in ali animai flutds. 

Many chemists bave obserred^ in their analysis of animai fluids* 
that the alcoholic solution when evaporated leaves a yellow, deli*' 
quescent extràctive mass. Of late« more attention^ has been paid 
to this extract, and if I mistake not, it has been considered as a 
single substance, and has reeeived the name of osmazome, One 
of the component pafts of this cxtract is lactate of stoda, and the 
other, with which it is intìmately eombined, is an animai matter 
that may be separated by means of tannin. To prove the pre^ 
sence of lactic acid> dissolve the whole in alcohol, and add a mixture 
of sulphuric acid much diluted with alcohol, as long as there ap- 
pears any precipitate, which is sulphate of potash or soda. Di- 
gest this spirituous solution (which contains muriatic, sulphuric, 
lactic, and sometimes phosphoric acid) with carbonate of iead, 
and ali the above aeids will unite with . the oxyd of lead, but c^ 
these only the lactate will be soluble in aleohol. Decant the alco-» 
holic solution of lactate of lead, separate the lead by a- stream of 
sulphuretted hydrogen gas, and by evaporating the clear liquor, 
th« lactic acid will remain in the state of an acid syrup. 



ÒF ANIMAL FLUIDS. 227 

butxien by thè boilifìg water, duritig iU coàgulation, 
ànd to be analogous to the éubstance obtained by 
boiling fibrin with water. 

We bave beén told^ that the blood contains much 
àlkaliné and earthy phosphates. I coagulated a 
large quàntity òf serum, and thus procured a good 
deal of the residiiary uncoagulable fluid. This I 
mixed with barytic water, which after a time gave a 
felight precipitate, soluble in muriatic acid. Some 
of the same serum, mixed with lime-water, was 
not clouded. It follòws from this, that the blood 
contains no sulphuric acid, and only a véstige of 
the phosphòric. In my Trèatisé on Animai Che- 
mistry, I bave endéavoured to prove, that the 
phosphates, às well as the lactates, afe always pro- 
dùded by thè spòntarieous dècomfpòsitión of animai 
substance^, ànd thàt the small quàntity òf eafch 
which is found in the blòod, is Càrtied thither by 
the absorbent system', in its progress to the secre- 
tions, through which it is discharged from the^ 
body, and hence the secretions contain always à 
much larger proportion of these aeids. 

Not to be toc difiusé, I shall pass over the de^ 
scription of the methods I employed, to ascertairi 
the rcspeetive proportions of the contents -of thef 
i^rum, and shall only give the resulta : 
A thousand parts of serum, I find to consist of 
Water . ^ . - 905.00 

Albumen v -^ -, < 79^9» 

Q 2 



8.74 



229 CHEMICAL FROPERTIES 

Substaiices soluble in alcohol, viz. 
Lactate of Soda, and extractive 

matter - - 6.175 
Muriate of soda and 
potash - - 2.565 
Soda and animai matter soluble > 
only in water - . > 
Loss 4.75 



1.52 



1000.00 



I washed the albumen well in this experiment, 
digested it in muriatic acid, and then burnt it to 
ashes, which were almost exacdy equal in qìuantity 
tq the ashes produced by the combustion of the 
same weight of colouring matter, But the ash of 
the albumen was white, and did not shew a parti- 
eie of iron. I found a trace of soda, but the 
greatest part was phosphate and carbonate of lime, 
with a little magnesia. It is clear, therefore, that 
the earthy salts found in the aJshes of coloured 
blood had not been dìssolved in the blood, nor 
even existed as salts in the blood, from whìdh they 
were obtained by means of combustion. Hence 
we may conceive, how the blood can produce and 
deposit in the animai economy, the earthy pho»- 
phates, which, however, are not soluble either in 
pure water, or in the blood; and hence too we 
may infèr, that ihe production of bone cannot be 
considered as a simple crystallization of a salt, con* 
veyedby the blood in a state of solution, but re- 



OF ANIMAL FLUIDS. 229 

quires US to suppose the decomposition of the animai 
matter of the blood, as well as in any other secretion. 

Ali the authors who have written on the blood^ 
assert that gelatine is one of its component parts* 
This, however, is a mistake, and arises from the 
gelatinous appearance of the albumen, as I have 
never been able to detect a partìcle of gelatine in 
blood ; and, as far as my researches extend, I 
have found gelatine to be a substance altogether 
unknown to the economy of the Hving body, and 
to be produced by the action of boiling water on 
cartilage, skin, and cellular membrane, substances 
which are totally distinct from fibrin and albumen. 

On Human Blood. 

The blood of man perfectly resembles in com- 
position that of the ox, but the coagulum of hu- 
man blood is more easily décomposed by water, 
and the fibrin thus obtained is more transparent,. 
When dried, it amounts to no more than 0.75 from 
lOCX). parts. Human fibrin has the same chemi- 
cai properties with that of the ox, but is more 
readily incinerated : the white ash coilsists of the 
phosphates of lime and magnesia, a little carbonate 
of lime, and soda» 

The colouring matter of human blood is also 
chemically the same with that of ox blood, but is 
much more easily reducible by fire to the same 
yellow ash, which seems to shew that it contains 



eSQ CHEMICAL PEQPERTIES 

Jess azDte or ammonium. A hundred parts of dried 
colouring matter of human blood, gave 15. parta 
of ash, of which 3 parts dissolved in water, and 
>vas alkaline, and when saturated with acetic acid, 
and mixed with muriate of barytes, it left a copious 
precipitate of phosphate of barytes, soluble in an 
excess of muriatic acid. I found in this aqetic so- 
lution? no trace either of muriatic acid or of pot- 
ash. It appears therefòre, that soda and phos- 
phoric acid ^s well as the earthy phosphates, are 
products q{ the combustion. As to the portion of 
the ash of colouring matter, which was insolubl^ 
in water, it consisted of the same substances in 
nature and in proportion, as that qf the a^U of tb^ 
polouring matter of ox blood. 

The serum of human blood is composed (accorda 
|ng to my experiments) of 

Water . . - . 905.0 

« 

Albumen r ? r - 80.Q 

Substances soluble in alcohol, m. 
Muriate pfpotash and soda 6.'\ 
Lactate of soda, united > jq;q 
with animai matter é.j 
Substances soluble pnly in water, "viz. 
ÌSoda,phosphate of soda, and a ) ' 



little animai matter 



} 



999.1 



* I cannot refrain here from coitfparing my analysìs, wi^h that 
inade in this country by Dr. Marcet, and given in the secpnd 
Yol. òf these Transactions, page 370. 



OF ANIMAL FLUIDS. . 231 

Human albumen is more easily incinerated than 
that of the ox, and contains more soda and phos- 
phate of soda. A hundred parts of the dried al- 
bumen give twelve parts of calcined ash. 

The muriates found in human blood are triple 
the quantity of those in ox blood, owing doubtless 
to the salt consumed by man in his food. Human 
blood also contains a larger proportion of muriate 
of potash, 

On the whole, the great agreement in the com- 
position of human and of ox blood is remarkable, 
and explains to us the possibility of the phenomena 
obseryed in the experiments in transfusion. 

General results of the analysìs of Blood. 
1. Blood is cpn^posed of one portion, which is 

J)r. Marcet fjnds the follpwing ingpedients : 

Water . ^ ^ , ^ yOO.Q 

Albumen 86.8 

Muriate of potash and soda - *• 6.Q 

Muco-extractive m alter ■? r 4.0 

Sub-carbonate of soda r * 1.65 

Sulphate of potash , r - - 0.35 

Earthy phosphates t - r . 0.60 
A more perfect agreement cannot be expected in the analysis of 
sfibstances Uable to so many accidental difièrences, particularly in 
the quantity of water, whichin the blood depends so much on the 
proportion of hquids taken into the stomach, It is clear that Dr. 
>larcet's extractive matter is impure lactate of soda ; and I must 
also observe, that the sulphate of potash and the eàrthy phos- 
phates found by him in the ashes of serura, are probably, for the 
li^asoas above^ipentioned^ formed b^ the process of combustioq, 



232 CHEMICAL PEOPERTIES 

liquid andhomogeneous^and of anotherwhìch isotlly 
suspended and spontaneously separates when at rest. 

2. The liquid part is a solution of much albumen 
and a little fibrin, both combined with soda. It 
also contains some other saline and animai sub- 
istanceS) but in very small quantity. 

S. The portion which is suspended is the colour^ 
ing matter. It differs from the albumen chiefly in 
its colour, and its insolubility in serum. The co- 
lour seems to be owing to iron, of which it con- 
tains j per cent of its weight, but which cannot 
be separated from it as long as it continues to be 
colouring matter. This separation can only be af- 
fected by combustion, or by the concentrated acids, 
both of which agents entirely decompose the sub- 
stance with which the metal was combined. The 
colouring matter cannot be artificially produced by 
uniting albumen with red sub-phosphate of iron. 

4. Fibrin, albumen, and colouring matter, re- 
semble each other 'so closely, that they may be con- 
sidered as modifications of one and the same sub- 
stance*. I shall in future cali thèm albuminous 

* One of the most striking points of diflèrence, exists in the 
property which the colouring matter has of absorbing óxygen, 
and thereby experiencing a vety remarkable change of colour. 
Scrum absorbs very little oxygen, and only in proportion as it is 
decomposed. Can the iron in the colouring matter give it this 
property ? This is probable ; but we shall never arrive at any ac- 
curate knowledge of these phenomena, without first analyzing 

these 



OF ANIMAL FLUEDS. 233 

contents qf the blood^ when speaking of them col- 
lectively. These three substances prodtcce when 
decomposed, but do not contain earthy phosphates 
«nd cai'bonate of lime; and indeed, the entire 
blood contains in solution no earthy phosphate, 
cxcept perhaps in toosmall a quanti tyto be detected. 

5. The albuminous contents of the blood will 
unite with acids, and produce compounds, that 
may be termed saline ; these, when neutralized, 
"will dissolve in water, but separate on adding an 
excess of acid. The acetous and phosphoric acids 
howéver must be excepted, as an excess of either 
of these forms a compound soluble in water. Ni- 
tric acid, digested with the albuminous contents, 
forms an insoluble compound consisting of the al- 
bumen in an altered state, and of the nitric and 
the malie acids. This property of combining with 
àcids, is retained in some instances by the albumen 
after it has updergone the changes produced in the 
secretory organs ; as for instance in the peculiar 
matter of the bile, the curd of milk, &c. 

6. The blood contains no gelatine*. 

these elements of the animai kìngdom uvith the most scrupulous 
exactness. It is then, and not till then, that we may form con- 
jectures ; at present they are useless. 

* It gives me great pleasure to find that an Enghsh chemist, 
Dr. Bostock> has arrived at the same conclusione without any 
previous knowledge of my work, and (owing to a delay in the 
puhhcation) prior to its appearance. See Dr. BostocVs experi- 
ments^ published in the first Volume of these Transactions. 



234 CHEMICAL PROPERTIES 



Secreted Fluìds. 



There exists no problem in chemistry more dlf^ 
ficult to solve, than that of the secretion of ani., 
mal iìuids. The circulating fluid is carried to the 
organized laboratory which nature employs, no fo» 
reign ingredient is added, no chemical reagent is 1 
interposed, and yet the fluid which flows from these 
organs has acquired chemical properties, which 
render it decidedly different from the common cir- 
culating mass. Not only is the chemical agent 
which produces these changes unknown to us, but 
we shall in vain search for any analogous chemical 
operation. It is doubtless easy tp conjecture, that 
it is by the influence of the nervous system, thì^t 
this decomposition of blood into the secreted fluids 
is effected ; but what is this influence ? If elec-^ 
trio, how can it be brought to record with our pre-» 
sent knowledge of electric agency ? But avoiding 
vain conjectures on a subject which perhaps will 
ever remain a mystery, let us determine from 
the knowledge we already possess, th^ chemical 
nature of the materials of their products. In prò- 
portion as we acquire light pn the nature pf the 
former, the analysis of the latter becomes more 
and more interesting,, and much may be done by a, 
judicious comparison of the one with the othen 

There are two classes of secreted fluids ; name^ 
ly, the secretionSj properly so called, or the fluids 
intended to fulfil some ulterior pqrpose in the ftni-» 

4 



OF ANIMAL FLUIDS. - 235 

mal economy; and the excretions vfhìch are directiy 
4ispharged from the body. The fluids 9f the former 
class are ali alkaline ; and of the lattei, ali acid. The 
excretions are the urine, the perspired fluid, and 
the milk. Ali the other fluids appear to belong to 
the former class. 

• 

The alkaline secreted fluids may be divided into 
two very distinct species. The former of these con- 
t^ins the same quantity of water as th^ blood, so 
that the change induced by the nervous influence, 
seems to be confined to that of altering the chemi- 
cal form of the albuminous materials, without af- 
fecting their relative proportion to the water ànd 
Dther substances dissolved in the blood. The bile> 
$permatic fluid, &c. are of this kind. The latter 
species consists of fluids in which the influence of 
the nervous system has separated a large portion of 
the albuminous matter, and left the remainìng liquid 
proportionally more watery. The saliva, the hu- 
jnors of the eye, and the efiused serum of mem- 
branes are of this species; and in these the quanti- 
ty of salts, and in general alsp of alkali, is the same 
3,s in the blood* 

The influence of the chemical agent of secretion 
is therefore chiefly spent upon the albuminous ma- 
terials of the blood, which seems to be the source 
of every substance that peculiarly characterizes each 
secretion, each of which is sui generis^ and is its 
|9rincÌLpal constituent. Ali the other parts of the 



SS6 CHEMICAL PROPERTIES 

«ecretion seém to be rather accidentale and to be 
found there only because they were contained in 
the blóod out of which the secretion was fbrmed. 

Therefore in examining the secreted fluids the 
chief attention should be paid to the peculiar mat- 
ter of the fluid, which varies in alL This matter 
sometimes retains some of- the properties of albu- 
jnen, at other times, none ; and hence an accurate 
analysis shewing the quantity and nature of this pe- 
culiar matter is above ali to be desired. 

If the several secretions be supposed to be de- 
prived of their peculiar matter, and the remainder* 
analyzed, the same residue would be found from 
them ali, which also would be identical with the 
fluid separated from the serum after its coagulation. 
Thus we should find, first, a portion soluble in al- 
cohol, consisting, as has been already shewn, of . 
the murìates of potash and soda, of lactate of soda, 
and of an extractive animai substance precipitable 
by tannin: and secondly, of a portion soluble only 
in water, containing soda (which acquìres carbonio 
acid by evaporation, and is separable by acetic acid 
and alcohol) and another animai substance, not ex- 
tract, precipitable from its solution in cold water 
both by tannin and by muriate of mercury. Some- . 
times a vestige of phosphate of soda will also be de^ 
tected. 

The excretions are of a more compound nature. 

8 






OF ANIMAL FLUIDS. 2S7 

They ali cantain a free acid, which is the lactìc^ 
and in the urine this is mixed with the urie acid. 
Urine seems to contain only a single peculiar cha- 
racteristic matter ; but milk has as many as three, 
namely, butter, curd, and sugar of milk, which^ 
however, seem to be produced by difFerent organs 
that mingle their fluids in the same receptacle* 
The perspired fluid appears to bave no peculiar 
matter, bùt to be a very watery lìquid with hardly 
a vestige of the albumen of the blood, and, in short, 
is the same as the other excretory fluids would be 
when deprived of their peculiar matter, If we sup- 
pose this matter taken away from those excretions 
that possess it, the remaining fluid wiU be found to 
bave properties very different from the fluid part of 
the secretions, when equally freed from their pe- 
culiar matten That of the excretions is acid, con- 
tains earthy phosphates, and when evaporated, 
leaves a much larger residue than the fluid of the 
•secretions, This residue is yellowish-brown, of 
the consistence of syrup, with an unpleasant sharp 
saline taste of the salts that it contains. It reddens 
litmus, is mostly soluble in alcohol, and this spu 
rituous solution contains the murìates of the blood 
together with free lactic acid, much làctate of soda 
(the soda being the free alkaU of the blood neu-* 
tralized by this acid) and the extractive matter 
which always accompanies this neutral salt. The 
part insoluble in alcohol contains a distinguishable 
quantity of phosphate of soda, a little of a similar 
animai matter to that found in the secretions, and 



240 CHEMICAL PROPERTIES 

matter and any of the minerai acids often forms 
with the same oxides a substance lìke a plaster, re» 
sembUng in this respect also the true resins. 

m 

The degree of insolubility possessed by these 
compounds of acid and biliary albumen varies both 
according to the species of animals, and also accord- 
ing to the length of time that the bile has bcen 
extracted; for the longer it has been kept, the 
more solubility these compounds acquire j but in 
this case I bave always found that by pouring in a 
fresh quantity of acid, and slowly evaporating the 
mixture, the resinous matter falls down as the su- 
pematant liquor becomes more acid. 

The biliary matter may be obtaìned pure in the 
following way: ,mix fresh bile with sulphuric acid 
diluted with S or 4 times its weight of water; a 
yellow precipitate of a peculiar nature first appears, 
which must be allowed to subside and be removedj 
then continue to add fresh acid as long as any pre- 
cipitate is formed; beat the mixture gently for 
•somehours, andafterwardsdecant the fiuidpart, and 
thoroughly edulcorate the green resin which is left. 
This resin reddens litmus, and is partially and spar- 
ingly soluble in water. It may be deprived of its 
acid in two ways: one of them is by digesting it 
with carbonate of barytes and water, whereby th« 
carbonate is decomposed, and the water forms a 
green solution possessing aU the peculiar charactera 
of bile: the otìier way is by dissolving it in alcohol 



OF ANIMAL FLUIDS. 241 

ànd digesting the solution, either with carbonate of 
potassor carbonate of lime tillit no longer reddens 
litmus, and then evaporating it to dryness. Either 
of these methods wiU give the pure biliary matter, 
and there are also other ways of obtaining it, which 
I bave described in my work on Animai Chemistry, 
Voi. II. p. 47. 

This peculiar biliary matter when pure, resembles 
exactly entire desiccated bile. Being soluble in al- 
cohol it might be supposed that it would dissolve 
in ether, but this is not the case, for ether only 
changes it tp a yery fetid adipocirous substance, 
exactly as it acts upon the albuminous matter of 
the bloodé One circumstance relating to the biliary 
matter has much surprised me, which is, that it 
gives no ammonia by destructive distillation. There- 
fore it contains no azote ; but what can bave be- 
come of the azote of the albuminous matter of 
the blood ? for, no vestige of azote is found in any 
other of the constituent parts of the bile, nor does 
^ bile contain any ammonia. 

The foUowing is the result of my analysis of bile. 

Water - 907.4 

Biliary matter - - - - 80.0 
Mucus of the gall-bladder, dis-> ^^ 

solved in the bile . . . > 
Alkalies and salts (common to ali > g g 

m m m ^ 



secreted fluids) - 



1000.0 

VCL. ni* . R — - 



242 CnÈMlCAL FÈOPCRTÌES 

2. 77ie SaUva. 

The saliva is one of the fluid secretions which 
cohtàin more water than the blood. When first 
discharged from the mouth it holds suspended a 
tnucus which is not dissolved in the saliva, but 
give» it ìts frothy quality, This mucus gradually 
subsides fì*om the saliva when kept in a cylindrical 
vessel, and with more ease when previously diluted, 
after which the supeirnatant saliva may be decant- 
ed ófl^. 



Saliva is composed of 




Water 


992.9 


A pecuUar animai matter 


2.9 


Mucus . - - - . 


1.4 


Alkaline muriates ... 


1.7 


Lactate of soda and animai matter 


0,9 


Pure soda . - - - . 


0.2 




1000.0 . 



Two of these ingredients require further noticè. 

The pecuììar ànìthal rhatter òF the saliva is òbtaìn- 
ed by adding spirit of wine to dried saliva, which 
dissolvès the muriates, lactates, &c. The ^òda 
which remains ih the insoluble portion is then ex-, 
tracted by fresh spirits slightly acidulated with acet- 
ous acid. The resìdue is mucus mixed with the 
peculiar salivary 'matter, which last may be dissolv* 
ed by water, leaving behind the insoluble mucus. 

1 



OF ANIMAL FLUIDS, 243 

This peculiar matter is therefore soluble in water 
but not in spirits of wine. The solution in i^ater,, 
when evaporateci to diyness, leaves a transpar^nt 
mass that easily again dissolves in cold water. This 
solution is mot precipitated either by alkalies, or 
acìds, or subacetate of lead, or muriate of mercu- 
ry, or taiinin ; neither does it become turbid by 
boiling. 

The nmcus of the saliva is readily procured by 
mixing saliva with ^distiUed water, from which the 
mucus gradually subsides, and it may then be col- 
lected on the filter and washed. In this state it is 
white, and would seem to contain phosphate of lime 
ini:sed with it. This mucus is quite insoluUe in 
water ; it becomes transparent and horny in the 
acetic, sulphuric, and muriatic acids, but does 
not dissolve in them, and the alkalies separate no- 
thing from them. The mucus therefore contains 
no earthy phosphate, though its appearance would 
lead tó suspect this earthy salt. It dissolves in 
caustic alkali, and is again separated from it by the 
acids. A small proportion escapes the action of 
the alkali, but yièlds to muriatic acid, and is not 
separable from this acid by an excess of alkali. 
Tlie mucus of the saliva is very easily incinerated, 
and though no phosphate of lime is detected in it 
by the acids in its naturai state, a considerable por- 
tioa of phosphate afipeairs iQ the ash aftet pcrmbus- 
tion, 



/ 



9é4 CHEMICAL PR0PERTIE5 

Is this mucus secreted in the saKvary glands, or 
is it only the common mucus of the mouth ? The 
Jatter appears most probable, though I confess that 
the large quantity of this mucus contained in the 
saliva, and the great diiFerence between its chemical 
properties and those of the nasal mucus, throw some 
doubt on this opinion. 

It is this mucus that produces the tartar of the 
teeth, which at first is only mucus precipitated on 
the surface of the teeth and adhering to them, but 
soon it begins to decompose, its colour changes by 
the influence of the air from white to yellow or 
greenish, the warmth and moisture of the mouth 
contribute to complete the decomposition, and the 
same earthy phosphates which are produced by oxi- 
dation and combustion in open fire are bere formed 
and slowly deposited on the sur&ce of the tooth by 
a slower but a similar process. The tartar is there- 
fore as it were the ash of mucus cr)'stallized on 
the tooth, and this, as is well known, will in length 
of time form very large incrustations. 

I bave found it to consist of the followìng sub- 
stances : 

Eaithy phosphates • • - 79.O 

Mucus not yet decomposed - * 12.5 

PecuHar salivary matter - . 1.0 

Animai matter soluble in murìatic acid 7.5 

100.0 



OF ANIMAL FLUID»; 245 

3» Tìte Mticus of the mticous membranes*^ 

I shall premise some remarks on the term mucics 
as applied to animai chemistry. It properly signi- 
fies the mucus of the nostrils, but many chemists 
bave extended it to other substanees found in the 
animai fluids, so tbat Jordan, Bostock, Haldat and 
others reckon it among the constituents of these 
fiuids. None of these chemists has considered mu- 
cus, used asa general term, a» identical with the 
nasal mucus, or, if they have thought so, it has been 
a very great error. I must now mention that there 
is no such principle as the mucus of animai fluida, 
the substance so considered being in reality lactate 
of soda mixed with the animai matter that always 
accoBipanies it. But if it did exist as a separate 
principle, some other term should have been used, 
to dìstinguish it from the mucus of the nostrils 
which is very different. 

The chemists who bave the most attended 
to the analysis of mucus, have been Messrs. Bos- 
tock, Fourcroy, and Vauquelin, but none has 
given a very satisfactory account of its properties^ 
The two latter chemists, who have published a 
long memoir on animai mucus, bave too much 
generalized the characters peculiar to nasal muco», 
in attempting to extend them to the mucus of the 
intestines and gali bladder, &)t example, where 
they are totally inapplicable. 

The mucus of mucous membranes is- prodiiced 



246 CHEMiCAt ^R0P£RtI£9 

from tlje some secretory organ throughout the body, 
and possesses every where the same external charac? 
ters which constitute miicus ; but in chemical prp- 
perties the mucus of different prgans varies ponr 
siderably according to the required use in protect: 
ing these organs from the contact of foreign subr 
stances. Thus t|;^e mucus of the nostrils and tra^ 
chea» which is intended to protect these membrane^ 
from the external aix> differs from that pf the urin- 
ary bladder which is to preserve this organ from the 
contact of an acid liquor, or from that of the gall- 
bladder whose contents are alkaline* 

The anime! matter peculiar to mucus is the same 
in ali cases, and has the following properties : it i$ 
insoluble in water^ but is able to imbibe so much of 

t 

this ifluid as to become more or less transparent^^ 
semi-Iiquid or what is termed glaiiy* If iij this 
state it be laid on blotting paper, and the paper 
changed as it becomes wet, the mucus ìnay be de- 
prived of the greater part of the moisture which it 
bad absorbed, and will then lose most of its pecu<- 
Kar properties. Mucus is not coagulablq by boil- 
ing, it becomes transparent when dry, atìd gene- 
rally resumes its mucous cbaracter on adding fresb 
water, but there is great difierence in thÌ3 property. 

The liquid part of mucus, 0t that fluid which 
the proper mucous matter imbibes, and tp which it 
owes its fluidity, id the same aa the liquid that re- 
mains after the coagulation of the serum. 



OF ÀNIMAL pLUIDS* 247 

My experìments give the foUowing constituent 
parte of nasal mucus : 

Water 9S3.7 

l^cous matter - - - - 53.8^ 
Muriate of potass and soda - SS 

Lactate of soda with its accompanylxig 

animai matter . « . 
Soda - - - - - - 0.9 

Albumen and animai matter insoluble '' 

in alcohol, but soluble in water ; 

along with a trace of phosphate of 

soda » » •. • 



1000.0 



■« 



Nasal mucus when just secreted contains a great* 
er proportion of wat^ than above stateci. It is 
very fluid, and gives by evaporation pnly 0.25 per 
cent, of solid matter. There is reason to suppose 
that its peculiar animai matter is first dissolved in 
the free alkaK, but is gradually precipitated as the 
alkgli becoraes carbonated by the contact of the re- 
spìred air. The mucus which I analy^j^cjl ^?^ ^^ 
such a consistence that the whole quaniity feU 0|at 
on ìnclining the vejssel that contained it. 

The proper mucous matter of the nose has the 
following properties : immersed in water it imbibes 
so much moisture as to become transpareiit, except*» 
ìng à few parti cles that remai n opake : it may then 
be separated by the Jfilter from the rest of the water. 



248 CHEMICAL PROPEETIES 

and raay be further dried on blotting paper till it 
has again lost nearly the whole of the moisture it 
had imbibed. Mucus thus dried will again absorb 
water when immersed in it, and resumé its trans- 
parency j and tbis alternate wetting and drying may 
be repeatedan indefinite numberoftimes^butitthus 
gradually becomes yellowish and more resembling 
pus. Five parts of recent mucus absorbed by 95 
parts of water produce a glairy mass which will not 
pour from a vesseL When mucus is boiled with 
water it does not become horny, nor does it coagu- 
late; the violent motion of ebuUition rends itin 
pieces, but when the boiling is discontinued, it is 
found coUected again at the T)ottoffl of the vessai, 
and nearly as mucous as before. I should observe, 
however, that this mucus naturally contains a little 
albumen, which must first be extracted by cold wa^ 
ter to enable the remaining mucus to exhibit the 
above mentioned appearances. The nasal mucous 
matter dissolves in diluted sulphuric acid : when 
the acid is concentrated, the mucus is carbonized. 
Nitric acid at first coagulates it, a number of yellow 
spots being dispersed through the coagulum ; but 
by continuing the digestion it soflens and is finally 
dissolved into a clear yellow liquid containing none 
of that yellow substance which I bave described 
under fibrin. 

Acetous acid hardens mucous matter, but with- 
out dissolving it, even in a boiling heat. Caustìc 
alkali at first renders mucous matter more viscous, 
and afterwards dissolves it into a limpid fiowing 



OF ANIMÀL FLUIDS. 249 

liquìd. Tannin coagulates mucus both when soft- 
«ned by the absorptìon of water, and when dis- 
solved either in an acid or an alkali. 

Thè mvcus of the Trachea^ as far as I bave been 
able to examine, possesses the same properties with 
the preceding. The first morning expectoration 
often contains bluish or dark coloured flocculi, 
which will imbibe 20 times their bulk of water, and 
sometimes become thereby so perfectly transparent 
as hardly to be distinguished in the surrounding wa- 
ter. Acids and alkalies act upon them as on nasal 
mucus. 

The mucus of the GaJJMadder much resembles 
that of the nostrils, but is more transparent, and is 
always tinged yellow by the bile. When dried it 
will again soften in water, but loses part of its mu- 
cous property. Biliary mucus dissolves in alkali, 
and its fluidity increases in proportion to the quan- 
tity of the latter. If this solution is exactly saturated 
with an acid, the mixture becomes slightly turbid 
and of a consistence to be drawn out in threads. 
Ali the acids produce with billiu-y mucus a yellow- 
ish coagulum that reddens litmus. The coagulum 
formed with the sulphuric acid may be restored to 
its mucous properties by exact saturation with an 
alkali. Alcohol coagulates this mucus into a very 
yellow granular mass, to which the mucous property 
cannot bp restored. A similar mass is often found 
in the adipocirous biliary concretions, and it is re- 

3 



iSO CHEMICAL PROPERTIEg 

markable that it may be produced from mucus by 
alcohol, as from biliary matter by ether. ^ 

Bile itself is often of such a mucous cottsistence 
as to be drawn out in threads. This is owing to 
the presence of mucus dissolved in ihe alkali of the 
bile. A very little of any acid (the acetous for ex- 
^mple) precipitates the mucus, and destroys the vis- 
cosity of the bile* Alcohol has the samel effect. 

Former chemists seem to bave regarded this prò-» 
perty of bile as owing to the presence of albumen, 
the existence of which has been considered as de* 
monstrated by the precipitate caused by addìng 
acetic acid or alcohol. From what I bave already 
mentioned, it is clear that no precipitate produced 
by acetic acid can be albumen, since the lattei is 
soluble in this acid; and as bile is not disturbed by 
prussiate ofpotassorby tannin after the precipitate by 
acetous acid is removed, this is a proof that no al* 
bumen can be contained in bile. The foUowing ex- 
periment is conclusive that the supposed albumen of 
bile is only mucus: mix some bile with very weak 
sulphuric acid, drain on a filter the yellow precipi- 
tate thus formed, andthen digest itwith a saturating 
quantity of carbonate of soda and water, and the 
precipitate will be changed to a mucus which will 
be more or less glairy according to the quantity of 
water employed. 

/ The mtunis of the Intestines accompanies the ex»- 



^remeats, in ì^hich it often fpnnslong and traùspa-* 
jrent filameijts. When once dried, the addition c^ 
water will not r^store its mjucous property, but al» 
]i^alies produce this effect, thpugh witliout rendering 
it transparent* 

Tlie mucus qfthe Urinary P^5^e* accompame3 
the urine, in which it is partly dissolyed and partljr 
isuspended n^echanically. Hie latter portion is ge-f 
nerally too transparent to be distinguished by the 
^ye, but it may be exhibited by letting the urine 
remain awhile at rest, decanting the fluid portion, 
and drying the mucus on a filten This loses its 
mucous property tptally by desiccatiqn, and then 
pften becomes rpse-colour^d, owìng to the presence 
pf urie acid, and appears to be crystalUzed. It 
Boft^ns a lit|:le in water. The urinary mucus is ear 
sily soluble in ^Ikalies, ^nd is not separated from 
this solution by acids. Tannin separ^ites it in white 
^occuli. I sha|l return to this subject under the 
analysis of prine^ 

4. Fluids of the Serous Membranes* 

It is well known that the surface of serous menar 
^ranes is ajways moistened by a liquid, which in a 
state of health is never secreted in quantities suffi- 
cient for analysis; it is therefpre only during a drop* 
sical st^te of these membrai^es that we can gain anjr 
knowledge of its properties. This fluid may be 
considered as serum deprived of from f to | of its 
^Ibumen. It does not coagulate by mere boiling. 



252 CHEMICAL PROFBRTISS 

bnt it gradually becomes turhid, and dorìng the 
evaporation a coagolated mass coUects. Tbis ap- 
pears to be aibumen, but it has a sulphur-yenow co- 
lour* It is composed of 

Water 988.30 

Albumen 1.66 

Muriate of potass and soda - - 7.09 
Lactate of soda and its animai mattar 2.32 
Soda - - -, - - - 0.28 
Anima] mattar only solubla in water.) 

^ ^ 0.35 



with a trace of phosphatas 



1 



1000.00 



The fluid whose analysis is bere given was that 
of Hydrocephalus*, which probably approaches 

* It gives me much pleasure again to fall in the track of Dr. 
Marcet's labours, who has analyzed many of these fluids with re- 
sults so nearly approaching my own as to be a considerable con- 
firmation of tlieir accuracy^ particularly as our experiments were 
made nearly at the same tìme, and without anyknowledge of cadi 
otber's operations. The following are Dr. Marcet's results. 

Tiuidtf Fluid rf 

Spina bifida. Hydrncephalus inlerntis. 

Water - - - - - 988 60 - - 990.80 

Miico-extractive mattar, &c. 2.20 - - 1.12 

Muriate», &c. - - - 7.65 - - 6M 

Subcarbonate of soda - - 1.35 - -, 1.24 

Phosphate», &c. - - ^ 0.20 - - . 0.20 

I may observe that the circumstance of Dr. Marcet's having^ 
fonnd a greater quantity of soda is owing to the decomposition of 
the lactate, as well as to the presence of carbonic acid. 



OF ANIMAL FLUIDS. 25S 

nearer than any other of the morbid efiused fluids 
to the naturai state, on account of the short dura* 
tion of the disease and the little time to which the 
fluid is exposed to spontaneous change ^dthin the 
ventricles of the braii;i. The other dropsical fluids 
are in general more concentrated, which may arise 
either from the mere consequence of being long 
kept, or from the transudation of the scrum of the 
blood that always occurs in the last stages of drop- 
sy, and appears also to take place into the urine and 

cellular membrane. 

/ 

5. The Htmuyrs of the Eye. 

The quantity of these fluids tbat can be procured 
is so small that it is not easy to obtain a very exact 
analysis of them. However, my experiments have 
shewn me that they bear a very dose affinity with 
the other membranous fluìdsw Those of the eye are 
distinguished by being perfectìy transparent and 
colourless; the other membranous flnids havìng a 
yellowish tinge. The humors of the eye are not 
coagulated by boiling* Their composition is as 
foUows: 

Aqucous Humor. Vitreous Humor, 

Water - - 98.10 - . 98.40 

Albumen, . . a trace - - 0.16 

Murìates and lactates 1.15 • - 1.42 
Soda, with animai mat* 

ter soluble only in ^0.75 - - 0.02 

water 




254 CHEMICAL PllOPERTrES 

TTie crystalline lens has a peculiar and very re* 
jnarkable composition. It has been considered as a 
^ muscle from the well-known experiment of M. Reil, 
who, on txeating it with nitric acid, discovered in it 
a peculiar muscular stnicture; and Mr. Chenevix 
also fbund that its density ànd specific gravity in- 
creased towards the center. But its solubility in 
water is a suflScient proof that it is not a inuscle, 
though to effect this solution it is necessary to 
break it down, and then it leaves undissolved a 
small portion of extremely pellucid membrane. 
This circumstance, added to that of the increasing 
density towards its center, shews that the structure 
of the lens is cellolar, the cells being fiUed with pel- 
lucid mattei- of different degrees of concentratiqn. 

The composition of the lens I bave found to be 
US foUows; 

Water , . , ^ , 58.0 
Peculiar matter - • - * 35.9 
Muriates, lafctates, and animai matter. 



ali soluble in alcohol 
Animai matter soluble only in water,, 

^ ' 1.3 



^• 



} 



with some phosphates - - - 
Portions of the remaining insolubIe| 
cellular membrane ^ • • j * 



100:0 



Thie tnatter peculiar to the lens is remarkable, 
It coagulates by boiling, and the coagulum has ali 



OF ANIMAL FLUIDS. 255 

the chemical properties of the colouring matter of 
blood, exicept colour, which is entkely absent. 
When bumt, it leaves a little ash containing a very 
small portion of iron. The liquor in which the co- 
agulum fs formed reddens litmus, has the smeli of 
the humors of the muscles, and like them contains 
free lactic acid. 

The petìfect àehronìatic transparence of the lens, 
notwithstànding ita similarity in chemical pn^er- 
ties to the colouring matter of the blood, is well 
worthy of noticé. The black pigment of the cho- 
roidea is a powder insoluble in water and acids, but 
slightly soluble in alkalies. When dried and ignited, 
it bums as eàsily às a vegetable substance, and the 
ash contains much iron. From these observations 
it may well be suppòsed that the circulating blood 
is decomposéd on the interior surfiice of the choroi- 
dea, leaving there its colouring matter, which is re* 
quired fòr the pùrposes of vision, and conveying 
the i^étóainder tó the ihner part of the eye perfectly 
lìihpid and colotirless. Need I add that the re- 
ceiVed opinion of the presence of gelatine and al- 
bumen in the lens is erroneous ? The existence of 
free kctic acid in the humors of the lens proves 
nothing witìi regard to its suppòsed muscUlàr struc- 
ture; but only shews the presence of absorbing ves» 
sèìs io conVey the products of the spontaneous de» 
composìtion of animai matter, one of the most im- 
piortaht bf which appears to be the lactic acid* 



256 CHEMICAL PROPERTIES 

Of the Fluids that compose the ExcreUons* 

I must refer the reader to what I bave already 
observed generally oii this subject, and shall prò- 
ceed to the individuai species. 

- 1. The Fluid of Perspiration. 

I bave not been able to make my experìments on 
this fluid in any large quantity, the organ that se- 
cretes it being extended over so large a surface and 
seldom affording much at a time. As to what col- 
lects in under-waistcoats after some days wearing, 
it must always be more or less altered by spmitane-. 
ous decomposition. 

I collected on a watch glass a few drops of sweat 
as they fell from my &ce, and evaporated them 
careftdly. The yellowish residue had ali the ap- 
pearance under the microscope of the usuai mixture 
of the muriates of potass and soda with lactic acid, 
lactate of soda» and its accompanying animai mat^ 
ter. It reddened litmus, and dissolved in alcohol, 
and was without doubt of the same nature as the 
analogous matter found in the other fluids. The 
alcohol left untouched a small trace of an animai 
matter which blackened in the Are, but was in too 
small quantity to admit of fiirther examination. 

Mr. Thenard dìscovers acetous acid in perspira- 
tion, but this acetous acid is produced bere, as in 
bis other experiments» from the lactic, by bis mode 



OF ANIMAL PLUIDS* 257 

of opèratìng. It is well known that litmus paper 
reddens instantly when put in contact with the skin 
of the living body ; which 3hews that the acid that 
produces this eflfect Ì9 not volatile, otherwise it 
would be evaporated hy the dry ^urface of the body 
which has always a temperature of 86° to 9(f Fahr. 

2. Urine. 

We possess many analyses of urine, botli in a 
healthy and diis^ased state, but none of them gives 
^ very extended view of the subject; and it is cl^ar 
that the ai^dysis of morbid urine acquires its chief 
interest from being able to compare it with that pf 
bealtbf 

A. The acids of the Urine.— Tì^ìq acidity pf 
Jiealthy urine has generally been attributed to the 
phosphoric acid. By the chemical change which 
the blood undergoes in the kidneys, a large portìLon 
of its consti tuent parts are acidifi^d; SQ that the 
blood which enters alkaline iijto the renai arteries^ 
retums from tìie renai vess^ls Ipaded with many 
^cids, som? pf which did not at ali exist in the 
blood at itsentrance, and others were present in yery 
minute quantityonly. The acids of the urine which do 
not atall exist inthebloodarethesulphuric, urie, and 
spmetimes the benzoic ; the others are the phospho-» 
rio and l^ctic. The muriatie and fluoric acids ap- 
pear to pass from the blood to the urine without in* 
crease in their proportional quantity. As by the 
}j^ws of chemical afSnity these acids will unit^ with 

yoj.. m, ^ 



258 CHEMICAL PROPERTIES 

any alkali that may be present, and saturate them* 
selves with it in the order of the force of their 
respective affinities, it must follow that where the 
quantity of alkali is insufficient to saturate ali the 
acids present, the weakest acids must be those that 
will remain uncombined and will give the urine its 
acid properties. These therefore must be the lac- 
lic and the urie. 

It is so generally known and so fuDy proved that 
the urine contàÌTìs the phosphoricj muriatica aìià urie 
acids, that it is usel^ss to add any thitig furtlier on 
this subject. 

Urine contains the Jlz^pric acid. In my analysis 
of bones I bave found that human and ox bone 
contain as much as two per cent, of fluate of lime. 
It is therefore naturai to suppose that the earthy 
phosphates dissolved in urine, which are chiefly de- 
rived from the decomposition and absorption óf 
bone, should also retain the same proportioh of flu- 
ate of lime. To prove it, I precipitated a largo 
quantity of urine with caustic ammonia, collected 
and calcined the precipitate, ìiiixed an ounce of 
it with as much si4phurìc acid, and then heatèd the 
mixture modefately in a platina crucìble covered 
witii a glass piate prepared for etching. After some 
hours I removed tlie glass, took off the graver*s 
wax, and found the lines corroded by the fluorìc 
acid vapour. 



OP ANIMAL FLUIDS. 259 

Urine saturated by ammonìa, fitered, and mixed 
with muriate of lime gives also a good deal of phos- 
phate of lime, containing no fluoric acid. The 
urine therefore contains no other fluate than that 
of lime. 

The sulphtiric acid is also foùnd in urine. The 
alkaline fluids merely neutralized by acetic or mu- 
riatìc acid, and then mixed with muriate of barytes, 
give no indication of sulphuric acid. But if the 
residue left after the evaporp^tion of these fluids, bè 
first calcined, and the saline part then extracted by 
lixiviating the ash, and tréated with muriatic acid 
and muriate of barytes, a notable quantity of sul- 
phuric acid is found^ produced from the sulphur 
contained in animai matter. But with urine the 
appearances are very different. Muriate of barytes 
added to it forms immediately a (^opious precipitate 
of sulphate of barytes; and I bave constantly found 
that the quantity of sulphuric acid in urine exceeds 
that of the phosphoric acid. Rouelle the elder long 
ago detected sulphuric acid in urine, but this was 
considered as an accidental circumstance: I bave 
however very goo4 reason.for supposing this acid to 
be a most essential constituent part of urine. The 
production of this acid takes place in the kìdrieys, 
and the action of these organs resembles combustion 
in this respect, that part of the constituent elements 
' of the urine, such as the sylphur, phosphorus, the 
radicals of the alkalies and earths, &c. become ox- 
idated to their mcmmum : and bere also the kid- 

s2 



260 CHEMICAL FROPERTIES 

neys generate some acids with compound bases. 
The remainder of the blood gives rise to the urea, 
which being formed from the materials of the blood, 
ought to contain more azote in proportion asa great- 
er number of the other eleraents of these materials 
has been acidified. It would however be incorrect 
to consider the production of urine as an excretion 
of the azote Which is in excess in the animai econo- 
my, because it appears thattheamount of itsquantity 
in the constituents of urine is not greater than in 
the constituents of blood. We might with as much 
reason consider the kidney as an organ for oxida- 
tion ; but it is certainly an error to believe that any 
organ except the lungs has the office of removing 
one particular element in a greater proportion than 
the rest. 

I at first conceived that the whole of the sulphur 
contained in the blood was acidified in the kidnèys, 
and consequently imagined that the same change 
might be induced on a part of the azote, the carbon 
and the hydrogen. Proust asserts that the urine 
contains carbonio acid ; but it isvery difficidt to esta- 
blish the certainty of this fact, because the urea is 
decomposed by a beat even inferior to that of boil- 
ing water, and produces carbonate of ammonia, 
which is decomposed by the free acid of the urine, 
and carbonio acid is disengaged. I am rather dis- 
posed to believe that urine does not contain car- 
bonic acid, because no bubbles of air are ever seen 
lo form on the sides of the containing vessels ; and 



OF ANIMAL FLUIDS. 261 

if urine stili warm be thrown on any substance 
"whatever reduced to powder, such as powdered su- 
gar, no eifervescence ensues. Urine is found to 
contain no nitric acid. If the residuura from eva- 
poration be treated With alcohol, and the undissolv- 
ed portion, (which must contain ali the nitrates of 
the urine) be exposed to fire, it will exhibit no sign 
of detonation : although this phenomenon is very 
perceptible whenever a very small quantity of m- 
trate of potass or even of nitric acid bas been add- 
ed to the urine. Lastly, I found accidentally that 
the whole of the sulphur contained in urine is not 
acidiiied. I had made use of nitrate of barytes to 
precipitate the sulphuric acid in urine, and had pre- 
viously added to the latter some nitric acid in order 
that the phosphate óf barytes might be retained in 
solution. Aft^ having separated the sulphate of 
barytes, I precipitated the phosphate by ammonia, 
and after having filtered the ammoniacal liquor, I 
evaporated it. During its evaporation it deposited 
small white shining crystals; exceedingly hard, in- 
soluble in water, in acids, or in caustic potass. 
After subjecting them to many experiments, I at 
length found them to be sulphate of barytes. In 
repeating the experiment with miniate of barytes 
and muriatic acid, in order to preventthe precipi- 
tation of the phosphate of barytes, no sulphate of 
barytes was formed. The production of this salt 
is the more singular because the nitric acid pre- 
sent was even supersaturated with anunonia. Instruct-t 



\ 



262 CHEMICAL PROPERf IE5 

ed by this experimènt, I precipitateci another por- 
tion of urine with nitrate of barytes, and after fil- 
tering evaporated it to dryness, and burned the re- 
siduum with a fresh quantity of nitrate of barytes. 
The ashes treated with ttiuriatic acid left a consi- 
derable quantity of undissolved sulphate of barytes. 

4. The benzoic acid is found, according to 
Schede^ in the urine of in&uts. I bave noi 
bèén able, in my experiments, to discover the least 
trace of it^ and I much doubt whether it be contain- 
ed in acidulous urine. 

5. Lactic acid. It is principally to this acid that 
urine owesits acid propertìes: and ìf I may be 
allowed to speculate on final causes, I should say 
that it is destined to hold the earthy phosphates in 
solution, and obviate the dire effects of their deposi- 
tion in a solid mass. In order to ascertain the pre- 
sence of this acid, the urine must be evaporated 
to the consistence of syrup, and treated with al- 
cohol. The substance which remains undissolved 
is acid, and bythe addition of ammonia is decom- 
posed; andthe lactic acid combined with the am- 
monia becomes soluble in alcohol. From its solu- 
tion in alcohol the ammonia is disengaged by quick- 
Ume, and from the new salt thus formed the lime 
may be separated by oxalic acid, which leaves the 
lactic acid dissolved in water. By this process a 
small part only of the lactic acid contained in tbe 



OF ANIMAL FLUroS. 263 

urine is obtained» the greater part, together with 
the lactate of ammoma> being carried off by the 
alcohol. 

B. The deposit from urtile. 

Urine, by cooKng, affords a deposit which varies 
considerably in different circumstances, not only 
in quantity, but also in extemal characters. When 
it is abundant the urine becomes turbid throughout» 
a grey powder is precipitated, and after continuing 
£ov some tim^ at rest, the precipitate is found at th^ 
bottom covered with a mucous stratum. The de- 
posit gradually acquires a red tinge, and after some 
time is found perfectly crystalUzed» When the 
urine does not become turbid, there only appeara a 
tbin cloud scarcely discernible^ which by rest sinks 
to the bottom or collects in light transparent floct 
culi, in which there are sometimes formedjt after 24^ 
hours, red crystals^ 

AH urine, when newly evacuated, contains a mat» 
ter suspended in it, which in some degree affects 
ìts perfect transparency. This matter is the mucus 
of the inner coat of the bladder. If the urine^ 
while yet warm, be poured on a filter, it will pass 
per&ctly clear, and the mucus will remain on the 
filter in the fbrm of transparent and colourless 
flocculi. The deposit which afterwards takes place 
in filtered urine is pulverulent, andnowìse mucous r 
which proves that it is from admixture with the mu- 
cus of the bladder, that the flocculent appearance». 

3 



266 CHEMICAL PROPERTISS 

In catarrhus vesicas the urine is loaded wìth an 
enormous quantity of a mucous matter whìch is 
suspended in it. This matter is a true mucus, 
although, in consequence of the morbid affectioii 
of the orgam which produces it, its characters are 
different from those of healthy mucus. If it be col- 
lected on the filter, in proportion as the water is 
absorbed, it becomes more and more mucous and 
vìscous ; and, during the desiccation, it becomes 
transparent and gree^sh. fiy maceration in water 
it recovers its mucous character, undergoes after 
some time an acid fermentation, and acquires a 
purulent appearance. In a word, the mucus of 
the bladder, when diseased, approaches more nearly 
to that of the uose, and differs much in its proper. 
tìes fÌTom the secretion in its naturai state. 

There is stili ano^er morbid condition of the 
urìnary passages, in which the urine carrìes along 
a matter mechanically suspended in it, and which 
has so dose a resemblance to that produced by ca- 
tarrh, that inattenti ve practitioners easily confound 
the one with the other. The urine when filtered 
leaves a mucous matter pn the filter, which however 
does not become transparent by desiccation, but 
gives, on the contrary, a white powder appearing 
only to the touch. This powder consists of phos- 
phate of lime, and the ammoniaco-magnesian phos-» 
phate, mixed with the mucus of the bladder. The 
urine in this disease has lo$t ali its free acid, it does 
not affect the colour of litmus paper, and I hav« 



OF ANIMAL FLUID8. 267 

scHfnetimes even seen it restore the blue colour of 
litmus when it had been reddened by vinegar. In 
obsérving this reaction, the paper should be inspect- 
ed immediately; if itbe allowed to dry, it reddens 
firom the decomposition of the ammoniaca! salts, 
and this happens even when the paper is immersed 
in a solution of neutral muriate of ammonia, or 
even when the ammonia is in excess. The urine 
in this disease has also the property of yielding a 
precipitate by common muriate of mercury, in 
the same way as during a paroxysm of fever : a cir- 
cumstance which is owlng to the absence of the 
free acid*. 

« 

The secondary precipitate which is formpd in 
urine, which has been filtered while stili warm, is 
pulverulent, and contains, as is already known, the 
urie acid in abundance. In the first moments after 
it3 formation it is of a greyish white, but it gra- 
dually acquires a réddish hue, and the pulverulent 

"^I once had occasion to treat a man attacked M^ith this disease. 
I endeavoured by large doses of phosphoric acid to supply the de- 
ficient acid in the urine, but without being ablc to effect any alter- 
ation whalever. The dose was ai length increased till it purged the 
patient, when the urine suddenly resumed its naturai characters, 
and became acid^ transparent^ and deposited urie acid. But these 
salutary eflfects disappeared with the purgative one, and they could 
not be again reproduced. After the phosphoric acid had been em- 
ployed in vain, the acetic and sulphuric acids were given, but 
without success. AlkaUne remedies had no efiect either benefìcìal 
or in^urious» and the disease stili continues, having produced ast 
great degree of debility in the inferior extremities. 



26Ì CHEMICAL I>R0PERT1È$ 

tnatter assumes at the same time a crystalline fbrm* 
Tlie change is efFected stili more quickly when ex- 
posed to the immediate contact of air, than when 
the deposdt is covered with urine. The greyish pre- 
cipitate which is first formed is soluble in caustic 
alkali, without the evòlution of ammonia ; but in 
proportion as it becomes red and crystallized, pot- 
ass disengages from it ammonia in abundance. It 
isevident, therefore, that the crystallization of the 
precipitate depends on tÈie formation of urate of 
ammonia with excess of acid, which appears to con- 
stitute the red crystals which fprm in urine by cool- 
ing. I think I bave observed that the mucus is in 
a great measure concerned in this change in the pre- 
cipitate, since it takes place more slowly, and in a 
less degree, in urine which has been filtered. That 
species of urine which on cooling becomes milky 
and appears like a mixture of day and water, yields 
about one thousandth of ìts weight of precipitate. 

The deposit, treated with acetic acid, is partly 
dissolved and gives a yellowish solution, from which 
a precipitate is thrown down by carbonate or prus** 
siate of potass, as well as by ìnfUsion of galls, but 
net by the caustic alkalies. The quantity dissolv- 
ed is greater, and the yellow colour more intense 
when the urine has not been filtered before cooling j 
which appears to prove that the substance dissolved 
by the acetic acid is in both cases mucusj of which 
a part has been dissolved in the urine, and since 
precipitat^d in a stat^ of chemical cpmbinatioQ with 



OF ANIMAL FLUIDS. 269 

the urie acid. It is t^is compound which is gradually 
decomposed, and gìves rìse to the crystallized su- 
perurate of ammonia* The deposìt contains none 
of the earthy phosphates. The muriatic acid di- 
gested with the deposit, and then saltirated with 
ammonia, precipitates nothing. Subjected tp fire, 
the deposi t burns, and leaves at length, and with 
some difficulty, a very small quantìty of a fused 
ash, which consists of carbonate of soda, proving 
that the deposit oflen contains a small quantity of 
superurate of soda, that insoluble salt which, ac- 
cording to the experiments of Dr. WoUaston, pro- 
duces the gouty concretions of the joints. 

The secondary deposit of healthy urine, there- 
fore, is not urie acid, but a combination of this 
acid with an animai matter, which appears to he a 
portion of the mucus of the bladder dissolved by 
the warm urine. The deposit contains stili a trace 
of superurate of soda, and by spontaneous decom- 
position there is formed superurate of ammonia 
which renders it crystalHne. 

Itis to be presumed that urie acid, which is de- 
positedinthe bladder and forms calculi, contains 
this same animai matter, which ought accordingly 
to be an essential constituent of ali calculi formed 
in the bladder. I bave thus found it in two differ- 
cut calculi which I examined with this view. The 
fdlowing is the mode of separating the urie acid 
from the animai matter. The calculus is dissolved 



270 CHEMICAL PROPERTIES 

in caustic alkali, and a precipitate obtainedljy add- 
ing to the solution muriatìc acid in excess« The 
precipitate consists of urie acid; and a combinatìonof 
the animai matter with muriatìc acid, which may be 
carrìed ofF by washing the precipitate freely on the 
iilter. The muriatìc compound is soluble in pure 
water, and is again precipitated by the additìon of 
muriatìc acid, or by allowing it to drop into the 
acid liquor which has passed tìirough the filter. 
The urie acid remaining on the filter is in a state of 
purity greater than any that has been hitherto the 
^ubject of examinatìon. 

C, Anàlysis of Urine. 

I bave béen at much pains to arrive at as accu- 
rate a knowledge as possible of the precise compo- 
sitìon of urine, both as to the quantìty and condi- 
tìon of its constìtuents. The task has been labori- 
ous, difficult, and often extremely complicated. 
It would be trespassing on the patience of the So- 
ciety, were I to attempt at present to give an ac- 
count of ali the details, and such is the nature of 
an exact analytical investìgatìon that it admits not 
of a brief recital. I shall therefore content my- 
«elf with communicatìng the general result which 
h as foUows : 

1000 parts of urine are composed of 

Water - - - - . 938.00 

Urea SO.IO 

Su^hate of potass - • ^ 3.71 



/ 



OF ANIMAL FLUIDS. 



271 



Sulphate of soda 

Phosphate of soda 

Muriate of soda - - - 

Phosphate of ammonia 

Muriate of ammonia 

Free lactic acid ... 

Lactate of ammonia 

Animai matter soluble in alcohol, and 

usually accompanying the lactate^ 
Animai matter insoluble in alcohol 
Urea not separable from the pre- 

ceding . . - . 

Earthy phosphates with a trace ol 
fluate of lime ... 

Urie acid .... 

Mucus of the bladder 

Silex 



8.16 
2.94 
4.45 
1.65 
1.50 



► 17.14 



1.00 

1.00 
0.32 
0.03 



1000.00 



With regard to the relative proportions of these 
ingredients, it is very probable they may vary inde- 
pendently of disease. I believe, howeyer^ that in 
urine they are never very differente unless from 
pathological causes which mat$rìàlly affect the 
faealth. / 



I should also observe thaf in the 17.14 paxts of 
lactic acid, lactate of ammonia, &c. thejre exists a 
^uautity of water which it ìs nòt possible to ab- 



272 CHEMICAL PROPEIITIES 

jstract without the rìsk of decomposing these sub* 
stances. The quantity of urie acid always varies 
according to the individuai, and also in the same in* 
dividual from different circumstances which bave 
little influence on health. In the above analysis it 
was determined from urine which became turbid 
throughout during its cooling, and which during 
its deposition resembled water mixed with day. 

The earthy phosphates contain rauch more mag^ 
nesia (as mach as 1 1 per cent) than in the bones 
or the ashes of blood. Of the cause of this I am 
ìgnorant ; but I bave likewise found much more 
potass in urine and in milk than in the blooO. 

The silex was not detected by the combustion of 
drìed urine : fbr in this way it might bave been 
considered as a constituent of some animai matter 
dissolved in the urine, I discovered it by treating 
evaporated urine with alcohol, then with water, and 
afterwards with muriatic acid, which left the un- 
dissolved silex in the form of a grey powder, which 
fused with soda produced a transparent glass, and 
which by the decomposition of the glass was con- 
verted into the gelatinpus state. The water we 
drink, and which supplies the continuai waste of 
that element by perspiration and by urine, always 
contains silex, which appears not to separate from 
it in the body, and which tfaus makes its exit in 
the same state in which it eatered. It is evideiit 
that this earth should be found dissolved in the 



OF ANIMAL FLUIDS, 273 

other animai flùids, ànd that the quantity must vary 
according to the quantity contained in the water 
ased as beverage^ 

■i 

Milk. • 

My experiments have chiefly been made on thè 
milk of the cow. The composition of this fluid is 
èxceedingly analogous to that of blood. It cdrisistSi 
lìke the blood, of a chemical solution, and an ad<& 
mixtùre of undissolved matter sùspended ili it; 
By éxpósing milk fór some days in a shallow vessel 
to the temperature of 32** Fahrt; J separated fròm 
it the cream as complétely as I could. The loweif 
portion of milk, decàtìted by a hole at the bottom 
of the Vessel, had a specific gravity of 1 .033 and 
yielded tìy analysis thè following constituents : 

Water - - i i - 928.75 

Cheese, with a trace of butter - 28.00 

Siigal- of milk - - . . 35.00 

Muriate of potash ^ • -i i.70 

Phosphate of potash - - - 0.25 
Lactic acid, acetate of potash, with ) 
a trace of lactate of iron - C 

Eàrthy phosphates -a - ^ Ò* 



6.00 



OÓO.oo 



Créam contains the emulsive matter which is 
not dissolved, more concentràted and mixèd with 
à portion of milk. This emulsion is éasily decom-i 

troXi. iir. T 



27^ CHEMICAL PEOP£RTI£S 

posed by agitation, abporbs oxìgen, and the butter 
separates : the milk becomìng by this operation more 
acid than it was at first. I found that cream of the 
specific gravity 1 .0244 was composed of 

Butter 4.5 

Chee.se 3.5 

Whey 92.0 

As 92 parts whey contain 4.4 sugar of milk and 
salts, it foUows that cream contains about 12*5 per 
cent, of solid matter. 

It is very remarkable that scarcely any other al* 
kali than potash is found in milk. I bave bumt a 
quantity of dried milk, and bave dissolved tìie mu- 
riate of the ashes in spirit of wine, and the alkali 
left undissolved by the alcohol, neutralized by the 
sulphuric acid, produced only sulphate of potash. I 
know not how far this observation is applicable to 
other kinds of milk, or to milk taken from other in- 
dividuals. 

Cheese, which is destined to be part of the nou- 
rishment of the young animai, has, very pecidiar 
characters, which, as it would seem, fit it for this 
office. It admits easily of incineration, affording 
a white ash which contains no alkali, and which 
forms as much as 6.5 per cent, of the weight of the 
cheese. This ash contains principally earthy phos- 
phates with a little pure lime : but it contains nei- 



I 

i 



*«< 



ÙxéT alkali nor oxide of iron. % Cheese digested with 
concentrsted muriatic acid yìelds the gn^ater part 
of its phosphates to the acid, and it afterwards burns 
mthout leaving any ash» But the cheese may be 
precipitated from the milk by an acid vnithout losing 
its phcMsphates. It appears then, that the latter 
arenot yetformed» but that a slight affinityonly 
is requisite to their production. We may con- 
clude that nature has thus sought to assist the di- 
gestive powers of the young during a period of 
their lives, in which there exists in the ceconomy 
the greatest demand for earthy phosphates for the 
purposes of ossification, which is at that time ad- 
vancing so rapidly. 

Cheese is generally considered as a substance in- 
soluble in water, and yet a great part of it is in act- 
ual solution in milk. A solution of it in water may 
be obtained, if cheese precipitated by an acid and 
well expressed, be digested with carbonate of bary- 
tes or carbonate of lime. The carbonate is de- 
composedwith effervescence, andthe cheese quitting 
the acid is dissolved. The solution is yellowisl^ 
and resembles a solution of gum. Evaporated to 
dryness it leaves a yellow mass which easily r^dis- 
solves iii water. The solution boiled in an open 
vessai, becomes covered with a white pellicle, pre- 
cisely as milk does, and acquires the smeli of boiled 
milk* The membrane is almost insoluble in water, 
and appears to be a produci by the action pf air on 
the dissolved cheese. 

T 2 



.* 



276 CHEMICAL PROPERTIES OF ANIMAL FLUIDS. 

With the minerai acids cheese produces the same 
combinations as albumen and fibrina although the 
neutral combinations are less soluble thàii those of 
fibrin. A great excess of acetic acid is required in 
order to diiSsolve the cheese, and the neutral com- 
bination with this acid appears to be insoluble. 
Cheese is easily dissolved in alkahes.» Its solution 
in acetic acid as well as in ammonia, becomes co- 
vered with a small quantity of cream every time 
that the cheese has not beent well separated fi:om 
the butter. Alcohol converts cheese into an adi- 
pocirous and foetid substance^ 

Butter and sugaf of milk are so weU known^ that 
no additional informatioB can result firom my expe^ 
riments on them. 



A CASE, 



OF 



FUNGUS HiÈJVIATODES, 

By GEORGE LANGSTAFF, Esq, 

SURCEON, NEW BASIIfCHALL STREET, 
COMMUNICATSD SY 

"WILLIAM LAWRENCE, Esa. 



Read Nov. IO, 1812. 



John WHITJEHQRN, ^ boot-maker, about 30 
years of age, of iqiddle stature, ratber corpulent, 
and of that s^ow complexion peculiar tp a femal^ 
whose constitution has been much impaired by long 
obstruction of th^ catameiJiaj applied tq n»e on the 
34th of October, 1811, respecting a small tumor 
ón bis left shoulder, sìtuated just bdow the spinq 
of the iscapula,. 

Jt was about the gìze of a cberry, and had a blu?^ 
isli r^d appearance, 

In the situation of the swelling, there had been 
Hqm the tun? pf birth, a large mple^, which;, eight^eu 



278 FUKGUS HJEMATODES. 

months Ugo, had gradually fretted into a sore. 
From the latter a painful and occasionally bleeding 
fiingus sprung up. Previously to this time, his gè- 
pera! h^alth had been exceedingly good, 

TwQ other tumors, each about the size or a small 
nutmeg, had formed in the left axilla about a fort* 
night before I saw him. They were free from pain ; 
and the skin covering them had its naturai appear- 
ance. 

I cut away the tumpr from the i^oulder on the 
26th of October. The operation was attended with 
considerale bleeding from numeraus small vesseku 
The removed part consisted of a firm purple vascu- 
lar mass, originating from the cutis. 



. i 



Ailisposìtìon to the formation pf fungus retarded 
the healing of the wound for fiye weeks; and the 
cicatrix had not a naturai appearancet 

The swellings in the axilla gradually increased, 
and iinited into one mass, which grew constantly 
krger, in spite of the employment of various locai 
means, such as leeches, cold washes^ and different 
stimulating applications. The health became af^. 
fected, and the functìons of the bowels particularly 
disturbed: small doses gf ipercury, purgatives, aixd 
tonics were employed; and a low diet enjoined. 

Py December the swelKng had increased so much 



\ 
/ 



PUN6US HiEMATODES, v e?9 • 

as to occupy the whole axìUa, from the pectoralis 
major to the latissimus dorsi; and it seemed to ex* 
tend outwards, between those muscles, so as not 
to press on the axillary nerves and vessels. Its cìn 
cumference and base were as hard as a cancerous 
breast: the body of the tumòr was elastic, and 
seemed divided into sacculi containing fluid: the 
sur&ce was irregular, and the prominences gave a 
feeling as of fluid contained in cysts. The.skin was 
much stretched and discoloured : it had a purpleish 
bue, not unUke that of erysipelas ; but its tempera^ 
ture was naturai. There was no pain until the end 
of November, whea a violent attack took place» 
with considerable fevei: theso subsided, leaving 
the patient occasicoially sulgect to darting pain in 
the swelling. 

Oae of the prominences at the upper part of the 
tumor.enla^ged considerably, and the integuments 
became thin. It evldently contained. fluid, and was 
very painfìil when touched; but there had been 
neither throbbing nor beat in ;the part« It continu* 
ed in this way for sanie time, causing great sufier« 
ing and disturbance in . the ocmstitution. I deter- 
mined to make a wmll.puncture, to give the patient 
a chance of relief, and gain someknowledge of the 
nature of the tiunor^ 

Pour punces of dark coloured blood flowed from 
the op^ning; and the discliarge was, iòUowed by 
immediate reJief* 



4- 



$80 yUNGUS HiEMATOD£S. 

I closed the aperture, which was much smaUep 
|;han that usually raade in phlebotomy, with adhe-* 
sive plaster \ but a considerable quantity of saioles 
and ichor flowed through it for nearly a fortnight, 
greatly debilitating the patient^ . 

The tumor increased but little after this periodji 
nor was pain complained of till the 1 2th of January , 
when excruciating and darting sensations were felt 
in the swelling, on the side of the neck, and along 
the under part of the arni. These were sometimes 
SQ severe, that the patient supposed he should net 
survlve them. The circumference of the tumòr 
pow beqame considerably enlarged, the prominent 
parts continued elastic, and the integuments were 
pf a deep purpleish red colour. The continued 
pain and constitutional derangement, accompanied 
with difficulty of breathing, confined him to bed 
from the 19th of January, and were not alleviated 
by any locai or general treatment. 

On the 8th of February, the tumor measured six 
inches and a half in the long axis, and six in the 
short; the centrai point began to project intp a 
nippleJike eriiinence, whicji was apparently only 
coverà with cuticle. It was surroiinded by a beauti* 
fui deep red and purple coloured disk, the diame* 
ter of which was two inches and a half; the skin 
from this part to the extent of the swelling, was , 
gradually shaded with purple and red streaks. It 
|)ore considerable resemblance on the whole to a 



FUN6US HJBMATODES. 281 

large inflamed female breast. To the vìolent pain 
already described, darting sensations were added, 
passìng from the axiUa through the chest, and ac* 
companied wìth dyspnoea. Durìng the paroxysms 
of pain, the pulse was from 100 to 12Ó in a 
minute, and on its abating sometimes as low asi 
Cd, 

On the 20th the integuments of the nìpple-like 
projection assumed a dirtiesh white appearance, 
9t the most prominent point, an4 an ìchorous dìsn 
charge exuded. 

The cuticle separated on the 22d, and exposed 
9,n opening about large enough to admit the end of 
a probe, through which a considerable quantity of 
blood and ichor oozed. Instead of a fungous 
growth, there was only a granular state of the sur- 
rounding cutis. The tumor stili increased, and 
measured on the 25th nine inches by seven^ 

Feb. 27.-r-The diacharge was stìU copious an4 
l^erfectly inodorous ; which indeed had been the 
cas^ from its commencement The integumenta, 
at the centre of the tumor, were of a brownish fed 
appearance, and so very thin to a considerable. ex- 
tent^ that I was inclined to tbink they Would giv§ 
•9fiky, 

Feb. 29,-— rThe discharge was Rot lessened, the 
4^dges qf the ulcerated part were beginning to ci- 



383 FUN6US HÀMATODES. 

catrìze, but the aperture shewed no disposition to 
beat. I introduced through it the whole length of 
a common sized probe ; it took an oblique direo 
tion towaids the axiUa. The discharge was not in- 
creased when the probe was withdrawn ; although 
it nùght bave been supposed from the fluctuation» 
that a large quantity of fluid was contained in the 
centre of the tumor. 

Another round, hard and painful tumor, about 
the size of a pea, was discovered on the shoulder, 
haif an. inch from the one last mentioned. 

March 1.— The swelling stili increased in the 
horìzpntaj: direction, though there had been a cobp 
siderable discharge of blood with serum ; the into- 
guments were of a brownish red cplour, and felt 
extremely thin. A fourth tumor, similar to thosje 
on the shoulder, presented itself about an inch 
above the upper absorbent inguinai glands. His 
health now declined rapidly, he was much ^ma* 
ciated, and complained of Constant and violent 
pain in his loins and chest, and bis respiration wa$ 
hurried on the foUowing day. 

March 2.--*The discharge fhun the sn»Jl ajM?* 
fure had greatly diminifldied; the tumor. waa 
mi^ch increased, ali the patient's sufFerings a^Q^a^ 
yated. 

». » 

■^ • * « t * * 

è , - -. - 

March 6i— Erom the last date to the pres^nt^ 



FUNGUS HJEKATODES. 9Sff 

the kteral ìncrease of the swellìng had been as- 
tonishìng, as its transverse measurement was now 
fburteen inches. The skin, about two inches above 
the part which burst and afterwards cìcatrìzed (ex- 
cept the small aperture through which the fluid had 
oozed more than a fortnight,) was extremely thin, 
prominente and likely soon to give way. 

llie circle, where the integuments first ulcer- 
atéd, was considerably enlarged, owìng to its dis^ 
tension by fluid, the aperture having been for some 
days closed ; the new formed skin was changed 
into a whìte and fibrous substance, which adhered 
with great flrmness. The pain in the tumor wi^s ^t 
this time so particularly violenta from the integu- 
ments being so much distended, that I felt inclined 
to make a small puncture ^o afibrd him temporary 
relief ; but on the evening of this day, the integu- 
ments gave way, and a considerahle quantity of 
bloody serum was discharged, which occasioned 
immediate ease ; but fluid stili seemed coiitained 
in several parts of the tumor. 

March 10. — Thedifficulty of breathingincreased, 
and he had coughed up blood. The integuments 
at th€i most convex part of the tumor were begin-. 
ning to ulcerate, and there were several apertures, 
through which a probe might be passed into it. 
The discharge was stili considerahle, though it did 
pot tend to the diminutioQ of the» swelling. 



Q&4t FUNGUS H^MATODES, 

The pain, difficulty of breathing, an<ì other symp* 
toms grew more and more distressing, and diarrhoea 
carne on, with excruciating pain in the bow^s. 
The tumor assumed an appearance òf sphaceW 
tìon at one part, and the discharge became very 
ofFeosive, 

Although the powers of the constitution were 
reduced to the lowest ebb, a disposition to form 
these tumors stili remained, as one made its ap-r 
pearance on the rìght side of the neck, s^nd ano* 
ther on the bs^ck, and the former became consider- 
ably enlarged, Violent sickness accompanied with 
tormina and tenesmus, and other dysenteric symp* 
toms continued till the 16th of M^irch, when 
death took place, 

After insulating the integuments from the base 
of the tumor, and dissecting back those covering 
the chest and posterior part of the arm, the sui^ 
perficies of the di^eased piass was found tq be form* 
ed of a congeries of yaripus-sized dark purpl^co» 
loured tumors, 'wbich had extend^d bet^een the 
pectoralis major and minor mtiscl^s, as far as the~ 
prigins of the latter and backwards two inches 
beneath the latìssimm dorsi^ but had not produced 
any alteration in their structuret 
"■ ». 

The axillary absorbent glands were larger than 
naturai j and allbough the tumor a^h^ed tq the 



5 



FUNGUS HJSMATODES.* 28^ 

capsukr ligameiit, the consequencé was otily slight . 
thickening of that parL 

4 

The véssels and nerves of the stxilla were closely 
imbedded in the upper part of the disease, but 
exceptthe musculo^òutaneus^ or perfbtans Casserii, 
which wasl complétely impacted^ and lost in the 
tumor^ they were not compressed to such a degree 
as to impede their fiinctions^ or produce any mor-' 
bid appearancei 

The morbid growth weighed four poutids aver- 
dupois weight, and when the integuments and 
cellular substance^ covering the various-sized tu-» 
mors which formed thè whole, were removed^ and 
the axiliary nerves and blood vessels cleaned, it 
bore much resemblance to an enormous bunch of 
black Muscadine grapes* 

» 

Ali the tumórs situated on the external part of 
the large one, had that spongy elastic feel peculiar 
to it, which so singularly characterizes this horrid 
diseasé, and which h^s been described by those 
who bave written on fungus haematodes, but par- 
ticularly by Mr< Burns^ Mr. Hey, and Mr. Ward- 
fop. 

Several of the tumors were cut through, to ex- 
amine their internai structure and contents ; some 
were found to be composed of a soft medullary 
substance j like braiii mixed with coagulatéd blood \ 



others wìth a dark grey-coloured substance in con* 
astence similar to the former ; a few were of a 
blackìsh colour, but had the same arrangement of 
structure as the former, and the fluid expressed 
firom them was exactly like the pigmentum nìgrum 
<m the choroid membrane of the eye, or die inky 
fluid in the bronchial glands, and when their con* 
tents w^e pressed out, the condensed cellular 
cysts only lemained, with a loose iìbrous retiou- 
lated arrangement of their internai parts, with the 
ramifications of several minute blood vessels. 

The main bulk of the disease was next divided j 
it presented an irrcgular union or blended ap- 
pearance, similar to what composed the other tu- 
mors, and the contenta were confined by strata of 
apparently fibrous reticulated condensed cellular 
substance; but there.were three cavities, each of 
which contained about an ounce of loose coagu- 
lated blood. 

The sloughing- process on the anterior part of 
the tumor had not penetrated beyond the integu- 
ments, but had changed that part of it beneath 
them into a white sloughy looking substance. 

The blood vessels were numerous, but very 
smsdl. 

There was a tumor in the sternum^ under the 
periosteum, «feout the size of a walnut^ of a brown* 



FUNGUS BJ£MATO0ES« SS? 

ish red colour, and a pulpy structure. It had 
caiised the absorbents to remove the bone, to al« 
low of its projecting inwards and outwards, and 
was only held by the Ugamentous ftembrane which 
covers both sides of that bone ^-the stemum was 
soflened, and its cancelli filled ymih the same kind 
of matter through one half x>f it ; several of the 
rìbs onboth sides had similar tumors in them, tiot 
&r from their cartilages, and under the penosteum. 
ITie liver was of a paleish red cdour, rather soft in 
testure, and bestudded throughoùt its substance 
' with various sized tumors, contained by capsules ; 
some of them consisting of meduUary matter mix- 
ed with blood, others possessing exactly the same 
consistence, but of a cinerìtious colour, and in- 
jtersected with cellular septa. 

There was a small tumor similar to those in the 
liver, between the layers of perìtoneum which form 
the ligamentum suspensorium hepatis; and two 
on the front of the pancreas, one about the mag- 
Hitude of a pìgeon's egg, the other the size of a 
haEel nut, but connected only by cellular subì» 
gtaiice to that vìscus, which was perfectly healdiy. 

The stomach, duodenum, and jejunum, present- 
ed a healthy appearance, but the mucous coat of 
the ilium was considerably thickened, and seemed 
covered with a lay^r of coagulable lymph of a 
greenish colour: and I was led to suppose this idea 
correct, as the valvute connivente» were firmly 



!288 FUNGUS HiCMATODES^ 

àgglutinated, and their extremities thickly coated 
with the same substance; 

The coeciim wìtli its appendale and a great parf 
of the colon, exhibited the sàme diseased appear- 
ance, only in a greater degrèe ; and in some parts 
of those intestines there was an increased state of 
Vascularity^ 

ÌThe iliàc and lumbar absorbent glands were eh- 
larged, but did not partake of the primary dìsease, 
as in the cases of meduUary sarcoma, related by 
Mr. Abemethy. 

The perìcardium and heart were healthy ; the 
iungs were studded in their substance with small 
tiimors, similar to those in the liverj and there 
were many immediately beneath the pleura pùìmo- 
nalis ; and one of the lobes on the left side was 
loaded with blood and mucus. 

On reflecting the integumehts of the cranium^ 
mnother tumor was percèived on its vertex, beneath 
the pericranium, which had never been noticed 
during the patient's life ; it had affectèd the bòne 
only in à^slight degree. 

On removing the skulì-cap, a similar tumòr was 
found on the dura mater, under the occipital bone ; 
it had caused absorption of the surface of the 
boné^ so as |p expose the diploe. No deviamoti 



FUNGUS HJEMATODES. 289 

ftom the naturai appearances was noticed in the 
brain, except that the ventricle^ continued rather 
more fluid than usuai. 

The testicles were perfectly healthy. 



yoL. ut. 



HI STORY 



Of A 



SEVERE AFFECTION 

OF THE 

ORGANS OF RESPIRATION, 

WITH THfe 

APPEARAJSrCES ON DISSECTION, AND KEMARKS. 
By a. P. WILSON PHILIP, M.D. 

tHYSICIAN TO THE INFIRMARY AT WORCESTER. 

COMMUNICATED BY 

DR- BAILLIE. 



Read Sept. S, 1813. 

. -JL- 



^•a 



XHE subject of the following detaìl was a gentle» 
man residing about ten miles from Worcester, sixty- 
three years of age. In the early part of his life> 
he had served in the American war, in which, he- 
fbre he was thirty, he lost his right leg. He was 
of a fair and florid countenance; about five feet 
ten inches high, and of a strong and manly figure, 
his chest being particularly capacious and well 
formed. He was a man of qvick feelings, but of 



OiRGANS 0F hBSPIRATJOK. 291 

grett resolution and bene\folence. His habits were 
temperate. The loss of his limb prevented hi* 
walking much, but he generaljy spent many bQ^^ir* 
in tibe day on horseback» 

For ^xteen or eighteen years, he had occasion- 
ally hawked up a little mucus, tinged with dark cof 
loured blood^ without cough, to which he had ne^- 
ver been subject. He had had several attacks of 
rheumatic fever; and wa$ so much troubled with 
indige$tion, that for some years he had been obliged 
to regniate his diet with great care. He had also 
been several times affiscted with a peculiar kind of 
dyspncea, which I shall presently bave occasion tp 
describe, and which was most violent after his first 
attack of acute rheumatism^ The dyspnoea was 
never attended with congh, but always with morii 
or less expectoraùon of mucus tinged with dark co»* 
loured blood. 

In th^e early part of last wìnter, he was vùmcìk 
troubled with rheumatic pains, which prevented 
hi» ufiual exercise oh h<Mrseback ; and at the $am^ 
time the symptoms of imligestion increased, and 
the dyspncea returned, which last Uniformly carne 
on early in the morning, and obliged him to sit up 
in bed. These symptoms sooii yielded to the use 
of rust of iron, extract of gentian, and infiision of 
bark, with gentle aperients, chieily magnesia; and 
fbraweek or ten^iays seemedwholly tofaave left him» 

u 2 



S92 SEVEKE AIPFECTIOK Ot* 

They again returhed however, notwithstànding 
the continued use of the medicines^ and the dys- 
pnoea began to be more troublesome, and to harass 
him during the day. It was now attended with 
some frequency of pulse, but without any other 
symptom of fé ver. He said the dyspnoea was al- 
ways least after dinner, and seemed relieved by eat- 
ing animai food and drinking a few glasses óf wine* 
He complained much of a sense of sinking and de- 
bility at the stomach, and stated that he could re* 
Jieve the dyspnoea by pressing hard on the epigas- 
trio region, or by a fuUer inspiration than usuai. 
The pulse was never either intermitting or irregi^lar 
at any period of the disease*. 

The character of the dyspnoea was very peculiar. 
It consisted of about twenty full, deep, and quick 
inspirations, succeeded by perfectly iree breathing, 
for perhaps a minute, when the paroxysm retumed. 
After several such alterations, the dyspnoea, in the 
earlier periods of the complaint, often ceased for 
many hours. In these intervals, as well as in thè 
short intervals between the paroxysms, the patient 
could lie in the horizontal position without brìnging 
on the dyspnoea, till within a very few weeks of 
h:s death. 



* Unless it be regarded as an exception to this^ that ìa the lat- 
ter part of his illness, it was slower during the paroxysms of dys- 
pnoea, than in the intervals between the paroxyHns. 



Oa^ANS OF BESFIRATIQ^. 293 

Yarious antispasmodic and other medicines were 
aow tried without effect« 

Having exposed himself to a cold wind on the 
22d of last March, (for he stili continued to ride 
out occasionally,) he experienced a sudden ìucrease 
of the dyspnoea, and the pulse was for the first time 
rather hard. Althouglv there was no cough, I ad- 
vised the application of leeches, and afterwards of 
a blister to the chest, which gave considerable re- 
lief. This, however, proyed of short duration, thQ 
sense^ of aebility and fits of dyspnoea evidehtly in* 
creasing, though unattended with cough or fever, 
and the pulse becoming more frequent, 

4 

On the 30th of March, Dr.^Edw. Johnstone of 
Birmingham was requested to see him, with me. 
It was agreed that he should take stomachic 
draughts with a small quantity of the vitriolated 
iron, and occasionally an anodyne draught, with 
tincture of opium and camphorated mixture, whichf 
be had been using. 

Within two days after this, he was attacked in 
the night with so alarmipg a traiu of symptoms, 
that Mr. Ricketts (the surgeon under whose care 
he had been from the comipencement of bis illness) 
hardly expected him to survive till mojming. When 
I saw him early in the n^orning, I found tji? dys- 
piioea extreme^ but sjiU ^ppearìng in paroxysms fi^ 



S&4 SEVERE AFFECTJON OP 

àbove described, uhattended with either cough or 
fever. The piilse was very feeble but regular, and 
appeared to be about 1 60, though it could not be 
accurately counted, Laxative medicities ànd the 
occasionai repetition of the anodyne were advised. 
Next day, (Aprii 3d) the symptomt? havitig by no 
nieans abated, Dr, Johnstone was again requested 
to meet us, 

We now considered the case as bop^less, but <m 
account of the great frequency of the pulse, agreed 
to make a cautious trial of the ibxgiove, hoping 
that it might, by lessening the frequency of the 
pulse, produce some xnìtìgation of the symptoms. 
This we added to the anodyne draught; and di- 
rected two grains of ipecacuanha and four or fìve 
òf rhubarb to be given occasionally, fbr the pur- 
pose of excitiag the bowels. 

1?HiiIe the pulse and breathing continued in the 
state bere described, the sense of anxiety was ex- 
treme, and the feelings of the patient such, that he 
said he would rather die twenty times, than pass 
oné such night as the two làst* He was now oc- 
casionally affècted whh a degree of delirium. It 
is on^ of the peculiarities of this extraordinar}-' case, 
that even when the fits of dyspnoea were worsrt, the 
patient never had any swelling of the jugular veins, 
unusual beating of the carotid or temporàl arteries, 
òr other symptoms of impeded return of blood irpiu 
th^head^ 



Q^GAm QF RSSPIRATION. <295 

^ SQon. after the fir«t dose qf rhubartx and ipec^cu- 
>Q^ was giveu bina, he was seized with vovnìtivig 
ancj violent str^iming, which, although there was 
.but little brought up fiom tha stom^ch, continued 
.for a cousld^rable time. I was not displeased at 
^tfais eSactp asf I |had been long in vain urging bim 
. to take an emetic. Tl^e change of symptoms wbich 
^etiisued was very singular* The pulse at once lost 
. its great frequency and feebieness, and became a 
good steady pul^e of from 96 to 100. Ali appear- 
ance of dyspnoea ceased, the patient conceived him- 
.96if aloió^t reaiored to bealtn, and said that if he 
recovered, the em^c had eaved him. 

^ I remained witìi him several hours after this, 
during whìch he continued perfectly easy, and tìhe 
pulse was strong and good. I left him about six 
o'clock in the morning, telling him, that, as he was 
so much better, I should not see him again till 
next day. 

On my return next day, I found that toou after 
I was gone, the dyspnoea had recurred with great 
viole&ce; but the pube, instead <^ bei^g feeble and 
extremely frequenta was now^oply about HO or 
120} and not only very.strong, but, as Mr. Rick- 
etts, and Mr. ^lukes^ surgeon at Stourport, (wiio 
had seen him ou the preceding day for thè firpt 
tiwpjr) inform.ed m^^ decidedJy hard. Ujider these 
^ dr^aa3kstanoe&5 threy very properly took eight or 
ten ijunces of blood from bis arra, and repeated the 

4 



596 SEVERE AFFIICTIÒK ò*- 

blood-lcttìng ón the following moming, to about 
the same extent, by which the symptoms were 
greatly relieved. The first blood drawn, shewed a 
little of the buffy coatj but there was no appear- 
ance of it in any of the succeeding blood-lettings. 
As mid-day approached, the fits of dyspnoea again 
returned, but by no means to the same degree. 
They had now, for many days, shewn a periodic 
tendency, being evidently worst about one or two 
o'clock, both in the day and night* 

Wc then gave the patìent a scmple of ipecacu- 
anha, whichproduced repeated vomiting with much 
straining, and another very complete remission of 
the symptoms. Towards midnight, however, the 
fits of dyspnoea again returned, stili, as usuai, \vith 
perfecUy free breathing between them, and without 
cough or fever. The pulse was a little above 100, 

• stròng and good, and in some degree hard. 

On the 6th of Aprii, I wrote to Dr. Baillie, giv- 
ing a full detail of thìs very unaccountable train of 
symptoms, stating fhat blood-letting and emetics 
were the only means which had latterly afibrded 
much relief, àpd that the relief from emetics had 
beeh the most complete* I was not then awàre, 

• that, although more immediate, it was of shortér 
duration Ihau that firom bloodJetting, and that, at 
an earlier period, the symptoms had been wholly 
removed for a little time by bark, geiì^tian, and nist 
of iron. Dr* Baillie advised the repétition of th^ 



emetic, and the use of such tonic medicjnes as at 
th^ ^ame time possessed some antìspasmodic power. 

Befbre I received Dr. Baìllie's answer, the patient 
refusing to submit to the repetition of the emetic, 
we again had had reconrse to blood-letting; and as 
Dr. BailHe had noi mentìoned blood-^etting» I 
wrote to him on Aprii lOth mentioning what had 
happened since my last letter. In his answer, he 
observed that the symptoms could neither arise from 
inflamtnation nor water. He recommended the re- 
petitìon of blood-letting in the more severe, of 
emetics in the slighter attacks, and the use of such 
tonic medicines as had formerly been found usefiiL 

The patient would on no account again submit 
to the operation of an emetic, and such symptoms 
of debiEty soon began ^ to ^hew themselves, as de- 
terred us from a frequent repetition of the blood- 
letting. After thjB third blood-letting, (which was 
to the extent of about six ounces, and was per- 
formed on the moming after the last emetic) the 
relief was more permanent than on any former oc- 
Casion. Within the succeeding ten days small 
quantities of blood were occasionally taken from the 
arm. At first the loss of two or three ounces gave 
relief; but at length little or no advantage was de- 
rived from bleeding to this extent : and as the leg 
and stump began'to swell, and symptoms of water 
in thè chest appearéd, the patient being now un- 
able at any time to lìe in the hprizont^lposition ; 



SOO .SEVERE AFFECnOK OP 

after deatb. On a general view of the abdominal 
viscera they appeared healtliy, with the exception 
of a greater degree of redness and a more vas* 
cular appearance of the small intestine^ tban ìs 
usuaL Our time for the inspection of the body 
being rather limìted, we proceeded ìmmediately to 
the examinatìon of the thoracic viscera, where it 
was evident that the immediate cause of the disease 
hadexiated. 

On opening the thorax, àbout three qttarts of 
water were found, chiefly occupying the right side. 
The rìght lobe of the lungs appeared diminished 
in size ; but, not more than was to be e^ected 
irom the quantity of water found in this side of the 
thprax. The whole of the lungs appeared of a 
darker colour than usual^ the pulmonary yessels 
being in a state of great congestion with very dark 
coloured blood. Part of the right lobe, for the 
space of about an inch and half in diameter, was 
converted into a spbstance like liver» and at this 
place only, there was ^n adhesion of the pleura^ 
A iBmall part of the edge of this lobe W9S of a white 
ccdour. In ali other respects the lungs were 
healthy. 

Tlie pericardium was found every where firmly 
adbering tp the heart, and the heart itself, especi- 
ally on the left side, appeared gf a dark red colour. 
There was no other indication of disease in it* 
The semilunar ^nd Qther yalves appeared in the 
naturai state. 



OROAXS O]? RESFIRATION. SOI 

Most of these morbid changes were apparenti/ 
the con^equences^ net the cause, of the disease. 
llìat the fluid found in the chest ìs to he regarded 
as a consequence of the disease is obvious; for tìie 
patient, till mthjn about a month of bis death, 
couldy evenin the shortest intervals of the dyspnoea, 
lie in the horìzontal position without any inconve- 
nience. That the inflammatory afiection of the 
heart must be regarded in the same point of view, 
appears from a variety of circumstances ; and par- 
ticularly from this, that, at an early period, the 
syxnptoms were whoUy removed by the use of bark^ 
iron, and gentian, and the patient aiways found 
himself easiest after eating animai food, and drink* 
ing wine» 

It is almost unnecessary to observe, thiat, had 
the dyspnoea arisen from the inflammation of the 
lieart obstnicting the passage of the blood through 
the lungs, it was impossible that the patient could, 
every five minutes, bave had an interval of perfect- 
ìy free breathing. 

The pericardium every where adhered closely to 
the heart, giving reason to suppose that the adhe* 
gioii had been of late date*. It may appear at first 
view very surprìsing, that inflammation of the heart 
dionld bave existed, for however short a time, with- 
out foetraying itself by any of its diagnostic symp- 
toms« There was no fever, permanent dyspnoea, 

* See De. Baillie's Morbid Anatoroy, pagie 6th. 

2 



SCSi tEVERB APraCTIOW ÙP 

or cough*; and the symptomS) which occaèionally 
attend ìnflammation of this organ, were also 
absent ; viz. irregular pulse, palpitation, and sy»- 
cope. In the coUectìons of Bonetus and Morgagni^ 
the reader will however find cases related, which 
prove that there is a chronìc inflammation of the 
heart, which, not impeding its functions, may exist 
without betra}dng ìtself by any syin{rix>in j and can 
only be detected by dissection. 

We might at first view be inclined to suppose, 
that the héart is subject to this species of inflamma- 
tion from its being an organ of very duU feeling 
notwithstanding its importance ; (or it has met ^th 
severe woundst; worms and other extraneous bo* 
dies bave lodged in ittj and abscesses and ulcera- 
tions bave formed in it§ , firequently without the pro- 
duction of any painfìil sensation, and wbat is sttU 
more extraordinary, of any material derangemrat 
of its functions* ' But we find the same species o£ 
inflammation occasionally existing in oigans of the 
greatest sensibility. 

The reader will see instances in whidi the intest- 
ines were inflamed, with ìitàe or no sensation of 
pain, in the S5th epistle of Morgagni, iti Van 
Swieten's Commentane» on the aphorisms df Boer- 

* Dr. CuUen's Synopsis Nosol. Method, genus XIIL 

t Medico-Chiriirgical Transactions, Voi. IL 

X Sepul. Anatom. of Bonetus. ìib. 2. sect. 8. and 1^. obè. t9. 

§ Sepul. Anatom. Ub. 2. £ect. 10. AdditametUa ob». % 



ORQANS or RESFIBATIOK» 303- 

htóTe, Sir John Pringle's Account of the diseases of 
the array, and in tlie fburth volume of De Haen's 
Ratio Medendi. The case before us, may be re- 
garded as another ìnstance of the same kiiid ; evi- 
dent marks of ìnflammation appéaring on the ìsmall 
ìntestines, although the patient liad never com^ 
plaìned of poin in thern, nor had their functions« 
been any fuither deranged, than to require the use 
of smail doses of magnesia. The same species o£ 
ìnflammation has been found in thè stomach itself, 
of ali our organs perhaps the most sensìble. D^ 
Haen, in the work just alluded to, mentions one 
case, in whìch the stomach was found inflamed after 
death, where there had been no vomiting ; and 
anotfier in whìch there had been neither vomiting 
nor pain. ' 

Such cases lead to a curious ìnference, that th« 

derangement of fimction in an inflamed part, de» 

pends more on the irritation g£ ìts nervesr, than 

the dìstension of its vessels : for it appears firom 

these cases, that, if the latter exists without occa- 

^oning the former, the function of the part is often 

little, if at ali, impaired. The nerves appear tp 

perfiirm a part in the production of ìnflammation, 

Avhi^h is, and probablyever will be, but little under- 

ttbod. In extracts from a work by Pedratto, in 

the 21 st epistle of Morgagni, and in the Historia 

Hepatica of Bianchus, the reader will find cases 

and dissectìons related, in which the cause that 

produced the ìnflammation, was wholly confined to 



dÒ4> 6EVERS AITBCTIOir OF 

one organ, and the ìnlBammation to anothef* Thel 
ìnteresting nature of the subject wìll apologìze fer 
this digression. 

It 13 difiicult to judge of th^ kind and degree of 
inflammation by examintng the inflamed part after 
death. In the casa before us, the . appearance of 
the heart seemed to ali present but myself to indi* 
cate a state of active inflammation. To me it ap* 
peared too flaccida and of too dark a hue to a£S)rd 
this inference ; and its colour seemed to me in a 
great d^ee to depend on the same cause» which 
gave the dark colour to the lungs, the vessels car-» 
rying vety dark coloured blood. It is wcll known 
that^ in highly inflamed parts, the blood retains a 
very florìd colour long after death*. That inflam* 
mation had existed to a considerable degree, there 
can be no doubt, ftom the general adhesion of the 
perìcardium ; but chronic inflammation of the heart, 
as appears f rom the dissections just aUuded to, h 
capable of producing even abscess and ulceration. 

We cannot conceive that any great degree of 
dyspncea could be occasioned by the diseased por* 
tion of the lungs, which was coipparatively so 
small. Besìdes we may say of this, as of the in- 
flammation of the heart, that had the dyspngea 
arisen from such a cause, it must bave been .perw*- 
nent. We cannot teli whether this changeofstnic- 

* Dr. BaiDie's Morbid Anatomy« page 2. and otber passa^s. 



OROANS OP RESPIRATION. SOS 

ture in the luiìgs had exìsted from the commence- 
ment of the disease, because it might have existed, 
without betraying itself by any sufficiently marked 
symptom. But I think we may very positively say, 
that it was noi the cause of the disease. 

On reviewing ali that has been detailed concem- 
ing this extraordinary case, the follawing observa- 
tions naturally arise. The explanation which they 
alFord must be admitted to be in several respects 
conjectural; but I know of no other which can at 
ali account, either for the symptoms, or the effect 
of the means employed. 

It appears, frora the whole course of the symp- 
toms, that no permanent course of obstruction to 
the circulation through the heart or lungs existed; 
And, ih the dii^section, no such cause could be 
found : for, that the inflammatìon of the heart only 
supervened in the ktter stage of the disease, and 
that, when it did supervene, (as in the cases men- 
tioned by Bonetus and Morgagni) it occasioned no 
obstruction to the circulation, as I have already had 
occasibn to observé, are proved by the history o£ 
the disease. It follows then, that, without organic 
derangement, spasm, or any other cause capable of 
obstructing for the space of a minute the circula- 
tion through the heart and lungs, (for the fits of 
dyspnoea never iasted so long as a minute) some 
cause existed capable of occasioning such fits ; and 
consequently of impeding the oxygenation, or, we 

VOL. ui. X 



306 ^' SEVERE AFFECTION O» 

x>ught rather to say, from the late veiy accurate 
experiments of Mr. Ellis*, the decarbonìsation of 
the blood in the lungs ; and that such a cause did 
exist to a greater or less extent, from . the com- 
mencement of the disease, appears from the blood 
hawked up having always beeri of a dark colour. 
This state of the lungs being admitted, does it not 
afford a ready explanation of the peculiarìties of 
the foregoing ca^e ? We know from direct experì- 
ment, that the left side of the heart cannot be ex- 
cited by venous blood. This does not seem sur- 
prìsing, as arterìous blood is its naturai stimulus* 
And may we not safely infer, that the smaller rami'* 
fications of the pulmonary artery, and the trunk, 
as well as ali the ramifìcations of the pulmonary 
vein, which, in the naturai state, carry only arte- 
rìous blood, are also insensible to the stimulus of 
venous blood, which is the naturai stimulus of the 
right side of the heart, and of the trunk and larger 
branches of the pulmonary artery. As soon, therfe- 
fore, as the decarbonisation of the blood began to 
be impaired, the action of the former set of ves- 
sels would be impaired in the same proportion. 
Would not the consequence of this te, that these 
vessels would require a greater degree than usuai of 
tliie stimulus of distpnsion to excite them to carry 

"^ An inquirj into the changes induced on atmosphtric air bj{ 
the germination of seeds, the vegetation of plants, and the respira- 
tìon of animals, by Daniel EHis, 1807. 

Farther ìnquiries into the changes induced on atmoapheric air 
&C. by the satne author> 1811. 



v# 



\ 

\ 






0&GA1^3 OF RESPIRATION* 807 

ne quantity of blood, and that they would 
'% ^ect to a Constant repetitioti of tempo- 

n, ié e, of such preternatural disten-» 
^ssary to excite them to vigorous 
' • neans their power could not &il 

'^. X'^ -ed. 

« 

. necessarily give immediate reliei^ 

v^ompressing the lungs, by which the 

.ed vessels would be emulged, and àt the 

.uè timeexcited to a more vigorous action. It 

was evidently the effortof straining which gave relieC 

Little was brought up, and what was brought up 

was of an inoffensive nature. In the same way, 

relief was obtained by pressing on the epigastric 

ragion. 

Blood4etting would necessarily relieve, by less- 
ening the quantity of blood thrown into the debi* 
lita!ed vessels. The effects of the bloodJetting 
would prove more permànent, because they would 
continue till the increasing quantity of blood, or 
increasing debility of the vessels, again called for 
a dimination of the blood. The good effects of 
the emetic would be more transitory, but more im- 
mediately felt, because, by it, the distended ves- 
sels would be immediately enabled to contract ; but, 
the quantity of blood to be circulated remaining 

* The unusually distended state of the vessels of the lungs with 
dark coloured blood, was evidently a necessary coosequence of 
the coDiinuHnce of this state of them. 

X 8 



308 SEVERE AFFECTION OF 

the same, they would in a short time àgain be op- 
pressed. Now ali this was exactly what we re- 
peatedly witnessed. The circumstance of the pa- 
tient obtaining immediate ease, in slight paroxysms, 
by a very foli inspiration, seems to indicate, that 
nothing was wanting for the free circulationthrough 

;he lungs, but a more perfect decarbonisation of 

:he blood. 

It may also be seen, why there was no ìmpedi- 
ment to the return of blood from the head. For 
as the right side of the heart and larger pulmonarj 
arteries possessed their naturai stimulus, it is evi- 
dent, that, long before congestion could take 
place in them, from the cause I bave mentioned, 
death would ensue. 

It may also be observed, that the deficient decar- 
bonisation of the blood could never, in this way, 
go so far, as greatly to affect the \vhole mass of the 
blood. In the case of a blue boy it does so; because 
there, arterious blood is, to the last, supplied to the 
left side of the heart and pulmonary system, although 
this may be in too small quantity. But bere, the 
defèct is first felt in these organs, and consequently 
cannot go to any great length without destroyiug 
their action. 

If these observ^tions be just, tlie foregoing case 
aifords an instance of a diseased state of the lungs, 
which, 9S far as I know, has not been noticed by 



ORGANS OF RESPIRATIOK. S09 

writers. And indeed the symptoms were such as 
it seems difficult to suppose could bave arìsen from 
any of the common causes of pulmonary disease. 

It is not unlikely that this dìseased state of thè 
lungs, whatever it was, had given rise to the change 
of structure observed in one part of them, and 
which, could the functions of life have gone on, 
\wuld probably have spread to the rest. 



AN ACCOUNT 



OF A 



NEW MODE OF TREATMENT 



n 



CHRONIC RHEUMATISM, 

AND ESPECIALLY IN SCIATICA, 



COMMUNICATED 



By ALEXANDER MARCET, M.D. F. RrS. 

ONJi or THE FHYSICIANS TO GUY's HOSPITAU 



Read Nov. 24, 1813. 



I H AVE frequenti jhad the opportunity of observ« 
ing, for the last six or seven years, that the pro- 
fuse and unavailing sweats which often spontane* 
ously take place in the early stages of rheumatism^ 
and exhaust the strength of patients without allevi- 
ating their sufferings, are almost in every instance 
checked, and the pains proportionally relieved, by 
the use of antimonial medicines. Several distinct 
instances of this kind were recorded some years ago 
at Guy's Hospital in our clinical diarìes, and the 
explanation which I ventured to ofier of this para* 
doxical result, was, that the profuse flow of moist- 
ture from the pores, is not, in ìtself, the circum* 

5 



CHHONIC RHECMATISKTr Slt 

stanca which dìminishes pain in rheumatic afFec- 
tìons ; but that the relief is produced by a certain 
conditìon of the sur&ce, or peculiar action of the 
cutaneous vessels, which, though generally pro- 
ductive of moisture, is not necessarily connected 
with profuse perspiration^ It is this peculiar ac- 
tion which antimoniais are so apt to promote ; and 
there is no diflSculty in conceiving, how the violent 
and colliquative paroxysms of sweating which oc- 
cur in rheumatism, gradually yìeljd to this gentle 
and uniform operation*. 

The following interesting case, which I think in 
eveiy respect worthy of being communicated to the 
Society, appears to me to contain ingenious and 
instructive hints on the treatment of rheums^sm, 
and on various physiological points, and to throw 
some light upon the preceding observàtions. It 
was drawn up by the patient himselft, a gentleman, 
who, although not belonging to the medicai profes- 
sion, is so well known in the philosophical and li* 
terary world, that bis name, had I been at liberty 
to giva it at fuU length, would bave added great 
weigbt to the opinions and statements which hi» 
paper contains. 

* It is probable also that the ìnvarìable tendency of aittimonials 
to determine gently to the intestines, may eontribute to this bene- 
ficiai eftect. Opium alone, often checks the most distressing 
tymptoms, but its mode of operation is altogether diiièrent 

t R. C. Esq. F. R. S. &c. &c. 



\ 



sia A NEW MODE OF TREATMENT 

**About eighteen years ago," says Mr. C. " Ifc- 
ceived a sprain on horseback which occasioned very 
violent pain in myloins,and stili more in the left hip, 
thigh, and leg, foUowing the course of the sciatic 
nerve, and spreading itself over the sole of the left 
foot. I was then on the continent at Bruxelles; 
and after severe blistering and other remedies, not 
finding myself better , I was ordered to try the mud 
baths and douches of St. Amand. Having used them 
six weeks to no efFect, I proceeded to Paris. I 
tried various methods of cure under the most emi- 
nent surgeons there, as warm and cold bathing, 
vapor, air conducted through a heated pipe direct- 
ly to the part affected, warm and strengthening plas- 
ters, fumigations, &c. till at length the celebrated 
and unfortunate Monsr. De Seaux proposed the 
moxa. This was accordingly applied with more 
than common severity, and the suppuration was 
maintainedlonger than usuai, butwithout effect. In 
this state I was, with many other English, put into 
a damp prison, and a violent rheumatic afiection fell 
upon the injured parts. I remainedin this situation 
fifteen months without a possibility of applying any 
remedy. Upon recovering my liberty, an English 
phywcian proposed to me a quack medicine, known 
in Paris by the name of Goderneau's powders*, 

* I bave since that ti me had an opportunity of examining these 
powders chemically. They are a preparation of mcrcury. Each 
pafcel given as a dose contains 12 grains (French). The colour 



. IN CHRONIC RHEUMATISM, 313 

adding strong testimoni^s in its favour,although the 
French physicians reprobated it as unfit for human 
creatures. Much more con vincedby the Englishphy- 
sician than deterred by the French practitioners, I 
began this powder ; 'and, after six doses of it, the 
pain diminished, and I was able to walk. Time has 
since that helped to wear out th'e complaint, and I 
bave occasionally been five or six years witìiout its 

is not so wliìte as that of calomel. Examined with a lens, small 
globules of metallic niercury are discernible, and also some red- 
dish particles which are red precipitate. They are wholly volatile 
at a low heat 4ike calomelj but volatilization separates them in a 
manner wbich proves tbem not to be homogeneous» for the vìal in 
which they are sublimed is roarked with threedistinct zones^ white 
xed> and grey. Water does not dissolve any sensible portion of 
them. Nitrìc acid dissolves the whole of them, and nitrate of Sil- 
ver poured into the solution lets fall a quantity of muriate of Sil- 
ver corresponding to about nine grains of calomeU The remain- 
ing three seem composed of one and a half metallic mercury, and 
one and a half red precipitate. By triturating the above sub- 
stanccs in the above quantities^ I produced a compound very like 
Goderneau's powders^ but rather mòre unìformln its appearance» 
This is a very rude preparation of mercury, and the use of it 
sbould noi be encouraged. Its efi^ct is to produce a disagreeable 
sensation in the stomachi and aflerwards to increase the appetite. 
It also purges, and, as I am told, sometimes produces vomita 
ing. ' The French faculty excìaim against it, but this they are 
apt ìQ do against every medicine more active than orange-flower 
water ; and yet they admit corrosive sublimate. The Chevalier 
Goderneau was a inilitary man, and a knight of * St. Louis, but no 
chemist; and since the revolution has swept him from off the face 
of the earth, the care of preparing the powdcrs hasdevolved upon 
bis sister, an old maiden ladyi who from ti me to time swallow# 
large doses of them for a sore foot, which has the advantage of 
^ways being about to heal. 



313 A NEW MODE OT 

"About eighteen years 
ceived a sprain on horseb^ ; 
violent pain in my loìns, p 
thigh, and leg, followi' i 
nerve, and spreading i' 
foot. I was then on 
and after severe blist' 
finding myself batter 
baths and douches o i 

six weeks to no e 
tried various meth i 

nent surgeons tb 
vapor, air condu \ 

lyto thepartafff 
ters, fìimigatior 
and unfortuna I 

moxa. This ; 

than commo 

maintaìnedl I 

this state I - i 

a damp prì^ 
upon tìic ; 
fiftecn mr 
rcinedy. 
physicir 
in Par' 



parte' 



/ 



e so 
thi» 
vere 
een 
ing. 
iber 




JSO-, 

tive' 

■ ent 

o to 

piiun 

; aod 

.iig. I 

a time, 

>i) as soon 

ilow a fresh 

.Ldical eflèct, and it 

Lt the weijfht of a co- 

preshure of the entire 

<if ihe coliimn of waLer. 

increases ìq the ralio uf tlie 

of the pipe throiigh whichit 

\e fourlh pari of the force of 

of their eflèct ti vei-y great. A 

ly thÌ9 deficìeiicy at Bath, and estabhsh 

from one to fifty feet if necesaarj-; and 

.cation, naight be pTo}Jortioned to the sensi. 



SI 6 A NEW MODE OP TREATMENT 

application. By other medicai advice sirice that 
period I bave tried bathing in warm se?i water, in 
artificial sulphureous waters, the same as tbose 
which had afTorded me relief in Paris, and in the 
Bath waters. I bave also used the dry pump there, 
vapc»: baths, and heated air, friction, cupping» 
leeches,andelectricity. I bave taken intemallynitric 
acid, James's powders, guaiacum, nitre, cicuta, hy- 
oscyamus and the eau medicinale; bark,and finally 
arsenic, but ali to no purpose. Were I to state in 
general terms the effect of ali these, I sbould say 
that cicuta, byoscyamus and the eau medicinale 
procured me temporary relief j and tbat bathing of 
whatever kind usually made me worse. In short» 
I had nearly exhausted the materia medica, and I 
had no hope left but in a more favourable climate. 

^ Happening about five weeks ago to bear of a case 
which bore a strong analogy to my o^rti, tbougb 
the subject was not a human creature» it ^ggested 
lo me an cxperiment which I resolved to trjrimme- 
diately. A celebrated race-horse \ belonging to a 
Bobleman very well known at Newmarket, had been 
ctired of a disorder which ha[d ali the symptoms of 
rfierraiatism, by sweating in body clotlies, after 
every oUier remedy had failed. I therefore clothed 
myself in a sufBcient quantity of flannel, and set 
out to walk as far and as fast as I could. With the 
iitm^st difficulty I proceeded half a mile ; and the 
pain I suffered contributed not a little to the effect 

* YandvL 



IKT CHROKIC KHEUMATISM. $11 

of the exercìse in promoting perspiration. 1 re- 
tumed home in a profuse sweat, rubbed myself 
dry before a fire, and went to bed. In about an 
hour I gqt up, found myself very much fatigued, 
but in other respects not worse. Forty-eight hours 
after this, I fepeated the same kind of exercise, and 
found that I could walk a mile with as much ease, 
as I had walked half that distance on the first day. 
My general sensations were the same as before; 
but, as the fatigue diminìshed, I thought I could 
perceive an amendment in my rheumatic pains. 
Two days afterwards I took my third walk, proceed- 
ing as before, and after it I had a better night, less 
interxuptedbypain than anyl had enjoyed for eight- 
eèn months. From that moment I looked forward 
with confidence to a ciire, and I bave not been dis- 
appointedr Every succeeding walk has diminished 
my suflFerings, and I may safely say, that after the 
sixth, I was as free from pain as I had ever been 
in my life. The only remnant I bave left to re- 
mind me I was so lately a cripple, is aweakness in the 
left leg, particularly about the ankle, together with 
now and then a slight sensation of numbness along 
the sciatic nerve. These are naturai symptoms,' 
considerìng that I had been so long without using 
the limb; and there is every reason to suppose they 
will yield to time and moderate exercise. I bave 
. now walked nine times in this manner for the pur- 
pose of sweating, and shall continue to do sa pro-^ 
bably much longer; for I find it of the greatest use 
to my general health to counteract the effects^of 
sedentary habits. 



àia A NEW MOD£ OB* TREATMENT 

" I usuaHy proceed to my sweating walks ia the 
following manner. Next to my skin I wear stock- 
ings, drawers, and a shirt, ali of fleecy hosiery. 
Over these I put one, two or three pair of flannel 
drawers, one, two or three flannel waistcoats; and 
round ray hips and loins I gird six yards of thìck 
flannel, making beside the drawers and waistcoats 
eight thicknesses of flannel on the chief seat of 
pain, and the origin of the scìatic nerve. Over ali 
this I wear warm pantaloons and a great coat. When 
I have walked one or two miles, more or less ac- 
cording to the heat of the day, I am generally in a 
profuse perspiration. I return home, take off my 
wet clothes, have a couple of changes of well aired 
flannel, and then lie down upon a bed not warmed» 
I use no means to excite further perspiration after 
the muscular action is over ; but, on the» contrary^ 
rather incline to check it as speedily as I can, tak- 
ing particular care however to avoid catching cold. 

*^ I do not perceive that the quantity I perspire,. 
has any influence on the efficacy of the remedy. I 
imagine that a violent action produced in the gene- 
ral system is the chief cause of iis salutary effect. 
In coti3equence of this opinion, I cease the exer- 
cise the moment that a very increasied action is* well 
establi^hed. This is fully produced with tlie shov^^ 
quantity of clothing in moderately warm weather, 
by walking from one to two miles. For patients wfao 
ar^ very much disabled, the quantity of dothing 
wight be increased) and the distance diminishe^* 



\ 
\ 



IN CHaOKIC RHEyMATISM. 919 

When the excitement is well established, I find my 
pulse rìse to between 90 and 100, and it is full and 
strong. 

^^When I bègati to experience relief from this, 
mode of treatment, I was eager to prosecute the 
cure, and took my walks every second day. Being 
now relieved, I resumé them only every fourth, 
6ftìsiy or sì^th day, as most conveniente 

** I do not find myself under the necessity of any 
particular precaution as to avoiding cold the day I 
exereise ; and, in this respeet, sweating by muscu- 
Jax iK^tion has an immense advantage over warm 
baths» vapour, orheatedair; particularly in a cli- 
mate so damp as that of an island situated in the 
north seas must be. Physiology will easily point 
cut many other advantages in exciting perspiration 
by a stifflulus which invigorates, rather than by the 
eneryating raethods of heated air or water. 

" Since beginning this process, I do not find that 
I am grown thin; and in my general health I ani 
infinijtely better. I feel myself more strong and 
active, and less sensible of cold. My diet has been 
mach as usuai, but my appetite rather increased. 
I bave occasionaliy taken a little bark to maintain 
the general tone of the system ; and òn retuming 
home after each walk, I bave found that a few 
drops of harti^om in water were refresllìng, and 
prevented thirst during the rest of the day. 



520 A NEW MODE OF TREATMENT 

* • 

** By what I have leamt from very good authority, 
the exercise I perform is not one-twentieth part of 
t^rhat the Newmarket riders undergo. Hiere ìi* 
hardly an example of one of those who follow the 
advice of a skilful physicìan in their process of 
wasting, that suffers by it; and the opinion that 
either their health is injured or their life abrìdged, 
is altogether erroneous. ' Excessive purging is ne- 
ver used now, except when the riders are too lazy 
to undergo violent exercise, for purging is found 
by experience to be a much more prejudicial mode 
of reducing their weight. Sweating by muscular 
action with an increased quantity of clothing ibight 
be recommended not only to rheumatic patients as 
a saie and easy remedy for their pains; but to per- 
sons of both sexes who are troubled with redundant 
corpulency> 



" P. S. Since the above was written, I have had^ 
leisure to make some further observations whìch I 
teg leave to add. 

*' I am stili more convinced thataveryprofuseand 
long continued perspiration, promoted by muscular 
action, is not ne«essary to the cure of rheumatism, 
pr to the improvement of general health, unless 
corpulency be one of the evils which is to be re- 
moved. Perspiration may be useftd as.aproofthat 



IN CHRONIC RHEUltATISM. S21 

m 

a very strong action is established in the system, 
and may in some sort be regarded as the measure 
of that action ; in the same manner as the point of 
ebuUition is referred ta as a rough thermometer by 
those who want very warm water. Of the very . 
much which has been attributed to sensible and in- 
sensible perspiration a great deal certainly is true ; 
but may not much also be attributed to the action 
excited in the system by those very medicines which 
are supposed to promote perspiration ? Does mer- 
cury, independantly of the diseases it cures or 
causes, diminish the quantity of flesh by mere per- 
spiration ? 

" As an encouragement to those who might be de- 
terred from the use of this remedy by the apprehen- 
sion that it is too severe for a weak constitution, I 
add the foUowing table of my weight taken twice or 
thrice each day, during the time that I was per- 
forming six of these sweating walks, (one in every 
forty-eight hours) undertaken with a view to ascer- 
tain whether the quantity of exercise necessary to 
cure a sciatica, in such a case as mine, is so great 
as to cause a ihaterial loss of flesh in the patient. 

" Before I began to weigh I had already walked 
nine times, It is therefore only by my general ap- 
pearance that I can say I had not lost flesh by my 
first walks. Previously to the six walks of which I 
am going to state the results, I had been obliged to 
suspend my exercise for fifteen days, as the weather 

voL. III. y 



S2^ A NEW MODE OF fREATUlÈÌ^T, kó. 



bad been extremely bad, and I hàd an accidcRtal 
ftttack of diarrhcea during fbur days. I weighcd 
night and morning, before and after walking, al- 
ways in the same clothes, and these as few as pos- 
sible, and tdok every precaution against error. 



. 




WEIGHT, 


s. 


Morn- 
• ing. 


After 
vraUiiog. 


Night» 


Nov.26 


st. 
IS 


ife. 

1 


st 


Ib 


St. fc 

1^ li 


Walked 40 minutes ; sweat prò* 
fuse. 

Out in a carriage most of (he 
day. 

Walked near three miles; sweat 
very profuse. 

Cut on foot aU the morning. 

Walked 30 minutes ; sweat rao- 
derate. 

Out on foot. 

Walked 30 minutes, wìth in- 
cre^sed clotbing; «fwcat pro- 
fuse. 

Out on foot most of the day. 

Walked 30 minute»; swea^mo^ 
derate. 

At home ali day« 

Walked more than three mjles; 
sweat very profuse^ 

Out on foot ali th^ morning. 

Out on foot. , 

J 


27 


13 


1 


12 13 


13 1 


28 


13 









13 2 


29 


13 

> 


1 


12 


12i 


13 2i 


30 


13. 


1 




13 3è 


Dee. 1 


13 


1 


12 

• 


13 


13 2 


2 


13 


1 




1» 3 


3 


i3 


2 


13 





13 3 


4 


13 


»là 




13 3^ 


5 


13 


2 


13 


0^ 


13 3 


6 


13 


H 


* 


13 3 


7 


13 


2 


13 





13 3i 


8 


13 


2 


• 


13 4 


9 


13 


2i 


V 


13 4 



APPENDrfX 



TO TH£ 



PAPER ojr 



CYNANCHE LARYNGJSA. 



By j. r. farre, MD- 






Read Dee. 22, iSlgi 



N* 




iN th€ casés of Cynanche Laryngjea, which 
I had the hònor to còmmuniòate to the Society, 
were read, the leamedPresident, Sir Henry* HaU 

...» ^ ; "^ 

fbrd, noticed the deficiency of coimuunicatìou iu 
the various medicai records respecting thi's form of 
cynanche, and briefly'referred to the cases of Dr. 
David Pitcaim, and Sir John Macnamara Hayes, 
as instances of the same species» Kespecting the 
former only of these distinguished physicians, was 
I at that time successful in obtainii^ the particu- 
lars which I wanted. In an interesting biographi- 
cal memoir of Dr. David Pitcaim, pffbUshed in the 
Gentleman's Magazine-for- Aprii, and in the Euro- 
pean for June, 1809, I read thchistory of the dis- 
pase v^hicb d^prived the world-^of this e^cellent 

y 2 



324 CYNANCHE LARYNGEA, 

r 

physician. A more valuable report, giving an ac- 
count of both cases, has been recently presented to 
the profession by ÌDr. Baillie, in the third volume 
of the Transactions of a Society for promoting Me- 
dicai and Chirurgica! Knowledge. 

The conversation to which my communication 
gave ijse, has induced me to ofter some observa- 
tions'on the diagnosis, and treatment of a disease 
which seems to be Uttle known, and which assumes 
a more than usuai interest from its having proved 
fatai to two physicians, notwithstanding their own 
practical knowledge, and the aid of the most emi- 
nent in the profession. 

In ali the cases of cynanche laryngea, the mucous 
membrane investing the epiglottis, glottis, an^ 
chiefly the extemal and posterior surface of the 
larynx, was the seat of the inflammation, by which 
the rima glottidi^ wàs so much narrowed, that the 
vital functions were actùally extinguished by the 
stricture. It is true that the tonsils, the arch of 
the soft palate, the uvula, the tongue, the internai 
membrane of the larynx and, trachea, ali, or seve- 
ra! of them were inflamed ; but this was only an 
extension of the action to one common membrane 
which invests the whole, whilst it was most intense 
at the mouth of the larynx. In both the cases 
communicated by Dr. Baillie, uneasy sensations 
were felt in the larynx. In one of them, tliis 
symptom appeared at the accession of the inflam- 

3 






AND CYNANCHE TRACHEÀLIS. 325 

mation, and. strongly excited the patient*s anxiety 
for the result, at a time when the apparent inflam- 
mation in the fauces was so iiiconsiderable, that 
upon a superficial observation it would hardly have 
been noticed. I did not see Essex alìve ; but the 
slight swelling of the uvula and tonsils which ap- 
peared on dissection, n]ade it obvious that bis dis- 
ease could not have been mistaken for cynariche 
tonsillaris. In Case II, when I desired the patient 
to point out the seat of bis suffering, he placed bis 
fore-finger on the middle notch of the thyroid car- 
tilage, to which the epiglottis is fìxed. The diiffi- 
culty of the diagnosis does not in fàct He between 
this inflammation and the cynanche tonsillaris, but 
between it and the cynanche trachealis. Dr, Pit* 
cairn wrote on a piece of paper, that bis complaint 
pwas croup. Croup very nearly approaches the 
cynanche laiyngea, but the difference between the 
seats of the inflammation will appear by comparing 
the symptoms and morbid appearances which be- 
long to each disease. In the cynanche laryngea 
the symptoms are, uneasy sensati on in the larynx, 
difficult and painful deglutition, partial swelling in 
the fauces, a supervening and perpetually increas- 
ing difficulty of breathing, inflammatory fever. In 
the cynanche tracheaHs there is a diflSculty of breath* 
ing*, without any swelling in the fauces, or painful 
deglutition, the expirations, especially in cough- 

* Th^ difficulty in the respiration is the symptom l>y which 
the danger must he estimated, for the ringing cough, without that. 
adjunct^ is of little importance. Many confoupd merely this 

symptpm, 



ing;, ^xe vfwry dirill, tfap fever is inflammatory. • In 
both, the voice is ch^ged, and, in extreme c^tses^ 
is suppressed ; thje termination is by suffocation. — 
The following are the morbid appearanceS : in the 
former, the mncous membrane investìng the epi- 
glotti^ and margin of the giottis is inilamed ; 
serum is effiised under it, qr coagulabie ]ymph on 
its extemal suriace, by which the rima glottidis is 
narrowfed, or actually closed^ (See piate III.) In 
thp latter, the mucous membrane of the larynx and 
trachea is inflamed, and ajayer of coagulated lymph 
is formed on its internai surface, from the extremity 
of the epjglottis to an indefinite éxtent within the 
trachea, by which the tube it&éif is narrowed, or 
actually closed. A puriform fhiid, instead of mu- 
cus, is found in the trachea and bronchia. These 
charjj^cters chiefly apply to simple cases of both 
species, for g,s they difFer in their seats, but not in 
their nature, it is possible for both forms to he 
combined in the same patient, and it were an easy 
matter to prove that a stili greater extension of 
inflammation than this does actually take place in 
these organs. 

In cprnparing the morbid appearances with the 
symptpms of cynanche laryngea, it is not difficult 
to determine that the inflammation, fron^ its limited 

symptom, which also not unfrequently occurs in the catarrhal 
afièctions of children, especially during dentition, with croup, 
"which is Goraparatively a rare disease. 



AtD CTNANCHE TBACHEALIS. 827 

seay:, fram its not exceeding the bounds of the ad- 
hesive stage, and from the symptomatic fever, re- 
quires the use pf the lancet. I may be here allowed 
to give an unbiassed opinion ; fòr in neither of the 
cases which I bave described did I order general 
bleeding : the first, I bave already stated, was not 
attended by myself ; the second was not in ^ state 
to adrait of tìiis remedy when I was consulted. 
Both were bled, it is trae, but it was doife in the 
very advanced stage of the disease. \^Tien the 
function of respiration can scarcely be carried on, 
the body will not then bear large bleeding ; but 
although in the ultimate stage, the vital powers 
are greatly depressed by the copious abstraction 
of blood, yet on the accession of the inflammation 
this remedy seems to be less a matter of choicé 
than. of necessity. Dr. Pitcairn was bled once 
cópiously on the third day, and died on the fourth. 
Sir John Hayes was thrice bled, to the amount, in 
the whole, of thirty or forty ounces, on the second 
day, and died on the fourth morning. In both 
these cases, it must be manifest to every one who 
reads the history of them, that the patients died 
not from exhaustion, but from strangulation. By 
those who will take the pains to consider inflam- 
mation as a process, it will be understood that it 
may be checked, but cannot be suddenly extin- 
guished by the most active means ; time must be 
allowed for the process to deqline, even after the 
fiiirest efforts bave been liiade to arrest its progress, 
Unhappily, this necessary tim.e can rarely be ob« 

1 



328 CYNANCHE LARYNGEA, 

tained in this disease, in which the activity of ^e 
inflammation is expended on a smaU, but most vital 
seat ; for the glottis once narrowed, may be closed 
by the locai action, even after the general powers 
are prostrate. 

These sijmple, and, I trust, naturai views of the 
subject, lead to a treatment which must be varied 
according to the stages of the inflammation : the 
first, or stage of congestìon, is the period for active 
depletion ; on the accession of the disease, in the 
first twenty-four hours, as soon as the patient feels 
the slightest uneasiness in the larynx,, or a very 
painfiil and difficult deglutition, which the appa- 
rent state of the fauces cannot explain. There is 
not in this stage any objection to copious general 
bleeding, suited to the strength of the patient; biit 
if this treatment fails to relieve, and the diflSculty 
of breathing supei'venes, it is too certain that the 
narrowing of the glottis has commenced. In this 
second and alarming stage, or t^at of eftusion, it 
may be proper to try locai blood-letting, by free 
cupping from the neck and shoulders, and by a 
continued oozing from numerous orifices made by 
leeches on the throat. In both stages it is reason- 
.able to resort to those internai means which dimi- 
nish the force of the circulation in the capillary 
àrteries ; and to produce this effect, none seem 
better adapted than the combined powers of the tar- 
tarized antimony and the submuriate of mercury, 
in doses suited to the strength of the patient. 



AND CYN ANCHE TRACHBALIS. S29 

Jn the advancèd period of this second stage, 
when the glottis is so much narro wed that the 
signs of strangulation begin to appear, a persever^ 
ance in these or other ordinary means seem no 
longer to aflFord even a chance of preserving the 
life of the patient, his physician must now resign 
him to the horrid death of slow sufFocation, or 
make a last effort to save him by the operation of 
bronchotomy. That the disease is a locai one^ that 
it is acute, and of short duration, that it affects a 
mucous «lembrane, which consequently does not 
readily take on the adhesive inflammation, or if it 
should be so acutely inflamed, easily sheds the 
lymph that had been effused on it, are circum- 
stances which, in the otherwise hopeless state of 
the patient, justify a trial of this operation. But 
if it be further considered, that bronchotomy has 
actually preserved life under the more unfavour- 
able disease of cynanche trachealis, the operation 
becomes expedient. And bere I am happy to find 
that the resort to bronchotomy, in Case IL is sup- 
ported by the opinion of Dr. Baillie, who had ac- 
tually proposed this operation in one of his cases, 
which was only not performed because the surgeon 
arrived too late. He also enforces this opinion by 
the foUowing advice. " If no substantial advantage 
is produced by this pian* in thirty. hours, it might 

* Viz : Al the verj^ beginning of the attack, one copious bleedin^ 
until the patient faints, foìlowed by the use of opiates, to remove 
the spar;m, which, in his opinion, has some share in producine 
the difficulty of breathing. 



$S0 QYÌìJAÌSCUE LAR7KGEA, 

be advisable to perfbyrm the operatioa of broncho- 
toHiy at the upper part of the trachea, just under 
the thyroid gland. TKis operation would probabljr 
euable the patient to breathe till the infiammatioa 
in the larynx, more especially at the aperture of the 
glottis, had tinie to subside." 

Different parts of the windpipe bave been selected 
ibr the operation by different surgeons» This seems 
to me a matter of considerable importance ; but to 
enter upon it would lead me Qut of my province. 
It is more within the line of my duty to consider 
what forms of cynanche admit of the operation. 
In the cynanche maligna, the inflammatory action, 
which is vehement, effuses coagulable lymph on the 
tonsib, and, in the worst cases, on the mucous 
membrane of the larynx ; but the strength of the 
action is soon spent, the lymph perishes, and the sur- 
faces which effused it die, and slough, or open into 
ill-conditioned ulcers. In such a disease, if symp- 
toms of strangulation supervene, it is almost need^ 
less to say, that bronchotomy is inadmissible, But 
the badly ulcered or sloughing tonsils, with typhoid 
fever, sufficiently distinguish this malignant disease 
. from the simple cases which demand the operation* 
In every uncombined case of cynanche laryngea,^ 
when otlier means bave failed, I think that the 
patient ought to haVe the chance, even if it should 
prbve a small one, which this operation aiFords» 
Every c^se of simple cjmanche trachealis is so 
nearly allied, both in its nature and manner of 



AND CYNANCHE TRACHEALIS. 331 

proviiJg fatai, to the cynanche laryngea, that the 
same mode of treatment, with a little modifìcation, 
which is applicable to the one, is also suited to the 
other. But when the cynanche trachealis is com« 
bined with pneumonic inflammation, of whatever 
kind, then the operation cannot avail. In propor- 
tion as the infiammation is extensive, it is less in- 
tense in the larynx, and I think it is not difiicult 
to discriminate between the cases, at the period 
when the operation is required, by the manner in 
which thg respiration is conducted. In the one, 
the difficulty of breathing is evidently that of im- 
pending strangulation ; in the other, that of deep 
seated and extensive oppression. The difference 
may, perhaps, be illustrated better by a case of 
each kind. 



Case qfCì/naricJie Trachealis* 
Williams, a fine boy, at the age of two 



years and five months, was carried off by an acute 
disease in little mone than forty-eight hours after 
the attack. The distressing and violent symptoms 
which markèd its progress, and the rapidity with 
which it proved fatai, induced his mother to solicit 
me to ascertain, by dissection, the cause of his 
death. Previously to the examination, I minutely 
• enquired into the circumstances of the case, and 
the follo wing simple, but impressive history, is given 
Dearly in ber own words. 



S34 CTNANCHE tARYNGEA, 

tions of th« brondiia wére dissex^ered : from fhe 
krtter a whitish fluid issiiéd* The pericardium coiì- 
tained very little liquor. 

Throat — The larylix, trachea, and larger branchés 
of the bronchia were removed. Qn looking in^ 
lo the larynx, through the glottìs, the passage 
seeraed to be closed. The cxtemal mucous mem- 
brane of the larynx was not affected ; but on 
cutting open th^ ^ndpipe posteriorly from the 
rima glottidis to the subdivisions of the bron- 
chia, a thick layer of coagulated lymph was found 
on the internai inucous membrane of the larynx, 
extending from the extremity of the epiglottis into 
the trachea, about a finger'» breadth below the 
cricoid c'artilage. The rest of the membrane 
lining^ the trachea and bronchia was visible, and of 
a red; colour. The sàcculi laryiigis were com- 
pletely conceaied, thegreatest deposition of lymph 
having taken place near this portion of the wind- 
pipe, by which it m^ so much- narrowed, that 
tliere was scarcely roomfor the point of a crow's 
quill to eiiter, It also contained a puriform fluid, 
some of which lodged in the narrow passage within 
the coagulated lymph» gave the impervioufr ap» 
peàrance before noticed, and probably occasi<)fied, 
^y its ascent and descent during respiration, the 
peculiar noise which the mother described^ 

In the head (ind ^.bdomen the appearance^ were 



AND CtìilAJ^QHS: XMACUZAUS. 335 

those which belong to the ixiost perfect state of the 
deverai organs. 

Tliis \itas a case of simple croup^ ia whicfa the 
lite of the chlld might pxobably have been saved 
by the timely perfòrmapce Qf tlie operatioa of 
bronchotomy*. 

^ Thi& opfiraVion havin^been performed frequently and suc« 
cessfuUy in cases of forcign bodies lodg<ed in the windpipc, it 
xnay he affirmed that» under the circumstnnces which denpand Its 
employment, whilst it constitute& the only mcans of preservine 
the patient, it is in itself^ the mere operation being cousidered, 
nearly void of hazard. It has not been sa frequently performed 
in cases of Cynanche Tracbealis. On this account I may be 
allowed to extract from the inau epurai Dissertation of Dr. Thomas 
White, published at I«eyden in 1786, a most happy case of this 
kind. *' Puer quinqne annorum per duos vel tres dies signi* 
Cynanchj^s Tracheaiìs laboraverat, cnm medicus advocatus fuit. 
iEgrum invenit anhelum^ fere strangulatum. Hespiratio enim 
maxime fuil laboriosa^ atque spiritùs emissio adeo impedita, ut 
vix ilammà facis speculove prope os admotis sentiri posset. Die 
Febniarìi undecimo. Anno 1782, rebus ita se habentibus» emetl« 
cum hor. 2E. A. M. preescriptunì fuit, atque oitini horà repetì 
jussum. Quot emetica devoravit> quidve vomitione ejecturo^ non 
didìci ; sed omnibus frustra usus est. 

Hor. ix. vespertina nil remittente morbo> morteque ipsa mìnU 
tante, complures chirurgi tracheam incidefìdam esse consentici 
bant; quod stalim perfecit Domin. Andree. Incisione factà, aer 
magna vi proruebat, respiratio protiuua facihus absolvebatur, 
atque seger (c^j^s vox ante vix audiri potuerat) exclamabat» se 
nunc levatum^ se nunc sanum esse. Tussi» vehementis&ima per 
^^nulam argenteam» aut tubrnn cavum flexilem, (qui Gal] ice 
Bougie vocatur) intra plaghe orasimmissum excitata est, nec prius 
cessavit quam ea peuitus fuerunt* amota. Pein vuhaus panno ex 



Uebulà linedx^nfecto tegebator. 



Die 



536 CYNANCHE LARTN6EA, 

Case ùf Cynanclie Trachealis^ combined *with Pneu-^ 

monta. 

Miss S. three years and a half old, had been 
for three days afFected with a catarrh and hoarse 
cough. Her mother^ during tliis periòd, had 

Die Feb. xiìmo. delirium leve noctu supervenit. Spirìtum 
nunc facilius ducit. Calor et pulsuum crebritas minuuntur. 

Die Feb. xiiimo. Nocte magna copia muci flavi pus referentis 
(qui a bronchiis piane excreari videbatur) e vulnere effusa est, 
totumque thoracem externe humectavit. Hodie facies, et prae- 
sertim musculi oris, levibus convulsioni bus afficiuntur. 

Die Feb. xivmo. Pyrexia multo minor, facilis per os spiratio, 
vox quae ad hoc usque tempus submissa ac stridula fuit, nunc ad 
tonum naturalem redire incipit. Mucus miaus copiose ejicitur. 

Die xvmo. Omnia symptomata leviora. 

Posthac nil dignum notatu occurrit ; intra mensis unius 
spatium vulnus perfectè fuit curatum, segerque ad pristinam 
sanitatem restitutus. 

Duobus abbine annis valetudo permansit bona, nec ullum in- 
commodum ab incisione expertus est puer.** 

The above interesting report seems to be defìcient only in the 
particulars of the operation ; and these, through the kindness of 
Mr. Astley . Cooper, I hs^ve obtained. They are given in the 
words of Mr. Andree. *' At nine in the evening, in the presencc 
of several of the faculty, among whom was my esteemed friend 
Mr. Ford, surgeon, I performedthe operation. The child being 
laid on bis back, and kept as qui et as bis great restlessness in 
struggling for breath would admit of, I commenced the opei3- 
tìon by a straight incìsion from the thyroid gland tpwards the 
sternum, about one inch and a half in length. I then cautiously 
laid bare the anterior part of the trachea, without any material 
hemorrhage or difficulty, except what arose from the child's 
struggìes. I then inade a sraall trans verse incision, or ratlier 
puncture through the membrane, which connects the second 




ÀND CYlSrANCHE TRACHEALIS. SSf 

Ven her a tea-spoonful of -antimonial 
^ had freely vomited her. The last 
n on Friday evening, July the Tth^ 
^so applied a large blister ta hef 
>rning of the 8th the sytnptomsr 
ed; she then gave her an 
«?- V- ''t n6on sent for Mr. New- 

"^ '^e disease to be croiip, 

vaII of tartarized antimonv in 

X mfusion of senna, of which a 

.vas to be given every half hour, till 

.xced vomiting* He also ordered that two 

.oecbes shouid be applied to one of her arms. 

Meeting with Mr. Newington in the afternoon, he 

asked me to see the child. The respiratìon was 

perfbrmed with considerable difficulty, but it was 

' not noisy, nor was the cough so ringing as I bave 

heard it in cases of Cynanche Trachealis. Thè 

character of a general oppression of the respiratìon, 

and third annulnr cartilages, and then a similar ìncìsìon between 
the fourth and fìfì:h cartilaginous rings ; the respiration was im* 
mediately relieved. I now proceeded, according to the rules laid 
down by the most approved authors^ and as myself had taught 
in anatomical lectures, to introduce a silver canula into the 
trachea through one of the orifices. It instantly produced a most 
violent and incessant cough, until the instniment was with- 
drawn. A hollow bongie being introduced, produced the same 
efJèct. I then contented myself with dressing the wound super^ 
ficially, cutting an orifice in the plasters to correspond with the 
openings into the trachea, and covering the wound with a piece 
of gauze laid loosely on the neck'\ 

roL,. III. z 



S38 CYNANCHE LAUYNGEA, 

yet passive state of the child, as opposed to the 
com^lsive and struggling eflforts with which it is 
performed under a more complete obstruction of 
the upper part of the windpipe, in cases of simple 
croup, was striking. The child being of a vigorous 
habit, and the inflammation acute, it was proposed 
to draw six ounces of blood between the shoulders, 
by cupping, I did not visit this child agaìn, but 
Mr. Newington communicated to me the follow- 
ing parti culars : She was cupped, and in the even- 
ing a doublé quanti ty of the mixture, ordered ili 
the morning, was repeated at four doses, without 
producing any^ other effect than great languor and 
cold perspirations. The breathing continued to 
be very laborious, but the cough was not so frc" 
qu^nt. On Sunday moming, the 9th, before Mx. 
Newington saw her, ber mother had given her a tea- 
spoonful of antimonial wine ; she vomited a litde, 
and in the course of the morning had three evacu- 
ations from the bowels. In the afternoon the 
antimonial wine was given in the dose of a tea- 
.spoonful and a half without exciting vomiting. The 
countenance, which was at first very florid, had 
now become pale and languid j her palse had lost 
its fulness and hardness. At seven in the evening 
he found her a little easier, but very languid. Her 
mother had administered, without bis order, a 
tobacco glyster ; about two sciiiples o£ the leaf had 
been infused for that purpose. On Monday her 
pulse was weak, and about 160, ber breathing 



AND CYNANCHIE TRACHEALIS. SSd 

vety difficult, her head thrown back, her face 
pallid. She was perfectly sensible, aiìd swallowed 
some ttìììk in a hurry, as if in danger of being 
strangled. A squill mixt'ure was given, and 
brought up some viscid mucus. In the eyening 
the frequency of pulse and general languor had 
increased, her lips were slightìy livid, but the rest 
of the comitenance was pale, and about twelve 
o*clock at night she died. 

July 12, 1809, the body Was examined by Mr. 
Astley - Cooper, in the presence of Mr. Newing- 
ton and myself, and I noted the following par- 
ticulars. 

External appearances. — The general' aspect was 
pallid--*^ The growth proportioned to the age, and 
the abtindance of fet proved the pfevious vigour 
of the child, and that she had been cut off by a very 
acute disease. 

Thorax.^ — The right cavity of the chest being 
laid open, a dark coloured fluid appeared in cen- 
si derable quantity. It had not the character of an 
effusion from an inflamed sur&ce.^ A mòre par- 
ticular examination ascertained that the oesopha- 
gus had been acted upon by the gastric fluid, 
whiqh had also destroyed the pleura posteriorly, 
and thereby admitted of an exudation of blood 

22 



840 CYNANCHE LARYNGEA, 

from the lung, which, together with some of the 
contents of the stomach, and probably some prìor 
serous effusion from the pleura, made up the 
quantity of fluid. The left cavity contained a little 
serous effiision. A partial exudation of coagulable 
lymph, on some parts of the surface of the pleura, 
had made it somewhat rough, impairing that 
polished surfaci3 which is naturai to the healthy 
membrane. The pericardium and heart were faot 
affected. The tongue, pharynx, oesophàgus, larynx, 
trachea, and lungs were removed together. On 
cutting open the windpipe posteriorly through its 
whole length, its membrane was found besmeared 
with a brownish mucus, under which it was every 
where covered with a thin coat of coagulated 
lymph, that extended into the ramifications of the 
bronchia, (see piate VII.) but was no whQre in 
sufficient quantity to dose the pipe : even in the 
larynx the sacculi were apparent. The lungs had 
suffered excessive congestion ; their parenchyma 
was very generaljy red and tumid, yet they floated 
when thrown into water. The effusion, therefore, 
into their reticular texture was serous, but the 
air-cells and minute ramifications of the bronchia 
were loaded with a yellowish white fluid, the secre* 
tion of an inflamed mucous membrane. 

Abdomen.— The stomach had been extensively 
acted upon by the gastric fluid, and in raany places 



ANO CYNANCHK TRÀCHEALIS. 



S41 



was ih a state of dissolution. The other viscera 
in this cavity were not minutely examined— their 
general appearance was healthy» 

The head was not c^^ened. 



This was a case of cronp, combined with ex* 
tensive catarrhal and pneumonic inflammation, in 
which the operation of bronchotomy was incapable 
of benefiting the patient 



50MK 

REMARKS 

ON TBE 

USI> OF NITRAT OF SILVER, 

Fon THIS DETECTION OF 

MINUTE PORTIONS OF ARSENÌC. 
By ALEX, MARCET, M.D. F-R,S. 

ONE OF THE FHYSICIANS TO GUY^S HOSFXTAS*. 



9m. 



Read December 23, 1812. 



X N the interesting account of the poisonous ef- 
fects of axsenic, presented to the Society by Dn 
Boget, and publìshed in the second volume of the 
MedicorChirurgical Transactions*, the author has 
recommended, for the detection of this poison, a 
test which I pointed out to him, and which^ from 
a variety of experiments which ve tried together, 
with a view to ascertain its comparative merits, we 
were induced to consider as the most effectual of 

^ I take this opportunity of staXìug, at Dr. Roget's requestj 
that the patient, whose case he there related^ coxnplet^Iy recoverecl 
Ji^r bealth, ?tnd ì^ rem^ined w^ll eyer sipce, 



ON THE USE OP NITRAT OF SILVER, &C. à'4^ 

ali the tests hitherto used for that purpose. The 
method consists simply in adding in succession, to 
the fluid suspected to contain arsenic, minute 
quantitìes of solutions of anamonia and of nitrat of 
Silver j by which means, if the smallest quantity of 
sirsenic be present, a dense yellow precipitata will 
be prpduced. 

Ali the particulars respecting this mode of de- 
tection having been fuUy stated by Dr. Roget, with 
such refèrences to former writers on the subject as 
tìie case required, it would be quite superfluous to 
enter into any fìirther detail on this head. My ob- 
ject in resuming the subject, the practical import- 
ànce of which need not be pointed out, is to com- 
municate to the Society the result of an inquiry 
which I bave made on the nature of the yellow 
precipitate, the appearance of which is assumed as 
denoting the presence of arsenic, and to ànswer 
sòme objections which bave been made against this 
test by Mr. Sylvester, of Derby, in a paper on me- 
tallic poisons, recently published in Nicholson's 
Journal *. 

Tlie yellow compound in question has the fol- 
lowing properties : 

If, after being well washed with distìlled w^ater, 

• '. * Nicholson's Joniijal fgr December, 1812. Vo^ xxxiii. 
t>. 306. 



944 pìS NiTBAT OF SlJ^Vnnr 

it be sufiered to stand fot some timo in an opea 
vessel, it gradually passes to a brown colour ; bui 
it does not, lìke nitrat of silver, becpme black on 
continuing this exppsure. 

It is readily soluble in dilute nitrìc acid* It alsq 
dissolves on adding an excess of ammonia at the 
moment of its formation; but ailer it has been 
separated and dried» it is nq lopger sfei^sibly soiulflii 
in ammonia.. 

If a small quantity of this precipitate be e3q[K)€|ed 
to the heat of a lamp on a slip of laminated platina^ 
a white smoke arises frpm it, a;id metaUic silyerxe- 
mains attached to the platina^ The reductipn of the 
Silver, in the form of a globale, is 6t;iU more distinct 
andstrikÌHg,if 9. little carbonaceous matter bemix- 
ed with the precipitata, and the blowpipe applied. 

When the yellow precipitai^, inclosed in a tube, 
is exposed to the heat of a lamp, th^ white smoke 
condenses on the cold part of the tube, in minute 
octohedral crystals <^ arsenióus acid» 

It appears, therefbre, that the precipitate in 
question is a combination of wlùte arsenic (arse- 
nióus acid) and sii ver, or an arsenite of Silver; and 
it is inferred that its formation, when ammonià and 
nitrat of silver are added to a mixture containing 
arsenióus acid, is owìng to a doublé elective de- 
composition of the arsenite of ammonia, by the 



AMA TEST OF AWZÌSIQL 943 

fàXnt of Silver 9 in consequènce of whiob arsenìte 
of Silver is formed» andseparates as. an insoluble 
precipitate firom the nitrat of ammonia which re- 
mains in the solution. The addition of ammonia 
ìs necessàry» because arsenic acid alone cannot de- 
^onìpose. nitrat of Silver; but in Fowicr's solution, 
in which the arsente ìs already combìned with an 
alkali, the decompòsition takes place at once, 
ivithont any addition of ammonia. The fixed al- 
kalies, therefore, can answer a similar purpose; 
but ammonia has this advantage, that- it does not, 
wfaen added singly, decompose nitrat of silver, a 
iCircttmstance which, in using the fixed alkaHès, 
leight opcasipn aom^ confusione. 

. With regard to Mr. Sylvester's objectìon, I shall, 
prevtóus to itiy ofièrìng any remarks upon it, state 
It in bis own words. ** If ever muriatic acid be 
preseQt,' - says this gentleman, ^^ the test is then 
wbofiy useless, as a muriat of silver will be imme* 
j^tely formed, and the yellow compound, said to 

* It is necessary, as Dr. Roget has observed in the paper ai- 
ready quoled, that the quantìty of ammonia sliould not be too 
làrge; for in that case the precipitate is redissolved. But, even_ 
then» it may be madc tp reappear, by the addition of niiric acid* 
in suficient quantity tp saturate the alkaH. In tbis case, bmv- 
ever^ the precipitate is mA permanent, owing, I find, to iu 
beiag sduble in the nitrat of ammonia whigh is formed in the 
process. Carbonat of ammonia has also the property of prò- 
ducing and redissolving the precipitale. 

The fixed alkalies in excess bave not the power of redissolving 
fhe precipitate. 



846 ON KITRAT OF SILV£B, 

be so unequivocal in its indication of arseBic, of 
course be prevented from appearing," 

This danger of ambiguity, however, though 
applying in some degree to the process in question, 
and well deserving to be noticed, will be found to 
bave been greatly overratedj and there are such 
easy and obvious means by which this ambiguity 
can be entirely removed, that it can make no solid 
objection to the utility of the test. 

There cannot be the least doubt, as Mr. S. obw 
serves, but that whenever nitrat of silver is added 
to a solution containing murìatic acid, a precipitate 
of muriat of silver must be the consequence. But 
if the nitrat of silver be added in excess, the ar- 
senite of silver is also thrown down by the inter* 
vention of ammonìa, and a . mixed precipitate c^ 
luna cornea and arsenite of silver is obtained» 
which partakes more or less of the yeDow colour 
of the latter, according to the proportion of the 
two salts. 

If to this dubious precipitate a few drops of di- 

. Iute nitric acid be added, the arsenite of silver is 

ìnstantly dissolved, and the muriat of silver, 

which is insoluble, immediately resumes its pecu-» 

liar density and whiteness. If a little ammonia be 

now added to the clear fluid, the yellow precipitate 

appears in the most distinct manner, and becomés 

cyen more characteristic from atcomparison with 

3 



AS A TEST OF ARSENIO; S47 

the white precipitate, the appearance of which 
differs from this in evejyrespect. 

By this method, I believe that every objectioa 
to the test will be removed; and in order to anti- 
cipate ali ambiguity, and to avoid any complica* 
tion or practical difficulty in its application» I 
would propose to modify the process in the fol- 
lowing manner : 

To the suspected fluid, previously filtered, add, 
first, a little dilute nitric acid, and, afterwards, 
nitrat of silver, till it shall cease to produce any 
precipitate* The muriatic acid being thus re* 
moved, whilst the arsenious acid (if any, and in 
whatever state) remains in the fluid, the addition 
of ammonia willinstantly produce the yellow pre- 
cipitate in its characteristic form. It ìs hardly 
necessary to add, that the quantity of ammonia 
must be sufiicient to saturate any excess of nitrìc 
jicid which the solution may contain. 



HISTORY OF 

A CASE 






REMITTING ÓpHTHALMU, 



AKD IT» 



SUCCESSFUL TREATJUSNT BY OPNJM. 
By JAMES CURRYy M.D. F.A.S. &c. 

ikND SENIOR PHYSICIAN TO GUY^S ROSPITAU 



I . 



BeU JSbt. 2A, IBIS. 



.*^ 



XN the earli^r period of life, my eye^ vfere re* 
markably strong i and the power of viaum veiTjr 
complete, both as to disti^it and to minute. objectft. 
The first injury they sustained, was during my stay 
at Edinburgh» and that owing to the practìce of 
reading to very late hours in the night» without 
using the protection of a shade to keep off the di- 
rect light of the candles, or a screen to intercept 
the Constant giare of a blazing coal-fire. Stili» the 
only effect of this» was simply fatigue ofthe eyes ; 
from whìch they would probably have recovered en- 
tirely, by mere rest. But having igiprudently ex- 



A^m 



REMITTING OPHTHALMIA; 849 

posèd myself upòh one occasion, by getting out of 
bed, and standing for some minutes subjected to 
the night air at an open window, in consequence 
of a quarrel in the Street, I was attacked, in a day 
or two after, with acute ophthalmia in the left eye ; 
which, however, was in a great measure removed, 
in about a week, by the application of leeches, and 
the use of saline purgatives. A slight degree of 
obscure vision remained, from turgescence of the 
vessels in the fore part of the cornea; butthis gra- 
dually lessened, so. as, in a year after, to be scarce- 
ly perceptible to myself, and not at ali to the exa- 
mination of another. A subsequent residence of 
eight months in Bengal, during which I sufiered no 
less than five attacks of severe illness, in the dif. 
ferent endemie fbrms of intermitting and remitting 
fevers, &c. not only radically impaired my general 
constitution, but laid the foundation of that parti- 
eularly weakened state of eyes, which I bave ever 
since laboured under; every general fehvil^ attack at 
that time, being foUowed by a recurrence of oph* 
thalmia: and even a slight relapse of intermittente 
which I sustained during the short prevalence of a 
westerly wind immediately after doubling the Cape 
of Good Hope oh the voyage home, was attended 
by the same sequela*. From the period of my re- 

* The chief mate of the ship had also a relapse of ague, but in 
bpth it was «light^ and stopped after the second paroxysm by a 
remedy much used by the natives of India, for the cure of recent 
intermitting fevers. 



550 REMITTING OPHTHALTinA. 

tum m September, 1787y my eyes gradually gained 
«tréngth; and -v^^ould probably have continued to 
do 9o, had it not been for an unlucky accidente 
Durmg' the very severe wèather in January, 1789, 
at whicH tìme the Thames was so completely frozen 
afi to bare booths erected ùpon it, a heavy fall 
of snow wasimmediately succeeded by a rapid thaw; 
and the pipes belonging ta the house in which I 
resided, being ali chokéd with ice, the snow water 
io the leaden gutters of the roof, rose ^o high as to 
get undet the tires, and made its way down tbrough 
two floors, so as to come into the bed where I ky. 
How long I was exposed to its influence ih the slow 
oàode in which it descended, is impossible exactly 
to say ; but when I awoke through the cold, I 
found the feft side of my night cap, and my left 
«honlder and arm, with tìie bed clothes covering 
them, quite wet* After putting on a dry shirt, 
éhifting the bed clothes, turning the feather bed, 
and drawing the bedstead into another part of the 
i?QOHf, Iwent to sleep again; andhopedthatnoincon- 
venience would ensue, as I had more thanonce 
been similarly wetted in my cot by sea-water, wìth- 
out any bad consequence. In a few days, howevéf , 
I was attacked with ophthalmia in my left eye, 
whick ptoved more severe and obstinate than any 
preceding attack; confìning me three weeks to the 
house, and nearfyaweek of that time to bed: even 
when the continued pain was abated by leeches to 
the check and tempie, foUowed by a blister, and 
aiEed by purgjng, the vessels of the eye continued 



mEMITTING OFHTHALMIA. S51 

iUstended with blood, and violent pains, affecting 
not only the fore part of the eye, but extending ali 
round the orbita carne on every night. Under 
these distressing symptoms, I consulted the late 
Mr. Hunter, who recommended the use of the cin- 
chona rubra ìnfìised in lime water, which was at-* 
tended by such speedy relief, that the very first 
night after I began its use, I was quite free from my 
usuai paroxysm of pain, and the eye instead of be^ 
ing dry and burning hot as before, now discharged 
tears most copiously, which felt as cold as water 
&om a spring. By continuing this remedy §or se- 
veral weeks, I v^s enabled to go into the country 
and settle in business; but I was for many months 
distressed with inflammatlon of the glandulse Mei- 
bomtì, the acrid secretion from which kept the tu- 
nica adnata in a Constant state of irritation, and no 
doubt served to fix stili more obstinately, a distinct 
speck which had formed exactly in the middle of 
the cornea, so as greatly to obscure the vision with 
that eye for many years after. 

From the period of this attack in 1789, I conti- 
nued tolerably free from ophthalmia until the sum* 
mer of 1 794, when I was visited by it in a stili 
more formidable shape, about a fortnight after re* 
covering from a smart fit of regular gout; fin: the 
pain now was not confined to the fore part ef the 
eye, but extended into the. interior, and at times 
darted through to the back part of the head, with 
$UQh violence as to resemble what I conceive woizld 



55^ R£MITTIKO OFHTHALfttlA^ 

be the effect ^f a pistol shot Thè retina becatti* 
so exquisitely seusible, that I could not bear the 
smallest ray òf ligfat; and I could discern every ar^ 
ticle of furniture in a room so completely darkened^ 
that other persons were obliged to grope their way, 
in order to avoid the table and chairs. Being tben 
resident in a country town (Ketterìng) none of the 
medicai men would undertake to open the temporal 
artery, which I wa9 urgent to bave done, às I knew 
that under such agonizing paìn, I could not long 
retain my senses. I therefore dispatched a messen* 
ger to Dr. Kcrr of Northampton, who was ludfily 
met on the road, and very kindly hastened to assist 
me. His opinion exacjiy coinciding wìth my own, 
he immediately performed the operation, and took 
away eìght ounces of blood before I became &int, 
but even before half the quantity was drawn, I felt 
my whole head relieved as from the pressure of a 
vice, and the darting pains entirely subsided. From 
that moment, I b^an gradually to recover, in eveiy 
respect; but the sight of that eye stili remained ob* 
scure, from the former opacity of the cornea; and 
both ey es were at times Uablè to slight degrees of 
redness and tenderness from exposure to cold. 

In the spring of 1798, 1 underwent great fatigue 
and anxiety, in attendance upon a gentleman for 
wbom I had the highest regard; being three days 
and nights, without taking off my clothes, or lying 
down in bed more than an hour or two at a time^ 
On the very evening when I was liberated from this 



XlEMiTTIN'G OPHTHALMIÀ. 35S 

feXertìonby the patient's death, I was seized^- in a 
fe^ hours after getting home, with increased dim^ 
ness of sight in the left eye, followed bj violent 
pain, which carnè on, with augmented severity, in 
pangs that otcurred just àt the moment I was drop»- 
ping to sleep. Having no other mode of relief at 
band, 1 took a grain of opium with some antitaio^ 
nial poTC'der, by which I at last T)btained sleep^ 
and the next morning I felt my eye almost free 
from pain, but with a particular sensation of ten* 
demess upon the cornea whenever I moved the ey^ 
!ld over ìt. As the eye was nòw capable of hearing 
the light, I examined it attentively by means of a 
small looking-glass, and distinctly perceived a pit 
or hoUow in the fore part of the cornea about the 
sixth of an inch in breadth, nearly circular in form, 
and exàctly corresponding with the place where the 
speck or opacity was formerly situated, but which 
now no longer appeared : in short it was evidènt, 
that the speck had inflamed, and sloughed off dur- 
ing the course of one night : the eye has ever since 
remained free from any opacity visible to another 
person ; but the new formed tunica adnata has not 
the same fine polish as in the naturai and heaithy 
state, and consequently small objects, such as the 
letters in a hook, viewed with that eye^ appear hazy 
and undefined in their edges, unless I look at tfaem 
through a narrow chink, so as to defiect the rays 
of light, and make them pa«s a little to one side of 
the scabrous part ; in which way they ar« clear 
and distincti 

VCL. ni. A a 



S54 REMITTING OPHTHALMIA, 

Tbis detail may to some appear tedious and un- 
iateresting ; but I thought it might be satìsfactory 
to the Society, as it certainly would be to me, to 
bave a complete history of the rise and progress of 
a complaint, which subsequently displayed itself in 
so disti net a shape, and with such severity of symp- 
toms as I shall now describe ; being perfectiy con- 
vinced, tliat nothing will contribute so much to en- 
large our knowledge of^ pathology in general, as 
that concatenation and sequence of phsenomena, 
which at present are often considered as distìnct 
disorders, though in fact only varìations of one 
genus of derangementm the human system. 

On Friday the 23d of Dee. 1802, after going 
tound the hospital, and subsequently visiting some 
private patients, I returned home ' at 3 o'clock in 
order to dress myself for dining out ; but before 
four o'clock, I felt so much stiffhess in my right eyey 
that fearing the consequence of exposure in com- 
ing back at night, as well as drinking any wine un- 
der such threatening, I sent an apology, and de- 
termined upon staying within doors ali the even- 
Jng. By five o'clock the eye was become veiy stiff, 
with some degree of soreness ; and só dim, that 
the candles appeared duU, and surrounded by an 
extensive halo or haze ; and at eight the paìn was 
so considerable, that I could not read. I therefore 
took at going to bed a grain of opium, tliree grains 
of calomel, and two of antimonial powder ; after* 
wards drinking a basin of water gruel to promote 



pérspiratìon» I passed but ari indifferent night, 
however; and in the moming, fìnding the eye- 
considérably inflamed, I applied slx leeches round 
the lower atìd outer part of the orbit; and took 
gome colocynth extract, which operated 2 or 3 
times with slight relief* In additìon to these mea- 
sures, I put some of the vinous tincture of opium 
(the old Tinctura Thebaìca of the London Fharma^ 
copoeia ed. 1 740) into the eye several tiriies, by 
means of a large camiePs*hair pendi ; this occa- 
sioned very pungent pain for a few «econds, and 
was followed by a short abatement of pain, which, 
however, was more comparative than real, for in a 
quarter of an hour after, tlie eye felt no better 
than before. At night the pain again increased, 
and I repeated the opium &c. with relief, taking at 
the same time some liquor ammonise acetatis to ex- 
cite diaphoresis. The pain abated in the night, 
and I got some sleep ; but no amendment appeared 
next moming in the eye, which was now stili more 
red than before* On the third night I blisteréd the 
rìght tempie, and repeated the opiate, calomel, and 
diaphoretic, without gaining any more than a tcm*- 
porary benefit. On the fourth day, I became ex- 
tremely alarmed by the increasing obscurity of vi- 
sion, which was now so great that I could not dis- 
tinguishthe barsof thewindow sash, and could bare- 
ly count my fingers when held within a foot of my 
face ; added to which, this was now not only in the 
right eye which had never been more thaii 
slightly aflfectcd before, but a similar though less 

A a 2 



356 R£MITTING OPHTHALMIA. 

obscuiity, was making progress in the left eye also. 
I therefore sent immedìately for an eminent sur- 
geon-oculist, whom I will beg leave on this occa- 
sion to designate by the name of myfriendy a name 
to which his kindness and attention give him a just 
claim. He carne tome soon after, and upon exam- 
ining the eyes, remarked, that there was no opacity 
in the cornea ; a circumstance which I had noticed 
my&elf before his arrivai as difFerent from every for- 
mer attack; though from the dimnessofmy vision, 
I could not ascertain this so well as he did : I can- 
not describe this peculiar state of vision better than 
by saying, that every object which I could discern, 
appeared of a dusky grey colour as if obscured by 
smoke or steam ; and such as I conceìve would be 
the case, if the aqueous humour of the eye had lost 
its limpid transparency, and acquired the blueish- 
grey tint, which I bave noticed in some minerai 
waters. I held this as probably indicating an opa- 
city of the capsule of the cristalline lens, or of the 
vìtreous humour; and I could perceive from my 
friend's mànner, that he had much doubt about my 
recovery. I then stated to him the steps that I 
had already taken, ali of which he approved of, éx- 
cepting the opìum ; advising me by ali means to 
abstain from it, às it would tend to weaken the ves- 
sels of the eyes, and certainly retardj if not, in the 
end, entireb/ prevenir them from regaining their na- 
turai strength. However reluctant I felt, at giv- 
ing up the employment of a medicine from which 
I had found at least temporary relief, yet consider- 



REMITTING OPHTHALMIA. 85? 

irig the disease as now altogether beyond my own 
management, and having the utmost reliance upon 
his judgment foundéd on long experience and ex- 
tensive observation,- I determined to submit to 
whatever measures he might think proper. As the 
most ready means of lessening the extremely tur- 
gid state of the vessels on the tunica adnata, he 
proposed scarification ; which was immediately per- 
formed, by drawing dowii the lower eyelid, and 
scoring its surface in severai pkcés with the shoul- 
der of a lancet, so as to take away about a tea- 
spoonful of blood. No sensible relief attended 
this operation ; . on the contrary, the clots of blood 
which formed upon the incisions during the night, 
acted like so many foreign bodies, and aggravated 
the pain whenever the eye-lid moved upon the ball. 
In addition to this, he recommended fbmenting 
the eye with a decoction of poppy-heads, which 
was accordingly employed, as soou as it could be 
got ready. I had always found ease before from 
cold applications ; and the present trial of an op-- 
posite temperature, concurred to strengthen my 
fbrmer experience ; for the pain became so mucb 
worse under the fomentation, that I could net con- 
tìnue its use above a few seconds» Observing na 
abatement of inflammation when he carne next day^ 
he conceived that the failure depended upon the 
quantity of blood evacuated, being toosmall ta 
lessen the congestion : and as a more adequate 
depletion, opened the vein wlùch runs betwees^ 
the inner canthus of the eye^ and the aose, and 



35S REMITTING OPHTHALMIA. 

drew away a large tea-cupfoU of blood (about à% 
ounces). During this operation, I thought my 
head felt lighter, and the eye less stiff and full ; 
but the relief did not last much beyond the flowing 
of the blood j and the pain at night, with the red- 
ness g,nd turgescence of the vessels next morning, 
were exactly the same as before. My pulse being 
nowlanguid as to strength , and unaccompanied either 
by hardness in ìts stroke, or by febrile beat of skin, 
he did not consider fartherloss »of blood, either ge- 
nerally or topically, at ali adviseable; but recom^ 
mended a large blister to the head. I accordingly 
had my head shaved without delay, and a blistering 
plasterapplied over thewhole of thescalp,extending 
fromone ear to another, andfrom the top of the forar 
head to the nape of the ìieck. Notwithstanding 
what might bave been expected from the imtation 
^f so extensiv? a surface, I certainly slept better 
than I had done for the three preceding nights ; 
but this was ali the advantage it procured, as the 
inflammation was not in the least diminished by it; 
and the succeeding night was attended with the 
same severity of pain as before. I now, agreeably to 
his desire, took a quarter of a grain of the muriate of 
quicksifver, dissolved in half an ounce of the spirit 
of nutmeg, "and diluted with half a pint of warm 
waterf^gruel sweetened to the taste. This excited 
most profuse sweating for several hoors, and gave 
me greater ease than any thiijg which had previ- 
ously been done : indeed I had observed in former 
j^nd s}ighter attacks, that sweating always proGure4- 



REMITTING OPHTHALMIA. S59 

relìef frolli pam, especially while the diaphoresis 
was presenta I accordingly repeated the same me- 
dicine on the foUowing night with veiy sanguine 
expectations but by no means with equal success, 
the pain being more severe aithough the sweating 
was nearly the same. .The third night it failed en- 
tirely ; and pwing to the nutmeg spirit then em- 
ployed being made by uniting the essential oil 
with proof spirit by triturating it with sugar, ìnstead 
of distilling them together, the muriate of mercu- 
ry was probably not completely dissolved, .in con- 
sequence of which it occasioned considerable sick- 
ness and vomiting : observing, however, that as 
oftefa as I strained to vomit, though nothing was 
brought up except the gruel, the pain of the eye was 
sensibly lessened for a short period, I conceived 
that fuller vomiting might be attended with stili 
greater and more permanent benefit, and with this 
view got to a medicine chest which stood in the 
room, and guessing five grains of tartarised anti- 
mony by lifting it between my finger and thumb, I 
placed this in the palm of my band, and by wet- 
ting the poìnt of my finger, took up what I supposed 
raight be from half a grain to a graìn : I swallowed 
this quantity every quarter of an hour, until I be- 
. carne very sick, and vomited several times : after 
which I gòt ease and fell ^sleep. Next day, the 
eye appeared exactly as before j and feeling great 
debility, and loss of appetite, I did not recur 
either to the sweating or the vomiting pian. The 
nocturnal exacerbation of pain having iigw become 



\ 



SSO REMXTTlNa OPHTH^LIaMIA. 

I 

grc^itly aggravateci, as well as more distìnclly 
marked in its remitting form, I had recourse to the 
cinchona, from which I had fòrmerly experìenced 
such remarkable advantagej but although taken in 
the same way, and in doses of a drachm every 
&ur haurs, xt produced no sensible effect. One 
article stili remained, which is known to possesa 
extraordìnary powers in the cui'e of intermitting 
fever, even where the Peruvianbark has feiled; 
I mean the arsenjcal solution. This, therefbre, 
I had recourse to, in doses of ten drops three 
timesa day; but after two days* tiial, it occasioned 
suchloss of appetite and of general strength, with- 
put any perceptible advantage to counterbalanc^ 
these efiects, that I abandoned it as I had done the 
rest.' I was now left, in the middle of the third 
week, apparently wìthout any resource ; my sight 
being only capable of distinguishing between day 
stnd night y the flame of the candles upon the ta- 
bìe appearing like two drops of blood, and the fìre 
when buming bright, like a mass of red-hot iron, 
whilst ali around was utter darkness : in addition to 
which, the paroxysms of pain through the night, 
could only be compared to screwing the eyeball 
out of^ the socket ; and the only ease I had from 
this, was by sitting up in bed, with a wash-hand- 
basin of cold water placed between my knees, and 
dipping a towel in this, which I applied to both 
ey^s. Just so long as the sensation of cold lasted 
(the ground was then covered with snow), so long 
w:as the pain rendered bearable j but as soon as the 



REMITTIN6 OPHTHAX.MIA, 361 

wet tawel acquired a little warmth, the pangs re^ 
turned as before. Worn out hy suffering, and with 
iJie melancholy prosppct of irremediable blindness 
before me, I resolved to obtain ease at ali events, 
by having recourse to opium ; and wishing to pro- 
cure this more particulafly in the night, when the 
pain was always wòrst, I took two grains of solid 
opium at six o'clock in the evening/ I can scarcely 
express the delìght I experienced on finding, that 
instead of the paroxysm coming on between 7 and 
8, as usuai, I felt quite easy ; and on going to bed 
atten o'clock, gotinto a sound sleepfrom which I 
awoke greatly refreshed and free from pain, at 8 
next moming. The next day also, was compara- 
tively a day of ease ; and it will readily be con- 
cluded, that I did not fall to take the opium again 
as on the precedingevening. The second night, like 
the first, was a night ofbliss^ which was perhaps the 
moreapparent, by my not sleepingat ali, but lying in 
perfect ease. On the foUowing momìng, my friend 
called, after an absence of two days (for indeed I 
beKeve the obstinacy of my case had put hìs kind 
attention to a severe trial by previous daily attendr 
ance); and it was with unspeakable pleasure, I heard 
him pronounce my eyes considerably better. I 
then candidly stated to him, that the severity of 
my sufferings had compelled me to disobey bis in- 
junctions against taking opium ; and that, as I had 
left off every other medicine except the occasionai 
use of colocynth pili with calomel, as a laxatìve, 
I could only attribute the amendment to the effect 



362 REMITTINO OPHTHALMIA. 

of that femedy. Under suqh circumstances, he 
admitted, that I should continue its use ; observing, 
however, that there was either something vety sin- 
gular in the nature of the case, or that opjum wasi 
peculiarly frien41y to my constitution. Notwith^ 
standing the strong proofs which I already had of 
its beneficiai ipfluence, I was by no means firee 
from fears, that in thus procuring temporary relief, 
I might not ultimately do injury to my eyes ; and 
believing that I had now in my power the means 
of eifecUially checking the farther progress of the 
disorder, 1 was determined to maintain my profes- 
sional allegiance, by abstaining from opium until it 
became imperiously necessary, Accordingly, oa 
the third evening I did not take my dose as before 
at six o'clock, but waited th^ coming on of the par- 
oxysm, and though not without some anxiety, yet 
certainly with greater hope, that I might either 
escape the attack altogether, or bave it in a veiy mild 
and bearable degree. At eight o'clock, I observed 
the usuai precursor, a feeling of soreness, aggra- 
vated by pressure, in the integuipents round the 
eye, and especially at the infra and super-orbitari/ 
Jìoles, through which the nerves pass to supply these 
parts. In twenty minutes the pain became very 
severe^ and I immediately swallowed twograins of 
opium. At nine o'clock the pain, instead of abat- 
ing, was cvidently upon the increase ; I therefore 
repeated the dose ; and having remarked that the 
full effect of any individuai dose of this medicine 
is generally experienced in three quatters of an 

5 



REMITTING OPHTHALMIA. 363 

hoùr from the time of taking it, I deteririined to 
repeat the same quantity every hour at farthest, un- 
til relief ensued ; and as no sensible abatement 
look place from what was previously administered, 
I persevered at the assigned intervals, until I had 
swallowed ten grains of soiìà opium, wlthout the 
smallest alleviation of my sufferings. At twelve 
p'clock, I became stupid to every sensation, except 
that of agony ; and retired to bed in a state which 
can better be conceived than described ; nor do I 
exaggerate the deseription of my wretchedness 
when I declare, that I should bave blessed the 
fiiendly band which presented a pistol to terminate 
my existence. FoTjòurteen hours aiid ahalf^ I lay 
in this struggle between stupefaction and torture ; 
the muscles of the right side of the face quivering 
with pain as if tom from the bone, and a continued 
stream of scalding tears running down the check, 
whilst £he eyerball itself was, at intervals of only a 
few seconds, afFected with a convulsion that made 
every limb shake with the agony. At half past 
eleven o- clock in the forenoon, the power df suf. 
fering was itself wom out, and from that time till 
five in the evening, I lay in a state which alarmed 
the people in whose house I lodged, as I neither. 
called for nourisliment^ nor even rang the beli to 
say I wanted assistance of any kind. My convic- 
tion, so dearly purchased, was now complete; and 
ì resolved, whatever might be the ultimate event, 
never to pass such another night, whilst I had the 
pertainty of relief within my power. Aceordingly, 



364 BEMITTING OFHTHALMIA. 

at six in the evening, I took three grains of opium, 
with the satne happy efiects as at first ; and by re- 
peating this every evening at the same hour, I not 
only completely prevented ali recurrence of pain» 
but in the course of ten days, was able to go out 
daily in a carrìage to visit a patient at Canonbury ; 
and at the end of three weeks, resumed my hospi- 
tal business and lectures as before my attack. 

Tlie case just related, offers grounds for much 
new and interesting inquiry respecting ophthalmia 
in general, and particularly that form of it which 
has committed such ravages among those of our 
soldiers and seamen who were employed in the ex- 
peditìon to Egypt : as I am strongly inclined to 
believe, that they bore a considerale resemblance 
to each other in many essential points. At present, 
however, I have no leisure for so extensive an in- 
vestigation ; and were I even so disposed, 'I hayie 
not had sufficient opportunities of seeing the 
Egyptian ophthalmia as it has been prolonged or 
propagated in this country, to qualify me for such 
an undertaking. 

One circiunstance has surprìsed me greatly, 
which is, that in the course of a pretty extensive 
examination of authors, both ancient and modem, 
which I have been obliged to go through in order 
to coUect materials for my lectures, I have not met 
any case resembling my own. Does this proceed 
from its being unique in its kind, or from want of 



REMITTING OFHTHALMIA. 365 

due discrìmination in those who bave treated on 
ophthalmia, especially in its epidemie form ? How* 
cver reluctant to admit the lattei conclusion, yet 
I am compeiled to do so when I aiHrm, that, not- 
wìthstanding the almost exclusive treatment ofsuch 
complaints by the oculist, and the consequent in- 
frequency of their coming under the cognizance 
of the physician, I bave myself met witb several 
of the same kind ; and, therefore, reasonably pre- 
sume, that I am not the only person to whom they 
bave occurred. Being bereditarily of a gouty con- 
stitution, and bàving bad to the amount of six m 
seven severe and regular attacks, beside many 
sligbter and irregular pnes, it might be ìmagined^ 
especially as gouty opbtbalmia is mentìoned by a 
few authors, that mine was of that descrìption ; 
and such indeed was the opinion of the friend who 
attended me; as be acknowledged, that on no 
otber ground could be account for the disorder 
giving way to opium, wbile it resisted every mode 
of treatment which be had before found successfiiL 
At first I was disposed to admit this reasoning ; but 
from subsequent attention to the disease, as it bas 
occurred both in myself and in otbers, I am satis- 
fied that it is not correct : for three of the cases 
which I bave seen besides ray own, were in females 
who are well known to be very rarely the subjects 
of gout, comparati vely witli men ; and in no gouty 
attack which I bave ever bad in the inflammatory 
form, did I ever receive any considerable relief 
from opium. The progress^ likewise, of the two 



866 REMITTING OFHTHALMtA< 

forms of disorder is very different ; for I hàve hié 
gouty paroxysms of varìous intermediate duration 
between ten days and six weeks, whereas the oph- 
thalmia in three distinct attacks posterìor to the 
one related above, has regularly assùmed the f ebrile 
perìod of three weeks^ so raarkedly so indeed, that 
in three of a milder degree which occurred in 
1806, 1810, and 1811, although by the use of 
opium I kept the disease so completely in check, 
as not to be confined from my business a single day, 
yet it ran its usuai period. But a very curious 
circumstance yet remains to be mentioned, which 
will, perhaps, of itself be sufficient to disprove the 
alledged gouty nature of my ophthalmia in 1802-». 
It must be remembered by most of the Members 
of this Society, that themonth of January, 1803, 
was that in which a very violent, and in many in* 
stances fatai, catarrhal pneumonia prevailed in 
London and its environs particularly, but I. beh ève 
also, though in a less degree, in every part of En- 
gland. The same disease had previously appeared 
in some part of Germany, whence it spread to Pa- 
ris, where it raged with unusual violence under the 
name of la gripe ; and it had begun to decline at 
Paris, about the time it arrived at its gi^eatest heighf 
in London. From the date of the memorable in- 
fluenza of 17825 which was perhaps the most uni- 
versai ever recorded (having traversed the earth in 
a westerly direction, fbom the Tartar hords con- 
tiguous to the Great Wall of China, and finally 
spent itself in the West India Islands and Americo,) 



B£MITTÌNG OPHTHALMIA. 867 

t had never escaped an epidemie catarrh in its or- 
dinary form, until this time. My escape on this 
occasion may indeed be accòunted for, upon a 
prìnciple which, though not universa!, is yet so 
general as to be admitted atnong the laws of the 
human constitution, vìz. that one disease super- 
sedes, or prevent» another of an analogous nature, 
from taking place at the same time; and it w31 
readily be granted, that my constitution was suffi- 
ciently occupied by one kind of suffering, to en- 
title me to an immuni ty from any other as long as 
the first continued. But will this, as applied to 
any case, explain why the same freedom from ca- 
tarrh should equally attend nmny other persons who 
were afiècted with ophthalmia about the same time 
as myself, although in so trifling a degree, as scarce- 
ly to confine them to the house ? Mr. Stocker, Apo- 
thecary to Guy's Hospital, and several of his fa- 
mily, had slight ophthalmia during the pre- 
valence of the influenza ; but not one so a£Pected 
had any attack of catarrh. A person who carne 
to me on business during my convalescence, ob- 
serving that I wore a shade and green spectacles, 
told me that he had been himself a sufièrer, about 
three weeks before, with the same complaint in his 
eyes, as had many of his neighbours, aiid of his 
-workmen ; and upon inquiring whether he or they 
had also the influenza, he said it had been remarked 
i>y alias surprising, that they escaped the epidemie 
cold. During the summer of 1803, I met Sir 
Jan^es £ellow93, who had lately befor? retumed 



368 HEMÌttÌNG Ò^HTIiALMlÀ. 

from Paris, whére he was during the whole time that 
h gripe prevailed j and Upon mentiomng to him 
the singular connexion between it and ophthalmia 
in London) he informed me, that a similar coinci- 
dence was noticed ih France, with this unac- 
countable difference however, that there the ca- 
tarrhalpneumonia j?rec^flk(S?the ophthalmia 5 butthat 
the immunity Was the sàme ih bóth places, no per- 
son who had laboured under ta gripe being known 
to sufFer afterwards from inflammation of the 
eyes ; Dr. M^Donnell, of Orchard Street, Portmatì 
Square, whò was likewise in Paris at the period re- 
ferred to, confirmed by his testimòny the informa- 
tion of Sir J. Fellowes, both às to the ordèr in which 
the two forms of complaint took place, and to the 
exemption which each of them affi>rded against the 
other. 

The evidence which I bave bere adduced, will 
perhaps be deemed by. the Sopiety quite sufficient 
to decide the qhestion in the negative, as to the al- 
ledged gouty nature of the ophthalmia; butwhat- 
ever doubt might remaìn on that point, it must be 
ientirely done away by the account I shall now give 
of my last attack, which I watched most minutely 
through its several stages, with a view to place this 
circumstance beyond controveri^y ih. future. 

In the latter end of March 1812, J had a smarf 
fit of gout, the violencè^ of which was greatly mi* 
tigated |3y-taking Jwò half bettles of the-eau- me* 

S 



KBMITTÌNO Ol»HTÉ[ÀtMIA* ^ 669 

dìeinde at the distance of four days, so that I Was 
enabied to go about, though stili with ìnflamma^ 
tion, swelling atid pain ; and at the end of a month 
from the commencemènt, the symptoms spentane- 
ously ceased, leaving me in better general health, 
than l' had been fbr a considerable time» Durìng 
the latter part of May, though able to walk very 
well, I was prevented by the coldness and wetness 
of tìie weather, fronì taking any exercise on foot, 
which is the only kind that is eifJier pleasant or be- 
neficiai to me, On Monday the 4th of May, the 
weather became suddenly mudi finer than it had 
been for many wéeks, and I determined to avail 
myself of the change, by dismissing my carriage in 
Oxford Street about three o'clock, and doìng the 
remainder of my business on foot. The sky was 
perfectly free from clouds, and the sun considera 
ably hot ; but the wind was easterly,. and had a 
bleak chillness in it which made the alternate sen* 
aations of beat and cold, accordingly as I was in 
the sunshine or shade, peculiarly unpleasant. In 
passing* along Heet Street on my return home^ 
about fivtt o'clock, I felt suddenly a painful sensa<>> 
tion in the lower part of my right eye, exactly as 
if a person had forcibly thrust the end of their 
finger against the under eye-lid; and as this took 
place not only without any obvious cause, but as 
the dull pain continued, though in a less degree» 
during the .remainder of the evening, I had no 
doubt but it was a prelude to a severe attack of 
ophthahnia. As soon as I could examine the eye^ 

VOI-. III. JB b 



I foTlnd my alarm was but too well grounded^ fot 
there appeared a stream, as it were, of red vessels 
running from the lower part of the eyeball to the 
edge of the cornea, exactly at that part where I 
had felt the paìn at first. I lost na.time in taldng two 
gralns of opium, which procured me a very good 
night i and as the eye was scarcely at ali painfttl, 
and had become but very little redder when I 
looked at ìt again the next moming, I flattered my- 
self that I shonld escape without much ìnoonvexiì- 
enee. When the evening caule, however, this hope 
was done away, as the pain recurred, and compdied 
me to take three grains of opium to get relìe£ 
The foUowing morning the eye was very red, and 
the sight £0 obscure^ that I could scarcely read a 
letter. As the treatment difiered in no i^i^ect 
from that which I bave already detailed^ it is nn* 
necessary to repeat it here; suffice it (to say, làat 
by pursuing the same pian now^ I was not kepi 
within doors more than three days, and these luri; 
in succession ; for afìter staying at home on Thurs- 
day and Friday^ I felt so much better on Saturday 
that I made a number of visits, and in the evening 
ftént to apprize my fnend Dr. Babington, who was 
lecturing fòr me, that I should resumé my hosj^tal 
duties on the Monday. Very early on Simday 
morning, however, the pain came on with great 
violence, so much so indeed, that it required mx 
grains of opium taken within the first hour, to 
render it bearable j and eìght grains more, at 
difierent periods through that day, to keep it off. 



SìEMiTiPtNG aTwrUAlmÀd S7i 

In tte course of the succéeding weèk the inflam* 
matìon abated^ and a second timé did I§ at the 
distance of seven days, ànnounce my intention of 
retuming to leeture j but a second time wàs I dis*^ 
appoìnted, by the vessek of the eye becoming 
stili more disterided^ though Hot more paitlful than 
before ; and the vision with that eye being as 
much obscùred as in the attack of 1 802-^3. At the 
end of the third week the pain ceased entìrely, and 
the redness abated so fast, that in four days more 
I returtied to the discharge of my several dutìes as 
before my attack* 

The complaintj in this ìnstance, clifiéred £rom 
that of 1802->S in two partìculars^ viz. that the 
diumaì exàcerbatìon of pain was not so great as it 
was then, whilst the septenary or hebdomàdat stages 
Were much more distinct; in which respect the 
first partook more of the ìnt^mitting, the lattea 
moi^e of the contìnued febrile type^ 



BbS 



F^ DONATIONS 



TO THB 



MEDICAL AND CHIRURGICAL SOCIETY. 



Vonon. Donations. 

STnvenfà Inquiry ìnto the ProceM of Na- 
ture ia repaìrÌDg injuries of the Intet» 
tines. 

in» Ti/rnDi>T«#Aitf CMcrriman*sObBcrvatioiison Vaccine Ino-' 

IML MERRIMAN. ^ cuktion. 

^ e Merriman'B Diasertation on Retroyenion 

\ oftheWomb. 

« **-»« mr^^m.^ ««^ C Moorc*« Two Lettera to Dr. Jones on tho^ 
JAM«8M0011E.ESQ.^ Compo«itì««i of the Eau Medicinale. 

John Ring, ISQ. Rìng's Treatise on the Gout 

t\d iTADvir CSaunden*! Treatise on some Practical 

lJR,ifABRE. ^ PointsrelatingtoDiseasesoftheEye. 



rarre's Morbid Ànatomy ^of the Liver, 
Parti. 

"W. ChambeA- f Chamberlaìne's Treatise on the Dollchof 

UUNE, ESO. l Prurìens» or Cowhage, lOtfa Edition. 

rCR. E. PERCIVAl. (^^^ "^ *• '"*• Dr. Pe«:ivaL 
X>E. Robertson» Robertson's Synopsis Morboruni. 2 yoh. 



3*74 



Pr, RogeTj 



POKÀTIONSi 



Thomsoii on ibe Scurvy. 
fGataker's Inquiry into several Sul^ecti 

^^,, Rit8p^ on Abrtinence from Animai Food, 

C The New England Jpurnal pf Medicinp 
THeEdITORS. I andSur^try. 

rPlates III and IV pf the present Volume, 
CHARtESBELL,Esa. < iHustrating bis Paper pn tjie Mu»c}e# 
^ "^ * l oftbeUrctep,., 



V 



>i 



t' - - 



INDEX 



TO 



VOLUME THIRD. 



A. Page 

AlBUMEN oi ^th\o^ 222. 

Anscsthesia» a case of ^ • ••... 90* 

Animai fluids, on the composition of 198* 

Appendix vermtfbrmisy case of dìseased 57* 

Arsenicy test of S42* 

.. . > note on the case of poison from •..» ••••• »•••»..• 342* 

B. 

Bathy on the douches at •••.•••.••.•••••..•••• , • . • . S14. 

Stil^ account of the rauscles of the ureters» Scc • •• 171 « 

Berxelius^ general yiewaof the composkìon of animai fluids ...• ISIS* 

Bile, chemìcal properties of , 238. 

Bladder» anatomy of the neck of » 176» . 

' -y irritable» efiects of the muscks of the ureter in • 171* 

Biane, Sir Gilbert y on the Walcheren ferer, 3cc • • 1 • 

Bloody chemical properties and analysis of •• 199L 

'— ^ — ^» general results of its analysis 23L 

BoJiocif Dn on diabetes insipidus , ^ „• 107* 

■ I , on the bark of the coccoloba uyifer^ 146. 

BreCf Dr, on spleoitis «« 155* 

Bronchotomy» in cynanche tracheaUsy successful case of • .^ 335» 

e. 

Calculus voidedfrom a tnmor inthegroin , 191. 

Cheese, chemical p^perties of 274. 

Cbemical properties of animai fluids •••• , 198* 



S76 IKDEX^O VOUJUE THIB9. 

Page 
CkemaUer^ cate of ovarìan dropsy^ •• •• 40. 

■ » improved mcthod of tyiagdiicaaed tonsib .• 80. 

■ ■ ^ , cxtraTatation withio the theca Tcrtebralis 102. 

Coccoloba uvifera» experìmentt on the faarìL of 146» 

Colourìng matter of theblood « «..•• 208. 

Copelaudf case of calculus Toided from a tumorip the groin ••• 191 # 

Corpora carnosa Morgagni 172i 

Curry^ Dr. on remitting ophthalmia '• 348, 

Cynanche laryngea, cases of » •••••' 84, 

^ . . ■ I, ■ , fbrther observations on • • •••... 323* 

Diahetes insipidus „.«. ]07* 

Piabetic urine» experiments on extract from 120, 

Pifficult parturition from dropsical ovarìum •• • 47* 

Piseased testicle and riscera •.••••• 59. 

PoQches» mode of applyingy in Paris S14. 

Drops j of ovarìum • ,..••,..,,• 4Q« 

■■ ■ I produ(.ing difficult parturition •••.. • , ••« 47* 

E. 

Sark^ case of diseased testicle» 5cc. - 59. 

England and Wales» health and population of «•••• S4« 

£ye» humors of» analysis of the .., • • • 9£$^ 

Sxcre^ioQs» analysisof the • 256» 

£xerci9e» it9 use ìq sciatica*, ,*«•*« «••«.«•••««•o- ^\^ 

F. 

FarfCi Dr. on Cynanche Laryngea .• 84. 

,. ■ ,. .. ■ » appendix to his paper « 883* 

Fever of Walcheren» &c ^ •« 1. 

flbrin of the blood» chemical properties of 2001 

Fluida» animai» chemical properties of .^ , 19& 

FuDgus tematodes ••..... ^ • 277* 

Gelatine» not present in the blood ..•..« 233» 

Goderaeau's powderi» analysisof ».,. ,•••••••. 315. 



INDEX TO VOLUMt TfilRD. 8l7 

H. Page 

« 

Health aod pojmlation of England and Waka •• » •••• S4h 

L 

Internuttent federa L 

Iron of the blood, inquiry into its influence in producing the 

colour of the blood •••« •»•••••.. 21S. 

KlnOf conpared witLthe coccoloba uvifera 150. 

L. 

Labour artificially bduced 123. 

Lactic acid, note oo 224» 

Langstafff case of ftingus haematodes 277* 

Lanurenccy note on a disease òf the testicle and yiscera 71. 

Lewifif Dr, caseof diabetes 114. 

Ligature on tonsils 8(X 

Lttette yesicale , •••» •••..••••••... 172» 

M. 

Marcete analysis of a calcolila from thegrom « 197» 

■ , on a new mode of treating chronic rheumatbm m. 810. 

» on a test of arsenic 842. 

M^Cartneyt Dr, case of diabetes 117* 

Merrimanf on difEcolt parturition from dropsical ovarium ....^. 47* 
, on laboar artificiali^ induced , 123» 

iGasmata of marshes 19. 

Milk» analysis of • • 273. 

Mucus of the mucous membranes • 245. 

Musdes of the vreters ; • .•./••••., «••••• 171* 

N. 

Nitrate of ailrer, vith ammonia» as a test for anenic 342. 

Opbtfaahniai remitting, case of •••• , 348. 



911 WntX TO VOLUMt IWIBL 

O* Pag» 

Opiufliiiueofy in remitting ophthalmb r 84^ 

Ovarìan dropsyy case of 40l 

->produciog difEcuIt parturìtion « *..«• 47» 



^*^^v< 



p. 

Parkinsùth John% case of diseased appendix vemiiforxnis 57t 

Parturìtion» difficult, from dropsical ovarìum , . . . 47« 

Pelvis» distortedy requirìng premature labour »^, . . . 1 ^S» 

Peripiration, analysis of the fluid of..... 25BL 

in rheumatism SIO, 320, 

PMlìpi Dn A* P* Wihony case of dìsord^red respiration ,... 29Qi 

Pieromel in bile, not a peiculiar eubstance , »....^ 258, 

Populatìon and health of England and Wales •; 34i» 

Preséntations, pretematural , 197* 

postate, tiurd lofie of the , .,...•... 172. 



Rft^iiation» disordered .*..» • r... S9(X 

.Rheumatism» on the remedies in ,. 310. 

Rogetf Dr, note on the case of recovery from ars^iq 342. 



* 



Saliva» analysis of .••....,. 242, 

Saltsof the blood 222, 

Sciatica» new mode of treatment in .......r*.. 310. 

Secreted fluide» chemical properties of 234, 

Serou9 membrane, fluid of , 251« 

Serum of the blood « 222, 

Silver» nitrate of, with ammonii» as a test for arsenic ..#...•,..• 342, 

Splenitis» case of ,...#..., 155* 

Sweating» as a remedy in rheumatism ..,. .~.r*.o 310^ 

T. 

Tesdcle» diseased ....••....• , 59, 

Theea reriebralis» extrayasation within th^ « 102i 



INDEX TO VOLUME THIKD. S79 

Page 

Tansiisy^ improved method of tying dlseased ..*... ......*••• ^f 

rigope del^yesgie .»v*v*v t tf « •• ^7^* 



Uretersy muscles q£ the ,• .«t ..? ?••• 17lr 

Urìncy analysis of • ,, •... 257» 270. 

yvula yesi^» .....f. .,..?— ff t .,,,.....!.•? •-. 172, 

«W^cherei) feyer, Sir Gilbert Blane oa the ..,„„..,............, }, 

*ellohf fiff casepf aoaesthesU .«...m***** «•? •••••.«• 90* 



ExpUmation qf tìie Piata. 



Piate I. illustrates the morbìd appearances in the 
brain, descrìbed p. 67* 
Jig. 1^ represents a section of the tumor ; fihew- 
ìng the looseness of its connection with the 
brain, and the bloody and mottled appearance 
of its structure. 
^g. 2. represents. the appearance of thè tumor 
in the surface of the brain cover ed by pia 
mater. 
Piate IL represents the mstruments for tying dis- 

eased tonsils, descrìbed p. 80. 
Piate III. was engraved from the drawing of the 
recent preparation mentioned in the note at 
p. 87) and represents the morbid appearances 
in Case II. of cyhanche laryngea, descrìbed 
at p. 86. 
a. The tongue. 
bbbb. The pharynx cut open. 
fc. The arch of the Soft palate, in the centre 
of which is seen the uvula of its ordinarjr 
si£er 
dd. The tonsìls somewhat tumid, being slight- 

ly inflamed. 
e. The epiglottis acutely inflamed, and yery 

tUHlid. 



S818 EXPLANÀTION ÒF ttìE PtAtÈS^ 

ff. Coagulateci lymph which had been efitisecl 
from the ii^med siir&ces abaut the glottis^ 
and epìgiottis. 

g. The rima glottidis closed by the tùmefac^ 
tion of the mucous membrane^ and by the 
lymph efilised on it. 

h. The termination pf tìie pharynx iiji the 
£]esophagus« At ibis part^ and for some 
space above it, the mucous mgmbrwe is 
notinflamed. 

Flates IV, V, and VI* are explaincd in pages 187^ 
188, and 189. 

Fiate VII. represents the morbid appearanees in 
cynanche trachealis, which if contraeted* with 
l;he jmorbid appearances in cynaiicb^ laryngea, 
illustrated by piate III, wili give a distinct 
iiotion df the seat peculiar to eadi speeies. -The 
layer of coagukted lymph, repjesentéd in 
piate VII, although thinner, i» more eMen- 
(Mve than is proper to simple eroup, appearìng 
not only on the mucous membrane of tfee la- 
rynx, and trachea, but also on that rf the 
bronchia ; for, in this case, the inflammation 
of the windpipe was combined with infiamma^ 
tion of the lungs : see th« case of Miss S# 
Page 336. 
a. The epiglottis. 

hhhb. The windpipe cut open posterìorly from? 
the glottis to the subdivisìons of the bron^ 

s 



«XPLAKATION OF tHE PlATES. USA 

e. Two portìons of coagulated lymph raìsed 
from the mucous membrane of thè trachea, 
bétween which and the lymph a black bris^ 
tle is* inserted, From these portions the 
layer of lymph may be traced upwards to 
the epiglottis, and dównwards into the bron* 
chìa. In the larynx its sacculi are appa-^ 
rent, the layer of lymph being there yery 
thln. 

This preparation is preserved by Mr. Astley 
Cooper, who kindly permitted me to bave a draw- 
Ing made from it. 



SUD OF YOL. III. 

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Oi Wo9BtAtu Frlilter, 
Aiigtl*ooun^ SkvtBCfn^cet, London, 






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